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25C-159 (5) City of Norfha ton, Department use only x" Building Depa men Status of Permit: f Curb Cut/Driveway Permit 212 Main S reet AP% Sewer/Septic,Availability Room 100 Water/Well Availability Northampton, MA Ti Two Sets of Structural Plans phone 413-587-1240 Fax 4 7-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 ProoertvAddress: This section to be completed by office i a<►Ca C C ��' Map V Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) -Qf (� A P 7 l Q�� Current Mailing Adaress. (See Com rad) - - Signature Telephone 2.2 Authorized Agent• Name Pd ) _102.q Norfih �C� "(!Sk'f1C rl MA 010155 / Current Mailing Address. ignature r-- _ 4-13" 4 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Completed b permit a licant Official Use Only 1. Building ay sG (-1 (a)Building EFee 2. Electrical � (b)Estimate 3. Plumbing Construc Building Pe4. Mechanical(HVAC)5. Fire Protection6. Total=(1 +2+3+4+5) fCheck Numb This Section For Official Use Only Building Permit Number: 60— 2-0` loz4 b Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all a licable) New House Addition ❑ Or Doorsoors 2rRe en�Wjgdows Alteration(s) I Roofing Accessory Bldg. ❑ Demolition ❑ New Si ns g [C7] Decks ([� Siding Other[pj Brief Description of Proposed Work:amu �?nl CI (('MQ()'3 W 1',0CI�w Alteration of existing bedroom Ye Attached Narrativ® s No Adding new bedroom Yes Renovating unfinished basement No Plans Attached Roll -Sheet Yes No 6a. If New house and or addition tD existing housin 'Gom Ietethe followin a. Use of building:One Family_ Two Famil Y Other b. Number of rooms in each family unit: Number of Bathrooms C. Is there a garage attached?_ d. Proposed Square footage of newco rnst uction. 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 ft.of wetlands? Yes No. 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 I C)1Ci L AA /Y1 I G'S�Ynt�n r property as Owner of the subject hereby authorize to act on my behalr in an matters relative to work authorized by this building permit application. S' Gd>11 ) 2 Signature of Owner �o n Date Agent hereby declare that the statement, and inform'+:^��-•�_ as Owner/Authorized and belief. information on the foregoing application are true and accurate,to the best of my knowledge Signed under the pains and penalties of perjury. Print N'me f lam ' /<:. ;-� `-7..•/" "� Signature f Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed ConstructionSu�jpervtisor: Not Applicable ❑ e o Namf Lic®ns®Holder: Ro i A-(J- License Number �a i r� Ln � cies�c9K N1R o n"I 71 1 Address Expiration Date :Sign ure iTelephone 9.Registered Home Impr,_eV ent l;Ontractor Not Applicable ❑ R Ob�,rt �t-rs�n1?�I Company Name 1105 6 41 Registration Number �I ena world—.(,)f "i �eYt� MASS 1rnr 31314.12-7,Address ss Expiration Date W QS�F1 f'� U MA 010JJ5lephone 4{3"�'�1a35 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 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....... No...... ❑ 11 Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 owner acts as SUDervisor.CMR 780 Sixth Edition Section lno 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-vear 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 buildinn 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 Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature_ ( 5oL, con}xu u� The Commonwealth of Massachusetts w Department of IndustrialAccidents a 1 Congress Street,Suite 100 Boston,MA 02114-2017 5 www mass.gov/dia Uorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Applicant Information TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Lee>Ibly Name(Business/Organization/Individual):Window World of Western MA Address:1029 North Road City/State/Zip:Westfield, MA 01085 Phone#:413-485-7335 Are you an employer?Check the appropriate box: [2.Cl ✓ am a em to er with 20 Type of project(required):❑ P Y employees(full and/or part-time)."I am a sole proprietor or partnership and have no employees working for me in �' New COttStrllCtiOn any capacity.[No workers'comp,insurance required.] 8. E]Remodeling 3.[J I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• [IDemolition 4.[31 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.[I Electrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs Or additions These sub-contractors have employees and have workers'comp,insurance.1 13.[]Roof repairs 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Replacement Window: 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state 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 Company Name:Liberty Mutual Insurance Policy#or Self-ins.Lie.#:WC2-31 S-377947-020 05/07/20 Expiration Date: Job Site Address: Attach a co City/State/Zip: copy of the workers compensation 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#:413-485-7335 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5EPlumbing or 6.Other Contact Person: Phone#: AlC�.C)-�RL>® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 04/02/19 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED pndorsed. rovisions or be e If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Forrest Insurance Agency NAME: 603 North Main St PHONE A/c No Ext: 413-858-2680 413-858-2685 East Longmeadow, MA 01028 ADDRESS: INSURER(S)AFFORDING COVERAGE INSURED INSURER A: ARBELLA PROTECTION INSURANCE CO. NAIC# WINDOW WORLD OF WESTERN INSURER B: LIBERTY MUTUAL FIRE INSURANCE CO. MASSACHUSETTS INC INSURER C; 1029 NORTH RD INSURER 0: WESTFIELD,MA 01085 INSURER E: COVERAGES INSURER F CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABREVISION NUMBER:POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I R LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER X COMMERCIAL GENERAL LIABILITY MM/DD/YYYY MM/DD/YYYY LIMITS CLAIMS-MADE OCCUR EACH OCCURRENCE $ 1,000 000 PREMISES Ea occurrence $ 100,000 A 7520025998MED EXP An one arson $ 10,000 GEN'LAGGREGATE LIMITAPPLIES PER 04/09/19 04/09/20 PERSONAL&ADV INJURY $ 1,000,000 POLICY❑ PRO- LOC GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OPAGG $ 1,000,000 AUTOMOBILE LIABILITY $ ANY AUTO 0 BINED SINGLE LIMIT Ea accident $ 1,000,000 OWNED v BODILY INJURY(Per person) $ A AUTOS ONLY X AUTOSULED 1020063881 X HIRED NON-OWNED 04/09/19 04/09/20 BODILY INJURY(Per accident) $ AUTOS ONLY x AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIABx OCCUR $ A EXCESS LIAR CLAIMS-MADE 4600055451 EACH OCCURRENCE $ 1,000,000 -04/09/19 04/09/20 AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N STATUTE ERH- OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) Certificate To Follow E.L.EACH ACCIDENT $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN :Attention: :BuiId1n:gDep:artment, ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All rights reserved. .ITY INSURANCE DATE(MM/DD/YYVY) D CONFERS NO RIGHTS UPON THE CERTIF5/5/2019 ICATE HOLDER. THIS Commonwealth of Massachusetts END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES �( Division of professional Licensure ,,t CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED Board of Building Regulations and Standards i Constr 4� kl rvisor i�f (ies)must have ADDITIONAL INSURED provisions or be endorsed. CS-0570111 �'' icy, certain policies may require an endorsement. A statement on egpires:06/28/2021 1 idorsement(s). ROBERT E BASH T 12 DAIRY LN"e, �' f SOUTHWICK plh: S i Fax A/C -AS — - C)JS�'3Jtt��S INSURERS AFFORDING COVERAGE NAIC Liberty Mutual Fire Insurance 23035 Commissioner � / ,,,,.,,,,,�.�_ y. � iR B RC: RD: rf�r Vn111ueoiunrTr�/�n�hl�a.Uatfrtdel(J I E: Office of Consumer Affairs&Business Regulation :F: HOME IMPROVEMENT CONTRACTOR TYPE:Corporation REVISION NUMBER: I Expiration I ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 165641 03/14/2022 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, WINDOW WORLD OF WESTERN MASSACHUSETTS,INC. EDUCED BY PAID CLAIMS. i MPOLICY DIDY MM IGY E LIMITS P ROBERT JR. EACH OCCURRENCE $ 1029 NORTHTH RD RD WESTFIELD,MA 01065 �1- PREMISES Ewa occurrence $ Undersecretary MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ OTHER: PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY $ ANY AUTO COMBINED SINGLE LIMIT Ea accident $ OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS HIRED NON-OWNED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR $ EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE _ DED RETENTION$ AGGREGATE $ A WORK ERSCOMPENSATION WC2-31S-377947-019 $ AND EMPLOYERS'LIABILITY 5/7/2019 5/7/2020 PER oTH- ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N ✓ STATUTE ER OFFICE(Mandatory In NEREXCLUDED7 NIA E.L.EACH ACCIDENT $1000060 (Mantlalory In NH) Yes,describe under DE.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 MAIN STREET ACCORDANCE wITH THE Poucv PRovlsioNs. NORTHAMPTON MA 01060 AUTHORIZED REPRESENTATIVE Jon Smith ACORD 25 2016/03 ©1988-2015 ACORD CORPORATION. All rights reserved. ) The ACORD name and logo are registered marks of ACORD 48525637 1 1-3.17947 1 19-20 WC 1 n0270258 1 5/5/2019 7:59:45 PM (PDT) I Page 1 of 1 AFFIDAVIT In accordance with the provisions of MGL c 40, §54, 1 acknowledge, as a condition of the Building permit, all debris resulting from construction activity governed by this Building Permit shall be disposed of at (NAME OF FACILITY) a properly licensed solid waste facility a,p defined by MGL C 111,,§150A. „I �2-U � �U Date Signature of Permit Applicant PRINT OR TYPE THE FOLLOWING INFORMATION:(NAME OF PERMIT APPLICANT) (TYPE OF MATERIAL TO BE DISPOSED OF) (PROPERTY ADDRESS) order,trdethe {e r?dOW3 Af td Doors { V; 1�d0 Wast Market C i l E hitt Arty 3+fkC 4 - 4. _ Gratz, RT v � b�0ltvestiNarketS Doors Gratz PA 17030 t 665 1660 * 1�: � f�2NlN1�Ut'sri�� astra3on D�ffi/tNYu 5th e,4; P+$Y fIWI C+a .a R3P°in�M 'r ive ti'aner. ^mss PaneiY$2:Lte Ne Grids ,In fI, ._ �.. s.=r�t gosi;CS if 45 5f� t�trejr F3:s;d.'eer wr�F'('f8 iCetear LQg,�rtr€ealed; difieFrft � F 2: 1,Argon;371/2X37 5 and doors e�t-a`3tsaMATI-Mn ne/.,..� MCM a: ro dues.�y 10 Z3;y c° 0 varldlon in performance [� Lsdtniduad Fradutf[ R 216 {403 - y-� _ Ik may ba s46Jatt foGoaol fion in pBor tPERFOi s - C�i" T�N T11tE1ta r � ��� mortes ®i P Neat i51�� i € f€`i 1 4'-icsi�i�.S./l-R) �rtFi WOS aregenerauy '. ■A■ ■�� Solar meat Gain Co troduct cer- 0. qiI■� ! efficient >locae,onsin =---- t x1ULif11@ '' - 0■29 f:::OMT!ONAL FERFORMIANGE RATINGS � NAL PERS Visiftl�?r CR6LiAnfCE RA7iNGS Tiraps titance- ? €'. €Ma age-(U.8.11-p) ansmittaRce ;ht Air bake ._ ■4� '�� Leakage P) 9 Ern r.•RI ei perr,r m`rerr Rt pt[t mere nargs eorsnrm w a ' �. �d a 3 t 980r7[tff0an +� rp F eRc¢tQEGa.1rEF far Q6ierR1Y!!tf(riYtnle jlrOHL'CtG^rEcu. z u@EetEr�AineJ tGra lUca pl�canre rlFRCANCeCurES rbt i ' 9r263Gln a6fa.5fXi tQ![t 3.[rndEfl.Ta ?cOnafiam[fi9ar zrrEna arypra6uttare does rrot sorra �menmt nrmr ! 1PFYJrC 9`r R £t peran.proa,xeede. ryaaur[- sac"ar"'. acre oris.Uses f Sr 8 nwi8^ef9raLli[fAdaf ,911•f of flny pf6JvEl for[rV ORCR$Yee.consult tvrEPJ atPl3furE far M mE ratan, h ROa s a N w a 2 F i.a�C •A _'pr".-nRE t$s.2ure roe a4fEt ptaQteEt OlttarFO![M61flt�me90ri. _ arerproauct nrY oraryproc-, mss_ r _• ■rt AlfrtAfp a` •nrrc.arg paA6f�arxE vna Y ra-y sF.EcuPre, uy`�z` _ R.afti "8 f � �-'4F -�.x�, E.�c•si�z..s.�.,�....� y a .�;-•1 r �" c _- _ _ ';r r� rr r' -r -t + •< �yi rl -_._—_ _ Q t earr9Ystargov lvinAaws !� ��� Jr`vf�••� eeargytt[LjOeJIYIOdOW[ � `11, y`( l�CertilitWCertifieado Para 1. For r r i,f°relation,see robe{on rtificado t for full'infomwtien,$n fatl■1 on product ®Certifietuce �i l�afa iafdrmaci3n complete,consuftar la etiqueta del Pfo6cto. mAlera,c°nsrttrar la stir Product rtel prartuc e Perf Grade t Perf Greats +DP(ASD) -DP(ASD) Water LC-PG +dP(,4SD) LC-PG35 gS,Og Max Test 35.30 -CP(ASD) 35.09 g Og Size Re Water 50.13 [ Max Test ize epprt# STC f?7C 40 p0 X 72.00 1 72.o P 7 Florida ID 5.43 ( 72.00 X 60.00 'i Floss Ot-tas�T tm 7,,V Florida 26/24 stings are for individual winds Ratings are for individual windows and doors only. For information regarding mulled r r stacked ws -f Oardin r stacked ants,please contact your bales representative.Pos and Nag OP limited by nit test size mss'Please contact Ind doors only For into your sales re emotion re 6 did onal rlfor�MAlab�elima�eMo cealed�II.S.tiA440.ptive p01and g9OP9mrtegby t the unit test size.Tested to MMMMDMAtCSA 101fl.S.2lA440 05 AAfr1A label maybe oration re and Ne nail concealed by gla ft bead or track fitter.For additional information regarding gardin by giaz n9 bead or t AcC0rdin9 to installation instructions,please visit www,mWd.com. 9 ledtion instru�ions 2ckfili r.o For ing ,5 7856 73. 1■1. Please visit wvhv.mfwd.com. �.� t 201 zs772468.1.1.1 Printed on 71512076 3:69:03 PM Pnntea on 8/7212016 8:10:.2�, Window World Of Western MA 1029 North Road 413-485-7335 qilc westernmass@windowworldworld.com Michele Mimi Kirouac rllimikirouac@yahoo.com Estimate :Who,e house Bill Address: Install Address: Estimate# E1585173155256 186 Bridge St, 186 Bridge St, Northampton,MA Northampton,MA Date of Estimate:3/25/2020 01060 01060 Valid Until:4/24/2020 DESCRIPTION CITY UNIT- • 4000 Series DH Solarzone 24 549.00 13,176.00 Colored Exterior 24 165.00 3,960.00 Colonial Grids(Contoured) 25 40.00 1,000.00 EPA Lead Containment 24 65.00 1,560.00 Tempered DH Sash 2 180.00 360.00 Permit&Administrative Fee 1 200.00 200.00 Setup and landfill disposal fee 1 400.00 400.00 Woodgrain int.Colonial Cherry 22 179.00 3,938.00 TOTAL AMOUNT $24,594.00 CUSTOMER PAYMENT DETAIL Check Amount $12,250.00 TOTAL PAID $12,250.00 CUSTOMER DUE $12,344.00 *No extra work if not in writing *Customer Comments: *Installer Notes:TIM DROST 413 636-5329....ck basement windows and replace exterior rot Design Consultant-Tim Drost HIC:165641 FEID#27-1993659 Customer ID Details Id Type* Driver's license Id#* S46u Id Issue State* Mas Id Expiration Date 24227 Sales Rep Recommended: r Interior Stops r Exterior Capping F;- Customer Declined: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature Sales Rep Signature NOTICE: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 dispute resolution even"where this section is not signed separately by the parties." This Window World®Franchisees independently owned-and operated by Window World of Western Massachusetts,Inc.under license from Window World, Inc.