18-005 (2) Jul 2015 03:48a P.1
HOhIE IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished and Installed by.
Branch Nam.Boston North&South Date:e/�!Gl ( THD At-Horne Serviccc,Inc.
d/Ua The dome Depot At-Home Services
Branch Number:31 and YN 90S Roston 7tuTpike,Unit 1,Shrewsbury,MA 01545
Toll Free 877-903-3768
Federal ID N 75-269+S46(;:NiE Li:#C 02439;R[Cone.U0 16427
n.� Cr Llc 4 WC.05655222:NNIA Hom=Dc Connuctor Reg.#1122689933
Installation Address: i/t r V b k(1)0 J7 Yv ` o i l t'7)
City State Zip
Purchiser(s): „ Work Phone: Home Phone: Cell Phone:
� P m t SMtS (�i� ] ] [ l
41 C ] [ ] [ ]
Home Address:
(If difforont frw Installation Address) City State Zip
E-mail Address(to receive project communications and Home Depot updatts):
❑I DO NOT wish to receive any mar';tctinc emails from The Home Depot
Prgiect Information: Undersigned("Customer),the corners of the property located at the above installation address,agrees to buy.
T THD At-Hotue Services,Inc.("The Hone Depot")agrees to furnish,deliver and arrange for the installation("Installation-)of
all materials described or the below and on the referenced Spec Sheet(s),all or which are incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively,
"Contract"):
job#: Products: Sec Shret(s)#: Project Antrum
Roofing Siding Windows 0 insulation
C_i"► G QGutters t Cevers O Entry Doors 0 1 A L-2„,
Roofing OSiding El Windows Insulation �•
❑Gutters 1 Coeers []Entry Door ❑
Roofing Siding Windows Lj insulation
[[Gutters!Cm+ers (Entry Doers Q 5
Racoon ' Siding 0'ttr'iodnws El hrulation S
❑Gutters/Covtxs ❑Eouy Dax.i
1►1Tinirnuro28Sro Deposit e>f Centtralt Anioud due upanearxtnion utdiic contract. •�---t
Mlink rumb"eit+ropy not deposit more than one-third orthe Contract Ammrul Total Contract Amount 4 •^7 33
Customer agrees that, immediately upon comlleri(xt of the work for mch Product,Customer will execute a CorornpWion Certificate
(one for each Product as defined by an ittdiv;dua Spec Shuct) and 1-xty any balance due. As applicable,rich Customer under Chic
Contract agrees to be jointly and severally obligated and liabL;hereunder.
The Horne Depot reserves the right to issic a Chargc Order or terminate this Contract x any indMdual Prodact(s)included herein.vt
its discretion,if The Horne Depot or its authorizer)set-vice provider determines that it cannot pertorni its obligations due to a structurat
problem with the home,environmental ha7=ds such as mold,nsfe toi or lead paint.other•rarely concetr.s, pricing-rrors or because
work required to complete the j0h tvaN nix included in the Contract.Pavment Summary: The l ayinctr Summary# �.,�`t 5 1 included as part of this Contnkt,sets forth the total
Contract amount and payments required for tlrc dclxnits and final frnpuents by Product(asapplicahle).
NOTICE TO CUSTOMER
You are entitled to a completely filled-in copy of the Contract at the tune you sign. Ike not sign a Completion Certificate(note:
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product
Is complete
In the event of termination tit this Contract,Customer agrees to pal The H(ime Deport the crests of materials,labor,expenses
and services provided by The Home Dep(A or rAutborizcd Service Provider through the date of termination,plus any outer
amounLs:et forth in this Agreement or allowed under applicable:leer, THE HONK;DEPOT MAY WITHHOLD AMOUI\TS
OWED TO THE HOME DEPOT FROM THE DEK)SIT PAYMENT OR OTHER PAYMENT'S MADE WITHOUT
i.IMITiNG THE HOME DrPOT'S OTHER R"' I`EDIF,S FOR RECOVERY 03.1 SUCH At►JOUNTS.
1cr e 'ance uttd Authorization: Customer ago rs and undcslands that chi.;:%,_ttivnocnt ;s the entire a_rccntcnt between Customer
and The I otti ie Depot with regard to the ProdUC s rind Install:lion stn ices anJ s soda+all prior di,cussionS and aerccm--nts,either
txaf or r:Tiven.relating to said Products aotd Installation.This Acrd m_nt rn a En s igned n airtendcd except by a wtitim,signed
by Customer and The Hone D--putt.Cuctgnua acknM!ed e,,%1J u,,rccs:a: a tent has read.undc.-mond5,voluntarily accepts the
terms of and has received a copy of this Agreement.
Acct by: Sub ht
Customer's Sign:a tre Date Salts C i ❑?t's signature Datc
X Tdcphone t.
Cuz-oner'.s Siptature Date
Sales Consultant License No.
CANCELLATION: CUSTOMER TANY CAYCEI, THIS ro Mti.a;,lcf
AGRF"iENT WITHOUT PENALTY OR OBLIGATION ,n
BY DELIVERING WRITTEN NOTICE TO THE HOME .r�
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE. SUPPi.EMENT ATTACHED HERETO
CONTAINS A NORM TO USE IF ONE IS i
SPECIFICALLY PRESCRIBED BY LAW IN
Cl 1STnMFt 121S RTATE I
SECTION 8-CONSTRUCTION SERVICES
$.1 Ucenjqd o n rvis Not Applicable ❑
Name of License Holder:
License Number
;nat es Expiration D e
Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration ITumber
Address Expiration Da e
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
11. - Home Owner ExemAtion
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.Aperson who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement ndows Iteration(s) [Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (En Decks [Q Siding[p] Other[a
Brief Description o Pro
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.If New house and or addition toexisfina h6 using,i complete the follow)
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade 4
k. Will building conform to the Building and Zoning regulations? ✓ Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,
property .d as Owner of the subject
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
W nature of Owner Date
as Owner/Authorized
Agent hereby declare that the stat rents an information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed and e pains penalties of perjury.
Pri a
Sign r of Own Agen Date
Department use only
City of Northampton Status of Permit
Building Department Curb CuttDriveway Permit
I2 2015 212 Main Street Sewer/Septic Availability
L - Room 100 WaterANeil Availability
Electric, f ra
olv�orthampton, MA 01060 Two Sets of Structural Plans
N , phohp d1 S-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
V2145 V\� ` f V10 5T Zone Overlay District
K film St District C8 District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
-- e„
Name(Print) Current Mailing Address:[,
L/� Telephone
Signature
2.2 Authorized A en :
6al:�hw
Name(P t) L�urre ailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 4D
5.Fire Protection w 0 60
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
245 NORTH KING ST BP-2016-0113
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18-005 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPLACEMENT DOOR BUILDING PERMIT
Permit# BP-2016-0113
Project# JS-2016-000203
Est. Cost: $2337.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin HOME DEPOT AT HOME SERVICES 92937
Lot Size(sq. ft.): 46304.28 Owner: HUNTER JOHN L&SHEILA C
Zoning: Applicant: HOME DEPOT AT HOME SERVICES
AT. 245 NORTH KING ST
Applicant Address: Phone: Insurance:
5 RIVERVIEW DR (401)935-2633 O Workers Compensation
NORTH PROVIDENCER102904 ISSUED ON.712912015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT ENTRY DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Date Paid: Amount:
Building 7/29/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner