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29-449 (4) Window World of Western Massachusetts �0�5 KEELING 1029 North Road-Hampton Ponds Plaza,•Westfield MA 01001 Phone(413)786-9900 • Fax(815)366-8039 NAT-41779-1 BBB www.WindowWorldofSpringfield.com HIC#165641 sg,4ea , 'Simply the Best for Less" CSL#57011 A mrch Hn pi[ Customer: Phone(h) - ,w' !' r a,:,: _>; Phone(w) Install Address. r r t_ Bill Address: E-mail WINDOW WORLD VALUE PLUS 4000 + 6000 SERIES PACKAGES 2000 Series Mech.Frame Welded Sash $189 Energy Star Plus U-Value_SHGC_ $79 1 4000 Series DH $205 I;-,'" Foam Insulation Wrap $26/C 6000 Series DH $239 ! Lifetime Glass/Seal Failure Warranty $32 N Picture Window $329 I Transferable Lifetime Warranty $15ll 2 Lite Slider $329 k/ Double Strength Glass $26 � 1 3 Lite Slider "('/4,1/2,1/4) (1/3,1/3.1/3) $520 - 7 Total Options: $178 Awning $285 PACKAGE PRICE $89 1'J Casement LH RH $285 Triple Pane U-Value_SHGC_ $50 1 Twin Casement(Requires 2 Value+)(0973)(0979) $570 Three Lite Casement(Requires 3 Value+) $885 PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMENT LAW) Basement Sliders<55 UL---- $239 MY HOME WAS BUILT IN THE YEAR -'i5 INITIALS-.,. ":< Hopper(In existing wood)(Vent add$150),'$185/$250 EPA LEAD SAFE(Per Window) $60 _Specialty Window — $ EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100 Bay/,Bow(Insulated seat,Int.Casing&Ext.Cap) $2875""E =w Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1875 EPA Lead site setup 8,disposal fee: $100.00 Grids/Eat.Color,9nt.Woodgrain/Colors calculated in WW upgrades EPA Lead,third party verification: $475.00 Remove Existing Bay/Bow $250 1 decline third party verification ❑(INITIAL): Reframe&Retrim(stain/paint not included) $250 _ (Initial)I have received a copy of the Lead hazard information pamphlet Roof for Bay/Bow Window $450 informing me of the potential risk of the lead hazard exposure from renovation activity to be Second Floor Installation $500 performed in my dwelling unit,the EPA"Renovate Right"brochure. Window Color / <' ' (initial)I have received a copy of the lead test result(s). Inside Outside Sign,- Date: WINDOW WORLD UPGRADES Name(s)(Print) Full Screens $25 BEIGE Color charge $35 MISCELLANEOUS LABOR Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79 + `r Woodgrain Interior(LO)(DO)(CH)(FX)(RM)(SM) $95 Color Other Than White $10 Contoured/Flat Grids(TOP)(FULL)(ENDS) $45 Specialty Custom Exterior Trim/Wrap $ Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Quick Trim(Int) (Ext) $30 Diamond/Brass Grids(TOP)(FULL) $69 Aluminum/Vinyl or Steel Out $50/$125 Oriel/Cottage Style(40/60)(60/40) $30 Mull Removal $30 Obscure Glass Per Sash(BOT)(FULL) $35 Mull to Form Multi-unit $30 Tempered Glass Per Sash(BOT)(FULL) $65 Install Interior Stops(WHITE VINYL) $45 Catalog Options $ Install Exterior Stops(WHITE VINYL) $45 VINYL PATIO DOORS-LH or RH(Outside Looking In) Customer Provided Stops/Trim $20 (Includes:White Interior Casing and Exterior Trim.) Install Interior Casing $60- 5 Ft.Sliding Patio Door(LH)(RH) $1250 Repair/Replace Sill or Jamb $75 6 Ft.Sliding Patio Door(LH)(RH) $1300 Mobile Home Conversion $200 - 8 Ft.Sliding Patio Door(LH)(RH) $1500 Remove/Re-Install A/C or Awning $100 Patio Door Beige Color $125 Patio Door Low-E/Argon $125 Site Setup,Removal,In Home Service,etc.: =250.00'• Heat Buster Package Upgrade $215 Extra labor(Box on left fQrrdescription)$ Patio Door Grids(Regular)(Woodgrain) S100 Total Amount Due$ Woodgrain/Brown(LO)(DO)(CH)(FX) S225 50%Deposit Amount $ Exterior Colors S395 Patio Door Triple Pane Upgrade $250 []Cash Keyed Lock$36 Foot Lock$51 Storm Door Model $ []Finance-( )Wells Fargo ( )Other NO EXTRA WORK IF NOT IN WRITING! -4-1-Check made to Window World of WM# _ Exp.Date: V-code Final Payment Amount$ To be paid to the installer upon installation.Thank You. Sales Rep Recommended:[]Interior Stops []Exterior Capping: WINDOW WORLD CARES Customer Declined: []Interior Stop []Exterior Capping: St.Jude Children's Research Hospital $ WW of W.Massachusetts anticipates starting this work on and being substantially completed in_days.Security Interest:Yes_No_ Any deposit required in advance of the start of the work SHALL NOT exceed 33 1/3%of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of all parties. �r e-lrnprovement-wntractors and subcontractor"hall-be-registared and ttrt-anyinquires about a-comractor subcontractor relating-toa-Tegistratiorrshculd be- directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973-8700 -, No work shall begin prior 10 the signing of the contract and transmittal to the owner of a copy of such-contract. ion WW of W.Massachusetts under provis of Chapter 142A of the general laws is requiredto apply for and obtain all construction-related permits.WW of W.Massa- chusetts shall not be deemed responsible for delays.in The work described in-this pgreenrl caused by regulatory permit granting agencies+authorities or individuals. Notice:If the PURCHASER(S)obtains his own construction related permits for the work described under this greeinent or deals with unregistered contractors, the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M,G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following third business day. THIS IS A CUSTOM ORDER NOT.FOR RESALE! Owner Date' Salesman` l.. Date Owner Date This Window World®Franchise Is Independently owned and operated by Window World-of Western Massachusetts,Inc.under license from Window World,Inc. wM WC 05-14 White Copy-Original Yellow Copy-File Pink Copy-Customer sommoommomw The Commonwealth of Massachusetts Department of Industriat Accidents Office of Investigations 600 Washington Street IF Boston,MA 02111 www mass gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizabon/Individual): W 1 N bf)VJ ) UQ Lb aE wE6TE-RA MA,StAc-NKSfTTS Address: 102-q NV91-4 91) City/SwWZi : W lES'TIF t 1 t_t) M 1°r D t O$S Phone #: 413 '11S - 7315' Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with Z 4. ❑ I am a general contractor and 1 6 ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees 'these sub-contractors have g. ❑ Demolition work' for me in an aci employees and have workers' working y capacity. 9. ❑Building addition [No workers'comp. insurance comp.insurance.• regw�-] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑.1 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 employees. [No workers' 13.(�Other comp.insurance required.) W f>t `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 cbeck 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 tkat is providing workers'compensation insurance for my employees. Below is Nu policy and job site inform adaiL Insurance Company Name: 1-..16E0-T`/ MkTUAL IMSu0.F"CE Police#or Self-ins.Lic. 2- 3 15- 377 q q7 -0� Expiration Date: •7-M 15 Job Site Address:/(D G-k ItVi Lo D! iii', City/State/Zip: Y1O t LIU / I,+ &(co(o Z 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,Neteby certify//m4der the prakss wo pemas of pe#u)y that the information provided above is true and correct ✓ran 41' 7 1�?d^ Date: Phone t# 1413 yq S • '7339 OffxW use only. Do not write in this area,to be completed by city or town offX*l City or Town: PermitlLieense# 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#: " SECTION 8-CONSTRUCTION SERVICES 7 1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number 127 ROOSEVELT AVE 57o 1 ) Address Expiration Date FEEDIMG 14ILLS MA a 03k) 413 451&6A-)4 Signature r? /, Telephone 12� A.Registered Home Improvement Contractor. Not Applicable ❑ Ro 6EP.r BuS4f_y SfL. I �0 5 u 4 Comparn Name Registration umber W I Q1DD-J W Tak-b t� W F_sTe2>`% .M 466 1)J C� 3 15 ) 1 fv Address Expiration Date 107A NoaT:i 9—D W26if►EL-6 MA 01085 Telephone 9i341&&7335 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...... ❑ 11. - Home Owner Exemption 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 1083-5.1. 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 strictures 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 buildina 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 i i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1 Addition F-1 Replacement Windows Alteration(s) Roofing Or Doors OR I Accessory Bldg. 0 Demolition 0 New Signs [m] Decks [M Siding[M] Other[EX Brief Description of Proposed ��I Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No f 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? I 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. 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, A h 11 lz k7Q W I c;l as Owner of the subject property hereby authorize RjlD�'-rt• L. Riy 517 1� J12' to act on my behalf,in all matters relative to work authorized by this building permit application. ( Sep (itim 6'C-f) -- Signature of Owner Date 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. 126BE2T NAS NE-/ Pint Name ,? 7 ; Signature of Owner/ nt 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 Frontage Setbacks Front Side L: R L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Penrlit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES Q 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 O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO O 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 O IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,them a Northampton Storm Water Management Permit from the DPW is required. 7 f, n — rte: I 00partmentuse only City of Northamptons i L! j; I�� Building Department i a _ « DEC 5 ` � 212 Main Street Room 100 M lectric, Plumbing&Gas inspection .: Northampion, MA 01060 orthamoton, MA 01060 r 3-587-1240 Fax 413-587-1272 �> 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 Lot Unit Zone Overlay District - Ekn St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) \ Current Mailing Address: _ C see Lo WM Telephone Signature 2.2 Authorized Agent: P_,0&B _T E SusHEy 10M cm wFsTf-iteL_p AAA ©►osg- Name(Print) Current Mailing Address: 4i3 4-w5 -)335 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complete by ermit applicant 1. Bui.Jing 2 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number t� This Section For Official Use On Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date 16 CRESTVIEW DR BP-2015-0638 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-449 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2015-0638 Project# JS-2015-001224 Est. Cost: $5462.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: ROBERT BUSHEY JR 057011 Lot Size(sq. ft.): 10018.80 Owner: REWIS ANNIE Zoning: Applicant: ROBERT BUSHEY JR AT. 16 CRESTVIEW DR Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 O WC WESTFIELDMA01085 ISSUED ON.-121812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 12 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: FeeTvpe: Date Paid: Amount: Building 12/8/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner