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18C-122 (2) Customer: Linda Graves Project Nfame: Graves, Linda 15 AU ison Skeet Northampton FAA Order Flumber 739 Quote Nu nber: 890712 listeb. Pella Products Inc. management has final authority on acceptance of this order. Your signature confirms the accuracy of the product(s) chosen. Pella Products assumes no responsibility for accuracy of take offs from drawings or blueprints or that the products listed will be sufficient to complete customer's intended project. The Buyer agrees that the product(s) listed herein are correct, final and cannot be changed, returned or canceled, Deposits are partial payment of the contract and are not refundable. The Buyer agrees that if paying by credit card that authorization is granted to the seller to debit the Buyers credit card by signing this contract. The Buyer agrees that payment discounts do not apply when paying with a credit card. A 1 -1/2% SERVICE CHARGE per month (18% PER ANNUM) will be added to all outstanding balance past our stated terms, plus lawyer and account fees for collecting outstanding accounts. The Buyer agrees that the customer delivery date is a realistic estimate of when the product is to be delivered. Items remaining in our warehouse for more than 30 days beyond the agreed to delivery time will be subject to a storage and handling fee of 1% of the net amount of the order ($25.00 minimum charge). The Buyer agrees that the product can be delivered without the Buyer present and agrees to accept the shipping documents as proof of delivery. The Buyer agrees not to hold the Seller responsible for any damage to driveways, sidewalks, trees and overhead wires caused by the Seller's delivery vehicles. The Buyer agrees to examine the product(s) upon delivery and within 7 DAYS OF DELIVERY provide the Seller notice of any discrepancy between the product(s) ordered and the products(s) delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is. "Project Checklist has been reviewed Order Totals Taxable Subtotal $1,540.28 Credit Card Approval Signature Sales Tax c 6.25% $96.27 Non - taxable Subtotal $2,440.00 Ca( ra 1 ( • t1 �`� Total $4,076.55 Customer Name (Please pant) Pella - _ - - ep N me P Deposit Received $0.00 z�1 L- Amount Due $4,076.55 Customer Signature Pella Sales Rep Signatur- � C0 - c & -1 Date Date e �� � !� For more information regardingthe finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Dpi„ +esel nn 1( /47 Plf1nCi r,,,, +.n,,.+ noti; ioa Del ,.,, . 4 ' 1 Office Order Copy P r ni -- ,� ?‚‚ Branch Number 73900 Order Number: 73913KP241 Window Store Name: Quote Number: 890712 Quote Description: Flat window Project Name: Graves, Linda 15 Allison Street Northampton MA Customer information Deliver To Address Order Information Linda Graves Lot # Sales Rep Name: Picard, Paul Cust Delivery Date: 12/07/2009 Address: Business Segment: Retail Quoted Date: 09/23/2009 15 Allison Street 15 Allison Street Market Segment: Single Family Replacement Contract Date: 11/03/2009 Order Type: Installed Sales Booked Date: Effective Discount: 0.581% Earliest LRD: NORTHAMPTON, MA01060 NORTHAMPTON, MA01060 Commission Split: Picard, Paul - 100% Contact Name: County: HAMPSHIRE Tax Code: MASS Tax Exempt #: Payment Terms: Deposit/C.O. D. Customer PO #: Day Phone: (413) 585 -8937 Owner Name: Accessories Managed Accessory Delivery Date Mobile Phone: Linda Graves Fax Number: E -Mail: Owner Phone: (413) 585 -8937 Great Plains #: 53H5858937 Customer Number: 3696881 • Delivery Instructions: 91S to exit 20 Northampton. Take right at light by Dana Auto, then left on Prospect Ave. Then left on Allison Street. House on right. Installation Notes: 91S to exit 20 Northampton. Take right at light by Dana Auto, then left on Prospect Ave. Then left on Allison Street. House on right. Printed on 11/03/2009 Office Order Copy Page 1 of 6 • ■ FROM Berkshire Ihsurahse Group (WED)NOV 4 2008 9:21 1ST. 5: 19 /No. 7527319275 P 1 A C °Rp m Y) 11/4 C � CERTIFICATE OF LIABILITY INSURANCE DATE {MMIDD/YYY 1 11/4/2009 Il PRODUCER (413) 773 -9913 FAX: (413) 774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MassOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 638 Greenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Continental Wes tern Pella Products, Inc. INSURER B: ATTN: John Benjamin INSURER C: 155 Main Street INSURER D: Greenfield MA 01301 -3258 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 1 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. AGGREGATE LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATE POLICY M /DDIYYI EXPIRATION LIMITS LTRJNSRD D ( ) DATE( GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 300,000 A CLAIMS MADE f X I OCCUR CPA020470112 1/1/2009 1/1/2010 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,00b GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 ,TQ POLICY JE CT LOC — AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ ANY AUTO (Ea accident) A ALL OWNED AUTOS 1d.A020470212 1/1/2009 1/1/2010 BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) .. . GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ T ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY E $ .j EACH OCCURRENCE OCCUR I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND X I T( LIMITS I O ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER!EXECUTIVE EL. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? WCA020470512 1/1/2009 1/1/2010 E.L. DISEASE -EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Operations usual to the sales & installation of doors & windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE_., Linda Graves EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 Allison Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Northampton, MA 01060 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE. INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Rob in Sargent /RMS ACORD 25 (2001/08) © ACORD CORPORATION 1988 INS025 (0108).O8a Page 1 of 2 PAGE 61/61 PELLA PRODUCTS INC 04!' 009 11:17 41373 e The Commonwealth of Massachusetts " - M Department of Industrial Accidents r a ,l Office of Investigations ^ . 606 Washington Street n" =:,� :.∎7 ,= .?Boston, MA 02.121 ;,,,4' www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders /Contractorst lecixiciansiflumbers • A !leant fufornxatiart klease "rilnt Le `1il Name ( Business /Organization/lndiv Address :_ `57 /ra- - ,,�j li"G4-9 Are you an employer? Check the appropriate box: Type of project (required): 1.54 1 am a cmplaycr with e, 4. {J I am a general contactor -and I ' employees (full and/or part-time).*. have faired the sub - contractors 6. ❑ New construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet: 7. 0 Remodeling ship and have no employees These subcontractors have s. 0 Demolition working for me in any capacity. employees and have workers' Building addition No workers' comp. insurance comp. insurance t required.) 5- 0 We area corporation and its 10.1 Electrical repairs or additions 3. 0 I arcs a homeowner doing all work officers have exercised than 11.0 Plumbing repairs or additions myself. (No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.) t C. 152, § 1(4), and we have no employees. [No workers' 13• [] OthGx comp. insurance required) "Any applicant that cheeks box 01 must also 511 out the section below showing their workcrs' compensation policy infotiT ation • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached ati additional shoat showing the name of the sub - connectors and state whether or not those entities have cmployees. I£ the sub- ontractors have empiayccs, they must provide their workers' comp. policy number. . / am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Natxte: G o7tt� i Ir v" car) Cl' r A , ." Policy /# or Self ins. Imo, #f:_� /"..L ,Q r_lzl y2G'J,,'j % Expiration Date: D /' 6/- r Q/1' Job Site Address: City/State/Zip, • Attach a copy of the workers' =venation policy declaration page (strowing the policy.nurnber and expiration date).. Failure to secure coverage as required under Section 25A of MML o. 152 can lead to the imposition of c riminal penalnes 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 fee 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 DU for insurance coverage verification. ,l do hereby ce- u der the pains and penalties of perjury that the information provided above is true 9 truce and correct S.?c -0 _ • 1 . ' _ .4, / . it 4 _ Mate: DEC 2008 • ' oie is /1- d` .6 / e2 o Official use only. Do not write in this area, to be completed by city or town ojjiciaL City or Town; Permit/License # Issuing Authority (circle once): 1. Board of Health 2. Building Departtnent 3. City/'Town Clerk 4, Electrical Inspector S. ?plumbing Inspector 6. Other Contact Persona: Phone #: _ - _ . . PELLA PRODUCTS NC 155 MAIN STREET QREENF1ELD,KOA013O1 (\ ��\� ��� J \~ k\N}-"N subject: Disposal o|Debits Thopu/poeeof this letter is(ocnJfy that ail \hadeb/is iny project uoVartmken Pella Products Inc. in yourTown wiU be nuns;orted to n dumpstat at our main facility at 155 Main Street. Greenfiekl. MA, Pella Products |ncis underoon1ract mtilVVus!e Management o/ r\Aassachusutts |o/ the disposal o| the contents et this domps e, Very Truly Yours, PELLA PRODUCTS INC, John P. Bomamm AccounbngKAaoager tions;m1) „TqApti u. \J \1 .. :) W 1), all', 011'0. S.1;:111:1Stil i2I \.(11),"sli U.01).1.31}R1S11! 5.4(114a 'MAMA :DJ 1:014 91.11141 umqwwok4.1 j n4h1t1 tge i• 0 VIN 30N NM), ) avw.; 41434mcprvsepy • _.,:.. IS 8311\38V0 frg alp oft unippa )1.11a19 w Ntwssud II) 31IHM 3 CiiAVC ou ' ,4,110 11 *LIMA Z' 104.31.1414.11111 - po :al ilattinS.H 4,. 004:an.ir5vV) .v.Iriturh; j1411 11111 Jo viol' )1 lir, .11141/1,1 / fUMAi /1'11.10 - 1J:utnip",111, S;)SUX,Iii 10 ';d0:7) 1 1 ,1,(7, 1111 AIR) pl,W 90 160.; rOli(ide N.11 0P1i \,..1Ni11 s 11011uisti0) pompmi e mu 1 \J) pup, tr:w Jo; ioutt - ,1111)(Ao.id sc).1H1put .11)( ) .mo Jo! .. put! . <..\\optii Tiur. t1 W 1OIC,R)(1,10;)(ii SImpo.id rrd sami`it!sa(1 stio!yeawitly rft.i!unti :1 ! vo. :olt41 11 wI11 i!!!!!111 '10 moa,,1 i:kui !!t;;t1lp1ilifil 10110 ‘Pl;q1 tiplk ( %)111 ‘S wad , . • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ' J C) -L CL C • 4\, y-e 0 9 ( (.Q License Number (9`-t Cu'peA (3k 0( C1vl� \.-k_. 1i1P (11 3(04 1 - aQti Address 1 C kiliki Expiration Date N . �t. C i 3 - �)) - (t 53 Signature Telephone 9. Reg tered Home provement Contractor: Not Applicable ❑ Company Name .- Registration Number \» \y \c (�; e-e i \ \ r (\ r = 1 a;3Uk. r - d- o t% Address ^ Q c 1 t'_ ( Expiration Date rids.., (t Telephone (4‘2,- Tic " "0 ‘53 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 -near 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 Surtervisor 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 r , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement_Wyrdows Alteration(s) El Roofing ❑ Or Doors L Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed (� Work: i c k t I h.-) s 1 L o i ry * 1 k .:1 R � O ' A t !\ a • 1 1 O -. ,4 A O \ ei.i.):> ( 14.., O ( 4, e 4 ). L ) w N . LI.)u f - U y1ec E3o.r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family ,.> Two Family Other 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._ c1Ck(A 6 ! CU-YU , as Owner of the subject property J ' W } hereby authorize l f l tC7,- ■�/' !1 '�..L t`� I `J 0,'`.E , rk C. W . '{_ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, ' 1 O.. Pi ti) a J_t.c l `', t-tne • CO ().... 1 d c,- (A) in,.. , k-t-_ , as Owner /Authorized Agent hereby declare that the statements and infotion on the foregoing application are true and accurate, to the best of my knowledge and belief. Sig ed under the pains and penalties of perjury. 0....:. O. l - w"1 '., t(-- Print Name � 0a c I I - 3 - a t Signature of Owner /Agent Date Aom000mmimmomommmoinmimmik 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 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 4 4 1 I ` .. Department use only City of Northampton Status of Permit: s ''' Building Department Curb Cut/Driveway Permit ,212 Main Street Sewer /Septic Availability c O,S) Rom 100 Water/Well Availability t 1- Northampton, MA 01060 Two Sets of Structural Plans , ; `(Y+ phone 416"-:513:7 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPIJeATION 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 15 4 �1 t 5 ON 5t' Map Lot Unit r) � �� ���� Mr} o t o u o Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ckAito 15 I-; k1i -\ 6k- • V) ,A Name (Print) Current Mailing Address: 4 -+t Win X3`1 Telephone Signature 2.2 Authorized Anent: \ Ct_ ( rkki.ti YA(k, 3 k 6(ceiv(tt1d i Name (Print) /1 1 n ,•(1X) c to ,. 1 Current Mailing Address: 0 \ ' 7 3 413 3 3 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only com•leted b •ermit a• •licant 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) y o `l (p , 55 Check Number 36111 ,t ,55 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 1 11 BP- 2010 -0530 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) Category: BUILDING PERMIT Permit # BP- 2010 -0530 Project # JS- 2010- 000744 Est. Cost: $4076.00 Fee: 535.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 8058.60 Owner: GRAVES LINDA S Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 15 ALLISON ST Applicant Address: Phone: Insurance: 240 MOHAWK TRAIL (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:11/13/2009 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 11/13/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo , . . . .. 'WORE, CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (413) 625 -6527 FAX: (413) 625 -8210 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackmer Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1000 Mohawk Trail HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Shelburne MA 01370 -9737 INSURERS AFFORDING COVERAGE NAIC # INSURED INsuRERA: American Ins Co I Co -op Power, Inc - INSURERB:Hartford Insurance Group I 324 Wells St INSURER C: PO Box 688 _ INSURER D: Greenfield MA 01301 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LADO'Ll POUCY EFFECTIVE I POUCY EXPIRATION I LTR INSRD TYPE OF INSURANCE POUCY NUMBER DATE (MMIDD/YYYY) DATE IMMIDD(YYYY) LIMITS GENERAL UABIUTY EACH OCCURRENCE 1$ 1,000,000 1 DAMAGE TO COMMERCIAL GENERAL weary PREMISES (Ea occurrence) 1 $ 100,000 A X CLAIMS MADE 1 OCCUR BA05599600 11/8/2009 11/8/2010 MEDEXP(Anyoneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 XI POLICY I 1 JECT 1 ILOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1, 000 , 000 — ANY AUTO (Ea . AU. OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ A HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS 1,BA05599600 11/8/2009 11/08/2010 (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT J $ ANY AUTO OTHER THAN EA ACC I $ AUTO ONLY: AGG 1 $ • EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ 3 WORKERS COMPENSATION 1 WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY I !HITS I I FR ANY PROPRIETOR/PARTNER/EXECUTIVE© 8WECLC6866 11/01/2009 11/01/2010 E.L. EACH ACCIDENT $ 500000 OFRCERIMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ 500000 If yes, dcribe undr e SPECIAL es PROVISIONS below EL. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Certificate issued subject to the terms, conditions, exclusions, and endorsements attached thereto. Operations ususal to alternative solar energy resources. National Grid is listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION National Grid DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN P 0 Box 960 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL Northborough, MA 01532 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) 01988 -2009 ACORD CORPORATION. All rights reserved. INS025 (now) The ACORD name and logo are registered marks of ACORD , . ` <Jl ,l• llt V1 \AJu Ull l r 1G 111a11J Wilt DUS1IleSS tceguiation J 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165217 Type: Corporation Expiration: 1/21/2012 Tr# 292798 CO -OP POWER, INC. _ PAUL SCHMIDT 324 WELLS ST GREENFIELD, MA 01301 — -- Update Address and return card. Mark reason for change. Address I, Renewal Employment 7 Lost Card DPS -CA1 0 50M- 04/04-G101216 ✓Are famrnanu ea`d 0/_, d asaa.•kwela Office of Consumer Affairs & Business Regulation License or registration valid for individul use only before the expiration date. If found return to: 1 4 HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Regi 165217 x- 10 Park Plaza - Suite 5170 ;b Expiration: 1/21/2012 Tr# 292798 Boston, MA 02116 Type: Corporation CO -OP POWER, INC. PAUL SCHMIDT 324 WELLS ST ...6 -- _— = r , ei GREENFIELD, MA 01301 Undersecretary Not vat' i without signature Massachusetts - Department of Public Safet% ■ g Board of Building Regulations and Standards Construction Supervisor License License: CS 103635 Restricted to: 00 PAUL SCHMIDT 24 CHESTNUT ST HATFIELD MA 01038 Z ` .-- — '` Expiration: 5/20/2013 t'ummissiuner Tr#: 103635 f _; • I • • • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 1 M/ J66117 1 ) 3 63,, License umber ti / 46, 7 1 1 1t r 3r /-1 Arrficli? -05 - zz' / Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ p' if %�> � � j Z � 7 Company Name Registration Number 32 CV 07S � 3 i 1 zi ti)) Address Expi tion Date Telephone V) 3 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 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 buildinE 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 • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors 0 Accessory Bldg. Cl Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0] Brief Description of Proposed - —, -rte (� �n ,) , Work: �L>�/Sl. % /. - _.� 1 �--r) o''- WAN IV i ' gll �,N / C['�.) Gt' Alteration of existing bedroom Yes lJ` No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other 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 t ti D q- c J , as Owner of the subject property ) �)� hereby authorize fi 91) / J c 4m 1/ ( C0— cP f to act on my behalf, in all matters relative to work authorized by this building permit a ion. 14) tS Signature of Owner Date " )/ J 2 t2) 7 t , 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. i/r (. 6/11 I� Print Name - 71 7,1 Signature of er /A 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 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO IC1 DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO 's IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO CO 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 ;9 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. J ' Department use only City of Northampton ' Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street v� — g 2 - V Sewer /Septic Availability Room 100 P" W,rIWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other 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 J ,/ll�„� ,J � 3 � - Map Lot Unit /' y ' Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1-1 ti P.4 3 G e 4- U t- S /J /P. L. /sox) ST WA' 7*-4 -4 P rail). !4- Name (Print) Current Mailing Address: GlLL, J -- Gu 4 ' 3 ° s S `l 3 Tele phone Signature 2.2 Authorized gent: sr Name ( nn) . _' Current Mailing Address: % Jfo 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 % 60 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) � U ,C 7'7 Check Number d/- y 3 I This Section For Official Use Only Permit Number: Date Building Issued: Signature: Building Commissioner /Inspector of Buildings Date I ■ File # BP- 2010 -0888 APPLICANT /CONTACT PERSON PAUL SCHMIDT ADDRESS /PHONE 24 CHESTNUT ST HATFIELD (413) 247 -5739 PROPERTY LOCATION 15 ALLISON ST MAP 18C PARCEL 122 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Q� Q ^ Fee Paid 0/ lw Typeof Construction: INSULATE EXTERIOR WALLS W/BLOWN IN CELLULOSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 103635 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: (Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission - Permit DPW Storm Water Management Demolition Delay ( ,_.. 4 .,,_,._ � J Y i 3 0 g g Signa e of Building icial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. P a ,.; BP- 2010 -0888 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 122 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0888 Project # JS- 2010- 001312 Est. Cost: $2600.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL SCHMIDT 103635 Lot Size(sq. ft.): 8058.60 Owner: GRAVES LINDA S Zoning: URB(100)/ Applicant: PAUL SCHMIDT AT: 15 ALLISON ST Applicant Address: Phone: Insurance: 24 CHESTNUT ST (413) 247 -5739 WC HATFIELDMA01038 ISSUED ON:4/13/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSULATE EXTERIOR WALLS W /BLOWN IN CELLULOSE 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 4/13/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo