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29-455 (13) BP-2023-1252 64 CRESTVIEW DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-455-001 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-2023-1252 PERMISSION IS HEREBY GRANTED TO: Project# WINDOW S 2023 Contractor: License: Est. Cost: 6696 HOME DEPOT USA INC 106106 Const.Class: Exp.Date: 09/29/2024 ZANVETTOR GINA J AND SALLYANNE E Use Group: Owner: LAVENTURE Lot Size (sq.ft.) Zoning: WSP Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-41 12 WLRC50668058 ATLANTA, GA 30339 ISSUED ON: 09/12/2023 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: 1./ • )2 (r/85 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 4 A/Are..)„," / .(, The Commonwealth of . 4.: i - 14 P(atet.4,0 Elites;1 fte,rni I; 710 — ,„ ,— ,-Ar rs-,„se, Board of Building Regulations and.tan s//' FOR Massachusetts State Building C•s -, 780/CM p vp. i CIPALITY Building Permit Application To Construct, ' 4.. - , 1 : . - Or I a revise Mar 2011 One-or Two-Family Dwel1ing r^�, R, +Y This Section For Official Use a.:'n'^ , Buildingennit Number. g �- �,c� J%� ,�:3 � 13-�.1— Date Applied: ^>` mac,. �,°6')ks ��,� �5, �� 9-12.20Z, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 6 Y. (lest ke o D'fwl 1.la Is this an accepted street?yes r/ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(MG_L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone_ — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ecord: (ykot Don vett6r .1iie.1tG Ai 4/v0z Name(Print) City,State,ZIP No.an Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other pecify,7%Ie,.// Bef Description of Proposed Work: ,/ MU& Clete Ntrlf B' w.'4 des fee 1'i' l.'ll.0 w%,k 40 a► 4 X Cll' ' , 3o SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6696.J' 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees• a Check NoM6Y1 Check Amount: VAKCa) sh Amount: 6.Total Project Cost: $ 4A0„� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supenisar License(CSL) /D`/j(, �;44* � License N On Nam a lSf CSL Holder �List CSL Type(see below) P S L 6(4 1°t w► S f No.and StreetType Description R Slat, 6 r J vital Unrestricted(1Fiddiugs cep to 35,000 cu.ft.) ram, Resided I�Z Family Dwel>ing City oZIP usd Maser}. RC Roofing Covering Window and Siding SF Solid Fuel BurningAppliances G Telephone 4SZ-402 p'p+►X eRst o 0 s I D baboon lition 5.2 Registered Hove hapresemant C..taac (HIC) wCpal ^S N HIC on Number on Date or HIC V:� C y /Cat d !� .k. I1y '7s�<� d d� f' opt 9431 goo - Q- adder City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFDAVIT(M.G.L c.152.§25C(6)) Workers Compensation Ire affidavit must be completed and submittal with this application.. Failure to provide this affidavit will result in the denial of the Lssua the building permit. Signed Affidavit Attached? Yes .......... No .Cl SECTION 7*C OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property_hereby authorize to act on my behalf in all matters relative to mirk authorized by this building permit application_ Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORS AGENT DECLARATION By entering my name below.I hereby attest for the pains and penaties of perjury that all of the information contained in this application is trine and •«, to the best of my knowledge and warding. ‘Pees/t! I- OrtIre/r 1:1094; (111,10e644) 1).11 Z T Print Owner's or Authorized Agent's Name a- z f„ • Date NOTES: I. An Owner who obtains a building permit to do hisihear own work.wan owner who hires an unregistered contractor (not registrar!in the Home Improvement Contractor(IBC)Program).will mat have access to the arbitration program or guaranty fund under MG_I._c 142A_Other important inform on the HIC Program can be found at www.mass.govloca Information on the Cow Supervisor License cite be found at wzv-vv.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage.finished basement/attics decks or porch) Gross living area(sq.ft.) _ Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton oyYN�MP'o,, 5 "r,S s; c ti� , Massachusetts L ti ` K, w err OF BUILDING INSPECTIONS ww �,,.�•! 212 Main Street • Municipal Building y�. .�'0p r `,.,.:x' Northampton, MA 01060 r 1 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECT ) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: ,j i-C ,fee / Location of Facility: �2 540 /yaw I1•+r/ 2 1� 1�G'� eTe g Z The debris will be transported by: Name of Hauler: &i r)/14- .c brti �-t Signature of Applicant: digNagit_ _ Date: 7" //- z 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 / www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leilibly Name (Business/Organization/Individual):Home Depot USA, Inc. Address:2455 Paces Ferry Road City/State/Zip:Atlanta GA 30339 Phone#:1-860-952-4112 Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' • 9. ❑Building addition [No workers' comp. insurance comp.insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 ❑Roof repairs insurance required.) + c. 152,§1(4).and we have no 13.11O rWindow replacement employees. [No workers' comp. insurance required.] *Any applicant that checks box u 1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-crastractots have empkaees.the must provide their wikets camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Company of North America Policy#or Self-ins.Lie.#:WLRC50668058 Expiration Date:3/1/2024 Job Site Address: 6 r e/eS?<4 W af/t" City/State/Zip: /6e 4Y/9 D/G'Z. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ;let`�� Date: // 2 Phone#: 860-952-4112 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 20 Building Department 30Citv/Town Clerk 4.❑Electrical Inspector 5falumbing Inspector 6.0Other Contact Person: Phone#: e ' ome Depot - ermal Value of Products Manufactured by Simonton Without Grids With Grids Style Glass Package Glazin Spacer IG Fact SHGC Fact SHGC (all with Argon) 6500 \wring 6500 Base ProSolar Supercept 718" 026 023 • • • 026 0.21 • • • :asement 6500 Base ProSolar Supercept 7/8" 026 024 • • • • 0.26 022 • • • • ['ransom 6500 Base ProSolar Supercept 1' 027 0.32 • • 0.27 0.29 • • )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 026 • 0.29 024 • • • 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 026 028 • • 0.26 025 • • • • 'icture 6500 Base ProSolar Supercept 718" 0.27 0.29 • • 027 0.26 • • ?Panel Sider 6500 Base ProSolar Supercept 7/8" 029 0.26 • 0.29 0.23 • • • 3 Panel Sliders 6500 Base(s 21 Sort) Pro Solar Supercept 7/8" 029 0.26 • _ 028 023 •I• • •500 DOORS 3arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 10.30 0.24 I •I •I•I•1 0.30 0.21 1 01 •' •' • 'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • 1 0.31 0.23 • 0 0 0 •1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. kwning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.28 0.21 • • • • :anent • 6100 Base Pro Solar Intercept 718" 027 0.24 •• •• •o •• 0.27 0.22 •• • • • ipuble-Hurd 6100 Energy Star Pro Solar Supe3w�,t 3/4"k 0.30_,0.30 • 0.30 0.27 • • • lima 'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 718" 027 0.28 • • 027 025 • • • • 'icture 6100 Base Pro Solar Intercept 3/4" 027 0.31 • • 0.27 0.28 • • ?Panel Slider 6100 Base Pro Solar Intercept 314" 0.30 0.28 • 0.30 027 • 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 0 0.30 0.27 • • 10 0 Doors 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 • • 0.28 0.23 c s 0 o -- • • 0.28 0.26 'atio Door NARROW FRAME6200 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 _ 6 2 0 0 . _ located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island NY. \wring 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 025 • • • • 0.26 023 • • • • :asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • • • 0.29 0.17 • • • • 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 025 021 • • • • 025 0.19 • • • • 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • • 0.26 0.22 • • • • Single Hung 6200 Base Pro Solar SHADE Supercept 3/4" 028 0.23 • • • • 0.28 021 • • • Single Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 (a • • 028 0.21 • • • I Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 [• • • 0.28 0.21 • • • *tormBreaker Pius 300VL . . located in coastal areas. \caning SB+300VL Energy Star PS SUN/Lami Supercept 1' 026 023 • • • • 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' 029 0.25 • • • • 029 0.23 • • • • Slider SB+300VL Base PS/Lami Intercept 1' 029 025 • • • • 0.29 0.23 • • • • 'atio Door SB+300VI ETC 366 PS Shade/Lauri Super Spacer 1' 0.30 0.19 • • • e .. G..d s At Ivied 3arden Door(CH) 98+3001/1_ Base PS/Lami Super Spacer 1' 0.30 028 • • _ 0.30 0.25 1 13 1 c 1 c Dots indicate Energy Star certified for that zone Hease Note: Simonton Windows may substitute East&West windows given the requirements of each order. WINDOW SPECIFICATION SHEET - Spec.Sheet#: F37205834 Sheet: 1 of 1 Customer: Gina Zanvettor Job#: F37205834 Consultant: Ronald Engelbrecht Date: 09/04/2023 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 Glass Misc Items Hardware Screens Code For doors use LL ❑ c To Mull "S"=stationary or Style Wraps v a, q 9 Tgo r p °P x°=operating Room FloorCode _ (YIN) _ Style Code Series Code L _ _ xi 5 t- ui 8 a _, > x° —I > _ 1 BED1 2nd OH Y OH 6100 WH WH 36 46 82 Standardlte, GlassPack: WRAP ALDER STD,White, GlassPack: WRAP 2 BED1 2nd DH Y OH 6100 WH WH 36 46 82 Standard ALDER l 3 BED1 2nd DH- Y DH 6100 WH WH 36 46 82 Standardite, GlassPack: WRAP ALDER STD,White, Glas5Pack: WRAP 4 8ED1 2nd DH- Y DH 6100 WH WH 38 48 82 Standard ALDER ' 5 BED1 1st OH- Y OH 6100 WH WH 36 52 88 STD,White, GlassPack: WRAP ALDER Standard + `STD,White, GlassPack: WRAP 6 BED1 1st DH Y DH 6100 WH WH 36 52 88 Standard ALDER ,7 BED2 1st DH Y DH 6100 WH WH 38 52 88 STD,White, GlassPack: WRAP Standard ALDER STD,White, GlassPack: WRAP 8 BED2 1st OH Y OH 6100 WH WH 38 52 88 Standard ALDER SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,8:White,7:White,8:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(OH,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) ACCPRI]e CERTIFICATE OF LIABILITY INSURANCE DAT,7.IIINDOtYYYY) 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 TIE 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 certificate holder Is an ADDITIONAL INSURED.the pole)must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WANED,sts►sct to the Isms and condition*of Nis policy,cattalo peMcbs may requite an endomentswt A elatiment on this certificate,does not tenter rights to the conflicats holder In lieu of such endomente d(s). PRODUCER wwTACT HARSH USA.NC PHONEINC ALLIANCE CENTER :-• I fn... 35E0 LENOX ROAD,SUITE 2400 ATLANTA GA 30326 RNUR9NN AFFONDerI COVERAGE NAE s CYIC1642 4MArD-GME.22.25 SUMNERA:ONArouticInksonceCA 24147 IMMDTPE HOME DEPOT,MC. II:Indoor Las Co Of NIMI A 43575 HOME DEPOT USA.INC. Nana c:ACE Miwt an Imam Caroler 22 67 2455 PACES PERRY ROOD BUIDPIG C-20 INSURER D ATLANTA,GA 33339 INSURIGt E: SUM Eit F: COVERALGES CERTIFICATE NUMBER: ATI:005072225-15 REVISION NUMBER:7 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 DESCRIBED HEREM IS SUBJECT TO AU.THE TERMS, FYrI 1131ONS AND CCNOXTTONS OF SUCH POLICIES LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. see TYPE OF ROURNIIE POLICY NUM* � a YYL UNITS A lI OD KaBEMLiAAaLHTY MWpY3166M 0SO112022 03511Qb25 EACNOccuRrtENcE s 1 0600 ICWMS.w.s a OCCUR PREEMIESOPAMMElEAaGpII�I'rl[t1 A f 1.000.00D >< SR$1,000 000 MED EPP IAA'aim Amon] i EXCLUDED ffR80hinLaAlN wvRY 3 1.000 A00 GEHL AGGREGATE LS&1'APPLIES PER GENERAL AGGREGATE i 2,O00000 PDUCY a Q LOC ODUC1 S-COu OP At3G $ 2.003000 OTHER $ A AUTONDIIEmown? 'iNWTB3,6i40 '0361112022 owns iCajuntatu 91PIGGLELOAR $ 1,020000 X ANY MITO BODILY MA1RY Diu prom) I ~OWNED SCHEDULED SELF INSURED AUTO PHY CMG G BODILY MIRY(Per aammmt) t �,AUTOS ONLY AUTOS 'P ROPIDIGY DAMAGE AUTOS ONLY - AUTOS ONLY IPar aooi0rai I $ A _IN LLAUaa EX...1 MWIl(316WT 03101>2W2 WMWM5 E 4OGCHCE i 106EO.W0 a Emma eras 1 CLAMS A4aE AQOaEGGTE $ 10:Z4000 CED I I RETENTION$ I B WORSEN,COMIENeATION SCFC505661 9SIW) 03N1711f23 6001.0024 X I MIDENPUTTERI'LLAULITY 3�TA I I TUTE ER CYIN WLRC 150 IMT} 03A11B023 I2I° OFFI RILEYTC REXCd N?A EL EACH ACCIDENT I 5�0'JO.Q00 IEwOrsy in III) E L DISEASE-EA DIPLOYEE 1 5.000.000 B yyarlan ar 6.014 OF OPERATIONS bolo* COntfLlld M AdrloeY Page E L DISEASE-POLICY LINT I 5.0011000 f DEIC/ETION OFOPEAATON5 t LOCATIONS)rBIcLa ozamo HM.AeYYaslMeika Satoh.,IIIM M Atreaas Soma limn H fewimi MEW OF NSIIRANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,NC SHOULD ANY OF TIE ABOVE DESCRIED POLICIES IE CANCELLED BEFORE 2455 PACES FERRY ROAD BUILDING C-20 THE EXPIRATION DATE TH RECIF. NOTICE Mall SE DELIVERED IN ATLANTA.GA 30339 ACCORDANCE REIN THE POLICY PROVISIONS_ ^AUTpDeMEDeEFRERBRATIM 1 litalial ZLSf 'l cc. 12 IN$.201$ACORD CORPORATION. Al rights rammed. ACORD 25(2015103) The ACORD name and logo are tagistsnd thinks of ACORD AGENCY CUSTOMER ID: CN"C1&42O6g LOC t Atlanta ACOROe ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MAIMED er3UREO At4RSr!USA INC irk MCAlE DEPOT,NC rICME DEPOT LI SA,NC POLICY NUMBER 1455 PACES PERRY ROAD BULDING C 20 AT ANT&GA 30339 CARRIER NMC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER. 25 FORM TITLE. CertAhcate v4 Llat:silty tnsurance erarkem Cava,dater r_and-ue: Sonar Safety"ammo:CaeLaty Caryorular P C NurttserLDSo06030i,AL.AR.AZ.FL.D.IAIL;GAY LAYSMO,NC.NE,NUND.CKSC.SO.TNVA, WAVY) MINN Our.33412123 Evaded Dot S3i412O24 (Eli Lent SSOX.000 Canter Salary MYonaK Casey Cargo e: Paic}tAurber.SP446@391513Sll lC&OR'W Steam Celt 03412023 Eaaraeen Cede:DY012)24 ,;.EL i Lad$5.0E0.300 SIR It 000300 Came-ACE Mew reuranae Carmelo ery Poky IIurur.VL";.450E6E&I 5.OSlt;GAM Nr'.CM.UTI Moto Dale:3341,2023 Emersion One 0.10312024 r ELt Led S4 003.000 SIR$1.000.000 SIR IGAI:STSO,O Cameo Inemm4y Insurance CL.wy o4 Noh Amoco Nair.hurter',NLRC50058Y40 COLT.IX MASOR&1 D YE.f1►L1 4 PI4.NY.P&RI.V11 Etlataee Our 0361 2C23 EyNaeon Dal 334,2024 tELI Litt IS WC. TX Eepbters eS IrdersafY C,amerLo Dr Morten murex e Ccotery Policy/ANON NSL1136119(130 ENO*Our 03414023 Etonian Our 03I71,2024 ELI Lod R030,330 SIR 55000.000 ACORD 101 (2006/01) ©2003 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marts of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff Fand Business Regulation 1000 Washi . •.L rt-Suite 710 B. . ... �t 118 Home • • -,, , N:s ~' •istration ; � u " Type: Corpora/tom ♦;t HOME • Meat USA INC z$f 112785 G: Try.:"' � .• . 04,2212D25 P 0 BOX tL5451 : ATTN. LICENSE MGMT'TEAM ........ ii ATLANTA,GA 303481 - r. ter, :.--.1— Update.Address and Return Card. 1HE COMMONWEALTH OF MASSACHUSETTS Ort.c.at Canaanite Attars it,aualnese Requl.Mon Millelsettion valid toe individual sae only before the HOME HAPROVEVICONTRACTOR aspiration date. If%and Warn 10' TYPE: OOoe d C nsio tar Affairs and Business RagWabon 3alastpltil s._.balogip� no Washington Street •Suite TIC 112786.',. i.r- iaaatiRlA S?1ti WI Di t1SAlk i,4 ;"H( _..k.COURINLY A HCW E ,r 1,__':-,-, .)� 2465 PACES FERRY R�f ii 179C' 44.„.0,a 1204.4c ATI AMA GA 30.139 Undersecretary NOl vied without signature SE AWRL7 CERTIFICATE OF UABIL.ITY INSURANCE emirs 23 1 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 INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate bolder is en ADDITIONAL INSURED,the polcy(ies)must have ADDI11ONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the leans and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certifcate holder in lieu of such ems). PRODUCER J,CT Deborah Marino Canary Blomstroni hlsurance Agency room° CO,66 Spainp{wid Street xo.Elm:(413)750.0022 I CO pal(413)786-7004 Fending Nails,MA 01030 I cintatinolgcanarylito t►om•com ersornRi*t ArrORt7NO covErt C:E _.,...,.�._. NMC INSURER A.NGM Insurance Co. 14786 INSURED PleMPIII.SArbeR,FrqeCliM(nsurpnce ComDaIlY 41360 Exterior Remodeling Group Inc. skEUREAC:AIM Mutual insurance Co. 23 Bonham St lMSUR@tal Springfield,MA 01109 emote*g erleMbee COVERAGES CERTIFICATE NUMBER: 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. MOTWITHSTA )ItiG ANY REQUIREMENT, TERM OR comm N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HERE IN IS SUIELIECT TO ALL THE TERMS EXCLUSIONS N.Y)CONDITIONS OE SUCH POLICIES.LIMITS SHOVE/MAY NAVE BEEN REDUCED BY PAD CLAIMS. IIR TYPE Or vmsURANCE _IMIS OMB POUCY eal�t a�SMYY t C DOI ERR LIR YYS LBWS A X COMMERCIAL GErERAL LABILITY EACH OCCURRENCE f 1,000,000 r,LHM n UE I^I:.+r f,ust MPP3376W 7/27/2022 712112023 r1AW4E Tq RENTED f 500,000 F'�INSF6,Pa ac�unra,roe _ MED ExP:Are cox Lorsen.: i 10,000 PFCr;`OHRJ},ALIa)..toRy A1.000,000 00 L AC:GFI LR1r AP.t.IFS PER GENERJU.AOCREC,,ATE I 2, , tt ,_ MILKY Li rROWS;ts-uVRwee.C-* I 2.000,000 X OTHER B AUTOMOBILE L M t,IY tEn for ail tn4OL�iirMt i 1,000,000 Ar.Y AUTO 1020110392 811712022 611712023 BEY TN,iukv fit,,Z .i _ �r OWNED XXAU� Rom ALTOS OM Y � ROOLY NARY trwC JnaNerli I Y(AMAiFX LTtpp omv HL p tr.tr41,-OttYi UMBRELLA USe 'OCCUR EACH C CURREICE I � EXCESS MIAB C.,AM4t.MA€ AGtiOCCSAti rE.0 1 R=TERMINI p C marmots COMetoismtpN X I MUSE 11 RH_ AND tswLcraws'tIAENitY ANr y WCC-500-5244 -2023A 1r2512023 1/25/2024 f 500,000 sporov-rA pART.ERF]E.CUTi>F f E3 EACH ACCtOEEVT +lhodog IL MiEXCLUDED• N A 500.000 EA.DISEASE-EA EMPLOYEE.S "I__}}c_1 recroe r,rrg 500.000 u't r'r'LFtF I1Ch5'view k_._,......,...,,...:................_.,........�., ..,.»..-..�,....w,- I A5E-Pcuc'1"L1MIt { DEBCtpitON OF OPERATIONS•LOCATK)ss'YEMCLES tACORD se1 Atecetsveal RC 4111.3 5c+'l4161e tsas be ATKIMf a fNOn spore Is fegUInO¢ Home Depot U.S.A.Inc.Is named as Additional Insured with respects to General I.wbifity. Eugeniu Ciubotaru is excluded from the Workers'Compensation Policy, CERTIFICATE HOLDER __;ANCgLLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE pS THE EXPIRATION DATE THEREOF. NOTICE WILL BEDELIVERED IN Hama Depot U FU.S.A.Inc Rd Gt 1 HI ACCORDANCE TH TIE POlICY PROVISIONS. 2455 Paces Atlanta,GA 30339 AUTHOR REPRESENTATIVE ACORD 25(2016/03) Ci 190!2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Tba S.PROLIF Ti*Macao al fha E-aacutbra ,"".• . .• -T a:Mason at TTmaspasamal taarsvot aaauta„bloat:PT N'aarataala . . , vow 4 _1,6 Public Safety 16411111. ii .--illir . ., Mass. Licensee Details Demographic Information riaName EUGENIO CtUBOTARU 1 Pssret Marne License Address Informatics, __ StAnghfitti rat MA 4$4>Claig 01109 United States _1 License Information ;License No CSSL-t 061% I cense Type Constr.:don Stoe,v.sor Spec arty Professor Bultdog Licenses Date of Last Renewal 10431022 issue Date 4;12/2017 Expealon Date 9129/2 24 pcense Status Active Todaly'S Date 101142022 Secondary License Type Own Business As Status Change Reason UCIMISS Renown Prerequisite Information ILIcensere CIUSOTARU,EUGENIU Reiationstier Atinbute Of iLtcettse No: CSSL-105106 No itemise*Documents —I cie.w.-4.. 1— :"; ,:. loomminallmoill111.1111.11.111.1111111111111 i Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards CIL f: COnstructiQii'gtiper449r Specialty 0 s.s CSSL-106106 t4 ....... peres: 09/29/2024 EUGENIU C100 23 BENHAM itTRE':. ,. ,..... SPRINGFIEL6 . ' ( , -,i,,, , 4rotlysi-v33 n 9 7 -11,-.'-' •• . ..„ Cc,"'"sioner c.;„1" ' - , 7" f• Constniction Supervisor Specialty Restricted to: CSSLMS -Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.govfdpl Othee of Consurner Affairs and Business Regulation 1000 Wa^itgngkm Strut State 710 Bogen,Massachusetts 02118 Nome Improvement Contractor Reglstratson 'Ype CapCf.L EXTERIOR REACCE1.0407 0LiP.-M: $P*Icsse 18N966 Office of Consumer 2BENNO«- SPROCGF`£10.144 CI r Affairs and Business __. �#�;�.�.�turn C..__.._ bliqmil.C.,evom.AA..e..,+.ra11Y•na PM..IMPROVeluite CGWTAACM4 Rowers*.vow..-.na.now.us.«.., rill s:,.rxv, hew,dmompwwa..m... rN..w,wr...-,p Regulation (QCABR l NCOommer A...ne Ana NwrS/4p91610.0.• x't xr =6. .3 i:•4 MNO.R..p Mykiiw+e. 6ws.,c LX TTINVP KWX4t N :dQ,P r..EuiENti CkklIkTI.PA, e.:�:err.s....a�---= .. HIC Registration Complaints ".'s` .t,,: --� �� „,,teak!m,,,o,,,ognatuto i,,otese¢wets, Registration# 187666 Registrant EXTERIOR REMODELING GROUP.INC Name EUGENIU CIUBOTARU Address 23 BENHAM ST City.State Zip SPRINGFIELD MA 01109 • q Expiration Date 05/09/2025 I 6,(,� .11(V a(�,�Q 4i• autnot Go rermits LLC to pull permits using my Complaints Details CS License li LO 6 ana my No complaints found for this registrant S 6 HIC Registration# I p 6 • -,:cstions°tease call me at: (LI 13) 3 3 5=3 7 0 a insuuiet SuF.L. company Piaui,. E. t'.@..Ri.o mo out