38D-047 (3) BP-2023-1364
21 WINTHROP ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38D-047-001 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-2023-1364 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2023 Contractor: License:
Est. Cost: 6622 PELLA PRODUCTS, INC 096558
Const.Class: Exp.Date: 03/01/2024
Use Group: Owner: RANDALL PAVA JOSEPH J&KAREN
Lot Size (sq.ft.)
Zoning: URB Applicant: PELLA PRODUCTS, INC
Applicant Address Phone: Insurance:
155 MAIN ST 6H15382
GREENFIELD, MA 01301
ISSUED ON: 10/02/2023
TO PERFORM THE FOLLOWING WORK:
REPLACE 3 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:
i ►/ �' I
:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac, settk �9 FOR
Board of Building Regulations and S . •.. , <0
Massachusetts State Building Code, 780 •i= y,''<n,°/^, UIP LITY
•
Building Permit Application To Construct,Repair,Renovate Or S 3,�' ' evise' Mar 2011
One-or Two-Family Dwelling �0's02.1
0
4
4,
This Section For Official Use Only
Building Permit Number: 5'�-- 01?j t 3r `-1 Date Applied:
lc i I, t , 10
Building Official(Print Name) I Signature i to
SECTION 1:SITE INFORMATION
1,1 Pro er Address 1.2 Assessors Map&Parcel Numbers
11�1t1hrpo 1r
1.1 a Is this an accepted street?yes U noT Map Number Parcel Number
�3 Zor ��.� �in Inf rmation•xl5�h 1.4 Property Dimensions:
G
Zoning District Proposed UsM Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
41
areal rm)) 1\ 1hlkIllp LW A Otvr
Name(Print) City,State,ZIP
al Wine 9rr€} L -6V-Dco z r itiE s�..r&smn
No.and Street Telephone ess
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 17Specify: 1P1 )0- VU 10bL' j"
BriefNte
D cription of Propostkpw
d Work':
/ 3cln S lA1 j e .ash c i)inrS W)+h it
1i, ar4tyO.&Oandbur-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ /jO 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ l� 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ ar 2. Other Fees: $
4. Mechanical (HVAC) $ Ya List:
5.Mechanical (Fire $
Suppression) Total All Fest: $.„2
Check No.7 J ;heck Amount. 4 Cash Amount:
6.Total Project Cost: $b f�ad1 i .) 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) _r./�LL
-Trevor Bf s License CNumber ExpirationDate
Name of CSL Holder f ,
10
a9 I ^ Sher-1
— 1 List CSL Type(see below) IA
No.and Street j '1� T e Description
/) /� A U Unrestricted(Buildings up to 35,000 Cu.ft.)
� ��c.�C.( � A a Restricted 1&2 Family Dwelling
City/To ,St te,ZIP 4 .0 M Masonry
RC Roofing Covering
WS Window and Siding
•
41 19— � � F/ SF Solid Fuel Burning Appliances
T r I Insulation
Telephone Em I address D Demolition
Registered Home Improvement Contractor(HIC) ( t l p PAC �. HIC Registration Number ation
Date
pany N HIC e s t ame
�R.e.[d, pit am q 13-61a-510 E ail 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 P 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 or
-PliciAlteiti&_
to act on my behalf,in all matters relative to work authorized by this building permit application.
Mnra R' oall - Atictolwl a I li'93
Date
Print Owner's Name(Electronic Signature)
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 tru d ccurate to the best owledge and understanding.
f o r SS .tip. °II 1 a 3
Print Owner's or Authorized ( Signature)me Agen
t's Electronic Si 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
14, Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski, Adam
69 Ashley Avenue Sales Rep Phone: (413) 335-3237
West Springfield, MA 01089 Sales Rep Fax: 413-774-6348
Phone: (413) 736-9239 Fax: Sales Rep E-Mail: alukomski@pellasales.com
Customer Information Project/Delivery Address Order Information
Karen Randall Randall Karen 21 Winthrop St Northampton MA Quote Name: Lifestyle Series 3 Windows 413-588-8190 Phase
21 Winthrop St GF
21 Winthrop St Order Number: 739Y2JL021
NORTHAMPTON, MA 01060-4221 Lot# Quote Number: 17305980
Primary Phone: (413)5888190 Northampton, MA 01060 Order Type: Installed Sales
Mobile Phone: County: Hampshire Payment Terms: C.O.D.
Fax Number: Tax Code: MASS
E•Mait: karen@propolispress.com Quoted Date: 9/12/2023
Great Plains#: 1006430456
Customer Number: 1010254136
Customer Account: 1006430456
Line# Location: Attributes
10 Kitchen Lifestyle, Awning, Vent, 1003.30 X 933.450, Without HGP, Hartford Green Item Price Qty Ext'd Price
$2,208.87 1 $2,208.87
1: Non-Standard SizeNon-Standard Size Vent Awning
PK# Frame Size: 39 1/2 X 36 3/4
2144 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16"
Exterior Color/Finish: Standard Enduraclad, Hartford Green
Interior Color/Finish: Linen White Paint Interior
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Wash Hinge Hardware, Fold-Away Crank,Champagne, No Limited Opening Hardware, No Integrated Sensor,Sill
Viewed From Exterior Screen: Full Screen, Linen White,InViewTM
Performance Information: U-Factor 0.29,SHGC 0.27,VLT 0.51,CPD PEL-N-37-00714-00001,Performance Class LC,PG 30,Calculated Positive DP
Rating 30,Calculated Negative DP Rating 30,Year Rated 08111, Egress Not Applicable
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied, Pella Recommended Clearance, Perimeter Length= 153".
Frame Size: 1003.30 X 933.450
IHQMPII -1 Wide Mod Pocket+Ext Aluminum Capping Qty 1
LP-1 -Lead safe practices this opening 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 9/18/2023 Contract-Detailed Page 1 of 11
Customer: Karen Randall Project Name: Randall Karen 21 Winthrop St Northampton MA Order Number: 739Y2JL021 Quote Number: 17305980
Line# Location: Attributes
15 Top of Stairs Lifestyle, Double Hung, 1003.30 X 1136.650, Without HGP, Hartford Green Item Price Qty Ext'd Price
$2,259.50 1 $2,259.50
I PK 1: Non-Standard SizeNon-Standard Size Double Hung,Equal
# Frame Size: 39 1/2 X 44 3/4
2144 General Information: No Package,Without Hinged Glass Panel,Clad, Pine, 5",3 11/16",Jambliner Color: Gray
Exterior Color/Finish: Standard Enduraclad,Hartford Green
Interior Color/Finish: Linen White Paint Interior
I
- Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Cam-Action Lock,2 Locks,Champagne,No Limited Opening Hardware,Order Sash Lift,2 Lifts,No Integrated Sensor
Viewed From Exterior Screen: Full Screen, Hartford Green,InViewTm
Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00427-00001,Performance Class LC,PG 30,Calculated Positive DP
Rating 30,Calculated Negative DP Rating 30,Year Rated 08111,Clear Opening Width 36.312,Clear Opening Height 19.125,Clear Opening Area
4.822688,Egress Does not meet typical United States egress,but may comply with local code requirements
Grille: No Grille,
Wrapping Information: No Exterior Trim,3 11/16",5", Factory Applied, Pella Recommended Clearance,Perimeter Length=169".
Frame Size: 1003.30 X 1136.650
LP-1 -Lead safe practices this opening Qty 1
PF-9-Lifestyle PFit(Backer rod,caulk,frm exp&3/8 jmb plugs) Qty 1
EAC-1 -Exterior Aluminum Capping(Coil Stock) 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 9/18/2023 Contract-Detailed Page 2 of 11
Customer: Karen Randall Project Name: Randall Karen 21 Winthrop St Northampton MA Order Number: 739Y2JL021 Quote Number: 17305980
Line# Location: Attributes
20 2nd Floor Bedroom Lifestyle, Awning, Vent, 1003.30 X 1136.650, With HGP, Hartford Green Item Price Qty Ext'd Price
$3,356.92 1 $3,356.92
1:Non-Standard SizeNon-Standard Size Vent Awning
PK# Frame Size: 39 1/2 X 44 3/4
2144 General Information: No Package,With Hinged Glass Panel,Clad, Pine,5",3 11/16"
Exterior Color/Finish: Standard Enduraclad, Hartford Green
Interior Color!Finish: Linen White Paint Interior
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hinge Panel: Clear,Annealed
Viewed From Exterior Hardware Options: Wash Hinge Hardware, Fold-Away Crank,Champagne, No Limited Opening Hardware, No Integrated Sensor,Sill
Screen: Full Screen, Linen White, InViewTM
Unit Accessories: Snap-In Between-The-Glass Fabric Shade Bottom-Up, Bamboo Room Darkening, Manual
Performance Information: U-Factor 0.25,SHGC 0.22,VLT 0.41,CPD PEL-N-246-00101-00003, Performance Class CW, PG 45.Calculated Positive DP
Rating 45,Calculated Negative DP Rating 45,Year Rated 08111, Egress Not Applicable
Grille: No Grille,
Wrapping Information: No Exterior Trim, 3 11/16",5",Factory Applied. Pella Recommended Clearance, Perimeter Length=169".
Frame Size: 1003.30 X 1136.650
Customer Notes: I SPOKE WITH THE BUILDING DEPARTMENT TO SEEK APPROVAL FOR USING AN AWNING STYLE WINDOW IN A
BEDROOM. THEY APPROVED THE USE OF THE AWNING WINDOW IN A BEDROOM DUE TO THE FOLLOWING REASON:
THE ROTO OPERATING HARDWARE ON THIS AWING CAN BE RELEASED TO ALLOW THE WINDOW TO BE PUSHED OUT
TO VIRTUALLY 90 DEGREES. THE HARDWARE DOES NOT NEED ANY SPECIAL KNOWLEDGE OR TOOLS TO ALLOW THIS
HARDWARE TO BE RELEASED.
LP-1 -Lead safe practices this opening Qty 1
IHQMPI1 -1 Wide Mod Pocket+Ext Aluminum Capping Qty 1
Line# Location: Attributes
25 Head Stops Wood Products Stop Square 1, Length: 96, Linen White. Wood Type: Pine Item Price Qty Ext'd Price
$33.77 2 $67.54
1: Accessory
PK# Frame Size: 1 X 1
2144 General Information: Pine, Stop Square 1
Interior Color/Finish: Linen White Paint Interior
Wrapping Information: Perimeter Length=0".
Viewed From Exterior
Frame Size:0.0 X 0.0
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 9/18/2023 Contract-Detailed Page 3 of 11
DocuSign Envelope ID:2E9EBDD4-CEOD-41F6-88C8-AB5CF64BD4AE
t.usturner: naren manual! rrulecr Name: Randall Karen 21 Winthrop St Northampton MA Order Number: 739Y2JL021 Quote Number: 17305980
[Project Checklist has been reviewed
Karen Randall Adam Lukomski Order Totals
alliame (Please print) n)tep Name (Please print) Taxable Subtotal $4,406.59
- — f' Alm tests i Sales Tax @ 6.25% $275.41
"--aNtlItifgPMature pellrS'a1leellepSignature
9/13/2023 9/13/2023 Non-taxable Subtotal $1,940.00
Total $6,622.00
Date Date
Deposit Received $3,311.00
Amount Due $3,311.00
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 9/13/2023 Contract-Detailed Page 7 of 7
DocuSign Envelope ID:2E9EBDD4-CEOD-41 F6-88C8-AB5CF64BD4AE
Pella Products Inc.
• 155 Main Street
Greenfield, MA 01301
To Whom it may Concern:
Karen Randall , 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; 21 Winthrop St
Northampton, MA 01060
Please accept this letter in place of my signature on the permit application.
Thank you,
r--DocuSigned by:
Signature:
�CE676C1B1B7240E_.
Date: 9/13/2023
The Commonwealth of Massachusetts
^r ; } Department of Industrial Accidents
r ►= , Office of Investigations
_ —" Lafayette City Center
2Avenue 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 50 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
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. 0 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. 0 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: /1/2024
Job Site Address: 21 Winthrop Street City/State/Zip: NHampton, MA 01060
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 certi u er the pains and • • ' es of perjury that the information provided above is true and correct.
Signature: Date: 09/18/23
Phone#: 413-5 2-5968
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):
10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5alumbing
Inspector 6.0Other
Contact Person: Phone#:
PELLPRO-01 CHRISTINE
AcoRo CERTIFICATE OF LIABILITY INSURANCE °"�'M""'°°"'�"'
`..►� 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 COACT Christine Sullivan
Phillips Insurance Agency,Inc. PHONE 413 594-5984 FAX 413 592-8499
97 Center Street IAA,No,Ehrt):( ) (AIC,No►:( )
Chicopee,MA 01013 Kiss:christine@phillipsinsurance.com
INSURERS)AFFORDING COVERAGE NAIC N
INSURERA:EMC Insurance Companies 21415
INSURED INSURER B:EMCASCO Insurance Co
Pella Products,Inc INSURER C:
155 Main St INSURERO:
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.
INSR TYPE OF INSURANCE ADDLINS YYVDR POUCY NUMBER (MMMIDDIYCY YYY) (FF MMIDD YYYY) UMW
A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR 6A15382 1/1/2023 1/1/2024 DMMG Oa EoNcaTEuDre 500,000
MED EXP(Any one person) $ 10,000
PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY X PEL'T LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
A AUTOMOBILE UABIUTY (COMBINED SINGLE LIMIT $ 1,000,000
Ea accident)
X ANY AUTO 6Z15382 1/1/2023 1/1/2024 BODILY INJURY(Per person) $
OWNED SCHEDULED
_ AUTOS��� ONLY AUTOS BODILYBODILY INJURY(Per acadent) $
AUTOS ONLY MTV (Per accident)DAMAGE
$
A X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 4,000,000
EXCESS UAB — CLAIMS-MADE 6J15382 1/1/2023 1/1/2024 AGGREGATE s 4,000,000
DED X RETENTIONS 10,000 y
B WORKERS COMPENSATION X STATUTE OTH-
ER
AND EMPLOYERS'UABIUTY 6H15382 1/1/2023 1/1/2024 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE YNN N/A E.L.EACH ACCIDENT S
FFICER/M M EXCLUDED?
andatory n )R E.L.DISEASE-EA EMPLOYEE $ 500,000
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 attached It 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
City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
tY pt ACCORDANCE WITH THE POLICY PROVISIONS.
212 Main St
Northampton,MA 01060
AUTHORIZED REPRESENTATIVE
i°
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
PELLA PRODUCTS INC.
155 MAIN STREET
GREENFIELD, MA. 01301
Date: �l Oa;
I
To: 00-1,1 �,�I1h1�1, I` '
9ia Miin
'6 f
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
j Division of Occupational Licensure Unrestricted-Buildings of any use group which contain
Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed
Constion S (visor space.
7" u
CS-096558 �� Qi.epires 03/0112024
TREVOR BR tSS 4 . ,
10 GEORGElt a ,a. 3
GREENFIELJOAA ^ >,
}r,l.LvAA'' i Ab
Failure to possess a current edition of the Massachusetts
k State Building Code Is cause for revocation of this license.
Commissioner d ti. For information about this license
QQQ C.tI 0S17)727-3200 or visit www.mass.govldpl
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.Srlppfement Card Office of Consumer Affairs and Business Regulation
Registry _= -Expiation 1000 Washington Street -Suite 710
142279' _ 024 Boston,MA 02118
DELLA PRODUCTS,INC=-
,
-REVOR BROSS
55 MAIN STREET ;,
3REENFIELD,MA 01301`M , url�,t.,>
Undersecretary scat vriliel 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