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08-09-06 u4:59P11 FR0G1-CHD 4137464657 T-209 P.006/006 F-744
HOME IMPROVEMENT CONTRACT
Sold,Furnished and Installed by:
$ranch Name: B�OStti Date: '' 7'ci�o THD At-Horne Services,Inc.
d/b/a The Home Depot At-}-Torn Services
345A Greenwood Street,Worcester,MA 01607
Branch Number: l Job Toll Free(800)657-5182; Fax:508-756-2859
Federal ID#75-2698460 ME Lie#C 02434 RI Cont.Lit#16427
CT Llc#565522: MA Home Improvement Contractor Reg.#126893
Installation Address: 54 Ae>etln .+ 42`Ze '01t?A- G/O W
City State Zip
Purchase s r Last 4 Di its or Driver's Lia It&Ex p.Mo/Yr: Work Phone: trome Phone;
f�cYnr P/1401- J,- r, �`fi Ho)
Home Address: S �z
(If different from Installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Project Information: I/WelYou("Purchaser"),the owners of the property located at the above installation address,offer to
contract with Home Depot U,S.A.,Inc. ("HQmQe DeD_ot') to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet# `2'L< ,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,Dome Depot determines that it
cannot perform its obligations due to n 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 fiord vcrificauon and/or credit approval,)
y' 1. Check,Cashiers Check or US Postal Service Money Order
CONTRACT AMOUNT $ (Made payable to The Home Depot).
G o
*LESS DEPOSIT $ �� �• 2, Credit Card'and/or other payment options-Circle One Below
Visa MasterCard Discover American Express
ON COMPLETION DU $ Q �v /The Horne Depot Home Improvement(Loan The Home Depot r rd
�6.Ncw Account n Existing Account (H1L& DCC ONL
;Minimum 25%of Contract Amount due upon ! °
execution of this contract Available Credit:$��� r.� (tf(L&HDCC ONLY)
Acttd:Ca(J3S.1'2%7�)2./�Z 9�y Exp.(late:
Nnme as it appears an card: Z..
Indicate Payment Method For -By my/our signature below,I/We agree to allow Horne Depot to
BALANCE DUE ON COMPLETION: charge the abov ferenced credit card for the deposit indicated.
Cardholder's S' attire Date
HIL or HDCC Authorization Codes
Deposit Final Payment
# Z. #I st
Purchaser agrees that,immediately upon 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
between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NO'T'ICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time
you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law
prohibits home repair contractors 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 may cancel this transaction at any tine prior to midnight of the third business day after the date of this contract-
See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 250/of the contract
amount if the job is cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW, FWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. IIWE
ACKNOWLEDGE RECRIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE
OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, IIWE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF
MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT
RECORD WITH AN JNDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY
INCURRED FROM INADVERTENT OMISSIONS OR ERRORS.
SUBMITTED BY: � � f�/' J� H 1�o G� Date: �S p
sales can sal ay! J
ACCEPTED BY: Date:
Homeow er
_ Date:
Homeowner
NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE
AND ARE PART OF THIS CONTRACT
4-07-06 C-SC White—Branch File Yellow—Customer Pink—Sales Consultant
0¢ Crxty of Warthamptan
�718SSACjtIf8t�t8 � - _
S' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
North,unpton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as its/her construction supe: sor. 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/footings (before backfiIl),
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
� O�•S 1tAJ•!p�O
Uri of �QL"fljcilll�JfDll
'� A � E ��a�anrrint rlla' - - —_ •�
DEPARTMENT OP BUILDD1,C wSPPCTiO1.•5 -
i 212 Alain Strcet Municipal Building
Northampton, Mass. 01000
NV O RICER'S C O YQ'ENS A 777 N Ni S TJRAN CF Al, , A Vj-j-
(li ccnsx/perrnj ttcc)
vIith a principal place of business/residencc at:
:EEL 1 1 � none=')
do hereby certify, under thc.paiuis and penalties of pc 'ury.; h,.r
I -
I am an employer providing die following worker's comoeasabon cove age for my
etuptovees worlang on Ous job:
(Lasu nc oar Z- --
;,. ) (PeLic:?vtL�r) (r:ptrti
O I am a sole proprietor, general cootraaor or homeowner (ccie one) and have hired
the conrractors listed below rgbo have the following worker's c ptns2don pakies:
(NaIDC of Con=^CiOr) (IRRranc: Coinpa i)-RI oUc-, N''uc1LC:) Ditc)
i
i
(Name of Conmcior) (lnsuranec ComoazvRO i(n Nurnccr) (E.,DLr,:tion Date)
{
(Name of Conuaao,) (Insvran= Compan)•/Pouq- Numb,-j) (Expu-doo Datc)
(Name of Contractor) (Insuran Company/Policy Numb,-Zr) (E��irdtion Dale) .
(an.' z6fii„—xJ>3ea.tr aeoa.�•to ax!ue�u1rOrC1il oo pert,azQans LO a.l.l Coal-LA:'�) -
{ ) I am a sole proprietor and have no one worldng for me.
( ) I am.a home owner perfornung all the work myself.
NOTE:pl=-se be aorlrC[h••v WG LCn Kyy Cpl%PCi�1 LO fSl w r c�c e rrnu .ore on.d..�11^�of
oot tnoce then dzs unn,is u-t�eh the bomoowoer r mido cc oa the Qottacts zppurtcw-.=tbccs e-c trx t=-a 1y oc,=.d-rc i to be
ca*oye ua.A-the�=S:cr-s oexpc.z;on Act(GL152=1(5))�:;*Uczaon by a bomoo vQ far-bc5=or pa=s I mzy n-idm the
lcP1 r--,.,of as cpleyor=dar d,o Worital, Ad
1 u a tit a ivy or tbu mtemma my be to Lb.DoP.c or rn&Xricl OT,-or Gszu.nco roc th.
Dove�e-=Z =ioa a--d a-L• =r-to tmd,=s4clioa 25 A-r),(GL 152 an ted to the i-P s—of cimiaa!prnal -
coasisiag of a fsac of up to S 1-oDOM and/or of up to roc yar z.od ovir pcaahio is t5c roan of a Sum Work Order aad a
rr=of S 100.00 a d_y apiaA me
For dcp.rt¢+C�1 u,c only .
Pc mtt l`ILLML-x
Si z of Lia�scclperrruUcc e J ¢
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Not Applicable -❑
'��2eais#ereil lf6me4rnproxrement+�Co`iraetor
`:M— e--, �aJ
Company Name Registration Num er
Address Gy Expiration Date
� )6 fool TelephoneLDr
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.c.132,§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...... ❑
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
SECTION 5-DESCRIPTION-OF-PROPOSED"WORK-(check all applicable)
New House F7 Addition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors ED
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[01 Other[pj
Brief Description Pro ose
Work. (T p o2 g I!n p {
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sari N Mnse t r fi gaa . st ems= Tel of yur+ Q:
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
L 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-T013E COMPLETED WHEN
OWNERS AGENTOR'C""ONTR�GTORAPPLIE�$FOR:BUILDtNG PERMIT
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
I, t Cl� +[3i 1 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 Name
�5
Signature o wn r/Agent Date
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
Frontage
Setbacks Front
Side L>' R:` R:E�
Rear
Building Height
Bldg. Square Footage %
F
Open Space Footage � %
(Lot area minus bldg&paved I
parking)
#of Parking Spaces
Fill:
volume&Location
I i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW ® YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the.Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page! 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:
C. Do any signs exist on the property? YES 0 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.
r
fie a tt-pswentg *. L
- City of Northampton
- ! _!��-� 1' Building
2 di M De Street
a :
i' Room 100
I G 5 C�� ! rthampton, MA 01060
phon 1272 5 � x �� $
_11
APPLICA71Oki'd4GNsTftUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Property Address: This etd n�to be sompfe d by�ffice
�� vti
� e
MB mot 'sUrtt
Overlay Dis#rftcfi
Elmf D�str►ct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
� I nee 1`b
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name n Current Mailing Address:
ure Telephone
SECTI0313-"ESTIMATED"CONSTRUCTION"COSTS-
Item Estimated Cost(Dollars)to be Official Use Only
..l..- - completed by ermit applicant
1. Building -(a)"Builiing Permit Fee
2. Electrical (Li)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) 1 Check Number
This Section For OfficIM Use Only
Date
Building PermiYNumber. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2007-0171
GIS#: COMMONWEALTH OF MASSACHUSETTS
s"id CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0171
Project# JS-2007-000257
Est. Cost: $16257.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 5052.96 Owner: MARTINEZ MARTIN
Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES
AT: 18 BATES ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON:811512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 21 SQUARE ROOF
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 8/15/2006 0:00:00 $25.0014301
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
18 BATES ST BP-2007-0171
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A- 143 _ CITY OF NORTHAMPTON
Lot: -001 i
Permit: Building
OCT z o �co6 LDING PERMIT
Category: L., R1
Permit# BP-2007-0171
Proiect# JS-2007-000257 nF^T^`
.�n, nn,,-
Est. Cost: $16257.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Gro : HOME DEPOT AT HOME SERVICES 126893
up
Lot Size(so.ft.): 5052.96 Ownef'_ MARTINEZ MARTIN
Zoning: U.W ,I n «.t::t�: i-_^4n��rr�nT 4 H0111= SERVICES
Y
AT: 18 BATES ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON.811512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 21 SQUARE ROOF
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 8/15/2006 0:00:00 $25.0014301
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo