23A-047 winaow vvoriu ui VVUJL=11111
1029 North Road-Hampton Ponds Plaza,•Westfield MA 01085
Phone(413)485-7335 • Fax(413)-485-7055 NAT-41779-1 BBB
www.WindowWorldofSpringfieid.com HIC#165641
"Simply the Best for Less" CSL#57011
7
Phone(h)
Customer:
Install Address: -77-, Phone(w)
Bill Address: ,—E-mail
WINDOW WORLD GLASS OPTIONS ADD U VALUES
2000 Series Mech.Frame Welded Sash $189
SolarZone Glass Package* (LE) $79
-0 4000 Series DH $215
6000 Series DH(Triple Pane) $249_ SolarZone Elite Glass Package*(LEE) $89
Picture Window $329_ SolarZone Plus(Super Spacer) (LEEP)*$110
2 Lite Slider $329_ SolarZone TG2 3 Pane Glass(6000 Only) $155
3 Lite Slider (1/4.VZ,1J4) (1/3,113.1/3) $575 SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185
Awning $295
*All SolarZone packages include 112 screens,Foam Insulation on Jambs and Head,Double
Casement LH PH $295_
Twin Casement(Requires 2 Value+)(0973)(0979) $590_ Strength Glass,Double Locks(>29"),Lifetime Glass Breakage and Labor Warranty,Argon Gas
Three Lite Casement(Requires 3 Value+) $885 PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMEfflT LAW)
Basement Sliders<55 Ul $239 MY HOME WAS BUILT IN THE YEARIXC2 INITIAL-�,�?V
Hopper(In existing wood)(Vent+$150) $195/$250 >v EPA LEAD SAFE(Per Window)
—Specialty Window - $— EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100_
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap)8'Plus$3375.
Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995 EPA Lead site setup&disposal fee: $100.00_
Grids/Ext.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).-< "'- I
Reframe&Retrim(stain/paint not included) $300 .,, (initial)I have received a copy of the Lead hazard information pamphlet
Roof for Bay/Bow Window $600 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.
7—
-,Window Color_ (initial)I have receiv I elda copy of the lead test result(s).
Inside Outside
Sign: Date:—
WINDOW WORLD UPGRADES Name(s)(Print)
Full Screens $35
BEIGE Color charge $50— 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) $49— —Specialty Custom Exterior Trim/Wrap $_ 1
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 —Quick Trim(Int) (Ext) $30
Diamond/Brass Grids(TOP)(FULL) $120 —Aluminum/Vinyl or Steel Out $50/$125
Oriel/Cottage Style(40/60)(60/40) $45- - —Mull Removal $30
Obscure Glass Per Sash(BOT)(FULL) $35/$70 Mull to Form Multi-unit $30
Tempered Glass Per Sash(BOT)(FULL)$60/$120
$ Install Interior Stops(WHITE VINYL) $45 4
Catalog Options ---Z:-In stall-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 Brickmould $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 $125 Site Setup,Removal,In Home Service,etc.: 2$ .00
—Heat Buster Package Upgrade $215_ Extra labor(Box on left for description)$
Patio Door Grids(Regular)(Woodgrain) $100 Total Amount Due$ -i 3-z-- `7-'
T
—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$51
—Storm Door —Model Finance-O Wells Fargo Other
�f6heck made to Window World of WM#
NO EXTRA WORK IF NOT IN WRITING! cc#
Exp.Date: V-code-
Final Payment Amount$
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 irrv��_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�equipmiint 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 14�.A 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:It 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 Worfd�Franchise is independently owned and operated by Window Word of Western Massachusetts,Inc.under license from Window World,Inc.
WM We 11-14 White Copy-Original Yellow Copy-File Pink Copy-Customer
JThe Common wealth of Massach usetts
Department of Industrial Accidents
Off-we of Investigations
600 Washington Street
Boston,419 0211,E
www.mass gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AAniicant Information Please Print Lezibly
Name(Business/Organization/Individual): W j ti LO hDgL gyp W'l:S,TERA MA Sf AC-NLt sf TTS
Address: 102-5 P V Q-14 (21)
City/State/Zip: W 1:STF 1 v Lt> to lk U i O$S Phone #: L4 1 3 `'I I S — 7 33 5'
Are you an employer?Check the appropriate box: Type of project(required):
1.M I am a employer with 4 4. La 1 air a general contractor and I 5. ❑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 � $, ® Demolition
working or me in an capacity. employees and have workers'
g Y aP 0'� 9. [] Building addition
[No workers'comp. insurance comp. insurance.'
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.Ell am a homeowner doing all work officers have exercised their I I.[] Plumbing,repairs or additions
myself (No workers'comp. right of exemption per MI GL 12.[] Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.M Other RA L-ACF.MF.MT
comp. insurance required.]
W1p1DOWS
`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 subcontractors 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 tkepaUcy and job site
information.
Insurance Company Name: 1.-18Et2111 MlXTU iL
Po1ic, #or Self-ins.Lie.#: W(!.2.- 3 IS° 317 T7 -d_J_5 Expiration Date 7.2..0
Job Site Address: "J
// _� � ,S j City/State/Zip:F�,11�,EnCE A ®10,03
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,iereby certify under tains and pe�fp �'that the information provided above is true and correct
Si ature: �7 �N ` Date: 47 L Z.-l
Phone#: 411P `106 5 ` 7339
Offrciol 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):
I. 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
6.1 Licensed Construction Supervisor_ Not Applicable 0
Name of License Holder i E bits
License Number.57011
Expiration Date
Address
L
Signature 12Sj Is-
14
'9 Registered Horne Improvement Contractor. Not Applicable El
t4
-
Company Name Registration mber
3
vyi&:,OaK) V�-v7aL
Address Expiration Date
I CYL:t iVV yZT�j jpb P S f I 1�L !A A V 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 VAII result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yes...--.N No-
�—
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include caner-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
gage
as supervisor.CMR 7S0, Sixth Edition Section 1083.5.1.
Definition of Homeowner= Person(s)who own a parcel of land or.%Nhich heishe 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-Derson who constructs more than one home in a two-vear period sha❑not be considered a homeowner.
Such"'homeowner"shall submit to the Building Official.,on a form acceptable to the Building OfficiaLtbat be/she shall be
resl)onsible for all such work performed under the building permit.
acting Construction Supervisor your presence on the Job site wall 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 wider 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 Ge ner al Laws Annotated.
Homeowner Signature
j SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
I
i
New House Q Addition L_-.' ' Replacement W4pdovm i Alteration(s) Roofing
r—t
Or Doors L�
Accessory Bldg. Q Demolition New Signs [CJ] Decks [M Siding[0] Other[pj
j�IlVnef Description of Proposed
work: 13 El PL-WILMENIT _�1 "5
i Alteration of existing bedroom Yes No Adding new bedroom_ Yes No
A ached Narrative Renovating unfinished basement Yes No
Plans Attached Roil -Sheet
_ I
6a. if New house and or addition to existing housing complete the following
1
I a. Use of building :One Family Two Family` —Other
b. Number of rooms in each family unit: _ Number of Bathrooms__ i
C, Is there a garage attached?
I
d. Proposed Square footage of new construction _ _ Dimensions
i
! e. Number of stones?
f. Method of heating? Fireplaces or Woodstoves Number of each
g- Energy Conservation Compliance.v Masscheck Energy Compliance form attached?
1 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
i
k. Will building conform to the Building and Zoning regulations? _ __Yes No -
Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN �-^—`-
j OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I
t-. C. oww c— _ as Owner of the subject
Property
hereby authorize
to act on my behalf, in all may ers relative to work authorted by this building permit application.
Signature of Owner gate y i
i
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
1 and belief-
Signed under the pains and penalties of perjury.
I Py nt Name
f
Signature of Owner/Agent Date R
Must
Section 4. ZONING AU Information Be Comptleted. Permit Can Be Due To Incomplete Information
Existim� Proposed Required by Zoning
This colurnn to he filled in by
Lot Size
Frontage
Setbacks Front
Rear
I Building Heigh-,
Bld.g. Square Footage %
Open Space Footage
(Lot area minus,bld!z k-paved
of Parking
A. Has a Special Permit/Variance/Finding ev een issued-."or/on the site?
IF YES, date issued:
IF YES. Was the permit recorded the Registry of Deeds?
IF YES: enter Book Page and/or Document#
D' Does the site contain rook, body of water orwetlands? NO \ / DUw| KNOW 0 'c, \~~/
IF YES, has ape it been or need to be obtained from the Conservation Commission?
Needs tobeobtaned /—� Obtsioed /—\ Date bsued'
/ �—� \`� . '
C. Do any signs e)dston the property, YES /—\ NO 0
IF YES, describe size, type and iocahon:
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 \ocadon:
E. Wii| the construction activity disturb (d aring.Brading excavation. orfi||ing)over I acre o/isit part ofa common plan
that wiUdisturt over 1 oce? YES ��( ) NO ( }
��
/F YES, then a Northampton Storm vva ter wanegementpermur from u,a DPW/srequired.
Department use only
j�
j City of Northampton Status of Permit:
�
Building Department �Cutf{7rivewa Permt# -
i I 1 M ,SUN 9 De p
U �!` 212 Main Street Sev+ i'/SupticAyaitAility
u-- &Gas Inspections Room 100 44latei?�Avartabiti +
lectric, �lum�'ng orfhamoton, MA 01060 TWO sets afStTlIans
Northamp
ton,MA 01 060
phone 413-587-1240 Fax 413-587-1272 PlotlSite PWi4
Other$Ncify
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
,Q q \A t,ST Map Lot Unit
F LO R E N LE OA ft O (��`� Zone Overlay District �
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Fp,Nk E O' DONNELL _ q �JEar CC.NTC ST
Name(Print) Current M iling Address:
See LC 1A a C, $ Telephone
Signature
2.2 Authorized Agent:
RDOEP i E i. 5F+tr y1F_ -4 4 Wi:_STf-1fLt7 'ViA 611012'_5
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Buiding r 0 (a)Building Permit Fee
2 Electrical (b) Estimated Total Cost of I
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection _
6 Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
29 WEST CENTER ST BP-2015-1309
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-047 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-2015-1309
Project# JS-2015-002401
Est.Cost: $6332.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 5837.04 Owner: O'DONNELL LUKE&BERNICE J&GARY O'DONNELL&SHARON HART
&JEFFREY ALAN O'DONNELL
zonin : URB(100) Applicant: ROBERT BUSHEY JR
AT. 29 WEST CENTER ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON.611612015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL18 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:
FeeTvue: Date Paid: Amount:
Building 6/16/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner