06-022 (29) 46 EVERGREEN RD BP-2019-1510
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:06-022 CITY OF NORTHAMPTON
Lot:-005 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2019-1510
Project# JS-2019-002443
Est.Cost:$8468.00
Fee:$100A0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011
Lot Size(w.ft.): Owner: YANKEE HILL CONDO
zoning: URA Applicant: WINDOW WORLD/ROBERT E BUSHEY JR
AT. 46 EVERGREEN RD
Applicant Address: Phone: Insurance:
1029 NORTH RD (413)485-7335 () WC
WESTFIELDMA01085 ISSUED ON:711012019 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 or Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplam/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 7/1020190:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
(t) IN 0011)
Department use only
City of Nort am ws o Permit:
Building De a ant C Cu Driveway Permit
212 Main Stre t JUN 2 7 2019 5 er/S p5c Availability
Room 00 w terM A Availability_
\\\
Northampton, MA Set of Structural Plans
phone 413-587-1240 FatP$% W,L 'MpPoFC,o Site Plans
ecify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE DOOR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION ✓" '/,?/"
1.1 Property Address: n 1 This section to be completed by office
I4u f,y&Y, q{yr< Y� Map n? Lot tJd, Urh
l_f.&S Ma QI(x Zone Overlay District
Elm St.disWct CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 1/
`2`.1 ow er of Record: ��1y km,f1n� )lr-& w
(1114 l tNY�uS
15011 ILLlnSiYtel- hl,4" hi xA OilC�
N me(PtlM) C nl1 dress: r — I
(See contro(f) Telephone
� 13c
e
Signature
2.2 Authorized Acent:
1029 North Rd V*5ificM MA 01085
Na P Cunent Mailing Address:
�
ynature ' — Teleplwne
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pennnit applicant
1. Building O 11'_d' (a)Building Permit Fee
O tZVJ3
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
B. Total= 1 +2+3+4+5 Check Number
This Section For Official Use Only
Building Permit Num Date
4 4z ssue&
Signature: 4 /—1
- 2-261
Building Commissloner/Inspector of Buildings Dale
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel
New House ❑ Addition ❑ Replacemen dows Alteregon(s) Roofing Ej
Or Doore
Accessory Bldg. ❑ Demolition ❑ New Signs =1 Decks [O Siding IC] Other ICJ
Brief Description of probed
Work: \f4Iau I_&"waU WI✓1dUK6
(a)/ YI
Alteration of existing bedroom_Yea No Adding new bedroom Yes X N
Attached Narrative Renovating unfinished basement Yee No
Plans Attached Roll -Sheet
ga.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?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form allached?
h. Type of construction
I. Is construction wit 100 ft.of wetlands?_Yes No. Is construction within 100 yr. floodplain_Yes_No
J. Depth of ment or cellar floor below finished grade
k. WIII ding mnfo.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, nnVu— I I ,as Owner of the subject
proV M ' I ^
hereby authorize U�IndouZ) �OYId o� IIk�P�k,✓n IUA-
to act on my behalf,in all matters relative to work euthodzed by thio bulltling perm&application.
f5PP. GorYtrnc�� 1�4�tllg
Signature of Owner
I, P O10e Yt s7U5 .as OwnerlAuthod7Ad
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.
t .
Print me ...
I�YI�g
SignaWro dl Owner/Pgenl �� Is
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1., Not Applicable ❑
Kama of Llesnsa HOlWr: Rohe.�i- '� Iley
License Number
_12 Dalry Ln 9)oothw(Ck MR olOi'1 51011
Aaamce C,c C EaptralWn Dale G�
S re Telephone oJ_, 33J I Z o If
9.Replstered Home Improvement Contractor Not Applicable ❑
RotXrt Ib5b41
Company Name Registration Number
Window Worl(l a Wfstfrr\ MOM Inc. 3114120
Address E)Ombon Date
I ICI N Orth RA NI Mt(TPI d NIA IAO 5lephone 413--4`65-1335
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,a 1SY,S 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affitlavit 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 Ownerbecupted Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for him who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 1083.5.1.
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 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 permit.
As acting Construction Suvirvisor 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 Deady)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.
Homeowner Signature
1
The Commonwealth of Massachusetts
Department of Indrrsrnal Accidents
I Congress Street,Suite 100
Boston,MA 01114-1017
www.mass.gov/dia
\lirkers'Compensation Insurance Affidavit Builden/Contractors/F.lectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name(Bminew/OrgmizWon/IndMdu l):Windm World of Western MA
Address:1029 North Road
City/Shd,/Zip:Westfield, MA 01085 Phone#:413485-7335
Anyon as emp[We Cb«k the appmpdate bas: Type of project(required):
LEJ 1 an a and".wbh 20 _enryles.(full and/or Pmt-time).• 7. [1 New construction
2.❑lamemle propdemrar pumrnhip and have no employem wohing fmmein g, ❑Remodeling
any asininity.Mo workers'over.itumence requited.]
].Ol smahonaowmr doing all work myself.[No workocovv,P is .mquimd.]t 9. ❑Demolition
4.[]l eno a hameowaer and will be hiring conaactom to conduct all work an my property. I will 10❑Building addition
emm,that all contractor;either have workers'compenmtion insurance or am sole 11.❑Electrical repairs or additions
prapdetors with no enployxs.
12. Plumbing repairs or additions
5.[3 Tho a general sulaaahave I have biers the wo na wra, i on the an.anw.hese 13. Roof errs
These sub-cantrecmm have employee W have workers'�,ineutanrz.t ❑ �
b.❑We am a empombm vrel io o,lays rave mraeleed Heir right s ram�tion per MGL a
14 ❑,r OHR,Replacement Window:
152,41(q,and n love no employm.(No wohm'w�,inamevice wyaiwd.l
•Any applicant thn cheeks box#1 most also fill not the section below showing Nor worker'aompenmM1on policy mountainous.
t Flomeowmre who submit Mb atadavll indicating thry w doing all work and then hire nurture,conlrazims noun submit a neo affidavit ineicatins such.
ICmmacaus that check this box must attached an addikmal shun showing the name of the orb-mntracmn and We whoher ar net naive nations have
employees. If the aab an mcton have enmloyees,they most provide their workeri comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job.site
information.
Insurance Company Name:Liberty Mutual Insurance
Policy#or Self-ins.Lic.#:WC2-31 S-377947-0420 peon Date:05/07/20A�ls
Job Site Address-� �Xt7l7AY/1� 0. City/States/Zip: MA-01065
Attach a copy of the workers'climpersigatiors 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 in S1,500.00
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.A copy of this statement tray be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
f do hereby a fy undue penaldes ofperjury Char the information providedabove Is true and correct
S: erre Date 10I1,2L4I I C1
Phone#:413-4857335
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 S.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
. �. WAS-E /16AWAw% ,VIVI , 01001
(NAME OF FACILITY)
a properly licensed solid waste facility as defined by MGL C 111, §150A.
6kq I I q I;; I= i ;),j 'i
Dae Signature of Permit Applicant
PRINT OR TYPE THE FOLLOWING INFORMATION:
R00E27
I- NAM 3YL
(NAME OF PERMIT APPL ANTJ
tAllnduu5/nlda_ mal' l
(TYPE OFFER/ALT BE DISPOSED OF)
4Ka ` ttd5}M4 01053
(PROPERTYA RESS)
bron"it,
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Market
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doo,o ENERGY RMANCE
tlO`"S0 Ma ENERGY PERFORMANCE RATINGS U-Factor U PERFORMANCE RATINGS
( S'A"P) Solar Heat Gain Coefficient
U-Factor(U.S.fl-P) Solar Heat Gain Coefficient 0.a�7 � a�
react - 0.27 0.26 I ADDITIONAL 0.29
)duecer- PERFORMANCE
°raeoua In ADO171ONAL PERFORMANCE RATINGS Visible transmittance RATINGS`
m. _ Visible Transmittance Air Leakage(U.S.11-P) O.C2 Air Leakage(U.Sfi,.)
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py, w ,SII Window World Of Western Massachusetts
1029 North R0ad
413-4657335
syryrn.arb�• wealernmaea@windowworla.cam
Sabrina Bardwell Yankee Hill
sbardwell@!hpmgnoho.com
Bill Address: Estimate:Hallways
Hampshire PropertyManagement,150 Main Install Address:
9 Estimate If E1561218468928
St 46 Evergreen Rd,
Northampton,MA Leeds,MA Date of Estimate:6/222019
01060 01053 Valid Until.71=019
DESCRIPTION Cry UNIT RATE($) AMOUNT($)
4000 Series DH 12 389.00 4,668.00
Spiel Low-E 12 110.10 1,320.00
Full Exterior Capping 12 110.00 1,320.00
Install lnterictriBerior Stops 12 80.00 960.00
Permit&Administrative Fee 1 200.00 200.00
TOTAL AMOUNT $8,468.00
CUSTOMER PAYMENT DETAIL
Cash Amount $1.00
TOTAL PAID $1.00
CUSTOMER DUE $8,467.00
'No extra work If not In wrlting
'Customer Comments:
'Imilaller Nelec
Cuetamer ID Dwe lle
Id Type' Dr7-e.license
Id#' 5241
Id Issue State' Mase
to Expiration Date 24t
Bales Rep Recommended:
r Interior Stops r Exterior Capping - - - -
Customer Declined:
r Interior Stops r Exterior Capping
Pre 1878 built homes:
'\ " treat,deo.UiNp et,'eM tim
windows.Delicate plants and shrubs in area right below a window should betemporarily relocated if they carrot survive being stepped on and you warn tepreserve
Nem.We strive to be careful when working around vegetation,but du prionfics are to focus on our work,you windows and our safety while working on your
property.We are not responsible fu any damage to plants,shrubs or landscaped ones.
5.Arrival and Departure Times.We will advise yon ofthe"peeled arrival time for our crew at the time we set up the installation date with you.We generally may
fill the job is done,unless it will be a 2 or 3-day job,in which case we may work n long as there is daylight.It is our policy dim our installers get a sigh-off form and
collect the outstanding balance at the completion ofthejob.We ask that you be available to approve the job and make fins)payment at the time ofcompletion.Ifthis is
not convenient for you,we need to knew before we start the job.Inclement weather and orb"unforeseen hindrances are a fait of life and as such we ask that you
understand ifthe weather,traffic,etc.cause a delay u cancellation of an Installation appointment.We typically do not schedule more than a day or two to advance to
by to avoid such issues.
6.Our Worksite.We like in set up our work-site as close to you windows and doors n possible and generally you driveway is the best apo.Ifusing the driveway
will block a garaged car,plane be ready to pull it out 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 reco wfion ofyouaid=system.
g.When do we starl?Upon arrival,the crew leader will suvay the job and determine where to begin.Ifyou have a prelino mec,feel five 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,sampling of"rather,etc.),we don't
complete the job one window at a time.Thejob moves along in a rolling progression where each operation is done on all windows at the same firma.This produces a
qualityjob.
9.If the job takes more than a day,will there be May openings in my house?Of course not.We only remove that which can be minstalled in the same day.
Although there may not be a complete window,it will be weather-fight and secure for overnight(Please no crifiquing at this brae).
10.Pets.We love forty,four-legged creatures;however,we need your help in supervising them.Weare not always able to close a gate or door behind us when
carrying a window,ser please keep them in a safe place.Oadjob description don not include scampering down the street after Fido with new found freedom.Many
people 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.
11.Expect some dust,noise and general disruption of your living space.Construction work can sometimes be messy depending upon the scope of you job.It's
an unfortunate reality of remodeling,but we do our best in keep,things under control.We appreciate your patience and understanding.during the job and writ
everything is finished.Even after we have cleaned up,it is advisable to survey the areas fm something we may have overlooked(Le„kids moms,baby's room).
12.*Damage to walla and old trim stops.For those ofyou who have old dominant and steel windows and are replacing them due in sweating and dam*ng of the
walls be advised that all water damage plater will most likely fail out.in addition,all the patch works you have done ova the years will fall outside.This m normal;
however,we are not plaster enpens,so the repair to those was would best be left To the experts.In some cases,due to out di square openings,new trim is required to
make the window look good."Unless noted on the contract new urn will not be provided or installed by us.You can expect to do some touch up painting on the trim
after the installation of you new windows.This is not always necessary and is usually minor if it occurs.Ifyou aha stops mound you sashes are very old,dry,and
bridle,they may snap and crack upon removal.If this happens,we can leave than offifyou please,or for a stall up charge,replace them with newer ones.Many of
the old-style stops are an longer available an we world replace the enure window with newer style sups Should we discover any hidden damage to the frame or wall
area we will advise you before we proceed.Should you decide to replace or repair anything,the price will be added to you baMmce.
13.Relax and enjoy the show.After we've been introduced in you home,feel free W run errands,take a walk,or just relax.Ifa question should arse;ask the crew
leader for clarification.We enjoy people who are interested in what we do,and most customers are intrigued with the process.We do gel nervous,however,when a
customer commonly hovers over our shoulder.Like any professional,we're always happy to answer questions,but we appreciate being able in concentrate on our
work without interruptions and distraction.This ensues a safe and quality installation.
14.Past Due Balances are subject to a service charge of 1.5%per month.In the event that this amount in placed in the hands often attorney for collection,the
purchaser agrees to pay all cosh of collation,including a rmsomble Marney fee.Retain check fa is 150(fifty dollars).
Customer Signature Sales Person Signature
P.S.Now would be a good time to review contract with the smnman to be sure of your order options and work to be done.Only the items and sernces on Me contact will be
done,If you have any memories whatsoever,now is the time to ask.
Window Word of Wastes Massachusetts may not refund an acceleration of payments as specified in the payment section(front)fa Me reason that he deems himself or Me
Payments to be insecud.However,where the connector deems himself to be insecure he may require as a prerequisite to confining said wprk that the balance of funds due
under the contrail,which are in possession of the owner,shall be placed in a joint escrow acmunl requiring Me examines of Me hares improvement connector and the owner
far wirhddwxl.
Arbitration',Willow World of Western Maseachueens and Me PURCHASERS)hereby mutually agree in advance Me in Me event Window Wood of Western Massachusetts
nee a dispute conceding the contract Window Word of Western MassaMusens may submit such dispute to a Private maintain service which has been approved by the
Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be refuir al he submit to such arbitration in M.G.L.c 142A.
Window Wood Owner
Date .__.._...___. .........._....Date
NOTICE.The signatures of the parties above apply only W are agminated of the paries to anemate dispute manutian insisted by the contractor.The owner may initiate
dispute reMuton even where this section is not signed sum ely by the bodies.-