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23B-054 (5) 40 BERKSHIRE TER BP-2020-0340 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-054 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-2020-0340 Project# JS-2020-000576 Est. Cost: $4351.00 Fee: $40.00 PERMISSION IS HEREB Y GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq. ft.): 10890.00 Owner: ERBA MARK Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT. 40 BERKSHIRE TER Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON.9/16/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.4 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 9/16/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 20- 3q Department use only 0. City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit (, 212 Main Street Sewer/Septic Availability (; Room 100 WaterNVell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 PropertV Address: This section to be completed by office Map Lot VJ Unit Zone Overlay District `4 j —T (- Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT f 2.1 Owner of Record: Name(Print) Current Mailing Address: -'? �/i 3 • s��o•6r�o ,�3 y 7- �,3 7- dk�k Telephone Signature 2.2 Authorized A ent: 0 Cgc= }(-)Fft-n-Zl d QUA 0 Name(P ) Current Mailing Add ss: X113---1-7 3- 115 Signature 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 0 4. Mechanical(HVAC) — D 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only BuildingPermit Number Date Issued: Signature: / 7- 2U/ 1 Building Commissioner/Inspector of Buildings Date 7bMSS @ '�t 110SOi It - r cn-) EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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/Findigg ever been issued for/on the site? NO 0 DONT KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at theR gistry of Deeds? NO 0 DONT KNOW YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW NJ YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O Date Issued: C. Do any signs exist on the property? YESO NO 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 IF YES, describe size, type and location: }�V 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 Q 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 Replacemeiat windows Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[C7] Other[E7] Brief D cription of Pro os d MWork: 1 ngrs V v , 1 U FAC 0' 0.2-9 ����"" Alteration of existing edrErn Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes --'so 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, &/� tL) ��,�'/� as Owner of the subject property hereby authorize to act on my behalf, all afters relative to work authorized by this building permit application. Signature of Owner Date I, ► tC 11L1 V�TArk --(-_ 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. V Print Na 1 (42 Signature f OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not ApplApplicableicaabee ❑ Name of License Holder: �� V cs- o -1 (0554 License Number 1 O C'-x--n one (s-�-. C seen-Fzdd M�- nim] Address U Expiratibn Dat Sig elephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 1 l(3 � I g 2.2-D 9 Company Name Registration Number ) 5---) Q j n S T C> �Q� l 01�O 12-5 1-2o 20 Address Expirat n Date Telephone ) -J 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...... No....._ ❑ 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. Cortrnomveafth of MassaChUS011% tl � ConstruQwn Supervisor Dtvis+on of Prafessronaf t.tnelWAMe Restricted to Board of SM16411rto paytalsdoae ani 8111110dMOS Unrestricted-Buildings o1 any use group which contain ors;r�CtlL' Or lr o less than 35,000 cubic feet(991 cubic meters)of enclosed space CS-096558 TREMOR M661111 10 WORSE OREENFIELO(AA Fasure to possess a curnM ad0m of the Massad weaft Stals code is pass 1w ferocallim or Ids ttaaftss. CommissionerIftllw"No"rias WAVI.AiAttdi01Ymm ., office of Consumer Attalra i Business ReguUtlon NOME IMPROVEMENT CONTRACTOR Registration valid for Individual use oMy TYPE:Suooternent Card before the mmirstlon date. if found return to: Office of Consumer Atfa and Business Regulation 142279 oa232020 One Ael+bu Pleoe. *1301 80a1on, PEVA PRODUCTS.WC. TREVOR BROSS 155 MAIN STREET Not valid without signature GREENFIELD.MA 01301 Llndersecretmy 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 C5106010 Vladimir Shevchuk CSSLO99209 Scott Bowdish CSSL100232 Bill Leger CS89338 David Ruffner C557308 Brian Thompson CS67121 Igor Kravchuk CS094911 PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: To: 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; ISS 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, PELTA PRODUCTS, INC. John P_ Benjamin Accounting Manager The Commonwealth of Massachusetts Department of Industrial Accidents Office of In vestigations 600 Washington Street Boston, AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPLicant Information /- { Please Print Legibly Narnp(Business/OrgailLmtirnJlndividnal): C�(c7 /C -- City/State/Zip SEE 4�34 Phone #: Are you an employer?Check the appropriatee °x: Type of project(required): 1.[M I am a employer with 59 4- l�1 am a general contractor and 1 employees(full and/or part-time).* `have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. gRemodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9_ ❑Building addition [No workers`comp.insurance comp,insurance.« required_] 5. [] We are a corporation and it-. 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I_❑ Plumbing repairs or additions myself.[No workers'comp- right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] Any applicant that checks box a I must also fill oul the action 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 anached at..additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractor 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 sit,- Information. iteInformation. Insurance Company Name:--z�c67 Policy 4 or Self-ins.Lic.#: �,(l/f/� QpZ Expiration Date:_ Ql:�DOz� Job Site Address: 40 1 FC ��f- City/StateJZip: I 1�1�� Q'M2— Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)L Failure to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fare 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 DI_A for insurance coverage verification. I do hereby cerd nd r the pains andn lk ury that the information provided above is true and correct Te _ signature, (G ate: j Phone#: Official use only. Do nor write in this area,to be compfeted by city or town official. City or Town:_ Permit/Lieeuse 9 Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S_Phtrttbin-- lnspector 6.Other _ Contact Person:------- _ Phone#: 1 ® IDATE(MMI)DYY /YY ) ACCERTIFICATE OF LIABILITY INSURANCE 01!04/2019 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 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 UUM NAME:CT Maureen Cormier Berkshire Insurance Group,Inc. AICONN Ext, (413)773-9913 AIC,No: (413)T74-3872 117 Main St. nooaeSs: mcormier@berkshireinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIL 8 Greenfield MA 01301 INSURER A: Citizens Ins.Company of Amer 31534 INSURED INSURER e: Allmenca 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: 19GL,Auto,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. —1.—i PULICY EFF —FO—LEXP L TR TYPE OF INSURANCE INSD PIVD POLICY NUMBER MM/DO/YYYY MM ICID MYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000GAMAut 10 RtzN ILL) 100,000 CLAIMS-MADE [XI OCCUR PREMISES Ea omu—nce S MED EXP(Any one person) $ 10.000 ZBND459395 01/01/2019 01/01/2020 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 5 2000,000 X POLICY ❑PR6JECTF�LOC PRODUCTS-COMPIOP AGG $ 2000,000 S OTHER: CBINED AUTOMOBILE LIABILITY -(Eaacade,t SINGLE LIMI 1,000,000 j X ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED AWND459487 01/0112019 01/01!2020 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acadent 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ HDED RETENTION$ S WORKERS COMPENSATION X STATUTE ERPER S AND EMPLOYERS'LIABILITY Y I N 500,000 C ANY PROPRItIOR/PARTNEWEACCUTIVE lul NIA WHND376502 01/0112019 01/01/2020 F.I. FACH ACCIDENT $ _ OFFICERIMEMBER EXCLUDED? I`_` JI E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS bel.. E.L.DISEASE•POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations usual to the sale and 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 ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Schulz, Jonathan 69 Ashley Avenue Sales Rep Phone: 413-736-9239 West Springfield, MA 01089 Sales Rep Fax: 413-736-3390 Phone: (413) 736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: jschulzd@pellasales.com Customer Information Project/Delivery Address Order Information Mark Erba Erba Mark 40 Berkshire Ter Florence MA 011062 Quote Name: Erba Mark 2372608 250 Garage Windows 40 Berkshire Ter 40 Berkshire Ter Order Number: 739T2JS031 FLORENCE, MAO 1062-1914 Lot# Quote Number: 11772280 Primary Phone:(347)6370868 Florence, MAO 1062-1914 Order Type: Installed Sales Mobile Phone: County: Payment Terms: C.O.D. Tax Code: MASS Fax Number: Quoted Date: 8!29/2019 E-Mail: mark3722@gmail.com Great Plains#: 1005388657 Customer Number: 1009294002 Customer Account: 1005388657 Customer Notes: Previous Pella Customer. House built 1910. Includes installation,building permit,sales tax,and disposal. Tested-09/03/2019-No Lead Paint Line# Location: Attributes 15 Studio Pella 250 Series, Double Hung, $1 $953.01 2 ,906.02 $1 X 64, Almond Item Price Qty ExtPrice ( 31 `5 '-<4 1 fl 1: Non-Standard SizeNon-Standard Size Double Hung,Equal J PK# Frame Size: 33 1/2 X 64 L I P 2043 General Information: Standard,Vinyl, Block, Foam Insulated,31/4", 3 1/4",Sill Adapter Included, Head Expander Included Exterior Color/Finish: Almond U Interior Color f Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude s Hardware Options: Cam-Action Lock,Almond, Standard Vent Stop, No Limited Opening Hardware Viewed rom Exterior Screen: Full Screen,Conventional Fiberglass Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00087-00001,Performance Class R, PG 30,Calculated Positive DP 9 7i'S Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Egress Meets Typical for ground floor 5.0 sgft(E1)(United States Only) Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length= 195". Frame Size:33.5"X 64" PF-1 -Interior Pocket Installation 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 9/312019 Contract-Detailed Page 1 of 9 r Customer: Mark Erba Project Name: Erba Mark 40 Berkshire Ter Florence MA 01062 Order Number. 739T2JS031 Quote Number: 11772280 Line# Location: Attributes Item Price Qty Ext'd Price 20 Studio Pella 250 Series, Double Hung„-,,A XA Almond $1,128.61 2 $2,257.22 1 �1,S "16 I` 1: Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 33 1/2 X 64 61 2043 General Information: Standard,Vinyl, Block, Foam Insulated,3 1/4",31/4",Sill Adapter Included, Head Expander Included Exterior Color 1 Finish: Almond Interior Color/Finish: Almond Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude .5• --- Hardware Options: Cam-Action Lock,Almond, Standard Vent Stop, No Limited Opening Hardware Viewed rom Exterior Screen: Full Screen,Conventional Fiberglass Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00087-00004, Performance Class R, PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111, Egress Meets Typical for ground floor 5.0 sqft(E1)(United States Only) Grille: No Grille Wrapping Information: Pella Recommended Clearance,Perimeter Length=195". Frame Size:33.5"X 64" PF-1 -Interior Pocket Installation Qty 1 Line# Location Attributes 30 Building Permit BPC - Permit-subject to change if actual cost greater than shown Item Price Qty Ext'd Price $65.00 1 $65.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 9/3/2019 Contract-Detailed Page 2 of 9 Customer: Mark Erba Project Name: Erba Mark 40 Berkshire Ter Florence MA 01062 Order Number: 739T2JS031 Quote Number: 11772280 [project Checklist has been reviewed Order Totals j Customer N e (please pant; Pella Sales Rep Name (Please pnm) Taxable Subtotal $2,893.18 Sales Tax @ 6.25% $180.82 i Customer Signature 7—efla/Sales Ignature Non-taxable Subtotal $1,277.00 � 3/app Total $4,351.00 Date a Deposit Received $0.00 Amount Due $4,351.00 C dit Card A r'Mg Signature I 1�00 'bir�c'os l 6-0 0-4 o-4 &cPmPLr i�oYJ For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pelia.com Printed on 9/3/2019 Contract-Detailed Page 9 of 9