28-013 eni w MA Hm Im m
oe proveent Contractork
License#170810(Expires 12/23/2015)
bYAndersert. Renewal by Andersen Corporation Federal Tax ID#41-1918413!
'WINDOW REPiRe EMENT ate.4rvA,nl'."nrn=nv
104 Otis St. Northborouah.MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
i
I
Buyer(s)Name Date:
Et
KRSTIN A. LOSERT - APRIL 6, 2014
Buyer(s)Street Address city State Zip Code
i
256 SYLVESTER RD. FLORENCE MA 01062
Email Address Home Telephone Number Work/Cell Telephone Number
KILOS E RTOCOM CAST.NET 617-407-4620 617-407-4620
Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor"),in accordance with
the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement").
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. i
Total Job Amount $ 14,777.00 Amount Financed$ 0.00 Est,Start Date Method of Payment
Deposit Received(33%)$ 4,925.67 f0-12 weeks ✓ Check/Cash
Balance Start of Job(33%)$ 4,925.67 Deposit at signing$ 0.00 Check# 1897
i
Balance on Substantial Est.Install Time i
At Substantial Credit Card
Completion of Job(33%)$ 4,925.67 Completion$ 0.00
T.B.D. If credit card is selected,please 1
see Credit Card Payment form
4
Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent
of both 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,includingthee 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 SIG THFI IS CO R TRACf f ERE ARE ANY BLANK SPACES.
i
Renewal by Andersen Corporation B er(s) Buyer(s) 1
By.
Signature of Project Manager Signature Signature
i
ALAN ABDERRAZZAQ KRSTIN A. LOSERT
Printed Name of Project Manager Printed Name Printed Name
i
f
E
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. i
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
i
NOTICE OF CANCELLATION i NOTICE OF CANCELLATION I
i
I #
Date of Transaction 4/6/14 You may cancel this I Date of Transaction 4/6/14 You may cancel this
'transaction,without any penalty or obligation,within three business days from the I transaction,without any penalty or obligation,within three business days from the
above date.If you cancel,any property traded in,any payments made by you under I above date.If you cancel,any property traded in,any payments made by you under i
the Contract of Sale,and any negotiable instrument executed by you will be 1 the Contract of Sale,and any negotiable instrument executed by you will be j
returned within 10 days following receipt by the Contractor("Seller") of your I returned within 10 days following receipt by the Contractor("Seller") of your
cancellation notice,and any security interest arising out of the transaction will be I cancellation notice,and any security interest arising out of the transaction will be
canceled. If yon cancel,you must make available to the Seller at your residence,in I canceled. If you cancel,you must make available to the Seller at your residence,in
anbstamially as good condition as when received,any goods delivered to you under I substantially as good condition as when received,any goods delivered to you under
this Contract or Sale; or you may if you wish,comply with the instructions of the I this Contract or Sale;or you may,if you wish,comply with the instructions of the
Seller regarding the return shipment of the goods at the Seller's expense and risk. Seller regarding the return shipment of the goods at the Seller's expense and risk. '
If you do make the goods available to the Seller and the Seller does not pick them up I If you do make the goods available to the Seller and the Seller does not pick them up
within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available I of the goods without any further obligation. If you fail to make the goods available
to the Seller,or if you agree to return the goods to the Seller and fail to do so,then I to the Seller,or if you agree to return the goods to the Seller and fail to do so,then
you remain liable for performance of all obligations under the Contract.To cancel I you remain liable for performance of all obligations under the Contract.To cancel
this transaction,marl or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a signed and dated copy of this cancellation notice
or any other written notice,or send a telegram to Contractor:Renewal by Andersen,I or any other written notice,or send a telegram to Contractor: Renewal by Andersen,
!104 Otis St. Northborongh,MA 01532,BY NOT LATER THAN MIDNIGHT OF I 104 Otis St.Northbomugh,MA 01532,BY NOT LATER THAN MIDNIGHT OF
4/9/14 .(Date) I HEREBY CANCEL THIS TRANSACTION. 1 4/9/14 .(Date) I HEREBY CANCEL THIS TRANSACTION.
I
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ReCIewa Renewal by Andersen Corporation MA Home Improvement Contractor
ibyAndersei1 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015)
WINDOW REPLACEMENT (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
,Buyer(s)Name Date of Agreement
KRISTIN LOSERT SUN, APR 6, 2014
1
'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 WINDOW AND DOOR REMODELING
!AGREEMENT,of which the Specification Sheet is part.
WINDOW DETAILS
Approx. Exterior/Interior Color Hardware Hardware LowE4/ Grille Grille Glass
Room A U.I. Window/Door Style Detail Casings Ext-Int Color Sys Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts Options
Dining 1 127 CT 1:1:1 full frame Ext.MF Flat vvFvwF Stone Standard FTS SmartSur None ----- ----- ----- No
Dining 1 79 CS:R full frame Ext.MF Flat NH/WF Stone Standard FTS 3martSur None ----- ----- ----- No
Dining 1 79 CS:L full frame Ext.MF Flat WW Stone Standard FTS SmartSur None ----- ----- ----- No
Living 1 1 141 CT 1:1:1 full frame Ext.MF Flat FNH/WF Stone Standard FTS ISmartSur None I ----- ----- ----- No
Living 1 83 CS:R full frame Ext.MF Flat WH/WF Stone Standard FrS SmartSur None ----- ----- ----- No
Living 1 83 CS:L full frame Ext.MF Flat WH/WF Stone Standard FTS SmartSur None ----- ----- ----- No
Dining I 82 PW Full Frame Ext. MF Flat wa/wH ;martSui
Living I 96 PW FULL FRAME Ext. MF Flat H/ Smart
H
Total BAY&BOW DETAILS *See Bay/Bow Measure Sheet
Style Detail/ Approx. Approx. Number Frame Window End Center LowE/ Roof/ Hardware
Room Count Style Flankers U.I. Casin s An le Litas Interior ExtAnt Color Grilles sashes sashes Screens Smartsun Soffit Color
SPECIALTY WINDOW DETAILS
Full/ Approx. LowE/ Specialty BAY/BOW ADDITIONAL WORK NOTES
Room Count Style Insert U.I. I Smartsun Grilles Grille Style Ext/Int Color Customer is aware that with bay/bow windows under 72 inches
there will be si ificarn lass lose.
ADDITIONAL WORK DETAIDS:
fill in the circle top over each Casment group.Also Adding a PW over each Casement group only over the Triple CammenD.Transom Style look.
Please make sure to be careful removing the interior Casinp We NEED to replace them these are distinct Casings,
Exterior Casings are to be M.F.Flat/same measure of Casinp in place now
I No Contractor will wrap exterior casings with coil stock color of
Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments/hardware.It is the
responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to
whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the
2 amount will be dependent on the type of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.
i Customer is aware and understands any and all unseen rot is not included in this contract.Should any rot be found there will be an additional charge for
time and materials unless so stated in this contract.
i 3 yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris,
{ windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
4 Yes 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. Check# 1898 $ 35
5 yes Al discounts have been applied to this agreement.
6 ✓ Yes No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
IIt 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 understa ' han 'ng or modifying any of the terms. This Specification Sheet may not be changed or its terms
imodified or varied in any way unless such changes are in writing and signed by both the Buye s ntractoc Buyers)hereby acknowledge that Buyer(s)has read this Specification
Sheet.
jRenewal by Andersen Corporation Buyer(s Buyer(s)
j By / &Q/Zllwl m lz7zl
Signature of Project Manager Signature Signature
,
ALAN A ABDERRAZZAQ KRSTIN A. LOSERT
Print Name of Project Manager Print Name Print Name
The Commonwealth of Massachusetts
Department of lndustrial Accide�lts
Office of Investigations
600 Washington Street.
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Aff1davit: Builders/Contractors/Electricians/plumbers
AyRficant Information t (� Please Print Legibly
Name(Business/Organization/Individual): �6' 0 ew C, `Q,,, 1"D✓��p,( Sc V-\
Address:
City/State/Zip: 1\\,o 6' , o 3 hone#: 5-&, a ° 3 g-jd}06
Are you an employer?Check the appropriate box:
4. I am a general contractor and I Type of project(required):
t�I am a employer with 3 t) ❑ g
employees(full and/or part-time).* have hired the sub-contractors 6 F]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. modeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers' 9. Q Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.Q Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12• Roof repairs
insurance required.] c. 152, §1(4),and we have no ❑
]t employees, [No workers'• 13.❑Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compen9ation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they.must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ��&AaVCI n ,
Policy#or Self-ins.Lic.#: MW C, 30b 35_q Expiration Date: 0—
Job Site Address: as City/State/Zip: 1��b^�--�c e p rh 4 O 16 b Z
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 der the pains and penabes of perjury that the hiformadon provided above is true and correct
S' afore: un Date: Zi 8
Phone
OfJ mal use only. Do not write in this area,to be completed by city or town gricial
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical,Inspector 5.Plumbing Inspector
6:Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: JAIME MORIN 90125
License Number
86 GARDINER ST LYNN, MA 01905 10-06-14
Address Expiration Date
508-351-2200 X 55285
Si:�:r Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
104 OTIS S THBORO, MA 01532 12-23-15
Address Expiration Date
Telephone 508-351-2200 X 552[5
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....... N No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacemen indows Alteration(s) 0 Roofing El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[o]
Brief Description of Pro osed
Work: REPLACE 8 WINDOWS - NO STRUCTURAL CHANGE
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing. complete the following:
a. Use of building : One Family X 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 REPLACEMENT WINDOWS
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
KRISTIN LOSERT as Owner of the subject
property
hereby authorize JAIME MORIN
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
JAIME MORIN as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
JAIME MORI
Print Name
Signature of Own t IV 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: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
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 Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , 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 Q 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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic'Availabilit
l JUN 2 0 2014 �'
( : Y
.�,1 Room 100 Water/Well Availability
F
l Northampton, MA 01060 Two Sets of Structural Plans
Electric. P u„ "�''& 3-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
256 SYLVESTER ROAD Map Lot Unit
FLORENCE, MA 01062
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
KRISTEN LOSERT 256 SYLVESTER ROAD FLORENCE, MA 01062
Name(Print) Current Mailin Address:
617-40g/-4620
Telephone
Signature
2.2 Authorized Agent:
JAIME MORIN 104 OTIS ST NORTHBORO,MA 01532
Name(Print) Current Mailing Address:
508-351-2200 X 55285
Signatur Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 14,777.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2 +3+4+ 5) 4, 7 .00 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
256 SYLVESTER RD BP-2014-1366
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28 -013 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2014-1366
Project# JS-2014-002301
Est. Cost: $14777.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sg. ft.): 390733.20 Owner: LOSERT KIRSTIN&MARA SLAWSKY
Zoning: Applicant. RENEWAL BY ANDERSEN
AT. 256 SYLVESTER RD
Applicant Address: Phone: Insurance:
104 OTIS ST (508) 919-0900 WC
NORTH BOROMA01 532 ISSUED ON.612012014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 8 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 6/20/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner