36-045 (2) 'OM HILL DREW FAX N0. : 413-315-3550 Apr. 11 2006 07:08AM P4
HOME IMPROVEMENT CON"TRACT
Sold,Furnished and installed by'
Branch Name: �' '� Date: _y �� U THD.At-Home Services,Inc.
d/h/a The Home Depot At-Home Services
��66.7b 345A Greenwood Street,Worcester,MA 01607
J
Branch Number: Job#: Z Toll Free(800)657.5182; Pax:505.756-2859
Federal II)n 75-2698460 MI-:Lice C:024:9 RI Cont.Liu:1 16427
CT t.ic#565122; Y1.4 8omc Imptovu»cnt Co¢tractor IZc�.as 26893
Installation Address: I 1 W J
X)e,14 � caczCx� 'u-4 O(°�z
City' State Zip
Pun:haset s): Last S
Di pits of Dri�cr's Lit-0&Ez .Nlu/Yr Work Phone! Home Phone:
<3 7 e5
I ) (
Home Addmis: _
{f different from Installation Address] City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Project Lnformatinn: i/WefYou("Purchaser") the owners of the property located at the above installation address,offer to
contract with T•Tome Depot U.S.A_Inc.(°Ho e Depot")lafurnish,deliver and arrattge for the installation of all materials as
described on the attached Spec Sheet W 2 K y 11 ,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,Rome Depot determines that it
cannot perform its obligations due to it structural problem with the home,pricing errors or because work required to
complete the job was not included in the Spec Sheet or Contract.
DEPOSIT PAYMENT OPTIONS
(Subject to fired verification aneJorcrcdit approval.)
Sh! i. Check,Cashiers Check or US Postal S rviw Money Order
CONTRACT AMOI:NT S VV t (Made payable to The Home Depot).
*LESS DEPOSIT S 2. C.-dit Card'an Nor other payment options-Circle One Below
Visa MasterCard Discover American Exprass
BALANCE DUE Home Im rovermnt L,o The Home Depot Credit Card
ON COMPLETION 5_.333 8 7
New Account tJ F.zivrinE Account (IIIL&IIDCC ONLY)
Minimum 25%of Contract Amount due upon execution Avanuhle O'edlt.$ 49'04C:l(J (HIT,&HDCC ON 1,Y)
f this contract. [�
n«tn:6o3 5�za��g32 ��p-Date:
Indicate Payment Method For Name as it appears on carts,
BALANCE DUE ON COMPLETiON-. *By my/our signature below,I/Wc ag=to allow home Depot to charge the above
referenced emdit card for the deposit indicated.
Cardholder's Signature flats
66 3 5 T+?+�A� 7 Q 3 O 3� HIL or HDCC Authorization Codes
l ! De osit I Final Payment
# { o � ' # 1\ 0576
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder,
Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement
etween t to parttt s and can not be amended or modified unless in writing m a separate agreement signed by bot L parties"
NOTICE TO PURCHASER
On not sign this contract before you read it. You are entitled to a completely filled-Ln copy of the contract at the[sine you sigtr. Kccp;
it to protect your rights. Do not sign a Completion Certificate before this project is complete: Law prohi2,ouiitm-`rep'F
conn•actom 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 in"v cancel this transacrian at am time prior to midnight of the third business day after the date of this contract See Notice of
Cancellatiun for an explanation of this right. There will be a set-vice charge equal to 25%of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
!1Y NIY/OUR SIC}NATURE;BELOW,I/WL ACIRI.iLi TO 3rd 1301IND BY TI1L'FERMS OF THIS CONTRACT. YWli ACKNOWLLIXiIi
RECEIPT OF?.n COPY OF THIS CONTRACT AND T O COMPLL'rEe COPIES OF THE NOTICE OF CANCELLATION.
8Y MY/OUR SIGNAI URE BELOW, I E INf _Rs,rAND THA"C THE A(-iRFFMFNT iS S11141R.C;T TO RF.ViPW OF MY/OUR
(_'REL)IT HISTORY AND I/WE AU'1'H I ' H ML' DEPOT TO VE'RIF'Y ANI)REVIEW MY/OUR CREDIT RECORD wrrH AN
INDF.PENDENT CRI.011' RFP 7RT C' ELEASE THEM FROM ALL LIARiLiTY INCURRED FROM
INADV'7RTF,N'1'UM35ti10 S U S" GN TH CONTRAC THE ARE ANY BLANK SPACES
Oj
SUBMITTED 8Y: ate: �� d6
Sales C.oaa "ni
ACCEPTED BY:. Date: [4
Homcnwncr
Date:
Homeowner
'NOTICE:_%DD1TIONAL TF,RMS,CONDITIO'NS AND WARR ANTIE•S ARE STATED ON THE REVERSE SIDE AND ARE PART OF TIES CONTRACT
Whim-Braach File Yellow-Ctsionier Pink-Sala C�nail:ant
0.27-05 C-SC
O4�t1AMp�O v,
$ � jl�itasaAC3titsstts -
DEPARTMENT OF BUILDING INSPECTIONS /=
212 Main Street * Municifal Building
INSPECTOR Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/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"twig-anu y
—
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�ui1 mg department for the City of Northampton wants-any person(-s)-who-seek-to
use the home owner exemption, to act as their oven 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/footines(before backfrll),
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
L understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building perrrlit,
- is sued-to me. :
Date
Address of work
location
pR `E (rik) OfQ ParfIILIlllutoil
Il � I�i7 iRCh RL[It6• � _
DEPART MENrT OP BUILDf)�,'C INSPPCi IOt:S
j 212 Main Strcet Nfunicipal Building
Nor(hampton, TTass. 01060
WORKCR'S CON'T NSATTO.N GNSURANCF AFI'U)AA,
(li c�nsxJperm�ttcc)
With a principal place of businessfresidence at: - -
( ty/stasdap)
do here certify, under the pains and penalties of per3ury, 1:11 I - —
{ Vol, am an employer providing die follo.ving;%vorircr`s colnocas"ion
cover-age for Inv
emplovec:s Nvorlk�ng on this job:
-CPS( OAT 153/1 k-7
i =ConrZv) CPolic: Nu--ter) :pir` or }
i
( ) I am a sole proprietor, general coorraczor or homeowner (c c;e one) and lizve hired
the conractors lined below wbo have the `011owing worker's comnen– don pokier
I
I
;
l+� c of CO2- =CiDr) (InStranr COIADIS]}'t�GUC� ?�tilII1�C:) �C>Sr'J SQn 11111
1
(Name of Cono-zclor) (Lnsurznczz ComDaa:iPo!ie} \u>7ccr) (iipiriion Due)
(Name of Conn-aao:) (t»n Compan}/Pot;cy Numb-r) (Expim600 Datc)
(Name of Conaaetor) a=uranc-- Compaay/Policy Numb`r) t�t�irtion Date).
- (aIIac:]zd�i�ooJ acc�i_-ti•to mcud=iarormL-ioo
I O I am 'a sole-proprietor and have no one working for me.
I� ( ) I am..a home owner performing all the work myself.
INOTE:pl=..be sw Lrc[fi*•ktjC hC OK�JCL]Ktyj C$P1oY pCLO=La da �- —=joc c rc a r _ of, .
not more that'ra tiara is��ui�the bomoowac raids a oa the p vtn t�zppurL-==Lb=cLo • we —lty m.id-mt to Uc
citploy unG=ttx Dui z{z --.,:cxi A=(GUI 52-=1(5)l =PPtin.Soo try i bomcoa-os fc «pc-mit r._-y cvid.•mcK tl`c
1c-57.1 e-"^s,or rs�...-ioyor wader dso wortidi ,,y�pa filer_
I uadctx�.nd th..c a Dopy of tLii ctcm.sx may be ror�.nrda.d zo Lbo pop,rtmco:of laduxs;al Ac�dcra'Off oe oC t�Cx Lb.
covea�e"eireslioa rid th.:t L-ilt�w s.oarrt fovr�������2311 of MOL!57 m Icd to the imposition oCciaiaal pcasltie
eoasi>:cg oC a ftac of L:p to S 1}00.00 aadrOC or up b Doc ytr sad civil Pmiltio in 6c form of a Stop W ori;orde and a
fim of 5100.00 d y c
IFor u-only .
pCSRUt NuMbCT _ -
- 1IL3PZ
{ — tpla of Lic=sccfPcrmiu= e J
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SECTION f8-CONSTRUCTION SERVICES +
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
9�ReglS�ered�nle�inDr emeionl� c i i r � +a s� Cana � •
Company Name ` Registration um r
Address Expiration Date
7 Telephone
SECTION 10-WORKERS'COMPENSATION i1NSURANCE"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....... p/" No...... ❑
1
it
On
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 buildine 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 As*iotated,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
r
1
SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑:- Replacement Wjpdows Alteration(s) ❑ Roofing ❑
Or Doors 2
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[Cl]
Brief Description of Proposed
Work: °� 416 ��-
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa }�I�eW=loo semen >l �dcora�tc� aclstinc>�,tioraslntt.:�orxtplet�.tl�e�o�to�rrina:
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 OWNERAUTHORIZATION-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 all matt rs relative.to work authorized by this building permit '/J L9/_0 4
Signature of Owner Date
as Owner/Authorized
Agent hereby declare hat he state-- s a reformation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed and a pains d pe alties of perjury. '
[Print caner/Agee D ate
Section 4. ZONING All Informati6h 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 ' 1
Setbacks Front
Side L:' R:= L:'� R:-
I
Rear
Building Height `-- — 77-7
Bldg.Square Footage I
Open Space Footage % q---
(Lot area minus bldg&paved
parking)
#of Parking Spaces I 1
Fill: I
volume,&Location) E'
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:`
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book 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 Obtained Date Issued: s_
C. Do any signs exist on the property? YES 0 NO I
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0
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.
.Ir ,
J .---� °, - rAepartmenl. lse only �,
of NorttPampton tatiLOetn71L" rc t � a a
ii Ong Department �
1 Main Street ti
1J
c�om Fl
O 100 e ��� ��
2� ort ampon MA 01060 e ; a
phone 413- 7-12 0 Fax 413-587-1272o�� a �
ffla
NMII
M.
APF �1 t STRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
IT
SECTION 1 -SITE INFORMATION
This section to be completed by office --
1.1 Property Address: r"
s �
• ,,��F� ,�Ot 4 ti.a w, f Unto
"Tone h Ove�laybistnct
4 Elrn 5t Dis3nct CB Disinct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _
I Alto �e,
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authoriz ent:
Name n Current Mailing Address:
Lki 33sd/00
Signature—I Telephone
SECTIO 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:
i
Building Commissionerlinspectorof'Buildings Date
r File#BP-2006-1114
APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 345 GREENWOOD ST UNIT 1 WORCESTER (508)341-9401
PROPERTY LOCATION 11 WINCHESTER TERR
MAP 36 PARCEL 045 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
--f3uilding Permit Filled out
ee Paid A 1 _Z^7 6 ES-00
Typeof Construction: Replacement Windows
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included• -
Owner/Statement or License 126893
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
V 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
cq4(� t012
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.
1) 4 U _ 'ERR BP-2006-1114
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map Blocl5.1*4, 5 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Cate og ry: BUILDING PERMIT
Permit# BP-2006-1114
Project# JS-2006-1645
Est. Cost: $5013.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sg. ft.): 10018.80 Owner: ANDREWS KENNETH R&BARBARA A
Zoning: URA Applicant: HOME DEPOT AT HOME SERVICES
AT. 11 WINCHESTER TERR
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON:411912006 0:00:00
TO PERFORM THE FOLLOWING WORK: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 4/19/2006 0:00:00 $25.0012276
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo