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38B-277 (11) BP-2024-1004 27 REVELL AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-277-001 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-2024-1004 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2024 Contractor: License: Est. Cost: 13036 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: WERTH, BARRY A.&GOOS, KATHY J.TRUSTEES Lot Size(sq.ft.) Zoning: URB Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC314158 NORTHBOROUGH, MA 01532 ISSUED ON: 08/12/2024 TO PERFORM THE FOLLOWING WORK: 5 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: 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: 170 Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED The Commonwealth of Massachusetts AUG 1 2 Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR MUNICIPAL,I YrE DEPT.OF GUY OM(VsVU TI Building Permit Application To Construct,Repair,Renovate I ?= �1 . A • t rl� / One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: dag_f 9-f 7 C l Date Applied: STZTW / -/2-2.y BuildingOfficial Name) lure Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers a� ft Mil 14vc 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(d) 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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: owrvv Mor4'Inar,wrrien P4A O IOl,o Name(Prow) City,State,ZIP as4 Ewa Ave. 41 -/44 a w Gv l cAmc 4a4..m 4 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(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 C'1'Specify: (eptAGe.n.►Tf rr;AA..r Brief Description of Proposed Work': Qswtvve akotet rtrl..ct 5 fw wi}I� Ao s tvuc. l . .s SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ l3,G .0 6 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:$ Check Nq '1€(OCheck Amount: UP Cash Amount: 6.Total Project Cost: $ ,0 06 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 010 LAS /0/04/Ay Ih( L t" r r h License Number Expiration Date Name of CSL Holder NN,, fovbc.S ►�-A List CSL Type(see below) No.and Street Type Description Norm o�S 3' U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State, R Restricted I&2 Family Dwelling • M Masonry RC Roofing Covering Window and Siding SF Solid Fuel Burning Appliances S40-4S2-'ill7l rbieumlbyov►dtrsen Psoper,_!; I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) r�V ��;( ft/0 (� laS 12,coet��l Y�/ An - HIC Registration Number Expiration Date HIC Company Narhe or HIC Registrant Name 30 Gevbc} fZd r le bitjaz.I iq•�ace No.and_�Street .�/l Email address .� Nwii+btveo0h tfill O153 %4,a '.S?. (ins 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.......... t'+� No...........O 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. Pilaw I aC ( pp:c4] $/$Iay Print Owner's or Authorized Agent's me(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 infonnation on the HIC Program can be found at www.ma%..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 Massachusetts �s `x I It y F fi 4` DEPARTMENT OF BUILDING INSPECTIONS y ,' 212 Main Street • Municipal Building A Northampton, MA 01060 fly 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: 30 FovLjLS rUorThiCo,ro id() "1 A 01539, The debris will be transported by: Name of Hauler: Y1et irk\ 10,1 NIL/5 01\ Signature of Applicant: Date: gPN ay The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ici= Lafayette City Center 1 ` k2 Avenue sate Lafayette, Boston,MA 02I1I-1750 �� WPM.mass.gov/dia Workers'(:ompcnsation Insurance Affidas it: Builders/Contractors/Electricians/Plumbers Applicant Information Pkase Print Legibly Name(Bus ne..Ornanizatic Individual): Renewal by Andersen Address: 30 Forbes Rd. CityiState/Zip:Northborough, MA 01532 .__ Phone #: 607=966-0412 , Are you an employer?('heck the appropriate hos: type of project(required): 1.ig lam a employer with 34 4. ❑ lam a general contractor and 1 employees(full and/orpart-timc).* have hired the sub-contractors 6 ❑ Nos construction 2 El I am a sole proprietor or partner. listed on the atlacl>•d sheet. 7_ ❑Remndelir� slip and have no employees These subcontractors have g. ❑Demolition working for inc in any capacity. employees and have workers' 9. El Building addition [No workers'comp.insurance comp. insurance.* required.) 5. r] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myselfworkers' righexemptionper t of MGL [No comp. 12.0 Roof repairs insurance required.I c. 152.*1(4),and we have no ertlet>t employees. [No workers' 13]$[Other R � comp. insurance required.) *Any applieam that chocks box a 1 must aiw fill out the swim below showing their worker"compensation pokey lafmmatio►. 1 Eionuownen who*Omit this affidavit Indicating they are d..ing all work and then hies outside contractors must submit a new.affidavit indicating such. tComtactc,r%that check ibis box must atiaehe d an additional sheet iJtowtnii the name Le-the subcontractor-.and state whether or not those entities has: employee, If the.uh-contractor,hiss cnrployit+.they mu-st pros tdc ihcir workers'comb,polies riwnb r. I am an employer that is providing workers'compensation insurance for my employeel.. Mow is the policy and job site information. ln.uranrc t ompam 'game: Old Republic Insurance Co. Policy#or Self-ins. Lic./l b: MWC 314158 22 Expiration Date:1�1�24__ Job Site Address: dtl- I24 r VG(I !At. C'ityyStatelxip: Nor{11ivh1lorl iMJ)O10 to D Attach a copy of the worker'compensation policy declaration page(show ing the policy member and expiration date). Failure to secure coverage as required under Section 25A of MC;L e. 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and'or tine-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S2S0.00 a day against the violator. Be advised that a copy of this stateifl nt 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 perjure'that the information pro i'ided abase is true and correct. Signature )014,44IL Date: / [1/ Phone#: cic(tG _ a5? 4 bq Official use only. Do not►suite in this area,to be completed by city or toien official. ('it♦ or Iowa: Permit License it Issuing Authority ichrck one):1❑Board of Health 20 Building Department 30CitytTown Clerk .i.❑Ekdrical Inspector 5O'lumbing Inspector 6.0other Contact Person: Phone r: U.B. Canada ENERGY ENERGY rc 3 STAR STAR Andersen• Andersen NFRC Certified7. 10 v 6.0 v 4.1 Product Line& Glass GritTyp9 Product 'tt�� g Product Type Typa Directory Number 3 $ fifi Z 40 22 Annealed G1aw-w!No Grilles and Gress Law Than 1• No WSW N 41410409N•00041 126 1.06 0.32 0.66 22 <02 - NC - - - - - 4. annulated Divided Lib or lneWNd Interior Raniovabb AN0.N-00-00648.00002 1129 1.46 0.29 0.49 20 <0.2 - NC - - - - - Full Divided Live AN611d9-00066-00001 031 1.76 029 0.49' 17 <02 - -l _ - -_ • FInel9ht"(Ordles-betr,e•n-theglaa) AND-N-0a-00017.60001 0.30 1.70 020 0.49 19 <02 - NC _ _ _ No(Iris AND-M•40.0090900001 030 1.70 029 0.30 14 <02 - MC Se - - - c Swill dad WSW Live or leati0sd Inferior Pams. M AIID•N-4r00900M002 920 1.70 0.10027 12 <02 - NC >1C - - s} Full Divided LJY MD-N-0 1000900.01001 0.31 1.711 0.10 027 11 <02 FInvlgM"VOA=&Si sae) - _... _ - NlU-1(�1-0p040-06001 0.31 1.70 01E 0.27 11 <,.2 - - - - . - No Gnlle• ANDN-69-00651-00001 0.21 1.65 0.21 0.49 15 <0.2 . NC SC - - t W Simulated DMded Lite or Installed Interior Ramoveble AND-N.59-00851-00002 0.29 1.6ti 0.19 0.44 14 <0.2 • NC tl� - - - Foil Divided life AN044-59-00657-00001 0.30 1.70 0.10 0.44 13 <0.2 w- NC IC - - FM•bgivl 19m1e+-Miw..n.negyee) A/IDJld9-00SMM111 0.30 1.711 s19 044 13 <0.2 - NC • - - - 1111amw- -- •.A-. ..,...- v. -' . - - 21 ii Simulated Divided Lib 0011eta1ed IntrIor Rw ersebl• Mp•N-01.0004600002 0.302 1.70 OAT 0.04 <12 N Z1 it - Ufa Divided U MID44-0600164.00001 031 1.76 0.47 0.64 24 <02 Z1 u , FInelight"(9rl Iles-bet eeMMglaeat AND•Nd9-00060-00001 0.31 1.70 0.47 0.64 26 <02 - - - 21 - _ / No Grilles AND41-69-00969-00001 0.0 tee 0.31 0.54 22 <02• _ MC _ y 6imulated DN9d the e or InateN .. b d ed Wirier fl_ ANO-N1001M0 1.A 40 0002 029 020 0. 21 <0.2 NC 11 Full D ed ivid UN ANDai•6P001 -N 72001 02tt ISO 021 0.41 21 <0.2 y 9y - NC - Z1 - - • Fineugnt`•(9r9MabetNeen•10e•lies) AND-u•00-0017600001 020 1.61 0.21 0.40 21 <61 - NC • 21 • _ 1 No Galles A21D41-60-0097900001 0.21 1.00 021 0.41 17 <03 - NC SC 21 - - .• Simulated DMded Lite or Installed Interior Removable AN04I-69-00970-00002 024 110 0.19 0.43 10 <02 - NC a1.' - - - n 200 Series - E = Full Divided Use ANDa460-00973-1001 026 1.50 0.19 0.43 15 <02 - NC SC - • - Tilt•Wash 3 Double-Hung Flnetgt'•( seee'beedeenthe.re) MIO*000017001001 021 131 0.19 6A3 15 <12 - NC SC - - - ! No G•Ilea NMM O001 026 1A4 0.40 SAS0. 36 <0.2 N - 21 23•Y y SYsrdMd Divided Lite or Yst•IM h d b pr rtor tgvaDte AIO.11A0011 6010�2 0 02t{ 1A/ 0A3 0.02 <3.2 N w • = Full Divided LiteLit AN6JL0603071J1001 029 1.16 0.43 1.52 ed 932< N - 21 Flnelght" b M(9rIlleetws. heylase) AIIOM4- 00177.10001 029 1.40 0.43 0.12 26 <1.2 N - _ _ Z10- - 2.2 Annealed Glass-wi Chines 1"or Greeter &mulcted Divided Lib or Installed Interior Removable ANC 029 1.46 021 0413 10 <02 - NC - - - - - Y .,1 AFull Divided Ulm ANDJ446.0901-00001 0.30 1.70 0.211 0.43 17 <02 - NC - - - - - F1na49ht"(9rIllea•baaeaar►Owg .) ANDai-660017100001 631 1.76 029 0.49 17 <0.2 • -I, • - - - Simulated Divided Ute or InstSad interior Removable AND-N-50d0650-00003 630 1.70 0.11 0.24 11 <02 - NC IC - - - 1 N Full Divided Lite AND4/36-00602-00001 0.31 1.70 0.14 0.24 10 <02 - - - • - Firwllght"(grilles•behwen-pro-plan) AID-N-01-000/400001 132 1.02 0.10 027 10 402 - - - 3 - - - / Simulated Divided LIb or Installed Interior Rem ovebl• AMD41-0600161-00003 021 1.06 0.17 0.39 13 <02 • NC SC - `j 1 {1 Full Divided Lie AIDN- -51 0010J1001 4.30 1.70 0.17 0.39 12 <02+- ^NC SCR - - `�.. Floelphl"(9r01aabdaeen4hosboa) A4D-N•01-00f/1.11001 0.31 1.70 0.11 5.44 12 <12 _ _ _ _ Ifs Slmldabd Divided UI or bstslbd interior Reenovebb ANO-NdP•00146M003 0.30 1.70 0.42 M7 24 <0211:1 _ _ 21 _ _ 1 - - Full LJte ANU-N-0I-0OMPg001 0.31 1.74 OA2 M 26 <12. Z7 Flnslght"(OAIWbe0ween4h►gWe) AND-Na000672-00001 032 1.12 0A7 0.54 27 <L2 ,, - . •f • 21• _ _ y Simulated DMded Lite or lnMdlod Wrier Removable AND-N-60-0096100003 024 1.60 026 0A2 /9 <02 - NC SO Full Divided die ANPNd1-0017601001 012 1.50 026 0.42 16 <02 NC AC Z1 ifFlneap/rt"torIbia'baaeean41eW M 9e) ANO-N-69.001-00001 an 1.51 020 OAS 21 <02 - NC • - 21r , - - r '1' / N Simulated Divided Lib or Ineie9ed bb ro rlor Rerrvabb AND-N-6L0067000003 025 LSI 0.17 0.36 14 <0.2 - NC - - f Full grl Me ded L AND4ty9-00976-00001 020 1.30 0.17 0.30 14 <p1 - NC SC ' - - - 999 fill IIFlrn00M"(pr*NesbeOaean•Mglees) ANDr/-00-00062i0007 021 1.00 0.19 0.43 16 <02 - NC SC _ - _ This information is for reference only. Performance vanes by unit size and options selected. Page 2of16 o•remmeerdD•o•rOr15.701< arsebMugs Iles Dem'ter wee raamnrim For specific unit performance information, please contact your dealer or Andersen Sales Representative. Go Permits, LLC 105 Buttonball Lane GO_ 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: renewalbyandersenggopermits.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 Supervisor111 T_ - Division of Occupational Licensure Unrestricted-Susldrsps of err/use group which contain Board of Building Regulations and Standards less than 31,000 cubic feet(WIcubic meters)of enclosed Const venom' tpervisor Vacs CS-090125 ti 15:spires: 10/06/2024 JAIME L MOligN $4 NOTTINGWiAM -" RAYMOND Nll ;;4 IiO ,,00 nnpl L%dt1'3.3 Falters to possess a cwmnl edition of the Massachusetts C.......,...or.M i7tq.�q 4 grat a. Style Building Cods is cause for evocation d thee license. vv For utlormitlan about this tcense Cal(tin T71-32W or visit www.wus.govMpi Unice of consumer Attatls and business Kegulation 1000 Washingtq t- Suite 710 Bostorh.-Massachusetts 02118 Home Im ro ;.i=•=►. i.L"'ractor Re istration CA 'r �` r,, Type: Supplement Card ro .....�.-- ice: anon: 170810 RENEWAL BY ANDERSEN LLC (n ""' . E 30 FORBES ROAD '____ �ation: 12/22/2025 NORTHBOROUGH,MA 01532 �.0 y M/NM/S, .e 1 , ••=1„,' 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:Supplement Card Office of Consumer Affairs and Business Regulation RAILI Expiration 1000 Washington Street -Suite 710 170810. _ J 12/22/2025 Boston,MA 02118 2ENEWAL BY ANDERSEN LW, IAIME MORIN �.� —a E% ylrd 'r t0 FORBES ROAD t'`. `_ r2i C• tiv«J.to�. Lii.��YL� '_ 4ORTHBOROUGH,MA 01532 Undersecretary Not valid with6ut signature )57 byANDERSENENL` �tus��111N1�rtAolitli'U�t To Whom It May Concern' This letter will authorize the following personls) to act as agent(s) on behalf of Renewal by Andersen 11C, 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 Actors 1.n-trier Maccarhusetts State Home Improvement Contractor license number 170810 and Cort truttion Supervisor License number CS-09012S. If you have any questions, please call me at 508,351.2277 ert 6. Authorized person(s): Go Permits LLC Sarah Hammad David Anderson Maureen Kivel Scott Doughman Ryan BFondo Sovannara Kuy ivlark Faster Glynn Norgan Jennifer W ink e Wendy Holden Gerald(tamer Nick Rago Dane!Vickerrnan Steaher Wilder Katie Grocott Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff 1` ) -Jamie Morin Renewal by Andersen LLC HIC 170810 CSl—CS090125 Local District Office Address 30 Forbes Rd Northbornuen, MA 0153 2 enswat by Andersen LLC 9900 lamairs Ave South,Commie Grave MN 55G16 Page 1 of 1 ACORO® 09/21 CERTIFICATE OF LIABILITY INSURANCE D /DDIYYYY) 9/21/2023 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 PHONE Es* 1-877-945-7378 (A/C,No);E4AA 1-888-467-2378 P.O. Box 305191 _ADDRESS; certificates((xillis.con Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC INSURER A: Old Republic Insurance Congany 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 SUER POLICY EFF POLICY EXP LIMITS LIR INSD WVD POLICY NUMBER ,IMMIDDIYYYYI IMMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I S 3,000,000 CLAIMS MADE x OCCUR DAMAGE TO RENTED500,000 PREMISES_1Ea occurrence) _ A MED EXP(Any one person) S 10,000 )IIZY 314161 23 10/01/2023 10/01/2024 PERSONAL 4ADVINJURY i 3,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 6,000,000 X POLICY -1 JPERa LOC PRODUCTS-COMP/OP AGG S 6,000,000 OTHER. 5 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Es saMent) X ANY AUTO BODILY INJURY(Per person) S A OWNED ' SCHEDULED I$TB 314159 23 10/01/2023'10/01/2024 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED � NON-OWNED 'PROPERTY DAMAGE S AUTOS ONLY _AUTOS ONLY (Per acddent) S UMBRELLA LIAB OCCUR EACH OCCURRENCE _ S EXCESS LIAB I CLAIMS-MADE AGGREGATE S _ [ DED RETENTIONS S WORKERS COMPENSATION X PER OTlt- AND EMPLOYERS'LIABILITY STATUTE_ ER YIN A ANYPROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 n NIA 154C 314158 23 10/01/2023 10/01/2024 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S II yes.descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIAR S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II 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 J Evidence of Insurance `r't"A 4'^ n 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD OR ID: 24694639 1'AT•11 3138799 - .. RENEWAL y byANDERSEN f hit SERHCE MAMDOW 8 DOOR REPIA(EAIEMf 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 dba:RENEWAL BY ANDERSEN OFBOSTON Barry Werth&Kathy Goos Legal Name:Renewal by Andersen LLC I license♦HICB 170810 2/Revell Ave. RENEWAL 30 Forbes Road I Northborough,MA 01532 Northampton,MA 01060 by ANDERSEN Phone:(508)351-2200 I Fax:(508)986-7072 I H:(413)588-1992 KR.urea NWI1 Oftl4P 1.de RbABostonOrderingOandersencorp.com Measure Tech:Charles Faust,(978)868-6358 Installation Package 27 Revell Ave. Northampton, MA 01060 PRODUCTS: 5 WINDOWS: 5 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 Updated 7/26/24 BUYER REPRESENTATIVE Barry Werth & Kathy Goos Matthew Pelletier 27 Revell Ave. (774)303-7850 Northampton, MA 01060 matthew.pelletier@andersencorp.co H: (413)588-1992 m Year Built: 1900 TECH MEASURE barrywerth@comcast.net Charles Faust Est. Duration: (978)868-6358 charles.faust@andersencorp.com dba:RENEWAL BY ANDERSEN OF BOSTON Legal Name:Renewal by Andersen LLC I License 8 HICB 170810 30 Forbes Road I Northborough,MA 01532 Phone:(508)351-2200 I Fax:(508)986-7072 I RbABoston0rderin gOandersencorp.com Measure Tech:Charles Faust,(978)868-6358 07/26/24 Page 1 / 10 Order Summary dim RENEWAL BYANDERSEN OF BOSTON Barry Werth&Kathy Goos Legal Name:Renewal by Andersen LLC I License•HICS 170810 27 Revell Ave. RENEWAL 30 Forbes Road I Northborough,MA 01532 Northampton,MA 01060 brANDERSEN Phone:(508)351-2200 I Fax:(508)986-7072 I H:(413)588-1992 RbABostonorderingeandersencorp.com Measure Tech:Charles Faust,(978)868-6358 IDk ROOM SIZE DETAILS JOB 101 Kitchen 32" 50" Window: Acclaim TM Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 31-1/2' 48-7/8' Traditional Checkrail, Exterior White, Interior White Performance Calculator: PG Rating: 40 1 DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: White, Standard Color Recessed Hand Lift Screen: Fiberglass, Full Screen Grille Style: Interior Wood Only (INTW) Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille Misc: None Construction: Interior stops 4-sides (1), LSWP Windows (1) Material: None Sill Angle: 14° 102 Kitchen 32" 50" Window: AcciaimTM Double-Hung (DG), 1:1, Slope Sill, Insert Frame. 31-1/2' 48-7/8" Traditional Checkrail, Exterior White, Interior White Performance Calculator: PG Rating: 40 j DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: White, Standard Color Recessed Hand Lift Screen: Fiberglass, Full Screen Grille Style: Interior Wood Only (INTW) Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille Misc: None Construction: Interior stops 4-sides (1), LSWP Windows (1) Material: None Sill Angle: 14° 103 Kitchen 32" 50" Window: Acclaim1M Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 31-1/2" 48-7/8" Traditional Checkrail, Exterior White, Interior White Performance Calculator: PG Rating: 40 I DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: White, Standard Color Recessed Hand Lift Screen: Fiberglass, Full Screen Grille Style: Interior Wood Only (INTW) Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille Misc: None Construction: Interior stops 4-sides (1), LSWP Windows (1) Material: None Sill Angle: 14° 07/26/24 Page 2 / 10 Order Summary �.„ . �r dba:RENEWAL BY ANDERSEN OF BOSTON Barry Werth&Kathy Goos l egal Name:Renewal by Andersen LLC I License a HIC#170810 27 Revell Ave. RENEWAL 30 Forbes Road I Northborough,MA 01532 Northampton,MA 01060 byANDERSEN Phone:(508)351-2200 I Fax:(508)986-7072 I H:(413)568-1992 •i VIM"m.axw.u,11r RbABostonorderingOandersencorp.com Measure Tech:Charles Faust,(978)868-6358 ID# ROOM SIZE DETAILS 104 Kitchen 32" 50" Window: Acclaim"' Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 31-1/2" 48-7/8" Traditional Checkrail, Exterior White, Interior White Performance Calculator: PG Rating: 40 I DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: White, Standard Color Recessed Hand Lift Screen: Fiberglass, Full Screen Grille Style: Interior Wood Only (INTW) Grille Pattern: Sash 1: Colonial 2w x ih, Sash 2: No Grille Misc: None Construction: Interior stops 4-sides (1), LSWP Windows (1) Material: None Sill Angle: 14° 105 Kitchen 37" 37" Window: Acclaimno Double-Hung (DG), 1:1, Slope Sill, Insert Frame, 35-1/2" 36-7/8" Traditional Checkrail, Exterior White, Interior White Performance Calculator: PG Rating: 40 ; DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: White, Standard Color Recessed Hand Lift Screen: Fiberglass, Full Screen Grille Style: Interior Wood Only (INTW) Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille MIsc: None Construction: Interior stops 4-sides (1), LSWP Windows (1) Material: None Sill Angle: 14° PRODUCTS: 5 WINDOWS: 5 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 Updated 7/26/24 JOB NOTES LSWP 5 inserts going into Andersen split jambs,all in the same room, all on the first floor. L trim outside and new scotia stops on the interior. Nice easy install! Please call or text me when the project is complete or if you have any questions, Charles 978-868-6358. Also, please let the homeowner know that they will receive a survey about YOUR work today and you want to make sure that you earned a "10" on the first question "Would you recommend?". Please correct anything that would earn you less than a 10 on the first question. Also, and this is very important, I need to know ASAP if for any reason if the job can NOT be a First Time Through(FTT). Also, I need to know if any extra labor or materials are needed. No extra extra labor, mileage or materials will be paid unless you call me as soon as you notice any shortage at the start of the project. Basically, if you can't do the job as described in the install package, I need to know before you discuss the project with the customer. Please call or text me when the project is complete or if you have any questions, 07/26/24 Page 3 / 10 Docusign Envelope ID:08E5E81C-65EC-4A3C-9E63-3F84CD76BD62 • .47 Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF BOSTON Barry Worth&Kathy Goos Legal Name:Renewal by Andersen LLC 27 Revell Ave. RENEWAL HIC#170810 Northampton,MA 01060 brANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)588-1992 Wl'.FMi MIJ:"t DY}gq/,(I W t1 Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonbooking@andersencorp.com Barry Werth&Kathy Goos 07/24/24 BUYER(S)NAME CONTRACT DATE 27 Revell Ave., Northampton, MA 01060 (413)588-1992 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER barrywerth@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: $13,036 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: $4,301 BALANCE DUE: $8,735 Estimated Start: Estimated Completion: 8-12 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: 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: Buyers)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 07/27/2024 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. �L� DocuSigned by: DocuSigned by: (1�1t Vf{� Gees 49A438428 -- 9593BaFB SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Matthew Pelletier Barry Werth Kathy Goos PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 07/24/24 Page 2/ 23 Docusign Envelope ID 08E5E81C-65EC-4A3C-9E63-3F84CD76BD62 p� Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Barry Werth&Kathy Goos Legal Name:Renewal by Andersen LLC 27 Revell Ave. RENEWAL R EN A L HIC#170810 Northampton,MA 01060 byASEN 30 Forbes Road I Northborough,MA 01532 H:(413)588-1992 Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonbookIng@anderscncorp.com IDN: ROOM: SIZE: DETAILS: PRICE: 101 Kitchen Window: Acclaim'" Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator: PG Rating: 40 I DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Recessed Hand Lift, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille, Misc: None 102 Kitchen Window: Acclaim'" Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator: PG Rating: 40 I DP Rating: + 40/ - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Recessed Hand Lift, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only(INTW), Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille, Misc: None 103 Kitchen Window: Acclaim'" Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator: PG Rating: 40 I DP Rating: + 40/ - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Recessed Hand Lift, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille, Misc: None 07/24/24 Page 3/ 23 Docusign Envelope ID:08E5E81C-65EC-4A3C-9E63-3F84CD76BD62 6� "` Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Barry Werth&Kathy Goes RENEWAL Legal Name:Renewal by Andersen LLC 27 Revell Ave. RENEWAL HIC#170810 Northampton,MA 01060 m,MO bY ANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)588-1992 Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonbooking@endersencorp.com ID#: ROOM: SIZE: DETAILS: PRICE: 104 Kitchen Window: AcclaimTM Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator: PG Rating: 40 I DP Rating: + 40 / - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Recessed Hand Lift, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille, Misc: None 105 Kitchen Window:AcclalmTM Double-Hung(DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator: PG Rating: 40 I DP Rating: + 40/ - 40 Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Recessed Hand Lift,Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only(INTW), Grille Pattern: Sash 1: Colonial 2w x 1h, Sash 2: No Grille, Misc: None WINDOWS: 5 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $13,036 • 0Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 07/24/24 Page 4/ 23 Docusign Envelope ID:08E5E81C-65EC-4A3C-9E63-3F84CD766D62 Payment Authorization Form NIN DBA:RENEWAL BY ANDERSEN OF BOSTON Barry Worth&Kathy Goos Legal Name:Renewal by Andersen LLC 27 Revel Ave. RENEWAL Well R EeWell170810 Northampton,MA 01060 ANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)588-1992 Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonbookIngeandersencorp.com Barry Werth Kathy Goos BUYER NAME CO-BUYER NAME 27 Revell Ave. Northampton ADDRESS CITY MA 01060 (413)588-1992 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 Matthew Pelletier $13,036 SALES REP CONTRACT BALANCE PAYMENT SCHEDULE ($13,036) CASH DEPOSIT(1) FINANCED DEPOSIT(2) SUBSTANTIAL COMPLETION (3) CREDIT CARD $4,301 -(! $8,735 (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. DocuSigneerdd I E'by: Barry Werth O3t.Vft���I - 07/24/24 1A49A49B429 BUYER NAME SIGNATURE DATE -- -------- - (- I D�'/uchne by- 07/24'2400S \ �S 07/24/24 Page 5/ 23 _ -A2450 �59593B4F8 CO-BUYER NAME SIGNATURE DATE