23A-126 4 A01.S4-4,:, h TM . n ,l, Window World of Western Massachusetts HIC#165641
r� �� �y ∎ 1029 North Rd.-Hampton Ponds Plaza CSL#57011
C, 4. ;� `�','��,�,f'� \ Westfield,MA 01085
1F1 °.F� J 'Sim f me est/or Less^ Phone(413)485-7335•Fax(413)485-7055 I 0 ;':coo-o'"'
P Y NOUSEKEEPING
NAT-41779-1 www.windowworldofspringfield.com BBB ,.-. ,,7 sst /�/
Name: 1.11,--Y7 b.:re.�- �0 {ip/1k Phone(H): /�? S J Z70
Install Addr: U 3 v f11+a q cP i "-f Phone(W):
Bill Addr: TI,;Ke N[,- //,I i 0104, 4- E-Mail:
WINDOW WORLD I 1 VALUE PLUS 4000+6000 SERIES PACKAGES }Series 2000 Mech.Frame Welded Sash $189 Energy Star Plus U-Value SHGC $79
r<V Series 4000 Double Hung $205 ,.(40 Foam Insulation Wrap $16
Series 6000 Double Hung(triple pane) $239 Remove Window From Property $16
Picture Window $329 Lifetime Glass/Seal Failure Warranty $16
2 Lite Slider $329 Transferable Lifetime Warranty $15
3 Lite Slider(1/4,1/2,1/4)(1/3,1/3,1/3) $520 In Home Service $20
Awning $285 Double Strength Glass $16
Casement LH RH , Total Options: $178
Twin Casement(Requires 2 Vue +)(0973)(0979) $570 I Z SALE PRICE(Save 50%) $89 �Ot
Three Lite Casement(Requires 3 Value+) $885 Foam Enhanced Frame U-Value SHGC $25
Basement Sliders<55 UI $239
Hopper(In existing wood)(Vent add also) $185/250 -I PRE 1978 BUILT HOMES(Federal Lead Containment Law) '—
Specialty Window /L EPA LEAD SAFE(Ren Window) $60 77O
Bay/Bow(Insulated seat,Int Casing&Ext.Cap) $2875 EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100
Garden(Insulated seat,Int Casing&Ext Cap) $1875 MY HOME WAS BUILT IN THE YEAR /2Z L x:. !_!
Initial:
Grids/Ext Color/Int Woodgrain/Colors calculated in WW Upgrades I decline third party verification(Initial):
Remove Existing Bay/Bow $250 -, 1.
(Initial))have received a copy of the Lead hazard information pamphlet
Reframe&Retrim(stain/paint not included) $250 informing me of the potential risk of the lead hazard exposure from renovation activity to be
Roof for Bay/Bow Window $450 performed in my dwelling unit.The EPA"Renovate Right"brochure.
Second Floor Installation $500
(initial)I have received a copy of the lead test result(s).
Window Color
Inside outside 'I
I WINDOW WORLD UPGRADES I _ Sign: ,,,%A"A-C - - ?0r* -'-- Date: f .-/ ;1
Full Screen $25 Name(s)(Print):
BEIGE Color charge $35 MISCELLANEOUS LABOR
Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 C��
11- Full Exterior White Trim/Wrap(SMOOTH)/(PVC) $79 6
Woodgrain Interior ILO)(DO)(CH)(F)q(RM)(sly() $95 Color Other Than White $10
Contoured/Flat Grids Tod(FUtu(ENDS) $45 Specialty Custom Exterior Trim/Wrap $
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Quick Trim(Int)(Ext) $30
Diamond/Brass Grids crop)(FUU) $69
Oriel/Cottage Style(40/60)(60/40) $30 Aluminum/Vinyl or Steel Out $50/$125
Obscure Glass Per Sash(Bar)(Fuu.) ,, $35 Mull Removal $30
Mull to Form Multi-unit $30
Tempered Glass PerSash,(Bon(FUL $65 Install Interior Stops HITEVINYu $45
Catalog Options $ Install Exterior Stops(WHITE VINYL) $45
1 VINYL PATIO DOORS-LH or RH(Outside Looking In) I Customer Provided Stops/Trim $20
Includes:White Interior Casing and Exterior Trim. Install Interior Casing $60
5 Ft.Sliding Patio Door(LH)(RH) $1250 Repair/Replace Sill or Jamb $75
6 Ft.Sliding Patio Door(LH)(RH) $1300 Mobile Home Conversion $200
8 Ft.Sliding Patio Door(LH)(RH) $1500 Remove/Re-Install NC or Awning $100
Patio Door Beige Color $125
9 Site Setup: -$250:00---,
Patio Door Low-E/Argon $125 EPA Lead site setup&disposal fee: $100.00
Heat Buster Package Upgrade $215 EPA Lead,third party verification: $475.00
Patio Door Grids(Regular)(Woodgrain) $100 Extra labor(Box on left for description)$ ;,,,..,, -/ •
Woodgrain/Brown(LO)(DO)(CH)(Fly I $225 Total Amount Due$ -, -) /w
Exterior Colors' $395
Patio Door Triple Pane Upgrade $250 50%Deposit Amount:$ ,*
Keyed Lock $36 ' Foot Lock $51 [ ]Cash y
Storm Door Model $ [ ]Finance-( )Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING/INSTALLER NOTES [ ]Check made to.Window World of WM#
L [ CC#: Y!bj) L/5 8t 3 6O QW6 ot 2—`.
Exp.Date: 1 sal!a'- �e>api-V-code: 1
Final Payment Amount:$ b
To be paid to the installer upon installation.Thank you.
I WINDOW WORLD CARES I r)
Sales Rep Recommended: [I Interior Stops []Exterior Capping: n f/
Customer Declined: [I Interior Stops []Exterior Capping: d 5-, St.Jude Children's Research Hospital
WW of W.Massachusetts anticipates starting this work on and being substantially completed in_days.Security Interest.Yes No '.Any deposit required in advance of the start of the work
SHALL NOT exceed 33 1/3%of the total contract price or the actual cost of any material or equipment of a special order 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:if 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 cancel this transaction at any time prior to midnight of the third business day after the date of the transaction.
Notice of cancelation must be in writing or postmarked no later than midnight of the following third business day.THIS IS A CUSTOM ORDER NOT FOR RESALE!
/ f 1
//& 7 Owner Date
/./17\//)'3 ,-;--/„,, ,//'-')
Sales Rep. / ✓ Date /' Owner Date
White Copy-Original Yellow Copy-File Pink Copy-Customer Rev.0711
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
_ ;a=- 600 Washington Street
'''= Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
-
Name(Business/Organization/Individual): W(N DOW Am A) OF 1"/STRI,) MA SS ACKa SETTS
Address: l 02dt NvC-114 R)
City/State/Zip: W ESTF I F L-tj MA- p l 0 SS Phone#: 413 11. 1S —
Are you an employer?Check the appropriate box: Type of project(required):
1.21 I am a employer with 0 4. 0 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. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
g yap ty. 9. 0 Building addition
[No workers'comp.insurance comp. insurance.
required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions
3.0.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 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
13. Other Q1-AClr►ENT
employees. [No workers' W t A VOWS
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 subcontractors 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: 1—I BEQ1y MKTUAL Su € —
#or Self-ins.Lic.#: W e Z- 31S- 377 a 1.17 -013 Expiration Date: 5-7•ZD (4
Job Site Address:80 KC-\6\f, N __,.__City/State/Zip:cdRANtt ,V\k)1, 0‘ob2
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do,fereby certify nder the pains and penalties of perjury that the information provided above is true and correct
Si: attire: it ...1
Date: /D /CI- i
Phone#: 4 13 14425 - -7335.
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
�/$.1 Licensed Constructions Suppee revisor. (� Not Applicable ❑
Name of License Holder: \\Ot,X�r� 1, • �c��C6��Q
License Number
i r1 RDa`se-4-e,iA • Nt;nut. 101l
Address Expiration Date
c2.tc-V■\nC . \�4\\`� , \, 0UD60 to ZS w\�
Signature 00 Telephone
. Registered Home Improvement Contractor. Not Applicable
�o`oex-\* C v sintut -r. 1c���io i
Company Name Registration Number
o�c)O ll�orkc� o �Jes � MA C rim, 3\\ \Ili
Address ` _ p A 1� Expiration Date
10Z�=1 `40 tt i a. \Z-e tt\a. i. O ID65 Telephone4t3"_1f 35
' _ ,
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 11 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 10835.1.
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 LI Addition n Replacement , dows Alteration(s) I I Roofing I I •
Or Doors
Accessory Bldg. f t Demolition I I New Signs [p] Decks [ J Siding(DI Other[DI
/WorkDescription of Proposed 1 CJ �� m �* � ��05 1m
Alteration of existing bedroom 1 Yes No Adding`new bedroom Yes No
Attached Narrative 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.
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
iZo .k. ›v‘ssoe ,as Owner/Authorized
Agent hereby declare that the statements and inform on on the foregoing application are true and accurate,to the best of my know_edge
and belief.
Signed under the pains and penalties of perjury.
12-0 13 EII a -,
Pyint Name i
/0/I14I3
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 Q 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 O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW C) 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 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
1� -..---t-°'
� �''. {, City of Northampton Statuso€Permtt •
Building Department Ct�ff�wayl'etltt
2013 t
9
� , 212 Main Street ewer/Se ttcAyatta iitty
,fln Room 100 4a � a
Northampton, MA 01060
AO,g'{:SIt1 *'! '
h r e
Nor'" j' phone 413-587-1240 fax 413-587-1272 Pfot,Site
titer 6
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:
'30 W.�`'e t¢" kree' " Map Lot Unit
CkoceX QJt, \C'1<. 0■C)(o2 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
6Cx„slnes 4 V\\e )o c c x 30 t`1 c lie. reL1: C\ortinee, YL 01Cl2
Name(Print) Currgnt fling A% . 32 'mot to
.0.ii... - f.c4,c,, Telephone sLJ
Signature
2.2 Authorized Agent:
o`oe.{k . Qv,51ry \02C� hoc pct .NAds&t■ \,Kck.0t055
Name(Print) Current Mailing Address:
` ■ - '4 ' 133
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS,
L
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Bui.ding 5 . CkkO (a)Building Permit Fee
2 Electrical (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) 513Ct(Q,Od Check Number ie )- ( ,3,5
This Section For Official Use Only l
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
30 MIDDLE ST BP-2014-0472
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A- 126 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-2014-0472
Project# JS-2014-000813
Est. Cost: $5396.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT E BUSHEY JR 57011
Lot Size(sq.ft.): 15463.80 Owner: DOPPMAN JAMES P&PATRICIA A
Zoning:URB(100)/ Applicant: ROBERT E BUSHEY JR
AT: 30 MIDDLE ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 0 WC
WESTFIELDMA01085 ISSUED ON:10/18/2013 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:
FeeType: Date Paid: Amount:
Building 10/18/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner