24D-230 (2) BP-2022-0039
224PROSPECT ST l COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D=230-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
1
•
Permit# BP-2022-0039 . PERMISSIONISHEREBYGRANTED TO:
Project# window Contractor.* f . License:
Est. Cost: 2753 HOME DEPOT USA INC 1 '106106
Const.Class: Exp.Date:09/29/2022 I
Use Group: • Owner: FITZGERALD REALTY CORPORATION
Lot Size (sq.ft.)
Zoning: URB Applicant: HOME DEPOT USA INC '
Applicant Address Phone: Insurance:
2455 PACES FERRY RD NW XWC-1647259
ATLANTA, GA 30339 -
ISSUED ON:01/12/2022 1
r
TO PERFORM THE FOLLOWING WORK:
REPLACE ONE WINDOW 1 ' ,
i
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring ) D.P.W. Building Inspector
1
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Gas: Final: Final: Rough Frame:-
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
1
THIS PERMIT MAY BE.REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
-
'fi x-,,„ . .4,.,
Fees Paid: $65.00
1
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212 Main Street/Phone(413)587-1240,Fax:(413)587i 1272
Office of the Building Commissioner
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phone 413-587-1240 i=ax.,473,-.587t-, 2 05> pilev4-94:c..a,:.."1,0.-9R.0,,,,,,,,,i,..4,0.ty,,,kv.,,miti,,.,1:401:',.:;T',1,,o,,,,q,,,f,f,
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APPLICATION APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE 0R-DEMOLISH A ONE OR TWO FAMILY DWELLING
. . .
'SECTION 1 ..;SITE INFORMATION :-..,,-... '':.':..' .•
. . , .
.. . ,
:•:,,,,, -::,.....-:Tbid•---SeCtii:in,teibeoOttinieted by office. ,--.-,
1.1 Property Address: ,,,..,..,.,,,,..:,,,,,..'„:„.,,,::;,-;• ,. .4.---'..,.,• .;',-..,,-„.4:::.,;::, ,,,;:....:;-,,-.,,,,,'..,,,.., _,,-.-,,, i,,‘,.',.,,,.,,,,...\• ,,,,-'1:',.-:.;.-.. .:.*.."..',:'-'.:,"--.1'ry
4/ Pro specJ94,f75' '''71-. -',infiat,--,,ei is"1:1-.-7„-,I ::. Lot Unit
'‘,Univr.-:'
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, .-,.-;,. ,,--'-:--',,--g-,,,;,-:-:----:,',..t,'7::',,,,,:,,--
Zone,':•-•;-' ,....-:.....;- ':-.--,-, .::.-,,,..9verlarDistrict
/11A414,11,0/ 4 /1/fi o/o6 o
Elm SLbitiik:- -,-..„--. ,,,,,,,,,,,,--:.,!,--,2-1-:„, :--,.CaDittripl..,?:,'.• :: ._ :,• ,....,. ,.:,-,
.._, .. . ,
SECTION-2-;PRoFiEkTir-oinINERskiPiAuTHoRizED AGENT
. : .,, ..-. ... . .
2.1 Owner of Record:
Ad ,j, 5, 2LI L 'icor ji, 6,6- ell Ar-,4-a.peit .e4-g
- ,
Name( t) Current Mailing Address. c0/06 0
46 Sig ture 1a4 Telephoiinie 3 -
2.2 Authorized Agent:
6erev Id t/ Cra-rvte.,r cb— Ap--,_c ea i ./7 ,irc.. Of/e4/127711z.f Iii Cr
Name 'nt) Current Mailing Address: 69 1466f 33
O - 9S 2- Y)l Z_
Si ture Telephone
SECTION 3-IESTIMATED-CONSTRUCTION'Cbsts5--
Item Estimated Cost(Dollars)to be .:'::;...-•••-..-•:. .. '.: :, '..-.-:' •-:. .:: pffiCiel Use only-" ' •i. . • '... :• : .; .
. .. . ; ; , _ ....
completed by permit applicant - ,--- : - i -. :,. :. -.:
1. Building
°/1 2 -3 . ao (a)Building Permit Fee .
2. Electrical -(b)EatimatedTotal.Oost of.--.. -- - . - : ..•
:. Construction frOm-(6):-':
3. Plumbing Building Permit Fee
. ..: . . : . .
4. Mechanical(HVAC)
. ... .
, ., i •• s .:.. s.. s.. : . .: , :
. - •-• . -- - -, b‘
. .
5. Fire Protection
6. Total=(1 +2+3+4+5) A 2-"q-53, (ro , .- - - 0 '
.Check-Number' . . , . ,. : , : , 0 . . 0.2-,
This Section for Official Use Only
Building Permit Number. -- ..... . : 0t : . . .: Issued -- ' - • ':- - 'f -- •. ., • : ---, • : - :. .. ., .., . . . .
- , . : -
„
----- ' .r. -- . . ' r.' -.---• :-.----:-.::.:- ' ' - --1 4 I -ZZ-
Sig
: :,.,-,•,:i.Building Cornirussioner/Mspector.of puddings... •'•-•,, . .---..:,• -.:- : : .•-- ; .:, • q -. - -...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 1 I
Frontage 0
Setbacks Front = re -'I
k
Side L: R: L:= RI= FT1
Rear = r
Building HeightI.
Bldg. Square Footage = I 1 % I. 1 I I
Open Space Footage f 1 ,1 % 1 1-1
(Lot area minus bldg&paved
parking)
#of Parking Spaces i
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued: I
IF YES: Was the permit recorded at the Regi of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book ' I Pager and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO07
DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained I Obtained 0 , Date Issued: 1
C. Do any signs exist on the property? YES 0 NO Iv
IF YES, describe size, type and location:
I
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location: [ I 1
E. Will the construction activity disturb(clearing,grading,exca lion, or filling)over 1I acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1
•SECTION 5-DESCRIPTION OF PROPOSED.WORK(check alll applicable)
New House ❑ Addition ❑ Replacementr ows Alteration(s) I❑ Roofing El
Or Doors [[�'
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding[0] Other[Dl
Brief Description of Proposed / d / / P /_ � eitev.5"'4,
Work: 0241/04- Al c lae /�✓�� /'1/d
Alteration of existing bedroom Yes t/ No Adding new bedroom Yes No /
Attached Narrative Renovating unfinished basement Yes v No
Plans Attached Roll -Sheet
`sa..lf Newhouse;antl.or adtlition to=ezlstinq�;housing;�.coit�plete..the4fohowing�:
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 i 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 1001yr. 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, r.
� I
I, 4''(1 2-)t c'' 4 c' C�� , as Owner of the subject
property J /
Dhereby thorize fj'`‘'e-'`‘'e- � { U S �Y�" !i x J9"'4.2I tYP li'
to act o y be If ' all matters re ativeto k authorizedby t s building permit application.
Signature of Owner Date L;Z
I, 6e (c L (/Q/Kb' �� , 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. j
Print Name
Signature o wner/Agen Date
SECTION 8 CONSTRUCTION;SERVICES
8.1 Licensed Construction Supervisor: .G liAt tr-°�'L60.10- 4j Not Applicable 0
L
Name of License Holder: C +et.✓ I 0 6 /O 6
n License Number
Z.3 ge, �� fr.� i-r G n 9�7 eI d ?�1 D i/O 9 9- 2 9 — zZ
Addre _ V Expiration Date
C,06,4)
Y/3- 335- 3-70z
Signature ' Telephone
�9:"'Registered'.Home Improvement Contractor: Not Applicable ❑
/661116 o,L 4,519- e. / l Z8 �c
company Name y, , n Registration Number
Z51W Paces yy 14,D c1 4'.14.-elr, 64 30339 1-1l2..Zf7, 3
Address ✓ E piration Date
Telephone .moo- FSz
SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT'.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building ermit.
Signed Affidavit Attached Yes No 0
1:13 Home Qwner,Et ti0n
The current exemption for"homeowners"was extended to include Owner-occupied Dwellint s 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" citifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,Stat d L oning Laws and State of sachusetts General Laws Annotated.
.i %,
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Homeowner Signature '
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City of Northampton 212 Main Street,Northampton, MA 01060
i
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: Z z N I-o 5 pe c. sd n e/ a i., /44 0/0 6 0
The debris will be transported by: 64 -f/1- igt4f�'eD
The debris will be received by: h64., d MTi
Building permit number:
Name of Permit Applicant 0XGIrmwCP---
/16p _Th
Date Signature of Permit Applicant
;;:: The Commonwealth of Massachusetts
»µ> = Department of Industrial Accidents
4il —bit, Office of Investigations
l,'',''' .Q _ Lafayette City Center
���, �� 2Avenue de Lafayette, Boston,MA 0�111-1750
--= ww vlsti.Inass.go'/dia
Workers'Compensation Insurance Affidavit:Iluildersl+ContractorslElectriciansiPluntbers
Applicant Information Please Print Legibly
Name(BasinessiorganizationfindividualpHorne,Depot USA kit.
Address:2455 Paces Ferry Rd ,
•
City/State/Zip: Atlanta, 3033 Phone#:85°•952-4112'
•
Are you an employer?Check the appropriate box: Type of project(required):
1.0 1 am a employer with 4. 0 1 am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors b. New construction;
2.® I am a sole proprietor or partner- listed on the attached sheet. 7. J Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for rate iii any capacity. employees and have wort ers`
comp.unaurmnnce.* 9.1 Building addition
[No workers'comp.insurance
required_] 5. gg We are a corporation and its 10.11 Electrical repairs or additions
3.0 lam a homeowner doing all work officers have exercised their I 1_D'Plumbing repairs or additions
myself.[No workers' comp. right of exemption per MO.. 12.0 Roof repairs
insurance required.]f c_152„§1(4),and we have no ttrt�n� s'
employees.[No workers' 1 .®m�ilner r r .
comp.insurance required.
'Any applicant that cheeks,-ki.ttt must u15aa iUunt ale raericinlast showing that nta741ta n`calinpeeimatienpalieyinformation.
t RamcoviticaS Ira ae submit this affidavit iiiilal hilt;they UM:tieing all 1K n t and Llieii hire ouisiik cent:L ol5ma ntust submit a ii't_'iI>affidavit aiidicatindstittl_
Itentaaeters that chi t:this,traix must anarliedl an additional&ben s9lmviug the name of aic seh-e rontraeliis andstate whatcar ter olurt elarmc imtitits have
etuplepts. if the ssubs-al- meietansharetentpleyci ,they tam!t,sitk theme markets't t 1p.politgtnut
Iwo rat employer that is providing workers'compensation insurance for my employees Below is the policy muf fob site
fir,formafiws
Insurance Company Name:•National Union Fire,Ins,orance Co_
•
Policy#or Self=ins.Lie.##: C Er47259(9;al ' MA) p, Expiration late:3. 9/22 . ,
Job Site Address:`. .2'i e/17sff€i Cityi'State�&Zip: /14?""7 H PIP 0/v6-0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,518100 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to 8250.00 a day, against the.violator, Be advised that a copy of this statement may be forwarded to the°dice of
Investi;thous of the DIA for insurance coverag,e verification. 1
I do hereby certi f under the pains and penalties of perjuty that the information provided ab®re is true and correct
Signature: �'��v� Date: /' 1/- zo 2 Z
Phone : 860-352-41.12 - '
Official use only. Do not write in this area,to he completed by city or town officiaL
City or Town: . _ PertnitiLicense# - ;
Issuing Authority(check one):
ICI Board of Health 2D Building Department 3.DCitylTown Clerk 4.0 Electrical Inspector 5[)hri tbiing
Inspector 6.DOther •-. -
Contact Person: Phone k:
City of Northampton
j '" MassachusettsAy a
aii
!1 d, - DEPARTMENT OF BUILDING INSPECTIONS y d�,
'( v'4,4 212 Main Street • Municipal Building I JC ?��
� `� ""� Northampton, MA 01060 s • 4C
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 &i 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 / 1
,r
I, ��/Z 71i-0A 1 Re iv I r/L4understand the above.
(Home owner/residderSt's signature r es ing exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date • /-21 - 207i2
Address of work location 22 a ®n,sied ffred
iris kel At a>DG o
4 "S S ., Go Permits, LLC
- it 105 Buttonball Lane
Glastonbury, CT 06033
,440,40i.
4 IT
° r � Scott Doughman
Phone: 860-952-4112
Fax: 860-430-6719
.4 w 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#: 1-1YDEQMSL Sheet: 1 of 1
CuStonier: FITZGERALD REALTY Job#:1-1YOEQMSL Consultant: Kyle Harmon
Date: 01/06/2022
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
E E Mull "E"=stationary or
2 Style Wraps .� •S rn `o p "X"=operating
Room Floor Code (Y/N) Style Code Series Code xi 5 1—a o. 22 > x� J > x�
STD,White,TMP:Full, WRAP,LSR
1 LIV 1st PD2- Y PDD5 6100 WH WH 71.26 79.5 150.75 GlassPack:Standard X S
FR-C
SPECIAL CONSIDERATIONS:
1:White
Wrap Color
Interior Casing Type Colonial
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 ' • - - Rep. - Ther al V. I e o Pro• uc s Ma ' c • --d • T S . - •. •
)ate¢ : 6I 0/20 8
aj-i , Of(101p37.
a
Without Grids With Grids
Style - Glass Package.` Glazing Spacer IG V rr}@ U - @
SHGC' nl�J CJ' ai,SHGC�' @,
(all with-Argon) Fact 1' - GI C Fact Gc1 c,
6500
wning 6500 Base ProSolar -__._ Supercept` 7/8" 0.26 0.23, 0 0 0 0.26 021 0 0 0 I
;asement 6500 Base ProSolar Supercept 7/8" 026 ! 0.24tom 0 0.26 $ 0.22 0
ransom 6500 Base ProSolar Supercept 1' 027 0.32 0 0 0.27 0.29 0
ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 o 0.29 j 0.24 - 0
icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 j 0.28 0 0 0.26 2 0.25 0 . 0
icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 0 0 0.27 ; 0.26 0
Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 ! 0.26 _0 0.29 023 0 0 0
Panel Sliders 6500 Base(s 21 Sqf) Pro Solar Supercept 7/8"} 0.29 0.26 0 0.28 j 0.23 0 0 0
,500 DOORS
arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 ; 0.24 0 0 0 0 0.30 0.21 0 0 0 0
atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 101 0 I0.31 i 023 o o o I o
1 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and
Washington.
wning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 i 0.24 0 0 0 0 0.28 0.21 0 0 0 0
asement • 6100 Base Pro Solar Intercept 7/8" 0.27 024 0 0 0 0 0.27 0.22 0 0 0 0
ouble-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 i 0.30 0 0.30 ! 0.27 0 0 0
icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 0 0 0.27 ; 0.25 0
icture 6100 Base Pro Solar Intercept 3/4" 027 0.31 0[0 1 1 t 0.27 0.28 o o'
Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 x 0.28 0 0.30 : 0.27 0 I
Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 ; 0.29 I o 4 10.30 i 027 0' 1
1100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and
Washington.
atio D.• • e • e _ 6100 Energy Star Pro Solar Super Spacer 1" 0.2288 026 I 0 I 0 I I 028 0.23 I o I o I o I o
•a• � .• I•r?:�"tL:;nlrn=k 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 .30 0 o J8 {)0.26 0 01
6200 Homes located only in following markets:Dallas,Denver,Detroit Phila,Northern NJ,Long Island,NY.
wning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 0 0 0 0 026 1 023 0 0 0 0
asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 o o 10 0 0.29 i 0.17 0 0 0 0
icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 ; 0.21 0 0 0 0 025 •f 0.19 0 0 a 0
icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 ; 0.24 0 0 0 0 0.26 } 0.22 0 0 0 0
Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4 0.28 0.23 0 0 0 0 0.28 f 021 0 0 0
Ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 C 0.23 0 13 0 0.28 ; 021 VA 0
Panel Slider 6200 Base Pro Solar SHADE Supercept 314" 0.28 ! 0.23 0 0 0 028 ! 021 0 0 0
.to rm B re a ke r Plus 300VL Homes located in coastal areas. \
wning SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 k 023 0 0 0 0 0.26 ; 0.21 o o 0 1 0
asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 0 0 0 0 0.25 ; 021 0 0 0 J o
ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 i 0.25 0 0 0 0 0.29 } 023 0 0 0 0
lider SB+300VL Base PS/Lami Intercept 1" 0.29 i 0.25 0 o o 0 0.29 j 023 0 0 0_0
atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 0 o 0 o No Grids Allowed
arden Door(CH) SB+300VL Base PSILami Super Spacer 1" 0.30 f 0.28 0 0 I 0.30 10.25 0 0 OF
o
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
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 k
The Home Depot The Home Depot
Service Provider Contact Name Service Provider Company Name
(203) 265-7037 IFTercancellationnortheast@hom MA: 107774, 112785
Phone# vPPdec$ eider Email Address Service Provider License#(s)
2 Customer Information
REALTY FITZGERALD New England West I 1-1Y0EQMSL
Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO#
224 Prospect Street Northampton MA 01060
Customer Address City 1 State Zip
(413) 835-5689 I fitzgeraldproperties123@gmail.com
Home Phone# Work Phone# Cell Phone# Customer Email Address
`3 NOTICE OT 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 ACKNO LED: YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YO RIGHT TO CAN, E HAT
Acknowledged by: 01/06/2022
Customer's Signature Date
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i 4 Description of Work to be Performed ....,' ' ... ... .'
A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification,
Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement.
5 Anticipated Delivery,Date/Installation Schedule
Approximate Start Date: 07/05/2022 Approximate Finish Date: 08/04/2022 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 rc
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: $ 2753.00 Includes all applicable taxes. Excludes finance charges.*
Sales Tax: $ 0.00 ' • - total amount of taxes included in Contract Price)
*Maximum deposit 0' I I'applicable in '. vr, .E(33%) NJ, WI(99%)
Deposit% 25.0 Deposit 688 25 2064.75
p posit ount$ emaming Balance $
8 Finance Charges}
Any interest payments or other financ: charges will be . • ermined by Customer's separate cardholder or loan
agreement, to which Home Depot is NO ' : .nd 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'Authorization777.77,
.. ._ .
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" abov - and (iv)Electronic signatures will be deemed originals for all purposes.
X 01/06/2022
Customer's Signature / Date
X /s/The Home Depot 01/06/2022
The Home Depot Digital Signature Date
For questions related to your installation,contact Service Provider at (203)
Lbb-iu�i
For any other concerns, contact The Home Depot at 1-8'00-466-3337
Scope of Work
REALTY FITZGERALD New England West 1-1Y0EQMSL
Customer Last Name Customer First Name Store#/Branch Name !, Lead#
Job#: (Internal
Reference) Products: Spec Sheet(s)#: Project Amount
Re
1-1Y0EQMSL 4 Windows Entry Doors 1-1Y0EQMSL! 2753.00
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Sales Tax 0.00
Total Contract Amount 2753.00
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):
II
A., 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 (III) 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.
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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. Tile 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, (II) authorize
the correction or replacement of each Defect; or (111) 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 ' 1 n Y 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. TERMIINATION: 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.
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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 Proyider(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.
Go Permits, LLC
S\ 105 Buttonball Lane
te Glastonbury, CT 06033
4111114114
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
Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor.,
CSSL-106106 Exp. 9/29/22 HIC 187666 Exp. 5/9/23
Workers Comp.Associated Employers Ins. Policy WCC-500-5021510-2021A Exp. 1/17/22
All licenses and insurances are attached.
Once the permit is ready:
• Please fax or e-mail a copy of the permit and receipt to the below address and mail
the original to the homeowner:
Fax: 860-430-6719
Email: permits@gopermits.ora
• 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
c s► CERTIFICATE OF LIABILITY INSURANCE DATED 15O.'YYYt
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ACORCA ADDITIONAL REMARKS SCHEDULE Page 2 of 8
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ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM.
FORM NUMBER: 25 FORM TITLE Certficate of Liability Insurance
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ACORD 101(2008f01) 02008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Business Reguliation
1000 Washington Street-Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Card
112785
HOME DEPOT USA INC Registration: 04l22
P O BOX 105451 Expiation: Q4122/2023
ATTN: LICENSE Mt:MT TEAM
ATLANTA,GA 30348
Update Address and Return Card.
Office of Consurnw ttsee tL tuelmss won
HOME MIPROVEITENT CONTRACTOR Registration valid far Individual use ordy
TYPE:Supolament Card before the expiration date. If found return to:
Realitress Office of Consumer Affairs and Musings Regulation
11 0 33 MO Washington Street -Suite 7111
HOME DEPOT USA INC Boston,MA 02115
RICHARD OLMSTFAD
1'5)2455 PACES FERRY RD C•11 HSC of veltd with signature
GA 30939 Undersecretary
1
EXTEREM-01 MARDE1,
ACC:0 °f CERTIFICATE OF LIABILITY INSURANCE ?t3o oATe r
21
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer dolts to the certificate holder in lieu of such endorsement(s).
PRODUCER ACT Deborah Marino
Canary Blomstrom PHDNE l:+ix
MI Spri field Street Mc,Na,e. {41 750-9022 i ta+c,Na (413)786-7004
Feeding tills,MA 01030 lkdmarino@canaryblomstronicom
INSEAMS)AFFORDING COVERAGE NAIL
INSURER A NGM Insurance Co.
INSURED JtiWRElisAssociated Employers Insurance Comi any ^,11104, .,
Exterior Remodeling Group Inc. INSURER C_
23 Benham St INV,IS€R41e
Springfield,MA 01109 INSURERS!
vltv9tAERFs _.
Stairg,MG _ CE1171E ATE D►0H11 REVIS1QN NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTYITTHSTANDING 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
INSR
P
LTTI• TYPE OF INSURANCE OL SUBR' POLICY M
POLICY
j Ouc WETS
PISD 61'YD INAC EFF iPOUC YYYYEKP�'L,
A X-COMMERCIAL GENERAL LIABILITY
- � EACH OCCURRENCE ,8 1,000,000
CIAIMSNIPSS OCCUR MPP3376W I 7127/2021 712712922 i O 500000 ATED.F.KP?Ammo irpmrJl $ 10,000
PERSONAL&ADV MAR S 1,090,000
2s ,
G_NLAGGREGATE I rJ+P PLEB PER: GENERAL AGGREGATE $ OOO OQEI
X PLUM'El gla El LOC PRODjICTs_cauPOR AGO 3 2,000,000
BOTHER' S
A AUTOMOBILE LWSSUSY Eaa,81:t1t}NED INGLEUMIT $ 1,000,000
r--ANY AUTO MPP337SW 7127/2021 7127/2022 BODILY tN URY trjaswrssk S
OI,YNED -' SCDULED
AUTOS ONLY � DS O A��MOS��,,qq,,77 BODILY INTURY Ter axiartl 5
X ED ONLY X ALiT PROPERI r✓'i+drelI Y1GE
_ g
UMBRELLA LIAR _J OCCUR
E.6C,14'OCCURRENCE $
.....EXCESS LIAR C...k7.2"a-A!N.RNDE AGGREGATE S .,
CED} !RETENTION$ _ S
B WORNERS CDMPSYBATION ' - X I TZTUTE 1 ER
AND ESEPLOYERB'1.IA�ST'Y YIN ER
WCC-500S021510-2021A 1117/2021 111712022 500,000
Ati0'Pii9FWvemaiRTUCED7 ECU7JE [J N(A EL EACH ACLlGE7F 5
,CF+PmICEA� ExCLLL^i 'I E.T_o15rA;iE-EA EMFt 590,000
IIII Vet ddooser to uxCw S00 000
DESCRIPTION OF-O Wow
ow EL DISEASE.PCUCY LIMIT r
, r
DsSCRIP on OPOFEATIORS I LOCATIONS',VEHICLES(ACOEND 16T,AdSlsloaa7Remuhs cNsRCo, t1 rJ ud If mum spelt Is mquked)
Home Deport U.S.A.Inc.Is named as Additional Insured with respects to Ge Liability
iity
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEOF, NOT
Home Depot U.S.A.Inc ACCORDANCE WITH THE POLICY PROVISIONS.
S WILL BE DELIVERED IN
2455 Paces Ferry Rd C-11
Atlanta,GA 30339
AUTHORIZED REPRES ENTATPIE
ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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