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30A-003 (3) —Ren-e—wall—by-And—e-'rsen Corporation----—-------------------------MA Home Improvement Contrator 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2016) (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Entry Door Specification Sheet Buyer(s)Name Date of A reement AMANDA ANDERSON JJune 13,2014 The buyer(s)listed above bereby.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. ENTRY DOOR DETAILS Location Living Width 36" Height 801, jamb depth 49/16 49/16 49/16 49/16 49/16 49/16 Inside style Her/006 Outside style Her/006 Sidelitestyle Inside color Cafe Cream Outside Color Vallis Red #/si—idelite Glass style Canning Add grid Do,,skin Grid options Operation Grid Inside color Outside Color Int lockwt Flair Int Finish Satin Nick Ext.lockwt Flair Ext Finish Satin Nick Threshold Bronze Kickplate Peephole Peephole Mail Star Cladding color Transom STORM DOORS Door Style Storm Color Handle Style Handle Color Additional Job Notes: Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system and door treatments/hardware.It is the 6 responsibility of the homeowner to have the alarm system and door treatments/hardware removed prior to Installation. We make no guarantee as to whether alarms,door treatments or hardware will fit after replacement. Customer is also aware In some cases there will be glass loss. If there is,the amount will be dependent on the type of existing doors,type of installation and window style.We make no guarantee as to the amount of glass loss. 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 7 Yes Contractor will insulate,caulk and sea]windows with 3-point system to prevent water and air infiltration. Removal and disposal of alljob related debris,doors, storm doors and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued. 8 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.Check 1 9 yes All discounts have been applied to this agreement. 0 V Yes No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). -No Final payment shall be,demanded until the contract is completed to the satisfaction oJ 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 teren,modified or varied in any way unless such changes are in writing and signed by both the Buyer(s?and Contractor.Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by Andersen Corporation Buyer(s) Buyer(s) luw� sa� �-4m�?L- Signature of Project Manager Signature Signature MARK SALEM AMANDA ANDERSON Print Name of Project Manager Print Name Print Name ------------------------------------------------------------------------------------------------------------ by Renewal Renewal by Andersen Corporation MA Home Improvement Contractor Andersen.am 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015) WINDOW REPLACEMENT . A,,a�,0« ,,,,,;,,,, (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet Buyer(s)Name Date of A reement AMANDA ANDERSON FRI,JUN 13, 2014 The buyer(s)listed above herebyjointly 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 NVIN'DOW AND DOOR REMODELING AGREEMENT;of which the Specification Sheet is part. WINDOW DETAILS Approx. ExterlorAnterior Color Hardware Hardware Low E4/ Grllle Grille Glass Room # U.I. Window/Door le Detail Casings Ext-Int Color Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts Options Elvin 3 84 DB square equal full frame Ext.Ant.MF 908 Cv/Cv Sat.Nickl Standard FTS martsu GBG 3/2 ----- ----- No Dinin 3 84 DB square equal full frame Ext.Ant.MF 908 Cv/cv Sat.Nickl Standard FTS martsu GBG 3/2 ----- ----- No Bed 1 3 75 DB square equal full frame Ext.Ant.MF 90 Cv/cv Sat.Nickl Standard FTS martsu GBG 3/2 ----- ----- No Bed 2 2 75 DB square equal full frame Ext.Ant.MF 908 CV/CV Sat.Nickl Standard FTS martsu GBG 3/2 ----- ----- No Bed 3 3 75 DB square equal full frame Ext.Ant.MF 908 CV/CV Sat.Nickl Standard FTS martsu GBG 3/2 ----- ----- No Office 1 73 AN full frame Ext.Ant.MF 908 CV/CV Sat.Nickl Standard FTS martsu None ----- ----- ----- No Bath 1 1 73 AN full frame Ext./Int.MF 908 Cv/CV Sat.Nickl Standard FTS martsu None No Kitchen 2 73 AN full frame Ext.Ant.MF 908 Cv/Cv Sat.Nickl Standard FTS martsu None ----- ----- ----- No Gara e 1 73 AN full frame Ext.Ant.MF 908 Cv/Cv Sat.Nickl Standard FTS martsu None ----- ----- ----- No Total 19 BAY&BOW DETAILS *See Ba /Bow Measure Sheet Style Detail/ Approx. Approx. Number Frame Window End Center LowE/ Rapt/ Hardware Room Count Style Flankers U.I. Casings Angle Lltes 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. SmartSun Grilles Grille Style ExtAnt Color Customer is aware that with ba,/bow windows under 72 inches there will be si nificara glas,lose. ADDITIONAL WORK DETAILS: 1 No Contractor will wrap exterior casings with coil stock color of Owner is aware that Contractor does not do any paintinglstaining or removal/installatlon of alaml system or window treatments/hardwa re.h 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. H there is,the 1 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. 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 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,stone windows and vacuum nightly Included. Upon completion of the job and payment in full,a limited warranty shall be Issued. 1 4 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. Check# $ 5 Yes All 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). 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 Buyers)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by Andersen Corporation Buyer(s) Buyer(s) Signature of Project Manager Signature Signature MARK SALEM AMANDA ANDERSON Print Name of Project Manager Print Name Print Name .. .......... ............ .................... .............. Renewa MA Home Improvement Contractor License#170810(Expires 12/23/2015) bAndersen Renewal by Andersen Corporation Federal Tax ID#41-119118413? 104 Otis St. Northborcluoh.MA 01532 (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date: AMANDA ANDERSON JUNE 13, 2014 Buyer(s)Street Address City State Zip Code 280 FLORENCE RD. FLORENCE MA 01062 t Email Address Home Telephone Number Work/Cell Telephone Number AKANDERS982@HOTMAIL.COM 413-320-6300 1 1 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. Date Method of Payment Est.Start Total Job Amount $ 26,873.00 Pmount Financed$ 26,873.00 rt Deposit Received(33%)$ 0.00 Check/Cash 10-12 weeks Balance Start of Job(33%)$ 0.00 Deposit at signing$ 13,436.50 Check# Balance on Substantial At Substantial Est,Install Time Credit Card Completion of Job(33%)$ 0.00 Completion$ 13,436.50 T.B.D. If credit card is selected,please I I I see Credit Card Payment form 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,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 THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyer(s) Buyer(s) By: Signature of Project Manager Signature Signature MARK SALEM AMANDA ANDERSON Printed Name of Project Manager Printed Name Printed Name 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 E NOTICE OF CANCELLATION Date of Transaction 6/13/14 You may cancel this I Date of Transaction 6/13/14 You may cancel this transaction,without any penalty or obligation,within three business days from the 1 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 the Contract of Sale,and any negotiable instrument executed by you will be 1 the Contract of We,and any negotiable instrument executed by you will be ,returnedwitbin 10 days following receipt by the Contractor("Seller") of your 1 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 you cancel,you most make available to the Seller at your residence,in i canceled. If you cancel,you most make available to the Seller at your residence,in substantially as good condition as when received,any goods delivered to you under 1 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 net 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 1 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 1 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. I.cancel this transaction,mail 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 Contract—Renewal by Andersen,I or any other written notice,or send a telegram to Contract • Renewal by Andersen, .104 Otis St. Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF 1 104 Otis St.Northhomugh,MA 01532,BY NOT LATER THAN MIDNIGHT OF 6/16/14 (Date) I HEREBY CANCEL THIS TRANSACTION. 6/16/14 (Dam) I HEREBY CANCEL THIS TRANSACTION. Buyers signature Print N.— Date Buyers Signature P6M N— Dale ........................ .......... ...................... ...... i eeal bydeen. WINDOW REPLACEMENT �nAndec�cnt%�MtnY f WoodMrip composite IF A Dual Argon tmu E4 SmattSun Dome Hung 100 M73618-010 ENERGY PERFORIi MCE RATINGS U-Factor(U.S)A-P Solar Heat Gain Coefficient c n 0 19) ADDITIONAL PERFORIVIIANCE RATINGS Visible Tmnsmittaf)ce JIM u; r42 wft&""f 6-ah"a-"Mvaokw—amw seem& "6~Pw ft—wNwMiw waewPw.a . rAanr�n..NYRn wrinyeaw MMw�6.A lnrafwaau Aawl�s.w.MMCrNirsa"aap.ot@/wara.r. MfgC earaw wmaaw�saey paareYa.a ea.as aaaurt Mr r.LelY4ary P�•��a•YaD�efe•�. Cant wam/.aaw�'a tamn loranw pwp■a paAw�paoa iMa�aUoa. , . YlMW.1�Rald s SIE41 TaipaAYparne6wrn is haev6"Mme al •ffim"•Y1r.Yww10in A`tMUawiwa" xgteowwuw.aua-raM • DESIGN PRESSURE(PSF) 14Na'allaaaaal�M m � RbA DB Sloped Sill DH 'IN TMWIINS@P'ANAM�IJC4A1M1�NAIOJi WM1RaM/N mAanM�bq aYrtltre. N«tsar.mwOsN��..C.EL.atE.C.C./1irM�weie�w«irw.rs WOMA/WMM�C.wi�Nor/1�aw. - Do not remove un61 final code inspection. Save label for future reference, .. 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AND-N-1 03 `.I3str6j; �ktc�v: WoodNinyl-Composite ........ •------°---• Dual Argon Low-E4 Product Type: Awning ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0. 29 1 . 65 0 . 28 U.SJI-P (Metric/St) ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 .48 Manutacoaer sdpul-atn that these ratlngs cantorm to appllcaUr NFRC procedures for^-r-nnlniv whole product pertonnance.NFRC rathfgs are detertNnad for a rued set of enoronmental condWma arm a spacnc product stv- NFRC doo not rammmend any product and dam not warrant the auft3ww or any product for any spednc us& cunsun manunchaer•s Bnradrre tar Wrier product partannance Wormatlon. wwwxm.org . .w.Yav, Andersen Co ora on:RbA Awninq n ow �Aanuracttirer stipulates conroffnancs m me rowmng Mae= Standard Ratlng NAF1-D2 orAAMWMMACSA:g:asaA44D-Ds DP psf DP40 • �� S ir.F,t Tttls prmlxtmeets ' Gram Bears anWnranennl tnftrd C? 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' �. �*4 tNenu(s�(RrsBppWa_ IheaefsUngs r ro ppf� NG uractde _ E ng� eoeirormJns ble• 7 _T,� a `v y `m>t [m'isartd�upcPfn$usizs- FRCdvaermt�ecomm®rich _6N a°''`.`z I +?Y- C' 1- �rol " y-`�'• '�h �'�` �'�f ivy. �` Yr�c. '`F=-� `" ', i' �`�`�� � �t � �..� •` �� R, Q Fj�5� i:D f� �'tr�12R�;�1 _ �'`� ,����,_ �,�tu�'=-- a�� �:. _ ..�'s"'a. ��It �_ rr-•,T r t i"-'*�-^y`�c..-^.�-�•�f'��'-" �`- "� � T>--r`�� ,:x- �f...+�".. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance AtUdavit: Builders/Contractors/Electricians/Plumbers Applicant Information {� (� Please Print Legibly Name(Business/Organization/Individual): I\V)raw ct, l\per Address: 30 J�-ar�)e_s City/State/Zip: �S3,�Phone#: - ~`-CAL U 6 Are you an employer?Check the appropriate box: Type of project(required): 1., 1i 4.am a employer with 3 L) * E] I am a have hired the sub-contractors contractor and I 6. E]New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 2'ICemodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof insurance required.]t c. 152, §1(4),and we have no repairs employees,[No workers' 13.[1 Other comp.insurance required.] *Any applicant that checks box N 1 must also fill out the section below showing their workers'compensation policy information. I 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 now 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: �e t� '4�,�c. 'in c z Policy#or Self-ins.Lie.#: 'A(�W C•, 306?>5p 6 Expiration Date: Job Site Address:S2�(l T b t-e_Al C t _ City/State/Zip: e_^.<_c- V p[0 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 here cer ' under the pains and penalties of perjury that the information provided above is true and correct. Sign —D. 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): I. 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 GARDJNQT. LYNN, MA 01905 10-06-14 Address Expiration Date 508-351-2214 Sig ture Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ RENEWAL BY ANDERSEN 170810 Company Name Registration Number 30 FORBES OAD ORTHBORO, MA 01532 12-23-15 Address Expiration Date Telephone 508-351-2214 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....... gl No...... ❑ 11. ome Owner Exemption The current exe tion for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such ho eowner to engage an individual for hire who does not possess a license,provided that the owner acts as su ervisor.CMR 7 Sixth Edition Section 108.3.5.1. Definition of Homeowner: son(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 t family dwelling,attached or detached structures accessory to such use and/or farm structures.A erson who constructs ore than one home in a two-year veriod shall not be considered a homeowner. Such"homeowner"shall submit to the Bu' ing Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work verfor med un r the buildine permit. As acting Construction Supervisor your presenc n the job site will be required from time to time,during and upon completion of the work for which this permit is issue . Also be advised that with reference to Chapter 152(Work ' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massach tts 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 fo ompliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Mass husetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement&indows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [tom] Other[o] Brief Description of Proposed Work:REPLACE 19 WINDOWS AND 1 DOOR - NO STRUCTURAL CHANGE Alteration of existing bedroom Yes XX No Adding new bedroom Yes XX No Attached Narrative Renovating unfinished basement Yes XX No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family XX 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 AMANDA ANDERSEN 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 I, 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 nalties of perjury. JAIME MORIN Print Name Signature of Owner ge 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 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 Q DON'T KNOW Q YES 0 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 Q NO G IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 Q NO ©X 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 AUG - 6 X014 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Electric, F.w :r ' i P'-t' rthampton, MA 01060 Two Sets of Structural Plans N°`t"``l P'`n " j„, eo -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 280 FLORENCE ROAD Map Lot Unit FLORENCE, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AMANDA ANDERSON 280 FLORENCE ROAD FLORENCE, MA 01062 Name(Print) Current Mailing Address: 413-320-8300 Telephone Signature 2.2 Authorized A JAIME MORI 30 FORBES ROAD NORTHBORO,MA 01532 Name(Print) Current Mailing Address: Z'� 508-351-2214 Signature Telephone SECTI 3,-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $26,873.00 (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) $26,873.00 Check Number v This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 280 FLORENCE RD BP-2015-0161 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-003 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-2015-0161 Project# JS-2015-000282 Est. Cost: $26873.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 24611.40 Owner: ANDERSON AMANDA Zoning: URA(100)/WSP(100)/ Applicant. RENEWAL BY ANDERSEN AT. 280 FLORENCE RD Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTH BOROMA01 532 ISSUED ON.•81612014 0:00.00 TO PERFORM THE FOLLOWING WORK.INSTALL 19 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 Sisnature: FeeType: Date Paid: Amount: Building 8/6/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner