05-019 (7) PELLA PRODUCTS INC
155 MAIN STREET
GREENFIELD, MA 01301
413-772-0153
Subject: Disposal of Debris
The purpose of this letter is to certify that all debris rusulting from any project undertaken by Pella
Products Inc. in your Town will be transported to a dumpster at our main
facility at 155 Main St. Greenfield, MA.
Pella Products,lnc. 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
Pella Products Inc.
240 Mohawk Trail
Greenfield, MA 01301
413-774-7231
City of Northampton, MA
Department of Inspection Services
Thank you for reviewing our building permit request for Emma Janr Carnes 277
Audubon St. . Leeds, MA 01053 Please direct any questions or concerns, you may have
to me, Lauri, at the Greenfield, MA retail showroom. All customer and project
information is located in this particular office, therefore I will be able to answer any
questions or address any concerns there may be more efficiently. Once the permit has
been approved please remit it to Pella Products in the stamped envelope provided.
Thank you for your anticipated cooperation.
Sincerely,
Lauri-Ann Rice
Pella Products Inc..
240 Mohawk Trail
Greenfield, MA 01301
Phone 413-774-7231
Fax 413-774-6348
gam "
- Board of Building Regula ons and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 142279
Type: Private Corporation
PELLA PRODUCTS, INC. Expiration: 3/24/2010 Tr# 263223
GARY SHERMAN
155 MAIN STREET _
GREENFIELD, MA 01301.
Update Address and return card.Mark reason for change.
C, soon-07/07-PC8490 E] Address ❑ Renewal D Employment ❑ Lost Card
��e �a7nnzoi a�,j��a*kacu.�iccGP,�4 ---
,_ Board of Building Regulations and Standards
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
j Registration: 142279 Board of Building Regulations and Standards
Expiration: 3/24/2010 Tr# 263223 One Ashburton Place Rm 1301
TYpe: Private Corporation Boston,Ma.02108
1LA PRODUCTS, INC.
1RY SHERMAN
5 MAIN STREET µ
2EENFIELD, MA 01301 Administrator Not val' ithout signature
�• ��ie i�U���yytnazuseall� a��-�lcraeacfiratel�ii
Board of 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: 3/24/2010 One Ashburton Place Rm 1301
Type: Supplement Card Boston,Ma.02108
PELLA PRODUCTS, INC.
PAUL PICARD
155 MAIN STREET
GREENFIELD, MA 01301
Administrator Not valid without signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 1500 Washington Street
Boston, MA 02111
6Y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/lndividual):
Address: l
City/State/Zip: ;1: til '1(? 1 � ! ?t�1 Phone #: I _; - °--[-7 -(1
Are you an employer?Check the appropriate box: Type of project(required):
1.�1 am a employer with_ 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ [ Remodeling
ship and have no employees These sub-contractors have 8. ❑ 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 l0.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.E] Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
.l.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 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
information.
t
Insurance Company Name:��
Policy#or Self-ins. Lic.#: ����,:� - i� :,r -- Lti t-�--� �,�;, 1 1 Expiration Date:
Job Site Address: _cr C lLT C.C_--c- ,�� City/State/Zip:
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
line 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 and p nalties of perjury that the information provided above is true and correct.
Si nature: C71-c C4, Date: 00
Phone#
Official use only. Do not write in this area,to be completed bv 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#:
Office Order Copy �S „11,�
PELLA PRODUCTS, INC.
240 MOHAWK TRAIL
GREENFIELD, MA, 01301
Phone: (413)774-7231 Fax: (413)774-6348
Customer Project I Ship-To Ur der
Carnes,Emma Jane Carnes,Emma Jane Order No. 73938DP30P Order Date 06/05/2008
277 Audubon 277 Audubon Customer No. 53115840198 Need Date 07/10/2008
Tax Code MA Sales Rep. Code 41
LEEDS,MA 01053 Leeds,MA 01053 Taxable no Sales Rep.Name Picard.Paul (53)L.
HAMPSHIRE HAMPSH Tax Exempt No. Window Store 000003
Terms Code C.O.D. Territory
Lic.No.: P.O.No.: Customer Type Ship To County HAMPSH
MDR Code SP Prepared By Paul
Jane Owner: Ms.Emma Jane Carn Overall Discnt. 0.000% Architect Name
Bus. Phone: (413)584-0198 Bus. Phone: (413) 584-0198 Comm. Split 41: 100. % Dist. Order No.
Bus. Fax: ( ) - Home Phone:
Cellular: ( j -
Home Phone: ( ) -
Delivery Instructions: : 91s to exit 20 Northampton. Right at first light, go staright for several miles, right at stop by Look Park, left on Florence Rd. Florence Rd. turns into
Audubon Rd. by Leeds Post office. House on right use 2nd driveway.
Comments: All Grilles are to have White Paint on the exterior and 2 coats of clear poly on the interior.
()4 Side'.Ww Ttenn (qty. Descriptions Tnit Price Extended
Item# 10 Qty: 2 Vent-DH Standard Jambliner Precision Fit Window,Male Size:23-1/2 57049 1,140.98
Location:P-Living Room X 49-1/4:Architect Series, Clad,Model 3.White.Half Vent/match Half 0.00 0.00
R.O: 2' 0" X 4' 1-3/4" Vent, 5/8" InsulSlild IG Glazing,Full Screen,Champ Lock Only. 3/4" REM 570.49 1,140.98
Traditional Grille( Grille Lites Wide=03, Grille Lites High Upper Sash=02, 0.000%
Grille Lites High Lower Sash=02 ),Unfinished, Unfinished
Value Added Items: Pella Interior White Semi-Gloss Paint-Qtv i
Custom Color Paint Semi-Gloss Paint - Qty 1
Notes: Pella white on exterior of grilles,Nvindows and interior of grilles to have 2 coats of clear pole.
Office Order Copy-Page 1 of 5
Proposal for Customer Project: Carnes,Emma Jane Quote No.: 38DP30 Alternate No.: 2
outside View Item No. Ott. Summarl Descrintion Unit trice Extended Price
Item#80 Qty: 1 Interior trim:None 0.00 0.00
Location: C
Picture
Not
Available
Notes:
Outside View Item No. 1711, SummarX Descrintion Unit Price Extended Price
Item#85 Qty: 1 Exterior trim:None 0.00 0.00
Location:
Picture
Not
Available
Notes:
Thank You For Your Interest In Pella Products
l
Taxable Subtotal $6,155.94
Customer Sign re Pella Sales Represen ative Signature Sales Tax at 5.0000% 307.80
Non-taxable Subtotal 4,212.00
/a 9— I? Total $ 10,675.74
Date Date De osit Received I $ 0.00
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. 5 3
j
For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at
www.pella.com.
Proposal-Page 6 of 7
Jun 17 08 01:54p ACCOLlnting Dept 1,413,773-3740 p.2
ACCRD CERTIFICATE OF LIABILITY INSURANCE 6/V2008'
`UCER (413)773-9913 FAX: (413)774-3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
i_isOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 638
Greenfield MA 01302-0638 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:Acadia Insurance Compamy Company 31325
Pella Products, Inc. INSURER B:
ATTN: John Benjamin INSURER C:
155 Main Street INSURER D:
Greenfield MA 01301-3258 INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVVfTHSTANDING 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 CF SUCH POLICIES.
AG RE T _111AITa SHOWN Y HAVE BEEN REDUCED BY PAID CMIMS.
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATE MfNIDDlYYE POLICY EXPIRATION
D4JW N LIMITS
GENERAL LIABILITY EACH QCCURREN S 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGOaEo N 7uED
PR NI EERrra nce S 250,000
A CLAIMSMADE FX70CCUR CPAD20470111 1/112008 1/1/2009 MED EXP(Ary one srscn) S 10,000
PER ONAL&ADV INJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- MP. PAG- S 2,ODD,000
X POLICY JE O LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000
ANY AUTO (Ea accident)
A ALL OWNED AUTOS MAA020470211 111/2008 1/1/2009 BODILY INJLRY
X SCHEDULED AUTOS
(Per person) S
X HIREDAUTOS BODILY INJURY
X NON-OWNED AUTOS
(Per accident) $
PROPERTYOAMAGE S
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHERTHAN EA AC_^ S
AUTO ONLY: AGG S
ERCESSIUMBRELLA LIABILITY
- FACHOCCUR RENCE $
OCCUR CLAIMS MADE AGGREGATE S
$
DEDUCTIBLE $
RETENTION $ S
A WORKERS COMPENSATION AND x WC STATUS OTH-
EMPLOYERS'LIABILITY 500,000
ANY FROPRIETOR/FARTNERIEXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEb:BEREXCLUDED? WCA020470511 1/1/2008 1/1/2009
E.L.DISEASE-EA EMPLOYEES 5005 000
If yes,describe urder
SPECIAL PROVISIONS b=low E DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Operations usual to the sale & installation of doors & windows
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Emma Jane Carnes EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
277 Audubon Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Leeds, MA 01053 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Robin Sargent/TG -Q -
ACORD 25(2001108) (P ACORD CORPORATION 1986
INS025 pias).Oba Pape 1 of 2
SECTION'S-CONSTRUCTION SERVICES
8.1. iconsetl Constr a^tion Supervisor. Not Applicable
Claoo_ i License Molder
License Number
Address Expimetion Data
519natwo Telephone
e rod f rtycftmu vament Cnnlrs curry .. t;+ ,,,_:+i . Not Applicable 0
Comnan Name y� Registmt(on Number
Naoc
Address Expiration Date
�- Telephone_E O\5
SECTION 10-WORKERS'C;OMPEN$ATION INSUPANCE AFFIDAVIT(M.G.L.C.162,§25C(a))
Workers Compensation Insurance affidavit must be completed and submitted with this application_Failure to provide this affldavit will result
in the denial of the Issuance of the buUino permit,
Signed Affidavit Attached Yes....... No...... 0
_.
1Came O'I'd >r xe=it bur
The current exemption for"homeowners"was extended to include Owner-occupied Ilwellinks 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 as
as upervisor.GMR 780. Si&th_ Edition_ ectign 108.3.r,.Tyt
D linition of Hum owner:Person(s)who own a parcel of land on which he/shc 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 farin
structures.A person W o constructs MgrS than one home in a two-year Period_shal)not be cnnsidered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,,t„ the/she shall be
responsiOlr for all such work performed und. f the building errn�i,t,
As acting-Construction Sine visor your presence on the job site will be required rrunt 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'Lompcnvatiou) and Chaptcr 153(Liabi)igl of Employers to
Employees for injuries not resulting in Dcath)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
"I'he undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building C;odc,City of
Northampton Ordinances,State and local Zoning Laws and State of Massachusetts Cenera)Laws Annotated.
Homeowner Signature
tot)(A 6"LZTL85CTf XFd TZ:OT LOOZ/to/So
SECTION 5-06SCRIQ IaN OF PR POSED ORK tchp2k,011 mpljcabrlol
New House ❑ Addition Replacementviindows Alteration(s) Roofing
or Coors 91
Accessory Bldg. ❑ Demolition ❑ NWW Signs [C1] becks [M Siding(p] Other[M]
Brief Oescription of Proposed
Work: ` e- Y�`
Aneration of existing bedroom No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement yes No
Plans Attached Roll -Sheet
�a ifNew�hr�use andt�r'add(flr�t"II tib.��ils#ist�>'�k�� ' �'�—'�5xuit�►t��'tt��xfoMli�nn►�r�i'�t
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._ Masseheck 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,lNo
j_ Depth of basement or cellar floor below finished grade
k. WIII building conform to the Building and Zoning regulations? Yes�No.
I. Septic Tank _ City Sewer_ private well City water Supply
SECTION 7a.-MNER AUTHORIZATION-TO BE COMPLETED.WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, cam a_ as Owner of the subject
property
f
hereby authorize L)CLLf!t _:Ley-_- (S5 l(A, oAA _
to not on my behalf,in all matters relative to work authorized by this building permit application. r�.
Signature of Owner Date
e c 11( 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.
Print N
S owner/Agent Date
Coosa ZLZTLRgCTt YYd T9:0T L009/to/git
,'��' it Y Yrr�ray „y,,4 1 M y
- — -C�fy of Northampton 's y' '+ b r - ': �I�till,
.J�Bogidtng Department o Pd
212 Main Street
koarn 100
L008Northarnpton, MA 01060 �t � '►fir ii�Itil �I I
phone 413-587-1240 Fax 413-5B7-1272
awlt will
�iPPLiCAT1ON TO Go 13TR LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION -
1,1 Property Address TnI soO.Ion to be completed by office
„�dvbv n }-• Map.. . Lot Unit
OveNay District
Elm St.District-
. „
CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
n i t4u&u- o d k -
Namo(Print) Curren Me ng Ad es
Telephone
Signature
2.2 AuthorVzed Aunt
Name"Ma Current Mailing Address:
pre Telyphone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Costa
C011$trLlCtlpll fro l' 6
6. plumbing Building Permit Fee
4. Mechanical(HVAG)
5_Fire protection
6, Total=(1 +2+3+4+5) l `� .� Check Number 30 30q •;6
This Section For Official Use Only
Building Permit Number: oats
issued:
Signature:
Building Commissloner/Inapectar of SuildingQ Data
Tt)t.I� 4lrls Fr.SJ�'�.Tt� X��7 �L•tI F .�.t7t7L/1'U/Sti
BP-2008-1150
CIS#: COMMONWEALTH OF MASSACHUSETTS
F 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-2008-1150
Project# JS-2008-001697
Est.Cost: $10675.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 142279
Lot Size(sq. ft.): 273992.40 Owner: CARNES RICHARD CHARLES&
Zoning: RR Applicant: PELLA PRODUCTS, INC
AT. 277 AUDUBON RD
Applicant Address: Phone: Insurance:
240 MOHAWK TRAIL (413) 772-0153 WC
GREENFIELDMA01301 ISSUED ON.612012008 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 6/20/2008 0:00:00 $25.0030304
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo