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10-012 (3) Quote http://sstsrv.lowes.com/m2o_a/mediumQuote.jsp?... Glazing Type: Insulated Insulated Type: Dual Glass Strength:Annealed Insulated Glass Option: Low E Low E Glass Style: Advanced Gas Filled:Argon High Altitude:Non High Altitude Sash Lock: Standard Lock Window Opening Control Device: Standard Vent Stop Limited Opening Hardware:No Limited Opening Hardware Hardware Finish:White Screen Option:Full Screen Screen Shipping Option: Shipped In Unit Grille Type:Grilles Between Glass Actual Grille Bar Profile: 3/4-in Contour Grille Interior Color: White Grille Exterior Color:White Grille Pattern:Traditional Upper Grille Division Type:Custom Lower Grille Division Type:Custom Upper Lights Wide: 3 Upper Lights High:2 Lower Lights Wide: 3 Lower Lights High:2 Will This Product Be Installed By Lowe's(R)'?: Installed By Lowe's(R) Is This A Remake?:No Lead Time:28 Item Number:530802 Project Total: $425.42 Salesperson: CHRISTOPH CAMERLIN(S066OCC1) Accepted by: Date: 11/03/2015 Print Detailed Quote This Millwork Quote is valid until 11/9/2015.This is an estimate only.This estimate does not include tax or delivery charges.Delivery of all materials contained in this estimate are subject to availability from the manufacturer or supplier. All the above quantities,dimensions,specifications and accessories have been verified and accepted. 2 of 2 11/03/2015 04:19 PM Quote http://sstsm1owes.com/m2o_a/mediumQuote.jsp, Back to Quote LOWE'S HOME CENTERS,LLC#660 1560 BOSTON ROAD f SPRINGFIELD,MA 01 129-1141 USA Date: 11/03/2015 (413)543-0601 Project#: 457318851 Description: pella 250 for baths Customer Name: EDWARD O'BRIEN Customer Phone: (413)586-2726 Customer Address: 507 KENNEDY RD LEEDS,MA 01053 USA Line Item Product Code Frame Size Description Unit Price Quantity Total Price 0001 Manufacturer:Pella(R)250 Series Windows Size=27 1/2-in W x 37 Division:Millwork 1/4-in H Product: Windows Type: Double Hungs Manufacturer:Pella(R)250 Series Windows Energy Star(R)Qualified Products Only: Yes-I would like to view only the units that are qualified for Energy Star(R). Energy Star(R)Zone:Northern Room Location: Bath 1 Configuration: 1 Wide Frame Type:Block Actual Frame Width: 27 1/2-in Actual Frame Height: 37 1/4-in Fits Opening Width: 27 3/4-in Fits Opening Height: 37 1/2-in Venting Height: Equal Unit Type:Complete Unit Performance Option: Standard Exterior Material Type: Vinyl Foam Insulated: No Foam Insulated 6 Actual Base Frame Depth: 3 1/4-in Actual Base Wall Depth: 3 1/4-in Sill Adapter: Sill Adapter Included Head Expander: Head Expander Included Exterior Color: White Interior Color: White $212.71 2 $425.421 5 1 of 2 11/03/2015 04:19 PM CONTRACT At 0 0 0 2 u 1 U MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LO S AUT�RIZED REPRESENTATIVE NUMBER CUSTOMER STORE NO.v STREET ADDRES;� ) ,s STREET ADDRESS _ [..., 4-_ tr--.V_a;GCL _jT -J r ��✓7 �.' CITY STATE ZIP CRY ) STATE ZIP TELEPHONE f TELEPHONE DATE 7 LOWE'S HOME CENTERS,LLC'S MA HIC NO.:748688 CASH BANK LCC REG 1, FEIN:56-0749359 CHARGE This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment.Upon payment the antis agreement,including the specifically completed pages of this document the Terns and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY STATE ZIP r 12..4'f��- f, - PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Contract Total Are permits required for this installation?:[X Yes [ ]NO "applicable tax included ' U NOTICE TO CUSTOMER:Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:If rotted wood is discovered during installation additional charges will a ply.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. 9-_Customer must initial. 4 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY INSTALLER) I,the undersigned Installer/Independent Contractor,having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project will be or has been completed in a workmanlike manner and to the Customer's satisfaction.In consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by applicable law,I hereby waive and relinquish all liens and all rights and claims of liens which 1,the undersigned,now have or may hereafter have for labor or materials fumished,and further certify that all work performed and materials furnished,if any,by any other party or parties upon the order of the undersigned,have been fully paid for.Further,I the undersigned,agree to cause the prompt release of any mechanic's lien(s)which may be filed against the Customer's premises by any subcontractor,laborer,mechanic or material supplier claiming the right to file such a lien through work related to the Customer's Contract with Lowe's.In addition to any warranties provided by law or specified elsewhere,including the Customer's Contract with Lowe's,the undersigned,further warrants that all work fumished for this project shall be free from defects either in material or workmanship.If any defects in material or workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees to replace or correct such defective work or material,free from all expense to Lowe's and the Customer in a manner satisfactory to the Customer. I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customer's premises. If applicable to the performance of the work required for this project,I,the undersigned Installer/Independent Contractor,do hereby certify that I have complied with all requirements of the Lead Renovation,Repair,and Painting Program Rule("LRRPP Rule'),40 C.F.R.sec.745.80 at seq.,or any applicable state laws or program regulating lead-based paint safe work practices, including compliance with all information distribution,notice requirements and work practice standards in performing the work required for this project.I certify that I have provided the Customer with all documentation required to be supplied under the LRRPP Rule or state program,shall retain all records required by law,and have attached to this document copies of all of the records required to be retained by the LRRPP Rule or applicable state program. Signed and delivered this day of (seal) Installer Print Name CERTIFICATE OF COMPLETION 1.I,the Customer;certify that the InstallersllMependent Contractors or their sub-miltrectois,have furnished all Goods ardior,services,that installation,repairs and alterations or improvements (°the installation servicesl have been completed as set forth in mylour contract with Lowe's,and that I have been offered the opportunity to request that Lowe's allow me to retain some or all of any unused,receripted surplus materials rather than have such surplus materials remain the property of Lowe's. 2.Buyer's initials(Buyer INITIAL ONE only) There were no such surplus materials: I accepted all surplus materials I warded. I declined to receive any surplus materials. Date: Owneft Signature Owners Printed Name INSTALLER COPY 02 Dy Lowe's.®Lowe's and the gable design 55102 REV. 12/13 are registered trademarks of LF Corporation. City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 50� K'— PQ Oaf W -'I'- ('S m4 ok O-�; The debris will be transported by: �3 ,��,�.�=�_ The debris will be received by: 1KAC..QAIW _ -�") Building permit number: Name of Permit Applican Date gnature o ermit Applicant The Commonwealth of Massachusetts 000���bb Department of Industrial Accidents Y Office of Investigations -/ .a l Congress Street, Suite 700 Boston, MA 02774-2077 7M 0� www.m ass,govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name deai). ���"l� ly��yl�� " (ZeQ Address. �J - -�S- City/State/Zip. Li+ yJV�C�Iry(-1�� I � ne Are you an employer? Check the appropriate box. qq ❑ Type of project (required). 1.❑ I am a employer with `t aiTr a gen oral contractor and ❑ =g have hired the sub-contractors 6' New construction ttt���///�,�,� mployees (ful and/or part-ti rn e). s 2 I am a sole proprietor or partner- listed on the attached sheet 7. El Remodeling ship and have no employe These sub-contractors have 8, ❑ De rn al in cin working for „e in any capacity employees and have workers' �. 9. ❑ Building addition [No workers' 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 par MGL_ 12. Roof re airs insu,once required.] + �. 152, X1(4), and we have no employees. [No workers' 13. Other 31 comp, insurance required,I *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Hoi.,eownEis who submit tin is affidavit irdi ing they Ore doing ull work and then mint submit a 111.w affidavit indicating such. °�onLractor�th at check this box state✓rhethet or nottho>c e_nti[ies have e m g ioyee�, f the s,,b-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 ,nfo,—ti°n. Insurance Company IAeme: �� Policy # .- Self-ins, L_.- #: / V' �'” � Fxpirat—, ate I Job Site Address: �Q {��' � VJJ 1 1 l City/State//,,p o i(3�) 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 MGF c. 152 can lead to the imposition of criminal penalties of a fines up to $1,500.00 and/or ono-year iuIprison ant, as well as ci„il pa (ties in fine form of a STOP WORK ORDER and a fine of up to 5250,00 a day against e violato e advised that a .op f this statement may be forwarded to the Office of Investigations ofthe DIA f nsw on overage verlfican on ldo hereby certify i de the ain and penaltie at the info,rn ate n provided above rs true and correct. Si<natt 1 Date: Phone 5 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. pity/Town Clerk 4. Electr cal Inspector 5. Plumbing Inspector 6 Other Contact Person Phone #: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable t❑ �{ t Name of License Holder: License Number Address Expiration Date �Wre Tele 9. Registered Home Imarovement Contractor: Not Applicable ❑ Company Name Registratio Nu ber Address ) T � Expiration Date Telephone�I� J 5 D C;b ©� Y` . SECTI N 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 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 y 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 ❑ Addition ❑ ReplacementW,01dows Alteration(s) ❑ Roofing ❑ Or Doors Z Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[p] Other[0] Brief Description of Pro d Work: '6 �fA' >:� W t' r�' 134 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -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. 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. 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 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit app cation. r Signature of Owner Date as Owner/Authorized Agent hereby de-dare that the statements and inT'ormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains a Itie ry. Prin e l� re er/A e 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 tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage °o (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 U DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 Q DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q 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 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: NOV 201 Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability p Room 100 DEPT o Pa:'� Water/Well Availability NORr"AM rc VA sc�. Northampton, MA 01060 Two Sets of Structural Plans. phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 55T Map�� Lot Unit CAC Overlay District `` Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: L•�t`-+ �( T Telephone �� .• 9G Signature 2.2 Authorized Agent: 016S75- Name Current Mailing Address: Sig ur Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted bV permit applicant 1. Building f (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) z 03' Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 507 KENNEDY RD BP-2016-0699 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 10-012 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-2016-0699 Project# JS-2016-001172 Est. Cost: $1075.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWE'S 049918 Lot Size(ssq. ft.): 26397.36 Owner: O'BRIEN EDWARD F&ANDREA M Zoning: RR(100)/WSP(100) Applicant: LOWE'S AT. 507 KENNEDY RD Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588-0270 WC HADLEYMA01035 ISSUED ON:11/18/2015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 2 PLACEMENT 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 11/18/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner