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29-144 (4) 64 SPRUCE HILL AVE BP-2019-0083 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block:29- 144 CITY OF NORTHAMPTON Lou -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:Door Replacement BUILDING PERMIT Permit# BP-2019-0083 Pro ject# JS-2019-000126 Est Cost: $2954.00 Fee, $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sa.ft.), 30099.96 Owner: TONER JOSEPH A&TERESA tonin : Applicant. RENEWAL BY ANDERSEN AT. 64 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTHBOROMA01532 ISSUED ON.712312018 0.00:00 TO PERFORM THE FOLLOWING WORK:REPLACE 1 PATIO DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 7/23/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ()COQ City of Northampton StaWa pff' I Building Department qL" ^nwPft*'wpNnV'-aimll 212 Main Street Sayr4rflbg AYaltabp „' 11 } Room 100 Wa14I lll�ld Northampton, MA 01060 T,,cn.��§jajyia,pDfit.�dpDlufafilPW@ phone 413-587-1240 Fax 413-567-1272 q({ ylene, _„_ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FA/MJILY DWELLING SECTION 1 -SITE INFORMATION P� (_' This section to be completed by office 1.1 Property Accuses: 64 Spruce Hill Ave Map "�Q — Lot_ t !qq___Unh Zone Overlay Dia l Elm St.District CB Disidot SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Terri Toner 64 Spruce Hill Ave., Florence, MA 01062 Name(Print) Current Mailing Address', See Attached Contract Telephone Signature 2.2 Authorized Agent: JAIME MORIN 30 FORBES ROAD NORTHBORO,MA 01532 Name(Print Current Mailing Address'. 508-351-2277 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $2,954 (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) $2,954 Check Number This Section For Official Use Only Dale Building Permit Number: Issued: Signature: Building Commissionerlinspector of Buildings Det. Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Acquired by Zoning This column to be filled in by Buildin8 De carlmeat Lot Size Frontage Setbacks Front Side L R:- L R: Rear Building Height Bldg. Square Footage na Open Space Footage na (Lot area minus bldg&paved parking) 9 ofParking Spaces Fill: volume&Lwation A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan that will disturb over t acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows I Alterations) Q Roofing Or Doors IM Accessory Bldg. ❑ Demolklon ❑ New Signs [O] Decks [D Siding[O] Other[Q] Brief Description of Proposed Work: Replace 1 Patio Door Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.If New house and or addition to existing housing, complete the following: a. Use of building: One Farl 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 fl.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 Teri Toner as Owner of the subject property hereby authorize JAIME MORIN to act on my behalf,in all matters relative to work authodzetl by this building permit application. SEE CONTRACT 7/12/18 Signature of Owner Date I 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 Nsr�2tk 7112118 Signature f wnar/Agent Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construetlon Supervisor: Not Applicable ❑ Name of Llcanee Holder: JAIME MORIN 90125 License Number 30 Forbes Rd. , Northborough, MA 01532 10-06-18 Address Expiration Date 508-351-2277 alum Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ RENEWAL BY ANDERSEN 170810 Company Name Registration Number 30 FORBES ROAD NORTHBORO,MA 01532 12-22-18 Adores Expiration Date Telephone 5 0277 SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,§25C(8)) 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....... 1] No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings alone(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 fans structures.A Person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall serum 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 buildtne permit. As acting Construction Supervisor your presence on the job site will be required from time m 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 persons) you hire to perforin 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 City of Northampton 212 Main Street,Northampton,MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I admowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111. S 150A. Address of the work: 04 Spruce Hill Ave.,Florence,MA 01062 The debris will be transported by: Renewal by Andersen The debris will be received by: Renewal by Andersen Building permit number. Name of Permit Applicant Jaime Morin 7/12/18 Date Signature of Permit Applicant The Common wealth ofMassachusetts EVDepartment of IndushialAccidents I Congress Street,Suite 100 Boston,R4 02114-2017 rvwlnmass.gov/dia Rbrkers'Compensation Insurance Affidavit:Buaders/Contractors/Electricians/Plumbere. TO BE FILED WITH THE PERMITTING AUTHORITY. AooBcaot Information Plant Print Legibly Name(Business/Olpeointion/ledividual):Renewal by Andersen Address:30 Forbes Rd. City/State/Zip:Northborough,MA 01532 phone#:508-351-2277 Are you m empbyert Cheak de appropriate box: Type of prof est(required): 1.❑J l am a ertpkyer W IW 30 employee(foll antllm pan.)• 7. ❑New construction 2. l em a sok papnemr or pmnshipevd Ww no emploYecs wokmB fix.. 8. ❑Remodeling my cepsa ty.[No workers'comp.uaumcc required.] l lamahomrdoallwkmywlf INowokeiromp mamereghM), 9. ❑Demolition s.❑I am a homwwa r mM will he hiring conmemrs m cmMam an week on my peopeny. I will 10❑Building addition aiure Wtau coma[tmseium nave weekeri compensation imurememme role I1.❑Electrical repairs or additions propricmrs win m mpploym. 12.❑Plumbing repairs or additions s.❑Iamae.I conuactm and I havebawl the suba'aobacmrs lined oo Oe couched ilo.,hive new ril l3.❑Roof repairs co mous employers and love wokrrs'comp.imumore: b.❑We are acorymeaan and in om[em Nveexerckd theuright ofexempuon per MGL c. 14.DOthcr Replacement ISi,8110),and sve have ret employees.INo workers romp.iraurmx required.) eMy applkmt dm checks bon al meet also fill am Ae wcdon belowahowing Heir wmkers'rompe�tioo policy mfoimanm. �Hmarow�ma wM suMvit rho andavu ivdicatbg WeY medomg ell week and tbrn hire owside convectors must aWmit a new aMdavit mdkatiaa such. :Conuacwsautebeck thio box m�s[WehedroadditiwW aM1 tzhowwg ds workvmneoanp5ubavnaactora eodame wheNa or vol thoxeodties love aoployem. Ifthe mbcwammrs Nva emploYem,WeY muse provide their eri romp.policy number. [Oman employer thatis providing workers'compensation insurancefor my employees. Below is the policy andjob site information. Insurance Company Name:Old Republic Insurance Co. Policy#or Self-ins.Li,.#:M WC 311129 00 Expiration Date:10/1/2018 Job Site Address:_64 Spruce Hill Ave City/SwdZip:Florence, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,p25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificaf I do here ertify under th tee andpenaldes ofperjury thatthe Informadonprovided above is nue and eonreb Signmu Date, 7/12/18 Phone#:5 1-2277 Official use only. Do not write In this area,to be completed by city or town official City or Town: PermiMcease# Issuing Authority(circle nue): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Paye 1 of 1 A CC>Rbr CERTIFICATE OF LIABILITY INSURANCEDATI� 09/3]/301] 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 INSUREINS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certillcab holder is an ADDITIONAL INSURED,She policy(les)must haw AD04MNAL INSURED provisions or IN,welomeC. If SUBROGATION IS WAIVED,subject W the terms and condMom of the polity,certain policies may require an erldorsemenL A sts M on this cora ews does not confer rl to the cotMcwte holder In Ileu of such endoreemen a. .U. W Millis of Nivouota, UP. PNo11E 1-e77-945-7378 'F'�h . 1-88e-{6]-]3]e a 0/O 3I Cutury HIM E41NL pctl[ScaL.sNr1111s.w P.O. m 305191 RaeaHlla. YB 373305191 q9a INSus"So AFIOROxO LOYEMOE _ I RAILF yggpER A. Ole AayWlla in sots CuyuY -- 34147 Nalxre NehNFA B: ___ _ .vSo . Nod—.. so Ton.. IM, NDRUPEa L: Nonm0Y0we, AN O.S. xsuREno: ' N UaERF: COVERAGES CERTIFICATE NUMBER:NJ]6xao4 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO ME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNNITHSTANDONG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT KITH RESPECT TO VMICH 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.UNITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NMI TYPe0P N6URINLE M POLICYNU PmrfflP PN1LY �e X CO ER GENER/JdW � 11000,000 C.5-A. X OCCUR M f 5001000 A MEDW(Anv. ml S 101000 ,nRY 11113310/01/2017110/01/2010 PER50NAL8ADVINAIRV S 11000,000 GEHL AGGREGATE UNIT APPUES PER. GENERRLACGREGATE $ 41000,000 X 'y PECi iLCC PROIXICTS-CGNPgP AGG'f _._ 4.0001000 ._._.OTNER. — S AU]OYOBnFLWILIf\• �9�N�—R —LI �—f 5.000.000 X'AXYAUTO BODILYI BODILY INJURY IP.P—n) 'S A ~—' 00 LYM0 YNSH 311130 10/01/301]'10/01/3010BODILY INJURY(PrxtgN�l) f HIRED N r�i DO... dUUGE AUTOS ONLY L_ AUTOSONLY P Ia UMaNIALW —1 UR EACNCCCURRENCE i is EAOSa9 LW �iCWN61sADEi AGGREGATE I3 OEDRVEMIIXi f WCAIIMPL.. 'URIDU N X -PUTOE R ARYPRA ry�NNQTTACLX0 J[ECUTNE YIN E.L LV6EASECFA EMf4AYEE f 1.000.000 ANDOEMPRIETOR ARTNE1Y HS OGFlCE0.NEMSERE]tLLUDE01 OIN,A YXC 311131 00 10„1,301] 1p/pl,itl. --__1.OUB.004 CUONapugM 1.B,P.004 ' 6CRIPTIg1 OPERATIONS Wx EL.g6FA6E-PoIICY UMrt '.s DENRNTION OF pphATN:N.ILOCAT(ala l VENCLES WORD WI, —I bm.Na SWHA..mry C.mohNd Nnm.Nn bnNeand) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE UPIMTNWS DATE THEREOF, NOTICE VALL BE OELPJERED M ACCORDANCE PATH THE POLICY MOVIBNJNS. ANIIDRDED MPRgENrAT1 VE ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD ra m. 15326108 noes. 459145 _ .. ,; .`-' ' ' 1 i. t'' 1 , � �` i * '� x ��� � +.� `� v � 'Wraa,y9.rt r. +h1 � > r., n - �J �� Y kf a 7 '',.ty'�����F 3 �.. � ._ t �� i� c, 6�Tt4 + xr , ti: .. x. ! unf r t a�"3 � K},� " �r q � .ry S �J ` Sy L.�1 C 1 MV�i lP13� � 1 '� Il�.rrw�� .,-. �a Ou x vr ' � ��" � z„.� � ' � � s ( k . , 'x"'y1 w � u '°"2 �.�� tia r cj' 1 0°��`Stli^ �� , s'..d, • 1 1 1 : tl � S . .. r .... ... .. r O • PRODUCT PERFORMANCE Wo 'NRC CarUBed Taft UaN Perterm " eeaw'a.aa ea.Lm waeea aer . yr :: most am m as a,_aJr..inur_ au nno as morn a.n na na n:- owe.nxw'w iaN.mrma ojo na J 3 wi..aams.yea. m na m =� a�orr. we m aao ue.er o..ae evinr ow as+ nn rssortue.. a.� ¢io on aee _ __ u<eram m oa eb _ OYarWv 6A pB 6Y pgrr' I'✓zYrMyiYr aM 69f uf0 n..rrn.. We 6Ei 6Y QN _ a.s+oew nz1 nan as' 9 arnrre ae m ¢a orad ROOrenle as oen .od r¢.V NOS ION 0]n G9 6'S I�Eine� adY i w6Y J iOeea.use eao o7 vaaor m m w Ovasl Faei6d 'm m = m pyira. NB m 6Y ONiy�Fln ISEOLBA� 6]! On 6b J .J �aEYOOY u31 a9 m � _'� utao.rer nzr � eee �b �Yb nAf m uY 0a�11Pai Ye W ¢® oY u•! as m me yneWf 16E�Nfn! 63n na W .J� ensn�i nm IaE9e m aA m ] 10 iwe'rm m ab au 7 7 . rrff�iiYa an ay W "J Y nenrir. ac m om aunt M1�iBe! m w neo rc na m mo mroir w[an as na oeo 9 _l] _ �ri.nner nm as> en' i J iaaanm ea oa m J7 rEneeo.unwo. m m as 7 in o�o,tis o.a m w mororinr m oa na ir[ os mn as J!1 ns+W v.eieu em m aan r.r om mea. m na na 7 O� r.eamiu. oen na m ra.w.r.+nor m au a9v �k R QQ EIVED enDVal Agreement Document and Pa (m �n silRenewalbyAndenmoFEicam. JUl i l net Legal Name:Renewal by Andersen LLC 9 201�A"Six ce Hill we HIC#170810 Ronan, .MA 1062 wn..w n uor,n.. 30 Forbes Road I Northborough.MA 01532 Phone:508-35122001 Fa. (508)9867072 bobostonOguAlmm DEPT OF BUILDING INSPECTIONS NORTHAMPTON.MA01080 Buyer(s)Name: Terri Toner Contract Dane: 06/30/18 Buyers)Street Address: 64 Spruce Hill Ave, Florence, MA 01062 Primary Telephone Number: Secondary Telephone Number: Primary Email: toner@crockeLCOm Secondary Email: Buyers)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 no this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement'). Buyers)hereby agrees to sign a completion ectri6ca[e afar Contractor less completed all work under this Agreement. Total Job Amount. $2,954 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed most be made by personal check,bank check,credit card,or cash. Deposit Received: $984 Balance Due: $1,970 Estimated Start: Estimated Completion: Amount Financed $0 10 weeks 1Day Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on the date 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 a a lacer daze. Rain and extteme weather Are the most common.uses for delay. Nola: 1/3dep$984.00; 1/3start$984.00; 1/3subcomp$986.00 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 alteratiom m or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyers)hereby acknowledges that Buyers) I)has read this m Agreement,underseands 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 Buyers right to cancel this Agreement. NOTICE TO BUYER. Do no[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 07/05/2018 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,d Nema Renewal by Andersen LLC dba:Renewil by Andenm d imimn Buyer(9 Signature of Sales Person Signature Signature Brandon Harvey Terri Toner Print Name of Sales Person Print Name Print Name UPDATED. 06/30/18 Page 2 / 23 Renewal Itemized Order Receipt Andersen dbam Renewelb'A aeeunof Horton Tee Tom., Legal Name:Renewal by Andersen LLC 64 Spruce Hill Ave PIC#170810 Florence,MA 01062 uom. . ueoem 30 Forbes Road I Noahborough,MA 01532 Phone'.508-351-22001 Fax(508)986-0072 l rbahoston0gmail com ID# ROOM 101 Family Patio Door: Gliding, 200 Series Perma-Shield, 2 Panel, Active/ Stationary, Exterior White, Interior White, Glass: All Sash: Tempered High Perf. Smart5un Glass, No Pattern, Hardware: Albany, White, Auxiliary Foot lock C0101 Matched, Screen: Gliding, Grille Style: No Grilles, Misc: None WINDOWS:0 PATIO DOORS:1 SPECIALTy:O MISCO TOTAL $2,954 Renewal by Andersen i/commirted to our cus omen rofery by fful liql complying with the rules and lead-safe work practices specked by the EPA. UPDATED. 06/30/18 Page 3 /23