25A-128 (7) a
k
Renewal
NFRC byAndersena '--•
WINDOW REPLACEMENT an Andcrsen Company
NaFenal Fenestratbn WoodNinyl Composite IF
Rating Cauncllg Dual Argon Low E
Double Hung
Idiots I
100-00414585-007
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)A-P Solar Heat Gain Coefficient
0 . 30 0 . 31
ADDITIONAL PERFORMANCE RAi il4US
Visible Transmittance
0 . 53
Manutactumrstlpulates that these ratings conform to applleable NFRC procedures for detorrnining whole product
performance.NFRC ratings are dato"Ined fora fixed sot of environmental condftions and a specific product slza.
NFRC does not recommend any product and does not warrant the suitability of any product for any speclfic use.
Consult manufacturer's literature for other product performance Inforrn ition.
www.nfrc.olg
k
SE This product meets Gr r I
4� Seal's environmental
III I: standards governing
energy efficiency,hea
^ Ip metals in the frame an
`14 sash materials,
CERt��
education materials.ti
materials. )'
�y
DESIGN PRESSURE(PSF)
On d.and uua
(,� fi
M. on
s I;I
1 1 - L C 2 5 RbA DB Slopeda Sill DH IN
Tested to NAFS-02 or AAMAM1IDMA/MA 101 /A440-05, Maoufecturer sti ulstes confommnce to then limble standards
Moats or oxceeds M.E.C.,C.E.C,81.E.C.C.Air Infllleatlon requirements WDMA Halsnark Cortificatlon Program.
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Window Agreement-Page 1 of 2
J&L Windows,Inc.,d/b/a
104 Otis St,Northborough,MA 01532 Renewal MA Home Improvement Contractor
(508)919-0900-Fax:(508)919-0903 �i License#149601(Expires 1/24/2010)
Customer Service:(8001 573-7606 byAndersen. �� Federal Tax ID#83-0404201 1
WINDOW REPLACEMENT —A de.aen Company
Product Manager Window A reement Contract Date: 7-A-<D R_-
Homeowner("Owner")'s Name(s):
Street Address
/= City/Town:I (j/l StatePl Zips1a20k�
Hume Phone: -1 5— Work Phone:
Job Site Address(if different): E-mail Address:
Materials to be provided and work to be performed by Renewal by Andersen("Contractor"):
Contractor will furnish and install Renewal by Andersen-approved materials to the following specifications:
1. Date on which Work is Sched led to Begin: Expected Date of Substantial Completion:� �
ntractor will Install a total of windows in Owner's home,using the following individual quantities:
ouble Hung(DB)<;Flraal 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(CDW) ❑Standard handle ❑Metro handle
Casement/Picture/Casement(CPW) ❑ 1:1:1 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)
Picture Window(PW)
B y or Bow Window:
3. ❑No #Windows to be Custom Fit Replacement:
4. ❑Yes of sills to be replaced by Contractor:
5. ❑Ye Windows to be New Construction Full frame(includes new interior&exterior casings):
Exterior casings: ❑Pine ❑Maintenance-free material ❑Factory applied 908 Fibrex brickmold
6. Glazing to be:;5)Qigh performance ❑Other If other,please specify:
7. Exterior color to be: White ❑Sand l�ltanvas ❑Terratone
8. Interior color to be: hite ❑ �
Sand�Bnvas ❑Terratone ❑Wood
Note:Interior color can orly be white,wood or same color as exterior. Wood interiors need to be finished by Owner.
9. Hardware: White ❑Stone ❑Canvas❑Brass Double Hun II lifts?�gs ❑No
10. ❑Yes ntractor will remove metal frames or grilles. Units:
11. ❑Yes ontractor will install new paint-ready oista, re casi ngs. ide or outside stops#of openings:
Interior casing#of openings: Exterior casings ❑Pine ❑Maintenance free material
Owner' a re that Contractor does not do any paint Owner initials
12. ❑Ye o on ractor will wrap exterior casings wi inum coil stock of color.
Note:Required with storm window remov removal of storm windows wilQeave rew holes in casing.
13. New windows to have: ❑Half screens Screens to be:--R'iberglass ❑Aluminum
14. Windows to have grilles: ❑Ye es: ❑Grille Between Glass(GBG) ❑Removable Interior Wood(INTW)
❑Full Divided Light(FDL) Grille patterns:
R B R M
DH DH DH DH CW/Picture Glider CPW or GPW
`use additional sheet if needed Owner approved(initials):
1 Yes ❑No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
1 s ❑No A limited warranty shall issue to Owner upon completion of the job and payment in full(see reverse side).
17. es ❑No Buildina Permit-Contractor will secure any and all necessary permits.The fee for the permit(s)is not
inclu ed in the Contract Price a a�sep�to check i required at the time of sale for this fee.
18. Additional job details: / 1 t 4it�iJA-S S
19. ❑Yes ❑No Owner has reviewed the Additional Terms and Conditions governing this Contract on the reverse side,
including Owner's Three-Day Ca railation Rights pursuant to MGL c.93§48,c.140D§10 or c.255D§14(See Section 25).
20. Total Contract Price:$ 2 WtIQ Regular Retail Price:$ All available discounts applied:❑Yes ❑No
21. Deposit(1/3):$ paid by❑Cash ❑Finance (Account#: )
Second(1/3)$ to be paid by Cash at start of job on (Estimated start date).
Final(1/3)$ (4730;_J to be paid by Cash at completion of job on (Estimated completion date).
22. ❑Yes ❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.
No final payment shall be demanded until the contract is completed to the satisfaction of all parties.
NOTICE: All home improvement contractors and subcontractors must be registered. Any inquiries about a contractor or
subcontractor relating to a registration should be directed to: Registration Division, Program Coordinator,One Ashburton Place,
Room 1301,Boston,MA 02108,Tel: 617 727-3200,Website:hftp://www.mass.govidps
The parties hereby mutually agree in advance that should a dispute arise regarding this contract,Contractor may
submit such dispute to a private arbitration service that has been approved by the Office of C nsumer Affairs
&Business Regulation,and Owner shall be required to submit to such arbitra provi
' d"n GL c.142A.
Contractor Signature: Owner Signature:
NOTICE:The signatures of the parties above apply only to their agreement to ern to isp resolution initiated by
Contractor.Owner may initiate alternate dispute resolution even where this section is not gne separately by the parties.
DO NOT SIGN THIS CONTRACT IF THERE ARE Y BLANK PACES
J&L Windows,Inc.d/b/a Renewal by Andersen
By:
Product Manager OwNer Si at e
Product Manager(Print Name) Owner Signature
White—Renewal by Andersen Yellow—Installation Pink-Homeowner
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston;M.01111
www.rrtassgovldia
Workers' Compensation Insurance Affidavit:BuUdersl Contracto.rs/EIectricians/Plumbers
Applicant Information PIease print LeQibIv
•Name(Busincss/organizatiawwividuap: J�� e ti t I J`JJl�C rr�sE
Address:_ (J� 16W
City/State/zip:1d b b rs r egs-z phone n
Are you an employer!Check the appropriate bar: Type of project(required);.
1.8j am a employer with 30 4. ❑ I am a general contractor and I 6• ❑New construction
employees(full and/or part-time).* have hired the sub-coatiactors �• Remodeiin
2.[] I am a sole proprietor or partner- listed on the attached sheet t g
ship and have no employees TScse subcontractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9. ❑Building addition
[No workers'comp,insurance 5. [] We are a corporation and its' 10 Electrical required,} otncers have exercised their repairs or additions
3.❑ I am a homeowner doing aI1 work right of exemption per MGL 11.❑Plumbing repairs or additions
myself[No worlmv comp. c.152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t• employees.[No wod='
comp.insurance required] 13.[]Other
*Auy applicant that eheela bm#1 must also fill out the section below showing their workers'"compensation policy-information.
t Homeowners who submit this affidavit indicating they are doing as work and then hire outside contractors must submit anew a{Cdavit indicating snch
160ntmctors that check this box must attached an additional sheet showing the name of the sub-contractors and their worker'comp.policy infarmatiM
r=an employer that is providing workers'compensation insurance for my employees Below is the poticy and job site
irtformativn, •
Insurance Company Name:_ _-
.� .
Policy n or Self-ins.Lic•# ;b Expiration Date: a
Job Site Address: - City/Statemp:
Attach a copy of the workers'compensation policy declaration pate(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
tine up to S 1,500.00 and/or one-year imprisonment,as well as civt2 penalties in the form of a STOP WQRK ORDER and a fine
Of up to 5250.00 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 c rtai fy under pain and penalties o rjury that.the information provided above is true and correct
5ianature• Date-
Phone# t1 d
Official use only. Do not write in this area to be completed by city or town officiaL
Ciiy or Town: PermitUcense 9
Issuing Authority(circle one): 1
L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone� ,
I ;
x= Mastiachusett- - Department of Public Sufetc
Board of Suilding Red-ulations and Standards
Construction Supervisor License
• License: CS 99255
Restricted to: 00
SCOTT PHILLIPPI
58 D STREET
WHITINSVILLE, MA01588
c
Expiration: 6/7/2011
Co ni nis sio ner Tr#: 99256
Restricted ta: 00
00-.Unrestricted
1G-1 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
Refer to: WWW-Mass.Gov/DPS
. r'/ze �oomnzo�ea/,�i o�,/l�eaoc�u�ael7d -'�
Board of Building Regulations and Standards
lugHOME IMPROVEMENT CONTRACTOR
Regist...Ion',, 149601
E_tptratiC 2010
Tp`ei :upplement Card
RENEWAL By A4506AN
SCOTT PHILLIPPG.'9=59_ i T
104 OTIS STREET �_111-``
NORTHBOROUGH, MA01532 Administrator
ACORDry CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDNYYY)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 333
Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 0
INSURED Renewal by Anderson INSURER A: Hartford Ins n
J&L Windows,Inc. INSURER 8: Hermitage
104 OUs St INSURER C:
Northborough,MA 01532 INSURER D:
I INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN'R DT. POLICY CTIVE POLICY EXPIRATION
POLICY NUMBER EFFE LIMITS
B GENERAL LIABILITY HCP 507 404 09/07/2008 09107/2009 EACHOCCCE f 1000 000
COMMERCIAL GENERAL LIABILITY PREMISES Ma ooaaonoe f 100,000
CLAIMS MADE ®OCCUR MED EXP(Any one person) S _ 5.000
PERSONAL L ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2.000.000
GENI.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S '2000000
POLICY 7 PRA LOC
A AUTOMOBILE LIABILITY 35 MCC XD 6390 10/01/2007 10/01.2008 COMBINED SINGLE LIMIT f 1,000,000
$ ANY ALTO (Es a=dent)
X ALLOWNEDAUTOS
BODILY INJURY ' f
SCHEDULED AUTOS (Per parson)
HIRED AUTOS BODILY INJURY S
NON-OWNED AUTOS (Per accidora)
PROPERTY DAMAGE f
(Per Dewerd)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC f
AUTO ONLY: AGG f
EXCESSIUMBRELIA LIABILITY EACH OCCURRENCE S
OCCUR F1 CLAIMS MADE AGGREGATE f
f
DEDUCTIBLE f
RETENTION S S
A WORKERS COMPENSATION AND 35 WEC PP 1444 02/17/2008 02/17/2009 1 TwQRYsLT,`M`,uTS' OTH•
EMPLOYERS'LUUULITY E.L.EACH ACCIDENT f 500 000
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500,000
Rs
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25(2001108) Cr(4/0 ACORD CORPORATION 1988
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 �I
Side LE R: L:= R:'
Rear
Building Height
Bldg. Square Footage
Open Space Footage _ °/U
(Lot area minus bldg&paved
parking)
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
r-�-;
IF YES, date issued:i
1 .. ...�._._,_-
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW kj YES
IF YES: enter Book Paged and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 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,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-'CONSTRUCTION SERVICES
8.1 Licensed Constructions Supervisor: Not Appliliiccable�❑
Name of License Holder: J�' y 'I
NVI, 1� ITT I _L C—
License Number
0 + O'CA�OVV IS�A I (-A
Addre Expiration Date
c'— )<6 �1 Cl " 09 G
Signature T lephone
9 Reiaisterecl'Hotti®"lrriproYement Contractor, ,.. Not Applicable ❑
(al
Company Name I T Registration Number
0,-( c�, s s�. >Jo4 I LVU [AAA- D111�
Address Expiration Date
Telephone-gu�-'C,ICt_�;c ya
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...... ❑
9fi 'F
11� dome t�►W—ner Etembfi
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-vear 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
SECTION 5-DESCRIPTION OF PROPOSED WORK'(check'all applicable)
New House ❑ Addition ❑ Replacement Wipdows Alteration(s) ❑ Roofing ❑
Or Doors Ey
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[0] Other[L7J
Brief Description of Propose
Work: k t�la C-Z W'�c���x�S IJ U
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ___.,=::::�No
Plans Attached Roll -Sheet
sa,if New House-and'`ar addifon�to existiha housina: corrip1ete the�foilawinsa:
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
1 a, d y as Owne uthoriz
OgWhereby declare that the statements and information on the foregoing application are true and accurate, to the best of knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Date
Signature of Oe
wn
I i IVIDe p�ttt t� sniy
City of Northampton
" Building Department
212 Main Streetery
ff
��Room 100
$ iohampton, MA 01060 jctu L SEs
` phone413- 87-1240 Fax 413-587-1272
APPLICATION TO 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
OL
Map Lot Unit
done, a Overlay District
:'El St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: (}
2t i(Y'N ICJ L r�' h t G �-e s s t �U �'f n1 n f-t v u i ci to o
Name(Print) Current Mailing Address:
HIS ~ � �— 5S 7
Telephone
Signature
2.2 Authorized Agent.
MCI" C�S i` t U -� L7� S S�- c� L(i u* G(S-3
Name(Print Current Mailing Address:
Signature 1 Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS'.
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building C% (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
J Construction from 6
3. Plumbing U Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check NumberJ�r
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2009-0322
GIS#: COMMONWEALTH OF MASSACHUSETTS
y ,
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-2009-0322
Project# JS-2009-000435
Est.Cost: $7950.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 149601
Lot Size(sq. ft.): 19209.96 Owner: NIGROSH BARRY J&ELLEN EMERSO
Zoning:URB Applicant: RENEWAL BY ANDERSEN
AT: 21 BATES ST
Applicant Address: Phone: Insurance:
104 OTIS ST (508) 919-0900 WC
NORTHBOROMA01532 ISSUED ON.912412008 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Date Paid: Amount:
Building 9/24/2008 0:00:00 $35.006544
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo