18C-127 (5) 86 BLACKBERRY LN BP-2016-1029
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 127 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-2016-1029
Project# JS-2016-001736
Est. Cost: $17086.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq.ft.): 19384.20 Owner: SULLIVAN NEIL
Zoning: URB(100)/ Applicant: ROBERT BUSHEY JR
AT. 86 BLACKBERRY LN
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON:2/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 30 REPLACEMENT WINDOWS & 2
ENTRY DOORS
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 2/17/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
�EQENEQ
Department use only
FEB 7 Z��s City of Northampton Status of Permit
Building Department C ffb C6t7Drfv y;Permit-
212 Main Street SewedSepticAvailabtlity
DEPT.OF BUI D!Nr INSPECTIONS
NORTHAMPTON,MA 01060 Room 100 VVafef7SN iAvatla'bill
Northampton, MA 01060 Twa Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Slte,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
.Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: (�
Name(Print) Current Mailing Address: 1 V
pA
l Telephone
Signature
2.2 Authorized Agent:
af�c�t d asui:ra� )y"'f :T_H I A) L,ti�`eTf i LL) iviV 610` 5
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
complete by permit applicant
1. Bui.ding 1 C v (a)Building Permit Fee
1
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
_f t7q
This Section For Official Use Only
Date
Building Permit Number: Issued.-
Signature:
ssued:Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
i
New House ❑ Addition [] ReplacementWjndows Alteration(s) Roofing
Or Doors �.
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [CJ Siding[CI] Other[Cg
1
,{Brief Description of Proposed ne
� W
! Alteration tgexisting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
t Pians Attached Roil -Sheet
i
sa. 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?
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 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
I, as Owner of the subject
property
hereby authorize ,::-
to
to act on my behalf,in all matters relative to work authorized byi building permit application.
Signature of Owner Date
as OwnerlAuthorized
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
j pain's'and penalties of perjury.
Pyint Name
V LIZ,-41
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing PPIroposed Required by Zoning
Tlas colurm to be filled in by
Building Department
i
Lot Size
Frontage
Setbacks Front
Side L: R- L: R:
Rear
Building Height
Bldg-Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arkinQ)
of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been ' sued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
1F YES: Was the permit recorded at the Reg' try of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body f water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or n d to be obtained from the Conservation Commission?
Needs to be obtained 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.
I SECTION 8-CONSTRUCTION SERVICES
X8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder: )`tl( -
License Number
C,
i.�,_" YJCl �
5 7
;
Address Expiration Date
i
;f
ILL ' !y1i 1�#O7� L)I`t
Signature Telephone
Registered H e Improvement Contractor. Not Applicable ❑
Company Name Registration Number 99
VV l i•..�1?4S�"�.' !�*�%�r�L..t` }.,, trW r '� 1 -Y��`F 9 s- �. f t 0-
Address Expiration bate
Telephone
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.--- r 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 faun
structures.A person who constructs more than one home in a two-vear period shaD 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
The Commonwealth of Massachusetts
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 Leldbly
Name(Business/Organization/Individual): W I N DOMI hi DL- 7F WES'T1ERA MA SSa""'CTTS
Address: 102-'t
City/State/Zip: W EsT1F l F Lp M Pr MSS Phone #: L113 `I' S S – 733 5'
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 1 6 E]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 These sub-contractors have g. [] Demolition
working for me in any capacity. employees and have workers' g 0 Building addition
[No workers'comp. insurance comp. insurance.•
� J 10. Electrical repairs or additions
required-] 5. [] We are a corporation and its
3.❑.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 13.99 Other R MF-91
employees. [No workers' w i A Vou S
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 those entities have
employees. If the subcontractors 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 thepolicy and job site
information
Insurance Company Name: LADE-0--TY MKTLIt4L INStOtMCE —
Police#or Self-ins.Lic.#: _ (!.2— !S— 3 a q7_-01!5 Expiration Date: F'- -2D _( _
Job Site Address: City/State/Zip: G J 0 p
Attach a copy of the workers'compensation polic eclaration 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.
I do.hereby certify u the
pains ' ��n of perjury that the information provided above is true and correct
Si ature: '�` � � Date: C
Phone#- 1413 t4q 5 - 7339
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):
i. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Window World of Western Massachusetts
atcktw 1029 North Road-Hampton Ponds Plaza,•Westfield MA 01085 J Hou6ee6alrrc
Phone(413)485-7335 Fax(413)315-3714 NAT-41779-1
"Simply the Best for Less"
www.WindowWorldofSpringfield.com HIC#165641 BBB.
scmarc w� ftp
CSL#57011 rs�a,mfio+v�1
- Phone(h) ✓
Customer: _
Install Address: _ Phone(w)
Bill Address: Email
WINDOW WORLD _ GLASS OPTIONS ADD U_VALUES
4000 Series DH $245 SolarZone Glass Package* (LE) $79
6000 Series DH(Triple Pane) $279 -
Picture Window $359 SolarZone Elite Glass Package*(LEE) $89
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 *All SolarZone packages include 1/2 screens,Foam Insulation on 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
Three Lite Casement(Requires 3 Value+) $885 MY HOME WAS BUILT IN THE YEAR i% INITIAL: :* -�
SAFE LEAD
Basement Sliders<55 UI $250 EPA_ (Per Window) $<J .-rte
J topper(In existing wood)(Vent+$150) $250 EPA LEAD SAFE(Patio Dr I Bay/Bow/Garden) STOO-
Specialty Window $ EPA Lead,third party verification: 499-00
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap) $3375 1 decline third party verification C)(INITIAL):` `-
Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995 _' (Initial)I have received a copy of the Lead hazard information pamphlet
Grids/Ext.Color/Int.Woodgrain/Colors calculated in WN Upgrades in oTrming me of the potential dsk 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.
Reframe&Retrim(stain/paint not included) $400
Roof for Bay/Bow Window $600 (initial)I have received a copy of the lead test result(s).
Second Floor Installation $500
Window Color -- / _ Sign. Date:
Inside Outside
Name(s)(Print) --
WINDOW WORLD UPGRADES MISCELLANEOUS LABOR
Full Screens $45 , - Full Exterior White Trim/Wrap(SMOOTH)(PVC) $79
BEIGE Color charge $50 Color Other Than White $10
Ext.Color(AT)(AB)(DC)(HI)(FG)(ER)(CG) $165 Specialty Custom Exterior Trim/Wrap $
Woodgrain Interior(LO)(DO)(CH)JFX).(RM)(SM) $95
Contoured/Flat Grids(TOP)(FULL)(ENDS) $49 - Quick Trim(Int) (Ext) $30
Piain`e 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 Stops/Trim $45
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 Ai $100
Patio Door Beige Color $125 g
Patio Door SolarZone $125
Heat Buster Package Upgrade SolarZone Elite$215 Site Setup,Removal,In Home Service,etc.: $250.00
Patio Door Grids(Regular)(Woodgrain) $100 Extra labor(Box on left for description)$ _
Woodgrain/Brown(LO)(DO)(CH)(FX) $295 Total Amount Due$ 1
Exterior Colors $395 50%Deposit Amount:$
Patio Door Triple Pane Upgrade $250
Keyed Lock$36 Foot Lock$51
Storm Door Model $ []Cash
�•- []Finance-O Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING! ]"Check made to Window World of WM#
f j CC#
/ I -Exp.Date: V code
- I~ t' Final Payment Amount$ _
' v - 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 orthe 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!
Ownery Date
Salesman Date Owner Date
This Window World`a Franchise is independently owned and operated by Window World of Western Massachusetts,Inc.under license from Window World,Inc.
HIM we 06-15 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayes Pnnting 8e8-667-1116