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24D-214 (3) HOM IMPROVEMENT CONTRACT ` PLEASE READ TMS ! Sold,Furnished and Installed by. Breath Name:Boston North&South Date!-3t ' �L THD At-Rome Services,Inc. d/b/a The Home Depot At-Homo Services Branch Number:-31 and 33 908 Boston Tusnpilce,Unit 1 Shrewsbury,MA 01545 ',Cull Free$77-903-3768 Federal IA#7S-2698460;ME Lie#C 02439;RI Cont Lid#16427 CT Lic#H[C 552 : A"am' vtment C9ptnictor Reg,#126$93 Installation Address: ' y City state Zip Furchaser(s}: Wprii Phone. Rome phone= C7eli Phone r� l� TT ryry t J Home Address: (Ifdiffmirt from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): Lj I DO NQri'wish to receive any marketing emails from The Home Depot o ect eta Underna mud("Customer'),the owners of the property located at the above installation address,agrees to buy, an HD At-Home ervices,Inc,{"The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all nmtetials described on the blow and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Ordets(collectively, 'Contract"): Job S: (nd,,..r agar ) products; S a sheets ft, pro act Amount �y + Roofing Sidmg tj Windows 0 Inlsulation ©c3dners/Covers MEnt y Dom Q Je $ Roofing Siding El Windows Insulation oGumrs/Covers QEntryDoors o 1 � hoofing Siding Windows Lj Insult t on ❑C,uttM i Covers©Entry Doors❑ Roofing ElSiding LJ Windows insulation _ QQuttet'a I Covers©Entry Doors ❑ $ Minimum 25%Ilepcelt of Contract Amow4 due upon execution ol'this eomcraet p� Moime Purchasers may not depth mere than one Wd#f the Contract Am Total Contract Amount $ ount 2—A9 L Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Coi Otaion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each QWomer under this Contract agrees to be jointly and severally obligated and liable heretutder_ The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,++tiler safety concerns,pricing errors or because work required to complete the job was not included in the Cantr Payment mnarv: The Payment Summary# �. � _included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheat9)bcforc work on that Product is complete. In the event of terailpation of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable low. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. tance and Aut gr tion: customer Agrees and understmtds that this Agreement is the entire agreement between Customer an a Home Depot with regard to the products and installation services and supersedes all prior distarssions and agreements,either oral or written,relating to said Products and Installation.This Agreement emmot be assigned or amended except by a writing signed by Customer and The Home Depot Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreeepment, xccepted �-`� Suboutted byr. Customer's Signature Date —T Sales Consultant's SikAalurc Date X Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION. CUSTOMER MAX CANCEL THIS tax applicable) BY DELIVERING WITHOUT PENALTY OR OBLIGATION ME BY OT ID WRITTEN THE T TO TBTs HOME DEPOT BY MIDNIGHT ON THE TI[It2D BUSINESS (�-•,�J I DAY AFTER SIGNING THIS AGREEMENT. THE STATE ' SUPPLEMENT ATTACKED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TUMS AND CONDITIONS ARE STATED ON THE It&vr Mg SIDE AND ARE PART OO THIS CONTRACT eR-14-11 WhLe-Beameh Fae Yeflow-CN9tWm4* City of Northampton � Massachusetts �-•' �,._ '.l{• y •, � s .u; ;�j l �r DEPARTMENT OF BUILDING INSPECTIONS ;x, 212 Main Street • Municipal Building J r Northampton, MA 01060 � INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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 regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footinqs (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 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 Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 y 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 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. E] 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 g• ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. F-1 Building addition required.] 5. ❑ We are a corporation and its 10.❑ 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.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervi Not Appli ble £ Name of License Holder License ber el e7l_ Address ' Expiration Date SignatureT Telephone 9.:Re istered Home lm 'r'ov `meet C'` &rector Not Applicable £ � ComDanv Name Registration Number / Lr^ ss Expi ion Date Telepho 0 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 permit. Signed Affidavit Attached Yes..... No...... £ 11. =.Ho"me Owrier.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. Derinition 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 buildins 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, SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement doves Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks Siding [❑] Other[❑) Brief Descriptio of ase _ `',, �i Work: Tl�ry Alteration of existing bedroom Ye No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa."If Newhouse anii'or adtlifori toexistinq.houslnq;"complete 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 1W as Owner of the subject property hereby authorize C to act o y behalf,"ll m_a�r/� aut orized by this building permit application. Signature of Owner Date a as Owner/Authorized Agent hereby declar that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. c Signed under ins ^penalti s of perjupp--t- -( / Print N nature of Owner/Agen Date . Section 4. ZONING AIL Information Must Be CompLeted. Permit Can Be Denied Due To Incomptete Information Existing Proposed Required by Zoning This column to be filled in by Building Depa=ent Lot Size Frontage Setbacks Front Rear Building Height J---' Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved E771 4 of Parking Spaces A. Has a Special Permit/Variance/Finding ever been issued for/on the site? ���~� ��` NO «�«_� VY� DON7KNO YES ��� |F YES, date issuedj / IF YES: Was the permit recorded at the Registry of Deeds? NO ��� ) DONTKNOYY 0 YES IF YES: enter Book Page and/or Document#L �� �� �� B. Does the site contain a brook, body of water nrwetlands? NO �~� DONT KNOW �~/ YES �_� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tubeobtained ~��-� Obtained �~�~�\ Date� ' � �� �� C. Do any� dgn�� ston the pnnper� ��/Y YES NO �~� /F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orioit part ufa common plan ' that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW ia required. ^ — z Department user onl�r FIR E e A�_fi �_�7_h=- �1 fc ity of Northampton Status,ofPermrt ` " h "'� h*'NSF f k 1 7 214 Building Department cUr6 CurADnvevui�y Fer'rntt � ' x � ��� ' 212 Main Street Sey�er/SepticAvaifa[�ilrtjr ,� - r EteCtric, Plumbing Ga Room 100 Watertt�tel€Availability rn`pe0t' rthampton, MA 01060 Twa fiefs of s#ructriralYRlans « ' oso phon 6—n T-47 Fax 413-587-1272 P[ot/Sitie Puns s ' Dtfrei Specify` a. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfion fo be completed by office 1.1 Property Address: Map Lot Unit ................ y Zone Overla District ' / y Elm St.Distract CB District SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name' (Print) !(P Curre g A �, ' `Z f �v> / Telephone Signature 2.2 AuthorizEd A ent: �s Name t Current Mailing Address: ignature 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=0 +2+3+4+5) ^ Check Number 3 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 4 PROSPECT CT BP-2014-1079 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-214 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2014-1079 Project# JS-2014-001850 Est.Cost: $2496.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 105953 Lot Size(sq ft.): 3615.48 Owner: GREENLAW ROBERT Zoning URC(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 4 PROSPECT CT Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON:411812014 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT 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 4/18/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner