43-125 Window World of Westerly Massachusetts - Wo�SE ssm«c
1029 North Road-Hampton Ponds Plaza,•Westfield MA 01001
Phone(413)786-9900• Fax(815)366-8039 NAT-41779-1 B86
www.WindowWorldofS rin field.com HIC#165641
PY P
P g s i�ar cwaren:
"Simply the Best for Less,, #57011 eas�arrn no:nm
Customer: Phone(h)
Install Address: Phone(w)
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
4000 Series DH $205 Foam Insulation Wrap $26 N�G
6000 Series DH $239 Lifetime Glass/Seal Failure Warranty $32---N./C
Picture Window $329 Transferable Lifetime Warranty $15 /C
2 Lite Slider $329 Double Strength Glass $26 NIG _
3 Lite Slider (1/4,1/2.1/4) (1/3,1/3.1/3) $520 Total Options: $178
Awning $285 PACKAGE PRICE $89
Casement LH RH $285 Triple Pane U-Value_SHGC_ $50—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 UI $239 MY HOME WAS BUILT IN THE YEAR -"\ INITIAL;,_.'.-�.
Hopper(In existing wood)(Vent add$150)$185/$250 EPA LEAD SAFE(Per Window) ' $60
Specialty Window $ EPA LEAD SAFE(Patio Dr 1 Bay/Bow/Garden) $100
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap) $2875 EPA Lead site setup&disposal fee: $100.00
Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1875
Grids/EA.Color/int.Woodgrain/Colors calculated in WW Upgrades EPA Lead,third party verification: $475.00
Remove Existing Bay/Bow $250 1 decline third party verification ❑(INITIAL):
Ref rame&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 S35 MISCELLANEOUS LABOR
Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79
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
B 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 $215 Extra labor(Box on left for description)$
Patio Door Grids(Regular)(Woodgrain) $100 Total Amount Due$ '
Woodgrain/Brown(LO)(DO)(CH)(FX) $225 50%Deposit Amount:$ -
Exterior Colors $395
Patio Door Triple Pane Upgrade $250 []Cash
Keyed Lock$36 Foot Lock$51
Storm Door _- , °> Model $ I]Finance-OWells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITINGI [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.
- - _ _ __ WINDOW WORLD CARES --
Sales Rep Recommended:[]Interior Stops []Exterior Capping:
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 1/377/%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.
All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should 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 to the signing of the contract and transmittal to the owner of a copy of such contract.
WW of W.Massachusetts under provision of Chapter 142A of the general laws is required to 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 agreement 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 agreement 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 Date Owner Date
This Window World`s 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesfiga&ns
' 600 Washington Street
Boston,MA 02111
www.massgov/dies
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Auiplicant Information Please Print L gbly
Name(Business/Organization/Individual): W t N LNDW IVUR LD QF WESTT~RtJ MA StACNyISETTS
Address: t 02A N V 0,W {t)
City/State/Zip: W>EST1F l e Lt) M ik V I O$S Phone#: L113 ''t q S — 7 3 3 5
Are you an employer?Check the appropriate box: Type of project(required):
1.[9 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
work for me in an aci employees and have workers'
mg Y capacity. 4. E] Building addition
[No workers'comp. insurance comp. insurance.•
required.) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑.1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.(�Otherl'CYLACEME�T
comp.insurance required.) W 1 N
*Any applicant that checks box#I must also fill out the section below showing their worker'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 subcontractors and state whether or not those entities have
employees. If the subconuactors have employees,they must provide their workers'comp.policy number.
I am an enrloyer that 1s providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: L16Ett7y MICTUAL. IMSUAWa
Polio,#or Self-ins.Lie.#: ty{/C 2— 3 1 S— 377 a L7 -QJ 4 Expiration Date: S•7•Zr) I
Job Site Address: i I G—felm,1 t � �/Zti'u`(`. CitylState/Zip:'F(J)-e�G1(Q , 1�,Ai C)I l-�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 5250.00 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 iereby certify under,�e painsSand p;N rsNapf perjury that the information provided above is true and correct
SigmWe' � , C �' Date:
Phone# 'T 13 4O S - '7335
Official use only. Do not write in this area,to be completed by city or town offacial
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#:
SECTION 8-CONSTRUCTION SERVICES
-8.1 Licensed Construction Supervisor. Not Applicable ❑
` Name of License Holder: D BE 2T E 6 f1S F}�y
License Number
12-7 RoosFV-lr:J- AvF 57o I
Address Expiration Date
I
FEED W6 N )W-S MA Qrl p y 13 J 55&Ci-)
Signature Telephone
�4� zl
i I�G o 7 ��� i
_Registered Home Improvement Contractor Not Applicable ❑
Rv BFg.-r oRs�wy sr2 ) �Ji s 1p 4
Company Name Registration "umber
W I AJIDt3„) W ova L.p OV- wF s�.2�% M Ass 1 r) L 3! I S ) ) (,o
Address Expiration Date
127A Np(gh Q'b W267EItl b /MA V1065 Telephone y)3 L%!;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 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
tructures.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 buildine 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
I� New House Addition E-1 ReplacemeniWindows Alteration(s) Roofing
Or Doors
i Accessory Bldg. ED Demolition 0 New Signs [p] Decks [M Siding[0] Other[d1
Brief Description of Proposed
Work: �� �CIC.ir)c�.. 7G1'Ft�J dc;o�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil -Sheet
sa. 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
I 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, 1�7f' I C' �( n ky' as Owner of the subject
property
hereby authorize I�t) t `t �. 'v► "
to act on my behalf,in all matters relative to work authorized by this building permit application.
( 5* 4 c,4,+mC-f)
Signature of Owner Date
I, R 0 BEIE T 4tkS HE 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.
RBBF�T Busl���
P#nt Name
Signature of Owner/Agent 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 Permit/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 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 0
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 O NO 0
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 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 0 NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
�^ i M Deft use only
-. - City of Northampton � t
;Building Department "
DEC 292014 212 Main Street
v Room 100 w K
Electric, Plumbing&Gas InspeciN hamoton, MA 01060
Northampion, r 87-1240 Fax 413-587-1272
s
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH'A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooertv Address:
This section to be completed by office
Map Lot Unit
' [0V—C'+1 CQ..j ;USA, 01062- Zone Overlay DftWct
Etrrr St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C'1 lP l e �F l i'C I Cl'r lit 1�' r° l l ��r"i14.�1 F'(� {' Dj'
Name(Print) Current Mailing Address:
C Sep: Lq MY&C+-) Telephone
Signature
2.2 Authorized Agent:
RID aERT E IBU S N e y 102 NOM wig sT1✓teLp AAA 01 DI&S
Name(Print) !1 Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Bui.Jing 43 (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=(1 +2+3+4+5) 3 1 o-o. Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
I<
I I GREENLEAF DR BP-2015-0694
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43 - 125 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate ory: REPLACEMENTDOOR BUILDING PERMIT
Permit# BP-2015-0694
Project# JS-2015-001345
Est. Cost: $3100.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 48351.60 Owner: FRIEDLANDER GENE&MAUREEN MOORE
zonine: Applicant: ROBERT BUSHEY JR
AT. 11 GREENLEAF DR
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 () WC
WESTFIELDMA01085 ISSUED ON.1213012014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE 2 PATIO DOORS
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 12/30/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner