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17D-069 (2) HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold, Furnished and Installed by: �h Batten Date: THD At -Home Seavicee, Inc. dJb/a The Home Depot At-Home Services 908 Boston Tuniplke, Unit 1, Shrewsbury, MA 0l$45 � - Toll Free (800) 657 -5182; Fax (508) 845 -6017 Branch Number: 31 Federal ID # 75- 2698460; ME Lie e C 02439; Cent Ire 16427 I ' t CT LLic l HIC.0565522; MA +a�p Contractor Reg, # 126893 r Installation Address: ; ["11,[x a C` t tip & s 1c._ I City State Zip Purehaser(s)t - Work Phone: Hoene Phone: Ceti Phone: MA i2 .o I l Ni315 - sin " [ I [ 1 [ l Home Address: - (If different from Installation Address) City . State Zip • E-mail Address (to receive project communications and Home Depot updates): ©I b0 NOT wish-to receive any marketing emaiis from The Home Depot Project lufermadoa: Undersigned ("Customer"), the owners of the arty located at the above installation address, agrees to bay, furnish, and THD At -Home Services, Inc. ("The Home Depot") agrees to p deliver and arrange for the installation ('7uatallalioun of all materials described on the below and on the referenced Spec Sheet(s). all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Sununary attached hereto and any Change Orders (collectively, "Contract"): • Job #: tea em) R+et w,.) • , sets: S • $ #: Pr , act Amount • Roofing r Siding : __ Wows • Insulation (:). G DOuata: / covers ❑eany Do«a Q ] E27 L ` /� Roofing ■Siding ■ Widows ■ Insulation 4 t W [Putters / Covers ❑Envy Doors ( $ • .. • ■ 'ding ■Windows ■ Insulation U! ) s • . / ..,.. D . .,,. El • W ■ Roofing • Siding Di windows is insulation ❑(}Utters i Covers °Entry Doors n MIMS • Minimum 25% Deposit ofeestrattAmount due upon a tendon Ideas contract. • Total Contract Amount S - MI WtePRIOR: Ms tone! sotdpositmore tfaan C P Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate St Wit) • (one for each Product as defined by an individual Spec Sheet) and pay any balance due As applicable, each Customer tinder this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s) included herein, at its discretion, if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # � t 6q 52, included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product (as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled -in copy of rite Contract at the time you sign. Do not alga a Completion Certificate (note: there is one Completion Certificate for each listed Product as debited by individual Spec Sheets) before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Horne Depot the costs of materials, labor, expenses and services prodded by The Dome Depot or Authorised Service Provider through the date of tertninetien, Pius any other amounts set forth n this Agreement or allowed under A cable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE1HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Aecettlance an4 Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all or discussions and agreements, either oral or written, relating to said Products and Installation. This Agreement cannot be assigned o amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that • • .. has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. • . b Sub en's S Date Sales 'i . t s SimtAire r ���� Date x • i/ CL„ 5/1 �.�, Telephone No. CJ._7C7 " _ . Customer's Si: -s Date Consultant License No. CA CELLATION: CUSTOMER MAY CANCEL THIS (ere applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE 1$ SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 0540.12 White - Branch File Yellow - Customer I ';" a,. k 'I�� Al : _ 1 : . A, �I., ) t .'ACA' r: n!3 C _,'> d FICA - 10 =LIED AS A MATTER Cr iNFCR:111, - T1Cf�l G ?L AND .- R3 )C' i :=ON l _ .0 , A, i CERTIFICATE COES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND. OR ALTER THE COVERAGE AFFORDED Sf THE >d - ..2 r;: 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EETWEEN THE ISSUING. INSURER(S), AtiiHO,,Z2' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED the polio, /(ies) must be endorsed. If SUBROGATION IS WAIVED, ub ect. r., the terrns and conditions of the policy, certain policies may require can endorsement. A statement an t.=3 certificate close no confer ;'.r'4h't .;. Certificate holder hi lieu of such endorsernent(s). 'ROatjCER 1- 366-96 - 66 =1 j CONTACT NAME: - -- - -- - -- - -- - -- , larch USA Inc. PHONE f FAX (A/C. No. E t): _ (; /C�i?ioj_ lomedepot .certrequest@marBh.cora E-MAIL _ADDRESS_ — — - - - - - Cw•o Alliance Center, 3560 Lenox Road, Suites 2400 - -- Ltlanta, GA 30326 — INSURER(S) AFFORDING COVERAGE. NAIL Fax (212) 948-0902 _ — INSURER A: Steadfast Ina CO 26387 NSURED INSURERB: Zurich American Ins Co 16535 ['he Home Depot, Inc. New Ham come Depot U.S.A., Inc. INSURER 0: pshire Ins Co 23841 ?455 Paces Ferry Road NW INSURERD: Illinois Natal Ins Co 23817 3uilding C -20 INSURER E: NATIONAL UNION FIRE INS CO OF PITTS 19445 Ltlanta, GA 30339 INSURER F: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 25776028 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 T 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. VSR ADDL SUBR POLICY EFF POLICY EXP _TR TYPE OF INSURANCE INSR_ WVD POLICY NUMBER (MMIDD/YYYY) (MM /DDIYYYY) LIMITS A GENERAL LIABILITY GL04887714 - 02 03/01/12 03/01/13 EACH OCCURRENCE _ $ 9,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 DOD 000 PREMISES (Ea occurrence) $ , , CLAIMS -MADE X OCCUR MED EXP (Any one person) $ EXCLUDED X LIMITS OF POLICY XS PERSONAL &ADVINJURY $9,000,000 X OF SIR: $114 PER OCC GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 9,000,000 _ X POLICY JFCT , -LOC $ B AUTOMOBILE LIABILITY BAP 2938863 - 03/01/12 03/01/13 COMBINEO SINGLE LIMIT (Ea accident) _$ 1, 000, 000 . X •• _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS NON -OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) X SELF INSURED PHY DMG $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ _ _ __DED RETENTION$ _ $ C �WORKERSCOMPENSATION WC019736915 (ADS) 03/01/12 03/01/13 X WCSTATU- 1 0TH - AND EMPLOYERS' LIABILITY TORY LIMITS ER — Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE WC019736917 (FL) 03/01/12 03/01/13 E. L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N N / A E (Mandatory lnNH) WC019736916 (CA) 03/01/12 03/01/13 E.L.DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1, 000, 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ E Workers Compensation WC1192494 (QSI) 03/01/12 03/01/13 SIR (AOS) /SIR (GA) 1M /750,000 C Workers Compensation WC019736918 (WI) 03/01/12 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/12 03/01/13 Occurrence /SIR 30M /1M )ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) tE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'HE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. i' 455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE IUILDING C - ,TLANTA, GA 30339 �- 62, USA - 7 ©198$` AC,ORD CORPORATION. All rights reserved. ,1 +, > . ... ....... rep Office ofInvestigation! , Washington S1 i. z .4 . = Boston, MA 02111 -:X 'Z, 31 W J .i2J,s.fi o g /LL a Workers' Compensation ion ifITIIr ne .' ffi i vIt B Ild2rsiV nt cv.,,.D ' i le.e it al2s1P ilia 3e '> Applicant Information _, _,�{- __ __ __ _ _ -� _,._ 'ri1t t 111 Name ( Business /Organization/individual): 0 0 i'vt, 12' • ° ____...�,..t-- 9.* Address: t5 ' . Ge S &rr P D d s City /State /Zip: 14 ( t U \ l - ,, A-- 3 03 3 I Phone #: ' ' 6 5 - 7 - 5 - / g Are you an employer? Check the , ppropriate box: Type of project (required): 1. tgi I am a employer with d- 0 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part- time).* have hired the sub - contractors 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 an , capacity. employees and have workers' g y P tY• t 9. ❑ Building addition [No workers' comp, insurance comp. insurance. 10.0 Electrical r epairs o r additions required.] 5. 0 We are a corporation and its . 3. ❑ I am a homeowner doing all work officers have exercised their 1L❑ 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 employees. [No workers' 13)Z1 Other�,U sf, r L- • comp. insurance required.] wt vw S Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homedwners 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. �) 1 � • , Insurance Company Name: ►V et�J �Q,,M ,�G�ti•� �— S s (b. , . . _______ ______. Policy # or Self -ins. Lic. #: W C o173 6 1 ( c5 Expiration Date: 3 . / . /3 Job Site Address: 14(c 'H City /State/Zipre , D /06 Z Attach a copy of the workers' compensation policy declaration page ( 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 ' . iii ce coverage verification. I do hereby certify under th , r r s and , marries of perjury that the information provided abo a true and correct. le if Signature: ,, / 'f4 Date: I / L. . Phone #: ■ Official use only. Do not write in this area, to be completed by city or town official City or Town: . Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City)Town Clerk 4.'Electrical,Inspector 5. Plumbing Inspector 6.Other , 4 I rne.tont parcnn� Phone #: '' v/ AO I/ / ., ,� , , I' // *,__ 0 ' ice o onsumer • al and : usiness Regulation "' � = 10 Park Plaza - Suite 5170 = s , e ° Bosto Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2014 The Home Depot At -Home Services ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE 300 . ATLANTA, GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal ❑ Employment Ei Lost Card DPS -CA1 Co 50M- 04/04- G101216 Office o 1' i t o ns u me r • a irs . t us eReg License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: t Office of Consumer Affairs and Business Regulation ' w « 1 - a Registration: 126893 Type: 10 Park Plaza - Suite 5170 —,W' Expiration: 8/3/2014 Supplement Card Boston, MA 02116 T M - Depot At -Home Services 0 ANDREW SWEET + ' 2690 CUMBERLAND PARKWAYS , 4 ;7 -.-- 1 ----- 7 ,9 , -- _ ,w �"�_ A it , GA 30339 ∎ --ow. Undersecretary ■ . - 1 .-- I tthou signature v-9F • - vya,utl, tuigi.vemcz —7=0 • , ' P• CURA Vt,Vki0ORQ Yt5.) • • • 1391/1,41 N9Clen. - 611HiM61 woo, ten, ma.,71 Ge s3 :6,418%41 Dzutpri kgjepags ed3c3p.t,,s geo*ii,Aas'UV3 iugptinIgq ma? xvillygvg 179 towirag fp ,vpla No.v,i.wczbe , •3113.1,quivtlx•zigh • • • • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable 0 Name of License Holder : (h-At I /h I[-t , Govaii4c. cr9z License Number l� d - ► .�N Ct1oopee mA Oto /3 /0%z f lof Address //r Expiration Date IIiri 40/ 735 33 Sig. ,"l;►��� Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ TW E bEpOr /1/ S c ! ab Company Name Registratio Number Address , "1,` Q u Expiratio Date Va-EW of - /C Telephone 401-7- b3!! �+�j SECTION 10- 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 1 No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license. provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. Construction will - .) during acting 1. Uil9tYil%titill SU�i`tilSUi yUl.i presence on the jut) bite will UG required horn Lime to time, uiuliig uIl` upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House U Addition ❑ Replacemen endows Alteration(s) U 1 Roofing U I Or Doors Accessory Bldg. ❑ Demolition El New Signs [O] Decks tD Siding [D] Other [CI] Brief Description of Propose �t y A / , Work: flUST 44-1.- 3�� �> �ru Sv� s ND 577 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in al matters relative to work authorized by this building permit application. Cb Signature of Owner Date I, j41) 61-V .,q(.017-----E-1--- (.0 I=mo , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed u der the pains and penalties of perjury. -tz_-7--- Print Name /ice, AO /Obit 2.--- Signature of Owne , t/Allk Date ir Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Pr Required b Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO C DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only R ,, ` . `\ Ci y of Northampton 1 B ilding Department Status of Permit: Curb Cut/Driveway Permit OC i - 4 2O 2 , 12 R et Sewer /Septic Availability ROOM Main 100 Str e Water/Well Availability M ort ampton, MA 01060 Two Sets of Structural Plans roa , i sP io :7-1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 1 i th S� Map Lot Unit Zone Overlay District FicRr,Pc -E , nn A otot Z. Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: /lf r' i OAtzt yk/ &c, Ss 1 4tatf T, r/c t e, mA 006 Z. Name (Print) ( Current Mailing Address 1/3— ,5 - oD /g i S A tC fU C * -T Telephone Signature 2.2 Authorized Anent: 9.0 fc r3cts-aw) 7 ?i- AU& - EU) S w Fx j S N- 0s 3 rd i . /j"Ii4 of.s` — Name (Print) / Current Mailing Address: �Ai i 401— 7 11 Signature ` ...1.1111.P Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building l ! / 9, ----- (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) , ?` Check Number 3 f 3 60 35 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 11 HIGH ST BP-2013-0389 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 069 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit # BP- 2013 -0389 Proj ect # JS- 2013- 000628 Est. Cost: $1496.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(sq. ft.): 23391.72 Owner: GROSS MANUEL L & CAROLYN M Zoning: URB(l00)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 11 HIGH ST Applicant Address: Phone: Insurance: 908 BOSTON TPK Workers Compensation SHREWSBURYMA01545 ISSUED ON:10/4/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/4/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner