Loading...
Fichman permit applicationThe Commonwealth of Massachusetts Board of Building Regulations and Standards VVMassachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two -Family Dwelling FOR MUNICIPALITY USE Revised Mar 2011 This Section For Official Use Only Building Permit Number: Date Applied: Building Official (Print Name) Signature Date SECTION I: SITE INFORMATION 1.1 Pr pert Address: V 1.2 Assessors .Map & Parcel Numbers Map Number Parcel Numbor l , l a Is Mean accepted street? ycs no 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sq ft) Frontage (ii) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.C.L c. 40, §54) Public ❑ Private ❑ 1.7 Flood Zone Information: Zone: _ Outside Flood Zone? Check if yes❑ 1.8 Sewage Disposal System: Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 OwnR? of ma RecG1 1r--T Name (Print City, State, ZIP Pr q r d �o. [ (/A No. a ct Teleplione Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction ❑ I Existing Building'O Owner -Occupied `0,, Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg. ❑ Number of Units � Other N/Specify: `-0 '3 " .C..L,4. Brief Description of Proposed Workz: / ,+} M SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials)Official Use Only 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: [3 Standard City/Town Application Fee ❑ Total Project Costa (Item 6) x multiplier x 2. Other Fees: $ .List: 2. Electrical $ 3, Plumbing $ 4. Mechanical (HVAC) S S. Mechanical (Fire Su ression) $ - Total All Fees: $ Check No. Check Amount: Cash Amount: 0 Paid in Full 13 Outstanding Balance Due: 6. Total Project Cost: $ q 7 6t 6 C; (YA SECTION5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) License Number Expiration ate Name of CSL Holder _ List CSL Type (see below) Type Description No, and Street U Unrestricted Iiuildin s u to 35,000 cu. ft.) R Restricted 1&2Family Dwelling City/Town, Site, UP M Mason ry 666rrr RC Roofing Cove'rtn WS Window and Siding SF Solid Fuel Burning Appliances 1. Insulation —�` dl;.:)Ae�:_aJt i 9ZOf•� ,�441, Tdlc lion Email address D Demolition 5.2 Registered Home Improvement (HIC) \Contractor IIIC Registration Number Expiration Datd' HIC Company Name or HIC Registrant Name �� a... N�. and Street Email address Cis /Towta, State, ZIP Telephone SECTION G: 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. Siped Affidavit Attached? Yes .......... EK, No ........... 13 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize�t� to act on my behalf, in all matters relative to work authorized by this building permit application. Print O er's Name (Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained i this ap Teri i is true and accurate to the best of my knowledge and. understanding. Print er' Authors d A s Name (Electronic Signature) Date NOTES: l . An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Homc Improvement Contractor (HIC) Program), will not have access to the arbitration program or guaranty fund under M,G,L, c, 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass, gov� /dt?s 2. When substantial work is planned, provide the information below: Total floor area (sq. fL) (including garage, finished basement/attics, decks or porch) Gross living area (sq. tl.) Habitable room count Number of fireplaces Number of bedrooms Numbcr of bathrooms Ntunber of half/baths Typc of heating system Number of decks/ porches Type of cooling system Enclosed Opera 3. "Total Project Square Footage" may be substituted for "Total Project Cost" City of Northampton Massachusetts DEPARTMENT OF BUXLDXNG INSPECTIONS 212 Main Street 9 Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFMAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: �-� " f\A- \&�— Signature of Applicant: Date. I, 9 7ol v 1 day, year), hen City of Northampton Massachusetts DEPARTMENT of BUILDING INSPECTIONS 212 Main Street + Municipal Building Northampton, MA 01060 �r �T HOMEOWNERS' EXEMPTION ELIG.IB.ILITY AFFIDAVIT' and state the following: (insert full legal name), born _ (insert inonth, �. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirement.; of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work oil a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured Uuildings constructed in accordance with 780 CMR 1 IO,R3. 3. I qualify under the State Building Code's definition of "homeowner" as defined at 780 CMR 110.R5.1,2: Person(s) who owns a parcel of land on. which he/she resides or intends to reside, on which them is, or is intended to be, a one -or two-family dwelling, attached or detached structures accessory to sucl, use and/ farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work illVolving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this S day off 'r. 20 o-)U OS nature) r The Commonwealth of Massachusetts Department of Iraduvtr"al Aatrciderlt"c I Congress kreef, Suite lot) 110000, Mai 02-11 4-2017 wIww-n2ays govIdzrt Workers' Cray Pensa"Iltirrrr Insurance Anidsivitc Duilt avilContrrttt"adeEUctrieia nsf.i lumbers. TO BE i{Ildl;D't�IT11'I"1I11; Ixt.li.lVll1""t°i1VC� A'[.r"!'Ht)�1"N"Y. A ll rat Irtf rrrtrtiirttr Name(I3%ISilt0t;sV0gYatrri?1601111[1divr`dtrs,l}: Window World of Western Mass Address,641 ga'niel Shays: Hwy .,.,,.,..,,,.,.............. w...,,,..., ..... M...... .., �M._._,.... _..................... C"il'y/ tFIC % ip; Belchertown H9A I]1 00'hCrl7 A. 4.13 485 7315 �,,w_ w„w ._ _.._.._.,w,w._,_ ....,._.......... __......... Are ynu an udrr lat;rat 4 f,Ireck We nPPrt,ll0nte IRIXr I..[lanruulvtl,iakarwith so�,.„..,„,.e�rrployr:es(.l'ttllRrrdlrrrf,artwrirtrel."' 'I Roll a Fodor tr116111ic>tnr csr I'lartnersltlla aart'I Irrrve ncr +wrrapicryerz,., wrark09 for Im ill ttrry rw.t pac;ity,'[No; A10rkvo%' (:Roma, insurance roquired..l .�.N Ran a Irtrnrccnvuer doiatlt sat work rrryalelr, lNcr workers' comp, insurance roluirarsd.l a4, I Rana a }urra,eowaa+ r and wSNI Iry hlrin earnrrral orsfir c,,onducl a'1N wtrrk or, Illy 01,0 rerty. I wilt LrtwnretI1R1 tall mlltractorseNtKar Ilavo workers" ��<anslawrrvnlic,n iatxurrnrc rn sloe �irlc Prnr1-i"M will, nor en,loloye0s. 5, I atoll a Vilero.l Mitractcrt• and I l,arve Itir ed I Irec sub•currtractors I Isted on the; auaclte]c.i slls at• "fltusc raul>urcralrlat:trrt's hravu u�ralrltrv4es arrrd hmve r3aol'kr�r;a' i°cYI1V,�" iaasura.rlr:e. s da. WoeAN, s corvnr atiurr and its ofllc cos Iaavc ex 'risen their »kht of uxaarrpiion pr dolt L C, 152, $1(4)� irnd wa halve no 4m,rptny"s, [No warners' COMP, in81araarc;0 t'crluir;d,1 TYPe of Project (r.ottiolred): 7, u„i Now aMonsirtw.t.id:rn 8. C Ronode inn 9. ED Demolition 10 Building nddition 19C."I I'.;lccatr°ica'r1 rcp airti a..n ,acl�iilir�ri 12. l'lla�t�hira a"�porid, rrr Iarltlili,n,�, 13, Roof rcPairs 14, R ()the,, Replacement °,�..u..„. ay upplicani,that w1at^cks fuA o1 must also i'iIt out t1 smcliern taa".laowaadrc,rvin tlAcia wpr)cua°,y' crsnrNaoixrultiran N3rrlics,y inliarrrrtriicrn, I''E•lrwrriowild's who aulnnril this afl'idavi► iluai"atirt,'v 1110Y tu•u doing; all wovkm id tien Irian a,,,t Caln„<.rstrnalwrs MUM aGart>rrrlt 41 new cal'('ialaavir indictaClrrwr wliw^h t 1111J ractcrrs alamt irtsck. tlxi tgux ratu�t atur.cla�ed tin tacNdiCdtaaaald slrexal rnc�wri. I alL rrxnre u1'd.iwa 0b-jonrraa;tor, auact,rIRtc wltieutr�r,,rrnat Iht.xti.c Cloth1c,, truv,,� a rlaiolc+yc+.s" .Nf Iire.KtIh�;un11'ncltarrg hava esrr,laltlyeeg' i.iley rrtusl prawiade I11161. warrkeiN' c^01111a, p011cry rrartrrlrc,r. +C am an er17Pl4'yyer.th(jt IV1.)r'#ulWn9 Workerv" eo)Lnpenscrtr`bn tire i ihs'rrx�xn cr>po. +aav arrsplx►Yrac�,i'. 13e1nwtire piaJ�cV r�rtcl,Jr�ly sICa i'vormatims. Indemnity Insurance 00, of North Arnerics Ilttidlt'eraea�Gclt'Ill�rrl'y hitcnxe;_..�.....,_,M..� Policy * Or 19al'f irls,:lwie" � ..._...._....._� �........._.^—.�.�.,w..__�... N::;xp.ir°sticart.i')ate,.'l0101/2024w_.,.�..,",��,�,,,,�.,, Job Site Address: l� AaiIu It t copyof, l^'nNte wall t" "+cnittpettnattitrtr pr►€icy cicuatr°atirrrt laar�;c (sltmving the P011cy nulalwr and expirat lion dale), QI�610 ilur�c to sccua'c c;0vca"rrge its mqu.ired utador MGL c, 1 .2, §25A is a criminal vie>latticon taurrit~hdkhlc lay ,,t E"irlaw t1p tc�r $1,"�'1J,iltd �l'nC1>ct l" ran. yemt" d11rL tti attttaclwk, tat* wall mta cavil r+ aluitir� ia, tltc Icl;rrra of as STOP WORK ORDER C and afireI;aN' lPl:) tt't , 2ti('l,tit� .a c11ry rtg'tainst.the viols coo. A copy of this h1lttelneltt maybe forwt3ccieti t.i1 t;ltt 4Jf1'ic;c OfI.Itvarsti9artirtrt4 or the, C.�IA !'car ilt,wtit"t r;c1, Coverage volific ation. Ewe aared coo" ecr, :> 418 488.7385 Cif, cial.atw.onlr.' 1y0 not Write irr bras area, Io be conalrleted 0 clev oar town a?" letai � :•rr oty ,,______w,.1 acrlrlitJiW,i,�+vwtsl� ��, _ llsepiaoA,rrlhrrlriity (circle rrne): 1, Board otHe>wl}lt 2. 1111dfn Departrrraerrt 3. Qy/'mown Clerk 4, Elet.'I.I'.ieW Iltgpeptor �" pltr.rttlybig Irrspep.taor 6. other �,.. Contact per°+Irarr: A f> DATE (MMIDWYYYY) 0412217.07.3 GEKTIFICATE OF LIABILITY INSURANCE ACCt#:2970777 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AIITNORI"1_EF) REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, M PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or br- ondorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the this certificate does not confer rights to the certificate holder In policy, certain policies may require an endorsement. A stalnment or lieu of such endorsement(s). PRODUCER CONTACT--""'^^"" LOCKTON COMPANIES, LLC 3657 BRIARPARK DR., SUITE 700 (AJC (IUC, No, Exl)t $88.82$•8365 FAX (A1C, Nal: USTON, TX 77042 EMAIL ADDRESS; _INSPERITYCER75t�LOCKTONAFPINITV.COM-___. �_,_ IN5URER(S)AFL DjNc,.CQVERA,GE " NAIC It ---- - INSURED - ..- ...INSURER-A.;._Ind.em_nity Ins-urance_C..o: Qf KgJh Americ;l_ �S:3676 .. _.- ....._. WINDOW WORLD OF WESTERN MASSACHUSETTS INC. lNsuRER B 641 DANIEL SHAYS HWY INSUR . _.._..___.__._._.. _._....._...- _-- INSURER D INSURER E A UVI=KAUt5 CERTIFICATE NUMBER: REVISION NUMBER: — THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI, ICI' PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W1 IICH TH€; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL "I I II: Ti::riMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ADDLOR TYPE OF INSURANCE POLICY EFF POLICY E)th- INSD WVO POLICY NUMBER (MMIDDIYYYY) {MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY 'LEACH OCCURRENCE. CLAIMS- OCCUR I DAMAGE TO RENT kl 1 AGGREGATE LIMIT APPLIES PER: iLICY nPRO- El 4L..--IIIFrT AUTOMOBILE LIABILITY -- ANY AUTO OWNED SCHEDULED ..—. AUTOS ONLY HIRED NAUTON-OOSWNED _ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ <ERS COMPENSATION ,MPLOYERS' LIABILITY YIN .O P R I E TO RI PAR TN E RIE X E C UT I V E =RIMEMBCR EXCLUDED? latory in NH) NIA X describe under IIPTION OF OPERATIONS below _PREMISE$.{Ea occurrence) MED EXP {Any nnn pnrson) _ .'I PERSONAL A ADV INJURY $ GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG S S BODILY INJURY (Par pomon) .� BODILY INJURY (Par Rcoldont) ;) PROPERTY bAMATC ...- b $ �__ �. EACH OCCURRENCE AGGREGATE C56098598 1010112023 10/01/2024 E.L. EACH ACCIDENT $ 1,00o,c)p0 E.L. DISEASE - EA EMPLOYEE $ 1 ,OpO 4)00 E.L. DISEASE -POLICY LIMIT 1,0C11),�10Q DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Town to Northumpton Building Dept 212 Main St Northampton, MA 1060 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Dr.-,'U ERLED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) (V 1UUU-ZU16 AGUR❑ CORPORATION. All right::: roservef3. The ACORD name and logo are registered marks of ACORD WINDWOR-01 F LAAIJk�DATE (MI9)1'1)NYYY) CERTIFICATE OF LIABILITY INSURANCE 41912i124 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDr,I;.'rHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE I101-ICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTIR-RIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be k Ir Iorsecl. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A stal noorpt on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Laura Misseri — Phillips Insurance Agency, Inc. PHONE ---- ---- --- - ---_ "X ._. 37 CenterStreet fAlc No=Exy_(113) 594-5984 __— _....____ (A/C,_No):(413) 59?-'1499 Chicopee, MA 01013 E_ AIL (aura hilli sinsurance.com —A 'Ss:___- _ p p------_. --- -- - INSURER{SAFFORDING COVERAGE- _ __ ,NAIC V _ INSURER A: EMCASCO Insurance Co _—_ 24/107 INSURED INSURER H:Employers Mutual Casualty Com _an -215 Window World Of Western Massachusetts Inc INSURER C; 641 Daniel Shays Highway INSURER D: Belchertown, MA01007 INSURER E INSURER F COVFPAAPR f^COTr CI!•AT= unllaacn. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLII INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT" TO N CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SuBR POLICY NUMBER '------ P POLICY EFF ---_. POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 6A44324 EACH, OCC1U_RRENGE , _ _ DAMAGE TO RENTED 5 I " I 41912024 419l2025 PREMISES _(Ea_pc=:urr,9ncv) — :5 MEb EXP (Anx ann pnrsonj _ „t _PERSONAL &--ADV INJURY_ _ ------ GENT AGGREGATE LIMIT APPLIES PER: X ❑X _GENERAL AGGREGATE 3 POLICY JC ❑X LOC PRODUCTS - COMP/OP AGG _.. _ - ,a OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO X 6Z44324 419/2024 4/9/2025OWNED B()DILVINJURY{Perperspn}. --- AUTOS ONLY AUTOS BODILY INJURY (Per dccidenQ a X WIRED �( NCN-ppyy��JJN D AUTOS ONLY AUT03 0Y PRe�r aCcitlenfppAMACE _C..__._ :6 D X UMBRELLA LIAR X OCCUR EACH OCCURRENCE_ y EXCESS LIAR CLAIMS -MADE 6,144324 4/912024 4/9/2025 _ -AGGREGATE ;s DEC) X RETENTIONS 10,000 _—___..—_--...--_._._. ANDWORKERS MPL COMPENSATION AND EMPLOYERS' LIABILITY Y / N QNFICEO M IMSER EXOLU©El7 EGUTIVE j� RR�� E L I ( andaEory In NH) -- NIA ___ _-STATUTE ,- _ERN E.L. EACH ACCIDENT, .__.-. x If yes, describe under E.L._DISEASE - EA EMPLnYEE 7ti DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiflunal Remarks Schedule, may be Rtlached if mnro space is required) Town of Northampton Attn; Building Department 212 Main Street Northampton, MA 01060 Y 'E121()Il I I II :f-I 'fl�ll; ERMS, a00,000 10,000 11000,000 ',000,000 ',000,000 I,000,p00 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED IIEFORL: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIHI I,ED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , ACORD 25 (2016103) O 1988.2015 ACORD CORPORATION. All right-, f serlrud. The ACORD name and logo are registered marks of ACORD �, u�rntr:.,rryu�wPPat ri r4ia ruy.IanRI utre�: tl��' 1, P�uwahJtrtr 1'rufullP9,t�irtttl 4WN But It.iu:lanr.uar•r, �'{y1f1�J att't'srrPlilurr Ftr 4! 1rlJlirCluprpti lafral.,.ig7.Alr�nrrJ;L tr'tartt.�ot:a��f t�l'i d;viGitia�;r•r,+iirr .�' ri r �E,;,�,,'ralrrar:' �,9.•R•I��"'4�3 � i n:5+"'�i:'i�liil ����J"r;�k�;�r k`d!�"si�CDliIr,CTi `�`,i9iLd,6' �'����'1 �r4'�ii.`• •,, 'P�tz �,31+ifd!<21r.�C��s � F����� ���r�?` ��;, ?�' Ct,r..kik EC 6 ` y a!I • �'rf� �'.10 t}4KP9 �1V'i'I�. a ��rrraatkPAat�tarPt�r �r.�hr���d a`� ���:� lrri��n„ � . ��• THE C+U`MfUli1Nh1V'L.AU11 011,t ra' ASSAd^.-HN.JGF7TS Ofd'co -old CorPsraPaaor AhfpWs.A Duq.Inuq;$ �P Maur pP9ean1 karul ivjiprFiovi do r rcorITn.nomn 'Tp oFp klr,liW61lal Elw��P �1'9tESPr'd VI{al'11w"kwX4� l,�1�1�7� r �I�rl� 102 Q!>,,KRirx:f o I.3 l IV F „r�Y ,., J I fAJINi d' i3 L,LiI'� I Y 1N7hE!I MA6JAl`141� ,.... �r1%ClF"rC"SrCI'GiTs'gr'!p�' THE CON1'MONWEAlW'M OP MASSSMCHUSHTT ' 411'iaa or R'Df)Watiaum "Mr-IMfSR0wgP! 9NT'C0XTRAGT0:K 'T•Y.P,E,,lU64r br.&Da P„; p1ration 4Uk!3Ttt}'r�d4VJrtl_tt i71^��'aMkPY`_I1{lswJ+4;RIlJSL'I"r5, INC, TIMOTHY VkDST tar--1-0 PERl'0WN, Ml,. f iON l�nti�r•�e�relzrry IFt091sflraxllon va Vd !fDr Imidriv I du,r:at aal:frr,. H-1c, mplr•ellrraat elnuq, rP ikrtund r0hu n kcn alflroof conuumorM*0., and�I}11i9111rix;+l3C;[s,Wrt�Bin,lr 10100 VA-111i]Ili fItolll Stmnt $!Wtl TIC) ff9or;.tmnq , MA 02110. •I Ids 'Or,I ;.,.r• Mot V»;aU>dWMmQLA SigPlOtAiro Roplrllrattw vat'id Par IIscPIa,~ladu,mI use Only tl30imo tho exttlratfulk MAU, Uto and rolum to, Of c-D &Callsuillor A4tlalro trod P.Pttdnos9 P uLlulnomm 1000 w1:611:11110041; 814,4101 r S3r U 710 Hostdlnl MA 02116 Not vallild vwithouit slunattire Docusign Envelope ID: 61F8115E-lB4D-45E6-8F33-647D6836BODD Customer: s Window World of Western Massachusetts 20 Daniel Shays Hwy - Beichertown, MA 01007 &W Phone (413) 485-7335 a Fax (413) 315-3714 www.WindowWorldofWesternMA.com Phone (h) lknc C- { You the buyer may cancel this transaction at anytime prior to midnight of the third business day after the date of this trai isBCti011. 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 RESALEI This window World," Franchise is independently owned and operated by Window world of Western Massachusetts, Inc. under license from Window World, Ir 4Vq-1:2-7q Salesman Date 1Signed Uyr 9/17/2024 Owner C), re Owner D, Extra Woik 1.07 Whito (Anw - a lrirsinal YailAVj f`nnv - Pilo Pinir r`nnv - r.i rctr%mor Window World of Western Massachusetts 641 Daniel Shays, Hwy, Selchertown, MA 01007 /&qv 975 North Read, Westfield, MA 01085 Office: (41.3) 485.7335 v-ww. WindowWorldofWosternmA .rom Marilyn Fichman Phone: 5085236179 Install Address: 26 James Ave Email: marilyn.fichman@gmail.cam Northampton, MA 01060 Contract. Name. Marilyn Fichman - Sales - Doors Design Consultant: Tim Drost Date: 9/13/2024 Payment Method: Contract Type: Sales Comments: Measured By: Measure Approved Status. Contract Lender: Product Description Entry Door, �.� Casio Entry Door, Casing + Capping 15 lite sdl 36x 79112 frame right 5.1/4 15 lite g Color TBD BOTH SIDES venture wide nickel Capping Permit & Administrative Permit & Administrative Fee Fee Entry Door, Entry moor, Casing f Capping 2 panel craftsmen, 4 block, granite glass, color Casing + TBD inside ,outside black, venture wide nickel 36x79-1/2 total frame height 5- Capping 1/4right Setup and landfill disposal Setup and landfill disposal fee fee �mn,�na �5prcans,r�ano _ � r CA -RE$.. TxblQty Price Extension N 1 $4,286.00 $4,286.00 N 1 $300.00 5300.00 N 1 $4,970.p0 $4,970.00 N 1 $1.50.00 S150.00 Total Information Unit Total: 3 subtotal: $9, 706.00 Tax Rate: 0% Tax: SO,00 Total: $9,706.00 Amount Financed: SO.00 Payment Method: Deposit Amount: S0.00 Balance Paid to Installer upon Completion: $9,706.00 Renovation, Repair and Print Act (RRP) Compliance RRP Pamphlet Provided Date: Year Home Built: RRP Signed bate: Window World ofWegterrn Xlseachitsetts 641 Daniel Shays, Hwy, Belchettown, MA 0140'7 [IZit 975 North hoar, WcsLfieid. MA 01085 Office: (413) 485-?335 iv%vw 4VandowWortdoAVestern MA.com. Product Acknowledgements -I' I have received a Copy of the lead hazard information pamphlet informing me of the potential risk of the lead Hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before work began. Primary Homeowner Secondary Homeowner srvnn[l5 �iFLIpJ c niYS'r[[li� ENVW IA�y �+ / WINDOWCARE a Window World of Western Massachusetts ortrcAw�s aiu�eF. ���,n��� 641 Daniel Shays, Hwy, $elchertown. MA 4rN 01007 975 North Road, Westfield, MA 01085 office: (413) 485-7335 wsreon CAR vWa�as � wwsv.WindowWorldafWestemMA.com .-.._......._. , ;Preparing for Your New Windows and Doors Thank you for choosing Window World to complete your home improvement project. Thfs letter Is designed to simplify your upcoming installation experience by letting you know what to expect. 1. HOW LONG DOES IT TAKE? It takes approximately 4-20 weeks to receive your custom-made window order from the factory following your final measurement and your job exiting the Massachusetts State three day rescission period. A Window World associate will contact you shortly after your products have arrived to schedule the insta€lation. Please note that we will make every effort to install your products within a reasonable time after they have arrived, but weather (rain, snow, high winds and extreme cold), high volume sales periods or other conditions (factory production delays, factory closure for holidays, shipping delays, etc,) beyond our control may govern the installation date. Homeowner understands and agrees that any such delays will not result In a discount from their contract total. 2. HOMEOWNER REQUIREMENTS: I understand that by signing this, I am certifying that I am the owner of the property listed on the contract. I agree that a property owner will be present far the duration of the installation to ensure that the work is performed to my satisfaction and to inspect the work completed. If a property owner is not present, the contractor will be released of liability for any installation issues, This allows us to better satisfy our customers and ensures that the windows or materials are installed in the correct openings. Customer must sign off on completion certificate and leave final payment with installer if he/she wishes to leave the job site prior to completion. Customer understands that by not being present at the time of installation may result in the automatic charging of the final payment to the credit card used for deposit. 3. UNFORESEEN CIRCUMSTANCES: If during the installation process a condition is found that would prohibit properly installing a window (i.e. wood rot, termite or other hidden damages, etc.), the installer will promptly notify the Homeowner as well as the Window world office of the problem. Any additional work that is required to properly complete the job will be discussed with the Homeowner and billed on a time and materials basis, In the event we have received the incorrect or damaged window for your job (due to an incorrect measurement or factory error). Window World will reorder the proper window and will schedule the installation as soon as passible. Window World expects payment on the work completed to date at the time of installation that is not affected by warranty issues, 4. WHAT YOU NEED TO DO PRIOR TO OUR STARTING THE INSTALLATION: • You will need to remove all curtains, shades, blinds, window air conditioning units etc, from the existing windows. • Vie also ask that you remove any pictures mirrors, etc. on nearby walls and tables. • Move all furniture away from the area around each window leaving approximately 3 ft in front of the window and 1ft on either side of the window to be replaced. • Secure any pets (and children) For their own safety and for the safety of our Installers. 5. ALARM SYSTEMS: It is the responsibility of the Homeowner to inform the alarm company of the upcoming window or door installation and to arrange reconnection after Installation is complete. C. EPA -LEAD SAFE GUIDELINES: Homeowners of homes built before 1978 have received a copy of the lead hazard information pamphlet informing the Homeowner of lead hazard exposure from renovation activity to be performed in their home. The Homeowner understands and agrees to indemnify and hold Contractor, Contractor's representatives, and employees harmless for any lead paint health issues. 7. INSIDE INSTALLATION (Normal): If the windows are to be installed from the inside, the interior stop moldings will be removed from the existing windows and reused after the new windows are installed, Please note that the paint or stain on the trim/moldings may get chipped and would need to be touched up by the homeowner. S. OUTSIDE INSTALLATION (Special): If the windows are to be installed from the outside, the existing window's woad "stops" will need to be removed. In addition, if there are existing storm windows in place outside of your current windows, these will need to be removed as well. Please note that the area(s) where the wood 'stops" and/or storm windows were removed will need to be patched and painted by the Homeowner uriess the exterior trim is to be installed by Window World. 9. UPON COMPLETION OF INSTALLATION: After the installation is complete, you will be asked to inspect the entire project with our Installer. An evaluation sheet will be provided for the Homeowner to sign after the final inspection is complete. Please make sure that any corrections have been made before the installer leaves the job site. When the job is complete, we ask that you pay the installer the remaining balance due on yo.rr contract. 20. METHOD OF PAYMENT: Our installers will accept your final payment in the form of check, money order, Wells Fargo financing, or Visa/MasterCard/Discover Card authorization. As a courtesy and to ensure the safety of our installers; please DO NOT pay your final paymern In Cash. 11. REFERRALS: Our goal is that you are pleased with the work we have done and will refer us to your friends and neighbors. You will receive a 550 referral fee for each person ynu refer who purchases 8 or more windows. Please have your referral mention your name when contacting our office. We trust that your remodeling experience will be a pleasant one. If for some reason you are not completely satisfied, please contact our office. Your comments are welcomed and will be used to better serve you. Thank you for your business? Primary Homeowner Secondary Homeowner Design Consultant EPA "renovate Right" Brochure can be viewed and printed from here: Renovate bight Brochure [VW of W. Massachusetts anticipates starting this work on and being Substantially completed in days. Any deposit required in advance of the start of the work SHALL NOT exceed 33 113% of the total contract price OR the actual cost of any mateilal 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. No work shall begin prior to the signing of tice contract and transmittal to the owner of a copy of such contract. WW of W Massachusetts under provision of Chapl,er- 142A of the general laces is required to apply for and obtain all construction -related permits. WV+! of W. Massachusetts 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 PVRC%lASER(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 YURGHASER(5) will not be entitled to make a claim or collection from the guaranty fund established by chaptor 142A, M.GL. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the dame of this transaction. Notice of cancellation must be In writing postmarked no later than midnight of the follo%%ing third business clay. THIS 1S A CUSTOM ORDER NOT FOR RESALE This Window World@ Franchise is independently owned and operated by Window World of Western Massachusetts, Inc. under license from Window World, Inc.