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32C-001 (9) FROM Berkshire Insurance Group <THU)JAN 19 2012 17:51 /ST- 14: 03 /No. 7527319811 P 22 A �� ° ® CERTIFICATE OF LIABILITY INSURANCE 1/19/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Robin Sargent Berkshire Insurance Group, Inc. (A /C. Nn. Exn: (413) 773 -9913 arc Nol[ (413)774-3872 117 Main Street E -MAIL ent @berkshireinsurance rou coat rsar g g p INSURER(S) AFFORDING COVERAGE NAIC # Greenfield MA 01301 INSURERA:Citizens Insur Company of Amer 31534 INSURED INSURERa:The Hanover Insurance Company 10212 Pella Products, Inc. INSURERC: 155 Main Street INSURER D: INSURER E : Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER:12GL, REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE . POLICY NUMBER MM /DD/YYYY MM DD LIMITS • GENERAL LIABILITY EACH OCCURRENCE 000 • F DAMGE TO RENTED PREMISES (Ea occurrence) • • , BN941943300 - /1/2012 /1/2013 pgED EXP (Any one pe son) 000 el LOC PERSONAL & ADV INJURY • • GENERAL AGGREGATE • • PRODUCTS - COMP /OP AGG 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 r ANY AUTO ALL OWNED BODLY INJURY (Per person) $ 1/1/2012 /1/2013 BODILY INJURY (Per accident) $ AUTOS SCHEDULED . 93977 AUTOS HIRED AUTOS PROPERTY DAMAGE ■ AUTOS Per accident) PIP -Basic $ ■ I UMBRELLA LIAB ■ OCCUR OCCURRENCE III III DED RETENTI• CLAIMS -MADE AGGREGATE $ I WORKERS COMPENSATION STATU- OTH• AND EMPLOYERS' LIABILITY X TORY I NITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y N E.L. EACH ACCIDENT $ 500,000 OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under 939976600 /1/2012 1/1/2013 E.L. DISEASE - EA EMPLOYE: $ 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE •POLICY LIMIT $ 500 000 1 111111111111111 DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Operations usual to the sales & installation of windows & doors. CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Puchalski Municipal Building AUTHORIZED REPRESENTATIVE 212 Main Street Northampton, MA 01060 Robin Sargent /RMS ° ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD 4 The Commonwealth of Massachusetts • ,� „ Department of Industr.ial A ccidents r,i Office of Investigations . R !me • • 600 Washington Street " ' Boston, i4. .02111 • y - ``, www. mass.go:v /dice • Workers' Compensation Insurance Affidavit: B. uildersl,Con_er ctars/.Ele_ct.l i,ci n- s/gl:urr>ber=s =_ _ - __°_ -_-= --- - -A.p:{ Uca:at- Inforaratian Please Print Legibly Name ( Business /Organizahon/Individual _.. --- . .- - ___ • C O Address: 5 . S /- Address: City /State /Zip: 6rCC� tE !d / Nq 61 i3p/ Phone #: ' 77, - O/ - 3 Are you an employer? Check the appropriate box: Type of project (required): • 1. W 1 am a employer with ')• 4 . ^ I am a general contractor. and 1 • . employees (full and/or part- time).` have hired the sub- contractors 6. E , New construction 2.1 I am a sole proprietor or partner listed.on the attache.d•sheet. 7. .0 Remodeling . ship and have no.employees . These.sub- contractors }lave , - . 8 . J Demolition . • Working. for me in any cap e mp loy ees and have workers 9...0 Building addition • ...N6 workers' comp ..insurance comp :in uranc $ - • re qu i re d . ] . 5. fl We are a co and its 10 HJ.Electrical repairs or additions. 3. D f ain a homeowner doing all work offcers have e>cercisedtheu- 1 1 .Li Plurri in repairs or additions - myself. [No workers' com • • right o e xemp ti on per MGL P 12. Ro repa • :. rs • .insurance required.) •t _ _ . c 152;§ 1.(4), _and we hav no • • employees. [No workers.' . 13._ Other comp. insurance required -) --- - -... .:.._._ --- -'- lAny box #1 must also fill out the.scction.below i.:." ■ .ork. eompcasatie ol'icy orrsetrop. =- lorucusrurcrs ho -subee r ii" is ayil. indicating they arc doing a]l:wori: aisd tticn hirp;out'sidc ;contracto s must submita new affidavit indicating such__ :Contractors that check this box - must attaaef1 an a4iditionals beet-showiog-the-namc- of t ntractors.and'state:whether or not those entities havc . • employees_ If the ..subcontractors have employees,. they must provide (Hek workers'. comg poLicy.n.u.mber_ . ' . . • I am employer an e that is providing worke compensenion insuranc fr o. my employees. Belo w is the policy a job site information_ Insurance.Company Narif`e:• • • . _ a 6 ti e r : Lc Y . - .0 V cVr2 Policy # or Self -ins. Lic. #: . L�J /--72/V ',- 7 6 00 K - o Expiration Date: / �- } /- Job Site Address: 150 Plain _ ,S--, Cit /State /Zip: Nor- hai'npttn Va. 0 i ( QO Attach_ a copy of the workers'.compensation policy d.eclar.ation (sh.o.wing the policy number and ezpiration date). ____- Failure to sectsse coverage as required under Se _tion2S.a:..of -tu1GL c. 152-- can t e rmposit of criminal penalties of a - firre up to $1 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 .S250.00 a day against the. violator: Be advised that a. copy of this - statement maybe forwarded. to the Office of Investigations of the DIA for .insurance coverage verification - I do hereby certify der the pains an.. penalties of perjury that the information provided above /� is true and correct. Si . ature: MP" 4 / if `���`�r Date: 30 1a Phone #: 7 /(O ' l ? 3 `�C � . Official use only. Do not Write in this area, to be completed by. city or.town official . City or Town: • • . Permit/License # . . Issuing Authority (cirele.,on.e): 1. Boa of Health 2. Building Departm_ ent 3. City/Town.C.lerk .4. Electrical Inspector 5. Plumbing Inspector . 6- Other. . Contact Person: Phone #: �'tz -e 0I / '/ I I I 'i Office of Consumer Affairs and Business Regulation • G 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cta1 -tor Registrat __^ Registration: 142279 : cam - _ ;;`� _ - -.'y �_~ ^ Type: Private Corporation ^ ~ -`; Expiration: 3/24/2014 Tr# 222153 PELLA PRODUCTS, INC. =__. :.: >� =__ ` ,, GARY SHERMAN ^- _ • 1 • 55 MAIN STREET `-'' - � 4 ' _= _ GREENFIELD, MA 01301 ;a __ ; . Update Address and return card. Mark reason for change. - G Address 0 Renewal 0 Employment f Lost Card DPS -CAS O SOM- 04/04-GIn1216 �� Office of Consumer Affairs & Business Regulation License or registration valid for individul use only /HOME IMPROVEMENT CONTRACTOR before the expiration date.. If found return to U -- a Registration: ,,..i.:142279 Type: Office of Consumer Affairs and Business Regulation '1.4 I �' 10 Park Plaza - Suite 5170 c - Expiration: 3F24 Private Corporation � = o .__ Boston, MA 02116 PEA • PRODUCT 1 =r-s; • GARY SHERMAN = .I 155 MAIN STREET ; : ,, ::". GREENFIEID, MA OT3D1 Undersccrcta ry • Not valid houfsigne ure • • • , 7 -------- • 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: March 19, 2012 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. Massachusetts Department of Public Safet■ __ Board 01 Bu Odin!! Re!ulatiotix : Standards �'� �,,,nnanuealdi y ��'"a"�"°etl Construction Supervisor License ' Office of Consumer Aftairs & Business Regulation t N OME IMPROVEMENT CONTRACTOR License: CS 91496 ; I _ Registration: 142279 Type: DAVID C WHITE / Expiration X412©14 Supplement C } t PELLA PRODUCTS INC 64 CARPENTER ST ORANGE, MA 01364 a DAVID WHITE 155 MAIN STREET i=g -- .--e -- --- _- Expiration: 1/31/2013 GREENFIELD, MA01391 '' Undersecretary C omniisit,acr TrS 8661 WM:00W to; cct c N - Unrestricted ; License or registration valid for individul use only IG tl before the expiration date. If found return to: s Office of Consumer Affairs and Business Regulation I 10 Park Plaza - Suite 5170 „ard Boston, MA 02116 Failure to a eurteet edition of the Mausecbusetts State Beading Code la cause Ayr rerocatiom at thin license. .. _ Refer te: WWW'_ Ma Go' IMPS Not valid without signature I 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: Willard Brown CSSL100231 Lorne Betit CS101355 Scott Bowdish CSSL100232 Curt Boyle CS78514 Jeff Pollock CSSL100327 Richard Guillemette CS60082 Duane Cortis CS092246 Vinny Cole CS96838 Dave Ruffner CS57308 Dan Rosenthal CS52165 Chris Gamache CS86946 Bill Leger CS89338 Ron Haskell CS82630 Brian Thompson CS67121 If you have any question please contact me using the numbers listed above. - 1 - Customer: Thornes Market Project Name: Thornes Market 150 Main St Northampton MA - Order Number: 184L21S051 Quote Number: 3476434 ❑ Project Checklist has been reviewed Customer Name (Please print) Pella Sales Rep Name (Please print) Order Totals Taxable Subtotal $3,873.23 Customer Signature Pella Sales Rep Signature Sales Tax @ 6.25% $242.08 Non - taxable Subtotal $2,668.30 Date Date Total $6,783.61 Deposit Received $0.00 Amount Due $6,783.61 Credit Card Approval Signature For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 6 of 6 Customer: Thornes Market - Project Name: Thornes Market 150 Main St Northampton MA Order Number: 184L21S051 Quote Number: 3476434 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system. Neither Pella Corporation nor PELLA WINDOWS INC will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening (egress) information does not take into consideration the addition of a Rolscreen [or any other accessory] to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty, unfmished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually, thereafter. Variations in wood grain, color, texture or natural characteristics are not covered under the limited 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 customers 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. Refer to Pella Corporate Warranty For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 5 of 6 Customer: Thornes Market Project Name: Thornes Market 150 -Main St Northampton MA Order Number: 184L21S051 Quote Number: 3476434 Line # Location: Attributes 25 None Assigned Installation Sealant, Hartford Green Item Price Qty Ext'd Price $74.24 1 $74.24 1: -1 -1 Accessory Frame Size: -1 X -1 PK # Exterior Color / Finish: Hartford Green Interior Color / Finish: Not Applicable Interior 527 Package: Box 12 Tubes Wrapping Information: Viewed From Exterior Line # Location: Attributes 30 Building permit INSTALLATION - INSTALLATION Item Price Qty Ext'd Price $100.00 1 $100.00 Line # Location: Attributes 35 OCAW0000 Touch Up Paint Item Price Qty Ext'd Price $0.00 1 $0.00 PK # 0 For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 4 of 6 Customer: Thornes Market Project Name: Thornes Market 150 Main St Northampton MA Order Number: 184L21S051 Quote Number: 3476434 Exterior Paint Seacoast Warranty: Yes Final Wall Depth: 3 - 11/16" Rough Opening: 123" X 110.25" MP -1 - Modified Pocket Installation up to 60 UI w /wrap Qty 2 MP -3 - Modified Pocket Installation up to 71 -80 UI w /wrap Qty 1 MP -6 - Modified Pocket Installation up to 101 -110 UI w /wrap Qty 2 PF -3 - Cut back sills or stops (Interior) Qty 3 MP -8 - Modified Pocket Installation up to 121 -130 1.11w/wrap Qty 1 AC -8 - Elevated Work over 1st Floor Qty 1 Line It Location: Attributes 15 Sill Trim 1" Frame Expander, Length: 96, Hartford Green Item Price Qty Ext'd Price $13.01 2 $26.02 1: 1" Frame Expander Length: 96 PK # Exterior Color / Finish: EnduraClad Plus, Hartford Green,Exterior Paint Seacoast Warranty: Yes 527 Viewed From Exterior Line# Location: Attributes I 20 coil stock 24" wide Aluminum Coil, Length: 600, Hartford Green (Seacoast EnduraClad) Item Price Qty Ext'a Price $178.85 2 $357.70 1: 24" wide Aluminum Coil Length: 600 PK # Exterior Color / Finish: Seacoast EnduraClad, Hartford Green,Exterior Paint Seacoast Warranty: Yes 527 Viewed From Exterior For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 3 of 6 Customer: Thornes Market Project Name: Thornes Market 150 Main St Northampton MA Order Number: 184L21S051 Quote Number: 3476434 Line # Location: Attributes 10 Windows Architect, Double Hung, Architect, Double Hung, Architect, Double Hung, Support Item Price Qty Ext'd Price •; Product,Rectangle, Support Product,Rectangle, Support Product,Rectangle, 122.25 X $5,983.57 1 $5,983.57 1: 27.577.25 Double Hung, Equal Split I =� Frame Size: 27 1/2 X 77 1/4 al 0 PK # General Information: Standard, Style Edition, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green 527 Interior Color / Finish: Unfinished Interior Glass: Insulated Tempered Low E Advanced Argon Gas Viewed From Exterior Hardware Options: Spoon Lock, Installed, Brown, No Sash Lift Screen: Full Screen, InView Grille: Vertical Mull 1: AlignedWith, 12" 2: Non - Standard Size Fixed Double Hung Frame Size: 43 1/4 X 77 1/4 General Information: Standard, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green Interior Color / Finish: Unfinished Interior Sash / Panel: Custom, Standard Rectangle Glass, 3 Glass: Insulated Tempered Low E Advanced Argon Gas Grille: Vertical Mull 2: AlignedWith, 12" 3: 27.577.25 Double Hung, Equal Split Frame Size: 27 1/2 X 77 1/4 General Information: Standard, Style Edition, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green Interior Color / Finish: Unfinished Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Spoon Lock, Installed, Brown, No Sash Lift Screen: Full Screen, InView Grille: Vertical Mull 3: AlignedWith, 12" 4: Non - Standard Size Fixed Frame Frame Size: 27 1/2 X 29 1/4 General Information: Interior Glazed, Factory Assembled, Standard, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green Interior Color / Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Grille: Vertical Mull 4: AlignedWith, 12" 5: Non - Standard Size Fixed Frame Frame Size: 43 1/4 X 29 1/4 General Information: Interior Glazed, Factory Assembled, Standard, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green Interior Color / Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Grille: Horizontal Mull 5: AlignedWith, 3" 6: Non - Standard Size Fixed Frame Frame Size: 27 1/2 X 29 1/4 General Information: Interior Glazed, Factory Assembled, Standard, Clad, Pine Exterior Color / Finish: EnduraClad Plus, Hartford Green Interior Color / Finish: Unfinished Interior Glass: Insulated Low E Advanced Argon Gas Grille: Wrapping Information: 3- 11/16" Factory Applied, Perimeter Length = 464 ", Glazing Pressure = 85 For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 2 of 6 Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Schabacker, Don ® 69 Ashley Avenue Sales Rep Phone: (413) 736 -9239 West Springfield, MA 01089 Sales Rep Fax: 413 - 527 -3620 Phone: 4137369239 Fax: 4137363390 Sales Rep E -Mail: dschab @184.pellapdsn.com Customer Information Project/ Delivery Address Order Information Thornes Market Thornes Market 150 Main St Northampton MA Quote Name: Main Stairwell Material & Installation 150 Main St 150 Main St Order Number: 184L21S051 NORTHAMPTON, MA 01060 Lot# Quote Number: 3476434 Day Phone: (413) 584 -5582 NORTHAMPTON, MA 01060 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Wall Depth: Fax Number: Owner Name: Payment Terms: 1% 10th /Net 30th E -Mail: jon @thornesmarketplace.com Thornes Market Tax Code: MASS Contact Name: Owner Phone: (413) 584 -5582 Cust Delivery Date: 09/17/2012 Quoted Date: 2/9/2012 Great Plains #: 52C5845582 Contracted Date: 8/22/2012 Customer Number: 1002686501 Booked Date: 8/22/2012 Customer Account: 1000423869 Customer PO #: For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Printed on 8/30/2012 Contract - Detailed Page 1 of 6 Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 6 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, v0 nWl.. _ 1 \ C, l�l a . ... c ..T nQ& V\ . t as Owner of the subject property hereby authorize Y.e., \c..t. l c D C? c- l .\'N c_ . to act on my behalf, in all matt rs relative to work authorized by this building permit application. Sew Cane; S 30`?-- Signature of Owner Date I, l Pr O (ALA C_- o-C. , 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 perjury. i ned under the pains an d penalties of perjur Print Name Q9C1JbJ SI3 DJ, Signwne Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :1 A v .l CV ... C. '.._.. Th 0 C t \ 4 LO License Number l 65 M T\ S/ Green Q1, .0 ._ l-'\c C) t 1 1 � 1 113 Addre _ Exp ate lijkis Signature Telephone SECTION 13 - 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 Cr No Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number 1 i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ?,� c� ro l�.T J �__ TrIc Not Applicable ❑ Company Name: • Responsible In Charge of Construction 15 N1a (� S . Gran 42.-l tAici- 0\30 Address cz.-AAQ C. it) hit f c. ut3113. 115 Signature Telephone Kg).-) Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: ..__ L: R:': Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Findin ever been issued for /on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW (25 YES IF YES: enter Book Page, and /or Document # B. Does the site contain a brook, body of water or wetlands? NO e5 DON'T KNOW 0 YES 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 any signs exist on the property? YES (2C NO Q IF YES, describe size, type and location: 'Dyv - } Ge D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO qf 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration 0 Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other g W , r O&j Qtpk bt Brief Description Enter a brief dev t ion here. t nS�4`\1tt \. ` la W: Of Proposed Work: L.161 R -b4 % ri o pen% I`csS• O ' C, tr.& Chan c eS 14-q 4YX-4. __.. A St) , ...._. . SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business Er 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C 1 - 0 H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: re..., Of F C E S Proposed Use Group: Sq. rh Q.,..,. i Existing Hazard Index 780 CMR 34): ,,. Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1s 1St 2 nd 2 3rd 3 rd i 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone El Municipal ❑ On site disposal system Version1.7 Commercial Buildin Permit May 15, 2000 Depertmen; use only City of Northampton S tus P Building Department Guff DnVevvay Permit ` 212 Main Street Sewer / epti , w # tr 6 2012 Room 100 Water!WellAvaltabihty Northampton, MA 01060 two of aural Plans of L ;..FECT;otpho 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plane NCRTHAM .'; MA 01060 Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Th0>r'if1¢� Mekr \<-4-7\ Map Lot Unit l'S 0 MGM % N o r k, CtM P 4-or�, `Q ` Q Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: A, 4_l 32� =Sola Signature Ste_ �n 1 L.. � Telephone s 2.2 Authorized A ent: ?e, \,\ Vco AUCAS � \r&. I SS . Flair' • 6ren e-\d. MCI - Name (Print) Current Mailing Address: Dibb) - 413 . 17 1/4 .• 1151 x,31 Signature Q, �i C. Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building - 000. b'p (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ■ Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 +3 +4 + 5) DOD • °° Check Numbert571 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0247 CALL — tic% cAT AO e 4oTo APPLICANT /CONTACT PERSON PELLA PRODUCTS, INC 5 R6E 1 5 ( ADDRESS/PHONE 155 MAIN ST GREENFIELD (413) 772 -0153 XI t l o f �,,�- ,opoo E PROPERTY LOCATION 150 MAIN ST MAP 32C PARCEL 001 001 ZONE CB(100)/ 51-lowt J � �� l0 N j 7 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1/541 �� ISO Fee Paid Typeof Construction: INSTALL 6 REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 091496 3 sets of Plans / Plot Plan T HE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: A pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay .____C 1.`-(`-`2' 21 7,_ Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 150 MAIN ST BP- 2013 -0247 is #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 001 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2013 -0247 Project # JS- 2013- 000409 Est. Cost: $7000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG Zoning: CB(100)/ Applicant: PELLA PRODUCTS, INC AT: 150 MAIN ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:9/10/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 6 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 9/10/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner