Loading...
31A-286 (5) BP-2022-0892 101 WASHINGTON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-286-001 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-2022-0892 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 10837 HOME DEPOT USA INC CSSL098785 Const.Class: Exp.Date:04/27/2024 Use Group: Owner: MIKEY TOLEDANO Lot Size (sq.ft.) Zoning: URB Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-4112 WC 06588608(AOS) ATLANTA, GA 30339 ISSUED ON:07/28/2022 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: V � / . '1 • II Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner -., fi"^/ `..': Department use only City of Northarrpton ' t4hisa of Permit: Building Depanme ✓u/ Curb•.Cut/Driveway Permit 212 Main Street/ 44 2 7 lnBewer/ eptic Availability ¢". -water ell Availability Room 100 �, Northampton, MA 010etre1n/ Two ets of Structural Plans phone 413-587-1240 Fax 413=51 2 fi^sP . rp ite Plans 4°jr'�thlNg.Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office /O O✓4..5_// / / // 4U C Map 4 Lot r 'T Unit /U0/ ott4 /C411 A ll D/06 a Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ali ktti % le((a tA o /4/ 0._____e3 !/e,h%4 9/►i) 1Zw /O4a`r/ I Name(Pr ) Currg fddL p/UbI ,,.? Sq - 9'Y - cbJ Gyi) Telephone Signat e 2.2 Authorized Agent:/ / (/ C c/ C . C 1 1'a�(/Y J "I- /O{ L4104 b411 64 AA- el afh � CT Nam (Print Current Mailing Address: 06033 C ?---' ,e-6a - SSz - y, t 7-- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) lcd 5. Fire Protection 6. Total=(1 +2+3+4+5) l /0) 839. 00 Check Number 37ge 7 This Section For Official Use Only Building Permit Number: aPY�� - s,9 Date sued: Signature: /%2 7- 28 ZOZZ 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 L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding r 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 ry of Deeds? NO 0 DON'T KNOW ( YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES ® NO Cr 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 LJ IF YES, describe size, type and location: E. VAiiI the construction activity disturb(clearing,grading,exca on,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® 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 ows Alteration(s) n Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs ED] Decks [0 Siding[CI] Other[o] Brief DeAription of Proposed Work: 12 VIZJ.e., ck,.tid Mr 61c e l2 w;A.A.).4/Sjt k.c -4?,•"-Irikc. /Like)k6 "1 ,S ..--e c L Alteration of existing bedroom Yes No Adding new bedroom Yes Noarc- Attached Narrative Renovating unfinished basement Yes V No , 3o 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 OWNE�RS1 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT /)i I, i AL j -(5 le clkna ,as Owner of the subject property /� hereby authorize M in.Q J) / (4SA Tr.e.y T C9 f 6mode1//� to act on# behalf,in al rs rela a to work auth d b /is bui permit application. ��JJ ) Signat"'of Own f ' Date Z'L I, 6 e l C/ G' Cra ' ✓ ,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. &rai1 v a/nfer �/1— Print Name /C44"71) Signat Owner/A ent CCri Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: VYL� k o S o ti C 55 t- - 098 '-S ,,�1 License Number aso/� It 1 07 a4- q/2.117i`/ Addr s Expiration Date / 9/3- ( -67°6 i ture w V Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 (,".e Dap,I- use /1 Z. Company Name V Registration Number / 6A go 3 3 9 a&I Address ✓ Expiration Date Telephone giej0 - Z, y/t 2- 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 t 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 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" rtifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,Stat Loc Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature (-- /-1 e+xJ 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: / / MaJ A/1,44 //`''t► Nor 7 'o icy o The debris will be transported by: -i jJ e o bey y The debris will be received by: ro-a- 0,2,04 ut,s G Building permit number: Name of Permit Applicant 6Crq/1 C C . Cra / 1/t- Date Signature of Permit Applicant City of Northampton sS r ' .C�',. Massachusetts 4� I Ir � DEPARTMENT OF BUILDING INSPECTIONS Z *t.' 212 Main Street • Municipal Building 4.`b' q..x� Northampton, MA 01060 ESN ,.ATD CN 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 hpme 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 insp ctions are made / I, `JGw1 understand the above. (Home owner residen signa a equesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Z Z Address of work location to/ ,S /1/90 4v'-e444, A/• a� ") MA O/OIL The (o,nnu,nwealt/i ref_flas-sack uKtts • Department of Industrial.1ccidents t '` Office of Investigations i., Lafat•ette Citr Center 2.avenue de Lafayette. Boston. .‘1.-1 02111-1 750 Workers"Compensation Insurance.1ffida►it: Builders/'Contractors Electrician% Plumbers _1.ppliaant Information Please 1'rint Legihls Ndre ttit..+tun7el.hy,Atimiettaxi inch ridwi►:HOME DEPOT USA Address:24' -,:2-ES FERRY RC ('its Stag lip: ti'Lr"i iTA. GA 30339 Phonc -&60-95 .\re sou an empluser" ('heck the appropriate boy: t pe of project(required)- ]. 1 am a employer with 4. ; 1 am a general contractor and 1 employees!foil anti nr;urt-tinicl.• has hired the soh-cuntrartors t'_ New construction _ t am a,...! rr.rrrt.:�r or t+ictn,rr- listed on the attached sheet. 7, ;Itcmodehnr ship and base no crripltryce:s 1lxsesub-contractors has, h_ Ucmo9ition working tor rive in ai, i.a(Eacits r¢nE+lo�i-�-s and hat workers 9. Building adefit \o norLr`' ii rn insurance rcomp.. insurance.. _. 4, %* are:t+ctT tratiun arid its 1t1.. .il repairs or adtittt+.�n> required.' � � _ I.leetr-Ee officers cers hate exercised their 11_ Plumbing or additions. i am i hC�mci�tirtkr.futm+ all ours: nia.set1 f 10 workers' comp. right of exemption per 11i;1. i_'. i{, ifi =;crr,.t insurance re uir+-ti. C. 15 §1141.aiid ;�r hate no • *i 13►.� -TLhcf _ employees. 1No worker.; comp. insurance reouired.1 •Am.atrba.:anEr itaat ncCcks l t' 'E mac+t itx a hit,wi1 Uri+cRt<rt.1'ck s c!s h Graz that w ori;as'rormta:-n+.x:urr,w, ter,•ant n Ii.rre,..-ka'.nrr.who.sialtrort this atI.da.EA ttti<ivaiGau ilia a.doing ilt ' ri anJ that hire oast rr:h.rttra..'r-ram.[sah+nui i rut%ai tid.is t ande roar.mkt +.+ntri:ecr+that check ihts box mresi atia hal ai atishumal 41.cci 7low,we the now G'i yeti sub iaaEtr ,.•h s Mai e!stc whither kW Ea.+s ethesc rerun.+Fin:: :-.-.-� _ ::L'1- �. , ,. t,.,.. ,._ -:.4GGt,' p.R9u}es-�snt•.z I am an employer that is providing w•nrAers•compensation insurance for my enip/ni'eer•,. Below is the policy and job site in insurance t.cimpany \a.me:AI i.1 Insurance.Co- or 065886028 AOSN . ,:t, folic err Self-ins. Lie,M` I xpiration 1)at� =i Job Site Address-. /o/ WaJ Il tnaj ✓) 4vEG/Z„e..— Cif:State lip / ' t/'44r t o' ✓ 0/060 Attach a cups of the in urkers' compensation policy declaration page tshoninrg,the peTlit s numhrr and rapi,tioe date,. 1 atlure to seiuire cos crape as required under fiction. A tit M(,L t:. 152 can lead i'.. tJC krtipo 1th)n i+t Criminal penalties of a tine up to 1.44►1.1_410 and or one-year imprisonment. as ucil penalties in the term of a SE(PP tilt)[fps OR1)I.1t and a tine of up to]2{tl.ik,1 a day against the iiolator. fir adh tcd that.i cop, of this statement ma 'he tot-warded to the Office of 1n.estigations of the 1)I:t for insurance cuseragc %critii: on. I do hereby certify under the pains and penalties of per,uri that the inhumation provided above is true and r,rre:t_ Signature: _ � _ _. .-. Date: - Z a-- ao as Phone 860-952-4112 Official use only. Do not write in this area. to he e rnipie ted by city or town.official ('its or town: i'rrmit t.ki rise Issuing luthorit (.check one,: 1 1.._-1Buard of Health 2jBuilding Department 31_it its/Tone Clerk 4.DUcctrical Inspector 5. •lutnbin+g Inspector b.JOther ( (Intact Person: I'lirtnt OCI >r Go Permits,LLC PERMIPERMITS 105 Buttonball Lane TS Glastonbury, CT 06033 ,0400. Scott Doughman Phone:860-952-4112 Fax:860-430-6719 scottdoughma n@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#: 1.209D4HXA Sheet: 1 of 2 Customer: Mikey Toledano Job#:1.20904HXA Consultant: Kyle Harmon Date: 07/25/2022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right --- Bays,Bows Location Color Rough Opening 4 of bars 4 of bars Csmnts,1 Pnl, use L,R or S Glees Misc Items Hardware code Screens For doors use 55 ;Q 8 Mull "s"=stationary or Style Wrapsf Y I ,� At „X"=operating S e Q & 25 Room Floor Code (Y/N) Style Code Series Code 1: w 5 t 5 l-co o. 3 > 2 > 2 STD,White, GlassPack: LSR 1 GAME 1st SH-A N DH 8100 WH WH 35 45 80 6100-Energy Star- Northern STD,White, GlassPack: LSR 2 GAME 1st SH-A N DH 6100 WH WH 35 46 80 6100-Energy Star- Northern STD,White, GlassPack: LSR 3 EXER 1st SH-A N DH 8100 WH WH 33 60 93 6100-Energy Star- Northern STD,White, GlassPack: LSR 4 LAUN 1st SH-A N DH 8100 WH WH 33 60 93 8100-Energy Star- Northern STD,White,TMP: WRAP,LSR 5 BATH 2nd SH-A V OH 8100 WH WH 33 60 93 Bottom, GlassPack: 8100-Energy Star- Northern STD,White, GlassPack: WRAP,LSR 6 STUDY 2nd SH-A Y DH 6100 WH WH 33 80 93 6100-Energy Star- Northern STD,White, GlassPack: WRAP,LSR 7 MBED 2nd SH-A Y OH 8100 WH WH 33 80 93 6100-Energy Star- Northern STD,White, GlassPack: WRAP,LSR 8 MBED 2nd SH-A V OH 6100 WH WH 33 60 93 6100-Energy Star- Northern SPECIAL CONSIDERATIONS: 5:White,8:White,7:White,8:White Line Level Notes: 1.00 NOT WRAP ANY WINDOWS 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-Whtte Plonks,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1.209D4HXA Sheet: 2 of 2 Customer: Mikey Toledano Job#:1-209D4HXA Consultant: Kyle Harmon Date: 07/25/2022 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 Aof bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use $ Mull "S"=stationary or g Style Wraps ;� t _ g t "X„=operating Room Floor Code (Y/N) Style Code Series Code E w 3 = S H ui U tad 5 > > STD,White, GlassPack: LSR 9 BONUS 2nd SH-A N DH 6100 WH WH 33 60 93 6100-Energy Star- Northern STD,White, GlassPack: LSR 10 BED1 2nd SH-A N DH 8100 WH WH 33 60 93 6100-Energy Star- Northern STD,White,TMP:Full, LSR 11 MBATH 2nd SH-A N DH 6100 WH WH 33 60 93 GlassPack:6100- Energy Star-Northern STD,White, GlassPack. LSR 12 BONUS 2nd SH-A N DH 6100 WH WH 24 48 72 6100-Energy Star- Northern SPECIAL CONSIDERATIONS: 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(OR,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,Birth or Oak) e •ome Bepo - erma 7a ue o • ro. ucts Manufactured by Simonton Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC 3 (all with Argon) Fact Fact 6500 wring 6500 Base ProSolar Supercept 7/8" 0.26 0.23. • • • 0.26 0.21 • • • asement 6500 Base ProSolar Supercept 7/8" 026 0.24 • • • • 0.26 0.22 • • e • ransom 6500 Base ProSolar Supercept 1' 027 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 • • • • icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 0.27 026 • • Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 023 0 • • Panel Sliders 6500 Base Is 21 So) Pro Solar Supercept 7/8" 0.29 0.26 ' a 0.28 0.23 ' m 1 0 v ,500 DOORS iarden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 10.30 0.24 I•I•I •I•10.30 0.21 I•I •I•I I. atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • 0.31 0.23 • • • • 1 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. wning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 •l 0 0 0 10.28 0.21 I o •I• • asement 6100 Base Pro Solar intercept 7/8" 0.27 0.24 • • • • • • • • rblibie-Hung 6100 Energy Star Pro Solar Supercept 3�i " ..0.30)0.30 • 0.30 0.27 • • • ictuure Casement(No►4nge) 6100 Base Pro Solar Intercept 7/8" 0.27 028 • • 0.27 0.25 • • 0 • icture 6100 Base Pro Solar Intercept 3/4" 027 0.31 • • 0.27 0.28 • • Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • _ 0.30 0.27 • Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 •) 0.30 0.27 I e 10 0 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 • • if 0.28 0.23 I•I o I • • atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 0.28 0.26 • • I 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. wning _ 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 • • • • 0.26 0.23 • o • 0 asement 6200 Base Pro Solar SHADE Superoept 3/4" 0.26 0.18 • • • • 0.29 0.17 (soap icture Casement-NH 6200 Base Pro Solar SHADE Superoept 3/4" 0.25 0.21 • • • _• 0.25 0.19 • • • o icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 026 0.24 • • • • 0.26 0.22 0 o • m Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • • 0.28 0.21 • • • ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • 0.28 021 • • • Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 o •_ 0.28 0.21 • 0 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 • • • • 0.25 021 • • • • ouble Hung SB+300VL Base PS/Lami Super Spacer 1' 0.29 0.25 • • • • 0.29 023 • • • • lider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 • • • a 029 0.23 • 0 • • 0- atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 • •~ ,arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • • 0.30 0-25 • • • • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. ` ,* 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,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 )customercancellationnortheast@hom MA: 107774, 112785 J Phone# gg i°cecPvider Email Address Service Provider License#(s) 2. Customer Information Toledano 1 Mikey New England West 1-209D4HXA Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 101 Washington Avenue Northampton IMA 11 01060 Customer Address City State Zip I (347) 992-4861 I Imikeytoledano@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 ACKNOW EDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE O HT TO L. Acknowledged by: I 07/25/2022 Customer's Signature Date pµ� Home Improvement Agreement: Page 2 tee 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: (01/21/2023 ] Approximate Finish Date: IO2/20/2023 I 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: $ [10837.36 -1 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applic , total amount of taxes included in Contract Price) "'Maximum rn deposit ONLY appl c:ca e in l' 2 ME (33%), NJ, WI(99%) Deposit% 25.0 Deposit Amount $ 127°9-35 maining Balance $ 8128 01 8. Finance Charges Any interest payments or other finance charges be determi by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, an e 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. 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 pers n listed as"Customer" above; and (iv)Electronic signatures will be deemed originals for all purposes. X[ - 07/25/2022 Customer's Signature Date X /s/The Home Depot 07/25/2022 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) Lab-/us/ For any other concerns, contact The Home Depot at 1-800-466-3337 Scope of Work ►!Il"+ Toledano Mikey New England West 1-209D4HXA Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Internal Reference) Products: Spec Sheet(s)#: Project Amount 1-209D4HXA Windows Entry Doors 1-209D4HXA 10837.36 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 10837.36 Notes: No wraps 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): 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. � `(ZiklitArThe 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 all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encoun ring conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Servi s, 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 void if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies y materials or Services provided under this Agreement; or (2) You fail to pay Home Depot in full as rovided 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 W S PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS ARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE R GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNES OF PURPOSE, WARRANTY OF MERCHANTABILITY,OR ANY OTHER ORAL,EXPRESS OR IMPLIED ARRANTIES. HOME DEPOTS EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUS BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARF/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS, MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO Y•U, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY D u; CT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU ; WARRANTY CLAIMS AGAINST MANUFACTURERS.(c)Limitation on Damages.Home Depot will not i,e liable to YOU for indirect,incidental, special, punitive or consequential damages RESULTING FROM PERF I RMANCE 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 of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termi ation. The Home Depot General Terms & Conditions 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. 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 Contract 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 Contract 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 Scott boughman 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.-AIU Insurance Co. Policy WC 065886028 (AOS) (MA) Exp. 3/1/23 Ivan Kosobutskyy D/B/A I & I Remodeling is the sub-contractor. #CSSL-098785 Exp. 4/27/24 / HIC#152379 Exp. 8/22/22 Workers Comp. —Atlantic Charter Insurance Company#WCV01468902 Exp. 11/13/22 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 ACORe HATE illINDONTYY} CERTIFICATE OF LIABILITY INSURANCE 02.732J71 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the certificate holder le an ADDITIONAL INSURED,the policy(tes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED.subfect to the terms and ce ndlbons of the policy,certain policies may require an endorsement- A statement on this certificate does not confer rights to the certiNcate holder In Neu of such endorsemengs). ���� CONTACT MARSH USA.NC PANE PHONE TY O ALLIANCE CENTER LAY. F.I I AC.No I. 3561)LENOX.ROAD.SUITE 2400 EMAIL AbOREAS ATLANTA GA 30326 INSUREINI1 AFFORD,*COVERAGE MARC• C'r 1C 642809#4 (}GAW.-71-25 elsUNER A:Oil ReOUNIC Ita...M C!CO 241.7 INSUREDTHE HOE DEPOT,INC. •IaURER II:Nes Hemnf a IliCn 2 1 NOSE DEPOT U:SA.INC. ,snsR1ER C:ACE AJnefvan I'iwerce Corueri ZE67 2455 PACES FERRY ROAD INSURER 0 BUILDING C-20 ATLANTA GA 30339 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: ATL-035072225-07 REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES OESCRt8ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Of SUCH POLICIES.LASTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AODUSLIND TMR TYPE OF INSURANCEPGLCr RUINERPOUCY EFF POLICY ESP LEA A GINDOYYYri etrOOIVITI • % ComeitCwLoeaRALUus.IrY MWZY316648 D 01r2022 01912025 EACH OCCURRENCE f 1,3CD000 CLAIM Aric n OCCUR PREMISE R RAISE s LEa os T® 1600,300 PREMI8E6lEa xwrt�nc•1 $ X SR 51.000 COO HI W ED E ($r one preunj f EXCLUDED •PERSONAL I MN INJURY f 1,XXI DOC CEM-L AGGREGATE UNIT APPLIES PER GENERAL AGGREGATE _f 2.,XO000 X POLICYQ 7ERgElLOC PRODUCTS-COMPOPAuG f 2.X30.006 .�...OTHER. I. A ALRONOae.EUAGIUTY MWTB316649 BM'2)2 Gill2225 CORNED FINGLE LINT I I.000,000 .5 ANY AUTO BODILY INAURY I,PW parsec) t ' ONTIED SCHEDULED SELF INSURED AVID PRY DING BODILY INJURY?Per asoNn1° i AUTOS ONLY AUTOS HIRE D ED tocrc 4ANED FRoPEATY CAIAAGE f y^ AUTOS ONLY AUTOS ONLY �.Yam . f A wtBRELtAUAa % 'occ, MWZX31664 D0t2071 4UC72C 3 EE[HOcruRREHGE I 13.COtt000 X EXCESS LAB �—II CLANS-BLADE AGGREGATE f 19.01X.CCC COO L I RETEHTDDH I f S WORKERS COLMENSAT1oN WC 3113M61329 Tall 03C12072 31012023 x [PER I OTH- ChD EMPLOYERS'LIABILITYYPROPRE TOR�FAR AECUTIVE rJ N WLR C6*3916439 AZ,LL) 03S1�20n MCt.'2023 ^E EACH ACCIDENT 'f 5.000.00C CFFICER�nEL�REXCLuOED7 NIA (Lm bry r IN) E L.DISEASE-EA EMPLOYEE,f 50 3.000 If R *mutt undp ' P CtlelirX (DESCRIPTION OF OPERATIONS Pao. ie Maw*! •ye E L.DISEASE-POLICY LINT I S,CfA.0G0 II I oreauto noN OF OPERATIONS!LOCATIONS t VEHICLES WCORD tel.AdeNefNP Ilomadins ewuae.Rae M NINON I m .space Is MEIIMeA E IIJENCE Or NSURANCE CERTIFICATE HOLDER CANCELLATION HONE DEPOT USA,NC SHOULD ANY OF THE ABOVE DESCR5SED POLICIES BE CANCELLED BEFORE 2456 PIKES FERRY ROAD TtiE EXPIRATION DATE THEREOF. NOTICE WILL U DELIVERED N BUILDING C-20 ACCORDANCE NRTH THE POLICY PROVISIONS. ATLANTA,GA 33339 AUTHORIZED REPRESENTATIVE I 4..54 S Vnse ©(SIN-2016 ACORD CORPORATION- AN rights reserved. ACCORD2S(2011103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC 1: Atlanta ACO ADDITIONAL REMARKS SCHEDULE Page 2 of AOENCY NAMED VIOURED MARS0 LISA NC THE ACNE DEPOT.NC HOME DEPOT U.SA.NC. POescY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 ATLANTA.GA 3 339 CAIOLE1 NAIC CODE EFFECTIVE GATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: Certificate of Liahitlty Insurance 'Mows C o-cermI an Ca^rue. Garner inee•-nty t-,s.ran:e Cory at hare)Merry %VI ka'tV..'N:RDA+'IB3IADs!IALAKFLIQl41LS,1(Y;UUisiio CNEMANDOL.SCSDTNNAWAW WY;. Mum Cate'Jf'2C22 Caprice OWE 11'31.2C23 al Last SS00G000 Caner A:U Namara*Ca �crlUriber VICWe I.A0SI WinorgE14.01.104IDIE14%.MTNHPJNY,PAR fr) MO*OM.0101222 EiprilanC•r:3301=23 (ELI Lime.ISOM D 0 Camer ACE Amevicen r.srroe Camaery Pa cf,Water-'Wt J CE8916145 oCtS1i rZA DR INAI Elkcaae Ca*,31012C22 Eat/calm Darr.rC.&91 2s ELS L .S1.OX aA SIR$1.03C.Xe Came Niue/Union fie Imarm+.CaaeWatl Rip N,nter Mt 161772310S1)ICT,GAIN,PA.0H1ITl EfiNsm oar:3241+21322 Espalier Dar.I3.312023 (ELI tat S1032.X0 SIRS4i00.1f0 SIR ICTFS330 00C SIR IGA(17540: TX Endows%S haer ii C marilaacs LYron insamx C ry Pilty Winter TN9:669910Lt (T)Li Moro Da!d3A14222 EapaaIsn Dmr 31.012023 ELI Unit 8i000,3C0 SIR SSA00400 ACORD 101(200e101) 0 2001 ACORD CORPORATION. All rights reserved. The ACORD name and logo are regieMred 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 Rewatration: 112785 HOME DEPOT USA INC Expiration: 04/22/2023 P O BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. osac.of Consumer/Weirs a wain«*Reauistson HOW IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SJooternenl Cans before the expiration date. If found return to: RINOMICK1Exo4ri inn Office of Consumer Affairs and Business Repulsion 112785 04t2212023 1000 Washington Street -Suits T111 -HOME DEPOT USA INC Boston,MA 02115 RICHARD OLMSTEAD 2455 PACES FERRY RD C•11 HSC L.40*"r' ATL NTA,GA 30339 undersecretaryvalkl Wtthou signature Ac ve CERTIFICATE OF LIABILITY INSURANCE DATE DIMroD"""' `../" 1111U/202i 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 INSURERS).AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the carriAcate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. tt SUBROGATION IS WANED.subject to the terms and conditions of the policy.certain policies may require an endorsement. A statement on hhls certificate does not corder rights to the certificate holder In Neu of such endorsementts). PRODUCER COIrrACr iamsn Greylock Insurance Agency RARE_ o E Mary R�r fa PO Box fiO3 „, 413-129-6090 I IN moi.A 13-568.6 708 Pittsfield MA 01202-0603 ADDREEM mbereamlnearevIeck.orq INtURERDS AFFORDING COVERAGE NAIC s LiN enxtr.1 dy3779,INSURER A.ADannc Charter Insurance Co. 44326 aisumD Iv ANKOS-Ct mown a. Man Kosobutskyy trams c. 72 Stafford Rd Monson MA 01057 INSURER D. INSURER E MENSER F. COVERAGES CERTIFICATE NUMBER:25176358 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCWSIONS AND CONDITIONS OF SUCH POLICIES OMITS SHOWS/MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE JIVO POLICYNUlBI awielannIYIn AdOO'YYYYt, LaaTI COIaBICNAL GEERAL LNAMIJMY EACH OCCURRENCE S DANNCUUMS-MADE ED OCOJR PRESAGES Ea OU%T PAEMtSES tEa aaurranoei $ MED EIS Art,area Amon; $ ^_ PER:NALa ADV INJURY S GENL AGGREGATE LAST APPLIES PER. GENERAL AGGREGATE S PCUCY0 0u.,R PRODUCTS-CDaNR�OP AOG i OTHER S AUTOYDOLE NAWRY CCMBIED SINGLE UNIT S ANY AUTO BODILY INAIRY iPar parlm) S QEED SCHEDULED BODILY WARTY Mar au.hnt; S .....,AUTOS bD ONLY AUTOS CH PROPERTY DAraAD.E AUTOS OY � AUTOS OILY ,i�a[acrdret S IL a UMBRELLA LAB _J OCCIR EACH OCCURRENCE $ •— EXCESS UAB -MADE AGGREGATE S DEC [ 1 RETENTaONS .- A WORKERS COMPENSATION WCV0148S802 I inS2021 11/131022 }I I Fsl:jITE I HP' AND EMPLOYERS LABLSTY FFP R TO R AATNEI � Y0 MfA EL EACH ACCIDENT S 100.000 Mandatory M MIN E L DISEASE-EA EPAPLOYEE,S 100,000 I!vo.marsh undb DESCRIPTOR JON OF OPERATIONS bate E L DISEASE-POLICY LSAT S 500.000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES WORD 101,Atl INANl RaNwaAs BURMA&may 0a amaeAN I mow sown Y CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED II ACCORDANCE WITH THE POLICY PROVISIONS. THD At-Home Services Inc 2590 Cumberland Parkway I1300 Atlanta GA 30339 Al ITfY7I7F11I t FPOIFIS TATTOr I C11188-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(201003) The ACORD name and logo are registered marks of ACORD .-�^'40 IVANKOS-01 Qum ACORO CERTIFICATE OF LIABILITY INSURANCE Sian 2os�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 AMEN. 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 N an ADDITIONAL INSURED,the poticy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain polcies may require an endorsement A statement on this certificate does not confer Hafts to the certificate holder In lieu of such endorsemenl(sl. PRODUCER CONTACT HUB international New England %PHDUE FAX 1070 Suffield St c N>,.Erc.(800)2t3 8134 1 am,am(413)731-9S3Suffield Agawam.MA 01001 , INSUREAIs1 AFFORDING COVERAGE NAIL s eiteeERA Oho Second!Insurance Conioap/ 24082 INSURED NeueF44 Commerce Insurance Company 34754 Ivan Kosobutskyy swim c. I A I Remodeling 72 Stafford Rd MONIERD Monson..MA 01057 INSURER E Na1NER f J COVERAGES CISTWICATE NINNEft REVISION NUIMSER_ THIS is TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �+nR TYPE OF INSURANCE 01004FIUSS AND AND, POLICY NUMBER POUCreasioarryn► I UNITS A X�COBa®ICNL G sera&immure. 1,000.000 F d"H� RF79CE Y I CLAIMS-MACE E3 OCCUR X BXSSBS3S7s2 511512021 $11512a22 P °.t,,.a s 300.000 MED DIP:Aar:un.PAMPA I 15.000 PERSONAL b ADY NARY I 1,000.000 .---• AGGRE TE�pL�S�AAI.APPLES PER . GEl�1cesi.AGGREGATE t �'� zOL1CY JEC1 Ei LO[. PRODIJ TS-CCUPOP ADG t 2.000.O0C OTHER i El AUTOMOSIX LIAR COMBINED SINGLE UNIT l ..iLEA ity;;e;1]liL ANY AUTO BBCRLL ef2812021 e/2e12022 aooILY IN.uRY(pm L"6'm5";.$ 100.000 —OARED XO•S €DUtEO WOO `..,•I AUTOS ONLY AUTOS BODILY MAIM Ply A:C11e011 i X u' ONLY x 17.9 r Mtn DAMAGEt 100,000 i _ LY UMBRELLA LAB .� � iiOO R EACkt OCCURRENCE i EXCESS AS E O_ADES.4A4DE AGGREGATE i '. OED I 1 RETENTION1 i WORKERS AND EMPLOYERS LIA COMPENSATION I5TATUTE I F_R— YIN ANY oROPRtETCR'PARTN CUTTOE 0 N/A E L.EACH ACCIDENT t �A ' E C ,EL.DtSEASE-EAEMPI OYES I iamL t OF OPERATIONS below E L.DISFAAF-POLICY LIMIT It DESCRIPTION OF IcTtde;Le Mr ctsL frier I.tlYt Is Home USA In is named as adAtionaI Insured sa respects OINfalwty MWan�as b minim contract or mitten agreement. 2012 FAA,V1naWDPPF4CCeC4512141 • CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE Home Depot USA Inc EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Home SedYiCeS Compliance C11 ACCORDANCE WITH THE POLICY PROVISIONS. 2455 Paces Ferry Road Atlanta,GA 30339 AUTHORIZED REPRESENTATIVE I 113 ACORD 25(201$103) 031900-2015 ACORD CORPORATION. All rlghta reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts D1vls+on of Occupational Llcensure Board of Burideng Relit/aborts It tabors :rnn Sttleln,o/iN Constructa�iilper" r Spect afty �� CSSL-098785 ..pplres; 04)27i2624 :4` IVAN KOSOBUTSKYY 72 STAFFORB ROAD MONSON MA O10S7 ,` fPar:. �r'ihrva ' ' ;,,r_ 1 e • CSi :: 0132 utleisuare ' eOOOOOC OO I S 3 °ti CS-9804 fe' ?/,_a,,,F4;a v); CS-9805 Ivan Kosobutskyy CS-9806 ,vet,rY:F54./fy2.1420fiN24#rdw4,42440479 CS 9807 MASSACHUSETTS CONSTRUCTION SUPERVISOR LICENSE (" 6 HOUR ONLINE CONTINUING EDUCATION f. «.0w.4 4were:.+O.t✓rr1 ,:IC/AtJO02(V^Hs M •H.v-ICi MIH•4 t 04 yatvfuwa COSH/AI vaa CKC r4024.ttr / 1.aaa raAtrva^.,•444Mlaa'1 rarwv.Iry semi 1 vovf v rI HU OH aw•ra:.«, A 02n2 axr ICS.*I O,'1.rwp Cauaaa.COCHC nAiw. `2 Sl Imd}f I I54.74bl'll.:4Z 3Wft'IIe COO*OrMAit.aroanYAa M4M/Ca.. y QICI CH 4GlIC00 AN60C$0Pr r Aa t i4.0AS t <,C01 IrtCa1$344M0l'1(: 3I24SIA32E 4Y1.25411 .) I...a.Or PA111e CIraMI C.14.4.+..afOpaa/is.wfl 01VlM 0! MIYM•C: i ! --./P( r,-NI me il",,ti,/// ,/ - /1(r,...i4ere/'A.-W/-1 Office of Consumer Affairs&BusineR,;Fiegutat;ii= HOME IMPROVEMENT CONTRACT DP TYPE: Individual Registration Exp:ratjatt. 152379 08/2212020 IVAN KOSOBUTSKYY D/B/A I & I REMODELING IVAN KOSOBUTSHW R- . ---- 72 SATFFORD ROAD C.-.2 MONSON, MA 01057 Undersecretary Registration 152379 Registrant Ivan Kosobutskyy DBA I&I Remodeling Name IVAN KOSOBUTSHYY Address 72 STAFFORD ROAD City,State MONSON.MA 01057 Zip Expiration 08.122;2022 Date authorize Go l'ctili its 1.1 (' to pull pcnii it, tt,irq.!, my CS License :: 0.0 0 74.4":1_ ___,,,,,,_ HIC Registration ;-: 15_2, _1...t....._.......... .________-- . An% tlitestions please call me at: y/s - zat- ciiO4 'ffInstaller Signature -8, Coniparty Name "r..,1,2" f?itio$4°deli v.%a'''' „ 4 •,,,,, ,,.. - ,i Ivan . Kosobutskyy k•.4,,,,,-,;`,.,'''',1i,"4:',.:4? $.4, n. , triZ, ,,,,npleir4 the 4-hour.ours" .1-)tre Ai !., I cad-Safe Reno‘ator- . . Supervlor Refresher ,..,,, ... ... :.,,,,t to.4=1• MR 22.,X)=t nd 40 CFR K.r. 7455:23 Mav 10„.201$ 4'.'4.",„1P,_,Z1Vi t....oroDales Y/;47 i ‘ 18-1340- 74-401704 hioy.1.9,2921 Cotsksce ti:smaet , — ,,1'I. • .." . ‘,.. . .' . . , , ,, :'.-..L.'. . .. ,. . .. . . . . INSTITUTE FOR ENVIRONMENTAL EDUCATION commonwealth of flotassachusetts 117.; Div of Occupational ltcensure Board of Bunching Requfations and Staticiatrth. ConstructiqirPgiogr Specialty CSSI-098785 - .*ipireS 04127/2024 ,k e IVAN KOSOBLITSKYY , 72 STAFFORD ROAD MONSON MA-01067 ....; e'l Cornmiss:oncr :9;014, f, ti e.,11Lia.i._ i i;11;111 leisure CS-013902 . CS-9803 • ...ecIOR etrelefilogi CS-9804 CS-9805 , 0 Ivan Kosobutskyy CS-9806 k CS-9807Amirl:04‘,140,froliAt'maw,/ fro"arfi nrweezt,rwt/4,- MASS ACIIUSETTS CONSTRUCT ION SUPERVISOR LICENSE .='\ e HouR ONLINE CONTINUING EDUCATION cafe OOlellile FOOS NOD rOleOLOVNIO* ooky.,KO.../*Car I oroo. Coo.Orrocoo.......or COrleor fo/n,rICOAVIOS.I Moo IIVOIVOrkreref!WW1*Its SSOfl,,Or•Or •114.4reerorrei COS.O.•CTore e.erwerSNO et1 iiresf000l leemormott eeirOtektor.4*pc0-0001..I NOM re 0 soy 0.14 ok',v....Po... COMM.,eClere•Ooker e seal .1 Ho elmoree*0*oektOof I orpor Clod.C000000420.0e MAOCI.24 ZahtI Oro.eiloolo k 72 stoiCA£t A=SI:artittee. tOO.KkerearrOlk OrroreOtok.voigiOlielt, , 01057 Clo...00.1.11 . — 41.001/11r1 VW PAROICepow e COOOletrekTer sourr 1 elEa. •e 312451032024212541 , lailarflingam Sago,OP 11.0.411,.C101 WI COOIreoroTOO OlOter"Plette , ‘) CSSE.-0981/$5 t"'ROOM 1114,11•Irto 111 - - •.. C . S . ! — r 14 `6.r.,we'it( filrilsorAfiw/6 Office of Consumer Affairs&Busineat. Fleijul3uvrk HOME IMPROVEMENT CONTRACTri9 TYPE: Individual Registration Expitati qrt 152379 08/22/2020 IVAN KOSOBUTSKYY D/B/A I & I REMODELING IVAN KOSOBUTSHYY f\,(2.-CC.C.e.-es------- 72 SATFFORD ROAD (—........ MONSON, MA 01057 Undersecretary Registration 152379 rt Registrant Ivan Kosobutskyy DBA I&I Remodeling Name IVAN KOSOBUTSITYv Address 72 STAFFORD ROAD City.State MONSON.MA 01057 Zto Expiration 08/22/2022 Date I _ "rAn. ___Kos136u.4- sk>ry authorize Go Permits I. I t tt1 pull pernttt' tt•Ninit 111 CS License # .._Q°!$. $ ".__ and n1. HIC Registration µ 1.521?aS ,1 Atli, questions please call the at: y!'.s - 2 Z I C$0 G Installer Signature 3i"' ��.... '" .... _. /....:�..Company Name __...r -x_�_g a t'� dZ[uil I ' ... ., ., e ,. ,,,i A,.. , ' ." • Rt� r x y � L �9��kg.` 0 Ivan . Kosobutskyy IL` '. �' : ltu5 s41'r°t°s\I WA �nll!pleter the 44tot�r -oucATV7tz .- Course Lead-Safe Renovator- Supervisor Refresher "If 'putrsis.nt to 454 C'MR22 t5>e•Atrri 4,5 CFR Part 745.23 ' 1 ARM for EtwMNf�R,, ,-0#004 18-1840-$74-441744 MAY 19.,lia)'`it: * INSTITUTE TE FOR EN'ir IRONIVLENTAL EDUCATION