32C-063 (4) we5i-ernMa.s5@_(�1rr'da s) ova( id.0 cry
F.O-S4 Window World of Western Massachusetts HiC#185641
,, ,tit (�' *Lld I1 1029 north Rd.-Hampton Reads Plaza CSL It 57011
•: .!', j Wes tfield.MA 01085
=r`-- i'eooel•
R>,:IFn CA" Phone(413)485 7335.Fax(413)485 7055
Sdre�tly Mrs Boer Mr test'` uoalauasueo
tAt
NAT-41779.1 ww.wtrtdowworldolsprtngfFe,d coyri
Name: " !( J; Phone(H): 1-ii 1 3 1St-$/37
Install Adds 8 r r,,,. if a >1 1 ti-C..- I a r , a I aj f Phone(W):
Bill Addr. E-Mail _
WINDOW Wbttt.D I f{ VALUE PLUS 4000•9000 SEPt85 PAcKAQES 1--'
• Series 2000 Mech.Frame Welded Sash $189 a MA.Energy Reg w/SoletZone+Argon $45
777 S• eries 4000 Double Hung $205 3 Energy Star Upgrade $24
Series 6000 Double Hung $239 r Foam insulation on Jambs S16
t I-- Picture Window - 532g WE Remove Window From Property $16
2 Ute Slider $329 _ Lifetime Glass/Seal Failure Warranty Sib
3 Ute Slider('/.,'1r,'/.)(Y.,'/a,'h) $520 Transferable Lifetime Warranty. $10
Awning $285 _ In Home Service $15
Casement to rw $285 r Double Strength Glass $16
—
Twin Casement crwar:e2wu..ii0+atpe79) 5570 t Total Options: $158
Three Ute Casement sans. $885 /V( SALE PRICE(Save 50%) S79 .7125
— Basement Sliders<55.U1 5239 Heat Buster Package Upgrade $20
hopper On cola%woo*Owl are SI 25) $185 •:1"1: 8 •uI ^..Y w..1 es.-- r.•-- . . ar,+r,
Specialty Window
Bay/Bow eaaanee seat re.aasp a ay.ewe $2875 EPA LEAD SAFE per rinaay $�
Garden(I nt . AI en.caopee $1875 EPA LEAD SAFE porno Dr/asr rap.r Caere $100
—
diie1Adera��tiew, MY HOME WAS BUILT IN THE YEAR Initial
endears• Remove Existing Bay&Reframe $295 I decline third Party verifroation(Initial):
-R• oof for Bay/Bow Window $450 I trove reached a copy of tie teas inward Informetlon ta11vt el
Second Floor installati $500 informing meal the potato'45c al the I®d Maud eomosrre tram ranee iM salty to he
r� 1 W L�[.� 5 perarmed In my dwelling set M EM'Rerovate Wit*brochure.
Window Color riff
ma)I the teethed a dos dew lead test rested.
I }yl$0OW 41<oRLD UP¢RADES ] •
Sign:
Full Screen $25 Date:
B• EIGE Color charge $35 Names)(Print):
t xt.Color troll triennia Pen eoOi:WI S165 t MISCELLANEOUSLAb0G j _
Woodgrain Interior a.rx ma Pe mese va $95 /Q/ Full Exterior%Mute iNm/Wrep pr oonorowo 575 259_5
Contoured/Flat Grids taoPreza.eG $40 Color Other Than White S10
Prairie Grids w awit000w-pralconarl $69
Diamond/Brass GridsmcriFuau $69 Specialty Custom ExteriorTrtmAVrap S
Or1eV Cottage Style noes eons $30 ei' "" nt ' 100
—Obscure Glass Per Sash won dams $35 -r � � $100 U
Tempered Glass Per Sash eronarx.y $65 - u em
oval 530
28 Glass moo eon eh $129
_ Mug to Form Multi-unit $30
Catalog Options $ Install Interior Stops writwrYU $45
Install Exterior Stops n rrrevenu 545
H VINYL PATIO DOORS-W orRH(Outside Looidng hrd Customer Provided Stops/Trim $20
includes:White Interior Cashtoa nd Exterior Trim. install Interior Casing 560
5 Ft.Sliding Patio Door are two $1250 Repair/Replace Siff or Jamb $75
• 6 Ft.Sliding Patio Door dot>s
ro S1300 Mobile Home Conversion $200
8 Ft Sliding Patio Door we pal $1500 Remove/Re-Install A/C or Awning 5100.
Patio Door Beige Color $125 Site Setup: $250.00
Patio Door Low-E/Argon $125 EPA Lead site setup&disposal fee: $
Heat Buster Package Upgrade . $215 EPA Lead,third party verification: red
Patio Door-Grids 03%w*0•333,333) $100 Extra labor(Box on left for description)S
Woodgrain/Brown saatemic*aes $225 Total Anoint Due$ t f c 4.0-3.
Exterior Colors $395 ,
Patio Door Triple Pane Upgrade S250 50%Deoprslt.Atnou ;$ 2..f 27 1 ,�
Keyed Lack $36 Foot Lock $51 y{,egA 5-0 £JiMl7�js De D 63 r
Storm Door $ ( )Finance-( )Welts Fargo ( )Other .1
NO EXTRA WORK IF NOT IN WRITING/INSTALLER NOTES I 'Chet*made to WMdow World_of Wed A
L.;s.1"" Uf. 3It5-- [ )cca:
-
.� Exp.Date:_ V-code:
�2 UQZ(jet~ 1�SCOtIK / ��jJ
z�l.-. 3 -{rj�, Final Payment Atttourtt:: /U,I?Jrt�
- a owl to aw ie; a upon;r pen,In rot
"-IT O:"•••.•a: .11-4
ISales Reo Recommended: I{Interior Stool 1 1 Exterior Capping:
C uSlomer Oedined' I I interior Stone 11 Exterior capping: St Jude Chlldren•s Research Hospital
worlW.Ma5.nb erfieba'b eeWq CMS walk on and stns aeaeaatal iiiimioliono_.aip.Saa.ee aymc a!a wo .M1 amoadi reams in above d the Paidteroh
SNAU Nur warn 33 IO%d to tear weed Ace ape w=and d any nee:tlorea/2~ide eoetia otter pail=made=Dow iron me ee 5uI th scars d es awl at.oat way en o**
.da eeee.4e model.Nofed or mon eel Ee dossed ariiae crawl is mrolaua a Om Vieth m m lie pates N boon ersnl. wore And Oea7 terns oral to all tia.earede •
Pad a moss or bmm br re=tire to it rtyth.sot•ee ore droned tr.Cabe of Commaaaees en Swine=llPe¢trs rer Vat Rana,Sde Slur Boreal MA 02116Ptele PM itsEMho Bert
aretapeOwtoenuseudma meted aidte CleltoNeseerdaoogdIWOesrtraGMYd,.Massubrets mks weesite dame 1420.dam were areh MOM torep/t'reddaJn
a*tree aiatneria+.ekba owner.WW d w.Msawore rs alas nor to assess rMdaatpb a.*Amin rw work decreed In its pmarlmt.anted by regdat y,pemetpeatle egarees.lard5a a Meer
es.Moo a Cr. K7/Mile hie own eraiV1 r Waled*mitt be en oatdareftbed ode Ws pepraata deab atm r,pepLtal meheinrs,ore liuntinlislilid3li I asap Wood owl in
au Mad•d$ata.hdpeMal fad ealprnaot as RSrDlanne(9)eta rot a mead M od a•dim a Need*,from the graeady weernelreaed elm 1121.MAL
We the aoyw may aaW pas banana=R Cif the peer b midnight el the sadbole=try wet re dale dam ev raWon
Mafia d Caen oat hot went a paamaad renter ten oidaion of the bleat*fed*meals do ',',. . DRDER NOT FOR REaALF1
I 1 ,/ !�J L GZ/y ��
.A a _I.1/ ) A. J)'__V______tea.4),/r
Sexes-ep. ..,_ Owner Q [� Date
wares aeo.-owaMl Yeeew Cep-re. ! '] 2.7-' I - ._
.
4, .4Q--- -4/"c, .1,o tq , roc-
The Commonwealth of Massachusetts
to*—
Department of Industrial Accidents
'rii__: Office of Investigations
1a—, 600 Washington Street
i ' : - Boston,MA 02111
T ��
�':.:•.., " www.mass.gov/dies
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information , Please Print Legibly
-
Name(Business/Organization/lndividual): W t 1n1 1tir hQ!� of V T>ERJ3 MA SSF4CKK Sf T L
Address: l 0 Zet O t a PI)
City/State/Zip: w ESTP 1 F i-j At A- p LOSS Phone #: 413 `. ' S — 7335.
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with 2- 4. ID am a general contractor and I 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. 0 Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers'comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑.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❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.(�Other Rl1CF1+�►ENt'f
W ill POWS
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 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.
I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site
information.
Insurance Company Name: t.1 BER?y M64.TUAL lnf t RANICE —
Policy#or Self-ins.Lic.#: we_2.- 3 1 S- 37'741147 -Pig Expiration Date: s---7-w14
Job Site Address:20 fM,VWM CvE. -)L -VK.. 3 City/State/Zip:l0\\ -0l OLOO
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failu-e 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.§ereby certify under the pains and enalties of perjury that the information provided above is true and correct.
Si! attire: t „S ,�, ✓r L/ Date: (1" 13
Phone#: 1413 yi S - 733c
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
X8.1 Licensed Construction QSu�perrvissoorn 1 Not Applicable 0
Name of License Holder: `k,V�)C�,v . \ vl��A�1 3.1 0 i'
License Number
j 2 1 Q.0 JCv alt "0%..=:. c����\k�C, AktX,. , rya . 0 i 03. 0 (o (z J 15
Address Expiration Date
4)1'144 X13- A55 .8q+7�
Signs ure Telephone
/9.Registered Home Improvement Contractor Not Applicable 0
C .0,cev-. v6het.j. 46 11n56 41
Company Name Registration Number
Wt■AcluLO WoVic, o c Ules1evvi. 1A1A 5 . TMC. 3(Iq/I
Address t�t �c Expiration Date
\net to y RD V cit-u ,t-tA, OQDb5 Telephone�I33 405-7'J3 5
—
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 t No 0 ,
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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- ear *eriod 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 Li Addition I 1 Replacement V idows Alteration(s) 1 Roofing I 1
Or Doors [�
Accessory Bldg. U I 1 Demolition I 1 New Signs [p] Decks [[J Siding[DJ Other ID]
/Brief Description of Proposed `
�' Work: (iv �..e-'0\C\Ze1ni(Yenk \)0\RIC\LCA.C)7.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Pians Attached Roil -Sheet
sa. 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 they( 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
, 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
; ' e0C. "J�`���� , as Owner/Authorized
Agent hereby declare that the statemen 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.
/Print Name
• as/id-L-9- -2-1
Signature of Owner/Agent Date
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:
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
.arkino)
#of Parking S••
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 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 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 O
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 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.
'---.)
Department use only
itty of Northampton Stats.of Permit.
j L` SEP 2 3 2013 _wilding Department 00:
• 212 Main Street ` l Jrd�lii
.' Room 100
Electric, Plumbing& inspections �
"1 Northampton, MA 01060 Nnrtiamoton, MA 01060 3,4 .; ,: yt,1'
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH'A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: r This section to be completed by office
20 1A,'A'M.?TbN, P\JG 1A. L■T 3 tP Map Lot Unit
MUiZTk•-\WilA t., 'ROI-. C 1 U(P 0
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
te,\- 0C.� - ZU.SCR,ti.t= 115 k-oeu2aL St. %UvZC '700
Name(Print) Current Mailin Address:
e3t.c C-o -\c_T. Telephone
Signature
2.2 Authorized Agent:
.B.O't i Q.R.V C--,% I C b 1 Z 1 i k q-\i \O a C S 1 y I R'" \ , \)J tkO •O t o SCJ
Name(Print) Current Mailing Address:
/A4Ad i *X4 /1)
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Bui.ding s-00 _G, .)___ (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
• Construction from(6)
3. Pk,mbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) tcc 00 -&.} Check Number / ; p
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
20 HAMPTON AVE BP-2014-0360
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# BP-2014-0360
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 Q WC
WESTFIELDMA01085 ISSUED ON:9/23/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 10 REPLACEMENT WINDOWS - UNIT
36
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