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029-033
32 PIONEER KNLS BP-2017-0829 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-033 CITY OF NORTHAMPTON Log-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: replacement windpws%siding BUILDING PERMIT Permit# BP-2017-0829 Proicct# JS-2017-001385 Est.Cost:$26114.00 Fee:5100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 105953 Lot Size(sa. ft.): 1979.00 Owner: SCHNEIDER DAVID&HITOMI Zoning: Applicant: HOME DEPOT AT HOME SERVICES AT: 32 PIONEER KNLS Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCERI02908 ISSUED ON:I/4/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 REPLACEMENT WINDOWS AND STRIP 16 SQRS VINYL SIDING FOR REPLACEMENT 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: FeeTeoe: Date Paid: Amount: Building 1/4/2017 0:00:00 $100,00 212 Main Street, Phone(413)587-1240,Fax_(413)587.1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit / / ti Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability ' � ' Room 100 WateriWell Availability i � j Northampton. MA 01060 Two Sets of Structural Plans \ / phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans `r/o``- Other Specify__„ A" CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION pip- f'i" g' •' 1.1 Property Address: This section to be completed by office l Map Lot Unit �i 7. . A -/---r r i&ialult ite.- F - Zone Overlay District Elm St.District CD District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 'r r • I I z 'CAv 12)7Y _ -3z ) !p-dvtee.( ri,)th / 3 Name(Pnre / Curr li A ress PTA idif4e4 itvvLE him. cob Telephone ' f -7 Signature Z / %�� ) ( �' 2.2 Authh,rs"t,zed``i�nt: -�y1 1 I//4,145q72aVir Na Corr n fling Address: - ? ��;C,i I�1� - fi1 ,� Stetture Telephone /kV— l i^_ /EJ-±6 +k SECTION 3-ESTIMATED CONSTRUCTION COSTS _ Item Estimated Cost (Dollars)to be Official Use Only ,completed by permit applicant 1 Building II? /.)4 i J fd (a)Building Permit Fee 2. Electrical r (e)Estimated Total Cost of Construction from(6) 3. Plumb4ng Building Permit Fee 4. Mechanical(HVAC) ��/""" 5.Fire Protection 6. Total=(i +2+3+4+5) 4 I Check Number dQQ00 f This Section For Official Use Only Date Building Permit Number - .. Issued: Signature: SAO ,6�� / 3 /7 Burg Commissioner/Inspector of Buildings Date Section 4. ZONING AR Information Must Be Completed.Permit Can Be Dented Due To incomplete Information Existing Proposed Required by Zoning This unlade to be filled in ny Building Depanmcnt Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height -- Bldg.Square Footage io Open Space Footage Ibm area mmu+bidg&paved parkin #of Parking Spaces Fill: &wham&Lu .iunl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 5.1 Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(Nearing.grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSER WORK(check all applicable) New House D Addition ❑ Replacementows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg, CI Demolition ❑ New Signs [CI Decks IC] Siding l®J Other[p] Brief Desr, do of Pm used MP>. 'W; / It; °7� •d -'4/friiG - ry1L hz. '/1 Work: d eedirAn= 10 Ft vhsiL -,,,tothio-- : - (24111 r 't teiradiu'Gf�cd Z G"f yi1fS Alteration of existing bedroom Yes No Adding new bedroom Yes No -'f L:, �jr_ � Attached Narrative Renovating unfinished basement Yes No L O-Se'� Plans Attached Roll -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 T c, Is there a garage attached? d, Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance,_ Massoheck 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 fFOR BUILDING PERMIT I. CW,P .4i,42J 7)riz ,as Owner of the subject property y y� �f hereby authorize 2(/ef14 1 J to act on my behalf, in all ma ors re ative to work authorized by this building permit application. Signature of Owner Date I, ''gt" _ s -"7 ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief, Signed under pain I'nd penalties of perjury. N < , • 0 `dnt Name ' /_ 7_7, Signatur oro ner/A•° Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable El _ Name of License Holder i , 7- ,s Lice se Number � �/ riI 'I is 1 291-3 „ AOC -/°��.--S� Address i1 Expiration Date f7'A r P>Vv' YY' C11) 3,L, Sgnature Telephone QUI — hey.'3 ,/,-) -- 9.Registered Home Improvement Contractor: .2Not Applicable ❑ Company Nam Registration Number Addres .y t`}/�'— f�/ ','��' $(,( �} Expiration Date �, it' i%.�hi'i /11! ` ' (/I1..- ..± _Telephone , s . — ,--''-�.� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(el) 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 o 1 ermit. Signed Affidavit Alt d Yes O -/ No El 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I1 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 arts es supervisor.CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which hershe 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 an&or farm structures. A person who constructs more than one home iq 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 buildinv 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 he 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 he liable for persons) 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 taws and State of Massachusetts General I taws 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 solid waste disposal facility, as defined by MGL c 111 , S. 150k Address of the work: 32 f DN€€4- 2<OU ica: y / �j/ /i rv4f The debris will be transported by: � -4�t h-t lL„„ The debris will be received by: i'ii'i (-L ;;Iii i 4 Building permit number: Name of Permit Applicant t . Y:/� 1/ /IF Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents - 'i Office of Investigations !* 1 Congress Street, Suite 100 g _� ,= Boston, MA 02114-2017 S" www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ Address: City/State/Zip: _ Phone#: Arc you an employer? Check the appropriate box: Type of project(required): 1.❑ lam a employer with 4. 0 lam a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sok proprietor Or partner- ship and have no employees These sub-contractors have &. ❑Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers' comp.insurance comp. insurancat ❑ " required.] 5. 0 We are a corporation and its 100 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roofrepairs insurance required.]' c. 152. §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] TAny applicant that checks box al must also In out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tCmtactors that check this bon must attachedanadditionalsheet showing the nameor the sub-contractors and state whether or not those entities h rt employees. If the sub-contractors have employees,they must provide their Corkers'comp.policy number_ l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nara::_ „ Policy# or Self-ins. Lie.#: Expiration Date: Job Site Address:_ City'State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25.A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a foe of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sigrwore: Date: Phone#: .„ Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ' 6.Other Contact Person: Phone#: Job Contacts kink Leads CY'� Friday,December 16,2016 Comments Lead: 19749876 Go Advanced Search 2:19 PM IMS Homeowner information Job Information Commissions Homeowner WM David Schneider Sale Amount $2.139M0 Balance Due: $1.433.13 Homeowner2 Product 6500/6100 Series Windows(8%) ggsts Job Site Address 32 pioneer knowles Status Sale/Material Ordered pocumsnts FLORENCE.MA 01062 Branch Boston North Measure* 79898876 Schad Measure County HAMPSHIRE Sales Homeowner Billing Address 32 pioneer knowles Commission Rate FLORENCE,A 01062 Consultant Name Term Date Split Comp Plan glob issues Timothy Drost 100.00%Straight Commission Labor Update Primary Phone (413)341-3834 Work Phone Ext B-Back: No Cross Bet* 1-9336012543 Siebel Ord... 122443 Order Detail Cell Phone Key Dates Order EntryWork Phone 2 Sale Date 12/1172016 FUP Date Cell Phone 2 Credit Date 12/11/2016 FPD-Customer Payments Email schntomcgmaii.com RIP Date 12/12/2016 Post Install Date Permits Cross Street Start Date 1/162017 FPD-Hama Depot Markafbrp Inspection Referral Store 8452-14ADLEY Job Indicators Result Combo Rase Store 8452-tHADLEY Combo Job. Services Lead Source 0205 SC Working Store Lead Paint:Assumed-LSWP�R'equir Show Map L') A) a A—� TouchPoints ..,) Update Job Mier_ -�� Time _Stews (Cort. APpt Date Ant.mile Consultant! Ashley S Asigbey 12/14/2016 8:29 AM Material Ordered No 12/11/2016 10-00 AMITimothy Drost MOd Work Orders David Richter 12/12/2016 606 PM Order Received-PSG No 12/112016 10:00 AM Timothy Prost David Richter 12112/2016H 6:08 PM Measure Complete No 12/1112016 10:00 AM Timothy Drost Cykhina Ragiin 12/32710161 ID:55 AM Released to Production No i 12lt 12016 10:00 AM Timothy(Post .Cythina Raglin 12/12/2016 10:54 AM Order Entry No 12/11/2016 10:00 AM Timothy Drost 'Timothy Drost 12/112016 1145 AM Credit Pendkng No ' 127112016 10:00 AIITrnothy(Post timothy Prost 12/11/2010. 11:45 AM$ale Pending No 12/11/2016 10:00 AM'SimotM1y Drost SHA SHAMAYA WINE' 12/10/2016 111:44 AM Confirmed-Customer No 12/11/2016 10:00 AM�ITimothy Drost y No : 12/11/2016 10:00 AM imothy Drost SHAMAYA WINFI 12/10/2016 11:44 AM Pre-Book No 12/11/2016 10:00AMITimothy Drost SHAMAYA WINFI 12/10/201G 11:43 AM Lead Entered No Close I Print Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: Timothy Drost : HIS 0553710, R-R-073-15-00005 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: David Schneider Boston North 9749876 First Name Last Name Branch Name Lead 32 pioneer Knowles FLORENCE MA 01062 Customer Address - City Slate Zip (413) 341-3834 r Name Peones Workilwnee Celt Ploy& _ schntomi@gmail.com Customer e.mas Address ,. .... . NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address CZY state Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE, YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOTS RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL,AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOTS EXPENSE, THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged 14: X __ _... 12/11/2016 cgarom,,' sigaawn Data 1 Distribution: White-Home Depot Yellow-Customer Copy Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. 2139.00 Includes all applicable discounts, rebates, and ,taxes. Contract Price $ Excludes finance charges.* Minimum %deposit$ Due Immediately Remaining balance $ Due upon completion Finance Charges *Any interest payments or other finance charges will be determined by Customers separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s)made payable to The Home Depot. Insurance proceeds will H will not r be used to pay some or all of the total amount of sale. Descrlption of Work to be Performed: Installation of Windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on pages of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 02/05/2017 Approximate Finish Date: 03/05/2017 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By initialing this paragraph, I consent to receive only electronic records related to this transaction. L _]Initial A ce.t.nce nd Authorizatioa By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made,as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete copy of this Agreement. Keep it to protect your legal rights. X <-- r '- 12/11/2016 • CtS9ner(•'•pS4bl.) Date xl 112/11/2016 r SI Ctln WM1nb A9nXun�- '" - Dab 2 Distribution: White-Home Depot Yellow-Customer Copy WINDOW SPECIFICATION SHEET - Spec.Sheet p'. 9749876 sheet: 1 of 1 Customer: David Schneider Job%'. 9749876 Consultant Timothy Drost Dale: 1211112016 New Window ___ Existing WindowHinge LocationsM easurements Gnds Product Options Labor Option From outside, - _ Left to Right Bowls Location Color Rough Opening Not bars pot bars smnts,Bays,Bl nl, — use L.R or S IGlass sc Items — Hardware amensM Code Foruse c 11 a c 9 Mull Stadonary or w RoomSNI¢ Wrapsit ta ` 9_ 'q 9 = o fr a Soperaling Floor Code (YM) Style Code Senes Code 3 I , n m U rt d m �r II=tam 47 It so,piwPark StanStandardminnrt.L SR sin.GFas Pea Standard WRAP WRAP.L SR I 1st S3 LP ack Standard WRAP I 1st BH aSPH oo � t.W ., N 1 1111 � � %Ir. 1 1 _ . , , ••• , mull SPECIAL CONSIDERATIONS'. rap Color Interior Casing Type - Bay or Sow window -ealboard materiel(vinyl only-Birch or Oak) Say Protect Angle(30 or 451 _ :ayFlankerType(OK BH,or Csmnt) op of window to soft(Inches) I bed to soft,color of soffit malenal I have reviewed and agree with all he lob specifications above end the ongmol Roof(Yes or No)' - Special erms and conditions on the lollowing page Garden Window eatboard Material(vinyl only-White Planite.Birch or Oak( all Thickness(inches) Customer Signe re dd111onai Shelf(Yes or No) •There is no guarantee that new shingles will match existing color, Job Contacts Link Leads Friday,December 16,2016 Comments Lead: 19749868 Go I Advanced Search 2:20 PM IMolUpdaba Homeowner Information Job Information Cgmmissions Homeowner MIM David Schneider Sale Amount $22,975.00 Balance Due: $17,975.00 Homeowner2 Product Insulated(8%) Costs Job Site Address 32 pioneer knowles Status Sale/Material Ordered Documents FLORENCE,MA 01062 Branch Boston North Measure 0 79898875 Schad Measure County HAMPSHIRE sales Homeowner Billing Address 32 pioneer knowles Commission Rate FLORENCE,MA 01062 Consultant Name Term Date Split Camp Plan Job Issues Timothy Drost 100.00%Straight Commission it,bar Update Primary Phone (413)341-3834 Work Phone Ext. B-Reck: No Cross Refit 1-9336015323 Siebel 0M... 122482 Order Detail Cell Phone Key Dates Order Entry Work Phone 2 Sale Date 12111/2016 FUP Date Cell Phone 2 Credit Date 12/11/2016 FPD-Customer Payments Email schntomi(pgmaii.com RTP Date 12112/2016 Post Install Date Permits Cross Street Start Date 1/16/2017 FPD-Home Depot Marketing Inspection PO Referral Store 8452-HADLEY Job Indicators Result Combo Base Store 8452-HADLEY Combo Job. Services Lead Source 0205 SC Working Store Lead Paint:Assumed-LSWP Requir, phew Map , TouchPoints Update Job User ..LDataTime _MMus ]Corr. IAPPt Date APDL Time Consultant t Erikka M Lewis 12/13/20161-1:17 PM Material Ordered No . 12/11/2016 9:30 AM Timothy Dios% Werk Orders :Enkke M Lewis 12/132016 1:15 PM 0rder Received-PSG No l 12/11/2016 9:30 AMrTimothy Drost David Richter 12/122016 7:59 PM Measure Complete No I, 12/11/2016 9:30 AMITirnothy Crust Mary Harris 12/122016, 1:29 PM Released to Production No . 12/11/2016 9:30 AMSimothy Orost-- Mary Harris 12/12/2016 1:23 PM On1er Entry No 12/11/2016 9:30 AMITimothy Drost Timothy Nest 12/1120161 9:17 PM Credit Pending — No 12/11/2016 9:30AMITimothy Drost -- Timothy Drost 12/71/2018' 9:17 PM Sale Pending No 12/11/2016 9:30 AM Timothy Drost _. . _....- —.. �.. payentl Dayend 12/10/2016 9:04 PM Sent to thhe Field No 12/'1!2016 9:30 AMTlmothy Drost SHAMAYA WINFI 12/102016 11:42 AM Confirmed-Customer No 12/11/2016 9'.30 AM.Timathy Drost SHAMAYA WINE 12/10/2016i 11:42 AM.Pre-Book No . 12/112016 9:30 AM Timothy Drost 11:41 AM Lead Entered No ? SHAMAYA WINFI 12/t0l201RI Clow i Print 1 Dec 121607:51a• p.t HOME IMPROVEMENT CONTRACT PLEASE READ THIS Surd,Famished and installed by: Broach Name:New England Daiet2Jl( J I TUG At-Home Services,'nib oMa She Home Depot Ar-Home Services Broach Numbers 33 SUS Basta Turnpike.'!nit I,S'httw bury-.lid 01595 Toll Free 8P..9)3it6£ FodeTai Mir"i-3N9SMi:ME Lk C Oath:RI Com 4¢91Mel CT Li.: HICCt655'12.rMA Hem lmm cveen'.Camircmr.k,-g.#t'.6593 Innalladqqun Address: az_ 't,L(EAIP f.V AP:+4' Q� 5—... f"" 1.PF slitEs Cin State Zip Purehnerls): Work Phone: Home Monet Cell Phone: fu7PlA g.ti [ 1 [ 1 1: 1 Home Address. (If differing from lmaaaGon AMm.s) Cin State Zy &moil Address(to ram We project communications NM Homo Depot updatesl: O I DO NOT wish to recast ay naaknang:mails from The Home Depot Prnicet Iaformatiuo: Undersigned CCastnn ter"l.ate aunts of:he property'Pealed at the above inscull:,tion address.agrees to hey, and ;HD At-Home Styr ice& Inc. ("The Home Depot")cess to furnish,deliver and gramme for the imiaLntioe t'Iostafapdn")o` aL tMeSals described on the below mad or. the:e(nrenced Spec Sheens).all of which are incorporated no this Conine by this rclrence.along with any applicable State Sapplement aid Pafm ,t Swnmury attached Immo rind any Change Ordcry(col ci>. 'Contract—it ;�f(;7 1 Jobri'. warm) P tl $ -r Sheeels Si Amouot Tritium**+Hag Cls Windom doO Trs on et.) [clotTt) co.ners ren..,,OHM Doom p, . fltf1' ._ ac —. I URonn.g jsehg CwNm.i CJr,..r,lltina I Ocxacs'Ccurn a=nti.Doors r_ jeaeing Ctiieg EITeasknej 0 Insolation �.._..._. ...—_. OG DF.ry MOM 15 A °Roofing []Sldio�ndaws Q-Im i Ta+ [+Gotten/Covers OEnlry Doors D ,_ FZFimam25%Deposit efCantraa Anterior doe Won camasn ofthhmntract maicontract Amount 5 Menu Parehraerx eau tat dap di momOanonvOnI HUME.rand Armonk 'i•j.[J 5 Customer Puce'thatimmediately upon completion of the work for each Product.Hummer will concise a Completion Certificate (ore for each Predict as defined by an individual Spec Sheet)and pay any Mance due As applicable,each Customer under this Contract Hams to be jointly and severally obligated and liable hereunder. rho Home Depot removes the right to issue a Chane Order or terminate this Contract or any individual Madames)included herein,at to discretion.if Tnu Home Dupe;or its abthoAud service provider determines that it cartwi perform Its obligations due to a structural problem with the home.eovimnnrrdal ba,urds such no mold,asbestos or lead paint,other salary mamma.pairing errors or betvuse work required un complete thejob was not included in he Contract. m Payment Sogtaryc The Payment Summar I n F... 3 -(,5C b included as post of Mir Contract sets forth toe teal Cauram amount and payments mquiruz for the depo;its and final payments by Product(an applicable) NOTICE TO CUSTOMER You are entitled to a completely filled-tummy of the Coatram at the time ran sign. Donor sign a Completion Certificate(note: there is use Completion Certificate for each listed Product ns defined by individual SpecSheets)before non(on that Product n e replete. In the event of terntinaaon of this Contract.Customer*(Rets to pay The Home Depot the earn or material',labor,expenses and services presided by The Home Depot or Author-tad Service Provider through the date of termination.plus uny other amounts sm.forth iu this Agreement or allaned under applicable but THE HOME DEPOT.MAY WITHHOLD AMOUNTS OWED CO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME Dopers OTHER REMEDIES FOR RECOV ERY OF SUCH AMOUNTS. Aeceicanee antler. r•_ 111 hl'° .,inn. .ni itl i i i 'i� l i01i1119noir rami.[ . . ii p2 Deo 121607:51a - • aanaoem' VINYL SIDING SPEC SHEET a"Lecsi>aeI � i Banda* .-- .-- DESCRIPftON OF WORK %b x._�,11.I 11YJV � ^ 11 TOMER INFQMIATON "'atter lama , AV 1 )0 .5 �P IC TER eye.aomru:t , ____ Ir aItk Adaresv.__3 {3 nwx g4_ ZPJ(x.a.YJBurkCall Penne s I I Sheet Peeress'�1 Ci? --- 4bIM]ron tnc,lbn Lf�Lf. DabRnU ry carrY,_ .— CY SUte ?IF Codo VINYL SIDING AREAS to be SIDED PRODUCT E PROFILE CORNERS,. COlOW51 u C m6 pE Market Square Pwtxnio Ili Sllakc 51 dieseep -yen 'Clapbud S CNpboard' J Oed I L a ni c ma LA) I{ Ler. EC. WSed� 'rbottlead 1 Mar d-Spii 65`t xlbc' Stere _ __ ark ?w.A6M enll 'Sifcboar SASSI Richt I Perin �� ShaEi ke ]E" SA' XNa Dmcl CarOrifla SmOA Had R nc' Other _ _ NSVLAt1ON; JI r r, d5 .Dikskpr Oeaced Es' 1C RcuN. Yes - No — . ..r aaax Y NGBSEWRAR; ,, EJ SOFFIT.PABOA FRIEZE BOARD AREAS tobeOOVEREO ' nark _ L Rare Soffit — tows H 4u .edl aa _ I ,/1028 Stare MEM .._I —� Se4 edierf _. F rnQPf I I J _..�._ 'Cow-Frieze Bond woe PVC AIunT Co I i'-3 pe Van Rt4 i i%k Va C% UnoxLuno; r u_ � bd� � COSTONWRAP wee eve cote REMOVE E REI TALL op — Ory 'Ninkvn/Cxa _ .QJJyyj±�. SIOn AhmvNs I— ,1 Pest.",vixa_ Galaye(P oJwL � ( _ 'rant Awg0,re H Aetna-age:AAF_ _ G Jot Ne s'L' 4 ...SwnS.4__ Eula O.L rrenel 'Burglar Bare can be removed.but no:roent end., RCMOVE E48TIN68rorIiG 1-77—'°g0 Nn if es.. 5R 1r(r e r £.MArum� 3 Erit Area.sew Meyer;A rniaLen.hese Depay.it*)T AAA esoaslle Telenet PAR OVER MASONRY FORA{CEILING,REPASS POSTS NAN earcESWRIES vru rbimle a Poet! Cow: GABLE VENTS Pal- i BOA:Soled Lecst o,:.,--.—_.—... Oty l 'CONDO• Lea hce'u l _ _—_..._ __ Y:N 'COLOR' O:d;m L__ _ _ .._.—_ vamp Poen Orme Arae Parra Pas;r__ _ NEW EASTERS SPECWLY MOPS - 'COLOR 4 APers_ 'COON` 1"t'i __ L—.._ �nd NAet F teen __ REPLACE M(TEO WOOD ',Lees 'RemiN m^5. , 7 Ly9Juikic. p�. Y �c�A[) D e Specify the!Deal: . ._f.1'W�1/K " P (, J�..— SFFCML CONSIDERATIONS .—.._.—.ii— I have roe eared and a• with to Kb cilcatons described/b bed ow.and I IAA reV,euryd and agre.,itt . SPaaa,Tenn,ani oncitlons(1104 on e reverse side of Peyelbw lCualamah copy M As Spec Sheet rr Am. .ateerect AL TER remaN(q in rating xidrg i ,or vh bnal could nor be bfed lee time al sale there Wei be .AM:tar/0 AS_ __per Seat.fe Preened and S_. _.. ➢olio.R Sal th%rfpwi Lumber Customer Annette. Ge. /,.}-..�E�e..�e✓1` om: Mete.Lep Anne MAX Yellow.euticmo set-0 cca`s '.'�294 619/2016 20160518 1509023peg MENEEMENIMMINIENiallat - - . }. J _ - _ -- ..' CSSL-105953 ay IGOR GUSEV i 21 KIBBE LANE f HAMPDEN MA 01036 : ' U31 Ib/ii= iC https://mail.google.cpm/mailHRnbox/154e5466103bf4b?projecla=1 111 li i. it o"S=iG vas—^_e?oirle i it I :-,_.,G� - I - .- - . s_ - .-loci•A;a.�.--..,.a:«Gass I -__ a:i--. :cc.L. .4LaSr--°ria_..--5rani-Adria f CPDa vuCiu 07-75 01-4! =a^,-P._R f�N � iiNc11 gv-7_ ACOi ;3• -iEl1in,IIEflET!CC _ EfaLU. {.01N cupLe;1=_!TS N.Te RE\Oli0E�M] I - J • Ura qu no tor Ex: GY' i`- F ,( �'-*_ s-,00 -gicnlsl Naa:_m �'` � ' "=r ria' p--r4: l'illti Oral,Satin Cenral ., 1 f y' s.... 5 i(-an lilD Rein 00tG'ass ProSolar0.-I-LC25 j P:- .7 '`_=i Tests SSize:48"X90" J ! rcrez P:cud ?prarat FLa 1c :i• I • 'I I I ''! cal:caabieT-,-t. rdiai: ^'!511-__ iX1411 DA.Aif.S^"- 0_A4>i?fl'Jfl fiNCsk 50'4a'-2i.-^_G6.AAI:et^?+GivirtSMa :1 S.JPeiO G&. 'I 1r.:440St-v C=n_w:n Scan: il 'i� @35E?a"OlO. avaaa Ho rri 84000.4:.it _ I!! 'II -- —_ = e._=—r=:e t—.= it S.„\\_ ` The Commonwealth of Massachusetts Department of lndustrialAccidents > _ 1 Congress Street,Suite 100 --t- ; anota,. MA (0114-7017 ' www.nms's.gov/din Workers'Compensation Insurance Affidavit: Buiiders&ContraetorstEtectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY, AMA/cant Information Please Print Legibly Name } (Busines40rganizotionnndividuap. }j a -P A'^F ;��j, 2_ V c 4 dd Fb)7 7� City/State/Zip t([�t�,i;IntC'�(igi../ A4-'E �!3hone#: 479--`" ij2 -,,[112- Are you an employer?Chock the appropriate boy: Type of project(required): 10 am a employer with employees Mit andler panilne)' 7. 0 New construction 2.El I nm a sole proprietor or partnership and have no employees working for me in 8. [J Remodeling any capacity [No workers compinsurance required.] Ir'''}} I am a homeowner do lne all wo*n self(No workers comp. 9. uDemo Demolition 3 p insurance lvquilcd_): LI 4.DI am a homeownerand will be hiringtractors to conduct an work on myi4'[]Build;ng addition canixopeoy htul! ensure that all contractors either have workers'compensation insurance or are sole II.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions I am a general contractor and I have lured the subieoraractors listed teil he attached sheet. t3.�RooRepeirS ' hro sub-contractors have employees and have. k s pinsurance.; e p 6DW comorauonand is aims haveexercwxl d right r mpi per MCI I: I4. yI�h�erldr�f.-,f A4-.),7‘1/:''' EE�� ;``"ry�� I. .§1(4),and we have no employees,{No workerse p insurance requiredl Akn> Vlbil,O ,i'' •Any applicant liar checks hos Y.'I must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating such. :Contractors that check this bon must anacheelan additional sheet showing the name of the subcontractors and slate whether or norhese entities have employees. lime sub-coiracors have employee,they inst provide their workers camp policy nunsr, I ran an employer that is providing workers'compensation insoruate for my employees. Below is the policy and job site information. p 2CoInsurance Company Name: Neje() �^+f^A' ' f77/T[j l/-_1_-./�^'-, ' c } Policy ti or Self-ins.Lie,#: 12}G.�o i.gi�t `6�-t'...! Expiration Date a I - 17 lob Site Address: , 1141 7t Z''r"1t'— a int 3,City/State/Zip:EePM'vZ/ ' pia?"' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to SI 500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance coverage verification. a I do Jr 'Eby anti ide D->, ri penis ties ofperjary that the information provided above is true and correct, S e),2ture: "... . / �� /'(..j . j..�77 Date: ✓ — 1‘ Phone if: --12( - `7 l bz_mfjzi z--- .. �._. Official use only. Do not write in this area,to be completed by dB or town official City or Town: Permit/License N Issuing Authority(circle one): I, Board of Hata 2.Building Department 3.Ctty£fown Clerk 4,Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone ft: —, ACOR1 3 CERTIFICATE OF LIABILITY INSURANCE DATEE(MP DDIYeeel 02/18,216 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, 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 endorsemengs). PRODUCER CONTACT MARSH USA'NC. NAME PHONE ---FAX TWO ALLIANCE CENTER Et _ ._ :INC.JNJ_ _ 3663 LENOX ROAD, EMAILM SUPE 2.10e EEA IL ATLANTA.GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE I NAICY 100492-HorecLGAW Ih-17 INSURER A_Steal1V Insurance Cnmpa'ly 126337 INSURED INSURER B.ZWCAmanCan Insurance Co 16535 6S3S THDAT-HOME SERVICESINC t DBA TNE HOME DEPOT A HO SERVICES INSURER c: 23�) 26W CUMBERLAND PARCNAlSUITE 303 New INSURER Hampshire Ins Co O MIDIS Ndliondl1py12ncc company 23817 ATLANTA.GA 30339 — INSURERE: INSURER F: ' COVERAGES CERTIFICATE NUMBER: ATL-003746646-l4 REVISION NUMBER:B 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 BE 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. INSR 'ADOLIMAR' POLICY EFF I POLICY EXP i - - LTR MD OF INSURANCE IN5D D POLICY NUMBER IIMM/DO/WVn 11MWOUfWYel 11MITS A X COMMERCIAL GENERAL LIABILITY GLC488n14- 6 ..03101/2616 •03/01/2017_ EACH OCCURRENCE 9030.W0 _ LllMS-MADE Y OCCUR I DAMAGE TO RENTED S 1x,620 EX-Es IEP occurrecel _._. LIMITS OF POLICY XS MED EXP(Any Ona par.am EXCLUDED OF SIR SIM PER OCC PERSONAL a ADV INJURY 5 9000600 GEV_AGGFIECATTS LIMI r Az PL'ES=ER GENERAL AGGREGATE 9066,203 Enc._ __. O Douce JECP __we PRoouc S-OCMPIOPAGO I S 9p00,000 OTHER S S AUTOMOBILE LIABILITY BAP 293886113 0310112016 A310112017 COMBINED SINGLE LIMIT ;s 1300603 _—- (Ea accident} __. X ANYAUTO e001LY INJURY(Per person) ! S ALL OWNED SC4C UL•O SELF!TEMPERED AUTO PHY DMG Aa1Os NSUTOS ON-U BODILY INJURY Per ecclnenp S _ HIRE _ NON-OWNED PROPERTY aERTY DAMAGE s UMBRELLA LAB OCCUR ' EACH OCCURRENCE S EXCESS LIAR CLAMS-MADE AGGREGATE S -_ OED RETENTIONS '5 C WORKERS COMPENSATION WC015519215(AOS1 '0310112016 10310112017 ' X PER • .DTH- „ AND EMPLOYERS LABILITY I STATUTE I ER_ I Ails PROPRETORIP„mNEREXEc TIVE v1N IW00155192171AN,KY,NH.N1,V11 03N11z01fi �031m12DP 1006,000 o OFFICE(Manda /Mry nNH) !NIA EL EACH AccI5 EM s aF�cewMEMBER.zcLJDEm NI -- — �'NC0155192161EL7 03N112U16 031012017 .L.DISEASE-EA EMPLOYEE` 1,000,600 'DESCRIPTONe O OPERATIONS below ICOnllnued on Additional Page E.L.DISEASE-POLICY LIMIT s tQ30,RA DESCRIPTION OE OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe mach a more space Is required) EVIDENCEOF INSURANCE CERTIFICATE HOLDER CANCELLATION RED ARNCME SERVICES.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PARES FERRY ROAD ACCORDANCE WITH THE POLX:Y PROVISIONS. ATLANTA GA 30339 AUTHORQED REPRESENTATWE of Marsh USA Inc. Manashi Mukherjee .3'4aNwaoI--. .-3,4--st.ts"-Alci- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. RICHARD TROIA 2455 PACES FERRY ROAD, HSC C-11 ATLANTA, GA 30339 Update Address and return card. Mark reason for change. Address - Renewal Employment Lost Card Office of Consumer Affairs& Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 126893 Type: 10 Park Plaza -Suite 5170 Expiration: 8/3/2018 Supplement Card Boston, MA 02116 THD AT HOME SERVICES. INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA 2455 PACES FERRY ROAD, HSC - • - - cX °� AT1PATA, GA 30339 I 'signature Undersecretary of valid without signatpure