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50-007 (2) 30 PARK HILL RD SOUTH BP-2020-1232 GIS#: COMMONWEALTH OF MASSACHUSETTS MR-Block: 50-007 CITY OF NORTHAMPTON Lot:-001. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: Door Replacement BUILDING PERMIT Permit# BP-2020-1232 Project# JS-2020-002077 Est.Cost: $5164.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sq.ft.): 30709.80 Owner: WILLARD KRISTI A zoning: Applicant. PELLA PRODUCTS, INC AT: 30 PARK HILL RD SOUTH Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREEN FIELDMA01301 ISSUED ON:6/12/2020 0.00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE PATIO 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: FeeType: Date Paid: Amount: Building 6/12/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Departmep(t Curb Cut/Driveway Permit 212 Main Street AM' Sewer/Septic Availability Room 100 \- � � Wa�or/Well Availability fi f Northampton, MA 01060--, T Sets of Structural Plans a' phone 413-587-1240 Fax 413-587- 272 lot/Site Plans Other,'Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map 60 Lot .002 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: VLIC �`'l , W \��c- A) S . �lOf�ncs .I`nA C710F� Name(Print) Current Mailing Address: (C1i's) GQ C� --G(►q Telephone Signature 2.2 Authorized Agent: eJ CA( )i Name(P' Current Mailing Address: L{13Y-173- k6,'1 t-N+ 3►`� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 0 5. Fire Protection 0 6. Total= (1 +2+3+4+5) ��, ( (o U ► Check Number / This Section For Official Use Only Building Permit Num e 1-421 —r: 6Pf Of(/ 93a Date Issued: Signature: (p IZ-zd-)w Building Commissioner/Inspector of Buildings 1 Date 9QA,G Sc'u j l cc EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Frontage _ Setbacks Front Side L:'- . R: L:= R:= F Rear JVp t I A Building Height Bldg. Square Footage `"' % iw__ Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces --- t---� Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued:[ IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 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 O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding [O] Other[U Brief Description of Proposed Work: c; Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following 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 Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, VON"� �� AC tS �� as Owner/Authorized Agent hereby 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. Print Na Signature Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:: Not Applicable ❑ Name of License Holder: �f;�� Oc, C_ —COD%w Ssg License Number Gc :cl of Addres Expiration Date "7'Z3-1 l S'lQ��31� Signatu Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Qom,\\ cbc�US1.�S. -X%,(. \Ude ?"i Company Name Registration Number )C,S -► �� , CTc�-�r��C�e�d�rM ©►30� la3 �a.�a. Address Expiration Date C 4t�'7?3-tls7 exp 3�'i Telephone SECTION 10-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...... ❑ City of Northampton Massachusetts 41 \r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street *Municipal Building Northampton, b% 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by IVIGIL c 111, S 150A. The debris from construction work being performed at: 30 10(-Qr,'C_Q (Please print house number and street name) Is to be disposed of at: Q^Awb In.,— I r-S JJ6.' S; G r.A4LVV,� (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4. Signatub of Permit Applicanf-or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. DocuSign Envelope ID:46CBD4AD-CEAB-43A5-A8BO-4E5A9F74954B Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: Kristi Willard 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; 30 Park Hill Rd South Florence, MA 01062 Please accept this letter in place of my signature on the permit application. Thank you, DocuSigned by: ASignature: `yb Date: 5/21/2020 Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-773-1157 Ext. 317 Cell:413-834-8799 To: Building inspector From:Trevor Bross—Installation Manager Date: February 21, 2021 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. IV Co4r,=)"wealm of Massachusetts Construction Supervrssm Dnnsws of Profess+ooal LEce tsure unrestricted•BW#dings of any use group Wtllctt contain Beard of Building Regulations and Standards less than 33,000 cubic fret(991 cubic meters)of enclosed f...°e tr'J&f A'St*e visor space. CS-096556 "' atea�;$ itl1d2g2Z TREVOR SRO" 10 GEORGE GREENFIELD*A r Al�#rsit �.. Few"to possetw 0 cum;*editiatt of Ow Ma sachos4u Starter suadkv Code is saute for revocation of I Commissioner �" " '� i For ittfor'enptioA afiboilt No call(617)727,V00 or V"WWW4"*a%,0**V t J .7/tP C;Mrtfrlll9llYVsl/�/f�?'C3<•GJ.l?,LYTiC.SPl�si Office of Consumer Affairs&tiuslness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE..Cormation before the expiration date. If found return to: Rcgistratim Expiration Office of Consumer Affairs and Business Regulation 142279 03/23/2022 1000 Washington Street -Suite 710 PELLA PRODUCTS, !AC: Boston,MA 02118 ELW IN HERRINGSHAW-.- J 155 MAIN STREET ,�wR GREENFIELD,MA 01301 Undersecretary Not valid without signs e 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Aven ue 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 STREE City/State/Zip:GREENFIELD, MA 01301 Phone#:413-772-0153 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 50 4. X 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 g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. E]Building addition required.] 5. F1 We are a corporation and its 10.F] 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.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no 13.F] Other employees. [No workers' comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: EMC INSURANCE COMPANIES Policy#or Self-ins. Lic. #:6H 15382 Expiration Date:01-01-2021 Job Site Address:©94G 's\A,NC14 S City/State/Zip: uz c e MA G 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 cerci n r the pains and p of perjury that the information provided above is true and correct Si ature: Date: I a� �a � Phone#: A �_L 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): 11113oard of Health 211 Building Department 3❑City/Town Clerk 4.11 Electrical Inspector 50Plumbing Inspector 6.00ther Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: S/a'7 J�Dac� To: C:)r4 0A JVcX ac�Q�� 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. John P. Benjamin Accounting Manager PELLPRO-01 CHRISTINE ACORD" DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1x8/2020 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 pol)cy(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 C2jJ+CT Christine Sullivan Phillips Insurance Agency,Inc. PHONE 413 594-5984 FAX 413 592-8499 97 Center Street (ac,NLo,Ext):( ) (AIC,No):( ) Chicopee,MA 01013 A UARESs:christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC i INSURER A:EMC Insurance Companies 21415 INSURED INSURER B: 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. INSR TYPE OF INSURANCE ADDL SW POLICY NUMBER POLICY EFF - POLICY EXP LIMITS LTR IN D A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR SA15382 1/1/2020 1/1/2021 PREMGETORENTED 500,000 PREMISES(Ea occurrence) S MED EXP(Any one person) S 10'000 PERSONAL&ADV INJURY S 1,000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY X %CpT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: COMBINED SINGLE LIMIT S 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) _ $ X ANY AUTO 6ZI5382 1/112020 111/2021 BODILY INJURY(Per person) ,S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S p PROPERTY DAMAGE AUTOS ONLY AUTOS ONELY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE 6.115382 ,1/112020 1/112021 AGGREGATE S 4,000,000 DED RETENTION$ S A WORKERS COMPENSATION STATUTE ER ATH ND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN 6H15382 111/2020 1/1/2021 E.L.EACH ACCIDENT S 500,000 OFFICERIMEMW R EXCLUDED? N/A 500 000 (Mandatoryin H) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Ramarks Schedule,may be attached if more space is required) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPATION ATE City of Northampton ACCORDANCE WITH THE POLICY P OVISIONS.NOTICE WILL BE DELIVERED IN 212 Main St Northampton,MA 01060 Al1T14OPoZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Docucgn Envelope ID:46CBD4AD-CEAB-43A5-A8B0-4E5A9F74954B Contract - Detailed 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: (413) 736-3390 Sales Rep E-Mail: alukomski@pellasales.com Customer Information Project/Delivery Address Order Information Kristi Willard Willard Kristi 30 Park Hill Rd S Florence Quote Name: Lifestyle Sliding Door 413-6956119 Phase 2 30 Park Hill Rd S 30 Park Hill Rd S Order Number: 739U2FL091 FLORENCE, MA 01062-3613 Lot# Quote Number: 12628861 Primary Phone: (413)6956119 FLORENCE, MA 01062-3613 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: kristicdw@aol.com Quoted Date: 5/21/2020 Great Plains#: 1005474009 Customer Number: 1009362374 Customer Account: 1005474009 Line# Location: Attributes 10 Kitchen Lifestyle, Double Sliding Door, Contemporary, Vent Right/ Fixed, 71.25 X 81.5, White Item Price Qty Ext'd Price $6,269.59 1 $6,269.59 i _ 1:7282 Vent Right/Fixed Double Sliding Door PK# Frame Size: 71 1/4 X 81 1/2 `— General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5 7/8",4 9/16",Oak Threshold 2059 Exterior Color I Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Black,Standard, Handle Included,Handle Included,Champagne,White, No Integrated Sensor Viewed From Exterior Screen: Sliding Screen,Wood Interior Color Matched Exterior,Champagne, InViewT°" Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.52,CPD PEL-N-4-00323-00001, Performance Class R, PG 30,Year Rated 11 Grille: No Grille, Wrapping Information: Foldout Fins,Factory Applied,No Exterior Trim,6 9/16",7 7/8", Factory Applied,Pella Recommended Clearance,Perimeter Length=306" Frame Size:71.25"X 81.5" EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 EXTTRIM15-Kick board to match ext trim PVC Qty 1 AC-9B3-OTHER-3 Qty 1 PDA -Patio Door Install up to 6FT in width Qty 1 EXTTRIM18-Strip and Reuse Vinyl siding per 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 5/21/2020 Contract-Detailed Page 1 of 7 DocuStn Envelope ID:46CBD4AD-CEAB-43A5-A8BO-4E5A9F74954B t ustumer. ensu vvnlaru rruiect game: Willard Kristi 30 Park Hill Rd S Florence Order Number: 739U2FL091 Quote Number: 12628861 [Project Checklist has been reviewed Kristi Willard Adam Lukomski Order Totals Customer Name (Please print) Pella Sales Rep Name (Please print) Taxable Subtotal $2,857.41 ,]Docuftned by: DocuSigned by: /1,�� Sales Tax @ 6.25% $178.59 ~AWtur Pena s 63eG Signature Non-taxable Subtotal $2,128.00 5/21/2020 5/21/2020 Total $5,164.00 Date Date Deposit Received $2,582.00 DocuSigned by: Amount Due $2,582.00 j��,g@jpro al 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 5/21/2020 Contract-Detailed Page 7 of 7