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32C-063 (5) we_5{- nNaS5 L.,i1vldatJ wa( (d •Cary-) • ":-.>-----•••••:"EAO Sa - .• Window World of Western Massachusetts HIC>r 165641 ?A' W inflow M 1029 Borth R .-Hampton Ponds Plaza CSL It 57011 ild 'A Westfield,MA 01085 • ` ?r;'"'�4ts' - Phone(413)485-7335 Lit) r'- e� 11. 'srr•1oAYrAa•Baer yo,t..a,� ) Fax(413)485-7055 uou*NOU•-.n NAT-41779-1 www.wfndowwarido! d.com `. Name: & It,✓ v> S L( 1;P. Phone(H): L /3 3 7 8-D937 Install Addr. ',_ I . ,, /I e v. / C1' . r a , . I • Phone(W): Bill Addr. E-Ma(l: ( WIND)OWW'bRLO 1 vALU5 PLUS 4000+6000 SERIES PACKAGES }---- Series 2000 Meth.Frame Welded Seth $189 MA.Energy Reg ve/SolarZone+Argon $45 -77 S• eries 4000 Double Hung $205 Energy Star Upgrade $24 • .� Series 6000 Double Hung $239 Foam Insulation on Jambs $18 c I 1 Picture Window - $329 (. E Remove Window From Property S16 2 Lite Slider $3P9 Ufetime Glass/Seal Failure Warranty $16 3 Ute Slider CA,,h,'/..)('/a.'/a,'/3) 5520 Transferable Lifetime Warranty. $10 Awning • 5285 In Horns Service $15 Casement ui wr $285 Double Strength Glass $16 — Twin Casement wirq P.2 usloo.1 ONO CNN $570 4.....3)....) n Total Options: $158 Three Lite Casement 4.....3)....) 5885 /L �7 ( SALE PRICE(Savo 5O%) $79 - Basement Sliders‘55.Ui $239 Heat Buster Package Upgrade $20 Hopper fo. rre.00tWs',sato25t $185 ••1•1,78 ill] "1' r rm 7r. • rr Specialty Window Bay/Bow Prwrwed...t sa a..iw a tot Cep) $2875 EPA LEAD SAFE gr w►ewy GardenWe.Qan,Aeraapoem $1875 EPAIFADSAFE�asoare+trtlo.7awd.nl S1DD y ,tnICod soda h MY HOME WAS BUILT IN THE YEAR • Initial R• emove Existing Bay&Reframe $295 I decline third party verification(Initial): R• oof for Bay/Bow Window $450 Mire I toes reserved a copy or to Lead lead Mlommflln canphtet S• econd FloorInstallatlon ) 5500 Worming meor tie p dgcof the Wei Mard raetromrero�mactAtytobe l o W oe er ati m my dweEng WL The E -eercvate R9hr Draftee. Window Color P rf, t1.�Ll�i g trove +r'.a. Ihrtmp I here waled a copy d Ere feed Est'eRdo). ( WINDOW WQgLD IJPQRADES I Date: Sigel Full Screen 525 BEIGE Color charge $35 Hornets)(Print): Ext.Color tAna.cororaw.sdo on xl $165 1 MISCELLANEOUSLAt30R 1 (y Woodgreln interior am Loa Ices 61ote'a an $95 /Of Full Exterior White Trtm/Wrep rs•nonor(two $75 2575 Contoured/Flat Grids rroettw,eete $40 Color Other Than White $10 Prairie Grids Rr,y.rtoo,o.r-Ira-,rca,a.i $69 Specialty Custom ExteriorTrirn/1NraP S Diamond/Brass Gridsnes r w.0 S69 - e, .1 r1 nt (F4i $30 OrleV Cottage Style tap'ea7Rn'M $30 Obscure Glass Per Sash eon tsau $35 t Q � � $i 00 U as u -amovel $30 Tempered Glass Per Sash en1)t•w 7 $65 Mull to Form Multi-unit $30 28 Glass oo N a. $129 Install Interior Stops WM%wrna $45 Catalog Options $ Install Exterior Slops nwrirs weet) 545 - H VINYL PATIO DOORS-LN or RH(Outekto Lo g otdr. in) Customer Provided Stop5J1-rim $20 includes:White Interior Case.)end Exterior Trim. 1 Install Interior Casing 560 5 Ft.Sliding Patio Door Aso tag 51250 Repair/Replace Sill or Jamb $75 6 Ft Sliding Patio Door and pee 51300 Mobile Home Conversion $200 8 Ft.Sliding Patio Door rue Pep $1500 Remove/Re Install A/C or Awning 5100 Patio Door Beige Color $125 Site Setup: $250.00 Patio Door Low-c/Argon $125 EPA Lead site setup&disposal fee: $10D p Heat Buster Package Upgrade $215 EPA Lead,third party verification: 454 16.60 Patio Door Grids r.ay r,mdx.n $100 Extra tebot(BOX on left for description)$ WoodgreirlBrown aao mates ,rt $225 Total Amp_ttrrt Duel Lt Z�$ [�; Exterior Colors $395 _ Patio Door Triple Pane Upgrade $250 50%Desesit Amoun$ 2-1,27/ — Keyed Lock $36 Foot Lock $51 H S'0 LJ;'41&i l it%e. 1.0 4,3C Storm Door S ( )Finance-( )Wells Fargo ( )Other 2 NO EXTRA WORK IF NOT IN WRMNO/INSTALLER NOTES I I Check made to 1Nh1 w WalsLat f I L;)/- 4$3'i S' ( .c..4:� Exp. V-code: _....# .ry .r(02 ()0j iare, U;SCOkK _ Final Payment Amount:: /U` i b • Jie7 SY 3 -13'14 r0 at paid to to made upon iv+ttaitlwl none en, ^'•q..'••••.•-Ii .a1-e }Sales Res Recommended; (t Interior Stool[1 Exteriee Gapping: Customer Declined: (I Interior steed I l Exterior Capang; _ St Jude Children's Research Hospital y awew.Weertmlta rtiarto Naito do Mk co ad at serum eey ocovieted In cam Scoot,Cavan tin'No .No tocceareoM.o In mhos=d to eMdtm oak 1 Saitil Nor sone3 3WedITeel mead ptaaeeaadmdvat Matta or aplpre•ad■medn ado Neon made rat" niettNag sfol* I,ta rcsuST 01-e eIaseamprgeti ; der primed aimam),w fad'mart dd be demxeded mid to=trod emvyItaeo to neenton m of rotes.el ham trrparsoorl eacaaibra and aIDmomalossMa to'Wand Ind tit aysraddea • • tad a domed oraokamete al-q a e reinteern tned to droned so:arltm of CersolowMoho ml Boohoo fleguloan,Vol Pane Pb xti Sift 517M BorC4 at a2ttt Num d31112,2342M Now* Nod WO odor to to strap of to.erttad and hae®rltal a to eww d a copy of aoG creams.WI OIL Ms>a to s7 ads eeddan of damn 142A Of ON peed laws a MUM b qy b ate aaatn , '.Mel ud'omreetdmmrh nw tip.Mmachr.emr wd a a.dxeed nbpastba ko carry.Al M wok draumed mars peewef csbea to sopNaay,oamf pea 8 p Om*,AD/TAN a 06Yde- !i Modes a the /4 R7 cattalos fis owl aonsfro tlom___wrath br Qo wxtdm:Med aide et ostroaaeeta Nosh attic mxeptrlaad mcaamn,Se RWC Y naeo abhat 1M It . to ow*ti adh0ob.hArfOefd tad ofOorfolloot to Rsed1A3E4{5)NO rya a55d to wear.Oslo or ooBaeao,sent to p®aey hal mamma 15 Meta,LOA I-Pt. toe de a.yar Mar.*8*.hoarem d oat ere wM to~to!o!tto eed boolne a day am to ear of as taadan. Nem ofraoodaeen mot te to wttto or Patnanad cola*to ddra5SId to baa.Aycad*WOE=RA.V24';4. 'r• ORDIM NOT FOR Pr-a41-Et� J� y . - Sates-ep, ...- Owner Data .rwnao.sr-ow.ir.e r.pw.tow_re. ,V , __, / - .- 4/?:. / 4— `lc -1,004'1 I floc • The Commonwealth of Massachusetts Department of Industrial Accidents --. Iii._ Office of Investigations __= = ' 600 Washington Street '--''t= Boston,MA 02111 .4. ••• + '°=•�..., www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information , Please Print Le 'lot Name(Business/Organization/Individual): W kb . , ,,' ) • WE - M• ACWNSETTS Adciress: l 02.ct t4 vii T f ( 1) City/State/Zip: w> sTF 1 F t- M A- (0 t O$S Phone #: 413 ''I' 'IS — Z 33 S Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with Z- 4. 0 I am a general contractor and 1 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in an aci employees and have workers' g y capacity. 9. ❑ Building addition [No workers'comp.insurance 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 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.]uired t c. 152,§1(4),and we have no 13 R . �- employees. [No workers' '�Other F.MEIAC IN 1 N 1DOW5 comp. insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownets 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 employees. Below is the policy and job site infor.nation. Insurance Company Name: LI 1 EP:n1 MIRTUAL INSURANCE — Poiicy#or Self-ins.Lic.#: W C2..— 31S- 377 q 47 -013 Expiration Date: s--7-ZD i 4 Job Site Address: 20 AC-000\r) NeA\ke., \,kXt\ 3Y City/State/Zip:\ tit 1),1` . 010100 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do,'iereby certify under the pains and penalties of perjury that the information provided above is true and correct: S_igrtature: e4 f''4- /i tl. : cl' ' (3 Phone#: 'I 13 Ll$ 5 • 7338 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.CityiTown 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: RID1(42Ar' ' . S i C k 1 License Number 271 .Q0, Rye . VQ�cV\ a. , Vt4r; , oto ca) ) iS Address Expiration Date Sig ature Telephone JO.Registered Home Improvement Contractor, Not Applicable ❑ Company Name Registration Number \Ylc,‘,O AA \ZOVA C. Ske rv). t om 'Zoe, . 3‘l5 t at Address Expiration Date 02-9 -0`fA{Y\ Rat, ©\o C5 TelephoneAS5-7335 — 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 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- ear .-riod 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 I I Replacement(ndows Alteration(s) Roofing I 1 Or Doors Accessory Bldg. u Demolition I I New Signs [Q] Decks [Cl Siding[0] Other[DI v//WorkDescription of Pro. I f Q 1� ,3\ace;N A� w�U l� \ Alteration of existing bedroom 0 Yes _No Adding new bedroom Yes No Attached N.>.rrative Renovating unfinished basement Yes No Plans Attached Roil -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, \ 0\43q)(-\-* U,SV\e ,as Owner/Authorized Agent hereby declare that the statemeli is 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. Z©ber A u \ Pyint Name A �s ( 5 Signature o:Owner/Agent Date Section 4. ZONING Ail Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information . . Proposed This colorful to be filled in by Building Deparanent Frontage Setbacks Front Rear Building Height Bldg.Square Footage % - Open Space Footage (Lot minus bldg&paved •arkinanQ) 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 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 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 0 , 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. - -:, .:,' r 1-- - q r---; .7.--\_ Department use only i : p ty of Northampton ampton Statts,of Perro t , SEP 2 3 2013 ` � din s De p artment . i 212 Main Street �ilif L Electric,Plumbing&Gas Inspections Room 100 Northam ton,MA 01060 � amoton MA 01060 phone 413-587-1240 Fax 413-587-1272 pjorojeyttw --, APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH'A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: (�`'1 J This section to be completed by office 20 -\WAS tV� l�Ul� U KT `J g Map Lot Unit y,� TMAill VIVA V . 0 k n(00 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: . t e C\OCN�C'`T — ouscRt 1'15 -E.O .AL.�C. c .L�e' / 0 Name(Print) Current Mailing Address: (%CE CO\\S.T2.aeT) -. ‘"-3 34S ec01- Telephone Signati re 2.2 Authorized Agent: Wnl C.''•\- .S .kL� lOrt 1\XO A VSO, \ • Ott)E35 Name(Print) Current Mailing Address: 1"4 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Bui.iing 9 0 00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of • Construction from(6) 3. Plumbing Building Permit Fee 4 Mechanical(HVAC) 15. Fire Protection 6. Total=(1+2+3+4+5) 1 c D .to ) Check Number Ttc� This Section For Official Use Only • Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date t< , • F 20 HAMPTON AVE BP-2014-0361 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-2014-0361 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 () WC WESTFIELDMA01085 ISSUED ON:9/23/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 10 REPLACEMENT WINDOWS - UNIT 38 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