17A-303 (8) 107 HILLCREST DR BP-2020-1224
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-303 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: window replaced BUILDING PERMIT
Permit# BP-2020-1224
Project# JS-2020-002063
Est.Cost: $9377.00
Fee: $80.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: YANKEE HOME IMPROVEMENT INC 89442
Lot Size(sq. ft.): 21823.56 Owner: DONNF,LLY TERRENCE P&GAIL K
Zoning_URA(100) Applicant: YANKEE HOME IMPROVEMENT INC
AT. 107 HILLCREST DR
Applicant Address: Pli one: Insurance:
36 JUSTIN DR X413) 341-5259 O WC
CHICOPEEMA01022 ISSUED ON:6/11/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT BAY WINDOW
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 Si�lnature:
FeeType: Date Paid: Amount:
Building. 6/11/2020 0:00:00 $80.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department dry Curb Cut/Driveway Permit
212 Main Stree3-;�,
T Q Sewer eptic Availability
s ¢ Room 100 'Vo OA-� <90� at/ellell Availability
Northampton, MA 0106A�t °'�- Twp Sets of Structural Plans
phone 413-587-1240 Fax 413-587.-1 7 ot/Site Pians
then Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map 174 Lot Unit
Cre s+
Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C�Q11 I�rr�, 170nr�Il�a (m N W res Lir. VIomncA ,AF1\
Name(Print) Current Mailing Address: !=C I _ (QO
* nn �� 1 11��J Telephone J0 W
Signature e
2.2 Authorized Agent:
Gl-efoaj 3(A Ju's+kr\ �Dny� , ChtCo , Ivt
Name(Print) Current Mailing Address: Ion
Signature - Telephone
SECTION 3 STIMATED 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)
5. Fire Protection
6. Total= 0 + 2 + 3 +4 + 5) Check Number
This Section For Official Use Only
1�0 Date
Building Permit Number: Issued:
Signature: G- �U-ZoZy
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 ® DON'T KNOW k YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW � YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, a avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® 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 wAdows Alterations) 0 Roofing EJ
Or Doors 19
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other[CA
Brief De npption of Proposed
Work: �,E�ryij)jd_ (loci f 11gue- 1- 1 I,�1,,u uj ow �Y 01)62, • ko \rf)[)
Alteration of existing bedroom Yes No Adding new bedroom Yes No I ra�4P_Wo Y-
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, 1 (:6 1 -t Je`r y IU , as Owner of the subject
property J
!�
hereby authorize +;'f ome
to act on my behalf, in all matters relative to work authorized by this building permit application.
X LVA_�YCIG�r (o I ct l au �ao
Signature of Owner Date
I, Cnu Prom Worne ,Mvr7V(_ry'e f'-t 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.
Gef I o rn
Print Name /
Signature of wner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
3 I iZ-4 1
Address Expiration Date
LA C5
Signatur Telephone
9.RenistiWed Home Improvement Contractor: Not Applicable ❑
0 3 rye 1 mE(bv-r re(-)t WC.- I nOJ a l-1
Company Name Registration Number
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 build'ng permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
y\'" 212 Main Street *Municipal Buildin
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:
ICY? � ll�sr���� Dyr
(Please print house number and street name)
Is to be disposed of at:
(P ease print name and localtion of facility)
Or will be disposed of in a dumpster onsite rented or leased from: ORA
(Company Name and Address)
ce )g I a ac)
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.
vfftce of invesugattons
S Lafayette City Center
2Avenue de Lafayette, Boston,MA 02111-1750
www mass gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): [xAYf Z "nw\—P— l��-a�/�(yt,t
Address:
City/State/Zip: Phone#: Q( - 31-(,1 - Sq
Are you an employer?Check the appropriate box: Type of project(required):
1.[rI am a employer with 4 O 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet_ 7. [g4emodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers' 9. E]Building addition
[No workers' comp.insurance comp.insurance.:
required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]i c. 152,§1(4),and we have no
employees. [No workers' 13.[1 Other
comp.insurance required]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
GContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
:mployees. 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.#: Y Ojo Expiration Date: 10b, / aO
lob Site Address: M 4 ` L(elll)� �)C• City/State/Zip:
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
if 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.
t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: C( ab
Phone#: Q[3 — 3 —5 a lsG
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
11111oard of Health 20 Building Department 3f]City/Town Clerk 4.0 Electrical Inspector 50lumbing
Inspector 6.❑Other
Contact Person: Phone#:
Page 1 of 11
Yankee Home Improvement MA Lic#160584
CT Lic#0673924
Yj36 Justin Drive YANKEE RI Lic#33382
HOME Chicopee, MA 01022
413-341-5259 or 877-88-YANKEE
www.yankeehome.com
Customer Information
Gail Donnelly Home: (413)586-2460 Date: 04/17/2020
Terrence Donnelly Terrence: (413)219-0123 Rep: David Curtis
107 Hillcrest Drive Gail Cell: (413)218-2400
Florence, MA 01062 tpol077@aol.com
The following windows will be installed by Yankee Home Improvement
Total number of windows being installed 1
Bay/ Bow Window
Window Item Z U. 25
Window Style Bay Quantity 1
Window Brand Veridis 500 2x Pane Window Type Bay Casement
, Location Living Room Size 96 x 56
Coil Color Glacier White Interior Window Color White
Exterior Window Color White Hardware Color Cocoa
Screen Type Full Bay/ Bow Roof Soffit Mounted
Unforeseen costs that could occur.
- Homeowner is responsible for removing and replacing any window treatments or air conditioning units in or around
any windows/ doors to be replaced. Yankee Home cannot guarantee that window air conditioning units will fit in any
windows that are replaced.
- Homeowner is responsible for removal and re-installation of alarm components on any windows and/or doors to be
replaced. Contractor will NOT replace alarm components.
(Customer Initials) T-' b
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 approvals are the responsibility of the homeowner and will be provided by homeowner unless otherwise
stated on this contract.
vP o
(Customer Initials)
S ecial Instructions
Customer is aware window is double pane glass.
Customer wants Congnac interior color, not white as listed.
Customer wants cocoa colored hardware.
Page 3 of 11
Payment Schedule
YHI agrees to perform the work, furnish the material and labor specified above for the total sum of: $9,377
Form of Payment Cash
Deposit $3,126
Deposit Type Credit Card
Cash Due Upon Completion $6,251
David Curtis
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.
-P-0
Gail Donnelly
04/17/2020
Date
Terrence Donnelly
04/17/2020
Date
This space intentionally left blank
Page 6 of 11
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 the 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.
„y9
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.
s <.
u
.m'...«.. ow rn or '.,4 '` Massachusetts
Division of Professional Licensure
atoand of BuildingRegulations Standards
ConstruCtiOn 3sd,pV�tsor
S w,
Or-�- -
CS-089442 t�- xptres : 03/ 19/2022
GERARD J RNA
?33^ T
PO
BOA 675 r
EASTHAMPTON MA 01027
COmm * ssioner
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.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Coruoration before the expiration date. If found return to:
Registration bion Office of Consumer Affairs and Business Regulation
160584 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 V out signature
YANKHOM-01 NICOLE
ACORN CERTIFICATE OF LIABILITY INSURANCE
DATE 1011(L(201 YY)
`--� 1a1a2o1s
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(les)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 413 594-5984 FAX
97 Center Street (A/C,No,Ext):( ) (A(C,No):(413)592-8499
Chicopee,MA 01013 A p IE :nicole@phillipsinsurance.com
INSURERS AFFORDING COVERAGE NAIL 8
INSURER A:Ohio Security Insurance Co 24082
INSURED INSURER B:Selective Ins Co of South Caro 19259
Yankee Home Improvement, Inc. INSURER C:Ohio Casualty 24074
Ger Ronan --
36 Justin Drive INSURER D:
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 EXPLTR LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE �OCCUR BKS56702381 10/1/2019 10/1/2020 DAMAGE TO RENTED ���(�
-PREMISES Ea occurrence) $
MED EXP(Any one son $ 15'000
PERSONAL&ADV INJURY $ 1'000'000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000'000
POLICY❑X EO- F LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY EOMBIN e.,J 000
SINGLE LIMIT $ 1,000,
X ANY AUTO A 9106918 10/12019 10/12020 BODILY INJURY Per $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUTOS ONLY AUTOS ONLDY PRer accidenOPER t AMAGE $
$
C X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1'0009000
EXCESS LIAB CLAIMS-MADE US056702381 10/12019 10/12020 AGGREGATE $ 1,000,000
DED I X I RETENTION$ 10,000 $
C WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY YEN ST T TE ER
XW056702381 10/12019 10/1/2020 1,000,000
ANY CERIMEMBER/PXCLUDE/EXECUTIVE NSA E.L.EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? INI
(Mandatory in NH) E.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 10/1/2019 10/1/2020 Building Limit 3,117,000
A Property BKS56702381 10/1/2019 10/1/2020 Personal Property 153,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required)
Workers Compensation coverage is included 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.
AUTHORQED REPRESENTATIVE
v