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02-019 (10) re of ' ri�Re af'urosasrX , Wood/.Vnyl Composite Frame Dual Argon Low E Awning . RES97- ENERGY PERFORMANCE RATINGS U-Factor.O.S)/I-P Solar Heat Gain Coefficient 0 . 33 0 . 30 1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 Manufacturer Stipulates that the so rodny►conforin Ilk applicable NFl1c procedures for otrmininp wgol•prbdad pmrfomunce.NFRO ratings of dotamiuvd for afood set*(imfronmanrf Conditions and a•pocdic product dts.NFAC doom not r coexoend any produm and does not warrant the so IA04y of any product for any spooft us•.coneutt manufactureeo literature for other omevct performance k"mulbn. asww.nMO. . 1 1 , DESIGN PRESSURE(PSF) r Ilnmaacrm.dCrniolsn AP-LC25 100-00. 228615-001 new. wt Me l•or mace ado M.E.C„CI.C,k LE.CA.Air Mfli"re ion roaukarnent•VVOUA NNarwrk CaralGc 11on proynun. I NFXC re i ilF�ia�eet�bA WooWpyl Composite Frime _ FLtia►a Carfldm OUAI. kgon 'low E Picture , ' - :.`:•';" "r.'1•. ems.: -ENERGY PERFORMANCE: TINGS { r u4actor P-S)l1-P. Solar H• at Gain Cceffc?ent -3.2 a 2'. 1' lu l Visible Tra*nimittance M.nit.air.��y {rowl win yikaw/y�{O�I�ewlrerMhM'(�h�n�w��V�w i y •• , ' r•ftWN*f.:.•"Amer."ON 1.1 660 a•r alft pm!-4 aY.• .. .- �MRe:�w.n.l^har.nMi�ep•►rdwlNl�:.ir•{�+�•�I14.+N•MM•:►�,r►r!Iw,�.ye�►►..Mi.�:..• E . .. •A T.wvr.v./�a/1q.l�n NriM.r/p/�e4 r..{,awrww:�iNMeN�n. . . ' %PSSIGN PRESSUAropSF}'•' 1• i 0=26229554- M.Ayitt.a..•-0.M,CO..o.40.s :ax r� *.nwwVrr.Rawo�uM•FrMe.w�r. ��i�T 2009-04-07 22:18 » 17749873013 P 115 r MAUCense#149601 (nxpiles 1/24/10) Renewal RENEWAL BY ANDERSEN FederalTa 1041830404201 Andersen' nl't.,IZI':INr1.1t N'1,v�w:vclll'tir:rr.�AND Nrw H:vNIIISIIIRIr WINDOW err.ACEMENT ­111­11­14 , Iof Oti-,Strut•Vr,rtlllsnrun h.NM 015'12 Phunr 51tfO9I(H000•Fax 508,919.119)3 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT 6uyerhl Na„e �+ Date,of A0leenwt duyerlsl fitrcnl Address;Clry•Srota,and IF Code .. ._. ... _. .._ - -- JG '� FILJr�(�� F Moll Address H,,,,e lele hone NUm6n1 _Work Telaphanr,Numbe[ —— Y� .sr�tj 13 1111'1 lJ;n'I'>to ptildla.<r Iln'I,rnthlt t:;,tl l(I/,n'yr r'v it'r�ui j l I.\'\4III(Irnrs.Int'.rll cl Itt'I ri'1ta11)1'i\II[Irl'�rll nl (n'rllrl NLi,,av husrtl,'lud[\L s\ I I:uull hire °Cnnlrarlur:,in at((It dol 1(r ml It the uy'nt.imI rnndiliutl>d,•<tt'ibcd 11n du•(ru11t and III( r,u I'v I,I'IIlk a},rrrturnl and nn du';tll;u'I11 d,I)•rill(Aden shrrr,v (,111ri'licely Ihis'AN Ivrlllotit liucrrs:I(rrrllc,ign I,(I,si n a rontplrlirnl rrl Uh(;Il(.slim (hnnrdrtur ha,rnuq,l('Ird all ondtl'thi'Agivrnlrnl. C, UV Method of Pymnt 1J Cosh J Check 'l Mastercard J VISA Total Job Amount: v Estimated Starting Dula: z W V e y J Discover }liinanced,App#: Deposit Received(33%): Name on C rodit Card: T Balance at Start of Job 133%): fstimoted Completion Com l Dole Credit Card#: Balance on Substonliol e,el-5 Completion of Job i33%j. CC Exp.Date. CC 5ecurity Code: I - - f{s'inili:Mitt_;hrn•,1illl,u'knotslyd.t;( Ih;ulhrlSahuur;util;ulul'Joll;ludlhrli;dantruutiub�lautiulCuutplrli„u Buyer Initials — d'Jnh ratuog I.(•111;u10 bt ('1„lit I;ud aild niti'l I,,nla lr In In'r.,(,nal(iln k,hank,rhrrh.1r.'ra>h. 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 content of both Buyer(s)and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the twins 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 byAn crsv ,f Greater MA and Nll Buyer(s) Buyer(s) Sil_n:,u nr of I'rodurt NLuuts;rr .5is;nalnrr (ii t;n:llurr J-4 ur 11tim Vint of I'nthict Nllnagrt I'mil N.mic hint Natur 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 EXYLANXI'ION OF THIS RIGHT. .- - - - - - - - - -• - - - - - - - -%- -- - - - - - NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction - - Y , You may cancel I Date of Transaction If- 7- 9 .You may cancel this transaction withodany penalty or obligation,within 1 this transaction without any pens ar obligation,within three business Joys from the above date.If you cancel,any three business ys from th®above ate.If you cancel,any Property traded in,any payments made by you under the roperty traded in,any payments made by you under the contract of Sale,and any negotiable instrument executed Contrac of Saks,and any negotiable instrument executed by You will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Seller of your cancellation notice,and any security I by the Seller of your cancellation notice,and any security interest arising out of the transaction will be canceled. 1 interest arising out of the transaction will be canceled. If you cancel,you must make available to the Seller at If you cancel, you must make available to the Seller at your residence, in substantially as good condition as your residence, in substantially as good condition as when received, any goods delivered to you under this I when received, any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the 1 Contract or Sale-or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of instructions of trie Seller regarding the return shipment of the goods at the Sellers expense and risk,If you do make I the goods at the Seller's expense and risk.if you do make the goods available to the Seller and the Seller does not I the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods 1 of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the I without an further obligation. If you fail to make the goods available to the Seller,or if you agree to return the I goods available to the Seller,or if you agree to return the goods to the Seller and fail to do so,then you remain liable I goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract. 1 for performance of all obligations under the Contract, To cancel this transaction, mail or deliver a signed and To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written I dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by Andersen 1 notice, or send a telegram to Renewal by Andersen of Greater Massachusetts and New Hampshire, 104 1 of Greater Massachusetts and New Hampshire, 104 Otis Street,Nortilborough,MA 01532,NOT LATER THAN Otis Street,Northborough,MA 01532,NOT LATER THAN MIDNIGHT OF - (Date) MIDNIGHT OF Ld' (n -o�_.(Date) I HEREBY CANCEL THIS TRANSACTION. X I HEREBY CANCEL THIS TRANSACTION. I Consumer's Signature Date Consumer's Signature Dot* K,IU111")lIf1V RUAPI,"N11 2009.04.07 22:19 » 17749873013 P 515 : nlnlatvaart vI4;160 1 i- 11 Kenewdi RENFWAT,By ANDERSFN n);l S;i oWa20l hyAnderser OF GREATER MASlACHI ISf I' 4 AND V1W HAM5HIR; WINPPW ...... 104 Otis Street•Northhorough,Massachusetts Q 1532 Phonc 5w91t),01)w•His 50.91`.0903 SPECIFICATION SHEET Ituycrk)Nantr hate of Agreement b 1z it '1410 Buyers)listed aLxwc'ieroby,joinlly taxi severally agree to purchase the gtaxis and/or services listed blow,in aecord3nce with the In ices anti trews described oil the Specilleallion Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOok REMOPKI INl Al%Ri'I'S1FNI' of Wltieh this Specification Sheet is a part. WINDOW DLTAILS 1. Contractor will htstall a local of.-J--3—windows in clwnces home,using the t1111OwillS individual quantities: Double Ilutl;y(1)13) ❑ Eglal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash 12/3 lop. 113 Wtionu Casement(CW) ❑ Ilia;{e rid{III ❑ I IMAC Ic(t(cis viewed from exterior): ❑ Standard handle ❑ Morn handle L)oubk-01sellient(OW 7 Standard handle ❑ Metro handle Caseutelu/Picture/Casement(CI'W) ❑ 1:1:1 Or ❑ 1:2:1 ❑ St:andard Ila11dIC ❑ MCtrO 11AIAle LAC Glidimt Window(GW) l%lido/riehor/Uliticr(Gl'W) ❑ 1:1:1 or ❑ 1:2:1 _ — Awning Window(AW) 7 Fieltur Window(lW) Ray or Row Window Patio (sec scpanlle Ikx)r Slax:il'it:anion Slcct) 2. f" 1'cs No Qly of Wiltdows to be Custom Fit I(t'I'+Iakeillenl: 5, u" Yee 'g No `fly 01 SillS 10 Ln•rclAAed 11y C'01111'3001': 4. 42Fg�1'2s 7 No Qly of Windows ID lc New Construction Full Iraule(includes new illterior&exterior casings) f:xt,:twl cx,111:s: ❑ Pine Q Maintenance-free material ❑ Faclory applied 8025 Fibrex brick-111,11,i 5. Gla/in;{to bv:Jr 111'ww.rk'.SnlartSuwll (Tsx0tayt7F.WIC) El Other if olhgr,please specify: la. Exterior tolor 10 ix,. Wltiic ❑ $ante ❑ Canvas ❑TernitURe ❑ L i coo BC:pi 7. hilonoreoloi to br:,J White n Santa ❑ Olnvns❑'1'erratonr ❑ rinc ❑ Maple n Oak Note: lntcrior color can only bC.while,wot<1 ar same color as exterior, World in Ioriors need to I nished by Owner. 6. Ilaudw,llv:-?!FWltilc ❑ Slone ❑ Convas ❑ lirass Double Ilutlw: 8. ❑ Yea-IKNo Ilwall 1.111",Willi Rouble Htu>k Window's 10. Screens: window.,It+have: ❑ IUlf or,�`rullscreens S't'ems 10lx::-R 11110,khtss- Aluulirtuut ❑ T1,16cenc GRILL£DETAILS 11.Window.,have grilles: ❑ YCS.J2'No It'yes:❑ L;nlle Bvhvvvn 6l,.",(,:a,:)❑ Rculovable lilichor Wood n Jrwt❑ fill 1livided 1,1;4111(11'1,1 Qly. Qlv: Qly: QIY: illy: Qty' Qly' on on nu EDH cwwl•a�,• GhOe, caws Grw Draw`4riHe I+alllcrn.able "Ilse additional Sheol if needed Owner approved(initials):(_ ADDITIONAL WORK DETAHS Z. Yes IVO Coith•aayor will remove metal li'autleS of windows. Qly of Ullils: 13 1'es Nc+ Cotln'Nelor will install new paint-ready or stain ready asill;{S. htlil;1it,c'a in Y,illy of Openings:� Exterior'clisj tK5 qty of olutit As:� ❑ Titre n Mailltelutm C-n'CC 1tl;llet'i,il I,I.n 1'es•�jy,No Contractor will ia.,h+ll new paint-ready Or rM-4y,4 a4I tnlside+tops qty of openings: Interior Stops t)ly of openings: ._ Mxtcrit)[Stoles 111 0l o1v ningN: _ ❑ fine❑ Maintenance-iree nuucrial 1 +. Owner is aware that Contractor does not do any pain er Initials I(1. 11'cs [1 No COnlr'at'lor will wrap cxtcl'iOr eosin,",will.ltu irk of , . rotor. Note: Wrullpiu;{MAY I1c required Willi storm window icntow%removal Of slorill windows will leavC screw holvS ill r;ISin;t• 17.N 1'cs ❑ No Contraclor will insulate,caulk and.seal windowS will,;5.hoint Nystent to prevent water:utd air infiltration. 1 "cs ❑ No A limited wau'rnnly shall be issued(o Owner upon contplelion of the job and paymoill in(till. I`>, cN ❑ No Buildietg_Petjtit Contractar'will SCC'ure any and 311 ueLCSSM'y permits. 111c Ic'C tot.the pertuil(s)is nil II1011ded in the Couh•acl Priec and a srptu ate cheek is required at Cllr f'llW of sale for this Ere. %lt. Additional lobdClai F: -- l l,y�f'r i❑ Nn llwilel't!!{I'CCN it)bC pre5Cl11 Ott the filial clay Ol i1151a IINtipn 1'Dr(infll i1iSpCC110n ante to ticlivCd'1111111 pilyw Crll. No r 11N:f11L`t}'ffll'lrI51Ai11Ix flt`lilalldofill)Ill lht'colli lief LS completed l,1 ilw Saasf1 ic!hw tll It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW ANI) DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes arc in writing and signed by both the Buyer(s)and Contractor. Buycr(/s�)hereby acknowledge that Buyer(s)has mad this Specification Sheet. Renew terse Greater MA and NH Buyer(s) (/ Buyer(s) 'Q�(,.,A,-A,. . 1 ) Signature of I'rcduct Manager $igttalurc Sig»alure Print Name of Product Manager Print Name Print Name Kl,A Colt. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ley-ibly Name(Business/Organization/Individual): 'Re r) LJ Ci, r.5 e ei Address: /04 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L aI am a employer with 30 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• modeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f M KQInsurance Company Name: ] }ea n E' Policy#or Self-ins.Lic.#: J LJ -A Expiration Date: Job Site Address: 1 S City/State/Zip: 6 J<> Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer u �er the pains and penalties.of perjury that the information provided above is true and correct. Strnature• Date: "l (� ' G / Phone#: �U - 0 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#: ACORDru CERTIFICATE OF LIABILITY INSURANCE °A�" 02/17/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 cy, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC# INSURED Renewal by Anderson INSURERA Hartford Insurance Co any J&L Windows, Inc. INSURER e: Hermi a e 10400s St INSURER C: Northborough,MA 01532 INSURER 0: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR A.DH POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION B " GENERAL.LIABILITY HCP 507 404 09/07/2008 09/07/2009 EACH OCCURRENCE S 1.000.000 DAMA(m TO HEN I ED COMMERCIAL GENERAL LIABILITY PREMISES Me omaence $ 100,000 CLAIMS MADE ©OCCUR MED EXP(Any one perwn) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO S 2,000,000 POLICY n PRO• LOC ECT A AUTOMOB0.E LIABILITY 35 MCC XD 6390 10101/2008 10101/09 COMBINED SINGLE LIMIT ANYAVTO CEO accident) f 1,000,000 X ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-0WNEDAUTOS (Per aetldont) f PROPERTY DAMAGE S (Per accident) 7GI5 LIA BILITY AUTO ONLY•EA ACCIDENT S AUTO OTHER THAN EAACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S _ OCCUR F�CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S OTH• A WORKERS COMPENSATION AND 35 WEC PP 1444 02/17/2009 02/17/2010 WC STATU• EMPLOYERS'LIA&LITY E.L.EACH ACCIDENT S 5O0 000 ANY PROPRIETOPJPARTNERAEXECUTIVE OFFICEWEMBER(EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500,000 d ee, wrier SPECIAL desai PRObo VISIONS belay EL DISEASE.POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUINO INSURER WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTkOR12ED REPRESENTATIVE ACORD 25(2001/08) 0ACORD CORPORATION 1985, If r;,.•. -OT 1DO9lYl7tO�ttl�e O�✓lG¢d6Z Board of Building Regulations and$tapdards i Construction SupervisorLicense•,,,,.; License, CS •95707 BirthdaW"=''g_/8"/1982 ' 1 ?5Ri'rafiori .g18/2010 Tr# 95707 BRIAN DENNISOIt;'r 86 CREST CIRCLE WORCESTER, Commissioner RENEWAL BY ANDERSON BRIAN DENNISON 104 OTIS STREET NORTHBOROUGH, MA 01532 DPS-CA1 Cs 50M-07/07-PC8//490 //tC 'lOpm7/77L007.CIJ66GLit O�✓[�LlZdd � - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrafion� 149601 raEi�1W 2412010- ppplement Card RENEWAL BY A[yl0ER::' BRIAN DENNISON ? 1 2 104 OTIS STREET` NORTHBOROUGH,MA 01532 Administrator SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: L y-� c,�� c-,-\ v� i S c,\/� C( 5 -� c>1 License Number cry G A G s 3 Cl- T - o Addreesst Expiration Date Signature Telephone 8 Res�s#tired' ome lmprovernent Contractor „ . ... ` Not Applicable PP ❑/ v�fM:,\ J�l�tc.��."��, I ��•�C �v1 Jv✓� ( SCI VU( Company Name ( Registration Number _/ b---1 S S- - I,�� ,�i ..k1 �, r2� ,IVIA of C 3..1 1 - a -( -1 y Address Q Expiration Date '�� ev_.✓w c� ,v�-�4�c�,.� Telephone S r-°[ t Dgt�- 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....... I111� No...... ❑ 11 -H4ml�=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 Winfows Alteration(s) ❑ Roofing ❑ Or Doors Ev Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other(Cfj Brief Description of Propos d 66,, Work: &fit ctC� l - ��J C)C- '; p�C) I 5 A f, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa, If Neri+�'houSO'' or:ac�ifition:to existin`"'o hour nsl. complefe tie 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 l 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. Signature of Owner Date as Owner/�orize ' nereby 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. �} +� — ✓� Sal l Print Name Signature of Owner gent 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 1 1 parking) #of Parking Spaces �— °-- volume&Location A. Has a Special Permit/Variance/Finding.ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:��. IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book I Pagel and/or Document#I B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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 C) 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Depa�ent usenIY l '� y / City of Northampton S4054"; Building Department Department " t►tt�e 212 Main Street {' !� ^ rl ` Room 1006 Lt U Northampton, MA 01060 phone,413-5> 7-1240 Fax 413-587-1272 cifyW3 kaE i - APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: f This section to be completed by"office C1 � "Map trot unit - U�-eA c 2 M v �`' bane Overlay District 61 'St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: � �iv -e ✓N �CJ� �Ap-. 5 c1 A.) w�S �c� �Iore.lc& t'oA Name(Print) Current Mailing Address: L-tl '� - 5 `{- Svyo Telephone Signature 2.2 Authorized Agent: e% 1 04 Dec S S+ A-),,✓ ,,j) ,/L4/} O i�-3 J, Name(Print) Current Mailing Address: �CX �/Lti/Ln C1�r/1 5 0 1 - (I I - c' rt r14- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of C-) Construction from 6 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 1 -Z Check Number lj This Section For Official Use Only Building Permit Number: bat ed: Signature: Building Commissioner/inspector of Buildings Date BP-2009-0832 GIS#: COMMONWEALTH OF MASSACHUSETTS Plea-16&, i} 9 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0832 Project# JS-2009-001232 Est. Cost: $18500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 149601 Lot Size(sq. ft.): 128937.60 Owner: CORBETT LAUREN&JULIE FISHER Zoning:RR(100)//WSP Applicant: RENEWAL BY ANDERSEN AT. 589 NORTH FARMS RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919-0900 WC NORTHBOROMA01532 ISSUED ON:411312009 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 13 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 OccuDancy Si nature: FeeType• Date Paid: Amount: Building 4/13/2009 0:00:00 $35.007435 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo