23B-043 (9) 51LOCUSTST BP-2019-0135
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-043 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:window replaced BUILDING PERMIT
Permit ft BP-2019-0135
Project# JS-2019-000215
Est. Cost: $1029.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT BUSHEY JR 057011
Lot Size(sp.It.): Owner: KAMEL MOHAMED S&PAULA D
zoning,NB/URB Applicant: ROBERT BUSHEY JR
AT: 51 LOCUST ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413)485-7335 O WC
WESTFIELDMA01085 ISSUED ON.81212018 0:00.00
TO PERFORM THE FOLLOWING WORK INSTALL REPLACEMENT 1 WINDOW
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: Qik 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 Occuoancv Shmature•
FeeTvpe: Date Paid: Amount:
Building 8/2/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
-RECEIVED �N��
Cityty of ortamptonJUL 3 1 2 idin De artment
212 ain treet
F BURDMGSNSP NIMImTI
In 00
amm�7ProNNGrlham 01060
phone 413-587-1240 Fax 413-587-1272 :r
d l � Nit
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY1 DWELLING
SECTION 1 -SITE INFORMATION 6O-l l Up
1.1 Property Atldreas: This section to be comppllleeted�by�olfln
J j Locus+ S+ Map Lot!,LVnIt
Zone _ Oyeday Dlstl
Npf'f(lumplon, Mfl 01060
EM SL.DlebleF CB Dlehlet
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Or. MohGmed k4mel $ I iocu5+ S+ NoyA pf„ Mq r,(06o
Name(Pant) Cunent Mailing Addreea:
(See CAy1'1Y da \ Telephone
Signature
2.2 Authorized Agent:
1029 Nort1-t Rd VJeStfiflA MA 010$
Name(Print) Current Melling Address'.
41a aes �a3s
SignaNre � ielephona
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
completed by pennit applicant
1. Building 10Zq po (a)Building Permit Fee
2. Elecblcal (b)Estimated Total Cost of
Construction from e
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) y
5.Fire Protection
6. Total=(1 +2+3+4+5) 1 � y,oO Check Number
This Section For Official Use Only
Building Permit Number. Date
sued:
Slgna e:
Building Co aionedlnspector of Buildings Dale
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Most Be Completed.Permit Can Be Dented Due To Incomplete Infonnattan
Existing Proposed Required by Zoning
This cohenn m be filkd in by
auiNbog Depemoeet
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:_ ,
Rear - ...
Building Height -
i
Bldg.Square Footage - %
Open Space Footage _ % ---
(L t area minus bids&paved -
#of Puking Spaces —' ---
Fill'. �
v Jumc&Louafion)
A. Has a Special Permit/Variance/Finding ever issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the istry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book I Pagel and/or Document#
B. Does the site contain a brook, of water or wetlands? NO Q DONT KNOW YES Q
IF YES, has a permit been need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the 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 activay disturb(clearing,grading,excavation,or filling)over 1 am or Is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Stonn Water Management Permit from the DPW is required.
SECTION 5•DESCRIPTION OF PROPOSED WORK/check all applicable!
New House ❑ Addition ❑ Replacemen indows Aftomdon(s) E] Rooting E]
Or Doon fIJ
Accessory Bldg. ❑ Demolition ❑ New Signs [o) Decks [p Siding ip] Other[p]
Brief Description of Proposed
Work: 15-hr,110a; o{ 1 r{placemari w;ndn✓
Aiteralicn of existing bedroom-Yes_No Adding new bedroomYes No
Attached Narrative Renovating unfinished basement _Yes _No
Plans Attached Roll -Sheet
Ga.If New house and or addBlon to.exlsilna houeina,complete The following:
a. Use of building:One Family Two Famity 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 Woodstovea Number of each
g. Energy Conservation Compliance, Mosschedr Energy Compliance form attached?
h. Type of construction
I. Is construction vAthin 100 ft.of wetlands?_Yes _No. Is consW cdon within 100 yr. floodplain_Yea_No
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_ CitySewer_ Private well_ City water Supply
SECTION 7a•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMR
i, D(. r'Ioliwed k-,.(,( as Owner of the subject
ProPeriY I,
hereby authorize _ nett P,r} V�Shey Tf.
to act on my 6ahefi,in all metiers relative to work euthori ed by this building permit application.
(set cwdya(0
Signature of Owner Date
Dale
1
7 U1V ,as Ormer/Authorized
Agent hereby declare that the stateme and infomration on the laregoing application are tore and accurate,to the beet of my knowledge
and belief.
Signed under the pains and penalties of perjury.
t
Prim Name /
7
Signature of Owns enl Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 11
Na.,of Lion Holder: Robert
1 l"r1 m hey
Ucense Number
r2, paiN Ln wick ane mon 5-1Wk
Addre9s i
expiration pet,
,,el 413 4k5 335
Signature T� Telephone to /2C� 114
8.Ruuial,red Herne Improvement Contractor: Not Applicable ❑
Robfrt Ib5641
Company Name Registration Number
W(rdnw WOYIrI of Western MA5S Inc. 3114120
Address Expiration Date
1029 N Oft RA W16tfie\ d MA(AD lephoms 413•-4555.1335
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.192,$29C(8))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide thle e8ldevk will reauk
in the denial of the Issuance of the bulidine permit
Signed Affidavit Attached Yes....... No...... ❑
11. -Rome Owner Exemption
The current exemption for"homeowners'was extended to include Owneroompied Dwalileas 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 swear seta
as supervisor.CMR 780, Sixth Editfop Sectioe 1033.-.1.
Definition of Homeowner:Person(a)who own a parcel of lend on which he/she resides or intends to reside,on which them
is,or is intended to be,a one or two fancily dwelling,attached or detached struchm accessory to such use and/or farm
structures.A name who constricts ague than m h e In a twosaser period shell not be considend 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 buttdin r permit
As acting Construction Supervisor your presence on thejob site will be required from time in time,during and upon
completion of the work for which this permit is issued
Also be advised that with reference in 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 persons)
you hire in 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_ (See Ga114/G GI')
The Commonwealth of Massachusetts
Department of IndustrialAceldents
QB4ce of Invesdgadons
I Congress Street, Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lemibly
Name (]3miness/Organizationfindividml): Vl%O&NN ftC-tA (A WtStrrn VAR
Address: 102_9 NOY-Vn Rd
City/State/Zi : N A 5 Phone#: 1 4SS --l -5-21>5
Are you an employer?Check the appropriate box: Type of project(required):
I.X I am a employer with b _ 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 These subcontractors have g. ❑Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance.t ❑
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 per MGL 12. Roof airs
insurance required.] t c. 152, §1(4),and we have no ❑
employees. [No workers' 13.e"Otherr OCPPllf.11'1-
comp.insurance required.]
*Any applicant that checks box#1 moat also fill mathe section below showing their workers'eompeosationpolicy information.
t Homeowners who submit this affidavit indicatingthey are doing all wmk and than him outside cousactoremuet submit anewaffidavit indicating such.
rContoutors that checkthis box must attached an additional sheet showing thename of the sub-contrisa s and some whether or net those entities have
employees. Ifthe aubcontmetors have employees,they must provide than workas'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is ike polky andjob site
Information.
Insurance Company Name: Ltbertj MU.tuak IC1Sllrcincf.
Policy#or Self-ins.Lic.#: W M '3IS-,2,-] -1 C1+1 ' [)($ _ Expiration Date: 5 -1 I I
Job Site Address: D Locust S+ree+ City/state/Zip: Nor4h6lapfo tIA,O106C
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$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 certifyr the p retries of perjury that the information provided above is tre and rorrecr.
Siwnature >� `K Date:
Phone#: 4-13- 4tsS --1335
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#:
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(THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED
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IMPORTANT: If the wrtHicats holder Is an ADDITIONAL INSURED,the pollcy0es)must have ADDITIONAL INSURED provisions or be Endorsed.
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INDICATED. NOTMTH8TANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
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CERTIFICATE HOLDER NCELLATION
CITY OF NORTHHAMPTON SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
212 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NORTHHAMPTON MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS.
A0TIb111SEp gF.AgrsalTwTNa
Jon Smith
®1888-2016ACORDCORPORATION. Allrlphb.a .d.
ACORD 26(2016103) The ACORD name and 1090 ars registered marks of ACORD
.615070 I 1-377941 1 "-19 PL 1 P0214901 1 5/2/2018 4:39:52 H6 IBUTI I Psye 1 o2 1
Window World Of Western Massachusetf.
1/l✓a/i/ 1029 North R.
413485-733
eMpy.wad..-l`Q westernmass@windowworld.cor
X Mohamed Kamel
Estimate : 011ii
Bill Address: Install Address:
51 Locust St, 51 Locust St, Estimate#E153245853688'
Northampton,MA Northampton,MA Date of Estimate:7/24/2011
01060 01060 Valid Until:8/2312011
4000 Casement(Left) 1 359.00 359.00
SolarZone Low-E 1 110.00 110.00
Full Exterior Capping 1 110.00 110.00
Misc labor 4 75.00 300.00
Permit 1 150.00 150.00
TOTAL AMOUNT $1,029.0(
CUSTOMERDETAIL
Credit Card Amount $350.00
TOTAL PAID $350.0(
CUSTOMER DUE $679.0(
Vo extra work if net In writing
�ustom•r Comments:
header Notes:
ustomer ID Details
it TypeDrivers license
d#• 5213456
d Issue State' Mass
d Expiration Date 304201
ales Rep Recommended:
'r.q ✓y�.yi,p!
— Interior Slops r Exterior Capping
ustomer Declined:
Interior Stopsr Exterior Capping
re 1978 built homes:
yhonewaseuBucmeyear tees (incal)
5cined decline mini parry venncanon
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.Arrival and Departure Times.We will advise you of the expected arrival time for our crew at the time we setup the installation date with you.We generally sta
11 the job is done,unless it will be a 2 or 3-day job,in which case we may work as long as there is daylight.It is our policy that our installers get a signroff form an
oil=the outstanding balance at the completion ofthe job.We ask that you be available to approve the job and make final payment at the time ofcompletion.If this i
of convenient for you,we need to know before we stat the job.Inclement weather and other unforeseen hindrances are a fact of life and as such we ask that yo
nderstand if the weather,traffic,etc.cause a delay or cancellation of an Installation appointment We typically do not schedule more than a day or two in advancer
y to avoid such issues.
.Our Worksite.We like to set up our worksite as close to your windows and doors as possible and generally yourciriveway,is the best spot.If using the drivewa
;ill block a garaged car,please be ready to pull it out upon arrival.
.Alarm Systems.For those of you who have alarm systems,the alarm company should be notified and advised of our job.They will be responsible forth
isconnedion and reconnection ofyour alarm system.
.Where do we start?Upon arrival,the crew leader will survey the job and determine where to begin.Ifyou have a preference,feel free to advise us and we wt
cconam odate to the best e four ability.Because we work in stages(i.e.,removal of old windows,setting the new window,wrapping of exterior,etc.),we don
omplete the job one window at a time.The job moves along in a rolling progression where each operation is done on all windows at the same time.This produces
unity job.
.If the job takes more than a day,will there be any openings in my house?Of course not.We only remove that which can be reinstalled in the same da;
dthough there may not be a complete window,it will be weather-tight and secure for overnight.(Please no critiquing at this time).
0.Pets.We love furry,four-legged creatures;however,we need your help in supervising them.Weare not always able to close a gate or door behind us who
anying a window,so please keep them in a safe place.Ourjob description does not include scampering down the street after Fido with new found freedom.Man
eople say,don't worry,he doesn't bite,but many installers have been bitten.So please secure dogs that have an aggressive bark towards strangers.
1.Expert some dust,noise and general disruption of your living space.Construction work can sometimes be messy depending upon the scope of your job.It
n unfortunate reality of remodeling,but we do our best to keep,things under control.We appreciate your patience and understanding,during the job and art
very0hing is finished.Even atter we have cleaned up,it is advisable to survey the areas for something we may have overlooked(Le„kids rooms,baby's room).
2.*Damage to walls and old trim stops.For those ofyou who have old aluminum and steel windows and are replacing them due to sweating and damaging of ill
rails be advised that all water damage plaster will most likely fail out.in addition,all the patch works you have done over the years will fall out also.This is norma
owever,we are not plaster experts,so the repair to those wails would best be left to the experts.In some cases,due to out of square openings,new him is required t
rake the window look good."Unless noted on the contract new into will not be provided or installed by us.You can expect to do some touch up painting on the on
her the installation of your new windows.This is not always necessary and is usually minor if it occurs.If your trim stops around your sashes are very old,dry,an
rattle,they may snap and crack upon removal.Ifthis happens,we can leave them off if you please,or for a small up charge,replace them with newer ones.Many c
he old-style stops are no longer available so we would replace the entve window with newer style stops.Should we discover any hidden damage to the frame or wa
res we will advise you before we proceed.Should you decide to replace or repair anything,the price Will be added to your balonce.
3.Relax and enjoy the show.After we've been introduced to your home,feel free to ran crrands,take a walk,or just relax.If a question should arise;ask the cm,
rather for clarification.We enjoy people who are Interested In what we do,and most customers are intrigued with the process.We do get nervous,however,when
ustomer constantly hovers over our shoulder.Like any professional,we're always happy to answer questions,but we appreciate being able to concentrate on or
rork without intemhption,and distractions.This ensures a safe and quality installation.
4.Past Due Balances are subject to a service charge of 1.5%per month.In the event that this amount is placed in the hands of an attomey for collection,th
urchaser oldees to pay all costs ofcollection,including a reasonable attorney fee.Return check fee is$50(fifty dollars).
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Customer Signature Sales Person Signature
.S.Now would be a good time to review contract with the salesman to be sure of your order options and work to be done.Only the items and services on the contract will be
one If you have any questions whatsoever,now is the time to ask.
/indow Word of Western Massachusetts may not require an acceleration of payments as specified In the payment section(front)for the reason that he deems himself or th
ayments to be insecure.However,where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due
hider the contract,which are in possession of the owner,shall be placed in ajoint escrow account requiring the signatures of the home improvement contractor and the ow e,
rt withdrawal.
rbitration;Window Wood of Western Massachusetts and the PURCHASERS)hereby mutually agree in advance that in the event Window World of Western Massachusetts
as a dispute concerning the contract,Window Word of Western Massachusetts may submit such dispute to a private arbitration service which has been approved by the
scretery of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration in M.G.L.c 142A.
/indow World Owner
ata......... .................-.....Date
OTICE:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor.The owner may initiate
ispute resolution even'where this portion is not signed separately by the parties."