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18D-067 40..... 1•1.1 RECEIVED 12/15/2010 1B:47 4137363962 MAJOR HOME IMPRS PAGE 12/15/2010 16:36 0604665079 05 illIll AIIIIIIIIIIIIIIIIIIII -•:',-',-:-.,1 lightfa ,_ ',::t•-7-•. r a iiUI UIIIlIIIIII : = 1111111111111111 ...... 111111111111111111111 ........ Pla:lv "': 1 :11114, 11 111111111111111111 ' mouniimil111111IIIMIIIMINEMI 11.11111111111111111111111. , ..... t Joim1111111111111r1 .".7. k tommailall III .... v 3 111 11111111111 ria 11101111111111 ., . '..- • 'k 1 g ; ' t: . . ,. . '. ..... k ' Ai I • 1 .. 0 • 41,11 k. iiiiiisi .:,-;....?. 16 4 ;% ill, III .15 1 ' Sill 2 nS i r. 1 ■ 4 -1 411110aSteV ': 474 -' .-- • 7.- i rosi110111111111.111 I if .;;;.:-'::--; • 1' 1 I 15 IIIIIN 01111 t. II 11 .:..... :„. 11! i t z. a . '. -: 0,1,MIEKG 4 , sil JP . 11111111111 A 0 I 111111 . , 1 4 • 1 J 11 ' 11011111111111111 ,.... i . dill. . . 9 3 - TT millEMIIIIIIIIIIII 10/10 2evd 5 3WOH aortow Z96E9ELE1 t EV:eT ZTOZ/OT/6A f k 0 00 0 00 0 0 0 0 2nd 1st 0 0 0 0 0 0 0 0 0 0 House Customer Signature Date Customer Signature Date 2 of 2 JOB NUMBER: 14366497 -0001 PROPOSAL DATE: 9/5/2012 WINDOW ORDER ADDENDUM 1 PROMO Window - DOUBLE HUNG PROMO 24 35 W X 48 H WHITE - -' LOWE /ARGON /CLEAR HALF SCREEN TOTALS: 24 COMMENT: 1 of 2 Job Number: NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. 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 TO 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 "I 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. NOTICE TO MASSACHUSETTS RESIDENTS ONLY 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.O. Box 871 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 customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ( "DOS ") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination 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 verifies 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 Mew-5 rrbrif.0.44) Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc. ( "Sears ") on by: I " Date Management Representative SW1 -MA (Dig.) Rev 02/09/12 Page 3 of 3 1111111111 111111 Job Number: APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately (Approximate Start Date) It will be substantially completed by approximately (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 will 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 $ Contract Price $ Initial Payment (not to exceed 30% of Total Price unless Special Order) $ State Sales Tax ( %) $ Final Payment (balance payable upon completion of job) $ Local Sales Tax ( %) $ The Initial Payment is due prior to Sears ordering products. Total Amount Due l$ The form and method by which the Customer(s) will pay is described in a separate Cash /Credit Customer(s) initials � Card Payment Addendum made a part of and incorporated into this contract by reference. NOTICE TO BUYER: YOU, THE BUYER, 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. ADDITIONAL PROVISIONS Proposal and Approval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and /or the attached sketches and specification sheets for the TOTAL PRICE shown. This 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 and 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' installation contractor(s) will obtain all building permits required by local law. For homes located in historic or landmark zoning districts, Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. 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 to 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. Delays in Installation. 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. Oral Agreements and Changes 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. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical & Plumbing Service. I will provide adequate electrical and /or plumbing service(s) to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(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. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information. 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 Sears' arranged installation proves faulty within (i) 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 1- 800 - 222 -5030, Option 4. This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. SW1 -MA (Dig.) Rev 02/09/12 Page 2 of 3 111111111111i III Office Location: Proposal Date IJob Number 0\\\O Sears Home Improvement Products, Inc. Customer Name P B ox 290 SearS 1024 .O. Flori52d2 a Central Parkway Customer's Home Phone Customer's Work Phone Home Improvement Products Longwood, FL 32750 -7579 Phone (800) 469 -4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number MA (148607) City State Zip Code Windows All plumbing and electrical services performed by Is installation within city limits? licensed subcontractors Installation Address County (Yes /No): FEIN 25- 1698591 Billing Address Of different from above) City State Zip Code Project Consultant Name & License No. (if applicable) Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed 1. Remove existing units to be replaced. (PLEASE NOTE: The removed units are likely to be damaged.) 2. 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 of all job - related debris upon completion of the job. 4. (If 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. ( "Sears ") will not re- install any affected security bars. 5. (If applicable) In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work, Sears will refund any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum (see detailed Window Order Addendum for more information): Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by Customer(s) initials eff reference. Additional work to be done: Work NOT to be done: SPECIAL INSTRUCTIONS: All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s) initials ,n "Special Instructions" sections have been reviewed and explained to me. SW1-MA (Dig.) Rev 02/09/12 Page 1 of 3 1024 Florida Central Parkway, Longwood, FL 32750 PH 407 -551 -6000 June 2011 LETTER OF AUTHORIZATION I, Alfred W. Nyman, Jr., Assistant Secretary and Connecticut State Qualifier for Sears Home Improvement Products, Inc., grant permissinn b Nikole Easley to submit permits and licenses, pick up permits and licenses, make changes to permits, licenses and plans and initial changes made by the building department on behalf of Sears Home Improvement Products, Inc. I also grant permission to Nikole Easley to purchase permits and /or licenses with a company - check, personal check, personal credit card or cask I certify that the above information mation is true and correct k .,,,, - Alfred W. Nyman, Jr., Assistant Secretary and Connecticut State Qualifier (HIC.0607669, HTG_233 -Si) Sears Home Improvement Products, Inc. STATE of Florida COUNTY of Seminole SWORN TO AND SUBSCRIBED BEFORE ME THIS 16th day of June 2011, by Alfred W. Nyman, Jr., Assistant Secretary for Sears Home Improvement Products, Inc. and who is X personally know to me or has produced a valid Drivers license. Seal: • )b.ii7OML i WINN PRtGSTATEt FPL MA Print Name: Deborah P. • .' r • s Deborah R Imps Notary Public, State of Florida #DD689011 1_ Commission # DD689052 l AUG 13, 201 rts+mr,a as ce, MY COMMISSION EXPIRES: Aug 13, 2011 '4 °� CERTIFICATE OF LIABILITY INSURANCE ) �` 012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 'nos 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to m` the terms and conditions of the policy, certain policies may require an codorsement A statement on this certificate does not confer rights to the w certificate holder in lieu of such endorsement(s). t Pnonuc t CONTACT Is NAme Aon Risk Services central , Inc. PHONE 066) I ) 283 - 7122 FAX (847) 953 -5390 m Chicago IL Office Na. E'dk Duc. Nok 'o 200 East Randolph " Chicago IL 60601 USA INSURH4S) AFFORDING COVERAGE NAIC * INSURED wsUftER A: ACE American Insurance Company 22667 sears Holdings Corporation riLT: Indemnity Insurance Co of North America 43575 dba Sears Home Improvement Products, Inc Attn: Ri sk Management E3 -219A mac: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER e INSURER F: COVERAGES CERT1FICATE NUMBER: 570047126648 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LINT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lllas shown are as requested MISR LL7R TYPE OF INSURANCE MR y POLICY PASSER 1 � �uW L O I 0 0 0 Y fyYY $ Y�1 F ( �1t� g P � OL � R p .Y � E y X �r P � A G9e3iALLIABe rrlf HD 08,/01/2012 08701/2013 eACH 0 UNITS $5,000,000 X COMMERCIAL GENERAL UAeHUTY DAMAGE l0 RENTED S5,000,000 PREMISES (Ea oalmence) — ClAILIS SADE © OCCUR - tIS1E0' (Any one person) Excluded — PERSONAL A ADV POURY $5,000,000 a i ' GBERAL AGGREGATE 55,000,000 w Geri AGGREGATE UMW APPLIES PEft PRODUCTS - COtE/OPAGO S5,000,000 ti o JECT A AUromoesELtoow( ' i _ ISAH08710132 08/0172012 08/01/2013 COWSHED SINGLE LAST $5,000,000 E A IsAH08710120 08/01/2012 08/01/2013 iga ANY Al ROILY INJURY (PerpeNon) Z AIM X ALL OWNED SCHEDULED BODILY NUURY(Par aodt re den AUTOS AUTOS a PROPERTY DAMAGE X HIRED AUTOS X (Per :redden* u 0 UMBRELLA r a LIAR OCCUR EACH OCC(1F ICE C) — EXCESSLrAB CLAIRSMADE AGGREGATE DEDI ON A 'WORKERS COMPENSATION AM) WLRC47123021 08 /01/2012 08/01/2013 x I TORY s I W- A EIWUNERS'LMBILRY y /N SCFC47123045 08/01/2012 08/01/2013 B ANY PROPRIETOR/ PARTNER riBECUME EL_ EACH ACCIDENT $2,000,000 oFFtC B tEft LUMMB © N/A wLRC47123033 08/01/201208/01J2013 (la m,yInNii) El. f .EA EMPLOYEE $2,000,000 t S RIPTION OF OPERATIONS helae E.L DEEJSE.POlIC1 LIMIT S2,000,000 — n DESCRIPTION OF OPERATIONS f LOCATIONS n.EHICLES (Mach AGGRO 107, Additional Rm:ta<Sched+er If mere space le required) At s >� CERTIFICATE HOLDER CANCELLATION la SHOULD ANY OF TIE ABOVE DESCRIBED POLICES BE CANcELLED BEFORE THE Zs' ,4 EXPIRATION DATE THEREOF, NOTICE Wei BE DELIVERED II ACCORDANCE IMTH THE s POLICY PROVISIONS Sears Home Improvement Products, Inc. ABHORRED REPRESENTATIVE j 1024 Florida Central Parkway A Longwood FL 32750 USA `�' e s � t�fHArL WS 01988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ..amminmem SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Y CLS i / ( + 21 "I L-ht CI) (0 30 License Number 1 r Address Expiration Date c1 s Q L 113 - (3 (. s - r - Signature �/ Telephone 9. Re. istered Ho - Im • rovement Contractor. Not Applicable ❑ Company Name < Registration Number S `'J G t - / G L /0(1i (►3 Address �GC�� f Ca �, r " Expira Date � /3 4.2 /�iic5:2) 4J / } Telephone ��Cn6 -Nt -�a -5660 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 Cv 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 Wind Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition El New Signs [0] Decks [q Siding [0] Other [0] Brief Description of Proposed ' , Work: 1' --�V 1(2_( Q Li L�yl_ (7 Alteration of existing bedroom Ye 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 . l. 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 j # L o`t, hl Q) I r2_ it l I , as Owner of the subject property / hereby authorize ,_____ C — QSj AJ J2f z i - 5 1.3) 2 ‘ to act on my behalf, in all matters relative to wor . u orized by this building permit application. S CL Q.. C' g'-71. 9/ l C� f /- Signature of Owner Date (( /V / h_c /t L eZ 5 j ,�, , as Owner /Authorized Agent hereby declare that the statements and infotion on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. h' , cc/ 6:, Shy Print Name /-, ) Signature of bwner/Agen{� Date t 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 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW A ES 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 ©/ 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 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavati , or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 13to(o 2/x:1-7 DFCFI' �. Department use only City of Northampton Status of Permit: : uilding Department Curb Cut/Driveway Permit b 1012 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT. OF BUILDING INSPECTIONS N rthampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON • to - 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 10 1) C C � r V Map Lot Unit /V& � f 1)4 f)-1-(-)P )Y)4 Zone Overlay District 0 1 6 (1 U Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: - r; �� {'J�. {y��t / C /Z /1 i S /0 r C /Le,' 1IF J 0-4 • Name (Print) J Current Mailing Address: S k i' ra( - (,; Telephone Signature 2.2 Authorized Agent: /v)/ f f 1 " = & )/2 L och ?eacit_ id(L-4 / 1 t / 73 Name nnt) Current Mailing Address: // Signature v Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /7.54 ) (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) '� (6 Check Number d,"/ This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 10 PINE BROOK CURVE BP- 2013 -0352 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D - 067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2013 -0352 Project # JS- 2013 - 000559 Est. Cost: $7595.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEARS HOME IMPROVEMENT PRODUCT 103054 Lot Size(sq. ft.): 15812.28 Owner: MAGINNIS PATRICIA M Zoning: URB(100)/ Applicant: SEARS HOME IMPROVEMENT PRODUCT AT: 10 PINE BROOK CURVE Applicant Address: Phone: Insurance: 51 BELAMOSE AVE (860) 620 -9036 O WC ROCKY HILLCT06067 ISSUED ON:9/26/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL 24 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 9/26/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner