25A-050 (4) 09-2094 04: IPM FROM-HOME DEPOT 6226 +860 266 5502 T-754 P.004/006 F-134
HOME IMPROVEMEIV'I t,Uly I It.AL,I
) / ++ Sold,F1umished and Installed nc
Branch Name: f_'�/� _ Data; f� 3 � THD At-Homo SCNICCS,Inc_
d/b/a The Homc Depot At-HDnte Services
345A Greenwood Street,Worcester.MA 01607
Branch Number; Job 4, `�3�'�J Toll Free(800)657-5182; Fax:508.756.2559
redeem IDA I5-269A460 ML Lie 0 C 01439 RI Cant LIMY 16427
CT Lieu 565522: I,IA Hume linpinvemew Contractor RRrrg.9126893
Installation Address: �yu]���.Gr�D r Am iOIL' - �4/
�� City Slaw Zip
Patch...r a; Driver's Lk.9&Ex .Date; 1 0 Work Panne: Iramc Phan.:
CAt�tsitl►f 1�11 y U �•5'D�7a-� L c ( t3 0 iL Yf9 4113) ' 6137
Home Address:
(if different from Installation Address) City State Zip
Yroiecr Information: I/WclYou(-Purchaser"),the owners ofthe propny located at the above installation address,offer to
contract with Horne Depot U.S.A.,Inc.("�Fiqme�;a of"}to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet#: W t? 1 � 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,Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
CONTRACT AMOUNT S } 3 L 1. CaC4k. 'oshiers Check of us Postal S H• ervice Many Ord.,
yabie to The ,,Depot).
U*LESS DEPOSIT S L t,(�� 2. Cred lr Card-and/or other payment options-Circle Out Below
Visa MasterCard Discover Arooriean Express
BALANCE DUE rte,
ON COMPLETION $ y� The Home Depot l lame Improv.tnenl U101 The Name Depot C edit Card
"Minimdrtt 25%of Contrnct Amount due upon execdriort Available Credit!S (111L&HOCC ONLY)
of tbis eonrrnet. Acv*_ _ Exp.Date:
Name ag it appeals on curd:
Indicate Payment Method For -By my1our sianature beiow..U*C aaree to allow Home Depot ra 6aritd the above
BALANCE DUE ON COMPLETION: mkffliced credit card far ilic deposit indtcatad.
G7 D .1(,",J c 1 •t�•-(\r Lhrdholdcr's Signature Date
HIL or HDCC Authorimitlon Codes
Deposit Final Payment
# #
Purchaser agrees that,immediately upon satisfuetoty 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.
fire A cement:This agreement.and its anitchmcnis,including any financing agreement,contain the cumpfete agreement
eCWCCR a parties and can not be amended or modified unless in writing in a separate agreement signed by bout parties.
NOTICE TO PURCHASER
Do not sign this contract before you read It. You arc entitled to n completely filled-in copy stifle contract at the time you sire. Keep
It to prorcct your rights. Do not sign anyy Complerion Certificate or agreement stating Rat you are sudafied with die entire project
before this project is complete_ Law prohibits home repair contractors from reyaesting or accepting it Completion Certificate signed
by the owner prior to the actual completion ottlie work to lac performed under the contract.
You may cancel this transaatlod at anytime prior to midnight of the third business day after the date orttris contract. Scc Notice of
Cancellation for all explanation of this eight. Thorn will be a service charge equal to 25% of the contract amount If the job is
cancelled by Purchaser AFTER the third business duy.
BY MYIOUR SIGNATURE BELOW,I(WE AOREE TO BE BOUND BY THE TERMS OF"fl"11S CONTRACT" I/WE ACKNOWLEDGE
RECEIPT OF A COPY OF TI"lIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE ULLOW, r/WE UNDERSTAND THAT THE AGRrEMENT IS SUBJECT TO REVIEW OF MYIOUR
CREDIT HISTORY AND)]WE AUT ORIZC HOME DEPOT AUTHORI7IRD CONTRACTOR,TO VERIFY AND REVIEW MY/OUR
CREDIT RL•CORD WITH AN IND 1INDENT C DIT RliPORTiNG AGENCY D ELEASF:THEM FROM ALL LIABILITY
INCURILED FROM INADV 1'CN M I S FRRORS. J/
SUDMITTEI?BY: Date: 0
Su ons
ACCEPTED BY: Date:
liomro er
Date:
)tamFnWn=r —
NOTICE:ADDITIONAL TERbts,CONDITTON'1 AND WAkMNTM,S ARE STATED ON TllE aRVERsE s%Dz AND AU TART OF TFIS CON TRACr
Whits-@nmch PSI=Yeaow•.customer Mink-Sd=�curotunent
063-A-038
40-45 DH
a�
6100 Renovations
Double Hunq - Vinyl
Argon/Low S SC ,
s
Vi th Grids
1-800-746-6686
NFRC- 2001
ENERGY PERFORMANCE RATINGS
U-Factor(118J1-P) Solar Heat gain Coefficient
0 .36 0 . 27
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 44
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spedAc prodirt aita,Carottlt mruhw4nr'a ltanfura tar otsr product psrlbrnunr�Y�lornntlon.
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Unit qualities !or 9usr97 star
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South Central, Oouthacn
^� : O 3ND: REIN 00/GLA99 88/9-130
D Test Giza: 44 x 60
Order #:3744748030001 40260 Hs
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�� ✓�e L�am�sraiaurea/,�l a��f �i�,tla
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
UIP Registration: 126893
Expiration: 8/3/2006
Type: Supplement Card
THE Home Depot At-Home Servic
WCHARD FALLONE
3200 COBB GALLERIA PKWY#20
ALTANTA,GA 30339
Administrator
�LTANTA,GA 30339 Administrator
g'ttSAA1P�.
_ rity of Norfl ampton
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�1l1I dSS8CI�1(SttfB -
DEPARTMENT OF BUILDING INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building
Northampton, MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as l.is/her construction sup(::,fisor. 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 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 r',egulations. 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
-
fiO
Crii� of �arti}�ili}�to�1 _
9 E r1 a3sitchnsctts'
DEPARTMEI-r"T OF BUILDTNC INSPPCTIOI.'S
212 Alain Street ' hfunicipal Building
Northampton, Mass. 01060
�V O MCC R'S CO DTI EN S ATIO N M S URAI t'CE A 17M)AI-1
(Ii ccnsxlperm�tttx)
v"ith a principal place of businesslresidence at: ----- -
(strr,..t/city/sta.tr./a p)
do hereby cer-di ;, under die.pa_ins 2nd penalties of perjury, thal
(,/)/iam an employer providing the followine!workces cornocnscoor, cove age Cor im
elnPIoyecs wortDtlg an ulis job:
(7�sw-��Conr ) (Pclie: N;L=Z"cr) F:.xp r< or Dzte)
( ) I am a sole proprietor, general conrractor or homeowner (ci:c;e one) and have hired
the consactgrs listed below who leave the foUo%V1nQ wocker's oom o don policies:
``+file Oi Conmle or) GrlStll3nc: Ccinpany/i?oUC,- ?�tl1II1LC) �_?:pLJ:'_^i'.I)atC)
- (Name of Cocu-,mcr) (bas-w-anec Comoaay/Potic" \urns^_r) (—EaDir lion Date)
(Name of Conn-aao:) (IMSUrzacc COIDZany/poc-q- Namb--r) (Exairaoa Dalc)
(Name of Contractor) a=rancc ComczEy/PoLcy Numl;s) (Expirdoa Date).
(an1Gr1..t�:�oc31 ca,ifntcc --vw incv�inrorzv�oo pc,niaias to all
O I am a sole proprietor and bave no one worming for me.
( ) I am.a home owner performing all the work myself.
NOTE:plc be aw-4rc ts,•v'4Jo bcmco,n .-b.cr,ploy poor=w do rcptn.-ork oa a d..c1L•;Z or
ant most then tt..zse unrtr in wbch the bomoawmcr re=do or oa the Crouac!,zppunen:.r;tb,,w� oo(C).:,Uy cc=.d.—ai to be _
eirployes uric c the x c� _-*ea Alt(G1_!1 SZn l(5)�=+ linoon by a botaco-=far a tic--:=a pamh�y—6—the
1cr,17 na't of an c=,loyx uoda dw Wcckze.Compom.l-ioo Act
I uadcrz.ad thaz a oopy of thra-==c m may bo for--id w tha popnnmcor of L-,& si j OT,—of 4aur•nu for tba
covcfxFc v=irletioa and t1t1 L•iltac to jco=bovcr und-r.oat on 25A of MGL 151 an led to the i=pozitioa of aimiaal pca Wes
corm xx of a rrae crup to S I,S00.00 arzfor iapai-�o�of up to ooe y--=r end evil pmahia in do form of a Stop Work Ord-and a
fi>�of S 100.00 a d--y tpinA me
For dcp<+ts�=-�u.c oa17
per i't Numbcr -
1 Lot
Si of Li ccmiuc^ e -- .J k
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SECTION_8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
.{„ rK.2tE„w ,x • X ? C .: k"5^"vnln° E 2M1.-
:9 ;Reaisfe�edEfomeImpravemen�Contra�c+t�ar�`.�� �,�.t� y-. `� �� � � Not Applicable ❑
Company Name Registration Nu e - -
Address Expiration Date
(/ Telephone
SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,1;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 buildin ermit.
Signed Affidavit Attached Yes....... No...... ❑
°t
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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-near 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
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check°all applicable)
New House [] Addition ❑; Replacement YVipdows Alteration(s) EJ Roofing [J
Or Doors P`*Is
Accessory Bldg. ❑ Demolition ❑ New Signs [[:1] Decks [p Siding[E3] Other[[3]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes _y„ZNo
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6:0,1 New'fioase anc Q6--a cTd'►.t r #aexisfixic hor incr..-cal rptete fihe fio_tOw dd:
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. floodpiain 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 BOLDING PERMIT
I, 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.
Signature of Owner Date
1�M40 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 ame
Signature f Owner/Agent ate
* x
r
Section 4. ZONING All Informatibh 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 — I �
Setbacks Front 3
Side L: �•�- R:' L: � R:'
t � '
1
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?
N0 0 DON'T KNOW 0 YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T 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 O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued: a
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
IF YES, describe size, type and location: 2
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 Q , NO 0
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
a Departtaten [se nl
f Northampton
I ing Departmentrls�euua�r Perm n
` ----- --1 ° �
2 Main Street Sewer e t< rlarrh wa
oom 100 1tat�r/Welvar#a G �
NOV 2 �. 2�a4 No ton MA 01060 Tuva Sets oStructura�t?Ians
phone 413 87- 240 Fax 413-587-1272 PlottSlt t?ans
tiler S�ecrfiy � ,...,rY -*.'C.:. - `„€-
�FCIQNS fi ..
I APFNACATI,0 �,,1 ` ,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 Drstrrct
,°Elm St nistnct �CB DistFrct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
CCA U in 17.r+^ O), a
Name(Print) i Current Mailing Addre
Telephone
Signature
2.2 Authorized A ent:
-A 44;7
Name(P' t) Current Mailing Address:
LID I 35203
Signature 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
• f
22 CROSBY ST BP-2005-0625
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-050 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2005-0625
Project# JS-2005-0204
Est.Cost: $5534.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor., License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 19384.20 Owner: DION MARK
Zoning:URB Applicant. HOME DEPOT AT HOME SERVICES
AT. 22 CROSBY ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON.11/30/04 0.00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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: Receipt No: Date Paid: Check No: Amount:
Building 11/30/04 0:00:00 4962 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo