34-025 (3) 19-28-200E 14:44 FROM•-THD AT HOME SERVICES +508 756 8823 T-058 P.006/006 F-877
HOME EVIPROVEMENT CONTRACT
Branch Name: Q 27U k 5' Sold,Furnished and Installed Inc.- Date: �i THD At-1-Come Services, nc.
dfb/a The Home Depot At-Home Services
,f 345A Greenwood Street,Worcester,MA 01607
Branch Number: �� Job#-. 62 UD?y Toll Free(800)657-5182• Fax;508-756-2859
G "7 �f Federal IDS 75.2698460 ME Lic#C 02439 Rl Cont,Lich 16427
C%' Z CT Lic#565522; MA Horne Improvement ContrmlorRcg.#126693
Installation Address: /0 S� V467 k/CP Ai< 610 V—'
City State Zip
Purellaser e: LWL 4 Di "s of Driver's IGie. E .Mo/Yr: Work Phone: Home Phone:
I P A 0 7 D U �.
{ ) { )
Home Address:
(If different from Installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to
contract with Home Depot U.S-A.,Inc.("H a Da of"I to furnish,deliver and arrange for the installation of all materials as
0 7%
described on the attached Spec Sheet#: 815 ,incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract it;upon re-inspection of the job,]Rome Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
CONTRACY,AMOUNT, $ �,� �j
I. Check ashlers Check or US Postal Service Money Order
- Lit==-= (Made payable to The Home Depot).
*LESS DEPOSIT S 2. Credit Card*and/or other payment options•Circle One Below
^-�=— Visa MasterCard Discover American Express
BALANCE DUE //--
ON COMPLETION $ The Home Dcpot Home Improvement Loan The Home Depot Crodit Card
S
'"Minimum 25%of Contract Amount due upon execution Available Credit (HIL&HDCC ONLY)
f this contract. Acct#; Exp.Due:
/Gr Name as it appears on card.—
Indicate Payined Method For 'By mytour sisnsturebclow,I/we agree in allow Home Depot to charge the above
BALANCE DLTE ON COMPLETION: referenced credit ca rdfortbedeposkindicaled.
Cardbolder's Signature Date
BOIL or HDCC Authorization Codes
Deposit final Pa went
# #
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder_
Entire A eement;This agreement and its attachments,including any financing agreement,contain the complete agreement
etween t e games and can not be amended or modified unless in writing in a separate agreement signed by both panics.
NOTICE TO PURCHASER
Do not sign this contract before you read it You are entitled to a completely Riled-in copy of the contract at the time you sign. Keep
it to protect your rights. Do not reign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete. Law prohibits home repair contractor a from requesting r accepting a Completion Certificate signed
by the owner prior to the actual completion of tin:work to be performed under the contract.
You may cancel this transaction at any time prior to midni ht of the third business day after the date of this contract. Sec Notice of
Cancellation for an explanation of this right. There willT.a service charge equal to 25% of the contract amount if the lob Is
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW,IME AGREE TO BE BOUND BY THE TERMS OF Tl�-IIS CONTRACT. IME ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MYIOUR SIGNATURE BELOW, UWC UNDERSTAND TEIAT THE AGREEMENT IS SUBJECT TO REVIEW OF MYIOUR
CREDIT HISTORY AND 11WE AUTHORIZE HOME DEPOT AUTHORIZED CONTRACTOR,TO VERIFY AND REVIEW MY/OUR
CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY
INCURRED FROM IN¢A,VERTENT 0 1v SS)ONS OR ERRORS. DO NOT SIGN THIS CONTRACT IF TUER:E ARE ANY BLANK
SPACUS. I/�/,l «l 1
SUBMITTED BY;_ �� Date: U�� 7/o
Sales n it n
ACCEPTED Sy--Z Date:
DatC' 16 0- 05
1/1 ltf/�
Homeowner
NOTICE:ADDfr1oNA1,IMMKS,CONDrrIONS AND WARRANTIES ARE STATED ON THE REVPRSP SMJ AND ARE PART OF THIS CONTRACT
White-DranchPle Yellow-Coatonxt Pink-3alosCon`vhant
5-27-05 CSC
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DEPARTMENT OF BUILDIITG INSPECTIONS
INSPECTOR
'212 Main Street • Muilicilull Building, 5 •`
Nc�rthaunPton, MA OlOfiO
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction supc.-,•isor. The state defines"Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a one or two fame —
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
home owner."
The buil mgepartmenf for tt�e City of Northampton wants-any person(s)-who-seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and ftulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings(before backfill),
sonotube holes (before pour) a rouzh building inspection (before work is
concealed) insulation insuection(if required) and a final building inspection.:The
building department requires these inspections before the work is concealed,failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing&gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
- permits in conjunction to the building permit issued, and that they get their required
inspections.Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
L understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me
Date
Address of work
location
r
I
0 �ti� Crii 4f ;arfl}aill33toll
Af -51 csa a chncc(la' _
e.. DEPARTMEIJT OP BUILDO\,G INSPECTi01.'s
i 1
.I 212 Main Street Municipal Building
! Northampton, Mass. 01060
WORKER'S CONf-PENSATTO.N MSURANCF- AFFD)�ij-j-
I� —�$.l�L ���'i�ms's � /���,-c_✓L�-�:1�����_._._ .- --- ---- ---
�;ccnsxJper(n;tftx)
vVith a principal place of businessfresidence at: --
�S��e>n�o��""
(sn-t~ticzty/sza.tL��p) G�^`w(/
do hereby certify, under Llic.pa_int and penalties of pcfjury, -hat
am an employer providing the follo.ving,workcr's comoc isaoo, cove�ge for ln�
e(vplovices «•or>ang on this job:
�x -- �°
i (Insur—any Con ' :) (Polio:Nunzbcr) (l=:•pi ' r. (Dar=-)
( ) I am a sole propficior, general contractor or- homeowner (Cilcie one) and have hired
the conirac or's listed below wbo have the foilowiog workers c000ep_,a6on pokies:
(i+HSI1e of CO?(nCiO"} (IRRJr311c Cornoin)'iPouc; Nlumrc:) (i�`:71idRQR ��11C}
(Nzmc of Conczaor) (Insarznc ComoaatirPo!ic) \urncrr) (`Li�ir�ion Dare)
(Name of Coasaao;)
� (IZ1SlLia.nC:.Compa-o)-/PoLc}• N:>.sbJ} (Expiraen Datc)
(Name of Contlacior) (taa=c-- Comcaay/poucy Nuxntx:r) ( apirddoa DaLc).
(arsc3 fir;ocil t'`u�,.facccar:to mcudr utrorm.�-ioo pct,estins to.17
i •
j O I am— a sole pr-opnetor and bane no one worldDg for me.
( ) I aa(..a home owner perfor='- c all the work myself.
NOTE:Frlesc be cwzre tt... +•lvlc bcmcA++.vm uryo cu�lay pc•.ana eo 4i -•;••,-•,••�•,. �s.:e�aa a re,�ar•,•oric on.d..<!1_�of
aac mote th=e L to is-' cht the bomoowae r=id=oc oe the pvuob zppurtca-a tbe-r o c o c C=cr-By oecd.-sd to Lc
employes twee the..v S�z -_.,:ca Act(GL'1 S2=1(5)}L:pp(in.00a by.bommava fc a 6c==n or pc-mit mzy c idcaoc tti:c
legal cLs-=of=e•)loyx under dw W-ke.Cooaaam.tion Act '
I uo4er d Ilya a Copy of tb.6 mt®tea o y bo fo .,.d.d to tbo Dopersmcai of ln�.czsicl Accdcffi.�'Offioe of(a-roc Lb.
covcao^c reitie=xioa and th t r i]tac to uauc Lvvet a Ce updG sccsioa 23A of),((3L 137 c=led to the iaxai6oa of eimiasl p=hi=
oo¢uaatg of a fine arup to 51X00.00 arzf0t 6=pr6oamc=orup w one y=r a�d cNil pcoxitia io t c form of.Stop Word;Orde a d.
G1�of s 100.00 s dzy.CZinA me '
For depv' �•t u.c only
perMjt NambG
ouY:otLi�r crmittc: C � I Is=
SECTION 8.-CONSTRUCTION SERVICES r
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9�Reatslerecom'bmprovment :orttrao r Not Applicable ❑
191 6-1 3
Company Name Registration um er ----�_-
tLe.�
6
/3/cf
Address Cj j�a l J�///; 7 Expiration Date
(Telephone7(X YJ�� 61t
SECTION 10 WORKERS'COMPENSATION'INSUkANCE AFFIDAVIT'iM'.G:L.'c:152,,;§;25C(rr))
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....... LV-' No...... ❑
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 hue who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
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.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and 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 Viable 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
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check alt-applicable)
New House ❑ Addition ❑: Replacement Windows Alteration(s) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[o]
Brief Description of Proposed r C _I �"
Work: �- T VI^�—
Alteration of existing bedroom Yes ZNo Adding new bedroom Yes ---'No /
Attached Narrative Renovating unfinished basement Yes �ryO
Plans Attached Roll -Sheet
:r :n e � .
6A EVN'6 ioase�-arxd�0or t io OAXIS 115"I I d _cor'ItAd IiP7
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 AUTHIORIZATION 'TOBE COMPLETED WHEN"
OWNERS AGENT.OR GONT.RACTOi2 APPLIES'FOR:BUILDING PER -
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.
Signature of Owner Date
as Owner/Authorized
Agent he eby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print, me /
Signature of Owner/Agent Date
^
Section 4. ZONING All Informati6h Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume,&Location)
A. Has o| Perm�/Vahunoe/Fndi ever been �suedfor/on the s�a?
m" 0 DON'T KNOW 0 YES 0 �
|F YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON7KNOW 0 YES
IF YES: enter Book Pag6 and/or Dooument#
'
B. Does the site contain a brook, body of water or wetlands? NO 0 DON 7KNOV 0 YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission?
'
Needs tobeobtained v�� O�tm�nad v-� Dmte �saum��.
«�� «�� '
C. Dn any signs exist on the pruperty �� ��� YES «_� NO v��
IF YES, describe size, type and |uoadun:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E Will the construction activity disturb grading .or filling)over 1 acre mis it part ofocommon plan
that will disturb over 1acre? YES r NO K )
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
` Building Department
212 Main Street e •
Room 100
4� Northa` ton; MA 01060
��,phone 41587-140 Fax 413-587-1272 tons
y
APPLICAT TCt(±OI`1STRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed'.by of ice
1.1 Property Address: "
„NEap )=ot Unit
4 �r
� �'11� Z"nlne OvesKa�Dksfnc!
7
r
Eliit S Qistrrct t -CB Dtnct r M
SECTION 2-PROPERTY`OWNERSHIP/AUTHORIZED AGENT'
2.1 Owner of Record:
Name(Print) Current Mailing Address: t 'l� tint. 7�
Telephone _I y
Signature
2.2 Authorized Agent:
Name rint) Current Mailing Address:
Tignature Telephone
SECTION 3-ESTIMATED'CONSTRUCT[ON'COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (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=0 +2+3+4+5) Check Number
This Section-For Off cial,Use Only
Date
Building Permit Number.'_ Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
105 TURKEY HILL RD BP-2006-0553
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 34-025 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
CatejZory: BUILDING PERMIT
Permit# BP-2006-0553
Project# JS-2006-0815
Est.Cost: $10897.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq.ft.): 145926.00 Owner: COHEN DAVID G&DONNA M
Zoning:RR Applicant: HOME DEPOT AT HOME SERVICES
AT. 105 TURKEY HILL RD
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401) 935-2633 O Workers
Compensation
WORCESTERMA01607 ISSUED ON:11 11512005 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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 11/15/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo