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36-279 (3) Sold,Furnished and Insstalled by. Branch Name: Date: G t t THD At-Theme Services,Inc. g S d1b/a 00-Horne Depot At-Hume Service -�. 345A Grts�voed'Street Womater,NSA 01607 fig[ x✓C °J Branch Number , 3x6#c" Free 00 f>57=SI82 Fax:508-756-2859 tt J Faderal ID#75-26 0 ME Lie if C D2439 R1 Cont,Liar l 6427 CT L.ie R 565322 MA'IlDtne Imprevemmt Cantncior Reg,#126893 Installation Address: EEL, a L-'!6 Oita d>t0 2. State zip last 4 Digits jyrivor's Pu reiaaesFtsj: )3c.0 Jk E tlf*1Vr: Work Phone: Heave Phone: Home Address: (117 different from Installation-Address) �Ci State zip E-matt Address(to receive npdatis and promotions£tom"Tbe l"o Depot): M Project Information: V Wgi� W.("Purchasw),the owners property located at tt .ab rve installation address,offer to contract with ThID At-HomeSerNiccs,Inc.(Ha a Dapot'7 ish,deliver and artav�gp far the installation of all materials et;described on the attached Ipec Sheet#__y __ incorporated 5eteirr reference and made a past'hereof. Home Depot reserves the r4btt fp caned this contract if, epoctlaa sf the j ,Horne Depot determines that it cannot perform Its amigati its 46e to a structurall proble ;rte home,pricing e*ure or because work required to complete the job was,not irioud#9 in the Spec Sheet or Coatn r DEPOSIT'P 'YMENT OPTIONS „ (Subject to Dud mr�ystian eidloi coedit approval.) COI d[i T AliIOUN f< "S. 1. ",Casmas chwk Of US astal Service Macey tgrder ' payshfe to Ta'atotna Llepot). tl JB DEPOSLt 2. Dmfit.Caed-wdlor otbcr payg Dint eptiom-Orde one Betae CE DM Waa WsbmCcd tksftmr American Ex== CtkChN �ETIOt+� $r r TI Hente caper Hatrx Improve" taw dome Depot CroLt j'M 4*ww4f a o(Contrfrt Amount dae atpea (IN, Am6ust [I ttsisth Ig Aeenaot (HI gsecndoa oft contract Ava(atbhCtetni:f __^ (ArAL 4t.MDCCC ONLY) t' yma Me1bod For Am BA�LANCIL DUE OlY4MMPLETION: N as i[appeaes on rnd:_„ •• mytour signature'belon;,I/We agree to allow Horne Depot to �''��-j Ch ge the a ve rcferarc slit card for the de/p�ositt/in�d' ted. •When you paavide a cheek as p�'ghtatt�.yeu authorize us oifier - iF' 7 V Q b use iefottuetion float Ytwr s m$ce s ono-time slocavttk tc Moisture' tttc &nd tnrufor ft eh Yevt w-mw to prtlrm the payment as s check unwcum.when Na a*istran odoe timer Yaw cheek b mate,sr.de"rome fiord trances;f ash�usay he ad&dmwn Cram I t or HDCC''.utha Codes your account as soon as the IsYmettiis 2" 4 and you will not it Final payment� Twove yea check back. .IDS. y, Purchaser agrres that,imie4ately upon completion of the wo Purchasesr will execute Completion Certificate said pay any balance due, Purchaser alm)9*re4 W jointly and severally ligated and liable hraruns . Entire A>3rceases1 This ag aemi�rt and its attachments,inn! ing any financing agreecrett,contain the complete agroemcm between the patties[end t:.an trot be amended or moth Bed unles in writing in a separate agivernani signed by both parties. NOTICE UItC11ASCR Do not sign this contract btdori�;you read it. You are call ad to a complettdy tilitd4n copy of the contract at the time you ftm Heap R to prot yttilr tights Do nut sign.a ocupl4fion CeRitteatc btore this project is complete. LAW probibits home repair cot#,nctdtts from requesting or ting.o Campledon Certificate stgnetl by the owner prior to the actual completion of roe walk to be performed under t e contract. You may cancel this trausaetioa any time prior to midaigl of the third business day After the date of this contract. Sec Notice of Cancellation for an explanstiou of this right. here will be a service charge equal to 10% of the contract aasount if job is cancelled by.Purchaser AFTER the third usiness day,but BEFORS materials are ordered.There will be a service charge equal toi,2504 of the contract amount i job is cancelled by Purcha"r AF ThTR materials are ordered. 8YMY(OURSIGNATURE�B WW,IIWE'UM)ERSTAN THAT 7 11E,AGRF"EMENtN1AYUESUBA?CTTOREVITW OF MY/OUR CREDIT IIIOORY AND I/WE AUTHO HOME. DF,POT TO YERAY AND REVIEW MWOUR CREDIT RECORD W11 It AN$INDEPENDENT CREDIT EPORTING AGENCY AND RELEASE'THEM FROM ALL LIA$I.LITY INCURRED I1W?4:JNADVERTENT OM1SS) NS ilkaRRORS. BY MY/OUR SI(JNATURLrBl W,VWE AGREE TO BOUND BY THE TFE'i'�v' [S OF THIS CONTRACT. IIWE ACKNOWLEDGE REC..Ift OVA COPY OF THIS CO RACT AND TWO CO ETED COPIES OF THE NOTICE OF CANCELLATION, SUBMITTED BY: Date: ACCEPTED AY: Date: aer NOTICE.Al) TiONAL TERMS AND CDN I P1( A*E STATED ON THE REVERSE 91DE AND ARE PAR . P 7 tCONT1tAG7' 9-21-07 tav 4 2.47 C;-SC '=0 Whim—8tanah-F1ts Yal —CuMarrea Plnk—Solos CoribWterk Xb� 13C21351j1 dH Wd�.E=fr 800Z 10 I nC a _nc.,y ..:,.... �:{ -- Brah Nuue: `��D ate. /Q� �, 'Fi,�A1-Home Services Inc. We me'iirjiot At-;Home'Se"Irm c , 345A. nod Sored,Worcester,MA 01607 Branch iWttlnber. Iota►k Toll14ree. 00)657-5182; Paz 588-756-2839 ..Federal M 11:73.269 WE Lic#C 02434.*fit M-ULV 1642? Gt Lic#365522 MA `me Smpravtrneat Cann iCmi lteg,#126893 Installation Addrieas s'- - +zip. Ihrrcaasoris): t.wp;d-9lgha, 's. _W*�k F} u do a Pkaue: Address:_ __ _ { from erent Installation kildtessj ^— Ci State Zip _ E-mall Address(to Teceive iodat6 sari promotions from The tt t)rpotl: Project 14%rmwtion; the owners oft Tty located at di .above installation address,offer to coot uct with THD At-Honto$ ,Inc.("j nt�lC po") f deliver and for the installation of tell materials as described See Pie attached ptx_heert N__ _,incotpora�d herei r:feretteo and made a pan hereof, S. ,y Rome Deepot reserres the iftht tD cancel this rooltract it V&W ip0cAayy V the, Muse 40twi thies that it cannot perform ltu obligstf*s ike twit atrueattai problem �ta.hot►¢,�t1ng ra or.be¢4baa task regatred to complete the job was not its4itdo to the Spec Sheet or Can AEPKISy1T° '��$1PxIETNS '` (SLII]C:ttntb[Wv onuadfltr'emdu-aliptovat.). CUNTRAC'T AMOUiif _--4 1- cubmsclod:w u4oatal.5arvtd:Money Ordet " pay.blc tc T`tie Hnnte t�iatl #LESS DEPOSI'' •�� .. p, -r<C'arill•ardor otbw pq#W1 gpriona-Circle one Hetuw BALkNCE V Vag Mesta cw mopver A �� ON CONIPLETK� "5_ kas,a D[pct Fiomeimpmve t 1 11u ilome t L'redit Card 7 rMtalmurn 259/6 of C Aipwout due upon O N AcrobM 0 Existing A&Munt etecudop of t4.4 cur tact fi}ple CreAlt S (iTIL tit IMCC ONLY) Indim-tt paytrren>E tle hod For Act ._ • +It 4'} ate - BALANCE OVE OFCCO"PLETJON: N m it 4ppram on card iilyvdat signamro below 11AVe agwo to allow Home Depot te, 770(z, 'h Ala hove effl dit card ft the deposit iindicate& -When ym peovklo..back as you sallxntcc us cidtur sa W e mtomra!im from your.hu rnAe a one-time ekxutndc e fund ttaftfer tram your acc:oun,44o S4-'c 11c pay,rccat as a .beck uan"on.Wbtm wt Senn i 5om your cheek to makc.mekrLVOic ftmd era,,.ctt. ty bt tvit)tdtaw,n nuaz ° L e _ ;v Ori• Hon COO" yDl'r taaaPat as suoq s4 We"pay ' is nxmval.ind Yon v3i11 rat Deirotk. lTin�PavenCat rettmt eau deck back. Pnn;hasor wows that,imn tc upon completion of the Wo Fvrcheser iwiA ekeoutt C ompietion Certifiorde and pay any belancedtie. P=haseTdlso tl toliejointlyand-sevtrniJy ligx`tad•aad liable'hemani % e: � F,nU niggj:This s cr ipt and its attachments incl inn,any finstteitig.avtt4 contain the complete agreement betwten the parties and edx ttbl b:atneaded or modified uni in venting in,a Separate ag�em�'ml signed by both parties. NOTICE T iJRCRASCR Do not slgn this.extract 4tforW you read it. You are-cell ta;g cotrrplete(y fii!_ thtpty pf the contract•t the time you sign. Keep it to pro y4hr rtghts. Do nut atget a o eltoa Certificate b�re;tbrs proJeet i9 oampleW Law prohibits twm repair co ctiJr s from requesting or ace ptln o-Completion Cer cane signed by the owner prior to the actual curnpintion of lho watk to be pertormri3 an der v can t'ou may cancel this tran4tioar any tine prior to midnig of the third besinesr.day lifter the date of this contract. See Notice of Cancelksdan fnr'&u dtiplaaation of tbik right, here will be a service charge equal to 10% of the contract amount if job is eaocelled j#F*ebasor AVfEJA the 4Wt d agni wa gay bat BEFORS ntsteriala are ordered.'Chere will be a service ebatge equal t+1`_Z3%of the contract amount job B 0 sibee6d by Pure ioer AVM1k materials are ordereii. BY MWOUR.SICINATUR NIiMW,VW F.UNDERSTAN "i7IAT T}il;AdPBFME*MAY BE SUBJECT TO RF.,VTI?W OF MWOUR CRFAIT F I Y AND I/WE AUTHO 7..E VILW: m,'POT 7'O XBRIFY AND Rl3V1BW MY/OUR CREDIT RECORD Wl'I'lT' D-,YHNDFNT CREDIT POSITING AGENCY Aril?PELE,+1SE THEM FROM ALL LIABILITY INi:URRED l hl-.NAbVERTBNT OMISSI ItiS OR CRRi RS. BY MYIOUR.SIGNATU 8 0%IAVF AGREE 'm l 33(?!LND BY TI'IE-rE 1S OF THIS CONTRAC-1-. ItWE: ACKNOWLRDdlE RECEIt _ A COPY"OF'rats CO ACt AND TWO CO&MM'MD COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: - Date: ACCF?PnD BY'_ �. Date: _ V NOTI'CL:AD t vAL TERMS ANQ -ARR STATED MN THE RISWERSE SIDE AND..ARI; OF COfifTItACT 8.24-a7 rev 4.2-OT C:SG rRhite--Brantn fee Y --Cuai6mee- Pink-Sales COsuitaru XU3 13r83SUI dH WHSb =ir 800Z 10 tnC 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 supervisor. 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 person(s) 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 sour) a rough buildin¢ 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 1, 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 In dustrial Accidents Office bf Investigations 600 Washington Street -- Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: 9M�7. Are you an employer?Check the appropriate bog: 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. ❑ Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity. employees and have workers' 9 7 Building addition [No workers' comp.insurance comp. insurance. required.] 5. F-1 We are a corporation and its 10.0 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 required.] ; c. 152, §1(4),and we have no li.�ther employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'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: 1 lZ? I Yk CD Policy#or Self-ins. Lic. ir: Expiration Date: Job Site Address: City/State/Zip: 74 Z, I Q( Attach a copy of the workers' compensation 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 Investivations of the DLa for insurance coverage verification. I do hereby certi a dn and penalties of perjury that the information provided above is true and correct. Siunature- Date: - Phone#: / , Official use only. Do not write in this area,to be completed by city or town offciaz City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone'I: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9. Rectistered Howie Im rovement�Contractor ...,', Not Applicable ❑ -The Company Name - Registration Number Address Expiration Date IT Telephone 1 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 buildigg permit. 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 i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wi ows Alteration(s) Roofing F-1 Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[0] Other[0] Brief Description of Proposed Work: t Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. if New house and or addition't zistin housin" corn fete 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 I, pe r7n�/jL"iC1 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. e 4-lak Signature of Owner Date Moog I, V�i(' 11- 16--C , 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 and e pains anid penalties of perjury. 1 int ame ��//�� r I / x,l Sig at re o Own r/Agent Date (� f 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 _.._v. ._ . _ _.. 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? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:'; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONTHKNOW 0 YES y0 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 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist 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 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. _ 3 Deirartrnda use only City of Northampton Status of Perm€t fi Y Building Department Curb OutL)IwdwayPerrnitY 212 Main Street SeNrerCSept€cAvailab€I€ty Room 100 Uflater/flUet Auailatsi(Gty r5 Northampton, MA 01060 Two Sets-6f Structural Plans o'h6m6 413-587-1240 Fax 413-587-1272 PioUS€te Plans Other Specify APPLICATION TO CO; S`rRUCTJ'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 Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: �S Telephone Signature 2.2 Authori A ent: Name(Prin Current Mailing Address: a � SignaturEK 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 7 , BP-2009-0062 GIs#: COMMONWEALTH OF MASSACHUSETTS "PW ¢ .r;;. CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0062 Project# JS-2009-000078 Est. Cost: $3275.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq. ft.): 93218.40 Owner: SHAPIRO JODIE F&JOANNE GOLD Zoning: SR Applicant: HOME DEPOT AT HOME SERVICES AT: 881 BURTS PIT RD Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:711612008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & DOOR 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 7/16/2008 0:00:00 $25.0023427 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo