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24A-166 (2)
319 PROSPECT ST BP-2017-0043 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 166 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit a BP-2017-0043 Project JS-2016-002631 Est. Cost: $7900.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grouo: HOME DEPOT AT HOME SERVICES 105953 Lot Size(sq.ft.): 12588.84 Owner: BIXBY GEORGE W&NATALIE A Zoning.. URA(100)1 Applicant: HOME DEPOT AT HOME SERVICES AT: 319 PROSPECT ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-26330 Workers Compensation NORTH PROVIDENCERI02904 ISSUED ON:7/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 12 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 tt 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 7/12/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only 4Cft deCity of Northampton Status of Permit. �;:.' - 'adding Department Curb ae/Drweway Permit 212 Main Street •Sewer,'s_-pttcAvanamlity Room 100 Water/Wett Availability ''•rthampton, MA 01060 Two Sets of Structural Plans \IOL `ur?�oc • phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans-_ Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING J SECTION 1 -SITE INFORMATION 1 1d Property Address: This section to be completedby office "fit QMap Lot Unit /io at I r Zone Overlay District Elm St.District CS District T SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2-1 Owner of Record: 1l14T 01X137 3!q ficmitcT 6F Nazilem Name(Ptlnt) ,/�y.LyCurrent Mating Address. e 1'1Tg e Telephone Signature 2.2 authorise Agent: Narttg{PttRD / ��p ---- Current maw Address. Signa re- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost((Boilers)to be Offiolet Use Only _ comaleted b- )erm2 am(cant 1. Building ((//"i� AAl //1-t � (a)Building Permit Fee 2. Electrical U (b) Estimated Total Cost of Construction from(a) a. Plurnhino Building Permit Fee 4. Mechanical(HVAG) 5. Fire Protection • Check Number •°- / 6_ Totai=(1a2+3+4w5) This Section For Official Use Only Date Building Permit Number Issued: Signature: Date Building commissioner/Inspector of Buildings Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete nfor ation Existing Proposed Required by oni • ' This columnn .etil nn by ti Building D p • ent lie JLot Sme Frontage Setbacks Front `-" dile L .__ R ._ ' L _.. R• __. _... Rear ..- i._ _ Building Height ' Bldg. Square Footage % - — — OpenSpace Footage _> _..__-. % -.—. - (Lot area minusbldg&Paved _ __ parking) _ . . S of Parking Spaces -- "—""— _ Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book 1 Pagel and/or Document It B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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? YES Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. a SECTION 8-CONSTRUCTION SERVICES (� 8.1 Licensed Construction Stmenrison Not Aeble Name of License Helder License Number £1 u)bee Address Expiration Date fP mfr - P104 Signature Telephone 9.Re•istered Homelm•rovement Co tractor. Not Applicable E .:,: 1 .469 Company Name (0��J1 ^ 2}--- Registration Number Address /(��y/rJI'Dn%"�/1L,/p4-�J�1t_\ �/� _ [I//�,/ .[ry� Expiration Date r/Ji / i..)/'`71, Telephoner'/�/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§250(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 A ed Ves....... E No E 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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'is,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 { V SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoplicable) New House ❑ Addition ❑ Replacemenndows Alteration(s) n Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I= Siding l0] Other IDi Brief Descriptio rgppse0 ga ray �ir /n_ r- / ' j_ _ / n /,��. Work: 11��11/�� nipa's yLl'(,f N/fCWJ N/,�j DQt�C) '-(_, (�.(j',(1'%i0`[7 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 5a, 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 a 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/ yyI ' APPLIES FOR BUILDINGBy�� PERMIT I, NA-Ti -4 c "' /�� yal as Owner of the subject property l� r , OI hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 6tt ennii2ita" -7 -9-16 Signature of Owner �/,/� pr, y�,� Date / )CI 1)"� T J17 ,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 under he n' d penalties of pei� Print Nrc r}-^ // 6:1/4 Signature of Owner/Agent Date • The Commonwealth of Massachusetts _._ Department of Industrial Accidents Office of Investigations ] � lj 600 Washington Street Boston,MA 02111 'm. www.nmaass.govrdia Workers' Compensation Insurance Affidavit: ]Buu➢eters/Coretractors/Llectricians/1BIn¢nbers Applicant Information please Print Legibly Name(Business/Organizatiowindividua2)i Address: City,/State/Z-ip: Phone ft:_ Are you au employer? Check the appropriate box: Typeproject of New (required): 1.❑ I am a employer with I am general contractor and I a 6. ❑ Neconstruction employees(NI andior 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, ❑Demolition working for me in any capacity, employees and have workers' [No workers' temp. insurance comp.insurance:I 9. ❑ Building addition required.] 5- ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.Ifl I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself (No workers' comp. right of exemption per MGL I2.❑ Roof repairs insurance required.) t e. 152, §1(4), and we have no employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. tHn meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if Wa 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. m; Expiration Date: ......... xp 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 DLA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury 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#: City of Northampton ' fes ts. ;' 'c ;[ Massachusetts c -- �� DEPARTMENT OF BETIDING INSPECTIONSIP 212 Main Street • Municipal Building is �., Northampton, MA 01060 Sr -1,0t.� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT 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 building 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 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 inspections. 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 I, 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 City of Northampton 212 Math 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, aass defined by MGL c 111, S 150k Address of the work: r.. 119Cei er`4^. The debris will be transported by: h ,� im1 g The debris will be received by: itiezir5 ) /"49.- Building permit number: Name of Permit Applicant U- id KP ��7 Date Signature of Permit Applicant Jun 21 1606:14a P'2 • HONE IMPROVEMENT CONTRACT PLEASE READ THIS //q Sok,Furnished and Installed by: Brandt Name:New EngInd Date:. II L THE AI-Home Services,Ix. _ Obis' Thc Horne Depot At-Hone Sersired Branch Numbee 333 908 Boston Tampike,Unit I,Shrewsbury,MA 015115 Toll Fee 877-9D3k3T68 Federal TD 975.269&IW;ME Lk 4 C 02419,RI Com.U&16427 CT Gee H160565522 MA Ilonie lmpr o•enye !Contractor 0. p b 12689) Installation Address: CA PA bap 'Sk {i(,�L tlLutto iyu City Slave Zia haJwsvls)'. xurk Phone Hew Phone: Cell Phone: _n G.� ,x 11 ir l I � yi] c 1 _ ] ; [ 1 l Home Addreaa: (If different footit nstali m.oil?ad:exist City State Zip E-mail Address ho receive,project communications and Itome Depot updates): _ ❑I HO NOT wish tc receive a-v msrketirit emails tram The Home Depot - Project!Mamma :tiers poi( Customer).LhO ownera of tar P pe : - r 'e above-nvIalik donadtl cog-lobo of s THD IF e Inc. . Home Defoe') dlmJ g c . iIo C y'tif all mat described on and on L referenced Spec S all of which incorporatedintothis x cioli by Ibis " orm 3;UM any applicable Slate ppli bl5la¢Styplement and Payment Summary ullCN tram and any Chore Orden(collectively,'Conm¢Y)' tub ii: hnnro...[ Prd I _deo Meats)0: 'Naito.amount lfes6 � ly ❑ff5JS-d-nq ❑K d I ':anon I ✓�i oGliners/Coven oEattyD ❑ __ I I05952� 7'1 OL) �Ro 6 g J S a' N ni neve 0 Bailor ion i ❑c C Doors 000rs rlS RocG [I oa ❑Voodoos ❑1. Ilia. 1 I JR� ❑S tit' p D1 do 0 s laithn h / i ❑C. 'C • CEM Coots Cl EJl/ ) b Minim DI-Contra']monmdae npno Camelia of contract Thou Amount I L) Main Pmsm ehs ,may notdrynh more than methtrpof me Guinan Anto,a IS 7 ` b 0 Customer agrees that,immediately neon completion of the:work for each Product, Customer will execute o Completion Certificate (are for each Product a defined by s Witte nal Spec Sheet)and pay any halama due. As aurrLcable.eat.Customer under this Contract agrees lobe)raptly and severally obligate°sod liable hercund O. The Maine Depot worms the right to issue a Change Order or lanrdralC this Contract nr aoy ndicidui Product(s)it eluded hereat.a: H di samion.if Tau Holm Dwot or its authorized emote provider Setter:inec that it cannot ocrform its obligations due ton xmcma'' prnhlcm with do Sore,cnvitounental iavards su sh as mold,asbestos or lead paint,other safety content,pricing C.vm OF because work required roe oleic the job was r 01 ialuded ir.the Contrcctt.. Payment Summary: The ?torment Summary a' I3 O 4-l1 c-- _ lFude° as tori of this Conroe.. sets foul' Ac total Co.tuact:n uet and l yTems=wired for tic 6tposiFS and'Taal payments by Product(n,ap,iic 5le I. NOTICE TO CUSTOMER You pre Cumtled m a completely Trlledin copy of tie Contract at the time you sign. Do not sign a Completion Certificate(nom: there is one Compledmt ecrNiirme far each listed Product as defined by individual Spec Sheets)before work nn that Product is complete. In the event of termination of this Contract,Customer aarecs to pay The Flume Depot the cosh or materials,labor,expenses anti services provided by The Hume Depot or Authorized Sepia Provider through the date of termination,plus any other rants set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AAMOUNTS OWEDIO THE HOME DEPOT FROM THE DEPOSIT PAVEMENT OR OTHER 1'ASTIENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance nd A,mriat Ccs -r agrees d noirtstands that this Agrcericni bele n Customer mudTh a Hem Diel oath regain re 'e Pocuct and 1, laPa/ions _v and sanal prior douas mt. and ageeneither oral or w. Muting b saidslite and Installation.This Agreement cannot he assigned or a.xnded ekosial by n. Cir c IS.iynod by CosTilsit int 7,1ff I Depot Customer ck q and tierces that COL40111:1 has moo.oodyrtionds.voluntarily oceep.a Lc Icn30rendd hos [inch ad a copy of this Age .t itl. \cc tealamr O Suborned b': _ ' Cy, Imo( `i ( ' :? e ' t9r;u x , i l'l ._ >): e`•rs{- c- J S -e 1 Salco Cc Ian's SiOnOture Date X __. Telephone No. enforces Signature i Dare Sales Consultai a License No. _ CANCELLATION: CUSTOMER HAY CANCEL THIS inipp:sstml AGREE NIENT WITHOET PE\ALTI OR OBLIGATION BY DELO ENING WRITTEN NOTICE IC THE HOIIE I I 3 / 5 so C. DEPOT BY MIDNIGHT GN' THE THIRD BUSINESS � 5— DAY AFTER SIGNING THIS AGREEMENT. THC STATE SUPPLEMENT ATTACHED HERETO CONTAINS a FORM TO LSE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. ACRD' CERTIFICATE OF LIABILITY INSURANCE .av+arWDDerr YI ‘......--' 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 poticy(ies) must he 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT • MARSH USF.INC. PHPHOS ?NO ALLIANCE CENTER WINO No rain: _ iINC.NM: 3980 LENOX RCA,.SUITE 24CG E-MAIL ATWaTA.GA SOPS AooRFss: INSURERIS)AFFORDING COVERAGE i RAW X 1004924omeDGArv':317 _ INSuRER A:Slea11Ias1 Insurance Company 726387 INSURED __. __. INSURER a:EUA American Insurance Co 1118535 THD.AT-HOME SERVICES,INC OSA TIE HOME CEOT.CT:IGME SERVICES INSURER C:Roo H 11102 la Ins Co IMO( 2890 CUMBERLAND P.RKRAY.SUITE 320 INSURER 0:IPOTS National Insurance Company 23811 ATLIMTA.GA 3C339 INSURER!: INSURER F: 1 COVERAGES CERTIFICATE NUMBER: ADAM/46646-14 REVISION NUMBER:8 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 Vu1TH RESPECT TO WHICH THIS CERTIFICATE MAY SE 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. ILry TYPE OF INSURANCE INS'NOD POUCY POUCY NUMBER •mmOi WY1�(MWDCtlYY). Mrs A Y COMMERCILGENERAL LwaIUTY GLp488971426 10321(2016 :031012019 I EACH OCCURRENCE s 9.200.000 pAAAGETORIFNTEO 0,AIMS-MADE X OCCUR • PREMISES IED Amumnce) 1S 1,000.000 'LIMITS OF POUCY XS •MED PIAya'e Demon) Is EXCLUDED OF SIRSIM PER OCC ! PERSONAL&ADV INJURY I$ 9,0(2,000 GEN'.AGO!`ATE LI IT A an_Sae GENERAL AGGREGATE i S 9010200 'OLCY jS_r '_CC • PRODUCTS-COMPIOP AGO Tis 9.x000200 • OTHER- - I I s • AUTOMOBILEUABIL;TY BAP 293E863-13 9201i2016 OJOL2011 I COMB SINGLE LIMIT [5 1,000.00D • X ANY AUTO BODILY INJURY(Ps,person) l$ ___ ALL OD.NEE —SCEEDULED SELF INSURED AUTO PHY DMG I WD LY INJURY(Per accidemliiS _. AUTOS AUTOS NCH-MANED I PROPERTY DAMAGE I 5 HIRED_AUTOj ALTOS . • • .(Menem:ADDY. S UMBRELLA DAB OCCUR EACH OCCURRENCE 113 EXCESS UPa LUIMS MAGE I AGGREGATE DEO RETENTIONS `'s ✓ WORKERS COMPENSATION IMC015519215{ADS) 1033018016 035011217 X PER 1 mw 1 ANO EMPLOYERS LIABILITY YIN, STATUTE I Eft L ANY PROPRIETORIPARSNER,sECUTNE :00201559929(AK,K(,P1H,NJ.I1� 1031012016 03211218 I EL EAT>(ACCIOEm. IB 1.000000 O O=EICEwre:ZEHR)xCLLOEO+ N IxIA :031012015 03(01/2111 1,WC,WO 1Manaatmyin NXl !WCBIS$19P191Fq I EL DISEASE-EA EMPLOYERS If yes,desmbe unser IConilnued on AddNOndPays1,000.00E DESCRIPTION OE OPERATIONS Deicw ' IELOIBFASE-PIXICY LIMIT I. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached Rmortryau6 required) EVIDENCE OF INSURANCE • CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES.INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE OBA THE HOME DEPOT..AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA GA 30339 AUTHORQED REPRESENTATIVE or Marsh USA Inc. Masashi Mukherjee _Ma.AnohL ..14../0taw3a•- @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Simonton Windows I i. % `':- {1 6500 V rroirts �I ms`s-= 1i.- _yc:= __"C-'as_ ATI.4111.-Lnc_c.No__.t.roaGess- i •=uav, t ;fr2rs-_c dale C::::[0,a-ISRO-SV_R40 yCV10-Yabi:-LC_'-E-SIA i � tcz,.: 1 Hilt'tscirnna-Gan ryi4cs I, -^rte _ . 1 t CPD_ S3 "'0_-00003 07-75 Di-illP-- 1 ENERGY i-s FORIMANCI RATING-S It JAWACIGNOSRENDIMENTU El ERCETICS '1 Sas-Hat ESC Me. i `7n 1 .667 .• 0.24. Ili - ii ADDITIONAL PERFORMANCE RATINGS ti 2. EfALUs?.tOPI ciTLE5EWilita OE=E IMIERrip �� •I • lia]6Lc nd� It; 1 -Ti..C... _ I siv 3 L. -C E. -telt/ - fir;,_ . 1 �" S i;,a W:.[ NIat:Cadial south Ccns .474-7.-.�`� 1 _ l_ned I iI Wil-. ?v�^--1 T32;Y 3icc:=8"X Sr I :II it 11 11 11 �1; Rarica PmcuctAsprov F:R.ai3: i. I II li ti r: .- - ii II l Ili Pro auca"---- tS nderd e): "MSU-ci{gnNNAar•N_10I -9-37 AA-VAIN/DNNCSA 11 444051-09 C_C_rl SUUPI II 11 r » it III 83[187901010"u G7SOIO1 a33 HS Hm:a;d 6400044A4 Hermes S9Nrces 4U1 Z402bbb p.2 • 97 Cie (n�rn� waatvecr �i digests anibea eLli Office of Consumer Affaics'and Business Regulation 10 Park Playa - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC- Expiration: 8T312016 RICHARD TROIA 2690 CUMBERLAND PARKWAY SUITE 30.0 ATLANTA, GA 30339 Update Address and return card.Mark reason for change Sar 0 mum,n Address Il Renewal ...mplonew! f Loa La;� cZL.' '—' URce of Consumer Albin&Basins Regulation License or registration valid for individul use only before the expiration dazes If found return to: 9c•--- HOME IMPROYE89ENT CONTRACTOR S 1T. -pie Office of Consumer76 and Haziness Regulation Registration:_ - Registration: 126:93 Type: 10 Park Piars-Suite SI5196 Expicadorr sa/2016 Supplement Card Bonen,MA 02116 THD AT HOME SERVICES.INC THE HOME DEPOT AT'HOME SERVICES RICHARD TROIA 2690 CUMBERLAND PARKWAY S ew ' - A5[F.I GA 30339 Cadtrxva,ry Not valid w'I out signature ":;\. _tee Gcrrarzcn;.i+elain,%-flriESSP-C1nrSe ' I -. ( Der I' 21"' Of ing5e..• eACCMPRI, 1=7i-k�; Office gi essi ,i tD s • �' ..tiEgress i elf :did WilT,:4T 2:'SS.gaViaa - Wrr i r`'t:.0 e S= 9y-Sat A-.d'i::Builders/es 2-a k C_S '3e=u nfrn--. --v.'__ afer ___- _ ?fees,pi aLe-onjf-7 . Y ',%Ibu to /G p omLc-ndu): / I a.11 ,liso1,1.�i ft r- N!lJf. ?tel?c..1.',% e~ y t„s8_ r -' :')4- ic?c I ortitic3l,F7 __ C- -1f ~tar v ' 1 'i''ll .7 1.1> PhO e : G-( 2 (2:- you e c`I oar 17 eaya ,- 1 if-maa general os-actcz-r33 7:10r Iarp r). have Mien ta sub conv=cto a 6, ❑Newoorsvetion -.„.f _=sole o,Rneahto.asp y;.ti_ S.:: d o-!tivattached sb=-z 7_ 0R .RMin g . __e zd=ve as o_a303ztc These SUPcont*aci is Save S. 0 DCnoiiim wo_-g ___-a:_uy casac!ty. employees nadhave Workers' ms ::"a o:__,, cir,', .:n.,re, coma.:; sus_ace e 4_ BS tddiai reors-so.1 S. ill Ire at3.acne orafcar d'3 =O.0 Biewiral rtpvj eadeians ahamem3mer cloinv.,A133,0,13 o cue haw.exmisetitt& I ILO Plothingrenaks oriud-i:ons L wortenf turn t of erampdan par ivia, I _ � c - c2. 9'-(7 a ♦-re halt.>o Ian Yeo:xtpa;^a � cnatoyees.I do otkere 13 O[aer I•{�il"Gf[l comp.i smmiu remdrred-] - -a:_ co s_ c_:sa<.zsa flu =also au ea udb%A,ovag acir =woe faleal RmliR¢. avr.-= to_ -:eo stoats: dantani:Sa-ter/rceoivea➢r;c3:cu;am Ora outside cees.san murmbmit_aer.sffiauv¢m8lcuaesti."v. 4to� ie,oniaistors faa_ahacathatmaa emaaeaeaaeiila Sitsnm- a Looms:ceivsh%-oaacmrsdsayovbcrocrcrnaithoo-eenitesti-se nano:.= If u_i;_t.cc,'-:. ham ma-alpaca Ory ms ru:ir..; ti r,.»_cwm),-,a.Volic,mmbc. i.,. . :i'2Mby_MelispiniGle.;workers'cOipcasaU,T;inaum;Cefor fay imp!Oyets 3e!Ow I!'the pail and job sae Calp�- n�u: =1);:3../V / 5 it tea- --/--11):. - . 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