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38B-267 20 REVELL AVE BP-2016-1539 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 388 -267 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Siding BUILDING PERMIT Permit# BP-2016-1539 Project# JS-2016-002626 Est.Cost:$285$0.00 Se: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VLADIMIR SHEVCHUK__ Lot Size(sq. ft.i;, 6621.12 Owner: DRAKE MARY C/O LEONA HAGGERTY Zoning: UK130 Applicant: VLADIMIR SHEVCHUK AT: 20 REVELL AVE Applicant Address: Phone: Insurance: 100 BURLINGTON DR (413) 386.5212 O FEEDING HILLSMA01030 ISSUED ON:6/27/2076 0:00:00 TO PERFORM THE FOLLOWING WORK: Side house with vinyl siding and aluminum wrapped trims 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 Fink Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvue: Date Paid: Amount: Building 627/20160:00:00 $60,00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner Department use only R7R7 s^' " 7.2 'Ity of Northampton Status of Penne � �_.— UIIding Department Curb.Cut/Driveway PermRAN __ 2; ^ 212 Main Street Sewer/Septic Availability Room 106 Se er/S ell cAvAvailablbili No Ihampton, MA 01060 lity rwo sets of Structural Plans Arra Orn, .` istfer413,1587-1240 Fax 413-587-1272 PloUSee Plans„_„ Other Specify_ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION MI Property Address. This section to be completed by office nn ..//��//yy,�jj((jj// Thl€ Map_` Lot Unit �,�/'y g'Y - t/l N 1'u' Zone Overlay District Elm Si.District^ _ CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: GNSile . s .� . . i 6. . i A4 © 0zi7; Name(Pont) Current Nattily Aggress oy( G`/IT Telephone Signature 2.2 Authg;, edA eat RR :t. i Ts mr 14 r . Name(P Current Mailing Addrei : ,r1ki Si; cure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTQQ Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 9-41, 3-ed-011 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cast of ,_,,,,, _ Construction from(6) 3. Plumbing Building Permit Fee 6" 4. Mechanical(HVAC) 5 Fire Protection / E}� 5 B. Total a(l+2+3+4 +5) ,Check Number /l6 This Section For Official Use Only Building Permit Number Date �//jam^' r. Issued: /�/ Signature: ///4 / �-X / U BuildingCoLLommissioner/Inspector of Buildings Date Section 4. ZONING AU information Moat Be Compteted. Arum Came Den�ed Due to Incomplete information Existing Proposed Required by Zoning lhie column to be filled in by Building Depmm,ent Lot Size .. . Frontage Setbacks Front Side L R'. L: R .... . .. Rear • _.. . . J Budding Height — Bldg.Square Footage Open Space Footage fLot area minus bldg&paved parking) W of Parking Spaces (volume&Locmion) --_ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES, date issuedf. IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document if B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date issued C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location E. Will the construction activity disturb(clearing,grading,excavation, or filing)over 1 acre or is it pert of a common plan that will disturb over I acre? YES Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) r�' l� f' 1 L � New House Addition ❑ Replacement Windows Alteration(s) 1 Roofing ❑ Or DOors O Accessory Bldg. ❑ Demolition ❑ 71i Signs [1 71 Decks [IX Siding or Other[DI Brief Des�r�rll ,gj�r4�/7/t!A rya, '. ' 01. " ... . .x i. I . . Work: ipc Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet sa. If New house and or addition to existing housing,complete the following 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 k. Will building conform to the Building and Zoning regulations? Yes No I. Septic Tank City Sewer Private well City water Supply, SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES/ FOR BUILDING PERMIT I, L�� iv o ltd ,as Owner of the subject property j{� /j �,,.� j''� {� hereby authorize J�1,4/r1/•1///Y /20 dIr to act on my behalf,in all matter' alive to work authorized by this building permit application. Signatu:e of 6a G_� Dale I, ( lint ../ //N Lr l„ , as Owner/Authorized Agent hereby declare that the sta ments and information on the foregoing application are true and accurate,to the best of my knowledge and belief Signed under the psi and Patties of perjury. 09 0 Punt Nate /I Signature of a1- gen Date SECTION 8-CONSTRUCTION SERVICES §.l Licensed Construction Supervisor: Not Applicable F. // (1 ?igme of License Holder yY/�,( f/`+Y1- ' 4_b License Number I M 4)2 - Address g� Expiration Date �1r31c� /1/6_241±-: O1030 Signature Telephone _ 1/0/ 3— 13 - iS.Res stored Nome I .rovement Contractor Not Applicable £ Com aNa k � Re stration umber Addrts�^'7 ��,try. Expiration Dale ✓�y ��'-%�j?���' Ofcit Telephone7U[ mer Z., SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.Gi-e,152,§25C(8)) 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 ih ing permit Signed Affidavit Attached Ye 11. -Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 ads 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.A person ovito constructs inure 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 tinder the buildinPser�t As acting Construction Supervisor your presence on the job site will he 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 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed send waste disposal facility, as defined b/y MGL �c 111, S 150A. Address of the work: .7a P VIU & The debris will be transported by: 1024i- AM-- The /7The debris will be received by: WB1Zcfrn4 Building permit number: /J, Name of Permit Applicant V( 64-42 /"' e -77' i . 1,91 sl a Date Signature of Permit Applicant HOME.IMPROVEMEVTCONTRACT PLEASE READ THIS p Sole Fumiahed and Installed by: Breath Namg Names NewE land throb, l THD AtHame Sew MEL Inc. u bra The Home Depot A:Home Services Branch Number.13 9O5 Boston Tumcikz Unit I Sb:evntnry_MA GI SH Fall Frost 877-903-1376a Pedeml ID z r..:698650:MP lac M C GSM;IU Cora LIM IMT Cr Ge e fi�1C7'�O'Se'r'2 MA:lone Inom:mm�Camrcua Ram c USED IawtalMdmr Address: 20 (!'IEVeI� /1U� W\-kcov 4 af eco. City Sate Zip P N r(s)` j _ Work Them: Home thane GODInert _ ( � _ j // i J / �E 1 _ HU cAddress'. `j SEA{rt^r { Nce fie. Qt-ts-r4o ),-4 rt it Of QC dr diftereot from OvallLM n Address) C"y S . Zip ll! Es mail Address on receive pinyon comma 'eat ns and Finks Lkpt'updates): ❑I LRS NOT wish ;MAX:.any Haltn mods°An TM Hei PSI InTramie ant UMnaigmed l"Comemet"),the owners pine-roymy tocsin a:the abase insatt I on addres,ameee to ply. nd TAo At-Home Sc-vievc,enc T Ca Home Deport agrees (trtrish.deliver sod arrange Tar the ossa Elation C (natakmMn 1 nl a(, materials dncriked on Mc Mow and orthe armored Spec Mends),4J of whips are incorporated M'.o 1h L Cunrracr by this reference,along with any applictbia Sate Supplement argil Payment Summary attached hereto and any Change Order(col_vemly, 'Corot Ivry dubF th..M.ma~a,( P M n _ ..._ Spec Sheet.® - Project Ammar ❑ d g'greatLW dleak a ¶ 9117otrnQEn Danrso_ (_alb`1 s2 'vi 55 ca g ... Qling 0 Windows a Insuithrs s , oGarr t,Cove( D-a IV not CT "Je r r 15d s,c LTwmd ax ¢Bim I DC/JIMMY C Cele Maar _... Q4Ig mwxOuintro— _2 1f 7 ( Q<nmGaern Ot >Drs PridittereHOADepataraCnetrad Ainenritrive imenesmatiorafthismouvett f T [ lContract Mma 5 MaircHneliderste dmorcitmerethen onataireettbeCentradAntadat cliSialtar attack that rnntd'aes mien teepees to of the work.for each P c'rt Cbst mer will cremate a CompletionCentime -, ,y '/✓�o I. lone tat snit Prole t s defined Iw an individual Spee SI eet)and nay any b n _ .As appl'ctbh each flow a under this \ Conner macs lc bepimly and vocally obligated and liable hereunder. The Han:Dego.moon dwu nghr le issue Sainte Oaks m tsrmin'ute this Contract or any individual Produals)included herein.a: its discretion.if The Hone Oepat or h5 nttoriud snrvnx pabaialtiltnaine5 that it canso ti-`a-m its obligations on to asrecmri problem with the home owireareentaI hazards such as molt ahuk's or lead paint ether safety cnncea5,miens errors or because MOSS tsLWed m eomplote the Nb was not included in�� ���}1 the?oC.i!raae' Payment Summar: The Payaatem Summary.t_1N'i'{ 3`7 , invaded as part of this Contract sets forth die rota) Conrad amount and payments required for the deposits aid fire)payments by Product(as'apptieable). NOTICE TO CUSTOMER Yon are eatMim to a completely filled-in copy of the Contract at the time you sigh. Do not sign a Completion Certificate(nate there is one Comptetiun Certifies°fns each Wed Product as defined by)adividual Spee Sheets)before work as that Product is complete. In the trent of termination or this Conhvet,Cvstonier agrees to pay The Home Doper the matt of materials.labors eapease5 and services provided by The Hume Dept M Anti erkN Service Provider through the date of terniinatom n.pins a other amounts in tort Mthis Apemen!mens or allowed Aider appliiabk Inf. THE HOME DEPOT LIA\'WITHHOLD AMOUNTS OWED TO TftE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. A e and A tiorian el. Ciag sod and ia h: Mat PM A is the nib". Customer and TI a Hone Deptwith retard to Fit Products nd Installation Saar:_s o.:d Stria:MS ai',prime ilia Sinha and agrv'me t..ureic orad %Eaten.mlai:n to sad Poduels andsstal:a.on. Il isAgreement room be nccded raeeot by a writrog lgneu by Custom:.ad The Noma Ceaoe.Cramer ono sutra:edges and atom at Ca.S.Mber n.-=4 imdosa rd..oh.0 nly-aspic the )dots of and has rccieed u copy of alb Apt root. MAMMA. y C I SEbmitta_d�x,----- I lttit 1-3634-J'T- X CAMOM biSigram c Odra Sulks Cotisoh a m Mataw¢ Date % _.... .__ Telephoncao, CmlomeisSigrwNrc Date Sales Con seltzer License Tr. CANCELLATION: CUSTOMER MAY CANCEL THIS )E G"J !..:.sp-liT)eSm) TO DELI DELIVERING WRIENT TTEN NOTICE TO OBLIGATIONT PENALTY 0 P. HE HOME f Ir 4,l✓�`, 3 aT DEPOT BY MIDNIGHT ON THE THIRD BUSINESS 1111. iii t DAY AFTER SIGNING THIS AGREEMENT, THE STATE SUPPLEMENT ATT.ACHFD HERETO j CONTAINS A FORM TO GSE IF ONE. IS ' SPECIFICALLY PRESCRIBED BY LAW IN r i oro 1FR's STATE. Z.d Pi ISO91. 99 DDr - tote: a. G > �TS� lNnaia►at • ..tr69 Soret Panda On. `4a tn,a Might '&s.P. VARY L *P 44 Vert n� :9M1 OilyGotten but, won atn, : .kr) iik..; ire ,It a t:. . . : :._ : -4%. If, off, 7 . a rimapaimmon irizeansmaceuzzer# '7iiii .:x kEt • � 1"" ' r :. �.. . �.F�n,. , ,kms, i .. a � W : ' �r ----L.- rtgRirellitiltall HOMO a_ LED , s . INIMMIIMIIINSICIThilreglailitillIMISIM (d, A. 4 9", 4.,,,-9: + `< c .:i't+:.7'' a" 4, + `�-.n !aW ...y ilillailattitaf a=-•,%.4 , . ;$!'!eut!iWpgawg!.; °.Watnos. " �a . 'MetprWp . ' ir+�in.; yy ,R • . a riieNac SUCH Irtir°la_ 1‘...I Piikinfan . Ine..Pieta at Ulla 41004 _ R►a tukkitneeikhtQa4:lt, iLISTAN F I . �o del. 9091790\Jnf 9d 1t9t Y pt r 4ej , PM ek' ,4. f ¢ � � :,HH : ► 100 RUNG f. 42 t, FEEDING HIS�L.= � a { $ :. is '`Yst igts } y xh� x.41 'Y pYy ti� � ` � �y,� . t ar * '4,,,,,k4.''..-i.:�'+x �; x tt 5r''- . z < 1 /12/201 ' a � a x< y a . y'C' r✓) .e Y' 1a3 4iK f ..... '+"{k .Qt..l'2..Yi' � N. 4 .� �� w. .:"� +�n1'StY'�°"fiY 4 5 � '^C . U a G1 fie €Post rifeciini .4% CL - aig- c $ • :Oce of Consrni er Af`ait Rrd R,aeiness Rega-la>,aon V rI 10 Pariz Plaza- Suite 5170 • Boston, Massachusetts 02116 Home Improvement Conisactor R'e&stration • Registration: 126893 Type: Snppiement Card Gpiratton: 01372016 THU AT HOME SERVICES, INC. RICHARD TROIA --- 2690 CUMBERLAND PARKWAY SUITE 30.0 - — ATLANTA, GA 30339 Update dddras ono pion earl,Mark rason for ch itgn sc:, c soy^ - _v ddres C Renewal -.nptoy=a-:5:1,12 r „�,.�..�.../J,,:� r7.4_„r5,..0.. — ” eMcm. FCunsccr atc;rs-3nsinessYgmstio,: License or n_g{stn_Dvalid lid Cor iadividul ue only 'g- •ta_ 62i3RIPROVELi NiactiTRRCpR blocs the expiration duo, Ifzevnd retern to: '`=s;p``"-f5"i_ IC Fark Cana-SrntELSIns and Easiness Rey+olation ::^_g::t«`.-ar_ __ = Tvps: i6 ric Pias-SviEaSIpC cyitaaos.art?one _ SuPP:emaniCart5 3oran,iyi-^P2116 rhe HOMEiO!PCTAnES.MC. R „ �. 1H iiAREJ TROIA fiT AbLSEP,U1Cca V (f// RlCjinftn TROIA z6p0 CU.a_RLAK7 P-aRFNAY S ._ /41‘147 '4,5f'WN'gi1,W 3Cn9 andam,.axr 1/ Not valid ivi f •utsignature The Co.mazonwerd7A ofMgssechusei De-pot:Lent ofbzduau-d Accidents =r-Vi"sg Office ofTves gat o s a as 1 Congress Steel,& e IN Boston,WIA 0277:2017 mLV'°. ' IPrn'2Ynassg.v/Ata Workers"Commenartfloo insn'aced-order±::Builders/ContraetorsPiecflr'•mms!Embers —no;ez:.< to :n3a ar, ?tease Paint .ehiv _nl'me(A+ssincsslOr,rni_donfina ridez):Ja�1? ,(1��+�`✓L Y }-1;i .0 •"0 .'S n • a.,dress: 4�r i h7.;,--5'i�';v µ1Villip i, 9 ' —.._^ `G_ fSiaela :`) i1 ' ' dfr% Mill- _5-t' meet yit . + 7 ,r ._ Are you an employer? Clsack the a?piopriete box. +,ppe of project( ). • 1.0 I-m a employer w?th 4- r I am a general contacts and T e7nloyeess(5iIl snd/orpari-uwe).* have hiredthe subcontractors 5. 0 New construction 2.0 i anomie uropdetor or p +rer- hated on the etteched sheet_ 7. 0 RamoiNting stip nod have no employees These sub-contractors have S. 0 Demolition ro'•-b+c for me many capacity. employees and have workers' i NO s is„a,.s,�_ coma.iesvmscc . 4. 0 beading addition "' _ COMM.htSIZaVe ,eq tent 5. 0 We sea corporation LRdits 190 Electrical repairs eaeddLlons 3.0 I'm ahomeovmer doing'flat °Mom Imo Eternised that 11.0 Phmbh,tepaim or additions myself. No waters' comp. tight of exemption per MGL 12.0 Rcofreparzs insurance recut s&]t a.152,4l(4),andvre have no employees-[No workers' 1Z0ter ' ' / comp.hamlet required.] :'iy MSS cmcdaat ccG^'arstn=ado Sna?:ncs¢taobtla,sboSingticimwsas'compansathanpolicsinixrtualicm. t Homcormc swho mbmdinis eras*intligessihey ac daogsn wwi and samWmotaitle cant=muumbmitanew aiiitlavehicieaengm it 'Conhactan h`ir:chuck Luhe:austoto- e¢n,adivno:dsheatsoowcg the nsc tmcsob-conttrnetarsaadsWkwiioNacmc aetthenN am � 3th taptoy . .sub-eramacava_4acrapk?as.:hgaa:ts"+%o'ridtlimir corkse costa.Anlleponmhc. i mr ars emabye;that is raids-mg workers'compeusciio,:inn;sung for my employees. Below Ic the p0119 and job Nita infor s:Sion. - /z rssureuce CompaayName: (JRRz,l )t !i.i-//lir 4yiijj - L%0 - - { ry Polley 9 or Self .Lin.T: t/1/ !� V f&b(/ -/ .- y_Lf&piaonDate: J ,/ / (, ` lob Site Address: P Jx-frN7,iL.. .1427eCity/State/Zip- -'0 awe ae, /nlik Attach a copy of the workers' compensation polity reriaratiun page(showing thepolicy number and " =Motion date). Sedum to secure coverage as regrind under Sconces25A of NICE,c. 152 conleadto rho imposition of gimbal penalties of a sea up to$1,540.00 end/or one-year imprisonment,es well as cholpenelthg in the£onn of a STOP WORM ORDER wad a See oflip to 5254.00 a day agsstaae violater. Be advtted theta copy of this sta,eareut may beforw;Atteditthe Office of Investigations of the Da for hnmsmc coverage moron. Ido ricer. eTdify run, t,f,zss T L.:of ofperjttyh le`jnrve<onprovided ober-wits brae cad eoPi't Sivas e .r 6 r)"�1"^'-"L" .-._.. Dakg tf� J1 1 1K kr Phone co Gt , 7'v f" % s� Official use only. Da tot write i'w ads are;to be cut7pieled by sip or ovn officio. City orTowu. Perr!f/€:tetmse€f IssaiagAuthority(circle otte)_ 1.Hoard offRealth t Bottdi,+.gDeparlment 3.Ciyfrowo Clerk 4.Electrical inspector 5.Plumbing inspector 6.'Othe Contact-Person: Phone Phonet a A�R J CERTIFICATE OF LIABILITY INSURANCE ;AT amts n I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA.INC. NAME PRO ALLIANCE CENTER PNIRLC. F.r1 i FAX Nol: 35EO L ENOX RDAS.SUITE TFCC EMAIL ATLANTA,GA 31326 ADDRESS: INSVnERIS)AFFORDING COVERAGE 1 NAIen 1cc492'HOmsDG.A4_-:&I ..__. NSURER A:Sleadresilns!tmiceCanpanY 12101 —_ INSURED ZR!NI Ameriml Insurance Co ..16535 RD.TEDM1E SERVICES,INC. BINSURER 9: DBA THE HOME CEROi>i-HC1dE SERYICFS INsuRER C:Re/Hampshire Ins Co 12M41 2690 CUMBERLAND?.RNR-Y.SURE INsurtER 0:lints National Insorence Company 12381-r >TL1NTA.GA ae.139 INSURER a: INSURERS; 1 COVERAGES CERTIFICATE NUMBER: ATu037116646-14 REVISION NUMBER-9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. sWITS OF rNSURANCE ANDTSVen. I POUTS EFF POIWY DIP I LM SD WW1 POLICY NUMBER 'pAypN. YYYY)I 1MAIMOrnV I UNITS A X COMMERCIAL GENERAL LIAaILrnt GLOIEBT114-Ba 103101122016 031011262 - EACH OCCURRENCE 9,OLU.G"10 I OAMAISE TO3o EO _ CLANS-MACE .00CUR :PREMISES(Ea ommentel `DED -_ _ :LIMITS OF PCLIC'!XS MED FSP IAnv ale Persons - EXCLUDED ___-_.__ _ OF SIR:SIMPEi4 CCC PERSONAL a AOV INJURY - 9.000,000 _EN.AGGRE3A :!:D _ o P GENERAL AGGREGATE 9,000,000 PRODUCTS COMP/OP AGC1 9.60,0.0G0Ogvc IS AUTOMOBILE UAslun - - BAP 293983513 .03012016 01101i7017 COMBINED SINGLE UMET I3 1.100.000 (Ea 3mCmn ANY AUTO GODLY INJURY(Per Person) —ALL OUT!_ —_cAROULo • SEL'-INSURED AUTO PHYDMG BODILY wuftT IPeSen S __:OTOSAUTOS HIRED AUTOS __ 'ICN-OUMED 1 PROPERTY DAMAGE .a _AUTOS (Pe.eoieenp UMBRELLA LlA OCCUR. I EACH OCCURRENCE 3 EXCESS LIAR CLAIMS-MADE ' AGGREGATE OW RETENTION3 • S J WORKERS COMPENSATION reVC015519213(ADS) !0:30112016 0310112017 X PER ' 1MN" AND EMPLOYERS'LIABILITY STATUTE' I 'ER -ANY PROPRIECRIPART;INRWECUm4 Y`n. �WC01551921Z(A!(M!,NHMJIr 030112018 030112011 i EL EACH ACCIDENT 's 1,00E090 IC �Izvaep,MeMN„e U:xvDED, d '',NSA WC015519216FI 031012015 '0101YL0D 1,0006]0 1 cn 1 IJ REL MFFFSE-EA EMPLOY'-ES I ]esds enbN der 1,Op0,CN CESCRIPDO GN OF OPERATIONOeipv Ccnilnusd on Additional Pa S°e I E L DISEASE•POLICY LIMIT:S E IO• NPTION OF OPERATIONS I LOCATORS(VEHICLFS(ACORD TOLAUdINonal Remarks SGTedn1S may be attached if mom apse Is ragolred) ICE OF INSURANCE CERTIFICATE HOLDER CANCELLATION RID AT-NOME SERVICES.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THEPOLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATNE or Marsh USA Inc. Manashi Muknesiee —1Kce.Vaory ..y�L..t ' ea- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD