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30B-073 (8) . � � enelQyslar.nrcan—rncan.gc.ca . .. .mow �ti• r ._ % QudUled Remove label.after final inspection; SAVE for future reference ' • Weather Shield CP 01050' A--172 ' NFRC Model 810(1 Double Hung Operating Alum clad Thermal Frame Ir >-r .n 314 inch Glazing , rwN qc axs sa ZD—E .022 Low—E Argon Fill Grille in Air Space ENERGY PERFORMANCE RATINGS U-factor Solar Heat t+frl Coefficient 0.30 1.70 0.1 SJf-P Melridsl ADDITIONAL PERFORMANCE RATINGS Visible il'ansraftlaace Resistance 0.40 0 Neautacluter stpulates het&a=mings cw1ur s to applicable NFRC procedures for deiemdolnp rhote prodeet anirgr pertannsnre.NFnC rstngs art dalenntned lar e tsad set at istrimmanW sonditon{and sp edit product fires.NFRC does sal resarrrnend +ny product and'doet net rernrrt he wlbblOq of pradacr 1W any:pectic ua. t�asull msnulacturst's 111sralure tar other/mduet pevlortrwce Inlorntsaon. www.Orr.aEg Meals or exceeds M.E.C., L.E.G.,and I.E.C.C, Air Irtltttration Fie ulrements (DP) (psi} rctred to ANSVAAetAJNWWDA IUlLS.2- 11-1.C35 e43M 1Wad Is AAMAlW04M&A + 31U loln 51+s40'—aS 35 H_LC75 tll{XZZ{a(4Y9Qi r� Unt mists S4401ra)iadanamass Ps,►SAY Fac VIM n�Za7d5—1-1 1101SCMA118STO t HOME IMPROVEM OT CONTRACT PLEASE READ THIS Sold,Pttrrlished and installed by: Branch Nam:Boston worth&Son& Date:1-2j/'7 THD At-Home Services,Inc. diVa The Nome Depot At-Home Services Branch Number-31 and 33 908 Boston Turnpilm,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID It 75-2698460;ME Llc*C 02439;RI Cont.Lion!16427 CT Cie*HIC.0565522;MA Home Improvement Contractor Reg:#126891 Installation Address: iL`t lt1 i� QrL Fin n Qa — Ca(b ) City State Zip parchaser(a): worlt]>U t: iloome Pboae: Cell Phone: �) FA#1 [ j goons Address: (If citiferent from Installation Address) City State Zip E-mail A,dd rem(to rcccivc project communicatiarrs and home Depot updates): ❑1 DO NOT wish to receive any markatittg entails frorn'Me Hone repot Proleet Refer Uou: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD Ai-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and artange for the installation("Installation")of all materials gibed on the below and on the referenced Spec Sheet(*), 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 Orders(collectively, .Contract"): ,Job*I av"o 6.4r. ) Froduetr: Sec sb m a 0: Pmjvct A fflwani Roofing Siding windows inaulotion �y y /� y l EIGutters I Covens 0Entry Dom © RcRn$Owing 0 windows Insulation �15 fo ❑cutters,Cover, al"ntry Dooms 0 TWof g LISiding Ll Wtndowe Ll Imlation ❑Cutters I Covers C Entry Dowry❑ $ Roofing Siding Wladowa Insal;tion ©Gutters 1 Covers❑Entry LtoOrs [] Minirnan25%Deposit ortCanirwetklmoowtdneupanerteetrtta►QfW5tcut ml, Total Contract Amount $ Main Pwdta m may no deposit rare than one-tMrd ofthe C rthZetAmnum Customer agrees rhat, immediately upon completion of the work ror each Product,Customer witl execute a Completion Certificate (one for each Pruduci as defined by an individual Spec Sheet;and pray any balance due. As applicable,catch Customer under this Contract agrees to be jointly and severally obligated and liable hereunder, The Home Depot rewves the tight to issue a Change Orden or terminate this Contract or any individual Product(s)included herein,at its dih=don.if The Home Depot or its authorized service provider determines that it cannot perform its obligations due:to a structural problem with the hone,environmental hazards such as mold.asbestos or lead paint,other safety concerns.pricing errors or because work required to complete the job was not included in the Contract.E, i:avment Summary: The Payment Summary# %60-7b . included as part of this Contract,sets foath the toad Contract amount and payments required Rw the deposits and final payment;by Product(as applicable). NOTICE TO CUSTOMER Yon are entitled to a eompietely tilled-la copy of the Contract at the tune you sigh. Do not sign a Completion Certificate(note: there Is one Commpletion Certificate for each listed Product as'defined by individual Spec Sheets)before work on that Product is complete. in the event of tertrdnation of this Contract,Customer agrees to pay The Bone De of the c nta of materials,labor,expenses and aervices provided by The home Depot or AuthoOzed Service Provider thr the date of termination,plus any other amounts set fortk in this Agreement or allowed under__applicable law. THE ROM DEPOT MAY WITHHOLD AMOUNTS . OWED TO THE HOME DEPOT FROM THE DEPOSIT PAXWNT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER 119M OM FOR RECOVERY OF SUCH AMOUNTS. Acteotance and Authorization: Customer agrees and understandti that this Agreement is the entire agreement between Customer and The l;ome Depot witty regard to the Products and Installaticm services and supersedes all prior diwuo5icm5 and agreements,either oral or written,relating to said products,and InstaDation.This Agreement cannot 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 Agreement. iA,ccep4d by: A f Submitted b�°-"k k X l rye `� ' M 16 kKY4— Customer'8 sfpature Date Sales Consultdrtt's Signature Date X e, M, 7W 4 Telephone Nat _ Customs igrnrture Date Sales Consultant License No, CANCELLATION: CUSTOMER MAX CANCEL THIS (*s eppiiot6u} AGREEMENT WIT'.ROUT PENALTY OR OBLIGATION BY DEMERING WRITTEN NOTICE TO THE HOW DEPOT BY MIDNIGHT ON THE THIRD BUSINESS ,DAY AFTER SIGNING THIS AGREEMENT. THE SPATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO I15)♦~ 17 ONY IS SPPL70FICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NO'a`IfCEe A001MON 4L TRRMS AND CONpITIONS ARE STATED ON ME 1"%M SJUDE AND ARE FART OF THIS CONTRACT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _4ppiicant Information 7� Please Print Legibly Name(Business/Organization/Individual): � ' J/L� J 2 �V/ Address IMP � �i�-� ko q p City/State/Zip: a,4)V C��� 30 3f Phone#: 17 t 2 Are you an employer? Check the appropriate lyoa: Type of project(required): 1.❑ I am a employer with 4. M I am a general contractor and I 6 []New construction employees(full and/or part-time).* have hired the sub-contractors 2. listed on the attached sheet. 7. E]Remodeling El am a sole proprietor or partner- ship and have no employees These sub-contractors have g, [j Demolition working for me in any capacity. employees and have workers'comp. E]Building addition [No workers'comp. insurance comp.insurance. 5. � We are a corporation and its 10.❑ Electrical repairs or additions required.] 3,❑ I am a homeowner doing all work officers have exercised their I L 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' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. /� `^� �1 Insurance Company Name: / l � -slil-L° �.t�NY 00 . Policy#or Self-ins.Lie.#: W C, ® g Expiration Date: Job Site Address: V City/State/Zip: o1zzz, 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 u e th pains d pe ties of perjury that the information provided above is true aryd orrect. — Si ature: 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 Su rvisor: Not Applicable £ Name of License Holder: j�A z License Number A Ad �- V� ,^„ , �� Expiration Date Signature �Teelephone 9.Re `stered Home. roveme t Contractor: Not Ap licable £ Comr)anv Name Registrati ^ er / e r' ss Expiration Date Tele r phon 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...... £ IL-, Horne Owner_EXempt on The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 Wi s Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (0 Sidin Other(Oj Brief Descri ti of P o ✓ Work: � Alteration of existing bedroom Yes No Adding new bedroom Yes ��� � w Attached Narrative Renovating unfinished basement Yes No C~ T , Plans Attached Roll -Sheet 6a.if New house+and or.addifion to`ezisting-housing; complete the'foiiowing: 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. 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR PERMIT as Owner of the subject property hereby authorize n to act o�behalf,�l�t�I�C/��authorized by this building permit application ? — /Z Signature of Owner Date c as Owner/Authorized Agent hereby declare fhat the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed undertW sin and penalties r . Print Name Signs of Owner/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 Setbacks Front Rear L--j Bldg. Square Footage 011'0 Open Space Footage r---, % (Ut area minus bldg&paved #of Parking Spaces (volume&Location) A. Has u Special Permit/Variance/Rrding ever been issuedfor/on the site? x_� �.� NO �~x~�� DONTKNO\� «�� YES �~� IF YES, date issued:! IF YES: Was the permit recorded at the Registry ofDeeds? NO C� DON7^nu , YES - --- IF YES: enter Book Page and/or Document� �� �� O. Does the site contain a brook, body of water orwed ��wetlands? NO �_� DONTKNO\� �~� YES ��, IF YES, has permit been or need to be obtained from the Conservation Commission? Needs to be obtained ��` Obtained �-x Date Issued: �~� �_/ ' ' C. Do any signs exist on the property? YES �~/ NO �.��� IF YES, describe size' type and location: D. Are there any proposed changes toor 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 nriait part nfa common plan ' that will disturb over 1 oona? YES 0 NO K ) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ -' F7epartrt�enk use only _ - U) f Northampton Statusof Perntt r 'I'I g Department UN 02014 Curb Gut/t�ri�ceWay Petmtt J J i Main Street sewer/septlGva�rallrty oom 100 ' ' Electric.Plumbing&Gas I o ton, MA 01060 TWoS2fs ofStiuctural:Ptans' Northam - 240 Fax 413-587-1272 Plo(/Site plans t r Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section fo be completed by office 1.1 Pro a Address: Unit : Zone Overla D�strrct EIm St .f7istnct t CBD'istnct SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: vw"44 l'u"a qw� Name(Print) CPO ,p.),__ Current Mailing Address: 6� *" " Telephone Signature 2.2 A rize ent: T(2*) Name r' t) --F741� Current Mailing Address: nature I Te ephone 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 134 RIVERSIDE DR BP-2014-1319 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B -073 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: vinyl siding BUILDING PERMIT Permit# BP-2014-1319 Project# JS-2014-002219 Est. Cost: $8601.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 92937 Lot Size(sq. ft.): 22389.84 Owner: MCKITRICK MARY C&VERNON H FATH Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 134 RIVERSIDE DR Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)015-26-110 Workers Compensation NORTH PROVIDENCER102904 ISSUED ON:611012014 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOW& VINYL SIDING 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 Occupant Signature: FeeType: Date Paid: Amount: Building 6/10/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner