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36-129 PREPARING FOR YOUR NEW WINDOWS AND DOORS Congratulations on your decision to increase the comfort level, value and appearance of your home. To maximize your investment and enable the installation to take place as smoothly as possible, we have created this handout to acquaint you with what to expect when our installers arrive. 1. Expected Delivery Time. All of our windows are custom made at one of our manufacturing plants located around the country and shipped to any of our over 200 Window World locations. The time between when your order is placed and when the windows are ready to be installed, though not guaranteed is typically 6 to 8 weeks. At that point we will call you to set an installation date. If for some reason you need to delay your installation for more than a couple of weeks after notification that we are ready to install your order we will be happy to work with you. We will need to collect the remaining balance before installation if the delay you request is more than three weeks. 2. Access to the Windows and Doors. We will need approximately 2 feet in front of each window, inside your home, so we can place our drop cloths and tools necessary to perform our work. When the old windows are removed, gusts of wind typically flow through your home. It is advisable to gather together important papers, and other small items that can be disturbed by the wind and relocate them. Computers and other electronic equipment should be covered or relocated temporarily. Please move aside any furnishings that are in the way of our work. If any furniture items are too heavy to move easily, we will gladly assist you. 3. Window Coverings. To gain access to the interior of the windows, we need all mini blinds, vertical blinds, roll -up shades, shutters, drapes and any other window covering removed prior to our installation. We are not responsible for removing or reinstallation of these items and are not responsible for damage resulting in the removal and reinstallation. We also are not responsible for any window covering alterations that may be required to reinstall them. 4. Plants and Bushes. Occasionally we need to work in planters and other landscaped areas of your home that are adjacent to the windows and doors. Please survey your yard prior to us arriving and look for potential problems. Some trees and vigorous bushes need to be pruned back to give us access to your windows. Delicate plants and shrubs in areas right below a window should be temporarily relocated if they cannot survive being stepped on and you want to preserve them. We strive to be careful when working around vegetation, but our priorities are to focus on our work, your windows and our safety while working on your property. We are not responsible for any damage to plants, shrubs or landscaped areas. 5. Arrival and Departure Times. We will advise you of the expected arrival time for our crew at the time we set up the installation date with you. We generally stay till the job is done, unless it will be a 2 or 3 -day job, in which case we may work as long as there is daylight. It is our policy that our installers get a sign -off form and collect the outstanding balance at the completion of the job. We ask that you be available to approve the job and make final payment at the time of completion. If this is not convenient for you, we need to know before we start the job. Inclement weather and other unforeseen hindrances are a fact of life and as such we ask that you understand if the weather, traffic, etc. cause a delay or cancellation of an installation appointment. We typically do not schedule more than a day or two in advance to try to avoid such issues. 6. Our Worksite. We like to set up our worksite as close to your windows and doors as possible and generally your driveway is the best spot. If using the driveway will block a garaged car, please be ready to pull it out upon arrival. 7. Alarm Systems. For those of you who have alarm systems, the alarm company should be notified and advised of our job. They will be responsible for the disconnection and reconnection of your alarm system. 8. Where do we start? Upon arrival, the crew leader will survey the job and determine where to begin. If you have a preference. feel free to advise us and we will accommodate to the best of our ability. Because we work in stages (i.e., removal of old windows, setting the new window, wrapping of exterior, etc.), we don't complete the job one window at a time. The job moves along in a rolling progression where each operation is done on all windows at the same time. This produces a quality job. 9. If the job takes more than a day, will there be any openings in my house? Of course not. We only remove that which can be reinstalled in the same day. Although there may not be a complete window, it will be weather -tight and secure for overnight. (Please no critiquing at this time). 10. Pets. We love furry, four - legged creatures; however, we need your help in supervising them. We are not always able to close a gate or door behind us when carrying a window, so please keep them in a safe place. Our job description does not include scampering down the street after Fido with new found freedom. Many people say, don't worry, he doesn't bite, but many installers have been bitten. So please secure dogs that have an aggressive bark towards strangers. 11. Expect some dust, noise and general disruption of your living space. Construction work can sometimes be messy depending upon the scope of your job. It's an unfortunate reality of remodeling, but we do our best to keep things under control. We appreciate your patience and understanding during the job and until everything is finished. Even after we have cleaned up, it is advisable to survey the areas for something we may have overlooked (i.e., kids rooms, baby's room). 12. *Damage to walls and old trim stops. For those of you who have old aluminum and steel windows and are replacing them due to sweating and damaging of the walls be advised that all water damage plaster will most likely fall out. In addition, all the patch work you have done over the years will fall out also. This is normal; however, we are not plaster experts, so the repair to those walls would best be left to the experts. In some cases due to out of square openings, new trim is required to make the window look good. *Unless noted on the contract new trim will not be provided or installed by us. You can expect to do some touch up painting on the trim after the installation of your new windows. This is not always necessary and is usually minor if it occurs. If your trim stops around your sashes are very old, dry, and brittle, they may snap and crack upon removal. If this happens, we can leave them off if you please, or for a small up charge, replace them with newer ones. Many of the old style stops are no longer available so we would replace the entire window with newer style stops. Should we discover any hidden damage to the frame or wall area we will advise you before we proceed. Should you decide to replace or repair anything, the price will be added to your balance. 13. Relax and enjoy the show. After we've been introduced to your home, feel free to run errands, take a walk, or just relax. If a question should arise; by all means ask the crew leader for clarification. We enjoy people who are interested in what we do, and most customers are intrigued with the process. We do get nervous, however, when a customer constantly hovers over our shoulder. Like any professional, we're always happy to answer questions, but we appreciate being able to concentrate on our work without interruptions and distractions. This ensures a safe and quality installation. 14. Past Due Balances are subject to a service charge of 1.5% per month. In the event that this amount is placed in the hands of an attorney for collection, the purchaser agrees to pay all costs of collection, including a reasonable attorney fee. Return check fee is $50 (fifty dollars). Salesperson Home Owner P.S. Now would be a good time to review contract with the salesman to be sure of your order options and work to be done. Only the items and services on the contract will be done. If you have any questions whatsoever, now is the time to ask. National WC 3 -10 - M Window World of Western Massachusetts MA HIC Reg. # i_ at l� - 351 Walnut Street Extension • Agawam, MA 01001 165641 j r Q4 /4 Phone (413) 786 -9900 • Fax (815) 366 -8039 Construction Supervisors www .windowworldofspringfield.com License # 57011 "Simply the Best for Less"' c Customer: i ; 4," , r'' /) - fr /'r j Phone (h) Install Address: d - . „. R Phone (w) Bill Address: ' E -mail WINDOW WORLD GLASS OPTIONS 1000 Series DH Mech $180 j Stimulus Energy Package* $79 ` / / 2000 Series DH Mech - Weld $189 Includes Solarzone ETC Package }4000 Series DH All -Weld $200 Solarzone Glass $45 6000 Series DH All -Weld $235 ' Argon Gas $15 2 Lite Slider $3297 Triple Glazed TG2 ** (Argon Filled) $155 2 Lite Slider Swing & Clean w _ $389 Triple Glazed TK2 ** (Krypton Filled) $196 3 Lite Slider (1/3,1/3,1/3) (1/4,1/2,1/4) $520 ( *Series 4000 & 6000 Only - Qualifies for Federal Tax Credit) 3 Lite Slider Swing & Clean (1/3,1/3,1/3) (1/4, 1/2, 1/4) $595 (* *Series 6000 Only - Qualifies for Federal Tax Credit) Picture / Fixed Lite $329 WINDOW OPTIONS Awning $255 1/2 Screens INCLUDED Casement $285 Foam Insulation on Jambs and Head INCLUDED 2 Lite Casement $570 Double Strength Glass (4000 & 6000 Only) INCLUDED 3 Lite Casement (1/3, 1/3, 1 /3) (1/4,1/2,1/4) $855 Double Locks (> 26 ") INCLUDED Basement Hopper $200 Full Screens $22 Bay Window $ Colonial Grids (Contoured /Flat) $38 Bow Window $ Prairie Grids $44 Garden Window $ Diamond Grids $69 Specialty Window $ Simulated Divided Lite $182 Beige $35 Tempered DH Sash (BSO) (TSO) $65 Wood Grain Interior (Series 4000 / 6000 only) $95 Obscure Glass (BSO) (TSO) $35 (Light Oak/ Dark Oak/ Cherry/ White / Fox Wood) Oriel Style (40/60 or 60/40) $30 Brown Exterior (Series 6000 Only) $95 - Foam Enhanced Frame (Series 6000 Only) $25 Window Color / PRE 1978 BUILT HOMES (Federal Lead Containment Law) Inside Outside ` W Custom Premium Exterior Trim $50 DOORS _ ` ! Without Custom Premium Exterior Trim $70 Vinyl Rolling Patio Door 6ft. $895 MY HOME WAS BUILT IN THE YEAR Initial Vinyl Rolling Patio Door 8ft. $995 MISCELLANEOUS Vinyl Rolling Patio Door 9ft. $1095 ` Custom Exterior Trim $60`' Includes Exterior Vinyl Trim i Facing Color �' `- Facing Color Specialty Window Exterior Trim $ Specialty Door Facing Color Grids Patio Door $100 MuII to Form Multi Unit $30 Solarzone Glass for Patio Door $125 Install Interior Stops $45 Solarzone Elite Glass for Patio Door* $168 Install Interior Casing $45 ( *Qualifies for Federal Tax Credit) Repair Sill or Jamb $50 $ Mullion Removal $30 $ Remove Storm Window $15 Storm Door $ Remove and Install A/C $100 - Door Color / WINDOW WORLD CARES ..- Inside Outside I St. Judes Children's Research Hospital $ j., '; t ' -' ' I DISCLAIMER: The information herein related to the Federal Stimulus Package is for informational purposes ONLY. This information is not intended to be legal or tax advice. You should contact your accountant or other tax professional for advice related to specific tax benefits of purchasing energy efficient windows. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: Extra Labor $ t > ..; Site Set -Up Fee $ "S2049:41(1 / .. - T Amount $ "1 w7 ~,:, * ;s ' Xx " Custom Order Deposit 50% $ rt , n , ,€ , " Ck# / , i +.l' Balance Paid to Installer upon Completion $ 1 ' f.% r Amount Financed $ WW of W. Massachusetts anticipates starting this work on , and being substantially completed in days. Security Interest: Yes No Any deposit required in advance of the start of the work SHALL NOT exceed 33 1/3% of the total contract price or the actual cost of any material 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_s chedule. No final payment shall be demanded until the contract is completed to the satisfaction on 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(S) will not be entitled to make a claim ort" collection from the guaranty fund established by chapter 142A, M.G.L. You the buyer may cancel thislransaction at'anyiime prior to midnight of the third business day- Her the i of this -transaction. Notice of canceT(ation must be 1n`writing postmarked no later than midnight of the fol ing third business day: THIS IS A CUSTOM ORDER NOT FOR RESALE! -- � , , ,v j' l -r f ;. _ T Owner Date . -- { Salesman Date Owner Date Agawam WC 3 -10 White Copy - Original Yellow Copy - File Pink Copy - Customer The Commonwealth of Massachusetts = �; Department of Industrial Accidents == chic M Office of Investigations w r 600 Washington Street ��'-'-- . Boston, MA 02111 .:�itve www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): J j ' V I CA (A; (Ai 0 x., t. 0 6 Sit C , I/l u S C' He J 4', Address: 3 5 i w ct I k ,/f S 1- j A -1-, City /State /Zip: A a I,. i c`- ` i /1/ f}- O / a b i Phone #: «I 3 - 7, ( .. q 7 o v Are you an employer? Chtik the appropriate box: Type of project r 4. am a contractor and I YPe P J (required): 1. ❑ I am a employer with ❑ I general 6. ❑ New construction employees (full and/or part- time).* have hired the sub- contractors 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 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 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'- _ __ ___ -- -- _ - - - -- - - -- comp. insurance required.] 1.i; ra. *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contactors 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 haw employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employee& 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 $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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov e verification. I do hereby certi under th p ' penal ' ofperjury that the information provided above is true and correct »Jgnature: a �, f�5 / Date: TA//e) Phone #: '/ /3 - ` ?? - ` v ' c) r ` 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 #: 2e eammtan acoluadea �� R �� Office of Consumer Affairs & Business Regulation i HOME IMPROVEMENT CONTRACTOR V Registration 165641 Expirationt 3/15/2012 Tr# 294588 Types Private Corporation WINDOW WORLD OF WESTERN MASS INC ROBERT BUSHE JR 351 WALNUT STREET EXT AGAWAM, MA 01001 Undersecretary Massachusetts - Department of Public Safeth Board of Building Regulations and Standards Construction Supervisor License License: CS 57011 Restricted to 00 ROBERT E BUSHEY JR 127 ROOSEVELT AVE FEEDING HILLS, MA 01030 >. �i --�- -�- Expiration: 6/28/2011 ( o anmisiuner Tr#: 1339 CERTIFICATE OF LIABILITY INSURANCE DATE 'INN01 ) 05/20/2010 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 SUBRO PATON i 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 Neu of such endorsement(s). PROOUCER smite Laurence R. Forrest Forrest Insurance Agency a r 413 858 2680 f =m013 958 2685 603 North Main. Street EMAIL - ACORES& East Longmeadow, Mass. 01028 PRODUCER - Cusraretmx S) AFFORDING COVERAGE ROCS INSURED easunstaArbella Protection Insuran .ce Cody Window World Of Western Massachusetts, Inc_ nouHERsLiberty Mutual Insurance Company 351 Walnut Street Extension INSURER C: Agawam, Mass. 01001 INSURED: INSTILLER E: =SURER F: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE) NAMED ABOVE FOR THE POUCY 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 POLICES. UNITS SHOWN MAY HAVE BEEN REDUCE) BY PAID CLAIMS. INSR 1 AWI. SUNK POLICY BF - POLICY EXP ' LlR TYPE QFINSURANCE BFait wVD POLR.YMRBER (Lrlm yYYY) (If OI5YYYY) I UNITS A MINERAL Lu 7500046889 04/09/2010 04/09 /20111 EAcH OOCL s1,000,000 IC COMMERCIAL GENERAL LIABILITY 4 (Eam a ece> s- 100,000 CLAIMS-MADE Jx j OCCUR UanEW (Any weppm* $ 5,000 PERSONALSADVRUU(RY 1,000,000 GeMERALAXMW6AM S 2 ' 00( 4 000 `GEtil AT;GREGNTE LM51A PLEB PEft PROalcm- COM9oPAGG 5 2,000,000 - t POLICY - - I- . i LOC _ - $ AUTOMOBILEUAEUJTY - - - COMBINED WHOLE LINT S- • • (Ea aceiled) ANY AUTO BODILY INJURY (Per pews) _ ALL OWNED AUTOS BOOLY INJURY (Per=Ma $ SCHEDULED AUTOS PROPERTY DAMAGE s FIRED AUTOS EPwartidet4 NON -OWNED AUTOS - 5 • • s UMBRELLA LAB OCCUR EACH OCCURRENCE s EXCESS LAS CLAIMS-MOE AGGREGATE - 5 oEDUCTIME 5 RETENTION 5 s 8 WORMERS COMPENSATION - WC3372193 05/07/201005/07 /2011 [ wcsranl- i ronT" TTNtY. tlLRTS ! AND EMPLOYERS' LIABILITY_ Y! M c ANY P sOR/PART E7cEcmvE ( I NIA Et EACH cmevr s 100,000 ( ( DOS t 1 El. `SE- EA EMPIXIYEE s 100,000 describe D E OPERATlOB EJ_O1SEASE- POLICY uurr s 500,000 DESCrnPITON OF OPERATIONS / LOCATIONS! VBIICL.ES (Mach ACORDIOL,Addidowl Tunic Scheduler, limn: VIM Ls,apdeetq CERTIFICATE HOLDER CANCELLATION Window World Of Western Massachusetts, Inc_ SHOULD ANY OF THE ABOVE DEE srR1R p0UctES BE CAIICUIID BEFORE 351 Walnut Street Ektension THE EXPEA710B" DATE" THE NDTICE WNl LIE DELIVERED ED - N • ACCORDANCE WITH THE POLICY PROvISiQNS Agawam, Mass. 0100.1 -.: -, __ AUTNORIOR( fTATWE E. 9-#,,,..;1 - - __ _ ®9988 -2009 ACORD CORPORATION. AN rights reserved. ACORD 25 (2009!09) The ACORD name and logo are registered marks of ACORD • SECTION 8 - CONSTRUCTION SERVICES ti /8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : /'t L iti' h f 7 License Number J 7 (cUse - ) f Ave 51- x11 Address Expiration Date r ,11,1 ffi/ /5 // /0 (1931) / �/�5ign. ur /Telephone 6,,/ �/ '� c t / n F 4 :.r Regis eyed Home Impro e�ment Contractor: Not Applicable ❑ i?c',bc r t 13 a A t j / 6 5 k?' l Company Name Y Registration Number 14I /061 cL (4,1e/ / p o-F / ce toll /'l his /nL, 3 / 1,5 / Address Expiration Date / J5 U ✓� (A;/+ Sl - 6x•+ Telephone L i13 - 1 S4 • 1c10(D 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 ❑ 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 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 Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding [0] Other [0] /Brief Description of Proposed o / /Brief 1 f - cj �a Ceii7 €4f ' / nog°6,, S °1 - l O II Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 stones? 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 1, , 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 1, Ro 6ei -- f E ,bus Fry , 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. a ��" /JV.t_ /1 P{r P nt e 76- � / _ tG L ), 7 is Signature of OwnenAgent Date ti Section 4. ZONING Alt 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. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O 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 O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit SEi P - 8 20n 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -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 .1 Property Address: This section to be completed by office B FI j , , , �'� C C. i ✓ Map Lot Unit N 'y iDii Cj Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of ord: /J Name (Prix( r / / � � Current Mailing Address: Telephone Signature 2.2 Authorized Apent: / / 0 b Cr . S „s ii 3 6 1 t.J.: i i1 v i Sr e„k+ Ai e Nap Print / Current Mailing Address: � .. t / r ; '-i'3 - 7S'c '1 `i 0L. • ignat a re Telephone SECTION 3 - ESTIMATED CONS/RUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant _ /1. Building kL 3.7b,Q . a© (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 /19 y - 1 36 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /inspector of Buildings Date t ": i BP-2011-0205 GIS #: COMMONWEALTH OF MASSACHUSETTS 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- 2011 -0205 Project # JS- 2011- 000360 Est. Cost: $3780.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT E BUSHEY JR 57011 Lot Size(sq. ft.): 22172.04 Owner: ANDRULIS TINA Zoning: URA(100)/ Applicant: ROBERT E BUSHEY JR AT: 287 BROOKSIDE CIR Applicant Address: Phone: Insurance: 351 WALNUT ST EXT (413) 786 -9906 WC AGAWAMMA01001 ISSUED ON:9/8/2010 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 9/8/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner