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31B-087 Fran: Jancewicz & San 04/04/2011 10:36 1185 P. 001/(M2 • ) Page 1 of2 Mike Doherty Flom: .Mire Dohexp Sent: Monday, November 22, 2010 2:55 PM To: 'geargla_ telentahotmail.com' Subject: REVISED WINDOW PROPOSAL FROM JANCEWICZ Georgia, below Is the revised quote reflecting your selection of the Pella windows with selected options listed below. Please sign and mai or fax back so we can get the windows ordered and get you project on the schedule. the work will take us parts of 2 days, so we can schedule to coiled the remainder of balance of the at the end rather than our typical half completion payment and then a final. Attie Data* 1 t. 800.281.3585 f. 802.463.2203 6 Morgan St Bellows Falls, VT 05101 OPTION & ACCE SSORIES INVEST1kiENT 2 Regency Vinyl replacement windows clear / clear 81155.00 3 Pella wood replacement windows with Integral 85,650.00 Light Grilles over clear bottom sash. Pre- Pared white interior, aluminum clad exterior in classic white. Oil rubbed bronze spoon locks. Full screens. Pantry Screen Full 875.00 Door Screen 8150.00 Entry side lights repair 5325.00 87,355.00 TOTAL 192 TERMS: 33% DEPOSIT DUE UPON 33% Deposit ACCEPTANCE -? .Y 33% DUE UPON HALF COMPLETION 33% Hair ColoPkilion BALANCE DUE AT SUBSTANTIAL Balance Due 410 SWIMS COMPLETION , TT 9 r p l ■ q . YOU, THE OWNER MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE NOTICE OF CANCNIZATION CIAUSE BELOW FOR AN EXPLANATION OF THIS RIGHT. ACCEPTED AND AGREED: The prices, specifications and conditions contained herein this Agreement are satisfactory and hereby accepted. You are authorized to perform the work as specified 12/13/2010 From:Jancewicz & Son 04/04/2011 10:37 1185 P.002/002 Regency Vinyl Windows ATG Glass Packasie (Low- E1Araonl • Solid Vinyl Construction • Foam Filled Welded Frame and Sashes • White, almond or bronze color • Fully- Welded, Sloped Sill • Block and Tackle Balances • Extruded Aluminum Half- Screen • Dual clear 7/8 Insulating Glass with Argon gas between the glass PPG Intercept Warm -Edge Technology • Low cuing on one layer of glass. • Sash Interlock • Ventilation Limit Latches This proposal may also qualify for the Same As Cash Payment Option. This Proposal is based upon current material and labor cost. This Proposal may be withdrawn If not accepted wlthbn ten (10) days. OPTIONS & ACCESSORIES -- INVESTMENT 2 replacement windows pie / clear 3160.00 46 "1 ( 60 3 - • Iacement win . • - :G , 4 . Pantry Screen Full $7 Door Screen • 5150.00 I 10 Entry Side Lights replace Entry side lights repair $5325.00 c_ TOTAL P -1710 TERMS: 33% DEPOSIT DUE UPON ACCEPTANCE 33% Deposit $ { L 33% DUE UPON HALF COMPLETION 33% HsIf Compietlon BALANCE DUE AT SUBSTANTIAL COMPLETION Balance Due 4 - "1 9 YOU THE'OWNER MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANBAC ION. SEE THE NOT1C.'E CANCELLATION' CLAUSE :.. ; BELOW FOR AN EXPLANATIONQFTWS RIGHT: ACCEPTED AND AGREED: The prices, specifications and conditions contained herein this Agreement are satisfactory and hereby accepted. You are authorized to perform the work as specified. (MUST BE SIGNED BY ALL OWNERS) f � c l OWNER: 3/.., i.►.r,�t.�' C OWNER: DATE: • /61 ! '' � • O/ O — ii koi I r C. AGREEMENT IS NOT FULLY EXECUTED UNTIL SIGNED BY A LICENSED SALES PERSON THAT 1S CURRENTLY EMPLOYED BY JANCEWIC2 8 SON. ar►ce z on Remove this label after final inspection; SAYE for future reference °'^ Pella Corporation �[ Architect Series ?PO, / NFRC r,7 Precision Fit Double Hung ,►.; HII8 Annealed Luxury (LX) �■ j o . . Regency Vinyl 'double Hun Nation Fenestration Advanced Low — ' �, Low Rr9on We lded Frame / Sash Rating Council Argon Gas Natlon&Feneatratlon CWLJDH ENEI RatirgCouncil° STS :: CERTIFIED CPD#PEL -N -119 CERTIFIED T 1 0 10 - 3 9288 08 - 001 Low — e Aruon QUHL Il ENERGY PERFORMANCE RATINGS U - Factor Solar Heat Gain Coefficient ENERGY PERFORMANCE RATINGS � ta32 � ■�� O. � U- Factor (U.S./I -P) Solar Heat Gain Coefficient (U.5.11 —P) (MetrldlBq 0.26 11 _ 30 0 _ :3I!1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance ADDITIONAL PERFORMANCE RATINGS 0.48 ._ _ Visible Transmittance Air Leakage (U.5./1 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determinim it _ 51- - _. __ ___ whole product performance. NFRC ratings are determined for a fixed set of environmental conditi and a specific product size. NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. For more Information, call (641)621 - 3114 or visit the Pella web site at www..ella.com or visit the NFRC web site at www.ntrc.or. Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole Wind Load product performance. NFRC ratings are determined for a fixed set of environmental conditions and a Design Pressure a specific product size. NFRC does not recommend any product and does not warrant the suitability of any (oP)(par) ENERGY STAR Qualified in Highlighted Regions product for any specific use. Consult manufacturer's literature for other product performance information. + 30/ - 30 www,nfrc.o 7 PerASTM E330 �, 1 i_. t y ter_ _.. � ti '1f"' { , , Canada —_ PeMormence P � _ � � Classification -- ^�� WW `�� F' CANiCSA k 4 4 T+ .a P . , ...' 4, 1 ; A440 -00 rNERC>YS7AR � �, + 1 /41+ V , wk 9, * A2 Air Leakage , 4 t° 1 ,, ro ..y, 1,. B2 Water Leakage C2 wind Resist. Qualified WDMA LC30 (Performance Grade30) n.oa M .MO Mooe Tested to ANBIIMMNN WDA 10111.5.2 — 97 HALLMARK " w,, ;; " "" CERTIFIED H —LC30 48 "x84" WDMA Llcenseilumber :411 —H -982 Tend to AAMNWDMNCSA101n.8.21M40 - 05 ebaeboera st eat" doormen bee apdeeba *Mud: H LC30 1219x2134 (48 "x84 ") WDMA Hallmark Certification. Pella products labeled with the Window & Door Manufacturers Association (WDMA) Hallmark Certification are tested in accordance with applicable WDMA performance standards, which requires products be tested for air infiltration. water infiltration, and structural performance. Petermann of Pella products will change over time depending upon the conditions of use. For details on Hallmark Certification, go to www.wdme.com. Complies with HUD 111 (Macomb. IL) Meets or exceeds M.E.C.. C.E.C., and I.E.C.C. Air Infiltration Acquirements Florida Product Approval System(FPAS) Number:FL11694.1 Glazing type and thickneas:Mnealed,2.5MMboth penes. designed per ASTM E1300 Window or Door Actual Size wide by47.995 "tall r six, 9 - _ e Office of Consumer Affairs and usiness Regulation 10 Park Plaza - 7 C_f P rk Pla Suite 51 0 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 121544 Type: Private Corporation Expiration: 5/20/2012 Tr# 296049 JANCEWICZ & SON/ Home Imp Co of Ver JAYSON DUNBAR 6 MORGAN ST BELLOWS FALLS, VT 05101 Update Address and return card. Mark reason for change. Address ❑ Renewal 0 Employment ❑ Lost Card DPS -CA1 0 50M-04/04-G101216 ,,��� ,,� ,�,� ,�,,���� Office iTkol mer �s � l32ine'sslYeg4diton License or registration valid for individul use only =_- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ^ — I Registration: 121544 TYPe� ce o Consumer rs an ness g Offif Affaid Busi Re ulation �Jii+= Expiration: 5/20/2012 Private Corporation 10 Park Plaza -Suite 5170 11f Boston, MAI037116 J • WICZ & SON/ Horne Imp Co of Ver JAYSON DUNBAR 6 MORGAN ST / BELLOWS FALLS, VT 05101 Undersecretary ; valid without signature itCOR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDpnYYY) ��-�� 5/6/2010 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Clark - Mort enson Insurance NAME: PHONE FAX P.O. Box 606 IAIC.No. EMI; 601 -157 -2121 (A/C, No): Ea3-35 - Keene NH 03431 E - MAIL ADDRESS: PRODUCER -- CUSTOMER ID JANCEWICZI INSURER(S) AFFORDING COVERAGE NAIC 6 INSURED INSURER A:peerless Insurance Company 0 Jancewicz & Son Home Improvement Co of Vermont Inc dba INSURER B: 6 Morgan Street INSURERC Bellows Falls VT 05101 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:2106177663 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A • D I R POLICY EFF POL XP - -- LTR INSR WVD POLICY NUMBER IMM /DIYYYYYI IMMIDD/YYYYJ LIMITS A GENERALUABILITY CBP9593918 5/6/2010 5/6/2011 EACH OCCURRENCE 51,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) 5100, 000 CLAIMS-MADE Fl OCCUR MED EXP (Any one person) 55,000 PERSONAL & ADV INJURY 51,000,000 GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG 5 POLICY PRO- LOC JFCT A AUTOMOBILE LIABILITY BA9593618 5/6/2010 5/6/2011 COMBINED SINGLE LIMIT 50,000,000 (Ea axidsM) X ANY AUTO ALL OWNED AUTOS SAMPLE BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE X HIRED AUTOS COPY (Per eccidenl) 5 X NON -OWNED AUTOS S A X UMBRELLA UAB X OCCUR CU8698805 5/6/2010 5/6/2011 EACH OCCURRENCE 52,000.000 EXCESS LIAB CLAIMS -MADE AGGREGATE 52,000,000 DEDUCTIBLE 5 X RETENTION 510,000 A WORKERS COMPENSATION WC9594118 5/6/2010 5/6/2011 I WCSTATU- OTH- AND EMPLOYERS' LIABILITY Y I N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE� E.L. EACH ACCIDENT 5500, 000 OFFICER/MEMBER EXCLUDED? i " N I A IMandatoryInNH) E.I. DISEASE - EA EMPLOYEE 5500,000 If yes, describe under DESCRIPTION OF OPERATIONS below El. DISEASE - POLICY LIMIT 5500, 000 DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required) VT, NH & MA Workers Compensation Laws apply. No officers are excluded. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. XXXXXXXXXXX XXXXXX XXXXXX XX XXXXX AUTHORIZED REPRESENTATIVE 44/74,...e © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents L =+ Office of Investigations = ..... $1 4:10 600 Washington Street ", Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information CO. ` V � Please Print Legibly Name ( Business /Organization /Individual): tt L 1 ,�,L 11k0 s'∎ VT n('. • i Jn CitI iCti3611 Address: (p MOYScun St-,ree+- City /State /Zip: 1 1 all VT Phone #: 701 -y # 35g5 Are you an employer? Check the appropriate box: Type of project (required): 1. g I am a employer with 1Jt� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub contractors 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 have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ['Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.111 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.111 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. ❑ 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. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T C `r ICS I Ingur YiCe. (0 rip n9 Policy # or Self -ins. Lic. #: NCgS — 1 L T I I g Expiration Date: 51 ( 201 I Job Site Address: 4 B a w d Place. City/State/Zip: NorielahiplOn , A 0 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. dvised that a copy of this statement may be forwarded to the Office of Investigations of th,. r r• for insur a coverage v 'fication. I do hereby cer' ' nder th pains d penalties p ury that the information provided above is tr and correct Signature: / Si , Date: g xx �a 4/ Phone 4 : . ' J E 5 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not App App9ble / Name of License Holder : , ■ '„f r � r License Number Address / Expiration Date Signature Telephone / ,a 9. Registered Home Improvement Contractor: Not Applicable ❑ lAYcc?/ DUJA/ /4 / 2 /.S^yy Company Name Registration Number ,CAYC-/2 L z 4 so / // CO or kfi 0C 2O - /2 Address Expiration Date • T ' ,L• S f ' 1// cc 0 /Telephone 8c0- 2S / 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 )Zl 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 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 Chaptcr 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 Windows Alteration(s) I I Roofing I Or Doors JEL Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding [O] Other [CI] Brief Description of Proposed Work: L/4ar- ; l,,) //v c,)S Alteration of existing bedroom Yes ie No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No 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. tloodplain 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 , 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 , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner /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 Ileight Bldg. Square Footage 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 CD DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW tt. YES 0 IF YES: enter Book Page and /or Document #' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Date Issued: C. Do any signs exist on the property? YES NO 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 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, xcavation, 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. 4 • City of Northampton Status of Permit: Department use only Building Department Curb Cut/Driveway Permit ..! 1ECEIVED 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability APR - 4 20H Northampton, MA 01060 Two Sets of Structural Plans pion • 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans i� mi nrn l Other Specify ONSTRUCT, 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 "7 ?,, / R E / 7DLh c Map Lot Unit IY RrHAMP`CAI, f-i,4 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: r o R -1 3A " .3A R 2E. Fr F2/4(-1_ 4 /0/77/ ff- 0>TO/4 til( Name (Print) Current Mailin Address: i ll ? - 582 - 4'8 Telephone Signature 2.2 Authorized Agent: STEL' 5% S rf, I- JIWCE.4) 1C2. 4' c`oN Ho26 A/ 5i: i�iLl1OWc I -7 VT' 61570/ Name (Pri Current Mailing Address: 8co -- 2 8/ - Signature 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 y,6/9 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) �/ 6 /? 11-47— Check Number .60 215 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 4 BARRETT PL a BP- 2011 -0792 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 087 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- 2011 -0792 Project # JS- 2011- 001306 Est. Cost: $4619.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JANCEWICZ & SON 99725 Lot Size(sq. ft.): 8668.44 Owner: BARWICK GEORGIA Zoning: URC(100)/ Applicant: JANCEWICZ & SON AT: 4 BARRETT PL Applicant Address: Phone: Insurance: 6 Morgan St (802) 463 -3585 Workers Compensation BELLOWS FALLSVT05101 ISSUED ON:4/5/2011 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 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 4/5/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner