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41-042 (4) BP-2023-1403 63 NORTH LOUDVILLE COMMONWEALTH OF MASSACHUSETTS RD Map:Block:Lot: CITY OF NORTHAMPTON 41-042-001 Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1403 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2023 Contractor: License: Est.Cost: 6390 HOME DEPOT USA INC 106106 Const.Class: Exp.Date: 09/29/2024 Use Group: Owner: BATES TAMRA L&JEAN M PETTY Lot Size (sq.ft.) Zoning: RR/WP Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-41 12 WLRC50668058 ATLANTA, GA 30339 ISSUED ON: 10/10/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT DOOR 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: TAIT 4 • • >2 • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner WIWI re'', ,, 4 (WM�G.te ®k4 -e0t `J lot" 'Y' @ 91> i£t . • 0(5 The Commonwealth of Massachusetts i'<\ Board of Building Regulations and Stand, ds 0 4�� FOR we Massachusetts State Building Code, 78 0 CM' NICIPALITY n del �. USE Building Permit Application To Construct, Repair, Rer vaf®,,` Demol�lla '• 1 ,ar 2011 One-or Two-Family Dwelling ',.' °„ �/� This Section For Official Use Only ;,,,),,,. 't" Building Permit Number: 60—)j -/yQ 3 Date Applied: 7,,,c, 'K/,, y 1/),n Ti A J/� V iv—) (-Z5 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers L 3 A)a, 1.owc I4-r1(s Ram o! 1.la Is this an accepted street?yes ✓no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public 0 Private 0 Check if yes!: Municipal❑ On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 'P.eitarot JO ilk 6.3 F ,,Cd tce '4 A di o6 L Namej (Print) �/ /�j �( ,/ City,State,t ZIP //��/ 4. ,vO/�+ GOM�✓I�1 e. / d '43-Sez- / S/ 'fpM1rr4,�tAG.,"a:I •[OM'. No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other L�Specify:fee(GCciNeok,f l..IAdalt!' Brief Description of Proposed Work2: Rtot#A4, a.v► ✓ ,pr<tu I c,.fry ello t /i t i 40 SVA,a44$,A.l li gct, o(, 3o SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 03 5b,o0 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No4692Check Amount: qO Cash Amount: 6. Total Project Cost: $ t.6 3 9�,civ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 EGG /d 4 9 a y o j� C.iu 4'(p•`. License Number Expi ation I ate Nameof CSL Holder 2_ 3 be RRM Cf. CSL Type(see below) %#"S No.and Street Type Description ,1 t‘e a a l 0/(0 9 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling C i tyillown,State,ZIP M Masonry RC Roofing Covering — CIV Window and Siding / SF Solid Fuel Burning Appliances y/3'33 -- S904 if(/�dv /J 00/ef,«. 1,p0 I Insulation Telephone Email address D Demolition 5.2di'stered Home Improvement Contractor(HIC) L ,,czJ /(2 7 0 .1 2L r-5 +1 `�,1 HIC Registration Number E iratio Date HIpany all:or HIC Registrant Name VY� tom$ 'WI /�d et.7 O�/.n;�s. ♦9 l a No.and Street ilfddress ntt-A 6/1 S o i31' 86c-CSL—y/t 2 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 Cr'... 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 accurate to the best .f my kn. edge and understanding. 6 e/4 e1 C. C4t1r ,.9`d1 ►�ii �, li -.c-e. 3 Print Owners or Authorized Agents Name(Electronic Sig :WI- ' Date NOTES: I. 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 al^M; s i ." p4\ Massachusetts �`��5. '. cf`A. . 0 2 . DEPARTMENT OF BUILDING INSPECTIONS y 4 \A► 1,"r "' 212 Main Street • Municipal Building Jti. �a \N ,. 4r' Northampton, MA 01060 �sfr, 0•',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: Location of Facility: ' ghell'"' (04°" ei•I 'f c ��et1 4r.06af- The debris will be transported by: Name of Hauler: G Ak" ‘1,.44<4/' 6f•ty Signature of Applicant: Date: to -S' t 3 The Commonwealth of Massachusetts Department of Industrial Accidents j 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/Organization/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 -I. © 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. El Building addition [No workers' comp.insurance comp.insurance.: 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 13.0 OtiyerWindow 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. tContractors 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: 6 g ,"D 1 tOstcly fie,7�G 9c c'/ City/State/Zip: /,d ie t ce /411 O/0 6 Z- 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 fme 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 fme 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: 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 3.0City/Town Clerk 4.0 Electrical Inspector 5Dlumbing Inspector 6.0Other Contact Person: Phone#: Go Permits, LLC 105 Buttonball Lane 430_ Glastonbury, CT 06033 PERRM1TS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Massachusetts Solid Waste Affidavit Good day, Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 Gallant Moving & Storage • 375 Airport Drive Worcester, MA 01602 Euro-American Worldwide Logistics • 12 Linscott Road Woburn, MA 01801 Silvas Transport Inc • 50 Maria Ave Johnston, RI 02919 Vito's Express Thank you, Go Permits SPEC CUSTOMER NAME Bates MANCHLOCATION New England West DOOR 0, 1 SHEETI 411111 `�- ORDER paoNENUNBER 4135221631 EIEPIDLOCA710N Enfield r FORM or • ADDRESS 63 N.Loudville Rd.Florence Ma 01062 SALES REP Ron E JOB NUMBER 11252255 13111 1 CONFIGURE THE DOOR Viewed From Exterior,Select Configuration&Appropriate Dimensions I II I11111 1111 1111 SINGLE DOOR SINGLE DOOR SINGLE DOOR SINGLE DOOR W/ SINGLE DOOR SINGLE DOOR DOUBLE DOOR SINGLE DOOR W/LEFT SIDELITE W/RIGNTSIDELITE W/2 SIDELITES RECTANGLE TRANSOM 2SIOELITESd SIOELITES6 DOUBLE DOOR W/2 SIDEUTES ELIPSE TRANSOM RECTANGLE TRANSOM ❑SELECT ❑SELECT 0 SELECT Z SELECT 0 SELECT ❑SELECT ❑SELECT 0 SELECT ❑SELECT 2 SELECT DOOR TEXTURE,STYLE,SIDELITES&GLASS OPTIONS DOOR TEXTURE ❑Smooth(Unfinished) Z Painted Smooth ❑Oak Grain ❑Mahogany DOOR STYLES ------ -- ..__ ��j Ti: SIDELITE STYLE,QUANTITY&OPTIONS �_ ,.� a C 00 it Il1U 2 11 0� j I—_i _ a,ANNTY:❑1 gn2�a ., p oo Too I,': 00 op DO J L PgIGLE,MOUNT: ❑Hinge Side ❑K abSide ❑ ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Z ❑ ❑ ❑ ❑Ye"SldeEtee ❑Operating Sltlellte' r -4 N N N pp Al N ea AL a. V O n 1-9 Full Lite ❑3/4 Lke ❑1/2 Lice i y p y !p y S p U y p r i 'S S. Mount On.❑Hinge Side ❑Knob Side 5e, Si SL 6i 5y!y 55• f S! , 5! [3L i $y $o` •When selecting a Sideae Quantity 9I2 win an Operating F • F a f, r . skkale,one Sidere wi/be Operating and the other Flxed.. C t, 4 9 E a f 1" I. Teo Venthg Side/Ratan available per toot I S" P $p i C g Fr W I r •IS'&14'SMaaM,OMy.3/d Vetting Sidw'da and Full Craftsmen Sidene unavadebie i f in 14'.12'.Full Lie,Venting Sidsites unavailable with any Craftsmen style glass. TRANSOM STYLES CLEAR GLASS OPTIONS(Non-Decorative) Rectangle Transom ❑37-12"z 15-12' 0 84-1/2'x 161/2' ❑58.12"x 16.12" 0 No Grids Ellipse Transom ❑64-12'x 143i8' 069-1/To 13-7/8' ❑Contoured ❑vmae Oren ❑aey ❑Internal Grids*of Lkes_ ❑Flrt ❑yn,te Dian ❑cuy ❑Moth. DECORATIVE GLASS PATTERN(+GAMING) ❑Extern.'Grids s of Utes (Contoured Only,Match InsideOutsda Door Fedr/H ❑Aurora(Platinum) ❑Mediterranean(Wrought Iran) ❑Monterey(Satin Nickel) ❑Reiss,Lower,Tilt Blinds ❑Brentwood(Bright Lnc) ❑Riverwood(Patina) ❑Heirlooms(Brass) ❑Harmony Blinds OF.Lie Kt ❑rma Lae L`a. (').Panel v?Lrre IL 02 Panel1/2 Lee 9L ❑Brentwood(Patin.) ❑Monterey(Patine) ❑Heirlooms(Satin Nickel ®SDL S of Lkes 3 (Contoured Only,Match Inside/Outside Door Finish) 3 FACTORY PRE-FINISHED(Specify Finish) 0 CASING&BRICKMOULD PAINTDOORS dame.._.__ EMCN• CASINO SIDELfIlf— Interior Casing: Poplar(Nat avekable atahnd) 0 Oak 0 None &SIDE OUTSIDE INSIDE OUTSIDE MOULD INSIDE OUTSIDE WHITE 0 ❑ ❑ ❑ RI ® ❑ ❑ ---Y gn 31?Colonial BDckmoUd IT Standard Feature):®YES ❑NO UNflNISFED ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ALMOND 0 0 0 0 0 0 0 0 Il-�J 0 2-1/2'Colonial Custom Brickmauld VJdt(Additional Charge): • swam 0 0 0 0 0 ❑ 0 0 L SLACK 0 ® ❑ ® 0 ❑ 0 ® I� ❑2-1/2'Ranch &icknnoud Shipped Attached Standard MOWN ❑ ❑ ❑ ❑ El ❑ ❑ ❑ Ship Brlckmo/Ad Separately: IL YES COLONIAL SLUE 0 0 0 0 0 0 0 _ 0 7 HARDWARE(Hinge Color!vitt match Handleset.Deadbolt Standard) GRANS/PRY 0 ❑ _ ❑ 0 0 0 CI CLAY 0 0 0 0 0 0 0 0 , FINISH: El BrightBrass U LI Antique Brass Satin Nickel Z Bronze ❑Black CYPRESS 0 0 ❑ 0 0 0 0 0 .Lace nnsn o„� EOOPLAMI 0 0 0 0 ❑ ❑ ❑ 0 MULTIPLE DOORS KEYED THE SANE: ❑YES ®NO ava,uue n,a ,ao. maim SLUE 0 ❑ - 0 0 0 0 0 ❑ INCLUDE DUNNY HARDWARE WITH DOUBLE DOORS: ❑YES Z NO HUNTER ONION 0 0 0 0 0 0 0 MESA ISIES 0 0 0 0 ❑ 0 0 0 EXTERIOR HANDLESETS(Will include interior bckset In matching Knish) MEDIUM MOWN 0 0 0 0 0 0 0 0 MILK CHOCOLATE 0 0 0 ❑ CI 0 ❑ If1 Camelot(Inc.Lockset ❑Georgian Knob «Fair Lever ❑Accent Lever) MOCHA 0 ❑ 0 0 0 0 0 0 0 Plymouth(Int.Lockset:❑Georgian Knob ❑Flair Lever ❑Accent Lever) PPM 0 0 0 0 0 0 0 0 STILLWATER SLUE 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑Addison (Games with Addision Levy ONLY) SMOKE ® 0 I? 0 0 0 ® 0 Knobs&Levers Both Sides:❑Georgian Knob' ❑Flair Lever ❑Accent Lever TAN 0 _ ❑ ❑ 0 0 0 0 0 vALu RED 0 0 0 CI 0 0 0 0 I Only Georgian Knob handlesr in Bright Brass available for 20 Minute Fire Door. STAIN DOORS alas SNICK- CASINO MOSL1TEll 8 ACCESSORIES I Match Hinge/Locksef rayon unless specledl (TEXTURED ONLY) INSIDE OUTSDE INSDE OUTSIDE MOULD (Oat Ono) MIDI CUMIN See Prbergiass Door 4vailaBMy Chan for none lnlormalon CEDAR 0 0 0 0 D 0 0 0 ❑Moll slot ❑Door Knocker ❑Door Knocker w/Peepshe ❑Peepvte Only CHARCOAL 0 0 0 12 ❑ 0 0 0 Measured_ CHERRY 0 0 0 ❑ El ❑ 0 0 Peepaits la 541/2'from floor,Standard.Custom Peepete Loatm: " From Floor EMOLIS'WN.NUT ❑ 0 0 ❑ 0 0 0 0 0 Ode Plate Pet Doors NNE OAK 0 0 0 0 0 0 0 ❑ ❑Inside ❑Smen(Flap Opening 5-1R'x el/4) UNIT OAK 0 0 0 0 0 0 0 0 ❑Medium(Flap Opening 8-1/8"x12.1/4') NATION&OAK 0 0 0 0 0 0 0 0 ❑Outside MAHOGANY ❑ 0 0 ❑ ❑ 0 0 0 ❑Bath ❑Large(Flap Opening 10-1/8"x 1131140 MOORISH TEAK 0 0 0 0 0 0 0 I❑ Kdf Pitany21T,-Nen Pet WhDeoOrsy a vIrMirle on Firnies ShPan!a DrseO ePPD ooDEmr sru ior oorudendr edIn . WALNUT 0 0 0 0 0 0 0 I '.....I." or'. •See Door Availability Chart(reverse)for Accessory/Pet Door Availability. 4 SIZING Ell HANDING(Viewed from Exterior Handing by it nob) SINGLE DOORS: ❑30' ❑32" ❑34" 1Z 36" Door Swig Use picture diagram below to identity handing and swing,Viewed ratan Onside Looking In. DOUBLE DOORS: 0 60" ❑64" 0 88" 0 72' SIDELITES: ❑10" ❑12' VI 14' II E 01 FRAME HEIGHT LZ 80' 0 Castor Haight ' FRAME DEPTH:❑4-9/16'Standard 0 61/4" om 69nr ❑Cust Frame Depth ' m18M Len In-Swing 0 R Ira-Swkq ❑Lea OudSaAI5[11 ❑ r F NO Out-S'Mg (Tp-toTE) Additions!Charge for any non-standard Frame Depth. nil lig ;Mill Finish LiSatin Nickel ❑&one. 0 ADACoepkante' ® ill 04-9/18'&5-9/15'Mill Finish Only.Height reduced 718'IS end 1'on OS.Addtionel charge spoke. Al In-Swing ID Right Henri In-Swing ❑Uri Head Out-Swing 0 Right Hand OuFSWing Al doors are priced as prehung with the following standard specs:4-9/1 B'Composite Jamb,Ball Bearing Hinges,In-sing,Adjustable Threshold,Double Bore,7'Bndtmould and 2-1/7'Intend poplar casing.Bnclanould wil match the jamb cola.Double door Astragals will complement the exterior fresh.Doors with sidelkes have a continuous head and sil.Transoms are attached to the door when overall height does not exceed 96'. I have reAeered and agree will the job specifications described above.If rotted wood is discovered AFTER removing the existing door I understand that Hone Depot may stop completion of the job(after securing the original opening)until the damaged wood has been corrected.Note:Hone Depot does not make structural repairs.For custom pricing and more Information please reference Special Pricing Request Form(SPR). NOTES: DOOR SDL ELITE/I SIDELITE SDL 3LITE. CUSTOMER SIGNATURE DATE 07-23-2015 SREILOOPY'I OVOT YE GWOOP'f-CUMDEN THD-932 `NI � Home Improvement Agreement: Page 1 Home Depot License#'s -For the most current listing visit www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Ronald Engelbrecht Salesperson Name Registration #(Req. in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. 1. Service Provider Contact Information [The Home Depot j The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 lcustomercancellationnortheast@hom MA: 107774, 112785 Phone # ggRi ecnvider Email Address Service Provider License#(s) 2. Customer Information Bates Tamara 1 New England West F37633009 Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# ................... [63 North Loudville Road Florence MA 01062 Customer Address City State Zip (413) 522-1631 tamra.bates@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT 06492 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME 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: 09/18/2023 Customer's Signature Date 460 Standard Farm H1A(21 Jul.21)(E) Generated Date o g/1$/�0 Lead/PO# .F37633009 v 0.1.12 Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 03/16/2024 Approximate Finish Date: 04/15/2024 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 6390.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) Maximum deposit ONLY applicable in MD, NL9, ME (33%), NJ, WI (99%) Deposit% 25.0 Deposit Amount $ 1597.5 Remaining Balance $ 14792.50 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9.Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that: (i)You have read, understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as "Customer" above; and (iv)Electronic signatures will be deemed originals for all purposes. X �.� 09/18/2023 Customer's Signature Date X /s/The Home Depot 09/18/2023 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) For any other concerns, contact The Home Depot at 1-800-466-3337 lu5 iu di 460 Standard Form HIA(21 Jul 21)(E) Generated Date QQ/18/9023 Lead/PO# P 37633009 v o.l.12 `11 Scope of Work Bates Tamara New England West F37633009 Customer Last Name Customer First Name Store#/Branch Name Lead # Job #: (Internal Reference) Products: Spec Sheet(s)#: Project Amount Reference) F37633009 Windows Entry Doors F37633009 6390.00 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 6390.00 Notes: Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: Warranty Name(s): 460 Standard Form RIA(21 Jul.21)(E) Generated Date Lops/709 Lead/PO# F37633009 v 0.1.12 4.0 The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and (III) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "Home" means the real property, fixtures and any physical improvements where the Services are performed. "Services" means(i)the delivery and furnishing of goods, equipment, materials, and hardware; and (ii)any related labor and services, including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance, repair, and testing. "Scope of Work" means a detailed description of work or Services to be performed, including, but not limited to, any quotes, schedules, invoices, specification sheets, proposals, confirmation emails or otherwise. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES:(a)Payment: You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area, including,without limitation: (1) obtaining in advance of the Services consent,permission,or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2) providing the location of utilities, whether underground, concealed, overhead or visible, to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area;(5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area; (7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services; and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. 460 Standard Form HUA(21 Jul 21)(E) Generated Date 09/18/207s Lead/PO# F37633009 v 0.1.12 4. N`♦ The Home Depot General Terms & Conditions 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order").A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time,or both.Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date (the "Warranty Period") that all Services will: (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the Warranty Period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole discretion (I) correct or replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each Defect and refund all or a proportional amount of the Contract Price thereof to You;provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement; or (2) You fail to pay Home Depot in full as provided in this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY. YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER, INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY,OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES. HOME DEPOT'S EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE, MISUSE, NEGLECT, ACTS OF GOD, LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRANTIES PROVIDED FOR GOODS, MATERIALS, OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c)Limitation on Damages.Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten(10)days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination. 460 Standard Ran HIA(21 Jul.21)(E) Generated Date 09/18/2073 Lead/PG# F3763'1009 v 0.1.12 40. The Home Depot General Terms & Conditions 1 9. CHOICE OF LAW; SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement. 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. 11. SECURITY INTERESTS: LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed, unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed. You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e., goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its Contract Price cannot be refunded unless Home Depot or Service Provider(1) incorrectly ordered item, or (2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the Contract Price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE QRDER COMMUNICATION PREFERENCES,You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call);(2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order (including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program, 460 Standard Form HIA(21 Jul.21)(E) Generated Date -00/18/2023 I c d Pc)- F37633009 v 0.1.12 Go Permits, LLC 105 Buttonball Lane �O 1 Glastonbury, CT 06033 PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/2025. Workers' Comp: Indemnity Insurance Company of North America Policy: WLRC50668058 Expires 3/1/2024 Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor. CSSL-106106 Exp. 9/29/2024 / HIC 187666 Exp. 5/9/2025 Workers Comp: Associated Employers Ins. Policy WCC-500-5028443-2023A Exp. 1/25/24 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits@Qopermits.orq • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits CERTIFICATE OF LIABILITY INSURANCE 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: It the certificate holder la an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED.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 endorsements) PRODUCER i ZACr MARSH USA NC 1 TWO ALUJANCECENTER ,a�r en c.., efiE/c-wI 35E1 LENOX ROAD,SUITE 240C E.MAn. ATLANTA.GA 30326 4OOREsa INSURERS)AFFOROMrG COVERAGE IAC I Of101642069HonkDGAM.-22.25 RIMER A:lid Ragout_Irotrerce U 24147 EIROPEO ---`-v- 14BII11ER6:IRdeMrah ir[s C9 Of Ilutilt*r'.enu3 43575 THE HOSE DEPOT,INC. HOME DEPOT USA,INC. mama c:ACE American Insurance Cemmin 22667 2455 PACES FERRY RCM N SURE R 0. RADIO C-21 — ATlANTA GA 30339 NSJIRERE INSURER F. COVERAGES CERTIFICATE NUMBER: 4TL-005072225.15 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R'9R +IooL�uNa ►OI.ICYEIf POLICY EAR LAIRSLTR TYPE OFaSIRANCF ._ roLJCrNI�EI erMomrtm IMMOG'YYm A X COIMIERCIAL GEMBIALL)ABETY MWZY316646 0312022 03,41-1025 EACH OCCURRENCE I 1,000000 GLAIMSLIACE ElOCCUR PREMISES iEacccurr.nai I 1.000,002 X SR P.O000100 MED EXP one pawns I EXCLUDED PERSONAL L ADV INAIRY I 1. 000000 GEM.AGGREGATE LIMIT AFPUES FER GENERAL AGGREGATE E 2,020.000 x,PCLICY U S'ERa ED LOC PRODUCTS-cOMPVP AGG S 2,000,000 OTHER $ A AUTOMOBIEIMM*UTY MWTB316649 03,0112022 O3'OI2;::= OEC:ABINED SINGLELIMIT t 1;000000 X ANY AUTO BODILY INJURY(Par mace) l ~OWNED SO EDULED SELF INSURED AUTO MY CMG BODILY ItUURY(Pa aawnri) I OS �t AUTOS HIEDD ONLYO OWNED PROPERTY DAMAGE AUTOS ONLY �r AUTOS ONLY A(,MOSPILI = 4 - A UMBRELLA LAI Y _ :, M WZX 316647 030U20022 01D112025 EACH OCCURRENCE I IM,00 MO X EXCESS UAa . .1,14E-MADE AGGREGATE f 10,002,000 'CEO l 1 RETEVTON$ ,$ E WORKERS COMPENSATION 'SCFC50C66t9QNC) 123R120Z3 03IO11024 X _ AND EMPLOYERS'LABILITY , L I I v.'�R-�F'RETOR°PARTNERs£XECUTII'E Y;M WLR 150 lMTi 0301t2023 03141."202'i. EL EACH ACCIDENT M 54000011 CF F ICE P.IrE MEEREXCLUDELY? D NIA Mandatary N NM E L DISEASE-EA EMPLOYEE,1 5,020.000 ;r Ycs et.:,I:e„n:Fs; �.. CE SCR IP-ON aF CPS RATIONS.Gat« COf1 dOn A!' OIMI.Page EL DISEASE-POLICY LI►IT I 5' � 1 DEW RIPTX)N OF OPERATIONS r LOCATIONS/VE)N'XE8 4ACOR0 111,AMIR.OM RsN.ws&M 514.,say Ur AtlicIntl I RIa...PANe is wawa* EVIDENCE.-Y-IN,S'J ''CE CERTIFICATE HOLDER CANCELLATION -ICME DEPOT.iSA.NC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 245E PACES FERRY ROAD BUILDING C-2O THE EXPIRATION DATE THEREOF- NOTICE WILL BE DELIVERED N 47_.t,'r 4 Tr-.a ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RE PRESENTATIVE L:1988-2016 ACORD CORPORATION Ali rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER I6: CNI01642069 LOC Or A1L rla ACORDe ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCYNAMED INSURED MAR_ THE HONE XPOT.M: HOME POT SA. N_ POUCY NUMBER 2455 PACES PERRY Rc: E_iLDIlk C 20 C,4 30339 CARRIER NAaC CODE EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER. 25 FORM TITLE: Certificate of Liability Insurance 'Makes Co-Fe-ssten Car-rued. Came Sarety sa►ra Cas.aty Cormincr P�te3Wttritor U3S40300113,,At.ARAL LeAktLKS,KY LANS MO 1.C,1•41.04,10 CK.SC St Thi kV:We' EMesa.e Del:331010023 Upsilon On 031010024 (ELI Lot$ Oa_,XO Cartir SaWy tows Caa.aty CsAratn+ Poky Pluntet SP4048234OS0 ICAOR,W* Effective tat:0101 023 Eepram Oa*01012021 (ELI Lrrt$5 00C.X€ SIR$1.000.000 Came-ACE Amman rsrarce Canary RNct%Latter WCtC50068C 6(OS11;GA MIM:Ch1,tfTl Etlledrr.Dal:E0012023 Erpralen Del 01010024 ,,ELI Lott i1.000.000 SIR$1,000,000 SIR IGA1.S75R,0-X Came,-Indemnity Insurance CarrprIt d holn Marc& pair}Nurbr WLRC50660068 M(CO,CT DC CE HIM VAAIDME.YN.NINl.NY,PARI.VTI Ellett*Cale 010112021 Erpralon Cate nei0C24 Eli Or($503C000 7-K Enplcyers!.5 hdar-e:r C.a ner2u'c Mercan nsu•rae CCRf a'ry Palict Number ASO 130319:,TXI Vitae Cale 03612023 Erprawn Car 310112024 (ELI Lot$6.0 2200 SIR$5000.D10 ACORD 101 (20O8 01I 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs anti Business Regulation 1000 Washingtg4§roit-Suite 710 Bosto ,_Massachusetts I 118 Home Im i ;;factor. :r istration I, tlrl.e•r V. w y ra :' Es ' 7 `;type: Corporation HUME C3EPU1 USA INCcrowd 112785 P O 80k t11,5459 .4 "=y.'. :.�. s,I . : O4f2'/2O25 ATTN. LICENSE MGMT TEAM .+ ,eia s Er!/ ArLANYA.GA 30348t 5 j =.' II tk ♦• Week Address and Return Cad. IHE COMMONWEALTH OF MASSACHUSETTS Otf.ce of Convattor Altars A BusMMssa Regulseon Registration valid taw individual use only before the HOME IMPROVEp ENTCONTRACTOO esptrat+on date. it found return to 'crE:COpkation Office of Cot Affairs and business Regulation ttRYtil(i1t0A c, t3 1000 Washington Street i Suite 710 tt27Sti _ I,t-•04t92i ,M B04101 A 0211E HCMtt-III;POf OOSA a 't 4 1 .ii, t I.1jt t l 1Ii '.1 CUUHINL"A HOWL v;i.!¢_ /2 2455 PACES FERRY Rbi"11�M O 1,0kit e,a 14'ile.w. MkATHA GA 30339 , • 0ndnranunlary Not valid without signature ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 111YIDDNYYY1 1131/2023 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 ACT Deborah Marino Canary Blomstrom Insurance Agency evo+wr FAX 868 Springfield Street ovc.No.col,(413)750.022 I ac,Noi 1413)786.7004 Feeding Hills.MA 01030 toss_drnallGOIRTCannblOMMEGEMGOIA NANTERiti WORDING COVERAGE NAIL INSURER A.NGM Insurance Co. 14788 INSURED papj8ERD Arbelia Protection Insurance Company 41360 Exterior Remodeling Group Inc. NsuREA C AIM Mutual Insurance Co. 23 Benham St NIURERD. Springfield,MA 01109 emote t NSURCR P COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS LS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE rOR THE POLICY PERIOD INOICATED. 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 SAIBiUCT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BCCN REDUCED BY PAID CLAIMS. PAW TYPE OF P$URANCE ADOL_BWR POLICY NII�Em POLICY EFF POLICY EXP UNITE LTR INS° VIVO iMRVDDJYYYYi IMWDDITYYYI A X ODSNERCIAL GENERAL LABILITY EACH OCCURRt LE i 1,000,000 I CLNMS.AMDE []OCCU" MPP3376W 7(27/2022 7/27/2023 O.WAGEEE i TO P a RENTED S 500,000 Pi uIE tLfYRr.',il incExl':Inv c o DGEOTi ,,t 10,O130 I'titSUNAi_a AU'; 1,000,000 _Qa11.AGCREn LIMB E PER GENERAL AG:.RFC.ATF $ 2,DOO,000 _ Pi.AICT LOC PRODVOJS-LLM';2F hrirj t 2,000,000 X :'TI•FR I i;anBr.EIJ 51NraL:nur 1,000,000 g AUTOMOBILE ISAIIIIITY iP n S;Lrct[L 1 env AUTO 1020110392 8i 17!2022 8/17(2023 D4IU1'Y INIUNY vrr c'' "'.- $ _ OWNED BCHEC4if:: _ ALTOS ONLY x AUTOS W L SO01.Y INJURY,F.n•u:.:anq # X bin%ON,Y x A11T 5 ONyI i PCii:G O CmMAC/. rt t UMBRELLA Leda { OCCUR EACH OCCURRENCE # EXCESS UTAS it C:AIMSAIAD= F+i'.zAtL 1 DED I I RETENTION P rr ff Cwomoas IRS STY ! X 1�'fATLLIE I I iEHn- ANY FROVNIE TOFLPARTAERE?TECUTPX WCC-sea-5028443.2023A 1125/2023 1;2512024 i r:.,;n AC,.c�1UFM1 500,000 F"F5,_ IyE�.1,9ral EXCLUDED N.A 4�N�a�Y 1 NN) E._.DISEASE-EA EMFt°TEE`t �0,000 n I ffrs ecs:rx ucr S00,000 'E:ir+ M+J('!KMUFr.7PERA!JOYS bek,w L-.l(lDa etlit i'EUCY I I DESCRIPTION OF OPERATIONS LOCATIONS.,VEHICLES SCORD 101.Aee t.m t R[�Mrn.s Scivoule,;salsa sated If more apace is regare0) Home Depot U.S.A.Inc.is named as Additional kwured with respects to General Liability. Eugeniu Clubotaru is excluded from the Workers'Compensation Policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICES BE CANCEL I_ED BEFORE Home Depot U.S.A.Inc THE EXPIRATION DATE THEREOF, NOTICE WLL BE OELMERED IN P ACCORDANCE WITH THE POUCY PROVISIONS, 2455 Paces Ferry Rd C-11 Atlanta,GA 30339 AUTHORIZED REPRESENT/EWE L ACORD 25(2015/03) m 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO irw to r.cd Watmar of no nraihnos Ada of EttHED.in*tmtri on at ei ssto al Lmansua and tra Now,d Standard: NNW 40 Public Safety ter:° O Mass. Lcet'isee Details Demotraphic information FJI.%ame ELGEN,U C U8OTARI) License.\ddress adortnation Cr:y Sonne t:ttl- — ---- State MA .pcode 01109 Co nt , United States License Information 1 cense No CSSL-106106 License Type Construction Suoerrmsor Spevart; Profession Building Licenses Date of Las?Renewal. 10.132022 Issue Date 4;1212017 Expiration Date 9129+2024 License Status: Active Today's Date 10.142022 Secondary License Type Dog BuSinexS fi5. Status Change Reason License Renewa _._., r _ �• �_ � _ Prerequisite Information peens® U13OTAAtiT UGENtU ftetabon ►: Attribute Of tcense No: C$St•t06106 Flo Available Docurnenls Commonwealth ot Massachusetts Division of Occupational Licensure 4,11, Board of Building Re ulations and Standards Constructs upJ r Specialty Y CSSL-106106 �•:� �. empires: 09/29/2024 EUGENIU CIkiBOTA• ' ,1 ► == 23 BENHAM $TRE Jam` SPRINGFIELbM Vs//./II.IJJJVI/trI 12, Ii• 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 ot this license. For information about this license Call (6171 727-3200 or visit www.rnass.govldpl Oft ce of Consumer Affairs and Business Regulation 1000 Wa9hing on Street Stale 710 Roston,Massachusetts 02118 Home 1rov*rnent Contractor Registration 'roe Cogatairr office of Consumer 2311 AIM al � '; 5flgpKiF.EtD. t+, ittiOWA Affairs and Business :..."�£ �t,a} ur�QY..sa,rllw�o.ir. arsesC•oumao Mao*•ea.r«...flaw.4..• ION MP Wittins tCONTNACIntl 'OY1YaIwMdIAAMWWluw.0,egu Regulation (ocABR� nng,i t tinilLi Yytp.r the 4xp1l•1•3e 0010 r.DOm 1111n4 ry 1V V.,t'd N CansYRM•11N11 artl auOgN¢i Nowleiiar 11•411.6 ;614=S .1 Nall 71t•t•=Suns 71Q •XTt''I�M IRREI•Cla1Nb t0,1"M+CE a a u+.MAlflwe full/M HIC Registration Complaints 70eit s.rteasest.o Ina in tag No!valid+nnan signature ,MINVOUCP Registration# 187666 Registrant EXTERIOR REMODELING GROUP.INC Name EUGENIU CIUBOTARU Address 23 BENHAM ST City.State Zip SPRINGFIELD,MA 01109 Expiration Date 0510912025 j _ e n 0 -6t... autnori Go rermtts LLL, to punt permits using my Complaints DetailsINo complaints found for this registrant l J License+i �Q D 6 ana my HIC Registration# J$3 666 . a ,. ^, , .cstions oiease call m (e at: t L{1 3) 3 3 S 3 709, , instiller Jtsv:. Lompany tear,.._ •e- • o.R__Ro Mo `.._____Cp_ROui