30A-014 (4) 353 FLORENCE RD BP-2019-0185
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-014 CITY OF NORTHAMPTON
Lot:.001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catcgorv' window replaced BUILDING PERMIT
Permit# BP-2019-0185
Project JS-2019-000308
Es[ Cost $5030.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011
Lot Size(sp.R.): 15115.32 Owner: LYMAN DENNIS C&MARYANN S
Zoning URA(100)/WSP(100)/ Applicant: WINDOW WORLD/ROBERT E BUSHEY JR
AT. 353 FLORENCE RD
Applicant Address: Phone: Insurance.,
1029 NORTH RD (413) 485-7335 0 WC
WESTFIELDMA01085 ISSUED ON:8/15/2018 0:00:00
TO PERFORM THE FOLLOWING WORK INSTALL 8 REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROMTHESTREET
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 8/15/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
0J/N now
D Deperbnent use only
Sfetuis of Pertnib
Building Departmen Durg C->)R(OtIfaYla),r P,enn0. ___,_:.
k'(ly MaIT ���t Bev(ealBAPds.�t+auat�utv��,,:.:: �.
Room 100 Wglp AvaileitlNp�
ortham ton MA 010 0 Two$at@ of ffiWejulal Plana
ph ineWT1MllM�ftjX,,Tf"87-1272 P1?Vj0Aapq,
oder eperary
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION lJl- `� ^ `
1.1 Property Adddress: This section to be compla� a by oftice
353 poft-j-'Ce r�� L -� Map?A Lot l(+ t
Z... Overlay District—
Elm
lstdaElm St.District CB Dlsi
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
1,2.1 Ow of Ree rd:
111 L�InCc l� � Ck(fn � A I
Nams(PHnt— ) I Current Mailing Addiess:
(See Contract) Telephone
Signature
2.2 Authorized Arent:
1029 North Rd WeSWielA MA 01085
Name(PnM) C Cunent Mailing Address:
�lL ", 413 485 1336
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bmit applicant
1. Building % 0- t Q (a)Building Permit Fee
2. Electrical -J _J� (b)Estimated Total Cost of
Constmceon from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) TU
S.Fire Protection
e. Total=(t +2+3+4+5) , U Check Number
This Section For Official Use Only
Building Permit Number: Dale
ssusd.
Signeta:
Buldlno mi lonW11.peotor of Buildings
Dem
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Mug Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Requmed by Zoning
This column an be filled in by
Building Depermmt
Lot Size
Frontage
Setbacks Front
Side L' R:' L:1 _ R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage �o
(tut mea minus bldg&paved
#olParking Spaces
Fill: acesFill:
volume&I.ocanm
A. Has a Special Permit/Varlance/Finds ever been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:'.
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Pages. and/or Document#'
B. Does the site Contain a brook, body of water or wetlands? NO O DONT KNOW 6 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size,type and location:
E. Will the construction activity disturb(dearing,grading,excavation,or filling)over 1 acre or is It pan of a common pian
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW Is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable
New Nouse ❑ Addition p Replacement ndows Alterstion(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (p] Decks [O Slding[p] Other=
Brief Description ro �°pos
Werk:
Alteration of ezisfing bedroom_Yes_No Adding new bedroom Yes No
Attached Harrell" Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
ea.If New house and':or addltlon to eadedna.houslna..Complete the following:
a. Use of building:One Family Two Famlly Other
b. Number of moms 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 S.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, 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.
(5ef. Gomyna)
Signature of Owner -r� Data
I, �he.Y'�'- 17UbNP V ea Owner/Authorized
Agent hereby dedare that the etatemen and information on the foregoing application ere true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
t hem
Print Name
ti fZ, s Jlp/r�
Signature of Omer ant Data
SECTION S•CONSTRUCTION SERVICES
3.1 Licensed Construction Sump soror: 1.. f� Not Appllcable E3Nemo MLleense Holder, Rober- Bush"
licence Number
1 t 51011
Addreca Fi�piraava Date
4-I3 4%533-65 e lZsc � Iq
Signature r Telephone
9.Raalstemd.Nomo hnnnesamam Contractor. Not Applicable ❑
Robcrt g1 J6Y?P\I I b5 b4I
COnlnamr Nsom Registration Number
Wirxlnw World cif Western MASS Inc. 311+ 120
Address Expiration Date
t 029 North Rr� yaest{vel d MA a08�alamtpne 413'aK5-i ass
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVtt(M.G.L.c.132,5 25C(e))
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 Dwelling 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 Mien 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.q person who constructs assire thing home,In tw bested shall not be considered a hisminine
Such"homeowner"shall submit to the Building Oficial,on a form acceptable to the Building Officials that he/she shat be
responsible for all such work cerfarmed under the building pe 1L
As acting Construction Saperi*isr 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 1"T be(able for person(s)
you hire to perform work for you under this pemdt
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 Sipatere
�s Window World Of Western Massachusetts:
�al 1029 North 733
owworl5-733
6666eeee���� ,uysesd - westernmass@windowworld.cor
clary Ann Lyman
Estimate : Partia
Bill Address: Install Address: Estimate# E153295721301t
353 Florence Road, 353 Florence Road,
Northampton,MA Northampton, MA Date of Estimate:7/30/2011
01060 01060 Valid Until:8/29/201!
DESCRIPTION OTY UNIT RATE(S) AMOUNT($)
4000 Series DM 8 330.00 2,640.00
Soladolie Level 8 110.00 880.00
Full Exterior Capping 8 110.00 880.00
EPA Lead Containment 8 60.00 480.00
Permit 1 150.00 150.00
TOTAL AMOUNT $5,030.0(
CUSTOMER PAYMENT DETAIL
TOTAL PAID $0.0(
CUSTOMER DUE $5,030.0(
Vo extra work if not in writing
:ustomer Comments:
nstaller Notes:Exterior install..Anderson deeppocket—white trim......all first floor except back there is a walkout basement need ladder..customer removing blinds and
ower box out front
ustomer ID Details
d Type" Driver's pusese
tl#` 54471530
it Issue State' Mass
d Expiration Date 9041956
ales Rep Recommended:
— Interior Stops r Exterior Capping
ustomer Declined:
— Interior Stops I— Exterior Capping 1�1 —t -ry---
re 1878 built homes:
y home was built s the ye tr 19% tlnaap
oomagl decline mind party.e Fcencn
linivan I have received copy of the Lead hoped information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed In my
U thejob is done,uuless it will be a 2 or 3-day job,in which case we may work as long as there is daylight.It is aur policy that our installars get a signoff form an
ollect the outstanding balance at the completion of the job.We ask that you be available in approve the job and make final payment at rhe time ofeampletion.if this
of convenient for you,we need to know before we start the job.Inclement weather and other unforeseen hindrances are a fact of life and as such we ask that yo
nderslal if the weather,traffic,etc.cause a delay or cancellation area installation appointment.We typically do not schedule more than a day or two in advance t
y to avoid such issues.
.Our Work-site.We like to set up mor work-site as close to your windows and doors as possible and generally your driveway is the best spot.If using the ddvewa
nil block a garaged car,please be ready to pull if out upon arrival,
.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 th
isconnection and reconnection ofyour alarm system.
.Where do we start?Upon broad,the crew leader will survey the job and determine where to begin If you have a preference,feel free to advise us and we wit
ecommodate to the best of our ability.Because we work in stages(ix.,removal of old windows,setting the new window,wrapping of oxterio ,etc),we don
omplete the job one window at a time.The job moves along in a rolling progression where each operation is done on all windows at the same time.This produces
ualityjob.
. If the job takes more than a day,will there be any openings in my house?Of course not.We only remove that which can be reinstalled in the same dap
dthough there may not be a complete window,it will be weather-fight and secure for overnight.(Please no critiquing at this time).
0. Pets.We love furry,four-legged creatures;however,we need your help in supervising them.We arc not always able to close a gate or door behind us whe
arrying a window,so please keep than in a safe place.Omjob description does not include scampering down the street after Fido with new found freedom.Man
could say,don't worry,he doesn't bite,but many installers have been bitten.So please secure dogs that have an aggressive hark towards strangers.
1.Expect some dust,noise and general disruption of your living space.Construction work can sometimes be messy depending upon the scope of your job.It
n unfortunate reality of remodeling,but we do our best to keep,things under control.We appreciate your patience and understanding,during the job and not
verytlting is finished Even after we have cleaned up,it is advisable to survey the areas for something we may have overlooked(Is„kids rooms,baby's room).
2.*Damage to walls and old trim stops.For those ofyou who have old aluminum and steel windows and arc replacing them due to sweating and damagmg of th
rails be advised that all water damage plaster will most likely fail out.in addition,all the patch works you have done over the years will fall out also.This is norma
owever,we are not plaster experts,so the repair to those wails would best be left to the experts.In some cases,due to out of square openings,new trim is required t
take the window look good."Unless noted on the contract new trim will not be provided or installed by us.You can expect m do some touch up painting on the ma
fter the installation of yam new windows.This is not always necessary and is usually minor if it occurs.If your mm stops around your sashes are very old,dry,an
rime,they may snap and crack upon removal.Ifthis happens,we can leave them off ifyou please,or for a small up charge,replace them with newer ones.Many c
to old-style stops are no longer available so we would replace the entire window with newer style stops.Should we discover any hidden damage to the forme or we
ren we will advise you before we proceed.Should you decide to replace or repair anything,the price will be added to your balance.
3.Relax and enjoy the show.After we've been introduced to yam home,feel free to run errands,take a walk,orjust relax.If a question should arise;ask the cre,
ader for clarification.We enjoy people who are interested in what we do,and most customers me intrigued with the process.We do get nervous,however,when
ustomer constantly hovers over our shoulder.Like any professional,we're always happy to answer questions,but we appreciate being able to concentrate on OL
cork without interruptions and distractions.This ensures a safe and quality installation.
4.Past Due Balances are subject to a service charge of 1.5%per month.In the event that this amount is placed in the hands of an attorney for collection,th
urchaser agrees to pay all costs ofoollection,including a reasonable attorney fee.Repair,check fee is$50(fifty dollars).
Customer Signature Sales Person Signature
.S.Ni would be a good time to review contract with the salesman to be sure of your order options and work to be done.Only the items and services on the contract will be
one.If you have any questions whatsoever,now is the time to ask.
/indow World of Western Massachusetts may not require an acceleration of payments as specified in the payment section(front)for the reason that he deems himself or in
syments to be insecure.However,where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of fund.due
niter the contract,which are in possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the own,
awithdrawal.
rbitmtion;Window World of Western Massachusetts and the PURCHASERS)hereby mutually agree in advance that in the event Window World of Western Massachusetts
as a dispute concerning the contract,Window World of Western Massachusetts may submit such dispute to a private arbitration service which has been approved by the
ecretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration in M.G.L.c 142A.
!indow World Owner
ate ......__... __..... ................Data
OTICE 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
(spite resolution even'where this section is not signed separately by the parties.'
his Window World e Franchisees independently owned-and operated by Window World of Western Massachusetts,Inc.under license from Window World.Inc.
The Commonwealth ofMassaehusetis
Department ofindustrial Accidents
OJfrce oflnvestigations
1 Congress Stree4 Suite 100
Boston,MA 02114-2017
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leniblv
Name (Business/Organization/Individ=l):yMr Of Wletkrn MR
Address: (62_4 N OY-Vh R d
City/State/Zip: NUWdd MA 01OWS Phone #: 13 4`65 1335
Are you an employer? Check the appropriate box: Type of project(required):
m
1.N(I aa employer with b _ 4. E] I am a general contractor and I
employees (full and/or part-time).' have hired the subcontractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in ao ca act employees and have workers'
Y P tY t 9. ❑Building addition
[No workers' comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doting all work officers have exercised their i l.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §l(4),and we have no
employees. [No workers' 13.�Other HCP Mf comp.insurance required.]
'Any applicant that checks box#1 must also all out the sexton below showing dair workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside nontrsemte must submit a new affidavit indicating such.
tContmctons that check this box must attached an additional shat showing the more of the subcontractors and state whether eunot those entities have
employees. If the eubcwtoctms have mployees,they most provide their workers'camp.policy number.
Isms an employer that Is providing workers'rompensadon insurancefor my employees Below is thepolicy andjob site
information.
Insurance Company Name: LlbeYN MUtuckk Insklrancc
Policy#or Sel&ins.Lic.#: �N�2-iiIS'���(]�-I CI II' I1 - O 18 _ Expiration Date: 7 I q
Job Site Address:�5 -ACAs)C� �Y�fY.Qd City/State/Zip: OHf).Xrryt _mp'i
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). i OU-)
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
£me up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the fool of a STOP WORK ORDER and a for
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.W for insurance coverage verification.
I do hereby er the penalties of perjury that the information provided above is true and correct
S tom' Date: 'ib ell
Phone#: 4-13- 4IJ -1335
Official use only. Do amt write in this area,to be completed by city or town off tial.
City or Town: PermittLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
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PROPTDaR FORREST INSURANCE AGENCY
803 NORTH MAIN STREET P
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INSURED WNDOW WORLD OF WESTERN
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COVERAGES CERTIFICATE NUMBER: 41575M REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLNMS
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WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA
This cRINICA a cancels and supeived a NI pmvlously issued eem8catea,only as they rolsM to workers compenalmon coverage.
MTE R CANCELLATION
CITY OF NORTHHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
212 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NORTHHAMPTON MA 01080 ACCORDANCEWOH THE POLICY PROVISIONS.
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Jon Smith
O 1988.2013 ACORD CORPORATION. All rights me .d.
ACORD 26(2016/03) The ACORD name and logo am mgtstamd marks of ACORD
1675012 1 1-311941 1 16-19 R 0025<981 1 5/2/2018 9:39:52 P (.W1 1 I,. c, L