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30A-068 Window World of Western Massachusetts Gaon'"' NOUSFKEFVING 1029 North Road-Hampton Ponds Plaza, •Westfield MA 01001 `•`* •� �, � f Phone(413)485-7335 • Fax(413)-485-7055 NAT-41779-1 BBB. www.WindowWorldofSpringfield.com HIC#165641 s<, "Simply the Best for Less" CSL#57011 aew Customer: 7- 'i: .. Phone(h) _ Install Address: t Phone r Bill Address: E-mail /N-j- C WINDOW WORLD GLASS OPTIONS ADD U VALUES 2000 Series Mech.Frame Welded Sash $189 SolarZone Glass Package* (LE) $79 4000 Series DH $215 SolarZone Elite Glass Package*(LEE) $89 6000 Series DH(Triple Pane) $249 Picture window $329 SolarZone Plus(Super Spacer) (LEEP)*$110 2 Lite Slider $329 _ SolarZone TG2 3 Pane Glass(6000 Only) $155 3 Lite Slider 4.,1z,,141 +,a ap ira1. $575 ` SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185 Awning $295 Casement LH RH $295 'All SolarZone packages include 111 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 LA1YV) Basement Sliders<55 UI $239 MY HOME WAS BUILT IN THE YEAR—';, INITIAL: --!it Hopper(In existing wood)(Vent+$150) $195/$250 EPA LEAD SAFE(Per Window) $60 I Specialty Window Y; ; i l %' EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100 — Bay/Bow(Insulated seat Int.Casing&Ext.Cap)H'Plus$3375 EPA Lead site setup&disposal fee: $100100 Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995 Grids/Ext,coiornra.Woodgrain/CGlorscalculated in ww upgrades _ ,,,.- EPA Lead,third party verification: $4M00 Remove Existing Bay/Bow $250 - P��ciine third party verification ❑(INITIAL): i Reframe&Retrim(stain/paint not included) $300 ' 1� I " I)I have received a copy of the Lead hazard in orT matron pamphlet Roof for Bay/Bow Window $600 infornrintrme 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 1, / (ir tial)I have received a copy of the lead test result(s). Inside Outside J / r l Sign: 4/-146,1t✓L(/ Date: ` 1, a" WINDOW WORLD UPGRADES NameO(Print) V,r g(,v cr0 k. +'..iii;;7-7"j Full Screens $35 BEIGE Color charge $50 MISCELLANEOUS LABOR Ext.Color(AT)(AB)(DC)(HK)(FG)(ER)(CG) $165 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 Specialty Custom Exterior Trim/Wrap $ Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Quick Trim(Int) (Ext) $30 Diamond/Brass Grids(TOP)(FULL) $120 Aluminum/Vinyl or Steel Out $50/$125 Oriel/Cottage Style(40/60)(60/40) $45 Mull Removal $30 Obscure Glass Per Sash(BOT)(FULL) $35/$70 Mull to Form Multi-unit $30 Tempered Glass Per Sash(BOT)(FULL)$60/$120 Install Interior Stops(WHITE VINYL) $45 Catalog Options $ Install Exterior Stops(WHITE VINYL) $45 VINYL PATIO DOORS-LH or RH(Outside Looking In) 'I 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) $1300 Mobile Home Conversion $200 8 Ft.Sliding Patio Door(LH)(RH)_ ', $1500: Remove/Re-Install A/C or Awning ` Patio Door Beige Color $125 Patio Door Low-E/Argon $125 Site Setup,Removal,In Home Service,etc.: 256:00 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 50%Deposit Amount: Exterior Colors $395 Patio Door Triple Pane Upgrade $250 []Cash Keyed Lock$36 Foot Lock$51 Storm Door Model $ []Finance-( )Welts Fargo ( )Other [].Check made to Window World of WM# NO EXTRA WORK IF NOT IN WRITING! � R 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 f - 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! Owner ate ^ D >. . Salesman Date i Owner —Date''t' This Window World®Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc. WM we 11-14 White Copy-Original Yellow Copy-File Pink Copy-Customer _ _ nn The Commonwealth of Massachusetts Department of Industrial Accidents Of free of In vestigations 600 Washington Street Boston,MA 02111 u4m mzvs gov1dw Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOcant Information Please Print Leidbly Name(Business/Organization/individual): w LJ,DW �jDk Lb_ IJE WE-5T A /i1A S:C.4GNUl5ETTS Address: 10 2a N V 91W AT) City/State/Zip: W)ES IP)I L--t> M lk 010$S Phone#: q 13 `f 15 — 7 3 3 5' Are you an employer?Check the appropriate box: Type of project(required): 1.[9 I am a employer with ?- 4. 0 I am a general contractor and I 6 New construction employees(hall 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. DemoIition work' for me in an capacity. employees and have workers' � Y aP tY- 9. ❑ Building addition [No workers'comp, insurance comp, insurance.*. required.) 5. We are a corporation and its 1 o.F-1 Electrical repairs or additions 3.F-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, §i(4),and we have no employees. [No workers' 13.N Other PC,F.1 &J comp.insurance required.] w!JM'DOwS 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 anew 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 that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LOU—Ty /MKIMAtL 1AL5UA WGC_ Polic;,#or Self-ins.Lic.#: H/C.2— 3 11 S- 3-77-9 q -015 Expiration Date: �-7D -Z Job Site Address: iJ J I _City/State/Zip: Not a �� 'PA ft ' `' Ii,l Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ()1 V 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 hereby certify under he pains an enables of perjury that the information provided above is true and correct . t 5 Signature: Af '� Date: Phone#: 14 13 `1oz 15 - ?33S Official 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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES ,_kS.1 Licensed Construction Supervisor. Not Applicable 0 I� 1 Name of License Holder: b5z Q771-�._�_i I ' License Number j 2� SOS 5V E t.,.�i A V'�� Address Expiration Date Signature Telephone Registered Home Improvement Contractor. Not Applicable 0 5L- i ! jCompany Name Registration umber I yv t ti 7 D-rj w-vR-L® ©fir ( r`a i�a< � M 4_S6, i Address r Expiration Date !G?lq "�jZT0 eb WPS'r�iEL-� /AA 010 _Telephone y1;L-4 .� 33 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.Lic^152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted wrath this applicajon. Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached Yes....... No...... 0 IL - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellinags 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.:.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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) I 1 New House r__j E Addition u FZePlaceme down 1 Aiteration(s) Roofing Or Doors /� Accessory Sidg. 0 j Demolition E New Signs !(-1] flecks Siding[0] Other[CI] Brief Descnp>ion0 P: sedd Work: __.� -1�.. X _� i Alteration of existing bedroom Yes No A;ding new bedroom Yes No Attached Narrative i Renovating unfinished base_ment Yes No Plans Attached Roil -Sheet i �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 i I C. Is there a garage attached? i d. Proposed Square footage of new construction-------_ Dimensions e. Number of stories? I f_ Method of heating? Fireplaces or Woodstoves —Number of each o. Energy Conservation:Compliance. Masscheck Energy Compliance form attached jh. Type of construction i. Is construction within 100 ft_of wetlands? Yes No. Is construction within 100 yr. floodpiain Yes No i i + j. Depth of basement oc cellar floor below finished grade_ k. Will building conform to the Building and Zoning regulations? --Yes No. i I. Septic Tank City Sewer Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN 1 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 RCr /1 h ���� _�reP,(�,11 - ,as Owner of the subject property hereby authorize &1)6e?4-T c (3u S w'l- to act on m/y behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I _ _ is 0 REg I, . i"S He 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. I j Signed under the pains and penalties of perjury. j i Py nt Name Signature of WeT/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 t � Frontage Setbacks Front j Side = L: R: L: R: 1 i Rear Building Height Bldg.Square Footage—--�� Open Space Footage ( % (Lot area minus bldg&paved 1 C ar` p king) #of Parking S aces Fill: (volume&Loc ion) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 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 Obtained U 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 chances to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Weil 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 Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. rZ Department use only ty of Northampton staters of Permit., JUN 8 2015 ilding Department ,CU/D0VeWay Pem�ut ________--_ --az 212 Main Street Sewerl, p%lcAuarlability Electric, Plumbing&Gas inspections Room 100 ft. Northampton. MA 01060 amDton, MA 01060 two Se#s�S ,�1:Pl�is " phone 413-587-1240 Fax 413-587-1272 Plot/Site Flans per �ify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH'A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION sJ� This section to be completed by office 1.1 Property Address: aq S R fsrt A ce PIA Map Lot Unit Nb(+�MptM M n -, 0(©�9, Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � t)(A I K a -nom qS� �b�, 1�,P 't` Name(Print) Curr nt Mailing Address, 1 3 - �-}_-`33�1 a- Sf� (,r,)7'I''a C" Telephone Signature 2.2 Authorized Agent: jZ10 6—t —T E g if.5 H E 102-q jy C j`-714 iZ-� irk c STP-1 f L D AA14 Name(Print) Current Mailing Address: 413 4<sS 'T33 5 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted b ermit a licant 1. Buiding (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) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date w 295 FLORENCE RD BP-2015-1270 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-068 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2015-1270 Project# JS-2015-002329 Est. Cost: $1454.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin ROBERT BUSHEY JR 057011 Lot Size(sq. ft.): 14897.52 Owner: WHEELER RICHARD H&CATHLEEN M Zoning URA(100)/WSP 1001/ Applicant: ROBERT BUSHEY JR AT. 295 FLORENCE RD Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 () WC WESTFIELDMA01085 ISSUED ON.61912015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOW 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 6/9/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner