Loading...
11C-066 (10) BP-2023-1674 83 FLORENCE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 1 1 C-066-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1674 PERMISSION IS HEREBY GRANTED TO: Project# GARAGE DOOR 2023 Contractor: License: WINDOW WORLD OF WESTERN Est. Cost: 5799 MASS INC 115719 Const.Class: Exp.Date: 04/30/2025 Use Group: Owner: KOLODZIEJ PETER J& MARILYN J TRUSTEES Lot Size (sq.ft.) Zoning: URA Applicant: KOLODZIEJ PETER J & MARILYN J TRUSTEES Applicant Address Phone: Insurance: 83 FLORENCE ST LEEDS, MA 01053 ISSUED ON: 11/28/2023 TO PERFORM THE FOLLOWING WORK: GARAGE DOOR 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: � I • y9 . T1'I • ' I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1(1c The Commonwealth of Massach setts� tt (11 u, �8 Board of Building Regulations and tan T (90 F 1N1 PAt.i'i'Y Massachusetts State Building Code, l;I►([, l c0,i JSE 3zo,, Hg41 nine . Building Permit Application To Construct,Repair,Renovate etp/ Revis d Mar 2011 One-or Two-Family Dwelling 9 oTo 7pAv -) j'This S tion For Official Use Only Building Permit Number: AV e4 3• /N Ti Date Applied: , eviat, (Z,-, /'/%l - 11'25-2023 Building Official(Print Name) Signature Date i SECTION 1:SITE INFORMATION 1.1 Pr perty A dress: 1.2 Assessors Map&Parcel Numbers loremc,e 5"( 1.la Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) _______ Front Yard Side Yards Rear Yard Required Provided Required Provided Required I Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ ._ SECTION 2: PROPERTY OWNERSHIP' _ _ 2,1, net.'of /O R o /i 1- 0S3 Mier Ko fd:toga i ed orf hq✓t'1�-�o i Name(Print) City,State,ZIP 8-3 FloreMte 5 f y,3 .58% 17 o 22 elk /,oc/a '5/ �-rmct / /)494 No. and Street Telephone Email Add ��s SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building IA Owner-Occupied'111, Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units \, Other Specify:r\i ' t , le' _- Brief Description of Proposed Work': Ct cr e door ri;p fo cc� 4 7 e ----_ -it SECTION 4: ESTIMATED CONSTRUCTION COSTS __ Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 7q G 1. Building Permit Fee: $ indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: — 5.Mechanical (Fire $ Total All Fees: ,.-tip Suppression) f� � Check No.6 h v Check Amount: Cash Amount: 6.Total Project Cost: $ `; .79 c/ ❑Paid in Full 0 Outstanding Balance Due: , __j SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C- , pq '; t . \(11)41lAa. `e-0 ">\r License Number Expiration Bate Name of CSL Holder pp List CSL Type(see below) 'k,_ '� a cN " Q Type Description 1 No.and Street t' U Unrestricted(Buildings up to 35,000 cu.ft.Z11 c-�V CSZ.N.,4 r—\-,[Thm."'Y"1. \C'\f'_ G\ a1 R Restricted I&2 Family Dwelling City/Town,S • , IP b M Masonry44,1! / RC Roofing Covering - y �"` WS Window and Siding SF Solid Fuel Burning Appliances KA\ )\1T).•� rl 4.42=Y'•o...V5 tJ\A.d1v7t)tic, c, iuk 1 Insulation — -----__ Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) r, i W\,1&0 w �--0,3 VrAC- HIC Registration Number piration Datc I HIC Company Name or HIC Registrant Name Ng and Street ( Email address1Z)c rAi m�-\Q -S .,: �(n-Nt. rvk.l'AM �' 9 \ `3) r� 7 5 City/Town,State,ZIP Telephone SECTION 6: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 D7 No CI SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize '1J\1\e�\ L.0 ksDi•i..)k.. ':, to act on my behalf,in all matters relative to work authorized by this building permit application. Print er's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained i this ap ication is true and accurate to the best of my knowledge and understanding. .. �r -4- /�y/� 3 Print Owt)criz.s ot'Authorazed`A s Name(Electronic Signature) Dale _ r_— NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at wH_w.ma;ss.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count _____ Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths _ Type of heating system Number of decks/porches__ _ Type of cooling system Enclosed Open __ _� I "Total Project Square Footage"may be substituted for"Total Project Cost" _ City of Northampton tiAMw r✓,af r,„r 1%\. 7 1 Massachusetts t 1+ ��r #: � A ,•,} DEPARTMENT OF BUILDING INSPEGTICIVS 212 Main Street • Municipal Building a, Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall he disposed of in a properly licensed waste disposal facility, as defined by MGL c 111., S 150A. The debris will be disposed of in: Location of Facility: � �n \Ct \&Q \e . , \N41Coc\ . The debris will be transported by: Name of Hauler: \‘1\`• 0 \ >"" Signature of Applicant: Date: o. -r City of Northampton r � , ,.., . . 1 Massachusetts � ,• 4i , DEPARTMENT OF BUILDING INSPECTIONS ' yi 212 Main Street • Municipal Building t Vr Northampton, MA 01060 \,c ,./ n HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1��° I, 1/e r ioclo2<� (insert full legal name), born (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of tlr;' Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on n parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 710,R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1,2: Person(s)who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that 1 qualify;fi:n. and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on thisa�`l day of Ak've m��� 20 . (_. 90_0 C4 C.r"Y‘ r ,e•,C (Signature) The Commonwealth of Massachusetts t Department of IndustrialAccidents ..� 1 Congress Street, Suite 11I0 • ‘kitt: Boston, MA.02 ZI4-20I7 Sir www.rnass.gov/dia W 'Workers' Compensation Insurance Affidavit:Builders/Cmttracturs/k'.leetricia ns/.Pionabers. TO RE FILED WITH THE PERMITTING AUTHORITY. Applicant.Information Please,Print Lea,i t;:Window World of Western Mass Name(Business/Organization/individual): ___ , __._ Address:641 psniel Shays Hwy City/State/Zip: Solchertown MA 01007 phone413 485 7335 Are you an employer?Check the appropriate box: Type of project(required): 1• , .,1 am a employer with__._,,..,,.,employees(frill and/or part.tines)."` = 7, D New construction 2.01 am a sole proprietor or partnership and have no employees working for me in ; 8, 3 Remodeling 71ny.eapaeily.[NO workers'comp.insurance required.] I 9. 7..]Demolition a 1.01 am a homeowner doing all work myself.(No workers'comp.insurance required.] ' . ; i ; 10 0 Building addition 4,0 i am a homeowner and will he hiring contractors to conduct all work on my property. I will s ensure that all:contractors either have workers'coral en.sation insurance or are sole # 1 1. l l?Icctrletu repairs or addition:; proprietors with no employees. y d 12. J Plumbing repairs or;addi icrtr�, ; 5.01 am a general contractor and I have hired the suh-contractors listed on the attached sheet. 1 'These sub-contractors have employees and have workers'comp.insurance.$ d (�. Roof repairs i 14.2O01et Replacement 6,0 We are a.corporation and its officers have exercised their right or exemption per MGL c. _ 152,§I(4),and we have no employees,(No workers'comp,insurance required,' "Any applicant that cheeks boortI roust 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 indicatimc:.,!^.i� ;Contractors that cheek this box must attached en additional sheet showing the name of the sub-contractors and state.whether or not those entities h11'v employees, If the.suh•comrttetors have employees,they must provide their workers'comp.policy neither. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jolt:sits. information. Indemnity Insurance Co,of North America Insurance Company Name: • Policy#or Scl'f-ins•.Lic.#: C56O98598 Expiratien Date:_101011_024_..T // e/p53 ha' Joh Site Address: 3 if City/Stale/Zip: 4/42 . ., Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration tittt•.'). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine op to'5I_..'i l !, 'i' and/or one-year im lritonmeft,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to day against the violator.A copy of this statement may IN forwarded to the Office of Investigations of the DIA for in a' coverage verification. __ . r I do hereby cer ' un er the pains iCa d penall 'es of perjury that the information provided above is tare and correct, Signature: —% Date: // /iy/a te _... Phone#: 413 485 7335 „., y:nrr_— -........,2 ewc-4.,.-., ...:.; • Official use.only;Do not write in this area,to be completed by city or town official. f City or TWO: ,. ,Permit/License#_ 'Issuing Authority(circle one): 11 1,Board of:Health 2.Building Department 3.City/Town Clerk 4.I+alectrical Inspector 5.Plumbing Inspector• 6.Other,V,_,. ' Contact Pe.rstrn: _,., ,. ..,w.. ... Phone#: CERTIFICATE OF LIABILITY INSURANCE Acct#:2970777 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T'1(. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TtiE POI KIX BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHOiil:l:r 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. rnth,tm'+r. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A stafrmr•:ti this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LOCKTON COMPANIES,LLC NAME:-- 3657 BRIARPARK DR.,SUITE 700 PHONE (A/C,No,Ext):888.828-836lS I FAX N,:l: HOUSTON,TX 77042 E-MAIL ADDRESS: INSPERITYCERTSQi LOCKTONAFFINRY.COM INSURER(S)AFFORDING COVERAGE NAv:R ---_--- --- -_------- INSURER A:Indemnity Inayrance Co.__of North America_ INSURED WINDOW WORLD OF WESTERN MASSACHUSETTS INC. INSURER : 641 DANIELSHAYS HWY INSURERC: BELCHERTOWN,MA 01007-9529 INSURER D: f INSURER E: ; INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PFRIOI INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 118 R.kroE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE NSR ADDL SUER POLICY EFF POLICY EXP - - INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) 'IR'ITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS- OCCUR DAMAGE TO RENTED PREMISES(Es occurrence) I MED EXP(Any ono porarm) I S PERSONAL S AU'✓INJURY GENII_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- LOC OTHER: IFCT PRODUCTS-COMP/OP AGE $ AUTOMOBILE LIABILITY �(1FiT31Nh g171 E OW I a — (Ea accident) ANY AUTO BODILY INJURY(Per porson) $ OWNED SCHEDULED — AUTOS ONLY AUTOS BODILY INJURY(Pa Acack)nq ri HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per acceleni) --. .. I UMBRELLA LIAB . .--.-- .__._.....__... ...,_ OCCUR I EACH OCCURRENCE EXCESS LIAB -- 5 ,CLAIMS-MADE AGGREGATE DED RETENTIONS , WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY YLN_ X STPTUTE IER A ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH A'CInGNi I t 1,900(19(1 OFFICER/MEMBER ory in I EXCLUDED? (Mandatory in NH) —"/A x C56098598 10101/2023 10/01/2024 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE 1,t1i19,(100 E.L.DISEASE-POLICY LIMIT 1 01)0,00(1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space le required) CERTIFICATE HOLDER CANCELLATION 2970777 - -. Town fo Northampton Building Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICES 212 Main St BEFORE THE EXPIRATION DATE THEREOF, NOTICE W1L.i.I'(1_ O('1.;ir;"!2''i-I !'+' Northampton,MA 1060 ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. AEI ritlhl::!o--+-r'vr :. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WINDWOR-01 "Ra ;` A. M� CERTIFICATE OF LIABILITY INSURANCE iyinArEir4;20 .3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE,FIOLDER. i')-IS': CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TI-EE t'OI./CitL- BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHtO;ti:%EI:: REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITICFAL IP!SURED provisions or be ends rued. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A stateln":lt OP this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Laura Misseri • • Phillips Insurance Agency,Inc. PHONE 41 FAX 41 Ti 97 Center Street (A/c,No,Ext):( 3)594.5984 {(arc,No):( Chicopee,MA 01013 ADDRESS:laura@phillipsinsurance,com INSURERS)AFFORDING COVERAGE , ?JAIL INSURER A:EMCASCO Insurance Co INSURED INSURER B:Employers Mutual Casualty Company Window World Of Western Massachusetts Inc INSURER C: 641 Daniel Shays Highway INSURER D: Belchertown,MA 01007 INSURER E:.. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR [HE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD NNVD POLICY NUMBER itimrii ca IMMIDDNiYYI I _ LIMIT` A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE l ' 1,000,010 500,000 1 CLAIMS-MADE [J DAMAGE TO RENTED OCCUR 6Q44324 4/9/2023 4/9/2024 PREMISES(Ea cccurr3rice) 1.5 MED EXP(Any one person) ) 10' 01 PERSONAL$ADV INJURY 'R oII(}'otbl GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ")p)tl'5,f){ X POLICY i X I lief I X j LOC PRODUCTS-COMP__/OP AGO l 3 I,0(10,gl)(, OTHER: —..—___—.1.5 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I !,�)0) '1,`„� accident) . (Ea cident) ANY AUTO 6Z44324 4/9/2023 4/9/2024 BODILY INJURY(Per person) I;; AUTOS ONLY SCHEDULED ( I XBODILY{�� INJURY Par accident) $ X _X (PrOr accident)DAMAG[ ._. $ NON-OWNEDUTOS __. AUTOS ONLY AUTOS ONLY - B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1 Q 'I,000 4./(,Ili EXCESS LIAB CLAIMS-MADE 6J44324 4/9/2023 4/9/2024 $,'1i� 0 Z't't'I AGGREGATE S DED X RETENTION$ 10,000 13__ ..__._ WORKERS COMPENSATION iPERTUT- I .!.ERH- I_ .. AND EMPLOYERS'LIABILITY Y/N j ANY OFFICER/MEMBER EXCLUDED?ECUTIVE 1 N/A El.EACH ACCIDENT (Mandatory in NH) ---'I E.L.DISEASE-EA EMPLOYEE $ 1 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space la 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. Attn:Building Department 212 Main Street —"— ---— Northampton,MA 01060 AUTHORIZED REPRESENTATIVE `1`1 `ki* l'. '.. I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rigl;in YE'ioi :a1, The ACORD name and logo are registered marks of ACORD H r_Th"M.5SI'35-C.H,'Cr-7'S :---r--"c•9 cf.Oiltr-s.Lrn•=: Affairs Z,..l'Itnern.e$_e Pz,n.)t,r—n --zZa C-':',. k,..,:t.--..'.i••',E, PQM E 44 P R OVEM ENT GOWIL'34(:10., expitatifil d./te. 'r fnund T'r :indiv:AUE0 Office of Censumer Aff.9irS?:ld eualness Pleguiatioo Fir.g"straticiri E-'4Q`-'r-atk);:l. i Vie Iry'ash:ogion Streei -'iiiIte 710 )0174E 00,2702E BOSt01,MP. 0%11t1 S 7c- S- \PCHOI AS OPOST . ' --. '02 OAKRIDGE;"...::--RiF f-• .4,' •'':./..;'00.4.,' . ,..,ra,.../.• F.-:_CHPEITCWN.MA 01007 --:...._.-- _ Undersecretary Net valid without signature Ti-Ca COMMONWEALTH OF MASSACHUSETTS Grine*I Consumer Affairs S Business Regulation HOME IMPROVEMENT.CONTRACTOR TYiEporatiO1t: Reaistratiortr-.. A009.2.°I .--7•-....----._________...._._—_........._.__,__.. 16.9 ...-7.':.-r-.703t.14igq4 IliDiArtsion of Professional Licensure WINDOW WORLD OfAVESTPINf SIAC4USETTS,INC. Board of Building Regulations and Standards I-;. Donstotitilil rtlit ' .,.. . glp.IVISOr ` ......,:, ',....:....:::-. ,‘7.---::1;: 'i TIMOTHY D ,.. CS.115719 _ . ' ,-Et'''-'---.1 4.7Ocpires:04/30/2025 Ft 0 ST 01 .=--.'-'-`-,-,11.1gel"-__--.. ...,-"':-.7 I..7 641 DANIEL SHAYS -!W . ----,...1- :z- -1-, gewsAda-1.2d4'4 4, „- NICHOLAS TpROS: DELCHERTOWN,MA 01007.:, 7,7,. • 1:• 5 . ,.._ Undersecretary 102 OAICRIDGE DR 1 = - BELCHERTOWg4 MA is0'111 B .' - A - „.• --•isr s N. l'f.:V t'..' i•, • c ‘ t.()11A:ILOs • .,,,,,i• 1 Commissioner .019ct8G g Btotho ..,_. Window World of Western Massachusetts 0.,,non.Ar,n,mn:nn 641 Daniel Shays,Hwy,Belchertown, MA 01007 975 North Road,Westfield,MA 01085 `/�� WINr'AVW Wt,tdczw ti Office:(413)485-7335 CARES www.WindowWorldofWesternMA.com Peter Kolodziej Phone: 4135867722 Install Address: 83 Florence St Email: pjkolodziej51@gmail.com Northampton, MA 01053 Contract Name: Peter Kolodziej -Sales - Doors Design Consultant: Tim Drost Measured By: Measure Approved Date: 11/13/2023 Status: Contract Payment Method: Cash Lender: Contract Type: Sales Comments: Product Description Txbl Qty Price Extension Permit&Administrative Fee Permit&Administrative Fee N 1 $200.00 $200.00 Setup and landfill disposal fee-Windows Setup and landfill disposal fee - Windows N 1 $100.00 $100.00 Garage Door Opener Belt Drive w/Camera (one remote included) Garage Door Opener N 1 $799.00 $799.00 Garage Door Classica Single Garage Door Classica Single long Panel corona N 1 $3,800.00 $3,800.00 white , with Madeira glass Garage Door Classica Add Glass Garage Door*Classica*Add Glass N 1 $900.00 $900.00 Total Information Unit Total: 4 Subtotal: $5,799.00 Tax Rate: 0% Tax: $0.00 Total: $5,799.00 Amount Financed: $0.00 Payment Method: Cash Deposit Amount: $0.00 Balance Paid to Installer upon Completion: $5,799.00 Renovation, Repair and Print Act (RRP) Compliance RRP Pamphlet Provided Date: Year Home Built: RRP Signed Date: i Window World of Western Massachusetts venison.we��"?commons 641 Daniel Shays,Hwy,Belchertown,MA y {, 01007 j'' 975 North Road,Westfield,MA 01085 Office:(413)485 7335 WINDOW WORLD ai CARE www.WindowWorldofWesternMA.com Product Acknowledgements i have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. i received this parnnhiet before work began. Primary Homeowner .1"A:>C1 i� V-e).442‘....,--/ Secondary Homeowner Window World of Western Massachusetts 1PUF Vf7PRPRf P 1g1mm.�.nD 641 Daniel Shays,Hwy,Belchertown, MA r= 01007 975 North Road,Westfield, MA 01085 Vindomi W Office: (413)485-7335 WINDOW wo.�..O www.WindowWorldofWesternMA.com CARES Preparing for Your New Windows and Doors Thank you for choosing Window World to complete your home improvement project.This letter is designed to simplify your upcoming installation experience by letting you know what to expect. 1. HOW LONG DOES IT TAKE?It takes approximately 4-20 weeks to receive your custom-made window order from the factory following your final measurement and your job exiting the Massachusetts State three day rescission period.A Window World associate will contact you shortly after your products have arrived to schedule the installation. Please note that we will make every effort to install your products within a reasonable time after they have arrived, but weather(rain, snow, high winds and extreme cold), high volume sales periods or other conditions(factory production delays,factory closure for holidays,shipping delays, etc.) beyond our control may govern the installation date. Homeowner understands and agrees that any such delays will not result in a discount from their contract total. 2. HOMEOWNER REQUIREMENTS: I understand that by signing this, I am certifying that I am the owner of the property listed on the contract. I agree that a property owner will be present for the duration of the installation to ensure that the work is performed to my satisfaction and to inspect the work completed. If a property owner is not present,the contractor will be released of liability for any installation issues. This allows us to better satisfy our customers and ensures that the windows or materials are installed in the correct openings. Customer must sign off on completion certificate and leave final payment with installer if he/she wishes to leave the job site prior to completion. Customer understands that by not being present at the time of installation may result in the automatic charging of the final payment to the credit card used for deposit. 3. UNFORESEEN CIRCUMSTANCES: If during the installation process a condition is found that would prohibit properly installing a window(i.e. wood rot, termite or other hidden damages, etc.),the installer will promptly notify the Homeowner as well as the Window World office of the problem.Any additional work that is required to properly complete the job will be discussed with the Homeowner and billed on a time and materials basis. In the event we have received the incorrect or damaged window for your job (due to an incorrect measurement or factory error), Window World will reorder the proper window and will schedule the installation as soon as possible.Window World expects payment on the work completed to date at the time of installation that is not affected by warranty issues. 4. WHAT YOU NEED TO DO PRIOR TO OUR STARTING THE INSTALLATION: • You will need to remove all curtains, shades, blinds, window air conditioning units etc.from the existing windows. • We also ask that you remove any pictures mirrors,etc. on nearby walls and tables. • Move all furniture away from the area around each window leaving approximately 3 ft in front of the window and ift on either side of the window to be replaced. • Secure any pets(and children)for their own safety and for the safety of our installers. 5. ALARM SYSTEMS: It is the responsibility of the Homeowner to inform the alarm company of the upcoming window or door installation and to arrange reconnection after installation is complete. 6. EPA-LEAD SAFE GUIDELINES: Homeowners of homes built before 1978 have received a copy of the lead hazard information pamphlet informing the Homeowner of lead hazard exposure from renovation activity to be performed in their home.The Homeowner understands and agrees to indemnify and hold Contractor,Contractor's representatives, and employees harmless for any lead paint health issues. 7. INSIDE INSTALLATION (Normal): If the windows are to be installed from the inside, the interior stop moldings will be removed from the existing windows and reused after the new windows are installed. Please note that the paint or stain on the trim/moldings may get chipped and would need to be touched up by the homeowner. 8. OUTSIDE INSTALLATION (Special): If the windows are to be installed from the outside, the existing window's wood "stops"will need to be removed. In addition, if there are existing storm windows in place outside of your current windows, these will need to be removed as well. Please note that the area(s) where the wood "stops"and/or storm windows were removed will need to be patched and painted by the Homeowner unless the exterior trim is to be installed by Window World. 9. UPON COMPLETION OF INSTALLATION:After the installation is complete,you will be asked to inspect the entire project with our Installer. An evaluation sheet will be provided for the Homeowner to sian after the final inspection is complete. Please make sure that any corrections have been made before the installer leaves the job site.When the job is complete, we ask that you pay the installer the remaining balancet due on your contract. 10. METHOD OF PAYMENT: Our installers will accept your final payment in the form of check, money order, Wells Fargo financing, or Visa/MasterCard/Discover Card authorization. As a courtesy and to ensure the safety of our installers; please DO NOT pay your final payment In Cash. 11. REFERRALS: Our goal is that you are pleased with the work we have done and will refer us to your friends and neighbors.You will receive a $50 referral fee for each person you refer who purchases 8 or more windows. Please have your referral mention your name when contacting our office, We trust that your remodeling experience will be a pleasant one. If for some reason you are not completely satisfied, please contact our office. Your comments are welcomed and will be used to better serve you. Thank you for your business! Primary Homeowner Secondary Homeowner Design Consultant r\l/\ 11 C> I G2'_1 "l eIlovcitc. Right" Brochure can be viewed and printed from here: R ile)vate i ight. Brochure V‘, >1 i'.`. i assachuse!is anticipates starling this work on and being substantially completed in days.Any deposit required in tlr:? start of the work SHALL NOT exceed 33 1/3%of the total contract price OR the actual cost of any material or ce(;utiimeft cc a sp clal order or custom-made nature,which must be ordered in advance of the start of the work to assure that the t: will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all l)„rt.es. Ali home improvement contractors and subcontractors shall be registered. No work shall begin prior to the signing of the c, ntr„ct and iransnritlal to the owner of a copy of such contract.WW of W. Massachusetts under provision of Chapter 142A of the '.s reenuired to apply for and obtain all construction-related permits.WW of W. Massachusetts shall not be deemed fur delays in the work described in this agreement caused by regulatory, permit granting agencies, authorities, or is. Notice: if the PURCHASER(S) obtains his own construction related permits for the work described under this agreement or ri ti,il.ii unregistered contractors,the PURCHASER(S) is hereby advised that in the event of a dispute,judgement and n:•i;i,r;y:..:;sc, the PLftOHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 1• :L.., 1,1 let leh tare imiycr may cancel this transaction at any time prior to midnight of the third business day after the date of this tr-ta tac:i dui. Notice of cancellation must be in writing postmarked no later than midnight of the following third business cl: v. a' "('(1i•I ORDER NOT FOR RESALE This Window World® Franchise is independently owned and operated by Window World of Western M ._,,ch i urts, Inc. under license from Window World, Inc.