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05-056 (6)
453 AUDUBON RD BP-2021-1313 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05 -056 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTYFUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2021-1313 Project# JS-2021-002174 Est.Cost: $6838.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq. ft.): 194277.60 Owner: GORDON JOEL P Zoning: RR(100)/WSP(100)/WP(53)/ Applicant: PELLA PRODUCTS, INC AT: 453 AUDUBON RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:5/11/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE 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 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. 4 . Cg615/ Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/11/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / •'N The Commonwealth of Massachusetts / * /R Board of Building Regulations and Stan•: .”, of OR oi: Massachusetts State Building Code, 780‘ O �/T o�, <90 USE;TI`Y Building Permit Application To Construct,Repair,Renovate+ I lish a�/ ised 1l ar 2011 One-or Two-Family Dwelling °ti/4N'S,, f j}lis Section For Official Use Only °�°L6T�o'L �" 0- > /2) PP1/4sBuildingermit Number: � to Applied:e�i� er) 511-ZoZ 1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map&Parcel N ers x--15 3 Ac�dt u boa) N 14.4 N1 A'�:o '<DI : • l�. 1-. : 0001 1.1 a Is this an accepted street?yes X no Map Number Par - 'umber 1.3 Zoning Information: 1.4 Property Dimensions: Ci%s-ii Zas 1 d-er►)-i=i A. .. Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: -To e1 Gorc on.J 1-,e -c_cdsiilAA C. Io53 Name(Print) City,State,ZIP t-{ 5 3 A kcL - bo.>J 4t3-3av-1o'3. 2i p o cd ho+n,a:1.cunt No.and Street Telephone �r Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other (3/Specify: kepku\,JO- Poo 2 Brief Description of Proposed Work2: U 1/-CTDit = . 7.$ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ LP — 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ to 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ 9/ Suppression) ' Total All Fees: $6 22 Check Nei;Z).le'heck Amount: 44 Cash Amount: 6.Total Project Cost: $ tp i 3% — 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Cs —09 le 55cZ 3- I- CZ.et.J o ft— r0 S S License Number Expiration Date Name of CSL Holder List CSL Type(see below) V O Cr C.011..G-F St No.and Street Type Description ^ •�CIV �L1� ')J A!-! 13 O U� Unrestricted(Buildings up to 35,000 Cu.ft.) U R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 591 0% +bs O5sO aell4SaleS•CaM I insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ' a 1 q 3 -a3_2hv (I.. Pr0±U c+S HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 5$ MA I.k) ST pc< +S p c 11 a sal es.col No.and Street Entail address City/Town,State,ZIP (2 130 Telephone SECTION 6: 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 . ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize '€ to act on my behalf,in all matters relative to work authorized by this building permit application. ;Sd c\ G-o cdo - Scc ,4-7 rA€ac ) t--I- 1 -a- l Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in 's a lication is true an e to the best of my knowledge and understanding. — ZI Print Owner's o Authorized Agent's Name lectronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 Contract - Detailed 70 Pella Window and Door Showroom of Greenfield 240 Mohawk Trail Sales Rep Name: Langan, Brandon o 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: blangan@pellasales.com Customer Information Project/Delivery Address Order Information Joel Gordon Gordon Joel 453 Audubon Rd Leeds MA Quote Name: LS HPD 1252818 453 Audubon Rd 453 Audubon Rd Order Number: 739W3EL101 Leeds, MA 01053-9771 Lot# Quote Number: 13955136 Primary Phone: (413)3202042 Leeds,MA 01053 Order Type: Installed Sales Mobile Phone: County: Payment Terms: Fax Number: Tax Code: MASS E-Mail: jpgordon@hotmail.com Quoted Date: 4/16/2021 Great Plains#: 1006184314 Customer Number: 1010020076 Customer Account: 1006184314 Customer Notes: Price includes removal and disposal of old products, new products.installation,interior/exterior trim, building permit. Total-$6838 for special 20%discount. Pella Care garuntee included. Lifestyle Series Hinged patio door. Home built in 1987. For more information regarding the finishing, maintenance,service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 4/17/2021 Contract-Detailed Page 1 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 ustomer:Joel kooraon rroleci Name: Gordon Joel 453 Audubon Rd Leeds MA Order Number: 739W3EL101 Quote Number: 13955136 Line# Location: Attributes 10 Upper solarium Lifestyle, Double Inswing Door Fixed I Active, 71.25 X 79.5,Without HGP, Portobello Qty 1 1:7280 Fixed/Active Double Inswing Door n PK# Frame Size: 71 1/4 X 79 1/2 2086 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5 7/8",4 9/16",Standard Sill,Mill Finish Sill r-- nilExterior Color/Finish: Standard Enduraclad,Portobello Interior Color/Finish: Linen White Paint Interior _ Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Champagne,Multipoint Lock,No Integrated Sensor,Order Handle Set Viewed From Exterior Screen: Sliding Screen, Portobello,Champagne, InViewTM Performance Information: U-Factor 0.28,SHGC 0.22,VLT 0.41,CPD PEL-N-221-00392-00001,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,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=302". Frame Size:71.25"X 79.5" PD-1 -Patio Door Install up to 6FT in width Qty 1 EXTTRIM20-5/4 X 6 Exterior Style PVC Qty 1 Line# Location: Attributes 15 Interior trim Wood Products 3112 Craftsman 2, Length: 96, Linen White.Wood Type: Pine Qty 4 • 1: Accessory PK# Frame Size: 1 X 1 2086 General Information: Pine,3 1/2 Craftsman 2 Interior Color/Finish: Linen 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.pella.com Printed on 4/17/2021 Contract-Detailed Page 2 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 trustomer:Joe't.,oraon rroJect game: Gordon Joel 453 Audubon Rd Leeds MA Order Number: 739W3EL101 Quote Number: 13955136 Line# Location: Attributes 20 Jambs 2 27/32"w/kerf Solid Jamb Extension, Length: 96, Linen White.Wood Type: Pine Qty 3 1: Accessory PK# Frame Size: 1 X 1 7 !'' 1 2086 General Information: Pine,2 27/32"w/kerf Solid Jamb Extension Interior Color/Finish: Linen White Paint Interior Wrapping Information: Perimeter Length=0". Viewed From Exterior Frame Size:0"X 0" Line# Location: Attributes 25 None Assigned BPC -Permit-subject to change if actual cost greater than shown Qty 1 Line# Location: Attributes 30 Local Promotion Qty Thank You For Purchasing Pella® Products For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/17/2021 Contract-Detailed Page 3 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 t•ustomer:,joei,oruon rroject game: Gordon Joel 453 Audubon Rd Leeds MA Order Number. 739W3EL101 Quote Number: 13955136 PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system. Neither Pella Corporation nor the Seller will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening (egress)information does not take into consideration the addition of a Rolscreen [or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty, unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually, thereafter. Variations in wood grain, color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS: In addition, Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. Notice of Collection of Personal Information:We may collect your personal information when you interact with us. Under the California Consumer Privacy Act (CCPA), California residents have specific rights to request this information, request to delete this information, and opt out of the sharing or sale of this information to third parties.To learn more about our collection practices and your rights under the CCPA please visit our link https://www.pella.com/california-rights-policy/at pella.com. ARBITRATION AND CLASS ACTION WAIVER("ARBITRATION AGREEMENT") YOU and Pella and its subsidiaries and the Pella Branded Distributor AGREE TO ARBITRATE DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS (INCLUDES PELLA GOODS AND PELLA SERVICES)AND WAIVE THE RIGHT TO HAVE A COURT OR JURY DECIDE DISPUTES.YOU WAIVE ALL RIGHTS TO PROCEED AS A MEMBER OR REPRESENTATIVE OF A CLASS ACTION, INCLUDING CLASS ARBITRATION, REGARDING DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS. You may opt out of this Arbitration Agreement by providing notice to Pella no later than ninety(90) calendar days from the date You purchased or otherwise took ownership of Your Pella Goods.To opt out, You must send notice by e-mail to pellawebsupport(pella.com, with the subject line: "Arbitration Opt Out" or by calling (877)473-5527. Opting out of the Arbitration Agreement will not affect the coverage provided by any applicable limited warranty pertaining to Your Pella Products. For complete information, including the full terms and conditions of this Arbitration Agreement,which are incorporated herein by reference, please visit www.pella.com/arbitration or e-mail to pellawebsupport( pella.com,with the subject line: "Arbitration Details"or call (877)473-5527. D'ARBITRAGE ET RENONCIATION AU RECOURS COLLECTIF ("convention d'arbitrage") EN FRANC,AIS SEE PELLA.COM/ARBITRATION. DE ARBITRAJE Y RENUNCIA COLECTIVA("acuerdo de arbitraje")EN ESPANOL VER PELLA.COM/ARBITRATION. Seller shall not be held liable for failure or delay in the performance of its obligations under this Agreement, if such performance is hindered or delayed by the occurrence of an act or event beyond the Seller's reasonable control (force majeure event), including but not limited to earthquakes, unusually severe weather and other Acts of God, fire, strikes and labor unrest, epidemics, riots, war, civil unrest, and government interventions. Seller shall give timely notice of a force majeure event and take such reasonable action to mitigate the impacts of such an event. Product Performance Information: U-Factor, Solar Heat Gain Coefficient(SHGC), and Visible Light Transmittance (VLT)are certified by the National Fenestration Rating Council (NFRC). Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a fixed set of environmental conditions and a specific product size. NFRC does not recommend any products and does not warrant the suitability of any product for For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/17/2021 Contract-Detailed Page 4 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 ustomer:Joel oroon rrolect game: Gordon Joel 453 Audubon Rd Leeds MA Order Number: 739W3EL101 Quote Number: 13955136 any specific use. Design Pressure (DP), Performance Class, and Performance Grade (PG)are certified by a third party organization, in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests. The certification does not apply to mulled and/or product combinations unless noted. Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System (FPAS) Number and Texas Dept.of Insurance (TDl)number go to www.pella.com/performance. Refer to Pella Corporate Warranty HOMEOWNER -FOR YOUR INFORMATION LEGAL CONTRACT REQUIREMENTS FOR HOME IMPROVEMENT CONTRACTORS IS DETAILED BELOW THIS SITE RESPONSIBILITIES FORM IS PART OF YOUR CONTRACT WITH PELLA PRODUCTS INC. 155 MAIN STREET,GREENFIELD, MA 01301 HOME IMPROVEMENT CONTRACTOR REGISTRATION# 142279 EXP. 3-24-21 FEDERAL TAX ID#: 04-2303271 The law requires the following fourteen items to be included in any contract between the homeowner and a registered home improvement contractor in all contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the owner and a clear description of any other documents which are part of the agreement. 2. The full names,federal ID,addresses(not PO box#'s)of the parties,the contractor's registration number,the names(s)of the salesperson(s))involved,if any and the date the contract was executed by the parties 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4. A detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract. 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars,including all finance charges, if any. Any deposit required to be paid in advance of the start of the work shall not exceed one-third of the total contract price or the actual cost of any material or equipment of a special order or custom-made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. 7. All parties must sign the contract. 8. There shall be a clear and conspicuous notice stating: a. That all Home Improvement Contractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Registration Division,Program Coordinator One Ashburton Place-Room 1301 Boston,MA 02108 617-727-3200 x 25239 b. The contractor's registration number must be on the first page of the contract. c. The homeowner's three-day cancellation rights under MGL c93s48;NGK c 140D s lOor MGL c255D s 14 as may be applicable. d. All warranties on the owner's rights under the provisions of 780 CMRR6 and MGL c 142A e. In ten-point bold type or larger,directly above the space provided for the signature,the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f. Whether any lien or security interest is on the residence as a consequence of the contract For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/17/2021 Contract-Detailed Page 5 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 customer:Joel uoraon rrohect r4ame: Gordon Joel 453 Audubon Rd Leeds MA Order Number: 739W3EL101 Quote Number: 13955136 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth 11. Permit Notice: Every contract shall contain a clause informing the owner of the following: a. and all necessary construction related permits b. that it shall be the obligation of the contractor to obtain such permits as the owner's agent c. that the owner who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment:No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems himself to be insecure. However,where the contractor deems himself to be insecure,he may require as a prerequisite to continuing said work that the balance funds due under the contract,which are in possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute,the contractor wishes the dispute to be settled by arbitration,this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A Owner Contractor: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. When Pella Products,Inc.is the Builder or Contractor,as defined by the Vermont Residential Energy Standards(RBES)it agrees to meet or exceed the Vermont RBES then in effect with the products it installs. Unless the customer requests greater energy efficiency targets be met in writing prior to the execution of this contract,Pella Products Inc.will at its sole discretion determine how to best satisfy the basic RBES then in effect at the time of installation. Pella Products Inc.shall not be responsible for any windows or doors installed by third parties or the homeowner independently of the Pella Products,Inc.installation and it cannot certify that the project will meet or exceed the RBES when other parties install windows or doors that do not individually or collectively meet the RBES standards then in effect. The customer agrees to indemnify,defend and hold harmless Pella Products,Inc.from any and all claims related to the RBES related to windows and doors installed by third party installers or the homeowner. SERVICE LABOR WARRANTY:The standard Pella Service Warranty applies.Please note that any costs for equipment,scaffolding and safety equipment that is required to obtain access for large or to inaccessible units will be at cost of homeowner,even if these costs are incurred during the labor warranty period. This form constitutes a contract between Buyer and Seller. Prices are subject to change any time after 30 days following date of estimate and does not guarantee availability of any product listed. Pella Products Inc.management has final authority on acceptance of this order. Your signature confirms the accuracy of the product(s)chosen. For more information regarding the finishing, maintenance,service and warranty of all Pella®products. visit the Pella®website at www.pella.com Printed on 4/17/2021 Contract-Detailed Page 6 of 7 DocuSign Envelope ID:09660171-855E-46C0-BEC3-F07A833390C2 Customer:Joel uorcon r-roject Name: Gordon Joel 453 Audubon Rd Leeds MA Order Number: 739W3EL101 Quote Number: 13955136 [Project Checklist has been reviewed Joel Gordon Brandon Langan Order Totals �e (Please print) EFbai►c so:Rep Name (Please print) Taxable Subtotal $4,964.71 Jett t or�.etA, I f raan,�.bin, boAlaan, Sales Tax @ 6.25% $310.29 OSCGCOCr1CC]]Af11 1 Customer Signature vl e aE3 a eTTRep Signature 4/17/2021 4/17/2021 Non-taxable Subtotal $1,563.00 Total $6,838.00 --06tiSianea by: Date Deposit Received $3,419.00 Jett Gore A& Amount Due $3,419.00 ‘ xrocorDC.-- er 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 4/17/2021 Contract-Detailed Page 7 of 7 PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: 4- 1_I - a 1 To: U L 1 a-c LefeCi S 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. Denise Chartier Accounting Manager 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: February 21, 2021 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. Commonwealth of Massachusetts Ce1Mfr11Cllfln Supervrsynr Division of Professional Licensure Unrestricted-BWidhgs of any uee nn,p which contain Board of Building Regulations and Standards fess than 30.000 cubic feet ff01 cul,u rnilersi o1 enclosed Constafltlliw lefvis*r spate. CS-096558 s, ?; txp,res:0310112022 TREVOR BROSS i 10 GEORGE STREET GREENFIELD MA 01301 , Failure to possess a current edition of the Massachusetts COm r t o s ti!s rtcr %...f i w°N""�.1 State Building Code is cause for revocation of this bcense. For information about this license limsoisidl Call(617)727-3200 or visit www.mass.govldpiair.J ..Re V!/ ,,wdevxi'rvil//if. //,i:.iriey"i.. /.4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 142279 03/23/2022 1000 Washington Street -Suite 710 PELLA PRODUCTS,INC. Boston,MA 02118 ELWIN HERRINGSHAW r' l • /_, 155 MAIN STREET ,,,osf lG ,:z64, GREENFIELD,MA 01301 Undersecretary Not valid without signs 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 Christian Lambert CS065102 Robert Kairnes CS113305 Igor Kravchuk CS094911 The Commonwealth of Massachusetts Department of Industrial Accidents =.= —= �= Office of Investigations f Lafayette City Center =:I 2 Avenue de Lafayette, Boston,MA 02111-1750 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.® I am a employer with 50 4. II 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p t3' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.; required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.1=1 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 the policy and job site information. Insurance Company Name: EMC INSURANCE COMPANIES Policy#or Self-ins. Lic. #:6H15382 Expiration Date:01-01-2022 Job Site Address: "I 5 3 AL,A LLbO.X Z0(. City/State/Zip: Lced, A f)- 01053 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 DTA for insurance coverage verification. I do hereby certify de the pains and pe ' of petjury that the information provided above is true and correct. Signature: Date: 14— o)•1' a 1 Phone#: `ii3— 514 - 59 (s:S Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3.City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: PELLPRO-01 CHRISTINE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IDDIYYYY) 12/21/2020 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 CONTACT Christine Sullivan NAME: Philips Insurance Agency,Inc. PHONE PAX 97 Center Street c,No,IBM:(413)594-5984 trot,No):(413)592-8499 Chicopee,MA 01013 48:christinegphlllipslnsurance.com INSURERS)AFFORDING COVERAGE NAIC S INSURER A:EMC Insurance Companies 21415 INSURED INSURER a:Union Insurance Co of Providen Pella Products,Inc INSURER C: 155 Main St EISURERD: Greenfield,MA 01301 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EIBR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POUCY EXP URTS LTR INSD WVD (MMIDD/YYYYL(MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2021 1/1/2022 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POUCY I X JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (1 COMBIEa NED SINGLE LIMIT $ 1,000,000 X ANY AUTO 6215382 1/1/2021 1/1/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY AUTOS BODILY pR INJURY(Per accident) $ _. AUTOS ONLY AUTO ONLY (Per P ER tDAMAGE 1 $ A X UMBRELLA UAS X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE 6.115382 1/1/2021 1/1/2022 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 6H15382 1/1/2021 1/1/2022 EL.EACH ACCIDENT $ 500,000 OFFICERIP M EXCLUDED? N N/A (Mandatory in ) , EL.DISEASE-EA EMPLOYEE $ SOO OOO If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached if more space is required) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Leeds(Northampton)BuildingCommissioner's THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( p ) ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main St -- - _ ' --— Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD