17C-068 (5) Apr 17 06 08: 43a Acct Dept (4131773-3740 p• 2
677—/
Gwonow
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 142279
Type: Private Corporation
PELLA PRODUCTS, INC. Expiration: 3/24/2008
GARY SHERMAN -- ---- _
155 MAIN STREET _
GREENFIELD, MA 01301
Update Address and return card.Mark reason for change.
)PS-CAI 0 saM-oaros-PCSSSe Address n Renewal Employment Lost Card
Board or Building Regulations and Standards
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 142279 Board of Building Regulations and Standards
Expiration: 3124/2008 One Ashburton Place Rm 1301
Type: Private Corporation Gaston,Ma.02108
PELLA PRODUCTS,INC.
GARY SHERMAN
155 MAIN STREET
GREENFIELD,MA 01301
Administrator Notvalid hout.signature
The Commonwealth of Massachusetts
_=— Department of Industrial Accidents
�' _ _— �flts.fhvsstl,�lo�s
600 Washington Street, 7 h Floor
- ,+f Boston, Mass. 02111
Workers'Compensation Building/Plumbing/Electrical Contractors
,.,. ,_,... � Insurance ce A., ,ffi
5 sy.
r '11
name E✓��� ��3CJ(1�-�5 r��C -
address:
city TCeco i e state M14
zio� phone#
work site location(full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction [Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition
Rss?�a74�+.flf s'�kL�iH'F.'.Ail±cm,:4'EF35vr?�i:ns�fi,;iiF•i+f."satiL- e"�T,�5itia�ukr..l,n:.k'.1�.,,.,r.. .....r........ t. . ..........
I am an employer providing workers' compensation for my employees working on this job.
company name:, �C t°� ?r6&"'s r�`�°`� .
address: &,''` {'L-
city: L GO Dhone#• 41 ;-774 _
0
insurance co. �-�c�'z, l-��Sv(`�h �. policy# L �o S ",
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices:
company name: -
address:
city phone#•
Insurance co.
company name:
address:
city: phone#:
insurance co. olic #
'$.' ry.. I E,.ith n4f 1> >y„? .'� -:s��..,ti.:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one yap'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
/do hereby Gerd/ under the pains and enalties of perjury that the information provided above is true and correct.
Signature t "��- Date
Print name ^{E: �'r Phone# 1 Z 31
official use only do not write in this area to be completed by city or town official
city or town: permit/license# []Building Department
[]Licensing Board
❑check if Immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; []Other
(r,,i d Sort.2003)
f�; ,crier Project: Kanouse, Maggie Quote No.: 26CL I 1 Alternate No.: 2
"' BE SUBJECT TO A STORAGE AND HANDLING FEE. THIS FEE WILL BE 1% OF THE NET ON THE ORDER ($25.00 MINIMUM
,�'FJf ,�rIARGE).
�axable Subtotal __$ 3,419.13
r__�L_er Pella Sales Representative Signature
MA _at 5.00% 170.96
None at 0.00% 0.00
None at 0.00% _ 0.00
3 /��/O Non-taxable Subtotal 3,028.60
/ Total $6618-69
Date Date Deposit Received
Proposal-Page 3 of 3
S�C30N8=CO1148RUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
e>e x e- VG""a Not Applicable ❑
Ile
Company Name Registration Numbe
ress Expirati Date
c ) t �(�;�_• ���C � Telephone
anw ,
a Q• p 0 ..KFRS'kCOMPENSATION INSURANCE AFFIDAVIT(M.;G.L. c. 152, § 25C(6))
.....x. . 1 ru fi"v • r,
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2) famines
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 acecptable 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[ D:ESCR PTitONtOFimPROPOSED�WORKI(et e k all fapplicablel
u
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ J Siding( J Other [ J
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D - Sheet 0
sa bd orMdifi ffAb existi iZ;h usihJ comp°l- e trd f61' dw—Mg:
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. bimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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
�.
SECTta WNERUHORIZATION TO BE COMPLETED VYHEN
OWHE A E i GONTReCTOR qPP� lE5 FOR<SUILDC-NG PEFCZ.T
* ����
I, as Owner of the subject property
hereby authorize to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/.Authorized Agent
hereby declare Mat 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.
Print Name
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
( � Setbacks Front
\� Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arkin
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW " YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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 _
No
IF-YES, describe size, type and location:
City of Northamptcrm
Building Departme,6fv
212 Main Street`'
Room 100
Northampton, MA 01060 e,
phone 413.587.1240 Fax 413-587.1272 to
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE`:1`.NF0.RMAT1,ON
1.1 Property Address: T � Th�c seetton" to bcomp eedy ffic-e.
r _
Ma µ
All
EIrnStDistrict
FIRE -ict
�,..
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SECTION 2 - PROPERTHY;OWNERSHI
P/AUTHHIZED:AGENT
,
2.1 Owner of Record: 1
Na (eri t) ; Current �, L �r lh�101 0 Ad s
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SI=GTfON�3 -EST.IkMAIT Eb CONSTRUCTGON:CO"STS '
Item Estimated Cost (Dollars) to be Official Use=Only
completed by ermit applicant
1. Building 0(� (a) Building Perm'it Fee
2. Electrical (b) _:stimated Total Cost of
Construction.from
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (l + 2 + 3 + 4 + 5)7 Check Number
This Section For Official Use Only
Building`Permit Number Date:lssued;_
Signature:
Building Commissioner/Inspector of Buildings - Date
r
File#BP-2006-1108
APPLICANT/CONTACT PERSON PELLA PRODUCTS,INC
ADDRESS/PHONE 155 MAIN ST GREENFIELD (413)772-0153
PROPERTY LOCATION 145 CHESTNUT ST
MAP 17C PARCEL 068 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Auilding Permit Filled out
Fee Paid "
Typeof Construction: Windows Replaced
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved 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
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.
145 CIMSTMYr ST BP-2006-1108
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-1108
Project# JS-2006-1635
Est. Cost: $6500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: PELLA PRODUCTS, INC 142279
Lot Size(sa. ft.): 27834.84 Owner: JEROME KITTY&MAGGIE KANOUSE
Zoning Applicant: PELLA PRODUCTS, INC
AT. 145 CHESTNUT ST
Applicant Address: Phone: Insurance:
155 MAIN ST (413) 772-0153 WC
GREENFIELDMA01301 ISSUED ON:411212006 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 4/12/2006 0:00:00 $25.0022269
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo