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49-007 (3) 282 GLENDALE RD BP -2009 -0870 GI3 : COMMONWEALTH OF MASSACHUSETTS Map:Block: 49 - 007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2009 -0870 Project # JS- 2009 - 001272 Est. Cost: $5495.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN_ Lot Size(sq. ft.): 7797.24 Owner: GAUTHIER LYNDA M zoning: SR(100) / /WSP II Applicant: RENEWAL BY ANDERSEN AT: 282 GLENDALE RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919 - 0900 NORTHBOROMA01532 ISSUED ON:4/24/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: Replace 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 4/24/2009 0:00:00 $35.007486 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo s of permit: Department ent use only city of Northam Statu B u i I d i n g p e psatrrirempetetonnt v vSC eu \le Sut s laacatYibluaciiPrlbiatyReitYplans, iLy DwELLING 212 Main 100 Twa . pians _ Room MA 01060 plot/site , ; ,;;•-;„,,,, Northam M r' `' 3_587-1272 Northam, _40 F 41 O ther SP phone 413-587-1z TW A ON APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMO Tb L i l s SH seotion to boo,o by office ....— Lot SECTION 1 - SITE INFORMATION dress. • t zMoanpe Overlay District 1.1 Property Ad .....,, (..‘ 1 ,..t*...... ‘' IP/AUTHOR IZED AGENT Ty OWNERSH ,,,,,, N 2 " - i.. -4 SECTION - - PROPER Elm St. Distri,ct GB District , i c, 1,,, ' r '''' ' 2.1 Owner of Record: L Current Mailing i t ''''' r ' Name (Prin" i i , — i I ' l •'4 ' ''. Signature 1 Tel:ph i' one c .',i•• Address. f ,•• ' '.•, i '•'° ,, Ir., ) '•'•- , E ., '_•-' 11 , , .. 2.,,,•,,), 2.2 Authorized Agent: Telephone Nm i e ., •„.,, t) ESTIM •0•TIMO260••0•••;!40 Signature •;,00•• • , •,_ ,,,• CCurrent nt Mailing Address: , 0 i ,00, , • --) be SECTION 3 - Estimated Cost - r ili ng Permit Fee ATED CONSTRUCTION COSTS (Do completed by permit applicant Item _ liars) to - C. (a) Buil_ , Off_icial Use Only 1 Building <At,'' ''''''-,, 2. Electrical ,-- I ' 13 ( b i E cd t m t ni t f a Fro l eni C e o ( s 6 t ) ot 3. Plumbing i(,,_ 7 35, * (-: .14,. 7(-1- 4 Number Check Num 4. Mechanical (HVAC) . Pro prot ,_, 'b. iii This sec 5 Fire 1+.....n+4+D) 6. Total = ( iz ± 0 ' Lt. t Section ForsoasfftlicdC1.:a Use only Building Permit Num hle a, ti lizi 1 O Jo bet': ,,,... Signature: Building CoMrrlissioner/Thspector of Buildings Date 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: Rear .., Building Heighr_ Bldg, Square Footage % Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces - - -< Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES 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 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc nation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 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 n Addition ® Replacement Widows Alteration(s) n Roofing n Or Doors [� Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0] Brief Description of Proposed Work: L - t l , ,s'vs ,{ c 4 V �: i � F- 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. Wit 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 1, , 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, `s \ 1.:, t- , as Owner /AB{h orized Foment 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. — S ; Print Name Signature of OwrU /Agent -- Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder �`, } � l License Number I G Address Expiration Date Signature Telephone JJ 9. Registered Home Improvement Contractor: Not Applicable ❑ q`— �_... .. �J• �t '� � - r v . e: 's I 1 -) C .3 ✓I , :i i 1 Company Name Registration Number ( l I\, l . t t _ 5 j ,, i Address Expiration Date „ Telephone 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 12' 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 he 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 __ FTCORD. CERTIFICATE OF LIABILITY INSURANCE DATE iXIAIDDNYY'l 02/17/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph Mc Keene ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP McKeone insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RO. Box 333 Ann Arbor, MI 48106-0333 1NSURE:RS AFFORDING COVERAGE ' t-zA1c # — INSURED Renewal by Anderson INSURER A Hartford Insurance Company -- -- J&L Windows, Inc, INSURER e. Hermitage ; _ 104 Otis St INSURER C Northborough, MA 01532 INSURER D I 1 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUED 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLI POLICY EFFECTIVE I POLICY EXPIR __ ATION I TP IN5RDI TYPE OP INSUPLA.±RTE POLICY NUMBER DATE (1.:MICD 1 pr E rip•A/D0A/y1 LIMITS B GENERAL LIABISTY HCP 507 404 09/07/2008 09/07/2009 EACH OC,C URRENCE S 1 000 000 1 nAivi.AGE TO R=1,ITED _X! COM) ci...Aims 1,(4E X I DCUR MERCIAL GENERAL LIABILirr I PREWSES (Ea o=..(ren) 1 S 00,000 _ o r S L j I— MED EXP (Any Crxt persc,M1 S LPERGONAL & ADV INJURY $ 5 000 1,0.00 000 AGGREGATE LIMIT APPLIES PER POUTS CO C 2.000,000 OGENL GENERAL AGGREGATE -- i $ RDS • MPIOP AO S 2,000,000 /ECT 1 I L'-' I 1 POLICY 1 PRo- i i • ,_,- A 1 AL/TOW:GU. LIABILITY 35 MCC XD 6390 10/01/2003 10/01/09 COMBINED SINGLE. LIMIT _ 5 1,000,000 Ej ANY AUTO i,ati acavaanI) ,... , Y--,, . , 0 A' -',. -• _ W IRY .., 5 .PAGID LY (Per persan) I 1 SCHEDULED AUTOS I HIRED AUTOS BODILY INJURY S a=ear,t) N (Per ON-ONNED AUTOG • , r I 1 , 1 PROPERTY DAMAGE. s 7 (Per aclentl 1 GARAGE, Laziury AuTo ONLY . EA ACCICEW I 5 7 ANY AUTO EA ACS I S I I OTHER THAN AUTO ONLY ASG i $ 1 . i EXCESS:UMBRELLA LIABILITY I EACH =CURP.ENCE ,-- 1 1 I AGGREGATE S 1 S I , 7-1 1 , OEDIJCITE:E 1 ' s 1 RETENTION S I I 5 - A 1 Y•CRISERS COMPENSATION AND 35 WEC PP 1444 02/17/2009 02/17/2010 1,..v,,,4- IT'' I I EMPLONERS' LLABBITY I s , E L 'SASH ASCISENT 500,000 ANY PROPRIETOR+P,kRTNEVEXECUTIVE i CMCEPAIEFIBER 'EXZ,LUL'PED7 I E L DISEASE . EA EMPLOYEE ; 5 500.000 S PECIAL pv ixta...4 I EL iptszAsp .poLicy L.IMIT 1 I 500.000 1 ori—izR 1 , DsLIRIP'11C3N OF OPERATIONS I LOCATIONS i N,IICLE.5 1 excLusioNs ADDED BY ENDORSES:ENT 1 SPE=L PROVISIONS CERTIFICATE HOLDER CANCELLATION .........-- ssvdLo ANY OF TEE ABOVE CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION NSURED CO DATE TNPREOP, ThE ISSUING wsuRER virtu. ENDEAVOR TO man.. 10 DAYS ekrgITT.-N .. IPY NOME TO THE .RTIFICATE HOLE KAMM TO THE LEFT, Din' FAILURE TO DO 5 SHALL IMPOSE NO OBLISATION OR LIABILITY OF AMY KIND UPON THE INSURER. 'TS AGENT'S OR REPRESENT:OWES. AUTF431121:, REPRESENTATIVE 411/ Ce1071.---e.•-• I — ACORD 25 (2001/08) (f)ACORD CORPORATION 1988 Renewal License 1490 0I rpires 1 /24/ 10) . e. E RENEWA B Y ANDERSEN Federal I t In' s ')40420 �'Y�[�d�t SE'il Of wiREATER MASSACHUSETTS AND New HAAIPS,.URE WINDOW P LACEM �Ni n An.. �. C:,nry +.y 104 Otis Street A Northborough, Massachusetts 01532 Phone 508,919.0900) Fax 508,919.0903 SPECIFICATION SHEET Buyers) Name Date of Agreement y'� t�:� Cy Gu a. — 1 - dy -61' ,_ - 7, The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and /or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOV'J AND D000 REMODELING,AGREI MENF, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of _ windows in Owner's home, using the following individual quantities: _ Double Hung (08) X Equal sash ❑ Cottage sash (1/3 top, 2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom) Casement (CW) ❑ Hinge right ❑ Hinge left (as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement (01 Vs) ❑ Standard handle ❑ Metro handle Casement / Picture / Casement (CPW) ❑ 1.1: or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) Glider / Picture / Glider (GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) — PictureAViindow (PW) Bay or Bow Window Patio Doors (sec separate Door Specification Sheet) 2. X Yes ❑ No Qty of \A/indows to be Custom Fit Replacement: >. r i Yes x No Qty of Sills to be replaced by Contractor: 4. g Yes ❑ No3Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) Exterior casings: ❑ Pine ❑ Maintenance -free material Factory applied 908 Fibrex brickmold 5. Glazing to be: X TIP Low E Ri SrnartSun' (Tax Credit tEa El Other If other, please specify: G. Exterior color to be: ,X, White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7 Interior color to be: Xj white ❑ Sand ❑ Canvas ❑ 'Terratone ❑ Fine ❑ Maple ❑ Oak Note: Interior color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. 8, Hardware: X White ❑ Stone ❑ Canvas ❑ Brass Double Hung: 9. X Yes ❑ No Install Lifts with 1)ouble Hung Windows 10. Sri cens: windows to have: X Halt or ❑ Full screens Screens to he ❑ Fiberglass ❑ Aluminum, ItnScene GRILLE DETAILS 11. Winaews have grilles: X es ❑ No if ytsX Grille Between Glass (csc) 1 Removable Interior Wood stem) ❑ Full Divided Light mnri Qh' Qty Q _ _ Qt ! yy Qty: _ Qty: _ Qty: r. i�- - DH 011 CW /Picture Guider C1'1 GM. Difing g patterns above `Use additional sheet if needed Owner approved (initials): ( "- )- ADDITIONAL WORK DruAILS 12. ❑ Yes xi No Contractor will remove metal frames of windows. Qty of Units: 13. ❑ yesA No Contractor will install new paint -ready or stain -ready casings. Interior casing qty of openin -- Exterior casings qty of openings: _ ❑ Pine ❑ Maintenance free material 14. ❑ 1'es No Contractor will install new paint -ready or stain -ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty opplings: ❑ Pine ❑ Maintenance- -free material 15, Owner is aware that Contractor does not do any painting. ( - . 7j ) Owner Initials 16, ❑ yes No Contractor will wrap exterior casings with aluminum coil stock of color. ote: 33 rappi may be required with storm window removal; removal of storm windows will leave screw holes in casing, 17. al Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 18.X Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 1 lt. Yes ❑ No Building Permit — Contractor will secure any and all necessary permits. The fee for the permit (s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. 20. Additional job details: 2 I X Yes ❑ No Owner agrees to be present on the final day of Installation for final inspection and to deliver final payment. No final pad rncnt shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) her#iy acknowledge that Buyer(s) has read this Specification Sheet. ge7 Renew at by Awl er of r MA and NH Buyer(s) C. ; Buyer(s) by. `"�`� -- - ---- - - - - -- — - - - -- Signatur4 f uc r t Manager Signaht e J If ( 4,-, Signature f a C ` J , G ( ` f 7 C i/ it'i( Print Name of Product/Manager Print Name Print Name RbA Copy T ' - , .. MA. I.i wise n 149601 expires I/24; '01 Renewal r` 1�T I:��'��I BY ANI�h;� I� Federal Tax e <, ")Andersen w,.�nw aEPr��rmE r OT (;RLATFi; \ I.�SS.tvC111, tiFT1S - 1y1) \l_vvH. vy1PSTilRE 101 ( -3ttrci • \urlibor(it {h IV'I.\ f)I iSy Phone 508,9H WOO • Fax Si18. i O (1 1 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Euyeoul Nome Dote of Adreemenl' - l 3,,,e s beer, Address, Cty, 5!vte, aid Zr i Code Z Z C r j 1 o i c L 2 6Marl Adore Home Telephone Number work Telephone Number / /A,, '�� c 5"" �.«'^ yi7 I 4 4-0?/ «It) TTur -a s lurrcls j� dv;tud 1 vrrally I n es to l,ttr tht InuducL and /or,t rvi uf) tc L \\iuiloA - rs 1oc db_t Kenosval he �ndersrin \Loser liter its t.� I Arw Hau Contruiru '� in �t a,rdanc s.jth th, trt to ansl tnxiiticm, dr, on !hF tinter and rile ics rt r- of rtes i -nt t11111 ■1 the 11 anon dicer , !( 111 1 lively his :ne recn�cnt',. Rl)ct r, hereb, at%rr„ t', ,inn a ornp1 ale ,,tree 11111. r iv Itas omplr.icd all vwork under this .A erneitt. Method of Pymnt j Cash J Check J Mastercard ' VISA rolal lob Amount. tsrmnted .Startir0 Date. 1 J Discover -J Financed, App# Deposit Received (33 el " 6 ,JeeLS Name on Credit Card --------- - - - - -- --- - - - --- Belance at Start of lob (3'3%1 Fstimated Completion Date; Credit Card I . Balance on Substantial / C )1 /1 Completion of Job (33%(: Y CC Exp. Date CC Security Code: By Ina thug to c Law led th wt [he L'dl.tncr_ tit 1rt of ! 1 uirl th TIJI2d11, m 8ubst tt t I Comp!! iiun Buyer Initials „T jul. cann. r ha tnadr by _r dit card and must be 1111110 IA Iprr,unal clo k Lank s It s k. or :salt Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verhal understandings changing r.r modifying any of the terms of this Agreement. No alteration to or devie tirrn From this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyers) hereby acknowledges that Buyer(s) I) 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. DO NOT SIGN THIS CONTRACT IF T IERE ARE ANY BLANK SPACES. Renewal by Andr rsen f Greater MA and NH Buyer(s) 7 Buyer(s) ai nc u�[ I da .Mart■,-r i St uaturr Si enure / %I T'r■hw \lhrrtgcr Print Name Prini A trnc YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction '1 _ /q _ Ci' . You may cancel Date of Transaction L i ] / - 61 . You may cancel this transaction, without any penalty or obligation, within this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any three business days from the above date. If you cancel, any property traded in, any payments made by you under the property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed ! Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security by the Seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at If you cancel, you must make available to the Seller at your residence, in substantially as good condition as your residence, in substantially as good condition as when received, any goods delivered to you under this f when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not the goods available to the Seller and the Seiler does not pick them up within 20 days of the date of your Notice f pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the 1 without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written dated copy of this cancellation notice or any other written notice, or send a telegram to Renewal by Andersen ! notice, or send a telegram to Renewal by Andersen of Greater ,1 :ssachusetts c New Hampshire 104 of Greater Massachusetts and New Hampshire, 1C4 Otis Street, Northborough, MA 01532, NOT LATER THAN Otis Street, Northborough,, MA 01532, NOT LATER THAN MIDNIGHT OF - 1 7- C✓- I —. – . (Date) MIDNIGHT OF L/ /3 - . (Date) (Date) I HEREBY CANCEL THIS TRANSACTION. r,. I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date Consumer's Signature Date mov , P. vzdn RNA (t;nv k 0 .4-,.' Renewal b [ 4... Allot F�c YAC�C�CS�Cie " . �� 4 WINDOW REPLACEMENT anArdcrscnCampany WoodNinyl Composite IF Iti ateanal Fe-rest-goo Dual Argon Low E Pengfia lndie W., Double Hung ': 100-00414585 -007 ENERGY PERFORMANCE RATINGS d U- Factor (U.S) /l -P Solar Heat Gain Coefficient 0 30 0.3 ADDITIONAL PERFORMANCE r i sS Visible Transmittance 0.53 Manufacturer sUpulates tnat these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined fore fuad sot of environmental conditions End a specific product size, NFRC dons not recommend any product and does not warrant the suitability otany product for any specific uso. Consult manufacturer's literature for other product performance information. www.nfrc.org , S This product meets Gr 't 31AR° le21113D 1 4.' „r s Seal's envirommntal k► ” standards governing • energy efficiency, heav} t, ; ,, r i j ® meals in the frame ana 4. ,: `v• „. 4 4r sash materials, t . ii cr RI packaging, ducationma E MS= `7 s DESIGN PRESSURE (PSF) � a 13nt Me ,g=tt't tine c r 3 u R bA DB Sloped S ii JWV. aims, .Cm p ill DH IN ., Tested m NAPS -D: tr A 4.M.4r9.DMA/nA IM/IS /A4ID On Mn.nufpnturen snnulntes vInfnrmnoce tn the nnnhanble .rendnrds. Meaty or azcecds M.LC., C E.C, & LE.C.C. Air Inftllttation requirements =NIA Hallmark Certification Progrem. r • • • ,;��e'� re nk ia1•° , ., . R. - Md % . • " W Nlp Yl Co mpait Fr se me " • , ,. .. , • ' . r DuAl, • Atzyt , Low E Picture • . • - EN EF GY PERFOR.EMMMCE'. TINGS i ' . ., • • • ' . , • U- Factor (U. % t. -P • So lar Heat Gain Coeffclent • • ) m . . ..... • , . .. . , • ,. ADDITIONAL PERFORMANCE RATINGS • . , • 1 • ... Visible Transmittance. ` • '.. NU, al•pub ie. aeai N..e pWN •M4A'k Yi■...1. j h. pteredee.r . fa Mirtlhimi*A a • Fee i•es ' ° • L":".,,, i•- iAM •r e r� !R d•HrMr..d W. 0...4 ��i W.gYhMr^at eee.alYane elks ■ err.* rpe e6., .. ' ' _ PC S6 wnol.. r.ert *+o e e l - m e e Ptefeer rdwt:gtl gfeel �ell "a,vtofir Iq l rr�tie.be seef/..las. i.. • ° o.p.vk.P..�ume.w,ar^e P Jr •le Hr: M.[ fntv.i;..}.Inae.lettMenRm, • } , , r. e •'' Fia -! • a`1 #, • • • - • • • .PESit`N PRESSupE'(P.SFI IIIIall'VA • _ ® ' • 5, Q, 1010 -00 98 4 -0 •, • • T.e4J U ,..,,fir's,.$ .. . .. t .,,,,, ^NRNt A} I • • *.t u.,.....I.µ,E,t., P• Ee, i4C:6,®-IrInf44.4rtna*.TeRbrr Pit'.. ce.ySe'aW r•Nn•e • • • , 282 GLENDALE RD BP- 2010 -0858 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 49 - 007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0858 Project # JS- 2010- 001276 Est. Cost: $15000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED LEARY 47932 Lot Size(sq. ft): 7797.24 Owner: GAUTHIER LYNDA M Zoning: SR(100) / /WSP II Applicant: ED LEARY AT: 282 GLENDALE RD Applicant Address: Phone: Insurance: 46 SOUTH LIBERTY ST (413) 283 -3561 WC BELCHERTOWNMA01007 ISSUED ON:4/6/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN & TILE FLOOR 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 4/6/2010 0:00:00 $90.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo Department pse only City of Northampton S ta r s of Permif Building Department Curb Petit* 212 Main Street SewerISeptiCAvatlability Room 100 WateriWell A vailabtlify Northampton, MA 01060 Twa S et s o fStruetural Mans= phone 413 -587 -1240 Fax 413- 58 - 1272 Plot!Site Pf - �. - - O the r S p ectf} APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION -1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: �" Map Lot Unit �" Zone O verlay District . e Etm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record / 7 t r' l n74 ( a ::4_, r Name (Print), , -- ,,= Curre ailing Addr st nt f. 3 _ rr _ ti _ Telephone Signature 2.2 Authorized Agent: Name (Print) . Current Mailing /. r t ms`s °7/e m g ,,. ,_, , f Signature f ~ Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building < (a) Building`' Permit Fee 2. Electrical ,t.a ,,) y -n-, (b) Estimated Total Cost of - - Construction fr ©m (6) 3. Plumbing A Building Permit Fee k Mechanical (HVAC) 5. Fire Protection ,. ; � , r 6. Total = (1 + 2 + 3 + 4 + 5) v ? = ` Check Number t ' " . , This Section For Official Use only Date Building Permit Number: Issued: Signature: . . = r r. Building Commissioner /Inspector of Buildings Date Section 4. ZONING All Inforrnation 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 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/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES (3 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 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 changes to or additions of signs intended for the property ? YES (0 NO 0 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. ' SECTION 5- DESCRPTION OF PROPOSED WORK (check all applicable New House l F- Addition El Replacement Windows Alteration(s) FI� Roofing � --- --- Or Doors [] �-~ ' ' Accessory Bldg. El Demolition F-1 New Signs [O] Decks [[] Siding [DJ Other [El] BhefDeao�pdonofPmponed �, ' / � �� / � / Work: /`~^��^�e�^� ,-~� -�i �,z , � �7^y//� =/ //2' 8Ken�iunofex�hngbedmom Yes ' n Adding n ew bedroom Yes �~ .o/' Attached Narrative Renovatirig unfinished basement Yes 7" No Plans Attached RoU - Sheet 6a. If New house and emr addition to existing nomm/mqmcmn,n'exe the following: a. Use of buUding : One Family Two Family Other U. 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. Numberuf�ohos? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Coriservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. ofwet!ands? Yes No. Is construction within 100 yr. Onodp|ain Yes No j. Depth of basement or cellar floor below finished grade k. WUI building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION '- OWNER OWNERS AGENT OR CO .1 y �� |. /- �� (.1 � �^ ��r r�� as Owner of the subject property � �� �� hereby authorize <���� / }�/�/' ' 1�vt a authdrizedby this building pemni , to act on my,t0 Y T - ^� ^` ~~-- 7 � s/un�u� r Date 4 ,1 : - /\ |. ��-�� �~ r/a/ �� c . as Agent he�bydeome�a the and infonna8onon the � �going application are true and accurate, tothe bestof my knowledge and belief. Signed under the pains and penalties of perjury, -"- -- -~ /- /7 ' ���7: [� ��� ° ^� Print Name - / c �, � ���� / -- -----'— ��� Signature of Owner/Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : � .r' License Number " fit" 71/ Cf ! e, {p. '..t 7 1/— t°Z I ( C i ' . _ Address p.; Expiration Date y . Signature Telephone 9. Registered Home Improvement.Contractor „ Not Applicable ❑ } ... .._, 4'J /..3 5' Company Name Registration Number / 2 Address Expirati n Date Telephone '7/21'2 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 11. o IIolzrie ()Wile!' emetic n 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 .erson who constructs more than one home in a two - year 'eriod 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 1WT rthamptori Ordinances; State aricrUdoat - f Massachusetts General - Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts Department of Industrial Accidents ... w; 7 ........,A=. Office of Investigations 600 Washington Street MINI* • WNW/ 7- Boston, MA 02111 ..,.;., — . • www.mass.gov/dia - Workers' Compensation Insurance Affidavit: Builders/ContractorsiElectricians/Plumbers Applicant Information Please Print Legibly , ,... Name (Business/Organization/Individual): ) / y 6, Address: Li 4 „52, ,./ X. (1 t . s ; ".; ' ; ' C ':°- , / City/State/Zip: te,Ce id, „„..,--4, ,,-- 44,4- Phone #: '// ...," 4. / Are you an employer? Check the appropriate box: 'Type of project (required): 1 1. al am a employer with 9-m 4. El I am a general contractor and I 6. El New construction have hired the sub-contractors employees (full and/or part-time).* 2. am a sole proprietor or partner- listed on the attached sheet. 7. Ei Remodeling 0 I tr ship and have no e These sub-conactors have. 8. Ej Demolition ' working for me in any capacity. employees and have workers' 9. 11] auldi g addition comp. insurance. [No workers' comp. insurance required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 1 3. El I am a homeowner doing all work officers have ex.ercisecl their . . 11.0 Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12. [1] Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other 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 ail work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attnrhed 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: Policy # or Self-ins. Lic. #: Expiration Date:- Job Site Address: City/State/Zip: 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 $1500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a 1ne of up to $250.00 a day against the violator. lle advised that a copy of this statement may be forwarded to the Office of Investiautdons of the I)IA for insurance coveraze verification. • I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sionature: , , 'l.... - ., Date: Phone #: • . , Official 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): • L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations_ The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill) sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits -in -- conjunction to-- the _ building _ permit_ issued,_ and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. _._Date Address of work location L4/%211 E1 I 1 : '20 41323t3'.up BEL_ AND HUDSON PAGE 01/02 ------ _ 0 AC___ - ,, CERTIFICATE OF ...,_ LIABILITY INSURANCE ;, DATE' 1M0/1/DDrri (Y) i 04/05/Z010 , ...,...... __ . _ , .. ' (413)323-9611 FAX (413)323-6117 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bell & Hudson Insurance Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 19 North Main St. L ALTER THE COVERAGE AFFORDED By THE POLICIES BEL OW, P . D. Box 669 1 Belchertown, ?4A 01007 INSURERS AFFORDING COVERAGE ' NAIr if 1 — - -- -- -- ._ H Edwin Lear Y ---- INSURER r Nat i Onai Grange Mututai ins .Eo 20759 I .._ DBA: Ed Leary Home Improvement tIrSURE2Safety Indemnity 1 1 33616, I , - -------- _ 46 Scnsth Liberty Street iNSUREFI. C: NatiOnal Union F Ins , Co 1 , __ --- --- .-__. Belchertown, MA 01007 ICatu —_- Rf I.) _ - — — ... THE POLICIES OF INSURANCE LISTE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMUJ ABOVE FOR THE POLICY PERIOD SI' NOTWITHSTANDING i ANY REQUiREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR i MAY PERT,PuN, - 1HE iNsuRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO Al L THE TF2IRMS EXCLUSIONS AND CONDITIONS O- SUCH 1 POLICIES AOGRE(ATE umirs SHOWN MAY HAVE BEEN REDUCED E- PAID CLAMS I , - — 1 ADDII 1 eFFRC if. CO/RATION ... Di sl isar j, _ TYNE OP JNSORANCE , Y L M Atiati>.-12(2■----EMEMIMaIWQ-___ — --,-- — — L GEN ERAJ. LW:OUT MP088639 11/17/2009 11/17/2010 1 EACH CpccuRFeriCe., 'b 1, 000 000 ' I _.—.I_____ , , I oAmAGE TO RENTFc3 $ 500 0 L____ 1 COMMERCIAl, qENERAL LiA6FUTY 1 I 1_213E.Mia5JF-A ne...4!!!cinr.-) t _____,, I i ! .! CI,mms mADE i x i occuR I , I FAC..0 F.XP (An ,- y or!R pc ' 'ir 10 , 000j ‘...—, h A FX11 PD DeduCtible ' Rp.e. $ .1 AD,./ Jr.J.ri,JRY 1,000t000 C Per laim I i , GENERAL ACiGHEGATE , $ i GENT AGGREGATE i_Nrr APPLiE5 PER. 1 i_ PROr. - C.;(3.4P,JOP AGG 1 i_$ 2,000,006 r ----- ' t p 1 I LOC r..J - ' _ ____L____ ".,_;_i 1 •-, I 1 1 _ i J - — ----- -- i I_AUTON0811E LIABIUTY 3952776 CO M 04 11/23/iniflitii/ 3 / 2 e 1 e l iCC:MF(N.r.3 .IGLE LI" NI''' 1 I , ANY PrUTO I 1 ALL FrANED pz‘tiT 1 ' PiCol, YiNJORN, J J 1 ,. X 1 SCHET- A Li TO5 1 , i ;PG, pervpor, i 2000lY 1 1 !-AIRED N_IT(*. j er..11iiL iroUcc‘f r Ptr C'C.: .301t) SOO , 00 ' i NON-01/0&D AUTO?. 1 , i 1-- , — t r c,,.,„ D,,,,,,,,„,,E. 1 ; 2 ________ -4 1,4 v. 1 To cir,p., h- 0,000i ,ARAGF_ L IMAM I t--:1-" i ,----, - 1 i I FA AC' I S ! AN./ AUTO iTi''' ExcessiumaRp,_LA LIAStLITY 6 --1- EACH OCCURREIV:t. . 1 OCCUR E ----1 CLAIFAJ1 MACE 1 i AG.C2RGATE j $ l______J , • , — I 1 ----- I r , . i DEDUCTIBLE I r . ri RETENTION j_ __, — i NWt — -____ L (4 58 58 88 1 01/03/2010 101/03/2011 ! wc STATJ=i- 1 crr WORKERS CUMPENSATION AND E.riFLOYERS idAEALiTf i 1 i , C ANN pRopplETGRARTNERIEA.ECUTNE j Ei, EACH rv.C.IPENT , , , 500,000 oFncEnimEmBER Exc.:Luau)? I 1 ! F. DaEASE • EP. EM rwFFi. T 500,000 i . If Felt., C1.613, uride! t I 1 5F'ECLAt„ PROVISIONS be:Icw ; , E I DISEASE , POLICY 1..!N4!" i $ 500 ,000 , OTHE4 i 1.- ,----- i - ---I 1 i i I k I — i __, i _ 1 I 4 ____ L___ _ - tp£ siap of OF f LOCATio / ves-IICLES I ExcLusions ADDED 13Y .UNOCMAEMENT1 PROSODIONV- . _ _ Interior Carpentry Work / Horne Improvement Work Proprietor is excluded from the Workers Compensation payrol 1 . - TIFIC I *La' : CANcELLATION — ______ / SHOOLID ANY OF THE An DV G CESCRIBEI3 POLICIES HE GAN ca,LED BEFORE rhe i 1 txpompoN oATt THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn: Building Inspector 10 GAYS WRITT - I NOTICE rO THE CERTIFICATE &FOLDER J AMEE) TO THE LEFT City of Northampton , J / BUT FAI1_URE TO ' J.1 SUCH FieTfCE SHA II. IMPOSE RIO On ki ION OR LIAbILI 0P ii HE t1.) r 7 Y 212 Main Street ANY KIND 1 - ,. f43 • -. A 5 J - tc Cot RE E EREER i - mrs. f Northampton. MA 01060 AUTROPMCM R , . ___________ 1 ACORD 25 (2001/06) FAX t (413)587-1272 ©ACORD ;', r. • • ' ATION 1981