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44-090 (4) BP-2023-1328 964 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-090-001 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-2023-1328 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2023 Contractor: License: Est. Cost: 18202 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 BERGERON LEONARD &MARY ELLEN & Use Group: Owner: VICTORIA L BERGERON 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: 1 REPLACEMENT 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: 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 � TATif .Y2 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner if .L-41.0( ( cuki k tea, 7 . off) sF.� wt )_.. The Commonwealth of Massachusetts ti' Board of Building Regulations and Standards °v°�\ F . ICIPAL ITY Massachusetts State Building Code, 780 CMR ',,c,--, '���� Building Permit Application To Construct, Repair, Renovate Or Demolish a ife ar Z011 One-or Two-Family Dwelling y"Voq,� This Section For Official Use Only F',�. Building Permit Number: (3)9` 3-.3 — ) 32'' Date A plied: L' Z1 /euio /� q-25-2023 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Eby Flo'ewre fief I.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 0 Zone: _ Outside Flood Zone'? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 1i-efN 15t n)A F/oie4te /ti� 6?tat Z- Print'](Name City,State,ZIP `l i, Y 1/ocm /o d" el (113-s't f. 8b Wv I M Je.r r:).-s ec.s c ne } No.and Street Telephone mail Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Dpecify: (•ti!/r!v_i/' Brief Description of Proposed Work2: at Me/4 AM d Ol'r de l Mit, 4/P0, /ik€ 6 r 1,Az SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 61 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ` ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: 5 '� O Check No.4 6 heck Amount: Cash Amount: 6. Total Project Cost: $ i•o LoZ, (.11) ❑Paid in Full 0 Outstanding Balance Due: 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 Northborou MA 01532 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-952-4112 renewalbyandersen@gopermits.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@gopennits.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 El 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) Date SECTION 7b: OWNER1 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. 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 ` Office of Investigations "1111�. 1"— Lafayette City Center / 2 Avenue de Lafayette, Boston, MA 02111-1750 ti www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei ibly Renewal by Andersen Name (Business/Organization/Individual): Address: 30 Forbes Rd. City/State/Zip: Northborough, MA 01532 Phone #:508-351-2277 x 6 Are you an employer? Check the appropriate box: contractor and I Type of project (required): 1. 30 4.I am a employer with 0 I am a general employees (full and/or part-time).* have hired the sub-contractors 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 8. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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: ! G V Poi-144e 4 s City/State/Zip: 4.reAce M A 6J66 2. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sign iz 'u.>+� Date: / Z 2- - Z�j Phone #: 5 -351-2277 x 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: City of Northampton T.AAp,` OQ O. ,y\ S`S ..«`�..SAC Massachusetts 4,e I.- `e Ae x 4- I.(t ! a' DEPARTMENT OF BUILDING INSPECTIONS . ►' .. r �" 212 Main Street •• Municipal Building vti. r'' Northampton, MA 01060 •I': .0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: bc.)Z6k., VIAAM---612*$ Location of Facility: 50 !, 5 4/ /624 Gzro L Oft cD1S3 2— The debris will be transported by: Name of Hauler: 761 ' iD►v(in AA°`fie 41-'' Signature of Applicant: Date: � 2 2 - 7 ENEWAL j� RAN E RS E N tlisit/ ;, lumina WINDOW&DOOR IEPlACE M[N1 ♦ 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 U.S. Canada ENERGY ENERGY 5 W o STAR STAR Andersen" Andersen NFRC Certified o o u w v 6.0 v 4.1 Product Line 8 Glass Grille Type Products u `�' m 1 r am 77 Product Type Type Directory Number j M at m .E _ A t. _ U Q C c .. m m m Z O O N o 0 0 N N N Z VS 3.1 Tempered Glass-wl No Grilles and Grilles Less Than 1" No Grilles AND-N-6-00981-00001 0.30 1.70 0.26 0.44 16 <0.2 N NC - - - - - w Simulated Divided Lite or Installed Interior Removable AND-N-6-00981-00002 0.30 1.70 0.23 0.38 14 <0.2 N NC SC - - - oFull Divided Lite AND-N-6-00987-00001 0.32 1.82 0.23 _0.38 12 <0.2 111 - - 111 - - - Firelight`"(grilles-between-the-glass) AND-N-6-00999-00001 0.30 1.70 0.23 0.38 14 <0.2 N NC SC - - - No Grilles AND-N-6-00982-00001 0.31 1.76 0.16 0.25 9 <0.2 - - - - - W Simulated Divided Lite or Installed Interior Removable AND-N-i-00982-00002 0.31 1.76 0.14 0.21 8 <0.2 - - . - - 3 v, _ 3 ' Full Divided Lite AND-N-6-00988-00001 0.32 1.82 0.14 0.21 7 <0.2 - - - - - Firelight'*'(grilles-between-the-glass) AND-N-6-01000-00001 0.31 1.76 0.14 0.21 8 <0.2 - - No Grilles AND-N-6-00983-00001 0.30 1.70 0.18 0.40 12 <0.2 N NC SC - - - w S Simulated Divided Lite or Installed Interior Removable AND-N-6-00983-00002 0.30 1.70 0.15 0.34 10 <0.2 N NC SC - - - 3 9 N Full Divided Lite AND-N-6-00989-00001 0.31 1.76 0.15 0.34 9 <0.2 - Finelight'.(grillesbetween4he-glass) AND-N-6-01001-00001 0.30 1.70 0.15 0.34 10 <0.2 N NC SC - - - No Grilles AND-N-6-00980-00001 0.31 1.76 0.43 0.49 25 <0.2 - - 21 - �"e ' Simulated Divided Lite or Installed Interior Removable AND-N-6-00980-00002 0.31 1.76 0.37 0.42 21 <0.2 - - - - - w o 7 Full Divided Lite ANDN-6-00986-00001 0.32 1.82 0.37 0.42 20 <0.2 - - - - - Firelight'.(grilles-between-the-glass) ANDN-6-00998-00001 0.31 1.76 0.37 0.42 21 <0.2 - - - - - No Grilles ANDN-6-01058-00001 0.27 1.53 0.26 0.43 20 <0.2 N NC - Z1 - - e Simulated Divided Lite or Installed Interior Removable ANON-6-01058-00002 0.27 1.53 0.22 0.37 18 <0.2 N NC Z1 - - Ill 3 m 0.22 0.37 15 <0.2 IJ NC I 3 Finelight*""(grilles-between-the-glass) ANDN-6-01067-00001 0.27 1.53 0.22 0.37 18 <0.2 N NC -, Zt - - ` No Grilles ANDN-6-01059-00001 0.26 1.48 .17 0.39 16 <0.2 N NC Z1 - - 2 y ' w ; 3 Simulated Divided Lite or Installed Interior Removable AND-N-6-01059-00002 0.26 1.48 1.15 033 15 <0.2 N NC - - - 400 Series 9 E i Full Divided Lite ANDN-6-01062-0tlool 0.29 1.65 1.15 0.33 11 <0.2 N NC - - - Frenchwoodt m 3 - Gliding Patio Door Firelight*""(grilles-between-1he-glass) ANDN-6-01068-00001 0.26 1.48 `.15 0.33 15 <0.2 N NC - . . . s No Grilles ANDN-6-01057-00001 0.27 1.53 .39 `0.48 27 <0.2 N NC - - Z1 - - o Simulated Divided Lite or Installed Interior Removable AN DN-6-01057-00002 0.271. 0.34 0.41 25 <0.2 N NC Zt 9 7 i Full Divided Lite AND-N-6-01060-00001 0.30 1.70 0.34 0.41 21 <0.2 N NC Firelight*.Ignllesbetween-the-glass) ANDN-6-01066-00001 0.27 1.53 0,34 0.41 25 <0.2 N NC - - Z1 • - 3.1 Tempered Glass-IN/Grilles 1"or Greater Simulated Divided Lite or Installed Interior Removable ANDN-6-00981-00003 0.30 1.70 0.20 0.32 13 <0.2 ©NC SC. - - - v 3 Full Divided Lite ANDN-6-00993-00001 0.31 1.76 0.20 0.32 11 <0.2 o _ _ _ J Finelight*o"lgrilles-between4he-glass) AND-N-6-01005-00001 0.32 1.82 0.23 0.38 12 <0.2 - - - Simulated Divided Lite or Installed Interior Removable AND-N-6-00982-00003 0.31 1.76 0.13 0.18 7 <0.2 - - - - - - "v 3 in Full Divided Lila ANDN-6-00994-00001 0.32 1.82 0.13 0.18 6 <0.2 - - - _ , J Finelight° (grilles-between-the-glass) AND-N-6-01006-00001 0.32 1.82 0,14 0.21 7 <0.2 Simulated Divided Lite or Installed Interior Removable ANDN-6-00983-00003 0.30 `1.70 0.14 '0.29 9 <0.2 © NC SC , - - - t Full Divided Lite ANDN-6-00995-00001 0.31 1.76 0.14 0.29 8 <0.2 9 E _ - v+ Finelighire(grillesbetween-theglass) ANDN-6-01007.00001 0.31 1.76 0,15 0.34 9 <0.2 - - - - - - - `Simulated Divided Lite or Installed Interior Removable ANDN-6-00980-00003 0.31 1.76 0.32 0.36 18 '<0.2 w '^ j Full Divided Lite ANDN-6-00992-00001 0.32 1.82 0.32 0.36 17 <0.2 - - - - - - - a _ _ a Ftnelight*"'(grilles-between-the-glass) AND-N-6-01004-00001 0.32 1.82 0.37 0.42 20 <0.2 - - - - - - - _,e Simulated Divided Lite or Installed Interior Removable ANDN-6-01058-00003 L 0.27 1.53 0.20 0.32 16 <0.2 NC 21 - - w 3 w Full Divided Lite ANDN-6-01064-00001 0.29 1.65 0.20 0.32 14 <0.2 NC - - p = - r , 3 Finelight*"'(grillesbetween-the-glass) ANDN-6-01070-00001 0.28 1.59 0.22 '0.37" 16 <0.2 NC Z1 - - 2 Y Simulated Divided Lite or Installed Interior Removable ANDN-6-01059-00003 0.26 1.48 0.13 0.28 14 <0.2 NC - - - W S ro 0.29 1.65 0.13 Full Divided Lite ANDN-6-01065-ODODt 0.28 10 <0.2 NC - o E _ - - - - or- Finetight""(grillesbetween4hegless) AND-N-6-01071-00001 0.28 1.59 0.15 0.33 12 <0.2 tNC - - - This information is for reference only. Performance varies byunit size and options selected. Page 120 o1155 Data is current as of December 15,ee page 14 o moreoieinf change. p aB See page 1 for information. For specific unit performance information,please contact your dealer or Andersen Sales Representative. -/�� ,'" Agreement Document and Payment Terms ` ' DBA:RENEWAL BY ANDERSEN OF BOSTON Lenny Bergeron&Mary Ellen Bergeron RENEWAL Legal Name:Renewal by Andersen LLC 964 Florence Rd HIC#170810 Florence,MA 01062 by ANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)584-8040 IYOME MOW,WORAFHNW YI Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)626-5436 Lenny Bergeron & Mary Ellen Bergeron 09/19/23 BUYER(S)NAME CONTRACT DATE 964 Florence Rd, Florence , MA 01062 (413)584-8040 (413)626-5436 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER Imbergeron@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: $18,202 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: $6,066 BALANCE DUE: $12,136 Estimated Start: Estimated Completion: 12 weeks 1 day AMOUNT FINANCED: $0 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Check 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: 1/3 signing; 1/3 start; 1/3 completion 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 09/22/2023 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 William Abdelnour Lenny Bergeron Mary Ellen Bergeron PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 09/19/23 Page 2/ 32 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Lenny Bergeron&Mary Ellen Bergeron RENEWAL Legal Name:Renewal by Andersen LLC 964 Florence Rd HIC#170810 Florence,MA 01062 b ENL DER„un N 30 Forbes Road I Northborough,MA 01532 H:(413)584-8040 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)626-5436 ID#: ROOM: SIZE: DETAILS: PRICE: 101 Room 1 Patio Door Gliding A-Series 4 Panel Stat / Active / Active / Stat, Exterior White, Interior Pine, Interior Pre-Finish None, Performance Calculator PG Rating: 50 DP Rating: + 50 / - 50 Glass, All Sash: Tempered High Perf. SmartSun Glass, No Pattern, Hardware, Newbury® , Bright Brass, Screen, Double Gliding, Full Screen, Grille Style, No Grille, Mlsc, None , WINDOWS: 0 PATIO DOORS: 1 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $18,202 Renewal by Andersen is committed to our customers'safety by c�1+ complying with the rules and lead-safe work practices specified by the EPA. 09/19/23 Page 3/32 Payment Authorization Form DBA:RENEWAL BY ANDERSEN OF BOSTON Lenny Bergeron&Mary Ellen Bergeron Legal Name:Renewal by Andersen LLC 964 Florence Rd RENEWAL HIC#170810 Florence ,MA 01062 EN A 30 Forbes Road I Northborough,MA 01532 H:(413)584-8040 Phone:(508)351-2200 Fax:(508)986-7072 I rbaboston@gmail.com C:(413)626-5436 Lenny Bergeron Mary Ellen Bergeron BUYER NAME CO-BUYER NAME 964 Florence Rd Florence ADDRESS CITY MA 01062 (413)584-8040 (413)626-5436 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 William Abdelnour $18,202 SALES REP CONTRACT BALANCE PAYMENT SCHEDULE ($18,202) CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION (4) CHECK $6,066 $0 $6,066 $6,070 (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 initiate debit or credit entries for payments based on the amount(s),form of payment(s),and timing specified in the Payment Authorization Schedule above. 2. Acknowledge that this Authorization is to remain in full-force and effect until Renewal by Andersen has received written notification from the Customer of its termination in such time and manner as to afford Renewal by Andersen and their Depository Institution a reasonable opportunity to act on it. 3. Acknowledge that the origination of a ACH transaction (recharging of checking account)or recharging of credit card to Customer's account must comply with the provisions of US Law. 4. Understand that if there is a change in the set date of a debit or credit entry, Renewal by Andersen must notify the customer minimally 7 days in advance. Lenny Bergeron 09/19/23 BUYER NAME SIGNATURE DATE Mary Ellen Bergeron ^^a- , ag-At"'' 09/19/23 CO-BUYER NAME SIGNATURE DATE 09/19/23 Page 4/ 32 Go Permits, LLC 430 105 Buttonball Lane Glastonbury, CT 06033 ,1 PERMIT% Scott Doughman\\444444.44,00:0000.00/1 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 31415822 — 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 or I Af nR[I DATE r�r.CSINTYYI CERTIFICATE OF LIABILITY INSURANCE 09/2i/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 policyflesl-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 C0 rACT Millis Towers Batson C.itlficat. Center kAME Wa11ae Tawr• Neuun ita duvet, Inc. PHONE cfa 26 Century Blvd .a.Y I Nn cm 1-B77-945-7378 h'C.Not 1-888-467-2378 P.0. Rua 305191 ADDREAS er GIL 1 ca to sP v1111s-COO Nashval la. to 37 2 30 5191 USA INSURER(Bi AFFORDING COVERAGE NAILS NSURERA Old Republic Insuranca Company 24147 INSURED INSURER B Reneeel by Arielorrea LIC 30 rorb.r Xo.d NBUR£R C Nortaboraogb, IU. 01532 MSURER D. MSURER E MSURER F COVERAGES CERTIFICATE NUMBER:W26007651 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 AU. THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NBR ADDLSUH1t POLICY EFF POUCY EXP L1R TYPE OF INSURANCE MO Web POLICY NUMBER ONMOCYYYYYI.,MISID YYYYYI UWTS X COMMERCIAL GENERALLNANLITT E.AJ:H OCCUPfi£NcE 5 2,000,000 TICLAIMSMACE n OCCL_+FI PREMISES GEOlEa VEND , I 5 500.000 A LIED EI(P.ary ua;arr-n s 10,000 IilltZE 31416-1 22 10/01/2022 10/01/2023 PERSONALIAO'.IN.LIR'� s 2,000.000 t-- CENT AC0REOATE LMIT APPLES PER GENERAL AGGREGATE s a.000.000 X PCt ICY j£&, [J LCC PRODUCTS-CCMR0P ACC 's 4.000.000 ^y DTHE S AUTOMOBILE LUAB*JTY CCSAINED SINGLE LiltT s 5.000.DOC iEA uLesr.Ci X ANY AUTO BODILY INJURY,Per carver i s A � ORNED SCHEDULED AM 314159 22 10/01/2022 10/01/2023 BODILY INJURY.Per,tcnenl. $ AUTOS ONLY ALTOS WRED NON-OWNED PROHER'TYIIAMACE S .�AUTOS ONLY AUTOS ONLY iPar asrrdenli UMBRELLA UAB iacci EACH OCCURNCE s ~~EXCESS UAB rLASr<I,titrE AGGREGATE C.£D I 1RETENTON5 S WOR11i.ER8 COMPENSATION X IP£R I I OTH AND EMPLOYERS'LIA84UTY STATUTE j GR A .C,Y.s+IERPRIETCRPI.R %ECUTA'E I EL EACH ACCIDENT f 1 C2I IC C �f F CER,ME►f£RExCL.uG€OOF.D? Nc NIA Nit 314156 22 10/01/202I 10/01/2023 1.000.000 IMand gory M Mil) E L DISEASE•EA EMPLOYEE} It yes 3CKfiSe under E i DISEASE-POLICY LIMIT s 1.00 0,000 CE SCRIP'ON OF OPERATIONS Weis. DESCRIPTION OF OPERATIONS:LOCATIONS i VEHICLES IACORD 101 A6dilwnal Ramses Soloed*mat be Mashed if RGIe Apace A Hpartwi 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 REPRESENTATIVE , Es id.ao. of Insurance, jL~ 1988-2016 ACORD CORPORATION. All lights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l 30'G_ 2 aAT2U, 2676324 Commonwealth of Massachusetts � � Division of Occupational Licensure Unrestricted- M any see grotto tvekh comsat Board of Budding Regulations and Standards I fess than 35,000 chic test(N1 cubic means)of enclosed Constt�L. ervisor space CS-090125 E spires: 10/06/2024 JAIME L MOF}tN 54 NOTTINGNAM RAYMOND WI 1 IFOLjtitdtt Fad W porissas a cwrsnt edition d the Massachusetts Ca-r,.s:�s:oncr ' !; 'ant:z tlbb Sullding Code is came for revocation of ttnc hcsnse. For 1Rfos nstIon about this lionise Call(017)727-32110 or NU www..heesgowdpf THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair's and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type Supplement Card E7e RENEWAL S RD Expiration 12t2212023 NOf2TIOROUGH.MA 01532 Update Address and Rattan Card. THE COMMONWEALTH OF MASSACHUSETTS Ofrtcs of Consumer Affairs&Bua r»ss Regulation Regnatration val►d for individual use only bofora:ha HOME IMPROVEMENT CONTRACT01t .pGra6.Mo dita 14 found notion to: TYPE,Sul;dement Card office of Consumer ARaMrs and B+rsinaye R,qulateon RallIMMIM0 EaPingiun 1000 WasMngton Street -Su 1a 710 170810 1222/2023 Boston,MA 02118 REtVE'WAL BY ANDERSEN LLC r.+ JAIME MORIN 30 FORBES RD ,+»+ ;• �.'t...+i ( )1?‹.— NORTHBORD41611,MA 01542 Undersecretary Not Vblid without signature , RENEWAL brANDERSEN iocr To whom It May Concern: This letter will authorize the follow'ng persons) to act as agents} on behalf of Renewal by Andersen LtC. 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for per nits and inspections with respect to the installation, maintenance and repair of windows and entry rinnrt indpr Moccarhiicetts State Home Improvement Contractor license number 170810 and Construction Supervisor license number CS-090125. It you have any questions, please call me at 508,351.2277 ext 6 Authorized persons: Go Permits LLC Sarah Hammad David Andersol Maureen Kivel Scott Doughman Ryan 8aondo Sovannara Kuy Mark Foster Glynn Norgan Jennifer winke wendy Hoiden Gerald Cramer Nick Rago Danel V ckerman Stephen Wilder Katie Groton Bonnie Myers Carrie Fol.gno Michael Rogers Rachel Orloff mie Morin Renewal by Andersen tLC HIC 170810 CSL—CS090125 Local District Office Address 30 Forbes Rd Northhorough, MA 01532 Rer•cwal by Anderson L.0 99M1 Jamaica Ave Saud%C.cetaor Grove MN 55016