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MORMANIAM= RATINCD& visible Trarlsr»ittarxaw 0151' . see 4WAUWOAM l46ev+dq�� ftlk Wtpa m r�MIMNp ►m+l s. � OP pef F-MO �E�� tar�rwarrs w*,Cn "'WE�_asM�sraertlis ; . �ao.00Bttaoe.aoy • pp���II Renewal bV Andersen Corporation MA Home Improvement Contractor llklMewal 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015) wuvoamr .—ACE.— (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet Buyers)Namc Date ot'Agreement ELLIE ADAMOWICZ TUE, JUL 29, 2014 The buycr(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 NVI_NDONV AND DOOR REMODELING AGREEMENT,of which the Specification Sheet is part. WINDOW DETAILS Approx. Exterior/Interior Color Hardware Hadaware LowE4/ Grille Grille Glass Room # U.I. Window/Door S le Detail Casin 5 Ext-Int Color S le Screens Smartsun Grilles Sash IM Sash 2 Lifts O bons a1B.S BAY&BOW DETAILS *See Ba /Bow Measure Sheet Style Detail/ Approx. Approx. Number Frame Window End Center LowE/ Hoof/ Hardware Flankers U.I. Casin s An le Lites Interior ExVlnt Color Grilles sashes sashes Screens Smartsun Soffit Color CS.FW.CS 45 Int/Ext 20-25 3 White WH/WH GBG 2/5 4/5 FFG Smartsun Soffit White SPECIALTY WINDOW DETAILS a Spec il BAY/BOW ADDITIONAL WORK NOTES Full/ Approx. LowE/ tY Room Count S le Insert U.I. Smartsun Grilles Grille S le Ext/Int Color Cuw"ncr L ro dim"4th bav/bw,�do„-.undrr 72 irh, there will L,sim,ihcant ol:ros lose. ADDITIONAL WORK DETAILS: Isw,d,ae tE,rofi n:l I No Contractor will wrap exterior casi is 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 2 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 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. 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. I 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 it 2323 $ 35 Yes All discounts have been applied to this agreement. e 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). II 6 n—A and—clem.,by and between the panics that 00 Speco m" She rt along wuh tht.C lNMM MM)Oy1 -1ND DOOR KI;MODPJ.ING AC RI 1 31CM1 constitutes the .entire understanding between the parties,and there are no"%A uudersta &lp changing of nt dm Rig any of the lean' Ilan Spc om m Shut m ry net be changed nt us tet ms modified of jai icd in are way uulcss such changes arc in uruing and Q" both the Buyers.and Conn-a— Bu V,r hereby acknowledge shat Buyers)has lead this Specification sheet. 'Renewal by Andersen Corporation Buycr(s) Buyeriaj Fes.0,$4- .____ _ - Signature of Project Manager Signature Signature GREG TAUTKUS ELLIE ADAMOWICZ Print Name of Project Manager Print ame Print Name RenewC�l MA Home Improvement Contractor R License#170810(Expires 12123/2015) hn,A dersen.. Renewal by Andersen Corporation Federal Tax ID#41-1918413' Wl NOOW .E>LaC£MEN? \ f 104 Otis St. Norihborough.MA 01532 (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date: ELLIE ADAMOWICZ - JULY 29, 2014 Buyer(s)Street Address City State Zip Code 432 RYAN RD NORTHAMPTON MA 01062 Email Address Home Telephone Number Work/Cell Telephone Number 413-584-8557 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. Est.Start Date Method of Payment Total Job Amount $ 8,844.00 Amount Financed$ 0.00 Deposit Received(33%)$ 2,948.00 v. Check/Cash 10-12 weeks Check# 2322 Balance Start of Job(33%)$ 2,948.00 Deposit at signing$ 0.00 Balance on Substantial At Substantial Est.Install Time Credit Card Completion of Job(33%)$ 2,948.00 Completion$ 0.00 1-2 days It credit card is selected,please see Credit Card Pa ment 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) Fn Signature of Project Manager Signature Signature GREG TAUTKUS ELLIE ADAMOWICZ 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. ___________________________________________________________________________i NOTICE OF CANCELLATION NOTICE OF CANCELLATION 1 Date of Transaction 7/29/11 You may cancel this 1 Date of Transaction 7/2e/l 1 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 1 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 Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor("Seller") of your 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 1 cancellation notice,and any security interest arising out of the transaction will be anceled. If you cancel,you must make available to the Seller at your residence,in 1 canceled. If you cancel,you most make available to the Seller at your residence,in Lsubstantially 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 1 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. 1 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 1 of the goods without any further obligation. If you fail to make the goods available i 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,mail or deliver a signed and dated copy of this cancellation notice 1 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,1 or any other written notice,or send a telegram to Contractor: Renewal by Andersen, 104 Otis St. Northbomugh,MA 01532,BY NOT LATER THAN MIDNIGHT OF 1 104 Otis St.Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF R/I/17 .(Date) I HEREBY CANCEL THIS TRANSACTION. R/I/I1 .(Date) THEREBY CANCEL THIS TRANSACTION. 1 Buyer's Signature Pn.Name Date Buyer 5 Signature Prinl Name Date - The Commonwealth of Massachusetts Department of Industrial Accidents F Office of Investigations d 1 Congress Street, Suite 100 Boston, MA 02114-2017 Y v� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip: NORTHBORO, MA 01532 Phone #: 508-351-2200 Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with 30 4. ❑ I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. [J Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.F] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 15 2, §l(4),and we have no employees. [No workers' 13.❑ 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 all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic. #:MWC 30293800 Expiration Date: 10/01\/15 Job Site Address: y 3 oZ Q c4i City/State/Zip: a,,,,"10—,C;,, , ✓,� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).O lOb- 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 ce t y u er the pains andpenalties ofperjury that the information provided above is true and correct. Si mature: Date: to- 3— t4 Phone#: 508-351-2200 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): 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 GARDI R LYNN, MA 01905 10-06-16 Address Expiration Date 617-966-0412 Signatur Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ RENEWAL BY ANDERSEN 170810 Company Name Registration Number 30 FORBES R9AD NORTHBORO,MA 01532 12-23-15 Address Expiration Date Telephone 508-351-2214 1 4z SEC/60N 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....... ;7 No...... ❑ 11. - Home Qwner 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 ❑ Replacement Windows Alteration(s) E] Roofing ❑ Or Doors i Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[0] Other[d] Brief Description of Proposed Work: REPLACE 1 WINDOW- 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 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 ELLIE ADAMOWICZ 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 MORIN Print Name /a Signature of Owner/Agen 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 0 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 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: 11 Building Department Curb Cut/Driveway P"it 0I 212 Main Street ei rlSt i Avabtii bilty Room 100 tatbr/Well Availability I td c,Plumbing$(;a, orthampton, MA 01060 Twig'Sets of Structural plans Northam ton,MAlli ne 4 13-587-1240 Fax 413-587-1272 P1otO Mink- 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 432 RYAN ROAD Map Lot Unit NORTHAMPTON, MA 01062 Zone Overlay district Elm St,District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ELLIE ADAMOWICZ 432 RYAN ROAD NORTHAMPTON, MA 01062 Name(Print) Current Mailing Address: 413-584-8557 Telephone Signature 2.2 Authorized Agent: JAIME MORIN 30 FORBES ROAD NORTHBORO,MA 01532 Name(Print) / Current Mailing Address: 508-351-2214 Signature Telephone SECTION 3- -S ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 8844.00 (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) 8844.00 1 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 432 RYAN RD BP-2015-0401 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29- 102 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-2015-0401 Project# JS-2015-000720 Est. Cost: $8844.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 14069.88 Owner: ADAMOWICZ ELINOR T C/O ELINOR ADAMOWICZ TRUSTEE Zoning: Applicant: RENEWAL BY ANDERSEN AT. 432 RYAN RD Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTH BOROMA01532 ISSUED ON.101712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOW 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 10/7/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner