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35-137 (6) 34 WESTWOOD TER BP-2019-0793 GIs#: COMMONWEALTH OF MASSACHUSETTS Map Block: 35 - 137 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-2019-0793 Proiect# JS-2019-001320 Est.Cost: $8848.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sa. ft.): 10323.72 Owner. SANTANGELO SHANNON Zoning: Applicant: PELLA PRODUCTS, INC AT. 34 WESTWOOD TER Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON.111512019 0.00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 10 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: 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 1/15/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner R �/v 0060 S only - t L--_ 121Main Northampto g Departmen u Ott " JAN . JAN 1 1 2019 Street se Room 100 W N4rthai n Pt on, MA 01030 SFr r c �7 11:Han L',F PT of FUI Dl �pphom"$ s687 1240 Fax 413--%- r 2 h ,Uii i HAMPTo�1.PAA01060 Oti1 r a APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION J�7p It'7 ` ep 1 7 This section to be completed by office Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) CuGent Mailing Address. �� (16q?)) 210 -(0611 1 Telephone Signature 2.2 Authorized Agent: yUo_ Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building C c6j A � 4 � (a)Building Permit Fee 2. Electrical Q _�1 (b)Estimated Total Cost of 0 Construction from 6 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) �� DID 5. Fire Protection 0 6. Total=(1 +2+3+4+5) 56 4(�. y 1 Check Number This Section For Official Use Only Building Permit Number: DateIssued: Signature: 1'11-lq 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 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 0 DON'T KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q YES 0 IF YES: enter Book Pageand/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 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 © 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�windows Alteration(s) ElRoofing F-1Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[E3] Other[a Brief Dscription of Proposed Work: Q\Gra(\u iU w,r\drx.» IJS%RC, OO�n�eY4S.W.W\ n(.) c YYa�n(jXS to � Duld�n ' hccje✓ UCkr U.Tl Alteration of existing bedroom Yes No Adding new bedroom Yes No t7.rv� Ic w Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. If New house and or addition to existino housina, 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 as Owner of the subject property n hereby authorize �f��U. �"C�(�UC.�S V\C• _ to act on my behalf, in all patters relative to w rk authorized by this building permit appl'cati n. IJ119 Signature of Owner V Date ` CUSS D� �1�a �cx�U���S ��( , 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. vfo 55 Pa q Sign re of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not CAppliicable ❑ Name of License Holder:T,czjbr ���as ( J' yq(0 55 License Number 03�C) I C)Q0 Expirat oni Date X53 Si9fature Telephone 8.Reaistered Home Imomyom-ent Contractor: Not Applicable ❑ ��lc� 1�rvc�yr �oc I aa�g Company Name Registration Number ►ss �Acu . E] f « oc�uv 6-311�3/JW0 Ad ` Expiration Date Telephone15.3 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....... a No...... ❑ 11. - Home Owner Exem don 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 �'- Pella Window and Door Showroom of Greenfield Sales Rep Name: Sanderson, Thomas 240 Mohawk Trail ® Sales Rep Phone: 413-774-7231 Greenfield, MA 01301-3209 Sales Rep Fax: 413-774-6348 Phone: (413) 774-7231 Fax: (413) 774-6348 Sales Rep E-Mail: tsanderson@pellasales.com Customer`Information: Project/Mlivery Address Order Information Shannon Santangelo Santangelo Shannon 34 Westwood Ter Florence MA Quote Name: Santangelo Shannon 2210686 250 Series 34 Westwood Ter 34 Westwood Ter Order Number: 739T3BS01I FLORENCE,MA01062-3538 Lot# Quote Number: 10920009 Primary Phone:(843)8106961 FLORENCE,MA 01062-3538 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: Paid In Full Fax Number: Tax Code: MASS E-Mail: Quoted Date: 12/31/2018 Great Plains#: 52H8106961 Customer Number: 1008995868 Customer Account: 1005032162 J\✓✓✓ TC ' Customer Notes: Replacing current windows with 250 series vinyl casements Paid In Ful For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com 41A,nn4n C:nntract-Detailed Page 1 of 14 .,ustomer:Shannon Santangelo Project Name: Santangelo Shannon 34 Westwood Ter Florence Order Number: 739T3BS011 Quote Number: 10920009 MA line# Location: Attributes 10 Living Room Pella 250 Series, 3-Wide Casement, 85 X 37,White Item Price Qty Ext'd Price $2,209.29 1 $2,209.29 1:Nonstandard Size Left Casement PK# Frame Size: 171/2 X 37 "* 2024 General Information: Standard,Vinyl,Block,No Foam Insulated,31/4",31/4" Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.26, SHGC 0.25,VLT 0.46, CPD PEL-N-239-00005-00001, Performance Class LC, PG 35,Calculated Positive DP Rating 35, Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress, but may comply with local code requirements Grille: No Grille, Vertical Mull 1: FactoryMull,1/2"Joining Mullion 2:Nonstandard SizeNon-Standard Size Fixed Direct Set Frame Size: 481/2 X 37 General Information: Standard,Vinyl, Block, No Foam Insulated,31/4",31/4" Exterior Color/Finish: White/ Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Attitude Performance Information: U-Factor 0.27,SHGC 0.30,VLT 0.57, CPD PEL-N-240-00005-00001, Performance Class LC, PG 35, Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111 Grille: No Grille, Vertical Mull 2: FactoryMull,1/2"Joining Mullion 3:Nonstandard SizeNonStandard Size Right Casement Frame Size: 18 X 37 General Information: Standard,Vinyl,Block,No Foam Insulated,31/4",31/4" Exterior Color/Finish: White Interior Color 1 Finish: White Glass: Insulated Dual Low-E. Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware Screen: Full Screen Performance Information: U-Factor 0.26,SHGC 0.25,VLT 0.46,CPD PEL-N-239400005-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35, Calculated Negative DP Rating 35,Year Rated 08111,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Vertical Mull 1: FactoryMull,1/2"Joining Mullion Wrapping Information: Pella Recommended Clearance,Perimeter Length=244". Frame Size:85"X 37" MP-8-Modified Pocket Installation 121-150 UI wiwrap Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 1/4/2019 Contract-Detailed Page 2 of 14 ustomer:Shannon Santangelo Project Name: Santangelo Shannon 34 Westwood Ter Florence Order Number: 739T36S011 Quote Number: 10920009 MA Line# Attributes :.Location: _ 15 Little Room Pella 250 Series, Casement Left, 35.5 X 45.5,White Item Price City Ext'd Price $1,032.29 1 $1,032.29 1:Nonstandard SizeNonStandard Size Left Casement PK# Frame Size: 351/2 X 451/2 2024 General Information: Standard,Vinyl,Block, No Foam Insulated,3 1/4',3 1/4",Sill Adapter Included, Head Expander Included Exterior Color/Finish: White Interior Color I Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude $ Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White,No Window Opening Control Device, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.26,SHGC 0.25,VLT 0.46,CPD PEL-N-239-00005-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Meets Typical 5.7 sgft(E)(United States Only) Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length= 162". Frame Size:35.5"X 45.5" MP-4-Modified Pocket thstallation up to 90 UI wlwrap Qty 1 Line# Location: Attributes' 20 Master Pella 250 Series,Casement Left, 35.5 X 45.5,White Item Price City Ext'd Price $1,032.29 2 $2,064.58 1:Nonstandard SizeNonStandard Size Left Casement a-; PK# Frame Size: 351/2 X 45 1/2 2024 General Information: Standard,Vinyl,Block, No Foam Insulated,3 1/4",3 1/4",Sill Adapter Included, Head Expander Included Exterior Color I Finish: White Interior Color I Finish: White s . Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.26, SHGC 0.25,VLT 0.46,CPD PEL-N-239-00005-00001, Performance Class LC, PG 35, Calculated Positive DP Rating 35, Calculated Negative DP Rating 35,Year Rated 08111, Egress Meets Typical 5.7 sqft(E)(United States Only) Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=162". Frame Size:35.5"X 45.5" MP-4-Modified Pocket Installation up to 90 UI w/wrap Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella@ products,visit the Pella@website atwww.pella.com Printed on 1/4/2019 Contract-Detailed Page 3 of 14 .astomer:Shannon Santangelo Project Name: Santangelo Shannon 34 Westwood Ter Florence Order Number: 739T3BS01I Quote Number. 10920009 MA Line:# Location:: Attributes 25 Guest Room Pella 250 Series,Casement Left, 35.5 X 45.5,White item Price Qty Ext'd Price f $1,032.29 2 $2,064.58 t 1:Nonstandard SizeNon-Standard Size Left Casement to PK# Frame Size: 351/2 X 451/2 V. 2024 General Information: Standard,Vinyl,Block, No Foam Insulated,3 1/4",3 1/4",Sill Adapter Included, Head Expander Included ,�`•. Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance information: LI-Factor 0.26, SHGC 0.25,VLT 0.46,CPD PEL-N-239-00005-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Meets Typical 5.7 sqft(E) (United States Only) Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=162". VAR 2i5t1 Frame Size:35.5"X 45.5" MP-4-Modified Pocket installation up to 90 UI w/wrap Qty 1 Line# ; . Location: Attributes 30 Bathroom Pella 250 Series,Awning Vent, 37.5 X 17.5,White Item Price Qty Ext'd Price $1,022.61 1 $1,022.61 1:Nonstandard SizeNon-Standard Size Vent Awning PK# Frame Size: 371/2 X 17 1/2 2024 General Information: Standard, Vinyl, Block, No Foam Insulated, 3 1/4", 3 114", Sill Adapter Included, Head Expander Included Exterior Color/Finish: White 37.5' Interior Color I Finish: White Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.27,SHGC 0.25,VLT 0.46,CPD PEL-N-241-00005-00007,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Not Applicable Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=110". Frame Size:37.5"X 17.5" MPA-Modified Pocket Installation up to 90 UI wlwrap Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella@ products,visit the Pella@ website at www.pella.com Prinfari nn 1/dl7n1Q Contract-Detailed Page 4 of 14 customer:Shannon Santangelo Project Name: Santangelo Shannon 34 Westwood Ter Florence Order Number: 739T38S011 Quote Number: 10920009 MA Linc# Location: Attributes 35 Kitchen Pella 250 Series, Casement Left, 35.5 X 48.5,White Item Price oty Ext'd Price $1,044.99 1 $1,044.99 ' 1:Non-Standard SizeNonStandard Size Left Casement tl PK# Frame Size: 351/2 X 481/2 General information: Standard, Vinyl, Block, No Foam Insulated,3 1/4",3 1/4",Sill Adapter Included, Head Expander Included 2024 Exterior Color I Finish: White -, Interior Color/Finish: White 3�s. Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware, Fold-Away Crank,White, No Window Opening Control Device, No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.26,SHGC 0.25,VLT 0.46,CPD PEL-N-239-00005-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Meets Typical 5.7 sgft(E)(United States Only) Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=168". Frame Size:35.5"X 48.5" MP-4-Modified Pocket Installation up to 90 UI w/wrap Qty 1 Line# Location: Attributes 40 None Assigned 2 27132"wlkerf Solid Jamb Extension, Length:96, Bright White.Wood Type: Pine Item Price Qty Ext'd Price $37.52 18 $675.36 1: Accessory PK# Frame Size: 1 X 1 2024 General Information: Pine,2 27/32"w/kerf Solid Jamb Extension Interior Color/Finish, Bright White Paint Interior Wrapping Information: Perimeter Length=0". Viewed From Exterior Frame Size:0"X 0" For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella@ website at www.pefia.com ararIniQ Contract-Detailed Page 5 of 14 M Customer,Shannon Santangelo Project Name: Santangelo Shannon 34 Westwood Ter Florence Order Number: 739T3BS011 Quote Number: 10920009 MA ❑Project Checklist has been reviewed Sk Sat-A'gL, g e.-C O Ka"a s SQ�,�Lrccn^ Order Totals Customer Name (Please pnnW Pella Sales Rep Name (Please print) Taxable Subtotal $6,390.70 Sales Tax @ 6.25% $399.4 Customer Signature Pella Sales Rep Signature Non-taxable Subtotal $2,058.2 Date1 Total $8,848.41 Date�T Deposit Received $8,848.41 Amount Due $0.00 Credit Card Approval Signature For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com �:_. 4 MIM40 Contract-Detailed Page 14 of 14 DATE(MMIDDIYYYY) ACOREN CERTIFICATE OF LIABILITY INSURANCE ��. 12/27/2017 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(iss)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 andorsement(s). PRODUCER NAONTACT ME: Robin Sargent Berkshire Insurance Group,Inc. PHONE (413)773-9913Nr,: (413)774-3872 No Fst 117 Main Street C-MAIL : rsmgeM@bmt ireinsurancegroup_com ADDRESS INSURERS)AFFORDING COVERAGE NAIC K Greenfield MA 01301 INSURER A: Citizens Ins.Company of Amer 31534 INSURED INSURER e: 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMID MMIDD LIMA COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000,000 DAMAGE TO RENTED CLAIMS-MADE ®OCCUR PREMISES(Ea occt mmad S 100,000 MED EXP(Any one person) $ 10,000 A ZBND45939500 01/01/2018 01/01/2019 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE UMIT APPLIES PER: GENERALAGGREGATE S 2.000,000 POLICY®JECT ©LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: Damage to Rented S 100,000 AUTOMOBILE LIABILITY EaE0 88 SIN0kC—hNn' s 1,000,000 ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWND45948700 01/01/2018 01101/2019 BODILY INJURY(Per ao6dent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY er accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE s DED I I RETENTIONS S WORKERS cOMPENSAnON PER YIN OTH- AND EMPLOYERS'LIABILITY STATUTE I I ER ANY PROPRIETOWPARTNER/FJ(ECUTIVE EL EACH ACCIDENT $ 500'000 C OFFICERIMEMBER EXCLUDED? a NIA WHND376502 01/01/2018 01/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500'000 If yes,descnfbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT y 500'000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H 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 Town of Florence(Northampton)Building Commissioner's Office, ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZM REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rightftrmeserved. ACORD 26(2015!03) The ACORD name and logo are registered marks of ACORD 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: 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. Conviortwealth of Massachusetts construction Supervisor DivlSaDrt4f Meal l+Gensure Restricted to: Board of ilattr Surds Unrestricted-Buildings of any useup which contain less than 35,000 cubic feet(991 cubic MeWS)of . ' enclosed space. Ccntmiftsx �<� : . %6,•'f r-iaurorniuwrll�r�'^ljawr�uufra Office of Consumer Aftsirs&Business Regulation HOME IMPROVEMENT CONTRACTOR RegwvitlonvatMfor IrA ldualuseordY TYPE:Supolement Cana before the vokedon date.N found return to: g291mWign guiration Office of Consumer Affaf and Business Regtdetlon 142M 03!232020 _ Ash Plaea 1301 PELTA PRODUCTS,INC. f TREVOR BROSS C�' " 155 MAIN STREET Not Vdtd vAthout 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatiorOndividual): 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: 4. ■ I am a general contractor and I Type of project(required): 52 1.X I am a employer with g 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [M-1 Remodeling ship and have no employees These sub-contractors have g, E]Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. []Building addition [No workers' comp.insurance comp. insurance.: required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions 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#1 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 thepolicy and job site information. Insurance Company Name:Hanover Insurance Group Policy#or Self-ins.Lic.#:WHND376502 Expiration Date:01/01/2019 Job Site Address: VQe5�ogl TPN City/State/Zip: A(XG'nCC /440, QiWlc� 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 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 DIA for insurance coverage verification. I do hereby ce ?der the pains and en of perjury that the information provided above is true and correct. i Signafore: Date: l Phone#: Ab 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 GREENFIELD, MA. 01301 Date: -rT � 1 1 To: i cin Q ' � 1 C3 ern e 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