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12C-081 (4) JUL-22-2015 21:15 HOME DEPOT 413 543 9407 P.001 HOME IMPROVEMMENT CONTRACT J PLEASE READ THIS 722" 1_5"— Sold,Furnished and Installed by. Branch Nam.Boston Nor lb South Date-_J__l THD At-Home Services,Inc' d/b/a The Home Depot At-Home Services Branch Number 31 33 908•8oston Turnpike,Unit I,Shrewsbury,MA 01545 Toll Frec 877-903-3768 FedcW ID#75-2698460;ME lie#C(r-439;RI'i Cont.Lie;#16427 i ie#MW.0.565522;MA Home,Improvement Contractor Reg.#126893 Installation Address: .- " �tt�/ �-�a. L4-- v — �- City State Gip" Purcht�scr(s): Work Phone: Home Phone: Cell Phone: Home Address: (if,different from installation Address) City- •. State Gip. E-mail Address(to receive project.co+nmtuntutuons and Home Depot updates): D 1.DO NOT wish.to receive,any mw eting emails from-The-Mome Depot � i e�la-blurtition:`Undeimgned'("Customer"),the owner%of the'j roperty ktcated'at the above installation address.agrees to buy, and•I•ki.D At-Home Services,Inc.("The Home Depot")agrees to furnish.-deliver and arrange for the installation("Installation")of alt.mattrials..described.on.the below and on the referenced.Spec Sheet(s),all of which are incorporatcei into this Contract by this reference;along.with.any applicable State Supplement and Payment.Summary atiached hereto and any Change Orders(collectively, Job*: t_„„iur<...r Pttiductsi S 'sticetts)#: Project AMant mg LJSiding windows Insulation �� '�D: 2$ ]CritaetK ceneix C] iitry u Q tS 7.., R g Usiding El Windows El Insulation. 'UGuutrXZ-,/Coven L]Bntry Door., C1 $ `�-�1►x'4 URRpoting b#wo,Windows minsaia. $ U.(]Gerttet�/Covt;rs.(�fctetry DOO+s[] . Rooling Siding U Wlsajo_ws Insulation p!Gutte'rs'Icovers'pEntryi>� © $ Minimurn2S%Deposit'geC.ontraR•Amount due neon exccr#ioo of"o mP*ct Maine Purvhusers malt'nut depwit aaae thim oft third of the Conlnxt Anmont Total Contract-Amount $ Customar'agrae..,rhat;'irn eicdi itciytipon' ctxnpl�ficm of the work for'each Product.Customer will:eXeeute 'a Cotpletion Certificate (one for each•Product'as&fined'by an individnal•Spec Sheet)'and pay any hal'ance'due:`.As applicable,each Customer under this Conuwtagrccs to he jcri'ntly and:ccvcrslly'obligated:in&liabIL hereunder. The Home Depot reserves the right to issue 4.Change Order or terminate this Contract Or any iudividtial Pro ducts)inclutkxl herein,at it.discr tian,if The Home.Depot or it%authorized serwiee provider determines that it cannot pexformits obligations-due toa structural problea with the home,environmental hazards such as wold,asbestos or lead paint,other safety concerns,pricing,errors or bccamc: work iwuired to complete the jolt was not ineludod'in the Contract. / PPayr rtSummarv: The Payment Summary,# E l S. t��✓ included us part of this Contract; sets forth the total Contract amotuiP and payments required,for the deposits and final payments by"Product{as applicable). NOTICE TO CUSTOMER Vou an!tntitled to a completely filled-in copy,of the Contract it the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as by individual Spec Sheets)before work on that Product is complete. In the event of termination or this Contract,Customer agrees to pay The Home 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 amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WiTHHOi.D AMOUNTS OWED TO THE, HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LEWT ING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. t and Aathorfzatiaml:_Ctutom=,agrees,and undetstapds,.dhat,tleis AI'rcX ncnt.is the snare agreement between Cttistomer and The Home Depot with regard to the Prcxiucf,and installation services and supersedes all prior discussions and agreements,either" oral or written,relating to said Products and Installation,This Agreement cannot he assigned or amended except by a writing signed by Custotrter and The Home Depot.Customer acknowlt tigcs and agrees that Customer has read,understands,voluntarily accepts the terms of and has revived a copy or this Agreement. to by: 2 5 hmi Custy' 's Signature Date Sal Consultant's Signature Date �-_ Telephone No. 9 1> 6? Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THiS (as applicable) 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 SPECII?ICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE NOTICE%ADDITIONAL TERMS AND COND11IONS ARE STATF,n ON THE REV F:RSN,SIDE:AND ARE PART OF THIS CONTRACT 03-17.15 White-Branch Filo Yellow-Cusuanor SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Consbuction Supervisor: Not Applicable ❑ Name of License Holder: hk-2 1,261 1 License umber Addres Expiration ignat Telephone 9.Registered Home Improvement Contragor: Not Applicable ❑ Company Name_ -'Q Registration um er 5FID6 i fl 04wdy-le Address 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 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 Windows Alteration(s) Roofing Efr Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (Q Siding[01 Other[a Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding nevro Yes�to Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house and or addition t"Astina h6using. complete the follo in : 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 1. Is construction within 100 ft.of wetiands? 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. 1. 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, L2 f-<<G i 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 deGare that the stat ments an in on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed and a pains=penalties of perjury. ir Z-)Orl,A. Prin Sign r 0 f Own Agen Date < -` ity of Northampton Status of Permit Department use only uilding Department Curb Cut/Driveway Permit I 212 Main Street Sewer/Septic Availability I 'i A 282015 j'� Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans Electric, Plurbing&Gil I is 3 587-1240 Fax 413-587-1272 Plot/Site Plans Ncriha;rh,on, MA 01060 Other Specify 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 Zane Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 Owner of Record: lure �. Name(Print) Current Mailing A Tess: _ � '-cam -!1?��1 I � Telephone Signature 2.2 Authorized A e.-v Name(P t) Ctitre ailing Address: Signature Telephone ao 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) L40220 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) q0 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number Thi-;—Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date 36 MARY JANE LN BP-2016-0112 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-081 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0112 Proiect# JS-2016-000202 Est. Cost: $15220.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 106011 Lot Size(sq. ft.): 10585.08 Owner: TUMAL VINCENT J&JANE E Zoning:�I(100)/URA(100)/WSP(l00)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 36 MARY JANE LN Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.712912015 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF 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