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24C ..--f •N sue f ..L. �� - -../. ..rte Illj =- � �V .1 [11 — i 0 r 7 J L'^ 'C to ' n `l G != �) , a_ Ci, o r) .5 r 0 CD . U7 =` l f s °� S ' C17` a3 G1 . h� 9 ' / � j„' t - ° ms s -i` • r CD . nn j 7,, .may w F • S 4 as siqv • C tea • ft • ° ` -. w n C! 1i u P ld r - • ii , 1 ° 0 o a .� p0 . }- d y� • • ? a rt 0 1. :1tQ? L..�" `' . �zd ..,:i ; i a oA� \ !TJ ' Q o a - x oaa t I r i ~ i • ON 0 i o a C Q EW \ • (7 - . 9-- N ..,.,,. I " %L.,' .,• - i''''''\'' ro - • . . i • 7• . N —{ ci/ • u :—, . C • Vi vt G G •1 .. .. _ . P.- e • 3 1 c w d r • ®ro Ca Cn .ao U W �' . C �; • , a • 7 - ' • • • O • _ w -• • _. $1 • - • -- ? ' \-- Cont ructiim Super, but- Special* _ , 2 - s: CSSL-08785 IVAN KOSODIASKYY • 72 STAYFORD ROAD MONSON A(44. 01057 ;7-7: 04/27120:14 • ROME IMPROVEMENT CONTRACT PLEASE READ THIS - Sold, Furnished and Installed by. timbal Date: THD At- Home Services, Inc. 1 d/b/a The Home Depot At -Home Services 345A Greenwood Street. Unit 2, Worcester, MA 01607 Toll Free (800) 657 -5182; Fax (508) 756 -8823 Branch Nwnber: 31 Federal ID # 75- 2698460; ME Inc # C 02439; RI Cont. Lio# 16427 CT Lic # HIC.05.5522; . Slone lmpcovesnent Contractor Reg. # 126893 Installation Address: ., �L r . L _L J L0 J `., *.e►... 1A ±, I c)6 City l State Zip Purchaser(s): Wok Phone: Hume Phone: Cell Phone: Rome Address: of different from installation Address) City State Zip Rama Address (to receive project communications atld lion= Depot updates): p 1 DO NOT with to receive any marketing entails from The Home Depot Protect Ido'matlon• Undersigned ("Customer"), the owners of the property located at.the above installation address. agrees to buy, and THD At -Horne Services, Inc_ ("The Rome Depot") agrees to furnish, deliver and arrange for the installation ("It> tIon ") of all materials described on the below and on the referenced Spec Sheet(s). all of which Ara incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, _C,onsrate): .lob #: uva,vi ao ••an Products: Spec Sheets) #: PraW.Amount Ultaof ng ['Siding ai['Siding U Windows E1 Insulation ' $ ' . .. C / [Entry Doors ❑ 5 13 - , a • Roofing • Siding • Windows RI Insulation $ ❑Ovnnrs / Covers ❑Entry Doors ❑ URooting ❑Siding D Windows U Insulation $ [Kneels / Covers ['Entry Doors 0 ❑Roofing USiding ❑ Windows ❑ Insulation 09Y ❑Cotters / Covers DFntry Doors ❑ $ . , t lallnhatan25919 Dept& al Contract Amomi due limn nuallen of this mars& Total Cothrct Amount $ 7 c ' — Mahn Perehmess nib ant &PO*!sore than me-third d•e Cataract Amount. Customer agrees that, immediately upon completion of the work for each Product. Customer will execute a Completion Certificate A.... 1_4T — (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable, each C 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 servioe provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns. pricing wort or because work required to complete the job was not included in the Contract. Payment teary: The Payment Summary #_,bite. 2 . included as part of this Contract. sets forth the total Contract amount and payments required for the deposits and final payments by Product (as applicable). NOTICE TO CUSTOMER You are n sign. e e Co to a achY m >sted Product as defitet b p yindivldual Spec Sheets) before we* o that Product there is nee CatepietiMOm,e � each . is complete. In the event of terminatitoe of this Con tract, Customer agrees to pay The 'Home Depot the coats of materlais, labor, expenses aced servkes by The He Depot or Authorised Service P rovider through the date of termination, pies any other amounts set fords iin this Agreement or allowed under applimbk hat THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LINITTING THE ROME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Ac ct a a nd Antimiriaatiorn Customer agrees and understands that this Agreement is the entire agreement between Customer ande a w: regard to the Products and Installation services a • • -.es all prior discussions and agreements, tither oral or written, relating to said Products and installation. This Agreement a , assigned or amended except by a writing signed by Customer and The Horne Depot Customer acknowledges and agrees , : • er has read, understands. voluntarily accepts the tears of and has received a copy of this Agreement. a A . .,. : t Customer's s tare 0; • to S,' - . Inters Signature Date 2(—V 4�j�-"'y�^ _n / / - .horse No. -. 1- w Ctlstt net's Signature !� V Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (at applicable) AGREEMENT WPTtIOUP PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON TIIR THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERE'T'O • CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN - CUSTOMER'S STATE. r ' NOTtMR: ADDmONAL TERMS AND CONDITIONS ARE STATED ON THE gFVERSE SIDE AND AIM PART OF Tint$ Corti-RA ' 01 -15-12 GsC White - Branch Fla Yellow - Customer • �; ,'a- Ci°� P''° �Q, J , .J / � _ , �, i , A � >. � ., 5.�..: F (CI y' r ' e V ) -- y ,a S r `L ° 7 � � h � � e B� J $ a d! a� 9 ®ms � x 11/15/201t ., ,.6 , i - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE rIER W 2 - ; 0 1 _ ,FI PL TH ! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR .ALTER THE COVERAGE AFFORDED EY THE POLICIES FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 9NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORT' • NT. If the certificate holder is an ADDITIONAL INSURED, the poiicy(les) must be endorsed. If SUBROGATIOI I IS ITAI' ED, suble,ci tc the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights ,o the I ( c*:rtilicaie , Marsh USA Inc mot' In )ieL1 �a s'uJClu ePO a¢iri °52cdi' 1-866- 966 - ".664 - -- l PHONE -. ., = n. = —_— -- i PRODUCER r (A /C. No, Ettt): - -- -_ _ ---_L (A /C, Nay): homedepot.certrequest@marsh.com E DSS: Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 INSURER(S)AFFORDINGCOVERAGE NAIC# Fax (212) 948 -0902 INSURER A: Steadfast Ins Co 26387 INSURED - INSURERB: Zurich American Ins Co 16535 The Home Depot, Inc. New Hampshire Ins Co 23841 Home Depot U.S.A., Inc. INSURERC: P 2455 Paces Ferry Road NW INSURER D: Illinois Natl Ins Co _ 23817 Building C -20 INSURERE: NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, GA 30339 INSURERF: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 30289573 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR POUCY EFF POLICY EXP ILT� TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY GL04887714 -02 03/01/12 03/01/13 EACH OCCURRENCE $ 9,000,000 ____.___._._. ___ ____ _ ... DAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE X ! OCCUR MED EXP (Any one person) $ EXCLUDED X LIMITS OF POLICY XS PERSONAL &ADVINJURY $ 9,000,000 X OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 9,000,000 X POLICY ,PIE � $ LOC B AUTOMOBILEUABILITY BAP 2938863 -09 63/01/12 03/01/13 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ — ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NO OWNED -. PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X SELF INSUR D PHY DMG $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC019736915 (AOS) 03/01/12 03/01/13 X TORYI MTS O FR , C AND EMPLOYERS' LIABILITY D ANY PROPRIETOR /PARTNER /EXECUTIVE IYiN N/A WC019736917 (FL) 03 /01 /12 03/01/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER(MEMNEREXCLUDED7 N E (Mandatory In NH) WC019736916 (CA) 03/01/12 03/01/13 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Workers Compensation WC1192494 (QSI) 03/01/1: 03/01/13 SIR (AOS) /SIR (GA) 1M /750,000 C Workers Compensation WC019736918 (WI) 03 /01 /1's 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/1: 03/01/13 Occurrence /SIR 30M /1M DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (Attach ACORD 101, AddIUonal Remarks Schedule, it more apace Is required) RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. HOME DEPOT U.S.A., INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES PERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C -20 ATLANTA, GA 30339 ,. jv QtikCvF tti Vl<hi,�l.t USA U I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ' Jthornton_hd ,nnoncin _ r lti •1 O: 1 )_ )./ 1 5 1 , YI - T I l 1 orIck I �� �J x;tjt i _ �!]i i{ .. aa' ' � i.. rl k �l /�.1 �., i �"' � J `_ _ _ ;i . - t . 1 i. ' ' 1(_. iI ! „ .. .c \T7 1r l e rtOrT119 fir # City /s I _ end Are yon , : employer? Cheek the appropriate box: Type of project (required): 1. EI am a employer with 4. 0 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 proprietorpr 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 .t required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 12.0 re p ai insurance required.] t c. 152, §1(4), and we have no employees. [No workers' I3. Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy iufomiation. Homeowners who submit this affidavit indicating they are doing all 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 - contractors have employees, they must provide their workers' comp. 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: i ( /,e,(j�, __,�' _ _ r Policy # or Self -ins. Lic. #: ITO O i l S Expiration Date: Job Site Address: PL.O City/State /Zip: \ 1//4 Attach a copy of the workers' compensation policy y lleclaration page (showing the policy number and expiratio 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 abo a is tr and correct. Signature: - Date: " / Phone #: 1 DI Official 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 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: G h , I _SEC -TION $ CONSTROCTIO"N S ERVICES h s 8.1 Licensed Construction Supervis, Not Applicable ❑ ✓ �br Name of License Holder : e/ }4 License Number /lr i . '►A ilk /i64 1 Addr -Wr Expiration Date Sign - . Telephone • a &ed w Oi]e.E rn oveme Cor trae ai A t ,.- -'C 4 a tf,` M�ng A i EM" , i " 5A` Not Applicable ❑ 1 -_ �}- o Company Name _ Registration Number AP (1.1 164, C g _Address 1 � • Expiration Date b f : : d a C t J i ` , /i elephone I C I b -....--07 /99? F*Z= a a T*+ S k ..:.:.V. k %WtW -L -fi ai`` gV+a. ''-QMt'4t: k A`t h a "�:.'sf'Vur6V*. SECTION.10 WORKERS COMRENSATION k WSt1RANCEAFFIDAV!T (M G L S CC(6} O - , 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 buildin ermit. Signed Affidavit Attached Yes . No ❑ t @ *..116 es mien The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to all.^w 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'suchuse 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° submit - 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 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 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone m s PP Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MAL. 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. Signed Affidavit Attached Yes ❑ No ❑ vpAi c ;n - er )titi 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- DESCRIPTIQN OF PROPOSED WORK (check all applicable) , New House ❑ Addition ❑ Replacement • doves Alteration(s) l l Roofing pi I--� Or Doors Accessory Bldg. i I Demolition El New Signs [0] Decks [0 Siding [0] Other [0] Brief Description of Proposed0.-- IIII 11 11 Work: _ -/ ..44 J, ? 1 V 1 �� ' C r[/ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet a I f� , e whouse :. and o %ad • " - x is tin • .` o • , com • Pe te the fo llowin.: 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. •5 Masscheck Energy Compliance form attached? h. Type of construction 5 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 AG OR CONTRACTOR APPLIES FOR BUILDING PERMIT , : w 1, : ��w I�j as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to k aut horize d by this building permit application. Signature of Owner Date I 1 i Q t r AO , as Owner /Authorized Agent hereby declare t hat a statements and in ormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains an. jiffies of • '. �^p� i 411 74, A. .4 \./ ae- Print Name WS: Signature of Owner /A. -nt Date M. 260 PROSPECT ST BP- 2013 -0651 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 015 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 -0651 Project # JS- 2013 - 001073 Est. Cost: $7225.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 98785 Lot Size(sq. ft.): 27442.80 Owner: MAGINNIS WILLIAM T JR & TERESA Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 260 PROSPECT ST Applicant Address: Phone: Insurance: 345 GREENWOOD ST (401) 935 -2633 () Workers Compensation WORCESTERMA01607 ISSUED ON:12/12/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOW 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 12/12/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner