36-195 (6) 778 BURTS PIT RD BP-2021-1486
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 195 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2021-1486
Project# JS-2021-000587
Est. Cost: $2703.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT USA INC 098785
Lot Size(sq. ft.): 31450.32 Owner: LAFLAMME JOHN
Zoning: Applicant: HOME DEPOT USA INC
AT: 778 BURTS PIT RD
Applicant Address: Phone: Insurance:
2455 PACES FERRY RD NW (413) 335-3702 () WC
ATLANTAGA30339 ISSUED ON:6/1 5/20210:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE & REPLACE 1 PATIO DOOR FOR LIKE
WITH NO STRUCTURAL CHANGES
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!.• • y2 •
•
Certificate of Occupancy signatu,i.:
FeeType: Date Paid: Amount:
Building 6/15/202I0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1 ' Department use only
- G City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
E z 212 Main Street Sewer/Septic Availability
a = Fir-'3 Room 100 Water/Well Availability
w p. Northampton, MA 01060 Two Sets of Structural Plans
?n
n o �,-phone 413 587 1240 Fax 413 587 1272 Plot/Site Plans
c'a Other Specify
APPLICATI.ONITO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: p This section to be completed by office
4.7g a,,,,-,F-s ?i-I- Ro& 1 Map ,j� Lot I (/47. Unit
Flo r0.n« / 0106 i Zone •R A L Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(P nt) / L) Current Mailing Address: 0/06Z
C3-50-- ,/,(19'+// TelephO ES(o
13 - S - tf3d 3
9
Si natureU
2.2 Authorized Agent:
6 c. / 1 L . C/-4'ic.- .Jrt i o s ea,. --,4...11 b lajA 4.'.--7 cT
Name(Pr•�1� Current Mailing Address: Cy6(73.r.
v�o g'40 - 95-2 - 4///2—
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®
2"4-0.3 .0�
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) _co5. Fire Protection b
6. Total = (1 +2 + 3 +4 + 5) 41 ,21-J* ,d° Check Number 23'-76v6
This Section For Official Use Only
Building Permit Number: r3P- ZO_( - I Z(4 Date
Issued:
Signature: 7/2 (r- /1/-26Z)
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 I,: 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 ever been issued for/on the site?
NO 0 DON'T KNOW V YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW CY YES O
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 Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0 NO er
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 e
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 Q 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 pi Addition ❑ Replacement Wows Alteration(s) I I Roofing n
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [DJ Decks [0 Siding [D] Other[DI
Brief Description of Propos cl /1 / '!
Work: 1 tm G?s�C� mei)iac-e a�tp coon- f;k 2r /,i�C W/,44 /70 Sf`«6- e •
r- d( 30
•
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes f 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
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, gDir1 t-o` N ham''?'` , as Owner of the subject
property �I� ,/
hereby authorize 4D/N? tip( ✓ / ij /Pt',io�'� f
to act on y be If, i all matters relati e to work authorized by this building permit ap ication.
Signat of 0 er Date
G€Y e " C , 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.
ljera(1 << (i Mt/
Print Name
✓s- �i' 2vZ/
Signature of 0 er/ Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / // / Not Applicable 0
Name of License Holder: Z'*.i As-di., 4, /f .J (/ License Number
sq � ,. J ��..J , /441Svn "el D/oS7. y ,l —zZ
Addr 80 6 Expiration Date
_,./ ./.er
natu Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
iS'/XC a,-/ elPf . fit ;(5
Company Name Registration Number
1-Ysf / l'es iii, A ,#,A4 in 507 Pf 22- Z3
Address Expiration Date
- Telephone $6o-952- Y/'z
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 buildin permit.
Signed Affidavit Attached Yes 1� 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, Stat#• Local oning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature tiel—r)
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: 1-S --' ?14- Ftora^et MA o/04 2-
The debris will be transported by: X 4- _I ge <<r,Aj
The debris will be received by: ( ,,M-e. beep (As A c_
Building permit number: t3 -Zozl - i (-I2C,
Name of Permit Applicant 2c,- C/4-
6--I/- Zoe/
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
la
Office of Investigations
c7 -41 Lafayette City Center
2 Avenue de Lafayette, Boston, MA 02111-1750
. . 4
www.mass.gov/dia
Workers'Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Annlicant Information Please Print Legibly
Name(Husiness.f( rganuationindual):_Home Depot.USA. Inc.
...
Address:2455 Paces Ferry Rd
CityState!Zip:Atlanta, GA 30339 phone#:8-60-952-4112
Ere ou an employer?Check the appropriate box:
Type of project(required):
I I am a employer with 4. I am a general contractor and 1
6. 'j New construction
have hired the sub-contractors
employees(full and/or part-time).•
2 J I am ale p ietor or partner-
limed on the attached sheet. 11 Remodeling
oropr
ship and have no employees These sub-contractors have 8. jDemolition
working for me in any capacity employees and have workers'
9. ,D Building addition
. e.,1
No workers' comp. insurance comp insunnic
rcquired.) 5. im We are a corporation and its 10.7 Electrical repairs or additions
3. 71 I am a homeowner doing all work officers have exercised their I I.D Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12._I Roof repairs
insurance required.] c. 152.§I(4),and we have no
13.gi Other Windows
employees. [No workers'
comp. insurance required.]
"Any applicant that check.but 4-E rini,t also fill out the:welkin below %bow i'4t then%garters'compensation ula information.
Homeowners Who submit this affidia.it indicating the!.Luc dome all work and then hire outside ix/atm:tuts must suhniit a new Aida it indicatine such
'Contractors that check this but must attached an additional chit 5.111,141r112 th =Ira;of the sub-contractors and state whither ur nut those intititt ha c
employees. lithe sub-contractor.hair e ernplo!yees_they must rozdc thexr v..i.,fitrs.comp.policy nurnha.
I en an employer that is providing workers'compensation insurance for my employees. Below iN the policy and job Site
information.
Insurance Company NaMr: I'Jational Union Fire Insurance Cc.
Policy 4or Self-ins. Lie. #:XWC 1647259 (OSII (MA) Expiration Date:3/1/22
Job Site AtILlre , 41- g A-s ?iA- Oft. City/State/Zip: ....
Attach cop!, of the workers' compensation policy deeLaration 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
tine up to$1.500.00 and one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to S250.00 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 of perjury that the information provided above is true and correct.
_
Signature: Date: 6,7 // - 202-I
860-952-41 12
Phone
Official use only. Do not write in this area,to be completed by city or loom official.
(-it!, or Town: Permit/License#
Issuing Authority(check one):
IL Board of Health 20Buikling Department 31:]City/Town Clerk 4.1:Electrical Inspector 5.D'Iumbing
Inspector 6.0()ther
Contact Person: Phone Si:
City of Northampton
gPcN.M jo,
f' >- " Massachusetts �w?`Ns s
w. �i;
1, ,..i W v r'
\4 �' 1 DEPARTMENT OF BUILDING INSPECTIONS a 1" 1
�, 212 Main Street • Municipal Building ti,) tea~'
a Northampton, MA 01060 rs`fjv NA
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, �, goJnel La Lia.»� understand the above.
(Home ow e resrent's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date 6, it - ZoL 1
Address of work location �-r r3..,-+'5 7,4. a.. •1
fora-ice MA O/O G Z
Go Permits, LLC
105 Buttonball Lane
41310 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
WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1W2OWMNW Sheet: 1 of 1
CustOmer: JOHN LAFLAMME Job#: 1-1W2OWMNW Consultant: Kyle Harmon Date: 06/09l2021
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
y = c = T Mull "S"=stationary or
ei
E 4 o Q
M Style Wraps B `m d a s sp m f p Q [ "X"=operating
Room Floor Code (Y/N) Style Code Series Code E § i 5 i vi U > =
STD,White,TMP:Full, WRAP
1 LIV 1st PDG- Y PD05 6100 WH WH 71.25 79.5 150.75 GlassPack:Standard X S
B2
SPECIAL CONSIDERATIONS:
1: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 'epo - erma Talue o Products Manufactured by Simonton
Without Grids With Grids
Style Glass Package Glazing Spacer IG U SHGC U SHGC S"
(all with Argon) Fact Fact C';C„
6500
awning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 Ala • a 0.26 0.21 Q Q •
:asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 c o • C, 0.26 0.22 r 0 CI Q
'ransom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 e 0 .
)ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.24
'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25
'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 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 sgrt) Pro Solar Supercept 7/8" 0.29 0.26 ^r 0.28 0.23 e • •
500 DOORS
larden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 1 0.30 0.24 1 •I•I 0 • 0.30 0.21 • 0 • •
'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 0 • I
0.31 0.23 • •, • o
1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and
Washington.
wning(Inc Hopper) 6100 Base Pro Solar Intercept 718" 0.27 0.24 • • • • 028 021 • • • •
asement 6100 Base Pro Solar Intercept 7/8 0.27 0.24 « 0 0 0 0.27 0.22 • •
►ouble-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0.30 a 0.30 0.27 • • •
'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 027 0.28 •_ • 0.27 0.25 • • • •
'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • • 0.27 028 • •
�nel lid r 6100 Base Pro Solar Intercept 3/4" ofillen. 0.28 • O. 1 0.27 •
Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 • 0.30 0.27 •
it 100 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" I 0.28 0.26 1.114 0.28 0.23 ! 0 0 0 0
'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • 0.28 0.26
6200 Homes located only in following markets:Dallas,Denver,Detroit Phila,Northern NJ,Long Island,NY.
,caning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 • • • • 0.26 0.23 • • • •
:asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • a • • 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 0 •
'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • 0 0.26 0.22 • • • •
Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • a_ 0 0.28 0.21 '�el 11
ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 .13 en 0.28 0.21 Vail a
Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 a • • 0.28 0.21 0 • e
•to rm B rea ke r 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 a a a •
:asement SB+300VL Base PS/Lami Super Spacer 1" 025 0.23 • a • • 0.25 0.21 • • • a
)ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • • • • 0.29 0.23 • • • •
Milder SB+300VL Base PS/Lami Intercept 1" 0.29 I 0.25 • • • • 0.29 0.23 • • • •
'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 i 0.19 • • • • No Grids A _
larden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • • 0.30 025 • • a •
Dots indicate Energy Star certified for that zone
Please Note: Simonton Windows may substitute East&West windows given the requirements of each order.
> Home Improvement Agreement: Page 1
Home Depot License #'s - For the most current listing visit www.Homedepot.com/LicenseNumbers
MA: 107774, 112785
Kyle Harmon 1
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 The Home Depot
Service Provider Contact Name Service Provider Company Name
(203) 265-7037 'i Kyle_T_harmon@homedepot.com
Phone # Service Provider Email Address Service Provider License#(s)
2. Customer Information
'LAFLAMME JOHN New England West 1-1W2OWMNW
Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO#
778 Burts Pit Road Florence MA 07062
Customer Address City State Zip
(413) 586-4303 I johnlaflamme@comcast.net
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 1
OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
1070 N. Farms Road, Unit 3 Wallingford I 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 TO A OWLEDGE THAT YOU HAVE BEEN GIVEN
ORAL AND WRITTEN NOTI F YOUR RIGHT CANCEL.
Acknowledged by: _ of 6/09/2o21
Custo&r's i e Date
Home Improvement Agreement: Page 2
o
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: .08/04/2021 Approximate Finish Date: 09/01/2021 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: $ 2703.00 Includes all applicable taxes. Excludes finance charges.*
Sales Tax: $ 0.00 (If ap 1' e total amount of taxes included in Contract Price)
*Maximum deposit ONL Tlicable irritlIVIA,ME(3.3. NJ, WI(99%)
Deposit% 25.0 Deposit ount$ 1675.75 Remaining Balance $ 1_2027.25
8. Finance Charges
Any interest payments or other finan e charges will be determ. d by Customer's separate cardholder or loan
agreement, to which Home Depot is T a party, and wi in addition to Customer's payment under this
Agreement. Customer is subject to the term rtions 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 the person listed as"Customer" above; and (iv)Electronic signatures will be
deemed originals for all purposes.
X r06/09/2021
Cust mer' Signature Date
X /s/Th ome Depot l 06/09/2021
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 lb5-/U./
Alq -
Scope of Work
"LAFLAMME JOHN 1 New England West I1-1W2OWMNW
Customer Last Name Customer First Name Store#/Branch Name Lead#
Job#: (Internal Products: Spec Sheet(s)#: Project Amount
Reference)
1-1W2OWMNW 4 Windows Entry Doors 1-1W2OWMNW 2703.00
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Sales Tax 0.00
Total Contract Amount 2703.00
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):
tip~
NIP
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/SUBCON 1'RACTING: 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 Agreement.
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
r
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
105 Buttonball Lane
G Glastonbury, CT 06033
PERMITS 1 Scott Doughman
Phone: 860-952-4112
Fax: 860-430-6719
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
Ivan Kosobutskyy D/B/A I & I Remodeling is the sub-contractor.
#CSSL-098785 Exp. 4/7/22 / HIC#152379 Exp. 8/22/22
Workers Comp. —Atlantic Charter Insurance Company #WCV01468901 Exp. 11/13/21
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(a.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
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:455 PACES FERRY RCAC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
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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 BOX 105481 Expiration? 04r72J2021
ATTN. LICENSE tMlGMT TEAM
ATLANTA,GA 30348
scA t 01-0919 Update Address and Return Card.
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AlBELOtlon Office of Consumer Affairs and Business Regulation
112785 04122 2021 1000 Washington Street -Salty 710
HOME DEPOT USA INC Boston,MA 02118
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RICHARD OLMSTEAD l •
2455 PACES FERRY RD C-It HSC +w`lt.t' Gr,.rr
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: Corporation
HOME DEPOT USA INC Registration: 112785
P O BOX 105451 Exprradon: 04122'2023
ATTN: LICENSE MGMT TEAM
ATLANTA.GA 30348
Update Address and Return Card.
Office of Consumer Attu d fmnbnima 5sP,rmian
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration data. V found return to:
Redstration Expiration Office of Consumer Affairs and Business Regulation
112785 04l2212023 1000 Washington Street •Suite 710
HOME DEPOT USA INC Beaton MA 02118
COURTNEY A.HOWE
2455 PACES FERRY RD C-11 HSC 'sl�.rric
ATLANTA,GA 30339 Undersecretary Not valid without signature
,rtc Ra CERTIFICATE OF LIABILITY INSURANCE DATE MM90YYY Y,
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PRODUCER '.i•cCC-OLI t F�QKTACT
Roger Butler Insurance Agency.Inc. I bk.c. Em (413)562-2304 I FAX
No.
PO Box 816 I Wham
Westfield.MA 01086
NSUREIRM AFFORDING COME(SAQE NAIL I
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72 STAFFORD ROAD &SURERD_
MONSON MA 0105T
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CERTIFICATE HOLDER CANCELLATION
THD At-Home Services,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
2590 Cumberland Parkway 4300 BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY
Atlanta.GA 30339 WILL ENDEAVOR TO MAIL NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUT}N]RIZfDREPRESENTAnYE 4.744/4:21,1A....
1906-2014 ACORD CORPORATION.Ail rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER COPY
IVANKO S-01 K°VAR)
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CERTIFICATE OF LIABILITY INSURANCE 7/221020
THIS CERTIFICATE IS ISSUED A S A MATTER 0; si,-•:.T,.'',I:--ON ONLY AND CONFERS NO RIG,-E _::14 THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRI-I A-VELY OR NEGAT.v EL I AMEND EXTEND OR ALTER THE CC,'FSAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE ".:.''7 ',.:.RANGE DOES NOT CONSTI'7.1TE A CONTRACT BETWEEN --F. SSUING IN SURER(S),AUTHORIZED
REPRESENTATIVE OR FR :I=7 -'-''.." "-F. 77 E- -f CATE HOLDER
IMPORTANT: If the ce:• -..--, . :., i..-:- .I::.:TONAL INSURED,tre poNcyliesi must have ADDMONA,_,NSLIRED pf0Vt5,40f#S or be endorsed
if SUBROGATION IS WA:v E.-- , szt to tne !skins and ettftdtttOr S:I et*;Jolley certain policies may require AM endorsement A statement on
this certificate does not Conte -:i to trio certificate holder vs Neva of s acit endorsessenals
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72 Stafford Rd
Monson MA 01057
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7140 AT HOME SERVICE S INC --:::Rs--...:E.---,--"---E 7 -..7-4,.:. s-7..1,i
Attn Installer Rotators Dept
Horne Serwc es Compliance C11
2455 Paces Ferry Road sv...tivotisom 410EIMENEWAWAVE
Atlanta,GA 30339 9411..
ACORD 25(2016103) t 1988-2015 ACORD CORPORATION. All rights reserved
The ACORD name and logo ate.-sorstered Mats of ACORD
ass.
Licensee Details
Demographic Information
Pull Name: IVAN KOSOBUTSKYY
Owner Name:
License Address Information
City: MONSON
State: MA
Zipcode: 01057
Country: United States
License Information
License No: CSSL-098785 License Type: Construction Supervisor Specialty
Profession: Building Licenses Date of Last Renewal: 5/5/2020
Issue Date: 4/10/2008 Expiration Date: 4/27/2022
License Status: Active Todays Date: 5/6/2020
Secondary License Type:
Doing Business As:
Status Change Reason: License Renewal
Prerequisite Information
Licensee: KOSOBUTSKYY, IVAN
Relationship: Attribute Of
License No: CSSL-098785
ri raid ""'
Office of Consumer Affairs & Busines:v
HOME IMPROVEMENT C'ONTRACTISP
TYPE: Individual
Registration xp ration
152379 08/22/2020
IVAN KOSOBUTSKYY
D/B/A I & I REMODELING
IVAN KOSOBUTSHYY
72 SATFFORD ROAD Ci
MONSON, MA 01057 Undersecretary
Registration 152379
Registrant Ivan Kosobutskyy
DBA I&I Remodeling
Name IVAN KOSOBUTSHYY
Address 72 STAFFORD ROAD
Ctty. State MONSON MA 01057
Zip
Exoiration 08/2212022
I 1v+3.4._ Ko,V36vit ifk 4yy,„.. *
authorize Go Permits LLC to pull Permits using I")
CS License .t: _0_527g_57, _ _. ...,... .. ....., and my
IlIC Registration r; 152.„
An, questions please call me at: yi S — 2 2 I—
Installer Signature
Company Name "rgysiosiWi ek
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