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11C-069 (2)
Renewal bYAn dersen. -.;. WINDOW REPLACEMENT an Andccsen(;c+mpany 1NoodNinyl Composite IF Dual Argon Low E4 SmartSun Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0 . 29 0 . 19 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 42 pianutacturer stipuhtas that these ratings conform to applicabla NFRC procedures for datemuinitg whola product performance.NFRC ratngs era determined fora read sat of envit neaental cond'eions and a specti:product sae. NFNC do's not recommend any product and does not warrant the sueabBey of any product for any speC00 use. COneat m1mUfaCtarar'e literature for other product performance information. www.nfrc.org SEA. •4#F � This product meats Green � Seal's 'sonmaolal :standards env Vernin enar ,,- Y~ ' '?'^!• x ati:iancy,heavy metal.in .•`Vi,'µ: ;l�^�' the f ema and sash l;;fYr;:.z{"./7•,.:.rY fr;r e"materal,paclmging,and ;` i.:r' ,^•;?f} ! con-mar educational { •:,.S%`•: ;::••'!.,}•`n'` ':i :.:,. .• DESIGN PRESSURE(PSF) I,1111 Door flora �' 1 H-LC25 RbA DB Sloped Sill DH IN Tested to IIPFS42 or AN,IANOIA/CM 1MAS'A440ffi htaMa(:htff sliptilahis cortotmarM to VA appIkAbla stargazes. chats or exceeds hLE.C.,C.E.C,R I.E.C.C.Air Infk tion requirements WMA Hallmark CedBication Program. Renewal Renewal by Andersen Corporation MA Home Improvemerit Contractor byAndersen.1m 30 Forbes rnd�fN+�o+rthborough,MA 01532 License#170810 (Expires 12J23/2015) WINDOW REPLACEMENT ..n 1u.k.<<.C.,uu:.,.. (508)351-2200 Fax:(508)-98 6-7072 Federal ID#41-1918413 Window Specification Sheet 1Buver',sr Namc Date of Agrecment LINDA BURQUE RICHARD BURQUE TUE, AUG 1 1, 201 S The lwyt.ris;listed above hereby jointly and severally agree to purch.i r the goods and/or services listed below,in accordance with the ptieea and terms dtscHIWd on the Specification Sheet and the front and the reverse of the accony)anying CUSTOM WINDOW AND DOOR REMODELING AGREEME-f;of which the Specification Sheet is part. WINDOW&DOOR DETAILS qpp, qpp, Apo- Exterwrnmenor Odor Hardware Hardware LoNEA/ Grille Ilk Glass Room t wpm hegE ul. Window/Door$ le Detail Cas Ext-Int Odor style Screens Smartwn Grilles Sash 13 1 Sash 2 Lifts Options Bed 1 100 1 32 53 85 DB sq rail tail inert sloped sill Int.Pine WWI- White Standard FFG martsurl rer. 312 1 312 Yes No Mst Bath MI 32 53 85 DB so rail equal insert sloped sip Int-Pine HWI- White Standard FFG 4 GBG 312 3/2 Yes Temper Mst Bed 102 32 53 85 D8 sq rail equal insert sloped sir Int.Pine White Standard FFG r GBG 312 312 Yes No Bad 2 10:3 32 53 85 1 DB sq rail equal insert sloped sill Int.Pine NHIWP White Standard FFG r GaG 3/2 312 Yes No 104 32 5:3 85 DB sq rail equal insert sloped sill Int.Pine White Standard FFG GBG 312 3/2 Yes No Living 105 32 53 85 DB sq rail equal insert sloped sill Int.Pine NH1WH White Standard FFG kts. GRG 312 3/2 Yes No 106 :32 53 85 DB sq rail equal insert sloped sip Int.Pine wt+wH White Standard FFG 6manSur GBG 3/2 3/2 Yes No 107 32 53 85 DB sq rail equal insert sloped sip Int.Pine wKNvH White Standard FFG 6,inSur GBG 312 312 Yes No Total 8 BA BOW&BUILD OUT DETAILS roE Style Detail 1 WAIN Approx. Number Frame Window End Center LowE/ Roof! Hardware Room Count We Ranters hojont casings Anne Utes 1,Interior ExtAnt Color Gripes sashes sashes Screens Smartsun soffit Color SPECIALTY WINDOW DETAILS Fun! Approz. tows/ Many BAY/BOW ADDITIONAL WORK NOTES Room Count Style Insert U.I. Smart Sun Galles Caine Style Exont Cdor [:u.t,ma-r a a,ea—h.wah t.,A.-Hieu4r.+s unA" �•hrr nu-,=-nitl tx knit--etas.Lair_ ADDITIONAL WORK DETAILS- pro primed interior trim and introduce 2"stool cap on all the windows I No Contractor will wrap exterior casings with coil stock color of Owner is aware that Contractor does not do any paintinglstak ing or removal/installation of alarm system or window treatmentsthandware.It is the responsibility of the Homeowner to have the alarm system and window treatments/haidware removed prior to installation. V*make no guarantee as to whether alamu or Window treartments/hiardware will fit after replacement Customer is also aware in some cases there will be glass loss. H there is,Ule 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 nchided in this contract.Should any tot be found there will be an additional charge for time and materials unless so stated in this contract 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,stone 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 included in the total contract price. yes All discounts have been applied to this agreement. ti ✓ YV' Ne> Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). ft i+a�rcrtl:aril unuG•nur,d be wNi b+twa'n the Itiatu s That thi,hl-ifu:unvl bhret..don +sith the CI 4`I'O\I WI\T)OW ANA DOOR RF\I0DEI.I\G AGRfk1fF_\1:r rn rotate.uhr ,entin nn[h•ra:ualing hrtwsen IN,1>:utire awl Ili-- n"e'I'A artek•rst.uuiin>a dI iging,w m rhf ing am e f the uv tw. This 51r du.4i(ru Slt t tint,not Ix ehankh-d ur n team m+Klifiod or+ad'A in ':ate++'air oink ss�atit duurt'«an in wriuI1g.ntd Tined In bell the BI»rn s,and Gaimwitit. Ru)'rrs;he win it,rkii-%h d2(-that 6 ap+1,�.Ira-A thi.Slx-til iealu�rr�htxrl_ Renewal by Andersen Corporation !Suer r s t3uver(p a �er�t(�,✓/�iry# Signature of Consultant Signature Signature GERALD PERRON LINDA BURQUE RICHARD BURQUE Print Name of Consultant Print Name Print Name MA Home improvement Contractor I Renewal License#170810(Expires 12123/2015)i byAndersen. Renewal by Andersen Corporation Federal Tax ID#41-19184131, 004"Oom, 30 Forbes Rd. Norlhborough,MA 01532 (508)351.2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date: LINDA BURQUE RICHARD BURQUE AUGUST 11, 2015 Buyer(s)Street Address city State Zip Code 81 FLORENCE ST LEEDS MA 01053 Email Address Home Telephone Number Work/Cell Telephone Number RBWFtQ1JEQC2MF,6§T.N&T 1 (413) 586-9775 1 .Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Anderson 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"). 11 Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. g Total Job Amount $ 12,427 kmount Financed at.Start Date Method of Payment Deposit Received(33%)$ 4,142.33 Dposit at signing 00 0. Check/Cash 8 to 10 weeks Balance Start of Job(33%)$ 4,142.33 Chock# Est,Install Time Balance on Substantial At Substaftal Credit card Completion of Job(331%)$ 4,142,33 Como awn S 0.00 1-2 days If is selacted,please .:Cdft card I No final payman Moll todemandW unu ail partes are saLst*q I re gift Card Payment form Buyer(&)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings I changing or modifying any of the terms of this Agreement No sherstion to or deviation from this Agreement will be valid without the signed,written consent of both Buyer(*)and Contractor. Buyerr(s)hereby acknowledges that Buyer(s)1)has rood 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,an 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 AndersCon Corporation Buyer(s) Buyer(s) -JL L Signature of Consultant Signature Signature X GERALD PERRON LINDA BURQUE RICHARD BURQUE Printed Name of Consultant Printed Name Printed Name YOU,THE BUVER(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'""RIGHT. ---------------------------1 NOTICE OF CANCELLATION NOTICE Of CANCELLATION Dmet of Transmit— Ili 11iii You may cancel this I Dot.of Transaction 11/11/1:. You may cancelthl. troom"don,with",any penalty or obligation,within three business dales from the I gmummilon,without any penalty orobiltration,withlu these bmainesadays from the i show date.If you camel,any property traded In,any payments mad*by you under above date.if you cancel,any property traded In,any payments made by you under gg win he the contract of Sale,and any negadable,Instrument amended by you will he the Contract of So*and any negotiable Instrument executed by you receipt by the contractor("Seger") of your returned within 10 days fatlawing ere pa by the Contractor of year —turned within 10 days following cancellation notice,and any security Interest mistan out of the transaction will be I cancellation notice,and any security interest arising not of dw iransacdon will be canceled, If you cancel,you most make available to the Seller at your rcsiglence,in i can"Ird, tr you cancel,you som,make available to the Seller at your residence,In red 10 under substantially m good amodido.as.bra m..Ived,any goods delivered to you under I substandallyma good comiltiou, as when received,may goods 4*Uw you uml this Contract or Saki or you may,if you wish,comply with the instructions of the I this Contract or Salel or you may,if you wish,Comply with the instructions of the cap—and risk. I Seger regarding he return shipment of the goods at the Sllees expense and risk. 1. ficiter regarding the reimm,shipment of the good.at the Settee. If you do make the goods available to the Seger and the Seger does not pick them up I If you do make the Sun&available to the Sell"and the SeRst,does not pick them up within 20 days of the data of your Notice,of Cancellation,you may retain or dispose I within 20 days of the data of your N161100 Of Cmc*A&doz4 you may retala or dispose or the goods without say further obligation. If you fall to make the goods available I of the goods without any further obligation. It you fail 4o make the SO."available to she Seiler,or If you agree to return the pod.to the Seller and fail to do so,than to the Seiler,or If you agree to mcma the gongto to the Seger and fail to do an,thou t you reaudo liable for performance of all obligations"der the Contract.To camel I you remain liable for performance of an obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice I this tramaction,mail or deliver a signed and dated copy of this canectiallon notice or any other written notice,or send a telegram to Contractor: Renewal by Andersen,I or any other written notice,or mends,telegram to Coutractov. Renewal by Andersen, ! 30 Forbes Rd. NorthboroughMAOIS32. i 30 Forbes Rd.Northborough,NA 01532. I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THUS TEANSACITON. P1.1 N- 0,y—Srm— P11.N— DM. pee The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street,Suite 100 Boston,AMA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/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. 1 am a employer with 30 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 5 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 4. ❑Building addition [No workers' comp.insurance camp.insurance.1 required.] 5. ❑ We are a corporation and its l0.❑Electrical repairs or additions 3.El officers have exercised their 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.] t c. 152, §1(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. #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 isproviding 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. 4:MWC 30293800 Expiration Date: 10/01/15 Job Site Address: 81 Florence St City/State/Zip: Leeds, MA 01053 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 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 Investiga' ns of the DIA for insurance coverage verification. 1 do her y rt fy n e pains and penalties of perjury that the information provided aabove is true and correct. Si ngture: Date: ! < phone#a 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 Gard i r St nn, MA 01905 10-6-16 Address Expiration Date 508-351-2214 Signatu a Telephone 9 Resilstered Home Improvement Contractor: Not Applicable ❑ Renewal by Andersen 170810 Company Name Registration Number 30 Forbes Rd orthb rou h, MA 01532 12-23-15 Address Expiration Date�.4 Telephone 508-351-2214 SECTI 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 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�ndows Alteration(s) E] Roofing F7 Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[O] Other[o] Brief Description of Proposed Work: Replacing 8 windows, no structural change 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 house and or addition to existing housino, 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 I, Linda Burque 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 pe f perjury. Jaime Morin Print Name Signature of Owner/ 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 DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 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: 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,excayaffon,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O 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/Wye myPermit 212 Main Street Sewer/SepbeAvallability Room 100 Water/Well Avaitabflity► Northampton, MA 01060 TWO Sets of structural Plants of - phone 413-587-1240 Fax 413-587-1272 PIOVSite 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 81 Florence St Leeds, MA 01053 Map 11C Lot 069 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Linda Burque 81 Florence St Leeds, MA 01053 Name(Print) Current Mailing Address: 413-586-9775 Telephone Signature 2.2 Authorized Agent: Jaime M 30 Forbes Rd Lynn, MA 01905 Name(Pr' t) Current Mailing Address: Sign a Telephone CTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 12,427.00 (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=0 +2+3+4+5) 12,427.00 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 81 FLORENCE ST BP-2016-0352 GIS#: COMMONWEALTH OF MASSACHUSETTS MapBlock: 1 l C-069 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2016-0352 Project# JS-2016-000562 Est.Cost: $12427.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 19994.04 Owner BUROUE RICHARD C&LINDA L Zoning. URA(100)/ Applicant: RENEWAL BY ANDERSEN AT: 81 FLORENCE ST Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTHBOROMA01532 ISSUED ON.911512015 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 9/15/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner