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32A-208 (2) 22 BUTLER PL BP-2021-0001 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-208 CITY OF NORTHAMPTON Lot:-001 . PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2021-0001 Proiect# JS-2021-000002 Est.Cost: $8138.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sa. ft.): 7840.80 Owner: CONKLIN LINDA S Zoning: URC(,100)/ Applicant. RENEWAL BY ANDERSEN AT. 22 BUTLER PL Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTH BOROMA01532 ISSUED ON:7/1/2020 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 7/1/20200:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner m Department use only City of Northampton Status of Permit: ZP Building Department Curb Cut/Driveway Permit c r-- � 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability C= Northampton, MA 01060 Two Sets of Structural Plans r„ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans N Other Specify APPLIC N TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ORMATION 1.1 Property Address: This section to be completed by office 22 Butler PL Northampton, MA 01060 Map 13kvl Lot �470'F Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Linda Conklin 22 Butler, PI ., Northampton, MA 01060 Name(Print) Current Mailing Address: 413-237-1$52 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 ----F- Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 8,183.00 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) �0 5. Fire Protection 6. Total=0 +2+3+4+5) 8,138.00 Check Number d L This Section For Official Use Only Building Permit Number: Date Issued: Signature: 7 Z "26z0 Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors L7 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[O] Other[p] Brief Description of Proposed Work: Replacement of 4 windows 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 Linda Conklin 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 6/25/2020 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 6/25/2020 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 10-06-20 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 12-22-21 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 Renewal Agreement Document and Payment Terms byAndemn. dba:Renewal by Anderscn of Boston Linda Conklin Legal Name:Renewal by Andersen LLC 22 Butler Place �j�i - HIC#170810 Northampton,MA 01060 WINDOW HE LACEMENT 30 Forbes Road I Northborough,MA 01532 C:(413)237-1852 Phone:508-351-2200 1 Fax:(508)986-7072 1 rbabostonbookingr@andersencorp.com Buyer(s)Name: Linda Conklin Contract Date: 06/11/20 Buyer(s)Street Address: 22 Butler Place, Northampton , MA 01060 Primary Telephone Number: Secondary Telephone Number: (413)237-1852 Primary Email: 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: $8,183 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: $2,727 Balance Due: $5,456 Estimated Start: Estimated Completion: Amount Financed: So 8-10 Weeks 1-2 Days 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: CK1315 Dep 1/3 at sign, 1/3 at start, 1/3 at comp. 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 06/15/2020 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 Na :Renewal by An ers LLC dba:Rene by An ersc a ost n Buyer(s) (� -lj(� , "JW -- Signature of Sales Person Signature Signature Gary Haglund Linda Conklin Print Name of Sales Person Print Name Print Name UPDATED: 06/11/20 Page 2 / 22 Renewal Itemized Order Receipt byAndersen. dba:Renewal by Anderscn of Boston Linda Conklin M.. L Legal Name:Renewal by Andersen LLC 22 Butler Place HIC#170810 Northampton,MA 01060 30 Forbes Road I Northborough,MA 01532 C:(413)237-1852 Phone:508-351-2200 1 Fax:(508)986-7072 1 rbabostonbook ing®andersencorp.com t 'O• DETAILS: 201 Bed 1 Window: Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior Black, Interior Black, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Black, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: None 202 Bed 1 Window: Picture, Insert Frame, Exterior Black, Interior Black, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Black, Grille Style: No Grille, Misc: None 203 Bed 1 Window: Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior Black, Interior Black, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Black, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: None 204 Bed 1 Window: Double-Hung, 1:1, Flat Sill Insert, Traditional Checkrail, Exterior Black, Interior Black, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Black, Screen: TruScene, Full Screen, Grille Style: No Grille, Misc: None WINDOWS:4 PATIO DOORS:0 SPEQALTY:0 MISC:0 TOTAL $8,183 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 06/11/20 Page 3 / 22 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: 22 Butler Pl., Northampton, MA 01060 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 6/25/2019 Date Signature of Permit Applicant C 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 O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW (7 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained O , Date Issued: C. Do any signs exist on the property? YES ® 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 © 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ti F�i 600 Washington Street Boston, MA 02111 r 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 Rd. City/State/Zip:Northborough, MA 01532 Phone #:508-351-2277 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. E] Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] r c. 152,§1(4),and we have no Replacement employees. [No workers' 13.® Other P 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. 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 31415819 Expiration Date: 10/1/2020 Job Site Address: 22 Butler P) City/State/Zip:Northampton, MA 01060 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 certify under the wins d penalties of perjury that the information provided above is true and correct. Si ature: Date: 6/25/2020 Phone#:508-351-227 Official use only. Do not write in this area, to be completed by city or town ojjiciaL 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 DATE(MMIDD ACO164�RO CERTIFICATE OF LIABILITY INSURANCE IYYYY09/18/2019) 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(les)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). NTACT PRODUCER Willis Tower* Watson Midwest, Inc. c/o 26 Century Blvd PHONE1-877-l4S-7378 �I�No1: 1-888-467-2378 P.O. Box 305191 cartiiiaataaewillis.coa ADDRESS: Nashville, TN 372305191 DSA INSUREP43)AFFORDING COVERAGE MAICO _ INSURERA: Old "Public ID"Vaaaa comp—y 24147 INSURED INSURER 5: Renewal by Andersen LLC 30 C Forbes Road INSURER C:__ Northborough, NA 01532 OSA INSURER 0: INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER:W12663065 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. _ INBR ADDL TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIAB1UTV EACH OCCURRENCE S 1,000,000 DAMAGE CLAIMS-MADE I—XI OCCUR PRE $ 500,000 A MED EXP(M one person) i 10,000 UMT 314161 19 10/01/2019 10/01/2020-PERSONAL 4ADV INJURY S 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X JFC L1 LOC TS S 4,000,000 POLICY❑ OTHER: $ AUTOMOBILE LIABILITYCOMBINED1SINGLE LIMN(Em amden) S 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED WrLH 314159 19 10/01/2019 10/01/2020 BODILY INJURY(per accident) i AUTOS ONLY AUTOS HIRED NONOWNED PROPERTY DAMAGEZ AUTOS ONLY AUTOS ONLY (PW 400000 f UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CWMS MAGE AGGREGATE S DED RETENTION $ WORKERS COMPENSATION i X ST T AND EMPLOYERS'LIABILITY A AIIIROPRIETORIPARTNEPIEXECUTIVE YIN E.L.EACH ACCIDENT S I ER 1,000,000 OFFICERMIEMBEREXCLUOED? F-3-.1 NIAMMC 314158 19 10/01/2019 10/01/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 11000,000 K describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddWonal Remarks Se Wuls,may be anxhed M 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 Evidence of Insurance 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD sit ro1 18532909 RATCHi 1372547 D o u b 1 e H u n g _ e _e .val "MG byAndersera WINDOW' REpt•ACEMEN? nn Mdetaenficwiputip y�19i�lE("�� WoodAgnyi Composite IF iCrg£Yr 3 Dtaip r Sln Low E4 artSun 41 100-00473518-Wo I:IIERGY PERFORW-10c RhTIijGS LI-Factor(U.S)A_P Solar Heat Gain Coefficient U , 20- U 1 mu AOQITIMIAL P7 ORiW,_CE RMOINPS Visible Transmittance Oz4^- NaaWselarar MO Iliat tMw saCgr ceator i le appfea►M NfpC preeadaraa for aatamvidnp iubk product parlsaeaG-MF71C afYya M daNrlaited lora fwd ri W aalAleapreatal aeedibr dad•tpaci�b product aka. 'dwt tef NospitH. dry product and dws not tYa•taM tha tu�D31y daay Pre'dact ler rry apaGYc use. ��arch Mratura kx otMr pro¢act Oadorenna iMoatstion. 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CS-090125 Expires: 10106/2.020 JAIME L MORIN - 86 GARDINER STREET LYNN MA 01905 Failure to possess a current edition of the Massachusetts �, � State Building Code is cause for revocation of this license. 0�4 For information about this license + t;rmis510ner Call!(617)727-3200 or visit www.rmss.gov/dpl Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card RENEWAL BY ANDERSEN LLC Registration: 1708102021 /22/2021 30 FORBES RD Expiration: 122!22/ NORTHBOROUGH,MA 01532 Update Address and Return Card. SCA 1 0 20M-W1�77 / J �'�. `'I:)iIlJI3I. t Plli��sar�',�yty;lJ.YIIYJ/11e'�li Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Sumlement Card before the expiration date. If found return to: EN irn alien office of Consumer Affairs and Business Regulation 170810 12122/2021 1000 Washington Street -Suite 710 RENEWAL BY ANDERSEN LLC Boston,MA 02118 JAIME MORIN 30 FORBES RD NORTHBOROUGH,MA 01532 Undersecretary 1 ' Not valid 461thout signature