17C-072 Window World of Western Massachusetts
\ HO USEKEEGING
1029 North Road-Hampton Ponds Plaza,•Westfield MA 01001
Phone(413)786-9900• Fax(815)366-8039 NAT-41779-1 ELt*
^ w''w.WindowWorldofSpringfield.com HIC#165641
"Simply the Best for Less
CSL#57011 xes�nH ya°
Customer: Phone(h) R �T ;
Install Address: F�f(i f C� Phone(w)
Bill Address:
E-mail
it
WINDOW WORLD VALUE PLUS 4000 + 6000 SERIES PACKAGES
2000 Series Mech.Frame Welded Sash $189 1".Energy Star Plus U-Value SHGC_ $79
4000 Series DH $205 - -Foam Insulation Wrap $26 N/C
6000 Series DH $239 Lifetime Glass/Sear Failure Warranty $32 N
Picture Window $329 Transferable Lifetime Warranty $15
2 Lite Slider $329 Double Strength Glass $26 N/C
3 Lite Slider (1/4,1/x.114) (1i3,i13,113) $520 Total Options: $178
Awning $285 PRICE $89
Casement LH RH $285 Triple Pane U-Value_SHGC $50
Twin Casement(Requires 2 Value+)(0973)(0979) $570
Three Lite Casement(Requires 3 Value+) $885 PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMENT LAW)
Basement Sliders<55 UI $239 MY HOME WAS BUILT IN THE YEAR INITIAL: .,
Hopper(In existing wood)(Vent add$150)$185/$250 EPA LEAD SAFE(Per Window) $60 " - -
Specialty Window $ EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100 r
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap) $2875 EPA Lead site setup&disposal fee: $100.00
Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1875
Gnds/EA Cobdlnt.Woodgrain/Colors calculated in WW Upgrades EPA Lead,third party verification: _ 475.00
Remove Existing Bay/Bow $250 1 decline third party verification C3(INITIAL):.
Reframe&Retrim(stain/paint not included) $250 (Initial)I have received a copy of the Lead hazard information pamphlet
Roof for Bay/Bow Window $450 n.m rig me of the potential risk of the lead hazard exposure from renovation activity to be
Second Floor Installation $500 performed in my dwelling unit,the EPA"Renovate Right"brochure.
Window Color _ / f (initial)I have received a copy of the lead test result(s).
Inside Outside
WINDOW WORLD UPGRADES Nam Date:
Name(s)(Prini)
Full Screens —`$25
BEIGE Color charge $35 MISCELLANEOUS LABOR
Ext.Color(Al)(AS)(DC)(HK)(FG)(ER)(CG) $165 Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79
Woodgrain Interior(LO)(DO)(CHI(FX)(RM)(SM) $95 Color Other Than White $10
Contoured/Flat Grids(TOP)(FULL)(ENDS) $45 Specialty Custom Exterior Trim/Wrap $
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Quick Trim (Int) (Ext) $30
Diamond/Brass Grids(TOP)(FULL) $69 Aluminum/Vinyl or Steel Out $50/$125
Oriel/Cottage Style(40/60)(60/40) $30 Mull Removal $30
Obscure Glass Per Sash(SOT)(FULL) $35
Tempered Glass Per Sash(BOT)(FULL) $65 Mull Form Multi-unit $30
Catalog Options $ Installl l Interior Stops(WHITE VINYL) $45
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(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 A/C or Awning $100
Patio Door Beige Color $125
Patio Door Law-E/Argon $125 Site Setup,Removal,In Home Service,etc.: 251
Heat Buster Package Upgrade $215 Extra labor(Box on left for description)$
Patio Door Grids(Regular)(Woodgrain) $100 Total Amount Due$
Woodgrain/Brown(LO)(DO)(CH)(FX) $225 - "50%Deposit Amount:$ —
Exterior Colors $395
Patio Door Triple Pane Upgrade $250
Keyed Lock$36 Foot Lock$51 []Cash
Storm Door Model $ []Finance-( )Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING! [I Check made to Window World of WM#
[].CC#
Exp.Date: V-code
Final Payment Amount$
To be paid to the installer upon installation.Thank You.
Sales Rep Recommended:[]Interior Stops []Exterior Capping: WINDOW WORLD CARES
Customer Declined: []Interior Stop []Exterior Capping: 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 the work to assure that the project will proceed on schedule.No final payment
shall be demanded until the contract is completed to the satisfaction of all parties.
All home improvement contractors and subcontractors shall be registered and that any inquires 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 construction-related permits.WW of W.Massa-
chusetts shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals.
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 this transaction.
Notice of cancellation must be in writing postmarked no later than midnight of the following third business day.
THIS IS A CUSTOM ORDER NOT FOR RESALE!
I
I
Owner Date
Salesman Dater Owner Date
This Window World®Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc.
wM WC 05-14 White Copy-Original Yellow Copy-File Pink Copy-Customer
4 The Conumnweallh of Massachusetts
Department of Industrial Accidents
Office of Investigations
V 600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AQglicant Information Please Print Legibly
Name(Business/Organization/Individual): WINDOW )j Dg a DE W 1r STE RO MA SS ACYA Sf TTS
Address: 102 1 NV914 AD
City/State/Zip: tA Pr 010$S Phone#: 413
Are you an employer?Check the appropriate box: Type of project(required):
1.[9 I am a employer with Z- 4. E] I am a general contractor and 1
employees(full and/or part-time)."
have hired the sub-contractors 6- New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 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.❑Electrical repairs or additions
3.[1.1 am a homeowner doing all work officers have exercised their 1 I.[]Plumbing.repairs or additions
myself[No workers' comp. right of exemption per MGL 12❑Roof repairs
insurance required.]* c. 152,§1(4),and we have no
employees. [No workers' 13.�Other QJr►E1JT
comp.insurance required) Mt t A
'My applicant that chocks box#I 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 drat is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name: L1 P ERT{ MKIMAL INSLt.RANCE
Police#or Self-ins.Lic.#: K/ 2.— '� 1 S- 377 q a,7 701_4r Expiration Date: S-?-2D E 5
Job Site Address: 25 `%'A Q FF 16-U-�> Av t= City/State/Zip: Fl-OkUN C AAA 6"(W2-
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,'tereby eerty nder the pains and elsies of perjury that the information provided above is true and correct Si e: n1
Date: < 2 tP C
Phone# "[ 13 Lilo
OfJw,W 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/rown Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other '
Contact Person: Phone#•
SECTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder: 7�b b.2T 12 b k$1'}'Cq
License Number
1'Z-7 RODSEVCLT AVE 57o l )
Address Expiration Date
FE ED i 6 W L L-S MA �01 o3Q 41-3 J 51&&CQq
Signature elephone I
b
.Registered Home Improvement Contractor. Not Applicable ❑
{ Rv BE2T Bu.SUf.V UJL 1 �* S(.0 4
Company Name Registration Number
W t AYDUIQ W DV-U,0 OV- WP-5TEa�; .MASS i>J C., 3 ( I S 1 (c
Address Expiration Date
IDA NOM Q,D WESiEIEt-Z� MA 0106'' Telephone yi3yK57335
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 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 Officiate 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 F_� Replacement windows Alteration(s) Roofing
Or Doors
I Accessory Bldg. 0 Demolition New Signs [p] Decks [[] Siding[o] Other[pJ
Brief Description of Proposed i
V Work: C el-yl 4 i\i I
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
I Plans 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 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
�4 A ti� !�C'/t Ct_✓ as Owner of the subject
property
hereby authorize '�-"'�,-�D,yZ JE P(A ,71� J
to act on my behalf,in all matters relative to work authorized by this budding permit application.
Signature of Owner 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.
i2�BE2T f3us N�
Pyint Name
Signature of er/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
azkinQ)
#of Parking Spaces
Fill:
(volume&Lotion)
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 pen-nit 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 a DON-r 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 0
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 i acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
t3epartrnent-use only
City of Northampton PeV
Building Department
° 212 Main Street
Room 100 g r r
p1' 9Q�
s s Northampton, MA 01060 ,.
phone 413-587-1240 Fax 413-587-1272 i
PLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Pronertv Address:
2 C,-1 AP-f-)O > AVE Map Lot Unit
t CE
MA C t C(L)IL Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �j q�2,ti�� N N�R;A 12-D
Name(Print) Current Mailing Address:
CSee UC AtmC+- Telephone
Signature
2.2 Authorized Agent:
1Z1D DEt?T E BUSM I BUS N c m R1 wE 5Tf-ieLr-) />,ti9 M Q,
Name(Pri Current Mailing Address:
413 5 33 S
Signa re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Bui.Jing (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=0 +2+3+4+5) S Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
25 GARFIELD AVE BP-2015-0627
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-072 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Build'Inq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2015-0627
Project# JS-2015-001207
Est. Cost: $3442.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sg. ft.): 13634.28 Owner: MENARD NORMAN E
Zoning. URB(100)/ Applicant: ROBERT BUSHEY JR
AT. 25 GARFIELD AVE
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON.121512014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 10 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 12/5/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner