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23A-220 (2) 17 NEW ST BP-2016-1482 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block:234-220 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2016-1482 Project# JS-2016-002535 Est. Cost: $10986.58 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 142279 Lot Size(sq. ft.): 12414.60 Owner: THALER PAUL S&LINDA G BATCHE Zoning:URB(1001/ Applicant: PELLA PRODUCTS, INC AT: 17 NEW ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC G R E E N F I E L DMA01301 ISSUED ON:6/13/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL12 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 ft 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 6/13/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED ,� I 0 < . Department use only City of North.mp n I° of Permit Building Departm err or eunninonsa.ccri .utlOnveway Permit 212 Main Street NOR11 1ON:NA01060 ptiC Avadabilrty Room 100 Avalabirty Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address; This section to be completed by office NiEvo S ,A Map Lot Unit c'LO(e,,n Ct M A Zone Overlay District Elm St.Distict Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT j.1 Owner of -ecod: 120.11 QIQf (� NeN) + � k rtn CO HA 010(02- Name(Print) Current Mailing Address: u3 —Sk'}4q e .� /�� - .4 Telephone Signature 2.2 Authorized Agent: ame/(let Pctdulnc or 3ue-3 155 Hew 5} 6cel., ell HA o13 / Name' Current Mailing Address: ,i/64244 1413-113 " itS1 F 3r7 Signatu• Telephone SECTION 3•ESTIMATED CONSTRUCTION COSTS, Item Estimated Cost{Dollars)to be Official Use Only completed by permit applicant 1. Building I os clue. 55 (a)Building Permit Fee 2. Electrical 6 (b)Estimated Total Cost of Construction from(8) 3. Plumbing a Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection tJ 8. Total=(1 +2+3+4+5) 10 q (p, Sg Check Number S'7 1C.1 44/0 This Section For Official Use Only Building Permit Number Date tIssued: Signature: Bolding Commissioner/Inspector of t id gs 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 C,Kt 1`t\ it • ALLA'het Building Department Lot Size Fron :e MilMa Setbacks Front av Rear Building Height -■__■ Bldg. Square Footage Openmar Space Footage (Lot minus bldg&payed parkin( #of Parkin_ Sraces Fill: volume&Location/ A. Has a Special Permit/Variance/Finding e r been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Regist of Deeds? NO 0 DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW er-YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O 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 Cr- IF /IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, exca on,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(Check all 5001 able) New House ❑ Addition ❑ Replacement ws Alteration(s) n Roofing ❑ Or Doors Accessory Bldg. 0 Demolition ❑ New Signs (CI Decks II= Siding IC] Other Ito] Brief D prion W Proposed Wank: wren) I(b� w„vth,a,.,-.h1 il5t.wr e-K�S�i nr, o(a^..�,n9t (u IA AO Anekny)c �o 1k. irmici.n53 Stni Alteration of existing bedroorcT5 eenkg§� No Adding new bedroom Yes No ��� Attached Narrative Renovating unfinished basement Yes /"r No Plans Attached Roll -Sheet Sa. If New house and or addition to existing housing,complete the following: a. Use of building: One Family Two Family Othe "IL b. Number of rooms in each family unit: Number of Bathri.ms C. Is there a garage attached? d. Proposed Square footage of new construction. Dim- e. Number of stories? Illy f. Method of heating? _� Fireplaces .r Wo.(moves Number of each g. Energy Conservation Corn.fiance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft . wetlands? Yes No. Is co .truction within 100 yr, floodplain Yes No j. Depth of basement or cellar Thy y below finished grade k. Will building conform to the Build g and Zoning regulations? -s No. I. Septic Tank City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. P�,i 1 r}Cl'Q/ ,as Oumer of the subject property {� y, hereby authorize PP2Ia Pale' �(;1� Ikiik to act on my behalf, in all matters relative to wo authorized by this building permit application. x/7.7/ Signature( (�of Owner y, Date 1, t'e(�A {"Cocof 's 'tl(,..' _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. �revuC �tt}5S - Pnnt/me &i3lft, Signet of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 01 Licensed Construction Supervisor: Not Applicable ❑ Raneof License Holder CS-00 license Nuber o � • • G ' # � ' (J HA Oi3oI Address I Expiration Date Air L1' S- ,. 1 - 73-IIS7Y3 cif- Telephone S.&agftlitnIXIMEISs-cSagift Not Appiicabie C7 P'.11 111aloeInc 117,1-.7q Company Name Registration Number 55 Ka. 31- . etri MA o, i I18 Addr, J Expirati•n Date Ar -' Telephana3/3.713' IIS7)r .1'7 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 buildin it. Signed Affidavit Attached Yes f3 No.. 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 l08.3.ST. Definition of Nuaeowner: 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 rxw:sibte fa Al such work n,Wormed d'r the ',r.... . rmi 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 -cal Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature , City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: LI kk,„> The debris will be transported by: ?e;U U 0. PrbcAuc+ inc The debris will be received by: Pe,IIA Pcauc s 15s Nta,.-' s4, ( -c $e11 k Building permit number: of 30� Name of Permit Applicant re'n4 PrvrLic a Inc /Trcuor 13rnSS Date Signature of Permit Applicant Pella Products, Inc. 155 Main Street • Greenfield, MA 01301 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#CS-096558 and my HIC# 182150. Please find a copy of my licenses below. Stas achuse s :,ep ._or o Sofro; t oroard or Burrorog 429. 1 o s a: s Construction Supervisor s CS-096558 , 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 _ _ _ 1 Failure Code ascaus edition revofthe Masson of achusetts 0310112018 BuildingStateensCooersconsefiNNVV/MASSGovIs Dense. — '---------._ ._ . OPS Licensing information visit:NNfN.fdA55 GOV:OPS nun. umn�/�r� ��ro/tc.(/. —."—Office of Consumer Affairs&Business Regulation License or registration valid for individu]use only _ .,....-HOME IMPROVEMENT CONTRACTOR- before the expiration date, If found return to: :'1'?' Office of Consumer Affairs and Business Regulation -Registration: 14227910 Park Plan-Suite 5140 Type; ExpUC TStion; 3/24/2018 Supplement Card Boston,MA 02116 PELLA PRODUCTS,INC TREVOR BROSS 155 MAIN STREET C/�j . , __ GREENFIELD,MA 01301 Pi- 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 these individuals as my Designees: Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Scott Bowdish CSSL100232 Curt Boyle CS78514 Dave Ruffner CS57308 Bill Leger CS89338 Chris Gamache CS86946 Brian Thompson CS67121 Andy Kimball CS8598I John Joy CS004599 If you have any question,please contact me using the numbers listed above. \\DATAFILES\Shared\INSTALLATIOMPictures,CSL scans\CSL-Designees 2015v1.doe The Commonwealth of Massachusetts 1 -tat 2 Department of Industrial Accidents ' i Congress Street,Suite 100 a Roston, MA 02114-2017 Y . www.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/Organization:Individual):Pella Products, Inc. Address: 155 Main Street City/State/Zip:^ Greenfield, MA. 01301 phone#:413-772-0153 Are you an employer?Cheek the appropriate box: Type of project(required): 1.1j l am a employer wait 49 employea(tJI and/or pan-time• 7. 0 New construction I m a sole proprietor or partnership and have no employees workin tot me in '-Q ° cdg &. 9 Remodeling any capacity.(No worker?comp.insurance required] 3.01 am a homcow net doing all work myself.[No workers'comp-insurance minding( 9. 0 DemOhminding tiOn 4.01.am a homed nec and will be Acing contractors to conduct all work on my pmpoly. I will IOO Building addition ensure that all co,l actonather have workers'compensation insurance or are sole I In Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions SO I am a general contractor and I have hired the sub-contractors listed on the attached sheer 13ORoof repairs Thane subcontractors have omployec and have workers'unmp.insurance' 6.0 We am aw rite/and its officers have exercised their right ofexen tionM. Other rptxa g p per MCL c __........ 1,5X,§1{ey and we have no employxs.]No workers'comp.insurance required_} *Any applicant that checks box k I must also fill out the section below showing their workers'compcosation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then lire outside contractors must submit a new affidavit irdicabng such. IContraetors that check this box must attached an additional sheet showing the name oftho sub-contractors and slate whether or not those entities have employees. lithe subcontractors have employees,they must provide their workers'comp.policy number. tam 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 k or Self-ins.Lie.#: WHN•9399766-04 Expiration Dale: 01-01-2017 Job Site Address: 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to Sl 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 7 do hereby cemfy under the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: phone#: Above t 1 Official use only. Po 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.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector , 6.Other Contact Person: Phone#: A De CERTIFICATE OF LIABILITY INSURANCE DATE`YWODne,f! 1/7/2016 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, H 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 CONTii/AJAEE�cr Robin Sargent _ Berkshire Insurance Group, Inc. PHONE (413/773-9913 ,FAX ijoe..Nor 44131774-3erz 117 Main Street ADOPEs rsargenteberkshireinsurancegroup.Com INSURER(S)AFFORDING COVERAGE NAIC 0 Greenfield NA 01301 OSuRER A Massachusetts Bay Insurance Co 22306 INSURED INSURER The Hanover Insurance Company 10212 Pella Products, Inc. INSURER C: 155 Main Street INSURER D _� — INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER:16GL,AL,WC 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. WER TYPE OF INSURANCEADDL.$ISEmmy R - - - PotiCY EFF PCY EXP 1---MSDLIMITSLIMITS LTRso wt POLICY NUMBER MMIDDIYYYYI IMMADTYY). X ';GDNMERoAt GENERAL I WWI WY 'EACH OCC4M@ryCE 's 1,000,000 RESO A CUaA4A4DE LX j OCCUR PREMISES .DECnence) S 100,000 i SRR942720204 1/1/2016 1/1/2017 MED EXP(Any One person) $ 10,000 11 _ _ PERSONALS ADV INJURY E 1,000,000 OENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREOAWE $ 2,000,000 _ PotKY E Pros . X top: ! PRODUCTS-cO4POPAGG 5 2.000,000 OTHER: COMBINED SINGLE ourAUTOMOBILEUA&Llry (Ep accident) $ 1,000,000 A 1ANY AUTO BODILY INJURY lPrpe an) s _. ALL OWNEDX R LED .ADN933971004 1/]f2016 i 1/1/2017 BODILY INJURY iPt xudxf 5 ANUNONOM4EO PROPERTYDAMAGE ,$ HX I HIRED AUTOS IX AUTOS -LR apcgen) _.. _..._. $ UMBRELLA LIAR . EACH OCCURRENCE $ EXCESS LIAR I CLAIMS-MADE AGGREGATE 5 t.._.. DEO ( 1 RETENTIONS (5 WORKERS COMPENSATION IAND EMPLOYERS'LIABILITY X $TAME )I..... Kt I I ANY ANYICEOMPEEBER TORPARTNER'EE?ECNIVE N NIA' 'EL EACH ACCIDENT S 500,000 B Nyes,describe bs(Mandatary Nn under 1/1/2016 1/1/2017 DISEASEEL_ EA EMPLOYE E 500,000 IOESCRIPTION or OPERATIONS tpp. Er DLSKAsE.POLO'LIMIT 5 500.000 I DESCRIPTION Of OPERATIONS I LOCATIONS,VEHICLES (ACORD 101,AddlteRM Remarks Schedule,may M attached a men space Ia NK ORdl Operations usual to the sales and installation of doors and windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Florence (Northampton) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Co>mmissioner'e Office, ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St Northampton, MA 01060 AUTHORIZED REPRESENTATIVE _404.�...i- Robin Sargent/RMS c 'i- a 019884014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD IN5025(2014Th) Pella° Windows & Doors _Pella Products, Inc 240 Mohawk Trail Greenfield, MA 01301 Building Commissioner's Office City of Northampton 212 Main Street Northampton, MA 01060 Thank you for reviewing our building permit request for Paul Thaler located at 17 New Street, Florence. Enclosed you will find the required documents and permit fee. Please direct any questions you may have to me, Katelyn Nadolski, at Pella Products, Inc. of Greenfield, 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 your anticipated cooperation. Sincerely, Katelyn A. Nadolski Pella Products, Inc. Retail Coordinator 240 Mohawk Trail Greenfield, MA 01301 (413) 774-7231 240 Mohawk Trail Greenfield MA 01301 a VIEWED TO BE THE BEST.' Fax 413 774]231 ax 413]]4.6348