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35-107 (5) BP-2023-0823 86 DREWSEN DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-107-001 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-2023-0823 PERMISSION IS HEREBY GRANTED TO: Project# SHOWER 2023 Contractor: License: Est. Cost: 12500 BATH BUSTERS INC 072772 Const.Class: Exp.Date: 04/07/2024 Use Group: Owner: B SLABINSKI RICHARD P &JOAN Lot Size (sq.ft.) Zoning: WSP Applicant: BATH BUSTERS INC Applicant Address Phone: Insurance: 30 NORTH MAIN ST UB6N457719 LEOMINSTER, MA 01453 ISSUED ON: 06/22/2023 TO PERFORM THE FOLLOWING WORK: REPLACE TUB WITH SHOWER 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: '• Q I Fees Paid: $81.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner l� coil J(/ v The Commonwealth of Ma :ache s ,ii,t Board of Building Regulations an. t. ; a R Massachusetts State Building Code, . OP. , � UN IPALITY USE Building Permit Application To Construct,Repair, Renova�-�0�� a •lish . R. ised Mar 2011 One-or Two-Family Dwelling 4o cii ,004,8 This Section For Official Use Only Building Permit Number: 8 P-0)-3- ga-3 Date Applied: i 1 A 991 as , 'Si 4 6 ' = Building Official(Print Name) i Signature / Da e SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: /3 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(II) 1.5 Building Setbacks(ft) Front Yard Side Yards 74,11p Required ro ' ed Required,��/ / vided Provided 1.6 Water Suppl (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sews I isposal System: Publi ili4 Private 0 Zone: _ Outside Flood Zone? Munich M site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,/�,�,� --,.,, S/ L/ S /2 ciAmo .11- ! .5i/►''7"lam 14-L Ce— Name(Print) City,State,ZIP g6 Dxect,t e-2 ,di(- t-1' -�2` /mod 0 /. c-c) No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs( )Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work':�/ 2) AEG},/✓ �),v/� RE/-�'ii � 7-06 4_,,YAr L. Se /ov L'XJ s r -t) tc- C a C4-'T/u.•✓ £ JL-T 4/204 (,t/g2t-{ OA-ai y SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1. Building $ e) c,c.p 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ) 0 Standard City/Town Application Fee 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 3 -1 G b 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fed41heck ��i �� Check No. Amount: ► I Cash Amount: 6.Total Project Cost: $ / 21 J v 1 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construc 'on Supervisor License(CSL) 47Z77 Ll— — 2 r LiQ____!� License Number Expirationti Date Name of CSL Holder 7 y V!4� / 4- List CSL Type(see below) No.and Street T Description a4. -1tAf i 0l 2) U Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 180 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 9 y r, r^ y du-k' � SF Solid Fuel Burning Appliances (G ' / � I Insulation Telephone Email address r 6".''L'" D Demolition 5.2 Regist d Home Impr ement Contractor(HIC) /r-ra ) -7./c/_ Z �5 �1'7-6 HIC Registration Number Expiration Date HIC Company ame or C Re ' 36 /, 741 l.�stratlalue �v� a-g9r� l..)freWS -CO"-- N end 0 j�S/-..C 14 0/0-3 Email address 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 Issuance of the building permit. Signed Affidavit Attached? Yes .i No...........❑ SECTION 7a:OWNE• UTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize I4� If cW YT / to act on my behalf in all matters relative to work authorized by this building permit application. 4c44A4 3(.../OZAJ.,V,Cr C—( e': U 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 this applicatio ' tt urate to the best of my knowledge and understanding. —1X= z3 '-- ' Owner uthorized Agent's Name(Electronic Signature) Date NOTES: 1. 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 ofhalf/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" City of Northampton 0.YHAMY) .0* %?° S`S...JS1C / .4' Massachusetts tit G 1ry� �l ,, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 TYly-. �^0c 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: Location of Facility: Ai, M/9I•-J S— � S4''`1 /.j'; - 4 The debris will be transported by: r Name of Hauler: /j� l"CC; 7.6 / '� � C,6-S/O Signature of Applicant: Date: Cat^ he commonwealth of Massachusetts - Department of Industrial Accidents ^I Office of Investigations =t�t1 ; Lafayette City Center cl 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Bath Busters Inc Address:30NMainST. City/State/Zi.:Leominster Ma. 01453 Phone#:508-925-4300 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p 9. ❑Building addition [No workers' comp. insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no bath tubs employees. [No workers' 13.�Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Universal Insurance Agency Inc — Policy#or Self-ins. Lic.#:UB6N457719 Expiration Date:6/9/23 Job Site Address: b ,9./ L t-✓S City/State/Zip:/54 57-47-ir a(4.7L� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 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 form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains a erjury that the information provided above is true and correct. Signature: Date: Phone#: 508-925-4300 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0Electrical Inspector 51:Plumbing Inspector 6.1:3Other Contact Person: Phone#: AR DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/06/2023 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 CONTACT Mosarene Scalzer NAME: Universal InsuranceAgency,Inc. tP(pHlCNN Ext): (508)752-9333 No): (508)752-9303 374 Belmont Street ADDRESS: mscalzereuniversalinsagency.com INSURER(S)AFFORDING COVERAGE NAIC# Worcester MA 01604 INSURER A: Berkshire Hathaway Guard Ins Co. INSURED INSURER B: Travelers Indemnity Co of CT 25682 BATH BUSTERS INC INSURER C: 30 North Main St INSURER D: INSURER E: Leominster MA 01453 INSURERF: COVERAGES CERTIFICATE NUMBER: Master 05 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POLICY E F POLICY EXP - LIMITS LTR TYPE OF INSURANCE INSD_WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 50,000 occurrence)CLAIMS-MADE X OCCUR PREMISES(Ea S MED EXP(Any one person) S 5.000 A Y BABP367156 11/12/2022 11/12/2023 PERSONAL BADV INJURY g 1,000,000 GEN'LAGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S 2'000,000 POLICY �JEcy LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) X ANY AUTO BODILY INJURY(Per person) S 100,000 A OWNED SCHEDULED BABP367156 11/12/2022 11/12/2023 BODILY INJURY(Per accident) S 300,000 AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE S 100,000 AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION #I PER 1 OTH- AND EMPLOYERS'LIABILITY Y I N N STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A UB6N457719 05/06/2023 05/06/2024 EL EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Town of Lexington is listed as additional insured on the above General Liability Policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Lexington ACCORDANCE WITH THE POLICY PROVISIONS. 1625 Massachusetts Ave AUTHORIZED REPRESENTATIVE Lexington MA 02420 (- - CC:3-411P'—'----- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ii, III Division of Occupational Licensure Board of Building Re ulations and Standards Cons tServisor . L < 772 ►� ices: 0410712024 II FF C STE Et ,. SHERWO AV 7-- :° • LAVERS ink 0192 i . ..*: - - fs, ISSIoner (la) K. &dia.. 4 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai (Sand Business Regulation 1000 Washing t- Suite 710 Boston M - • _._ + 118 T"-- - istration Home im ro -e•.����..---- _ --- r •= _i wi == T Corporation 0 _....-.. Type:..) �" "'•""' ~- '. J5IOfl C. "' :� :�-" : 07/14/2024 30 NORTH MAIN ST :z = -� LEOMINSTER, MA 01453 Illinill 1 U W „V 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 159p5'_ -}; 07/14/2024 Boston,MA 02118 TH BUSTERS, INC. • ; , , q wr ENER ALMEIDA JORTH MAIN ST. ‘4,7,40(a.4.4. ►MINSTER,MA 01453 Undersecretary Not valid ut signature t.' i r ,:r 4` Scope of Work Scope of Work will be found below or in separate document. Slabinsky Richard ) 8452 F34222690 Customer Last Name Customer First Name Store# Customer Lead/PO# Program Name: Other. Description: Remove and dispose of existing tub and walls Install new temperature/pressure control valve and drain Repair walls and subfloor where needed Install custom acrylic shower base and walls to ceiling Install 4 shelf corner unit and shower rod Folding teak seat and grab bars Remove and dispose of all project related debris Products to be ordered 60 x 30 RH white shower base Silver white marble pinwheel tile Moen valve with Delta Magnetic hand held(chrome) 4 shelf tower caddy(swm) Folding teak seat Grab bars(24,2-18)chrome Straight rod in chrome lb Hem Depot-2455 Paces Ferry Road,N.w.Bldg.B3,Atlanta,Georgia 30339-CemnierOwn 14114663337 3160wedsA01Q(07Dea70) OuebiDNe nn21 Lead/PM Fjg222,(AQ v 6.0 htt S F.orn ss:,ces.. i.s!te.00^ o `!-!�C " ? 'j7.'�,...00..f.' •:2F::is 222Eieci -P �ii w:s; s.�. nt- _ ,. _ :�i3K�xVJfi:'! -,a t aBFst:ce:t3.::°C3:cur.;>rts 5;22:23.9:27 PM sage 3 of 10 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 S.Anticipated Delivery Date/Installation Schedule Approximate Start Date: `621/2023 ) Approximate Finish Date: `6/22/2023 ) A11 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-marled 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: $ (12500.00 ) Includes all applicable taxes.Excludes finance charges.' Sales Tax $ ( , (If applicable,total amount of taxes included in Contract Price) *Maximum deposit ONLY applicable in MD,MA,ME(33%),NJ,WI(99%) • Deposit% ` ( ) Deposit Amount $ (4200.00 ) Remaining Balance $ (8300.00 &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 latet)By signing,you acknowledge that:(i)You have read, understand,and accept this Agreement in its entirety,including the General Conditions and State Snppi®oat if any;(it)Von are a eeeivtrla o 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 (5/82023 �i� .'_,t..A...,- Date Customer's Signature 1 X (/s/The Home Depot ) 5/82023 Date The Home Depot Digital Signature For questions related to your installation,contact Service Provider at (508-308-4435, For any other concerns,contoci The Home Depot at 1-800-466-3337 The dome Depot-2455 Peas Ferry Road,N.W.Bldg.8-3,Atlanta,Georgia 30339-Customer Corm 1-LMHf63337 Generaedptra3 2l Lead/POkElA 690 vGO 316 Genetic AGMs(07 Dee 20) .site.cc:`;sc;Saiii-do=urnam-t rriplla.::3:_00r __ .. '" =.:tab Home Improvement Agreement:Page 1 Home Depot License#'s-For the most current listing visit www.Homedepotcom/LicenseNumbers 9875,112785,CS-107774 (MANNY ALVES ( 1 Salesperson Name Registration#(Req.in CA,CT,11E,11ZD,1NII,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 `manny@bathbusters.com Bath Busters Inc. Service Provider Contact Name Service Provider Company Name (508-308-4435 (many@bathbusters.com ) 897775 Phone# Service Provider Email Address Service Provider License#(s) 2.Customer Information Slabinsky ) (Richard (8452 ) (F34222690 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# (86 DREWSEN DR • ) (BAY STATE VLG (MA 01062 Customer Address City State Zip (4135842298 ) ( • (4135842298 • (no@ematl.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: manny@bathbustcrs.com / OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: (30 North Main St. ) (Leominster 01453 (01453 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY Al!TIrR 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 CANCEL. Acknowledged by: 449-c r"•1 5/8/2023 Customer's Signature Date The Home Depot-2455 Peas Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Cam 1-800.166-3337 316 Generic AGMT(07 Dec 20) Generated Date pt2023 Lead1PO#g3y2=Q v 6.0 het site.✓-. :.a; is-�cct m r.: --_ ;- --- :Fccf24:22f30z:3Fshor::e. ...ct:merts 5/24/23,9:27 PM Page 1 ot 10 11 Home Services Installation Customer Approval Home Depot License#'s-For the most current listing visit aww3lomed 1.G0m/t.ic enseNumbers 9875,112785,CS-107774 � t Slabinsky (Ridtssd ) l 8452 ) (F34222690 Customer Last Name Customer First Name Store# Lead or PO# 86 DREWSEN DR (BAY STATE VLG ) `MA ) (01062 Job Site Address City State Zip 4135842298 ) (4135842298 • no@emailcom Home Phone# Work Phone# Cell Pone# Customer Email Address Additional PO(s): ( ) Waiver:Upon receipt of payment from Home Depot U.S.A.,Inc.("Home Depot")on behalf of the customer named above,this document shall be effective to waive,relinquish,and forever release any right of the undersigned Service Provider to a mechanic's lien,stop notice,or any right against a labor or material bond on the job performed for the customer and the property at the job site address listed above.The undersigned Service Provider represents that all laborers,mechanics,and materialmen furnishing services or materials on the job either have been or will be fully paid for the services or materials. Release and Indemnification:The undersigned Service Provider agrees to cause the prompt release of any liens,stop notices or other property encumbrance that may be filed against the property at the job site address by any laborer;mechanic,or materialman claiming the right to file such lien,stop notice or encumbrance through or under the undersigned The undersigned Service Provider further agrees to defend,hold harmless and indemnify Home Depot,the customer named above,and the owner of said property,from and against all costs and expenses arising from or by reason of such lien,stop notice or encumbrance,or the release or discharge thereof Acknowledgment:The undersigned acknowledges and agrees to the above terms and conditions. (BathBusteis Inc. " (508-308 4435 ( _I Service Provider Name Service Provider Phone# Service Provider License#(SF&I) 30Nartii MainSt. Leominster ) (01453 ) (01453 Satvica Provider Adder City State Zip X ( ) f Service Provider Signature Date NOTICE TO OWNER Do not sign this completion certificate or any agreement stating that you are satisfied with the entire project before this project is complete.Home repair contractors are prohibited by law from requesting or accepting a certificate of completion signed by the owner prior to the actual completion of the work to be performed under the home repair contract. Certificate of Completion:Customer sign here only upon your acknowledgement of actual completion and final approval of the work. S ) ( ) ( Customer Last Name Customer First Name Customer Signature Date The Home Depot-2455 Paces Item Road,N W.Bldg.1 3,Mlanta,Georgia 30339-Customer Carr.1400-0663337 329 Customer Approval(01 Om.20) Generated Date 524/2023 Lead/PO#t3.1222M v 111.0.0 • '�'=P` = _ =•rtt,aiF..ert ,ez:a. -^ce r=rt , r r:_._:.. C� G3✓3x`IU„;t°'_�r _.= s'�2fion:;3rsr :..._ : Page l of