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37-043 (5) 220 ROCKY HILL RD BP-2017-0220 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block:37-043 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2017-0220 Project JS-2017-000377 Est. Cost: $3287.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 092937 Lot Size(sq. R.): 44866.80 Owner: KAKOS PETER J&LINDA L Zon�n2: Applicant: HOME DEPOT AT HOME SERVICES AT: 220 ROCKY HILL RD Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCERI02908 ISSUED ON:8/19/2016 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL 2 ENTRY DOORS 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: DatePaid: Amount: Building 8/1920160:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner File#BP-2017-0220 APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES ADDRESS/PHONE 24 SUNRISE DR PROVIDENCE PROPERTY LOCATION 220 ROCKY HILL RD MAP 37 PARCEL 043 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: INSTALL 2 ENTRY DOORS FOR REPLACEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 99209 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: _Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D-s•.lition Delay Ire _40.° 777/Cr ,Sigma Thi a ins S i'cial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. + -Fr. ;UFD - L.r=Harr n useoni 1 Ids 18 2016 C Cr Incrnanpt0n �5 a u�oPP r B idino D pa rmen; Curb CuJD i✓ vay Pa mi . 12 Mahn :.free( Ses+eoseF iovanabilty `--I DEPT Cr 1. s Room 10n paterN iAva-landity. 1 1 North —c1 n, MA 01950 lur Sets or Strucaral pl r_ phone 413-587-1240 Fax, C 13-587-1272 PlodSt Pans — 0th r p ug APPLICATION TO CONSTRUCT,ALTER,ER REPAIR,RENOVATE R DEu11OL!S9 A ONE OR TWO FAMILY DINE_LIIVC I I SECTION 1 -SITE INFORMATION 1.1 Procertr Address: Tffi#. section to be completed by office •,? //''//nnO hB ' I Pii p - Lo _ Un Zon Overlay Dis.rlc^ EI St Gstrcr CE•District- I I SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I — 1a k'mzos C� /_l __, �.)L Iii A ll ' I. Name(Print) /n'�..,� Cunent Malting Add :ss' I phone Signature II II 2.2 Authorized •,.ent: Name( net) en;Mating Ao d-ess' i.:_ stgnatu--/ TeleHone SECTION 3-EESTIMATED CONSTRUCTION COSTS I Item Estimates Ccsr(Colla I .o he i Oficial Use Only I completed by iaerry.!aoolicart I. 1. Building l) (a) Building Permit F i 2. Electrical 1 (b) Estimated Total Cost of Construction from (6) l3. Plumbing I Building Permit Fee I I 14. Mechanical (HVAC'i 15. Fire Protection jI ( 6. Total=(1 +2.3+4+5) F fr4.07^ (/[� I,Check Nu Number / 7 70, I 0/4/0 This Section For Official Use Only Cat 1, Building Permit Number: ssued: I 1 Sicrature: I Building Commissicner/Inspectoroi Builolnos Date For' a� p a o a .n .. _ . ... Seca on 4. 201 0NC i A I N:semen ressr G Cornsreeed. . :, t Can Ce period aue To Incorr et Information . 'c_cssr, 1 Pas,Tarreri rxys n s ) l This n xr as filled i " 1 Building Dnprrnen: Lc ,Sae ...,_ .r — 1 I Frontage I. _— I I -- 1 Setbacks Front S_ce I -._ I Building Height II Bldg Square F -tag I . r 1 , Ta Open Enact Footage I (L camasb & Et red 1 i _ i reFa .� -- __ nnalcanaaarinnaEan A. Has a Speciai Permit/Va ria nce/Fl ndicg ever been issued for/on the site? NO i) DON klN10V/ 0 YES 0 its YES, date issued:'. IF YES: Was the permit recorded at the Registry of Deeds? I NO a DONT KNOW 0 YES IE YES: enter Book I Pam and/or Do-u ni : i B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be:Stained from the Conservation Commission? I Needs to be obtainedS,0ir' Obtained , Dat Issued: _ C. Do any signs exist on the property? YES 0 N0 t IS YES, describe e, b.me andtoeLocation 1 s. D. there any proposed chances to or Sredditio,na of signs intended for the property? YES 0 NO 0 IF YEE, describe size, type and location: ' i E. Will e construction activity disturb e_ring, grading, excayarion, cr riding;over 1 acre r ls L parr of a canon plan that nil!diszurt,over1 aced YES C) NCI 0 S,then a Northampton Storm Werer ralan£NPe-mit i( e DEW is regisree . I SECTION S.DESCRIBTiOiN OF PROPOSED WORK(check Eli applicable) New Boase 7 Addition ❑ j Replacement Mfindows I Alleratlon(s) ? I P.oc'ing Or Doors ki. Accessory Eidy_ ❑ Demolition New Signs [�I Decks �[] SidingiD] Other[Mt Brief Description or{epy�r�0 21 �jT/]�� `/y j) ffry/ /�� —/y,-� Work_ p /4- ✓ 11)72) i `/ M , "n4.-/ ` �1,q"y^�,� j Alteration of existing bedroom Yes No Adding new bedroom Yes No ✓_ „cl'`�/ Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet se If New house and rte addition to exist ra^ houstndC corngete the fouovvind: a. Use ofbuiiding_Ore Family Two Family Other b. Number of rooms in each family unit Number of Bathrooms C. Is there a oars re attached? d. Proposed Square footage of new construction. Dimensions a. Number of stories? Method of heating? Fireplaces or Wocdstcves Number of each g. Energy Conservation Compliance Masscheck Energy Compliance form attached? h. Type of construction Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr floodpiein Yes No j. Depth of basement or cellar floor below finished grade k. Will building confirm-,to the Building and Zoning regulations? Yes No. I Septic Tank City Sewer Private well City water Supply _ SECTION 7a-OWNER AUTHORIZATION •TO EE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUBUILDING PERMIT l �' T ea-r a as Owner of the subject property, ,,,��/ } � /7 f hereby authorize N/7d-> OIS9 to act on my behalf, in all ma tern relative to work thorized by this building pemi�h application. of orrA,T t'i rig.-1, signature of Owner Date alt « ta.*I'SIcst aay-#,a im,?�n,� krati .�M. ar s% 0•:-7 - I, i,9 `6rryf ���1 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 the psiiid pe / ins of per.ry. Print Name i ...,- _ -fl'le n�pfD, dent ._7 SECTION a-CONSTRUCTION SERVICES ApplicableIaoi = N n tic ors u tom Suoervi At . 4 92) c--.n9 e737 ti "---"tE:p;rat on Date Ggar255 kli /214--• ©TDA aiynatrre Tektnone I � t .- Not Ap/i26�GI� B.Fears er drl.d pray me0` op -ac:or� iCrr Com^ mr Name . Registration .. r[ � � -13 .31 c� Expiration Date SuJ nlif. p sTelephone 40-6):3735:2--- I [[[JJJ ri SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M-G.L.c.152,§25C(6)) Workers Compensation insurance afficavit must be competed and submitted with this application. Failure to provide this affidavit will result in the denial or the issuance of the building permit. Signed Affidavit Attached Yes.. No E fl; -i,Heallie Owner nerintion The current exemption for`;-omeewners"was extended to include Owner-occupied Dwellinss 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 1083.5.7. 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 rwo family dwelling, attached or detached structures accessory to such use and/or farm snucmres.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shalt submit to the Building Oficial,on a foam 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 jot)site will be required from tame 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,yon may be liable for persons) you hire to perform work for you under this per wit. The anderse ed"homeowner"certifies and assumes respc siputy for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State ofMassach-usetts General Laws Anro:ated. Homeowner Signature The Commonwealth of Massachusetts l�; Department oflnelastrfut 4eefdents ?it- '. :4 I Congress Street,Suite 100 �iBM' Boston,&L4 02114-2017 - r wwwanass.gov/dia lti orkerC Compensation tnsuranea Affidavit:Builders/Cbmractorsflledrlcians/Plumbers. TO BE FILED WISH THE PEriAllTriNG kW i0E11113 t,nnlfeant Iniont:alien yy)) Please Print Legibly �+�jq�ar r Name (But;ncsiOnpetiniio�ndiividaap: !�f73177t- =�=Ci9 *.,_ './,;7•. ---- - RV I6Ce. Address: ry�C1 '052:l 0b-2`fST�1`�'\.% . /�/ / J+ Cix;/�teteiLi /120bC;.lt g6�, �ki jet, f95" --4b2 k14L2. Art you no employer?Chock 2c Gppr priatc hoc: t t Type arprajret iraqulredT I I W am a emplaces‘..11?) earsomermultanearmrotwer 7. 0 ! New construction s0 in e sole svoptimr or nrmeraipmidiirnvano anpinyea wm dna; ramie til &. 0 Remodeling any cpac i.No narkcrs camp.fimrane nlairei4 :.Liam a hamee:vnecduiny ail wort casein lido aortas'comp.Inmr eernutr qd_j: 9- 0 Demolition 2.0 tam a immeewanrendwnil to hiring comment to conducing week on my pmpony. 1 will 1 10 Building addition csara dwell contractors either Leve workers'compeacmion insuronn v wroath I 71.❑Electrical means or Mons pwricEerg vvnk raa=May 's. 120 PIumbina repnir:or=_ddiEcn; ss rn14 an a g ocrut di camr and 1 iaataurod rhevinsn%a!ors used on no c._tnv Iver. 7-4 eeSU-cenu^e:asNava=ploy=cid havesod ss`camp.insumtec: 13_x(Roof se s � aC(tom;`-vete:_ araion and irs ojjktrshancnamimd @mini+ td. §4' 'cm➢ �ntoi exunn�yn ca Mac 152,51(3),tad=have no cmployac INo oaikcr'amp.iicaznear t i add applicant Wal char t!cos Si mist coo rdl our dssenian bciowshowinn their evokers'conpetsmian policy urornctioa Hercanmrstvlle§mu this JrNaie fairciaing dcy mu chin all cat anThan iuv oursidacmuaawrsmtm submit a ntwailidavn radiating such. :Cemrenem ant 4rnci this bo::0ufl an3602 n aadidenl sli erne=ring We nice al the seb-canrwaors and strn MPvna or nal thm_amides bye e:rdmoy:-.'s. 1 WCnb-,-vitrmszeveer»pby�s.dxy nit ppcidnttmin.van:.-,'comp poticynamcsr. • I not an ernnloyer arm is providinywor(ms'c9Mperrnntian ftrsirm;cefar my employes. Bdmvis the policy and job site Enf6Pne(Fon. i 9n insurance Coinpany!tJfle: ).. e211,V 1-71.5-In ief - t Policy d or Self-ins Liee...g:Ij�kiv li//�/�• jam=, 7 ''' -� Expirzdan Cate: 0 / �___ ry"/�y�}. lob Site Address. JF"tD a-st, - it' City/State/24r, ,Y/rA �/! tl/ /'7P • Attach eap_-ci:heworicers'ea •peasntioraflay declaration page ishomagMe poiteynomber and cap'/lion dale), Failure to secure coverages required under?SOL c.152,1124A is a cdminni viola ial punishable by a finemp Io81,506.(YI [enter anc-Year imprisonment,as Well as civil penalties in the roan of a STOP WORK ORDER and a fine of up to$250.100 a day against the violator.A copy Willis smtement may be forwarded tp the Office of in'sUCagdim s of The DIkihr i,isuraft coverage verhention. 1 do berebY . piper ep -• rattier.of perjury Mattbe igforntationprorided alumis in a awl correct. -- - 5 15=1 Phone ri t.g r% % —q,b —h e-5`7' '.` Official ere anis Po natty—lie in rb/r arca,to be coarpletea by dip or town official City or Town: ___i, Permit/License, _ ' issuing Authority(circle one): 1.Bo2rd oT13enith 2.Building Department 3.City/Town Clerk 4.wiemrieal fnapeelor IPiembiw Inspector 1, 6,,Other LCantnot Percent Phoned: _. City o_fNorthampton 212 Min Street, Northampton, MA 01.060 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 NIG-L/c 111, S 150A. Address of the work: �Z� eti& 1117-6--22Z The debris will be transported by: o ' ` 0,- The debris will be received by: L//VZG� ti' r iff- Building permit number: Name of Permit Applicant R mtb �� Jr' Date Signature of Permit Applicant Jul 2516 0208a P'2 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by Kennett Name:Set Englund Date7il _y E_ THD At Home Se-senor:Dr. di1i The Home Depot Ai-Horne Service Branch Number:31 9084ostoo Turnpike.Unit I,Shrewsbury'.MA 0'64! Toll Free 871-903-3168 hotel ID a fl-M9 a®.M4.Leo L n±a.v;RI Cmt.Un:SOF Clinic fl HIO 055522_:SMA Here'nerorr C ntr:LYer Reg 0126593 I�tiemAddeo:8 -__ 2.2-P . b&c {. Mdl gnat) eli_ IGT - _ City Sure 'Lip —P�urehJea�-a�)-,T- 4Ver%Phot_ Phone:I Hoer Pho _dell Phnom ` Ye„ Kenos • [ [ rf ] 1E i i L 1 Li 1 Home dol L Address Umdsiror ddUuul City Stas Zip E-mailbtdd I0.recei ei DSO m.ucrationsurd Home Depot updeasi ,ii I D(1 NOT wish mrmrake ng erratis tiara The Flame Depot - - - Pro*. rmrnhon Undersigned("Cathor .beowners othe pip-Ntms kentd s Metre saRateaddress agrees to bay. end THD Ar-Moro Scrvica,.Is.("The Home Doper ' grecs To furnish.deiivcr and'u'r pe lot the;thud l "LWallatr n')of all zit rials described on the below:md on the footrace a'ptc Shreds:, all of when arc incorporated Iran his Contract:or this mlerenie,along with any cop Rabb Stye S spptemen-and Noce:Summary ataths hereto ruer ane Change Orders Ic:Ucaia-;y, 'Cowart r. //yy���}j�q. Job. ,mu.eou, Ppm • A cSlhet(s;b: Prkect`Alm yt Yt^^f� ap-r � ❑I — i 'U1Y ala, F rye ❑ 76 1.(31 a Z C 4 I 'tit•••1 t ng c.h °' ' °DO iJln,e: n prisma .c.„„-„, sn Ira n _ 16:1790 $ IQ�. ' j .��6<' L�L - -^aremst Covers a-vaDoe..DI t Li¢ f . ❑Sd�R i_...-�lnnhmm _... _.. _. .._ ❑ or (CoversCE re C. S (Hinman %OgndtKCooi+¢-tnuntaue imamimdmtardib'mrttn Torn'Contract Amount $ 2)(/ .. ' /j My Pu^tllax[atm neonate-it ore Mince third ettbfmtrett Annum. Colornet Ages that,immediately upon completion of int work for each Pro&ec Caaoner wilt execs a C mpktioi Coe 5 one (one For:arch Products(kilned to re incivic.al Spec Sheet)arid pay nay buten due. As:puntetle.each Cwtomer other this Cocnctapes to Sijointly and severally obllppted end liable hereunder. Hee Homo Depot referees Nn right to issue a Change ONcr or terminate this Croton or arra Lodividtmi Rdtm«s)in itded herein,at its d lsoetion,if The Hone Dot or its avthotized seMce provider determines that it ennui period°its ubliw(rone due to a structural problem with the boom,emtonment l Meads such as ANAL aims or kat ROW.Ober safety morns.prizing enters of boo rove oak r'zmned to conolute tlm W urn rot indudcd in ReConn m. Payment Manama Theoody Ferment SiSmoodyA (3(-)4-51,,j_ included ac par an drug Cone::rt, a'at3 forth the total Cc hactartnnrtmra payments required SS Om deposze and Anal Flamm.ba Poduc!z;apptabk. NOTICE TO CUSTOMER You are entitled lou completely 1111N-in eery of the Contract at the Gime you sign, throat sign a Completion Ccrfifrah tante: dn,rt is one Completion Certificate for each listed Product to dcrnM by indicidvai Spec Sheen)before wort an Nm Protium is completes lit the°dent of termination of this Contract,Castemer agrees to pay The Home Depot the torts of nmterbk,tuber.expenses and ventrices provided by The Home Depot or Authorized Strike Provider through the dace of termination,dies may ether amruntals*,forth m this Agreement or allowed under applknlle In, THE HONG:DEPOT MAY WITHHOLD)AMOUNTS OWED TO INE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PA VNIENTS MADE. WITHOUT CIAIITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH ANIOUN S. Ataloumct gad d uWnrirallm: Chore.'arrrees mrd umlc'toner rite anis hgrcemcnt it the cMue n pyu^ateat between Cunory ralTo florae Depot t.ith -heed to Me Product DC Itucdlctiod and super 'all SCOW discs ne%gins nrd artrectnente tither ar.d er wanton.Cri f "ro said Products no lestallation.TMs Agmenine canna:le assierred or aerie eon by or Wnietd.: n:d by CtIbtelibb and Thehoc Lkymt Ctmsmac eetknowleteges and pmt tbst Qtuim has end. neer.ands.eel emptily access Ills corms of and has re:Steil a cnpy of this Agreement. ,teecpkdbY �� Shbmittedbyr % o--, .� �. J X 11'f � `I��» . . Lt.toners Signature Dnk i Saes CConsultant's'Signature Rim -- % 1 _... _____ I Tele.-home Nn. ..__ .. eur,arxrei Signee Jr'. Ohre Se lot Cansticnt t:ren.::No. �... CAtSCEL5ATtO t CUSTOMER PIAY CANCEL THIS a.-We- AGREEMENT WITHOUT IFNAt.TA OR ORLIGAIION l ap DIY DE I4 E RING WRITTEN NOTICE TO THE HOME I— 13 L j b 4 *7 3 ) DEPOT BY 3ISIGNINT ON THE THIRD BUSINESS tJ DAY AFTER SIGNING THIS TACHEVRVT. THE , STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORIY1 USE IF ONE IS "-"-'- SPECH ' PRESS CRIBED BY LAW INsirn.c 9 Massachusetts - Department of Public Safety ¢ Board of Building Regulations and Standards ai a *:cerise: CS-092937 a , : 44 ,'• `0" SLAV MOKAN - `- 43 SABRINA BR is I • . , �. * ys WESTFIELD Mk QI t to r t ii / pe Rti;_ a! # 1 Expiration Commissioner 0+111"9t2017 I k • II. �_ l_. Si iio�nton I nQOLr . . _ ti _ li r � l o5^_G iii U41 I it - i -_ 1. i' • _ '�"r'=s_ .- Lo5 i:c�:os.�tiyey- II _— =as_a ii `.r.v.-_a aclo_ciEtm-WIG-"82fA nidiio-A_ndi -LcY E-SEE zn ,•r+c<_cinz•,a-Gon ras 1� __rte' CPas--;. t= 07:-7E DH�I l • 11 Sclero=s�_r C:,z;_ ti -_ - ii - l,�' - -i ^ri=i-`til '= l-i_ FL l'iP17=Nc-E RATINC38 i �f -, ii BPUlRL!m6i Fit E=l@ITA¢6.Oc&0@01@11ffitriU ii • J.45 _ is 11 - Z - Ural qurL a aZCY i . - . STARQ 'Na-r n ' -, ^w- xE Noah Cental South Celazi 1 1- _-s.4- 'ae x:;0._=_- _ Soure:_ 1 _ _' -_ --ems.»a�. ' - -: SIC:__- 11 U.,:eiaei 11 __ . 'ma Fran 00iGias=_AraSu2rN-LC25 0 1 Q . Tested E 11 ii I i I ii 1. i1 .§�^:whieT- SIE, -.-=i=Y- n"11311AN A.01 p,D_-iU:f:.e^-__A34f,ANVDY'w'CSA p ii il:IILS2M`.4.^_-O =_1E1riliiIP.YSAiC A.S / 4 -UC. II iif �:l. 83E87E0101 0.0.33., as re!m-.i 64000-ni:: ___ II Office of Consumer Affairs and Business Regulation 0 Park. laza - Suite 5170 Boston, Massachusetts 02116 Home 1i_;r, ro'ver,_,ent Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. RICHARD TROIA 2455 PACES FERRY ROAD, HSC Cr, ! ATLANTA, GA 30339 Update Address and return card. Mark reason for change. i Address Renewal Employment Lost Card O2tic, of Consumer Affairs S Rosiness Reg-olatioo LScerose or re lstratiou valid for individnai use only HOME IMPROVEMENT CONTRACTOR [done the expiration date. If found return to: C flke of Consumer Affairs and Business Regulation Registration: 126893 Type: n i';;rk Plazu - Suite 5174) Expiration: 8/3/2018 Supplement Card Boston. M . 92116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SERVICES I RICHARD TROIA ) 2455 PACES FERRY ROAD, HSC - - - ATLANTA, GA 30339 Jr.d;_:hri t=-ems; ' '08 fdrvathnae¢tieree[u/ac / / Ac0ROD CERTIFICATE OF LIABILITY INSURANCE AT1(BROa16BI 0 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 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 ceniticate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA.INC. PHONE FAX TWO ALLIANCE CENTER _INC.BO.FAIL. — — _._ I WSNJ: 3560 LENOX ROAD.SUITE 2400 EE-MAIL ATLANTA.GA 30326 ADDRESS: -_ INSURER(S)AFFORDING COVERAGE HAIC U 100492-HOmeDCAW'.13-lI INSURER A:&Fa&SI Msurarce Company 26387 INSURED INSURER B:Lerch AmHF#'Insurance Co ThrR+3•` DHA AT-HOME SERVICES,A INCO DBA CUMBERLAND PARKWAY SERVICES INSURER C:New Hampshire Ins Co - _ 23811 2690 CUMBER 3033 PSRKWAY SUITE 300 INSURER 0:ninths National Insurance Company 123811 ATLANTA.GA 30339 —...— INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: ATL003746646-14 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II POLICY WF I FOUL,/MCP LTR TYPE OF INSURANCE IM D.a p. POLICY NUMBER I IMMNMYYI Y ,IMWBWYYYYI I UMIIS A % COMMERCIAL GENERAL LIABILITY r '!GLO488)114(B '0.1FFQ016 100112017 EACH OCCURRENCE I5 9,000,000 x I DAMAGE TO RENTED 1 i 1,Q.e" D31 ___ CLAIMS-MADE OCCUR PREMISES I Ea awn nm) 'LIMITS OF POLICY XS MED EXP IAM ane Person) EXCLUDED iz _ :OF SIR.SIM PER DCG PERSONAL a ADV INJURY '5 9,003003 • 3Ervv AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE _ iS _ 9900'000 X POLICY ).00T _ LOOI PRODUCTS-COMP/OP EGG I5 9.000.000 OTHER: ' S B AUTOMOmLE LIABILITY . BAP 2938863-I3 010112016 03/0112017CO�NNINGLE UTAIT !,s 1,600,000 X ANY AUTO _ I BODILY INJURY(Pe,Persm) s A OWNED SCHEDULED 'SEL INSURED AUTO PH?OMG I BODILY INJURY(Per accident):5 _AUTOS AUTOS - HIRED AUTOS NON-DEEMED • . :PROPERTY DAMAGE L,5 AUTOS '(Per avweMl 5 UMBRELLA LMB OCCUR ' EACH OCCURRENCE EXCESS LIAO CLAIMS-MADE ' • AGGREGATE S_ DED • RETENTIONS I S C WORKERS COMPENSATON1WCm5519215(AOS) 103110112016 10501I20I .I X 1 ST µATUTE I I ERI SAND EMPLOYERS'l1ABILlry YIx' .WC015519217 AK,KY,NH.NJ,VII 1030112016 '031112011 1 , .EACH ACCIDENT S `3, 'ANY PROPRIETORIPARTNEWEXECUTNE N ;NIA. 1 I EL 1'�'�" D (Ma datoEnNH)ExcwDED' �WC01551921fi(FL) •310112016 [03,01/2017 I E 1,000,WO OFFICEorym9ER 1.DISEASE EMPLOYEgs If yes.desmbe under 1,000,000'DESCRIPTION OF OPERATIONS Selo Can'NIm1 MI AddIIMMI Pew . IEA DISEASE-POI ICY LIMBS 1 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD 101,Additional flume Sd,edSe,may be attached R more space Is ragweed) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION TBD AT-HOME SERVICES.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DSA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WDH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED REPRESENTATNE of Marsh USA Inc Manashi Mulcherjee _3.4dµea I_L �D4AJ-Le .ew}ri- ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD