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30C-072 - HOW EWROVEMEN'TUONTRACT - PLEASE READ THIS Sold,Furnished ar>d.Installed by. Breach Name:Bostou NorHt&8wt>a 1}atec`-�� TF1D At-lloma.Servicae;loc. dlUla The Home Depot Ao-Hoaae Services Branch Nmuber:31 and 33 908,Boston Turnpike,Unit 1,Shrewsbury,MA 01545 . Toll Free 877-903-37618 Federa]ID#75-2698460;ME Ilc#C 02934;RI Cont.Tic#16421 Cr *HIC.0�5d5S22;MA Ho=lr*ovemmreynt Conttastor R/e�g.0 1266893,. 1waFalletionAddress: � " �^2I 'f 7T tt-t�' City State Zap Pnr c6aser(s): Work'PhDas- $ome Phone: Cell Phone' I l I ] [ 1 Home AddresK (If different ftm jAstailatiou Address) City State Tag E•mall Address(to receive project communications and Hone Depot updates): ❑I DO NOT wish to receive any marketing entails from The Home Depot Proiect ldbemadon:'Undersigned("Customer%the owners of the pro located at the above installation address,agrees to buy, and THD At-Home Services Inc.('"I'tre Ronne Depot")agrees to furnisft,deliver and arrange for the installation("Insteliatim")of all.materials described on the below and on the.referenced Spec$beet(s), all of which are' ted.into this Contract by this reference,along with any applicable State Supplement and Payment.Suntm&rcy attached hereto and my Cbangp Crdera(collmtively, "Contract"): Roofing `5iding En Windows U b"latioe /oGurt¢rs' owl- ritnttyDoors Roofing' Siding Plndows IiagulatAtm OGutteis 1 Covers ElEntry Doors © 1 Roofing siding 'arrndows hrsnl*ao `1/,1/► G EIGImus t Covets❑Evowy Doors F-1 __ $ Rooting D.Siding LjVrn4ows U Insulation ❑tArtters)Covers I�Doors M ' M�tmimr2SRo Elepo®tctCmdrat tAmouotdmupmcmctdionotti6co d^act Tow ContractlAmottnt $ Matne Purdwwmkv not dgm0 moan A than one-third of a Co»tt� MARTI customer agrees that,immediately neon corttpletian o$the,t ork for.each Product,'C6stosner will execute a ComplWon-Cettiftcate (one fr eaob Product as defined by an individual Spec Shd6t)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly ond%vocally obligated and liable hereunder ' The Home Depot reserves the right to issue a Change Ordet 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 9bligations due to a structural problem with the home,eaviraameotal bawds Bauch as mold,asbestos or lead paint.other safety concerns,pricing errors or because work required to complete the job was not included in the,C�oynEt i accts )}aylttaut Saw"IMt The payment•Summary* "i Lbo ,included as part of this Contract. sets forth the total Contract amotmt and paytttmts required fvr the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to ai c&bpletdy Sled4n Copy of flue Cold Tact at the time you 64P. no not sign at CaanpltinnCeriflicat i(riow. there is one Completion CertMoate for each Mad Product ss de5tted by individual Spec Sheets)-Woke 17k on that)Product is compkte. In the event of tarmlestion of this Cmtrad,Customer agrees to pay The Home Ile the cost&of materia�,labor,expenses and services by The Hoene Depot or Authorized Service Prodder go the date of teradnadon,plus any other arnnunts set' t"h In this Agreement or allowed under applicable law. THE HO DEPOT MAY WITHHOLD Alva LINTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR O'>f1E CA PAYMENTS MADE, WITHOUT LIMITING THE 0OMR DMT'S OTHER REMEDIES FOR RECOVERY Of SUCH AMOUNTS. race and Autharizatian: Custoter agrees and understands that this Agreement is the entire agreement between Customer Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assiped or amended except by a writing signed by Customer and The home Depot,Customer aclaaowle%es and agrees that Customer has read,understands,voluntarily accepts ttte terms of and has received a copy of this Agreement Accep Submitted by: r C m s Signature Date Sales Consul 's t Date _ Telephone No. Customer's Signature Date Sates Consul Na CANCELLATION: CUSTOMER MAY CANCEL THIS tae aypUaabta) AORELMENT'WITHOUT PENALTY OR OBLIGATION BY DELIVVAM VVAITTEN NOTICE TO THE ROME DEPOT BY MIDNIGHT ON TH11M BUSINESS �4� 6� DAY AFTER SIGNING TM ACRE NT. TIME 6 STATE WffLEME1NT ATTACHED HERETO CONTAIN_S�� -P'OA-_jp USE V ONE IS n C�LY PRF��Ffi BY I A W ' IN CU R'S STAT'lr " "� Ca:AnDMOMAL TEiM AND CMMITIONS AU STATED ON TMyt13V ME SIDE AND An FART of Tms coNr .4C7 energysla►.nrcan—rncan.gc.ca P, 215M "J'HT- t T j E i s Ate• � ti � � y ousaned Remove label.afier final Inspection; SAVE for future reference . Weather Shield . CPD1 050 A-172 LNFRC Model 8108 Double Hung Operating a Alum clad Thermal Frame rtritrev%F--riearori.n 314 Inch Glazing , nalslg can:ta ZO—E .022 Low—E Argon Fill Grille in Air Space ENERGY PERFORMANCE RATINGS U—fatter Solar Heal 1>FIt CoellMenl 0.30 1.10 0.1 SA—t' 1tlelriel5l • ADDITIONAL PERFORMANCE RATINGS Visible 7ranstanlaore Condensation Resistance r 0.40 0 Yrauistuw s4pulatts het mesa mangs euolorm to sppDrahle NFRC proteduru br datermlatng whale pmdeel,eirgr pettomwnee.NFNC rsenge ere daletesinad 6r e" Iced eat at aavimnment#eondEeans and sp Wfit pmdall sim NFRC don sot reean+nxred t my prodrirt end'daec nit creaser be sul"Itltt or aay�r�pmdoet W any specfac use. Coasull manu(eeturer's RLeretun for olbet pmduel perbnrsanee Inlonnseon_ www.nrro.o Meets or es:aeeds M.E.C.. C.E.C.,and (.E.C.C. Air)nrinrstlon Se utrament-t (D P) (psf} tectedla AKSVNttsMr W'WDa ICILS.:. N—LC75 44X" tested to LARA YDUAMSA + U 1e1n S20AA4a'—gS N—LCJS T11/YZ2�0(vY9ln 1t2S1 Ono idiots Sirgebrsl FaAeneaeee f,r WU ESL alezn grnri.1 d7L6_1--1 1iG1SCO2kl1RSTD The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 aM www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /] Please Print Legibly Name(Business/Organization/Individual): �Lye, ��1jL '127/ &;!4j f- V/ 'S t 4D Address• C' ��� City/State/Zip: "kz- • 303 3 Phone#: �/ 7 `" Are you an employer? Check the appropriate 4ox: Type of project(required): 1.❑ I am a employer with 4. EJ I am a general contractor and I * have hired the sub-contractors 6. E]New construction employees(full and/or part-time). 2.El I am a sale proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have g. E] DemoL++•lion working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp.insurance.: required.] 5. EJ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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. 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: / ve'O > �� $f1�I�% �1�/�� (...-o , Policy#or Self-ins. Lic.#: W 0 Ll q 1® g 8 Expiration Date• 3 j 5' 2 � � 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 fozInsurance coverage verification. I do hereby certify der pains d . s of porjury that the information provided above is true and correct. Signature: ��'J Date: Phone Official use only. Do not write in this area,to be completed by city or town off 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 Supe isor: /67#��d Not iiable £��� Name of License Holder 'lei A - � License Number Address ✓ / L L �— Expiration Date Signature Telephone .. 9.Re istered Home lm Gov ment Contractor Not Ap licable £ l l Comijanv Name Registration Number ess Expiration Date N—r � Telepho 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 Home Owner'EgeiAp.1 n 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 buildine 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 W' ows Alteration(s) Roofing E::]Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks IM Siding [O] Other[I]] r Brief Descri f p r2 vy\ f� ���,� ) Work: /� `�lr !/r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. if New house and or addition to ex sting housinO complete Ethe followingl: 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 as Owner of the subject property 1 hereby authorize 4 to act on my behalf, in ma ters lative to work authorized by this building permit application. k ' Signature of Owner Date as Owner/Authorized Agent hereby declare that the sta ements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the ins an penal tie of perj J�J Print nture ent Date . Section 4. ZONING AIL Information Must Be Compteted. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning THs column to be filled in by Building Department Lot Size Frontage Setbacks Front ED Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&pav d ....... of Parking Spaces (volume&Location) A. Hasa Special Permit/Vahunce/Rmding ever been issuedfor/un the site? NO y-� DONTKNOYY 0 YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the Registry ofDeeds? � NO ~� UONlKNuW 0 YES ' IF YES: enter Book Page and/or Document# B. Does the site contain abrook, body of water or wetlands? NO 0 DON7KNOW 0 YES � IF YES, has permit been or need to be obtained from the [nnnemsdnn Commission? Needstobeobtained �- � Obtained �-� Date Issued: �~� x�� ' C. Do any signs exist on the property? YES �=��� NO v=�� � 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. YW||the construction activity disturb(clearing, gradingexcavation,or filling)over 1 acre oriait part nfa common plan ' that will disturb over 1acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. C7eparfRlent use only -- .. ity of Northampton 5fatus of Permit W �'` a�' r iiding Department curb cif!C�riyeway Perrrttf 3 U7 212 Main Street Seyver/SepticAvalfablllty ' $ Room 100 UVater/VrteliRua�lablllty }�� JUN 02014 IdtS hampton, MA 01060 Two sets of Structural Plans F 3- 87-1240 Fax 413-587-1272 P[a/Site Plans Electric,Plumbing&Gas Inspections OtFter Speoify tham ton, MAO.060 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE,INFORMATION 1.1 Property Address: This section o be completed by office Zone Overla District ' Y _ - Elm CB District = SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner o ecord: ' Name(Print) Current Mailing Address: Telephone Signature 2.2 A oriz A ent: Na ri �— Curren Mailing Addres'—C i�`- �,�—'�/,� nature 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 f l� 2. Electrical I (b)Estimated Total Post 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 Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 572 BURTS PIT RD BP-2014-1317 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C-072 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-2014-1317 Project# JS-2014-002215 Est. Cost: $5092.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: HOME DEPOT AT HOME SERVICES 92937 Lot Size(sq 1): 33584.76 Owner: RAE J PATERSON&MELISSA GREENSPAN Zoning: SR(100)/WSP(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 572 BURTS PIT RD Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401) 935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.611012014 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT DOOR W/2 SIDELITES 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 6/10/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner