11A-014 Authorized signature
%($ / }upon completion of 1
%CS M 1/ 6 a )upon completion Of I✓ u^'12- ~
Notice:No agreement for home improvement contracting work Oa require a dawt payment(advance
JUG (J� J L deposit)of more then one•third of the total contract Moe or the total 9vnount Of all deposits or payments
%(y �.—., )shall be made forthwith upon which the contractor must make in advance,to order and/or otherwise obtain delivery of special order
completion of work under this contract. *tetanal,and equipment,whenever amount la greater.
Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated. I understand that upor
signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller, which may be his main office or
branch thereof,provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than
midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred
to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
I
Signature ..is c yr Arli-ii_ Date l ./$ $Ignature Date
NOTI,e_QF CANCELLATION
ATION
DATE OF TRANSACTION
YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL,
ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NCOOTIADLE INCTRUMCNT CXECUTED BY YOU WILL
BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS
CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: YANKEE HOME IMPROVEMENT, INC., 02 INDUSTRIAL DR.,
NORTHA /ON, / 0106O NOT LATER THAN MIDNIGHT OF
If /Y / 1 HFRFRY r;ANCFl THIS TRANSACTION _
tome.Su yt holidays eXcIUded) BUYERS SIGNATURE DATE
Buyers)acknowledge r eipt of two comp etely filled in copies of this notice on the date first above written hereof.
Buyer's Signature az•t Buyer's Signature
/ 1.,,)/3 coin. / 1't/Z t'
Siding_Atreement
I i t i Thousands of Satisfied Clients!
'�j li I�E I 82 Industrial Drive MA Lic#160584 225 Cedar Hill St,Suite 200
11 Northrampton,MA 01060 r CI 4ic#0673924 Marlborough,MA 01752
ly p (� j,� '�" 413341-5259 RI Lic#33382 877 88-YANKEE
The MOST Reit!rreci Contractor All home improvement contractors and subcontractors must be registered and any inquiries
in New Englarui about a contractor or subcontractor relating to a registration should be directed to
Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170
www.YankeeHomelnc.com Boston.MA 02]id Phone:(617)973-8700
dor im omorr
Homeowner Information
Name itg i��q./ G Street Address /�;�!� /4,/ti ' Kb City LI & S Stat ' ip 61/416,
Home Phone 2 cP 2 L/7)Work Phone Cell Phone C5,6 g V7 d E-Mail AG /i /l/2//e6 4g
Mailing Address (if different) _,, .58 -3/4.5 i ,4/7/itr. 174
The Con(ractara,fees to do the*Rom' r ►Mark for the Homeowner. _
IDING Type ' • 5 Colorer r •I"' P S'•/ra Style . e4
Removal of Existing Si s ONo Yankee Ind. Sealant ❑r10
Removal of Garage Siding Pries ONo New Gutters Li es ONo Color��
Dumpster i $es ONo , New Downspouts t 'es ONo Color Lai/1W
Window Trim ❑0 stied Sided Old Gutters ❑ Remove/Re-install Existing Cl�.6ispose
Coil L�'P/VC U Flat Color 17< /7A`'t• Gutter protection ❑Yes CINo
Gable Vents I gees ONO Attic Energy Barrier C]Yes C214o
J-Blocks L]s ❑No ❑ Rafter Install ❑ Floor Install
Soffit Covered s ONO Color 1er4. Storm Door ❑Yes ❑No
Soffit Venteds ❑No # Type _ Color Entry Door
Fascia Covered [Wes ❑No Color ')/�/!/tl Entry Door ❑Yes ❑No
Rakes Covered I2/es ❑No Color # Type Color
Contrasting Corners ❑Yes ONo . Color/ ' '1 Shutters CkrJ/1 'V p O' es ONo
Repair Rotted wood (not sheathing) Wag ❑No #Pairs !!d`Raised Panel 0 Louvered
Location Porch Ceiling ❑Yes ❑No Color
Porch Inside Wells DYes ❑No Color
Glass Screens Color GRIDS Fixtures
I 3 Pane Option Half Full Inside Exterior Layout Style Style
MN —nada
Spada,Instructions CAr5i B U G r fd%410/1 G Oh 5/0,44 6a/JA' $u/ it/ a ✓S
—
,_ r& • Or' / F Ir9tr lb7/r ateR _ —
-
Do Not Do We do net do any painting or staining)
We' HE LE �■
Co d: . not begin the work or order the materials before the third day following the signing of this Agreement,unless spec•flif ref .jdbntractor will begin the work on or about
• • (date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed ay re_ .eta).The Owner hereby acknowledges
en• ag a scheduling data are approximate and that such delays that are not.avotdabia by the Contractor Inciudi t,butt ,Z.• to strikes. Acts of God, shortages of
material ,accidents,and all other delays beyond its control,shell not be considered as violations of this Agreement,
WARRANT'? r� f
The Contractor warrants that the work furnished hereunder shelf be free from defects in materials and workmanship for a period of otiowinq completion and shall comply
with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,Its subcontractors,employees or agents,Is discovered
after completion of any Job,Including cleanup,the Contractor shall,at Its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such
damage or such defect In materials and workmanship.The foregoing warranties shall survive any Inspection performed in connection with the agreed-upon wont.
YHI agrees to perform the work,furnish the material and labor specified above for the total sum of: ".7-)a-6/'
/a� �y/�
W.(tom 1/ ._ V a { /: .r.D J( '
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33 YEARS,_ _fl,..[Rhc,de.i.,.'--.-_;,4 ,,..„...a! .•';"".'•..-.7-,..-::.-.:=-4,-.,77,-;;,;. ..,,-...i..:t. ,- .7-,,,t,-..,_.-..';',•.:-'..-L,.s....',..7-4., :.-1,:.,,,::--..-;,,-::::...4.-:.,,;:-.-':, • ...,. .
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Waste
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tury Street
32 Cen MA 01001
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& E-mail
/-)
Phone
l
-1455-1672 Loca
•
(413,
innl-) orito
The Commonwealth of Massachusetts
Department of,industrial cll Accidents
I_ Office of Investigations
t.„7:-.JIM�,� 600 Wasizizzgton Street
,sg 3~ ,rosz`a,-.7..3,41 02z z.z
3#ww_nossgoviti a
Workers' Compensation Insurance Affidavit:B si tiers/Contractors!EIectraeiaos/PIumbers
Apaicait Information Please Print Legibly
Name(Business/Orgauizationalndividual): f E #- ME 17v7 VI=i✓E"ht'7
Address: 2 =k i.D Us s e t L TC?A Vc-
City/State/Zip: 3JD tA14 ;7;D7ti.,IviA., 0 10 60 Phone-#:_ 'ft3-3�t-1 °SL 5 43
Are you an employer?Check the appropriate box: 1 Type of project(required): 1
I. i am a en with �O 4. 0 I am a genera;contractor and I
0 New construction
6.
er piovees(full andior pare-tip:;).* have hired the sub-contractors
I am a sole proprietor or penmen listed on the attached sheet. I. 23 Remodeling I
ship and have no employees These sub-contractors have 8. D D�hdan
working for me in any capacity. employees and have workers' 1
4_ D Building addition
[No workers'comp_insurance imp-iasruartce.i i
7N: ed_] • 5.0 We area corporation and its i0.0 Electrical repairs or additions 1
work
officers have exercised their
3.LI I am a homeowner doing all work 1 1.0 Plumbing repairs or additions 1
myself. workers'comp_ • rift of exemption per AlIf33 12_ Roof repairs
insurance req�ea.]t c.152,§1(4),and we have no 1
employees,[No workers' 13•0 °r
comp_insurance required.]
'Any appiiant that checks box#1 utastalso fill oat the scctios bciow showing flair workers'compensation policy infornzat�on.
Homeowners who submit this affidavit smdcaicn g they are dab g all work and Aim hie outside contractors mast submit a new affidavit mdirating aech.
4'C-oat-actors that rhetk this box must attached an:idditionai eb•es showing tlae name Of the suit-conaacuns and std wheilacx ornot those entities have
employees. if the sub-contree o s have employees,they must IA if,ide their wakes°comp.policy number.
ram an enipicytha is providing wort er s'couzpeis r inskrmir'F for my empkyees. Below is the policy and job ste
infori natZOn.
Tncurance Company Name: t A IV i"t f.. S TZ 7 1.1".Li S11T24 AIL Critiell A.PY"
Policy r Or Sett-ins.Lie.T: (G ledS--.5B507'Y5-- —12 Expiration Date: ID-2— 2043
Job Site Address: 21t4 I-JA Y. .A0VI L L E Tca1)iQ V Cityl e/up: 1.-Zia AelA. 04053
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Secdon 25A of MGZ c.152 can lead to the imposition of c iminal pules of a
,sae up to$1,500.00 andtor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of r.,p to$250.00 a day aping-the violator.. Be advised that a copy of this statement may be forwarded to the Office of
iavesaaatxons of the DIA for insurance coverage verification.
I do hereby semi,fy wider the pains- , - ,•k,..of peljury that the information provided above is true and conned
Si-.ature: v
Date:
phone#: 403 "-3'--frr 525S
11 Official use only. Do not write in this area,to be compiEled by city or town official
ii
411
Y C#tv or Town: PermitlLicense#
Issuing Authority(circle one):
i_$...,d ofHcantz, 2 Suitelkig Depa.rrraert 3.Cityrr wn Clerk 4,Electrical Inspector 5.Planking Inspector
1s 6.Other
it
II Contact Person: t`
i$
Phones : f
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 720AIA fr CS S`)'-f 4 Z. - a
License Number
E5Z Z'N.DU5772L// L_ .D RIVE- tUd.'7141:11Y1P7Mf MA-, DrO( Q 3- 9 -• 'ZGS/r-f
Address Expiration Date
1-/-/3- 34-1 SZSy
Signatur- Telephone
9.Registered Home Improvement Contractor Not Applicable ❑
YA•/VKEE HOME .ZMPRnVE MEN 7 /cOS2S-1-
Company Name Registration Number
02_ IA/DUST-01A L.DR/VE•/VDRTHAMPTOA r MA, DiO6.7L3 fk -7- ZO/-/
Address Expiration Date
Telephone `413--34/-SZ5
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) J Roofing n
Or Doors 0
Accessory Bldg. 0 Demolition U New Signs [0] Decks [[] Siding[ ] Other[0]
Brief Description of Proposed
Work: 57 'fP AND 7e'PLA.CE S/TJ/NCB
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, A/AA/CY 4I/3RDIA/G , as Owner of the subject
property
hereby authorize YAlVKEC /1E =11r7,PRlJVCMEA/'f
to act on my behalf, in all matters relative to work authorized by this building permit application.
cw CON 7-17-4C-7—
Signature of Owner Date
I, GERM D RONAM WhvIrEE 2MPi26VEMENT ,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.
C�ERARD 120A/AN
Print Name
�-- Date
Signature of Owner/Agent
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 8c Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ® , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO e
..........._ ...__..
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 0 NO al
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
RECEIVE Department use only
City of Northampton status of E'etmtt
APR 2 5 Building Department Curb Ct 7rt�r Gray P alit
212 Main Street
Room 100 Watrlflyell Avatlab;lify
DEPT.OF BUILDING INSPECTIONS Northampton, MA 01060 Two getsbt Structural Plans_ -
NORTHAMPTON,MA 01060
pt iane 413-587-1240 Fax 413-587-1272 Plot/S to Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
21iL HA'/DEkI VILLL 1 O4D
LECD�i s /'TA. 01.05"3 Zone _Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
A/AA/C Y FFA2D/NG 21'i 1-14Y17670/71.4...E R.D. LEEDS:rV.444 0105:3
Name(Print) Current Maiiingg Address:
=113 -5£3E Li.TO
OA/ CO/1/77'A r Telephone
Signature
2.2 Authorized Agent: GERIt Tc'Z] TTO IJA N
YAIJ KCC_ 1.401 WE .2A'/PIZOVCMCNT R2 Zn(DUST7?ui tL DR. A/RTi-4N/PrOItls 64A 0/CC-O
Name(Print) Current Mailing Address:
y/3- 34-/ - 52Sy
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed b •ermit a••licant
1. Building 0,‘" (a)Building Permit Fee ,e 3G.C./Cr
2. Electrical (b)Estimated Total Cost of
Construction from
3 Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) 3Z+&/5• Check Number
This Section For Official Use Only
Building Permit Number. Date
r.
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
214 HAYDENVILLE RD BP-2013-0998
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11A-014 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:vinyl siding BUILDING PERMIT
Permit# BP-2013-0998
Project# JS-2013-001669
Est. Cost: $32615.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: YANKEE HOME IMPROVEMENT INC 89442
Lot Size(sq.ft.): 24306.48 Owner: HARDING NANCY J
Zoning:URA(100)/ Applicant: YANKEE HOME IMPROVEMENT INC
AT: 214 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
82 INDUSTRIAL DR, UNIT 2 (413) 584-8318 WC
NORTHAMPTONMA01060 ISSUED ON:4/26/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 4/26/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner