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25C-049 a a IMPORTANT F" ID = 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). 0) 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). 1) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing 0 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. 0 IA F A Z 0 f v D. L C7 V • 2 N ACORD 25 (2001/08) Page 2 of INS0251omal.oaa m f 0 LL 0. 1- 1- 0 W DATE(MMIDDIYYYY) M ACORD, CERTIFICATE OF LIABILITY INSURANCE 3/29/2010 t. PRODUCER (413)773 -9913 FAX: (413)774 -3872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE N M assOne ONLY Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ti 117 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. • P.O. Box 638 i Z Greenfield MA 01302 -0638 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. Continental Western ' M Pella Products, Inc. INSURER B. r ATTN: John Benjamin INSURER O 155 Main Street INSURER 0, Greenfield MA 01301 -3258 INSURER E. ,. F COVERAGES • N TI-16 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 HER DOCU WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY R, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED OT HEREIN ISC SUBJECT MENT WITH TO RESPECT ALL THE TO TERMS, EXCLUSIONS ANO CONDITIONS O1 SUCH PO TAIN a AGGREGATE LIMITS SHOWN MAY HAVE BFFJ REDUCED BY PAID CLAIMS. ✓ INSR ADD/ POLICY EFFECTIVE POLICY EIRATION - LTR Mien TYPE OF INSURANCE POLICY NUMBER PATE (MM /DD/YY) DATE (MMIDD/YY) XP LIMITS 0 GENERAL LIABILITY EACH OCCURRENCE 0 1,000,000 • X COMMERCIAL GENERAL LIABILITY PREMISESO(Fe RE occurrence) 5 259,000 O A I CLAIMS MADE © OCCUR CPA020470113 1/1/2010 1/1/2011 MEDEXP(Any onepe*0r1l $ 5,000 r PERSONAL A ADV INJURY $ 1,000 , 000 O 2,000,'900 N GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP AOC 9 2,000,000 , W POLICY IFTT I LOC N AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s (Ea accident) - —` _ X �_ ANY AUTO ___ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ . Z _ HIRED AUTOS BODILY INJURY 0 (Per accident) 5 I _ NON -OWNED AUTOS ✓ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC $ AUTO ONLY', qGG 5 EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 0 0 OCCUR ❑ CLAIMS MADE AGGREGATE S $ _ _ DEDUCTIBLE S 1-.I RETENTION 0 I $ A WORKERS COMPENSATION AND X I TORY IM T$,f 1 FR - - EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E EACH ACCIDENT $ 500,0.00 OFFICEFIMEMBER EXCLUDED? WCA020470513 1/1/2010 1/1/2011 E. L. DISEASE - EA EMPLOYEES 500,000 Q If yes, describe under SPECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT $ 500.,000 7 OTHER 0 L 0 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEmENT/SPECIAL PROVISIONS 9 Operations usual to the sales s installation of windows k doors V 1 C 7 L 7 0 CERTIFICATE HOLDER CANCELLATION C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ■ Edwina Zebrowski EXPIRATION DATE TNEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL_.; 0 233 North Street 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT - 1. Northampton, MA 01060 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE_] f• INSURER, ITS AGENTS OR REPRESENTATIVES, ... ....1 9 AUTHORIZED REPRESENTATIVE ( I ` Y Robin Sargent /RMS �7 -�' 2i7. ``"`�� 1 G ACORD CORPORATION 198'8 S. ACORD 25 (2001108) y m NS02510108).oaa Page I 0 Z LL The Commonwealth of Massachusetts �.-—. Department of Industrial Accidents i ' .t / Office of Investigations li ,, ;� 600 Washington Street ' iCI. Boston, MA 02111 -q' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly J Name ( Business /Organization/Individual): / / /r el 12 c �3 � -1 /7 C, Address: y 53-- /I/ c7/r) S 4- C' City /State /Zip: 6 rem t / E /i /Y//7 0 /30 / Phone #: "7 - 77; • O / J .f Are you an employer? Check the appro box: Type of project (required): 1.14 I am a employer with 7(2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. El 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. n 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 10.11 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.H Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.M Other r /crrc- 7/%, clove ) comp. insurance required.] , V , -)c/ .1�0o r S *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: ' ,74 / n u r- 4 e g n Policy # or Self -ins. Lic. #: W G 1 4 ,,,,7 e) 7 7' o5/ 3 Expiration Date: /- i2 / 0 // Job Site Address: c233 Kioiiirt Sk re .e. - City /State /Zip: Klt -kl'yl (tn1 __LAA 0 ` o b a 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 cer ify under the pains and penalties of perjury that the information provided above is true and correct. Si. nature. 1.■1 L! dilit: Date: Phone #: Cu‘3) 73(a — Q 339 X 1 ( b 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 #: gi . , ,, , , , „ , 4 0 4 " OF 4 (7) ' , `, 1------- =1*-1-- ------- .1 ‘ Office of Consumer Affairs and usiness Regulation il , ..„.... _ .„,.,: 1 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 142279 Type: Private Corporation Expiration: 3/24/2012 Tr# 294515 PELLA PRODUCTS, INC, GARY SHERMAN 155 MAIN STREET GREENFIELD, MA 01301 Update Address and return card. Mark reason for change. 11 Address Renewal 1 ---- Employment , Lost Card °Ps-cm $:*, 50M-04/04-G101216 ',,,, L 7k 6).-' ni,m,o/ftweald ot, limuctemiede6 License or registration valid for individul use only Office of Consumer Affairs & Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 142279 10 Park Plaza - Suite 5170 Expiration: 3/2412012 Tr# 294515 . Boston, MA 02116 Type: Private Corporation PELLA PRODUCTS, INC. GARY SHERMAN ,/ 155 MAIN STREET t-- GREENFIELD, MA 01301 Undersecretary illf ° .4.41114 ',4 1 ot vali itho 1 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. x r r 4_1 j, Spard o " iidl Rt uI sn %'ai l itivricuditx Pansituttl ""34I rvIaer ¢n 17n .t 1C -1 2Fiunilblkotati ttesos: , 0!; 21444 .,' to bArl t Faun e ko * tiatrttmt adiiiraii atilt *' ff` ; I� i ir sehusattl St:ict Biti[ding Cook �E. '1 . - ?. t caaaciQroix041424ufthis Pcmpft cr �k 1i'3if.37i1 tn: ��M Cor1D`PS Trif; SITE RESPONSIBILITIES Customer: Edwina Zebrowski Date: 03/17/2010 Order #: 0 Signature: *411V� Salesperson: Michael Balthazrr Signature EvelmwmfyysIsIMftr. - 1 50% Oeposit required at time of order . •r • 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 08% 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 wit 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 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) 1 1 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 I x I Home was built prior to 1978, Lead Paint discloser has been signed and "Protecting Your Family FTom Lead in Your 'Home' brochure has been given to home Owner #2I x Are there children under the age of 6 or women who are pregnant? Pella Mil Owner Will Pi ( Authorized to install Yard Sign on 1st day of installation and remove 7 days afterward n Ensure someone over age 18 is present at all times while Pella employees are in the home. [TIC pi D eliver and unload products t XX I ? r 7 P lace drop cloths in worm areas I ^ I 1 R emove & reinstall interior and exterior trim if applicable y X I y Remove & remstaK existing strutters and zoonings b3 contract © ri R emove existing product and adjust or modify opening as needed n Provide all equipment necessary to install products © I-I Cut all wood and other materials outside of home n install all prr,rdi arts purchased © 1 1 Insulate and caulk around products I X! j j Remove stickers and perform initial cleaning of all glass surfaces © n D emonstrate proper operation of products n 0 Confirm that all products are in working order X pi R emove drop cloths, vacuum and remove all old products from premises FR] i n F inish (paint or stain) product purchased I © Cut -back or tie trees, bushes, shrubs from exterior wall I X I 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: 35 -3552 (� Q Remove and reinstall existing window treatments, wall hangings and Please make sure you air conditioning units. mention that your project 1 1 1 X Remove and reposition furniture in voos'k area was isystaiied 3 Pula Fl Pit Secure pets in a safe manner and reference your order number Remove valuable / breakable items from work area I I X I Remove snow from area of worksite if necessary j • .. T.J.• _ «.. _..Y'..�,t:^ -x' :: ,. ,r4 Y F "! "': � F�:. /. 8.1 Licensed Construction Supervisor:. Not Applicable ❑ '� Name of License Holder: ,)(.'J kk3 d^kC. OCA l (A(A(D License Number 155 Nate S .ems a Ge.e)n- eic MA 61' $1 t�31 11 Address Expiration ate OOJJ Ct1iJ , 64 �� a (s3 Signature Telephone iizi. °.� il_ r;t'< Not Applicable ❑ TQACK7VmC1Qd 5 , \n c, u a a-1 cl Company Name Registration Number J r -L ■' Jk • 1 DLA Address Ex p ira io Date TelephonelA∎3 - 0 S3 �y- ,.✓✓�- „,,y °���r�- �y— „�!.t4.#' � ��..AZ'�. k40, � 1'a � Ft..:/�S i t `�.€?�.�'�i..� Firi:1. y161 'e.` i�l� '"" � t �._�``� ,• '. ,. i}.' �'Q' i s i < 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 build' permit Signed Affidavit Attached Yes No ❑ it, .” ' f ffi 94 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 • w ... rs x '� ? �"" `,�`� - rasro�- E '£` ems �II i+: , i. $ r , '`a' i .-,,,i; ..:Ni --, f V y --, . ., C 3." dsF A ®°fi ° w c�s.T ® 6 ?:D D Y' :7` ae , 1 i'' .,. ,: ,.. X:.1', s;' ✓ ^ T .w >. .- Ark- c? . .. New House [J Addition El Replacement I _en" doves Alteration(s) 2 Roofing 1::: Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [O] Other [CI] Brief Description of Proposed Work: Ke 00 C� P A do o c . U St nc7 42).A ..4i (v9 0? en i `n . NO ne Alteration of existing bedroom Yes 47 No Adding new bedroom Yes NV No L'Ar1Strvc L fi `n, Attached Narrative Renovating unfinished basement Yes V No Plans Attached Roll - Sheet :f, 1r:N4 .sfc1 age fro to ® ®3• 4"a , r , v', "`e5 D a ;d I 0... ;Yir WI, i'. 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. floopplain _ Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1 Septic Tank City Sewer Private well City water Supply I, CO Eduk.) \ Ze_ DIML -% , as Owner of the subject property 1 hereby authorize ?e Ca Co \ _. c - 1 1 r c_ to act on my behalf, in all matters relative to work authorized by this building permit application. ( Sees o d etz)Cltfor. -+) (313i 110 Signature of owii Date I, 1 . Poods_Dok s , 1 Y> C_ . as Owner /Authorized Agentifereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. t ■NI a Wh∎ Print Name ouvia c t j 6A Signature of Owner /Agent Date " , Section 4. ZONING Alt 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 11 11 1 Frontage 1 11 11 1 Setbacks Front 1 1 1 1 1 1 Side L:1 1 R:I 1 L:1 1 R:1 1 1 1 1 1 Rear 1 1 1 1 1 1 Building Height 1 1 I 1 1 Bldg. Square Footage 1 1 1 1 1 1 1 1 1 1 Open Space Footage 1 1 1 % ( ( I 1 (Lot area minus bldg & paved I 1 parking) # of Parking Spaces 1 1 1 1 1 1 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES IF YES, date issued:I IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0/YES 0 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 e IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca tion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. a City of Northampton 1 ` j - Buildin De artment ® y � 212 Main Street 'i > • 0 �0 Room 100 a � � r 4 � .4 E • , North MA 01060 r,,r 3�ksre� ... �� ' phone 413 -5&7 -I 40 Fax 41 3 - 587 -1272 '- v � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ON OR T WO FAMILY DWELLING • 1.1 Property Address: a�3 N 3 �(Q� � �� 3 NC) k n ,,,k- -4N air o�ob� sr a • � � i''' ��-'�`.,� r+sd {sue kr '�aF`y 'CC, -�+ �?�S. € 5 � fir. ^4 �' .a r� v t l. c £6 3 :i'y' 4k'4 � t 4: k D CFS i<� i 1 � ; R.k° 9 1F` R J $.4 J' 2 Owner of Record: II • • E dw 1C -�� r ��lkh0►fY1� I “A a33+� a .�-�, .k Name (Print) Cu !It M A ddress: 0106). (5 e Si C'sb src � • . `p hone s ou - ua�� Te Signature u 2.2 Authorized Aqent • Fexta �Ir�d l �� (S5 Mal► `fire -.� Carserr��,l v 13c� ti • CLItS) 1-7 Name (Pant) Current Mailing Address: 0 ,c) C Signatur Telephone ,tom — tii x • Estimated Cost (Dollars to be y : N l s; < ' ��.: x.X... com•leted .ermita..lican ' " > < . __ xy'f >:<kie-: �;:<;- : r :; F ;.;: n :; v � , . '.' ks �.... 'tiila. ' 1Y:I: � _ .. <:ra:..._,u ._e�,:.v �:.f: "' :C i:i ::u:_va: _ _:...:. �. t_::__::.... ,:..7 ' 1, Building `I `- . - l 9 � ' >` L ' R y ' } 4 i s , 3 2. Electrical a Y 'a° ,a E �� ::::,.,, w � °`Y .� tJ - }.:1 ,b ^J 53� -s �E Y.. }, f ..'.• $ it �-'. - «: g ..o rE."i -:i 'x,. S:.. +vii r 3, Plumbing tf�t= 4 4. Mechanical (HVAC) "a M.x �, 1..-i ��`a f �I k . ,2'.. `k z y • 5. Fire Protection, ,�Y F Fes' s4 6. Total =(1 +2 +3 + + 5) l� 1` 1 '< F a z� y, ; _.:: r M `r <.»., °..: '' - m.{ . ..<. : _v:.- . � � .,:. :..<: '::v.� ... <a., -ruay. _.•c: � a i> l'��'�::.: '...:c24� - SY i6irrsulvl S: v r" � rt�+ ,,gg,,,,Y � J :. .::a.: . v .:. �.. . ,:r +::'�: :.� v .;... <. n. ., �..i..;::aS;'s7': � ' S' :` ?� \�r..,� -.., .,, <.. �. -. .:,.,.....:. '� ,v . y Y {� ?;�;>Y : r,.•.�_, • . . .: :.. :;.}'•..:.:^:. :. ::':.;.......n_.:. \d' \ • - -. . .i > v �.,�, .�:yk.e re .v =i<.. ..eZ S_.w. > ' ^ - :r.: �.3: :�� il b.: _: • ... .;. n &' #laT2 \.r,< E • g4r a. a Z : bh ° ) k .�„ "2 , ^'•.t: _i:R�i `.aj . : = �:�;: -� : ',y :...... .:�b+�:�;.ti���'_.. -. ....,. <'::�1 „._..: :.as.ti�:�... >�:u.>i'i; � y o- _ Y t a"< . ....._ BP-2010-0871 GIS #: COMMONWEALTH OF MASSACHUSETTS F � 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 -0871 Project # JS- 2010- 001293 Est. Cost: $4949.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 9408.96 Owner: ZEBROWSKI PETER A & EDWINA C & KAREN MATHERSON ET AL Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 233 NORTH ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:4/8/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: 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: FeeTvpe: Date Paid: Amount: Building 4/8/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo