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38b-080 (4)
179 SOUTH ST BP-2016-1421 GIS =: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-080 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit-. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit 4 BP-2016-1421 Project# JS-2016-002446 Est.Cost:$17000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 142279 Lot Size(sq.R.): 161172.00 Owner: GRAVES GREG zoning: URB(10o)/ Applicant: PELLA PRODUCTS, INC AT: 179 SOUTH ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC G R E E N F I E L D MA013 01 ISSUED ON:6/1/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:20 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 6/1/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 7115 City of Northampton wt z x --- Building Department 212 Main Street l Room 100 LW" oMs N. hampton, MA 01060 g4- onn .t.ti . 3-587-1240 Fax 413-587-1272 rio APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: rtrt e Tht ;tb ba"ter ehptdted by office tl1 Seow Sk Nork'ka4 /141`1 UIOitO ' ,i4/%1714. z , unit 4- r XF� z Zod4.ri� ss s bVgHay Di§lrictx' l;Im SLDlstttct 'CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record; {octo\ {¢caueS tl9 Souttn St, uovttotMoton nM ate? Name ) Cu ent M Ilin Addres 347 35-his Telephone Signature 2.2 Authodzod Agent: Tctvolr BroSS ID foeinle SFGt'eeafieid M19 013o1 Name(Pr. Current Mailing ddress: ('i13) Ti3-Us7 Signature Telephone SECTION a-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4 13000' (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+34-4+ 5) .17/000 M© Check Number €730. 4cio r This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissionerflnspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Required by Zoning This column to be tined In by Building Department Setbacks front 11. 77.1 Side Lin. If= L:U R: ] i T Rear [ Bldg.Square Footage Ell ®® OpenSpece Footage ®®®® (Lot area minus bldg&paved kin: WillneleMMAIMMMENI A. Has a Special Permit/Vadance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES 0 IF YES,date issued:!f IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 IF YES: enter Book I Pagel and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (3 DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and location: i... D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 I acre? YES 0 NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition n Replacement Windows Alterations) n Roofing El Or Doors g] Accessory Bldg. ❑ Demolition New Signs (O] Decks [q Siding[CI Other(OI Brief Description of P spored Work:K plari s? 20WIhdg.i5 USingiiSkjgq oDehiniAS,/10 Vrt 4tivral G}Etnctttd nreA ed Alteration of existing bedroom`Yes SC No J Adding new bedroom Yes he No Attached Narrative Renovating unfinished basement Yes X. No Plans(( Attached Ron -Sheet .11.1fJA.�24 ,ir i5 dole Wl°A:A` S >.SL��t.J1`1'YIALFltnad.'i lrt��_ a]'11_ta ��eA,6Al : 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? 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Gnem!, nt2r/ e • as Owner of the subject property f to hereby authorize m pk.Z ti `wo k.-,home I qc . to act o behalf,in all melativo to work authorized by this building permit application. c/2 I/n Signature of Owner Date I, TCeuov Brots as Owner/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. e r✓ ISDOSS Print Na 00. 5/2Nf(e Signature•'Owner/Agent Date SECTION 6-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Appplicabbllee�"❑ Q Name of License Hokiq[: Tctvcw x055 CS-0tty S License Number to (Pen't (tree. tfr a Meq d1301 3hlhs Address Expiration Date ro Art Act-we 3- 1157 Signature elephone .:i:1L?:x`f i!armtin iligr afc.L.C. lin. a.sn 'v v is- ti's' ,m'=`k Not Applicebie 0 ?MA Yrodu*S enc. 1422.11Co Darty Nam Registration Number (55AAA in• S�- , {ereevNcI t k. MA Ot3at 312�}ts Address Expiration ate Telephone(413)173-1(57 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G:L.e.162,§250(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 X No 0 shar, Hit 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 ps supervisor,CMR 786, Sixth Edition Section 188.3.5.1. partition of Homeowner.Person(s)who own a parcel of land on which hetshe 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 permits 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,von may be liable for person(s) you hire to perforin 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 The Commonwealth of Massachusetts aDepartment of industrial Accidents • rm f Congress Street,Suite 100 mur 1=7 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (sasiness/Organizationrtndividual):Pella Products, Inc. Address: 155 Main Street City/State/Zip: Greenfield, MA. 01301 Phone#:413.7724)153 Are you an employer?Check the appropriate box: Type of project(required): ha am a employer with 49 employees(full and/yr parttime)' 7. t❑��t New construction 2.0 I am a sole proprietora or pannship and have no employees working for me in S. ID Remodeling any capacity.[No workers'comp.insurance required./ a 9. []Demolition 30 i am a homcowna doing all work myself.[No workers'comp.insurance required.] 4_0 I am abomeossacr and will be hiring contractors to conduct ail work Oct my property_ I will 10 Building addition mama that all contractors either have wntken compensation insurance or ate sole I1.0 Electrical repairs or additions proprietors with no annploycra 12.0 Plumbing repairs or additions 5.0 I am a general conhactor and I have hired the sub-contractors listed on the attached sheet. 1.3.0Roof repairs these sub-coop-actors have employees and have workers'comp.insurance) 6We aa corporation and its officers have escrowed thou right of exemption per MGL<. 14.[]Otbei re ISa§i(4),and we have no emptoyccn.(No workers'comp-insuixpu required.] 'Any applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy tr foetation. Homeowners who submit this affidavit indicating they arc doing all work and then hie outside contractors must submit a new affidavit indicating such 'contractors that check this Pox must attached an additional sheet showing the name oft he sub-contractorsand stale whether or not those entities hs c employees. if the sub-eonractors haze employees.they must provide their worker-s'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sire information. Insurance Company Name: Hanover Insurance Group Policy#or Selfins,Lie,k: WHt4-9399766-04 Expiration Date: 01-01-2017 lob Site Address: « I s7U11,(A St City/Stateilip:NOY1410„AAP/Mal A- 0 WOO 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 51,5000 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 512911 CP Phone#: Above _._ 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: Phoned: PELLA RODUt:I S, INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: 5/211!1‘ -.r e' Cr eq (graves Il15ev+b s- Subject: - Disposal of Debris The purpose of this letter is to certify that all debris from any project undertaken by PSDa Products, Inc. in your town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products„ Inc. is under contract with Waste Management of Massachusetts. for the disposal of the contents of this dumpster. Very truly yours, PELLA PRODUCTS, INC. John P. Benjamin Accounting Manager Debris 06-17-14 ibex A� CERTIFICATE OF LIABILITY INSURANCE DAT 2016(M oDrrm) 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 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 corder rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAiCT Robin Sargent NAME Berkshire Insurance Group, Inc. (Z HO Eau. (413)773-9913 inAcc Noll"13)714-3873 117 Main Street EMAIess:reargent@berkshireineurancegroup.com INSUREW6I AFFORDING COVERAGE NAIC I Greenfield MA 01301 woman A Massachusetts Bay_Insurance Co 22306_ INSURED aimlesR6:The Hanover Insurance Company 10212 Pella Products, Inc. INSURER C: 155 Main Street INSURERD: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER:16GL,AL,WC 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. WSR ADDL SUER POIICY EFF- POLICY EXP LW TYPE OF INSURANCE /MD WVD POLICY NUMBER (MM/DDIYYYYI IMMNDNYYYI, LIMITS X COMMERCIAL GENERAL LIASILRY EACH OCCURRENCE 1 1.000,000 DAMAGE TO RENIS ' A CLAIMS-MADE I X OCCUR PREMISES(Ea ocwnencel L 100,000 ZI@942720204 1/1/3016 1/1/2017 MED EXP(Any one person) 6 10,000 PERSONAL 8.ADV INJURY _F 1.000.000 GERI AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000 POLICY f XSI JET X LOC PRODUCTS.COMP/OP AGC S 2.000.000 OTHER: i $ AUTOMOBILE LWBIUTY I COMBINED SINGLE LIMIT $ 1,000.000 (Ea YEenll A ZANY AUTO I BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS ADN919977004 1/1/3016 1 1/1/3017 BODILY INJURY(Per accident) S �KK AUTOS ED ,PROPERTY accident) $ _.. HIRED AUTOS X AUTOS $ UMBRELLA LMB JI OCCUR EACH OCCURRENCE S — EXCESS UAE CLAIMS-ADE, [AGGREGATE $ DEO RETENIION4 S WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'UAUTY X STATUTE ER BI __ N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A ELEACH ACCIDENT 5 500.000 OFRCER.MEMBER EXCLUEXCLUDED? N {— B (MarMalery In NM WRN9199766 1/1/2016 1/1/2017 TEL DISEASE-EA EMPLOYE 5 500_000 Nie EeacnN under pESGEIPIN)NOFOPERATIONSE&aw TEL.DIGEASEPOUCV LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more epee/tie required) Operations usual to the sales and installation of doors and windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ,,y� Robin Sargent/RMS / ' Y"'7. ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(20140) Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone: 413-772-0153 Cell: 413-834-8799 To: Building Inspector From: Trevor Bross—Installation Manager Date: February 23,2016 SUBJECT: Building Permit Applications&Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building permits will be applied for using my CSL#CS-096558 and my HIC# 182150. Please find a copy of my licenses below. 'dassa husctts ]euart t vat of Pubi Board cf Building R gu arons and Standards ConstruMion Supervisor Ise. CS-096,558 Restricted to: Unrestricted-Buildings of any use group which contain - ... . . less than 35.000 cubic feet(991 cubic meters)of mail enclosed space. TREVORBROSS 10 GEORGE STREET ( i GREENFIELD MA 01301 ale Failure to possess a current edition of the Massachusetts 03101/2018 State Budding Code is cause for revocation of this license. - . OPS Licensing information visa.WWW.MASS.GOWOPS =-Toffce of Consumer Affairs&Business Regulation License or registration valid for indiridul use only ��IOME IMPROVEMENT CONTRACTOR before the expiration data iffound inns to: _,� Ogee of Consumer Affairs and Business Regulation Registration: 142279T 10 Park Plaza-Suite 5170 Expiration: : 324/2018Supplement Card Bastes,MA023i6 FELLA PRODUCTS,INC. TREVOR BROSS 155 MAIN STREET et"' __ /� GREENFIELD,MA 01301 � Not valid without signature Undersecretary Each installation will be staffed by our installers who are all licensed in accordance with current building codes. Following are copies of their current licenses. Please accept these individuals as my Designees: Willard Brown CS106010 Vladimir Shcvchuk CSSL099209 Scott Bowdish CSSL100232 Curt Boyle CS78514 Dave Ruffner CS57308 Bill Leger CS89338 Chris Gamache CS86946 Brian Thompson CS67121 Andy Kimball CS85981 John Joy CS004599 If you have any question,please contact mc using the numbers listed above. \\DATAFILES\Shared\INSTALLATION\Pictures`.CSL scanslCSL-Designees 2015v1.doc Pella Products, Inc. 69 Ashley Avenue W. Springfield, MA 01089 4 OPBuilding Department 3 2016 City of Northampton OF BUILDING INSPECTIONS 212 Main St NORTHAMPTON MA 01060 Northampton, MA 01060 Thank you for reviewing our building permit request for 179 South St, Northampton MA 01060. Enclosed you will find the required documents and permit fee. Please direct any questions you may have to me, Derek Shaw, at Pella Products, Inc. of W. Springfield, MA. All customer and project information is located in this particular office;therefore I will be able to address any concerns you may have. I have included a stamped envelope for the return of the permit or permit receipt. Thank you in advance for you anticipated cooperation. Sincerely, I l� Derek Shaw Pella Products, Inc. Retail Coordinator 69 Ashley Avenue W. Springfield, MA 01089 (413) 736-9239 ext 103 e-mail: sc52@l84.pellapdsn.com