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17C-025 HOME EWMOVENIEN'T CONTRACT PLEASE READ THIS ���7", Sold,Furnished and Installed by: Branch Name;Bostoo North&Sorsh Date:�E� THD At-home Services,Inc, d/b(a The home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1.Shrewsbury,MA 01545 Toll Free 877-903-376$ Federal-ID#75-2698460;ME Lic#C 02489,K Cont.L c#16427 Ue#MC.0565522;MA Home Improvement Contractor Rag_#126893 Irtsiatlation Address; VOtiI�C( 14 .- �t� MA N062— City state Zip {s): Work Pone: Herne Phone: Cell Phone: [ ] l [ 1 Horne address: (If different from installation Address) City State Zip E-mail Address(to receive project communications and Horne Depot updates): ❑I DO NOT wish to receive any marketing emails from The Horne Depot eet IpPMMa. Undersigned("Custoilaear ),the owners of the property located at the above installation address,agrees to buy, and THD At-Horne Services,Inc.(-The Home Depot")agrees to furnish,deliver and arrange for the installation("X%1xlJation")of all rcaiterialti described on die below and on the referenced Spec Sheet(s),all of which we incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Suirimary attached hereto and any Change Orders(collectively, .'Contract"): (/ Job tk t:."M+uwr—1 a?ruducte: Sow sheet(g)$t Froject Amowat Roortng Siding Windows 0 Insulation �� p "7 y °a[]4 3 000mrs/Covers 3(= Kooning Siding Windows Insulation $ EIQutters/Covers OhntryDoors C _ __ Roofing Siding Windows lnwlauion $ ❑Gutters/Covers ❑Entry doors[7_..w.,._. Roofing LJSiding 0 Windows L rnsulatiuu OGutters/Covers l]6nvy Doors C❑ Mlidmurn 2996 Mpoek at Contract Amotmt due upwaxecuffen dtaxis 0X*Wt- Total Contract Amount $r Maine Fwvbasm may not deposit mm*tban one-third of the Contract Amount Customer agrees that, immediately upon completion of the work for each Product.Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due, As applicable,each Customer under this Contract agrees,to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Produci(s)included herein,at its discretion,if The Home Depot or its autborized service provider determines that it carumt perform its obligations due to a structural problem with the borne,envzrarimcntal hazards such as mold,asbestos or lend paint,other safety rnncerns,pricing errors or because work required to complete the job was not included in the Contract Payment Suuituarv: The Payment Summary fF q-7 included as part of this Contract, sets forth the toW Contract amount and payments required for the deposits and final payments by Product(as applieable)- NOTICR TO CUSTOMER You are entitled to a completely fllled•li,copy of the Contract at tbte lime you sign. Do not sign a Completion Certificate(note: there Lc one Completion Certificate for each listed Product as defined by Individual Spec Sheets)before work on tivat Wfxluct Is complete. in the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labiw,expenses and services provlded by The Home Depot or Authorized Service Provider tbur�the date of termWatiou,plus any other amounts set forth in this Agreement or mowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNT5 OWED TO THE HOME DEPOT FROM TOE DEPOSIT pAyMNT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS, tenet and A ati u: Customer agrees and understands lhat thin Agreement is the entire agreement between Customer an e a Home Depot With regard to the Products and Installation scrvices and superacdes all prior discusswns and agreements,either oval or written,relating to said Prod=l;and Installation This Agreement cannot be assign mended except by a writing signed by Customer and The Home peps.Customer acknowledges and agrees that jlomer read, de stands,voluntarily accepts the terms of and has received a copy of this Agreement, accepts y Submitted ustomer's Signaty Date Sates Consul ignature Date X Telephone No. Customer's Signature Date Sales Consultant License No. CANCE ONt CUSTOMIER MAY CANCEL THIS (•v+�Pl'cabi¢7 AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELTvERTNG WRITTEN 740TICE TO THE BIOME U DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY ArTrK SIGNING THIS AGREEMENT. HE STATE SUPPLB�MENT ATTACHED HERETO CON'TAXNNS A FORM TO USE EF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTO?AER'S STATE. NOTICE:ADDITIONAL TERMS AND CU"MONS ARE STATED ON THE REVERSE Rr)E AND ARE PART OF Tlits CONTRACT ii-08-13 While-BranOh File Yellow-Customer The Commonwealt/i ofAlassr chmse vs Deparbnent of Industrial Accidents Office oflnvestigations 600 War hington,Street Bvstan,MA X2111 wt x.rrrr�SS kovldja �t>r c�;s'Compensaticr Insltrant e Af 'davit: Builders/Contractors/�lectricaa��Mumbers A'npli `i ' o tir;'a Please frimt LeMbly Nasr€(BusinessjOrgatuzafion!Individual}: Address r rjVA CrtyfSl;te �p._ 1?1ione#: ><•o }7 to ilQ$ A><e_�� � �� � +� P `� � Type of, protect,(required): Y ` ❑I am g gatractar and I l s = _ 6 [Q New construction ohtplq�est o)* hive htr tkre s64 q i',ted on the aft lied sheet. 7. F1 Reiaiodeling 2.❑ I a�pntye l��oeto .Fl ` These s>It?-ctr tors have g. Demolition ship and have nci enllxloXees . :. j ❑ ' em Ioyegs an�have warkers' v of 6 for rixe irl aziy oapacity. $ 9. ❑Building addition. ._. comb t_urance. Wo workers comp ulsuranee 10. Electrical repairs or additions requtrec:] 5. ❑ We ire a,corporahon and its ❑ P 3 ❑ I am q he bxteowaer tl*k all work pf cers DWY a gmI0 d their 11.0 Plumbing repairs or additions xnysel€ No workers' comp. right oxemptlota per MGL 12.❑Roof repairs C. 152 1 ,and we,have no incrrs+nce re weed t ;� ) 13.[]Other 4 , cQnup,u�stu�ncle required.] *Any applicant that cltecks lox#1 tngst a}so fill out the sechon below showing then wodcers cgmpensatton policy information. Homeoviugrs who submat this affidarnt wdteating they are do'iag all wor)r agd then hue outside contractors must submit anew affidavit indicating such. tContraetors that ceGIC this box must attached$!t add►honal sheet_showing the u$me of the dub contractors and state whether or not those entities have 9jnp�oyee If the sub-catfttacfot5 ltatr loyeest they rt►ust provi policy number. , I am a�►!employer that$sprovdig N'otkers'compensa#pn i�isurance for teay employees Below is thepoiicy and job site , Tn surance Company Name Policy#or Self uts Lic # Expiration Date: j Job Site Address City/State/Zip. Attach ca p, . . py:othe workers'cgmpensahon oltcy deslarata®n,page(sin®wing the polacy,number and expiration date). Failure to��Gute coverage as zequtred under Section 25A o£lyiGL c.152 can Iead tq the imposition of criminal penalties of a fine up to$l;SQO.QQ and/or one yearnptasonment,as Well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250 O;Q a day_agamst'the ytolatoze advised that a.copy.o f this statement may be forwarded to the Office of ' :lnvestgattoms;.�f the T:?IA for astu'ance covctage vertficattou _ - `I do 7aereby certafy uq�de a az ad �' •: er�asry that rice rnfort�ataon j�rovaded above�s a an correct f ; Si .a e Date: &- z Phony . : p seta!use Qtsty... o.not w r►te M this area,to be cmp oleted by city or town o ciaL " arty a>r�4 . Perinft/License# kIs'-s At<thop (circle olne): , 1 OA of Health 2 u ldtng Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6'Uthcr Contact Perot? `Phone#; SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: D � Not Applicable E Name of License Holder: . > License Number Address Expiration ate Signature Telephone Not Applicable £ si—Re istered H e.lm `ro ement'tractor � f Corn an r am Registration Number dr s (,� Expiration Date v Telephon Ar SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§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: Home Owner:. emption 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 ❑ Addition ❑ Replacement Wigdaws Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [M Siding[❑] Other[E3] Brief Descripf Work: N' TI ✓ 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'additlon tb exisfing,housing;coniplefe 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, as Owner of the subject property �- hereby authorize to act on my behalf, in al mat a lative to VDrkauthorized by this building permit application. Signature of Owner Date f 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 4underins a d enalties of perju Print Na Signa ent 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 x ! s Frontage. Setbacks Front Side L:.�-----� R: L: ` R: Rear I — -- Building Height Bldg.Square Footage E Open Space Footage __ %o —-- tarea minus bldg&paved = parking) 44 #of Parking Spaces Fill: #i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document#i B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES C IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 1 �t a i 5r Departure se gnly� ity of Northampton Status,of rmit rat u 7 ,ullding Department Jr.CTZ Cut/Dnveway Pertrtit f 212 Main Street ...Tn IS MAI 2� 2(�1A Room 100 `✓1(ater/Vkte�CAvailablity r Northampton, MA 01060 T y Se is of StructaFal Plans 1 -587-1240 Fax 413-587-1272 PIof/Site Plans PWmbeny& a I v i Electric, ampton,MA�''0�0 Otter specify 1 , T + APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This secteorr fo be completed by office j Map Lot Unit =Zone Overlay D�sfrict - Elm St°Destrect' C5 District . SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � �/ ^_„ © qv/Z' Gj Y/°l Name(Print) Curr�r fling Add UN&Z' ^ /7O� Telleeeph/on f e ` Signature 2.2 Aut orize A ent: ;nature P Current ailing Address: Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building z (a)Building Permit Feb 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 This Section For Official Use'Onl Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 9 KING AVE BP-2014-1267 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-025 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-2014-1267 Project# JS-2014-002130 Est. Cost: $2366.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 92937 Lot Size(sq. ft.): 7753.68 Owner: FLYNN MICHAEL B&THERESA M Zoning URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 9 KING AVE Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.512912014 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL ENTRY 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 5/29/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner