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29-334 (2) Window World of Western Massachusetts u GOOD /��� 1029 North Road-Hampton Ponds Plaza,•Westfield MA 01085 Phone(413)485-7335• Fax(413)-485-7055 NAT-417791 www.WindowWorldofSpringfield.com HIC#165641 "Simply the Best for Less" CSL#57011 Re as Hospim Customer: Phone (h) Install Address: ;n f Ra Phone(w) f^ /1V 7, E-mail Bill Address: WINDOW WORLD GLASS OPTIONS ADD U—VALUES $245 4000 Series DH SolarZone Glass Package* (LE) $79 6000 Series DH(Triple Pane) $279 7�; , 1 Picture Window $359 SolarZone Elite Glass Package*(LEE) $8 9 2 Lite Slider $359 SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185 3 Lite Slider (1/4,1/2,1/4) (1/3,1/3.1/3) $605_ Aft Soli packages include 112 screens,Foam insulation oil Jambs and Head,Double Awning $295_ Strength Glass,Double Locks(>29'),Lifetime Glass Breakage and Labor Warranty,Argon Gas Casement LH RH $295 _ PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMENT LAW) Twin Casement(Requires 2 Value+)(0973)(0979) $590_ MY HOME WAS BUILT IN THE YEAR I INITIAL—"' Three Lite Casement(Requires 3 Value+) $885 EPA LEAD SAFE(Per Window)t"`�'7_17t, $60 —Basement Sliders<55 Ul $250 Hopper(in existing wood)(Vent+$150) $250 —EPA LEAD SAFE(Patio Dr/Bay/Bow/Garde n) Specialty Window $ EPA Lead,third party verification: $475.00 �Ba ecBow(Insulated seat,Int.Casing&Ext.Cap) decline third party verification ❑(INITIA ard en Window(Insulated seat,Int.Casing&Ext.Cap) $1995 (Initial)I have received a copy of the Lead hazard itorFn5fi pamphlet Grds/Ext.copont.Woodgrain/Cclors calculated in M Upgrades �Ze of the potential risk of the lead hazard exposure from renovation activity to be Remove Existing Bay/Bow $300 performed in my dwelling unit,the EPA"Renovate Right"brochure. Refirame&Retrim(stain/paint not included) $400_ Roof for Bay/Bow Window $600 1 have received a copy of the lead test result(s). Second Floor Installation $500 Sigirr Date: Window Color Inside Outside Name(s)(Print), WINDOW WORLD UPGRADES MISCELLANEOUS LABOR '4' Full Screens $45 Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79 +(7 BEIGE Color charge $50— 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) $49_ Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69_ Aluminum/Vinyl or Steel Out $50/$150 Diamond/Brass Grids(TOP)(FULL) $120_ Mull Removal $30 Oriel/Cottage Style(40/60)(60/40) $45 Mull to Form Multi-unit $30— Obscure Glass Per Sash(BOT)(FULL) $35/$70_ Tempered Glass Per Sash(BOT)(FULL)$60/$120 Install Interior/Exterior Stops(WHITE VINYL)$55 — Catalog Options Customer Provided Stopsi'Trim $46 VINYL PATIO DOORS-LH or RH(Outside Looking In) Install Interior Casing $95 (Includes:White Interior Casing and Exterior Trim.) —Repair/Replace Sill or Brickmould $75 5 Ft./6 Ft.Sliding Patio Door(LH)(RH) $1500_ Mobile Home Conversion $200 8 Ft.Sliding Patio Door(LH)(RH) $1800 - Remove/Re-Install A/C or Awning $100 Patio Door Beige Color $125_ Patio Door SolarZone $125_ Heat Buster Package Upgrade SolarZone Elite$215_ Site Setup,Removal,In Home Service,etc.: (I X250 0t7"; Patio Door Grids(Regular)(Woodgrain) $100 Extra labor(Box on left for description)$ Woodgrain/Brown(LO)(DO)(CH)(FX) $295_ Total Amount Due$ Exterior Colors $395 S 7 Patio Door Triple Pane Upgrade $250— 50%Deposit Amount: —Keyed Lock$36 Foot Lock$51 Storm Door Model $ - ]Cash Finance Wells Fargo Other Check made to Window World of W # NO EXTRA WORK IF NOT IN WRITING! ]•CC# Exp.Date: V-code Final Payment Almount$ To be paid to the installer upon installation.Thank You. Sales Rep Recommended:I 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 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 1,42'A 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! 7 Owner Date ,4 Salesman Date Owner Date This Window World*franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc. WM WC 06-15 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayes printing 888-667-1116 The Commonwealth of Massach use& Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 01111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plnmbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): W j N L7f)W )U0g D nF WJ�ST59A MA SFACYAs>£TTS I Address: 102-01 NVRIT A D City/State/Zip: W F_STF t F I. tA pr D t 0$S Phone#: L113 `'t 7 S — 7 335 Are you an employer?Check the appropriate box: Type of project(required): 1.(9 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 ship and have no employees Thy subcontractors have g. []Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers'comp. insurance comp. insurance.+ required.) 5. We are a corporation and its I0.❑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 12.0 Roof repairs insurance required)t c. 152,§1(4),and we have no employees. [No workers' 13.99 Other R�C�t'T' A VOWS comp. insurance required) I W 1 *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 am 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 subcontractors and state whether or not those entities have employees. If the sub-cons actois have employees,they must provide their workers'comp.policy number. lam an employer tlW is provid ng workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LI 6ER7ry MKTUAL 1MSU*P"CF_ - Policy#or Self-ins.Lic.#: %(!.2_- r .2— ';1 S- 3'7'7q L17 -015 Expiration Date: 197-7-2Z Job Site Address:_CY I—!C ��r f)C)K. City/State/Zip: f- �} p. 0 (U 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 a 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 8areby certify r thepa1ns,,;m#pejgW&of perjury that the information provided above is flue and correct Si e: ! Date: L O Phone#: '4 13 yQ S ' 7335 Of)°icw use only. Do not write in this area,to be completed by city or town gQuial City or Town: PermitlLicense# Issuing Authority(circle one): I.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 ofLicenseHolder: dksgrq License Number _ 12-7 AVE 57011 Address Expiration Date FE EN 96 IM-1-S MA 01030 413 51SW)4 Signature Telephone 12S J 1 -7 .Registered Home Improvement Corr4actor Not Applicable ❑ Rv eF-e.-r Bus4f-y S2 1 t* 5 1p q Company Name Registration umber) W I tipper w 0-al-p ©`r W F STeRJC M ASS 1� G 3 T 1 5! 1 (o Address Expiration Date 1074 Np{LT}; Q'b W E S7p I E Lab AAA Mo f q` Telephone q 19 4EiS 733 5 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 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 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 OntY a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition F__J Replacement Alteration(s) Roofing Or Doors Accessory Bldg. 0 Demolition 0 New Signs [Q] Decks [Q Siding[M] Other[CO Brief Description o Proposed —7 �p a t �1 Work: C i► 1101 / 1' X) C UL Y I L� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No 1 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? l+ d. Proposed Square footage of new construction. Dimensions I e. Number of stories? I 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 fL 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 coLe M JJ as Owner of the subject property p hereby authorize ) u.5 t tvL 1 to act on my behalf,in all matters relative to work authorized by is building permit application. , ( SQL /Go myaC'-) " 1 Signature of Owner Date I, R 0 BED BVS H£I-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. 1 IDSF-9 " Bus NE Py nt Name - alo�. �� �. 7, . Signature of Own r/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 Frontage Setbacks Front Side L: R L: R RearF' J 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 ver been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit record at the Registry of Deeds? NO O DO KNOW O YES O IF YES: enter Bo Page and/or Document# B. Does the site contai a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a p it been or need to be obtained from the Conservation Commission? Needs to be tained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO 0 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. Deparhmlt.+�se only City of Northampton 'Building Department r r� 212 Main Street k" Room 100 ..,. yX P bin9&Gas i 0 hampton, MA 01060 P tnampton,MA a 413-587-1240 Fax 413-587-1272 No APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH'A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION yre�ss: (� This section to be compietied by office 1.1 'Property Add js-C ` ,c. e o�()� l "� Map Lot Unit `,._ I u e o l_e Oft p- O 100� tone Overlay District Elm SL District CB Dist ict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Print Curre�nqt M ding Addr ss: _ ( � see cc r�Y'IXC� ) `�-1 A� Telephone Signature 2.2 Authorized Agent: Ro&EPLT E BUs146 102-q NCM wEsTEWLD AAA ®ID'S Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Buiding VV5 ()o (a)Building Permit Fee 2. Electrical V (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Comm issionedlnspector of Buildings Date 252 ACREBROOK DR BP-2016-0273 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-334 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-2016-0273 Project# JS-2016-000418 Est. Cost: $35.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT BUSHEY JR 057011 Lot Size(sq. ft.): 10497.96 Owner: COLEMAN CHARLES L zoning: Applicant: ROBERT BUSHEY JR AT. 252 ACREBROOK DR Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 O WC WESTFIELDMA01085 ISSUED ON.8/27/2015 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 8/27/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner