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23A-164 100 BEACON ST BP-2020-0326 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A- 164 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2020-0326 Project# JS-2020-000544 Est. Cost: $40528.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: YANKEE HOME IMPROVEMENT INC 160584 Lot Size(sq. ft.): 12153.24 Owner., MONTEIRO ARTURO JR Zoning:URB(100)/ Applicant: YANKEE HOME IMPROVEMENT INC AT. 100 BEACON ST Applicant Address: Phone: Insurance: 36 JUSTIN DR (413) 341-5259 O WC CHICOPEEMA01022 ISSUED ON.9/11/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.REMOVE AND REPLACE SIDING 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 9/11/2019 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner ,�S 11)/n/P224 r= G- Department use only City of Northam n St tus o Permit: .s Building Depart ent C rb CuDriveway Permit 212 Main;Stre t SEP 1 0 2019 S wer/Saptic Availability Room'100 W 3ter ell Availability Northampton,] MA p aT �F aoi,:G iNsaFc �"�Set of Structural Plans phone 413-587-1240 1 Fax 41y im NAA o1u lot/Si 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 J Lot Unit Zone Overlay District Florence - Ma , p�t�c�a Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: t� r'1e0.S2 sef swrxe6 OA-ac-b-ccl cuoll nc_L Telephone Signature 2.2 Authorized Agent: �1�aSkc �i r)os-& 3t� ��C�a���n nr - Chic m0, Name(Print) Current Mailing Address: I ra �Y C��pQ 1 W�7�-?M CSasg . Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building y� 5o1g 110 (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 ()q2-0 6. Total = 0 + 2 + 3 +4+5) Check Number This Section For Official Use Only BuildingPermit Number: Date Issued: Signature: "AL Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Q DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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 [E3] Decks [Q Siding[O] Other[ Brief Description of Proposed Work: Removdre, Qrd up\O_c\CIG SQA\(1G Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes ✓ 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 CONTRACTORAPPLIESFOR BUILDING PERMIT I, "6 w,O as Owner of the subject property herebyauthorize \1Cw*_ee to act on my behalf, in all matters relative to work authorized by this building permit application. phase sc t s i car ed 0. ached coc��Co�C 8 ag - 9 Signature of Owner Date 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. qlaskA �Pina�c� Print Nam Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder: 6a ux c�- WV-,0.C1 CS -D(A LALAO License Number 3l0 ��s� r1 C>r C\c u e . -2,020 Addre Expiration Date 7 y-A 5x5°1 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ )I a"Key No rn� rc��r ov ern e n \1v o 5 BL1 Company Name Registration Number ( \\ -'2621b Address Expiration Date Telephone'A -SOISq 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 build ng permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton ` Massachusetts �. �. DEPARTMENT OF BUILDING INSPECTIONS R �J - ��� 212 Main Street *Municipal Building b Northampton, MA 01060 Debris 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. The debris from construction work being performed at: �Oo C1) eacot, \cee� \t,�ence M (Please print house number and street name) Is to be disposed of at: Qepuh\k- yo Rise s� S�r����e�� C- (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: `Mate \-1cw\e_ (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Page 1 of 17 Yankee Home Improvement MA Lic#160584 CT Lic#0673924 Y YANKEE 36 Justin Drive RI Lic#33382 Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Arturo Monteiro (413)586-5432 Date: 08/16/2019 100 Beacon Street s-monteiro@msn.com Rep: Dario Trujillo Florence, MA 01062 cope Area is defined by the area of work in which services will be performed and does not include any excluded areas. Areas or structures to be INCLUDED in scope area All sides of house excluding side porch and inside the side porch Areas or structures to be EXCLUDED in scope area Side porch and inside the side porch. Front entry porch beams and ceiling. Selected Sidin Options Remove Existing Siding YES Existing Siding Style Wood Primary Siding Style Preservation Integra Siding w/ Fitted Insulation 6" Clapboard Primary Siding Color Vintage Wicker Corner Posts Color Vintage Wicker Siding Options Square/Rectangle Gable Vent Quantity 0 Shutters Qty 0 Capping Style 4 Side Picture Capping Color Glacier White Soffit Color Glacier White Additional Details Unforeseen costs that could occur. Additional cost could arise due to damaged wood not recognized at time of estimate. Any wood replacement will be charged upon the homeowners approval an additional cost of $60 per sheet of CDX plywood. Homeowner understands that damaged plywood can only be definitively evaluated after the existing layer(s) of siding/clapboard has been removed. Homeowner has completely read, and fully understands that any and all plywood replacement will be charged in addition to the total amount of this contract. I understand the additional charges that could occur at time of installation. (Customer Initials) Page 2 of 17 Acknowledgements and Notifications. Access is needed to driveway where possible. Please have all vehicles removed from driveway to allow for material delivery. Prior to installation homeowner agrees to remove any fragile objects that are on or against the exterior walls, inside or outside of the home, to prevent any damage due to vibration during install. Homeowner agrees to be home upon job completion in order to do a walk around with job foreman to inspect completed project. Entire job site will be cleared of all debris upon project completion. I have reviewed and fully understand all of the above. (Customer Initials) Special Instructions Entry overhang may be rebuilt in the future. Exclude front overhang and side porch inside and outside. Side vent can be pulled away from the house and re-fastened to the new siding. Do Not Do We do not do any painting or staining. Page 3 of 17 Work Schedule Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 09/16/2019 Barring delay caused by circumstances beyond Contractor's control, the work will be completed by 10/16/2019 The Owner hereby acknowledges and agrees that the 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 materials, accidents, and all other delays beyond its control, shall not be considered as violations of this Agreement. Customer Initials WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of DOUBLE LIFETIME following completion and shall comply with the requirements of this Agreement. In the event that 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 Authorized damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Arturo Monteiro 08/16/2019 Date Page 4 of 17 Payment Schedule YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: $40,528 Form of Payment Finance Deposit $4,050 Deposit Type Credit Cash Due Upon Completion $36,478 pgow / Dario Trujillo Notice: No agreement for home improvement contract 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 which the contractor must make, in advance, to oder and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. ^ Arturo Monteiro 08/16/2019 Date Page 5 of 17 NOTICE OF CANCELLATION You may cancel this transaction, without any penalty or You may cancel this transaction, without any penalty or obligation, within three business days from the below date. If obligation, within three business days from the below date. If you cancel, any property traded in, any payments made by you you cancel, any property traded in, any payments made by you under the contract or sale, and any negotiable instrument under the contract or sale, and any negotiable instrument executed by you will be returned within ten business days executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be any security interest arising out of the transaction will be cancelled. To cancel this transaction, mail or deliver a signed cancelled. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written and dated copy of this cancellation notice or any other written notice, or send a telegram to: notice, or send a telegram to: YANKEE HOME IMPROVEMENT INC. YANKEE HOME IMPROVEMENT INC. 36 Justin Drive 36 Justin Drive Chicopee, MA 01022 Chicopee, MA 01022 NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE DATE OF THIS CONTRACT. FROM THE DATE OF THIS CONTRACT. I HEREBY CANCEL THIS CONTRACT. I HEREBY CANCEL THIS CONTRACT. BUYER'S SIGNATURE DATE: BUYER'S SIGNATURE DATE: I Arturo Monteiro, HAVE BEEN PROVIDED ORAL NOTICE THAT I HAVE THE RIGHT TO CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION, WITHIN 3 BUSINESS DAYS FROM THE DATE OF THE TRANSACTION SPECIFIED ON THE "NOTICE OF CANCELLATION". Arturo Monteiro 08/16/2019 Date Page 6 of 17 TERMS and CONDITIONS Ownership of Property: MA The undersigned warrants that he/she is Owner of the property on which the work is to be performed or that he/she is otherwise authorized on behalf of Owner(s) to enter into this Contract. Notice of Scheduling Changes: Contractor agrees to provide Owner with notice when delays become known to the Contractor. Concealed Conditions: Should concealed conditions encountered in the performance of the contract be at variance with the conditions indicated by the contract and/ or Owner or should unknown conditions of an unusual nature, differ from those ordinarily encountered and generally recognized as inherent in the work of the character provided for in this contract be encountered, the contract shall be equitably increased. Furthermore, if unknown and/or concealed conditions prevent Contractor from completing the contract, the contract shall be equitably increased or decreased, as the case may be. Delays in Completion Due to Concealed Conditions: Owner hereby acknowledges that in certain remodeling work, the demolition of portions of the pre-existing structure may reveal additional defects, conditions or the need for additional work, which must be repaired, altered or carried out in order to complete the work described under the contract. In such case(s), Owner agrees that the duration of the work and the scheduled date of completion may differ from the date stated on the front, and that such variation shall not be considered to be a violation of this contract. Restarts: If the project is stopped by Owner for a period of greater than ten (10) days, a restart fee of ten percent (10%) of the contract price will be required to compensate Contractor for the necessary time and remobilization of staff and materials. Depending on the duration of the stoppage, an additional equitable adjustment may be necessary to cover wage increases and general escalation. Product Substitution: Without Owner's consent and at the discretion of Contractor, Contractor may use materials and articles of quality and merit equal to those designated in the contract, where the materials described in the contract are unavailable or their use in impractical, provided however, the material must be of equal or greater value than those specified in the contract and there shall be no additional charge to Owner. Page 7 of 17 Hazardous Waste/Asbestos/Contaminants/Mold: Owner represents and warrants that the project area and house are free from hazardous waste, lead paint, asbestos and/or other contaminants. Therefore, in consideration of this representation and warranty, it is agreed that by accepting this contract, Owner does hereby release and indemnify and hold harmless Contractor from and against all claims, damages, liabilities, losses, expenses, direct and/or indirect, including but not limited to, attorney's fees and defense costs arising out of or resulting from the performance of any of the services by Contractor or claims against Contractor relating to, involving or arising out of hazardous waste, lead paint, asbestos, and/or other contaminants unless such damages or claims are caused solely by Contractor's negligence. Owner is hereby advised that mold can grow and be present in concealed areas of the home, Contractor has neither made an analysis nor verification, and assumes no liability for the determination of mold existing in or on Owner's residence. Owner hereby agrees that Contractor shall not be responsible for the detection, containment, or remediation of and existing mold. Owner further waives all claims and agrees to hold Contractor harmless against any claim based in whole or in part on the release of spread of mold that does not originate with Contractor negligence. Additional Warranty Information: All work to be completed in a workman like manner. Any alterations or deviation form the above specifications requested by Owner involving extra costs will be executed only upon written orders, and will become an extra charge over the estimate.Payment/Default: Owner agrees to pay cash in accordance with the written terms and conditions; provided, however, if Contractor, at its sole discretion grants Owner credit, then Owner shall sign the Contractor's promissory note for the credit so granted. The terms of the promissory note shall be incorporated herein by reference and made a part hereof. If Owner fails to make all payments strictly in accordance with the terms of this contract, and/or otherwise defaults hereunder or on the promissory note, the entire unpaid balance of the contract and note shall be immediately due and payable, without further protest, notice or demand, and Contractor shall be free to exercise its cumulative rights and remedies, which may include, but not be limited to, suit, attachment and rights pursuant to various applicable lien-laws. Owner also agrees to sign a completion certificate upon completion of the work. Owner agrees to pay all costs of collection, including reasonable attorney's fees, costs and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. If Owner cancels this contract at any time subsequent to midnight of the third business day after the date of the contract, Owner will be responsible for all of Contractor's damages, which will include, but are not limited to, the difference between the contract price and the cost of material and labor which would constitute lost profits in addition to any and all other damages suffered and/or sustained by Contractor. Contractor reserves the right to cancel this contract at any time within thirty days of the date of this contract. If Contractor cancels, Owner will be promptly notified in writing by an authorized officer. If Contractor cancels, Contractor will promptly return any down payment(s) Owner has made. Page 8 of 17 Arbitration: The parties hereby agree that the Massachusetts Arbitration Act shall apply to all disputes and claims arising out of, or relating to this Agreement, including the breach thereof. The parties agree to follow the expedited procedures of the Commercial Arbitration Rules of the American Arbitration Association at a hearing only to be held in Springfield, Massachusetts. The commencement of arbitration proceedings by an aggrieved is a condition precedent to the commencement of legal action by either party except, mandatory arbitration procedures required in this Agreement shall not be applicable to any claim by Y.H.I., wherein it seeks a prejudgement remedy such as a real estate attachment, for cases where Owner has not paid a bill which is due to Y.H.I. Subcontracting: Contractor has the right to subcontract any part, or all, of the work agreed herein to be performed. All permits, license requirements, workmen's compensation and/or other job requirements shall be the sole responsibility of the subcontractor. Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. No Acceleration of Payments but Escrowing Allowed: The Contractor may not require payments to be made in advance of the times specified in Payment Section (front), provided, however, if it deems itself to be insecure, it may require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in control of Owner, shall be placed in a joint escrow account that requires the signature of both Contractor and Owner for withdrawal. Insurance: Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by itself, its employees or its subcontractors in the performance of, or as a result of, work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. Construction Related Permit Acquisition: Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals. NOTICE: If Owner obtains his/her own construction related- permits for the work described under this Agreement, Owner is hereby advised that in tie event of a dispute, judgment and non payment of Contractor, Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. Page 9 of 17 100% Money Back Guarantee 100% Money Back Guarantee There is nothing more important to us than our customer's satisfaction. We think that it is unnecessary for a homeowner to take a risk when using a home improvement contractor. That's why we offer all of our customers our exclusive 100% Satisfaction Pledge. Here is how it works: At any time within 30 days of your job being completed and paid in full, if you are not fully satisfied with either our work or your products, and if we cannot fix the issue to your satisfaction within 90 days, we will do the job for free. If we cannot make it right, we will refund your purchase amount. All we ask in return is a fair chance to remedy any issues. As you may know, I had $2500 taken from me by an unscrupulous roofing contractor. Our "No Worries" philosophy is based solely on creating a trusting environment for our customers that delivers what they were promised. I want you to tell all of your friends about how you felt comfortable and informed during the entire construction process, and most importantly, I want you to be happy with the products you will be enjoying for the rest of your life. Committed to your complete satisfaction, Ger Ronan Arturo Monteiro 08/16/2019 Date Page 10 of 17 Customer Information Arturo Monteiro (413)586-5432 Date: 08/16/2019 100 Beacon Street s-monteiro@msn.com Rep: Dario Trujillo Florence, MA 01062 Your family's health and safety is our top priority! I hereby acknowledge receipt of the pamphlet, "Renovate Right." This pamphlet informs me of the potential risk of lead hazard exposure from renovation activity to be performed in my home. I confirm that I have received is pamphlet before any work began on my home. Arturo Monteiro 08/16/2019 Date Page 11 of 17 Image: 1.1 rag I : rx.,,w.vo.wa n . Page 12 of 17 Image: 1.2 f \, 10 - --____ R M Page 13 of 17 Image: 1.3 7 IF - - - T -I _ IN I Page 14 of 17 Image.• 1.4 , +Aa.• r r t � x�a 4 1 { FRI m '► ♦ ?'{v Mfa'c t�. .�• '+ fes°� v i'� i`�� �' �� it a ♦.•1,! ', ,,. e.. ����R��� ��• $ �� ��'� ��. ���y� 1 • N��•�� j' ` L E s- t� r r 6 r Page of 17 Sat i. `k,a��� \.� \. ••, a ,:,j�• ,� it V�,.. a::--v,- .�� .�_,;. ■w �.,,,�"' � •gra. � f ,� ;�► a. Page 17 of 17 Image: 1.7 41i t F J i LL._ u { 6/�,h((wario 4w;e& Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation YANKEE HOME IMPROVEMENT INC Registration: 160584 36 JUSTIN DR. Expiration: 08/11/2020 CHICOPEE,MA 01022 SCA 1 20M-05!17 Update Address and Retum Card. � r+Tu��xllt7ltr:fttluttr'��n�`��l7.lJitr•�ittk�lJ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Cawabon before the expiration date. If found return to: 80018tratlon EKRIration Office of Consumer Affairs and Business Regulation 160584 08/11/2020 1000 Washington Street-Suite 710 YANKEE HOME IMPROVEMENT INC Boston,MA 02118 GERARD HONAN 36 JUSTIN DR, t'\ CHICOPEE,MA 01022 Undersecretary Not valid Without signature 8/29/2019 Mail-Brie Underwood-Outlook I)y,BRI,S I)I5P05AL AE'MA-1-11 In accordance with the proNisions of'l_G.1..c.40,s. 54.Building Permit was i."sued with the condition that all debrLs resultind from this wor Shall be d''x3sed of ism rn riy liceuseai soli wa.te dig xal facility aR det�tned i�4 4i G I c. 113,c 150A- TI e debris `'e disposed of;il: Name.of Waste Facilit". 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Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADnlicant Information Please Print Leeibly Name(Business/Organization,lndividual): ) (k ee Address: Jap City/State/Zi i v e ok a-L . Phone#: q 'l I --5 2--S Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. 1.�I am a employer with 5 2. ❑ g 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. ❑ 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.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.[] Plumbing repairs or additions Mo workersp. myself ' com right of exemption per MGL + c. 152, 1 4 ,and we have no 12. Roof repairs insurance required.] § ( ) 13.�Other r1 employees. [No workers' comp, insurance required.] *Any applicant that checks box#1 must also till 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: , Policy#or Self-ins. Lic.#: MQ 05 6I d 2 M Expiration Date: I U I I _ Job Site Address: 20•Con Sk City/State/Zip: '(1CP '(�C10. , 0kL)fo`07 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. /do hereby certifynunder _^the pains t(and �penalties of perjury that the information provided above is trite and correct. Signature: aur� � pU(wla Date: Phone#: I 1-5159 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#: YANKHOM-01 NICOLE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY) 3/6/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nicole Waslick NAME: Phillips Insurance Agency, Inc. PHONE FAX 97 Center Street (AIC,No,Exq:(413) 594-5984 AIC,No:(413)592-8499 Chicopee,MA 01013 � ss:nicole@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Co 24082 INSURED INSURER B:Selective Ins Co of South Caro Yankee Home Improvement,Inc. INSURER C:Ohio Casualty 24074 Ger Ronan 36 Justin Drive INSURER D:Philadelphia Insurance Company Chicopee,MA 01022 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD M/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR BKS56702381 10/1/2018 10I1I2019 DRE I ETORENTED a0ccure e $ 300,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ B AUTOMOBILELIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea acddent)X ANY AUTO A 9106918 11/1/2018 10/1/2019 BODILY INJURY Perperson) $ _ OWNED SCHEDULED AUTOS ONLY AUTOS �yy p BODILY INJURY Per accident $ AUTOS ONLY AUTOS ON Y PPeor ec dZ DAMAGE $ $ C X UMBRELLALIABX OCCUR EACH OCCURRENCE $ 1,000,000 PEXCESSLIII6 CLAIMS-MADE US056702381 10/1/2018 10/1/2019 AGGREGATE $ 1,000,000 I DED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION X PERTUTE ORTH- AND EMPLOYERS'LIABILITY 1/2019 IN ANY PROPRIETOR/PARTNER/EXECUTIVE YXW056702381 10/1/2018 10/ a E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMg REXCLUDED? NIA 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ A Property BKS56702381 10/1/2018 10/1/2019 Building Limit 3,000,000 D EPLI PHSD1268876 9118/2018 9/18/2019 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation includes coverage for the following states: MA,CT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD