Loading...
17C-256 ' HOME III+I mOYEMENT CONTRACT PLEASE READ THIS ' Sold,Furnished end Installed by Branch Nome:Beason Norm&Soatll Dew L213Ds3 . THD At-Home Services.Inc. d/b/a The Home Depot At-Home services Branch Number:31 and 33 908 Roatan Tw*ke,Unit 1,Shrewsbury,MA 01543 Toll Free 977903-3769 Federal M#75.2698460;ME l..ic#C 02439;RI Cant.IAA#16427 Cr Iii#HIC.0565822;MA Home t Contrachsr Reg.#126893 Insfslletion Address: 4{ , 1 I� ' 4 A�M�'.� � O10 City Stffite Zip Purchasers}: rr Wont Pbome: Hoteephone. Cell Phone: { Home Address: (if dittreot from Installation Address) City State Zip E-mail Address(to rewvr,prtpj:xx'owrt utieatt oAa and Home Repot updates: ❑I DO HOT wish to receive any marketing manila ftom The Home P" Praket Iaforrgeaj; Undersigned("Customer'% the owners of the totarttd at the above iustallation addncs,agrees to buy. and THD At-Home Services,Inc.("fbe Rome Depot")agrees to fumi de19 and arrwvge for the installation l Rttetallation of all matarWs described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Peyment Sumo Lary attached hereto and any Change Orders(collectively, �rt-- Job#: oaaatWW.- Products: $ ec s P. Proied,Amount Roofing Siding LJ Windows LJ JARdstion ❑criutetn,covens DEmm Dom© S 70 2 S-7 Roofing Si Windows Ll insulation S 0Gatters/Cauers❑EtnryDOMS El Rooting Milling U Windows lnaulatran $ 0(3unars/Covers D F,tdiy Doors n Siding mdm U l,Wlaticn S ❑c utters/Covers Olmtry Doors 0 — Mlahoumn%0aposkof Contract AWNWdulapau00mutioadthiscontrool, Total Contract,Amount S Maine Poerhsasra may ad dW**am lion one-Wrd ofine Ceatr adAmount customer agrees tba;immediately upon completion of the work fbr each Product,Customer will exmute a Completion Certificate (one for each Product as defined by sm individual Spec Sheet)and gay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable bereuader. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if Tile Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the horns,envirownwitel hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to corrVate the job was not included in the ContracL ,�,g_vment Snaamervr The Payment Summary# 60-23-70 included as past of this Contract,sets forth the total Contract amount and payments required fbr the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You ars oddtWd to a completely tilled-in May Of ft Cmtraet lit-ft flare"a eiC.•Do.goY n>t.Cgmpla�tim cftificiibe:(note there is one Comp"on Certificate for each listed Product as dented by individual Spec Sheets)before work on that Product is complete In the event of tertninatim of this Contract,Customer agrees to pay The Home Depot the casts of materials,labor,CIPOO es and services provided by The Hoche Depot or Autborized Service Provider throne the date of termination,plus any other amounts set froth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE !HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acs and A tg,�gg• Customer agrees and understands that this Agreement is me entire agreemenrt between Customer and The acne p�pot wit regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written{,relating to said Products and Instollatim.This Agreement cannot be 40wed or amended except by a writing signed by ofomd and rTheHo a Cott. tonneacknowledges and agrees that s read,unda'dands,voluntarily accepts the Submi 104 Customer's signature Date Sales C s Sigriatnre Date Telephone No Custornee's Signature Date Sales Consultant License No. CANT) bN: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT' BY MIDNIGHT ON THE THIRD BUSINW DAY AFTER SIGN NG THIS AGREEMENT- TILE STATE ' SUPPLEMENT ' ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUST'OMER'S STA'T'E. 140TICK:ADOMONALTBRMtS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND A**PART OF THIS CONTRACT 06,10,15 WWte—Bo0whF91e Yellow—Customer �. 6500 V'antagePointe FBC DcuNe-htn,:g tfn'P 1:Qu Glass Argon Lit'-re No Laiieia:ed Glass With G,ds Laliws de doileguillotna•Vni!o•3.18.mm, Lidrio Argon Lo=v�,;-E-Sin R-rfg cmm�;, vid3:o lar„inado-Con reifts CPD-.SSP-A-44-21042-00002 07-75 DH ENERGY PERFORMANCE RATINGS EVALIA4cION DE REPi mmcro ENERG61'tco U-Factor i Soiarhleat Gain Qmftient , 0.29 1.05 _ 0.24 ADDITIONAL PERFORMANCE RATINGS EVAU)ACM SiAI.EtAEMM A DE RENDMNTO Vis�bie Trans�nce i is s s& 0.45 't-a. ntl%- &SAM 0a!'W"V ptice6ls�F4C prxa�+��ehta WilPrOM4;o rrar-&tfpc—JrpW dM2.�.;:ad:ofa Lamedsetffamr,:QmWRe-WWLxe&nd a x?:a xxs-r.-g-,t aes n rz,'Y.enzm:a a�;chx»sr8 does�s•'kc+ai^ar�Ee s Of aR4 D:a�x artis:��c:aa:.amai Ta:svfatlra!a 5i�tu.��a^,a��r�iu.:pr.`ar.:2f;,a inb.-�saE�^:a�*.:,5�xy ub.Y:a�a cx sm[ere3 a..�•;r„3^car;qu Pn,ca::R'r�:�^=-i�'s.:r����sra a:tr=^a:�re z��u.:R�;4c3i�i F�xfi.�as'�tcr� W33�9+.i�P.:say.Ce9'rxi�fYi4�crw�,paba$y ca cu.�:a;�<s a.:.ae.�s;=;r:isr..�a�psi=:_s+�CS''-'..tfnC ro:+�Ki•�ia :r r't7ai�i nn fete NGNLYS�a ad a on ssc ase a�W 3 An at fc t?+'aoic da oara elm vmva am er sr Urit quaffies for ENERGY STAROregi*s):Northem, Nora Gentral,South Central, Soutttem. t STC:29 Cits�t�ai IND.Rein 00lGlass PraS�uAi-W25 DP:}25f—25 Tested Size:43"x 30" Ronda ProductApp-ovac FL5i67 Appicabte Test StandmAs): ANSUAAMAtt+WWDA 101A.S2-97,AAMA ANDMAPCSA 101A.8.21A440-05,AAMA/WDMArSA 101A.S.2/A440-08, A440SIL09 Canadian S4* r 8858790101 80333 HS Harvard 6400OW i zed-s�.z+:.,r=.ussb:eEi'�?Y'ST�-eaies.�c!ea:::��revsi:;nuw. �gts;ar.�:==. GLoje e"ebqueta; -An zemmm ENSIGY STAW P&-a r3s eceze 4a esta rye!spew ystac_¢v. The Commonwealth ofMassachuseft Department oflndashW Accidents Office of Invesdgadons 600 Washington Street Boston,MA 02111 www mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciam&hunbers ApPlicant Information please print 'b1 Name(Business/Organization/individual): Address_ . Jb%&& Are you an employer?Check the appropriate box: 1.g] I am a employer with Tj 4. [J I am a general contractor and I Type of project(required). 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. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition worlang for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp-insurance.1 requftvd.] 5. ❑ We are n carporation and its 10.❑Electrical repairs or additions 3.❑.I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12 Roof repairs insurance t c.152, §1(4),and we have no ❑ m4 employees.[No workers' 13.[]Other comp-insurance required.] J . *Any applicant drat checks box#1 must also fib out the seetioabelaw showing ft*workers'CDMpeosation policy information tHo meownets who submit ttris affidavit indicating they are doing,all work and then W=outside coneacton must subaorit a new affidavit iodicating swX $Contracts that check tins box must attached an additional sheet showing the nana of the sub-conhactors and state wbcdm or not those eWties bave employees. If the sab4maactors have=ployees,dray must provide their workers'oomp.policy number. I am an employer that is providing wrk=',coAWenf anon insurance f my emphWem Below is the and job site information. or 7 Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration I)ate:_ �'1 Job Site Address: �vn � Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Palm 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify avOlpen of perjury duct the information provided above is true and correct Sim-afore: Date: Phone Official use only. Do not write in this area,to be cenWlewd by rrty or town ofjwW City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Pb mbiug Inspector 6.Other SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction SuverVisor, Not A`pplica/b}le/£ / Name of License Holder: License Number Addr� � Expiration Date Signature Telephone 9.•Redistdreo.$onib.lm ""vementC ''actor Not Applicable £�� ComRany Name �� Registration Number Expiration Date Telephon�'�� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.,1 62,§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...... £ ll. Home Ovvner.:E16"tion 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 ❑ Replacement doves Alterations) ❑ Roofing ❑ Or Doors . Accessory Bldg. ❑ Demolition New Signs [lam] Decks [C] Siding [0] Other[0] Brief Description of rppp �Mo f-4 !/ Work: /t/ ,/.Y� Alteration of existing bedroom Yes No Adding new bedroom es No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. If ke, m house and or.adda on to°existing=h"ouslng;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 as Owner of the subject property n r hereby authorize'" to act on my beh in all matters relative to work authorized by this building permit applicatio . Signature of Owner Date as Owner/Authorized Agent hereby decl re that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed unde paii4and penalties of Print Name Sign atur wner/Agent 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 t —� Frontage Setbacks Front _--J� � Side L: --=— R:= L:�L---...:� R:= Rear Building Height � � Bldg.Square Footage –`-_1 % Open Space Footage I % � --- (I.ot area minus bldg&paved i f._.....-...1 �� parking) #of Parking Spaces s Fill: I ' (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES Q r--.. IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (D DONT KNOW�0 YES Q - IF YES: enter Book } T w Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q 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 0 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 Q 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. J — �iii`� �'3 xr�".,,.�'��3epantirberlt`use only k, , i.) tii tc R , kNyHEi LW� �G � a � a i5 V � 5� Y 4d�Y° ik! City of Northampton � atusl4i? Prrllr7 s# s�;� Cr�of i � 'L a FR Buildin g P De artment ctrrGut/CtteuvayPerrrtitY � 212 Main Street NU r, La,Y", .�,y,� Room 100 1NaterelCAirallafilht ''�t� 'b e [t ' i�!'P ti sk+k��Sjw YP4, � ir.il��tl��i�" L �kY six y ti :11 �t,i,th Ikii"� Northampton, MA 01060 TWaSts;dts#r¢rc�ral Pfa€� ;, z 3�4 �i il n w , phone 413-587-1240 Fax 413-587-1272 PIoflSlte Plans rI #F hu rt 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 i .i, r Ma J t Lot Umt Overlay District ' 1 i Y EIm.St-District CB Distract SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record: ja Name(Print) ` '�(� �1 Current Mailing Address: �L (✓� / y� Telephone Signature 2.2 Au#wized A ent- ►� Y�� - A Nam (PH Current Mailing Address: ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building / J��i (a) Building Permit Fee 2. Electrical ``BTU (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) Check Number This Section For Official Use Only Building ermit Number: Date : 9 Issued: Signature: Building Commiss loner/Inspector of Buildings, Date 46 NORTH MAIN ST BP-2014-0816 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-256 CITY OF NORTHAMPTON Lot:-001 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-2014-0816 Project# JS-2014-001404 Est.Cost: $1640.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size(sq. ft.): 22389.84 Owner: BRILL ELISSA Zoning.URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 46 NORTH MAIN ST Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON:112212014 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: FeeType• Date Paid: Amount: Building 1/22/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner