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41-039 (3) BP-2024-0527 1411 WESTHAMPTON COMMONWEALTH OF MASSACHUSETTS RD Map:Block:Lot: CITY OF NORTHAMPTON 41-039-001 Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-0527 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2024 Contractor: License: Est. Cost: 6775 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: GONZALEZ MARTIN GEORGE &HANNIA L Lot Size (sq.ft.) Zoning: RR/WP Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC314158 NORTHBOROUGH, MA 01532 ISSUED ON: 04/30/2024 TO PERFORM THE FOLLOWING WORK: REPLACEMENT PATIO 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: Cas: 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: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner If possible, please email a copy of the issued permit tot _ o_permits.org. Thank you. The Commonwealth of Massachusetts ---. it tW • i -' FOR Board of Building Regulations and Stan ds Massachusetts State Building Code,�80 RAPR 302024 BuildingPermit A lication To Construct, Re air,Ren Or Demolish a /UNTIPSEALITY visMar 2011 PP P One- or Two-Family Dwel ng AR,\t,oPnun., , Tr?,„. c lN�PiCT! This Section For Official Use Only'' J.Mq,,,t�oolvs Building Permit Number: 1S O- if- 3'a7 Date Applied: - _ Lo its Etas bra 1 6.,-0-v4.4- 41301 aq Building Official(Print Name) Signature D to SECTION 1: SITE INFORMATION 1.1 PropertyAddre s: 1.2 Assessors Map&Parcel Numbers /y/I wcsJlaµ•eki ad rtoKNe M! Z MapNumber Parcel Number 1.la Is this an accepted street?yes t/ no 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 0 Private 0 Zone: Outside Flood Zone' _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recor : i444 n,0. on 24tk- -rW«ter a Mil 0I06Z Name(Print) City,State,ZIP t(1I( West -v'4p¢.r) Rva.a 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 i Number of Units Other '13---pecify:fV/r&reesl*/t/ wit>dw1 Brief Description of Proposed Work':ee/'M'1041- 44 d Rert t,tG /peri'v cv60, hke 1i llt l v,1-4 i10 Soolv '--•'---el CLt.iz-e L ce,Z-r- af. - Z 3 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /`Ps, et' 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ (o ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees 10 Check No4i Check Amount: -''l Cash Amount: 6. Total Project Cost: $ (0i qqc, D 0 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) p QD/Z Ja.2 ALL. IWo License Number Expiration Date Name of CSL Holder List CSL Type(see below) l....42e,s Rd No.and Street Type Description /OA bora Nn o j,s 3 Z U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofmg Covering y��2 S-' Window and Siding SF Solid Fuel Burning Appliances Nj o-952 /i'cvd i il40c'-1.5ryYx,A;13' I Insulation Telephone Email addresst� J D Demolition 5.2 Registered Home Improvement Contractor(HIC) �, / /AP Flo /2-z3. -ts- / eri d i) GY'eelei''1 HIC Registration Number Expiration Date HIC Company Name"6r HIC Registrant Name G°�°A L('ScC -7 3t7 Fed I' S R t (�'G ls�• betiGVG r1 rot. r 01 No.and S et Email address io(o C• Mfg 0 652_ gip -9S2- ` Z_ 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 o e building permit. Signed Affidavit Attached? Yes .......... No ❑ 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: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 e best of my knowledge and understanding. 6tuz4,/I Lc, 67,11 cam (4Y Zit Print Owner's or Authorized Agent's Name(El 'c S ture 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" City of Northampton oa'fNAMrJc\. s°;.I°S ti, 5v5....:'..Sic V \ Massachusetts �Q� _ �i� '' ' .' N: % • t DEPARTMENT OF BUILDING INSPECTIONS 4 r. r * 212 Main Street • Municipal Building vA. Ca �\+��'''_ Northampton, MA 01060 �Sbry 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: Location of Facility: 31 -6rhG5 /2d Gdbl i %w. k del P-- 07..3—3 Z The debris will be transported by: Name of Hauler: lA"4t-S- Mat 7a,Ate /"'oA>1 / Signature of Applicant: Date: y /°V The Commonwealth of_Ifassaclrusetts Department of Industrial Accidents �.;y ` Office of Investigations =:ill:` Lafayette City ('enter "~ "d' '.Avenue de Lafayette. Boston.MA 62 111-175ff tctr ir.moss.gorfdia Workers'('ompensation Insurance.Affidavit: Builders`('ontractors/Electriciansi'Plumbers :applicant Information Please Print I_egibh Renewal by Andersen Name (Business Organization individual t: Address: 30 Forbes Rd. City/State/Zip:Northborough, MA 01532 Phone #:508-351-2277 Are you an employer''Check the appropriate hot: l Apr of project(requiredl 1.IK I am a employer with 30 4. 0 1 atti a general contractor and I employees(full andlor part-pia ).• Is:,',e hired the sub-contracture b. Li New construction 22-.❑ I am a sole proprietor or partner- lutt:d on the attached sheet 7. Remodeling ship and hate no employees 1 Ices sub-contractors have K. 0 Demolition working for are in any capacity. employees and hate workers' b P 9. 0 Building addition [No workers" comp.insurance comp. insurance., required.) 5. 0 We are a corporation and its 10.0 Electt'cal rcparrs or ael.fttrvtns, 3.1=1 1 am a homeowner doing,all work officers have exercised then 11.0 Plumbing repairs ur add tt orn. myself. [No workers' comp. right of exemption per MGl 12.0 Roof repairs insurance required.)* c. 152.*1(4),and we have noReplacement employees. [No workers' i 3.�(Aber _ P comp.. insurance required.) •:tilt at+p3t.aatt that.lktk%1st..=1 roust also tin etut the xltittn 1,4.40,4 showing their ww►cn'.Yt11rtittcu%arttnt t».•at.L utf&,trnatiun. ' I t.ntteUttnets u 110 sohtnit this Aida..tt indi.atiur they ate Jollity all out►and than hire.trttside cuntta.tut.uiu.t.ut+tutt a tech affidavit irwiic brag%Inch. 'l onctai.ttm,that.tse.lt this huv trust att:whed ant additiuuat shed Aiming the name of the sutseunn rats and state ttttether to not thotsx entities hart: CUtyl.net',. Ir the.uh—Lotttta.ttw.lt.ttecuq•kisee..thy+.tttu,.t rt.,tidethett tttnt.et.'.uutr.14.11,:',VW 151}!.:1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Conically Name:_ Old Republic Insurance Co. Policy a or Self ins.Lie.a: MWC 314158 22 Expiration Date. 10/1/2024 Job Site .Wdtess 1411 Westhampton Rd City Slate /Ail Florence, MA 01062 Attach a copy of the corkers'compensation policy declaration page isbossing the policy number and evpiratiern date). Failure to secure coverage as required under Section 25A of \l(i[.c. 152 can lead to the imposition of eranimal penalties of a tine up to S I.500.t$l and or one-year impr Lott lent" as well as ON it penalties in the form of a SLOP WORK t WIN-R. and a tine of up to S250.(K)a day against the vrotator. Fie adstsed that a cope of this statement may be forwaided to the Office of Ins t7t:attsn, of the I)1:\ for tttstrrarsec cos etJLe s.7tticatton IIIMMINIIIIIIIIIIIIIIIIIIIIIIIII I do hereby certify under the pains and penalties of pe rjurr that the tnfurmunon provided above is true and correct Signature )4a/Lil )04,44 i)I t.:,t 4/18/2024 Plsttnc g6 a - I'S?- Wi 2-- Official use ail)'. Do not write in this area.to he completed tit•city or town official ('its or I ono: Permit'license tt Issuing 1uthority (check one): 1(-'-`�1 1--� I❑goardofHealth 2❑RuildingDepartment 31_.I( it l onis ( leek .1.0tlrclrk:41Inspector SLJ'lunthing 1nslirctor b.[](lthrr Contact Person: Phone ts: U.S. Canada ENERGY ENERGY cc o STAR STAR Andersen" Andersen NFRC Certified o o a " w 15 m Product Line& Glass Grille Type Products m �. ,� r v 6.0 v 4.1 Product Type Type Directory Number - co 5 w - _ U Q -co m j m m 0 Z U U N N N N N Simulated Divided Lite or Installed Interior Removable AND-N-13-01521-00003 0.25 1.42 0.37 0.45 30 <0.2 - - - w 3o I I o � � Full Divided Lite AN 0.N-13-01527-00001 0.29 1.65 0.37 0.45 25 <0.2 - - • x a 3 Firelight'"(grilles-between-the-glass) AND-N-13-01533-00001 0.25 1.42 0.43 0.52 33 <0.2 - - - 3.9 Tempered Glass-w/No Grilles and Grilles Less Than 1" Na Grilles AND-N-13-01382-00001 0.28 1.59 0.32 0.55 23 <0.2 ' Simulated Divided Lite or Installed Interior Removable AND-N-13-01382-00002 0.28 1.59 0.28 0.48 21 <0.2 - - - 3 Full Divided Lite AN0.N-13-01388-00001 0.30 1.70 0.28 0.48 18 <0.2 r. - 111 - Firelight'"'(grilles-between-the-glass) AND-N-13-01400-00001 0.28 1.59 0.28 0.48 21 <0.2 - - No Grilles AND-N-13-01383-00001 0.29 1.65 0.19 0.30 14 <0.2 - - Simulated Divided Lite or Installed Interior Removable AND-N-13-01383-00002 0.29 1.65 0.17 0.26 13 <0.2 I. - - -' Full Divided Lite AND-N-13-01389-00001 0.30 1.70 0.17 0.26 12 <0.2 rl - - Finelight'.(grilles-betweentheglass) AND-N-13-01401-00001 0.29 1.65 0.17 0.26 13 <0.2 N No Grilles AND-N-13-01384.00001 0.28 1.59 0.21 0.49 17 <0.2 IJ - - Simulated Divided Lite or Installed Interior Removable AND-N-13-01384-00002 0.28 1.59 0.19 0.43 16 <0.2 N - - o � Full Divided Lite AND-N-13-01390-00001 0.29 1.65 0.19 0.43 14 <0.2 IJ - - Finelighl^'(grilles-between-the-glass) AND-N-13-01402-00001 0.28 1.59 0.19 0.43 16 <0.2 ii - - 'No Grilles AND-N-13-01381-00001 0.29 1.65 0.52 0.61 34 <0.2 Z3 Simulaled Divided Lite or Installed Interior Removable AND-N-13-01381-00002 0.29 1.65 0.46 0.53 30 <0.2 g „ Frill Divided Lite AND-N-13-01387-00001 0.31 1.76 0.46 0.53 28 <0.2 II Z. Firelight'"(grilles-between-the-glass) AND-N-13-01399-00001 0.29 1.65 0.46 0.53 30 <0.2 No Grilles AND-N-13-01537-00001 0.24 1.36 0.31 0.54 28 <0.2 - w Simulated Divided Lite or Installed Interior Removable AND-N-13-01537-00002 0.24 1.36 0.28 0.47 26 <0.2 . - 3 0 9 Full Divided Lite AND-N-13-01540-00001 0.28 1.59 0.28 0.47 21 <0,2( n I 200 Series Firelight'"'(grilles-between-the-glass) AND-N-13-01546-00001 0.24 1.36 0.28 0.47 26 <0.2 NII PermaShield® Gliding Patio Door t No Grilles AND-N-13-01538-00001 0.23 1.31 0.21 0.48 23 <0.2 N - t • S Simulated Divided Lite or Installed Interior Removable AND-N-13-01538-00002 0.23 1.31 0.19 0.42 22 <0.2 N - oN = Full Divided Lite AND-N-13-01541-00001 0.28 1.59 0.19 0.42 16 <0.2 IJ1411 II 3 Firelightr"(grillesbetweentheglass) ANOtJ-13-01547-00001 0.23 1.31 0.19 0.42 22 <0.2 n • x No Grilles AND-N-13-01536-00001 0.24 1.36 0.47 0.59 37 <0.2 - - - - Z3 ▪ ,7 o Simulated Divided Lite or Installed Interior Removable AND-N-13-01536-00002 0.24 1.36 0.41 0.52 34 <0.2 - - - Z3 o I- = Full Divided Lite AND-N-13-01539-00001 0.29 1.65 0.41 0.52 27 <0.2 - - - - - a 3 Firelight"'(gnlles-betweentheglass) AND-N-13-01545-00001 0.24 1.36 0.41 0.52 34 <0.2 - I - - - 23 3.9 Tempered Glass-wl Grilles 1"or Greater Simulated Divided Lite or Installed Interior Removable AND-N-13-01382-00003 0.28 1.59 0.25 0.42 19 <0.2 r i - - o▪ Full Divided Lite AND-N-13-01394-00001 0.29 1.65 0.25 0.42 18 <0.2 - - - J Firelight'"(gnllesbetweentheglass) AND-N-13-01406-00001 0.30 1.70 0.28 0.48 19 <0.2 - - - - - Simulated Divided Lite or Installed Interior Removable AND-N-13-01383-00003 0.29 1.65 0.15 0.23 12 <0.2 - - - 3• . Full Divided Lite AND-N-13-01395-00001 0.30 1.70 0.15 0.23 11 <0.2 - - v, J Finelight'"(grilles-between-the-glass) AND-N-13-01407-00001 0.30 1.70 0.17 0.26 12 <0.2 - - € Simulated Divided Lite or Installed Interior Removable AND-N-13-01384-00003 0.28 1.59 0.17 0.37 15 <0.2 - - - o C Full Divided Lite AND-N-13-01396-00001 0.29 1.65 0.17 0.37 13 <0.2 N - ro J v, Firelighl'"(grilles-between-the-glass) AND-N-13-01408-00001 0.29 1.65 0.19 0.43 14 <0.2 rJ - - - Simulated Divided Lite or Installed Interior Removable AND-N-13-01381-00003 0.29 1.65 0.40 0.46 27 <0.2 - - 3• > Full Divided Lite AND-N-13-01393-00001 0.30 1.70 0.40 0.46 25 <0.2 - - 0 J as Firelight'"(grinds-between4he-glass) AND-N-13-01405-00001 0.30 1.70 0.46 0.53 29 <0.2 - - - - Y Simulated Divided Lite or Installed Interior Removable AND-N-13-01537-00003 0.24 1.36 0.24 0.41 24 <0.2 w " Full Divided Lite AND-N-13-01543-00001 0.28 1.59 0.24 0.41 19 <0.2 - 3 Firelight"'(grilles-between-the-glass) AND-N-13-01549-00001 0.27 1.53 0.28 0.47 22 <0.2 - - This information is for reference only. Data Is currant as of December 15.2014 and Is subject to change Performance varies by unit size and options selected. Page 41 of 55 See Page 1 for moreinrormabon For specific unit performance information,please contact your dealer or Andersen Sales Representative. Go Permits, LLC 105 Buttonball Lane 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 12/22/2025 - Workers Comp - #MWC 314158 23 — Exp. 10/01/24 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: renewalbvandersenAgopermits.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 Commonwealth of Massachusetts Construction Supervisor-------'1 11- , Division of Occupational Licensure / Unrestricted -Bundler,'et arry set group snitch coin Board of Building Regulations and Standards less thart 35,000 clAtc seat ow caw orators)of enclosed ,. -ns. visor trytt, 4Q ISVoe r Voce. CS-090125 • Elipires 10/06/2024 -- JAIME L MORON , .„ -; 54 tiornmoiims RAYMOND NM 030rr 4 . 4.; 'i .'e 1 i IV 1401 Failure to pees's,a currant'canon of the**assailant., _i_ $OO Building Code is cause tor revocation of this license. Ccrnmissioncr g,alita if tv.covida.k. For Information abate this license Call($in 7773200 or visit wraw.asnis govidp1 Unice of consumer AttakS and business Kegulation 1000 WashingtQrt- Suite 710 BostorifAAassacl usetts_-02118 Home Improvement C wttractor Registration m —.17— =ilii r. .„r,,,.. ,,,_, . ,;;3 Type: Supplement Card RENEWAL BY ANDERSEN LLC ''" ' ation: 170810 30 FORBES ROAD i4 ..... . =i '- E .'cation: 12/22/2025 NORTHBOROUGH. MA 01532 ... 1 ..rr+r4rM ,. Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: buoplement Gard Office of Consumer Affairs and Business Regulation Registration EXatratiot 1000 Washington Street -Suite 710 170810 12122/2025 Boston,MA 02118 1ENEWAL BY ANDERSEN LLC It. RIME MORIN t�' 'pp r. ! �"—" .0 FORBES ROAD �, 1 " " {1/d:. az-214 , ,•_-f ,-i' - --- JORTHBOROUGH,MA 0154440 / r 1,9.. Undersecretary Not valid without signature RENEWAL V r - brANDERSEN it iilry(AW.081 i DON tPt kIiiiir To Whom It May Concern This letter will authorize the following person(s) to act as agent(s) on behalf of Renewal by Andersen LLC, 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for permits and inspections with respect to the Installation, maintenance and repair of windows and entry +loons under MAccAirivisetts State Home improvement Contractor license number 1 70810 and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508 351.2277 ext 6. Authorized person(si; Go Permits LiC Sarah Hammad David Andersol Maureen Kivel Scott Doughman Ryan Rondo Sovarl,nara Kuy Mark Foster Glynn Nargan ►ennirer wirke WcnCy Hulderl Gerald Cramer Nick Rae° Darin Vickerman Stepher Wilder Katie Grocott Bonnie Myers Carrie Fobgno Michael Rogers Rachel Orloff _Aiwa k amie Morin ' Renewal by Andersen, tLC HIC 170810 CSL—05090/25 Local District Office Address 30 Forbes Rd Northborough, MA 01522 ter Andean LC 9900 tamaira kit South r G'. Page 1 of 1 AC OR/" DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/21/2023 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 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 CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd (AfC No.�- 1-877-945-7378 aC Nol: 1-888-467-2378 P.O. Box 305191 ADDRIESS: certificates@willis.ocm Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAIC• INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC --- 30 Forbes Road INSURER C: Northborough, MA 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W30224860 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER IMMIDDIYYYY) IMMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 DAMAGETO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 MWZY 314161 23 10/01/2023 10/01/2024 PERSONAL&ADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 6,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PIPITS 314159 23 10/01/2023 10/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH- PER AND EMPLOYERS'LIABILITY STATUTE ER Y/N A ANYPROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NO NIA KC 319158 23 10/01/2023 10/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ele ;/ Evidence of Insurance ��"� ��'"- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24694639 BATOl: 3138744 CC If Using a Builder DBA:RENEWAL BY ANDERSEN OF BOSTON Hannia Gonzalez&George Martin RENEWAL Legal Name:Renewal by Andersen LLC 1411 Westhampton Rd HIC#170810 Florence,MA 01062 byANDERSEN 30 Forbes Road I Northborough,MA 01532 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Property Owner Must Complete & Sign This Section If Using A Builder I, as Owner of the said property, hereby authorize Renewal by Andersen LLC to act on my behalf, in all matters relative to building permit application for the property/address indicated on this agreement. 46,v,(5_ SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Victoria O'Day Hannia Gonzalez George Martin PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 04/16/24 Page 15 / 20 Agreement Document and Payment Terms OBA:RENEWAL BY ANDERSEN OF BOSTON Hannia Gonzalez&George Martin RENEWAL Legal Name:Renewal by Andersen LLC 1411 Westhampton Rd HIC#170810 Florence,MA 01062 brANDERSEN 30 Forbes Road I Northborough,MA 01532 iw ti wAaDwi DOOR u WEILLNI Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Hannia Gonzalez& George Martin 04/16/24 BUYER(S)NAME CONTRACT DATE 1411 Westhampton Rd,Florence,MA 01062 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER 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: $6,775 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: $2,235 BALANCE DUE: $4,540 Estimated Start: Estimated Completion: 9-13w 1d AMOUNT FINANCED: $0 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Credit Card 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 04/19/2024 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. /4.4.„,„.„,_ 436,16.. _ SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Victoria O'Day Hannia Gonzalez George Martin PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 04/16/24 Page 2/ 20 •,;,�r Itemized Order Receipt N. DBA:RENEWAL BY ANDERSEN OF BOSTON Hannia Gonzalez&George Martin RENEWAL Legal Name:Renewal by Andersen LLC 1411 Westhampton Rd HIC#170810 Florence,MA 01062 byANDERSEN 30 Forbes Road l Northborough,MA 01532 rw Stan wnO =em1a10n Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 101 Livingroom Patio Door Gliding 200 Series Narroline 2 Panel Stationary/ Active, Clear Andodize Sill, Exterior White, Interior Pine, Performance Calculator PG Rating: 35 I DP Rating: + 35 / - 35 Glass,All Sash: Tempered High Perf. SmartSun Glass, Hardware, Albany, Stone, Auxiliary Foot Lock Color Matched, Screen, Gliding, Full Screen, Grille Style, No Grille, Misc, None , WINDOWS: 0 PATIO DOORS: 1 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $6,775 Co" "4 Renewal by Andersen is committed to our customers'safety by iws complying with the rules and lead-safe work practices specified by the EPA. rt = 04/16/24 Page 3/ 20 C�' Payment Authorization Form DBA:RENEWAL BY ANDERSEN OF BOSTON Hannia Gonzalez&George Martin RENEWAL Legal Name:Renewal by Andersen LLC 1411 Westhampton Rd HIC#170810 Florence,MA 01062 brANDERSEN 30 Forbes Road I Northborough,MA 01532 1 L,.hN'WINrYII/e ryh ii%e':iMiM Phone:(508)351-2200(Fax:(508)986-7072 I rbaboston@gmail.com Hannia Gonzalez George Martin BUYER NAME CO-BUYER NAME 1411 Westhampton Rd Florence ADDRESS CITY MA 01062 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 Victoria O'Day $6,775 SALES REP CONTRACT BALANCE PAYMENT SCHEDULE ($6,775) CASH DEPOSIT(1) FINANCED DEPOSIT(2) SUBSTANTIAL COMPLETION (3) CREDIT CARD $2.235 $0 $4.540 (1) CASH DEPOSIT: Renewal by Andersen requires thirty-three percent(33%)of the purchase price paid at Agreement Signing. Buyer(s)may pay through the following payment methods:cash,check,debit card,or credit card("Cash Deposit"). (2) FINANCED DEPOSIT: Renewal by Andersen requires thirty-three percent(33%)of purchase price advanced when the windows and/or doors are ordered. For Buyer(s)that receive approved financing through a Renewal by Andersen lender("Lender"),the Lender will advance this required amount directly to Renewal by Andersen("Financed Deposit"). For open-end credit loans,the Lender will not extend credit to the Buyer(s)and. For all financings,the Buyer(s)will not owe any payments until Substantial Completion(as defined in item 3 below)and the Lender has delivered the remaining balance to Renewal by Andersen. (3) SUBSTANTIAL COMPLETION: Renewal by Andersen requires the final payment(which shall be delivered by the Lender in the case of projects financed through Lenders)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 Change Orders associated with the project covered by this Agreement,the difference in the Job Amount will be reconciled in the final payment requested from the Buyer(or the Lender in the case of a project financed by a Lender)upon Substantial Completion. BY SIGNING BELOW, I/WE,THE BUYER(S): 1. Authorization for Direct Payment Via ACH: The Buyer(s) acknowledges providing Renewal by Anderson a check or designating a checking or savings bank account at a depository financial institution by providing Buyer(s)' account and routing number information for the payments listed above at Agreement Signing and Renewal by Andersen entered the account information into its payment system. Buyer(s) authorizes Renewal by Andersen to electronically debit the designated account(and, if necessary,electronically credit the account to correct any erroneous debit) based on the amount(s),form of payment(s), and timing as specified in the Payment Authorization Schedule above. Buyer(s) acknowledges that Renewal by Andersen may reattempt any payment that is returned unpaid. 2. Authorization for Card Payment: The Buyer(s)acknowledges authorizing Renewal by Anderson to apply the payments listed above to Buyer(s)' credit or debit card that Buyer provided at Agreement Signing and Renewal by Andersen entered the card information into its payment system. Buyer(s)authorizes Renewal by Andersen to charge the Buyer(s)' credit or debit card based on the amount(s),form of payment(s), and timing as specified in the Payment Authorization Schedule above. Buyer(s) acknowledges that Renewal by Andersen may reattempt any payment that is declined. 3. Buyer(s) agrees that any payment transactions that Buyer(s)authorizes comply with all applicable laws. 4. Buyer(s) acknowledges that this payment authorization will remain in full-force and effect until Renewal by Andersen has received written notification from Buyer(s)that Buyer(s) wish to revoke this authorization at least three (3) business days' prior to the scheduled payment date. For any change orders that affect the payment amount set forth above,Renewal by Anderson will notify Buyer(s) of the payment amount that will be debited or charged at least ten (10) calendar days prior to the transaction date. ,6/66.5. Hannia Gonzalez 04/16/24 BUYER NAME SIGNATURE DATE 04/16624 Martin 04/16/24 Page 4/ 20 CO-BUYER NAME SIGNATURE DATE