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29-033 (2) i i i i I I � - i tlermit Ziervices / 4U1 Z40 Zt= P•Z ,�:., L.J fL2 �G'it?���`?.tr1�2��1Pr��'L fl��Jf/�•�f�JC1',+=� L- Office of Consumer Affairs and Business Regulation i 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor Registration Registtalibn_ 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration. 813/2016 RICHARD TROfA 2690 CUMBERLAND PARKWAY SUITE 300- --- ATLANTA, GA 30339 _ ^._.. . __ _.....•_ Update Address and return card.Mark reason for changa St:At 3 2o4-Wli ` Address I' Renewal Apt'.J.:._. . u,../crnIl may+��irl�il�rll!i:Ci i' •.ti. j AOfficc of Cuusucoer Afbirs&Business Regulation License or registration valid for individul use only ``1 0ME IMPROVEMENT CONTRACTOR before the expiration date- ff found return to: � � 5 Office of Consumer Affairs and Business Regulation s'Registration 126993 TYp- 10 Park Plaza-SuiteSI7D Expiration:.&G/20'116 - Supplement Card Boston,M A 02116 THD AT HOME SERVICES.INC. THE HOME DEPOT AT HOME SERVICES • RICHARD TROIA 2690 CUMBERLAND PARKWAY S )ktnM GA 30339 trndersccretary Not valid wif6o ut signature l HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and lnsudled by: Branch Name:New England Date:LZ1 f 7 '� THD At-Home Services,Inc. dth1a The Home Depot At-Forme Services Branch Number:31 908 Boston Turnpike.Unit 1,Shrewsbury,M. A 01545 Toll Free 877-903-3768 Federal ID#75-269g46();.14E Lie y C 02439:RI Cont.Lie#16437 CT Lie#IlIC.0565522-.NIA Home Improvement Contracc'.ofrj Reg.#".26843 Installation Address: 4l& Q f\ K IQZt n r )jO 4 tca I 1 L^rZ- City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: [ l Home Address: (If different:rum Installation Address) City State Zip E-mail Address(to receive project communications and Horne Depot updates;: ❑I DO NOT wish to receive any rnarketing emaiIs from The Home Depot Prolect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services.Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Ulsaallation")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#: umma+aarerrnce, Products: Sec Sheet(s)#: Project Amount t Roofing Siding Windows ,❑Insulation �[ ' � I]Guucrs I Co erg ntry Doors +� :�7' 1 'V Roofing Siding Windows tasuia;ion JJ ( ❑Gutters/Covers ❑Entry Doors ❑ $3. 3�y Rooting Siding Windows El insulation []Gutters:Covers Entry Doors[] $ oo7ne Siding Cl Windows 0 Insulation ❑Goners i Coven CEntry Doors ❑ Bfminaotn 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ Maine Purdlastxss may eel deposit mope than olio-third of the Contract Amount. Customer agrees that,immediately upon completion of the work for each Product, Customer will execute a Completion Certificate ilone for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Cislomer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Hone Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at r I its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural \V! problem with:he home,environmental huards such as mold,asbLstos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# --l , included as par[of this Contract sets forth the total Contract amount and payment+required for the deposits iaW final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely fitted-in copy of the Contract at the time you sign. Do not 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 Home Depot the costs of matcrlais,labor,expenses � and ser%ices provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other amounts set fortlt in this Agreement or allowed under applicable:law. THE I10ME.DEPOT MAY WITHHOLD ANIOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYXIFNTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS, Acceptance and Authorization: Customer agree,and understands that this Agreement is the entire agrcenhent between Customer and The Holm:Depot with regard to the Products and Installation services and S.tpetxdcs all prior discussions and agreemcats,either oral or w7iticn.rclatirc to staid Products and installation.This,Agreement cannot be assigned or amended except by a v;t'iting sib ied by Customer and The Noma Depot.Customer acknowledges anti agrees that C ,-05 ,r hus read,urdcrstands,voluntarily accepts the terms of and hits received a copy of this Agreement. Accepted by: Submi s4 17- ref I� x Cuslo tl is ienalure D:to Said n ant's Signature Date ){ l lephone+ c. Gust , r s Signutur Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS as yMiicbk) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME / / DEPOT BY SIIDMGH7' ON THE THIRD BUSINESS b Lj t 3i DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN !T_Wlry xavn fC CTA qM1 dbE L0 5 l tr 6 080 �-d M 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. Address of the work: 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 I I j i I I i j i I i i The Commonwealth of Massachusetts Departinent gf'dndustrialAccidents 1 Congress Street,Smite 100 Boston,MA 02114-2017 www mass.gov/dda Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMnMG AUTHORITY. EAynlicant information Please Print Legibly Name(Business/Organization/Individual): �' } yJ� l � Address: - City/State/Zip: �i/ ` • n� a Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.Q I am a employer with employees(full and/or part-time).' 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 3. M Remodeling . any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3.Q[am a homeowner doing all wor'�myself.[No workers'comp.insurance required.]t [j Building addition �i.�I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions p/rvprieror with no employees. 12.[]Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Z f re 1rS These sub-contractors have employees and have workers'comp.insuntnce.t p i 6.Q SVe area corporation and its officers have exercised their right of exemption per MGL c. 14. e 152,§1(4),and we have no employees.[No workers'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. (Contractor that check this box must attached an additional sheet showing 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 isproviding°workers'compensation insuranceforr iy employees. Below is the policy and job site informaton Insurance Company Name: /5' l Policy#or Self-ins.Lic.#: w� z-6-rz-5-2, i Expiration Date: - Job Site Address: 1 ��/� Ju City/State/Zipr� i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certNM i and naldes erjury that the hifonnation provided above is true and correct: Siena > - Date: _ ���� Phone#• ��" 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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other' Contact person: Phone#: City of Northampton Massachusetts DEPART=xT OF zuzzz N INSPECTIONS , x !E h 212 Main Street • Municipal Building . : Northampton, MA : 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEN=ION',ACKNO WLED GENMNT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour) a rough buildinq inspection (before work is concealed), insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be i responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspection. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location I i II The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street r Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bu ilders/Coutractors/Electricians/Plumbers Applicant Information Please Print 7Le0bly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with � 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. E]Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. We are:a corporation and its 10.F Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t C. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing 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. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: r SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not App cable £ Name of License Holder License Number Z- ?J-.27-4 Address Expiration Date Ap- , Sig aturl5 a Telephone � 2a-P3 9 Re` istere ° ` mean r ment.Cantraatorc ,. �L_ w ._ �' Not Applicable £ Comoany Name , RegistratioNumb �P A/,-4,7:7W r I Addr ss � Expiration Date � ��� J "' Telephone�p) 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...... £ �1 = Home �wner_Egeffipton 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.CNM 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 RALMUL. 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, i i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wi s Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks Siding[C7] Other[M] Brief Description of Proposed J fitl Work: c,-T �/�`` I(/G� �►'��'Tt1C Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba !f New.house andor.a�n'tb."existlnq:kiousitig.c©rnP dte#tie d116Wlnc: 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 /� r 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 un the pa" s and penalties of per' ry. 1� ��1 ' Print Name A, Sign atur wner/Agent Date Section 4. ZONING All information Must Be Completed. Perliit Can Be Denied Due To Incomplete Information Existing ,rcpcsed Required by Zoning This column to be filled in by Building Department Lot Size --- —t ' Frontage ------f Setbacks Front Side L:= R:E I L: R:f Rear1 Building Heights j Bldg.Square Footage j i % Open Space Footage ! i t (Lot area minus bldg&paved azkin #of Parking Spaces Fill: I' (volume&Location) - - - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? N Q 0 Y --7 IF YES, date issued:] ? IF YES: Was the permit recorded at the Registry of D@eds? NO Q DONT KNOW 0 YES Q IF YES: enter Book j Page ; and/or Document#1 . B. Does the site contain a brook, body of water or wetlards? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: f I D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q IF YES, describe size, type and location: j 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 Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i • i � ` 17eparfinent use only 5 i lRY f JAN l c J SCI of orthampton Sfatu�ofP�rm�t i 0/68 u in Department Cgrb CuDriyeuoay Perrriif —� 12 ain Street SewerlSepicAvaila6Elrty i � ID 3j, r,Vc�r,+sP om 100 a/Vaterhl�fal�Rva�lab�hty J 3 ha pton, MA 01060 Twa,Setsof 5 ai Pkrrsi' s phone 41 - 1240 Fax 413-587-1272 P1ot/Site Plans y u d _ r -'- r APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: This ecfion to be complefed by office t�_i..--_ _ - Lot_ Elm:St DGt ME— - GB Dlstiwt= SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED;AGENT: 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorize A ent: � �� 712 � *� Name t Currren/t Mailing Address: _ ®� Si ature ✓F 4/v Tele'p/hone/ J/ SECTION 3 -ESTIMATED CONSTRUCTION COSTS. Item Estimated Cast(Dollars)to be Official Use Only completed by ermit applicant 1. Building, ) (a) Building:"Permit Fee . 2. Electrical !/ v (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 Date Building Permit Number: Issued: Signature: Building Cammissioher/fnspector'of Buildings, Date i i 32 PIONEER KNLS BP-2016-0887 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-033 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: vinyl siding BUILDING PERMIT Permit# BP-2016-0887 Project# JS-2016-001505 Est. Cost: $7897.00 Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 98785 Lot Size(sq. ft.): 11979.00 Owner: SCHNEIDER DAVID&HITOMI Zoning: Applicant: HOME DEPOT AT HOME SERVICES AT. 32 PIONEER KNLS Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON:1/11/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT ENTRY DOOR & SIDING 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 1/11/2016 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner