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29-589 �l PRODUCT PLERFOR ANCE a.. And URry Ce hied Tbtai UalL Perb. runance (canunued) -- C M t _ Mderen Product Glass Type : LI- Factor' SHGC' VP .. _ Clear Dual Pane 0.45 46D 0.63 - ' Clear Dual Pane •.rith Gnlles 0.45 0.51 056 - - TiIE Wash LD -E 030 032 0.55 -'--.i : Douh1_e- Hung�wndow Lm E with GdOes 030 029 0.49 " - HP Lo -E4 SmartSun 030 021 0.49 HP LmvE4 Sman •. /Gn 031 0.19 0.43 Clear Dual Pane 0.45 0.61 0.64 - Na mfine Clear Dual Pane wide Gnllm D_45 051 0 .57 - " Dnuhle- HungWindow Lnw-E 030 03 0.56 Gnlles 0.31 - 029 0. Clear Dual Pane 0.44 0.0 0.66 - - Clear Dual Pane wvb Gnlles 0.44 Q-57 0.59 - - `Traas¢m.Windaw = Lun-E 027 034 0.58 _ _ -- Lmv- wft G 027 030 052 y - - ClearDualPane 0.45 0.0EED 0.63 - Clear Dual Pane rnlh Gnll� 0.45 054 0.56 - Lnu-E 0.30 03 0.55 j Ghdm Window . •. ... _ Lm - with Gnlles 030 029 0A9 Lmi�E SnrrtSun 030 021 0.49 lmv{ Sma vri GFlles 031 0.19 0.43 - . ......__ -:<.. ..:-' Clear Dual Pane 0.43 0.61 D.65 Clear Dual Pane with Gnlles 0.43 0.55 = 058 - Fu d lmns¢m Lnw-E 028 0-33 0.56 _ FEE `-- Lyfcle.T¢p Lmv-E with Gnlles 028 030 050 -� - - - = - - Lm SnanSun 0-27 D?7 051 _ Lm„E Sn w ith Gdfles 0 27 020 0.45 .Clear Dual Pane 0.44 0.51 D_64 - Clear Dual Pane with Gnlles 0.45 053 0.56 - Lmv-E 029 032 0.56 - Narroline' Lo with Gnlles 030 029 0.49 '6Liding. Pa6¢. Doors 1 , Lm, Sun 029 020 0.31 - Ln Sun with Gnlles 031 0.18 027E Lmv-E SmatlSun 026 0 0.50 .. L .,- E SmarlSun wim G 0.30 019 0.44 Clear Dual Pane 0.43 051 0.64 - Clear Duaf Pane with Gnlles 0.43 054 0.56 - Lnw{ 028 032 036 - Pertn Shiei¢ Love -E vab Gnlles 030 02 0.49 ' Waring P be:D.- - Lo,-F Sun 029 0.19 031) - Low{ Sun with Gnllz 030 017 027 Lmvt SmarSun 027 112 05D L-E 5 with Gal 029 019 0.44 - - Cl� Dual Pane 0.43 0.45 0.47 - Clear Dual Pane w [th Gnlles 0.43 039 0.40 - Law-E 0.32 024 0.41 J Hingedansving Lmv{ niih Gnlles 033 G-M 035 - Pah¢. Low{ Sun 032 0.15 023 - - . -. _ . .... . . .. ..... ..._.. '' Lmv{ Sun with Gdfles 034 413 419 _ Lm ESrnmtSun 032 016 037 r Lmv{ SmartSun with Gnlles 0 33 414 0.31 - r d �r5e n o i Andersen' NFRC Certified Total Unit Performance feDmenued) Andersen Product ' Glass Type U Factor' I sHGC' VP ���„ Andersen Product Glass Type + U- Factor I SHGCZ ! VP I "� 400 Sears ...: t, r .. HP Lary -E4 . 0.27 035 0.60 ' i HP Low -E4 0. 32 028 ' D 47 r HP Lm-;-E4 with Galles 028 031 0.54 - H Low -E4 w it h. Gnlles 0.32 02 0 . . = „R Circle Top' > HP Low -E4 Sun p27 021 0.33 �`� HP Low -E4 Sun 032 017 016 "m[`' -, Casement window - :1 HP Low -E4 San with Grilles 0.29 p .19 03p r Casement W hom - ® HP Low - Sun with Galles 0.32 0.16 023' . ! HP Lax -E4 SmartSun 0.26 U23 0.54 FE I '? Ep HP 1-ow -E4 SmanSun 0.31 0.18 0.42 HP Low -E4 SmartSun w /Grilses 026 OZl U-49 t . PER I HP Low -E4 SmartSun w /Gn71es 0.31 0 -17 038 W 1 . - f , ;J HP tmwE4 027 035 0.60 TT HP Lax -E4 0.32 028 0-47 r'!' J HP law -E4 with Galles - O.ZB 032 0.54 i HP Lo - E4 with Grilles 032 025 0. - ' HP Low -E4 Sun 0.27 021 0.33ro French Casement r i HP Low -E4 Sun 032 017 026 i " "' Crrcle F Ova, Wmdow" FER HP Law-E4 Su with Grilles 029 0 0,30 t" Window HP La Sun wish Gn71es 032 016 013 { ' it HP Low -E4 SmartSun 0.26 023 D.54 i l ® HP Low -E4 SmartSun 0.31 0.18 0.42 `^ i ' ,. ",j HP Law -E4 SmartSun vi/Gilles 028 021 0.49 1 1! HP L -E4 Sm w /Galle 031 0_Z7 03 STS k pJ HP Low -E4 026 033 0 -58 HP Lnw -E4 0.32 C28 0.47 HP inw -E4 with Grilses 029 030 0.52 rct s^ - HP lmv -E4 with Galles 0.32 025 0.42 ] '� Arab Wrndbiv HP Law -E4 Sun 0.28 020 0.31 .. ,r ® ' i HP Low -E4 Sun 032 U_17 026 i Awning Window.' HP Lmv -E4 Sun with Grilles 019 0.18 028 5!' f R . ? HP L -E4 Sun wi t, Galles 0.32 016 023 NP Lan -E4 Smart3un 027 013 0.52 ® HP Lm E4 SmartSun 0.31 0.18 0 42 ` S HP L SmartSun w /Griltes 028 011 0-46 `�^-? ); ' HP Law -E4 SmartSun w /Grilles 0.31 0.17 0.38 HP Low-E4 027 0.33 0.58 144 HP Low -E4 031 0.32 0.55 HP Law-E4 with Grilles 028 030 0.52 r? F" HP Low -E4 wi th Galles 0.31 029 0.49 Z .. HP law -E4 Sun D27 020 0.31 `lJ - : Casement/Awning Fiesrtrame rndow HP La Sun 031 020 0.31 p] II El ( HP Low -E4 Sun wim Gilles 029 0.18 028 s Pica .. Window ' - ! HP Law; -E4 Sun with Grilles 0.31 0.18 028 , 4 HP Low -E4 SmartSun 026 023 0.52 HP L OT SmartSun 031 0 0.50 HP Low {4 SmaM i1n w /Galles 0.28 021 0.46 I Ti ��� I HP Low-174 SmanSun w /Grilles 031 019 0.44 [ I I HP Law -E4 031 033 - 0.58 HP lmv-E4 030 037 0.64 1 HP Low -E4 with Grilles 0.32 030 0.52 "`? I HP Low -E4 with Grilles 030 033 0.57 9 Spnngime Window' HP Low -E4 Sun 031 02 w - 0 031 _ HP Low -E4 Sun 0.31 012 036 I `i NP Law-E4 Sun with Galles 0.33 0.18 028 Specialty Window' HP Low -E4 Sun with Grilles 031 020 0.32 HP Low -E4 SmartSun 0-30 - - 0-23 0.52 [ , HP Lmv -E4 SmartSun C30 024 0.5B �! HP Luw -E4 SmartSun vi/Grilles 0.32 02I 0.46 'I HP Law -E4 SmartSun w /Grilles 030 0-72 0.52 HP Lmv -E4 0.30 027 0.45•F - HP lmr-E4 032 022 037;': HP L ow -E4 vr$h Galles 032 023 039 G ^.? ® HP Law-E4 with Galles 033 C20 0.33 - Frenchwood•'.: HP Lm,-E4 Sun U31 0.16 025 9 i 2j Hinged fnswrng HP Lax -E4 Sun 0.33 014 021 - pirding Path, Door HP Low - Sun with Galles 0.32 0.14. 022 4r1 - ro N French Door HP Lm, -E4 Sun with Galles 034 0.13 CAB - HP Low -E4 SmartSun 030 018 0.41 F "! F HP Low -E4 SmartSun 0.32 0.15 0.33 - ..j HP Low -E4 SmartSun yr /Grilles 0.31 U.16 0.35 rj - HP Lmv -E4 SmartSun w /Gn'Oes 0.33 014 03D - ` i HP Low-F4 031 024 0.41 [R, F!i 9 HP Lrvt -E4 033 025 0.41 � m : j HP Law-E wdh Gilles 032 021 0.35 ta r H° LmwE4 wi th Grilles 0.34 012 036 Frenchw.ae Hinged HP Im -E4 Sun 0.31 0.15 023 m E 1 Hinged Outswing HP Low -E4 Sun .033 0.16 U23 p �- Inswing Paho ..I, HP LnrrE4 Sun with Grilles 0.32 0.13 0,19 French Ooor HP Lmv - Sun with Galles 035 014 C20 HP law -EC SmartSun 030 016 0,37 t� .;12 HP lmv -E4 Smart5un 032 017 031 ! HP Lmv-E4 SmartSua w /Galles 0.31 0 -14 0.31 HP I rnr -E4 SmartSun w /Gdllrs 0.34 015 0.32 - �a HP Low-E4 0,31 025 0.41 t HP Law-E4 0.33 C23 0.38 - r HPLm -E4 wdh Galles 0.32 021 035 ff,� G i; HP Lan -E4 w ith G 033 021 03 F . Frenchwood .Hinged` HP low -E4 Sun 031 0.15 023. Fued French Daor -.: HP Low -F4 Sun 0.33 014 021 - Ovtsmmng Patin Door HP Lo+ E4 Sun with Galles 032 0.13 0.14 .' d Sidelight HP Lan -E4 Sun with Grilles 0.34 0_13 0.1 - HP Lgx -E4 SmartSun 0.30 0.17 037 E HP Lary -E4 SmartSun 0.32 0.15 c.3 - HP LmwE4 SmartSun w /Grilles 031 0_£5 0.31 .` ® " HP Low-E4 SmartSim w /Gill 033 0 -1 0. - UP Imv -E4 0.32 022 0.37 : "I HP law -E4 032 025 0. 41 - - `I HP Lim -E4 with Galles Oa'2 020 033 F+ [% HP Lax -E4 with Galles 033 022 0,37 - Frencfmood HP Law -E4 Sun 032 0.14 021 Fixed Transom HP Lax-E4 Sun 032 015 013 - =) Pabo Door Siaehgfit ''i HP Law-E4 Sun w ith Galles 032 0.13 0.18 [ i. , 1(� 'French Door HP lax -E4 Sun with Grilles 033 0. 0. 20 - HP Low -E4 SmartSun 0.31 0.15 0.33 5 "9 1' �P,, I HP lax -E4 Smaitsun 032 0.16 03 - HP Low -E4 SmartSun w /Gnles 0.32 0.14 029 9 !y i HP tan -E4 SmartSun w /Galles 0.32 015 033 - _.. HP Low-E4 030 024 0.40 - I" 01 ; HP LwrE4 035 026 0.44 - - � HP 10w-E4 with Galles 0.30 021 0.35 Fa HP Lmv-E4 with Galles 036 023 0.38 - Fra.chwoad - HP Low -E4 Sun 030 0.15 022 + ® - HP Lm,-E4 Sun 035 016 024 - Patm Dogr Transom HP Law-E4 Sun w ith Grilles 031 013 p20 r.,, _ r .t •Folding 0 nr �' ® r.,. I HP Lary -E4 Sun with Galles 0.36 0.14 021 - HP law -E4 Smart5un 029 0 -16 0.36 ' ! ® HP Law -1 SmanSun 0.34 0.17 039 - `' HP Low-G4 SmanSun w /Galles 0.30 0.14 032 ° - _�'., ® HP Lmv -E4 SmartSun w /Gnlies C36 0.15 0.34 - c urmued an pert page • For NFRC certified total unit performance on units with capillary timathertu ms, for high altitudes, please visitandersemvindows.com. • "High - Performance' Law -E4` (HP {alr -E41, •High - Performance - Low -E4' SmartSun "'(HP Low -E4 SmartSun) and'High- Perfomrance` Low -E4` Sun (HP Low -E4 Sun) are Andersen trademarl¢ for'Low -I? glass. ' U- Factor defines the amount of heat less through the total unitin 8TH /hrsq- ft °E The Idwerthe value, the less heat is Lostthrough the entire product- Window values represent nun- tempered glass. Use of tempered glass can increase U- Factor ratings. See andersenwindows.com for WegTic performance values. Dourvaluas represerutempered glass. Sular Heat Gain Coefficient (SHGC) defines the fraction of solarradiation admitted through the glass both directly transmitted and absorbed and subsequently released inward -The lowerthe value, the less heat is transmitted through the product r Irm'Ne Transmittance n measures how much tight comes through a product (glass sad frame). The higherthe value, from 0 to 1, the more dayfight the product lets in over the product's total unitarea. Visible chance is measured over the 380 to 760 nanometer portion of the solat spectrum. NFRC ratings are based on modeling by a third party agency as validated by an independent test lab in compfiance with NFRC program and procedural requirements. • This data is accurate as of December 2010. Due to ongoing product changes, updated test results or new industry standards or requirements, this data may change overtime. Ratings are forsrces specified by NFRC for testing and certification_ Ratings may vary depending on use of tempered glass, different gall. op trans, glass for high altitudes, etc • PasinSun" glass values are available onfine at andamenwindows 277 Renewal Home Improvement Contractor byAndersen License # 170810 (Expires 12/23/2013) WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation Federal Tax 1D #41- 1918413 104 Otis St., Northborough, MA 01532 (508) 351 -2200 • Fax: (651) 351 -4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Name Date ff Agr ement 3uyerr(s Street Address, City, State, and Zip, Code E -Mail Address Home Telephone Number Work Telephone Number Buyer(s) here jointly and severally agrees to purchase the products and /or services of Renewal by Andersen Corporation ( "Contractor "), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement "). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: �a0�• Estimate Starting Dot : Method of Payment: Deposit Received (33 L ❑Check []Cash ❑Financed Balance at Start of Job (33%):_ �isa /MC ❑Discover ❑AMEX ��(�, _ Estimated Completion Date: If credit Card is selected, please see Credit Card Balance on Substantial Payment Form. Completion of Job (33 %): Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement -will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renew y �senration Buyer(s) Buyer(s) By: Signature of Product Ma / Signature Signature Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. —————-—--—————— �1c — - - — -— — — — — — — — - x — — — — — — — — — — — — — — —�c NOTIC ANCELLATION X NOTICE O C NCELLATION Date of Transaction i ff 120 12 . You may cancel Date of Transaction 2 1 1 1 Zal 2 . You may cancel this transaction, witho any penalty or obligation, within this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any three business days from the above date. If you cancel, any property traded in, any payments made by you under the property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Contractor ( "Seller ") of your cancellation notice, by the Contractor ( "Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition Seller at your residence, in substantially as good condition as when received, any goods delivered to you under as when received, any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply Contract or Sale; or you may, if You wish, comply with the with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk. If you do make If you do make the goods available to the Seller and the I the goods available to the Seller and the Seller does not Seller does not pick them up within 20 days of the date pick them up within 20 days of the date of your Notice of your Notice of Cancellation, you may retain or dispose of Cancellation, you may retain or dispose of the goods of the goods without any further obligation. If you fail to without any further obligation. If you fail to make the make the goods available to the Seller, or if you ag ree goods available to the Seller, or if you agree to return the to return the goods to the Seller and fail to do so, then to the Seller and fail to do so, then Y ou remain liable you remain liable for performance of all obligations under for performance of all obligations under the Contract. the Contract. To cancel this transaction, mail or deliver a To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written other written notice, or send a telegram to Contractor. notice, or send a telegram to Contractor. Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street, Street, Northborough, MA 01532, BY NOT LATER THAN Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF . (Date) OF . (Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Date Buyer's Signature Print Name Date RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink ©JBLLP2009.RBA- Ph.MANH R enewal ..., Re,_,Wal by Andersen Corporation MA Home Improvement Contractor 104 Otis St., Northborough, MA 01532 License #170810 (Expires 12/23/2013) byAndersen WINDOW REPLACEMENT an Andersen Company (508) 351 -2200 • Fax: (651) 351 -4810 Federal Tax ID #4I- 1918413 WINDOW SPECIFICATION SHEET Buyer(s) Name Date of 4greement 6 0 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and /or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home, using the following individual quantities: Double Hung (DB) ❑ Equal sash ❑ Cottage sash (1/3 top, 2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom) Casement (CVO ❑ Hinge right ❑ Hinge left (as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement (CDW) ❑ Standard handle ❑ Metro handle Casement / Picture / Casement (CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) Glider/ Picture/ Glider (GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AVM Picture Window (PW) Bay or Bow Window Patio Doors (see separate Door Specification Sheet) 2. Yes gAo Qty of Windows to be Custom Fit Replacement: El 3. Yes o Qty of Sills to be replaced by Contractor: 4. ❑ Yes M No Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) and actual Exterior cap' gs: ❑ Pine ❑ Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: HP Lcyw- E -4 TM F other If other, please specify: 6. Exterior color to be: White ❑ Sand F Canvas F Terratone E] Cocoa Bean 7. Interior color to be: White ❑ Sand ❑ Canvas E] Terratone E] Pine ❑ Maple F Oak Note: In for color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware White [] Stone ❑ Canvas ❑ Brass 7 1 EstateHardware: Style: 9. ❑ Yes No Install Lifts with Double Hung mdows 10. Screens: windows to have: ❑ Half or Full screens Screens to be: 15 Fiberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11. Windows have grilles: ❑ Yes f yes: ❑ Grille Between Glass (GBG) ❑ Removable Interior Wood (tNT r) ❑ Full Divided Light (FOL) Qty Qty Qt': Qty: Qty: Qty: Qty: DH DH DH DH CW /Picture Giitler CPW orG Draw grille patterns above 'Use additional sheet if needed Owner approved (initials): ( ) ADDITIONAL WORK DETAILS 12. ❑ Yes o Contractor will remove metal frames of windows. Qty of Units: 13. ❑ Yes [ No Contractor will install new paint -ready or stain -ready casings. I eri casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance -free material 14. ❑ Yes No Contractor will install new paint -ready or stain -read inside o outside stops qty of openings: Interior stops qty of openings: Exterior ps qty of ope i E] Pine ❑ Maintenance -free material 15 Ovmer is that Contractor does not do any pain ' er Initials 16. es N Confractor wi11 wrap exterior casings with a t stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. 17. [Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 18. VYes ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly. 19. � yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20. U Yes ❑ No B Permit —Contractor will secure any and all necessary permits. The fee for the permit(s) is not 1. ��ncluded in the Contract Price and a separate check is required at the time of sale for this fee. 2s ❑ No All discount t s have lied to this agrKT trice., 22. Additional job details: ` /(_ N 1 f V '�`� Z�? :2 !�5 23. [FfYes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No fmal payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be charged or its terms modified or varied in any way unless such changes are in Writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Ren JAnderseri Corporation Buye Buyer(s) By: X - , Signature of �°' r C u Manager Signature Signature �,� Print Name of Product Manager Print Name Print Name - CERTIFICATE OF LIABlUTY INSURANGE TIif5 CEKTiFiCA T E IS ISSUED AS A MATTER OF INFORMATION ONLY ,AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER. THIS , CERTIFICATE DOES NDT' AFFIRMk.TIVELY OEXTEND R NEGK71VELY AMEND, E -OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CEie_TIFICATE OF INSURAWCE DOES NOT C:DkSTPVFE A CONTRACT t3ETWEEN THE ISSUING INSURER(S), AU7HD REPRESENTATIVE•OR PRDDUCER, AND THE CERTIFICATE HOLDER... IMPORTANT: If the certificaiP hoYdar "is an ADD M- ONAL INSURFU, the poiicy(ies) must be endorsed, If SUBROGATION IS WAIVED, sub)ect tD the terms and condifiom of.the poiicy, certain policies may require an endorsement A statement on this ce[iificas_P does not confer rights to the z erfifi hoider in Iieu of su= endorsemenf�s), PRODUCER - 1 -612- 333 -3323 coNTAL'T JOne11e Have or )3tie Psimoe ?3aps COmnaaiee P� q 612- 333 -3323 ,No;E -373 -7270 elft SD 6a>zth Bth &heat E4VIh2 ADDRESS: Smite .7D.D PRODUCER - FI — apnlia, 2W .556112 CUSTOM !D R: INSURERS AFFORDMG COVERAGE - NAIC to INSURES ' • INSURERA : OrlD . - Ma'M X C INS CD 2 ]s:eaazp By ATfjpT Cozpa=ation INSURER a �+'r'T^ T• = OF FZgB SETS CD OR PLTTS 19465 LDa Otis Stxmat INSURER C: *Oar•thfiornugh., ESE 01532 NSURER D IFISORER E: INSUIZER F : . COVERAGES CERTIFICATE NUMBER: 2511 t2F7 REVISIDN NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE .BEEN ISSUED TO THE INSURED NAMED -ABOVE FOR THE POLICY PERIOD tF , NOTwiTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WFFH RESPECT TO WHICH THIS E MAY BE ISSUED -OR MAY PE3ZT THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN'IS SUBJECT TO ALL THE TERMS, S AND CONORIONS'OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN F EOUCED'BY PAID CLAIMS. Ap13LSUER POLICYHFF POLICY TYPE DF INSURANCE POLICY NUMBER W O MMIDD LIMITS LIAaLL►TY NRLT S °313 LA /11L/ 10/OL/12 EACH OCCURRENCE 5 L, DDD, DOD MERCIAL GENERAL LIABILITY pAMAG TO RE 6 SOD , O D D PREMISES ooeunanca LAIM& -MADE OCCUR MED EXP *(Any one parson) € 1D , D D D PERSONAL &. ADV.INJURY F .L; D D D, D D D GENERALAGGREGATE $ d,ODD,ODD REGKTE LIMMAPPLIES PEP PRODUCTS- COMP/OP AGG - 6 3 ,DDD , D O D Y PRCL t„pG S - . AUTOMO BILE UAIILM NKM Z1377 LO /OL/ LO /02 -/1.2 COM131WEDSWGLELIMIT 000, ODD _ (Ee arsidanq F F=D AUTO BODILY.INJURY (Perp —' OWNED AUTOS BODILY INJURY (Peremidano EDULED AUTOS PROP= DAMAGE HIR AUTOS (PeraoddenQ = S NON -OWNED AUTOS K • F B Z UM6RE LIAR Z .00CUR ,ZSO3D519 10 /DL /` 1 -pl L EACH - OCCURRENCE F 25,DDD,DDD . EY.CESS.LIRB CLAIMS -hMpE AGGREGATE G 25 ,DDD , D D D DEDUCTIBLE Z . % RETENTION F 25 , O D D p WDRIG: :SCOMPENSs'now ' XWC L3.72-4--D DD 1O /DL/ LD /DL /12 I WCSTATII DTH- AND E2rtPLDYERS' LIABILITT �' / N L, D D 0 , 'DDD ER /iyY PRPROIETpRfPARTNERlE ET U71VE EL EACH ACCIDENT 1, LDE�CRIFInON EMER EXCLUDED? 7. K / A- - brNIA EL DISEASE- EAEM 1,ODD,DDD 3eundar E1- pI5EASE- POLICL, DDD, DOD OF OPERATIONS beVow ' I 3'C RIPTION OF OPERKTTON6/ LOCATIONS I VEHICLES fAHaeh AMRD I I1L, AddTnm onel kwumrl¢ Seheduk, Tr more cpeee¢ mqurrnco , 'KTiFICATE :HOLDER CANCELLATION SHOLILD ANY OFTHE ARCVE D83MRBED POLICFS.6E. CANCE .1 HEFDR:E _cleav ❑f Lug>r —*+te THE 'Z2:PNZATION DATE .THEREOF, NOTICE 'V E-L HE D n/BZM IN ACCORDANCE WITH :TEE POLICY PROVISfON:S AUTHOR® RBIPE IHICKTIVE - -M=a ®'2S6& -2UIIB AC:DiW CORPDRATIDN. AF rights mserved. eRD 25 poslo) 'The AC:ORD -name and 'ic+gD are mgistamcl n ari` of A00RD �- Nlassachusett> - Dcpamnent of Public Sidet\ Board of Builclin- Reutlations anti titundartl� Construction Supervisor License License: GS 95707 BRIAN DENNISON r- 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ( ununissi mcr Tr 2622 ,: ✓j te 7�o9nmzoozwe¢ Office of Consumer Affairs & B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration:l Type: 3 URRWAL Expiration: 4 %2013 Corporation BY A N ' T10N .� ii BRIAN DENNISO i ' 104 OTIS ST. NORTHBORO UG��•� °r Undersecretary l t i . i i I i • .. 2'�e Carrzrnarwe��th rr�'Ifd�sse�c�CUSez�s . 1'))ep c&. ©f Industial Ac.cadents C)ice of lnvesfigadO?:s : 600 W& ington Street B astor, 314 07111 - www.m¢ss.gai�fi is workers' - Compensation Ingrrr AMdzvit Seders /�o�tz ae�ars/ eetrEei /P��nbers A �Riic t InfDrra ation Please Print Ledbi_r NaZat ( Business /Drganizaficn(lndiviaua4: e f\ P V, Q '\ \ Aa�rfss. 1 d y �� s. S , .. � • IrY\ -A C> S 3_DL Phone #: .5 6 'T 5 Are you an employer? Check the appropriab5"ba=; Type of prQ)ect (reguirei); I. I am a 10 with '3 D 4. ❑ I am a general contractor an , d I E em�p yer New eonsiraatian employees (fMu anworpart -Eme ), haw himd the sub - contractors 2, El am a sole proprietor orpartner listed an the attanhe>d sheet �.• Re modeling ship and have no employees These sub-confractors have S, ❑ Demolition working for me in any capacity, worl=rg' camp. Insuranct, g, ❑ Baming addition [No workers' camp, incrtrana 5. ❑ we are a corporation and its 10.7 F_lect - ical repairs or additions reguit ed ] officers have exercised their . a. ❑ I am a homeowner doing aIl work right of exemption per MM I I.❑ Pkrmibirag sirs or additions -myself, [No wormers' .comp. c, L52, j 1(4), and we have no 12.❑ Rnof repairs rosur= required] t employees, [No workers' LS.❑ Other comp, insurance re 'Amy applicant that cb=lo; box Al must also a out the section below shoe2ng 66e wwlx& compeosatinn pohcy daft —ation t aomeowneo; who submit this afadavit indicafing fhey arc doing all wort` and fhm him ougidc ra' mt=tats must submit a new affidavit indicating such �Cmtantnrs' that ahec�- this box must attacbed an additional sheet of the'sub -contM -_tern and theQ wo6=' coin. policy mfn* crm I Qr cn .eerrpivyer ti<s.rat iz pr©viding ward ers' earraperrs an ires�cr¢rzce for rry eirrpLayees. BeLa'Jv is tFre poFcey and job sGt° lnsrmanoe Compar<y Name;_ �' �b \ c. S �' Policy # ar SaLf =ms, I:ic, ¢ \ �J 1 1, ' 1 �[ 1 Giraiion Date; Sob Si4� A ddress; (Ze) G� rtp. tate(7rp: t _4ttach a copy of the workers' campEMRAon policy tieclarafion Faffe (shaWiug the pnEiey nUMber and e=pir elate }, Faihne to secare coverage as required under Section 25A ofMCF e, 152 can lead to the #position of criminal.perralties of a f ne up to 1, 500.00 'and/or one -year impasornnent, as well as cis it pen atfies in the form of a 5T QP WQP QRI}ER and a fine of up in X250.00 a day against the violafnr, $e advised that a copy of this statement maybe farwarded.tn tine D oe, of Investigations of tlic, DIA for insnran= Govt rage Vmaficatlon n _ I do hereby c j, r tFae p pena.Ldes afpgj�7 6.-at the irafarma€ibn provaded agave is zee 1 correcC Phone # tiU 'S 1 c9 0l S l) Q and use arr.£ju. Do not write ire tkis'.rarci; to completed by aky ar wwx-o . {qty nr Tnwa : ' �ss�ag Aufbority (cisrr3e. oue�; ' I Board of Heslth I $fig DegarE�ent .3. Ci ty�"I avert C'i�r 4; IIectrical �specfgr S. Plumbing °Inspector Contact Pei-Pu= Phone P.. SECTION 8 • CONSTRUCTION SERVICES 8.1 Licensed Construction Superv Not Applicable ❑ Name of License Holder: I t\ N License Number 9 C, C- 1\ e- W h rr-c' ASC L I Address Expiration Date - � ... J�1g �S 1 XSS`'c� LJ � Signature Telephone Not Applicable ❑ V)�4 X Company Name Registration Number lug \)'146t), 44.6, 01 Dl Address Expiration Date Telephone 5b' 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 ....... No ...... ❑ E .. ..... .. l woer .. Ump, on bme�zil," E" The curXnt exemption for "homeowners" was extended to include Owner-occupied Dwellings o one (1) or two(2) families and to allaIKsuch homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as suverviso? 780, Sixth Edition Section 108.3.5.1. Definition of HoNeowne 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, one or two family dwelling, attached or detached structures accessory to such use and/ or farm — structures. A . - son who c structs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall suhm Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work i)erfo?1=d under the building permit. As acting Construction Supervisor your �nl nee on the job site will be r . equired from time to time, during and upon completion of the work for which this permit isisijped. Also be advised that with reference to Chapter 152 Norkers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Ma chusetts 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 responsibi i for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and % State oWassachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION '0F PROPOSED WORK (check ''all applicable) New House ❑ Addition ❑ Replacement W' ows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [p] Other [Ej Brief Descriptipn of Proposed , ` Work: �.p r, \i L i 0, A (: 0'J � O Sit Y Lj ..T y �cti � L � [ ✓� Q r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet a, l l+levir:,houee "and or addif on fo "exists iio "usin c ©m fete the foif'6 41f `: 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 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 �V' as Owner of the subject property hereby authorize c` (` sex A � F IQ /1 1� �n to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best otM7'k Owtedge and belief. Signed under the pains and penalties of perjury. ON /A Print Name Signature of OwneSo<en Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 'Mis column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved # of Parking Spaces (volume & Location) A. Has a Special Perm it/ Variance/ Finding ever been issued for/on the site? �� �� �� NO �_� DON'T KNOW «�� YES �~� IF YES, date issued: IF YES: Was the permit �� n d dat the R i tryofDeeds? NO DO / KNOW YES «�� IF YES: enter Book Page and/or Document # 4��� � "o�. �~� 8. Does thesitecontain a bruok, bodyof waterorwet\andu? NO Y� ~v � DON'T KKNOW YES �~� IF YES, has permit been or need tobeobtained from the Conservation Commission? Needs tmbeob1ained »�� �btained m�� Date �~� k~� ' . C. Do any signs exist on the property? YES � NO AZ IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E Will the construction activity disturb (clearing, gradin va1iun.nr filling) over 1 acre oriuit part ofa common plan that will disturb over 1 acre? YES �� K � NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required City of Northampton Std spfer WA Building Department C rS 1 t 1 e it 212 Main Street Sew r�sAlualJa JJtty { f .1 r Room 100 to Northampton, MA 01060 Tw 413- 587 -1240 Fax 413- 587 -1272 PiotlStt NORTHAMr ." % ecI Z 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 ffi by oce �? C) o C� S C� .``Map =Lot a Unit V A w e tn-L e., , N*-� C A 010 of Zone 6aerla4District Elm St: Diskrict CS District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record (� i s t K 6_ � — p � AV lQ l� o Q& -c� t l n c,c , 01 Name (Print) Current Mailing Address: L L 3 52�j (. off y K u Telephone Signature 2.2 Authorized Agent: 7� l 01.✓\ e OLA �KM 1 �-1 V e t �F o r �_�0� 1�'tt� C) I a 3 Z , Name (Print) Current Mailing Address: a ()o3 X Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit 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 6. Total = (1 + 2 + 3 + 4 + 5) po . Check Number This Section For Official Use Onl Date Building Permit Number: Issued: Signature: Building], Commissioner /inspector of Buildings Date 96 WOODS RD BP- 2013 -0068 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 29 - 589 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP -2013 -0068 Project # JS- 2013- 000098 Est. Cost: $1200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin RENEWAL BY ANDERSEN 95707 Lot Size(sg. ft.): 21170.16 Owner: PLOTKIN DANIEL L & SHERI KATZ- PLOTKIN Zoning: Applicant: RENEWAL BY ANDERSEN AT. 96 WOODS RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919 -0900 WC NORTHBOROMA01532 ISSUED ON: 711812012 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: Feel e: Date Paid: Amount: Building 7/18/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner