Loading...
30c-089 569 BURTS PIT RD BP-2017-0415 GISII: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C-089 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2017-0415 Project# JS-2017-000689 Est. Cost:$20618.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(sq. ft.): 56628.00 Owner: MARUSEK PAUL S&HELEN S Zoning: SR(100)/WSP(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 569 BURTS PIT RD Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCERI02908 ISSUED ON:9/28/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 15 DOUBLE HUNG WINDOWS 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: FeeTvpe: Date Paid: Amount: Building 9/28/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner __ ------ Department use only of Northampton L Status of Permit 'Building Department Curb Cul/Driveway Permit �t� 2 7 212 Main Street Sewer/Septic Availability Room 1O0 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans __ ______gh 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 SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office %/✓[///�/]n/ fryyr�//,�;;11 T�'/ �y'�r^�� J,//��� Map Lot Unit ✓ G I / JI/�// Nj/ K / 1 Zone Overlay District /!!��'"' J ✓V/ Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner f Record: Pik JO2tk 5srz pre, Flprrat Name(Pn t),..� Cun nt MaAin tl ss 0/062-- Telephone Signature 2.2 Authored At •nt: 2 glEr AO /20/8- /U if,w 5,424 Jr Name(Fnnt) ( urrent Mai ing Address' ,/Li2'H g. r 110- - 7,33-2-- hz3 � ✓�Ci Signatu.t Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �J�G(/ e-� (a)Building Permit Fee 2. Electrical �7 (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) !/ 5.Fire Protection / �/ ry, p 77/0 6. Total=(/ +2+3+4+5) r/L•/� l/-•/S Ov Check Number /8yp0 �7 / " This Section For Official Use Only Date Building Permit Number: -al, Issued: Q// Signature: //J//7 y✓"�/- T r- 4077- 2r/p Buitdin ommissio/erllnspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete 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&pa‘ed parkin¢) 4 of-Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O 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 part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK I heck all applicable) New House [) Addition ❑ Replacement Windows Alteration(s) Q Roofing 0 Or Doors ,"®\ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Ip Siding[p] Other Ili Alts Alteration of existingbedroom Yes No �� � Dov l r�� w/N i2 / fro AddingnewYes Na aril/4: # Attached Narrative Renovating unfinishednishedbasement Yes No /ryy dd_fQ ',' " Plans Attached Roll -Sheet (,.qi J 6a. If New house and or addition to existing housing, omplete 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 crmstruobon. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance, Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar fioor 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 APPLIESPP� yLFOR BUILDING PERMIT 1_ _ i, L L��F !"" .... as Owner of the subject properly 1 �i ff Y7 f� lit+it4/ ��'7 }y����� hereby authorize p�(/2) A f/'eid/ _ to act on my behalf, in all maHera relative to ark . thorized by this building pe t application. CI 271 Signature of Owner Date �} 9(/� / }� I. r i 124 +J f d r � ,as OwnertAuthorized Agent hereby de re that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. ww Signed under the •- andf•enaltie of per • Itm Pant Name / -÷:.- 27-4 7 /1 Air Signature at it nen/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: J'�1f�� /(/�(I/p' NotoAp/pli ble ❑ Name of License Holder: YC/.'j®i/ 't'Jt- "li'G/'✓1C.G`/' (J! V'Z r 2o9 Lich>l iAiT�., � emae/9ter1z/7 Address Expiration Date ep I MU& YAP- 19/031) Signature Telephone 110H5-2-3 —/ 9L gee 9.Re•istered H• elm•r•vement Contractor: Not Applicabl• e O �� Com•an me Registration Number 84 eD4To-r\ G/�d�).. ,� E iration Date A(/ $7 p1511. Telephone 2_/✓/ �✓ J Z -- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issua•. o - .ing permit. Signed Affidavit Attach.d Yes ❑ No ❑ 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 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 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 bpirwpy MG c 111 , S 150A. Address of the work: ��j — ? b obz- The debris will be transported by: ph9: l�L nig The debris will be received by: Vik 4 ' Building permit number Name of Permit Applican (,./;G' ��� ¢/ 9-z7-ld it P Date Signature of Permit Applicant Job Contacts Link Leads Tuesday,September 20,2016 Comments Lead: 19503979 Go I Advanced Search 12:42 PM Info/Updates Homeowner Information Job Information Homeowner M/M Paul Marusek Sale Amount $20,616.00 Balance Due: $14,000.00 Commissions Homeowner2 Product Andersen Windows(8%) Costs Job Site Address 569 Buds Pit road Status Sale/Material Ordered FLORENCE,MA 01062 Branch Boston North Document} Measure# 77997523 Schad Measote County HAMPSHIRE Sales Billing Address 569 Buds Pit road Commission Rate Homeowner FLORENCE,MA 01062 Consultant Name Term Date Split Comp Plan Job lssuo6 Timothy Drost 100.00%Straight Commission Primary Phone (413)519-7833 Labor Update Work Phone Ext. B-Back: No Cross Raft 1-8104093592 Siebel Ord... 114429 Order Detail Cell Phone Key Dates Work Phone 2 Sale Data 8/18/2016 FUP Date Order Entry Cell Phone 2 Credit Date 8/18/2016 FPD- Customer Payments Email marusek@hotmau.com RTP Date 8/1912016 Post Install Date Cross Street Start Date FPD-Home Depot Perms Marketing Inspection PO Referral Store 8452-HADLEY Job Indicators Result Combo Base Store 8452.HADLEY Lead Paint: No Test- P Not Req Lead Source 0205 SC Working Store I Services Or;Show Mar TouchPoints -_Update JobUser Dat® Time Status Appt.Time ComuRaM I Edkka M Lewis 9/3/2016 11:21 AM Material Ordered No 6/18/2016 6:00 PM Timothy Drost Work Orders 'Erikka M Lewis 9/3/2016! 11:13 AM Order Received-PSG No 8/18/2016 6:00 PM'Timothy Drost David fticmar 9k/2016j 3:27 PM Measure Complete No 8/18/2016 6:00 PM Timothy Drost ............ __.. _.t—__. Cytnina Ra9Ln 8/19/2016 2:22 PM Released to Production No Bt1812016 6:00 PM Timothy Drost Cylhina Raglin 8/19/2016 1:59 PM Order Entry No 8/18/2016 6A0 PM Timothy Drost Timothy Drost 8/18/2016 7:59 PM Credit Pending No 8/18/2016 6:00 PM Timothy Drost (Timothy Drost 8/18/20161 7:59 PM Sale Pending No 8I18/2016. 6:00 PM Timothy Drost Dayend Dayend 6/I7(2016[ 9:04 PM Sent to the Field No 8118/2016. 6:00 PTimoihy Drost M,_ 'DEVARUS HARRI 8/15/20181. 2:53 PM Confirmed Customer No 8718/2016 6:00 PM Timothy Drost DEVARUS HARRI 8/15/2016 2:53 PM Pre-Book No 8/18!2016 6:00 PM Timothy Drost DEVARUS HARRI 8/15/2016 2-52 PM Lead Entered No Claw ( Print Home Depot Contractor License Numbers: MA Home Improvement Contractor Req. # 126894 Salesperson Name and Registration Number: Timothy Drost : HIS 0553710, R-R-073-15-00005 Home Improvement Agreement The Home Depot ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Paul Marusek 9503979 First Name Last Name Branch Name Lead # 569 Burls Pit road FLORENCE MA 01062 Customer Address City State Zip (413)519-7833 Home Phone# Work Phone# Cell Phone# marusek@hotmail.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 or Email CustomerCancellationNorthEast@homedeoot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: X 08/18/2016 cosom.,esmnatre Date Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. Includes all applicable discounts, rebates, and , taxes. Contract Price $ 20618.00 Excludes finance charges.* Minimum _ °/deposit$ Due Immediately Remaining balance $ Due upon completion 1 Finance Chases *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will will not ✓ be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of Windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on page 3 of this Agreement. Anticipated Delivery Date I Installation Schedule Approximate Start Date: 10/13/2016 Approximate Finish Date: 11/10/2016 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address,withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By initialing this paragraph, I consent to receive only electronic records related to this transaction. [- —J Initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete copy of this Agreement. Keep it to protect your legal rights. X 08/18/2016 Customers Signature Date X Co-Signer(Il apgFoblel Date X 08/18/2016 Sales Caneultaefs Swat,n Date License number(s) held by or on behalf of the Home Depot: MA Home Improvement Contractor Reg. # 126894 License numbers are subject to change in accordance with local or state government processes. For the most current listing of license numbers held by or on behalf of the Home Depot, please visit www.homedepot.com/licensenumbers. 2 Andersen Wood SPEC SHEET SC: Timothy Drost Measure Tech: INSTALLER: ¢ranee Name' embn None Job 9523979 Pi¢Dmee By: ISM: No To Loonton. wemnmr Name. Paul Maruxe+ Pamoen a/IDre SHEET t of S �— NONWINDOW UNIT •. ........ lea OPTION" Caecinint traaN. Xaresare 1%mWn W rrrdaoa panty Pia I. OH yupel M @ASE Slone or xmvs MIK EaI WMbn Muret FMK loses: Span moo mNw opWm Fpemm I.M[R 297" i NWrTYPE Cdaemlm ata SID rrWt TP MDAOUPE TECH SIZE ONLY {WS OwmmrvulryOWm+ P41 flrM WIMdPEe Sag.*PRgrg1 dtI emplLIFT OPTIONS m rml CeiCNS INN u0-ruc MusD, .I uce Sbbs Duke 000 Duel TIP co WADI SILL Sash II age Tamps a (WindOws. ISTO NASD a i per DO Imam, &Usu.'s, con roc :soup pc Flax Code DODE CODE ODIN I(..00E 12sIss meth hawk HEIGHT! W00% Hugh! TIP? ODPTH ANGLE Split Vsnling HansIiiii) Nye DONC only, CODE DOM sushi SUSI,/ CODE CODE CODE SUN !DUD TOD CODE ODLIUS I UV IN 011 Ca OH-0- TR PINE Gray 3t.GO es Uo IDS 4U.D0 kl COLON! 2 1 a.n Al 1 URA Cris SON sro UON AL I mm AA 4200 ... r _� .. a OV nr OH TW N PINE erav fa2n tlPW ret 42150 RI EL COsONI 2 0 1 n4 NON STD DON co SON CLIAD 4 W u 0M 4p wHt-m FFe Sry auu.a nen. 103 4OOI RI GaAs 2x Da Au SON arta Son SD SW mE At ..�. .............. I _. .. _ .. 5 115 sal OH SOD D11-0- TR PINE Gray DUCKS NT 00 103 40.40 PI COI ONI 1.2 a.3 Abb SON STD SON !CID SON A O.SPO 1" OH 2,22 EDI-I SR PINE Dsa, 350u 2222 80 ONG COCONP I I a a ALL SON STD SON DID SON of —•.. PAY r¢''mete uu+wren.Iwrw Mu.w.wum WH.—awevaw.w..S Mmy wswi5 W awenOi®eetmaiiiyr r No lye. T'FE CSIZE S(N➢1ry ITP1 EASUPE RCN SIZE FULL4ranf APP.," Mn 0$1011e(PER SASH px C pIIY1 OPTION °peal ryim imprirscl w Ounp Dom Orin drtwe MISC LABOR OPMMe m°," Inswing 'It'', GicarD i'l!'sWd E.ony Sores f gen Finch you,, DA 0)1011111 IWIDTH' RO I TIP MIMS Jarc lypts Pals a 41sur Van(PIN Obscure Sue., IN El VenUng, Denung 1 Pt) HP NWR HROWR KaDDI Moiled 1 Special Room Floor 0...Its DOLD CODE DUJOD COOL wall tp,4! ,IDGHT: 4.11M. HISNIN Su TIP .k:. Ixai on CODE, 0001 Nouu I NCSIs1..cocE cooe °DS u coriclu HcridriC nit-dna Ausembh. IUD Finish LUCA Stant@ Ncics MISC IS.,Dec DODUD 111,„. P.m Doss Paul Marusek m T..Home Over Andersen Wood SPEC SHEET SC Timothy Drost Measure Tech: INSTALLER: Brands Name. Boston North Job e 9503979 Prepared 2 y ISM: snip To!aalron: Customer Name: Paul Hareems Dateosnemo is SHEET 2 of S ScreenNEW Amoy/mar mune Dem Hemmer. onions Menmes tat ammo incluse imemonse Foram rum CH 97.Aar:~ FRAME INSERT um n eras ars 2 ease Glue we Hung SASH dymnimmmn LABOR ERM, ryw WSW mem*WYE ¢M SIZE SOLO(tgd WI MEASURE TECH SIZE ONLY ONLY OWma Carmel wrong gwne OPTION pawl Grim Options(PER SASH PRCiwI OPTION MINI LIFT OPTIONS SASE we pay OPTIONS TW TOTAL I-"'t'n Dusing Sleep Windup. Eperw Wee Jamb (WIDTH ROD, (Mew Gee How VW M1SC Window Type Slye. Cow Gulp, sym . I ID ID WALL SILL Sash Hew,Tempera UNinewb Type Pawn 1per leer ashen Obscure Finish Flash Lek/Were Non simr cm. oDDE cow y oue DODE cow myy, Hvgei Fir ICH D wen Negnr nn DEPTH ANo. ;II www:Renew Srym CODE I nrr CODE CODE swill sash CODE T r Ren Wm. CON DOOMS 7 BM me DB 400 OH-1 TR 'PINY- Grey 05013 45 00 BO ORG mom I 1 3.3 ALL sory STD SON STD SON AL 0 BED end DIA 410 Elii.1 TA PINE Grey 35 00 45 00 8,3 GAG COLON 1 I 3 a AU. sum WC aosi STLI soy AL 9 BED Old DR 400 D11.1 en ADE Gray 35 00 ss oy so Geo comity i 1 3 3 ALL sem STD sue WM DON AL 10 DEC end Dil 103 DP I TR PINE Gray 35W 4503 00 LEAL COLON! 1.I 3.3 ALL SON STD SON STD SON AL 11 BED 2nd OH 400 OH I TR POW Lee 3500 4503 30 GE10 DOI um 1.1 4.3 ALL 5041 STD SON STD SON AL 1? BED me ye my my 1 IR PINE Gray 3500 4500 au GBG [GLOM L 1 3 3 ALL SON SIC SON STD SON AL urannze mamma ammo ru.ma Pr Oroaq rwraaumaMo mar mesa.* I 110140PACISAVERROIMISM.Hue.m.ibiva... .wr.ar.•u,.r.re rge.r wq 301,W.110150111 mammy ramie ems rye,sai NEW DOOR UN1T MI endorsee cam. mewl MULL ISTACSS * HAWS DType dwry sae San cep m-rumr MEASURE TECH SIZE Rya Mm Opens(PER SASH FRKMI Im Cyon cram Dew Mewed W GAM Mapmns OPTIONS M6n LABOR OPTIONS Emsingmow" Sores Exterior F.nish ryuer Ow, TYPe Style Wiry Color tWIDTH. 110 0 TIP Jambs Jamb -Iwo Paw UM, Wu I Pe. Gmbeuee Shrow lir or v.ni,N,, v.,w9 I PD HPLOWF1 FIRDWIl Keyed Liplw 1 Weep! Reap, wer cpw, CODE CODE CODE CODE WPM !WW1 HEIGHT) Width !beget le TIP See I weep, CODE CODE Sash) 54,111 BOLA CODE OUT op 2.2: emery Hareem Asseredy Type Fin.sh Wm Sladme Now M1SC Labor ppm(300Es yyd,„,i w,.w.. Paul Mamsek my Home Owner Andersen Wood SPEC SHEET SC: Timothy Drost Measure Tech: INSTALLER: Branch Xame. POLIO°North doer 9503979 Prapme°W- ISM: Ship To Location. CPaomel Namo Paul MaTUSOR oa1e. oPn E..tme SHEET 3 of 3 NEW WINDOW UNIT Hug LOCK OPTIONS Casement Screen TI (StaWH OPTIONS ndup x860 OSA5E Stone OE MSC PENNE Undue Opal lrciwmen LABOR HUN type Ncwm TYPE ColoPFNITIT ED BPI SOLD Tree OP) MEASURE TECH SIZE ONLY ONLY Ogime Casement Hanging Ween WAW peel Grip Options PERS/L44 PPIIXGI OPMMI NEIN) LIFT OPTIONS SAS enapmal OPTIONS TW Hirai L°“(16" E coldly Sues Pule* Exterior Fiat Jamb (WIDTH Ria Sr Unice 0m tio.,: ve,t ms C Window Type Pyle Calm Coar Liver 1 IP io WALL SILL Sash lunge Tampa. Windows Type Poem per Ku Lupton &puma rush rosn Labor Pup Room Flu' Cue CODE CODE CODE COOL CPO, WPM Heuht HEIGHT) Win' Heigh' TIP I DEPTH ANGLE Emil V"Trd I HP3m3T siyi. CODE only) CODE CODE ..h) ..hi CODE CODE CODE Type Flash Type CODE CODES la LIFE) Ond DE 400 OR-I TR PINE Gray 35 00 45 00 00 GBE COLON 1,1 a 3 ALL SON STU SON SU] SON AL 14 BED ond OH 400 DIY-1 TR PINE Gray 35 00 45 00 00 GBG COLON! 1,1 a 3 ALL SON STD SON STD OLIN 15 ear 1 n Ohl 400 DTI-i TR PIVE Gray 31 00 37 00 ES GBG COLON! 1,1 3 3 ALL SON STD STU STD SON at MP acrevamoon stew NM.: M .um.u w Rwn me+mqv.410•11•01.1,Hnpr wmMvn ItineUMLINITI wM1 pewee +IMWMn NEW DOOR aarat ArrIelsen mea TMP MULL!STACK e Eateding ammo. Ow TYPE Cabealnish SO SIZE SOLDIryu T41 MEASURE TECH SIZE FULL FRAME ONLY CUM ryw,e(PEA SASSPRiCIMO( OPTION Option Oqm Hipped M(why Pe Options OPTIONS MISO LABOR OPiIaus !moon E'''''''g s''' E„,,,,,, Eddy TOT,dp PI Extension Or ri „,, „.y Dud Nu Lurk Luk cgwes DCOr Typo Slyis Color Cony WV'',• +40 I TIP yapty yappp Type paii,(pn um., wr,IF, ot,,,,,,. 5,1.11 1„r pump r venug I RT) H Pm Li lb mama Kew ammo I Sped 01 Rum Rue Cede CouE CODE CODE CODE WOK neon' HEIGHII Nun Hoerr le TM S„ Luau CODE CODE s...h) s.r CON coca Oc 1 0 panein Handed Harding ASSOMINV Tyre Kash LIU Sruud rcOo miCe I Ms Plea CU:11S .„e,., n..°,.. Paul Marusek n. Home Owner The Commonwealth of Massachusetts Department of Industrial Accidents Yo ; I Congress Street,Suite 100 L(A p t vnr7 www.mass.gov/die Workers'Compensation Insurance Affidavit Builders/ContrastorsfElectricianslPiumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. .Applicant Information �7 Please Print Legibly Name (Business/Organizanon/Ind)mdua0: k�h�:r Y ra-,) Address: (761 e .24finv "Fie .1 City/State/Zip:S .•.'14I T.; I ^o 4'hone#: 4# Z � Are you an employer"Cheek the appropriate box: Type of project(required): !_0 I am a employer with employees(full audior pamtinc)` 7_ New construction 2.01 am a sole propnetot or partnership and have no employees working for me in S. p Remodeling any capacity [No workers'compinsurance required 3 I am a homeowner dome all work myself: No workers comp-1 insurance requiredd' 9. I]Demolition n- 10❑Building addition e 0 l am a'ha emrxtn nand will he bun comrsemrs to conduct all work on my properly 1661 ensure that all coteraaors ether have workers compensation assurance or arc sok S I.0 Electrical repairs ar additions proprietors with no employees I 2.©Plumbing repairs or additions it am a general contractor and I have hired the sub-contractors!died on the attached sheet (hese sub-conrmmors have employees and have workers'comp.insuurance. I 3.1jR7 f repairs 6.El We are a corpurationaznl its otitis have exercised their tight orexemptfan per MGL c. 1A, they P! 1$2.$t{41,and we have no employees pro workers'coh@insurance required.] 'Any applicant that checks box S l must also MI our he section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name or the subcontractors and slate whether or nor those entities have employees tithe sub-contractors have employees:they must piovude their workers'comp polity number. I ton an employer dun is providing workers'compensation insurance for my employees. Below is the policy and job site information. A y Insurance Company Name: b�sf�t� �'. - r 7 M i /'tPolicy or Seitins. ie.4 T� . Expiration Date, r/%rt j A t 7 Attach a copy ss:the workers'1 con nsati 111 1� City/State/Zip p L�/// N0-4,1 tr./ "7 p declaration page(showing the policy umber and expiration date). Failure to secure coverage as required under MMGL c. 152,§25A is a criminal violation punishable by a fine up to 31,509.00 and/or one-year imprisonment,as well as civil penalties in the form ala STOP WORK ORDER and a fine of up to 3250.00 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 nit k y eby certif u ,e t --•��perza des of perjury tent Jhe information provided above is true and correcl. Signature: �'� /� /.� /✓^)�'^V) .'7 Date: 26 /tJ _ Phone U; _..... ,�:1�'-rJ l'JL�✓ (/_... Official use only. Do nor write In this area,to be completed by city or town official. City or Town: Permit/License n _ Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector B.Other Contact Person: Phone#: 4:,I. IA -5 lc r. C4Jc6 �16 q I ��'';44;,;,..; ' �� L EI t�� rJ? �I.,I fr!;fl II i 4 It:it ' 4IN v I' xl7r �C4 t$ A:t . . .,.... 1D i{ ... . ..,.. IIi.0 rrtem a; I- I .i ci:e_! �t' 3 ,.i IPI{ tr'a a I � t�! � "'Jp �,4 °:i:likirN': ..i �� s ;n�)) rrfef, !E al llisrj 'J7": a p. t' rid° {!: qII ie' i+ v ' ' 17: I. tIf A l.'I P. , °tiq l�N. - [" J �i�(tr J l' r .a • II Ibq R !4 " G1iI rs AI 0, G I (n �! s 1. t! t, ry „ ,n, Il .a ��>' 19ai9 tG * ,1 'r0 1. UA �� ! ., :.. in II 111 i 1� �GI" �( 11 II fl I�) Vi- + a f9Ill A4f l Ol 1(wI 7p r�`I , y�I� yJ t � p '�'` 't c to 1t{'ll ft,�ii 6 CO it u $ _ -, ACRO CERTIFICATE OF LIABILITY INSURANCE av omen Y? THIS CERTIFICATE IS ISSUED AS A MAI I tR 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 CONS U CUTE A CONTRACT BETWEEN THE 155113140 INSURER(Sj,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must bo endorsed. It SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate dons not confer tights to the certificate holder in lieu of such endorsement(aj. PRODUCER WNTA�LT MARSH USA.INC. — MO ALLIANCE CENTER WC No EN' IMIS.Nut 3660 LENOX ROAD.SUITE 21C0I ATLANTA.GA 30326 DDROM INSOREmmAfFonomOCOVERACE I NAIL IOIp92.HameDGAW'.I0-IT INEVRER A:AeaWarl mwrance Company j26387 INSURED MSaaeR a:LYG6 AIIf&IOas bSUAYRCP itfi515 THDAT-siasiESERVICES,INC. HOME THE HOME DEPOT AT-HOME SERVICES INSURER c:New Hamp.100 Ins Co 03841 2690 CUMBERLAND PARKWAY.SUITE 3C0 INSURER D:Irma Nadi Insurance Company 71817 ATLANTA.GA 30339 INSURE: ... MAURERF y......... COVERAGES CERTIFICATE NUMBER: AT1-003746646414 REVISION NUMBER:a 1 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 CONOMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED RV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. S EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILIRR TYPE°"45URANCR .VMM pOUCYmimacc '{MJSOLJPR mpornYM;I YV), Mins .....� A X ,COMMERCIALGENEFALWWLITT - GL048ami-c4 41'314Y20te :0341112016 Ea"y OCCURRENCE. tS 9.IUS43 AOA EA�To�a 3r 1E8. cL.aImS.MTOE OCCUR ' ,,ERUMSES fEau;ruAMces I> SODOMY) LIMITS OF PODGY XS ' COED EXP IA remp.rmm ! s EXCLUDED 'DF SIR SIM PER OCC IPPRSONALe ADV INJURY :5 400]. iE`tL.at2G,P-vn..UXtTAPPLIES..R'. • GENCRALAGGREGAIE ;S 9,�6.Oa'1 C POLICY. T JEC 14 'C 'PRODUCTS-COMPAOP AGG-I S _...... 9,N10.000 OTHER ' AUT0MOMLE LIABILITY �.......:. SAP 293880113 03.01,2016 .0340112117 J6iI4 !NEED1resesMIT s 1.000000 X NY AUTOI OOGILY INJURY(Mvimmenl 1s .LL SRNEI. 00..vcED0 SELF INSURAUTO Piss DMGUTOS I,SADLY!INJURY Plc acaRNN S __ UOS ON.C ,NED j PROPERWSAMAGb UMERELIA UPS _OCCUR 1 EACH OCCURRENCE E.5 . EXCESS LIAn CAWS-:AtOE : I AGGREGATE {5 _. DEC sEr=_Nrou; Is D WORKERS COMPENSATION !WC01519215 AOS 1031011201E 0310112017 'PER OTh I SAND EMPLOYERSLIABILITY ylN • ' ( I : I X I STATUTE I__ FR I C NY PROPRIETOWPARTNER€XECUTIVE IWC015519217(AK,KY,NH,NJ,VT) 10310112016 D31112011 LIIIp,W0 OPPICEAMEMBEP EXCLUDED', ELEIsEAse IcAo S 0 11MmtlaloNm NH) t.N1A• WC61$$192I61F4 D31B1I2015 1031011261] r P.I.DISEASE EA EMPLOYEE.a 1.x,00 Ny^ redMieU 'GESCR�Igry DEOP=Ranexs oe`n. Coal/mod=Mgltmal Raga ?ELmSEASE-PMK'V UMRIs OK= • OESCRIPTON OF OPERATIONS!LOCATIONS A VEHICLES IACORD 101,AddWe,* Remits SCMYbd,may be macnea mmempace is nquIrmg OAD"ENCE OF INSURA,E s. _ CERTIFICATE HOLDER CANCELLATION THD ATHOME SERVICES.INC. SHOULD ANY OF THE ABOVE BPSCRIBED POLICIES BE CANCFB J PD BEFORE OSA THE ROME DEPOT AT-HOME SERVICES THE EXPIRADON DATE THFRPOF. NOTICE WILL BE DELIVERED IN 245 PACES FERRY ROAD ACCORDANCE WITH THE POLICY mos/WHS. MANTA.GA 30339 DO 1988-2014ACORD CORPORATION. AR rights reserved, ACORD25(201401) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 0 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ? t ?rove neslt Contractor Registration Registration 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 8/3/2018 RICHARD TROIA 2455 PACES FERRY ROAD, HSC C ! ATLANTA, GA 30339 Update Address and return card.Marl<reason for change. I Address Renewal Employment I I Lost Card Office of Consumer.Affairs R Rosiness Regulation Lieease or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR be='ore the expiration date. if found return to: Mire o€Consumer Affairs and Business Regulation Registration: 126893 Type: 111 ?art Plan -Sulte 5170 Expiration: 8/3/2018 Supplement Card 11 o to.+o. MA 92116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SEI?VIGESP vaned without in re �/ RICHARD TROIA ,. '2455 PACES FERRY ROAD, HSC - } i TIsANTA,GA 30339 {hr, rceretar t ' Not t b L I F `v' bk r r a r �4 + 2 y 5� w h;trr E kS"i ,. ., :.. A, -- rte , IP ry. ka • b : w 1 VL.AL?1MIR SMEVC #UK �� ,fit' ,H " " ' rre r ` F vv, 0. 1y` .1ipd .xavEh••A .4a..[r s rateM KryR zr: §y s T s ' g .i '�" % t Ci ' iY n . } '& l