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32A-168 (18)
50 HAWLEY ST BP-2022-0017 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A- 168 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2022-0017 Project# JS-2022-000029 Est.Cost: $1041.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 106106 Lot Size(sq.ft.): Owner: LEWIS JUDY Zoning: URC(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 50 HAWLEY ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 () Workers Compensation NORTH PROVIDENCERI02904 ISSUED ON:7/7/20210:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE AND REPLACE PATIO SLIDER 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 Signat • V ) ' FeeType: Date Paid: Amount: Building 7/7/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner % ' Department use only City of Northampton/ `� Q tus of Permit: Building Department' kirI iveway Permit 212 Main Street,' / do Sew 9 Availability Room 100 -6+ *ref vailability Northampton, MA O106 °r 0, f Str tural Plans phone 413-587-1240 Fax 413-54 '3 ?d,,^, Plot/Sit Plan In? >/ off, "�s r pecify fed T, APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR OLISH/A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Sp ,N)lel •St ret* #'e{ Map 301, 4 Lot ' Ci 6 Unit No „a p is 1 M A O t Oh 0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 0- 1 Lam;s 50 44 S t- 0 Li /US.Si p.4 rK 4 Name Pall) Current Mailing Address' p/Obc, ( 4C;bal) _ �oZ- 6Ve - /96Y Telephone Signature aff 2.2 Authorized Agent: old (A Ccalke/✓' C2t_.. far B44"fir./hA!( to K.t (.,f as 10„ kez7 CT Name(Pri t) Current Mailing Address: 0 Co53 960- ?5Z — s-r/i 2_S t e Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Ai (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ( 6 5. Fire Protection 6. Total =(1 +2 +3 +4 + 5) 6t/e2 l f, OD Check Number j) 7 7 e This Section For Official Use Only Building Permit Number: Qp—a / 7 Date Issued: Signature: •e 7-7 •2dai Building Commissioner/Inspector of Buildings Date 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 I.: R: L: R: 77-1 Rear Building Height Bldg. Square Footage 04 Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO Q DON'T KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO C 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 er IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exca ation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 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 ❑ Replacementows Alteration(s) 17 Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [lam Siding [DI Other[D} Brief Description of Proposed) / Work: fitanb►►L fibre-Place / ip4i; st ok- //A Xi rite- tr4'14 04> s7T e--d cia,tyts >✓ 4-A.c�or0F Alteration of existing bedroom Yes No Adding new bedroom Yes No , 30, 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 . I. Septic Tank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �{ { �.,Q,41i.S , as Owner of the subject property _ ! Q ? /� hereby authorize /fD,kZ jgs et,�r1 ,__Z cee-A-4d✓f" (AG'/yrcie Ii it1 to act� my beh- f, all matters relativ�d to work authorized by thising permit application. mil F__,, _ 240v , re o Date I, e,/rai Li lii e-/k,kG,- J/ - , 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 pains and penalties of perjury. a & Cra//a4✓ ,1/' Print Na -7--6 - Zvz / Si ture of nC Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /' Not Applicable 0 t Name of License Holder: .E. c1t/!i K GLoAtt' . CSS'-- /c1G/v 6 License Number 23 6c41 a«. St. Sfrii0Cld MA o/ia9 1-L9 - 2- Z- Addre Expiration Date Cr? 19 ' i3- 335. - 3�2- Signature �/ Telephone 9.Reoistered Home Improvement Contractor: Not Applicable 0 Dee-1- kSA ic. I/ L 9-85". Company Name Registration Number 2Y.SS fifleS >€C/fl Aga 4 c. ?D3?7 'IILZ/L3 Address ✓ Expiration Date Telephone 066 - 952 FYI IL SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit ie Signed Affidavit Attached Yes No 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and vocal Zoning Laws and State of Massachusetts General Laws Annotated. i Homeowner Signature (y'1s#s&i') r 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 150A. Address of the work: S27 i ,•ale Si-fee-4 #`K Ad 4 014 04 0 The debris will be transported by: E, ,b- cie I t^-1 The debris will be received by: 14 (A-S c Building permit number: Name of Permit Applicant �a C'• ( Ge- I Date Signature of Pe mit Applicant City of Northampton $A P i , sic. •�' Massachusetts may .. • DEPARTMENT OF BUILDING INSPECTIONS I DNS: 4P 212 Main Street . Municipal Building yeti cam Northampton, MA 01060 ssNw ,,)V��` INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection, The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing &gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, d 1—eW i S understand the above. (Home °liner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date — Zo 2 I Address of work location ,'SD /-14.141/Gy,[ gree-f - `� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations • Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.got►/din Workers'Compensation Insurance Affidavit: Builders.l('ontractors/Electricians/Plumbers Applicant Information Please Print LeRibls Name(Husinessorganization Individual): Home Depot USA, Inc. Address:2455 Paces Ferry Rd City/State zip:Atlanta.GP , ' phone #:860-952-411.` Are you an employer?('beck the appropriate hos: Type of project(required): 1.. J I am a employer with 4. tJ lam a general comtractor and I employees(full and or part-time have hired the sub-contractors. 6. New construction 2.❑ I am a sole proprietor or partner- on the attached sheet. 7. Remod ling ship and have no employees These soh contractors hair g. = Demolition working for me in any capacity. employees and ha►e ►corkers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] 5. 0 We arc a corporation and its 10._Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercix-d their 11._Plumbing repairs or additions myself. [No workers' comp_ right of exemption per MGL 12 Roof repairs C. 152_,*1(41.and we have no insurance n�ywrcd Windows employees. [No workers' 13.�Other comp. insurance required.] 'Any applaeani thai -do. gi mu,i alw till out the xetiun below showing their 44.04L.1%.Cr mp..-n ationpolicy information. lionveownen who submit thn attidaa it Indicating the)we doing all work and them lure outside contract.nv nnai wMmt a new aff.da%tt rndiearinn web.. (untraeto»,that chuck thn but mint atta.lwd an additional shah struwrng the name ut the sub-come:ct.ns and%tate w twit i or nut theee cntitr.s have entelu}ot> It the ma+-:ontra.t..r,ha‘c mu-Li pnPyuk their workers'eLnrhh+.noble!,nunhlw. l am an employer that is providing►vorAers'compensation insurance,for my employees. Below is the policy and joh site information. insurance Company Name:Nationa! Union Fire Insurance Cc Policy#or Self=ins. Lie.#:XWC 1647259(OSI)(MA) Expiration Date:3/1/22 Job Site Address:_SO , tree-4 ('it♦ State Zip: Aiortitp...171v7 111A o lob Attach a copy of the workers'cot rasatiun policy declaration page(showing the policy number and expiration date). Failure to secure cogs erage as required under Section 25A of MGL c. 152 can lead to the imposition of-nntinal penalties of a tine up to 51.500.00 and or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the srolator. Be ads iscd that a copy of this statement may be forwarded to the Office of In%esttcation, of the DIA for insurance coverage seritication. I do hereby certify under the pains and penalties of perjury that the information provided ubos'e is true and correct Signature: Plx►hie#: 860-952-4112 Oflic•inl use only. Do not write in fhia area.to be completed hr city or town official. ('its or lawn: Prrnritf license# Issuing Authority (check one): 1 I Board of!leak!' 20 Building Department 3J('ity/Tow n Clerk 4.0 F:mectrical Inspector S.Li lumping Inspector 6._()Kher Contact Person: Phone#: Go Permits, LLC 4130 105 Buttonball Lane Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Massachusetts Solid Waste Affidavit Good day. Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 • 375 Airport Drive Worcester, MA 01602 • 12 Linscott Road Woburn, MA 01801 • 50 Maria Ave Johnston, RI 02919 Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1W8GYNZ7 Sheet: 1 of 1 Customer: Judy Lewis Job#: 1 1W8GYNz7 Consultant: Ronald Engelbrecht Date: 07/03/2021 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening a of bars A of bars Csmnts,1 Pnl, use L,R or S Glass Hardware Misc Items Screens Code _ For doors use c f0 c 10 Mull "S"=stationary or > Style Wraps '4 L g, a m " .g .� `�-' o "X"=operating w y P °' a m k 3 o ,a 8 o o 8 I o �' Room Floor Code (Y/N) Style Code. Series Code E w �s = 5 I- ui_ U a > x > r STD,White, GlassPack: WRAP,LSR 1 KITCH 2nd TDH Y 2 PNL 6100 WH WH 48 44 92 Standard X S SPECIAL CONSIDERATIONS. 1:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the Job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window. Seatboard Material(vinyl only-White Pionite,Birch or Oak) e - ome Pepo' erma 'a ue o • ro• uc s ' anu - ure• sy imonton Dated: Z. r F•r •_`9 30 3t1 G r ',R 30 '1 rr �a, Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC (all with Argon) Fact : Fact 6500 Wining 6500 Base ProSolar Supercept 7/8" 0.26 0.23 , • • • 026 0.21 • • • 3asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 0 • • • 0.26 0.22 0 • • • (ransom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 • • )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.24 • • • icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • • • picture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 0.27 0.26 • • i Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 • • • 3 Panel Sliders 6500 Base(s 21 SO) Pro Solar Supercept 7/8" 0.29 0.26 e 0.28 0.23 • • • •500 DOORS 3arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0-30 0.24 I•le 1 1 0.30 0.21 I•I•' •I• patio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • 0.31 0.23 0 0 • 0 •1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. kwning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • 0 0 0.28 021 0 0 0 0 '.asement 6100 Base Pro Solar Intercept 718' 0.27 0.24 0 • • • 0.27 022 • • • • )ouble-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0.30 • 0.30 0.27 • • • picture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 • • _ 0.27 0.25 • • • • Dictum_ 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • • 0.27 0.28 • 0 Panel Slider 7 6100 Base Pro Solar intercept 3/4" 90) 0.28 • 0.30 0.27 • 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 o r 0.30 0.27 1 0 • 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. 'atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" 0.28 0.26 • • I 0.28 0.23 I 0 I o 1 10 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • •_ 0.28 0.26 0 0 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phiia,Northern NJ,Long Island,NY. awning _ 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 025 • • • ' 0.26 0.23 •1• o • :asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • • 0 0.29 0.17 Gees picture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4' 0.25 0.21 • • • 0 0.25 0.19 a 0 0 • picture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • a 0.26 0.22 0 • • • >Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 l 0.23 • • 0 I 0 0.28 0.21 • • • 'Jingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 j 0.23 0 • 0 028 021 • to, • I Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" _ 0.28 1 0.23 o • 0 0.28 0.21 0 • • •tormBreaker Plus 300VL Homes located in coastal areas. \wring SB+300VL Energy Star PS SUN/Lami Supercept 1' 0.26 023 • • • • 0.26 0.21 • • • • :asement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 • • • • 0.25 0.21 • • • • - )ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • • • • 0.29 0.23 • • • • Oder SB+300VL Base PS/Lami Intercept 1" 029 j 0.25 • • • • 0.29 0.23 • • • • 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1' 0.30 0.19 • • • • No Gnds A:, wed 3arden Door(CH) _ - SB+300VL Base PS/Lami Super Spacer 1" , 0.30 028 • • 0.30 025 • • • • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. +4• Home Improvement Agreement: Page 1 Home Depot License#'s-For the most current listing visit www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Ronald Engelbrecht Salesperson Name Registration#(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc_("Home Depot") or Authorized 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. 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 I Phone# Service Provider Email Address Service Provider License#(s) 2. Customer Information Lewis Judy New England West 1-1W8GYNZ7 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 50 Hawley St#4 Northampton MA 01060 Customer Address City State Zip (602) 648-1864 I Ijudylewis151@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3.NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: 'customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT 06492 Address City State Zip 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: ( InsuviAitikg-QAAvim. 07/03/2021 Customer's Signature Date Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5.Anticipated Delivery Date/Installation Schedule Approximate Start Date: 08/28/2021 Approximate Finish Date: 09/25/2021 . 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. 6. 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. 7. 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: $ 1041.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) "'Maximum deposit ONLY applicable in MD, M4, ME(33%), .I, WI(99%) Deposit% 125.0 Deposit Amount$ 1260.25 1 Remaining Balance $ [780.75 1 8. 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 w be used to pay some or all of the total amount of sale. 9. 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; (iii) all rights and interests under this Agreement are solely vested in the person listed as"Customer" above; and(iv)Electronic signatures will be deemed originals for all purposes. X w.n 07/03/2021 Customer's Signature Date X /s/The Home Depot 07/03/2021 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) Lb5-/U�I For any other concerns, contact The Home Depot at 1-800-466-3337 liby4 Scope of Work Lewis Judy 1 New England West I1-1W8GYNZ7 Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Internal Products: Spec Sheet(s)#: Project Amount Reference) 1-1W8GYNZ7 + Windows Entry Doors 1-1W8GYNZ7 1041.00 Windows Entry Doors Windows Entry Doors Windows Entry Doors _ Windows Entry Doors Sales Tax 0.00 Total Contract Amount 1041.00 Notes: Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: VantagePointe 6500-6100-6060 Warranty Warranty Name(s): `;�a The Home Depot General Terms & Conditions ,�ti 1. DEFINITIONS: "Agreement" means the Home Improvement Agreement between You and Home Depot, plus (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions")and any documents referenced in or attached to any of the foregoing. "Defect"means any Services that are found not to be as warranted. "Home" means the real property,fixtures and any physical improvements where the Services are performed. "Services" means (I) the delivery and furnishing of goods, equipment, materials, and hardware; and (II) any related labor and services, including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance, repair, and testing. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement. 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES:(a)Payment:You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area, including,without limitation: (1) obtaining in advance of the Services consent,permission,or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2) providing the location of utilities, whether underground, concealed, overhead or visible,to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area; (5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area;(7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services;and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order").A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time,or both. Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. If You decline a Change Order request, You or Home Depot may terminate this Agreement. The Home Depot General Terms & Conditions 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date that all Services will (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the warranty period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole option (i) correct or replace each Defect, or (ii) remove each Defect and refund the full purchase price thereof to You; provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement, or (2) You fail to pay Home Depot as provided in this Agreement. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY, OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES.HOME DEPOTS EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE,MISUSE,NEGLECT, ACTS OF GOD,LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS,MATERIALS,OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c) Limitation on Damages. Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten(10)days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen,hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination. 9. CHOICE OF LAW; SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement. 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. The Home Depot General Terms & Conditions 11. SECURITY INTERESTS; LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed,unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed. You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e., goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its purchase price cannot be refunded unless Home Depot or Service Provider(1)incorrectly ordered item, or (2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the purchase price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE ORDER COMMUNICATION PREFERENCES: You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call);(2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order(including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program. Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/23 Workers Comp.- Union Fire Insurance Co. Policy XWC 1647259 (QSI) (MA) Exp. 3/1/22 Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor. CSSL-106106 Exp. 9/29/22 HIC 187666 Exp. 5/9/23 Workers Comp.Associated Employers Ins. Policy WCC-500-5021510-2021A Exp. 1/17/22 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits@gopermits.orq • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits Acaitar CERTIFICATE OF LIABILITY INSURANCE DATE 61111E0O-Y'Yi 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 INSURERfS). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED.the policyfies)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:W. PRODUCER CONTACT • r llR51'LAA AC. PHONE I FAX -NO ALLIANCE CENTER I Erb I ta'c NCL 3560 LENOX RDA S 5U'•E 24,X E-MA& AT. 14TA GA'fl''5 ADOREsa 11SURERfii AFFORDS.*COVERAGE AMC a CI C151-'069-H311L''.GAIN iNtV'FER A:CO Rembic(t`S,l31KE Cz. 24117 WINED INSURERS:Ail mimes CO ___ TIE HOVE DEPOT'P.0 HONE CVACT L-5A ir: S UuNER C:HomPRINs flank&V^s.rama r,urani NA 3455 PACE5 ROWS RCAD INSURER BJ..7Na O-20 ATLA TA CA 3=5 INsuREN I SOURER F COVERAGES CERTIFICATE NUMBER: A7..-097722 GN REVISION NUMBER 2 TH/S IS TO CERTIFY THAT THE PC`.JCIEC OF INSURANCE:.ISTED 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 DOGJMENT WITH REOPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS C'JE..ECT TO ALL THE TERMS. EXCLUSIONS AAC)CONDITIONS OF SUCH POLICES.UMTS SHOWN MAY HAVE BEEN REDUCE BY PA/0 C..AIMS. LAR TYPE INAUR NCE .NIA II I POLICY 17 NICITArrrn PAISISORYYTI urrra A x commen iAl.MORAL UMILNY WALT 314571 33Ct t9 CSC 1.= E ooccaveNece s I QOC 003 IcLASAE-MADE OCC,,C I 1.3OCp03 X 55t S1,03C.0 I7 •,a EXP Nisi ae team. 3 `JICLUli@.` PERSCh"1L 6 NOV i 1 AOOCIII 0 GEM.- AGDiM3ATE UNIT M"UE,PER A=+%REriATE 6 z.0C11,/YJO POLICY n:*� .RCCtC"S-COSARQPAGC I 2000,000 OTHERI A earO11I01PLE L,•m ITV M TB314573 03Ot:20 19 N.C:^32: :C4a xr?iNEO SINGLE LAA"T C,NN0 I AG0 x Ara nurv+ SE.F*sae)Acrc Plfr ONO rCC"L-NAN',.'Perrer:4r ^.Lh© 5ri#DULED DCVO,INJURY,Per=Vert i RED Ch1`' .—FL'ar CIANyED !.JTCG ChL" _A-C5 C$_Y c •1 3 UMBRELLA LA1 O-�.'R =_Y>•Cc-_RiENCE i EAE16 LIAR GAMS-MACE i :5C J SZZ'ENTIOY.) • - S e WORMERS COeeE+i!ATDN 5 .{ 331 021 S3"Jt'.`7.."' x I 7514 ( 'aTY` AND EMPLOYERS'L IASEST`! ER v.�PcraE CAP. tT�E3L c l^:E Y N :_F 5? v: o. 23,21.321 MC,C2C EL.�v.AcciD rtr I 5 OM CO3 CFCNEFi'LEr.6=JifXCUA3EC' I N A IWRlafory C SIH:j _OT:1'Lr.0-r AMA:p 7C= E1.DSE.YE•EA ENRLOTEE 6 5 CCC 003 CRes*wise axle* iCCC.03C DESCFOPTON CC oe -''cea bec, EL.Dr5ASE•PCUCY LAST 5 C Elce:s ALIO 35'1100110C^ 1 0301= MC T'.9:.2 Lint 1003.300 A Elv:3 General .5tZS 3'15D0 335W2019 03E012 Ls it t 000 300 OESC WPT'r0M OF OPERATIONS r LOCATIONS r VESICLES WORD 101,aasbcrrai Remarks laladialic yr t rN`sa Soo/Miss N NIOrrIRI EVCENCE OF 1NS;.RANGE CERTIFICATE HOLDER CANCELLATION t�^N.ff DEPOT USA INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY RCAS THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN BUILLMI3 C•ZJ ACCORDANCE WITH THE POLICY PROVISIONS ATLANTA GA 30333 AUTHORIZED RERESERTATI E at Cese U3 A MBE V3r35h.NJIh5'55 -14.0..NANON. -`9 s 1988-2016 ACORD CORPORATION AA rights reserved. ACORD 25(2016,03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN/Q1542Dd6 LOC 8: Atlanta A Rt? ADDITIONAL REMARKS SCHEDULE Page 2 of 3 Jimmy NAIIED OWNED PCIXY PROMIEP 2455 PACES FERRY RCA: 9Ult.3lv3 C•22 aut.ms.,se,30333 CRP MAIL COOS EFFECIPlE DAYS: ADDR)ONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE Certificate of Liability Insurance %Mars Zorcensss+or Crkruad Canie,inaierfriy aye Ca-pry or%cot A,-e-ce Pak?Monter KLR cs32sr in.:..=.F.C.•.:,.K. rti�t Id£„VO,NE A,ND, ,SC, ') Erecs.e Cale WOW :ayae5.,ak 0101.1022 Cwier EisYao ece c.. Poky Minter AC XX95003 CCDE,HI,i►4C„IJANT,41,16...NYA,1?; ElfeclatOak 0017.:02', Evader:sie 03ni 2D2 11 rot$5 000 YSG Cowie.AEA tee.earre Cemetery, Poky%amber.YYCUCS?605331 P2S11;CA,L,CR,di11i Eredve:ele 01t1.3122, Eapedm Ogle UM= I $5 a0000C Stet..St 1)3CA00 Cowie-Memona Una.,Fie eye.+a Caaysey Pew Mrrroer MAC'.517256 t,astp t1:Q.CT,F+Ple.NVAKPAA Medan cede 0301.20:1 5peekenO a 0S0t1122 ,EL".a,,it 1:0300C. SAS1000DM Greiff ACE te,erean t vurmae Company ozic„Ntermer 41.R C6 81100IA4 nectar:ate on c, .'master,:Me a30t25 S5 CO2 co: i sg+er%ore Lifts.,Fie imue Union, 2oi cy'i,moer>N4r":54'2.'3,IISfi ILA; ERecd.e.".str 5301.2021 Em +ar:str a30L'0u 2FL`,:ratSd d0oo„ SIR$500!AO 'X ffrydayers XS lnde•ety: Br+x„n,ca iIVrswoeCs+^pry zdx.Wnmr Tu:x6*1 fir: aoretc.,:ate a3r01; ;Et1 Lnrst$10,0a0.X0 ACORD 101 120011101) 2008 ACORD CORPORATION. AN rights reserved. The ACORD name and logo are registered marks of ACORD 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 Update Address and Return Card. t8CA 1 0 a6M 0 rt7 Office of Consumer Affairs&Busemes Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SupplerraN Caul before the expiration date. If found return to: Registration Explig ion Office of Consumer Affairs and Business Regulation 112785 04,22/2C.:1 1000 Washington Street •Suite 710 HOME DEPOT USA INC Boston,MA 02118 `� RICHARD OLMSTEAD 2453 PACES FERRY RDGt1HSC ,.aGG_ t6. Z. ATLANTA,GA 30339 UrlddrYerretary Not valid without signature Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston. Massachusetts 02118 Home Improvement Contractor Registration Type: Corporallion Registration_ 112T85 HOME DEPOT USA INC Expiration: 0412212023 P O BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA.GA 30348 Update Address and Return Card Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Regestrabon valid for individual use only TYPE:Corporation before the expiratron date. if found return to: Rerastration Expiration Office of Consumer Affairs and Business Regulation • 7�5 041,222023 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston.MA 02118 COURTNEY A.HOWE 24S5 PACES FERRY RD C-'I NSC ,T./ — ATLANTA GA 30339 Not valid without signature Undersecretary EXTER-2 OP ID:DM AC'C)RL) CERTIFICATE OF LIABILITY INSURANCE DATE Q.D�IIYYYI �.►- 01/11P1612021 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 ADOfTIONAL INSURED..the po4cyirest must be endorsed. It SUBROGATION IS WAIVED,subject to the temts 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 endorsementlsl. PRODUCER CONTACT Debbie Marino Canary Biomstrom Ins.Agency PHawE Fwx 868 Springfield St. 413 7B9-3995 ]iwc,Hal:413-7'86-7004 Feeding Hills.MA 01030-2151 ilooREss dmarinoacanarybiomstrorn.com '5SURERI9:.AFFORDING COVERAGE NAY i MEURER A Associated Employers Ins.Co. INSURED Exterior Remodeling Group Inc. NsuRER a Main Street America Group 29939 Eugeniu Ciubotaru 23 Benham St wsuRER c Springfield,MA 01109 NsuaER D NURSER E N5AIRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF HSURANCE.:STED BELOW HAVE BEEN ISSUED 70 TOE INSURED NAME. ASO'.E FOR TOE POLICY PER/OD� INDICATED. NOTWITHSTANDING ANY REOUIRESENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT d,ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAN. THE INSURANCE WORDED BY THE POLICIES DESCRIBED tHEREIN :5 SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ITS TYPE OF IYIIRMCE Illap gyp _ POLICY NURSER ATILLDDNYYYt,iIM DOYYYYt L1RRS B I COMIERctai.OBIERALaesA4.u ,TY EACH OCCURRENCE S 1,000,000 Q'mw;E'°REIITE.D CLAMS-MADE X occL X PAPP3376w oTI27I2D12o 07t21r2021 000,000 X Business Owners ✓y mGXPArwo epermA, s 10,000 MEn EXP Are one aN+oCii : r— , PERSONA,aAMIN/URN' 1 1,000,000 G EIHL A,OCRE ATE LENT APPLIES PER j GENERAL AGGREGATE S 2,000.000 aO.ICr El It Lc: • PRODUCTS-C# OP AGG s 2,000,000 OTHER S AUTOMOSLE LAMM r UNIamiclertT S 1,000,000 ^ B ARY AUTO YPP337516 07127,2020 eODRLY I URY RN ponee'r $ r'ALL CANED �SCHEDULED BODILY M ARTY RN a0e4wYl S 'Q''AUTOS M1TGS 7i -,:FED FUT05 -r NON SNN� t S S UMBRELLA LAB 0CC c EACH OCCURRENCE I r—• EXCESS LIAR �..CLANIr-WIRE AGGREGATE S C£D 1 I RETEATONS S ,......___._... EMPLOYER. COMPENSATION AND EMYLOY LMMJI'Y I STATUTE IX I ER A WI PROPRIETORIP EEECUTIVE Y N A WCC-500.5 2 021510-2021A 011174.21 a1I11'2 EL EACH ACCIDENT s 500.000 CFFICERAEIMER EXCLIEW'? (ManO.tory Is neil EL DISEASE-EA EMPLOYEE,S 500.000 it...,Se1[1EM Waft 500,000 CE..CRIPTION OF OPEAATIONS Asher _.. �.---, EL DISEASE.POLICY UNIT S �..,._ nDESC RUMOR OF OPERATIONS:LOCAnRNS:VEHKAES,ACCORD It'.AA4Yiae.e Rwerei SONdu:A.m.,bib/t IP,.d M'Rare spate is.1190iRadi Home Depot U.S.A.Inc is named as Additional Insured respects to General Liability. CERTIFICATE HOLDER CANCELLATION HOMEDE4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE RILL BE DELIVERED IN Home Depot U.S.A.Inc ACCORDANCE WITH THE POLICY PROVISIONS. 2455 Paces Ferry Rd C-11 _�. AUTHORIZEDREPRESENTAniE Atlanta.GA 30339 IZItl 0ful L ffi C1.a Li_G 1 C.1950-2014 ACORD CORPORATION. All rights reserved. ACORD 25 12014 01 i The ACORD name and logo are registered marks of ACORD The Ofiir:ai lithole of th ator.Mice ni EOrto.ihr;Chmonn 4 P citron lad t ammistr and the tkwr os,d Sd rKleWSis Public Safety • , Aft, Licensee Details Dentolyraplric Infoty ation Full Name EUGENIU CIUBOTARU Owner Name' license Address Information ItY: Springfleld te. MA ode: 01109 Undid States Livens*Iufonuatiou License No CSSL-106106 license Type Construction Supervisor Specialty Pratession Building Licenses Date of Last Renewal 9,141020 Issue Date 411212 17 Expiration Date 9'25.'2022 License Status: Active Todays Date 9`1612020 Secondary License Type: Doing Business As. Status Chance Reason. License Issuance PrerequisUe Informatitx>< Licensee CIUBOTARU, EUGENIU Relationship Attribute Of License No CSSL-106106 NO Ava Documents Ctate YMIerlow MASSACHUSTTS Y - DRIVER'S ' . ., 2 LICENSE .iill- • N$ -.".. '.fit, '•-.1 -, .--• '-' - :=, .ztiji,ar ,f,%.t - :_� 0911312016 i S4543160 i� ENa z1' z! '_— _- 291 .._091291198 fi r t ,x k.,-.. R r f NONE NONE 11 r '4- -z EUGENIU 1 r x 4., r CZ 73 BENHAM S • .. :; SPRING LDirA$4' 094304 • : _.• r >= ... Jr ({^�{ <' `mow -�_s.. t•_•_ - j1.,. :,; 5..-----''' • . .. _ -;Assn I0 1614GT c..pr t-: __ .Y. . . SEC 0911E40%Rot arms* 0912E Oftrce of Consumer A?f ars and Business Regulation 1000 Washington Strut•Suite Pitt Boson.Massachusetts 02118 tt-w ;tmnrover ient Contractor RegrStraltOrt 'We Cat110f M.r. E 00004;REMrjOetiNoi,InauP tw: R.540,skit 18766E :d Ea 44.6f/g+ F4a,-iM.r ili9G11.20,M '.PH,,KiF.E(O MA Gt)Q9 tgwu hew.*sno r+e,g:n C- d. aNMf 0 atoo Re110,1k lebwte.1..... MOM MMIOMMOMm moor;At/ rn „s,10,a.went r..1•01wau0101.0.00 y. igi CrFup+N62' b.M,E iM...Orin IOW rl..m.,exir,,ti NARKFgARKF ti♦r 7"0{0,C.,....wr M$,ss•n4 W.s vw n%qui.in. '0.10 :+&LMRil:•'1 `WA W001,0101.01 11,001 9.00.fl s-.liV3r1 ,M 0.al '- _. •,.ivogc r Net valet w1UOW glamour'. I _SLAP e n ,...„, a tRii,....tii,4( autnortW6o rerrnits LLi< to permits pun using m P pe g y c incense p /0 0 6 ant my HIC Registration # j 84 6 6 Ar Mzestions please call me at: (Li / 3 3 3 5= 7 0 a Instaiier aik__ - t.ompany Nan., __ .2 o.t�__Remo G._ROUf V