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10B-034 (2) 16 UPLAND RD BP-2018-0001 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 10B-034 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-2018-0001 Project# JS-2018-000004 Est. Cost:$11390.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq. ft.): 26397.36 Owner: DIETRICH JON W&DEBORAH W Zoning:URA(I00)/ Applicant: PELLA PRODUCTS, INC AT: 16 UPLAND RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREEN FI ELDMA01301 ISSUED ON:7/5/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:9 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: O1: 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 7/5/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner ,7 IAC S /. City of Northampton ;. no Building Department *' 212 Main Street _ Room 100 iik Northampto0, Fa 010-5� phone 413-587-1240 Fax 413-587-1272 IF- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING iSito—/Q- ga. .�5. 1.1 Property Address: ,t11s x+,iav YPy ea,*.l l= + C It 'W41: /(O t)p/A-nn/ /C{ ,Lee () /27A D1653 e.,,r ‘1:1417)i-wrier :41.10 Yr 7F}rrt _ _ _ .f.3fn,i,.t,i ,w s 2.1 Owner of Record7/:� [ (/) n l/i /- %e7rrcA /69 OfI j,r/ I? l .Cecr/S /l/4> ame CdA) Current Mailing Adress0,-Ote c ./ ,y�I/• tU. Telephone SO�(a-l7(a SS Sig/ 2.2 Authorized Aent: Pel -tieru0S `—X-C--At',V/ dro3-5 /SS /f7.47,h Sr C- e.,. /e#42 Na P' ) % Current Mailing Address, rig) 72,2 DLS3 Sign ure Telephone ` GTIONs'1 ESTIMATE t -it r 3mE 1 'C'E: Ti i. Item Estimated Cost(Dollars)to be ° w-f, dh n ;" 46641 f ?et a completed by permit applicant b fi isSl„?sz�y 4 1. Building .r lea @z„ k..t%r " 9°'`r & ,-;:, 4 11 390 2. Electrical _— c(bt s at elm, ostoT ° 4 ^ ' . ... fatwc'bb�YF`FNm ^a ' 3. Plumbing11 erlt Fahy ea 4. Mechanical(HVAC) -- 5. Fire Protection niT;.,�n ,y..ikt1. / 6 d 6 Total (1 +2+3+4+5) //13V0- - Cle _erytbtil °�; c1� „L;:;, e` 4e 'M ..f�ZC ,V.f>� Signablre ratan, €-§ '3 > ,kl. .1 A .t 1 ok // auAding Corrp(nlssfOnerllnspedaryof8,�i_, s - `e r ;T"�' 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 O Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: 1 f (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW B YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW .Q 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 O NO V 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 O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 4. �'7di"'¢ [CAYa'11 tJ 1in; 'cn'"`� ,? New House ❑ Addition ❑ Replacement pdows Alteration(s) n Roofing C Or Doors 24 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [D Siding [0] Other[CI] Brief Description,of Proposed 3c.Ic(,n95 Work. 1.<e01 xca 1 it brat/Mk ta,5/n52Y 54,n '-'n. r- P(n Qkn4r cs 3i+zuc,kvc Alteration of existing bedroom Yes ✓Jp Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yes NoJ Plans Attached Roll -Sheet J��/ Ji..ct.° (t11 - - 7r j_._,. -_,�..r +S95.i11 l t tl..:._� ..� I:GfFp:;: 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? 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 S.+f`¢l%_i�lt Yrtd CYIba fie} tx(" "``37"1; 'J> /eta ] _ / I I, k- - � �_ - (C / - KL_, as Owner of the subject property ,r thereby authorize Lee,. `-'�rCc&cc eta Inc . to act on beh n all matters relative to work authorized by this building permit application. Ob/17 Signa Owner Date I, W;ectp'N/t C L ocd -DDC. , as Owner/Authorized Agent hereby declare that the st-tements 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. --r £YOSs Print g- led ��QV/ Signa a of Owner/Agent Date 8.1 Licensed Construction Supervisor: r�)✓J Not Aplplica�ble0 Name of License Holder: / OfC✓(/✓ .r ? CSS l .] - 0 6 SS /� License Number (moi nrse uT �tcnnf c/r/ /1/ Az (I/30 0301100)2 J'- - Expiration Date .cam 11/43 77a0/53 Si. ature Telephone Not Applicable 0 -Pf"//6— "Pe?0JQCA _L-TX C- VottiQ ? Company Name n Registration Number /.53-- /27.0) Jricr� -h�/r/ 3- ina n.13oi 0:0 c//aved Address //// Expirati Date Telephone 7/.i'17a -2)53 l ! L14 sa, , -Abel r (, iet-2,9sic. 4.43#t j Y 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 budding permit. Signed Affidavit Attached Yes I4 No 0 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 Contract - Detailed ra. 240 PellaMohawk Window and Door Showroom of Greenfield Sales Rep Name: Lukomski,Adam Trail Sales Rep Phone: (413) 335-3237 Greenfield, MA 01301-3209 Sales Rep Fax: 413-774.6348 Phone: (413) 774-7231 Fax: (413) 774-6348mermirermerresee gams Rep E-Nell: elukomskiLrol84.pellepdsn.com Customer Information ProJect/Delivery Address Order Information J Debbie Dietrich Dietrich Debbie 16 Upland Rd Leeds MA Quote Name: 1910062Archiect Series 413-5860655 16 Upland Rd 16 Upland Rd Order Number: 73902GL101 LEEDS,MA C1:63-9725 Lae Quote Number: 9088857 Primary Phone:(413)5860655 LEEDS,MA01 3-9725 Order Type: Installed Sales Moble Phone: County: HAMPSHIRE Payment Terris: au. Fax Number: Tax Code: MASS E-Mail: Quoted Date: 6/15/2017 Great Plalna e: 53H5660655 I Customer Number: 1006369356 Lie? Tli (( r 7/ob J 1 1 Customer Account: 1004317900 / I 7/62() For more information regarding the 4n3shing, maintenance, service and warranty of ail PeliaS products,visitMe Pellet weoshe at wrw,peifa.com Customer Debbie Dietrich Project Name: Dietrich Debbie 16 Upland Rd Leeds MA Order Number: 73902GL101 Quote Number:9088857 Line* Location: Attributes 6 Pre'finish Disclaimer Item Price Qty Ext'd Price $OSO 1 $0.00 Customer Notes: PRE-FINISH DISCLAIMER Stained and paint color samples are produced as accurately as possible:however,actual colors may vary from batch. Because wood is a nesse(product,each window or door will dsplay its own personality with regards to variation in color,texture and grain pattern. Natural wood variations include disfinctive grain patterns or unusual shadings in color. Due to the nature of using natural products,Pella Mhndows and Occ s cannot be responsible for the actu&degree of variation that may occur In your purchase. I Line* Location: Attributes ! 10 Kitthen Architect, Replacement Double Hung, 27.5 X 53, Brick Red item Price Qty Ext'd Price r✓X L.4.1 $1,341.39 3 $4,024.17 i 1111 1:Non-Standard SlzeNonStandant Size Double Hung, Equal Cr, PK* Frame Size: 2712 X 53 t;. 1885 General Intimation: Standard,Style,Clad,Pine,43/4",3114" °' Exterior Colon Finish: Painted, Standard Enduraclad,Brick Red Interior Color(Finish: Bright White Interior Sash f Panel: Ogee,Ogee,Standard,No Sash Lugs Gass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Akitude Viewed From Extent* Hardware Options: Spoon-Style Lock.Satin Nickel,No Limited Opening Hardware, No Sash Lift Screen: Full Screen.Standard EndtsaOlad,Brick Red,Standard Inview'"° Performance Information: U-Factor 0,29,SHGC 0.28,VLT 0.53,CPD PEL-N-2330025306001, Performance Class CW, PG 50,Calculated Positive OP Rating 60.Calculated Negative DP Rating 50,Year Rated 09111, Egress Does Not Meet Requirements(United States Only: Guilt No Grille, Wrapping information: No Exlenor Trim, No Interior Trim.Pella Recommended Clearance,Perimeter Length=161" Frame Size:27.5"X53.7343" PF-1-interior Pocket Installation Oty 1 LP-1 -Lead safe practices this opening Oty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com • Customer Dewe Dietrich Project Name: Dietrich Debbie 15 Upland Rd Leeds MA Order Number 73902GL101 Quote Number. 9088857 { Line Location. Attributes 15 Kitchen Praline,2.Wide Casement, 37 X 3135,Brick Red item Price Qty ft/did Price J y fl $1,85608 1 51,85609 1:Non-Standard SIzeNon4fandaS Size Left Casement � PttqFraeln 18112 atln: a3 18� General Color) tkn; Clad,5".d Er.du" Exterior Color)Finish: Standard Enduraolad,Brick Red interior Color/Finish: Bright White interior Glass: !mutated Low-ft Advanced Low-E Insulating Glass Argon Nan High Altitude Hardware Options: Wash Hinge Hardware,Fold-Away Crank,Satin Nickel,No Limited Opening Hardware Viewed From 6xie d Screen: Full Screen,BrgnONNte,In1Aew"' Performance information: U-Factor 029,SHGC 0.27,VLT 0.51,CPD PEI.61-14-0048740001,Performance Class R,PG 50,Catajated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 08,Egress Does Not Meat Requirements(United States Only) Grille: No Grille, Vertical Mull 1: FactcryMull,Standard Joining Mullion.Nt'.dl Design Pressure-20 z:Non-Standard SizeNonStandard Size Right Casement Frame Size: 181/2 X313/4 General Information: Clad,S,311N6` Exterior Color i Finish: Standard Enduraclad,Brick Red Interior Color/Finish: Bright White Interior Glass: h slated Lax-E Advanced Law-E insulating Glass Argon Non High Altitude Hardware Options: Wash Hinge Hardware,Fold-Away Conk,Satin Nickel,No Limited Opening Hardware Screen: Foil Screen,Bright White, nVewTM Performance Intormation: LtFactor 0.26,SHGC 027.VLT 051,CPD PEL-N44-00467-00001,Performance Class R,PG 50,Calculated Positive DP Rating 50,Calculated Negative OP Rating 53,Year Rated 08,Egress Does Not Meet Requirements(United States Only) GNlie: Nc Grine, Vertical Mull 1: FactoryMull,Standard Joining Marian,MIA Design Pressure-20 Wrapping information: No Exterior Trim,No interior Trim,311/1r,5', FactoryApplied,Pena Recommended Clearance,Perimeter Length=138" frame Size:37"X 3175" LP-1-Lead safe practices this opening - c1, a Ary 1 Mwho*. y4-Modified Pocket installation up to 90 U wMn ' City 1 Line ii Location: Attributes 20 Kitchen Wood Products Stop Colonial 4, Length:96, Bright White.Wood Type:Pine Item Price QW Ezra Price $26.02 8 $208.16 1: Accessory PK# Fran*She -1 X-1 1 General Information: Pine,Stop Gaionial4 Interior Color I Finish:Bright White interior Wrapping Information: Perimeter Length a T. Viewed From,Exterior Frame Size:04 X r For more information regarding the finishing, maintenance,service and warranty of ail RenaS products,visit the Pellatiwebsee atwee.peed.com C C oV. 7 N A S ~ ca. J s m - J N, 7 N, % q ac 1 '-‘111r-----7--- 1 '°73 Q �D S 4 , /' y w i M S y N m T = >0. . cJ 41y Z � PnSR @.�S se :r, .n a -Z S "' 005 1 A -S m 0c %% r y ""'�64 d r�P 3 -,:k a. ' T. N" o 5.- d d a vv N„gm5 �yS;i�},1 '11 �• p S .- -'8 . 685's�%'. +% m v ��oo MSpnY T V 3 N` • 0' � O o °Idem% 30 .--(2 ° °. ° ' v $ OOaeae P ° ' 7E %S 3 . (-"A io i O 3 3" ig.•..n. a % m l tt 'N4r g 1 A 7 0%.S. o'9n �F' 3. : C d m J F > 06 . -�a. y g e d y} d '._ 0- o. m ,Z�e2s d pppp r "p DI p a `atag m a A O� �o '? SD `�Z ' Q % m 'J O 'O� gO� m6J mt d N 4. 6 s %10�iN p# d90 =i1 Q S r ^i �p mNgedmo !p d 0 t A ''cm 2 / i�- aJ 3-R 00 a o ' 3 ;S�2 `i 2 i "i �' o g a - d x' '80 6 c $ 1 co 8 ^ °11:" 4 0 all d'N a m �? j m�FFA T a m z Pio 5-+ mf� fdd u J oqr o• %ti 4 .O o a - s%-po� g2omo n G m % a ?co `{ mD` a A o. 03 o mm m %.1:410 t. 4.1 -c13 $1 Ay-m� Y> •4 S1 % 41 rn-m B$J�1 0' er m o OI tj m. $x o1% N o s ' �y2a"` d3s �r 13 it � `gym 3. -0-i.:10, %.% ^ A iC e Q o 6' m9�om Y 0 4 iV 4L, o o m8 m n 44 2 % e $. 15x. A 'S. ob %76 A d A'y I'aJ c 4 ;O of xJ 1 o. oZ S m 3 I Ili? tUi a -&- 4 v �^ & 3 m P m n �'q ?5 p n —' 0 9 a Y c �'m o co mY' ! (a 4 F A @ -0 n o a\ P S e m 1 Q 3 -a 0 A N y .' c0 b d N o G A G G d C' u -o J ig m uN Ynp w 1 0 co co c 51 co 14 Ia m d ' o o- R C \ '-V A tc li co A i m m$ m AN`e' m @.1 o o 3 0 A Customer.Dettie Dietrich Prgecl Name; Dad:Xs Debs 16 Upend Rd Leeds MA Order Number: 73942GL101 Quote Nurber. 2988657 gProject Checklist/has cF beenbereviewed JA%-/ D� -r 441 . i-4., Order Totals se ;4,t mer Nhese Few.° P•;a ales •ep,'ame , e-�-ii Taxable Subtotal $8,110.12 direv i /ti _ rSales Tax@ 6.25% 5508.68 mer Signature Pella mes '0p$k nzture Non-taxable Subtotal $2,773.00 007 G//6p/17 tel 511,380.00 Date Date pock Received $5,65500 Dunt Due $5,735.00 Crede Card Approval Signa we For more information regarding the finishing, maintenance,service aid warranty of all Pella*products,visit the Pella®websde at wwa.pelia.eom Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-772-0253 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 223 2017 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# 142279. Please find a copy of my licenses below. Its husetis Department of Public Safety 4 Construction Supervisor Boardor Bu Building Regulations and Standards a Restricted to 4 'x ® 4 _tense CS-0965583 Unrestricted35s5-Buildings of any use group which contain sit ? less Med 000 cubic feet(991 cubic meters)of n .:rc- soP ^ p enclosed space. a d, e TREVOR BROSS ' i 10 GEORGE STREET f GREENFIELD MA 01301 t 1 ti I Failure to possess a current edition of the Massachusetts R "--7."--7. ..'�— 'xp ration State Building Code is cause for revocation of(his reense. t1 ssiore 081012018 DPS Licensing information visit:WWW.MASS.GOV/DPS i ,»..+eimat 'd .ya-.w,.,....._.� �._._.». Orr of er nrt &x saaIr Tense or registration valid for adwdal ase cub' 1OME IMPROV CONIRAT before thetap ' ` 10 Pak lam- T110 Boston,MAara Suite S110 PELLA PRODUCTS,"' s e 1 Boston. 02116 TREVOR SRO 155 . a t, ew . ut signature bas frx - Each Installation will be staffed by our installers who are all licensed in accordance with current building codes. Below listed are our installers and their license numbers. Please accept these individuals as my designees. Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Aaron Torres C5108472 Scott Bowdish CSSL100232 Bill Leger C589338 David Ruffner CS57308 Brian Thompson CS67121 Ilya Katykhin CSFA106240 Igor Kravchuk CS094911 The Commonwealth of Massachusetts 1 �— 1 Department ofIndustrial Accidents 1i=;t =ii -b1= p 7 Congress Street,Suite 100 _?._j5 Boston,MA 02714-1077 eb. _ www.mass.gov/dia isol Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/OrganizatioMndividua0: 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.�✓ 1 am a employer with 48 employees(fail anmor part-time)." 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. LI Remodeling any capacity.(No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.INo workers comp.insurance required]' 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 0 El Building addition ensure that all contractors either have workers'coinpensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 i am a general contractor and I have hired the sub-contractors listed on the attached sheet Ij.O Roaf repairs These sub-contractors have employees and have workers'comp.insurance. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Gfher _ 152.§1(4).and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box cel must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name ofthc subcontractors and state whether or not those entities have employees. lithe 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: Federal Insurance Company Policy#or Self-ins.Lic.#: 71746014 �/ Expiration Date: 01-01-2018 lob Site Address: /Co U®/9i-cf RU City/State/Zip: LeeCFJ fY/.9 6/05 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 S1,500.00 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 certi u • /heir -. and t ..allies of perjury that the information provided above is true and correct Sivnatur: ___ _diger Date: 49 ex902/ Phone#: A boy] 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 Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET �7 GREENFIELD, MA. 01301 Date: ((1/PcR/ To: Gc.Jn 0-P Aeect3. /1(4 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 town will be transported to a dumpster at our main facility; 155 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, PELLA PRODUCTS, INC. John P. Benjamin Accounting Manager ACOROe CERTIFICATE OF LIABILITY INSURANCE DATE IMWDDIYVYYI 12/30/2016 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. 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 Berkshire Inauranca Group, Inc. PRONE (413)]]3-9913 FAX No (413)774-3872 117 Main Street 'MAILApE,Rmirsargent@be rk ahireinavrancegr sup.com INSURERIS)AFFORDING COVERAGE MIC Greenfield MA 01301 INSURER A Great Northern Insurance Co. 20303 INSURED INSURERS Federal Insurance Co. 20281 Pella Products, Inc. INSURER C: 155 Main Street INSURERD: INSURER E: Greenfield MA 01301 INSURERF: COVERAGES CERTIFICATE NUMBER 17CL,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 SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TYPE OFINSURANCE XENTISIXIS POUCY EFF POLICY EXP LIR ''INSD4WVD POLICY NUMBER IMWWTYO {MWDI DYYYYI LIMITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED A CLAIMSMADE X:OCCUR ', PREMISES(Ea occurrence{ 1,000,000 36043418 1/1/2017 1/1/2018 MED MOP(Any One person) 5.000 PERSONAL B ADV INJURY i 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE • 2,000,000 'SII POLICY X PET X LOC PRODUCTS-COMPIPAGG 2,000,000 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY Per ) A ANY AUTO ( person) ALL OWNED SCHEDULED 73596418 1/1/2017 1/1/2018 BODILY INJURY(Per accident); _ IAUTOS AUTOS NON-OWNED PROPERTY DAMAGE - HIRED AUTOS AUTOSPe Em PIP-Scss B 000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ OED RECOMPENSATOR '' I $ AND WORKERS EMPLOYERS' ATOX X PTR L OTH- IANYPROPRYTOR'UATNERJ yINANY STAHAER OFFICERMEIMBER EXCLUDED' VE N '.. NIA iELEACH ACCIDENT $ $00,000 B : Mandatory In NH) 71746014 1/1/2017 1/1/2018 E.L.DISEASE-EA EMPLOYEE$ 500,000 nYes ceaarlm umer DESCRIPTION OE OPERATIONS below EL DISCASE.POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule.may be attached IFmore space is required) Operations usual to the sale & installation of doors & windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Leeds (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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025om4nn