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32A HOME IMPROVEMENT CONTRACT' PLEASE READ THIS Sold Furnished and installed by: Branch Name; Boston 10ate: TAD At -Home Services, Inc. 73 R-'ti1 drbla The Horne Depot At -Horne Services • 345A Greenwood Street Veit 2, Worcester, MA 01607 Toll Free (800) 657 -5182; Fax (508) 756 -8823 Breach Number: 31 Federal ID # 75- 2698460: ME Lie* C 02139; PI Conk T,.vst 16427 CT Lie* H100565522; i , . verses[ Cowaa / ct r or Reg # 126893 Installation Address: t. .�� :a! r , r A! & i _ i _, i tit.. /1 City Ste Zip Purehaser(an Work Phone: Tune Phone: _ _ Cpl Phone , ..-A6C21 k,i [ 1 NG] 664 Islr 1 [ ] [ ] [ ] Home Address: (If different from Installation Address) City State Zip E-mail Address (m receive project communications and Home Depot updates): I DO NOT wish to receive any marketing entails from The Hoak Depot )E'ralect Information! Undersigned ( "Customer"), the owners of the property located er the above installation address, agrees to buy. and TKO At -Home , Inc. ('The Hume Depot") agrees to furnish, deliver and arrange for the installation ( "Inataliation ") of all materials described on the below and an 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 (collectively. "Contract "): Job*: every, Ammo, Products: bee Sbeet(s) #: Project Amount ['Roofing ❑siding ❑ Windows ❑ insulation lot j i 7 '" ‚‚°' er= ❑ ,, D. ❑ , Gs (..25 8 .? 7`t q _ ❑Rooreg ❑siding U Windows U Imcutation UQuners I Covers ❑Entry Doors ❑ ❑[tooting USiding U Windows ❑ ImN)at;ga $ al Doors DGutters / Covers ❑Entry Dos ❑ URoofing USiding U Windows 0 insulation — ❑Gutters / Covert: ❑Entry Door rl - pTle:aa=25% Deposit demand Amount due upon encotioa this contract, Total CptrhYCt "mo $ ( j (,�. lvlsasePund smaynotdepositauwethanmsotkint tw« - �•� ` ■ Amato Customer agrees that, immediately upon completion of the work for each Product. Customer will execute a Completion Certificate (one far 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 I4ome Depot or its authorised service provider determines that it cannot perform its obligations due to a structural problem with the home, enviromnental hazards such as mold, asbestos or lead paint, other sat@iy concerns, pricing errors or because work required to complete the job was not included to the Contract Payment Summary: The Payment Summary # 517 . 4 1 7 , 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 entitled to a completely filled-in copy of the Contract at the time you sip. Do not sign a Completion Certificate (note: there is one C000pletit on 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 tnateriats, labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other OWED forth DEPOT ROM THE DEPOSIT OR OTHER H PAYMENTS ADE, W1'THOWT LIMITING THE IIOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acn aad_.A t r Customer agrees and understands that this Agreement is the entire agreement between Customer and e e at wit regard to the Products and installation services and supersedes all prior discussions and agreements, either oral or writuai, relating to said Products and installation_ This Agreement not be assigned or amended except by a writing signed by Customer and The Home Depot. Custom acknowledges and agrees th' Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Acne. = -1 t'-' X 3 0 _ , x _cr. i •!'' Signature er : e , 81;7 suttant's Signature Date X Telep one No, q( 3 / (-o W +— 53 _ Customer's Signature Dart Sales Consultant License No_ CANCELLATION: CUSTOMER MAY CANCTi.1,. 'PSIS has applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERIPNG WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAV AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE CF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE: oporriONAL TERMS WO COtIDITIONS ARE STATED ON THE RSvER86 SIDE AND ARE PART OF THIS CONTttACT 01 - 18 - 12 C.5O White - Branch Fitts Yellow — customer Apr 14 12 05:25p Thompson 413-568-2678 p.1 3 i 1/4 7S DANE OW A C) yak pv)A--Jef-, 6 . 1 r - \,3 LS ' 70 \-e ) SL/54 Massachusetts - Department of Public Safety Board of Building Regulations and Standards • Curiszruction &wen iwr License: CS-067121 - • BRIAN CI110.1493 N ..die' 38 WILLOWEEOOK LANE WESTFEEL6.1V1A 01085 --6---e**-2 E;;piratori Commissioner 04/30/2014 THIS CERTIFICATE IS ISSUED AS A. MATTER OF INFORMATION ONLY AND CONFERS NC) RIGHTS UPON - THE (":PH TIFIev i Ht"Ii, D=R. `Nit; 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 hoiden is an ADDITIONAL INSURED, the pr- licy(iesi mus ors d. If SUBROGATION IS'4 NEE sutler* t the terms and conditions of the policy, certain policies may require an endorsement. A statement soda this certificate does 41Gt confer right to t , certificate hoiden in lieu ob such endcrsernent(s). PRODUCER 1- 866 - 966 -4664 CONTACT _ Marsh USA Inc. PHON — — -- — PHONE 1 rA:t JAM No. E t . __._.__ _._. _. __. -..._ - -- -.___... i IA/C, N -- - _ ot. certre est@marsh. com E-MAIL DDR homede P � ADDRESS: Two Alliance Center, 3560 Lenox Road, Suite 2400 - - - -- — ______ - Atlanta, GA 30326 INSURER(S) AFFORDING COVERAGE NAIL 0 _ Fax (212) 948 -0902 _ _ _INSURER A: Steadfast Ins Co 26387 INSURED INSURER B: Zurich American Ins Co 16535 The Home Depot, Inc. Home Depot U.S.A., Inc. INSURERC: New Hampshire Ins Co 23841 2455 Paces Ferry Road NW INSURERD: Illinois Natl Ins Co 23817 Building C -20 NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, GA 30339 INSURER E: 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. INSR TYPE OF INSURANCE AWL SUBR POUCY EFF POUCY EXP LIMITS LTR INSR WVD POLICY NUMBER IMM /DD/YYYY) (MM/DDIYYYY) A GENERAL LIABILITY GL04887714 - 03/01/12 03/01/13 EACH OCCURRENCE $ 9,000,000 -- -._... X ___ -- -.- _ _. _ - _ 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 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 9,000,000 _ X POLICY F� LOC $ B AUTOMOBILEUABIUTY BAP 2938863 -09 03/01/12 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 AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X SELF INSUR D PET DMG $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE � AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION WC019736915 (AOS) 03/01/12 03/01/13 X TOORYLMITS ER — AND EMPLOYERS LIABILITY Y / N D ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E (Mandatory in NH) WC019736917 (FL) 03/01/12 03/01/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICE EXCLUDED? N WC019736916 (CA) 03/01/12 03/01/13 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 NH) If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ E Workers Compensation WC1192494 (QSI) 03/01/12 03/01/13 SIR (AOS) /SIR (GA) 1M /750,000 C Workers Compensation WC019736918 (WI) 03/01/12 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/12 03/01/13 Occurrence /SIR 30M /1M DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EWE DEPOT, INC. HOME DEPOT U.S.A., INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C -20 ��.,(I ATLANTA, GA 30339 , j a v.st,S) ln,, v' u (c 1 Alc ( - USA 0 ©1988 -2010 ACORD CORPORATION. AU rights reserved. / ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Jthornton_hd 30289573 -p ' DD a r . cU . . . r Y, • } :., -r . • 0. • a° v . - › ° • ' .-, co. N G o MI • p' O G `CO a, • ‘• � ,.1 LYE : � gi-.4 OC ' 9 o - - , � .. • ". _ h 3131 A 0 0 . v = %. \ • '� 0 0 + 1Y, j � 03 [A *q ' Q � O j ai v) N > ed 4 t' �I11t. � o o p`tir 17.4 . (p: (F3 Sm4 zMS' ' B. - • g� 0 i F g - . e) E_ e, u • -. -6 . c:...., . ....--> }° °-°'.. ,.. . \p i • J M Z d V ...-1 fle / .., CP ,,, L 4 0.) .1.. ii. {{p c r }I, , Fri • i c� r„, 5 : r ., a t, rr z `;i c ' ""hr0,. t: -e - -.- f 5 y - t ti C U rir r te 3 Fyr r t t 4, 1,� I' _ - 1 ' ! i 1 Y101'_ t,,I ` h,al''..t t3 Ui _ I', _ 1 1113l _1. . , _R l'0i Ali _.I;'i I,I 1Zf_ ; _- ,_.+ 1 ti 1.1_t t _ i...._ , 1d # r, } 7 1i) °lrr i 'r'[flt rrjn `hin;, _.._ ._�.... ..„�..a� ._ 1 1C�� 1 ... 1,:o7/4n ra.i c'li,ii:l_1,.[,). 7 ! 1 ,___OJ tZ ∎ „ lei, .. - --- J fi r' Y d , Addr' � I( .. L f (f J y City /:.. .dip: __ I1 ,.; r = ° "� *tie #: " = . . Are you z; employer? Check the appropriate box: T Type of project (required): 4. 1 am a general contractor and 1 1.I am a employer with g 6. 0 New construction employees (full and/or part- time).* have hired the sub - contractors 2.0 I am a sole proprietor Qr partner- listed on the attached sheet. 7. 0 Remodeling ship and have do employees These sub - contractors have 'S 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance .t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 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 Roo rs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. they 60 ( 1440(i) 5 comp. insurance required.] *Any 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 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. I . Insurance Company Name: 4 1 Ar1t A ' -_A.. __ 1 — A i Policy # or Self -ins. Lic. #: 1 Expiration Date: Job Site Address: ..0 - i 1.! 11.... '' City /State/Zip: _ A 4 10 t . Irt__- Attach a copy of the workers' compensation policy declara ion 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 DI A coverage verification. — I do hereby certify un pa?". an , enact' s of perjury that the information provided abo'e is tr , and correct \ Si : ature: tf . , - � . / Date: .4:6 s Phone #: T g g , , - Ofj:<cial 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 #: 1, y SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder : )41 ` 444‘?—, CO 2 Number License Number Address /Mr% Expiration Da r _ Telephone 4. Home lm. o`verrien ontiictor �� ,�y� :,.., ;�� , ,,�,,, = ; , y , Not Applicable ❑ { , i X 11' Company Na - Registration Number r vo - Address 1 Expiration Date 'r��' & i Telephone LIP i j � j SECTION 10- WORKERS' COMPENSATION INSURANCE I 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. Signed Affidavit Attached Yes ❑ No ❑ itome,,ownerdExemption, 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 • 1 W SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Wi ws Alteration(s) n Roofing I Or Doors Accessory Bldg. ❑ Dem_olition ❑ New Signs [O] Decks [D Siding [O] Other [O] + Brief Description of Proposed �_ I 6. }- � iC- ] �– Work: �, 7 /. , 4 1/" 7 - 4 a 1 , r C � it Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet wit; New house..and.or addition existing: housing co mplete,the foll 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 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 OWNERAUTHOR[ZATION TO BE COMPLETED OWNERS AGENT OR CONTRACTOR APPLIES FOR BIJILDING PERMIT I, > - , 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. 4- -- Signature of Owner Date I, ! , as Owner /Authorized Agent hereby declare that t e statement a'S information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the •a d pe . • •erjury. Print ilifjOr // – .."— Sign o 0 - r /Ag -n Date m 4 J Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information k Existing Proposed Required by 'Zoning This column to be filled in by Building Department Lot Size ' ? I Frontage Setbacks Front i — Side L: R: --- L: R:' Rear i f Building Height Bldg. Square Footage % M Open Space Footage — % (Lot area minus bldg & paved _... i parking) I I i I # of Parking Spaces Fill: { (volume & Location) . A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book I Page? I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 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 I 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 0 IF YES, describe size, type and location: E. WiII 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. I k tDapartrpemt use=only i� City of Northampton Statt s of P T��;���� + � `;'��`� �� �8` �� �. i f s `kM1.. y r ta` '-tee a�'° .a� P o i Building Department Clan 6, ive 7Perrrlt , 212 Main Street Seier1Sep tcAva,ia i ity � �. Room 100 V17ate Utle71 A - a l l a b t l� �A � a ., i I `` r i 2 2012 Northampton, MA 01060 T'u i s ' t " - f ' �_, e ; u hone 413- 587 -1240 Fax 413 - 587 -1272 P pt/51eptans'� : DEPT. O ,, c QTfONS r Other,5pecify NORT MPTON. MA 01060 . ,. .� 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 ,-. �-__ Ma L f 1 £ ' -7'i� Zone -� Overlay District M �:� k ' • E lm St. District ' CB District ` SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: . „. Name (Print) " Vt Y ` �� X �� i ,. , at,0 �.. v.: r .;. _ , �� �l. ", ,,, .,7 w_._ ( ) Current Mailing A.d es c( ;'Q ef7.-N Lfi Telephone Signature 2.2 Authorized A. ` i 1 \ i1 ti► / ice_. A It ' I — JD Name (Print)' /� i Current Mailing Address: tf L )9 Sig ure . Telephone SECTION 3 STIMATED CONSTRUCTION COSTS Item - Estimated Cost (Dollars) to be Officia U se Only completed by permit applicant 1. Building (a)`BuildingPermtt"Fee 2. Electrical (b) Estimated' Total Cost o Construction from {6) 3. Plumbing .Building Permit Fee= 4. Mechanical (HVAC) 5. Fire Protection 6. Total = ( + 2 + 3 + 4+5) p7 Check Number 3 + ' .. . ;This. Section For Official Use Only Date Building,Perrnit_Number Issued. °- - ` Signatur Building Commissioner /Inspector of Buildings Date 16 POMEROYTER BP- 2013 -0654 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 236 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-2013-0654 Proiect # JS- 2013 - 001076 Est. Cost: $2744.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size(sq. ft.): 12240.36 Owner: NISSON JOEL D Zoning: URC(62) /SC(38)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 16 POMEROY TER Applicant Address: Phone: Insurance: 24 SUNRISE DR (401) 935 - 2633 () Workers Compensation PROVIDENCERIO2908 ISSUED ON:12/12/2012 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 12/12/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner