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37-079 (2)
48 PLATINUM CIR BP-2019-0319 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-079 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2019-0319 Proiect# JS-2019-000521 Est. Cost: $2986.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 31842.36 Owner: SCHIPELLITE KAREN MARIE Zoning: Applicant: RENEWAL BY ANDERSEN AT. 48 PLATINUM CIR Applicant Address: Phone: Insurance: 30 FORGES RD (508) 919-0900 WC N0RTHBOROMAO 1532 ISSUED ON.9/16/2018 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 9/16/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only ity of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit SEP 1 3 2018 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEPT OF BUILDING INSPECTIONS NO hampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON,M e 87-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION X p— ! q--/ 3 0 1.1 Property Address: 48 Platinum Circle, Florence, MA 01062 This section to be completed by office �^ O�� Map / Lot Unit Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Karen Schipellite 48 Platinum Circle, Florence, MA 01062 Name(Print) Current Mailing Address: 413-582-0048 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- T ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,983 (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) 2,983 Check Number 7 This Section For Official Use Only Date Building Permit Number: Issued: oq Signature: L 1 6 �(7 Building Commissioner/Inspector of Buildings Date �►�..of �' -.i:+.J 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/Findin ever been issued for/on the site? NO © DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DON'T KNOW ® YES 0 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 (7 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO 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 F_� Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors In I Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[O] 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 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 Karen Schipellite 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. SEE CONTRACT 9/5/2018 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 9/5/2018 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: JAIME MORIN 90125 License Number 30 Forbes Rd. , Northborough, MA 01532 10-06-18 Address Expiration Date 508-351-2277 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ RENEWAL BY ANDERSEN 170810 Company Name Registration Number 30 FORBES ROAD NORTHBORO,MA 01532 12-23-19 Address Expiration Date Telephone508-351-2277 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....... t 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 City of Northampton 212 Main Street,Northampton,MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity govemed 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: 411 Platinum Circle, 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 9/5/2018 22� Date Sig a of Permit Applicant "\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED R'ITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Renewal by Andersen Address:30 Forbes Rd. City/State/Zip:Northborough, MA 01532 Phone#:508-351-2277 Are you an employer?Check the appropriate box: Type of project(required): 1.E]1 am a employer with 30 employees(full and/or part-time).* 7. ❑New construction 2.[3 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No%orkers'comp.insurance required.] 9. ❑Demolition 3.[:]l am a homeowner doing all work myself.[No workers'comp.insurance required.]' 4.[:]l am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.C]1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.nRoof repairs These subcontractors have employees and have workers'comp.insurance. 14.[Z]Other Replacement 6.[]We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. +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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Old Republic Insurance Co. Policy#or Self-ins.Lic.#:MWC 311129 00 Expiration Date:10/1/2018 Job Site Address: 48 Platinum Circle City/State/Zip: 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,§25A is a criminal violation punishable by 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 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 verifrcat' I do hereb erd under th ains and penalties of perjury that the information provided above is true and correct Si atu • Date: 9/5/2018 Phone#:5 1-2277 Oficial 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#: ^ Page 1 of 1 ALft � CERTIFICATE OF LIABILITY INSURANCE D 9127/2017Y) 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 NAME: Willis of Minnesota, Inc. --" - ---- C/o 26 Century Blvd P(�N.Ext): 1-877-945-7378 _ (a Not; 1,-888-467-2378 E-MAIL P.O. Box 305191 -ADDRESS: certificatenewillis.com . Nashville, TN 372305191 OSA INSURERS)AFFORDING COVERAGE _ NAIC0 INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Anderaen LLC -- - - — — 30 Forbes Road INSURER C_ Northborough, NA 01532 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:W3762206 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 _ ADDU SXR' POLICY EFF POLICY EXP --- -_ ---- LTR TYPE OF INSURANCE POLICY NUMBER 1MMJODNYYYI I IMMIDDIYYYYJLIMITS X COMMERCIAL GENERAL LIABILITY __EACH OCCURRENCES 1,000,000 _ CLAIMS-MADE �t OCCUR PREMISES OIEaEoccurrence S 500,000 A MED EXP(Any one Person) S 10,000 XWZY 311132 i10/O1/2017';10/01/2018'PERSONALaADVINJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 � !PRO- r-- _ X POLICY JECT L ;LOC PRODUCTS-COMP/OPAGG}5 —__ 4,000,000 OTHER. _..._ i S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 5,000,000 _ a accident) _ X ANY AUTO BODILY INJURY(Per person) S A --OWNED SCHEDULED AUTOS ONLY AUTOSMWTB 311130 10/01/2017 10/01/2018:iBODILY INJURY(Per acodant) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY �AUTOS ONLY (Par acadent) $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATIONTAS YIN X AND EMPLOYERS'LIABILITY _ STATUTE ER A ANYPROPRIETOR/PARTNERrEXECUTIVE E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBEREXCLUDED� No NIA MWC 311129 00 10/01/2017 10/01/2018'— --�-- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It es descnoe under1,000,000 DESCRIPTION OF OPERATIONS telae E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached it 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 ke Evidence of insurance C ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SR IC: 15126108 BATCH: 459145 x ,. Board o"r 8 kung Regulations a -ia S�ta,ga s .,cense: CS-090125 VAI&I� Ma w 86 GARDINER ST LYNN MIA 4 1905 ,mT i+r 101-U."2018 ..,....mow,... ._-...-.««.. Office of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: SuppWnent card RENEWAL BY ANDERSON LLC. �@ 170810 30 FORGES RD Expo: 12J22J2011a NORTHBOROUGH,MA 01632 Updda Addrw and Retum Card. omw of ConoumwAftm i aurtrws RIguldbn HOME U&PROVEMENT CONTRACM Rplaaatbn valid for Individual use only TYPE:Supplement Card bofor expkallon dab. If found retum to: Bfgf� Awk wim oaf nauawr Af im and Buelrwaa Regulation 170810 12P12/2018 1 Park -supe 8170 RENEWAL BY ANDERSON LLC. Sion,to orfs JWE MORIN 30 FORGES RD NORTHBOROUGH,MA 01532 Not valid without signature UndermcnAary ANDERSEN•A-SERIES WINDOW AND DOOR NFRC/ENERGY STAR"INFORMATION This document provides NFRC certified U-Factor,Solar Heat Gain Coefficient(SHGC)and Visible Transmittance(VT)values for Andersen"products along with the corresponding ENERGY STAR"Version 6.0(2015)climate zones in which the product and glass type are certified. Aft These products rated,certified and labeled y National Fenestration Rating Council" (NFRC)-a non-profit organization that provides fair, a accurate and credible energy performance ratings for windows and doors. Many of our products meet the stringent energy efficiency certification criteria set by the U.S.Environmental Protection Agency and the U.S.Department of Energy. The certification criteria is based on the heat gain and loss of each product In various regions of the country. Check the Andersen product performance available at www.andersenwindows.com for units ® that are ENERGY STAR certified. United States ENERGY STAR® Canada ENERY STARE) Climate Zone Criteria Climate Zone Criteria i1Y STARS Northem �?t;t ZONE 3 ZONE Y Nath-Central LONE 1 sowh-Central •i ■ sovftm JK .y+ a Windom Doors Comate 1AiLe-ak2qg: g Lana U.S crrrLffr ffl?1` MT Pratngtba 90.17 No Rating :9025 Ic 1125 Ahem 90.40 9030 North-Central so hentnl '1125 �— or rp o6raS 6 ?e+ 0.30 90.40 lortalvnghg0oorasOScirrtirr Som 50.25 flf s 0.40 s 0.25 _ i• +ylr Air Leakage 50.3 cfmA etum t;f a Sole Had Gab Coefficient s The adbed"dole foram Northam Ions preaoiph" Need egllveasm"toy perfermeroe erten.tar vrsdovle laJntr t 2016. For NFRC certtfied total out performancefor units with ceplaary breather tubes,please refer to the High Ahatude information section for each unit. 'U-Factor d efines the amount of but loss through the total unit.BTU/hr'ft 2'4,metric In W/m2s K.The lover the value,the iess the heat is lost through the entire product. "Solar Neat Gain Coefficient(SHGC defines the fraction of solar mciloWn admitted through the glass both d recttytransmitted and absorbed and subsequently released inward.The ower the value,the less heat Is transmitted through the product. sVisble Transmdtanm(VT)measures howmuch light comesthrough a producttglass and frame).The higher thevalue,from Oto l,the more daylightthe product lets In owthe product'stotal unit area.Visible Tmnsmltanm Is measured over the 360 to 760 nanometer portion of the solar spectrum. NFRC ratings are basad on modeling by a third party agency as validated by an independent test lab in compliance with NFRC rpogrem and procedural requirements. This data Is accurate ss of December 31,2015.Due to ongoing product changes,updated test resuhs or new industry standards or requirements,this data may changeover time.Due to variations In dealer and distributor inventory levels,products chat weft manufactured before December 15,2014 that were designed,tested and labeled with different NFRC values may still be available.Check the labels on the product packaging to confirm NFRC values.Ratings are for sees specified by NFRC for testing and certlkcation.Ratings may vary de pend Ing on use of tempered glass,different grille options,glass for high altitude,etc. AN rtwrkc where denoted an trademarks of their respective owrora C 2015 Andersen Corporation.AN rights nameerd. RIR-newal Agreement Document and Payment Terms byAnderwn. dba:Renewal by Andersen of Boston Karen Schipellite a.. Legal Name.Renewal by Andersen LLC 48 Platinum Circle HIC#170810 Florence,MA 01062 wIMn9. �[ 30 30 Forbes Road I Northborough,MA 01532 H:(413)582-0048 Phone:508-351-22001 Fax:(508)986-7072 1 rbaboston®gmail.com C:(413)626-3352 Buyer(s) Name: Karen Schipellite Contract Date: 08/26/18 Buyer(s)Street Address: 48 Platinum Circle, Florence, MA 01062 Primary Telephone Number: (413)582-0048 Secondary Telephone Number: (413)626-3352 Primary Email: kschipellite@gmaii.com Secondary Email: 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: 52,983 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: $994 Balance Due: 51,989 Estimated Start: Estimated Completion: Amount Financed: So 8-10 Weeks 1 day 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 at a later date. Rain and extreme weather are the most common causes for delay. Notes: 1/3 deposit $994.00 check #1502, 1/3 start, 1/3 completion. Buyer(s)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 08/29/2018 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. Legal Name:Renewal by Andersen LLC dha:Renewal bs Andersen of Boston Buyer(s) C� Signature of Sales Person Signature Signature David Flynn Karen Schipellite Print Name of Sales Person Print Name Print Name UPDATED: 08/26/18 Page 2 / 25 Renewal Itemized Order Receipt byAndersen. dba:Renewal by Andersen of Boston Karen Schipellite Legal Name:Renewal by Andersen LLC 48 Platinum Circle 0A HIC#170810 Florence,MA 01062 WINDOW 30 Forbes Road I Northborough,MA 01532 R(413)582-0048 Phone:508-351-2200 1 Fax:(508)986.7072 1 rbaboston®gmail.com C:(413)626-3352 ROOM: 101 Backroom Patio Door: Gliding, 200 Series Narroline, 2 Panel, Active/ Stationary, Exterior Canvas, Interior Pine, Glass: All Sash: Tempered High Perf. SmartSun Glass, No Pattern, Hardware: Tribeca®, Stone, Screen: Gliding, Grille Style: No Grilles, Misc: None WINDOWS:0 PATIO DOORS:1 SPECIALTY:0 MBC:O TOTAL $2,983 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 08/26/18 Page 3 / 25