06-022 (27) 46 EVERGREEN RD 308 BP-2019-1509
GIs 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:06-022 CITY OF NORTHAMPTON
Lot.-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Cateeorv:window replaced BUILDING PERMIT
Permit# BP-2019-1509
Project# JS-2019-002442
Est.Cost:$2956.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011
Lot Size(so.ft.): Owner: ROSE LYNN R
Zonine: URA(991/ Applicant: WINDOW WORLD/ROBERT E BUSHEY JR
AT. 46 EVERGREEN RD 308
ApplicantAddress: Phone: Insurance:
1029 NORTH RD (413) 485-7335 0 WC
WESTFIELDMA01085 ISSUED ON:7/312019 0:00:00
TO PERFORM THE FOLLOWING WORK INSTALL 4 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 Sienamre:
FeeType: Date Paid: Amount:
Building 7/320190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fac:(413)587-1272 _
Louis Hasbrouck—Building Commissioner
I
(�IN00a)5
1 Department use only
City of North pt n stat of P rmlC
e Building Dep met Curb CuN veiny Permit
212 Main S reef AN 7 ?Ol ew "I., is Availability
Room 1 wat (well Availability
Northampton, 0 -DP ra-, 11'9 iso Structural Plans
phone 413-587-1240 Fix 41 272 -' ns
Other Specify
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE ATION INFORMA e /f^ /t�d
1.1 Promem,Address: This section to be completed by office,
Nb E%(M9fuxl Kd. SId9. &. #308 Map Lot ✓d a' Unit
L4ms, MA 01053 zone Ovartay Distrct
Elm St District CB DlsWct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
,,=r V Record:
( � � 1
I L(b TVCA at,Y1
Nerds(Print) trent M Atl a
(me GOntraC4� t5 ) 1to
Telephone
Signature
2.2 Authorized Agent:
1029 Northd W
RestfirliA MA Olicit
Name Pd Current Mailing Address:
1 ' � 413-485-1336
Signature V. . (/"— FZghone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building 1 (,t5b, (a)Building Permit Fee
2. Electrical O` (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fae
4. Mechanical(HVAC)
S.Fire Protection
S. Total=(1 .2+3+4.5) q Check Number
This Section For Official Use Only
Building Pam Num Date
Signature: Issued:
Building Commusionedinspeoror of Buildings Day
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
I __.G!:of :... .
i
i
'r i
..
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New Nouse ❑ Addition ❑ Replacement YrclavvsAKeration(s) E] Roofing
0r Doom
Accessory Bldg. ❑ Demoltllon ❑ New Signs [ol Decks [O Siding[O) Other=
Brief Descriptioof P110.0. ll //Proposed W w IrdAAS
Work: yy
Alteration of existing bedroom_Yes K No Adding new bedroom Yes �N
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing, complete the following:
a. Use of building:One Family Twe Famity Other
b. Number of rooms in each family unft: Number of Bathrooms
c. is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. Method of heating? F aces a W oodstoves Number of each
g. Energy Conservation Compliance. 1 Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 R of rids?_Vee _No. Is construction within 100 yr. floodplain_Vas No
j. Depth of basement or r floor below finished grade
k. Will building m to the Building anti Zoning regulations? Yes No.
I. Septic Tank_ City Sewer Private well City water Supply
SECTION Te-OWNER AUTHORIZATION-TO BE COMPLETED WNEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1 -kj rlh IV Kfi ,as Owner of the subject
properly r,\ MA-
to
hereby authorize (►1�t�di�w II.I7V�[l GFSfC,✓n {IIR
to act on my behal,Tin ell matters relative to work euttwrized by this building permit application.
( 5e,,. c ormo( O )9
Signature of owner T2
I, �o)gert CJIIb V ,as Owner/Authorized
Agent hereby declare that me statement and information on the foregoing application are true and accurate,to the beat of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Prira mel _,
., e "L I mDL jt.
Signature f� Omer%Agan) � Date
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suoervlsor: Not Applicable ❑
Name of License Holder: Robe-0-1y i3u-Shev
� License Number
12 �airy Ln .4cxtthvdtd� MR nlo�� 51011
nCErec Expiation Dela
4K 3335 (� Z`6IOtt
sm ! ' Telephone
Il
9..
9.Repiste ed Home Imor6v(unant Contractor: Not Applicable ❑
Robrr+ Njrz'— \! 1b5641
Company Name Registration Number
windnw tnlni-VA (A Western MUSS Inc. 3114120
Address Expiration Date
1029 N Orlin M WeS1<iP�d MA(AOk fralephone 4f3-4%S-1335
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.183,§g8C(Bp
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this elfldavll 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 an 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(a)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 consthructs 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 Derrell.
As acting Construction Supervise 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 Ilable for persons)
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
l� Department of IndmirialAccidents
7 Congress Stree4
021 4-20 700
Boston,MA 02114-2077
www.mass.gov/dia
\1 orkers'Campenmtion Insurance Affidavit:Builders/ContraMrs/Electricianr/Plumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Nestle(BmineWOrganiration/Individual):Window World of Western MA
Address:1029 North Road
City/Stafe2ip:WeslfieW,MA 01085 Phone#:413-4857335
Areyes m®ple'r?Cash me apprepdete Isco: Type of project(required):
1.E✓ I ane a employer with 20 mwloyem(fullandlorpal-1wX).• 7. []New construction
z,❑lanawlepropdemr err pumerehipaMhavc nn cmployem wmkine 6rcmein S. ❑Remodeling
any egtse ty.(No wodsm'aavn.imurence re uoni)
I.❑1 am s homwwmr doing all work myself[No workers'comp.irummiee required.]t 9. ❑Dervelition
e.❑ImahomeownerandwillbebidngconmuonwcorWmtelworkmmypropesy. 1wia 10❑Building addition
some that ell contractors either have workers'cosoenmtiw nuorma or are sole 11.❑Electrical repays or additions
proprietors with no employes.
12.E]Plumbing repairs or additions
50 Iama6medcaonswelowctors have
sdl l.,nesMlhe sob keaewrsl,.eel ununoeatbehed ehaet 13.E]Rollfreins
These sub-contrecmrs have emplaycee and have wmken'comp.weumme.l �
6.❑Weare aemporwehahao Loyesew[ oworkedtheirrightofoxenPaanper MOL c.
14 ❑r Dt]kpReplacement Window:
152,11(4t erW we love no amploram.Pio workers'wisp.inavamc requirdl
'My applicmt al Nchecks box#1 must also till out the wetwn below slowing their work.'campmeahan policy nalene wnon.
t Homwwma who submit Nu amdava indiesung they son doing 61 work and Nen him outride onnownw,most submit a new amdavir iMesfing such.
lConatele s amt check this box news selected an additional sheet showing the nems afthe sub-contractors and state whether runt those entities have
employees. Ifthe sub-euntr¢mrs have enplayen,they anw provide their workers'eomp,porky number.
Iam an employer film is providing workers'compensation insurance for my employees Below is the policy andjob site
information.
Insurance Company Names Liberty Mutual Insurance
Policy#or Self-ins.Liee..#:WC2-31 S-377947-020 Expiration Date05107/20 �
Sob Site Addrem:-4b Lw'Xr 711 i.?q City/State/Zip: �S, I yylr'f'1 010953
Attach a copy of the workerrs compensation policy declaration page(showing the Polley number and repiratbn date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby fy un pa'in/s anN_ penalties ofperjury that the information provnded a'1barri,is true and correct
S' m Mdu (1(.�l.IKtAr� D t
Phone 0:413-4857335
Official use only. Do not write in this area,to be completed by city or town ofciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cky/Pown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Perron: Phone#:
I
AFFIDAVIT
In accordance with the provisions of MGL c 40, §54, 1 acknowledge, as a
condition of the Building permit, all debris resulting from construction activity
governed by this Building Permit shall be disposed of at
WA-�i E A61W Hwt ;M la L1DC )
(NAME OF FACILITY)
a properly licensed solid waste facility as defined by MGL C 111 §150A.
Date Signature of Permit Applicant
PRINT OR TYPE THE FOLLOWING INFORMATION:
RoeExr E &SNSu s'2
(NAME OF PERMIT APPL ANI
unridcub/ hIcVa . WT,
(TYPE O�RIAO BE DISPOSED OF) _
4{0 <Vfr�rzeQ Qd La6(s ,-1A—
(PROPERTYA. DRESSJ
MI Windows And Doors
�1 65(weat Market St
NPRC W 1 Gratz,PA17030
Ml Windows And Doors VVV .
■ Market at 1550
i GrOM P^17030 OHNINYUNO Grids
or demoV the M` Grotx, :oliva f-ddeYslm PrrN142:Lata-1:1118°,CIeu,LOE,Amrealetn;lde-2:
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stbatranbe �p03MM (111°,gear,tJONE.Mnpladl.ArOon• ENERGY PERFORMANCE RATINGS
e Jamar, P.d°�°° 1.1-Factor-Factor(U.S./I-P) Solar Heat Gain Coefficient
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Then using.
ENERGY PERFORMANCE RATINGS
mows on the Solar Heat Gain COeglcielR ADDITIONAL-PERFORMANCE RATINGS
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I
n Window Wodd Of Weslem Massachusetts
IV 1029 NOM Road
07� 413485-7335
nwwierwuwr�.• wesbrnmass@windowworld.com
Lynn Rose
slipjig76@yhaoo.com
Estimate:Partial
Bill Address: Install Address: Estimate#E1561206215684
46 Evergreen Rd,Building B N308 46 Evergreen Rd,Building B 4308
Leeds,MA Leeds,MA Date of Estimate 62271019
01053 01053 Valid Until 7/22/2019
DESCRIPTION OTY UNIT RATE(S) AMOUNI
4000 Series OH 4 389.00 1,55600
SouvZone Low-E 4 110.00 440.00
Full Exterior Capping 4 110.00 440.00
Install laterior/Extenor Stops 4 80.00 320.00
Permit 8 Administrative Fee 1 200.00 200.00
TOTAL AMOUNT $2,956.00
CUSTOMER
Check Amount $1,500.00
TOTAL PAID $1,500.00
CUSTOMER DUE $1,456.00
'No extra work If not In writing
'Customer Comments:
'Installer Notes:Schedula unit with others
Customer ID Details
Id TypeDrivels license
Itl#- Se46u
Id Issue State• Mdsf
Id Expiration Date 3567
Sales Rap Recommended:
r Interior Stops r Exterior Capping
Customer Declined:
r Intenor Stopsr Extenor Capping
Pre 19711 buiR homes:
J
NY nare ww Wn nlM yx¢r 19ea aldl
J
+-�1^�-j[x'�� IInM4111 OeGme tlwd Pelt w^>•xelbn
widows.Delicate plains and shrubs in bands right below a window should be tempmetily relocated if they canna survive being stepped on and you want to preserve
them.We arrive to be cereNl when working around vegetation,but our priorities are to focus on out,work,yam windows and our safety while working on you
properly.We are not responsible for any damage to plants,shrubs or landscaped areas.
5.Arrival and Departure Timm We will advise you of the expected arrival time for our crew at the time we set up the installation date with you.We generally stay
till 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 thin our inuallers get a sign-off from and
collect the outstanding balance at the completion ofthejob.We ask that you be available to approve thejob and make final payment at the time of completion.If this is
not convenient for you,we need to know before we soon the job.Inclement weather and other unforeseen Machi tts are a fan of life and n such we ask that you
understand if the weather,traffic,etc.cause a delay or cancellation of an Installation appointment.We typically do not schedule mare than a day intwo in advance to
by to avoid such issues.
6.Our Work-site.We like to am up mu work-site as close to you windows and doms as passible and generally your driveway is the best spot.If using the driveway
will block a garaged car,please be ready to pull it out upon arrival.
7.Alarm Systems.For those of you who have alarm systems,the alamt company should be notified and advised ofbar job.They will be responsible for the
disconnection and reconnaoian of your share system.
g.Where do we start?Upon arrival,the crew leader wall survey the job and determine where to begin.If you have a preference,feel fiee to advise us and we will
accommodate to the best of our ability.Because we work in stages(i.e.,removal of old windows,setting the new window,wrapping of exterior,etc.),we don't
complete the job one window at a alma The job moves along in a telling progression where each operation is done on all windows m the same time.This produces a
qualityjob.
9.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 day.
Although there may not be a complete window,it will be weather-fight and acture fmovemight.(Please no critiquing at this thee).
10.Pets.We love furry,four-legged creaNres;however,we need your help in supervising them.We are not always able to close a gate or dem behind us when
carrying a window,so please keep them in a safe place.Omjob description does am include scampering down the street aHa Fido with new found heedom.Many
people my,don't worry,he doesn't bite,bat many installers have been biker.So please secure dogs that have an aggressive bark towards strangers.
11.Expect same dust,noise and general disruption of your Bving space.Construction work can sometimes be messy depending upon the scope of yew job.it's
an unfortunate reality of remodeling,but we do our best to keep,things under control.We appreciate your patience and understanding,during the job and until
everything is funished.Even affix we have cleaved up,it is advisable to survey the areas fix something we may have overlooked(Le„kids moms,baby's foram).
12.*Damage to walls and old trim stops.For those of you who have old aluminum and steel windows and an,replacing them due to sweating and damaging of the
walls be advised Nat all water damage planta will most likely fail out.in addition,all the patch works you have done ova the years will fall out also.This is normal;
however,we are not plaster experts,an the repair to those waits would best be left to the experts.In some cases,due w on of square openings,new trim is required to
make the window look good."Unless noted on the contract new trim will not be provided in installed by us.You can expect to do some touch up painting on Ne trim
after the installation of you new windows.This is tint always nassmy and is usually minor if it occurs.if your trim stops amuad your sashes are very old,dry,and
brine,day may amp and crack upon rebound.If this happen,we inn leave them off if you plans,m fm a small up charge,replace than with newer ones.Many of
the old-style stops are no longer available an we world replace the entire window with newer style stops.Should we discover any hidden damage to the home in wall
area we will advise you before we proceed.Should you decide to replace or repair anydaing,the price will be added to you balance.
13.Relax and enjoy the show.After we've been introduced N your home,feel face to run mounds,take a walk,orjnt relax.If a question should arise;ask the new
leader 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 a
customer constantly hovers over one shoulder.Lire any professional,we're always happy to answer question,but we appreciate being able to material on our
work without in¢muptions and distinction.This serines a safe and quality installation.
14.Past Due Baleares are subject to a service charge of 1.5%per month.In the event that this annum is placed in the hands of an attorney for collection,the
purchaser agrees to pay all costs m collotirn,including a kasonable attorney fee.Rehm check fee is$50(fifty dollars).
i'
Pi�lr 4U'J
Customer Signature Sales Person Signature
P .Now would be a gond lime to review contract will the talesman to be sure m your prier options and work to be time.Only Man items and services on Me embacl mil be
done.If you have any coushons whffisoaver,new is the lime to ask.
Window World of Western Massachusetts may not whom,an acceleration of payments as seasoned in the payment section joint)for the reason that he deems himself or the
payments to be insecure.However,where Me contractor deems himself to be insecure he may require as a prerequisite to continuing said work Net Me balance of funds due
under the contract,which are in possession of the owner,shall be placed in a joint escrow account requiring Ire signatures of U e home improvement contractor and the owner
for withdrawal.
Arnmition'.Window Wood of Western Massachusetts and Me PURCHASERS)hereby mutually agree in advance net in the event Window World of Westem Massachusetts
has a aisputo concerning the contract,Window Wood of Western Massachusetts may submit such dispute to a private mosation service which has been approved by the
Secretary of the Executive Does of Consumer Mfaks and Business Reputations and the consumer mall ba required to solitaire such arbitration in M G L.c 142A.
Wind.World Owner
Date---.. ..... Date
NOTICE.The signatures of the parties above apply only to the agreement of Me pelves to alternate dispute reWlution initialed by the connector.The owner may initiate
Module resdugbn even'wbere this section Is not signed separately by ate parties.'