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24C-168 . . , , . Future Sample Pre-Renovation Form Ihisoun tot ni mcy be used by rr300\ation tirnis to document compliance with t |eJam|p aec pant Cno1inmatioo , Receipt | have rere"ew pamphlet .mo potential risk or the lead hazard exposure from renovation actvry to be pemnnn*din my dwelling unit. \ received this pamphlet before the work began. Owner-occupant Opt-out Acknouv\ad0nnont (] Ko I nonhnn that I own and li''u in this properly, that no child under the age o|(3 resides oere. that no pregnant vvomaneyWeohe,o.andtxu\V/\yp^zortvisncxa child-occupied |ocUit» Note: x child resides k` the h residence o| his o, her custodial parents, legal guardians, foster parents, or irtforrnal caretaker ir the child lives and sleeps i nost of the moo at the, caretaker's es|cleoca. • . Note: AoW|d'noo:moUWuN\y/u Udi g isX�1 regrktrly bythe e 4 il d, under (3 years of age, on at lasi two difterait days within city week, for at lasl: .3 ticji.iro each clay. providd that the visits total at least GO hours annually. . nun m checked. check oxhe Box aur Box C.b�not both. • C G } |/a.|ucmi (heiVvemnovaVw�Unn uanUvy |va�'na�vwmkpect|cas byEFA'sAanomtioo. Repair; and Pai * Rule; or Op|m'der$md that the lit n" t*iorIb1lfl13 the rlrioVilliOln will flot tIc required to use 1:110 lee-sale work praetic eu . • .,___Air 4_ .____. _______,__________ ^/ '.41i,e...'.._ ___L | - .' , i9i ur ire of Oig/taium[Xate Rent.. vator's Belt Certification Option (for tenant-occupied dwellings only) histructions to Renovator: It the le:3cl lia;:ard information pamphlet was delivered [Air utenant siqnati ire wi-is tot obiwnable, you niay check' the appropi lie box below. Q Declined I cortily 'that I have made a good good taiUl elton to deliver the lead hazard information pamphlet '- the rental dwelling unit listed below -' the date and time indicated and that the occupant declined to sign the conlirmation of receipt. I further certify that I have left a copy ot l:lie pamphlet Sit this Unit with ih oct'upsirt 0 Unavailable tor signature - certify that | have made a good |attheffort to deliver . the lead hazmd information paniphlet to the rental dwelling unit listed below andthat |k* occupant was unavailalloio:;iyn the confirmation o[racwpt.. certify that i have left a copy of the pamphlet at the unit by sliding it under thG door or by ifill in how pamphlet was !*N. . ` . Printed Name (d Pamon Cm��og - Attempted Delivery Date .. Sig/xaruew Person Certifying LeadPal liphlci [xalivery unit Address Note Regarding m As an alternative to delivery in person, you may moU thm maon��mo 000nnmmn pamphlet to ow ox andlor le`om be mailed at least seven dove bmwemnovation. Mailing must be documented byu certificate Nmailing o curl the post office, Ncue: . form w not effective until �pmoo1U. • Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 3014091 Lead Safe Installation Customer Performance Expectations In order to ensure a proper Lead Safe Installation, it is essential that we have you complete the below tasks prior to your installation: ,ALL furniture needs to be moved at least 8 feet away from any window or door being replaced E(ALL personal items, wall hangings, and collectibles must be removed prior to your installation date All blinds and any interior window treatments need to be removed prior to your installation date A ny non - movable furniture (for example: pianos, entertainment centers, built in cabinets, etc) must be cleared of items and be surface dusted prior to installation You will be responsible for replacing all furniture and personal items after your installation .Other items: What to Expect the Containment/Work Area to Look Like order to ensure your safety, we will be taking measures to minimize dust / debris does not spread beyond our work area. This may include the use of plastic sheeting on the floors and /or walls, caution signs, sealing of heating and cooling air vents, and asking that you turn off your HVAC system during our work. During your Lead Safe Installation, you may also see your installation professional wearing Personal Protection Equipment. K For your own safety, we are not permitted to allow you inside the work area during the removal of your current product or the installation of your new windows / doors. By signing the form below, I am affirming that I understand all the expectations noted above and that I have agreed to have all items completed prior to my installation commencing. I understand that failure to have these items completed will result in the re- scheduling of my installation and that my installation date will be scheduled for the next available date. Ifht Cu Comer Signature Date For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com n., i -- oi4nP1ne4 i. a n i ,i a n An .s 44 Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 3014091 Remove interior or exterior stops, install new window in existing sash opening, re -use existing or replace window stops (interior or exterior). Glass loss will occur. Lead Paint Discloser: 1. > Home was built prior to 1978, Pre Renovation Form signed and "Protecting Your Family From Lead in Your Home" brochure has been given to the Home Owner, 2. Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will Authorize install of Yard Sign on 1st day of installation and remove 7 days afterward Finish (paint or stain) product purchased: Trim will be painted by customer _X_ Ensure someone over age 18 is present at all times while Pella Employees are in the home _X_ Cut -back or tie trees, bushes, shrubs from exterior wall _X_ Arrange to have alarm system disconnected and reconnected - Pella Products can re -route alarm wires but can not reconnect contacts _X_ Arrange to have any plumbing or electrical repairs or changes by appropriate licensed contractor - $500 charge for site unprepared on 1 day job X Remove and reinstall existing window treatments, wall hangings and air conditioning units - 4 -5 feet in front / 1 foot to side with clear path _X_ Remove and reposition furniture in work area _X_ Secure pets in a safe manner X Remove valuable / breakable items from work area X_ Remove snow from area of worksite if necessary _X_ Deliver and unload products _X_ Place drop cloths in work areas _X_ Remove and reinstall interior and exterior trim if applicable _X_ Remove and reinstall existing shutters and awnings by contract _X_ Remove existing product and adjust or modify opening as needed _X_ Provide all equipment necessary to install products X Cut all wood and other materials outside of home _X_ Install all products purchased _X_ Insulate and caulk around products _X_ Remove stickers and perform initial cleaning of all glass surfaces _X_ Demonstrate proper operation of products _X_ Confirm that all products are in working order _X_ Remove drop cloths, vacuum and remove all old products from premises ,1 Signature: / For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com o M n F7n 4 e n „i. a n i a a n.,,.,. 7 4 Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 3014091 may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitration, this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute conceming this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A Owner: Contractor: Notice: The signatures of the parties above apply only to the agreement of the parties to altemate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. Site Responsibilities 1. 50% Deposit required at time of order. 2. Final payment is to be made to installation team on the morning of the last day of installation. 3. If the customer will not be present at time of install, payment is to be made prior. 4. Checks retumed NSF will be assessed a fee of $50.00 to cover fees incurred by Pella. Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5. Due to inclement weather or site conditions, it may be necessary to reschedule. 6. We cannot and will not guarantee specific dates or days of the week for installation. 7. Time given to complete a job is an estimate, extension of time is possible. 8. An install appointment will be confirmed at Verification. A courtesy reminder cal will be placed 1 week prior. 9. Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10. Substantial completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 11. In the even that any products are unable to be installed, the final payment will be recalculated. The cost of the products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost of products not installed as • scheduled will be due upon final completion. 12. Order is not binding until approved by Pella Products management. 13. Pella will secure all necessary Building Permits. Type of Installation: New Construction: (tear out installation - existing frame is disposed of) Remove interior and exterior Trim, remove existing window frame, install new window in rough opening, trim both interior and exterior of window / door. Pocket Install: (sash replacement, existing frame remains) For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com n.o a 0 /.l(P n .le r i. n i ;i r n...... c .,r 44 Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 3014091 Line # Location: Attributes 55 Site Responsibilities Qty 1 Customer Notes: HOMEOWNER - FOR YOUR INFORMATION LEGAL CONTRACT REQUIREMENTS FOR HOME IMPROVEMENT CONTRACTORS IS DETAILED BELOW THIS SITE RESPONSIBILITIES FORM IS PART OF YOUR CONTRACT WITH PELLA PRODUCTS INC. 155 MAIN STREET, GREENFIELD, MA 01301 HOME IMPROVEMENT CONTRACTOR REGISTRATION # 142279 EXP. 3 -24 -12 FEDERAL TAX ID #: 04- 2303271 The law requires the following fourteen items to be included in any contract between the homeowner and a registered home improvement contractor in all contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the owner and a clear description of any other documents which are part of the agreement. 2. The full names, federal ID, addresses (not PO box #'s) of the parties, the contractor's registration number, the names(s) of the sales person(s)) involved, if any and the date the contract was executed by the parties 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4. A detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract. 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, including all finance charges, if any. Any deposit required to be paid in advance of the start of the work shall not exceed one -third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature, which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7. All parties must sign the contract. 8. There shall be a clear and conspicuous notice stating; a. That all Home Improvement Contractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place - Room 1301 Boston, MA 02108 617 - 727 -3200 x 25239 b. The contractor's registration number must be on the first page of the contract. c. The homeowners three day cancellation rights under MGL c93s48; NGK c 140D s 10or MGL c255D s 14 as may be applicable. d. All warranties on the owners rights under the provisions of 780 CMRR6 and MGL c 142A e. In ten point bold type or larger, directly above the space provided for the signature, the following statement; DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f. Whether any lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; a. and all necessary construction related permits b. that it shall be the obligation of the contractor to obtain such permits as the owner's agent c. that the owner's who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the balance not yet due For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 3014091 Project Checklist has been reviewed Order Totals Taxable Subtotal $3,923.89 Credit Card Approval Signature Sales Tax @ 6.25% $245.24 Non- taxable Subtotal $3,216.76 AAA, Gust," e same (Please print) Pella Sales Rep N e (Please print) Total $7,385.89 i Ai e Deposit Received $3,692.94 ` CIL__ Amount Due $3,692.95 Cust. , er Signature Pella Sales Rep ignature e i ; /[ a' Date Date f For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www. pella.com n.,.,x„a,.., 0/4nrnn44 r n..4..;1...1 n--. n .,x 4 4 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Line # Quote Qty PO Qty Description Item Price Ext'd Price 60 1 0 Pre - Finish Disclaimer List Price: $0.00 Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: $0.00 $0.00 Last Revision Date: Customer Notes: PRE - FINISH DISCLAIMER Stained and paint color samples are produced as accurately as possible: however, actual colors may vary from batch. Because wood is a natural product, each window or door will display its own personality with regards to variation in color, texture and grain pattern. Natural wood variations include distinctive grain patterns or unusual shadings in color. Due to the nature of using natural products, Pella Windows and Doors cannot be responsible for the actual degree of variation that may occur in your purchase. Order Pricing Totals Total List Price $7,140.65 Discountable Amount $8,777.65 Discount @ 0.000% $0.00 Non - Discountable Amount ($1,637.00) Net Before Payment Discount $7,140.65 Payment Discount Amount $0.00 Net After Payment Discount $7,140.65 • Taxable Subtotal $3,923.89 Sales Tax @ 6.25% $245.24 Non - taxable Subtotal $3,216.76 Total (Total Net + Taxes) $7,385.89 Deposit Received $4,192.94 Amount Due $3,192.95 Printed on 9/9/2011 Office Order Copy Page 9 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 New Construction: (tear out installation - existing frame is disposed of) Remove interior and exterior Trim, remove existing window frame, install new window in rough opening, trim both interior and exterior of window / door. Pocket Install: (sash replacement, existing frame remains) Remove interior or exterior stops, install new window in existing sash opening, re -use existing or replace window stops (interior or exterior). Glass loss will occur. Lead Paint Discloser: 1. Home was built prior to 1978, Pre Renovation Form signed and `Protecting Your Family From Lead in Your Home" brochure has been given to the Home Owner. 2. Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will Authorize install of Yard Sign on 1st day of installation and remove 7 days afterward Finish (paint or stain) product purchased: Trim will be painted by customer _X_ Ensure someone over age 18 is present at all times while Pella Employees are in the home _X_ Cut -back or tie trees, bushes, shrubs from exterior wall _X_ Arrange to have alarm system disconnected and reconnected - Pella Products can re -route alarm wires but can not reconnect contacts _X_ Arrange to have any plumbing or electrical repairs or changes by appropriate licensed contractor - $500 charge for site unprepared on 1 day job _X_ Remove and reinstall existing window treatments, wall hangings and air conditioning units - 4 -5 feet in front / 1 foot to side with clear path _X_ Remove and reposition furniture in work area _X_ Secure pets in a safe manner _X_ Remove valuable / breakable items from work area _X_ Remove snow from area of worksite if necessary _X_ Deliver and unload products _X_ Place drop cloths in work areas _X_ Remove and reinstall interior and exterior trim if applicable _X_ Remove and reinstall existing shutters and awnings by contract _X_ Remove existing product and adjust or modify opening as needed _X_ Provide all equipment necessary to install products X Cut all wood and other materials outside of home _X_ Install all products purchased _X_ Insulate and caulk around products _X_ Remove stickers and perform initial cleaning of all glass surfaces _X_ Demonstrate proper operation of products _X_ Confirm that all products are in working order _X_ Remove drop cloths, vacuum and remove all old products from premises Signature:_ Printed on 9/9/2011 Office Order Copy Page 8 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f. Whether any lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; a. and all necessary construction related permits b. that it shall be the obligation of the contractor to obtain such permits as the owner's agent c. that the owner's who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitration, this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A Owner: Contractor: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. Site Responsibilities 1. 50% Deposit required at time of order. 2. Final payment is to be made to installation team on the morning of the last day of installation. 3. If the customer will not be present at time of install, payment is to be made prior. 4. Checks returned NSF will be assessed a fee of $50.00 to cover fees incurred by Pella. Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5. Due to inclement weather or site conditions, it may be necessary to reschedule. 6. We cannot and will not guarantee specific dates or days of the week for installation. • 7. Time given to complete a job is an estimate, extension of time is possible. 8. An install appointment will be confirmed at Verification. A courtesy reminder cal will be placed 1 week prior. 9. Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10. Substantial completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 11. In the even that any products are unable to be installed, the final payment will be recalculated. The cost of the products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 12. Order is not binding until approved by Pella Products management. 13. Pella will secure all necessary Building Permits. Type of Installation: Printed on 9/9/2011 Office Order Copy Page 7 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Line # Quote Qty PO Qty Description Item Price Ext'd Price 55 1 0 Site Responsibilities List Price: $0.00 Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: $0.00 $0.00 Last Revision Date: Customer Notes: HOMEOWNER - FOR YOUR INFORMATION LEGAL CONTRACT REQUIREMENTS FOR HOME IMPROVEMENT CONTRACTORS IS DETAILED BELOW THIS SITE RESPONSIBILITIES FORM IS PART OF YOUR CONTRACT WITH PELLA PRODUCTS INC. 155 MAIN STREET, GREENFIELD, MA 01301 HOME IMPROVEMENT CONTRACTOR REGISTRATION # 142279 EXP. 3 -24 -12 FEDERAL TAX ID #: 04- 2303271 The law requires the following fourteen items to be included in any contract between the homeowner and a registered home improvement contractor in all contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the owner and a clear description of any other documents which are part of the agreement. 2. The full names, federal ID, addresses (not PO box #'s) of the parties, the contractor's registration number, the names(s) of the sales person(s)) involved, if any and the date the contract was executed by the parties 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4. A detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract. 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, including all finance charges, if any. Any deposit required to be paid in advance of the start of the work shall not exceed one -third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature, which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7. All parties must sign the contract. 8. There shall be a clear and conspicuous notice stating; a. That all Home Improvement Contractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place - Room 1301 Boston, MA 02108 617- 727 -3200 x 25239 b. The contractor's registration number must be on the first page of the contract. c. The homeowners three day cancellation rights under MGL c93s48; NGK c 140D s 10or MGL c255D s 14 as may be applicable. d. All warranties on the owners rights under the provisions of 780 CMRR6 and MGL c 142A e. In ten point bold type or larger, directly above the space provided for the signature, the following statement; Printed on 9/9/2011 Office Order Copy Page 6 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Line # Quote Qty PO Qty Description Item Price Ext'd Price 45 1 0 Order Now Discount: $374.00 off Expires: 9 - 1 - 11 List Price: ($374.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($374.00) ($374.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 50 1 0 INSTALLATION - INSTALLATION List Price: $35.00 Location: None Assigned Rough Opening: Discount %: 0.00 % Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $35.00 $35.00 Last Revision Date: Customer Notes: Permit Printed on 9/9/2011 Office Order Copy Page 5 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Line # Quote Qty PO Qty Description Item Price Ext'd Price 30 1 0 Project Volume Discount: $175.00 off Expires: 9 -1 -11 List Price: ($175.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($175.00) ($175.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 35 1 0 National Pella Promotion: $857.00 off Expires: 9 - 1 - 11 List Price: ($857.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($857.00) ($857.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 40 1 0 Local Pella Promotion: $231.00 off Expires: 9 - 1 - 11 List Price: ($231.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($231.00) ($231.00) Last Revision Date: Printed on 9/9/2011 Office Order Copy Page 4 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price I III 20 1 1 Architect, Precision Hung Double Hung, 31.5 X 57, White List Price: $1,493.14 Closet ILocation: ' Rough Opening: 32" X 57.5" 1: Non - Standard Size Double Hung, Equal Split Discount %: 0.00 % G Frame Size: 31 1/2 X 57 Discount $: $0.00 $0.00 I II Frame Size: 31.5" X 57" General Information: Style Edition, Clad Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White Interior Color! Finish: Prefinished White Interior Frame Perimeter (inches): 177 Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, Order Sash Lift Screen: Full Screen, InView Net Price: $1,493.14 $1,493.14 Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 177 ", Glazing Pressure = 90. * * * PF -1 - interior Pocket installation for Precision Fit Qty 1 * * * LP -1 - Lead safe practices this opening under 150 Qty 1 UI * * * EAC -1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to 110 UI Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 25 1 1 Entry Systems, Midview Storm Door Rolscreen Right, 36 List Price: $1,219.09 XI: Location: None Assigned X 84, White � Rough Opening: 1: Non - Standard Size Right Rolscreen Midview Storm Door Discount %: 0.00 % Frame Size: 36 X 84 Discount $: $0.00 $0.00 Frame Size: 36" X 84" General Information: Clad try Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White Sash / Panel: 1" Solid Core Frame Perimeter (inches): 240 Glass: Clear Assembly Type: Pella Assembled Hardware Options: Standard, Brass Exterior / Color Matched Interior Model: 3525 Net Price: $1,219.09 $1,219.09 Last Revision Date: Wrapping Information: Perimeter Length = 240 ". Installation Notes: EXISTING UNIT IS 1/4" OUT OF SQ., YOU MAY NEED TO CUT EXTERIOR CASING TO SQ. OPENING. * * * ED - - Storm Door Install on Existing Entry Door Qty 1 * * * LP -1 - Lead safe practices this opening under 150 Qty 1 UI Printed on 9/9/2011 Office Order Copy Page 3 of 9 Customer: Marge Bruchac Quote Description: 739 Architect Series Phase 5 Order Number: 739K31L131 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 10 2 2 Architect, Precision Hung Double Hung, 31.5 X 57, White List Price: $1,546.45 Justin's Bedroom II Location: Rough Opening: 32" X 57.5" 1: Non - Standard Size Double Hung, Equal Split Discount %: 0.00 Frame Size: 31 1/2 X 57 Frame Size: 31.5" X 57" General Information: Style Edition, Clad Discount $: $0.00 $0.00 Ilia Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White Interior Color! Finish: Prefinished White Interior - - Frame Perimeter (inches): 177 Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, Order Sash Lift $3,092.90 Screen: Full Screen, InView Net Price: $1,546.45 $3, Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 177 ", Glazing Pressure = 90. * * * PF-1 - Interior Pocket Installation for Precision Fit Qty 1 * * * LP -2 - Lead safe practices this opening over 150 UI Qty 1 * * * EAC -1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to 110 UI Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 15 2 2 Architect, Precision Hung Double Hung, 27.5 X 57, White List Price: $1,468.76 Location: Guest Bedroom Rough Opening: 28" X 57.5" 1: Non - Standard Size Double Hung, Equal Split Discount %: 0.00 % 0 Frame Size: 27 1/2 X 57 Discount $: $0.00 $0.00 Frame Size: 27.5" X 57" General Information: Style Edition, Clad Final Wall Depth: Exterior Color! Finish: Standard EnduraClad, White I _ Frame Perimeter (inches): 169 Interior Color / Finish: Prefinished White Interior Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, Order Sash Lift Net Price: $1,468.76 $2,937.52 Last Revision Date: Screen: Full Screen, InView Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 169 ", Glazing Pressure = 105. * * * PF-1 - Interior Pocket Installation for Precision Fit Qty 1 • * * * LP-1 - Lead safe practices this opening under 150 Qty 1 UI * * * EAC-1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to 110 UI Printed on 9/9/2011 Office Order Copy Page 2 of 9 Office Order Copy C it ; ,. C_ 9 Branch Number: 73900 Order Number: 739K3IL131 Window Store Name:Pella Window and Door Quote Number: 3014091 Showroom of Greenfield Quote Description: 739 Architect Series Phase 5 Project Name: Bruchac Marge 63 Franklin Street Northampton MA Customer Information Deliver To Address Order Information Marge Bruchac Lot # Sales Rep Name: Lukomski, Adam Cust Delivery Date: 10/5/2011 63 Franklin Street Address: Business Segment: Retail Quoted Date: 8/18/2011 63 Franklin Street Market Segment: Single Family Replacement Contract Date: 9/9/2011 Order Type: Installed Sales Booked Date: NORTHAMPTON, MA 01060 Effective Discount: 0.000% Earliest LRD: Contact Name: NORTHAMPTON, MA 01060 Commission Split: Lukomski, Adam - 100% Day Phone: (413) 584 -2195 County: HAMPSHIRE Tax Code: MASS Mobile Phone: Owner Name: Tax Exempt #: Fax Number: Marge Bruchac Payment Terms: Wells Fargo Other Customer PO #: E -Mail: Order Verifier Name: DAVID RUFFNER Order Verification Date: 9/9/2011 Great Plains #: 52H5842195 Owner Phone: (413) 584 -2195 Customer Number: 2458071 Delivery Instructions: GPS, WHITE COLONIAL HOME WITH #63 MARKED CLEARLY ON THE HOME Installation Notes: GPS, WHITE COLONIAL HOME WITH #63 MARKED CLEARLY ON THE HOME Order Verification Notes: PM NOTES FOR INSTALL: 5 AS PFITS ON 2ND FLOOR OF COLONIAL STYLE DWELLING. NEW UNITS POCKETING IN TO EXISTING WEIGHT POCKET OPENINGS. STORM DOOR IS 1/4" OOS, SO YOU MAY NEED TO CUT EXTERIOR CASING TO SQ OPENING. OTHER THAN THAT INSTALL IS FAIRLY BASIC, LEAD -SAFE PROJECT WITH WRAP. 2 CATS. GOOD PARKING IN DRIVEWAY. MP: 2 FOR 2 OR 4 MAN DAYS INSTALL DATE: WED. -THUR. / 10- 5/6 -11 Printed on 9/9/2011 Office Order Copy Page 1 of 9 tILH)t'dH I Ht INS r ax: 141 JbbUU4LL4 Jun 1 LLII I I I:IJ r•`l ACOR'a CERTIFICATE OF LIABILITY INSURANCE • DATE(MM /DD./YYYY) _- 6/1/2011 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 pollicy(les) must 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 NAME: CT Robin Sargent Berkshire Insurance Group, Inc. PHONE � . (413)773 -9913 N 4413)774 -31372 117 Main Street AD R E S r sargent @berkshireinsurancegroup • corn PRODUCER 00000036 Greenfield MA 01301 INSURER (9) AFFORDING C4VERAGE NAIL# INSURED INSURER A:Fir Inn'$ In Co of D.C. INSURER B ;Continental 4TErstezn Insurance Pella Podu4CS, Inc. IN$uRERC; ATTN: John Benjamin _ INSURERA: ---- 155 Main Street INSURER E: —, Greenfield MA 01301 INSURER F : 1 COVERAGES CERTIFICATE NUMBER :11GL, AL, EL 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, ILT YP TE OF INSURANCE I INgR POLICY NUMBER (MMfDDNYYY) (MMIpnIYY'p�'} LIMITS GENERAL LIABILITY EACH OCCURRENCE rl $ 1, 000, 000 DAMAGE TORENTED 5 300,000 A CLAIMS-MADE � OCCUR CFA X 1 COMMERCIAL GENF_RAL LIA$ILfrY PREM.ES a • - :nee I 1/1/2011 1/1/2012 ME D < � pon e person) S 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER ;— PRODUCTS • COMP/OP AGO $ 2,000,000 ■ PDL,ECY f PR X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ • 13 ALL OWNED AUTOS 020470219 1/1/2011 1/1/2012 BODILY INJURY (Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE $ (Per acc dent) X MIRED AUTOS PIP - Basic $ X NON-OWNED AUTOS Meeks! payments $ EACH OCCURRENCE. $ UMBRELi.A LAB OCCUR AGGREGATTE $ EXCESSUAB CLAIMS -MADE $ 1 DEDUCTIBLE i RETENTION WORKERS COMPENSATION X .uf - ■� B AND EMPLOYERS' LIABIUrY Y / N El. EACH ACCIDENT $ 500,000 ANY PROPRIEfOR/PARTtlERIEXECUTIVE OFFICER/MEM9Ek EXCLUDED? N. ' N /A I 0204705y9 1/1/2011 1/],/2012 E_L,DI$Fy.BE -EA EMPLOYE' $ 500 000 -- (Mandatary In NHl El. DISEASE - POLICY LIMIT $ 500,000 It yes, describe under r DESCRIPTION OF OPERATIONS below �.. l .fmarepsceI5reuid) DESCRIPTION OF OERATONS I LOCATIONS I VEHICLESS (Attach ACORO 101, Additional Remarks Sche Operations usual to the sales & ia$tallation of door$ & windows. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PATE THEREOF, NOTICE WILL INE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Northampton puehalski Municiple Building AUTHORIZED REPRESENTATIVE • 212 Main street Northampton, MA 01060 7. Robin Sargent /RMS ©1988.2009 ACORD CORPORATION. All rights reserved. IN O (2009/09) The ACORD name and logo are registered marks of ACORD S0S (zooso9) To Whom It May Concern: a I, ; � y . r �C; l ,�c , as property owner, give per on to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at . Please accept this letter in place of my signature on the permit application. Thank you, Awe / c%& - Pleaserint Name 1/ d-247-61(( Ho owner's Signature r Date • ■ • PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 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 • • • The Commonwealth of Massachusetts Department of Industrial Accidents *v....45u Office of Investigations PV. �... ��..� 600 Washington Street .tzr. Boston, MA 02111 `k. _,:eL , www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): / � / Gc� ,•- f, Address: i � ) A/( •`17 v7 ( /�i 7 f City /State /Zip: 6 v . t r M Iv/ 30/ Phone #: 0 • 77 (2/53 3 Are you an employer? Check the appropriate box: Type of project (required): 1. VI I am a employer with _ 4' / 4. E I am a general contractor and 1 employees (full and/or part-time).* have hired the sub contractors 6. I I New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Li Remodeling ship and have no employees These sub- contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.: _ required.] 5. Li We are a corporation and its 10.1 Electrical repairs or additions 3. _ I am a homeowner doing all work officers have exercised their 11.[ Plumbing repairs or additions myself. [No workers' com right of exemption per MGL Y comp. 12.1 Roof repa' - s insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Others' i, ' v d u.._) comp. insurance required.] e t cI I �, t‘' *My applicant that checks box # I 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. /� r Insurance Company Name: / ' G1 5 t r ( Policy # or Self -ins. Lic. #: (+%� C 6)12 G/ O / Expiration Date: (1 /' 0 / { • Job Site Address: t . - TVA 1.1 (C Lt 41, ,.J C City /State /Zip: ( V ,u • . • 71A I O Attach a copy of the workers' compensation policy declaration page (showing the policy number and ex I ration 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 cert fy under the pain and penalties of perjury that the information provided above is true and correct. Signature: Date: q- 27 . Phone #: (--/ 17 -_ / 7 Li 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 #: , SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 11, () c7 f l ) License Number JST 14h `S r ti er l kAA C ►00. 20 1 7 Addresa, Expiration Date C q(,. 772 I S 3 Signature Telephone 9. Reaiatered Home Improvement Contractor Not Applicable ❑ l �r.� Triv,3t!c,� -ic Company Name Registration Number r� - 4144 < Y ( GreCiit 0 fie 7 2(1 ��► L- Address (, 1 1 7 Expiration Date C o (�' `� 1 &J � Telephone 4- I 1G- C ? 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 buildin permit. Signed Affidavit Attached Yes kl No ❑ H. - 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. 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 — i 4 • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacemeni<Wyndows Alteration(s) J Roofing 0 Or Doors �[ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [D Siding [p] Other [0] Brief Descripti n of ropose Work: 1. n,� in n,. o (� aa_�� fan a ]ov. S c cu • et t t U Alteration of existing bedroom Yes y No Adding new bedroom Yes 7 " No Attached Narrative Renovating unfinished basement Yes f No Plans Attached Roll - Sheet sa. ,if New house and or addition to existing housing. comolete 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, 4 /6E w(t budoc- _ , as Owner of the subject property _ hereby authorize (, /fa 1 t ` bcu -C - S�� C C to act on behalf in all matters relative to work authorized b this bu/ ng permit applica Y by Sign re of Owner ate I � �� 1 (1 t , as Owner /Authorized Agent hereby declat`e 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. c 5. .tl �� � t\ -- Q . _ Print Name a)....4 Signature of Owner /Agent 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 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW Q YES 0 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 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 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 Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 7 111eilfOrtnr"," ; 10. • I�i���mt U'S@ poly RECEI VED ity of Northampton Status Permit. : uil • ng Department Curb Cut/Driv way Permit SEP 2 7 2011 21 Main Street Sewer/Soot Availebitity • oom 100 ttllaterlV�tell.Av ilabili jr rc - h-.. pton, MA 01060 Twtz Sets of St turail Plans f 1240 Fax 413 -587 -1272 Plcf/��l #e €'lefts Other ;Specrcy; 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 6,3 -� f 32,t1 Id I rl NS4Y Map Lot Unit . l Q l L V Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: r k cur �Y ■1(j^ L d b t +1 Name (Print) i Current Mailing Address: `' ' 40 a,, Telephone Signature 2.2 Authorized Agent: n A di? ,c,c GADGA/ (2 510( Name (Prin Current Mailing Address: (`30 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit 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 = (1 + 2 + 3 + 4 + 5) ,�bC> . to Check Number y rzi v ( This Section For Official Use Only Building Permit Number: Date r: Issued: Signature: Building Commissioner /Inspector of Buildings Date . • 63 FRANKLIN ST BP-2012-0300 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 168 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- 2012 -0300 Project # JS- 2012- 000487 Est. Cost: $7500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 6882.48 Owner: KENNICK JUSTIN H & MARGARET M BRUCHAC Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 63 FRANKLIN ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:9/27/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:.INSTALL REPLACEMENT WINDOWS & STORM DOOR 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 9/27/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner