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23D-136 (5) BP-2023-0240 58 HINCKLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-136-001 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-2023-0240 PERMISSION IS HEREBY GRANTED TO: Project# tub 2023 Contractor: License: YANKEE HOME IMPROVEMENT Est. Cost: 15872 INC 066324 Const.Class: Exp.Date: 03/28/2023 Use Group: Owner: R. BRAZEAU, LOUIS 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: 02/28/2023 TO PERFORM THE FOLLOWING WORK: REMOVE AND REPLACE TUB 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 I LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: j .1 3-11 'I ‘r Fees Paid: $104.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1 Ek.., -a V L 1 The Commonwealth of Massachusetts °6 (, Board of Building Regulations and St4ndar s F E B 2 8 MtUNiFOPALiTY R Massachusetts State Building Code, 78'0 C R fl o USE Building Permit Application To Construct, Repair, Renovate.Or Dernnlich_a__....wised Mar 2011 One-or Two-Family Dwelling• "'-'r.7F[,U"_D'r'(''P'SPFGT'ONs This Section For Official Use Only Buildin Permit Number:.1 - .2 3— a-4f 0 Date Applied: //2>, //e .Z 28-ZUZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Prop erry Addreests: 1.2 Assessors Map&Parcel Numbers 1.1 a 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 Private El Zone: _ Outside Flood Zone? Check if yeses' Municipal 0 On site disposa system 0 SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner'of Record: Sue e,ve V1/4- -j 2.. ILLS (a2-ectu VtOr`e9'\C.,._ • t'`(\('\ O3O c3 Name(Print) City,State,ZIP 5t tt�n(3,CkeA SV. • 4-tlT U c LtSS3 S6r.t1+ 2Ltt-tom Z 0.0 ,C,C NA No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building fa' 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: Q-ertv-vr. cirri_ 1-Lo0...u_ - ' y t b °. N. i(re Ur.LkItC S 1NPX' 100S.Q. , nctA0 a c,f u �l P w S td\tud 01/40-e_SSovU.S . jXj_ r c .e,• SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1S t C�' 2....,) 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees rl p Check No.j Check Amount IU Cash Amount: 6. Total Project Cost: $ 15 , O-72 0 Paid in Full 0 Outstanding Balance Due:, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) l t (V 1 ! o , (- ! V(7,rtt r O License Number `f Expiration Date Name of CSL Holder I 13 Pa Fjpy \a5G List CSL Type(see below) (/I No.and Street T/yps., Description j 1,0 r cur PAP �/j� j ]�'' Unrestricted(Buildings up to 35,000 cu.ft.) \ / J R Restricted l&2 Family Dwelling City/Town, State,ZIP M Masonry RC Roofing Covering WS Window and Siding �J (. SF Solid Fuel Burning Appliances I 13 J_lI C 50i rr,pi?,f-occt CL aCIE r ht'm'c_- I Insulation Telephone Email address t.D vl D Demolition Ckc 5.2 Registered Home Improvement Contractor(HIC) \F a 1 \pv--0vt, ? HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 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 Issua e of the building permit. Signed Affidavit Attached? Yes 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 roe hereb authorize \1 LA yI-, ) t,,�t Gice.Cc 1 to act on my behalf, in all matters relative to work authorized by this building permit application. (Jo r*r G+ cif— a3 Print 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. eOc'1 C10 caC& I fa3 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.nov/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"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts ii=S—= = t. Department of Industrial Accidents x m1ifl= 1 Congress Street,Suite 100 •=�:�9`- Boston,MA 02114-2017 -�: www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WiTH THE PERMITTING AUTHORITY. A.•licant Information Please Print Len bl Name (Business/Organization/Individual): & a r ' „ati .��. �.! ,M l ri��L�m ��r Address: 3(0 TVU 1\r\ Oc . 2 . City/State/Zip:06\C ) Q_ r (�'R Q (�'�Phone#: -Ak3- �7Lt t "J QSR Are you an employer?Cheek the appropriate box: Type of project(required): l.El am a employer with (00 employees(full and/orpart-tine).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. dRemodeling any capacity.[No workers'comp.insurance required.] - 9. ❑Demolition 3.0 tam a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 0 Building addition 4.0 1 sin 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 arc sole 11.❑Electrical repairs of additions proprietors with no employees. 12.D Plumbing repairs or additions 5.❑f am a general contractor and/have hired the sub-contractors listed on the attached sheet. 13.❑Roof repair's These sub-contractors have employees and have workers'comp.insurances 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other _�_ 152,*I(4),and we have no employees.[No workers'comp.insurance required.) *Any applicanrthat checks box 41 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. I_ Insurance Company Name: ?` 1\\\ S \ Sur r... - e,r�R-/� LJ + �� 2 Policy#or Self-ins.Lic.#: �> 0 Uqq a,..�,,' Expiration Date: ��I \ 1 a..3 Job Site Address: j v (- t rC d eti c k. CityiStateIZip:'\O I l i t d i0(p2 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 SI,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 to 5250.00 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 certif delthe a and penalties ofperjury that the information provided above is true and correct. Signature: , 1.- . - �"Ci Date: c..k_ .-131 -CS Phone . *Th ga a SBk"tS -.... 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#: 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 Registration: 160584 YANKEE HOME IMPROVEMENT INC Expiration: 08/11/2024 36 JUSTIN DR. 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 ; I6 JUSTIN DR. .4„.,a( e.a- i ;HICOPEE, MA 01022 • r.i..a . I .i ...i44,.•1.♦cirrnn4.Bra ACC)co- YANKHOM-01 )OCELY HIillessS CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE r12f2o2x THIS GERT1f1CATE IS tffiffiUED A8 A " _ THIS CERTIFICATE DOESC ISSUED OR NEINFORMATION ATTOVEiLy AMEND,LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW' THIS CEOTIFIROTE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the pollcylies)must have ADDITIONAL INSURED pr�viskons or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer ri,his to the certificate holder In lieu of such endorsements s}.PRODUCER Phillips insurance Agency,Inc. c ACT Jocelyn M Douglas _,_ . _._ FAX 97 Center Street HON► E tt,/C.Noi: Chicopee,MA 01013 AIc,No,Est):________ �._.._ . ocelyn@jphillipsinsurance.com ___ __ WSURERLS AFFORDING...COVERAGE,..,_„ NAIC I —, INSURED INSURER A:Selective insurance CoofAmer 12572 Yankee Home improvement,Inc. INSu� cSelective Ins Co Of South Caro n 19259 .___ 36 Justin Drive Chicopee, MA 61022 iNSURERD: __.__.__._ INSURER E: __._—_. COVERAc ES INSURER F --- 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. ..LSR TYPE OF INSURANCE IAOOL?SUBRpOLK Y NUMBER POLICY EFF POUCY EXP LIMITS A iINED WVD IMMiDDIYYY't'1 IMM(ODNYYY), - 1,000,00 X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE # —1 CLAIMS-MADE OCCUR S 2517693 10/112022 101112023 DAMASt LTOiFRENTED't sl...._ $ 500,00 15,00 MED EXP IAny one peeson) .._.,.J .. 1 000 00 ' PERSONAL 6 ADV I4:I1RY $.._ 2,000,00 OWL AGGREGATE LIMIT APPLIES PER __GENERAL AGGREGA lE $ . ._..,._... POLICY[ X PEa Li LOC PRODUCTS, AGG S 2,000,00 , OTHER _d_._... . I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ; . 1,000,00 faacc:model* ti..— __.__._.— X ANY AUTO A 9106918 10/1/2022 10/1/2023 RODILY INJURY(Per rson) `$ OWNED '"" SCHEDULED BODILY INJURYLPeraccident) $ AUTOSgq��pD ONLY _ AUTOS BODILY p .._....... AUTOS ONLY AUTOS ON Y (I'err accWenrMAGE $ S A X UMBRELLA UAB X OCCUR EACH OCCURRENCE 1,000,00 EXCESS LIAR CLAIMS-MADE S 2517693 10/1/2022 10/1/2023 AGGREGATE _� , 1 000,00 DED X ;RETENTION S 0 $ A .WORKERS COMPENSATION X 1 STATUTE j ER 'AND EMPLOYERS'LIABILITY - WC 9099267 10/1/2022 10/1/2023 1,000,00 ANY PROPRIETORIPARTNERJEXECUTIVE Y/N E.L.EACH ACCIDENT $ 8:11 R-MEMBER EXCLUDED? (N N/A (Mandatory+n NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 It yes,describe under I 1,000,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I 1 DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule may be attached It more spate is required) Workers Compensation coverage Is Included for the following states:MA,CT,Nil 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 ACORD 25{2016/03} GJ 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD I'as 1 of 11 Yankee Home Improvement MA Lic#160584 p CT Lic#0673924 p a 36 Justin Drive RI Lic#33382 Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Suzette Hoye (413) 455-4253 0 Date: 02/17/2023 Louis Brazeau sbritt2440©aol.com Rep: David Musante 58 Hinckley St 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 RH Wet Area Wall Quantity 1 Type Acrylic Surround Color/Style Santorini White Marble Smooth Ceiling Panel Ceiling Panel Qty 1 Ceiling Panel: Yes Color White Shower Rod Shower Rod Selection Straight Shower Rod Shower Rod Finish Matte Black Shower Disclaimer Curtain rod will be installed 72" from the top of the shower base curb. The only exception is when the customer has the desired curtain present at the time of install. In this case, we will install the curtain rod at the appropriate height to accommodate the desired curtain. Shower and Bath Accessories Quantity 1 Accessory Recessed Soap Dish Recessed Soap Dish Color White Quantity 2 Accessory Single Tier Corner Shelf Color White Grab Bar Grab Bar Quantity 1 Grab Bar Size 18" Finish Matte Black Ashlyn/Stryke Grab Bar Location Wet Wall Page 2 of 11 Grab Bar Quantity 1 Grab Bar Size 24" Finish Matte Black Ashlyn/Stryke Grab Bar Location Soap Dish Wall Hardware Delta Fixture Selection Ashlyn "4: In2ition ,' Shower Head Trim Kit Finish Matte Black Temp Assure Valve? Yes, style only available with temp adjust valve ;I e l $I ; !I < 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 Both grab bars are horizontal. Single tier shelves are in the wet end. Customer looking for install date asap to accommodate elderly father. Current grab bar near dry end of shower will remain. Hoping for install prior but customer not available for install week of 3/13. Page 6 of 11 Payment Schedule YHI agrees to perform the work,furnish the material and labor specified above for the total sum of: $15,872 Form of Payment Cash Deposit Amount $5,290 Deposit Type Credit Card Measure Payment $0 Start Payment $5,291 Progress Payment $0 Cash Due Upon Completion $5,291 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. SH A timmk 1111 Suzette Hoye 02/17/2023 Date 611141y-914 Louis Brazeau 02/17/2023 Date This space intentionally left blank