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24C-096 (4) 73 MASSASOIT ST BP-2019-0567 Q5#: COMMONWEALTH OF MASSACHUSETTS Ma : ock:24C-096 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Qateggry:window replaced BUILDING PERMIT Permit# BP-2019-0567 Proiect# JS-2019-000922 Eat.Cost:$11535.90 Fe : 4. PERMISSION IS HEREBY GRANTED TO. on Lt.SjLs s. Contractor. License: 11je Grgup: HOME DEPOT AT HOME SERVICES 98785 Lot Size(sg;8:): 14592.60 Owner: KATZ DAVID E&KATHLEEN A Zoning:URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 73 MASSASOIT ST Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON:11/14/2018 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: Drivoway Final: Final: Final: Rough Frame; Gas: F r aWM nt Fireplace/Chimney: Rough: 211 Insulation: Final: n o : Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvne: Date Paid: Amount: Building 11/14/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r1y City of Northampton Building Department �t 212 Main Street !( Room 100 %#y Northampton, MA 01060 � . ►ta phone 413-587-1240 Fax 413-587-1272e APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA E O R O F MILY DWELLING SECTION 1 -SITE INFORMATION NOV — 2018 dmf O 0�� 1.1 Property Address: This section to be mpl ted by office DEPT.OF BUILDING INSPECTIONS MPP NORTHAMPTON.gMI060 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Telephone Mailing s: yi ®j /-� c�� V �--��✓L ®�— `U(�(f Signature � R ,.._ 2.2 Authorized A ent: )2)6PFS 6p�ro TPk Name(Pr' Current Mailing Addres / Signature Telephone —7 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �-2 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) Check Number a/ This Section For Official Use Only Building Permit Number: Date Issued: Signature: 11/13 16 Building Commissioner/Inspector of Buildings Date �1 J2f1 @r tM 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 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? �� �� NO �_��� DONTKNOVY �~� YES �~� r------------1 IF YES, daLcissue& � ---- ---------^ IF YES: Was the permit recorded at the Registry of Deeds? NO »�-� v���`� DON'T KNOW �~� »��YES �~� - _ - ' --- - - IF YES: enter Book Page ) and/or Dmcunent#L_ _ �� �� �� B. Does the site contain a brook, b��w�r or wetlands? NO �� �NT�� �� YES �� IF YES, has a permit been or need to be obtained from the Conservation Commission? x�� �~� / - Needs tmbmmb�dned Obtained Date ' «�� �~� ' . _ . C. Doany signs exist on the property? YES �~��� NO «~~�� � IF YES, describe size, type and location: | D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,cvfilling)over 1acre cviskpart ofacommon plan that will disturb over 1acre? YBK��� NO K��3 i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement_Widows Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [ice] Decks [0 Siding [D] Other[�] Brief Description of Proposed Work: tj(/L j✓� V (o vL�l/�,(� Alteration of existing bedroom Yes No Adding new bedroom Yes No Crt'/1 ZU Z� Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house and or add4lon to existing housinu, complete the followina: 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 _ 1. 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 1, D'Jy "' Z, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized 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 the pains and pe (ties cf perjury. Print N e c Signature df Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 71 8.1 Licensed Construction Supervisor: �N7ott Ap plicable�]❑ Name of License Holder: 7�lIV (�`27, L License Number � Address Expiration Date Signature Telephone 9.Registered Home Im roy Ment Contractor: Not Applicable ❑ � 1127� Company Name Registration Number Address /1 Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi g permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts Gy ' 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 coontracted with a corporation or LLC,that entity must be registered. Type of Work: Ad1nfbi47_w AJ'� Est. Cost: �Z Address of Work: Date of Permit Application: �4 P �� 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: I hereby apply for a building permit as the agent of the owner: ) 4 ,/g ��� /12 7- 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 Massachusetts f �,t X DEPAR"ONT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building J4 ca 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 i''��-�;: s�s••�� sic Massachusetts mow? fic ' DEPARTMENT OF BUILDING INSPECTIONS ' 212 Main Street •Municipal Building Northampton, NA 01060 �ry _. i1a 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: lnll - 4- (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 Permi 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 Department of Industrial Accidents 1 Congress Street,Suite 100 < Boston, MA 02114-2017 www mass.gov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly 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 employees(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. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F1 I am a homeowner doing all work myself[No workers'comp.insurance required.]' 10E] Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.[]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.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 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.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t 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 jab 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 l .. 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 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 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 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: Eric Luukko 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. KATZ I DAVID New England South 1-6HRD4YN Customer Last Name Customer First Name Store # / Branch Name Lead/Customer Order# 73 Massasoit Street Northampton MA 01060 Customer Address City State Zip (413) 695-6081 1� katz127@yahoo.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 @ 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. Ot 11 Acknowledged by: 09/06/2018 Customer's 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: 111533.22 =Includes all applicable taxes. Excludes finance charges.* Sales Tax: 0.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl(99%) Dep. 25.0 % Deposit Amount 2883.31 Remaining Contract Balance 18649.91 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 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 V 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: 11/01/2018 Approximate Finish Date: 11/29/2018 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. IS 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 09/06/2018 1 The Home Depot Customer's Signature Date Service Provider Name X 1 109/06/2018 908 Boston Turnpike Unit 1 Co-Signer (if applicable) Date Service Provider Address Xnr� 09/06/2018 Shrewsbury MA 01545 igna ehalf 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 Customer Agreement(C,E,I)(31 Jan.18) v 50.1.2 s Andersen Wood SPEC SHEET SC: Eric Luukko Measure Tech: INSTALLER: Branch Name: New England South Job#: 1-eHRD4YN Prepared By: ISM: Ship To Location: Customer Name: DAVID KATZ Date: 09/06/2018 Page' Of 2 SPEC SPR SHEET# REF# NEW WINDOW UNIT H r FULL[AANGLE H 7R... 1"lErRII #96ttdIA $ $11ri19':" ' d318RN ufdC -6L k MEASURE TECH SIZE ONLY LY Ot{ar1Slptlons Prka} TOTAL MT/ISM Interio TW SC UI Standard #Bars #Bars #Bars #Bars Pattern MISC Location Ezistin Series Windo Exterio Finis Jam Standar (WIDT Size Grid Exterior Interior Yen Hodz Vert H.riz & Labor Wind. Type Style Color Color Liner Size AW + CODE WALLL Sash Hin Temp Screen Type Grid Grid Pattern (per (per Locatio (Per (Per Location ObscureFinish Finis Finish Item Roo Floo Cotle CODE CODE CODE COD Colo Code Witlt Height HEIGH Width Height DEPTSplit Venting Handling Style CODE Options COD Color Color CODE sash) sash) CODE Sash) Sash) CODE CODE CODE Type COD Type CODE CODES 1 1400 DH-I H WH Whit 30.0 55.00 5 [S-N H BG H WH COLON 2,2 1,1 ALL WH STD WH TO H WRAP 0 IAL 2 400 DH-1 WH Hhit 30.0 55.00 85 S-NH BG H WH COLON 2,2 1,1 ALL WH STD H STD WH WRAP 0 IAL 3 400 DH-I WH WH Whit 1 30.0 55.00 85 EI-14 H GBG WH WH COLON 2,2 ,1 ALL WH STD WH STD H WRAP 0 IAL 400 DH-I WH WH Whit 30.0 55.00 5 S-N H GBG H WH OLON ,2 ,1 LL WH STD WH STD H WRAP D IAL b3ir!'4QiVtlRN r SGM�pMOM:wo."MWR L#PaR YUN.91�mY dptlw.+MaM#wgtlawtlM MrRIWitltlr@IyMndn'stl00r1 WNUFAgN1�11W78lk¢P�SM:r rGbaYSno.... Prolectgn Angie:(9ay ao-or 45°) Top of Wind—to Soft(i—sl rap Color(1) White,Wrap Color(2) White,Wrap Color(3) White,Wrap Color(4) White Bay Wind-11...(DH I Casement) Width of Overhang(inches) Construct Root 1(Yes I No) tt tied w soait coax of Soffit material 1 ere is ro guarantee that new shingles will match existing mlor. NEW DOOR UNIT 1af18ara�n MEASURE FULL tbs and'a�ltptxofir# � G ,. .;MlSO1.AL�(TgQpftbf ', fiPffoll FlhYL: f "Y, 'Igf l3Abr`1 rP '- scfI.O w`.`'ry TECH SIZE ONLY `,' MYile. Ri - PD Nonnem Assembl ES? Note: TOTAL (200, Smansun Location InteriorUI RO/ In s w i n g PD PD Gliding Hinged 400,8 meals Existin Serie Exterio Finish Standar (WIDTH TIP Ext Extensio Grid Extern Interio #Bar #BaDoor Door A-Ser Lock lock Options all other c uay Door Type Style Color Color Size AW + to Jamb Jamb Type Grid Grid Patter ert( riz( IN or # Venting Venting gliding HRDW HRDW Keyed Mulled/ Special e5Roo Floo Code COD CODE CODE CODE Code Width Heigh HEIGHT Widt Heigh TIP Size Location COD Color Color CODE Sash SasOU7 Panel Handing Handin only) Type Finish Lock Stacked Notes MISC Labor Item CODES Yea or No es Width h Yes #of be. Yes Color Approv l Prior Name DAVID KATZ T.Home Owner Andersen Wood SPEC SHEET SC: Erie Lnukko Measure Tech: INSTALLER: Branch Name: New England South Job#: 1-6HRD4YN Prepared By: ISM: Ship To Location: Customer Name: DAVID KATZ Date: 09/06/2018 Page 2 of 2 SPEC SPR SHEET# REF# NEW WINDOW UNIT Htup f .. - FULL �7Nklilaw 4: $L -. L .def TYPE SCB}ZES43t0 CtiRf�. MEASURETECHSIZE ON4ONLY �; '# - . . � _ f�SA4}l l�itCf�, i -: TOTAL MT/ISM Ihterio TW SC UI Standard #Bars #Bars #Bars #Bars Pattern MISC Location Existin Series lWinconExterio Finis Jam Standar (W IDT Slze Grid Exterior Interior Vert Heriz Vert Horiz tt labor Windo Type Style Color Color Liner Size + CODE WALL SILL Sash Hing Temp Screen Type Grid Grid Pattern (per (per Locatio (Per (Per Location Obscur Finish Finis Finish Item Roo Fioo Code CODE CODE CODE COD Colo Code Will Height HEIGHTWidth Height DEPT ANGLESplit Venting/Handing Style CODE Options COD Color Color CODE sash) sash) CODE Sash) Sash) CODE CODE CODE Type COD Type CODE CODES 5 400 DH-I H H hit 30.0 55.00 5 [S-N H BG H H COLON 2,2 ,1 ALL J.H STD H STD H WRAP 0 IAL 6 400 DH-I WH H Whit 30.0 55.00 85 ES-N H GBG WH WH COLON 2,2 ,1 [ALL H STD [11 STD H WRAP 0 IAL 7 400 W WT H PINE 60.0 55.00 15 S-N H GBG WH H COLON 2,2, 1,1,1,i ST STD T STD ST MULL DH-1 0 IAL 2,2 R,WRAP ,) YAYlOOW4ntlolm': 86Mp91r`,IIaFF pnaluO�pWo.ltlarltuY�altlSDpmaop Yl mJ1!lalh,iMfl®r#4tMntllyNAtOMAiV.or) 1�IaarilllY Pro)ecoon Angle(Bay,ao^or 45') Top of Win— Sona pnchesl rap Color(5):White,Wrap Color(6):White,Wrap Color(7):White Bay WIWI Flankers(DH Casement) I Width of ver Ohang Ilnches) Conatud Roof 1(y!a /No) If tied N sone,color of Beth material 1 ere,s noguarantea that L—shingles wii match euehng color. NEW WOR UNI MEASURE FIAT FRAME '.. MULL TECH SIZE ONLY _l� eA�H _, .r, -Oad t.�N .` OPTIONS, PD Nonnem A.iblel Noe. TOTAL (2W, Smedsun Location Intario UI RO/ Inswing PO PD Gliding Hinged 400,8 meets Existing Serie Exterio Finish Standar (WIDTH TIP Ext Extensi Grid Extent,Intend #Bar #Bar Door Door A-Ser Lock Lock Options anomer capalery Door Type Style Color Color Size AW + to Jamb Jamb Type Grid Grid Patter ed( riz(P oscur Scree IN or # Venting Venting gliding HRDW HRDW Keyed Mulled Spacial zoges tutee Roo Floo Code COD CODE CODE CODE Code Width Heigh HEIGH Width Heigh TIP Size Location COD Calor Color CODE Sash Sash CODE CODE OUT Panel Handing Handin only) Type Finish Lock Stacked Notes MISC Labor ttem CODES res or No Pnkia Width Yes Width Yes #of boxe es Color Appoval Prim Name DAVID KATZ rule Home Owner d einove until final code inspftcli n Save label for future raferilwe , to is Canada 1, snernCan r.caan f CU U.S./ . tG �• r - M oil Cf energyatar.gov =Ouaritied/Adm-s rftfe Renewal am! byAndersen•. WINDOW AND-N-28-00457-00001 Wood/Vinyl Composite IF Dual Argon Low-F4 . ........ Product Type: Double Hung ENERGY PERFORMANCE RATINGS LI-Factor 3clar Heat Gain Coefficlern- 0 . 1p 9 11 - 65 Q . 3 �. S -P) ! IUtetric/Sli ADDITIONAL PERFORMANCE RATINGS Si.le+Transmittance r _,3 . 5 3 u3fuf3::,, :.i3 as Tai Te?8•3Gn�3:LNGr"�:]3GtF�c3t:�e'rF�i.5ru:e;:4re3'tif]8I8'm:f�'.].r,.,_•r-- •••3' •30r9!are 1MSMP90'ar 35Aea jet a ar-rcrreM3i:]f3 Gw:3 3!•]3 me fic !:a -3:t.re'!Sae3:v2'ur:.Te.•vz3]at Selfanar:e nfVT•3G01 rnrr rrrt.ara .unr.w.r.e�ee T _ CCL 129-H-835.06 CCL 129-H-835.07 -'- Andersen Corporation:RbA Double-Hung _ .—...— tan�rc4rar ii:3�•ataa:--r�marca to Ta•oa]:nn'Q star•oar]a —� Standard Rating '3'?3'7333- r. 100-00571177-04 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 2455 PACES FERRY RD C-11 HSC Expiration: 04/22/2019 ATLANTA,GA 30339 Update Address and return card. Mark reason for change. �1 t3 20M-05!?? ❑ Address ❑ Renewal ❑ Employment ❑Lost Card v, ��{tn (C o-l'N-7NCiiiUnlll��I��p�[[3r[!C/7llJP�J- Office of Consumer Affairs&Business Regulation .r HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only -TYPE:SUDDlement Card before the expiration date. If found return to: Reaistration Ex irp ation Office of Consumer Affairs and Business Regulation 112785 04/22/2019 10 Park Plaza-Suite 5170 HDME DEPOT USA INC Boston,MA 02116 RICHARD TROIA ,.. �? 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 Undersecretary Not valid withou signature ATE AC Ro® CERTIFICATE OF LIABILITY INSURANCE 002/22/20 BD A 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 c No Ext: AIC, No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 9 CN701642069-HomeD-GAW-18-19 INSURER A:Old Re uhlic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER 8:Neu Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Ca live Insurance Company 2455 PACES FERRY ROAD INSURER 0: 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 1"E TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MMIDD MMIDD A X COMMERCIAL GENERAL LIABILITY MWZY 312717 03101/2018 03/0112019 EACH OCCURRENCE $ 9,000,000 DAMAGE TO RENTED CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 1,000.000 LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:SIM PER OCC PERSONAL 8 ADV INJURY $ 9.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 POLICY❑JECTPRO �LOC PRODUCTS-COMPIOP AGG $ 9,000,000 X OTHER: $ A AUTOMOBILE LIABILITY MWTB312718 03/0112018 03/01/2019 COMBWEDSINGLELIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED SELF INSURED AUTO PHY DVIG BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION WC 014122577 (AK,NH,NJ,VT) 03/0112018 00112019 X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRI ETORiPARTNERlEXECU7IVE B YIN WC 014122578(WI) 03/01/2018 03/01/2019 E.L EACH ACCIDENT S 5,000,000 8,000 000 OFFICERIMEMBEREXCLUDED? M N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under Continued on AJditional Pae ,000,000 DESCRIPTION OF OPERATIONS below 9 E.L.EDISEASE-POLICY LIMIT $ C Excess Auto 297-1-10011-00-2018 03/01/2018 03/0112019 Limit: 4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE 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 C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee �LcLatioo ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC#: Atlanta AC40 EO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. THE HOME DEPOT,INC. HOME DEPOT U.SA.,INC. POLICY NUMBER 2455 PACES FERRY ROAD BUILDING G20 ATLANTA,GA 30339 CARRIER NAIC CODE EFFECTNE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continueo: Carder.indemnity,Insurance Company of North America Policy Number.WLR 064783191(ALAR FL,ID,IA,KS,KY,LA,MS,MO,NE.NM.ND,OK.SC.SD.TN,WV WY) Effective Date:03/01/2018 Expiration Date:33+01/2019 (EL)Limit:51,000,000 Carder.New Hampshire Insurance Company Policy Number.INC 014122576 (DC,DE,HI,IN,MD,MN,A+T,NY,RO Effective Date:03/0112018 Expiration Date:5XV2019 ;EL Limit:S 1:000,000 Carder ACE American insurance Company Policy Number WCU 06478322'fQSll W.CA.IL.IIC,ORVA.VJF-) Effective Date:03/01;2018 Expiration Date:0310112019 IEQ Limit:S1,000.000 SIR:S'.000.000 SIR for the states of.f,Z.CA.tLNC.OR;VAMA Lamer.National Union Fire insurance Company Policy Number.XWC 4595580(QSI)(CD.CT-GA,ME.MI,NV.OH PA UT. Effective Date:03/0112018 Expiration Date:03/0112019 (EW:unit:51,000,000 S1,000,000 SIR for the states of CO.ME.NV.MI.OHR&UT 5750.000 SIR for the state of GA S350,000 SIR�r the state of CT Came[National Union Fre insurance Company Policy Number.XWC 4595581(OSI)(lAAj Effective Date:0310112018 Expiration Date:03101/2019 1 (EQ Limit:S1,000.000 SIR:5500.000 TX Employers XS indemnity: Canierlllinios Union insurance Company Policy Number TNS 1.4916693A('Xj Effective Date:03101/2018 Expiration.Date:03/01/2019 (EQ Limit:S10.000.000 SIR:S19 OM', ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Cointpoinvedth ofAli msticlizise-Its Depariment of Indrish-ittlAccidents I congi-ess Street,snite 100 Bostcriz, AYA 02114,20 17 Workers'Compensation Insurance Affidavit:gi)ildei-.5/Contr,-ictorslElecfricians/)'Iumbers. TO BE FILED WITIT TRE PERNUTruNG AUTUORITY. Ar llien n t Infornin tiun Please Print Legibly Name (Busi!ics,-z/Organizatiorjlndi-.tidual): 440)n E— TU rz/V Address-. qpo City/Statet'Zi, - i,: Are i ounn eMPluYer?Check theapprupTiate ho.1. Type of project(required): am a em.plever with cmployccs(full andlur part-time). i 7. EJ Nem.,construction T Inmi a so[,-propriewr ur partnership and have no employeas working Forme in 8. Remodeling any capacity.F1,40%vorl.'ers,comp.insumuca required.) air.a hu incovine r doing all work 1711neir.FIN a v.-Grixi-S,co in p.i n pzqu!rc,..-;. 9. ❑Demolition 10E]Building addition 4, am a I-,oirmovni cr and will be hiring conlracims to conduct Al work on my pmpri:y- I will Cr,SLir--flint all contactors compensation insurance,urvre.:ole 11.Q Electrical repairs or additions proprietors with no cniployers. i 2.0 Plumbina repairs or additions I am a general contractorond I have hi.cd the sub-conlratatims listed on the'"Itzchudsliest, 13-E]Roo repairs Thine szrh coatraetars have cinployeas arid'have workers'comp.insurance..' 4.F9'Ol 011ier 141)'A) 6.EJ-We are a corporation and its officers hate uxcrciscd their right of e.-,cmptio;i perc. 152.§10).and we have rio employees.iNo worKcrs'comp.insuranct:anluired.) Any applicant that chicks box#1 must also fill out the s.-cflun b-clow 0io-,%ing lhuk workers'compensation policy inFornumion. Horneov%mers who submit this afFidavit indicating they arc doing all worl,;and U::r;hire ouisidz�contractors must sub-nit a new affidavil indicat;ng such. ,Cantractors d3n check this box must auacbc,, additional ea sliciAng the na-me of the sub-contractors and state%Ylitilicr or not those entities have empluve,-S. It'the sob Loniractors have ernplayees.they tumt provide their woil.;ml'comp policy number. 1 i7in aii en rplayer di at is providing i VOTICLITS'COMMISfil i0i I h-8-11 M I i cefor my employees. Belo)v's the poficv aril job sfie Insurance Company Mrilecu*)u K 4T Policy il,or Self-ins.Uc.ff-.Awz�, Expiration Date'. YN., — 1�Tim Job Site Address. City/Statefz ip: AA' Att9ch n copy of the workers'compensation p0icy declaration page(showing The policy number and expiratiOn date). Failure to secure coverage as required under N,1GL c. 1527,§25A is a criminal violation punishable by a fine up to$1,500-00 andlor one-year imprisonment,as well as civil penalties in the form ofa,STOP NVORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be fonvarded to the Office of investigations of the DIA for insurance coverage Vel-mcwti0j). ]do hereby cerrify un,*the p in 3 per thalih ornzationprovided uballe is true and correct. Si nature: Official use all!),. Do not:write its tills area,to be cowpleted by city or town officiaL City or Town: Permit/License-Y Issuing Authority(circle one): I.Board of MOM 2.Building Department 3.CiMTown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 4: „y�, �,��`+-�• �.� � x� �rte;.. t N t6 y is `f`� '� �"a ."ath._ �a.�}.,wP r.���'x.-�.�,�dy,;���+.•.s.. � .w _ -. t'�_ r ':rtly, "x•'=µ *3C �.r A .� �..` 'k yt�r' `a 3 - F .Y� - „ 3 ka�rc � �• x aywe - t- '`.dam” ,� � "` '�•�u* ,u^.y'Aw��"" �� L ,;;;' ��/ _ - 0 i * � f � � � - its '',, i•. ��r.'w♦ �� .L+a'�� `jT�f� '4nt r verµ .. . n a w -n s a a '