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35-171 (4) 1363 BURTS PIT RD BP-2019-0781 GIs#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 35- 171 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# BP-2019-0781 Proiect# JS-2019-001288 Est. Cost: $13258.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq. ft.): 19994.04 Owner. KOWAL JOANNE T C/O JOANNE KOWAL LASTOWSKI Zoning: Applicant: PELLA PRODUCTS, INC AT. 1363 BURTS PIT RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:1/7/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 18 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: Feelype: Date Paid: Amount: Building 2/5/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (4 13)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton StoAldf Building Department curb4. , t /pri nn t 212 Main Street Sewer/S+ #Av�lat�i Room 100 Waterli/ Atabltity Northampton, MA 01060 Two 3ewof�ura1 Piatj phone 413-587-1240 Fax 413-587-1272 =' its" APPLICATION TO CONSTR T,A EMOLISH A ONE OR TWO/FAMILY DWELLING SECTION 1 -SITE INFORMATION I 1.1 Property Address: 7 2019 This section to be completed by office L I ap 15 Lot 1 f Unit DEPT. RT E3UIL. TON IN A 0106 0%n@ y District ORTHAMPTON,MA 01060 Overlay �•NN���� Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) •. , Cu /l3ailingAc/�rgs ��y G�7��l�rc�)L Telephone Signature 2.2 Authorized Agent: Name(Print) 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 o2 / (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) I— A 1 D 5. Fire Protection !41 6. Total=0 +2+3+4+5) 413Wd? Check Number This Section For Official Use Only Building Permit Number: DateIssued: Signature: 1- 7- Building Commissioner/Inspector of Buildings 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 Q DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES Q IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 © NO Q 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 ❑ Addition ❑ ReplacementWindows Alteration(s) ❑ Roofing ❑ Or Doors 1p, Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[ice] Other[0] Brief De iption of Proposed _n..i�� .. ) 6'X.S nS olx� r�� Work: ICir' •n S ] 0 l,� i n[�Uiiw�T ��c�c-+ �'�S�f , (a S,hr Alteration of existing bedroom Yes No Adding new bedroom Yes `� No Attached Narrative Renovating unfinished basement Yes i 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 l I A b. Number of rooms in each family unit: Number of Bathrooms N 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, _J r)C__YI /")e. k86 as Owner of the subject property � / r hereby authorize 1 �!'C� ��C�C1 U� �� C. to act on my behalf, in all matters relative to work authorized by this building permit application. ":S:=)—&' z /V__111 he Signat of Owner Date u e as Owner/Authorized Agent hereby declare that the stat ments 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. Print N r Signa a of O _ Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ✓Ue QSS W ()9(o55 License Number �U GCUrSe �"T4c�n�►r�r� /71 C) dl3aJ A3/ U 4,.o Address Eviration Date re Telephone Registered t Home Imoroyanord Contractor: Not Applicable ❑ Company Name n Registration Number Address Expiration Date Telephone VJ3 ' 7?o)-6153 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....... 4 No...... ❑ 11. - Home Owner Exem flon 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. Defmition 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 Contract - Detailed Pella Window and Door Showroom of Greenfield Sales Rep Name: Sanderson, Thomas ® 240 Mohawk Trail Sales Rep Phone: 413-774-7231 Greenfield, MA 01301-3209 Sales Rep Fax: 413-774-6348 Phone: (413) 774-7231 Fax: (413) 774-6348 Sales Rep E-Mail: tsanderson@pellasales.com Cu t+��rterlnformlatiosn Plr161e6fibelivery Address Order Information Paul Lastowski Lastowski Paul 1363 Burt's Pit Rd Florence MA Quote Name: Lastowski Paul 2203086 Vinyl Replacements 1363 Bums Pit Rd 1363 Burts Pit Rd Order Number: 739T3ASO41 FLORENCE, MA 01062-3656 Lot# Quote Number: 10880372 Primary Phone:(413)5863644 FLORENCE, MAO 1062-3656 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: Paid In Full Fax Number: Tax Code: MASS E-Mail: Quoted Date: 12/10/2018 Great Plains#: 52H5863644 Customer Number: 1008981680 Customer Account: 1005018795 Customer Notes: Replacing 14 windows with 250 Series Vinyl and 4 Windows on the porch with Encompass Vinyl Paid In Full $9000 received on credit card$4,258.31 received by check Lint ' .. AtCrfbCites Lata#ion: *' 10 Bedroom 1 Pella 250 Series, Double Hung, 29.5 X 55, White item Price city Ext'd Price 1 1: Non-Standard SizeNon-Standard size Double Hung,Equal $949.49 3 $2,848.47 PK# Frame Size: 291/2 X 55 2022 Exterior Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4",Sill Adapter Included, Head Expander Included Exterior Color 1 Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001,Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, wrapping Information: Pella Recommended Clearance, Perimeter Length=169". Frame Size:29.5"X 55" For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella website at www.pella.com Printed on 12/11/2018 Contract-Detailed Page 1 of 15 Castomer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3ASO41 Quote Number: 10880372 PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops qty 1 Loicsn: °`' Atlxibr�es 15 Dining Room Pella 250 Series, Double Hung,29.5 X 55,White Item Price Qty Ext'd Price 1 $949.49 2 $1,898.98 41: Non-Standard SizeNonStandard Size Double Hung, Equal PK# Frame Size: 291/2 X 55 Ln 2022 General Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4",Sill Adapter Included, Head Expander Included Exterior Color/Finish: White Interior Color 1 Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29, SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001, Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=169". Frame Size:29.5"X 55" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 +�' Location: Attritrii 20 Bedroom 2 Pella 250 Series, Double Hung, 27.5 X 58.5, White Item Price Qty Ext'd Price $958.80 2 $1,917.60 1: Nonstandard SlzeNonStandard Size Double Hung,Equal W, PK# Frame Size: 271/2 X 581/2 oa -- General Information: Standard,Vinyl, Block, No Foam Insulated, 31/4",31/4", Sill Adapter Included, Head Expander Included 2022 Exterior Color/Finish: White Interior Color I Finish: White 1 Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001,Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=172". Frame Size:27.5"X 58.5" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 12/11/2018 Contract-Detailed Page 2 of 15 Customer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3ASO41 Quote Number: 10880372 Attributes 25 Bedroom 3 Pella 250 Series, Double Hung,27.5 X 58.5,White Item Price Qty Ext'd Price $958.80 1 $958.80 1: Non-Standard SlzeNon-Standard Size Double Hung, Equal IQ PK# Frame Size: 271/2 X 581/2 2022 General Information: Standard,Vinyl, Block,No Foam Insulated,31/4",31/4",Sill Adapter Included,Head Expander Included Exterior Color f Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001, Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=172". Frame Size:27.5"X 58.5" PF-2-Exterior Pocket Installation Qty 1 yyyyyy EXTTRIM10-PVC Ripped for stops Qty 1 30 Living Room Pella 250 Series, Double Hung, 35.5 X 58,White Item Price Qty Ext'd Price $991.39 1 $991.39 J3 1: Nonstandard SlzeNonStandard Size Double Hung, Equal PK# Frame Size: 35 1/2 X 58 � 2022 General Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4",Sill Adapter Included, Head Expander Included Exterior Color I Finish: White Interior Color I Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude ' Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001, Performance Class R, PG 35, Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=187". Frame Size:35.5"X 58" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 12/11/2018 Contract-Detailed Paoe 3 of 15 Customer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3ASO41 Quote Number: 10880372 rte L.ocaion` Attributes 35 Living Room Pella 250 Series, Double Hung,27.5 X 58,White Item Price Qty Ext'd Price $954.14 2 $1,908.28 1:Nonstandard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 27 112 X 58 urn 2022 General Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4", Sill Adapter Included, Head Expander Included Exterior Color/Finish: White Interior Color 1 Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001,Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=171". Frame Size:27.5"X 58" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 1. dti: 40 Kitchen Pella 250 Series, Double Hung,27.5 X 46.5,White Item Price Qty Ext'd Price $902.95 2 $1,805.90 1: Nonstandard SizeNonStandard Size Double Hung,Equal inF4 PK# Frame Size: 27 1/2 X 461/2 ° 2022 General Information: Standard,Vinyl, Block, No Foam Insulated, 31/4",31/4", Sill Adapter Included, Head Expander Included Q Exterior Color 1 Finish: White t Interior Color I Finish: White 1 Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude ' Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001,Performance Class R,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=148". Frame Size:27.5"X 46.5" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.corn Printed on 12/11/2018 Contract-Detailed Paae 4 of 15 Customer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3ASO41 Quote Number: 10880372 Lcm+ tc+rK Attribtlit r. 45 Kitchen Pella 250 Series, Double Hung, 27.5 X 34,White Item Price Qty Ext'd Price $842.44 1 $842.44 1:Nonstandard SlzeNonStandard Size Double Hung,Equal PK# Frame Size: 271/2 X 34 M 2022 General Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4",Sill Adapter Included, Head Expander Included Exterior Color/Finish: White Interior Color I Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude �' Hardware Options: Cam-Action Lock,White,Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00057-00001,Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress, but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=123". Frame Size:27.5"X 34" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 ,;. _ .... . 50 Porch Vinyl Windows I Doors By Pella, Double Hung, 27.5 X 58,White Item Price Qty Ext'd Price $838.19 3 $2,514.57 1: Nonstandard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 271/2 X 58 � ' 2022 General Information: Standard,Vinyl, Block Frame With Mull Groove, 31/4",31/4", Sill Adapter Included, Head Expander Included Exterior Color I Finish: White Interior Color 1 Finish: White Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.53,CPD PEL-N-108-00116-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=171". Frame Size:27.5"X 58" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 12/11/2018 Contract-Detailed Paae 5 of 15 Customer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3ASO41 Quote Number: 10880372 Alfrtbtite 55 Porch Vinyl Windows I Doors By Pella, Double Hung, 34.625 X 58,White Item Price 4ty Ext'd Price 7 $870.77 1 $870.77 5 1: Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 34 5/8 X 58 00 ko 2022 General Information: Standard,Vinyl,Block Frame With Mull Groove,31/4",3114',Sill Adapter Included, Head Expander Included Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E Advanced Low-E insulating Glass Argon Non High Altitude 34.625' Hardware Options: White, Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.53,CPD PEL-N-108-00116-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=186". Frame Size:34.625"X 58" PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 Lute. ` Location: At#rilbtrt 60 None Assigned BPC - Permit-subject to change if actual cost greater than shown Item Price my Ext'd Price $50.00 1 $50.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 12/11/2018 Contract-Detailed Paae 6 of 15 Customer: Paul Lastowski Project Name: Lastowski Paul 1363 Burt's Pit Rd Florence MA Order Number: 739T3AS041 Quote Number: 10880372 JJ�rProject Checklist has been reviewed Ll oiW nt L-NAStoy)5 K t 7—A o&f Customer Name (Please print) 8 P ) Pella Sales R p Name (Please print} Taxable Subtotal $10,161.80 Sales Tax 6.25% $635.11 V'Customer Signature Pella Sales Rep Signature Non-taxable Subtotal $2,461.40 1a)(1118, /Z Total $13,258.31 Date Date Deposit Received $13,258.31 Amount Due $0.00 dit Card Approval gignature For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 12/11/2018 Contract-detailed Pana 1fi of �F Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-773-1157 Ext. 317 Cell:413-834-8799 To: Building inspector From:Trevor Bross-Installation Manager Date: March 5, 2018 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#142279. Please find a copy of my licenses below. ConrrtaPts + 1Anssacttusetts rsfticted nstruction Supervisor 0 OM� kIli'tr i 1 liri► to: t restricted-Built d wo �.ow4ow s then 35000 cubic tid( I =l- closed space. i � y t F' r%/y�rt+r+w,Henne^tt�I/r I �i�atsav�l�rc/Is otft*of Consumer Affsink8 Business Rsyuled" HOME NPROVEMENT CONTRACTOR Re tbrtvs dlarindtvtdWtustaniY TYPE:SuPolorat Card bek"tpi�fly. tt f to rdorn w. ureic.of Ca"Wow end BMW" sWtlmt 142279 03/23 020 ons. PEt1A PRODUCTS,M TREVOR BROSS - 155 MAIN STREET Hh;0A Mgfwbxo GREENFIELD,MA 01301 Undersecretary Each Installation will be staffed by our installers who are all licensed in accordance with current building codes. Below listed are our installers and their license numbers. Please accept these individuals as my designees. Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Scott Bowdish CSSL100232 Bill Leger CS89338 David Ruffner CS57308 Brian Thompson CS67121 Igor Kravchuk CS094911 ( The Commonwealth of Massach usetts Department of Industrial Accidents Ogee of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 sv v www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/C ontractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name (Business/Organization/Individual): Pella Products, Inc. Address: 155 Main Street City/State/Zip:Greenfield, MA. 01301 Phone #:413-772-0153 Are you an employer? Check the appropriate box: Type of project(required): 1.Q 1 am a employer with 52 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑■ Remodeling ship and have no employees These sub-contractors have g. E] Demolition workingfor me in an capacity. employees and have workers' y ' 9. RBuilding addition [No workers' comp. insurance comp. insurance.'. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[] Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hanover Insurance Group Policy#or Self-ins. Lic. #:WHND376502 Expiration Date:01/01/2019 Job Site Address: r'3�J ��+� ;)j4 RC( City/State/Zip: X71 A 610la,.1- 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. I do hereby cern u er tl pai nd penalties ofperjury that the information provided above is true and correct. Signature: Date: o? Phone#: A Ove 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 Date: la ain�1� To: Mw n 0- A rce- , Subject: Disposal of Debris The purpose of this letter is to certify that all debris from any project undertaken by Pella Products, Inc. in your town will be transported to a dumpster at our main facility; 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 A`OR�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ Y) 12/27/2017 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 Robin Sargent NAME: Berkshire Insurance Group,Inc. AHONN Ext (413)773-9913 (A/c,No): (413)774-3872 117 Main Street E-MAIL rsargent@berkshireinsurancegroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC If Greenfield MA 01301 INSURER A: Citizens Ins.Company of Amer 31534 INSURED INSURER B: Allmerica Financial Benefit 41840 Pella Products,Inc. INSURER C: Hanover Insurance Company 22292 155 Main Street INSURER D: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER: 18GL,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. INSR DOLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 100,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 A ZBND45939500 01/01/2018 01/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a PRO JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Damage to Rented $ 100,000 AUTOMOBILE LIABILITY COMBIMEB 9IN(3E£LHv11T $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWND45948700 01/01/2018 01/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION XPER OT v/N AND EMPLOYERS'LIABILITY STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? � NIA WHND376502 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations usual to the sale&installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Florence(Northampton)Building Commissioner's Office, ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD