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36-054 (7) 57 REDFORD DR BP-2019-0250 GIS#: COMMONWEALTH OF MASSACHUSETTS Mamfilock;36-054 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Categorv' window reolaced BUILDING PERMIT Permit# BP-2019-0250 Proiect# JS-2019-000402 Est. Cost-34603 00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const Ctass: Contractor: License: Use Group HOME DEPOT AT HOME SERVICES 106106 Lm Size(sa. fu 12501.72 Owner: STEELE KELLI zoning: Applicant. HOME DEPOT AT HOME SERVICES AT. 57 REDFORD DR Applicant Address: Phone: Insurance: 5RIVERVIEWDR (401)935-26330 Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.-813012018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 7 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/30/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DepsrtmaM use only City of Northam Status l: Building Depart n AUG 2 c yPerr it 212 Main Sir t Sewer/ vailabilily ?(, Room 100 A Ilatill Northampton, MA 10��eQ1°'Pwnm`ng s ci a ne N�.,v..un.m.�� I: � e I kictural Plans phone 413587-1240 Fax 413587-1272 Pfotato Plans Other Spedfy APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATIONR-R- O-MD 1.1 Property Address: This section W be coo.-mrplleted by orgce Map Lot n.7`-f Uof Zone Overlay District Elm SL District_ CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 Owner of Record: ) �,�-, /� 57 K�/LL /`/G`LyL/ (7gf�°J,//n�JJ1 Name lPri ) Teleph°def�G�J��L Signature .2 Authorin Ai en n Curren II gAddress: In„�� ` Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed bpermit applicant 1. Building /) ;74 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from e 3. Plumbing Building Permit Fee 00 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 + 2+ 3+4+5) Check Number This Section For official Use Only Date Building Permit Number: Issued: // pp�� Signature: / �� Z a Building Commissionerllnspector of Buildings r� Date V EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZON I NG7 All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 'nuL column to be filled in by Building Dcpanuuvt Lot Sire Frontage Setbacks Front Side L R: U R: Rear Building Height Bldg. Square Footage un Open Space Footage % (Lot arca minus bldg&pavW parking) #of Parking Spaces Fill: (volume&Lowtiun) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 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 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 b DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement WBows Alteration(s) ❑ Roofing ❑ Or Doo s 10 Accessory Bldg. ❑ Demolition ❑ New Signs [t71 Decks SSii�diir [.0]y Olher[Of Brief Description Alteration of existing bedroom_Yes No Adding new bedmom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet Ga.If New house and or addition to existing hOUSina, 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 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. Septic Tank Cry Sewer Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. kkii -6 as Owner of the subject property ^ /J �� hereby authorize Jlabve' to act on my behalf,in all matter elative to work aulhorizetl by this building permit application. SignaWa of Owner ...� /� Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are time and accurate,to the best of my knowledge and belief. Signed under the pa' /nd p alties of erjuFy Signature of Owner/Agent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construct; nSu rvicor. ,1 /7J�,�{- Not Applicabl ❑ L/ Ner License HuMer: /v elw6N &4) �—" ��/D`' I License Numper— �9 AddressB !�D A Expiration Dale Signature Telephone l /U 9.RoalsthergA Home Im wm Co Not Applicable ❑ Comnanv Name Registration Number Addre � Expiration Date elephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e)) Workers Compensation Insurance affidavit must be completed and submitted with this application. FaAure to provide this affidavit will rest in the denial of the issuance of the build; permit. Signed Affidavit Attached Yes....... i NO...... ❑ City of Northampton Massachusetts - A z DEPARTMENT OF BUILDING INSPECTIONS 212 Nein Street • Municipal Building Northampton, M 01060 iyy :y7� 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-exisfing ownerbccupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note.Lf the homeowner has contracted with a corporation or LLC,that entity must he registered /' ,�j �"� Jam' /, Type of Work: !/),7,/ W7 ,(f�L�� �Y/�/rlJ�d�t/ Esl Cost U 2 7� Address of Werk: 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 owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT 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 THE RFSPONSLBILIT'ES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply or a�bui�lydi)�gj9 per-�rI/.tt assrtthe agent too�f the ow/n/y/k/��/��qy-, T y� Date Contractor Na4e I 1 FIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above properly: Date Owner Name and Signature City of Northampton +t Massachusetts �PARMWWOF SGZLDIZNSPSCTZOMS 212 Hain e Municicial p6uilaing .s Noru,iNampcon, MA OlOfiO rah yj�^ Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s)who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton 55 s, Massachusetts.�' assachusetts i �( DEPM]ADSNT OF BDZI,DZNG ZN£P£CTZONa 2 212 Naln Si eet •Municipal Building Northampton, N 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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 MGL c 111, S 150A. The debris from construction work being performed at: -677 /2tb& bn (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 ofPermit 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. \ The Commonwealth of Massachusetts WL Department of Industrial Accidents I Congress Street,Suite 100 7 Boston, MA 02114-2077 www.maesgov/dia YYnrkers'Compensation Insurance Affidavit: Builders/Contractors/ElecMctans/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apulican(Information Please Print Leeibb' Name(Bns'muss/Orgaoiutiodmdicidoap: Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.[]I am a employer with co'k,ecs(fuu and/or pan-lima)'' 7. New construction 2.�Iamasole pmpneert or partnesM1ip and have no ompWyeeswmtlng fnrmcht S. Remodeling any,mg.aitypaowemxers comp....... u. reyahed.l em El Demolition 3-❑1 amah urcownedomgarwmkmroe f_Mownkeimmn. umocvreyred 10 Building addition 4.[Tama hmneownerand hwill itherbse..'se,contractors mcendutlalhwork accul poly , Irvin a..net all mmmemrseilnecho�e wnrkcrs'mmpennminn iwnence nm um sole II Electrical repairs or additions pmpdcmrs with no cmployces 12.❑Plumbing apeire or additions 5[:]1 am a general conaaem,real I have hired the satrcooauctors fisted m are attached cheat. 13.[]Roof repairs 1Tesc suM1-cantra.+ors have employee.and have workerr'comp.insrwmve: 6_n We are a coo madon and its oRtuzs have exereised theonght of exemption per MGL c. 14.[]Other 152,81(41,and we M1eveno employees.[No workers comp.insmnnae required.] "Any applicavt that checks box#I must ale all out the section below showing their workers'eampcnsafion policy information. I Hnmememers who mbvdt this atlkeellt indicating they ate doing all work and than hire ounide connectors roust armed anew uttwit ivdicariag such. tConaactors stat check this box mutt attache)an additional sheet showing the name of tFe subcuntmctors and state ......those entities have emplayces_ Ifthe subeonaaetors have employees,they must proaiJe @air workers map.lefrymmabn. I am an employer thin is providing workers'compensotion insurance for my employee..,. Below is the policy and job site information. Insurance Company Name: Policy P or Self ins.Lic.#: Expiration Datc: Joh Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,g25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fort..of a STOP WORK ORDER and a fine of up In$250,00 a day against the violator.Acopy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenahies of perjury that the information provided above is true and correct Si lu ' Date' Phone a Official only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License N Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 4 Other Contact Person: Phone N: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"-every person in the service of another under any contract of hire. express or implied,oral or written." An employer is defused as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,g25C(6)also stales that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states ")Neither the commonwealth our any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please till out the workers' compensation affidavit completely,by checking the boxes that apply to yew situation an4 if necessary,supply sub-contractor(s)name(s),addresses)and phone numbers)along with their cerificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned N the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be need as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and undor`Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must he filled out each year. where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit in bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and Fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workerscompensation for their employes. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also stales that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the weaken' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate ofinsurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are rat required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also he sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compenvation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure in fill in the permit/license number which will be used as a reference number.in addition,an applicant that must submit multiple permih'lieense applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been ofliciuby stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must he filled out each year. Whom a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia corm aevtsed 02-21-15 Home Improvement Agreement: Page 1 Home Depot License Number(s): Visit www.homedepot.comk/SV. HS-Contractor_License_Numbers for latest license into MA: 107774, 112785 Registration No. (if applicable): Salesperson Name: Eric wckko Home Depot U.S.A., Inc. ("Home Depot") or service provider named below ("Service Provider') will furnish, install or service the equipment listed below at the price, terms and conditions as outlined on this form. STEELE KELLI —1 New England South -68NDZYX Customer Last Name Customer First Name Store #/ Branch Name Lead/Customer Order# 57 Redford or Florence MA 01062 Customer Address City State Zip (413) 575-8251 msteele67@9maiLcom Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT HOME DEPOT USA INC., 2455 PACES FERRY ROAD, BLDG. B-3, ATLANTA, GEORGIA 30339 or EMAIL he Home Depot i loio ustomercancellationnortheast@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 PAYMENTS 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 SERVICE PROVIDER, 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 HOME DEPOT 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 CANC L. Acknowledged by: 07/10/2018 Customer's Signatu Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: 46oz.75 Includes all applicable taxes. Excludes finance charges.' Sales Tax: o.00 (If applicable) "Maximum deposit ONLY applicable in MD, MA, ME(3301.), NJ, WI(99%) Dep. 125.0 -= % Deposit Amount 1150.69 Remaining Contract Balance 3452.06 The Home Depot-2455 Paces Ferry Road, N.W.Bldg.B-3,Atlanta,Georgia 30339-customer Care:1-800-466-3337 Csione,ng—e In e.1 ldl Jan.,ul , so.,2 fin Home Improvement Agreement: Page 2 ' Finance Charges : Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which 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 payments made payable to Home Depot. Insurance proceeds will will not 1 be used to pay some or all of the total amount of sale. Description of Work to be Performed : A detailed description of the work to be performed is included in the paragraph entitled Scope of Work or Specification which is included in this Agreement. Anticipated Delivery_Date./Installation Schedule Approximate Start Date: o9loalzols Approximate Finish Date: iolo2/2018 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 any Services 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 or permitting information may need to be provided to You later.) By signing, you acknowledge that: (i) You have read, understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; and (iii) all rights and interests under this Agreement are solely vested in the person listed as "Customer' above. X 07/10/2018 The Home Depot Customer's Signature Date Service Provider Name X I I7/t0/2018 908 Boston Turnpike Unit 1 Co-Signer (if applicable) Date Service Provider Address )( 07/1012018 Shrewsbury MA 01545 a Signature On alf of Home Depot Date City State Zip MVendor/Service Provider Phone # Service Provider License Number The Home Depot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-customer care: 1-800-466-3337 Cuabme,A,Memen,(e.EI)Wdan.181 a K12 WINDOW SPECIFICATION SHEET - Spec.Sheat N-. 1- eAn". Sheet Pt l customer.KF u ITEEII Job N " s consultant: El'o.n° o Oat., OTn OrzO,e - - _ -II— E liy Window Grids PrMuc1O Code- LeM1 pa".fl", B'Ps C,lar Pou9h Open N9 t 10 D na r5 M W lxalion tlo als Mo m ae an H.o-ae GOO, Br.e _ Mull ^5- atonary or opperoung In RW mi Rod GM 11-1 -dalele ger esI 3 0, o EED DH a Y 0 WH 36. 45.0000 9 V G0 1111,11, In E� H 0 36.Oo 45.00 .610 P0 Qrv tar- g s iWn _ �- 9ID,W e, y lR ar cW, P.150. BED 0 dS00 0 d1ohen eYSar- ff , G sP ,Inal R o 0 91 k WP4 ,9G P,LSC, 6 EATe 0 ii 00 3 00 9 5 n DH 5 BED IDH 6100 WH 0 4500 6100nennegv5lar- ETD e, G P,LSP Poe. 1al 9 o W„ 3.0p 32W nn0 . II sPEcuL corvsloERAnorvs. npe P WM1e,d'.Wnuc 4.w i1P 6 NMIe,6-WnYe p,Won, ap Cobt Inlerioa Casing Type Bay or 90 window End melenel'P"Exty Anon or Gal( ay PmleclM -P.or46I 9av Flanker TylX RDH AH,or csmm) afar wlnmwmsonu ones) j Inlea]o soon dolor at conn mela.a I nave reJ�ewal ana agree wm au melon slaepnlwlmmc alwve ana ma Votl Aool(Vosm NoJ' Spedel Terns and nordtbnson the lollowinp Page Ga Nen Wina wa ,aboard M,HAaI Fayl only pose Plonne,$Into m6akl The Conunornvenith ofiWassttchasettr VQ: Departmear of-IndustriatAccidents 1 Congress Street,Sane 100 ' . Bostair, :VA 02114-2017 •. xncic.rnassg0v/Ain Worhers'Compensation insurance Affidavit:Builder's/ContractdrslEledriciaas/Plumbers. TO BL FILM)R'ITIT TRE PERFIITIING AUTHORITY. :10 diem information Please Print L sibs None jBusincsJOrganiePliarJ!n�Mdi/vi�Ldva0: wAM ---�;',� ,, I Address: City/StateiZi Ar leu nn C13Pureft Check lilt appreprintebol Type of project(required): LQ t am a emPlayar•ai;h__empia):r.(fall and:'mmnaimep 7. ❑NeM construction i ?.pL+mawlc piaPriuwrurpa¢nclshiP andhawno craPla)se,aaskinyr ea.. 2. E] Remodeling c y eap n,.Rb workers'coma mmnnee%'0.".1 9. ❑Demolition ].i]Izmahumeoivaerdoiny all nark ".IT.MI.cndrr temp.inzuauc¢amni!' ' J. trams s l:enceciew vnd v.•iil L buten cor.ew.!a candudnll:•mk ea cop I 10❑Ruildine addition B CPrcrry. I refill Pnsua;hat eii cmm�¢erseilharlmvnmY.xS'cdwervnoahiu',neu. arc.ole Ij.[�!dcenieal repirs or additions aP:icmrs,vilh na empiapcos- - 12,[1 Plumbing repairs or additions i lamxaeae:ai conmmorznd l have heM he avleanVaeve,lined an Meulucired shat 13-❑ OfrCpBna True nilscd::Imclmslmt2 emolgxes and inveuvrleas W.insunnc:: e, - 6.0 We are n caraorelive end iu ofleas Arum kccned their debt of cam til. 14. Other lJ p:ioa p;n. .-2,:Ifd1,wad iw have no emplgxm jNowahsn'eamR insorsneer_ ui:edl 'Anv sppbcanl ue"Cmsksba.l mua.Iso rtll onl shzzzgion Faow shewin3lhcis'eckes'compJaalian polity irromuiim- 'Homemmers 11N-subnhnIes amdavhindinling one,an Wit;all work ami dao-iise oulside mneuclm muss subeit a sm amdavil imlieming such. " Ce�jefnar'.s ehlek Ibis tax nem.u..chedan addidond ahMt showing limnama of Ne Sea clenaCare and sole rvhetht;ar na la,eriucz have t <mPluees. If!hemb-ronyxxorsbmeemplapes,auy num P�avide their.vods;'-amp�roliry aumcs. leo rtn employer amtirpr/on-vti�dl�rp�yn�rorlr7er yY7cm�tonSntiUr�W/:(rysr(rr�pmr—crfor my ernpioyees. Rdmvisthapialmatdjobsfre infurince rax " `7/T1L�L i'� /VI/ //�✓ �DA/ insumncd Company Name - PolicyisorSelf-ins.Lie. ;�J;py`i 7� ,7�s✓ /J y� Expiration Date, ✓-'1 1 Job Site Address: �/ /e✓3V!/� �ir�� City/Smle/Zip: ������ Aft.ch a copy of',be ivorlcerO compensation policy declaration page(showina tbepollcyrumberand exp! tion dote). Failure m scm=coverage as required under MOL c.1:2,§25A is a criminal violation punishable by a fine up to$1„500.00 and/or one-year imprisonment,as}yell as civil densities in the room oi'a STOP WORK ORDER and a fine ofup to 5250.00 a day against the violator.A copy ofthis statement may be fonvarded in the Office oflnvestigntions ofrhe DIA for insurance coverage verification. l do hereby cerrfJy l" rhe in fp chat lir rmnlims provided abm•ea true andror cr. Phone Official arse 0ar0'. Jo notowl!a Inthirarea,rube coorpletedby drp ortmva oycid City or Town: rem,blUdonse-;: suing Authority(circle one): 1.Been]of health 2.Building Department 3.City/Town Clerk d Electric.!Inspector 5.Plumbing Inspector o.0thcr Con[a[;Pursue: Phone:: i A4COR0® CERTIFICATE OF LIABILITY INSURANCE DAD nir291eryYYY1 �i 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 cartMeate holder is an ADDITIONAL INSURED,Nle policy(les)most have ADOOBONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject W the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the cartMcats holder in lieu 0 such endorsement(s). AMDUCEIR MARSH USA,INC. PHONE PAAIXO x TWO ALLIANCE CENTER 'Age too. 3550 LENOX ROAD SUITE 24M E ATLANTA GA 30326 A INSURE AFPoRgNGCOVFMGE —NMI DN1D1B42669-H.* GAW-IB19 a..A:OI1RNpubNoI.1xKVCP 124147 INsuss.THE HOME DEPOT,INC. IxsuRERe:NeM Ham him lns fA 23841 HOME DEPOT U SA.,INC. IxsuRERc:HomeMskC 'W lmuMnoa Coma 24M PACES FERRY ROAD IxsuREa o: BUILDING C20 - ATANTA,GA 309 INSURER E: _ INSIASHIF COVERAGES CERTIFICATE NUMBER: ATLA0935343816 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 MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IXB0. ryPE OFIH$VMNCE A PgICYNUMBER M DYQU� ' MMN�P ' MLLI$ R A % COMMERCUILGENERALLWBIIItY I 'MWLY 3121P X19 'i EACH OCCURRENCE 'i 9,BD3,000 CLAIMBNAOE 1 X 'OCCUR PREMILEB(I Puummra f 1000,E LIMITS OF POLICY XS MED EXP(NIy wx PNaonl f EXCLUDED OF SIR 51M PER OBC i PERSONAL a ADV INJURY E 9,000'" GEN'L AGGREGATE LIMn APPLIEB PER. GENERALAGGREGATE "..s SWC." X POLICY g_m3D]0 _ PP0._. PRO- _ LOC PPODUCTL-COMPIOP AGG b CTH _ f A AUMMOBIEUAINLm MWTB312I18 03'01fA1B -03M1MIS) L=INGLELIMrr :E 1X W0 X ANYAUTO SOOILYHU.FYIPx P! I Ia `— OVMED SCHEDULED SELF INSURED AUTO PHY DING BODILY INJURY LAIN VocI3 AUTOS ONLY AUTOS . HIRED HON-OIMIED PROPERTY DAMAGE a AUTOS ONLY AUTOS ONLY IPBr—V-11 _. S UMBRELLA.8 _'OCCUR EACH OCCURRENCE '.E EXCES$DAs CLAMSJMOE : 1 AGGREGATE S DED I RETENTIONS E B WORNERBCOMPENSARON W 1 NH,NJVIY I X T - ',ANDENPLOYERYW&Llry 1 AOHAC OR B YIN 'WC 0141225)6(X1) 03X112018 01➢t1X119 S,W3,C00 ANYPRO.EWVRPARTNCICD1 LITrvE E.L EACX ACLIDEM f OFFICEWM 1.NHU XCLUOEO} HIA. IlMentlttary In NHl EL DISEASE-FA EMPLDYEEf 5000.D30 lly E6901lB '"do'AO CgmilWod on Mdaural Pa90 IEC.DISEASE POLICY LIMIT 5'XC� DEBCmMION OF OFERATIOrvS�ekm' C Eceaf Auto '291-1-10011-082018 03018018 '03AHS019 ' urat 4000,000 DESCMPNON OF OPEM90NS I LOCATIONS IVEHICLES(ACORD 101,AOEMemI RmwM SGNJMe.OIL t eaWGM Nmon yam brpulretll EVI DEt4CE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,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 020 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AtrouNWFDREPRESENTATIE P1 MI USA Inc. Manashl Mukhegft ®1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta "1 ACCN?a ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME COROT,INC HOME DEPOT U.SA.INC. POLICY NUMBER 2455 PAGES FERRY ROAD BUILDING G2D ATLANTA,GA M339 CARDER MAIC CODE EFFEc1NE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM, FORM NUMBER: 25 FORM TITLE: CartifCate Of Liability Insufa0ce wim.a CDa[em5a5em Continued: Carter PD[mBy Inwmnc[Company ANOM AmEnW Polity Summer WHIR C97MI91 ALAR FL.ID IS,AS,NY,LAMS.HO,NEAM,AUDI TN M WY) EIFANT Dale'.0101¢019 EANASEDa CON'.On IA19 fEq Umlt 61,000.000 Caner Nw Hampshire Im i Company _ P,Eq Num6Er.WC 0141 U576 (DC OE,HI,IN,MD,MN,MT NY Pit EBect DAM.01,0112018 E,mmon Dae'.01 (ELI Limit S1 OWNS ,.amen ACE Am[mcen Insurance Cpnpany Polley Nummer.WCU 064783221 OSU(AZ.CA,ILNC,OR,VA,WA) EB[OAW We 0310112018 E[Mrabn Oale 01 !Eq omit Si 000ON SIR SIMI),010 SIR for:ri,SM of AZ CA IL NO,ORVA,WA Cami Nadi Unpn Fire Im N SO,CHAT PDq NumW XWC 1593590(Ni RCC.CT GAME,MI,NV OR,ii CONT¢DMM DA112018 Erpradpo DaM'.03Nt12019 EDLmR$1,004000 $1 ON SIR Mhit mamm COME NV.MI,OH PA Uf i]aLW)SIR Nr the,lith M GA $I5000091R1m Ve slak NCT p Prim,Number NG4FR OSI) � ^ /' Posry Number ANG d59AB1(DSII(MA) /V Gl\J` Effedr Dale'.031018018 Esp m.Dale.GNVN19 (E4 U. 81,M MAY SIR$500,001 TX Employers%SHAMMY carm-111mga UP., u.m.C.", Piney Number TNS C49166W QX) EII five Dale:010112018 6I1imWn Dws 03)1120'9 (EL)Limit$10 ODD SIR$1,000 NO ACORD 101 (2008101) ©200B ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �,_: �f7� C�C�?y2T1'ZC�I2[C�C'CLCIM CSG n��C:yiCCCfGlG:1e '- Office of Consumer Affairs and Business Regulation ` 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Re piragon. 1127&5 2455 PACES FERRY RD Gl1 HSC - E=xar ' OM22/2019 ATLANTA,CIA 30339 Uptlate Adtlress erM return card Markmasonfore5angs. R°.15,1 O Address O Renewal O Employment O Lost Card once of Consumer Affairs 6 Business Regulation r- HOM E RI PROVEN ENT C RACTOR Registration valid for Individual use only TYPE:Supolemwd Cam 1letme me expiration date. Hound return to: Registration EtmiraHon Once of Consumer AMira and Business Regulsuan _ - 112785 M22/2019 10 Park Plans-Suite 5170 HDME DEPOT USA INC'"- Boston,11A 02118 RICHARD TROIA.. 2455 PACES FERRY RD C-t1 HSC ATLANTA,GA 30339 Undersecretary Not valid withou signature ..........�,- All Sol C3 Kj jai Im Iq Milo III MET" A 19 Hans R I hRS — A IT i A 4 1 i� g IN gig Massachusetts Department of Public Safety MASSACHUSETTS DRIVER'S Board of Building Regulations and Standards LICENSE Ti License: CSSL-106106 q ° r> Construction Supervisor Specialty _ tl r��" w, �W� �,la��J11512016,'y $43' 606 EUGENIUCiUBOTARU , t29t2021REV 23 BENHAM STREET �r , NG11Fi ONE . .� SPRINGFIELD MA 09109 g z D BENHAM STREET , - �'� r _,. y SPRINGFIELD MAOttu923pt . �1tL •, =.tet Expiration: tSxM o-axt b'OY' 'Commissioner 0912912020 sonowiErmrsaoropmm�o 491��f��.. t