35-067 (7) Window World of Western Massachusetts
NOUSEKFFPING ``
1029 North Road-Hampton Ponds Plaza,°Westfield MA 01001 CIZE �`*_'°.• �l
Q/L Phone(413)485-7335 ° Fax(413)-485-7055 NAT-41779.1 BBB
www.WindowWorldofSpringfield.com HIC#165641
"Simply the Best for Less" CS #57011 P9
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 $329 SolarZone Plus(Super Spacer)(LEEP)*$110
2 Lite Slider $329 SolarZone TG2 3 Pane Glass(6000 Only) $155
3 Lite Slider (1/4,1/2,1/4) (u3,1/3,1/3) $575
Awning $295 SolarZone TK2 3 Pane Glass/Krypton(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 +.z INITIAL:�-ti
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)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/Colomo iculated 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 in ormatlon pamphlet
Roof for Bay/Bow Window $600 n of rmmg 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
Sign: �..:',< Date:
WINDOW WORLD UPGRADES Name(s)(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(sMooTH)(Pvc) $79
Woodgrain Interior(LO)(DO)OH)(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
Catalog Options $ r, 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) $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 Low-EiArgon $125 Site Setup,Removal, In Home Service,etc.: $250.00
Heat Buster Package Upgrade $215 Extra labor(Box on[eft for description)$
Patio Door Grids(Regular)(Woodgrain) $100 Total Amount Due$ 1
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-O Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING! [].Check made to Window World of WM#
[]CC# -
t
Exp.Date: V-code
Final Payment Amount$ 1' -
- 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 ridnight of the following third business day.
THIS IS A CUSTOM ORDER NOT FOR RESALE!
Owner Date
Salesman Date Owner Date
This WindowWorld®Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc.
wM WC 11-14 White Copy-Original Yellow Copy-File Pink Copy-Customer
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass gev/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Auiplicant Information Please Print UMMY
Name(Business/Organization/Individual): W l Al l tDW kVgLD DE WC-6M5Ah) MASKAC- ISETTS
Address: l 02-q N V Q-4 WD
City/State/Zip: vY)ESTF I E l-t) tA Pr b 10$S Phone#: L4 13 `t 15 — 7315
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 Q New construction
employees(full and/or part-time)." have hired the sub-contractors
2.El 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' g Q Building addition
[No workers'comp. insurance comp.insurance.
required.] 5. Q We are a corporation and its 10.C] Electrical repairs or additions
3.0.1 am a homeowner doing all work officers have exercised their 11.0 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.M Otherrli� 1r►ENT
employees. [No workers' W`N
comp.insurance required.]
'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 sheet showing the name of the sub-contractors and state whether or not lose 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 kwancefor my employees. Below is the policy and job site
information.
Insurance Company Name: L16ERT<J MKIMAL 1M5U*ANC-V-
Polic:,#or Self-ins.Lic.#: WC.2.- 315- 311947 -015 Expiration Date: S-7• O _
Job Site Address: l-N � City/State/Zip: 'P�B y—A c,
_ A-A l��
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 tm 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.4ereby certify mn e pains and penalties of perjury that tke information provided above is true and correct
Si e: 1J- Z 2-t 1)
Phone#: 'i 13 40o 5 . 7335
Official use only. Do not write in this area,to be completed by city or town o.&w-,k l
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
Licensed Constructio n Supervisor. Not Applicable 0
Name of License Holder
License Number
570 11
crress Expiration Date
at 1 L L h'i A
Telephone
,/9. Registered Home imorovernent Contractor. Not Applicable El
CornpanN Name Registration 'umber
vV i k;-00%j �vV-L-0 oi-
A,4UFess ExDiration Date
j2.'r,) WE�5— !NJA 010� T lephone t3 -73
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
'Alor'kers C-ompensation insurance affidavit mijst be completed and submitted with this appiication- Failure to provide this affidavit vAl result
in the denial cF:-he issuarca of the building permit
Signed Affidavit Attached Yes... No Ej
11. - Rome Owner Exem tion
The cun-ent exemption for"homeowners"was extended to include Owner-occuivied Dwellings of one(1) or two4,2)families
and to allow such homeowner to engage ar ipdi�Jdual 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') •hC cwn 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 mo-year period shad not be considered a homeowner.
Such"homeowner"shall submit to the Plaildin2 Official,on a form acceptable to the Build=Official-that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction S�misor your presence on the lob site will he required from time to time,durin'o,and upon
completion ojffhe 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
Employ for injuries n
,ot resulting no,in Death)of the Massachusetts General Laws Annotated,you may be liable for person'sr
you hire to perfoan work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
"orthampton Ordinances,State and Local Zoning Laws and State olfMassachusetts General Laws Annotated_
Homeowner Signature
Si::CTION 6-DESCRIPTION OF PROPOSED WORK`--heck 9L�i�Iicable)
i Ro�lacerne endows t4e-.A,House 7!, Addition rl indows Alteration(s) F-1, Roofing ❑
0,P
-:],I Other T=I
Signs
Decks [E:J Siding[L
Acce,,- ,y Bldg, Demolition
D�-�sc;n,ptiori cl Proposed
of ex-:sLm.c bedroarn No A^ling new bedroom Yes No
At:ached Nar-mitive ReriovatinQ unfinished basement Yes No
Plans Attached Rol -Sheet
�ajf New house and or addition to existinct housinq, complete the following:
Use of building : One Family— Two Family------.Other---
N:-Iriber of rooms in each family unit:— N u r i ne r o'�Bath roo r n s
I Is mere a garage attached?
-�-,,posed Squa.?e foct2-4e of new C;onssucbon- D;Iner:sions
e. Number of stories?
Method of heabna? Fireplaces orWoodstoves Number of each
--Masscheck Energv Ccmpi;a7!ce form attached-,
vne -o, ;T-uct:on
n Yes No
�_lc7L�onvvit.iinlOOft. DfWet!2nds'? los No Isc�oistrL,�,cion,�.%ri,th;n !Ot,1 yr loodplai,
I
C'eptf7 of basement or cellar floor beiov✓'n'fshed grade
x buildma conform to the Building an d Zon.narecuiahons? Yes- No .
Septic Tank City Sewer P!wate well Cfty'Aeter Supply
uI-7�:TiON 7a-OWNER fi UTHORIZA7 ION-TO BE COMPLETED WHEN
0'vV`NERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
'ropeit,,
ce&a,
P-,v behalf n oil matters relative towork auttlorizedby this building per.--I application-
N
iatui-e Owner Date
A as OwneriAuthorized
y knowledge
i
declare that the statements and information on t�-,e foregoing application are true and accurate,to the best of rr
end belief.
under the oa;ns and Denal es of per]urr
eL
nt Date
7his colurrm to be filled in bv
Building Depamnent
ot Size
Setbacks F
Bldg. Square Footage
Oper,Space Footage
�F m�f Parking Spaces
A. Has a Special Permit!Variance/Fimbngever been issued for/unfne site?
H �� D0NTKM0YY \^��� YES \_���
O \~/
1F YES, date-issued:
IF YES. Was the permit recorded at the Registry ofDeeds?
�� �� ��
N0 DON'T Y2�
�� �� ��
IF YES: enter Book Page and/or Document#
B' Does the site contain a brook, bodI of water orwetiands! NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tnbeobtained �—\ Obtained /—\ Date '
[ Dm any signs e)dston the property? YES 0 NO 0
|F YES, describe size. typeaod \ocadnn�
D. Are there any proposed change� orad{ on� ofsi8oinendedforthepop �y � YE NO 0
!FYES, describe size, type and location:
E VWi|the cnna�uohonacdvd�di�urb( ring. goading vsion. or filling)over 1ameo/��pa�ufaoommonp!an
triatmiU disturb over � acre? YES ( ) NO ( )
��
|F YES, then amorthamnu,nStorm.Water Management porTn.:from'he opvvisrequired.
r�) C iC
Department use only -
z
'
82015 I ty�of Northampton Status of Perml:
I "1..h it ding Department -Curb Cuttc3ri_vq,wayPerr* 1
rg S`
212 Main Street epticAvafCakrliiy
pections Room 100 Water7lAteN,,�vaitab� j
N rha noton, MA 01060 T'wo Sets of a'trucwrw Plans �. I
l
phone 413-587-1240 Fax 413-587-1272 Plot/Site ,la`ns
Offier Specify
r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Pi ocoert r Address '�-- This section to be completed by office �{
Map Lot Unit
i 1`r 1 t O I�� Zone _- Overlay District I
i
Elm SL District CB District
;E4TiON 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
7
Ow,
er of Record:
l l'iame(Erin''=-) Current Mailing Address: I
t✓C Telephone e
icnature i
WY - -
22 Authorized Agent:
_ P-Ir i
i
t dame(Print} Current Mailing Address:
a,-e Telephone --
- - -�
�;ECTpION 3 -ESTIMATED CONSTRUCTION COSTS
—`te'^ I Estimated Coat(Dollars)to be Official Use Only ^_�
completed by permit applicant
(a)Building Permit Fee j
WS,
^ i
'' Electrical (b)Estimated Total Cost of
Construction from 6
?lun?bing Building Permit Fee
i
Mec,anical riv.AC)
i
L. ;.;r� ?rote&µion
s__�
`otal 4+3+2+=i1 +5) �(Q .UU --heck lumber
_ _ 5�.-
_
This Section For Official Use OnlyI
8uilding Permit Number: y V Date
i Issued:
Signature:
i
�y Building Commissioner/inspector of Buildings Date i
881 RYAN RD BP-2016-0100
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV.-Block: 35 -067 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-2016-0100
Project# JS-2016-000182
Est. Cost: $6855.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. ft.): 12806.64 Owner: ADAMS JANE
zoning: Applicant: ROBERT BUSHEY JR
AT. 881 RYAN RD
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON.7/28/2015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 10 REPLACEMENT WINDOWS & BAY
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 7/28/2015 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner