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04-004 (2) BP- 2010 -0420 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) C atet,ory: BUILDING PERMIT Permit # BP- 2010 -0420 Project # JS- 2010- 000572 Est. Cost: $33182.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 81021 .60 Owner: KELLIHER PAUL G & JOANNE F Zoning: RR(100)8WSP Applicant: PELLA PRODUCTS, INC AT. 520 AUDUBON RD Applicant Address: Phone: Insurance: 240 MOHAWK TRAIL (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON. 1011912009 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/19/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 - 1240 Fax 413 - 587 - 1272 Plot(Site Plans Ether Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION a y 1.1 Property Address This section to be completed by office 64 I/- v,6, J b C n VZA ° Map Lot Unit L'e -e & 0 v S Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: f29 n Name (Print) C Mailing Address: Telephone Signature 2.2 Authorized A ent: e (IC � /u)(JA -kL( -rtIr. l hCLU c� �'. (cJh;f C I' � �"✓�iE � ,� JF - G, ee.gC,eyd tY) Name (Print) /'� � (� ^` / , Current Mailing Address: � L4 13• 17d (61 3 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2+3+4+5) „Z Check Number This Section For Official Use Onl Building Permit Number: Date Issued: Signature: 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 p arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO ® DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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 ® NO 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 ❑ Replacement vindows Alteration(s) Roofing Q Or Doors 10 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other [d] Brief Description of Proposed Work: Cella Le - (`� �tnd � � 1 ! 5IC&0 i r1 �IC�'�i -�,,� ;g ��n /�0 &.; y&J efc,ir of T— 1 U / �fun�e�/a: IGoeceSS J r Alteration of existing bedroom Yes _/ No Adding new bedroom Yes �/ No Attached Narrative Renovating unfinished basement Yes _� No Plans Attached Roll - Sheet Ga. If New house and or addition to existing housing, complete the following: 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, &(,L Ke fC i h e as Owner of the subject property hereby authorize �e (((1 �� r�ci.t �tf5 -f no. to act on my behalf, in all matters relative to work authoriz d by this building permit application. Signature of Owner Date I, / C fla J A L C(4�c(5 _i{'l(' I,l� .C� ( . Wk, 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. Si ned under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date ` SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction S Supervisor : Not Applicable ❑ Name of License Holder : �� > /t. l_i fk l t!iJ h , 14Q co License Rumber UH "/ -r4 Address / t —� Expiration Date 0 Q hi , Gt_�.I,4. � 11 - 774 0153 Signature Telephone 9. a Istered Home Im provement Contractor. Not Applicable ❑ C_ 116 ( 1 L' CLu-( t 5 E1142 / L - f .).) - 7 9 Company Name Registration Number Address ^ _ ^ Telephone 4t Expiration Date 3-77� �t c� �3 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....... No...... ❑ 11. - Home Owner Exemption 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. Definition 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 PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 y D �- Pl ot- &GA_rn �en C 1 a / a n ; � I Z o o (� rk(�, r11 A U I y (o O Subject: Disposal of Debris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc. in your Town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, PELLA PRODUCTS INC. John P. Benjamin Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone. -4 I _ _%7?_o ► Yo: [ uilciilI" lI)SP C10I 1= rom: 17av id iVhite - Installation ,'VlaliaLm Date: Jmlllar` 11), 200() St'1i.1tu�"1': Building Permit applications & Designees fell l'r {)il let ; Incorporated is in the hil"Iliess ol ti`indor�s aml Cl oolr fo mll customers. ()ur process Includes pro\ (ding a building permit tOi C_' Ich a nd C\ crV protect. 1 a3)1 a licensed C `onstructioil Supel - N Isor. RulldinI Pei ts v� I'll be applied IIIv CSL 09 -1 6 and mlr I If(." l -j Ple;,Se fill(i �i Co p� ()f ln� licen -'es l)Qdo�\ . �) t`�:k`) YY.i'[I+ E3a IY ;rY`irrtt•nl +YI Public 4.110 NNW RoSLrfGMtl la: OO R .Mr1 .d Builslin fta•:;ulatY. +tY..ued Vaud.ira+ ". t34C'UC tin f) S0(N!r t Llrkrt'rlrimd Lwon 12: JT41A If; - 1 2 FAM fly I&treea Resttirlwl to kb DAVID C 'WHITE 64 G4R;:IENTER ST FMilure w p+nsn>, r current rdltlun or the Ma-% choetts S1 *tq Building Code ORANGE NIA 01364 Is (Must for re 44 thin license. Referlrl: www.M :ss.Gm i0pS 1:dtcl) illstallatioll \ \II1 be staffed b\ our installers ��ho are all licensed II) 1CC 0I , dilrlcC \% iI II clll b�li ld'ii coitus. Follm ink are C c)pic s of , the , r Currel)t licellscs. Please accept these indi\ ideals as Ins Deslt -111ees. 11 t oil Jm\ ` Im Cluestioll please Contact me using- the uliniber s listed aho\ e. PAGE 01101 PELLA PRODUCTS INC jt,/04/2009 11:17 4137363350 1 he Commonweauh oflMassachusetts Department of Industrial Accidents Office of Investigations 606 Washington Street Boston, MA 02111 www.mass govldia Workers' Compensation insurance Affidavit: Builders /Conn ractorsfl&leetriciansiplumbears Applicant Information Please Xriut L 'lil Name ( Business /Otsanization/lndividual):� J Addzcss:��� /,Sa r City /State/Zip Mao #: P6.Are you an employer? Cbeck the appropriate box: pe of project ( requirted): 7 Picsuodelin 4, I ara a general cofltractor and I - 1. Z arty a employer with �] NGW C4AStractiOA employees (£ill, and/or part-time).*- have hired the sub- coatracton 2. [] I am a sole proprietor or partaer- listed on the attached sbect ❑ g ship and have no employees These sub - contractors }nave $, [] Demolition working for me in any capacity. ttloyees and have workers' 9. a Building addition [No workers' comp. izisuratnce comp. insurance zecluircd.] 5- (� W e are a corporation and its ( 0.{3 Electrical repairs or additions 3. (� I amt a homeowner doing all work o - Meets have exercised #hear 1 ] .[] plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.) *Any applio mt that checks box 91 must also fill out the section below showing their, weckors' roagw- Mation policy inf4rtr>: dML t liormowners who submit this affidavit indicating they am doing all work and then Hire outside wntractm must aubrnit a new affidavit indiGa6ag such• - Contractors that cheek this box must attached an additional sheet showing the none of rho sub- wnw- tetots and stage whether or not d0w- een6tiet hat's employees. If the sub - contractors have anployecs, they must provide dtcir workers' corny. policy number. X ace an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Corttpany Name- 4�1G4'cli 1�► T. r : A • C Policy # or SelMM. 4 4 — � Expuatiorr Date: 4 I ' f1 ` �7d / C� Job Site Address: City /Statel7.ip. Attach a copy of the workers' coanpezrsatiort policy drelarat3an page (sinowvJug the policy.lnumber and expiration date) -' Failure to secure coverage as required under Section 25.A of MCI.0.152 can lead to the imposition of a6winal Penalties of a £'ice up to $1,300.00 and/or one -year iznprisonznmt, as well as civil penalties itt the foam 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 DLk for insurance coverage verification. .i do hereby cc u der the pains and penalties of ped ury that the information provided above is true and DEC b L008 e �3— �• .dl c2 Official rase only. Do not write in this area, to be completed by illy or town officiaL City or Town: PertnitlL,icense # Issuing Authority (circle one): L Board of Uealth 2. Building Department 3. City/Town Clerk 4, Electrical Inspector 5. )?luznbing Inspector 6. other Contact Person: Phone #: FROM Berkshire Insurar-- Group <PRI)OCT 2 ZOOS 14:34/ST.14:ZSZH- .752731SSS1 P 3 o a n m D y D D-1A N F' H 0 z 1 1 ro H 0 T O � y N x m x K m H m �' K H w p N '� _ y GJmOm N to H r p N � m N ®owro n o f m� my �yCmg ro w M trl w p m m y m° z S� Zo oA y x k k c X o >< o r�nmm to 0 M N% C m p w C 7i S ®9 << N c A m ° �' z o n ° o> o z �m ~ O 91 m 0 Q pl m m 0 W D c ' " rt G w fr w i O F ' Q ry zp AA mm n p 3 C m Q O z c a A r< ND AZ H m m o Y m pi:� o_ _ o N m o ip�c m t* m M J i m r o 0 o n a o A o D n u.:� R 7 w n p W gym, O m ° m f'71M n v o pm H m e n Kmor p n Y X Wa z v gg 33 w �{ ❑c urio b Y o M ° '71 f N a n < W o mmcc ° W r o 0 oN0< T� N N C) f ] W O . m N y m 0 (jam N W j O o DOAC m r s O M v am mA �zo� 00 A N u - m GN z O c O z - z Z ' O p D A C qoz= >Mm m mo < ' mo w w ft V' my C) O n = 2p z 00 m m m o c OX > A, m n< r p z n c No Ix un a z m mlm Z 3 m o 0 0 0a° Sur rt 41 Ozm_ - � w c��aN m m o oY y nxn N 0 m1 > c° c �o 00 ° n 3 poi oA m Om m y c o m p our o m� - �° um o f m 3 >i IZiirm rt L) A p0 y ° z o m _ < z 9 ymo n �o n m m0G1D "o omo py�m z m m D Z > _ 3 g m M? on , O J m m y o m l - s ° _ a t om-i m i - o n m c V n Z O > r O zNZ z oc A n g o m r Nco O ? �Zio O z m po O °mr A F u m- z ~ ° n x � < = s m CAVx m i - \m D V o ur m N N N N N =y mtiyP N o •'� v N lT N O 0 0 0 w 0 A OZT O O 0 O O, O • rn 3s ' CO) m a T C0 T � LL t6 a c o C1 o O LL p � �i v �•�, Z' o ' o G o, °' • >�_ � m r- Q ca LU � 3 co Q y m m m� m m U Q O = 8 � S Q C D� O N N o r vi cA ti c o ci y CL rn 0. � a V c a ro 00 o N CS N C a, Soo n 0 O. %V d:.. a I Rp '�CO m T o c c 3 � � . 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