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24A-123 Ill LU� ,o ) n � � owl- l� � 4' of ep _... ..�. _ 1. :J / 7Y Pi© Fu a completion 4111/41kor .2,v, (S b�40, ) nor 424katt_ • / J Q� r� f rs 4 ' 26,68-7- o 7 5 . .% (S V 8 . ). ulon completion of ,oli ' �} 4 No agreement for home improvement oonIradag oak sisal require a down payment (adderee al deposits or payment (5 I V 3 r e ) 311811 be made to(d'rMth Upon which the oo cto �t to order otherwise obtain delivery of comial ado' completion of work under this contract. maaeriala and equipment Acc ptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that won Signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. Yoti May cancel this agreement if it has been signed by a patty thereto at a place other than an address of the Seller, which may be his main t 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 rhidhlOht of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred toV'e and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. gigtildura Date 9 -tot - _ 1 Signature Date NOTICE OF CANCELLATION DATE OF TRANSACTION , Y CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU • , PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU TURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTO N0O OUT OF THE TRANSACTION WILL BE CANCELLED. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF 1` r TION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO YANKEE HOME IMPROVEMENT, INC., 82 INDUSTRIAL ';. , tILOIHAMPTON, MA 01060 NOT LATER THAN MIDNIGHT OF bi 11 I HEREBY CANCEL THIS TRANSACTION Ode.. S jnd undays excluded) BUYERS SIGNATURE PA TS i$uyett(s) acknow receipt of two completely filled in copies of this notice on the date first above written hereof. i$nyet s Signature Ct.Ar�C Buyer's Signature r" t . 0 I 0 il YO.,PfY ° ' indow A reement ..,/,7., A4.41-6i-5 ) ousands of Satisfied Clients! 9 /30 YANKEE . 21nd 'al Drive MA Lic# 160584 225 Cedar Hill St, Suite 200 N • , - -1 pton, MA 01060 CT Lic# 0673924 Marlborough, MA 01752 140 M E I M P R O V C M E N T 413 341 -5259 RI tic # 33382 877 88- YANKEE rho MOST R oft rrc d Contractor All home improvement contractors and subcontractors must be registered and any inquiries 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 *Ww.YankeeHomelnc.com Boston, MA 02116 Phone: (617) 973 -8700 Homeowner Information �laItte � 1U .. Street Address 66 to Cit r Stat Zip .i 0 Home le Phone4l3� 3L Work Phone48— .V2416 Cell Phone E -Mail /14-64(1030wj-hug. Mailing Address (If different) c Q D,, do ►. The Contractor ep to do the blowing work for do Homeowner.' Glass Screens Color GRIDS Qty. Brand . Style 2 Pa"n 3 Pane Option Half ' Fu ij/ Inside ' Exterior Layout Style -' N i✓A � A L S V ` r/ ti�u� �c� , b -jo0 1 LL B ‘f w i .*! 4 -bd . 7� 1.\ � , .s r plc ✓ I _ • Repair Rotten Wood Is ONo Lead Safe charge l "es ONo Amount $ MO, it House Built 1140 MIA removal # ❑Yeses Disposal of old Windows 8tes ONo Yankee Ind. Sealantliales ❑ No irtsCllation around ��// Trim color T-t4. l ONo PVC lir Smooth ❑ mainframe I�1Yes :No Interior casings DYes itNo G -..,, Dbbrs # Storm Entry Type Color Ext. Color Int. i ;4-'= /Instruction Lfi',. " , A ..Li/' _ .,., _ �,, �. ,1. ,. ,v impi i? I snit RI'i." '� sW f l�iL.'.I a tr " +l � i ' / /ai s. = 4- "'�`T:mrr .._ /:..�. ,.. , . ,.. L . _ (We do not • • any pa '77 • f, Inlpg) i,,A I�il 7� L �i ?_'�ii:�Y 1 i , t . _ / tau t ..S i" f : - 4 4 $ ., i. .. : i.. .I 1 WORK SCHEDULE rat begin the work or order the materials before the third day following the signing of this Agreement unless Contracto will d the work on or s II ( date). Barring delay caused by circumstances beyond Contractor's control, the wait will be completed by daee). T h e Owne hereby t hat the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including. limed to strikes, Acts of God, shortages cc INACIRANTY accidents, and all other delays beyond Its control, shall not be considered as violations of this Agreement The Contractor warrants that the work furnished hereunder shall be free from defects In materials and workmanship for a period of fligrng comple tion and strap goitlpty Wait 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 daitrage or such defect In materials and workmansNp. The foregoing warrarNies shall survive any inspection performed in connection with the agreed-upon work. YHI agrees to perform the work, furnish the material and labor specified above for the total sum of Fe ote ...L PO figtid % (S R4g� . D ) upon s oork# /20 resenfaitve f) L -i$640 Ps Narr>a of Rep / 4 Department of Industrial Accidents Office of Investigations • 7 1 = 600 Washington Street • ' = Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): )/cfi ,tee, 1 �LI � r M .1 t" '� . r ^� Re..);') c yi Address: , d Uf i'i 'a L ^, City /State/Zip: No/Wm/lei m4 /C)ho Phone #: //3 —3 9i/ Are you an employer? Check the appropriate box: Type of project (required): 1. ' I am a employer with .10 4. 0 I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub - contractors 2. ❑ t am a sole proprietor or partner- listed on the attached sheet $ 7. .2g ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 1 0.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] 1 * employees. [No workers' 13.0 Other comp. insurance required.] *.Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G ('u n i¢ re._ _z ,i- )tai CC' ., CO Policy # or Self -ins. Lic. #: (j) C 00 97 if 3 4,7/ Expiration Date: Job Site Address: 6c. e oe 11V City /State /Zip: A)(fie1 a1, 24 .� Ma . c' i o6, a 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 penuWee -offer ury that the information provided above is true and correct. ,/Signature / Date: T `L,/ Z Phone #: '1/3 " - S ^ ��Sr / 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ -� Name of License Holder : ��eA 2 l) i EE LJA r.J CS el 7 L/ 2. - cxs dryergafy License Number .ELxi -r4i ', r( o60 31)9( aoi Address ° -- Expiration Date ature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ C6 mpanv Name Registration Number 6'2 Mi M A . ©io 60 8 7 �rZ Address � ExpiraSion Date Telephone 'fly 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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [D] Other [[k'f' Brief Description of Proposed Work: VPVLAces. t <a t4( DeX.iLD Alteration of existing bedroom Yes )C No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes X' 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 Est_ t-UEI L4A3 &a C , as Owner of the subject property hereby authorize Xa -(-la 1-1(1: 1 E4 -tEh. 6 eocie-) ►Ar' to act on my behalf, in all matters relative to worklauthorized by this building permit application. 01 14 Cck4 72f4 C r 1 �Z � Zc�i I Signature of Owner Date (1c_egQ, D 700 P I-1 O tc .rl-{ '� L�t/eM UT , 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. G.ffeb 'Rog a Print Name (t 2 La Si. nat Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) At of Parking Spaces Fill: (volume & 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 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained ® , Date Issued: C. Do any signs exist on the property? YES Q NO 6j IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ]1 CEIVED Department use only City of Northampton Status of Permit: DEC - 5 201$ Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability )EPL OF BUILDING INSPECTIONS Room 100 Water/Well Availability NORTHAMPTON, MA01o6o Northampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413- 587 -1272 Plot/Site 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 E'OE )46,vEU Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: PAO L We 114 BEe 6. 6 `e,e Ave Name (Print) Current Mailing Address: 413 t792 1-t Cpl. j -,AC T Telephone Signature 2.2 Authorized Agent: A#-L -t; _ t ►� ° -_..�� _ Lit R. -.A■-t ruDos7 ij L. Utz. -rfAL -frro ) 4( arty.,, Name (Print) Current Mailing Address: 1 41 3 -- - 5 2S Sig re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2 S,44 -- 2. Electrical (b) Estimated Total Cost of Construction from (6) e 4 4-7 • 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 3 � _ ' "° 6. Total = (1 + 2 + 3 + 4 + 5) 2 5- 44 7. ' D Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 66 ROE AVE BP- 2012 -0547 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 123 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2012 -0547 Project # JS- 2012- 000918 Est. Cost: $25447.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC 89442 Lot Size(sq. ft.): 15420.24 Owner: WEINBERG PAUL S & MARY K FAGO Zoning: URA(100)/ Applicant: YANKEE HOME IMPROVEMENT INC AT: 66 ROE AVE Applicant Address: Phone: Insurance: 82 INDUSTRIAL DR, UNIT 2 (413) 584 - 8318 WC NORTHAMPTONMA01060 ISSUED ON:12/6/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 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: 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 12/6/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner