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23B-075 (4) BP-2022-0968 84 SOUTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-075-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNRI:(•ISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0968 PERMISSION IS HEREBY GRANTE I TO: Project# window Contractor: License: Est.Cost: 5598 HOME DEPOT USA INC CSSL098785 Const.Class: Exp.Date:04/27/2024 Use Group: Owner: MCDONALD JAMES R& CLAIRE C T'USTEES Lot Size (sq.ft.) Zoning: URB Applicant: HOME DEPOT USA INC Applicant Address Phone: Insurance: 2455 PACES FERRY RD NW 860-952-4112 WC 06588608(AOS) ATLANTA, GA 30339 ISSUED ON:08/11/2022 TO PERFORM THE FOLLOWING WORK: 1 WINDOW 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: n Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only REC E I V t . , City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit ` I AU6 1 1 20� 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability i 1 Northampton, MA 01060 Two Sets of Structural Plans DEPT.OF BUILDINCOPPer41.3-587-1240 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON,MA 01060 Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: Thissection to be completed by office 0 5,,44., pier; S/rt' Map a?3 Lot 0 7,C.— Unit Pvr4^re MA 0/O6 y Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .- �� .�o -S M.c-C)o exa�t A 'y ��04,44 Ma;,! Sire et P4TC,1refili4 / Name(PO t) , Current Mailing Address:veil bb2 1 0 L{0 3 - Z q- -��-t 7— � � /� Telephone Signature 2.2 Authorized Agent: / 6era1J L. (�ia,0A-c./ '�— (cc ��fl,had Gaor- / Wets/nb'^'ry C7c, o33 Name(Print Current Mailing Address: J .7&o QsZ — yi/L Signatur Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ?ia (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) # Lib 5. Fire Protection 6. Total = (1 +2 + 3+4 + 5) 45-pg, as Check Number _ 37Q[f This Section For Official Use Only Building Permit Number: C ?N r '. ((A ; Date Issued: Signature: /./. - e ii- ZZ Building Commissioner/Inspector of Buildings Date Section 4. ZONING All 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 Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 3 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O 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 Gy- 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 © NO Cy 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 D Addition ❑ Replacementows Alteration(s) [] Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [0 Siding[p] Other[DI Brief Description of Propose Work: Reftin+c. 4nd eel*le /w;r7/dw /'& 6i {•K,[ We/ iw S�rK��•-� L�.+ $ 'o- of .30• Alteration of existing bedroom Yes '"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 I, 1�i vtn[ S /t ,c on.a.Q'c] , as Owner of the subject property hereby a -,orize 1 Do po - (ASA . ice I "` k o 5o f s � to act on O' beha f,in all matters Native to work authorize by this building permit application. ! . ' • , 1,L) g —eoo--- Signature of Own! 111111111 Date t.al ✓ C. C/a ' 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. l�r C 6 ' Cra w✓' 74,L Print Name Signature of Owner/Agen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ,/1/r.I I�oS ha.Alt"), ji�I X4 e(i� 4 78 a--a 5 License Number 4 Z S f1f ci &v.'d /n a4J- ► /ti9 6/d c Li/z -/2 y Address' Expiration Date 0� 61fig.d) Bea- 2cz - '/r z Signa ire Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 404a Seri cS/f �c // Z ?-8 s Company Name Registration Number ZYSS PEGS f!//41 Qoa c/ ofial4 303T 9 `7Z Z/2 3 Address Expiration Date Cr Telephone QW-9S2_ yi"Z 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 buildin permit. Signed Affidavit Attached Yes No 0 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 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"certif�i and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Lodal Zo ' g ws and State of Massachusetts General Laws Annotated.; Homeowner Signature / J 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: g''Y �.�. Af'-%�,Sly{ 674/ai The debris will be transported by: ,L-" 1' ham. h f' The debris will be received by: niitc Oer Sly er Building permit number: Name of Permit Applicant 6ev4" C, D� Zv2v ,// C CVA••4 Date Signature of Permit Applicant City of Northampton VH14\ •' Massachusetts �� '�;, �. DEPARTMENT OF BUILDING INSPECTIONSA. trw '�: �,, 212 Main Street • Municipal Building ,Jf Via'; -! Northampton, MA 01060 Ss,., # 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 structure accessory to such use and/or farm structures. A person who constructs more than one home i 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 yoi 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 world 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, M s i-(GRM•Al 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 ?' /0 2 0 Z Address of work location q.i s,4-4 1i1i4 3./7? 1 14,4enrC fr14 0/04L The Commonwealth of Massachusetts 1-- ti Department of Industrial Accidents Office of Investigations k F Lafayette City Center �s Y 2 Avenue de Lafayette, Boston, 4L4 02111-1750 � . s www.mass.gor/dia %%orkers' Compensation Insurance Affidavit: Builders/Contractors/EiectricianslPlu mbers Annlicant Information Please Print Le2ibh Name (business,Orgattuauonlndtvtdual►: Home Depot USA, Inc_ `___- ,._. Address:2455 Paces Ferry Rd City/State/Zip:Atlanta. GA 30339 phone #:860-952-4112 Are you an employer'Cbeck the appropriate box; Type of project(required): 1.0 lam a employer with 4. 0 I am a general contractor and I 6. 0 New construction employees(full and Or part-time).* have hired the sub-contractors __0 I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. D Demolition working for me in anycapacity. employee's and have workers' 9. 0 Building addition [No workers'comp.insurance comp. insurance.* required.) 5. MI We are a corporation and its 10.0 Electrical repairs additions 3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs aramuns myself: [No workers' comp. right of exemption per MGL 12.D Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13_(I Other comp. insurance required..) 'Any applicant that checks box PI must also fill out the section below atoning their%wrier compensation policy information. •Homeowner,who submit this affidas it indicating they are doing all work and then hire outside contractor.must submit a new affidavit Indic ing such. •t'untracturs that check this bus matt attached an additional sheet show ing therife name of the sub-contractors and state whether or not those ontiten.have employees. if the sub-contractors hate tirrrploVecs..ihcti trust prcW tdc that worker,'comp policy number. I am an employer that is providing workers'compensation insurance jar my employees. Below is the policy and job site information. Insurance Company Name: National Union Fire Insurance Co. Policy*or Self-ins. Lie. > :XWC 1647259 (OSI) (MA) L Expiration Date:311122 Job Site Address: fy S'44A Ale•n S` re- City,/State/Zip: �ir1Af' _ __WOO J Attach a copy of the Norkers'compensation policy declaration page(showing the policy number and op lion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal ties 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 O ER and a tine 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 Investigations of the D1A for insurance coverage verification. I do hereby'certUY under the pains and penalties of perjury that the information proitided above is true and correct. Si}nature: -'�'`ef<� - Date. F.—/' - to L Z" Phone#: 860-952.4112 ©/fetal use only. Do not write in this are*,to be completed by city or town official City or Tow n: PermltiLkense# Issuing Authority (cheek one): I ' ID B and of Health 2>J Building Department laity/'Town Clerk 4.DElectrlcal Inspector 5.Eklumbing Inspector 6.[}Other Contact Person: Phone N. _ Go Permits, LLC 11130 111 105 Buttonball Lane Glastonbury, CT 06033 4: PERMITS Scott Doughman Phone: 860-952-4112 Fax: 860-40-6719 scottdoughman@goper#nits.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. Contact is Jason Timm 203-265-7037 72 Shaker Road, Unit 2 Enfield, CT 06082 (USA Hauling 32 Scotland Boulevard Bridgewater, outh Shore Disposal) • 12 Linscott Road Woburn, MA 01801 (ACME Waste Systems) • 535 Grand Army of the Republic Hwy, Somerset, MA 02726 (EZ Disposal) When filling out any solid waste affidavit, it's the installer whom will be removing the garbage and dumping the trash at one of the above Home Depot dumpster locations closest to that job. Thank you, Go Permits WINDOW SPECIFICATION SHEET - Spec.Sheet#: 1 2OJKR5HL Sheet: 1 of 1 Customer: James McDonald Job#:1-20JKRSHL Consultant: Kyle Harmon Date: DB/04/2022 New Window Existing Window Hinge Locations Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bows Location -Cd)or — Ptougtt Opening #of bars 4 of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use c 7-6 Mull "S"=stationery or Wf Style Wraps - Lg, c 0 Q ° 6 a H X"=operating C Room Floor Code (Y/N) Style Code Series Code Lt i o tS a > x° > __ STD.White, GlassPack: WRAP, 1 KITCH 1st GW Y BY-C-45 6100 WH WH 60 37 97 Standard ROOF,LSR L S R SPECIAL CONSIDERATIONS: 1:White Wrap Color Interior Casing Type Colonial Bay or Bow window: Seatboard material(vinyl only-Birch or Oak) 1:Birch Bay Project Angie(30 or 45) 45.00 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)' Yes Special Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite,Birch or Oak) e 'ome 'epo - erma Ta ue o . roducts Manufactured by Simonton Without Grids With Grids Style Glass Package Glazing Spacer /G Fact SHGC Fact SHGC (au n) 6500 ,wring 6500 Base ProSolar Supercept 7/8" 0.26 0.23 0 pop 0.21 0 c ;asement 6500 Base ProSolar Supercept 7/8" 0.26 0.24 ri 0.26 0.2_2 I ransom -_n _ .. _6500 Base ProSolar T Supercept 1' 0rt27 0.32 0 � 0.27 _ 0.29 a _a rouble-Hung 4m 6500 Base ProSolar 3 Supercept 7/8" 0.29 0.26 - 0.2• 0.24 ( ) Supercept 7/8" 0.26 0.28 'o 0 t_ .I 0 • 0.25 - o 1 0 I c icture Casement NH 6500 Base ProSolar 'icture 6500 Base ProSolar Supercept 7/8" 0 27 0.29 0 0 0.2 0.26 i a ti -_.____._., _-- max__ �__ Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 0 1 _ 0. • 023 0 0 1 0 Panel Sliders 6500 Base Is 21 Sgft) Pro Solar Supercept 7/8" 0.29 0.26 ^I I 0.28 0.23 0 - 500 DOORS iarden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 10.30 0.24 I o I o I o 1 0 1 0.30 0.21 1111•1•1• atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 0 00.31 023 • •I• 1 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 i 0[0_ • 0 0.28 0.21 C o c o asement 6100 Base Pro Solar Intercept 7/s" 0.27 0.24 00 0 0 0.27 0.22 0 0 0 0 rouble-Hung W 6100 Energy Star Pro Solar Supercept 3/4' 0.30 0.30 r 01 1 1 0 30 0.27 0 o I�a icture Casement(No Hinge) 6100 Base Pro Solar Intercept 7/8" 0.27 0.28 0 © 0.7" 0.25 0 CI 0 0 icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 0 0 0.27 0.28 0 0 -nil Slid -_ 6100 Base Pro Solar Intercept 3/4" 0. 0.28 0 10.30 027 0 Panel Slider 6100 Base Pro Solar Intercept 3/4"' 0.30 0.29 01 I 10.30 0.27 ' v 1 1100 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" 0.28 0.26 0 • 0.2 0.23 9 • • o I• I I0.26 0.26 I • •i f atio Door NARROW FRAME 6100(P005)Base Pro Solar Intercept 3l4" 0.28 0.30 • a 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 0 0.2, 0.23 0 0 0 1 0 asement 6200 Base Pro Solar SHADE Superoept 3/4" 0.26 0.18 �I 0 0 0 0 0.29 0.17 0 0 0 a icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 I 0 0 I 0 0 0.25 0.19 0 0 0 0 icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 024 0 0 0 0 0 022 • 0 a 0 ingle Hung Supercept 6200 Base Pro Solar SHADE 3/4" 0.28 0.23 0 0 I a 0 0.2 021 a 0 0 Ingle Slider � 0.s 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 0 a 02 021 • • ° Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 I 0 I 0.28 0.21 0 .tormBreaker Plus 300VL Homes located in coastal areas_ wning SB+300VL Energy Star PS SUN/Lami Supercept 1" 0.26 0.23 0 0 0 0 0.26 0.21 a 0 0 C asement SB+300VL Base PS/Lami 0.250.23 0 a 0.25 0.21 c 0 0 rouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 a 0 0 0.29 0 23 13 a a a lider SB+300VL Base PS/Lami Intercept 1" 0.29 0.25 0 0 0 0 0.29 0.23 0 0 _ 0 atio Door SB+300VL ETC 366 PS Shade I Lam, Super Spacer 1" 0.30 0.19 0 • a • NoGrasA'-c:ri T Arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1" 0.30 028 • 0 0.30 0.25 • • • • Dots indicate Energy Star certified for that zone Please Note: Simonton Windows may substitute East&West windows given the requirements of each order. 4, r Home Improvement Agreement: Page 1 P g g too ,f 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 The Home Depot -1 The Home Depot Service Provider Contact Name Service Provider Company Name (203) 265-7037 ,customercancellationnortheast@hom MA: 107774, 112785 Phone# Sg i°ceclgbvider Email Address Service Provider License#(s) 2. Customer Information McDonald James New England West 1-20JKR5HL Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO# 84 South Main Street Florence MA 01062 Customer Address City State Zip (413) 727-3712 ( service_connect_4137273712@prorefferal.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 1 OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 1070 N. Farms Road, Unit 3 Wallingford Wallingford CT , �1 06492 Address City State Zip BY MIDNIGHT ON I'HE 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 DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE HAT YOU HAVE BEEN N ORAL AND WRITTEN NOTICE 0 YOUR RIGHT TO Cib`s L. "—` Acknowledged by: rrr �L,� ��• -��� 08/04/2022 " •mer's Signature Date 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: 01/31/2023 Approximate Finish Date: 03/02/2023 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: $ 5598.01 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 0.00 (If applicable, • . amount of taxes included in Contract Price) "Maximum deposit D1 ' applicable in A , 4, ME(33%),1 :I, WI(99%) Deposit% 125.0 Deposit A ount $ 1399.51 Remaining Balance $ [4198.50 8. Finance Charges Any interest payments or other finance charge = • -termined 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. 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 Agreement are solely vested in the person listed as"Customer" above; and (iv onic si s will be deemed on ' als for all purposes. X 08/04/2022 st er's Signature Date X /s/The Home Depot 108/04/2022 The Home Depot Digital Signature Date For questions related to your installation,contact Service Provider at (203) "Lb0-feif For any other concerns, contact The Home Depot at 1-800-466-3337 �� Scope of Work McDonald James 1 New England West 1-20JKR5HL Customer Last Name Customer First Name Store#/Branch Name Lead# Job#: (Internal Reference) Products: Spec Sheet(s)#: Project Amount Reference) 1-20JKR5HL Windows Entry Doors 1-20JKR5HL 5598.01 Windows Entry Doors Windows Entry Doors Windows Entry Doors Windows Entry Doors Sales Tax 0.00 Total Contract Amount 5598.01 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: Simonton 6100 Warranty Name(s): The Home Depot General Terms & Conditions 1. DEFINITIONS: "Agreement" means (I) the Home Improvement Agreement between You and Home Depot, (II) the following listed documents, and (III) any documents referenced in or attached to any of the following listed documents: (a) any Change Orders; (b) the State Supplement, if any; (c) these General Terms and Conditions ("General Conditions"); (d) extended installation warranty documents, if any; and (e) the Scope of Work. "Defect" means any Services that are found to be non-compliant with manufacturer's installation instructions. "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. "Scope of Work" means a detailed description of work or Services to be performed, including, but not limited to, any quotes, schedules, invoices, specification sheets, proposals, confirmation emails or otherwise. "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. • The Home Depot General Terms & Conditions pt.: 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. Home Depot may also ask for a change order in the event of errors or omissions in measurements or quantities used to determine the Contract Price. If You decline a Change Order request, You or Home Depot may terminate this Agreement. 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 (the "Warranty Period") 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 discretion (I) correct or replace each Defect, (II) authorize the correction or replacement of each Defect; or (III) remove each Defect and refund all or a proportional amount of the Contract 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 in full as provided in this Agreement. Any warrantable corrections, replacements or repairs made in accordance with this Agreement will not extend the Warranty Period. (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 WARRAN PIES. HOME DEPOTS 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 WARRANTIES 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. The Home Depot General Terms & Conditions 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. 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 Contract 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 Contract 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 105 Buttonball Lane Glastonbury, CI 06033 Scott Doughman yr, 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.-AIU Insurance Co. Policy WC 065886028 (AOS) (MA) Exp. 3/1/23 Ivan Kosobutskyy D/B/A I & I Remodeling is the sub-contractor. #CSSL-098785 Exp. 4/27/24 / HIC#152379 Exp. 8/22/22 Workers Comp. —Atlantic Charter Insurance Company#WCV01468902 Exp. 11/13122 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@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 RO D$ CERTIFICATE OF LIABILITY INSURANCE DATE WYt THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER/SI. AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy{lee)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 Neu of such endorsementls). PRLKGO ER CDR FACT HARSH USA f C IMME PHGIE F F.AIt TIS10 AaiANCE CENSER WAX`win FIN.e Ji ML,Nvl, 35EC LENCI t ROUC.SUITE 241C ERAS ATLANTA GA 3032E iNSURERNIN AFFgWap COMERMW WIC/ N 1 C'6623E9•rier eLti aAW.•22•25 PAWNER A.Oil Reiman:lmaa're E...e 24147 ---- ALLURED THE HOME DEPOT.INC OWNER B:News i'ia,sniwe Ins Cc 23184 I HOAIE.DEPOT U 5 A..INC. INSURER C:AGE Ampex:IIMANI t:trtroah' 22667 2455 PACES FERRY RCADD DuILDN5C-2t. NORM .t;LAVA GA 30339 WOW E. aalrlErRf: COVERAGES CERTIFICATE NUMBER: ATLO05O72225-07 REVISION NUMBER: •I THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED`TAMED ABO'.'E FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREANENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER NJ-C'iVENT 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 St^tOW/l MAY HAVE BEEN REDUCED BY PAID CLAIMS RA 4TRR I TYPE OF$NURAMCE ADOLISUISIT IWO yg rQLY NUMBER Poucr EfF POUCY ESP atripartrill Asentrnrch LYYT5 A x CONNERCLK GENERAL LAAUTY MWZ(31S6A uSE'= aTf1i•"J?'S Edi.!••]CC;IRFri Fk.E S 1.3a LC>: DWAGETIOReRTEIZI CU4 M5.MADE ri OCCUR, PREAPPE$CE Miurrauat I ,CM 30C, X SR S'.D00DM MEDEXP0/Ay ono trawl, I EXCLUDED PERSONAL IL ADV WEARY I S 7CC L'ac GENT.AGGREGATE LAIR APPLIES PER. GENERAL AGGREGATE I 2.XC.00C 17:AicyElJEC LC+C. I P ROD CTS-CCeLPOP AC.G I 2.3E0 CCC THER I A AIROYo e,EwYIMILItY ►AWTF316649 C3>012022 Q3oCt1023 COMB COMEINED SINGLELaaT I '.BCC'CGC X ANY AUTO BOWL,II44UR'w•PSI pence) S GINNED SC CULED SELF INSURED AUTO PHY ONG AUTOS ONLY ,_ A."TDS H:IOLv»i{:R',�aox I Noe., i�i WED NCH-006NE 'RR/O-vR'r DA4.IA I y..,AUTOS ONLY ..•,^ AUTCS:-nit' } fikitatotettt I � � A alIBRELLA L:AE A , ,, 'Ma 31E647 0i1202I al't'2325 EACH OCCURRENCE OC *S 13.300.O �, X EXCESS LAS CLAWS-MAZE AGGREGATE S ID.n.00C :4L I IR-E IF^.'.:Ha 5 .5 B WORKERS COMPENSATION WC afeRSEC29 yell 03.r ZTIT2 43OV2ll23 x I PEATtt�1 laB AND ENFLOY£RS'UAS LRY . C r N<. WLR C t16433 AZ.IL: 03�t'2022 Oarcum23 5 XXC CU OFTICER.APENEIEREAC NER;E ECUTIVE l n., } N,A EL EACH ACCIDENT t tMalramy IAIarl EL.DIPFe::F-EA EMPLOYEE I 5 iC.D.0 IOESC OF OPERATIONS bee. tl .r•b'ut'Id an Mao*Page EL D15c4C. -ACi CY Lilt' E 5.3J EEC I • II DESCRIPTION OF OPERATIONS,LOCATIONS t PERICLES(ACORO 101,Aeperiorso RATANS*k NIRAIL Isar be atlN'JMd I mot*space H"a'rlait*G' r:CENCE.3-NSURANCE CERTIFICATE HOLDER CANCELLATION 'CUL 2CPCT :S.A.,h':: SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PAP. S FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WILDINGC-20 ACCORDANCE WITH THE POLICY PROVISIONS, ATLANTA.GA 3ti35 AUTHORIZED RE PRESENTATIVE I ?/fa:.zk Zr!S 1,:c. ty 1961-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER D: CN101642069 LOC N: Manta ACC d ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY leAeED POURED MARSH USA MFC THE HOME DEPOT.Ai+= HDt,SE CEPoT S.A. IVC POLICY*AMER 2455 PASS TERRY ROAD &ALONG 2.20 ATLANTA GA 36339 CAMSt AMC CODE EFFECTIVE GATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance *mars t rrcarsaten Cwreritae Caller&sternly hsaance Cancan,u{Morin Armco Pyle)Plerbe^AIR a83168831ADS''(ALMFLID.AKS.K)().4*SW NCNE NSA NDCASuSDTNVAH'A'ON teef Diem*,Del!'.DY+E` 2 Umber,Safe t13'X23 EL Ler^t S5 MC 3t:t <:mtia Mi ttsurarre Ca Pdtg*M ter WC WISKOM6iAO61 tAKCCYIIICC Weq.1i WeAIDAA kF&VTNNPLI,NY,PA,Rf VT aldieeOre 141s2C22 Elgrraianase LINT.ITZ23 (EL)Lair SSEE.XO Carver ACE Amman ravrame Daromry Pap Murder MU C6119164 ,1 1 trAOR WAI Efieca,eCar 11431(D22 Eryaaim,2.4./3331 23 ELi Lam 34.1)3I::X4 SLR 51.0OC.000 Croix Mum)Uttar Frog+rs ranee Carom Pyc,Natter XWC 16LT3:3 ice}SCT.4',rR,116,►N.C)1l.UT) D iecl*Cale:W1;= JPaatrx.Dale J3e3123 .;EL!Log L Li 0,10 NCO Sf+CCst.tYA;-7iA SIR I Cr,s3Y)>o 1i2 ILA$133.Q:x TX Eni k toers IS l a/00,4 t. . -tterik,ce Uwr tmranae Cowry ?sic{.%tartar INSCAMI ie iTXi Erma:se Dse.51)Til.2:22 avatar Dot 11131;2C23 EL)Limit K OMI OU SIR$5.ISSCAll ACORD 101(2006/01) 0 2006 ACORD CORPORATION. MI rights reserved. The ACORD name and logo we 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 12785 HOME DEPOT USA INC Registration: 1 Expiration: 04/22J2023 P O BOX 106451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. owe.el Cana...Mike a mairase Ih•W.O.n valid for NrrYvldusl use only NOtE IMPROVEMENT CONTRACTOR Registration TYPE:SupolmrenI Card before the expiration dale. i1 wound return to: assignalss faakatisa O1lke of Consumer Affairs and BuNngs Regulation 112785 04/22/2023 1000 Washington Street -Sulte 7111 HOME DEPOT USA INC Roston,MA •2110 RICHARD OLMSTEAD i 2455 PACES FERRY RD C-11 HSC , 4140•4 valid • naturs ATLANTA GA 30339 Undersecretary ACC)RLI CERTIFICATE OF LIABILITY INSURANCE DATE i.MIUDOYYYY) 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: If the certificate holder Is art ADDITIONAL INSURED,the pohcyties)must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WANED,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 m lieu of such endorsementts). PRODUCER CONTACT dem, Mary R Benlanw, Greylock Insurance Agency ErFtw/t c. 413 lA SU9 taaC rCAt3 PO Box 603 -7- Pittsfield MA 01202-0603 Ames mbeniarntrierderiodk.OrQ morel AFFORDING covsRAOE PIMA Ltszurded,t.803772,MILN ER A.Atlantic Charter Insurance Co. 44326 s.9UREt7 e,•Arac,S-cl Ivan Kosobutskyy NSLSIERa: , 72 Stafford Rd NaOREBC. - Monson MA 01057 N>rwIER0. INSURER E. NSIMER F- COVERAGES CERTIFICATE NUMBER:25176358 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PGY.ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT.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 slip IGN'T TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN RECI CED BY PAID CLAIMS. TYPE OF INSURANCE t. roller Ruret POLSCY EFF POLICY ERP j.illiAtirerro dalsOWYrrYi Ullne - -GENERAL LIABILITY EACH OC1 URRENCE 7.1 R teatCL CLAIMS-MADE a OCCUR PREMITJACE SES 11 I >i MED EXP,.Uri ona serreml I �, PERSONAL s AM INAIRY I NEVI AGGREGATE LINT APPLIES PER GENERAL AOGREGATE , II c icv ACT ®LOC PR�_''DLICTS-...DUCTS AGO $ , OTHER s AIHOYDBLELMSUTY COMBING SINGLE LAYS f$ we." , 'ANY AAVM53OI1 IN 1' AIRY aPitr pM Y'Nl I ~— Or1NED SC.,EDULEC SCIOILY IN*IRY feet emsahty $ CNN.), �� .y_:'C5 ��ALTOS CN rifED NON-OWNED 6aLADE s AUTOS ONLY Ac745 OW Y ,t ,r-.6r71...,....., $ UMBRELLA.:AB C,R EACH OCCURRENCE I �r ....v EXCESS LAB CLArMS.IMLE AGGREGATE 5 :.¢L: l 1. Je -ON% I A WORKERS COMPENSATION WCV014eeso2 I I!13'2O2' 11;''3f2322 Xi Ialnin I AND EMPLOYERS'LIABILITY AMYPROfREE TOR'PARTNER�EAECtrnVE `IS N EL.EACH AIDE1Vr s 100,000 CFFiGER-veS EREsGL,OEZl ' CCNIA tManeteery N owl EL DOME-EA E IPLOYEE $100,000 II,es.0¢aifi0a under C£SCiifF'01.4OF„ ERA7CALSbelt. EL.OREEM.POLICYLIMIT $500,006 ' i DESCRIPTION OF OPERATIONS LOCATIONS'VEHICLES(ACORO 141.AAIXEIIr RamaLLa Schedule./tray de Matted I mere apace is wISYe0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLYGIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELNERED ei ACCORDANCE WITH THE POLICY PROVISIONS. THE)At-Home SeNrces Inc 2590 Cumberland Parkway#300 at TMRixnecPecAFYTeY1VF Atlanta GA 30339 ,..fk,a. .` k:,.,,.‘...... 1 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 1201E43) The ACORD name and logo are registered marts of ACORD NANKOS-01 �_O ,4j>f , ACC CERTIFICATE OF LIABILITY INSURANCE DATE` ' �.I.►' 10/25/2021 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. It the certificate holder is an ADDITIONAL INSURED.the policy lies)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 cerohcate does not confer riots to the certificate holder in lieu of such endorsement(s). PRCOUC ER T HUB International New EnglandjHUC 10T0 Suffield St lit E.II (800)243.8134 1 M4j4111 T 4 Agawam.MA 01001 � - MsiraimISI AFFORDING COVERAGE $ _ MBnsR A Ohio$4Gtfrfhl In53ttrnc*Company INSURED %Row a Commerce Insurance Company 34 , Ivan Kosobutskyy INSURER C I&I Remodeling 72 Stafford Rd ,.BLSIIOLI D -_ -- Monson.MA 01057 INSURER E *SORER F COY.Ef3AGES cE,RTIFICA1 NUMBER; REVISION NUMBER_ This 5 TO CERTIFY THAT THE POLICIES OF 'SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA.1:t%D ABOVE sDR'HE PCUCY 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 Pic INSURANCE AFFORDED BY THE POLICIES DE9 rBE^.: HEREIN IS S,./BJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ROM TIFECF awuaANCE iMSG PMPOUC1'NUMBER IWfOOISYYYi IM YYL LIMTS A X CIssumacseseeEIMLUAearr, 77 ,,,._.... 1,000,000 ��Oti�E Ili R.R hKS56539752 511512021 5d15/2022 n.�+a„as;E-�RENEGL .r,5._,....�.___,..300 000 )� ?�"�=i.9l:�Si�"artite.lr0f:ov� 3 ME.: L E.W-Aix LlAt. TB ,3 15.000 _ PERSONA,d AD'IN.F...v 3 1,000,000 •".. 2,000.000 LIMIT PER GENERAL AG/RSC.ATE 1 POLICY QR4 tjux .f +';I:S'c '"3?ASI= ,; 2 000.000 OTTER € 8 AUTOeWkE 1U 1E,A C hED SINGLE LIMIT Ea :g14rra1: 5 .. ANY AUTO IBCRLL 84812021 8128i2022 atztLY BLUR'I,Pea per.,:r, >< 100.000 ^"-*MI OILY X . AUTOS t.L SthEQ BOOTY It etiRY�Pn*idrR1 1 000 AUTO �AtFI'08 ONLY X A7J'rL'E flxCY ...,n7!fi`ER7Y DAMAGE100.000 tW+r_In 'ri 1 T • t 'UMBRELLA LAB E X:COR ,_I °r h OGGVRffEhC b . EXCESS UAS 1':LAWS-MACE. AGCREOATE 5 C I 1 •TENTON3 I WORKERS ONVOCTION PER AND ERBL AIAPJIl17Y YIN I STATEITE I I E4- ANY F'?t>PFAETCft'PARTNE'k+EYECUTTIIE (""'"'1 EL.EACH ACCIDENT I F(,f C,EItyEill .�I EXCLUDED, �) N,A I YIM9 Ei DISEASE-EAEt/KO ;I[ tty"da o5.urArr DESCRiPRON of(WEARTI01IS Dale. El..DISEASE-POLICY LIMIT s 1 4 DESCRIPTION OF OPERATSDN9.'LOCATIONS VEHICLES�,ACORD MI,AdAEIoIui Romal A HcAra.M,rlft be uuKiva a mew Apacr e Home Depot USA Inc is named as additional insured as respects General Liability Imiar nce as red by whiteen contract or written agreement. 2012 Frtt,Vin1WDPPF4CC8CS511141 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE Home Depot USA Inc THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN PACCORDANCE WITH TIE POLICY PROVISIONS. Home Services Compliance C11 2455 Paces Ferry Road _......__......__...___...__...____.._,.. Atlanta.GA 3033S 949:?Aa,'"9— I ACORD 25(2016/03) ID 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD , Commonwealth of Massachusetts V. Division of Occupational Lnsure • Board of Building ReliMations and 'Standards Constructigiirgi4per44ip9r Specialty .. 4.... CSSt. 098785 - ",'"'.,,. " EStptres 04127(2024 WAN kOSoVTSKY 72 STAFFORE, ROAD z.. MONSON MA-01067 fli ?It 3 1 ' Comnusstorter '..t„,,,, f ,,,, a t I e i sure CS-013902 1 1 CS-9803 ' CS-9804 t CS-9805 Ivan Kosobutskyy CS-9806 -, C3-9807) Aim riArrvoi4,•aomeNkalthr mirreeihy ., Mvertm Perw,rownye kr . t MASSACHUSETTS CONSTRUCTION SUPERVISOR LICENSE . 6 HOUR ONLINE CONTINUING EDUCATION C*n IGINtoror.AU.2*awe f.1.0.1..... ...,0 tCti..•al.00 I-,... C.o......WA..a.4•40.7.4 ....1•If•940M...... Ily....ta...1...iv,VC11.4101. 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' 'in,ima iefifre47/44 r / Office of Consumer Affairs&Busines ReQuistit---• HOME IMPROVEMENT CONTRACTOP TYPE: Individual Registration Expiration 152379 08/242020 IVAN KOSOBUTSKYY D/B/A I & I REMODELING IVAN KOSOBUTSHYY 6.,,i2,.. ,,, 72 SATFFORD ROAD MONSON, MA 01057 Undersecretary Registration 152379 Registrant Ivan Kosobutskyy DBA I&I Remodeling Name IVAN KOSOBUTSHYY Address 72 STAFFORD ROAD City.State MONSON,MA 01057 Zip Expiration 08122/2022 Date :'.,'', :-,'-'-:',';•-,- -,;.:--r 'r ' .,-•r I 1-V0,14 K044:16 .A.4.- Aikyy ... authoriie (io Permit, I I t ' to pull permits using tri, CS I.icense t= 050 7‘57 . *Inci tit:. HIC Registration Ti ,fi..6...g, , ,7,g,..___,--- ,-- -------- , • An questions please call Inc. at: teiS - 2.21— CiiO4, Installer Signature ..-s , Company ,..,. .... , . 41,0-v-t, MIA 4.,ro certif.)that , ... 1.;;: -4 Ivan . Kosobutskyy -,.. . 4 .,,. . kis*.ucte,Vitilt.ompleirql Ow 4-how course Lead-Safe Renovator- Supervisor Refresher 4,77,7 k M R 22.00,-.4nd 4‘i( 1.?Par t 1745-21; r ' tlonir Lwow(' too***ft,teosamogermi tlocoroon +e inetmOrhoWieninqbote.MA AMC MAY 10,201$ v...rxr5o1.140e. k4.147it k . 7$4340-174.401704 10.itio kip ',...`10M,,,"Att.OCMIVISAY , • : •• INSTITUTE FOR ENVIRONMENTAL EDUCATION