22-022 (3) 247 RYAN RD BP-2017-0190
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22-022 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pennit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2017-0190
Project# JS-2017-000311
Est.Cost: $9460.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot siae(so.8.): 19079.28 Owner: DIEMAND RICHARD A&ANITA
zoning_ Applicant: ROBERT BUSHEY JR
AT: 247 RYAN RD
Applicant Address: Phone: Insurance:
1029 NORTH RD (413)485-7335 0 WC
WESTFIELDMA01085 ISSUED ON:8/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 20 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 8/11/20160:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED Department use only
ity of Northampton Status pf Permit-<.
uilding Department Gagi;;Cti r+ayFen„
AUG I I 2016 212 Main Street senerSS�ucAvairatiiliry`
Room 100 Wa iAVetlAYaliahB.W
N. hamoton, MA 01060 T Sets
of
Nr' I' .re..;- ' 587-1240 Fax 413-587-1272 Pm1ISde Plans
Osler Specify - �,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address: This section to be completed by office
9,L)1 R 1 an Rd Map Lot Unit
Florence m r o uxo r Zone Overlay District
Elm St.Mind CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
cp -n + Kirinrri Dinmcrx4 Atli kVnn Rri
Name(Pdnp Cunct/a Sg AtY/ - 7 cq
5'� (.0YLTelephone
Signature
2.2 Authorized Agent:
Ih L 3G 5i✓y IG2r"t ivCRTN :Leh we5TF1tri.D ,Liw ir105c
Name(Print) )/ ,/ Current Mailing Address:
V(4 I d}t,/ 4n 44s5 ; 335
Signature 4 Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
(tem Estimated Cost(Dollars)to be - Official Use Only
completed by permit applicant
1. Buiding 9, f InWo C� (a)Building Permit Fee
2. Electrical -I (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection L1
6. Total-y.(1 +2+3+4+5)
(1 +2+3+4+5) -11100 ,cv Check Number &l9/4/ 100 J
This Section For Official Use Only
Building Permit Number Date
Issued.
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [J Addition I Replacemen nr�
dows Alteration(s) n Roofing l l
Or Doors
Accessory Bldg. ❑ Demolition 0 New Signs [CJ) Decks Ila Siding[CH Other[CO
Brief Descri•iron •t Pro•• -• _ .� I ,,, n
work: I a . i a I ' I 4 / 11 "& A t II hitt l ♦ S c1wrat
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
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 consvuction 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 R of wetlands? Yes Na 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
Anl �t t\(Y1l,th DIPr11 mcL
I. ,as Owner of Me subject
property � ��y�/71
hereby authorize R bbef f Jy�,,us l,&
to act on my behalf,in all matters relative to work authnazed by this building permit application.
v. v '_ _ ti - 8 '(t
Signature of Owner Date
ti D Pt:r i ;j&S Ht 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_
t0FsEC Ovs F)Eyf
P$nt Name
J (Z � ri g $l
Signatre of gent 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
SideL: L: It
Rear
Building Height
Bldg-Square Footage
Open Space Footage
(Lot area minus bids&paved
padang)
it of Parking Spaces
I Fill:
(volume a tion)
A. Has a Special Permit/Variance/Finding ev been issued for/on the site?
Ni() O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at e Registry of Deeds?
NO 0 DONT KNr, O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, ••• of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been •r need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on th= property? YES O 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 I arse 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.
j SECTION 8-CONSTRUCTION SERVICES
7 Licensed Construction Supeervisor. Not Applicable ❑
Name of License Holder: IGD[YA='27 L al.:S }t:y
License Number
570 II
12/ tiOOS-cv PC-1 titin_
Address Expiration Date
1=EEDikijj MCLS mg CIo3c; 413 j556414
Signature Telephone
L- 1
'Lid;
id. I I '2)
/9.Registered Home Improvement Contractor. Not Applicable 0
IZ08�T 9,LLSHty 52 I Lf 5L' LI I
Company Name Registration}Nfumber,
vvl&J7Jit: ye!tall: , L Y-'S-_. -H ySF L 31`, I 15 ' ' VR
Address Expiration Date
I0'21 ;v,„Rri.4 12:17) wci�
2S71iL, .v1,i) 00'$5 Telephone 4134'557335
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.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 C No 0
11. - Home Owner Exemption
The current exemption for`homeowners"was extended to include Owner-occu jS welline&ofone(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 10835.1.
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 arressory 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 arreptable 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 Ordinance. State and Loral Zoning Taus and State ofMaccarhusetts General Laws Annotated,
Homeowner Signature 1 'WM A
The Commonwealth of Massachusetts
—-- Department of Industrial Accidents
II ,, OffieeofInvestigations
, ' 600 Washington Street
Boston,MA 01111
_- www.mass gov/diet
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusinessrorgmdnnonMdividual): WINDOW hr(gI ty DP WESTGRN MA StACFh4 SETTS
Address: t Ota /4PR-1/4 9.1j
City/State/Zip: WE6TFl et.> MR 0lOSS Phone#: 413 `t SS - 7335
—
Are you an employer?Check the appropriate box: - Type of project(required).
I.NI I am a employer with 4. ❑ I am a general contractor and I
employees full and/or have hired the sub-contractors 6. ❑New construction
( or pa part-time).* 7.time).* haproprietor
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers 9. ❑ Building addition
[No workers' comp.insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑.I am a homeowner doing all work
officers have exercised their 11.0 Plumbingrepairs or additions
myself.[No workers'comp. right of exemption per MGL 12❑ Roof repairs
insurance required.]' c. 152,§1(4),and we have no
employees. [No workers' 13.E Other REPtlnEmetT
W in VOWS
comp.insurance required.]
'My applicant that checks box dl must also fill out the seubn below showing their workers compensation policy information_
t Homeoweers 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 mutt attached an additional sheet showing the name of the sub-contractors and sate whether or not those 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 insurance for my employees- Below is the policy and job site
information-
Insurance
nformationInsurance Company Name: i-I BED-TV MIITtAAI IALStuRANCE
Pont,#or Self-ins.Lic.#: Wc2.- 3IS-n377g47 'd1(O Expiration Date: S-7-20 VI.
lob Site Address: 9\g 1 e.\)6.n f�d city/State/Zip: F tD'(pncv inn O 1 U5
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 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 5250.00 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 cniter the pains • of perjury than the information provided above is mice and correct
Signature: i1 -27-PC- Dana -C -R I
Phone#: 413 t(4 5 - - 335
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. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
!*- q �I Window World of Western Massachusetts "'"� t )
ordeal 1029 North Road-Hampton Ponds Plaza.•Westfield MA 01035
d I Phone(413)485-7335• Fax(413)315-3714 .vus°°o Bge
-J I www.WindowWorldotSpringfield.cam HIE#165641
"Simply the Best tor Less" CSL#57011
Customer: - _ _. Phone(h)
Install Address: - . , Phone(w)
Bill Address: - - _ _E-mail _
WINDOW WORLD GLASS OPTIONS ADD U-VALUES
4000 Series OH $245 -, SolarZone Glass Package' (LE)
6000 Series OH(Triple Pane) $279
7 SolarZone Elite Glass Packager
Picture Window $359 (LEE) $89
2 Lite Slider $359 SolarZone Triple Pane Glass Package $99
3 Lite Slider orzna-li Er:,-i vin $619 'All SolarZone packages Include 111 screens Foam Insulation co Jambs and Heat Double
Awning $295 Strength Glass Double ads I>29'),fihllme Class Rieakge and Wer Mira,*/Woo Gas
_Casement LH RH $295 MISCELLANEOUS LABOR
Twin Casement(Requires 2 Value+)109731(0979) $590_
$79 )
Three Lite Casement(Requires 3 Value+) $885_ -" Full Exterior White Trim/Wrap-(5(000119 IPvty - -
Basement Sliders<55 UI $280 _Color Other Than White - $10
Hopper(In evicting woad)(Vent+$150) $250_ Specialty Custom Int./EM.Trim Wrap. $D. �—
Specialty Window $ Aluminum/Vinyl or Steel Out 530!$150
Bay/Bow llnsulated seat,int Casing&Eat Cap) $3475_ Mull Removal $30
Garden Window ilesusted seat Inr.Cams&EH.Capt $1995
GraraCploGIrt _Mull to Form Multi-unit $30
Remove Existing Bay/Bowentiw.,rte '.' uv00 Customer Provided Stops/Trim $45
Reframe&Hetrim(Haw-paint not included) $400 Install Interior/Exterior Stops(WHITE vmrp$55
Roof for Bay/Bow Window $600
Second Floor Installation $500 Woodgrain Interior Stops $75
InstalLlnterior Casing $95
Window Color / - - . +-a r- Repair/" ¢place Sitar Brickmould $75 ,
Inside Outside MoDile Home rsion $200
WINDOW WORLD UPGRADES Remove/Re-Install A/C or Awning $100
Full Screens $45
—BEIGE Color charge $50 EXTRA LABOR MUST BE IN WRITING
Exterior Color . $165
Woobgrain lnteder r - .- , 595
—Contoured/Flat Grids(TOP)(FULL)(ENDS) $49—,gip - -
Prairie Grids(Single)/( oubre)-( iat)/lcontourl $69
Diamond/Brass Grids(TOP)(FULL) 5120 -
Oriel/Cottage Style(40/60)(60/40) $45 - -
Obscure Glass Per Sash!BOT)(FULL) $35/$70
Tempered Glass Per Sash(BOT)(FULL)660/5120
Catalog Options - $ - -
PRE 1978 BUILT HOMES(FEDERAL LEAD CONTAINMENT LAW)
MY HOME WAS BUILT IN THE YEAR INITIAL: -
EPA LEAD SAFE(Per Window) $61} '-Sales Rep Recommended!I Interior Stops l]Exterior Capping'.
EPA LEAD SAFE(Palle Dr l Bay i Bow iGamenl $300` Customer Declined: []Interior Stop ❑Exterior Capping:
EPA Lead,third party verification. $475.00-
- 1 decline third party verification U(INITIAL): - Site Setup.Removal,In Home Service,etc.: $250 00
(WWI)In received copy f thLead hazards o -Pamphlet Extra labor(Box above for description)$ —.— -
es op-Fr—sop me orrre p l rta shot male hazard exposure from tenovation acniry to be Total Amount Due$ - = -
pertormedlnmydsrellingunittheEPA"Renovate Right'brochure. 50%Deposit Amount:$ - .- -
. Swap I have.eceiweo a copy of the lead test result(s). !]Cash
Date: --- [I Finance-( )Wells Fargo ( )Other
I I Check made to Window World of WM#
Somas)(Hint)(Print) - - I ICC# - - _
Exp.Date: V-code
If tenants reside in home,Renovate Right Booklet lett with: Final Payment Amount$ - •
To be paid to the Installer upon Installation.Thank You.
or loft at: WINDOW WORLD CARES
St.Jude Children's Research Hospital $
WW et 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 d the work SHALL NOT exceed 33 1)3%of the total contract price OR the actual cast 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 bereglstered and that any inquires about a contract orsu-beentractor relating to aregistraton should be -
directed to:Off ce w 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.
Notiice:li the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors,
the PURCHASERS)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.
I You the buyer may cancel this transaction at any time prior to midnight of the third business day alter the dale of this transaction.
Notice of cancellation must he 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 OwnerDare
This window World.Franchise is:naependenly owned and operated by Window Word of Western Mevatlmsetts,Inc.unrl¢ense from Window Word be.
au'NC 0eIs White Copy-Rnoinal Yellow Ceoy-File Pink enov-Customer _ww m.n...mum.....