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43-033 (10) BP-2024-1258 483 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-033-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2024-1258 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2024 Contractor: License: Est.Cost: 13350 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date:03/01/2026 Use Group: Owner: PEPPARD GRAY CAROLYN &GEORGE Lot Size(sq.ft.) Zoning: WSP Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155 MAIN ST 4 1 512-5968 6H15382 GREENFIELD, MA 01301 ISSUED ON: 09/30/2024 TO PERFORM THE FOLLOWING WORK: 7 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: Final: Final: Final: Rough Frame: Gay: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: / fig Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ^o `^^ ez The Commonwealth of Massachusetts A --� O . IR sFA Board of Building Regulations d Standards 7 M• LITY ? // . .VI). 6 Massachusetts State Building Co , 780 CMR ' Building Permit Application To Construct, Repair, Re vateb emolffi a / Rev e, •',,��-! 1 `�O?� One-or Two-Family Dwelling �/ b'1•%' This Section For Official Use Only '19;`-Ti„� / �'o ce�� Building Permit Number: jQ. 37- 13S ( Date Applied: Jd ,s � �°ohs ►e--/ ab q -ay Building Official(Print Name) ature Date SECTION 1: SITE INFORMATION 1 P!Pe)rtYAdrs • 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number Zoning Informs ' 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ii) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 24L Owner'of Red: ��A C n �-e- , r<< TIC) CSz Vim. 1 Name Pn City,State,ZIP No.and Street Telephone Er►idil res SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) di Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of ProposedWork': (7 ' - c CQ(k_4f . Y\ Q LOW tYYjc k v CNA°.%/ 5 , ) <<r v19 ,'S.t c.Lt r'� )— T .cA-er - n.aq SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ / 2�'U 1. Building Permit Fee: $ Indicate how fee is determined: 1`� � ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. —H'—. heck Amount a►C) Cash Amount: 6. Total Project Cost: $ 131 �c� 0 Paid in Full 0 Outstanding B lance Due: gi'd41 if L..111 (U9 -off SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C`J_ C1 < 3 f I 1�Cf 1 4 t ,v 0 C 'U S3 License Number �l Expiration Date Name oftSl Holder List CSL Type(see below) �N- 10 e •) - S� No.and Stre Type Description C7,1 � f\ �:31.0 t '"`A AA- 0�- I U„ Unrestricted(Buildings up to 35,000 cu.ft.) �) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Li(" -Sia-3`17b farm;45 e Qit,Lecc t (os. 0-', I Insulation Telephone Emil address D Demolition 5.2 Registered Home Improvement Contractor(HIC) IPIO 45: ly�a�� �-' HIC Registration Number Expiration Date IC Company Name or HJJC gistrant Name ��• C T (.t.'tn., perti ` i 1� ��"Yr C� _C mot' o.and Street Email address —�62J2.1 1/0- CA-1 N13_SIB tty/Town,State,ZIP Telephone SECTION 6: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 O No .O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize__5O Q D to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contain • t •s application is true_aid urate to the best of my knowledge and understanding. Print Own 's or Authorized Agent's N me(Electronic Signature) Date jir8 8 ) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Docusign Envelope ID:B61A5160-74C6-40C1-687B-D2B8A6C05543 Contract - Detailed Pella Window and Door Showroom of Greenfield 155 Main Street Sales Rep Name: Rousseau, Mitchell Sales Rep Phone: 413-768-8379 Greenfield, MA 01301 Sales Rep Fax: Sales Rep E-Mail: mrousseau@pellasales.com • Customer Information Project/Delivery Address Order Information George Peppard Peppard George 483 Park Hill Rd Florence MA Quote Name: George Peppard-483 Park Hill Rd,Florence, 483 Park Hill Rd 483 Park Hill Rd Order Number: 739Z31R101 FLORENCE.MA 01062-9750 Lot# Quote Number: 18545719 Primary Phone:(413)5879750 Florence,MA 01062 Order Type: Installed Sales Mobile Phone: County: Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: peppardgray@gmail.com Quoted Date: 8/15/2024 Great Plains#: 52H5879750 Customer Number: 1007950346 Customer Account: 1003895811 Customer Notes: Total purchase price with installation:$13,350.00 Split into two payments.$6,675 due at contract and$6,360 due at installation Line# Location: Attributes 10 2F Northeast corner Impervia, Double Hung, 33 X 49,White Item Price Qty Ext'd Price S2.008.39 3 S6,025.17 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 33 X 49 2173 General Information: Standard,Duracast®,Block,Foam Insulated,3", 1 11/16" Q Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E NaturalSun+Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Full Screen. InView'"" Performance Information: U-Factor 0.24,SHGC 0.48,VLT 0.58,CPD PEL-N-1 26-01 539-00001,Performance Class LC, PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,STC 26,OITC 22,Clear Opening Width 28.875,Clear Opening Height 20.75,Clear Opening Area 4.160807, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance,Perimeter Length=164". Frame Size:33"X 49" For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 8/16/2024 Contract-Detailed Page 1 of 8 Docusign Envelope ID:B61A5160-74C6-40C1-687B-D2B8A6C05543 lauswrmer. Leurye repparu rroleet Name: Peppard George 483 Park Hill Rd Florence MA Order Number: 739Z31R101 Quote Number: 18545719 PF-1 -Interior Pocket Installation Qty 1 EXTTRIMIO-PVC Ripped for stops Qty 2 Line# Location: Attributes 15 2F Southeast corner Impervia, Double Hung, 33 X 49,White Item Price Qty Ext'd Price S2,008.39 4 S8,033.56 1: Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 33 X 49 2173 General Information: Standard,Duracast®, Block,Foam Insulated,3", 1 11/16" 4 Exterior Color/Finish: White Interior Color/Finish: White 1 Glass: Insulated Low-E NaturalSun+Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Full Screen, InViewTm Performance Information: U-Factor 0.24,SHGC 0.48,VLT 0.58,CPD PEL-N-126-01539-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30, Calculated Negative DP Rating 30.STC 26,OITC 22,Clear Opening Width 28.875,Clear Opening Height 20.75,Clear Opening Area 4.160807, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: No Exterior Trim,Pella Recommended Clearance.Perimeter Length= 164". Frame Size:33"X 49" PF-1 -Interior Pocket Installation Qty 1 EXTTRIMIO-PVC Ripped for stops Qty 2 Line# Location: Attributes 20 Ext Sill 2HS-2 Inch PVC Historic Sill Item Price Qty Ext'd Price $135.00 1 $135.00 For more information regarding the finishing, maintenance,service and warranty of all Pella@ products,visit the Pella®website at www.pella.com Printed on 8/16/2024 Contract-Detailed Page 2 of 8 Docusign Envelope ID:B61A5160-74C6-40C1-B87B-D2B8A6C05543 .usturner: .eorge repparu rroiect',lame: Peppard George 483 Park Hill Rd Florence MA Order Number: 739Z3IR101 Quote Number: 18545719 George Peppard Mitchell Rousseau Order Totals Cust�w me�Nance (Please print) Pella Sales Rep Name (Please print) Taxable Subtotal $9,603.76 r— Igned ,-8Wn.d by .��.-.. di `�f i t to 1:1 �, lebttiSSt,alti Sales Tax @ 6.25% $600.24 6-ast9'i4@R ilk Pella-S@ RWSWature Non-taxable Subtotal $3,146.00 8/16/2024 8/16/2024 Total $13,350.00 D -oocusigned by Date Deposit Received $0.00 ,-D-w ou Qii Amount Due $13,350.00 CiitgfauArirMal 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 8/16/2024 Contract-Detailed Page 8 of 8 Docusign Envelope ID:B61A5160-74C6-40C1-B87B-D288A6C05543 Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: George Peppard _ , 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; 483 Park Hill Rd Florence, MA, 01062 Please accept this letter in place of my signature on the permit application. Thank you, DocuSign¢d by: Signature: r "� �' . f `—D 160250c 1 E83440 Date: 8/16/2024 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations —" 1- > II 11, Lafayette City Center ' 2 Avenue de Lafayette, Boston, MA 02111-1750 liar ' 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 st City/State/Zip:Greenfield MA. 01301 Phone#:413-774-7231 Are you an employer? Check the appropriate box: Type of project(required): I.11] I am a employer with 70 4. ❑ 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 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p �' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 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 Company Policy#or Self-ins. Lic. #:6H 15382 Expiration Date: 1/1/2025 Job Site Address: 483 Park Hill Rd City/State/Zip:Florence, MA 01062 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 de'the pains and penal ' f perjury that the information provided above is true and correct. Signature: Date: 9/4/24 Phone#: 413-51 5968 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 21:1 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 51:1Plumbing Inspector 6.DOther Contact Person: Phone#: City of Northampton i „, 5\S • • SACMassachusetts ��?•' =-- '<<.f c m• N t DEPARTMENT OF BUILDING INSPECTIONS y, //'�- 212 Main Street • Municipal Building J. ca 4 Northampton, MA 01060 r W�� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 1 � C(.,� ( • C.-1, CQQVl OkAd c JAA oi30 The debris will be transported by: Name of Hauler: ` Ocui/Q Y 1 \CCv\cie,1/V��� Signature of Applicant: ;k c Date: PELLPRO-01 CHRISTINE '4`oRo CERTIFICATE OF LIABILITY INSURANCE D 12i14/2 ATE ) 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 C ,cT Christine Sullivan Phillips Insurance Agency,Inc. PHONE 413 594-5984 F 413 592-8499 97 Center Street Imo.No :( (A/C,No):( ) Chicopee, MA 01013 Ms&christine@philllpsInsurance.com INSURER(S)AFFORDING COVERAGE NAIC INSURER A:EMC Insurance Companies 21415 _ INSURED INSURER B:EMCASCO Insurance Co 21407 Pella Products,Inc INSURERC: 155 Main St INSURERD: 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. TYPE OF INSURANCE BA 6D WM POLICY NUMBER Offiypp/yYYYYY) I DO/YYYTY) LIMITS A X I COMMERCIAL GENERAL.LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE L- OCCUR 6A15382 1/1/2024 1/1/2025 DAMAGE To RENTED 500,000 PREMISES(Ee occurrence) $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEM AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A AUTOMOBILE LABILITY (Ea COMBINED SINGLE INGLE LIMIT $ 1,000,000 X ANY AUTO �p(� 6Z15382 1/1/2024 1/1/2025 BODILY INJURY ee.r person) $ _ AURT�OpS ONLY _ NASCHEDULED UUTµOpSyy��p pBOODILY INJURY(Per accident) $ — AUTOS ONLY ____ Sege (Perraaccidenl) $ — 1 A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LAB CLAIMS-MADE 6J15382 1/1/2024 1/1/2025 AGGREGATE $ 4,000,000 DED X RETENTION S 10,000 $ B OTH- WORKERSXSUMOS'LIABILITY AT ER ANY PROPRIETORIPARTNER/EXECUTIVE Y/N 6H15382 1/1/2024 1/1/2025 El.EACH ACCIDENT $ 500,000 MFICER/MEMBER EXCLUDED'/ N N I A andatory 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) Installation Floater$100,000 Included Operations usual to the sale and Installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Florence(Northampton)BuildingCommissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( P ) ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington:S,treet-Suite 710 Boston.Massachusetts 02118 Home Improvement Contrartl .Registration Type: Supplement Card .Registration: 142279 'ELLA PRODUCTS.INC. Expiration: 03f2312026 '55 MAIN STREET - GREENFIELD,MA 01301 Update Address and Return Cord. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the liOME IMPROVEMENT CONTRACTOR expiration dote. If found return to: TYPE:Supplernen;Cord Office of Consumer Atfa a andddusiness Regulation RegUlcatlod EERf..dlsII 1000 Washingt��t-Ste 710 '42270 03l23,20Fv Boston.MA\ ! PELLA PRODUCTS.INC. TREVOR GROSS 155 AWN STREET - '" GREENFIELD.MA 01301 - Undersecretary ki without signature C+' Commonwealth of Massachusetts Construction Supervisor �s Division of Occupational Licensure Unrestricted-Buildings of any use group which contain less than Board of Building Regulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. Cons Refutations CS-096558 spires:03/0112026 TREVOR BR9SS - ^, 10 GEORGEaTREET 4 GREENFIELDJMA 0 2 . 0 ? O!LVdt10P b tOti71 YF Failure to possess a current edition of the Massachusetts State ti Building Code is cause for revocation of this license. Commissioner E1 / sue_ Contact OPSI:(617)727-3200 or visit www.mass.gov/dpllopsi