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30B-059 • CERTIFICATE OF LIABILITY INSURANCE ` DATE(MNI,D01'(YYY) 02/21/2011 THIS CERTIFICATE IS ISSUED AS A. MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the — certificate holder in lieu of such endorsement(s). PRODUCER 1- 404 -995 -3000 CONTACT Marsh USA, Inc. NAME: PHONE 'FAX _(.aiC Eat)._.__— .__.- ._.___.._ —_. __. _.__.— ______.__. , (ALC,No�;_.._ ... _. —..._ .. -.... ...__. homedepot.certrequest@marsh.com E - MAIL ADDRESS: Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 -- 1NSURER(SAFFORDING COVERAGE - - -- _ NAIL # __ Fax (212) 948 -0902 INSURERA: Steadfast Ins Co 26387 INSURED INSURERB: Zurich American Ins Co 16535 The Home Depot. Inc. N ew Hampshire Ins Co — - 23841 Home Depot U . S . A . , Inc. INSURER C : P —_— - -�_ - -- ,- •, 2455 Paces Ferry Road NW INSURERD Illino Dratl Ins Co 23817 Building C-20 Atlanta, GA 30339 - INSURERE: NATIONAL UNION FIRE INS CO 0' PITTS 19.45 _ INSURER F: Illinois Union In, Co 27960 COV'EP.AGES - - - - CEP TIFICATE NUMBER: 19834682 Ji 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. NOTWIT SrANG'iaG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ttESPEC. 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. r - -' - - - - - -- - — D = - - ICY PO LI C Y -- -.. -- -- INSR I ADDL SUOR 1 POLICY EFF POLICY EXP LTR I, TYPE OF INSURANCE IN$R WVO POLICY NUMBER (MMIODIYYYY) (MM /DD /YYYY) I _ - -- LIMITS -- - -- A GENERAL LIABILITY GL04097714 -01 03/01/11 03/01/12 EACH OCCURRENCE $ 9,000,000 DAMAGE TO RENTED • COMMERCIAL GENERAL L IABILITY occurrence)_ 1,000,000 _ PREMISES Ea 5 _ � CLAIMS -MADE. [ X I OCCUR MED EXP (Any one person) S EXCLUDED X LIMITS OF POLICY XS PERSONALBADVINJURY 59,000,000 X OF SIR: $1M PER OCC GENERAL AGGREGATE $ .9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 9,000,000 X POLICY FCT LOC • 9 AUTOMOBILE LIABILITY BAP 2938863 -08 03/01/11 03/01/12 COMBINEDSINGLEUMIT 1,000,000 _(Ea accident, X ANY AUTO BODILY INJURY (Per person) S ALL OWNED • SCHEDULED - - _ _._ _......___.__....._............ AUTOS AUTOS BOOILYINJURY f NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _ . _jeer accidenll — -- _ — ._.. "_ — - -_• X SLR AUTO P Y $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S — EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTION 5 S C WORKERS COMPENSATION WC0 619 673 52 (ADS) 03/01/11 03/01/12 X TDRYIIvI I 1_5R ANO E LIABILITY - ---- •------ - - - - -- - -- Y N D ANY PROPRIETOR /PARTNERIEXECUTIVE N WC061967354 (FL) 03/01/13 03/01/12 E.L. EACH ACCIDENT f 1,000,000 OFFICER /MEMBER EXCLUDED? N — -- -"" - -- E (Mandatory in NH) WC061967353 (CA) 03/01/11 03/01/12 E.L. DISEASE - EA EMPLOYEES 1,000,000 II yes, describe under _ DESCRIPTION OF OPERATIONS below _ _ E.L. DISEASE. POLICY LIMIT 5 1, 000, 000 C Workers Compensation WC061967355 (KY,MO,NY,W1,WVp3 /01 /11 03/01/12 F TX Employers XS Indemnity TNSC46244151 (TX) 03/01/11 03/01/12 Occurrence /SIR 30M /1M E Workers Compensation ,. WC1192378 (QSI) 03/01/11 03/01/12 SIR 1M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Allach ACORD 101, Additional Remarks Schedule, it more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U. S . , INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C -20 ( - ATLANTA, GA 30339 / - 62 • USA C © 1988.2010 ACORD CORPORATION. All rights reserved. • ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD jfiero_hd 19834682 ll •• • • .. ..t.i.1 . So Y d. Fiuniahed end Mica hy; ;. ''\ �edta: FhcEC�itt�►t- Hoetosesv;Ce `. ��. t>1t«ast t3iti4.2. ; , 1QVercct�;MA Ultif;7 £pt�, e:(>iiio) 8.57442; imx ( 7564823 . Brenda Numb 31 ; :` Pfdat� '�l) M g08p NE.I *A 9 Rtcbat. 1 40 h 5427 CC3ac ii . id:. Ret 4, 12689.3 Installation Adi;reem _{ l� itl ate.. i' = ' r n r i � nt• J f . - Syr Status - . . - -`rip Pi :Hue• FM i. ,t i ep (Q 1... • 1 : . ° . • r , • y t ,' • ] • • . u l , ►E'er -'I I : ••: , -......, - ` 1 Home Address: • IX different from Installation Address) FS y semi zap E-mall•Address (to teceivep: oject•cammunic ens and'licene'I]epor•ri seeY .:.:..'. ' ' '...• . • 0 I i O NOT with to receive any marketing mails tern ThellonseDt .. .:.. ••• ' Preen llnfotrm.Aloy underaivied •C scours , the o : o?f rite ' " 'lnea`ed: ai stiovO insiul 1 agrooa tv buy, TIM M. and TI Home Scrvicee, Inc. rfhe Hoi e Near) a to • #tee ' fiver ands ge:iar the' ("Installation") of all materials doecdbed on the beioow.and mi cn:the refeotnt d'Spac.Sbeetisy, all of which are.idttepesarcd:ix.dhis Contact by this reference, along with any applicable Stare.Slipplement andFirromatinnannty attach tt htuetolud.aay Change Orders (collectively, "Contract"): Job i1: nw.ata,e:..w *et -ranee iskile reelect Aymara • 4 - t • gelkt3(Ci 0ontten0 era IDEMrWere 1: - t .dal • DfBhtttra.J torts D> Doaas Tl ' n cam D y D rn,�am . l/ IIRoo:bnt Dig -O arnidolvs 0 iaa .: . • . ©Guess i Cora [Piny Dods Q..:... ' - ` ` ...:: . • nereem.zs ueposittecaientetea nstdoenin i' a .''Taiis1! iIr .. ur• :$. 1Vd�eParchmerseay sane Itimanethird afar Cp ati alit: :. .. •...: • .: \ 1 0'1 Customer agrees that immediately upon completion of the wol Ie:4i ProodwcK::C' r' s Completion Certificate (one for each Product as defined by an individual. Spec .Std)`a�¢ rote : a�pPlicihle, tech Customer under this ' Contract agrees m be joiady and severally Obligated and liable _ :-• - . • The Homo Depot reserves the right to issue a Change (.td 'oa lib/s Cnmisetar tad vuiita1•p40duct(s) included hefc , at ' its discretion, if The Horne Depot or its authorized sar�+ioa ilravidec' ' • Inesrl et ii term t,peetoein itsabliptions due to a a. problem with the lama, environmental hazards nth as mold, aabeaios or lead p in othersafety concerns. pricing - errors of because work required to complete the job was not inducted. in the Co _ ,: ; : .. . Payment Su* i vt The Payment Smnmary * :'•included• as .pint of this Contract. sets forth the total , Contract amount and payments required for die deposits a d finial payments by- Pradnet'(aa Vie), NO1fUCE TO CUS'F- t.i R • You are emitted to a 1�e t .ly t�cd -in copy of tore Cei.L.et et the it me'yaiel, ' ° nut sign si C.ompb lion Certificate (notei there is one CompkI on0a4 ieame for each Bated ProdlIct as i;ilafed t Spec Sheeta)'before work on that Product is ohnt/ptere. In the event of ternsination -of this Contract, Customer agrees .to•pay The Horne Depot the costs of materials, labor, expenses and sertices provided by The Home Dcpat or Atithodzed Service FroyM r *hie.date of tettnixartoih plus isel ether amounts set forth In this Agreement or allowed under ble law. THE HOME DEPOT ,MAY: WITHHOLD A11OUNTS OWED TO THE HOME DEPOT N'ROM THE DP�TT PAYMENT OR OAR PAYMENT'S MADE, WITHOUT LIMITING THE HOME DEPCYf'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The pore Depot with reg trd to the Products and Installation services and supersedes all prior discussions and agreements, tither 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 aciaiowledges and agrees that Customer has read, understands. voluntarily accepts the terms of and has received a copy of this Agreement. Accepted by Submitted by: C ustomer's S ig n atuxe Dere Sales Consult: a s Date 7C a 40 . __ 4.- - i<-i t i Tele No. • Customer's - n Dare Sates Consultant Laoense No. • CANCELLATION: CUSTOMER MAY CANCEL THIS (es M3.11161510 AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE SOME DEPOT KY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING T WS AGREEMENT. THE ' STATE SUPPLEMENT ATTACH) HERETO • CONTAIN$ A FORM TO USE V ONE IS • SPECIFICALLY PRESCRIBED BY LAW IN . • CUSTOMER'S STATE. rafter& AnomobtaL TEa Ms ANn CONDP1TONS AOESTATEDOKnOLREVELUffen AND ARE PART on miS CObirit +cr 6 -31-10 0-so Whhe - Bmnch 'Yellow -tuner. • 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 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 occupancv until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper Permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 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 tome. Date Address of work location . -, . . . • , . . The Corninonwealth of Massachusetts Department of Industrial ACcidents • , . Office of Investigation§ • . • 600 Washington Street ti. vals= •.., Boston, MA 02111 • - www.mass crov/dia • -.5• -,----,.,:' -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers ' Applicant Information • Please Print Leeiblv Name (BusineseOrgsniiation/Individual): rThe • • Address: R600( lin lb! • - ' ; '••• City/State/ ' .Aft4 t33 Phone.#:‘,201ZZ7 61-. ir Are v,p6 employer? Check the appropriate box: • -Type of project (required): 1 ' ---. 1. I am a employer with 0/ ) 4. 0 I am a general contractor and I 6. 0 New co - 'on employees (full and/or part-time).* have hired the sub-contractors 2.0 1 moi a sole proprietor or partner- listed on the :attached sheet.. 7. 0 Remodeling . ship nd have no c-3loyees These sub-Contractors have. - 8. 0 Demolition • . - o working forme in any capacity. tiaAgo_YPC.4.-ctbave 0 E 'svgrke' Is' .. ,.....:=1-_—..„...- ......-,.....___. , Y: u ins= E aaamon .inturance_L. .- {No workers' comp-. insurance . -. comp. lectrical. repairs or additions - . 5. 0 We are a corporation and its 10.0 3.0 I am a homeowner doing ail work officers havexercised their . 11.11 Pluinb' - repairs or additions . myself No workers' comp. • right Of exeraptton per MGL r-, . . 12.0 f repairs . • i nsurance r t • . c. 152, §1(4)", and we have no • • entployees: [No w 13. Other orkers'• comp. insurance reqUilied.j. . • • . . . ' .. . . *Any applic:ard that checks box #1: must also fill out the section belawshowing their Workers' compensation policy infcamation; . . •-,.: . l' Homeownesi who submit this afEdaVit indicating they are doing all work and than hire outside contraCtori must submit anew affidavit indicating such. :contractors that check this box must attached an additional sheet showing the name of the stth-conuactors and state whether or notthose-entities have . • employees. If the sub-contraCtorshaVe employees, they must provide Ilicir wOrkeis' comp. policy number. 1 am an employer that is providing }porkers' compensation insurance for my employees. Be1079 is th e policylnd job site information. • ..{_, ..„, Insurance Co Name: - ,,,,) 40/ qe \5: ( • - Policy # or Self-ins. Lic. #: (c) 6, 74 • Expiration Date: Job Site Address: 1 , r5 , . - ' City/State/Zip:' .• All ,.,i ,. 171 • • • Attach a copy of the workers' compensation policy declaration pst,ge'(showing the policy nuMber. ande.ap: ition date). . . . . . . Failure to secure coverage ig required under: Seetiblit5KiifIsAGI/e. 15 26,iii laidlo the in of penalties of a fine up to S1,500.00 and/or one-year imprisorune4' as well as civil Penalties in the for of a STOP WORK-0 and a fine of up to $250.00 a day against the violator. Be advised that a copy Of this statement may be forwarded ia the ofrtc.eof - a - ÷'i's1i'ill66 - iiilifilieDr4 roFiii cov - • : viiificatioll. - . . • • ' — . --, .... .1.::,...... -..... „..._ ...: .. _ . .rdo hereb_y*th,u , 4, the p , , r, , - - -,-. rperjaryiltat the iiifirtruitiOnprirvit&dTribTOv '". 7-aid*rier:f ' .... . . / - - -_ - ...,. - - ..---__- • Sienatire: • • • - Doti: iii Phone li: • - . ' 0 1 93G L3, ' .. ' . • • - Official use orzly. Do not write in this area, to be completed by city Or to }P riOfficzat City or Town: • - Issuing Authority (circle one): • . , '• • Permit/License # • • . ..61..00Botharcetrd Person: ofHealth, 2. Building Department 3. City/Town City/To Contact Clerk . 4. Electrical Inspector 5. Plumbing Inspector • • SECTION 8 -- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : '� I�f f ` IGj VVV [ License Number 1\) . 14446 4 T FAcifmrttZ-i Ft, - Addre Expiration Date • „. - ign. ur Telephone �. r x , " m : "'Alga Fri , '. m = r >> , vemenfo ctar• � ” ���•� -�..�. m ���.��.a Not Applicable ❑ Company Name 1 Registration Number Address Expiration Date ` /V�elephone l �o ' SECTION 10- WORKERS' COMPENSATION RANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit u st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin permit. Signed Affidavit Attached Yes ❑ No ❑ 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 Wi s Alteration(s) El Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CI Siding [O] Other [0] Brief Description of Proposed �^ !� Work: ��l i t 11 ! 'J rl is �.?� V /fitg Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 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 Ta OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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. I II Signature of Owner Date PO as Owner /Authorized Agent hereby declare that the state en s and it formation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under tns and es of pe Print Nam: J ill" ARE Sign. • ! ner , gen Date .� Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomple • Inf Existing Proposed Required b Zo ` g This col . be led in by f Building 1 ..mn Lot Size € 1 F y Frontage 1 ` € Setbacks Front 7_1 i 1 i i Side L:i 1 R:1 1 L:? € R: , r I J , Rear I Building Height ) 1 t i j t _ Bldg. Square Footage 1 -1 € 1 % I € = FT Open Space Footage 1 1 - 1 % , (Lot minus bldg & paved ? I i M g P i , E parking) # of Parking Spaces Fill: S € (volume & Location) } 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:I I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book I P ag e € and /or Document # Y B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued: ` C. Do any signs exist on the property? YES 0 NO 0 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 Q IF YES, describe size, type and location: 1 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 ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. it, City of Northampton° �� : uilding Department }: fY 212 Main Street' ' Room 100 orthampton, MA 01060 v n d ,. • ' 1 .1 . e 413- 587 -1240 Fax 413- 587 -1272 3 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 RI Map . Lot Unit i 5'? ,1 �r-r, Zone Overlay Distr Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Reco 9oIl 1 �� ne q Name (Print) Current Mailing Address: ��� Telephone Signature 2.2 Authorized A. en ap ii.‘ 7 -4 6)7 Name (Pri Ctu ent Mailing Address: �� r d 4-- ()l 3 5 3 Signature Telephone SECTION 3 -! -- TIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applican 1. Building (a) Building Permit Fee , �� 2. Electrical (b) Estimated Total Cost of onstruction fro (6) 3. Plumbing Buii Permit Fe 4. Mechanical (HVAC) 5. Fire Protection 7 6. Total = (1 + 2 + 3 + 4 + 5),�— Check Number ? C' S / This Section For Official Use Only Date Building Permit Num Issued: Signature: Building Commissioner /Inspector of Buildings Date 139 RIVERSIDE DR BP- 2011 -0816 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B - 059 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- 2011 -0816 Project # JS- 2011- 001338 Est. Cost: $1649.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 56454 Lot Size(sq. ft.): 27442.80 Owner: QUIGLEY HOLLY M & MICHAEL H Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 139 RIVERSIDE DR Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341 -9401 Workers Compensation WORCESTERMA01607 ISSUED ON:4/11/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 3 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 4/11/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner