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24B-015
BP-2022-0506 26 DENISE CT COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 24B-015-001 CITY OF NORTHAMPT N Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FIND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0506 PERMISSION IS HEREBY GRANTED TO: Project# 2022 WINDOWS Contractor: License: Est. Cost: 18735 HOME DEPOT USA INC CSSL098785 Const.Class: Exp.Date:04/27/2024 KOPELL WILLIAM N Use Group: Owner: DANIEL J WE:NER Lot Size (sq.ft.) Zoning: URB/WP Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-4112 WC 06588608(AOS) ATLANTA, GA 30339 ISSUED ON:05/10/2022 TO PERFORM THE FOLLO WING WORK: REPLACE 20 NONSTRUCTURAL 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 1 Department use only .i City of Northampton Status of Permit: o =T Building Department Curb Cut/Driveway Permit •y 212 Main Street Sewer/Septic;Availability ru Room 100 Water/Well Availability o` , Northampton, MA 01060 Two Sets of Structural Plans (1i- 'pilule 413-587-1240 Fax 413-587-1272 Plot/Site Plans r '�- Other Specify -, i ' APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: RGo Dent be CO'k-r-T Map 2140 Lot 0/6_ Unit 00 I AVar ta,v,apiv^ MA. 01060 Zone (Af #3/w P Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: a n a o((y 1A) Cnt✓ 2� DCA r c..� re,.. .f /�4i t�w�j43n /A Name rint) I Current Mailing Address: 0/40670 GC;ieous4f--) one 3 ' (o — 9 �!� 6 TelephoneSignature 2.2 Authorized Agent: COC,'.c I L . t^i-a friG,' ✓el- /OS Arh�.l G4,tc L�/43 J".i.4,l ci- Name(Print) Current Mailing Address: O6j0.3.3 �60 - 9sz - f• - Z Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building N! G 3-35 (a) Building Permit Fee ' r 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 +4+5) 1 f$) -7-35, ov Check Number # 2h( . z— This Section For Official Use Only Building Permit Number: 13P-202 - O,5-D(o Date Issued: ii7 5- to- 2-0z Signature: � Z Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: I.: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW U YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO 0 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 0 DON'T KNOW YES Q 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 ® NO er- IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO e IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, exc tion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® 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 D Replacement Wjpdows Alteration(s) Roofing Or Doors L Accessory Bldg. El Demolition El New Signs [p] Decks [0 Siding [ID] Other[DI Brief Des ription of Propose //�� `L- �� l �G�a� Gs Work: PMi7�R.. q ci,.4 pree c6 2 0 1v�`nc1a�r-S a r Ak /4 me Sic 9 C(<acbi , ZS Alteration of existing bedroom Yes ✓No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes i- 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, Daniel a,' I -/ 4 /l//(4e/ , as Owner of the subject property hereby a thorize ig,KG Dediol uSi ,r.le f f,y �CMoh%2 to act ., y behalf, II matters relative to work authorized y this building permit application. 410 a , .--f S - F- z2 Sign- re of O Ine Date I, 'tot t I I'� �°� (� 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. 6LT 4 e ei C- . (`fa Ae- Jz Print Name ^ Signature of Ow ek Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: 3 I r`bSOb� �l�y /- Name 4GMo4'J4, O 9 $�'8 s J / License Number -Z s-1-4. ,a gm461 MD4c n _AMA 0/19s?- _ y /z7/ Li Addre Expiration Date i > 4f/ - Z Z r — CFO& ature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 / der-f u,S/ 7 c- /,'z i-i$ Company Name Registration Number �YSS Doe .1 `'ir, lfso•c I 411 z z /Z 3 Address Expiration Date #4-1Q'fix 64 3e) G 3 ? 9 Telephone 6 4a "9•2-yf/Z SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes CY/in No 0 11. - Home Owner Exemption The current exemption for-homeowners-was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner- shall submit to the Building Official,on a form acceptable to the Building Officialtthat he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned`homeowner"certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State "Local Zonin aws and State of Massachusetts General)Laws Annotated. /(Homeowner Signature •�j / 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: a` t'enu G -1 NL"- 0.,W. ^ MA ofo`o The debris will be transported by: I 4C. i ��fito.✓e /4 j The debris will be received by: ikpie Per { 6I97 sek, 11 �"cld Cod Building permit number: Name of Permit Applicant (Ilia G. Cc4 Atec J-� tt,2 z /C4-4111 Date Signature of Permit Applicant The (commonwealth of.Massachusetts Deportment of Industrial Accidents Office of Investigations Lafayette City('enter 2 Avenue de Lafayette, Boston, NA 021114 750 WNW.mass goy/dia Workers'Compensation Insurance Affidavit: Builders/('ontractorslElectriciansfPlumbers Applicant Information Please Print Legibly prg ni nuo,; HOME DEPOT USA Name t 1i�>nn� 'ladividual): Address:2455 PACES FERRY RD City State/Zip:ATLANTA. GA 30339 — Phonc#:8W-952'4 112 Are you an employer?('heck the appropriate bon: Type of project(required): 1. ] I am a employer with 4. 1 am a general contractor and employees(full artd'or part-time).* havr hired the sub-contractors 6- U New construction 2.❑i am a sole proprietor or partner_ listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have B. ❑Demolition workingfor me in an capacity. employees and have workers' y ' ty. 9. Building addition [No workers' comp_insurance comp. insurance.: required.j 5. 0 We are a corporation and its 10_[]Electrical repairs or additions 3.J I am a homeowner doing all work officers have exercised their 11_0 Plumbing repairs or additions myself (No workers" comp. right of exemption per MGL 12n Roo(atpra s insurance required.' ' c. 152, *1441.and we have no 'J1rtndo; employees. [No workers" 1 ` (Aim comp. insurance required.) 'Any applicant that checks box r t mum ntw till out the awctian below%flow nng their w urkers"compensation tlohey ufontolws. f Horrionme s who subunit ibis altiLa%ti indicating they arc doing all work and then hire asitsuJic cenitractora must sigma a slew affidavit mdscatms such. ..contractors dial chock this box must attached an additional*hect show tng the nine ul the sub contractors and state wttietfaR or not those cubis ►bast: employee% It the+tit'coaltrat.iors hasc erirFtehctx they must proside their wv tcri comp.policy number I am an employer that is providing trariers'compensation insurance for my employers. Below is the policy and job site information_ Insurance Company Name:AiU Insurance Co Policy it or Self-ins. Lit:. WC 065886028(AOS) Lspiration Date 03/0112023 Job Site Address: 6 ni>;ti ou-i 4' C e/yha.� n 1,� a � C _ _ --- � �=N �>� o robe Attack a copy of the workers'compensation policy declaration page(shower the number and expiration date/. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to imposition of criminal penalttc,. ,i1 a tine up to$1.5(10.00 and or one-year imprisonment_ as well as civil penalties in the form of a STOP WORK()RD! R. and a line of up to S250.00 a day against the s iolator_ He advised that a copy of this statement tray be forwarded to the Office of Investigations of the DIA for insurance coacrage verification_ /do hereby rrrti/r under dm pains and penalties of perjury that the informatirnr provided above is true and correct S►_nature: - .01v ale: �� Z Z- Phone#: 860-952-4112 Official use only. Do not nrrite in this area.to be completed by city or tore official. (-its or Town: Permit license # Issuing Authority(check our): 1tBoard of Health 2D Building Department 3DCity/fown Clerk 4.0 Electrical Inspector ;.�'lumbint; inspector 6..JOther - Contact Person: Phone#: City of Northampton aYHAMPj\ Massachusetts ��' ..! '- 44 m.` ':� y `k, F�1 DEPARTMENT OF BUILDING INSPECTIONS �`• S_rem* • Muni opal Euilding INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and insp tions rem de I, - j understand the above. (Home o er/reside s signatu r�n exemption) 9 requesting p ) I will call to schedule all required building inspections necessary for the building permit issued to me. Date / - 1-0Z2— Address of work location 2-6 Peni se Ca" 14 44°1 114 /414 a o 6 o Go Permits, LLC 430 105 Buttonball Lane Glastonbury, CT 06033 PERMITS Scott Doughman — Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman©gopermits.org Re: Massachusetts Solid Waste Affidavit Good day, Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 • 375 Airport Drive Worcester, MA 01602 • 12 Linscott Road Woburn, MA 01801 • 50 Maria Ave Johnston, RI 02919 Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1.1ZF464LF Sheet: 1 of 3 Customer: Daniel and Holly Wiener Job#:1-1ZF464LF Consultant: Ronald Engelbrecht Date: 05/03/2022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening A of bars H of bars Csmnts,1 Pnl, use L,R or S Glass Hardware Misc Items Screens Code For doors use m c c Mull "S"=stationary or `g LL E ° 1= ° c`0i o o ct°i c "X"=operating Style Wraps `m `il rn `o m .y 'm r Pe 9 Room Floor Code (Y/N) Style Code Series Code E 1 3 xi -ro U ti I > _ x° > _ STD,White, GlassPack: WRAP,LSR 1 KITCH 1st SH-A Y DH 6500 WH WH 40 36 76 Standard STD,White, GlassPack: WRAP,LSR 2 MICR 1st- SHA _._Y_ OH -0500 WH WH 36 42 78_ - _ Standard STD,White, GlassPack: WRAP,LSR 3 LIV 1st C1- Y C1-O 6500 WH WH 20 62 82 Standard L HPS STD,White, GlassPack: WRAP,LSR 4 LIV 1st Cl- Y C1-O 6500 WH WH 20 62 82 Standard R HPS GlassPack:Standard WRAP,LSR 5 LIV 1st PW A Y PW 6500 WH WH 84 62 146 STD,White, GlassPack: WRAP,LSR 6 BATH 1st SH A Y DH 6500 WH WH 24 38 62 Standard MULL,STD,White, MULL, 7 ENTRY 1st AWN Y AWN1 6500 WH WH 43 31 74 GlassPack:Standard MULL R, X HPS WRAP,LSR GlassPack:Standard MULL, 8 ENTRY 1st AWN- Y PW 6500 WH WH 22 31 53 WRAP,LSR HPS SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1ZF464LF Sheet: 2 of 3 Customer: Daniel and Holly Wiener Job#:1-1ZF464LF Consultant: Ronald Engelbrecht Date: 05/03/2022 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,RorS Glass Hardware Misc Items Screens Code _ For doors use c _ c0 c _ E Mull "S"=stationary or > Style Wraps a `= = v� u_ !4Q 0 m 1 g "X"=operating w Y P' a k0 o § m o f o Room Floor Code Y/N) Style Code Series Code _ u) 3 x 5 I—to U �° > x w > 2 STD,White, GlassPack: WRAP,LSP 9 STUDY Basem SH-A tit DH 6500 WH WH 32 46 7S Standard ent STD,White, GlassPack: WRAP,LSR 10 STUDY Basem SH A Y DH --6500. WW _ WH 32 46 7£ Standard ent STD,White, GlassPack: WRAP,LSR 11 STUDY Basem SH A Y DH 6500 WH WH 32 46 78 Standard ent STD,White, GlassPack: WRAP,LSR 12 LAUN Basem SH A Y DH 6500 WH WH 32 46 78 Standard ent " STD,White, GlassPack: WRAP,LSR 13 BED1 2nd SH A Y DH 6500 WH WH 32 46 78 Standard STD,White, GlassPack!WRAP,LSR 1 BED1 2nd SH-A Y DH 8500 WH WH 32 46 78 Standard 4 STD,White, GlassPack: WRAP,LSR 15 BED1 2nd SH-A Y DH 6500 WH WH 32 46 78 Standard STD,White, GlassPack: WRAP,LSR 16 BED2 2nd SH-A Y OH 6500 WH WH 32 46 78 Standard SPECIAL CONSIDERATIONS: 9:White,10:White,11:White,12:White,13:White,14:White,15:White,16: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 Csmrtt) 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 ony-Whlte Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1ZF464LF Sheet: 3 of 3 Customer: Daniel and Holly Wiener Job#:1-1ZF464LF Consultant: Ronald Engelbrecht Date: 05/03/2022 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 bar,, Csmnts,1 Pnl, useL,RorS Glass Misc Items Hardware Code Screens For doors use 5 t✓ c c E Mull "S"=stationary or ft Style Wraps c a o, m 0 o m r N m r N "X"=operating u.iRoom Floor Code (Y/N) Style Code Series Code E 1 3 I 1.- vi 0 o > x° >8 as _ STD,White, GlassPack: WRAP,LSR 17 BED2 2nd SH-A Y DH 6500 WH WH 32 46 78 Standard STD,White, GlassPack: WRAP,LSR -3—-REn7- 2.4 _.SH-A _Y _f1H- _. 6500 WH WH 32 46 78 Standard 8 -_- - - - - ----- - -- - - - - _ STD,White, GlassPack: WRAP,LSR 19 BED3 2nd SH-A Y DH 6500 WH WH 32 46 78 Standard STD,White, GlassPack: WRAP,LSR 2 BED3 2nd SH A Y OH 6500 WH WH 32 46 78 Standard 0 SPECIAL CONSIDERATIONS: 17:White,18:White,19:White,20:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) e 'ome 'epo - erma Ta ue o Products Manufactured by Simonton Sated: 5/30l2.11" Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC • (all with Argon) Fact Fact 6500 _ _ u'•g 6500 Base ProSolar Supercept 7/8" .2 0.23 • • • 0.26 0.21 • • • :asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 • • 0 • 0.26 0.22 • • • • • 'ransom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 • • )ouble Hun 6500 Base ProSolar Supercept 7/8" =. 2 ? 0.26 • 0.29 0.24 • • • 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • • • '-ictt 6500 Base ProSolar Supercept 7/8"7.27 0.29 • • 0.27 0.26 • • 'Panel Slider 6500 Base ProSolar Supercept 7/a" 0.29 0.26 • 0.29 0.23 • • • Panel Sliders 6500 Base(s 21 Sgrt) Pro Solar Supercept 7/8" 0.29 0.26 ^1 0.28 0.23 • • • .500 DOORS garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 10.30 0.24 1 •1 •I •`•10.30 0.21 I •1 •I •1 • 'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • l 0.31 0.23 • • • • . 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. mining(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • 0 • 0.28 0.21 • • • • :asement 6100 Base Pro Solar Intercept 718" 0.27 0.24 • • • • 0.27 0.22 • • • • )ouble-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0.30 • 0.30 0.27 • • • 'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.2'7 0.28 • • 0.27 0.25 • • • • 'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • • 0.27 0.28 • • Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • 0.30 0.27 • Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 I 0 0.30 0.27 0 •100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. 'atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" 0.28 0.26 • • 0.28 0.23 • • • 0 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 0.28 0.26 0 0 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. wning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 j• • • • 0.26 0.23 • • • • :asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • • • 0.29 0.17 • • • • 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • • • • 0.25 0.19 • • • • 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • • 0.26 0.22 • • • • tingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • • 0.28 0.21 • • • " tingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • 0.28 0.21 •_ • • Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • 0.28 0.21 • • • .tormBreaker Plus 300VL Homes located In coastal areas. ,wning SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 0.23 • • • •10.26 0.21 • • • • :asement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 • • • • 0.25 0.21 • • • • rouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.2p9 0.25 • • • • 0.29 0.23 • • • • Alder SB+300VL Base PS/Lami Intercept 1' 0.49 0.25 • • •• • 0.29 0.23 • • • • 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1' 0.30 0.19 • • • • No Grids A_Ilswed iarden Door(CH) SB+300VL Base PS/Lami Super Spacer 1' 1 0.30 0.28 • • 0.30 0.25 •• • • • 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 _ IRonald 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 rcustomtercancellationnortheast@hom1 PA: 107774, 112785 Phone# ��F%t8 Y vider Email Address Service Provider License #(s) 2. Customer Information Wiener Daniel and Holly 1 New England West 1-1ZF464LF Customer Last Name Customer First Name Store #/ Branch N: e Customer Lead/PO# [26 Denise Court 1 [Northampton MA f 01060 Customer Address City State Zip (413) 687-9416 weinerd@ccsu.edu 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 1 Wallingford 1 CT 06492 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER S GNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PE ' OD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESC I:ED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) :USINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVA II ABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRES`, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDI E OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTR I CTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NO CE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THA YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT 0 CANCEL. Acknowledged by: __AlE471.111111111.111111_ 05/03/2022 Customer's Signature Date 1 �` ' Home Improvement Agreement: P ge 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragrap 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: 10/30/2022 Approximate Finish Date: 11/29/2022 y All dates are approximate and subject to change based on unforeseen events including inclement we her, 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 con ent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written commu ications related to this Agreement. By contacting your Service Provider,you may update your email address,withd w your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your co sent and verifying your email address above, you confirm that you have access to a computer that can receive and pen 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: $ 118735.28 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit ONLYappli� ' f ID, MA, ME (33%), N.J. WI(99(! ) Deposit% 25.0 Deposit Amount$ 4683.82 Remaining Balance $ 14051.46 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 '111t�0 05/03/2022 Customer's Signature Date X Is/The Home Depot 05/03/2022 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 "b-/us/ 4 440 NINib Scope of Work Wiener Daniel and Holly New England West 1-1ZF464LF Customer Last Name Customer First Name Store ft/ Branch Name Lead ft Job #: (Infernal Reference) Products: Spec Sheet(s) #: Project Amount 1-1ZF464LF Windows Entry Doors 1-1ZF464LF 18735.28 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 18735.28 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 6500 Warranty Name(s): ,`1 The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agree ent 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, f any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty ocuments, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-com iant with manufacturer's installation instructions. "Home" means the real property, fixtures and any physical 'mprovements where the Services are performed. "Services" means(i)the delivery and furnishing of goods, eq 'pment, materials, and hardware; and (ii)any related labor and services, including without limitation, construc on, 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, sc edules, invoices, specification sheets, proposals, confirmation emails or otherwise. "Service Provider" means 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 deem• in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically co tracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous o unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provi I er may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may del gate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be a.signed 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 Dep i t in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home D pot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work • ea, including,without limitation: (1) obtaining in advance of the Services consent,permission,or relief from an, covenants,easements, restrictions,or other legal encumbrances affecting the Work Area; (2) providing the loc.tion 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 affe directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, incl •ing 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 . 1 utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area;(71 removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permi P,, 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'. performance of the Services;and(11) not interfering, impeding, impacting or otherwise disrupting the Work • ea 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 S:rvices in any way, You assume all risk for property damage and for injury to Yourself and others. 1 The Home Depot General Terms & Cond tions • 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 A t•eement("Change Order"). A Change Order will be issued by Home Depot or Service Provider on behalf of H ime Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of thi. Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Se ice Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the pe ormance of the Services, requiring an increase in cost,time,or both. Following the discovery of any conditions 1 at impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately sk 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 Contra' 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 m. erials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You •r(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Pro der will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (.) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the compl-tion date (the "Warranty Period") that all Services will: (i) be performed with good workmanship and (i ) 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 • replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each D fect and refund all or a proportional amount of the Contract Price thereof to You; provided, however, that . 1 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 Ho e Depot in full as provided in this Agreement. Any warrantable corrections, replacements or repairs mad- in accordance with this Agreement will not extend the Warranty Period. (b) Limitation on Warranti : THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FO' GOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTI IN OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER W• ' ' • TIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY,OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES. HOME DEPOTS EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LACK OF PRESCRIBED O' STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S W• ' ' • I S PROVIDED FOR GOODS, MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY OME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR ' I DY 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 RES I TING 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 •r its convenience, and by either party for cause if the other party fails to correct a material breach within ten ( 0)days after receiving notice from the non-breaching party identifying the breach. In the event Home Depot to Mates this Agreement because You fail to provide Safe Access to perform the Services, or if either party termina es the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe onditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services • ovided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider Is a result of the termination. `�` The Home Depot General Terms & Cond tions ►` N , T 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 "ntend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under a plicable laws. In the event any term or condition in the Agreement violates applicable law, such term or conditio will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalida ing 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 ayment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed p ase of the Services and before making any further payments, You should request from Home Depot or Service P ovider a signed, unconditional release from, or waiver of, any right to place any claim against Your property plicable 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 ade, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements f 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 merchandis may be returned, and a refund for all or part of the Contract Price provided, in the discretion of Home Depo . Please contact The Home Depot for additional details concerning returns. 13. A REEMENT/ ERVI E ORDER ATI N P FEREN S: You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the f llowing: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call); (2)C ntact 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 > -Store Special Orders to access Your account to update Your Agreement/Service Order Communication Pref rences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Yo Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages er 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. S andard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You '11 be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voi communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including cu ent and future orders) via automated technology to the phone number You provided. The total number of c is received depends on the number of orders placed and order activity. You can press 9 during a call to opt out r call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per ord r(including current and future orders) via automated technology to the Email address You provided. The total umber 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 determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by our 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. xp� Go Permits, LLC 105 Buttonball Lane 7. „lik Glastonbury, CT 06033 . ,,,,ct i, ;$ r) 1 la 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.-AIU Insurance Co. Policy WC 065886028 (AOS) (MA) Exp. 3/1/23 Ivan Kosobutskyy D/B/A I & I Remodeling is the sub-contractor. #CSSL-098785 Exp. 4/27/24 / HIC#152379 Exp. 8/22/22 Workers Comp. —Atlantic Charter Insurance Company #WCV01468902 Exp. 11/13/22 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( aopermits.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 DATE trAuoo rrlrra ACORD CERTIFICATE OF LIABILITY INSURANCE �,�- Dz'2>za2i 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUWG INSURERIS►, AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED.the poi tykes; must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION iS WAIVED subfect to the terms and conditions of the policy, certain polcies may require an endorsement. A statement on this certificate does not confer rights to the certficate holder,n lieu of such endorsement:sl PRCOUC EP '-oNTT It ME II+.,ISr__A i,_ PHONE i?;AX IWO ALLIANCE CENTER At- AinF.<: I A N,L 3560 LENOX ROAD.SUITE 240C EAAA. ATLANTA GA 3E326 knri¢Faq r INSURER(S)AFFORDING COVERAGE MAIL I • CTVMCI642369ND'neD-GAW.-l2-25 tisURER A.08 R POI:::I ejwce C5 t4147 INSURED T11E•,=DEPOT.INC INSURER 8.Res Han WWre Ins Cc 23tT41 i HOME DEPOT U.S A.INC t R S.RE R C.ACE AmeriSt'In#Yia•CC✓ir€ar1 22667 2455 PACES FERRY ROAD BUILD G2C INSURER D. ATLANTA SA 3C339 INSURER E POURER F. COVERAGES CERTIFICATE NUMBER: ATE-0053T2225-C7 REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS WOR AODURRIr POLICY EFF POLICY EXP TYPE OF INSURANCE LIR ,llKI,VIVO POLICY RUINER OIfOQWYYTYS iMM9NYTYYy LAMS - A X COMMERCIAL GEERALLMILR'Y MWZY 316648 GICI'2 2 C1'2025 EACH OCCURRENCE S ICLAIMS-MADE Q OCCUR PREMISES tEa cc-Cumin(s) S i SR I1.00DOCC _. MED EXP ylry cos pylon] i S ..- _ PERSONAL&ADY(HAIRY GEM.AGGREGATE L14R APPLES PER GENERAL AGGREGATE S _ - • • - x o�C,u EI PR6 Q LOC �E�' PRODUCTS-COMP,OP AGOG f • DTHE; • I AUTOMOBILE LIABILITY 14WTB316649 _3'01 2022 o1111!2CQS 1 COMBED SINGLE LM!'T S 1)'--I.I, Ma a[ndrtI X ANY AU IC BODILY INJURY,pat prim, I —OPINED SCHEDULED • SELF INSURED AUTO PHY CMG BODILY INJURY:Pr accoarst; S 1,,....AUTOS ONLY � AUTOS .**RED � NCN-011PED • PROPERTY DAMAGE I 1.... AUTOS ONLY ALTOS OILY1 Mat C WCI .. f USmRELLA UAB [ .y_ _ MW:''` :i..- :_ . :i-- G3+C1'2025 - _ EACH OCCURRENCE f X 1 EXCESS LAB JCLA�dS VAL1 AGGREGATE I • _EC I IRE.II'.-,D.1s I B WORKERS COMPENSATION WC 365286C29 WI --.0312DZZ 0301,21123 x I PER { OTH- AND EMPLOYERS'LABILITY ST4,TLITE 1 ,ER G AhYPROPRF TrA'PARTHER+EAECUT:VE Y/N WLR C6E916109;ALL: -1.t12022 03N1,2323 E L EACH ACCIDENT I OFFICER�LEVEEREXCLUDED7 N NIA 5,ICI.C•CO Mandatary M 108 E L DISEASE-EA EMPLOYEES S 5.300.000 •.. s_•,OI urMMr Ccoto ed lei A�.>,1ha. P ..=-ON OF OPERATIONS bInw - E L DISEASE•POLICY LA*- I 5.0�.000 t 1 1 1 DESCRIPTOR OF OPERATIONS.LOCATIONS.VEHICLES*ACORD 101.AddAanr Rants Schema**,now/be MUICS.d I nw.sa:ar.,s wquwlc t4CE_F nSURAN:E CERTIFICATE HOLDER CANCELLATION .CML C€PC }•.I, hV. SHOULD ANY OF THE ABOVE;DESCRIBED POLICIES BE CANCELLED BEFORE 2455 P.ACES FERRY ROAD THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN 3..!LC+NGC-20 ACCORDANCE WITH THE POLICY PROVISIONS ATLANTA.GA 33339 AUTHORIZED REPRE5E VTATIYE I 71f vs i4 2f5-'i' '2sre. 1988-2016 ACORD CORPORATION All nghts reserved ACORD 25 12016 03i The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN10163 O69 '""N LOC#. Atlanta ACCORD* ADDITIONAL REMARKS SCHEDULE Page of AGENCY I INUNED INSURED MARSH USA INC THE HONE C£POT EM_ HOME DEPOT USA,NC POLICY sRMaER 2455 PACES FERRY RCiAD BULDINS C 23 ATLANTA CA 30339 CARRIER NAIL CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER. 25 FORM TITLE: Certt44Gate Qt Liability Insurance Ivxaars GarCrsatcn Cotrued Cam.h.:rmly I,s.ran_e Corpay of North Amara A:1c.NATtet WLR Ca85164811AOS)I LeR.FL.IDAIKS.KYLt MS.VC NC NE NY.ND OK.SC SD TN VAN'A.'M ter EHed7.e Cote.33A1.2022 Eapraao,uRe 33f312:23 .EL l Lrnt SS OCC.3CC ;Lamer Au he.ta a Ca %lcN North'NC 055816328,AC61 iM DDDCDE M h.AKAMDME ARI MT NH Ni NY.PARI vT E1kdr a Oft 33411,2:22 E.pra6o-i Cate 3Y012C23 •EL;a*i S5 03C C C Cam.ACE Amman rsraa Canpanp PHrcp N rrtr'HAi M8916116(QSII IC&OR N'A} E}kc.eCee 31011022 Eipratcn Cale 31,311023 EU ur'E Si 03C 300 31C SIei:xc :a,rter NNYJNI Ltron FrAre mow=CanGarN ?�I,.N.rrtr,XDC 1647313 109 ICT.GA.M.M'OHUTi 1 ecs*Cate.334112022 Eapratan Cats 33,312C23 ELI Lrrt u.0X 3CC a'IRS10X.300 SIR ICI.,SW COG SIR IGAI5755.07C 'X Err aea AS Nerve! Call Aiwa Unor h*saanac Co'"carY aycs'Auriga TNS1:699110Ct .Tx ENaetm Dale 31 1t1Q22 awaken DNA 33''31uC23 Eli Lent$603C300 SIR S503C.VC ACORD 101(2008.'01) 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston. Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Regtstretion: 112785 HOME DEPOT USA INC Expiation: 04122,2023 P O BOX 105451 ATTN LICENSE MGMT TEAM ATLANTA.GA 30348 Update Address and Return Card. Office of Cansumar Maine I Business Regulation HOYE IMPROVEMENT CONTRACTOR Registration valid for IndNtdusl use only TYPE:SJoplernent Care before the expiration dots. If found return to: Bt9istrieloo Exaltation Office of Consumer Affairs and Business Regulation 112785 04.22t2023 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston,MA 02118 RICHARD OLMS'EAD -6:17644e2r- 2455 PACES FERRY RD C-11 HSC ATLANTA,GA 30339 01 Valid wtthou signature Undersecretary .---.14 ACORox CERTIFICATE OF LIABILITY INSURANCE DATE tlBiroorrrrr} �,.►-- I I 1 D,lag 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 INSURERS,. AUTHORIZED REPRESENTATIVE OR PROOUCER.AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate bolder is an ADDITIONAL INSURED,the pollcy(les)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 certifcate does not confer rights to the certificate holder in Neu of such endorsemengs). PROpuc ER. j WILT Mary R Benlarmr Greylock Ll uran•;;e Agency PHONE �Ae PO Box 603 .r eM e.0 4"-,.':'i-5U44" ' 4'.INN • - ---- -'l,b EMAIL Pittsfield MA 01202-0603 lioOResa mbeniarr in.&gre,o_I.org INSURE3t;S AFFOR.DeNG COVERAGE NAIL s Liza-, # 'e 1779 INSURER A.Atlantic Charter Insurance Co. 11 INSURED frANKOSC I NBIN1ER B. Ivan Kosobutskyy 72 Stafford Rd INSURER C. Monson MA 01057 NBURER0. INSURER E. NetNBER F. COVERAGES CERTIFICATE NUMBER 25176358 REVISION 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 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 ALA THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LTR R TYPE OF II URAMCE N POLICY NUMBER OAPOLICY CWYYYYI IMIMI IJISIS CONNERCIAL OBERALLfABLITYreSUBIF EACH OCCUFRENCE I I CLAIMS.AMNE El QA M ES'RENTED PgE6E5Ee axunen c.. 6 �� I MO EIi+'Any MI pNsonl S PERSONAL L ADV INJURY f GEP(L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY D Z P D_O_ PRODUCTS-CChIP,t7P AC,G S OTHER ALITOMOBLELAABIUTY COMB ED SINGLE LtIAT ~. r AN AUTOINJURY BODILY Pst woven Y' I ~OARED SCrEDULEC .MAD '—' �^ NON-01RT/E':.: BODILY INJURY SAG icCallnl; S M PROPERTY DAMAGE AUTOS ONLY AJT K xC.OSOY I ONE' fee[1 i - . - . UMBRELLA LAB OCCA.F ' E.- .... . EXCESS LAB CLAMS-MALE AGGREGATE $ i "-^ I `RETEMTON 5 5 YWS Rti ERS COMPENSATION •.. ..: .. MUTEI 11.'?3'202Z �X (�ATUTE lER FFl ER VE66EREXCLUOED'7 C AE Y' N/A EL.EACH ACCIDENT MOO,UtIC Mandalay M MIR E L DISEASE-EA EMPLOYEE I t 00,00D II yti OtlGrIte under ` CESCRIP GN OF OPERATIONS belt. E L DISEASE-POLICY CART 1500.000 DESCRIPTION OF OPERATIONS,LOCATIONS,VEHICLES AC ORD I el.Aide...m Reme*5 ScnrdU..Inky ne etuctwd f more Now room* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THD At-Home Services Inc 2590 Cumberland Parkway#300 Atlanta GA 30339 el I TIC1O17F,OF POP CF wT ATP... I C 1988-2015 ACORD CORPORATION Ali nghts reserved ACORD 25 1201 610 3i The ACORD name and logo are registered marks of ACORD VANK05-0: Q.R.Q��j 7( ACORO CERTIFICATE OF LIABILITY INSURANCE (� DATE CERTIFICATE�..-= l µ lonsrzo I HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTSUPON TIE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE CC$VERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERtS).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 WANED. subject to the terms and conditions of the policy.certain policies may require an endorsement. A statement on this certificate does not confer nghts to the certificate holder in lieu of such endorsementtsl. PNCOUC ER r`(aiACT HUB International New England PHONE E.i, (800)243-8134 c,No;(413)731-9539 1070 Sutfreld St Agawam_MA 01001 $a, INSURERISI AFFORDING COVERAGE MAIL S 4118URERA Ohio Security Insurance Company 24082 tNSLRao fix;, Commerce Insurance Company 34754 Ivan Kosobutskyy I&I Remodeling e4s., £R 72 Stafford Rd =r e= Monson.MA 01057 NE,RER E N Si7RER COVERAGES CERTIFICATE NUMBER: ._ RE ISIQN teIIIBER._ THIS IS TO CERTIFY THAT THE POLICIES or INSURANCE LISTED BELOW HAVE BEEN S SUED TO THE INSuAED!%AP.iLD ABOVE FOR THE POLICY PERIOD . INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF{CATE 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. edit I IDOL SUER POLICY EFF POLICY EK► -e j TYPE OF INSURANCE ale Jelin FOLIOS NUVBER iMM.nELYYYYr �YOMYYYYi. WT8 A X cOeBIBtcML GENERAL UAaRm 1.000 000 .LAMS-MACE ❑X 'OCC`-a X 'BKS565397S2 5/15/2021 5115f2022 ,.111f1e111 $ 300.000 htL;L.: ' =v IMM�O' i 15 000 PERSONAL ADY iNJ..t^nY 1,000 000 SO GEHL AGGREGATE LMIT APPLES PER I GENERAL AGGREGATE s 2.000 000 PCucY 7 _T a.oc ,PRODUCTS-CCAAPOPAar_t 2,000..000 OTHER i s B AUTOMOBILE LMBNITY aizAMPC A D�SINGLE LIMIT ANY AUTO — IBBCRLL 6 2&2021 8'213 022 B00ar w.uPY.Pei penal s 100,000 ViSIED SO-FOULED .-�AUTOS ONLY X AUTOS OWL,/I L.URY;Par ar.L derct $ 340'006 r�H�Ep ryCOµ..pOyY��►q� PROPERTY JAMWCF 100,000 hX AUTOS ONLY X AUTOS ONLY PR P RTY I • UMBRELLA LIAR ".. . ECM OCCURRENCE 1r£ACESA LAB :t A.'1-19ACE AGGREGATE i j==C I BETE'• s wok"(errs COMP6LMTION I AND EIIPLDYERB LIABILITY YIN 'STRATi1TE 1 ERN anF P edPRIETCR•£aRT E E LECU':r=i'E xcLuocc M 7 A E L EACH ACCIDENT t }�•°` Y' °sig ,E,,DISEASE,EA F.1Wt,0,'t'EF.i It on dHSUna W'OM CESCPI"'ON OF OPERATIONS b ac.- E CISEASE- CUCY LIMIT DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES ISCORD I•1.Ad i.ne/Plseesels SCR lfe,eery be attAm u It Ilwrc N 1A Is'ryu,4a; Home Depot USA Inc is named as additional insured as respects General Lieblity Insurance as required by*WW1 contract or written agreement. 2012 Frht.VlrtiWDPPF4CCBC8512141 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Home Depot USA IncTHE ExPiRATION DATE TNEREOF, NOTiCE WiLL BE DELIVERED IN Po ACCORDANCE WITH THE POLICY PROVISIONS. Home Services Compliance C11 2455 Paces Ferry Road Atlanta-GA 30339 A,ITHORIZEO REPRESENTATIVE ft ACORD 2512016103j r 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth ot Massachusetts. Divrsion of Occupational Licensure Board of BurItteng Rerrattoos and Standard% ConstructiQWgupertet4gr Spec;aity CSSL-098785 04'271-,. ptreS. . .' 2024 IVAN KOSOBUTSKYY -- ."- 72 STAFFORD ROAD MONSON MA-01057 .: ...- • i.1 , k t .," ..; On.:r "::‘,.t..;.... f; __. ....- .: - - ,!........, ' : 2,',40112%,;:sis,:.,<:,..,:.:•'-.';'''itio. 7. ' '.-,,itz;.',:.,:„...--.. ,., . . . . • I , Allik,0, 1 leisure CS-013902' CS-9804 .'i . CS-9805: .. . : Ivan Kosobutskyy CS-9806 CS-9807 .., • MASSACHUSETTS CONSTRUCTION SUPERVISOR LICENSE , . 6 HOUR ONLINE CONTINUING EDUCATION l ' r'.4 - -•-• — ' - " )..r r , . . . .1124S109.2024212341 ,,, (^ • i 'i ,..,„,..t -010- ! .... 1 Office of Consumer Affairs &Business Regulation HOME IMPROVEMENT CONTRACTOP TYPE: Individual Registration ExpiratIon 152379 08/22/2020 IVAN KOSOBUTSKYY D/B/A I & I REMODELING I IVAN KOSOBUTSHYY L\12-CC-QAI----1' 72 SATFFORD ROAD MONSON, MA 01057 Undersecretary Registration 152379 Registrant Ivan Kosobutskyy DBA I&I Remodeling Name IVAN KOSOBUTSHYY Address 72 STAFFORD ROAD City.State MONSON MA 01057 Z,p Expiration 08;22;2022 Date I __Z.VA4. _ Koso6ok4.- skyy authorize Go Permit, I I c to pull permits using my CS License t ..._ Q 9 8 7$ ---_.--___-- and my HIC Registration n 152_,7_$ __.__ • Any questions please call me at: Yt 3 - Z 2 I-- C$ O Installer Signature SK4 Company Name 'VI S R .�AZ'?dN..0 l ill\I f to CPrl,/)that El* TIvan . Kosobutskyy ' ,I \l r n MA.tit,),' F.• R�' ;NEr w'� has surcessfullt completed the 4-hour course Lead-Safe Renovator- Supervisor Refresher Ixtrsuant to 454 CMR 22.00 and 40 CFR Part 745.'25 Como t.Cc on Insrat,tot Environmental Educatbn '6 Uoton Chive WMmMpton,MA Otari7 May 10,2018 rnat 19 2!) , Dalas Yrf 18-1340-314-401704 Mav t9,202� CNttMcate Nwnner �+L*ad,:�U>"e 'r^^'"'4�°�'0` INSTITUTE FOR ENVIRONMENTAL EDUCATION