11C-001 (6) Branch Name/ t-- • Date: 7Z V./-42.'" Sold,Furnished&Installed by
/ The Home Depot Installed Sales
Branch Number: )7 Job#sJ�rs 345 Greenwood Street,Unit 1 Worcester,MA 01607
Toll Free(800)657-5182; (508)756-6686; Fax:508-756-2859
Federal 113#75-2698460 RI Cont.Lic#16427 CT Lick 565522
/MA�oome Improvement Contractor Reg.#126893
Installation Address: % / J�(�� . � g Q(/i%/� O!V,) 1
City ^r 4 j _ -._ 1 Suite Zip
Purchaser s : SS#: Driver's License: W rk Phone: Home Phone:
O )
Home Address:
(if different from Installation Address) City State Zip
Proiect Information I/We("Purchaser"),the owners of the property located at the above installation address,offer to
contract with The Home Depot"H9seDepot")to furnish,deliver and arrange for the installation of all materials as described .
on the attached Spec Sheet rj�n) ,incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract. - •
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
SALE AMOUNT $ 1 Che-y cJ[,Cashiers Check or US Postal Service Money Order " _
(,Ifede payable to The Home Depot).
CONTRACT AMOUNT $ -
2. Credit Card'and/or other payment options-Circle One Below -
*DEPOSIT $ Visa Mastercard Discover American Express
BALANCE DUE Home Improvement Loan Home Depot Credit Card _
ON COMPLETION $�Ci O Available Credit:S (HIL&HDCC ONLY)
*25%of Contract Amount due upon execution of Acct#: Exp.Date:
this contract(unless project is financed through Name as it appears on card:
Chevy Chase,in which case no deposit is required). -
'By my/our signature below,I/We agree to allow The Home Depot to charge the
Indicate Payment Method For above referenced credit card for the amount indicated above.
BALANCE DUE ON COMPLETION •
Cardholders Signature Date
If this is a finance transaction,the agreement for financing is contained in a separate document,which is incorporated herein by
Reference,and made a part hereof. At-Home Services Credit/Loan Application Ref.#
•
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any
balance due(unless the job is financed,in which case,upon submission of the executed Completion Certificate,Home Depot will be paid in
full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mass.Residents Only: Contractor,at owners expense,shall procure all permits required by law as follows: Owners who
secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this document,this contract shall not imply that any lien or other security interest has been placed on the residence.
Entire Agreement: This agreement and its attachments,including any financing agreement,contain the complete agreement
between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed under the contract.
You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED
CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY AND RELEASE THEM FI7M ALL LIABILITY INCURRED FROM INADVER ENT OMISSIONS OR ERRORS.
1
SUBMITTED BY: (GC.-el 1 4'(ti Date:, �L 04_rJ2_02P1?:t
t ales Cottiulta t 4 R C V D
ACCEPTED BY: i :'fit:( ;%�� Date: � ;�00�- •
iomeowner
Date: 04-02-02PC1 :`i4 CFt1D
Homeowner
NOTICE:ADDITIONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
White-Branch File Yellow-Customer Pink-Sales Consultant
10/15/01 SA-SC
MFR#063
cu
Owens Corning•
NFRC - 6100 Renovations
/11- Double Hung - Vinyl
Low E(HC) -Argon
National Fenestration
Rating Council
CERTIFIED ENERGY Performance
• nervy savings will"al! elefarJhl e and lifestyle
•For mom int iion,ca l T��t or visit NFRC'sweb
site atwww.ifrc.org
Technical Information
Res 0-Factor 0 . 3 7 sobr Heat gain 0 . 51 woe 0 . 52
Coefficient Transmittance
Non- 0 . 36 0 .51 0 . 55
Res
Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining
whole product energy performance.NFRC ratings are determined fora fixed set of environmental
conditions and specific product sizes.
Product nests energy Star
guidelines for region(el:
s•*ion Central
'• P 4 5 IND: REIN A2/GLASS SS/*a—R45
Test Size: 36 x 60
Order #:2958082030002 40177
e9Inm 4o,
Board of Building Regulations aid Standards
I ' HOME IMPROVEMENT CONTRACTOR
►i Registration: 126893
Expiration:_t)8/03/2002
Type: Supplement Card
Home Depot At-Horns Services
MIKE BED.ARD
3200 COBB GALLERIA PKWY#20 -'r,r
ALTANTA,GA 30339 admin`strator
r
OQ� 2 o=�
= ti GSN- of NartIla11yfoI1
. pIR``!G �r�l�
a t� 'asset tssctts' =1`_
'I WIT _-
�'a DEPARTMENT OF BUILDING INSPECTIONS 4 __i_•
212 Main Street ' Municipal Building 'e
ue
Northampton, Mass. 01060 ,~ _''s
WORKER'S OMPENSATION INSURANCE AFFIDAVIT
I, KILL- 0Q /1-1 Cc.:P.s
permit/ze)
with a principal n place of business/residence at:
3,)-0.0 �I96 Cafe* io- P46: G - 6. 37 (phone#) by7c57 .)-
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
("I am an employer providing the following worker's compensation coverage for my
employees working onthis job:
Uir 4ilJl�' 5ua Co C . c_ • 0025"-OOto6 )3 ./110/ a
v (Insurance •••m••s ) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
err
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shoot if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maintenance,omsiructionor repair work on a dwelling of
not more than throe units in which the homeowner resides or co the grounds appurtenant thereto are not generally considered to be
employers under the workers compensation Act(GL152,ss 1(5)),application by a homeowner for a license cc permit may evidence the
legal ctahrs of an employer under the Worker's Compensation Act
I understand that a copy of this statement may be forwarded to the Department of Industrial Accidents'Office of Insurance for the
coverage verification and that failure to aware coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties ,
consisting of a the of up to S1,500.00 a andforimpaisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against mc.
For departmental use only
�/� Permit Number
Lit �� y� �_0� Maps Ut
Signature of Licensee/Permittee Late
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
' y �.��� F ��� ...�... ; Not Applicable ❑
1119-Ad_ 19`� . e ' Fce,S / 6 grf 3
Company Narrfe Registration Number
3'1,3 G-ex-mAittrt(2- t Ices ,1 /b07 S/37.0.2--
Ad res�'/ � u Expiration Date
r tf���Wl . Telephone L578 'V/ P/D/
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 lD" No ❑
la
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
$ECTIO_Ni- DESCRIPTION PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacemenj,Windows Alteration(s) ❑ Roofing
Or� ❑
Accessory Bldg. ❑ Demolition❑ New Signs®[' ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: $ t( C: 0/1( 4cesi& Wi^ (Jo c1-at( Cl yes)
Alteration of existing bedroom Yes "� No Adding new bedroom Yes ✓ No //
Attached Narrative❑ Renovating unfinished basement Yes ✓ No
Plans Attached Roll ❑ - Sheet❑
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. Mascheck 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
V I I i'e-- , as Owner of the subject property
hereby authorize 146114... 11+ ce v7c- 5 i-4e- Fiefaz to act on
my behalf, in all matters relative tb work authorized by this building permit application.
/ Sep C44-t-a-44-7) tie /0— 0
Signature of ner Date
I, Ir` ` , as Owner/Authorize'
�g-
hereby declare that the statements and information on the foregoing application are true and accurate, to the best o
knowledge and belief.
Signed under the pains and lt�of perjury.
�I
Jr
Print Name
Signa ure of Owne 'ge t Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
,
h l of Northampton � s �
T2Main StreetAPR 1 6 200
iii Room 100 g �
N, rth.�mpton, MA 01060 � ��
n , ,. I�� l.
e 58 1240 Fax 413-587-1272 ,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This t �� � � �
1.1 Property Address:
goz Flom/)� s - : �
Zell„, *l C D114 r
EIi i St L#istri d f3�tClc
SECTION,2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
�
-i-tef 2.1 Owner of Record:
Vi'ki Gtbre_,
Name(Print) Current Maili A/d,°drree s N Fc`-e-- ?r a
Telephone C97I�Q
Signature
2 Authorized A ent: 92. _ 10/e6A11'1"°.°1CL cf 141-(-e4-7lei-
Name Pr' t) Current Mailing Address:
6,( ' 3qi 9y'/
Signature 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)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 + 3 +4+ 5) 3; � Check Number
This Section For Official'Use Only
Building Permit Number: mate Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
92 FLORENCE ST BP-2002-0896
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11C-001 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0896
Project# JS-2002-1468
Est.Cost: $3000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq.ft.): 285318.00 Owner: GABLE REALTY COMPANY&
Zoning:URA Applicant: HOME DEPOT AT HOME SERVICES
AT: 92 FLORENCE ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON:4/18/02 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 5 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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/18/02 0:00:00 2494 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo