44-092 (8) BP-2023-1326
942 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-092-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1326 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW 2023 Contractor: License:
Est. Cost: 7536 RENEWAL BY ANDERSEN 090125
Const.Class: Exp.Date: 10/06/2024
Use Group: Owner: JR DOUVILLE MARTHA J&RICHARD L
Lot Size (sq.ft.)
Zoning: SR Applicant: RENEWAL BY ANDERSEN
Applicant Address Phone: Insurance:
30 FORBES RD 508-351-227 MWC31415822
NORTHBOROUGH, MA 01532
ISSUED ON: 09/25/2023
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT WINDOW
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Q
. Tit .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts '2/
Board of Building Regulations and Stand. •s
FOR
, ��� CIPALITY
Massachusetts State Building Code, 780 C i Ro�"q �,a SE
S
Building Permit Application To Construct, Repair, Renovate t4•1�: olishc? R', e% 4'it 2011
One-or Two-Family Dwelling ����
This Section For Official Use Only ,''156'9
Building Permit Number: �S Q-j-3• I5,14 ' Date Applied: Ly?sq
/4110 &CP*55 /1 ck7`s • -ZSZG03
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: mil21.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?yes ,/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone'? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
R i tArvt.re/ Oo' v,lft. fW,eAcC /NA 0/at. 2—
Name(Print) City,State,ZIP
91/2— Po.-ewc 142vm1 �t13 .5�Z-DVo". e/J &00M 0- x ne f
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Cl/Specify: itt,la e 1€e4.7
Brief Description of Proposed Work': V'i ria..e_s
Rennzv-e- .004 ei 1)e,/? c
, s /A,. �e 4., I/ fi r_
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3�. I. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All F.1)0 3 ''ll
Check No. eck Amount: 4°Cash Amount:
6. Total Project Cost: i $ 36,OV 0 Paid in Full 0 Outstanding Balance Due: 1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-090125 10/06/24
Jaime Morin License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
30 Forbes Rd
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Northborough MA 01532 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
860-952-4112 renewalbyandersen(agopermits.org I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
170810 12/22/2023
Renewal by Andersen LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
30 Forbes Rd renewalbyandersen@gopermits.org
No.and Street Email address
Northborough MA 01532 860-952-4112
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .... CI No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) I)ate
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
444. ZZ > Z
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
="— Department of Industrial Accidents
�µ Office of Investigations
:rN-:_) Lafayette City Center
"'"" 2 Avenue de Lafayette, Boston, MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Renewal by Andersen
Address: 30 Forbes Rd.
City/State/Zip: Northborough, MA 01532 Phone #:508-351-2277 x 6
Are you an employer? Check the appropriate box: Type of project(required):
1.NI I am a employer with 30 4. 0 I am a general contractor and I 6. 0 New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. [j Demolition
workingfor me in anycapacity. employees and have workers'
p 9. 0 Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no 13.1KOther Replacement
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: Old Republic Insurance Co. _
Policy# or Self-ins. Lic. #: MWC 314161 22 Expiration Date: 10/01/2023
Job Site Address: ? V' ' '//A - X 1 City/State/Zip: - j B/1re / A e/C60
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. 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 of perjury that the information provided above is true and
correct. Sign /� 4-lf'' Date: 2 Z 3
Phone #: 5 -351-2277 x 6
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (check one):
10Board of Health 20 Building Department 3.00ity/Town Clerk 4.0 Electrical Inspector 5E:Plumbing
Inspector 6.DOther
Contact Person: Phone#:
City of Northampton
O �.. O\
Massachusetts ÷s k c'f`
114
L'. DEPARTMENT OF BUILDING INSPECTIONS .
� 212 Main Street • Municipal Building Jj Cs
s �� f� Northampton, MA 01060 J' v3v%`1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
wa , Meme /We f
Location of Facility: .�v 6/be-, Xci /vo✓L, 4 ii IN- /ifl 4%/5
The debris will be transported by: J4:i'u- /,:?" -4
Name of Hauler: /(jas L Aa r.einetAAL
U
Signature of Applicant: Date: 9-' Z ` 2
rv` RENEWAL
ANC byANDERSEN
�€n4" FNEL-SER4ICE WINDOW&DOOR REPIACEMENE
•
Re: Massachusetts Solid Waste Affidavit
Good day,
Please find attached location where the installers will bring their debris from the jobs. These
are all Renewal by Andersen location.
• WASTE MANAGEMENT—30 FORBES RD, NORTHBOROUGH, MA 01532
When filling out any solid waste affidavit, it's the installer whom will be removing the
garbage and dumping the trash at the Renewal by Andersen dumpster locations
closest to that job.
Thank you,
Go Permits
RENEWAL BY ANDERSEN SPECIFICATION B TECHNICAL MANUAL TECHNICAL INFORMATION
PERFORMANCE RATINGS AND TEST DATA
NFRC Total Unit Performance (continued)
r U-Factor
Renewal by Andersene - ... -.. - , z a 9 (B1U!(hr ft2 oF))
Product
Air HP Gas Blend 1 Atr- 4 HP Gas Blend
Without Grilles 0.46 0.44 0.57 0.57 .82
Clear
Full Divided Light Grilles 0.46 0.44 0.51 0.51
Without Grilles 0.33 0.30 0.31 0.31 .72
Low-E4®
Full Divided Light Grilles 0.34 0.31 0.28 0.28
Double-Hung DB ® Without Grilles 0.33 0.30 0.19 0.19 .40
(Full Frame) Low-E4 Sun
Full Divided Light Grilles 0.35 0.31 0.18 0.17
Without Grilles 0.33 0.29 0.21 0.21 .65
Low-E4®SmartSunTM
Full Divided Light Grilles 0.34 0.30 0.19 0.19
Low-E4®SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63
with HeatLockTM Full Divided Light Grilles 0.28 0.25 0.18 0.18
Without Grilles 0.46 0.44 0.57 0.57 .82
Clear
Full Divided Light Grilles 0.46 0.44 0.51 0.51
Without Grilles 0.33 0.30 0.31 0.31 .72
Low-E4®
Full Divided Light Grilles 0.35 0.31 0.28 0.28
Double-Hung DB Low-E4®
Without Grilles 0.34 0.30 0.20 0.19 .40
(Insert Frame) Low-E4 Sun
Full Divided Light Grilles 0.35 0.31 0.18 0.18
Without Grilles 0.33 0.29 0.21 0.21 .65
Low-E4®SmartSunTM
Full Divided Light Grilles 0.34 0.30 0.19 0.19
Low-E4®SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63
with HeatLockTM Full Divided Light Grilles 0.27 0.25 0.18 0.18
Without Grilles 0.47 0.45 0.59 0.59 .82
Clear
Full Divided Light Grilles 0.47 0.45 0.53 0.53
Without Grilles 0.34 0.30 0.31 0.31 .72
Low-E4®
Full Divided Light Grilles 0.35 0.32 0.29 0.28
Without Grilles 0.34 0.30 0.20 0.19 .40
eliding Low-E4®Sun
Full Divided Light Grilles 0.35 0.32 0.18 0.18
lithout Grilles 0.33 0.29 0.21 0.21 .65
ow-DeSmartSunTM
Full Divided Light Grilles 0.34 0.31 0.19 0.19
Low-E4®SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63
with HeatLockTM Full Divided Light Grilles 0.27 0.27 0.18 0.18
09-10 COMPANY CONFIDENTIAL- REVISION AA-01
i•w
Agreement Document and Payment Terms
' J// DBA:RENEWAL BY ANDERSEN OF BOSTON Richard Douville
•RENEWAL Legal Name:Renewal by Andersen LLC 942 Florence Road
HIC#170810 Florence,MA 01062
byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)582-0406
FmistmxtM OW Mgtanuutxr
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Richard Douville 09/18/23
BUYER(S)NAME CONTRACT DATE
942 Florence Road, Florence, MA 01062 (413)582-0406
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
rdoutoo@comcast.net
PRIMARY EMAIL SECONDARY EMAIL
NOTES:
Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal By Andersen of
Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in
the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and
incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed
all work under this Agreement.
TOTAL JOB AMOUNT: $7,536 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed
must be made by personal check,bank check,credit card,or cash.
DEPOSIT RECEIVED: $0
BALANCE DUE: $7,536 Estimated Start: Estimated Completion:
16 to 20 weeks 1 day
AMOUNT FINANCED: $7,536
We schedule installations based on the date of the signed contract and secondarily on the date
METHOD OF PAYMENT: Financing in which we complete the technical measurements.The installation date that we are providing at
this time is only an estimate.We will communicate an official date and time at a later date. Rain
and extreme weather are the most common causes for delay.
NOTES:
Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal
understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the
signed,written consent of both the 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.
NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign.
YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/21/2023 OR THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF
CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Rich Gizzie Richard Douville
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
09/18/23 Page 2/ 28
-5Itemized Order Receipt
,4+
�' DBA:RENEWAL BY ANDERSEN OF BOSTON Richard Douville
ENEWAL Legal Name:Renewal by Andersen LLC 942 Florence Road
R
RENEWAL HIC#170810 Florence,MA 01062
30 Forbes Road I Northborough,MA 01532 H:(413)582-0406
Phone:(508)351-2200(Fax:(508)986-7072 I rbaboston@gmail.com
ID#: ROOM: SIZE: DETAILS: PRICE:
101 Living Window Gliding Triple 1:2:1 Base Frame, Exterior White,
Interior White, Performance Calculator PG Rating: 301 DP
Rating: + 30/ - 30 Glass, All Sash: High Performance
SmartSun Glass, No Pattern, Hardware,White, Screen,
TruScene, Full Screen, Grille Style, No Grille, Mlsc, Standard,
Replacement of window frame and sash, includes casing
from standard options.,
WINDOWS: 1 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $7,536
_.„ , ''. Renewal by Andersen is committed to our customers'safety by
v4iiiime
tea complying with the rules and lead-safe work practices specified by the EPA.
09/18/23 Page 3/ 28
ma :` Payment Authorization Form
ofh.w' DBA:RENEWAL BY ANDERSEN OF BOSTON Richard Douville
RENEWAL Legal Name:Renewal by Andersen LLC 942 Florence Road
HIC#170810 Florence,MA 01062
byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)582-0406
ivuumnMOW DOMcm.cuuxr
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Richard Douville
BUYER NAME
942 Florence Road Florence
ADDRESS CITY
MA 01062 (413)582-0406
STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2
9.99%for 10 years 3740 $7,536
FINANCE PROGRAM' FINANCE PLAN#' CONTRACT BALANCE
Rich Gizzie 2326103985 09/18/2024
SALES REP APPLICATION ID OFFER EXPIRATION DATE
*If your financing is pending,the Finance Program and Finance Plan Number are subject to change
PAYMENT SCHEDULE ($7,536)
CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION(4)
FINANCING $0 $2.512 $2,512 $2,512
(1) CASH DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or in whole by cash,check,or credit card
("Cash Deposit").
(2) FINANCE DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or in whole with financing("Finance
Deposit").
(3) START OF JOB: 1/3 of the purchase price is due at Start of Job.
(4) SUBSTANTIAL COMPLETION: Final payment is due on the day of installation when all windows and/or doors included in this agreement
have been installed into their openings and any interior and exterior trims have been applied("Substantial Completion"). If there are any outstanding
warranty claims or service items,customer may retain an amount equal to the value of the outstanding item(s)or work to be done,not to exceed
10%of the total purchase price. Due to project changes after Contract Signing,the final payment is subject to change.
BY SIGNING BELOW, I/WE,THE BUYER(S):
1. Authorize Renewal by Andersen to transact payments based on the amount(s),form of payment(s),and timing specified in the Payment
Authorization Schedule above.
2. Acknowledge the use of the loan to make a purchase will constitute acceptance by all Borrowers of the Loan Agreement.
3. Instruct the Lender(if applicable)to disburse the proceeds of the loan to Renewal by Andersen as identified above in the amount(s)
and timing specified in the Payment Authorization Schedule.
4. Understand that Renewal by Andersen must be notified in writing of a change in payment method in advance of the respective payment.
Richard Douville 4A)".;,01),1k• 09/18/23
BUYER NAME SIGNATURE DATE
09/18/23 Page 4/ 28
Go Permits, LLC
105 Buttonball Lane
Ga Glastonbury, CT 06033
PERMITS Scott Doughman
Phone: 860-952-4112
Fax: 860-430-6719
scottdoughman@gopermits.org
Re: Building Permit Application - Licenses
Good day,
Please find attached permit application, licenses and supporting documents.
Renewal by Andersen sold the job and is the G.C. and CSL
- CSL #CS-090125 -- Exp. 10/06/24
- HIC #170810 -- Exp 12/22/23
- Workers Comp - #MWC 3145822 — Exp. 10/01/23
Old Republic Insurance Co
All licenses and insurances are attached.
Once the permit is ready:
• Please fax or e-mail a copy of the permit and receipt to the below address and mail
the original to the homeowner:
Fax: 860-430-6719
Email: renewalbyandersen(a.gopermits.orq
• If you unable to mail the permit to the homeowner please send to the below address
and we will ensure the permit is at the home posted at the time of installation:
Go Permits, LLC
105 Buttonball Lane
Glastonbury, CT 06033
If we are required to pick up the permit in at the building department, please call 860-952-
4112 once it's ready and we will come to get it.
Thank you,
Go Permits
Page 1 of 1
AWRC!" CERTIFICATE OF LIABILITY INSURANCE DATE(MAIDESYYYYp
�r. OS/21/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 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 policyfles)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 endorsementls).
PRODUCER I:CAIACT 111111s Tur.ra Watson Cartiflcate Canter
VAME
W111ia Tower. Nat = Nxdrast• _r.,. ))
ti/o 26 Ca.tusy Blvd .PHONE., 1-S77-94S-7378 FAX
1-883-467-2378
P.O. boa 305191 AOOR`ESB car tit icatasPv111/1•cos
Nash ell la. TN 372305/91 USA INSURER:Si AFTORDINO COYERA.6E NAIC s
NSURERA 01d Fapubllc Insurance Company 2 414 7
INSURED
NSURERB
sa0awal by Atdrraae L:1:
30 rarba. Woad NSURERC:
Nor thtneavph, MA 01532 INSURER D,
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:W26007651 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLKAS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAtilED 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
ISM -ADOL'SUBAI POLICY EFF POUCY LOP
LTR TYPE OF RBURAIMCE M80 R VD POLICY NUMBER IMMOGIYYYYI LIMA MYYVYi LINTS
X COMMERCIAL �(GENERAL.LIABILITY EACH OCCURRENCE f 2,000,000
J.IIAS VAC*: I t OD='.41 PREMISES
7ORENCI 500,000
PREMISES LEa ptt++nrranitl I
A MEDE5P,AAy orepasonl f 10.000
�+ —�-- MAZY 314161 22 10/01/2022 10/01/2023 PERSONAL.hADv IN.URY S 2.000.000
AUL a.,5CRE GATE L.MJIT APPLES PER. I CC-NERAI AGGREGATE S 4•000 000
X ocLiCY lE& El LCC PRODUCTS•CCNRYIP AGG f 4.000.000
OTHER
AUTOMOBILE LIABLIN' j COMB:IIF_D SINGLE LIMIT f 5.000,000
X ANY AUTO BODILY IN:l1RY'ipe WAX.,
A (WINED SCHEDULED MTh 314139 22 10/01/2022 10/01/2023 BODILYIN,URY+Par aauam; f
AUTC.IS ONLY AUTOS
wRED NDAto'IANED `PRAPERT,DAMACI f
�r AUTOS ONLY AUTOS OAST I t'aridonIL
UMBRELLA LEAS OCCUR EACH OCCURRENCE f
EXCESS LAB CLAMS-MADE AGGREGATE 5
CEO 1 RETENTIONS 5
WORKERS COMPENSATION y(i IERH
AND EMPLOYERS'LABILITY STATUTE l
A Y 1,000.000
4N,RH3PRIET ORIPARTNEREXECUTh'E IN EL EACH ACCIDENT 5
CfF CER4IENEXREXCLLOE.^.7 N0 N A WIC 314161 22 10/01/2022 10/01/2023
IIlandslary Is NEN EL DISEASE EA EMPLOYEE,5 1,000,000
If yes 3eeurtpe untie 1,000.000
DESCRIPTON OF OPERATIONS tMOe E L DISEASE,POLICY LIMIT 5
DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES IACOIG/101 Mldilional Ramada s[As4As.mat be ansLhad if more pats a rseareal
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
1rL
Evtdanca of Irat-lance Ft' �(�t/^-
C 198b-2016 ACORD CORPORATION All rights reserved
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
sa 10. 23076070 nArCa 2676324
Commonwealth of Massachusetts C.CiAeaYG7ioM
Division
of Occupational Liceand Uhrestncted Buildings of�case group which contain
Board of Building Re ulattons and Standards case than000 cubic feet
Canst�tfi i 1 SUpervEsor OW cubic meters)ot entiosed
space
CS-090125 E spires: 10/06'2024
JAIME L MOI(N -
54 NOTTINGWAM RD
RAYMOND NM 0307r
614V4313 Fai4urs to poss,rss a currant edition of the Massachusetts
C;,mmisstoncr eistea, go. °tt;t.>tta.. State Rutlibrig Cads is cause for revocation of this license.
For information about this keen
Cat!(4117)727-330$er visit ttrwutr.wises.govtdpl
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washingto0 Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type Supplement Gard
RENEWAL BY ANDERSEN LLC Fie pon o 120$10
30 FOFtBES RD # txEcpltatan 1?12Z�202�
NORTHeOROUGH,MA 01532
Update Address and Return Card.
THE COMMONWEALTH OF MASSACNUSE1TS
Office of Consumer Affairs&Businose Regutatlon Registration valid for individual use only before tho
HOME IMPROVEI*ENT CONTRACTOR .rpirat:•+o Awtw If frr.+nd return to-
TYPE,Staiplarnient lard Office of Consumer Affairs and 54/stools Regufabon
RcalattiMPn 1000 WesAsngton Streel -Suite 710
1708t0 12,2021023 Boston,MA 02114
RE beEvou,BY ANDERSEN lit
I
JAIME MORIN
:io FOES RD •
c , r. s•Gr.+i /
NOHYHBOROU(;H,AAA 01532
Underaecrt rly Not lid without signature
RENEWAL1111
4 _ brANDERSEN
../1
To Whom It May Concern:
This letter will authorize the following persons) to act as agent(s)on behalf of Renewal by
Andersen JAC, 9900 Jamaica Ave South. Cottage Grove MN 55016 to pull for permits and
Inspections wail respect to the installation, maintenance and repair of windows and entry
doors undar Massvhl.+setts State Home improvement Contractor license number 170810 and
Construction Supervisor license number CS-090125.
If you have any questions, please call me at 508,351.2277 ext 6.
Authorized person(s):
Go Permits LLC Sarah Hammact David Anderson Maureen Kivel
Scott Doughman Ryan B4ondo Savannara Kuy Mark Foster
cilynn Norgan Jennifer winke Wendy Holden Gerald Cramer
Nick Rago Panel ifrckerman Stephen Wilder Katie Grocott
Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff
{
'! amie Morin
Renewal by Andersen tIC
HIC 170810
CSl—C5090125
Local District Office Address
30 Forbes Rd
Northbarough, MA 01532
?errwal by Andrxsen 1. C 9900 Jama ur Ayr South.(Cttagi Grave MI4 55016