7 MAJESTIC WAY - BUILDING INSPECTION 1 The Commonwealth of Massachusetts
fn)\a Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIP EALITY
�\\ Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
.This Section For Offid e my
.Building Permit Number: ateA ied:
-Building Official(Print Name) S500FDate
SECTION 1: SITE INFORMATION
1.1 Property Ad ss: 1.2 Assessors Map&Parcel Numbers
IG ,
l.la Is this an accepted street. es 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner 7 Mr F• � )i9
Name(Pnnt) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check al at apply)
New Construction❑ FExisting Building❑ Owner-Occupied ❑ Repairs(s),< Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Uni Other ❑ Specify:
Brief Description of Proposed Work 2: c--
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item LEbsttimated Costs: Official Use Only `
and terials
1.Building $ - 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 Fees: $
6.Total Project Cost: Check No. !"'Check Amount: Cash Amount
�0�� 0
$ Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Ideense(CSL)
�- � T Licensel u� Exp to Date
Name of CSL Holder 111
\ ig I AI I,>-WI; lf1t42— List CSL Type(see below)
No.and Street Type Description
�N U Unrestricted(Buildings u to 35,000 cu.ft.
1^m O, -- R Restricted 1&2 FamilyDwelling
City/Town,State, IP M Masonry
RC Roofing Covering
WS Window and Siding
` ' SF Solid Fuel Burning Appliances
I Insulation Telephone Email address D Demolition
5.2 Registered Home ImD r vem nt Contractor(IIIC
_ HIC Regis�r Ex m D to
H o alWamstrant Name
No.and et Email address
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 the building permit.
Signed Affidavit Attached? Yes ........ No ...........❑
SECTION 7a:.OWNE AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES:FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 4sz.P C.d.;1'.�
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) /, 7 a e
:SECTION 7bd.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 ac to to the beq of my knowledge and understanding. 1
( Print Owner's or Authorized Agent's Name( lec m gn )?late
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.eov/oca Information on the Construction Supervisor License can be found at wwnrmass.eov/dos
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 Si1i ECM tiLxss kCHusETTS
ButLDLNG DEPARImENT
P 120 WASHNGTON STREET, Yo FLOOR
-0f TEL (978) 745-9595
FAx(978) 740-9846
KINfgFRT F.Y DRISCOLL
:MAYOR THows ST.NERRE
DIRECTOR OF PUBLIC PROP£RTY/BUILDNG CONMUSSIONER
Construction Debris Dis
posal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the 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 dehris will be transported
�by: �
(name of hauler)
The debris �will
be disposed of in :
(name of acdity)
(address of facility)
signature of permit appEicant
dale
Jdm s:d7.lac
f
05/13/2013 19:08 17BIB940331 TODD RIDEMAN PAGE 01
HOME IMPROVEMENT CONTRACT
7 PLEASE READ THIS
S I /, Sold,Furnished and Installed by:
Branch Name: Boston Date: /, f/ THD At-Home Services,Inc.
d/b/a The Home Depot At-Horne Services
908 Boston Turnpike.Unit 1,Shrewsbury,MA 01545
Toll Free(800)657-5182;Fax(508)845-6017
Branch Number:31 Federal ID is 75-2698460;ME Lie 4 C 02439;R)Cont.Lic#16427
CTLLiic#HIC.0565522:MA Hume Improvement Conl+a�cttpr Reg.# 126893
� �(�Installation Address: �� cW ._�c.N ram"r MA• `�11:70
City State Lip
PurchasH(s): Work Phorre: Home Phone: Cell Phone:
klomc Addaess: .--..--
(lf different from Installation Address) City Slate Zip
F;mail Address(to receive pmiect communications and Home Depot updates):
❑I DO NOT wish to rc<cive any marketing emails from The Home Depot
project Information: Undersigned('Customer"),the owners,of the property located tit the ahove inst:lation address,agmes to buy.
and THD AI.Homc SCMUC'a, Inc.(...Me Home Depot")agrees to furnish.deliver and arrange for the installation("installation')of
all materials described on the below and on the referenced Spec Shect(s), all of which are incorporated into this Contract by this
reference.along with any applicable Stine Supplement and Payment Summary attached hereto and any Change Orders(cullcdivcly,
"Contract");
.lob#: ...... i u,.rr..,,,,., _ Products: 5 Sheet(a)#: Project Amount
�Roofog Elsidir,g Windows t3imulation �( +�
6 175'a ❑G%ma s/Coven ❑Entry Doors ❑ �/�'%/s(/ $ Lill
U ✓ Q U
'Rooting 'Siding Windows ImYlation /_ r'
❑Gutters/Covers Entry Door% ❑ �O 4 j,Z $ a 1&d` 0 0 1 Wry
Rooling LJSiding U Windows U insulation /I $ -
❑Guners/Covers ❑Entry Doors❑—_____ I�GS M -0QO
❑Rootng ❑Siding ❑Windows ❑Insulation $
❑Guners/Coven ❑Entry Doors ❑
Minimum 25%Deposit ofContranAmoum due upon eaeWtion of thin cmtratl- Total Contract Amount $ Sl iJ JS
Maine Purchasers may not deport mine than one-third of the ContraRArtuun4 / /Y� U
Cuswmcr agres that, immediately upon a>mpletion of the work for each product,CuuPro r will execute a Completion Certificate
(one for each Product a% defined by an individual Spec Sheer) and pay any balance due. A% applicable, each Customer under this
Contract agrees to he jointly and severally obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate This Contract or any individual Producl(s)included herein,at
its discretion.if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because
work required to complete the job was not included in the Co//ntract.
Payment Summary: The Payment Summary # -7/b i included as pan of this Contract, sets forth the total
Contract amount and payments required for the deposits and final payments by Product(as applicable).
NOTICE.TO CUSTOMER
You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note:
there is one Completion Certificate for each listed Product as defined by individual Spec Sbeets)before work on that Product
is complete.
In the event of termination or this Contract,Customer agree,to pay The Home Depot the costs of materials,labor,expenses
and.services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other
amnuute set forth in this.a E.greement nr allowed under applicable law. THE HOME,DEPOT MAY WITHHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE. DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Acre tance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home Dcphn with regard to the Products and Installation services and superscacs all prior discussions and agrrx:mcals,either
oral or written, relating to said products and installation.This Agreement cannot be assigned or amended except by a writing signed
by Customer and The Home Depot.Customer acknowledges and agrees that Customer has ad, undersurnds, voluntarily accepts the
com rs of and has received a copy of this Agreement.
Acf<+eg by: Submitted by'
x /�jtlo -�u�$mae
Customer's Signature Date Sales Consultant's Signuture Dale
Telephone No.
Customer's Signature Date Sales Consultant License No.
CAN 7F�.I t ATI,ON: CUSTOMER MAY CANCEL THIS las nppncoe1e1
ACRF.EMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
CUSTOMER'S STATE.
NOTICE!ADDITIONAL TERMS AND CONDITIONS ARE STATED C VN T"E REVERSE SIDE,AND ARE:P.111T OF THIS CONTRACT
tart-12 Whae-Bianchi Fie Vallow-Cusainuv
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
I uq� Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information Please Print Le ibl
Name (Business/Organization/Individual): r:
Address. fC4141Af
-i1 .
City/State/Zip: cam. one#:
Are you an employer?Check the appropriate brye: Type of project(required):
1.9 I am a employer with 4. Q I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I a sole proprietor or partner- These sub-contractors have g, ❑Demolition
ship p and have no employees working for me.in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.t
5 and its 10.❑Electrical repairs or additions
. ❑ We are a corporation
required.] . officers have exercised their 11.❑Plumbing repairs or additions
3.❑ I a homeowner doing all work right of exemption per MGL
myself. [No workers' comp. 12.❑ R repairs
insurance required.]t c. 152, 1(4);and we have no 13. Other
employees. [No workers'
comp. insurance required.]
Any Applicam 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.
:Contactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
emploXees. If the sub-contactors have employees,they must provide their workers'comp.policy aumber.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. \i �
Insurance Company Name:
Polic #or Self-ins.Lic.#: ` L Expiration Date:
Job S.Ite Address: > City/State/Zip:
AttJh 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 a 152 can lead to the imposition of criminal penalties of a
of a STOP WORK ORDER and a fine
fine tlp to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form
of up Ito$250.00 a day against the violator. Be advised that a copy of this statement may
forwarded to the Office of
Investigations ofthe D for insurance coverage verification.
I do hereby certify d th par an penalties ofperjury that the information provided abobe is ue and correct
Si alture:
Date:
4
Phone#:
O}ficial use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Liceuse#
Issuing Authority(circle one):
1.1Board of Health 2.Building Department.3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
it
NA
ERT if"1C A O- F, U-A Bli I
CER'rfF!CA7E S ISSUED AS A MATTER OF INFCRIIrLATJIDN CNI-Y V4
END 9P Il- _xn mv ot!
l,7I=If_AT;: DOES NJQT AFFIRMATIVE!Ly OR INS3A.
CE rC)E.5 NOT CONSTITUT A
SEI OK THIS CERTIFICATE OF INSUFIAN
r EPR S NTATIVE OR PRODUCER,AND THE CERTIFICATE.HOLD
li:ha csrrira to i_Older isar, ADDITIONAL MILIFIZID,
IMPORTANT;
ishe arals;and conditions of ihe Policy, sentain poli'llea n1:cy vsqUiTs an-Oc!07-1�rant
---
case hclOs,1n lio, Of Sur.h and o ——------
nsem*ntfs�.
MARSH USA,INC. PHONE
TWIO.Ai LIANCE CENTER E-MAIL
0 LENOX ROAD,SUITE 24CF,
AT I 4IiiTA,CA 30326 INSURERS)AFFORDING COVES-4GS NAICY
NSURERA steadfasl insurance Gomcany 126367
INGUNIZO INSURER B o Zurich American Insurance Co 116535
THE HOME DEPOT,INC. INSURER C Nevi Hampshife Ins Cc 22841
HO�I=DEPOT U.S.A.,INC.
2455PACES FERRY ROAD,NW INSURER D. Illinois National Ins Cc 123817
BUILDING C-N INSURER E
ATLANTA,GA 30339
COVERAGES CERTIFICATE NUMBER: ATL.00315954504 REVISION NUMBER: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 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
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. CYEXP LIMITS
INSR WAWr (MWDDNYYY)I
LTR TYPE OF INSURANCE POLICY NUMBER (M
A GENERAL LIABILITY 0311OW013 U310112014 EACHOCCURRENCE 5
11—AI 9,000.000
1,000'a IG IFT D m
X 1 CCMMERCI�L GENERAL UABILFTY PREMISES Es !:X!,Luutu
CLAIMS-MADE I OCCUR LIMITS Of POLICY X5 NIED EXP(Any one person) s
OF SIR:SIN PER OCC PERSONAL&ADViNJURY Is 9,000,000
GENERAL AGGREGATE L s 9,000,000
PRODUCTS-S' S
GENLAEGRE�7J_.I ITAPPLIESPER:P,O_POU,
X 1 'Y I LOC 0310117014 ,COMBINED SINGLE LIMIT 1,000,000 A.
B AUTOM081LELMBILITY SAP 29311863 103ID112013 I Ise acadent)
ANY AUTO BODILY INJURY(Per person)
ALLOY ED P ACHOESULED SELF INSURED AUTO PHY DMG - BODILY INJURY(Per accident)
AUTOS LIT tpV
NON-DANED
HIREDAUTOS AUTOS
UMBRELLA UAS OCCUR EPCHOCCURRENCE
EXCESSUAB CLAIMS-MADE AGGREGATE
DEO RETENTION 5
I X I gyST
C WORKERS COMPENSATION WC033575314(ADS) 0310112013 0310112014 LATMU-S
IM
C orH-
ANDEMPLOYERS-LIABILITY YIN IWC031.111111(AK,AZI 0310112013 103101014 Is
ANY PROPMETORTARTNERIEXECUriVEACCIDENT
D OFFICERMEMBE El WC033575316(FL) 1111112111 113fll'2114 e !1 Is 1.QUuUuu
R EXCLUDED? NIA E.L.IL DISCH, -EA EMPLOYE
(Mandatory in NH) 1,000,000
Us,do'Ic,ibe VerPERATIONS bel. E.L.DISEASE.POLICY LIMIT I S
SCRIPT;ON OF 0 0311112013 10310112014 I(EL)LIMITC033575318(NJ) tollC 03/70112013 GTOV2r 'WORKERS COMPENSATION WC033575317(KY,NC,NH,VT) 1,000,000
W
IONOFOPERA71 KPl LOCA70NS I VEHICLES (Atiz�h.ACORD iOl,Additional Pemar!,&Schedulo,lf more space Is required)
DE. npnNc,"p,"'O
EVIDENCE OF COVERAGE
CERTIFICATE HOLDER CANCELLATION
THE HOME DEPOT INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
HOME DEPOTUSAJNC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
2455PACESFERRY'ROAD,NW ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING C,20
AILANTA,GA 3,0319 -jTiiO;UaEO Re .ES5NTATIVE
of Mars"USA Inc.
Manashi Mukherjee
� N
�i �Jt¢ -l9dy/NruOpt.(MldUdb O�✓I/�G�L45;,�11% ..
01fice or con unaea Affair F Exp.,mess R n-:„teari - 1.ata:- cr De I,axie3n da ul aua anc§ry t3tta w j -)''IVrJ
.
a OME IMPROVEMENT COOTRACTOF baSora the e-cpaa rttoa,d�2> Yf rand return i •.
O , e of cor ,ar, el affair,alld Lusane 1,CgRI ,on i
Pey�t afataoaa 12$493 .T ypd, 10 Park Phan-'Staite 5170 �}
0-iston,MA 02.116
The. Horne
P,ICHARD FA 51
2690 CUMBF_'F2LANp
A'IrL.rAN`�`�i,GA 3k339 — Unders c etarg-�-- ;03+alirl ithoui sign --
e
e
. e e
�--� Massachusetts - Department of Public Safety
Board-ofi Building Regulations and Standards
Cnn.tnicTiun Supini.ar Spcd;da ,;
License: CSSL-099699
ROBERTPOC?�BUT
172 WHALEALAN
sateen MA Qt970
i" Expiration
Comrrnssioner 02/68/2014
Apr 18 2013 9t31PM MIKE SIDMAN 6039345514 p. 1
HOME DSIPROVEMENT CONTRACT
PLEASE READ TIES
Sold,Furnished and insta8ad by:
B unchAmer; goetan DaWt TIC At-Home Services,Inc,
Y/sQf _ dlble, The Hurnes Depot At-Name Services
909 Su:don Turnpike,Unit 1,Shrewsbury.MA 0I345
Toll Pre.(SM)657-3182:Pun($08)845-6017
BrUnch Member!31 1161 lO 075.269MO:Me IJc e C 03439:RI Cont.Use 16427
y A.f CK Liu Is HIC.03AS322;MA Hu hipm%vinern Contratair Res.0126195
Insralknbn Addrits: Y 2 a r�/✓IC S.f— _ Naa a Toe/^�' Mf.� b19.10
city State Zip
Ih,rvha0er('ah Work Phata: Rome Plains: Cell Phaaet
a " a fir [ J [
(11 di1(**frtmt lnsteOallon Addreas) City Stale Zip
F.•ui.il AlMrealltomeain project communication,and Harris Petrie updates):
[l l I)O NOT wish to receive my marketing crnaila from The tinme Depot
Underai Wm gned('Cueer'),tea owners. n)•at'the prmpe located at the above.inslallation addt>'sk,agrees w buy,
ern: .!R t At- is Slairiess. lot.01ire Hearst Depot')UPI to furnish,do Itver and wrange fat the inetallxdnn('Inatallatton")of
nil :wWs desctibrd on the below and on the rrfrpenccd SWShrofs),all ur.vhich air irtcorponrQ4 into this Contract by this
me. along with roes.ripp8ca61e Stare Suppiemunt am! Payment Summary amtched hcrcir and cols.Change Ordus(collectively,
-
,hd.•. n ee„aws urlet _ Sonilimandib. _ Protect Antritt
ry pt� Doling SWlag wlndmvx InluhlhM �-•- p c Pq� -�
8o/1n/Gown �Bouy Ooun �_ v�J o.� s
RbMing' aiding Wlnaawe IaatBdon
. woamraiCuwtm []Fntry Oeon (7 $
Saofing Siding . wlrrdowa ircubtioa $
. QW(mie/Coven,08ptuy DCIXa❑
Surfing 03iding Lj Wtnduwn E3 Inroartiea $
. j]daaae/Et,ven [3FAUy0mar []
DepodtdCararadAnv®I4beapmoereuel gfthkmatnc4 Total Ctmtnot Amount $ ry
n:. 1 P ndusse COW edepopertmtedmnam•WeAofthe t�ontrae�AntwM. S9J
Cu, -,,.r ug*s dual invarcdiotaty tlpun cornplat on of the work fee each Product.Cussolra.T will execute a 6inpletical Certificate
(tar inr reset Troduct as darrrned by an individual Spec Sheet)and pay any balance due. As applicuble,em;h Cuawmcr under dote
C,..:,;:ct mgtees m be jointly and severally obligated sued liable isnrn.der.
TIl, . •,,,o Di)pat raervpa Ilra.etght to Issue a Change Order er oerminme this Compact or my intividual Product(.)included h stabi,ut
Its lion,IPThe Hoots Depot or IN author9ttd sdrvirx provider determines that it cannot perform its obligations due to a seactard
pn.. .,,with the bome,eoviroamenml harardv ands as mold,IObosms or load paint.otter sarery concerns,prkial emors or became
"I-:- gdrrd so cramptota thasJob was plot included in the Contract.
The Paysnont Summary N 0'70 'I . inelnded us pan of this Contract, sets forth the III
G, anumat and peymenes.cequited Ear the deposits anal final payments by Product(as appiicwhle).
NOTICE TO CUSTOMER
1•„ ..ru mtMed to a eonsp)etelf"Med-M Dopy of the Contrast at the thne Cott ill■■IM Do trot sign a COMVI on Certificate(torte:
lh.. acre Congiktko Crr ate for each listed Product r deflued by mtLvideal Spec Sheels)haNie week on OW Product
IN, .date
In ent of termination of thin Contract,Customer alrew to paY The Home Depot the emus of materials,labor,axpenau
ac Ices provided by The Home Depot or Auehoriced Ser%im Provider thria s the date of larmWldon,plus any other
ono. •.A sell Inl*in irk ikgTMWot Or allowed Under allppt1lesbte low. THE HOME the
MAY WITHHOLD AMOUNTS
HE O: TO THE HOME DEPOT FROM T DBPp.4Tr PAYMENT OR OTHER PAYMENTS MADE, WTTHOUT
LP NO THE HOME DBPOT'S OTHER REMEDIES FOR RECOVrRY Oa'&UCH AMOUNTS.
ar. • Cltsmrster agrees and dndnsentds that thi•Agreenwnl is ilia ensue agreement between Customrr
wn ,:lion"Depot wr regntd so the Products and Installation services and supciardea all priut diveuariona and agreements,either
ern. , wiinea,relating to said Products mid Installation.This Agreement cannot be assigned of wnended"uspi by a writing signed
by, -:outer mad The Home Depot.Casul acknowledges and agrees tint Customer htu read.undu,etandx,volumorily'aceapt,the
tv. and has moeited a ropy of this Agreement.
A.. •I nyr ._ Subbdtted bye
C.. vex Sillem:ne Date Rake,consultann't Sigpn{ore Del
X... : _ TOct,brne No. I&
C:: :'s SignatureISnte SA)"Consultant License No.
Zn '.:i.LAYION, CUSTOMER MAY CANCEL THIS IwaN,ns:mb)
Ai.. .::)IENT WTTHOuT PENALTY OR OBLIGATION
1t5 I.i VFRING WRlYfJZN NOTICE TO THE HOME
D:. R IW Y MIONMUT ON THE THI BUSINESS
D.'% "rER SWMNC TH11g AGREEMENT. THE
S'; SUPPLIINEN'f ATTAC.ABD HERETO
C :VS A FORM TO USE IF ONE is
St CALLY PRUCRIBpA BY LAW IN
C ',ZRsSSTATE.
rt'IC6ADDITS)NAL TERMS AND Cc*(DMDNS ASH RTATPA ONT EREVERSE eku%AND ARE PART OF 7HIa COMAirr
te. WhBe-Bnnoh Flk Yearn-LLatomer