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35-257 73 TURKEY HILL RD BP-2017-0638 GIS II: COMMONWEALTH OF MASSACHUSETTS Map:Block:35 -257 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2017-0638 Project# JS-2017-001032 Est.Cost:$6182.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo PELLA PRODUCTS, INC 096558 Lot Size(sq.ft.): 48787.20 Owner: KUNDA PETER H Zoning: Applicant: PELLA PRODUCTS, INC AT: 73 TURKEY HILL RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFI ELDMA01301 ISSUED ON:II/7/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACING 2 SLIDING PATIO DOORS USING THE EXISTING OPENINGS U VALUE 0.31 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 11/7/20160:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify j. APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OF TW?-FAMILY DWELLING SECTION 1 -SITE INFORMATION 1t r "G 37 - 7 This section to be co noleted by offing _.. 1.1 Property Address: , I f� '73 TVr�.• Nt I l Rd Map Lot Unit --_ flare-rrc.e. rAf} o1OloZ Zone Overlay DlsMet Elm SL District CB District // 5. ECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: PETE K� �NhA 7� % A� Weil ,Oh Nam n n[ Curren Mallin Address'. ef3 gam 7NFr / i I,�f. f Telephone Signature 2.2 Authorized Agent: -114-4/0r3r ss feel 4 +S 1.4 155 S}/ Getnl t(clMf0/3-11Named in Current Mailing Atltlress'. 1-113. 773- 11S7 k31 - Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building P I at�rt . 5 '9 (a)Building Permit Fee 2. Electrical �-P G (b)Estimated Total Cost of Construction from(6) 3. Plumbing (} Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection U 6. Total=(1 +2+3+4 +5) C tcc 2 . 59 Check Number ',9/f ) 4/C) This Section For Official Use Only Building Permit Numb- : Date ued: Signatur. / /< Building Commissionerllnspector of Buildings Date Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning ThisDepartment eat din by Building ldingmn to be emrn[ Lot Size Frontage Setbacks Front Side L: R: L: _ Rear Building Height Bldg. Square Footage °o Open Space Footage '/o (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding a een issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Regis of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document It B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES 0 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 O NO ©� IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation )over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO ing 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 ❑ Addition ❑ Replacement doves Alteration(s) E Roofing E Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks IC] Siding(0] Other[Cl Brief D scription of Propposee�d 5(,0e Work:t €(110.x. a doq $ U9tri 'k•'C € f$Iln�r OGrn,n55 with no c ncnc�e\ {J �j i'kt_ vtldi n9 V-Vnl . =0:31 // Shy r4vrc_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet ea.If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other iik b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. i Dimensi.•: e. Number of stories? f. Method of heating? K Firepla.'s or IWwIoodstoves Number of each g. Energy Conservation Compliance.` Massch•ck gnergy Compliance form attached? h. Type of construction yIl i. Is construction within 100 ft.of wetlands Yes No. Is •.nstruction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below fig hed g -•_ k. Will building conform to the Building and Zo 'ng regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTORJAPPLIES FOR BUILDING PERMIT 1, PBk ( � r`Uri.& ,as Owner of the subject property hereby authorize Pe I IA Pt kDix_KL S Inc to act on m ehalf, 'n all matters relative to ork authorize by this building permit application. l Signature or Date I, TC Ila PccG.V C Iz, Hr._ , 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. rUjor 3rosS Print N, e/ Signatu of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Trevor -Nit.S (S3 S CS — I G, SSk License Number to Ge, Si-- CL A lit - I HA 013 el 3)17, £S Addres` / Expiration Date il Ar ..i L113-7i34151 k311 -- Signatu r: Telephone 4..Registered Home Improvement Contractor: Not Applicable ❑ Pella Producl3 Inc I91alct Company Name Registration Number SS Mo-, r, SI- 'del , MA 01301 m/a-1/rg Add r,- Expiration Date / Telephone"113'1 /3- 11.57k3I1 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the builds permit. Signed Affidavit Attached Yes No ❑ 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 108.3.5.1. 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,Stat and ocal Zoning Laws and State of Massachusetts General Laws Annotated, Homeowner Signature 1NI 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: 73 TorLei Hill RA I nort,ee_,p r f} 610(02_ The debris will be transported by: ?eIIG Prcrluc I3 irrr. The debris will be received by: 153 Mai., S} , 6reariRd d (-IA 0130) Building permit number: Name of Permit Applicant %Ila Procloct\ If /Ycwor WD55 II /3/r6 Date Signature of Permit Applicant Kunda 73 Turkey Hill Road Florance, MA 01062 2nd floor(walkout basement below)back of home sliding patio door replacement locations Stairway Stairs le Drivewry Dining Poore living Room f sum m ground level Unit NI unity aeplaz ng 2 Sliding Patio Mrs Into entitles openings Deck Area 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. .,n sc n,y a do ar Bu gu 1 res a ' Coastinction Supervlsor e OS�6558 Unrected - Unrestricted Buildings icof ny use group wcontain less than 35.000acecubic feet(991 cubic meters)of enclosed spce- ' TREVOR BROSS 10 GEORGESTP.EET - - { GREENFIELD MA 01301 __ „_ Failure to possess a current edition of the Massachusetts 03!0112018 State Building Code is cause for revocation of this license. - - - ----. _ OPS Licensing information visit:NAnN.MASS.GOVIOPS Y id,.• it i,.rli, 'r• ='Office fConsumer Affairs&Business Regulation License or registration valid for ndividul use only q; .,HOME IMPROVEMENT CONTRACTOR beforethe expiration date if found return to: Office of Consumer Affairs and Business Regulation • Registration: 142279Type: 10 Park Plaza-Suite 5170 • Expiration: 3242018Supplement Card Boston,MA 02116 PELLA PRODUCTS,INC. TREVOR GROSS 155 MAIN STREET dl . GREENFIELD,MA 01301 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 CSI 06010 Vladimir Sbevchuk CSSL099209 Scott Bowdish CSSLI00232 Curt Boyle CS78514 Dave Ruffner CS57308 Bill Leger CS89338 Chris Gamache CS86946 Brian Thompson CS6712I Andy Kimball CS85981 John Joy CS004599 If you have any question.please contact me using the numbers listed above. VDATAFILES\Shared,INSTALIATIONIPIctures\CSL scans\CSL-Designees 2015v1.doc The Commonwealth of Massachusetts 1 Department oflndustrialAccidents v=tic ; 1 Congress Street,Suite 100 ''_x� l? Boston, MA 02114-2017 s r www.massgov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (HusinessOrganizationrindividual):Pella Products, Inc. Address: 155 Main Street City/State/Zip: Greenfield. MA. 01301 _ Phone#:413/7724:1153 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I vs.a orrployer with 49 employees(full endPor part-time)' 7. ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working forInc in 8. 9 Remodeling any capacity.[No workers comp.insurance required] 3.0 I am a homeowner doing all work myself[Nu workers'comp.insurance )required9. Demolition 4.1:1I am a homeowner and will be hiring contractors to conduct all work on mg property. I will 10❑Building addition ensure that all contractors either have workers compensation insurance or are sole [1.0 Electrical repairs or additions proprietors with no employees. l2.❑Plumbing repairs or additions Srlum a general contractor and i have hired the sub-contractors listed on the attached sheet. 13.0ROOfrepairs These sub-contractors have employees and have workers'comp_insurance 6 We are a corporationand its officers have exercised thorright ofexem tion per MGL C. 14Q Other p 152.31(6)and we have no employees.[No worked comp.insurance required.) 'Any applicant that checks box el must also fill out the section below showing their workers compensation policy information. 'Homeowners who submit this affidavit indicating they arc doing all work and then him outside contractors must submit 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'camp.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. Lic. : WHN-9399766-04 Expiration Date: 01-01-2017 Job Site Address: 73 7vrkav Hill City/State/Zip: FIorena (rill 010(02 Attach a copy of the workers'lRq ompensation 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 51,500.00 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: )/ 3) I(i2 Phone#: Above Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License k 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 It: • rR d CERTIFICATE OF LIABILITY INSURANCE DATjM/2omv1 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 HpNEAGT Robin Sargent Berkshire Insurance Group, Inc. PHONE eiD. (413)773-9913 FAX No)_l9v)n+-3en 117 Main Street AEIRFSs:rsargent®berkshireinsurancegroup.cos INSURER(S)AFFORDING COVERAGE NAICX Greenfield MA 01301 INSURER AMaseachusetts Ba Insurance Co 22306 INSURED INSURER eB:The Hanover Insurance Company 10212 Pella Products, Inc. INSURER C: 155 Main Street INSURER D: I INSURER E: Greenfield MA 01301 INSURERF: 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. INSRI ADDL USR POiCYEFF POLICY EXP I LTR TYPE OF INSURANCE INSD IMO POLICY NUMBER IYYmOryYYY1 1MYN0rYYY1I LIMITS X COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE !$ 1,000,000 DAM1.GfYO RENEE A CLAIMS-MADE [X J OCCUR PREMISES(Ea occurrence}pence) $ 21m943720304 1/1/2016 1/1/3017 MEDEXP(Any we person) I$ 10,000 IPERSONAL&ADV INJURY I$ 1,000,000 GENERAL AGGREGATE I GENLOLIO/1AGGREGATE GMRMPI PER. PRODUCTS-COMPNP AGG $ 2,000,000 POLICY X JERC LIC;LOC PRODUCTS $ _ 2,000,000 ITh J OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT- (Ea xcmm) $ 1,000,000 A "TALL AUTO BOO s INJURY(Per person) $ IAOwwED SCHEDULED AUTOS AUTOS MN9399]]009 1/1/2016 1/1/301] I BODILY (Per accident) NON-OWNED PROPERTY DA AGEXXIREO AUTOS AUTOS I(Per accgdenl $ 1 ' UMBRELLA MAR EXCESS UAB I- -I OCCVR— III I 1 ` EACH OCCURRENCE $ JCLAIMS-MADE AGGREGATE OE r $ DEO RETENTIONS I S WORKERS COMPENSATKKII I PER 10TH. ' AND EMPLOYERS'LIABILITY YIN IX STATUTE I ER _, ANY PROPRIETOR/PARTNER/EXECUTIVE I-_ EL EACH ACCIDENT '$ 500,000 OFFICER/MEMBER EXCLUDED? [II II NIA I -- B (Maniatory In NH) 1611119399766 1/1/2016 1/1/2017 IEL DISEASE-EA EMPLOYE 5 500,000 H yye2s descnce under .$ -- -- �DESCRIPTIONOFOPERATIONSE¢Ipw IELpISEASE-POLICY LIMIT '.$ 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may b attached If mon 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 Town of Florence (Northampton) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Commissioner'S Office, ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St Northampton, MA 01060 AUTHORIZED REPRESENTATIVE C:FiRobin Sargent/MIS ��. ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011 ® 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 Peter Kunda located at 73 Turkey Hill Road, 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 Greenfieid,MA 01301 Phone:413 774 7231 VIEWED TO BE THE BEST' Fd)( 413 774 6348 i