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37-083 (15) 266 GROVE ST BP-2020-0623 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:37-083 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2020-0623 Proiect# JS-2020-001048 Est.Cost: $3223.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: YANKEE HOME IMPROVEMENT INC 89442 Lot Size(sg.ft.): Owner: DOSTIE-SLAVICH ALEX& F:IXSE Zoning- Applicant. YANKEE HOME IMPROVEMENT INC AT. 266 GROVE ST Applicant Address: Phone: Insurance: 36 JUSTIN DR (413) 341-5259 0 WC CHICOPEEMA01022 ISSUED ON.1111312019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 1 SLIDING GLASS DOOR 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 11/13/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only Cit of Northam t n' ��1 Status of Permit: y P \_ V Building Department ^�� urb G�t/Driveway Permit I; `, 'A 212 Main Street's ov 3ewer('Septic Availability Room 100 �� e Wate//Well Availability Northampton, MR i9 Tw Sets of Structural Plans . , phone 413-587-1240 Fax 41.9� 8'>?„ PI /Site Plans o .,4,4 01�T/CNg O her Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION ge-Ao 1.1 Property Address: This section to be completed by office G%'bV-e-- S'+ LM%� Map '7 Lot Q f 3 Unit MA- oiowo Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: lex a.nc1 LW S-e- --Dos-be - SI a.vi ch 6rD\/t-- S} jy\ -I- tt- i L Name(Print) Current 3 Mailing,Adddress, I n S "I Telephone Signature 2.2 Authorized Agent: Mask,- 61na rd S—Y V'P— Name(Print) Current Mailing Address: 1&jk,f&' 'fI-A - SL41 - 522.9 Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) AA 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) ?j a °` Check Number /�U This Section For Official Use Only Building Permit Number: Date Issued: Signature: 13 7 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement endows Alteration(s) ❑ Roofing ❑ Or Doors P9 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding (0] Other[D] Brief Description of Proposed Work: 1 n 5tl'.1.��f�LP _ I S�1 AA VU Aocw 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 CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. NCUSC 1C� I �O i 19 Signature of Owner Date I, tilj Ct I1 O'c(A / ( �tN r Iii I � -e�� 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. ICL. n.__ Print Name ) Signature of caner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:rc� 'n Not CApplicable /0 + n Name of License Holder: I C_Jl ©` , �_.� V 11"I"[t CX- License Number V`P-. t C,z -Q- MA 6 10- olt- � �o Addr ss zLJ ` Expiration Date J l 7 — Ja5q lure Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number J wS-t, to n� C��c, IA rpt 0lca— L 1 I 1 1210 02c� Ad ress Expiration Date Telephone{ -r -Sa 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...... ❑ City of Northampton r-•�` �' Massachusetts G DEPARTMENT OF BUILDING INSPECTIONS 7 212 Main Street a Municipal Building �J CSS Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporlat�ion or LLC, that entity must be registered Type of Work: � �1�'t n�— C - C�(� Est. Cost: Address of Work: C2 C cD S+ llY U T #a, Date of Permit Application: C) I ct I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton ~` Massachusetts A w 'K DEPARTMENT OF BUILDING INSPECTIONS Z 212 Main Street •Municipal Building Northampton, MA 01060 Sfb�� .},���� 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: a(Q (0 &(bVC "S- **- (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: . USA OO U (Company N me and A s) � b-X CT U(o03� i 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. The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia fi Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): �m 2e- flD e—`ion Address: 'NQ 3w�h n T)n11, CA-6 cbpe-t_i MA 6LD 02 9-- City/State/Zip: Phone #: ,(e — ?- —5L2_1�9 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. []New Construction 2 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. L1 Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4 El am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions ❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t V 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. l4. Other .�e � 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 1 d 0V r *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 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: nsl,t,(C i(,Q .P nC(_q _, W c ' Policy#or Self-ins.Lic.#: ' UJ 0 fL(,077 Q o2�J D Expiration Date: I('7 I 9'— Job Site Address: as,10 _ S,-' ()h City/State/Zip: O V%a&p}1In a j O09- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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: Q&.��/YKI�[ Date: U13(2zlq Phone#: L} l-� — 3!� ) - s s q 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#: 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 Update Address and Return Card- SCA 1 Q 2pM-0-05/1��7 S//,r.Y(�ra7xn nrlwlrl/li ! '/FIrJJrrr�rr.IP�/J Office of Consumer Affairs S Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: fleglaketlon ExDjration Office of Consumer Affairs and Business Regulation 160.584 08/11/2020 1000 Washington Street-Suite 710 YANKEE HOME IMPROVEMENT INC Boston,MA 02118 GERARD RONAN 36 JUSTIN DR. � CHICOPEE,MA 01022 Undersecretary Not valid without signature YANKHOM-01 ANGELA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) 1/7/2019 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 Phillips Insurance Agency,Inc. PHONE 413 594-5984 AX,No>:(413 592-8499 97 Center Street A/c,N°,Ext):( ) ) Chicopee,MA 01013 E-MAIL :nicole@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC M INSURER A:Ohio Securit Insurance Co 24082 INSURED INSURER B:Preferred Mutual Insurance 15024 Yankee Home Improvement,Inc. INSURER C:Ohio Casualty 24074 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 CONTRACT OR 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRIDDNYYYi A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE �OCCUR BKS56702381 10/1/2018 10/1/2019 DAMAGE TO RENTED 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 PPOLICY jp LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO PCA0100300301 10/1/2018 11/1/2018 BODILY INJURY Perperson) OWNED SCHEDULED AUTEO�S ONLY AUTOSBODILY p BODILY INJURY Per accident AUTOS ONLY AUTOS ONLY PROPERTY AMAGE Per accident r $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 11000'000 EXCESS LIAR CLAIMS-MADE US056702381 10/1/2018 10/1/2019 AGGREGATE 1'000'000 DED I X I RETENTION$ 10,000 C WORKERS COMPENSATION X I PER OTH- TATUTE ER AND EMPLOYERS'LIABILITY Y/N XW056702381 10/1/2018 10/1/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT WQ�.F.1 ER/M,.MBER EXCLUDED? N/A ndatory m NH) (lulE.L.DISEASE-EA EMPLOYEE $ 1,000,000 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 9/18/2018 9/18/2019 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Webster THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. Webster,MA AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 10 Yankee Home Improvement MA Lic#160584 36 Justin Drive CT Lic#0673924 AI YANKEE RI Lic#33382 HOME Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Alex Dostie-Slavich (413)341-1193 Date: 10/18/2019 Elyse Dostie-Slavich a.dostie.slavich@gmail.com Rep: Jon Shrair 266 Grove Street Unit #2 Elyse's phone: 413-822-8736 Northampton, MA 01060 The following windows will be installed by Yankee Home Improvement Total number of windows being installed 1 SI ding Glass Door S iding Glass Door Item Quantity 1 Window Brand Veridis 800 Location Living Room Size 60x80 Coil Color Glacier White ! Interior Window Color White Exterior Window Color White Hardware Color White Tempered Glass Yes Foot Lock Yes Unforeseen costs that could occur. - Homeowner is responsible for removing and replacing any window treatments or air conditioning units in or around any windows to be replaced. - Homeowner is responsible for removal and reinstallation of alarm components on any windows and/or doors to be replaced. Contractor will NOT replace alarm components. (Customer Initials) Acknowledgements & Notifications. - Any furniture must moved at least 5 feet away from windows and/or doors to be replaced. - All pets shall remain secured in safe location inside of the home away from windows and/or doors to be replaced. - All driveways shall remain clear during date of installation. - Any HOA approval will be provided by homeowner unless otherwise stated on this contract. (Customer Initials) Special Instructions Tuesday and Thursday are good days for measure anytime between 8:30am and 10am. Page 2 of 10 Do Not Do We do not do any painting or staining. 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 12/05/2019 Barring delay caused by circumstances beyond Contractor's control, the work will be completed by 12/23/2019 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. elz� Alex Dostie-Slavich 10/18/2019 Date V.A�Al _ Elyse Dostie-Slavich 10/18/2019 Date Page 3 of 10 Payment Schedule YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: $3,223 Form of Payment Cash Deposit $1,077 Deposit Type Credit card Cash Due Upon Completion $2,146 YT��N�� Jon Shrair 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. Alex Dostie-Slavich 10/18/2019 Date Elyse Dostie-Slavich 10/18/2019 Date Page 9 of 10 Yankee Home Improvement MA Lic#160584 36 Justin Drive CT Lic#0673924 AJ YANKEE RI Lic#33382 HOME Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Alex Dostie-Slavich (413)341-1193 Date: 10/18/2019 Elyse Dostie-Slavich a.dostie.slavich@gmail.com Rep: Jon Shrair 266 Grove Street Unit #2 Elyse's phone: 413-822-8736 Northampton, MA 01060 Arc Lead Home Program In consideration of certain specially priced Yankee Home Improvements Products, which will be furnished and installed in exchange for valuable consideration by Yankee Home Improvements Inc. at the residence in the attached contract, I/WE the undersigned homeowners, consent and agree to provide the following to Yankee Home Improvements Inc. Reviews YES I agree to write a review based on my experience with Yankee Home Improvements. These review will be on Google, and/or Facebook. Flexible Install NO Social Media NO Facebook Post NO Testimonial Video NO Before/After Pictures YES /We grant permission for YHI to take before, during, and after photos of our home, to be used on their website with geotagging metadata and/or their in-home demonstration. (Geotagging info will not disclose full address, but solely their town) Job Sign NO Alex Dostie-Slavich 10/18/2019 Date Elyse Dostie-Slavich 10/18/2019 Date `.�- I • � . • - �' �, ,: ,a °� t ���������� � _ f � 1 < ' E � � �� , � � �, ', -_ � l r t ' v �� a ' ,� w r 1 • `r �; ��� - r, •�