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17A-207 J1 p t � 6; it of Northampton *_ $ n� s yi jillsssec�asttta` '—'!�� CL DEPARTMENT UP BUILDING INSPECTIONS ' , 212 Main Street • Municipal Building , 'o Northampton, Mass. 01060 \I, 4'V . • WORKER'S COMPENSATION rNSLI NCE A.FMUMVIT 1_, ? c.V- (icensteipennittee) with a principal piace of bi'sinessJresideu e a:: 1 t 0 t 141 7 P 1 Rcl, t Y r I (street/cityistaccip) do hereby certify, under the pains and penalties of perjury, ilia:. am an employer providing the fcilowing workers compensation coverage for :ny employees wor ? on this job: __., . Ace 'loon() ,) flt0120165 - (-dra_n i ') (Policy Nurrb:r) (Expiration Date) ( ) I am a sole p: oprietor, general contractor or hom.eowcer (circle one) and have hired the contractors listed beio w who have the following worker's comp :nrahon policies: • (Name of Contractor) (Lnsurance Cornp• n7 N.ini ) (Expiration Datc) e( (Nance of Coutrirctor) (I.nsurancc Company/Policy Number) (Expiration. Dale) . _ Name of Conr.acior) ;iuuranc.:• CompanyFcl;cy Number) (Expiration Date) (Naze of Contractor)., (Insr..r^aa Company/PoUcy Number) (Expiration Date) (attach srtsii -dooar sSect if nexaary to ioalude infcrraatiaa pectxitring to ell can radon) ( ) I a a sole proprietor and have no one m working for me. ( ) I am a home owner performing all the work myself. NOTE: ,leas.: be aware that while becoerioneers wse eecpiny persons to de aniroter-uaee, cone„nsctioo a re;wir worlc e:e z dw--1 g of sot tmrl - tan t..ve trni's in tciioh the lterzeoweer resides or as Ira gn ,d5 appurt caves there a ace rxx yeaomt±y cccsic cr.x to be cmpteycs uack a the woc'Y.a's tarroc sa ice Act (OL152. s1(3)), apptia.aoa by a homeomra fa a liter= a perms way e',idmx:fle legal sta. uJ elan acaployer uadrr the Worker's Compa�.atiou AO- I uoaaraad bat A copy of this rt, e - - . may bo forwarded to the DepsrtmtxQ ofIrsdautzi e.1 P.criiocts' (YES oo of L`tsttuwo Cot rho coverage vcriftatlon•tta4 that failure to saws coverage under section 25A of MOL 152 an lean to the imposition of aitrsnal penatiid coaaisti;g et-4;4e of up to Si ,500.00 =See ieeceisonartat of up to ow year and evil pataltiei in the form oft Stop Wort Orr and a Sato of 10000 t.day tganast toe. • I r I g dal uaa only !b P X11 mt> Si :. stun of Li xnse;JFcxmitfce = i ,__ et;.. K t t fa�s m :"' • P ' 44 ONSTRIJ,CTIbr.1 SERVICES , { ` 0.1 Licensed Construction Supervisor: Nct Applicable ❑ Herne of License hioider : w t ss P I License Nurtwer i n ; « r1,t 6 Address Expiration ;Date P-rs AA+ S`fi -7i 11 Signatu Telephone t a " a <w is 1 " ., ►i�f+���'� 1� -� ,s��"�� }h „°i„ �. s't� , = +��f > ; �'pl' A;~�'' Not Applicable ❑ at 01 \416 : am - - 1 Registration Number • Address v Expiration Det —_ t J'''' -. — Teiephonc l I (1 0 (ii 'fJOI* 10:WORkERS' COMPENSATION INS;URANO AFrIDAVlT (IVf G :I . c: 1'52. § 25O(6)) Workers Comp.nsatior• Insurance affidavit m:+st be completed and submitted with this eppiication. Failure tc provide, this aridavit will result in the denial of the issuance•cf the buildirg permit. LSigned Affidavit Attached `'es...... +?I No 0 • n �r�• < '��a� ,, A: kit ,:.•.;.. The current exenption,fpr "homeowners” was extended to include Owner - occupied Dwellings of one (I) or two(2) families and to allow such r.o :mc' weer to engage an individual for hire who does not possess a license, provided that the owner nets as supervisor. C YR 780,_Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,'a one or two family dwelling, attached or detached.structures accessory to such use and/ or farm structures, A person whg constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, or; a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the buildins nermit. As acting Construction Supervisor you: presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusets General Laws Annotated. Homeowner Signature _ • • .. . 1 . -.:„. ,..,,..,_ , 1... * 417,,, tvti o, - , --,,,,,....,01 .: qq` . t' . ." , , ,,, 4.147,•"''' 0 . „inivs -0: 4 1 2U-'L'''14t.g17:75.j-W-V711W."-4TqirrF,gWPL'.4W"qiL,E2E!;r4g!4'-'IP*I'' , New House 0 Addition 0 Replacement Windows Alteration(s)gc Roofing 0 Or Doors 0 Accessory Bldg. 0 1 Demolitionc New Signs ( I Decks [ ) Siding r ] Other [ } ... Brief Description of Proposed Work: _lik +4.0 ik.t.t .A.01 rtc• 4otti_j p c i, Alteration of existing bedroom Yes V No Adding new bedroom Yes _1_ No / Attached Narrative 0 Renovating unfinished basement ________ Yes .CL___No Plans Attached Roll 0 • Sheet 3 :IA 4- . ,,,O)Thjilrirg: a. Use of building : One Family r" Two Family Other b. Number of rooms in each family unit: Ak+ Number of Bathrooms IL - c. is there a garage attached? d. Proposed Square footage of new construction. 1 Dimensions e. Number of stories? t\JA f. Method of heating? A.Pr Hroplacos or Woodstoves rte r ) Number of each Ath" g. Energy Conservation Compliance. A/71 Mascheck Energy Compliance form attached? h. Typo of construction i. Is construction within 190 ft. of wetlards? _ Ye- S 1 Is construction within 100 yr. floodpla n Yes No I. Depth of basement or cellar floor below firished grade /CA k. Will building conform to the Building and Zoning regulations? 4 /Yes Nc . I. Septic Tank N kCity Se.Wer Private well City water Supply - 45 Staiii '. ' . NiiiMit 4) 44. .I.:::PIOP ..L 0 es Owner of the st.hjec.t property hereby authorze , III to act on • I my behalf ' - : .. c re o work auth. • 4 • . • . • , permit application. Sr Oa C Signature of Owner Date ., . • - . , - ., . I I, i6,„-„, ,Je 5 „ sof . as Owner/Authorized Agent hereby d dare that the statements and Information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ■ a s and pen Wes cf erjury. ,.., . Print N.: if t • , NI; 6 ic 0 e , .7-- sdgna 're of Owner/Agent l Date If . _ .._..... Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing 4 Proposed i Required by zoning . This column to be filled in by Building Department Lot. Size /V /' Frontage f{ Setbacks Front r a 3 0 10 Side t.: R:,___ J R: 1 3 c ) I k ! 5 Nit 3a Rear ! Building Height fli 7* Bldg. Square Footage • Open Space Footage (Lot area minus bldg & paved .arkinI j li of Parkin: Sines • .\'( ' I Fill: (volume &Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW V YES . IF YES, date issued: : IF YES: Was the permit recorded at the Registry of Deeds? NO • ' DON'T KNOW V YES • IF YES: enter Book; Page anc /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES . IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained _ , Date Issued: C. Do any signs exist on the property? YES .. • NO IF YES, describe size, type and location: 0. Are ti e e any proposed changes to or additions of signs intended for the property ?YES _ . No ( / IF YES, describe size, type and location :_____ 4 • r w a City of Northampton � � � � _ � � � = r z , , ' r x , , r� \., Building Department w d x ��� , �`>3"pi F1rX�`i. -- �V c � - v , 21 Main Street 4.a,t , . -F7 i y ie T , r . 5 , • - i;, .4 r `; . ra +, Y a i ,,. �{ t Y Y: Normoton MA 01064 ®���� E } �z�� y "� n � �� � S �fty, f w.. e a .iaY h•r y . phone 413 587.1240 Fax 41� 587.12?z � ",° �� i � Y{ p� �* K P c f mr ''a f r�r t??F zyf� td� . } .._— ._.._— .a� �ka0.' �. 4:....>.',U�"r 1" ' « L ?b F.� j .,t ' .T f .. k +Yh'. .-- APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1. • SITE INFORMATION t 1.1 Property Address: S This sect 4ti t be completed by offi ce t 1 N e .t1 J (-e .C-- ' p i i , , x ,A IYIa : " v' ,,v l "" c rt t� e T 5 �1Fi t '1 to / gr e et Zone ` ? "` Vr Distri . • 610 6 2-- Elm St,'District_ . ___ CB District_ SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Ownetsf Record: i ( - r Al t,i.J4 z)& hi nI P 10 If -Cr. - Name (Print) - - Currerit Mailing Address r : _ / t___ Telephone Sgnatur- -- " Q 2.2 • uthori ed Agent: • ,Z NIE 1 ) A-7 CAP (( (I0 ftt./f 1t1(/k pd, Js7T4A Na a r >rint; ('44 $f e,ic 7? Current Mailing Address. - - 7571 c !Fa ture Teiepl•one — G-TION3 - ESTIMATED iCO1 TRACTION CO STS Ite n •. I Es Cost (Dollars.) to be Vif•cial Use Only completed by permit applicant 1. Building Do i (a) Bund.iii Perrnit Fee 2 Eie,tricai L i (b) Estimated Total Cost of f Construi :icl.f -om — 3. PLimbing 6 Building Permit Fee 4. Mechanical ( 5. Fire Protection I. 6. Total - (i - 2 +3 +4 +5) I vhec't /1 p7 J 6 This Section For Official UseQbl .. Bi 11tfrrrg`Feritli.0um er: • Date issued: . • Signature: • . Buiidirig Carruniss lnspeCtor of•Bufid Date• e • File # BP- 2010 -0382 APPLICANT /CONTACT PERSON INTEGRITY DEVELOPMENT & CONSTRUCTION INC ADDRESS /PHONE 110 PULPIT HILL RD AMHERST (413) 549 -7919 PROPERTY LOCATION 131 NORTH MAPLE ST MAP 17A PARCEL 207 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out (f Fee Paid IIa Typeof Construction: INSTALL NEW ROOF OVER PORCH STAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 059672 3 sets of Plans / Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay 0 / 20 ." Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. e 14* PLE # BP- 2010 -0382 GIS #: COMMONWEALTH OF MASSACHUSETTS Istliip;Olock: 17A -207 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0382 Project # JS- 2010- 000505 Est. Cost: $4000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: INTEGRITY DEVELOPMENT & CONSTRUCTION INC 059672 Lot Size(sq. ft.): 49222.80 Owner: WALDER MARTIN J & JOAN Zoning: URB(100)/ Applicant: INTEGRITY DEVELOPMENT & CONSTRUCTION INC AT: 131 NORTH MAPLE ST Applicant Address: Phone: Insurance: 110 PULPIT HILL RD (413) 549 -7919 Workers Compensation AM H E RSTMA01002 ISSUED ON:10/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW ROOF OVER PORCH STAIRS 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/13/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo PROM Berkshire Insur erica Oroup <WE0)OCT 7 2009 15: 43/ST. 15: 19 /No. 7527319035 P 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Page 2 of 2 1NS025 0108) 080 FROM Berkshire Insurance Group (WED)OCT 7 2009 15:42/ST- 15: 191No. 7527319035 P 1 ACDRD CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) 10/7/2009 PRODUCER (413) 773 -9913 FAX: (413) 774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MassOne Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5 y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 638 Greenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Continental Western Pella Products, Inc. INSURER B: • ATTN: John Benjamin INSURER C: 155 Main Street INSURER D: Greenfield MA 01301 -3258 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MOONY] DATE IMM /DDIYY) LIMITS -... _ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,400_ X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ A CLAIMS MADE X OCCUR CPA020470112 1/1/2009 1/1/2010 MED EXP (Any one person) $ 15 ,PU0 PERSONAL &ADV INJURY $ 1,000,400 GENERAL AGGREGATE $ 2, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY JECT r1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,0.0-0 A ALL OWNED AUTOS MAA020470212 1/1/2009 1/1/2010 BODILY INJURY (Per person) $ X SCHEDULED AUTOS _ X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ -- - . AUTO ONLY: AGO $ EXCESS /UMBRELLA LIABILITY EACH OCCIJRRENCF $ - - -- OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ _ ff A WORKERS COMPENSATION AND X I ORY t-IMITS I I EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE E.L EACH ACCIDENT $ 500,000' OFFICER/MEMBEREXCLUDED? WCA020470512 1/1/2009 1/1 /2010 500,000,• E.L DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below _ E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS)LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Operations usual to the sales & installation of doors & windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marty Walder EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL=". 131 Maple Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT^ Florence, MA 01060 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE. INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Robin Sargent /RMS ACORD 25 (2001/08) © ACORD CORPORATION 1988 Page top INS025 (010808a r • The Commonwealth of Massachusetts • sogememo Department of Industrial Accidents 1 1/444.,... ' 4 Off600 ice of Ini i k 4 , ; W as hington vest Stre gations Boston, MA 02111 .y g,r;" www..mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information . • . Please Print Legibly Name ( Business /Organization/Individual): i " / / t?.il/7 i! e J , I) C Address: /SY Af ,Wee.e City /State/Zip " /a AO' , /3i Phone #: 'y/.3 770i- Q /�,. • Are you an employer? Check the appropriate box: Type of project (required): ' 1. I am a employer with ..7 2 . 4 -. 0 I am a general contractor and I: • ' • employees (full and/or part- time).* . have hired the sub- contractors 6. ❑New constritcion 2.0 .I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have g. 0 Demolition working forme in any capacity. -employees and have workers' g . Y P t3' 9. 0 Building addition [No workers' comp, insurance comp. insurance:I required.] . . 5. . We area corporation and its • . 10.0 Electrical repairs - or additions officers have exercised 11.0 Plumbing repairs or additions 3. ❑ I am a homeowner doing all work 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 Waist submit anew 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 mustprovide 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: / eX d / i b' S c/ r €1r, Ce r-n ,,„, ..7 n y . Policy # or Self -ins. I #: (,[0 Al (1, Wd '5 /,-g, . Expiration Date: O /- el- o/o Job Site Address:. - -IS I 10 hr tin jilt t a.I) 1e , 54-re T. cit . 0 10 6 2 Attach a copy of the workers' compensation p 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 and penalties ofperjury that the information provided above is true and correct. Signature: tiu 4, io it r.G✓ - Date: D C C 2008 Phone #: /.3 - %d' 4/ a Official use only. Do not write in this area, to be completed by city or town official City or Town:. Permit/License # - Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: # - 6 2 . / '/ / / I ',I i = ci Board of Building Regula and Standards _�.-_'� One Ashburton Place - Room 1301 ' �, Boston. Massachusetts 02108 • Home Improvement b itractor Registration `- -_ Registration: 142279 4� a .- _ - ;, Type: Private Corporation r 1= 'v Expiration: 3/2412010 Tr# 263223 PELLA PRODUCTS, INC. I'' --.4--' -. ' GARY SHERMAN ( ` 155 MAIN STREET GREENFIELD, MA 01301 �t �_ - , ,', ;.,® Update Address and return card. Mark reason for change. [] Address El Renewal El Employment 0 Lost Card -CA1 0 50M- 07/07- PC8490 Board of Building Regulations and Standards License or registration valid for individul use only }� __ N HOME IMP.tOVEMENT CONTRACTOR before the expiration date. If found return to •► i 7- , Board of Building Regulations and Standards ' Registr lio; 142279 One Ashburton Place Rm 1301 : ;-, ExPtatiisriv=3 21/2010 Tr# 263223 Boston, Ma. 02108 ? E _ NODS= .Pri`ate Corporation l PELLA PRODU( t� C - = i't GARY SHERMAIV, 6 _: .fy 155 MAIN STRE 4 % �r.� -✓ri GREENFIELD. MA 01301 "" Administrator Not va ithout signature Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone: 413- 772 -0153 Cell: 413- 834 -8799 To: Building Inspector From: David White — Installation Manager Date: January 19, 2009 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 #091496 and our HIC, # 142279. Please find a copy of my licenses below. k1 ..w ltus tt� - DOPLiittlient of Public Safcty Rostricrod 1 Beard of Budding Re l irntx sod nmi 'ti_h . CO ' Construction Sarperu Sor Lleeratce . Unrestricted lets o 91406 L(- 12 F #y 13nne' Restricted use 013 n k � P + ,• p� DAVID C DA ID V 444TE q Fader* cement edition of t& 54 CARPENTER ST setts Mae MANGE,. OiNi4 Is cease dar rr:«+enCion crisis* °• . " - Expansion: on: 1+312011 Refer hi Mt 1Elf'S t' +t»nenioti Barr Tr*; SITE RESPONSIBILITIES Customer: - LLIi! L if _i►./ Date: Order #: j'�' {., j Signature: Salesperson: Kevin Mckay Signature: ,e evin McKay 1 50% Deposit required at time of order. 2 Final payment is to be made to installation team on the morning of the last day of installation. 3 If 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 Due to inclement weather or site conditions, it may be necessary to reschedule. 6 We cannot and will not guarantee specific dates or days of the week for installation. 7 Time given to complete a job is an estimate, extension of time is possible 8 An Install appointment will be confirmed at Verification. A courtesy reminder call will be placed 1 week prior. 9 Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10 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. 11 In the event that any products are unable to be installed, the final payment will be recalculated. The cost of 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. 12 Order is not binding until approved by Pella Products management 13 Pella will secure all necessary Building Permits Type of Installation: New Construction: (tear out installation) ❑ Completely remove interior and exterior Trim, completely remove existing window frame, install new window in rough opening, re -trim both interior and exterior of window / door. Pocket Install : (sash replacement, existing frame remains) Remove interior or exterior stops, install new window in existing window frame opening, re -use existing or replace window stops (interior or exterior) Some glass loss will occur. Lead Paint Discloser: #1 ❑ Home was built prior to 1978, Lead Paint discloser has been signed and "Protecting Your Family From Lead in Your Home" brochure has been given to Home Owner #20 Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will n Authorized to install Yard Sign on 1st day of installation and remove 7 days afterward © Ensure someone over age 18 is present at all times while Pella employees are in the home. n D eliver and unload products © n P lace drop cloths in work areas © n R emove & reinstall interior and exterior trim if applicable © 0 Remove & reinstall existing shutters and awnings by contract © 0 Remove existing product and adjust or modify opening as needed 0 Provide all equipment necessary to install products © n C ut all wood and other materials outside of home © El Install all products purchased © 0 Insulate and caulk around products © n R emove stickers and perform initial cleaning of all glass surfaces © n D emonstrate proper operation of products © n Confirm that all products are in working order © n Remove drop cloths, vacuum and remove all old products from premises © n F inish (paint or stain) product purchased © Cut -back or tie trees, bushes, shrubs from exterior wall © Arrange to have alarm system disconnected and reconnected © Arrange to have any plumbing or electrical repairs or changes by For all service needs, appropriate licensed contractor please call: ❑ (800) 957-3552 © Remove and reinstall existing window treatments, wall hangings and Please make sure you air conditioning units. mention that your project © Remove and reposition furniture in work area was installed by Pella ❑ and reference your order © Secure pets in a safe manner number El © Remove valuable / breakable items from work area © Remove snow from area of worksite if necessary view 8.1 Licensed Construction Supervisor: . Not Applicle , ❑ Name of License Holder : - Dail ck LL(11 �� Oct I '! T q 6 License Number ISS P , s4re ef 6ceer, . M,4 1 131 20 0 i3o I II Address Expiration Dhte ' . _ _.� - 77 --01 Signature • ephone li 1' 2 sa Caai a - Not Applicable ❑ 4?e U a TroduCtl I r c. 142 1q2279 Company Name Registration Number ISS aun ee-1 Greek.' e(d MA 01761 312 /20!0 Address Expiration ate Telephone { 13 4.33—`102 x3 t"`y 7 y< �Y x sfs > . ! .r y + J ` � . a� t s ". ,s Y � >3^'B C f.�o iek 1+05M °�''` ©J t� gk` Ur i.Y �,L PIP r I a' Fve' ° .t 7 € t < �f4. l ���' LMF �_. Z"��� 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 ti No ❑ The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature "A ec S t n e4 _ . _._ ii1e1 "X71 e� `b r �i �t '"1-Z ', <. �� .'�`a ' �•- u�' . �,, , s� n ' k s D ehS i4 `� . F 4a5 f s4 p ; S c rt4 $E f< t ®� � e .Q �a� 6 7, , $3 i r s• 3` , i� �" ,�C e� i � �� New House n Addition ❑ Replacement Windows Alteration(s) Roofing El Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding [0] Other [0] Brief Description of Proposed ( ��r ►r 11 � Work: T� ,.cf0t.it O. e F 7 (fai OW (, S• 2X• ti O n;el S. !UQ •Sfroc tt '4 C ia eS. vJ� Alteration of existing bedroom Yes No Adding needroom es vNo U Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet �sF ��i�?' ; e� 4.301 I ® - } ®'':� g = ' e ... ;a <';e a ? 46 � s , o a a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? • h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floogplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes _ No . I. Septic Tank City Sewer Private well City water Supply . a"°l'X '3�'"."1°"`S'q'x'r'� �. � , �» ,,. �'`r" . - }k .�tt �+'S d ' `'•.� h '� f � 17 4 1e <3 n ,..�7 �'.�' 53 ` k ',i j A ° 6.. ' J " 4_11- 4 � a Y 7 sot xi xi . f t X 1 I, M aCfy balder , as Owner of the subject property hereby authorize C & 'ProL rt'yt.0 • to act on my behalf, in all matters relative to work authorized by this building permit application. See SI iiect C' 4 (0 • $ • 0 9 Signature of Owner Date I, Kev Meka. _ Re,t(rA 'c acs -- ris. as Owner/Authorized declare that the state ents and information on the fore application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Ketl i n Mc Kay Print Name /A • •0 • Signatur: of • er /Agen 1 / Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 1 H I 1 1 1 Frontage I 1 I I 1 Setbacks Front 1 1 I 1 1 1 Side L:1 1 R:1 1 L:1 1 R:I 1 1 1 1 1 Rear I 1 1 1 . 1 1 Building Height I { I I ( I Bldg. Square Footage 1 I I I I 1 1 1 I 1 Open Space Footage paved I 1 I I % I I I I I 1 (Lot area minus bldg & aved parking) - - -- # of Parking Spaces I I 1 I I I Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO C IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size,_type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. $ • .. 33` 3' '/� C31���k - L j City of Northampton � Building Department��,- ��� �' 212 Main Street 4 x�,' Room 100i °:: • 4 Northampton, MA 01060 � ;,{ �,� pho 413- 5 87 - 1240 Fax 413- 587 -1272 �a • • APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE O T WO FAMILY DWELLIN I . 1.1 Property Address: I W c P� S4 _ (, > T *. Y . 13t Nor Nor - a 4 w�, MA DIors2 "?)--:-'777,--:::::-. . t E � _ : 2.1 O of Record: • Ma� a c�e,r t�1 ar (e S • Current Mailin � Name {Print) / Ad es e ( "I. .3ZO-ZSSZ See- S 1'1COl C.(111 Ir ac - I Telephone Signature 2.2 Authorized Agent: i(c k AS da s�r ' Pen Pea MJ kj Name (Print Current Mailing Address: 30 i.�.. 13)533 - 4022 . . A Sign • u e Telephone Item Estimated Cost (Dollars) to be y a. r a e ti {> ) . com• leted b • a . •l i ca nt , LL• ,, ,; 3 ,, :: .. 1. Building 1-i b ()° �,.; g , x r. ** > <"" ° 3 3 x VI - R' L a°�' '�•-` ` 't : yam: • : . - : -r:.. � C h t 2 '`c 2 ' # 2. Electrical rt 3x> �? � 3. Plumbing tai€l -* ; z a • • 4. Mechanical (HVAC) _ - , �' >1, >y0 i" � � ` ...7 ..; te n e P r te " \� Protection , ' .:: : : , : >.. 5. Fire �v � : 4; ! " a ' 6. Total =(1 +2 +3 +4 +5) i ` ;� � � e ti4 , 'w . fi H .... ... :........ ......... : ::,;:...::-.7., ::: ,, .;?..:,.;-::: ::: : *. , y \*; ,,,E �3 .b: ,. � -r':2' di:,Cbi.:i6 ' "i' �`. �i.?.�; dJ:C ' '4ii:: a �:.:::: :.: ..... ::: :�:h':i_'..E..; ♦: .}: :.. � `S'v TK {" .:. v..b. , : .: fi yY >., {.z: ., +)x..;.F. �. .Yc Yi - s: x:`� u '':i'.3....: n• ;>`-)` -,.0 ..wig iK: :'L�`:�`': ' R S E: 4 y : ' x i. u '6 . b R 4 -. '- % 1 ;.,�:), " i`C . ;Ci::'... "r: ::,�, { ..,.�.,� ..; : 131 NORTHSAPWSII BP- 2010 -0422 GIS #: COMMONWEALTH OF MASSACHUSETTS 1A 4 207 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0422 Project # JS- 2010- 000575 Est. Cost: $7178.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 49222.80 Owner: WALDER MARTIN J & JOAN Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 131 NORTH MAPLE ST Applicant Address: Phone: Insurance: 240 MOHAWK TRAIL (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON :10/19/2009 0 :00 :00 TO PERFORM THE FOLLOWING WORK :INSTALL 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/19/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo NO 5Nr2