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23D-121 94- 3 4,0 3 i 0 a3 x WINDOW WORLD HIC #160143 56 Dimock St. CSL #78297 Leeds, MA 01053 Telephone 586 -8712 CONTRACT Date ,45' - /6 20 /t5 This agreement, between " /lc Act r (Owner) of L 7,040!rr . , and (Ad r ess) WINDOW WORLD OF LEEDS, MASSACHUSETTS. Phone ,S"J • /3 firms SPECIFICATIONS Window World will .�r L (,j vJn .Y 'L. S , 3Letc 7- 0.0 w4.4/ telt " a A /J!7 [ i}i,(eaw3 41_311-1 /Qt IX/A 1 eVi-.✓ , i' r r c. )l ,i/n y .2 i i L, f rho n A. et-nTy ,. A e S re/et 4t ,l.L C On rla f � � �"l Lin w� s» r ,,",orte,,s. Q. . on the premises located at 7) n..sa:o a total cost of With this order owner pays down the sum of $ / O CJO: 00 Owner agrees on completion of said work by the Contractor to pay the sum of $ dollars ($ ) Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else. Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain material. This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be binding unless in writing signed by both parties. WINDOW GUARANTEE Window World's glass is guaranteed for 20 years from date above not to fog up between the panes of glass. All other parts will be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked glass after one year from date above or any damage resulting from neglect, abuse, 9r acts of God. Condensation build up on the glass is caused from high humidify levels and poor ventilation within the home therefore there is no guarantee that this condition will not occur. In witness whereof, I have here n signed my name this yx ›"Pi day of A A c) ., y Con ractor o7Aut prize Agent I ner — — (Joint Owner) HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation - inspe ' -.* i '• • 1 • • • • n • In. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancv until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location Y 4 J • - The Commonwealth of Massachusetts i= Department of Industrial Accidents R. = !t Office of Investigations . ft fl 1 = r�tt_ 600 Washington Street Boston, MA 02111 : :� a www.mass govidia • -Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/PIumbers Applicant Information Please Print Legibly Name ( Business /organization/Indivirinn1): WINDOW WORLD 56 Dintock Sheet . Address: Leeds, MA 01053 . M4)-6/12 City /State/Zip: . . Phone. #: Are you an employer? Check the appropriate box: Type of project (required): / 1.0 I am a employer with 4. El I am a general contractor and I 6. ❑New construction employees (fall and/or part-time).* have hired the sub- contractors 2 I am a sole proprietor or.part partner- listed on the attached sheet 7. Remodeling • ship and have na loyees These sub - contractors have. .8. 0 Demolition working for me m any capacity. employees and have workers' • r �� 4: - Q l3utldmg` addition workers'' comp. insurance comp. inmrranrP _ __ [No required:] 5. D We are a corporation and its 10.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have xercised their . , 11. ❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12:0 Roof repairs c. 152, 1 and we have no insurance required:) t � 4 § ()� - -_ -- .:aa a [No workers'- 13.0 Other • comp. insurance requited. ] . *Any applicant -that checks box #1 must also fill =die section below showing therwoticers' compensation policy information: t Homeowners :who submit this affidavit:indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub contractors and state whetherar not those entities have employees. lithe sub - contractors have employers, they must provide their workers' comp. policy number. I am an employer that ts providing workers' compensation insurance for my employees Below is the policy and job site information. . • Insurance Company Name: • • Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip:' - Attach a copy of the workers' compensation policy declaration page - (showing the policy number and `expiration date). required . i Apo nmmil Penalties of a Paz7ure to secure covers" as re ' - un�.Soction' of1VIGL`c. 152 can lead to the ' " • srtioui of c 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 $250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the Office of Investigations of the °DIA for insurance coverage verification: • _ I do hereby certify under the pains and penalties ofperjurythat the infornrdtion providedabove_is_true_aad corre t Sit;nattire: /(mot Date: /51// _ Phone #: .S?' - e; 7 7/ 4.2---. . - Official use only. Do not write in this area to be completed by city or town offciaL City or Town: Pernut/Lfcense # Issuing Authority (circle one): . I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other . • Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder : 3 j&..- s-�, S C L l © ,7 O /Gr� License Number 3 A c s Address Expir tion Date S ture Telephone S, Ido us. "D t 1trC` .._Au =yk 41 Not Applicable ❑ /Go /$x Company Name WINDOW WORLD Registration Number 56 Dimock Street Pt 4s /i .0-- Address Leeds, MA 01053 Ex pl'ration to 586-8712 Telephone 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 - 0 No ❑ - lie„ E i 1 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 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 buildine 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 • • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement in' lows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [1:=J Siding [DJ Other [D] Brief Description of Proposed C Work: 4A- ` (? S !i )/`-TL 1 1 S U !s - • 36 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 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 stones? 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 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 6 .,c) c I,j , as Own /Authorized alnit hereby declare that the statements and information on the foregoing application are true and accurate, to the best o edge •elief. Signed under the pains and penalties of perjury. Print Name Signature of Own. Agen Date k Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i ' t i i Frontage ({ 9 Setbacks Front € j 1 1 Side LT —1 = R: Li I R:` i L 1 i i Rear i , Building Height --`- _____ i i Bldg. Square Footage I % 1 i Open Space Footage % (Lot area minus bldg & paved ? �� ;..,...- parking) . # of Parking Spaces Fill: i (volume & Location) , A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 1 IF YES, date issued:, I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page 1 and /or Document IV ____ B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued: C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 IF YES, describe size, type and location: 1 E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r City of Northampton Building Department A DO 212 Main Street = g @ Room 100 0 _ Northampton, MA 01060 �_ phone 413- 587 -1240 Fax 413- 587 -1272 � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION This section to be completed by office 1.1 Property Address: Lot : ' Unit Zone Overlay -Mt" Etrrt St District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: l�N� (� c' /„v G l'. -c� r� t . �l _ Name (Print) Current Mailing Address: s ‘ - 5 4 . Telephone Lf ---- Signature 2.2 Authorized Agent: • Pie � .-L- d,,,41 cs C CG sr. 1 4A - .- ' c- • M f� Name (Pri ) Current Mailing Address: 7/ — Si re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use OMy completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 7 6. Total = (1 + 2 + 3 + 4 + 5) �? �+ �, Check Number / 1 L." This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date - • 186 FEDERAL ST BP-2011-0244 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D - 121 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0244 Project # JS- 2011- 000408 Est. Cost: $2585.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN CORBETT 078297 Lot Size(sq. ft.): 8929.80 Owner: HENNESSEY ANN M & Zoning: URB Applicant: JOHN CORBETT AT: 186 FEDERAL ST Applicant Address: Phone: Insurance: 56 Dimock St (413) 586 -8712 LEEDSMA01053 ISSUED ON:9/17/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # 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 9/17/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner