36-326 (4) 224 CARDINAL WAY BP-2018-1044
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map.Block:36-326 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: REPLACEMENT DOOR BUILDING PERMIT
Permit BP-2018-1044
Proiect d JS-2018-001895
Est. Cost:$4412.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot size(so.R): 18730.80 Owner: LANGE RAY&ELAINE
zor n� Applicant. RENEWAL BY ANDERSEN
AT. 224 CARDINAL WAY
Applicant Address: Phone: Insurance:
30 FORBES RD (508) 919-0900 WC
NORTH BOROMAO1532 ISSUED ON.4/17/2018 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 1 PATIO DOOR
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 a 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 Shmature:
FeeType: Date Paid: Amount:
Building 4/1720180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
r+ i2 ` pool
IIx
City of Northampton A -
Building Department
212 Main Streeti ---m—=:
Room 100
Northampton, MA 01060 7Wid:.$af�gk,
phone 413-587-1240 Fax 413-587-1272 A11,110NtpYlaa
Other ,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE
,OOR/TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Promrty Address: 224 Cardinal Way Florence MA 01062 This section to be completed by_by oBke
Map Mi Lot l0 Unit
Zone Overlay District
Elm St.District co Dianna
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Raymond Lange 224 Cardinal Way,Florence MA 01062
Name(Pont) Current Mailing Address:
207.432.3734
See Attached Contract Telephone
Signature
2.2 Authorized Anent:
JAIME MORIN I 30 FORBES ROAD NORTHBORO,MA 01532
Name(Print) Current Mailing Address:
508-351-2205
Signature Telephone
SECTION 3-ES MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bmlitapplicant
1. Building 4412 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) 4,412.00 Check Number (J
This Section For Official Use Only
Building Permit Number: Date
Issued: /
Signature:
Building Commis erllnspector of Buildings 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 U R: L: R:
Rear
Building Height
Bldg, Square Footage
Open Space Footage
(Lm arca minus bldg&paved
parking)
IF IFF
#of Puking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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 t acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors LXl
Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks [[:3 Siding ID] Other[m
Brief Descriptiorkeff Froc��patio door
Work:
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.M New house and or addition to existing housing- complete the following:
a. Use of building:One Family Two Family Other
b. Number of rooms m each family unit: Number of Bathrooms
c. Is there a garage altachetl?
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 fl.of wetlands? Yes No. Is construction within 100 yr. Floodplain_Yes No
j. Depth of basement or cellar Floor below finished grade
k. Wiil 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
Raymond Lange ,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.
SEE CONTRACT 04/07/2018
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
04/07/2018
Signature of Owner/Agin Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder JAIME MORIN 90125
License Number
30 Fo es Rd. , Northborough, MA 01532 10-06-18
Address Expiation Date
ri 508-351-2277
Signature Telephone
S.Rellatered Home kmorovament Contractor: Not Applicable ❑
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 FO BES ROAD NORTHBORO,MA 01532 12-22-19
Adtlress A Expiration Date
TelephoneS08-351-2205
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
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_..... It No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwel ines 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 1083.5.1.
DeDnition 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 fondly 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 persons)
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
City of Northampton 212 Main Street,Northampton,MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: zea Cardinal way, Florence MA 01062
The debris will be transported by: Renewal by Andersen
The debris will be received by: Renewal by Andersen
Building permit number.
Name of Permit Applicant Jaime Morin
04/7/2018
Date Sign ure of Permit Applicant
C"\ The Commonwealth of Massachusetts
Department of IndusbialAccidents
I Congress Street,Suite 100
Boston,MA 01114-1017
wsomtslassgouldia
Wil.rkers'Compensation Insurance Affidavit:Builden/Contrmor$Mft riciano/Plumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Usti&
Name(Business/OrganizationgMividuap:Renewal by Andeteen
Address:30 Forbes Rd.
City/State/Zip:Northborough,MA 01532 Phone#:508,351-2277
Are 5wa an empkyer^Cheek me.""Prue Eos: T Project Type of P 1 (required):
I.❑J ImnaemploymwiN 30 employes lmllm or Wa- )• 7. ❑New construction
3.❑lemawk peoprierormpamenhry cod have vo empbymwahing fwmein 8. Remodeling
en)cope , [No xorkms'romp.uawmce req ard.]
3❑Iunalmnmowner doing all xork mvxlf(Noxorkers'cmnp.imumxe ru,.W.1 9. ❑Demolition
a.❑Imahom llo Wwill hhiring matramars rper uctalwwkm my sol. Iwill
10❑Building addition
um masall convacmn eilFm have walkers romxnmtim inslaaneemarc sole Il.❑Electrical repairs or additions
PoPkrma win no employees. 12.❑Plumbing repairs or additions
5.❑I an a'mora conuacmread I have hhW We subwntmmars lismd on rhe mmched sheet. 13.�Raof repairs
ilaa sub<anunctors Mvc employees and rwx xarlen'mnp hn.x
6.❑We me a cmpweri.n m,1 ss.mccrs have e.ercised their rigor ofe.ca xr.W MGL,, 14.QOther Replacement
153,§u<I,and xe hwe m employees Mo workers'cmnp.immaore mquinxi l
•Any epplicmt Ihat eheeb boa el moa elxi fill om as ucd of below od ing deir wmkeri m�emoE.n mas s bnorwrion.
f wu,
H. sub mit this must at Won atheyart dome allwink actI ax a tpupaecm,awbrtmoamwss •omv aot usn mdicatuwmelt.
.upsoy . Mrcheck ddsbox mono oovloan adorn..ahem,ho ,rda norm con subeomsu:toraaM suewhm6morvo�dmeeetiEm hove
employem. Iftla orb-cmaxlors have empbyem,rhry mon provge rheir wohers'emn,policy rounber.
I am an employer that is providing workers'compensation hum,ancefor my employees Bdow is the policy andlob sae
infonnefiom
Insurance Company Name:Old Republic Insurance Co.
Policy It or Self-ins.Li,.#:M WC 311129 00 Expiration Data 10/1/2018
Job Site Address: 224 Cardinal Way Cit,/StaWZip: Florence MA01062
Attach a copy of the workers'compensation policy declaration page(showing the Polley number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or one-year imprisonmenl,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificat
I do here ereffy under ,th ns and penames ofperlury that Me&formation provided above is true and ronvri.
si..uL On,, 4/7/2018
Phone#:5 1-2277
Offleial use only. Do not write in this area,to be completed by city or town oicial.
City or Town: PermittLicense#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City7Fown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Page 1 of 1
wcoRd CERTIFICATE OF LIABILITY INSURANCE °"'°p'w""fW
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CE AM HOLDER THUS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOREMO
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N ON,umNcato holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED proNabnf or W eildamed.
N SUBROGATION IS WAIVED,subject W Ma Same and LOmfmons of se,polky,eeMm policies may reRuke an endomMleM. A M&MW m on
MIs GlIBBtate don not corder rights W the CmlMssla holder In lieu of such endemm m •.
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INDICTED. NOTWITHSTANDING ANY REQUIREMENT.TERM M CONDITION OF ANY CONTRaCT OR OTHER DOCUMENT WITH RESPECT TO MCH THIS
CERTIFICATE MAY BE ISSUED OR NMN' PERTNN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREm IS SUBJECT TO ALL THE TERMS.
EXCLUSIONSAND CONDITIONS OF SUCH FOUCIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PND CiA BIS.
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CERTIFICATE HOLDER CANCELLATION
SHOUM ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOME WILL BE DELIVERED IN
ACCORDANCE WTM THE POLICY PROYISON8.
A�RFAefBRA]NE
01988-2015 ACORD CORPORATION. All rights re elmd.
ACORD 25(2016/03) The ACORD name and logo am mglatemd marks of ACORD
as x0. 15126108 -- 455145
Renewal Agreement Document and Payment Terms
byAnder5ef4 Alba amewrl by Anderoen of Boson Bayni laps
Legal Name:Renewal by Andersen LLC 224 Cardinal Way
Pill170810 Florence,MA 01062
wuev .W 30 Forbes Read I Nonhtcmugh,MA 01532 H:(2071432-3734
Phone:508-351-22001 Fair(508)996 7072 I rbabostonegmaiLcam
Buyer's) Name: Raymond Lange Comma Dam: 04/05/18
Buyer(s)Street Address: 224 Cardinal Way, Florence, MA 01062
Primary Telephone Number: (207)432-3734 Secondary Telephone Number:
Primary Email: elray1963Qaol.com Secondary Email:
Buyers)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by
Andersen of B...n("Contractor"),in accordance with the recons and conditions described in this Agreement Document and Payment
Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which
are all agreed rt by the parties and incorporated herein if reference r this gree this"Ag[eement").Buyer(r)hereby agrees m sign a
completion cerdfica¢after Contractor has completed a8 work under this Agreement.
Total Job Amount: $4,412 By signing this Agreement,you acknowledge that the Balance Due,and the Amount
Financed most be made by personal check,bank check,credit card,or cash.
Deposit Received: s0
Balance Due: $4,412 Estimated Start: Estimated Completion:
Amount Financed: $4,412 8-10weeks 1 day
Method of Payment. Financing We schedule instillations based on the date of the signed conttaa and secondarily on
the date in which we complete the technical measurements.The installation dare that
we are providing at this time is only an estimate.We will communicate an official date
and time at a later date. Rain and catmom weather are the most common noses for
delay.
Notes: Financing Plank3068; 1/3dep$1470.66; 1/3start$1470.66; 1/3subcomp$1470.68
Buyer(y)agrees and understands[hat[his Agreement constitutes the entire understandings between the parties and that there are no verbal
understandings changing or modifying any of the terms of[hiseemem No alterations to cur deviations from this Agreement will be
valid without the signed,written cons cn[of both[he Buyer' I
s)aC mctu ctor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this
Agreement,understands rhe 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 firs[written above and 2)was orally informed of Buyer's right to canal this
Agreement.
NOTICE TO BUYER:Do nor sign this contract if blank You are endded to a copy of the conaact at the time you sign.
YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT
OF 04/09/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION OF THIS RIGHT.
Isyol Noma 1,Anile by Andeaom LLC
Alba:Renewal by Mdrun of Bosmn Baya(s)
Signature of Saks Person Signature Signature
Brandon Harvey Raymond Lange
Prior Name c $ales Person Print Name Print Name
UPDATED: 04/05/18 _ - ----- _---__—�-- Page 2 1 22
RReal Itemized Order Receipt
AnderSerE dbu Rawaa..i by Andee.en of Isonon Raymond Lange
Legal Name:Renewal by Andersen LLC 226 Cardinal Way
HIC 8170810 Florence,MA 01062
...nn U 30 Forbes Roetl I himmborough,MA 01532 H:(201)432-3734
Phone:508351-22WI Fax'(508)986-70721 rbabostonOgmail com
.. ROOPA DETAILS
101 Kitchen Patio Door: Gliding, 200 Series Peters Shield, 2 Panel, Active/
Stationary, Exterior White, Interior White, Glass: All Sash.
Tempered High Pert. SmartSun Glass, No Pattern, Hardware:
Anvers®, Bright Brass, Exterior Keyed Lock, Auxiliary Foot Lock
Color Matched, Screen: Gliding, Grille Style: Grilles Between
Glass (GBG), Grille Pattern: All Sash. Colonial 3w x 5h, Miss:
None
WINDOWS:0 PATIO DOORS: 1 SPECIALTY.0 MISCO TOTAL S4Al2
Renewal by Andersen is committed to our customers mfery by
complying with the rules and Bad-safe work practices specified by the EPA.
UPOATEO. 04/05/18 Page 3 1 22
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Office of Consumer Affairs and Business Regulation
One Ashburton Place-Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
TYPE SupNmwacwd
RENEWAL BY ANDERSON LLC. ROgNhetlm: 170610
30 FORBES RD EIg1N/IIPR: 120=19
NORlHBOROUGH,MA 01692
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