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36-203 (5) 01/04/2012 19:34 FAX 11001 HOME IMPROVEMENT CONTRACT Pi.EASE READ THIS / Sold,Furnished and Installed by: 1 lBranch Name:Boston North&South Datet ��Q�v` TIID At-Htxnc Services,Inc. d/b/a The Home Depot At-liome Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877.903-3768 Federal ID#75-2698460;MG Lie#C 02439;RI Cont.Lich 16427 CT Uc#HiC.0565522.MA Iiome hnprovcmcnt Cuntnwtor Reg.#126893 Installation Address: "7' / �l�/ _ h"y�+/ / IFA' . d H.4, t>1 City I State Zip Purchaser(s); Work Phone: Hoe Phone: Cell Phonet rn(y1 (tN3 � Horne Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑1 DO NOT wish to receive any marketing emails from The Home Depot an� D laormutirm: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, At-Home Services,inc.("The Home Depot")agrees to furnish,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#: fw ma xa r«w.t Products: Spec Sheets #: MOW Armtunt � j7 Ronors Siding WiUhmrs insulxtiutt qD, / $ �O W,2 ^ � / ��� ❑Cnrttcry/Cnvera'❑entry Ucxrrc ❑ G� _ Rooting Siding Windows Insulutiva $ 7W ❑Gulkrs I Covers ❑Entry Doors ❑ Roofing Siding Windows lnsulatitm $ ❑Gutters/Covers ❑Entry Doors❑ _ Roofing Siding Windows 0 Inw-1ation ❑Gutter/Covers ❑Entry Door's ❑_ $ M6timum 25%Deposit or Coadnct Animal due under execution of this contract. Total Contract Amount Madre Purchasers nosy not deposit nwre than rnarthlyd o rthe Contract Arrxxrnt. Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one fW each Product av defined by an individual Spec Sheet)and pay any balance due. As applicable,each Cutitnmer under this Conu'a t 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 perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing rarors or because work required to complete the job was not included in the Cu mra t. ry Payment Summur_y: The Payment Summary#1t� - d © , included as put of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(m applicable). NOTiCF'1'O CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do nut sign a Completion 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 Hume Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other remounts set forth in this Agreement or allowed under applicable law. THE ROME DEPOT MAY WITHHOLD AMOUNT'S OWED TO THE HOME; DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. A_CLT ce an Au h-or in Customer agrees and understands that this Agreement is the entire agreement between Customer and Z het one spot wu 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 Ageennent 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. Accepted by! _ '" Su� a fy: �.�. •o~ Cust is nii attue ate bales onm tant's S-gnattuu�re Dfate�j1 / /r Telephone No. Cus ner's Signature V Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS w Applicablo 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 IN CUST'OMER'S STATE. NOTICL;ADDITIONAL TERMS AND CONDITION+ARE STATED ON THE REVERSE SIDE AND ARE PART'0k"t'n15 CONTRACT 03.17-16 White-Branch File Yellow-Cu6tnmor SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constru ctlon u isor. Not Applicable 11 Name of License Ljoid le It�� ---- License Number Addres Expiration aat ignat Telephone 9.Reaistgred Home Imorovement Contractor: Not Applicable ❑ A Company Name Wn Registration ,um eb r Address J, Expiration Da e- Telephone 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 Exemption 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 1083.5.1. 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 Icheck all applicable) New House ❑ Addition ❑ Replacement vyinaows Alterations) Roofing Or Doors p Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks (M Siding[p] Other[a Brief p' r Work: 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 ta4xistina housing.completo 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, lL�r6�L 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 1, as Owner/Authorized Agent hereby declare that the statements an information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed and e painspenalties of perjury. �._ Pri a r-- Signa of Own Agen Date Department use only r— City of Northampton Status of Permit: uilding Department Curb CuttDriveway Permit •L- Z J 212 Main Street Sewer/Septic Availability, Room 100 Water/Well availability "' hampton, MA 01060 Two Sets of Structural Plans ne 3-587-1240 Fax 413-587-1272 Plot/Site Plans Other Speafy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit L+-7 Zone Overlay District 1�'►+r'�• Elm St District C8 District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Re AL�ejud LP70- &.AA=.4 41 't Name(Print) C1 t Mailing Address: or Telephone Signature 2.2 Authorized A nt: _ Name(P t) urre a(ilin�g Addre�srs:� Signa ure 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 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 Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date 47 WINTERBERRY LN BP-2016-0114 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-203 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-2016-0114 Project# JS-2016-000204 Est.Cost: $8076.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 103054 Lot Size(sq. ft.): 86248.80 Owner: WENTZEL RICHARD&KATHLEEN Zoning: Applicant: HOME DEPOT AT HOME SERVICES AT: 47 WINTERBERRY LN Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON:712912015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 4 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 7/29/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner