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23D-101 (4) 136 HINCKLEY ST BP-2017-0405 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 101 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT WINDOWS/DOORS BUILDING PERMIT Permit# BP-2017-0405 Project# JS-2017-000672 Est. Cost: $9826.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 082485 Lot Size(sft. ft.): 44431.20 Owner: GARTON DOUGLAS A Zoning:URB(1001/ Applicant: HOME DEPOT AT HOME SERVICES AT: 136 HINCKLEY ST Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCERI02908 ISSUED ON:9/26/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 WINDOWS AND 2 DOORS(PATIO & ENTRY) FOR REPLACEMENT 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: FeeTvpe: Date Paid: Amount: Building 9/26/20160:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0405 APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES ADDRESS/PHONE 24 SUNRISE DR PROVIDENCE PROPERTY LOCATION 136 HINCKLEY ST MAP 23D PARCEL 101 001 ZONE URB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �O Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL 5 WINDOWS AND 2 DOORS(PATIO&ENTRY)FOR REPLACEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082485 3 sets of Plans/Plot Plan TH OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION PRESENTED: Approved 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 Dem iti Delay acif__ J -0v -02, Signature of ui ing O' '(I 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. • Sty r1 3 ��(� Department use only L ity of Nortpton Status of Permit: fuOiRSPECO)AS 1 uilding Department Curb Cut/Driveway Permit o o�nnuur f°N u"^"pe' 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 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 I?/-� J�-lj- r�I nil Map Lot Unit ' / r t �/ i Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: mzTc yy _ nt44u y El i% Name(Pnnt) C ntMatkass706 pO2- L (.y�rika-� Tphne Signature 2.2 Authorized Age x 1 0- A/(/�1 21 � 1 ✓'�O Ili- 9I � 1 o 1 flL f • I Name(Pnn Current Mailing Address: 477 gDl Jf23 z- o%b Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1940 / at (a)Building Permit Fee 2. Electrical (ff (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection /� .t 6. Total=(1 +2+3+4+5) 944,, Check Number /b p/1f L7 y(/(Jo This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings pate Section 4. ZONING AU Information 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 Side L: R: L: R: Rear Building Height Bldg. Square Footage DA) Open Space Footage ,n (Lot area minus bldg&pa,ed parking) of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT 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 O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and Location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it pail of a common plan that will disturb over 1 acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement ndows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. 0 Demolition ❑ New Signs [O] Dec [q Siding[O] Other[0 y q1 n .n y Brief Descdpt o. +fP •�� �� id �, �l�iT c - rL�n1 ,r f x Work: 5 • 1 7 i,40i - No &Tita/��/ J.. Alteration of existing bedroom Yes No Adding new bedroom Yes No �/ Attached Narrative Renovating unfinished basement Yes No '1� .''JL4 Plans Attached Roll -Sheet La.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 CONTRACTORNTp' APPLIES/ FOR BUILDING PERMIT L G?�V& `� rT rte" �T , as Owner of the subject property .n,.. hereby authorize 121 TL —Th.. ) A- to act on my behalf,in all matters relative to work aut rized by this building permit application. 4 : Gtnirrz -r,, g-Z3/k Signature of Owner �.y�(j� /fes y�� Date I, h7 �% ' T7 /Z/ ,as Owner/Authorized Agent hereby d claret at the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pr and i enalties of perjur-yr— v--.7- Print Name r , J Z LL ial Signature of Own!/Agent - r Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Nott Applicableb� El Name of License Holder: !`r✓n� e `- `� 2. / v� License Number ly ,4eLJ ki/ Pi 3 —179 Address Expiration Date 6 d epho 'm ,' fr' p1094' Signature Telephone z/o/-623-136-z__ 9.Registered Home Improvement Contractor: Not Applicable ❑ rrik. rtT)atier I ZG 0.93 Company Name Registration Number qD4 b© 4—9 -1 A-ddddd S � �) �j�� Expiration Date ?foe �� , fl L " /' Telephoned/ SZ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 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 th ding permit. Signed Affidavit Attach es 0 No ❑ 11. - Home Owner Exemption The current exemption for-homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 tand on which he/she resides or intends to reside,on which there is, ur 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 shat/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 _ 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: /3t t7/uL0 i S 1/ {( mif • The debris will be transported by: _ /4J t - PITS- The 73The debris will be received by: W(5* W/9"i Building permit number o� Name of Permit Applicant 72e/Ad) -am- -)03-lb r/ed Date Signature of Permit Applicant Jo&Contacts Link Leads >Cko .{ "' — '! i-/ Tuesday,September 20,2016 Comments Lead: 19550118 Go I Advanced Search 12:47 PM Info/Updates Homeowner Information Job Information Commissions Homeowner M/M Douglas Garton Sale Amount $7.454.00 Balance Due: $4,970.00 Homeowner2 Product 6500/6100 Series Windows(8%) Costs Job Site Address 136 hinckley st. Status Sale/Material Ordered Documents FLORENCE,MA 01062 Branch Boston North Measure N 78390941 Sched Measure County HAMPSHIRE Sales Billing Address 136 hinckley st Commission Rate Homeowner FLORENCE,MA 01062 Consultant Name Term Date Split Comp Plan Job Issues Timothy Drost 100.00%Straight Commission Primary Phone (413)586-7706 Labor Update Work Phone Ext. B-Back: No Cross Refit 1-8207619712 Siebel Ord... 115961 Order Detail Cell Phone Key Dates Work Phone 2 Sale Date 9/10/2016 FUP Date Order Entry Cell Phone 2 Credit Date 9/10/2016 FPD-Customer Payments Email d.a.gartonou812Qgmail.com RTP Date 9/12/2016 Post Install Date Permits Cross Street Start Date FPD-Home Depot Inspection PO Matt sting Referral Store 8452-HADLEY Job Indicators Result Combo Base Store 8452-HADLEY Lead Paint:Purchase/No Test-LSW (�� / ' Lead Source 0080 Store Associate-OLS \U w Services /^, lJ !!!'''��� Show Map ( vim^. 20 I 1 / ��UJ (r'Pv�//YYJJ(J C 1 TouchPoints Update Job User Date Time Status Corr. Appt.Date AppL Time Consultant 1 Ashley S Asigbey 9/19/2016 2:12 PM Material Ordered No 9/10/2016 4:00 PMTimothy Drost Work Orders PETER TALBOT 9/18/2016 11:03 AM Order Received-PSG No 9110/2016 4:00 PMTimothy Drost PETER TALBOT 9/18/2016 11:03 AM Measure Complete No 9/10/2016 4:00 PMTimothy Drost Cythina Raglin 9/12/2016. 10:56 AM Released to Production No 9/10/2016, 4:00 PM Timothy Drost Cythina Raglin 9/12/2016; 10:49 AM Order Entry No 9/10/2016', 4:00 PM Timothy Drost Timothy Drost 9/10/2016: 5:46 PM Credit Pending No 9/10/2016 4:00 PMTimothy Drost Timothy Drost 9/10/2016 5:46 PM Sale Pending No 9/10/2016. 4:00 PMTimothy Drost Dayend Dayend 9/9/2016 9.07 PM Sent to the Field No 9/10/2016, 4:00 PMTimothy Drost THERESE MARTI 9/9/2016. 10:35 AM Confirmed-Left Message No 9/10/2016'. 4:00 PMITimothy Drost Internet Lead 9/5/20161 9:10 AM Pre-Book No 9/10/2016 4:00 PMTimothy Drost .Internet Lead 9/5I2016. 9:10 AM Lead Entered No Close I Print I Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126894 Salesperson Name and Registration Number: Timothy Drost : HIS 0553710, R-R-073-15-00005 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or 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. Customer Information: Douglas Garton 9550118 First Name Last Name Branch Name Lead 136 hinckley st. FLORENCE MA 01062 Customer Address City State Zip (413) 586-7706 Home Stinnett Work Pbonekt Cell PM1oneb d.a.gartonou812@gmaiI.com Cusmmer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com 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 PROFESSIONAL, 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 DEPOTS EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR 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: X 09/10/2016 Customer's Signature Date 1 Distribution: White-Home Depot Yellow-Customer Copy r WINDOW SPECIFICATION SHEET - Spec.Sheet W'. 9550118 Sheet. 1 of 1 Customer. Douglas Garton Job P. 9550118 Consultant: Timothy Dmst Date: 09/10/2016 • New Window Existing Window Hinge Locations Measurements Grids Product Options. Labor Options Frurn ouDide. Lett to Right Bays,Bowls Location Color Rough Opening P of bars ri of bars Csmnls,I Pah use L.R ur S Glass Misc Items HardwarScreense Code For doors Hr at Mull 'g=stationary or Styria Wraps g a fe 'ry 8 'P 2 XmPsra brig G Room Floor Cope (YM) Style Code Series Code _ 3 9 r m U a 6 sm rap reit r Ise SIB TMP Full. r LSR 2 BED 2nd CI Y CI 6100 V31-1 CH 34 00 30 00 64 ClossPack Siannard L a OATH 2nd on a OH smo MI 19.31) 45 00 64 Bia3sp,d, sE3333,33 STD Cla33P333 siodeer F.LOP SIC IMP Full. F.LSR 6 DINE ls.l PD Fs PD03 6100 WH CB 95 25 73 50 174 G133313333 sionaard a s SPECIAL CONSIDERATIONS. Wrap Color DISCI:Cut mull MISC2 Cut mull,MISC3 Cut mull•MISC<'.Cut mull DISCS Cut mull.M Senor Casing Type 18C6 Cut mull Bay or Bow window. Sealboard material(vinyl only-Birch or Oak) Bay Project Angle(30 Or 05( 3ay Flanker Type(CH.SH.or Csmntl Top of window to sonn(Inches/ if tied to soffit.color of soffit material I have reviewed and agree with all the job specifications above and the .construct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window Seaboard Material(vinyl onlpWhite Picnile.Birch or Oak) Was TMdness(inches/ Customer Signa re Additional Shelf Yes or No) •There is no guarantee that new shingles will match existing color Job Contacts Link Leads >C4-1-2,Y1--e_/ Tuesday,September 20,2016 . Comments Lead: 19564880 Go I Advanced Search 12:50 PM Info/Updates Homeowner Information Job Information Commissions Homeowner M/M Douglas Garton Sale Amount $2.372.00 Balance Due: $1,500.00 Homeowner2 Product Wincore Entry Doors(8%) Costs Job Site Address 136 hinckley st. Status Sale/Order Received-PSG FLORENCE, MA 01062 Branch Boston North Documents Measurek 78409848 Schad Measure County HAMPSHIRE Sales Billing Address 136 hinckley st Commission Rate Homeowner FLORENCE,MA 01062 Consultant Name Term Date Split Comp Plan Job Issues Timothy Drost 100.00%Straight Commission Order Detail Primary Phone (413)586-7706 Work Phone Ext. B-Back: No Cross Reit/ 1-8355581562 Siebel Ord... 115994 Order Entry Cell Phone Key Dates Paymenlg Work Phone 2 Sale Date 9/11/2016 FUP Date Cell Phone 2 Credit Date 9/11/2016 FPD-Customer Permits Email d.a.gartonou812@gmail.com RTP Date 9/15/2016 Post Install Date PO Cross Street Start Date FPD-Home Depot Marketing Inspection Result Combo Referral Store 8452-HADLEY Job Indicators Services Base Store 8452-HADLEY Lead Paint: Purchase/No Test-LSW I �� Lead Source 0205 SC Working Store Show Map Touch Points Update Job User Date Time Status Cor Work Orders - - .App[.Data App[Time Consultant 1 • Erikka M Lewis 9/16/2016 7:14 PM Order Received-PSG No 9/11/2016 1:00 PMTimothy Drost David Richter 9115/2016 9:32 PM Measure Complete No 9/11/2016 1:00 PM Timothy Drost (Heather Hill 9/15/2016', 5:03 PM Released to Production No 9/11/2016: 1:00 PMITimothy Drost Heather Hill 9/15/2016 5:01 PM Order Entry No 9/11/2016. 1:00 PM'.Timothy Drost Timothy Drost 9/12/2016 5:04 AM Credit Pending No 9/11/2016 1:00 PM Timothy Drost .Timothy Drost 9/12/201615:04 AM Sale Pending No 9/11/2016 1:00 PM[Timothy Drost Dayend Dayend 9/11/2016. 12:30 PM Sent to the Field No 9/11/2016: 1:00 PMITimothy Drost Irania Cortizo-huert 9/11/2016 12:24 PM Confirmed-Customer No 9/11/2016 1:00 PM Timothy Drost 4rania Cortizo-huert 9/11/20161 12:24 PM Pre-Book No 9/11/2016, 1:00 PM Timothy Drost Irania Cortizo-huert 9/11/2016 12:23 PM Lead Entered No I Close I Print Sep 121604:58a P ) • HOME IMPROVEMENT CONTRACT PLEASE READ THIS � 1/ Sold Furnished and lunged by. Bench Name:New England Date:-A—111/`-] IC., THDAr-Home Sem-ices,Inc. dbla The Home Depot At-Homo Semen Branch Ntmtban:31 908 Boston Turnpike.Coit I.Shrewsbury.MA 01555 Toll Free BTI-9013965 Federal ID a 75-269%560:ME LICK C 0153h RI Cort:ice 16427 ' I CT sic c FRC 0565522;MA Hone Improves-rat Conoco R . I eg.a 26993 Installation Address: 13ry (0 fn)eb:(OtjF1 ono 5-4- Mecr 1 Cis, State Puncha¢r(s): Woo Phone: Han Phone: CellPhone: I -LLuI I a-c Ateresizr, L I r 1 1 1 1 - : 1 1 i1 ) t [ 1 Home Address: (If different from Installation Address) City State Tip E-mail Address to receiveproject communications and name Depot updares;: ❑I DO NOT wish to remise any menet ng cleans from The Home Depot Project Information: Undersigned("customer'),the owners oldie premny located at the above installation address,agrees to buy. anc THD At-Home Services,Inc_Vibe name Depot)agrees to furnish.deliver wJ arrange for the insailatian("Installation")of all mated:is isaihed on ere below an on We referenced Spec S'xm(s),all of which are incorporated into this Contract by this reference,along with any applicable State Scpplencnt and Puyrrent Summary attached hereto and any Change Orders(cohetlively, "Contract"): bug: m.,aaa ne..,.a Products: CY'-Rmfing Y1 Of SvecShert(sl a'. Hulett Amen id9 [0 H'tndmvs J Inaulnam 456q(d60 [anersar'.mver Doors 4,31133 5 X372 1 • 'ancone prong O Windawa C Inaolarnn O�re..u�a�ema Coven QEUNyDotrs❑ S I CDRocm.rg ❑siding 0 window, 0 ,l tins 1 • Carters/Covers OFaryDoors❑ 5 iRmlinp• siding 7 windows J lmulmi n - j DC—runes/Carer. CEno Dasa ❑ $ • MoimmnLc%e Dep®terCoatsa}Anmm due upon auatim of this enamel Mane Purdwscs may rmdepmit mere thanone-gird aftheCOntractAmount Total Contract Amount $ 2 '"J� Customer agrees that. immediately upon completion of the work for each Product,Customer will execute a Completion Certificate lone for each Product as definec by an Individual Spec Sheep add pay any balance due. As applicable,each Customer under this Contras agrees to be joint:),and severally obiinated and liable hereunder. The Home Depot reserves the right to issue a Change Order or tenminate this Conran or any individual Preduct(s)included herein,at its discretion,if The Home Depot or in authorized service provider defemrines that it cannot perform its obligations due to a strucuml problem with the home.environmental hazards such as mold,asbestos or lead paint ether safety concerns,pricing errors or because work required to complete the job was an included in the C( 11 ontrraL Contract. b Payment Sunman: The Payment Summary V l(V ? 7 ,included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and foal payments by Product[as appkmable). NOTICE TO CUSTOMER Yon are entitled to a completely filled-in copy of the Contract al the lime you sign. Do not sign a Completion Certificate(tote: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product Is conrp4le. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,«roses and services provided by The Home Depot or Authorized Service Proof der through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME 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 AMOUNTS. Ace Lana and Authorization: Cua:omer agrees and understands that this Agreement S the entire agreement between Customer an> a ire Heine Depen with regard Co the Products and Installation services and aupendes all prior disematons and agreements,either oral -urilen,relating to stud Products mid Installation.This Agreement cannot be ocsigned or amended except by a writing sigcd by Customer and The Home Depot. Customer ackmwiedees red agrees that Customer has mad.underuonds.voluntarily accepts she Huns of and has tennis cd a copy or Mir Agreement. Accepted by: Submitted by: l l YV` , \ n T .1Oe I Cu cc Bien sure .e Sales Consult:aUN Signature Dim 7i1,rd., ' z.,i /0. 1 Telephone No. oto.miner's it Au Date Sales Cumrtant Licenser No. _ CANCELLATION: CUSTOMER MAY CANCEL THIS s:teacmt`a AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME I / 2 /_ ^'J ( t— } DEPOT BY MIDNIGHT ON THE THIRD ausrNeSS Yl l �J lb L t °1 DAY AFTER SIGNING THIS AGREEMENT. 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N amww "' .1.16 awnv)' CDolcnkl1t $oX" „ ,N' ants - f ..a.� ^ e4urarnam - '' `? t- .maw ` r . err . ,arm.", /411A.m4.�oa , . GCVFY Z d eVS 4e BL Z L de :/82016 2016 CS IJO Ray Hunt 001.1pg CS-002485 RAYMOND M HUNT 14 MELIHIAN DR WILBRAHAM MA 01095 03'0112018 haps://mail.googlo.GaNmaiAnblu:/15356cOde8o3947d?Projectw=1 ---> CORD CERTIFICATE OF LIABILITY INSURANCE X812016(MIVDDITYYT v 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 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 CONTACT MARSH USA,INC. NAME: PHONE :3560 LENOX ROAD.NO ALLIANCE CENTER 24C0 EMAIL ew' IISK,Not: ATLANTA GA 30320 ADDRESS: MSUREWSI AFFORDING COVERAGE I NAILS I00492HonieOGAIN'4641 INSURER A:SSW:1WSI NISW2nre CclralY 126387 INSURED ZurichAnIPI®nylBlla113C0 IIu 355 THD AT-HOME SERVICES,CIC. INSURER e: DBA THE HOME DEPOT AT-HOME SERVICES NEUTER G:New Hampdvm Ins Co 123341 2690 CUMBERLAND PARKWAY.SUITE 300 WSURER O:Mins National InsuranceCrcryany 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003146646-14 REVISION NUMBER:a THIS IS TO CERTIFY THAT 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.LIMITS SHOMM MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTSR R TYPE OF INSURANCE IIN D'BMID HMV/NUMBER buDD YFFF TRP I LAMS IrAVacY EFF IMMIOWYS'S'1t A X COMMERCIAL GENERAL LIABILITY GL048/3TI144 03110112016 I03B11i2017 I EACH OCCURRENCE S 9.W3J003 X CLAWS-MADE OCCUR /PR YSE51F2omuL TO m,l®1 IS 1.000,000 LIMITS OF POLICY XS MED EXP()LH one peas") •3 IXcEXCLUDED Of$IR:SIM PER OCC -PERSONAL&ADV SOUR? IS 9000'000 INJ G EN'L AGGREGATE LIMIT AP PLIES PER 'I GENERAL AGGREGATE IS 9000000 X POLiCv PRO. 1 _ JEU _ LOC PRODUCTS-CAMPIOPAGG S 9.OD3.D.a OTHER I S B AUTOMOBILE LIABILITY RAP 293/3863-13 :03101I29I$ .03/01(2012 i COMBINED SINGLE Lith �s 1.000.003Y Ha ama nll ANY AUTO __ • I BODILY INJURY IPVPpvn) I S AUTOsnIEO SCHEDULED uIDS L_0 SELF INSURED AUTO PHY DMG I,WwLV INJURY Per accident)] :ICN-0WNEC PROPERTY DAMAGE HIRED AUTOS . __.AUTOS •(Pgr a7J0eln) i 5 • UMBRELLA UAB OCCUR •_ I EACH OCCURRENCE :s EXCESS LIAR CLAMS-MADE I AGGREGATE SI S DEO RETENTIONS I IIS G WORKERS COMPENSATOR IWC0155I9215IAOS) 1030112016 E3/01/2011 I X PER IOTH- E (AND EMPLOYERS'UABILT' 1.I N' )STATIJIE ER OFPROPRIETOR/PARTNERFxECUmvE IIWC015519211(AK,KY,NH,NJ,Vt) 103101/2016 ' 311111201/ 1000000 FFICERIMEMSER EXCLUDED, N ',NIA SEL EacHACGDExr S D IMandaloy in NH) WW135192101FG .03)01)2016 iO3/010017I If lops desrnce underE.L DISEASE..EA EMPLOYIT S 1.00(1.000 'DESCRIPTION OF OPERATIONS below �IDOiNIrttl on 4AtlNOn9 Page l 1 EL DISEASE-POuCY owl-Is 1,000,000 I • DESCRIPTOR OF OPERATORS I LOCATORS I VEHICLES(ACORD 101.AddIEonal Remahs Scheele.May be A4[nn N mom space is Lequbed0 EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA.GA 30339 AUTHORIZED RFPRFCFNTATNE of Marsh USA Inc Manashi Mukherjee _M<...mL- 4d sJaa`e^des- (g,1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. RICHARD TROIA 2455 PACES FERRY ROAD, HSC C-11 ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address Renewal Employment r Lost Card Office of Consumer Affairs R Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 126893 Type: 10 Park Plaza -Suite 5170 Expiration: 8/3/2018 Supplement Card Boston.MA 02116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA ' 2455 PACES FERRY ROAD, HSC — I A7IANTA, GA 30339 Lhrde sevretary ' of va id without sibuture Iil I' '( �:I Ill' + 'CII ill n p . , :014 r'�1Gii 1, L?1L' I,I I#. Eng p lf,.„ 'ilrw.(gYl1I „- lA #'J` e, . E k '� ,.,Ii9•Q )I t 0,3 I,IJ; : slV 74 h\.I ..IltijP..•ip I i,>�1�.1, fI 1I pl y�. �il q'I .. I� Ii' G-r �I � ,..1i�I,I' fJ S '� 1x f `II`p ildl (I ' i,4� rtS1 Lf ? nl'O , u rl q s: 4'; 'd (p cP,J(( }}tit 4 !: f p 6'� /; : n 71 J °.2' ,1(sd'� f. E'� I I li li 4P I:. 1 A tl . Iii E. '� ;;, E �2' ,� rlp pF 4 ii n b I la u C^i j I) "I{I .a, hI:;T Y14 �'1'1f Iflr t a ..iuy 1 t 9 >li Y : f^ n Id ��II m �' �E.II N W114 �t pfI I it 15.114 II CS) Ifl `° �l 0} ,yI, ,).�ll M1I I' �,i II fl FS_! :Fig( {, co .. WI.r.T: :: "�L 1'` I ('!"41 I ' P .. ,CJ Q I 01/11,„,4 ii I N .. ril ff.! r�yn �I if, Et N} ` �T , ^r ygr,N:Ji„A(n,lylly�lcd° I�Ndf it I, Iu I'll (I till I�1 . ... uC 27 "7 ii 1 �> . J. Sc 1.9 .n s 3 ! ;111 ..... �.. 1• , now.' f '9t }I # 0 1/l blu i:� f• I' til I I it 'p'!I I t° c.9:U IFI j)i'J. 1 'rti u 'I ,,. , ��: iq li rEr he Itis dt, ,.r (i :, '' ir 6n a Ea Pa:, l 4; S di I;' IE 4j I y r Jia E'r� av it ' ' � y e - To 611112 (m` 1/ a : } �� in b n S,in f# �E I, „�.' 11 m1n 6 in c' n Iti �,, k d IA'N v ' u N+' -II IP'i,,�� '{'•.E i. 9 I rnr+ DSII h';” ' g }� n �' � �� 'I'i�9 �I li 2� ' e_'s t Fw m" Ca-,'_7 I. li in . [c[ W c 1/l n Y "t I I I�.p Si1 per' 7�1 Co UA aEl Gri �#0 IC.10 it J, b. it Fig !i1iIi � P • 0 g: • `m` The Commonwealth of Massachusetts Department of Industrial Accidents ai Fae .1�= (i I Congress Street,Suite I DO Roston,.MA 02//4_3017 www.nmss.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information pr. ]j.��-��.���,,P�lease Print Legibly�l Name(Business/Organization/Individual): Cm�i pY-feet) pr ' } ciyl�_ .�.7CTZt')� S Address: �J � �%1/ tali;' 10f'-.hkc City/State/Zip:l.'JT/I�'Q[-j;via; ,P-1 rn4'C'11i�/4honet{: th2-"ttl"L2/2_- are you on employer'Check the appropriate box: Type of project(required)'. I lam a employer with employees(full and/or parr-time).' 7. Li New construction 2.0 1 am a sole propnetor or partnership and have no employees nwrking for me In any capacity [No workers comp insurance required) S. ❑Remodeling 3 I am a homeowner doing all work myself:[No workers'comp.insurance required 9. El Demolition 4�I am a homeowner and will r nrocenr. Nal l be hiring contractors to conduct all troon m IO� Building addition ensure that all contractors either have workers compensation insurance or are sole I I.fl Electrical repairs or additions proprietors with no employer's. 12.❑Plumbing repairs or additions 5. I am a general contractor and l have hired the sub-contractors listed on the attached sheer I;. Roof repair?y airs These sub-contractors have employees and have workers'come.insurance.- �y 6 We are a corporation and its officers have exercised their right or exemption per MGL c. 14. Other /I/ eV/�a�J 152 31(43 and we have no employees.INo workers ,comp insurance required.) 77 fi1/rin'N E9.' 'Any applicant that checks box Al must also fill our the section below showing their workers'compensation policy information. �V✓�`� t Homeowners 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. Insurance Company Name: y+ t7j` .. Policy#or Self-ins. Lig 4: U,)t/ V itis IE-lh Expiration Datee�,/J '��s,) r 17frf Job Site Address: ) 17 � City/State/Zip:/ L f//e..arv(t ,414 Attach a copy of the workers'compensation po cy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do It thy certiif ii de tn'' p-entries of perjury that the information provided above is true and correct. Signature: G�" � / ,24111/' Date: �l dal - 16 Phone#: :J-462----4 / `j(2- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License 4 Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: