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INR.big,030111AVVV. 41113.A
12 STOTOWD'ROAD
MONSON 0. 0107
0-4127;2.614
•
Toll Free(800)657-5182;Fax(508)845-6017
Branch Number:31 Federal ID#75.2698460;ME Lie#C 02439;RI Coot Lida 16427
CT Lic a R1C.0565522;MA Home Improvement Contractor Reg 4 426893
• I
Installation Addrem: ,i dir , 4 " 1S " IP it.. , ' qs:e5;,.
/ City State Zip
Purchaaer(s): _ Work Pixies• Howe Phone: Cell Rhone
for , A r , . [ I [ ] [ l
_,[ ] . � [ l _ [ l_
some Address:
(If different from Installation Address) City State ZIP
E-mail Address(to receive project communications and Home Depot updates)-, i
01 DO NOT wish to receive any marketing entails from The Horse Depot i
Pr• eet'iu rcr:a : Undersigned("Customer").the owners of the property located at the above installation address,agrees to buy,
and T D At. one Services,Inc.("The Roane Depot")agrees to furnish,deliver and arrange for the installation C"lnstallatiun")of
all materials described on the below sod.on the referenced Spec Sheets),all of which are" into this Contract by this
reference,along with any applicable:State Supplement and Payment Summary attached herewllCiange Orders(collectively.
"Contract"): i
Job#: (bonus Sp
ets: Spec Sheens)* Aarmat
Roofing OSidinaVutndows Ci Insulation S
q,0 5-7‘kb CIGutters/Covets QEntry Doors o. S'
—Lns❑siding 0 Windows (a lnautanon S
OGutteas/Covers Otnny Doors n
o o5ng Siding ❑windows 0 Insulation $
OGuttets/Covers ❑Entry Doors❑ _--r.-
°Roofrng Siding Windows C)Insulation $
Domes/Covers QEntry Pools {Z
' Minimum 29%Deposit of Contract Amount due upon a ecudon otthisca act. To a um Contract Am tt S LVA
Maine Purchasers may eat d epodt more than one-mild of the Contract Arnow. 1
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 Products)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.
vnnent Summary: The Payment Summary# 4{2) ( ,included as
Pa part of this Contract, sets forth die total
Contract ar)tount and payments required for the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely filed-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note:
there is one Completion Certificate for each fisted 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 House 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
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOYUNNTS. MADE, WITHOUT
.Lti tance and Autborizo: 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 a x-., •es all prior discussions and agreements,either
oral or written,relating to said Products and Installation.This Agreement can • ., igned or amended except by a writing signed
by Customer and The Home Depot.Customer acknowledges and agrees that 7 to mad,ad,understands.voluntarily accepts the
terms. ■ �: ived al copy of • Ag -a I. f
/..dee' _..,i _. '11r...'...'.,.,.di:, rj..r su. 1...i4 iv,.
■
• ust'otner' ;tgnature Date Saa `r.:tant'sSignature Date
X Telephony o.-
•
Customer's Signature Date Sales Consultant License No. _
CANCELLATION: CUSTOMER MAY CANCEL THIS tasapalieswet
AGREEMENT WITHOUT PENALTY OR OBLIGATION 1
BY DELIVRI�ING WRITTEN NOTICE TO THE HOME qt D U 36 - 53029'
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:ADDmOrAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
05.16-12 White-Erandr Fie Yellow. Cush
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su isor: i Not Applicable ❑ .--
Name of License Holder: V) i�'('oil,( 'St
7 License Number
--19/MFotP, On //:g
Address ' Expiration Date
Sign. gr- Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
603 " ki. VA'
Address Expiration Date f0-44
�✓711121/0511/11y �/ Telephone
—
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 buildin it.
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 p Replacement W ows Alteration(s) I I Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CJ Siding[0] Other[0]
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Brief Description of Proposed'
Work: .it. it/.r'1 a 71
v
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 !sting 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
6:41';7-
,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, �I(r.11 as Owner/Authorized
Agent hereby declare that the state ents and information on t-he foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains:nd p naltie u
Aed _ - I
Print Name /
Signature of• r ••- t 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 filled 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 O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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 O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
RECEIVED f Northampton Status of Permit:
ing Department Curb Cut/Driveway Permit
2 Main Street Sewer/Septic A vailability
Room 100 Water/Well Availability
mpton, MA 01060 Two Sets of Structural Plans
t c
N9r?TH;Mr MIAtoT S-5 -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
i fttije r
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of RecM
r ' i. ms'
I s
Name(Print) Current Mailing .•dress:
Ste (2 Ct Telephone
Signature
2.2 Authorized AgQC-n-4e-
;
05i' eTi 6 P,r- /a/r6-
Name(Prin Current Mailing Address:
Signat 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) �/'�1-
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) � Check Number 5y?
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
s0
89 PINES EDGE DR BP-2013-1201
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18-002 CITY OF NORTHAMPTON
Lot: -000 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-2013-1201
Project# JS-2013-001975
Est. Cost: $3755.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 98785
Lot Size(sq. ft.): Owner: CORBETT DARLEEN B
Zoning: Applicant: HOME DEPOT AT HOME SERVICES
AT: 89 PINES EDGE DR
Applicant Address: Phone: Insurance:
908 BOSTON TPK Workers Compensation
SHREWSBURYMA01545 ISSUED ON:6/14/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 4 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 6/14/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner