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38A-041 PELLA PRODUCTS INC PAGE 61101 11/1012010 11:33 4137363390 To Whom It May Concern: I, . NeA p N4 , as property owner, give permission 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 thi3 letter in place of my signature on the permit application. Thank you, Please Print Name Homeowner's Signature Date • 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: May 26, 2010 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. tl as4tchtt +k, ft. - Paf( tweet eil I'aitrlu, salt 1, Rwatrichettu: 40 , It ai ∎I rd halal+ F..1 Icc til,Nw +ii.. ,iaril '.t sfill ,if I. \_, ,',, , r, . 00- Unrestricted k,kt toll r,. r.c ,i..,urt IC: - l 2 Iemlllr Maws k OktrMraawi ic• ; On " DAV D C WHITE l.4 GARENTER ST ,, Endure to possess a torrent elution tot ih , Massarttusctts Seek Butedinq t tide ORAN E kite. 0'364 4 is cause foe firs RwAwe of due berrase �f i , ku„ w I ,, ,it, Refer tai: W W'W'.Nsae.Gs DPS P p.;. Jain 7 nd i r�.i -4 ""' \ Office of Coasamer Affairs & Business Regulation before date. If found return tot License before the exp istration va f use y B OAAE IMPROVEMENT CONTRACTOR ira o Office of or Cons Affai lid and or Business individul Regulation Registration 42279 Type: 10 Park Plan - Suite 5170 I , Expiration /2012 Suppbmenl (' :ard Boston, MA 02116 PELLA PRODUCTS INC , DAVID WHITE C- W p l 155 MAIN STREET ° ,« � •'••�"••+,+ l - i G,REENFIELD, MA 0130i Undersecretary Not valid without signature Each installation will be staffed by our installers who are all licensed in accordance with current building codes. Following are copies of their current licenses. Please accept these individuals as my Designees. Richard Guilmette CS60082 Tim Schrocki CS60927 Lorne Befit CS101355 Curt Boyle CS78514 Brian LaCroix CS65214 Jeff Pollock CSSL100327 Duane Cortis CS092246 Scott Bowdish CSSL100232 Paul Pellerin CSSL100325 Willard Brown CSSL100231 Mark Courtemanche CSSL100233 If you have any question please contact me using the numbers listed above. - 1 - PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 rCt n \ / Llt 1 1 J .-- 1/ 4 7 mi r7( K dOJ Ai x& 9 )( AIA Cpl0E0 qi,- - 32 0 - - - g 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 11/0412010 12:20 4137363390 PELLA PRODUCTS INC PAGE 02/02 SITE RESPONSIBILITIES Customer: / (fri a , / : . / J ^ - z ) Date: b i l l lip Order #: Signature: ,. 0 e_ - ..• I Salesperson: do/ 'ea"' Signature: �.asr�:I✓. ■SIC _. 1 % )epostt 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 cue tomer will not be present at time of install, payment Is to be made prior. 4 Chocks returned NSF will be assessed a fee of $50.00 to cover fees Incurred by Pella Fallu a 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 I o Inclement weather or site conditions, it may be necessary to reschedule. 5 We cannot and will not guarantee specific dates or days of the week for installation. 7 Time given to complete a lob Is an estimate, extension of time is possible 8 An it stall appointment will be confirmed at Verification. A courtesy reminder call will be placed 1 week prior. 9 Unfo eseen rot repair will be quoted on site as additional work via a Change Order. 10 Subs tantial completion is achieved when all available products have been Installed and are operational. Item 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 thi event that any products are unable to be installed, the final payment will be recalculated, The cost of products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost )f 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 Const wction: (tear out. Installation) Completely remove interior and exterior Trim, completely remove existing window frame, Install new window In rough opening, re -trim both interior and exterior of window I door, Pocket Ir stall : (sash replacement, existing frame remains) l n l Remove interior or exterior stops, install new window In existing window frame opening, re -use existing or replace window stops (interior or exterior) Some glass loss will occur. Lead Paint C Iscloser: #1 Home was built prior to 1978, Lead Paint discloser has been signed and "Protecting Your Family From Lead In Your Home" brochure has been given to Home Owner #271 Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will Authorized to insta$ Yard Sign on 1st day of installation and remove 7 days afterward tx l Ensure someone over age 18 is present at all times while Pella employees are in the home. n D eliver and unload products j Place drop cloths In work areas Remove & reinstall Interior and exterior trim if applicable Remove & reinstall existing shutters and awnings by contract Q Remove existing product and adjust or modify opening as needed n Provide all equipment necessary to install products 1 Cut all wood and other materials outside of home © Install all products purchased e n Insulate and caulk around products © n R emove stickers and perform initial cleaning of all glass surfaces ® n D emonstrate proper operation of products ® n C onfirm that all products are In working order L Li Remove drop cloths, vacuum and remove all old products from premises F inish (paint or stain) product purchased I ^ i Cut -back or tie trees, bushes, shrubs from exterior wall n Arrange to have alarm Syst em disconnected and reconnected Ti ] Arrange to have any plumbing or electrical repairs or changes by For Alt service needs, appropriate licensed contractor please call: x Remove and reinstall existing window treatments, wall hangings and (5001957.3552 make su ❑ 9 please make surd you air conditioning units. mention mat your project © Remove and reposition furniture In work area was installed by Pella © Secure pets In a safe manner and reforc m e b your order Ti I x I Remove valuable I breakable items from work area x I Remove snow from area of worksite if necessary 11:'04/2010 1 2: 20 4137363390 PELLA PRODUCTS INC PAGE 01/2 t r \ C V 1 � I C.d 0 e - - C 4 4 4 ' & `1 11. V U.A. r 15 4 4 „ . A . A . 4 aju_ j c re_ 014 uJ t` ii IrYLOV e u kG�� - fUf nc - koi' & Car\ a.+nct f't.Ir: � u 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 HOW IMPROVEMENT CONTRACTOR REGISTRATION # 142279 EXP, 3 -24 -10 FEDERAL TAX ID #: 04- 2303271 The saw rt squires the following fourteen Items to be Included in any contract between the homeowner and a registered home Imp - ovement contractor In all contracts for home improvement work subject to MGL c 142A 1 The c )mplete agreement between the owner and a clear description of any other documents which are part of the at regiment. 2 The ft ll names, federal ID, addresses (not PO box #'a) of the parties, tho contractors registration number, the names(s) of the sales person(s)) involved, It any and the date the contract was executed by the parties 3 The d He on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4 A dell died description of the work to be done aril the materials to be used 5 The is tel amount agreed to be paid for :the work to be performed under the contract. 8 A tint schedule of payments to be made under the contract and the amount of each payment stated in (Jolters, Includ ng all finance charges, if any. Any deposit required to be paid In advance maf the start of the went shall not exceed one- t Ira of the total contract price or the actual cost of any material or equipment of a special order or custom made naturt 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 pa lies 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 817- 727 -3200 x 25299 b. The contractors registration number must be on the first page of the contract c. The homeowners three day canCeitatlon rights under MGI, c93s4t1; NGK c 140D s lOor MGL c255D a 14 as may be applicable. d. All warranties on the owners rights under the provisions of 780 CMRRB and MGI, c 142A e . In ton point bold type or larger, directly above the space provided for the signature, the following statement: DO NOT SIQN 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 en.mmeration of such other matters upon which the owner end contractor may lawfully agree. 10 Any o her provisions otherwise required by the Applicable laws of the Commonwealth 11 Permi: 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 owners agent c. that the owners who secure their own construction related permits or deal with unregistered contractors snail be excluded fromaccess to the Guarantee Fund, 12 Accel !radon of payment No contract Shah contain an acceleration clause under which any part or all of the balance not yet du a may be declared due and payable because the holder deems himself to be Insecure. However, where the contri ctor deems himself to be Insecure he may require as a prerequisite to continuing said work that the balance funds due u ter the contract, which are In possession of the owner, shall be placed In a joint escrow account requiring the signal urea of the home Improvement dontractor and the owner for withdrawal, 13 No we rk shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14 Arbftri Won: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitrt ton, this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The c )ntractor and the homeowner hereby mutually agree in advance that In the event that the contractor has a dispute cones ming 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 orbits Hon ea provided in MGL c 142A Owner: Contractor Marc Guillemotte 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. sy 24 10 03:06p p.1 The Commonwealth of Massachusetts Department of Industrial Accidents ==t+_ Office of Investigations " 600 Washington Street • Boston, MA 02111 • tt '' 1 0 °, w wW.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers A a +licant Information Please Print Le. ibl Name {Business!Organization /Individual): Address: / / !` e4/ h F e 6 City /State /Zip: t: i iN ld / 1 C /.�O/ Phone #: // 77:7 G — Are you an employer? Check the appropriate box: Type of project (required): I. [ I am a employer tivith 79 4 . ❑ I am a general contractor and I b ❑ 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 have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp_ right of exemption per MGL 12.D Roof repairs insurance required.] t c. I52, §1(4), and we have no ��/ employees. [No workers' 13.� Other�C���cr eat,' c►/duJS comp. insurance required.] E► red ,Ljoa r s *Any applicant that checks box # I 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. tContractors that check this box must attached an additional sheet showing the name of the sub.eontracters 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 worker..' compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: /' 1 ) el/C.7 n S u r Xr't cc 7p /� R,- Policy it or Self -ins, l .ic. ; �� Qc� ay �O 3 Expiration Date: 7/– .O O / — Job Site Address: 7 NAv narJ k 604 City/State /Zip: t i .!_ is 1- 0/0 b 0 Attach a copy of the workers' cony ensation policy declaration page (showing the policy number and ex m iration 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 51.500.00 and/or one - year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $2.50.00 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 ' under the pains fdp[itieS of erjury t at the information provided above is true and correct. Signature: • t ; 1 � 1 Date: ' l0 ' / V` Phone t: e • 7�f - 7 231 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License ti 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 #: 4 PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 I ' I _ mbrel t r W 1l 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 • "2410 03:06p p,1 • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street y4 Boston, MA 02111 wWw'.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly '2 Name ( Business . /Organization /Individual); Address: f� ^ / �?r r ec CityiState /Zip: err..? 7 • /VI l� el Phone #: A ' 7a 7 - _0/53 Are you an employer? Check the appro rriate box: Type of project (required): i 1. a I am a employer with 7Q 4. ❑ I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. El New construction 2. ❑ I am a sole proprietor or partner listed on the attached sheet. 7_ ❑ Remodeling ship and have no employees These sub - contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance_1 required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 1 L 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' l3.0? Other42/Wee comp. insurance required.] end 1)00 V's *Any applicant that checks box 41 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. tCoutractors that check this box must attached an additional sheet showing the name of the sub- eontracters and state whether or not those entities have employees. If the sub - contractors have employees, they must provide tlteir workers' comp. policy number. I alit an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Nance: �` Cia / c 7 e) S U r ro n c? n — Policy if or Self -ins. Lic. i?: ( - ad av 7e2 3 /J Expiration Date: r7 / .O( r7 2 C. / Job Site Address: (,dice ee " Ci IStateIZi �: / :L/ c�' L �S�C � ty- , p. t 01060 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $ l.500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. • I do hereby certify under the ins and penalties of rjury that the information provided above is true and cor / rect- 411 Signature: � i4L Date: ! d - 2 ` /! Phone #: I'7 / 7 - 72Z ( 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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: May 26, 2010 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. It N! ivv,iclittvi tts - iilrar tom rll twf C"taiei< '»dtct, RwrhlgaAtu: DG 11...+14 p i t K w i4ltrw Fte krlu9et +� .ttI I �l�r }al:rrel» 611 Unres*ricerie Wow., 4,5. 1 t: - l 2 F ninth Mimes 1+. !ptTwrtw,r :c... 6( DAV 71 C WHITE fro C aR� EWTER 57 Milts re to possess tomcat aARR* of 0111! Massathusetts hate Building t ode i 1'lkl4i E MA S}' 364 s. is sate ' ON Ira ocatwro of this license ?, Ott Refer to: W W 11 ". Wtss.C:s,s U!"S Office of Consenter Affairs & Rosiness Regulative License or registration valid for individul use only B $" OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: E r Office of Consumer Affairs and Business Regulation Registration: 142279 ryp' 10 Park Plaza - Suite 5170 Expiration 3 Supplement (i and Boston, MA 02116 PELLA PRODUCT$ INC. 155 WHITE MAIN - ,.� L i 155 MAIN STREET •d:••��- f i ` y... { GREENFIELD, MA 01301 Undersecretary Not valid without signature Each installation will be staffed by our installers who are all licensed in accordance with current building codes. Following are copies of their current licenses. Please accept these individuals as my Designees. Richard Guilmette CS60082 Tim Schrocki CS60927 Lorne Befit CS101355 Curt Boyle CS78514 Brian LaCroix CS65214 Jeff Pollock CSSL100327 Duane Cortis CS092246 Scott Bowdish CSSL100232 Paul Pellerin CSSL100325 Willard Brown CSSL100231 Mark Courtemanche CSSL100233 If you have any question please contact me using the numbers listed above. -1- , Building Inspection Services I, r as property owner, give penn to our contractor 'ella Products Inc., to obtain a building permit for the inst.. tion o windows or t oors in my home, located at � - IA— � . Please accept this letter in place of my signature on the building permit application. Thank -You 'tip ff- / j9 ,- --r - L-_ - /11= - Print Customer Name _., 7 r G Home Owner's Signature - \-----) (0A770 Date Thank -You Ore Sample Pre - Renovation Form This sample form may be used by renovation firms to document compliance with the Federal pre- renovation education and renovation, repair, and painting regulations. Occupant Confirmation Pamphlet Receipt P_ I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. O ner- occupant Opt -out Acknowledgment (A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman resides here, and that this property is not a child- occupied facility. Note: A child resides in the primary residence of his or her custodial parents, legal guardians, foster parents, or informal caretaker if the child lives and sleeps most of the time at the caretaker's residence. Note: A child- occupied facility is a pre -1978 building visited regularly by the same child, under 6 years of age, on at least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours annually. If ox A is checked, check either Box B or Box C, but not both. (B) I request that the renovation firm use the lead -safe work practices required y EPA's Renovation, Repair, and Painting Rule; or L I understand that the firm performing the renovation will not be required to use the lead -safe work practices re. Tired by EPA's Renovation, Repair, and Painting Rule. Prin e rf Owner -occ frf. ' t ignature of Owner - occupant Signature Date enovator's Self Certification Option (for tenant - occupied dwellings only) Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. ❑ Declined – I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. LI Unavailable for signature – I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left). Printed Name of Person Certifying Delivery Attempted Delivery Date ° Signature of Person Certifying Lead Pamphlet Delivery Unit Address Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner andior tenant. Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a certificate of mailing from the post office. ° Note: This form is not effective until April 2010. ° Customer: Barbara Weene Project Name: Weene Barbara 18 Laurel Street Northampton MA Order Number: 739 Quote Number: 2082789 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: E"ALL furniture needs to be moved at least 8 feet away from any window or door being replaced 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 Any non - movable furniture (for example: pianos, entertainment centers, built in cabinets, etc) must be cleared of items and be surface dusted prior to installation [1 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 0' In 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. ,�] 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 understancdthat failure to have these items completed will result in the re- scheduling of my installation and that my installation • - : will be scheduled for thy' next available date. •, � j i i V 70 /6/7 Customer 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.o i s enic1 r i n i ;i r 7 .,s 0 SITE RESPONSI : ILITIES Customer: _ c f/t! 4 / Date: / Order #: Signature: 4 f x� l I — Satespersote. Pdare t_.Wswaalel Stgnate . ege ilr- 1 50% Deposit required at time of order. 2 Final payment is to be made to installation team on = morning of the last day of Installation. 3 If 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 $50.0013 cover fees into, e d 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 emd will reek guarantee speoWto dates eh days of the weep 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 call 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 event that any products are unable to be installed, the final payment will be recalculated. The cost of produrrts test ittstaLIad wilt be subtracted from ttva 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) i Completely remove interior and exterior Trim, completely remove existing window frame, install new window in rough opening, re -trim both interior and exterior of window / door. Pocket Install : e. (sash replacement, existing frame remains) I I Remove interior or exterior stops, install new window in existing window frame opening, re -use existing or replace window stops (interior or exterior) Some glass loss will occur. Lead Paint Discloser: #1 I I Home was built prior to 1978, Lead Paint discloser has been signed and "Protecting Your Family From Lead in Your Home" brochure has been given to Home Owner #211 Are there children under the age of 6 or women who are pregnant? Pella WM Owner'W111 I X ( Authorized to install Yard Sign on 1st day of installation and remove 7 days afterward � � i X I Ensure someone over age 18 is present at all times while Pella employees are in the home. l I Deliver and unload products © 1 Place drop cloths in work areas I X I I Remove & reinstall interior and exterior trim if applicable [ X� n Remove & reinstall existing shutters and awnings by contract I X ( I ] Remove existing product and adjust or modify opening as needed n n P rovide all equipment necessary to install products [ n t ut all wood and other materials outside of home I X1 rI Install all products purchased LX] I I Insulate and caulk around products I X I ( I Remove stickers and perform initial cleaning of all glass surfaces t Xi 1 Demonstrate proper operation of products - X I I I Confirm that all products are In working order i xl n R emove drop cloths, vacuum and remove all old products from premises n n F inish (paint or stain) product purchased I i I X Cut -back or tie trees, bushes, shrubs from exterior wall 1 A rrange to have alarm system disconnected and reconnected LI I X ( Arrange to have any plumbing or electrical repairs or changes by For all service needs, appropriate licensed contractor please call•. 1800)957 -3552 i [ Xl R emove and reinstall existing window treatments, wall hangings and Please make sure you air conditioning units. mention that your project L J i X i Remove and reposition furniture in work area was installed by your order reference your order X I Secure pets in a safe manner number I Ft() X i Remove valuable / breakable items from work area } Remove snow from area of worksite't necessary Customer: Barbara Weene Project Name: Weene Barbara 18 Laurel Street Northampton MA Order Number: 739 Quote Number: 2082789 delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is, oject Checklist has been -- viewed Order Totals III r Taxable Subtotal $4,062.46 Credit Card Approval Signature Sales Tax © 6.25% $253.90 ` � � Non - taxable Subtotal $3,396.88 1 21 / ��� C - • er Name (Please prin Pella Sales Rep Name (Please pri ) Total $7,713.24 Deposit Received $0.00 ZA— Amount Due $7,713.24 Customer Signature Pella Sales Rep Signature /6 /( Date Date For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com or■., +o+,., 1(1cI'n no +nao,+ o.,,., g f a Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Line # Quote Qty PO Qty Description Item Price Ext'd Price 65 1 0 INTSTYLE3 - Interior style - square edged stool and apron List Price: $0.00 Location: P -For # 15,20,26,27 Rough Opening: Discount % = Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $0.00 $0.00 Last Revision Date: IW - Impervia White Semi -Gloss Paint Qty 1 Order Pricing Totals Total List Price $7,771.02 Discountable Amount $10,360.02 Discount @ 0.000% $0.00 Non - Discountable Amount ($2,589.00) Net Before Payment Discount $7,771.02 Payment Discount Amount $0.00 Net After Payment Discount $7,771.02 Taxable Subtotal $4,092.39 Sales Tax @ 6.25% $255.77 Non - taxable Subtotal $3,678.63 Total (Total Net + Taxes) $8,026.79 Deposit Received $3,857.00 Amount Due $4,169.79 Printed on 10/19/2010 Office Order Copy Page 10 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Line # Quote Qty PO Qty Description Item Price Ext'd Price 50 6 6 3 -1/2" w /holes Solid Jamb Extension, Length: 96, Prefinished List Price: $44.92 White Location: Rough Opening: 1: 3 -1/2" w /holes Solid Jamb Extension Discount % = 0.00 % Length: 96 Discount $ $0.00 $0.00 Frame Size: 0" X 0" Interior Color / Finish: Prefinished WhiteWood Type: Pine Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Assembled Net Price: $44.92 $269.52 Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 59 1 0 PREFINISHING - PREFINISHING SERVICES List Price: $250.00 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: $250.00 $250.00 Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 60 1 0 ITC -PFJ1 - New interior casing PFJ 3/4 X 3 -1/2 List Price: $0.00 Location: P - Trim for Tearouts Rough Opening: Discount % = Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $0.00 $0.00 Last Revision Date: Shop Notes: 10 @ 8' also 1" X 10" is needed 2 @ 8' iW - impervia White Semi - Gloss Paint Qty I Printed on 10/19/2010 Office Order Copy Page 9 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Line # Quote Qty PO Qty Description Item Price Ext'd Price 30 1 0 INSTALLATION - INSTALLATION List Price: $120.00 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: $120.00 $120.00 Last Revision Date: Customer Notes: Permit Fee Line # Quote Qty PO Qty Description Item Price Ext'd Price 40 1 0 End of Summer Promotion: 25% off Product List Price: ($1,363.00) Location: Rough Opening: 0" X 0" Discount % = Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Last Revision Date: Net Price: ($1,363.00) ($1,363.00) Line # Quote Qty PO Qty Description Item Price Ext'd Price 45 1 0 End of Summer Promotion: 25% off Installation List Price: ($1,226.00) 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: ($1,226.00) ($1,226.00) Last Revision Date: Printed on 10/19/2010 Office Order Copy Page 8 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 27 1 1 Architect, Awning Left, 29.25 X 28.25, White, 5- 9/16" List Price: $1,539.96 Location: Side Porch Side ;q i Rough Opening: 30" X 29" 1: Non - Standard Size Left Awning Discount % = 0.00 % " Final Wall Depth: 5 -9/16" Frame Size: 291/4 X 281/4 Discount $ $0.00 $0.00 Frame Size: 29.25 X 28.25 General Information: Standard, Clad, Pine imiNE Exterior Color / Finish: Standard EnduraClad, White 15 -• Frame Perimeter (inches): 115 Interior Color / Finish: Prefinished White Interior Glass: Insulated Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Standard Roto Operator, White 539.96 Last Revision Date: Screen: Full Screen, White, InView Net Price: $1,539.96 $1, Grille: ILT, No, 7/8 ", Traditional (3W2H) Wrapping Information: Foldout Fins, Factory Applied, 5- 9/16" Standard 4- sided Jamb Extension, Factory Applied (DVA), Perimeter Length = 115 ", Glazing Pressure = 155. Installation Notes: Lead -Safe Required Interior Trim: 1 X 10 for apron and 1 X 6 ? for the rest of the window EXTSTYLE2 - Exterior style - PVC historic sill Qty 1 EXTTRIM9 - New exterior trim 1 X 6 PVC Qty 1 FF -1 - FF w!Trim (Tear Out) Installation up to 60 Qty 1 UI ITC -PFJ1 - New interior casing PFJ 3/4 X 3 -112 Qty 1 INTSTYLE4 - Interior style - eased edge stool and Qty 1 apron • Printed on 10/19/2010 Office Order Copy Page 7 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 26 1 1 Architect, Awning Right, 29.25 X 28.25, White, 5- 9/16" List Price: $1,739.96 111 Location: Side Porch Back tq Rough Opening: 30" X 29" 1: Non - Standard Size Right Awning Discount % = 0.00 % 119 ! Frame Size: 1/4 X 28 Discount $ $0.00 $0.00 Frame Size: 29.25" X 28.25" Genera Pi Information: on: Stanan dard, Clad, Pine 1 111111111 Final Wall Depth: 5-9/16" Exterior Color! Finish:Standard EnduraClad, White r- — Frame Perimeter (inches): 115 Interior Color / Finish: Prefinished White Interior Glass: Insulated Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Standard Roto Operator, White Screen: Full Screen, White, InView Net Price: $1,739.96 $1,739.96 Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (3W2H) Wrapping Information: Foldout Fins, Factory Applied, 5- 9/16" Standard 4- sided Jamb Extension, Factory Applied (DVA), Perimeter Length = 115 ", Glazing Pressure = 155. Installation Notes: Lead -Safe Required, Non - Standard Trim Interior Trim: 1 X 10 for apron LP -2 - Lead safe practices this opening over 150 Qty 1 UI INTSTYLE3 - Interior style - square edged stool Qty 1 and apron ITC -PFJ1 - New interior casing PFJ 3/4 X 3 -112 Qty 1 FF -1 - FF wlTrim (Tear Out) Installation up to 60 Qty 1 UI EXTTRIM9 - New exterior trim 1 X 6 PVC Qty 1 EXTSTYLE2 - Exterior style - PVC historic sill Qty 1 • Printed on 10/19/2010 Office Order Copy Page 6 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 25 1 1 Architect, Precision Hung Double Hung, 23.5 X 33.5, White List Price: $1,443.59 Location: Downstairs Bath ,ra Rough Opening: 24" X 34" 1: Non - Standard Size Double Hung, Equal Split Discount % = 0.00 % R Frame Size: 23.5" X 33.5" Frame Size: 23 1/2 X 33 1/2 Discount $ $0.00 $0.00 General Information: Style Edition, Clad Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White Frame Perimeter Interior Color / Finish: Red Mahogany Stain Interior (inches): 235 '" ( Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, No Sash Lift Net Price: $1,443.59 $1,443.59 Last Revision Date: Screen: Full Screen, InView Grille: ILT, No, 7/8 ", Traditional (3W2H / OWOH) Wrapping Information: Perimeter Length = 114 ", Glazing Pressure = 190. Installation Notes: Lead - Safe Required LP -1 - Lead safe practices this opening under Qty 2 150 UI PF -1 - Interior Pocket Installation for Precision Qty 1 Fit ITS -EX - Re -use existing stops (replace if Qty 1 broken) • Printed on 10/19/2010 Office Order Copy Page 5 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 20 1 1 Impervia, Double Hung, 21.5 X 47, White List Price: $1,088.69 I U Location: Upstairs Back • I Rough Opening: 22" X 47.5" 1: Non - Standard Size Double Hung, Equal Split Discount % = 0.00 % Frame Size: 21 1/2 X 47 Discount $ $0.00 $0.00 Frame Size: 21.5" X 47" General Information: Standard, Duracast, Block Frame, Foam Insulated I Fin Wall Depth: Exterior Color / Finish: White Frame Perimeter Inches :137 Interior Color / Finish: White Interior ( ) Glass: Insulated Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Color Matched Net Price: $1,088.69 $1,088.69 Last Revision Date: Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (2W2H / OWOH), White Wrapping Information: Standard Fin, Perimeter Length = 137 ", Glazing Pressure = 170. Installation Notes: Lead Safe Not Required ITC -PFJ1 - New interior casing PFJ 314 X 3.112 Qty 1 INTSTYLE3 - Interior style - square edged stool Qty 1 and apron FF -2 - FF wlTrim (Tear Out) Installation up to Qty 1 61 -70 UI EXTSTYLE2 - Exterior style - PVC historic sill Qty 1 EXTTRIM9 - New exterior trim 1 X 6 PVC Qty 1 Printed on 10/19/2010 Office Order Copy Page 4 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 PF -1 - Interior Pocket Installation for Precision Qty 1 Fit ITS -EX - Re -use existing stops (replace if Qty 1 broken) Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price ........ ......_. 15 2 2 Impervia, Double Hung, 27 X 35, White List Price: $1,265.10 5 P 5 Location: Driveway Side M E M Rough Opening: 27.5" X 35.5" 1: Non - Standard Size Double Hung, Equal Split Discount % = 0.00 % Frame Size: 27 X 35 Discount $ $0.00 $0.00 Frame Size: 27" X 35" General Information: Standard, Duracast, Block Frame, Foam Insulated Final Wall Depth: Exterior Color / Finish: White Interior Color / Finish: White Interior Frame Perimeter (inches): 124 Glass: Insulated Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Color Matched Screen: Full Screen, InView Net Price: $1,265.10 $2,530.20 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H / OWOH), White Wrapping Information: Standard Fin, Perimeter Length = 124 ", Glazing Pressure = 165. Installation Notes: Lead Safe Required Attention: Non - Standard Trim LP -2 - Lead safe practices this opening over 150 Qty 1 UI EXTSTYLE2 - Exterior style - PVC historic sill Qty 1 INTSTYLE3 - Interior style - square edged stool Qty 1 and apron EXTTRIM9 - New exterior trim 1 X 6 PVC Qty 1 ITC -PFJ1 - New interior casing PFJ 3/4 X 3 -1/2 Qty 1 FF -2 - FF wlTrim (Tear Out) Installation up to Qty 1 61 -70 UI • Printed on 10/19/2010 Office Order Copy Page 3 of 10 Customer: Barbara Weene Quote Description: 739 Impervia Architect 413 - 626 -3570 Order Number: 739J3KL021 OL' side View Line # Quote Qty PO Qty Description Item Price Ext'd Price % 10 1 1 Impervia, Double Hung, 23.5 X 33.5, White List Price: $689.05 ®P1 i . Locatio Dormer Inside L eft •n 11111111 - Rough Open 24" X 34" 1: Non - Standard Size Double Hung, Equal S plit Discount % = 0 .0 0 % R Frame Size 23 1/2 X 33 1 D $ $ 0 . 00 $0.00 Frame Size. 23.5 X 33.5 General Information: Standard, Duracast, Block Frame, Foam Insulated Final Wall Depth: Exterior Color / Finish: White Interior Color / Finish: White Interior .-- 235 -, Frame Perimeter (inches): 114 Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Color Matched Screen: Full Screen, InView Net Price: $689.05 $689.05 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H / OWOH), White Wrapping Information: Replacement Precision Fit Kit, Perimeter Length = 114 ", Glazing Pressure = 205. Installation Notes: Lead - Safe Required PF -1 - Interior Pocket Installation for Precision Qty 1 Fit ITS -EX - Re -use existing stops (replace if Qty 1 broken) Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 11 1 1 Impervia, Double Hung, 23.5 X 33.5, White List Price: $689.05 I ■ PI O Location: Dormer Inside Right w I kin : Rough Opening: 24" X 34" 1: Non - Standard Size Double Hung, Equal Split Discount % = 0.00 % 7 F rame Size: 23.5" X 33.5" Frame Size: 23 1/2 X 33 1/2 Disc ount $ $0.00 $0.00 General Informatio Standard, Duracast Block Frame, Foam Insulated Final Well Depth: Exterior Color /Finish: White Frame Perimeter (inches 114 Interior Color / Finish: White Interior s Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Color Matched Screen: Full Screen, InView Net Price: $689.05 $689.05 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H / OWOH), White Wrapping Information: Replacement Precision Fit Kit, Perimeter Length = 114 ", Glazing Pressure = 205. • • Installation Notes: Lead -Safe Required Printed on 10/19/2010 Office Order Copy Page 2 of 10 Office Order Copy Cl io• ti 1t, �� Branch Number: 73900 Order Number: 739J3KL021 � Window Store Name: Quote Number: 2082789 Quote Description: 739 Impervia Architect 413 -626 -3570 Project Name: Weene Barbara 18 Laurel Street Northampton MA Customer Information Deliver To Address Order Information Barbara Weene Lot # Sales Rep Name: Lukomski, Adam Cust Delivery Date: 12/08/2010 Address: Business Segment: Retail Quoted Date: 10/5/2010 18 Laurel Street 18 Laurel Street Market Segment: Single Family Replacement Contract Date: 10/18/2010 Order Type: Installed Sales Booked Date: 10/18/2010 Effective Discount: 0.000% Earliest LRD: 11/12/2010 Northampton, MA 01060 NORTHAMPTON, MA 01060 Commission Split: Lukomski, Adam - 100% Contact Name: County: HAMPSHIRE Tax Code: MASS Tax Exempt #: Payment Terms: C.O.D. Customer PO #: Day Phone: (413) 626 -3570 Owner Name: Accessories Managed Accessory Delivery Date Mobile Phone: Barbara Weene Fax Number: E -Mail: Owner Phone: (413) 626 -3570 Great Plains #: 53H6263570 Customer Number: 3627142 Delivery Instructions: GPS, Light Pink Colored Home with White Trim and Red Front Door # 18 Clearly Marked on the Home Installation Notes: All Trim is Pre - Finished for Tearouts, GPS, Light Pink Colored Home with White Trim and Red Front Door # 18 Clearly Marked on the Home Printed on 10/19/2010 Office Order Copy Page 1 of 10 S ECTION 8•- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable / ❑ Name of License Holder : `JQ 1 (1 �,1 1 i ( li .�7 / ' T .7': License Number 1 °.4'n �1 f v4 `5 M. MA n (. "t) i b.�/ 20/1 Address Expiration Date � nn ct, C 77 — 015.3 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name ' _ Registration Number pfi a ,i-n Ace. f GYeer MA GI 36 q 2 (0 i Z Address Expiration Date Idh:kLC. Telephone 1(3` 772 V /S3 — 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 buildin>? 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 ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [D] Other [0] Brief Description pf Proposed Work: --- rt,,_Str.itGtRaln (1 4 R Ti 649 t •ulrAe ir 030Ua) (1.SI ex,k - /y ff Alteration of existin bedroom Yes • o Addin new b oo Yes /No `✓ '5 ��1'� . 9 9 Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet (Ay) . 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, - ir w rte , as Owner of the subject property Q hereby authorize (', I L 'Pro It u Tri C . to act on my behalf, in all matters relative to work authorized by this building permit application. 0 fi� r Signature of Owner Date I, -D Jatil A (, kl-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. ---' S)(TAIt (k WO i Print r3e 1 CA , ' "`'" /V • 2J / ) 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 C DON'T KNOW 0 YES C IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW C YES 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 0 YES 0 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 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO IF YES, describe size, type and location: E. WII 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. e Department use only City of Northampton Status of Permit: .,>.,/* Building Department Curb Cut/Driveway Permit ''' 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability c �r C Nort a mpton, MA 01060 Two Sets of Structural Plans ti ph 41 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans � ` ��, Other Specify APPLI C/tTION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SllE INFORMATION 1.1 Property Address: This section to be completed by office I' 8 Luxe_ / .5 e-1 Map Lot Unit N or T► cur) / MA O 1 0 6 6 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: a,r \jcUr 1 (e,1 (k L a.r /,1- e. ( , // kr Viat with) MA Name (Prin Current Mailing Address: ' 1 % -L - 77Z -0153 aiv�c ... L : _ 4 If& . Telephone Signature 2.2 Authorized Agent: I ( (`� ^ 4h /� 1 J (�.�1� l a1 al I 1 i "� '�� � Gl'�'Pt'f1" /14, J Name (Prin ..,.. C'. CJhds. Current Mailing Address: Q 3 Signature I °el 9- � e ho 772 — 0 6 3 P SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee KS DO 2. Electrical (b) Estimated Total Cost of Q Construction from (6) t� I lOU . ®U 3. Plumbing O Building Permit Fee 3 , T . 0 0 4. Mechanical (HVAC) a 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) $ l 10(100 Check Number ac 8'% This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date BP- 2011 -0391 GIS #: COMMONWEALTH OF MASSACHUSETTS RN. 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- 2011 -0391 Project # JS- 2011- 000650 Est. Cost: $8100.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 5009.40 Owner: WEENE BARBARA J Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 18 LAUREL ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:1 0 /28/201 0 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/28/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner