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15-022 (3) 188 CHESTERFIELD RD BP-2019-0615 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 15-022 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2019-0615 Proiect# JS-2019-001003 Est.Cost:$9980.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sg.ft.): 138085.20 Owner: COOPER JANICE Zoning: Applicant: PELLA PRODUCTS, INC AT. 188 CHESTERFIELD RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:11/27/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 2 DOORS USING EXISTING OPENINGS 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 Deaartment 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: FeeTvoe: Date Paid: Amount: Building 11/27/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r • (-)— S Department use only City of Northampton Status of Permit: =.x Building Department Curb Cut/Driveway,Permit -v. 212 Main Street Sewer/Septic Availability: Room 100 Water/Well, #vailabili, Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans I r --- r L-F APPLICATION TO CONSTRUCT,ALTER,RE LISI I A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION N O v 1 9 2018 6P" j q— 0/S 1.1 Properly Address: This ection to be completed by office � b DEPT.OF SUILDI INSPECTIONS ' J `ACAO"i Kc� NORTHAMPTM�Ip Lot Unit A/A O i 035-3 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r SI►� �. ow i2A LL s �r S Name(Print) Curent dailing Address: L4 -175 q O Te'llephone)) Signature 2.2 Authorized A ,r Il a / rac�vc�5 ��, c. l 5 f i'1e,.k Name(Print) Current Mailing Address: 5 7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I Y G q Or � (a) Building Permit Fee / I 0 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee / 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) (} , ¢S- Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: fl- ZL- ZD 16 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) c � Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information N Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW 4& YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading exvation, 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Vyindows Alterations) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[D] Brief Description of Propol�ed ` 1 Work: Qty C\vmA d. d�GOf S VS�tiS e�i s�:v 4 .v�:�n:ria f t✓E T `t /UG C�^Au��J /4 o ht4 1�. Alteration of existing bedroom Yes '�C, No Adding new bedroom Yes No N Attached Narrative Renovating unfinished basement Yes 1� No Plans Attached Roll -Sheet 6a. If Newhouse and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f', �'�— as Owner of the subject property t- hereby authorize 19'e u f0end4 C 1 S —+ --K-- to act on my behalf, in all matten relative authorized by this building permit application. Signature of Owner Date TYbclDc 5 �� C - 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. ?e /okc Print Name Signature of 9&er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: j� Not Applicable ❑ Name of License Holder: ry Jof I ro 5 S (f_5 - G q(-:5—F License Number /6 GYor�r_ S� t��;.��� MA rc3c, .2094 Address U Expiration Date yk kks Sign 9.Registered Home Improvement Contractor: Not Applicable ❑ ?CU, 'r?roJ,A-5 \,,-,c _ I Ll X 2 vl � Company Name Registration Number SSS �u,�, 5 . .��c�. , �tA o►30 � 312 311 g- Address Expiration Date Telephon 1 -17 3-11 S 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....... Of No...... ❑ Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski,Adam ® 69 Ashley Avenue Sales Rep Phone: (413) 335-3237 West Springfield, MA 01089 Sales Rep Fax: 413-774-6348 Phone: (413) 736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: alukomski@pellasales.com Customer Information ProjectlDelivery Address Order Information Janice Cooper Cooper Janice 7 Shepherds Hollow Rd Leeds MA Quote Name: 2176436 Proline and Entry 718-744-7390 7 Shepherds Hollow Rd 7 Shepherds Hollow Rd Order Number: 739R2LL051 LEEDS,MAO 1053-9707 Lot Quote Number: 10711631 Primary Phone:(718)7447390 LEEDS,MA 01053-9707 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: jcoop3434@gmail.com Quoted Date: 10/15/2018 Great Plains 8: 52H7447390 Customer Number: 1008492141 1 i I !`z; Customer Account: 1004526673 Line# Location: Attributes 10 None Assigned Pella Brand, Entry Door Inswing, 37.5 X 81.75,Whitrr; 6 9116" Item Price catty Ext'd Price I , .; . PQ 1 4 r C41 $4,192.21 1 $4,192.21 1: 3680 EntryDoor . PK a Frame Size: 371/2 X 813/4 G;) 2020 Unit Type: Right Inswing,Standard Sill,No Fire Rating,No Fire Rating Dimension Options: No Cut Down General Information: 7 7/8", 15/16",6 9/15' l Panel Style: Full Light Glass: Tempered Low-E Air Filled Viewed From Exterior Grilles: Simulated Divided Light,7/8"Contour,Match Interior Panel Finish,Match Exterior Panel Finish,Prairie,Typical,3 Panel Selection: Smooth,Painted,Brick Red,Painted,Linen White rc'r'lug Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,40Mv,Wood,Linen White Hardware Options: Latch Bore with Deadbolt,2 3/4,21/6', No Integrated Sensor, Chesapeake Lever,Chesapeake Lever,Oil Rubbed Bronze, r ' Aluminum Adjustable,Oil Rubbed Bronze,Bronze Finish Sill Unit Accessories: No Wrought Iron,No Bang Panel Performance Information: U-Factor 0.29,SHGC 0.17,VLT 0.28,CPD PEL-M-174 02568-00001,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08 Wrapping Information: Nail Fin,Factory Applied,No Exterior Trim,6 9115',7 7/8",Factory Applied, Pella Recommended Clearance, Perimeter Length= Frame Size:37.5"X 81.75" EXTTRIMI9-514 x 4 Exterior Style PVC Qty 1 For more information regarding the finishing maintenance. service and warranty of all Pella®products visit the Pella®website at www.gella.com Prinlafl nn 1110/101R n .a n-•.a-� i1 Customer: Project Name: Order Number: Quote Number: ED4 -Entry Door Installation w/o Sidelight Qty 1 EXTTRIM14-Kick board,up to 54/2 Inch match ext trim PVC Qty 1 Line# Location: Attributes 20 None Assigned Proline, Double Inswing Door Inactive 1 Active, 59.25 X 79.5,White Item Price Qty Ext'd Price $6,563.24 1 $6,563.24 1:6080 Inactive/Active Double Inswing Door PK# Frame Size: 591/4 X 791/2 -� 2020 General Information: Clad,7 70,6 9/16",Standard Sill,Brown Finish Sill Exterior Color/Finish: Standard Enduraclad, - r i— w Interior Color/Finish: Linen White Paint Interior Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Oil Rubbed Bronze,Multipoint Lock,Order Handle Set,No Handle Set,Aluminum Adjustable Viewed From Exterior Screen: Hinge Screen,White,Oil Rubbed Bronze, InViewTM Performance Information: U-Factor 0.29,SHGC 0.26,VLT 0.49,CPD PEL-N-221-00190-00001,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 0811 Grille: No Grille, Wrapping Information: Foldout Fins,Factory Applied,No Exterior Trim,69/16",7 7/8",Factory Applied, Pella Recommended Clearance, Perimeter Length=278". Frame Size:59.25"X 79.5" EXTTRIM19-,5/4 x 4 Exterior Style PVC Qty 1 EXTTRIM14-Kick board,up to 54/2 Inch match ext trim PVC Qty 1 PD4 -Patio Door Install up to 6FT In width Qty 1 Line# Location: Attributes 25 None Assigned INSTALLATION -INSTALLATION Item Price Qty Ext'd Price $700.00 1 $700.00 ITC-BC8-Non-Standard Interior Trim-8 FT lengths Qty 8 AC-9B3-OTHER-3 Qty 3 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at at wwwpella.com 0r1n40dnn 11/0P')n1S! Customer: Project Name: Order Number: Quote Number: �roiect Checklist has been reviewed Order Totals Customer Name (Please int) Pella Sales Rep Name (Please print) Taxable Subtotal $6,491.5 Sales Tax @ 6.25% $405.72 Customer Sign Pella Sales Rep Signature Non-taxable Subtotal $3,082.73 Total $9,980.00 Date Date Deposit Received $4,990.00 Amount Due $4,990.00 Credit Car roval Signature For more information regarding the finishing maintenance service and warranty of all Pella®products visit the Pella®website at vm w.pella.com PrintRd nn i llq olA (`nnlre f-rIl.A ^--- Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-773-1157 Ext. 317 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: March 5, 2018 Subject: Building Permit Applications & Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL#CS-096558 and my HIC# 142279. Please find a copy of my licenses below. Comrwnweatth of Massachusetts Construction Supervisor Om$ion of pr 1 t.icaruu re Restricted to: Board of a standards Unrestricted-Buildings of a0 use group which Contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. CS-0996s am*lilt Fathrc�o a eAfrrraE�� 141Ar�NM�h11A1M�+li ` OMItlttiilrifllfNN OWL' 110 iiftlIli �1M1� _0 7/.� *•�irvreoeauw/J+G c /47 Office of Consumer Affairi3 Business Regulation HOME IMPROVEMENT CONTRACTOR Regwastlon va lld for Individual use only TYPE:Svwlement Card before the expiration date. N found return to: ggq g nEiRlredon Of11cs of Consumer Alta and Business R"Wation 142279 03!23/2020 One Pl�e- s1301 PELLA PRODUCTS,iNCe fin' TREVOR BROSS ' 155 MAIN STREET Not valid Without signature GREENFIELD,MA 01301 Undersecretary 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 Scott Bowdish CSSL100232 Bill Leger CS89338 David Ruffner CS57308 Brian Thompson CS67121 Igor Kravchuk CS094911 l PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: 1 i To: �� �y o o rawin ve,1n 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 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 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? Check the appropriate box: Type of project(required): 1.0 I am a employer with 52 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling ship and have no employees These sub-contractors have 8. F1 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9• ❑ Building addition required.] 5. E] We are a corporation and its 10.E] Electrical repairs or addition: 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or addition: myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Hanover Insurance Group Policy#or Self-ins. Lic. #:WHND376502 Expiration Date:01/01/2019 Job Site Address: 77 5�1,erp1r s ,UCJw 124 City/State/Zip: Lv.tds WA 01 o5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fin 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 DIA for insurance coverage verification. Ido hereby certify under t e pains and penalti perjury that the information provided above is true and correct. Signature: Date: 11 1 Phone#: Above Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: A��" CERTIFICATE OF LIABILITY INSURANCE 7121/28/2017 / Y) 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(les)must have ADDITIONAL INSURED provisions or 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 NAME: Robin Sargent Berkshire Insurance Group,Inc. PHONE (413)773-9913 FAX Nu: (413)774-3872 A/C No' o Ext 117 Main Street E-MAIL SS: rsargent@berkshireinsurancegroup.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC 0 Greenfield MA 01301 INSURER A: Citizens Ins.Company of Amer 31534 INSURED INSURER B: Allmerica Financial Benefit 41840 Pella Products,Inc. INSURER C: Hanover Insurance Company 22292 155 Main Street INSURER D: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER: 18GL,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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY/YYYY MM/D POLICY EFF EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 lu CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A ZBND45939500 01/01/2018 01/01/2019 PERSONAL&ADV INJURY y 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑X JECT O- FxLOC PRODUCTS-COMP/OP $ 2,000,000 OTHER: Damage to Rented $ 100,000 AUTOMOBILE LIABILITY E0M91WEB81HOLE-lIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWND45948700 01/01/2018 01/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident a UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBEREXCLUDED? a NIA WHND376502 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 if yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 � � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD