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32C-079 (2) 10 WILSON AVE BP-2016-1375 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-079 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-2016-1375 Project# JS-2016-002368 Est. Cost: $16000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq. ft.): 5096.52 Owner: BARRY MICHAEL S&REBECCA L zonine: URC(100)/ Applicant. PELLA PRODUCTS, INC AT. 10 WILSON AVE Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 Liability GREENFIELDMA01301 ISSUED ON.-512312016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 12 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 5/23/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Pella Products, Inc. 69 Ashley Avenue W. Springfield, MA 01089 Building Department City of Northampton 212 Main St Northampton, MA 01060 Thank you for reviewing our building permit request for 10 Wilson Ave, Northampton MA 01060. Enclosed you will find the required documents and permit fee. Please direct any questions you may have to me, Derek Shaw, at Pella Products, Inc. of W. Springfield, MA. All customer and project information is located in this particular office; therefore I will be able to address any concerns you may have. I have included a stamped envelope for the return of the permit or permit receipt. Thank you in advance for you anticipated cooperation. Sincerely, Derek Shaw Pella Products, Inc. Retail Coordinator 69 Ashley Avenue W. Springfield, MA 01089 (413) 736-9239 ext 103 e-mail: sc52@184.pellapdsn.com Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - ----7212 Main Street Sewer/SepticAvailabiiity Room 100 Water/Well Availability jNor hampton, MA 01060 Two Sets of Structural Plans o phone 1 3_11 87-1240 Fax 413-587-1272 Plot/Site Plans Other Specify DEMI.CF 7E"sLfir r, �, Jl 1 afIST UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION /� ye, This section to be completed by office 1.1 Property Address: 'p wl�sOh rT' NeyAiA0X ?0N,AAA DIOGO Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A cc e, &oa,P Ib WilsoA IVe,Af 0Vfkat1MPkj MA 61000 Name(Print) C Trent Mailing Address: N13)3Z0 -9205 14 oe eT p one Signature r - 2.2 Authorized Agent: Tido,voy[ Sross 10 Georgy St.&Qen6etd N00 0130f Namd(Pnnt v, Cu ent Mailing Address: N 773- 1157 igna ure T phone SECTIO 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (/ll O©o,OD (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) 000.0co Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 Q DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW ® YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DON'T KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , 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 Q NO 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 Q NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F] Addition ❑ Replacement4indows I Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[p] Brief Description of Proposed Work: Kt�1nLlna i2windOWS 1��`�1A 6Xi5vina nJ„S,fiMural G�►410t S �ee4d. I or Alteration of existing bedroom Yes_J)e' No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing Complete the following: 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. Masscheck 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-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, A`c ha e L �� as Owner of the subject property hereby authorize a, PA;v)dH.C4 i to act on my behal all matters relative to work authorized by this building permit application. I, Signature of dwner Date 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. f ur �jr v Print Na � l(o ( Signature Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ('Pi�/OT BUSS C -5-o%5515 License Number 10 r ��( 3 r $ Address Expiration Date ( �Ii Y44"3-167 Signature I Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ kAl&. Prol.tia& I-6c, 17277 CoMpanv Nanie Registration Number (S.5 Ma'r► S+, bftetf ttd /VIA 0130 312glt,s Address Expiration Date Telephone SECTION 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 of the building permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption 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 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 144 c Boston, MA 42114-2017 v , wwty mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizatiottlIndividual):Pella Products, Inc. Address: 155 Main Street City/State/Zip: Greenfield, MA. 01301 Phone#.413-772-0153 Are you an employer?Check the appropriate box: Type of project(required): I.R- I am a employer with 49 cuiployces(full and/or part-time)." 7. ©New construction 2.01 am a sole proprietor or partnership and have no employees working for me in $, Oy Remodeling any capacity.(No workers'comp.insurance required.] 3.[31 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. n Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property, I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.f7r I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp,insurance.e 13 Q Roof repairs 6. we are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other- 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subtnit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hanover Insurance Group Policy#or Self-ins.L/icc.#: WHN-9399766-04 Expiration Date: 01--01-2017 Job Site Address: Ill W1 I50kvQ. City/State/Zip: TlJ1�/V1 �D�I �'lalltl/O110(0 G U31 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 anchor 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sinature: _ Date �,�b'I� Phone#: Above Official 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 Contactfierson: Phone#• PELLA RQDUCTS, INC. 155 M,AD1 S'T'REET GENFIELD, MA. 01301 Date: b W i Subject: Disposal of Debris The:Purpose of this letter is to certify that all debris from any project undertaken by Pella.Products, Inc. in your to-Am will be transported to a dumpster at our main facility at 1.55 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, :PELL-A PRODUCTS, INC. John P. Benjamin Accounting Manager Debris 06-17-14.docx Pella Products, Inc. 155 Main Street Greenfield, MA 01.301 Phone:413-772-0153 Cell:413-834-8799 To: Building Inspector From: Trevor Bross—Installation Manager Date: February 23,2016 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 9CS-096558 and my HIC 9 182150. Please find a copy of my licenses below. :-epartrnent ofpliblic 611-tv of Builcl i."19 Recjulataons and 3-Indarcis J construction Supervisor --;cP:ise: CS 1396568 Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. TREVOR BROSs 10 GEORGE STREET GREENFIELD MA 01301 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. 03/0112018 TIPS Licensing information visit:WWW-MASS.GOVIOPS Y,t,ntnzr 11)ffict Of Consumer Affairs&Business Regulation License or registration valid for individul use Only Z A before the expiration date. Iffound return to; "'bME IMPROVEMENT CONTRACTORiicss Regulation 4 Registration: office of Consumer Affairs and uusi 142279 Type: 10 Park Plaza-Suite,5170 3/2412018 Supplement card Expiration. Boston,IAA 02116 PELLA PRODUCTS,INC. TREVOR GROSS 155 MAIN STREET GREENFIELD,MA 01301 r Not valid without signature Undersecretary 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 Z: these individuals as my Designees: Willard Brown CS106010 Vladimir Shevehuk CSSL099209 Scott Bowdish CSSL100232 Curt Boyle CS78514 Dave Ruffner CS57308 Bill Leger CS89338 Chris Gamache CS86946 Brian Thompson CS67121 Andy Kimball CS85981 John Joy CS004599 If you have any question,please contact me using the numbers listed above. .\DATAFILES\Shared\INSTALLATION\Pictur&s CSL scans\CSL-Designees 2015v1.doc TE A�® CERTIFICATE OF LIABILITY INSURANCE 71/6/201(MMIDDN6YYY ) 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 NAME: g Berkshire Insurance Group, Inc. PHONE x (413)773-9913 (413)774-3872 117 Main Street E-MAIL rsar ent@berkshireinsurance rou ADDRESS: g g pcom ' INSURERS AFFORDING COVERAGE NAIC# Greenfield MA 01301 INSURER A:Massachusetts Bay Insurance Co 22306 INSURED INSURER B:The Hanover Insurance Company 10212 Pella Products, Inc. INSURERC: 155 Main Street INSURER D: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER:I6GL,AL,we 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER M MM D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑ PREMIS OCCUR DAMAGE ES Ea occurreTO RENTED nce $ 100,000 ZHN942720204 1/1/2016 1/1/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I JEo 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _(Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS ADN939977004 1/1/2016 1/1/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory In NH) WHN9399766 1/1/2016 1/1/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Operations usual to the sales and installation of doors and windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE Robin Sargent/RMS ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)