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23B-067 (6) BP-► 022-1268 3 BERKSHIRE TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-067-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1268 PERMISSIONIS HEREBY GRANTE/ TO: Project# 2022#5 -SHOWER Contractor: License: YANKEE HOME IMPROVEMENT Est. Cost: 15918 INC 066324 Const.Class: Exp.Date:03/28/2023 Use Group: Owner: ABBOTT DAVID A Lot Size (sq.ft.) Zoning: URB Applicant: YANKEE HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 36 JUSTIN DR (413)341-5259 XWO56702381 CHICOPEE, MA 01022 ISSUED ON:10/05/2022 TO PERFORM THE FOLLOWING WORK: REPLACE SHOWER STALL ON 1ST FLOOR IN 5 BERKSHIRE TER 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: I 1 59• I •` I � Fees Paid: $103.00 212Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner OCT___________________ REcEi-v;_ -.: _____...... L _1 ' - 4 ?Ci2 + The Commonwealth of Massachusetts / *--- B and bf Building Regulations and Standards FOR' assaohusetts State Building Code, 780 CMR MUNICIPALITY _JORTHAMpTN ,INSPECTIQNS USE, Bttrl` 4It Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 4 ,'-'-- 2;,J"-/,,?u 57 Date Applied: I 11 4 ��i 6 i io as Building Official(Print Name) i Signature i ate SECTION 1: SITE INFORMATION 1. Property A� ddress: 1.2 Assessors�vlap & Parcel Numbers-5 r KFh i r- `---e_r . A ./9 0 ti 7 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private El Zone: _ Outside Flood Zone? Municipal 0 On site disposal syste►h 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 13\i ck_ '{*h1- n-\- �1 ter-(-1,c e. . 1CY1 a , (M D l n q_ Name(Print) City, State,ZIP \)>2 c\ S c- ce ex . t4\ f �-( co Q.1)1-tc1-rA cN i k VA?,E cm-n t l .(on-. No.and Street Telephone Email Address _ SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other t1 Specify: * C ki-Is we It-LcQ_kts. Brief Description of Proposed Work': \Z PrYNo\;e rf c�$ C,.e.__, f V i S n(--, -t h C?�r\ $.)(f' \003\S VOI 'te rL 0,C \v( . Wa. \k. r-rr,.) cc- Sh r 1r`c bt�)� n .A >^ , -( ) rACC,essar>`e , . t ike r U .. .10 .5\rc.k- \ ck\grrses SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ \t q l oc I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost; (Item 6)x multiplier x..........„.__ 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: Suppression) `, 1, Check No. 13 'Check Amount: 103 Cash Amount: 6. Total Project Cost: S \S q\qj .ba 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) p C-S- o 3a+-\ 3- 8- Q3 \(1C.lQ:e_1 P-f_- l r a License Number Expiration Date Name of CSL Holder List CSL Type(see below) PD • N 1DS1. }No.\and Street Type Description 1}�yQ rr �n G �(� U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances LI43-'�11-5-4.6c1 �la.y\derrtj.)0/YA onk.echnme . i insulation Telephone Email address Ctym D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 1lbQS5kyy\\-a�1 all V.e C. 1 1cll'\� \�1�\--rNi e_me.S'ZA- HIC Registration Number Expiration Date H C Company Name or,HIC Re�istrant Name �j� c\ lSr-li- VVC • SC,\t?CMIY:\ g,`kantLee\bc e • No. and Street Email address C Ot c C\ c s e-e _Ma , 0,10 Lk 1?,-3yk-sasci City/Town, State,ZIP Telephone SECTION 6: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 Issu ce of the building permit. Signed Affidavit Attached? Yes No . ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES` FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize Os \:ee -kc 'cue '-iri 'iNQ r ' 'IN+ to act on my behalf, in all matters relative to work authorized by this building permit application. Please sct sscko-ca &\-acE,Qcl c,o41-(Ac-k-• 10 -3-aQ Print Owner's Name(E1 ctronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HJC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HiC Program can be found at www.mass.cov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton sr, f-'y` Massachusetts �w * ! i.v y DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ssr j,14. CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: (VAsAi -, '\r _ �\*\s r _ \-Nr1 The debris will be transported by: Name of Hauler: 0.�' PQ. tN\P� - r Signature of Applicant: Date: '\ -Da- 1 Page 1 of 11 Yankee Home Improvement MA Lic#160584 �! CT Lic#0673924 yYANKEE 36 Justin Drive RI Lic#33382 HOME Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information David Abbott (413) 585-0000 0 Date: 07/11/2022 5 Berkshire Terrace abbottdavid143@gmail.com Rep: Patrick Shaughnessy Florence MA 01062 Replacement Work Details Replace and Dispose of Existing Tub Install Base Base Type Acrylic Shower Pan Single Threshold Base Color White Drain Location LH Wet Area Wall Quantity 1 Type Two Wall Panels Color/Style White Smooth Shower and Bath Accessories Quantity 3 Accessory Single Tier Corner Shelf Color White This space intentionally left blank Page 2 of 1- Hardware m Delta Fixture Selection Ny ram-. (. - Ashlyn ` In2ition Shower }may,.., . „.„ Head Trim Kit Finish t, Matte Black i Temp Assure Valve? Yes, style only l available with temp adjust valve i z r i <i R t. l,/ l f is I: , • i ill i` . is i r Job Specifications Remove existing Drywall/ Plaster in the wet area and replace with moisture resistant board per code. Inspect insulation on exterior walls and replace as needed. Inspect Sub-floor under wet area and replace as needed. Replace mixing valve, inspect drain and trap and bring up to code. Misc Additions Description Move/Build Wall Custom Product 2 glass panels Quantity 1 This shower will have a glass panel on the front and on the right hand side of the shower. Scope of Work and Special Instructions 1 We are building a wall on the left side where the plumbing is, 2 white acrylic panels, 2 glass panels ordered in add section, 3 single tier corner shelves, ashlyn in2ition handheld shower head matte black, 60x30 white base LH drain.We are removing a claw foot tub. This space intentionally left blank The Commonwealth of Massachusetts Department of Industrial Accidents 1 Con trress Street, Suite 100 Boston,MA 02114-2017 wwwmass.gov/dia Workers'Compensation ;insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TI•IE PERMITTING AUTHORITY. Applicant Information - Please Print x ettibly Name (BusinessfOrganization indiVidual): �Ci,,,r\ 2e `` kcj, -L.,pCU\P\ ., Address: '-�ttr,R ( u.'" in_ \\C' • City/Stare/Zip{`1t'(zioeQ -P of , D1, Phone#: 0-Aka)) ?4L11"SQSc\ 1 1 • Are you an employer?Chock thet appropriate hoc: Type of project(required): t. �, i k am a employer with "'it) employees(full and/or part-hmej.' 7. D New construction 1 2.J 3 air a sole proprietor or partnership and haven()employees working for me m 8. J Remodeling 1 any capacity ('Jc workers'camp.insurance required.] i 9. J Demolition 3 D 1 am a homeowner doing all work myself.[No workers'comp. insurance required.)' 4.J 1 am a homeowner and will he hiring contractors to conduct all work on my property. i will IC ❑Bui!dins addition ensure that all contactors either have workers compensation insurance orarr sole I 1.J Electrical repairs or additions propnctors with no employees. 12.11 J Plumbing repairs or additions >.J r am a general contractor and I have hired the sub-contractors listed on the attached sheet. J 13. � oof repairs These sub-contraciors have employees and have workers'comp. insurance- < 6.J We arc a corporation and its officers have exercised their right of exemption per MGL c. 14. Othe[-� �� ' IS_, ?N I(C) and we have no employees o workers'camp insurance required; WO. `` 1 "Any applicant that checks box ill must also fill out the section bolo'•showing their workers'compensation policy information. .Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new aitidava indicating such :Contractors that check this box must attached an additional sheet showing the name Pith,:soh-contractors and state whether or not those entities have employees. lithesub-contractots 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 ant,'job the information_ 1 , •`1 Insurance Company Name: Pl \l 1 1 ` he , lr YjC_e... Policy#or Self-ins.Lie.#: kXOF-)t ----f4,72., E�nDate: 10 - t —0 Job Site Address: 4=.1a--s1,kre t-er City/State/Zip:VACc-c__0.C' _ __3 DU) Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dire). Failure to secure coverage as required under MGL c. 152,;25A is a criminal violation punishable by a tine up to S 1,500.00 and/or one-year imprisonment.as well as civil penalties in the iol rn ore STOP WORK ORDER and a tine of up to S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby cerrifj'u.der tl e pair nd penalties of perjury that the information provided above is true and correct. Si nature: ' G Data: ,b 'Q Phone 4: (IA\3) 3 ‘ -5a59 -- - IOfficial use only. Do not write inthis area, to be completed by city or town official. I 11 City or Town: Perro.it/License se issuing Authority(circle one): i 1. Board of Health 2.Building Department 3. City/Town CIerk 4. Electrical inspector S. Plumbing inspector Ii THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingto art- Suite 710 Bostor Massachusetts-02118 Home Impro'ement o`.ntractor f egistration , ' " _ � i ti!,.;I F==;:, ...: 4 i....,..,-,”,,,-4;4.r i,, * „ f ; Type: Corporation 1 ! 77: l tegisttation: 160584 YANKEE HOME IMPROVEMENT INC k 1 . Expiation: 08/11/2024 36 JUSTIN DR. \,':' .22:-.�.�; .�, / CHICOPEE, MA 01022 --- i i Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration, +,, ''Expiration 1000 Washington Street -Suite 710 1605841,',r- „ _08/11/2024 Boston,MA 02118 IKEE HOME IMPROVEMENT Ii'{C W twsz�: • .; LARD RONAN i =-- , _= USTIN DR. ,�F,, _..._ ,,;4. 1�,�.sYGLl%zGl1e<t' �OPEE,MA 01022 `ti,�-'. 4:`_` — --i":;� Undersecretary Not valid without signature �.--..IN YANKHOM-01 BROOKE ,aR© CERTIFICATE OF LIABILITY INSURANCE DATE 9/29/2022 DNYYY) 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 Jocelyn M Douglas NAME; Phillips Insurance Agency,Inc. 97 Center Street (A/C, o,Ext): FAX No): Chicopee,MA 01013 teDNiss,Jocelyn@philiipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Co of Amer 12572 INSURED INSURER B:Selective Ins Co Of South Carolina 19259 Yankee Home Improvement,Inc. INSURER C: 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR JNSD wVD (MMIDDIYYYYI (MMJDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR TBD 10/1/2022 10/1/2023 DMGO EoNcTDe neel $ 500,000 MED EXP(Any one person) $ 15,000 i 1,000,000 PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000i (Ea accident) $ X ANY AUTO A 9106918 10/1/2022 10/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSRREE ONLY AUTOS BODILY INJURY(Per accident) S HIRED ONLY NON-OWNEDOS PROPERTY DAMAGE (Per accident) S S A X UMBRELLALJAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS UAB CLAIMS-MADE TBD 10/1/2022 10/1/2023 AGGREGATE S 1,000,000 DED X RETENTION$ 0 $ A AND EMPLOYERS'LIABILITY X H STATUTE ER Y!N TBD 10/1/2022 10/1/2023 1,000,000 OFFIIMBEC PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT S (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 _S 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,NY 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 s' I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. Commonwealth at Massa hu uu Oiv s on of Prof *ma yy _c v y •,z; Board of But$d!n ague j$�y■}y+� �11lt 7 1 k n k� \- s tro " 11 Si f l t £ cif 17 41 �T � Q .. MICHE P` # BOX 1O5 + CiarniviSSioner O N tD LC)