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17C-126 (6) B -2023-0028 67 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-126-001 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-2023-0028 PERMISSION IS HEREBY GRANTED TO: Project# NEW SHOWER 2023 Contractor: License: YANKEE HOME IMPROVEMENT Est. Cost: 15170 INC 066324 Const.Class: Exp.Date: 03/28/2023 Use Group: Owner: CONNOLLY JAMES F&JAYNE REEVES Lot Size (sq.ft.) Zoning: URB Applicant: YANKEE HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 36 JUSTIN DR (413)341-5259 WC 9099267 CHICOPEE,MA 01022 ISSUED ON: 01/12/2023 TO PERFORM THE FOLLOWING WORK: REMOVE AND REPLACE TUB WITH NEW SHOWER 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 VI LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( �� IF �( Fees Paid: $104.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner e r 't s' , " The Commonwealth of Massachusetts W FOR Board of Building Regulations and Standa 1 0 2023 MUNICIPALITY Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair,Renovates 4N- Revised Mar 2011 One-or Two-Family Dwelling '`'•' '' ',''°'oF.,; This Section For Official Use Only Building Permit Number: 8 P- 7 3 .A s2 Date Applied: 4u ) ass //7/2 [-II-2023 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers L 7 N• rMe t 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 Wate Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: _ Outside Floodne? Municipald On site disposal system 0 Check if ye SECTION 2: PROPERTY OWNERSHIP' 2.LOwner'of Record: \\161 C nRo11,1 c10re.�n cie_ , o U 2 Name(Print) J City,State,ZIP ClIQ , Mar 1_ SA- Ld t3 S8 Fr-2c i Onr\c) L C CY\&U ,C)ry No.and Street Telephone Email Ad ess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building" Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: V__Q cnc i C r ck cep kaCsa.- ey S�ir-9 tub Liu\ r .&' , ac r \i( . Wu v lr car rye o,.c r9 l i L , iioJ,kS . O r\C1 r u00 i x N-Wre s • SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 5 , \-)D 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire — Suppression) Total All Fees: $ Check No.1?ll0)Check Amount0 IA Cash Amount: 6. Total Project Cost: $1 S, \ D 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) os �y ro �{� i G J 'r l ci[ I ��� ��,t 101 License Number JOB T Expiration DateO Name of CSL Holder List CSL Type(see below) No.and Street Tyke Description i g 1n r r o,/� (�/�� �`�i o `? (`„ ) Unrestricted(Buildings up to 35,000 Cu.ft.) CiltylfT/oU1wn,State,t ZIP 1 0 ` V 1 110J R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding ir,�34 i 5a i (Yl pelf-6 anIcep hl7rnL SF Solid Fuel Burning Appliances1 insulation Telephone Email address C OM D Demolition 5.2 Registered Home Improvement Contractor(HIC) yCxn\.p kcrn \cp c , �nL I �, HIC Registration Number Expiration Date HIC Comny�l�a�m`�HI.CDRegistrant Name � Q r i c r-c \-SCE\l . Y11 Email f C 1J52� Emailaddress 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 Issua a of the building permit. Signed Affidavit Attached? Yes No .0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize V C �'l(��, '�� I fif)`G ravr_fifit to act on my behalf,in all matters relative to work authorized by this building permit application. w nt raC-+ - t 1310,3 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. oc) CA)( ji- c* * 3 a3 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(HIC)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.gov/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" �__-..'1 YANKHOM-01 JOCELYN ,4�..-- CERTIFICATE OF LIABILITY INSURANCE DATE 12/2022Y) 10/12/2022 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 NAMEACT Jocelyn M Douglas Phillips Insurance Agency,Inc. PHONE Ext): FAX 97 Center Street (A/C,No): Chicopee,MA 01013 A or ss:jocelyn@phiIlipsinsurance.com I 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 EFF POLICY EXP W POLICY NUMBER LTR INSD VD (MM/DD/YYYY)_ YYYY) LIMITS WM/DD/ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2517693 10/1/2022 10/1/2023 PREM SES(Ea occcurren¢e) $ 500,000 - MED EXP(Any one pers n) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEI f LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIM T 1,000,000 (Ea accident) $ X ANY AUTO A 9106918 10/1/2022 10/1/2023 BODILY INJURY(Per peson)_ $ OWNED SCHEDULED BODILY INJURY(Per ac¢'denQ $ AUTOSO ONLY AUTOS AUTOS ONLY _ NON-OWNEDO Y PROPERTY acEcidentDAMAGE $ _ _ $ Al X__ yUMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2517693 10/1/2022 10/1/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE R ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 9099267 10/1/2022 10/1/2023 1,000,000 OFFICER/MEMBER Fandato y In N iR EXCLUDED? N N/A E.L.EACH ACCIDENT $ ) E.L.DISEASE-EA EMP.OYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 , Y2d'?/. k 'i e ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts 1t "� Department of Industrial Accidents ''r 1 Congress Street,Suite 100 .,`';�:� Boston,MA 02114-2017 �.=, wwwfnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. • TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le Libby Name (Business/Organization/Individual): \��P,e \}r `r\I ,_. _\�rs mP.. t Address: .30 u63-\:\r 'c. City/StateiZip:0( kCQnp2p r ( lam Osay,hone#: CAP)- 3Lt 1 ', S----1. Are you an employer?Check the appropriate box: Type of project(requir d): l.El am a employer with (00 employees(full andior part-time).* 7. ew construction 2.�I am a sole proprietor or partnership and have no employees working for me in 8. remodeling any capacity.[No workers'comp.insurance required.] • 9. ❑Demolition 3.0 1 am a homeowner doing all work myself[No workers'comp.insurance required.]' 10❑Building addition 4.0 i Ian a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs I,r additions ro rietors with no employees. p p12.0 Plumbing repairs 'r additions 5.0 I ant a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.) "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indica ing such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or riot those multi s 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 an•job site information. `^ . Insurance Company Name: C 1\ rQn..Le„. PrcPx' Policy#or Self-ins.Lic.#: , CAO(1°1 a... ..-) Expiration Date: 101 \ 3 A ' M N� r em Job Site Address: ( 1J • 1 t lope CityiState/Zip:FC' JfJ .l 1 9 1� 0 tOu Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir•lion 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 tine of up ti, S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for nsurance coverage verification. I do hereby certif the andan penalties of perjury that the information provided above is true and cor ect. Signature: l%i�� . trG � Date: t ( Si' 3 Phone �\7 ?- _A1 2- _.... 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): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone#: 1 City of Northampton �yt F1. �� 1, st ` j` '• Massachusetts +_ e` 1. `, ,e. f yj °� ; DEPARTMENT OF BUILDING INSPECTIONS o° =A SJs L1 212 Main Street • Municipal Building ' -- Northampton, MA 01060 bpi"° j�b 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: %� ? U,��V r vt C CD Q L 1 Pr Q16-D- The debris will be transported by: Name of Hauler: \(*e,X( ,--C) , Vnu1 Q11k 4aW.trl It 5/ 93 Signature of Applicant: rn,,t)/(A_ 0,14 Date: Page 1 of 10 Yankee Home Improvement MA Lic#160584 p CT Lic#0673924 YANKEE 36 Justin Drive RI Lic#33382 Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Jim Connolly (413) 588-2062 0 Date: 12/29/2022 67 North Maple St jfconnolly57@gmail.com Rep: David Musante 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 Acrylic Surround Color/Style White Subway Ceiling Panel Ceiling Panel Qty 1 Ceiling Panel: Yes Color White Shower Rod Shower Rod Selection Straight Shower Rod Shower Rod Finish Chrome Shower and Bath Accessories Quantity 2 Accessory Single Tier Corner Shelf Color White Grab Bar Grab Bar Quantity 1 Grab Bar Size 24" Finish Chrome Linden Grab Bar Location Soap Dish Wall =pis space intentionally left blank Page 2 of 10 Hardware Delta Fixture Selection Linden Tub ,1 or Shower Trim Trim Kit Finish lie' a4.� Chrome s410 4 4 SO Temp Assure Valve? /4 '�, 00 : Not available • '` in chosen style 1 ,t $ � u 5 i ( 1 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. Scope of Work and Special Instructions YH will sheet rock above shower and install ceiling panel over sheet rock. Customer will finish rest of ceiling in bath. Shelves go in dry end. Grab bar on long wall is horizontal. Do Not Do We do not do any painting or staining. This space intentionally left blank Page 5 of 10 Payment Schedule YHI agrees to perform the work,furnish the material and labor specified above for the total sum of: $15,170 Form of Payment Cash Deposit Amount $5,056 Deposit Type Check Measure Payment $0 Start Payment $5,057 Progress Payment $0 Cash Due Upon Completion $5,057 David Musante 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. Jim Connolly 12/29/2022 Date This space intentionally left blank ilor0,1 iston o "Pruf' sl1.41Co ^S� YVA iititt e Board of atiiitittlq. Recj uIE lli {1nn44 t ti(Itt ( Construction , ,(-.; t`'tt' ' O O 0 CS-066324 1 i MICtIAEL PEREI A BOX 1056 tARRE • MA 01083 m g i. . mis ioner 3 . ` r , ; P • O N L. THE COMMONWEALTH OF MASSACHUSETTS 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: 80582 0 36 JUSTIN DR. Expiration: 08/11/2024 CHICOPEE, MA 01022 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 160584 08/11/2024 Boston,MA 02118 'ANKEE HOME IMPROVEMENT INC 3ERARD RONAN 16 JUSTIN DR. :HICOPEE, MA 01022 I InrinrcnnroMni AIn4 valid uii+hnii4 ciirnafiIro