36-189 (5) Pella Products, Inc. — Designees
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HOME IMPROVEMENT CONTRACTOR
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HOME IMPROVEMENT CONTRACTOR
Registration; 142,21422?',W.5
Expirallon:
DENNIS SHOCKRO Tym
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Pella Products, Inc. — Designees
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Suptiry qn, 1,pf-ra1I,/ icrnse. Board of RuIlding Retidatiolt,at-041andarih
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-,Wir. HOME IMPROVEMENT CONTRACTOR
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Registration;
Expiration:
TROY AGUUI=8
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1C7 HARR 13ON AVENUE 0
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GREENFIELD VAOIK3 __ 'R0DJCTS.INC
IRUY JACQUES
MAIN STRFF:T
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License CS'iL '30229 W,m"l of Itaildinc Revulatin and Standards
Rostrwtpfl to WS v, Z HOME IMPROVEMENT CONTRACTOR
Registration: 1422755
CARL KUKLEWICZ r Expiration: 3�124i2n10
33 RIVER ROAD Type- SUIDDIerr"111 Cald
rRVING.MA 02344 rE_Ljk rR(XYJ(;7S.!Nr-.
CARL KJKEWICZ
7:282012 175 MAIN S7REET'
GREENFIELD,NIAC-13'D'
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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: October 6, 2008
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.
. r..
Ei4 ARf)OF BUILDING REGULATIONS H.>r�rt n N rsirnG trio ittit=..ne mirdifJ,
,.: Lrcense °,r 1.T"i:r.':-�`. -JVt. !�!)k .,� MOMS IMAROVE.MPNi CONTRAiCTOR
Nurn6er r:� Reyietratlon ..
Ebirtttxits .++ - "t EKplrnUon 3,-.4 .:_
a •:,r:,:r r, n. - du-. Type: a i,t, .r.:c:Cs d
Expsres:C .-
Rasircted: - _r•.! ��•-
s �.� �i� §(' f u.wma..'.;.ar
Kir 11s'.�"
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.
If you have any question please contact me using the numbers listed above.
- i -
- �v/
_ Board o .0"
Building Re ulaiOn
One As g sand Stan ands
Ashburton Place - Room 1301
Boston. Massachusetts 02108 Home Improvement :
, Co.ntractor Registration
st rati
on
Registration: 142279
Type: Private Corporation
PELLA PRODUCTS, INC.
Expiration: 3124/2010 Tr# 263223
GARY SHERMAN Y
155 MAIN STREET
GREENFIELD
MA 0130 '
AI t; 50M-07/07-PC6490 Update Address and return card.
Mark reason for change.
Address
❑ [] Renewal (l Employment
C! ✓ize fnrirninai Lost Card
_ ! o ✓Li'r,, ...do"
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR before or registration valid fot•individul use only
RACTOR of
Registration: ore the expiration date. If found return to:
tl 142279 Board of Building Regulations and Standards
�• Expiration:
3/24/2010 Tr# 263223 One Ashburton Place
TYPO: Private Corporation Boston,Ma.02108 Rm 1301
ELLA PRODUCTS,INC..
ARY SHERMAN
55 MAIN STREET
REENFIELD, MA 01301
4 Administrator Not val' _ —
ithoutsignature
,��\ ✓�e 'IOUirvrrtcviacr�y`C�' 6��r'�JCPCtLCr:Jldlt
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only
before the expiration date. If found return to:
F Registration: 142279 Board of Building Regulations and Standards
Expiration: 3/24/2010 One Ashburton Place Rm 1301
TYPQ: Supplement Card Boston,Ma.02108
PELLA PRODUCTS,INC.
PAUL PICARD
155 MAIN STREET
GREENFIELD,MA 01301
Administrator ---
Not valid without signature
g
The Commonwealth of Massachusetts
— Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Atvlicant Information ) Please Print Lel_ibly
Mole (Business/OrganizatiorYindividual): Y t'
Address:_l
1
Phone#: C t �� a
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ I am a employer with ` `s " 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I ani a sole proprietor or partner- listed on the attached sheet.t 2 ORemodeling
ship and Have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10,0 Electrical repairs or additions
3.❑ I ann a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §I(4),and we have no 12.❑Roof repairs
insurance required.]'[ employees. [No workers'
comp, insurance required.] 13.❑ Other
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
TCoutractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
inj'orniatiou.
_t
Insurance Company Name: ` C_CK GC
Policy#or Self-ins.Lie.#: (l (°, - i� �,. _ U��' ��, � 1 1 Expiration Date:
Job Site Address:Ll " t*Al T C.G°j_i' � ;� ��� City/State/Zip:
Attach a copy of the wol•kers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine 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 fuse
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 and p nalties of perjury that the information provided above is true and correct.
Signature ( ' fit c� (;�r d ck- Date. / — ,.;10,0,1s _-
-r
Phone
dfjicial 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 i
Contact Person: Phone#:
PELLA PRODUCTS INC
155 MAIN STREET
GREENFIELD, MA 01301
r
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
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----------
SKTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor CSL + q`n —
`°%.)r 'XA a � License Number Expiration Date
Name of CS Holder
List CSL Type(see below)
U -i
Address T ype Descri.tion
� U Unrestricted a to 35,000 Cu.Ft.
Signature R Restricted 1&2 Family Dwelling
M Masons Qu
RC Residential Roofing Covering
Telephone WS "Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2, istered Wme Improvement Contractor(HIC)
HIC Company Name or HIC{Rtegistra rt Name �^ Registration Number
Address
4 0 7 7,)--01 _-5 ration Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, \fl l c•, as Owner of the subject property hereby
authorize °'ok to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
r
1, L (;i. c � S 1�i le - ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
be f.
Print Nam
C.
Signature of weer or Authorized Agent Date
(Signed under the pains and penalties of e •u
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted for"Total Project Cost"
The Conurionwealth of Malslsachusetts
Board of Building Regulations and Standards FOR
I V� Massachusetts State Building Code, 780 CMR, 7"' edition MUNICIPALITY
Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised January
One- or Two-Family Dwelling 1, 2008
This Section For Official Use Only
Building Permit Number: , _ Date Applied: _
Signature: "
Building Commissioner/Inspector of Buildings Date
_ SECTION 1: SITE INI+ORMATION
1.1✓Property(Address: P� 1.2 Assessors Map &Parcel Numbers
1.1a Is this an accepted street'? yes___ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks (ft)
Front Yard Side"Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 Owners of Record:
Name(Print) U Address for Service:
Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) 11 Alteration(s) ❑ Addition ❑
Demolition, ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: ('
Brief Description of Proposed Workz: �', Y
i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1. Building $ 1. Building Pen-nit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa (Item 6) x multiplier x
3. Plumbing $ 2. Other Fees:
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ �d ❑Paid in Full 0 Outstanding Balance Due:
BP-2009-0593
GIs#: COMMONWEALTH OF MASSACHUSETTS
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-2009-0593
Project# JS-2009-000851
Est.Cost: $18597.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 142279
Lot Size(sq. ft.): 31232.52 Owner: SIEGEL,DONALD S&SHARON G
Zoning: SR(100)//WP Applicant: PELLA PRODUCTS, INC
AT: 846 BURTS PIT RD
Applicant Address: Phone: Insurance:
240 MOHAWK TRAIL (413) 772-0153 WC
GREEN FIELDMA01301 ISSUED ON.1211012008 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Date Paid: Amount:
Building 12/10/2008 0:00:00 $35.0031993
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo