23A-110 (2) • ,' Y S7 f WINDOW WORLD HIC #10
" y S-3 1.. I
56 Dimock St.
Leeds, MA 01053
Telephone 586 -8712
CONTRACT
Date 0Gc /ci .'e „t 20 C) C ?
This agreement, between A /Lao f1 ��e-r ra L L.
(Owner)
of /61 , ...co L. _Me. ; e> z j l ea 4 -ei , and
(Address)
WINDOW WORLD OF LEEDS, MASSACHUSETTS.
Phone t " /X v j . 3.0 - '7
SPECIFICATIONS S 3 y
._L d': J c,. L (ij) VI, ,Y L- I C.ep —ei'e .d 1 fit j� l', L 'f �c.11 / v_j l " L Li zr
Q LL (..4l i s te:7 t2 bt1.4.C_ jr ciz i i !: >A i 7 tit-/) /1 C, G°. ila I -me ..�, . i/
. a r ..
on the premises located at /6 . o 7'p' /s
e ,4 l� �' A ..d" ) a total cost of ma y '``/ 1 '7 , ella
With this order owner pays down the sum of $ ‘ 0.9e4 s0
Owner agrees on completion of said work by the Contractor to pay the sum of $ J' % 7' 6 dollars
($ ).
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be
binding unless in writing signed by both parties.
WINDOW GUARANTEE
Window World's glass is guaranteed for 20 years from date above not to fog up between the panes of glass. All other parts will
be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked
glass after 90 days from date above or any damage resulting from neglect, abuse, or acts of God. Condensation build up on the glass is
caused from high humidify levels and poor ventilation within the home therefore there is no guarantee that this condition will not occur.
In witness whereof, I have hereunto signed my name this c1e" 7.4. day of c3e , t,t 20 6 . 1 7
by 7
Y - - t - `
( o Authorize Agent) (Owner)
(Joint Owner)
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City. of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations Th. —e inspection pro equ�i that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure . these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
--- - - - - -- permits -in- conjunction to_the..building permitissued,_ they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
—Date _ _ ._ -- _ _
Address of work
location
vot
The Commonwealth of Massachusetts
Department of Industrial Accidents
Vii. — F'
— Office of Investigations
ti 600 Washington Street
'•1 = Boston, MA 02111
www.mass.gov /din
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/IndividuaI): WINDOW WORLD
56 Dimock Street
Address: L eeds, MA 01053
City /State /Zip: 586-8,712
Phone m:
Are you an employer? Check the appropriate box: Type of project (required):
1.0 I am a employer with 4. 0 I am a general contractor and I
Y 6. 0 New construction
loyees (full and/or part-time).* have hired the sub- contractors
2 a sole proprietor or partner- listed on the attached sheet 7. Remodeling
ship and have. no employees These sub - contractors have g. 0 Demolition
working ca ace eu pioyees'and have workers'
working for me in any capacity. 9. Q Building addition
[No workers' comp. insurance comp. ins'—:
1
uired.
re q 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I
_o cers av xezcset —�1 Blumbi-n r
3. [� am a �emeowaer deiag all �vorlc id i 0 g repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required]
*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.
ICont:actors 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, they must provide their workers' comp. policy number.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:"
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 51,_500.00 and/or one -year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fi
of up to $250.00 a day against the violator. 'lie advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify under the pains and penalties of perjury that the information provided above_ittrue_and correct
Si:u.. ture: n.. (" ---e ,:2 • ')ate; /c /) //O 9 _
Phone #:-..- —.< r (v 7 7/ 14--
1 T 01 use o Do not writ in li to be completed by c or town Offltiat
City or Town: Permit/License #_
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbinb Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction
---- Suuppe Supervisor: Not Applicable ❑
J
Name of License Holder : " 3 1 AN, 9 7
C License Number
f�
/JJ 144 QCAL- S ; - �- 444 e7 /0 3 GiP - 41 /6
Address Expiration Date
i 3 6 71 _
Si ure Telephone
9: Registered_Home Improverrient Contractor ., , ,.., , Not Applicable ❑
Company Name WINDOW WORLD Registration Number
56 Dig iock Street Date
Address Leeds, MA 01053 Expiration ate
586 -8712 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 will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
titIRMAImVemuniptioit
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 building 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
Employers 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
4__ .__ - nrtharriptan • - -- tts eneml Annotated.
NC7r i nattces, a e n: - � • - -. ,.
Homeowner Signature
w
.s ,
s
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement jndows Alteration(s) 0 Roofing 0
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [El Siding [ID] Other [ID]
Brief Description- ef-- Pfeposd -
Work: ,yr%-- r ; /AN- -L ✓ r 1 / 4 -:)i iit% -i1 S . 3 d el Vr1-41e___ �s e 7truaLa
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative . Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a_ if. Nevi, house and = addition to'existirrq'housiraq comp the foilowinc
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
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner- Date
I j 0 vim L-ll r -.�.. I (, , as Own r/Authoriz
geu,iereby declare that the statements and information on the foregoing application are true and accurate, to the best df my nowledge
a tejief.
Signed under the pains and penalties of perjury.
Print Name
Signature , • s!wne gent) Date
� a
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 _ % r °"
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:h
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Pager and /or Document # ry
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location:�
D.` re there any proposed changes to or adations�o l nsintended t e ? 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 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton
Buildin a artment � �� a
g .P p y1 it tt ,
212 Main Street ✓
Ro 100 u 1,
4 Ngrth pton, MA 01060 � o tr ctrscai rss
phone,41'3 -S87 -1240 Fax 413- 587 -1272 te5it
4a
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
Map Lot Unit
/ � , /Yh 9 / l$/ - Zone Overlay District
L t/ r C iwG c=
Elm St District CB District
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agentt: �1
"jc-3 VJ r.J C a� i I .5 A/ 111 c / 57 �-*Le•.- s .1
Name (Print) Current Mailing Address:
- 7/
�ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (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) 4 T / 7, — Check Number • ?Q
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of-Buildings' Date
•
168 SOUTH MAIN ST BP- 2010 -0490
GIS #: COMMONWEALTH OF MASSACHUSETTS
., ru 4. V23A i 1O: " CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
•
Category:
BUILDING PERMIT
Permit # BP- 2010 -0490
Project # JS- 2010 - 000677
Est. Cost: $4417.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
L'se Group: JOHN CORBETT 078297
Lot Size(sq. ft.): 9757.44 Owner: HEXDALL AARON
Zoning: URB(100)/ Applicant: JOHN CORBETT
AT: 168 SOUTH MAIN ST
.9pplicant Address: Phone: Insurance:
56 Dimock St (413) 586 - 8712
LEEDSMA01053 ISSUED ON:11/4/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
I ; nderground: 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 11/4/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo