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31B-188 76B GOTHIC ST APT 2 76B GOTHIC ST APT 2 BP-2021-1348 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B- 188 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:window replaced BUILDING PERMIT Permit# BP-2021-1348 Project# JS-2021-002224 Est.Cost: $9850.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 106106 Lot Size(sq. ft.): 13808.52 Owner: RUESCH DEVON Zoning: URC(100)/ Applicant: HOME DEPOT AT HOME SERVICES AT: 76B GOTHIC ST APT 2 Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 0 Workers Compensation NORTH PROVIDENCERI02904 ISSUED ON:5/17/20210:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 13 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: Cas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON PO VIOLATION OF ANY OF ITS RULES AND REGULATIONS. i 0 4 • j • Certificate of Occupancy Signature: I FeeType: Date Paid: Amount: • Building 5/17/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ^' `--- City of Northampton Status of Permit VE'' R l- Building Department Curb Cut/Driveway Permit use only 212 Main Street Sewer/Septic Availability n 1 7 �021 Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans r15-pT pho e 413-587-1240 Fax 413-587-1272 Plot/Site Plans °J!�ATMA!r4�,ON,'p�q n,� NS Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: - I This section to be completed by office 5 6.-eh'c S --4 /4+ Z Map ,_,3/.6 Lot / gff Unit //" a.-, /t^ MAD/O6o Zone Overlay District G Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .p Dew, /1NCSvL 4 S &oi uc 5/yee.11 fffi7IZ Name Print) L Current li=g6s. /g 6�/ �(�¢N C /ic..s�f/ Telephone 7 Signature 2.2 Authorized Agent: 6 - ' d Cia ete/ 4- 7 At /'4• ( Z a•tG 64 r 744 4 Cr Name(Print) Current Mailing Address: pc& 33 i j 1 �v 860- 9.f2 - Y!! z S g n/ lu�fe�f Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building l Q o 9) do (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 !�p 6. Total = (1 +2 + 3 +4 + 5) ss` 7 Q8� . at) Number a� 7 This Section For Official Use Only Building Permit Num er: tof-I�cd Date Issued: Signature: 7 Ge 5" 17 ZOZ Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information 1:.yfisting Proposed Required by Zoning This column to be filled in b_y Building Department I,ot Size Frontage Setbacks Front Side I.. R: 1. R: Rear Building Height 131dg. 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 O DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW .r YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW O YES O 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 er 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 0 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 O NO \J 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 indows Alteration(s) [] Roofing n Or Doors [1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [O] Other[0] Brief De cription of Propo ed Work: 0ly61� 4-.4 ate. I I., eh✓L /1-ke � �(ke w/f� na .s 4,4„ e tx„,c5 . U ac:t r o, Alteration of existing bedroom Yes 1"—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 dea0,1 '1 ke st-t• , as Owner of the subject property hereby authorize zio ite.4 ,t7{ s 1 u 1.3tG �?{��i�l �C•�.c.f-( to ac n my be. , in all matters relative to work authoriz d by this building permit application. re e J S- �� z/ Signature of•� ner Date I, 60,a(e' C/aMI/ , 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 under the pains and penalties of perjury. Cfaxui J� Print Name Signature of OwneriAgen Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable El Name of License Holder G ��en�ti Cj...t h4"4 i� / E r fei t `DD eotecielit c� /o (o fa G I1 License Number Z 3 (3C..ka44 Sf sa�,'i ! eia �11� otlo? f,2`/e2- Addre s I Expiration Date ..‘ 11,4 ) 4 - giS - 535' - 57 z Si ature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number LY.S3 Awes ki") /" a ,f-- a"'4`' 6A ;0 339 c//Z zI 15 Address Expiration ate (H71 ) Telephone g°— ILL Vir 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 Q" 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 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 he 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-Deal Zoning Laws and State of Massachusetts General Laws Annotated. homeowner Signature Cr, t r y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette Cit►' Center ' . . ?.-ft'enue de Lafayette, Boston, MA 02111-1 i50 • www.mass.Rov/dia Workers' Compensation Insurance Affida it: Builders/Contractors/Electricians/Plumbers Anulicant information Please Print Leeibly Name iaustnessorganizationIndividual):Home Depot USA. inc. Address:2455 Paces Ferry Rd City/State/Zip:Atlanta. GA 30339 phone#:860.952`4112 Are you an employer?Cheek the appropriate box: Type of project(required): 1.❑ 1 gin a etnpluy+et with ,—_ 4. ; 1 am a general contractor and 1 have hired the sub-contractors 6. New construction employees(full andior pari-time)." _'_E I am a sole proprietor or partner- listed on the attached sheet. 7. Remodelingship and have no employees These sub-contractors have g. Demolition working for me in any r capacity. employee and have workers' 9. Building addition (No workers' comp.insurance comp. insurance.' required.) 5. (I we art a corporation and its l0.D Electrical repairs or additions 3. j I am a homeowner doing all work officers have exercised their 11.3 Plumbing repairs or additions myself (No workers' comp. right of exemption per MGL 12.0 Roof repsiir4 insurance required.)' c. 152. 1(4)..and we have no Windows employces. [No workers' till Other comp. insurance required.) 'Any applicant that checks but Pt must also fill oat the section below showing their wralktxa`cvmpensatiun pokey information. +Homeowners who submit this affidas it indicatingthet ire doing all wutk And tht-n hire outride contractors must sutxtat a new affidavit indicating such. 'Contractors that chock this bra mtmt attached an additional shut showing the name Of the sub-cx cttracturs and state is hethti ur not those=hula.have exr+.rt,t..,:, 1"th.•.iz--contrict•>rktra._•_rnt+l.,ycc+. 414:+ r,!z-S r* it.4:'ht ,sofk.a>'c,rrnr ta'ltr•numhtY. I am an employer that is providing workers'c ompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:National Union Fire Insurance Co. Poky#or Self-ins, Lie. e:XWC 1647259 (OS1) (MA) Expiration Date:3/1/22 Job Site Address: 3-6.(S Go i- z City/State/Zip: ,v'oid4a. A.Po "1/t e2/06 e Attach a copy of the workers'compensation policy declaration page(showing 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 ties. 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 Investi`iations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct_ SiV,nature: r Date: 2- I Phone#: 860-952-4112 Official use only. Do not write in this area,to be completed by city or town ofciaL ( its or Town: Permit/License Issuing Authority (check one): 10Board of health 2[]Building Department 30CityfTown Clerk 4.DElectrical Inspector 5.Li'lumbing Inspector 6.DOther Contact Person: Phone#: 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: +t3 ("1 o ve. S'�r�� 4-Z The debris will be transported by: Gk .v The debris will be received by: (-4 p 4 to S . v-c a c cT Building permit number: Name of Permit Applicant Cr,.'-' 20 Z/ Date Signature of Permit Applicant City of Northampton 1` 4,„ OS y�`.� Massachusetts"r/t . . , ,� DEPARTMENT OF BUILDING INSPECTIONSLti 212 Main Street . Municipal BuiIding Northampton, MA 01060 77. INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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, (pt.,,,.t N ue sL4 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 S'ry— i'Ll Address of work location ' 6 ti 6 �o -e S//«f L f /4/0/4.e7 44 114 0(060 Go Permits, LLC 105 Buttonball Lane ..--'\,-. / Glastonbury, CT 06033 I ri r) I I �� 1 ` .. F „ ,_ ilJli . _, , ' Scott Doughman ,:; Phone: 860-952-4112 Fax: 860-430-6719 \�, scottdoughman@gopermits.org Re: Massachusetts Solid Waste Affidavit Good day, Please find attached locations where the installers can bring their debris from the jobs. These are all Home Depot USA, Inc. locations. • 72 Shaker Road, Unit 2 Enfield, CT 06082 • 32 Scotland Boulevard Bridgewater, MA 02324 • 375 Airport Drive Worcester, MA 01602 • 12 Linscott Road Wobum, MA 01801 • 50 Maria Ave Johnston, RI 02919 Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1VOX2BKF Sheet: 1 of 2 Customer: DEVON RUESCH Job#: 1-1VOX2BKF Consultant: Kyle Harmon Date: 05/06/2021 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,A or S Glass Misc Items Hardware Code Screens For doors use ?ks c c o Mull "S"=stationary or iiti f Style Wraps a 9 LL d q m G f o `� o "X"=operating Room Floor Code (Y/N) Style Code Series Code _ x 5 H�vi t 2 > x � > x STD,White, GlassPack: WRAP,LSR 1 ENTRY 2nd DH- Y DH 6100 WH WH 27 53 80 S, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H STD,White, GlassPack: WRAP,LSR 2 ENTRY 2nd DH- Y DH 6100 WH WH 27 53 80 S, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H STD,White, GlassPack: WRAP,LSR 3 KITCH 2nd 1 PNL Y 2 PNL 6100 WH WH 35 29 64 Standard X S STD,White, GlassPack: WRAP,LSR 4 KITCH 2nd DH- Y OH 6100 WH WH 30 53 83 S, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H STD,White, GlassPack: WRAP,LSR 5 KITCH 2nd OH- Y DH 6100 WH WH 30 53 83 S, WH,W C ALL 2 1 ALL 2 1 Standard HITILT GBG H STD,White,TMP: WRAP,LSR 6 DINE 2nd DH- Y DH 6100 WH WH 30 57 87 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP: WRAP,LSR 7 LIV 2nd OH- Y DH 6100 WH WH 30 57 87 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP: WRAP,LSR 8 LIV 2nd DH- Y OH 6100 WH WH 30 57 87 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard SPECIAL CONSIDERATIONS: 1:White,2:White,3:White,4:White,5:White,6:White,7:White,8:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(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: Seatboard Material(vinyl only-White Pionite,Birch or Oak) WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1-1VOX2BKF Sheet: 2 of 2 Customer: DEVON RUESCH ,Job#: 1-1VOX2BKF Consultant: Kyle Harmon Date: 05/06/2021 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,RorS Glass Misc Items Hardware Code Screens For doors use E _ To Mull "S"=stationary or t E1. E Q 1 o °R 1 o "X"=operating W Style Wraps m 5 k r7 .Q a g 2 E� tl f .N C Room Floor Code (Y/N) Style Code Series Code _ 5 t-ai r-i a J _ > _ x J > i' _ STD,White,TMP: WRAP,LSR 9 LIV 2nd OH- Y DH 6100 WH WH 30 57 87 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP: WRAP,LSR 10 LIV 2nd OH- Y DH 6100 WH WH 30 57 87 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP: WRAP,LSR 11 MBED 2nd DH- Y DH 6100 WH WH 30 55 85 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP: WRAP,LSR 12 MBED 2nd DH- Y DH 6100 WH WH 30 55 85 S, WH,W C ALL 2 1 ALL 2 1 Bottom, GlassPack: HITILT GBG H Standard STD,White,TMP:Full, WRAP,LSR 13 BATH 2nd DH- Y DH 6100 WH WH 27 53 80 S, WH,W C ALL 2 1 ALL 2 1 GlassPack:Standard HITILT GBG H SPECIAL CONSIDERATIONS: 9:White,10:White,11:White,12:White,13:White Wrap Color Interior Casing Type Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(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: Seatboard Material(vinyl only-White Plonite,Birch or Oak) e - ome II epo - erma v a ue o • ro• ucts ' anu acture• •y imonton Without Grids With Grids Style Glass Package Glazing Spacer 1G (1 SHGC U SHGC (all with Argon) Fact Fact 6500 >wning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 , • a Q 0.26 0.21 III • • • :asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 • • • • 0.26 0.22 0 • • • transom 6500 Base ProSolar Supercept 1' 0-27 0.32 • • 0.27 0.29 • • )ouble-Hung 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.24 0 0 • 'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • 0 • 'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 0.27 0.26 • • ?Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 0.29 0.23 a a • 3 Panel Sliders 6500 Base(s 21 SO) Pro Solar Supercept 7/8" 0.29 0.26 e' 0.28 0.23 0 0 • •500 DOORS 3arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 10.30 0.24 I o I a r 0 I el 0.30 0.21 1 o I o 1 a I 0 'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 Oa II 0.31 0.23 II a o • 0 •1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. \wring(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 •' • • 0 0.28 0.21 0 0 0 0 asement 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • a 0.27 0.22 • • • • u e-Hung 6100 Energy Star Pro Solar Supercept 3/4" 0.30 _ o "3D') 0.27 • • • m . , 'icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 7 0.28� o I a 0.27 0.25 I • • • • 'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 0 0 0.27 0.28 0 0 ?Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 0 0.30 0.27 • S Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 I 0 0.30 0.27 • • 100 Doors Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and Washington. 'atio Door INOVO 6100 Energy Star Pro Solar Super Spacer 1" I 0.28 0.26�• •• 0.28 0.23 11.1.r ... 'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 • • 0.28 0.26 0 6200 Homes located only in following markets:Dallas,Denver,Detroit,Phila,Northern NJ,Long Island,NY. \wning 6200 Base Pro Solar SHADE Supercept 3/4" 0.27 0.25 0 I 0 I 0 0 0.26 0.23 •I • 0 I• ;asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 0 • 0 0 0.29 0.17 0 0 • a 'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 0 a a 0 0.25 0.19 0 a • • 'icture Window 6200 Base Pro Solar SHADE Supercept 3/4' 0.26 0.24 • • • • 0.26 0.22 0 • • • Tingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • 0 028 0.21 • • • jingle Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 a a 0 028 0.21 0 0 0 S Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4"_ 0.28 0.23 0 • 0 0.28 0.21 0 • • •tormBreaker Plus 300VL Homes located in coastal areas. \wring SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 0.23 • • • • 0.26 0.21 0 0 • a :asement SB+300VL Base PS/Lami Super Spacer 1" 0.25 0.23 • a • a 0.25 0.21 0 • a a )ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • • • • 0.29 0.23 • • • • jlider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 • a • • 0.29 0.23 a • a a 'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1" 0.30 0.19 • • • • No Gods A-),.ved 3arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 0.28 •, • 0.30 0.25 pep Dots indicate Energy Star certified for that zone _-- Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. ifiN Home Improvement Agreement: Page 1 Home Depot License#'s -For the most current listing visit www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Kyle Harmon Salesperson Name Registration#(Req,in CA,CT,ME,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized 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. 1. Service Provider Contact Information IThe Home Depot j ,The Home Depot A. Service Provider Contact Name Service Provider Company Name (203) 265-7037 K let harmon@homede I _y pot.com Phone # Service Provider Email Address Service Provider License#(s) 2. Customer Information RUESCH 1 DEVON j New England West 1-1VOX2BKF Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 76B Gothic Street Apt2 ] NORTHAMPTON 1 MA 01060 Customer Address City State Zip I (508) 246-1964 I drue004@yahoo.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford `Wallingford —_ CT f 06492 J Address City State Zip 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 SERVICE PROVIDER,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 DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DE ' �0 . WE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW T 6 1 KNOWLEDGE THAT YOU HAVE BEEN GIVEN ' ORAL AND WRITTEN NOT OF YOUR RIGH I 1 CANCEL. Acknowledged by: 05/06/2021 Customer s Signa e 44166, Date a C( +c�rfi • Home Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 07/01/2021 Approximate Finish Date: 07/29/2021 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 9849.80 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price) '1laxinauin deposit ONLY applicable in MI), MA, ME(33%), NJ, WI(99%) Deposit% 25.0 Deposit Amount $ 12462.45 I Remaining Balance $ L738.135 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. Insurance proceeds will will not be used to pay some or all of the total amount of sale. 9. Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing, you acknowledge that: (i) You have read, understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii) all rights and interests under this Agre ent are so ested in the person listed as"Customer" above; and (iv)Electronic signatures will be deemed ri inals for a purp. es. X r 05/06/2021 Customer's Signature Date X /s/The Home Depot L05/06/2021 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) 1E'b /cd/ For any other concerns, contact The Home Depot at 1-800-466-3337 `Os Scope of Work RUESCH DEVON _ ] New England West 1-1VOX2BKF Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Internal Reference) Products: Spec Sheet(s)#: Project Amount 1-1VOX2BKF Windows Entry Doors 1-1VOX2BKF 9849.80 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 9849.80 Notes: Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: VantagePointe 6500-6100-6060 Warranty Warranty Name(s): 0, The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means the Home Improvement Agreement between You and Home Depot, plus (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions")and any documents referenced in or attached to any of the foregoing. "Defect"means any Services that are found not to be as warranted. "Home" means the real property, fixtures and any physical improvements where the Services are performed. "Services" means (I) the delivery and furnishing of goods, equipment, materials, and hardware; and (II) any related labor and services, including without limitation, construction, consultation, fabrication, erection, installation, inspection, maintenance, repair, and testing. "Service Provider" means an independent contractor, authorized by Home Depot, and its employees, agents, and subcontractors. "Work Area" means any property, buildings, or structures necessary for the staging, temporary storing and performance of the Services. "You"/"Your" means the customer identified in the Agreement. 2. HOME DEPOT'S RESPONSIBILITIES: Home Depot or Service Provider will complete the Services in a workmanlike manner and in accordance with applicable law without causing damage to Your Home,provided, however, that Home Depot or Service Provider will not start or continue with any Services upon discovery of any condition at Your Home that Home Depot or Service Provider deems in its sole discretion to be hazardous, unsafe or, materially changes the Scope of Work. Unless specifically contracted to do so, neither Home Depot nor Service Provider is obligated to repair such pre-existing hazardous or unsafe conditions. 3. ASSIGNMENT/SUBCONTRACTING: Home Depot and Service Provider may assign this Agreement, or any right herein, or any monies due or to become due hereunder, and may delegate or subcontract any obligations or Services hereunder without Your consent. This Agreement will not be assigned by You without first receiving Home Depot's written consent, which may be denied in Home Depot's sole discretion. 4. YOUR RESPONSIBILITIES: (a)Payment: You agree to pay Home Depot in full for the Services pursuant to the terms of this Agreement. (b) Safe Access: You agree to provide Home Depot and Service Provider Safe Access to Your Home. Safe Access means safe and complete access to the Work Area,including,without limitation: (1) obtaining in advance of the Services consent,permission,or relief from any covenants,easements,restrictions,or other legal encumbrances affecting the Work Area; (2) providing the location of utilities, whether underground, concealed, overhead or visible, to Home Depot or Service Provider; (3)removing from the Work Area physical impediments, hazards, and building code or zoning violations that affect directly or indirectly the Work Area; (4) removing unsafe working conditions and hazardous materials, including environmental hazards, from the Work Area; (5)providing sanitary facilities to Home Depot or Service Provider convenient to the Work Area(or, alternatively,paying for the rental costs of such facilities);(6)providing all utilities,including without limitation, power,water,ventilation and climate control,in and for the Work Area;(7)removing from and protecting against minors, pets, guests and visitors in the Work Area; (8) keeping permits, if required, visible at all times; (9) disengaging, suspending or terminating any security systems protecting the Work Area; (10)providing adequate temporary storage space as needed for Home Depot's or Service Provider's performance of the Services;and(11) not interfering, impeding, impacting or otherwise disrupting the Work Area at any time during Home Depot's or Service Provider's performance of the Services. (c)No Performance: Services are to be performed by Home Depot or Service Provider. If You attempt to perform or assist with the Services in any way, You assume all risk for property damage and for injury to Yourself and others. 5. MODIFICATIONS AND CHANGE ORDERS: Without invalidating this Agreement, You may authorize Home Depot or Service Provider to perform Services beyond the scope of the Agreement("Change Order"). A Change Order will be issued by Home Depot or Service Provider on behalf of Home Depot, which You may accept by signing.Upon Your signing of the Change Order,it will become part of this Agreement, subject to all of the terms of the Agreement. Change Order may also result from Home Depot or Service Provider encountering conditions at the Work Area that impact, impede or otherwise interfere with the performance of the Services, requiring an increase in cost,time,or both. Following the discovery of any conditions that impact, impede or otherwise cause the Work Area not to have Safe Access, Home Depot may immediately ask for a Change Order or discontinue the Services without further obligation to You. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 1 The Home Depot General Terms & Conditions 6. TITLE AND RISK OF LOSS: The title to and risk of loss for any materials or goods provided to You that originate from Home Depot will pass to You when paid in full by(1)You or(2)the Service Provider as part of the Services. Title to any other materials or goods provided by Service Provider will pass to You upon completion of the Services. 7. WARRANTY LIMITATION ON WARRANTIES AND DAMAGES: (a) Warranty: Unless otherwise stated in the Agreement, Home Depot warrants for 1 year from the completion date that all Services will (i) be performed with good workmanship and (ii) conform to the requirements of the Agreement. During the warranty period and within a reasonable time after receiving notice from You of a warranty claim, Home Depot may, at its sole option (i) correct or replace each Defect, or (ii) remove each Defect and refund the full purchase price thereof to You; provided, however, that all warranties are voided if(1) anyone other than Home Depot or Service Provider performs work upon or otherwise modifies any materials or Services provided under this Agreement, or (2) You fail to pay Home Depot as provided in this Agreement. (b) Limitation on Warranties: THE WARRANTIES PROVIDED IN THIS AGREEMENT ARE STRICTLY LIMITED TO THE FOREGOING EXPRESS WARRANTIES CONTAINED IN THIS PARAGRAPH IN THE WARRANTY SECTION OF THE AGREEMENT, IF ANY YOU ACKNOWLEDGE AND AGREE THAT NO OTHER WARRANTIES ARE MADE OR GIVEN BY HOME DEPOT OR SERVICE PROVIDER,INCLUDING ANY WARRANTY FOR FITNESS OF PURPOSE, WARRANTY OF MERCHANTABILITY, OR ANY OTHER ORAL,EXPRESS OR IMPLIED WARRANTIES.HOME DEPOT'S EXPRESS WARRANTIES ARE VOIDED FOR ANY DEFECT CAUSED BY ABUSE,MISUSE,NEGLECT, ACTS OF GOD,LACK OF PRESCRIBED OR STANDARD MAINTENANCE, OR IMPROPER CARE/CLEANING. ANY MANUFACTURER'S WARRAN PIES PROVIDED FOR GOODS, MATERIALS,OR EQUIPMENT WILL BE PASSED THROUGH BY HOME DEPOT TO YOU, AND YOU AGREE TO LOOK SOLELY TO SUCH MANUFACTURER FOR REMEDY OF ANY DEFECT IN SUCH GOODS, MATERIALS, AND EQUIPMENT. HOME DEPOT MAY ASSIST YOU WITH WARRANTY CLAIMS AGAINST MANUFACTURERS. (c) Limitation on Damages. Home Depot will not be liable to YOU for indirect, incidental, special, punitive or consequential damages RESULTING FROM PERFORMANCE OF THE SERVICES, including, BUT NOT LIMITED TO, damages for lost opportunities, OR lost profits. 8. TERMINATION: This Agreement may be terminated by Home Depot for its convenience, and by either party for cause if the other party fails to correct a material breach within ten (10) days after receiving notice from the non-breaching party identifying the breach.In the event Home Depot terminates this Agreement because You fail to provide Safe Access to perform the Services, or if either party terminates the Agreement because You decline a Change Order request resulting from unforeseen, hazardous, or unsafe conditions or conditions that materially changes the Scope of Work,then You will pay Home Depot for Services provided through the date of termination plus any costs or expenses incurred by Home Depot or Service Provider as a result of the termination, 9. CHOICE OF LAW; SEVERABILITY: This Agreement will be governed by and interpreted in accordance with the laws of the State where the Project is physically located. The parties intend for the terms and conditions in the Agreement to be complementary, consistent, and enforceable under applicable laws. In the event any term or condition in the Agreement violates applicable law, such term or condition will be severed from the Agreement, but only to the extent necessary to avoid such violation, without invalidating any other terms and conditions of the Agreement, 10. ENTIRE AGREEMENT: This Agreement is the final, integrated, and exclusive expression of the parties' understanding, which supersedes all prior offers, orders, understandings, representations, proposals, confirmations, and negotiations between the parties, whether oral or written. No course of dealing, usage of trade, course of performance, course of conduct, or any other evidence of additional or different terms will be admissible to contradict or vary any term in the Agreement. `, The Home Depot General Terms& Conditions 11. SECURITY INTERESTS: LIENS: If You make all payments as required under this Agreement, no security interest will be placed against Your property by Home Depot. If a security interest is placed on Your property, it creates a lien, mortgage, or other claim against Your property to secure payment and may cause a loss of Your property if You fail to pay as requested. After paying on any completed phase of the Services and before making any further payments, You should request from Home Depot or Service Provider a signed, unconditional release from, or waiver of, any right to place any claim against Your property applicable to the work then completed. You may ask an attorney about Your rights to discharge security interests. 12. RETURNS: Custom order merchandise (i.e., goods that are custom made, uniquely altered, colormatched, shaped,sized,or otherwise uniquely designed or fitted to the requirements of a particular space)is non-returnable, and its purchase price cannot be refunded unless Home Depot or Service Provider(1) incorrectly ordered item, or(2) damaged item beyond repair. Special or custom order merchandise may be returned, and a refund for all or part of the purchase price provided, in the discretion of Home Depot. Please contact The Home Depot for additional details concerning returns. 13. AGREEMENT/SERVICE ORDER COMMUNICATION PREFERENCES:You can visit www.homedepot.com > In-Store Special Orders at any time to access Your account for the following: (1) Update Your Agreement/ Service Order Communication Preferences(email,text,Auto Call);(2)Contact Home Depot for order assistance; (3) View latest order status; or (4) Take action to schedule pickup for Your Service Orders. To stop any of the following communications You may visit www.homedepot.com > In-Store Special Orders to access Your account to update Your Agreement/Service Order Communication Preferences, contact The Home Depot, and take action on orders. If You signed up to receive updates about Your Agreement/Service Order(s) via: (a) Text Message Communications, You may receive multiple messages per order (including current and future orders) via automated technology to the mobile phone number You provided. The total number of messages received depends on the number of orders placed and order activity. Standard message and data rates apply. Not all carriers covered. You can text STOP to 97710 to stop (You will be sent a confirmation message). Call 1-877-467-2581 or 1-800-466-3337 for help; (b) Electronic voice communications (Auto Call), You may receive multiple pre-recorded phone calls per order (including current and future orders) via automated technology to the phone number You provided. The total number of calls received depends on the number of orders placed and order activity. You can press 9 during a call to opt out or call 800-HOME-DEPOT for help; or (c) Email Communications, You may receive multiple Emails per order (including current and future orders) via automated technology to the Email address You provided. The total number of Emails received depends on the number of orders placed and order activity. 14. LEAD PAINT:Homes built prior to 1978 may require additional testing to determine if lead paint is present, and additional precautions if lead paint is present. You will be informed by Your Service Provider of any additional costs resulting from lead paint requirements prior to performing the Work. For additional information, visit www.epa.gov/lead/renovation-repair-and-painting-program. Go Permits, LLC 413 11111 ' 105 Buttonball Lane Glastonbury, CT 06033 PERMITSScott Doughman '\ "" " ` Phone: 860-952-4112 ` Fax: 860-430-6719 scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Home Depot USA, Inc. sold the job and is the G.C. HIC 112785 Exp. 4/22/23 Workers Comp.- Union Fire Insurance Co. Policy XWC 1647259 (QSI) (MA) Exp. 3/1/22 Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor. CSSL-106106 Exp. 9/29/22 HIC 187666 Exp. 5/9/21 Workers Comp.Associated Employers Ins. Policy WCC-500-5021510-2021A Exp. 1/17/22 All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: permits a@.gopermits.orq • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits _A[C:X.)RdDATE TAM x.,yr CERTIFICATE OF LIABILITY INSURANCE 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 poticyfies►must have ADDITIONAL INSURED provisions or 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 solder in lieu of such endorsement(s). PRODUCER CONTACT NAME WIRS1'tSA NC. PHONE cAx "My A.UANCS CENTER fAL" NC EAT Not 3560 LENOX ROAD.SIAM 2400 E-MA_ AT-A NTA GA 303.8 A.QDPEbs :N0UPERj3:AFFORDING COVERAGE ANC I CNIC154: Hom G W.21.22 N1 RER A, Qk1 ReDLLII::rs.,-rl e Cc 34147 MIMED INS,;ER a:Allris arse c 19399 TYE MOLE DEPOT,INC. HOME DEPOT USA-NG Siam EP c. rIsmeRR,-7++.e r:,rrany • PACES FERRY ROAD t#WER D. MALL M C-20 ATLANTA GA 30335 PREP.E INSURER; COVERAGES CERTIFICATE NUMBER A_-5550T222SOt REVISION NUMBER: 2 TO CERTIFY TrtAT ThE ,Et OF INS R.ANCE_1 TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY.1.EOJtREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT'*RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PCUCIES DESCRIBED HEREIN IS SUB,:ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AMR LTR TYPE OF MMAIRMICE A�ObDOI aWrG POliCY MUMBErI t oo'mrt laeroorn POUCY ESP UNITS A x COMSERCLAi GENERAL LIAEIJTY MA9CY3145i4 2301.7019 OSC1.2022 O',.0.RIREMCE a 1,000.000 aaMAGE Tc I ENT :,O.IMS-M OE M _-_ PREVIS a Ea ccavmR t S 1,DOODX1 x 5',R.Si fCC.000 N!ED:xo Ar;ane caws; a EXCLUDED PERSONAL 3 474 IAA RY a 1 CDC.000 GEM1.:YORE•3STE LAST APPLES PER. :B.ERA_A✓DREGATE i 202C.COO POLICY❑• ❑.00 RRC'CI.CTS-GCIAP.OP MG a 21100CDO OTHER 0 • AUTOMOBILE i..U1 itir1Y 1N+1153 t4573 330t'2019 o3rt`.„2022 .O SINGLE LSAT a 1 OOC.COO x .ANY AJTC 5E_r INSURED AL':PMY pus 0CC?Lw AULRY,4fpermit. 5 — CANED srs.EDUiEC ?CO,L*...%AIRY I'er a¢Nerlt S ,AUTOS ONLY AT-OS '�— )(RED NDAllAT.EC a2 CPE.r',DAIAADE AUTOS CAC, _ AJ'CS CAL) Rr•r achxt. s AIBRELIA uaa , E*.c.iocC-P4ReiCE a E}.cE43 JIA.B CN.is4MCE +'.cAECA-S. a e r e=rtERa COMPENSATION i C 552A32591'Al) Ds0t2 21 ..y,_, x I PEF :Tr P AND EMPLOYERS LIABILITY Y i N SSA-- =R �..FR. RtE7ONPATT.�. :).r E , �C�eta<6, bA, 1.2 , T. EEC D� '„.RGERLEABER FY:121PC' N A IMsa6Mcq Si MM4) CCtS!LIec 01!A11O3 P3ge EL.OAEASE-EA ENPLoEE a 500C.000 •,r,aesctiae 61111e, 5 C1Y.000 DE CRi°.ON C4 CREFA'Ce s bee* ?3E.45E-POUCY LACY" a E$e_3 H.0 297110011rr'+5.,1 :_':1 L'r'..C:22'.2 Lett 4000.X0 A EI:,c!S Senn'_ r• MOM vlsec 53..:'- :1> .'t°LI.2..:' U'It 8.000200 C•ESCRIF'O i CC OPERATIONS LOCATION: VEHICLES(ACORD 101,Atlat/cra,P•Nrvrls 7a1MOW.NA,be rtdbMd!!Iron cpaCm I RGATAdl CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA SIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROTC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N BUILDING C-23 OCCORDANCE WITH THE POLICY PROVISIONS ATW(TA aA:C339 AUTNCWRED REPPE SENTA?NE of Mash USA tile Var35P:Muktteree - rLLn.�es- r's 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER D: CNiD1042:f; LOC 3: Atlanta Acc,Rtt ADDITIONAL REMARKS SCHEDULE Page 2 of 3 ABBACY NA&EC INSURED 94R:H ii:4 N: T^E "J=DEPOT HNC. ttCME EPC"JSA.I C. POLICY NUMBER :SSA PACES FERRY ROAD 5UU.DlNG C-20 LT,,4TA/.,.A 30339 CARPER ,rAJC CODE EFFECTVE CA-E: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: Cori'; ace pf L,3p7iitY Insurance Mears Cance's:r Crtra d. 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ACORD 101(2008/01) :D 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 P O BOX 105451 Expiration!' 04122/2021 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. scr.t C. 2Gt4.Oii17 �/ f J.bi Y.wi v.na uwl.�/r r :. yryyi stereo Office of Consumer Affairs X Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suopieirer t Card before the expiration data. if found return to: Rsaistratiorl Eptrauon Otfiro of Consumer Affairs and Business Regulation 112785 04,222021 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston.IA 0211E RICHARD OLMSTEAD 2455 PACES FERRY RD C-t 1 HSC ..w'C&{ iG«k• r _. ATLANTA,GA 30339 Undersecretary Not valid without signature Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston. Massachusetts 02118 Home Improvement Contractor Registration Type Corporation HOMERegistration 112785 DEPOT USA INC P O BOX 105451 Expeabon 04,22'2023 ATTN: LICENSE MGMT TEAM ATLANTA.GA 30348 Update Address and Return Card. Office of Consumec Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: :orpera[.c=n before the expiration date. It found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 'T2755 0 2212023 1000 Washington Street -Suite 710 HOME DEPOT USA INC Boston MA 02118 COURTNEY A.HOWE 24S5 PACES FERRY RD C-1 I HSC ,,.✓. ATLANTA GA i0339 Not valid without signature Undersecretary �--''"'1 EXTER-2 OP ID:OM ACORO DATE PANOISYYYY1 CERTIFICATE OF LIABILITY INSURANCE 0111612021 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED.the poecy(Ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the pobcy,certain policies may require an endorsement. A statement on this certficate does not confer rights to the certificate holder in Neu of such endorsement(s). PRODUCER CONTACT Debbie Marino Canary Blomstrom Ins.Agency ZHowE sAX 8i8 Springfield St. ,� r�u.413-7U-3995 I IAtc,Na.413-786-7004 Feeding Hills,MA 01030-21 si A�:dmarinoecanafybicros om.com . S)AFFORDING COVERAGE NAiC C , NIUBERA:Associated Employers lne.Co. INSURED Exterior Remodeling Group Inc. wsuRER6:Main Street America Group 29939 Eueeniu Ciubotaru 23 Benham St INSURER C. Springfield,MA 01109 INSURER O. INSURER E. INSURER F COVERAGES CERTIFICATE NUMBER: 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDM N OF ANY CONTRAICT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS Si IRIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Arse RIDER BURR POUCY EFF POUCY VIP LIRR TYPE OF INSURANCE POLICY RUINER ItM49OYYYYI 011111130TYYp. UNITS a cossessciAl GENERAL LstuuuTY EACH OCCURRENCE 3 1,000,000 CLAIMS-MADE M.OCCUR. X MPP3376W 07127/2020 07/27/2021 Et4"44E,a R@i+ED $ 500,000 X Business Owners MED DIP,Afsi aria minion! 3 10.000 T PERSONAL A ADV INJ.RY S 1,000,000 GGENL.AG•CREaAT=_LAST APPLYS PER. GENERAL A.GEA LATE 3 2,000,000 OCLICY a, LOC.R THER PRODUCTS-COMP OPAGG $ 2,000,000 $ AUTOMOBILE LIA919TY CGMNNET5 91NGLE JAM . t 1,000 Ea Acoslienn r rE B ;w,AUTO MPP3376W 0V27t2020 DODKY IN.A.IRY,,A4X pence' S `r ALL OWNED --SC,EDULFD - DMA.'e,'Lt3RY,sew OARNTEt S AUTOS AA7C5 t#iED AUTOS N,,fros NED F_RTY SAAUUG f Ati+Td6 , s s. _ l WrBRELLA LIAR OCC,JN EACH OCCURRENCE 3 _,EXCESS LIAR �_CLA.+adw-MADE AGGREGATE �, $ CEO I IREtermINS p 1 M---WORKERS COMPENSATION -'""""' I SSTATUTE1 F X 1 ER , AND EMPLOYERS'LIANUTY A AN P OPR:ETORAArTNER4E ECuc eE Yj ti,,A WICC-500-5021510-2021A 01111,2021 01t1712022 E L EAcwscc oE�sr s '�� OfFICERNENEER ETC:AXE£Y7 L....F'- eessee�t IteandMely In RN) E c DISEAfiE-EA EMPLOYEE 3 r�..1 T s dean Ls sir rilY50� OE SCRIP-GN OP OPERATIONS booty E C.DISEASE-PCFJCY"JMtT 3 DESCRIPTION OF OPERATIONS r LOCATN)NS VEHICLES iACOWO lat.AOaSIO h R*RIMIA StNadwAi,s*4 be*1Egd K moss spat*S•sgWtsd`. ............,..... Home Depot U.S.A.Inc Is named as Additional Insured respects to General Lability. CERTIFICATE HOLDER CANCELLATION HOMEDE4 SHOULD ANY OF THE move DESCRIBED POLICES BE CANCELLED WORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Home Depot U.S.A Inc ACCORDANCE WITH TIE POLICY PROVISIONS. 2455 Paces Ferry Rd C-11 Atlanta,GA 30339 AUTHORIZED REPRESENTATIVE 11A LA Cr C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Thr Oifgsd l*bs+h:Oft a in O1i.r,of EOt/T.thr,taus n of Pae,Frsstuiai tmr rlwr ani#'r f)Frrsx qi Si anoards Public Safety • '* k 0 Mass. ,. Licensee Details Demographic Information Full Name: EUGENIU C{UBOTARU Owner Name License Address Information City. Springfield State. MA Zipcode 01109 Country: United States License Information License No CSSL-106106 License Type Construction Supervisor Specialty Profession Building Licenses Date of Last Renewal 9/14/2020 issue Date 4/1212017 Expiration Date 9292022 License Status: Active Today's Date 9/16+2020 Secondary License Type. Doing Business As Status Change Reason. License issuance _ _.______________.-.________—_ Prerequisire Information Licensee CIUBOTARJ EUGENIU Relationship* Attribute Of License No CSSL-106106 No Available Documents dote avi� - MASSACHUSETTS :_,. ` : DRIVER'S �� -.. +.; LICENSEit- ,. r ` ,i. ,.+ . huneER "''i` ` -- ' . Lir" . 0911512016 AAA444`S4543160 I. Doe ` 1 ' ` 412912021 1 . . , - 09129l198 r . v i►. r^ _. t2 afar • EVJ i k„t lc- ,-> , t NONE NONE .,..........:. 1 .., ‘44,1; • ' 1 L.I li a , U-., . .'', g f2 EUGENIU' . r1,`'t.`� le 23 BENHAM STREET SPRINGFIELD,MA Q1109.2301 'S SEX ki VI,i+GT 6'-02" t-. 5ECcst6Mts Rev OrtZ7216 0912V mice of Consumer Affairs & Business Regulation 4OME IMPROVEMENT CONTRACTOR TYPE: Corratton Registrotioa f xoirition 87566 05.'09/2021 ExTERiOR RE?' OD€L 3 ROUE INC - _ BOTARU *, - ___ "A `O9 Undersecreta &,9e.nOk Uinta-PA autiaorizecso Permits LLc to permits uii using P Pc my i b License if to if)1 6 ana my H[C Registration# I 666 ' _iYV••^mo" ..r ^ ons please call me at: (Li ! 3) 3 3 5=3 7 Oa insuiiier t,ompany cratuu 0 _ ..R pap