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31A-163 (3) .. ,A . MONA) NOLitift s OtOti51441$3 s MOSE stlatIMPAS s 041011 waisgt INV 6I:9;8 600V/2101H 0011 s ZIZ asvd ; • To Whom It May Concern: • , L .......4Air4rar.,.._ku&As.,,, as property owner, give permission to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or de / rs in my home, located at _... . ; a/ 4 ,. or apealc- - i a l",.,,,,,/ 0 /4 . . Please accept this letter in place of my signature on the on the permit application. Thank_ you, • • '.. L i _ e -.- .. ... • . . Please Print r .■oi ' ..44.1,t ! gi __jg2Wca_ Home • , re er's Signa A Via Date • ,- , . , . . . L. . , • . . . . . . ' . , • . . , . . . . . . , . . . • . . . • . . .. . . .. - • . .., •. . . . . . . . • . . .., . • . , . . . • . . . . i -. • . . . . . . :...a.- ' , •,-* . . . . , . . . , . . . ,... .. EIVE917LLEIP 00:SO 600Z/a/OT ZO/Z0 39Vd ----------------- Customer. Michele Kunitz Project Name: Kunitz, Michele 108 Maynard Street Northampton Order Number: 739 Quote Number: 1011420 MA roject Checklist has been reviewed � � M . d , � e rn � ,> R .F4, Ill —7r— .r � � .4. ;,$ „ „ t ..:. , s , fir, waisei . Taxable Subtotal $11,734.43 Cr Card Approval Signature Sales Tax 6.25% $733.40 M f / Non - taxable Subtotal $2,408.00 lyt i(�.5[.g KJrv2, LZ(C./V-k Total $14,875.83 Customer Name (Please prig r ., a es �• Nam (Please Print) j , - Deposit Received l Ar t ,e.r �� _ Amount Due $14,876,83 Customer ignature Pella Sales Rep Si nature tb l .11/01 lf ' Date Date • For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 10/29/2009 Contract - Detailed Page 6 of 6 Office Order Copy 444 e 71* Branch Number: 73900 Order Number: 73913LP051 Window Store Name: Quote Number: 1011420 Quote Description: Architect Spoon locks Project Name: Kunitz, Michele 108 Maynard Street Northampton MA Customer Information Deliver To Address Order Information Michele Kunitz Lot # Sales Rep Name: Picard, Paul Cust Delivery Date: 12/23/2009 Address: Business Segment: Retail Quoted Date: 10/28/2009 108 Maynard Street 108 Maynard Street Market Segment: Single Family Replacement Contract Date: 11/10/2009 Order Type: Installed Sales Booked Date: Effective Discount: 0.012% Earliest LRD: NORTHAMPTON, MA 01060 NORTHAMPTON, MA 01060 Commission Split: Picard, Paul - 100% Contact Name: County: HAMPSHIRE Tax Code: MASS Tax Exempt #: Payment Terms: Deposit/C.O.D. Customer PO #: Day Phone: (413) 226 -1084 Owner Name: Accessories Managed Accessory Delivery Date Mobile Phone: Michele Kunitz Fax Number: E -Mail: Owner Phone: (413) 226 -1084 Great Plains #: 53H2261084 Customer Number: 3394587 Delivery Instructions: 91s to exit 20 Northampton. Follow Rte 5 (King Street) to center of town, tum right on to Main Street, then bear right onto Elm Street (Rte. 9) go past Smith College. Maynard Street is on the left, follow to end of street house on left. Installation Notes: 91s to exit 20 Northampton. Follow Rte 5 (King Street) to center of town, tum right on to Main Street, then bear right onto Elm Street (Rte. 9) go past Smith College. Maynard Street is on the left, follow to end of street house on left. • Printed on 11/10/2009 Office Order Copy Page 1 of 7 PELLA PRODUCTS INC 1S5 MAIN STREET GREENF|ELD.K8AO13&1 - T - f or� k ^ —=�� ---- T � '�] _ 1 n ) � �?�� 0 �--- -- -- ` -�� \ \ Sullied: Disposal of Debi |s The purpose of this /ette/ a io caU/[y that mU 1he debris mou}tng kom any pi 4aot undaAaken by Pella Products info. in your Town v:! be tmnspoAed Io a dumpslor al ou mein facility at 155 main Street, Greenfield. K84 Pella Products |ncAs under corm mUwith@las1e Managomen|ofKXassaohuaeUs;or the disposal nt the contents of this Uumpc1r. Very Truly YouIS, PELLA PRODUCTS INC. John P Be/omm Accounting K8anaJer PAGE 01/01 PELL� PRODUCTS INC '041'7'009 11:1? 4137363350 " . . The Commonwealth of Massachusetts Department of Industrial Accidents l ; t i!+ = l Office of Investigations 144, _ `'; 601) Washington Street .. ='' .. �t Boston, M4 02111 ... ;'':{ " ' www.mass.gov /dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers • Applicant Information f Q Please Print L - ._ 'b1 Nance ( Business /Organization/individual):_ X fig -f�F cf.S C _____�..� -S Address: /,�'`. /A'�4'rri %I"Ge'T C~ity lState/71p r >a d /Wig /.3 'ho ne #: 3 Are you an employer? Check the appropriate box: Type of project (required): 1. X I tun a employer with &' 4. 0 1 am a general contactor •and I.. . employees (full and/or part tinrxe) "'. have hired the sub-contractors 6. 0 New•constructiou 2.0 I am a sole proprietor or partner listed on the attached sheet. 7. 0 Re uodelinrg ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' ©Blxilding addition 9. [No workers' comp. insurance comp. insurance t required.] 5. f 3 We arc a corporation and its 1 0.0 Electrical repairs or additions 3.0 I an a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12 I{. repairs insurance required.] t' c. 152, § 1(4), and we have no employees. No workers' 110 Other comp. insurance required.] -- -- *Any applicant that cheeks box in must also 611 out the section below showing their, workers' compensation policy infom%rtion. . t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the n:uno of the sub - contractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. 1 am an employer than is providing workers' compensation insurance for my employees. Below Ls the policy and job site information. Insurance Company Natne_ 4 c i 1� r" eqn Ce , ,,, t7 n Policy # or Self -ins. I W. #4t7 Expiration Date: 4 Job Site Address: . .. , _ City /State /zip - Attach a copy of the workers' compensation policy declaration page (showing the policy.nuinber and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of tuiminal paualties of a fine up to $1,500.00 and/or one -year in:prisonrncnt, 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 Moe of Investigations of the DIA for insurance coverage verification. 1 do hereby ce u der the pains and penalties of perjury that the information provided above is true and correct. S:.wa s: i _ / • AO_ 4 /,„ 4 . sate: DEC 2 J 2008 • o e /3 o'• .Flf 02 Official use only. Do not write in this area, to be completed by city or town oJciaL City or Town: _ ]Permit/License # Issuing Authority (circle one): 1.' Board of Health 2. Building Department 3. City/Town Clerk 4, Electrical Inspector 5.1'lu mbing Inspector 6. Other _ L Contact Person: . Phone #:_ . Pella Products, Inc. 155 Nlaht Street t;reenlieki, NIA 01301 Phone 4 1:.1cH . 41 3-8 . 34-87 0 c) — — - lo: iluildiiP,.!. hispertor Front: Da‘id \\line Insttillation Nil:matter Date: January 19. 10 13.J E(T: Building Permit Applications & 1)esignees Pella Products Incorpornicri Is in the husill,:ss oir reak:iirq, \\imio and door, l'or our ('ustoinePs ()in proce's includes providnul LI bliddill^„2: pCITIlii I.C)F L'.ach and e\ er\, proicei, 1 am it licensed Consiruct ion Super\ isor. Building, permits ,,,,, ill he applied for usint,2 up CS!. : 1 -PR ;:ind our I 1 1C.. -,' I 4.7;17 Please find ;21 copy ol Inv licenses hclo\v. m...14....,ti, - f.}, 1■311Fricrl I .1 Public ",....11c1±. Roolvd1 .1 Bull,link Kt:!..,311■1414.01. will S•1.1111d.i rd.. C,tn ICtiflrt .S11(74,, 9 ,,:e--cr.. Rroarlooti to: Do 131.1- tlurtvfirictet1 ■ It; - 1 2 Frarvily Itonnes L i.- cs 914t.#.3 Fqactrictoo 10 00 0IAV1D 0 'NHITE ,,,.,,,..tAlit...,..2.,,,, Fttilurt til Farly,en 3 current vibliluit Lot Illu. , 84 CARENTER ST , :r:::.*::„ :40' . ,A , .;k , Masseduipets MCA. thillgIiug Carlo , ORANGE MA 01384 '*,-''''' -. ''''''''' il ti; tor retacmtion of Ow licills. 13rfier in: Vi WIN. Mxt,i.GuniliPS C •9 inn.: 1:31 Each installation \\ ill ttc sullied ty\ our in \\ 110 :11 all licensed 111 tecordance ,,\ nit ciirreni buildmh. co dcs 1:0110\VIT!, .dri2, C.OpiCS 01 1hCir current licenses. Please ;Accept these indi\iduals a;-; ni\ 1)swriccs II von have an qud pl contact Inc iisiFT, the numbers lisied ahoNe, FROM Berkshire Insurance Group (THU)NOV 12 2008 14:48,87.14:42/M..7827318352 P 1 • ACORD_ CERTIFICATE OF LIABILITY INSURANCE 11/12/2009 PRODUCER (413) 773 -9913 FAX: (413) 774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Mass One Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 638 Greenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Continental Western Pella Products, Inc. INSURER B: ATTN: John Benjamin INSURER C: • 155 Main Street INSURER D: Greenfield MA 01301 -3258 INSURER E: • COVERAGES 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: AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MIA/LIMY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000' X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 3 0 0 ,..000 PREMISES (Ea occurrence) A CLAIMS MADE XI OCCUR CPA020470112 1/1/2009 1/1/2010 MED EXP (Any one person) $ 15,0;00 PERSONAL&ADVIN,IURY $ 1,000,000 GENERAL AGGREGATE _$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 GE X I POLICY JECT I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) A ALL OWNED AUTOS MAA020470212 1/1/2009 1/1/2010 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ ._ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ •, :3 I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ . EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ - 1ire)I OCCUR CLAIMS MADE AGGREGATE $ LI DEDUCTIBLE $ _...., RETENTION $ _ $ A WORKERS COMPENSATION AND II WC STATU- 0TH - EMPLOYERS' LIABILITY X 1 TORY LIMITS j ER ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICERJMEMBEREXCLUDED? RCA020470512 1/1/2009 1/1/2010 E.L DISEASE - EAEMPLOVEES 500,000 If yes, describe under 500, 000 SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES?EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS • Operations usual to the sales & installation of doors & windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE �THE 1 Michele Kunitz EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO M AIL, 108 Maynard Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Northampton, MA 01060 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE_ INSURER, ITS AGENTS OR REPRESENTATIVES. ... AUTHORIZED REPRESENTATIVE Robin Sargent/RMS ACORD 25(2001/08) © ACORD CORPORATION 1988 INS025 (0108).o8a Page 1 of 2 SECTION ECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: I ,� Not Applicable ❑ Name of License Holder: 1 J (1. (1 � CA l . �) kk i ce.— (' LP License Number G Address Expiration Date 04 C + �-It > - - Via - 0 , 3 5 _ Signature Teephone 9. gistered Home Improvement Contractor: Not Applicable ❑ R �(10. 1 ' r'LGI.�c��� �i� e. 1 - 19 Company Name Registration Number vi i �' , a _ >��t'� lc� . ►1 "1 cy t 1 (4 0k1 Address /� /� Expiration Date ` (, . Telephone 11c " L A J 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 buildjng permit. Signed Affidavit Attached Yes 6( 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 own 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Wjfidows Alteration(s) n Roofing J Or Doors L1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [L7 Siding [0] Other [0] Brief Description of Proposed ( Work: 1"L00. v. 3 % (\ CIA. = 4 11 J.. � � .� fir\ ' - 00o6.0 ti,„. 0( t'■i1AeIJJ t\ec gory. Alteration of existing bedroom Yes )( No Adding new bedroom Yes )‹ No 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 O il it ( f V\ Q � '` i kl\ L kL- , as Owner of the subject property , k hereby authorize t �(� f L1 0.3 S Tij� P C (AA.) Cl C W �� . to act on my behalf, in all matters relative to work authorized y this building permit application. Signature of Owner Date • I, t' I CS �! i C F 0. ( . ck C • V.4 ■ '- , asOwner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. O Print Name c f. I .K419., 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 m 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 ® 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 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES,. describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 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 413 -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 y -ic r �'� Map Lot Unit r 'ji O fv\ ,p A_ w A , `1A(A 3 r '6n e Overlay District • Elm St district, CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: kke Lo Name (Print) Current Mailing Address: L A( - Telephone Signature 2.2 Authorized Ascent: I `et c (kAt ck (b(A.A.), C • Iti1t.1/4 n (* ' e t 4 1 Name (Print) /1 a ^ / 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 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 1 (g 1 .� &;') Check Number C(J'6O This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 108 MANARDRI 4 BP- 2010 -0559 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A 2101 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0559 Project # JS- 2010 - 000785 Est. Cost: $14875.00 1 ee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 10497.96 Owner: KUNITZ MICHELE Zoning. L'RB(100); Applicant: PELLA PRODUCTS, INC AT: 108 MAYNARD RD Applicant Address: Phone: Insurance: 240 MOHAWK TRAIL (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:11/23/2009 0:00:00 TO PERFORM THE FOLLOWING WORK :INSTALL REPLACEMENT WINDOWS 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 11/23/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo