Loading...
12C-114 (2) 95 SICK ISR BP-2019-0422 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 12C- 114 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: window replaced BUILDING PERMIT Permit# BP-2019-0422 Proiect# JS-2019-000676 Est.Cost: $4686.00 Fe $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 98785 Lot Size(scl. ft.): 10105.92 Owner., STAMPA MAURA J Zoning:RI(100)/URA(100)/WSP000) Applicant: HOME DEPOT AT HOME SERVICES AT. 95 RICK DR Applicant Address: hone• Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.10/5/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 6 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISID.LLE FROM THE E 'T E T 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 peaar^t t Fireplace/Chimney: Rough: 1!.1 Insulation: Final: :�:nK final: THIS PERMIT MAY DE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA"T"ION €1F ANY OF ITS RULES AND REGULATIONS. Certificate of Occu.anc ; star FeeT. use: Date Paid: Amount: Building 10/5/2018 0:00:00 $40.(10 212 Main Street,Phone(413)5891240,Fax; (413)587-1272 Louis Hasbrouck—Building Commissioner w//vIDOGU S City of Northa Ti pto f Building Depa met 212 Main SI reet OCT - 4 20 4 Room 1 y; NortOhampton, TQEW } - phone 413-587-1240 F x 41 - r 'N Ma• y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR�TTWO FAMILY /DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office I— L�- Map 1A�' Lot /�� Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ln"�Vg' q,5 oelek� Name(Print) Currea�hlgili��q ;�f�y - 0142--- 1 4� TelephoneT'✓^,� Signature �l� 2.2 Authorized A e �� //!�/�/�" �D� ��!//i /;w- Nam j Curr t ling Address: Signature Telephone r' SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit aaWicant 1. Building •Of) (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) fzfo 5.Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 101tf/(p Building Commissioner/Inspector of Buildings Date /0�do*lr �lz7 @ C4->-;p7 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 This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L.: . _., R.:..'. _..;, L:'__... R:'-.— Rear . .Rear �_. Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES O IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Pages and/or Document#! B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 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 © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all apalicable) New House ❑ Addition ❑ Replacement. ' flows I Alteration(s) Roofing Li Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[p] Other[Cd] Brief Description o �j//�jLe:: � Y, Work: TV / Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If Now house and or a to ext Ono housinta. comdle%the fOlowina: 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 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 City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �oqy„/ � �/ as Owner of the subject property hereby authorize to act on my behalf,in all matters r tive to vyDLLauthorized by this building permit application. Signature of Owner Date 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 thG�`,pejns 06 penalties of perj� Print Name Signature of O ge Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ ��� Name of License Holder VO e�s� �� " ��� - 72— �/---�\ License Number 2?y lzo Address Expi�Date Signature Telephone 9.Registered Hom r w n a rector: Not Applicable ❑ i 25f, Z/Z7�s� Company Name Registration Number zj- �' ie6trd-n TPA Add re A�- Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit Mot be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' permit. Signed Affidavit Attached Yes....... 16 No...... ❑ City of Northampton Massachusetts �a}'S ~�`►..° c�% Nt �; DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 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-existing owner-occupied 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:If the homeowner has contracted with a corpora 'on or LLC,that entity must he registered. > Imo' j/ Type of Work: WJ��/'�✓ / Est. Cost: 4 Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 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 RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the agent of the owner: 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 yes 'e'.sic } Massachusetts _ 4� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 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 Massachusetts �j DEPARTAWNT OF BUILDING INSPECTIONS �t 212 Main Street •Municipal Building Northampton, MA 01060 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: A/It"4T,f (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 Appli ant 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 Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 ' www massgov/dia «"orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Let=_ibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑i am a employer with employccs(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10❑Building addition 4.F]1 am a homeowner and will be Wring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.0 nsurance.♦6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] JL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 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 of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job 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, §25A 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 form of a STOP WORK ORDER and a fine of up to$250.00 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 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint 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 states 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 workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(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 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' 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 fill 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 used 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 under"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 be 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 to burn 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 1 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 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 defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint 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 states 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 workers'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 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 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'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 fill 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 used 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). 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 be 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 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 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Form Revised 02-23-15 I k Home Improvement Agreement: Page 1 Home Depot License Number(s): Visit www.homedepot.com/c/SV_HS_Contractor_License_Numbers for latest license info MA: 107774, 112785 Salesperson Name: IRonald Engelbrecht Registration No. (if applicable): 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. STAMPAMaura —� New England South 1-61FQWQB Customer Last Name Customer First Name Store #/ Branch Name Lead/Customer Order# 95 rick dr Florence — I MA 1 01062 Customer Address City State Zip (413) 588-7429 (413) 584-2876 mojstampa@gmail.com 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 The Home Depot I @ 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 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 CANCEL. Acknowledged by: 09/11/2018 Customers Signature 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: 14686.05 7includes all applicable taxes. Excludes finance charges.' Sales Tax: 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(331yo), NJ, Wl(991yo) Dep. 125.0 % Deposit Amount 11171.51 Remaining Contract Balance 13514.54 The Home Depot-2455 Paces Ferry Road,N.W. Bldg.B-3,Atlanta,Georgia 30339-Customer Care: 1-800-466-3337 Customer Agreement(C,E,1)(31 Jan.18) v 50.1.2 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 ✓ 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: 11/06/2018 Approximate Finish Date: 12/04/2018 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 09/11/2018 The Home Depot Customer' Signature Date Service Provider Name X 1 09/11/2018 1 908 Boston Turnpike Unit 1 C -Signer if applicable) Date Service Provider Address X 09/11/2018 1 Shrewsbury—� I MA 01545 Si nature n Be alf f lHome Depot Date City State Zip HIS 0554523, R-1-073-13-00004 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 Customer Agreement(C,E,I)(31 Jan.18) v 50.1.2 WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-61FQWQB Sheet:1 of 1 Customer:MUARA STAMPA Job#:1-61FOWQB Consultant: Ronald Engelbrecht Date: 09/11/2018 _ New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, i Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Misc Items Hardware Code Screens For doors use 6 Mull "S"=stationary or $ F- Style Wraps i mm rcE N m N 'X' operating W 0 o 0 0 0 o d o Room Floor Code (YM) Style Code Series Code S w 3 x 5 F-vi U a > x STD,White, F,WRAP, 8ED1 1st DH Y DH 6100 WH WH 33.00 50.00 83 GlassPack:Standard LSR TD,White, F,WRAP, BED2 �st DH Y DH 6100 WH WH 33.00 50.00 83 GlassPack:Standard LSR STD,White, F,WRAP, 3 BED2 1st DH Y DH 6100 WH WH 33.00 50.00 83 GlessPack:Standard LSR STD,White, BF,WRAP, BSMT Baseme DH Y DH 6100 WH WH 33.00 50.00 83 GlassPack:Standard LSR nt STD,White, BF,WRAP, 5 BSMT Baseme DH Y DH 6100 WH WH 33.00 50.00 83 GlassPack:Standard LSR nt STD,White, WRAP,LSR BSMT Baseme BH Y BH 6100 WH WH 31.00 13.00 44 GlassPack:Standard nt SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White Wrap Color Job Level MISC1:Extra work,MISC1:Scab sill,MISC2:Scab sill,MISC3:Scab sill Interior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak) ACC? CERTIFICATE OF LIABILITY INSURANCE DATE 021KI2018Drc ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. -NAME: PHONE FAX TWO ALLIANCE CENTER A C No): 3560 LENOX ROAD.SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC 9 CNI01642069-HomeD-GAW-18-19 INSURER A:Old Republic Insurance Co 124147 INSURED THE HOME DEPOTINCINSURER 8:New Hampshire Ins CO 23841 . . HOME DEPOT U S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-004353439-16 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 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 BY PAID CLAIMS. INSR TYPEOFINSURANCE AD LSUBR POLICYNUMBER MMIDDIYYYY MPOLICY EFF MIDD EXICY P LTR LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 312717 03/01/2018 03/01/2019 EACH OCCURRENCE S 9.000,000 DAMAGE TO CLAIMS-MADE I OCCUR PREMSES(Ea occu ante $ I,000,000 " LIMITS OF POLICY XS EXCLUDED MED EXP(Any one person) $ OF SIR:SIM PER OCC PERSONAL&ADV INJURY S 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9.000,000 POLICY❑ PRO � PRO- JECT L__J LOC PRODUCTS-COMP!OP AGG S 9,000,000 X OTHER: S A AUTOMOBILE LIABILITY MWTB312718 03/01/2018 03/01/2019 COMBINED SINGLE LIMIT S L000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) 3 OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOSONLY (Per accident $ UMBREL.LALIAB OCCUR EACH OCCURRENCE_ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC014122577 (AK,NH,NJ,VT) 03/01/2018 03/01/2019X PERTOTH- ' UTE ER LIABILITY STA AND EMPLOYERS 'LIABILITY YIN WC 014122578(WI) 03/0112018 03/01/2019 5,000.000 ANYPROPRIETORfPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED9 N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under Continued on Addtional Page 5.000.000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POL Y LIMIT S C Excess Auto 297-1-10011-00-2018 03/01/2018 03!01/2019 Limit _T 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) E\PDENCE 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 G20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GN101642069 LOC#: Atlanta ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 II AGENCY _ NAMED INSURED HARSH ,SA, NC. THE HOME DEPOT.INC. HOME DEPOT U.S.A.,INC. POLICY NUMBER i 2455 PACES FERRY ROAD 3UILDING G20 ATLANTA,GA 30339 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Norxers Compensation Continued: Career.Indemnity'nsuranceCompany of North America Policy Number.WLRC64783191(ALAR,FL,ID,IA,KS,KY,tA,MS,MO,NE,NM,�%4D,OK,SC.SD,TN,'NV,'NY) =ffective Date:03101/2018 Expiration Date:03101/2019 'EL)Unit:31,J00,000 Camey New Hampsnlre(nsurance Company Policy Number.'NC 014122576 (CC,DE,HI,INMD,MN,MT,NY,RI) _tfective Date:0310112018 Expiration Date:0310112019 EL)Limit 31,000,000 rawer:.ACE,Amercan'nsurance',amoany Policy Number.'NCU C64783221(.QSI)(AZ.CA,IL.NC,OR`/A,WA) Effective Date:03101/2018 Expiration Date:03101/2019 ;EL)�mit:31,M0.600 SIR:;1.,00,70(1 SIR for'he states of.AZ,CA.ILNC.OR,`JA,'NA Carrier.National Union Fire insurance Company Policy Number.)ONG 4595580(OSI)(CO3CT,GA,4AE,MI,NV.0H,P.A,UT) ffective Date:03/0112018 Expiration Date:73101019 ;EL)Limit 31,000,000 31,000,000 SIR ior the states of CCAE,NVAI,ORPA,UT 3750,000 SIR'or the state of GA 33350,000 31R`or the state of CT c Carrier.National Union Fre Insurance Company t t1 \ Policy Number.XWC 4595581 1QSI)(MA) Effective Date:03101/2018 Expiration Date.0310112019 ✓� (EL)umit:51,000,000 SIR:3500,000 X Firployers XS Indemnity: Cartierlllinios Union:nsurance Company Policy Number TNS C4916693A(TX) Effective Date:03101018 Expiration Date:03101019 (EW Lmit 3111000,0130 SIP,31.000,W) ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _1 T he Corfttnoiitvettith of 1illftssuchzise-ilS !G' Depot nietitoflfwhistrititticcidents i 1 Congress Street,Su to 100 : Boston,AYA 02114-2017 34131w.n7ass. ouffi'ilt NN orlters'Compensation Insurance A ffid?vit:;ladders/Con:victors/Llecfr)cians/Plumbers. YO BR TILED IVITHTn- PEMMITI'I\G AUT110ijffY. et nt)lieant Inform-ition Please Print Legibly !Name (BusincsJOrganira iorJlnd�iv6Ldual): —77r<-1V ;' ;icidr4ss: D� /1J r.� City /Stal eiZi rLKrJ I �1 Ph�1rit 't �J 1 � :`.re ynu an etnpiuycr''Check thespprupriatc bot: Type Of project(required): LIM I ant a_mpluyer with employes(,hill andlu:rart-urnc).• 7. []Ni tv construction t t!i am a sole piaprictor ur pannership and have no etuplayes>carting fibrime in 3. Remodeling any capacity.ipto e•orl;ers'comp,insulattce%.-I ired 9. C3 Demolition ! am a hurl-townet doing all:vara rrtyse:_;.iT\110::•erkers'comp.insuralm:re;umr-=-1 l 10E]Building addition 'l i ani>_Itomcowner mid '.,It t=e hiring coakacion;to conduel ail work on m•p;ep:rt_ !:viii ensure that all contractors either huvev art:e a compa-isation insuranc_ur a c sole T 1.0—Electrical repairs or additions proprietors:with no cmpio ccs. „ I 17.ID Plumbing repairs or additions f 5gl am a general corimctor and I havc hired the sub contractor iisled on the_r=cit a sheat.Gljtf repairs o I ties:strh-ce:itr^ctors hove ciaployeas and'n=_ve;torler'comp.insulanca.: 13-n /t' 1 x1.18`61 er�/WDA � € it.�`;de xce a coraertion and its at ise[s hair exercised their ri3itt os:acmptian e; .e. I i2,�t(�).and:ve havc tto t.ntplo}•ecs.i\°o i:nr<:cr'co;np.i;tsrnce r-_• u::i.i ( t *Any applicant that checks box=1 must also fill out til_=lion &lin•:•in3�:eir:ti•c,:cs`con rsstinn policy iniorm,iion_ 'Homeowners iv'ao submit ibis a(Fidaw,indicating they or,doing all;;'or%and titer:hi;.euis'.'4e contteeto:s nidal submit a rely alFidavil indicating such, ,Contractors Oma checi;this box?lust attichci an additional sll-W$hexing the n_mu Oil St 13-cans_•etors and slaw ttltUhC;ornot those entities have employers. lf'[hc sub'Lontrictors have ernploye s,they test I wMle their::obi:cr 'cants policy tr_mb:r. 1 inn air en7plgyer that is providin worlrers'cotnAe11VItfi0J1 11JSura nCt'f it trif t'tll7/OfeeS. 3eto)Y Is t7)e poftg avid fobSite insurance Company1615 /tai Policy;,or Self-ins.Lit:.: ' _ Expiration Date: Job Site Address: CitylStatelzip: / :�ttaeil n copy-a;the 1vorlters'compensation pn:icy decltaration page lshairing the policy number and expiration date}, �I��Z Failure_o secure coverage as required under MGI.c. 152, 25A is a criminal violation punishable by a tine up to S1,500.00 andior one-year imprisonment,as well as civil penalties in the`,Form oi'a STOP VIORK ORDER and a fine of up to$250.00 a day against the-violator.A cop;of this statetrent tnay be forwarded to the Off ice of InvestigPtions of the DIA for insurance coverage verification. 1 do hereby ccrdfjl tin r Ibe in i ' ? j Per' r}dial fire' vrniation provided above is trite and correct Signature: te: Phone �— Official use nii/j -Do not-write in 111is area,to bfT colilpleted by eitp or town off.•ciaL l City of Town: Periaii/I..icense- - s=. I Issuing Authority(circle one)- I.Board of health 2.Building Department 3.C1t)F1TGiYn Cleric 4.Electrical Inspector 5.Plutubing lnspectar ii.Other Conine',Person: Pholie 4: l t 1� Tyi 3.:,.,—,rte:="•�SaG.-1�•�_�'=�x{"`w M'�w a�_c_r.'�:•�+=',-�"._��u�•�tea:¢::�z"c..•.v�+L'., 3 i}t z..=�gf��A•�T_•ie?�:"S�.... .... .. r.=="..�'� ::£� _:r"«'`'-"."'.;7 '3i� i 180-ot-I)d rZ,S`LJ;�i'iSJrl''!r{?t`v�i��IL�'`'s~v'cs':. 5�3iat jy �, `�53f��Cl�tt�lf�tfr'�L�is S'J=4b �ni:fi�'�v.•1�u=flSW,. -(s.puap =:S ! lInnPald 2�7U MIS_1 �j �i c'��Wai;;ogaao s�;'�f00 u?=;:::3��ii• - — t vg- !: rte. ifes, r= :: _• .r,: :° `-��--r+,rfsff._• 'fs�to3 i!'�.noS`t&t�'mS[.,��.,;v ��:-"�:;/+rra .c._•'_� .. ly Wit.. f y •...;f.Ga �l'..: gi !L-1 _� =tQfll�-Z31LI`J �-�arj� .c�% � M a :'� • .us��' f j! r.:. :-• • :,:,�,:.�:.:---."- s a :I ;i .."'.J'��{._.:�•^i«.1��i��si .• is i i O,L�Rtill�ti�d?Q i7i'}!f!�sl?idt35 liOl�i*tll?'!a ! a SUNU M11ivlitl'>:c)E: -01,11swillal ME Be _i �!}'T'.1�/LU s:tu".�iL G:'?rf<'r:`TsT'r'•_4'�f��v:$ �`--`�---•-----..r. ., Z-1-�ia�`=_ a'CL—.�t'-QL�' zt`!E:''3zp G`SiF_!l: gx s r rrrg- •. ��-7!,ifi�.� '-ate � -tea••'.^ iy!r - 1•+-.v a _ � 0'!•4� Z' 35?:J nvre{.-}"vu;,-=:e`.Y-y r�.+rr+i.. y 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 Registration: 112785 Expiration: 04/22/2019 2455 PACES FERRY RD C-11 HSC ti 1 ATLANTA,GA 30339 Update Address and return card. Mark reason for change. I n 201%a-05,11 ❑ Address ❑ Renewal ❑ Employment ❑Lost Card Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only -TYPE:Supplement Card before the expiration date. If found return to: Reaistration Expiration Office of Consumer Affairs and Business Regulation =_ 112785 04/22/2019 10 Park Plaza-Suite 5170 HOME DEPOT USA INC Boston,MA 02116 t � RICHARD TROIA - 2455 PACES FERRY RD C-11 HSCL�, ATLANTA,GA 30339 Undersecretary Not valid withou signature -t. � oA` ...,,,. �""• -�, to ��µ�►�R � � w + t a .. r �.rvW0 W, '+ '... 'FA ommonviealth of Massachusetts sion of Professional Licensure soard of Building Regulations and Standards p a _109 8 7Expires ; 0412`2020 ="2020 IVAN KOSOBUTSKYY 72 STAFFORD ROAD MONSON MA 01057 ` `.�omrmssioner