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05-044 (5) 219 AUDUBON RD BP-2017-0339 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05-044 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2017-0339 Project JS-2017-000554 Est. Cost: $19998.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grouo: HOME DEPOT AT HOME SERVICES 082485 Lot Size(su. ft.): 58806.00 Owner: MURPHY SUSAN E Zoning:RR(1001/WP(I)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 219 AUDUBON RD Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCERI02908 ISSUED ON:9/13/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP AND RESIDE 22 SQ FT VINYL SIDING FOR REPLACEMENT 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 9/13/2016 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner —_ ...-Department use only RLC -'`f�.1- ity of Northampton Status of Permit: =uild ng Department Curb Cut/Driveway Permit SEP 12 2Q18 212 Main Street Sewer/Septic Availability Room 100 Waters Wef Availability arra me am:r,.a'a::F:,:,.t•: hampton, MA 01060 Two Sets of Structural Plans N°' pliztOa"fl 587 1240 Fax 413-587-1272 PIoUSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address:45,17/P), 1..NJE>%JTT "_" This section to be completed by office -2)' CJ � Map Lot Unit_ • 7• �� Zone Overlay District _ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � .co ..3: Pett,/c0712:1 e7 r .®t rr 6 Or 7) _' Name(Print) � /> Current Mailing Address r�' lit : `'4`' 6rk: / -le/7- Telephone Signature t _ Au r d • tent: .77291P— T7y — )n Name(P t - ` Current Mailingg A:ddreesss: ill t)Q i. , !ii, '19) 2 /-ate? �. Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1, Building /o /'q53 (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 /9 /, 9 " 6. Total=(1 +2+3+4+5) 1 9, t ' 'AI Check Number/SO C-41 . i-/ This Section For Official Use Only Date Budding Permit Numbe Issued: i,p q /l Signature: / �ia/I / /�< Bviidtng Commissionerilnspecter of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tlits column to be filled in by Building Depanment Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg_Square Footage Open Space Footage ,a (Lot area minus bldg(tc paved parking) 4 of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it pad of a common plan that will disturb over 1 acre? YES (3 NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) lE Roofing El Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs ICI becks [0 Siding roil Other[I! Brief De it lion of Propo ;t d • 9-,s // 214 ',, '//. Work' ri ' f�q lam"''. �l OM /4.1- 71✓1 falI ,..`G Yhy t Alteration of existing bedroom Yes No Adding new bedroom Yes No C - 0 744 Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga. 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 a. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions a. Number of stories? 1. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction r Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No I. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR, � APPLIESPPFOR BUILDING PERMIT 51//717-371�✓ I, /ll1 / zt`le`�" ! I .as Owner of the subject property ((�� II 6 hereby authorize /- 2 � u /M— to act on my behalf, in a I matter etative tow rk authorized by this building permit application. Signature of Owner /�,' y�.tf..' /� ,p— Date i, f1 t< ¢' ' —'� r ) J''"0dfJ 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 t - :.ins . d penalties of per tia . ! print Name Signator- . or/Agent / O ./ Date wne SECTION 8-CONSTRUCTION SERVICES 0 802(ICC 8.1 Licensed Construction Superyisor: ---- of Applicable O ,._— Name .y}�, G.a Name of License Holder _... J � '/ _ /� a' I/ License Number y M 1,ity ( .I-. r/_ Addresst Expiration Date i1!t 2-P'1ddeb tam i'1G)e,` Signature Telephone 7 1 n 9,R,•iste ad I •rovr.m, . Contra or: Not Applicable 0 pm• n site ..-- Registration Number F 1r / :A .. - -. Addre/ss- r Expiraifon pale _i /✓✓/1/2. � dmf r '/✓/ P/'.fi794Teleph911e L --/P/771---/—, ` SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 15Z§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 oftpermit. re n Signed Affidavit Att ed Yes ❑ No 0 11. — Rome Owner Exemption The current exemption for"homeowners'was extended to include Owner-occupied Dwellings of one(1) or two(',)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 145.3.5.1. 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-veer period shall not be considered a homeewner. 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 buildino permit. As acting Construction Supervisor}rour 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 he 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 Ala_ssachusets General Laws Annotated_you mat he liable for person(s) you hire to perforin work for you under this pemrit. 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 _ The Commonwealth of Massachusetts — Department of Industrial Accidents I Congress Street,Suite 100 G. pr. Boston,MA 1121.14-2017 •'r- www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED W1111 THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(RusinosWorgantzattonrn,aiviaaalr Dfir !3'T ,u ' Address: t tl 'ri(%y`� , u AUY� if -�,,r City/State/Zip:Li L{,:'xG�ll t I'!I"`'etf.'-° ?hone#: — Are you an employer?Check the appropriate box: Type of project(required); 0 i am a employer with employees(Poll and/or part-time)" 7. 0 New construction 2 I am a sole proprietor or pannership and have no employees working for me in 8. O Remodeling any capacity INo workers'comp insurance required9. 9)O h am a homeowner doing an work myself[No workers'comp.insurance required.I' Demolition t am a homeowner and willhiringcuntractors m conduct all work an myty. lwdl he I 0 Q Building addition ensure that all contractors either have workers'compensation'mutat=or arerc sole I lc Electrical repairs or additions proprietors with no employees. 12.9 Plumbing repairs or additions I am a general wmra:tot and I have.hired the suh<ontac,ors listed on the attached sheet These sub-connectors have employees and have workers'comp.insurance) 13.�Roofineans GDWearcaco ratioearN its ofiuKs have eserc sed that right titancioption Pee 9101 14. Qt her 152.41(4).and we have no employees.INo workers comp insurance required *Any applicant that chocks box al mast also 611 old the section below showing their workers'compensatton policy infomviian. Homeowners who submit this affidavit indicating they arc doing all work and then bile 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 hose entities have employees If the subamnactors have employees,they most provide their workers romp polrcy 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:_ Alt. 1W (07 Policy tor Self-ins.Lie. K- (2):41,2_1„.56-1Q../—/6. Expiration Date 7)��i ^ 17 )tib Site Address:... �,.) '�U-C/L � a t Giy/StateiZip:J-see, ? ] ' � t ` 4.96 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 c 152,§25A is a criminal violation punishable by a fine up to 41,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I ebycertif u-de t rt' penis lies of perjury Mat the information provided aboveis true .n 4andcorrect. Signature:. Date: er 9 l� . (4ii27-- Phpne e: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License k_ Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone M. City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal �] facility, as defined��2tby MGL c 111 , S 150A. Address of the work: 2// 9 �'/V M/ 7' The debris will be transported . 7,,//n 4 `.7`" The debris will be received by: /r %/ZC '? lam/ / b/ Building permit number: Name of Permit Applicant pdA `/ 67-12 -1r Date Signature of Permit Applicant AUy01 16 05:55a p,? HOME IMPROVEMENT CONTRACT PLEASE READTHIS �� 1 / See,Famished enc h caned by: Branch Name:New Smite Date: �]!_J� TWO, At Home Scniers.Inc. IVbea lame Hume Depot AL(lome Services Branch Number:31 90$Boston Tenpite,Uan I,Shrew,bury,Aa CI545 Toll Ewa 8709033753 Polecat D)P 15-2$$460;ME Lk S C 0269:RI Com.Lie Ta565yIbi27 Q n� CLic N HIC 22;MA Hrre ImpowemCeuta atter Cerr Ref.n I'+[d9: €nstaBation Addaem: _:d-�._yJ i. , E o f 1 1 " t'�E--D i frhi on OJ3 City Stare Zip Purtbreceat Wodt Phone Hums Omar Cell Thorn: u.SAIW (1_1u.40.. L a Ir j , a� r�, oa z It I� 1 1 �(� n Rome Addrd `] c� 2...T5- U p✓191�5^r1 �` j,y„rC,CE Qf diffecm nos h,tallsien Addvt Cita Vitt Zip Ilemai Address(In reset°project eommrmiml ions and Home Octet rpdeiu):,_, C I DO NOT wish to Icuve any marhetias manila crop The Home Coral Protect Tnfnteatiopt Ca:er.i nod CCCustowerh,the owner:of the property'waned at the above inatilluion adOtesa.OgraCN to buy. and THD At-Home Servicer,Inc("fie Home Depot i agrees to Ender deliver and arrange fur the install.vi:n FTsnlallation" of all materials described en the helms:,nd on the referenced Spec Shears),all or which we ineroroamled into the Co.nrect by tEe reference.tram with any applicable Same Supplement are Payment Swnmav attached herd°and we Etianue Order.cot Petively, 'Contnet t deb It: /mire esorm, 14M Shaiatx Paq+•ciA%•wt t7R r a a s Wiese maiauon � El 16 Se33' a cow., oh,"Do.„; 4 3 i ci 74 ...-i13RgCisr Jwma Jl inion S f7en i?U:,yjl • ce nEr q O C 4/ . 1 :Rreltring. ESkiny ]w d ❑Tsu]atic, •___ $ .-�.. ___ DCa:arsi Cnrerr DEari neon[U - ORsiling Ljs;e1 e L WirdoWsQ Insulator.. I OCurtara Covea Elam Does Ft Miemum ISE Hyena stOseras Arnexat dee upon esecatienordes eonmrw Tots,Contrast Atmum S ilaieePrehawn may act deposit more amanita-Hind dem Centred Ammer Cmtnnlei ngtecs that immediately upon comp:Ne n ori the work Mr each Product.Cusweet will execute a Comp•etion CelniGcmc lone for each Product as aeaned by H. r mtividual Spec Shect and coy any balance Amen As applice9e,each C•islomc under thin Contract apes to be piney andsevcnrlty obligated and Gable hereunder. The Horse Depot reserves the right m issue a Crams Order or termi tater hit Contract or any indiyided En ema:Ai included hetet,.w us d-ecretion,if The Hume Depot oras authori,ad service provider determines:1st it camel perform its obligations foe m a structural prcbtm}with the beam.wiaemenul'wcmds tame as mold,asbestos or leaf print otter safely•.Ao- er3.padre error or b000t-,c war.<regui rod to complete the job,ns not:needed in dun Commal. PsymAI Smmury: The Pelmets Summary ti f 014 9l ineteed at part of Nie Contract,sets lone dte total Cnnaag armrna end payacns respired for the Hernia an foal payments by Product Is appi'eeble. NOTICE TO CUSTOMER Teatime entitled m A completely Med-in copy ar the Contract at thetime yen sign. Do eel sign a Completion Cortirrcnlo[note There is me CmtpieNnn Csrtitkate tot each listed Product a defaM by indtridnaa Spec Bimetal berme work on that Prodoet is romplees. In the event of termination of thin Contract,Customer egret:.to pay'The Home Depot the cat.r mentor,labor,acpen4s And sere-ices praarded by The Home Depot or Authorized Service Provider through tie date of termination,pias any other amons set forth in this Agreement or allowed under applicable law, THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE. WITHOLI LEMMING THE HOME DEPOTS OTHER REMEDJES FOR RECOVERY OF SCCH AMOUNTS, r pY%nce and Authorisation: C r ma egm and understand,that this Agreement is the cm ire agree t errs between caxm.irer :ire Home Depot with regard to:henPmducts and Installation tar:ices out.upe tri all poi idlmusdont and agsamen W.ci r oral or a two.relating to said Products and Irmailation.This Aa ti donut he assigned or artseceedenewpt try .riing signed byCustomer a1 TM Wage tkpet Ceniomar acknowledges gad aereex than container has rad,undsrct :silt'amRty tit moons Vend hits received a cep)elitist Agreement. .pub lar:f Suhm trod b.: ,anLt. )r 9.1(L x t l VV\ C Treat -i r • 'y Sales COImnfs Signature Doc % 7d J Psi/L _ _ Telephone No _ Cratointra linetralurc Daw Salm C . ultu1 Lice nc 41. CANCELLATION: CUSTOMER MAY CANCEL THIS 'm"mkI ACREEMLT;T wrruour PENALTY OR OBLIGATION BY MITERING WRITTEN NOTICE TO THE HOME l / 3 DEPOT BY MIDNIGHT ON THE THEA) BUSINESS t l I C,) j t) DAY ALTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A PORN TO IME I ONE IS SPECIFICALLY PRESCRIBED BY LAW IN Auce01 16 05155a P.3 enrol°Ince. I ps'{cv111 VINYL.SIDING SPEC SHEET 5E3 33 Bonix. DESCRIPTION OF WORK Tara 'i ti//pJa33 :. CUSTOMER INFOflYUTgX Coaerne w 1 }}-rrle, h tiRO+ s : t 3AtVVli intathet rACION:AI 40_e_ u'y0`v AVwketo PMne ' t 1 accessSEMI w 1 EEO 5 1,l& l/10 J / Sit r Locca&ai::�.... mygl{r Loca4nn'. che sine zgcdde VINYL SIMILAR AREAS Iv be SIDED PRODUCT d PROFILE CORNERS COLORIST //�� ErWles�a Market Square PoMmduth Shake sm,dere 1 I swine "A)I4t Troll Lee! 6' CFpMMdI 5'Outc Ie CedarR (POWs Comers Len !n C'Ciapboved NTONC 9 outcnlu Hnn It ".6"irvsuia.etl'`,7 omers sad: /I Hcarc d SattmL,,. 4 CMpbea.nl I Steago e r —Right Perfection Pedocn n SMR .e8' i l _ Oracle Carolina Sands HT/Rounds Other INSULATION: I Me __ 4E i t Banded�NTI Ov r .o- T� No __,_ 9 Clp000rd Daher __ Craneesa cern NOUSEWRAP:I _, SOFFIT,FASCIA,FRIEYE BOARD AREAS to be CDS/FRED ford Dee L^fi Other Anse "'COLOR' STD Eth Facia _.. 0 ...._ __. SRI OnG FasciaOnly —... Coves Frieze Board with: PPG Air.CbIf 1 OR 'Vert.Sp/Dr".I Tuck Fascia Under GAten Yes [-I ea CUSTOM WRAP WITS PVC COIL REMOVE&REINSTALL ON 'COLOR' OD Qt 'NMYnW Oen Door Sturm Wncb.s ._ Parings le to Oar3TalPNb OaIX Stttn Jrcc Aw-RGZDna E' Du mle Canoe Doe. �ylary- [wlmq sin,. Eked:NI Foca 'Burglar Barscol be resound but ma reinstalled. —` REYOVEEa19TIMG&OMCs ' Yes1-1 NoI la Yee. JovyllVemtln P.I,InI L)r I ' Onlp'.rnnre nee siing iab be tisaIlsa Wine Copy wad NOT remove ASbe4W nNeeia.. FOR OVER MASONRY PORCH MING,XFAN9&POSTS NEW ACCESSORIES Y!N Dolls s'Sellr 7 Color; _ ,_ GABLE VENTS -M °claIA%1f.J}11M'1 , Beck YIN 'COLOR' NOdawg]s R'NC IMIIII PEW cna SPECS I _c.c. __— Wrap Pate,PL.� Reit, NEW EMT:9r. SPECIALTYWRAPS V(N 'COLOR' ec(Pais 'COLOR' Krcra Brass Lwmlud Trio/Nor Gobi Cent/ I _...._ _ — Rased Pare) _ _ . REPLACE ROTTEC WOOD Pfw od-Soberly _ adnaisorrei.Spear111e LaoMbna —. ^— SPECIAL CONSIDERATIONS I have reviewed and wen wih the job specifications described above,end I have reviewot and agree site the Spec at Taros and CoeWltlons Need on the remise side a'the gWow;Cuarsins Cele/Nth s Spec Sheet. If rotted rood in discovered ATTER romovinp the eaielies sltilq taorcouldi[ en o4 he idt ed at the time 01 elle lly atldilkia I charge of 5_ . ._per S4 R.feel wood andoe.r Lia FT for Dimensional Lumber. Customer Signature C. n _.,r 4-,Pe_. Date: q/a.Jly V111'4 '1111`" „ DNW Vepmv-11 arrutcj 5aro BEC-S-S THD-O4 71612016 2016 CS Lc Ray Hunt 001.jpg __ s. CS-082485 RAYMOND M HUNT 14 MELIKIAN OR WILBRAHAM MA 01095 - x 03'0112018 Fwpsfimail.googie conimail/IRrbo4153560O0e8a3947duprojector=1 ,4CORI M CERTIFICATE OF LIABILITY INSURANCE av lfi 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 policy(ies) must be endorsed. If SUBROGATION IS WANED, 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 USA.INC. NAME: ^NO ALLIANCE CENTER PHONE ,En1: ..... FAX Not SECO LENOX ROAD.SUITE 2459 EMAIL ATLANTA,GA 30328 ADDRESS: INSURER(S)AFFORDING COVERAGE I NAIL M 100492YnmeDGAW-ifi1 I INSURER A:SIeadEsl 10111Vnce Canal( 120387 INSURED THE)AT-HOME DEVICES,INC. INBURE0.B:Zunch American Insurance Co :165-- CBA THE HOME DEPOT AT-HOME SERVICES INSURER c New Hampshire Ins Co '23841 2890 CUMBERLAND PARS'+VAY.SUITE 300INSURER D:Illinois National Insurance Company 12381) ATLANTA,GA 30339 _-_.— INSURER E: WSURERF: COVERAGES CERTIFICATE NUMBER: ?71.0037486d6-14 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSSR MITE OF INSURANCE AN OTSUBR — POLICY EFF i POUCY EV : LTR 150 WD POLICY NUMBER ILAVOMYYV)yMMIDNYYYYI LIMAS A X COMMERCIAL GENERAL LIABILITY GLCQE87711-C3 ?3191:2015 03101:2011 —_._— EACHOCCURRENCES _ _ 9m0.a9 CLAIMS-MADE _t OCCUR DAMAGE TO RENTED 10096D3 ED EXP [Ea uiumnmei LIMITS OF POSSE XS WED EXP?Any one nernnl 5 EXCLUDED OF SIR:SIM PER CCC PERSONAL S ADV INJURY ' S 9,000,000 •GEN_AGGREGAE LIMIT.A? LES 0R GENERAL AGGREGATE 3 910000R0 A POLICY .).-: PRODUCTS.COMP/OP AGO I$ 9000.000 OTHER: 5 B AUTOMOBILE LIABILITY DAP 293985313 ,5. 5 !912017 COMBINED SINGLE LIMIT 'Is 1.000,00O '(Ea accident) X ANY AUTO I BODILY INJURY{Per person) IS ALL OV:NED SCHEDULED SELF INSURED AUTO PRY DMu i.BODILY INJURY P ' S AUTOS _ AUTCS p ( & c n1) ___ XIdED?V'i05 _ NONCSNNED (Pm OER nITY DAMAGE� UMBRELLA LIAR OCCUR I EACH OCCURRENCE 1 5 EXCESS LIAR CLAIMS-MADE AGGREGATE S 'DED RETENTIONSS I S WORKERS COMPENSATION 'WC015519215(AOS) CSei Zii 'D300112017 i X I PER I DTH. I „ AND EMPLOYERS LABILITY YIN' STATUTE , ER ANY PROPRIETORPARTNEROJECOTrE AC015519217(A1(NY,N14N1YT) 0101(2%7 IEC EACH ACCIDENT I'S 1,1x0,000 D OFFICERIMEMBER EXCLUDED' N .NIA (Mandalory-nNH) IWC015519215(FL) 03 012-0 03101/2017 E.L DISEASE-EA EMPLOYEE S 1000,000 ifyes. OF OPERATIONS o®w !Cunilnuedon MUilional Page E.L.DISEASE-FOLIC LIMrT 5 la00.000 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES(ACORD 101,AddthonL Remarks Schedule.may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEA 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 AUTHORQE°REPRESENTATNE of Marsh USA Inc. Manashi Muktierjee _DXts.,lml-c ,.-Net -LWLIc� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 8/3/2018 RICHARD TROIA 2455 PACES FERRY ROAD, HSC C-11 ATLANTA, GA 30339 Update Address and return card. Mark reason for change. Address Renewal - I Employment I I Lost Card Office of Consumer Affairs& Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 126893 Type: 10 Park Plaza -Suite 5170 Expiration: 8/3/2018 Supplement Card Boston. MA 02116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA 2455 PACES FERRY ROAD, HSC - - - ATtANTA, GA 30339N� l.. "� Undersecretary of v t td without signature