05-052 (10) Board of Building Regula ons and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
ReAistratlon: 142279
Type: PrNete Corporation
ExPJ(eWn: 3/24/2006
PELLA PRODUCTS, INC,
GARY SHERMAN
155 MAIN STREET
GREENFIELD, MA 01301
Update Address and return card.Mark reason for cbaog
Address D Renewal F1 Employment Lost Card
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L\ Board of Saildiat Retuladons and Standards License or registration valid for indlvidul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Rcgulationsand Standards
Registration: 147179 Out Asbburtou Place Rm 1301
.J19 Expiration: y24/2006 Boston,Ms.02105
Type: PAvate Corporation
PELLA PRODUCTS, INC.
GARY SHERMAN
155 MAIN STREET
GREENFIELD,MA 01301 Admiobtrator Not lid wi bout signature
t
PELLA PRODUCTS, INC.
CHECK REQUEST/EXPENSE REPORT FORM
r r
Al PAYEE NAME t Y _Z?�) DATE �^
ADDRESS ` SOCIAL S C TY O.
ADDRESS 2
CITY, STATE,ZIP'"Jrr A"I/?in_i)#)n 1^011 0
SEND CHECK TO: .�
DATE ITEM OR SERVICE AMOUNT DO NOT USE
4L S — ACT
S $
[ S ACT
_
$ $
$ ACT
S S
$ ACT
SUB-TOTAL $
PAY
DATE REIMBURSABLE EXPENSES AMOUNT_
TOLL SUMMARY $ 8273
MEAL SUMMARY $ 8350
MILEAGE SUMMARY* $ 8280
$ O.K.
S
$ VCH
S
SUB-TOTAL $
GRAND TOTAL.................................................5
REQUESTED BY CUSTOMER WNMER
i
ACCOUNT BALANCE DATE INTTIALS
*MILEAGE PAID®.30/MILE Request for Petty Cash Petty Cash on Hand$
Contacts: Human Resources
Updated 12-31-03
G
Proposal P 10/27/2004
f� Pella Products, Inc.
69 Ashley Ave.
West Springfield, MA 01089
VIEWED TO BE THE BEST® (413) 736-9239
Proposal Submitted To: Work to be performed at:
Name: Mary Olson
Street: 307 Audubon Road Street: Same
City: Leeds State: MA City: State:
Phone: 1-413-586-5238 Proposal# Sales Branch: 52
We hereby propose to furnish the materials and perform the necessary labor for the completion of
Supply: (1) Fixed Casement, Frame:65 X 64: Architect Series Classic, Wood, Model 1 , Primed Wood, 5/8"
InsulShld IG Glazing, 1-7/8" Bkmld (per design)
Notes: Labor materials & Disposal to remove existing fixed window, Prepare opening for new window, Install new
fixed casement, Insulate & Caulk, Apply new wood interior trim. Dispose of old window & all debris.
This contract includes all building permits
For the sum of:
$1,604.64
711.�
Price includes MA state sales tax
Alternate Prices:
Fall Spruce Up Sale if Contracted by 11/04/2004 Deduct: $25.00
*OR*
0% intrest No Payments for 360 Days
Any alteration or deviation from the above specifications involving extra costs wiii be executed only upon written orders,and will
become an extra charge over and above the estimate. All agreements contingent on strikes,accidents or delays beyond our control.
Owner to carry fire,tomado and other necessary insurance upon above work.
Respectfully Submitted:
This proposal may be withdrawn by us If not accepted within fifteen(15)days
The above prices,specifications and conditions are satisfactory
and are hereby accepted. You are authorized to do the work as Signatu
specified. Payment to be made as outlined above.
Date: Signature:
Page 1 of 1
/ - = The Commonwealth of Massachusetts
Department-of Industrial Accidents
600 Washington Street, y"Floor
Boston, Mass. 02111
Workers' Com eosadoo Insurance Affidavit: Building/Plumbing/Electrical Contractors
.r
k
clr Y state: rl zip:t1f L� phone M
we:'site location(full address):
I am a homeowner performing all work myself. Project Type: ❑New Construction t[�del
I am a sole roprietor and have no one workin in any capacity. Building Addition
Jam an cmpl Providing workc ' com r pens/ati/on for my employees working on this job.
.s'`�.L.�l
adcra i
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tns�rance Co. G`' J 1�iY,C L W, ou w C Pr— O 0
i am a sole proprietor,general contractor,or homeowner(circle one)and have hired the oontmctors listod below who have
th_ 'ollowing workers' compensation polices:
L''^rnv name; —
ad 'r"$:
cl, nboae N:
III',..'ante co. _ DQucy N , wows
f
+rev n+I➢t• -_ —-
eil Dhnno N:
1L 10Ct CO. 011 cy
..rt to steure coverage as requJrW under Section 25A of MGL 152 can lead to the ImposJtion of etiminal penald"of s fine up to$1.500.00 and/or
oc. ;
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°� Crx�7 l� �Ltx•#[�i�11t��IITT -
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WOR CER'S COMPENSATTON INSURANCE AFFIDAVIT
(li ceI>see/pelmi ttee>
with a principal place of business/residence at:
�.r� ",e Mtq (phone#
(street/city/sta W2ip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insi=ce Company) (Policy Number) (Expiration Daze)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml sheet ifneccnary to iochtde idb oration pertaining to ell 000trnetors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homcowo=who employ pcxsoas to do m *fir*+*nce,o=str ton or repair work on a dwelling of
not mono than throa units in-Lich the homeowner mides or oo the grounds appurtenant thereto are no(eawraIly ooasidcttd to be
cmploytrs under the worker's.compc='ion Act(GL152,ss 1(5)�application by a homeowner for a lic=e or permit may evidence the
legal stahra of an employer under the WNI'Ves C.ompemation Ail
I undecsiand that a OKW of this rut--may be forwarded to the Departmrnt of Indushiel A=&alne Offioc of Irrnuwca for the
coverage vtnficatioa and that failure to s,==coverago under sectioa 25A of MGL 152 can kad to the i ioa of criminal penalties
oomisiing of a fine of up to S 1,500.00 and/or imprison of up to one ytar and civil penti ies in the form of a Stop Work Order and a
fi>m 0(5100.00 a dly agpirnt me-
N For dep=tneaw trso only
Permit Number
/
Maps
Lot#
}.. t of Licen erriiittee e
SECTION :CONSTRUC'f1ON SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
IN
_ Not Applicable ❑
„.
Company Name Registration Nu ber
A ress /
Expiration Dat
Telephon
S CTIQN,,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 oft the building permit.
Signed Affidavit Attached Yes....... No...... ❑
NIMWVMW� z =
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
S T'0N 5-�D�� F., N aV. ".;POS D, ck a(�a ' i�cable
t,
New House ❑ Addition ❑ ReplacementyAndows Alteration(s) ❑ Roofing ❑
Or Doors NK
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: )e ) _
Alteration of existing bedroom__Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
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. 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
SECTION 7a OIIYIER AUTHORIZATION -TO:BE COMPLETED'°WHEN
OWNERS/GENT OR CONTRAPTOI�APR ES°'FO BUIC:I)ING PERMIT
...
l r LJ, as Owner of the subject property
r
hereby authorize �l t / t'f �y to act on
my behalf, in I matters relative work authorized by this building permit application.
ignature of Owner Date
116 �) , as Owner/Authorized Agent
hereby declare that the statements and information on tie foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
flkt—N ame
i "0
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
parking)
#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:
• +ti r •
City of Northampton
Building Department
212 Main Street
Room 100 F
Northampton, MA 01060
phone 413-587.1240 Fax 413.587.1272
pe.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This
1.1 Pro ert Address:
section to becompl tad by office
--�-
6
Map Loi 2 U ► Fey
, Zone 4uer ay Cistrt 3 s �
a .3 w
m �
N
Elm.St. DiMrict B'D►stirict
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
N me(Prin Currwn/t Mail' Add
�s�s://
(_ Telephone
Signature
2. uthorize nt:
j 1
e(Print) Current Mailin Address:
3
Signature Telephone
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 �p (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) t Ll Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner%Inspector of Buildings Date "
307 AUDUBON RD BP-2005-0649
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:05-052 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-2005-0649
Project# JS-2005-0863
Est.Cost: $1605.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 142279
Lot Size(sq.ft.): 65340.00 Owner: OLSON MARY
Zoning:RR Applicant: PELLA PRODUCTS, INC
AT. 307 AUDUBON RD
Applicant Address: Phone: Insurance:
155 MAIN ST (413)772-0153 WC
GREEN FIELDMAO1301 ISSUED ON:1212104 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: Receipt No: Date Paid: Check No: Amount:
Building 12/2/04 0:00:00 17250 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo