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17C-251 (7) c ffl�Off�i Window World of Western Massachusetts HIC#165641 1029 North Rd.-Hampton Ponds Plaza CSL#57011 Westfield,MA 01085 Phone(413)485-7335•Fax(413)485-7055 j HO US GOOD` •. • "Simply the Best for Less" HOKEEPING NAT-41779-1 www•windowworldofspringfield.com BBB *•" .f St.Jude� Name: (�%f:'?(� r,r'; a t -/ Phone(H): — > Install Addr. t ; /` - -`r r�� „ Phone(w): Bill Addr. s/ E-Mail: WINDOW WORLD VALUE PLUS 4000+6000 SERIES PACKAGES Series 2000 Mech.Frame Welded Sash Energy U-Value, $79 a Series 4000 Double Hung ,..hit,) \ $205 r' 4 ��- Eoam insulation Wrap $16 Series 6000 Double Hung(wlepanes $239 Remove Window From Property $16 Picture Window t-----' $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 $285 Total Options: $178 Twin Casement(Requires 2 Value+)(0973)(0979) $570 SALE PRICE(Save 50%) $89 Three Lite Casement(Requires 3 value+) $885 Foam Enhanced Frame U-Value_SHGC_$25 Basement Sliders<55 UI $239 PRE 1978 BUILT HOMES(Federal Lead Containment Law Hopper(in existing wood)(Vent add$150) $185/250 r ` Specialty Window I - t" EPA LEAD SAFE(Per Window) $60— ' > Bay/Bow(Insulated seat,Int.Ca ng&Ext Cap) $2 Z8 5/ EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100 Garden(Insulated seat,Int Casing&Ext.cap) $1875 MY HOME WAS BUILT IN THE YEAR i Initial: Grids/Ext.Color/Int.Woodgmin/Colom calculated in WIN upgrades I decline third party verification(Initial): Remove Existing Bay/Bow $250 (Initial)I 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 �' � '�' � t��' Inside outside WINDOW WORLD UPGRADES Sign: Date Full Screen $25 Name(s)(Print): BEIGE Color charge $35 MISCELLANEOUS LABOR Ext.Color(AT)(AB)(DC)(HIq(FG)(ER)(CG) $165 Full Exterior White Trim/Wrap(SMOOTH)/(PVC) $79 Woodgrain Interior ILO)(DO)(CH)(FX)(RM)ISM) $95 Color Other Than White $10 Contoured/Flat Grids(rop)(FULL)(ENDS) $45 Specialty Custom Exterior Trim/Wrap $ Prairie Grids(single)/(Double)-(Flat)/(Contour) $69 Quick Trim lint)(Ext) $30 Diamond/Brass Grids(TOP)(FULL, $69 Aluminum/Vinyl or Steel Out $51 Oriel/Cottage Style(40/60)(60/40) $30 Mull Removal $30 Obscure Glass Per Sash(Boll(FULL) $35 Mull to Form Multi-unit $30 Tempered Glass Per Sash(BO-0(FULL) $65 < � Install Interior Stops(wHITEVwvL) �- $45 Catalog Options $ Install Exterior Stops(WHITE VINYL) $45 VINYL PATIO DOORS-LH or RH(Outside Looking In) Customer Provided Stops/Trim $20 Includes:White Interior Casing and Exterior Trim. Install Interior Casing $60 5 Ft.Sliding Patio Door ILIA)(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 A/C or Awning $100 Patio Door Beige Color $125 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)(FX) $225 Total Amount Due$ t Exterior Colors $395 Patio Door Triple Pane Upgrade $250 50%Deposit Amount:$ Keyed Lock $36 Foot Lock $51 [ ]Cash Storm Door Model $ [ ]Finance-( )Wells Fargo ( )Other TING/INSTALLER NOTES [ )Check made to Window World # NO EXTRA WORK IF NOT IN WRITING J " [ ,]CC#: - f' L Exp.Date: V-code: Final Payment Amount:$ To be paid to the installer upon installation:Thank you. - WINDOW WORLD CARES Sales Rep Recommended: []Interior Stops []Exterior Capping: Customer.Declined: []Interior Stops []Exterior Capping: St.Jude Children's Research Hospital Will of W.Massachusetts anticipates starting this work on and being substantially completed in days.Security Interest:Yes—No­Any deposit required in advance of the start of the work SHALL NOT exceed 33 113%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! Owner Date Sales Rep. Date Owner Date The Conunonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print LeiziblY Name(Business/Organization/Individual): W[NDn h)URLib nF WEST -Yt45ETTS Address: ! 02-a N V 911 POD City/State/Zip: vY)~STFI F_0> M K 010$5 Phone #: 13 ''1 S — 733 Are you an employer?Check the appropriate box: Type of project(required): L[K I am a employer with Z 4. ❑ I am a general contractor and 1 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. ❑ Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers'comp. insurance comp. insurance.*- required.] 5. (] We are a corporation and its 10.❑ Electrical repairs or additions 3.[1.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.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.�Ocher (tLAC,F.ME�JT comp. insurance required.] W i N VOW'S `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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: i-I OW-Ty MN.T14AL 1nlSt&Rh1 ;6E Policy#or Self-ins.Lie.#: W C,2- �3 1 S- 3"17 q LJ -Q13 Expiration Date: S-7•z U Job Site Address:_ 1_ City/State/Zip: A4,A 0)0&2___ 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.4ereby ce nder the pains an717,' D alties of perjury that the information provided above is true and correct Si e: ' ate: 2 -2 ) Phone#: 14 I3 LK 5 • '7335 OffWal use only. Do not write in this area,w 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 Construction Supervisor t Not Applicable ❑ Name of License Holder License Number l 2J P-aoSF V E t-i ?A 55 7° 1 Address Expiration Date 4(1 Signature Telephone Registered dome Improvement Contractor. Not Applicable ❑ Company Name Registration Number W IA AW Wki 1A A l es�em . a I Is Pat L, Address 10 Expiration Date o Telephone y t3� $5T 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...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellinas 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 SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable} i New House ❑ Addition ❑ Repfacemen indows Alterations) ❑ Roofing Or Doors l Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [0 Siding[L7j Other tQ1 Brief Description of Proposed f /� I work: ` 1(..[_ ��� I lrl �, -f- yq f'1'i Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No ! Plans Attached Roil -Sheet I - 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 a 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-, jh. Type of construction Ii 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 1. 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 fto act on my behalf,in all matters relative to work authorized by this building permit application_ cm4,,&r4- Signature c`Owner r Date as Owner/Authorized Agent hereby declare that the statements 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. I Pyint Name l� Signature of OwherJAgent 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 bld.-&paved parking) of Parking Spaces Fill: (volume&[ocauon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 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 Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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 4 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 �'City of Northampton Status of Permit: uilding Department Cam Gutfliy teem #" S „� tons 212 Main Street $ewer/ ttc,�varra�tttjr U. Leo Room 100 N z Northampton MA 01060 T Set` phone 413-587-1240 Fax 413-587-1272 PdotlSitlet'larsg '` tester S APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 41 N , o 4w L ) Map Lot Unit C t ob.Z_ Zone Overlay District Elm St.District C8 District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 8 f-0©y- SC Nv>j M 0-i AY S T Name(Print) Current Mailina Address: (w f Telephone Signature 2.2 Authorized Agent: Z06UT l- 6t•l.sl-4t'�1 tt32cl iVt?f1 RI> WES iC-' eL ) AA Name(Print) -� Current Mailing Address: (1?S 13 5 Signature ` Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Builling (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) 7 24 Check Number 7101.3 ~ This Section For Official Use On Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date R - 41 NORTH MAIN ST BP-2014-0917 GIs#: COMMONWEALTH OF MASSACHUSETTS Map B1ock: 17C-251 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows re In aced BUILDING PERMIT Permit# BP-2014-0917 Project# JS-2014-001584 Est. Cost: $7216.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT BUSHEY JR 057011 Lot Size(sq. ft.): 29969.28 Owner: SCHNABEL BROOKE Zoning: URB(100)/SI(0)/ Applicant: ROBERT BUSHEY JR AT. 41 NORTH MAIN ST Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 O WC WESTFIELDMA01085 ISSUED ON:212712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 19 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 2/27/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner