17C-168 (5) SEP-14-2005 IL:07AM FROM-HOMEDEPOT WSPRINGFIELD 4137476613 T-083 P.004/004 F-821
IIV H/3 V V LiVIL1N I LAJIN I HAL:I'
Sold,Furnished and Installed by:
Branch Name: J` "� Date: THD At-Home Services,Inc.
d/b/a T Ie Home Depot At-Home Services
345A Greenwood Street,Worcester,MA 01607
Branch Number: �.,_ Job#: t �7l! Toll Free(800)657-5182; Fax:508-756-2859
Federal IDM 75-269846(1 ME Lic#C 02439 RI Cont.Lie#16427
CT LicW 565522; MA Homy Improvv4nwnt Contractor Reg.#126893
Installation Address: 3 9 A-O qI; Gz` M�4
City State Zip
Purchaser(s), ,Lust 4 Di its of Driver's ie.#&E o(Y Work Phonet Rome Phone-
H�o R E �D 'R
Home Address:
(If different from Tnstallation Address) City State Zip
Project Information: l/We/You("Purchaser"),the owners of the property located at the abave installation address,offer to
contract with Home Depot U.S.A.,Inc.("home De of")to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet#:_Tg !3! 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. Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DEPOSIT PAY VTENT OPTIONS p
(Subject to fund verification and/or credit approval_)
1.
CONTRACT AMOU $ r��JJ Check,Cashiers Check orUS Posttl Service Molloy Order
rrr Ill Y>
(Made payable to Tba Hotrmc Depot).
*LESS DEPOSIT $ -7'-�D 2. Credit Card•and/or other payment options-Circle One Below
�( Visa MasterCard Discov:r Amaacarl' ress J
ONBCOMPLET ON S lJ !� t The Home Depot Ho=Improvemaat Lmi The Horne Depot Credit Card //Ij�/
Available Credit:S_ r O'a IUL S IIDCC ONLY)
*Minimum 25%of Contract Amount due upon execution t, ^�ry�
f this contract. A=4: a00+Zl j a'I Pxp_Dates n 7�
Name as it 4PPears on card'
Indicate Payment Method For •By-my/our sign Lure below,Uwe agree to allow Home Depot to charge the ove
BALANCE DUE ON COMPLETION:
aanc xedl card t fated.
e arc 0
I�
HTL or FIDCC Atitborization Codes
De osit Final Pa ment
# 0 rod # ()i O-)
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due, Purchaser also agrees to bejointly and severally obligated and liable hereunder.
Entire A cement:This agreement and its attachments,including any financing agreement,contain The complete agreement
etween t to parties and can not be amended or modified unless in writing to a separate agreement signed by both parties.
NOTICE TO PURCHASE,R
Do not sign this contract before you read it. You arc entitled to a completely tilled-in copy of the contract at the time you"Igo. KWp
it to protect your rights. Do not sign any Completion Certificate or agreement slating that you are satisfied with the entire project
w
before this project is complete. La 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 t to contract.
You may cancel this transaction at any time prior in midni bt of the third business day after the date of(his con(racl. See Notice or
Cancellation for an explanation of this right. There will be a service charge equal to 25% oi'the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
BY MYlOUR SIGNATURE BF,LOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CGN'1 RAcT. 1/WL ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLE•TE-D COPIES OF THE NOTICE OF CANCEL.L ATION.
BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUI)]EC'T TO REVIEW OF MYIOUR
CREDIT HISTORY AND UWE AUTHORIZE HOME DEPOT AUTHORIZED CONTRACTOR,TG VLRIFY AND REVIL'W MY/OUR
CREDIT RECORD WITH AN INDFP NDENT CREDIT REPORTING AGENCY AND RL'LEA:.E'IHEM FROM ALL LIABILITY
INCURRED FROM INADYE ENT 1SSIONS OR ERRORS. DO NOT SIGN TIiI CO PACT IF TIIEI2L ARL• ANY BLANK
SPACES•
SUBMITTED BY: Date:
tI"Consult t
ACCEPTED BY: Date:
�� _
Ho ow
Date: _
Homeowner
NOTICE:ADDITIONAL TERMS,CONDITIONS AND WARR,%NTIRS Aaf s-nveyn ON THE REVVIL5F STDE Nao A1zF PART OF THIS CONTRACT
While-Hnnch Fdt Yellow-cmic—r Pink-S�les Cansulmm
5-17-05 C-SC
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DEPNtTMEI-TT OP BUILOMG INSPECT1O1.'S
212 Main Strcct Nfunicipal Building
j NorthampLon, Mass. OIOGO
«`OMO:R'S CONITENSATION LNSURANCE Al,I-D�AvIT
(1,ctvsxlpc7 mMOO
principal place of businessfresidence al: -�--
tal aa 0
'i (suit/c�t`r/szalcla p)
do hereby certify, under the pait>5 and penalties of perjury, ha.►
( ) I am an employer providing the followine�workcr's eomoens-z6op cove: se for ►ny
e-mployces ivortng on tills job:
_J� e01 C,V
(L mr- Coar. z-\) (Pelie Nu-mbcr) (T:pir o Du}
I
( ) I am a sole proprietor, general contractor or homeowner (c cie one) and Lave hired
t-he contractors listed below wbo have the `ollocv,Log worker's comperls2Dion ao!tcles:
(,Name Oi COntnclor) Ons-urznc Cornpan)'rPoucl >�1 = :) (Yti�ti�t3Ql Matt)
(Name oC Contraor) (lnswaacc Compa y Pol.im; -unccr) (-Eapuz6on Date)
I -
I
(Name of COUZl IMO,-) Onswajacc Com Tom)' n'/Poll N:tmbj) (Expirstioo Dalc)
i
(Name of Contractor) a=rancz Comcaay/Policy Numbs) (Ex adoo Date).
(-CAI:h cbcd tracca.�-w a�cv�-iaforza.ioa pctniaias to.11 oosr-�vn) -
O I am a sole proprietor and Save no one working for me.
I. ( ) I am,a home owner perforrning all Lbe work myself.
I
jNOTE:plc=sc be cw-A=LfjJ N JC bomcrµ -n Mbp Cloy pcwm to LSD ..n rc;Q-r wont oo a d-,U,.t of
nu mom lb--a Lr--=rte is u-ich Ux bom.-Dcr nw&.cc oa tb,-pvuD,:,zppurtcn:a th,-, c ax rUy xe+cd re 1 m he
eitplayes uac'.c the..vc1 d7 m nc---„oa Aa(G L'1 52,a I(S)�z;>pliaDao by a bomcoa-ac f=_ties:ac Permit try c+-rdmcc tbC
Icgs1 rtsiuc of ea e=Ployer-edcr duo Wack e,Coaspomatiou Art
I ua4--d the a copy or thi.mtcmcm m.y be for---ti-d to the Dcganaaca¢of laA ,ir1 Accdcav'OlLoe or Irra+l+000 for the
eovcra�c vc c3Iioo and tlu L-il=to ioc.Yioa 25A of MOL 15-2 ctn led a the izgoa O.of cimim-']p�liio
cowiriag of a Gx of tap b S1}00.00.r,&cc of up to ooc yc�wd 6%i1 pca.hia tin 6c roan of.Stop work Ordc and a
o(S 100.QO a day aF�yinA CDC
Far *�,t v+c only .
[Ott t`rlLnliJCS —
1.�p: L.ot .".
Si of 4Liranuia(cc
SECTION 8-CONSTRUCTION SERVICES r
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Applicable Not A ble ❑
PP
• � d lc
Com an v Name Registrafion Aum .er - -"-
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION-INSURANCE AFFID"AvIT(W;.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....... Ef in No...... ❑
} tt a
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-vear 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
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition []_ Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[tom] Other[p]
Brief Description of Proposed 40W L-b M
Nf.�
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _�No
Plans Attached Roll -Sheet
sa 1f vi oias6 nannm dditiaia,to exisfin'u o is ni co o ete e r :
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
Or 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, 1 rC►r 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
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 Nime
Sidrfa ure 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 `
Frontage
Setbacks Front
Side L:' i R:` L:' R:i _
Rear
Building Height ---
f
Bldg.Square Footage I % (-
Open Space Footage % r--
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: 1
(volume*Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:!.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page':— and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T 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 ® 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 Q
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.
•� ity of Nortoarripton
Bu ing Department
�,s Asa
12 Main Street
Room 100
`. Northampton; MA 01060
413-587-1240 Fax 413-587-1272
s P,
AP IIC�T10N TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTIOI SITE INFORMATION
This sectioh to be Co
1.1 Property Address:
�Tb �'`'1r�'h �fi 1 {��eI��Q. Zone �OVerlaIstnct�
�-Elm-Sf.Distract � ,. �,+•+C$�D;iStriyGt'
SECTION 2;PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record,;.,
Name(Print) Current Mailing ress
(Z r� Telephone 5$
3igriatwG
2.2 Authorized A ent:
t c,vYl (L'�r- S Ck�
Nam (Print) Current Mailing Address: L
1 3
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 1 o(a (a)Building Permit Fee
of r
2: Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
a5'
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number. Tate
ssued:
Signature: r
Building Commissioner/Inspector of Buildings Date
38 HIGH ST BP-2006-0395
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 168 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0395
Project# JS-2006-0576
Est.Cost: $1222.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 8189.28 Owner: BRODEUR GEORGE J&THERESA R
Zoning:URB Applicant. HOME DEPOT AT HOME SERVICES
AT. 38 HIGH ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
WORCESTERMA01607 ISSUED ON.1011112005 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL PICTURE WINDOW
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 10/11/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo