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22-009 (2) Project Total: $4,061.38 Salesperson: CHRIS CAMERLIN(S 1916CC2) Accepted by: Date:09/04/2015 Print this Page This Millwork Quote is valid until 9/10/2015.This is an estimate only.This estimate does not include tax or delivery charges. Delivery of all materials contained in this estimate are subject to availability from the manufacturer or supplier.All the above quantities, dimensions, specifications and accessories have been verified and accepted. owe's(R) Is This A Remake'?: No Lead Time: 28 tern Number: 354137 I ! ***This price reflects a 1517c off Promotion on SOS Pella(R) [ Windows&Patio Doors-08/26/15 to 09/14/15*** i This quote is good 08/26/15 to 09/14/15 0006 Manufacturer: Pella(R)350 Series Windows And Patio Doors ) ]vision: Millwork Size=59 3/4-in W x 49 1/4-in i H Product: Windows Type:Picture $ j anufacturer:Pella(R)350 Series Windows And Patio Doors 11 Energy Star(R)Qualified Products Only: Yes-I would like to � view only the units that are qualified for Energy Star(R). Energy Star(R)Zone: Northern S Room Location: Living Room jProduct Category: Fixed Frame � --- onfiguration: 1 Wide I peration/Venting: Fixed Frame hape: Rectangle Frame Type: Block Actual Frame Depth: 3 1/4-in Performance Options: Standard Actual Frame Width: 59 3/4-in Actual Frame Height:49 1/4-in � its Opening Width: 60-in l/11- i its Opening Height:49 1 12-inV' ; Exterior Material Type: Vinyl Actual Wall Depth: 3 1/4-in Sill Adapter: Sill Adapter Included ead Expander: Head Expander Included 1 Exterior Color: White a Interior Color: White Glazing Type: Insulated Insulated Type: Dual f lass Strength: Annealed i Insulated Glass Options: Low E Low E Glass Style: Advanced Gas Filled: Argon 1 High Altitude: Non High Altitude Insulated Glass Overall Thickness: Standard Per Design Grille Type: No Grille E ill this product be installed by Lowe's(R)?:Installed By ' towe's(R) Is This A Remake'?: No Lead Time: 35 Item Number: 354137 ***This price reflects a 15%r,off Promotion on SOS Pella(R) i Windows&Patio Doors-08/26/15 to 09/14/15*** E � I This quote is good 08/26/15 to 09/14/15 1 $307.20 1 $307.201 IThis quote is good 08/26/15 to 09/14/15 0005 Manufacturer: Pella(R)350 Series Windows And Patio Doors Size= 19 3/4-in W x 49 1/4-in Division: Millwork H Product: Windows Type:Double Hungs i Manufacturer:Pella(R)350 Series Windows And Patio Doors , E- nergy Star(R)Qualified Products Only: Yes- I would like to view only the units that are qualified for Energy Star(R). € I Energy Star(R)Zone: Northern (� Room Location: Living Room i i ] onfiguration: I Wide I Operation/Venting: Double Hung Shape: Rectangle 3 Frame Type: Block ctual Frame Depth: 3 1/4-in Performance Options: Standard Actual Frame Width: 19 3/4-in i Actual Frame Height:49 1/4-in Fits Opening Width: 20-in its Opening Height: 49 1/2-in Venting Height: Equal Exterior Material Type: Vinyl Foam Insulated: No Foam Insulated Actual Wall Depth: 3 1/4-in I Sill Adapter: Sill Adapter Included Head Expander: Head Expander Included Exterior Color:White Interior Color: White lazing Type: Insulated nsulated Type: Dual Glass Strength: Annealed Insulated Glass Options: Low E Low E Glass Style: Advanced i } Gas Filled: Argon High Altitude: Non High Altitude i s Insulated Glass Overall Thickness: Standard Per Design F ash Lock: Standard Lock Limited Opening Hardware: No Limited Opening Hardware Hardware Finish:White Maximum Opening Hardware: No Maximum Opening Hardware Sash Lift:Integrated Vinyl Sash Lift Screen Option:Full Screen Screen Cloth: Conventional Fiberglass Grille Type: Grilles Between Glass Actual Grille Bar Profile: 3/4-in Contour a Grille Interior Color:White rille Exterior Color: White f Grille Pattern: Traditional Upper Grille Division Type: Typical t � Lower Grille Division Type:Typical op Sash Lite Pattern: 2W2H Bottom Sash Lite Pattern: 2W2H j 4 Will this product be installed by Lowe's(R)'?: Installed By l $308.32 2 $616.64; i (I I— Energy Star(R)Zone: Northern Room Location: Living Room ' i onfiguration: 1 Wide Operation/Venting: Double Hung hape: Rectangle rams Type: Block 4 Actual Frame Depth: 3 1/4-in I � Performance Options: Standard ctual Frame Width: 31 3/4-in Actual Frame Height: 33 1/4-in 9 Fits Opening Width: 32-in Fits Opening Height: 33 1/2-in Venting Height: Equal ¢ Exterior Material Type: Vinyl Foam Insulated: No Foam Insulated I Actual Wall Depth: 3 1/4-in ' Sill Adapter: Sill Adapter Included Head Expander: Head Expander Included j Exterior Color: White Interior Color: White ,lazing Type: Insulated Insulated Type: Dual Glass Strength: Annealed Insulated Glass Options: Low E _. ow E Glass Style: Advanced Gas Filled: Argon i High Altitude: Non High Altitude Insulated Glass Overall Thickness: Standard Per Design Sash Lock: Standard Lock Limited Opening Hardware: No Limited Opening Hardware Hardware Finish:White Maximum Opening Hardware: No Maximum Opening Hardware ash Lift:Integrated Vinyl Sash Lift Screen Option: Full Screen Screen Cloth: Conventional Fiberglass Grille Type: Grilles Between Glass Actual Grille Bar Profile: 3/4-in Contour Grille Interior Color: White Grille Exterior Color:White Grille Pattern: Traditional i Upper Grille Division Type:Typical ower Grille Division Type:Typical Top Sash Lite Pattern: 3WIH Bottom Sash Lite Pattern: 3W 1 H Will this product be installed by Lowe's(R)?:Installed By owe's(R) Is This A Remake'?: No Lead Time: 35 Item Number: 354137 3 ***This price reflects a 15%off Promotion on SOS Pella(R) t indows&Patio Doors-08/26/15 to 09/14/15*** i i s � Actual Frame Width: 31 3/4-in Actual Frame Height:49 1/4-in x Fits Opening Width: 32-in L- its Opening Height:49 1/2-in✓ Venting Height: Equal xterior Material Type: Vinyl t Foam Insulated: No Foam Insulated j ' Actual Wall Depth: 3 1/4-in Sill Adapter: Sill Adapter Included ead Expander: Head Expander Included f Exterior Color:White # Interior Color: White I Glazing Type:Insulated 1 Insulated Type: Dual i Glass Strength: Annealed 3 Insulated Glass Options: Low E Low E Glass Style: Advanced i Gas Filled: Argon igh Altitude: Non High Altitude 1 nsulated Glass Overall Thickness: Standard Per Design Sash Lock: Standard Lock Limited Opening Hardware: No Limited Opening Hardware Hardware Finish:White aximum Opening Hardware:No Maximum Opening Hardware Sash Lift:Integrated Vinyl Sash Lift f Screen Option:Full Screen creen Cloth: Conventional Fiberglass k Grille Type:Grilles Between Glass Actual Grille Bar Profile: 3/4-in Contour Grille Interior Color:White I , rille Exterior Color: White E Grille Pattern: Traditional i Upper Grille Division Type: Typical Lower Grille Division Type: Typical I Top Sash Lite Pattern: 3W2H ottom Sash Lite Pattern: 3W2H 6 Will this product be installed by Lowe's(R)'?:Installed By t owe's(R) 11 3 Is This A Remake'?: No Lead Time: 35 Item Number: 354137 3 ***This price reflects a 15%off Promotion on SOS Pella(R) Windows&Patio Doors-08/26/15 to 09/14/15*** { his quote is good 08/26/15 to 09/14/15 __ _. 10004 Manufacturer:Pella(R) 350 Series Windows And Patio Doors Nize=31 3/4-in W x 33 1/4-in Division:Millwork 1H Product: Windows 3 Type: Double Hungs Manufacturer: Pella(R)350 Series Windows And Patio Doors nergy Star(R)Qualified Products Only: Yes-I would like to j iew only the units that are qualified for Energy Star(R). E $301.52 �� $603.04= 1 (2 I Sill Adapter: Sill Adapter Included 1 Head Expander: Head Expander Included Exterior Color: White t E Interior Color: White lazing Type:Insulated 1 i nsulated Type: Dual j lass Strength: Annealed Insulated Glass Options: Low E ow E Glass Style: Advanced as Filled: Argon t igh Altitude: Non High Altitude Insulated Glass Overall Thickness: Standard Per Design ash Lock: Standard Lock € s Limited Opening Hardware: No Limited Opening Hardware Hardware Finish:White Maximum Opening Hardware: No Maximum Opening ardware ash Lift: Integrated Vinyl Sash Lift Green Option: Full Screen Green Cloth:Conventional Fiberglass Grille Type: Grilles Between Glass i Aictual Grille Bar Profile: 3/4-in Contour i rille Interior Color: White rille Exterior Color: White Grille Pattern: Traditional Upper Grille Division Type:Typical , Lower Grille Division Type:Typical Top Sash Lite Pattern: 3W2H Bottom Sash Lite Pattern: 3W2H ill this product be installed by Lowe's(R)`?:Installed By owe's(R) i Is This A Remake?: No Lead Time: 35 € Item Number: 354137 i ***This price reflects a 15%off Promotion on SOS Pella(R) indows&Patio Doors-08/26/15 to 09/14/15"* € I ¢ This quote is good 08/26/15 to 09/14/15 0003 Manufacturer:Pella(R)350 Series Windows And Patio Doors ]Size=31 3/4-in W x 49 1/4-in Division: Millwork JH Product: Windows j� Type: Double Hungs f Manufacturer: Pella(R)350 Series Windows And Patio Doors I� Energy Star(R)Qualified Products Only: Yes- I would like to 4L_ view only the units that are qualified for Energy Star(R). Energy Star(R)Zone:Northern i' Room Location:Living Room onfiguration: I Wide peration/Venting:Double Hung Nape:Rectangle Frame Type: Block Actual Frame Depth: 3 1/4-in Performance Options: Standard � $328.71 \. $657.42; l Low E Glass Style: Advanced Gas Filled:Argon High Altitude:Non High Altitude Insulated Glass Overall Thickness: Standard Per Design 4 ash Lock: Standard Lock invited Opening Hardware: No Limited Opening Hardware ardware Finish: White aximum Opening Hardware: No Maximum Opening s Hardware Sash Lift: Integrated Vinyl Sash Lift ? Screen Option: Full Screen i creen Cloth: Conventional Fiberglass rille Type:Grilles Between Glass Actual Grille Bar Profile: 3/4-in Contour 1 Grille Interior Color: White Grille Exterior Color: White Grille Pattern: Traditional Upper Grille Division Type: Typical Lower Grille Division Type: Typical op Sash Lite Pattern: 3W2H ottom Sash Lite Pattern: 3W2H � Will this product be installed by Lowe's(R)?: Installed By owe's(R) r Is This A Remake'?:No Lead Time: 35 tem Number: 354137 I t ""This price reflects a 15%off Promotion on SOS Pella(R) Windows&Patio Doors-08/26/15 to 09/14/15*** his quote is good 08/26/15 to 09/14/15 0002 Manufacturer:Pella(R)350 Series Windows And Patio Doors Size=31 3/4-in W x 37 1/4-in Division:Millwork sH Product: Windows Type: Double Hungs Manufacturer: Pella(R) 350 Series Windows And Patio Doors i 1 Energy Star(R)Qualified Products Only: Yes-I would like to view only the units that are qualified for Energy Star(R). 1 Energy Star(R)Zone:Northern c ! � Room Location: Living Room f onfiguration: 1 Wide Operation/Venting: Double Hung r Nape: Rectangle ; s 1 Frame Type: Block Actual Frame Depth: 3 1/4-in Performance Options: Standard ) Actual Frame Width:31 3/4-in dual Frame Height: 37 1/4-in its Opening Width: 32-in its Opening Height: 37 1/2-in I enting Height Equal xterior Material Type: Vinyl s oam Insulated:No Foam Insulated l ctual Wall Depth: 3 1/4-in $308.32 2 $616.641 Back to Quote . LOWE'S HOME CENTERS. LLC#1916 282 RUSSELL STREET HADLEY,MA 01035-0000 USA Date: 09/04/2015 (413)588-0270 Project#: 451546281 Description: Pella 350 Customer Name: ELEANOR BURDIN Customer Phone: (413)584-6396 Customer Address: 101 SPRUCE HILL AVE FLORENCE, MA 01062 USA Line Item Product Code Frame Size Description Unit Price Quantity Total Price 10001 Manufacturer:Pella(R)350 Series Windows And Patio Doors ISize=31 3/4-in W x 41 1/4-in Division:Millwork IH Product: Windows f �{ Type: Double Hungrs Manufacturer: Pella(R)350 Series Windows And Patio Doors 1 + Energy Star(R)Qualified Products Only: Yes-I would like to f view only the units that are qualified for Energy Star(R). Energy Star(R)Zone: Northern Room Location: Living Room onfiguration: I Wide Operation/Venting:Double Hung Shape: Rectangle Frame Type: Block I Actual Frame Depth: 3 1/4-in ( Performance Options: Standard Actual Frame Width: 31 3/4-in I Actual Frame Height 41 1/4-in Fits Opening Width: 32-in its Opening Height: 41 1/2-in + enting Height: Equal I xterior Material Type: Vinyl } Foam Insulated: No Foam Insulated Actual Wall Depth: 3 I/4-in Sill Adapter: Sill Adapter Included Head Expander:Head Expander Included Exterior Color: White Interior Color: White s lazing Type:Insulated I nsulated Type: Dual s ¢ lass Strength: Annealed ( Insulated Glass Options: Low E $315.11 $1,260.44; 1 CONTRACT# 00®2 8 S 6J MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE`S AWTHORIZED REPRFESEriTATIVE j I NUMBER CUSTOMER v l %It:rt i l I'"� STORE NQ STREET ADDRESS -; STREET ADDRESS CITY STATE ZIP CITY " STATE 21P TELEPHONE _ TELEPHONE DATE" F LOWE'S HOME CENTERS,LLC'S MA HIC NO.:148688p LCC CHARGEIRIEG FEIN:56-0748358 This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment.Upon payment,the entire agreement,including the specifically completed pages of this document,the Terms and Cordtions included with this document and any other addenda and attachments hereto,shall be referred to herein as this'ContrecL" PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CI STATE ZIP /� ,S-- ✓:,i�� Ott !I ��f- ,�";; ,, ,�:�� -�� :�i� :�Z l :.f /L/-- C' 1, � _Y,� �7. C- f �,/. r/t 3.��J Y 1�� ..�' �i �i�� f�I l..�t _,J �1�. �f.... ✓)i-� f \i.�,_.-�t /l �"' !",.''; j <� " - 'IY,�'f C%-tJJ� ';cr PI;✓ i' PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Contract Total Are permits required for this installation?:[ es [ ]No *applicable tax included / NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:If rotted wood is discovered during installation additional charges wilyapply. ou will be given a quote and a change order must be completed and signed by the customer for any additional charges. E A 'Customer must initial..* 'Any work or material not specified is not included in this contract.Any changes or additions Will be at an additional charge for the material and labor. WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY INSTALLER) I,the undersigned Installer/Independent Contractor,having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project will be or has been completed in a workmanlike manner and to the Customer's satisfaction.In consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by applicable law,I hereby waive and relinquish all liens and all rights and claims of liens which I,the undersigned,now have or may hereafter have for labor or materials furnished,and further certify that all work performed and materials furnished,if any,by any other party or parties upon the order of the undersigned,have been fully paid for.Further,I the undersigned,agree to cause the prompt release of any mechanic's lien(s)which may be filed against the Customers premises by any subcontractor,laborer,mechanic or material supplier claiming the right to file such a lien through work related to the Customers Contract with Lowe's.In addition to any warranties provided by law or specified elsewhere,including the Customers Contract with Lowe's,the undersigned,further warrants that all work furnished for this project shall be free from defects either in material or workmanship.If any defects in material or workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees to replace or correct such defective work or material,free from all expense to Lowe's and the Customer in a manner satisfactory to the Customer. I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customers premises. If applicable to the performance of the work required for this project,I,the undersigned Installer/Independent Contractor,do hereby certify that I have complied with all requirements of the Lead Renovation,Repair,and Painting Program Rule("LRRPP Rule',40 C.F.R.sec.745.80 at seq.,or any applicable state laws or program regulating lead-based paint safe work practices, including compliance with all information distribution,notice requirements and work practice standards in performing the work required for this project.I certify that I have prodded the Customer with all documentation required to be supplied under the LRRPP Rule or state program,shall retain all records required by law,and have attached to this document copies of all of the records required to be retained by the LRRPP Rule or applicable state program. Signed and delivered this day of (seal) Installer Print Name CERTIFICATE OF COMPLETION 1.I,the Customer,certify that the installers/Independent Contractors or their sub-contractors,have furnished all Goods andfor services,that installation,repairs and alterations or improvements (°the installation serviced have been completed as set forth in myfiour contract wiUt Lowe's,and that I have been offered the opportunity to request that Lcwe's allow me to retain some or all of any unused,receipted surplus materials rather than have such surphu materials remain the property of Lowe's. 2.Buyers ketials(Buyer INITIAL ONE only) There were no such surplus materials. 1 accepted all surplus materials I wanted I denied to receive arty surplus materials: Dad: S;,C9re t7v�ar'��Nati�' 55102 REV. 12/13 INSTALLER COPY ®ae4 rea ot LF b�eq� Com �9° 1-he Holder of this Card stipulates conformance to - • Certified Installer AWDI Residential Installation of Vinyl Window Guid Vers n 5 D' and Door Systems Qj U &p: 12115 axp• 12/15 ML Mark Jodoin The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bu sine ss/Organization/Individnal):� --��,��---- Address: � � ' City/State/Zip: dun(rl-'1 V4Vy\z *4 I'll Ps11 11e T-3 C, Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 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.❑Electrical repairs or additions re 3.❑ I qu 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, ti 1(4),and we have no J� s employees. [No workers' 13�Other�___ „ comp.insurance required.] C *Any applicant that checks box*I must also fill out the section below showing their workers'compensation police inlorniation. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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,the-v must provide their workers'comp.policy number. I an:an employer that is providing workers'compensation insurance for ntv employees. Beloit,is the policy and job site information. C. _ Insurance Company Name: ' Policy#or Self-ins. Lic. #:y 00� �� Expiration Date: Job Site Address:��A � City/State/Zip:�� `� ' e- ��"� ��6� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration (late). 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 it day against the violator dvised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuran• c erage verifi non. I do hereby certify and the s and penalti f perjury t'kat the information provided above is true and correct. Signature: Date: Phone#: 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#:------------ — — — City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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 MGL c 111 , S 150A. Address of the work: 1() I 15(�C(-- The debris debris will be transported by: � The debris will be received by: �f2 Building permit number: Name of Permit Applicant Date Signature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suupe�rvisoo Not Applicable ❑ Cr Name of License Holder: 1 `\` 1 \ _ t�� v Ll �q 3 License Numb r � '� Address Expiration Date Signature Telephone 9 Registered Home Improvement Contractor: Not Applicable ❑ HT L Company Name Registration um r lo t5 Address 1 / Expiration ate TelephonegG 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 builcfing 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 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 buildins 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement:rndows Alteration(s) Roofing Or Doors !N Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [0] Other[dj Brief D c . iPnA of Proposed ;Work: . _ Wle- r oolc_ �yk�fxlly� (5) L G TkL- i I/—S Alteration of existing bedroom Yes No Adding new bedroom Yes No kXi Attached Narrative Renovating unfinished basement Yes No C 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 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, , � .� as Owner of the subject property hereby authorize C;c�.� [�0 to act on my behalf,in all matters relative to work authorized by this building per it application. !S� oc��( C� fl_41 (.1" Signature of Owner Date as Owner/Authorized ge eclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and b ef. Signed under the pains and penalties of perjury. Print l N e Si r/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. Hasa Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES Q IF YES, date issued: IF YES Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES Q IF YES enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES Q IF YES; has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: 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 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 Q NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only - - I y of Northampton Status of Permit: Ilding Department Curb Cut/Driveway Permit =SE 1 7 2015 ( 12 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Electric, Plumbing&Gas Inspe Q ampton, MA 01060 Two Sets of Structural Plans Northarnpton, t of s 7-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: �.` , �^n• ,�� G ►,—�1 � q,�� Map Lot Unit V ✓\C�J�C.,L ,1• , V Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT w 1 2.1 Owner of Record: m ,yk Yto Id co Name(Print) �— Current Mailing Address: Telephone �� Signature 2.2 Authorized Agent: Name ) Current Mailing Address: �w/,- G' (i ,�� H f3 S 6 o f,,r V atu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building t., ( '� (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) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 101 SPRUCE HILL AVE BP-2016-0366 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22-009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2016-0366 Project# JS-2016-000583 Est. Cost: $8694.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWE'S 049918 Lot Size(sq. ft.): 22999.68 Owner: BURDIN BLAINE M&ELEANOR W Zonin : Applicant. LOWE'S AT: 101 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588-0270 WC HADLEYMA01035 ISSUED ON.911712015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 13 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: FeeType• Date Paid: Amount: Building 9/17/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner