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31A-087 (10)
BP-2023-1251 18 VERNON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-087-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1251 PERMISSION IS HEREBY GRANTED TO: Project# windows 2023 Contractor: License: Est. Cost: 2409 HOME DEPOT USA INC 106106 Const.Class: Exp.Date: 09/29/2024 BARBER ROBERT E& CAROL J EDELSTEIN Use Group: Owner: TRUSTEES Lot Size (sq.ft.) BARBER ROBERT E&CAROL J EDELSTEIN Zoning: URB Applicant: TRUSTEES Applicant Address Phone: Insurance: 16 VERNON ST NORTHAMPTON, MA 01060 ISSUED ON: 09/12/2023 TO PERFORM THE FOLLOWING WORK: 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: 31,1T ivy0 • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner .� Fs @ ya �C, s ,Qo IGau r °`" ��y 1, The Commonwealth of Sep 1 OR Board of Building Regulations Stand ards ' ` i, Massachusetts State Building ode, / f) IPALITY N 0 USE Building Permit Application To Construct,Repair, lish a R ised Mar 2011 One-or Two-Family Dwelling 7( ^"<sp,, This Section For Official Use Only °,oso°Ns Building Permit Number: 6/1- .1 3 /2,1 J Date Applied: 1t u �S5 %/// 9-12•2 .3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /1 Y sire cf I.la Is this an accepted street?yes if. ....-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) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone_ — Outside FlOOd ? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Owneri of Rec rd: �RD)twf &6bGr 9SDAilt Ai ," rn /Vl/7 6,lad 0 Name(Print) City,State,ZIP / Tb ✓I/Am Sire el 4//3. GQs, s3Y3 toted at.bAr i;-Powad. , No. and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify:!/1�Id t�dMln f Wi l t4S Brief Description of Proposed Work: /'Gaowc Aeto /Cy14<< ✓i` 04eS /rkt 6e /,'ke os"WI /la StA.M,— (i`, ,/s.a0 - (A e.- S , sz. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2 yo 9, ire I. 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-$ Suppression) 71 Check NO1 3 y 1heck Amount: O Cash Amount:_ 6.Total Project Cost: $ 2 7 0 9.,p 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) AO G Z Z y � � ti.. Cj.,�hyf4/K License Number Expiration to Name iSf CSL Holder List CSL Type(see below) S Z ii ( *1 $ # No.and Stree Type Description ty�^ I 6(J PI/� ©'I o U Rest is a ted(Buildings up to 35,000 cu.ft.) ►��n/,' I R Restricted 1&2 Family Dwelling Ci o Sta ZIP M Masonry RC Roofing Covering ® Window and Siding SF Solid Fuel Appliances ances G60 451-`/2 * t€iAapit/ .iS.o' Insulation Telephone D Demolition 5.2 Registered Home Improvement Contractor(HIC) /12 �-SS y t z f t S �� qo/ �S HIC Registration Number Expirdion Date HIAComply NAm or HIC R strant Naive /� Y$3 /'nee rj/� /[oa er etrwi' C�5odterr.}1'e d e3 No. ,i4 64 mail address ,, �33� gbo -4.�Z-rlrr2- 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 f 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 this application is true and .• Zi to the best of my knowledge and understanding. i ------�� tee',// C• O 4ir 7,t -: s ( ,-h.,y) Print Owner's or Authorized Agent's Name(E ec •I, Sig : C- 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" City of Northampton vr Massachusetts DEPAICWNT OF BUILDING INSYLCTIONS 212 Main Street • Municipal Building ti � -ret Northampton, MA 01060 t,t ,,�\�� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJEC N 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: ,4,144- Pee..f (4s'9 13.t c" Location of Facility: .9"2- 6'4.Cj t 'r 2 Cic t 'I CT 6 408 2— The debris will be transported by: Name of Hauler: E 'brut C 1 4 tobi,w Signature of Applicant: lib 4. Date: ?' The Commonwealth of Massachusetts Department of Industrial Accidents 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(Business/Organimtion/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): 1.0 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 -contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' q El 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 11.0 Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12.0 Roof repairs insurance required.] + c. 152. §1(4).and we have no 13.11MOtherWindow replacement employees. [No workers' comp. insurance required.] *Arne 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 thaw entities have employ_ If the sub-contractors have employees,ees,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 Nang:Indemnity Insurance Company of North America Policy#or Self-ins.Lie.#:WLRC50668058,r,, Expiration Date:3/1/2024 Job Site Address: a Ve. '4o-7 S✓/ec, City/State/Zip: ,44 i tg, /IA O meo 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:9t Date: Z' Phone#: 860-952-4112 Official use only. Do not write in this area,to be completed by city or town c ficial. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 2❑Building Department 31:1Cits'/Town Clerk a.❑Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: e " ome repot - ermal Value of Products Manufactured by Simonton Dated: 5/30120/8 ,er9Y.sr s""0-{3oada- �r25125 Without Grids With Grids Style Glass Package Glazing Spacer IG U SHGC U SHGC N I S 1 S ( ++ Argon) Fact Fact i C C 6500 >wning 6500 Base ProSolar Supercept 7/8" 026 023 , • • • 026 0.21 • • •� :asement 6500 Base ProSolar Supercept 718" 026 024 • • • • 026 022 • • • • rransom 6500 Base ProSolar Supercept 1' 0.27 0.32 • • 0.27 0.29 • • )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 026 • 029 024 • 0 • 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 026 0.28 • • 026 025 • •1 0 • 'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 027 0.26 • • ?Pane!Seder 6500 Base ProSolar Supercept 718" 0.29 0.26 • 029 023 • • a 3 Panel Sliders 6500 Base(s 21 Sqm) Pro Solar Supercept 7/8" 0.29 0.26 • 028 023 • • • •500 DOORS 3arden Door(CH) 6500 Ene Star ProSolar SUN Super Sper 1" 0.30 0.24 • •• • • 0.30 0.21 • • • • 'atio Door!NOVO 6500 Base Pro Solar Super Spacer 1" 10.28 0.26 I•I •' ' 1 0.31 0.23 ,• •'• • •1 0 0 ' , located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico.Oregon,Utah,and Washington. kwning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.28 0.21 • • • • .asement • 6100 Base Pro Solar Intercept 7/8" 027 0.24 • • • • 027 0.22 • • • • •u:^-1 • 6100 Energy Star Pro Solar Supercept 314 0.! 0.30 • 0.30 0.27 • • • Casement(No Ifimge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 • • 027 025 • • • • 'icture 6100 Base Pro Solar Intercept 3/4" 027 0.31 • • 0.27 0.28 • • >Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • 0.30 0.27 • 3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 • 0.30 0.27 • 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" 028 026 • •I 0.28 0.23 • a o 1 a 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 028 0.26 • • 6200 - - located only in following markets:Daaas,Denver,Detroit,Phika,Northern NJ,tong!Markt NY. >wning - 6200 Base Pro Solar SHADE Supercept 3/4" 027 025 • m 1 9 • 0.26 023 • • • • :asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • 0 • 029 0.17 • • • • 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 025 021 • • • • 025 0.19 • • • • 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 026 0.24 • • • • 0.26 0.22 • • • • Single Hung 6200 Base Pro Solar SHADE Supercept 3/4" 028 023 • • • • 028 0.21 • 0 Q Single Slider 6200 Base Pro Solar SHADE Supercept 3/4" 028 0.23 •E• • 028 021 • • • 3 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 •1•e• 0.28 0.21 _• • • -tormBreaker Plus 300VL . --located in coastal areas. >wning SB+300VL Energy Star PS SUN/Lami Supercept 1" 026 023 • • • • 0.26 0.21 • • • • :asement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 m• • • • 025 021 • • • • )ouble Hung SB+300VL Base PS/Lami Super Spacer 1' 0.29 025 • • • • 0.29 023 • • • • Slider SB+300VL Base PS/Lami Intercept 1" 029 025 • • • • 0.29 0.23 • • • • 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 • • • a •,_ J. 3arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1' 0.30 0.28 • • 0.30 0.25 CI el ID • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&Wes- rdcws given the requirements of each order WINDOW SPECIFICATION SHEET - Spec.Sheet#: F37134648 Sheet: 1 of 1 Customer: Robert Barber Job#: F37134648 Consultant: Chad Minton Date: 09/02/2023 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening 8 of bars #of bars Csmnts,f Pnl, use L,RorS Glass Misc Items Hardware Code Screens For doors use T Mull a 4 L £ LL S"=stationary or Style Wraps y- m j z �a C p p p X"=operating Room Floor _ Code (Y/N) Style Code Series Code = 5 r m t g° �3 > = 2JS j = STD,White, GlassPack: WRAP,LSR 1 LIV 2nd DH- Y OH 6100 WH WH 38 56 94 F, WH,W C TOP 2 1 Standard ALDER GBG H STD,White, GlassPack: WRAP,LSR 2 DINE 1st DH Y DH 6100 WH WH 38 58 94 F, WH,W C TOP 2 1 Standard ALDER GBG H a- r . " SPECIAL CONSIDERATIONS: 1:White,2: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) ACCORD,' CERTIFICATE OF LIABILITY INSURANCE DATE " ,'° r` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORISATION 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: N the certificate holder is as ADDITIONAL INSURED,to poic lies)aeuet RPM ADOTTIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED,subject to the lawns end conditions of the policy.Certain policies may requite an endorsement A stMementt on this certificate does not co.Msr nights to the certificate holder in Wu of such endorsemengs). PRODUCER CCINTACT MARSH USA NC NAME: • r O ALUANCE CENTER Mn011W a.. I rfiAlc are 3560 LENOX ROAD.SUITE 2400 ATLANTA.GA 30326 NNIN6NM AFFORlae COMEIMDE NAC* CN1016/29394lL -GAW•22-25 INSURE!A:Oa Recibic I Canoe CO 24147 SOURED HD MOUE DEPOT,INC. NSINER•:IMsAMv Ira Co Of W M AIIAanta 43575 HOME DEPOT USA.INC. NSISEl1 C:ACE Maim Imam Comm 22E7 2455 PACES FERRY ROAD BLINDING C-20 RlBI�1 D ATLANTA.GA 30339 SI*UER E. NI NENf COVERAGES CERTIFICATE HUMMER: ATL.00537222S-15 REVISION NUMBER:7 THIS IS TO CERTIFY THAT THE POLES OF INSURANCE LISTED BELOW HAW BEEN ISSUED TO THE INSURED NAILED ABOVE FOR 7HE 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. F Yr.wSlONS AND COeiDRIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID Ng TIPS OFllaq#AIIPE TMS POUCYwUI HER PYY► I 7f..-. LENn A X COSwlesClALo91EnALuemjry MilRY3166M 03BiI I22 03141Y2IQS EACH OCCURRENCE I 1.000D00 ICIA MS t ADE X❑OOCUR MIMES Ma a wgani i 1000.000 X Mt S1,00E1 021 PEED E70'NAY oaA Dimon] 5 EXCLUDED PERBONALiA .1IMAIRY $ 1.002000 GENL AGGREGATE MIT APRJEB PER GEeERA1 AGGREGATE I 2.0004C0 X1 P�OIICr Q Q ICI C PRODUCTS- OP MSG I 2.020,600 "'"�i OTHER II A eanafe0aEELAaCRY MWT8316649 0(3.S'I2022 (+u arm giaffanE0 SNOLELIWT I IlE0000 X ANY AUTO BODILY PUURY CNN pintoI $ owNED BCIEOWED SELF INSURED AUTO PH'/ONG BODILY MASSY pp sec Ili I HIRED ONLY AUTO PROPERTY DAMAGE ALTOS ONLY AUTOS OMLT Igor I $ A UeOEUALIAO (x occ MVVIX316641 0341:7022 01+D1.�i5 EAcmocCU ENCE $ ILIEC0O X EXCESS OASj)(�JJ QIgrBJMOEr AGGREGATE 1 mum0 1 CED L I RETFaa11ONI ,t B WDENENScOe.MENIA110w SCFC5066I196i1A) o3Q1 3 03+01,2324 X IRa"1 I 1SH- C YIN tA1 15D IM1} 03112073 001012024 EL EACH ACCIDENT $ , OFFICERAENBEREXCLUDED'?ANYPROPROETCRIPARTNERtEXECUTIVE Q NIA S. OQO UrneOeleMer r ION EL DISEASE-EA EMPLOYEE t 5.004.000 IT yyaarr.MI.4u..nFbr DESCRP'T.ON OF OPERATIONS beet. CooVesd Ott AedYt Pile! E L DISEASE-POLICY LIAR I 5.000.000 e III 1 I I OE.CRMn0N Of OPERATIONS 11OCATIONSI YBICLES WORD TOL AeYrew CwtkM eeOMeR ass be 41155100111 SWIM awe is•IMIMA EVIDENCE OF hSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL!.®BEFORE 2455 PAGES FENtY ROAD BUILDING C-20 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELMERED N ATLANT&GA 30339 ACCORDANCE WITH TIE POLICY PRON$IONS_ AUTNOnSIED NEPREEMTATNS I Wet/Via te.511 9.ec. Q 1/Si-201i ACORD CORPORATION_ Al rights reserved_ ACORD 25(201003) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: C N 101642069 LOC it: Atlanta Aco D ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED NNIUNED AV RS.,USA!NC THE HOME CEPOT,MdCC HOME DEPOT USA,NC POLICY WOOER 2455 PACES FERRY R0,4.O BULDING C 20 ATLA NTA GA 30339 CARRIER MMC CODE EFFECTIVE DATE ADDITIONAL REMARKS TINS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE. Conticid0 01[Abaft Insurance Weems Converse=Garment Cesar Sde1y Puricra Gamely Cacoraer Paler Weer LOSA558289OLAR.AZFL.O,IAk KS.KY1AMEMO.NC.NEWJ13OKSC.SO,TNVA,nfV.WY) Moue O. 03p12023 Espraton Diew 01.012124 Elf trra S5003.000 Canter Sekxy Igaaa Caesar Comore= oerp Weer SP403879G'OSII ICAOR'WAi Efkmre Dame.031012 23 EeprLon 0Th 001,2c24 (EL)lark I50X.Z0 SIR SI.00G.300 Came ACE Amens=rare=Cannery Parr Nionter WC'JC508613095�OS11idA1AtN'VO41.UTi Mate Dne 334n2C23 Eapralm Oae 01,212021 ialLi?t$4.000000 SIR 51.O1Q000 SIR'G 11754000 Can Iridoeort Hawranca Convey d flaert Macs Penh arEer NLRC50E68J58r4ACO.CTDCOEAi.A.MA PAD mEM'1MtlltNfi 'n Elbows pee-334012023 Eapre=Csle 133'2C24 iEll Lam SSO.X.X0 TX EnpbyasAS 1dmvrtr CanerZu'rn Amecan rounret Camaro Pdcf Nunrmr IVS.1138319 Effaram Oak D301:2e23 Eerie n One:03a012G24 ELi Leak S4090000 SIR I5.000;200 ACORD 101(20001101) C 2000 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff "ehd Business Regulation 1000 Washing4gilr>> t-Suite 710 Bost° Massacbiwetts-T 118 Home I ,*,, _ ,,.�_ -..,•istration sermw lry .,.::.. j0� : �--- .Type Corporation t DEPOT USA INC --- ---.IN ;* =_ _ .46. '; : „2785 P O BOX.05451 +`. '. G4t22/2025 ":. ATTN: LICENSE MGMT TEAM : ,,,... AT ATLANTA,GA 30348 T^ •IT �^ }r ltit>� F lllll� N Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS OMca of Cortese+.ARM,&Maimed'Rme&Mlon M s strop send Sot MdWlduat es*only before Ms HOME IMPROVEMENT CONTRACTOR ampM+ttan dam. M found return to TYPE:Cdlp&_ Oloe of Consumer ANahs and 8usinuc Regulatwn ga "a. Uaf MOWasMnyton Street.Suite 110 1127186"-,..i)-0 tiesIa, MA Mil HUMI 1)f POI USA Ifid; 4 r COURiNkyA HOWL:;,' �_,,��,,��((CCC 2455 PACES FERRY RtM ti1�G.' r1,4,.....e4(/a.ewrA. ATtANTA.GA 3COM -` t" Undersecretary M ei valid without signature A . )Rai) CERTIFICATE OF LIABLITY INSURANCE DATE 1 31YYYYV1 `.r' 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 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 INSURERIS).AUTHORIZED REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 ems). mowers =ACT Deborah Marino Canary Bbmstrom Insurance Agency °O no ERy (413)750.9022 1 rc,1601(413)786-7004 e8e Springfield Street Feeding Mils,MA 01030 Ms&dtnanngecanarybIons trom.corn em$e0tERA1 Af f 0110PIG COvt AAGt %M,I *SORER A.MGM Insurance Co. 14788 INSURED jteaclEvta Arbella P►o*eoliyn Inegradncc Company 41360 Exterior Remodeling Group Inc. drSUREA c AIM Mutual Insurance Co. 23 Benham St f455IMID, Springfield,MA 01109 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. NOTW!TIETANt1NG ANY REOUBREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ROWED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS FYrt USIONS AND CONDITIONS OF SUCH POLICES.LISTS SHOO,/MAY HAVE BEEN REDUCED BY PAID CLAIMS. Iiapsi TYPE OF I IMMAN E SIND ova P000Y riouese emenarrryy, RIMMOIETTYi UNICS A X corrE«CSA1 GENERAL mewl, 1,000,000 EACH t1GL'URRhCE _: I CLNLISAMDE Q OCCUR MPP3378W 7127/2022 7C27/20123 A1n Es MENTED I m 500,000', " - MEC EXP:Ary u+0.won t I 10,000 �. PERSON0L A ALP,04,61r I 1`00D.000 GEN)A:7CRECATE Laming PER GENEn,t.Ac.r~REi.ATE t 2,000,000 rt n IC,❑78 1.00 2,000,000 f'FIOOtULTS-GCTY4'yP M_� $ X OTHER I B AUTOMOKEtJAdatSn 31 OtsurttttrAti f 1,000,000 ANY AUTO 1020110302 WW17/2022 8/1712023 notoT JNJItY Am vt nix•I I ^_ALTOS DC P.V X AAUUTTOS ED BOOST INJURY(Pot a 'uw l I MAGE X "'i 9 C.M.v X Tin t4Y i>'�:a YloyERTY� t . UMBRELLA LIMB :.4.i:UP EACH CCCURRESCE I ~— EXCESS LAB ;...AAr1u15JAa.'_D A'U.S:eL:iATL MD E 1 RE rENTION S f C esOieran C0 MPtirsomN p�X I iA I 1 P�,t rTi"- Ar10 EMPLOYERS'LIMOUTY S ATUTE IN,'t°RDPWE-rIA PART' REtE�'11T1'�E WCC•600-�5020443-2023A I(75.2023 1125/2024 EL_FAC►+rtcciOEVT ,f 500,000 �E:ERtR) EACLUE.ED NtA `n^"' EA-DISEASE-EA EMPLOYEE,5 O.00D CmotC$CH c u�c4 500,000 P[IUN3F OF'L tGhs Ey.DISEASE-Et!iY LUd1 _1 �y --_ _- _ -- DESCMPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD/Ot.AdeEo sI Re'°arLs Sct*dWM may be akgexo0 M mon sport N requWd! Home Depot U.S.A Inc.is named as Additional Insured with respects to General Liability. Eugenie CNbotaru is excluded from the Workers'Compensation Policy. CERTIFICATE HOLDER CANCELLATION SHOUl D ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE DepotHome S. .Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN 2465 PeeFU. Oil ACCORDANCE MATH THE POLICY PROVISIONS, s Atlanta,GA 30339 AUTHORIZED REPRESENTATIVE I...,.._ ...,.....,_............�._.....M....„... .......... ACORD 25(2016/03) 01688-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TI?s zY J+N F';OcultMah Othett at c+»44,a o;Ma.st..y W r<4- to^ead t lover,frrt sn9 aC ,Notott 4 tiT.°t uFx Public Safety : ILA Mass. Licensee Details utslitIZaffie" EtiGENIU CIUBOT RU Mama: License Address Inimandent tate pcode ©i 09 Country LIftled states L ioense Information it dense No C9S1-'06106 I cense Type Construction Supervisor Specrattt, rotessron Butaa10q Licenses Date of Last Renewal 10 13,2022 sue mate 4/12 2017 E'ps'alron Date 9.29t2024 License Status' Active Today's Date 10/14/2022 Seconder} License Type Doing Business As Status Change Reason License Renewal Prerequisite Information .Licensee C UBC!A.RU,EUUGENIU Reratxonsnrp Attr'tute Of License No CSSL-106106 o jIaDIe menis I Clout r ,ts, (_ Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Constructi 'f per Specialty CSSL-106106 ye { E cwpires: 09/29/2024 EUGENIU Cl BOT 23 BENHAM .$ i SPRINGFIELt,M i mwiwe n t% v-r.l voesil•r»\OSOlive 04644.4 It. v),477tA.�N. Construction Supervisor Specialty 1 Restricted to: C SSL 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 f6171 727-3200 or visit www.mass.govldpi Office of Consumer Affairs and Business Rrgulat on 1000 Washington Street S4 to 710 Boston,Massachusetts 02118 Horne Improvement Contractor Regtstratuxr 'VW Cccrdv: tOR 7406 office of Consumer SPtt~i � P a� ., _.. a,3 FA:F4F40.vUt Ct+ Affairs and Business _ �°�'�`�"u' Mootl G9ANar Af499{am...WN9m. 1400.1 Row.moo.9w InoWEEkNO we.ant, Regulation (OCABR rmt um e.rarsaww+w�+a OWN r•v„a.r�..na ✓ tt. 00 r� a M awe Cdw•uowr 4w9 9 Ouwww74 9I :6�' 8:.:'A !pp wawnpre,30.41 OWN 714 tx*ta4C . ▪i_f ac,3a0.NC O9loew,Nw. 07114 HIC Registration Complaints EECitA Registration# 187666 Registrant EXTERIOR REMODELING GROUP.INC Name EUGENIU CIUBOTARU Address 23 BENHAM ST City.State Zip SPRINGFIELD MA 01109 N • Expiration Date 05/09/2025 l e( ' iU 0466, audio rermns LLc w pwi permits using my Complaints Details Cb License s /06 D 6 ana my No complaints found for this registrant ` I'ilC Regtstt'$tton# I u6 6 • ~ (zcstions please call me at: t L(I 3) 3 3 S 3?O9 1nst41tef company ivaw. 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