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23A-055 (4) 31 MAPLE ST BP-2021-1347 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-055 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-2021-1347 Project# JS-2021-002223 Est.Cost: $4593.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 106106 Lot Size(sq.ft.): 32190.84 Owner: FITZGERALD REALTY CORPORATION Zoning: URB(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 31 MAPLE ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 () Workers Compensation. NORTH PROVIDENCERI02904 ISSUED ON:5/17/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 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 Signat 1 �. ' 1 • I I FeeType: Date Paid: Amount: Building 5/17/20210:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit I � �,/ { Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability l Room 100 Water/Well Availability IE72o2f orthampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans DEPT.OF duILDtNG in;—CTE- " _ - Other Specify NnRT �,+, � �./ EGTinki 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 ?&I maP6t Sdre-e - Map , 3/f Lot U S Unit R;inLnce ?In 0/o62- Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ril-L ,a, cJ a«.{ill 3/ 42ppi- 3fic,i ibre,we AMA a/O6 2- Na rri:(Pri Current Mailing Address: y!3 3 S— $--6 8 9 . Telephone Signature 2.2 Authorized Agent: i-4 I/ Cr-el.te.G — ( 4- /95 ,6u (9,n4-61 Cas G/al-A./A...I CT Name(Print) Current Mailing Address: �!O 6o1.3 F60— 'ICZ— 4/ft a- Si natur_e g Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee q593 . 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) /,C 5. Fire Protection j (� p 6. Total = (1 +2 + 3 +4 + 5) tj'$ ; al) Check Number a � 7 �/ This Section For Official Use Only ��� 4)� ,./3 / 7 Date Building Permit Number: Issued: Signature: / ( - 5 11 ' Z 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 1. R L: R: Rear Building Height Bldg. Square Footage Open Space Footage 40 (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW a- YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ( YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO Q" IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 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 Widows Alteration(s) n Roofing pi Or Doors Q' Accessory Bldg. ❑ Demolition ❑ New Signs [pi Decks [E3 Siding [p] Other[p] Brief Description of Proposed Work: jLixs� em� Xec(4 c 'ndwj 4-A4 G �s c,‘� , tS Alteration of existing bedroom Yes v".. 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 existing 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 J. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No I. Septic Tank City Sewer Private well _ City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, cif& 'e.g./1 ife. , as Owner of the subject property /_ hereby authorize 1+ PG/f- I (,1)/yA v 'i Wes* AZ/y(1--i to act on behalf, in all m tters1elative to work authorized by this building permit application. S�6 y— 2P1( Signature of Owner Date 6, 'd , 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. G[r4!ejC aft#i,✓ J.C. Print Name Signature of Owner/Agent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /t ' / � Not Applicable 0 Name of License Holder Cis 9Cn. Itiy.�4 r... »/ �Cis.,�dC!/�j /a' License Number Address Expiration Date C4,,,Z.--0 ry/?— 3 3S- S 2- Sig rlaCure Telephone P 9. Registered Home Improvement Contractor: Not Applicable ❑ lik,44.c pr.( („,A _ 1/2 -rs 5- Company Name f� / Registration Number ZY f ces '//i , e,/ /t/ Ca,-A' 64 'o37 7 Y/ZZ/Z 3 Address � Expiration Date �\J/'' Telephone gGr)-- 43-1-V(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 4Y No ❑ 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;'.e Local oning Laws and State assachusetts General Laws Annotated. Homeowner Signature 1 / �'/l�6' The Commonwealth of Massachusetts 1..— . , xt Department of industrial Accidents : r _ . Office of investigations Lafayette City Center ' 2 Avenue de Lafayette, Boston, MA 02111-1750 - . . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/(ontractors/ElectriciansIPlumbers Applicant Information Please Print Lei ibly Name iHusincss tkgantrituin Individual): Home Depot USA. Inc. --- Address:2455 Paces Ferry Rd CityiState/Zip,Atlanta. GA :',l s39 Phone#: .952-4112 Are you an employer?Check the appropriate box: Type of project(required): 4. : I am a general contractor and 1 I. 1 am a etttployer with - 6. New construction employees tfull andior part-timer)." have hoed the sub-contractors _ 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ?_ A Remodeling ship and have no employees Theme sub-contractors have 8. - 1 Demolition working for me m an capacity. employees and have workers' 1~ y ' P tY 9. 3 Building addition [No workers' comp. insurance comp. insurance. required.) 5. in We are a corporation and its 10.J Electrical repairs or additions 3.v._.? 1 am a homeowner doing all work officers have exercised their 1 t.J Plumbing repairs or addition. myself. [No workers' comp. right of exemption per MGL 12.j Roo frepairs insurance required.)4 c. 152. §t(4),and we have no Windows employees. [No workers' BIM Other comp. insurance required.) •Any applicant that checks bus vl mugs also fill out the section below shuµrng their wwnkas.compensation polity information. *Hisn uwncr,who subunit this affidar.it indicating they arc doing,all work and then hire euiidc contraeiurs must submit a new affidavit indicating such. :Contractors that check this butt must attached an additional sheet shays ire the name of the wh-cwntracturs and state whether or not thine entities hacc errrrhot:+... If the ul,,.i'nir,ctior'hatie emrli,aei,. they mint pro.id,:thin! could!?•'cm-nr r"I,., ,„'i,h I am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site information. Insurance Company Name:National Union Fire Insurance Co. Policy#or Self-ins. Lie. ,t:XWC 1647259 (QSI) (MA.) Expiration Date:3/1/22 Job Site Address:_ t gi 90/t 97ed CitylStat,Zip: #4 /r/NG "If D/OGL mttsch a copy 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 line up to$1,500.00 and:or one-year imprisonment. as well as civil penalties in the t.trm of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be 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 cV petjun-that the information provided above is true and correct. Signature: -"mac-- G-- —_ ,S-/y— 2 ort Dale: Phone x: 860-952-4112 O,ffidal use only. Do nut write in this area,to be completed bi•city or town official. ('lb or Town: Permit/License# — Issuing Authority (check one): ![Board of Ilealth 2[]Building Department 313City/Town Clerk 4.0 Electrical Inspector S. Iumbing Inspector 6..DOther ('ontact Person: Phone#: ._._._ _____ 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 budding 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: 3/ /04/0/4 9-fee Rarcice ama 2_ The debris will be transported by: a ,v P X6,44.>(le The debris will be received by: '1-2 shm f,&I d GT .0 Fez Building permit number: Name of Permit Applicant 6ecee fe' J . -.44.c� J. L Date Signature of Permit Applicant City of Northampton oa�4aMYro\ Massachusetts k2S .� '• u * t. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street . Municipal Building --�� Northampton, MA 01060 �s"w a+ol 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 are made I, /791i 4-// Arai understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date aj / Address of work location 3/ "l�‘ Vice /'!o✓e/t /1 W e2/ '6 Go Permits. LLC 105 Buttonball Lane Glastonbury, CT 06033 PEBM �� Scott Doughman K �'•• Phone: 860-952-4112 ,10404414, 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. Contact is Jason Timm 203-265-7037 • 72 Shaker Road, Unit 2 Enfield, CT 06082 (USA Hauling) • 32 Scotland Boulevard Bridgewater, MA 02324 (South Shore Disposal) • 12 Linscott Road Woburn, MA 01801 (ACME Waste Systems) • 535 Grand Army of the Republic Hwy,Somerset, MA 02726(EZ Disposal) When filling out any solid waste affidavit, it's the installer whom will be removing the garbage and dumping the trash at one of the above Home Depot dumpster locations closest to that job. Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1VR18H61 Sheet: 1 of 1 Customer: FITZGERALD REALTY Job#: 1-1VR18H61 Consultant: Kyle Harmon Date: 05/12/2021 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 - W A Mull "S"=stationary or c c t "rL B g 1 c g 1 c „X„=operating Style Wraps L m g g' a O s > f p f p Room Floor Code (Y/N) Style Code Series Code E 3 = Hai cg a > _ > _ STD,Dark Bronze, WRAP,LSR 1 LIV 2nd OH- Y OH 6500 0 WH 25 49 74 GlassPack:Standard HITILT STD,Dark Bronze, WRAP,LSR 2 LIV 2nd DH- Y DH 6500 0 WH 25 49 74 GlassPack:Standard HITILT STD,Dark Bronze, WRAP,LSR 3 LIV 2nd OH- Y OH 6500 0 WH 25 49 74 GlassPack:Standard HITILT STD,Dark Bronze, WRAP,LSR 4 LIV 2nd DH- Y DH 6500 0 WH 25 49 74 GlassPack:Standard HITILT STD,Dark Bronze, WRAP,LSR 5 LIV 2nd OH Y OH 6500 0 WH 25 49 74 GlassPack:Standard HITILT SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5: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) e ' ome Bepo - erma Va ue o Products Manufactured by Simonton Dated: 5/3012018 nergy • 3r a " Without Grids With Grids Style Glass Package Glazing Spacer IG tJ SHGC V SHGC (all with Argon) Fact Fact 6500 wning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 , • • • 0.26 0.21 0 0 e asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 :Is • o a 0.26 0.22 0 0 0 0 ransom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 • • Quble-Hun 6500 Base ProSolar Supercept 7l8"cQ 0.26 • 492V 0.24 0 • • icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • o • icture 6500 Base ProSolar Supercept 7/8"I 0.27 0.29 • • 0.27 0.26 • • Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 I 0 • • Panel Sliders 6500 Base(s_21 Sgft) Pro Solar Supercept 7/8" 0.29 0.26 • - 028 0.23 • • • 500 DOORS arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" I 0.30 0.24 I e • • e 0.30 0.21 e 0 0 0 atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 •' a l , 0.31 0.23 10' 0, • 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 a a a © 0.28 0,21 0 • a • asement 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 Dump 0.27 0.22 • • • • " ouble-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0.30 • 0.30 0.27 • • • icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 • • 0.27 0.25 • • • • icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • e ' 0.27 0.28 • a Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • I 0.30 0.27 • Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 _ e 0.30 0.27 I 0 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. atio Door(NOVO_ 6100 Energy Star Pro Solar Super Spacer 1" 0.28 0.26 0.28 0.23 0 0atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 1.1.1• • i 1 0.28 0.26 } 0, 0 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. wning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 a • • 0 0.26 0.23 • • • 0 asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 0 o c 0 0.29 0.17 • a a a icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • • 0 • 0.25 0.19 • • • • icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • e o 0.26 0.22 • • • • ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • o a Q 0.28 0.21 • • • ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • 0 • 0.28 0.21 0 • • Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • 0 • 0.28 0.21 • • • .torm Breaker 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 • • • c asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 • • • • 0_25 0.P1 0 0 • 0 ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • • • • 0.29 0.23 • • • a lider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 • • • • 0.29 0.23 0 a a • atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 • • • • Nc Grids A;lowed _ arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1' 0.30 0.28 • a . 0.30 0.25 • •1' • Jots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. V1 7+ Home Improvement Agreement: Page 1 Home Depot License#'s -For the most current listing visit www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Kyle Harmon Salesperson Name Registration#(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price,terms and conditions as outlined on this form. 1. Service Provider Contact Information The Home Depot I be Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 IKyle_t_harmon@homedepot.com Phone# Service Provider Email Address Service Provider License#(s) 2. Customer Information REALTY 1 FITZGERALD New England West 1-1VR18H61 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 31 maple st f Florence 1 MA 01062 Customer Address City State Zip (413) 835-5689 fitzgeraldproperties123@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT 06492 Address City State Zip 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 PAYMENT(S)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 THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW AC OWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN N ICE YOUR RI T ANCEL. Acknowledged by: 05/12/2021 Customer's Signature Date 4AW- , ► Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5.Anticipated Delivery Date/Installation Schedule Approximate Start Date: 07/07/2021 ' Approximate Finish Date: 08/04/2021 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. 6. 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. 7. 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: $ 4593.25 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If ap e ' . • • taro.:,?'ount of taxes included in Contract Price) '%IctVittaaaaai deposit(J\i.I' 'cable in MD, M=7,4 E(33N), NI, WI(99%) % 25.0 1148.32 3444.93 ti Deposit Deposit � *tint$ R- aining Balance $ L 8. Finance Charges Any interest payments or other finance charges will be •etermane• by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. Insurance proceeds will will not be used to pay some or all of the total amount of sale. 9. 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; (iii) all rights and interests under this Agreement are solely vested in e person listed as"Customer" above; and (iv)Electronic signatures will be deemed originals for all purposes. X j 05/12/2021 Customer's Signature Date X Is/The Home Depot [05/12/2021 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) For any other concerns, contact The Home Depot at 1-800-466-3337 Lbb-/U3/ L"0 4 Scope of Work REALTY FITZGERALD New England West 11-1VR18H61 Customer Last Name Customer First Name Store#/Branch Name Lead# Job #: (Internal Reverence) Products: Spec Sheet(s)#: Project Amount 1-1VR18H61 + Windows Entry Doors 1-1VR18H61 4593.25 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 4593.25 Notes: Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: VantagePointe 6500-6100-6060 Warranty Warranty Name(s): 6) � The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means the Home Improvement Agreement between You and Home Depot, plus (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions")and any documents referenced in or attached to any of the foregoing. "Defect"means any Services that are found not to be as warranted. "Home" means the real property, fixtures and any physical improvements where the Services are performed. "Services" means (I) the delivery and furnishing of goods, equipment, materials, and hardware; and (II) any related labor and services, including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance, repair, and testing. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement. 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES:(a)Payment: You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b)Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area, including, without limitation: (1) obtaining in advance of the Services consent,permission,or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2)providing the location of utilities, whether underground, concealed, overhead or visible, to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area; (5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area;(7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services; and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order").A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time, or both. Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. If You decline a Change Order request, You or Home Depot may terminate this Ag cement. The Home Depot General Terms & Conditions 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date that all Services will (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the warranty period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole option (i) correct or replace each Defect, or (ii) remove each Defect and refund the full purchase price thereof to You; provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement, or (2) You fail to pay Home Depot as provided in this Agreement. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY, OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES.HOME DEPOTS EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE,MISUSE,NEGLECT, ACTS OF GOD,LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS,MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c) Limitation on Damages. Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten (10) days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination, 9. CHOICE OF LAW: SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement. 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. ,` �.' The Home Depot General Terms & Conditions 11. SECURITY INTERESTS: LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed, unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed, You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e, goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its purchase price cannot be refunded unless Home Depot or Service Provider(1) incorrectly ordered item, or (2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the purchase price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE ORDER COMMUNICATION PREFERENCES: You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call);(2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order(including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program. Go Permits, LLC 4131105 Buttonball Lane t Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 , j' 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. 4/22/23 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: permitsagopermits.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 o CERTIFICATE OF LIABILITY INSURANCE °°'E NA"`°°" ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE 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 ?AMIR'1 I.-GA.NC NAME HON T O AeiANCE CENTER CNN F t I AC NU 3560 LENOX ROAD.ELITE ZOC SAW- AT.ANTAG.+A °'E DPcss S OURER{S,AFFOP.DIND COVERAGE NAO s C IDS. 5-22 INSLIRER A a!FeCS;Tr5,T311a. INSSIRED IMSWAEP e a, v;i zrce CC 13 THE HOVE DEPOT,INC. HONE DEPOT U.EA,NC. IN SLEEP.C hYrERRA a-zeiCttsu'Wk C rcagi i A 3555 PACES FERRY ROAD tN S..•FEP C BULDNG C-2O ATLMTTA:a191338 NSUIEP E. INSURER F COVERAGES CERTIFICATE NUMBER: A €USI 222SOt REVISION NUMBER: THIS 4S TO CERTIFY THAT THE D+:L.1CM: -_RANCE USTE.7 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F•:F ' _' _ER 2,22 INDICATED. NOTWITHSTANDING.ANY RE E ENT.TERM OR CONDSTION OF ANY CONTRACT OR OTHER DOCUMENT WITH r: T CERTIFICATE MAY BE ISSUED OR LIA- - 'HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS CLIE.,ECT TC A__'-1_ _ EXCLUSIONS AND CONDITIONS OF C :-__ __ _IM1TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NOR TYPE OF INSliAAJrC£ "-C L =F POUCY EFF POLICY EIP LTR INLC MIXT1IN.NBER 6101Oo'rrrYI DOSSIOrYYTYI WAITS A x OOMMERCSAL OENE7A,LAB.L—Y ..`"315574 0E'3I2019 0SC1= svy.+r o:= RE•+CE 5 I DDC.DOO _ _4koz.=T. FEV,G,. CLAMS-MAZE • -___ E":SEC Ea x_rmrce 5 1,000,003 X SR.SI OCC.O 3 ',!£D exP•AID we aersai 5 EXCLUDED _ -E'SOVAL A ACT..,MART 5 10OC.000 GEiI AGGREGATEUSeTAPPLlt.-".iPE_R CEAERA,ASKIREGATE 5 2000IIOO cva n-o= -CCAIP.l7em,c 5 2DDCOOD DINER 5 AIRTOMogN.ELuu1RRY I.^.I:"e3�a`; DSe0H2019 OSGt2D22 o SINGLE USAir 5 - I=ODD ;( AN'ALITI'1 tt �s';.[E:A,.-- ^'Jr.Iu &COILT AWRY Ref wow, S OMMrED DCOST NALIRT Per accicMt. f AUTCG CMiL -`' frJTC e_r,- C', PROPER•4YDAMA]E 5 t U A 51AB `:___. EACa!O; YiRENCE I Ex. sA LtAB .^-1'CEfGGREGATE S JFa ENT S e NKArIEP.3 COIAPERIATON .. -.._. •' "33tSS21 OS,Ji:"2O,"' x I I ER AND EMPLOYERS I uLRILITY C �' VsIP.: R1E-CrvFAR?.ERe IESEC ITLE OFFICER-VELIBER E]SY._L.CiECT •.. N ; • IMs ANcoy ti NHI COESLEG d'AtIatiyu F3ge EL.DGEASE-EA EVPLO`'EE 5 =If AN dractime aroer DESCRIPTOR CP OPER1^e5 SOON EL.D SEASE-Pr,.tICYUMR : --. C E✓ es AL,C 29711D0110Cl2I ...- ___I OS,C12022 Unit :rc::>C A Eerss 3ena3,:ice 5,M2X 31a510 n -- _ Ct 1.22 2 UT& ._X,_ DESCRIPTOR OF OPERATIONS'LOCATIONS LEMCLES.i ACORD 101,Atldllmtv9 Romn.:c Sc4t*Ce,*,mar be a'bo'.F7..r more:.psme Sroc aTou E.C•ENCE OF IL:-FA++:E CERTIFICATE HOLDER CANCELLATION I-C1,1E DEPOT JEA INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE 245 PACES FERRY ROAD THE EXPIRATION DATE THEREOf, NOTICE WILL BE DELIVERED ei BUILDING G•23 ACCORDANCE WITH THE POLICY PROVISIONS ATLANTA,GA men AUTHORIZED REPPE5£N"ATr,E a Sarah USA tno. Mana5h'MJkh2^ee -.ft41LArAn+.. •ZdM.4" . '" s 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 i201E0"03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER D: C N 1 C 1642069 LOC*: Atlanta AC(R J ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MANED IN1URED MARSH USA,AFC. TrrE ?EPCT INC ti3UE DEPC'v.S.d NC. POLICY NUMBER 2455 PACES FERNY ROAD J_DIND C•2t ATL tNTA s A 30335 CARPER 1NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: Certi`ecate of Liability Insurance 'ddxte':arree..xav Ca *uaa Carta^inlet-ark/ ,,ce Cagy d Not+.America �4:cg Number NLR C6TI2537 tA.-AFLAINI AY,tANIS,WYN£MAND,01I,SC,SD,IN,:{tY..Pa`: !Ont.!21Pit 0101:2021 Eapaebcn DIN 0391121= DEL; svt 55L42.000 Ga*sier».,tie CC As6cr Nvmeer x91C05 Plc DCEIE,H1AND,615tYf)YNNYJf1,V7)) eleca,e Dote 0.a01.202t 'spaabrn 0s111.203 :fLI Limit 65 93520C Canis.ACE A^%erisar+tsefiaerce Caron PAS Number Y4CJ#C57555331 tOSI;;CA.LCR,141 Effective Dote 039t2 2 eterekr Date 0391."20 ^;t 55 C4\MC Stc 51 ax,DOC •LamerNs»ro:_ :•F-. _. .. A:ficr%Lanes XA_. s _' -_ _ _-=y. effecNe 2 ersetcrCV&03'01,_':_ EL; r it$S 502 D'C SIR51 00,50X. Carver 4CE A..,;..,.treas once ocher Number+VAR C675166212IA4 Efledre:ems 01 ;02t Sprs*er eie 3191.20ZT .sit 55 Max Ca+e 1{ets a lUsms Fre iteuverce 201,ry ternber XINC:.61' :SSr;. elective:ite 0391.2021 titmice 03r[il25,c. ;a!font 53.500 0x SIR 5505,00 TX s sees z tngler.r4 Ce riertiriee:,mart rtaaence C rrops^y Alcy Number TNSS CE6919072(TX elective Osie 0.3,01,202- Umber lute 0391.= ;Elj It 510,900,1.70 S1R 511100,00C ACORD 101(200(V01) :D 2008 ACORD CORPORATION. Alt rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration. 112785 P O 00X 105451 Expiration. 04'221'2021 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. SCA i O 24m0fin7 Office of Consumer Affairs&(Wetness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Sum:derref:t Card before the expiration data. If found return to; Raarsfrafion E,xa4ret1f4111 attire of Consumer Affairs and Business Regulation 112785 04,722021 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston,MA 02118 RICHARD OLMLSTEAD -• _ 2455 PACES FERRY RD C-11 HSC .�.+✓:2 i"f'(4.er'• ATLANTA.GA 30339 Undersecretary Not valid without signature Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston. Massachusetts 02118 Home Improvement Contractor Registration Type: CO!Fxxation Registrabon. 112785 HOME DEPOT USA.INC H O BOX OT51 Expiration. 04t22t2023 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. Office of Consumer Affairs&Business Raguiatrore HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before me expiration date. if found return to. Registration Expiration Oft:ce of Consumer Affairs and Business Regulation `2755 04r2.202` 1000 Washington Street -Su'e 710 HOME DEPOT USA INC Boston MA 02118 COURTNEY A.HOWE 2455 PACES FERRY RD C-11 HSC ,, r .• ATLANTA GA 30339 Undersecretary Not valid without signature EXTER-2 OP ID:DM AC7C3PRL7 CERTIFICATE OF LIABILITY INSURANCE rATE NM^�DYYV, %i....• 01118,2021 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 be endorsed. If SUBROGATION IS WANED.subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certlicate does not confer rights to the certificate holder in lieu of such endorsement(s). Debbie Marino PRODUCER c 'Cr tlrna�i 789 3a9n5a blomsirom.com 0"r.wp 413-786 7004 Canary Blomstrom Ins.Agency PHONE FAx 868 Springfield St *E 1_.-..-...__..,:7 FeedingHills MA 01030-2151 A/amiss noOc 6N31JRERt8 AFF:Yi C.4G COVERAGE �MAXA _ POURER A Associated Employers Ins.Co. IhsL'RED Exterior Remodeling Group Inc. Nsuese a.Alain Street America Group 21939 Eugeniu Ciubotaru 23 Benham St _NSuRERCI Springfield,MA 01109 *ISMIIERD_ INSURER E. NSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE PC1LICtES OF['INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME: Ai:..',L 7OR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT .YiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HA4 E BEEN REDUCED BY.AID CLAIMS MB TYPETYPE %DDL BURR POLICY EFF POLICY EXP LTIII OF INSURANCE $4iB0 yivo POLICY NUMBER I.MMDO-YYVYI ,BRADOIYYTY). UNITS , a COSIMIBRCSALasi ALtliliJTY .EA:CL000URREIMCE S 1.000,000 (CLAIM&7.0?.Di [ oc t, X PP3376W 07.1271020 07(27/2021 CAYACE °REhrED $ 500,000 �X Business Owners MED F P.S�'y uls nsrsani ,a 10,000 ___ PER>oiil & AD:INa2Y ,a 1,000.000 GENL.a.GGREGATE I, A=PL£E PER. GENERAL AAA- C-ATE S 2,000.000 ��OTHER HCY PRE='. n:.= —_._.— PRODUCTS-COMPi7P AGO S S 2,000 000 1E OTHER AUTOMOBLE LABILITY t0fA6 SINGLE LIMB a 1,000,000 iEa aw0a0r} B 'Jo AUTO PP3376W 07'27,2020 BODILY IN AIRY TM'Da an; a _--'ALL OWNED — S.:-ecuLaD BODILY PLURY•?et accaOw[i S AUTOS A..T.5 NCh.•7A EC) PROP ERrr OALIAGE X HAED AUTOS X ,,,,,,,,..Gs 1 IPA,acudri) a s UMBRELLA LAB OCCJR • EACH OCCURRENCE S EIS LUAB C,LAMSAAALE. AGGREGATE S CEO ' I RETEN.'•oNtfii S ..-.... ....._........�......................,_.._.... WORKERS COMPENSATION {{I STATUTE 1 X 1 ER .. AND EMPLOYERS'LIABILITY A ?AY PROFRIET CRTA TNER:EiIECUTVE I' N I�.J WCC-SOO-5021510-2021A 011712021 01117)2022 EL.EACHACcIDENT a 500,000 OFFICER 4.0E WEEn ii 0CLI.C'E07 1.Wrw ny inN W EL DIMEASE-EAEMfLOYEE $ 500,000 If��vvss Bata.. iLa' DESCRIPT'r]N OF CPER.ATI17N5 balm EL DISEASE-PODGY ULBT 500,000 DESCRIPTION OF OPERATIONS:LOCATIONS VEHICLES IACORD iqt.Atieltt.u.na R.marks Scrm.L.m.mar La asiA ai if man moat*is required' Home Depot U,SA.Inc is named as Additional Insured respects to General Liability. CERTIFICATE HOLDER CANCELLATION HOMEDE4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Home Depot U.S.A.Inc ACCORDANCE WITH THE POLICY PROVISIONS. 2455 Paces Ferry Rd C-11 —--- Atlanta,GA 30339 A�U}TTHHORIZED REPRESENTATIVE \--k-iil'.) L Alit tJL U` 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Thk,Orkwe Wetlite rilhe t vckaktea:Os ni COUIFD.tut Di vkpora of Probessoorval,licorstero arskii atkek Dokrkson of Slam-1m* Public Safety ,,, !-:: , , i • - 0 MaSS. „ • Lit'r risee L)etai1. Demosraphie Information Full Name EUGENIU CIUSOTARU Owner Name --- licnse Address Information ttY State ipcocle. Springfield MA 01109 ,raprttry. UnitetStates License information License No Protessron- issue Date tcense Status: clary License Type: Doing Business As. CSSL-106106 eullOing L 4/12,20171censes Active Status Chanoe Reason, License Issuance License Type ,Dapwate ottionLasci aRteepewal 9/14/2020Constn1cti Today's Date' 912912022on Supervisor Specialty 9/16,2020 econ Prerequisite Iniormation Licensee CIUSOTAR .1 I,1'3Ftil j Relationship Attnbute O License No CSSL-106106 No Avallatile Dccul-rents clot*wimo. - : . :: : ‘,::::,' -• • - _ _____ _____.__. ____ — ' : MASSACHUSETTS :-','- DRIVER'S '_ _ LICENSE Va-T'ren7orrOliMO,- . ' /).**.."•.- ' . r•—• . .--,. ' ' ,''..' i'*, . ....t,..f.t .-q...., ... .. - :.,..-.- _.,...... ..,,......, .:..., :....i.. , .s....44k.._.--....-4 .... -.... , 44 WAVER OM• - -,. - .. k, l' ' - -,.- . -474 w2016 6' RA.g.nian ..,.._ - %or-Tv-Tv ;y%; ii.t ;,, ' ....-2:..,.., ,4.4,- - - ::4..'..ft '--.2 .'• Th, ., „.. 91291202 1 1 D°80912.91198 EVJ i 1,' , k' ',k:7,,AA,' :-.-- .• ''• .f. •i;,-...1 •t....;tptg_.: NONE . , -• ,., I,' .1. 1 . . .' 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