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06-022 48 EVERGREEN RD #114 B P-2021-2178 48 EVERGREEN RD#1 14 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-022-036 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2178 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 2660 HOME DEPOT USA INC 105953 Const.Class: Exp.Date:05/18/2022 Use Group: Owner: TOUGAS, DENISE Lot Size (sq.ft.) Zoning: URA Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW XWC-I647259 ATLANTA, GA 30339 ISSUED ON:11/15/2021, TO PERFORM THE FOLLOWING WORK: INSTALL 4 NEW 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. Signature: .>t2 . TIT Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only 1 RCity of Northampton Status of Permit: Department Curb Cut/Driveway Permit 12 Main Street Sewer/Septic Availability NOV Room 100 WaterIWell Availability '"9'r N hampton, MA 01060 Two Sets of Structural Plans pho 41 -587-1240 Fax 413-587-1272 Plot/Site Plans —�n;011rN Urar,;,; OtherS , P Specify APPLTCAT1ON 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 eve,yeea t&v,:+C� SC•Aii, l' Map Lot Unit 1—e IAA 0 Jos'3 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: At f w- 'coais h 'ff 15 1 ILI Name t) Current Mailings A ss: ,?—cd9ri&4'444) Telephone Sign lure 2.2 Authorized Agent: /0/ G, �.,/ /pl/r -7 r'v J- At .,"Az.„4/L�:e-- ljAff-, Name(Print) Current Mailing Address: Cr e.u.c,3J Signal CO L� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only corn leted by permit applicant 1. Building r (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 41S 5. Fire Protection Yd 6. Total=(1 +2+3+4+5) sl 266ji0,0e Check Number i q,/ This Section For Official Use Only Building Permit Number: 6 P'.7, �I 7 g Date Issued: Signature: ///0 /1"1 Z-Z6Z( Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: 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 ver been issued for/on the site? NO 0 DONT KNOW 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 GY.YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, c on,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 i ws Alteration(s) ❑ Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief De ription of Proposed /�""" /J C���r_✓ ' work: C/'1dr31�C Q�1G! ��ltt„C,C' 7 L!/.,.;I��/y✓.f �L/ lf.�� Alteration of existing bedroom Yes •No Adding new bedroom Yes r/eNo Attached Narrative Renovating unfinished basement Yes 1.0"--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, .I( `� Ad 1 f� / etsia 1 ,as Owner of the subject property llll jj�� 440044 � hereby authorize Ake Vote/ 4S 61v �% to act % my b-h. , ' all m. ers re ative t 'ark authorize Jay t is building permit application. � �' ) Si• •- <� Date I, faC, C/e,(-1/4- ,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. l -"WI) ( ai4 / rint N e ture of er/Ag Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Go y� �,r d J"ot Applicable ❑ Name of License Holder: !,✓' V 661. .'r/ v 4 ,� /Q ?,l ` License Number 2/ /<'I27e Q- '2 Marie. /i/if aroS' 5- a--Z a Addr s Expiration Date A¢i1 4(/�l2/ -Zas2 gnat ei Telephone 9. Realstered Ho a Improvement Contractor: Not Applicable ❑ of , le //2?5 Company Name Registration Number 2exc Ace ,€'/ c� r i, 64 ,3V339 Y ZZ Z 3 Address i Expiration Date Telephone r�!/ %z-- (er12 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 ermit. Signed Affidavit Attached Yes 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"ce ' i.s and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State . d i cal•nin aws and State of Massachusetts General Laws Annotated. Homeowner Signatur i�,` 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: ecCiaea eixtdC f/`t kec5 ifO S 3 The debris will be transported by: Ci'l) 1414/ � 2 IQyIAe- - The debris will be received by: Building permit number: Name of Permit Applicant 6C70?// Date Signature of Permit Applicant The Commonwealth of Massachusetts a Departntent of industrial Accidents • ��, • Office of Investigations 1.i Lafayette City Center 2.-tvenue de Lafayette, Boston, MA 02111-1 7S0 . www.maskgov/dia Workers' Compensation Insurance Affidavit: Builder iiContractorsfF lectricians/Plunthers Applicant Information Please Print I.ctihly Name inu messor niratton lndividuall: Home Depot USA. Inc Address:2455 Paces Ferry Rd CitvState%Zip.Atlanta. GA 30339 Phone #:8•t_rta ' •.- .re you an emplower:' ( heck the appropriate box. f�lrr of project (required). 1.0 I am a employer with 4. l am a gee cal contractor and 1 employees(full yeah or tan-ur,l�L. have hired the sub-contractors fr. 'Vcww ccm.trctclu,r '. I am a sole proprietor or partner- listed on the attached sheet. 7. ;7;Remodeling ship and have no employees These sub-contractors have K_ ;Demolition t%orking for me in any capacity. employees and have'workers' [No workers' comp. insurance comp. insurance.' 4. Burldiraa addition workers' required.) 5. [I We arc a corporation and its to._ electrical repairs or addition!. 3.0 I am a homeowner doing all work officers have exercised their I I- Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I Roolrepairs insurance required.) c. 152. §1t41,and we have no 1; ,dcoA _ employees_ [No workers' I3.( t niter comp. insurance required.) •Arty applicant that c KIN r i must also till out the•eetiun he low showrnr their wotkevs',:ornitemal1011 policy information. t Homeowners w1w submit Ihr.affidarrt indacaune they are doing all work and then hire untsrde eaxetraek,ts tnu.t suhrnrt a new,aft'rdairt indtcaUnu such 't'untractor%that check the.!. ti roust attached an additiunal shoat shrrwinu the name of the.uh-ee traetans and.tate r.(a:ther or not(Flom:entitrea tent employees. It the s r-‘7,0ntr.ui,.•n.hakeentptoyers.they rots 1 pro,. c them Needier,'comp rnhcy nurtrt.x. I am an employer that is providing worAers.'compensation insurance for my employees. Bela w is the policy and fob site information. Insurance Company Name:National Union Fire Insurance Co. Polley#err Self ins. [_t kArC 1fr41159 t S1)(M ►3 ,} 'aptralion Date: 3/1?22/ d Job Site Address: 7 v Eve , e�! t�O�t __.Sum `j`7 C ity,'State Zip: �eed S Mn FJ/O.S 3 Attache a copy of the ss urkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure cao%crtck: as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a dav against the violator. Be ads ised that a copy of this statement may be forwarded to the O11ecc of Investigations of the DI:\ for insurance coverage verification. I do hereby certif_-under the pains and penalties of perjury that the information provided above is true and correct. __ `_ l'lam" °7 `stgna►lLrr: Date__----_._. Phone�: 86Cf-95'2 4 112 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permitil_icense# Issuing Authority (check one): h Board of health 2J Building Department 3.DC'ity°rrown Clerk -.0 Electrical Inspector- 5.L'lunrhing Inspector b.r )other Contact Person: Phone#: City of Northampton Massachusetts f DEPARTMENT OF BUILDING INSPECTIONS " — 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can D LAY the pro' until such time as the proper permits and inspections are made J U<�Sh 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 il' 70 2/ Address of work location L}' E /C fee'? ifeec ci c�� q 1,ee4s f4141 6/05 3 WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1X9TODv9 Sheet: 1 of 1 Customer: Matthew Kadish Job#: 1.1X9TDDY9 Consultant: Ronald Engelbrecht Date: 11/03/2021 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 4 of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use I. b LL.g O Mull "S"=stationary or f Style Wraps m o O o p r9. . o "X"=operating Room Floor Code (Y/N) Style Code Series Code_ 3 •i 5 — in t3 a tJS > J yffi x . STQ,White, GlasaPack: WRAP 1 FAM 1st SB-DH Y OH 8100 WH WH 36 38 74 Standard STD,White, GlassPsck: WRAP 2 FAM 1st SB-DH Y OH 8100 WH WH 36 38 74 Standard STD,White, GlassPack: WRAP 3 FAM 1st SB-DH Y DH 8100 WH WH 36 38 74 Standard STD,White, GlassPack: WRAP 4 BED 1st SB-DH Y DH 6100 WH WH 36 38 74 Standard SPECIAL CONSIDERATIONS: - 1:White,2:White,3:White,4: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 Camnt) 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(Yea or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Plonite,Birch or Oak) The Home Depo hermal Value of Products Manu '- ured by Simonton Without Grids With Grids Style Glass Package Glazing Spacer lG U SHGC U SHGC (all with Argon) Fact Fact 6500 Awning 6500 Base ProSolar Supercept 7/8 0.26 0.23 • •yq 0.26 0.21 4 I lop] Casement 6500 Base ProSolar Supercept 7l8 0.26 0.24 0.26 0 22 ' Transom 6500 Base ProSolar Supercept 1 0.27 0.32 11 11 0.27 0.29 0 0 Double-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 0 0.29 0.24 n .0 Picture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 a 0.26 0.25 • • • 0 Picture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 o " 0.27 0.26 0 0 2 Panel Slider 6500 Base ProSolar Supercept 7/8 0.29 0.26 0 29 0.23 i1_0: r -. ... _._ ...._ , 3 Panel Sliders 6500 Base(_zt sort) Pro Solar Supercept 7/8" 0.29 0.26 11 I 0.28 0.23 ' 0 6500 DOORS Garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 • a a • 0.30 0.21 0 • a a Patio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 f•f o l f l 0.31 0.23 l clef•l• 6100 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. Casement c Hopper) 6100 Base Pro Solar Intercept ` ^�7/8 v0.27�0.24 0 0 0 © 0.27 0 21 0 Awning(Inc pP ) 0.27 0.22 0 0 c> 0 e un 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0 0.30 0.27 0 0 0 Picture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 o 0 0.27 0.25 0 0 0 0 Picture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 ° 0 0.27 0.28 0 0 0 0.30 0.27 0 2 Panel Slider 6100 Base Pro Solar intercept 3/4" 0.30 0.281 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 ,, 0.30 0.27 i �..._1 6100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. Patio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" 0.28 0.26 0.28 0.23 • • • Patio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4"l 0.28 0.30 1114_1 •0.28 0.26 • • 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. Awning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 e 0 0 • 0.26 0.23 a 0 0 0 Casement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 " • 0.29 0.17 • 0 0 0 Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • 0 0.25 0.19 0 0 0 0 Picture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 0 • 0.26 0.22 0 0 0 0 Single Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 0 0 O 0.28 0.21 0 Single Slider 6200 Base Pro Solar SHADE Supercept 3/4' 0.28 0.23 0 0 0 0.28 0.21 ' 0 0 0 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 , 0.23 4, .-, 0.28 0.21 I a o a StormBreaker Plus 300VL Homes located in coastal areas. Awning SB+300VL Energy Star PS SUN/Lauri Supercept 1' 0.26 0.23 J• o 1 0 0 0.26_ 0.21 0 • 0 • Casement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 0 0 a a 0.25 0.21If ^ a a Double Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 0 • A 0 0.29 0.23 = e =_ Slider SB+300VL Base PS l Lami Intercept 1" 0.29 0.25 e a 0 0 0.29 0.23 0 ' r, Patio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1' 0.30 0.19 0 0 0 • No Grids Allowed Garden Door(CH) SB+300VL Base PSILami Super Spacer 1" 0.30 0.28 1411• 0.30 0.25 0 c u - •Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. 41,0 Home Improvement Agreement: Page 1 Home Depot License#'s-For the most current listing visit www.Homedepot.com/LiccnseNumbers MA: 107774, 112785 Ronald Engelbrecht 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 customercancellationnortheast@hom MA: 107774, 112785 Phone# ggR°Penvider Email Address Service Provider License#(s) 2. Customer Information Kadish Matthew New England West 1-1X9TDDY9 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 48 Evergreen Road Suite 114 Leeds IMA 01053 Customer Address City State Zip (860) 810-6094 mkadish@cox.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 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 TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: 11/03/2021 Customer's Signature Date �/0 �2OZL 460 Standard Form 111A(21 Jul.211(E) Generated Date � _ Lead'P(# 14X9TDDY9 III 12 411 Home ImproNement 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: 05/02/2022 Approximate Finish Date: 106/01/2022 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: $ 2660.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, WI(99%) Deposit% 25.0 Deposit Amount $ 665 Remaining Balance $ 1995.00 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 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 /J` 11/03/2021 Customer's Signature Date X /s/The Home Depot 11/03/2021 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 lnb-iusi 460 Standard Form 111A(21 Jul.21)(F) Generated Date um�/7O2.1 Lead/PO# 1-1X9TDDYq__ ` " �' 404. 111 , Scope of Work Kadish Matthew New England West 1-1X9TDDY9 Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Interned Products: Spec Sheet(s)#: Project Amount Reference) 1-1X9TDDY9 Windows Entry Doors 1-1X9TDDY9 2660.00 Windovv s Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 2660.00 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: Simonton 6100 Warranty Name(s): 460StandardformIiIA(21Ju1.21)(E) Generated Date 11i0'/2n21— Lead%PO# 1-1y9TDDY9 ` ��I I_ '14 s The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and (IIl) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "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. "Scope of Work"means a detailed description of work or Services to be performed, including,but not limited to, any quotes, schedules, invoices, specification sheets, proposals, confirmation emails or otherwise. "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. 4td)Standard Form 111A(21 Jul.21)(El Generated Date 11/M/2021_._—_ Lead,104 1_1)(9TDDY9 lk-I 12 t164‘ The Home Depot General Terms & Conditions e , 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. Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 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 (the "Warranty Period") 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 discretion (I) correct or replace each Defect, (Il) authorize the correction or replacement of each Defect; or (III) remove each Defect and refund all or a proportional amount of the Contract 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 in full as provided in this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (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 DEPOT'S 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. 460 Standard Form 111A(21 Jul.21)IE1 Generated Date 1iin 3/2Q21— LeadP((•' 1X9LD.D_Y9-. ' " � A "I he !tome Depot General Terms& Conditions 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. 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 Contract 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 Contract 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. 4(O Standard Form 111A(21 Jul.21)(E) Generated Date luo3/2021 Lead/PO# 1-1X9TDDY9 V 01.12 Go Permits, LLC GO 105 Buttonball Lane 1111 Glastonbury, CT 06033 PERMITS ' 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 Igor V Gusev GIV Home Improvement is the sub-contractor. #CSSL-105953 Exp. 5/18/22 / HIC# 181018 Exp. 2/16/23 Workers Comp. — Liberty Mutual Fire Insurance #231S609567011 Exp 3/3/22 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits(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 ACRD CERTIFICATE OF LIABILITY INSURANCE DATE(IMIXSYY'YY) 31S'2r+ 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 policylies)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 endorseme'at. A statement o' this certificate does not confer rights to the certificate holder in lieu of such endorsementfs). PRODUCER coirrACT LtA SI-GSA NC. NAME _ "AU jANCE CENTER IACPHON , N ENG I.A.'G-Mae 3ri3 LENOX,ROAD.RA-E.2.00 E-MAIL ATPh'r&GA;9:2S A rESS NAURERt$I AFFORDING COVERAGE NAIC S Oh IC 154,2059 ;A'IN,Zt-= INSURER A. OH F.eeusic ISSYa!F.e Cc 2I117" INSURED INSURER B A_—ZEAL :C 1'' ME HOME DEPOT.INC - -- HOME DEPOT t,;SA.NC. INSURER C_ F.KI AI::=1 a rsian:a CarearlY' NA 2455 PACES FERRY ROIl7 INSURER O:. BIADINGC-20 ATtANTA„A19k395 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: A---33501 SS-ol REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW '(AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR.THE D. ^ER INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER.DCCJUENT WY!TN RESPECT T'_' ,.i :- CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOROE: S" THE POLICIES DESCRIBED HEREIN I;SUBJECT TO A 'L' EXCLUSIONS AND"CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HA'JE BEEN REDUCED BY PAID CLAIMS OMR ACM SUER POLICY EFF POLICY EM, LTA TYPE OF INSURANCE 1 MED POIJGY NUMBER uraivourrros P DOlYF Y1 UMRS A x coMrERc+AL GENERAL LINER ITY MD(314374 D'Y01 OD19 CrSt 12322 SACK 04:.4NAENOE I I CIXCI: OV.NGE rCRENTE3 O.AMEKSACE ri i!C::..c PREI'ISES,Ea occurrence; I V000)X X Sit SI OGC VI rOED CX ,,Airy one Pe m. 1 -UDE: — GEMI..AGCREGATE LIMIT APPLIES PER f:.ENERA.A. RELATE I _1..... PDLIGY n.ECT ri'-oc CCt CS-GGf. :OP Air. r :CC(CC. OTTiEie. I A AUTOMDBILELLAEILITY AAHTB314573 0341,2019 C0t12022 E'='a3 INEDSIMSLELurrt I I:CC.CO: ArrAyrnt; x-MIX AUTO SER INSURED NJTQ PRY CNIS ACCIL'F WtIRY-:=er iesa', S CANED E+'.,MEDULEC BODILY atURY'Per arc Mot I AUTOS ONLY KREDNOI4-E :AUTOS �CA&T =er xWriNED PROPERTY DNAKGE I Y I iMBRELLA LIAR O"i c-R EAC1 C.C.C.PARENGE I EXCESS LAB Cl yt. -MACE ArsrcREGATE ZED J j RE:NTIC _• e WORKERS COMPENSATION WC 582402,391'Mi 99412021 33012022 xI PER 'TM- AND EMPLOYERS'LIABILITY I -1' >ti I >:R B M-'�FR•:+PRIETfhPAF.TF�Rz_SECilF'u'E Y N V F a C^s'" q -33131`5021 t.^02i L chG-I ACCIDENT SGL41.QD0 OFFICERSAFLCERFXCJ-OE ' NIA iManddt oY In Mil C:r - - _L.36E4£E-EA E'PL.KEE 5 5 CCC COO r AL aeXC 1:e nee. DESCRIPTCf C€OPERATORS Mon _ EL.0 S:Eh:E-PCLC.v'_MIT - ^Cl CC: C EX:..ess AL _c 297119:: __- 39001,2021 931012022 Lint 1 933 300 A EEess aee:lE 3..a0iiTr ma 3`-.A._ 03:012719 :St I2:22 L'1. E.00Fa.909 DESCRIPr'IDN OF OPERATIONS,.LOCATIONS i VEHICLES IACORD I St,Additional Reworks RiNKAM,may be*boned If mere made Ii H.s.APd1 E."ONCE OF INS+,.?5NC'E CERTIFICATE HOLDER CANCELLATIC*1 HOME DEPOT JSA NC SHOULD.SNY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE .2d5,5 PALES PERRY R3AC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDINGC-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 93339 AUTHORIZED PEPPESENTAm E of Merits USA Inc. W.3r.3bl VJkhe-fte -.P,4'..ANK3M 111-3.w2l 1 N,IJ. -.I- I t988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 4 20 161031 The AC ORD name arid logo are registered marks of ACORD AGENCY CUSTOMER ID: CNC14236g LOC 0: Atlanta "ts9RrI ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INIIURED MARSH ust INC THE"(NE DE AO"' :NC HOME CEPO',"L A NC POLICY NUMBEP 2455 PACES FERN','ROAD BUILDING C-20 ATLANTA Gti 033.11 CFRRIEP kAJC CODE EFFECTIVE 0A,E, ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: .7.:E FORM TITLE: 0 erica:e of Liaaii,ty Insurance Waxers CansensarcH Crt-rod: Cave,Indenrty',--arsrce Car-pery No* .Arre+Cs Racy oienter INLR C67125:707 1ALAR ft,C.a.ICS,Wej.ANISNO,NENIAND,OOLSC,SO,TN,WV,V0 1 Effectim Dole 0:11:1100" 5pretcr Dec.31'01,0.0Z ;EL:LrHit.$504000C• Came.A...PT:x.6m!Cc Racy Nana,ñCT.,3245:001 114 17C.DE,HIALC,Leor NY,114NYRI,VT? ERectee 111e 01'01.2021 Expreker::ate 0131,a12.0 EL: 4$5:000,003 Orme,AZE Anermr Insoirce Oxman norm,Numter,ACJ:06-7335,301 1Sl Ca.....Ot,fti11 Eflecue Ogle 01,171,20Z: Exprabon De*0101,= X14 Lmit 35,030.00C SIR$1 03C,D30 Caner Nekre URO,Fre Imp:me Co" . Racy Nolber.xw, "317258,:0SC,(30,7104.141E,M1,14',OHN,Lm Mara Dote,MUM, Expesbon NA.3191:2022 XL;Unit K0033,0C SIR$1,1)33CCC C.X.Pe, E Arr,exur Ccrrovni Rarc,%mop,61.8 C673"32'0,JAZ: E.Flecin:Mr 010 mr. Ezp.i.Dar Lrxit 15300110G CiMi Natcers Una,Fir.sursce Ccmptep Racy%ember XVi,0 aktrixe ca91/Mzt Exprelm, rle•01111,2022 ;ELI 50,7 333 SIR 150003 Erpolopers XS Inde..ky: Cari cnNare Cwrpery Racy honer INCS CE6949:172 IT Elieran Os*31E1021 Eurretcr 0331022 ACORD 101(2008/01) ".,D 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r54'W2/1?..eviwieezia(1- 1 •/./17(.7,-.4.5.-erze.4/' Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration. 11278'.7, HOME DEPOT USA INC ExpiretIon- 04/22.?2021 P 0 BOX 105451 ATTN. LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. SCSI el 20.4-05e I 7 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplen-erl Card Wore the expiration dote, if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 12785 'J4r.22/2021 1001:1 Washington Street •SWIG 710 HOMI-.()WO T USA INC Boston,MA 02118 RICHARD OLMSTEAD _ 2455 PACES FERRY RD C-11 HSC 4~0.4' ATLANTA,GA 30330 Undersocrelary 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 Registration 112785 HOME DEPOT USA INC Expiation 04e2212023 P 0 BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA. GA 30348 Update Address and Return Card. Office al Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE :-orpryaton before the expirabon date If found return to. Redostration Expiration Office of Consumer Affairs and Business Regulation 112/85 04122/2023 1000 Washington Slice) •Suite 710 . HOME DEPOT USA INC Boston MA 02118 COURTNEY A.HOWE 2455 PACES FERRY RD C-11 HSC Not valid without signature ATLANTA GA 30339 Undersm etary _....-- GIVHQME-01 CHITSAC95 ACc RD CERTIFICATE OF LIABILITY INSURANCE DATE rA+Nrpon YYYI Itex--�'' 2/19/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS l 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 sndorsoment(s), PRODUCER `-CONTACT Berkshire Insurance Group,Inc 1PPHAOMNEE FAX PO Box 4889 i�A:�5IAINLe,ED).(968)83B fl244 MVO,Nei:(413)447-1977 Pittsfield,MA 01202 I ADDRCSS: INSURER(S)AFFORDING COVERAGE NAB a ,INSURER A:Patrons Mutual Ins.Co.of CT 14923. INSURED INSURER a:Safety Indemnity Co. 33618 CIV Home Improvement,Inc. SMILER C 21 Kibbe Lane 1rs nsRo Hampden,MA 01036 'INSURER E; CPYIRAOLI, CERTIFICATE NUMBER: _ REVISION NUMBER; THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LASTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSA IADDLSUER POLICY EFF POLICY FAR ... ._.... _.. TYPE OF INSURANCE tI FOLIOS Numatm LIMITS _L7B-___�__�— RI5.4 iA'YD. ..11rtSh'P.Q!YYYYl_.{61k4DD�YVYY1 .r.__... A X COMEIERCIALGENERAL LIABILITY -_.-. 1,000,000 EACHaccLrRREr+cE ,$ ' CLAIMS MADE X OCCUR X R BOP2725892 3/9/2019 3/9/2020 DAMAGEREMI¢ES CTO RENTED 500,000 F�oac,amRna 7 ,$ MED LXF LAny PER Par:«,) $ 10,000 PERSONAL&ALP/INJURY $ 1,000,000 OWL AGGREGATE MT APPLIES PER: ( . GENERAL AGGREGATE ,S 2,000,000 X 1 POLICY I I Sri I LOO i - PRODUCTS-COMP/OP AGO.S 2,000,000 .... 1 f —_B - COMBINED SINGLE LIheT -A-)AUTOMDSILE LIABILITY - CEa amAIRES $ 1,000,000 I ANY AUTO 15901197 2/19,2020 2119/2021 RIVET(NJUHY[Pm ovraor $ AUTOS ONLY X MMIri�0ry3�q l°p 1 I RpODILY INJURY(Per s d,N,'Y $ X'ASITOS ONLY X AUTOS OHLY j ,Per aond Y, AMAOE 4 '_ ------ -------.....-_� [6 _ UMBRELLA LIAR OCCUR EACH OCCURRENCE I EXCESS LIAR CLAIMS-MADE, AGGREGATE 5 DED- RETENTIONS WORKERS COMPEAND E 'NIAnTION Y/_N� I PERTUTE R ER OT14- .. __ I ANY PNOPRIETORPAATNEWEXECUTIVE EL EACH ACCIDENT I$ OL7FRCERY4EMReEER EXCLUDED? N/A EEi IAtandeIo v in NR) EL DISEASE EA EMPLOYE S _--`Ityr a,deaait*u'4, DESCruonoN QF OPERATIONS UeIes EA.DISEASE•PQUCY gAr s i I DESCRIPTION OF OPERATIONS/LOCATIONS/YEIiCLEs(ACORD 1E1,Additional Remarks Schedule,may be attached if mere space Is toquired Hoe Depot USA Inc dba THD Al-Home Services,Inc.,are included as additional insured with respects to general liabili ty ty Insurance.Forms CG2010 provide additional Insured status and form CG2037 for completed operations coverage are Included.; Auto Coverage: Optional Bodily Injury and Property Damage-Combined single limit 1,0110,000. Uninsured Motorist 100,000l300,000 Underinsured Motorist 100,0001300,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Home Depot USA Inc.OBA 7HD At-Home Services Inc. ACCORDANCE WITH TION TH E POLICY PROVISIONS.NomE WILL BE DELIVERED IN Home Services Compliance C-11 2455 Paces Ferry Rd Atlanta,GA 30339 (AAUTHORIZED REPRESENTATIVE f' }} I \ .1 - -4. G11.--- ACORD 25(2016103) ICT,1988-2015 ACORD CORPORATION. Alt rights reserved. The ACORD name and logo are registered marks of ACORD Accwor CERTIFICATE OF LIABILITY INSURANCE DATE clillSOINNYIN, 0101,'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 INSURERfSf. AUTHORIZED REPRESENTATIVE OR PROOUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED. the poiicyfies; must be endorsed. If SUBROGATION IS WAIVED.subject to the terms and conditions of the policy,certain policies may require an endwsernent A statement on this certificate does not confer rights to the cerhhcate holder in lieu of such endorsement(s) PRODUCER NANoE e Leonafc BERKSHRE INSURANCE GROUP INC PHONE 1,41312:16-3304 E HA. ADDRF5,5 rrileonardS,berkshireinsuranc,,::,,, up 43 East SI INSURER1115 AFFORD'S;COVE RAGE SAE I PITTSFIELD MA 01201 INSURER A. LIBERTY MUTUAL FIRE INt INSURED INS., N B GIV HOME IMPROVEMENT INC ieSRC SYS.RER 0 21 KIBBE LANE INS,AER E HAMPDEN MA UlUiii SSERF COVERAGES CERTIFICATE NUMBER: 62/24C, REVISION NUMBER: -iiis is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE rOR THE POLICY PERIOD INOCATED NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TrIIS 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,.IAVE BEEN REDUCED BY PAID CLAIMS INSR FOLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER ifswitNirfrrYl_onworrrra UNITS COMMERCIAL GENERAL UAOLITY EACH OCCURRENC.E VJASAE.E FENTBD CLAIMS-MACE OCCAAR PREMiaE S LEA r.rIi $ MED E"..PLIPSON S RSONA_ AU,INLURY S Ill N L LSAT APF1JE PER AGGREGATE S POLICY ,94 Ei.2c CCAIFYOP Ania I OTHE AUTOMOSII.E-ABILITY civ MO AUTO All OWNED E1'F,.:HEDULED AUTOS BODI. 5 NO`COONEO PROPERTY E.V,V.,,E HyRED AUTOS JTOS kpAt avalief LISIBRELUI LAB OCCUR EACH OCCURRENCE 5 EXCESS LAS amg64,0,DE NA ACIGREDATE ZEC I I:i.ETEV .1 S I • 'WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X J I 1 i4"' , Tx Y f .R0r.ACE MPARTNE4sEXECUTIVE r1 EL EACH ACCIDENT I 1,000,U00 A OFFICER VE IMBREXOLuDED1 MA OSA WC231S60956/011 03/03/2021 03033/2022 iliananory in MR Si.DISEASE-EA EMPLOYEE I I-000.000 If 7,1. DEE:GRIP',001 OF OPERATIONS balm E.DISEASE POLICY LILVI I 000010 WA. DESCRIPTION OF OPERATIONS,LOCATIONS VEHICLES,ACORD III,AWN...,Ay nurks ficheskis,PAN e.Ruched mon spars Is Paquin", Workers Ccenpensa hen benefrls wit be paid to Massachusetts empioyees only.Pursuant to Eresorsement WC 20 03 Ob B,no atahorization is grven IC pay claims for benefits to employees tn stares othe,than Massachusetts if the insured.hres_or has hired those employees outside of Massachusetts This certificate of insurance shows the policy in force on the cote that this certrhcate was issued iuniess the exptrabor,date on the above poicy precele issue date of this celficate of Insurance,. The status of this Coverage can De monitored daily by accessing the Proof of Cove•age-Coverage Ve,Acabon Search too at wommass go.p`fo•clhvorkers-corricensation*,^veEligabons.'. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF'. NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Home Depot USA Inc OBA THO AtHome Services Inc Home Services Conviance C ' 24SS Paces Ferry Rd AUTHORIZED REPRESENTATIVE Anar4a GA 30339 Daniel M.CYOWIC'. l'e.s4dent-Residual Market-WCRIBMA 1988-2014 ACORD CORPORATION. All rights reserved_ ACORD 25(201401) The ACORD name and logo are registered marks of ACORD 0 14* Ma ss.4, 0 geniae_s Licensee Details Demographic Information 'Full Name: IGOR GUSEV Owner Name: License Address Information City: Hampden State: MA Zlpcode: 01036 citintry: United States • — License Information License No CSSL-105953 License Type: COnstruchon Supervisor Specially Profession. Building Licenses Date of Last Renewal. 6/112020 Issue Date. 61270012 Expiration Date: 5/1812029 'cense Status: Active Today's Date: 6/2/2020 econdary License Type: Doing Business As: talus Change Reason: License Issuance Prerequisite Information 'Licensee: GUSEV,IGOR Relationship• Attribute Of 'License No CSSL-105953 • J'f./....,,•)("/.(ilf,-.,;(//) Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Sly HOME IMPROVEMENT,INC, Registration: 181018 21 KIBBEE LANE Expiration: 0211612021 HAMPDEN,MA 01036 Update Address and Return Card. 0 mike!,- Offloo of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Ind,viduar use only TYPE:Dora:ea/don Lxt&tethexpiration date. If found return to: Rouistration Edo:Onion Office of Consumer Affairs and Business Regulation 181018 02/16/2021 1000 Washington Street.Suite 710 GIV,oME IMPROVEMENT.INC. Boston.MA 02118 GOR GUSEV 21 KIDDE LANE C—) Not valid without signature HAMPDEN,MA 01036 Undersecretary Click on the registration number to view cumpiaint nistory You vex,arbitration and Guaranty Fund history The list is current as of Tuesday February 2.2021. Search Results RegistrantName RESPONSIBLE INDIVIDUAL REGISTRATION ADDRESS EXPIRATION DATE STATUS NUMBER GIV HOME IMPROVEMENT INC GUSEV IGOR 181018 21 KlbbeE LANE '32 1M 202', (7,1erpor HAMPDEN MA01036 11111fri 4(11) authorize Go Pcmiks LLC to pull pe mitts using my CS License # C and my HIC Registration # I I Any questions please call me at L! Li. .Z. .) istaller Signature ompany Name lr t ,;i't