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38D-060 (3) 53 REVELL AVE BP-2020-0853 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma Block: 38D-060 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERI:1)CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT, Permit# BP-2020-0853 Proiect# JS-2020-001462 Est.Cost: $21440.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC 89442 Lot Size(sg.ft.): 6708.24 Owner: CAMPOSEO JOSEPH O JR Zoning,: URB(100)/ Applicant. .YAN KEE HOME IMPROVEMENT INC AT. 53 REVELL AVE Applicant Address: Phone: Insurance: 36 JUSTIN DR (413) 341-5259 0 WC CHICOPEEMA01022 ISSUED ON.1/27/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 DeDartment 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 1/27/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only S TCF rli. City of Northampton --=�_ Status of P$rmit: - Building Department Curb Cut/D�riveway Permit 212 Main Street SAN Sew r/Se tic Availability 2 my q Room 100 Wa r/W I Availability Northampton, MA P, Tw Sets f Structural Plans phone 413-587-1240 Fax_4158r'� �"asp=,.. IrSite Plans ther 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 �V e Map Lot (:n Unit NorAA-)o,-m per . ma I Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C'amp(c� en \k PN e -MCL oint" Name(Print) Current Mailing Address: t'\e G`"e �Se e Si QD'Lct Q C f ( (;iltCC'C Telephone Signature 2.2 Authorized Agent: 910' a Name(Print) Current Mailing Address: L's A5C', Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building i 1 y� b� (a) Building Permit Fee 2. Electrical `-� (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) PI o 5. Fire Protection ` 6. Total = (1 +2 + 3+4 + 5) Check Number This Section For Official Use Only Building Permit Number: — `"4y Date �7p Issued: Signature: �© JU Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) E Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[ Brief D scription of.Proposed Work: Ke yn o-4 kricA Cele(-.(' 10G C(-,O� / Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes Z No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housinm 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, ,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. �Ie0.Se See- SiQneA a ape(# ( c7garar� 1� '_71)C) CJ Signature of Owner J Date 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. PIQs' d Print Name (o- 19 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction ((Supervisor: Not Applicable (❑ Name of License Holder: V ( ('1( c'Loan C s- 07nL4LAo� -r� License Number C_h�unee - MCA ur):�)Q 3 --tCA - 20 a Address VExpiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ,I Q.n K,ee- Hom-e l a m t P m n 11 n Company Name 1 Registration Number 31i�L1� r �� 11 - 2.C)20 Address Expiration Date Telephone�113"3�11 >9 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....... IA No...... ❑ City of Northampton Si Massachusetts �W?5 c�c DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building - _ Northampton, MA 01060 �rN➢Y �`�o Debris 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: R.el�iuh\ic Se diceS yb 'Ruse A - SD(r-IQ ;\06 '(`(1c, . (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ozw--)� CLAA ►'a -30-19 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www tnass.gov/dia Workers'Compensation Insurance Affida0t:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING ACtTHORITV. Applicant Information Please Print Legibly Name (Business/Organizationilndividual): Address: x'12 .�l>,�A kes q City/State/Zip:``_.�1iC���Z �( yq C1u2 :. Phone#: (� I �3Ll I Are you an employer?Check the appropriate box: _ Type of project(required): I.Q[am a employer with C)5 employees(full and/or part-tune)." 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.(No workers'comp.insurance required.) 9. El Demolition 3.❑1 am a homeowner doing all work myself.f No workers'comp.insurance required.]i 10[]Building addition 4.E)1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 LQ Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑(am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.-* 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL a 14. Other Qs 152,§1(4),and we have no employees.f No workers'comp.insurance required.] "Any applicant that checks box#I 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 n y employees. Below is the policy and job site information. "� Insurance Company Name: L� a _ Policy#or Self-ins.Lic.#:X V V 05 6 I 0 2—J?) Expiration Date: Job Site Address: 5_�) Q��C'�� !N 2. . City/State/Zip: ] p r bl(Dtzi p Attach a copy of the workers'compensation policy declaration page(showing the policy number and exl1iration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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. Signature: �i1 ��� "'�----' Date: Phone#: ct Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: YANKHOM-01 NICOLE ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYr) `� 9/3012019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nicole Waslick NAME: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext):(413)594-5984 (Ax N.):(413)592$499 Chicopee,MA 01013 ADD�ESS:nicole@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Co 24082 INSURED INSURER B:Selective Iris CO of South Caro 19259 Yankee Home Improvement,Inc. INSURER C:Ohio Casuatty 24074 Ger Ronan 36 Justin Drive INSURER D: Chicopee,MA 01022 1 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. INSR ADDL SUER POLICY EFF POLICY EXP TR TYPE OF INSURANCE INSD POLICY NUMBER MIDD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X]OCCUR BKS56702381 10/1/2019 10/1/2020 DAMAGE TO RENTED 300,000 PREM E Eaoccurrence) $ MED EXP(Any oneperson) $ 15,000 PERSONAL 8ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY FX�jE F—]LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMafBIINdED SINGLE LIMIT $ 1,000,000 X ANY AUTO 9106918 10/1/2019 10/1/2020 BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS W p BODILY INJURY Per accident $ AUTOS ONLY AUU ONLY Peracddent AMAGE $ $ C X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESSLIAB CLAIMS-MADE US056702381 10/1/2019 10/112020 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 C WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN XWO56702381 10/1/2019 10/1/2020 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N NIA E.L.EACH ACCIDENT $ _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE III 1'000'000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A 'Property BKS56702381 10/1/2019 10/1/2020 Building Limit 3,117,000 A Property BKS56702381 10/1/2019 10/1/2020 Personal Property 153,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation coverage is included for the following states:MA,CT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) s ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 11 Yankee Home Improvement MA Lic#160584 Y 36 Justin Drive CT Lic# 3338 24 YANKEE RI Lic# 33382 Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Joe Camposeo (413)584-1232 Date: 12/17/2019 53 Revell Avenue joecamposeo@comcast.net Rep: David Prats Northampton, MA 01060 Locations INCLUDED in scope of work to be performed Single family home and attached garage and shed in back Locations EXCLUDED in scope of work to be performed All plastic standing seam roofs Job Specifications Existing Shingles Asphalt Installed Shingle Type Atlas StormMaster Shake Shingle Color Silver Stone Starter Strip Atlas Pro-Cut Starter Shingles Install Underlayment Atlas WeatherMaster Ice & Water Underlayment Install Drip Edge F-8 Heavy Duty Drip Edge Drip Edge Color White Hip & Ridge Atlas Pro-Cut Hip & Ridge Shingles Install Chimney Lead (roof surface meets chimney) in all applicable areas. Quantity: 1 Ventilation Install Ridge Vent attic ventilation system on all required areas (Length): 0 Special Instructions The shed in the back just put shingles on top do not strip no warranty will be given for that shed just wants us to put layer on top f the shed Do Not Do We do not do any painting or staining. Page 2of11 Work Schedule Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 01/13/2020 Barring delay caused by circumstances beyond Contractor's control, the work will be completed by 02/13/2020 The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including, but not limited to strikes, Acts of God, shortages of materials, accidents, and all other delays beyond its control, shall not be considered as violations of this Agreement. Customer Initials Unforeseen costs that could occur. Additional cost could arise due to damaged wood not recognized at time of estimate.Any wood replacement will be charged upon the homeowners approval an additional cost of$60 per sheet of CDX plywood. Homeowner understands that damaged plywood can only be definitively evaluated after the existing layer(s) of shingle(s) have been removed. Homeowner has completely read, and fully understands that any and all plywood replacement will be charged in addition to the total amount of this contract. I understand the additional charges that could occur at time of installation. (Customer Initials) Acknowledgements and Notifications. Access is needed to driveway where possible. Please have all vehicles removed from driveway to allow for material delivery. Saw dust and debris can fall inside of the attic during the installation. Homeowner is responsible for the protection of any belongings in the attic and cleanup for all debris that may fall into the attic. Homeowner agrees to be home upon job completion in order to do a walk around with job foreman to inspect completed project. Entire job site will be cleared of all debris upon project completion. I have reviewed and fully understand all of the above. (Customer Initials) _LL WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of LIFETIME following completion and shall comply with the requirements of this Agreement. In the event that 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 Authorized damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Joe Camposeo 12/17/2019 Date OSM oil �R? M .. • J( u r �i FF 3 � J Mid ' _�r�l,.l,�`'x7/! `.._ :,r, j"4�,!`i..•�r+�., .i . 4 t �e�• .`- €�j} i Mie:, � 3`�,y`6 "^+moi 1�i( �'��� � • ,,'+:.a. ,w, •