Loading...
10B-033 (2) BP-2021-2087 8 UPLAND RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10B-033-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2087 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 4032 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date:03/01/2022 Use Group: Owner: O'CONNOR JUSTIN S& HEIDI A STEVENS Lot Size (sq.ft.) Zoning: URA Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155 MAIN ST (413)772-0153 6H15382 GREENFIELD, MA 01301 ISSUED ON:10/27/2021 TO PERFORM THE FOLLOWING WORK: 2 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. Signature: � • 1 . .Il Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner , 11 The Commonwealth of Massachusetts *w Board of Building Regulations and Standards FOR - -,Qr 1 Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Build' Permit Number: A0•- 0 g 7___/,_,Date Applied: E ) (.255 id_,,, ,Oz, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers rt U W'�Ct P4 NPA-m O/O& _33/_ 0 00 / 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: , 1.4 Property Dimensions: C,4lSfilI14 reSlctDithat 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❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 er'of Record: co( SI-ev,eriS s, rn� to53 Name t rint) City,State, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other V Specify: 1,,e)0I a Ce_f__Y._11'.bt Brief Descr' Lion of Proposed Work2:--77�� �4 07" a- «Xistm J1UaI o 1n il G C C(f r k)L I( (CJ`h(f )it hiocum SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ yU 3 a, 6,) 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check Not 3� eck Amount: 1U Cash Amount: 6.Total Project Cost: $(,/ 0 3 a, 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) M JOr 6(ZS License Number Expiration Date Name o'‘...St.,Holder ) o cl— List CSL Type(see below) V No.and Street ly Type Description grecr ( ir/d l /' Y n �'3,lV l Unrestricted(Buildings up to 35,000 Cu.ft.) Cit own,State,ZIP n I t7 Restricted 18a Family Dwelling M Masonry RC Roofing Covering WS Window and Siding f ] T SF Solid Fuel Burning Appliances "l i 3 77, 0 iS3 a•Ymitel�n rr/fI 6Q f'Covi I Insulation Telephone Email address D Demolition 5.2 Regist ed Home Improvement Contractor(HIC) /`� 1 -,-p� 3. 013 3. 1a I��C n HIC Registration Number Expiration Date HIC Co Name or H C Registrant Name Si—' p yr p e lI C JCtLQ cce No.and treet Email address )Fjf0( nitq 0 ?vl tll, 77a 0113 City ,State,ZIP Telephone )3!7. 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 L4 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize PkL. 2 1 U-C-'`t . to act on my behalf,in all matters relative to work authorized by this building permit application. a- -ht c 4i I Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest er the pains and penalties of perjury that all of the information contained in t ' a plication is true d e to the best of my knowledge and understanding. Print Owner's Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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" DocuSgn Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 Contract - Detailed ?4,4 Pella Window and Door Showroom of Greenfield Sales Rep Name: Langan, Brandon 240 Mohawk Trail Sales Rep Phone: 413-774-7231 Greenfield, MA 01301-3209 Sales Rep Fax: 413-774-6348 Sales Rep E-Mail: blangan@pellasales.com Customer Information Project/Delivery Address Order Information Heidi Stevens Stevens Heidi 8 Upland Rd Leeds MA Quote Name: LS 1728348 8 Upland Rd 8 Upland Rd Order Number: 739W3JL06I Leeds, MA 01053-9725 Lot# Quote Number: 14472112 Primary Phone:(413)5881327 Leeds,MA 01053 Order Type: Installed Sales Mobile Phone: County: Payment Terms: Fax Number: Tax Code: MASS E-Mail: heidi@heidistevens.com Quoted Date: 8/18/2021 Great Plains#: 1006403907 Customer Number: 1010229033 Customer Account: 1006403907 Customer Notes: Price includes removal and disposal,new products,interior/exterior trim where necessary,installation,and building permit. Pella Care Garuntee included(10 year labor warranty). Total-$4,032.00 50%deposit and remaining due upon completion. Lifestyle series wood/clad windows. Home built in 1900.Lead safe practices throughout. 2 master bedroom dh.Lifestyle series pocket replacement with color matched backer rod and caulking. For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/18/2021 Contract-Detailed Page 1 of 7 DocuSign Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 customer: neioi atevens rroject Name: Stevens Heidi 8 Upland Rd Leeds MA Order Number: 739W3JL061 Quote Number: 14472112 Line# Location: Attributes 15 Master Bedroom Lifestyle, Double Hung,30.5 X 57.25,Without HGP,White Item Price Qty Ext'd Price $1,977.39 1 $1,977.39 MIN; ; 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 30 1/2 X 57 1/4 2095 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Gray u-, ft Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior ( Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor Viewed From Exterior Screen: Full Screen,White,InViewTM' Performance Information: U-Factor 0.30,SHGC 0.27,VLT 0.50,CPD PEL-N-35-00426-00002,Performance Class LC,PG 40,Calculated Positive DP Rating 40,Calculated Negative DP Rating 40,Year Rated 08111,Clear Opening Width 27.312,Clear Opening Height 25.375,Clear Opening Area 4.812792, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/OWOH),White,White Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=176". Frame Size:30.5"X 57.25" LP-1 -Lead safe practices this opening Qty 1 AC-MSF-Minimum Set up Fee(less than 2 FF or 5 Pockets) Qty 1 PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1 Line# Location: Attributes 20 Master Bedroom Lifestyle, Double Hung, 30.5 X 57.25,Without HGP,White Item Price Qty Ext'd Price $1,577.39 1 $1,577.39 i ;! 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 30 1/2 X 57 1/4 2095 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Gray ' Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor Viewed From Exterior Screen: Full Screen,White,InViewT"' Performance Information: U-Factor 0.30,SHGC 0.27,VLT 0.50,CPD PEL-N-35-00426-00002,Performance Class LC,PG 40,Calculated Positive DP Rating 40,Calculated Negative DP Rating 40,Year Rated 08111,Clear Opening Width 27.312,Clear Opening Height 25.375,Clear Opening Area 4.812792, Egress Does not meet typical United States egress,but may comply with local code requirements Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/OWOH),White,White Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=176". Frame Size:30.5"X 57.25" LP-1 -Lead safe practices this opening Qty 1 PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) 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 9/18/2021 Contract-Detailed Page 2 of 7 DocuSign Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 customer:Neu atevens rro)ect Name: Stevens Heidi 8 Upland Rd Leeds MA Order Number: 739W3JL061 Quote Number: 14472112 [Project Checklist has been reviewed Heidi Stevens Brandon Langan Order Totals /CLI4Sgraglb (Please print) yall@ApAlMitesp Name (Please print) Taxable Subtotal $2,524.24 c ,e4 5 „ t5rav- ,e1n, OitluA, Sales Tax @ 6.25% $157.76 oarw sons uo ustome gigs M re Pella'Safen'ep' ignature 9/19/2021 9/18/2021 Non-taxable Subtotal $1,350.00 Total $4,032.00 ,Beteocesigned by: Date Deposit Received $0.00 {c�j Amount Due $4,032.00 ` /^ID^fr'71410'Ca . 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 9/18/2021 Contract-Detailed Page 7 of 7 DocuSign Envelope ID:2C972191-8B0E-4A86-AE3C-8D64AAF53F40 0 Project Name: Heidi Stevens Today's Date: 9/19/2021 Quote#: 14472112 This is a "Do-it-Yourself" project all dimensions, attributes, installation, and disposal are the responsibility of others. Signature: We cannot guarantee that existing window treatments(i.e.Shades,Blinds,and Interior Shutters) will fit on new Pella Windows/Doors. This is an Installed project Condition of Work: 1.50%Deposit required at time of order. 2. Final payment is to be made to installation team on the final day of installation. 3.If the customer will not be present at time of install,payment is to be made prior. 4.Checks returned NSF will be assessed a fee of$50.00 to cover fees incurred by Pella.Failure to pay your final bill will result in finance charges of 1-1/2%per month(18%Annual)and legal fees associated in the collection of owed monies. 5.We cannot guarantee/will not your existing shades and blind will fit in your new windows. 6. Due to inclement weather or site conditions,it may be necessary to reschedule. 7.We cannot and will not guarantee specific dates or days of the week for installation. 11 8.Time given to complete a job is an estimate,extension of time is possible. 9.An install appointment will be confirmed at Verification.A courtesy reminder call will be placed 3-days prior. 10.Unforeseen rot repair will be quoted on site as additional work via a Field Change Order.Rot repair or additional installation charges are due at the time of installation and cannot be financed through GreenSky Financing,Check or Credit Card Payments only. 11. Upon Substantial Completion final payment is due,Substantial Completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 12.In the event any products are unable to be installed,the final payment will be recalculated.The cost of the products not installed will be subtracted from the balance due.A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 13.Pella will secure all necessary Building Permits. For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Type of Installation: X New Construction:(tear out installation-existing frame is disposed of) Remove interior and exterior Trim,remove existing window frame,install new window in rough opening,trim both interior and exterior of window/door. Pocket Install:(sash replacement,existing frame remains) x Remove interior or exterior window stops,install new window in existing sash opening, re-use existing or replace window stops.Some glass loss will occur. Lead Paint Discloser: x Home was built prior to 1978,Pre-Renovation Form signed and"Protecting Your Family From Lead in Your Home" brochure has been given to the Home Owner. —Are there children under the age of 6 or women who are pregnant? DocuSign Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 Condition of Work(Continued): Owner Will: Y Authorize installation of Yard Sign 7-10 days prior to installation date and removed after installation is complete. Ensure someone over age 18 is present at all times while Pella Employees are in the home _Cut-back or tie trees,bushes,shrubs from exterior wall (Grass and Shrubs may be damaged during construction) _Have alarm system disconnected and reconnected-Pella Products can re-route wires but cannot reconnect _Have any plumbing or electrical repairs by appropriate licensed contractor-$500 charge if unprepared on 1-Day job Remove and reinstall window treatments,wall hangings and A/C Units-4-5 feet in front/1 foot to side with clear path _Remove and reposition furniture in work area r DS _Secure pets in a safe manner —Remove valuable/breakable items from work area _Remove snow from area of worksite if necessary Pella Products Will: _Deliver and unload products _Place drop cloths in work areas _Remove and reinstall interior and exterior trim if applicable _Remove and reinstall existing shutters and awnings by contract _Remove existing product and adjust or modify opening as needed _Provide all equipment necessary to install products _Cut all wood and other materials outside of home Install all products purchased _Insulate and caulk around products Remove stickers and perform initial cleaning of all glass surfaces Demonstrate proper operation of products Ds _Confirm that all products are in working order �tkS —Remove drop cloths,vacuum and remove all old products from premises _Installer will collect balance due on final day of installation PRE-FINISH DISCLAIMER Stained and paint color samples are produced as accurately as possible: however, actual colors may vary from batch. Because wood is a natural product,each window or door will display its own personality with regards to variation in color,texture and grain pattern. Natural wood variations include distinctive grain patterns or unusual shadings in color. Due to the nature of using natural products, Pella Windows and Doors cannot be responsible for the actual degree of variation that may occur in your purchase. ,—DocuSigned by: Signature: 4'4 5 Today's Date: 9/19/2021 DocuSign Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: I,Heidi Stevens , as property owner, give permission to our contractor, Pella Products Inc. to obtain a building permit for the installation of windows and/or doors in my home. Located at; 8 Upland Rd Leeds, MA, 01053 Please accept this letter in place of my signature on the permit application. Thank you, ,—DoeuSigned by: Signature: —1C1BBA47F35A4C3... Date: 9/19/2021 DocuSign Envelope ID:2C972191-BBOF-4A86-AE3C-8D64AAF53F40 • PRE-RENOVATION FORM Occupant Confirmation YEAR OF CONSTRUCTION(check one) ACTUAL YEAR HOME CONSTRUCTED 1900 I certify that my home was built BEFORE AFTER Dec. 31, 1977 PRESUMED LEAD X Property Address: 8 Upland Rd Additional Notes: Leeds, MA, 01053 If BEFORE is selected,continue to LEAD TESTING APPROVAL. If AFTER is selected,proceed to the PRINT NAME/SIGNATURE section. LEAD TESTING APPROVAL I agree to have Lead Testing performed in my home by Pella Products,Inc. I understand the Lead Testing protocol may cause: Cuts and chips through the existing fmish on and around the windows and doors included with this project;including interior and exterior trim,painted walls,and exterior siding. Staining or discoloration of the existing interior and exterior finishes occurring in the tested areas. Interior and exterior trim to be damaged due to removal to provide access for the Lead Testing Protocol. TESTING RESULTS I have reviewed the results of the Lead Testing accomplished by the above named Certified Renovator. I understand the results of my test will be sent to be me,via U.S.mail,within 30 days of the renovation.I have been shown the testing swabs as used for this testing and understand if any test swab indicates a shade of red,lead is assumed present and EPA Renovation,Repair and Painting Guidelines apply. CHECK ONE OF THE FOLLOWING: (A)My home tested positive for lead. I request that Pella Products,Inc use the lead-safe work practices required by the EPA's Renovation,Repair and Painting Rule and will be supplied a pamphlet on lead hazard. (B)My home tested negative for lead. I understand that Pella Products,Inc will not be required to use the lead- safe work practices required by the EPA's Renovation,Repair and Painting Rule and will not be supplied with a pamphlet on lead hazard. PAMPHLET RECEIPT X I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. [Tenant occupied dwellings require a separate notification process.] RENOVATOR'S SELF-CERTIFICATION (for tenant-occupied dwellings only) Heidi Stevens Instructions to Renovator:If the lead hazard information pamphlet was delivered Printed Name of Owner-Occupant but a tenant signature was not obtainable,you may check the appropriate box below: /—DocuSigned by: /) Declined by tenant;a copy was left with the tenant Unavailable for signature;good faith effort made and have left a copy 1—g'fii feu'f Owner-Occupant at the residence for the tenant Mailing Option;pamphlet must be mailed at least 7 days before 9/19/2021 renovation and mailing must be documented by a certificate of mailing from the Post Office. Signature Date [This is an alternative to delivery in person to the owner and/or tenant.] • • • • : . • , t.: .- 'i.. (•!.• ,4f1ti r. (),ii;?... •ier)....(.1411111/?4. ft r kn.- 1 t , • • • 1 16; : ;•• ; , ; •• • : ;• t-46 c•v,0#1t:•>;.#'? • •r",;.•••••';•,•Vii ; 'r.` • • • •• • .• r • ' .:;! . ,,,.! , " • . • ' ••'f: • ••.te- ••••• ,••••••••• 1 • 1.°%•,,•• • pi •••, •••0 i.•• -••••• • ;,..1;;;A:1•<::,••• '••<• -• •.; . • •,1 i)G e " : : ; Y . VUI • • ••YI ?AS,A.!,izire ea? ;); •t, 4;,r f ; . , • • i• •• ; ;t1r; ..; • I-. ( •. :Tr; • # -/..• e. ;••" 1.„:.? ! .; k• t?; • • 74f7 • ; ..' ".; I 74; • • • •..!! • i;:c,r •r: .• • •-1.; 1##.17 , • • • •.".9•,1'• ; : .4. . r • .1.44r: f ; . ; • P • ' • •', f^ • • • - . , 14(4..rAi" !c.f f:11 •722-t (-r.)' • " • I :` '" ' • ' • •‘••• _ • , . - : The Commonwealth of Massachusetts Department of Industrial Accidents --� Office of Investigations ` Lafayette City Center 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): 1.0 I am a employer with 50 4. ® I am a general contractor and employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- - listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp.insurance.+ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.D 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' 13.0 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.#:6H 15382 Expiration Date:01-01-2022 Job Site Address: 0 \C.k1'1d ert City/State/Zip: 1 -u S, tn9 Di aS3 Attach a copy of the workers' ompensation 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 certi un er the pains and e s of perjury that the information provided above is true and'correct Signature: Date: 0 / I / o2- Phone#: 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 3DCity/Town Clerk 4.0 Electrical Inspector SElPlumbing Inspector 6.DOther Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: — D ) t To: l wt.() o ( GtS 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. tor Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted -Buildings of any use group which contain Board of Building Regtulations and Standards less than 35.000 cubic feet 1991 cubic meters)of enclosed Coastrktefi tliidpRrv►sor space. CS-096558 'Expires:03t0112022 TREVOR BROSS 10 GEORGE STREET GREENFIELD MA 01301 • Failure to possess a current edition of the Massachusetts Commissioner 1 tc.w c_�- A`� State Building Code is cause for revocation of this license. For information about this license Call(617)7273 w 200 or visit ww .mass.govldpl ` J 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 C ELWINHERRING5HAW �% (� p 155 MAIN STREET GREENFIELD,MA 01301 Undersecretary Not valid without signatle 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 PELLPRO-01 CHRISTINE AlCaPREP CERTIFICATE OF LIABILITY INSURANCE D 12/2ATE 1/2020 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 ACT Christine Sullivan Phillips Insurance Agency,Inc. A"O"N 413 594.5984 F'X 413 592.8499 97 Center Street )` ,4 ( Chicopee,MA 01013 Miss;christine@phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC INSURER A:EMC Insurance Companies 21415 INSURED INSURER s:Union Insurance Co of Providen Pella Products,Inc INSURER C: 155 Main St INSURER D: Greenfield,MA 01301 INSURER E: siSURER 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 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. LTR TYPE OF INSURANCE IIWO AODLSUMPOLICY NUMBER ( y/DDP/ yYf yp Y yy uiurs A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 6A15382 1/1/2021 1/1/2022 PRE ra j l:acarren e) $ MED EXP(Any one person) $ _ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE FIR LIMIT�a APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 _LEa acrid r t X ANY AUTO 6Z15382 1/1/2021 1/1/2022 BODILYINJURY(Perperson) $ _ OWNED SCHEDULED AUTOSE�ONLY _AUTOS PB�O2DILY INJURY4 (Per accident) $ AUTOS ONLY NON-OWNEDUUTS Y tre i SAGE $ $ A X UMBRELLA LIAO X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE 6J15382 1/1/2021 1/1/2022AGGREGATE 4,000,000 DED X RETENTIONS 10,000 S B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6H15382 1/1/2021 1/1/2022 EL EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N I N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under 500 000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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)BuildingCommissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ry'' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD