Loading...
23D-168 � _ r Building Inspection Services e (Ai g /J' S ,_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 r Ci - to E - 1 FC�i ea 6 L . Ple ase accept this letter in P place of my signature on the building permit application. Thank -You Et2,;v4 -0.:p � 1114-4,41 f S Print Customer Name Home C)wner' Signature Date • Thank -You a PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 a ►ter; izq [6(°.i, c e MA Subject: Disposal of Debris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc. in your Town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, PELLA PRODUCTS INC. John P. Benjamin Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone: 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. >•i.,..,, i,s..ti 1 pxi101 n1 01 Villa!, ".ib:l` l RmrklcMdto: x 1.x.. It ,;t, 1 1 IfiaiI I ti Ira;,til 11i ir. ianif '1.1E1ilar . S' bt"; rt`tn `* a (.� , .� .'r. 09- fietreitri[RH) (. ,�n.. J'4'►' H. - 12 Family Plumes. r < Ft 01,, mat 1,,_ 511 DAti o C WI-ITE 5+1 G4REVTER ST Failure to pn rsrs a a current edition of thr Massachusetts Stair Building i ode ORANGE MA 3'3(34 is taus kw res,l.as un of this license. Refer ter MiYiW'.Mats.GsniDt ._. .... ,..,.. r ..._ .. .. r ., a /kr (-,I.,),,,,e4wallfi rf`', itiu:,ackea.9Lf .7 Office of Consumer Affairs & Business Regulative License or registration valid for individul use only < ,NONE IMPROVEMENT CONTRACTOR before the expiration date. if found return to Office of Consumer Affairs and Business Regulation � 'Registration: 142279 T ye' t0 Park Plaza - Suite 5170 Expiration: 3/24/2012 Supplement ( ;red Boston, MA 02116 PELLA PRODUCTS, INC. DAVID WHITE `'� 1 � \ '� J 155 MAIN STREET � � - - -- 4w '�X C W K" _. , ,C) 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- Ed Harris Project Name: Harris Ed 134 Maplewood Terrace Florence MA Order Number: 739J3IP031 Quote Number. 1525432 Pre- Renovation Form Occupant Confirmation Pamphlet Receipt C° I have received a copy of the lead hazard information pamphlet informing me of the potential risk of lead hazard exposure from renovation activity to be p ormed in my dwelling u I. I received this pamphlet before the work began. , It- Printed`IVame ofi Owner -occ , s ant r 0 4-4• = rr- - / - ( Signature of Owner - occupant Signature Date Renovator'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. 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 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 and /or tenant. Pamphlet must be mailed at least 7 days before renovation. Mailing must be documented by a certificate of mailing from the post office. For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com o,- 4„ +e,+,.., nar47i-7n1n rs,,,, —..+ nm.,a.a o.,,.,, a "f a ;: Ed Harris Project Name: Harris Ed 134 Maplewood Terrace Florence MA Order Number: 739J31P031 Quote Number: 1525432 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: i Di ALL furniture needs to be moved at least 8 feet away from any window or door being replaced [I ALL personal items, wall hangings, and collectibles must be removed prior to your installation date E7All 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 D 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 Ef 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. w ring 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 understand that failure to have these items completed will result in the re- scheduling of my installation and that my installation date will be scheduled for the next available date. Z .A..--L--- - "d A.,,t......-t----", - ..--/ y -,(0 Customer Signature Date For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.corn n.;..i, a,... no / 47 PIA 4n n,...4.......4 n,.4...1.. n...... c ,.1 c • - cd Hams Project Name: Harris Ed 134 Maplewood Terrace Florence MA Order Number: 739J3IP031 Quote Number. 1525432 roject Checklist has been reviewed Note: These totals DO NOT include tax Order Totals � Taxabl e Subto $2,167.17 Credit Card Approval Sales Tax @a 0% $0.00 Non - taxable Subtotal $1,143.77 rti' ‹' /f /G �� Total $3,310.94 Customer Name (Please print) P. R - ; ep Na Please print) ` '. Deposit Received $0.00 qtr i/ - �1 Amount Due $3,310.94 u stomer Signature P- a Sales Rep Signature Date Date • For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com n.:..l...J ,... no ,l 7P1/14 r n,...4. -,.,,� n,.4„a,.,A f)...... A ..F c /I Hams Quote Description: 739 Architect Phase 1 Order Number. 739J3IP131 • Line # Quote Qty PO Qty Description Item Price Ext'd Price 40 1 0 Summer Promotion: 25% off Installation List Price: ($161.28) 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: ($161.28) ($161.28) . Last Revision Date: Order Pricing Totals Total List Price $4,257.19 Discountable Amount $4,418.47 Discount 22.227% $946.25 Non - Discountable Amount ($161.28) Net Before Payment Discount $3,310.94 Payment Discount Amount $0.00 Net After Payment Discount $3,310.94 Taxable Subtotal $2,064.73 Sales Tax 0% $0.00 Non- taxable Subtotal $1,246.21 Total (Total Net + Taxes) $3,310.94 Deposit Received $3,310.94 Amount Due $0.00 Printed on 08/24/2010 Office Order Copy Page 4 of 4 j Hams Quote Description: 739 Architect Phase 1 Order Number: 739J3IP131 Line # Quote Qty PO Qty Description Item Price Extd Price 30 1 0 INSTALLATION - INSTALLATION List Price: $95.00 Location: None Assigned Rough Opening: Discount % = 0.76 % Frame Size: Discount $ ($0.72) ($0.72) Final Wall Depth: • Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $94.28 $94.28 Last Revision Date: Customer Notes: Building Permit Fee Line # Quote Qty - PO Qty Description Item Price Ext d Price 35 1 0 INSTALLATION - INSTALLATION List Price: $1,220.00 Location: Install Line #15 Rough Opening: Discount % = Frame Size: Discount $ ($9.22) ($9.22) Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $1,210.78 $1,210.78 Last Revision Date: Installation Notes: Exterior Trim: AZEK Drip -Cap 1 @ 12' Gust in case existing is broken during install) 1 x 6 AZEK 3 © 12' Fro side, lower head trim, and ripped for batten as needed 5/4" x 4" AZEK 1 © 12' for upper head trim capping lower head trim and fitting under drip cap AZEK Historic sill nose 1 @ 12' FF -9A - FF w!Trim (Tear Out) Installation up to Qty 1 141 -150 UI Printed on 08/24/2010 Office Order Copy Page 3 of 4 Harris Quote Description: 739 Architect Phase 1 Order Number 739J3IP131 Jutside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 15 1 1 Architect, 3 -Wide Casement, 107.25 X 45.25, White, 6 - 3/16" List Price: $3,103.47 Location: Living Room Mai a' Rough Opening: 108" X 46" 1: Non - Standard Size Left Casement Discount % = 30.17 % 'VIII I Ma l F Size: 25 X 45114 Discount $ ($936.31) ($936.31) Frame Size: 107.25" X 45.25" General Information: Standard, Clad, Pine Final Wall Depth: 6 -3/16" Exterior Color / Finish: Standard EnduraClad, White Frame Perimeter inches :305 Interior Color 1 Finish: Unfinished Interim • Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Side Pivot Hardware, Brown Screen: Full Screen, Brown, InView Net Price: $2,167.16 $2,167.16 Last Revision Date: Grille: RMB, No, 3/4 ", Traditional (3W5H), Unfinished Wood, Unfinished Wood, Shipped Separate Vertical Mull 1: FactoryMull, Standard (Vertical Factory) (0") 2: Non - Standard Size Fixed Casement Frame Size: 571 /4 X 451 /4 General Information: Standard, Clad, Pine Exterior Color / Finish: Standard EnduraClad, White Interior Color / Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Grille: RMB, No, 3/4", Traditional (7W5H), Unfinished Wood, Unfinished Wood, Shipped In Unit Vertical Mull 2: FactoryMuf, Standard (Vertical Factory) (0") 3: Non-Standard Size Right Casement Frame Size: 25 X 451 /4 General Information: Standard, Clad, Pine Exterior Color 1 Finish: Standard EnduraClad, White Interior Color / Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Hardware Options: Side Pivot Hardware, Brown Screen: Full Screen, Brown, InView Grille: RMB, No, 3/4 ", Traditional (3W5H), Unfinished Wood, Unfinished Wood, Shipped Separate Wrapping Information: Foldout Fins, Factory Applied, 6 -3/16" Factory Applied (DVA), Perimeter Length = 305 ", Glazing Pressure = 50. Customer Notes: Full Frame install w/Removable Grilles. ET-1 - Exterior Trim Qty 1 LP-1 - Lead safe practices this opening under Qty 1 150 UI EXTTRIM9 - New exterior trim 1 X 6 PVC Qty 1 ITC -8730 - New interior casing 2 -112 ranch #8730 Qty 1 Printed on 08/24/2010 Office Order Copy Page 2 of 4 / , _\),'„(0 L QeiS.. ? . Z . 6 Le t , , ..... i . Office Order Copy Ji.3 ?d& Branch Number: 73900 Order Number: 739J3IP131 /i r,,,tvyt Window Store Na me : C Lit. Quote Number: 1525432 2S".10 Quote Description: 739 Architect Phase 1 Project Name: Harris Ed 134 Maplewood Terrace Florence MA Customer Information Deliver To Address Order Information Ed Harris Lot # Sales Rep Name: Picard, Paul Cust Delivery Date: 09/24/2010 ' Address: Business Segment: Retail Quoted Date: 05/03/2010 134 Maplewood Terrace 134 Maplewood Terrace Market Segment Single Family Replacement Contract Date: 08/14/2010 Order Type: I nstalled Sales Booked Date: 08/20/2010 Effective Discount: 22227% Earliest LRD: 08/25/2010 FLORENCE, MA 01062 FLORENCE, MA 01062 Commission Split: Picard, Paul - 100% Contact Name: County: HAMPSHIRE Tax Code: MAEXEMPT Tax Exempt #: Payment Terms: Paid In Full Customer PO #: Day Phone: (413) 584 -6555 Owner Name: Accessories Managed Accessory Delivery Date Mobile Phone: Ed Harris Fax Number: E -Mail: Owner Phone: (413) 584 -6555 Great Plains #: 53115846555 Customer Number: 4246393 Delivery Instructions: GPS TO HOME Installation Notes: GPS TO HOME Printed on 08/24/2010 Office Order Copy Page 1 of 4 BERKSHIRE INS Fax :14135664224 Aug 26 2010 8:24 P.01 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 2 6/2a o .RODUCER (413) 773 -9913 FAX: (413) 774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION lassOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR L17 Main Street ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW. _ ?.O. Box 638 3reenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE _ NAIC# NSURED INSURER A: ContinenEa1 Neat ern Pella Products, Inc. INSURERS: N1TN: John Benjamin INSURER C'. 155 Maid $treet INSURER D: 3reenfteld MA 01301 -3258 INSURER E: V THE POLICIES OF INSURANCE LISTED BELOW HAVE B ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AG(;REGAT u T SH • ,,P. AY HAV : N • ED • :Y PAID . _ ■1 •SR ADD•L - POLICY p.FPECTIVE POLICY EXPIRATION ,TR NOD TYPe OF INSURANCE POLICY NUMBER DATE (MM DP /DYY) DATE IMMPD • LIMITS GENERAL LIADIUTY FADH OCCURRENCF $ 1,000,000 X COMMERCIAL GENERAL LIABILITY • DAMAGE TO RENTED . MI ES E:.... ,,,r.; $ 300,000 A CLAIM6MADE [l OCCUR CPA020470113 1/1/2010 1/1/2011 MEDEXP (Any one peson) $ 15,000 pFRSr7N s ADV II'1,11 MY $ 1,000,000 , G, FRALAGGREG: $ 2,000,000 � GENII AGGREGATE LIMIT APPLIES PER: c•• ►u,_C•,,• •. act $ 2,000,000 i' I LL ' fl LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (ER a accident) $ 1,000,000 A ALL OWNED AUTOS MTAA.020470213 1/1/2010 1/1/2011 BODILY INJURY Per person) $ X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accklent) X NON OWNED AUTOS • . - PROPERTY DAMAGE S • (Per soNde -r5) GARAGE LIABILITY AUTO ONLY - EA AD iDENT S ANY AUTO OTHER THAN $ AUTO ONLY: EXCESSIUMDRELLA _� • • 0 I OCCUR i 1 CLAIMS MADE $ • t{ DEDUCTIBLE ' ' ' " MEI y— . RETENTION A WORKERS COMPENSATION AND © • :M u . 1110 • EMPLOYERS' LIABILITY 500, 0 0 0 ANY PROPRIETORPPARTNERPEXECUTNE E.L. • H ACCIDENT OFFICER/MEMBEREXCLUDED? WcA0204470513 1/1/2010 1/1/2011 EL DI • E- . MPLOYE 5 500,000 lr yee,dacribeunder 1 g 500,000 S 'CI • - VAS bel , OTHER DESCRIPTION OF OPCRATIONS !LOCATTONSNEHICLEO/$XCLU$IONS ADOED BY ENDORSEMENTISPECIAL PROVISIONS �--- operations usuAl to the sales of windows S doors• CERTIFICATE HOLDER _ CANCELLATION — .-- (413) 774 -6348 SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Northampton EXPIRATION DAVE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Building Xnspector 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 212 Main Street FAILURE TO DC $0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Northampton, MA 01060 INSURER, ITS AOENTS OR REPRESENTATIVES. .--� • AUTHORIZED REPRESENTATIVE Norma Laforest /SPG ACORD 25(2001/08) @ ACORD CORPORATION 1988 page I of 2 INS025 (U1o8).OS• May 241 0 03:06p p.1 The Commonwealth of Massachusetts ' = ' ; •, Department of Industrial Accidents Office of Investigations _ '' 600 Washington Street gh i. r ei" Boston, MA 02111 v www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business/Organization /Individual): f // _f y5 Address: / g .4/ vn -5 V f ec- City /State /Zip :_6reern i/- /d /V(f 4 / JO/ Phone #: / 7702- ?/ Are you an employer? Check the approp box: Type of project (required): 1. 41 am a employer with 70 4. ❑ I am a general contractor and T 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 have 8. [2 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance_: required.] 5. r i We are a corporation and its MD Electrical repairs or additions 3. ❑ lam a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, ;1(4), and we have no employees. [No workers' 13.E Oth e,o/Wee Ga.; days •--, comp. insurance required.] e V rid ,/)oa r s *An 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. tContractors 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 Cornpan■ Name: / L , ..e / e.7 ,• 5 tt r Xr) CC Ct'ivn o l� — t ` Policy f or Self -ins, Lie. : El../6-/q ( jrcp a/ 70 57S Expiration Date: (J Uf -2 0 / Job Site Address:'. 3 / A Ap Ir. l am( T. rr Cit /Zip: Ore..oil c i M4 010 6 2' 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 andfor 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. 1 do hereby certii5r under the pa' s and penalties of per - ury that the information provided above is true and correct. Signature: � / T<I, , Date: j '_, ' /d Phone s: – I 1 . -- ! ! - � 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 #: { • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of Lic ense Holder : 1JJ l� I - Q 9 / ( 4L / 16 License Number l 61.-TO) /S3 /1/(r� J I r e f GYe ti ft kV 1 , 31. 26 , 1 Address Expiration Date aj:4 - 7 7Z - 0/.5 - 3 Signature Telephone 9. ;Registered.Hotne lmurovernentCoiitractor° 1 ! r Not Applicable ❑ du .-k 1 4 122. 79 Company Name Registrat umber , 3' 2Y 20/2_ ism /.r e , en D 1 / Address Expiration Date C OJ A C1J kk Te lephone �{ � 7 �? /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 ❑ The_current_exemption for "homeowners" was extended to include Owner Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor you! pi esence on the job site will be required from time to time, during and » pnn completion of the work for which this permit is issued. Also be advised that with referenceto 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" c ertifies and assumes responsibility for compliance with the State Building Code, City of " amp on • r• mances, a a • • { • tts--Gener - a:1... Laws - Annotated. Homeowner Signature - i • f SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [] Addition C] Replacement Windows Alteration(s) ❑ Roofing ❑ Or boors c ig Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [II] Siding [D] Other [D] Brief Description of Proqposed \ I/ /110 Work: •..L tii.11a CP I (3 "(.1i Cil, mevl /. OSii . €XlJt( C2' /1 / °.3 . � " Alteration of existing bedroom Yes No Adding new bedroom / (es uc - Attached Narrative Renovating unfinished basement Yes No C{�2 Plans Attached Roll - Sheet ,. )If New bouse'and oradd tion.io"existi g houslncl cor mplete the.followlrnq: a. Use of building : One Family X 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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, } 142,(r1 \ , as Owner of the subject property a n hereby authorize 'Cr? ' I � 1" /`c (do _tC_ ..ro r . to act on my behalf, in all matters relative to work a thorized by this building permit application. Signature of Owner Date I, P I I 4, T O LC,4,S i7,1c . -, as Owner /Authorized Agent hereby declare that the statements and infomation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 7 ck r -e. Print Name ;---14 0a�-tc c to h 93 —0------------ 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 %__ _ a 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 0 DONT KNOW 0 YES IF YES: enter Book Pagel and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 dny signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: 11 T °4`ra`t�ien= any propos?d r angPS tri n a. _Mons of Signs iritpn ;ifir r ffiP prnrperty 7 YFS 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. • City of Northampton Sta - ,® i''e ,7 i ' � t , Building Department Cu�zt:t1 ►vewa tf J A F1' rt Z $ 212 Main Street Se ;�" vain 1 � - , � Room 100 = . at a b � � t K �' ' 2010 Northampton, MA 01060 phone 413 -587 -1240 Fax 413 - 587 -1272 t er �s M�� `' . - -. - - -- APPLICATION To CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1;- SITE INFORMATION This section to be completed by office 1.1 Property Address: I3 I ( e �l cyJ Iii cock t „ k ���_ �T' Map -{' -( �� l .' f v \Le im L (O( 2— Lot Unit Zone ` Overlay District Elm Sts District CB D istrict SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: -- - – - F- 01- - - - -1- rat — i, - M.444 tti T e (re-cc - 4 - - -- (arPyvt,Lz / Name (Print) Current Mailing 4 dress: i 0 ((X 1- ' ..Sj noi CON,173a Telephone Signa ure 2.2 Authorized Agent: Name (Prin Current Mailing Address: 130 0 (bdt•■Q ' t C td CktSl 77Z r S.5 Signature • T(6/I) epho SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building -, (a) Building' Permit Fee 3 .oa 2. Electrical (b) Estimated Total Cost of 0 Construction from (6) 3. Plumbing 0 Building Permit Fee 4. Mechanical (HVAC) 0 3J OC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 3 1 300. CO Check Number (). 8 2 q This Section For—Official—Use' Only Date Building Permit Number Issued: Signature: Building Commissioner /Inspector of Buildings - Date 134 MAPLEWOOD TER BP- 2011 -0203 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D -168 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP-2011-0203 Project # JS- 2011- 000355 Est. Cost: $3300.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 144837.00 Owner: HARRIS EDWARD S & FAYE C Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 134 MAPLEWOOD TER Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON :9/8/2010 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 9/8/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner