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29-439 (7) 67 ELLINGTON RD BP-2020-0992 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-439 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: REPLACEMENT W IN DO W S/DOORS BUILDING PERMIT Permit# BP-2020-0992 Project# JS-2020-001678 Est.Cost: $11948.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011 Lot Size(sa. ft.): 10018.80 Owner: FINLEY JAMES A JR&MICHELLE G Zoning: Applicant. WINDOW WORLD/ROBERT E BUSHEY JR AT: 67 ELLINGTON RD Applicant Address: Phone: Insurance: 1029 NORTH RD (413)485-7335 O VV(' WESTFIELDMA01085 ISSUED 6N:3/5/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 9 WINDOWS AND 1 ENTRY 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: 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: FeeTyne: Date Paid: Amount: Building 3/5/2020 0:00:00 $80.00 212 Main Street, Phone(413)587-1240,Fax:(413)5$7-1272 Louis Hasbrouck—Building Commissioner II f Department use only City of Northam ton ; Status of Permit: f. Building Department Curb Cut/Drive ay Permit 212 Main Stfeet A'�AR Sewer/peptic vailability Room 100 �= WaterMell ailability Northampton, MA 01060 Two Sets oVStructural Plans \ phone 413-587-1240 Fax 413-587-1272 Plot/Site Pans 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 section to be completed by office L� �� IN) V n I Map o�Cl Lot "�� Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:_ Im i 01 6111 N r MA O 1plo2 Name(Print) Cure,nj Mass• conkad) Telephone Signature 2.2 Authorized Agent: Robcyft 102. 1 N05'( V) "CS%ifW MA OWY5 NaTej"Pri ) Current Mailing Address: ignature ' ... ---- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted 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 �Y O 6. Total=0 +2+3+4+5) Check Number a Q, � This Section For Official Use Only Building Permit Number: 8� ad0"G lLi Date Issued: Signature: Building Commissioner/Inspector of Buildings Date ` EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5•DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition [] Replacement indowsAlterations) Roofing Or Doors A [ - Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [C] Siding[l3] Other[p] Brief Description of Proposed [ Work: 1 ("e, o fj I t/)&UJ 6 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X— No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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. Dirr)&msions 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 as Owner of the subject property 11,,ll hereby authorizeQ1641111) W)n4/,d 6 ,IP�j�Yyl �Q to act on my behalf, in all matters relative to work authorized by this building permit application. See I Goryly!act) ") Signature of Owner bate as Owner/Authorized Agent hereby declare that the statementd and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print,4rne Signature df Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:_. License Number A2 _ �10) k Address Expiration Date Signyn ure J( Telephone 9.Re-gistered Home Imprr,6 ent Contractor Not Applicable ❑ _Rob-e,rt tit rs�net b��ti 1 Company Name Registration Number l i�d(l�na VIA of If�,ieyr M�SS inc, 3� 14 �2Z Address Expiration Date 10_2-1) N W4 V16 L6�f\ d L4A 0 -lephone 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....... 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-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 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 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 �•�`•W www mass.gov/dia Uorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly 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: Type of project(required): 1.E]I am a employer with 20 employees(full and/or part-time).* 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. E]Remodeling 3.[]l am a homeowner doingall work myself. t 9. El Demolition y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.ro I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.F]Plumbing repairs or additions These sub-contractors have employees and have workers'comp,insurance) 13.[:]Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[D 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: City/State/Zip(/&r(AU, MA D�[�,a Attach a copy of the workers'. mpensation 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 ce/rtrfy under t pains and penalties of perjury that the information provided above is true and correct Si natur 11Date: '7 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �'4�Rte® 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 Hoaro2/1 s OLDER.THIS 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Forrest Insurance Agency PHONN ExtI: 413-858-2680 A/c No: 413-858-2685 603 North Main StE-MAIL East Longmeadow,MA 01028 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ARBELLA PROTECTION INSURANCE CO. INSURED INSURER B: LIBERTY MUTUAL FIRE INSURANCE CO. WINDOW WORLD OF WESTERN INSURER C: MASSACHUSETTS INC 1029 NORTH RD INSURER D: WESTFIELD,MA 01085 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IAIJUL UBR POLICY-EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP An one person $ 10,000 A 7520025998 04/09/19 04/09/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY 0 PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A — OWNED AUTOS ONLY X AUTOS 1020063881 1020063881 04/09/19 04/09/20 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB X1 OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600055451 04/09/19 04/09/20 AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER TH- AND EMPLOYERS'LIABILITY y/N STATUTE I IER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A Certificate To Follow (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 Northampton,Ma.01 060 AUTHORIZED REPRESENTATIVE Attention: Building Department, t, 'l(� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r .ac Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYyy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONF5/5/2019 ERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FORREST INSURANCE AGENCY NT 603 NORTH MAIN STREET NAME: T E LONGMEADOW, MA 01028 P "'No• FAX EMAIL ADDRESS: —-- .NSURER S AFFORDING COVERAGE NAIC 0 INSURED INSURER A: Liberty Mutual Fire Insurance 23035 WINDOW WORLD OF WESTERN MASSACHUSETTS INC INSURER B: 1029 NORTH ROAD INSURERC; WESTFIELD MA 01085 INSURER D: INSURER E: COVERAGESINSURER F: CERTIFICATE NUMBER: 48525637 THIS IS TO CERTIFY THAT THE POLICIES UI INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR D NAREVMSION ED D ABOVEB OR,THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM A CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYO 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. ILTR AD L LTR TYPE OF INSURANCE POLICY EFF POLICY EXP COMMERCIAL GENERAL LIABILITY POLICY NUMBER MM/DD/YYYy MM/DD LIMITS CLAIMS-MADE 0 OCCUR EACH OCCURRENCE $ A — PREMISES Ea occurrence $ _ MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL$ADV INJURY $ POLICY❑PRO- LOC 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 LIAR $ CLAIMS-MADE OCCUR EXCESS LIAR EACH OCCURRENCE $ DED RETENTION t AGGREGATE $ A WORKERS EMPLOYCOMPENSATION ILIT WC2-31S-377947-019 5/7/2019 5/7/2020 PER orH- $ AND EMPLOYERS'LIABILITY ✓ ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN STATUTE OFFICER/MEMBEREXCLUDED? Y N/A E.L.EACH ACCIDENT (Mandatory In NH) $1000000 It yes,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,maybe 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 POLICY PROVISIONS. NORTHAMPTON MA 01060 AUTHORIZED REPRESENTATIVE Jon Smith ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 48525637 1 1-377947 1 19-20 WC 1 n0270258 15/5/2019 7;59:45 PM (PDT) I Page 1 of 1 IFM_-J�s V _ — fCorder u EtI €t �v RM. igid doors �:. 0 �D �4w, �. - -50 West market�a T7�: _ l� ���aWS An= C a - 5bt;r Uvest " s ' __ er it=tf i[ Crat2,Pgi703f}t&t _ nGrYINYL Gric-s ia�t lF"`^'uU ti 1 t,t[�/(■t rflt(y �f r. [ F 4tP,nai ibwv,r-6}`sR!1 + DRl V jNy N� `[ _t CC 1^i`f9 leans L/ �� r:ed}:�Ete-2; F -- tr t_�t :Cite-5:(1!8"Cf Gni ion fo �,, t , 5th X 4a,i!e , E c ',`���tb,,,.,.eeGW Lt?g,Anreafed);t_it a Q;Argoq;37 e`2: 1/2X37 5 and doers R'M[v� zawa:tc vert t:d[e[d produ tc tdEl A 216-M403 ,aC'vl�. 'prodsa. r y to �„+ to rerhtfQn in performance - ma tq/han nein,... � - � Y be subJact to v --. _ E� Tp= _p_/�•p gt- enation in enormance .Z dGYa°S T(}8 t - �L-2L Ye �I^a [ _'ct�CE CilltflF �..' Gi• �"�['y`rVYi".r�c P _�t _ "'7n€RF'`���'�'�i�CoeffiCIeriQ (t1.S. } SOIar 0.21 Neat Gain Coefficient are genCer- V� a e rroduct ser- (� © S lowuons in a�BI►if3N `�•��7 ADDITIONAL�E ORMANGE RATINGS Vigi(�te 4Fansm�R ER>rt[RM,�nIC� RATINGS sols. m fT, F'tt€t' € e _ AIr a`aakaage(U,S.II-P} Air Leak ft,bake age(l1.S.tf-P) 0.46 'c wen Su Neat a cFrarnarh.Y.NFRCAt smetmeae EtuF E -''�.3f ti...tt>z Et,i,Qt Gta- �9.Q€,.pCSS!6rffRC p'�'C66drEEtOr968M7in} tvftQ!E praQaa `-r treccmrrt �&s arc ee[errugirenow BePFycreic NFRC prucea 0e3 [ firfQ'fTiEr 'au�a 1'.$.rue tretarr cff rQrff rC#?itof or ellc'Loru1'MtB+cc.oeant arQi 1p8E1(I:pfQQuct btu, l'pfQQUL2Lrd 6DG5 r Q3lIGI Efi"F CP " (OrGItGfPNkf brlS.ilsea [ vie_` r,;eR�eu,€ �aR era�cRtmpe+rQrme a �°�`"'epxfleu e.consul nd"�kYurtrtuteraturepro°e�F a"a �n6a fsp�P"4a T _ -.<. _ tYlp6•dlfrG.MQ xir+r~.Mrc-Qr8 crunUff�ae,nrc —jwecucuse cµ'4..,: l e - #'T �r 3- t ' � � � r! i f t ��;� •� � MMM � 411 4 SviQAuws `1!� 1 i eft 11 M fidows �.Certi6edtt ertifeado For full information,see label onProduct 0 CertifiettiCertiFicedo P era informacibn oam For fnll infamutian,zea lebaf on product plena,consaltar la eritdel Para informaci3a eompleta,comilhar la etiqueta del producto. Perf Grade l prwlucro- +DP Perf Grade +DP(ASD) -DP(ASD} Water LC-pG35* 3g D� -Dp(ASD) LC-PG35 35,09 35,09 f3 06 r N►ax Test Size 5013 Water Max Test fze eport# - STC!OIC 40.00 X 72.00 "3722,oip e7� Florida tD 5.43 72.00X(30.00 F2op8ot-fo9�7 _ gg 1 /� .atings are for ind ' 1. 20840 r stacked units, mdual windows end doors on Ratings are for¢[dividual windows and doors only. For information regarding mulled nd test s ze.Te Please contact Your sales representative, g mulled or stacked units,Please contact your sales representative.Pas and Ne DP limited 3TN Et300, sled to AAMzuou information regarding Nag POs and N dditiona[info SMA labPa din Y be con ea ed by 9 az[ng011l-&21A440-05 �a d oG�ass AccOP ord g ted by fie unit test size.Tested to AAMANVOMA1CSA 10111.S.21A44f)•05AAMA label may be s rmation re reit concealed by gta [g bead or track filler.For additional information regarding ���� 8 instaffation Inst racktilter.F installation instructions,Please visit www.mWd.com. ructions,please visit ckfi or 3e 1■1.1 miwd.com. 26772468.1.1.1 Printed M Printed on �� 7B/20f 6 8:ti9:0.7 PM 8/12'2016 8:10:72 AM 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 PSG , WASTE A (A W A-W) M a (NAME OF FACILITY) a properly licensed solid waste facility, defined b 'MGL C 111, §150A. r Date Signature of Permitfpplicant PRINT OR TYPE THE FOLLOWING INFORMATION: P, rh,'=,,2-r F cit Sit�v.4 -,,a— (NAME OF PERMIT APPL CANT) III u I nG1�c� (TYPP OF MA TEPIAL TO BE DISPOSED OF) (PROPERTY ADDRESS) u� Window World Of Western MA 1029 North Road 413-485-7335 *J0 western mass@windowworld.com Michelle &Jim Finley mfinley@smith.edu Estimate:Whole house... Bill Address: Install Address: Estimate#E1582752142601 67 Ellington Rd, 67 Ellington Rd, Florence, MA Florence, MA Date of Estimate:2/26/2020 101062 01062 Valid Until:3/27/2020 DESCRIPTION • • *ST.JUDE PROMO" 1 625.00 -625.00 4000 Series DH Solarzone 7 549.00 3,843.00 4000-2 Lite Slider 1 769.00 769.00 4000-3 Lite Slider(1/3-1/3-1/3) 1 1,903.00 1,903.00 Mullion Removal 2 60.00 120.00 Full Exterior Capping(Slider j 4 121.00 484.00 Colonial Grids(Contoured) 11 75.00 825.00 Install Interior/Exterior Stops 3 80.00 240.00 Entry Door,Casing+Capping 1 2,890.00 2,890.00 Storm Door 1 899.00 899.00 Permit&Administrative Fee 1 200.00 200.00 Setup and landfill disposal fee 1 400.00 400.00 TOTAL AMOUNT $11,948.00 CUSTOMER PAYMENT DETAIL Check Amount $5,500.00 TOTAL PAID $5,500.00 CUSTOMER DUE $6,448.00 *No extra work if not in writing *Customer Comments: *Installer Notes:All interior install....black exterior white interior 36 left 449/1 Concorde multi point 1/2 lite black caming...storm door is a 36 full view with black handle Design Consultant-Tim Drost HIC:165641 FEID#27-1993659 Customer ID Details Id Type* Driver's license Id#* S245 Id Issue State* Mass P.S.Now 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 done.If you have any questions whatsoever,now is the time to ask. Window 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 the payments 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 funds due under 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 owner for withdrawal. Arbitration;Window World of Western Massachusetts and the PURCHASERS)hereby mutually agree in advance that in the event Window World of Western Massachusetts has 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 Secretary 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. 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.