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12C-052 (14) BP-2022-0769 20 CLOVERDALE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-052-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0769 PERMISSIONIS HEREBY GRANTED TO: Project# BASEMENT RENO Contractor: License: Est. Cost: 12500 MR HOME CSL103401 Const.Class: Exp.Date:03/19/2023 GRIFFIN ANNETTE &SUSAN D REARDON Use Group: Owner: TRUSTEE Lot Size (sq.ft.) Zoning: RI/WSP Applicant: MR HOME Applicant Address Phone: Insurance: 74 CISLAK DR (413)222-5368 UB003R873577 LUDLOW, MA 01056 ISSUED ON:06/30/2022 TO PERFORM THE FOLLO WING WORK: RENO BASEMENT 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: I _ r . Q3 f Fees Paid: S81.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / MjVELCE The Commonwealth of Massachuset is JUN 2 V Board of Building Regulations and Sta r ZI'Z FOMassachusetts State Building Code, 78l C �'ICIP LITY U .0 FQUIInN Building Permit Application To Construct,Repair,Renova - . iir - . ,. 1Sp -1;. sed ar 2011 •One- or Two-Family Dwelling MAo� ,o S This Section For Official Use Only Buildin Permit Number: 3 P' ?- ` g Date Applied: �"U IrJ ..0 ___y,�/�.._ 6-3U-ZOZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prope Address ___wMtee „ 1.2 `Assessors Map& Parcel l uu�mb � 1.1a Is this an accepted street?yes/, X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 1 Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public 0 Private 0 Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: f-14/AA/ /4ergnPO/i ,/1/A/`1, 141% Name(Print) City,State,ZIP c2D C�aVe,CPil/' � f )7 2 No.and Street // wi Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: . A.re.�,0 , 2/i I j✓'t' ,yj p `�'i//, .1/ ��� -27VA //7 ,-1 /7',02> si . (Jz/►�I v�',4 J J SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ -0 Suppression) Q t Check No heck Amount: (f 6.Total Project Cost: $ 47 g0 0 Paid in Full 0 Outstanding Balance Due: City of Northampton w. Massachusetts E ° 0I k DEPARTMENT OF BUILDING INSPECTIONS ; VP 0, 212 Main Street • Municipal Building Northampton, MA 01060 rSf .y.) 3 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) igj yn- l I 1 .2 I b/i/l J/t1M ii4.0).nni License Number Expiration Date Name of CSL Holder 2 / L,0� / , List CSL Type(see below) No.and Street / T Description /4,o, )2i 7 U nrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,Z)P f ✓ ' / Restricted 1&2 Family Dwelling Masonry RC Roofing Covering WS Window and Siding / /c � ��� /� � SF Solid Fuel Burning Appliances C <J I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /9 is,i 1 J g;21 A' l9"f 6 HICRegistration Number Expiration Date HIC Company Name or HIR a}slrant dame No.and Street < G- �/ Email address 76 City/Town,State,ZIP Telephone SECTION 6: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 Iss ce of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in/thhis appli tion is tru and accurate to the best of my knowledge and understanding. 4"' Print Owner's or Authorized Agent's Na Electronic Signature) Date ' NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" .., cab,- 1 The Commonwealth of Massachusetts o=-.....—...--- I Department of Industrial Accidents III er..... glamor I Congress Street,Suite 100 T.-.71141,1= 0 r Slifif--= i' Boston,MA 02114-2017 •,- .,„ www.ntass.gov/dia Workers'Compensation Insurance ..t BMA it:Builders/C7ontractorsiEleetridans/Plumbers. TO BE FILED‘‘I III I III PERMITTING AUTHOR'UN. Applicant Information Please Print Leighlv Name i Business(A;i na.ation.[ruin idual r Address: City/State/Zip: . , . rc yea am employee Cheek tbe appropriate box: 1. 1 oei a employer with __Vempoloyets(full asid 4,4*pull-Lune I..* ( Phone#: Type of project(required): 7. 0 New construction 2 lam a sok proprietor or pormerslisp and have no employees working for me in 8. 0 Remodeling any lArraeny.[Nu workers comp.intim-arta sesprinni] 9. 0 Demolition 3.0 lam a hump IICT doing all work myself,[No workers'cocas,insurarke required.]* 10 0 Building addition 1.E3 I am a homeowner and will be hams contras:tors to etroduct all work on my property. I will mom that all ssinoractors either have workers*coarspitriari insurance or are solc 110 Electrical repairs or additions proprietors with nu employraN. 12.0 Plumbing repairs or additions 5 1 am a sto general contractor and I IlaVe hued the h-eontractors listed on di e attadies1 sheet i30 R.00f repairs. mese itib-cooirsciois Ixave erripluses and has e nruriLL`r.1.comp.insurance.: 14.0 Other 6.0 We are a corporation and its officers have exercised their right of exemption per 114GL c. 1.52.§1441.and we ha vo no employeet.[No workers'comp.insurance required] Any applicant that checks box 41 moat limn fill°La the section below showing their workers'compensation policy ink-tri :ii *Homeowners who submit this affidavit indicating ilk].are doing all work and then hoe OMade,Zortir.watim=ea,ubnut a Deo,affidav it miticaung such. lContrai:tors that check this box MUM anaehed an.1.11ALional shett AID%mg the nione of the sitb,:untr1etor3 and gate Win:the':,.T:10 flume enlItic,have employee-, It the uli--eurstr-resors have employees.rile!. mom pros ide their workers'ccirrp.rulit'].number 1 am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 7-ie-ily8/e/v Policy#or Self-ins.Lic.#: i/ffizAZird 7-Le7? Expiration Date: 51 'AI-i A 2- Job Site Address: .26° ./.1/2W/2---191?/-1 • CityiStateZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and eypiration date). Failure to secure coverage as required under MGL c. 152, §25A is a crirniiial violation punishable by a fine up to S1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. A copy of this statement may rwarded to the°trice of Investigations of the DIA for insurance cot era,4e I,erification. 1 du hereby certify under the ' akies if ieriirry that the ' ornialion provided above is true and correct. Siipiature: 1).,.',..' Phone:;•: Official use only. Do not write in this arra.to he completed by city or town official i City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.. Plumbing Inspector b.Other Contact Person: Phone 4: —moil City of Northampton /0' 1 � Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ?r 212 Main Street • Municipal Building , o Northampton, MA 01060 k,Y CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: ��1�0�/ /0 Location of Facility: //ago The debris will be transported by: Name of Hauler: Signature of Applicant: Date: City of Northampton C1 t Massachusetts vi : 4) 1k wi DEPARTMENT OF BUILDING INSPECTIONS y� 212 Main Street • Municipal Building y �' Northampton, MA 01060 419V30gam HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. 1 do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature) Permit Pack 2022 • Certificate of insurance Valid Until 9/25/22 (Ideal Insurance Agency, Inc.) • CSL License Valid Until 3/19/23 (CSFA-103401) • MA Home Improvement Contractor License Valid Until 1/29/23 (REG#194368) • W-9 r'1 HOME-01 OP ID:AC 'AC®RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �-�� 03r1 sr2o22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 413-589-0901 I CONTACT House I NAME: Ideal Insurance Agency,Inc. PHONE 413-589-0901 FAx 413-583-6511 187 East St. (alc,Nc,Exr): We.,No): Ludlow,MA 01056 i AODREE-MAIL SS: House INSURERS)AFFORDING COVERAGE 1 NAIC# INSURER A:Travelers Insurance 19046 INSURED INSURERS: Mr.Home 6 Dumaine Street INSURER C: Wilbraham,MA 01095 INSURER D: INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDLISUBR' POLICY NUMBER POLICY EFF POLICY EXP UMITS LTR INSD N/VD (MM/DOIYYYYI (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S _ — MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S — POLICY u jE LOC PRODUCTS-COMP/OP AGG S OTHER: S I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S — ANY AUTO _BODILY INJURY(Per person) S AUTOS ONLY SCHEDULED SSyUyLED BODILY INJURY(Per accident) S A R S ONLY _ WISELY( (PROPERTY RntDAMAGE S — S I UMBRELLA UAB — OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED ( RETENTION S S A AND EMPLOYS ERS'LIABILIITY Y!N X STATUTE I I FR H ANY PROPRIETOR/PARTNER/EXECUTIVE UB003R873577 09/25/2021 09/25/2022 E.L.EACH ACCIDENT 5 500,000 OFFICER/MEMBER EXCLUDED? N!A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S i' I DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Concrete Services CERTIFICATE HOLDER CANCELLATION INSRECD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INSURED'S RECORD ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE qL,J, Q. co,, - ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • r Commonwealth or Massachus. !s Dwvision of Professional Lscens e Board of Building Regulations and c sndards COnstructiols$trgier •isor 1 a 2 rniiy CSFA-103401 Expires:03:1912023 WILLIAM H SWEENEY 74 CISLAK DRIVE LUDLOW MA 01056 ' Commissioner i. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration y w < ti Type: Corporation MR HOME, INC. f Registration: 194368 74 CISLAK DRIVE t Expiration: 01/29/2023 LUDLOW, MA 01056 s. 1,0 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 194368 01/29/2023 Boston,MA 02119 MR HOME, INC. WILLIAM H.SWEENEY 6 DUMAINE STREET `0l.4.! WILBRAHAM, MA 01095 Undersecretary Not valid without signature • tFrrrtI„g Requestforjaxaer Taxpayer Give Form to the (Rev.October2013) Identification Number and Certification requester.Do not \DeoanmontolthoTreasury send to the IRS. internal Revenue !% ►Go to www.irs,govlFonmW9 for instructions and the latest information. wit ur iworgetax return).Name urged on this tine:d not)eave this line blank. i/.l 1 / JiAfileAJ/1 2 tarn ma/disregarded entl p name.i[ from above �;L / -k' . /J-- --- m 3 Check approprete box for federal lax classification of the person whose name is entered an One 1.Check only one of the 4 Exemptions(codes apply only to m following seven boxes. certain entities,not Individuals:sec O. 0 instructions an page 3): g 0 Individual/sale proprietor or ❑ C Corporation S Corporation Partnership L]Tnstiestate ei C single member tie. Exempt payee code if any) ao r--1 ,Z' Limited liability company.Enter the tax classification(C.- corporation.S=S corporation,Partnership)► o i Not=Chock inc appropriate box in the Inc above for the tax erasrification of the single-member owner. Do not&took Exemption from FATCA reporting = c LLC if the LLC is cia si red as a single-member U.Cdisregarded that is fromowner unlessowner the the on of the LLC:;. code(if any) -r.E another LLC thatt_is not disregarded from the owner for U.S.federal tax purposes.Otherwise.a single-member LLC t . -- - O. 0is disregarded from the owner should mock tho appropriate box for the tax cW.. cation of its ovmer. m 0 Other(see instructions)I'. (kio ,c a c c•-uinnoceujr-UoNoUS1 O 5 Addre%(number.street.and apt or suite no.)See Instructions. 2., Requester's name and address.:optional) t /,‘' ZIT/A/rya cri 6 City,state,and ZIP code /4o ,11/, 7/A /)k 7 List account number(s)here(optional) . Part I Taxpayer Identification Number("RN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social sccuftty number backup withholding.For individuals,this is generally your social security number(SSN).However.for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other -• I - entities,it is your employer identification number(EiN).a you do not have a number,see How to get a - TIN,later. or Note:if the account is in more than one name,see the instructions for line 1-Also see What Name and iEmployer Identification number 1 Number To Give the Requester for guidelines on whose number to enter. T—/ ,�„ Part II Certification Under ponaltios of per}ury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.I am not subject to backup withholding because:(a)i am exempt from backup withholding,or(b)I have not been notified by the internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I arm no longer subject to backup withholding;and 3.I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct Certification instructions.You must cross,out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because - you have'failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,canceliat of debt.contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends.you are not r r to ign the certification,but you must provide your correct TIN.See the instructions for Part iI,later. ,.,h nature of �J -- - /` Here u.8.person► iet Se //1 Date i 6 �- General Instructions •Form 1099-DIV(dividends,including those from socks or mutual funds) . Section references are to the Internal Revenue Code unless otherwise •Form 1099-M1 SC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments •Form 1099-8(stock or mutual fund sales and certain other related to Form W-9 and its inactions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transaction) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest). information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number MN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(MN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. if you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subfect to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.182018) CONTRACT MA License#147560 CT License#613751 Mr-Nome.net crt �/ 6/6/2022 We Do It All! , /41‘ 6 Dumaine Street Wilbraham, MA 01095 Susan Reardon 413.222.5368 / 860.627.5610 20 Cloverdale St Office.mr.home®gmail.com Florence, MA 413-923-8393 / agriffin@communityaction.us SALESPERSON JOB PAYMENT TERMS DUE DATE BILL SWEENEY 20 Cloverdale St PLEASE SEE TERMS BALANCE UPON RECEIPT DESCRIPTION PRICE BASEMENT FINISHING; refinish front half of the basement. $11,670 Approximately 50' x 12'. (attached drawing) • drop ceiling • stud EL insulate with walls R-13 • Sheet rock walls primed • Baseboard trim • (1) closet • (2) Interior doors • Permit Included • Ceiling Panels Upgrade $100 • Add foam board to ceiling for sound reduction $780 (No flooring, No electric, No plumbing) GRAND TOTAL $12,550 1/3 required to PAYMENTS start Please mail a check payable to Mr. Home or contact the office to BALANCE DUE UPON RECEIPT $12,550 discuss payment options. THANK YOU FOR YOUR BUSINESS! a h y t.,� P e it,t/ .9 # -1.0)/(vici „...1/7/04,/,/c-$0,./07/, f 1 j) ',,'//I(1/1/;,,,,1 Cl/ -- \ t 1 L.ei/9 6/ 71/ ii— r . "--- 1 I-I- or/i(jr- \-11/Q21( \ e r I