38C-029 (3) BP-2008-0402
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category_ BUILDING PERMIT
Permit# BP-2008-0402
Proiect# JS-2008-000588
Est. Cost:$14552.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 142279
Lot Size(sa. ft.): 10497.96 Owner: STEWART ROBERT G&ENDAMIAN S
Zoning:URB Apylicant: PELLA PRODUCTS, INC
AT. 316 SOUTH ST
Applicant Address: Phone: Insurance:
240 MOHAWK TRAIL (413) 772-0153 WC
GREENFIELDMA01301 ISSUED ON.10/1612007 0.00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 2 REPLACEMENT DOORS & 12
WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
i'n d e rg ro u n d: 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 10/16/2007 0:00:00 $25.0027968
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
r ,
lr
Department use only
Ov ^ C ty of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
+� �Z DO212 Alain Street Sewer/Septic Availability
1\ '�b) N Room 100 Water/Well Availability
tZ5
amptdn, MA 01060 Two Sets of Structural Plans
phone 4871240 Fax 413-587-1272 Plot/Site Plans
Other Specify
F- c,
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
MIN of otoo
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
3(U �5ouh st- p+-Ja . gin
Name(Print) Current Mailing Address:
((Tp
I��—
Telephone
Signature
2.2 Authorized Agent:
-& u',
Name Current Mailing Address:
Sig ature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: DateIssued:
Signature:
Building Commissioner/Inspector of Buildings Date
I'
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 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 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 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 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 0 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 0 NO 0
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 Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [[ ] Decks [Q Siding[O] Other[p]
Brief Description of Proposed
Work: 1 '1 A\ 00 S e-'i-� ac, oden\lNeA D o V e aJk*Atr o f
fU-M�wdd IcV1e�G<
Alteration of existing bedroom Yes No Adding new be room s _ X No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house 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,A0 10 5��i-�Jp��- as Owner of the subject
property 11t
hereby authorize ��l OL, r �OTOd-5YIC. 5J S � i n t)�
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
11,7eJ5 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.
Print Name
Signature of ner/Agent Date
r
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
2, 10_ e r odu.c4-s Inc. I y.,;i�9
Address Expiration Date
t S-S V i n -D r e nit' 1 i�TelephonA 13-l1,)-O S�I
- 3 �aool�
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152,§25C(6)) -7
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 buil ng permit.
Signed Affidavit Attached Yes....... W No...... ❑
11. - Home Owner Exemption
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
Northhmpton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
Office Order Cga
PELLA PRODUCTS, INC. �� S
240 MOHAWK TRAIL
GREENFIELD,MA 01301
Phone: (413)774-7231 Fax: (413)774-6348 ✓�j �`
custotner Project/Ship-To Order
Stewart,Rob Stewart,Rob Order No. 73937IP32P Order Date 10/05/2007
316 South Street 316 South Street Customer No. 53H5879263 Need Date 12/17/2007
Tax Code MA Sales Rep. Code 41
NORTHAMPTON,MA 01060 NORTHAMPTON,MA 01060 Taxable no Sales Rep.Name Picard,Paul(53)L.
HAMPSHIRE HAMPSH Tax Exempt No. Window Store 000003
Terms Code Deposit/C.O.D. Territory
Lie.No.: P.O.No.: Customer Type Ship To County HAMPSH
MDR Code SP Prepared By Paul
Rob Stewart Owner:Mr.Rob Stewart Overall Discnt. 0.000% Architect Name
Bus. Phone: (413)587-9263 Bus. Phone: (413)587-9263 Comm. Split 41: 100. % Dist. Order No.
Bus. Fax: ( ) - Home Phone:
Cellular: ( ) -
Home Phone: ( ) -
Delivery Instructions: : 91s to exit 18. Left off ramp left by bowling alley,left at 2 sets of lights on to South Street.House on corner of South and Charles.
Comments:
Outside View Item Qty. Description Unit Price �t1+1'Dtl�d
Item# 10 Qty: 1 Vent-DH Standard Jambliner Precision Fit Windom,Make Size:27 X 510.» 510.55
Location:P-Play Area 44:Architect Series,Clad,Model 3.White,Half Vent/match Half Vent. 5/8" 0.00 0.00
R.O: 2'3-1/2" X 3'8-1/2" InsulShld IG Glazing,Full Screen,White Hardware, 3/4" REM Traditional- 510.55 510.55
top sash only Grille(Grille Lites Wide=03,Grille Lites High Upper Sash=02 0.000%
Value Added Items: Ultra Pure White Semi-Gloss Paint-Qty T - -
Notes:
Item#15 Qty: 3 Vent-DH Standard Jambliner Precision Fit Window,Make Size:31-1/4 634.76 1,904.28
Location:P-Baby's Room X 64: Architect Series,Clad,Model 3,White,Half Vent/match Half Vent, 0.00 0.00
R.O: 2'7-3/4" X 54-1/2" 5/8" InsulShld IG Glazing,Full Screen,White Hardware, 3/4" REM 634.76 1,904.28
Traditional-top sash only Grille(Grille Lites Wide=03, Grille Lites High 0.000%
Upper Sash=02)
Value Added Items: Ultra Pure White Semi-Gloss Paint-Qty 1
Notes:
Office Order Copy-Page 1 of 5
Proposal for Customer Project: Stewart.Rob Quote No.: 371P32 Alternate No.: 1
Outside View Item No. Ql.,U Summai-3 Description Unit Price Extended Price
Item#80 Qty: I Interior trim: 2 1/2 Colonial and Flat casing on doors 0.00 0.00
Location:
Picture
Not
Available 40/7�
Notes:
Outside View Item No. Ott_ Summary Description Unit PrictExtended Price
Item#85 Qty: 1 Exterior trim:Flat primed casing on doors 0.00 0.00
Location:
Picture
Not
Available
Notes:
Thank You For Your Interest In Pella Products
Taxable Subtotal $8,228.01
Custorgr Signature 4elila4esesentative Signature Sales Tax at 5.0000% 411.40
Nontaxable Subtotal 5,883.00
Ze Total Date � � � Deposit Received $ 1 52
2,41
Date $ 0.00
Prices are subject to change anytime after 30 days following date of estimate. This estimate does not quarantee availability of any product listed.
For information regarding the finishing, maintenance, service, and warranty for all Pella products, visit the Pella Website at
Proposal-Page 6 of 7
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LetZibly
Name (Business/Organization/Individual): + fi L
Address: Ci i sn] .
City/State/Zip: �� f P /1 t A m� 01 fo Phone#_ `{13 0(S 3
Are you an employer? Check the appropriate box: Type of project(required):
1. – I am an employer with :I'S — 4. I am a general contractor and I 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. I 7. – Remodeling
Ship and have no employees These sub-contractors have 8. – Demolition
Working for me in any capacity. workers'comp.insurance. 9. – Building Addition
[No workers'comp,insurance 5. We are a corporation and its
] officers have exercised their
required.] 10. – Electrical repairs or additions
3. – I atn a homeowner doing all work right of exemption per MGL 11. – Plumbing repairs or additions
myself. [No workers' comp. C. 152, ' ](4),and we have no 12. – Roof repairs
insurance required.]H employees. [No workers' 13. – Other
Como.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
H Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
I Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and their workers'
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.
Insurance Company Name:_ (-.C_ &t_C , �`�u� i e Co
Policy#or Self-ins.Lic. #: WL -- 6 OA - 05 ( C) Expiration Date: ( - C)
Job Site Address: For all FCCIP towns City/State/Zip:
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 certify rider the pains an penalties of perjury that the information:provided above is true aml correct.
Signature: Date: p
Phone#: -y 1,:3 • `7 7 r� " D 15 3
Official use only. Do not write in this area,to be completed by city of 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#:
5
Board of Buildin Re >
g g ala{ions and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
!lone Improvement Contractor Registration
Registration: 142279
PELLA PRODUCTS, INC. Type: Private Corporation
Expiration:ration: 3/24/2008
GARY SHERMAN
155 MAIN STREET — --------------__
GREENFIELD, MA 01301
SOM Oy/05-PCfi6�JN
Update Address and return card. Mark reason forchange.
----- — -- _..._ Address Renewal
Ej Empioyment -1 Lost Card
t!?CYIIMTL047t1f;(7.(C/Z O�✓7�(� -"--. ._.- .-._._------------------
Board
-"-...'--.Board of Building Regulations and Standards
oix
HOME IMPROVEMENT CONTRACTOR License or rcgistratiou valid for individul use only
before the expiration date. If found returnto:
fll5tration; 1,12279 Board of Building Regulations and Standards
Expiration: 3/24/2008 One Ashburton Place Rin 1301
Type: Private Corporation Boston,IVIa. 02108
ELLA PRODUCTS, INC.
ARY SHERMAN
35 MAIN STREET -----�� / _ .._.
REENFIELD, MA 01301
Administrator
Not valid bout signature
:\ �� ta�ivaeartuiecziC/i a��Z�leJaclurteC�i
Board of Building Regulations and Standards License or registration valid for individul use only
- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
= Registration: 142279 Board of Building Regulations and Standards
Expiration: 3/24/2008 One Ashburton Place Rm 1301
Type: Supplement Card Boston,Ma.02108
PELLA PRODUCTS, INC.
PAUL PICARD
155 MAIN STREET
GREENFIELD,MA 01301
Adminisn•ator Not vali ,d without'-
signature
'F
'4
--- _ Pella® Windows & Doors
Subject: Disposal of Debris
The purpose of this letter is to certify that all debris from any project
undertaken by Pella Products, Inc. in Berkshire and Franklin counties
will be transported to a dumpster at our main facility at 155
Main Street, Greenfield, MA.
Pella Products„ Inc. is under contact with Waste Management of
Massachusetts for the disposal of the contents of this dumpster.
Very truly yours,
PELLA PRODUCTS, INC.
I
John P. Benjaarrin
Accounting Manager
Generic Debris 05-23-07.doc
Pella Products,Inc.
155 Main Street
Greenfield,MA 01301
Main Office Phone:413.772.01 S3
IEWED TO BE THE BEST Service:800.957.3552
Fax:413.773.1158
10/1012007 1558 4137743872 MASS ONE INS PAGE 01/03
AC4RDCERTIFICATE OF LIABILITY INSURANCE iolioi2 fl
PRODUCER (41.3)773-9913 FAS: (413)774-3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MassOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Sox 638 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
117 Main St.
Greenfield MA 01302-0638 INSURERS AFFORDING COVERAGE NAIC 9
INSURED INSURERA:Acadia Insurance Company 31325
Pella Products,, Inc. INSURER B:
Attn: John Benjamin INSURER C;
155 Main Street INSURER 0:
Greenfield MA 01301 INSURER E;
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,
A D D BY AI
INSR DD'L POLICY EFFQCTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIfn DATE MM/DDfYY LIMITS
GENERALLUIBILITY EACH OCCURRENCE S 1,000,000
DM
COMMERCIAL GENERAL LABILITY DAMAGE TO RENTED S 250,000 SES
A IF
RE acairrenc9l
CLAIMS MADE aX OCCUR CPA020470110 1/1/2007 1/1/2008 0 An One reon $ 10,000
PE A &A v $ 1,000,000
AQQREQATE S 2,000,000
GENT AGGREGATE LIMIT APPLIES PER; _ e 42 $ 2,000,000
—1 POLICY F7LjpER8j F7
LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT S 1,000,000
ANY ALTO (EA ACddenl)
A ALLOWNEDAUTOS HAA020470210 1/l/2007 1/1/2008 BODILY INJURY
X 9CHEDULEbAUToS
(PerPeredn) S
X HIRED AUTOS BODILY INJURY
X NON-OWNEb AUTOS (Per ecGdertt)
PROPERTYDAMAGE S
(Per accident)
13ARAOE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO OTHER THAN $
AUTO ONLY: OG
EXCESSAJM19RELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE ArGREGATE $
S
DEDUCTIBLE $
RETENTION
A WORKERS COMPENSATION AND X WC STATU- OTH-
EMPLOYE"'LIABILITY I EI
ANY PROPRIETORIPARTNER/EXECIITIVE E.L.EACH ACCIDENT S 500,000
OFFICERIMEMBEREXCLUDED? WCA020470510 1/1/2007 1/1/2008 EL.DISEASE- AEMP YEE$ 500,000
It yes,describe under
SPE.OJ61L,PROYISIONS E,L.DISEASE-P V LIMIT 500,000
OTHER
DESCRIPTION OF OPERATIONVLOCATIONSNEHICLE9fEXCLUSIONS ADDED BY ENDORSI?MENT/SPECIAL PROVISIONS
OPDX4ti.On9 USuAl to the sale & installation of Qooxa S windows
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Rob Stewart EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
316 South Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Northampton, DTA 01060
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR 41ABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE �.
ACORD 25(2001108) 0 ACORD CO. PORATION 1968
1NS025{0106}.060 Page 1 of 2