43-051 windows BP-2023-0870
185 PARK HILL RD COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
43-051-001 CITY OF NORTHA PTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0870 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2023 Contractor: License:
Est. Cost: 10263 HOME DEPOT USA NC 106106
Const.Class: Exp.Date: 09/29/202
Use Group: Owner: TREM:LE MARY TRUSTEE
Lot Size (sq.ft.)
Zoning: WSP Applicant: HOME D EPOT USA INC
Applicant Address Phone: insurance:
2455 PACES FERRY RD NW 860-952-4112 WLRC50668058
ATLANTA, GA 30339
ISSUED ON: 07/03/2023
TO PERFORM THE FOLLOWING WORK:
10 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:
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 NO HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I ,
Fees Paid: S40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commiss.oner
C'\\1°)
RAG
The Commonwealth of Mas achu efts �,. t 1
FOR
4° a Board of Building Regulations . d S S . dal N
Massachusetts State Building Cody, 781 CMR �i�vNg A060 1:ICIPALTTY
� ok_o oN.Ma USE
Building Permit Application To Construct, Repair,Renweite0 I . s 1 a Revised Mar 2011
One-or Two-Family Dwelli ,g N
This Section For Official Use Only
Buildine
ggPermit Number(2 ?3. 57v Date A lied:
UPt-) &55 -7•3-ZOiZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
SS IaAL ( rti a.)
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Awl 7/Ggi£'Ie Girt /1411 b 1 b6 2-
Name.nrint) City,State,ZIP
)5S Pa eaHO/ Roi.d 1.4i3-- 53)-^ fixq- _ vi t,/ T1`M-t Q 1•10d i. taw
No.and Street Telephone y Email Addre
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other O•-Specify:, Iuea,G.t/1`
Brief Description of Proposed Work:
L✓,Kda-•.,r
.
IQGw►J"t- A,.--cl ge f ka..--t LD w/4d.'...s 1 A-,c. .. 1. it,
AO g ?tk`fi..� �i� /ti . 06 2 9
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ l0/ L 4 S. d,, 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All FNà0eck " ]
Check No. Amount:
Cash Amount:
6.Total Project Cost: $ `.,' L65. 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/ /e, if
y;h (2 j..,b r F a ru. License Number Expiration Date
Nameof CSL Holder W S
List CSL Type see below)
ZS 3e t 4401.1. .$ €
No.and Street Type Description
J U Unrestricted(Buildings up to 35,000 cu.ft.)
r' u /114 /0 9 — R Restricted I&2 Family Dwelling
City wn,Sfate,ZIP M Masonry
RC Roofing Covering
[S) Window and Siding
SF Solid Fuel Burning Appliances
"'757- C///Z I In elation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
T e h�� De o f 4 S/F HIC Registration
Registration Number E iration Date
I-LC Company Name or HIC Regisfant Name
ceSS Paces ,e sk a d G � tAil, ,h �".0100'' et,fy
No.,,a�nnf�d,sstreet address
11-erefilf, 6A 303g9 '&1-Q52-WI&
City/Town,State,ZIP Telephone
SECTION 6: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 .......... CIS No .❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the% of my knowledge and understanding.
[X/alcl C - C-rQ.wci �.L .j ' Z
Print Owner's or Authorized Agent's Name(Electronic Signatt e) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License ca I be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed_ Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
L�< •" , Massachusetts ��2.
f
DEPARTMENT OF BUILDING INSPECTIONS u- f
a 212 Main Street • Municipal Building yvy ca•
Northampton, MA 01060 �-l'n I a\-N
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: (544kl Awe/ cot' Z Ettief el CT06 �z
The debris will be transported by:
Name of Hauler: VtieS. /I'l4
Signature of Applicant: czi-4Date: 6-30 --Z 3
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
V www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):Home Depot USA, Inc.
Address:2455 Paces Ferry Road
City/State/Zip:Atlanta GA 30339 Phone#:1-860-952-4112
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. IN I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp. insurance comp.insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no 13.111OtherWindow replacement
employees. [No workers'
_ comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Indemnity Insurance Company of North America
Policy#or Self-ins. Lic. #:WLRC50668058 Expiration Date:3/1/2024
Job Site Address: /gS Pa rIL ('�j i i l 'ttet d City/State/Zip: r/o/iitee /114" 0/06 2
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 fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
,ice 6 - 3° - z,3
Signature: Date:
Phone#: 860-952-4112
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
10Board of Health 2❑Building Department 3tJCity/Town Clerk 4.0 Electrical Inspector 5.1=1Plumbing
Inspector 6.0Other
Contact Person: Phone#:
ACo CERTIFICATE OF LIABILITY INSURANCE DATE4;WORNYVY)
Vim z1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 1110 RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED.the pohcy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
II SUBROGATION IS WAIVED. subgect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsernent(si
PRODUCER )CO FACT
MARSH USA INC 1011 ■1
TOAD.ALLIANCE CENTER j �Fail I IAfC.MS¢
3550 LENOX ROAD.SUITE:ICC EMAIL
ADDRESS
ATLANTA GA 3E325
INSURER S AFFORDING CCNERAGE NAIL s
CV 1C 1642369$s^AO-GAD'.-22 t2S INSURER A-Oat Reptltp:FRY....�C.::i 24147
POURED T?'E HOVE DEPOT,INC. INSURER e B.Inde Indent* Ca OI Wxth A;-emx t35T5
HOME DEPOT USA,INC. NSUNER C.ACE Amet,an hturarce:o-caRA 2266'
2455 PACES FERRY ROAD
BULL-MG C-20 INSURER D.
ATLANTA GA 3C339 INSURER E.
NNIRER F.
COVERAGES CERTIFICATE NUMBER: ATL•005072225-15 REVISION NUMBEIt:7
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 REDLOREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUHENT 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 LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
t� TYPE OF INSURANCE NOD IND POLICY NUMBER TRIREIRTYTYI INMOOTYYYY urn'
A X CONNEACIAL GENERAL ua,aS.Iry MWZY 316E48 010120Tc Q3<01217,• EACHOCCURAENCE s IZet0C
ICLAIMSMACE OCCUR PREMISES IEaaculrenpa) 1 1000.0a)
X Sit.$1,001000 MED ESP;Ark one penmen M EXCLUDED
— PERSONAL&AOV INJURY 5 1,000000
GENL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 2.000.000
IX POLICY ElJIEG EDLOC PRODUCTS-COMP,'AGO E 2,IE0.CCC
OTHER 1 —
AUTONCOLEI1AIKITY MWT8311643 03101a022 03r012025 COASTED SP4GLELAST I 13CI:CCC
X ANY AUTO BODILY INJURY iPar poison) 1
CRANED SCHEDULED SELF INSURED AUTO PHY DWG BODILY INJRY;Pm a daliM) f
—AUTOS ONLY AUTOS
HIRED ` NON•OWNED FROVERrY SI MOE 1
^AUTOS ONLY AUTOS ONLY iPet a:.:dari
1
UMBRELLA LIAO H.J. wax 316647 0310',2022 ' 03411°21115 EACH OCCURRENCE $ 3.Xi.C00
X EXCESS LIAR -m.4r.s AGGREGATE I 13.:Le 000
1 DEC FETENirON 1 f
E WORKERS C OMPENSATION SCFc5D6681t6(hi, DSU'.D23 2E0J1,2024 'X 1 5PER I I -
AND EMPLOYERS.tWIRY tA7ifT E ER
OTH
L E' An pp.IDFR TCR'PARTNERIEXE u7Sve Y t N WLRCSL"iM"�1 I14 113,C'?3�-. Q3/121'2'.IZ4 5.000.000
E L EACH ACCIDENT 1
CfFIC-ER.Ufk6=REXCLIOEti1 NIA
i14Andelory In NMI E L DISEASE•EA EMPLOYEE`$ 5.XO.000
Ir 1+1.def.:1 me undo COrNse l On AddOainr P&p, E L DISEASE.POLICY LAST f 5,000.000
s.DESCRIPTOON Of OPERATIONS Den
1
DESCRIPTION OF OPERATIONS 1 LOCATIONS•VEHICLES.,ACORD 161.AudAL,nw Rarna.ts&heads.away S.at i . r mart s{.ae*n'v5u.wa9
EVIDENCE eY PSURANCE
CERTIFICATE HOLDER CANCELLATION
-1CiAE DEPC-_,SA RC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
2155 PACES FERRY ROAD BUILDING C-20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATLANTA.GA 33339 ACCORDANCE 6ITH THE POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE
I 11l'411-4 ZCS.,it 7.cc.
C:1988-2016 ACORD CORPORATION. AN rights reserved
ACORD 25(2016,03) The ACORD name and logo are registered marts of ACORD
AGENCY CUSTOMER ID: CN1O1642O9
LOC I: Atlanta
^fie
ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 3
AGENCY NAMED axSURED
Lt4R.5+-U&A IN: THE HOME O POT.NC
HCUE DEPOT':SA,NC
PCAJCY b octet 2455.ACZ PERRY ROAD
5--ILDII 3 C.23
"Xt4TA 3Z030
CARRIER NAIC CODE
.�.._.._,.e.V..... i EFFECTWE DATE.
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM.
FORM NUMBER: 25 FORM TITLE: Cer1YNte of Liability Insurance
Waken Cmpinneaton Cuaraced.
Came Saftey Nstasai Caeudy Cm oratt
Pdq Wnter IDS (ALJR.AZFl,13.1A,%IfS,I(YIAKX10,MC,t ,MM.N O)(SC.S0.TN Y:A'NY WYI
EM1erar Ott*=112023
Emission Oats 33✓S1102e
(Ell Lent 15 33C 3fA
Cams Salty Ottawa Caaaty Corematon
?Jry Netter SP4.36105S:OS1i IGAOR,WAt
Efkcta Cain.3301X23
Uptown Celt J3012024
(ELIbrat S10Jv.X00
SIR 11OX.JCO
Carter ACf Anlentar rsrrrs Canary
Poky Mmoer WC.,05f s58336(0S11 IGA1194V C14.UFt
Enema Coe:33C12C23
(palm Cite.3.0i2C24
(Ell Lott$1•043,110
SIR 11.000.000
SIR aGAl.S759.0CC
Cams IndeFnav Insaan:a CorwzrY ai Nolh Anima
Polc1 Norte.NLRC50EESD10 AK CO CT DC CE HIi1'i..iMfID1AE.We.A44.NI,NY.PA.RI,VTI
Etkcaa Odin 334312023
E.praton Lein;tYi)1i2',2l
ELI LnR 15,000.900
TX Errpbleae XS Ydanstr:
Comer/inch Antrum bu mrs Cc Pony
Policy Water f01Lt138319(Td(t
Maio Gain.33/012823
Expiator Cain.034312C241
tELI Lart 1QDX)X
SIR SS.KCMG
ACORD 101(2001101) ID 200E 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
Expiration: 04/22/2023
P O BOX 105451
ATTN: LICENSE MGMT TEAM
ATLANTA.GA 30348
Update Address and Return Card.
off ee of Consurtwr Affairs•euNrwe Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:S.wplement Caro before tie expiration data. W found return to:
EtsaistaSion Esea'tIpp Office of Consumer Affairs and Business Regulation
112765 04/2212023 1000 Waetdngton Street -Suite 710
-TOME DEPOT USA INC Boston.MA 02115
RICHARD OLMST AD
2455 PACES FERRY RD C.11 HSC
ATLANTA.GA 30339 Undersea, valid signature
Office of Consumer
Affairs and
Business
Regulation (OCABR
HIC Registration Complaints
Registration# 112785
Registrant HOME DEPOT USA INC
Name Courtney Howe
Address 2455 PACES FERRY RD C-11 HSC
City State Zip ATLANTA. GA 30339
Expiration Date 04/22/2025
Complaints Details
No complaints found for this registrant
AC'oRU CERTIFICATE OF LIABILITY INSURANCE DATE Iw1DIXY IVYI
1/31/2023
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 INSURERIS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the poltcy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement()).
PPIGOucER c ACT Deborah Marino
Canary Blomstrom Insurance Agency P"'o*'E
E68 Springfield Street iA.c No Evil (413)750-9022 I AC No}(413)786-7004
Feeding dls,MA 01030 Ej dmarin dean blomstrom.com
Si5U4f Ri5)ArroM1NC COVERAGE NAIC
INSURER A NGM Insurance Co. 14788
INSURED ImErat Ar 1 Pr i n n ur IIIm n 41360
Exterior Remodeling Group Inc. eisussN c AIM Mutual InsuraOce CO.
21 Benham St NSVRER
Springfield,MA 01109
sown*r
NSuntS P
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
INOI A EO. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INIR - AVOLISUIR r POLICY OF POLICY VIP
LTR TYPE Or NSUrANCE REED MVO POLICY MUMMER afER1DRYYYi IMINOCVYYYYI IMPS
A X COMMERCIAL GEUERAL LI.BIITY EACH Cicc.URPk ct t 1,000,000
1 CLAINA.'-W'Ut :N:cU" MPP33T$W 7/27/2022 7/2712023 DAAiAGE TO S�£RENTED 500.000
PRsfrf'-# a orcutta:ml f
FltC ExP:ACitrfrI r e'`) I 10,000
Tc)c;,{LNA4JAINMAO �S 1,000,000
-Fh- .AGGREGATE Lair urnsPER GENERALAOC:REi.ATE S 2,000.000
r..i)IC.Y❑ ROC PRODUCTS-SaAP`LTV AGC S
2,000,000
X ,I,rce S
p '�+:•aerL-D SINGLE OMIT 1,000,000
O ;AAJTCMB OEr,IAH1ITY l�aaC.eleral
sf..AUTii 1020110392 817/2022 S117/2023 tiLiteLY MAIRY o'er miner)
� OWNED SCHEDULEDSCHE
AAA TOp30AL.Y !A*1TT INJURY OS 8008Y (Per eocrMMi I
X .f1.,T�CIS CN.'✓ x AUT��' (Pre sierY Qtil1AGf
ti
UMBRELLA Loa OCCUR EACH OCCURRENCE S
—+ EXCESS IIIAB CLAIMS.MADE I AGGREGATE I
DEO I I RETENTIONS MELTS
5
C WORKERS COMPtNSATSSP1 X I I TH-
ANO EMPLOYERS'LAMA ATLi€
ANY PROFINE'CA-ON 'iNCC-b00-5028443.2027A 1(25.12023 1'25i2024 E L EACH S 500,000
ACCIDENT
r csl EEC►ET,61:R EXCLUDED', y N.A
(if,Mdllsy/^RANI EL.DISEASE-EA EMPLOYES
�Q'0�
I1r. acv:Occ uMtt 500,000
DfSS:+APIE)N Of OPERA WAS Pefaw ___..._,._.....�.. .,...__,._.._..,.__-ry T tl D & CU YEASf-PCY LIMIT S
1
DE SC stenos'Or OPERATIONS LOCATIONS'VEHICLES IACORD¶U1 AOeeonM Remade Schedule,Alf be attached IIearl epees leHome Depot U.S.I.Inc.is named as Additional Insured wrth respects to General Liability. Eugenie CIUbotwv b snc0Msd from the Workers'Compensation
Policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE INSCRIBED POLICIES BE CANCELLED BEFORE
Nome Depot U.S.A.Inc THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN
P ACCORDANCE WITH tHE POLICY PROVISIONS.
2455 Paces Ferry Rd C-11
Atlanta,GA 30339
AUTHORIZED REPRESENTATIVE
1
ACORD 25(2018/03) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
1t*,..knoll{Ws[..caf d Aga`r,WRIVINK,iA04 It •:Ht C1 rP.o:Y IMVIi at i'rcLrsnpnai I.iG/fS une%at 4 iv ./oesevi ar Saar ar25
PLlbirc Safety r ,.
s* ` I.
,a� :_ e.' . Mass.
Licensee Details
Demographic Information
Fur.ira•'e EUGENIU CIUSOTARU
EOrmer%a—e '
Licen.r address Information
MA I
01109 '
auemry United States
License information
License No CSSL-106106 license T,pe iStructton Supervisor Speuall
Profession Buildingg Licenses Date of Last Renewal. 1 13J2022
issue Date 40212017 Exparatton Date 29r2024
License Status Active Today s Date 1 '14/2022
Secondary License Type
Doing Business AS
Status Change Reason License Re'reteca . ..
Prerequisite information
Licensee GtUBOTARL.EUGENIU
Retationsnip Attribute Of
License No CSSL-10610E
'l;Ava!'abe' cumeris
1 r._
ism.«..=.rrs.'; '.
kW....... Commonwealth of Massachusetts
Division of Occupational Licensure
Board of BuildingRe_ ulation gI r` sand Standards
Constructgitupel' y Specialty
CSSL-10610E ��w,,,,,,�;,.., Icpires: 09/29/2024
EUGENIU CIk BOTAR' 3) , "
23 BENHAM .STREET°( St,
%
SPRINGFIELb4111P'
�MA .�i
.` r "f* yl t
V V N I f f f f J J/V l f fr f u(/�/^u r,,,..,,r,„,,,
Or Construction Supervisor Specialty y
Restricted to.
CSSL-WS •Windows and Siding 1
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call (6171 727-3200 or visit www.mass.govidpl
Oft - of Consumer Affairs and Business Regulation
1000 Washington Street Su'te 710
Boston.Massachusetts 02118
Home Improvement Contractor Registration
'soe CAAPWanr.
office ofConsumer sPhoieeeto. . . .�. 5
as� ��•• 7sc�axv,:
S r sh4 tM►ne t
Affairs and
Business
tw..»,�...m ia�v�n ea.+
rc ui+gove ,wr eta•r+*i/,r • %veva ,ward m�weam u..ant,
r*r - T:eraan trtl.f the niyswgn OW M fame noW •r
Regulation (OCABR) Carau , tl a, ,..
E€k35 eJ„4,,,*c7ARt/ l�
HIC Registration Complaints GkA4F1 - ,,,4
valid ,tstp-__.
i s nayscao
Registration e 187666
Registrant EXTERIOR REMODELING GROUP INC
Name EUGENIU CIUBOTARU
Address 23 BENHAM ST /1
City State Zip SP09/202 ELD MA 01109 rl Q
Expiration Date OS/D9r2025 j n (,(►L{J
-La-.PA
autitori i.io rermttsi.i.0 to pun pertntts using my
Complaints Details n
Lb License if 1lLfi ana my
No complaintss found for th registrant H1C Registration# I aT 6,6 6 '^
"•�^,;:cetions please call me at: (Li 3) 3 3 S 3 7 09,
1I1SlHlICC
k,ompany Nair.
40,S Home Improvement Agreement: Page 1
Home Depot License#'s-For the most current listing visit www.Homedepot.com/LicenseNumbers
MA: 107774, 112785
Ronald Engelbrecht I I
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 The Home Depot
Service Provider Contact Name Service Provider Company Name
(203) 265-7037 Icustomercancellationnortheast@hom (MA: 107774, 112785
Phone# ggR°cecnvider Email Address Service Provider License#(s)
2. Customer Information
Tremble Mary New England West F34602526
Customer Last Name Customer First Name Store#/Branch Name Customer Lead/PO#
1185 Park Hill Road (Florence MA 01062
Customer Address City State Zip
(413) 531-1037 maryritat@gmail.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 06492
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 DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL.
Acknowledged by: ' 0Q"4.r— FTit,r.,,.1.-k_ 06/24/2023
Customer'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: 12/21/2023 Approximate Finish Date: 01/20/2024 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: $ 10263.60 Includes all applicable taxes. Excludes finance charges.*
Sales Tax: $ 0.00 (If applicable, total amount of taxes included in Contract Price)
'Ma intunt deposit ONLY applicable in MI), MA, ME (33%), NJ, W'I(99%)
Deposit% 25.0 Deposit Amount $ 12565.9 I Remaining Balance $ 17697.70
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.
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)Electronic signatures will be deemed originals for all purposes.
X L �f 774. Titi.. \Q,9- . 06/24/2023
Customer's Signature Date
X /s/The Home Depot 06/24/2023
The Home Depot Digital Signature Date
For questions related to your installation,contact Service Provider at (203)
Lb5-/U'/
For any other concerns, contact The Home Depot at 1-800-466-3337
�`~ Scope of Work
Tremble Mary New England West F34602526
Customer Last Name Customer First Name Store#/Branch Name Lead #
Job#: (Internal Products: Spec Sheet(s)#: Project Amount
Reference)
F34602526 Windows Entry Doors F34602526 10263.60
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Windows Entry Doors
Sales Tax 0.00
Total Contract Amount 10263.60
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.
•
ti 46 The Home Depot General Terms & Conditions
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 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 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.
` A- 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.
001 Go Permits.LLC
T 105 Buttonball Lane
S Glastonbury, CT 06033
PERMIT
Scott Doughman
Phone: 8
2-4112
ax:80 430 6719
Fax:860-430-6719
scottdoughman@gopermits.org
To Whom It May Concern,
If you have any questions or require any further information for
this building permit application, feel free to call us at your
convenience and we would be happy to assist you.
Once the permit is ready, please mail it in the provided
envelope to the following address:
Go Permits, LLC
105 Buttonball Ln
Glastonbury, CT 06033
Thank you!
David Anderson, Permit Expediter
Go Permits, LLC
Phone: 860-402-3293
Email: davidanderson@gopermits.org
Go Permits,LLC 105 Buttonball Lane,Glastonbury CT 06033 www.gopermits.org
Go Permits, LLC
43 105 Buttonball Lane
Glastonbury, CT 06033
PERMITS ' Scott Doughman
"' w\\44444000.00000000"/ 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 Gallant Moving & Storage
• 375 Airport Drive Worcester, MA 01602 Euro-American Worldwide Logistics
• 12 Linscott Road Woburn, MA 01801 Silvas Transport Inc
• 50 Maria Ave Johnston, RI 02919 Vito's Express
Thank you,
Go Permits
e -ome •epo - erma 'a ue o a ro• ucts Manufactured by Simonton
Dated: 5/30/2
Without Grids With Grids
Style Glass Package Glazing Spacer IG U SHGC {�yy�,.. U SHGC
(all with Argon) Factir, Fact
6500
>wning 6500 Base ProSolar Supercept 7/8" 0.26 0.23 • • • 0.26 0.21 • • •
:asement 6500 Base ProSolar Supercept 7/8" 026 0.24 • • • • 0.26 0.22 • • • •
(ransom 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 • • •
'icture Casement (NH) 6500 Base ProSolar Supercept 7/8" 0.26 0.28 • • 0.26 0.25 • • • •
'icture 6500 Base ProSolar Supercept 7/8" 0.27 0.29 • • 027 0.26 • •
?Panel Slider 6500 Base ProSolar Supercept 7/8" 0.29 0.26 • 029 023 • • •
3 Panel Sliders 6500 Base(s 21 so) Pro Solar Supercept 7/8" 0.29 0.26 c r - 0.28 0.23 0 o 0
•500 DOORS
3arden Door(CH) 6500 Energy Star ProSolar SUN Super Spacer 1" 0.30 0.24 I•I•I •I 0
1 0.30 0.21 I
•I •1•1 •
'atio Door INOVO 6500 Base Pro Solar Super Spacer 1" 0.28 0.26 • • 0.31 0.23 • • • •
• 1 00 Homes located everywhere EXCEPT:Arizona,California,Idaho,Nevada,New Mexico,Oregon,Utah,and
Washington.
>wning(Inc Hopper) 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.28 0.21 • • • •
:asement • 6100 Base Pro Solar Intercept 7/8" 0.27 0.24 • • • • 0.27 0.22 • • • •
ouble-FCun2) 6100 Energy Star Pro Solar Supercept 3/4 0.30 0.30 • 0.30 0.27 • • •
'icture Casement(No Hinge) 6100 Base Pro Solar hdenc.eFit 7/8" 0.27 0.28 • • 0.27 0.25 • • • •
s
'icture 6100 Base Pro Solar Intercept 3/4" 0.27 0.31 • • 0.27 0.28 e •
Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.28 • 0.30 0.27 •
3 Panel Slider 6100 Base Pro Solar Intercept 3/4" 0.30 0.29 • 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
'atio Door NARROW FRAME 6100(PD05)Base Pro Solar Intercept 3/4" 0.28 0.30 }• • I
' 0.28 0.26 I/110_
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 • • • • 0.26 023 • 0 • •
'.asement 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.18 • • • • 0.29 0.17 • • • •
'icture Casement-NH 6200 Base Pro Solar SHADE Supercept 3/4" 0.25 0.21 • • 0 • 0.25 0.19 • • • •
'icture Window 6200 Base Pro Solar SHADE Supercept 3/4" 0.26 0.24 •_ • _ • • 0.26 0.22 • • • •
Tingle Hung 6200 Base Pro Solar SHADE Supercept 3/4" 0.28 0.23 • • • • 0.28 0.21 • • •
Single Slider 6200 Base Pro Solar SHADE Supercept 314" 0.28 0.23 0 • • 0.28 0.21 - • • •
3 Panel Slider 6200 Base Pro Solar SHADE Supercept 3/4"_ 0.28 0.23 • • • 0.28 0.21 I a • 0
.tormBreaker Plus 300VL Homes located in coastal areas.
>wning SB+300VL Energy Star PS SUN/Lami Supercept 1' 0.26 0.23 • • • • 0.26 0.21 0 0 • 0
'.asement SB+300VL Base PS/Lami Super Spacer 1' 0.25 0.23 • • • • 0.25 0.21 • • • •
)ouble Hung SB+300VL Base PS/Lami Super Spacer 1" 0.29 0.25 • • • • 0.29 0.23 • • • •
il'ider SB+300VL Base PS/Lami Intercept 1' 029 025 • • • • 0.29 0.23 • • • •
'atio Door SB+300VL ETC 366 PS Shade/Lami Super Spacer 1' 0.30 0.19 • • • • Nc Grids Alowed
3arden Door(CH) SB+300VL Base PS/Lami Super Spacer 1' , 0.30 0.28 • • 0.30 0.25 • •_•1•
Dots indicate Energy Star certified for that zone
Please Note: Simonton Windows may substitute East&West windows given the requirements of each order.
WINDOW SPECIFICATION SHEET - Spec.Sheet#: F34602526 Sheet: 1 of 2
Customer: Mary Tremble Job#:F34802526 Consultant: Ronald Engelbrecht Date: 08/24/2023
New Window
Hinge Locations
Existing Window
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,R or S
Glass Misc Items
Hardware Code
Screens For doors use
T 1-3 Mull "S"=stationary or
p "X".operating
2 Style Wraps
Room Floor Code (YIN) Style Code Series Code X 1 5 I 5 t- a -J > _ —J > _
STD,White, GlassPack: WRAP,LSR
1 OFC 1st DH- Y OH 6100 WH WH 32 80 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
STD,White, GlassPack: WRAP,LSR
2 OFC 1st DH- Y DH 6100 WH WH 32 80 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
STD,White, GlassPack: WRAP,LSR
3 OFC 1st DH- Y DH 6100 WH WH 32 60 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
" STD,White, GlassPack: WRAP,LSR
4 OFC 1st DH- Y DH 8100 WH WH 32 80 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
" STD,White, GlassPack: WRAP,LSR
5 OFC 1st DH- Y OH 6100 WH WH 32 60 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
STD,White, GlassPack: WRAP,LSR
8 OFC 2nd DH- Y DH 6100 WH WH 32 60 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
STD,White, GlassPack: WRAP,LSR
7 OFC 2nd DH- Y DH 6100 WH WH 32 60 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
_ STD,White, GlassPack: WRAP,LSR
8 OFC 2nd DH- Y OH 6100 WH WH 32 80 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
SPECIAL CONSIDERATIONS:
1:Woodland Green,2:Woodland Green,3:Woodland Green,4:Woodland Green,5:
Woodland Green,6:Woodland Green,7:Woodland Green,8:Woodland Green
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 Rod(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#: F34602526 Sheet: 2 of 2
Customer: Mary Tremble Job#:F34602526 Consultant: Ronald Engelbrecht DHte: 06/24/2023
New Window
Existing Window Hinge Locations
Measurements Grids Product Options Labor Options From outside,
Left to Right
Bays,Bows
Location Color Rough Opening S of bars S of bars Csmnts,1 Pnl,
use L,R or S
- — Glass Mlsc Items
Hardware Code
Screens For doors use
5 li 4 0 9 m Mull "S"=stationary or
HStyle Wraps .� `m a .g k C7 0 m 2 .y e t "X"=operating
Room Floor Code _ (Y/N) Style Code Series Code E w 3 I 5 r— 55 U 0- y- > _ - > I
STD,White, GlassPack: WRAP,LSR
9 OFC 2nd DH Y DH 6100 WH WH 32 60 92 S WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
STD,White, GlassPack: WRAP,LSR
10 OFC 2nd DH- Y DH 6100 WH WH 32 60 92 S, WH,W C ALL 3 2 ALL 3 2 Standard
ALDER GBG H
SPECIAL CONSIDERATIONS:
9:Woodland Green,10:Woodland Green
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)
Go Permits, LLC
105 Buttonball Lane
Glastonbury, CT 06033
PERMITS Scott 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. 4/22/2025.
Workers' Comp: Indemnity Insurance Company of North America
Policy: WLRC50668058 Expires 3/1/2024
Eugeniu Ciubotaru of Exterior Remodeling is the sub-contractor.
CSSL-106106 Exp. 9/29/2024 / HIC 187666 Exp. 5/9/2025
Workers Comp: Associated Employers Ins. Policy WCC-500-5028443-2023A Exp. 1/25/24
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: permitsAgopermits.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