38B-018 pOD ,4 �� r , " TM �i Window World of Western Massachusetts , " HIC # 165641
'®, ,C ,I `' 1029 North Rd. - Hampton Ponds Plaza CSL # 57011
t �li. ''I� Westfield M
r
c� �t D .
rr f . �, , Phone (413) 485 485-7 • Fax (4 4 I Goa - " '.
Simply the Best for Less MOU K6GPIN
www .windowworldofspringfield,com � B88 4, .. *.,., St
NAT- 41779 -1 "«__.�... �»' R
` c) ) S ` Y - /fa • Name: l\vl 1 P,.� h alt' w� Y Phone H : !�
ii t )1
Install Addr: f . 0 f s ' ' ✓ ! , !t7J V i L ( Ph one ( ( ) i _ _ •
Bill Addr: �:_ S , .. U/U � 11 E -Mail: Aw—•• ,[,t+ LW • N; a- a Lif
Ma i/. Ae... IaMIit
WIND • W WORLD VALUE PLUS 4000 + 6000 SERIES PAC . GES
Series 2000 Mech. Frame Welded Sash $189 Solar Glass w /Low E $45
3 e Series 4000 Double Hung $205 = MA. Energy Reg. Upgrade $24
Series 6000 Double Hung $239 Foam Insulation on Jambs $16
Picture Window $329 Remove Window From Property $16
2 Lite Slider "' $329 Lifetime Glass / Seal Failure Warranty $16
3 Lite Slider (' /a, ' /z,? /a) (1/3, 1/ 1/3) $520 Transferable Lifetime Warranty $10
Awning $285 In Home Service $15
Casement LH RH $285 Double Strength Glass $16
Twin Casement (Requires 2 Value +)(0973) (0979) $570 , Total Options: $158
. Three Lite Casement (Requires 3 Va ue +) $885 �-�j SALE PRICE (Save 50 %) $79 / F' /7
Basement Sliders <55 UI $239 Heat Buster Package Upgrade $20
Hopper (In existing wood) (vent add $12) $185 7
, -S —1 PRE 1978 BUILT HOMES (Federal Lead Containment Law) F--
Specialty Window V e,tk. 1
f „2.. - EPA LEAD SAFE (Per Window) .7'$56 (?
Bad/ /BOW (Insulated seat, Int. Casing & Ext. Cap) $2$75 I EPA LEAD SAFE (Patio Dr / Bay / Bow / Garden) $100
Garden ( Int. Casing & Ext. Capping) - $1 875 I � //
Grids/Ext. Color /Int Woodgrain/Colors calculated in WW Upgrades MY HOME WAS BUILT IN THE YEAR / Initia
Remove Existing Bay & Reframe $295 I decline third party verification (Initial): ---
Roof for Bay /Bow Window $450 I ha • rece a copy of the Lead hazard information pamphlet
Second Floor Installation $500 in orming me of the potential risk of the lead hazard exposure from renovation activity to be
Window Color $ performed in my dwelling unit. The EPA "Renovate Right" brochure.
Inside outside (initial)-4, have received a co of the lead test result(s).
WINDOW WORLD UPGRADES 1 1 �Q 3
Sign: t ;,r •- Date: 1 II
Full Screen $25 v e ' -
BEIGE Color charge $35
Name(s) (Print): ` f' , (-I r,•. ', f (p 4 (:IA ri otpoiv tn
Ext. Color (AT) (AB) (DC) (HK) ( FG) (ER) (CG) $165 MISCELLANEOUS LABOR
Woodgrain' Interior (LO)(Oo)' (FX) (RM) (sM) , $95 t�-Z Full Exterior White Trim/Wrap (SMOOTH) / (PVC) $75 3/ s
Contoured /Flat Grids (TOP) (FULL) (ENDS) $40 ( Color Other Than White $10
Prairie Grids ( single ) /(Double) (Flat)/(contour) $69 Specialty Custom Exterior Trim/Wrap $
Diamond /Brass Grids (TOP) (FULL) $69
Oriel/ Cottage Style (40/60) (60/40) $30 !" Quick Trim (Int) (Ext) $30
Obscure Glass Per Sash (BOT) (FULL) $35 Metal / Vinyl Out $100
t $30
Mull Removal
Tempered Glass Per Sash (sor)(FULL) " � ;:: $65 "
Mull to Form Multi -unit $30
Triple Glazed TG2 (Argon)'(e0000nly) $155 1 Install Interior Stops (WHITE VINYL) i $45 4 (r.
Triple Glazed TK2'(Krypton) (6000 only) $195
" Install Exterior Stops (WHITE VINYL) $45
Catalog Options $ ;!�
Customer Provided Stops/Trim „..''th $20
VINYL PATIO QOORS 1 , LH or RH (Outside Looking In) ) Install Interior Casing $60 60
Includes: White Interior Casing and Exterior Trim: 1 Repair / Replace Sill or Jamb " / $75 7c
5 Ft. Sliding Patio Door (LH) (RH) $1250 Mobile Home Conversion $185
6 Ft. Sliding Patio Door (LH) (RH) • $1300 Remove / Re- Install A/C or Awning $100
8 Ft. Sliding Patio Door (LH) (RH) $1500
Site Setup $250.00
9 Ft. Sliding Patio Door (LH) (RH) $1800
EPA Lead site setup & disposal fee: $48e-.)96- , .
Patio Door Beige Color $125 EPA Lead, third party verification: pp
Patio Door Low - E/Argon $125 Extra labor (Box on left for description) $
Heat Buster Package Upgrade $215 Total Antoufnt Dice $
4. Woodg ao /Brown (LO) (DO) (CH) (F n) ° ' -. $1 00 ...... , PRtict
$225 50% Deposit Amount: $ 7 - j _-
,Exterior Colors $395 [ ] Cash
' :Patio Door Triple Pane Upgrade $250 [ ] ( ) Fargo ( ) Other
Finance - Wells Far o
eyed Lock $36 Foot Lock $51 Check made to Window World of WM # •
NO EXTRA WORK IF NOT IN WRITING / INSTALLER NOTES [ #: - - -
Exp. Date: V -code:
Final Payment Amount: $ r t
I w i , / . To be paid to the installer upon completion. We do not accept cash as final payment. Thank you.
. ;,, I r1 ' ORLDCARES 1
Sales Rep [ ] Interior Stops [ ] Exterior Capping: I
Customer'Deplined: [ 1 Interior Stops [ 1 Exterior'Capping: St. Jude Children's Resech Hospital
WW of W. Massachusetts anticipates starting this work on ihs, v f Y,, Kand being substantially completed in J' days. Security Interest: Yes No w�. Any deposit required in advance of the start of the work
SHALL NOT exceed 331 /3% of the total contract price or the actual cost of any material or equipment of a special orde P or custom made nature, which must be ordered in advance of the start of work to assure the project
will proceed on schedule. 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 inquiries
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 required construction - related permits, WW of W. Massachusetts shall not be deemed responsible for delays in the work described in this agreement caused by regulatory, permit granting agencies, authorities or individu-
als. Notice: It 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 or collection from the guaranty fund established by Chapter 142A, M.G.L.
You the buyer may ncetth)s transaction at any time prior to midnight of the third business day after the dateof the transaction.
Notice of Canc. ation must be in writipg�or postmarked no later than midnight of the following third business day. THIS IS A CUSTOM ORDER NOT FOR RESALE!
/ Owner c-" = Date
Sales - ep. _ �, ; Date Owner Date
/,,
The Commonwealth of Massachusetts
—,— — Department of Industrial Accidents
l !/,
;7, Office of Investigations
=PO 600 Washington Street
1= Boston, MA 02111
r' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): W [ polio t A5 )R i_1 D f- IAJE5TE -R Ni M A sc. /1\ 1- j-•j ,tSe TTS
Address: 1 02 i\1 C Z- i) £ t
City /StatelZip: WE 5T1F' I C U B , AAA c l o g s - Phone #: L413-- k s S- 7 3 3S
Are you an employer? Check the appropriate box: Type of project (required):
1. I am a employer with 2-- 4. ❑ I am a general contractor and 1 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. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3. n I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13:" Other (_e LA cevnek i
*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 their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 1.- 16 E121 N1 I ]n & L ti N $ (,t A J C E.
Policy # or Self -ins. Lic. #: tAi C 2 — 3 15 - 37 7 9 N 7 - O) 2- Expiration Date: S) 7' 13
Job Site Address: 3Z- I-04 H 1 1 - (e r 14 City /State /Zip: l v a(i t' - MA ()(() 60
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 coverage verification.
I do hereby certify nder the pains and penalties of perjury that the information provided above is true and correct.
Signature: K ,1 Date: 3 I
Phone #: 413 S 5 - - 7 3 3c -
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 Applicable ❑
Name of License Holder : �\C ' l l% 5( 3 �:1 tl C it
II License Number
Ri:Se -
A. rwinAi dll(c bWv3
Addre Expiration Da
6' /*- 4/
S nature U Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Rc v t 130 hkt, 3 -. 1 (` {I
Company Name A A Registration Number
tv - ld6t t,�of U o W s4i►rr', Mt S 10.c . 3 SIIIW
Address Expiratio Dat
ry Z' l L . R� . LA)es -lf.t I c I M A On Telephone 1113 - y _C-7335
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 Vljindows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [E] Siding [0] Other [0]
Brief Description of Proposed
Work:
„� Z r pJ ee rAA Lv r ch',Nd t - rrrh
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
, as Owner of the subject
property
hereby authorize
to actpn n my behalf, in all matters relative to work authorized by this building permit application.
(.5 c o d \)
Signature of Owner Date
l� u b i 31.1LSUa , as Owner /Authorized
Agent hereby declare that the statements ant 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.
1Ro►xdd 61A5 v1
Print Name
i t'' ?/ 1617 / - 44, 3 H 3
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 DON'T KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained lQ , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO
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 Q NO Q
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
\ MAR 3 2013
i7 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans lt
pEPT.OF BUILDING WS one 413- 587 -1240 Fax 413- 587 -1272 Piot/Site Plans
NORTHAMPTON, MA 01060 Other Specify
ss--
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
3Z For-4 C t ( it if 0U-12- Map Lot Unit
M c:1 4 (131 D4c�;^. A MA 0 (0 6 0 Zone Overlay District
1 EIm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: t
Oaj E' ( 6(e b u.(+P 12 Q ( Lk015O4A J / ), Peliitavu ptv O/ 2 O
Name (Print) I Current Mailing Address:
C 6 ee c 0)v-tract \ ephone - ii i, 141:3- fib' -Z50
) Telephone
Signature
2.2 Authorized G Agent: �/ I ) n
/c� he ri G , /345l'A- /o) Z4 �/l✓W z' k / d • weS#t ld � 44A 01 016"
Name (P t) Y Current Mailing Address:
Ik - 7/ 4 e ( 4/1" 7 / — K4 ,- ) " Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building j t.. gl 7. (a) Building Permit Fee
2. Electrical I I (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) tNl667, at Check Number / 055
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
32 FORT HILL TER B P -2013 -0820
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 018 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 -0820
Project # JS- 2013- 001411
Est. Cost: $14867.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT E BUSHEY JR 57011
Lot Size(sq. ft.): 8058.60 Owner: BRADBURY DANIEL S & JOHANNA B CHODOFF
Zoning: URC(97)/URB(3)/ Applicant: ROBERT E BUSHEY JR
AT: 32 FORT HILL TER
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485 -7335 0 WC
W ESTFI ELDMA01085 ISSUED ON:3/13/2013 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:
FeeTvpe: Date Paid: Amount:
Building 3/13/2013 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner