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31A-018 (3) BP-2022-1490 4 SANDERSON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-01 8-001 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-2022-1490 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 4000 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date: 03/01/2024 Use Group: Owner: LESLIE CONSTANCE Lot Size (sq.ft.) Zoning: URB Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155 MAIN ST 6H15382 GREENFIELD, MA 01301 ISSUED ON: 11/16/2022 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: 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Cj-.1";°1 * Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts/ �' a/ r'�./. '.\ Board of Building Regulations and Sta rds4Ok \ IC PALITY W Massachusetts State Building Code, 78 ,� R Q MUNICIPALITY E 0� �i7, Building Permit Application To Construct,Repair,ReriBv enrol a /Revisg1 Mar 2011 qq,n,,, One-or Two-Family Dwelling ._ T,> •,�,,, o / This Section For Official Use Only '-''�a'S�FC'r, f' Building Permit Number:60 �a.(G/ee Date Applied: °hb... f 4,0 4 _____i 1I-15-26Z2, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1• P per Address• 1.2 Assessors Map&Parcel Numbers er n AVentif- Y WAMM a I 1.1 a Is this an accepted street?yes N no Map Number Parcel Number 3 Zonin Inf rmation• 1.4 Property Dimensions: c ►11 (.�SIlne Zoning District Propose Use, Lot Area(sq ft) Frontage(ft) 1 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 O er'of Rec rd: ano eslie. 1\)Dr-'a(1 l MR aaoa Name(Print) City,State,ZIP 43anr ai M-enue — ��1I.c►am No.and Street Telephone mai 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 ❑ Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Pro osed Work2: l vlM no narrjr5 -1 dln S T. LI -FO e*o r O.aGl SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 4100D.ob 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee a 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 1/5 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire Suppression) $ 0 Total All Fees: �� .Total 6 ' Cost: $ II Check No." 4. ( heck Amount: Project `A 1 OW. co 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /1S0q G16 rev ) License Number Expifation1Date Name of CSL Holder (D Stio4 List CSL Type(see below) U No.and Street J T m Description arUnrestricted(Buildings up to 35,000 Cu.ft.) e�� �1 ) O� R Restricted 1&2 Family Dwelling City/To e,ZW M Masonry RC Roofing Covering WS Window and Siding ,�.,� SF Solid Fuel Burning Appliances 41.9)-6 ,a-Y1 lam! I Insulation Telephone Email ad ess �}b D Demolition 5.2 Registerede Home Improvement Contractor(HIC) )i I ?Wok1 l Ok Tit wC ne_ HIC Registration Number Ex irat n Date Name or Registrant Name �� .! M ll�iLt �I ll e�} I 1Q 1(n. can Nnd Stree brePn cid1 1-k1 )--50'rr,(1,102 Fmail address 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 Issuance of the building permit. Signed Affidavit Attached? Yes 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 Pea , rtyj��J�p(� . to act on my behalf,in all matters relative to work authorized by this building permit application. 5 Cc-- R i-o Y-7°j 1 ,4Z'aa 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 accurate to the best of m wledge and understan Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTE : 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" /�j� Contract - Detailed ?p(0�r 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 Sales Rep Fax: Phone: (413) 736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: tsanderson@pellasales.com Customer Information Project/Delivery Address Order Information Constance Leslie Leslie Constance 4 Sanderson Ave Northampton MA Quote Name: 250 Series Windows 4 Sanderson Ave STORE 52 4 Sanderson Ave Order Number: 739X2KS161 Northampton, MA 01060-2022 Lot# Quote Number: 16163242 Primary Phone: (413)8006704 Northampton, MA 01060 Order Type: Installed Sales Mobile Phone: County: Hampshire Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: leslie.constance@gmail.com Quoted Date: 10/28/2022 Great Plains#: 1006976828 Customer Number: 1010786712 Customer Account: 1006976828 Customer Notes: 250 Series DH Window in office 250 Series Sliding Window 1/3 Vent in Kitchen Full Screen for Office 1/2 screens for kitchen No grilles $2018 due at signing,$1982 due upon completion For more information regarding the finishing, maintenance, service and warranty of all Pella@ products,visit the Pella@ website at www.pella.com Printed on 11/8/2022 Contract-Detailed Page 1 of 9 Customer: Constance Leslie Project Name: Leslie Constance 4 Sanderson Ave Northampton Order Number: 739X2KS16I Quote Number: 16163242 MA Line# Location: Attributes 10 Kitchen Pella 250 Series, Sliding Window, Vent Right I Fixed I Vent Left, 2159.0 X 1117.6, Item Price Qty Ext'd Price White $2,184.94 1 $2,184.94 1:Non-Standard SizeNon-Standard Size Vent Right/Fixed/Vent Left Triple Slider PK# Frame Size: 85 X 44 4 2124 General Information: Standard,Vinyl, Block, Foam Insulated, 3 1/4",3 1/4",Sill Adapter Included, Head Expander Included Exterior Color/Finish: White • • Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock, 1 Lock,White,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen, lnViewTM Performance Information: U-Factor 0.27,SHGC 0.29,VLT 0.55,CPD PEL-N-210-00055-00001,Performance Class R, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Clear Opening Width 23.405,Clear Opening Height 39.75, Clear Opening Area 6.460755, Egress Meets Typical 5.7 sqft(E)(United States Only) Remake: . Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=258". Venting Width: 1/3 Vent Frame Size:2159.0 X 1117.6 EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 MP-9-3 Wide Modified Pocket Installation Qty 1 Line# Location: Attributes 15 Office Pella 250 Series, Double Hung, 854.0750 X 1838.3250, White Item Price Qty Ext'd Price $1,796.04 1 $1,796.04 z 1: Non-Standard SizeNon-Standard Size Double Hung, Equal PK# Frame Size: 33 5/8 X 72 3/8 General Information: Standard,Vinyl, Block, Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included 2124 Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude 33.625 Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen, InViewTM Performance Information: U-Factor 0.29,SHGC 0.28,VLT 0.53,CPD PEL-N-211-00087-00001, Performance Class R,PG 20,Calculated Positive DP Rating 20,Calculated Negative DP Rating 20,Year Rated 08111,Clear Opening Width 28.579, Clear Opening Height 30.7765,Clear Opening Area 6.108067,Egress Meets Typical 5.7 sqft(E)(United States Only) Remake: , Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=212". Frame Size:854.0750 X 1838.3250 AC-MSF-Minimum Set up Fee(less than 2 FF or 5 Pockets) 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 11/8/2022 Contract-Detailed Page 2 of 9 • DocuSign Envelope ID:CO1FF86D-FDAE-4D9A-B34B-F603FE3F65E7 Customer:t,onstance Leslie rroject Name: Leslie Constance 4 Sanderson Ave Northampton Order Number: 739X2KS161 Quote Number: 16163242 MA ❑Project Checklist has been reviewed Constance Leslie Tom Sanderson Order Totals Customer Na Docusi9nf 4�se print) EPella Sales h�aiprdnea by: I (Please print) Taxable Subtotal $2,011.29 C61�Sfatn Gt, �,t,S�lt, owl Sal at,VSbl&, Sales Tax @ 6.25% $125.71 8r4Customer Signature o�mooraxs. Pella Sales Reptg,g aturecrw31 10/29/2022 10/29/2022 Non-taxable Subtotal $1,863.00 Total $4,000.00 Date Docusigned by: Date Deposit Received $2,018.00 Fiht&SteitAtt, bt,Sltt. Amount Due $1,982.00 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: a.. For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 10/29/2022 Contract-Detailed Page 8 of 8 DocuSign Envelope ID:CO1FF86D-FDAE-4D9A-B34B-F603FE3F65E7 • Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: I,Constance Leslie 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; 4 Sanderson Ave Northampton, MA 01060 Please accept this letter in place of my signature on the permit application. Thank you, DocuSigned by: Signature: ,6tn,5114)."(' 3F40B71808F8425... Date: 10/29/2022 The Commonwealth of Massachusetts _ Department of Industrial Accidents __; ►=' Ofce of Investigations Lafayette City Center e44= 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly 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): I.111 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. In Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anyaci employees and have workers' capacity.• = 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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 13.0 Other employees.[No workers' 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:01-01-2023 Job Site Address: IA Sondes AVf'1)U City/State/Zip: N*J nvinni M 1FtQ1( 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 DIA for insurance coverage verification. I do hereby cert. a er the pains and en t' erjuri'that the information provided above is true and correct. Si ature• Date: Phone#: 1-u Sig- Y��I10? 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/I'own Clerk 4.0 Electrical Inspector 5EIF'lumbing Inspector 6.0Other Contact Person: Phone#: The Commonwealth of Massachusetts ter... Department of Industrial Accidents =_ �� 1 Congress Street,Suite 100 ` "z Boston,MA 02114-2017 7_":-. www mass gov/dia 11 urkrrs'Compensation Insurance Affidavit:Builders1Cantractors/ELrctrician Plumbers. '10 RE FILED WITH THE PERMITTING,Al.rflIORI rY. Applicant Information Please Print Leeih[v Name(Busincssorganizauonlndividual): Address: City/State/Zip: Phone#: Are yam or emplanes^_Check the appropriate box: Type',project(c+elpired): 1.0 I am a rmpk cr with emrpluyees(hull and or part-tirrre;l-* 7. 0 New construction 2.0 I am a sole Romani ors pannershrp and have no cmployem working for mr m IL a Remodeling an)capacity.[No wur►erx'comp.rnsurantz rt qunrr.J 30 I anta homeowner doing all work myself.[No wmkete comp.insurance ntluired.)' 9. ❑ Demolition ne 4.0 I am a Kona r and will be hiring l:elrtr:atatato c induct all work on nn property. I w ill 10 0 Building addition iv n- croon:that all eunlrattors either ha-%c woricrs'eampensatwrr inawana or air tole 11.0 Electrical repairs or additions propnrtors with no c7rrplovecs. 12.0 Plumbing repairs or additions s.0 I am a general contractor and 1 lime.hired thesub-cuntractoas listed on the attached sheet. 130 Roof repairs Ihe.se uh-etmtractara hove Lmnplupers and have workers'comp.uuurae>Le; 6.0 We are a corporation and its offwers have exercised their right of exenipiiut per MGL e. 14.Q(hiker 152.$1(4),sad we have no cmplo of.[No workers'comp.imstramcc requmrnl) *Any applicant dna dads bins Si must alo fill out die ac+ctiun below abortive licit awakes"c r ip traation puled iafotawbor. +Hiwreawalra wine albeit it iris affidavit indicating,they are Jung all work and Arta hits ovtai&rmtvrac't,rcs mint s.utemit a aew alidat it m iie:amp srrh +t'ontraci ua that cheek this boa roast anaclied an additional sheet slum into name.tithe!id►c7ntractors and state w heihcr or not those twine,.has nytrs.. If the tub-ccutrat otaa bans emplcinam they mini purr purr&their workers-volm.puIi nuent i. I act an employer that is providing wurhers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attack a copy of the workers'compensation policy dechratloa page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a tine up to S I.,.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator.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 the pains and penalties of perjury that the information provided above is true and correct. Signature: I)atc: Phone#: ,Official use only. Do nut write in this area,to be completed by city or taws Wide ('its or Tuwn: Permit/License# issuing authority(circle one): 1.Board of Health 2.Building Department 3.('itolflown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: To: (1)-t1 cj- N DrThc, n dlo(1 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 City of Northampton z • SAS �..'.5�� `� Massachusetts w?' �.. '�� DEPARTMENT OF BUILDING INSPECTIONS �'. m `. 212 Main Street • Municipal Building w`•,• c ri S� Northampton, MA 01060 �3'jA;•. N'v CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: Signature of Applicant: Date: PELLPRO-01 CHRISTINE ACORO CERTIFICATE OF LIABILITY INSURANCE DATE /6/2D/YYYYI 12/6l2021 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: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,EA:(413)594-5984 INC,No):(413)$82-8488 Chicopee,MA 01013 oI R�E8S:christIne@philllpslnsurance.com INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:WOO InsurafiCe CO of Providen Pella Products,Inc INSURER C: 155 Main St INSURER D. 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 RES CT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT O ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR IMIDD/YYYY) IMMI0OIYYYYI INSR TYPE OF INSURANCE INSD WVD M ADDL,SUBR POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2022 111/2023 PDREM SESO(EeEoc uienso $ 600,000 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE pU�NpIT,APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (COMBINEDSINGLE LIMIT $ X ANY AUTO 1215382 1/1/2022 1/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED 1000,000 AURTEO�S ONLY AUTOSp BODILY INJURY(Per oxidant) $ AUTOS ONLY _ NON-OWNED ONE tOPER 1 DAMAGE lrO1 ) A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESSLIAB CLAIMS-MADE 8.115382 1/1/2022 1/1/2023 AGGREGATE $ DED X RETENTION$ 10,000 Aggregate 4,000,000 B WORKERS MlH AMOYES LIABILITY STATUTE I ER IN 8H15382 1/1/2022 1/1/2023 500,000 ANOFFICE PROPRIETOR/PARTNER/EXECUTIVE iMNH)EXCLED NIA E.L.EACH ACCIDENT . $ _ — / andato n 000 E.L DISEASE-EA EMPLOYEE $ �0 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY p ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St Northampton,MA 01060 — AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-512-5968 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 17, 2022 Subject: Building Permit Applications& Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL#CS-096558 and my HIC# 142279. Please find a copy of my licenses below. milt- VIICommonwealth of Massachusetts Construction Supervisor Division of Occupational Licensure Unrestricted -Buildings of any use group which contain Board of Budding R t ions and Standards less than 35.000 cubic feet (991 cubic meters)of enclosed j Cons Hier space. CS-096558 i l pires:0310112024 1 TREVOR BROSS "jj 10 GEORGE ETRE GREENFIELB)i1A i ,'`.01-W a•' Failure to possess a current edition of the Massachusetts ,.crz'n,f�q^ State Building Code is cause for revocation of this license. rnm l;oissioner r ci For information about this license Cott f$Ca17)7274200 0,visit www.nuss_uov/Apt 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 'ELLA PRODUCTS.INC. ` -REVOR BROSS r 55 MAIN STREET r�,,s �:-aifq,L ...._ ,. ,,,. . 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