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36-174 (2) Window World of Western Massachusetts LZ 1029 North Road-Hampton Ponds Plaza,•Westfield MA 01001 FA uo�sF*E6plNG! Phone(413)485-7335 • Fax(413)-485-7055 NAT-41779-1 BBB "Simply the Best for Less" www•WindowWorldofSpringfield.com HIC#165641 CSL#57011 Ra rch Ha prta Customer: - Phone(h) Install Address: Phone(w) Bill Address: E-mail WINDOW WORLD GLASS OPTIONS ADD U_VALUES 2000 Series Mech.Frame Welded Sash $189 SolarZone Glass Package* (LE) $79 4000 Series DH $215 6000 Series DH(Triple Pane) $249 SolarZone Elite Glass Package*(LEE) $89 Picture Window $3291— SolarZone Plus(Super Spacer)(LEEP)*$110 t 2 Lite Slider $329 SolarZone TG2 3 Pane Glass(6000 Only) $155 3 Awning Pane Krypton y)Slider c,14,,lz.,/4> i,/a,,/a,,lal $575 Awning $295 SolarZone TK2 3 P Glass/Kr ton 6000 Only) $185 Casement LH RH $295 All SolarZone packages include 112 screens,Foam Insulation on Jambs and Head,Double Twin Casement(Requires 2 Value+)(0973)(0979) $590 Strength Glass,Double Locks(>29"),Lifetime Glass Breakage and Labor Warranty,Argon Gas 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+$150) $195/$250 EPA LEAD SAFE(Per Window) $60 Specialty Window $ EPA LEAD SAFE(Patio Dr/Bay/Bow I Garden) $100 Bay/Bow(Insulated seat,int.Casing&Ext.Cap)a Plus$3375 ` Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995 EPA Lead site setup&disposal fee: $100.00 Grids/Ext.Color lint.Woodgrain/Colors calculated in WW Upgrades EPA Lead,third party verification: $475.00 Remove Existing Bay/Bow $250 1 decline third party verification ❑(INITIAL): Reframe&Retrim(stain/paint not included) $300 (Initial)I have received a copy of the Lead hazard information pamphlet Roof for Bay/Bow Window $600 informing 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 / (initial)I have received a copy of the lead test result(s). Inside Outside WINDOW WORLD UPGRADES Sign: Date: Names)(Print) Full Screens $35 BEIGE Color charge $50 MISCELLANEOUS LABOR Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 Full Exterior White Trim/Wrap(sMccTH)(Pvc) $79 Woodgrain Interior(LO)(DO)(CH)(FX)(RM)(SM) $95 Color Other Than White $10 Contoured/Flat Grids(TOP)(FULL)(ENDS) $49 Specialty C Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Exterior Trim/Wrap $ Quick Trim Custom t) (Ext) $30 Diamond/Brass Grids(TOP)(FULL) $120 Aluminum/Vinyl or Steel Out $50/$125 Oriel/Cottage Style(40/60)(60/40) $45 Obscure Glass Per Sash(BOT)(FULL) $35170 Mull Removal $30 Tempered Glass Per-Sash(SOT)(FULL)$60/$120 Mull to Form Multi-unit $30 Catalog Options $ Install 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 Brickmould $75 6 Ft.Sliding Patio Door(LH)(RH) $1306 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 Low-E/Argon $125 Site Setup,Removal,In Home Service,etc.: $250.00 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 Exterior Colors $395 50/Deposit Amount:$ Patio Door Triple Pane Upgrade $250 Keyed Lock$36 Foot Lock$51 []Cash Storm Door Model $ []Finance-( )Wells Fargo ( )Other NO EXTRA WORT(IF NOT IN WRITING! [1 Check made to Window World of VIM# []CC# Exp.Date: V-code Final Payment Amount$ To be paid to the installer upon installation.Thank You. �S.I,s Rep Recommended:[]Interior Stops []Exterior Capping: WINDOW WORLD CARES ustomer Declined: []Interior Stop []Exterior Capping: St.Jude Children's Research Hospital $ WW of W.Massachusetts anticipates starting this work on :3 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. Ail 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-7elated 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 PURCHASERS)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! Owner Date Salesman Date Owner Date This Window Worlds Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc. wM WC 1,-14 White Copy-Original Yellow Copy-File Pink Copy-Customer i�°► Ro® CERTIFICATE OF LIABILITY INSURANCE UA7l (MMIUWiiirl 4/5/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FORREST INSURANCE AGENCY CONTACT NAMF: 603 NORTH MAIN STREET PHONE FAX E LONGMEADOW, MA 01028 N' E-MAIL ADD S: INSURE S AFFORDING COVERAGE NAIL# NSURERA: Liberty Mutual Fire Ins 33600 INSURED NSURER B: WINDOW WORLD OF WESTERN MASSACHUSETTS INC NsuReRC: 1029 NORTH ROAD 14SUREKO: WESTFIELD MA 01085 NSURERE: NSU RF: COVERAGES CERTIFICATE NUMBER: 19759433 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF ADDLISUGR SUBR POLICY NUMBER MMIDD EFF MMIDDIYYYY LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RE CLAIMS-MADE D OCCUR PREMISES Me occuawce) $ MED EEXP(Any one person) $ PERSONAL&AOV INJURY $ M'OTHER.LAGGREGATELIMITAPPLIESPER. GENERAL AGGREGATE� $ POLICY F LOC RODUCTS COMP/OPAGG $$P $ COMBD AUTOMOBILE LIABILITY Me e.1.11 $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PR PERTYDAMAGE $ HIRED AUTOS P AUTOS Per accident $ UMBRELLALIAB OAR EACH OCCURRENCE $ EXCESS LIAB ClA1MS�AADE AGGREGATE $ DEC) I I RETENTION $ A WORKERS COMPENSATION WC2-31 S-377947-014 5/7/2014 5/7/2015 ,� STEATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE Y/N E.L.EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDEDI Fy]NIA (Mandatory in NH) E.L DISEASE•EA EMPLOYE $ 1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be adached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTHAMPTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET NORTHAMPTON MA 01060 AUTHORIZED REPRESENTATIVE UCL Liberty Mutual Fire Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 19759433 CLIENT CODE: 1461715 Anne Chandler 4/5/2014 4:39:16 PM Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MWOO/YYW) /23/2014 THIS 05 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Laurence R. Forrest NAME: Forrest Insurance Agency PHONE 413 858 2680 ' 'No'�) (ac,Nor413 858 2685 603 North Main Street EadAIL ADDRESS: East Longmeadow, Mass. 01028 INSURER(S)AFFORDING COVERAGE NAIL 0 INSURED INSURER A:Arbella Protection Insurance Company Window World Of Western Massachusetts, Inc. INSURER 6: 1029 North Road INSURER C; INSURER D: Westfield, Ma. 01085 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR PO CY EFF POLICY LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS ,A GENERAL LIABILITY $ t noocurrence) § 1,000,000 X COMMERCIAL GENERAL LIABILITY 7520025998 04/09/14 04/09/15 $ 100,000 CLAIMSMADE ®OCCUR § 10,0 D 0 § 1,000,000 GENERAL AG § 2',-00-0,-"- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG § 1,000,000 POLICY JECT x LOC § AUTOMOBILE LIABILITY 1020018702 05/12/2014 05/1212015 (Ea accident) § 1,000,000 ANY AUTO BODILY INJURY(Per person) § ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS § (Per accident) s A X LA EXCESS B OCCUR 4600055451 05/17/14 05/17/15 EACH OCCURRENCE § 1,000,000 B EXCESS L1A X CLAIMS-MADE AGGREGATE § DED RETENTION § WORKERS COMPENSATION a WC STATC7 Certificate TO Follow AND EMPLOYERS'LIABILITY �,/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTtVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT § (Mandatory in NH) under If yes,tlescriba un I E.L.DISEASE-EA EMPLOYEE § DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT § DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,R mom space Is required) CERTIFICATE HOLDER CANCELLATION City Of Northampton 212 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton, Ma. 01060 ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Building Department AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Con%truction SuperN kor License: CS-057011 ROBERT E BUSIWY, 127 ROOSEVELTA Feeding Hills MA=01 1• a gy Expiration Commissioner 06/28/2015 .o� �'/1r• -r uuru:,,rar•rrlf�r f C lj ___Office of Consumer Affairs&Business RegulationJr/(J ME IMPROVEMENT CONTRACTOR egistration: 16%41 Type: xpiration: 3/15/2016 Private Corporatio WINDOW WORLD OF WESTERN MASS INC ROBERT BUSHEY 1029 NORTH RD WESTFIELD,MA 01085 Undersecretary The Commonwealth of Massachusem Department of Industrial Accidents 0fftce of Investigations VJ 600 Washington Street Boston,MA 02111 www massgov/daia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leebly Name(Business/Organization/Individual): W I N tN?W JU Ug Lb RF Wg fiM5: J MA g Ac-WA Sf TTS Address: 102A N V RI V P-1)i) City/State/Zip: vY F-6 Tf 1 F L-> tA Pr d 1 O SS Phone #: L413 at 4 S - 7 3 3 5, Are you an employer?Check the appropriate box: Type of project(required): 1.9 1 am a employer with_Z 4. ❑ I am a general contractor and 1 employees(full and/or part-time)." have hired the sub-contractors 6. Q 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. ❑Demolition working for me in any capacity. employees and have workers' 9 Q Building addition [No workers'comp.insurance comp.insurance..* required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑.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.]+ c. 152, §1(4),and we have no employees.[No workers' 13. Other Qf 1.-CE'J*&JI comp.insurance required] W I A VOWS '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 shat 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 emlployer that is providing workers'compensation insurance for cry employees Below is the po&7 and job site information Insurance Company Name: 1-10! iF-71 MK MAL ti'J_,St t.RANa Polic;,#or Self-ins.Lic.#: Vl/�„2-— 1 S- 377 q q7 -01 A Expiration Date: 5-?-ZD Job Site Address: 701 �Fi' C_P 1`d- City/State/Zip: b cLmaz M14 01 Q(4� 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do.§ereby cerdfy unde a pains andPen fpedury that the information provided above is ru(e�and correct Signature: !� J Phone#s 94 13 ti$ 5 •'7335 Ofi`uial use only. Do not write in this area,to be completed by city or town Q89eial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk t Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder: License Number 12-2 R OOS Ev`IT AVE 5 70 11 1 Address Expiration Date PEEN 96 N ILLS MA M30 413 155kei74 Signature Telephone 12-S ( 5 . Registered Home Improvement Contractor. Not Applicable ❑ RV bE2T 14kSU>Gy 3-2 1 �p 5u 4 Compam Name Registration mber w 1�1DD1Q iN 01a�-b ©V- W s_STE2� .M RSS 1, :31-15 ) ) Address Expiration Date ITA NCA144 Q,D WCSi IOL-Z� AAA 0106! Telephone 913LAS733L 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 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 shaD not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Officials,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 I i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) i New House Addition C] Replacement VJRr►dows Alterations) Roofing Or Doors .] Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks {[] Siding[0] Other[p] Brief Description of Proposed Work:- — 7 r2 n I 1U 4-id f LA IndLWY Alteration of existing bedroom 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_ floodpiain 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 1, _ �) 11 R_U I ' as Owner of the subject property hereby authorize ^be -t b u S f — l C to act on my behalf,in all matters relative to work authorized by this bur ding permit application. Signature of Owner Date 1, QLSo HF- ,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. ',08 T Bus H4 Pyint Name 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 Fronta;e 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 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 0 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 a 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 IP YES,then a Northampton Storm Water Management Permit from the DPW is required. It "=JF11\ {} - � er1t uS�Otlly _ ��� of Northamptontai Btlil ing Department f" 2 2 Main Street ._ Electric,Plumbing&Gas Inspections ROOM 100 ` Northampton,tJiR01060 ;^�^"'^"^"'" "-- ort amoton, MA 01060 .: phone 413-587-1240 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: -7Uq Fj()r-ence V Map Lot Unit NortMm( M , o ova Zane OverlayDistnct_ Elm St.District CS District- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _d i I I S 6 7oq F lutnce d 610ca a. Name(Print) Current Mail n Address , ` 1432- ( see "Kt MC -) Telephone Signature 2.2 Authorized Agent: _ r210DEP.T E IBUSH&A 102q NCM " WI�STRELa�l AAA 01016 Name(Print) Current Mailing Address: 1—?f 4l3 4�5 7335 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Bui.iing 0 0 (a)Building Permit Fee 2. Electrical J J (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 -Q Q Check Number This Section For Official Use On Date Building Permit Number. Issued: Signature: Building Commissioner/inspector of Buildings Date 709 FLORENCE RD BP-2015-0942 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 174 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-2015-0942 Project# JS-2015-001819 Est. Cost:$5373.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011 Lot Size(sa.ft.): 14549.04 Owner: SCOTT JILL A zonine: Applicant: WINDOW WORLD/ROBERT E BUSHEY JR AT. 709 FLORENCE RD Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 () WC WESTFIELDMA01085 ISSUED ON:41612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 7 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 4/6/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner