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37-069 • • • ._. -_.. • -.. .. .r_._�_. .F .._..... .._..__.4 ... s01' ` 4-ozLo -vn cri3Lazzej9 - f',.taasishoynssi- - Emtivt • � • . .r� . !OL 1 to3tx3rc c 7L0H _' _ :. - • • fircPmtS Pint su 1n P•rF == • • • Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone: 413- 772 -0153 Cell: 413- 834 -8799 To: Building Inspector From: David White — Installation Manager Date: January 19, 2009 SUBJECT: Building Permit Applications & Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building permits will be applied for using my CSL #091496 and our HIC, # 142279. Please find a copy of my licenses below. ri tx Delkintee0 o P.MMi $ I B i ouI� R o stand0 R9- o Con Aensitruidloa SapovisAt tis►s - t Pik 1`4 -i A Mewl C ► '+` P . ' r, ��� e x d } t of i . - "�R Ex litiam i It4crt*: "► Ttis.. c. nkthe Trig: OW To Whom It May Concern: I, 7 z- 6 ' /A0,74.eir , as property owner, give permission to our contractor, Pell. Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at 7'25_ l =2 -�/llc 1�1 Please accept this letter in place of my signature on the permit application. Thank you, Please Print Name o eowner's Signa ure Date W N e) IMPORTANT 0 Z If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this - - certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). N DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing O insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively 0 amend, extend or alter the coverage afforded by the policies listed thereon. N A I- V a L' • f7 L L N • ACORD 25 (2001/08) ▪ INS025 (0108)Om Pagezof2 I 0 LL r O. N CO N CO bATE (MM/ROY/TYY) ✓ ACORD C ERTIFICATE OF LIABILITY INSURANCE 5/6 /2010 e� • r . PRODU (413)773 -9913 FAX: (413)774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION N A ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE N MassOne Insurance Agency y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR t. 117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. • P.O. Box 638 Z Greenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE NAIC # T. • INSURED INSURER A Continental Western r Pella Products, Inc. INSURER B . ATTN: John Benjamin INSURER C. a 155 Main Street INSURED ✓ Greenfield MA 01301 -3258 INSURERS _ 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, I \ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. i AGGREGATE I IMITS SHO WN MAT HAVE BEEN REDUCED BY PAID CLAIMS. ✓ INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION •• LTR )NUNS TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYI DATE (MMIDWYY) LIMITS Q GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 I' X COMMERCIAL GENERAL LIABILITY - PREMISES (Ea occurrence) $ 300,000.. O A �_J I CLAIMS MADE © OCCUR CPA020470113 1/1/2010 1/1/2011 MEDEXPIAnyo,SPasonl S T5, DOD O u PERSONAL S ADV IN IIIRT S 1,000,000 N GENERAL AGGREGATE $ 2,000,000 OEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG S 2,000,000 X J PDLICY I JEGT I I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 8. _ ANY AU IO (Ca accident) CC • A ALL DINNED AUTOS MAA020470213 1/1/2010 1/1/2011 BODILY INJURY A X $CIIEDULED AUTOS ( PerperSoI — O X HIRED AUTOS BODILY INJURY S I ▪ X NON -OWNED AUTOS (Per accklenlI PROPERTY DAMAGE - (Po accrtlenl) 3 GARAGE LIABILITY AUTO ONLY •EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S - - '-'-- AUTO ONLY qGG S EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE 1 OCCUR Ei CLAIMS MADE AGGREGATE S _S DEDUCTIBLE —S RETENTION S S A WORKERS COMPENSATION AND X I Ty! HY I IMO S I IOFR EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE EL EACH ACCIDENT S 500,000 OFFICERJMEMBER EXCLUDE)? WCA020470513 1/1/2010 1/1/2011 E.L. DISEASE • EA EMPLOYEE H 500,000 H yes, esrnbe under Q SPECIAdLPROVISIONS below E . DISEASE - POLICY LIMIT 5 500,000 OTHER 0 L • -- C4 DESCRIPTION OF OPERATION SILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS 0 Operations usual to the wales of windows a doors. Q OS 3 (1 CERTIFICATE HOLDER CANCELLATION .. .. -J r. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE �THE1 ■ John Tompson EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL O 705 Florence Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT L Florence, MA 01062 FAILURE TO DO S0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE. INSURER, ITS AGENTS OR REPRESENTATIVES. ((I AUTHORIZED REPRESENTATIVE �_.r,7 __ Y Robin Sargent/8M /� z ` �T `���� L _.. ....- _�..._._ 0 ACORD 25(2001/08) TU ACORD CORPORATION 1988 0) NS025 Io 1os) 055 Page 1 Ul2 I 0 X U. *AIL The Commonwealth of Massachusetts Department of Industrial Accidents 11 tri Office of Investigations 600 Washington Street 7: _ Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): /e / / p c/U, e � j —JO C. Address: /53 / %cVir7 S %r << City /State /Zip: 6 r«m t j f /d /l//7 0/30/ Phone #:_ / //J ' 77v Are you an employer? Check the appropriate box: Type of project (required): 1. ( I am a employer with 7(2 4. ❑ I am a general contractor and I / 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors hLve 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance.# 9. ❑ Building addition [No workers' co comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. _ 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.M Other ) /c'ce ti,2; Ay) comp. insurance required.] ,loo r 5 *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /'' / � c j n 5 u r c7 h e my) n 1/ Policy # or Self -ins. Lic. #: G iq c.,70 'V 70573 _ Expiration Date: / /- 07- r-51 0 // 1 0 � 1 �rQJ \CQ iZ� - _ City/State/Zip: o� MC& O\.�co2 Job Site Address: 1 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 car, 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 st<<tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pai and penalties of perjury that the information provided above is true and correct. Signature: -F Date: 51( 10 Phone #: 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 #: b y � u � a , 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ■C.N, LZVA % 0 S 1 Lk el 1p License Number IS5 Mrikn vp,e_r Ca reenfi. Id , WA ot30 k 11 31 / 1 Addr ss Expiration Date 0 CZ4 C lid iik/S• Signature Telephone , L'sra i . =. . u w } .O. ii r: : ai .: ist z. ; . Not Applicable ❑ PcAla. .xt 1Y . ,g22 9 Company Name Registration Number hdcAn - 671reill- fi -eAr1 to OI301 ` 3J2L 112. ddress Expira ion Date Telephone('-\ ra OISS " .. ° gym 0 � & R i , 'r` - � - °, 3< ® cd:� i • A et a �A. V f ? 3 , f, v) r / 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 f No ❑ 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 rot 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 detachec 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 accept able 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' Compensat on) 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 Mas: achusetts General Laws Annotated. Homeowner Signature _ .r v,.'? a.. ,•�,,� ➢'" "' ai' x„✓s;. ✓ a ,'ki H '� 9 S .mow" 1# NnediblehAtlegreate 4°.'"o -Aka ,0: New House EI Addition ❑ Replacement lows Alteration(s) Roofing n Or Doors L Wir Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] Other [0] Brief Description of Proposed Work: ►C p)fY1P.41� � afar' rA1�.►Yl% t�q t...6nrjot A . t ) rt C� e 1Ytq L r1; . S Alteration of existing bedroom Yes ‘/ No Adding new bedroom Yes ✓ No / Attached Narrative Renovating unfinished basement Yes ,/ No Plans Attached Roll - Sheet 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 , s A "� s z I x'aA a e °X� '" 61 'r3'�`' I, 30A( 0rnpSO(1 , as Owner of the subject property hereby authorize PCAG.. ciNz `k t . to act on my behalf, in all matters relative to work authorized by this building permit application. (Set_ s v e f uLa Csz 51 h � Jo Signature of whir Date I, __DQV ACl I I_AC — l ci. P ad ucj i flC , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing applicatic n are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. br'llJ Print Name � a C- 5 /11 � et 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 I 1 I 11 Frontage 1 1 1 11 1 Setbacks Front 1 1 1 1 1 1 Side L:I 1 R:1 I L:1 1 R:1 I I 1 1 1 Rear 1 1 I 1 1 1 Building Height I 1 1 I 1 I Bldg. Square Footage I I I I 1 I CD I I Open Space Footage 1 11 I I I 1� 1 I (Lot area minus bldg & paved parking) # of Parking Spaces I I I 1 1 1 Fill: _ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW er YES 0 IF YES, date issued:I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Pagel and /or Document It B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 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 ® ND e IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO er IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc ation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ..,- ' • •'. ., .:. .. .. „ '''' ''• -'•••• '.--'-'.I •• • „... , „ ........ . .... .. . ., . ... , . , , ., a • .- .,..„., , .,,.....,....,-----.' .. f:-...-:''''''.44k9-11i:. ' LL ' z '''''' .--- "'''''''''' . --- : ' Nor t ha mpton - •::;1-,:lii,41.-ii,970::04!',..-.':',..:•':: .•.:„..;::,,;'..:', -..:'1'.,L:'..-''. ' ''', ''''I ,-::::... • ,:. : 0..,:i. ,..„ , .... ., _, „.,,,,,,, ent 212 F,.;44t- ' ' ,:•„-.•.,' - ,,L-,„1,:q)-01.W@:.',,,,:',,,,,-.,--",•'..- . • .• . • .-. .i , . .....„- g N ij or p ha a B •ii:::',,,,rio,:'?,...' . . '. .- _„:..._,=, . . . . - _ •;. ton, MA 01060 , R o M o a m i n 1 S o t o reet ^00 North Fax 2 1 " North `" DWELLING ,;A:i. :J.'''";'''''' ''''' - . . FAMILY DWE TWO OR DEM DLISH A ONE OR _ k t .\•,1, '\ phone 4'13-587-1240 rax 413-587-1272 --- N TO CONSTRUCT, . - :,,.7 T1,?fii-P*141:1-4,:17.,-ter.401•7.,t-t-tIlti APPLICATION ALTER, REPAIR, RENOVATE 0 „.„..„... 7 :: 7: .....-.. : :-.;,, ,,,,,.,-., .„--,.' .",:::.:,'.;:-,,,,,„=,,,,,":,,k''' 'i'. -, ...I. • ": . • . ' ..:, '.. ,'„„t„),41,,E.,..:::::::,,.."74F7„-Y.4:4 ..,1,4,s,,,,..tWri"-:-.,,°-; ` @ ;,...,*.;',:i.,Z,.i',Z,,,,,,,.!.':,,,2:2„•:„. . i:3r. eirx.12._ R.scj.lts, ''..-,"..•-•'?„, - .., .-: 1,..,...,-;,.,-,,,,,-;:.'•:-:. :'.:'..,,:•:,,,,','',--);:q:1'...,- ,1'..!..:',,;177:',.-,.. L...::,;..".,,,7,:'.1•''k;;;,4%.!:li 12*,...,,,..„.4.-:.±...,„.7. -... ..:, ,..1.,-....:::::,,,.":„-.,,,,,,,:::::: ..4:: .....,..,),*00.*;...,,...:7:-fi,7:1:-,7i.i,,7:-.:..„.-.1;k•-..kk;174,-, Prope Address 1b5 . ," - - - - =,=•-• ".., ' '''. 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" ...;,.i.;,„t.: .... ,,,,,4,. t':,Z,-4ae-A V4 ' k'JY.' , ,„.,.,:,- t•6hjltjj*4 i ktkPATRIZ-,'''''''''. „,. _ 0 705 IIL' RP..- ; BP- 2010 -1011 GIS #: COMMONWEALTH OF MASSACHUSETTS 4 J. ,«d_; ic 37 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 -1011 Project # JS- 2010- 001489 Est. Cost: $1582.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 142279 Lot Size(sq. ft.): 63597.60 Owner: THOMPSON JOHN R & MARGARET E Zoning: SR(100)/ Applicant: PELLA PRODUCTS, INC AT: 705 FLORENCE RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -01:53 WC GREENFIELDMA01301 ISSUED ON:5/13/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL REPLACEMENT WINDOW 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 5/13/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, FaK: (413) 587 -1272 Building Commissioner - Anthony Patillo