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17C-122 (2) renewal ® BY ANDERSEN'I willow Iryl- Customer Service 800-573-7606 104 Otis St.-Northborough,MA 01532•Main:(508)919-0900•Fax:(508)919-0903 J&L Windows,Inc.dbe Renewal by Andersen•Contractor License#149601•Expiration Date 09/2312008 ,, WINDOW AGREEMENT SOLDTO: /`-4MIJ 6. / DATE: ADDRESS F1� i C^- tff�F PHONE-Home:(YtS 1- CITY: �OPL un' STATE: at06Z PHONE-Work: (_) JOB SITE ADDRESS(if different): Approximate Start Date: 4'L K Approximate Completion Date: SPECIFICATIONS Renewal by Andersen approved materials will be.furnished and installed to these specifications: 1, Install total of: ?-� windows. 2. Quantity of windows: _Double Hung(DB) ❑Equal sash ❑Cottage sash(1/3 top,213 bottom) ❑Oriel sash(213 top,1/3 bottom) _Casement(CW) ❑Hinge right ❑Hinge left(as viewed from exterior):El 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 or Bow Window: Yes ❑fjhf#Windows to be Custom Fit Replacement: 4. ❑Yes IT W#of sills to be replaced: 5. ❑Yes F NO #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: High Performance 0.Other If other ease specify: 7. Exterior color to be: ❑White ❑Sand ❑Canvas IFTerratone 8. Interior color to be: ❑White ❑Sand ❑Canvas ❑Terratone WWood Note:Interior color can o be white,wood or same color as exterior. Wood interiors need to be finished by cust. 9. Hardware:,❑White Stone ❑Canvas❑Brass Double Hung: Install lifts? ❑Yes ❑No 10. ❑Yes Iff�o Removal of metal frames or grilles #of Units: 11. ❑Yes EVNo Install new paint-ready or stain-ready casings. Inside or outside stops#of openings:_ Interior casing#of openings: Exterior casings#of openings: ❑Pine ❑Maintenance free material customer 4ware that RbA does not do any painting. I-S_Cust.initials 12. ❑Yes Ifd No Wrap exterior casings with aluminum coil stock: color. Note:Required with stone window n0oval.Removal of storm windows II leave screw holes in casing. 13. New windows to have: ❑Half or Vull screens Screens to be: iberglass ❑Aluminum 14.Windows to have grilles: []Yes No If Yes: ❑Grille Between Glass(GBG) ❑Removable Interior Wood(INTW) ❑Full Divided Light(FDL) Grille patterns: DH DH DH DH CW/Picture Glider CPW or GPW *use a ditional sheet if needed Customer approved(initials):_ 15. 21 Yes ❑No Insulate,caulk and seal windows with three-point system to prevent water and air infiltration. 16. /l es ❑No Remove and dispose of existing windows and storm u 17. Yes ❑No Clean Up. All job related debris removed.Vacuum nightly. 18. F s 13 No Insurance. All workers compensation and liability insurance maintained. 19. tr13"1'es ❑No Warranty,Given to customer upon completion and receipt of full payment. 20.Additional information: 21. Regular Retail Price:$ 22.Total Project Amount:$ ZSIZ All available discounts have been applied: Yes ❑No 23. Is Project to be paid in❑Cash EFfinanced ❑Combination of Cash and Finance 24.Cash Deposit(1/3):$ 113 of balance due at start of job and final 1/3 due at completion of job. Fe fining 2/3 payment is made by credit card,an additional fee of 3%will be added to cover fee charged by Credit Card 25. s ❑No Financed. If Yes,Amount Financed: 2Sl"L (Account#:026. ❑No Customer agrees to be present on the final day of installation for final inspection and to deliver final payment. 27. ❑Y VNo Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure. 28. D'i'es ❑No Building Permit-As a convenience the company will secure the building permit.The fee for the permit is not included in the agreement price and a separate check is required at the time of sale for this fee. 'RENEWAL BY ANDERSEN'IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE BEEN SEEN PRIOR TO OPENING THE WALLS.PLEASE FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS LPR OR TO THE I INSTALLATION OF YOUR NEW WINDOIW6.INSTAILLLERSI ARE NOT MAKE RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS.'SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND'OV NER'REPRESENTS THAT NONE HAVE BEEN MADE TO,OR RELIED UPON BY'OWNER,'YOU ARE ENTITLED TO A COMPLET ILLEO IN DUPLICATE OF THIS AGREEMENT.-CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN CONSTRUCTION EP ME TERM AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRIMED ON THE REVERSE SIDE.This contract Is a legal dOCUnlerlt. e I provem nt Contractors and Subcontractors shall be registered. Inquiries about a contractor or subcontractor relating to a re t tratio sh Id be dir ad to:REGISTRATION DIVISION,PROGRAM COORDINATOR, ONE ASHBURTON PLACE ROOM 1301,BOSTON,M 02108. ou, a home er have a three day cancellation right under MGL eg3 s 48 MGL c 140D s 10 or MGL c 255D s 14. All warranties are under t e owner' right accord) to the provisions of 780 CMR R6 and MGL c 142A. DO NOT SIGN THI CON T C IF T E ARE ANY BLANK SPACES. c- n RbA Rep.Signature: Date: Customer Signature: 2, Ei°j�.+ Customer Signature: Whim-Renewal by Andersen Yellow-Installation Pink-Homeowner 03-03-05 f a re al NFRC IIyANDNRtNN• r�ataniFenesValiorr WoodNinyl Composite Frame RatmgGafre"o Dual Argon Low E _ __. Glider ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 130 034 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 49 Manufacturer stlpuleles that these ratings conform to applicable NFRC procedures for determuiing whole product performance.NFRC(ratings em determined fora flaed set of environmental conditions and a specdk product size. y NFRC does not recommend arty product and does not wenanl the sultablYly ofany product forany speclflc use. Consult tr snufecturseS ktsreture for other product psrfornance letommtlon. www.nfi. t t DESIGN PRESSURE(PSF) - M thodsllm HS - L C 2 5 100=00296313-006 Toted to ANS AL)1 .5_'A7 or 5-02. Me ufectury lei lac eoafutmmccb lhce 6ceb estmumderds Meefs or exceeds M.E.C.,C.E.C,&1.E.C.C.Air Infkltmtlon requirements WOMA Nefirnark CerdAcatlon Program. 4 ACORD,. CERTIFICATE OF LIABILITY INSURANCE D0AM JMMIDDAYM 2/13/20 8 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MCKeone 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. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 0 INSURED Renewal by Anderson INSURER A: Hprtford I nsurartce Company J&L Windows,Inc. INSURER e: Hermitage 104 Otis St INSURER C: Northborough,MA 01532 INSURER 01. 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. UYSR 0 L POLICY NUMBER POLICY EFFECTIVE POLICY EXPtRAT10N OMITS B GENERALUABILITY HCP 507 404 09/07/2007 09107/2008 EACH OCCURRENCE s 1.000.000 COMMERCIAL GENERAL LIABILITY PREMISES Me a=rencej 100,000 CLAIMS MADE ©OCCUR MEO EXP( df10 person) S --5.0-00 PERSONAL d AOV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG s 2.000,000 POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY 35 MCC XD 6390 10/0112007 10101.2008 COMBINED SINGLE LIMIT S 1,000,000 AWAUTO (Ee accident' X ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIREDAUTOS BODILY INJURY S NON.OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Peraardenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 15 R ANYAUTO OTHER THAN EAACC S AUTO ONLY: AGG S EXCESSUMBRELLA LIABILITY EACH OCCURRENCE Is OCCUR CLAIMS MADE AGGREGATE S S 'DEDUCTIBLE S {RETENTION S S A WORKERS COMPENSATION AND 35 WEC PP 1444 02/17/2005 02/17/2009 WC MIT O R ORY EMPLOYERS'LIABILITY E.L.EACH ACCIDENT s 500,000 ANY PROPRIETORMARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S 500,000 N yep destrbe under CIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT S 500,000 SPE OTHER DESCRIPTION OF OPERATIONS ILOCATIONS IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD-MY OF THE ABOVE DESCRMED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL i0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIAOMM OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. may, AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ��(/{/ 0 ACORD CORPORATION 1988 i C - -- — _ ✓fie'rOOmvrizaruaeal� a�./l/`aaoacfiudeka i Board of Building Regulations and Standards !, Constructiort,SupervisorLicense License:'CS 74251 BIRtWARt =--51 t hpirat n I91k09 Tr# 11065 JOHN K ESLER f 104 OTIS ST NORTHBOR0,MA 01532 /Eommissioner � _. _.__.,__..__.. ..,x.7.-. ..,.0--•- - ... __�.._.__..__��.!!_.__.______.. . ✓fie TOOnvnwaxcuea�C a�✓ULCt4dacfu�ael�a Board of Building Regulations and Standards lugHOME IMPROVEMENT CONTRACTOR Registration:, 149601 Explrat1om"%24/2010 Type Supplement Card RENEWAL BY ANDERSON CAROL O-BRIE4 104 OTIS STREET NORTHBOROUGH,MA 01532 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Ret)e-&JA , An ersc m Address: ✓D free_- City/State/Zip: b ©ro Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.&LI am a employer with �-20 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. x Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]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'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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: &C� �r1:s U 1rCr n Cl Policy#or Self-ins.Lic.#: 0_­?� ��T Expiration Date: /7 Job Site Address: �_0, �f 1 l,e u ; . {h'e- City/State/Zip: ; /C� eh C t JP,4 G/a 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 ertify under th pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#- �� ()p 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: ���t � ��>° � q, License Number Ji A A !ss Expiration Date Signature Telephone 9.Realsteiidfl6me IMprovement Contractor; Not Applicable ❑ Company Name Registration Number loq N% stvf boo Address Telephone Expiration Date ��������� 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. Home.. wrier exempt ©ri 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 'Iteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[�] Brief Description of Proposed _( / Work: Le.� CC' o� C�r/�c v�u 3 i f'�L T1 �� 1!i�i GiQ�+�e_� 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_fiotlse`and-or'ad i ion;; o e istir 'ho sin aam late the foh "win 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 I, 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 A61 l as Owner/Authorized �c„-pe thereby declare th t t e statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ins and penal'es of perjury. Print Name t �g Signature of Own Agent 1 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 L.. . . . ...... m .. .�.. ._ Setbacks Front i WV Side 1 L � R. .__e._a l . ._ Rear Building Height ----.._..... i.......... ; Bldg. Square Footage 0 F" Open Space Footage m �. % (Lot area minus bldg&paved parking) #of Parking Spaces �...., Fill: I (volume&Location) ( A®.e. . __ ._ m_. ...... i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q 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 i Page' Document#, B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 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: i C. Do any signs exist on the property? YES NO Q 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 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. ly y ✓ r 31 3 Ap City of Northampton F OPI 'Building Department NINE fl 212 Main Street I werl gggz MAY 2 9 2C08 Room 100 �yr is � G t Northampton, MA 01060 TWAu #urIlPta r� phone 413-5p7-1240 Fax 413-587-1272 PIcS 3 g 3I, 1�31 .�3p�3 KA y °sc APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION n p� e //�/� r This section to be completed by office 1.1 Property Address: O� U y jy-�; �G�t��� Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C y Name(Print) Current Mailin Addr s: Telephone Signature 2.2 Authorized Agent: Name(Pnnt) //t C Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building X/ (a)Building Permit Fee 2. Electrical �( (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee U 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2008-1073 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate-ory: BUILDING PERMIT Permit# BP-2008-1073 Project# JS-2008-001582 Est. Cost: $2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 149601 Lot Size(sq. ft.): 24872.76 Owner: SIMMONS RICHARD&LAURA Zoning: RB Applicant: RENEWAL BY ANDERSEN AT. 52 SHEFFIELD LANE Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919-0900 NORTHBOROMA01532 ISSUED ON.512912008 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 5/29/2008 0:00:00 $25.005706 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo