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17A-132 (5) 264 CHESTNUT ST BP-2021-1056 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 132 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2021-1056 Project# JS-2021-001793 Est.Cost: $9176.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 106106 Lot Size(sq.ft.): 10715.76 Owner: CALLOWAY DENISE Zoning: URA(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 264 CHESTNUT ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 () Workers Compensation NORTH PROVIDE NCERI02904 ISSUED ON:3/24/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 15 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. ( i I• . r p1 n„�. Certificate of Occupancy Signature: I Y FeeType: Date Paid: Amount: Building 3/24/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner lip -�� Department use only WICity of Northampton Status of Permit �_, �, Building Department Curb Cut/Driveway Permit `� 212 Main Street Sewer/Septic Availability .* . = Room 100 Water/Well Availability It!: CVm a Northampton, MA 01060 Two Sets of Structural Plans 2 a � Y phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans z 111^ z Other Specify -_-:,, ARPLICA4ilON 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 completedj by office 0244( Ciesbi /Stzrec11 Map 74 �/Lot / � Unit No//44r►�/>4`n 011A 0 lc6 Zone ! Overlay District !/ Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:�e n I sc ra..12. d 6 y PCs/4 clir - I4,-/4 6^ Al/--. Name(Print) Current Mailing Address: - Z`, Il ) Telephone oe - yS /"4 p Tele hone Signature 2.2 Authorized Agent: 6er-a/J L. Cra Atte 74.— 4,5 %w10,1�2..e/ G-•�c_ 645-4 ,' ‘ cT Name( nt) Current Mailing Address: - c#.„ --"-- --/ Ae - 95-L - II//Z Si e Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building l pl. .6 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) #0 5. Fire Protection fir 6. Total =(1 +2+3 +4 +5) 67/�.G ,al? Check Number /�j /25 /, This Section For Official Use Only Building Permit Number: 6 —0)/' /l06v Date Issued: Signature: - 2q -Z02/ Building Commissioner/Inspector of Buildings Date 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: I.: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding e been issued for/on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOWOr— YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW OV.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 O NO GV- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES © NO (e. IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exca tion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 0 Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [0 Siding[Dl Other[Dl Brief Description of Proposed Work: Odd Arldete / w/'odvd' ilme, r+i ,(I yl/I q0 54,7Cs./G Alteration of existing bedroom Yes ✓'No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll -Sheet 6a. If New house and or addition to existinq housing, complete the following: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 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 !, /fiSC (4141 , as Owner of the subject property //// / ;% )IIC hereby authorize A artt.( � ,F� 47to act on my behalf, in all afters el ve to work authorize this building permit application N (W144 5— etivi Signature of Owner Date I, 6rK a C 1r44 On- , 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 penalties of perjury. �� Cra t G, �/'w�' /)' Print Name 3 - L S /2.0e,1 Signature of 0 er/Age Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 / Not Applicable 0 Name of License Holder: &1471 t. el.�v�a P '�-� �.b A j°, clef 45 le G/G C. License Number a; 4•41 Ctri,a,/ All bfi 9 7/2.- Addr s Expiration Date (, 4d) 4p3 -- 3 35- - 3qv2_. nature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 #� ay./ 4rsi G !,z Company Nam Registration Number 2YS.� r<ls �r�� 4o. J y/Lz/Z, Address/ / Expiration Date /E1`/Lt h,‘ ll A 30 33 ? Telephone 01 95Z-Wiz- 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 build permit. Signed Affidavit Attached Yes No 0 11. — Home Owner Exemption 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 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. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning ws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: .24;z( l' ,S/YrS , t"794 /0/06 z. The debris will be transported by: Cray- a• 4e.4.e,.l.0z The debris will be received by: $.w ,eys G(J ? T c Z Z 6rew C r • Building permit number: Name of Permit Applicant G "e4je' Cyr" �� L3 - L / 6r--) . , Date Signature of Permit Applicant Go Permits, LLC 105 Buttonball Lane G Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Massachusetts Solid Waste Affidavit Good day, Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 • 375 Airport Drive Worcester, MA 01602 • 12 Linscott Road Woburn, MA 01801 • 50 Maria Ave Johnston, RI 02919 Thank you, Go Permits City of Northampton r4kti Massachusetts ,, . . �: ,A, vt 1: DEPARTMENT OF BUILDING INSPECTIONS _ 212 Main Street . Municipal Building -- � • Northampton, MA 01060 ' , `' . INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building 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 a made 1 I, (..t/i4 understand the above. a(Home owner/resi en 's sign ure req esting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 3 - 2, - 202- / Address of work location 2- b f C leb/.z'f 5y €- /14// U 4- Md O/06 L The Commonwealth of Massachusetts W.. ____ ___-_--- Department of Industrial Accidents :I Office of Investigations - Lafayette City Center" ` 2 Avenue de Lafayette. Boston, MA 02111-I;,50 . - www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinessrOrganizationlIndividual): Home Depot USA Address: 2455 Paces Ferry Road City/State/Zip: Atlanta, GA 30339 Phone#: 860-952-4112 e Are you an employer?Check the appropriate box: I pc of project (required): 1.[] 1 am a employer with 4. M 1 am a general contractor and 1 6. New construction employees(full and/or part-time).' have hired the sub-contractors 2.[J I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. J Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required] 5. 0 We arc a corporation and its 10.0 Electrical repairs or additions 3.Li I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152,§1(4).and we have no employees. [No workers' 13.:$ Other window replacement comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this afftdavtt indicating they are doing all work and then hire outside contractors must submit a new affidas it indicating su:h. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities has c employees. If the sub-contractors have employers.they must provide their workers'comp.policy number- I art an employer that is providing workers'compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: National Union Fire Insurance Company Policy#or Self-ins. Lic. #: XWC 1647259(OSI)(MA) Expiration Date: 3/1/2022 Job Site Address: 264 Chestnut Street City State/Zip: Northampton MA 01062 Attach a coPs of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 a day against the violator. Bc advised that 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 -V--1° -— Date: 3/22/2021 Phrmc -- 860-952-4112 Official use only. Do not write in this area. to be completed by city or town official. City or Town: Permit/license # Issuing Authority(check one): IC3Board of Health 20 Building Department 30Cityllown Clerk 4.0 Electrical Inspector 5EPlumbing Inspector 6.DOther Contact Person: Phone#: WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1VE9KNQX Sheet: 1 of 2 Customer: DENISE CALLAWAY Job#:1-1VE9KNQX Consultant: Kyle Harmon Date: 03/19/2021 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, 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 c7, o Mull "S"=stationary or re Style Wraps m k cp s` 0 § f § f p X"=operating Room Floor Code (Y/N) Style Code Series Code i S H u Uo a _ �> -J > I STD,Dark Bronze, WRAP,LSR 1 LIV 1st SH-A Y OH 8500 0 WH 38 61 97 TMP:Bottom, GlassPack:Standard STD,White,TMP: WRAP,LSR 2 LIV 1st SH-A V OH 8100 WH WH 36 81 97 Bottom, GlassPack: Standard STD,White, GlassPack: WRAP,LSR 3 DINE 1st SH-A Y OH 6100 WH WH 36 49 85 Standard STD,White, GlassPack: WRAP,LSR 4 DINE 1st SH-A Y DH 6100 WH WH 38 49 85 Standard 5 DINE 1st SH-A Y DH 6100 WH WH 36 49 85 St STDndardte, GlassPack: WRAP,LSR STD,White, GlassPack: WRAP,LSR 6 KITCH 1st SH-A Y DH 6100 WH WH 36 49 85 Standard 7 KITCH 1st SH-A Y DH 8100 WH WH 36 48 85 STD,White, GlassPack: WRAP,LSR Standard STD,White, GlassPack: WRAP,LSR 8 KITCH 1st SH-A Y DH 6100 WH WH 36 49 85 Standard SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard 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: Seatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1VE9KNQX Sheet: 2 of 2 Customer: DENISE CALLAWAY Job#:1-1VE9KNQX Consultant: Kyle Harmon Date: 03/19/2021 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use B v Q _ s c Mull "S"=stationary or 1 •c L L g d m • i4 p°p c`1 ° "X"=operating W Style Wraps m a g C7 o m a m B m o C Room Floor Code (Y/N) Style Code Series Code 3 x I—u5 U n > x > 2 STD,White, GlassPack: WRAP,LSR 9 DEN 1st C10 Y C1-0 6100 WH WH 18 51 69 Standard L STD,White, GlassPack: WRAP,LSR 10 DEN 1st C10 Y PW 6100 WH WH 38 51 89 Standard STD,White, GlassPack: WRAP,LSR 11 DEN 1st C10 V C1-O 6100 WH WH 18 51 69 Standard R STD,White, GlassPack: WRAP,LSR 12 BED1 1st C10 Y DH 6100 WH WH 32 49 81 Standard STD,White, GlassPack: WRAP,LSR 13 BED1 1st C1O Y OH 6100 WH WH 32 49 81 Standard STD,White, GlassPack: WRAP,LSR 1 MBED 1st C1O Y OH 6100 WH WH 36 49 85 Standard 4 STD,White, GlassPack: WRAP,LSR 15 MBED 1st C1O Y OH 6100 WH WH 40 49 89 Standard SPECIAL CONSIDERATIONS: 9:White,10:White,11:White,12:White,13:White,14:White,15:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard 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: Seatboard Material(vinyl only-White Pionite,Birch or Oak) • - - - • • - - - • ... • - • . I ra u ac ure• .y imon on Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC (all with Argon) Fact Fact 6500 ,wring 6500 Base ProSolar Supercept 7/8" 0.26 0.23 • • • 0.26 0.21 • • ,• ' :asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 • • • • 0.26 0.22 0 • 0 • ransom 6500 Base ProSolar Supercept - 4227 0.32 • • 0.27 0.29 • • louble-Hung 6500 Base ProSolar Supercept Ire" 0.29 . • 0.29 0.24 • • • 'icture Casement (NH) 6500 Base ProSolar Supercept 7 . . • • 026 0.25 • • • • icture 6500 Base ProSolar Supercept 7/8" 0.27 029 • • 0.27 0.26 • • Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 • • • Panel Sliders 6500 Base(s 21 sett) Pro Solar Supercept 7/8" 0.29 026 a 0.28 023 1•I • • .500 DOORS garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 I•I•I.1•10.30 0.21 1•I•I •I • atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 o o 0.31 0.23 • • • • 0 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. wning(Inc Hopper) 6100 Base Pro Solar intercept 7/8" 0.27 0.24 0 0 • • 0.28 0.21 • • • • ':asement • 6100 Base Pro Solar Intercept 7l8" , 7 024 • • • • 027 0.22 • • 0 • ouble-Hung 6100 Energy Star Pro Solar Super ept 3/4" 0.30 0.30 • 0.30 0.27 • • I o icture Casement(No Fringe) 6100 Base Pro Solar Intercept 7 0.28 • • 0.27 0.25 • • • • icture 6100 Base Pro Solar Intercept 3/4" 027 0.31 0 0.27 0.28 • • Panel Slider 6100 Base Pro Solar intercept 3/4" 0.30 0.28 c' 0.30 027 • Panel Slider 6100 Base Pro Solar tntescept 3/4" 0.30 0.29 I I _•I 1 0.30 0.27 • 1100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" 0.28 0.26 • • 0.28 0.23 I I- • j I1 •1•1•10, atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 0.28 0.26 • 0 6200 Homes located only in following markets:Dallas,Denver,Detroit;Phila,Northern NJ,Long Island,NY. wring 6200 Base Pro Solar SHADE Supercept 3/4" 027 0.25 • •l =• o 0.26 0.23 c t o c 3 asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • 0 © 0.29 0.17 0 • • • icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • • • • 0.25 0.19 • • 0 • icture Window 6200 Base Pro Solar SHADE Supercept 314" 0.26 0.24 • • • • 0.26 0.22 • • • • Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 a • • • 0.28 0.21 • • • ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 0• • 0.28 0.21 I•I •I 0 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • a • 0.28 0.21 ' • • "tormBreaker Plus 300VL Homes located in coastal areas. wning SB+300VL Energy Star PS SUN/Lami Supercept 1' 0.26 0.23 • • • • 0.26 0.21 • • • • asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 • • • • 0.25 0.21 • • • • ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • a e • 0.29 0.23 • • • 0 lider SB+300VL Base PS/Lami Intercept 1" 029 025 • • c • 0.29 0.23 • • • • atio Door SB+300VL ETC 366 PS Shade/Lam, Super Spacer 1" 0.30 1119 • • ^ • NC.GnusAiiowed amen Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • • 0.30 0.25 c 1.FIG )ots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. Go Permits, LLC ' 105 Buttonball Lane 43110 WI Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 w - scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day. Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/21 Workers Comp.- Union Fire Insurance Co. Policy XWC 1647259 (QSI) (MA) Exp. 3/1/22 Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor. CSSL-106106 Exp. 9/29/22 HIC 187666 Exp. 5/9/21 Workers Comp.Associated Employers Ins. Policy WCC-500-5021510-2021A Exp. 1/17/22 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits@gopermits.orq • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you. Go Permits AC-c R)t) CERTIFICATE OF LIABILITY INSURANCE DATERNSOGYYYYE 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 Iieu of such endorsement(s). PRODUCER. CONTACT NAME • MARSH USA.ACPHONE AX TAO ALLIANCE CENTERum Na Ever I uIAC NAP 3560 LENOX ROAD 5UTE 2400 EMAIL ATLANTA GA 3032E AnoRFSS - INS UREPI$I AFFORDING COVERAGE NAIC I Ct1101642055HomeD-GA i.-21-22 INSURER A CC ReN01C rS.13TICE Co 24147 MISUSED T!E HOLE DEPOT.INC INSURER B XI.,:^Y.�il[C�ISfP Co19�'3i HOVE DEP2TU5A NC. NSUPERC 1,ctnnRbt .1.1:ra<:r ranceConvoy NA 2455 PACES FERRY ROAD BUI'DNS C-20 INSURER 0 ATLANTA GA 30339 MIIIJIER E: INSURER F: COVERAGES CERTIFICATE NUMBER: A11006D772225.04 REVISION AMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LICTES BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR.CONC..'TION 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 MAP HAVE BEEN REDUCED BY PAID CLAIMS. RIM POUCT SW POLICY DR ON TYPE OF MIMIUNCE IDOL MID POLICY UMBER IVQYYYYYI L Ipp1YITY1 UNITS A !i COINERCLAL GENERAL LAANaITY RANZY 314574 03I01,2019 03212022 EACH OCCURRENCE $ 1,003.000 OPAIACE RENTED CLM C NS�.NCE CCCUR P TO set S 1.0001000 x. SR.SI OM 000 NED EXP tAm.one Demon. S EXCLUDED PERSONAL&ADM INJURY $ 1000.000 GENI.AGGREGATE LAST APPLES PER: GENERi1 L GREGATE $ 2000.000 X POLICYr7,F° DLAC PR_Ct:- -:GlP/OPAISG I 2000.000 'TER 5 AUTOMORILEUAAIUTX IAVTB3M573 33.D1M19 0301 1 E'NED SINGLE LIMIT 5 I MAX x wrAUTO SELF I88 NIIOPHYCMG BCO.Y AWRY,Perovlall 3 OM MED SG A �gU'EOIAED (COLT RLAJRY�TlMRROO 3 — AUTOS CIAO, �J HIRED �. N AUTO.OILY COPE TYDNAAGE S AUTOS ONLscr UNBREU.AUAG cCOJR EPO4OOCBB1E.NCE $ ^— EXCESS LAG CLNEi1AACE 1GCREGATE 1 DEO J J RETmmON i E WORKERS CORRENSATION NC 50240269 W) 33 311 23_1 :2, 1 23= x 1 PER I �OTN AND 9PLOY9Rr UABIITY sT1TLRE ER B AJ+YPR-OPP.IE''ORPART8LE1lECUT A (� lIkR mimosa MC. A. 33 31_w l ..���_,.� EL EAv+M;:DER' S 5 000 000 OF1:1GFR IMF LEER EA UOED- I I N A I ISanntorl'In Ill camsiec On M000IU Page El.a.EA.E-EA EJPLOYES i 5 OOC 000 M DESCRIPTION OF OPERATIONS Oteri El.DLPEAOE-PCLK.Y uMIT 3 5 00C 000 C EAtess Amu 37110011CCo2.+ 33 31 22321 X.C12fi 2 LIM 4 000 DOC A Excess..relie01 UMW! SIAM 3145d3 33 31.3319 35C 1=2 Ur* S MO EC DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IACON O 101,A001Wna1 R ma&/*anemia_may S 11611011.43 If mart armee la remand; E'.C'ENCE OF INS-RANCE CERTIFICATE HOLDER CANCELLATION HOLE OEPOTUSA NC SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE 455PACES FERRY ROAD THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN BUILD NG C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTNOPI EDRPIESENTATII,E of Mann USA Ina I V3nasr.v.Itrle TAa uoloa. M.4.4c.K A�-e< 1988-2016 ACORD CORPORATION AN rights reserved_ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 10184206g LOC U: Atlanta AC ROr ADDITIONAL REMARKS SCHEDULE Page of 3 Aae*c► NAMED INSURED 1MR&f USA,NC. __ ",_ ►oterufNINER _:E3FE F1 CAME* NM CODE EMI ZINNDA1B ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Namee Conoeneebor Co rued Ceder Inderrty*ewence Comory of NoM Amerce Pfspfisnber i LR C6'a:5_'r iALAR FL.6,14KS.KYLAJIS,MONEltl1111,140,OII,SCrS0 ,W l BlerieDie 03912921 Elpiiwr011a 0301.2 .54 Lint$5.000A00 Circler AL insrence Cc Pak?.\amber tIC X3095003 IAK.DC DE.MI.PA110,11k,VTJIYNNYJN,VT) Efkct.e Cek 0391,20-�t Etprebcn:sie 0391 ELL-t.S5 000.MO :aTer ACE An a con Ire.r.ce Camprgr Pof,cy Number Y1CU craO5331[OSII lC4 L,OR,If1:1 Efkcbers*03911121 Eaprekon Crle 03A1;2022 XL;Lmt 35 000000 S112 El900,000 :emr%eked Unanfee beano Company Policy Number XNC tStTYA(Oril1iCO.L`TAI►,11EA1f.M',Of'I,AAi1Tl EAed r Ode 0391,321 Eepeslal Cod.0391:2022 1ELI Lent S4 t100900 SIR 000900 Csner ACE Ammar Inddece Csrnperry Poky Monter A4LR C6711103 IA4 °flectrre Ode.039124-'t E*Drafen Ode 0301,2O2 E..Led S5.000..000 :emir.Maker'Uxr+Fee'trident Company �xrx Number XNC 154729RCC i;INA: Eikcb.t:eit:039t'2021 &prim Ode 0381r2022 ELl Let S4,500000 SIR:1500A00 -1(Employed AS Inbnr2y- Cernerin m Union Tr-wenoe Canpry Rol,q.Number'ha'C66444D 2.�T1C Effect 03491,2021 EZDrebon Ode':0391,2022 Leek MEOW SIR:S1,000,000 ACORD 101(2008101) :)2008 ACORD CORPORATION. AN rights reserved The ACORD name and logo are registered marks of ACORD tr/k W0,12/nefielle&de0-A00:44€7.044e-a.1- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplernent Card HOME DEPOT USA INC Registration: 112785 P O BOX 105451 Expiration: 04/2212021 ATTN. LICENSE MGMT TEAM ATLANTA,GA 30348 SCa t A zOMosn Update Address and Return Card. ei4 Omrce of Consumer Affairs&Busir se Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoplerrent Gard before the expiration data. If found return to; R.9.21111131620 Ew iceBOn Office of Consumer Affairs and Business Regulation 112785 04,22t2021 1000 Washington Street •Suite 710 HOME DEPOT USA INC Boston,MA 02118 RICHARD OLf4STEAD / — 2455 PACES FERRY RD C-1'HSC i,'/.1"G ' T` ATLANTA,GA 30339 Undersecretary Not valid without signature EXTER-2 OP ID:DM A«�R CERTIFICATE OF LIABILITY INSURANCE °"'�' °""�"' 01M8f2021 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 POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TIE ISSUING INSURERS). AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER_ IMPORTANT: I the certificate holder is an ADDITIONAL INSURED.the pollcylles)must he 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). PROOUCER Canary Blomstrom Ins.Agency MANE ecT Debbie Marino rwx 368 Springfield St. MM.�'-413-709-399S tArc,Mel 413-786-7004 Feeding Hits,MA 0103e-2151 ADORESs.dmarinoecanarybiontstrom.com INSURERfS}AFFORDING COVERAGE AMC a NsuRERA.Associated Employers Ins.Co. INsuREo Exterior Remodeling Group Inc. mums.Main Street America Group *939 Eugeniu Ciubotaru 23 Benham St .NSWRERC _ Springfield,MA 01109 NsuRER0. INSURER E IMIME F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLKAS OF!'EURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDI1 ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'IMPUGN THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLiIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MA'Y HAVE BEEN REDUCED BY PAID CLAIMS TITS CIF eltewANCE RDOL 6IIdt r POLICY EFF POLICY ESP tir /WO WW1 POLICY RUMMER IMIII DOIYYYYI IMMoOIYYYYl• UNITS 8 cour e'AL0E11mM.Lamm EAcnoccuERRENCE s 1.000.000 I owtesmAne X�am.* X MPP3376W 07d2712020 07127/2021 e41416E 731IENTEID X Business OwnersPH£Lt15ES tE,i wumnt�+u _S 500.000 MED EAP i Inc P01MA I 3 10,000 PERSONAL&ADY'!NAP* f 1.000,000 GENt AGGREGATE LET APPLIES PER GENERA.:AGGREGATE $ 2.000,000 X F'GL1cY❑F Q IL GC =..CCAtP.tOP AGO $ 2,000.000 OTNER AUTOMOIME LMEIIY 'C� rySINGLE MET $ 1,000,000 B ANY AUTO MPP3376W 07/27/2020 ■DDLYMAURY$Prmwl $ ALL OWNED —SCHEDULED ROSILY INJURY rev aMAbe) s AUTOS AUTOS X HIRED AUTOS �NOUCFANED Fnupenv iara x .�. + AUTOS SPINNNAMMI e.IMMREL►ALMe oa m EACH°CCt ICE Excess tLis H nA..,.ADE AGGREGATE s 1 I RE1anirNs '$ WORKERS COMPENSATION ► _ I�IRITE I x 1 ER AND EMPLOYERS LNefITY 0MAM A AN,PR:nNRtETL PARTNEIOBEUIME I_ _ !A WCC-500-5021510-2021A 01,1712021 01/17/2822 EL EACH AacIDENT $ 9 OFF tCER.1ENGER E CLLOECO f�1I�,',' SINmemoty M een E L.DISEASE-EA ELP'LOYEE\$ M.999 If yyccs Oes.I'Ee'6r!.O DE SCRIPT OR OF OPERAT IONS tralom E L DISEASE-POLICY UNIT j NON DESCRIPTION OF OPERAT➢ON r LOCATIONS YEHN:LES IACORD let,Aa%aNM Rasr5s SCAB dry Y lMaeud I awe fpu M wquY.A Home Depot U.S.A.Inc is named as Additional Insured respects to General Liability. CERTIFICATE HOLDER CANCELLATION HOMEDE4 SHOULD ANY OF THE ABOVE DEICIIIIIIIIPOUCESIMECANCIRLII0 BEFORE RE THE EXPIRATION DATE THEIMICIP. NONCE mill BE IIINERED IN Home Depot U.S.A.Inc ACCORDANCE YNIN TIE:POLICY PROVISIONS. 2455 Paces Ferry Rd C-11 Atlanta.GA 30339 AUTHORIZED REPRESENTATIVE latbOA-4-1- L !l)o tov O 19811 14 ACORD COX ORA11011. Al rights reserved. ACORD 25(201401) The ACORD name and logo are registered marks of ACORD The Official WebaAe of the Executive Office of EOHED.the Drvsan of Pr00C3301180 l,rnrAwe rnd the ONCGIM of;tanearda NSW Public Safety1. • ; -» Maw • >}a!a Atoro�c 0 Mass. Licrtisrr Details Demugr.apliic Information Full Name EUGENIU CIUBOTARU Owner Name: License Address Information City. Springfield Slate. MA Zipcode. 01109 Country. United States license Information License No CSSL-106106 License Type- Construction supervisor Specialty Profession Building Licenses Date of Last Renewal- 9/142020 Issue Date 4/12/2017 Expiration Date 9r29r2022 License Status: Active Todays Date: 9r162020 Secondary License Type. Doing Business As. Status Change Reason. License Issuance Prerequisite Informdion Licensee- CIUBOTARU,EUGENIU Relationship' Attribute Of License No- CSSL-106106 No Ava►taDle Docu is Owe NMWow • MASSACHUSETTS DRIVER'S •a�= _ .; ' _ LICENSE - }. •�.tt.'• ..�._; " s > MR 09115120t6 -$443160 , R • 2912021__=091291198 • Utz , , z EUGENA! l • • • •'�'. • ; , ;�a23 BENHAM STREET .• • ` SPRINGFIELD,MA01109-2301 • • •~•.. 'fit-. '1 -.�'S•r --. .. • -`N-451119tI Son OT f- n : ' :;Y 50DMVIMIS1 ►arar2.s. , 0912S Office of Consumer Affairs & Business Regulation 1OME IMPROVEMENT CONTRACTOR TYPE: CofooraGion Registratiop E,xpir ion 187666 05/09/2021 ° � z REMODEUINGGROUP INC _ . _ _ _ OT RUJ . ti G 109 Undersecreta ea,9, enact P.( aumoriizeGo Permits Li.i; to permits pun using PC my t_.a License /0 Q 6 anti my HlC Registration# / ziv 6 6 6 r • aucctions please call me at (qi 3) 3 3 5=3 7 Oa installer JiSG__ t.ompany ' off_ pup