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32-015 Oct 2614 06:22a P•1 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold.Furrished and Installed by. Branch Name:Reston North&c South Date:)�,04AJ _ THD At-Home Services.Inc. dibla The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1.Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal m#75-2698460;ME Lie#C 02439;RI Cont.Lic#16427 CT Lie#RlC.t1565522:MA Horne Improvement Contractor Roe&0 1 16843 Installation Address: ._ F, City State I Zip Purchaser(s): Work Phone: Horne Phone: Cell Phone: ES ] [ J Home Address: (If different frost Installation Address) City State Zip E-mall Address(to receive project communications and Home Depot updates): 0 I DO NOT wish to receive any marteting emails from The Hot:Depot Proiect Information: Undersigned("Customer").the owners or the property located at the above installation address.agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to fvtnish,deliver and arrange for the installation("Installation")of all materials described on the below 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 Orders(collectively, "Contract"): Job#: `um` w Rem ) Pwoducts; Spec Sheet(s)#: Pre ect Amount Roofing LJSidingXJ Windows LJ Insulation 6 %N ❑Guuersi Covers ❑Entry Doors ❑ Roofing ElSid.ag Windows Insulation ❑Gutters i Covers ©Entry Doors ❑ Roofing LISiding LJ Windows 0 Insulation ��j ❑Gutters i Cover. ❑Entry Doors❑ r Roofing Siding Windows El Insulation ❑Gutters i Covers ❑Entry Dais ❑ Minimum 25%Deposit of Conti-Ad Amount due upon execution of this contract Total Contract Amount Maine Purchasers any not deposit more than ttrtrtltird ol'the Cuatrad Amount. Customer agrees that, immediately upon completion of the work for each Product.Customer will execute a Cwnpretion Certificate tone for each Product as defined by an individual Spec Sheet)and pity 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 Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot petibrm its obligations due to a stn:ctural problem with the home,environmental hazards such as mold,asbestos or lead paint.other safety concern,%pricing en-or,or because work required to complete thejob was not included in the Contract. Payment Sumrnarv: The Pay.•nent Summary# l b��ZIT , included as part of this Contract, sets forth:he total Contract amour:and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely tilted-in copy of the Contract at the time you sign. Do not sign a Comptetinn Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product Is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Horne Depot or Authorized Service Provider through the date of termination,pins any other amounts set forth in this Agreement or allowed under applicable law. 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 Or SUCH AMOUNTS. Acct: lance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and to Home Depot with regard to the Product;and Instal)ntion;ervices and wpersedes all prior discussions and agreements,either oral or written,relatin.-to said Products and Installation.This Agreement cannot as "oned or amended except by a writing signed by Customer and The Home Depot Customer acknowledges and agrees that Custo r ha read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ac ept Submitted r Cus er's Signature Date Sales Consult igralure Date X Telephon o. Customer':Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW W ns•mmr,.,a rro�n rm�mr -• � � �� ti • eea!gYCu:nran—rncan.gc.ca • • Q�ttttfcd ':nov: lzb:l,0:r FtnzI Inspecllon; SAVE for future reler:nc: ' l W�alh:r 5hl:ld • Cr D� 050:-,4—t72 �?q F R C Model SIOB•Double Hung Dperaiinp Alum clad Thermal Frans + ;r y~ .::n 314 Inch Glazing fbt;c4 1:1 z ZO_c ,D22 Low—C Argon rill Grille in Air Space ENERGY PERFORMANCE RAC �S U-FLitr $D!L Y.:�Av 111 CQ:IIi�:nl 0.30 1 ,70 0.18 NSA-Pl I} lri 1a(i ADDITIONAL PERFORMANCE RATINGS Ylil6lt lnsr.;,i!i:-: Lrndtei:{iin fltsiitu•:: 0.4.0 0 Cnuircunr tilul,ta hq Gta nupi rtabrn m ypTlr.Slt xrfl:p7scJu,ct br t.ltrrertnQ V}.tt pn1ul nir;i ptfc"=:L RFtC ntndt to dtlt nrtnt/ br t'T Lt n1 izl sl tenrnnutW tstdlwi u+l Wulff pndrd tart. XFR:lou 161 rcrnn* i .nr p kdrl tn['Itel All rt:ttnt ht u14.51Cy 91�pr""1 W•r*} rpeCte vvll rnenuU.,Wnt•l tLnun bl ithtrpndud ptrbnr. cs tnknrutw• vv,r•nlr..or7 , W..,tlt or t:utet k1.°_C c,°_,C., and I.E.C,C• 1.71 Iulpinilon P.ouir.mtnls (DP) BPS Itee/is LrcS t'21uu,rxWDL 1V1T.1-f7 []rl"1*-uQ'-Lt'�u IQ7r1 Lt • ' rc W-1:7i t11tS^.161u=1�t j �. � 3 U•1 Y..,,�.t+n.J 7•..,.�„,,l.r 111V I:L ' =_� z%74A 1_ ti 1101 S:U211fY�iD City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. S � Address of the work: `20 The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Sign-ature of Permit Applicant r riC i..U11tNLV11 II'C4-4LC/C Vf lil�s•�•llCILUS'L'If5•_ ' • �� Depart�nentof'fildustl'ial�4ccider.�''/' ' O;lZcg of r ' 1 Colt;res� sz1ee�- `ucts 100 BOSf011�"/.Sr3 UZII -Z 017 W.-- / t11ass.00vIdia ' Workers' Compensation'I>z��r�/tea nee Auidavif: Build ers/Contractors/EI°ctricians/PIumbers kvolicant fnformation' please Print LetribIv N3Z1° ss/Orgzn xzdo i/"lndividttal): /vim' t '`��j1 �'11 �' �!� iY ICj Address: City/St�tJZip,:. Are you an'employcr? Check the appropriat bow Type of project(required}: I. I am a C'm D}Dycr With 4. I am a general connc;ior and I ' -rnployet:'s (full and/or part-tire•-).'� Have•rived tha`sub-contractors 6 New const;vctiori 2.❑ I am a sole•proprieior or pa7n-r- listed on the attached she-t. 7. ks modeling s .ip a--a have no em-o ID s - These sub-contracto s have Yee 8. ❑ D..,nolition W0.1:mg ror-n--1_'1 any capacity. °�1710y�eS an' have WDr}:Lrs' - (N0 Work-rs' corno:Insur anCe Como. 1I1SilianCC•'i 9. 13llLlOLng addition ' S. We are a corporztion and its . 10. ' 1aecLLi:11 repairs or additions requ red.J �. 3.❑ I arm a homeown_r doing all%WOrl: o5c-rs have'exercised their 1l:❑Plu_-nbi'.;repzi*s or additions m}sell. ?vo worl:ers'.comp. :?°hf of exe 'tition per MGL , I iatt z*tec reou red.J t c. 132, X1(4); and A,--have no 1_.Q Ro s' enployees. [No workers" 1 Other . •'comp. insurance r'squired.J • 'p.ny ! 7:1LSt air, fill out tlr section below shoA g their worl:orS''comp-rsation policy infomiztion. t'iio coxr.c s who submit:cis affidavit indiczdng they z:doing zD work and then hire outside a new affidavit indica.=ng such. tCoatm :a that c..xh this box must a^ached an adni6cn al sbect showing the Barr.-of the sub-:.onta-Lo;;and'sate whaher or not thoso etititis have :mployees. If the sub-eon-zctors haw employees;they most provide their worl-,:s'comp.policy number. ' I ani a,i eufpioycr lira! providing workers' coniD_°ItSation insurence for my employees. Below the polity and job site' Irsu an-e Compzny 1�a_ne: Policy'-' or Self ins. Li c. �' !/vC_i DTI =xpirarion Date ^/ � �_ - ,�Job Sit.Aaaress: City/StatJZip Attach a copy of the workers' compensation policy declaration pzge(showing the policy number an piration date). silt:::to s-cure cov_,zge as required and-r Section 25A of MGL e. 1"2 can 1-ad to the imposition of�iminzl penalties of a :mz'up to 51,30D.OD and/or one-year imprisons:.-nt, zs well as civil p-nzlti°s in th-form of a STOP WORK ORDER and a f= of up to 5250.00 a day against the violator. Be advised that a copy of th_s s"—tem-nt may b-forwarded to the Omco of Invcsti;ztios of the DLk for insurznce.cov-ragc,v-rincation — I do 1, ,--by c_ri.' p nd 1 cirri« f crj:rn,!het t,bc infornrat`ion provided ebove is tree alld LDr7=f S1E all ': ''y y I .�/�✓ '�d �_ �- / Dot- none I 0 _ :1 L•sc 011,L. DD 1101 lvae in tits arcs, to oe cor,IDlcled by city or town ofJtaial. i 11- " 1i • City or Town - Per nitlLi-ense Issuin-,Authotzry (cisde one): 1.Beard of Health 2.3 1i nin,Depz.-t1.eat 3. CiryrI'oN%•n C1°rk l -cal r�sp^ for S.Plumbi_^o Lnsp°'tor 6.Othe - -� - -_ Contzct Person: Phone R: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su isor: Not Applicable £ Name of License Holder: /�-, .. '-license Number Address / / Ex ration Date Cz Sig ure Telephone 9.Re istered Home Im rovemerit Contractor: Not Applicable £ Company Name Registration umb zvw ss iration Date TelephoneL SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit ust be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b ' g permit. Signed Affidavit Attached Y £ No...... £ 11 - HO-me Owner EgemUtion 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 winaaws Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding [0] Other[p] Brief Des cr' � Work: 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 hoUS6 an or addition to`existing housing, complete the follo�iving': 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 hereby au rize to act behalf, in tynatters r ive to wor by this building permit applicattiion. /I e--17/ ! ^ gnature of Owner Date I, as Owner/Authorized Agent hereby de are that the statements and i formation on the foregoing application are true and accurate,to the best of my knowledge and belief. e Signed under ains d penalties o Print Name Signature Qer/A nt lo, 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 Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has Special Permit/Variance/Finding ever been issuedhn/on the site? ~�� � NO «v~��� DONTKNO\� �~� YES ^=-� � |F YES, date ioued: IF YES: Was the permit recorded at the Registry ofDeeds? NO �~�� � DUNlKNUYY 0 'ES C) IF YES: enter Book Page and/or Document# �� B. Does the site contain a brook' body of water orwetlands? NO �~��� DONT KNOW �~� YES k~�� � IF YES, has u permit been or need to be obtained from the Conservation Commission? Needs tobeobtained �~\ Obtained v�� Date |ssued.' �~� «_/ ' C. Do any signs exist on the property? YES ����/ 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 typeand \ocatinn� � | ' ' [-__-__-_-__-___-___-_'__________________'� E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre orioit part ofa common plan ' thut will disturb over 1 acre? YES NO (D IF YES,then u Northampton Storm Water Management Permit from the DPW ia required. — g Deparfinetit use only i ity of Northampton Status ofPerm�t,t LE C 1E j'7 r--= ,!'�`i uilding Department evri�CutiDn. eway Permit _.�._ F ! 212 Main Street Sewerl$epticAvairabll�ty f i' x k a I ��' ROOM 100 PA.�':' �- Water/�itelvailability ' L N70V 2 0 L)0(G Teo hampton, MA 01060 Two Sets ofS#ruCtural Plans' ��--��q}�.yyy•�.��r�._ q 1.Q 587-1240 Fax 413-587-1272 P.,►ofJSite Plans '`i ' ' Electric, PILL L Y'�"�1, :f`' n y Ncr n ;,, i,,.. ' i Other SpeClfy y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be com leted b office 1.1 Property Address: P y Map Lot Unit / G k ( Zone overlay District Elm St Dlstnct CB Distract SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: '' Ago Name(Print) �._ Cur t Lc�fs Telephone Signature 2.2 Auth=ized ent: `• �����t7vV 1 � v Name i Current Mailing Address: G nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit a licant 1. Building / r j}/ (a)Building Permit Fee 2. Electrical v (b) Estimated Total Cost of ..I 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 130 CROSS PATH RD BP-2015-0589 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32-015 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2015-0589 Project# JS-2015-001121 Est.Cost: $6112.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(sq.ft.): 133685.64 Owner: FUSCO LISA L zoning.: Applicant. HOME DEPOT AT HOME SERVICES AT. 130 CROSS PATH RD Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.1112012014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 15 REPLACEMENT WINDOWS 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 11/20/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner