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17D-021 (10) ri� 1.vma..,e.1d o�/ dfcuf/C<stdeab Board of Building Regulations and Standards l HOME IMPROVEMENT CONTRACTOR Registration: 126893 Expiration: 8/3/2004 Type: Supplement Card Home Depot At-Home Services MICHAEL BEDARD 3200 COBB GALLERIA PKWY#26 <G--; ,i ALTANTA,GA 30339 Administrator 10/24/2002 13:1B 4155003075 APPLIEDII PAGE 01/01 A RD. CERTIFICATE OF LIABILITY INSURANCE D ioi24ioD2YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE APPLIED RISK SERVICES, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O.BOX 281900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SAN FRANCISCO,CA 94128-1900 _ _ INSURERS AFFORDING COVERAGE NAIC# RMA HOME SERVICES,INC. INSURER A: CAM"Fp SREr1AL•T`F INIS in __-_. 3200 COBS GALLERIA PARKWAY,STE.200 INSURER E: - ATLANTA,GA 30339 INSURER C: - INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_NOTWITHSTANDING ANY REOUIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_. _ NBGR - -_ .._. PO Y FE E POUCVENPIRATION TR NO POLICY NUMBER DATE IMMOMI LIMITS SENERALLIABILITT EACHOCCURRENCE f TrSAERTF�_.__ COMMERCIAL GENERAL LIABILITY PR MISES_(Eaoaurer,ce) f CLAIMSMADE El OCCUR MED EXP(AnV ane perien) S _ — PERSONAL AADVINJURY f ^_ G6EALAGGRE S tR _ ISEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS•OOMP/OP AGO S POLICY PRO. LOC jECT AUTOMOBILE LUMILITY COMBINED SINGLELIMR $ ANY AUTO (Es eodsonl) AFL OWNED AUTOS - BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON•OWNEDAUT05 !(PeraccwonlI s --•••---•_--- PROPERTYDAMAGE f (Per accident) GARAGE LIABILITY AUTO ONLY"EA ACCIDENT_ f ANY AUTO OTHERTHAN EA ACC S AUTOONLY: AGG f EXCEZ&VMBRELLAUABU.ITY EACHOCCVRRENCE i OCCUR EI CLAIMS MADE AGGREGATE 3 S DEDUCTIBLE — S RETENTION ;i f WORKERS COMPENSATION AND %STATU- RMPLOYBRS'LIABILITY Y LIMITS I FR A ANY PROPRIETORIPARTNERIEXECUTIvE 025-M000503 3/1=2 3/10/03 E.L.EACH ACCIDENT f OFFICERIMEMBEREXCLUDED? E.L.DISEASE•EA EMPLOYE E $ 0 es desabe under — SPECIALPROVISIONSbelow El DISEASE-POLICY LIMIT f OTHER DEGCRIPTION OF OPERATIONS/LOCATIONS I VSWCLES/EXCW*OtA ADOED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE IMUNIG INSURER WILL ENOEAVOR TO MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UANLITY OP ANY NNO UPON THE INSURER,RS AGENTS OR REPRESENTATIVES. AUT114010ZED REPRESENTATIVE 0004843 ACORD 23(2001108) v R►ACORD CORPORATION 1988 HOME IMPROVEMENT INSTALLATION CONTRACT Branch Name: Date: 1�f�t��r Sold,Furnished&Installed by TJ he Home Depot Installed Sales Branch Number:� Job#: 345A Greenwood Grcenwoo Street,Worcester,MA 01607 Toll Free(800)657-5182; (508)756-6686; Fax:508-756-2859 Federal ID#75-2698460 RI Cont.Lic#16427 CT Lic#565522 MA Home Improvement Contractor Reg.#126893 Installation Address: / ..S' -,'/A,U.�) N�r7 W�Pk-) City State Zip Purchaser(s): /�j-J v SSM Driver's License: Work Phone: Home Phone: A- ,, a*A) �1/:7e83/.l" 5'3&5�5 2S5_ (YID'S 3 ( -x"66 Home Address: U (if different from Installation Address) City State Zip Project Information I/We("Purchaser'),the owners of the property located at the above installation address,offer to contract with The Home Depot( �cDepc>it')to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#,! 7 ; incorporated herein by reference and[Wade 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 PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) 1. Check,Cashiers Check or US Postal Service Money Order CONTRACT AM yy OUNT S `�G� (merle payable to The Home Depot)- *LESS DEPOSIT-p5 � 2. Credit Card'and/or other payment options-Circle One Below Visa Mastercard Discover American Express BALANCE DUE ON COMPLETION S s Home Improvement Loan Home Depot Credit Card Available Credit:S I I�(HIL&$DCC ONLY) •25%of Contract Amount due upon execution of this q contract.One-third(113rd)of Contract Amount is required Acct#: l s b�l ? pp ^ ��j Esp.Date: for MASSACHUSETTS RESIDENTS ONLY. Name as it appears on card: l� r 1fK� Q-. /✓j�a r'o4s Indicate Payment Method For By my�1P=a=I=f9rthc#epositiadic&ted_ ,I/We agree to allow The Home Depot to charge the BALANCE DUE ON COMPLETION above Ofirdh6lders Sign#ht Date If this is a finance transaction,the agreement for financing is contained in a separate document,which is incorporated herein by Reference,and made a part hereof. At-Home Services Credit/Loan Application Ref.# Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due(unless the job is financed,in which case,upon submission of the executed Completion Certificate,Home Depot will be paid in full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder. For Mass.Residents Only: Contractor,at owners expense,shall procure all permits required by law as follows: Owners who secure their own permits will be excluded from the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted within this document,this contract shall not imply that any lien or other security interest has been placed on the residence. Entire Agreement: This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep It to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete. Law 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 the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW,VWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR�' CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED CONTRACTOR, TO VERIFY AND REVIEW MY/OU CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE TH FR ALL LIABILI INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. 7 SUBMITTED BY: es Consul Date: Z 0 L- ?1-? -it 2 P,2: 1') 9 C V D altan ACCEPTED BY: t�`� Date: 7 6 2.IPL Hold 11-25-(;?pr,, : FCFlr1� Date: Homeowner 1n-MI nrvs sND W ARRANTIF_C ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT p�O 9 e GrIf7 of 'Wart4aillpf-an � 6 �lasaaclittsctts' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT with a principal place of business/residence at: 3DO (phone#} �8 V1 �e (strtredcity/statrlrip) do hereby certify, under the pains and penalties of perjury, that: N/I am an.employer providing the following worker's compensation coverage for my employees worlang on this job: La e'L7a-14' 's Co-- 0XS=t00005'4'3 3 i a. ansuraAce Co ) (Policy Number) (F_xgiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) �r (Name of Contractor) (Insurance Compam/Poiicy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/PoLicy Number) (Expiration Date) (Name of Contractor) (Insurance Compa.ny/Policy Number) (Expiration Date) (attach additional sheet ifneoesssry to include kdocmarion pertaining to all ooWrndon) ( ) I am a sole proprietor and have no one working for me. O I am a home owner performing all the work myself. NOTE:please be awaro that while homernwen who employ persons to do�__k+ j �w¢srnutiion or repair work on a dwelling of not moce than throe units is which the hom00%=resides or on the grounds appurteaant thereto arc not generally oonsidemd to be employes under tho wmrka'a oompeasation Act(GL152,vs 1(5)),application by a homeowner for a Hecase or permit may evidcow tho legal statue of an employer under the Workces Compensation Acs. I undentaad that a copy of this stat—at may be forwarded to the Dq rtmoot of Industrial Accidents'O!}ioe of Ins—for the coverage verification and tbat failure to secure oovaago under soctioa 25A of MOL 152 an kid to the imposition of criminal peanities comistatg of a fine of up to S1,500.00 andtoi imprisomna t of up to one year aid rivr7 peoaWcs is the form of a Stop Work Order and a fimo of S 100.00 a day against me. For d tun on1Y < Permit Number 'e3 O�0 Mao ------Lot# _ Z R of Licensee permitiu e SECTION 8-CONSTRUCTION SERVICES' 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:----- — ---------- License Number --------------------------------------------------------- ---------------- Address Expiration Date ---------------------------------------------------------- Signature Telephone 9. Registered Home Improvement Contracto(r. Not Applicable ❑ '. (� L Jew,c�S r 9 [ p Company Name �, / Registration N ber . J S �f�C�Nt+Ja — -----U/el`ceS`I�® � -----��-607---- ------ `3�0 ------- - --�- Add ss �/ - Expiration Da e _--Telephone ��?t1/f/b/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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....... 113 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 ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding M Other[ ] --------------------------------------- --------- Brief Description of Proposed j Work: t +� 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 to existing hou ina, 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. Mascheck Energy Compliance form attached?_--_--_---- h. Type of construction_—__—__—__- i. Is construction within 100 ft.of wetlands? ____Yes 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 [9— —--—_--_, as Owner of the subject propertyc hereby authorize ---�t G'----------------------- -LLB_---- - ------------------------- to act on my b alf, in all matters relati to work authorized by this b ilding permit application. S� ------- ---------------- -------------------- --------------------------------- Signature of Owner Date L 1 t C�'l(�2 _ J_�Q_Q _ _ _ _ _ _ ,as Owner/Authorized IA�e_�C)JFei�y_j.;cGa_re that the statements and information on the foregoing application are true and accurate,to the best of my knowledge elief. Signed und '13 a�and penalties of, jury„ ------ - `- ----------- --r--J(/` ------------------------------------------------------ Print Nam ------ ----- -------------- ----- --------------------- Signature of Owne Agen Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES 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 No IF YES, describe size, type and location: ZUUT Department use only City of Northampton Status of Permit: -Buildino Department Curb Gu#1 1ngeway Permit 212 Main Street SewerlSeptic Availability _ Room 100 Water/Well Availability ' Northampton, MA 01060 Two Sets of Structural Plans- phone 413-587-1240 Fax 413-587-1272 PlottSitePlans---L- 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---- -- 0 A rip Zone------------Overlay District__— ( t Y v Elm St.District_—___—__ CB District_ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name r nt) Current Mailing A s : L / L --------- _ �g --�3 ------------ Telephone S ig a 2.2 Authorized Agent: ----------------------- --------- ----- N e(P ) -- Current Mailing Address: ®/� 0/ Q Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building « q,3 (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=0 +2+3+4 +5) 3 Check Number s This Section For Official Use Only Date Building Permit Number:------------------------ Issued:---------------------------------- Signature:'----------------------------------- Building Commissioner/Inspector of Buildings Date BP-2003.0645 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category BUILDING PERMIT Permit# BP-2003-0645 Project# JS-2003-1064 Est. Cost: $12931.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(ss .ft.): 9583.20 Owner: MATHERS GAYLE J&JOHN zoning:URB Applicant: HOME DEPOT AT HOME SERVICES AT. 105 STRAW AVE Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:1123103 0:00:00 TO PERFORM THE FOLLOWING WORK:I N STALL VI N YL S I DI N G 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/23/03 0:00:00 4087 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo C r f f t t l 4. .... _ C r t i r I 105 STRAW AVE BP-2003-0645 GIS#: COMMONWEALTH OF MASSACHUSETTS Mag:Block: 17D-021 CITY OF NORTHAMPTON Lot: -001 Permit: B u i l d i n g Category: BUILDING PERMIT Permit# BP-2003-0645 Project# JS-2003-1064 Est. Cost: $12931.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq ft.): 9583.20 Owner: MATHERS GAYLE J&JOHN Zoning.URB Applicant: HOME DEPOT AT HOME SERVICES 11T. + 05 STRAW ."-%yE Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:1123103 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL 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: TncubWon: Final: Smoke: Final:Dk THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAPT OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/23/03 0:00:00 4087 $25.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner- Anthony Patillo