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23A-313 (2) BP-2022-0040 41 MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-313-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0040 PERMISSION'S HEREBY GRANTED TO: Project# WINDOWS Contractor: I License: Est. Cost: 5166 • HOME DEPOT USA INC 106106 Const.Class: Exp.Date:09/29/2022 Use Group: Owner: FITZGERALD REALTY CORPORATION Lot Size (sq.ft.) / Zoning: URB Applicant: HOME DEPOT USA INC Applicant Address Phone: • Insurance: 2455 PACES FERRY RD NW , ,XWC-1647259 ATLANTA, GA 30339 ISSUED ON: 01/12/2022 TO PERFORM THE FOLLO WING WORK: REPLACE 2 WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Insp ctor Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Gas: -Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney:. • Final: Oil: Insulation: Smoke: Final: • THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ''./• � 11 Fees Paid: $40.00 . , 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner * n k Kt Department+1 Only E ____ 7 'a t Y v " .� � r f , y, RECE_ �itir of Northampton status ofPem�t; � � R� t , < ;y a ug �,*��, i\ •,k t t r��"rNt31�'r 1 ) x� r"- irk `kx �� "s e 1 �` tz�� - Building Department Cufb Cut/dnueway Permit `3 r � �' su u ri ah& 1 2 2 Main Street Sewer/SepUcpAvailablhty � + ' ti fl rrk r �{��� /� '�y,��J(� Room 100 Naer,IWel(AallElhty�{ J�" wii 1" '^+�'§�i+�rkd k�wr� i'w�:'� trt�n�+a r (�T9 � / ^_lY•i As���`rt �'��5�7 k h ) tj At ��. rYw 7�5� orthampton, MA 01060 Two Sets of Structural Plans u ' , i t '1,*a r 4 r a` t kr,,r at tik y hone Zi-58 -1240 Fax 413-587-1272 PJotlSite`Plans "o- i rn + , �; �,;, '% i` >}i.4 x _______ DEFT.o? ru11_Dii•iC 1N�PFCi1pN`3 Other�Specifyd iY k ^ } , a, °a ; �,n jTiannnPtl1N MA01060 to 1t� 1 ice. ::" a `d. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION 1.1 Property Address: °,Th►s section to tie completedby. office 9/ /4410/e ee f Map Lot Unit 70/1/ICe �� Zone Overlay Distract 0/0bZ Elm St District . •. _ .CBDistnct` SECTION 2 .PROPERTY OWNERSHIPIAUTHORIZED.AGENT 2.1 Owner of Record: //�� / avid We��� V/ M4,G/ dke y e4 6- AO- DXy6z Name(Pri Current Mailing Address: ) ‘yiee'vd Telephone Signature G�3 S3S � I 6 2.2 Authorized Agent: 6efa/d t. CIA A$/,?- j)t- /of 6u taz( 6'(a0/n1 a Name(Pri ) Current Mailing Address: Q 6 033 g60 — 9S2,- Wh— Signat Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only; completed by permit applicant .. 1. Building q [6.6 (a).Building Permit Fee, 2. Electrical (b)Estimated Total Cost of,. 'Constructionfrom(6),._ 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection c� (. 6. Total=(1 +2+3+4+5) k ,7�6‘, 0Check Number E. mil This Section For Official Use Only - c� Date l Building Permit Numbe ' j Z 1O Issued. • 1- ` Signature: l /2 Za.Z Z Building Commissionedlnspector of Buildings . Date Section 4. ZONING AU 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 6 1 , Frontage Setbacks Front = r Side L:= R:t_ 1 L:LJ R: = t Rear 9 1 Building Height Bldg.Square Footage Open Space Footage % ---y (Lot area minus bldg&paved t.�._� parking) 1-1 #of Parking Spaces h.m___i Fill: ._.._ }ti i _._..._. . (volume&Location) I A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DON'T'KNOW � YES 0 �_, IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO 0 DONT KNOW YES IF YES: enter Book _._ Page —I and/or Document# m B. Does the site contain a brook, body of water or wetlands? NO 'L DONT KNOW 0 YES i 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 NO (V- 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. Wit the construction activity disturb(clearing,grading,exc 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 ❑ Replacement Bows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [0 Siding[CI] Other[Dl WBrioerfk D: eript io n of PrdS edopn(gee 2 kr S A2 A&- ttopi n a cY x / ca -" Alteration of existing bedroom Yes , No Adding new bedroom Yes i b-/-No,..." Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa,.ICNew btaite''aivibr addition.kAtiiistinq housing:gcompl ielholollo (riinq: 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? 1 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, Piro11 id , as Owner of the subject property T °,\`j _' /, hereby thorize b �Slt ,te~C' C� l °'" I/ to act n y behalf ' all matters elative to work auth ri ed by this building permit appli lion. 41,0wf f, ii-)72,2 Signa ure of wn Date I, bet-4 id << Cifi-- ,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 nder the pains and penalties of perjury. ben(I C. C j ti e Print ‘i me / p•-•--4 " o (y7 1'4) ( I'1 - 7-0 1 ' `ur:7O •-nt Date SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: t / Not Applicable ❑ NameofLicenseHolderiI�' 0044 ` / iije #t ' � ''i- /96/a 6 License Number 23 l(3ei h -i €I ,5pr; t4!th0' /hlA O// D ! 9—Z S - Z Z— Address / Expiration Date aa hd c, - 33s- 3 z Sig a • e / //v Telephone 9:Registered.Home'improve i ent Contractor,z , .<f ,F , _a _,, , „_` r f' Not Applicable 0 ��( I l4jSt9 Z 1/ 7,ComAL:Name`" Registration Number 2'/ 3 Aces PGr--, '41/40 6I go?�7 Address Expiration Date Telephone g60-9S2_ WIZ. 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 buildin permit. 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.CMR780, Sixth Edition Section 108.35.1. 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 congsidered 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 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. The undersigned"homeowner"ce es and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State oca o ' aws and State of M c tttss GenLaws Annotated. Homeowner Signature ad 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: '/l AO& &,ied Pk/ /ice rfix 0)06 z The debris will be transported by: Air-cp/ 4/14:0165 The debris will be received by: 2ncr jL . (Ain G Building permit number: Name of Permit Applicant aerai C- Cv / z- r � Date Signature of Permit Applicant .. . �..L� Department of Industrial Accidents (e 4 9---:'ti'^-3-"tee•'�, I - __ , Office of Investigations ., ; h #_...., Lafayette City Center •t�9 i,.... -: .n o p ..� ; 2 Avenue de Lafayette,Boston,M 4 02111-1 r 50 ,'`i6.:A_, :?''- www.atassgavldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlieant Information Please Print Legibly Name l iness.vaaninationIndhiduall:Home Depot.USA,inc. Address:245 Paces Ferry Rd City/State/Zip:Atlanta,GA 31133 Phone#: °-9524 12 Are you au employer?Check the appropriate tun: 4 "J I am a general contractor and I Type ofpa�,jeet(required): 1.,� Ina employer a employees(full 'urr part-time).(' have hired the sib-cOntrtact�sr} _ New construction ?_ I a m a sole proprietor or partner- lister on a attached shot + Remodeling ship and hatt't',no employees These sub-eei n1racturs have 8. ri Demolition working for me in any capacity. employees and have workers' 9. i Budding addition No porkers'comp.insurance comp.insurance) -- re q uircd. 5• a We arc a corporation and its 10.17 Electrical repairs or additions officers have exercised their x 3_7 l; as 13taatt+�o�a�zac�doing call work 1 I. ,Plaraan'hinp_,repairs or additions myself. [No workers' comp. right of exemption per NIGL l-a , �i,pout rwpairs insurancerequired.]' c. 152.§I(4),and we have no 13.E other ,c... « employees. [No workers' krao o as comp.insurance required] °Any upptit, r«t dint cheer box RI mug alNo fill oni the tiva baeti stxaoie5 their okntr compmiation policy inform-dim 4 Hsssax i-AVCIc .wltts Sta lilt thi s of ietoir intlic they are doing oll%tuck emsi tlt t hire I+nt,ittc cantors t n=Si st:^emit u nice;•oSfid i indices:inn:,seat. IllAnatr._ctors licit clic tL^iSiruimi-,./<ta: -.4 ma additional illioct showizs tlwzamvof€PutSub- tract a.dst tcw1_�-�iIre:ur:ant ui actin Eric ti,cupluyevz. If tcoiployail,duty iniistposvidt d it wuda '1. .policy ur:aJ t. l am an employer that is prraridhig workers'compensation insurance for my employees. Below is the policy mu!job site information insurance Company Name:National Union Fire Insurance Co_ Policy#or Self itns.Lie.#: `i U/ 472S9( P 1) ) xpirstiona Date:3/1122 .lob Site Address 9/ / Pie Shed i ce 4`ityaStaate izip:FA)ice 111 4 p)06 a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure w secure coverage as required under Section 25 A ofMGL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500 0D andfor one-year imp isonnteat,as well as civil penalties in the forma of a STOP WORK ORDER and a tint of up to$250.410 a day against the violator. Be advised that a copy of this stawin t may be ti mauled to the Office of Investitg ttioas of the DJ.A.for insurance coverage verification. I do hereby certifr under the pains and penalties afperjury that the information provided above is true and correct. s[ s a -''c2 � - Date: /—// - 2 2 Phone#: lt- 52 4112 Dacial use army: Do not write in this area,to be completed by+thy or town.oflieaaL - City or Town: Permit/License d; issuing Authority(check one): IDBoard of l leaith 0 Building Department 3 jJcityllown Clerk 4.DEleetrieal Inspector 5.1J himhing inspector 5[JDther a Contact Person: Phone fl: City of Northampton f5 = sic 'r. (( Massachusetts5 rifFt yJ.. # 1 ;wj IF � 1`„ DEPARTMENT OF BUILDING INSPECTIONS j .A s ` t 212 Main Street • Municipal Building y% Northampton, MA 01060 SbW gi?J ,4 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 foundationlfootings(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, C� 0 C62L &//44..alf) understand the above. (Home owner/resident's signatquesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date /— iif - 202-2' Address of work location Mai/ dhie�7 ekkie ie€ mil/ 0 10 z ,X1 f k ,°;"<,.., Go Permits, LLC r ' 105 Buttonball Lane ;.ex a '' �' , Glastonbury, CT 06033 ` _ ITS' f Scott Doughman tg •` Phone: 860-952-4112 Fax: 860-430-6719 n 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#: 1-1YOEJCGS Sheet: 1 of 1 Customer: Fitzgerald Realty Job#:1-1YOEJCG5 Consultant: Kyle Harmon Date: 01/o6/2ozz New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Mac Items Hardware Code Screens For doom use m c :4 Mull "S"=stationary or 2 Style Wraps y a v .. `o 9 p S3 p "X"=operating Room Floor Code (Y/N) Style Code Series Code u x" -us 8 C. > _ > xc STD,White,TMP:Full, WRAP 1 LIV 1st PD2- Y PD05 6100 WH WH 71.25 79.5 150.75 GiassPack:Standard X S FR-C -- - — -- - - -- STD,White,TMP:Full, WRAP 2 LIV 1st PD2- Y PD05 6100 WH WH 71.25 79.5 150.75 GlassPack:Standard S X FR-C - SPECIAL CONSIDERATIONS: 1:Red Brick,2:Red Brick Wrap Color interior Casing Type Colonial 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) ' Without Grids With Grids G/aztn U , U iiii p4.:...,,,,Lt,t,,,,, Style Glass Package f ) Spacer /6 F• act SHGC w,, SHGC . 6500 riming 6500 Base ProSolar Supercept 718" 0.26 0.23 0 0 0 0.26 021 0 0 0 asement 6500 Base ProSolar Supercept 7/Et' 026 :. 0.24 o o 0 0 026 - 0.22 0to 0 ransom 6500 Base ProSolarSupercept 1' 027 ' 0.32 o © 027 029 0 0 0 ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 . 0.26 0 029 0.24 0 0 0 __icture Casement (NH) 6500 Base ProSolar Supercept 718" 0.26 : 0.28 0 0 026 025 II 0 10 0p 0 7 icture 6500 Base ProSolar Supercept 7/8" 027 0.29 0 0 0.27 - 0.26 0'o Panel Slider 6500 Base „ProSolar Supercept _718" 029 0.26 b o _ 0.29� 0 023 a a 0 Panel Sliders 6500 Base(s 21 sgrr) Pro Solar Supercept 718" 0.29 0.26 t 01 0.28 . 0.23 I 0 0 0 500 DOORS arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 . 0.24 I 0 I 0'0 I 0` 0.30 0.21 1°1°1°1° atlo Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 0 0 1! 0.31 = 023 a o o 0 00 Homes located everywhere EXCEPT:Arizona,Caliifortria,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. olning c Hop _per) 718" 027 -, 0.24,0 0 01 0 0.28 021 0 ®f!0 0 asement Mr Base Pm Solar Intercept • 027 024 100010 1 0.27 0.22 J o 0 1 01 o ouble-Hung 6100 Energ�r Star Pro Solar Supercept 3/4" 0.30 0.30 j 0 f 0.30 0.27 : o 010 icture Casement(No Fringe) 6100 Base Pro Solar Intercept 718" 027 0.28 0 0� 0.27 025 0 0 o 0 icture 6100 Base Pro Solar Intercept 314" 027 0.31 0 0 027 028 0 0 Panel Slider 6100 Base Pro Solar Intercept. 3/4" 0.30 - 028 o 0.30 0.27 0 Panel Slider 6100 Base Pro Solar Intercept 314" 0.30 0.29 0 0.30 : 027 I 01 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,NewMerdco,Oregon,Utah,and Washington. atio Door �p• • 6100 Energy Star Pro Solar Super Spacer 1" 028 0.26 0 0 0.23Heloro • • ;!r_tta1Z•r 6100(PD05)Base Pro Solar Intercept 314�82 0.30 r o 0 02.026 o . 6200 Homes located only in following markets:Dallas,Deriver,Detroit.Phila,Northern NJ,Long Island,NY. ening 6200 Base Pro Solar SHADE Supercept 3/4"I 027 0.25 I 0 0 I o I e 0.26 : 023 0 o 0 0 asement 6200 Base Pro Solar SHADE Supercept 3/4" 026 0.18 O o 0 0 029 : 0.17 0 0 0 0 icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4 025 021 0 0 o 0 025 0.19 0 0 0 0 icture Window ' 6200 Base Pro Solar SHADE Supercept ' 3/4" 026 ' 024 0 0 0 0 0.26 0.22 0 0 0 c Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 028 ; 023 a o o a 028 . 021 0 o b o Ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 023 0 0 0 0.28 ' 021 0 0 0 Panel Slider 6200 Base Pro Solar SHADE Supercept 314" 028 0.23 0 0 9$ 028 021 o 0 4 ,tormBreaker Plus 300VL Homes located hi coastal areas. liming SU+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 ' 023 o 0 0 0 0.26 0.21 . 0 0 0 0 asement SB+300VL Base PS/Lami Super Spacer 1" 025 . 0.23 o 0 o 0 025 ' 021 o 0 0 0 ouble Hung SB+300VL Base PSR..ami Super Spacer 1" 029 0.25 . 0 0 0 0 3 o 0 • 0 lider SB+300VL Base • PS/Lami Intercept 1• 029 ' ;025 0 0 0 0 r 0 atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 • 0.19 . 0 0 0 0 ; 0 Grids.Allowed arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 028 o 0 0.30 ' 025 10 o'o I 0 )ots indicate Energy Star certified fart at zone Pie-ase Note: Simonton Windows may substitute East&West windows given the requirements of each order. to0V,Z1NH'A Home Improvement Agreement: Page 1 Home Depot License#'s -For the most current listing visit www.Homedepot.com/LicenseNumbers MA:107774, 112785 Kyle Harmon Salesperson Name Registration#(Req.in CA,CT,ME,M1),MLNJ,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. i. Service Provider Contact Information- The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 icustomercancellationnortheast@hom MA: 107774, 112785 Phone# gggffiecnvider Email Address Service Provider License#(s) 2. Customer information • ,;‘,,, 2,, Realty Fitzgerald New England West 1-1YOEJCG5 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 41 Maple Street Florence MA 01062 Customer Address City State Zip (413) 835-5689 I fitzgeraldproperties123@gmail.com Home Phone_ Work Phone# Cell Phone# Customer Email Address z - YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING IRE 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 TILE 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 GHT TO CANCEL. Acknowledged by: 1 01/06/2022 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,DeliireryiDatellnitallatiOU Schedule ,- - - • - Approximate Start Date: 07/05/2022 Approximate Finish Date: 08/04/2022 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confinning insurance coverage of Your claim for any repair, if applicable. 7 777%, Tr" to RecordsElectronic 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 acomputer that can receive and open emails and PDF documents. 7 Contract Price and Payment Sehedule. 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: $ 5156.00 Includes all ap I licable taxes.Excludes finance charges.* Sales Tax: $ 0.00 (If applicable,total amoun z taxes included in Contract Price) *Maximum deposit ONI, e in , .2. Ij (33%),NJ, WI(99%) Deposit% 25.0 Depo!" Amount$ 1289 P emaining Balance $ 3867.00 18 Finance Charges - , Any interest payments or other financ- :- - ermined 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 madepayOle to Home Depot. 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" abo ; and(i Electronic signatures will be deemed originals for all purposes. 01/06/2022 Customer's Signature Date X /s/The Home Depot 01/06/2022 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) Lbb-/t.L3/ For any other concerns, contact The Home Depot at 1-800=46-3337 O�aw�t� �s c �; Scope of Work I Realty Fitzgerald New England West 1-1YOEJCG5 Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Infernal Reference) Products: Spec Sheets)#: Project Amount 1-1YOEJCG5 + Windows Entry Doors 1-1YOEJCG5 5156.00 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 5156.00 Notes: Units to be worked on are 39 and 43 Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: Simonton 6100 Warranty Name(s): ' f't '; The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and(III) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "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."Scope of Work"means a detailed description of work or Services to be performed, including,but not limited to, any quotes, schedules,invoices, specification sheets, proposals, confirmation emails or otherwise. "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. ! `; 1 .,!� a ...r r r ( ._ r •f� .. I ri .. r _ - -. r r r kl, , ' • t - _ q 1 _ ' - - t . .2: '... C:''.. " ' '-. ' '. . . .• ' ' i 'I 1,. E �►' � ; The Home Depot General Terms&Conditions 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.Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request,You or Home Depot may terminate this Agreement. 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 (the "Warranty Period") 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 discretion (I) correct or replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each Defect,and refund all or a proportional amount of the Contract 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 in full as provided in' this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (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 DEPOT'S 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 Y 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. • • • r r a I(- l ' W. • .. . ". /. :' . i r. ' . , r I r r I , '+ .1 4. ,I 4 1 ^l . 1 r , } I i Go Permits, LLC GO®` 105 Buttonball Lane s Glastonbury, CT 06033 !�1��7 1: . Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 (\ss444000„, scottdoughman@gopermits.org I 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@aopermits.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 mac® CERTIFICATE OF LIABILITY INSURANCE DATEOADOCFYYYYI 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 CONSTTTUTE A CONTRACT BETWEEN THE ISSUING INSURERS).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 mum: I MARSH M MA,INC. PHONE , Fax TWOA"IIANCEcEREi'T MO Nth Exit I rn2X.nte- 3560LEdOXROA7&TIE24DD, ADDPFSIr ATLANTA,GA309?6 INSUREFNIOAFFORDINDCOU'ERAnE NAOS CIO0H.C20504immD-GAVL 2t-- naralsER A:OStl Hexed;Insjaute Co 24117e M6USED INSURER®:All9PYRITO5 co 19399 THEtiCAEDEADT,I ROUE OEPOTUSA,ENC. DIMMER C:t1/7-,Rtt 4•1A®Ustan*Erattw-my 111A 2155 PACES POW ROAD INSURER o: BUILEINGC-33 MANTA,GA30359 INSURER E: INSUSERF: COVERAGES CERTIFICATE NUMBER: AdL.OW'DiZ'Stet REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQULREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHM DOCUMENT 49LTt1 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. DOR EXP LIR TYPEOFINSURANCE MID MO FOIICYNUUDEf ATECNYYYY p5IDiY YYYYY* LIMNS A X coru�RanLOEF�taLl.emuiIY tMEY3,4574 031DLED19 03012D4 EACHOCCLaxAmE a 10UCODD IC1AIr15 L1RnE X OCCUR ONFsEcB�aEs o¢IatS7ts7 8 mum X 5R 81 ODO,ODD u.PD DP;Any umre-.SIR 5EXCLUDED Fs�'7'"ONM.AA7VINJURY s 1000,003 GDR AGGREGATE LU TAF5a1E3 PER: GmE,RN AGdRECAT_ S Z500,000 POLICY dECT [IOC PROW=-OCUMP ASO S 2500,005 angs s A ALROYDDILELIAEIUW L N7B1145'i33 83a0L2019 031012D1' OsT.7-1T1�SWGLELUNT 5 1.D00,202 YEn ach X ANY AUTO SEE INSUREAI TOPMMYIY EDOlLYt UR4r erreraa) S I— alms], SCHEDULE DIMLY 1alA!RY CRT acenent. 5 AUTCOCINLY Auras �— 64T.ED —rJCPFQNA'ED FRI7PE7r7Ya.V S t—�ALTFOSCMV Amos MYtFMtnCRYJSII S UimREr.LAMB OCCUR EACHOCCURRENCE_ S — EXCESS LUG �— CUl4,Gr1 PSIS AoceaOATE S ore J J RV-LIImCtas s B WORZEDSCOEFENZATION Y1058ZtO239QA11 C/3"2321 031Dis X IPER I Igr. oame'LoYmrIA eTA,4Ac B ANY'FROFRETCRIPARTIER9ECLTDV= a v31.IS.05uatcY' [NC,vAi1 113YJL°�'d1 mt0127k2 F�.EKFIADGmr71Tr S 5,000,000 OFFICERILSUSERr YrzI men? N NIA osansatolyb lsgl C9GtS:sd4nAltipi iP3ge EL.'OrnE4.SE-EAEMPLOYEE S 5,000,000 1ry=delerx untie! DESCRIPTION OF OPERATIONS mart EL'=EASE_-MUST GLUT 5 5,500,1205 C EGOSAIQD 287110011102021 03510021 03255522 lilt 4,000,003 A Brew Gefle3l LODI51 i Idh9ISI5530 535t55 9 011411121122 Gent 8,2010 3 DESCRIPTION occe cu1ONE;OCATIONS1VEHICLES OACORDISMIDIONNUTmaits Sdmclde,vaaybeathrON Fmore come It rewrote EVIDENCEOF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOTU5A INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2955PACE5 FERRY RCAD THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED III BOOM C-20 ACCORDANCE WITH TTIEPOLICY PROVISIONS. ATLANTA,G11,3D331 of rraech WA Ino. I raacasm Mummiee 41:64.1set kA 4, GIv4G1- G 1988-2lif6 ACORD CORPORATION.AN rights reserved. ACORD 25(2016103) The ACORD name and logo are registered mans of ACORD I I AGENCY CUSTOMER ID: CN101642O68 LOC 0_ Atlanta -----"'""Na• A aRO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NA{EDGRIMED UARSHUM',NC. ME HOME ms'PDT INC. • NONE DERN LISA,QJC. POLICY NURSER 2455 PACES FERRI'ROAD BUILRING C-211 ATEANTA,GA30339 CARRER NA1CCCUE EITEC76YEOATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM 11111.E: Certificate of liability Insurance Warms CranpunsekrttecErm.4: Cania:IndenrrtyI6rur s=C orrery ofNmlhrirraon Porzy Model:MLR C67 ICTLIAFIALA,KSAIEPS yd`ENNACIN,M,SEA,TNILW,12YI Eiktinre h=03D1r2Int }I33,aaunnm CanirALF hmven:e Co_ Pcice um:ecY1CW. 50.03 C IaCC HI A`a7',4A7,IyS.h'ir 9f7YA911) • Gi,B.e110 1/3111.12t &O fa l Dees 0.31:1112= Carrie ACED—..te an hearerazecrivzny PacylWm);er:'N1CCCtT LI5331[031 q>?,GR li �r • 13s1:131111r2LCE Egiiefce C 039U (E)Ei-dt$S,DOD,fY Sffi-S1.1MIE6 CsrisNe6a�Dim Fis6eurzra CaT9arrn CII:,.6a Ca)E03iO1rlIIS EgfreEcri Da'e D3r01e2 (ELI Fin/ SIR:SISIODpD0 CaniyACE Isreri anInnceCcmpeny Poky Parkr:INIJI 57BtM1a[t2} ElierEweCefE03O102I Erinefcn Coln 0.a01 (EL]'Lice Sump) CanixNn&rs1 Nan Fee trarr✓7seC , Poky 9dum tX9S01t37 C (ESA E eD .031)1Pr�2t Ei$fcn CE1E D3101 U22 (EL)EcJ} t,EDVX1 SI $300,000 B7CEnclyets7S Cerris.EEriv Urfa!6erearceCanp ny PctryN mferTNSC5Sfli T2 Efeeris Celt 03A1i_02t EepaaEcn SalE03OU2022 (EL)Lint SiD;O ,m SDi S1 ockr'o ACORD 10f(2008101) 02008 ACORD CORPORATION_Alf tights reserved. The ACORD name and logo are reins' tared masks 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 Reg piratin: 12765 Expiration: 0 BOX 105451 ation: 0d122/2023 ATTN: LICENSE MGMT TEAM ATLANTA.GA 30348 Update Address and Return Card. Dios of Commas'Affairs i iusfmss Nu Whore HOME IMPROVEMENT CONTRACTOR Regisbrtfon valid for Individual use only, TYPE:Supplement Cant before the expiration date. If found return to: Reatilailea Madman Office of Consumer AM,!ra end SuMInssa Regulation 112785 04f72J2023 1000 WeshIngton Street -Suite 710 HOME DEPOT USA INC Boston,MA 02118 2455 PACES FERRY RD 0.11 HSC £epo"d&•4.4' t ATLANTA.GA 30339 Undersecretary at valid with signature ...........as EX1ENEIR-01 MAJWE .a WRLY CERTIFICATE OF LIABILITY INSURANCE . BA>�tR IVrwl � 7/30/2021 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 DETWEEN THE ISSUING INSURER(S).ADTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)roust 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 moor Deborah Marino BM Canary� 5� r .mo=(413)750-0022 FAX 786-T004� �t Feeding Ms,MA 01030 .r,r-cg.dmarinOf Canaryb!OmStrom.COtit INSUREDS)AFFORDING COVERAGE MCC 8 INSURER A:NGM Insurance Co. INSURED wsvHERs_Arasociated Employers Insurance Company 11104 Exterior Remodeling Group Inc. INSURER C: 23 Benham St INSURERD: • Springfield,MA 01109 INSURERS: INSUCERF: ,,COVERAGES CERTIFICATE-NUM ' REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE DIMMED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREILENT,TERM OR CONDI111ORI OF ANY COWR/1CTCR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSIJUJECTTO ALL TiHETERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. MR rADDL SUER MUM EFF POLICY EXP UR TYPE OF INSURANCE KM TRW MOM =moryYYgD errry n Lance A X coeituRCrALGENERAL!MEIUIY { 1,000,000 EocwcCc�ltl&E s IOInIL+sue n &fPP3376W 1 7t27/2021 17/27/20g DaarACETorz�rttED 500000 PFNERttSEal�,7nav43,„" s , f.SIIt�xP rL a Ir+crarsatlt S 10,000 PERSONALaP+va�efmlaY S 1,000,000 GEM KODREGATELOSITAPPLIES PER GIEVERAL AGGREGATE S 2,800.000 POLICY 0 ga ❑ e P oouns-CM IP.v7P Ana; S 2z000,000 OTHER: S A ,AUrou�BEUAearrY MIcB 1tBIraGLEuwr + S 1,000,000 AHY AUTO MPP3376W 7/27/2021 7/2112022 aamLynuugy mormscro s — '--OOHED SCHEMED AUTOS G x ONLY AMOS BOOLVIIOURYl ardtHEEi S X iLLl�1 EOHLY X At ffaiI PFin a lmlilairF f Occ'TY ctvJtY;tl S S 11 UI.ERELLAME OCCUR EACIMCCURRRICE $ EXCESS UM ri aPtcadiHE AtvDREOATE $ • DED I IRIS g t cin ago Fir MID I STATUTE I ER LNE s vON crA WCC-500-5021510 2021A 1i1712021 1117f2022 Eil EL EACH ACCIDENT 5 - - - 500,000 EL DISEASE-EA EMPLOYEES 500,000 Ihrec.danatbrif ands 500o00 lDE CRIFnDN OF OPERATIONS Caw EL DISEASE-MOW LDSir S DESCAIPoONC C:MR=T1DxSr LOCATIONS MIMES(ACORD ffi9.4.S9t'lmltiRamse@c SchiddemayDaalra¢llecIloonspace Lssatiti Horne Deport U.S.A.Inc.Is named as Additional Insured with respects to General!Malty CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THE ADO'E DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION WILL BE DELIVERED Home Depot U.SAInc ACCOR EWowHEOLICYRISNS 2455 Paces Ferry Rd C-11 Atlanta,GA 30339 , AUTHORIZED REPRESENTATIVE /l I it,ftfah,//laiiiiI, ACORD 25(2016103) 01958 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ._ MASSACHUSETTS / DRIV;IS - -_ 7. -v;;; - ;. LICENSE ii- -- r. -• „.;1i.'::•:,,.4..':.U:11,,.: •:::- 'ti5 ,.=City,' A R•� y„.?-t-.,..•... J�,� O(/ o ({ { /{p,i�y�'�:,_:. L' :' Vi z.y s' :. n1/2,4,_ rf2gW ;•l ;ti. .-.. ,,, vi i ce- Y sa-a •. t t.' . t r• S• . �{ $fit• •:`'•� "� '•� - .1 P 4.:n rlr.y, ,-ZEUGENIU. ''a ,{{1 y t . ..{ . .-. '-. t4kt;,l ENIIAI>tSIREEr.. .�•': _ ^.i :1 :- . •A I0431140 [iiivbraitSS. 0912E t Gcammonwealtii or fay adhusetts Division of•ProfessionalLice sure = Board 'of Building ;Regulations and Standard'. CCotisti"Ucti`on:S ipr t' ` s.. r S ecialtyi {' ' 1- .. a. I'.- ; Expires: 09f29;12022` G :SL. 1QC?1UG I E£UGENIU CIEBOTARU r - 23:BENHAM STREETtµ " s~~ ' , SPRINGFIELDAVIA 01109, `, : - ~ l , -ornrnissioner . la, ,a k;: 3 -0 .,; { 1 Construction-`Su rvisor.s specialty Restricted to CSSL WS Windows Ind.Siding - • k Fad tire to possess,a current�-edition�:of the Massachusetts ., State Building;-Code rs cause,for revocation of this frlic"ense ,•- . For information about this license Call (6171,1174200 or visit www.rrraas govfdpl Office of Consumer Affairs and Business Regulation 1000 Washington Street•Suite 710 Boston,Massaehu<.etts 02118 Homo improvement Contractor Registration Typa' Cnr�at.Jiara E\Tt~3rcR semocEt,N7oupcup,!i\C t;!alSirlttm,. 1 B7r7ry DE1id}.<;,7 Er`:lipi`ti'n: ,75L30"t{t:i SPRtXaF LD.:t4 C11* Upealc Mdrtu ar4 R111.1tti Card. oft“ Cenrsna. rat n.,,afar', IC E IG?iOYf1I1947 CCITIA AC f . r=ipfi arr inOvAtul upyntr TifPE:Cxtte' R1fc,e lMtOn'-r,/lCatl.ftkoalJ ndun tC PatellareM Unit/rim Cor.cro&Callavc.Malts urrlwmnem;ION Ufian en:1RL rk5.y.c5:3 1:44>A'san4+g1at1 OL•11•9Wtt:7le rttrEFIOR K1.t2:2E1.CiX,ICI P(IC rt,71c11%MA anti 23EENHAtiIO iucOinFU ! y •I--�-- N sr S.I1a2r.G11 Iqa C7 f:u inge en:a� kW valid wrlhoit siggiwtU e i_ diG nco au.g6b5„.v.0 atltilorizeGo Permits LLC•to pun permits using Pe my US License# IN 106 and my HIC Registration# j$3 666 ;, 4::cstions please call meat: �-{ 3 J`` o insliier t.,ompany Nan', EX .C'��o R t e v to G g oup r