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23A-011 (6)
30 PARK ST BP-2020-0676 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-011 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2020-0676 Proiect# JS-2020-001152 Est.Cost:$8525.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sg.ft.): 11020.68 Owner: WILLARD KRISTI Zoning: URB(100)/ Applicant. PELLA PRODUCTS, INC AT. 30 PARK ST Applicant Address: Phone: Insurance: 155 MAIN ST 413 772-0153 WC GREENFIELDMA01301 ISSUED ON.1112512019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACEMENT DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspecl or of Wiring D.P.W. Building Inspector Underground: Servic : Meter: Footings: Rough: Rough House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire D artment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smokt Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND f EGULATIONS. Certificate of Occupancy Si nature: FeeT e: Date Paid: Amount: Building 11/2 /2019 0:00:00 $40.00 12 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northamptonn Status of Permit: Building Department Cuts iveway Permit 212 Main Street, r/se tic Availability Room 100 NOV 2^ W erjppecify_ Il Availability Northampton, MA Q1060 �� T Sof Structural Plans phone 413-587-1240 Faz 4t� 72 P t/Silans Nnr. 'UrcDrn rn�saFcr her iso APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVAT j ISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office S �\ti S Map Lot Id j Unit ��oCunc2 M A UO& Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: )6 6 41 1 Name rint) Current Mailing Address: 1 �_(\11 &9 ' -(ow-ju 1� elephone Signature 2.2 Authorized Agent: \c e�)cr �cosS SSS Mai„ �t Gc, . ;P\c1 c)\301 ame(Print) Current Mailing Address: 31`7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building CJ l) (a)Building Permit Fee J 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing n Building Permit Fee h 4. Mechanical(HVAC) �(V) 5. Fire Protection 6. Total= (1 +2+3+4 +5) Check Number This Section For Official Use Only Building Permit Number: g® O��-�� 7� Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [[I] Decks (M Siding [0] Other[a] Brief D scription of Proposed Work: - 1� L c�' r r .��Qfi 3}�_cSno..� a c c.� 'tl ren Lh cti.c�� to Alteration of existing bedroom 'f(es�_No Adding new bedroom Yes _�No � r 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 1 1i b. Number of rooms in each family unit: Number of Bathrooms /T 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. 1. 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 Y1• vv , as Owner of the subject pro e hereby authorize '��; rc:G{� to act on my behalf, in all ma rs relative to work authorized by this building permit application. fthdture of Owner Date 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. "l Ct� o r �&ool 5 Print Name 'i Signature of er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ( S C'C111 License Number to G' 03 I o� Address f n Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telepl►1 '?�73—I ISrI Q-V X1`7 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....... Oil No...... ❑ Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski, Adam s 69 Ashley Avenue Sales Rep Phone: (413) 335-3237 West Springfield, MA 01089 Sales Rep Fax: 413-774-6348 Phone: (413) 736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: alukomski@pellasales.com Customer Information Project/Delivery Address Order Information Kristi Willard Willard Kristi 30 Park Hill Rd S Florence MA Quote Name: 2405894 Entry and Storm 413-695-6115 30 Park Hill Rd S 30 Park Hill Rd S Order Number: 739T2LL051 FLORENCE, MA 01062-3613 Lot# Quote Number: 11989323 Primary Phone:(413)6956119 FLORENCE, MAO 1062-3613 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: Kristicdw@aol.com Quoted Date: 10/23/2019 Great Plains#: 1005474009 Customer Number: 1009362374 Customer Account: 1005474009 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 11/12/2019 Contract-Detailed Page 1 of 10 Customer: Kristi Willard Project Name: Willard Kristi 30 Park Hill Rd S Florence MA Order Number: 739T2LL051 Quote Number: 11989323 Line# Location: Attributes 10 Front Door Pella Brand, 3-Wide Entry Door Sidelight, 64.5 X 81.75, White, 6 9116" Item Price Qty Ext'd Price $8,600.48 1 $8,600.48 Y� 1: 1280 Fixed Entry Door Sidelight i PK# Frame Size: 13 1/2 X 81 3/4 2048 Unit Type: Fixed Inswing, Standard Sill Dimension Options: No Cut Down i General Information: 7 7/8", 1 5/16",6 9/16" 4:5 Panel Style: 1/2 Light Glass: Tempered Decorative Stella Black Wrought Iron Air Filled Viewed From Exterior Panel Selection: Smooth,Painted,White, Painted,White Frame Selection: Clad, Pine,Oak Threshold, No Panel Reinforcement, Standard Enduraclad,White,Wood,White Hardware Options: Nickel Finish Sill Performance Information: U-Factor 0.20, SHGC 0.08,VLT 0.07, CPD PEL-M-174-02309-00001 Vertical Mull 1: FactoryMull,Standard Joining Mullion-Doors, Frame To Frame Width-0", Mull Design Pressure-20 2: 3680 Entry Door Frame Size: 37 1/2 X 81 3/4 Unit Type: Left Inswing, Standard Sill, No Fire Rating, No Fire Rating Dimension Options: No Cut Down General Information: 7 7/8", 1 5/16",6 9/16" Panel Style: 1/2 Light Glass: Tempered Decorative Stella Black Wrought Iron Air Filled Panel Selection: Smooth, Painted,White, Painted,White Frame Selection: Clad, Pine, Oak Threshold, No Panel Reinforcement, Standard Enduraclad,White,Wood,White Hardware Options: Latch Bore with Deadbolt,2 3/4" 2 1/8" No Integrated Sensor, Del Mar, Del Mar, Satin Nickel,Single Cylinder,8tandef l-Steel,Satin Nickel, Nickel Finish Sill Unit Accessories: No Bang Panel Performance Information: U-Factor 0.25, SHGC 0.15,VLT 0.15, CPD PEL-M-174-02393-00001, Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08 Vertical Mull 2: FactoryMull, Standard Joining Mullion-Doors, Frame To Frame Width-0", Mull Design Pressure-20 3: 1280 Fixed Entry Door Sidelight Frame Size: 13 1/2 X 81 3/4 Unit Type: Fixed Inswing, Standard Sill Dimension Options: No Cut Down General Information: 7 7/8", 1 5/16",6 9/16' Panel Style: 1/2 Light Glass: Tempered Decorative Stella Black Wrought Iron Air Filled Panel Selection: Smooth,Painted,White, Painted,White Frame Selection: Clad, Pine,Oak Threshold, No Panel Reinforcement, Standard Enduraclad,White,Wood,White Hardware Options: Nickel Finish Sill Performance Information: U-Factor 0.20,SHGC 0.08,VLT 0.07,CPD PEL-M-174-02309-00001 Wrapping Information: Nail Fin, Factory Applied, No Exterior Trim, 6 9/16",7 7/8", Factory Applied, Pella Recommended Clearance, Perimeter Length= 293". Frame Size:64.5"X 81.75" ED-5-Entry Door Install w/Sidelight and/or Transom Qty 1 EAC-1 -Exterior Aluminum Capping (Coil Stock) Qty 1 EXTTRIM16 -Kick board,up to 9-1/4 Inch match ext trim PVC Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com PrinfaA nn 11/10/7n10 �,usUniet. nnsu vvniara rroject Name: vvulara Knstl su rarl( Hill Ka 5 Florence MA Order Number: 739T2LL051 Quote Number: 11989323 Line# Location: Attributes 15 Front Door Entry Systems, Storm Door Fullview Rolscreen Unhanded, 36 X 80, White Item Price Qty Ext'd Price (P390052332) $1,236.67 1 $1,236.67 1: 3680 to 81 Unhanded Storm Door PK# Frame Size: 36 X 80 (— 2048 General Information: Clad Exterior Color/ Finish: Standard Enduraclad,White Sash I Panel: 1 3/8" Extruded ls, Glass: Clear Hardware Options: Standard, Satin Nickel Viewed From Exterior Model: 3900 Wrapping Information: Perimeter Length=232". Frame Size:36"X 80" ED-8-Storm Door Install on Entry Door Qty 1 Line# Location: Attributes 20 Interior Trim Wood Products 2112 Colonial 2, Length: 96, Prefinished White. Wood Type: Pine Item Price Qty Ext'd Price $38.36 4 $153.44 1: Accessory PK# Frame Size: 1 X 1 2048 General Information: Pine,2 1/2 Colonial 2 Interior Color/Finish: Prefinished White Paint Interior Wrapping Information: Perimeter Length=0". Viewed From Exterior Frame Size:0"X 0" Line# Location: Attributes 25 _ interior TrimWood Products Stool Round 2, Length: 96, Natural Stain.Wood Type: Oak Item Price caty Ext'd Price $108.04 1 $108.04 1: Accessory PK# Frame Size: 1 X 1 2048 General Information: Oak, Stool Round 2 Interior Color/Finish: Natural Stain Interior Wrapping Information: Perimeter Length=0". Viewed From Exterior Frame Size:0"X 0" For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pellaa website at www.pella.com Printed on 11/12/2019 Contract-Detailed Page 3 of 10 t,ustomer: ensu vvinara F'roject Name: Willard Kristi 3U Nark Hill Rd S Florence MA Order Number: 739T2LL051 Quote Number: 11989323 .'roject Checklist has been reviewed Order Totals Customer Name (Please print) PelFa Sales Rep Name (Please print) Taxable Subtotal $6,091.29 Sales Tax @ 6.25% $380.71 us mer Signature Pell ales Rep Signature I/ Non-taxable Subtotal $2,053.00 fTotal $8,525.00 Date Date Deposit Received $4,262.00 Amount Due $4,263.00 tr%it Card Approval Signature For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 11/12/2019 Contract-Detailed Page 10 of 10 PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: To: 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 The Common wealth of•Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street f Boston, MA 02111 www.mass.gov/dia Workers' Compensatn Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j Please Print Le ibl Name(Business/Organization/individual): Address: _._ z-; City/State/Zi rFE q dl J0, Phone #: Are you an employer?Check t e appropriate x: Type of project(required): L. t am a employer with_J 4, am a general contractor and l employees(full and/or part-time).* lave hired the sub-contractors 6. F-1 New construction 2_❑ I am a sole proprietor or pa ner- listed on the attached sheet. 7. Remodeling ship and have no employee These sub-contractors have 8.'5 workingfor mein any ca ci employees and have workers' P �`• [No workers' comp, insurance comp.insurance. 9. ❑ Building addition. required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.[] plumbing repairs or additions myself.[ P No workers'comp, right of exemption per MG3L 12.Q Roof repairs insurance required.] c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must all: ll fill out the section below showing their workers'compensation policy information. r 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 subcontractors and state whether or not those entities have employees. 1f the sub-contractors have employees,they must provide their workers'comp,policy number. I am an emphyer that is providin workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: _t7t?._(Z{fL�i`" - td_. _�� _.......— Policy#or Self-ins.Lic.#: / � d� Expiration Date: 6Y_ Job Site Address:IQ QQd, WiV-RA S City/State/Zip.� 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-ye it 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 triolator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insu rice coverage verification. I do hereby cert'_ u er the pains and peal ' f perjury that the information provided above is true and correct. Signature: J Date: \1 1.4-,Z1 19 Phone#: Nk,-),, Official use only. Do not write in this area,to be completed by city or town official. i 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 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 etch 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 lic7ses below. Commonwealth of Massachusetts i��VC.--n—r,;u—ction'Super.Asor" Division of Professional Licensure Restricted to Board of Building Regulations and Standards . Unrestricted-Buildings of any use group which Contain less than 35.000 cubic feet(991 cubic meters)of }. ,r enclosed space CS-096558 TREVOR BROSS 10 GEORGE SIRE' i GREENFIELD MA 1r f Failure to possess a cufrsnt eddion of the Massactwsstts StMe Building Code is cause for revocation of this Scatse. Commissioner OPS Lkansing ordonnatlon v1sw WINKMASs.GOWDPS e1� oifics of Consumer Affairs&Business Regulation Registration valid for Individual use only HOME IMPROVEMENT CONTRACTOR e9 TYPE:Suoolement Card before the expiration data. if to ratum to: Realstretbn EN&A ion office of Consumer Affairs and Business Regulation 142279 03.737020 One Ashbur"Place-,26e 1301 PELLA PRODUCTS,INC. Boston, TREVOR BROSS 155 MAIN STREET Not valid without signature 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 CSS7308 Brian Thompson CS67121 Igor Kravchuk CS094911 i , 6.-R CERTIFICATE OF LIABILITY INSURANCE OATE(041201YYVV) �� 01!04/2019 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 Maureen Cormier Berkshire Insurance Group,Inc. PHONE (413)773-9913 F (413)774-3872 117 Main St E-MAIL Ext);: A1C,No ADDRESS: mcormier@berkshireinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC N Greenfield MA 01301 INSURER A. Citizens Ins.Company of Amer 31534 INSURED INSURERB: Allmerlca 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: 19GL,Auto,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. INSRwanupuaR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER MMIDDrYYYY MMIDONYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A ZBND459395 01/01/2019 01/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 r2X POLICY El PRO ❑LOC PRODUCTS-COMP/OP AGG $ ,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWND459487 01/01/2019 01/01/2020 BODILY INJURY accident $ AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (, E $ E UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION 5 I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? a N/A WHND376502 01/01/2019 01/01/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500.000 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 and 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 L.� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD