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31B-020 (2) 8 ALDRICH ST BP-2018-1326 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 3113-020 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category REPLACEMENT DOOR BUILDING PERMIT Permit BP-2018-1326 Proiect# JS-2018-002352 Est.Cost $3896.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group HOME DEPOT AT HOME SERVICES 98785 Lot Size(so. ft.): 5662.80 Owner: RICE RACHEL Zonine: URC(100)/ Applicant HOME DEPOT AT HOME SERVICES AT. 8 ALDRICH ST ApplicantAddress: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.611412018 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL REPLACEMENT DOOR 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 Shumbire: FeeTvne: Date Paid: Amount: Building 6/14/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner RE mie Department use only Q-- City of N rtha pion Statu of Permit: Building epa meRIN 1 2 2018 Curb utfDriveway Permit 212 M in S reet Se r/Septic Availability Ro m 1 srecnoNWe r/Well AvailabilityNorthampt (11000 o,.NA nmeo wo is of Structural Plans phone 413-587-1240 Fax 413-587-1 o its Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY�DQWELLING SECTION 1 -SITE INFORMATION 00 - / �a" 1.1 Property Address' This section to be completed by office Map 3u3 Lot 0--'a Unit !(/ Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reco Z p L� Name(Print) S�tV�O(� Telephone Signature 2.2 Authorized A ant: Current M ;ling Address'. Signa ure Telephone _ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only correlated bV Dermit aDDlicant 1. Building / nn (a)Building Permit Fee 2. Electncal �p (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee u M 4. Mechanical(HVAC) / t/ 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: e Building Co. loner/Inspector of Buildings Date �� Z7 @ 0711 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tins v.1—m be❑r x1 m In, Building Depamncnl Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage 9b Open Space Footage (Lm arvo minus bldg&paved mkin ) #of Parking Spares Fill: (volume&Lowliun) 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# 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 pan 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 ❑ Addition ❑ Replacement Bows I Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldppg.WW❑WWRRoo Demolition �❑l y/N�e'w Signs [0]D//.� ��Decks [� �'/Siding[IM) I Other[p] Work:Brief escrip/lll)/IM /'/ .Prd c • ndc—&7 by_4_; 'I 4n7— �'VI/ Alteration of native bedroom Yes No Adding new bedroom Yes No Narrative Naative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Be.If New house and or addition to existinu housing complete the f011owina a. Use of building :One Family Two Family Other It. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? J. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstoves Numberof each_ g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Sepi CitySewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property I // hereby authorize 2 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Omer n ^ Date I •W 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 p ' s aarena0ies of pertu Print Name I = 7 Signature o(Owne A en Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervri'sIo'r: Not Applicable �❑ Name of License Holder' !/ License Number /f 222v Address Expiration Date Signature Telep one .Re i lered Home Im "men!Contra or: Not Applicable ❑ 1 7x�- !12��✓r Company Name J/ Regis hation Number /G 7y/Ixi�®G�j7l /� �^ZZ Atltlress �//����f/� Expiration Dale �!/'✓/ 1 /r'x9/ fY) Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 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....... No...... ❑ City of Northampton ..,, Massachusetts � I DEPARTMENT OF BUILDING INSPSCTSONS 212 Hain St eet • lWnicipal Building noiNavgrton, HA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC'). M.G.L.Chapter 142A requires that the"reconstruction,alteration,renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-exisbng owneroccupied building containing at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted w,,ithh a corporation or LLC, that entity mast be registered Type of Work: L.Fy'T�C'v/'co/r 4e44 Est. Cost: Address of Work: � v'-- Iz- OT Date of Permit Application: I hereby certify that: Registration is not required For the following reason(s): Work excluded by law(explain): —Job under 51,000.00 Owner obtaining own permit(explain): Building not owneroccupied _Other(specify): OWNERS OBTAINING THEIR OWN PEP-MIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME'IHE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the)agent of the owner: � k � 1127 Date Contractor Name HiC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature _ City of Northampton s -- •'f Massachusetts I DEPAa1TffiNT OF BUILDING INSPECTIONS 212 Min St aet Municipal Building Noitbaaq,ton, M 01060 y„Acm Debris 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: `� &,P)Qd (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Job Contacts Link Leads G Friday,May 18,2018 � 70757496 Comments Lead: OO Advanced Search /Y 5:66 PM i Commissions Homeovmer MTA mchel rice SaleAmount 63,896.00 Balanw Due: $2,610.32 Homemensi Ii Product Wincore Entry Doors(8%) Documents Job SNS Address, 8Ali Street Status Sale/Material Received Job Issues Northampton,MA 01060 Branch New England South Slebel Lead[DO Siebel# Slebal OrdarA Measure• Order Detail County HAMPSHIRE 1-5VU2UJP 1-1280888451] 154804 87732048 Payments Billing Address 8Akldch Street Northampton,11 01060 Commission Rate Permits Consultant Name Term Date Solit Como Plan Primary Phone (413)588-1295 JOSEPH SULLIVAN 100,00%Straight Commission PO Work Phone Est 0 Result Combo Cell Phoney Services Work Phone Sale Date 4/11/2018 FUP Date Cell Phone 2 Credit Date 4/11/2018 FPD-Customer Show Mao Email sukianclucy®hobnall.com RTP Date 4/12/2018 Post Install Date Cross Street Start Date 6/16/2018 FPD-Home Depot - -. Inspectlon B-Beek: No Update Job Referral Store 8452-HADLEV Work Orders Base Store 8452-HADLEV Lead Paint:Assumed-LSWP Requir Lead Source 0250 StoreAssociate-Siebel I 7 ( \ CANDACE BUTLE 1 5/17/2018 11:11 AM Material Received No 4/11/2018 3:30 PM JOSEPH SULLIVAN Erikka M Laws i 5/16/2018 2:22 PM Material Ordered No 4/11/2018 3:30 PM JOSEPH SULLIVAN Erikka M Lewis 5/16/2018 10:20 AM Order Received-PSG No 4/11/2018 3:30 PM JOSEPH SULLIVAN Cythina Raglin 4/12/2018 7.494FReleased to Production No 4/17/2018 3:30 PM JOSEPH SULLIVAN Cythina Raglin 4/122018 7:47 AM Order Entry No 4/11/2018 3:30 PM JOSEPH SULLIVAN JOSEPH SULLIVA 4/11/2018 4:02 PM Credit Pending No 4/11/2018 3.30 PM JOSEPH SULLIVAN JOSEPH SULLIVA 41112018 4:02 PM Sale Pending No 4/11/2018 3:30 PM JOSEPH SULLIVAN JOSEPH SULLIVA 4/1112018 4:02 PM Sent to the Field No 4/11/2018 330 PM JOSEPH SULLIVAN #JOSEPH SULLIVA 411112018 4:02 PM Lead Entered No Close Print Home Depot Contractor License Numbers: MA:107774,112785 Salesperson Name and Registration Number: Joseph SuRven 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: �el rice � rNew Englantl SoufM1 � 1�-5VU2UJP First Name Lase Name Branch Name LendN =8 Street Northampton MA 01060 m Custoer Address -� � - Ciry sate Zip "1295 Home PM1oneIX Work PhoneIX Gell PMneU U"1pry@hoproodLoom — 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 Briton Turnpike Unit Shrewsbury MA 01545 Address CRY tam Zip 0r Email 00'mmercanrenatinnnortheast@nnm¢d¢pol.¢nm 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 DEPOTS 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. Xknowktl9eC by; 1 04/11/3018 ca.tomera si usa 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. 3896.00 Includes all applicable discounts, rebates, and , taxes. Contract Price $ Excludes finance charges.' 1285.66 Minimum 33 %deposit$ Due Immediately 2610.32 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 ✓ be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of Entry Doors 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: 06/06/2018 Approximate Finish Date: 0//04/2016 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. �y�'1�— 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. 4/11/2018 cone r. e .w,. X cos. , 1mwoo,. oan 12a16 — X con.ulm s oa,o oo� License number(s) held by or on behalf of the Home Depot: 2 $e "",ra. kid.'',.., [iY" '" 3 �py�� � e ��' �£ �-4. t cy , .. �';... 8 Yom',` �� �SS^YhY �• �� r ��P�Ml2 .P�a � j y( � 1«.^M"mA .,�2r " �°drG .x..9' x �� " "�a..,. ,,. pp[{�g��M &'� �A'iary�py+,.ygy^,,, « :' 6f 'I`Pi '''` � ' ��� g A„ yv�' ��, �� ��� N �. � �, xa r ACCWoN CERTIFICATE OF LIABILITY INSURANCE AFRE a" "0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOWED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED Provisions or be endorsed. It SUBROGATION IS WAIVED,subject to Me terms and condMons of Me policy,certain policies may require an endorsement A statement an this certificate does not confer rights to Me arfifiabs holder in Ile.of such end..rm m(s). 'RODUCER MARSH USA,INC. MORE° TWO ALLIANCE CENTER I SAN I=No: 35W UNOX ROAD,SUITE 2400 L ATLANTA.GA 3038 ADDRESS INGUREVIDUAffORDINGDOMBRAGE NAILS CNI016421M9 HoUNITSAW-I8-19 INSURERA:Old R udE lnzxrame Cu 24147 INEURED[HE HOME DEPOT.INC. Ixellaee e:Neel Nam Me MZCN 23PA1 HOME DEPOT USA.,INC. HVUVRiskCapUvEkorew0CmUem korew0C,6 2455 PACES FERRY ROAD BUILDING C-20 INSURER o: ATWVTA,GA 30339 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: ATLJI04353639 16 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MNY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH£T£RM$, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. IHSR rypEOFIN6UMNCE POOCY4F POUCYEXP LTR POUPYNUMBER NVp UMIE A X COMMERCMLGEMERAL UPSKJTY MWZY3127P 03AMR018 030112019 EACH OCCURRENCE S 9000000 CIAIMSMAOE OOCCUR PREM ES Ea xcvranm $ 1.000.NW LIMITS OF POLICY XS MEDEXPA m Pe> ) S EXCLUDED OF SIR:SIM PER OCC PERSONAL S ADV WJURY S 9"Mo GEN L AGGREGATE LIMIT APPLES PER: GENERALAGGREGATE E 9,000000 X PoLICY❑jELi [7 LOG PRODUCTS-COMPIOPAGG $ 9000.000 a HER $ A AUTOMCBREUANLIIY MWTB31DIB 030112019 030112019 OMmIMEDSINGLEDmT $ 1,000,000 X ANY AUTO BM'Ywjua,IPpww $ .NNE. SCHEDULED SELF INSURED AUTO PHO D`OR BOLHLYWJURY(Persm .) S AUTOS ONLY AUTOS NIREO 0"-0 .LG PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per id.W S UMB—UUM OCCVR EACH OCCURRENCE $ EXCESS WB CLpIMSMAOE AGGREGATE S OEO REIEMION$ 5 6 WORKERSCOMPEASATTON WC014122577 (AK,NH,NI.VT) 03011 1 031038019 X PER —TO­- 6 SfA1UTE B ANYMOPF1U0n`MIR RIEYECUTIVE YIN µrG 0,G1)}578 NIB D3,TI1Rm8 03IB1R019 ELEACHACODENT $ ;OLO'OOD OFFICEPMCMSCRrXCLWEO] O Xlq pantlalory in xHl EL05EASE-EAEMPLOYE $ 5,Ig0000 0 Ss.d—be umer CUnlinueUm AO3iA6nal Pee 5.000.000 DESCRIPTION OF OPERATIONS bebw B EL OI3EISE-POLICY UNIT S C Excel ANF 293-1-10m1JN-3018 0301218 03MIQ019 Limit: 4000.000 DESCRIPTION.1 OPERAT�..I...I VOICIFS(ALORD 101,gJG11wIRemsrYa SClwtlxN,mry W erlxNad Nmmepvu m'w-n EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HONE DEPOT NSA.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C 20 ACCORDANCE VATN THE POLICY PROVISIONS. AE-ANIA,GA M339 AUTHORIMED REPRESEMATIVE a Maas u3A Inc. Masashi Mukhses ®1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016105) The ACORD name and logo are registered marks M ACORD AGENCY CUSTOMER ID: GN101642069 LOC rY: Atlanta ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA INC. THE I IOME DEPOT.INC. HOME DEPOT ILS A,INC. POMY NUMBER 1455 PACES E ERRY ROAD BUILDING C20 ATLANTA.GA 30339 .NUER N/J[[PoE EFFECTVE OLTE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance VVI Cmrpel1111C,Conmucm Carrier lnNemnlyleumme CoopanyMNMlh America P&yNumber WIRCO)83191(AI.AR,FI.ID.W, KYLAMSMONE.NAN40K,SC,SDTN,VNWY) E6xova NI,'.OV01Q018 ExtrNroo Dale:O W/M19 (EL)Ilma'.VENDID Came,:New,Harepshinlreummeeompany Parry NumOen WE 014122516(CC,HE Hi IRMO,MN.MT,NY,Rfj EOxikx Dale-OVGIM18 Eapialeen Dale'.OVOlUO19 (EL)omit:61 CORWO re'.ACE Amemen lenience Cameany Poll,NUeIAr WCU C64783221(050(AZ.CAR BE OR,VAWA) 91KIDe Hale:OV0112018 E4plrallan Dale:OV0112019 (EU Lear $1 ONEAD SIR:$l PN 000 SIR To Pres@les WAZ,CAT NC OR,VA,WA Carer National UIN re,loeumnoe Cwnpany Per,Hurt FWC 4595580(0510(CO,CT GAME,W NV,COLA,UH Ellelve Dale'.UnlG 18 Fapiralian Dale:031011019 (Eq Limit VON NO $'.NN NO SIR for the slates of COMEAV,III.OH,PA,UI SI'AE00 SIR for Me stele of GA S3£OON SIR fw He state of CT E"Fee Not,"Unbn Eka"n ca Company PNee, w Ea a'. EHLOO '381(050(MA) FIISIIn Dafe'DYU11e18 En"Bern0ate'.OLb11019 IEE LBM:EIe00 T%Reme,ers%S InJarrear. Caere,Her-Union lBUrance Comparry Pace Numbef TNS C491669N(TX) EfisBve Dale'.031DlQO18 Enplmllon Dale 0VOIUO19 (Lu Dma $10,00.¢00 SIR:S1 ON 00 ACORD 101 (2006101) 02008 ACORD CORPORATION. All rights reserved. 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 Improvemerit Contractor Registration - Type: Supplement Card - - Registration: 112785 HOME DEPOT USA INC E)gtiration: 04/22/2019 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Update Address and return card. Mark reason for change. 1 i c zoiaos,., ❑ Address El Renewal O Employment O Lost Card = Wvss of Consumer ks a Busineaa Reguledon HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card betare the expiration date. Iffoural realm to: _ Recistration 9mlitnaqOMod of Consumer Affairs Bred Business RegulMion _- 112785 0422/2019 10 Park Fara-Suite 5170 HOME DEPOT USA INC Soston,MA 02116 RICHARDTROIA._ — 2455 PACES FERRY RD C-11 RSC Not valid withou aI nature ATLANTA GA 30339 Undersecretary 9 T he Conlrrornvealth cfAlrrssrrchnsetis - Deparirnent aflndas'frlulAceidents 1 Congress Street,Shiite 100 Bastmz.IVA 02114-2017 :p navlcrnassgovAlla R orkers'Compensation Tnsuranm Aigidnvh:Bnoders/ContractorslEleclricians/Plumbers. BE FLED tyITITTITE PERMITFIIG AU'rIZORITP. Amdiennr fnfor-mnt!hn !'lease Prin[ I, gibly 1\!2ID2(Hurines=JOrganizalieN�tsTd/iv�i�duan: CITY/StateiZi I .).resau:n nnpeu}ert uraek lircanmm�riafc hm: Type of project(required): I 1 ml a ee:Gc!uper nmh__e:nP:pyees(fiil midi part-time).` 7. QNav canstmchon i 1Im.r enk pinp,ielorur annvsM1lP and beano emploS.mKm3 roraem 8. 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I I; �s";3i411 MON`,1WHO�Jld3d'=ii 6/6/2018 Details LjQensee Details emographic Information Full Name: IVAN KOSOBUTSKYY Dymer Name: icense ress Information City: Monson Stale: MA ipcode: 01057 o nt Urlitedptyres icense norma ion License No: CSSL-098785 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: 6/5/2018 Issue Date: Expiration Date: 4/27/2020 License Status: Active Today's Date: 6/6/2018 Secondary License Type: Doing Business As: tus Chaneas License Renewal Prerequisite norma ion Licensee: KOSOBUTSKYY, IVAN Relationship: Attribute Of icense No: CSSL-098785 Close Window ©2011 Commonwealth of Massachusetts Site PoliciesI Contact Us http://elicense.chs.state.ma.us erification/Details.aspx?agency_id=l 8license_id=2877148 1A