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32A-091 (4) Gmail - FW: Documents now available for Windows job 6997541 Page 2 of 2 Original Message From: Lajeunesse, Rick A Sent: Monday, July 22, 2013 5:15 PM To: barrytcummingsa©charter net Cc: Bedard, Michael W Subject: FW: Documents now available for Windows job 6997541 Vlad shev to install https://mail.google.com/mail/u/0/?ui=2&ik=ec393e523e&view=pt&search=inbox&th=140... 7/23/2013 2013-07-26 20:24 2678-EXPDTR/PHN SLS 4135439417 >> Home Depot AHS P 2/8 PLEASE READ THIS a arch Beater North � ��.2 Sold.Famished and Installed by; Branch 8 TIID At-Horne Services,•Inc. d/b/a The Numher.31 and 33 e Home Depot At-Home Services 5108 Boon Tutnpilcc,Unit 1,Shrewsbury,MA 01543 Toll Free 11ii-903-3768 Federal 1D*75-2698460;MB Lie fit!02439:Ri Cent f lie 16427 Cl tic e t 11t:A56532 MA Items hgwuvement Contractor Rea.M 126893 InstaMatiat Adaireaba _2,5 Gemtl,a,1,ls.S 64e.. r t..,. 1...a (t1 a..• '0.10 City State 'A¢ Punttmeaerls): r/(�_y c� � wont mime, Rene manes Can t�6aoc .- ft k I Va.5l $'si. iiii I nabs �'t3 ' re I3'fv-9s+vk.I — Home Address:: . . (If different from lnetaliation Address) City ,a State !Sp . ��(o receive Project communications and Home Depot update} k t 41$• • c '.+-.r - 110 NOT wish to receive any marketing cmails from The Home Depot rn:pet Inlartaatigg: Undersigned("Customer"),the owners of the property located at the shove iaatailance address,agrees to buy, and'rhos)At-Hotue Servicra„Inc.("The Haire Depot")age to furnish,deliver and arrange hat the inseallatioti('I'stallation")of all materials described on the below and on the referenced Spec Sheet(s).all of which are incorporated into this Contract by this r reference,akog with any applicable State Supplement and Payment Stationary attached hereto and any Change Others(collectively, r Job k: (d.raar m d r { Spec fihaet(a)It: Pen)eet Amount r— --7Q—was usiding v,11"3, s Samn 1 a9 ra2! 10t3um ni Cavern DRetry Dears ❑_ .—�j o k3`f $,2`ry?, so0 T p1.5s, LiRootm g°Siding U mramdow s IThualanon 1-- ❑Glitters I Coven°Entry Doors Cl $ _ ORonfing L(Siclurg Cl Wiadoays toetixtian DGutters/Covers_Bony boors O. .— + $ dRot*ms-IT�vtrutdorv.U Insulation 1• DfJuttems/Covers Droury Doors 0. — — $ oCantractAnamtleasepsri, .nana[1Msmatraer. Tots Contract Amount $ .) p�/g� 4 o ateineFedusers +awyarsdope&mare than aeerhirelofther'a mm _tra to r. /(t O F !. Cnsuaocr agrees that,item ediately upon completion of the week far each Product.Customer will execute a Conmietion Certificate (cats for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable each Customer tinder this Contract agrees to be jointly and severally obligated and liable hereunder. The Dome Depot reserves the right to issue a Change Order it temiatate this Contract o t any individual Pmdua(s)included herein,at its discretion,if The Home Depot or its autheeizei service pmavider determiners 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 concern.Inking a ea or because work required to complete the job was nut included in the Contract. Payment Swtu err: The Payment Summary tk 7$ _ 'y . included as part of this Contract, sus froth the total Contract amuant and payments required for the apnea and final paymeate by Product(as applicable). . NOTICE TO CUSTOMER . You are entitled to a Wted4n copy of the Contract a t the time you taiga. Do not itg aid Cots tioa Certificate(mate: &nit [)osnplettaaear�stfa for each listed Product as defined by individual Spec ). fore work on that Pt'oduct In mg event of tdrroinatitw of this Contract.embalmer agrees to pay The Home Depot the Meta of materials,labor,expenses and provided by The Hare Depot or Authorized Sefcjec Provider thrtogh the date of tetmimliun,puns any other M, ammo set forth in this Agreement or allowed alder law. THE HOME DEPOT MAY WITHHOLD AMOUNTS TO THE HOME IJE1OT FROM THE Dd�r PAYMENT OR OTHER PAYMENTS MADE, WITHOUT 1 J IIT'1NG THE ROME DEPOT'S OTHER REMEDIES FOR RECOVERY OP SUCH AMOUNT'S. Atte ' ; Customer agrees and understands that this Agreement is the entire agreement between Customer an i t+orite tacos with regard to the Products and Installation services and supersedes all prier discussions and agreements,either oral err mitt**relating'to scud Products and Insta1Iarion.This Agreement cannot be assigned or amended except by a writing signed by Costumer' Ibe Than Depot_Customer a knmviedges anti agreen that Customer hoe road,understands,voluntarily accepts the terms of and has irt1 eived a aapy of this Agreement. not. Ardbr � i bY' .di•" 7/ .?O I.3 / 'AV" t iiir hate / n i$Idtwit'a,y ��V l'aleplteaea NQ t/,a ?_a! ,3 . a 1II. zit,. r ,late y , Sales Gxtaullant license No. _. ._ CANC'ELLAT I t : CUSTOMER MAY CANCEL, 1'HDS tat apdtoa' . AGREDIENT WtTHOL,T PENALTY OR O1IUGATION fly DELIVERING WRITTEN NOTICE TO 11W ROME DEPOT RV MIDNIGHT ON THE TU8ED BUSINESS DAY AFTER SIGNING 17HS AGREEMENT. 171E STATE SUPPLEMENT A9TAtIIJI) REREI'O 'CONTAINS A FORM TO USE IN ONE IS SPECIFICALLY PRESCRIBED RY LAW IN 1 . CUSTOMER'S STATE. NOUCm AINarnONAL IIIRMs AND 47014DMON$ARE srAlltD ON DIX REVERS=SIDE AND ARE PART OF'nitS CANTYAcr os44-ts white-Branch FAQ 'telww-Customer • (2%Xe` cmmamrtoerrla a/6llrrurrdrrte . _ ffice of Consumer Affairs& Regulation — — License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I.°Registration: 126893 Office of Consumer Affairs and Business Regulation Expiration: Type 10 Park Plaza-Suite 5170 8/3/2014 Supplement :ard The Home Depot At-Home Services Boston,MA 02116 RICHARD TROIA 2690 CUMBERLAND PARKWAYS ALFLVv4`A,GA 30339 Undersecretary Not valid without signature • • r - a CERTIFICATE II INSURANCE , DATE 2/272D 013 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C*NTA T MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHC N o h)): I FA%NO): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL S 100492-HomeD GAW-1314 INSURER A:Steadfast Insurance Company 26387 INSURED Zurich Amer American Insurance Co 16535 THE HOME DEPOT,INC. ' INSURER B' HOME DEPOT USA,INC. INSURER c:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW INSURER D:Illinois National Ins Co 23817 BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003159545.04 REVISION NUMBER:7 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:CONDIT(ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILYR TYPE OF INSURANCE �A• :i,Ai.BR POLICY NUMBER I POLICY EFf I POLICY I LIMITS A GENERAL LIABILITY 11 0L04887714-03 03/01/2013 103/01/2014 t EACH OCCURRENCE 5 9,000,000 DAMAGE TO I X {COMMERCIAL GENERAL LIABILITY PREMISES EaE occurrence) S 1,000,000 I 1 CLAIMS-MADE X OCCUR LIMITS OF POLICY XS MED EXP(Any one person) !S EXCLUDED I OF SIR:$1M PER 0CC ,PERSONAL&ADV INJURY S 9,000,000 .I_ _ 1 GENERAL AGGREGATE S 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 9,000,000 X POLICY PRO T I- [ ' — JEC Lcc s B AUTOMOBILE LIABILITY I BAP 2930563-10 03/D1/2013 103/01/2014 COMBINED SINGLE LIMIT 1,000000 7 W (Ea accident) S ANY AUTO I BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S t AUTOS AUTOS _ _ — HIRED AUTOS _, NON-OWNED ED PROPERTY DAMAGE 5 S --1 UMBRELLA UAB OCCUR 1 1 � EACH OCCURRENCE 5 — 1 EXCESS UAB CLAIMS-MADE AGGREGATE 5 I DED I RETENTION 5 I S , C WORKERS COMPENSATION WC033575314(AOS) 03101/2013 03101/2014 X I WC STATU- 10TH- , EMPLOYERS'LIABILITY I TORY I MOTS I FR C ANY PROPRIETOR/PARTNER/EXECUTIVE YI N/A N WC033575315(AK,AZ) 03101/2013 03/01/2014 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT S D 1(Mandatory In NH) WC033575316(FL) 03101/2013 03./01/2014 E.L.DISEASE-EA EMPLOYEE 5 1,000,000 fl If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 C WORKERS COMPENSATION WC033575317(KY,NC,NH,VI) 03/01/2013 03/01/2014 (EL)LIMIT 1,000,000 C WC033575318(NJ) 03/01/2013 03/01/2014 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Addltfonal Remarks Schedule,If more space Is required) EVIDENCE OF COVERAGE • CERTIFICATE HOLDER CANCELLATION THE HOME DEPOT INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HOME DEPOT USA,INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD,NW ACCORDANCE WITH THE POLICY PROVISIONS. 'BUILDING C-20 ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Manashi Mukherjee _Ma..caoL+L ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • The Commonwealth of Massachusetts --- Department of Industrial Accidents �E.,= _ ti Office o f Investigations iti! • • 600 Wetshington Street ...4111:P"'" e Boston,MA 02111 y,Zi Va www.massgov/dia Workers'Compensation Insurance Affidavit:Buiiders/Contractors/Electricians/Plutnbers Applicant Information PIease Print Legibly Name(Business/Organizationfindividual): e.f r—al:Zr Address: e j I® Cit r,i 't `( P 1ok . . . A._ City/State/Zip: _ ‘r--- ` PPhone*: 7/C � Are you an employer?Check the appropriate b= : • -Type of project(required): 1.0 i am a employer with 4. ft, I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a Sole proprietor or partner- listed on theattached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition . worlring for me in any capacity. employees and have workers' 9. Bus�ding addition [No workers'comp.insurance comp.insaranCe.t• required.] • 5. 0 We are-a corporation and its 10.0 Electrical repairs or additions •3.D 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.f 3 Roof repairs insurance required.]t • .c. 152,§1(4),and we have no E employees.[No workers' 13.0 Other s . • comp.insurance required.] { • *Any applicant that checks box#1 must also till 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 i employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. • 1 • I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information — Insurance Company Name:_ � �.d� 19431�,v°"Tr 1 Policy#or Self-ins.Lie.#: 1 114 Expiration Date: */:"...1 I I Job Site Address: City/State/Zip: 1 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 _ in the form of a STOP WORK ORDER and a Erne of up to$250.00 a day against .violator. Be advised that• ,• •of this statement may be forwarded to the Office of i Investigations of the D- for =ce coverts •'on. E • do hereby certify thafns a pi ' ry that the information provided abo, is tree and correct Si! attire � iii' Date: Phone#: 1401 `'-- _ v Official use onl}. Do not write in this area,to be completed 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 - . . • • r Contact Person: Phone II: 1 _ i 3 P SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervis r: Not Applicable ❑ Name of License Holder: 37(0 f . '9/Lt?r License Number j 1 ---t3 11711 Address G ,M � Cd� Expiration Date Signature I Telephone 9.Re•istered Home Im•rovement ontractor: / Not Applicable ❑ 1— . 0211 - PF://i ( .,9R Com•.n N. a Registrdtion umber / i 0 13:e7p. 03r‘dr..s Expir on Date (►� Ui✓ 0 12d9 lib phone 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 rmit. 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 act4 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 ❑ Replacement Windows Alteration(s) I I Roofing Or Doors CI Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief Description of Proposed ANY'�p ^-p.� Work: U r! 'U " 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 P RMIT I, ' r (; � 4eAreyr , as Owner of the subject property hereby authorize to act on my behalf, in all matters r lative to wor#c authorized by this building permit application. /AV ' ,1422 LIZ - . ).2"--T-75 Signature of Owner Date I, j1,b74/ , as Owner/Authorized Agent hereby eclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed un• r t - pain: and pena is s • 3- Print Name ` 1- ----1 )3 Signature of b er/ g-nt 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 O 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 O , Date Issued: C. Do any signs exist on the property? YES I 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(Gearing,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 AUG - 1 2013 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit DEPT.OF BUILDING INSPECTIONS 212 Main Street Sewer/Septic Availability NORTHAMPTON,MA 01060 Room 100 Water/Well Availability Northampton, 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 • �� �� Zone Overlay District /l Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) �( Current Mailing Address: A � � b Telephone Signature yi 2.2 Authorized •ent: ^ • v / 4etif - ,44P eliPY'44 Name(Pun Current Mailing Address: Si.,a .,. , Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 191 1�D (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) 99- 'O Check Number /3o ( 20 This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner/Inspector of Buildings Date 5 &7 GRAVES AVE BP-2014-0116 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-091 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2014-0116 Project# JS-2014-000223 Est. Cost: $2850.00 Fee: $70.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 100189 Lot Size(sq. ft.): Owner: SKRZYNSKI MAREK M&BEATA D Zoning:URC(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 5 & 7 GRAVES AVE Applicant Address: Phone: Insurance: 908 BOSTON TPK Workers Compensation SHREWSBURYMA01545 ISSUED ON:8/2/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL INSULATION 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 8/2/2013 0:00:00 $70.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner