16B-049 (3) i A- Window World of Western Massachusetts 0, .0u.R;;x
y ZCt *
1029 North Road-Hampton Ponds Plaza, •Westfield MA 01001
Phone(413)786-9900 • Fax(815)366-8039 NAT-41779-1 BBB
www.WindowWorldofSpringfield.com HIC#165641 �Jt
Jt-
'Simply the Best for Less" CSL#57011 ?
I
Customer: Phone(h) "
Install Address: Phone(w)
Bill Address: E-mail
WINDOW WORLD VALUE.PLUS 4000 + 6000 SERIES PACKAGES
2000 Series Mach.Frame Welded Sash $189 ? i tEnergy Star'Plus U Value. SHGC $79
4000 Series DH $265° Foam-tnsUtation Wrap $26�
6000 Series DH $239 Lifetime Glass/Seal Failure Warranty $32 N
Picture Window $329 Transferable Lifetime Warranty $15
2 Lite Slider $329 Double Strength Glass $26 N/C_
3 Lite Slider (1/4.1/2,114) (1/3,1/3,1/3) $520 Total Options: $178
Awning $285 ? "' PACKAGE PRICE $89—
Casement LH RH $285 Foam Enhanced Frame 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 3> + INITIAL_:.>C`''
Hopper(In existing wood)(Vent add$150)$185/$250 EPA LEAD SAFE(Per Window) _ -`x$60
Specialty Window $ EPA LEAD SAFE(Patio Cr1 Bay Bowl Garden) $100
Bay/Bow(Insulated seat,Int.Casing&Ext Cap) $2875
I decline third party verification ❑(INITIAL):
Garden Window nnsulated seat,Int.Casing&Ext.Cap) $1875 (Initial)I have received a copy of the Lead hazard In orb mation pamphlet
Grids/Ext.Colorllnt.Woodgrain/Colors calculated in WW Upgrades in offing me of the potential risk of the lead hazard exposure from renovation activity to be
Remove Existing Bay/Bow $250 performed in my dwelling unit,the EPA"Renovate Right"brochure.
Reframe&Retrim(stain/paint not included) $250
Roof for Bay/Bow Window $450 (initial)I have received a copy of the lead test result(s).
Second Floor Installation $500
Window Color r I Sign Date:
Inside Outside Name(s)(Print) x
WINDOW WORLD UPGRADES MISCELLANEOUS LABOR
Full Screens $25 Full Exterior White Trim/Wrap(sMooTH)(Pvc) $79
BEIGE Color charge $35 Color Other Than White $10
Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 Specialty Custom Exterior Trim/Wrap $
Woodgrain Interior(LO)(DO).(CH)(FX)(RM)(SM) $95 Quick Trim(Int) (Ext) $30
Contoured/Flat Grids(TOP)(FULL)(ENDS) $45 Aluminum/Vinyl or Steel Out $50/$125
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Mull Removal $30
Diamond/Brass Grids(TOP)(FULL) $69 Mull to Form Multi-unit $30
Oriel/Cottage Style(40/60)(60/40) --` $30 Install Interior Stops(WHITE VINYL) $45
Obscure Glass Per Sash(BOT)(FULL) ---i $35 Install Exterior Stops(WHITE VINYL) $45
Tempered Glass Per Sash(BOT)(FULL) $65 Customer Provided Stops/Trim $20
Catalog Options $ Install Interior Casing $60
VINYL PATIO DOORS-LH or RH(Outside Looking In) -Repair/Replace Sill or Jamb $75
(Includes:White Interior Casing and Exterior Trim.) Mobile Home Conversion $200
5 Ft.Sliding Patio Door(LH)(RH) $1250 Remove/Re Install A/C or Awning $100
6 Ft.Sliding Patio Door(LH)(RH) $1300 Site Setup,Removal,In Home Service,etc.:$ $250.00
8 Ft.Sliding Patio Door(Li(RH) $1500
Patio Door Beige Color $125 EPA Lead site setup&disposal fee:$:$100'.00
Patio Door Low-E/Argon $125 EPA Lead,third party verification: $ $475.00
Heat Buster Package Upgrade $215 Extra labor(Box on,left f_or description)$
Patio Door Grids(Regular)(Woodgrain) $100 Total Amount Due$
Woodgrain/Brown(LO)(DO)(CH)(FX) $225
Exterior Colors $395 50%Deposit Amount:$
Patio Door Triple Pane Upgrade $250 []Cash
Keyed Lock$36 Foot Lock$51
Stornf Door Model ,--. $ = +' []Finance-(-)Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING! [1 Check made to Window World of W # -
f # -
Exp.Date:
V code i
- Final Payment Amount$
' To be paid to the installer upon installation.Thank You.
Sales Rep— m ended Stops^ Exterior Capping: - ' WINDOW WORLD CARES
Customer Decl [[Interior Std []Exteior Ca p in g: St.Jude
CFiitdien's Research-Hosprta[`" $
WW of W.Massachusetts anticipates starting this work on W' and being substantially completed in ''; days.Security Interest:Yes_No
Any deposit required in advance of the start of the work SHALL NOT exceed 331/3%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
Owner Date
�
Salesman Date Owner Date
This Window Wodd®Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc.
WM we 05-14 White Copy-Original Yellow Copy-File Pink Copy-Customer
4 The Commonwealth of Massachusetts
Department of Indusirkd Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): W I N LOW yuUg b D WIrST>5R1J MASSaCNASfTTS
Address: 102-q NV91W WD
City/Stawjzi : W ESTF I E 6j M!or D l 0$S Phone#: 413 `r l S — 7 33 S
Are you an employer?Check the appropriate box: Type of project(required):
1.[9 I am a employer with Z 4. ❑ 1 am a general contractor and I
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. Q Remodeling
ship and have no employees These sub-contractors have g. Q Demolition
work' for me in an i employees and have workers'
mg Y capacity. 9. ❑Building addition
[No workers'comp.insurance comp.insurance.:
required.] 5. [] We are a corporation and its 10.Q Electrical repairs or additions
3.❑.1 am a homeowner doing all work officers have exercised their 11.❑Pluumbing,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 (;��111C1gMt�tT
w t p VOWS
comp.insurance required.]
'My applicant drat 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.
s I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: LI I3EaIN MtlTUAL IMSW,RE1 a
Policy#or Self-ins.Lic.#: H/C 2— 3 !S— 377 Q a,7 !OJ_4 Expiration Date: S•?•2D 15-
Job Site Address: _Fj q �, K\�'AN, � City/State/Zip:I67f',ul a MA 6(n�4 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 51,500.00 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.'eereby ctr4fy r the pains amt enalispc of perjury that the infortion provided above is true and correct
Si Z -z- K
Phone# 4 13P y 5 - '7335
OfJ'rcial use only. Do not write in this area,to be completed by city or town q,(jicual
City or Town: PermitAUcense#
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 Sup-�ervisor_ Not Applicable ❑
Name of Ucense Holder:
— license Number
12-7 9 oos Ev ELT AVE 5 7o l l
Address Expiration Date
FEEDIM6 N 1LI-S MA CrID30 1-113 J5'5840q
Signature Telephone
.Registered Home Improvement Contractor. Not Applicable ❑
Ro BE2T Bi•15 4 TfL 1 5 L 4 I
Company Name Registration mber
W I AJ1DTi) W D-a Uf) 0�- WF STER1�, M Ass 1) G :3 u 15) ) 1O
Address Expiration Date
107A N0444 QD WESTFI tl46 AAA oro65' Telephone 413 tAS733S
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§26C(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 Dwellinzas 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 buildine 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
j SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
i
New House ❑ Addition ❑ Replacement windows Alterations) ❑ Roofing ❑
f—� Or Doors
I Accessory Bldg. 0 Demolition New Signs [E7] Decks [(_] Siding[Q] Other[rZl
Brief Description of op
Work: AO /GI UXA1Q.V1.'C l)l r C4 6 )5
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -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
11 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.
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
I, �1 C NiV A S-1 0,, C-[ a as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work autfforized by this building permit application.
Signature of Owner Date
go gf-g-1 latkS H£--1 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.
_ K099F-T OVS INE�
Pyint Name 4 1151�
Signature of erlAgent 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
pa�ng)
#of Parki Spaces
Fill:
(volume&Location)
A. Has a Speciat Permit/VariancelFnding ever been issued for/on the site?
NO O DONT KNOW Q 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 O , Date Issued:
C. Do any signs exist on the property? YES 0 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 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
use only
City of Northampton
BUilding Department
F yS. Y
2 6 212 Main Street
�{ Room 100 . _
- .tc hampton, MA 01060
Elecinc Flu- "t` � �'"
87-1240 Fax 413-587-1272 %`
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:
Map Lot Unit
N t1 Paul
NSA a ! 0(0 2 zone Overlay ff�rict
Em St District CB r)isVlct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
v6:3NA SC10.0\C�. 2,la
Name(Print) Culr�1 ailing_ ddre -7 Q
( ,� (,o KtM Telephone
��
Signature
2.2 Authorized Agent:
R96ERT E BUS N E 1O2a No2-M R-1) wE sTf lJxO D AAA 0101&5
Name(Print) i Current Mailing Address:
4�3 4g5 7335
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted b ermit a li—nt
1. Bui.Jing (7 t 0 D (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) j , Q Lj Check Number C�
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
It
219 NORTH MAIN ST BP-2015-0763
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B-049 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 replaced BUILDING PERMIT
Permit# BP-2015-0763
Project# JS-2015-001483
Est. Cost: $9220.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 10149.48 Owner: SCIACCA JONNA
zoning: URB(100)/ Applicant: ROBERT BUSHEY JR
AT. 219 NORTH MAIN ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON:112812015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 20 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 1/28/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner