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24A-156 t/ i l) i..i �3 cu r�i i J oi7c 'CS f 7 r r • r tI td)9d tit��;(1rM �=f yt v h t _ 1 °t}: 11 ; 21 lk f/} 1411(; }V # Mint" z�a1wm131 �5Y �3 )fib , ,y /1 t;3�fi9 r ., twi n �� UP} - ROOfincd rs1Att -ar-rier Ac ireement Thousands of Satisfied Clients! _D � t 82 Industrial Drive MA Lic#160584 1224 Mill Street, Big B 224 Northampton, MA 01060 CT Lic#0673924 East Berlin, CT 06023 I i�"4 P �;�. V (- !'A : (`� I 413 341-5259 RI Lic#33382 877 88-YANKEE : .�' ' 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 Plata,Suite 5170 www.YankeeHomelnc.com Boston,MA oz1 tU Pnone: (617)973-8700 Date t� l� p 1-Igr►leowner Information Namey1,f fDi22sii0 greet Address...f __._ _._ _¢� -- CityZ� t �E7l,VJStat� ip Home Phone_ Work Phone -___—Cell Phone Mailing Address (If different)____-___ E-Mail The Contractor agrees to do the fol lowing work for the Homeowner ROOT=ING Type_ j� t.� 5 _ Color ' A�, C` =_ Style. lt/A'ii.q /lam Removal of Existing Roofing Nes ❑No Ice and Water Barrier Full J Partial Removal of Garage Roofing iJYes,NNO Ridge Vents Mes JNo C141 Dumpster Yes ❑No Replace Sheathing Yes iNo Sheets Incl. c Main House Roof #_Yes ❑No Price per sheet (as needed) Garage Roof JYes (CIO Rolled/Low Slope (..ayes NNO Front Porch Roof JYes Mo Location Rear Porch Roof []Yes IN Flashings ; Yes ❑No Drip Edge JNo Color t'�rt�t( Location L- AP A*T G".P-- , �'e5 GUTTERS Color _________ A Downspouts Color Layout Attached ❑Yes DN`6 ,-t - Gutter Pro t_ Residential 5jn J Commercial-Ein teetton ❑Yes JNo ,fM Downspout Residential ❑ Commercial Type" F__ Garage ❑Yes JNo Location _ Porch i_]Yes ❑No Color ATTIC: ENERGY BARRttR rr BLOWN-IN tAdSULATION 1-1 Rafter Install '`J Floor Install J Open Attic Blow Kneewali ``i_]Yes ❑No a Net Blow Walls es JNo Area to be cleared by homeowner FlYes ENO Kneewall -kY s CJNo Type of exterior Cladding Special Instructions �s C Assi�,or S0I<�"_I.` WORK SCHEDULE �zn actor will no�begin the worK or order the materials before the third day following the signing of this Agreement.unless speci1e6i ei ontractor will begin the work on or about *4"-(date). Barrng delay caused by circumstances beyond Contractor's control.the work will be completed lay_ _ Bate).The Owner hereby acknowledges an agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including, but to strikes, Acts of God, shortages of materials,accidents,and all other delays beyond its control,shall not be considered as violations of this Agreer_nent. "7/Z lyYyr�' j 21`�!S s WARRANTY ° ; �:�/d ,1'­e 01.4?B:_V t;,f The Contractor warrants that the work furnished hereunder shall be free from defects in matenais 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 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 work. YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: A ;? upon s�gn ig contract jU3 ntaximum}. NarneotRe Representative oi� �rd []Yes ��, F|a ohi»g« MesONo Rear PomhRoof Drip Edge Xes LINO Color V1101 L /4u-- OL-tv& llkltA-K ERS Color Downspouts -Color Commercial- in Downspout Residential D Commercial Garage LJYes DNO Location Porch 0-Yes END Color ATTIC, ENERGY BARRIER BLOWN-ININSULATION L-i Rafter Install Li Floor Install 0 Open Attic Blow Area to be cleared by homeowner LJYes- DINO Kneewall i�,,Yes [�No Type of exterior Cladding Speciail Instructions 14 tj el WORK SCHEDULE qlngor will no,4begin the work or order the materials before the third day following the signing of this Agreement,unless spol 4natractor will begin the work on or abuut (date). Barring delay caused by circumstances beyond Contractor',control,the work will be completed by to) The Owner hereby acknowledges an agrees that the scheduling dates are approximate and that such delays that are riot avoidable by the Contractor Including, but no limited tostrikes, Acts of God, shortagos of materials,accidents,and all other delays beyond its control,shall riot be considered as violations of this Agr%lenl T1 If,Contractor wartants that the work furnished hereunder snail be free from defects in materials and workmanship for a period of following 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 work. YHI agrees to perform the work,furnish the material and labor specified above for the total sum of: 2— Name,of Relmosentative 22- It:L 8& upon signing contract 0r3 Authorized SignaluLo_ upon completion of (m upon completion o/ ,~ Notice.o,a9°"m°m for w°°Improvement contracting work shall require"down payment(advance a*uxuomau*m*»�m"vo^ **�*,m~�'�""��m"m,'�m°w�m"=="*"�" !^mow"m"�/'ow*==���,m"m" ' completion m work under this contract, =°w""u=^eq"~=",,um 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 bo made an outlined above. You may cancel this agreement if i,has been signed by u party thereto ata place other than on address of the Seller, wmoo 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 o|the third business day following the signing of this agreement. Please refer tn the Notice nf Cancellation below contents o|which are referred kz above and incorporated herein 0yreference. 0O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. �/gnmvm Date /_/_/ Signature J,���� oato ��_L_ NQ– DATE o=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 a,YOU UNDER THE CONTRACT onSALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED e,,ouvv/u aE RETURNED wn*|wTEN BUSINESS DAYS pouovv/wo nEonpT BY THE ssusnopYOUR omxcELLArmm moT/oe. AND ANY SECURITY /wrsnesr xma/ws OUT op THE TRANSACTION WILL os CANCELLED, n) CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE nnANY OTHER WRITTEN NOTICE. On aEmo x TELEGRAM TO: vAwKss noMs |mpn0veMswT. INC., uo INDUSTRIAL DR., NORTH,AMP 0 MA 01060 NOT LATER THAN MIDNIGHT oF ' /*sn�svcxwos�rmsrn�ma�crmm _______________-�� _-___-_ ---.3��' —�- - BUYERS SIGNATURE a^`s I�mo_—.'=*'wm^pQxovovo/ hw bu � C Bu���uukom~kd�m�ptvfmvwm,buh ����pimvf��um�,vo,b,ouuDm Boy,/a��vo�v,c Do�r,'y���mvn City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: The debris will be transported by: _ �1 ------------ The debris will be received by: ALP- v� s,!`Z�_ 1C.I�CI� A t ,14 o/ Building permit number: ____________________ Name of Permit Applicant Date ignature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents u W Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name (Business/Organization/Individual): Ion P „,_I ' bmt ml) Q lzma _ Address: '3Z lndusl'-ric l V_ DhVE n 14 Z City/State/Zip: N0V4QLMpbn MO 010(40 Phone#: Are/you an employer? Check the appropriate box: Type of project(required): 1. 1 am a employer with� E]4. I am a general contractor and I employees (full and/or part-time).” have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.r_1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑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 anew 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 my employees. Below is the policy and job site information. } y'� Insurance Company Name: I I1 S � �1 �ran(Q, f'7Z u, Policy#or Self-ins. Lie. #: M U -to IQ I VI-6-1 Expiration Date: 5/2_5_/2_0L5_ Job Site Address: 6� l z, City/State/Zip: d A/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and Apiration 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 p s of perjury that the information provided above is true and correct. Si mature: Date: Phone#: L13-315-212 t 13-3�il-52�� 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 Su ervisor: Not Applicable?❑ Name of License Holder: ?ilGf+1 0 ?4 41- License Number Address Expiration Date Signature Telephone 9.R&kW egister ed Home Improvement/Contractor: Not Applicable ❑ 1-16121-e ,Cj220& 1 �6) a Co Sipany Name Registration Number 666 Address Expiration Date Telephone 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 buildingpermit. 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 F-1 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors E3 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[0] Other[a] Brief Description of Proposed Work: Alteration of existing bedroom Yes Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yesq✓ 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, v "y -� � " as Owner of the subject property hereby authorize I P to act on my behalf, in all matters relative to work authorized by his building permit application. Signature of Owner Date OEM { Z_PL_ -,as Owner/Authorized Agent here declare that the state ents and irtformAtion on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains an penaltie of perjury. Print Name � 6 Signature of Owner/Agent 77 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) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO M DONT KNOW ® YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO , DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES © 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 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 O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only V City of Northampton Status of Permit: Q Building Department Curb Cut/Driveway Permit SEP 2 5 2014 212 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability EI tric,Plumbing&Gas Inspections Northampton, MA 01060 Two Sets of Structural Plans Northampton, MA Di 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 � /��D ` � Map Lot Unit �, ✓� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A Name(Print) -� Current Mailing d 4u j (`� (`J L-1 o,6 CZ h Telephone Signature 2.2 Authorized A ent: (� U ? Name(Print) Current Mailing Address: Signature Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building / (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) ` Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 19 NORFOLK AVE BP-2015-0354 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A- 156 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-2015-0354 Project# JS-2015-000661 Est. Cost: $13702.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC 89442 Lot Size(sq. ft.): 13764.96 Owner: DINNEEN MARY JANE M D&DORYNE PEDERZANI TRUSTEES Zoning. URA(100)/ Applicant: YANKEE HOME IMPROVEMENT INC AT.• 19 NORFOLK AVE Applicant Address: Phone: Insurance: 82 INDUSTRIAL DR, UNIT 2 (413) 341-5259 O WC NORTHAMPTONMAO1060 ISSUED ON.9/2912014 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 9/29/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner