37-007 (2) Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Consttut ti n Supervisor License
License CS 89442
ReStficte� 00 ,s?
GERAR R
PO BCYX t,
EASTHAMI N frPrO1027
Expiration: 3/1912012
ommisiiioner Tr#: 18580
»9- (date). Barring delay caused by circumstances beyond contractors control me wMIK we ua u N cu uy
,. :es that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including, ut of limited to strikes, Acts of God, shortages of
arials, accidents, and all other delays beyond its control, shall not be considered as violations of this Agreement.
- - .NARRANTY
she Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of following completion and shall comply
vith the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, its sub tractors, 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 work.
YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: I /6 2 l
,�� � nr � Name of Representative il
($ ) upon signing contract; p l >
� � � " " j Authorized Signature
% ($ ) upon completion of 7 r
4,./ t" - "> ---------7-
%($ ) upon completion of
' Notice: No agreement for home improvement contracting work shall require a down payment (advance
deposit) of more than one -third of the total contract price or the total amount of all deposits or payments
($ . L ) 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. materials and equipment, whichever amount is greater.
Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated: I understand that upon
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 of
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 referrec
to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signatu D .Date i /6l / Signature Date
NOTICE OF CANCELLATION
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 NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILT
BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTERES•
ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THI:
CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: YANKEE HOME IMPROVEMENT, INC., 82 INDUSTRIAL DR
NORTHAMPTON MA 01060 NOT LATER THAN MIDNIGHT OF
r!' I HEREBY CANCEL THIS TRANSACTION
(Date. Su days and oli ays excluded) �� BUYERS SIGNATURE DAT'�
Buyer(s) acknowledge re p two co le l f y filled in copies of this notice on the date first above written hereof.
Buyer's Signature f ' Buyer's Signature -
Roofing /Gutters /Attic Barrier Agreement
III, Thousands of Satisfied Clients!
YANKEE i . N 82 Industrial Drive MA Lic# 160584 225 Cedar Hill St, Suite 200
Northampton, MA 01060 CT Lic# 0673924 Marlborough, MA 01752
HOME M P R O V E M E N T 413 341 -5259 RI Lic # 33382 877 88- YANKEE
The MOST Referred Contractor All home improvement contractors and subcontractors must be registered and any inquiries
in New England 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 02116 Phone: (617) 973 -8700
_ Homeowner Information
Name 1,c / t ✓�''1p Street Address / 17'(ep.lee.. 2c City 6/? -/j� State414Zip Q1:461
Home Phone /V/4' Work Phone Cell Phone 311:72612__E-Mail
Mailing Address (If different) .,7
"f
The Contractor agrees to do the following work for the Homeowner.
I ROOFING Type ,A A-0 Color Nr-f-tiOfield Style ^ ^c/, -, . I
Removal of Existing Roofing 1., es ❑No Ice and Water Barrier L Full ❑ Partial
Removal of Garage Roofing ' "�, es ❑No Ridge Vents ► es ❑No
Dumpster es ❑No Replace Sheathing y es ❑No Sheets Incl.
.3
= Price per sheet X 76 - as needed
Main House Roof `w ► es ❑No P
Garage Roof C! es ❑No Rolled /Low Slope ❑Yes \o
Front Porch Roof t il es ❑No Location
Rear Porch Roof I!t es ❑No Fleshings 0 ,- 4 3 1 es ❑No
Drip Edge s es ❑No Color 1, 3 a �3 L Location �,r /Owl
I GUTTERS Color_ . Downspouts Color ,y /,¢ I
A
out Attached -ii es ❑No
0 - esidential Sin ❑ Commercial bin Gutter Protection ❑Yes o
.ownspout ❑ Residential ❑ Commercial Type
Garage ❑Yes �- —es-, f \ Location e� 4�c7G�
Porch ❑YesMNo \ j ( ? L P j1j Color IC eicF ACJ -Q.--
ATTIC ENERGY BARRIER - BLOWN -IN INSLATION / I
❑ Rafter Install ❑ Floor Install ❑ Open Attic Blow
Kneewall ❑Yes ❑No CI Net Blow Walls ❑Yes o
Area to be cleared by homeowner ❑ es ❑No Kneewall ❑Yes o Type of ext or Cladding
Special Instructions nil ..1 � I ,Fla - 4. ‘, / 7- j
• 4 , l • ti�w' ' • tsts - CO ..., G-rt,
t i ,-, ^?
fir, �-i,1I c- `evtS * «4:4C- )Osu/ -47-i� S. ;(P o- (&L/ ec' et ire C? _
WORK SCHEDULE
Conir tor y�ill not begin the work or order the materials before the third day following the signing of this Agreement, unless specifi er '2 Contractor will begin the work on or about
and j,- (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (date). The Owner hereby acknowledges
gree that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including, ut t 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
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of _ following 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 sub ntractors, 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 work.
YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: 1 /67,,ii. ? f
N ame of Representative
�3 % ($ 5176', e " ) upon signing contract; resentative % p
The Commonwealth of Massachusetts
Department of Industrial Accidents
IIr Office of Investigations
600 Washington Street
=IR.= — Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization /Individual): YA lN1 KEE -l0ME TM PROVE ME N T - GER/AR.D Rt2kM tJ
Address: 2 Il\iDU5'i DIZNa
City /State /Zip: NORTH AM P TON MA . 010 0 Phone #: Lti 3 - 34} I - 5 2 5 9
Are you an employer? Check the appropriate box: Type of project (required):
1. I am a employer with 50 4. L I am a general contractor and I 6. [] New construction
employees (full and/or part - time).* have hired the sub - contractors
2.1 1 I am a sole proprietor or partner- listed on the attached sheet. i Remodeling
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. [1 We are a corporation and its
required.] officers have exercised their 10.E Electrical repairs or additions
3. ❑ 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.] t employees. [No workers'
comp. insurance required.] 13.n Other
*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.
1 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: GRAMf I E 5 TE _1:1'JSLIP,Af.(. COM PAki Y
Policy # or Self -ins. Lic. #: 1/t C 00 99 1.3'p 9 1 Expiration Date: IL) - 2 - /
Job Site Address: GO I FLO 2 E itl C E F OA1D City /State /Zip: i LOPEAiCE , MA . a 10 (o c
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
Signature: 4 t -'' Date:
Phone #: 4 i13 - 3 'r ` I - 525 9
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 : GERARD RC. hi AN C 5 89 4 4- 2
License Number
i~32 nsI.DUSTRIAL_ DRIVE 1 ORTHAMPTON MA, 0166:0 3 - t 9 2'01 t-�-
Address , Expiration Date
(� X13 3 y I - � y 9
Signature Telephone
9. Redisterei .fiome!lmpiovetnenxaGb itiii& ' :: I- , r , a i Not Applicable ❑
/// - EE NOME LNi PROVEMEMI- tCO5E3t(
Company Name Registration Number
S 2 1.1.11)05T'RIAL DRIVE • NORTHAMPTOki r MA, U1060 B --7 20 12
Address ; .. - Expiration Date
Telephone 1 -H13-'341- 525 9
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT ;(M.G.L. § 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 1. No ❑
1l ii° om OwnetExemwno
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 WORKJcheck?all applicable)
New House 0 Addition Q Replacement Windows Alteration(s) 0 Roofing
Or Doors D
Accessory Bldg. 0 Demolition EJ New Signs [D] Decks [El Siding [CO Other [0]
Brief Description of Proposed
Work: E /VAI a 2cti-r o5&
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll - Sheet
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, ( BERT TRUMP , as Owner of the subject
property
hereby authorize YAM KEE. NOME :IM ►P- ROVE1.t h1T - C ERARD RC?JAU
to act on my behalf, in all matters relative to work authorized by this building permit application.
Olt CON TRAC: T
Signature of Owner Date
I, e RO - YAM kEE. 140I'iE IMPROVENEMT 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.
6; ERA RD knIV A
Print Name
Signature of Owner /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete.lnformation
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ? i € 1 _ ---
Frontage ' .,.
Setbacks Front ! = i
Side L R:M L:? R:.
i
Rear
Building Height `` '
Bldg_ Square Footage I ? 1 %
Open Space Footage % r
(Lot area minus bldg & paved —..---i i I I -- — —
parking)
# of Parking Spaces
Fill: 11 __.... _.___..
(volume & Location) i
,
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW fri YES 0
IF YES, date issued:! i
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page t and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW aX YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , 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 0 NO Q
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
h �
� '"�'fl� use only
C u ding Department � � � ��� ' e �
212 Main Street
A 1 2
Room 100 e1i ulYaili��
0 ampton, MA 01060 ° e trci � rt
.7- 1240• Fax 413- 587 -1272 a -
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
(r01 FLa RE N CE Rl)AD Map Lot ".Unit"
Zone ; Overlay District
Elm St; District "" CB District
SECTION 2 - PROPERTY OWN ERSH1PIAUTHORIZED AGENT
2.1 Owner of Record:
ROB ERT ' TAI - U M' (Di FLOREI.ICC P.OA1) FLDREk1CCt MA. ()I
Name (Print) Current Mailing Address:
4-13 -33v5 1 3
l7 N CC)KITRAC T Telephone
Signature
2.2 Authorized Agent:
YAI.WEE IioNIE SMPRO VEMg4T- CERARD RSNat+i v2 D.1DU`5TR1AL - 'DR.- NORTUAMPTON,MR, DIOGJJ
Name (Print) ' Current Mailing Address:
L l 1 -4-1' 3 . ;3 -5251
Signatu 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 4i 3g. coca
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) -j g
5. Fire Protection
76, 6. Total = (1 + 2 + 3 + 4 + 5) ` 162 in-7 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
601 FLORENCE RD BP- 2012 -0891
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37 - 007 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0891
Project # JS- 2012- 001563
Est. Cost: $16789.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: YANKEE HOME IMPROVEMENT INC 89442
Lot Size(sq. ft.): 196020.00 Owner: TRUMP ROBERT & ROBERT TRUMP TRUST
Zoning: Applicant: YANKEE HOME IMPROVEMENT INC
AT: 601 FLORENCE RD
Applicant Address: Phone: Insurance:
82 INDUSTRIAL DR, UNIT 2 (413) 584 -8318 WC
NORTHAMPTONMA01060 ISSUED ON :4/12/2012 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 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 4/12/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner