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32A-080 ooi L / / zet77 i 1:34 6604665079 PAGE 03/03 Hint O iMM iIf AR 1TIONAL PADViMNS Proposal And Aggitmet. Sears offers to furnish the materials and arrange for their delivery end installation as specified on the first page and /or the attached sketches and specification sheets for the TOTAL- PRICE shown. Thls offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale, it must be approved by the Credit Sales Department. If this proposal Is not approved or the installation cannot be made In accordance with the law, this offer will be withdrawn and any payments you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property end will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the Installation. Sears is not responsible for materials or Installation NOT furnished or arranged by Sears. Sears agrees to procure all permits required by local law. Aliirmaraflon. I authorize Sears to: (1) arrange for a contractor (licensed where required by law) to make the installation of materials; (2) issue a work order for this Installation t0 a contractor; (3) Inspect the Installation: and (4) pay the contractor when the installation Is complete if I have signed a certificate that the installation has been completed to my satisfaction. • PAM Itallatlon- I agree that Sears is not responsible for delays in delivery or installation due to weather, fire, strikes, war, government regulations or any causes beyond Sears' control. Ara! Agreement* Ali* Quinn, In Contract. I understand that there are no oral agreements between Sears and me. Everything I expect Sears to do has been Included In writing in this contract_ Nothing can be changed In this contract unless It is in writing on a separate form accepted by me and Sears. ,aF,tbWly pi Dm x. I agree that any information or measurements that 1 give to Sears are correct and complete. t am responsible for any special work described In this contract. Electrical A Piumbina Service. I will provide adequate•electricaf and /or plumbing• servlce(s) to run any newly Installed appliances or other furnishings. If the electrical and/or plumbing servlce(s) do not meet the standards of the utility company or electrical and/or plumbing codes. I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment. !will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warri.nty Iptmtmatiog. Appropriate product warranty documents will be given to me by Sears. Sears' Warranty on Installation Is • SEARS' LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s) used (which warranty becomes effective the date the merchandise is Installed), If the workmanship (or application) of any Soars' arranged installation proves faulty within (1) one year for Weatherbeater Value Line, (ii) two years for Weatherbeater Plus, or (iii) three years for Weatherbeater Max. and Weatherbeater Stormbeater, then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. if Sears determines that repair Is not commercially practicable or cannot be timely made, then, at Sears' sole discretion, Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1400 -222 -5030, Ootlon 4. This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. NOTICE TO BUYER 1. 130 NDT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT DE THE AVAILABLE INFORMATION ARE LEFT BLANK. - 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN 1T. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME AND IN SO DOING YOU SHALL BE ENTITLED TD A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THiS TRANSACTION AT ANY TiME PRiOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN • ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THiS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THiS PAGE AS NOTIFICATION BY WRITING "1 HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. IIGTiCE TO MASSACHUSETTS RESIDENTS OMJ,X In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration . P.D. Box 071 • Taunton, MA 02780 -0871 Telephone; (508) 821 -9375 • Please note that owners who secure their own construction- related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos- containing material is known or ` likely to be present in that heating or air conditioning system, or any portion thereof. If it is determined or reasonably suspected that asbestos is present. either before commencement or during performance of the work, it shall be the cus- tomer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ( "DOS ") licensed Asbestos Contractor to remove ail asbestos or verify that none Is present in the components involved in the job. If the determina- tion or reasonable suspicion of the presence of asbestos arises after Sears has started the work. Sears will immediately cease.performing the work until a DOS licensed Asbestos Contractor. hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or veri- fies that none is present. By signing the contract the customer agrees that It understands the. above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES • Customers signature ate / customer's mil . Date A by Sears Horne improvement Products. Inc. ( "Sears ") on l*// d? by: '7 l j-� D agament Representative IOU/ Z I / LntJ i 1 L: de{ 1:ibE74bbtd r3 h'0 t Z/ C1.7 1111111111111 ID rowel oats 1 titi9 f Job C{QO;3 T Seats Home Improvement Products, Inc, ustomer Name P.0. Box 522290 '"fine Phone 7)(0 IQ --, 10Z4 Florida Central Parkway Alri ustomer6 Nome Phone Customers wails Phone 2c". -SS'S _ )1 2.:Z. Home Improvement Products Longwood, FL 32752.2290 Phone (800) 409 -4683 treat Aderes" ESTIMATE AND PROPOSAL Contractor License /Registration Number 3a g,s a "'`" Windows HiC 01486O7; all plumbing and electrical :Iry S tate Zip Code services performed by licensed subcontractors Trot w,4 MA 04.60 ( I5 installation within city limits? FEIN 25- 1098591 nstallation Address County J Q Yes 0 No tilling Aaerob5 (n different from above) Cny �'- Stale Zip Code Prolect Consultant Na 6 License No. (If appifcable) S r o 9 2.0 RS4 sc Deription 01 file Pmjoet end Description of the SlpnIfiCant Materials to be Used a nd rip M to e Instilled I. Remove existing units to be replaced. (PLEASE NOTE: The removed units are likely to be damaged.) t. Prepare openings as necessary to receive replacement units. (No finish work other than normal Installation is to be done unless otherwise noted below,) 3. Installation includes the clean up ot all job- related debris upon completion of the job. 4. Install Sears Weatherbeater , 4 eg,4 -..__C , Windows in the openings described below according to the following specifications: COLOR: 0 White 0 Tan 0 Clay 0 White/Ught Woodgrain Interior 0 White/Dark Woodgrain interior TYPE: 'DH Qty_ 0 PW Qty 0 Casement Qty Type 0 SH Qty 0 PD Qty 0 Bay 0 1 -LR Qty 0 Garden Door Qty 0 Bow: 0 3 lite 0 4 lite 0 5 lite 0 2 -LR Qty 0 Garden Window 1:13-L9 Qty 0 Other Qty GLASS: 0 Tempered' Qty. 0 OBS Half Oty. SCREENS: Check if other than FIBERGLASS 'PLEASE NOTE: Tempered glass will be installed to ❑ OBS Full Qty. (on sashes only) 0 Aluminum meet building codes. 0 Laminated Oty. GRIDS: Type Color Placement Existing units NOT to be replaced. 0 Yes C' 1 Col Flat 0 White • • 1j Woodgrain 0 Top ant t3 eat IS No 0 Col Sculp/Contour 0 Tan 0 Full 0 Other (Specify:) 0 Brass 0 Bottom 0 Clay _ 0 Hankers Only _ 5. (11 applicable) After the completion of the project. the customer will be responsible for the application and removal (storage) of shutter panels. in the event that the project requires the Installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ( will not re- Install any affected security bars - s. (If applicable) in the event Sears Is unable for whatever reason to obtain the proper permits prior to the commencement of any work. Soars will refund any previous payment and this contract will be automatically cancelled. Additional work to be done: _ th , work NOT to be done: _ , - _ _ - - . s - _ _ SPECIAL INSTRUCTIONS' NO rJ d W lo ws. I - C a fie Cr e..rv. Gvfo.a. All of the above check boxes and the "Work NOT to be done section have been reviewed and explained to me. Customer(s) Initials /C APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 4 2- 3_,4*,,il_ (flupproxlmate Start Date) and will be substantially completed by approximately j Z_„ s (Approximate Completion Date). These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, inc. ( "Sears") or at any other time by mutual written agreement. Customer understands that the Approximate Start Date Is only an estimated date and the Customer wilt be contacted prior to this date to schedule the actual start date, The TOTAL PRICE including all labor. material, taxes and any applicable discount is $ 0.07 •° 1 — Contract Price $ b5 Initial Payment (riot to exceed 30% ot Total Price unless Special Order) $ `2) . °• State Sales Tax (.____°/0) $ � /q _ t Final Payment (balance payable upon completion 01 job) 5'/z sa •°° Local Sales Tax ( %) , The initial Payment is due prior to Sears ordering products. , Total Amount Duel $ j y?S, ' The form and method Dy which the Customer(s) will pay is described in a separate Cash/Credit Card Payment Addendum made a part of are Incorporated Into this contract by reference. - _ _ Customer(s) {nit NOTICE TD BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT CIF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY iN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER) AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I Additional provisions Of this contract are stated on the pages tolIowing. Customer(s) inittalsi - 5W I•MA Rev O4OG .._ - -++ DDU bDt7ry P14(± l71 / Ell Sears Home Improvement Products 51 Belarnose Ave. Rocky Hi {I, CT. 06067 S60- 466.5065 MC ;{ 607669 Building Permit Request Form Date of request: X13 Projected Start Date: ASAP Date Needed: ASAP JOB INPOR)•!IATIC)N: 1 - -. Ir�'�G` Job #_ ` 382243 Cost of job: (D V .- 5 6 1 Cr Lc° Customer Name: Rail eel � r Ke-c1C i Address of work: r 32_ 1 E� c S _o . , Town/City /State: Ain(- 41)a i 4 -c A HA docoD '� `,�'� Cust. Phone #: _ o . 3 - S S k- 22 11 SIDING WINDOWS ENTRY DOORS _ GA..8AGE DOORS Product Brand Name: ().)i /1 t (CA- _ Square feet of siding: _ Thickness of siding: . Number of windows, entry doors, garage doors being replaced: 2-0 _ Egress window Size: 32% lc" D(Q_ What rooms are windows being installed in: KITCHEN REMODELING . New Countertops _ New Cabinets _ Other Extra permits needed for: Electrical Plumbing • Other Description of work:_ We hereby authorize Ntkulc Easley and its employees and agents' for Nikule Easley to apply for and procure building permits for our company's untlractcd work and we also authorize Nikole Easley to present this loner or a photocopy hereof to any building official in order to de ,mItstra1c its authority to apply for and pmcurc sttth permits on Pitt bclttilr in furtherance of this authorization we attach copies plow ur current contractors licenses for the several States in which we anticipate Niltolc Easley will he requested to apply for and procure such permits for us. We represent that we arc familiar with the applications for building permits and related documents in the various locations in which Nikuie Easley will he requested to submit applications on our bchalF. Nil:nle Easley is expressly ati thorized to sigt applications on our hthalf , Nikole Easley or tier employees and agent shitil he deemed to be the signer of any such applications a documents. We further ugr to hold Nikole Easley and her employees and agents harmless for anti indemnify them against and claims and crests (including at ney fees) arising from their activities eontcmpinied hereunder iis. JAI" N ame of Authorizing AgentSe titre P _ Dace Ci trA9/5-2,2 08/85/2009 12:.21 8684665079 PAGE 02/02 x/85/2889 12:84 4877678536 SHIP PERMIT88L.ICEN5E PAGE 01/01 ..km. CEi TEFICATE OF LLABJUTY 1NSVRANCE r ,x ° Ri sic forvices Central. xne. US CIi*PIficAn JS > A7) A MAT 431F �VMORMA flC ONLY Chia. Zt. o? ` cee A}�1� C0111 I4Q 11178 P x= 1i1CAll MM. � 17U6 CLIMIF2CATI DO= NM MOM EtTPIDInt AUER 17111 Chioil SL WW1 U SA nenggPOidC=BELON _ : , - -, :J �. t tync- e . - AFIO ill llE NNW, . MOW MiZAIRl4 ALE Ader1 Con 21I1IuPSece ce 22,167 Salts ibldings corporation mum a Un itr sersnee co of TWA Awl= 4 35 7 S a dba sears Home a impprovaorat Products. me _ . e 3333 Beverly oid t £3 -229A ^ +tlaa� es —_ �3 WPM Wafts sc 60179 me WNW Os MAIM lk al .. _ „n. S ap�f�es aer terms and conditions of the viols .4 r , - t eemo i allenlysuwtvs eeltRIZ►x meayel eA100�m a nTe3 ivem AriAl o orraseuem 7.1110wC clelerrIOlIORA17707e1 uerotaMBROOCW40470171 R9CCTteane0C1F16C11111 n ze4471STSSURDOn MAY lailtrAKTeavexatieCe O =WfCAEPOI=011SOMM suirecrto Au.U1511011, RID GD1rAR1ON$CF06:01'0 . AGGAIGATBUIAMI M WVATRAVientW1W1UQlO IMIX tli/18 IL ukars swim MU AS ::.1 - ' • r AO • ald3/2°IO $5.000,000 DAMAGETostonco O qq ILA N 794 r. ''nn ,.�, A A AVIONONLI my Auro UAM: aseeettteeenr MOLY IMAM permoduil MI 2 4m mix •Ile wawa MI 111 MI ■ ;II 1110105575501 01/0 01~010 gammee $5,000, ii OTARTNAN CA ACE ay 11111 OCCUR , 0 mammas I am eesesent 11111111111 weemseacemlenlemon me AMIPLOYZAPILIAIIIIM A I CA I 5701220 0 °:/osls°° ° ; 92. 21111~A satevea •••mow- 45701307 06/01/2009 X102/5013 ,, ,, 11 adKr Sates 1 i ll ti e II dYlrot ....... CANcE LL01019 P feQYttS. 11116 Mfr 7010 #MQ1f6!>�1147ti01t :C M lltLttlRJeR i.7Neuer. - • F ida = �rM11f�Y p0lw+rtO ews wig/1W Fl. 1 750 USA vwaw ° n � u�ii via Avila evreuelemeensannanriv ,.sae. MeleSremAve , . la ACd i 39 t�NlPI1) ..,.1,,............. 1 AC0107 C 00,00A710. MI v0 re0 The AcoRDWMvi e11415 WC reittorell Wage 01 f A Received on 8/5/2009 12:04:20 PM 12/3.2/2888 18:53 8684665879 • • • as Ma:nr:.chu%ctts - Di partmrnt nt Public .afcts Board of Building Rcgulati.ins and Sttndardr Construction Supervisor Specialty License License: CS SL 100311 • Restricted to: WS - VASILE KUKHERCHUx . ' 42 COOPER STREET • WEST SPRINGFIELD, MA 0108 Expiration; 8124/1011 c TrO: 100311 �i � 3C7 3 7Z. • • • 12/08/2008 16:31 4077678536 SHIP PERMITS& ICENSE rmuc r.P.I.ew.• • . ' . • • t . • • ' . • ' • . • • . • . • . • SSO, gite €20,1rfieitA / t./ifeg6iae d ig4ea Boar 1 o ff tu m r g e r 4 ns an One Ashburton Place - Room 1301 --, - - -- i\..... Boston. Mas - husetts 02108 Home lmprovem - v't • i tractor Registration ...... Registration: 148607 3 Type: Pubic Coreeration , ,... t" ',---,— . Expirations: 10/1112009 Tsis 259662 ,. SEARS HOME IMPROVEMENT ,I • . : 7 :Tal l t - -- - - - --: ' ALFRED NYMAN JR. ., =------44.-- 1.--._ .., - ..-.:;- . .----- -.. 1024 FLORIDA CENTRAL PKWY1!: - - - - - ______n : -------:'---- t LONGWOOD, FL 32750 IAf = ..7 Update Address sad retests card. Mark meson der change. 0 Address 0 Reeewal 0 Impleyronst 0 Lost Cud OPSCA1 0 501A-07I07-P03490 . OPIMFOOMMIahli Boars O gaden Reps and Stosdards Lamm er negistraties valid fer ladividel use only • ' mi ' HOME Malta/BENT CONTRACTOR before the expiratioa data Wood renew t�: A i r ReaiStre0104861:17 Beard of Building Regulations sad Standards „A ., One kabalism Men Ras 1301 WOW Ti. 250662 Rastas, Ms. Meg P' ---- - Corson:sew ; 1 •'' 1 .s.,,i --.'=- ..,: SEARS HOME 1 - - ,= - 3'1 , a , -7 Flowers INC. ALFRED NYMAN „*•aviti '' 1 1024 FLORIDA 'I:" -- 4 ' ' CP■40. LONGWOOD. R.327 --)- - *Owlet:ender Not vafid signature . . • , , ... . . _ E r ..... , E- I ON E INIPMOVIENIENT PRODUCT'S 1024 . rFLORIDA t PARKWAY, LONGWOOD, FL 32750 P11: 407 -551 -6000 CT. SEC # 607669 08/29/06 To whom it may concern: we hereby authorize Nikole Easley to obtain bin Iding permits on behalf of Sears Home Improvement Products Inc. Sincerely, A ifredW. Nyman. Jr. Ass't Secretary Coniiectic tt Home Improvement Contractor Director of Limning and Permits Sears Route Improvement Products SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : V a .l 1 Q _ 1' v•-k- 1 ? `- 6 t t 0,2 3 I' License Number ��� o21P a k,D. S pn rid ICI 1V1 of 04-' a'`ril l - Address Expiration Date SC( iiCQ -rtCOJ 1 /3 - (v 3u , S3 Signature Telephone 9. Re q �,gtered Home Improvement Contractor: Not Applicable ❑ __ `- 1 . NCO tS\-,--- 4nnpc> --z-- fry? ,i -ic )1 Company Name Registration Num er / ca /6_ itiz c D 11 a Cbq Address j oc_z , 1/ (, 6 , - Expiration a�e ., / Telephone 1'Coo </,1 -30 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 - e C ` ' L t' �c /` SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition [] Replacement Win Alteration(s) n Roofing J Or Doors Accessory Bldg. ❑ Demolition El New Signs [0] Decks [D Siding [p] Other [CO Brief Descript n of Proposed Work: tio ,D G)//z(1o..,aS• v' ;' / k �(a 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 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, £ ci/1 ('71 tL k a- /Q. K, u- /k , as Owner of the subject property // hereby authorize SW-1S `� (in a...) f Pvvvcn2 --+2. 6 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, \ /fro / t J � , 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. Ar/k cL. ��st Print Name L 74- 09 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 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 O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW YES 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 ® NO 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 a 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 © NO 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 212 Main Street Sewer/Septic Availability 212 100 Water/Well Availability Sort pton, MA 01060 Two Sets of Structural Plans phone, 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 1.1 Property Address: This section to be completed by office tom'+ a ves Map Lot Unit Ae 0 r i a 4 U lobo Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: eL jm bwld_ r 14 (,-ra. ve s Name (Pri ) Current Mailin Address: �D�i -�.S SQ&.. Telephone Signature 2.2 Authorized Agent: e a c /C) r4 k PI - -syil &a 0 66<-1-79 Name (Print) Current Mailing Address: C1Q41"(--' "49G-62-C/-4=7036. 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 c@ ln, U`7S 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 3 6. Total = (1 + 2 + 3 + 4 + 5) (yC.) ri x Check Number /b65 /5N7 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date r � AVgj BP- 2010 -0289 GS #: COMMONWEALTH OF MASSACHUSETTS "i 32A 080 ' 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 -0289 Project # JS- 2010- 000374 Est. Cost: $6075.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEARS HOME IMPROVEMENT PRODUCT 100311 Lot Size(sq. ft): 5880.60 Owner: KARAKULA RAYMOND J & JANE ANN Zoning: URC(100)/ Applicant: SEARS HOME IMPROVEMENT PRODUCT AT: 32 GRAVES AVE Applicant Address: Phone: Insurance: 51 BELAMOSE AVE (860) 466 -5065 WC ROCKY HILLCT06067 ISSUED ON:9/15/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL 20 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 9/15/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo