24D-183 (2) 125 PROSPECT ST BP-2016-1417
GIST: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 183 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category ADDITION BUILDING PERMIT
Permit# BP-2016-1417
Project if JS-2016-002439
Est. Cost $136000.00
Fee:$528.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVID BOYAJIAN 017661
Lot Size(sg. ft.): 13764.96 Owner; KARPEL MARK&DENISE J GELINAS
Zonino: UQC(100V Applicant: DAVID BOYAJIAN
AT: 125 PROSPECT ST
Applicant Address: Phone: Insurance:
10 CRANE AVE (413) 525-6747 WC
EAST LONGMEADOWMA01028 ISSUED ON:6/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORIC:DEMO EXISTING STORAGE AREA,
CONSTRUCT 2 STORY ADDITION
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: 00=I: 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:
FeeTvpe: Date Paid: Amount:
Building 6/7/2016 0:00:00 $528.00
212 Main Street,Phone(413)387-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Filed BP-2016-1417
APPLICANT/CONTACT PERSON DAVID BOYAIIAN v OKI the 9
ADDRESS/PHONE 10 CRANE AVE EAST LONGMEADOW (413) 525-6747 , , y
PROPERTY LOCATION 125 PROSPECT ST P L
MAP24D PARCEL 183 001ZONE URCY100)/ Nc'TE ; ��SLEMy,, NO�GlNFc�RM
THIS SECTION FOR OFFICIAL USE ONLY: %t 9ACAc.S F°inn NotTH
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE qtr, oK a
ZONING FORS]PILLlD our p S
Fee Paid (.iiZ1,,,, 447077 ,7oJ -
Building Permit Filled out {vtTkiip Lx6S1tFc
Fee Paid
Supeo£Construction: DEMO EXISTING STORAGE AREA.CONSTRUCT 2 STORY ADDITION E88Cei f APT
New Construction �7 1 r
Non Structural interior renovations C'3,50 13 A5
Addition to Existing V /P C>.1 o
Accessory Structure �Q�y`j j
Building Plans Included: bikyr
"`-hLr
Owner/Statement or License 017661
3 sets of Plans€Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION PRESENTED:
pproved 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 Permit DPW Storm Water Management
►. olition Delay
'�e 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.
i ' _ Department use only
1 ' City of Northampton Status of Permit:
I MM 3 I i Building Department Curb Cut/Driveway Permit212 Main Street Sewer/Septic Availability
i Room 100 Watermeil Availability
1 DEFT OF BUhW+G ms4Fi oNa
sean+amgeu,MA 010,73 orthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPUCATION 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
yds p405-/ C• /)04—ei Map Lot Unit
J/ Zone i„ Overlay District
Elm St District GB District_,,,_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
NaI< K/,?�/2 1.s ?, Adey-;
..... Curren Mailing Address:
.Ly , ten a 4aa5'•
l
Telephone
S".'cat . r
2.2 Authorized Agent: '
• - e(Print) Current Mailing Address: 1 /
n
..i „cis _ 418 - 3/ -D&& ?7Cc"<c) 4a Sas=,S-Py
,lgnature `"'ES/� Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
Building 'd./OO 000- �- (a) Building Permit Fee
f 2. Electrical / 000, ✓
/J (b)Estimated Total Cost of
i / Construction from(6)
ig
3, Plumbing '�—' Building Permit Fee ^�
/Or 000C j��
4, Mechanical(HVAC) d�NC'h' v-/9 "
6. Fire Protection t f 00Z>, a�
-a
o. Total = (1 + 2+3+4+5) )�q ee" '2--. Check Number W09'7? F
/ This Section For Official Use Only
Date
Building Permit Number: 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 tilled in by
��77 Bantling Depanamnt
Lot Size /3 T?C� ' . ./_7 9•. ,;'j '
9 ' 9D
FFrontage _. '
Setbacks Front ir3F y�
Side L /.+/yqi' R.4.." L://7/1 R "0' yJ�v.
Rear '7t+ Tu 0`v
Building Height -i ,tA
'�1Y ./ '
Bldg. Square Footage ` % ocAT
%
Open Space Footage 'Y"t3
(I.ot urea minus bldg.&paved
parking) qq ffii
#of Parking Spaces d +f
Fill: _ .__.. _...
(volume&Loca(onl -..
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO b DONT KNOW YES 0
IF YES, date issued:
IF YES: Was
'^the permit recorded at the Registry of Deeds?
NO V 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 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , 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 O 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
V
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(chock all applicable)
New House [3 Addition Replacement Windows Alteration(s) D ! Roofing n
r Or Doors O
Accessory Bldg. n Demolition IYJ New Signs [co Decks iii Siding IC) Other IC7j
Brief
k:4/Descriri °`,X �'r i�..i(2 s okfG/: PiA /a,47,f/ce-2cr i S7224,1/ /94J .
Alteration of existing bedroom Yes ✓ No Adding new bedroom y/ Yes No
Attached Narrative Renovating unfinished basement Yes V No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing. complete the following:
a. Use of building : One Family {r44Air Family Other
h. Number of rooms in each family unit: rx Number of Bathrooms ir
c. is there a garage attached? 40 ,1 1
0. Proposed Square footage of new construction. /06t. Dimensions tY.l1 X a
e. Number of stories?
t. Method of heating?(JAG 30,7E f46*i 649'2/' Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. zefritif s Masscheck Energy Compliance form attached? y/h'.S
h Type of construction aAZJ , 47E /
Is construction within 100 ft.of wetlands? Yes ✓ No. Is construction within 100 yr, floodplain.,, Yes t No
J. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? i/ Yes _No
I. Septic Tank City Sewer Private well City water Supply ✓
SECTION 7a-OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT
jO/R CONTRACTOR APPUES FOR BUILDING PERMIT
I. /41 j' 7R J� K r{ R eE t- ,as Owner of the subject
Properly - //��-/ {C 'y+
hereby authorize ,R f ♦,K? 1 ' ) i s .Y/ . �J /h'J) 4ya�?e)//:
topt on my be r.If, inII otters relati ?o work authorized by this •adding permit =ppl cation.
nJl,
s•.nature ofDate
I, ZIA,/ ?�174x.T/4� , as 8weerfAuthorized
Agent hereby dee are that th tatements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the painsaand penalties of perjury.
11Z)./I] V7//YA7/AA - -
Prir .me /
Signa ure of - Age:It Date
SECTION 8-CONSTRUCTION SERVICES 1
8.1 Licensed Construction
nnSupervisor Not Applicable 0
•Name of License Holder 1/A8 �PC ' V !I> es -01946 1
,o License Number
/e _C_ 2.A/6lg i9//G. fr, .f/i r .I ,�i t �- - ..
Address t7 Expiration Date
n /
—iignature or,
Telephone
Ara- 6-0,s ?Ft7(afn'iced
9.Registered Home Improvement Contractor. • Not Applicable 0
o mil amo Registration Number
1lz rFA.6r flu= 6 -./9-
Address 4/3 -6-9/ Expiration Date
A , 4 r7 fit 0/eo Telephonev.,0
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 C
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 108.35.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides of intends to reside,on which there
is,or is intended to be,a one or two family dawiling,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 Officials that he/she shall In
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 Mascarhusetts General Laws Annotated,you may be liable for pin-sofas)
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 Cenral 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: /o2S ?Nes-AA-e)--
The
4SPAe)'The debris will be transported by: (_Si7/ f/i.0 < //.
The debris will be received by:
Building permit number:
Name of Permit Applicant 12tri <
•
(/
Date Signature of Permit Applicant
Plan /Rook 4,-- 11 ,rtr74
o-NS
E I Godfrv �
I W arner
Le. tie ° .
.d Areawrth 4 ' °
shown
itN\ - — - busd i t I sting 2 tiorry
C Li Ae . i .. uxi
�, h 8t Ia to De
S r0 !(1UV4J t
AExIsiin �grlr' Pro oseJ
L p
�, ,v� "L2`0" x .'.'I` Or
}., - – I :�:_ i 2 Story Rddlt , on i
G
1 Lila
•
ta i Weill
of
<I c
0 U
L
C1, i
VI
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LP 14 ! 58 - O`
1 t.
Guif ter
° wain crt
M'a rJ4 A- 14 .a ,rpc L
Den ite? J, & cilinnay
//?' 5 Pre ,r, pert S >m
IVcrritcu .annrn tin . 41A 0n' r6cr t i 2®6 5
11 II 21" -.. .. .. .. _. ..
Office of Consumer Affairs&Business Regulation
M_, HOME IMPR4CONTRACT
�s RegiRegistration:: 100 1005411 Type:
Il Expiration 6/19/2018 DBA
BOYAJIAN REMODELING
David Royalton
10 Crane Ave
E.Longmeadow,MA 01028
Undersecretary
,gke „wn tical/A
�.\ r Mee of Consumer Affairs Business Regulation
ME IMPROVEMENT CONTRACTOR
gistration: 100541 Type:
- xpiration: 6/19/2016 DBA
> We.
BOYAJIAN REMODELING
David Boyajian
10 Crane Ave.
E. Longmeadow,MA 01028 Undersemalary
Massachusetts Department of Public Safety
V� Board of Building Regulations and Standards
License: CS-017661 0t7fifi1
Construction Supervisor or
DAVID BOYAJIAN
10 CRANE
AVE
EAST LONGMEADOW
g
-fr Ida
/',�'.yr.�%GdP
INI
^An 1Expl ration:
Commissioner 10118/2017
From.Betry Ramey FaxiD: Page 3 of 3 Dete:592016 03:00 PM Page 3 of 3
AU� CERTIFICATE OF LIABILITY INSURANCE OATS DONDONYMMI
TS/OB/2Ots
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(es)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 cerlificate does not confer rights to the
certificate holder in Ileu of such endorsements).
PRODUCER NNAMaEAtf Belt'Ramey
LEBEULAVIGNE &DEADY INSURANCE AGENCY, INC. usesNo at. (4131532-3291 juc.NT:
PDOFEss.•AIL bramey@Ildlns.com
637 GRATTAN ST. INSURERISIAFFORDING COVERAGE rules
CHICOPEE MA 01021 IxsuRERA: TRAVELERS INDEMNITY CO OF AMERICA 25666
INSUREC ... ..
INSURERS:
BOYAJIAN DAVE DSA BOYAMAN REMODELING SOURER
INSURERS:
10 CRANE AVE INSURERE:
EAST LONGMEADOW MA 01028 ea3URERF:
COVERAGES CERTIFICATE NUMBER; 51339 REVISION NUMBER:
THIS GTO 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 WDII RESPECT TO NMICH 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 SEEN REDUCED BY PAID CLAIMS.
LIR TIPEOF INSURANCE —A .np� — PoDtVFFF—Pouct Ek4""' - -
1 ,t , n POLICY NUMSeR pM(JOYVYYI IMMANYYYYI LIMITS
COMMERCIALOEYERALLMBARY •EACH OCCURRENCE' Y
CtAMSMADE I I OCCUR PREMISES(ES giSl!'''`rentel I$
MED EXP(Any one person) $
N/A 'PERSONAL a IN)V INJURYY
GENL OOREOA'E LIMN APPUC$PER'. GENERAL AGGREGATE I3
EDUCT
WI 1 LOC PRODUCTS-CUMVICP AGO 3
Ot11ER 1 S
AumMOelLE LIABILITY COMB NEEDsINOLC OMIP' 3
I ANY AUTO SOLELY N w pe'i n $
.. _.
ALL
OWNED —SCHEDULED NIA IEIDDLYi4/UR LP'aeaGen, s
.REO AUTOS
PROPERTY DAMAG $
HAM AVMS tics fser a¢menu $
UMBRELIALIAB r OCCUN , EACH OCCURRENCE S
EXCESS LAB (CLAMS-MADE N/A
AG6fl E3ATE Y
DED IRETENTION f s
WERSEI3COMPENSA1IUN , RR OlH
ANOEMPLOYERr LKBIUW eR I STA-VTE ER
ANYPROPRIETORPARTNEWEXECUSIVE YINACCI
A MFFICEtME'MNEREXCLUDEDI �NIAI WA WA 6HUB4885P00115 12/03/2015 12103/2015 ELDISE SE-EArv'r5100.000
Mandatoryyyyy In NH) EL DISEASE-CAEMPLOYEE $ 10.000
DFSCPrI N OF OPERATIONS Slow 1 r DISEASE-GOODY UMIT Js 500000
N/A
L_
DESCRIPTION OF OPERATORS I LOCATORS I VEHCLE6 ACORD Is 1,Additional Remnke Schedule.may be attached if mon mace Is rennidl
Workers Compensation benefits will be paid to Massachusetts employees only.Pu rsuanl to Endorsement WC 20 03 06 G.CO autho rizalon is given to pay claims for benefits la
employees in stain other than Massachusetts if the insured hires.or has hired those employees outside of M assatlwsee3-
This cediecale of insurance shows the poky in tome on the dale Thai this certificate was issued(unless the expiration dale On fie above policy precedes The issue date of this
certificate of insurance). The MMus of this coverage can be monitored daily by accessing he Pmor of Coverage-Coverage Verification search loth at
www.mass.govilwdiworkers-compensalonnnvestSWOP S.
Sole proprietor has not elected coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DEUVERED IN
City of Northampton ACCORDANCEWITH THE POUCY PROVISIONS,
212 Mash Street
AUhgPIIEOREI,RESENTATIVE
t '` r (f
Northampton MA 01060 ` iel P .C.
Daniel M.Crt vy,DPDU,Vice President-Residual Market-WCRIBMA
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
From:Betty Ramey FaxID: Page 2 of 3 Date:592016 03:00 PM Page:?of 3
/"*".1 BOYAJ-1 OP ID: BR
a� � 0
KCERTIFICATE OF LIABILITY INSURANCE O3109NIN1
06/09/20166
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 SY 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,ma policy(es)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).
PRGOUCER
t.eeei+Lariyyrto&OcatlY AEit
r LeBeavigne&Deady Ins 1Ax
insurance Agency,Inc. .IAIC,NO Ern:413-532-3291 (IAN Nel:413434-8982
637 Grattan Street 1 PO Box 59 E-MAIL
Chicopee,MA 01021-0059 ADDRESS: -,
LeBel/Lavigne&Deady Ins _ INSURER(S)AFFORDING COVERAGE NAC I
INSURER A'Commerce Insurance Companies 34754
INSURED Boyajian Remodeling INSURERS-
Dave Boyajian dba
10 Crane Avenue INSURER C:
East Longmeadow,MA 01028 INSURER O
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 WrIH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE NSURANCE 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,
LTR TYPE OF INSURANCEN.41, �bUCYEae POLICY ERP.... Luna
IflD '*eo P%YY NURSER iMMVOONYYI)I RAWDEeYSYL
A i COMMERCIAL GENERAL LIAeLiTY EACH PCCURSENCE IS 1,000,000
CLAIMS-MADE OCCUR BOTBPDmrn
12/15/2015 12/15/2016 DAMMAAGGE10RHa ENp CM $ 100,000
X 'Business Owners MED EAP Sins 5,000
yAn A person) S
PERSONAL a ADA INJURY 1F 1,0001000
Gael.APE HATE OMIT APPLIES PER GENERee A66[4CATE %o 2,000000
foucYLJECT LOC PRCDUCAS-SOMPYCP AGN a 2,000,000
iOTHER $
AUTOMOBILE LIABRITY I COMEINED SIN6LM OMIT IS
_LEA
I [ APO PO SOD LY INJLPY I '1PPenool $
u O MED ' Ac OIL30 STON 'Oup E sew Ae rrAix
HIRED AtR05 CN'OWNEO FROPPT C
V )' RA ) _ S
i
` UMBRELLA LIAR OCCUR EACH OCCURRENCE 1 _
—
EXCESS LIAR CLAIMS-MADE AGGREGATE S
i DEO FETEHMONi
WORKERS 90MPESATWN (RFS( OTw
AIL EMPLOYERS'LIABILITYr STF UTE ER '
+Y ROPRIE'TORPARTNER€YEC'.mVE iIN WILL COMB ONSEPARATBCM E L EACH ACCIDENT 4s
OFFICER/MEMBER E LUDEDT 1 NIA
Nandateryel Nm E L ESSEASE-CA EMPLOYEE;$
yes descnna ender
DESCiere ON OF OPERATIONS balm+ .El DISEASE-Pot CI I)MIT S
_^ PROPERTY 5,000
.......
PFEC0.WTION OF OPERATIONS I LOCATIONS I VEXCLE9 IP.CORU t01,Additional Remarks etRetlulA may be attached N more apace is required)
CERTIFICATE HOLDER CANCELLATION
CITYNOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTCH WILL BE DELIVERED IN
City of Northampton,MA ACCORDANCE WITH THE POLICY PROVISIONS.
Dept of Bldg Inspections
Inspector ofWtres AurwwLEaREPRBSENTATIVE
212 Main Street LeBel/Lavigne&Deady Ins
Northampton,MA 01060
@ 1988-2014 ACORD CORPORATION. All rights reserved.
AGGRO 25/2014101) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
rea—
t
Department of Industrial Accidents
=Mr. Office of Investigations
, ikt1 Congress Street, Suite 100
a ': Boston, MA 02114-2017
‘44—•,;04, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ,,.�� A ",� ` yn Please Print Legibly
Naim (Business/Organization/Individual): �4Loioir k+z�ff .2`%?c
Address:/O �r�/jJr 41,-4f• - fffe.'}
Ci /State/Zir: _ .
= — � ' ''r / . Phone#: • -� /'L X07 CGa!t
Are you an employer?Check the ap ropriate box:
4 I am a general contractor and I Type of project(required):
1.❑ 1amaees(full with ❑ g -
_�afiployees(full andfor parttime}* have hired the sub-contractors fi. ❑New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
4. 0 Building addition
[No workers' comp. insurance comp.insurance.]
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL
12.0 Roof repairs
insurance required.]T c. 152,§1(4),and we have no
employees. [No workers' l3.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information.
'tinmcoutiers who submit this affidavit indicating they are doing all work and then hire outside Contractors mst submit o new affidavit indicating such.
'Contractors that check this box must attachedan 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'comppolicy 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. (fL�Lt.I�,S q
Policy#or Self-ins. Lie. #'______________ �j
'71},0//,rj ,, Expiration Date: /rt)// ,7
' - /6
Job Site Address. / / 'v,<PeCj" <_l - City/State/Zip:,t2 1,249,22erk) 00
Attach a copy of the workers' compensation polity declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 254 of MGL c. 152 can lead to the imposition of criminal penalties ofa
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa 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 DTA for insurance coverage verification.
I do hereby certify under fhe�pains and penahies of perjury that the information provided above is true/nand correct
Signa[ r: `"1 -/ '" p pate' - /G
Phone#!... /3 '4— a a 4i -4f3 ' -07 6 2 4
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):
I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
r4i5lC
Energy Effciency Certificate
Insulation Rating R-Value
Above-Grade Wall 19.00
Below-Grade Wall 0.00
Floor 10.00
Ceiling / Roof 38.00
Ductwork (unconditioned spaces): _
Glass 8 Door Rating U-Factor SHGC
Window 0.29
Door 0.35
Heating&Cooling Equipment Efficiency
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
Generatedliance by REScheck-Web.
Software
0 Comp
Project
Energy Code: 2015 IECC
Location: Hampshire County, Massachusetts
Construction Type: Single-family
Project Type: Addition
Orientation: Unspecified
Climate Zone: 5 (6999 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
MARK KARPEL JOHN TRACY
125 PROSPECT ST JOHN TRACY DESIGN
NORTHAMPTON, Massachusetts 142 UPPER HAMPDEN RD
01060 MONSON.Massachusetts 01057
413-537-9948
Compliance: Passes using UA trade-off
Compliance: 4.3%setter Than Code Maximum UA: its Your UA: lit
Me%Better or Worse Than Code Index reeds Naw close to complibnce me douse is.bases on cede trade-Dry lutes.
It DOES NOT provide an est,mate of energy use or Cost relative to a rnlnlmum.code home.
Envelope Assemblies
Floor: Unheated Slab-On-Grade 74 10.0 0.684 51
Insulation depth:4A`
Wail:Wood Frame. 16in.o.c. 352 19.0 0.0 0.060 16
Orientation:Front
Window:Wood Frame. 2 Pane w/Low-E 51 0.290 15
Orientation: Front
Door:Solid 28 0.350 10
Orientation: Front
Wall:Wood Frame, 16in,o.c. 384 19.0 0.0 0.060 18
Orientation: Right side
Window:Wood Frame, 2 Pane w/Low-E 77 0,290 22
Orientation: Right side
Wall:Wood Frame, 16in.0.c. 352 19.9 0.0 0060 20
Orientation:Back
Window:Wood Frame, 2 Pane w/Low-E 15 0.290 4
Orientation: Back
Wall:Wood Frame. 16in, ac 96 19.0 0.0 0.060 6
Orientation:Left side
Ceiling:Fiat or Scissor Truss 528 38.0 0.0 0.030 16
Project Title: Report date: 05/31/16
Data filename: Page 1 of10
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements in
REScheck Version 5.5.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title Signature Date
Project Title: Report date: 05/31/16
Data filename: Page 2 of10
RInspection EScheck Software VersionChecklist 5.5.0
f
Energy Code; 2015 IECC
Requirements: 0.0% were addressed directly in the REscheck software
Text in the "Comments/Assumptions" column is provided by the user in the REscheck Requirements screen. For each
requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception
is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided.
Section Plans Verified Field Verified
x Pre-Inspection/Plan Review Value value Compiles? Comments/Assumptions
&Req.lb
103.1, Construction drawings and DCamplies
103.2 documentation demonstrate - Oboes Not
[PR1I' energy code compliance for the •
building envelope.Thermal DNot Observable
envelope represented on I DNot Applicable
construction documents. 11
103.1, Construction drawings and DComphes :.
193.2, documentation demonstrate - DDoes Not
403.7 '.energy code compliance for DNot Observable
(17R311lighting and mechanical systems. (
t;. Systems serving multiple DNo[Applicable
dwelling units must demonstrate
compliance with the IECC
Commercial Provisions. I
302.1, Heating and cooling equipment is Heating: Heating: DCamplies
403.7 sized per ACCA Manual 5 based Btu/hr Btu/hrDDoes Not
[PR2]' on loads calculated per ACCA Cooling: Cooling:
m Manual J or other methods j Btulhr_ Btu/hr DNat Observable
approved by the code official DNot Applicable
Additional Comments/Assumptions:
' ijHigh Impact(Tier 1) 2 Medium Impact(Tier 21 3 Low Impact(Tier 3)
Project Title: Report date: 05/31/16
Data filename: Page 3 of 10
Section
# Foundation Inspection Plans Verified Field Verified
& Re•,ID Value Value Complies? I Comments/Assumptions
402.1.2 Slab edge insulation R-value. R- QCom li
es SeejFOip 0 Unheated :0 Unheated ODoe RNot table for vetoese Envelope
eAsemties
0 Heated 0 Heated ONct Observable
ONot Applicable
402.1.2 'Slab edge Insulation tt ft DCompiies see the Envelope Assembies
EFO30 depth/length, --
ODoes Not Mable for values
QNot Observable
❑Not Applicable
303.2.1 A protective covering is installed I QCom lies
[FO11j to protect exposed exterior I p
H'
ODoes Not
insulation and extends a
minimum of 6 in. below grade. ONot Observable
ONot Applicable
403.9 Snow-and ice-melting system QComplies
[F0121f controls installed. ODoes Not
Xs
ONot Observable
ENot Applicable
Additional Comments/Assumptions:
I'Nigh Impact(Tier 1) J 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) 7
Project Title: Report date: 05/31/16
Data filename:
Page 4 of 10
Section Plans Verified Field Verified
# Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions
& Req.ID
402.1.1. Door U-factor. U- U- .DComplies :See the Envelope Assemblies
402.3.4 ODoes Not table for values.
(FRI]'
°Not Observable
ONot Applicable
402.1.1, Glazing U-factor(area-weighted : U- _ ll-_ °Complies See the Envelope assemblies
402.3.1, average). ODoes Not table for vatues.
40233.
402.3.6, : ONot Observable
402.5 ONot Applicable
(FR21'
N
303.1.3 U-factors of fenestration products DComplies
(FR43' are determined in accordance °Does Not
w, with the NFRC test procedure or ONot Observable
taken from the default table.
°Not Applicable
402.4.1.1 Air barrier and thermal barrier °Complies
[FR23I' installed per manufacturer's ODoes Not
.instructions.
❑Not Observable
DNot Applicable
4024.3 Fenestration that is not site built °Complies
[FR20]' is listed and labeled as meeting ODoes Not
Id` AAMA IWDMNCSA 101/1.5.2/A440or has infiltration rates per NFRC °Nal Observable
400 that do not exceed code ONot Applicable
limits.
402.4.5 IC-rated recessed lighting fixtures l DComplies
[FR16]2 sealed at housing/interior finish 1 QDoes Not
and labeled to indicate 62.0 dm °No[Observable
leakage at 75 Pa. 1I{ ONot Applicable
403.2.1 Supply and return ducts in attics °Complies
[FR12], insulated >= R-8 where duct is I °Does Not
hi' >=3 inches in diameter and>_ °Not Observable
R-6 where<3 inches.Supply and ONot return ducts in other portions of Applicable
the building Insulated >= R-6 far
diameter>- 3 inches and R-4.2
for c 3 inches in diameter.
403.3.3.5 Building cavities are not used as °Complies
[FR15]' ducts or plenums. ODoes Not
kr
ONot Observable
DNot Applicable
403.4 HVAC piping conveying fluids R-_ R- .°Complies
_
[FR1712 above 105 vF or chilled fluids ODoes Not
�, below 55 GP are insulated to all-
3.
R-
3 ONot Observable
ONot Applicable
403.4.1 Protection of insulation on HVAC DComplies
16122411 piping. ❑Does Not
se ONot Observable
1 ONot Applicable
403.5.3 Hot water pipes are insulated to R-_ R- DComplies :.
(FR18]' ?di-3. : ❑Does Nat
J DNot Observable
ONot Applicable
403.6 Automatic or gravity dampers are °Complies
[FR19)' Installed on all outdoor air ' ❑Does Not
intakes and exhausts.
ONot Observable
°Nct Applicable '..
1 High Impact(Tier 11 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Report date: 05/31/16
Data filename: Page 5 of 10
Section
# Insulation Inspection Plans Verifietl Field aloe Verified Complies? Comments/Assumptions
& Req.ID Value Value P
303.1 All installed insulation is labeled OComplies
[IN131' or the installed R-values
provided. ODoes Not
ONot Observable
ONot Applicable
402.1.1, Wall insulation R-value. If this is a R- R- OComplies See Me Envelope Assemblies
402.2.5. 'mass wall with at least'A of theO Wood 0 Wood ❑Does Not table for values.
402.2.6 wall insulation on the wall
[IN3p '..exterior,the exterior insulation OMass Mass ONot Observable
�.. requirement applies(FR10). 0 Steel D Steel ONot Applicable
303.2 Wall insulation is installed per OComplies
ONO manufacturer's instructions. ❑Does Not
ONot Observable
I ONot Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 1Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Report date: 05/31/16
Data filename: Page 7 of10
Section -'
k Final Inspection Provisions Plans Verified Field Verified
Sr Re..ID Value Value Complies? Comments/Assumptions
402.1.1, Ceiling insulation R-value. R- R P
See' the fore!
402.2.1,
OCom liesape assemmies
402.220 Wood 0 Woad Oboes Not tab:a tot batues.
402.2.6 O Steel 0 Steel ONot Observable
[Flip ONot Applicable
303.1.1.1. .Ceiling insulation installed per OCompbes
303.2 manufacturer's instructions. i
[FI2]' Blown insulation marked every ODoes Not
.300 ft'. ONot Observable
ONot Applicable
402.2.3 Vented attics with air permeable 1 OComplies
[F1221' insulation include baffle adjacent I
to soffit and gave vents that ODoes Not
extends over Insulation. lONot Observable .
l ONot Applicable
402.2.4 Attic access hatch and door R- R- OComplies
[F13]1 insulation eft-value of the — ODoes Not
adjacent assembly.
ONot Observable
ONot Applicable
402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50= ACH 50= OComplies
IFIL]]' ach in Climate Zones 1-2. and Oboes Not
<=3 ach in Climate Zones 3-8.
ONot Observable
ONot Applicable
403.2.3 Duct tightness test result of<=4 cfm/100 cfm/100 OComplies
[F141' dm/100 ft2 across the system or ft2 TtT° ODoes Not
<=3 cfm/100 ft2 without air
handler @ 25 Pa.For rough-in ONot Observable
tests,verification may need to ONot Applicable
occur during Framing Inspection.
403.3.2 Ducts are pressure tested to cfm/100 cfm/100 OComplies
IF12711 determine air leakage with ft' ft1 DDoes Not
either: Rough-in test:Total
leakage measured with a ONot Observable
pressure differential of 0.1 inch ONot Applicable
w.g.across the system including
the manufacturer's air handler
enclosure if installed at time of
test.Postconstruction test:Total
leakage measured with a
pressure differential of 0.1 inch
w.g,across the entire system
including the manufacturer's air
handler enclosure.
403.3.2.1 Air handler leakage designated 1 OComplies
[F$24]1 by manufacturer at<=2%of Oboes Not
design air flow.
DMA Observable
ONot Applicable
403.1.1 Programmable thermostats OComplies
[F19]' installed for control of primary
ODoes Not
heating and cooling systems and
initially set by manufacturer to ONot Observable
code specifications, ONot Applicable
403.1.2 Heat pump thermostat installed OComplies
[FI10]' on heat pumps. Oboes Not
ONot Observable
y.... ONot Applicable
403.5.1 Circulating service hot water OComplies
I F111]' systems have automatic or I.
accessible manual controls, Does Not
ONot Observable
ONot Applicable
1,1 High tmpact(Tier 1) L2JMedium Impact(Tier 2) 3 [Low Impact(Tier 3)
Project Title: Report date: 05/31/16
Data filename: Pages 0110
N.
Section Plans Verified Field Verified
* Final Inspection Provisions Value Value Complies? Comments/Assumptions
St Aeq.ID
403.6.1 All mechanical ventilation system OComplies
(F125)a fans not part of tested and listed ODoes Not
HVAC equipment meet efficacy phot Observable
and air flow limits.
• ONot Applicable
403.2 Hot water boilers supplying heat OComplies
[F12612 through one-or two-pipe heating e Oboes Not
systems have outdoor setback i ONot Observable
control to lower boiler water
temperature based on outdoor 1 ONot Applicable
temperature. i
403.5.1,1 Heated water circulation systems I _ OComplies '
[F126)2 have a circulation pump.The Oboes Not
system return pipe is a dedicated ONot Observable
return pipe or a cold water supply'..
pipe.Gravity and thermos- ONot Applicable
syphon circulation systems are
not present.Controls for
circulating hot water system
pumps start the pump with signal
for hot water demand within the
occupancy.Controls
automatically turn off the pump
when water is in circulation loop
is at set-point temperature and
no demand for hot water exists.
403.5.1.2 Electric heat trace systems OComplies '..
1F1291' comply with IEEE 515.1 or UL ODoes Not
515.Controls automatically
adjust the energy input to the ONot Observable
heat tracing to maintain the t ONot Applicable
desired water temperature in the
Offing. s
403.5.2 Water distribution systems that I OComplies
I F13017 have recirculation pumps that ' ODoes Not
pump water from a heated water ONot Observable
supply pipe back to the heated
water source through a cold ONot Applicable
water supply pipe have a
demand recirculation water I
system. Pumps have controls
that manage operation of the
pump and limit the temperature
at the water entering the cold
_water piping to 1048F. I
403.5.4 Drain water heat recovery units f OComplies
(F13112 tested in accordance with CSA ODoes Not
855.1.Potable water-side '
ONct Observable
pressure loss of drain water heat '
recovery units C 3 psi for t ONot Applicable
individual units connected to one ' j
or two showers, Potable water- i
side pressure loss of drain water
heat recovery units< 2 psi for '�
•
individual units connected to
three or more showers.
404.1 75%of lamps in permanent OComplies
I F16p fixtures or 75%of permanent ODoes Not
fixtures have high efficacy lamps.
1 ONot Observable
Does not apply to low-voltage
lighting. 1 ONot Applicable
404.1.1 fuel gas lighting systems have 1 ❑Complies
(F12313 no continuous pilot light. ❑Does Not
i . ONot Observable
❑Nat Applicable
High Impact(Tier 1) [ 2 Medium impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Report date: 05/31/16
Data filename: Page 9 of 10
Section IPlans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
Re..ID,�
401.3 Compliance certificate posted. OCompiies
1F1712 ODoes Not
ONot Observable
ONot Applicable
303.3 Manufacturer manuals for DCamplies
IFI181' mechanical and water heating Epees Not
systems have been provided. ONat Observable
ONct Applicable
Additional Comments/Assumptions:
111High Impact(Tier 1) 2 (Medium Impact(Tier 2) r3 ]Low Impact(Tier 3)
Project Tide: Report date: 05/31/16
Data filename: Page 10 of10
SUN-08-2016 00:56 From: To:14135B71272 Page:1'4
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ci 10 Crane Avenue
`f• East LOrgmeadow,Massachusetts 01028
Telephone:(413)525-6147 • (413)525.6149
tiax (413 ) 525-6748
FACSIMILE'/ TRANSMITTAL COVER/ SHEET
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Painted Complete Unit,Factory(Direct)Applied, Mulling Location:Factory (0irect),Mull Type:Narrow MUII,Mull Priority:Vertical m
Insect Screen,White
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Unit U-Factor SHGC ENERGYSTARS Certified
--------------------__
1 0.29 029 No
2 0.29 0.29 No
`l i7CC i,CC 771 0003 1 CW1455(LS-SSR) FAMILY ROOM $ 3712.45 $ 371295
III.....ii'..:.o RO Size 0.11'107/9"W x 4'53/9"H Unit Slut=11'10318"W x 4'413/16" II
Composite Unil,W hlte/White-Factory Painted, High Performance Low-E4 Glass,Divided Light with Spacer,Perimeter Extension.Jambs 6 9/16'White
Painted Complete Unit,Factory(Direct)Applied. Mulling Location: Factory(DkecI),Mull Type:Narrow Mull,Mull Priority:Vertical
Insect Screen,White
Hardware Pack,FSC,Traditional Folding-Antique Brass
Perimeler Extension Jambs,White-Painted.6 9/16',Factory (Direct)Applied,Complete Unit
Zone'.Northam
Unit UFactor SHGC ENERGY STAR®Deellied
1 029 0.29 No
2 0.29 0,29 No
3 0.29 0.29 No
4 0.29 0.29 No o
5 0.29 0.29 No
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Dealer A.BOILARD SONS, INC. Customer: 125 PROSPECT ST NORTHAMPTON
476 OAK STREET Billing
INDIAN ORCHARD,Nut 01151 Address:
413-5434100 Phone: Fax:
Sales Rep: Administrator-DO NOT REMOVE Contact:
Created By: Trade ID: Promotion Code:
Item .__Qty nem Size(Operation) _ Location
si".:.poi 0001 1 CW144(L-S-S-R) MASTER SUITE Ill
:,�: RO Size=9'612"W x 4'0112"H Unit Size=9'57/9"W x 4'0"H
Composite Unit.White/White-Factory Painted, High Performance Low-E4 Glass,Divided Light with Spacer.Perimeter Extension Jambs 6 9f16"White -
Painted Complete Unit, Factory(Direct)Applied, Mulling Location:Factory(Direct),Mull Type:Narrow Mull,Mull Priority:Vertical
Insect Screen,White
Hardware Pack,PSC,Traditional Folding-Antique Brass
Perimeter Extension Jambs,White-Painted,6 9/16", Factory(Direct)Applied,Complete Unit
Zone:Northern
Una UFactor SHGC ENERGY STARS Certified
1 0.29 029 No
2 0.29 029 No
3 0.29 029 No
4 029 0.29 No
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Zone:Northern 3_
Unit U-Factor 61-130 ENERGYSTAR®Certified
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2 0.29 0.29 Na
3 0.29 029 No
F ,--- 0005 2 CN125(L) MASTER SUITE 8 FAMILY ROOM
ROSize= /'9"Wx2'47/B"H Unit Size= 1'6112"Wx2'43f6"H
Unit, While/White-Factory Painted,L Handing.High Performance LOw-E4 Glass,Divided Light with Spacer,Colonial,2W21-1,3/4", Ext Grille-White,Int
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Unit,WhileWhite-Facto Painted,L Handing, High Performance Low-E4 Glass,Civided Light with Spacer, Colonial,2W2H,314",Ext Grille-White, Int 7.
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11-Factor:0.29, SHGC:0.29. ENERGY STAR®Certified:Na
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