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25A-070 i j , � OTil!e ��l!/ o�✓�aaoaduaeCta C—N Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registr4jgd� 126893 ExpiratJO '. 3/2010 j r Ty re Sa61ement Card The Home Depot At InSavite 111 j RICHARD FALLOhtR `�' r 3200 COBB GALL�41lkR(CW1Y' 0 �e.. ATLANTA,GA 30339''' ~ Administrator B,. oT ranch Name ' Date: _ THD At Home Services,Inc. — d/b/a The Home'Depot AtrHome Services �,..��`•� ((,��// 345A Grecn*ood Street,Worcester,MA 01607 Branch Number: #: (2b i full Free��igi"00)557,3182; Fax;508-756-2859 pedenl it)it 75 269460 Mr U.it C 02419 RI C.N.Lich 16427 'i C1'I,c Uj�i�(552 ; MA F3'oma 7mixov emrnr l nnhnctnr Rey.if 12tiR97 Installation Address: ' p— tly ;to tate_ Zip--- Lost 4 Digit of:Dsfver's. Purchaser(s): .LIC q&E t,.Mcwyr: Work Phone: Honte Phone: hq 1 ----- Home Address:•� L (If different from Ins uon;talla ddt sa) C State Zip E-mail Address(to receive ttfidatea and promotions from The H me'Depot):_ Project.lntormation: )tWe1 S otj.(`"Purchaser"),8t.e owner of e:propery located at ft-above installation address,offer in contract with TIID At-Hwne:l$er*iccsi.Inc.("Hcme i7'.of")to nish,deliver and aiTim a for the installation of all materials ag described or.the attache d 4pec Sheet incorporated Iicr In 1 y reference and made o Part hereof, Home Depot reserves the r#ot by canpel this contract-irk:upt aa+t�i'i<speetion•of:the,jt b,morre-Depot determines that It cannot.perform Its old igat*,ins 4v to structural.problem i itbAlitiAome,priting eiitors or because work required to comp lete:the job was not iaT` do in the Spec Sheet or Canter Let.., • ; DEPOS17 PAi,KENT OPTIONS -r (Subycot to Nnd ved tion andlor credit approval.) CONTRACT AMOIiN•F s '� t. Cheov,Cashiers Check(ir US 124stel Sem ice Money Order _Made payable[n The Hans Debot). fLESSDEPOSIT $ � D©`! 2. Credit Cad"enWair other payrrlbntoptians-Clsele Oat,Wow BALANCE DU$ h .._.._� _ Visa ot ie e.ver Amricn CNPM ON COMPLETION T HomDe a to ne Inn r nt Lon 'lire Homc Uepot Credit Cant f Miolmom 25N.of Cunl*t Aitftount due upon w Amo unt ❑Ezl9ting Aeoount (01L r exee1011011 of tltS;kntttt•aM. Available Credit:S f (H7L A 111DCC ONLY) Indicate Paymet!xM_ etbud For AoC, _ Hxp Uaai BALANCE DbE ONMOI TPLI3TIUN: ` Nan]{as itappoare on card LE'E`QihLq (c,03_5- c,0 3 S p 3 ;"0a. GJ t1�3G ""B niyltrur signaturvk;elow EITWe agree tti>allow Home Depot to C e e ve re en credit card for the deposit indicated. -When you pravidc a check at prylineut�r�y nu­111.'1 ua either to vac information franc pow heck'fibrnd;Tte a ono-tint elec[mnia Be Signs hind transfer iron your aocoum o'io pr(Saess Z payment as e check transaction.When we use i i4irn o0tir from yow check t0 mnkc an electronic fund trarnl r 4jils o ay bo;:wdthdrawu from- FIIi.of F1DCC�"'-uthorixatioa Codes your account as soon as the paym^t is r7,ved.,and yaa will no: De osit Final.Payment� roeeiva your ckxk beck. 1 # Purchaser agrees that,immetfiat4 upon completion of the won Puachaser will execute Kompletion Certificate and pay any balance due. Purchaser dso woo to be jointly and severally ob igAte&andliablehetcur4r. Entire Arreement:This rig intent and its attuchmentn,includ hg,any financing agreement,contain the complete agreement between the.parties and can(lot be amendod or niodifi ed unless ii writing in a separate agreement signed by both parties. NO'T'ICE TO PJRCAASER Do not sign this contract baiore.you read it, You are entitl J too completely filled Tilt copy of the contract at the time you sign. Keep It to proloot your rights. Do not sign a C .tpl'etion Certificate bet.0re this project is complete. Law .prohibits bent repair cuntractiks from requesting or accep am xCCompletion Certif cote signed by the owner prior to The actual completion of thdrtvoilk to be performed under the tudract. Yen may cancel this transa�':tloefany time prior to midnight the4hird business dayi-te.r the date of this contract. See Notice of Cancellation f tr`ltih opbenation of this right. rie will'be s service charge equal to to%of the contract amount if,job is cancelled I>?y Purehaser AFTER the third b -test day,but BEFOREEmaterials are ordered.There wilt be a service charge equal ttktMA of the contract amount It'J is cancelled by Purchager A.ETER materials are ordered. BY MY/OUR SIGNATURR$EROW,'I/WF UNDERSTAND'[• AT TIDE AGRFEMi iJ.r.MAY BE SUBJECT TO REVIEW OF MWOUR CREDIT 1-Ilk.7OILY AND 1/WC AIJTFIORIZ ROME DEPOT 10 VSRIFY AND REVIEW MY/OUR CREDIT RECORD WI11I ItAN INDEPENDENT CRIAfi'RE 1ORTING AGENCY RELEASE THEM FROM ALL LIABILITY INCURRED I f m'`INADVERTENi'OMISSION ORERRORS. BY MY/OUR SiGNATURe,'B W OW, I/WE AGREE TO BE BO.LIND BY TFiF [FINIS OF THIS CONTRACT. IiW l ACKNOWLEDGE REC HIF 011'-A COPY OF THiS(ONT CT-AND TWO COMFIF.TFD COPIES OF THE NOTICE. OF CANCELLATION. r SUBMITTED BY: glas y - ACCEPTED BY: _ �? — -- _ Date: P, x -M ;W31- - Date: --- Pt, NOTICE:ADDITIONAL TFRMS.AND CONDIT ONS ARE STATED ON THE REVERSE SiDE AND ARE PART OF THIS CONTRACT 9-21-07 rer4-2-07 C-SC White-Branch File Yellow- ustbmer Pink-Sales Consultant t � •d xd_J 13Cd3Sd_1 dH Wd62t1 8002 tr0 2nd �-- 780 CMR 7t" Edition Requirements for ALL 1 & 2 Family Projects Per 5310.7, Construction Documents, the following are considered to be the MINIMUM documentation for ALL permit applications Please utilize the boxes on this checklist to assure completeness Scaled drawings & details shall be submitted-with each application proposing construction, reconstruction, addition, alteration, demolition,or repair. The building official may waive the requirements for filing plans when the work involved is of a minor nature. Scaled drawings & details shall indicate &describe all proposed work, including location,size, grade & quality of materials&equipment to be used. A.) SITE PLAN 0 Property address; map& lot number, zoning district& overlays(wetland, floodplain, etc.) 0 Show well and septic locations (if applicable) 0 Location of lot lines, dimensions of lot, frontage 0 Location&dimensions of public easements, public utility easements, railroad right-of-ways. and established zoning setback requirements 0 Location&dimensions of primary & accessory buildings& structures B.) FLOOR PLANS. 0 Floor plan of each floor and any intermediate levels including basements, crawlspaces, ten-aces, porches,garages, carports, and decks 0 Dimensions, location&materials of foundations,*footings, columns, beams& piers (include any reinforcing) 0 Direction,dimensions,spacing,species &grade of all framing members(floors, roofs, wall. partitions) 0 Location of all walls,partitions, windows, stairs&doors 0 Location&description of all electrical equipment and alarm devices 0 Location& type of all heating and air conditioning(HVAQ equipment I C.) EXTERIOR ELEVATIONS 0 Front,rear&side elevations including foundation depth and finish grades 0 Location&dimensions of windows &doors (attach window/door schedule) 0 Description of exterior cladding or siding material 0 Show exterior stair locations&dimensions 0 Show chimney and vent locations D.) DETAILS & SECTIONS ' 0 Attach compliance paperwork for energy requirements: see Chapter 61, Energy Efficiency .i y &Section 6101.2 Compliance..(showing compliance with one of the four methods) 0 Sections.through exterior walls showing details of construction from footing to the highest point of the building (see attached) 0 Sections through shafts, landings& stairs- include framing details, tread, riser, headroom I 0 Describe location&dimensions of handrails&guardrails 0 Sections through fireplaces&chimneys(show dimensions and clearances) 0 Location&details of any roof trusses,glue-lam,or engineered lumber(include connection & bracing.details and Mass. professionals stamp on specification sheet) M2 family-71h t a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to coustmc.t buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage-required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been prasented'to the contracting authority." Applicants s Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their cettificate(s)of inshhrance. Limited Liability Companies(LLQ or Limited liability Partnerships(LLP)with no employees other than the memb=or partners,are not required to carry workers'compensation insurance. If an LLC or UT does bave employees,a policy is requiret Be,advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be save to dgn and date the affidavit. The affidavit should be returned to tie city or town that the application for die permit or license is being roquestod,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self4mured companies should enter their self-msutance license number on the appropriate-line. City or Tows Ofl'rclals Pkase be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in dic evrat the Office of Investigations bas to contact you regarding tie applicant. Please be sure to fill in do permb/luoease number winch will be used as a refauce number. in addition,an applicant that mast submit multiple pernOlioense spplicatim in any ghm yea4 need only submit ono affidavit iidicating current policy information(if ne essary)and under NJ&Site Address"die applicant should write NU locatioas in (city or town)."A et>py oft he affidavit drat has been officially stamped or madwdbydo city or town may be provided to tie applicant as proof list a valid affidavit is on We for fidur+e permits at hca= A now affidavit must be MW out each Yom Vb=#h bhome.nwner or d iaea Js.d*dning a Home or permit not related to nay ba�or commercial vemuue .(i e.a dog orb to bum kava etc.)raid pe>l m is NOrT,r gWmd to.00mplebo this affidav& .The OfSOCOf Investigations would lilac to dw*you in advance for your cooperation and should you have any questions, pkase do not hesitate to give ns a t11. `;"°,.` The Department's address,telephon 6u dfaxNumber: Y The COMMOMealth of Massaohus�ts DOP9ftmt of IadastM Aooldeats Office of I nswons 60 wadboadS td BostA 41(02II1 Tel.it 617-727-490 ext 406 or 1.877-MASSAFB Reviled 11-2246 Fax#617-727-7749 WWWM 4;OV1dia . ley l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgovldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLribly Name(Business/Organization/Individual): -- - — ;� Address: Vemi"T City/State/Zip: Phone.#: Are you an employer?Check the ap ropriate box: Type of project(required):. 1.❑ I am a employer with 4. Q I am a general contractor and I employees(full andlor p -time). « have hired the sub-contractors 6. E]Now construction 2. I am a sole proprietor or partner- listed on dwattached sleek 7. Q Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. employees and have worimrs' b workers,co co insurance X 9. ❑Building addition requ�] comp.insurance 5. Q We are a cotporatioa and its 10.Q Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.Q Plumbing repairs or additions myselL(No wod= comp. tight 6f exemption per MGL 12.Q R f ur � repairs insurance ;�•]t c. 152,$I(4),and we have no employees.[No walkers' comp.insurance.roquiredl *Any appliaat that box#1 vw*bo tin out the section bdowdhowing bar wad=,owpmsadoa policy mfmudon. t Homoownem vW submit this dMa k Mating d oy m doing A WO&and then hire outside coohad=must submit anew affidavit indicating such. ZCoaftctord tint die&this box must suachod an additional dod dhowing die nnae of me vA4w zaam sad state w•hetha or not those entifies have employes. K&epjb-coaftc(ombmaMlormdieynvjdpmvi&dm:irwod=s*oomppoficymmber lam an employer Ow is providing workers'contpensadon btsu artce for my employees. Below Is the policy and job site lnforntatlon. �_... Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date• Job Site Addrass• tateJZiP; �. Attach a copy of the woiicers'compemsation policy declaration page'(show ing the policy number and exp on date). Failume to to cwe coveage as roquit+od adder Section 25A of M(]L c.152c&aludlbdwimpositionofcdmiuipeadtiesofiL fine tip to$1,S0000 atad/or onoleff impasocni4 as Veit as CWR penalties in&c form of a SPOP WORK ORDER and a fine . of op to 5250 00 a day agdnd dtq violator-Be idaisod t M a coprof tins tt*idedimy be fo�imrdetl to dm Office of estl 'ons of the Mfor insurance coverage verification. I do Ureby we iurdp s af.palm3'OW due Womalm provlded above 4 tru#and ooh Y tin Phone 6: use o . o not wrMe U thk arts,tb o or(own q/, dal City or Town: Permtt/I.ic ense A` Issutag Authodfy(drde one): J.Board of 8edth L Building Department 3.City/Town Clerk 4.Elaftled inspector S.plumbing Inspector 6.other Coma:Perron:• . Phone d: l i Tax Collector Affidavit This is to certify that,in accordance with Chapter 74 of the Acts of 1996,the persons and properties named herein have no uncollected taxes,fines,fees or other charges owing to the City of Holyoke that would prevent the issuance of permits. Holyoke Tax Collector or his designee Date Rev.11.97jt t i S SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Name of CSL-Holder List CSL Type(see below) Address Type Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Imnmyem e t C t for 13 HIC Company Name r HIC gistrant am e Registration Number Address 17N lal;3IM( 7 Expiration a Signature Telephone SECTIO 6: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 f the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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 SECTION 7b:OWNER'OR AUTHORIZED`lGE1VTDE CI- ARATION I, 6 F4 ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signs re o e or ut oriz Agent Date Si ed under th pains and penalties of a'u KOTES;, 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" w • # The Commonwealth of Massachusetts e Board of Building Regulations and Standards g Massachusetts State Building Code,780 CMR,V` edition De a e 0 s g>tdJmVections aza,Room 300 W13uilding Permit Application To Construct,Repair,Renovate or Demolish a HUyo a 040 One or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Commissioner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property'�dre, s�: � .('� � 1.2 Assessors Map&Parcel Numbers I.l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard 0 Required Provided Required Provided Required Provided z a 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? rte Public 13 Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ Cr SECTION 2: PROPERTY OWNERSHIP' 2.1 Owners of Reco Name(Print) Address for Service: Signature Telephone i:. 2 SECTION 3:DESCRIPTION OF PRbk ED'WH c eck, shale 1^ New Construction❑ Existing Building❑ Owner-EofUniEts ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number Other ❑ Specify: Brief Description of Proposed Work 2: I en 77 '77 ON �4 N,. Estimated Costs: Item Labor and Materials ;t ,i, y...; g. : 1.Building 1::Budd`n,'P if Fee ~ i►diciite how fee is determined: 2.Electrical $ ❑Stand" Cityltown Application Fee ❑Total,Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) S List: C 2�S5 ` / Z) 5.Mechanical (Fire $ Su ression Total AtC' tes:$!. Check No. Cheok Amount: Cash Amount: 6.Total Project Cost: $ p Paid iti Fdl CJ Outstl Ming Balance Due:_______ "T BP-2009-0168 GIs#: COMMONWEALTH OF MASSACHUSETTS to 4w 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-2009-0168 Project# JS-2009-000218 Est. Cost: $12000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES Lot Size(sq. ft.): 5270.76 Owner: Lee Phylborn Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES AT. 18 HUBBARD AVE Applicant Address: Phone: Insurance: 345 GREENWOOD ST (401) 935-2633 O WORCESTERMA01607 ISSUED ON:811512008 0:00:00 TO PERFORM THE FOLLOWING WORK.-Replace 25 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 8/15/2008 0:00:00 $60.0023755 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo