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BP-2023-0602 20 BLACK BIRCH TRAIL COMMONWEALTH OF SSACHUSETTS Map:Block:Lot: 37-125-001 CITY OF NORTH MPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGIiSTERED CONTRACTORS DO NOT HAVE ACCESS(TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0602 PERMISSIO IS HEREBY GRANTED TO: Project# WINDOW 2023 Contractor: License: Est. Cost: 1416 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date: 03/01/20 4 Use Group: Owner: E MOLANO SUSAN M&WILSON Lot Size (sq.ft.) Zoning: SR Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155 MAIN ST 6H15382 GREENFIELD, MA 01301 ISSUED ON: 05/09/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOW 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: I t` � r � ' I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: 413)587-1272 Office of the Building Commissi er The Commonwealth of Massachusetts �r � +.9 FOR Board of Building Regulations and Standards, � (-0(-1 , FORMUNICIPALITY Massachusetts State Building Code, 780N �n _a 7,, % USE Building Permit Application To Construct,Repair,Renovate Or',l iolish a Revised Mar 2011 One-or Two-Family Dwelling '' %o, This Section For Official Use Only Buildin Permit Number: i✓0-A -"(jQ 7i Date Applied: t)i� /2 s-RZo2 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1..1 ropgrty Ad ss: 1.2 Assessors Map&Parcel Numbers _JD -1 64_ hirCh Trl lk)tkicam 0095113b196 Lb Cr)I 1.1 a Is this an accepted street?yes no Map Number Parcel Number 3 ZoninLInformation: t 1.4 Property Dimensions: _...0 Nat i dial (lsfil WI 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 o1 U Mrd: InnO DO it-lueryT1 mil CALY,Qa. Name(Print) City,State,ZIP au '1a. arch.- -rt, ao/palairi LrL I 1.cem No.and Street Telephone Email ddress SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Number of Units Other 'I Specify:% 3 Qi iV won Brief ��` �1Description Oof`opIlsed Work':o1i N no d Kl�L� ►1�� jit)114) I� uiai 5 �w�r W J J (t-FO Cyr 0,a4v SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 11 I i0 /_� 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ (G�' 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 0 2. Other Fees: $ 4. Mechanical (HVAC) $ /,( List: 5.Mechanical (Fire $ 0 Total All Fees:$ Suppression) 1 Check No.110 V'Check Amount: 41 Cash Amount: 6.Total Project Cost: $ /LI J/„ /. d ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) "( j7)j License Number Expiration Date Name of CSL Holder List CSL Type(see below) t/{ No.and Street 1 ,t1 Type Description C raven Re 1 1 M.rl l/�1 Unrestricted(Buildings up to 35,000 cu.ft.) `'R Restricted 1&2 Family Dwelling City/To S e,ZIP M Masonry C--• RC Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances 4 I3-60a-' L perms l ciin I Insulation Telephone mail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) `-, t r16 Taal, n_ HIC Registration Number xp. atio Date HIC C.1 tanv ame or HIC Registrant Name main ai-re_ Fermi► @ffilasolP ,Com N and Street, Email address Nos #AA (3I b1 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...........❑ 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 l IP\ 1 5 ©. "Pena a Prue'tc to act on my behalf,in all matters relative to work authorized by this building permit application. k a�C\ 5pla3 Print Owner's Nameectronic 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 ccurate to the best f owledge and understanding. 5191a3 PrintOwner's for Authorized Agent's ame(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" Contract - Detailed ?e, Pella Window and Door Showroom of Boylston Sales Rep Name: 280 Shrewsbury St Sales Rep Phone: Boylston, MA 01505 Sales Rep Fax: Phone: (508) 842-1112 Fax: Sales Rep E-Mail: Customer Information Project/Delivery Address Order Information Wilson Molano Molano Wilson 20 Black Birch Trl Florence MA Quote Name: Vinyl 250 Octagon 20 Black Birch Trl GFT 20 Black Birch Trl Order Number: 739Y6EN031 FLORENCE,MA 01062-3612 Lot# Quote Number: 16638426 Primary Phone:(413)6871027 FLORENCE, MA 01062-3612 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: wemo15@gmail.com Quoted Date: 3/26/2023 Great Plains#: 1007198155 Customer Number: 1010968991 Customer Account: 1007198155 Line# Location: Attributes 10 None Assigned Pella 250 Series, Direct Set, Fixed Frame Octagon, 635.0 X 635.0, White Item Price Qty Ext'd Price $1,588.75 1 $1,588.75 a '�;. 1: 2525 Fixed Frame Direct Set Octagon PK# Frame Size: 25 X 25 ckt 2133 General Information: Standard,Vinyl, Nail Fin, Foam Insulated,3 1/4", 1 1/8",2 1/8" I\ / Exterior Color/Finish: White Interior Color/Finish: White Z�-, Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Performance Information: U-Factor 0.26,SHGC 0.32,VLT 0.60,CPD PEL-N-209-00246-00001,Performance Class CW, PG 50,Calculated Positive DP Viewed From Exterior Rating 50,Calculated Negative DP Rating 50,Year Rated 08111 Grille: No Grille, Wrapping Information: Factory Applied, Pella Recommended Clearance, Perimeter Length=83". Frame Size:635.0 X 635.0 FF-4-1 Wide Full Frame Tear Out Installation Qty 1 EXTTRIM20-5/4 X 6 Exterior Style PVC 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 5/2/2023 Contract-Detailed Page 1 of 7 DocuSign Envelope ID:28C629FF-40AE-461 C-8E59-A134DAF40275 t.usturner: vvnson rntnano rroject name: Molano Wilson 20 Black Birch Trl Florence MA Order Number: 739Y6EN031 Quote Number: 16638426 ❑Project Checklist has been reviewed Wilson Molano Nickolas Diciolla Order Totals p.S'tag tOme (Please print) , Peya,fi t ep Name (Please print) Taxable Subtotal $636.82 G),'C,g, y e—,—ti ` ('1c t)(40 tit .al. Sales Tax @ 6.25% $39.80 \`"G°� �fff�r P��t°ature Pella Sales�tep Signature 4/4/2023 4/4/2023 Non-taxable Subtotal $740.00 r. ''ff Total $1,416.62 90t1uSigned by: Date Deposit Received $0.00 al/Wig, 4 )�e, Amount Due $1,416.62 —CPeTlii'tl d-Wroval 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 4/4/2023 Contract-Detailed Page 6 of 6 DocuSign Envelope ID:28C629FF-40AE-461 C-8E59-A134DAF40275 Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: I,Wilson Molano , 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; 20 Black Birch Trl Florence, MA, 01053 Please accept this letter in place of my signature on the permit application. Thank you, r—DocuSigned by: Signature: 4'. y &e,- . 4.---55E8C70FEA08484... Date: 4/4/2023 "1 PELLPRO-01 CHRISTINE ,d► ---- CERTIFICATE OF LIABILITY INSURANCE DATE 23 � � 1/3/2023 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 CONTACTE: Christine Sullivan NAM Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (NC,No,Eat):(413)594-5984 I IA(Ic,No�:(413)592.8499 Chicopee,MA 01013 ADDREss:christinetphillipsinsurance.com . INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:EMC Insurance Companies 21415 INSURED INSURER B:EMCASCO Insurance Co 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 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. MXP URK TYPE OF INSURANCE INgp yyyuR POLICY NUMBER DO Y) (EFF POLICY p/YYYj) LIMITS A X COMMERCIAL GENERAL UABIIJTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6A15382 1/1/2023 1/1/2024 DA gETO(F.RRENT D ce) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JEIT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO 6Z15382 1/1/2023 1/1/2024 BODILY INJURY(Per person) $ AURTEOS ONLY WNED — AUUTNOpSyUyLEDp pBRODILY INJURYD (Per accide $ AUTOS ONLY _ AUTOS ONLY (Perraaccident)AGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAR CLAIMS-MADE 6J15382 1/1/2023 1Nl2024 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X ;MUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6H15382 1hl202S 1/1/2024 E.L.EACH ACCIDENT $ 500,000 MFFICER/MEMBEREXCLUDED? N NIA 500,000 andatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISFARE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater$100,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Florence(Northampton)BuildingCommissioner's THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( P ) ACCORDANCE WITH THE POLICY PROVISIONS. Office 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts i r Department of Industrial Accidents UMI MIN+ Office of Investigations Lafayette City Center Okily2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pella Products, Inc Address: 155 Main st City/State/Zip:Greenfield MA. 01301 Phone #:413-774-7231 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ 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' 13.0 Other comp. insurance required.] *My 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 Company Policy#or Self-ins. Lic. #:6H 15382 Expiration Date:1/1/2024 Job Site Address: 20 Black Birch Trl. City/State/Zip:Florence, MA 01062 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 ce • u der the pains an 'es of pedury that the information provided above is true and correct Signature: c-- Date: 05/02/23 Phone#: 413- 12-5968 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): 1❑Board of Health 20 Building Department 3DCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: a/a 3 To: run ©P RU12'I"Y' '. a�a main 'ntree- 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' I 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 ?� Division of Occupational Licensure Unrestricted -Buildings of any use group which contain Board of Building Requlahons and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed i Corlst onS visor space. •s CS-096559 $ . ' ires:0310112024 TREVOR BR;SS ,ll' 10 GEORGE E ;( } GREENFIE a • Y T kr '1`�lf't� '� Failure to possess a current edition of the Massachusetts Corm + State Building Code fs cause for revocation of this license. For information about this fieense Cali t8171727-200 or visit www.nlass.govtdpt THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplernent Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 142270 03/23/2024 Boston,MA 02118 'ELLA PRODUCTS.INC. `, `-REVOR BROSS "rtr 55 MAIN STREET , ' .x,e,,,,,,,� e- ;f>r 3REENFIELD,MA 01301 �. Undersecretary Not valid without signature Each Installation will be staffed by our installers who are all licensed in accordance with current buildingcodes. 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