Loading...
18D-053 (20) 6/16/2015 Commissioner Hasbrouck Subject:Request for Waiver 1 request thatyou grant a modification to waive the requirement for control construction for the Bathroom Remodel at 80 Damon Road bld 8 unit 303 in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.All work will be completed within the prescriptive requirements of 780 CMR. Thankyouforyour consideration. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for this project" Respectfully, Jennifer Francis Sears Home Improvement Building Permits Department Sears Home Improvement 1024 Florida Central Parkway Longwood, FL 32750 Phone : 407-551-6000 6/12/2015 To:Building Dept. Enclosed is a building permit application as well as the info below. • Check for the permit • Application • Sears estimate &proposal • Layouts and design if applicable • Certificate of liability insurance • State of CT home Improvement license info • Authorization letter If you have any questions please call me at 203-556-4825 or jfrancispermit@gmail.com Please note any other trade permits that may be needed,will be pulled by the licensed contractor themselves. Please email me the permit once ready. I appreciate your time! Thankyou, i h Jennifer Francis Sears Home Improvement Building Permits Department Sears Houle Improvement 1024 Florida Central Parkway Longwood, FL 32750 Phone : 407-551-6000 �r❑n.in!rC i��J rOY.' 14�.7�a DV CL'4 40" Z,1 404 1U:44 11.U1 CERTIFICATE OF LIABILITY INSURANCE °"momtea"" 4/24/2014 TM CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDS THIS CERTIFICATE DOES NOT AFFNIMATTVELY OR NEGATIVELY AMEND. EXTEND (?R ALTER THE COVERAGE AFFORDED Ear THE POUCIES BELOW. THIS CERTIFICATE W INSURANCE DOES M07 CONSTITUTE A CONTRACT SETTNEEN THE ISSUING INSURER($). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: V ttls e:stttfttsts ttafdor an an ADDIYIONAL INSURED,the poliWift,must be indorsed q SUER UTION 15 WAMED, V*farms and oendRkmz of the Polley.Comet"P011daS MOY require On lndMement, A stabnant on this oetttfiCSte does not wr+v r y COAftagt holder in hem of such mdorsewen o. POOOUCER riRS'A 1dRT1t►s;i Derksbise Tma=anCe Ormv, Iaa. PA/' (I13)5ti1-3659 Iaxslfa-uu 31 Court St. isiaseFiSb.aClcreia oD�.aar >>feletfield MR 01085 eIIIJAMAlOaatilu/r rnsurance Consiany 17370 No�mEV e: >t[il @t, InC. DBA Ildjo! $d11e InWroTeleeIIt:B al1URERC: c/o Yasilis 1b0tb>afrahutc S(46#32bbbt 19 amtown elope � mostiiold JIM 01085 r COVERAGES CERTIFICATE MUM ;Ma0A3433502 REVI ON NUMBER: TM IS TO CERTIFY THAT THE PO jcrcg OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE OR THE POUcY PEFO00 INDICA1tep. NOTWITHSTANDING A14Y REOtMMENT.TERM OR COMMON OF ANY CONTRACT OR OTTER DOCUMENT WITH ASPECT TO WHICH Ti9S CERTIFICATE MAY BE 169M OR MAY PERTAIN.THE INLSLIRANCE AFFORDEU BY THE POLICIES DESCRIBED HEREIN IS SMACT TO ALL THE TERMB, MCCLU61ONtS AND CONDITIONS OF 3UC H POLICIES.LIIATS SHOWN WY HAVE BEEN REDUCED BY PAID CL"AS. M6R Tm OF MUM" F LM1fre bMVtAL UAer..ITY NCE s 1,000,00 C+AI ° f t00 00 A QA94-ft DE LXJ omm 12Des /27/201 /27/2 01.5 m f _ 5.00 _ tc LvAAtT s 1,000,00 GENERN,AQORE(TATE f _2.('^'i,�"'. c6Mt IE L"r APPW PM s z LOC I I I AtliONCOU UAewmt ANY AUTO a001LY Twuw(Pe yasm) 6 O [-0 CNa% a�Q5 A BOD Y"JURY f W06DAUr0S AUTOSO S S UUMPLUt LUA O0Q1R EACH OOlA1Ri18NCE S 9X=V NAP aaA[Ne AGOq "M S t be issued directly by Y11 IW AMY ARI11 /M tserl►naa awmiat C)tAC:C f1 S RIA #0100 F�RFi °tCL00FD` E_L DISEASE-FA S , i�a.l,enet wrar qE5 O0 OPERATIONS prw L .PDI,ICY LOOT : DENCI rA"W OPIRAVIOW I LOCATNINS:VIROMM(A+wti ACOAD t01.AediCwl Rawaflu Sd+AaI.,N spsoe It,lgiiN/I Itaars Baste jMra.srwnTtt: vreduo v. T.rac im r_10tod sm an &"itiowtl insuVed. CERnF=TE HOLDER TION (860)466-S079 SHOULD ANY OF THE ABOVE DESCRIAEO POLICIES BE CANCELLED Bt6'ORE THE MWAIM DATE THEREOF. NOTICE WILL BE DELNErLT Seara molding Convration ACCORDANCE WITH THE POUCV PROVISIONS. Soars.8=8 10pra"meat Produfate, Inc. 1024 01arida Cemtl-Parkway AIAMOK=R®PNeieMt.TNK ia r magwood, FL 32752 ACORD 25(2010!05) ®t9BbM0 ACORD CORPORATION. All dghfa reserved. IN911 waas),I' The ACORD nasty and logo are re®istued marks of ACORD DAi 07t2MJDp0 4vrr} �.. CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the tm certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 13 AOn Risk services Central, Inc. NAME. Chicago IL Office (LAC.N,.EM) (8Ei6) 2x1-7122 , .._ (900) 161-01(A 200 East Randolph E-MAIL p Chicago it. 60601 USA ADDRESS: _ INSUREP4S)AFFORDING COVERAGE NAIC 0 INSURED INSURER A. ACE American Insurance Company 22667 Sears Holdincis Corporation INSURER B: ACE Fire underwriters Insurance Co. 20702 dba Sears Nome Improvement Products, Inc Attn: Risk Management E3-219A INSURER C' 3333 Beverly Road INSURER 0' Roffman Estates It, 60179 USA INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:570054720047 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- Limits shown are as mquested LTR TYPE OF INSURANCE INSO yry0 POLICY NUMBER (MMI00rcfm (UVJOOrYYYY1 LOUTS A X COMMERCIAL GENERAL LIABILITY HDOG17334143 0810112014 08101IMP5 EACH OCCURRENCE SS,000,000 TORFNTEO ctrvnLS awoE u occuR PRErasFS F..oo�n.rnu, S5,000,000 MEOEXPiAnyonepenon) Excluded PERSONAL&ADV INJURY S5,000,000 v GENT.AGGREGATE LIMIT APPLIES PE R C.ENF.RAL ACGREGATE SS,000,000 N X POLICY JE T n IOC RRODUCTS-COMP OP AGG 55,000,000 N OTHER o r A AUTOMOBILE LIABILITY ISNi08821008 09101/2014 08/01/2015 COMBINEOSINGLELMT SS,000,000 A NV AU ISAN0882101A 08/01/2014 0810112015 F oden A ISAH08821021 08/01/2014 08/0112015 BODILY INJURY(Per person) O Z X ALL U.NNED SCHE DU FD BODILY INJURY(Per—dent) m AUTOS AUTOS X HIREDAUTOS X NON-TN D PROPERTY OAIMCE V AUTOS 1pet acadeno t m UMBRELLA UAB OCCUR EACH OCCURRENCE V EXCESS LIAR CtAWS-MADE A,GRFGATE DED RETE'FTION • WORKERS COMPENSATION AND WCUC47888 39 08/011I014 OS/OIJ2015 X PER EMPLOYERS'LIABILITY StATIrtF, -> ANY PROPRIETOR:PARTNER t EXECUTIVE YIN OH, 47 kV EL EACH ACCIDENT 52,000,000 • OfFICERTACMBER EXCLUDED, NIA VILRC47$88815 OS/Ol/201a 08/0111015 (Mandatory In NH) All Other States EL DISEASE-EA EMPLOYEE 52,000,000 11 yen dc.,V--der IX SCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMMT S2,000,000 DE SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD td t,Addamnal Remuta Schedule,may be attached it more space 1s required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION tit SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WS.L BE DELIVERED IN ACCORDANCE VATH THE POLICY PROVISIONS. sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1024 Florida Central Parkway Longwood Ft. 32750 USA I `�' ��� �� ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ,29244 STATE Of-- 'CON, NF" CT ! JC- 1-117 DEP�ART-NIENT 01.7 CONSUNIER PROTIECTION 5 1 A i C Attached is your 11-forne frnprovement Contractor Registration. This registration is not transferable. For questions.,contact the Trade Practices Division at(86o)713-6ilo or email Visit our web site to verify registrations and download applications at I F STATE OF CON-0-ECTIC 'T D-E-P.-4RTATFYT OF COYSE 1rEJ?--PR0TFCTJD.V HOME IMPROVEMENT CONTRACTOR SEARS ROME IMPROVEMENT PRODUCTS INC SEARS HOME IMPROVEMENT PRODUCTS INC 1024 FLORIDA CENTRAL PKWY 1024 FLORIDA CENTRAL PKWY LONGWOOD,FL 32750 . LONGWOOD,FL 32750 LIC,i AEG No- EFFECTIVE- EXPIR0T- HIC.OWD766? 12/01/2014 11/30/2015 SIGNEn6l. PA p R PROTwr 0 knowri thaOOH - -C OO IMPROVEMENTTROWJJ. TSJNC,�Io- , I-, VPZLOR P Jj DA WNGWOOD) FL,32750 is certified by the Department of Consumer Protection as a registered HOME IMPROVEMENT CONTRACTOR Registration # HIC-0607669 Effective: 12/01/2014 Expiration: 11/30/2015 William K Rubenstein,Commissioner FIE .......... A tf Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration 148607 Type: Public Corporation Expiration 1 011 1 201 5 Tr# 243758 SEARS HOME IMPROVEMENT PRODUCT ALFRED NYMAN JR. 1024 FLORIDA CENTRAL PKWY _ LONGWOOD, FL 32750 Update Address and return card.Marls reason for change. .-o Address !—1 Renewal F;nspioyment Lost Card ' oft'icr ore"ossunrcr Affairs&Ruuaess ltrgalation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: ogistratfon: 148667 Type: Office of Consumer Affairs and Business Regulation Expiration; 11111121)15 Public Cor➢oration 10 Petit Pf-1ra-Suite S1?0 ~=` Bostuu,MA 02116 SEARS HOME IMPROVEMENT PRODUCTS INC. ALFRED NYMAN JR 1024 FLORICA CENTRAL PKWY LONGa OOD,FL 32760 C_ __ ItoJersrcrctary Not valid wi t outstenatur Q°/28/2f314 10: 15 4137353°6? AOL—, CD- Massac�us _ DepartMenf of Public Safety scar of suildiR 9 Regula;;OM and Standards construction Supet'casor License: CS-103054 raYSUJR ?d 19 hunters slope WestfWd MA 0lftS I ✓ )rtN Expiration Co+tunissioner 0812412016 1024 Florida Central Parkway', Longwood, FI_, 32750 Pl f:407-551-6000 November 2014 LEITE:R OF AUI'I1ORIZATION I, Alfred li'. Nyman, Jr., Assistant Secretary and Connecticut State Qualifier for Sears Horne I flip rove men t Products, Inc., grant permission to Nikole Easley and her associate, Jennifer Francis to submit permits and licenses, pick up permits and licenses, make changes to permits, licenses and plans and initial changes made by the building department on behalf of Sears Home Improvement Products, Inc. I also grant permission to Nikole Easley and her associate, Jennifer Francis to Purchase permits and/or licenses with a company check, personal check, personal credit card or cash. I certifiy that the above information is true and correct. Alfred VV. Nvrnan, Assistant Secretary and Connecticut State Qualifier(IIIC.0607,669, IiTG.0400133-S1) Sears Home Improvement Products, Inc. SKATE of Florida COUNTY of Seminole SWORN TO AND SUBSCRIBED BEFORE NIE"1'FIIS_�,"day of November 2014, by Alfred IV. Nvman, Ir., .-Assistant Secretary for Sears Home Improvement Products, Inc. and who is X personally know to me or has Produced a valid Drivi'rS license. Seal: __ y c Print Name: Deborah P. Pliill'-1s + DEBORAH P.PHIWP8 �' rarrcoaa�ss ueera1 Notary Public,State of Florida r' ` EXPIRES Au gist 13.2015 Commission #: EE 090281 tic ±ilxu r:r�y ew,lz a derx im w, MY COAI MISSION EXPIRES: Aug. 13, 2015 Bathroom Remodel Addendum Proposal Adders: ile Surround Color.Tuscan Blue Corner Shelf Tile Surrounds. Ceramic Tile Comer Shelf Adders: ile Surround Comer Shelf:Large Shelf ile Surround Soap Dish Finish:White Drains Drains. Drains Adders: Drain Finish:Brushed Nickel Exhaust Fans Fans. Exhaust Fans Adders: ' Exhaust Fan Style: 110 CFM Lights Grab Bars Grab Bars. Grab Bar Adders: rab Bar Width:16" rab Bar Finish:WhfteBrushed Nickel Soap Dish Tile Surrounds. Ceramic Tile Soap Dish Adders: ile Surround Soap Dish Finish:White STESE-1/4- Shower Doors. Shower-Euro Frmiss Slider-60 x70 3/8-1/4"Thick Glass 60x7038 Adders: hower Door Glass:Clear hover Door Finish:Brushed Nickel Tub Conversion Tub Conversion. Tub Conversion 05/19/2015 F -, 05/19/2015 Customer Signature Date Customer Signature Date Bathroom Remodel Addendum Consultation Info Lead Number: 18219135 Date: 5/19/2015 Sales Rep: STEPHEN KELLY Customer Name: MARY DONOHUE Phone: (860)983-0013 Address: 80 Damon Rd City: Northampton State: MA Zlpcode: 01060 Worksheet Summary "� iCc�trtrtall9tr� '; Quote 1 Proposal - A p p 81 1 302-1 2TL Flooring-Tile. Best-Continental Slate 12" Adders: tyles Flooring:CONTINENTAL SALTE 12" Finishes Flooring:CS56 Tuscan Blue B114TL Flooring-Tile. Install Tile-Diagonal Pattern 81 16T Flooring-Tile. Install Backer board/Hardy Board (labor and mate B132FL Flooring non product specific. Remove&Haul Away Existing Ceramic&Backer board B204 Electrical. New outlet exist line,no GFI outlet upgrade B205 Electrical. Outlets-replace existing-duplex GFI Bench Tile Redi. Tile Redi Bench C2418-PU Faucet Lavatory. Luxart-C2418-PU-Carmella-Wideset Faucet(UD) Adders: Faucet Finish:Brushed Nickel C511TO Shower. Luxart-C511 -Carmella-Shower Only Kit(valve included) Adders: Faucet Finish:Brushed Nickel Cent.Swing Medicine Cabinets. Cent.Swing Door Medicine Cabinet w/Lights Door w/Lights Adders Bertch Vanity Width:22' Bertch Vanity Height:33" Bertch Vanity L or R:Left Bertch Wood Species:Birch Bertch Finish Color:White Bertch Hardware:SN-K21 -Satin Nickee Square Knob Center Drain- Am Acrylic Bath Sys. Center Drain Shower Pan Am Adders: Shower Pan Width:60 Shower Pan Depth:32 Shower Pan Drain:Center Shower Pan Finish:White Cimarron CH EL Toilet. Kohler-Cimarron-Comfort Height&Elongated Front(UD) Adders: oilet Finish:White allons per Flush: 1.6 Cimarron Ped 8 Pedestal Sink. Kohler-BK-2362-8-Cimarron-Pedestal Sink 8"Center(UD) Adders: Ped Sink Finish:White Continental Slate Tile Surrounds. Continental Slate Tile Tile Job Number: 18219135 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof. If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 05/19/2015 05/19/2015 customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc.("Sears")on 05/19/2015 by: Date Management Representative SBR1-MA(Dig.) Rev 08/13/12 Page 3 of 3 \I) /ILt. Job Number: 18219135 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 2wKS (Approximate Start Date) It will be substantially completed by approximately 6WKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. MOLD REMEDIATION: This Estimate and Proposal assumes that no mold remediation will be needed during installation work. If, upon inspection by the contractor or others,it is learned that mold remediation is necessary then Customer must arrange and pay for such remediation by a qualified person prior to the start or continuation of work.If Customer fails to arrange for necessary mold remediation within thirty(30)days,Sears may cancel this contract upon written notice to Customer. Customer(s)initials IF PLEASE NOTE that Sears is not responsible for correcting any existing code violations or pre-existing conditions of any subflooring not being replaced at this time. If additional work is required,it will be the Customer's responsibility.Any additional charges will be quoted and approved prior to the start of ny additional work. Customer(s)initials ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials("ACMs"j that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty(30)days, Sears may cancel this contract upon Customer(s)initials /,1A V-D written notice to Customer. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 18,044.94 Contract Price $18,044.94 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 6,000.00 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 12,044.94 Local Sales Tax( 0.00 %) .1 0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due $18,044.94 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Customer(s)initials �� Card Payment Addendum made a art of and incorporated into this contract b reference. NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation.I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears'installation contractors)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order fnr#hie ine+allaAnn fn a nnn+ron+nr• /91 incnnn#$\n ine+ally#inn• ­4[Al nay+he nnn#ren#nr ulhen+he inc+alla+inn is nmm�ln#n if I hallo oinnnA o ner+ifrna+e+ha++hn inctallatinn had heAn completed to my caticfarfinn ...,_,. . ,€,�r.a1aN=.C= �_ �.�1 -_ --,� Zvi. ;...v� -.�: :,.,..J.,.;uv _;� ., �._.__.�., _.,- - -•__._.. -,_-"_ -r ,�-._.. ,,._.,_.-'o' _ - ,..::�: causes beyond Sears'control. oral Enraaman+a and rhnnnaa in r^n+rar+ I I InAere#anrl+hat#here arc nn oral nnraemnn+e hofiueen Caare anA mo FvanAhinn 1 avnant Caare#n An hat keen ..nL1rlm+in ulri+inn in+hie nnn+ran+ Aln+hinn na.\hc+nhannr.l in+hie nnnM nn4 unlaee i+ie in lul+inn nn eena a#n fnrm annan+aA h,J mn—A Qnam Respansibility of Buyer, I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work VGJVItUGU 111 t111J VVIIU QVI. my expense unless Sears has agreed in this contract to make the changes. 1 .114....1..I YYIII I-Y VVGIIJ UIV VGJI1 tI11VG YIG\VV VCiIJ UI\3 tJ11VV VI Ills-,IlGllul YIiV IIIJIV IIUU VII GJ JIIVYIII VII UIG III JI tIGyV• •Iran un��II II VIIIIWYVIL/l1./LII VI111G1V Nl vuuva vrwluny uwuulGnw urw uo ylrvn w nlc vy VVGI J.VGUIJ ItGllGllt�vn nlJliunuuun w. SEARS'LIMITED WARRAN i r ON INSTALLATION In wirlifinn to anv maniifnrfilror luarrar4 nv+A rlorl±n ±nil n­fh.n r A;-f:z1 wzM /Ishirh warranty harnmac offortiva tho riato tho marrhnnrlica is inctnilaril if tears w1ii cruse such IaW S to D6 GCO601aQ Dy lepair at no auuiboriai cuai to you. a tears uate1"mines That repair is not commercially practicame,or cannot De timely made,then,at Sears'sole discretion, Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030.Option 4.This warrantv gives you specific leoal Hants.and you may also have other riohts that vary from State to State. '1'1"1"1""" Office Location:HARTFORD Proposal Date 05/19/2015 JJobNumber 18219135 Sears Home Improvement Products,Inc. Customer Name SW91,�,`� P.O.Box 522290 MARY DONOHUE 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood,FL 32750-7579 c�--) q J_vny, Home Improvement Products I'hor�e-8a0 469-4603 Street Address ESTIMATE AND PROPOSAL Contractor LicensetRegistration Number 80 DAMON RD 8-303 N1A(148607) City State Zap Code Bathroom Remodeling All plumbing and electrical services performed by NORTHAMPTON MA 01060 Is installation within city limits? licensed subcontractors Installation Address County HAMPSHIRE (Yes/No): Y FEIN 25-1698591 Billing Address(if different from above) City State 175p Code Project Consultant Name&License No.(if applicable) STEPHEN KELLY HIS 0556821 Description of the Project and Description of the Significant Materials to be Used and E ui ment to be installed Shower/Tub CENTER DRAIN SHOWER PAN / CONTINENTAL SLATE TILE (Including surrounds) Shower Doors SLIDER MOD.# TETE1/4 60X5738 Cabinets/Vanities CENTENIAL MED.CAC. W/LIGHTS Countertops NONE Flooring BEST - CONTINENTAL SLATE 12" DIAGONAL PATTERN TUSCAN BLUE Mirrors/Lighting NONE The Bathroom Remodel Addendum is made a part of and incorporated into this contract by Customer(s)initials / V 1 reference. Additional work to be done:TUB TO SHOWER CONV. TAKE OUT EXST. TILE REPLACE W/CONT. SLATE. INSTALL PED. SINK MED.CAB. EXHUST FAN,TOILET, Work NOT to be done: Removal or roving of any wails,painting,wallpaper work,repairs of water or termite damage to sub-fluors or walls,electrical or plumbing work outside of this bathroom project N/A SPECIAL INSTRUCTIONS:PLEASE BE AS NEAT AS POSSIBLE All of the above check boxes, "Work NOT to be done," "Additional work to be done,"and Customer(s)initials V—D 'Special Instructions"sections have been reviewed and explained to me. SBRl-MA(Dig.) Rev 08/13/12 Page 1 of 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): sears Address: 1024 florida central pkwy City/State/Zip: longwood FL 32750 Phone #: 800-469-4663 Are you an employer?Check the appropriate box: Type of project(required): sears am a general contractor and I 1.® I am a employer with 4. ® I g 6. New construction employees(full and/or part-time).* have hired the sub-contractors 213 1 am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g. ®Demolition working for me in any capacity. employees and have workers' 9. ®Building addition [No workers' comp. insurance comp. insurance. required.] 5. ® We are a corporation and its 10.®Electrical repairs or additions 313 I am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL 12.[3 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[3 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. lContractcrs that check this boy;must attached an additional sheet sheering 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 is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.##: Expiration Date: 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 for insurance coverage verification. 1 do hereby ee ti,fy under the pains and penalties of perjury that the information provided above is true and correct. i re Ph on #: —gz,­co -1 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 Supervisor: Not Applicable ❑ Name of License Holder riwc �-" 11 � License Number Address Expiration Date Signature Telephone $. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address r Expiration Date °()',A , -;�� �� Telephone - qLq SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affi avit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bui ing permit. Signed Affidavit Attached Yes....... 91 No...... ❑ 11. - Home Owner Exemption 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 Windows Alteration(s) ❑ JRooflng ED Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs M Decks [❑ Siding 0--3] Other.[ -F-___ Brief Des ription of Proposed Work: rn Alteration of existing bedroom Yes No Adding new bedroom Yes _ �oof' No Attached Narrative Renovating unfinished basement Yes / No Plans Attached Roll -Sheet — 6a. If New house and or addition to existing housing complete 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 1, , 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 I' as Owner/Authorized Ag nt ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and elief. Signed under the pains and penalties of perjury. -�I_04l c_is Print Name (^ // tA `` x o Sign+ re of er/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: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO W DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (D-- DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO ko 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 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? YE: O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only ity of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability J�N Room 100 Water/Well Availability u Y mpton, MA 01060 Two Sets of Structural Plans s�nsP -1240 Fax 413-587-1272 Plot/Site Plans Oectri�yort a-tp op� Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: T�section to be completed by office Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print)(j Current Mailing AAdr ss: 5� y11,f)- 1-9 CCU Telephone Signature 2.2 Authorized Accent: Name(Print) Current Mailing Address: ('U /s- g ature U Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building CZ (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 M This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1305 APPLICANT/CONTACT PERSON SEARS HOME IMPROVEMENT PRODUCTS INC ADDRESS/PHONE 1024 FLORIDA CENTRAL PKWY LONGWOOD32750(407)551-5962 PROPERTY LOCATION 80 DAMON RD 8303 MAP 18D PARCEL 053 000 ZONE GI(88)/SC(12)/WP(12)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 7oo7i I 5t 0111? Fee Paid Typeof Construction: REMODEL BATHROOM New Construction Non Structural interior renovations Addition to Existine Accessory Structure Building Plans Included: Owner/Statement or License 10031 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management on Delay Sig o ui din Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 80 DAMON RD 8303 BP-2015-1305 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-053 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-1305 Project# JS-2015-002397 Est.Cost: $18045.00 Fee: $114.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEARS HOME IMPROVEMENT PRODUCTS INC 10031 Lot Size(sq. ft.): Owner: DONOHUE MARY Zoning: GI(88)/SC(12)/WP(12) Applicant: SEARS HOME IMPROVEMENT PRODUCTS INC AT. 80 DAMON RD 8303 Applicant Address: Phone: Insurance: 1024 FLORIDA CENTRAL PKWY (407) 551-5962 WC LONGWOODFL32750 ISSUED ON:611612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM 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 OccuRancy Sienature: FeeType• Date Paid: Amount: Building 6/16/2015 0:00:00 $114.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner