35-142 (7) BP-2023-0423
35 WESTWOOD TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-142-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0423 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2023 Contractor: License:
Est. Cost: 21397 RENEWAL BY ANDERSEN 090125
Const.Class: Exp.Date: 10/06/2024
Use Group: Owner: A. LORENCO, TERESA M. &PETER
Lot Size (sq.ft.)
Zoning: WSP Applicant: A. LORENCO, TERESA M.& PETER
Applicant Address Phone: Insurance:
35 WESTWOOD TERRACE
NORTHAMPTON, MA 01060
ISSUED ON: 04/11/2023
TO PERFORM THE FOLLOWING WORK:
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• 1t • >9 .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissioner
Department use only
City of Northampton Status of Permit:
�i u � Building Department Curb Cut/Driveway Permit
•
212 Main Street Sewer/Septic Availability
� l
i Room 100 WaterNVell Availability
APR 1 0 2023 ! Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
:101 Dmr,INSPEC:.
F N,MA 01060
APPUCATIONTO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
c toest v-'• `� i ' Map Lot 7 Z' Unit
r is r."ee ,i,) Zone Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nam rint Current Mailing Address:
C • ''� , Telephone
Signature
2.2 Authorized Agent:
Name(Pr' Current Mailing Address: �L
•,,fc
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 4' l 9 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) 1
5. Fire Protection /�/�66
6. Total =(1 +2 + 3 +4 + 5) tA'Z f , 3 % f :�i Check Number 34 ` qP
This Section For Official Use Only
/J_ '1 � �7 Date
Building Permit Number: w p4 /' Issued:
Signature: i/ ZOIZ3
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Wkfdows Alteration(s) ❑ Roofing ❑
Or Doors ®®
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [C I Siding [D] Other[D]
Brief Despription of Proposed
Work: nr s l'/t j� C 44•..�
Alteration of existing bedroom Yes No Adding new bedroom Yes
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
, 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
I, 66'2(C L' `/'-i ir , 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.
(-)era c( L, ( A / )/t'
Print Name
Signatur f Owne/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: M f `o'r' 0 9O / 25
License Number
r Ise ;►i,z) /U� 1Wl �r:� h �� J�S32 /o /OC./ 2. 1
Addre Expiration Date
roof 111-f/ e6° 95-z - Wiz
S�a Telephone
9. Reoistered Home Improvement Contractor: Not Applicable 0
Company Name / Registration Number
34) FAle 5 XL/ /4.7e ha,�ssylt GMAT as 2 17 1 -z21 z3
Address V Expiration D to
Q
Telephone 060 -9' 1 - I f( Z
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No 0
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 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: 3 S jl /e:c'v,(P 14 v /GG
The debris will be transported by: )u % "4"'
The debris will be received by: CAlqi filer ►1 eJ
Building permit number:
Name of Permit Applicant 6e,,,, /j r4i
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
,� Department of Industrial Accidents
il4m-? . Office of investigations
==.= Lafayette City Center
,'i 2.-tvenue tie Lafayette, Boston, MA 02111-1750
t" www.mass.gor/dia
Workers'Compensation Insurance Affidavit: Builders/('ontractors/Electriciantii Plumbers
Applicant Information Please Print Legibly
Name(Biwn s4Grgaarmtion.lndivtdual):
Renewal by Andersen
Address: 30 Forbes Rd.
City/State/Zip:Northborough, MA 01532 Phone##:508-351-2277
Are you an employer?('heck the appropriate hos: Type of project(required):
I.N I am a employer with 30 a ❑ I am a general contractor and I 6. ❑New construction
employees(full andfor part-time).* have hired the sub-contractors
listed on the attached sheet. 7. El Remodeling
2.El 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
' P tY 9. 0 Building addition
[No workers'comp. insurance comp. insurance.:
required.} 5_ ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.0 i am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' cot right of exemption per MOL
12.0 Roof repairs
insurance required.] + c. 152,*1(4),and we have no Replacement
employees. [No workers' 13.�Other P
comp. insurance required.]
'Any applicant that checks box Ate must also till out the section below showing their workers'ccsnpcnsation polies information.
+Homeowners who submit this affidavit indicating they arc 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 hare
employees. if the sub-contractors have employees.thew Inuit ptoride then workers'comp.poky number.
I am an employer that is providing workers'compensation insurance for my employes. Below is the policy and job site
information.
Insurance Company Name: Old Republic Insurance Co. _
Policy 4 or Self-ins. Lic.#: MWC 314158 22 Expiration Date:10/01/2023
Job Site Address )tlX' „ ti✓t!5><reiib ej ree''IQ-G CityiState'Zip: )Bl 1 ?or-eitrc /44/1 d i c L
Attach a cops of the isorkers'compensation policy declaration page(Mowing the policy number and aspiration date).
Failure to secure coserage as required under Section 25A of MGL c. 152 can lead to the imposition of cru►utsai penalties of a
face 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 tine
of up to S250.00 a day against the s tulator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage veriftcatton.
i do hereby certify under the patina and penalties of perturt that the information provided above is true and correct
ti t a n a m: `— It Q. )y' t g.- I).,,, a y - .. - Z 3
--
Phone# 6(.:0 t5 Z t///z
—war
Official use only. I)o not write in this area.to be completed by city or town(official
('its or loon: Permit,I icense #
Issuing authority (check one):
10Board of Health 20 Building Department 3Dt'it)(lownclerk 4.0E:lectricalInspector 5E'lumhin
Inspector b.❑O*her
Contact Person: Phone!t:
4
RENEWAL
byANDERSEN
ciiisiu FULL SERVICE WINDOW&DOOR REPLACEMENT
Re: Massachusetts Solid Waste Affidavit
Good day,
Please find attached location where the installers will bring their debris from the jobs.These
are all Renewal by Andersen location.
• WASTE MANAGEMENT—30 FORBES RD, NORTHBOROUGH, MA 01532
When filling out any solid waste affidavit, it's the installer whom will be removing the
garbage and dumping the trash at the Renewal by Andersen dumpster locations
closest to that job.
Thank you,
Go Permits
YOUR PROFESSIONAL-CLASS PRODUCT PProviat, ia.:.,
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Signet Fir Fiberglass Entry Door with Clear Glass
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DETAILS
Signet Single Entry Door in FrameSaver Frame
Urnt Size:37 9/16'x 81 11/16'
Frame Depth 4 9/16'
No Brcttmold
Right Hand Inswing,inside tooking Out
420 Style Signet Fir Fiberglass Door
Condor Tech DLAiN
Colonial SOL Grid-2V s OH
Espresso Inside/Winter Rain Outside SDI.Grids(Dusty
Gray Sh+dow Grids)
Espresso beside A Winter Rain Outside
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Latrtude/Century Lockset
Century Thumbt urn Deadbolt
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Wont*LAC Auto•Ad casting Threshold 45 5# Depth)
Black Rau Bearing Hinges
SIZING HANDING ENERGY Security Plate
— '• INFORMATION AND WARNINGS
` wrier 0.20 0.03 Co*may wiry sightly due to the cream,hand applied
finish giving each door a unique aged loot iAtways refer to
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Agreement Document and Payment Terms
y;m
r� DBA:RENEWAL BY ANDERSEN OF BOSTON Teresa Lorenco
RENEWAL Legal Name:Renewal by Andersen LLC 35 Westwood Terr
HIC#170810 Florence,MA 01062
by ANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)331-9638
FIE MaOWNS KO 011101111
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Teresa Lorenco 03/13/23
BUYER(S)NAME CONTRACT DATE
35 Westwood Terr,Florence, MA 01062 (413)331-9638
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
titimariposa@yahoo.com
PRIMARY EMAIL SECONDARY EMAIL
NOTES:
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 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: $21,397 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: $0
BALANCE DUE: $21,397 Estimated Start: Estimated Completion:
20-24 weeks 1-2 days
AMOUNT FINANCED: $21,397
We schedule installations based on the date of the signed contract and secondarily on the date
METHOD OF PAYMENT: Financing 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: Gs plan #4569; 1/3 dep $7132; 1/3 start of job $7132; 1/3 sub.complete$7133
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 03/16/2023 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.
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Marc Festa Teresa Lorenco
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
03/13/23 Page 2/ 36
Itemized Order Receipt
CiNtrir DBA:RENEWAL BY ANDERSEN OF BOSTON Teresa Lorenco
RENEWAL Legal Name:Renewal by Andersen LLC 35 Westwood Terr
HIC#170810 Florence,MA 01062
brANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)331-9638
f{ILYrQ 101000IWI tlfila1 MI
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
ID#: ROOM: SIZE: DETAILS: PRICE:
103 sun room MIsc, Misc, ProVia, Entry Door System, See attachment for
details.0utswing
105 sunroom Window, Gliding, Double, 1:1, Active/ Passive, Base Frame,
Exterior White, Interior White, Performance Calculator, PG
Rating: 30 I DP Rating: + 30 / - 30, Glass, All Sash: High
Performance SmartSun Glass, No Pattern, Tempered Glass,
Hardware, White, Standard Color Extra Lock, Standard Color
Hand Pull, Screen, Fiberglass, Full Screen, Grille Style, No
Grille, MIsc, Standard, Replacement of window frame and
sash, includes casing from standard options.
106 sunroom Window, Gliding, Double, 1:1, Active/ Passive, Base Frame,
Exterior White, Interior White, Performance Calculator, PG
Rating: 30 I DP Rating: + 30 / - 30, Glass, All Sash: High
Performance SmartSun Glass, No Pattern, Tempered Glass,
Hardware, White, Standard Color Extra Lock, Standard Color
Hand Pull, Screen, Fiberglass, Full Screen, Grille Style, No
Grille, Misc, Standard, Replacement of window frame and
sash, includes casing from standard options.
107 Bedroom 1 Window, Double-Hung (DG), 1:1, Flat Sill, Base Frame,
Traditional Checkrail, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Hardware, White, Screen, Fiberglass, Full Screen,
Grille Style, No Grille, Misc, Standard, Replacement of
window frame and sash, includes casing from standard
options.
03/13/23 Page 3/ 36
Itemized Order Receipt
DBA:RENEWAL BY ANDERSEN OF BOSTON Teresa Lorenco
RENEWAL Legal Name:Renewal by Andersen LLC 35 Westwood Terr
HIC#170810 Florence,MA 01062
brANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)331-9638
Phone:(508)351-2200 Fax:(508)986-7072 I rbaboston@gmail-com
ID#: ROOM: SIZE: DETAILS: PRICE:
108 Bedroom 1 Window, Double-Hung (DG), 1:1, Flat Sill, Base Frame,
Traditional Checkrail, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Hardware, White, Screen, Fiberglass, Full Screen,
Grille Style, No Grille, Misc, Standard, Replacement of
window frame and sash, includes casing from standard
options.
WINDOWS: 4 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 1 TOTAL $21,397
''""! Renewal by Andersen is committed to our customers'safety by
714011F., complying with the rules and lead-safe work practices specified by the EPA.
03/13/23 Page 4/ 36
�01 Payment Authorization Form
f DBA:RENEWAL BY ANDERSEN OF BOSTON Teresa Lorenco
RENEWAL Legal Name:Renewal by Andersen LLC 35 Westwood Terr
RENANEWAL HIC#170810 Florence,MA 01062
DEoannx�n RSE30 Forbes Road I Northborough,MA 01532 H:(413)331-9638
mgmummo
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Teresa Lorenco
BUYER NAME
35 Westwood Terr Florence
ADDRESS CITY
MA 01062 (413)331-9638
STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2
6.99%fixed rate 15 yrs no pre payment penalty 3569 $21,397
FINANCE PROGRAM` FINANCE PLAN B` CONTRACT BALANCE
Marc Festa 0000000-0000000
SALES REP APPLICATION ID OFFER EXPIRATION DATE
*If your financing is pending,the Finance Program and Finance Plan Number are subject to change
PAYMENT SCHEDULE ($21,397)
CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION(4)
FINANCING $0 $7,132 $7,132 $7,133
(1) CASH DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or in whole by cash,check,or credit card
("Cash Deposit").
(2) FINANCE DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or In whole with financing("Finance
Deposit").
(3) START OF JOB: 1/3 of the purchase price is due at Start of Job.
(4) SUBSTANTIAL COMPLETION: Final payment is due on the day of installation when all windows and/or doors included in this agreement
have been installed into their openings and any interior and exterior trims have been applied("Substantial Completion"). If there are any outstanding
warranty claims or service items,customer may retain an amount equal to the value of the outstanding item(s)or work to be done,not to exceed
10%of the total purchase price.Due to project changes after Contract Signing,the final payment is subject to change.
BY SIGNING BELOW, I/WE,THE BUYER(S):
1. Authorize Renewal by Andersen to transact payments based on the amount(s),form of payment(s),and timing specified in the Payment
Authorization Schedule above.
2. Acknowledge the use of the loan to make a purchase will constitute acceptance by all Borrowers of the Loan Agreement.
3. Instruct the Lender(if applicable)to disburse the proceeds of the loan to Renewal by Andersen as identified above in the amount(s)
and timing specified in the Payment Authorization Schedule.
4. Understand that Renewal by Andersen must be notified In writing of a change in payment method in advance of the respective payment.
Teresa Lorenco 03/13/23
BUYER NAME SIGNARIRE DATE
03/13/23 Page 5/ 36
Go Permits, LLC
G , 105 Buttonball Lane
Glastonbury, CT 06033
PERMITS Scott Doughman
Phone: 860-952-4112
Fax: 860-430-6719
scottdoughman@gopermits.org
Re: Building Permit Application - Licenses
Good day,
Please find attached permit application, licenses and supporting documents.
Renewal by Andersen sold the job and is the G.C. and CSL
- CSL #CS-090125 — Exp. 10/06/24
- HIC #170810 -- Exp 12/22/23
- Workers Comp -#MWC 3145822 — Exp. 10/01/23
Old Republic Insurance Co
All licenses and insurances are attached.
Once the permit is ready:
• Please fax or e-mail a copy of the permit and receipt to the below address and mail
the original to the homeowner:
Fax: 860-430-6719
Email: renewalbyandersen a►(�.gopermits.orq
• If you unable to mail the permit to the homeowner please send to the below address
and we will ensure the permit is at the home posted at the time of installation:
Go Permits, LLC
105 Buttonball Lane
Glastonbury, CT 06033
If we are required to pick up the permit in at the building department, please call 860-952-
4112 once it's ready and we will come to get it.
Thank you,
Go Permits
Pigs 1 of 1
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�CO�RD' CERTIFICATE OF LIABILITY INSURANCE oE111/a.f 2a1ao I
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 INSURERS). AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER
IMPORTANT: N the eartlBc s holder I an ADDITIONAL INSURED,the polcy(!w)must Inv,ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may/squire an indorsement.snt. A ataMnMnt on
ties artificMe doss not confer rights to the certificate holder In lieu of such endorsesw. .).
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Willis Tamara Natsa&Mideast, Smc. PRONE
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COVERAGES CERTIFICATE NIl PR:V260o7631 REVISION RIMIER:
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 LS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PM)CLAIMS.
mess ADDLMUMN POLICY POLICY
TYPE OF BUIRAIICE WOOD POLICY
NUMBER OOIYYYY1 a�ffi/YYTY
IN 1 UNITS
X COMIERC104 GENERAL UNMET` EACH OCCURRENCE I 2,000,000
DAtg53E1URir ItU
I CWMSAWACE El OCCUR PRE/45Ee Ma owarsoc] I 500,000
A M1ED EMI(Mr one small f 10,000
retGY 314141 22 10/01/2022 10/01/2023 PERy ILAI RY I 2,000,000
''''GEHRI AGGREGATE W APPLES T PER. GENERAL AGGREGATE I 1,000,000
��
/POLICY a IX& a LAC PRODUCTS-CORIPIOP AGG t 4,000,000
OTHER I
AUTOMOBILE LABILITY COMORO SINGLE LAST f 3.000,000
Ma smarm
X ANY AUTO BODILY INJURY{Par mum) I
A OWNED SONEDULED MITI 31415E 22 10/01/2022 10/01/2023 BODILY INJURY NPR accnenhi I
� ,AUTOS S ONLY �� NcTHCFLO*P4ED 'P7LOPtRTY DAMAGE
AUTOS ONLY AUTOS 0N.Y iHmarm r a0 I
I
■SIMILE AL.AB H OCCLiR EACH OCCURRENCE I
•�MESA LAB CUMIS ADE AGGREGATE I
CEO I IRTENTIONI I
INORKMISCOMPENBATIoN X I STATUTE p`mot I I fRTM.
AMD EMPLOYERS'L1A Y IN 1,000,000
A IMPROPRSETORIPARTNEREXECUTNE EL EACH ACCIDENT I
OFFCERMENBEREX[YUOECP [J NIA MC 31A15a 22 10/01/2022 10/01/2023 1,000,000
SMINI Mrs N NIB El DISEASE-EA EMPLOYEE f
IT 0rcnbauOfld
DESCRIPTION F OPERATIONS dim E L 015549E•POLICY WAITI 1,000,000
GEBCAIPUON OF OPERATIONS/LOCATIONS(VBNCLES IACOMI NH.A6a50.M Ra.MMs SAAIaahr,RV/ea aaad d MOWS Well is nsma alq
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY Of THE ABOVE D[SCRSBD POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN
ACCORDANCE ATM THE POLICY PROVISIONS.
AUTHORSTED REPRESBITATNE
Evidence of lnauranco Al-1. -f ote-
01lNS-2N1i ACORD CORPORATION_ AN rights reserved
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
SM m: 23076070 *&TCA 2676324
Commonwealth of Massachusetts Comiliddisa Supervise►
litir Division of Occupational Lncensure Unrestricted-gum of eery use group which cedsi
Board of Budding ReluIsUons and Standards less then 36,000 cubic et Nei cubic meters)of ewior
C o nstklltkui Skioerv.s o r apace.
CS-090125 ', Empires: 10106l2024
JAIME L MORIN f ,
54 NOTTINGb4AM RD - i
RAYMOND 1S 03077- 4
Failure to possess a current edam of the Massachusetts
Cor m:sssorcr gotta 4 t tit. Stale adding Code is caws for rsvocuSon of this license.
For uilartl iatlaa spout this license
Cal flit 71727-3 or visit www.snsss.go sdp
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
.
,- Type Supplement card
170610
RENEWAL BY ANDERSE"N LIC 12t22'2423
30 FORBES RD
NORTHBOROUGH.MA 01532 .
7;4
' � Update Address and Return Card.
THE COMMONWEALTH Or MASSACHUSETTS Registration valid for individual use only before ins
Omc.of Consunwrr Alibis&Business Regulation fl M tewW return to:
HOME IMPROVEMENT MEN! ni Card TC»t iiripireswin Office of Consumer Affairs and Bustrrss Regulation
TYPE;SUppifMlwih Card 1000 Washington Straw -Suite 71e
170010 122?t20. Swami.Eta O Swami.NA 02111
RENEWAL K'r ANLDER+EN LI.0
' ---;-0,7
JAIME 30 FORBBEES1N RD ,.�G,,et.1,y iaifr►t Zlicl
.m.�._...�—_tvORTHBOROUGH,MA 01022 Undersecretary Notthout sign Mute
-, -, RENE .
ir
byANDERSEN
y
fit
To Whom It May Concern:
This letter will authorize the following persons)to act as agent(s)on behalf of Renewal by
Andersen U.C. 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for permits and
Inspections with respect to the installation, maintenance and repair of windows and entry
doors under Massachusetts State Homo improvement Contractor license number 170810 and
Construction Supervisor license number CS-09012S.
If you have any questions, please call me at 508.351.2277 ext 6
Authonzed pers,on(s :
Go Permits LLC Sarah Hammad David Anderson Maureen Kivei
Scott Doughman Ryan Biondo Sovannara Kuy Mark Foster
Glynn Horgan Jennifer Winke Wendy Holden Gerald Cramer
Nick Rao Dane!V ckerman Stephen Wilder Katie Grocott
Bennie Myers Carrie FolIgno Michael Rogers Rachel Orloff
arms Morin
Renewal by Andersen LLC
HIC 170810
CSl—CS090123
Local District(Ace Address
30 Forbes Rd
Northborough, MA 01532
=Yrwal by£rrdemen 9 OO 1ama.a Ave South.Cottage Grave MAt SS016