38B-254 (9) W9 dOWUtlt Id Ofd a eS
(HOUSEKEEPING)
of Western
Plaza, Westfield MA O085
*'
Phone(413)485-7335• Fax(413)-485-7055 NAT-41779-1�
wvvw.WindowWorldofSpringfield.com HIC#165641 sLt BBB
"Simply the Best for Less" C S L#57011 Aco AHo Pva
Customer: r -1' r-!_^ _ Phone,(h) - 7 -
- �- _
Install Address: ( '" Phone(w)
Bill Address: -•-, E-mail
WINDOW WORLD GLASS OPTIONS ADD U VALUES
4000 Series DH $245 '^L, SolarZone Glass Package* (LE) $79
6000 Series DH(Triple Pane) $279
Picture Window $359 SolarZone Elite Glass Package*(LEE) $89
2 Lite Slider $359 SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185
3 Lite Slider'r(1/4,1/2,1/4) (113,113,1/3) $605 *All SolarZone packages include 112 screens,Foam Insulation on Jambs and Head,Double
Awning $295 Strength Glass,Double Locks(>29"),Lifetime Glass Breakage and Labor Warranty,Argon Gas
Casement LH RH $295 PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMENT LAW)
Twin Casement(Requires 2 Value+)(0973)(0979) $590 MY HOME WAS BUILT IN THE YEAR INITIAL:
Three Lite Casement(Requires 3 Value+) $885
Basement Sliders<55 U! $250 EPA LEAD SAFE(Per Window) $60
Hopper( 4 )(V t+$150):, $250 ,. EP/�LEAD SAFE(Patio Dr/Bay/Bow/.Garden) $.100
I Specialty Window' r
Ho er In exlstm wood en
'� '� $ '�"�' '7" �- ' - EPA Lead,third party verification: 7.5:00
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap) $3375 I decline third party verification ❑(INITIAL): >f rr
Garden Window(Insulated seat,Int.Casing&E#.Cap) $1995 > 4-T'(Initial)I have received a copy of the Lead hazard information pamphlet
Grids/6d.Color/Int.WoodgraWColors calculated in WW Upgrades Informing me of the potential risk of the lead hazard exposure from renovation activity to be
Remove Existing Bay/Bow $300 performed in my dwelling unit,the EPA'Renovate Right"brochure.
Reframe&Retrim(stain/paint not included) $400
Roof for Bay/Bow Window $600 '?(initial)I have received a copy of the lead test result(s).
Second Floor Installation $500
(
Window Color ` / _ :- Sign: = Date:
inside Outside Name(s)(Print) r
WINDOW WORLD UPGRADES MISCELLANEOUS LABOR
Full Screens $45 Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79
BEIGE Color charge $50 Color Other Than White "$10
Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 Specialty Custom Exterior Trim/Wrap $
Woodgrain Interior(LO)(DO)(CH)(FX)(RM)(SM) $95 Quick Trim(Int)(Ext) $30
Contoured/Flat Grids(TOP)(FULL)(ENDS) $49
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Aluminum/Vinyl or Steel Out $50/$150
Diamond/Brass Grids(TOP)(FULL) $120 Mull Removal $30
Oriel/Cottage Style(40/60)(60140) $45 Mull to Form Multi-unit $30
Obscure Glass Per Sash(BOT)(FULL) $35/$70 ,
Tempered Glass Per Sash(BOT)(FULL)$60/$120 Install Interior/Exterior Stops(WHITE VINYL)$55
Catalog Options $ Customer Provided Stops/Trim $45
-VINYL PATIO DOORS=:LH or RH Looking ln) Install Interior-Casing- - $95
(Includes:White Interior Casing and Exterior Trim.) Repair/Replace Sill or Brickmould $75
5 Ft./6 Ft.Sliding Patio Door(LH)(RH) $1500 Mobile Home Conversion $200
8 Ft.Sliding Patio Door(LH)(RH) $1800
Patio Door Beige Color $125 Remove/Re Install A/C or Awning $100
Patio Door SolarZone $125
Heat Buster Package Upgrade SolarZone Elite$215 Site Setup,Removal,In Home Service,etc.: $250.00
Patio Door Grids(Regular)(Woodgrain) $100 Extra labor(Box on left for descripption)$
Woodgrain/Brown(LO)(DO)(CH)(FX) $295 Total Amount Due$ {
Exterior Colors $395 50%Deposit Amount:$
Patio Door Triple Pane Upgrade $250
Keyed Lock$36 Foot Lock$51 []Cash
Storm Door Model $ []Finance-O Wells Fargo ( Other
NO EXTRA WORK IF NOT IN WRITING! [],Check made to Window W,,World of WM#
[,4 CC# = —•�—
^7 Exp.Date: V-code m
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: [I 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
deposit requiredl0.-advance of the start of the work SHALL NOT exceed 33 1/3% the total contract price or the actual costa of any material or equipment of a --
T
special order or custom made nature,which must be ordered in advance of the start of the work to assure that the protect'-will p�oceFd on schetlufe.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(g)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!
i
Owner Date
Salesman . 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 o6-16 Whita Cnnv_Original Yellow Coov-File Pink Coov-Customer Hayes Printing 686-667-1116
The Commonwealth of Massachusetts
Department of Industrial Acc nts
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www nws gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Avylicant Information Please Print Lew'b
Name(Business/Organization/Individual): VIA W5 S MA S9 AC 4455-115
Address: l 0 VI N V 91V Q-
City/State/Zip: W F—STF I t;L.1) M 14- d 10 SS Phone#: '413 Lf 7 S — 7 3 15
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 aid I
employees(full and/or part-time).' have hired the sub-contrac rs 6• New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
ship and have no employees These sub-contractors hair g, ❑ Demolition
working or me in an aci employees and have work '
g Y capacity. 9. ❑ Building addition
[No workers'comp. insurance comp. insurance.*.
required.] 5. ❑ We are a corporation and il s 10.❑ Electrical repairs or additions
3.0.1 am a homeowner doing all work officers have exercised the r 11.❑ Plumbing,,repairs or additions
myself.[No workers'comp. right of exemption per MG r, 12.7 Roof repairs
insurance required.]+ c. 152,§1(4),and we have io R � .r
employees. [No workers' 13.95 Other
comp. insurance required.] W I N OOwS
*Any applicant that checks box#1 must also fill out the section below showing their workers'coml crisation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside co itractori must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-con ractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy tumber.,
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: LADE-P-711 MkT14AL 1
Polic.,#or Self-ins.Lic.#:��2— 3 ! S- 3??9 47 -015 Expiration Date: 5-?-2D I
Job Site Address: q y ity/State/Zip: ( ( rnJ�!(,� ► I I�"j
Attach a copy of the workers'compensation policy declaration page(show'2g the policy number and expiration date). } ( [i
Failure to secure coverage as required under Section 25A of MGL c. 152 can le 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 he 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 state ent may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do,iereby certify under a pains and..j�2j nnities of perjury that the info ' n provided above is true and correct
Signature:
L�& ` a "
I, Date:
Phone#: 4 Ili 1406 5 - '7335
Official use only. Do not write in this area,to be completed by city or town offmial
City or Town: Permit/License it
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. Cityrfown Clerk 4.E rival Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone
SECTION 8-CONSTRUCTION SERVICES
-8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder: Rot' ice: E-' 6k-zl4E,,/
License Number
7C
2----1 - - -- F
Address Expiration Date
Signature Teiephone
/S.Re-gistered Home Improvement Contractor Not Applicable ❑
> �°
Company Name Registration umber
vV
Address
Expiration Date
Vi 0
e-� '.i Telephone 13 Li
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.15 2,§26C(S))
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
L Signed Affidavit Attached Yes....... No...... ❑
Home Owner Exemption
The current exemption for"homeowners,,,was extended to include Owner eccuj)ied 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 she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached siructures accessory to such use and/or farm
structures.A nerson who constructs more than one home in a two-year r eriod'�shaLl not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form accepts l le to the Building Official.that he/she shall be
responsible for all such work-performed under the building permit
As acting Construction Supervisor your presence on the job site will be re,luired 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' Compensatio ) 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 comT liance,with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofMassac iusetts General Laws Annotated.
Homeowner Signature_
I
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)
it of Parking Spaces
Fill:
(volume&Location)
A. Has a Special PermitlVariance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the C nservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs existt on the property? YES O NO 0
IF YES, describe size, type and location:
D. Are there any proposed chances to or additions of signs intend Ed for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing, grading, excavation,or fil ing)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from'the DPW'Ss required.
I
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ReplacemeqtYyindows terataon(s) Roofing
Or Doors
I Accessory Bldg. ❑ Demolition ❑ New Signs ip] DecKs Sidin ai C7 l Other i c]t
Brief Descnn poc o`Pr posed
work: t 1G —stfu_
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
1 Plans Attached Roll -Sheet
jsa. If New house and or addition to existing housing, Complete the foilowin :
i
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?
1
f. Method of heating? Fireplaces or Woods oves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached
h. Type of construction i
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.
1. Septic Tank City Sewer Private well City water Su ply ,
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n 0, as Owner of the subject
property
1 hereby authorize
to act on my behalf,in all matters relative to work authorized by thi building permit application:
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application a e true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Py nt Name
r r J
Signature of Owner/Agent Date
Department use only
City of Northampton Ste is of Permit .
Building Department
Main Street Se ilSettcAvailabiflty
Room 100
wa
Avaltab�rty
-No'rthamgton, MA 01060 T Se.#s i uz Plans `
phone 413-587-1240 Fax 413-587-1272 0116 Paris
Ify
i
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEM LISH!A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooerty Address: his section to be completed by office
L45- LA -1 V M-C' S`v-' Map Lot Unit
Zone Overlay District
1 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: �/� }'
Name(SQ� (� "� QILsa 1 F J
Current Mailing ddre5:
Telephone
Signature
2.2 Authorized Agent:
iv IZ- _S) W ei 10 .`>
Name(Print) Current Mailing ddress:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Bui.Jing (a)Building Permit Fee
C4 U
2. Electrical (b)Estima ed Total Cost of
Constriction from 6
3. Plumbing Building Fleffniffee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) , cc) Check Number
This Section For Official Use O
Building Permit Number. Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
i
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45 OLIVE ST BP-2016-0859
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-254 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-2016-0859
Project# JS-2016-001449
Est. Cost: $4585.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 10497.96 Owner: SPINT JOSEPH
zoning: URB(100)/ Applicant: ROBERT BUSHEY JR
AT. 45 OLIVE ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON.11512016 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 10 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 1/5/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner