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29-256 (9) BP-2024-1154 101 OVERLOOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-256-001 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-2024-1154 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2024 Contractor: License: Est.Cost: 6447 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: A ALDRICH DALE&DEBRA Lot Size(sq.ft.) Zoning: WSP Applicant: RENEWAL BY ANDERSEN Applicant Address nom Insurance: 30 FORBES RD 508-351-227 MWC314158 NORTHBOROUGH,MA 01532 ISSUED ON: 09/09/2024 TO PERFORM THE FOLLOWING WORK: NEW PATIO DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector l:nderground: 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: ti.,./Z Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner lea , r • : assAndtrv�,n �10 pe 'r. . i f 1. The Commonwealth of Machusetts , Board of Building Regulations and Standards FO A ITY �' R ` r Massachusetts State Building Code, 780 I R BECE1 i SE Building Permit Application To Construct, Repair, Reno e to 0. Demolish a Revise. Mar '011 One-or Two-Family Dwelling SE? — 2°24 This Section For Official Use Onl ■ Building Permit Number: 6Pei ti• 1164 Date Applied: ►ri& cstoNS � DEPNo�z1NAM v oN.��' .. 7- 9- Building Official(Print Name) ignature Date SECTION 1: SITE INFORMATION 1.1 Property Address• 1.2 Assessors Map&Parcel Numbers 10 I Oar Wok -Rio 1.1a Is this an accepted street?yes- no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) From Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: __ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 215 Own r'of Record: U 4 Debra. r-iEk Etorotte, MA-, 0 iol Name(Print) City, State,ZIP (a 1 OvtvCook Mlle. Arm n-7735 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 01 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units I Other 0 Specify: pate door Brief Description of Proposed Work: %MOW d- r.epta, . I pace door — SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials)._ Official Use Only 1. Building S 6 ►..JL/?T1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost(Item 6)x multiplier x . 3. Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. Mechanical (Fire $ Suppression) Total All F e.,/k/ / �� Check No. h ck Amount: (� Cash Amount: 6.Total Project Cost: S 61,1j.'.... 0 Paid in Full 0 Outstanding Balance Due: City of Northampton \s Massachusetts DEPARTMENT OF BUILDING INSPECTIONS , 212 Main Street faMunicipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING. ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR. ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s)and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new / replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW/ private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0R018 5 - vOm t d h K License Number Expir ate N�ir,e of CSt.Hold 614 List CSL Type(see below) No.and Street �� �Type Description J Unrestricted(Buildings up to 35,000 Cu. ft.) ma�(,1) /'// Restricted 1&2 Family Dwelling Gin o v te,Z P M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5 Registered Home mprovement Contractor(HIC) HIC Registration Number Expiration Date H�. o ny Name or degistrant Name bq @ ga�rwts.o� N , d e t Email address City/Town,State, Telephone SECTION 6: 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 a` No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize tJ5 Cat b0 LLtti. to act on my behalf,in all matters relative to work authorized by this built g pe 't application. Gebraitickek. rint Owner s Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information co tamed in this application is true and accurate to the best of my knowledge and understanding. gr► Rey/ay_ Print Owner's or Author NJ A,ent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton 7 Massachusetts `` , t• ' }�.{ DEPARTINT OF Is INSPECTIONS ' —am 212 Main Street IsMunicipal Building r Northampton, MA 01060 s'sa CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: $O Sort)/5 ' Wad' gortiiiro reap 4'153 — The debris will be transported by: Name of Hauler: 1)0045tf, Woiiojtn'niP Signature of Applicant: tt IL Date: a(yiaV The Commonwealth of.f,lassachusetts 1` ai Department of ltulustrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-201 • :4 P ' www.inass.golVdia 110ticers' Compensation Insurance AfYidatit: Builder*+Contractors:Electrician. Plumbers. 1O Bt.111.t.l)‘S 1111 I III I'I.R'11 I"1-I\t: !DORI Il. . 1)I)licant lnforulatiun Please Print I.et!.ibis Name \lltua`.}. State zip Phone %re auu un(lapis cr'( bast+the aplrruprtu(r hot: I 11't)t:of project(required) 4 ...71 1 am a:ny+l,j a s% cm rioj:c,I tail artal ct par;•hnhcl' ; ]. \c x% construction .D I ant a+a,)c MT( ctot t.r i'.aY:I:r,h.p artat ha,c no nnpl.:a.c,% utl.I tot li,s. K. 0 Remodeling lap.7c1t4 I\ v,orlr.l:r,.contr.at,tsrarla: riyurtcd f I.) 0 Demolition am a)turn V.N lice Vr1ir1Y all Nurh:n.•c f: \. '.+.-I..1- :,•:t•{t ,c,urancc 1 U Building addition -=.a I in a horrxVN ItCo and'a 111 rc hum,:,Anil .fur,to a,.Yra!uct ail•,soft.r•r.nn pt,•p.rlj 1,.:I ensure that all c,•uu ac Wits citlwt 11aK N,I It:R• t YRiti lt,allvn InNularltc or at:sr•!c 11. lacclr teal repairs or aCldltlon' prupnaar,Nits•nu ctnpl.ncc� . 12_.Li Plumbint repairs or addition?, 1.3 I a c',cl r11 a 1cncta. imatal and l 11. c h +uho a!'. ucal tL•c -cnhc:ol,hsk i'am tF-altaatl:,!+:rca: thew,uh-cunttuctot,h.t,c crtlpluj.c, oall:a:c>a Other.':untp.ut.hrax:. I3�Root repairs -y 1 i.QOthei 60 11c an:a c,•1ism..ilion aril!It,othccr,tuac cxcrcis(J tlxtr nrht utcm:mi l:on pc, \I(rl.c. _.. - - l�1 I ;)talc 21nd ti.c ha+c t:u.tnp)u•.cc,.I\u.a uriccr,'comp.CI.,l:rancc tcywn•r:.l 'Any apphcmrl that ch.vl,box ul ntu,t ahu till ual[hc xch,vt!dux shuNtnr[heir xani a,':ouqu r.rtn•a;•.•I:,, :,.. :rI:1'I 1 H+nuco1 r,cro'Ail(',ul'au1 Ilu, Iudicultnl:this'arc I'.•n all:,ut6 aucl tt.:r.hue'.'rt,ial.con:Ia:D:t,t: ..Ir I.d J I JJ,I.rl:iJa%it Cunlractorn(6u1 che, Ilan box MLA attxbcti an.1Jattiona)skeet s;Il,Nir1.1!Iv carafe+•I I wh:r.nttnacC,an 1.:a'.: !:.:a: .•r:.,t rh•..::nl.lr:. .,.: :r.tpl,,r,, It ,:h:.•ri: c'..,1'Los:cntpk•..c•..Illct nr.r•l pr,•'•Idc 1st, 1 ant an employer that is providing tt'arAers compensation + urance•for myenmplo►'ee t. Below is the'Wier trio!job site lit formation. I insurance Conepatly �iattic t _ Policy r or Self-ills. Lie. p'Y10 l:splratton Date. . Job Sttc Address: ('1ty.Stag Zip: Attach a copy of the vsorkers'compensation policy declaration page(shossing the polio number and expiration date). Failure to secure cot I:ra'e as required under\1(,L c. 152. ;25A is a criminal t irlahon punishable b, d fine up to S1`UI)I)() an(t or one-''ear imprisonment.as total a•ervil penalties in the tone of d STOP WORK ORDER and a tine ot•up to S25(1.I0 a (Jay against the t utlatcrc- A copy of this statement may be fttrttdrded to the Office ot•Investigations of the DIA for insurance a: .rdt,'C s ertliCatKVtl. I do hereby certify under the pains and penalties of perjury that the infmrmatian provided above is true and correct. S;_na(ure. 11a1c l'•.:rt::c r.: Official use only. Dr,not write in this area.to he completed by city or town official. City or-Flinn: Pcrnritil.icense fl issuing.kuthorits Icircle one): 1.Board of Health 2. Building Department 3.City'Joss Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: fz"., The Commonwealth of Massachusetts ___ __ _: Department of Industrial Accidents 9 ____,,.,,„ Office of Investigations , -__ l,. Lafayette City Center � '` Boston, MA 02111-1750 �. :J 2 Avenue de Lafayette, .,�- 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 T 508-351-2277 x 6 T_ Are you an employer? Check the appropriate box: Type of project (required): l.):4 30 4.I am a employer with ❑ I am a general contractor and 1 6. 0 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. 0 Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in anycapacity. employees and have workers' p ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its I0.(l Electrical repairs or additions 3.❑ 1 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 l? ri Roof repairs insurance required.] $ c. 152, §1(4),and we have no Replacement employees. [No workers' I>. Other p comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t 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 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 314158 23 Expiration Date: 10/01/2024 Job Site Address: /0/ O eri0Ok Dri✓e City/State/Zip: JIOr4$Ce1 in O1O62 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 pains and penalties of perjury that the information provided above is true and correct. Signature: /'�'Gtg2.GlL Date: 08/31/2024 Phone#: 5 -351-2277 x 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): IDBoard of Health 2[3 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector :CEPlumhing Inspector 6.0Other Contact Person: Phone#: - �, �,.. RENEWAL �!:/ brA N D E R S E N • f at SERhCE 1YIFOOiY&DOOR REP1A(f.NEAT Ir f 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 If Using a Builder DBA:RENEWAL BY ANDERSEN OF BOSTON Dale&Debra Aldrich RENEWAL Legal Name: Renewal by Andersen LLC 101 Overlook Dr RE RE HIC#170810 Florence ,MA 01062 NDER AL 30 Forbes Road 1 Northborough,MA 01532 H:(413)320.7735 Phone:(508)351-2200 I Fax:(508)986-7072 ;rbabostonbooking@andersencorp.com Property Owner Must Complete & Sign This Section If Using A Builder I, as Owner of the said property, hereby authorize Renewal by Andersen LLC to act on my behalf, in all matters relative to building permit application for the property/address indicated on this agreement. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Daniel Blood Dale Aldrich Debra Aldrich PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 08/22/24 Page 27 / 32 ND/ Agreement Document and Payment Terms p,% �. DBA:RENEWAL BY ANDERSEN OF BOSTON Dale&Debra Aldrich NEWAL Legal Name: Renewal by Andersen LLC 101 Overlook Dr RE RENDER A HIC#1.70810 Florence .MA 01062 byAm y, 30 Forbes Road Northborough,MA 01532 H: (413)320-7735 Phone:(508)351.2200 I Fax:(508)986-7072 j rbabostonbooking@andersencorp.com Dale & Debra Aldrich 08/22/24 BUYER(S)NAME CONTRACT DATE 101 Overlook Dr, Florence , MA 01062 (413)320-7735 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER chevynascar03@yahoo.com PRIMARY EMAIL SECONDARY EMAIL NOTES: 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: $6,447 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: $6,447 Estimated Start: Estimated Completion: 8-12 week 1 day AMOUNT FINANCED: $6,447 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: 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 08/26/2024 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. D,J-t64 SIGNATURE am- SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Daniel Blood Dale Aldrich Debra Aldrich PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 08/22/24 Page 2/ 32 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Dale&Debra Aldrich RENEWAL Legal Name: Renewal by Andersen LLC 101 Overlook Dr HIC#170810 Florence,MA 01062 EN D 30 Forbes Road l Northborough,MA 01532 H:(413)320-7735 Phone:(508)351-2200 Fax:(508)986-7072 rbabostonbooking@andersencorp.com ID#: ROOM: SIZE: DETAILS: PRICE: 101 dining rm Patio Door: Gliding 200 Series PeralaShield 2 Panel Active / Stationary, Aluminum Sill, Exterior White, Interior White. Performance Calculator: PG Rating: 25 I DP Rating: + 25 ; - 25 Glass: All Sash: Tempered High Pert. Srar: Hardware: Tribeca- , Stone, Exterior Keyed Lockk. .4uxilia:,, Foot Lock Color Matched, Screen: Gliding, Full Screen, Grille Style: No Grille, Misc: Nr,, WINDOWS: 0 PATIO DOORS: 1 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $6,447 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 08/22/24 Page 3/ 32 .. ,... . ri.. Go Permits, LLC r^^*� 105 Buttonball Lane ,, Glastonbury, CT 06033 .::-. i ,-, Vi i, I.,:4''',, ' i Scott Doughman r Phone: 860-952-4112 1, ,: 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 314158 23— Exp. 10/01/24 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: renewalbyandersen0gopermits.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 1111111 ra 'R E Isi E WA L • {—! $- byAN D E R$E N / feud is MOON t mitlf +y r+rr►- To '.edam It May Concern. This letter will authnrre th(.! follow rj sre'soriIs) to act as agent(sl on behalf of R,,newal by Andersen LLC, 9900 Jamaica Ave Soutni, Cottage Grove MN 55016 :a pull fof per nits and irs p ectio"r5 w,tt'i respect to they installation, maintenance arid repair of wI"irjusys and entry rlrtrrc. rrn,ia� Macc_ar-arh3a'tc Stara -Morro smrirr.nftement (cntractor lir:en:e norrb t 1 1ng10i and Cori st ructi u i Supervisor License r l 'r De r CS-09012 5. If you h:a•vr ci ,r •')l.ustiu,<,, t 51(..)$ 351 2277 Lht 4 Authnrkzed pPrswrs(s): Go Permits L=1.C. Sarah Hammed David Anderso^i Maureen RitveI Scott Kean B ondo Say all7afa k.uy Marl.: Foster Ncrg,an Jernnif€r Wirki Vie Tidy HelCr_r, ,ljr.ralr; c,rarner Nick Ratio Dar,elVfekerrnan 5teoher- Wider Katie Grccott Bonnie Myers Carrie col_gnu Michael Rogers Rachel Orloff • n - ramie Mo in gry,`aw3I by Arirfer-se,' LLC HI( 17081C ('St —CS09Ce 2S Local District Office Atidc res5 30 Forbes's Rd Ncrthhoro.)0, MA 01532 Rtnewa)by Andersen 1,4C 99C4 brrram-a A,,!c-South.Cattaw:e Grate MN SSr t4 Page 1 of 1 ACU;� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD'YYYY) �- 09/21/2023 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. ---- .---'--------....------•--.._....-.------ -.-_--_—�. PHO c/o 26 Century Blvd LAlCNN._o,-)ixtl 1-877-945-7378-- - FAX N/4 1-888_467_2378--------- P.O. Box 305191 EMAIL ADDRESS: certificates@willis.com Nashville, TN 372305191 USA ERS AFFORDING COVERBAGE _. --------------INSUR-SURE. - ----- ---- _... . i -NAICB---- -- INSURER A: Old Republic Insurance Company I 24147 -------___---------------._._._-SUSS--------__ ---•- ----SUSS-- INSURED INSURER B: Renewal by Andersen LLC -----'---_---- 30 Forbes Road INSURER Nor thborough, MA 01532 INSURER INSURER E INSURER F: 1 COVERAGES CERTIFICATE NUMBER:w30224860 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! TA -DAT -POLICY EFF ri)OLICY EXP� LTR il TYPE OF INSURANCE JJJISD: �yO i POLICY NUMBER I(MMIDDIYYYY)i(MMIDD/YYYY)t LIMITS I XI COMMERCIAL GENERAL LIABILITY I ! I EACH OCCURRENCE �$—_ 3,000,000 jRe CLAIMS-MADE l Xl OCCUR I PRM SESrAM-TbE2oiTE-0-ce) 1$ -,—_ 500,000 A IMED EXP(Any one person) !$ 10,000 MWZY 314161 23 10/O1/2023'10/O1/2024' PERSONAL BADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 kX POLICY PRO• r t 6,000,000 r I C__,JEC'f t_.-..1 LOC I PRODUCTS-COMP/OP AGG $ _ ---- I OTHER I (SUSS-SUSS-- .-- $ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO5,000,000 I 1 X BODILY INJURY(Per person) '$ A I- 1 OWNED SCHEDULED ! MWTB 314159 23 l0/O1/2023 Lo/01/2024 II I BODILY INJURY(Peracodent) $ �AUTOS ONLY AUTOS • HIRED NON-OWNED PROPERTY DAMAGE -1 fAUTOS ONLY AUTOS ONLY .IPeraccdet._._ _-._• •— S- — __ -_-__ 1 UMBRELLA LIAB RETENTIONS OCCUR EACH OCCURRENCE $ _SUSS- R_NCE -- EXCESSLIAB CLAIMS-MADEi { AGGREGATE $ $ 'WORKERS COMPENSATION r X I PERTUTF. 1 0 T H- ANO EMPLOYERS'LIABILITY STAj` 1 ER Y!N E.L.EACH ACCIDENT $ 1,000,000 A ANYPROPRIETORIPARTNL'RlEXECUTIVE OFFICER/MEMBER EXCLUDED? No N/A WC 319158 23 10/01/2023 10/01/2024 r-- - 1(Mandatory In NH) LEI.DISEASE_EA EMPLOYEEI$ — 1,000,000 If yes,describe under I DESCRIPTION OF OPERATIONS below ; E L.DISEASE-POLICY LIMIT S 1,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if 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 O Evidence of Insurance '•`n*L be. 41420 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SIB. ,;'. 24694639 =nrcr._ 3138744 Commonwealth of Massachusetts Cot Syy,s,yr IIIII Orvision of Occupational Licensure iMrestrictod_ o0an use '.0 Board of Building Regulations and Standards �ub P which contmo t t less than JS,U00 cubic feet(t61 cuc moors)of endwsad ons`rdi'3.�n Sti r::s,_r s,pacx,. CS-090125 6:pi res: 10!0612024 JAIME L MORIN 54 NOTTINGHAM RD ..a,„ RAYMOND NIl 03077,'-•••?',' r g..). ....;:isooll:t Faitwe to possess a current edition of tha Massachusett4 Stale Budding Code is cares for revocation Lion d this gcanse. Corning.aicr c For trlartni ion about this henSe Cad(617)727-3206 or viaft www.resss.gorldpt Unice of Consumer Attatrs and business Kegulation 1000 Washingtca4,1r%et - Suite 710 BostoQrtitlassac husetts 02118 Home Improien ent_ tractor Registration r s • Type Supplement Card s 2egisttation: 170810 RENEWAL BY ANDERSEN LLC E*psration: 12122/2025 30 FORBES ROAD ':.. NORTHBOROUGH. MA 01532 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:SuPpretnent Card Office of Consumer Affairs and Business Regulation Rgyi511.8tl9D FaiRlitti520 1000 Washington Street -Suite 710 17.0810 12/22/2025 Boston,MA 02118 tENEWAL BY ANDERSEN LEC .f iME MOP.IN • t0 FORBES ROAD 4ORTHBOROUGH.MA 01532 Undersecretary Gz�Not valid with6ut signature