29-450 (13) 24 CRESTVIEW DR BP-2017-1113
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-450 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
Permits BP-2017-1113
Projects JS-2017-001896
Est. Cost: $1257.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 92937
Lot Size(sq.ft.): 10018.80 Owner: ROSA GILMA&FREDY
Zo_ nine Applicant: HOME DEPOT AT HOME SERVICES
AT: 24 CRESTVIEW DR
Applicant Address: Phone: Insurance:
5 RIVERVIEW DR (401)935-2633 O Workers Compensation
NORTH PROVIDENCERI02904 ISSUED ON:4/5/20170:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 3(2)PANEL REPLACEMENT WINDOWS
IN BASEMENT
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: OI: 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 4/5/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
p(0\{ 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
>p}(one 413-587-1240 Fax 413-587-1272 Plot/Site Plans
). Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLIS'HH,A ONE OR TWO FAMILY DWELLING
!•-/r�O
SECTION 1 -SITE INFORMATION - i i- III 1J
1.1 Property Address: This section to becompletedby office
//� �r-/�//��� ) •
Map r-2 9 Lot /'7 O Unit
241 (/� // ✓/ �V R Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
G)L * P12 ,4-- 2y G zeAi taz.
Name(Print) --rg. � Current M ztlQr ._:,y /( V9 y)_I �) —
" / f Telephon t'�yI 3 � � 1�1//9( // CiT/
Signature / / — 24) -U) 79
2.2 Authorized Anqnt:
GnliD D)At Mai ��
Ne nt ^ Current Mai' g Address: �-
)4 ole s
Signature Telephone y'�J-'J.a4__ �j -„›.-
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1,2?72-71 (a)Building Permit Fee
2. Electrical i (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection `' ��yy p{j
6. Total= (1 +2+3+4+5) I, 7 UD 7- Check Number JO/dG /1
This Section For Official Use Only
Building Permit Number: .. Dateed:ed:
a
Signature: 41,
'// Alt9-15.-17
B Iding Commissioner/Inspector of Buildings Dale
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
(Loi area minus bldg&pared
parking)
4 of Parking Spaces
Fill:
velums&Locution)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O 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 N
B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement ' dows Alteration(s) ❑ Rooting ❑
Or Doors
Accessory Bldg.
T.f❑yr�PPpp��Demolition �j❑ New Signs
[�17�] q,/Decks [/JQy/�/y�Siding
�r[0]'TOther ED] �l
WOYf: e/cnpn/ /JG/�d 0 .z 1-�I uvii'JDxi, VO/z- dev2/7LL'//�/x'/ ositz
C/
Alteration of existing bedroom Yes No Adding new bedroom Yes No a>✓ o,
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.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
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
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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. 6121— v -/X' ,as Owner of the subject
property //J���//
hereby authorize 12) 1/9-12b. 7. aC �� 71 b
to act on my behalf, in aafters relatve to work authorized by this building permit application.
g. E.-- �-- I7
Signature of Owner �), ��r Date
I. i /!7 ✓(y�) 40-1 , 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.
Signedyader9thins and penalties of per ry.
i 5::/
Signature Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:yy) /�',yn/ Not Applicable f0
Name of License Holder: 'G// V A 9 gal O/��t'
Number
License
1/ g)11/494— P A '
Address Expiration Date
Signature Telephone
VJ 422
8.Registered Home Imp ovement Co tractor: Not Applicable ❑
Company Name Registration Number
Addre sirat) / �',/f- '' Expiration Date
/%/� ) 1 01Vr e hone A Zoe see
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 issuance of the building permit.
Signed Affidavit Attached Yes...�,_C — 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 is intended to be,a one or two family dwelling,attached or detached stnictures 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 buildinu permit.
As acting Construction Supervisor your presence on the job site will he 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 pemit.
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
�byy MGL c 111, S 150A.
Address of the work: Z (,, ��jl 1(/ ) )
The debris will be transported by: LV
The debris will be received by: Wi1j �, .%il
Building permit number:
Name of Permit Applicant I//!� /P
Date Signature of Permit Applicant
Home Depot Contractor License Numbers:
MA Home Improvement Contractor Reg.#126693
Salesperson Name and Registration Number:
Timothy Drost : HIS 0553710, R-R-073-15-00005
Home Improvement Agreement
Home Depot U.S.A., Inc. ("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:
Gilma Rosa Boston North 9907818
First Name Last Name Branch Name Lead
24 Crestview Drive FLORENCE MA 01062
Customer Address City State Zip
(413) 320-8179
Home Phone# Work Phone# Cell Phone#
grosa@northampton-k12.us
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
Address Coy tam Zip
or Email CustomerCancellationNorthEast@homedepot.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
DEPOTS 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 03/14/2017
Customer'ssgnm,re Dare
1
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.
1257.00 Includes all applicable discounts, rebates, and , taxes.
Contract Price $ Excludes finance charges.*
Minimum _ %deposit$ Due Immediately
Remaining balance $ Due upon completion
Finance Charges
*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 v 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 / Installation Schedule
Approximate Start Date: 05/09/2017 Approximate Finish Date: 06/06/2017
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.
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 03/14/2017
Custe.ners Signature _ Date
X
Go-Signer Of appllcablel Date
X - 03/14/2017
Sales Consultant's signature Date
License number(s) held by or on behalf of the Home Depot:
2
WINDOW SPECIFICATION SHEET - Spec.Sheet#'. 9907818 Sheet 1 of 1 s.
Customer Gilma Rosa Job 6. 9907818 Consultant: Timothy Oros' Date'. 03/14/2017
New Window
e Le
EyISIIng window Measurements Gods Product Options Labor Options HFrom outside
s
Lel b Right
Bays Bowls
Location Color Rough Opening p of bars X of bars Csmnts,I
use L R or S
Glass
Mac Items
Hardware Code
Screens For doors use
Mull 'B'=stationary or
wStyle Wraps bo to a S m ry `R � 'p 2 = K =operating
F- Room Floor Code (YIN) Style Code genes Code w Z e r m es - E
5, Glasse, Standard
STD GlasaPaa Stand,
STD GIOSSPEILII Standard
SPECIAL CONSIDERATIONS.
Wrap Color
nterbr Casing Type
Bay or Bow window'.
Seaboard material(vinyl only-Birch or Oak)
Bay Project Angle(30 or 45)
Bey Flanker ype(DH.Sat,or Caroni)
Top of window to soffit(inches)
'led to sofbl.color of sit matenal I have reviewed and agree wlb all the fob specifications above and the
..onabuct Roof Wes or No)r Speoal Tem%and Consigns on the following page
Garden Widow'.
Seaboard Material(vinyl only-Whim Pone.Birch or oak)
Wag Thickness Ouches) Customer Signature
Additional Shelf Wes or No)
•There Is no guarantee that new shingles will match existing Dolor.
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r 33:58790/05 80332 HS Hazard 64000,50Ali
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: 6/3/2016
RICHARD TROIA
2455 PACES FERRY ROAD, HSC C-11
ATLANTA, GA 30339
Update Address and return card. Mark reason for change.
I Address Renewal - Employment j 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
2455 PACESS FERRY ROAD. HSC - - - -- _ } `` � �, — �� �,
I
ATLANTA, GA 30339 Undersecretary I lot valid without signature
r
ACORD a CERTIFICATE OF LIABILITY INSURANCE
DATE
"'
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. TH(S 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 pollcyges)must be endorsed. II 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 endorsements).
PRODUCER CONTACT
MARSH USA,WC. NAME:
N�ME: A
�AA
TWO ALLIANCE CENTER E rPm
35E0 LENOX ROAD,SUITE 24X0 PppRE9s:
ATLANTA,CA 30326
e1WRER(S)AFFORDING COVERAGE I HMO
10ft92.HameD,GAW'.1218 INSURER A:Od Republic Insurance Co I241°
INsuREsiHE H(XaE DEPOT,WC. INsuaeRe:Age Camel Insumce CaTPany IOW
HOME DEPOT US A,INC sag"C:'IB Hampshire Rs Cc )23641
2455PACES FERRY ROAD
INSURER 0:
BUILDING 010 INSURER E:
ATLANTA,GA 30339 _
INSURER F:
COVERAGES CERTIFICATE NUMBER: ATL003746387-l4 REVISION NUMBER:2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NO3WThSTANDINC 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 RY PAID CLAIMS.
IIR
LTRI TYPE OF INSVRNICa iAcmc IIAPOMammn'q Ie ICY II
IIhaO`WYD POLICY NUMBER LIMITS '
A 1 X k COMMERCIAL GENERAL mAOIRY IMWZY31002Z 031%(dlll 03/0112016 EACMCECURRENCE I 9,'730..003
y S ,UMn6E 7ORENTED
CLAMS-MACE occue 5 , `0.'6.D33
'LIMITS OF PCLCY%SMED EXP( Y are penalI
EXCLUDED
OF SIR:SIM FER CCC I PRSONAL a ADV INJURY 9,000,000
GGREGATELIM APMTES PER GENERAL AGGREGATE 9009,000
-O CV - EGOn LOC PapOVCTE-CUNP4PAGG 9.110,000C
OTHER k 5
A AUTOMOeIU UA911.1TY MW EXCO21 103/01/2917 03A1Q018 titM�aED51NCi_Uf*T IS TC01,000
X ANY AUTO ROCiLY INJURY(Perr*m) 5
• AL`OWNED In SCHEDULED
CHP ULED SELF INSUREDAUTO PHY CMG �RGOLYINJURY LPN ACCATSMI I s
;5
VMBREW IJAB F OCCUR I EACH OCCURRENCE IS
I 'EXCESS Loa CWMS.MADE, I ` AGGREGATE 5
(DEO , (RETENTION$ 15
3 WORKERS COMPENSATION I IWtRC491123GGfTNI ONII20IT 0101/2018IX IPEA,MTEI l0TH-
ANBtMPtOr6Rstuswry WC 0235924123 AX,NH,NJ,VI) 011112011 01.31.2018
PROPn1EDOR EXCLUDED, Y�NIA t LL EACH ACODENT IS *COM
OF:eENMEMRER EXCLUDEe'I 'WC 02310242/ 'N 03/01Qm] 03101/1019
Mandatary In NRI I O EI.ULSE45E FAEMP.OVE�S TOCO.009
y 19ESCRIPTION OF OPERATIONS OOIa+ Confined W MMNhnaI Page EL DISE.ASE-POLICY LIMIT IS 1300,000
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DESCRIPTION OF OPFAAT1ds r LoogroNs r VEHICLES IACORD 101.AadIWne Remarks SCHCN9,may be attached 11 mon.pa*a repuVMi
EVIDENCE OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
NOME DEPOT USA NC SHOULD ANY OF THE ABOVE DESCRIBED EDUCES BE CANCELLED BEFORE
2415 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATLANTA,GA 30339 ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Mnh USA Int.
Manashi Muthe:lee _Mouses.: .21q..4o.u.d.e.4.
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
;EN/G?CUSTSCAAPAR MA 1 CAPAI-32
LOO m. Atlanta
Acaun ADDITIONAL REMARKS SCHEDULE ?age 2 dr j._
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The AGGRO name and logo are registered marks of ACORD
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