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29-402 Bt dgitItt_ .4+wca � d+tib At+ 4. (alt(7 {� 3 0�CO cr Lit#%is iz: �1mp:wewwu CCcnftwwr RiLiao za68�" Installation Address: `? �Q 4 City State dip ) Ltetd4 Dlglea etDrirer's I/ Pnre6nerltk Lk.#&Esp.MdYr.. Work Phone: llone PM".. 5 Hamm AtWraw Slade (If different 5om Installation Adt�) City zip E-mall Address(to relve updates.and pavrnoaons froul The home Depot): Projod Informatlow I/WeNou r Pemcbasen,the ovrnara of thep�pperty located at the above installation address,offer to contract with THD At-Home Servitxa,Inc.CH a epos") tiarush" idd ver and arm for the inashllation of all mate,iaLt as descrtbcd on the attached Spec Sheet#__ —'incorporated harein re&M-1 and n**ti part hereof. IFEotnoogwt reserves the right to cancel this eontrat►Ifr asp"ro iospectlon of tie Job,Borne Depot determines that it cannot pafiarsa its oMiptiaat sitar to a drod ral pr4bkrm with 4he home,.pricing men or because work required to eoml$ete the job was net lacludled in the Spec Sbook or Contract. DEPOSIT PAYMENT OPTIONS (9*wt m fund v%Aewion aTWor cmdk■pprovst.) CONTRACT AMOUNT sj;�3 < t. Check*.Caebim Cho*or OS Foetal Servtoe Moaay order (btadgpsysblsmThallomeDop�R). {LESS DcPOSPF s z cseen Ceed'•end/or+eher pswg�s a-ate osat Hellas.. BALANCE DUE 480-'< Vsa'. hr-�-�5••� n:•• •• w•!nriwa Hxpras. ON COMPLETION S V Hem.tlgo<}io�.7mptwemmtoog Depot cradal Coat tMhtlaaaas 25%of Contrad Amesud ddaee ofton. O t+tew Aw■cat n Zx4dit Ao�a tit d�r�CC OIyLY) -.r 7�+��f��3„�,fI, q7.2 AveAbblie creak:$ ML A RUX oM-Y) IudiceMe Payment M For RXILDalm- I!ALANCF DUS ON COMPLETION: �r 1M �►1 i tdaew one k appears oc reed: A sQ`k y� 1�+d t ,i ••By mylow LW ogee w&Maw Home Dept to 1^ I i1 c> the ref credit card for the deposit indicated. *when y�ptevide a check as payment,yon eadwin m Ohba D .'.. -6 m see hdbrmadw 80m Y...b.*m realm a ace-time Aw"Ab fund ennsft from your 0==t m to pawan the Wy—one. ¢heck tw w&as.win.we on 196n sabre thkon ysev check to FIU[,�C AHlhorlratbn Codes make ono deatratb bad vuelb,finds maY be vridrVewe eon D t PlaC d tart yea aW=M one aeon a the paymset is received,anti you WW not eaeeiva yrna rheas baelc. # pumbtteer agrees that,knasediahety upon completion of the worlr,PurcbLw wilt execute a Completion Certificate A Pay any balance duo. Futchnow albs agrees to be jointly and severally obligated and liable hereunder. Entire All This agreement and its attachments,including any B—oiag sgreeamut,contain the axapiete agreement between the parties std can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do-net sign tits contract before you react It You are entitled to a aompkteq tilted.-in copy of the contract at the time yon sign. Keep it to protect your eights. Do not sign a Completion Certificate before this proJect 1s complete. Law prohibits home repair eonascton ftm"questing,or aoeepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contrucL You may caned this transactives any doe pries-to midnight of the third business day after the daft of this contract. Son Notice of CaneeBatim for as explanation of this right. There will be a service cxwp equal to 10%of the pct aumeut If job h canceled by Purchaser AFTER the third business day,but BEFORE materials are ordered-There will be a service charge equal to 25%of the contract amount if Job is caatxBed by Parehaser AFTER materials an ordered. BY MYlOUR SIGNATURE BELOW,L WE UNDERSTAND THAT THE AMEEMENP MAY BE SUBJECT TO REVIEW OF MY+OUR CRHDTT HISTORY AND WE AUTHORIZE HOME DEPOT TO 'VERIFY AND REVIEW MWOUR CREDIT RECORD INCUItRED FROM INADVERTENT OMISSIONS OR ERRORS.AGENCY AND RELEASE THEM EM FROM ALL BY MYIOUR SIGNATURE BELOW,UWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. YWE ACKNOWLEDGE RECEIPT OF.A COPY OF THIS CONTRACT AND TWO COMPLETED COViES OF THE NOTICE OF CANCEI.LATIO "rr SUBMITTED BY: Doge: ACCEPTED BY: Date: Ptadbmr Date: Patdnea NOTICE;ADDITIONAL TERMS AND CONDMONS ARE STATED ON THE REVERSE SIDE AND ARB PART OF THIS CONTRACT B-1-07 Iwt4-247 C-SC Y&IM-SmechPle Yellow-Cushxnar Pink-Sales Consultant B •d X1 3 1317d3SUI dH WdB T c B GOOZ ZO 2nd lg O 0 g� , City of 'Narthaillptan Z $ � �assxc3�uscffs I� "n DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building ' Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 to act aS i:is/her construction sup,": ,• sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any persons) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appfleaut information Please Print LeLytblv Name(Business/Organization/Individual): Address: City/State/Zip: Phone.#: Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. � I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have g. E]Demolition working for me in any capaci�y. employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. F-1 Building addition required.] 5. We are a corporation and its 101-1 Electrical repairs or additions 3.❑ 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 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] -" *Anyapplicant tnatcneeKs ox must also fill out the section a ow s owing their wor ers'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: ' Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: VJU I I City/State/Zip: i Attach a copy of the workers' compen lion 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 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 for insurance coverage verification. I do hereby certify un the in nd enalties of perjury that the information provided above is ue and correct Signature: Date: Phone#: 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 Contact Person: Phone#: . • 4 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date I I 1 Signature Telephone 9::Re isteed#lome lm FoveciientGnn#racfor ,� „� ,,r �„ „ _, ,. _ Not Applicable ❑ Company Name Registration Number Address Expiration Date I �Q;+� �C► ©�Cf/y � Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.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...... ❑ 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-vear period shall not be considered a homeowner. Such-"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that be/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) Roofing Or Doors 71 Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [p Siding p< Other[d] Brief Description of Proposed Work: (I 4 D D Qlteratio^of g'xisfir,bedroorri Yes No - Adding new-bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa f-14 ( onse r� i ter:°addif oi� o xistin .i�nusrng;complete the= oIlow ng: 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. nimensions i 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 o. s cons ru ion wi i es - 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, C �(�' 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. 4/D--7 Signature of Owner Date I, I ck 1 ea UnIn-a- 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 pains and penalties of perjury. Print Name 10 If k/ Signature of 2r/Agent Date 4, +o►f11 ��� 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? --AI$— -- Dv^,"dT I��P�n,�, �1 YES �'�1 - ----.__--- IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES i IF YES: enter Book Pagel and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO Q 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 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �;: Department;;nse onlp — ity of Northampton Status ofPemu � £ �18vilding Department CurbCt lDnvewa Permrk 212 Main Street Sewe..SBptlaablItY k a � Room 100 bi�fy _ "k 1 1, COI Nd4ha'mpton, MA 01060 utroSefsofStructuralPtans " r" J phone 413-587 240 Fax 413-587-1272 PIoUS►te Pans ' " ;S OttterSpecGfy APPLICATION.TO t 69§TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECT!ON—I --S-1—TE INFORMATION-------7- - ' 1.1 Property Address: This section to be completed by office . Map tot Unit Zone Overlay District - Elm St District CS District" SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Lpp- G5@� �I tl1GD Ell yr. 11;� a� Name(Print) j Current Mailing Address: Telephone Signature 2.2 Authorized A t: jeC C Name(Print) Current Mailing Address: qa "d1�3 Signature Telephone-T SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building D� _ (a)Building Permit Fee L 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection _ 6. Total=0 +2+3+4+5) Check Number This Section For Official°Use-Only Date! Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date fi BP-2008-0163 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-4072 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: BUILDING PERMIT Permit# BP-2008-0163 Project# JS-2008-000243 Est. Cost: $12065.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq. ft.): 22520.52 Owner: BELGE MARY E Zoning: URA Applicant: HOME DEPOT AT HOME SERVICES AT. 62 SANDY HILL RD Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:811412007 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & SIDING 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 8/14/2007 0:00:00 $25.0019442 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo