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22B-048 (5) 15 RYAN RD BP-2018-1324 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block:22B-048 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate2M-window replaced BUILDING PERMIT Permit# BP-2018-1324 Pmiect# JS-2018-002350 Est.Cost $2437.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: Use Group HOME DEPOT AT HOME SERVICES 106106 Lot Size(so. ft.): 12980.88 Owner: BAYLISS ROBERT zoning: WP(99)/WSP(99)/URA(66)/GI(32)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 15 RYAN RD Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.6114/2018 0:00:00 TO PERFORM THE FOLLOWING WORK)NSTALL 4 REPLACEMENT WINDOWS 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 It 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 siermt FeeType: Date Paid: Amount: Building 6/14/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner (� tNOUulS ' Department use only r- City of North mpt n sof emit: Building Dep rtm nt Cu Cu riveway Permit 212 Main tree JUN 12 2:018S S tic Availability Room 1 0 W IW Availability Northampton, AQ cBUILDING '1z .- i Ns� Structural Plans phone 413-587-1240 gAPoZ2P+. _ P,ousite lana Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION g p— I f" f 3 1.1 Prooertv Address: This section to be completed by office 15 94AA( 0 Map Let 0C-19 Unit Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1'6 Al Nome(Prink GunenteNr���We M n . * - Telep--k ite-y6, KKLL—M�.yyS '?b2-q-3 ) Signature 2.2 Authorized A ent: 7o; Nam �� Curre t ailingAAdre� Signature Telephone 57 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only corinDleted bv hermita licant 1. Building OL/0 (a)Building Permit Fee 2. Electrical "� / (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) yO 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Numb Issued: �} Signa re: /v Buildin missionerflnspectorof Buidings Date iXjz To,-1 @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER 0RR CONS Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Intonation Existing Proposed Required by Zoning Thi,column m be filled in by Building Depamnent Lot Sizc Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage 0,1 wca minus bldg&pa" rki,, ) #uf Parkin S aces Filb (volume&locativa) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book . Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O 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(cleanng,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 PROPOSED WORK(check all aoolioatt/lle) New House ❑ Addition ❑ Replacementtdows Alteratien(s) Roofing ❑ Or Doors El Accessory Bldg. ❑ DDemolition ❑ New Signs / A /Deckkss'[[[—_3 / Siding/[C ] Other[CI] Bnef Work Desl,V Z /!/' � ���� J' /VQ `J!1Wc—r'/� C4ft1- 5 Alteration of existingbedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet se.If New house and or addition to existing housing. complete the following: a. Use of building :One Farmli Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage aftachetl? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstaves Numberof each_ g. Energy Conservation Compliance. Masscheck Energy Compliance form aftachetl? In. 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, 1y RNGsS as Owner of the subject property h {� hereby authorize R(�p"�Y TAM- to act on my behalf,in all matters relaliv to work authorized by this building permit application. 'Af, C z (� ii - !-if Signature of Owner Date /L-D y�d ,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 t pain and penalties of Dery. Print Name Signature of Own Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor- � Not Applicable 0 Nanw of License Helder' V✓/�/��--�J t�+' D���✓ V'— ^` ©�/�flJ License Numper 9 2 9- Address Fx ration Date � l l�bfi Mt}_. Signature Telephone 9.Ragii Home m ro"men a r. Not Applicable ❑ 10 >/�7dS Company Name F Registration Number A dr Expiration Dale p �'✓1//7/✓D� �� LTelephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 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...... ❑ City of Northampton 't... . Massachusetts Aia src�� l ; t DBPARTNENP OF BUILDING INBFFCTIONS 214 Main atxeet • Municipal Building p° ��. NoxNae¢ton, Ma 01060 AFFIDAVIT Hume Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.C.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing ownerwccupied building containing at least one but net more than four dwelling unds....or to structures which am adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a�corp�orraation or LLC,that entity must be registered Type of Work: IOV l* Z l (-T-rn�� Esl.yCCost �7 e Address of Work: //�� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Jab under 51,000.00 Owner obtaining own permit(explain): Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the ag nt of the owner: P-) - )� Z" L�,;, 11zV�� Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton -+' Massachusetts DEPART mr OF BUILDING INSPECTIONS 2 s 212 Main Stmet • Municipal Building i p` NOrUsa tcn, M 01060 SJ4V`^ Massachusetts Residential Building Code Section 110.R5.1.2 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 who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall act as supervisor. 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. _ City of Northampton ` ��' " ' Massachusetts (i) � D8➢.V19'lt S Oe BDILDINO INSPECTIONS212 Nein Street •Nmicipal avilding� Northampton, NA OlOfiO Debris 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, 5 150A. The debris from construction work being performed at: 15 Aov gt (Please print house number and street name) Is to be disposed of at: WlY�7"� MTS (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) V4�'�T — � — /--/V Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. \ The Commonwealth of Massachusetts a Department of Industrial A ccidents ,1 1 Congress Street,Suite 700 Boston, MA 01174-2017 ze www.massgov/dia W morers'Compepsadon Insurance AHldavit:Bu0ders/Contractors/Electricions/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Ifo ation Please Print Legibly Name (9usinese/Orgaviea[ion/Individonp: Address: City/State/Zip: Phone#: Are yoe an employer?Check the appropriate boa: Type of project(required): II am a employer with ranpe,as(ftl l and/or purl-bore).' 7. []New construction 2❑Iama eoleptopvletoror partnership and have ow employees working fnrmem g- ❑ Remodeling any capacity.Mn wohnv'comp.inmiwme requirW.) ].❑IamaM1mneowner Jnin Il workm If. No workera'com , saran 'ed 9. [:]Demolitionn ge Ysc L p - cn mgnv ]: 4.❑I mia homeowner and will be hiring components,to conduct all work on my grope nY. l will 10❑Building addition atioune shot all wmmtaon either have workers'nompenmtion ireorance orate sole 1LE] Electrical repairs or additions proprinmrs with no employees. 12.[]Plumbing repairs or additions 5[:]1 am a general ovareYor and 1 havebired We sub-contracmrs listed on the swathed sheet 13 Roof repairs These subavntmcton have employees and have workersromp.msmarme} 6.❑We are a connotation and its olRcers have exercised their right of exemption per MGL,, 14.❑Other 152,41(4),and we have no smployces.[No workers comp insurance required.] 'Any applicant that checks box MI must also till out the section below showing their worked compensation policy inrWnuticn. i Homeonam,who submit this aftidevn indicating Way are doing all work and then hire outside convaaors must submit a new affidavit indicating such. :Comaaers that check this box must attached an additional sheet showing the name of the sub-cocirchurs and smic wheWer a,and Wose entities have employes. If Wcsubcontmtlors M1ave cmpluycw,they must pooidc their workers comp.mhcynmbcr. lam an employer that is providing workers'compensation insurance fur my employee..,. Below is the policy and job site information. Insurance Company Name: Policy ft or Self-ins.Lin.4: Expiration Date: Job Site Address: Cily/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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and corrceL Si m ' Dale' Phone 8: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License p 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 N: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,Or any two or more of the foregoing engaged in ajoinl enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or Other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such emplovment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or meal licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please till out the workers'compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply subcontmelor(s)name(s),address(es)and phone numbers)along with their eer ificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If m LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be rctumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the aMropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you 10 fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permib Iicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit 9icense applications in any given year,need only submit one affidavit indicating can'ent policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stumped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-0900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written," An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or inure of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer," MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the bactomm or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance at public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you arc required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be are that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofthe affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permidlicense number which will be used as a reference number.In addition,an applicant that must submit multiple permit,9icense applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the airy or town may be provided to the applicant as proof that a valid affidavit is on file for furore permits or licenses. A new affidavit must be filled out each year. Whore a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAYE Fax#617-727-7749 wwtv.mass.gov/dia From Rs,,,sd 02-23-15 L Home Improvement Agreement: Page 1 Home Depot License Number(s): Visit www.homedepot.com/c/SV_HS_Contractor_License_Numbers for latest license info MA: 107774, 112785 Salesperson Name: Kyle Harmon Registration No. (if applicable): 0 Home Depot U.S.A., Inc. ("Home Depot") or service provider named below ("Service Provider") will furnish, install or service the equipment listed below at the price, terms and conditions as outlined on this form. BAYLISS ROB New England South -5YT1J4F Customer Last Name Customer First Name Store #/ Branch Name Lead/Customer Order# 5 ryan road Florence MA 01062 Customer Address City State Zip (802) 355-6243 rfbayliss@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT HOME DEPOT USA INC., 2455 PACES FERRY ROAD, BLDG. B-3, ATLANTA, GEORGIA 30339 or EMAIL File Home Depot Q 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 PAYMENTS WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, 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 DEPOT'S EXPENSE. THE LAW REQUIRES THAT HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEWDE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR WHT TO CANC Acknowledged by: � 05/16/zols Cust rsSl ature a Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: za37.so Includes all applicable taxes. Excludes finance charges Sales Tax: o.00 (If applicable) 'Maximum deposit ONLY applicable in MD, MA, ME(3391.), NJ, Wit(99%) Dep. 25.o % Deposit Amount og.a5 Remaining Contract Balance 1828.35 The Home Depot-2455 Paces Ferry Road, N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care: 1-800-466-3337 cuemmer Fgreemom e.n of 1.,lel v .1e Home Improvement Agreement: Page 2 Finance Charges : Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which 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 payments made payable to Home Depot. Insurance proceeds will will not s be used to pay some or all of the total amount of sale. Description of Work to be Performed : A detailed description of the work to be performed is included in the paragraph entitled Scope of Work or Specification which is included in this Agreement. Anticipated Dee/.Installation Schedule Approximate Start Date: 07/13/2018 Approximate Finish Date: oano/zola 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 Fitial you have access to a computer that can receive and open emails and PDF documents. this paragraph, I consent to receive only electronic records related to this transaction. Acceptance-and Authorization : By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services 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 or permitting information may need to be provided to You later.) By signing, you acknowledge that: (i) You have read, understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; and (iii) all rights and interests under this Agreement are solely ve d in the perso fisted as "Customer" above. X 05/18/2018 he Home Depot s r S gna Cua Date Service Provider Name X I ff/Tist-2u—i 19o8 Boston Turnpike Unit 1 Co-Si r (if plicable) Date Service Provider Address X I 05/16/2018 Shrewsbury MA 01545 a OrBehalf of Home Depot Date City State Zip MVendor/Service Provider Phone# Service Provider License Number The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 F ——1 tQ EJI of Jen.M a W'12 WINDOW SPECIFICATION SHEET - spec.sneel It yT1Y•° Sheet I of l Customer Inch i JOh#.I.6YTval Consulters: k e ermnn Dale:o6n6nma New W aaow Fa Nlns Wmenw Measmemems Orl0.s FrNuc options ''laWr Oorons Fmm oNs�pais - to", Bays,Bows Location Calm East Opening #ol pars YotM1azs csmare l Pnl, ad L,Rm$ id M sc tram — Cotle A MJIs Byr tica nary sr sMe WnPs " s` _ y' 2 C '$a 'NE % Jodanling Fmm Floor coEa furs) slNe OOOe WerniA E I I9 9 — _ f cla,while. WRAP Ls 1 TO Dd s H shad 1, WH 10]00 110 , xp Slantlartl L zna IG r It, d o Th shalrroma.smnuam wane �S 3 0 PII 0 0 c 3igxPera P.LS '... Perk 0 6100 0 0 i8 Th,WhIt¢, [Vass,LSP Glass>a cc Sla nJ a�tl Lj SPECIAL corvsmE-110Ns. I White R:White,S.White <.White ap Godot IHimer CazPq Tylle Cay or Ity&ari Watchers malerlel d ral Only And,Or oak) y PmjM A"'.III or I') ey Flanker Type lOH.CX,or Csmntl cp sl wlMow to sold anohesl I lletl to cord wlol of coal malenal I have revel end agree wOp M"is.mrshaapons atervii In. nsbud Root lyes of Nol' ISpecial Terms and Cards' ns on III Elllowin g page Gartlan Window: ealEoand Malnlal)vinyl Only Mile Planar,III or Oak The foutmmil meaah of lllassadwswis t Departrnetlt of l711us'/ti&Aecidenis t Co agt ss Street t to 100 J1_ o ,sic n, ad,i J2114,.017 nay.,.umss.ooifia Ana kers'Coaanaasnlon insurance Affidavit',3ni!dn'siCon:ractnrs y;ecfririans/I':umbcrs. 'C 3c ML`D R;Tl T'dn?E_s)ITTflp'G AU 1 HORIT V. _`.rnlicnm infmnmaian %cease Prirt Le-ibiv .`+ante:3v4;;cJfj;eanivtiurJ%ndiddual): �;' - . ..0 emp:u.crt Cheui;[he"".Prurcbm: Type of praleet(required? J Ih _ oy U d Fa - cA ' ❑Yen^cens[melion IN Rannod.lip; F d - r rvs01 rat no Io g i S. � Benolincn � - Ji 1 1 a dm + - II n;cm Va a dv t 11 4 .,F d r•v. vvnl - 10 2uildine addition _Iilll IMI na-[.CIS r.ilh.r ? : j I I I �C�ealneal TGa1[S a(3fiGl[ItlnS .1010 a c9Gay.Ci - 1 !umhine apairs ar addidons- hutd M In.0ould h us.wcl clalE . e a - CIC es ne ,m l� ,p -11 Rc rtpairz ly. _Iher ,:blj,dnu m-'nrvc;a w^al.,ttL waartl", I, II -I. c1:M1at oittt= =1 yr a].'IN vltilt,cton".Is. 'slry.in�:vvs .s .an ialnnnn uli,imrtamfin amrh,aM&A . .ndmlins Cd,dac,-all na,43:ia u,5. _.dtaena.,mw;sahnlmnv nffJa:l md'cating,ud;. l_it aa.%._I an aaOnaNl e!l� ; ^J allllanri and..mla,r;.,m:.loa pn,wa h2rt it 04,a:6 ,,oa:Wr>42 t._nP!a.aes. mynl n♦..,.na nay .voG:. airy nsna_c %.7.all enrols)^er i/1'1NS prm;iptl4l�y`ly(a�ariceA'•:'mnnertsrltlUylt d,Snrpgacef)]r aq enJ)ar`jloyres..�Belmvb';Pa pa(mv andjobstie , unlet C. _e()7/RI�1�R 3/aJal .. V �PA/ fL Cy `nsumncc Company P:;m �-^ � Ac )/jj1'J �j(/. aIle '. ar Sdf-in I c �:��J r�a /J;/�' u e_ : ..or ss 115A A k.6- Cily/s.alNZlp• ,tracb u cap;If mu workers'comnensl ion policy deciarndon range(sbmving the policy number and eapirmio dato)�D anrc to secure coverage a.-.mquirad under'MGL c. i52,g2=A s a crimind violation punishable by a ane up to 31,500.00 antler=,vear,imprisonment.2swell as civil eenaitles in the Pain,at a STOP%VORX ORDER and a fine of op to 250.00 a _11ust the viclame A copy u'ihissmtemeni may be mn{atAcd!o[he Office or liam iealions of the DIA for insurance :cve;age verncation. i dci;erehc ecrrtfvut the in ' _ filer'-1 that ih nnrnlian proeitted nbm^e tr t�tGe and correct. s na r �il :] 2 O Y :home !IIsN q y - it O(frcial ire oral)'. Do not wd!e in this area,to ie conlplaaeorby dal or town g)icioi Ciq of Tert'n: Pernil/laense-i - rcl.g 3Wbor^A/('rule orae): 1 T a oar 1 aP 11e91!b 1.Budding Dep;rtment 3.Cn�iiTmvn C.c.k J E!ectncai lnspeerar 5.Plumbing iaspa,, or '..� il.Other :.an taC;'cr±mv ?hone S: acoRdB CERTIFICATE OF LIABILITY INSURANCE —a a° ) 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 Die certificate holder I.an ADDITIONAL INSURED,th Mlicy(ies)must have ADDITIONAL INSURED provisions or be endorsed. IF SUBROGATION IS WAIVED,Subject to me terms and conditions,of the policy,certain policies may numbe an endorsement. A statement on this certificate does not wnfaa dgMs W the matifleata holder In Dau of such endorsement(.). PRODUCER HOXTAGr MARSH USA,INC. TWO ALLIANCE CENTER MOVE AM �. 3560 LENOX ROAD,SUITE 24EQ ATLANTA.CA 30326 ADDRESS IN S AFFOROMGCDVEMGE HINCI C.NIMM2059 HSTeD�C W1819 INSURER A:Ch RqaUlc SIDI CA 24147 INSURED IHE HOME DEPOT INC. IMBUREa s:MWsll "eNSC9 13841 HOMEDEPOTU.SA,MC. IN5URERC'HCTeM&kC4IPffiAInRmKeC0man 2455 PACES FERRY ROAD IxsueeR D BUILDING C-20 ATUMTA.CA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: All20m35UP-16 REVISION NUMBER: 3 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 T YPEOFINSURANEEREEN. POLICYEfF Pm10EXP LTR 1 POISYMIMBER O UNITS A XCOMMERCMLDENERALUAII IY 6MZY 312713 031012018 030112019 FACNaccuaftBKE a 9.001 CMIMS E IT]OCCUR $ 1.000.000 LIMITS OF POLICY XS MED FYI' _ _ $ EXCLUDED OF SIR:SIM PER OCC RFR30NN.a AONwJURY E 9."'m0 GENT AGGREGATE LIMIT APPLIES PER S 9,000.wo GENEINL PGGREGAIE X IOUCY❑FE7 r]LOC vR000CT5-CIXAPbv FGG S 9,8084" OTHER S A AUTON ILe UASKITY M M312718 0320112018 03018019 1.000.000 X ANY AUTO BppILY M,IURY 1PMpa'un) E OANEoNly �UioB LED SELF INSURED AUTO PHI'WAG WOILY 1201080 RambM) 5 AUTOSHRO NON-0WNEO PROPERTYOMAGE 5 PIRUTOE..LY AUTOS ONLY peremM,Y 5 UMBRELLALMe DECNR EACH OCCURRENCE $ EXCESS WB CLANA E AGGREGATE S OED RET .A S B INORRERSCOMPENSATON WC 014122577( X.NHJWVN 1 I 03018019 X I TB ANDEMPLO Bel-LMBIMIY PER A OER D ANYPAOPmEroR1PARTNEUEXEOUITAE YIN WC0141225780NU 03018p18 03018mv S.Om.000 OFFI2R,M[MB[RE%CWDEO) ❑N NIA wEL EACXPCOCENi S IManGayin NM ELDI EASE-EAEMPLOYEE S 50.01.000 atebry CmNMetl an A}BbreIP ELDISEASE-PCUCYUNNTOESLRPTON OFOPERATIONS i.Om.000 5 C foes AlAn 297-710011-00-201B 030181118 03018019 1-vnil: 9'0'000 DESCRVTONOFOPERATMMBILOGTIONSIV MUS(ALOROlO1,gaElEp,plpmn4[BCAap,p,ppyMgp[6atlampafryu's,qunM EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLAN1 N CA 30339 ANTImMeD REPRESENUONVE mwsh.SAma ManasN MUklleOee 01988-2016ACORDCORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CNIO1642069 _ LOC N: Atlanta A��a ADDITIONAL REMARKS SCHEDULE Page 2 Of 3 AGENCY NAMED INSURED NOSM ARSr INL THE HOME DE,OT INC DROVE DEPOT L'A INC POLICY NUMBER 3455 PACES FERR1"ROAD 6WlDINC 221 ATLANTA cn 30331 URRIER NAIL CODE EFFECTVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM 15 A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certifcate of Liability Insurance "'re-ru,pensnucr xmlon,o ri. InoenNlp ...rwrwnfevam,IG, Pai_ry NomO, wLA C6m6iwl;Al nP KID IA Ku kT LT A'No NENM NC OK SL SD TIN III b uv; :flalrva Dales 03;;11201, Fmvaxon Dal,IGm1IJC9 IFI Hurl s roo.3'0 .. .�� N,, ,ml, Cnnpary Ptl¢y N'm.L,r N - 1L1pL '.I` eF HI IN A IN III II RR CflzliyeDal=03M. eOlP Gnlallon D[In AP"QC11 ILL' III'GIT; _'uT, IC,;amma'Im¢ervxG POI)Nun 06r2 A] All N: JR,A v;P, FNxOveDale 03ID11201B L.N i'nel IN, 01I0121nC ILL)Emil 5 LOU A, SIR Cl000001 SIF Im inc zlIlr,le IS.u'II N,OR I1 11 .. mr Na rra nnm Dw ITH,— 11 a Per,NumM1t1AC 051—S C11 1 -1 GF NL MI NV011 PN JT E, ,, "I OL9b]YB Eup.arlon Dale DaMl2911 TolHun 00 UO sm07 sF'or tH NuirL r Ce LIL NN N Or rrAL n`C 00"111 W mL Slnlu m cA S&Y W651R rur I',.rule O'C T -Irl=11 I�pui u eic(onoany N SP.(CSI IMq:;rmP 112mrG 1v FnnlOy:u%c E9omnlh. 'drIcimnlw Dn all Nfulanrr-mem- I,I,Number 1 Nu C40 6AY,A Il& Lnxlr Dal, mmrzOTB kv01'ellm Ddu bL012My EL,ml.aI 000A11 sR S.DCG DCS ACORO 101 (2888181) C 2888 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I•';hvCCCPE ez;ecu ^>'r. _�E^_c 'A/06+_3SE3 1 � iii BOvz^Nr5'V`.9k"Sa,u!2U�'v�idld4'J"-C�v+Hf'S�i!u4 'Cp; , tlS�lX?QOIVl�..9F"tlV-iE�S"/iC:':�iuiritNY.!i;--71Sti:' - . .-45�a!aar�r.' �I li .asx_a7MIS,Daasa, -1 51%1Ls 41noS'�iU3.7(NOS AMEN .� 1J='.,9-alb U'luaib�!',tiTi �__�—o .,Era'. 4.%•J ii o�u3nxion�aa?C'artn5n_un_;ar.,wou-ne!:�`f SUMLsxi nI_DNAJ JaoMi4R� , „m_DCltm ! ODi530H31L 6L:?IFWOi,13L�?C W.OR@f`.7Pi�_ ' �3Nii.v'o 597Jt`W}36�us�!nr:d_.PLs i ZO,..:.x_ .. i _--'rte=z�"?o\�S:sol-t _..' �x.9,.5;'i. _. ffI I .a Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 2455 PACES FERRY RD C-11 HSC v" � , Expiration: 04122!2019 ATLANTA, GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑Renewal EI Employment O Lost Card Office of Consumer Affairs A Business Regulation ` HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. H found return to: Recistration Expiration Office of Consumer Affairs and Business Regulation - _ 112785 04;22/2019 10 Park Plaza-Suite 5170 ROME DEPOT USA INC - Boston,MA 02116 2155 PACES FERRY RD C-11 45G (dL(� ATS N—A,GA 30339 Undersecretary - Not valid wlthou signature Massachusetts Department of Public Safety MASSACHUSETTS DRIVER'S ' V Board of Building Regulations and Standards x uµ LICENSE 4 i License: CSSL-106106 Construction Supervisor Specialty x s1 0911512016 x$45431606 EUGENIU CIUBOTARU 912021 r r 0929719$2 23 BENHAM STREET - � " �',� '"� w � "A i � � 1R REST SPRINGFIELD MA 01109 ._(� NG ' NONE "I 1 :1223 BENHAM 9TREET - SPRINGFIELD MA01109.23Bt �1. ' .�`L=' ;•,1: �..-' Expiration: 153UN taMT GA2^ t. .' Commissioner 09/2912020 eaa0911rdasawsyuwj$ 2Q9729��2 '.