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29-279 (2) , 4iJ {4 r I�..igt9t1A7 t4rbarYtN" IM CID Oaft '�c1�r+il �Jts�rt�jl � •,I, t6, �@ �itt&Y ,J t YStt ,ny7l. ��! S7fV 1 :+ /, r riCY • e Bill f uY �! L3tj t 7 ! i Atl f11�Ax+7 urga G t;t i.. G3 () (1t 1lJ �i ', �fA ,7 +?�,�` 7 i � '•xr�y} �k'`I t -t IIl vy +w ,},i � '.1 t1J ',!•i 1�.1 t iY `ib(tq C� r� 5, cn We, 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: --3-L L-- � ---- rye -- The debris will be transported by: _ ��/I �� �------------ The debris will be received by: / l�_� ll Gt /I//)- �5 Building permit number: _________________________ Name of Permit Applicant ----------- ignature of Permit Applicant Rear Porch Roof �hes []No Haak/ngu RYea uNo Location A Drip Edge es LiNo CofortVWX1, =GUTTERS Color &,e&Zl5 Downspouts Color Layout Attached �6es EJNo ,N� Residential 5in [-j Commercial 6in Gutter Protection Aes' RNo Downspout Residential 0 Commercial Type 22ble-1 Garage DYes. %0 Location-, i Porch lWes F-1,No Color ENERGY BARRIER—- INSULATION Rafter Install I Floor Install 11 Open Attic Blow Walls EJYes ONO Area to be cleared by horneowner NYes ']No Kneewall UYes LiNo Type of exterior Cladding WORK SCHEDULE ll.rl4begin the work or order the material before the third day following the signing of this Agreemef Jp1d, C t -let will begin the work or)or about y ircumstances beyond Contractor's control,the work will be te).The Own.,hereby acknowledges IVY,—-(date).Barring dela caused by cs cromnp'10.�,.cs Pb'y Agrees that the scheduling dates are approximate and that such delays that are not,avoidable by the Contractor includin it n,17iltiftd to strikes, Acts of God. shortages or materials accidew� and all 211her dqJiys beyond its commit shall toot be considered as violations of this 2men, I ki, fo-, following completion and shall comply he Contractor warrants that I e work fUr e eunder in als and workmans ip a p riod of -rw -01s,employees or agents,is discovered ,vf!h the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,its SO4 &�t 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 Lkiinage or such defect in materials and workmanship.The foregoing warranties shali 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: e 44 act(1/3 maximum) Name of Representative Authorized Signature ;Z!Z,24( I$ upon completion of upon completion m ww~° w"agreement for home inprovernent contracting wo*Ghw require a o=°payment(advance ~ of mort thart -m.m Milne wm/com"m price",the total amount mall deposits of payments .9-^^<u-__�_�_��J�1 ')shanue made/n*ow^*upon °"=...~=.o=m,".^°.°"^",."�"""c°,/""w",""*w.mm�."""m"."u"/.".�"."p°c.^/°,o"' ' -- cvmv/000vo/work under this contract. materials and°v"'"m=' sxicom�*�^�/�vmv�- 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 Unamm at a place other than an address of the 8o||or, which 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 of the third business day following the signing vf this agreement. Please refer to the Notice of Cancellation below contents of which are referred /u above and incorporated herein byreference. DO NOT SIGN THIS CONTRACT |F THERE ARE ANY BLANK GPAC D S/o"umrr Dam _�-��[' a.eoom,e -���-� _�� ute__-����__ DATE opTRANSACTION 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 BF RETURNED WITHIN TEN au8|mcSa DAYS FouOwwo RECEIPT av THE SELLER oFYOUR CANCELLATION NOTICE, AND ANY SECURITY /wrcnESr ^n|3|wG OUT OF THE TRANSACTION WILL BE CxwoEuso. TO CANCEL THIS TRANSACTION, MAIL on oeuvER A G/owco AND DATED copv OF THIS oAwosuxr/um NOTICE On ANY OTHER wR/rrew woncs OR aswo A TELEGRAM TO: v4wxsc woms |MpnOvsMsmT. INC., xu /m000TmxL on.. NORTHAMPTON, NOT LATER THAN MIDNIGHT op �- /*snsovc�m�s�rmnTn�wsxonom -----' ew,snou'ow^rvns ~ ` wnc Boyv,4^cknvnlexQ, ipnof two Completely fiOod,in copies vy this notice vo the date first above nrhteuhereof. t,, ~ . Buyer's Signature Buyer's Sinuum`, 4, ®ofonIGuters1 = Agreement Thousands of Satisfied Clients! 82 Industrial Drive MA Lic#160584 1224 Mill Street, Big B 224 Northampton, MA 01060 CT Lic#0673924 East Berlin, CT 06023 I "'A �� }� t� 'ef � !,°� � N j 413 341-5259 RI Lic#33382 877 88-YANKEE -POW All home improvement contractors and subcontractors must be registered and any inquiries - } r 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 . Date s �� / _ ___,__ Homeowner Information ./ Wa� Q,. ni' yy w - Name Street Address 3.51 -' ". 4 jj� City_ +'fi r Stated p Home Phone ' �," _Work Phone --- _------Cell Phone Mailing Address (if different) _ _ -- -E-Mail The Contractor agrees to do the following work for the Homgeo n 13 ,, ode ,p ROOFING Type "` r .5 Color / b �' ��` Style Removal of Existing Roofing AYes ❑No Ice and Water Barrier Full ❑ Partial Removal of Garage Roofing ❑Yes to Ridge Vents Ryes 0- No p Replace � Dum ster g -J +s UNo Sheets Incl. Main House Roof des D N o p Ce Price per sheet e"> _ ( as needed ) Garage Roof ❑Yes l.�Wo Rolled/Low Slope '0-Yes to Front Porch Roof ❑Yes loo yt.Qf7r* Location Rear Porch Roof Wes _No ��,P,i,A'�r��fm'b� Flashings %Yes LlNo Drip Edge fires DNo Color k 1 _t_'. , Location -fir , GUTTERS C olor ! y Downspouts Color Layout Attached es ❑NO I--; Residential Sip ❑ Commercial 6in Gutter Protection Yes r NO Downspout Residential ❑ Commercial Type Garage r'Yes 01(10 Location Porch Yes LINO Color EAEICENEIRGY BARRJE BLOWN-IN INSULATION F. Rafter Install ❑ Floor Install [.1 Open Attic Blow r 1 Kneewall ,PYes ❑No 0 Net Blow Walls _ Yes ENO Area to be'cle Kneewall 0Yes 77No Type of exterior Cladding -_ ared by homeowner t..�Yes L�NU . Special instructions �_ C3 a,.r' zM%r_� 0 — ": — A a " 77 WORK SCHEDULE 1�1cli511,11 b egin the work or order the materals before the thud day fallowing the signing of this Agreement unless spc d r 'nf Co tractor will begin 4he work an or about _(date). Barring delay caused by circurnstances beyond Contractors control, the work will be comp)©fed by �y / te).The Owner horaby acknowledges agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor includin , t not fit It d to strikes, Acts of God, shortages of materials,accider�}i�Ia,nd all other dq ys beyond its control shall not be considered as violations of this Agreerent, - WARRANTY L-V d.° s � ����� 76.' [[x�,' The Contractor warrants that the work furnisl5ei?"fiereundor s�all t�e hmefects in m3tenais and workman� or 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 s0tntractors,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 detect 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: - _ �{$ �-_ � ,± .� _)upon signing contract 11/3 maximum): Name of Representative f4� ':S The Commonwealth of Massachusetts Department of Industrial Accidents a 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 Leeibly Name (Business/Organization/Individual): Address: gZ Indusf-r c l D ri a Un I i Z _ City/State/Zip: N0V40LMpfVn MO Q 1 D(4() Phone#: - ( - 1 3" -5259 Are you an employer? Check the appropriate box: Type of project(required): 1.[VI am a employer with� 4. [] I am a general contractor and I employees (full and/or part-time)." have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' y F1 Building addition [No workers' comp. insurance comp. insurance.* required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Pl ing repairs or additions myself 'No workers comp. right of exemption per MGL Y � P 12.[GJWoaf repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 11M 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 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. Insurance Company Name: l I S_ I1 urana Policy#or Self-ins. Lie. #: (00A-to IQ 1 M-6 `f Expiration Date: Job Site Address:— >(' f/ f City/State/Zip: 4 M o166.4 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. 1 do hereby certify under the pains and alties ofperjury that the information provided above�issttrue and correct Signature: -J� Date: Phone#: 1 3- 2 �)�) 4L 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: r e ad f —� License Number Address Expiration Date (412 61 Signature / Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Co piny Name Registration Number �a la//14 ���( ham- ��i� , ./� ��/�, �C/7 A Address CI b 4, Expiration Date Telephone hone 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 O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[E:3] Other[0] Brief Description of Proposed Work: X Alteration of existing bedroom Yes_____.& Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yes 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 1 t�? as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work auth ized by this building permit application. Signature of Owner Date as Owner/Authorized Aged 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 penaltiiees-of perjury. Print Na�me Signature of Owner/A 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? PNO DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO i DONT KNOW © YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q/ 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 © , Date Issued: C. Do any signs exist on the property? YES NO v IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 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 Q NO W IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only ity of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit SEP 2 6 2014 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability. Electric,Plumbing&Ga ins ec No hampton, MA 01060 Two Sets of Structural Plans Northam on, M � 87-1240 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 Map Lot Unit Zone Overlay District Ye� () Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Currgn�l�ail'naAddreu � ��-(fir 06 Telephone Signature 2.2 Authorized Agent: Name( rint) Current Mailing Address: Ot t-,6j 4, 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) e, Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 351 BROOKSIDE CIR BP-2015-0352 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-279 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-2015-0352 Project# JS-2015-000658 Est. Cost: $14996.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC 89442 Lot Size(sq. ft.): 17380.44 Owner: CURRIE WARREN E JR&CHERYL N zoninp-: Applicant: YANKEE HOME IMPROVEMENT INC AT. 351 BROOKSIDE CIR Applicant Address: Phone: Insurance: 82 INDUSTRIAL DR UNIT 2 (413) 341-5259 O WC NORTHAMPTONMAO1060 ISSUED ON.912912014 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