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04-010 (4) i 640 KENNEDY RD BP-2020-0443 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:04-010 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2020-0443 Proiect# JS-2020-000757 Est.Cost: $6934.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(ssq.ft.): 269070.12 Owner. AQUADRO Zoning: RR(100)/WSP(10�) Applicant. PELLA PRODUCTS, INC AT. 640 KENNEDY RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON.10/1012019 0.00:00 TO PERFORM THE FOLLOWING WORK.-REPLACEMENT DOOR 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 Firtplace/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 i signature: FeeTvpe: I Date Paid: Amount: Building 10/1 /2019 0:00:00 $40.00 212 Main Street, Phone(41.3)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �) (30Z _ Department use only ' City of Nort am r.z. r 1nWerA ermit: t ' 1 V - BUlldlrl0 D art trivewayPermit 212 Mai Stre t tic Availability X Roo 100 0 - 2019 AvailabilityNorthampto , MA 01060 f Structural Plans phone 413-587-124 Fa -587-1272 ans nr �F r Ail nin;r,intsaFcify R APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVA H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION /"` W—Y V3 1.1 Property A,dddrees( ( ffi s: � (� This section to be completed by oce cpj 0 tl cl1`&j f \�o Map--P—(� Lot Unit Le.-- S kA 01 a 5 3 Zane Overlay District Elm St.District _ CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r_d � IQ f 111/ � Name(Print) Current Malin Address: ¢— 1 f(Lr�4t Telephone Signature /' 2.2 Authorized Agent: Trey m Pim,s _-- 10 GCCEQQ s�,Crc_c�n�1 d MA o► 301 Name(P' t) Current Mailing A ress: Signatur Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only -- -- com leted by�ermit 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=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: )0 V0 f Building Commissioner/Inspector of Buildings - Date 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—___ L: R:_�_' Rear -------- Building ___-_.Building Height Bldg. Square Footage % Open Space Footage aha (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) _ A. Has a Special Permit/Variance/Findi g ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at theRe istry of Deeds? NO 0 DONT KNOW YES O IF YES: enter Book Page and/or Document# . 6. 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 O Obtained Q , 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 O NO 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 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 [-1 Addition ❑ Replacement y(indows Alteration(s) EF-] Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [Q] Decks [M Siding D01 Other[Q] Brief D cri doof Propose Work: t X nq CM i oQ .W i S1-0 �U► i U QC r= 0.30 Alteration of existing bedroom Yes No Adding new bedroom Yes _�_No Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll -Sheet 6a.if New house and or addition to existing housing, comalete 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 dOR GONTRAGTOR APPLIES FOR BUILDING PERMIT operty I, J ;C,4--r u �'�� �^C as Owner of the subject prn hereby authorize f ��C' P--odc-4,!� h G to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner ( �` DateT-/ /Q 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. Sig ned und er the pains and penalties of perjury. Date i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable /❑ Name of License Holder \ . V` j License Number dVLA 301 cam- - Address Expir ion bate �1 a ph ne 3--773 -1157 5i 9.Registered Home Improvement Contractor: Not Applicable ❑ Pe 11 IP mdu&s-TfY' M z z Company Name Registration Number j��a.-Mcun. sj, Id A4A X1301 2-3 202-6 Ad ress ExpiratioA Date Telephone — 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...... ❑ Pelle 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 S,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-096SS8 and my HIC# 142279. Please find a copy of my licenses below. Commonwealth of Massachusetts Construction Supcnnsor Division of Prot"wonal Licensureti Restricted to Board of&+>kpny Rapulahone and Standards Unrestricted-Buildings of any use group which contain t%��r`r uQ r„ear less than 35,000 cubic feet(991 cubic meters)of ;f enclosed space CS 4)%558 E� f TREVOR aR&S WOEORAEt tiWA FEW MAI Fallum to possess a cumn i sdMa►of the lMassagNmeft (hate Budding Code is cause(tor ri evocasm off&Nabs a. Commissioner DPS Lkerisift Infotmalilon vblR:tMNW MASS QMMPs.. .� /rrr rrr rNlN(INrI���I � ONlcs of Consumer Attalr�aness Dust”"Regulation ROME IMPROVEMENT CONTRACTOR ReglalraWn valid for individual use only TYPE:Sucolement Card before the expiration date. If found retum to: 11294S[ati99 Exolratlon Office of Consumer Aria and Bualtleaa Regulation 142279 0323.2020 one Ashburt Place- e 1301 PELLA PRODUCTS.INC. ' TREVOR BROSS - 155 MAIN STREET Notvaifd 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 City of Northampton Massachusetts �A DEPARTMENT OF BUILDING INSPECTIONS 7{ 212 Main Street *Municipal Building J�;.,, •`y` Northampton, MA 01060 fs`• Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: - . - . I . A V)QQ d — (Please print house number aM street name) Is to be disposed of at: tb Ha 0 R CGyconrh��ld (Please print name 6nd location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ,5ignaturprot permit Appiicant of Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. \ The Commonwealth ofMassachusetts Department of IndtistrialAccidents Office of In vestigations 600 Washington Street Boston,MA 02111 www.ntass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers App Licant Information Please Print Le 'blv NStt1e(Business/Organizatioti/Individual): r ���� �C Address:_ - rT_ /V/�i� City/State/Zip SEE Phone ': r/C:lDemolition Are you an employer?Check the appropriate�°z:Iam a employer with 4. (J� i am a general contractor and Ict(required):employees(full andlor part-time).* • `have hired the sub-contractors nstruction2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. lingship and have n°employees These sub-contractors have working for me in any capacity. employees and have workers' [No workers'comp. insurance comp.insurance.; 9. ❑Building addition required.] 5. We are a corporation and its 10.[]Eiectricat 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 insurance required.]+ c. 152,§1(4),and we have no 12-El Roof repairs employees.[No workers' 13.❑Other t omp.insurance required.] 'Any applicant that checks box#l must also fill out the section below showing the workers'compensation polity 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 mtm attached an additional sheet showing the name of the sub-contractors and state whether er not those entities have employees. If the sub-conrm(Aws have employees,they must provide their workers`comp.policy number. are an employer that rs providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name; c-70�n!fl n S Fi rX� r rcu f✓ Policy#or Self-ins.Lic.#:_ ('.(��7e/y Expiration P �,'a1- Q���,.__ Ex on Date: Job Site Address: `1�J1 I� City/State/Zip: L t e S ���Q�j Attach a copy of the workers' compensation policy declarationsho�c ine aopolicy P e (showing the po cy number and expiration date)- Failure to secure coverage as required under Suction 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cerYlry under the pains and penalties o erjury that the information provided above is true and correct_ Signature: Phone#: Of.ftciai use only. Do not write in this area,lobe completed by city or town official City or Town: _Permit/License 9- Issuing Authority(circle one): !. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5-Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 -CONTe NAME: Maureen Cormier Berkshire Insurance Group,Inc. PHONE 117 9913 A (413)774-3872 A!C No Ext: AIC,No 117 Main St. L ADDRESS: '"ier@berkshireinsurancegroup.com INSURER'S)AMCOVERAGENAIC t Greenfield MA 01301 INSt1RER A: Citizens Ins Com31534 INsuRED INstIRERe: Allrnen-Financia41840 Pella Products,Inc. INSURER c: Hanover Insurance22292 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, NSRwDM sum LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM C/DDNYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE S CLAIMSMADE OCCUR DAMAGE TO R PREMISES Ea occurrcna 5 100,000 MED EXP(Arty one person) S 10,000 A ZBND459395 01/01/2019 01/01/2020 1,000,000 PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000,000 X POLICY O PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED AWND459487 01/01/2019 01/01/2020 BODILY INJURY(Par—d..t) S AUTOS ONLY AUTOS HIRED NON-ONMED ROPERTY DAMAG=, — P AUTOS ONLY AUTOS ONLY Per accrdentUMBRELLA LIAR OCCUREACH OCCURRENCEXCESS LUIS CWMS-MADEAGGREGATEOED RETENTION SWORKERS COMPENSATION AND EMPLOYERS'LIABILITY ,,I N X C ANY PROPRIETOR/PARTNER/EXECUTIVF E.L EACM ACGDENT S 500,000 OFFICER/MEMBER EXCLUDED? rN NIA VVNND376502 01/01/2019 01/01/2020 (Mandatory in NH) 500,000 H yes,describe under, E.L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE /� Northampton MA 01060 / .v .__ LJCA— ©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 Sphingfield 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 Project/Delivery Address Order Information Richard Aquadro Aquadro Richard 640 Kennedy Rd Leeds MA Quote Name: 2348853 Lifestyle 413-584-0495 640 Kennedy Rd JSD 640 Kennedy Rd. Order Number: 739T2JL071 LEEDS, MA 01053-9757 Lot# Quote Number: 11613646 Primary Phone:(413)5840495 LEEDS, MA 01053-9757 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: Quoted Date: 7/20/2019 Great Plains#: 1005001670 Customer Number: 1008968420 Customer Account: 1005001670 Line# Location: Attributes 10 Kitchen Lifestyle, Triple Sliding Door, Contemporary, Fixed I Vent Right/ Fixed, 108.039 X Qty 81.5, Puttv 1 1: 10882 Fixed/Vent Right/Fixed Triple Sliding Door LO PK# Frame Size: 108 1/16 X 81 1/2 2045 General Information; No Package,Without Hinged Glass Panel,Clad, Pine,5 7/8",4 9/16",Oak Threshold CID Exterior Color/Finish: Standard Enduraclad, Putty Interior Color/Finish: Unfinished Interior Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Black,Standard, Handle Included, Handle Included, Brown, Putty, No Integrated Sensor Viewed From Exterior Screen: Sliding Screen,Wood Interior Color Matched Exterior, Brown, Inview'" Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.52,CPD PEL-N-230-O0006-00001, Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year Rated 08111 Grille: No Grille, Wrapping Information: Foldout Fins, Factory Applied, No Exterior Trim,4 9/16",5 7/8",Factory Applied,Pella Recommended Clearance, Perimeter Length=380". Frame Size: 108.039"X 81.5' EXTTRIM15-Kick board, up to 7-1/4 inch match ext trim PVC Qty 1 LP-1 -Lead safe practices this opening Qty 1 PD-3-3-Wide Patio Door Install Qty 1 EAC-1 -Exterior Aluminum Capping(Coil Stock) 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 9/18/2019 Contract-Detailed Page 1 of 12 Customer: Richard Aquadro Project Name: Aquadro Richard 640 Kennedy Rd Leeds MA Order Number: 739T2JL071 Quote Number: 11613646 q�tProject Checklist has been reviewed +/__� 2 0 jjag 1) � � �i� ��� � Order Totals Customer Name (Pie se print) Pella Sales Rep Name (Please print) Taxable Subtotal $4,799.06 V OSales Tax @ 6.25% $299.94 1 Customer Signatures— Pella Sales Rep Signature / Non-taxable Subtotal $1,835.00 I is� /� Total $6,934.00 Date Date Deposit Received $3,467.00 Amount Due $3,467.00 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 Printed on 9/10/2019 Contract-Detailed Page 9 of 9