25C-159 (4) 186 BRIDGE ST BP-2020-1048
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 159 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2020-1048
Proiect# JS-2020-001778
Est.Cost: $24594.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 165641
Lot Size(sg.ft.): 12414.60 Owner: KIROUAC MICHEL
Zoning: URB(100)/ Applicant: WINDOW WORLD/ROBERT E BUSHEY JR
AT. 186 BRIDGE ST
Applicant Address: Phone: Insurance:
1029 NORTH RD (413) 485-7335 0 WC
WESTFIELDMA01085 ISSUED ON:4/1/2020 0.00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 24 REPLACEMENT WINDOWS AND
SIDING
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 Signature:
FeeType: Date Paid: Amount:
Building 4/1/20200:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1, J'
Department use only
y City of Norfha ton/ Status of Permit:
Building Depa�//men Curb Cut/Dnveway Permit
212 Main Sfreet AF
Sewer/Septic.Availability
Room 100 Water/well Availability
Northampton, MA 1 Two Sets of Structural Plans
phone 413-587-1240Fax 417-1272 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 _Property Address: This
i_s section to�=Unit
ce
Map ✓ Lot
&JO M ICAM P Ito n ' AA . 0110(-Q-6 Zone Overlay District
Elm St.District CB District
ffn
ROPERTY OWNERSHIP/AUTHORIZED AGENT
ecord:
M� mjy- �U��
ailing Add}�ss:C fika � -Telephone
2.2 Authorized Agent•
C,
, i 02.G Hort 1n c1 "CStfi6 C MA 010165
Name Pri ) a i/
Current Mailing Address:
ignatu
Telephone
SECTION-'A.ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be
coin leted b ermit a licant Official Use Only
1. Building
a y5C4 C I (a)Building Permit Fee
2. Electrical
(b)Estimated Total Cost of
3. Plumbing Construction from 6
Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) -1 5(�
Check Number
/1 / oThis Section For Official Use Only
Building Permit Number: e)0- �` 10.4 b Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings
Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all annlicable)
New House [� Addition
❑ Replacement�Wjpdows Alterations) Roofing
Or Doors jZl
Accessory Bldg. El Demolition ❑ New Signs [p] Decks
[Q Siding Other[a)
Brief Description of Proposed
Work: LU i drw �i 5)CJ Int?A
Alteration of existing bedroom Yes No Adding new bedroom Yes
Attached Narrative Renovating unfinished basement No
Plans Attached Roll -Sheet Yes No
6a. If New house and or addition to existin housin com lets th®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 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 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
property as Owner of the subject
hereby authorize —_ rah ,l y `�r
to act on my behalf, in all matters relative to work authorized by this building permit application.
S Gori
Signature of Owner 3 2
Date
Agent hereby declare that the state-menti and information on the foregoing appliIze
cation are true and accurate,to the best of my knrowledge
and belief.
Signed under the pains and penalties of perjury.
Print-Nim '
Signature f Owner/Agent
Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:__ RCS b l;i F�> rhe
License Number
X2. DGir�l Lin � ti-b�s� M� �►o� �1C�11
Address
Expiration Date
Sign ure 1 Telephone
9.Reaistered Home lmprtivement Contractor Not Applicable ❑
Rcabt�rt tic>r's�n�'�� I b�b'+I
Company Name
Registration Number
dd ►ndnv�l inlc�rlrl cif if tit Pin MASS Inc. 3114 2-L
Address
A, Expiration Date
A olq I v�r�I(l � 1�'� MA�)n�lephone 41 " -�X35
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....... I
X 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 to 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 108 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 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 buildiniz 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_ ( 5cg- con)Ta c
The Commonwealth of Massachusetts
Department of IndustrialAccidents
d I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
«-orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
Applicant Information TO BE FILED WITH THE PERMITTING AUTHORITY.
Please Print Lee>Ibly
Name(Business/Organization/lndividual):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:
Type of project(required):
1.❑✓ I am a employer with 0 employees(full and/or part-time).*
2.❑I am a sole proprietor or partnership and have no employees working for me in 7• ❑New construction
any capacity.[No workers'comp.insurance required.] 8. Remodeling
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition
4.❑I 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. I LE]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.t 13.❑Roof repairs
6•❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.21 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.Lic.#:WC2-31 S-377947-020 05/07/20
Expiration Date:
Job Site Address:
Attach a 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.
Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature:
Phone#:413-485-7335 Date:
F[Off-Icialusely. Do not write in this area,to be completed by city or town official Permit/License#
rity(circle one):
ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
.
Contact Person: Phone#:
®
AR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTEROF INFORMATIO04/02/19
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
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 provisions or be endorsed.
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 cFMASSACHUSETTS
nfer rights to the certificate holder in lieu of such endent(s).
ACT
ce Agency 771!i:R
St 13-858-2680
EMI, A/c No): 413-858-2685
ow,MA 01028
INSURERS)AFFORDING COVERAGE
RBELLA PROTECTION INSURANCE CO. NAIc s
NDOW WORLD OF WESTERN BERTY MUTUAL FIRE INSURANCE CO.
SSACHUSETTS INC INSURER C:
29 NORTH RD INSURER D:
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 NAMED ABOVREVISIOEN NUMBER:POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I
LTR TYPE OF INSURANCE 11 SID 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
GENT AGGREGATE LIMIT APPLIES PER: 04/09/19 04/09/20 PERSONAL 8 ADV INJURY $ 1,000,000
POLICY❑JEO
CT F]LOC GENERAL AGGREGATE $ 2,000,000
OTHER: PRODUCTS-COMP/OPAGG $ 1,000,000
AUTOMOBILE LIABILITY $
ANYAUTO CO BINED SINGLE LIMI $
Ea accident 1,000,000
OWNED BODILY INJURY(Per person) $
A AUTOS ONLY X AUTOS ULED 1020063881 04/09/19 04/09/20 BODILY INJURY(Per accident) $
X HIRED NON-OWNED
AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE
Per accident $
X UMBRELLA LIAB X OCCUR $
A EXCESS LIAR CLAIMS-MADE 4600055451 EACH OCCURRENCE $ 1,000,000
DE
04/09/19 04/09/20 AGGREGATE
D RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N $
STATUTE ERH
OFFICER/MEMBER EXCLUDED? ❑ N/A Certificate TO Follow
(Mandatory in NH) 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/LOCATIONS I 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
Town Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS.
212 Main Street
FNorthampton,Ma.01060 AUTHORIZED REPRESENTATIVE
Attention: Building Department,
ACORD 25(2016/03) The ACORD name and logo are registered marks ofACORD ACORD CORPORATION. All rights reserved.
A�R�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE019
R. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE SPOLICIES
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 olic
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policyED 1110i Ions Orbe endorsed., certain policies may require an endorsement. A statement d.
this certificate does not confer rights to the certificate holder in lieu Of such n(do semen 1s)®ADDITIONAL INSUR
PRODUCER FORREST INSURANCE AGENCY
603 NORTH MAIN STREET NAME: T
E LONGMEADOW, MA 01028 A/C°ONNo Ext
FAX
E-MAIL A/C No
ADDRESS: INSURERS AFFORDING COVERAGE
INSURED INSURERA: Libert Mutual Fire Insurance MAIC#
WINDOW WORLD OF WESTERN MASSACHUSETTS INC INSURER B: 23035
1029 NORTH ROAD
WESTFIELD MA 01085 INSURERC:
INSURER D:
INSURER E
COVERAGES CERTIFICATE NUMBER: 48525637 INSURER F:
THISI�ToCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
REVISION NUMBER:
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
INS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA
LTR TYPE OF INSURANCE A DL ID CLAIMS.
Y EFF
COMMERCIAL GENERAL LIABILITY POLICY NUMBER MMIDD Y MMND EXP
LIMITS
CLAIMS-MADE E]OCCUR EACH OCCURRENCE $
PREMISES Ea occurrence $
MED EXP(Any one person) $
GI AGGREGATE LIMIT APPLIES PER: PERSONAL$ADV INJURY $
POLICY❑JET 0 LOC GENERAL AGGREGATE $
OTHER: PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY $
ANY AUTO EO accident)
LIMIT $
OWNEDOS ONLY SCHEDULED BODILY INJURY(Per person) $
AUTAUTOS
HIRED NON-OWNED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE
Per accident) $
UMBRELLA LIAB $
OCCUR
EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $
DED RETENTION$ AGGREGATE $
A WORKERS COMPENSATION WC2-31S-377947-019 $
AND EMPLOYERS'LIABILITY 5/7/2019 5/7/2020 PER OTH-
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N ✓ STATUTE ER
OFFICER/MEMBEREXCLUDED? � N/A E.L.EACH ACCIDENT
(Mandatory In NH) $1000000
If Dyes,describe under E.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 apace 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 POLICY PROVISIONS.
NORTHAMPTON MA 01060
AUTHORIZED REPRESENTATIVE
Jon Smith
ACORD 25(2016/03)
11988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
98525637 1 1-377997 1 19-20 WC I n0270258 1 5/5/2019 7:59:95 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
i'V L 1'4 .JS1 L � ��� tt1 rUb t0 )
(NAME OF FACILITY)
a properly licensed solid waste facility,at defined by MGL C 111,'§150A. '{
a
IL'. i
Date Signature of PW7!.Applicant
PRINT OR TYPE THE FOLLOWING INFORMATION:
P-0 W--Q71- F &(S 4
(NAME OF PERMIT APPLICANT)
(TYPE OF MATERIAL TO BE DISPOSED OF)
(PROPERTY ADDRESS)
a � ✓a_
tCorde VU WiRdOWS Afld 0 ors ��r
A �,�
� m0 lrifoet Market
6 s50����W�fie€ �cr®rs�f�HC R , -- atm,P�t 7030 sft-ofest MLarket&t
Orate PA 17030
ish �,t; MROWnn ,€ enaStraBon r.
Fanef 1 D fV(yYL/N
is etea ter. nu ti��r. t ^�. r =3. e Grtd
14
t ..� _. a.�. �ovr6eer3
� e r
ion fo=dine!ttt
eiear ;AE Arrrizafedl;Lite-2:
rs and doors f �'>Etd6•@76�,42
;on;37112 X 37
lC rt P cduas Tay bo wti a to VA tion in performance Lsdleidurt ME!A 216
tNliwn uein„,. � @ Ftodu s may be 'aS40S'pQa07
in(3.:iHdS'3ri tti2 _ _�3 -._—w�ea__..-_..�a� _
I �' ' "aEala�RATe p —z_ ��� sub)ecttov
lit?1' _ ariatton in Psrforman E�
"FOjiFtjFi
1 (U.SJ1.p)
�~�oeqrpaieflt
Solar Na
aregeneratty /II1y1►► e� �/. Ew at Gain Co
troduct cer- 0€ ■ti■ �ffiCient
>ltiwoons in - — �ii�iff P
_ iE� e eOt►NCE RarINcsi 0.2g
NAL f�ERFORC F;';'i
visible r
Dots € s € �t�tl ` .m�Skage(U.sJt�F�) .ran�rnince RAYtNGS
Air La
;ht,bake _ ���� akage(U.Sjj.p]
• • alae 0 t rh'rKtwerSu
-. 0-3
SE''w��acc. pwatestt>lttnear ■!
°Stnt;`6a`..i0i8 -� $ F`x£F1,L-EEOr r'T'i'@th9p^"fig R'c^;€CG6�rEd10r Ce�neleyf7+Mlme prOHuct - �v"r.rrrE ln��a4 are" S tnrtor,to apFycaoie MFR �/
f @ROrt66ADS Wag°flona &r'"ll3Cti6eefortiIVAUtetO£Ke26nRig=?con mrnear -
,£�'Btnutr1cm"0� Etv`#-*e HF.or■anHetpetUlepraH tthe. anyrroauctare aret asetcltnvraraPruceauroa(OrOtte
bris.Usea cLeBA==M"dC�ia€UtilyorIrrypl6¢vClfar rcenura tvrersbteroaaesrmt3arraratneau �rmtcL� rmvkrNeree.
.,; �s.Ft°?9aftliB.27aretOroP[tr enytpeee�euse.Consult ruretor aetm.
-! - P WrrOrEGeM�IMM1Dt90f. w�rvrc.p�C`panc Orayp Z rycd, �jw.`s
.. .
••! 1•, �-� �r9rstargovrWindows ._ c '.J ��i /'�,4`�
enargyetu.'or/wierosvt YY Y�
Cenified/Certificedo For futt information,see label on a Certified C
t Far full infom)ation,sea label on product Para informacidu cu �tihcado
Para WOM18ci6n a mpleta.consuhar la etiqueta del producto. mpleta,consetrar to 0'!Product
Psrf GradeefillnetProrlucro-
Perf Grade +DP(ASD) -DP(ASD) Water LC-PG�r '�P{ASt?)
LC-PG35 35.09 35.08 B.06 N1axTests- 35.30 'DP(ASD} Water
. � - 40.00 X 7 50da
(( Max Test ize eport# STC/0 ITC 2.00 aas72Ra Fo�a7,n Florida tD 5.43
72.00 X 60.00 F�•o+-ta9.�7�0 20840
2911,4 /� stings are for individual windows -
RaCings are for individual windows and doors only. For information regarding mltlled / r stacked nits, end deers o _
nit to E1300 Teed 5 AAMtWOur sales representative fonnation regarding or stacked units,please contact your sales representative.Pos and Nag AP fanged try
�— .STM to
t the unit test size.Tested to AANfNWDMN r.For
101/bonalA440.05 HAMA label may be ' dditional info'AAMA ion regarding maybe 101/1.S.y o°ss and Neg Op9mited b
nail t stalls led in guctio bead or track filler.For d.co onai information re and gardin once by gi�i A440 Glass According to y
installation instructions,please visit w.vw.mnvd.com. g g mstatlation instructions,
_ _
)678,5673. 1.1.1
�7��V
Please N ek filter.For
V 3 1 t"N'.W.miwd.com.
t.t1 26772488.1.1.1 Printed on
r�� 71ttr1016 3:69:03 Ptd Printed on
817212x76 8:10:12 AAr,
Window World Of Western MA
1029 North Road
413-485-7335
western mass@windowworld.corld.coln
Michele Mimi Kirouac
mimikirouac@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
101060 01060 Valid Until:4124/2020
DESCRIPTION . •
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 I Driver's license
Id#* S46u
Id Issue State* Mas
Id Expiration Date 24227
Sales Rep Recommended:
r Interior Stops r Exterior Capping
Customer Declined:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
i
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.