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24C-168 (2) ULIII, "11111, IIIV I,]rh.IYIUJUU44U4 f1Ub r _ U C UIU U.L4 f.UI 4 4 • AGORA CERTIFICATE OF LIABILITY INSURANCE 8/26/2 0 IRODUCER (413) 773 -9913 FAX! (413) 774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Z assOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1.17 Main Street ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW. — ?.O. Box 638 3reenfield MA 01302-0638 INSURERS AFFORDING COVERAGE NAIC # NSURE.P INSURER A:CQIItinenEa1 Westerly Pella Products, Inc. INSURER D: 4TT2i: John Benjamin INSURERS; _ 155 Main Street INSURER D: areenfi,eld MA 01301 -3258 INSURER E: •OVFRA( _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AG( IREGATE_Lfi�Jl?S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MAR I ADD'L - POLICY EFFECTIVE POLICY EXPIRATION TR INRRIt TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYY) DATE IMM/PP/YYI UAIT$ GENERAL LIABILITY EACH OCC:IIRRFNC $ 1,000,000 X COMMCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 f,R DAMA (ER nN 'TED c$) A 1 CLAiMSMADE X OCCUR CPA020470113 1/1/2010 1/1/2011 maDE;XP (Any one Pef +D) $ 15,000 M RSONAL& ADVIURY $ 1,000,000 _ G.ENFRALAGGREGATE $ 2,000,000 GEN'L AGGREGATE UNIT APPLIES PER: :•• T -C•,,• • : 1 $ 2, Xi POLICY JF LOC . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaacc(dent) $ 1,000,000 ANY AUTO - A ALL OWNED AUTOS MAA020470213 1/1/2010 1/1/2011 BODILY INJURY (Perpefaon) $ X SCHEDULED AUTOS , X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ �^ (Pet a Ident) GARAGE LIABILITY AUTO NLY - EA ACtIbENT $ 1 ANY AUTO OTHER THAN EA ACC . $ AUTO ONLY: A G $ EXCESS /UMDRELLA - • O .• • S . - 1 OCCUR .. — CLAIMS MADE : GRE • $ • g DEDUCTIBLE . . REC 01 i L_- X A� °TH A WORKERS COMPENSATION AND � � EMPLUYER3'UABILITY 500, ANY PROPRIETOR/PARTNER/E.XECUTNE E.L. EACH ACCIDENT OFFICER/MEMBEREXCLUDED? WCA020470513 1/1/2010 1/1/2011 E.L. DISEASE- Ep,VPLOYEE $ 500,000 if yes, de' ,cribs UMW E.L, DISEASE - P0LICY LIMIT S 500,000 - CI. - 15 ^ bel . OTHER I I DESCRIPTION OF OPERATION $ILOCATIONSNEHICLErNEXCLUSIONS ADM BY ENDORSEMENT/SPECIAL PROVISIONS operation9 usual to the Sales of windows S. doors. CERTIFICATE HOLDER CANCELLATION (413 )774 -6348 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Northampton EXPIRATION DATE THEREOP, 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Northampton, MA 01060 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Norma Lafotest /SPG — r ^�— 1/?,� , @ ACORD CORPORATION 1988 ACORD 25 (2001!09) pa 1 of 2 INS025 (G1oe).oes 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 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. yvy boar(' to unfitting Kek;wl: tions .lnu `ft.►nt Construction Supervisor License **imcee4 to: oe License: CS 91496 Unrestricted It. - 1 2 Family Maws DAVID C WHITE il 4 0 l 4 a 64 CARPENTER ST . ORANGE, Mil A 01364 M s a. h m tt a s Stale K u , i d ,t ed a d se( the M Uncidtatt Cade Is soaks tor' nrrations id this bosses. a,,'. — _ . . . Expiration: 1/31/2Q1.3 veer to. S 4W.Mi.s.t;u,lops (' usnsnissiuster Tr#: 8661 0% . Mee or Adairs pi 3 1 1 1111111 0 111 0 401111 License or registration valid for individul use only OMB BAPROVVAENT CONTRACTOR before the expiration date. if found return to: 1 ' Office of Consumer Affairs and Business Regulation , - Rs0 t . 79 'typ 10 Park Plata - Sake 5170 Supplement t i Jail Boston, MA 02116 MLA PROs O § DAVID T �' f F 165 M N STREEt ''" !11/11, C 10 -, .. GREENFIELD,MAol301 tindkrsecresary 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 Betit CS101355 Curt Boyle CS78514 Brian LaCroix CS65214 Jeff Pollock CSSL100327 Duane Cortis CS092246 Scott Bowdish CSSLI00232 Paul Pellerin CSSL100325 Willard Brown CSSL100231 Mark Courtemanche CSSL100233 If you have any question please contact me using the numbers listed above. - 1 - The Commonwealth of Massachusetts Department of Industrial Accidents 614 Office of Investigations MAIM 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/ Organization /Individual): , �` � // ' / r't%elt.t } Address: i > M 5/ v2 (f.(re City /State /Zip: - ve eo / /Vf IQ 2 / Phone #: «f , j ---; 0/5 3 Are you an employer? Check the appropriate box: Type of project (required): 1. [(A I am a employer with 4 / 4. ❑ 1 am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6 U New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. _J Remodeling ship and have no employees These sub - contractors have 8. 1 1 Demolition working ca employees and have workers' g for me in any capacity. tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance required.] 5. ❑ We are a corporation and its 10.1 1 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.❑ Roof repai s insurance required.] t c. 152, § 1(4), and we have no ) . employees. [No workers' 13.iN Other cttc > comp. insurance required.] c./ vac/ 1) u C s *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: / t � i �� 5 u Y �� r� ( r v'n J Policy # or Self -ins. Lic. #: ,,(2 (2 ` A, lJ . 25 1 Expiration Date: (I '" (/ ? r' ' G)/ `' Y C CJ�� /� ✓ p cam' Job Site Address: 6 � f Atti 1 i � IMP City /State /Zip: 4,1 V„ a � � � (D Attach a copy of the workers' compensation policy declaration page (showing the policy number and e piration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains ndpenalties of perjury that the information provided above is true and correct. Signature: Date: ` 2? // Phone #: 4/ - t 7 'f " 72 .? 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 #: • PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 M Gt, i L "'4' • .a . 1 c. . - /VA 0/060 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 • Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 2508877 ;_}"Project Checklist has been reviewed Order Totals Taxable Subtotal $2,241.71 Credit Card Approval Signature Sales Tax © 6.25% $140.11 A jj // Non- taxable Subtotal $1,405.07 Cus Amer Mame (Please print) Pella Sales Rep Name (Please print) Total $3,786.89 Deposit Received Amount Due $3,786.89 Cu- omer Signature Pella Sales Rep Signature ,<)7 /// —2 , /1 / I / Date Date For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Drin +o.J '.., QM 1 Y)n4 1 A -4 A rulure rnpFe Pre-Renovation o•r • 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 IN 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. [received. this pamphlet before the work - began. Pwrier-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 moat of the time at the caretakers residence. Note: A child- occupied facility is a pre -1978 building visited regularly by the same child, under 0. years of age, on at least two different days within any weak, for at least 3 hours each day, provided that.the visits total at least 60 hours annually: If Bois checked, check either Box B or Box C, but not both. le[ (8) 1 request that the renovation firm use.the lead -safe work practices required b EPA's Renovation, Repair, and Painting Rule; or 0 (0).1 understand thatthe firm performing the renovation will not be required to use the lean -safe work practices.required by EPA's Renovation Repair, and Painting.Rule. Printer► : of 0 -r- occupant U Sgna. re of Qwn -r- occupant Signature gate • Re •vatoes Self Certification Option (for tenant - occupied dwellings only) ins . ctions 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 1 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 confirrnation of receipt. I further s. certify that I have left a copy of the pamphlet at the unit with the occupant. a Unavailable for signature =1 certify that I have made a good •effort to deliver • the •ead hazard information pamphlet to the rental dwelling unit listed below and that the was unavailable to sign the confirrriation of receipt. 1 further cet lily that 1 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 ownerand /or tenant. Pamphlet must be mailed at ieast seven days before renovation. Mailing rnust be documented by a certificate of mailing from the post office. Note: This form is not effective until April 2010. . SITE RESPONSIBII,.I IE Customer: Marge Bruchac Date: Order #: 2 354 T 7 Signature: ,/f J %, _ Salesperson: Adam Lukomski Signature: ,! 4 - 1 50% Deposit required at time of order. 2 Final payment is to be made to installation team on the morning of the last day of installation. 3 If customer will not be present at time of install, payment is to be made prior. 4 Checks returned NSF will be assessed a fee of $50.00 to cover fees incurred by Pella Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5 Due to inclement weather or site conditions, it may be necessary to reschedule. 6 We cannot and will not guarantee specific dates or days of the week for installation. 7 Time given to complete a job is an estimate, extension of time is possible 8 An Install appointment will be confirmed at Verification. A courtesy reminder 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 products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 12 Order is not binding until approved by Pella Products management 13 Pella will secure all necessary Building Permits Type of Installation: New Construction: (tear out installation) 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. Ppcket Install : (sash replacement, existing frame remains) 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: #1M 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 #2 1 Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will X1 Authorized to install Yard Sign on 1st day of installation and remove 7 days afterward X 1 Ensure someone over age 18 is present at all times while Pella employees are in the home. X 1 Deliver and unload products X I Place drop cloths in work areas X n Remove & reinstall interior and exterior trim if applicable X n Remove & reinstall existing shutters and awnings by contract X Remove existing product and adjust or modify opening as needed X Provide all equipment necessary to install products X Cut all wood and other materials outside of home X Install all products purchased X Insulate and caulk around products X Remove stickers and perform initial cleaning of all glass surfaces X Demonstrate proper operation of products X Confirm that all products are in working order X Remove drop cloths, vacuum and remove all old products from premises Finish (paint or stain) product purchased X Cut -back or tie trees, bushes, shrubs from exterior wall © Arrange to have alarm system disconnected and reconnected X Arrange to have any plumbing or electrical repairs or changes by For all service needs, appropriate licensed contractor please call: 500`, P57 - 35:57 X Remove and reinstall existing window treatments, wall hangings and Please make sure you air conditioning units. mention that your project X I Remove and reposition furniture in work area was installed by Pella and reference your order 1 I X1 Secure pets in a safe manner number X Remove valuable / breakable items from work area X Remove snow from area of worksite if necessary — Customer: Marge Bruchac Quote Description: Phase 3 Order Number: 739K3DL041 • Line # Quote Qty PO Qty Description Item Price Ext'd Price 30 1 0 Winter Promotion: 25% off Product List Price: ($747.00) 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: ($747.00) ($747.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 35 1 0 Winter Promotion: 15% off Installation List Price: ($247.00) 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: ($247.00) ($247.00) Last Revision Date: Order Pricing Totals Total List Price $3,646.78 Discountable Amount $4,640.78 Discount @ 0.000% $0.00 Non - Discountable Amount ($994.00) Net Before Payment Discount $3,646.78 Payment Discount Amount $0.00 Net After Payment Discount $3,646.78 Taxable Subtotal $2,241.71 Sales Tax @ 6.25% $140.11 Non - taxable Subtotal $1,405.07 Total (Total Net + Taxes) $3,786.89 Deposit Received $2,000.00 Amount Due $1,786.89 Printed on 3/11/2011 Office Order Copy Page 4 of 4 Customer: Marge Bruchac Quote Description: Phase 3 Order Number: 739K3DL041 • Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 20 1 1 Architect, Precision Hung Double Hung, 27.5 X 57, White List Price: $1,534.50 ` Location: 2nd Floor Bath I 1 : Non - Standard Size Double Hung, Equal Split Discount %: 0.00 % iv Rough Opening: 28" X 57.5 Frame Size: 271/2 X 57 Frame Size: 27.5" X 57" General Information: Style Edition, Clad Discount $: $0.00 $0.00 Final W811 Depth: Exterior Color / Finish: Standard EnduraClad, White Frame Perimeter (inches): 169 Interior Color / Finish: Cherry Stain Interior Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, No Sash Lift Screen: Full Screen, InView Net Price: $1,534.50 $1,534.50 Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 169 ", Glazing Pressure = 105. * * * LP-1 - Lead safe practices this opening under 150 Qty 1 UI * * * EAC-1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to110UI * * * PF -1 - Interior Pocket Installation for Precision Fit Qty 1 * * * ITS -EX - Re -use existing stops (replace if broken) Qty 1 Line # Quote Qty PO Qty Description Item Price Ext'd Price 25 1 0 INSTALLATION - INSTALLATION List Price: $120.00 Location: None Assigned Rough Opening: Discount °A°: 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 Printed on 3/11/2011 Office Order Copy Page 3 of 4 Customer: Marge Bruchac Quote Description: Phase 3 Order Number: 739K3DL041 r Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price .: 10 1 1 Architect, Precision Hung Double Hung, 31.5 X 57, White List Price: $1,493.14 1 1 Location: Green Room Front Rough Opening: 32" X 57.5" 1: Non - Standard Size Double Hung, Equal Split Discount %: 0.00 % • Frame Size: 31 1/2 X 57 Frame Size: 31.5" X 57" Final Wall Depth: General Information: Style Edition, Clad Discount $: $0.00 $0.00 Exterior Color / Finish: Standard EnduraClad, White Frame Perimeter (inches): 177 Interior Color / Finish: Prefinished White Interior Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, Order Sash Lift Net Price: $1,493.14 $1,493.14 Last Revision Date: Screen: Full Screen, InView Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 177 ", Glazing Pressure = 90. * * * LP-1 - Lead safe practices this opening under 150 Qty 1 UI * * * EAC -1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to 110 UI * * * PF -1- Interior Pocket Installation for Precision Fit Qty 1 * * * ITS -EX - Re -use existing stops (replace if broken) Qty 1 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 15 1 1 Architect, Precision Hung Double Hung, 31.5 X 57, White List Price: $1,493.14 I I i Location: Green Room Back Rough Opening: 32" X 57.5" 1: Non - Standard Size Double Hung, Equal Split Discount %: 0.00 V Frame Size: 31 1/2 X 57 Discount $: $0.00 $0.00 Frame Size: 31.5" X 57" General Information: Style Edition, Clad I Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White ( Interior Color / Finish: Prefinished White Interior . Frame Perimeter (inches): 177 Glass: Insulated Low E Advanced Argon Gas Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, Order Sash Lift Screen: Full Screen, InView Net Price: $1,493.14 $1,493.14 Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1 H / 2W1 H) Wrapping Information: Perimeter Length = 177 ", Glazing Pressure = 90. * * * LP -1 - Lead safe practices this opening under 150 Qty 1 UI * * * EAC -1 - Exterior Aluminum Capping (Coil Stock) up Qty 1 to 110 Ul * * * PF -1 - Interior Pocket Installation for Precision Fit Qty 1 * * * ITS -EX - Re -use existing stops (replace if broken) Qty 1 Printed on 3/11/2011 Office Order Copy Page 2 of 4 ✓aleck oes4 Office Order Copy feAR, Branch Number: 73900 Order Number: 739K3DL041 Window Store Name: Quote Number: 2508877 Quote Description: Phase 3 Project Name: Bruchac Marge 63 Franklin Street Northampton MA Customer Information Deliver To Address _ Order Information Marge Bruchac Lot # Sales Rep Name: Lukomski, Adam Cust Delivery Date: 4/25/2011 63 Franklin Street Address: Business Segment: Retail Quoted Date: 3/11/2011 63 Franklin Street Market Segment: Single Family Replacement Contract Date: 3/11/2011 Order Type: Installed Sales Booked Date: NORTHAMPTON, MA 01060 Effective Discount: 0.000% Earliest LRD: Contact Name: NORTHAMPTON, MA 01060 Commission Split: Lukomski, Adam - 100% Day Phone: (413) 584 -2195 County: HAMPSHIRE Tax Code: MASS Mobile Phone: Owner Name: Tax Exempt #: Fax Number: Marge Bruchac Payment Terms: C.O.D. Customer PO #: E -Mail: Order Verifier Name: Adam Lukomski Order Verification Date: 3/11/2011 Great Plains #: 52H5842195 Owner Phone: (413) 584 -2195 Customer Number: 2458071 Delivery Instructions: GPS, LIGHT GRAY COLONIAL WITH WITH WINDOWS AND TRIM, # 63 MARKED CLEARLY ON THE HOME AND VISIBLE FORM THE STREET Installation Notes: GPS, LIGHT GRAY COLONIAL WITH WITH WINDOWS AND TRIM, # 63 MARKED CLEARLY ON THE HOME AND VISIBLE FORM THE STREET Order Verification Notes: PM NOTES TO INSTALL: 3 LEAD -SAFE ARCHITECT SERIES INTERIOR INSTALL PFITS, INSTALL IS ON 2ND FLOOR OF OLDER COLONIAL STYLE DWELLING, 2 ARE IN THE UPSTAIRS GREEN ROOM FRONT AND BACK, 1 IN THE UPSTAIRS BATH, EXISTING WINDOWS ARE ORIGINAL WEIGHT POCKET WINDOWS, THE 2 GREEN ROOM WINDOW ARE BOTH ABOVE A SMALL PORCH ROOF, 2 INDOOR CATS, PARKING IS GOOD INTERIOR TRIM: RE -USE EXISTING STOPS EXTERIOR TRIM: WHITE ALUMINUM WRAP /// 0„, 4 C� 2 .. Printed on 3/11/2011 Office Order Copy Page 1 of 4 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ' DON.); ( tJJ-1� 1 ..\ O 1. t 4 q CO I SS lit 6 - $V. �` rQ C Q c t1 Q • O 0 ( 13 License Number t 3 ( 3 Address f { Expiration Date Ca C l,Oh- 413 ' - 17 2 —o t cD 3 Signa Telephone ;... 1ai_<...sLLt s + ii&Al`ialAse €'•"'�`' `Iffi x�- d"sY - .: _ o .. N t Applicable ❑ 2 eL.LA PC2S> UCtS N) C_ . 14 9 Company Name Registration Number I c I\ oCtr) c - c - - . C-,ic e7E. nc-i' ciA tACk 0 trO t ,$) .1(4 f (FL Address Expiratiod Date C)Q)..&4D C It)09 Telephone 7 7 01 5 - - ,tivsac`1 s i ¢z4Q . f� � , a d P s AlKI "'� i" -ip at,' � , x 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 ® ld 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 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 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 z T % *. ' 9f �' a E� y s • .t055 -e e, ES P ®' 5 G 5 ' OR o af ' 4 . 0 e ' ` . - _,..:. _� , ..c.E, - � , ..,._,.......?'�' '.� ,._.,,.. 2 r <.a.�.e `_� b ..•.U�s.,. ,moo,... 0 ���S�",. ..._ ....m '�" .. New House ❑ Addition ❑ Replacement V1(yhdows Alteration(s) Roofing El Or Doors LIJ Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [C] Siding [❑] Other [0] Brief Description of jC Proposed TvIJ fA n ,� / Work: (id* plrt C1T S c la..r CA4tFA:1 u .1 t�/ t �� ( 66617 14r Y ivu C.��G/ Alteration of existing bedroom Yes / No Adding new bedroom es (! ' " .e lka Attached Narrative Renovating unfinished basement Yes 7 No z. i> . Plans Attached Roll - Sheet a aka a : Y� �� a ?" f 9 a a w s `.1 :'� �•+ �. 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. floocIplain 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 I, /yird ' grabc-- , as Owner of the subject property n hereby authorize P 6 LL l (Z sb tt ) C_ to act on my be If, in all matters relative to work authorized by this building permit application. Signature of er Date I, V Q u i D t o of 'b L-L A r P� ,v 0 V C-T I N L. , as Owner /Authorized Agent hereby that the statements and in ormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name h-kk Signature of Owner /Agent Date t , 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 1 11 11 I Frontage 1 1 1 11 1 Setbacks Front 1 1 1 1 1 1 Side L:I I R: 1 L:1 1 R:I 1 [ 1 1 1 Rear 1 1 1 1 1 1 Building Height ( ( 1 1 1 1 Bldg. Square Footage 1 1 1 1 1 1 1 1 I 1 Open Space Footage (Lot area minus bldg & paved 1 1 1 1 1 1 1 1 I I parking) # of Parking Spaces 1 1 1 1 1 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 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 ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO (3 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. s- f a ���� City of N or th ampto n � � •�� wilding Departments t ,•� € -,ft gn : 5 `ZU11 212 Main Street ' '..,',4,04 i i t, Will b‘61‘‘ 100 � A - ' ?k )rr •4/4 �asPECta► ampton, MA 01060 �, 0 oFw- 7 A t : o ' ,. 3 -5 7 -1240 Fax 413 - 587 -1272 f _� • APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR. DEMOLISH A ONE OR TWO FAMILY DWELLING 1.1 Property Address: .. . 4 ? sx3-. 6 �rct.n h � lYl ,s �� - �u -.aa r fi t 4 L 1: 3. 4 2 s � 3 � 4 vP)1 , ,Z , ' -'� ° `'�i ' 3s.- firth$n +,. , F 3 :"'.�eF ;'`�� t�+r'?'c� / // z �- t v • i.xu �`i 1r vT'`4� 'u7§ _`_. -_ 2.1 Owner of Record: / I Q Name (Print) Current Ad • • Mailin dres r Sql- - � Telephone Signature r� - 2.2 Authorized Aq � ��� �'fzo cT� � 1\-)( (3 \ n —c CC °E. r 1'E LD • Name (Print) C urrent Mailing Address: p M A • . 013 1 S Signature Telephone %tat+• �,, L ® �/ a ' 4,4 g!,r'°'C".,' : - **' , c•' y - ,.. , > "". k i3,�A . Yl (�4 •pi's . ���,.>" .. ,°^a °.�-= ; ,x�, : , , ; ^_ --,� .w,r-. may-' : Item Estimated Cost (Dollars) to be F ' completed by perm a pplicant i `i * < ,, ., �� • 1. Building `1 000,00 j "� . .» , T .... t 0 ( .L. z ' ` . � r 2. Electrical r � � ,§l �' z ; - ,, , v.,, �^ r ; 3. Plumbing 1' � �i1g t1,fi - s -/� K ,ter c L 4. Mechanical (HVAC) � - . f K i i r� a 5. Fire Protection 0 'v _ 1�a�� 1 _ ._ Yom._ 6 Total= (1 +2 +3 + +5) � , Y i 3utldt�peri t N'f Jc e..., :c+. l:u .,.u..,.: ax?a`:::s ...:.5 _':.� >s t o rr3 �.` ti r< �' y t :. ^ 'i: ' �'` < .* , 4 } y , . M.. y�--r yyy y > a H. ?.y r ' I < j'. .t' 7 i :. - ,...- a lAr2 :S £J n t g 4. ' �j . � l T , c a F x s _ x: , s ; x Y ..: .. ., .. >. tom • a r 63 FRANKLIN ST BP-2011-0768 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 168 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit # BP- 2011 -0768 Project # JS- 2011- 001268 Est. Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC Lot Size(sq. ft.): 6882.48 Owner: KENNICK JUSTIN H & MARGARET M BRUCHAC Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 63 FRANKLIN ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 GREENFIELDMA01301 ISSUED ON:3/28/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL 3 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 3/28/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner