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44-007 ._ _. ._-_7_:1-----=--- ---r -- _.-_,-- •__ - -- , _ .... . __„ . — --,------, -- '---1--------___-±7.- ri:....-•t C.. I .i...I •■••1 - -2' .-- Bsc1:1--'=,';'CI1.1_17S 07 1 I Hnm.t. imorcFII::::17... Cciiiiiraii:..-;.0.i; Rt,1:1:115;d7.1.fiOrt iir',..-aciii-f-Fi..::-_-ii--.• -F-3IiIiiS"7 ADIMIR S Hi E.-_-'A,"HU..K. VLADIMIR SHEVCHLIK 5 OGDEN ST CHICOPi-LE, MA 01013 L udate Addrcss and return card.Mark reason fcr chaniJ.c. Address — Renew':1 ----- FrilriCN1H;E:-5". T o--ii:Ca::: . --- .., License or registration valid ft-,,r individid use only -,:-:- Offic rn e of Consuer AiThirs& Business Beautadon ,--,-,---,----, "0..ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to - =si---•--- -s.--- --- ---i---1 i---7----.-L_,-:_--- ' . . __- R. Office of Consurnr Affairs and Busins.s Re.2ulatIon i ;--Jegistra•ti on: 153517 Type: -i::-----i4•;:=1- Expira 10 Park Plaz te.a-Sui 5170 ' --i•--L-zi7: tion: 4.'5:2014 InidIviduai Boston.MA 02116 'fi 4inWER SHEVCHLIIK `ili DIViiR cHII:VCHUK :II CY:IDEN ST •-,,::::.-2= _-_,(-------,,•-:-.,_- .____ '-----f_....- ..______ _______ CHICOPEE• .01C13 Underseeretar Not valid without signature • litssiichliscus - i)cpiii-zmi.iii, iIi Iiii)iillIic •; Ii,.s -i J iiI 1:•■■arr, of Bn!hin.P...: R:".:a;:itli°n, anti \LIFi(ii,ril \---'' Co7istruction Super-i!sor DP:-..iati 'cen 99209 Restricted ;c: WS IiiIit,WX.Piilni i,,_.914Viia'i -- ii---.-•:. fficilif..:,; \1. A nw,,p ,r2‘.-'7 7r'—i' -- •I, ' CHICOPEE: MA 01013 \ ----- --- i.-=:-.---.=..•:-,: 10112;2013 -------: 7572 • LVifla+v PLEASE READ THIS Sold Furnished and Installed by: Brans Naas: Belton • Direr: THD At-Home Services,Inc. 1 I dlb/a The Horne Depot At-Home Services 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 7/ D Toll Free(800)657-5182;Fax(508)845-6017 Branch N her:31 Federal 1D#75,1698460;ME Lie e C 02439:RI Cast Lill 16427 �{ Q Cr Lie#HIC..0565522;MA Home Improvement Contractor Reg.#126893 a Installation Address: 't T l I7tllt!.k_+` Win ea i of . City State Zip Parebaser(s): Week Phone: Home Phone; Cell Phone: n ,Cri-r,.-4- [ 3 _ [ 1 t 1 [ l [ ] [ Home Addresse (If different from Installation Address) City State Zip E-mail Address(to receive project txxpmwtications and Home Depot updates): ❑1 DO NOT wish to receive any marketing mails from The Home Depot project Informatier• 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 ate incorporated main this Contract by this reference,along with any applicable Slate Supplement and Payment Summary attached hereto and any Change Orders(collectively. "Contract"): Job Al: newer ne.ew Predwds: Spec Sheet(*)#: Prole Amount ORoormg❑SIding windows[ — • •c 4 ob, OEtwy Doom 0 _ ('?$ek $ 8 sib —1 • .. erg ■Siding ■windows t•Insulation $ `E�' ''t (Gutters I Covers❑Entry Doom 12 Roofing lfRWing O Windows lnsaksion OCassers/Covers CjEntry Doors f ❑windows Irtatianon Daneters/Covers Panay Doors _ Miaknom 35'/.Depoth of Ceatroet Atwood due upon execution of this cutout Taut Contract Amount $ MaiuoeParham,me net deposit mas than erne-third Oche Contract mount 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 due 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. Pavmes$Sumnearl The Payment Summary C 7 C) , included as part of this.Contract.sets forth the total Contract airanmt 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 thine you sign. Do not situ a Completion Certificate(note: there is one Completion Cat-HRaate for each listed Product is defined by individual Spec Sheets)before malt 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 otter 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 Authorisation: 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 end Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees the - tomer has read,understands.voluntarily accepts the terms of and has received a copy of this Agreement. A �► T. Su. X .i/�>,,d u20 x .tt/ C !! 's ignature ►.. Sales ; is Signature Date XTe • �.�-- Customer's Signature Date Sales Consultant License No. CANOE LLAAM: CUSTOMER MAY CANCEL THIS ism applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME { l t I `?� (3 DEPOT BY MIDNIGHT ON THE THIRD BUSINESS I `1 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:ADDmONAL TERMS AND CONDITIONS ARE STATED ON TOE REVERSE SIDE AND ARE rafts'OF THIS CONTRACT 05-10.12 Mite-Branch File Yellow-Customer rr -104 1.1 i i r( F. ] i10.-----/5 as . , ; o ri ?,` w,(.i ld V C D:434)92:;xtbm lisi3-.r 2!.. s ._f.f0s"7e., -1312.1,: , +ii ,'1(, ti ' r'.-Ir' !, u'3 7 s prpfi li,14 ift riid tiwp �_ _ _ i-:t Print Lerdb� U ; Nnme (Business/Organization/Incliviclual): t§fi I1 __ Address: 2AC) ._ . � ,0 .1i( - , 3 W ._i- ` �City/St.to/Zip: iif � r' Phone #: . Are yr.. tan employer? Check the appropriate box: Type of project(required): 1 1. I am a employer with 4. _ I am a general contractor and I ipo a have hired the sub contractors 6. Y New construction employees (full and/or part-time).' 2.1 I I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees • These sub-contractors have g. Demolition • working for me in any capacity. employees and have workers' 9 n Building addition [No workers' comp. insurance comp. instirance.t — required.] 5. [ We are a corporation and its 10._ Electrical repairs or additions 3.1 1 I am a homeowner doing all work officers have exercised their 11.[ Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12-n leo.fri insurance required.]t c. 152, §1(4), and we have no 13 Other ©�� employees. [No workers' , 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. . Insurance Company Name: 1.\\113 r‘l41 ile_ ) (LD ter- Policy# or Self-ins.Lic.#: ' 31". 7;J- )4 Expiration Date: / /if I' . 3� Job Site Address: 1 • ..■ t' `�/ City/State/Zip: 4 0 -e Attach a copy of the workers' compensation poll 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 fo-insurance-coverage verification. I do hereby certify turd I`,in ° nr 11 names of perjury that the information provided abo e is rue and correct.1 Signature:. A i Date: Phone#: L- -3lC0 4 ' 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 1,i, '}a` - Phnne#: —� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervis : Not Applicable ❑ Name of License Holder: 411ar �I License Number CfP Add C� r Expiration Date ignat re Telephone 9. Registered Home Im•rovement Contractor: Not Applicable ❑ _ L - -_-a• Company Name Registration Number Address J� Expiration Dat I 1 /)/ 675-b TelepfYone 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. 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 he 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 ows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [E] Siding[D] Other[D] Wok escription of Proposed r ' Via` ) 4 7 [-/ 1O /5 �f r keritayf- +io Qf4 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 t 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 I, %CIi . / ,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, 4 Iry r;i /Qy7_S ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the p. nd pen: of perjury. `a ♦ —. Q`(.►✓- Print Name W Signature of I ner A gent 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 (I.ot 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 Q DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (3 DON'T KNOW Q YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (3 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES (3 NO 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. 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. � C� Department use only pityjof Northampton Status of Permit: itmy p au uil ing Department Curb Cut/Driveway Permit 2 2 Main Street Sewer/Septic Availability Room 100 Water/Well Availability NORTHAMPOTON!NA010T60 Orth mpton, MA 01060 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 Map Lot Unit t5/ `ry2 �`II /fin Zone Overlay District V (��C-�`' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reco bbe-4 -,-14.A.-- - • - • I 1 Name(Pent) Current Mailing Address: e CV/TWO- Telephone Signature 2.2 Authorized Aqe ,r Name(P4"," Current Mailing Address: 4-171-'---1- , Signatur Telephone SECTIOMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building gn00 (a)Building Permit Fee ,• 2. Electrical (b)Estimated Total Cost of i Construction from(6) Lt6Dn 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5 5. Fire Protection 6. Total=(1 +2+3+4+5) (4€OC. Check Number 11/1/ 0 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 459 ROCKY HILL RD BP-2013-1066 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2013-1066 Project# JS-2013-001761 Est.Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(sq. ft.): 11804.76 Owner: ECKERT ROBERT K Zoning: Applicant: HOME DEPOT AT HOME SERVICES AT: 459 ROCKY HILL RD Applicant Address: Phone: Insurance: 908 BOSTON TPK Workers Compensation SHREWSBURYMA01545 ISSUED ON:5/8/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT PATIO DOORS 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 5/8/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner