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Renewal r- Renewal bV Andersen Corporation MA Horne Improvement Contractor
[-Andersen 30 Forbes to Northborough,MA 01532 License#170810 (Expires 12/23/2015)
win oow nrecnc erne... (508)351.2200 Fax,(508)-988-7072 Federal ID#41-1918413
Window Specification Sheet
burr. Auto, Dal,of :1,,�rrrturnl
MATTHEW E MICKIEWICZ NOREEN MICKIEWICZ THU. AUG 6, 2015
i ti4 I'll,,I . IITI,',I ihov, 1111.1.1 lui ok .full lU pill,!,,I,, I Ili 1,and'.1 1-rl1,, II'tv'l hch'Ne.fll,tl', Ild"114 c 4,1111 IIIc In 1,c"Bald 1,1In,d—i I lltt,I
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WINDOW&DOOR DEMULS
t., At AI L,. j C t or.'Interor C)I 1111 ar. r1« i 11111 t o G 1 lie U.1- I GIaflS
Rwln z rn neiyn u l vVindow Door Style Uetaf r-a alo .E t I'll ; ul '.trl ,ar; . Gnlles Sasr+t.3 5ast - Lifts I Options
Room_.
hlst 3ed lit+? III I„ 1621 G full frame 121 InVExt MF 9081WHIN Stone Istandardi FFG naris, N,11 12 1 ;,1 W 48 4 GVl'full frame laic _— 1 InVExt MF 908 JWH V N Stone IStandaru FFG marts, r No�
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Total 3 —T� BAY,BOW'&BUILD OUT DETAILS
i I ^�ppru^ i i Y ------°-�---
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SPECIALTY WINDOW DETAILS
—. l BAY/BOW ADDITIONAL WORK NOTES
FUII ,,#par F P '.:+It} -- I
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ADDITIONAL WORK DETrULS:
aliirniniirri wrap exterior trim-with canvas color to match existingif trim.take down and reinstall extehdor shutters.take down c•urtairis but do not/rut back up
No Contractor will wrap exterior casings with coil stock color of
Owneris aware that Contractordoes not do any painting/staining or removakinstatlatiorr of alarm systern 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
treatmentsmardware will ht after replacement Customer is also aware In some cases there wilt be glass loss. It 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 adartional charge for time and materials unless so stated in this contract.
Ye, 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, tlpon completion of the lob and payment in full.a 5mrted warranty shall be issued.
1 Yes Builctng Pemnt--Contractor will secure any and all necessary perinits. The fee for the perrnit(s;is Included ul the total contract price.
Yes All discounts have been applied to this agreement.
Owner agrees to be present on the final day of Installation for final Inspection and to deliver final payment/finance form(s)
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Renewal by Andersen Corporationr1,1 It..,..
Signature of Consultant Signature Signature
GERALD PERRON MATTHEW E MICKIEWICZ NOREEN MICKIEWICZ
Print Name of Consultant Print Name Print Name
Renewal _I r MA Home Improvement Contractor
Andersen Renewal b Andersen Corporation License X decal (Expires 12!2312015)
�' P Federal Tax ID#41-1918413
N hOpW aEP[�CEMEhi .
30 Forbes Rd. Northborough,MA 01532
(508)351.2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name Date.
MATTHEW E MICKIEWICZ - NOREEN MICKIEWICZ AUGUST 6. 2015
Buyer(s)Street Address City State Zip Code
247 BROOKSIDE CIRCLE FLORENCE MA 01062
Email Address Home Telephone Number Work/Cell Telephone Number
( BROWNSWIGGLE@COMCAST.NET (413) 586-1839 (413) 219-5573
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 S 12,798 mount Fnanced
Deposit Received f331,1 S 4.266.00 Dep—it.0 ti,G_. S 0.00 ✓ CheeW°Cash
&-f0 weeks
Balance Stan of Job(331.f S 4.266.00 Chuck a 769
Baiance on Substantial AI Est.Install Time Credit Card
stic�:�"„�:
Completion of Job(331x)S 4.266.00 «re .,S 0.00
1-2 days if credit card is selected,please
ba m�i-ace sssn.Ce aeman c - - 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 Buyer(s)
Signature of Consultant Signature T Sgnature
X GERALD PERRON MATTHEW E MICKIEWICZ NOREEN MICKIEWICZ
Printed Nam:of Consultant PnilcYd 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 CANCELL1.110S _NOTICE OF C:ANCELLCTION
Date uC Transartioa You <r..—I this Date of Transaction You may cancel this
transaction,without any penalty or obligati..,within threerbuim—dais from the transaction,without any penalty or obligation,within three business days from the
.I--date,tf you cancel,any property traded in,any Pat norm.made by you under I above date.If you camel,any property traded ia,any payments[Wade by wu under
the Contract of Sah.and any nefit [iablr instrutaem ex.cuted by you wilt Tx ehr Contract of Sale,and any negotiable instrunaen[rsecuted by you will be
returned Evitluin 10 days Collowin¢receipt by the Cunt:actor i"2+rllrr"` of your i re[urued within 10 dos.(ullowin¢receipt by[lae Contractor{"Seller of your
cancellation noLixt,and any security imerest arising out of the transaction will be I cancellation notice.and any security interest arising out of the transaction will be
canceled. 1f you cancel,you must.aakr available[u the Serer at your re+idence,in i canceled. [f you cancel,you mue.t tnahe available to the SeAer at ytaar rrtsidrncr,in
.."m.tialty as good condition as when received,any roods delivered to you under I sutraamially as Rood 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 inay,if you wish,comply with the instructions of the
Seller reg—ding the return shipment of the goods a[the Seller's eapensr and risk. I Seller regardiag the return shipment of the goods at the Seller's expense and risk.
If you do snake 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 there up
within 20 days of the date of your Notice cif Cancellation,you may rain—dispose I within 20 days of the date of your Notice of Caneella[ion,you may retain or dispose
of the¢Dods widtuut a�further ubligatioa. If yar fan a.make ehr gc[ods available I of the¢aids without any further obligation. if yea fail to make the goofs available
to the Seller,or if you agree to return the goods to the Seller and Can to do so,then I to the S.n i.or if y[w agree to return the good..to the Seller and fail to do so,then
you remain liable for performance of all obligations under the C owt-act. To cancel i you remain Liable for performaner of all obligations under the Contract. "fa cancel
this transaction,mail or deliver a signed and dated copy of this cancellation notice I this transaction,.nail or deliver a signed and dated copy of this cancellation notice
or any other written antic..or send A[./,grain to Contractor: Rrnew Al by Andersen.I or any other written notice.or send a t.trgra.a to Contractor Renewal by Andersen,
30 furbes Rd. Northborough.SL101i32. 1 30(Forbes Rd.Northbo--gb,NA 01112.
1 IIERERY CANCEL THIS TrLSNSACTION, I 1 HEREBY CANCEL THIS TRSNSACTION.
I
The l"ommouwesUh of Massie hme&
.Dap t nt of lndn r d AceWnts
Opke of Invealke&
60n '�ir�alt
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Worken' Compenution Insure, ice Aff dsyk:Builder&/ ontmetorWEle tri ci,andolumbers
ARgficant • n Ughly
Name{&tsiitesatOrganixatieant individual}: RENEWAL BY ANDERSEN
Addy 30 FORBES ROAD
City/Statr ,ip: NORTHBORO,MA 01532 Phone 508-351-2200
Are ou an eng6yerl Check the appropriate boa: Type or project(required).
l.'9 1 ain a employer with 30_ 4. ❑ 1 stn a general mar and 1 6. New wmhwtion
employees(fall and/or part-time).* have hirer/the-qui)-contractors
2.0 1 am a sole proprietor or partner listed on the attacked sheet,x 7. ri Remodeling
sbip and have no employees These sub-contraclors have 8. Demolition
working forme in arry oalaacity. workers'cotnp. innsurance. 9. ❑Building addition
[No workers'comp.innurattce $. ❑ We are a corporation and its
required.] offica s i:ave exe raise d thtrlr 10, ]Flextrit�al repairs e>;additions
3.0 I am a homeou-M doing all work right ufssxwuption per.MaL I l.[]Plumbing repairs or additions
myself,[No workers'comp. c. 15Z,11(41,oxi wt have no 1 n Roofxepa rs
insi mice requhvd,J t eniplWeas.[loo workers' 13,(3
oomp.insurance nquiired„j --
'"Any applicant that checks box#I must a w All out the station Oda*showing dw*work='atxnponaeioa powy intbrmaML
t Homes nen wlw submit thin affidavit indic"S dre4 ors doing 41 work and dM hire outside cuntrau M must SWUldt a nM at'lidXM Witaijig sMh
-Contractors that cue-A this boat must Ct =additioad itlW show4 the now tesesilt oosirmwo and tip'workers`*MV poles+infinidion.
I ant an emq*ysr drat h providing workers'csnrrrpensadon irnsrrrance>/err egg w pruyeex &&w is tk r pWky mrd joo,rte
WPM
Insuranoe f,mrtpany Name: OLD REPUBLIC INS. CO.
Policy#or Self ins.Lie.#- MWQ 30&3,70Q„_,��, _ L;xpiration Date: 10-01-16 .
.lob Site Address: . ..City/5�,�ip;
247 BROOKSIDE CIR FLORENCE, MA 01062
Attach a copy of the workers'compensation policy declaration page(showing the pansy number and expiration data.
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crim-Mal p+wkW of a
fine up to$1,500.00 and/or one-year imprisonment,as well as eiv,it penalties in the form of 'STOP WORK 016ER and a fine*
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be fexyvarded to the Offices of
Investigations of the D1A for insurance coverage verification.
I do herby 7r pains and penastdcs o.f 9dury that the Worm Mom prcrt+irt'ed above fs twee and correct.
.. ...
10/13/15
Phone 4: 50 8-351-2200
01*iel use 044k Do not write in this area,to be eonVeled by cif or town oJ,j'FciaL
City or Tows: Per mitlLleense#
Issuing Authority(chyle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.numbing inspector
6.Other
Contact Person: Pbo ae#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: JAIME MORIN 90125
License Number
86 GARDIK R ST LYNN, MA 01905 10/06/16
Address Expiration Date
617-966-0412
Telephone
9.Rersls#ered Home Imarovem at.Contractor: Not Applicable ❑
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 FOR S R NORTHBORO,MA 01532 12-23-15
Address Expiration Date
Telephone 508-351-2214
SE TION 10..WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25G(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 ] N OF'P II applicible
New House ❑ Addition ❑ ReplacemenLyndows Alteration(s) ❑ Roofing ID Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [0] Other[E J
Brief Description of Proposed
Work: REPLACE 4 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
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 REPLACEMENT
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, MATTHEW& NOREEN MICKIEWICZ 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 enalties of perjury.
JAIME MORIN
Print Name �� 'Z__ 10/13/15
Signature of Owner/ a 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:L- . ._.J R: L:L_..............._i R:i,,,,,,,,,,,,,,,,,,,,?
Rear
Building Height "-'°°
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved P ....._. ..1 ......_.,.w.., i,......_.
parking)
#of Parking Spaces -_ ` -
Fill:
volume&Location)
A. Has a Special Permit/Variance/Findi ever been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued:
L_.. ..____ __w_..__,,,
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® 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 0 DON'T KNOW Qr 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 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: f
E. Will the construction activity disturb(clearing,grading,ex avation,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.
EIV D City of Northampton
Building Department
VT 5 mis 212 Main Street
Room 100
Northampton, MA 01060
DEFT.r;c� T, ,
y" 'phone 413-587-1240 Fax 413-587-1272
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
Map Lot Unit
247 BROOKSIDE CIRCLE Zone Fr
SECTION 2-PROPERTY OWNERSHIPIAUTHORI,ZED AGENT
2.1 Owner of Record:
MATTHEW& NOREEN MICKIEWICZ 247 BROOKSIDE CIRCLE FLORENCE, MA 01062
Name(Print) Current Mailing Address:
413-586-1839
Telephone
Signature
2.2 Authorized Anent:
JAIME 094�_� 30 FORBES RD NORTHBORO,MA 01532
Name(Print) Current Mailing Address:
508-351-2214
Signature Telephone
SEC N3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee .
12,798.00
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) 12,798.00 Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
247 BROOKSIDE CIR BP-2016-0506
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 36- 108 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-2016-0506
Project# JS-2016-000844
Est. Cost: $12798.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sq. ft.): 20647.44 Owner: MICKIEWICZ MATTHEW E&NOREEN
Zonine: Applicant. RENEWAL BY ANDERSEN
AT. 247 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
30 FORBES RD (508) 919-0900 WC
NORTH BOROMA01 532 ISSUED ON.1011512015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 4 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 10/15/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner