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31B-235 (3) HOME Dol[P COVEMI M CONTRACT PLEASE)READ THIS Soil,Famished and Installed by. IVapate: you Daw THD At-Home Services.Inc. 1.�. &We Tler home Depot At-home Services 345A,Greenwood Street,Unit 2,Woroestca,MA 01607 Toll Free(800)657.5182 Fax(508)756.8823 Brareh Numober:31 Feddral In a 154696460;M lie#C 02439;IU Cont.Lie#16427 Cr U * 522:MA Rom Improvement Cacmador U6.#126893 Installation Address: 15-A, { M e( City I State Zip lP*MbWrtr(a): 'tWokk>PMM lion Ptsone: Cell Phone: [ l [ J [ J Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and home Depot updates): ❑I DO NOT wish to receive any marketing entrails from The Home Depot Protect Taf ruistien: Undersigned("Customer ).the owners of the property located at the above installation address,agrees to buy. and`flirt Ar Home Services.Inc.("The Home Depot")agrees to famish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s3,all of which are incorporated into this Contract by this reference.along witb any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): I tloofin5 Siding W-mdows Insniation Win q 5 pcx / noon D � $ ' Oftofts tiling Vwi„d0- le-W- 0CMUM 7 Covers DER" s R _ $ Wow t Inn ZQ Owing Mwin—Niva 0 11IM atim $ pr3attas ICovxs p m roars❑ —1-UP-00fog-osiding omfindoin 0 hrsuSation ❑Guars/Cove:01sauy E1 Nimowa 2S%Dgw*etGaermAmetdmtspmenKxbmctdocm4 set. TOW Contract Amount $ MamePnr �satdepBtmethisesb4lindeftirtCgeQractArnerreL �.+r3 l Custorrter 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 Street)and pay any balance due_ As applicable,each Customer under this CotKract apm to be jointly and scyeraily obligswd and liable hereunder. i This Home Depot reserves the right to issue a Ctange Orda•or wramate this Contract or any individual Product(s)included herein,at its discretion,if The dome Depot or is authorized service provider dowmines 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. Payment Summary The Payment Summary* "� } included as pan 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 fdled-in eopy of the Contract at the time you ssiip Do not sign a Completion Certificate(note: there its One Completion Certificate for each listed Product as dnd-med by individusl Spec Sheets)before warts on that Product is complete. In the event of terms atiou 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 data of termination,phis aannyy other amounts set forth in this Agreement or allowed elder applicable law. THE HOME DEPOT MAY VJrMOLID AMOUNTS ! OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMI'T'ING TIM ROME DEIPBT'S OTHER REMEDIES FOR RECOVERY Of SUCH AMOUNTS- AVp;;gXN&jW Andmwizatkup Customer agrees and under ands that this Agreement is the entire agreement between Customer and The Ronne Depot with regard to the Products and and supersears all prior discussions and agreements,either rnai or writtcre.rcleting to said Products and Installation,This Agreemcrrt canna be assigned or amended except by a writing signed by Cumomer and The Home Depot.Customer admowledgea urd ag�x has read,un daminda,voluntarily accepts the i terms of received a copy of this AgneeroctiL x x ! .s S s Si Date Telepliilsic No. Crsstarrrer's Signature Dart Sales Consultant I3rtnsc No. CANC)ELIAT.IQN; CUSTObWR MAY CANCEL TWS tarspplitb6lci AGREENUM WRTHOUT P111VALTY OR OTi=ATION BY DEIJVBP NG WRITTEN NOTICE TO THE TIOME DVOT BY MIDNIGHT ON THE THIRD BUSOWSS DAY AFTER SIGNING TINS AGENT. THE STATE SUPPI..IdNT ATTACHED HERETO ! CONTAINS A FORM TO USE IF ONE IS MMCYI+'ICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NQ I1C&ADDI WAI MMM AND CMDMOM3 AU hTATED ON THE REVMM SIDE AND ARE P'ARY10F TRW CONTRACT 07-1377 C-W vnaee-Bran""" yeaaw-Cuuwffw Uri! fl on,yl 4 C1 ti';.'r1/, e x-tm r 600 Washln tDn Street Bvston MA 021.E Workers' Coo ensatiDn InsuaTance Affil yit 31EIntTidAM/Plumbers kppEcaT t Information Plesse Prhat L2 bb . r— < '4aMe(Business/Organization/Individual): Uless: �ity/State/Zip: Arta yo n employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I am I a emp loyer with ❑ _..- - ---- - -- - - — -•i— _g - -- ---.- --6. Q New construction employees(full and/or part-time).* have-lured the sub contractors I❑ I am a sole proprietor or partner- listed on the attached sheet. .7. ❑ Remodeling These sulr-contractors,have ship and haee no employees - 8. E] Demolition - working for me in any capacity. employees and have workers'. 9. ❑ Building addition [No workers' comp.insurance, comp.insurance.$ 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per , 12 repairs 1 c. 152, 1 4 ,and we have no insurance required.]t § O 13. Other employees.[No workers' comp.insurance required.] iy applicant that checks box#i must also fill out the section below showing their workers'compensation policy information omeowne,s who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors.and state whether or not those entities have �Ieyees. If the sub-contractors have employees"th ey must provide their workers'comp.policy number. m an employer that is providing workers'compensation insurance for my employees Below is the policy and job site ormation.` urance Company Name: L 'icy#or Self-ins.Lic.#: [!�1�(� � Expiration Date:4xDi r Site Address: lGZi City/State/Zip:_ tach a copy of the workers'compensation policy declaration page(showing the policy nuation date). lure to secure coverage as required under Section 25A of MGL c:'152 can lead to the imposition of criminal penalties of a up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER an d a fine ap to$250.00 a day inst the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of th IA r in uranc- overage verification. hereby ce under t p ins d pe !ties ofperjury.that the information provided above is true and correct: a Date: one#: �4(1 Offtciatuse only.Do�not=rite-in-this-area,to-be completed by city-or town-offciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Depart:rert 3. City/T-vn Clerk 4.Electrical Inspector 5.Plumbng I,.spector S.Other Contact Person: Phone#: 'Ei.:TIQtd$ �iQi+1STFirtJtsT1t3N1 J1=iZVlCES n 3.1 Licensed Construction SRM4. ,° ,or: Not Applicable 0 'lame of License Ho Wer:_ �(/3 i License i numb& Vol Address/ Expiraton Date Sign e' Telephone 3:,.`e cs eretly quiet m coveme Eori:tra for a Not Applicable ❑ (a�6175 . ;ompanv Name Registration Number address Expiration Date elephone 5EC?IAN 10 .UVORKER5'CQMPENSATIQt�ktNStJFtANCE AFFIC1AVtT(M G L cz�152 §25C(6p ��Y c.rymn+.,ref3.�:r.'.�?.k+ey«".e3nrz�-�{•x;� „f,.a.e.°:—,fiu_,..rr-r a�!..n-:Lx-�-.�;�.x'yrC "ur�-,.-sue'�-.'A��.aE•k:z�oa-''"...Ri,-rr �lorkers Compensation Insurance affidavit m be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the buildin errnit. Sighed Affidavit Attached Yes....... No...... ❑ 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 ass Pervisor.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 Officials-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 tfiaf with reference to Chapter 15Z(Wo'rkers'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'hi- you _........ The undersigned"homeowner"certifies and assumes responsibility for compliance with.the State Building Cade,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 El Addition E-1 Replacement Wi ows Alteration(s)�® Roofing Or Doors i i accessory Bidg. New Signs [o] Decks j[:] Siding[®j Other[01 Brief Description of Propos v--� Work: f P 1. C.( Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No �I 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? es 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 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 as Owner/Authorized Agent hereby declare that the sta errments and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under t e p ns andopepialties of perjury. _ t Print N e ( .. Signature of er/Agent Date `L� ii� "(♦a��i-;�tTt�z�� ;�2 u 'PeAm;: Idit� Department �tseo,�o 2 Main Street `Se• r•_- I a� .,I . Room 100 �. '.. Northampton, MA 61060 phone 413-587-1240 Fax 413-587-1272 i are APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1t4P;ya 4t t°�"'"� �?,'ltiV4"L ta.rclk iv4 s ac+✓•.�t�'-i ,.: aEC'1'ION�IY S4TEINFORNtA'f1dNs�.�*��av�` 1.1 !Prooertty Address: I Ell p • I' a t>Qi-, rcts:_r. kri. ... :°..rCEaDistrtct _:,::w •°,. ' w4 j�e�f"' kG°eP.JiAS�.f'ar♦ ," a�,.a.rr.�c ��" . r s+g'rv•v,,?+Y x.-�-�c ..`_ S�GTION2�ROEEE2.TY�OWNERSHIP/AUT�•IORIZED�AGEN•C�� � k;" ate'� Mi' :^�r✓0.4ru� 5''k"'-�'�i�`'�..v-^„�`Y«`tzi'�.r}�55'�� •'axe 2.1 Owner of Recor R LAI', 19'�. Name(Print) Curre7ni Mailing Address: ` a_ a / ( Telephone Signature 2.2 Authorized t: Pala C^ ^i,��t;. Address: INarne(Purr. "• ••g Lb Signature Telephone SECTI TIMA 1 GONSTRt7CTICIN COSTS! " tom•{`2' rt-Y .ai .F�'�- *^.©ftlC'.Ia�USe�nI Item Estimated Cost(,Dollars)to be r Z � y ?� • —completed by ermit applicant 1. Building 5-(a) +_. 'Yvas'';us'`§ ,,� r 1,c,•� '�r-se'i_yi g._7- �" rJ�xTr ye - 2. Electricals I7tlf[T3LedSOtal06� � max` x rr �* =�Consftzofia� i fz -xE_.k . 3. Plumbing BurCdin�Permrt Fee; ti�Las ; 101 _ ••C-�z�N 'S" �:A y +M..c S���P4���• S"tt'���.�{,�CX{+�M-`y .L�rd��G 4. Mechanical(HVAC) "- L SX � yi tea` a �S .Cx ' �M�nixv ?� rva . 5. Fire Protection 6 Total (1 +2+3+4+5) Checec Numtaer- �* i r , k Fr:{y yP"'Yri t>a".•'�'*+`�-F a '�+ '.a+s_ R� mg - t -.s_ sir �3 § ^3' �`'"ix' -kY�, y �y.r..u, 7 v 2 as+ecfion>Eo� fficial #sSF�.�'r �c s r a y x dtr S -as: xy. _;Saw�td'Z3-ea 1" -r'•: Sig a a„ yam- 1_••.,_,�. 'tt�. " '��"c' ',`~. 'BDate r Wf i-�-z r o -F Ct?' r '$. ^ - Sc n ♦ ,� zr -i� �r"' �c y r•�`s ti <-'"'r ' "° 1`r Y 1.7 r.�a �r r x w., T Yw F$ L s r _#�` •r f .r Building Permit Number ; a7� issued ., �• F '":.C�x^a .w''�31 au5�u "S'• rh" 3• G'.y++r'� ry .y,7''+±� .?-rS rt?.`�'1 r+'•' K 5 xa-- r �^w� g -^r .r'AR �'�/.. r"re w.p�,��.Fu a+* .+3,-.�. .a p� 3.•cy, gk �, 6. r 'Y.. f r y 'P v r a'�G��wvi1'�E;'3gkt}„"�A�'�'v�•'z'.+hnr3'8-Y'��S`=',^ryr`a c,�r'+;-v .rtj c"F e��''-�(a4+`�.,� �Y?°a-rsr��.1-'i' -"'Y r.+.+r y st.�`•.r`,,`��,N¢�e->'� �r- ��x-..�LL' �^' ,-�. .�.r»-- �C--t tamer ty4,ia.c`, '"Y.t wx.r r�'#G+ �:*x�^'S�•'J'� d•'k�- �t �cFf,. �"�"�..{,rr,�"� �".r"-fr -b a � ,ru �, Slgrtatuje u^ d� t r y1. � t.'ti�v "r x +at. it'.T"l^` -wrr{{u^ tykn'vr 2.,74yHa�t •a`Y '� -�' s !t s+ ♦ `'�'3.r. ,�s �'Y� U �`C. � I�. s�„�r- x a �`�,� ,+,..�' °^3•a'^" } '�' S.,i �,4„ r .i ,xs *x �L��' i-S r r p - ,r +� eLt s �x I 't 7.�u e h ,.r r u Budding Gomm�ssioherAns�ectono Buildings File#BP-2012-0719 C F N GcA i APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES 0 �X1ST1 L ADDRESS/PHONE 345 GREENWOOD ST UNIT 1 WORCESTER (508)341-9401 P Rdl R� �UNC, PROPERTY LOCATION 53 GOTHIC ST C� b�` MAP 31B PARCEL 235 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL(4)REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 67121 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information.