24D-243 IIIIMPOPNwar48 BP-2006-0499
GIS#: COMMONWEALTH OF MASSACHUSETTS
grta. CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0499
Project# JS-2006-0735
Est. Cost: $3665.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): Owner: KABOUS NEIL
Zoning: URC Applicant: HOME DEPOT AT HOME SERVICES
AT: 61 CRESCENT ST #8
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401) 935-2633 O Workers
Compensation
WORCESTERMA01607 ISSUED ON:11/3/2005 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 11/3/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
' \ Department use only
L� I 0 Nort amp ton Status of Permit:
\ ! Bu 1 ,Irtg Department Curb Cut/Driveway Permit
i h �OV _ 3 2005 !Main Street Sewer/Septic Availability
� .. Room 100 WaterNVeil Availability
\ -
ç! _ Northampton, MA 01060 Two Sets of Structural Plans
nFnr a ' phone 44 -587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map _q Lot 4 Unit
[y.f CT Zone Overlay District
1 ' I V Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�R-l1 4 bD-t -1 B Ix tt.q`}'re 4-Terre lta ifre,..414 ti
Name(Print) Current Mailing Addres Q �
CoAtaLt Telephone
3ignatuie
2.2 Authorized Agent: .�
I Cri)(it � I I cii L ,i1C 6u'4' i t WC l 'f 1.1,IGre-e.414/
Nam (Print) Current Mailing Address: yy����
J)
J L :� �z% �1�� ( Li o l 9 3 s.- V 5
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
31�--
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) '3e — Check Number
This Section For Official Use Only
Building Permit Number. Iss
te Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Informatioh Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colur#m to be filled in by
Building Iepartment
Lot Size
I
, ,
Frontage H
Setbacks Front I
—! i I
Side L: R:' i 'L:+ I R:I a
r— 1
Rear
Building Height 1 i
Bldg. Square Footage 1 1 1 i % I J ( 1 1
Open Space Footage %
(Lot area minus bldg&paved I k ! I I I
parking)
l I
#of Parking Spaces 1
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Fill: ' I ' ' I
(volume*Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page! i and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission? '
Needs to be obtained Obtained ® , Date Issued: :`
C. Do any signs exist on the property? YES 0 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 0 NO 0
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 0 r NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition Replacement VViriti,:isiefivs Alteration(s) Roofing
Or Doors
Accessory Bldg. n Demolition ❑ New Signs [El] Decks [[ Siding [El] Other[El]
Brief Work:
51G JDescription of Proposed f`(5)702CA
� 1)11,4C1 A t Q C
Alteration of existing bedroom Yes No Adding new bedroom Yes No({
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
f New house and-or addition to existing•housinq,complete the following:
z
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
COVi1'lfzc� _ , 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.
1/t
Signature of Owner Date
l
I ) l �;-6 "l I ((J t` , , as Owner/Authorized
Agent here y declare that the statements a d information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
f � 1LICk 1 i
Print me (.f r/
4 :L.L�1/6/1'( Date 113 D5
Sig a ure of Owner/Agent
SECTION 8-'CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone ,
,9 pis erg i -.� :. -r 4,.�r
��' mpr" emer�i dun ra Not Applicable 0
j
Company Name Registration Number
-r+ID f-temki S V3/6
Address Expiration Date
51 C 6Asti it uul 0Od St War Y V- Telephoney(}1 t/3 J
SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G_L.c.152 .§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 13 No 0
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
- as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached 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.
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 ' e 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 Chapt r 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.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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DEPARTMENT OP BUILDING INSPECTIONS 4
=o -
212 Main Strcct - Municipal Building
Northampton, Mass. 01060 SO
W'ORIC ER'S COMTENSATION II4SURACE AFFIDAVIT
L ____Kc_.60/1k. FATIlOtelt___ __.
O, perm )
with a principal place of businessfresidence at:
D '4� J G(A ld.D0 noon � y0( ci3S�L33
. • (sa-J.c/ciry/stalc.fap)
do hereby certify, under the pains and penalties of perjury, that
( ) I am an employer providing the followincz Worker's compensation coverage for my
employees working on tlus job:
, .2,klitAirMCOI CO Cb •
(Lswao Corer_-n1-) • (Policy Nurninr) (Exp r on Dom)
( ) I am a sole proprietor, general coon-actor or homeowner (cisce one) and have hired
the conn-actprs listed below who have the following worker's compensation policies:
(Name of Co_`.t:7!cio') (ln.r3nce Comnoarry/PoUCi 'tuml:I) P:pira on Da tc)
(Name of Concaaor) (Insurance Company/Policy Nu iCer) cE- irtion Date)
(Name of Coniracior) (insurance Company/Poticy Namlwi) (Expiraon Date)
(Name of Contractor) (Insurancc Company/Policy Numbes) (Expiation Date).
(saach:.duho.c.,60a,ifn.w�-,.ry to coda&iafoccti.00 octaiaias to.il 000cr-so:n)
• ( ) I am a sole proprietor and have no one wor dreg for me.
( ) I am.a home owner performing all the work myself.
NOTE:p1e_cc be tw rt tt wireio hemeow-octa.ayo co:V loy pct.o to b3 c,rt-+•-,•m• =s.:e.,00 c repair w•oric oa.d..e11 r,of
clot more tI_o tiro.tmitr ill wbid,tho bomoowoc raid=or cc the p oua6 zppu tcosri tbc-en r_z roc t ...11y occrid3c+7 to t,c
cnploycs t,wv'c the w =cr-r7c---tiaa Art(GUI52.n 1(S)).:.pplinaon by a booacoo-oa kr c ti¢z._oc peroir ra:y cvidmOc the
Icgs.,ct.0 of ea esployer uod.•r d.o Worlul.Compomalioa Arm
I uoi ,t.od thrs a oopy of thy.rat®cm co.y ho foc-..,rd.d to tbo Dopnnmma of IoA.w•icl AnOdozco'offoa of Lavora.ocas for tho
covcrr.SC vcrirt=tioa nod tlu C•ilta-c to acxurt`covira.be trod.= .cctioa 25A of MQL 152 cam lad to the i•* +r+rioa of aim-mai pa,+ttic
coosismg• . of up to S 1,100.00 ar.dior impri_loccoDcat of up to ooc yt_or cad civil pc oaloa to he form of a Stop Work;Or clad a
fi>n of 411.00 a.•y ay:.• tnc/ ---•----
/ / F« u.e only
Pc-rnart NuIDtx'S
/ t01�
.�_.r 1 1 US ?vial):
_
Si,..id/
of Li.-. •crmitt= to -- .
go Y.o $ ,,.(rxfy of Nortilamptnn _ — _ /,
7 .,„0,1, ery 8 IAA assacl,usetts = -1=
'�� k+ --� DEPARTMENT OF BUILDING INSPECTIONS _:-1_f ;
INSPECTOR 212 Main Street • Municipal Building any=5,.•�.
Northampton, MA 01060 .
e'
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup, : s. spr. The state defines "Homeowner",as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or family
�o f y
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 hot be considered a
home owner."
1
The building department for the City of Northampton wants any perso (s) who seek to
use the home owner exemption, to act as their own construction supe isor, to be aware
that by doing so you become responsible for compliance with state uilding codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection.:The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
- permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption) 1
I will call to schedule all required building inspections necessary for the building permit
issued to me.
j
Date
Address of work
location
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MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
ATL-000915907-02
PRCOUCEM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
ATTN. ELIZABETH BRISENDINE (404)995-3568 POLICY.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
CR BRENDA BOOKER 404)995-2594 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
FAX (404)760-5768 COMPANIES AFFORDING COVERAGE
3475 PIEDMONT ROAD, SUITE 1200
ATLANTA,GA 30305 COMPANY
100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY
INSURED COMPANY
THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY
DBA THE HOME DEPOT AT-HOME SERVICES, INC.
—
HOME DEPOT USA, INC. COMPANY
2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY
BUILDING C-8
ATLANTA,GA 30339 COMPANY
D AMERICAN HOME ASSURANCE COMPANY
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. . 1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE IMMIODIYY) DATE(MMIDD/YY)
A GENERAL LIABILITY IPR 3757 608-00 02/01/05 03/01/06
GENERAL AGGREGATE $ 4,000,000
X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000
CLAIMS MADE X OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000
FIRE DAMAGE(Any one fire) $ 1,000,000
MED EXP(Any one person) $ EXCLUDED
B AUTOMOBILE LIABILITY BAP 2938863-02 AOS 02/01/05 03/01/06
COMBINED SINGLE LIMIT $ 1,000,000
B X ANY AUTO TAP 2938865-02 TX 02/01/05 03/01/06
B ALL OWNED AUTOS BAP 2938864-02 VA 02/01/05 03/01/06 BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
(Per accident)
NON-OWNED AUTOS
X SELF-INSURED AUTO PROPERTY DAMAGE $
PHYSICAL DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
A EXCESS LIABILITY IPR 3757 608-00 02/01/05 03/01/06 EACH OCCURRENCE $ 5,000,000
X UMBRELLA FORM - AGGREGATE $ 5,000,000
OTHER THAN UMBRELLA FORM $
C WORKERS COMPENSATION AND 5899472(AOS) 02/01/05 03/01/05 X ORY L HITS I OTH-
ER
EMPLOYERS'LIABILITY
C 5899479(ADS) 03/01/05 03/01/06 EL EACH ACCIDENT $ 1,000,000
E THE PROPRIETOR/ X INCL 5899477(NY,WI) 02/01/05 03/01/05 EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
E OFFICERS ARE: EXCL 5899484(NY,WI) 03/01/05 03/01/06 EL DISEASE-EACH EMPLOYEE $ 1,000,000
F OTHER WORKERS 5899475(AZ,ID,MA,MD,OR,VA) 02/01/05 03/01/05
F COMPENSATION CONTINUED 5899482(AZ,ID,MA,MD,OR,VA) 03/01/05 03/01/06
D 5899473(CA) 02/01/05 03/01/05
D 5899480(CA) 03/01/05 03/01/06
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
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CERTIFICATE HOLDER CANCELLATION .
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL an DAYS WRITTEN NOTICE TO THE
FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: /,J1.1.4.4-4,A,1
MM1(3/02) VALID AS OF: 02/01/05
DATE(MM70DIYY)
ADDITIONAL INFORMATION ATL-000915907-02 02/01/05
PRODUCER COMPANIES AFFORDING COVERAGE
MARSH USA, INC. COMPANY
ATTN:ELIZABETH BRISENDINE (404)995-3568
OR BRENDA BOOKER 404)995-2594 E ILLINOIS NATIONAL INSURANCE COMPANY
FAX(404)760-5768
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3475 PIEDMONT ROAD,SUITE 1200 COMPANY
ATLANTA,GA 30305 F THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
100492-IPUSA-GWA-03/04
INSURED COMPANY
THD AT-HOME SERVICES INC.
DBA THE HOME DEPOT AT-HOME SERVICES,INC. G N/A
HOME DEPOT USA,INC.
2455 PACES FERRY ROAD NW
BUILDING C-8 COMP:INY
ATLANTA,GA 30339 H
TEXT
WORKERS COMPENSATION POLICY#5899476(TX) POLICY PERIOD 2-1-05 TO 3-1-05 CARRIER NEW HAMPSHIRE INSURANCE CO..
WORKERS COMPENSATION POLICY#5899483(TX) POLICY PERIOD 3-1-05 TO 3-1-06 CARRIER NEW HAMPSHIRE INSURANCE CO.
WORKERS COMPENSATION POLICY#5899478(QSI) POLICY PERIOD 2-1-05 TO 3-1-06 CARRIER AMERICAN HOME ASSURANCE CO.
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CERTIFICATE HOLDER
.um• �6.;du� .�...+`€kC.. � Oe.,�.ebl:#ti�b.�+.f.3w.eYi'.. "a+uc".��K X',tt..:.: .
FOR INSURANCE PURPOSES ONLY
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MARSH USA INC.BY
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1-S ID(.!-7 4;:-.,--;..,"-.:...;.3 f:
N F RC: 2001
ENERGY PERFORMANCE RATINGS
U-Factor(U.S./1-P) Solar Heat Gain Coefficient
0 . 2
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 49 •
. .
Manufacturer stipulates that these ratings conform to applicable NFFIC procedures for determining whole
• product performance.EFFIC ratings are determined for a fixed set of environmental conditions and a
specific product size.Consult manufacturer's literature for other product performance Information.
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Order #:3 Ell 0 9,7'3 0 3 0 6 0 L 40318 HS
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Ow ionantattee•eald or....."(Azeoacitudea-i
',L..... Board of Building Regulations rmtl Standat•ds I
HOME IMPROVEMENT CONTRACTON It
AV-;--- Registration: 126893 •
$„---=-2.:--- 4
\., . Expiration: 8/3/2006
Type: Supplement Card
1,
THE Home Depot At-Home Servic
RICHARD FALLONE
3200 COBB.GALLERIA PKWY#20 .
aLTANTA,GA 30339 • ""' __,..--t---j
Administrator
HOME IMPROVEMENT CONTRACT
�4��� ' C;) Sold,Furnished and Installed by:
Branch Name: Date: THD -dme ,Tne
d/b/e The Home DAtepot Aot•Honle SServiceservices
r ' )(C 3 345A Greenwood Street.Worcester,MA 01607
Branch Number, C�I U Job;I:: Toll Free(800)657-5 1 82; Fax:508-756-2859
Pedant!IDA 75.2698460 MB Lie C C 02420 RI Cont.L,ca 16427
CT Lien 565522; MA Home improvement Contractor Reg.N 126592
44
Installation Address! 6'i C-4--2 'S 4^' LJ t_)c 4_ (..1 4?/2 A.,[ill I
- City State Zip
Purchaser{0. Lair 4 Di of Orivor's Lie.N A cep,Mo/Yr: Home Phone:
i2t� R6Jl� li �+ oil a y?73_'��
_C 1�Sku�-10.) ( ) (tit )s us'
Home Addressl l l-7 lJL t 2 11-0. _ (r7 --17-u iz g k • ALL I.Q. • ..1.-A.J 41 7 '
(If ciiffercnt from installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Proje t ter format] : l/We/You("Purchaser"),the owners of the property located at the above installation address,offer to
contract with Home Depot U.S.A.,Inc. m��epot furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet it; Ca L ,incorporated herein by reference and made a par.hereof.
Rome Depot reserves the right to cancel this contract if,upon rc•itlspectiun of the job,Hume Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required Co complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS
(Sub.]at to food vedf,canon¢nd/or credt approval.)
CONTRACT AMOUNT S."31 ah,Check.Coers Check ar US Rataf Ser a Money Order
I— �, (Made payable to The home Depot).
`LESS DE 1
POSIT S 2. Credit Card'a het payimat option:-Circle Oae Driew
V i V ucovc' Arrwcica-.Fay res:
BALANCE DUE
ON COMPLETION $a • Thu Home Depot Hama lmprovatm¢:Lots 'Ihe Siomc Depot Credit Cord
Avnllabte Credit:$ (NIL eL 1i1)CC ONLY) /,
`Min1IDam 25%of Contract Amount due upon execution 4^� l��t / t/(i S AS Date'
Li . V'.-.!
of this contract. AcctA: I Q�`c�/!J b� lr�Evp'Dote_{ //1/"� /,,
Name¢n it uppeaH on anent. r"r l.�. 1 ti.0115 Dd"i .- .---t✓
Indicate Payment Method For •13y nryt04r signature below,l/we aunt to allow Flom^_Depo'to clmrye the above
BALANCE DUE ON COMPLETION: wfereneod credit card for the deposit indicated,
3Lt 5 l 2-t,,,IGLk D gci cj3 - -- - —_Lc' 't() s_':5
r Cr. holder's Signature Date
h
f 45t 64v2
r HD,or TIDCC Authuraatitn Codes -1
Deposit Final Payment
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due. Pm-chaser also agrees to be jointly'and severally obligated and liable hereunder.
Fntirc erecmcnt:TltiS agreement and its attachments,including any financing agreement,contain the complete agreement
etween:he,parties and can not be amended or modified unless in writing in a separate agreement signed by horn parries.
NOTICE TO PTJRCIIASER
Do not sign this ct'otract before you read it. You are entitled too completely ailed-in copy Of the eentroct at the time you sign, Keep
it to protect your right;- Do not sign any Completion Certificate or egcemcut stating that yeti are satisfied with the entire project
before this project is complete. Law prohibits home repair contractors trout requesting or accepting a Cotnplctfon Certificate signed
by the owner prior to the actual completion or the work to bat performed under the contract.
e
C au trurt,runnel anccllattoe this
u Planitionaof title thaw Torhere o midnight
hhe u servf the ice charge eqird business ual tof2j%buf date con this
tro i amount If the job it
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW.t(W E AG1tEN TO BE 1i0UNT)BY THE TERMS OF THIS CON'rRAC f, 1/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MYIOUR
CREDIT HISTORY AND 1/WE AUTHORIZE HOME DEPOT AUTHORIZED CONTRACTOR.TO VERIFY AND REVIEW MY/OUR
CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY
INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. DO NOT SIGN THIS CONTRACT IF THERU ARE ANY ITLANK
SP.U:ES. �_„
SUBMITTED SY _ ' tLl �`a_.. � Date:_�C • C Q '
lee Cocfultaat to IC, >✓�
ACCEPTED BY: It .? u d Datc
Idosn t , ICI.CD ice)
L.wkon �,.� Date: t�
llomcowner
NOTICE:ADDITIONAL TLitLMMS,coNDrrlON;i A1dD WARRAhYDtS ARc STATED ono THE RL'G'EIL.E SIDE Agri ARS PART OF TIt15 CONTRACT
waur-.Br¢nd Pita Yrllea-Customer P;ak-Solo Coatattort
019-d 200/900'd EBE-1 9102E62E117+ 10dea aw ___oH-tQad 1D:80 50-dt-Of __ —-