24B-073 74 BARRETT ST #210 HORSE IMPROVEMENT CONTRACT
PLEASE READ TEO
Sold,Furnished and Installed by:
Branch)Name:Boston Nortli&South Dlteal z THD At-Hume Servirxa InC-
d/b/a The Home Depot At-Home Services
Branch Number:31 and 33 908 Boston Tumpike,Unit 1.Shrewsbury,MA 01545
Toll Free 877-903-3768
Pederal ID#73-2698460,NW lac#C 024$9:RI Cont.Lic#15427
�i CP Lic#HtC•0565522:NA HoiLXVW ntractor Mg.011266893
Installation Address: �q t"3FaQ Q.� 1X���2-t 0 i�TV
City st>i c� zip
purcbaseda}: Work Phone_ Htme Phone: Cell Phone.
[ ] [ l C 3
Home.A.ddress:
(If different from Installation Address) City State Zip
E-mail.Address(to receive project communications and Home Depot updates):
1 DO NOT wish to receive any marketing snails from The Hoare Depot
Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy,
and THD At-Home Services,Inc.("Ttte Horne Depot")agrees to rurnlsh,deliver and arrange for the installation("Insilallatlota")of
all materials described on the below and ou the referenced Spec Sheet(g),all of which are incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached bemto and any Change Orders(collectively,
"Cmutrace):
Job#. a.—I Products: sftc Sh s # ect Amount
Roofing 5idiog Windows LJ 1na0-io0 S
EIGrutters/Covers ❑Entry Doors ❑
Rooruig Siding El Windows insulation $ '
0Gutters/Covm ❑Entry Doors ❑�,_
Roofing Siding Windows tasulativa $
QGutms/Covers dFntry Door,❑
Roo£tns OSiding'm Windows LJ lnsuladon $
❑Gutters/Coven ❑Entry Doors 0
14fiim=25%DepmiiefOWradAmmmdueWataecubonafthis Total Contract Amount $
MA%e pumas,&, 'M deposit mm tbm ooNW of the Contract AntMIL
Customer agrees that.immediately upon completion of the work for each Product.Customer will execute a Completion Certificate
(one for each Product as&-fined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder. Ah&s
The Home Depot reserves the right to issue a Change Order or termitlate this Contract or any individual Prodaet(s)included herein,at
its discretion,if The Home Depol or its authurimd;service provider determines that it cannot perform its obligations due to a structural
problem with the home,enviromnetttal hazards such as inoK asbestos or lead pains,other safety concerns-pricing errors or because
work required to complete the job way not included in the Gtmtruct•
payment Sttnln m: The Payment Summary# (5 5 E�, included as part of this Contract, sets forth the total o�
Contract amount and payments required for the deposits and final payments by Product(as applicable). n
NOTICE TO CUSTOMER
Yon are entitled to a completely Mtedmin copy of the Contract at the time you sign. N not sign a Completion Certffrcate(note_
there is one Completion Certificate for each listed Product as defined by individW Spec Sheets)before work on that Product
Is complete.
in the event or teratwtation of this Contract,Customer agrees to pay The Horne Depot the costs of ttraterisls,labor,expenses
and services provided by The Home Depot or Authorized Service Provider through the date of terminatioft,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DBPOT MAY WIT'HII LO AMOUNTS
OWED TO T13F ROME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
gcceptanee.and ortzation: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The fame spot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either
oral or written,relating to said Products and Installation-This Agreement canna be assigned or amended except by a writing signed
by Customer and The Rome Depot.Customer ac)tnvwIedgcs and agrees that Customer has read,understands,voluntarily accepts the
terms of and has recei ved a copy of this Agreement.
Accepted b Submitted by:
X �?_a-Q— 4 _)� X
Customer's gnature pate Sales Consultant's Signature Date
X Telephone No-
Customer's Signature Date Sales Consultant license No.
CANCEI,I�TIOIN: CUSTOMER MAY CANCEL THLS (asavnti�e)
AGREEMENT'WrMOUT PENALTY OR OBLIGATION
By DELIVERING wRTTTEN NOTICE TO THE HOME
DEPOT DY MIDNIGRT ON THE THIRD BUSINESS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED MRETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRMEII BY LAM' IN
CUSTOMER'S STATE.
N(rr=:ADDrl'IONAL TERMS AND CONDITIONS ARE STATED ON THE REVKRU SIDE AND ARE-PAR I OF Tnt3 C4?t rRAC7t
1i_o&13 White-Branch F11e Yellow-Qv0xtier
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Remove label.after final inspection;SAVE for future reference
Weather Shield .
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NFRC Model 8108 Double Hung Operating
Alum clad Thermal Frame
rr�rt>�rerrsa�:� 3/4 inch Glazing ,
rioting ZO—E .022 Low—E
Argon Fill Grille in Air Space
ENERGY PERFORMANCE RATINGS
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ADDITIONAL PERFORMANCE RATINGS
Visible Tfai stimuce Condensation Resistance
0.40 0
Raaufec9sror stipulates flat these ratings mbmt IN applicable NFRC proeedum hr
dsiemdning whole product aoergy perrannsnce.NFRC ratings are delemdnad br S"'
hod set of anrironmenbr Condition and Specific predict sizes.NFRC does act recommend
my proddst and-does not wenant the sualsbigty of anyy product for any speclec ute.
consult manukcbitees literature to other product perfoansoce inbmneon.
www.isfrr..org
Meats or exceeds M.E.C. C.E.C.,and LE.C.C.Aar Infiltration Re uirements
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The Commonwealth of Massachusetts '
Department of Industrial Accidents
Office of Investigations
I Congress Street,Suite 100
IF Boston,ASIA 02114-2017
www.mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Alpylicant Information Please Print Leeibly
Name(Business!Organizationnraividual):
Address:
a
city/State/Zip: !f1 C - VPhone
A�re,, u an employer?Check appropriate box: Type of project(regtrired)-
1.Lam`I am a employer with_n_ 4. I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. E]New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. [I Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers'comp.insurance comp•insurance.t
required,] 5. [] We are a.corporation and its 10.0 Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 1 i.❑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.]
sAny applipmt that checica Moot#1 must also fill out the section below showing their workers'motion policy information.
t Hoaeawnets who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit anew affidavit indicating such.
ors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those aatities have
employees, If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is prnviding workers'cosrpon insurance for employees. Below is the policy job site
information /V/M/Insurance Company Name: '
---Policy#orSeif-�Lzc::#:— r� 7EXpiration Hate.
Job Site Address-__ LA.1 L City/State/Z ip. �t
Attach a copy of the workers' compensation policy declaration page(showing the policy number alii 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 5250.00 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 hereb certi u e o the in ormation provided above is true and correct
Si I D to !.7;-7-
Phone#:
pf,jtciat use only. Do not write in this area,to he cosrpleted by city or town official
City or Town: Permit/License#
9
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sup sor: �� Not Applicable F
Name of License Holder: /vt
License Number
Address �— Expiration Date
Signaturig Telephone
w.: ..
9.Re ered.Home I `Movement r.nfiracto ;._, w_ „_.. ,,,... ..,..., Not Applicable £
ist
Company Name Registration Number
�,477 77?Kt dr s Expiration Date
Telephone
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 per
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 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.
• z
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement W' s Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[O] Other[0]
Brief Descriptio ropo, d , _ G�C�r� lvi /
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa:if Newhouse and or addition to ezistnq:hous>Ing`coriiplete"ffie fallowlna:
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 -
C
I ,as Owner of the subject
property `
hereby authorize ,' J
to act on my behalf, in matters relative to work authorized by this building permit application.
Signature of Owner Date
p� 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 a ins a penalties o erjury.
Print Name
f
p �~
Signaturo"f Owner/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
Frontage
Rear
Building Height
Bldg.Square Footage 010
Open Space Footage %
(Lot area minus bldg&payed
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Vahance/Rnding ever been issued for/on the site?
x_� �~�
�
NO �~�~� \Y «��DDNTKNO YES �~/
IF YES, date issued:
IF YES: Was the permit recorded at the Registry ofDeeds?
NO
C) DON / xnuvv 0 YES
IF YES: enter 800k Page[ and/or Document#1'
�� ��
B. Does the site contain a brook, body ofvvatprorwetlands? NO �~��� OONTKNOVY «�� YES �~�
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �~� Dbtained �^� Date
�~� �_� ' .
C. Do any signs pxis �� ��t 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 0 NO 0
|F YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre orinit part ofo common plan
that will disturb over 1acre? YES NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
t
ity of Northampton 5tatus,of Pere,t
f ����
WR ' g Ilding Department Gt�rB"CuUDri�teway Perrrsi# j �-
212 Main Street SewerlSe__t cavailabllltFy 4 1.
Room 100 Mffllg la�lllt}x
Poft ampton, MA 01060 g;ii nu r rc#urai q.
pt 5n F -587-1240 Fax 413-587-1272 P[ot/Site Ulan"sF `t 'ar k n
Otiie �
�Tt ��,
eC �kl t M1 F } £;k
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
d
1.1 Property Address: This section-to be complete by office
r
L /
�"`j� j 1 T i
/ / 14VI dZ�� Map Lot Umt
k
! Overlay Distract -
..
Elm St Distrvct CB Distract
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of cord:
Name(Print) Current Mailing Address: n
''!% �� �/� Telephone
Signature
2.2 A uf4orize ent: /�0 A
Name(Print14 14 //� Current Mailing Address: _ G
Sigtature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
74 BARRETT ST 210 BP-2014-0958
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B-073 CITY OF NORTHAMPTON
Lot: -000 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-2014-0958
Project# JS-2014-001663
Est. Cost: $2552.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 082485
Lot Sizes . ft. : Owner: BAK ROSE
zoning: URC(100)/ Applicant: HOME DEPOT AT HOME SERVICES
AT. 74 BARRETT ST 210
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON:311912014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 2 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 3/19/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner