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17A-163 • • �,►: • Renewat F -7- EyAndersene . * ; _. • Fr w WINDOW' REPLACEMENT *tMdetie COMpaay Wood/Vinyl Composite IF VatePeA FrifeInglters Dual Argon Low E4 SmartSun at r " 100 r - 04735 8 ENERGY PERFORMANCE RATINGS • U- Factor (U.S) /I -P Solar Heat Gain Coefficient 0 .2 9 0. 19 ADDITIONAL PERFORMANCE RATINGS • Visible Transmittance CI . • M.. cW.Vwips MStPmt Ms. �Nytasdemt b.ppia.le MFNC proe.d. * dwsnswipeeaeY ps d.ee p.dawase.. MOWC willows. dM.ssMd tom *NW OM MawioapMNecMiieus and ..pa:ie protium O .. WAG dell a ee.e *ed.syp edeet sd d..s eat w.Ntle tM.eisCiiy M s.y proeeq loamy specie e... Caws mseb4cfede l $ ah■re kr aMe p ed.w p.deq lseo. iakrw.tb.. 44* R4. Ths product w..oeGsar ., ..: SW* .. ironws.W p 4te ra.d•c'dsge wroite•ssroy ; ; ; -. , • .' 46- „ • 'c`Wsad wig �s flr`ur <,{ °fiti ^� itipawaria psdwhaaW fatal" _:,� :.....,,...... DESIGN PRESSURE (PSG • V∎' l 31∎1 • Ei -Lc25 • RbA DB Sloped Sill DH IN • 'keg teWAee.rAAMAAYOMMCSAINAVMADe. I**, awniamnr Amor coolamanom wat anemia O me& ■dwis et woods IL LC. cE.C, a IEC.C. Ai irlltdio. NQei..roros WOMA twieseicc.eNatisa Papaw • • • • • • • • • • . • ' , ' • : - . •Do nd teams m� fad tale h�6or - 8at.tahid iortiari td�ce.. ' • . . • _ y,ni •:)1 • 3= inn3_u i,"Ii Ott~ tar :- _ • c ? :e /La ' .. m amoirldalegar • ' l i . . • . • • '• • j_s,..... et n:' = . , ' 1 ' ., . • Y rrw�s • , - • 0- r • ::.filar t Gain • • • Cterlr-Jert _ O 9 1 ' 6 5 Q g • • . '� 1 aJ-� _ • • • . - , • • ' •trn�s • .. . . . • Ylabie Tram • - 0r48 ,rni.ae,. r . • • • IgCrss.mra®rsyrrama�r�� • VI l • • • —=-- -, • , , NH i.1,:11 ---" JJilJ 1` • • • . Andres MIA Caemed • • • . ,d • _ ►a+I2rNOUn�t�s eursams Op Ed DP • ' • . 1 I • , .. . • • ._ • 44:4 _ r e.m..ml — — — - - Db. od r WQYe rmfi 1 r d b� aed S n I W 16ler • • - n Z7pnIl ibl; A[T Llimra li.'. - a T ri i,., T l Il Ti.tia , • . . • . . . . Candi -1 .. . 41 11% . . • . . .;,:. ri c a I Q Ec m nc., wi • • • a . our v� .,,,wad• • • . . _ i =:x. • Renewal � • • ' - . .. r -k'Arid . - .- • ' . , . -w .. , -<. ; � . r;no...r .� -u.moa+ 1 .w�.+ +.c -w 7 D Vin u a l Y1Mical Arg W 4 n Product Type Plclure • • • _ .. • • U-F • • . Solar 1 -lei Galh (aeiticlant , :'.:O 2 x.53 4a� ;• . • .S.I�.P • , Rio= A . ' �sibfe Trans�nl[iahoe : " , • *kw mnlm .:k ' .. • , If7+c K,et dwMrr - aw , a wftr.w.a. ••∎4edAc�or . .?���I • • w r nkarMM DP•psr F - � • • . • • 1 . ' Or .,I°". ' •• a ' • . . 1CD -0051 irr6 -401 • , • • ►r+ax e c N wm.eonlagmnsrM>agM"'►+!+. ". " Do not remove until final code inspection. Save label for future reference, • • Qualified for lcuildigfoted area Repond aux exigoucos pour lei regions indittiia;;tn a Canada. e-` T t 800 387 -2000 Q enetpyetar.pc.oa I CV c a3 Ci :r= a N a a ENERGYSTAR • U W a U,S,! E.U.. j . 1 888 782 -7037 - C energystar_goY a • o _ Renewal lr� j I -► byAnd ersen, i . • WINDOW REPLACEMENT u. 4ndnrnesiCannpany NrifCM: Pof:R4rif.10. AND -N -103 •,1�s),t•;$ r:4.1.1ar: :& • Wood /Vinyl Composite Dual Argon Low -E4 =:.ZE:3 Product Type: Awning ENERGY PERFORMANCE RATINGS Li- Factor • Solar Heat Gain Coefficient 0.29 1.65 0. • (U.SII -P) (Metric /SI) ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 Manutacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a feted set of environmental conditions and a specific product stn.. NFRC does not recommend any product and does not warrant the sultablllty of any product for any specific use Consult manufacturer's literature for other product performance Information. w.vwntrc.org . ' YmY..uw. McNnn Andersen Corporation RbA Awning Window Manutacturar stipulates conformance to the following standares Standard Rating NAFS -O2 orAAMNt DMA1CSA 1011t.S2A440.05 DP psf DP40 1 1 , 4 \ ..... . - Tres product meets i Green Seal's .,• envlmnmende standard! . , governing energy emclency, heavy metals In the tram! and sash ti materiai, packaging, ant consumer educational materials. 1oD- 00518940 -015 Meets ar exceeds M.E.C., C.E.C, &LEC.C. Air IntIlltiafon requirements WDMA Hallmark Certiacatlan Program. • • R enewal renewal by Andersen Corporati MA Home Improvement Contractor byAndersen• ���� 104 Otis St., Northborough, MA 01532 License # 170810 (Expires 12/23/2013) WINDOW REPLACEMENT an Andersen Company (508) 351 -2200 • Fax: (651) 351 -4810 Federal Tax ID #41- 1918413 WINDOW SPECIFICATION SHEET Buyer(s) Name Date of Agreement The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and /or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS I. Contractor will Install a total of /d windows in Owner's home, using the following individual quantities: 6 Double Hung (DB) i Equal sash Cottage sash (1/3 top, 2/3 bottom) _ Oriel sash (2/3 top. 1/3 bottom) Flat sill (customer is o aware of Giass la ss) Square Check Rail 4 Check Rail Casement (CS) Hinge right Hinge left (as viewed from exterior) Double Casement (CD) 2 Lite Gliding Window (GW) 1 Casement / Picture / Casement (CT) 1:1:1 or Glider / Picture / Glider (GPW) _ 1:1:1 or _ 1:2:1 j clure Window Bay or Bow wning Windo # Lights Soffit / Roof Shingle / Copper Specialty Window Patio Doors (See Separate door spec sheet) Seat to be Primed / Oak / Pine 2. y-' 3 Qty of Windows to be Custom Fit Replacement: 3. 3 Qty of Windows to be Custom Fit Full frame (INCLUDES NEW INTERIOR & EXTERIOR CASINGS) Exterior casings: Pine Maintenance -free material J/ actnry.alapti . t clog Fib., hrickmol 4. Glazing to be: _ HP Low- -4 TM Tempered _�ther If other, please specify: MART S �•1 5. Exterior color to be: 10 WilLN I Sand _ Canvas Terratone _ Cocoa Bean Dark Bronze Forest Green Black 6. Interior color to be: a COO Sand Canvas in Maple Oak Same as Exterior Note: Wood interiors need to finished by Owner. 7. Hardware: {� 2� Canvas _ Estate Hardware: Style: 8. y v Install Lifts with Double Hung Window 9. Screens: windows to have: Half or ulI screens creens to be: .Fiberglass Aluminum ruScene ) 137AL GRILLE DETAILS 10. iV J ows have grilles: Grille Between Glass (GBG) Removable Interior Wood (INTW) Full Divided Light MO approved (initials) Draw grille patterns below "Use additional sheet if needed Qty: Qty: Qty: Qty: Qty: Qt Qt ADDITIONAL WORK DETAIIS 11. V Qty of Sills Sill noses to be replaced by Contractor 12. V Contractor will remove metal frames of windows. 13. 4" Contractor will install new paint -ready or _ stain -ready Interior Exterior casings in _ Pine _ Maintenance -free material 14. !v'tJ C etor will install new _ paint -ready or stain -ready Interior Exterior stops in Pine Maintenance -free material 15. ( ) Intls - Owner is aware, contractor does not do any painting or removal /installation of alarm system/hardware. It is the responsibility of the homeowner to have the alarm system/hardware removed prior to installation. 16. `J Contractor will wrap exterior casings with coil stock of '5T color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. 17. Contractor will insulate, caulk and seal windows with 3 -Point system to prevent water and air infiltration. Removal and disposal of all job related debris, win- dows, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued. 18. 2 Yes ❑ No Building Permit — Contractor will secure any and all necessary permits. The fee for the permit(s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. Ck # / $ 3 .) 19. (YYes ❑ No All discounts have been applied to this agreement price. 20. Additional job details: ZO % e .5 21. 12<es ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment /finance form(s). It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen Corporation Buyer(s) By: 1_- N (2/// / Signature of Product Manager Signature Signature / iL _ i67'.'4' G, Ri6lareQ3A Print Name of Product Manager Print Name Print Name Renewal /---: 9 MA Home Improvement Contractor bYAndersen. License #170810 (Expires 12/23/2013) �• WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation Federal Tax ID #41- 1918413 104 Otis St., Northborough, MA 01532 (508) 351 -2200 • Fax: (651) 351 -4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s} Name Date of Agreement -1 )3 Buyer(s) Street Address, City, State, and Zip Code I I J 'Mem - F /Oreht. • m A G 1 2 E -Mail Address Home Telephone Number Work Telephone Number eveI y l:t3 ,Q6 , . - 7,,'I (003 c'cYYE Buyer(s) hereby jointly and severally agrees to purchase the products and /or services of Renewal by Andersen Corporation ( "Contractor "), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement "). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Estimated Starting Date: Method of Payment: Total Job Amount: / a 7 2 ' Amount Financed c Check ❑Cash t- -9 e I -�� c S Deposit Received (33 %): ' „t 'i't Jv I:Nisa MC ❑Discover Balance at Start of Job (33 %): 0 LIAMEX Estimated Completion Date: If credit card is selected, please Balance on Substantial see Credit Card Payment Form. Completion of Job (33 %). 9 &c, &c, 0 D4 i1 Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyer Buyer(s) By: Signature of Product Manager Signature Signature ( FE 74 -j 2sZ d Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction - a -it. You may cancel Date of Transaction You may cancel this transaction, without any penalty or obligation, within 1 this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any 1 three business days from the above date. If you cancel, any property traded in, any payments made by you under the 1 property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed I Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt I by you will be retumed within 10 days following receipt by the Contractor ( "Seller") of your cancellation notice, 1 by the Contractor ( "Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition Seller at your residence, in substantially as good condition as when received, any goods delivered to you under 1 as when received, any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply 1 Contract or Sale; or you may if you wish, comply with the with the instructions of the Seller regarding the return instructions of the Seller regarding the retum shipment of shipment of the goods at the Seller's expense and risk. 1 the goods at the Seller's expense and risk. If you do make If you do make the goods available to the Seller and the 1 the goods available to the Seller and the Seller does not Seller does not pick them up within 20 days of the date I pick them up within 20 days of the date of your Notice of your Notice of Cancellation, you may retain or dispose of Cancellation, you may retain or dispose of the goods of the goods without any further obligation. If you fail to without any further obfigation . If you fail to make the make the goods available to the Seller, or if you agree 1 goods available to the Seller, or if you agree to return the to return the goods to the Seller and fail to do so, then 1 goods to the Seller and fail to do so, then you remain liable you remain liable for performance of all obligations under 1 for performance of all obligations under the Contract. the Contract. To cancel this transaction, mail or deliver a 1 To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any 1 dated copy of this cancellation notice or any other written other written notice, or send a telegram to Contractor: 1 notice, or send a telegram to Contractor. Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street, Street, Northborough, MA 01532, BY NOT LATER THAN Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF . (Date) OF . (Date) I HEREBY CANCEL THIS TRANSACTION. 1 HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Dote Buyer's Signature Print Name Date RbA Copy - White Buyer Copy - Yellow Buyer Copy - Fink ©JBLLP2009.RBAAPh.MANH The Commonwealth of Massachusetts !� Department of Industrial Accidents _' Office of Investigations i1.� _ . 600 Washington Street 1/441.. ' = Boston, MA 02111 = � "' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Annlicant Information Please Print Legibly Name ( Business /Organization/Individual): ` , p,, 1~J a,1 t 1 A A �, A Address: 1 0L\ . n-A s S . City /State /Zip: 1 t A-V\0 6 TJ ` J\ d I S 3d Phone #: 520 (i? - 3 5 t -0c) 0 0 • Are you an employer? Check the appropriate box: Type of project (required): 1. (] I am a employer with 3 c 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. j "Remodeling ship and have no employees These sub - contractors have P 8. ❑ Demolition working for me m any capacity. employees and have workers' insurance? 9, 0 Building addition comp. [No workers' comp. insurance 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. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.0 Other employees, [No workers' comp. insurance required.] Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. 1 Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation Insurance for my employees. Below is the policy and job site information. `` ` r Insurance Company Name: �i p_ c �O\ c t S • C 3 • Policy # or Self -ins. Lic. #: (■VA t,t c---e, C1 I .- q( Li ` J� O 6 Expiration Date: / 0 =- I - 1 3 Job Site Address: i \ Vb 4, (\ AA- .s I C A City/State /Zip: Ro,n0,,, r r e„, C 10. t. 9- 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 cert j „ d the pains and penalties of perjury that the information provided above is true and correct, Signature: MO Date: '3 12_ d / (3 Phone #: .37)'K ' 3 I - c 9p)() i] 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 : , � b � C �I /l e 2.-Gt ((l5 -?- II License Number I ' ^ \ L4 E''lt?.3 \U 1. A-A \e 0 } f VA Oj ? I C7S y 1 Expiration Date Sign a Te ephone 9.eiristered Home Iriiproveiaieint Goiacor. , Not Applicable ❑ Company Name Registration Number t nk-k U s S� I 0 -d 3 -( 3 Address \ Expiration Date OD r` A(A) D (5 3 4 Telephone.5 >!g • 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 ❑ vulk f 1111.)4 The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to a110 such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. R 780 Sixth Edition Section 108.3.5.1. Definition of Home r: 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 on two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constru more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the ding Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed un. • the building permit. As acting Construction Supervisor your presence . ' 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' pensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts i - eral 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 compli. - with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts It :. eral Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [D] Other [0] Brief Descriptiopp,�of Prpposed Work: Re1!Ar. 1h W1ncc�>� - n 0 - `(`t1C - r f I JVAA- ' 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 toto "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 1, 3 t )\ `R\ GN\ at- (\ S 0,n , as Owner of the subject property ON hereby authorize � D 5 �. to act on my behalf, in all mattelative to work authorized by this building permit application. Signature of Owner Date (-..1)\!\ e �Z'� , as Owner /Authorized Asn_t hereby declare at the statements and information on the foregoing application are true and accurate, to the best o myfi7tawtedge and belief. Signed under the pains and penalties of perjury. Print Name r 3 Signature of 0 er /Agent Date • Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information x ' ` Existing Proposed Required This column to be fihled m by Building Department Lot Size | ^ | __ . | | [ ���� �} -----�-----| Frontage , _ __--_- _� � ______J . Setbacks Front E [---1 1 |. Side L: DLF | L:_ — I R:= F---1 1 / [ [ | | Rear / ` �_-_^ ' _� Building Height | ' r - F---1 . 1 �___, Bldg. Square Footage [---� | | % i l F F ___� ' . �___' `___� `__� Open Spac Foo�� % ����m�m��mn�� �--� [ F ---7 E- F--- . | | | | F #ofPuddogSpaces �---� ` ' / _ � Fill: , ----------- T ,- -----' �ommomum^uv� L ___ ]L _ ! -- ` A. Has a Special Permit/Variance Fi ever been issued for/on the site? 0 �� 0 NO �~� DON7KNOVY A�� YES �~� IF YES, date1ssued:( -_ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT d�� YES «~� v_� �r «�� IF YES: enter Book —| Pa g e i -- and/or Document --1 ' L_J [---_______ i B. Does the site contain a brook, body of water orwetlands? NO 0 DON'T KNOW fil YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? �� Needs to be obtalned ��/ Obtained «�� Date 1 ) »�� , '| __] C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: | |___________ _ D. Are there any proposed changes to or additions of signs intended for the property ? YES »��` NO �� �� n� IF YES, describe size, type and location: ______ ____ E. VWU the construction activity disturb ( ring, gradingexcavation, or filling) over 1 acre orioit part ofa common plan that will disturb over 1 acre? YES NO ��� �� �� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. _ .� City of Northampton s I , � < - `,: AAR 2 2013 ! Building Department g 0 �d aF� ��x ; � � 212 Main Street i�f� ,° 3� ���,. Room 100 DEPT o . - fr r :t �" � " �u s rvoHrti , �rro r y „�oe� Northampton, MA 01060°;`:��'r'��`� phone 413 - 587 -1240 Fax 413 - 587 -1272 P4C(Air4f.t.'..it:',..;?:,-;---:,f . � �, � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR MOLISH A ONE OR TWO DE FAMILY DWELLING SECTION 1- SITE INFORMATION 1.1 Property Address: This section to be completed by of#Ice 1 1 -6 X . i` �n S Q Map Lot Unit Zone OverlayOisfr♦ct �D1`ZJ� cc- t C1� U10 1Q �. r Elm St District ` C District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: J�� � G��rc�S�n 1\,x ��es P. c\. �`u�enlP • �'�� Name (Print) ling Add!A - tnc c . sQ � g fn10(0 Telephone Signature 2.2 Authorized ` Accent: b � � V � � P. �-� \b t l�A.s s- . \ o � � � � >s�v , r'^-.- U� � � � Name (Print) Current Mailing Address: Air l Signature Telephone SECTI o •ESTIMATED CONSTRUCTION Estimated COSTS Cost (Do llars Item ) to be Official Use Only 1. Building completed by permit applicant (a) Building Permit Fee 1r. 1 • 461. " 2. Electrical (b) Estimated T Constru otal from (6) of 3. Plumbing Building Permit Fe Cost e 4. Mechanical (HVAC) LS 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) j ga , Cj• �ThL Check Number 750 Y 4 3 is Section For Official Use Only Date Building Permit Number: Issued: Signature: Budding Commissioner /Inspector of Buildings Date 11 FOX FARMS RD BP-2013-0857 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 163 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 # B P- 2013 -0857 Project # JS- 2013- 001464 Est. Cost: $18729.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 065272 Lot Size(sq. ft.): 9975.24 Owner: RICHARDSON JULIE Zoning: URA(100)/ Applicant: RENEWAL BY ANDERSEN AT: 11 FOX FARMS RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919 -0900 WC NORTHBOROMA01532 ISSUED ON:3/22/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 10 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 3/22/2013 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner