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29-554 (12) BP-2023-0409 385 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-554-001 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-2023-0409 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2023 Contractor: License: YANKEE HOME IMPROVEMENT Est. Cost: 15460 INC 066324 Const.Class: Exp.Date: 03/28/2025 Use Group: Owner: WAN CHAN WILLIAM T&HIGY Lot Size (sq.ft.) Zoning: WSP Applicant: YANKEE HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 36 JUSTIN DR (413)341-5259 WC 9099267 CHICOPEE, MA 01022 ISSUED ON: 04/07/2023 TO PERFORM THE FOLLOWING WORK: REMOVE EXISTING TUB FOR SHOWER PAN 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 1611.0 • . 9:1;11 • Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner /\,,,,N\ The Commonwealth of Massachusetts 9A9 , �t''�,,., FOR Board of Building Regulations and Standar.' 6• Massachusetts State Building Code, 780 C MUNICIPALITY' O RISE Building Permit Application To Construct, Repair, Renovate Or coolish a f Revisid Mar 2011 One-or Two-Family Dwelling \,?'9�, '`� This Section For Official Use Only °F; Buildin Permit Number: 6 P 13^' '(09 Date Applied: J EU 10 ° 20'5 5 ///// _ Li--1ZOZ?j Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1�groertyAddr�ess:� 1.2 Assessors Map&Parcel Numbers 1.1a Is this aJJn�a�,ccccepted 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 Private 0 Zone: — Outside Floo one? Municipal] On site disposal system 0 Check if yes)Zi SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: til l titi�ltarn cyan() rbreyo. , 1 MR' al OW Name'I4 � int) City,State,ZIP 35 ' I( 4135?cw gN_17) _ 49& alr>ti�ul f_r_ No.and Street Telephone Email Addres SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building)6 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 ,, t Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: nYVOIm eerno i{{ Brief Description of Proposed Work2: MOVe 'e;1C t S d l CUY \1\ c,� hve Foot n rd- - -e paynbi SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 15 t LA c00 0 e 1. Building Permit Fee: $ Indicate how fee is determined: 1 ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: Suppression) Check No. i'1 (heck Amount: al Cash Amount: 6. Total Project Cost: $ 15 i LA 10 0" ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES Construction Supervisor License(CSL) CS -O t o(C90,`-1 1 .2 ZY E5 m►CfOI' I Poi et rQ License Number Expiration Date Name of CSL Holder Po t30x os List CSL Type(see below) l No.and Street T e Description U)0 v .Pv , Nil 0l Q ' U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP 0 Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding ' + 2222`` '' C-�e�Y-yy SF Solid Fuel Burning Appliances 4' _ 41,53rl M ►( lit (PAWth roe.('hl I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I � �r �v 6 a� 1�11k �')� lm �1 �� t 1 Rr �(�S�-I HIC Registration Number Expiration Date HIC Company Name or HIC Regi trent Name juctin :)n\ rrn►t*l pn Leel brit, COY) o.and Street Email address 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 Issuance of the building permit. Signed Affidavit Attached? Yes f No 0 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 'an at. 1-1-bme, `1rn9rbV`eolmrrr to act on-my behalf,in all matters relative to work authorized by this building permit application. (;Yl con Ina.0 Mitt Owner's Name(Electronic 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. Cn COn1YGO- t Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 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 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 "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of.Massachusetts _'�1.= 1.AI of Industrial Accidents =u�1'= 1 Congress Street,Suite 100 e=it Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ` 1 yy�PlleasePrint Legibly Name (Business/Organization/Individual):_\ an�..et *t tmpY J ett ten 1 j- Address: -j(U -3-11St1 f Dy I VC City/State/Zip:Ch1COpe, M A• owaa Phone#: Li 3 34I 50 5GI Are you an employer?Check the appropriate box: i Type of project(required): 1.❑lam a employer with employees(full andior pan-tune).* 7. El New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] - 9. ❑Demolition 3.❑lam a homeowner doing all work myself.[No workers'comp.insurance required.]' 10[]Building addition 4.0 I am 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. j Electrical repairs Or additions proprietors with no employees. 32.0 Plumbing repairs Or additions 5.0 lam a general contractor and l have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance,: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1-4.a Other,_ __,___ 152,i1(4),and we have no employees.[No workers'comp.insurance required.j *Any applicanrthat 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 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: r 4i li\I p5 t fsu l IWp.._....AgJ —. Policy#or Self ins.Lic.#: W& cl DOI CI&tin Expiration Date: Job Site Address: City/State/Zip: I L( I 3. 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. 1 do hereby certif de the it and penalties ofperjury that the information provided above is true and correct. Signature: l'� ' - Date: Phone . 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#: . j THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration r = Type: Corporation 74 ___ Registration: 160584 YANKEE HOME IMPROVEMENT INC „. ' Expiration: 08/11/2024 36 JUSTIN DR. -M imam CHICOPEE, MA 01022 € ' r 4 y.\ • #Mp �' a .et r# -. _-. 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 ;6 JUSTIN DR. 1, a.,. ' ;HICOPEE, MA 01022 ::: :Commonwealthat: a a useft C vi i it `Pr fes t Li�w tt uu g!i .. r of f3uitdit10,, Regulations . nd $ atn•anni Y `-06 3 p MICHAEL PEE PO BOX 1056 , WARREN MA 01083 t F Commission e_#;‘ .4 # -t N O N • Select the licensee name below for more information. (If your search produced more than one page,you may select page numbers at the bottom of this screen.) • Select the Search for a Person or Search for a Facility button to perform a new search. • Select the Preview File button to view a sample of the fields included in a file you can download. Search • Select the Download File button to download a text file of your search results at no charge. Results • Click Public Information Request Form to order additional data. Name License Nu,r:rka r Licr r.ne Type License States Addre PEREIRA, MICHAEL. .....CS-066324_.._...._____._.,Construction Supervisor_,_Active WARREN MA 01083 ABC`R' YANKHOM41 JOCE,LY1 illlei--"' CERTIFICATE OF LIABILITY INSURANCE aA10/12/20 22 TE J CHR CERFICAT GC OE (g T ED AE AT MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS BELOIFICATE CERTIFICATE TE OF ATIVELY OR NEGATIVELY AMEND, Ex TEND OR ALTER THE COVERAGE AFFORDED BY TWE POLICIES REPRESENTATIVE THIS CEOR PRODS E INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. If SUBR ANT:OGA N the certificate holder is an ADDITIONAL INSURED,the ll Ira must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANEb, subject to the terms and conditions of thepolicy,) this csrttficate does not confer rights to the certificate holder In lieu of such endorsement certain ntla policies may require an endorsement. A statement on PRarwcERckrgAcT Jocelyn M Douglas Phillips Insurance Agency,inc. ___.___.FAz...w _.__ 97 Canter Street s PW3NE tNc ►±oj: Chicopee, MA 01013 IA1C,No,Ems: ss:jocelyn@phlllipsinsurance.com I043UREAL'I AFFORDING COVERAGE, -- INsuREb —. INSURER n,.Selective Insurance Coof Amer 12572 esu�ERa,.Selective Ins Co Of South Carolina 19259 __ Yankee Home Improvement,Inc. INsuREr+c____�..... _..-__._ 36 Justin Drive Chicopee,MA 01022 _INSURER 0, , _ ______ -- I INSURER E: —.—.. .. L. COVERAGE; ___. IINSURERF: - __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 SOakUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T1TE OF INaURANCE AODL°aIBR __ POtoor?ry T pM DDt t[XP EACH OCCURRENCE LIMITS A I►IDD VIVO POLICY NUMBER INwQpTYYYY)1 iNWODfYYYYt 1,000,001 X ; COMMERCIAL OENERALtIAaltm _ _ J CLAIMS-MADE I X 1 OCCUR DAMAGE..TO RENTED S00,O0I S 2517693 10/1/2022 10/1/2023 pcc�IFasrr+txGD4e1__,._ S 15,001 MED EXP(Any one person) "._. >: 1,000,001 PERSONAL INJURY S__ _ 2,000,01GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY( x RRppT LjLOC 'PRER OP AGG 1 S „ 2,000OO- OTHER L3 B 1 AUTOMOBILE UABILRY COUBINED(Ea=deISINGLE LIMIT 1,000,001 X ANY AUTO I A 9106918 10/1/2022 10/1/2023 BODILY INJURY(Per person) ' $ . . AWNED SCHEDULED BODILY INJURYiPer accident) S AUTOS ONLY AUTOS —_ �.y ��p pN pWNEp PROPERTY DAMAGE , AUTOS ONLY AUTOS ONLY ,(Per accident) S . S A X UMBRELLA UAB X OCCUR ,EACH O_CCURRE_N_C_E_ 1,000,001 EXCESS LIAB CLAIMS-MADE S 2517693 10/1/2022 10/1/2023 _ 1,000,001 IAGGREGATE __._.._.,..f......._.._....._____..._...._..._..._._ OED X REIENTION5 0 $ • A 'WORKERS COMPENSATION X STATUTE i 1 ER AND EMPLOYERS'LIABILITY WC 9099267 10/1/2022 10/1/2023 1....._.__...__.... ANY PROPRIETOR/PARTNER/EXECUTIVE Y J N E.L.EACH ACCIDENT S ,000,OOI QFFICER'MEMBEREXCLUDED? N NIA I ,000,001 (Mandatory pre NH) - E.L"DISEASE-EA EMPLOYE ; II yes describe under 1,000,001 DESCRIPTION OF OPERATIONS below E_L.DISEASE-POLICY LIMIT S I l I I DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule may be attached II more apace 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /�`•'°,1° i 2,4 I-v....' ------1 ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD