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