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17A-056 (4) BP-2023-1450 123 LAKE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-056-001 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-2023-1450 PERMISSION IS HEREBY GRANTED TO: Project# 2023 SHOWER Contractor: License: YANKEE HOME IMPROVEMENT Est. Cost: 17927 INC 066324 Const.Class: Exp.Date: 03/28/2025 Use Group: Owner: MCCREA LISA M &KATHLEEN POKLEWSKI 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: 10/18/2023 TO PERFORM THE FOLLOWING WORK: INSTALL SHOWER IN 1ST FLOOR 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: ` ' ' >2 51-1. . � �� art Fees Paid: $117.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED The Commonwealth of Massac sett OCT 1 7 2O23 . 0Board of Building Regulations and tan rds FOR Massachusetts State Building Code, 80 —�UNIcIPALITY � DEPT.OF BUILDING INSPECT IONS SE Building Permit Application To Construct,Repair, n o'obo Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 90^-73-/y$'I Date Applied: /tiii—.%/25, / ! Id-18 2v23 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 123 Lo,,\tie, S}r-eeh 17,9 -0S6 - COI 1.1a 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(II) 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: Zone: _ Outside Flood one? Public Private 0 Check if yet Municipal 1%On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of cord: 51Ort-rxt MR D 1 O/' '1 1l o,#'hlc�,h '�t'L l evs3�'Si /7 1 5t�oC Name(Print) uty,State,ZIP 13 bile Si-feris 4I3,aVV.30i2focho L,mail•Cram No.and Street Telephone Email Ado,ess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other %Specify: 13G}-h Briefer De�scrieptiioon of Proposed Work': f irmot) ex S�1 rig IV° os 'te1�\ace W.1 SalO Y SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 17i qa7,00 1. Building Permit Fee: $ Indicate how fee is determined: � 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $ 4. Mechanical (HVAC) $ 0 List: 5. Mechanical (Fire $ 0 li Suppression) Total All Fees: $ 71 o� Check No. color heck Amount: PI J Cash Amount: 6.Total Project Cost: $ 17,( -7, OU 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES Construction Supervisor License(CSL) roc ncue Pereira � r License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street a Description \(V,�� (n l 01® � U Unrestricted(Buildings up tol 35,000 cu.ft.) 1 i Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding p SF Solid Fuel Burning Appliances `t t 4 -. 5•1 1 c 6 kt ',e.X roe•com 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement�Contractor`(HIC) t—� \k ,0n1�f )1'� �JV 1 q�1 ��1 1 n�r HIC Os HIC Expiration Date HIC Company Name or HIC Registrant Name ts� itNr11'1 Dill�i I �' ic' �1 111r.I d'C i � m ld.)m No,and Street mail address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes t) No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize `tan hyme, 11n pYI \)-elTlt f to act on-my behalf,in all matters relative to work authorized by this building permit application. 6n cUn` iici- Prn t 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. 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD * On Con t FRONT SETBACK FRONTAGE City of Northampton • Massachusetts 4. x. -4. q l � y DEPARTMENT OF BUILDING INSPECTIONS '' `.r -:-.11 ? 212 Main Street • Municipal Building J D i Northampton, MA 01060 �``^ `^�O 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: 3C c�US\rliN Oti a /VT/ Ol as The debris will be transported by: Name of Hauler: USr) Uc,,�f e and Rec3cUrn Signature of Applicant:? _. Z/� — Date: I0"/I023 The Commonwealth of Massachusetts Department of Industrial Accidents C- Office of Investigations Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information i - Please Print Legibly Name(Business/Organization/Individual): Yon►"lee Home. Im prove men}- Address: 3 6 3 US l l nVnt /} City/State/Zip: CI inn CO y/ :xd.n C!d Phone#: 1!3,,3q/0 Ue c�5"I Are you an employer?Check he appropriate box: Type of project(required): 1.5K I am a employer with 7 7 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. D Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. •ther k3cL t t. comp. insurance required.] 'Any applicant that checks box#1 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. tConu actors 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 un employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. + • Insurance Company Name: Ph l b f)S Insurance f e_nc Policy#or Self-ins. ^Lic.#: g 09 q 3G 7 C1 Expiration Date: 10 / r Job Site Address: e43 Labe, S+ City/State/Zip:Sioce,, /1 t19 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 of 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. Ida hereby certif under th pal r d penalties o perjury that the information provided above is true and correct. r Signature: . G Date: IQ/l I /.2O)23 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(check one): IDBoard of Health 2E1 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Ilumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton (HAMh ? 'ti'•. s•....�.ti..,,.Sf y . \ Massachusetts �' f Al • t DEPARTMENT OF BUILDING INSPECTIONS D 212 Main Street • Municipal Building �t[ Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (insert full legal name), born _ (insert month, day, year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of ,20_. on Cold �C4~ (Signature) Page 1 of 10 Yankee Home Improvement MA Lic#160584 CT Lic#0673924 YANKEE 36 Justin Drive RI Lic#33382 r f Chicopee, MA 01022 413-341-5259 or 877-88-YANKEE www.yankeehome.com Customer Information Kathleen Poklewski Kathy cell: 413-297-3083 Date: 09/26/2023 Lisa McCrea Lisa cell: 413-270-5602 Rep: Ryan Irizarry 123 Lake Street pocko236@gmail.com 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-Othello Subway 3x6 Shower Rod Shower Rod Selection Straight Shower Rod Shower Rod Finish Brushed Nickel 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 4 Accessory Single Tier Corner Shelf Color White Grab Bar Grab Bar Quantity 1 Grab Bar Size 24" Finish Brilliance Stainless Linden Grab Bar Location Soap Dish Wall Grab Bar Quantity 1 Grab Bar Size 12" Finish Brilliance Stainless Linden Grab Bar Location Dry Wall This space intentionally left blank • Page 2 of 10 •Hardware • ,. Delta Fixture Selection :—_ Linden Tub or Shower .,,weer 1 \ Trim Trim Kit Finish di Brilliance • • ••• ! Stainless /0000 ��• Temp Assure Valve? • Not available _ in chosen style ,i; . , r f 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 Details Construct wall in front of window to accommodate 60"x32" shower base. Scope of Work and Special Instructions All discounts applied. (Big E sale with shower door credit and 5% off coupon) Construct wall in front of window to accommodate 60"x32" shower base. Install 2 shelves on each corner at 48" and 60" heights. Install 24" grab bar centered horizontally on "soap dish wall" at 36" height. Install 12" grab bar vertically on "dry wall" entry and at 48" height to center of bar. Do Not Do We do not do any painting or staining. Page 3 of 10 Work Schedule Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 11/21/2023 Barring delay caused by circumstances beyond Contractor's control,the work will be completed by 01/02/2024 The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including, but not limited to strikes,Acts of God, shortages of materials, accidents, and all other delays beyond its control, shall not be considered as violations of this Agreement. (Customer's Initials) c Kathleen Poklewski 09/26/2023 Date AAr4. �v Lisa McCrea 09/26/2023 Date This space intentionally left blank Page 4 of 10 RECOMMENDED ACRYLIC CLEANERS Use only cleaning products whose labels state that they are SAFE FOR ACRYLIC. Always test products on a small area of skirt before applying to complete bath area. • ZEP PROFESSIONAL STRENGTH SHOWER TUB&TILE CLEANER(#1 RECOMMENDED CHOICE) • DAWN DISH DETERGENT • RUBBERMAID COMMERCIAL STRENGTH SHOWER TUB&TILE CLEANER • HOME DEPOT HDX SHOWER TUB&TILE CLEANER • SCRUB FREE ORIGINAL SOAP SCUM REMOVER • KABOOM SHOWER TUB&TILE CLEANER WITH OXY CLEAN • SIMPLE GREEN ALL PURPOSE CLEANERS(ANY SCENT) • SIMPLE GREEN LIME SCALE REMOVER • SIMPLE GREEN NATURAL BATHROOM CLEANER • ALL FORMULA 409 PRODUCTS(EXCEPT PRO 409) • ALL TILEX PRODUCTS • ALL PINE-SOL PRODUCTS • ALL FRAGRANZIA PRODUCTS DO NOT USE the following on your ACRYLIC Bath System The use of the following chemicals will cause a dull surface or chemical cracks.The use of these products will VOID YOUR WARRANTY. • ANY PRODUCT CONTAINING AMMONIA • DOW SCRUBBING BUBBLES • ABRASIVE CLEANERS • AJAX • COMET • FANTISTIK • SOFT SCRUB • MR.CLEAN • NAIL POLISH REMOVER • SCOURING PADS • AMMONIA • TOUGH ACT • POWDER OR CRYSTAL DRAIN CLEANERS • GREENWORKS BATHROOM CLEANER • SCRUB FREE W/BLEACH • SEVENTH GENERATION BATHROOM CLEANER—REGULAR • MAGIC ERASER RECOMMENDED CLEANERS FOR ONYX COLLECTION Regular cleaning can be done with any non-abrasive product made for showers. Always test products on a small area of before applying to complete bath area. If mineral buildup does occur, it can be remedied using white vinegar, a product like Eliminate,or any other mineral removing product that is safe for your drain.Always follow directions on the label. • ELIMINATE SHOWER TUB&TILE CLEANER • REPEL CLEANER&PROTECTANT Page 5 of 10 Payment Schedule YHI agrees to perform the work,furnish the material and labor specified above for the total sum of: $17,927 Form of Payment Cash Deposit Amount $5,976 Deposit Type Credit Card Measure Payment $0 Start Payment $0 Progress Payment $0 Cash Due Upon Completion $11,951 Ryan Irizarry 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. L_‘;;2:;;;i7 Kathleen Poklewski 09/26/2023 Date I+ v Lisa McCrea 09/26/2023 Date This space intentionally left blank Page 6 of 10 ADDITIONAL TERMS AND CONDITIONS Delay/Unknown Conditions: Contractor's failure to perform any term or condition of this Agreement as a result of conditions beyond its control such as, but not limited to, strikes,fires,floods, acts of God, material shortages, Buyer's inability to qualify for or obtain financing, delays by local government authorities in issuing or otherwise approving inspections, permitting, or other required authorizations do not constitute abandonment and are not included in calculating time frames for performance by Contractor. Contractor and Buyer(s) have determined that a definite completion date is not of the essence to this Agreement. Late Cancellation/Late Payment/Default: If Buyer(s)attempts to cancel or repudiate this Agreement after midnight of the third business day after the date of this Agreement, and Contractor accepts such cancellation, which shall be in Contractor's sole discretion based on economic factors including, but not limited to, the status of Buyer's ordered product, all work under this Agreement will be stopped as promptly as is reasonably possible and Buyer(s)agrees to pay Contractor a cancellation fee equal to 15% of this Agreement's purchase price. Buyer(s)agrees to pay a late fee of 1.5% per month on all amounts due and owing from Buyer(s)to Contractor accruing from the date due and running to the date the payment is made. If Buyer(s) is in default of this Agreement, Buyer(s) agrees to pay Contractor's attorney's fees equal to 15% of the defaulted amount or as otherwise allowed by applicable law. Buyer(s) also agrees to pay any other costs or expenses of repossession or collection as allowed by applicable law. Contractor's Right to Cancel: In the event that Contractor determines that this Agreement cannot be performed as intended by the parties due, for example, to incorrect pricing, unforeseen structural defects, or pre-existing conditions to Buyer's property, Contractor may cancel this Agreement within thirty(30)days of its execution, notify Buyer(s)of such cancellation in writing, and return all monies paid by Buyer(s). No Set-Offs or Retentions: Upon substantial completion of Contractor's work under this Agreement, Buyer(s)shall pay to the installer assigned to the work, all amounts due under this Agreement without any right of set-off or retention. Substantial completion is defined as the job being materially completed, functional as intended, and a final inspection, permit or occupancy certificate, as the case may be, having been obtained. If after paying all amounts due under this Agreement, Buyer(s) alleges that Contractor's work is defective in any respect, Contractor, without waiving any of its rights, shall cause an inspection of the work and perform any remedial work to the extent Buyer(s) is entitled to under this Agreement or Contractor's warranty at no cost to Buyer(s). Buyer's Representations: Buyer(s) represents and warrants that (a) Buyer(s) owns the premises where the products and/or services are being provided by Contractor; (b) Buyer(s) will provide Contractor with reasonable access to the premises, including access to electrical outlets as may be required by Contractor; (c) Buyer(s) shall be responsible for the preparation, moving, and reinstalling of all wiring, water lines, power lines, plumbing, and the moving of any shrubs, plants, or other items as required by Contractor under this Agreement; and (d) Buyer(s)acknowledge(s)that any excess material not used by Contractor shall remain the property of Contractor and will not be considered part of this Agreement. Contractor's Responsibility: Contractor accepts no responsibility for any damage resulting from pre-existing structural or other defects in the property at which work is performed under this Agreement. Contractor is not responsible for remedying structural defects in Buyer's property. Buyer(s) acknowledges that Contractor's products do not correct or cure structural problems. Contractor shall not be responsible for (a) any damages arising in whole or in part from strikes, fires, accidents,floods, governmental actions, or any other causes beyond control of Contractor; (b) any incidental or consequential damages including, without limitation, lost profits or reduction in value of Buyer's property arising from Contractor's delay in performing under this Agreement or due to Contractor's breach of this Agreement; and (c) unintentional damage to flooring, window treatments, landscaping, driveways, sidewalks, gas lines, electrical wiring, plumbing, telephone installations, collateral or incidental damage to interior walls and personal property, it being understood that Buyer(s) is responsible at Buyer's cost for all preparations, protection, and/or moving of such items prior to Contractor's commencement of work. Contractor intends to use subcontractors on all or a portion of the work. This space intentionally left blank Page 7 of 10 Condensation, Mold and Related Matters: Condensation, which can form on or within walls or other surfaces(such as on windowpanes), results from pre-existing conditions in a home and internal or external temperatures. Condensation is not a product or workmanship defect. Reducing the humidity in a home will often remedy any condensation problems. Buyer(s) agrees to indemnify and hold Contractor and its employees, agents, and subcontractors harmless from any claims as to the identification, detection, abatement, encapsulation, or removal of mold, asbestos, lead-based products, or other hazardous substances inside or outside of the property at which work is performed. Contractor does not provide mold testing or remediation services. Miscellaneous: No waiver of any breach of this Agreement shall be construed as a waiver of any prior, concurrent, or subsequent breach hereof. The section headings contained in this Agreement are inserted for convenience only and shall not affect in any way the meaning or interpretation of this Agreement. In construing this Agreement, the gender and number of words used may be changed to meet the context. Both Buyer(s) and Contractor agree that this entire Agreement constitutes the entire understanding between them, and that there are no verbal understandings changing or modifying any of the terms and conditions of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s)and Contractor.This Agreement shall be governed by and construed in accordance with the laws of the state in which it is performed, except as may be preempted by federal law.Any part of this Agreement contrary to the law of this state shall not invalidate other parts of this Agreement. If a provision of this Agreement is held to be invalid or unenforceable,this Agreement shall continue in full force and effect and shall be construed as if the invalid or unenforceable provision was omitted. Assignment: Buyer(s) agrees that Contractor can assign any of Contractor's rights under this Agreement without Buyer's consent and that the person to whom Contractor assigns this Agreement shall be entitled to all of Contractor's rights under this Agreement. Buyer(s) understands that Buyer's rights will not be affected by such assignment. Neither this Agreement nor any rights or benefits hereunder are assignable by Buyer(s)without the prior written consent of Contractor. Any such prohibited assignment shall be null and void. Arbitration of Disputes: Contractor and Buyer(s) agree that any and all disputes, claims, or controversies (hereafter referred to as a "Claim") arising under or relating to this Agreement and any related documents, loans, security instruments, accounts, or notes, including by way of example and not as a limitation: (i)the relationships resulting from this Agreement and the transactions arising as a result thereof; (ii)the terms of this Agreement; or(iii)the validity of this Agreement or the validity or enforceability of this arbitration provision may, at the election of either party, be subject to binding arbitration to be determined by one arbitrator, in accordance with and pursuant to the then prevailing Consumer Arbitration Rules of the American Arbitration Association ("AAA), to be held and arbitrated in Hampden County, Massachusetts. Buyer(s) agrees that Buyer(s)will not assert a Claim on behalf of, or as a member of, any group or class.The findings of the arbitrator shall be final and binding on all parties to this Agreement. Each party shall be responsible for its own fees and costs, unless otherwise determined by the arbitrator.This agreement to arbitrate, and any award, finding, or verdict of or from the arbitration, will be specifically enforceable under the prevailing law of any court having jurisdiction.The party asserting a Claim shall file a notice of the demand for arbitration with the other party to this Agreement and with AAA.The demand for arbitration shall be made within a reasonable time after the Claim in question has arisen, and in no event shall any such demand be made after the date when institution of legal or equitable proceedings based on such Claim would be barred by the applicable statute of limitations. Any arbitration proceeding brought under this Agreement, and any award, finding, or verdict of or from such proceeding shall remain confidential between the parties and shall not be made public. Both Contractor and Buyer(s) are hereby potentially agreeing to choose arbitration, rather than litigation or some other means of dispute resolution, to address any grievances or alleged grievances. The parties believe this may allow for a faster and more cost-effective method of addressing a Claim. By entering into this Agreement and this arbitration provision, both parties may be potentially giving up their constitutional right to have any dispute decided in a court of law before a jury, and instead are potentially accepting the use of arbitration.(Massachusetts Sales)Contractor and Buyer(s) hereby mutually agree in advance that in the event that Contractor has a dispute concerning this Agreement, Contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Buyer(s)shall be required to submit to such arbitration. Page 8 of 10 (Massachusetts Sales)In Massachusetts, all contractors and subcontractors must be registered by the administrator of the Board of Building Regulations and Standards and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, Massachusetts 02116 Telephone: (617) 973-8700. In Massachusetts, Contractor is responsible for applying for and obtaining any and all necessary permitting. Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts law. (Connecticut Sales)The owner(s) of the home improvement contractor is or has been a shareholder, member, partner, or owner of the following corporations, limited liability companies, partnerships, sole proprietorships or other legal entities that have been a home improvement contractor during the previous five(5) years: None (Vermont Sales)ACKNOWLEDGMENT OF ARBITRATION. I understand that this Agreement contains an agreement to arbitrate.After signing this document, I understand that I will not be able to bring a lawsuit concerning any dispute that may arise which is covered by the arbitration agreement, unless it involves a question of constitutional or civil rights. Instead, agree to submit any such dispute to an impartial arbitrator. (New York Sales)Any contractor, subcontractor, or materialman who provides home improvement goods or services pursuant to your home improvement contract and who is not paid may have a valid legal claim against your property known as a mechanic's lien. Any mechanic's lien filed against your property may be discharged. Payment of the agreed-upon price under the home improvement contract prior to filing of a mechanic's lien may invalidate such lien. The owner may contact an attorney to determine his rights to discharge a mechanic's lien. Kathleen Poklewski 09/26/2023 Date 05fil Lisa McCrea 09/26/2023 Date This space intentionally left blank Page 9 of 10 YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction 09/26/2023. You may cancel this Date of Transaction 09/26/2023. You may cancel this transaction, without any penalty or obligation, within three transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any business days from the above date. If you cancel, any property traded in,any payments made by you under the Contract property traded in,any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the cancellation notice,and any security interest arising out of the transaction will be canceled. If you cancel,you must make available transaction will be canceled. If you cancel,you must make available to the Seller at your residence, in substantially as good condition as to the Seller at your residence, in substantially as good condition as when received,any goods delivered to you under this Contract or when received,any goods delivered to you under this Contract or Sale;or you may, if you wish, comply with the instructions of Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the the Seller regarding the return shipment of the goods at the Sellers expense and risk. If you do make the goods available Sellers expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail dispose of the goods without any further obligation. If you fail to make the goods available to the Seller,or if you agree to to make the goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you remain return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract. To liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or copy of this cancellation notice or any other written notice, or send a telegram to Yankee Home Improvement Inc.,36 Justin send a telegram to Yankee Home Improvement Inc.,36 Justin Drive, Chicopee, MA 01022, NOT LATER THAN MIDNIGHT OF Drive, Chicopee, MA 01022, NOT LATER THAN MIDNIGHT OF .(Date) .(Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. BUYER'S SIGNATURE BUYER'S SIGNATURE DATE DATE Kathleen Poklewski 09/26/2023 Date Lisa McCrea 09/26/2023 Date This space intentionally left blank Page 10 of 10 Image: 1.1 ..+ a .. Ors a:" • H y Mt j if .1 si ..k... .• i%go • ,. _ . . . ; . , . .. , . a ,,,- , 1 MINN ti 11/4 ..... f:i ,.. , ,If yv ! a .% 4IMMI r Commonwealth of Massachusetts ��K Division of Occupational Licensure • Board of Building Re ulations and Standards Constz tS 4 visor CS-066324 r i ,pires: 03128/2025 MICHAEL P EIRA .1,, 4 PO BOX 1054 WARREN MA'i1083. • rF: '7?O Commissioner dcv. g. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingto:Street- Suite 710 Boston;=-Massachusettsr.02118 Home Improvement Contractor ReFgistration t -- - = _ •Type: Corporation YANKEE HOME IMPROVEMENT INC - ; .> ; egistration: 160584 36 JUSTIN DR. ` , , Expiration: 08/11/2024 CHICOPEE,MA 01022 Y �..«�31 ......` 'x 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: TYPEt-Gocpbration Office of Consumer Affairs and Business Regulation Registration :_Expiration 1000 Washington Street -Suite 710 160584 - w_08/t1/2024 Boston,MA 02118 'ANKEE HOME IMPROVEMENT ING== 3ERARD RONAN 16 JUSTIN DR- :HICOPEE,MA 01022 YANKHOM-01 BROOKE ACORO CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 9/28/228/2023 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 Brooke Barre NAME: Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street (A/c,No,Eat):(413)594-5984 (A/C,No):(413)592-8499 Chicopee,MA 01013 aoDARIEss:brooke@phillipsinsurance.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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DDIYYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2517693 10/1/2023 10/1/2024 DAMAGETORENicg 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEt:T X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO A 9106918 10/1/2023 10/1/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSRE� ONLY _ AUTOS BODILYBODILY INJURYN (Per accident)_$_ AUTOS ONLY _ AUTO ONLY _(Per aacoRodeYntDAMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2517693 10/1/2023 10/1/2024 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y 1 N H WC 9099267 10/1/2023 10/1/2024 1,000,000 AAFFICERIMEMTOERRNY /EXCLUDED?ECUTIVE I�I N/A E.L.EACH ACCIDENT $ (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 $ 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD