17C-124 (4) ����AA���� f
M um
liml063-A-044
07-?5 OH
6500 Renovations
Double Hung - vinyl
SO
Argon/Um F sc
Rfto c DS
•����1-800-?46-6686 «wtlt�wli
�Ibatrr�rq
Miali�rd��rttLaeat�osbnabepplcdAetH�pioaeAea�talxd�tal
��� i�asf lra�rdelemrieAicrtOrMtotdeeWrwd
aoM�Mtl�depee�eO�oA�tl�
al
410 Unit ftac Region Gualitiew M for icy}
•*,y,tr7a,J�' "� star nsyiont�r): tlbceb»rs,
central. mwoulrca
DP : 50 xIND: Mx OO/GLASS DS/*H-R50
Test Sizes 36 x 60
'' Berra
of BWWM Re "d suwbnb
NOW VAPID MMAM CoNTRAC M
ikon~ 1283
Expkad":
SqvWmd Cmd
Herne Depot A%MWM SOV498
PJC AM FALLOW
=0 CON GALLMM PKWY#26
hTMTA,GA 3339
AG RD. CERTIFICATE OF LIABILITY INSURANCE °��1/20 0
RI`IIsfiO-1 11/20/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Shepard & Scott Corp. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
352 Seventh Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
New York NY 10001
Phone:212-631-7440 Fax:212-631-7443 INSURERS AFFORDING COVERAGE NAIL#
INSURED INSURER Evanston Insurance Co.
INSURER B Commerce 6 Industry Insurance
RMA Home Services Inc. INSURER
DBA Home Depot At Ham e Service
3200 Cobb Cfalleria Parkway INSURER D
Atlanta GA 30339
INSURER E.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRO TYPE OF INSURANCE POLICY NUMBER DATE(MMIDQ/YY) DATE(MMA)DIYY) _ LIMITS _
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A. X COMMERCIAL GENERAL LIABILITY 03GLP1006878 08/20/03 08/20/04 PREMISES(Eaocurence) $50,000
CLAIMS MADE X❑OCCUR MED EXP(Any one person) $Excluded
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
X POLICY P7 LOC Emp Ben. 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
$
{Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
(Per accldert) $
NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
E XCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR Il CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X TORY LIMITS ER
B ANY NC9696691 07/01/03 07/01/04 E.L.EACH ACCIDENT $1,000,000
ANY PROPRIETIETOR/RIPARTNERIEXECUIIVE
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,0 0 0
II yes,describe under
SPECIAL PROVISIONS below E L.DISEASE-POLICY LIMIT I$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
NORTHBO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLIER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
—�� r Fes'Jsr tJr
ACORD 25(2001 108) ®ACORD CORPORATION 1988
HOME IMPROVEMENT INSTALLATION CONTRACT
x
Branch Name: /L!(—' Date: 3 Sold,Furnished&Installed by
The Home Depot Installed Sales
Branch Number: Job#: 345A Greermood Street,Worcester,MA 01607
Toll Free(800)657-5182; (508)756-6686; Fax:508-756-2859
Federal IDS,75-2698460 ME L c i1('02439 RI Cont.Lic4 t6427 CT Lica 5655"
MA Home Impro,ement Contractor Reg.4126893
Installation Address: 6'�i sht l'�S•t'/t�� .!e,.� �l tkti��j___/Lti4 C?%CJ(<r Z
Ci y State Zip
Purchaser(s): SS#: Driver's Lic.#&F.x 1.Date: NN'ork Phone: Home Phone:
,f So ("4 1 U ) 13)
1-4 0 ( ) ( )
Home Address:
(if different from Installation Address) City State Zip
Project Information l,'We("Purchaser"),the owners of the property located alt the above installation address,offer to contract%%ith
The Home Depot("home Depot")to furnish,deliver and arrange for the installation ofall materials as described on the attached Spec
Sheet# . ,incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home 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 PAI MENT OPTIONS
(5ubjecl to fund,arili,,non and ,,c dil appro,al.)
I Check,Cushier,Check or(IS Postal Service Mond,their
CONTRACT AMOUNT S )�( (,nadc 1) v,,N,w the I fume Oepol)-
CU U J*LESS DEPOSIT $ Credit Card"andior other payment options-Circle one nelo%%
/0 Visa Mesa•rCurJ Uuco�cr- ;\mcru;an LxprP»
BALANCE DUE t7
Hones lmpratemenl Linn Hume Udl tCredil Card ="
ON COMPLETION
Available Credit:S (1111.&IIDCC'ONI,N)
*25'6 of Contract Amount due upon execution ol'this
contract.One-third(1 13"')of Contract Amount is required Accra: q I(�_1 Ly f LI y to P..p.U:�a•. __ _.
for�IASSACHtl51('F'1'S RIiSIDFN'I:S ONI-1'' Name as it appears on con: -Co 44k 1-'C Y
Indicate Pa)'ment Method For *111 1111 MII signmuro below,I.AV'e agree to allow The Hume Depot I'l charvc the
BALANCE DUE ON COMPLETION aho,�elellc III thedepo,it indic:ned.
L ( udhol d�:l Si n null IS ill
Mir/ti�'l' � � (n�-1
If this is a finance transaction,the agreement for financing is contained in a separate do•anent,vv uch is mcurporated%lterein by
Reference,and made a part hereof. At-Home Services Credit/Loan Application Ref.#
11wchaser agrees that,immediately upon satisfactory completion of the v%oik,Purchaser v%ill execute a Completion Certificate and pay any balance
due (unless the job is financed•in v%hich case, upon submission of the executed Completion Certificate,Home Depot,%ill be paid in full by the
lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mass.Residents OnI : Contractor shall procure all permits required by law acting as tlx:owner's agent. Owners who secure their
own permits will be excluded from the guaranty fund provisions of MGL Chapter 142A. Unless otliervvise noted within this
document,this contract shall not imply that any lien or other security interest has been placed oft the residence.
Entire Agreement: This agreement and its attachments,including any financing agreement,contain the complete agreement
between the parries and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. 1'on are entitled to a completely filled-in cop) of the contract at the time you sign. Deep it to
pretect your rights. Do not sign an)Completion Certificate or agreement stating that you arc satisfied with the entire project before this
project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner
pri�rr to the actual completion of the,cork to be performed under the contract.
Yon may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is cancelled b)
Put chaser AFTER the third business day.
HY MY OUR SIGNATURE BELOW, EWE AGRFF. '1'0 13E BOUND 13Y THE"PERMS OF IHIS CONTRACT. I'WE ACKNOWLEDGE.
RECEIPT OP A COPY OF THIS CONTRACT AND TWO COMPLEI ED COPIES OF THE NOTICE OF CANCELLATION.
BY MY OUR SIGNATURE BELOW, PINE UNDFRSI'AND TIIAT"1-111- AGREEMENT IS SUBJECI"TO REVIEW OF MY`OUR CREDIT
IIISTORY AND[WE AUTIIORIZ_F IIOME DEPOT AND RMA HOME SERVICES,INC.,A HOME DEPOT AUTHORIZED CONTRACTOR,
TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE
TI11:M I ROM ALL LIABILITY INCURRED FROM INADVER"I FNT OMISSIONS OR ERRORS.
SUBMITTED BY:�, - i Date:
ACCEPTED BY: �.�- �� Date: G y�
Date:
Homcu�%nrr —
NO]ft F:ADDI I ZONAL-ITIt11S,C ONDII IONS AND w ARRA'.N"1'IF.S ARE s'rATFD ON I[IF RF\'F:RSF:SIDE.AND:%n1-:PART OF TIIIS C'ON I'R:%('T
\Abite-Br:mch rile Yelloc-Ui��oiner Pink-Soles Conxdtam
O O
g� tig Gity of &Nazt4aluptan r
� � �gassacltnsctfs -
DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR 212 Main Street • Municipal Building '
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/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 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
home owner."
The building department for the 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 regulations. 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 rough building inspection (before work is
concealed), insulation inspection (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
I, 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
s
g - d !iZrsnacEEnsctts '
DEPARTMEP T OF DJILDDJ G INSPECTIONS
212 Main Street ' Municipal BuiUng
Northampton, Afass. 01000
WORY{ER'S COMPENSATION INSURANCE AFFMAVI.T
Wth a principal place of businesulendcncc ar
------- ��('�(J��`jj�•/�]- �-` - - `'°-.�.'`.�°'��- _6.11-L2�'�-��}]G�t1C�=�' ��-�131.��D�-
r
do hereby CCriLI)'. U:7:N we pals anj pCi]?1tICS OI pCr-jury, t_Ill!i:
I am an empAys- prOVlding the foHo,ng '.olces compemaLioI] CoVCrrp for in}'
elnployces worlring, on tLis job:
(L>Lru"anG. Cora�.m') ^e'�c:NttrnExr) (F._".r.: on Date)
l j I az-i a sole proprietor, general c:Dc�=-Or ionic owner (c c!e Oct) i?nd Lav, hired
the contractors Usted below who is the ` LIr-,-;t,L g workeb c mpenskon ;'O!iSS:
011une of Contractor? (Insu-ncc Coro::;t,F ctie; Nus ie r) }:: rauca Datc)-
(Name of Contr:cto.-) JILSU!7-,j!7 Comp arlylpoky 'Nluri'rer) (I ?:p ion Date)
Owame of Conwamor) (II]s Iicn Coy n;r'olic, Nulrtr=r) =z; Ti t;c_Dat',-)
- (Name of Contractor) -- (Iasufaict Coim _;)'!Pokcy Nu.mGzr)
(^ILIGI:.d'�ti]CY:a]i::]G't;i::!•-<-•�'.�•:: ..:`�•_•'-Yaat:Cti:r-.�:._.... .ai O:('::O:�i:"'I
( a ana I. SOlc propn(!"ol 2 I'1 i]i:V !]O anc . ov ng Or me.
I am a home all
.plcau be ati,�:c t: .��.:ilc tx<;�o.�;rz�s:o c-p1�; _ ._.�;n:t�;r.__:.cacti a;:r•^.=.:m cr
not tncce th,n three L11?I in t�t:iet
eaIploycs u_ti'er the woe}:rz's cca-=:a'irn +r.(C,L!S2s !(5);,',:, . z:ic;; y a hctaeou-xr for z
ICS-1 etatuc of as amployx under torn We kc<'-
I undo.-v"d thy z co?y of th:.c2atc::,x:c:xy bo Iaw+vcled to tl;o fY.txirLZZCn:oFIncfustnel AC6d=,f ot moo°of for tIx
cove-agc vcrilciion and th_t f-litr t 10!1: .--' 25A of MCI,157 Can lc—d to thz in:psilionn of c 1 peraL'-`-
co¢zuttng of n rmc of up to s I,SWoo tnt.' t i :;rivrZ',c:•1 of::P to cn.} e-.j civil rnenztticn in$�fc rtn of+S!c, -?.C}i tn:S=
f rW oC S I00.00 a dsy gltit>-t m.
4(11C Fac dg:uuzxztsl u.c oily prrrnit i1 IAI n. I'r.rnt,.t
SECT N—8 :GONS7,RUCTION SERVICES
8.1 Licensed Construction S rvisor: Not Applicable ❑
Name of License Holder : Faflai-e- 1 aUjJ
License Numb r
Address tj��,p'7 Expiration Da e
Sign ure Telephone
Re ter=fief o m, .Avemen; :°pon ]racto= ,„� Not Applicable ❑
Com i�Na� � t\VL �
P Y Registration N tuber
Ad ress Expiration a
Telephone !qa
T1,
Workers N WORKERS',CQMPENSATION AF 1L
INSURANCE-° FIDAVIT(M.G 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....... Z/ No...... ❑
l
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 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 pen-nit 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
SECTIONDESIPONOFFROPOSED�HORK checkafl a licable
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other [ ]
Brief Description of Proposed Work:_ tz
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 •Sheet 0
6a: r : ff xi 'hoisffi �cnp e e ie f V:ew 0use nd Odd0t fol.l.w.oinf :
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. Mascheck 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
SECTIOhL�a {))11ffNERAUTHORIZATION -TO BE COMPLETED WHEN
OWNEkSAGENT�ORyCONTRACTOR APPLIES FOR BUILDING!PERIVIIT
J
I,
as Owner of the subject property
hereby authorize to acs on
my behalf, in all matters relative to work authorized by this wilding permit application.
Signature of Owner Date
I' ��Dh10— as Owner/Authorized Agent i
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
t ihe ins d enalties of perjury.
er get Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by 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 DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
City of Northampton
Building Department ,. .. = IN
212 Main Street
Room 100
Northampton, MA 01060 2 v`
-hone 413-587,-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITEINFORMATION
1.1 Property Address:
This s ection,to�e�coaipteted by oiffice
Y $d
un,t
z � x
�2�anQ' °' lea Y�.J� Ct
EIm�S�D��ct _. '. _ , District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �� ` 11� e ��,,(��,,,� f�'"r11
E "-4-t-I�'1 kJ�"+-�'�--L-.If J1rIl<��—" (G CJ)c,(tr�
Name(Print) Current Mailing Add,S1ess
` i
Telephone
Signature
2.2 Authorized Agent:
Name(P ) Current Mailing Address:
Signatur Telephone
SECT—I&3- ESTIMATED CONSTRUCTION'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 Wilding',Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4+ 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
68 SHEFFIELD LANE BP-2004-0655
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 124 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0655
Project# JS-2004-0938
Est.Cost: $1865.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RMA HOME SERVICES, INC 126893
Lot Size(sq. ft.): 25003.44 Owner: Fox COREY A
Zoning.URB Applicant: RMA HOME SERVICES, IINC
AT. 68 SHEFFIELD LANE
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (800) 657-5182 WC
WORCESTERMA01607 ISSUED ON:1214103 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 Sienature:
FeeType: Receipt No: Date Paid: Cheek No: Amount:
Building 12/4/03 0:00:00 6135 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo