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R�1"lew "' Renewal by Andersen Corporation MA Home Improvement Contractor
byA dersen 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015)
wuaoovr H£TLACEMEgd ==°'=d��"'`""""" (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
Buver(s)Name Date of Agreement
JIM SCHUMACHER TUE, SEP 23, 2014
The buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms
described on the Specification Sheet and the Ihont and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT,of which the Specification Shat is part.
WINDOW DETAILS
Approx. Exterior/Interior Color Hardware Hardware L—E4/ Grille Grille Glass
asi
Room k U.I. Window/Door Style Detail Cn s Ext-Int Color S le Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts Options
Sunroom 2 89 AN insert No TT/TT Stone Standard FFG Low-E4 None ----- ----- ----- No
Sunroom 1 168 New GT insert 1:2:1 No TT/rT Stone Standard FFG Low-E4 None ----- ----- ----- No
Living 1 157 CT 1:2:1 insert No TT/PN Stone Standard FFG Low-E4 None ----- ----- ----- NO
Total 4 BAY&BOW DETAILS *See Bay/Bow Measure Sheet
Style Detail/ Approx. Approx. Number Frame Window End Center LowlE/ Roof/ Hardware
Room Count S le Flankers U.I. Casin s An le Lites Interior Ext/Int Color Grilles sashes sashes Screens Smartsun Soffit Color
SPECIALTY WINDOW DETAILS
Full/ Approx. Lowe/ Specialty BAY/BOW ADDITIONAL WORK NOTES
Room Count Style Insert U.I. Smartsun Grilles Grille S le Ext/Int Color Cuvmmer Iv:,w;,n thm with bo-/brnv windows under 72 Inches
dime will be si ntilteum list love.
ADDITIONAL WORK DETAILS:
I No Contractor will wrap exterior casin s with coil stock color of
Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments/hardware.It is the
responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to
2 V. whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the
amount will be dependent on the type of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.
Customer is aware and understands any and all unseen rot is not included in this contract.Should any rot be found there will be an additional charge for
time and materials unless so stated in this contract.
3 yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris,
windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
I Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permit(s)is not included in the Contract Price and a separate
check is required at the time of sale for this fee. Check# 5475 $ 35
yes All discounts have been applied to this agreement.
t> ✓ Ye, No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CGS'1'O.Nt tVINDOW AND DOOR Rl"MODEI.ING AGREE,NIEN't,constitutes the
entire understanding between the parties,and there arc no verbal undeis(andings changingoi modifying any of the terms. 'This Specification Sheet may not be changed or its terms
:modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and Cron u'actor. Bocci(s)hereby acknowledge That Buyer(s)has read this Specification
Sheet.
`.Renewal by Andersen Corporation $uycr(s) Buvcr(s)
,761rL lk'Yi _
Signature of Project Manager � Si natur � Signature
JAMES HALLORAN JIM SCHUMACHER
Print Name of Project Manager Print Name Print Name
RetlE'Wal MA Home Improvement Contractor
IDAndeirs n. Renewal b Andersen Corporation
License#170810(Expires 12/23/2015)1
w,NOOw aeriacex,rxt :;,,•.;,,.,..:,,',�„ y Federal Tax ID#41-19184131
104 Otis St. Northborough.MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name Date:
JIM SCHUMACHER - SEPTEMBER 23,2014
Buyer(s)Street Address City State Zi e Code
21 WEST PARSONS LANE FLORENCE MA 01062
Email Address Home Telephone Number Work/Cell Telephone Number
DRSCHU @COMCAST.NET 413-584-4727 413-210-3322
Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor"),in accordance with
,the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement").
;Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Est.Start Date Method of Payment
Total Job Amount $ 12.026.00 Amount Financed$ 0.00
Deposit Received(33%)$ 4,008.67 Check/Cash
10-12 weeks
Balance Start of Job(33%)$ 4,008.67 Deposit at signing$ 0.00 Check#
Balance on Substantial At Substantial Est.Install Time Credit Card
Completion of Job(33%)$ 4,008.67 Completion$ 0.00
1-2 days If credit card is selected,please
see Credit Card Payment form
i[Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
:changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent
of both 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
;Renewal by Andersen Corporation Buyer(s) Buyer's)
By:
�tmr ; a�<<�icta
Signature of Project Manager Sig e Signature
JAMES HALLORAN JIM SCHUMACHER
Printed Name of Project Manager Printed Name Printed Name
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
_____________________________________ ______________________________________i
NOTICE OF CANCELLATION NOTICE OF CANCELLATION
I
I
Date of Transaction D/2:31 It You may cancel this I Date of Transaction 4/13/11 You may cancel this
transaction,without any penalty or obligation,within three business days from the 1 transaction,without any penalty or obligation,within three business days from the
f above date.If you cancel,any property traded in,any payments made by you under I above date.If you cancel,any property traded in,any payments made by you under
k the Contract of Sale,and any negotiable instrument executed by you will be i the Contract of Sale,and any negotiable instrument executed by you will be
,returned within 10 days following receipt by the Contractor("Seller")of your I returned within 10 days following receipt by the Contractor("Seller")of your
cancellation notice,and any security interest arising out of the transaction will be I cancellation notice,and any security interest arising out of the transaction will be
canceled. If you cancel,you most make available to the Seller at your residence,in I canceled. If you cancel,you most make available to the Seller at your residence,in
substantially as good condition as when received,any goods delivered to you under I substantially as good condition as when received,any goods delivered to you under
this Contract or Sale;or you may,if you wish,comply with the instructions of the I this Contract or Sale;or you may,if you wish,comply with the instructions of the
:'.Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seller regarding the return shipment of the goods at the Seller's expense and risk,
`If you do make the goods available to the Seller and the Seller does not pick them up I If you do make the goods available to the Seller and the Seller does not pick them up
within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available I of the goods without any further obligation. If you fail to make the goods available
to the Seller,or if you agree to return the goods to the Seller and fail to do so,then i to the Seller,or if you agree to return the goods to the Seller and fail to do so,then
you remain liable for performance of all obligations under the Contract.To cancel I you remain liable for performance of all obligations under the Contract.To cancel
this transaction,mail or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a signed and dated copy of this cancellation notice
or any other written notice,or send a telegram to Contractor:Renewal by Andersen,I or any other written notice,or send a telegram to Contractor: Renewal by Anders
104 Otis St. Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF I 104 Otis St.Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF
.(D..) I HEREBY CANCEL THIS TRANSACTION. .(Date) I HEREBY CANCEL THIS TRANSACTION.
I
Buyer's signature Pnnl Name Date Buyers Signature P&I Name Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
�= Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip: NORTHBORO, MA 01532 Phone #: 508-351-2200
Are you an employer? Check the appropriate box: Type of project(required):
1.N I am a employer with 30 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. R Remodeling
ship and have no employees These sub-contractors have g
❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions
officers have exercised their
3. I am a homeowner doing all work o 11.❑ Plumbing repairs or additions
myself. k ' right of exemption per MGL
y �o workers' comp. 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name:OLD REPUBLIC INS. CO.
Policy#or Self-ins. Lic. #,:M`WC 30293800 / Expiration Date: 10/01/15
Job Site Address: rL l W %_rse)A�, L, City/State/Zip: yL.�c, 0(()(E, a
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do here r /y nder the pains and penalties of perjury that the information provided above is true and correct
Si ature: Date:
Phone#: 508-351-2200
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: JAIME MORIN 90125
License Number
86 GARD E ST. LYNN, MA 01905 10-06-16
Address Expiration Date
G 617-966-0412
Signature Telephone
9.Realstered Home Improvement Contractor; Not Applicable ❑
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 FORBES ROAD NORTHBORO,MA 01532 12-23-15
Address Expiration Date
Telephone 508-351-2214
SECTION 10-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....... No...... ❑
11. .. Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780 Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors Z3
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [o] Other[dj
Brief Descri tion of Proposed
Work: RPPLACE 4 WINDOWS - NO STRUCTURAL CHANGE
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes XNo
Plans Attached Roll -Sheet
6a.if New house and or addition to existing,housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
JIM SCHUMACHER as Owner of the subject
property
hereby authorize JAIME MORIN
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
JAIME MORIN as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
JAIME MORIN
Print Name
10-07-14
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: __ L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW C j YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
L�
Department use only
OCT "8 2014 ity of Northampton Status of Permit:
ilding Department Curb Cut/Driveway Permit
Plumbing R C;.. - '_.
212 Main Street Sewer/Septic Availability
E1RCtric
Nor ha r-- - ons Room 100 Water/Well Availability
Northampton, MA 01060 TwP Sets of Strubturai f-As-
phone -
413-587-1240 Fax 413-587-1272 P161118-te Plan
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
21 WEST PARSONS LANE Map Lot Unit"
FLORENCE, MA 01062 Zone Overlay District
Elm St,District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
JI SCHUMACHER 21 W. PARSONS LN FLORENCE, MA 01062
Name(Print) Current Mailing Address:
413-584-4727
Telephone
Signature
2.2 Authorized Agent:
JAIME MORIN 30 FORBES ROAD NORTHBORO, MA 01532
Name(Print) Current Mailing Address:
508-351-2214
Signature Telephone
SECTION 3-ES ATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building $12,026.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) $12,026.00 Check Number V6,01TWel -20535
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
21 WEST PARSONS LN BP-2015-0413
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-266 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2015-0413
Project# JS-2015-000742
Est. Cost: $12026.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sq. ft.): 39988.08 Owner: MANGIONE LORRAINE
Zoning: Applicant: RENEWAL BY ANDERSEN
AT. 21 WEST PARSONS LN
Applicant Address: Phone: Insurance:
30 FORGES RD (508)919-0900 WC
NORTH BOROMA01532 ISSUED ON.1019120-14 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 4 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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/9/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner