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31B-044 (7) BP-2022-0696 21 SUMMER ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 3 I B-044-00I 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-2022-0696 PERMISSION IS HEREBY GRANTED TO: Project# WINDOW Contractor: License: Est. Cost: 1873 HOME DEPOT USA INC CSSL098785 Const.Class: Exp.Date:04/27/2024 Use Group: Owner: WALSH WALSH ROBERT E JR &MARY ELLEN Lot Size (sq.ft.) Zoning: URC Applicant: WALSH WALSH ROBERT E JR& MARY ELLEN Applicant Address Phone: Insurance:. 21 SUMMER ST NORTHAMPTON, MA 01060 ISSUED ON:06/13/2022 TO PERFORM THE FOLLOWING WORK: WINDOW REPLACEMENT 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: >2 . (NT Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit JUN ' 3 2022 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans r�^>Matt r•. ,. _ 'phone'413-587-1240 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 2. I 5c.evl e," 5 fY< Map Lot 0 C J Unit /1/a/MQ /I�',1 M4 O BUG U Zone Overlay District (� Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / y E7I 1,'V (S 1 2( �r,,4,1 e i flY?fil /1/oi i�2k -X4 14a Name(P t) Current Mailin Address O/GerG I s3 � - 32 � � Telephone Signature 2.2 Authorized Agent: sectici L. cza. S /50, 4 (, 6 -S "tiw� C T Name(Print) Current Mailing Address: Oho 5 3 K-60 - Z- Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4/ 4. Mechanical (HVAC) Cf0 5. Fire Protection 6. Total = (1 +2 + 3 +4 + 5) b /L'a-3 .pa Check Number a*° 3� q/This Section For Official Use Only Building Permit Number: 6 /' - p�- I< l! Date /' Issued: Signature: // =-- 61- 13-Z6ZZ. 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: 1 L: R: Rear Building Height I_ 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 DONT KNOW er YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regis ry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DON'T KNOW a YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES © NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excav on, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Wi ows Alteration(s) n Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding [D] Other[D] Brief Descr,[ption of Proposed / // '' rr Work: 6'emly-c an �f f(ace / Lvift dw✓ li rtc �vc /r h w/'/ ito c k (� Ac. r. Lq Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 AGENTr OR CONTRACTOR APPLIES FOR BUILDING PERMIT �I, d� e�(Qil ' S , as Owner of the subject property 1 S // / //� hereby authorize / 'tt V A/e{ 41/1 4c- ( �/,z 65 0 6,,T_54dy to act on beh If, in all matters rel tive to work authorized b this building permit application. v Signature of Owner ,v Date Gera/I C . Cfa/'tc/ Jit— , 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. 6 l d tip C/n,►.i 7„_ Print Name 6 —(0 - Zo27-- Signature of Owne/Age )D Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: r Not Applicable 0 Name of License Holder: J /N ' 0004 S kyj ,- 6 1 ,e,,�G"� 0 pi 4"0- 11 License Number q'Z 5 a T f � �J f r d aoa.cf A 430,7 ,n t O f01'� y/Z•71 L y Addre Expiration Date ��� (2,--" L,`,(i (t o - 9S z- Y//z Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 �� A 2� C //Z ? O5- Company Name Registration Number 2 Y Ace.' 2C,/) g- i 4'71/14 dui GI- 3051 1 �//Z L f Z 3 Address f� Expiration Date Telephone Ow'95L-��//2 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 Hdi No 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 Hereon 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 Z ' g Laws and Sta of Massachusetts General Laws Annotated. 77I�)Homeowner Signature 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: 2-( S� ,1��� '' ,tetevo`o The debris will be transported by: J 4^ !Gs 0 S rk7 The debris will be received by: ( Der 4- (A-S c Building permit number: Name of Permit Applicant Ge'-u '< C Date Signature of Permit Applicant The C ommon,v eatth of Massachusetts Department of Industrial.-lccidents Office of Investigations 1 ,' Lafayette ette City('enter 2 Avenue fit'Lafayette, Boston,MA 02111-1.750 wht w mass..Ror/dia Norkers`(-ompensation Insurance.tffida it: Builders,('ontractors/ElectririanslPiutnhers Applicant Information Please Print 1.e1ihl% Nam: c.hta lo,,,eh,10:HOME DEPOT USA Address:2455 PACES FERRY RD City'Statc'Zip:ATLANTA., GA 30339 - Phonc#:860-952-4112 Arc you an employer"("heck the appropriate hos: type of project(requiredl: I. I am a employer with 4. I I am a general contractor and I employees d full anctor part-t,mrl. * have hired the sub-contractors6. \ is :ion+tru:t,aon 2_El am.sole proprietor or partner- listed on the attache she�>t. 7. Remodeling ship and have no employees These sub-contractors has N. 0 Demolition working forme in anyc employers and hate ssorkers'may. 9_ Building addition Rio workers" comp_insurancecomp. insurance.. traluired.1 5. D N e arc a corporation and lb iO-L,I.lcYtrical repairs or addali,kn. 3_ I am a homeowner doing all work officers hate exercised their I t. Plurnbin_ repairs+'r additions myself: (No workers'comp. right of-exemption per M6L 120 Rooitrfttcas insurance required" c. 15_'_ It li_and ue hate n�to Employers. [No workers" t3fL onc�rWin° ` s":., comp. utuuanee required.1 'Attu atq+ieastdot checks bat I etu+e at>o tilt out thc,•.tutu btk>va.bu iu a the r ukorl.c.: c ntrettaats'n policy urwsrion "lInna raam*hr,smears fills sltkt:t>ttamilcanng thcs sec ai+.!ttair ail work anal that hoc+*gut+tvt:ecreatra tor>v noun isibentainn airalass milicannimach_ :Caatracfns flid check tht>1,0%reins anar],ed am adelettonil>t cct>tt.•,+am thc mom of thc>uk'contractors and stare sitedwer ar aid Dose conlaes lac. eaoptatis%s. tithe sub—contractor,ha%c cawtp&>yccx.deck'nat,t Iron e3c dam tsoeicrl:comp.pulac}.amber_ I am an employer that is providing tr or(ers,compensation insurance for my employees. Below.'is the policy and job site information. Insurance Company Name:AIL/insurance Co. - — Policy#orSell=ins. WC 065886028 1_spiratir,n 1)at 03/01/2023 Job Site Address: 21 Jq.,01 i S/ C'ttyd5laoeZiP__ ` �1i1 eb4 Attach a copy of the workers"compensation policy declaration page(showing the parity number and ripiration date). iailurc to secure coverage as required under Section 25A of M(iL c. 152 can lead to the imposition of criminal t*enaltles of a fine up to S1500.00andor one-war imprisonment.as well as civil penalties in the form of a STOP WORK ORI)i.k and a firs. of up to S250.00 a day against the s iolator_ He advised that a copy of this statement nary be forvwanled to the Office of Inv cstirations of the I)I_A for insurance :overage verification_ I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct die LLturr: ' 1)aa:• & - L� z� 860-952-4112 Official use only. I)e'not write in this area,to be completed by city or town official. ( its or l ow n: Permit License Issuing .tuthority(thtetk offe): I Board of Width ZQ Buildins Department 3OCity/To a(jerk 4.DEldrira1 tripe for 5.- "lumhin Inspector f. er ( (intact Person: Phone At: City of Northampton Massachusetts 42,% • �t ; � �ir DEPARTMENT OF BUILDING INSPECTIONS } IN ? / 212 Main Street • Municipal Building yJ�j` !� Northampton, MA 01060 J y"w .0 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 Gc'f C_ c/a. ✓ t l l-) understand the above. (Home owner/resident's signature requesfing exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date - 42- 20 2 2-- Address of work location 2 l sk/4, Got Go Permits, LLC PERMITS 105 Buttonball Lane Glastonbury, CT 06033 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/ • tland Boulevard Bridgewater, MA—o2324 •375 Airport Drive Worcester,MA 01602 • 12 Linscott Road Wobum, MA 01801 • 50 Maria Ave Johnston, RI 02919 Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1ZTRRMOL Sheet: 1 of 1 Customer: Mary Ellen'Nalsh Job#: 1-1ZTRRMOL Consultant: Ronald Engelbrecht Date: 06/07/2022 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 #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use cc77 m i E Mull "S"=stationary or 4 L L LL o] E 4 u ° u "X"=operating W Style Wraps m a m ` _ 'm .t P 9 N Room Floor Code (Y/N) Style Code Series Code E w 3 I 5 - of -co' c u > I � > I STD,White, GlassPack: WRAP,LSR 1 DINE 1st C2C Y C2 6500 WH WH 56 44 100 Standard L R SPECIAL CONSIDERATIONS: 1:White Wrap Color Interior Casing Type Bay or Bow window, Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(OH,SH,or Csmnt) Top of window to soffit(inches) tf 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 B epo - erma 'a ue o •ro• ucts anu actured by Simonton `201 E I Without Grids With Grids r Style Glass Package Glazing Spacer IG U SHGC U SHGC inftirr- (all with Argon) Fact Fact, 6500 wning 6500 Base ProSolar Supercept 7I8" 026 0.23_ m a Q© 0.26 0.21 o a a asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 a 0 1311111 0.26 0.22 lit ransom 6500 Base ProSolar Supercept 1' 0.27 0.32 eV 0.27 0.29 inn ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 11111:11111 0.29 0.24 icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 0 I.111 0.26 0.25 1® 0 0 1 0 icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 _um 0 0 0.27 0.26 0 0 Parr 6500 Base ProSolar Supercept 7/;1 0.29 0.26 MI c 1 I 0.29 0.23 0 0 0 Panel Sliders 6500 Base(s 21 SO) Pro Solar Supercept 7/8" 0.29 0.26 - I I 0.28 0.23 ^i 7 500 DOORS arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" I 0.30 0.24 • • 0 • 0.30 0.21 • • • • atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 1 0 1 0 l 0.31 0.23 o o o 0 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. wning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 0 c 0 0 0.28 0.21 0 0 0 0 asement 6100 Base Pro Solar Intercept 7/8' 0.27 0.24 0 0 0.27 0.22 0 0 0 0 ouble-Hung _ 6100 Energy Star Pro Solar Supercept 3/4" 0.30 0.30 0 0.30 0-27 0 0 0 icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 U U 0.27 0.25 Y 0 0 0 icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 113121111111 0.27 0.28 111 0 11 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 0 0.30 0.27 1 0 1 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 1 0 I 0.30 0.27 1 1 0 10 0 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" 0.28 026 • • 0.28 0.23 • • • • atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • i 0.28 0.26 • • 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 1 0 1 0 0 0 0.26 023 0 0 0 0 asement Y® _ 6200 Base Pro Solar SHADE Supercept 3kt" 0.26 0.18 010 0 0 0.29 0.17 • 0 0 0 icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 0 0 0 0 0.25 0.19 • 0 0 a icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 13�Q 0 026 022 • • Ingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 El E 0 028 021 1111 0 0 • Ingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 11111121• 0.28 021 111[13 • • Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 0 0 0.28 0.21 0 • .tormBreaker Plus 300VL Homes located in coastal areas. wning SB+300VL Energy Star PS SUN/Lami IDySupercept 1" 0.26 0.23 0( 0 0 c, 0.26 0.21 0 0 0 0 asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 c c 0 o t 0.25 0.21 0 0 0 0 ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 1�0 0 10 0.29 0.23 0 I 0 0 lider "00+SB 300VL Base PS/Lami Intercept 1 0.29 0.25 o 0 0 0 • _...-- 0.29 0.23 0 0 el 0 atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 . 0.19 • 0 0 0 No G n d s A;owe d arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 • • 0.30 025 • • • • )ots 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 07.4+ 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,NII,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 Icustomercancellationnortheast@hom IMA: 107774, 112785 Phone# g 'Ocecfvider Email Address Service Provider License#(s) 2.Customer Information Walsh Mary Ellen New England West 1-1ZTRRMOL Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 21 Summer Street Northampton [MA 01060 Customer Address City State Zip (413) 537-3216 I mewalsh21@gmail.com 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 DEPOTS EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: MICA/1/iq os,o7/2022 Customer's Signature Date 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: 112/04/2022 Approximate Finish Date: 01/03/2023 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: $ 1873.01 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, W I(99%) Deposit% 25.0 Deposit Amount$ 1468.26 I Remaining Balance $ 1404.75 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 /s/The Home Depot 06/07/2022 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) zd5-'u'�'For any other concerns, contact The Home Depot at 1-800-466-3337 ,� 1�.+ Scope of Work Walsh Mary Ellen New England West I1-1ZTRRMOL Customer Last Name Customer First Name Store#I Branch Name Lead# Job#: Reference)(Inter Products: Spec Sheet(s)#: Project Amount 1-1ZTRRMOL Windows Entry Doors 1-1ZTRRMOL 1873.01 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 1873.01 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 6500 Warranty Name(s): 00 The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and (III) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "Home" means the real property, fixtures and any physical improvements where the Services are performed. "Services" means(i)the delivery and furnishing of goods, equipment, materials, and hardware; and (ii)any related labor and services,including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance, repair, and testing. "Scope of Work" means a detailed description of work or Services to be performed, including, but not limited to, any quotes, schedules, invoices, specification sheets, proposals, confirmation emails or otherwise. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES:(a)Payment: You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area, including, without limitation: (1) obtaining in advance of the Services consent,permission,or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2) providing the location of utilities, whether underground, concealed, overhead or visible, to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area; (5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area;(7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services; and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. • `4-k 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, (H) 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 WARRAN 11ES 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 WARRAN HES 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. ma` s 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 _ 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 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@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 AC RO �" DATE,M55130,Yry CERTIFICATE OF LIABILITY INSURANCE L :;,;:. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. W IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poIlcy(ies)must have ADDITIONAL INSURED provisions or De endorsed. H SUBROGATION IS WAIVED. subject to the terms and conditions of the policy.certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Neu of such endorsement(s). PRODUCERCONTACT MARSH USA INC PHONE T FAX TWO ALLIANCE CENTER '--so..r.r, LLNC.Na:. 3560 LENOX ROAD,SUITE 2AX1 E'MAADDR SS ATLANTA GA 30326 Ik lREaf(I)AFFORORNGCOVERAGE MAILI C11C'6420694 AW-22-25 NEMERA:GNRmuti4lnllsarceCo 2047 INSURED ri€ti06tE DEPOT.INC PO ROVER :Nor WaINre Ire Cc 23541 HOPE DEPOT USA INC. NSU ERC:ACENeen ar hiwwce Cur harm 22667 2455 PACES FERRY RC.AD Nti11RER0: BUILD!Ffa,C-20 --^ ' ATLANTA GA X339 NUIERE: COVERAGES CERTIFICATE NUMBER: ATL-00507V2S6T REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREC`.AMED AESOv[ FOR THE POLICY PERIOD INDICATED. NOTWTTTISTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TWS 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. OR TYPE OFIIIIRA110E POLICY NUMBS m PO Cf 201YY Lsl/ls A x wriest rAL d6ERAL UAeU►m MAZY 31664 036120ZZ 03i01.2025 EACH OCCURRENCE s 1.000A00 DAMAUETO Sep*PO I CLAIMS-MADE ❑ ,PREMISES Ma occun+nori f 11100,0D) x Sit$1.000,000 MED ESP(Any one person! ,f EXCLUDED PERSONAL I ADV INJURY I 1.00OD00 GENL AGOREGATE LAST APPUE5 PER GENERAL AGGREGATE f 2.00000C IPCLICY Q PFIC Q LOC PRODUCTS-COMP SIP AGG f 2,0DO.CWC ^'�1 OTHERS A AUTOYOBLEtAABYJTr MWl6316549 0.1.i.:'2D2E cit12J=. CCIABPED SINGLE LEST f 13W.CCC Ea JnN-CI X ANY AUTO BODILY INJURY rWr parson, S ""'" OHNED — BCFEOULED SELF INSURED AUTO PHY DN,G BODILY INJURY‘Per ILL aczaeot; I — NOTED AUTOS ONLY ..r NDA NOTTiW IWOPERTY ONJAGE 5 �„AUTOS ONLY `__*1706 ONLY lP%i mods* 1 A t J.AiJAB ter, OCCUR MWZX316647 03012022 01Uti2025 EACH OCCURRENCE I 10.2611OQO (X ��EXCESS LAB CL,LAI IADE AGGREGATE f 14; .000 CAD I 1 RETF".T2ON I ,, , 5 WORKERS COMPENSATION WC 0115E6629{W7) 030124Z2 43 1:21323 X I PER 1 CI"IV ANDELOYERs LIABLITY VAR 0�16409 AAZ,ILI 0.3 4:7022 034)1.2023 STl�g1rE lA Y.v..,e,:.,pike TORFVNTHESSEAECUTIVE n EL EACH ACCIDENTf S.�Q.44tS CfFICERMEIMERExCLUDEOT NIA Itrandrleey Pi Ie0 E L.DISEASE-EA EMPLOYEE I 5.0:0000 it yes utesc ibe under COINnied on Addams Peer E.- EASE-POLICY LAIR f 5.000.000 DESCRIPTS]N OF OPERATIONS bit. I DESCRIPTION Of OPERATIONS LOCATIONS r VEHICLES<ACORC 101.Aeltione Rernans Sch.Jae.sae 4e attached a teen space Ia wtlunea E;I2ENcE:r r; LUPA.CE CERTIFICATE HOLDER CANCELLATION ^I CME DEPOT,..SA.P"C SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2155 PACES EtIr4Y ROAD THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED N BUILDING 020 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA GA 33339 AUTHORIZED REPRESENTATIVE I 7041144 WSW riser. ::1988-2016 ACORD CORPORATION. AU rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101642069 LOC k: Atlanta ACC0 IJ ADDITIONAL REMARKS SCHEDULE Page 2 of Maim KAIED.t&NED WRSRI USA Slc. THE HCA1E DEPOT.N HCAE DEPOT USA..hC IptlCRiIMER 2455 PACES FERRY ROAD SJLDIGC23 ATIANTA.GA 12339 CARRIER KAIC COOS EFFECTIVE GATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: . 25 FORM TITLE: Certificate of LAabid$ty Insurance 'Marts%C+s¢erzatcn Cmruec Came'',demA*era ranee,:aery al Naet5 Amerce Paicee N,rrtar WAR 138891f 83IADS:IALAR,FLID.NKS.I1Y LAAti.I/C.NC NE NVHDCKSC SD TN.VAVWAWW NIT. Efface.:Nei 03Al2C22 Exprarrn O i3/01,2C23 'ELI List.SiBCf.Y.0 Caner.NU teravice Co Pdicl Nagar WC O&58&r2 i41k51 INCOQDCrDE..W.P& MDM:.S IMT.*UWIY,PARI,VT Eikciw OME SINUM22 Expnfaen Dew 0,10111023 EL l unit S5311200 Cams A ZE Amencin ratatx Canal.), Pdrfi%Leber WO.A 03891&4 6,QSl1 tCA.OR W'AI Plait Derr:M 1+Z 2 Expreal Oak.011/112C 3 (EU Lim$4.3,30,113 SR$1.030X13 Center NagiariN UIda,Fue in a ence Canonry Peict Maribor XVIC IN 323 IOSI,i(CTCC,✓M NYOH.U1t Eleair Dow:03.01I22822 EapratenDee 037312023 (at Ii¢e.5oX.0 SIRSI 030J30 SIR ICT S350 CIE SIR IGAIi75a.6I Tx Ertoayers XS hAaraet,: Cams sires U,,:r t,srm COMM.,/ Pycy%veer:t" L691015 (Tx. Effect:*Der.5 1u 2C ExpraMoi Cate.31,3i2C23 .O..tLet SCGXXC SIR S5,0X.510 ACORD 101(2006101) C.,2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC Expiration: 04/22/2023 P O SOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and R. Card. Office of Consumer M .$auk Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for indvlduai us.only TYPE:Sucolement Card before the expiration date. If found Mum to: RsWitrallon Ex lr tla+ Office of Consumer Affairs and Business Regulation 1127135 04/2212023 1000 Washington Street •Suite 710 *TOME DEPOT USA INC Boston,MA 02141 RICHARD OLMSTEAD 2455 PACES FERRY RD C-11 HSCvalid signature GA 30339 Undersecretary AC®Oe CERTIFICATE OF LIABILITY INSURANCE lewieornyvy 1110l202121 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 ISSUING INSURERISI. AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED.the policyfies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED.subsea to the terms and conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODS CONTACT 0Aary RGreylock Benlsm, PO Box 603Insurance Agency E FNa 413-72v-6t iA .Nv., --- 708 Pittsfield MA 01202-0603 ADDRESS mbeniamihrkorevioa.orq INSURERBSI AFFORDING COVERAGE MAC e LAgoselt ,Bow79 IN URERA.Atiant,c Charter Insurance Co. 44326 'INISIJ1EO NIAR S-ifs NBUNERa. Ivan Kosobutskyy NBURER c. 72 Stafford Rd Monson MA 01057 POURER INSURER E NaUIERF: COVERAGES CERTIFICATE NUMBER:251/6358 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 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 AU.THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES 1JUl1S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSADDLAUSIP POLICY EFF POLICY ESP TP TRW. OFartRAIICE Bin IND POLICY I O* demairrrinn_amiinanirrn Urns cowasaCULtarmataLWrJTY EACH OCCURRENCE I L.4tMS.IM El OCCUR CAN To Ea or-ammo) S MED ESP i,N-,y cola perfoe I PERSONAL L ACN INJURY I V�— GEIrt ADORELATE LSAT APPLIES PER. GENERAL AGGREGATE I PCUCY fJ• La7 LOC PRODUCTS•COMPOOP AGG I OTHER AUTOMOBLELMBLJTY CCORNED SINGLE LERV I iEa a:oMezi ^—AN,"AUTO &DDILT PLANT Mot peasant I �^ OANED Y_rIEOULEC I BODILY INAIR'i Mee modem I AUTC?S ONLY �AL:TOS HEED N0/4-0M1i PROPERTY DWAIN t AUTOS ONLY �^ A,:'TCS OILY ( JPM arrdanu URIBRELLA LIAM H OCf_',.oR EACH OCCURRENCE I EXCESS LAB CLAMS-MADE AGGREGATE I DEC 1 1RETENTIONI FpE�Rp `I A TNORRERSCORPENSATION WCVL14HAY902 I V1 D2T 11)1312022 X I n I um I OTH- ER AND ENPLOYERW LIABILITY Y J N DFFICEAA�EMEIE ESCLLOECAECL�VE " N A A EL.EACH ACCIDENT 6100,000 (212mdroey ra Nit EL DISEASE-EA 9R'LOVES 11f 200,000 If roe doodler Lassie DESCRIPTION OF DPERATIONS boa. EL DISEASE-POLICY LENT $500,000 DESCRIPTION OF OPERATIONS LOCATIONS EIECI,ES{ACORD IDI,A ILonr RnwAU Ba1WIM•may be MlacAtl BLU1L spur ILL. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IH ACCORDANCE WITH THE POLICY PROVISIONS. THD At-Home Services Inc 2590a Cumberland Parkway#300 4 Atlanta GA 30339 no p YT'Tunrn AFPGAFe TILT C 1958-2015 ACORD CORPORATION. All rights reserved. ACORD 25(20111/03) The ACORD name and logo are registered marks of ACORD IVANKOS-Ol _ •_Ii@ERQ .ACORU CERTIFICATE OF LIABILITY INSURANCE DATE ..VDOYY' kNrr+'-- 1 012 5/202 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED.the poticy(ies)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED. subiect to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s1. PRODUCER ,CONTACT — HUB International New England 1PRONE ,,FAX 1070 Suffield St �c No,E.q.(800)243-8134 i„at,Nui(493)731-9539 Agawam.MA 01001 - INsURERISi AFFORDING COVERAGE NAIC a /OW ER A.Ohio Security Insurance Company INSURED HPsfREBa Commerce Insurance Company "MIL Ivan Kosobutskyy I&I Remodeling *si+RER c 72 Stafford Rd •L.t+, @.2...._.-,...V.._t Y.. Monson.MA 01057 POURER E _INSURER F COVERAGES CERTIFICATE NUIdBEtt REVJSION AIUMBER: THIS t5 TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCLICY 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 II N �O I TYPE Of EUNAMCE POLICY NUMBER d`(Y`ti POLICY EXP i GAIIIILINTYY1 UNITS A X COMMERCIAL GENERAL UAs1FY EN'HOCCURIZEISCE 5 1,000,000 1 curia=-MADE El OCCUR x MKS5E639752 5/1512021 5/1512022 P I s°;EH O.I I 300.000 hME.:EhW-A•,v'esra w*iI I_ 15.000 I — PERSQ11AL SADY IN.k- �RS S 1,000+ ftENLAOCRELI TE pW��IT,APPLES PER GENERAL ACa FIECATE 1 ='�' 0 `�POCY 7,.. S +] El LOC PRDDl1CI5CIPP ADD f 2,000,000 OTHER S co me.NED SINGLE JNIT B AATONOOLE LILY L,-,.M ir;:.elirt -ti r—ANY AUTO _ BBCRLL 812812021 812&2022 BODILY trrAwri fa p.n.,,, s 100.000 "— OWNED SO-EDULED 300.000 Auras ONLY X AUTOS BODILY INJURY Uam a:.,:a reti $ X��¢� x PROPERTY Dk1AAC.E 100,000 Zfra ONLY AUTL'S C:liF �Ptl':ti,t..1..t, _ ,,....... ,S I EACH OCCt1RRENCE } LAIBRELLA LIAR D� � EXCESS UAB CUMIIMMDE EAcHOAGGREGATE I :"'FD, E TE'�-ONti WORKERS CONNBASATION I ANTE I 'EK ID A EMPLOYERS UAa uTY SrJN .. ft�egriryf11/ EX,CLL MIA RERrEICECTUTRIE El Ei.6IGNACCItJBh'T S awuY Neil EL MANSE•EA EMPLOYEES CAC d¢ws'ta:Y.la ,,�� RlP .oN•OF DPERATI Ms tarn. r___..___a _._—___EL DISEASE.POLICY curt J. DESCRIPTION OF OPERAT.L*!LS.LOCATIONS t'EHNCLES.ACORO 141,Additions#unarks ScANAIs,ew,Ise uiacrd V PAIN apace •ignoil Home Depot USA Inc is named as additional insured as respects General Liability insurance as required by vMttee£O4Mract or written agreement. 2012 FHA,Vin5WDPPf4CCBCI512141 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T HE EXPIRATION DATE IN Home Depot USA Inc ACCORDANCE YMTH THE POLICYIE PROVISIONS.NOTICE111KL � Home Services Compliance C11 2455 Paces Ferry Road Atlanta..GA 30339 Au1HONSIEo REPRESENTATIVE I 99://-----rf ACORD 25)2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD Mee and logo are registered marks of ACORD Commorivapaitts of Massachusetts Division of Occupationatitcensure Board of Building Regulations and Stand.);ds —1,i 71 Constructi . upeevStroy Specialty CSSI. 098785 - ittpires 04,27'2024 ' IVAN KOSOBIJTSKYY 72 STAFFORD ROAD MONSON MA-010157 011.V.1 );-- • Commissioner "••••„, .••, ,••„ • , ,• „ ,•• , * 131111•, aii?Nsit otleisure CS-013902 r • C 44444(TOR iJC.“.10.1. CS-9803 CS-9804 CS-98051 Ivan Kosobutskyy A CS-9808 W i CS-08C17 mu 4A VY:f964,719/164Y.alhe Ai rao,v • Mtiretin n9Wisrflt07/• • MASSACHUSETTS CONSTRUCTION SUPERVISOR LICENSE 6 HOUR ONLINE CONTINUING EDUCATION cow*WM.OM.*AM fre....116011 WAR tel14.14,0:*I Can owner-itita.•go,groom- KI.04011,• 11110.1.1.4.114,•••••fcsowsory -64.11.1Aree corarr*rms OWINOeha Peae•fea.F Vrafts11011.014.(CS-IMOIrp I Paws* • ales NW Vt...e.dent, 02.11411 tefe00:41/ «08.41. 1.100*WV.K-1.1.00,T COVIRSt COCA4114.44,CMIt Kart%24 2020 sLEA =''NIZZ:.;'T...tt. c<10.0.4.1.•APONICIV04,aKnaotere, Cat.041Cifit MOS- , ALaseita,4 irprtvo..r.roominc. $1111111111.0111110111 31245103/O242I2S41 KVA".O.../IIV,C104 / C041.1.0.4,64.1 LISIANINS 1164/01110• /6 Ny nevevid fit - Office of Consumer Affairs&Businest, HOME IMPROVEMENT CONTRAC TOP TYPE: Individual Registration £xpeatoj.t 152379 013/22/202::i IVAN KOSOBUTSKYY D/B/A I & I REMODELING IVAN KOSOBUTSHYY _ 72 SATFFORD ROAD MONSON, MA 01057 Undersecretary Registration 152379 st Registrant Ivan Kosobutskyy DBA I&I Remodeling Name IVAN KOSOBUTSHYY Address 72 STAFFORD ROAD City,State MONSON,MA01057 Zip Expiration 08/22/2022 Date t I Kotkyy ( authorize Go Permits 1.11' to pull permit-.. using 11‘) CS License # and gr. FI.IC Registration r i Any questions please call me at: ,y/s -2-21— CO _ . Installer Signature Company Name 'er 'I- 4,114 04.q_.1.t...4.A.r. rhi, certili that t VtipafAM.VaY Ivan Kosobutsk L1pI1d . itort!Rd, i„I'140tiTalf.*.C' 403'"lore",..fullv completed;kr,t-hintr coitMC CAT10I id 1 Sale Renovator- Supervisor Refresher :all;to 451 CMR 22 .0 and 4U CFR Part 745;23 'CIPA10.14041105,0 trimilkullio Erreironmotal Etiociallan 14 Uplodin Dolve IRA OKI Mu 10,2014 VIAL19.—?.91? <-1 A - 340-374-0 I Mt! INSTITUTE FOR ENVIRONMENTAL EDUCATION