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31A-046 (2) 253 CRESCENT ST BP-2020-0995 GIS#: COMMONWEALTH OF MASSACHUSETTS MapBlock:3 1 A-046 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-2020-0995 Proiect# JS-2020-001684 Est.Cost: Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sc. ft.): 6969.60 Owner: ELLEN M Zoning_URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 253 CRESCENT ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:3/5/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACING 6 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 Shmature: FeeType: Date Paid: Amount: Building 3/5/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r- {/ Department use only City of Northampton�` `'��V� Status of Permit: Building Department G 9larb Cut/Driveway Permit ' 212 Main Street#4 ewer/septic Availability Room 1QQ �Q ateoWell Availability /at 20 Northampton, AI(R TwoAets of Structural Plans phone 413-587-1240 >=ax_4"1 �f ��'( 2 Plo Rite Plans Otl er 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 �S3 6Ce5iCAdF Map (31/yLot Q '� Unit �loc�t�-,a 'racy MA ®lC6C Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: 'telephone Signature 2.2 Authorized Agent: T6--"10C ss 10 Name(Prin 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 '1 7 DT-i.OG (a) Building Permit Fee 2. Electrical Q (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 44 4. Mechanical (HVAC) 5. Fire Protection 0 6. Total=0 +2+3+4+5) & 7 OQ Check Number �f This Section For Official Use Only Building Permit Numb r: �' �v.7,s Date Issued: Signature: Building Commissioner/Inspector of Buildings Date �b �s \lasales.�o�, EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 C) DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) —ff7 New House ❑ Addition EJReplacement Windows Alteration(s) Roofing ❑ Or Doors 110 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[O] Other[O] Brief D scription of Proposed Work:Y)Q0 ,(-;n5 Alteration of existing bedroom Yes No Adding new bedroom Yes K) No Attached Narrative Renovating unfinished basement Yes _>�p No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing complete the following: I A 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, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 1 Cev p(, 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. 1 op-'I r Print Nam Signature o wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: C 5 - CR(C,,CA License Number Address Expiration Date <yi3)77�-AG7"Aj•7 Signature elephone 9.Registered Home Improvement Contractor: Not Applicable ❑ ?z��a P(,0au6s, ter, C. ►u aa�9 Company Name Registration Number 'IGC3 ,C Q ,��adl�A �� � ©-3 / a3 IaC,-ao Address Expiration Date Telephoncu C,,1 31-7 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....... 0 No...... ❑ 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: February 21, 2021 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. <Cwrirn nwveattn at mas%AIGnufietis Construction Supervisor C1avn,ion of Professional Lrc"skure Unrestricted-Bulk kvp of any use grow which contain Board M Building R"tions s arse#standwds less than 38,000 ct ("I cubic meters)of enclosed x�`�r�s$ ztigb�: xpece.-, CS-096558 �s 0310112022 TREVOR BR999 10 CtEC+R- GREENF�b A r M Failure to posse"a curiold edttida of the StBta Building+Gtr is Cid?fibM't '�,, +wozrrr»issiotl 1t 7tlab i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supotement Card before the expiration date, it found return to: B"istration Exniraum Office of Consumer Affa and Business Regulation 142279 0312$2020 One Ashburt Place. a 1341 PELLA PRODUCTS,INC. Boston' TREVOR BRO55 r�G 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 Christian Lambert CS065102 Robert Kairnes CS113305 Igor Kravchuk CS094911 The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PELLA PRODUCTS, INC Address: 155 MAIN STREE City/State/Zip:GREENFIELD, MA 01301 Phone#:413-772-0153 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 50 4. 0 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. Q Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y P n'• = 10. Electrical re 9. E]Building addition [No workers' comp. insurance comp. insurance. airs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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: EMC INSURANCE COMPANIES Policy#or Self-ins. Lic.#:6H 15382 Expiration Date:01-01-2021 Job Site Address: City/State/Zip: ]�C—*)ck OI&3,3 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 certify under The pains and penalties erjury that the information provided above is true and correct Si ature: If Date: a a7 a.4 Phone#: Nck- Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.MOther Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: To: C' o� Nc�c „r., 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 PELLPRO-01 CHRISTINE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY) 1/8/2020 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(les)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 endorsements). PRODUCER WUJACT Christine Sullivan Phillips Insurance Agency,Inc. PHONE -- FAX - - 97 Center Street AJC,No,Et):(413)594-5984 IAS No):(413)592-8499 Chicopee,MA 01013 ss:christine@phillipsinsurance.com INSURER(S)AFFORDINGCOVERAGE __ NAIC 0 _-_ INSURER A:EMC Insurance Companies 21415__ INSURED INSURERB: -- Pella Products,Inc INSURE RC: 155 Main St INSURER D: Greenfield,MA 01301 - - — -- INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER: 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 i TYPE OF INSURANCE INSO SUER POLICY NUMBER D/YY POLICY EFF LTR POLICY EXP LIMITS A X !COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 -- —------- -- CLAIMS-MADE LXJ OCCUR SA15382 1/1/2020 1/1/2021 DAMAGE TO AMAsETO REo_oa_Tirrence) 3- 500,000 MED EXPAA,ny onepwsoni_ -$ - - - 10,000 -- - - --- ------ PERSONAL&ADV INJURY i$ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. _ I$__-- 2,000,000 X POLICY X T LOC PRODUCTS_COMP/OP AGG $ 2,000,000 OTHER: OWNED (Ea aca ED ent) LE LIMIT 1,000,000 Eaatudenq __- _ $ 6Z15382 1/1/2020 1/1/2021 BODILY INJURY(Perperson) .S _ LIABILITY X ANY AUTO � SCHEDULED AUTOS ONLY AUTOS BODILY INJURY�er aocldent $_ HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY (Peraccident)__ __ _ S $ A X UMBRELLA LIAB X OCCUR 4,000,000 I_EACH OCCURRENCE _ _$___._- _ EXCESS UAB CLAIMS-MADE 16J15382 1/1/2020 1/1/2021 4,000,000 AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY -__�S_T.AT�TF-L-1.F.R_.. ANY PROPRIETOR/PARTNER/EXECUTNE YIN 6H15382 1/1/2020 1/1/2021 E.L.EACH ACCIDENT _ $ 500,000 OFFICER/ME(Mandatory NH)EXCLUDED? C� NIA SOO,000 (Mandatory in and E,L.DISEASE=EA EMPLOYE_..$_ yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&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 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:88FA9B9C-69D7-4CCC-87A0-98FB931496D4 Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski, Adam 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 Ellen Augarten Augarten Ellen 253 Crescent Street Northampton MA Quote Name: 2427759 Lifestyle and 250 Series 413-320-7234 253 Crescent Street 253 Crescent Street Order Number: 7391.12CL031 NORTHAMPTON, MA 01060 Lot# Quote Number: 12184348 Primary Phone: (413)586-6813 NORTHAMPTON, MA 01060 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: Quoted Date: 12/31/2019 Great Plains#: 1001067970 Customer Number: 1004473888 Customer Account: 1001067970 line# Location: Attributes 10 Stairs Lifestyle, Awning Vent, 22.5 X 22.5, White Item Price Qty Ext'd Price 7 $1,456.22 $4,368.66 1: Non-Standard SizeNon-Standard Size Vent Awning PK# Frame Size: 22 1/2 X 22 1/2 IA, x 2050 General Information: No Package,Without Hinged Glass Panel,Clad, Pine,5",3 11/16" CN Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Wash Hinge Hardware,Fold-Away Crank,Brown,No Limited Opening Hardware,No Integrated Sensor,Left Jamb Viewed From Exterior Screen: Full Screen,Bright White, InViewTM Performance Information: SHGC 0.27,VLT 0.51,CPD PEL-N-37-00472-00001, Performance Class LC, PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08111, Egress Not Applicable Grille: No Grille, Wrapping Information: No Exterior Trim, 3 11/16",5", Factory Applied, Pella Recommended Clearance, Perimeter Length=90". Frame Size:22.5"X 22.5' AC-9133-OTHER-3 Qty 1 MP-4A-1 Wide Modified Pocket Install ADD PVC Value Add Qty 1 EXTTRIM20-5/4 X 6 Exterior Style 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 Printed on 2/25/2020 Contract-Detailed Paqe 1 of 8 DocuSig [ meeeuyaBc-69D7accC-87Ao-9sF693149sD�Ousoi: tn Aeeci game: Augarten Ellen 253 Crescent Street Northampton Order Number: 739U2CL031 Quote Number: 12184348 MA Line# Location: Attributes 11 Stairs INSTALLATION - INSTALLATION Item Price Qty Ext'd Price $95.00 1 $95.00 LP-1 -Lead safe practices this opening Qty 1 Line# Location: Attributes 15 Bedroom Lifestyle, Awning Vent, 22.5 X 22.5, White Item Price Qty Ext'd Price 7 $1,353.06 / !_ $4,059.18 1: Non-Standard SizeNon-Standard Size Vent Awning PK# Frame Size: 22 1/2 X 22 1/2 1 2050 General Information: No Package,Without Hinged Glass Panel,Clad,Pine, 5",3 11/16" r Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Wash Hinge Hardware, Fold-Away Crank,Brown,No Limited Opening Hardware,No Integrated Sensor, Left Jamb Viewed From Exterior Screen: Full Screen,Bright White, InViewTM Performance Information ,SHGC 0.27,VLT 0.51,CPD PEL-N-37-00468-00001, Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP ating 50,Year Rated 08111, Egress Not Applicable Grille: No Grille, Wrapping Information: No Exterior Trim,3 11/16",5", Factory Applied,Pella Recommended Clearance,Perimeter Length=90". Frame Size:22.5"X 22.5' MP-4A-1 Wide Modified Pocket Install ADD PVC Value Add Qty 1 EXTTRIM20-5/4 X 6 Exterior Style PVC Qty 1 AC-9133-OTHER-3 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 2/25/2020 Contract-Detailed Paqe 2 of 8 DocuSig stepeu ugaeec-ssD7accc-s7Ao-saFBss1assD�tomtn mrtect(Jame: Augarten Ellen 253 Crescent Street Northampton Order Number: 7391.12CL031 Quote Number: 12184348 MA ❑Project Checklist has been reviewed Ellen Augarten Adam Lukomski Order Totals Customer Name (Please print) Pella Sales Rep Name (Please print) Docus,gned by: Taxable Subtotal $2,839.53 DocuSigned by: EQh/�.rignatu`re Sales Tax@ 6.25% $177.47 4DA se'i�a�;�zep Signature 2/25/2020 2/25/2020 Non-taxable Subtotal $4,257.00 Date Total $7,274.00 DocuSSignedby: Date Deposit Received $3,537.00 fit �Approval Amount Due $3,737.00 aoA&cWi 0 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 2/25/2020 Contract-Detailed Paqe 8 of 8 DocuSign Envelope ID:88FA9B9C-69D7-4CCC-87A0-98FB931496D4 Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: Ellen Augarten , as property owner, give permission to our contractor, Pella Products Inc. to obtain a building permit for the installation of windows and/or doors in my home. Located at; 253 Crescent St Northampton, MA 01060 Please accept this letter in place of my signature on the permit application. Thank you, DOCUSigned by: Signature: f a 4DA4A904B29A404.. Date: 2/25/2020