29-471 . —
) ., ).
1 e t
ita ioducts, inc.
155 \lain Street
t;r 01301
( Cii 11
TO: BUIO.11W..'. Inspector
Frorn: I )a id \\ hite Installation Niantdzei
Date: j:111HalV I (-).. 2
St 13,1 E(U: 13tiikliaig 1 Applic:ttions & 1)esignee
Pella 1)roclucts inck)rporated is HI trk.: ht.rxHi1/4f.x O IVPiaeir.O:. V\ HKION‘x. and
doors for ()tit customers t )ter prcss includes pp)), iditfc a huildird:.) permit
for each and (..)), LTV proneet
1 ani a licensed Construction Stip(,)r\ isor Buildrilm. permits. \\di he applied
ldr tip nic (1, - P NI HP and our 111C, . 1 -I22 Please find a copy of
npe licenses 1, .
NLik,i(aiuNoii, -11,,,:4111ticril 40 P400144: °^4.04. It
il Ft 4.10"0 441 84,444iirit,4. k4.1.440:04404, and '41 an-0.4r0.4
*
cnnstroctoon :',112,-, 1 44brarg4:114ina gc: D43
40 - Utirestriettil
It; - 1 z Fatuity itcrnea
L.y.or.-.444 ^. F. 0'405
Re-ctrir.4441 14, 1O
DAVID C WHITE
at the
' -. ---- l.:,, Mnsachusett• 'Ask Ifultimg t 4061!
ORANGE MA 01364 ,' ' -; ' II ta4140: Cyr regiwatagn 40 gran firens4e ,
131,791 Refer kr, WWW.M.13.1.1.GirriliPS
.
74-44- 044445
1
1:4Ieh inSiallatiOn \.‘ d H '.'CI4111L2d his our installers d, ii() are a11licemitcd in
accordance %)( ith current buddimr, coder- iadif nip are (2(.1i.ne-; of their
k.airreni licenses Ilease iiccept these inch\ idtrals as rip, De-nir.rices
If\ ou have an (lac-diem please contact ine maim the numbers listi..)d iit)()),c.
.. i -
PAGE 61/01
PELLA PRODUCTS INC
16104/2009 11:'17 4137363390
The Commonwealth oMassachusetts
p* ,1. Department of industrial Accidents .
a - - ,—,.. „ Office of Investigations
':.� �'w ^ 1T- ,, Gbh Washington Street
Boston, MA 02111
: ; : Mk . ' �`' www.mass.gov /dia • •
•
Workers' Compensation Insurance Affidavit: Builders/ Contractors /1lectrieians/x'aumbers •
A licant Znfonnatiort pleas j'r t L 'Il
Name ( Business /Organization/Individual) S ' EL.Agd ?, .j h C _
Address: ,,/,57 :' •.,,4 Ir C
pity /State/Zipir n4 1 /Vft t30 _ f'hon, #: /,5 f
Are you an employer? Check the appropriate box: Type of project (required):
1. M 1 an a employet with 7 & 4 . 0 I am a general contractor and I.. .
employees (full and/or part - time)." have hired the sub - contractors
6. 0 New construction
2.0 T an a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub - contractors have 8 0 Demolition
working for me in any capacity. employees and have workers' Building addition
[No workers' comp. insurance comp. insurance.;
required.] 5. 0 We are a corporation and its i0.D Electrical repairs or additions
3.0 1 arts 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 hoof repairs
insurance required.] i' c. 152, § 1(4), and we have no
employees. [No workers' 13.0 bthc
comp. insurance required.] -
*Any applicant that checks box #1 must also 611 out the section below showing their, workers' compensation policy irrnortmtion
t Homeowners who submit this affidavit indicating they are doing all work and then lure 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- corxtracmzs have employees, they must provide their workers' comp. poky number. •
1 ain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job Site
information.
Insurance Company Nan c egz.ortr / i C ,7
. r" eve) c . n
Policy # or Self-ins. W. # :. ,J i/, Expiration Date: __At 0l r ?P 1LI
dab Site Address: City /State /Zips
Attach a copy of the workers' compensadon policy declaration page (showing the policy.»umber and expiration date). ■
Failure to secure coverage as required under Section 25.A of MG1- c. 152 can lead to the imposition: of criminal pm:mines of a
£fine up to $1,500.04 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 DtA for insurance coverage verification.
1 do hereby ce - u der the pabts and penalties of perju,y that the information provided above is true and correct
Kai. y , _f , gate: DEC 292008
Phone # 1 . — ; 02
.
_ .
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 #:
PELLA PRODUCTS INC
155 MAIN STREET
GREENFIELD, MA 01301
Cl_t_
219, 01.0,1A V.L.. _ ._._._ _.....
Subject: Disposal of Del:ills
The propose of this * ib to ceitity th:31 a!I the derH is ( INJIn :;y Holed uTldertaRen by
Pella Products Inc.:. in your To vniill be tianspoiled to ..1 dumpster al of main facjiiiy at 155 Main
St i eel: C ennfield. MA
Pella Products Inc.is under co rdl act wth Waste Management of r., for ine dIsposal
of the contents of this dun4y,1:
Very Truly Your s,
PELLA PRODUCTS INC.
John P. Benjamin
Accounting Manager
To Whom It May Concern:
"Dri-IZA , as property owner, give permission to
our contractor, Pella Products, Inc., to obtain a building permit for the
installation of windows or doors in my home., located at
304,, Please
accept this letter in place of my signature on the on the permit
application.
Thank you.,
b aizA octde,,v1 Please
Print
Home
Owner's Signature
Date
•
•
•
Customer. Project Name: Darabi, 360 Ryan Road Florence Order Number: 739 Quote Number TBD
outstanding balance past our stated terms, plus lawyer and account fees for collecting outstanding accounts.
The Buyer agrees that the customer delivery date is a realistic estimate of when the product is to be delivered. Items remaining in our warehouse for more than 30 days beyond the agreed to
delivery time will be subject to a storage and handling fee of 1% of the net amount of the order ($25.00 minimum charge).
The Buyer agrees that the product can be delivered without the Buyer present and agrees to accept the shipping documents as proof of delivery. The Buyer agrees not to hold the Seller
responsible for any damage to driveways, sidewalks, trees and overhead wires caused by the Seller's delivery vehicles.
The Buyer agrees to examine the product(s) upon delivery and within 7 DAYS OF DELIVERY provide the Seller notice of any discrepancy between the product(s) ordered and the products(s)
delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is.
Project Checklist has been reviewed
Order Totais
Taxable Subtotal $3,867.02
Credit Card Approval Signature Sales Tax 6.25% $241.69
• 66k At3 a�� ! C,��/ Non - taxable Subtotal $1,160.00
- (Please n. (Please Total $5,268.71
P Pella Sales Rep Name ( print)
Deposit Received
-- '` Amount Due $5,268.71
Customer Signa - .".""' Pel Sales Rep Signat re
112-3/ 0°1 7— 2g ) 7 Moto 1 7C (6r
Date Date
ec -rte (a40 / A-J
ri - an U i - r vh
ociAl s6. U y (u i try
d- ro U gr 1 r, eft?' fl AN fool ,
T'f't1 ...=
i g
•
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella() website at www. belle. corn
Drinioa "sr. r10J7 r,,.,+. •a„+ no+eiiori o-,,.,, f Q
Office Order Copy Oim �✓�'
?" ,4 Window Branch NumbeStore r: Name: 73900 Order Number: 73913KP01I
Quote Number: 885445
Quote Description: Designer
Project Name: Darabi, Dara 360 Ryan Road Florence, MA
Customer Information Deliver To Address Order Information
Dara Darabi Lot # Sales Rep Name: Picard, Paul Cust Delivery Date: 11/19/2009
Address: Business Segment: Retail Quoted Date: 09/23/2009
306 Ryan Road 306 Ryan Road Market Segment: Single Family Replacement Contract Date: 10/09/2009
Order Type: Installed Sales Booked Date:
Effective Discount: 1.474% Earliest LRD:
FLORENCE, MA 01062 FLORENCE, MA 01062 Commission Split: Picard, Paul - 100%
Contact Name: County: HAMPSHIRE Tax Code: MASS
Tax Exempt #:
Payment Terms: Deposit/C.O.D. Customer PO #:
Day Phone: Owner Name: Accessories Managed Accessory Delivery Date
Mobile Phone: (413) 320 -3511 Dara Darabi
Fax Number:
E -Mail: Owner Phone:
Great Plains #: 53H3203511
Customer Number: 3685133
Delivery Instructions: 91 S to exit 20, tum right on Bridge Road at light, left on Hatfield Street, right on Rte 9 west (just past hospital) left at light in center of Florence, bear right on Pine Street,
left at stop sign on Florence Rd, then quick right on Ryan Road. House on left apprx 1 mile down.
Installation Notes: 91S to exit 20, tum right on Bridge Road at light, left on Hatfield Street, right on Rte 9 west (just past hospital) left at light in center of Florence, bear right on Pine Street, left at
stop sign on Florence Rd, then quick right on Ryan Road. House on left apprx 1 mile down.
Wells Fargo customer, no collection at install.
Printed on 10/09/2009 Office Order Copy Page 1 of 5
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
/�
Name of License Holder : J(M_� > c'l ` • LU t<4}(, n i Lt q (D
License Number
6 .1./ Coy pe k Of co8x.. 01.71 01-(041 - �/ n t
Address Expire ion Date
O aC. &Jk y1 5 7 - 015 3
Signature Telephone
9. Registered Home Improvement Contractor Not Applicable ❑
1 .IIG:. 1it 0 C k,L s I
Company Name Registration Number
1 55 40.1 Cat \Cve (c'k. tr -\ nkapt - eJ
Address / (� ^` t , I Expire 'on Date
1 �J� W' • ��O (` Telephone "1, 77a- Qt
SECTION 10 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 No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who on 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 homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement thdows Alteration(s) El Roofing J
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0]
Brief Description of Proposed i+
Work: 1 .1`)��• 1 . 1 1 (`) (� (),L,.... \ (\ e w,:: } n (' 0-)c Ain -, .031( O r - � ww� e �,xf iv
Alteration of existing bedroom Yes No Adding new bedroom Yes No 1
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing. complete the following:
a. Use of building : One Family / Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, (i," C..._ CIG (.A`V ' , as Owner of the subject
property //
hereby authorize ? { ((. k P / .,,+, 1�A.0 \8 ( '. li ..,+C_
to act on my behalf, in all matters relative to work auth6rized by this building permit application.
Signature of Owner Date
I, ?`e_- l G f n C.\ S .,k `4 0 • (0 �.∎ `lam- , as Owner /Authorized
Agent hereby declare that the state m ` J�l
ents and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Si ned under the pains and penalties of perjury.
Print Name
0 Ca ^` CO K.ts, '
Signature of Owner /Agent Date
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW fl YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES ® NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. WII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
^Northampton, MA 01060 Two Sets of Structural Plans
phone 41 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
30 Q t < yrc;t \e . Map Lot Unit
e J1 c .e , Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
lJ (J' r.. r (11) i 3C) 4 yu\ 4{9. < <� e (1 k�J�
Name (Print) Current Mailing Addr :� 1 _
L- 13 _ -4() t
Telephone
Signature
2.2 Authoriz d A ent:
oc)w..At) 5 I ti/krrt 1v 3 6 CC Ivc -t..t( li
Name (Print) 0 mot) tAtc td i • Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Budding Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3+4+5) 1.i1 0 j ( Check Number L q g9a Y"
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
BP- 2010 -0589
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catet4ory: BUILDING PERMIT
Permit # BP- 2010 -0589
Project # JS- 2010 - 000861
Est. Cost: $6019.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 091496
lot Size(sq. ft.): 50965.20 Owner: DARABI DARA
Zoning: URA(100) / /WSP Applicant: PELLA PRODUCTS, INC
AT: 306 RYAN RD
Applicant Address: Phone: Insurance:
240 MOHAWK TRAIL (413) 772 -0153 WC
GREENFIELDMA01301 ISSUED ON:12/11/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT SLIDER
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 12/11/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo