37-046 (7) Window World of Western Massachusetts 01
1029 North Road-Hampton Ponds Plaza,-Westfield MA 010 �/{ HOUSEKEEPING
Phone(413)485-7335 - Fax(413)-485-7055 NAT-41779-1
ww-w.WindowWorldofSpringfield.com HIC#165641
"Simply the Best for Less CSL#57011 newmltawyw
Customer: Phone(h)
Install Address: Phone(w)
Bill Address:
WINDOW WORLD GLASS OPTIONS ADD UYALUES
2000 Series Mech.Frame Welded Sash $189
SolarZone Glass Package* (LE) $79 1 _,EF
Series DH $215
6000 Series DH(Triple Pane) $249 SolarZone Elite Glass Package*(LEE) $89
Picture Window $329 SolarZone Plus(Super Spacer) (LEEP)*$l 10
2 Lite Slider $329 SolarZone TG2 3 Pane Glass(6000 Only) $155
3 Lite Slider (1/4,112,1/4) (1/3,1/3,1/3) $575 SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185
Awning $295
Casement LH RH $295- All SolarZone packages include 112 screens,Foam Insulation an 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 CPNTAINMENT LAM
-Basement Sliders<55 Ul $239 MY HOME WAS BUILT IN THE YEAR INITIAL:
Hopper(In existing wood)(Vent+$150) $195/$250 i��
t i EPA LEAD SAFE(Per Window)
--Specialty Window - $ EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100
-Bay/Bow.(Insulated seat,Int.Casing&Ext.Cap)8'Plus$3375 EPA Lead site setup&disposal fee: $100.00
-Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995
Grids/Ext.Color/Int.Woodgrain/Colors calculated in WW Upgrades EPA Lead,third party verification: $475.00
-Remove Existing Bay/Bow $250 1 decline third party verification El
Reframe&Retrim-(sfain/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: 4
Full Screens $35 Name(s)(Print) I r.,,—.t
BEIGE Color charge $50 MISCELLANEOUS LABOR
Ext,Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 L
Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79
Woodgrain Interior(LO)(DO)(CH)(FX)(RM)(SM) $95
Color Other Than White $10
Contoured/Flat Grids(TOP)(FULL)(ENDS) $49
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 —Specialty Custom Exterior Trim/Wrap $
Diamond/Brass Grids(TOP)(FULL) $120 Quick Trim(Int) (Ext) $30
Oriel/Cottage Style(40/60)(60/40) $45 Aluminum/Vinyl or Steel Out $50/$125
—Obscure Glass Per Sash(BOT)(FULL) $35/$70 Mull Removal $30
Tempered Glass Per Sash(BOT)(FULL)$60/$120 Mull to Form Multi-unit $30
Catalog Options $ Install Interior Stops(WHITE VINYL) $45
VINYL PATIO DOORS-LH or RH(Outside Looking In) Install Exterior Stops(WHITE VINYL) $45
Customer Provided Stops/Trim $20
(Includes:White Interior Casing and Exterior Trim.) Install Interior Casing $60
Ft.Sliding Patio Door l(RH) $1250 —Repair/Replace Sill or Brickmould $75
6 Ft.Sliding Patio Door(LH)(RH) $1300 Mobile Home Conversion $200
—8 Fl.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 $215 Extra labor(Box on left for descriptiop)$
Patio Door Grids(Regular) (Woodgrain) $100 Total Amount Due$
Woodgrain/Brown(LO)(DO)(CH)(M $225 50%Deposit Amount:$
Exterior Colors $395
Patio Door Triple Pane Upgrade $256 Cash
—Keyed Lock$36_ Foot Lock$51
-1811""nVWr Model $
Finance-OWells Fargo Other
NO EXTRA WORK IF NOT IN WRIT H'Check made to Window World of W
M# <
ING! cc#
Exp.Date: V-code
7-7
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 ';,'.!'i,,—! and being substantially completed in./Vdays.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!
Owner Date
Salesman Date Owner Date
This Window WorlO Franchise is independently owned and operated by Window Word of Western Massachusetts,Inc.under license from Window World,Inc.
WM Wr.11-1a
The Commonwealth of MassachuseM
Department of Industrial 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 M DOW hl DR I aF 1,1i'll,�F ST1ERJQJ JMA C1414 SETTS
Address: 102-1 r,1 V f 1M
City/Sta&Zip: W>ESTF 1 E L tj M l4 o t 0$S Phone#: 413
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with Z 4. ® I am a general contractor and I 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 1
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers' g Building addition
[No workers'comp. insurance comp. insurance.'.
required.] 5. [� We are a corporation and its
l 0. Electrical repairs or additions
3.0.1 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 13.[9 Other Ri1.ACFJMfrN"f
employees.[No workers' W 111 VOW
comp.insurance required.]
`Any applicant that checks 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 anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-conaractors 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 than is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: L-1 OEtLTV MtkTUAL 1MSuQANGF —
Polic-#or Self-ins.Lic.#: W I rJ— 377 q7 -Ul.S Expiration Date:
Job Site Address: n r.�j I I Qd City/State/Zip.n &J'1Ct' �I v(OL�_
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.
1 do hereby certify un#q the pains and 5. of perjury that the information provided above is true and correct
> 'k-
Phone#: L413 y Q 5 - '7335
Officio!use only. Do not write in this area,to be completed by city or town o,,�`icial
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 Not Applicable ❑
Name of License Holder: RD ' T I5 4,S 4 ��_
License Number
t t'Z'� �ooscy`�t✓R � v� .� _ 570 1 ►
Address Expiration Date
FE ED i 96 u t L l-S M14 Q11D3Q 41'3 -{596-ci,2�
Signature 112 Telephone
Registered Home Improvement Contractor: Not Applicable ❑ i
- RV BEET S� 14f tZ 1 10
_ s � � 5 I
Company Name Registration umber
II WIti'0Th) %i�vv-- UD f.7�r Wr=ST��?;; MASS t; C, 37 1 5 ) N e
Address �__� _ _ ' Expiration Date
I0744 i`ORT14 Qb wp5—jTICLa�, NA Telephone9igLltl 335
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
i Signed Affidavit Attached Yes....... No...... ❑
IL - 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 108-3.5.1.
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 _
SECTION 5-DESCRIPTION OF PROPOSED WORK{check all applicable)
New House j Addition [� Replacerne t ndows Alteration(s) � Roofing r j
Or Doors 3
rr-
ss--77
Accessory Bldg, El Demolition �f � New Signs [M] Decks [C] Siding[p] Other[CM] �
r
Brief Descri tion of Proposed
WorR:
I Alteration of existing bedroom Yes No Adding new bedroom_ Yes No
j Attached Narrative Renovating unfinished basement Yes ,No
! Plans Attached Roil -Sheet j
i 6a. If New house and or addition to existing housing, complete the following:
a. Use of building:One Family__ Two Family— Other _
I
b. Number of rooms in each amily unit__ Number of Bathrooms
C. Is there a garage attached?
d. Proposed Square footage of new constuction_ Dimensions It
e. Number of stones?
f. Method of heating? _ Fireplaces or Woodstoves_ Number of each
I
g. Energy Conservation Compliance_, _Masscheck Energy Compliance form attached-,
i
h. Type of construction
1. 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 }
1 fl Ly5 s a f (zq o w D as Owner of the subject
property
hereby authorize (��WkT t-5,4'o
' to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as OwneriAuthorized j
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.
Py nt Name _
Signature of er/Agent Date
Section 4. ZONING Atl 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 bidg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/19i ding ever been issued for/on the site?7Z
NO O DONT KNO 0 YES O
IF YES, date issued:
IF YES: Was the permit rec rded at the Registry of Deeds?
NO O NT KNOW Q YES 0
IF YES: enter Bo k 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 0 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 O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status.ofPem�it
'6 Building Department ivuf Pe' , I
212 Ma'Ir Street �' "' ' Vaitaf�ili#y
Room 100
Northamoton, MA 01060 Fxva Sc
phone 413-587-1240 Fax 413-587-1272 F fitSi Jain
t?ttier Sp�eclf3r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
I ��_ f�ocx_� ` Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
i w aocKvi
Name(Pant) � Current Mailing Ad re —7�1
5ce LA t,1 1 t a C � _ Tele hone
Signature
2.2 Authorized Agent:
R-'0 6E P-T E S U 5 H i; 10'Zq N Ir M w e STE I EL.D AAA
Name(Print) Current Mailing Address:
-S 41
Signatu a Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. BuiJing -� co (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) 00 Check Number T
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
it
188 ROCKY HILL RD BP-2015-1077
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 37-046 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-2015-1077
Project# JS-2015-002033
Est. Cost: $8737.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 43560.00 Owner: BROOKS ROBERT L&KYLE R ALAMED
Zoning: Applicant. ROBERT BUSHEY JR
AT. 188 ROCKY HILL RD
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 () WC
WESTFIELDMA01085 ISSUED ON.51712 015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 18 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 5/7/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner