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32C-063 we 5i-ern aSS @_�,itrtd.oL.J (,,ja( Id.Ccri--) E,D sa, Window World of Western Massachusetts WC 4 165641 c C �� ����css�g4u `7 1029 North Rd.-Hampton Ponds Plaza CSI_#57011•„ jI' rr .0A I, �, Westfield.MA 01085 nr� . /coon'. •'�7,.+E0 ptS - - Phone(413)485-7335•Fax(4131 485-7055 ill" NAT-417794 'Sbebtyras soar ra LAW _ www.wlndowworldofspr ngfield.cOm 1388 `<st`s��T� , + d {gyp Name: • l t✓ n u r■;a Phone(H): i 3 3 9 3 -V37 37 Install Addr. • - , if , , I toe, i a , I ,, Phone(W): Bill Addr. E-Mail: .I w S• •... VALUE PLUS 4000+0000 SERIES PACKAGES 1.----, • Series 2000 Meth.Frame Welded Sash $189 Mk Energy Reg W/SolarZene+Argon $45 -7:7 Series 4000 Double Hung $205 Energy Star Upgrade $24 Series 6000 Double Hung $239 Foam Insulation on Jambs $18 t i Picture Window • $329 WE Remove Window From Property $16 2 Lite Slider $329 Lifetime Glass/Seal Failure Warranty $18 3 Ube Slider(4..'/.,'!.)ff.,'l, 'h) $520 Transferable Lifetime Warranty. $10 Awning $285 W In Homo Service $15- Casement ur rw $285 # Double Strength Glass $16 Twin Casement Ilideawe2v.n..icoma:we 5570 Total Options: $158 Three Lte Casert ant(.o.s.,3vk $885 1 U j SALE PRICE(Savo 50%) 579 7929 Basement Sliders 455.U1 5239 Heat Buster Package Upgrade WO Hopper o,a4eraHood .de2e25 $185 •k1'1,78=w "•'• -M'rtt e^-'e 07,:7' . arm Specialty Window EPA LEAD SAFE s.wek — e .) $60 Bay/ Bow pa.aaae bae.t t awwa a ed.C•N $2875 EPA LEAD SAFE Nato a/e.Y/aw/Oaer4 $100 • Garden(rat Ostia a ea_aaaadi $1875 — d ,,,��el rev ,�, MY HOME WAS BUILT IN THE YEAR Initial Remove Existing Bay&Reframe 5295 I decline third party verification(initial): Roof for Bay/Bow Window 5450 Moil rave welted a copy of Me lead ward Intrinatte pamphlet Second Floor tnstaltlatlein, 14111...1-e,....'1 $500 Wortnt%me a the potade&kat the We heard ama3xr8 barn tenanton rathttp tube Window Color t,✓h.li, 5- °warmed in my dweAlnp udt Tht EPA'AVVVItte RVtrt=OMRe. ado. .tare. Ihntlat i tare reodred a nary of the lead test teadl(s). I WINDOW W0 Lo vPQWES 1 Date: Full Screen $25 � BEIGE Color charge $35 Nante(5)(Print): Ext.Color knOVeroaPas Ira,43h xr $165 i MlSCELlANEEUSLAM ) _ Woodgreln interior tot Pa tea ir4Foo era $95 JO/ Full Exterior White Trim/Wrap rweono/p' 575 7525 Contoured/Flat Grids flOPitnw clatrsi 540 Color Other Than White $10 Fredric Grids tsa antis.a r rnrrcanaq $69 Specialty Custom Exterior Trim/Wrap S Diamond/Brass Grids awl drew $69 a, i it nt (g0 530 OrieV Cottage Style wizens $30 167 iY-t sin Hi U Obscure Glass Per Sash.13011171A4 $35 u -moral 530 —Tempered Glass Per Sash eeonoutti 565 Mull to Form Muttl-unit $30 28 Glass MOO ter.shoo 5129 install Interior Stops rr..erewmr $45 Catalog Options $ Install Exterior Stops nerrawim.) $45 • VINYL PAT)DOORS-Lai orRH(Outside Looidng I.) Customer Provided Stops/Trim $20 Includes White=tort=Casing ere Exterior Mm. Install Interior Casing $60 5 Ft.Sliding Patio Door rue me 51250 Repair/Replace Sill or Jamb $75 6 FL Sliding Patio Door eaae Si 300 MMobile Home Gonverslon $200 a 8 Ft-Sliding Patio Door aka me $1500 Remove/Re install A/C or Arming $100 Patio Door Beige Color $125 Site Setup: $250.00 Patio Door Low-£!Argon $125 _ EPA Lead site setup 8 disposal Tao: $TpC Heat Buster Package Upgrade . 5215 EPA Lead,third party verification: .64x5700 Patio Door-Grids n• a.daoaed,.•• 3100 Extra labor(Box on left for description)$ Woodgraln/Brnwn ao+rnrtoeex $225 Total Amotmt Due 4 1-12/ Y 3 Exterior Colors 5395 Patio Door Triple Pane Upgrade $250 50°6tDeosssit Amou $ 2.�1 ,Z7/ —- Keyed Lock $36 Foot Lock $51 ) C CO WI NI pLJS Div%e- J.D,, ! 3 C Storm Door S [ )Finance-( )Welts Fargo ( )Other b NO EIcrRA WORK IF HOT IN WRITING/INSTALLER NOTES ( ]Check made to w Weill of.fed 4 L;s.1- U"K 3''5.— [ )CCa: - - J Exp.Date: V-code: �1 �� T°2-3 •13`,t6�nle. ©iSCt7kr1 Flnal Payment Amount:S Jl 4.5b • U� sit 3 1J7� w a o+:a 79>M insofar uw^^awaor.,1>.rka yea ^'^T.:••^0-ei .71-x Iserts Rep Recomrnendect i I Interior Sloan I I Exterior Capping: Customer Deduced (I Warier Stood I) staler Capping: SL Jude Children's Research Hospital Ma6W.lassaltaella radpats ebrkO aria Loth an ad oeap aesareadr kaseletet N ere.Saudi Moot Ito No .n0&ix=raaaat as sauce d do Sind resat 1 SNAIL NOt mood 33 IO%dtw=at tested Pier orae emd cod d say atddore4frrrwe of is mode cede cream made aa.e..tier oast to Ward to eddb d d•Car d mat to tare reMttt .0 pared an excess.abteat Farman ad a aeswkld seta tosmac boamdbatl bSs aKSacdm en Sportsa N ham bxPOraoent tread=sad sacctrotasSdee CO trtUsle Rk 4eariroi s • • shod a temad or=Worm=tabard a a reyaeeSmSen to doehd t:Me or CernmarMete ad Basilan Reg atto%Tat Para Rig Soda 617a Balls=115 w21ts Tae;11117)9134701.110 eft ea Ina pall to Sr=an d tea mead and b a m m l t e l to Ito awe of awl d m a t cakbad.OWd W.tlasastattat dais awake loom 147A ea.0o,eay tnrsliege=to raN to and otea , ✓metal wabr aia+emee tams NW d W.reasaunorm an'W la e.emed. tant:a to estop ar to week danecd h its warren mars lo ttvxaatRY,a retcm'ate•0are=tehafdm a Naar Ns.Rolm C rat RSetmASS(1)comes Ns sea asmeveaao rslatee Parch to Bo aatdem0ed tote estsaareavda dab adth aereetswes acIMIDrs•ere PiROtsarPS)P Nag Wed that M t o swede a ,hbaeaeat aid oabrarera ae RROIAMR(9)e75 rot Br oaettred to orb•date a collates Nom me pared)tadoaaereesd qty 1420.=U. r Tao OF Eafe mar ant On trzratrar 11 sir tam prat)to olleelyMci Sr tltd Wilma try era ace*tome baaear be ; S. as camels ten are m to antra or pamadad ea bar eta kidded die loloree it=Bodo=day.tit ORDER NOT FOR Room r * j ` .i 1aR1. _aJ! _ ) -A _- e�_„]1 r Sales-ep. •..- Owner (� Date .oar%Own.-Wicked Y.ae.Cam-fd. f� ant'74.417-1‘(,6 (/�J - -- 4(6..s,q�,t7 i� L' .'1 41 ,4 fl oc- The Commonwealth of Massachusetts • Department of Industrial Accidents "1 Office of Investigations 600 Washington Street Boston,MA 02111 www.nwss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le>:ibly Name(Business/Organization/individual): W I N DQM ly p•$LI) C) w Es-GER M3 ss 4CN14 SETTS Address: l 02-4 J3 Vg1 12 1) City/State/Zip: W ESTF l>G l-t) MA- d t O$S Phone #: 413 `1' 4I S - 7315 Are you an employer?Check the appropriate box: Type of project(required): 1.[21 I am a employer with . 4. (J I am a general contractor and I 6. New construction employees(full and/or part-time)." have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. [] Remodeling ship and have no employees These sub-contractors have g_ 0 Demolition working for me in any aci employees and have workers' g y cap ty. 9. 0 Building addition [No workers'comp. insurance comp. insurance.• required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0.1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[Z1 Other RlP �'"EPtT comp. insurance required.) w t N SOWS *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 state whether or not those entities have - employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ll Bea-n1 MICft4AL Iw1SU.RN4C ,{ Poiic� #or Self-ins.Lic.#: W e_2.- 3 I S- 31-79 q7 -01S Expiration Date: 5--7.2.D 14 Job Site Address:2O \`�,\'\ `mot "L) City/State/Zip: 0fL\-W AMA 01 0 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 frereby certify under the pains and penalties of peduty that the information provided above is true and correct Sig . e: Date: 9-20 l Phone#: 4 13 L K 5 - '7335 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 IContact Person: _ Phone#: SECTION 8-CONSTRUCTION SERVICES x/8.1 Licensed Construction Supervisor: l� Not Applicable l❑ Name of License Holder: � • `�� ��5 ` ca)1 V A License Number \Z C ,OO LVELT CAVe \\A6 .\11`x. e�i030 (91 201 / Address je Expiration Date • 44 A - ` c5 - 597 4 Signature Telephone Registered Home Improvement Contractor: Not Applicable ❑ '� \\O T ��\W � -. ce.5(0 4\ Company Name Registration Number \\ti()O\A) w O'P S) O 3 c '-k V \mac. \5 Address Expiration Date \v2.-1 qWC AC \OinVkm 1 A\,v10% elephone41s'AJ 1335 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 Y) 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 1083.5.1. 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 4. ZONING AU 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 O DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0 IF YES: enter Book Page and/or Document# •B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House El Addition I I Replacement Vyf'ndows Alteration(s) Roofing i Or Doors Accessory Bldg. El I Demolition I I New Signs [tom] Decks [[] Siding[tom] Other[D] /Brief Description of Proposed c / Work: t ) �J\0.GeVve.,v\k -Wk‘i"\&00.4 * -16\M 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. • -- , as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, K/RV k Q\A,V1�,lk., , as Owner/Authorized Agent hereby declare that the statemeflts 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. R0\3MV Vats EI? Pint Name I //d ei r' 1 1-20 '/Y Signature of Owner/Agent Date Department use only ity of Northampton Status ofPermif 1 t uilding Department SEp 232013 1 . 212 Main Street ! -� Room 100 Eiect�ic. Fiu�n0iflg 8,Gas InspectiN hamoton, MA 01060 e°f 50.E Nortra;n ton, tilt !;.:0§9. - 87-1240 Fax 413-587-1272 a a? 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: l 2.0 .k%-kcixo`y AUow.E. 1X X Map Lot Unit Wl‘aAM MIA, M • C k O(pC Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: tCVV)Q-\AFT \�\bUS`C \'1c--,, 'F COkn\, `5u-cNe '-1 o0 Name(Print) Current Mailing Addres �.SL CblC\�.AC-'C) X3 8�►3 Telephone Signature 2.2 Authorized Agent: ROV'oe X , '3-3 kr \K'N 021 MAQTAA RO, V E—\*Vla.0 ��, �»e5 Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Bui.jing (a)Building Permit Fee I80b• (PX- 2. Electrical (b)Estimated Total Cost of • Construction from(6) 3 Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ��� _1 6 Total=(1 +2+3+4+5) Ig'od-((J <;)- Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date 20 HAMPTON AVE BP-2014-0362 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-063 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-2014-0362 Project# JS-2014-000485 Est. Cost: $4800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT E BUSHEY JR 57011 Lot Size(sq. ft.): 9278.28 Owner: SCHOCHET INDUSTRIES Zoning: CB(100)/ Applicant: ROBERT E BUSHEY JR AT: 20 HAMPTON AVE Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 0 WC WESTFIELDMA01085 ISSUED ON:9/23/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 10 REPLACEMENT WINDOWS - UNIT 40 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 9/23/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner