25C-063 He ,it. ,. t•RO :w.t. TCONTRACT
...- i -. `E : a D THIS
..; c_..
Sold. Furnished and Installed by:
F y Na Balton D THD M -Home Services, Inc.
t �t 15 Ni l dJbfk The home Depot Al -Home Services
345A Greenwood Sum. Unit 2. Worcester. MA 01607
Branch Number-. 31 Toll Free (840) 657 -5182; Fax (508) 756 -8823
OF lL pMG NSPECTIONS pedant ID # 75 2608461): ME Ile # C 02439; Ri Cont. Lk* 16427
G ,+ Cr WC.; • • 322; Home I ContraetOr Reg. # 126893
ilrstatlation Address: f I L t'
City State Zap
Purchascr(s): Wok Pam! _Nom Mom Cell Phone:
( . gc 1 ,., t 1 [ 1 * t l
[ 1 [ 1 [ 1
Hama Addreaa: •
(If different from Installation Address) City Stare Zip
Email Address (to receive project communications and Home Depot updates)
0 I DO NOT wish to receive any marketing emaria from The Home Depot
Protect Inhumation: Undersigned ("Castanet?". the owners of the property located at the above installation address, agrees to buy,
and THD At- Efcene Services, Inc. ("The Dome Depot') agtCes to furnish, deliver and arrange for the installation (`7adta cation ") of
all materials described on the below and on the referenced Spec Sb tt( ), all of which are t into this Contract by this
traferenee•, along with any applicable State Supplement and Payment Summary attached hereto any Change Orders (collectively,
"Coatre&):
1oa ..■,ms1 .�...., slag Sbee(4) Pn ieet Aaronnt 1
567 ( Danner: 1 Covers Don I ,a l iOR , { 3
fa 351; l �`'
QR000ng LSsna fa vrtndows ❑ Insulation
Ermaen r CtrArr: perry Doors 0
DR ooting Sid1RB Windows LI Insulation
Croats /Covets °may Doors 0
't r , _ Owing ■ Windows ■ insulation
abases l Cars Diinay Doors R
nGoiwam 7516 Demak of Camino Annont doe eciansi a this contract Total Contract Amoum $
Mahe Pw sea may not depoeet rate Won mama otthe Centred Amemt. t
Customer agrees that. irnmediercly upon completion of the work for each Product. Cu tormer will execute a Completion Certificate
one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable. each Customer under this
Contract agrees to be jointly and sevoraily obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(a) included herein. at
its discretion, if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the home. environmental haxanbt inch as mold, asbestos or iced paint. other safety concerns, pricing e or because
work required to complete the job was not included in the Contract f
ben oat nntnn wi The Payment Summary if r � 13 53 1 included d as part of this Contract, sets fattt the total
Contract amount and payments required for the deposits and final payments by Product (as applicable).
NOTICE TO CUSTOMER
You are tee in a completely Tiled •in copy of t'e Contract at the thane you sign. Do net Sign s Completion Certificate (nose:
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets) byre work on that Product
is completes
In the event of termination of thh Contract, Customer agrees to pay The Home Depot the costs of materials, tabor. expenses
and services provided by The Home Depot or Authorised Service Provide throe glh the date of termination, plus any other
amounts set forth in this Agreement or idknved under applicable law. THE ME DEPOT OWED TO HOME DEPOT FROM THE DE PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acceptance and Authorisation: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home Depot with regard to the Products and tnataltation services and supersede% all prior discussions and agreements. either
oral or written, relating to said Products and Installation. This Agreement cannot be assigned or amended except by a writing signed
by Customer and The Home Depot. Customer acknowledge% and agrees that Customer has read, understands. vo)hnturily accepts the
tarns of and has received a copy of this Agreement.
'Q 9 4 .2EI N' DI
's Signature Date Sales Consultant's Siluature Date
Telephone No.
Customer's Signet= Date Sales Consultant License No. kA
CAANCELLATIQjit: CUSTOMER MAY CANCEL THIS to ) in v
AGREEMINT W1THO[1T PENAL'T'Y OR OBLIGATION
BY DELIVERING witirriroN NOTICE TO THE ROME r C (g
DEPOT BY MIDNIGHT ON THE TOM) BUSINESS •
DAY AFTER SIGNING THIS AGREEMENT. TIff t'
STATE SI1WPWJF NT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
CUSTOMER'S STATE.
NOME: ADDITIONAL TERNS AND CONDITIONS ARE S1 A? t ON rHE REVEL SIDE AND ARE PART Of THIS CONTRACT
12-27-ID C-SC White — Branch Fie Yeflow — Customer
or No,
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
•
The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 t0
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 fand67
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 person(s) who seek to use
the home owner exemption, 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
ermits 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
1 , understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to
Date
Address of work
location
1'
. .
The Commonwealth ofMassach usetts
Department of Industrial AC czel* ents .
. ." ■ " 7 5 .141 1 : ' •■•' '
; Office ofInvestigations ,
v. —.... . ...... .
600 Washington Street .
t • s
Roston, MA 02111
. .,,,..,...,..... .
'workers' Compensation Insur www.mass.gov/dia
ance Affidavit: Builders/Contra ctors/Electrici
,.---• -
A 1 I licant Information ans/PI b „
Please Prhit
Name (Husines.storgara - o n fi n di v id uao:
4- aci.lareSS: • .
, .
•
City/Statead . . • r - ,
_________:______ Phon.e.#: .
Are you all employer? Chec _
k the appropriate box: . . ,..,
•
Type of project (required): /
1. 0 I am a employer with 4.. 0 I am a general contractor and I
6. 0 New coristmction
employees (fill' antVorpart-tirne).* have hired the sub-contractors
2.0 am a sole proprietor or partner- listed on the attached sheet. 7. CI Remodeling
ship' and. have iin employees • - sub-contractors have. .8. Q D er - n a t i on . .
workers omp_.
for many an. josuianc capacity - ty. . 7: andha_. _ eg v ,.. e we rke7s' . 9.: r
N _ .. atclit • tit
10.0 Electrical repairs or ad&tions
5 0 We . a corporation and its
7 ..._, requirecq . : - ' g
3. Li 1 am a homeowner doing ill w* * °« ars havetxercised their . 11.0 Plumb* repairs or additions
myself No workers' eoinp. • .4. Ofexemptton per MGL
12.o Roof repairs
. p. 152, §1(4); and we have no •
insurance required.] t '
. r .
CMployees. (No workers' 13 0 other
. •
•
. .
CO ii required.J
*Any applicant .that checks box #1- must also fM out the section, showing ,, - , workers' compensation policy information. - ',' •
t Homeoameri who submit tbia afradairit jai:Beating they are . 41 _ all work .. - .... hire outside - , . -,,, - must submit a new affidavit indicating such.
:Contract= that check this box must attached an additional sheet .. . _ ., name of thc sub-con • —,;‹, and state villetber or not thosec neities have
employees. 'lithe sub-contractors:have employee, they must pawl. ,! -,', workers comp. poE. , umber.
I am an employer that is providing workers' corn, ensation insurance - r my an, .. Below is the . , licy and job site
• information. -
- - .
Insurance Company Name: • -
• . "
Policy # or Self-in.s. Lic. #: - A FFir. ' tic.. 0 • te:
. . . r
Job Sift Address: • • - City .,, , Aii . _ - - - •
Or
-Attach a copy of the workers' compensation policy declaration page"(sh , - ' . 1 . e . lIi, r and expiration date).
• . .. • ,
Failure to secure miTterike as regileited. text& Sectrolf25.A 1526afileacrto -,. iirgiositlini of ciiiainillienalties of a
fine up to S1,500.00 and/or one-year impriSonment; as well as civil penalties in the .... 9f a STOP woltx-oRDER and a fine
of up to S250.00 a day against the violator. Be advised tbat a copy of this statement ma , forwarded to the Office of . .
aiifthe inittritice•Coveiiie ierificaton. . — . _... _.. .,,.._ _...._ - ,-_-•-•____•-. . „ .... „....-
_ Dlii hereby_certin under the pains-and penalties ofperjmy that the infornurtionproviiiedabov ,..
. .
Signature: ' • • Date: •
• '
. , •
•
. . .
Phone 4: . _ . _ , -
• - Official use only. Do not write in this area, to be completed by city or town Official
. .
. .
•
City or Town: •• Permit/License # _
Lssuing Authority (circle one):
.1. Board of Health 2- Building Department 3. City/Town Clerk 4. Blectricalinppector 5. Plumbing Inspector
6. Other ,
Contact Person: Phone #:
- -
. '
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Su r r: Not Applicable
Name of License Holder : pe ,`' ` '4 I lh �� 6 , V 7 IQ1
License Number
tk) ' uk,-tek.m, DIOr/6 c_41,-,1
Address - Expiration Date
s r
mr-a re Telephone
C. ° ea isle = Miles m . rov nie `C d o «. ., l `r.: ,_t ,mil= Not Applicable ❑
E 44
Company Name ' ' , Registration umber
Address Expiration Date
1 f (� �'- V I Telephone
•
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c.152, § 25C(6))
Workers Compensation Insurance affidavit m be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildi ermit.
Signed Affidavit Attached Yes No ❑
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" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION.5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement W' ows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [0 Siding [0] Other [0]
Brief Description of Proposed ' ,/` *'
Work: sa A 4Ei! 4.11247A I i _ (ti 014
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
@ �a ra�di � r
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a- OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
s .. r
� ►7 ("/'el , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I * , as Owner /Authorized
Agent hereby declare that the statem n s nd info tion on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pa s an. penaltie • • - •
Print Name ,/
r
Signature of Owner /A. nt Date
_
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information /
i
Existing Proposed Required by Zoning
This column to be filledSn b f
Buil Department' 3
f
Lot Size ! ': . L,_.., »,�..
Frontage 4
Setbacks Front I i ( = '
Side L :i_ R: # L: i R:
Rear
Building Height 1 1 I
I.
Bldg. Square Footage -' j % 1-1 j I
Open Space Footage %
(Lot area minus bldg & paved I _! = [ .. , , 1 I
parking)
# of Parking Spaces -- ---- - 1 °
Fill:
(volume & Location) I i i
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:a
•
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book i 1
I Page ! i and /or Document #'
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ,Date Issued
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: o
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. �r nu b �i"z
RECEIVED City of Northampton ® 4 ` ' 4 } r s F s • uilding Department ,r ?
2' 2 Main Street 11 4
JUL � 5 2011 Room 100 , �� 3
ss s , �,r
N rthE mpton, MA 01060 '7-
z
• _ - . OFBUte • ":- T. -58' -1240 Fax 413- 587 -1272
NORTHAMPTON, MA 01060 a
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map . -`: • Lot Unif .
..1 I Zone Overlay Drstr ct
Efrri. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: . ill Ilt .4v , 4 11 . , 'a II 1 I , .... ‘11511 ., it %—
''ell' WErvik
Name (Print) C urrent Mailing ddre a
o :�3
ChilYiir Pir Telephone
Signature
2.2 Authorized A. : ' f
Name (Print) , Current Mailing Address:
is -•1 _ 1
Signatu - Jib R Telephone
SECTION 3 -i STIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use On
completed by permit applicant
1. Building (a) Build Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) r; 5�L .) � h
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) L.'c? "/� Number
Th Section For Official Check Use Only
Date
Building Permit Number: Issued:
.- : Signature: //
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0059
APPLICANT /CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 345 GREENWOOD ST WORCESTER (401) 935 -2633 Q
PROPERTY LOCATION 270 BRIDGE ST
MAP 25C PARCEL 063 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: 16 Replacement Windows
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ATION PRESENTED:
A pproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee '
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
(— /7–'67j /Pk
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
270 BRIDGE ST BP- 2012 -0059
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C - 063 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit # BP- 2012 -0059
Project # JS- 2012- 000090
Est. Cost:
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES
Lot Size(sq. ft.): 12893.76 Owner: Carrie Roche
Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES
AT: 270 BRIDGE ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401) 935 -2633 ()
WORCESTERMA01607 ISSUED ON: 7/20/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:16 Replacement Windows
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/20/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner