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24C-004 (2) HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold Furnished and Installed by: BrancUst `ma „ B� oston Date: THD At -Home Services, Inc. � dlbfa The Home Depot At -Horne Services 908 Boston Turnpike, Unit 1, Shrewsbury, MA 01545 Toil Free (800) 657 -5182; Fax (508) 845 -6017 • Branch Number: 31 Federal ID # 75•2698460, ME Lie # C 02479; Rl Cont. Lipp 16427 CT Lic # HIC.05655222; MA Home Improvement Contractor Reg. # 126893 Installation Address: 1 I • I - r a1 'a ■ i s t it tIk t _ City State Zip ' Purchaser(s): Work Phone: Home Phone: Cell Phonc: St u24t c [ ] [yc3 56 -6 * ill 1 iMMEN Home Address: (If different from Installation Address) City State Zip E Address (to receive project communications and Home Depot updates): ❑ 1 DO NOT wish to receive any marketing emails from The Home Depot Protect Informatign; Undersigned ( "Customer"), the owners of the property located at the above installation address, agrees to buy, and THD At -Home Services. Inc_ ( "The Home Depot") agrees to furnish, deliver and arrange for the installation ( "Installation ") of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders; (collecnvely, "Contract"): Job #: tt.�Aa a�r..a.a d ucts: Spec Sheet(s)#: _ Project Amount C ll'' / UP❑Gutters eo6ng / USi4ing Covers ❑Entry Doors W iRdOws U ❑ insulation � J� ✓ I / URoofing USiding Win dows OInsolation • t $ 0Chnters / Covets ❑Entry Doors ❑ ' I 1 [Roofing [jSiding 0 Windows El Insulation w ❑Gutters / Covers DEntry Doors ❑ LI Q$idin i] Windows ❑ Insulation ❑Gutters / Covets ❑'Entry boors ❑_ $ Minimum 25 %s Deposit of Contact Amount due upon execudou ut this contract �� Total Contract Amount $ Maine Purchasers may not deposit more than one -third of the Contract Amount 5377 Customer agrees that, immediately upon completion of the work for each Product, Customer 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 severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s) included herein, at its discretion. if The Home Depot or its authorized service provider determines that it cannot perform its obligations duc to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. � Payment Summary: The Payment Summary # - 71 J `f , included as part of this Cotttract, sets forth the total Contract amount and payments required for the deposits and final payments by Product (as applicable). NOTICE TO CUSTOMER You are entitled to a completely tilled •ln copy of the Contract at the time you sign. Da not sign a Completion Certificate (note: there Is one Completion Certificate for each listed Product as defined by individual Spec Sheets) before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Home Depot the costs of materials. labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS ` OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE. WITHOUT LIMITING THE HOME DEPOT'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 Home Depot with regard to the Products and installation services and supersedes 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 acknowledges and agrees tha r has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. A. et b : / _ Sub , itre ,1. '.vs- I.. %- .r r r Custom is Sign; 're Date Sale o [ant's Signature Date x Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (asapplitablc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STAYED ON THE REVERSE StDF AND ARE PART OF THIS CONTRACT 55.10.12 While - Branch File Yellow.- Customer 4 :3 s .-.7-.._.1.:,.-__.....4:, 6 00 WasMilgto.n. Stri:-:, 'Y' olke3 5 'CsinpZillifytioL i i 1i: - ;i.... r -. .3 d:, v : i 111'5; CE "._ a,' .; 'f.. # , A ;;;113 ill ti inb- {.. 4f?plicant Information _ le se Fyint e ihl Name (Business/Organization/individual): '111 0 i .-- —9 i If Address: � v �� � ce 5 '.e,rf" t7 4. lip, City /Statei Zip: i CIA t;, '_ - 3 c 13 e Phone #: giro ' 6 S 5 / g;- Are you an employer? Check the ppropriate bog: Type of project (required): t 1. in I am a employer with 0 0 4 . 0 I am a general contractor and 1 employees (full and/or part- time).* have hired the sub - contractors ❑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. 0 Demolition working for me in capacity. employees and have workers' g any P tY� t 9. ❑ Building addition sur [No workers' comp. insurance comp. insurance. required. 5. 0 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' camp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no - employees. [No workers' 13 Other co/k4046 comp. insurance required.] 496/ *My applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and slate whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name :_L" ._ L /., 1 ' 0 (- • r ,.t Policy # or Self-ins. Lic. #: VY C ® i �[ 7 3 6 / q �� Expiration ]Date: 3— / /3 Job Site Address: t G % P — - City/State/Zip:/t.41#4/ y /$ 0A 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 verif catio i3 I do hereby certify under the pains and penaties of per ,gh at the in ' mation provided abo e true and correct; Signature: �� 1 �I Date: 1 La • Phone #: L ID) 97J , . 0, ficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 1 Building Department 3. City/Town Clerk 4. Electrical,Inspector 5. Plumbing Inspector SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction ))^ Supervisor: c Not Applicable ❑ Name of License Holder : / oil r,7 /7 F �/ _ ?zio f License Number 6 0666 , � c ►.ce -- tv A ©10/ fo 4 Address Expiration Date f ►, 1ot-13c- 243 3 Signatu %- / % Telephone 9. Restistered Home Improvement Contractor: Not Applicable ❑ Company Name Registrati n N mber ?Pg 136 S7tbAO 7A� 3 /2diq Address e �,. L Expira on Date 9/Rews! ui / ( P74 C )/ '( Telephone y� v Yq .5f/ 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 building permit. X. Signed Affidavit Attached Yes No ❑ 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" 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 Replacemenndows Alteration(s) ❑ Roofing El Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed /O n,� �' /L' Work: / A� 7x� ! srat J" 'L Alteration of existing bedroom Yes No / Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l , 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. .)(° Agiriffs C9 1171724( Signature of Owner Date I , , as Owner /Authorized Agent hereby declare that the statements and information on the or • g application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalti- of perjury. Print Nam fir iv Signature of Owner /Agent all 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 tilled 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 ever been issued for /on the site? NO 0 DONT KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO l' DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO a 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 IF YES, describe size, type and location: E. MII 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 O NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 City of Northampton Building Department u, Department use only Status of Permit: 3 2012 Curb Cut/Driveway Permit 212 Main Street Room 100 L OF Sewer /Septic Availability Water/Well Availability DEP BUILDIN I N5PEC710NS rthampton, MA 01060 p7t{pMPTON ulaa�� Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other 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 1 l �c u?.lK‘{ ERR , Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: • CARbc- S i 1-L 1 4 I o I I /')u1 %y 7tZ , 1441 a firlati ft7,4 0/ Name (Print) Current Mailing Address: * S� / fI 4ft-/ C,vrr <i'3 -3"8'y - 63pFs Telephone Signature 2.2 Authorized Agent: 9 80S7a LU TM. . D to �f/Y� .0 � 4 � 6#1 /, ill A- 4 /S`' Name (Pr nt) of Current Mailing Address: .Ai..� � 4 IN 7 /al 3i f Signature l ip 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) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 1N ',.2 7D s Check Number 3973 $3,6 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 11 MURPHY TER BP- 2013 -0505 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 004 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2013 -0505 Project # JS- 2013- 000810 Est. Cost: $5275.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(sq. ft.): 16727.04 Owner: SILLUZIO CAROL L & LORENE A Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 11 MURPHY TER Applicant Address: Phone: Insurance: 908 BOSTON TPK Workers Compensation SHREWSBURYMA01545 ISSUED ON:10/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 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 10/30/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner