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16A-020 (3) 315 FAIRWAY VLG BP-2020-0134 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-020 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: window replaced BUILDING PERMIT Permit# BP-2020-0134 Project# JS-2020-000213 Est. Cost: $1109.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 104327 Lot Size(ssg.ft.): Owner: KEAN JODY Zoning: URA(102)/WP(17)/WSP(15)/ Applicant. HOME DEPOT AT HOME SERVICES AT. 315 FAIRWAY VLG Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 Workers Compensation NORTH PROVIDENCER102904 ISSUED ON:8/2/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 1 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# 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 Sisnature: FeeType: Date Paid: Amount: Building 8/2/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner s- "-- Department use only we-, City of Northam&E C E I V E tatus of Permit: Building D6partment Curb Cwt/Driveway Permit 212 Mair Street AUG - 1S wer/ eptic Availability Room 100 2019Water/ ell Availability Northampton MA 01060 T o Se s of Structural Plans phone 413-587-1240 Fagg 27$15PECTI Yq5t/Sita Plans NORTHA,Ar TON.MA 010, -- ecify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 4 o? /:3 V 1.1 Property Address: This section to be completed by office �Q /'] Map t�(. (/4 Lot x Unit yZone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: pp Name(Print) Current Mailing Add �� �L t4' ev� Telephone _�J Signature 2.2 Authorized Agent: Name(P Current Maili g Ad ress: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee D 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 0 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q IF YES, describe size, type and Location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement ndows Alterations) � Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [O] Other[dJ Brief Des r' i�rfIP r ose AIV Work: /J /V (/f� r �V!/ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ON I, V as Owner of the subject property Q� / hereby authorize (! to act on my behalf, in all matters relative to work authorized by this building permit application. 6Lcg' 7 r Signature of Owner Date I, 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 the ' s an penalties of perjur f Prinme Signature of C.neJE%n Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ' ,l Not Applicable ❑/ Name of License Holder: License Number Address Expiration Date Signature J �- Telephone 9. Registered Home Improvement Contractor: \ Not Applicable p� Company Name Registration Number � Addr ss kIV,- /� Expiration Date tv Telephon SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiW permit. Signed Affidavit Attached Yes....... No...... O City of Northampton Massachusetts , i �A H ; k DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building �► Northampton, MA 01060 AFFIDAVIT Home 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.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modemization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note.If the homeowner Inas contracted with a corporation or LLC,that entity must be registered Type of Work:_1,1 � g#!'ot?zEst. Cost:/Qpe Address of Work: �jJ {�!/ Date of Permit Application: 7— 214, I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _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 RESPONS1B1L1TES 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 agent of the owner: 17��,?i -/1 &Zi� 11,� 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 t a,, Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street • Municipal Building Northampton, MA 01060 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 S . 'VIC, Massachusetts p DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street •Municipal Building Northampton, MA 01060 eS, 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, S 150A. The debris from construction work being performed at: g1- 0041x", �, (Please print house number and street name) Is to be disposed of at: 49,�,r - /A&i AV, (Please print nam and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 4�"(Company Name and Address) Signature of Perini 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 Department of IndustrialAccidents 1 Congress Street,Suite 100 Roston,MA 02114-2017 www massgov/dia Z17orkers'Compensation Insurance Affidavit:Builders/Contractors/Electriclans/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[J T am a employer with employees(full and/or part-time).* 7. []New construction 2.[:]I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp,insurance required.] 9. ❑Demolition 3.[:]T am a homeowner doing all work myself.[No workers'comp.insurance required.]° 10 Q Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I.will ensure that all contractors either have workers'compensation insurance or are sole I L[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] JL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 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 ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/Liccnse# 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#: 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 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 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 fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(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 an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be 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 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 appropriate 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 to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current 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 stamped 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. A new 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. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Home Improvement Agreement: Pagel Home Depot License #'s - For the most current listing www.Ho_medepot.com/Li_censeNumbers MA: 107774, 112785 Eric Luukko Salesperson Name: Registration No. (if applicable): Home Depot U.S.A., 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. KEAN JODY New England South 1-LZ9EKDP Customer Last Name Customer First Name Store # / Branch Name Customer Lead/ PO# 315 Fairway Village Leeds MA 01053 Customer Address City State Zip (413) 588-2148 I keanoho7@comcast.net 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: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip Or Email: I customercancellationnortheast@homedepot.com Service Provider Email Address 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 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 THE HOME DEPOT 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 by: o4/z3/zo19 Custome s Signature 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: $ 1109.97 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl (99%) Dep. 1 25.0 % Deposit Amount $ 1 277.5 1 Remaining Balance $ 832.47 The Home Depot-2455 Paces Ferry Road, N.W. Bldg. B-3, Atlanta, Georgia 30339-Customer Care: 1-800-466-3337 460FI HDE Customer Agreement(24 Jul.18) V p 1 g Home Improvement Agreement: Page2 Finance Charges: 'Any interest payments or other finance charges will be determined by Customer's 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 will not / be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of windows A more detailed description of the work to be performed is included int the section entitled Scope o Work which appears on page ff--] of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 06/18/2019 Approximate Finish Date: 07/16/2019 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. Initial Acceptance and Authorization: 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 04/23/2019 J The Home Depot Gusto is 87ignature Date Service Provider Name X 04/23/2019 908 Boston Turnpike Unit 1 Co-Signer (if applicable) Date Service Provider Address X 04/23/2019 ShrewsburyMA 01545 ignature ehalf o Home Depot Date ity tate Zip Service Provider Phone Number Service Provider License Number The Home Depot-2455 Paces Ferry Road, N.W. Bldg.B-3,Atlanta,Georgia 30339-Customer Care: 1-800-466-3337 460F1 HDE Customer Agreement(24 Jul.18) v 0.1.8 Andersen Wood SPEC SHEET SC: Eric Luukko Measure Tech: INSTALLER: Branch Name: New England South Job#: 1-LZ9EKDP Prepared By ISM: Ship To Location: Customer Name'. JODY KEAN Date'. 04/23/2019 Page I Of f SPEC SPR SHEET# REF# NEW WINDOW UNIT Hung Casement LOCK Hardware OPTIONi OPTIONS Screen (ST or (Tradikonal Standarc WH Folding Stone is included or White Option FULL OH Frame Included in BASE Hungincluded MISC Existing Window Andersen FRAMI INSER Sash Glass in Base Glass unit SASH LIFT in BASE LABOR M Type I Window TYPE Color/Finish SC SIZE SOLD(Tip fo TIP) I MEASURE TECH SIZE ONLY ONLY Optionj Casement Handling Options OPTION price) Grille Options(PER SASH PRICING) OPTION pricing) OPTIONS unit pricing) OPTION TOTAL MT/ISM Interio TW SC UI Standard #Bars #Bars *B Is #ears Pattern MISC Location Existi Series intl Exteri FinishJam Standar (WIDT Size Grid Exterior Interior Ven How Ven Horiz & Labor Winds Type Style Color Color Liner Size AW CODE WAL SILL Sash Hing Temp Screen Type Grid Grid ' . dem (per (per Locator(Per (Per Location Obscur Finish Finis Finish Item Roo Fllw Code CODE CODE CODE COD Colo Code W Height HEIGH Width Height DEPT JANGLESplit Venting/Handing Sle CODE Options COD Color Color CODE sash) sash) CODE Sash) Sash) CODE CODE CODE Type CCIDE Type CODE CODES 1 BED 2nd C1 100 C1 SO SO 28.0 47.00 75 LStan ES- none SO STD SO STD SO WRAP 0 card N H BAY/BOW WINDOW a naleller Nt.:(inelude In—L.W,.Mu11 S—k Opllcri, wlid eondhlona,Uea Ifem#fo diinUly iii--hf-r) �MANUFACTURER NOTES:fl iude mullIng location; orlaa,Use IMm#to identity windowecon Prcalon Angle(B au—,15') rop nl v/endow to Soni,(inchasl Bay WnMOW EWnkars IDH I Casement) WiAh OI Uvernerg(mches) Construe,ROOT 1(Vas:No) II oed to SOMI,mbr of Sodx—ftinal I era is no quaran'ee that naw s Ingles wi match exi3lillg or. NEW DOOR UNIT I�— WINDOW & DOOR REM Andersen MEASURE FULL FRAME Glass Screor Hinge MULL I STACK Energy Star AW Trim for In Usdrlg Dorn Type Door TYPE ColorlFlnish SC SIZE SOLD(np to TIP) TECH SIZE ONLY Grille Options(PER SASH PRICING) OPTION Option Option Hinged and Gliding Door Options OPTIONS MISC LABOR OPTIONS Options Radius Unit PO Nome n Assembl Esq TOTAL Note: Location Interio UI RO/ Inswing PD PD Gliding Hinged 400,& meam„n Existin Seri Exterio Finish Standar (WIDTH TIP Ext Extensio Grid Exterio Intedo #Bar #Bar Door Door A-Ser Lock Lock Option eu Mnra Door T S e Color Color Size AW to Jamb Jamb 7 Grid Grid Patter en z bscur Scree IN or # Verdi Venting ragbrlal cepRery Type M r Type ( ri( Venting g gliding HROW HRDW Keyed Mulled Special zones tubev Roo Floo Code COD COD CODE CODE Code Width Heigh HEIGHT Widt Heigh TIP Size Location COD Color Color COD Sash Sash CODE CODE OUT Panel Handing Handing only) Type Finish Lock Stacked Notes MISC Labor Item CODES vee or No Pmrle Yes Width AW C-7 W.". pof boxes C--dor Approval PIM Name JODY KEAN Title Home Owner – — OWNER REQUEST FORM In accordance with the Declaration of Trust and By-Laws of Fairway Village Condominiums. I hereby request the following: 6-04-2019 DATE: TO: Board of Trustees c/o Iiampshire Property Management Group PO Box 686 Northampton, MAO 1061 (413)582-9970(x102)FAX#413-582-9973 PROPERTY OWNER(s): Jonathan Kean 4135882148 PHONE#: 315 UNIT#: DESCRIPTION of WORK -please describe below your request in as much detail as possible, include details of materials and methods, location of work and start and completion date. Please include any plans or drawings as applicable. • Install one anderson 100 series single casement insert window color sandstone to match-work will include taking out old window sash and installing insert inside Of Old WIndOW frame. This request is approved effective 6/13/19 On behalf of Fairway Village Condominium Property Manager CONTRACTOR: Home Depot LICENSE#(if applicable): AT-HOME Job# 10890281 To whom it may concern, Re: address: 315 Fairway Village Leads ma 01053 Concerning the above location, We give the Home Depot approval to install : Number of windows Style ( Double Hung/ Casement, name type) Casement Color Sandstone exterior Manufacturer Anderson Exterior finish as agreed to be PVC (wrap trim)? Nn color We agree to the grid or lack of grid configuration No-grids Are grids between the panes of glass? No As stated these proposed windows do meet with the Condo Management approval. Signed 7oiiatha4 McGee Print name Jon McGee Title Property Manager Phone # 413 650 9438 Date: Effective 6/14/19 The Colltrrtorttvealth of Massaclizisetis - Depal-ttnent of Industriul Accirients 1 — 1 Cotigress Street,Sulte 100 Bostolz, HA 02114-2017 141Mti 111ris5.-OvAlia� o `Z orkers'Compensation Insurance AlTrlavit:ffuilders/Contractors/Elecfricians/Plumbers. "1.O BE FILED WITH THE PEMMITTING Au'r t10i21TY. Ao Illeant.inforntatian ]')ease Print Legibly Name (Business/Organization/individual): ��— Address: city/state/zip:9LA Phone ll; —;7L) Are i.11 nn er»ployct'!Chcch the apprupriat hos: Type of project(required): I.❑f am a employer with cmployces(Cull and/or part-time).* • 2Q1 am s sole proprietor or partnership and have no employees marking nor me in 7. E]Ne,.v construction uny capaciy.]No workers'comp_insurance required.( 8. ❑ Remodeling 1f�I am a homeowner doing all work lnysclC 11Qo rnrl;crs'coma.inpuranse required I+ ❑Demolition 4❑1 am a homeowner anti will be hiringcontractors to conductnll work on my 10❑Building addition i property. I will cnsur-.tat all contractors either have workem'compensation insuranc_ur are pole 1 l.❑Electrical repairs or additions pr ictors Willi no employees t 12.❑Plumbing repairs or additions I 5.• 1 ora a general contractor and 1 have hired the sub-contractors lined on the attached sheet. Thcse sutrcartracturs have employees and have workers`comp.insurance.; 13.VE]R f rep'airrs ,qb.❑�Ve are a corporation and its officers have exercised their right of exemption per.MGI.c14• er y✓l�w } 152.§1(4).and the have Ito employees.[No workers comp.insurance required.] 'Any LIPPlicant that checks box']must also fill 0111 the section below shuwin-lhcir aver=:ers'compensation policy inrorms ion T I-lomeolaners who submit this affidavit indicating they arc doing all wort:and than hire outside eonuuetors must submit a new alFvit indicating such, ,Contractors that check this box must attached an additional sheet shovring the name of the sub-contractor and state lrhdhcr or not those entities have empluvees. Il'tte sub-co0trrctors have employees,they must provide their%vorke5'comp policy number. 1 arrl art elrtplo3+er drat is providing IPorkers''cor»perlslttion insurance for my employees. Below is the policy acrd job site q infornanllon. y; ; X92 4-f insurance Company Frame; i' Policy 4'or Self-ins.Lie.# Expiration Date: l Job Site Address:__ CitylStattJZilr F% Att telt n copy Lf the workers'compensation policy declaration page(showing the policy numberand�n date). rs Failure to secure coverage as required under NIGL c. 152,525A 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 Corm of"a STOP WORK ORDER and a fine of up to$250.00 a u day against the violator.A copy afthis statement may be forwarded to the Office of investigations of the DIA for insurance coverage veri?acatlon. Is S" I do hereby certify t de hilts tad ►tn ' of p jury drat rlte it fornmlion provided above is true and correct ' Si ature: Date: D 1� i Phone r: O fWal use only. .00 not ivrlte in this area,to be colnpletett by cltp or town ofjiciat City or Town: Permit/License# issuing Authority(circle one): 1.Board of health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 3.Plumbing Inspector G.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 P O BOX 105451 Expiration: 04/22/2021 ATTN: LICENSE MGMT TEAM ATLANTA, GA 30348 sca 18 znM.osin Update Address and Return Card. .�v �niniron�ii.o�//%nr /�ii-iiia%ice:.✓/:: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 112785 04/22/2021 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston,MA 0 118 RICHARD TROIA �. - 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 UndersecretaryNot valid without signature ACOR"® DATE(MM/DDfYYYY) L CERTIFICATE OF LIABILITY INSURANCE 1 02/06/2019 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER— CONTACT MARSH USA,INC. NAME: PHOE FAX TWO ALLIANCE CENTER MIC,No. o Exit): A/C.No): 3560 LENOX ROAD,SURE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC k CN101642069-HomeD-GAW-19-20 INSURER A:Old Republic Insurance CD 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD BUILDING C-20 INSURER D: ATLANTA,GA 30339 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 REVISION NUMBER: 21 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. INjR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS 1 O WV POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY MWZY 314574 03101/2019 03101/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE AI OCCUR A G DEa occurrence $ 1,000,000 PREMISES X SIR:S1,000,000 IAED EXP(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 X POLICY 0 PRO ❑LOC 1,000,000 JECT DUCTS $ OTHER: $ A AUTOMOBILE LIABILITY MWTB314573 0310112019 0310112022 CEa acOMBINcidentED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION 4VC 012717099(AK,NH,NJ,VT) 0310112019 03/0112020 X I PER AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N QVC 012717100(l^il) 03/0112019 03101/2020 5,000,000 OFFICER(AIEMBER EXCLUDED ❑N NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5.000,000 II es,describe under Continued on Additional Page 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Auto 297110011002019 03/01/2019 03/01/2020 Limit: 4,000,000 A Excess General Liability MWZX 314580 03101/2019 03/01/2022 Limit: 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �Lauvo ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta ACO® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMEDINSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 - --- --- - - ATLANTA,GA 30339 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number.WLR C65890549(AL,AR,FL,ID,IA,KS,KY,tA,MS,MO,NE NM,ND,OK,SC,SD,TN.NN,WY) Effective Date:0310112019 Expiration Date:03101/2020 (EL)Limit.$5,000,000 Carrier:New Hampshire Insurance Company Policy Number:WC 012717098(DC,DE,HI,IN,MD.MN,MT.NY,RI) Effective Date:03/01/2019 Expiration Date 0310112020 (EL)Limit:$5,000,000 Carrier:ACE American Insurance Company Policy Number.WCU C65890586(QSI) (AZ,CA,IL,NC,OR,VA,WA) Effective Date:03101/2019 Expiration Date:0310112020 (EL)Limit:$4,000,000 SIR:$1,000,000 SIR for the states of AZ,CA,IL,NC,OR,VA,WA Carrier.National Union Fire Insurance Company Policy Number:XWC 5565596(QSI)(CO,CT,GA,ME,MI,NV,OH,PA UT) Effective Date:03/01/2019 Expiration Date:0310112020 (EL)Limit:$4,000,000 $1,000,000 SIR for the stales of CO,ME,NV,MI,OH,PA,UT $750,000 SIR for the state of GA $350,000 SIR fo tatel�CT�_ Cartier.National Union Fire Insurance Company Policy Number.XWC 5565597(QSI)(MA) ti Effective Date:03/012019 �� ,I, Expiration Date:0310112020 (EL)Limit:$4,500,000 SIR:$500,000 TX Employers XS Indemnity: CarnerAmios Union Insurance Company Policy Number.TNS C65221019(TX) Effective Date:031012019 Expiration Date:0310112020 (EL)Limit-$10,000,000 SIR:$1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AA 1 fl emove until final code Inst roan Save label for-uture rafer�nr- —I 4 !! Canada -_7 1:snergystar.nrcan- t. mcan.gc.ca ' Ct •10 ' 7 •L .'.ey'f::Sv$_:jjw''i+w. tU }������ : ':v.i:'i is ir:::•:iXyX:Jvj I V c ELL tu L U.S.I E.0 i 'r I•.rt • I CC energystar.gov S ., Oualltied/Adm s 3ible 1 Renewal CM-s-p. byAndersen, WI1400W REPLACEMENT 1-�!...;<.-w•. +�..�. AND-N-28-00457-00001 WoodNinyl Composite IF Dual Argon Low-F4 .... . . ........ Product Type: Double Hung ENERGY PERFORMANCE RATINGS » LJ-Factor Solar Heat Gain Coeffic)en- 0 .-12 9 1 . 65 0 . 31 _ i I• S i-F') (,Metncisl ADDITIONAL PERFORMANCE RATINGS `, Si-let Transmittance 13 . 53 - \tefufy::•--ti.�3 sa 71SI:'_at-W-a3 onfurm z 3aapeave•t?4c.-.raceave3 of]'_IQ'm:F•�j IrAM!"a' n•:L M195 Me]etu ml3'V ea 3ea m at aft..mmentb:ar o n3 N]3 mu tic Sr.]c..!`.a 'k., gr.'it -ii'+c]IR!y]31,_3]=V0]Gtf iut varr3ri Yoe:u.BwN;:r 3rj 3r3.T :`a r,'..a:'_.._ j SIr3:JQ plc0.ct rQRJfr!1QKQ nfa'Tl4ar• wrr rfrt.]ra Q vaa�uw rowan Q CCL 129-H-835.06 CCL 129-H-835.07 Andersen Corporation:RbA Double-Hung .—»— ,•-t9f��Cyfar3taar<3:..r-trarcatcra�eus:n.•q'a[3cy3f7? Standard Rating •�••— �Sid -�3L� _--� :F' x�'• �_ • •'- -Ju -11:3 ��� ':3.:[3":3•]3 ,+_'1'73.1 3'3 sit' +'!_•rer 17:35'3' 100-00571177-04,- C of T cg to n _ re P rds SERGIY SUPOWI46514l y 376 bHflPEST