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06-022-036 BP-2023-0935 48 EVERGREEN RD#114 COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 06-022-036 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0935 PERMISSION I IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est. Cost: 2935 HOME DEPOT USA INC 106106 Const.Class: Exp.Date: 09/29/202 Use Group: Owner: MATT EW KADISH Lot Size (sq.ft.) Zoning: URA Applicant: HOME EPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-4112 WLRC50668058 ATLANTA, GA 30339 ISSUED ON: 07/19/2023 TO PERFORM THE FOLLOWING WORK: 3 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Ir • 5,2 . '1 • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissigner /V JUG U e Commonwealth of Mas cusetts Office of Public Safety andInspections •., r,-' 42a Massachusetts State Building Code(780 CMR) ' •.oA���i4 ;uilding P: . it pplication for any Building other than a One-or Two-Family Dwelling He b�4ft,l IN o f i SPp (This Section For Official Use Only) Building Permit Numlea,1 t' l 'k9 1 Date Applied: Building Official: SECTION 1:LOCATION 44 8 6woe: re-GI R dad n 0 Lacds rrg4 d/os 3 No.and Street City ov(ln i i- (I g Zip Code Name of Building(if applicable) Assessors Map# Bloc an or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair❑ Alteration ❑ Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other l 'pecify: ref/ace Aron/ w i 4 o/ti4CJ Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No a-- Is an Independent Structural Engineerin&Peer Review requi ? Yes 0 No Lii""-- Brief Description of Proposed Work !SG mom- •C tic m 3 v-44 e/iw1 /,"feC t /r lG40- le►-/A Flo tit* • SECTION 3:COMPLE It THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2❑ H-3 0 H-4 Cl H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-ID R-2❑ R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION&CONSTRUCTION TYPE(Check as applicable) IA 0 IB0 IIA0 IIB0 MA IIIB0 IV VA VB0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 0 Check if outside Flood Zone 0 Indicate municipal❑ A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9 PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ,cQ/ AAg:0s h tit ever.5.e.4 ,ram✓ t.G elf A19 D/e'5i Tame(Print) No.aria Street City/Town Zip Property Owner Contact Information: - - _d',b _ 4 o9jy /0+ J h f 3 9K*, ./,(Qry Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address ( ity/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of endosed space and/or not under Construction Control then check here❑. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Eixeleak- Ciu.bofaiti. yl1_ )5c_ 3 "-- femshQ'0lefmA.0 /66/d4 Name(Registrant) Telephone o. e-mail address Registration Number is bt,'ra•h 9r Sv r ,d eitof CSSL aqua/z 1 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 1./t !-N/Xc Diet U Sg f e. Company Name &u ,►;.. (,K 6a4,.1 -ft_ 1/2 Fb6 y/Zz/zC Name of Person Responsible for Construction License No. and Type if Applicable ISS Acft izerii 4 M , le 3 7 S Street Address City/Town L State Zip _`ISZ `t((?i /temf,7.5 Q� .trM'13 .o/7 Telephone No. (business) Telephone No.(cell) /' e-/mailKddress SECTION 11 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the sotrice of the building permit. Is_a signed Affidavit submitted with this application? Yes No 0 _ SECTION 1Z:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor 2.S 3c and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ `Z 1 jS dU Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ go 100. 3.Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contactA municipality) 5.Mechanical (Other) $ Enclose check payable to Gr4 07 /_J 6.Total Cost $ et ! 35' .00 (contact municipality)and write check number here (69 sit SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my kno edge and understanding. Gera e G C e C.t.v-v- .ice t art ,- 161 _9s2 _ ceps Z— �-'y Please print and lsign name Title Telephone No. Date /Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /7/2 7" lq'zoz3 Name Date City of Northampton Cli Massachusetts ��+ << Iti G; DEPARTMENT OF BUILDING INSPECTIONS �, st) a� 212 Main Street • Municipal Building d P Northampton, MA 01060 �S �,�\'‘, 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._ LOC,- }l� �— Location of Facility: -Z 54aki 40-K / 4 wellZ K ei ( - OCoa' Z The debris will be transported by: Name of Hauler: ate`` ` S ! S Signature of Applicant: Date: et" 17—? 3 The Commonwealth of Massachusetts Department of Industrial Accidents s=7 Office of Investigations Lafayette City Center _' - 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name BusinesslOrgani7ation/Individual): Home Depot USA, Inc. Address:2455 Paces Ferry Road City/State/Zip:Atlanta GA 30339 Phone#:1-860-952-4112 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ® I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑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 working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp.insurance. t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 131i OrWindow replacement employees. [No workers' comp.insurance required.] *Any 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: Indemnity Insurance Company of North America Policy#or Self-ins. Lic. #:WLRC50668058 Expiration Date:3/1/2024 Job Site Address: `II i?/ycli O�/�9 41 City/State/Zip: r.CG's All D /051 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 and penalties of perjury that the information provided above is true and correct. Signature: Date: - t 3 Phone#: 860-952-4112 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 31:City/Town Clerk 4.1:Electrical Inspector 5E}lumbing Inspector 6.0Other Contact Person: Phone#: 1iT41: 4-741914• • =Ili T7111V1[ •11• • •[r4MikTiTTI Er4 Mt: .: .I1 TZI . . • 3o Without Grids With Grids Style Glass Package GlazingSpacer IG U Fact SHGC U Fact SHGC , (an with Argon) 6500 >wning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 • • • 0.26 0.21 • • • :asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 1 i I I 0.26 0.22 i ii transom 6500 Base ProSolar Supercept 1' 0.27 0.32 0.27 0.29 )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 0.29 0.24 p 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • • • 'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 0.27 0.26 • • Panel Slider_ 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 • • • ®- I Panel Sliders 6500 Base(s 21 Sgit) Pro Solar Supercept 7/8" 0.29 0.26 0 0.28 0.23 - 0 0 •500 DOORS Barden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 • © e • 0.30 0.21 • • 0 'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 ' 0' 0` 10.31 0.23 lat 0 • • o • 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. \caning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • 0 e o 0.28 0.21 0 coo :asement • 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 I 0 e 0 0 0.27 0.22 6100 Energy Star Pro Solar Supercept 3/4" L• 30 0.30 0 0.30 0.27 Rao a 'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 • • 0.27 0.25 a • • • 'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 0 • 0.27 0.28 0 0 !Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • I 0.30 0.27 0 I Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 0 10.30 0.27 I o • 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. 'atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" I 0.28 0.26 • • 0.28 0.23 0 • • • 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 1 0.28 0.26 0 • 6200 Homes located only in following markets:Dallas,Denver,Detroit Phila,Northern NJ,Long Island,NY. lwning _ 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 11...0 0 1 0 0 l 0.26 0.23 I 0 a 0' 0 :asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 0 0 e 0 0.29 0.17 0 0 0 0 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3i4" 0.25 0.21 • • • 0 0.25 0.19 I 0 0 0 0 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 • • • 0 0.26 0.22 • • • o Tingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • •I • 0 0.28 0.21 0 0 • Tingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0 0 0 0.28 0.21 0 0 0 I Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 0= a 0 0.28 0.21 ' 0 i 0 -tormBreaker Plus 300VL Homes located in coastal areas. 1wning SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 0.23 0 • • • 0.26 0.21 0 • 00 :asement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 • • • • 0.25 0.21 0 0 0 0 )ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • a • • 0.29 0.23 • • • • hider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 • • • • 0.29 0.23 • • • • _ 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 0.30 f 0.19 a as s No Grids AI!owed ;arden Door(CH) SB+300VL Base PS/Lami Super Spacer ' 0.30 0.28 • • 0.30 0.25 • • • • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. WINDOW SPECIFICATION SHEET - Spec.Sheet#: F35695331 Sheet: 1 of 1 Customer: Matthew Kadish Job#:F35695331 Consultant: Ronald Engelbrecht Date: 07/07/2023 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S — .-• , ,. _ -- Glass Misc Items Hardware Code Screens For doors use c c = E Mull "S"=stationary or Wf Style Wraps d S p 0 4 yg4� o W p "X"=operating C Room Floor Code (Y/N) Style Code Series Code s~ _ 5 l— vi a - > > _ STD,White, GlassPack: WRAP 1 OFC 1st OH- Y OH 6100 WH WH 36 38 74 Standard ALDER STD,White, GlassPack: WRAP 2 OFC 1st DH- Y DH 8100 WH WH 36 38 74 Standard ALDER STD,White, GlassPack: WRAP 3 BED 1st OH- Y DH 6100 WH WH 36 38 74 Standard ALDER SPECIAL CONSIDERATIONS: 1:White,2:White,3:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) 'Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No)" Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) A`COROJ CERTIFICATE OF LIABILITY INSURANCE DATE ;,gjDrn Y ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policyltes)must have ADDITIONAL INSURED provisions or be endorsed. M SUBROGATION IS WAIVED.subject to the terms and conditions of the policy.certain policies may requite an endorsement. A statement on this certificate doss not confer rights to the certificate holder in Neu of such endorsemengs). PRODUCER CONTACT MARSH USA NC NINON. N TYRO ALLIANCE CENTER Ile Ws Ca. I LA/C.NIL 3592 LENOX ROAD,SUITE 2400 E-MAIL ADDREISS ATLANTA.GA 30326 CNeUR9NN AFFORDING COVERINGS RAC I 04101642003Hosss0-GAW•22.25 NSURER A:OM RaWNN Insuatie Co 24147 INSURED THE HOME DEPOT.NC. INSURERII:Indents*Ns Co Of North s1me /3575 HOME DEPOT USA.WC. INSURER C:ACE Amon Irglgrte Comers 22667 2455 PACES FERRY ROAD INSURER D: BULLING G20 ATLANTA GA 30339 INSURER E RIMER f. COVERAGES CERTIFICATE NUMBER: ATL 00507T 5-15 REVISION NUMBER: 7 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TRRI TYPE OF NAURANCE POLICY RUMMER MISISKWYTTLI AINNICIPTYTYI UNITS A X COANIERCIALORERALLWLTY MWZY315646 03A1Q022 CSIA1.2025 EACH OCCURRENCE S I. DOD ICLAIMS•MADE EDOOCLR PREMISES lEaoccwTcncat $ 1000,000 X SR51,000.030 MEDEP CAP*AA*;wrsoni I EXCLUDED _ PERSONAL s AO,INJURY S 1.030 000 GENL AGGREGATE LMIT APPLIES PER GENERAL AGGREGATE S 2.033.000 )R POLICY p Z44 Q LOC PRODUCTS-CO POP AGG S 2.300.000 OTHER I A AUTOeOSLE'AmuTY MWTB316649 0313.1,2022 031312425 iVANNED SINGLE 1.16,V 5 1.300.000 r-.. X ANY AUTO BODILY INJURY(Per person S ~OWNED SCaEOULED SD c INSURED AUTO PHY ONG BOLDLY INJURY(Fw aocAser} S � ,HARED ONLYNUTOS NN-OOWNED PROPERTY DAMAGE AUTOS ONLY — AUTOS OP1Y ITrar Mndtea) I , S A UMBRELLA LIAR -...Xd°cap MWZX316647 CO1C?`2022 03,0125 EACH OCCURRENCE I 19,300.000 rX, EXCESS UAB CLAMS-MADE AGGREGATE S 10,000.0C / X1 CEO I_ I RETENTION S B HONKERS COMPENSATION SCFC50668195 1W, 0. 1TYJL '23D1 2024 X I� I 1 G� AND EMPLOYERS'LMBLRY STATUTE 1 ER ... YIN WLRC50F,6615DIMTj 03,0?2St23 03��12024 5.000.000 ANYARDFRETORMNATNER7EXECUTWE EL EACH ACCIDENT S CfPICERAEMEEREXCLUOE07 N1A eWndslory in MN) E L DISEASE-EA EMPLOYEE S 5.000.000 if yat desalt*undo' COORIAd On AalaoiNt Page •E L DISEASE•POLICY LSAT f 5.000.000 DESCRIPTION OF OPERATORS MO* I I 1 I DESCRIPTION OF OPERATIONS I LOCATIONS/YOWLER(ACd1D 1111.AtESNAN Rrnrkt scrte4a,may N Nselltd I mem mum It 10110M1i0 EVICENC E Or NSUARANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,NC SHOULD ANY OF ME ABOVE DESCRBED POLICIES BE CANCELLED WORE 245E PACES PERRY ROAD BUILDING C-20 THE EXPRATION DATE THEREOF. NOTICE TALL RE DELIVERED IN ATLANTA GA 313339 ACCORDANCE 1NUTH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE i 71t'd ZZS111 ''KC. C 106E-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2015103) The ACORD name and logo are registered marts of ACORD AdENCY CuSTOMER t: CN1Of842O69 8 ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of s AGENCY OWED INSURED THE HOME*POT.PC HOME DEPOT USA,PrIC f �NVM&ER 2455 RAMS FERRY READ E.ALDING C?4 A,.ANTA GA X039 .CAARIEF NAICCODE EFFECTIVE DATE, ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER 25 FORM TITLE: Certificate of Lab;ity Insurance Oixterl Cc rpr tci;A7SiiM. Caller Safety Hama Camay Corzaafut P csNmber.LDSa 8.119,AtARAZTL,[1,IAIKS,KYLAMSAl0,NC,NE.NM,S0OKSC,SO.TIS A.SYMYI Efkor a Oat,3141023 Ecpratun Our 03612024 EL Lore SSDX:) Carver Siker Names Cesaty Comma xta Policy Marbly SM613090iOS0 ICAOR,`k 0 Bootie Oak.0341023 Eepeakn Oak.3L0112324 (ELItare S5,3X.400 SIR SIEa ate} Carver ACE Arorsoon rsia-oe Canpa g Pied Nub.'W3.rf,5,:4e8'035 t0511 i0A1,41 N'l.Otl.tri EffectreO.ak 3oiatYs Dotaton Oak.03331,2024 kW tore SU,030.00 SIR I1.030.00 SIR IGA11753040 Caner IA6eenty I soran:e Conyaey of NMh Mbr= Sin/late'NLRC5061i8058+';Mt.CO,CTDCDEHI:h.%MMD ME.kOs/gh N.biX«A RI T; _leitHe Ore.0301023 Eeyratan De*0141024 EL!Litt S5(0.330 `.K Erlpkyers kS tdanuRr. Cama2ures Amster ktauratQ Catgety aicy Nwd,v.MS01383190)1I Etlecfw tkae.0341023 Erog alanDue 4Y412I2t !EL!Look$6 OX IEf SIR S5080,008 ACORD 101 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered merits of ACORD AcoRL CERTIFICATE OF LIABILITY INSURANCE DATE INANDa'YYYYi 1/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFI 9tATIVELY 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 REPRESENTATNE 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 endorseanent(s). PROOuCEA COACT Deborah Marino yy Canary ebmstrom Insurance Agency tA.C.,`,Ero Earl.(413)750A022 i AC.Not(413)786-7004 868 Springfield Street Feeding Hills,MA 01030 iD ,dmarino@eanaryblomstrom.eom Nsu ERISI AFFORDING COVERAGE RAIL r INSURER A.NGM Insurance Co. 14788 INSURED INSURETI s_Arbela Protection Insurance Company 41360 Exterior Remodeling Group Inc. INSURER C.AIM Mutual insurance Co. 23 Benham St NSVREAD Springfield,MA 01109 ' 'meter . Murat*, 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 `ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSLaRANCE 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. NLTR TYPE Or INSURANCE POLICY RUMOR OSIND YDfYYYY1 11h POLICY �s A X COMMERCIAL GENERAL LNd1TY 1 1,000.000 EACH OCCURRENCE I f;t.n1M.,-►A0L El';cUN MPP33?OW 7127/2022 71.27/2023 DAMAGE 70 RENT[amunrrrf ED 500.000 P'REAIISF�IEl s S MEG LxP:14-y W.1101401 I 10,000 PER NNAL s Air:IN,A N. _ 1.000.000 • 1 Aq TE pp'�U1r APPLIES PER GENERAL AC,.REC.b1I I 2,000,000 P rICY' JFCT l`vf,. PRODUCTS-COWVP ACG I 2,000,000 X CtTMEk ClaMdsFtU WNGIE_IMi l I 1,000,000 B •IJTOYGItlt[Lart1TY 'Fame/6mM r ANY AUTO 1020110392 6f 1772022 8:17f2023 NOUILY PUUHY SPer"e.v,-r;, I OWED SCHEDULED ALTOS1pp OW, X MAUUTT}OSSµwEp EOM Y INJURY IP*.au:d roil I x A1.T05 CtdV x AUTGB OHI.`i I eDar o0riti tR1Ai;F I I UMBRELIA LIMO OCCUR EACH CCCURRENCE i -r EXCESS 1.1AB G:AIMSJI1AD1 AUGREGATI I DEC l I RETENTIONS I C WORKERS COMPENSATION P R Wt M h- ANO EMPLOYERS'LULITY X 1 S�ATUIP 1 1 YN4 ANY FwOPTT+EI1Eg' p.PART�ERExEcuTTue WCC-500-50 2844 3-20 2 3A 1,25/2023 1725t2024 f L FACH JyCC10EVT I SOD,000 LICo iY 1 NHF EXCLUDED, Y R.A500,000 " Ex.DISEASE-EA EMPLOYEE I f.[:aesc•1x under . „1, -..MNI1)11'I Cr'FRAnr i n-Ya.. , LLDISEASE.-PCAICYUMII I 300.000 1 i I OESC7IFIIDN OF OPERATIONS'LOCATIONS'VETICLES ACORD III.bra o.W RrwrM Sclvouie 'n be staKMO K more l ance a .equMca', Home Depot U.S.A.Inc.is named as Additional Insur.d with respects to General Lrahilty. Eugeniu Ciuhotaru is secluded from the Workers'Compensation Policy. CERTIFICATE HOLDER CANCELLATIQL, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN Home Depot U.S.A.Inc ACCORDANCE WITH THE POLICY PROVISIONS. 2455 Paces Ferry Rd C-11 Atlanta,GA 30339 AUTHORIZED REPR£SENTATNE ACORD 25(2016/03) rD 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t tm C}may 1VODw or a+a Eiretainte Ohm o<4C44£0,the 0111e1ee or PTAIKAK iai t ratasni z d irs:bnone.ar 5tardarts Public Safety A . . � .,. I 0 Mass. Licensee Details Demographic information 'pti1 Name EUGENIU CIUBOTARU wner Name. License Address information Ptye Sonngfield { StatMA Zpcode 01109 Country United States License Information t.icense No CSSI-t06106 License Ta pe Construction Supervisor Spec art, profession Bufdtng Licenses Date of Last Rene A ai 10113:2022 tissue Date 4 12,20017 Expiration Date 5,29,2024 jeicense Status Active Today's Date 10,i4.2022 {Secondary,Lcense Type rig Business ns Status Change Reason License Renev.a Prerequisite Information Licensee. GIUBOTARU,EUGENIU Relationship Attribute Of License No CSSL-106106 • 1 No A,alatve D :„mints I. Commonwealth of Massachusetts ® Division of Occupational Licensure Board of Building Regulations and Standards C©nstructgl5iupe>r� r Specialty CSSL-106106 ' ',NM,. E spires: 09/29/2024 4. EUGENIU CIVBOT. ; ,+ i 23 BENHAM STRE-'.' 4 MI1' SPRINGFIELet,M i I " fApt r � II � y'xt , ;✓ .fir`s . tr Ccw.w.iwwicr.zr ;9n // lam ! JI�.� V VIIIIII/JJIV I K.I t�I /1• Vti'il V-..Z�-,. r Construction Supervisor Specialty Restricted to: CSSL-WS -Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov'dpi Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 ration: Expiration: 04I2212023 P O BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. Chita or Consumer Mehra•liminess Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:SJDpiernent Caro before the expiration dab. If found return to: R Office of Consumer Affairs and Business Regulation 112755 0412212023 1000 Washington Street -Suits 710 •iOAAE DEPOT USA INC Boston,MA 02110 RICHARD AD 2455 DACE FERRY ERRY D C•11 HSC ATLANTA.GA 30339 , fJt V&$tt w1tt0U signature Undersea® • Office of Co Affairs and Business Regulation HIC Registration Complaints Registration# 112785 Registrant HOME DEPOT USA INC Name Courtney Howe Address 2455 PACES FERRY RD C-11 HSC City. State Zip ATLANTA. GA 30339 Expiration Date 04122112025 Complaints Details No complaints found for this registrant. Ott+oe, Consumer Affairs and Business Regulation 1000 Was►tngton Street•Stole 710 Boston.Massachusetts 02118 • improvement Contractor Registration '1M Office of Consumer SPBENHAM V i R � r S 7666 svm tsa.wt ut< , Affairs and Business �... �tt Aeu....�at„nt,c.•a. mooTAMON M$ $a s Cl r1GME ial COMT4Aob 1 Regulationrop.v,ewr,.wa+a e�.,1 nuwi r..e.,,r T* .+.7 Ural., ▪ lM•,AWA A6:+.n r'vu,.e,r.,q.: (OCABR) th.111�g1,t Wotan • lVCunwnr.nl„1AM 130.11¢ny1 gvyut.t,nA yea 45V?3;41 •xo aWitIgtav VTR, Sun.710 1xttPtCSC r ettwC A04...IV: 1 11,090 MA U2,'1 HIC Registration Complaints 3.5,43,15I".WT ' ` $�rtK'nit L�WA Qi,7{ NM valid v moot sipnrlUty Registration# 187666 Registrant EXTERIOR REMODELING GROUP.INC Name EUGENIU CIUBOTARU Address 23 BENHAM ST City,State Zip SPRINGFIELD MA 01109 �/ Expiration Date 05/09/2025 I C//��_n lu C ctg,O .. authori Cio rermtts LLC to puii permits using my Complaints Details l,J License R I[ E 1 6 ana my No complaints found for this registrant HIC Registration# $ 6 6( • A~. ....�stions please I me at: (Li/ 3) 3 3 S 3?o a 1nJtaiier NIL' _. t,ompany 'yaw.. Ey fR.Rto_k_ Reme1 1______.G.R out> A