31A-126 (2) 6 JEWETT ST BP-2016-1346
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A- 126 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-2016-1346
Project# JS-2016-002312
Est. Cost: $5326.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sq. 1): 8058.60 Owner: COHEN BATYA&NICOLE HAMER
zoning: URB(100) Applicant: ROBERT BUSHEY JR
AT. 6 JEWETT ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 O WC
WESTFIELDMA01085 ISSUED ON:5/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 12 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 5/17/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Fr_R_�EEi
Department use only
�Y ity of Northampton Status of Permit.
uilding Department Gu }Cuti3# vy; err»�t:
212 Main Street Seftil,SepticAvaitabtlity
TOFBU21M3INSP%.rlON8 Room 100 V►lafar/ teR:Avai .
-NORTHAMPTON MAoloso
rthamoton, MA 01060 Twfl:�of8t11tucatF'lans
phone 413-587-1240 Fax 413-587-1272 t?IoV91wplans
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
Q Map Lot unit
Zoite Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Cu,,ent alting Address:
-� - -x L3
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by permit applicant
1. BuiJing �+� P v0 (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=0 +2+3+4+5) �' �� Check Number
This Section ForlOfficial Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
i New House ❑ Addition Replacement dows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [Q]', Decks [[] Siding[Q] Other[p]
Brief Description of Proposed _
I Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
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
i
I, 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 ffin
{
to act on my behalf,, ap kation.
y��lf,in all matters relative to work authorized by this bu ►ng permit
�
Signature of Owner Date
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.
Py nt Name
J.
Signature of er/Agent Date
Section 4. ZONING Alt 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
Rear
Building Height
Bldg. Square Footage
Open Space Footage , %
(Lot area minus bIdg&paved
arkina)
Y of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever n issued for/on the site?
NO O DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at Registry of Deeds?
NO O DONT KN O YES O
IF YES: enter Book Page and/or Document#
B_ Does the site contain a brook ody of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit or need to be obtained from the Conservation Commission?
Needs to be obtain O ObtainedO , Date Issued:
C. Do any signs exist on e 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,a cavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
iF YES,then a Northampton Storm Water ManagementT;Permit from the DPW is required.
i
SECTION 8-CONSTRUCTION SERVICES
Licensed Construction Supervisor Not Applicable 0
Name of License Holder:
License Number
'V 1�
Address Expiration Date
PE E J)i Y4 Lf L) L
Signature T lephone
L 2
A. Registered Home Improvement Contractor. Not Applicable 0
L i..
n L",S,if� :Y I V -)
Company.Name Registration Number
VV I
Address Expiration Date
o
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§25C(6))
i
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---- 0
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.i4--
Definition of Homeowner:Person(s)who own a parcelof 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 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 buildigg permit.
As acting Construction Supervisor your presence on the jolt 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_
HomeownerSignature
The Commonwealth of Massachusetts
Department of Inde strial Accidents
Office of Inv0stigations
kv 600 Washington Street
Boston,MA 02111
www.n=s govldia
Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusineWOrganizationllndividual): W�.tJMW )UDQLb aE wg-ST115" e' ASSAC- 5f TTS
Address: 102-ct NV+91f4 91
City/State/Zip: vY 1GSTF I 1 L> M lk V t O SS Phone#: 413 '`ISS - 7 335"
Are you an employer?Check the appropriate box: Type of project(required):
L[9[?9 I am a employer with(� 4. ❑ 1 am a general contractor and 1 6. Q New construction
employees(full and/or part-time)." have hired the sub-contractors
2 Q 1 am a sale proprietor or partner-
listed on the attached sheet. 7. Q Remodeling
ship and have no employees These sub-contractors have g. Q Demolition
workingfor me in an capacity. employees and have workers'
Y aP ty� 9. F1 Building addition
[No workers'comp. insurance comp. insurance.«
required.] 5. Q We are a corporation and its 10.❑ Electrical repairs or additions
3.❑.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[:J Roof repairs
insurance required.] c. 152,§1(4)„and we have no
employees. [>r+to workers' 13.([Other RA C*fAEMT-
camp.insurance required.]
w t R VOUPS
'Any applicant that cheeks box#i 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 that 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 sub-contractors have employees,they must provide their worke"'comp.policy number.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and joh site
information.
insurance Company Name: 1-113EAIy Ml4.TUAL 11\1iSuAF 6P—
Polio=#or Self-ins.Lic.#: Vt/�` 2-" 1 S- 3-7-7 a U -01 Expiration Date: �-�•2 t� � �_
Job Site Address:_ (0 J E',��� � ��' City/State/Zip:N1 t�CQ,_ 'k Oa 01 j
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 MGH 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 ftereby certify under Mandp � of perjury that)the information providedabove is trueand correcti ature: Dat ; �
Phone#: J413o 4045 - -73-b5
O,jJickd use only_ Do not write in this area,to be completed 1iy city or town offLeial
City or Town: Ptrmit/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#:
Window World of Western Massochusetts
1029 North Road-Hampton Ponds Plaza, •W tfield MA 01085
VYLW Runtch Hospdal BBB.
Phone(413)485-7335 • Fax(413)315-314 NAT-41779-1
"Simply the Best for Less" '^i`^w.WindowWorldofSpringfield.com HIC#165641
CSL#57011
Customer: Phone(h)
Install Address: " Phone(w)
Bill Address: ri Email
WINDOW WORLD GLASS OPTIONS ADD UI-VALUES r�
4000 Series DH $245 SolarZone Glass Package* (LE) $79
6000 Series DH(Triple Pane) $279 SolarZone Elite Glass Package*(LEE) $89
Picture Window $359 g )
2 Lite Slider $359 SolarZone TK2 3 Pane Glass/Krypton(6000 Only) $185
3 Lite Slider (1/4,1/2,1/4) 1/3,1/3,1/31 $619 All SolarZone packages include 1/2 screens,Foam Insulation on Jambs and Head,Double
Strength Glass,Double Locks(>29" Lifetime Glass Breakage and tabor Warran Argon Gas
Awning $295 1. 9 ty 9
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 ' INITIAL:,('
Three Lite Casement(Requires 3 Value+) $885 EPA LEAD SAFE( Window w
Basement Sliders<55 UI $280 ( ) $60
—�THopper(In existing wood)(Vent+$150) $250 : EPA LEAD SAFE(Patio Dr/Bay/Bow/Garden) $100
Specialty Window $ EPA Lead,third party verification: 47-5-.00
Bay/Bow(Insulated seat,Int.Casing&Ext.Cap) $3375 I decline third party verification ❑(INITIAL):.,
Garden Window(Insulated seat,Int.Casing&Ext.Cap) $1995 (Initial)I have received a copy of the Lead hazard information pamphlet
—informing me of the potential risk of the lead hazard exposure from renovation activity to be
Grids/Ext.Color/Int.woodgrain/Colors calculated in WW Upgrades performed in my dwelling unit,the EPA"Renovate Right"brochure.
Remove Existing Bay/Bow $300
Reframe&Retrim(stain/paint not included) $400 (initial)I have received a copy of the lead test result(s).
Roof for Bay/Bow Window $600
Second Floor Installation $500 Sign: ^�- Date:
Window Color
Inside Outside Name(s)(Print)
WINDOW WORLD UPGRADES MI CELLANEOUS LABOR 1
Full Screens $45 I-• Full Exterior White Trim/Wrap(sMooTH)(Pvc) $79
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 Aluminum/Vin I or Steel Out $50/$150
Contoured/Flat Grids(TOP)(FULL)(ENDS) $49 Y
Prairie Grids(Single)/(Double)-(Flat)/(Contour) $69 Mull Removal $30
Diamond/Brass Grids(TOP)(FULL) $120 Mull to Form Multi-unit $30
Oriel/Cottage Style(40/60)(60/40) $45 Install Interidr/Exterior Stops(WHITE vwn)$55
Obscure Glass Per Sash(BOT)(FULL) $35/$70
Tempered Glass Per Sash(BOT)(FULL)$60/$120 Customer Provided Stops/Trim $45
Catalog Options $ Install Interior Casing $95
VINYL PATIO DOORS-LH or RH(Outside Looking In) Repair/Replace Sill or Brickmould $75 7 7-
(Includes:White Interior Casing and Exterior Trim.) Mobile Home Conversion $200
5 Ft./6 Ft.Sliding Patio Door(LH)(RH) $1500 Remove/Rn-Install A/C or Awning $100
8 Ft.Sliding Patio Door(LH)(RH) $1800 Misc. $
Patio Door Beige Color $125
Patio Door SolarZone $125 Site Setup,Removal,In Home Service,etc.: $250.00
Heat Buster Package Upgrade SolarZone Elite$215 Extra labor(Box on left for descri tion)$
Patio Door Grids(Regular)(woodgrain) $100 Total Amount Due$ �`:
Woodgrain/Brown(LO)(DO)(CH)(FX) $295 50%Deposit Amount:$
Exterior Colors $395 =
Patio Door Triple Pane Upgrade $250
Keyed Lock$36 Foot Lock$51 []Cash
Storm Door Model $ []Finance-O Wells Fargo ( )Other
NO EXTRA WORK IF NOT IN WRITING! []Check made to Window World of WM#
[]CC#
Exp.Date: V-code
Final Payment Amount$ ^_ _
To be paid to the installer upon installation.Thank U.
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 Q2116.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 Date
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. j
wM we 03-16 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayes Printing 888-667-1116