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30C-056 (2) t, /U 6 ....) upon signing contract Name of Representative i f .,A Aultro,iz9d Signature (°1"( ($ ) upon completion of ,,.._,4% (s ) upon completion of Notice: No egrebntertt for hone improvement contracting wait shall mulls a down payment redeem. � deposit) of more than one-third of the total contrast Oar or thug total amount of at deposits or payments °!v ($ ', 6 t.) .,) shall be mad61oftnwith upon much the contractor must maize. In advance, t0 0rdIr 6ndror c liirwlN Obtain delivery of spatial otter completion of work timer this contract. nalenlela mn( suuipmem, wluchever *Mount le sueebu, 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 wilt 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 Seiler 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 SION THIS C?NTRACT IF THERE ARE - BLANK SPACES. fr Signature i ' oats 'I 1 // Signature ' E • 1 I e - _ / r I I -- 1 NOTICE OF CANCELLATION 9 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 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 AIL OR DELIVER A SIGNED AND DATED COPY OF THIS OA NCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: ' HOM - IMPRIDV - „ NT, INC., 82 IND .- DR ., NORTHAMPT , M WOO NOT LATER THAN MIDNIGHT OF ` "• q f / I ! 9 f � — i HEREBY CANCEL THIS TRANSACTION � 7A ^ /./� '�`� yy.� =r1 id pm. And h e xcluded) eta - WON +RE DATE Buyer(a) acknowledge receipt of two completely tilled in copies of this notice on the date first ,,I• 1 ve wri er a5 , f / J/r t . a� . Buyer's Signature P , , . , I S Bayer's Signature F i f f' ,1$- ' �- --• At- 'pEC.60/713 „Mot,i2Te Roofing /Gutters /Attic Bar rier Agreem I 1 1 1 Thousands of Satisfied Clients! Y Vr l 82 Industrial Drive MA li+c# 160584 225 Cedar dill $t, Suite 200 Northampton, MA 01060 T Uc# 0673924 Maribor gh, MA 01752 1 O M 5 I M P R O V M N T 413 341.5259 RI Liar # 33382 877 YANKEE Pic MOST Rcfk_yr r ed Conti ,A.tvr All home improvement contractors and subcontractors must be registe and any inquiries „t New L= rncll.,rrdi about a contractor or subcontractor relating to a registration should be directed to: °aloe of Consumer Affairs and Business Relation Ten Park , Suite 5170 www.YankeeHomelnc.com Boston, MA 02116 Phone: (617) 97S -8700 &. Date 9 1/1 1/)"` Homeowner Information N7 Na 04u*5 Selfge Street Address /41 /42t/ <i City)Q4/ffC, Ste . �/)- Home Phone, '/ 2t) Work Phone & / /Gi 7 Cell Phone E -Mail ,�� /,��- "1r Mailing Address (If different) The Contractor agrees to do the fa&towirl1j wart fix the Homeowner. Construction Te _ ❑Yes DNo ROOFING Type C olor L i ' tilA4 ' Style -T111111 Removal of Existing Roofing lDr s DNo Ice and Water Barrier Ti up ❑ Partial Removal of Garage Roofing DYes [LJNVo Ridge Vents fifes DNo Dumpster °Yes ❑No J /ft D O Replace Sheathing [Yes aio Sheets Incl. Main House Roof [des DNo Price per sheet 76 . '' 1 (a s needed ) Garage Roof DYes Colo led /Low Slope EIYes UN° Front Porch Roof y eS ❑Na (� _r�-� Location Rear Porch Roof ❑1f s o 1 - \ V Fleshings Q es ❑No Drip Edoe es DNn Color 1�j Location t..k 4/ , f IfI1 GUTTERS Color Downspouts Color , - "„ Layout Attached ❑Yes ❑Na ❑ Residential Sin ❑ Commercial bin Gutter Protection ❑Yes ONo Downspout ❑ Residential ❑ Commercial Type H Garage ❑Yes DNo Location Porch DYes ON() Color FETIC ENERGY BARRIER FLOWN -IN INSULATION + ' ....1 ❑ Rafter Install 0 Floor Install 0 Open Attic Blow Walls ❑Yes ❑Nd Kneewall DYes DNo ❑ Net Blow - I Area to be geared by homeowner DYes ❑No Kneewall DYes DNo Type of exterior CladdI i g Special Instructions . WO `« Ell' LE Ccy ` �S r not begin the worts or order the materials betoru the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about Lr _ (date), Barring delay caused by circumstances beyond Contractor's control, the work will be completed by . (date). Tha caner hereby acknowledges an. agre -," 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 mate accidents, and alt other delays beyond its control, shalt not be considered as violation of thie Agreement. WARRANTY U The Contractor warrants that the work furnished hereunder shell be tree from defects In materials and workmanship for a period Of 41 following piston and shall oompy with the requirements o f this Agreement. In the event any detect in wonenanship or materials, or damage caused by me contractor ............... a •■..a or agents, In dinww„xl after completion of any Job, Including cleanup, the Contractor bhall, at Rs own expense, forthwith remedy. repair, correct, replace, or cause to be remedied repaired of replaced, such damage or such defect in materials and wbrkrttanahlp. The foregoing warranties shall survive any inspection performed in connection with the - t eechu I • n • rk, YH1 agrees to perform the work, furnish the material and labor specified above for th�l sum of: '4 1 1 nereilo Waste http://jtinnrellowaste.com .--- • Horne • About Us • containers • Contact Ls • Customer 1..oiin Fast & e b la I !lel .e Waste R e moval Services FOR FAST SERVICE CALL: ,.. 3)455-1672 4. r77 i N L--- - — -- - i -----“'4 1 (41 , , i ,,., 1 t , , r 1 i 1 , I , ; _ NJ' 11----1 i a i i - "I'f 1 AI f r i , • t -•=k"".. 3,ir "...2.1 r ' : ;_...-4........J ' . 1ftilr.,A. VIIIR 727„,---7...le,-irri4ilttlia,..Li.lk-7..Kik:T--• ,.‘,,,,,..,,,,...it....1,•:,,,,...,'*--..-.'"t`t, - a at - k.:41.112,Vrtf!ti .1; t : -.,_._:--- , g ✓ Roit-off and Recycling Service ;'''.---*'--::';'''''t'ii.-rai7--- - - E L Ai 6/ Compactor Service ✓ is yard and 30 yard d u rli Pste r , s ,,,„ - ,, ;1 , , , . ,, _ ' ! 11 ,_ I : . . - 4 1` E V Quick respon ,. a . , ,' 7., a se . 4 . ‘, ",::: ilt 45 5 ' It ‘ 'I % -- v` Competitive priang 30 YEARS EXPERIENCE •. - , -.- No enAra ... .. - 4 , , __.-„ ... _ .... , ,--, Connecticut and Rhode 'islantl. ,, ; ;,,;;;_ ri.".-- .. _ _T. 1.. , * ., , tr,e gi atE , t Sprincifid, 11,,,:, , ..,. - - ' - M INM Iv Ca Local Weather OF ( oF) Weather data nro.tdea by w-z4th/J corn k Our Address • J. Tinnerello Waste Tpi..)PIP L cc ki - 3? Century Street . Agawam. MA 01001 't) ' Phone & E-mail (413) 455-1672 Local 3/21/ 9:48 AM 1 The Commonwealth of Massachusetts Department of Industrial Accidents ►* /, =1-- Office of Investigations i 600 Washington Street 1■ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business / Organization /individual): YAK1K 1- c:)1.4E .17V ',F11 I jE JOE ki T Address: 8 2. :17/1)1.1.5 t AzIAL 2)'N City /State /Zip: MORNAMP2DU, 1414 . 0/060 Phone #: '413 - 3 / _ _? 5 9 Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with .30 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7 r.1 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. ❑ We are a corporation and its required.] officers have exercised their 10.n Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t 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. 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 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: 6/94A/ TrE' 5 7 , ..:1 Z. l,t IR NC c . Policy # or Self -ins. Lic. #: ,I C 009 9 6, 5 / Expiration Date: 14 - 2 - Job Site Address: 113 m.E E J -T S T City /State /Zip: 1 LCJRE&ICE MA, U 1 [)b2 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: �f ° "` Date: Phone #: & /3 - '° -) -5Z5:9 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 : ROXMA LD '-ILL_L_ CS- i 0G /5 Ce9 License Number ° 5Z BA( RDCREST ROAD 11 — 11 — 2I3/ Ad ' Expiration Date 4 . . , • 34-1 — 5 2.5 9 Si. ature Te ephone 9Regjstered iIomeimprovementt ontractorQ „ , Z 11 , ; 7.74 Not Applicable ❑ Y*NKFF I4dJ1 ZMPRDVaNV\EIJT / !o 0 5 ES i Companv Name Registration Number 252. MNID L ST AL T,12 .. MaR1 P T DIU , b-1A . 0106;0 - -7 - ?mil' -1- Addre; _ Expiration Date I 0 Telephone +t3 -341- 525 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 No ❑ orne wner, xe pti on 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 • J SECTION 5- DESCRIPTION OF PROPOSED WORK all -applicable) : = New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing p Or Doors 0 Accessory Bldg. n Demolition ❑ New Signs [0] Decks [E] Siding [0] Other [O] Brief Description of Proposed Work: 5!\' AUD REF'LACE F G>kJ P .JT ©f House Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes K No Plans Attached Roll - Sheet sal ew houseuand oc addition to existingrhous�riq; compete the following a. Use of building : One Family )1 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 OWNERAUTHORIZATION TO BE COMPLETED WHEN OWNERS.AGEhirOR CONTRACTOR ;APPL1ES.BOR .1101NG PARMIT , 7: Y Et 73073 TZ'.f7-' , as Owner of the subject property hereby authorize Y.1MLEE HLDNf EI1R/ zDC lJr` rv . & - . 1 7 1 2 1 ° 2 1 ' D 7QZCS/LfAA/ to act on my behalf, in all matters relative to work authorized by this building permit application. e w CIDAI T 2 C ?— Signature of Owner Date '/! Alk &' /-ZUNI E 174 P1 V EM f,V T & AI D /20N.4 , 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 ERARD /ZONA N Print Name Signature of Owner /Agent Date • .4 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information `` r Existing Proposed Required by 'Zoning This column to be filled in b ' Building Department a ! Lot Size Frontage Setbacks Front I € j n Side L R: L :' . R:= Rear I �--- -j Building Height 1 Bldg. Square Footage 1 6 % i E-- Open Space Footage % (Lot area minus bldg & paved 3 ` —. parking) I i i I I # of Parking Spaces Fill: (volume & Location) 1 P A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 44 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 i Pagel I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ed$ YES 0 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 0 NO CAA 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 0 NO i IF YES, then a Northampton Storm Water Management Permit from the DPW is required. y � � ', , y D t us onl RECEIVED City of Northampton t� `Pe � I 0 Building Department S, • Prue a t# r :� �- 212 Main Street Se ep ,n SEP 2 4 Room 100 a r -W + - t a • . ,°�.� ,> > t - � a •rthampton, MA 01060 DEPT OF BUILDING INSP ii': (-- 41 C - 587 -1240 Fax 413- 587 -1272 P cl a I g NORTHAMPTON MA 01060 4 : : a t i r g Other s t „*5 d "xt, ° »4 x 3 a- APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATI , „ s T hts section to b compleed b y ic 1.1 Property Address: ,} x » .. e t off1 e x , M 5 *.. v I a ,`. ry +.xr* i. r ' ':s? Ut1It! £ ' � '' +� a kf'cl'.c `"rr.�.' a , t �sN J.v. "a.4' r '�Fki�,j- E"_. "Zone' a ., br O�etlay . !,aWc .w / 13 CLEME1JT S7- RLE'T x ' -! l'.71 Etm St. _Distrlct .... .. CB District SECTION 2 PR OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 113 CLEME/V 7.5T, tZ(3I2EA/CC : C1104.2 PA1TY l' BOB C I'Z'ECIL/E Current Mailing Addres Name (Print) s: 4.13 - 5E3'4- °FOBS OIU CDI.#TRA C Telephone Signature , 2.2 Authorized Agent: _ YAM KEG MDMI� IMPROV MEtU "T. C# T'.42/3 -*:. = TNO[/' DR, I1lGt2TF1 /I/4PTL7iv . A4/4 . 0/06:)e) Name (Print) Current Mailing Address: CD Ai £ JTf ICT /7 L43- 39 -1 - 5 ?5 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only :,- completed by permit applicant 1. Building (a) Building Perm F ee Cc .3. Ur✓ 2. Electrical ( b) stimated Total Cost of .,F. ;Construction from, (6) , 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) r, Check Number 3 0 Th is . Section For Official Use Only Building Permit Number , Date; g Issued: S Building Commissioner /inspector of Buildings Date 113 CLEMENT ST BP- 2013 -0331 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 056 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- 2013 -0331 Project # JS- 2013- 000530 Est. Cost: $6400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC Lot Size(sq. ft.): 14853.96 Owner: GREENE ROBERT A & PATTY A Zoning: SR(100)/ Applicant: YANKEE HOME IMPROVEMENT INC AT: 113 CLEMENT ST Applicant Address: Phone: Insurance: 82 INDUSTRIAL DR, UNIT 2 (413) 584 -8318 NORTHAMPTONMA01060 ISSUED ON:9/24/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE FRONT 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 9/24/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner