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Feb 1215 02:20a p 1
HOME LMiPROVENIENT CONTRACT
PLEASE READ THiS
y{^- Sold,Furnished and Installed by:
Branch dame:Boston North&South Dat¢;�ti J \] THD At-Home Services,Inc.
d/Na. The Home Depot At-Horne Servicws
Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545
Toll Free 877-903-3;68
Federal ID#75-3698460;�9E Lic#CO2439-,Rf Coot.Lie#16427
t �} ' N Cr Lic#HIC.056SS22;MA Home Improvement Contractor Reg.0 126893
Installation Address: ` k3 Q t� Gb�NXQ AMA i A C;
City State Zip
Purchoser(s): i Work Phone: Home Phone: Cell Phone:
\ " L S rr
Horne Address:
(If different from Installation Address; City Stars Zip
E-mail Address(to receive project communications and Home Depot updates):
❑I DO NOT Kish to receive any marketing emails from The Home Depot
Proiect Information: Undersie,,nod("Customer"),the owners of the property located at the above installotion address,agrees to buy,
and THD At-Home,Ser.-ices.Inc.("The Home Depot-)agrees to furnish,deliver and arrange for the installation("Installation")of
all.materials described on the below and on the referenced Spec Sheet(s), all or which are incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively.
"Contract"):
Job#: n nueneferuloel ucts: S Sbect(s N: Project Amount
g, odaws L1 Insulation $ • 'YRl1Ut 1 ���
nP_nRZFcN!Covers [3 Entry Doors ❑
RmFing ElSiding Windaw.;M Insulation !r[�'^}
i✓' � s❑Giutters!Covers []Entry Doom L] ll;,) 1 3 $ `�l
LI Roofing Siding Windows Insulation
❑Gutter!Covers ❑Entry Doors
Roofing Siding \Vindows LJ insulation
❑Gutter I Covers)_]Entry Doors ❑ 5
1
M'utin rim 25 ro Deposit of Contract Amwstdue uponeucution of this oonttact. TotaI Contract Arnount S
Maine Purchasers may not deposit more tlmn one-third of the Contract Arnoant
Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate
tone for each Product as defined by an individual Spec Sbeet)and pay any balance due. As applicable,each Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Depot resemes the right to issue a Change Orderor 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 concurs,pricing errors or because
work required to complete the job was not included in the Contract.
Payment Summary: The Payment Summary# C1 16 ti k 0 , included as part of this Contract. sets forth the total
Contract amount and payments required fox the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note:
there Is are Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product
is complete.
In the event of termination or this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,ecpenscs
and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE ROME DEPOT MAY WITHHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNT'S.
Accei►taace and Authorization: Customer agmes and understand,that this Agreement is the entire agreement between Customer•
:aril The Home Depot with regard to the Products and Installation survices and;P • scd^s.Ill prim"discussions ar.d:agreements,either
oral w written,relating to said Products and Installation.This Agreement wan cigtcd or amended except by a writing signed
by Customer and The Home Depot.Customer aclurowlcd,es an agrees t!at C tdrt»has read,undersnmds,vuluntari)y accepts tic
terms of and has received a xpy of thi,Agroement.
i
Accepted by: f Suhmltt
Cus Signature Date Sales nt's Signature Date
X Telephone No.
Customer's Signature Date
Sales Consultant License No.
CANCELLATION: CUSTOMER MAY CANCEL THIS "s npi"7bic;
aGREEMBNT WITHOUT PFNALTV 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 IS
SPECIFICALLY PRESCRIBED BY LAW IN `
r•r Iv'tVl64VIOIC CTA rr
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: j
The debris will be transported by: _LOA '-r �� .
debris will be received b �
The d :
Y
Building permit number:
Name of Permit Applicant
Date Sign-ature of Permit Applicant
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: Dnw,4Lb
License Number
Address � + � % �/.,/�� E�piration Date
Signature Telephone
. _ ._
9,Re istered Hom�W rov merit Contractor _;; __.;:_. , , ';, ;., Not Applic���
1
Company Name Registration Number
��
Addr s Ex ' ion Date
Telephone 4t::3 '
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 bui 'ng permit.
Signed Affidavit Attached Ye ....... £ No...... £
IL !"Home Owrier 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 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 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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0]
Brief Desc ##ion of Pro Qsey�' � y� ,� / )
Work: 6MAI f� fJ/ ��ll��T�'1 �/`7 /�'��T C l�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.`lf New house and or addifion to existing h"ousing; 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 900 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
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters rre`lativ to work authorized by this building permit application.
Signature of Owner 7�~ Date
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 and the ains and penalties of perjury.
Print Name
7--)_)D
Signature oV6wnerAgen t Date
' .
Section 4. ZONING At(Information Must Be Completed. Permit Can Be Denied Due To Incomplete Informat
Existing Proposed Required by Zoning
This column to be filled ippy
Building Department #
Lot Size
Setbacks Front
Rear
Building Height
Bldg.Square Footage YO
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Hasa Special Pennit/Variance/Finchn8 ever been issued for/on the site?
x�t x-�
NO �~x~�� DONTKNOY/ �~/ YES �~�
IF YES, date issued:/ |
IF YES: Was the permit recorded at the Registry ofDeeds?
NO DO 7 N t~� n KNOW YES
IF YES: enter Book Page and/o, Document#i
�� ��
B. Does the site contain a brook, body of water or*ed ��wetlands? NO ��' DONT KNOW �~/ YES �~�
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeob1ained «-� Obtained �-x Date
�_� x_/ '
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 0
IF YES, describe size' type and location:
E. Will the construction activity disturb(clearing, gradingexcavation, or filling)over 1 acre orioit part ofo common plan
'
that will disturb over 1 acre? YES K } NO K 3
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_
C -
�/] - I3epar#ment use only '
V I
ity of Northampton Status ofPermtt ` �� x�` `
uilding Department curb Cut/Driyeway Permit f
FIN J 1 2015 i 212 Main Street $ewerlSepficAvaira6Elsty
Room 100 w:. fie, iUlteiiRva�la6tldy� ;
Etsolria,lPNnrtbinp S(1as In"ctlWQ hampton, MA 01060 Two Set of S#raotural Pfar}s
f4c"ha on,M 87-1240 Fax 413-587-1272 Plof/Si#�Plans s
Other Sgeoify . 1
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This secfion to be com leted by office
1.1 Property Address:
P
Zone Overla DlstrlCt
5.
Y
Elm St D�stnct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Own of Record: "
Name(P'rint)� Current Mailing Address: f
`, Y✓ �iC// l� (/� Telepho
Signature
2.2 Authorized A ent: i•�vly�rj�z �0 ,
Name(Pri Current Mailing Address: (�
Sign e Telephone
SECTION 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 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number �7
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature: _
Building Commissioner/Inspector of Buildings Date
File 9 BP-2015-0804
APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 5 RIVERVIEW DR NORTH PROVIDENCE02904(401)935-2633 Q
PROPERTY LOCATION 41 REDFORD DR
MAP 36 PARCEL 056 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Gel/Gh� ire
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 102535
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOPIMATION PRESENTED:
pprroved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission =Permit DPW Storm Water Management
D
1'U' y
Signat of i ding Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
41 REDFORD DR BP-2015-0804
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-056 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2015-0804
Project# JS-2015-001563
Est. Cost: $812.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 102535
Lot Size(sq. ft.): 12501.72 Owner: ALHASSAN SOFIYA
zonin : Applicant: HOME DEPOT AT HOME SERVICES
AT. 41 REDFORD DR
Applicant Address: Phone: Insurance:
5 RIVERVIEW DR (401)935-2633 () Workers Compensation
NORTH PROVIDENCER102904 ISSUED ON.•211912015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
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:
FeeTyge: Date Paid: Amount:
Building 2/19/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner