24C-168 (3) Pella Products, Inc.
Pella Windows & Doors
240 Mohawk Trail
Greenfield, MA 01301
Telephone: (413)774 -7231
Fax: (413)774 -6348
Dear Building Inspector,
Enclosed please find our Building Permit Application package for a
project within your city or town.
We are specialists in the Replacement Windows and Doors arenas.
Our typical projects use existing openings, with no changes to the buildings
actual structures.
Our Construction Supervisor is David C. White, CSL# 091496
Unrestricted 00, and Pella Products, Inc. is HIC# 142279. Copies of our
licenses are attached for your review.
Please feel free to contact me directly with any questions or concerns
at our Greenfield location, as I have all detailed contract information on file.
Pella Products, Inc. thanks you in advance for your time and efforts
concerning our building permit application.
Sincerely,
Amy Bernat
Store Coordinator
Pella Products Inc.
240 Mohawk Trail
(413)774 -7231
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.
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Roatticead to: 00
it. to d of t#urlaitioz kes„tai shoo* ° hared ° +t.tttatjrcl ,
. , DO Unrestricted k..M:otP - ! :. :5 45 It, - I 2 Famlty 1Maaea
Roc r¢rtw1 lo O() � n?r ` ,"
k k
DAV D C WHITE
CARlr' kTER ST y � � ritt ure to poauva a turtrat rditius tit the
r 4
ORANGE MA 31'364 ! Massarhusetita hate l ;11141ft t ode
a la a atnr for art. iix aam* of than lurasr
Refer In: V4 Mt W. Masa.Gsn ;DI'S
- Office of Gossamer Affairs & Business Reanlatioa
License or registration valid for individul use only
W : OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to
Office of Consumer Affairs and Business Regulation
w
, 10 Park Plan- Suite 5170
' „o'' Registration. t4f27B �,�; ts , Expila ft t2 StgPbment ( ; ;ard Boston, MA 02116
PELLA PRODUCT'S, ift(C.
DAVID WHITE '
156 MAIN STREET "
'\ Cwt. '' ('� C Vii
' : •� •- - — - *�,.,.,..\ r (, (� ! }
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 Betit 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
Al. 9-- Trl
- 41 /,A a/o 6n
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
•
y 24 10 03:06p p.1
.��. The Commonwealth of Massachusetts
r ,,;, ; � : _. =_. x
e Department of industrial Accidents
■ =...... Office of Investigations
- i - `l ; ,4. '4 600 Washington Street
:w Boston, MA 02111
• 4,60 - wwi mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business !Organization /Individual): j�f � � f /� - ff � /
Address: / �j_ � /( a, v S i."
^6 T`"
Cite /State /Zip: Ere r7 /F 1d / 4 /.v/ Phone #: / /---"?' 770 J / 6 ' -- --? __ __
Are you an employer? Check the approdriate box:
Type of project (required):
l . a I am a employer with 70 4 . ❑ I am a general contractor and I 6. ❑ New construction
employees (full and /or part- time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub- contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3, officers have exercised their 11.
❑ I am a homeowner doing all work ❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. I52, §1(4), and we have no
employees. [No workers' 13.[ Other n e Wee 6‘ a_
comp. insurance required.] rid - ,000 ifs c- J
Any applicant that checks box #1 must also till 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 nest 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.
In / surance Company Name: j `17? C.Re J / c 7 e) S L[ r ,v r) cc C!M n e4 r) l
Policy i# or Self -ins. Lit:. t?: (,(/C./- 0 a 7O 5 Expiration Date: (// .00 ,4 O / /
Job Site Address: b _) - �t'a,ttl k1 tip . (.. ,Tic-ec CitylState!Zip: Ai Y�, 4v") ./ t ( / C' U
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 $ 1.500.00 andlor one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
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 an penalties of rjury tha the information provided above is true and correct.
Signature: 1 Date: —/ 10
Phone #: i " 7
Official use only. Do not write in this area, to be completed by or ♦ official.
Issuing Authority
I. Board of Health 2. Building Department ♦ Plumbing Inspector
Person: 6. Other
Contact
•
•
Building Inspection Services
� I
I, f a 1 w as property owner, give
permis o o our contractor, Pella Products Inc., to obtain a buildiig permit for the
installation of windows or doors in my home, located at
. Please accept this letter in
place of my signature on the buildi g permit application.
•
Thank -You
Print Customer Name
� l
/ Home Owner' s Signature
1/ t_ 20 /o Date
Thank- You
•
•
•
SITE RESPONSIBILi I S •
Customer: Atee,.2 � Date: //
Order #: Signature: ;1i 1�"� •
Salewessiany. Priam Luk,o'n rt Signature. , , OIW .l
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 $50.00k 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.
, ' Ne cannot and wilt riot guarantee speceto *Mee or days of the week for tnatattatton.
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 swt irtsta#ed wet be subtracted from the balsoze 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)
C 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.
Pocke stall : ° (sash replacement, existing frame remains)
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 Pain isctoser:
#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
#2i I Are there children under the age of 6 or women who are pregnant?
Pella Will Owner Will
X I 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.
t� ! Deliver and unload products
LJ I I Place drop cloths in work areas
n t I Remove & reinstall interior and exterior trim if applicable
X I, L I Remove & reinstall existing shutters and awnings by contract
L� I I Remove existing product and adjust or modify opening as needed
I X. pi Provide all equipment necessary to install products
I f
I X tilt all wood and other materials outside of home
{ X n Install all products purchased
i X I I Insulate and caulk around products
X L I Remove stickers and perform initial cleaning of all glass surfaces
X Demonstrate proper operation of products
XI t I Confirm that all products are in working order
X I I Remove drop cloths, vacuum and remove all old products from premises
I Finish (paint or stain) product purchased
IX I Cut -back or tie trees, bushes, shrubs from exterior wall
n 1 X i Arrange to have alarm system disconnected and reconnected
1 1 { X Arrange to have any plumbing or electrical repairs or changes by For all service needs,
appropriate licensed contractor p 957
OM 957 - 3552
I X I Remove and reinstall existing window treatments, wall hangings and Please make sure you
air conditioning units. mention that your project
1 i I X I Remove and reposition furniture In work area was installed by Pella
and reference your order
X i Secure pets in a safe manner number
I
1 x I Remove valuable / breakable items from work area
'
XI Remove snow from area of worksite if necessary
•
Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 2209581
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:
[p4LL furniture needs to be moved at least 8 feet away from any window or door being replaced
TALL 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
[eYou will be responsible for replacing all furniture and personal items after your installation
1 s r ' ,/
[Other items: ice, /Cf � ( , /It . �..-
i
What to Expect the Containment/Work Area to Look Like
1?(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.
IZ your Lead Safe Installation, you may also see your installation professional wearing Personal Protection Equipment.
T" 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.
l tee/0
Cu iom / Signature Date
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.corn
Future Sample Pre - Renovation Form
This sample term may be used by renovation firms to document compliance with the
Federal pre- renovation education and renovation, repair, and painting regulations.
Occupant Confirmation
Pt als:t Receipt
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 r- 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 properly is not a
chiid- occupied taolllty'. �U y ,Gj 13E4,; /"1
Note: A child resides in the primary residence of his or her custodial parent; legal
guarans, foster parents, or informal caretaker it the child lives and sleeps most of the l '� I eve ) 5
di
time at the caretakers residence.
Note: A child-occupied upied f'n.ility is a pre - 1'4)'78 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 Box iB) y is checked, check either Box B or sox C, but not both
I request that the renovation firm use the lead -safe work practices required
by EPA's Renovation, Repair., Painting aiming Rule; or
U I undeistarid that the tirrn performing the renovation will not be required to use the
lead- -safe work practices required by EPA's Renovation, Repair, and Painting Rule. —
i
//// .tt'.t Aka.
Printed c — no of Owti') .occupant n ,,
Vi i. �1 O
Signa • .ere of .weer occupant Sig attire Date
Renp.vator'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.
U 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.
U 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
l 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 Deliver, Attempted Delivery Date
Signature of Person Certifying Lead Pamphlet Delivery
Unit Address _ _
Note Regarding Mailing Option - - -- As art 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 seven days before renovation. Mailing must be documented by a certificate of mailing
l oot the post office.
Note: This form is not effective until April 2010.
Customer: Marge Bruchac Project Name: Bruchac Marge 63 Franklin Street Northampton MA Order Number: 739 Quote Number: 2209581
Refer to Pella Corporate Warranty
This form constitutes a contract between Buyer and Seller. Prices are subject to change anytime after 30 days following date of estimate and does not guarantee availability of any product
listed. Pella Products Inc. management has final authority on acceptance of this order. Your signature confirms the accuracy of the product(s) chosen.
Pella Products assumes no responsibility for accuracy of take offs from drawings or blueprints or that the products listed will be sufficient to complete customer's intended project. The Buyer
agrees that the product(s) listed herein are correct, final and cannot be changed, returned or canceled.
Deposits are partial payment of the contract and are not refundable. The Buyer agrees that if paying by credit card that authorization is granted to the seller to debit the Buyers credit card by
signing this contract. The Buyer agrees that payment discounts do not apply when paying with a credit card. A 1 -1/2% SERVICE CHARGE per month (18% PER ANNUM) will be added to all
outstanding balance past our stated terms, plus lawyer and account fees for collecting outstanding accounts.
The Buyer agrees that the customer delivery date is a realistic estimate of when the product is to be delivered. Items remaining in our warehouse for more than 30 days beyond the agreed to
delivery time will be subject to a storage and handling fee of 1% of the net amount of the order ($25.00 minimum charge).
The Buyer agrees that the product can be delivered without the Buyer present and agrees to accept the shipping documents as proof of delivery. The Buyer agrees not to hold the Seller
responsible for any damage to driveways, sidewalks, trees and overhead wires caused by the Seller's delivery vehicles.
The Buyer agrees to examine the product(s) upon delivery and within 7 DAYS OF DELIVERY provide the Seller notice of any discrepancy between the product(s) ordered and the products(s)
delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is.
Project Checklist has been reviewed
Order Totals
Taxable Subtotal $2,877.47
edit 'rd Approval Signature Sales Tax @ 6.25% $179.84
� /� �� r � C -7 ; Non - taxable Subtotal $1,560.38
✓ ( " c � Total $4,617.69
fpl".113/ me (Please print) Pella Sales Rep Name Pleas rint)
Deposit Received $2,308.84
Amount Due $2,308.85
Customer Signature Pe a Sales Rep Sign ure
/4L 0/ i / g/t6
Date Date
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Dripfo f nn 1.1 IQ 10111f1 rnnfrnni. A of A
Customer: Marge Bruchac Quote Description: 739 Architect 413 - 584 -2195 Order Number: 739J3LL021
Line # uuote PO Qty Description Item Price Ext'd Price
40 1 0 Fall Promotion: 25% off Product List Price: ($958.00)
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: ($958.00) ($958.00)
Last Revision Date:
Order Pricing Totals
Total List Price $4,437.85
Discountable Amount $5,915.85
Discount @ 0.000% $0.00
Non - Discountable Amount ($1,478.00)
Net Before Payment Discount $4,437.85
Payment Discount Amount $0.00
Net After Payment Discount $4,437.85
Taxable Subtotal $2,877.47
Sales Tax @ 6.25% $179.84
Non - taxable Subtotal $1,560.38
Total (Total Net + Taxes) $4,617.69
Deposit Received $2,308.84
Amount Due $2,308.85
Printed on 11/9/2010 Office Order Copy Page 5 of 5
Customer: Marge Bruchac Quote Description: 739 Architect 413 - 584 -2195 Order Number: 739J3LL021
* * * ED -9 - Storm Door Install on Existing Entry Door Qty 1
* * * LP-1 - Lead safe practices this opening under 150 Qty 1
UI
Line # uuote 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 # uuote PO Qty Description Item Price Ext'd Price
35 1 0 Fall Promotion: 25% off Installation List Price: ($520.00)
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: ($520.00) ($520.00)
Last Revision Date:
Printed on 11/9/2010 Office Order Copy Page 4 of 5
Customer: Marge Bruchac Quote Description: 739 Architect 413 - 584 -2195 Order Number: 739J3LL021
* * * EAC-1 - Exterior Aluminum Capping (Coil Stock) up Qty 1
to 110 UI
* * * LP-1 - Lead safe practices this opening under 150 Qty 1
• UI
Outside View Line # uuote PO Qty Description Item Price Ext'd Price
20 1 1 Architect, Precision Hung Double Hung, 31.5 X 61, White List Price: $1,485.69
l Location: Living Room
T, 1 1 : Non - Standard Size Double Hung, Equal Split
Rough Opening: 32" X 61.5" Discount % = 0.00
w Frame Size: 31 1/2 X 61 Discount $ $0.00 $0.00
Frame Size: 31.5" X 61" General Information: Style Edition, Clad
Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White
Interior Color / Finish: Early American Stain Interior
Frame Perimeter (inches): 185 Glass: Insulated Low E SunDefense Dual LowE Argon Gas
Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, No Sash Lift Net Price: $1,485.69 $1,485.69
Last Revision Date: Screen: Full Screen, InView
Grille: ILT, No, 7/8 ", Traditional (2W1H / 2W1H)
Wrapping Information: Perimeter Length = 185 ", Glazing Pressure = 90.
Installation Notes: Lead - Safe Required
* * * PF -1 - Interior Pocket Installation for Precision Fit Qty 1
* * * EAC-1 - Exterior Aluminum Capping (Coil Stock) up Qty 1
to 110 UI
Outside View Line # uuote PO Qty Description Item Price Ext'd Price
. _ 25 1 1 Entry Systems, Midview Storm Door Triple Track List Price: $992.09
—, Location: None Assigned Unhanded, 32 X 81, White (90155)
i , .
Rough Opening: 1: 3280 to 81 Unhanded Triple Track Midview Storm Door Discount % = 0.00 %
Frame Size: 32 X 81 Discount $ $0.00 $0.00
Frame Size: 32" X 81" General Information: Clad
Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White
226
Sash / Panel: 1" Solid Core
• Frame Perimeter
(inches): Glass: Clear
Assembly Type: Branch Finished Hardware Options: Standard, Included, Color Matched Net Price: $992.09 $992.09
Last Revision Date: Model: 3031
Wrapping Information: Perimeter Length = 226 ".
Installation Notes: Lead - Safe Required
Printed on 11/9/2010 Office Order Copy Page 3 of 5
Customer: Marge Bruchac Quote Description: 739 Architect 413 - 584 -2195 Order Number: 739J3LL021
Outside View Line # uuote PO Qty Description Item Price Ext'd Price
10 1 1 Architect, Precision Hung Double Hung, 31.5 X 61, White List Price: $1,685.69
1 1I Location: Living Room + •
1: Non - Standard Size Double Hung, Equal Split Discount % = 0.00 %
Rough Opening: 32 X 61.5 Frame Size: 31 1/2 X 61 Discount $ $0.00 $0.00
I
Frame Size: 31.5" X 61" General Information: Style Edition, Clad
Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White
Interior Color / Finish: Early American Stain Interior
Frame Perimeter (inches): 185 Glass: Insulated Low E SunDefense Dual LowE Argon Gas
Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, No Sash Lift
Screen: Full Screen, InView Net Price: $1,685.69 $1,685.69
Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1H / 2W1H)
Wrapping Information: Perimeter Length = 185 ", Glazing Pressure = 90.
Installation Notes: Lead -Safe Required
* * * PF-1 - Interior Pocket Installation for Precision Fit Qty 1
* * * EAC -1 - Exterior Aluminum Capping (Coil Stock) up Qty 1
to 110 UI
- * * * LP -2 - Lead safe practices this opening over 150 UI Qty 1
Outside View Line # uuote PO Qty Description Item Price Ext'd Price
15 1 1 Architect, Precision Hung Double Hung, 31.5 X 61, White List Price: $1,632.38
1 II I Location: Living Room % 0
Rough Opening: 32" X 61.5" 1: Non - Standard Size Double Hung, Equal Split Discount /o = 0.00 /o
w Frame Size: 31 1/2 X 61 Discount $ $0.00 $0.00
Frame Size: 31.5" X 61" General Information: Style Edition, Clad
Final Wall Depth: Exterior Color / Finish: Standard EnduraClad, White
Interior Color / Finish: Early American Stain Interior
Frame Perimeter (inches): 185 Glass: Insulated Low E SunDefense Dual LowE Argon Gas
Assembly Type: Branch Finished Hardware Options: Spoon Lock, Brown, No Sash Lift
Screen: Full Screen, InView Net Price: $1,632.38 $1,632.38
- Last Revision Date: Grille: ILT, No, 7/8 ", Traditional (2W1H / 2W1H)
Wrapping Information: Perimeter Length = 185 ", Glazing Pressure = 90.
Installation Notes: Lead -Safe Required
* * * PF - 1 - Interior Pocket Installation for Precision Fit Qty 1
Printed on 11/9/2010 Office Order Copy Page 2 of 5
4
Office Order Copy
Branch Number: 73900 Order Number: 739J3LL021
® W indow Store Name: Quote Number: 2209581
Quote Description: 739 Architect 413 - 584 -2195
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: 12/20/2010
Address: Business Segment: Retail Quoted Date: 11/5/2010
63 Franklin Street 63 Franklin Street Market Segment: Single Family Replacement Contract Date: 11/9/2010
Order Type: Installed Sales Booked Date:
Effective Discount: 0.000% Earliest LRD:
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) 584 -2195 Owner Name: Accessories Managed Accessory Delivery Date
Mobile Phone: Marge Bruchac
Fax Number:
E -Mail: Owner Phone: (413) 584 -2195
Great Plains #:
Customer Number: 4890186
Delivery Instructions: GPS, Light Gray Colonial Home with White Trim # 63 Marked Clearly on the Home
Installation Notes: GPS, Light Gray Colonial Home with White Trim # 63 Marked Clearly on the Home
Printed on 11/9/2010 Office Order Copy Page 1 of 5
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Al * t Applicable ❑
vim►
Name of License Holder : t 1GW I a l I � 6J 9 / < I U
// License Number
13 � � M .c77ec Gre,nkeij IBC / `S/ ' ZOl/
Address / Expiration Date
cCit 3 c J&k 1, -7 -oI&
Signature Telephone
9. R 0iStered Horne Imi rove t Cont tor Not Applicable ❑
ThIc. rn C rig . / q 2 Z79
Company Name ,. Registration Number
/S // A /L slree:t ► C /� o1. -o i Zq Zvl z
Address CO ] 7 Expiration Date
O (JAM C & 6 , ��, Telephone Ti / / Z - Q/ S
—
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 L� 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 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors tW
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [D Siding [p] Other [0]
Brief Desch 'ton •f Pr•.po -ed ti • f
Work: . r. _ . ■ :L„f 7, i IN : ' 1 4 VA , A /.^ � . r s , e2(l„s iv
Alteration of existing bedroom Yes No •ding new bedroom Yes No 1 71 G I B v:(
Attached Narrative Renovating unfinished basement Yes No ��/
Plans Attached Roll - Sheet 1 `C. 6r
Ba. if New house and or addition to existing housint, complete the foiiowifra: . ..
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, P\ e t J(l}(,1/1G(,( , as Owner of the subject
property
hereby authorize 1 Ha -- k C -15 Tw'1C
to act on my behalf, in all matters relative to work authorized by this building permit application.
, C. Si r � C-44/1 {r .f // • / 7 /U
Signature of Ow ner Date
I, --- 1 - )(,(,til(, (A.11 / 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.
a 0 1 a LL i te-
Print Name
3oC.L&JJL. i/: /T /O
Signature of Owner /Agent Date
City of Northampton Status Peatrtt,
Building Department Curb ut/Orty way l e rrttt
S ` 4 "'' k- 212 Main Street SewerI$ept�c vailati(lty ..
Room 100 Vyat��l4itien A ii bdlty
Northampton, MA 01060 Tiara Sets d# ru turatt 'tatrts
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/S a Ptans
C)ther`:$pecity'
APPUCATION 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:
ajr T(A. r `� Map Lot Unit
6s r ∎ It I'd 1;1_ , J - 1 1 'ee Zone Overlay District
k' /Jr-YV' L1 '; - 61 1 AAA Ul b Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
/ 0 4i' ��11c Lim ( . � ? -7 _ t �� (I ih $I C fi 1
Name (Print) Current ill Address; C J
���JJJ ,
v /r, see S i( (JV , Telephone / T — - , d 01 C D
Signature
2.2 Authorized Agent•
— 0 aid , A (A , LSTS Plcur) 7 (;)-
Name (Print) Current Mailing Address:
n U /JO /
u a C Id r 7 2 - 0 4 5 - S -7
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
0 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection U
6. Total = (1 + 2 + 3 + 4 + 5) 70(),0() Check Number 37P3 / ,fi , 3
This Section For Official Use Only
Building Permit Number: Hate
r:
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
BP- 2011 -0469
W GIS #: COMMONWEALTH OF MASSACHUSETTS
4r „ 1 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 -0469
Project # JS- 2011- 000763
Est. Cost: $4700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 091496
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 WC
GREENFIELDMA01301 ISSUED ON:11/18/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 11/18/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner