Loading...
23C-108 (5) BP-2022-0636 497 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23C-108-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0636 PERMISSIONIS HEREBY GRANTED TO: Project# DOOR Contractor: License: Est. Cost: 4136 HOME DEPOT USA INC 106106 Const.Class: Exp.Date:09/29/2022 DRISCOLL-SBAR &FREDA L&LINDA M Use Group: Owner: DRISCOLL-SBAR Lot Size (sq.ft.) Zoning: URB Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-41 12 WC 06588608(AOS) ATLANTA, GA 30339 ISSUED ON:06/06/2022 TO PERFORM THE FOLLOWING WORK: PATIO DOOR 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: • • ap . Tt, I ' Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner TRECEIVED Department use only Cit of Northampton Status of Permit: Bui ing Department Curb Cut/Driveway Permit JUN - 3 2022 2 2 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEFT.OF BUILDING INSPFCTI�,firth mptOn, MA 01060 Two Sets of Structural Plans NOHTHAMrTolphtol4e - -1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ('q - R;/�&ts,t4 J?ri Map A3G Lot ld Unit 7riOt eA a /11 A' p 4 Z Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: •/IGCIA at4d Li/14. Dri scoI I S 13a. - CI 9. R;IY. -,r'lie Ori'r-c- P'Iv rence. &LA-- Name P nt) Current,Mailing Address: 0106 Z. fir la— C—Y,144-� Telep one .t b 3 - 9y06 Siqillure 2.2 Authorized Agent: /+ Ge aC C• (Ala 4- dos JwA4b if 61e.cc- 6/a561 4c" y Cr Name(Pr ) Current Mailing Address: 0 G 0 331 ‘f,(4 /i,€•(- __) F&O — Q SZ —911 ?- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building if V/36 I 0� (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 4 5. Fire Protection 6. Total = (1 +2+ 3 +4+ 5) ,I Y/ 36 , o0 Check Number a (iA This Section For Official Use Only Building Permit Number: 60- a ). 0, 3Q Date Issued: /72 Signature: G" G 20ZZ Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding e er been issued for/on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW CY YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW AYES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES © NO 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 O7 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 ❑ Replacementows Alteration(s) ❑ Roofing El Or Doors _ Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks [EJ Siding [D] Other[pi Brief Deyription of PropoSed 1_ Y� Work: Mows"— a.4-0 nP, kee / a'eh,e.- /Ci X � G4,/, Ao 7w` Alteration of existing bedroom Yes 'iNo Adding new bedroom Yes '� No Gt,,�ger,r Attached Narrative Renovating unfinished basement Yes ti/No Plans Attached Roll -Sheet Or t 8 a ' 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, d7Ge4 Q A aI C.'4 ott Air cin juoe. , as Owner of the subject property n- / �/ hereby authorize /N'-' I " to Zfe. 41ki 'c �&dr041/'", to act on y behalf, in all matters rel tive to work authorized by th building permit application. air/ Date g. - 2 - 20 z-2_ Signs a of Ow r 1, 60.4 /d L L. CIiAM.-.e J/L , 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. 6ec* rd ( ' Cram j - Print Name Signature Owne gent . Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / �,,-I ��/ Not/Appplicable 0 Name of License Holder: 6K9jGw/�.�, lI�,�,12 ehr / / iv ,q 04•/ CSSG- / e/O 4' / ((( License Number ZS &nk%01 2 rc,/ Sp6n,4;d f" ' 0/to Q QAzAddres Expiration VZ Caw tit 3 -- 335-- 34-0 z Signatur Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 1 - Pep..a 14 0 ... .-c / ,2- 4-SS C panv Name Registration Number ZY.y glees i.y ifoo., i 17'/4A '/1 3o7.37 Y- z z. - z3 Address Expiration Date Telephone Ro -7)2 viz 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 No 0 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings_of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State :';� Local Zo ' aws and State of ssachusetts)General Laws Annotated. Homeowner Signature 77 i�/ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: (e9 ;;,Grs : Ori�c rekce4cc. tslA 6104 Z The debris will be transported by: eidle.tryt gent-oetie, The debris will be received by: ,cc,L Qz 1 C'iJA Building permit number: Name of Permit Applicant i 6 - ,.744 / ciffAie) Date Signature of Permit Applicant City of Northampton .S �' .S� MassachusettsL��2 . Li;"wi • o DEPARTMENT OF BUILDING INSPECTIONS (' 212 Main Street • Municipal Building �J`•. :�a Northampton, MA 01060 tiS` hW•yO�1� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made / I, cieCk Q 4 N (I>'4'4C E -i s 42« 5b&r understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 6'Z ' ZZ Address of work location AP' ruz. veArt' /t// p /062— The Commonwealth of Ala4sachuset.ts • Department of Industrial Accidents • tt Office of Int-eshgatons • r Lafayette City Center 2 Atrenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dirt Workers' Compensation Insurance Affidasit: Builders/('ontractors/Electricians!Plurnhers Applicant Information Please Print Lejihls Name IHusine- 4.)Ip t,...u.ti ltydisidu iLt: HOME DEPOT USA Address:24 7 .,ACES FERRY RD City:state Zi r:ATLANTA. GA Phone Are you an employer?Check the appropriate hos: — t+pc ttf project (required): I. I am a employer with 4. I .1m a general contractor and I Nev. construction employees t full andlor part-time).* have hired the sub-contractors ' _ 1 am a sole proprietor or partner- listed on the attached*.beet. I Remodeling ship and have no employees These sub-contractors have r ; Demolition working for me in any capacity. employees and have workers' 9. Building addition [Noworkers' comp. insurance comp. insurance workers' required.] 5. )We are a corporation and its I I". Electrical repairs or additions 3. I am a homeowner doing;all work officers have exercised their I I. Plumbing repairs or addition, myself (No workers'comp. right of exemption per\l(,L I: Rtwti it{*alas insurance required.] r c. 152,„I(4).and we hair no employees. (No workers' I+t �]t)ttrc r' co insurance rc aired. Any applicant that checks hog u t must also fill out the xectton hckrw showing then workers'comps:Is:t.i+n polrey tnronnaixm. Itornoiwners who sutrnu this affidavit indicating they sae dung all work and then hire outside conarnsuvs must sulmut a new altida+st ind.cattng sa.`t. ontrasiors that cheek this flux must attached an additional sheet showing the name of the sub contnkrori and state whether or not these entities Mr.c employers 11 the suh-.-antrawturs hese employees.they-must pros Mc their workers'rkers'etrnr.;K+hcy number I am an employer that is providing rankers'compensation insurance for net-employees. Below is the pallet and yob art. information. Insurance Company Name:AI It Insurance Co. Policy#or Self-ins./ (Lice. ile.:WC 065888028 (AOS) Expiration Date:03I O'l 2O23 Job Site Add re'.: "! T g;f ecside VC i vt. City State Zip: Fro t s1CC /4 A 0)06 2 Attach a copy of the workers'compensation policy declaration page tshoss ing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. l 52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and=or one-year imprisonment. as well as civil penalties in the forni of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. Etc advised that a copy of this statement mat he forwarded to the tiff i c of Investip tions of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of per}rtrr that the information provided above is true grad correct. Siftnattirw L . __ Dale: t ` 2 - ZOZ Z- Phon; 860-952-4112 Official use only. Do not write in this area,to be completed by city or town official. 4 its or Town: Permit'l.icense st Issuing,.Authority Icheck one): I.--/Board of Health 2J Building Department 3.Di'it}'lfown('krk -l.DElectrical Inspector 5J'lumbint; Inspector 6. Other Contact Person: Phone #: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute.an employee is defined as"...every person in the service of another under any contract of hire. express or implied.oral or written." An employer is defined as"an individual. partnership,association. c.'noration or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer. or the receiver or trustee of an individual,partnership.association or other legal entity.employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein.or the occupant of the dwelling house of another who employs persons to do maintenance. construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152.§2S4'(6l also states that"even state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any. applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally.MGL chapter 152. §25C(7}states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract far the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely.by checking the boxes that apply to your situation and. it necessary. supply sub-contractortst masts►. addresatesl and phone numbers) along with their certificate-CO of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLPI with no employees other than the members or partners,arc not required to carry workers' compensation insurance. It an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested.nut the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy.please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit license number which will be used as a reference number. In addition.an applicant that must aulnrait multiply pc 1ilataliact.tac applitattiuus in aim .feat}cur. aced uttly auloutit one affidavit irlditdtiu;; ,.wtcut policy information lit necessary)and under''Job Site Address"the applicant should write"all locations in ietty ur town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture I:i.e.a dog license or permit to burn leaves etc.► said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address_ telephone and fax number: The Commonwealth of Massachusetts Ik partment of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue do Lafayette Boston, MA 02 1 1 1-1 750 Tel. (617) 727-49(X) or 1-877-MASSAFE Revised 7-2019 Fax (617) 727-7749 www.mass.gov`dta Go Permits, LLC GC) 105 Buttonball Lane Glastonbury, CT 06033 PERMITS Scott Doughman miew 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 De of USA Inc. locations. �2-Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Bou of vard-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 1zg19cAY Sheet: 1 of 1 Customer: FREDA and Linda DRISCOLL SBAR Job#:1.1Z019CAY Consultant: Ronald Engelbrecht Date: 05/27/2022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening ,h of bars b of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use § c1-1 m Mull "S"=stationary or .4 . tor u ° .Q u 0 "X"=operating irt w Room Floor Code 2 Style Wraps Style Code Series Code E 3 x°' 5 t-ui U i > xo J > _ J STD,White,TMP:Full, WRAP 1 LIV 1st 61P02 Y 61PD2 6100 WH WH 71.25 79.25 150.5 GlassPack:Standard S X BBG • • 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) The Home Depot - Thermal Value of Products Manufactured by Simonton Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC (all with Argon) Fact Fact 6500 Awning 6500 Base ProSolar Supercept 7/8' 0.26 0.23 •0 • • 0.26 0.21 c l ..1:-'I YJ Casement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 o Mg o 0.26 0.22 to 3 o o Transom 6500 Base ProSolar Supercept 1 0.27 0.32 o Q 0.27 0.29 0 Double-Hung 6500 Base ProSolar Supercept 7/9 0.29 0.26 1 0 0.29 0.24 j 1 n n Picture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 0 0 0.26 0.25 c 0 0 e Picture 6500 Base ProSolar Supercept 7/8 0.27 0.29 0 1 0.27 0.26 0 • 2 Panel Slider 6500 Base ProSolar Supercept 7/8 0.29 0 26 1 _ 1 0.29 0.23 • of 0 3 Panel Sliders 6500 Base(e 21 Sqft) Pro Solar Supercept 7/8" 0.29 0.26 ' ,1 0.28 0.23 - I ,. 6500 DOORS Garden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 0 1 o < 0.30 0.21 ir o Patio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 0 •- ( } 0.31 0.23 o I e 6100 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. Awning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8 0.27 0.2428 D.21 :^-, :. - Casement 6100 Base Pro Solar Intercept 7/8 0.27 0.24 o r 0 0 0.27 0.22 0 0 ., 0 Double-Hung 6100 EnergyStar Pro Solar Supercept 3/4' 0.30 0.30 0 3.30 0.27 0 0 0 Picture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 •1 0 J. 0.27 0.25 0 a o 0a Picture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 0 0 0.27 0.28 Pa lr =6_ W.6100 Base Pro Solar Intercept 3/4't 1.30 0.28 0 0.30 0.27 0�.. ,� 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 ' 1 0.30 0.27 °1 1 6100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. Patio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" I 0.28 0.26 I 0 c i 1 0.28 0.23 Patio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 0 0 0.28 0.26 ' ' I 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. Awning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 J 0 1 0 I 0 0 0.26 0.23 0 0 Casement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 0 0 0 0 0.29 0.17 0 0 0 0 Picture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 0 0 I e a 0.25 0.19 e 0 0 • Picture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • e • •1 0.26 0.22 • o • • Single Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • 0' 0 01 0.28 0.21 o 0 0 Single 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • 0 0 0.28 0.21 • • 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 11_0 1 1 „1 0.28 0.21 1 I Storm Breaker Plus 300VL Homes located in coastal areas. Awning SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 0.23 1 0 0 0 0.26 0.21 0 �_� PS/Lami 1 fJ. I o 0. 1 .1 _1 Casement SB+300VL Base Super Spacer 1' 0.25 0 23 0 0 c o 0.25 0.21 o • Double Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 0 0 C 0 0.29 0 23- 0 ip Slider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 • •• 0.29 0.23 0 Patio Door SB+300VL ETC 366 PS Shade I Lami Super Spacer 1" 0.30 0.19 Q • • No Grids Allowed Garden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • 0 1 0.30 0.25 1 1 1 1 •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 Ronald Engelbrecht Salesperson Name Registration#(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. 1. Service Provider Contact Information j The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 Icustomercancellationnortheast@hom MA: 107774, 112785 Phone# Sg °acRvider Email Address Service Provider License#(s) 2. Customer Information DRISCOLL SBAR FREDA and Linda New England West 1-1ZQ19CAY Customer Last Name Customer First Name Store #/ Branch Name Customer Lead/ PO# 497 Riverside Drive Florence MA 01062 • Customer Address City State Zip J (413) 563-9406 flds@comcast.net Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT 06492 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CAN Acknowledged by: 15T 2. ri Customer's Signature Date w ` N Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 11/23/2022 Approximate Finish Date: 12/23/2022 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. 7.Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 4136.01 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable,total amount of taxes included in Contract Price) *Maximum deposit ONLY applicable in MD,MA,ME(33%),NJ, WI(99%) Deposit 0 0 25.0 Deposit Amount $ 1034.01 I Remaining Balance $ 3102.00 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9.Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that: (i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer" above; and (iv)Electronic signatures will be deemed originals for all purposes. X Customer's Signature Date X Is/The Home Depot 05/27/2022 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (203) Lbb-/U3/ For any other concerns, contact The Home Depot at 1-800-466-3337 Scope of Work DRISCOLL SBAR FREDA and Linda New England West 1-1ZQ19CAY Customer Last Name Customer First Name Store #/Branch Name Lead # Job#: (Internal Products: Reference) Spec Sheet(s) #: Project Amount 1-1ZQ19CAY Windows Entry Doors 1-1ZQ19CAY 4136.01 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 4136.01 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): • The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (H) 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. The Home Depot General Terms & Conditions 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order"). A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time,or both. Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date (the "Warranty Period") that all Services will: (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the Warranty Period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole discretion (I) correct or replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each Defect and refund all or a proportional amount of the Contract Price thereof to You;provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement; or (2) You fail to pay Home Depot in full as provided in this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY,OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES. HOME DEPOTS EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS, MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c)Limitation on Damages.Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten (10)days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination. 11,E The Home Depot General Terms & Conditions 9. CHOICE OF LAW: SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement. 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. 11. SECURITY INTERESTS; LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed, unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed. You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e., goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its Contract Price cannot be refunded unless Home Depot or Service Provider(1) incorrectly ordered item, or (2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the Contract Price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE ORDER COMMUNICATION PREFERENCES: You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call); (2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order(including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program. Go Permits, LLC 105 Buttonball Lane GC)_ Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 -_ scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day. Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/23 Workers Comp.- AIU Insurance Co. Policy WC 065886028 (AOS) (MA) Exp. 3/1/23 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-500-5021510-2022A Exp. 1/17/23 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits(a�gopermits.orq • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you. Go Permits ACORIJ CERTIFICATE OF LIABILITY INSURANCE NA,. °°''""' 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 PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: I the certificate holder is an ADDITIONAL INSURED,the policyIss)must have ADDITIONAL INSURED provisions or be endorsed I SUBROGATION IS WAIVED,subtect to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not corder rights to the certificate holder In hen of such endorsement(s). 'COST PRODUCER IONE ACF MARSH USA.INC PHONE T FAX TWO ALLIANCE CENTER .ac- cry I LAC.Not, 3550 L E NOX ROAD,SUITE 2400 Ems. ATLANTA.GA 30326 eisRMeys*AFFORDING COVERAGE NAIL e CNti0I6N206941amaD AW..-2Z225 INSURER A.OILRegNFLIrevtrtxCrt N117 enUREDTIE HOME DI POI.INC BARRER a.NON HrFgRlae lnq Co23a41 HOME DD OT USA.INC Maumeitc.ACE AMMO htlwwxa Covalr 22667 245E PACES FERRY ROAD BULDMGC-20 e(saReRo. ATIANTA.GA 30339 NRIrBRE I NalalERIF COVERAGES CERTIFICATE NUMBER ATLE0011Z125,07 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICES OF!INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREUEHT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREBY IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILA AIDLNUOR POUCTIR, POLICY ESP TYPE OF INSURANCE WO, POLICY NINaIEN RIBMIYYTY10,. UNITS A X CONNERCIAL GENERALLUauunt MAZY31664 0301.2a2 03,41MM EACH OCCURRENCE S I030000 -I OACAA1 ri OCCUR UOE RENT a EDimi.el 1,II01}.000 X SIR 51.000.000 ►EMI EIIP EXCLUDED PERSON R AD PUURY i 1 Wi9D06 AL GENT AGGREGATE LW APPLIES PER GENERAL AGGREGATE S 2.020.000 POLICY �C LOC PRODUCTS-CCARPOP AGG S 2.033000• OTFER. A AUTOIIDasEL erJTY MWD3316619 03412022 03E'0121I25 COMBINED SPIGLE LAT s 1BOD00 Ica ao..ohno --. X ANY AUTO rxi3L:Y MXIRY IPr parson I f OWNED aTc LIL D SELF INSURED AUTO PHY DAM„ F11LNiLT INSUP.Y tPel.T[Ynlv[F S AUTOS ONLY ,_�MOOS AIREDNOIFOYIMED PRI.R'E37TY LYSLIAL'E AUTOS ONE MITO6 OILY i P9.21 r.t.pei S A' UMBRELLA LAB 1.2.(.1 mom UNIX 316647 0341 t:40T1 a3+011apS EAcH occupRENct 10 003.000 X EXCESS LIAS ,TNDE AGGREGATE S 10.001000 ` DE lJ t j RE TENTER s 33 'woeri ns COMPENSATION WC 0E5016029 rTY11 03012072 03101'2023 X 1 PER f I OT— AND ErlIOYERB'LABILITY STATUTE.1 I ER YO ANY PRO PRE T ufdEARTNEREXE.CInNE M YdLR,',6Ri916109 fix Li 03+012072 03AI7,7023 EL EACH ACCIDENT S 5�• OFFFCERNEINEREXOLUOEW N❑ NIA NINAIrrY is MIS EL DISEASE-EA EMPLOYEE 5 5 020000 It�s sp oifnsr CunLnuedcariNIkRowruPaw EL DISEASE-POLICY LAN s 5000.000 OESCRIPTRDN OF OFERA7IONS eeno�e DESCRIPTION OF OPERATIONS I LOCATIONS!IADICLES IACONO 181.ArY'rsal Re rws&chi .I,w Rr wreAN a Fars same is upiwf♦ EVIDENCE OF NSIYRMICE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA INC SHOULD ANY Of THE ABOVE DESCRIBED POLICIES NE CANCELLED WORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF. NOTICE WILL RE DE&JYFl1ED N BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS.. ATLANTA GA 30339 AUTF WROFD NEPRESENFATIVE aasA 7,CSY1 Vote. 1986-2016 ACORD CORPORATION. AS rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER M: CN101642069 LOC t Atlanta ACCD r° ADDITIONAL REMARKS SCHEDULE Page 2 or 3 ApBCV 4 NAMED ASSURED MARFAUSAINC {L ii taL H 3tE DUG* f:R wa_ POLICY NUMBER 2455 PAU FLRPr 5LiAE, ROLLINS E2 _ .ATA4TA GA 30339 CARRIER NAMC COO( EFFECTIVE DATE. ADORIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: Z5 FORM TITLE: Certificate of Liability Insurance Olaiea Ca mosoim Cerimt Owner MdneNltIm oCslsydldNAaeo Pac!wnas:Mt alma IAos1 IAI.ARKI I ASJ C1AII;SII LNCNEtakrW.atSC SD TN VAWA IV" Mays Ode anon Lamas ors OMte3 Caner ANIneaaees. wsytldil¢'COMMONS MOSt y1KCO,DC DE.Nt.UMANOlESMI N IOSHO.PAM VT if BuieOds108 MO CLI tint SHIM Cane ACE ANaevn texas:Comm" E#aim DIE NV 21173 LI Limit St NO COC OR S1.001000 Cow Neaa I Mahon Foe Ineuramx Carpet' Patel Weer XWNC 1647323 gOSly 1CT GUAM°IWO Ellecrye Oat C3012022 (swam Ost.03O1t2O23 (Ell limit St.0N000 SRS1.000A00 SIR(CTlS3e11000 SIR(C.SIST SOM TXEe*byesXShdneiX Cwe3aas tine Winn=Campo, Peer tionitI ESIONIM In0 Bidile Odr 10111D022 EIpli Oda MUNN NOUN"MOWN SR MOWN ACORD 101(2001/01) L 2008 ACORD CORPORATION MI 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 Rep HOME DEPOT USA INCRegistration: 112785 1 Expiration: 04t2212023 P O BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. Osios of ConsumnM.kn a Business Resulatlon HOME IMPROVEMENT CONTRACTOR RegIwatlon vend for Individual use only TYPE:S.ioplemenl Cars before the expiration dote. W found return to: Emaiikattao isistamIan Office of Consumer Affairs and Business Regulseon 112785 Wl22/2023 1000 Washington Street -Suit 71$ HOME DEPOT USA INC Boston,MA 82118 RICHARD OLMSTEAD i 2455 PACES FERRY RD C-11 HSC 44‘eire 4"f` ATLANTA,GA 30339 of valid signature Undersecretary .---1 EXTEREM-01 MARDEI 4C_..C.,RO CERTIFICATE OF LIABILITY INSURANCE DATEINFROI/TYwt \.._--- 1/19/2022 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 INSURER4S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER_ IMPORTANT: N the certificate holder is art ADDITIONAL INSURED.Bne poleyges)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy.certain potties may require an endorsement A statement on this certificate does not confer rights to the certlhcate holder In lieu of such sndareem engs). PRODUCER galreT Deborah Marino Canary&Dmetrom /NONE Eat(41sj 750-9022 I wic,m01413)790-7004 868 Springfield StreetGilFeeding Hine.MA 01030 dlnarinOticanariblomstrom-o0m INSURER/Si AFFORDING COVERAGE WIG a NNREA A.NGM Insurance Co. INSURED nwerjts Associated Employers Insurance Compeny 11104 Exterior Remodeling Group Mc. INSURER C. 23 Bedwn St Na_ER b_ Springfield.MA 01109 NNMIE1 E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECUHRESENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE NSURANCE AFFORDED BY THE POLICES DESCRIED HEREIN IS SUBJECT TO All THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICES_LILTS SHONN MAY HAVE BEEN REDUCED BY PAD CLAIMS. LIR TYPE OF NBURANCE POLICY NIaER ANINIONYVVI INENNIN YYYTY1 LIM A X COMMERCIAL DERMAL UAGMiTY EACH,ili:CU RRENCE s 1A00,000 CLAILMLINM 1 1 OCCUR MPP3376W 7127f2021 712712I122 V' �'CE 70 RENTED .000 11 ii FMWElf6E5;E�i:wrTM,.i $ %ED ElP LAIN ores ralsvn, $ 10"000 ~r PERSONAL A AM MART S 1.000.010 GENL AGGREGATE UNIT APPLES PER GENERAL AGGREGATE I 2'�,0011 POLICYa ❑LOC PRODUCTS-COMP.LIPA60 I 2,000�» OTHER 5 A AUTMr�LM ILITY LEA aGe[I COLUMNED SINGLE LAM I 1.000.000 ANY AUTO MPP3376w 7127.2021 7127,2022 sooty INJURY Pr poison) I �—.OWNED SCREdAED AUTOS ONLY AUTOS EQDLLY*NAORY Po,Naftali $ XA���jj Ev OyN a PNCeuRTY DAMAGE y AllTCsS OIL. X AYDTOS OLLY ..,u']U[bui S IlrrlEUA UNEI OCCUR EACH OCCURRENCE S �~EXCESS USE �C1ISAGNI1DE AOGRECWIE S OE0 I I IETemcN s S B WORKERS�LOYERRLIONRRY X 12TVTE I 1 FRH. AND Apron wigOFFIIEETTOR F�rLr XEarnuE r� NdA WCC-500-5021510-2022A 1r1712022 181 TI 3 EL EACH ACCIDENT S 500A00 �IeeqA� I . E I.DISEASE-EA EMP.QYEEF S •000 500 g•I*11.1X N OF OPERATIONS Mee E.L DISEASE-PCUCV LIUIII S 500,000 DESCRIPTION OF OPERATIONS,e LOCATIONS a VEHICLES wcORD 1St.ANISioNal Res r.s SUA.aNr Aft W aRNINNO 0 moos epet+e Is nNYIwA Home Depot U_S.A-Mc.is named as Additional Insured with respects to General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Home Depot U.S A.Inc THE EXPIRATION THE t HEEETHEREOF.ICY PROOIS O TUCE NULL BE DELIVERED IN 2455 Paces Ferry Rd C-11 Atlanta,GA 30339 ----- -----^_ ANYMORE')REPfEIENTAT1VE ACORD 25(2016103) 01988-2015 ACORD CORPORATION_ All rights reserved. The ACORD name and logo are registered marks of ACORD MASSACH SETTS ` .DRIVER'S ,-" ril _ ,, 2. LICENSE -wit- 4: : - - , ;,...,.,.- ,;:, _ , : ! -.'f el...._:. sr ...4. .- .• • _ - ~','•-' '_ „ 09/1512016 p. y�� R': 1 Cr i .L v ._ ;s4-.4 v✓a� r--414 9 teREST 9..BC li ',i.' ` #> - ; I EUGENIU • j• , '1``• y' s' �' i ,<<3a 23 BENHAM STREE>~ " "''1 SPRINGFIELD.M O110'9- 1 s j -is SEX M /6t aTir4r• E:— . '. : _ -: :_ 5"3 . , _ - 49125 Commonwealth of Massachusetts d Division of Professional Licensure Board of Building Regulations and Standards Construction Suptrviisor Specialty CSSL -106106 _w Expires: 09/29/2022 EUGENIU CIUBOTARU , f 23 BENHAM STREET '', : SPRINGFIELD MA 011091'• Commissioner c:tf , ' ( . 4 Construction Supervisor Specialty Restricted to: CSSL-WS -Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617( 727-3200 or visit www.mass.govldpi Office of Consumer Affairs and Business Regulation 1000 Washington Street-State 710 Boston.Massachusetts 02118 Horn:tr toravement Contractor Registration 'ma. Cctwararrcm EAry is rmEtivoc€"0 UP NC Rw�yraHT Ig�666 iinn 23 til:.°e1Au S' Etp+alra+ O54:8+2O33 Sf441445F.ftD e44 0t e00 *MM Aaareie Arw MOW/Cn i. Orip M Can.. ,aneaa i bowman grrraa nmwlt ra WWOVtW$M'CONTIACT041 Woolowit3os wad lw M4Wwwo ww nwE .;'s'w.3w.. below Ow w#w M.orl9e 1!muu9 man m 0114100740141 = One* Cow w alMNs atw wants'%Walton : w $11.174 4000 1�per 7Meer guile 7 is z x7r PQ. )W7Zt.n'Y.i 13LQ NC 01wMew YA ill t4 EL$E!nJ,Z1.MC'AFu _.. g?MM14 Or,D WA.et rca t:,yi+,.,gr-wvar Not wad without alOrrat111a i e n �U ttgo Riu authorizeGo rermtts Ll.A., co puii permits using my i:a License i /Q. , 1 Q6 ano my HIC Registration # j $; 6,6 6 ^• cstions please call me at: (tii3) 3 3 5=3 7 0 a .tYVJ .. . installer Jilt_._ company lvai,,. ,Q. ' o_g_ Ou >