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30C-058 (9) BP ► 022-1234 376 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30C-058-001 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-2022-1234 PERMISSION ISHEREBYGRANTEI TO: Project# DOOR Contractor: License: Est. Cost: 8977 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date:03/01/2024 Use Group: Owner: GOLDEN KEHNE DEBORAH L&JUS INA B Lot Size.(sq.ft.) Zoning:. WSP Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155MAIN ST 6H15382 GREENFIELD, MA 01301 ISSUED ON:09/30/2022 TO PERFORM THE FOLLOWING WORK: REPLACE SLIDING 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: � q A . * 21. Fees Paid: $40.00 212 Maui Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner The Commonwealth of Mass chus 1/L` p Board of Building Regulations nd S ilr. �' . FOR r • PITY { r Massachusetts State Building ode 80 ' C�� dy�y �� USE Building Permit Application To Construct, air; ate Or Dg�i ish ', ised Mar 2011 One-or Two-Family Dwe .n' `q4-//1/),err This Section For Official Use On ` °N 4, 7., Ns Building Permit Number: 60--A 2. - (Z 3 44 Date Applied: '<Tviu °Koss /,./ .2 g' 'ZOZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 31(11 V\cenr te.. Qd (� ()' $ 1.1 a Is this an accepted street?yes ` no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZsiiS;-,rv..i t .ICam"h'i c l 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: Publi 16 Private 0 Zone: _ Outside Flood;tine? Municipal lYOn site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner"of Record: Jvsk;(N0. Got astn Ptore.c,c.t_ MA oto(aZ Name(Print) City,State,ZIP 3-7 6 tU a ce Lck 41 1-585-gS.gt Jvsi-,na5vl6.2,uocc24Ana;1 No.and Street Telephone Email Address - c c,...- SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Cii Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ire?lo4rct ‘ 51i d j ng olotX Using cycis+.."CI OFe In/ W 4 tel n a c in f;note 4 too A c nci% iNt- n.).-4-/-. U = • 2q SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2j fm 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee r� 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ C.) 2. Other Fees: $ 4.Mechanical (HVAC) $ (> List: 5.Mechanical (Fire $ C.) Total All Fees: $ Suppression) P. c • . � �0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-00Cs6-5$ 3l 1 S z 4 1,re_s( l&CY5S License Number Expiration Date Name of CSL Holder 1 List CSL Type(see below) ( JT 5 kcA%!r Ss, No.and Street Type Description ��`e` c� Unrestricted(Buildings up to 35,000 Cu.ft.) G d 0 Pr 0130I R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances u 1 ---7349.--c ZUC f r"'►ma f ed\GScou- .•cu.., I Insulation Telephone Email address D Demolition t) 5.2 R istered Home Improvement Contractor(HIC) ( t-( 2 2?C1 3 I Z31 Z4 4 a S CQC$.UC HIC Registration Number Expiration Date MC Company Name or HIC Registrant Name ks5 1Acorl St- flu^'ise Pe ascuitis•cc+M No.and Street Email address (syftse, ' c t .c&1A(4-0 t 30i 1,(13 73(a—R23 w City/Town,State,ZIP 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 Issl ce 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 /It a (kJ au I✓s to act on my behalf,in all matters relative to work authorized by this building permit application. ctPot-aiteel el,(I0/2Z Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'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 this application is true and acc ate to the best of my knowledge and understanding. Print Owner's r Authorized Agent's Nam tromc 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 DocuSign Envelope ID:34A894B2-7667-4CDE-AC78-94861B8B128A Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: Justina Golden ,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; 376 Florence Rd Florence, MA 01062 Please accept this letter in place of my signature on the permit application. Thank you, —DocuSigned by. Signature: 31A. L-863A31E76846490... Date: 9/10/2022 PELLPRO-01 CHRISTINE ACORO DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/6/2021 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 NAME:CT Christine Sullivan Phillips Insurance Agency,Inc. PHONE,No, 594-5984 �jAI A/c,No):(415)592-8499 97 Center Street (ac Ext):(413) Chicopee,MA 01013 no ir( ss,christine@phiilipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC• INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:Union Insurance Co of Providen Pella Products,Inc INSURERC: 155 Main St INSURERD: 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT—O 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. INSR ADD.SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWpp/YYTY) (MMIDDNYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2022 1/1/2023 DAMA PREMGORaTEga ncel $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ D A AUTOMOBILE LIABILITY (Ea a�dentSINGLE LIMB $ X ANY AUTO 6Z15382 1/1/2022 1/1/2023 BODILY INJURY(Per person) $ OWNED ONLY ^AUTOS BODILY BODILY INJURYD (Per accident) $ 1'���'��� AUTOS ONLY _ AUTOS ONLDY ((err a dent)AGE A X UMBRELLA.IAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS UAB CLAIMS-MADE 6J15382 1/1/2022 1/1/2023 AGGREGATE $ DED X RETENTION$ 10,000 Aggregate $ 4,000,000 B WORKERS COMPENSATION PPERTUTE OT AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6H15382 1/1/2022 1/1/2023 EL EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? I I N/A 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be stanched If mom 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 Florence(Northampton)BuildingCommissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ��i: ' ""-/ I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents y- Office of Investigations o3ii_= Lafayette City Center •11•1_ / 2 Avenue de Lafayette,Boston,MA 02111-1750 for l� 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 St City/State/Zip:Greenfield,MA 01301 Phone#:413-774-0153 Are you an employer?Check the appropriate box: Type of project(required): 1.❑� I am a employer with 50 4. ❑ I am a general contractor and I 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. ❑■ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition 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 10.0 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 YP 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. tContractors 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:01-01-2023 Job Site Address: 31 (O F%eyQn C. fad City/State/Zip:Ftura_ockAA A O t O Co Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration datel. 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 5ne of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under tI.e pains and penalties of,p • that the information provided above is true and correct. Signature: /( Date: C1 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): r-� 1❑Board of Health 20Building Department 3fCity/Town Clerk 4.❑Electrical Inspector 5111'lumbing Inspector 6.00ther Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: Uh \ rZZ To: \(iwn U� (-Lodz- 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. Joy Grover Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-512-5968 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 17,2022 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 Construction Supervisor 111; Division of Occupational Licensure Unrestricted-Buildings of any use group which contain Board of Building Rmi rations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed Constton Svisor space. CS-096558 c ^' ires:03101/2024 TREVOR BROSS 411 10 GEORGE S .-- a GREENFIEIV}AMN , 4br.LYAiI3 F.ulure to possess a current edition of the Massachusetts Commissioner 1_/]_ ♦ (f�._L1 Slate Building Code is cause for revocation of this license. C.JWtIIR>t /n FJvn For information about this license Call(617)727-3200 or visit www THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 142279 03/23/2024 Boston,MA 02118 FELLA PRODUCTS.INC. -REVOR BROSS 4/1 �� �� 55 MAIN STREET y , :, H 3REENFIELD,MA 01301 Undersecretary Not valid without signature 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 Contract - Detailed .'D Pella Window and Door Showroom of West Springfield Sales Rep Name: Sanderson,Thomas 69 Ashley Avenue Sales Rep Phone: 910-514-8012 West Springfield, MA 01089 Phone:(413)736-9239 Fax: (413)736-3390 Sales Rep Fax:-M Sales Rep E-Mail: tsanderson@pellasales.com Customer Information _ Project/Delivery Address Order Information Justina Golden Golden Justina 376 Florence Rd Florence MA Quote Name: Justina Golden-250 Series Sliding Door 376 Florence Rd GF 376 Florence Rd Order Number: 739X2JS031 FLORENCE,MA 01062-2636 Lot# Quote Number: 15970694 Primary Phone:(413)5858581 Florence,MA 01062 Order Type: Installed Sales Mobile Phone: County: Hampshire Wall Depth: Fax Number: Owner Name: Payment Terms: GreenSky Financing E-Mail: justinagoldenvoice@gmail.com Justina Golden Tax Code: MASS Contact Name: Owner Phone: (413)5858581 Cust Delivery Date: 12/19/2022 Quoted Date: 9/9/2022 Great Plains#: 53H5858581 Contracted Date: 9/10/2022 Customer Number: 1007889489 Booked Date: 9/15/2022 Customer Account: 1003763173 Customer PO#: Accessories Managed I Delivery Date Hinge&Sliding Door Screens 12/19/2022 Customer Notes: 250 Series Sliding Patio Door White/White Sliding Screen No Grilles Provincial Stained Colonial Trim 60 Month 0%Interest Financing Through GreenSky For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/16/2022 Contract-Detailed Page 1 of 10 Customer:Justina Golden Project Name: Golden Justina 376 Florence Rd Florence MA Order Number: 739X2JS031 Quote Number: 15970694 Line# Location: Attributes 10 None Assigned Pella 250 Series, Double Sliding Door, Fixed I Vent Left,95.5 X 81.5,White Item Price Qty Ext'd Price $6,959.63 1 $6,959.63 1:9682 Fixed/Vent Left Double Sliding Door Frame Size: 95 1/2 X 81 1/2 PK# General Information: Factory Assembled,Standard,Vinyl,Nail Fin,Foam Insulated,5",1 1/8",3 7/8",No Sill Pan Exterior Color/Finish: White o'0 2121 Interior Color/Finish: White Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Viewed From Exterior Hardware Options: White,Keylock Included,White,White,Steel Screen: Sliding Screen,White,Premium,InViewTM' Unit Accessories: No Accessory Option Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.51,CPD PEL-N-251-00057-00001,Performance Class R,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 11 Remake:, Grille: No Grille, Wrapping Information: Pella Recommended Clearance,Perimeter Length=354". Rough Opening: 96"X 82" AC-5-Create New Opening Qty 1 EXTTRIMI9-5/4 x 4 Exterior Style PVC Qty 1 LP-1 -Lead safe practices this opening Qty 1 PD-2-Patio Door Install 8FT in width Qty 1 Line# Location: Attributes 15 None Assigned Wood Products 21/2 Colonial 2, Length: 144,Provincial Stain.Wood Type: Pine Item Price Qty Ext'd Price $114.67 3 $344.01 1: Accessory Frame Size: 1 X 1 PK# General Information: Pine,2 1/2 Colonial 2 Interior Color/Finish: Provincial Stain Interior 2121 Remake:, Wrapping Information: Perimeter Length=0". Viewed From Exterior For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/16/2022 Contract-Detailed Page 2 of 10 DocuSign Envelope ID:34A894B2-7667-4CDE-AC78-94861B8B128A customer,uusuna uuruen rro)ect Name: Golden Justina 376 Florence Rd Florence MA US Order Number: 739X2JS031 Quote Number: 15970694 ❑Project Checklist has been reviewed Justina Golden Tom Sanderson Order Totals Customer Name (Please print) Pella Sale pa4aryiRd by: (Please print) Taxable Subtotal $5,157.65 DocuSigned by: AttSfitkAt M41 S.61/L1-uio a. Sales Tax @ 6.25% $322.35 Customer Sign-MOW E76846490 Pella Sales Reif ignaturr�rr p�ignature Non-taxable Subtotal $3,497.00 9/10/2022 9/10/2022 Total $8,977.00 Date ,-DocuSigned by: Date Deposit Received $8,977.00 itAStil&A alttA, Amount Due $0.00J OW 2'C7C01C'126 Credit Card Approval Signature ** The date given for installation and/or delivery is an approximate date. Due to unprecedented demand and global shortages of raw materials,your installation and/or delivery date is subject to and likely to change. Pella Products Inc. cannot be held responsible for any additional costs, or lost time associated with manufacturing delays outside of our contract. Although we will do our very best to meet these dates,we ask for your understanding and patience during these times. ** Initials Below: r—DS For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 9/10/2022 Contract-Detailed Page 8 of 8