06-022 (28) 48 EVERGREEN RD 313 BP-2019-1507
GIs#, 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 c.142A)
Category,windows replaced BUILDING PERMIT
Permit n BP-2019-1507
Project 4 JS-2019-002440
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 Siu(sa ft.Y Owner: MOULTON SHARON
Zoning:URAf99)/ Applicant. WINDOW WORLD/ROBERT E BUSHEY JR
AT. 48 EVERGREEN RD 313
Applicant Address: Phone: Insurance:
1029 NORTH RD (413)485-7335 O WC
WESTFIELDMA01085 ISSUED ON.7/3/2019 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 N 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 Sieneture:
FeeType: Date Paid: Amount:
Building 7/3/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
Department use only
City of North pl tau of p it
Building Dep me t Curb uUD "wayPermit
JUN 2 7
212 Main S feet 201 ew r/Sep 1c,Availability
Room 1 0 Wal rMel Availability
Northampton, Od FSUIIDIND INSP= N ate Structural Plans
phone 413-587-1240 N.MAO t .e P ns
V. s
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO/H�O FAAMMILYY DWELLING
Ra
SECTION I -SITE INFORMATION vi 1N-IJS29 /
1.1 Property Address:�,p This section to be co/m'�plletedd,by office
t�Q £VPfQrnLnzxi f`" 313 Map Lot 0Unft
�(XSr IY1A �(� Zona Overlay District
Elm St.District CB Dearkk
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Shltrim nu.A 'ov14g �ualarun pd . X313 Lads Wr ()1
Name(Print) Cu nt Melll drew:
(See C.Ontra(h) �ho-4 9v3q
Telephone
Signature
2.2 Authorized Anent:
1029 North Rd WeStfifiii MA 010155
Namur Comm Mailing Address:
d 413-4%G-1336
ignawre --- Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completedqb`,permit a licant
1. Building 01 "I Jry i (a)Building Pennil Fee
2. Electrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building Permit I" •„
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(I +2+3+4+5) gj Check Number
This Section For Official Use Only
Date
Building Permit Nu her: Issued
Signature: 7-Z-zo(g
Building Corran salpnerflnspeotor of Buildings DOW
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all applicable)
New House ❑ Addition ❑ Replacemen(Tndows Alteration(s) ❑ Roofing Q
Of
Doore
Accessory Bldg. ❑ Demolition E] New Signe [01 Decks (ice Siding[p] Other[m
Brief Description of Proposed
Work: I/ .l-tau 10
Tl 1 Lul ndUws
"hei/ `/
Alteration of existing bedroom---Yes K No Adding new bedroom Yes R No
Attached Narrative Renovating unfinished basement _Yes �No
Plans Attached Roll -Sheet
sm.If New house and or addition to existing housina, complete the followlna:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Baarroorna _
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliaace.� Masscheck Energy Compliance form attached?
In. Type of construction
i. Is constm within 100 R.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes 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_ City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, r�kyir7m I 1 RCI(�O 111 .as Owner of the subject
property
hereby authorize lk), l I1 L) 11�d✓l d dMf!!kyyl N^
i'f
to act on my behalf,in all matters relative to work authorized by this building pemlft application.
( `ef, GontY6(0 Iq
Signature of Mat
r7 ,,.
I, P, at Fik( `,Ic V ,as Owner/Authorized
Agent hereby declare that the statemen and information on the foregoing application are two and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
t
print e _
Gi 01
ISgneture df Owner/Agent y Dille
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Suoerviaor: Not Applicable ❑
Name of License Holder: Ro 14air 11. t3Liht
License Number
12 Dq\YV Lr) oi >thw cls MR mul 51011
Addreu Extxmgon Date
4ts5 � 335 (� �Z� lall
Sign re telephone
9.Realstered Nome Improvement Contractor. Not Applicable ❑
Rotxrt 13(esflfV 1165641
Company Name Registration Number
WIV&)Vj WnriA cif' WeSterrn MASS Inc. 3114 /20
Address Expiration Date
1029 N orty� Rd Westf�el d tAA aOic€wephpne M3 485 7335
SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,e.152.1 25C(8))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this efBdavlt 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 Ownermccuoied Dwellinss of one(1) or two(2)families
and in 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 106.3.5.1.
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 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 m the Building Official,on a form acceptable to the Building Official,that heAhe shall be
responsible for all such work performed under the buddies permit.
As acting Construction Supervisor your to on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Alan be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employer;to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Amwtated,you may be Bable 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
'LN The Commonwealth of Massachusetts
WR.rkcrs'
Department of IndustrialAccidents
7 Congress Street, 100Boston,MA 02774-204-20 177wwwmass gov/dia
Compensation Insurance Affidavit:Boilders/Contractan/Electridans/Plumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Bmmess/Organbstion/Indivlduel):Willow Word of Western MA
Address:1029 North Road
City/State/Zip:Westfield, MA 01085 phone#:413"485'7335
gore yea as e.p.ren o«k tneappmpdate nor: Type of pmjeet(required):
I.E✓ lunaenplo eraoth 20 mployere(tellerWaput-tines).' 7. New construction
2.❑I un eerie prapnewra partnership and have no employees working fame in $, ❑Remodeling
anycapacity.Mo worker'coup.ie.,
3.❑l ane homeowner doing At work mWlf Mo wakexces" inemwae ngeird]t 9. ❑Demolition
4.❑I an a homwweer and will be housemews tomdun an wok corn 10❑Building addition
arscan y progeny. 1 will
aethat all mnmctor eimanave workers 2oepemation imnrae2eo arerole 11.❑Electrical repair or additions
proprietae with no employeem. 12,E]Plumbing repairs or additions
501anageneralcontactorand 1havcinitial thembti nftctnrliswdonthe at«Adshort
Them,subcannecwn have ner loyses and have wakrn'mmp.nauran,vI 13.❑Roof repairs
a.❑152,§1 acanot wi h area in oficm teary o workdtheir tiglns ran,e oxm per MOL o
1sIElOtherReplamment Window,
152,41(Oh ad we have no employ«e.[No worker'camp.imuranm requimd.]
'Any apglI=1 Met checks box al amn fill t alsll out the scetion blow showing their waken'contpeneation policy infrmation.
t.. who submit MIs amdevit indicating they are doing all work and then him Lora de conheeton amt submit a new affidavit indicating such.
fContectrn that check that box moat overbid an ldnion.1 ahemshowing thename of thesubcontactas and emote whether on,not one.anti.hive
employee. litter sub- trxtton have employee,Mey moat provide Meir waken'map.Mlicy number.
loan an employer that is providing workerx'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:Liberty Mutual Insurance
Policy#or Self-in�s��.,,rLic..#:WC2'31S37779�47-020 pv�-Dggp.05/07/20rV1 r�
Job Site Address,'K IVgn4n,,fi'1 �L . 4;112) City/State/Zip: ["-AS IIIN Q���
Attach a mpy of the worken' ompensation policy declaration page(showing the policy number and expiration 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 mgwismment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00.
day against the violator.A copy of this statement maybe forwarded to the Office of lnvestigations of the DIA for insurance
covens verification.
Ido hereby,�car*underpains andpenuldu ofperjury that the Information provided above is ante and correct
seem ;J�Illfli
in(i)4611 CDt - G�-la�j Cl
Pl a#.413 85-7335
Official use only. Do not write in We area,to be completed by city or town ofjiciaL
City or To": 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#:
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
WASTE 16AWAwt iviIi
(NAME OF FACILITY)
a properly licensed solid waste facility as defined bMGL C III §150A.
Dateft
aatu
Signature of Permit Applicant
PRINT OR TYPE THE FOLLOWING INFORMATION:
RoaE2.T E WSM 5y-
(NAME OF PERMIT A ANT)
(rYPEOFMATE !ALTO D/SPOSEDOF)
.4 �Vvrnrun �d�3i3 leed� �� piu53
(PROPERTr ESS)
_ MI Windows And Doors
. . �� 950 Wast Market St
a
Gratz,PA17030
MI Windows And Doors .
M� 650 West Market 51 1650
or desrmy Me Gretz,PA 17730 aD,ral sa,.gtre3Pa DHNINYUNo Grids
Paid 181: Me
Lee-1:11/e', agLOE,AnnealeeF Lae-2:
NFRC 1685 Fa'd COtci® Paid 1412:
37 to X 37
SLIDER2NINYUGrids ® raa.AalsavmoobDl
5akto NdbJa PXiasaol Pww116T:LXe+I.(1IB',CIev,LOE,annea 1,w'2' manlwn Praewls ma b.sugaar,000PI nmP.nwme<e
zthat on be si Cplfle (1n1•.7iaar,NoN,,Aarwdad);Argon;45112 X 45112
e dasner, ate.Aa+aoDmomaa ENERGY PERFORMANCE RATINGS
m for dii(ernt U-Factor(U.SA-P)
IiKNlyw Pmaab my w nalsd u vn1"I•n"° Solar Heat Gain Coefficient
and doors TINGE 4f
)hen ming. ENERGYPERFORMANCERA 0.27 0.29
rlarem on`he Solar Heat Gain Coe.RcteM
U-Fedor(U.8.1I-P) ADDITIONALPERFORMANCE RATINGS'
re generanv 0.27 0.26 Visible Transmittance Air Lealmile(UU.SA-P)
contains
,duainsI cer- 0.52 0.3
neon:in ADDITIONAL PERFORMANOE RATINGS
Air Leakag ( �.,aaw.
Visible Transmittance -M1 aM can�w..n..,..,•,w.�.e „,..,.,.,Aw.•..a,r.wre,�..
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26772468.1.1.1
Window World Of Western Massachusetts
llf�artr 1029 North Road
413-485-7335
�s.arr� wasternmass�windowworld.com
Sharon M. Moulton
smm2250@aol.com
Estimate: Bedr
IBill Address: Install Address: Estimate#El 561216569107
48 Evergreen Rd, Unit 313 Building C 48 Evergreen Rd,Ung 313
Laetls,MA Leeds,MA Data of Estimate:62212019
01053 01053 Valid Untie.722/2019
4000 Series DH 4 389.00 1,556.00
SolarZone Low-E 4 110.00 440.00
Full Exterior Capping 4 110.00 440.00
Install lnleriorlExlerior Stops 4 80.00 320.00
Permit 8 Administrative Fee 1 200.00 200.00
TOTAL AMOUNT $2,956.00
CUSTOMER PAYMENT DETAIL
mommmommmmo ME
Credit Card 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:
Customer ID Details
Id Type" Drrvets license
Idk' Slid
Id Issue State' Mass2
Id Expiration Data 2333
Sales Rap Recommended:
r Inlenor stops r Exterior Capping _
Customer Declined:
r Interior Stops r Exterior Capping
Pra 1918 built homes:
Mrnanewaswntintnevear law pnsaq
`��^h`t"sM— Omuagi aeeune mad peM�camn
windows.Delicate plants and shrubs in ares right below a window should be temporarily relocated ifdwy cannot survive being stepped on and you want to preserve
them.We strive to be careful when working around vegetation,but our priorities are To focus on our work you windows and our safety while working on your
property.We are not responsible for any damage to plants,shrubs m landscaped areas.
5.Arrival and Departure Times.We will advise you ofthe expected arrival time lox ou 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 a 3-day job,in which case we may work m long as there is daylight.It is our policy that our meddlers get a sign-off form and
collect the outsmlyding balance at the completion ofthejob.We ask that you be available to approve the job and make foul payment at the tune ofcornpletion.Iftds is
not convenient for you,we need to know before we slant the job.Inclement weather and other unforeseen hindrances are a fact of life and as such we ask that you
understand if the weather,millic,etc.cause a delay or cancellation ofun Installation appoinunent We typically do not schedule more dun a day or two in advance M
by to avoid such issue.
6.Our Workalte.We like M ser up our work-site as close to you windows and doors as possible and generally you driveway is the best spot.Ifusing the driveway
will block a ganged car,please be ready to pull it ora upon arrival.
7.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 for the
disconnection and recompegtion ofyour alamh symbon.
A.Where do we stet?Upon arrival,the crew leader will survey the job and determine where to begin.If you have a preference,feel free to advise us and we will
accommodate to the best ofour ability.Because we work in stages(i.e.,removal of old windows,seting the new window,wrapping of exterior,etc.),we deal
complete 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 tune.This produces a
quality job.
9.If the job takes more than a day,will there be any openings in my house?Ofcom a not.We only remove that which can be reinstalled in the some day.
Although there may not be a complete window,it will be weather-tight and secure for overnight.(Please he critiquing in this time).
10. Pets.We love forty,four-legged creatures;however,we need you help in supervising them.We are not always able to close a gate or door behind an when
canying a window,so please keep than in a safe place.Om job description does not include scampering down die sordid after Fido with new found frredom.Many
people say,don't worry,he doesn't bite,but many Installed,have been biter So please secure dogs that have an aggressive bark towards strangers.
11.Expect some dust,noise and general disruption ofyour living space.Construction work can sometimes he messy defending upon the scope ofyourjob.If$
an automobile reality of remodeling,but we do our best to keep,things under control.We appreciate yon patience and understanding,during the job and until
everything is finished.Even after we have cleaned up,it is advisable to survey the areas for something we may have overlooked(Le„kids room,baby's mom).
12.*Damage to walls and old trim stops.For those ofyou who have old aluminum and steel windows and are replacing than due m swooning and damaging of the
walls be advised that all water damage plasty will most likely fail out.in addition,all the patch works you have done ova the years will fall out also.This is named;
however,we are not plaster experts,so the repair to those wails would best be lento the experts.In seine taus,due m out of square openings,new trim is required to
make the window look good."Unless noted on the contract new triol will not be provided or installed by us.You can expect M do same touch up painting on the trim
after the installation ofyour new windows.This is trot always necessary and is usually minor if it occurs.If you trim stops around you sashes are very old,dry,and
brittle,they may shop and crack upon removal.If this happens,we can leave than uffifyon please,or for a small up charge,replace than with newer ones.Many of
the old-style stops are no longer available she we would replace the entire window with newer style stops.Should we discover any hidden damage to the flame or wall
area we will advise you before we proceed.Should you deride to replace or repair anything,due price will be added to your balance.
13.Relax and enjoy the show.After we've been inmdused to you home,feel five to tui emends,take a walk,or just holes.Ifs question should arise;ask the crew
leader for clarification.We enjoy people who are interested in what we do,and moss colonel are intrigued with the presumes.We do ger nervous,however,when a
customer constantly huven ova our shoulder.Like any professional,we're always happy to arawer questions,but we appreciate being able to concentrate on our
work without internrylions and disnactigns.This usual a safe and quality installation.
14.Past Due Balances arc subject to a service charge of 1.5%per month.In We event that this amount is placed in the hands ofan attorney for collection,the
purchaser agrees m pay all costs disinfection.including a reasonable attorney I'ec.Baan check fee is S50(fifty dollars
1`44- UL"\I
Customer Signature Sales Person Signature
P.S.Now would be a good One to review contract with the salesman to be sure of your order options and was to be none.Only Me items and services on the contract will be
Mine.If you have any questions assassins.now Is the time to ask.
WiMox World of Western Massachusetts may rut require an acceleration d payments as spectral in Me paynneot section(rant)for Me reason that he deems himself or Me
payments to be insecure.However,where Me contractor deems himself to be insecure he may require as a prerequisite no continuing said work that the balance of funds due
under the contract,which are in possession of the owner,shall be placed in a joint excess,account requiring the agneWres W yes hone i osswemenl cnntreda and the owner
lar wiMdrewal.
Arbitration',Window World of Western Massachusetts and Me PURCHASERS)hereby mutually agree in advance then in Me event Window Wald of Western Massachusetts
has a dispute concerning the cal Window Wald of Weslem Massachuseas may submit such dispute to a private arbitration service which has been approved by the
Socretery 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.
Window World Owner
Date.... , ......- ...................._.._......................._Dale
NOTICE.This signatures of the parties above apply only to Me agreement aides pelves to normal dispute resolution initiated by Me contractor.The owner may initiate
dispute resolution even where this sadist m not signed separately by the Parties.'