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29-070 (4) 14 ACREBROOK DR BP-2020-0588 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-070 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DON OT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2020-0588 Project# JS-2020-001009 Est.Cost: $6536.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 12763.08 Owner: ALICE L SADLOWSKI Zoning. Applicant. RENEWAL BY ANDERSEN AT. 14 ACREBROOK DR Applicant Address: Phone: Insurance: 30 FORBES RD 508 919-0900 WC NORTH BOROMA01532 ISSUED ON:11/6/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2 REPLACEMENT WINDOWS I POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspecl or of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire ftartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smok : Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Skptiature: FeeType: Date Paid: Amount: Building 11/6/2019 0:00:00 $40.00 12 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner R C� Department use only N0V City of Northampton Status of Permit: 5 2019 Bui ding Department Curb Cut/Driveway Permit pFaT OF X12 Main Street Sewer/Septic Availability NOR O rU/CO1N ROOM 100 Water/Well Availability AT C,/N HA44nT�N gPECTlONS Northampton, MA 01060 Two Sets of Structural Plans i""o 131587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION B M'— ��s 9 1 1.1 Property Address: This section to be completed by office 14 Acrebrook Dr. Florence, MA 01062 Map -/ Lot -70 Unit Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Alice Sadlowski 14 Acrebrook Dr., Northampton, MA 01062 Name(Print) Current Mailing Address: 413-584-8072 See Attached Contract Telephone Signature 2.2 Authorizd ent: JAI RIN 30 FORBES ROAD NORTHBORO,MA 01532 Name(Print) Current Mailing Address: 508-351-2277 Signature Telephone SECTION -E TIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4qv 4. Mechanical (HVAC) 5. Fire Protection 6. Total=0 +2 + 3+4 +5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: I Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors In I Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[O] Brief Description of Proposed Work: Replacement of 2 v./indcvvs 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 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 Alice SadiOWSKI 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 10/29/2019 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 pains and penalties of perjury. J IME MORIN Print Name Y\L' �- 10/29/2019 Signature of O r/A ent Date SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: JAIME MORIN 90125 License Number 30 o bes Rd. , Northborough, MA 01532 10-06-20 Addres Expiration Date 508-351-2277 Signat a 14 Telephone 9.Reaiatered Home Improvement Cbntractor. Not Applicable ❑ RENEWAL BY ANDERSEN 170810 Coma ame Registration Number 30 OR ES ROAD NORTHBORO,MA 01532 12-22-19 Addres Expiration Date Telephone 508-351-2277 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....... b 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 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 Leeibly Name(Business/Organization/Individuai): Renewal By Andersen Address:30 Forbes Rd. City/State/Zip:Northborough, MA 01532 Phone#:508-351-2277 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 30 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6 E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 E]Building addition [No workers'comp.insurance comp.insurance.= required.] 5. ❑ We are a corporation and its 10.L] Electrical repairs or additions 3.1:11 am a homeowner doing all work officers have exercised their 11.0 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 Replacement employees. [No workers' 13.Z Other P 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Old Republic Insurance Co. Policy#or Self-ins.Lic.#:MWC 31415819 Expiration Date: 10/1/2020 Job Site Address: 14 Acrebrook Dr City/State/Zip; Florence, MA 01062 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 A or insurance coverage verification. I do hereby certify ul er hepains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: 10/29/2019 Phone it:508-351- 7 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 b.Other Contact Person: Phone#: Page 1 of 1 ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis Towers Watson Midwest, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd xU: AIC No: P.O. Box 305191 ADDRESS: certificates@willis.com ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Old Republic insurance Company 24147 INSURED INSURERS: Renewal by Andersen LLC - --- _ -- - .- -- --- 30 C Forbes Road INSURERC: Northborough, MA 01532 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W12663065 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUBR POLICY POLICY NUMBER MM/DD EFF POLICY EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FKOCCUR PREMISES Ea occurrence $ 500,000 A MED EXP(Any one person) $ 10,000 MMZY 314161 19 10/01/2019 10/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT F-1LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 Es accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 19 10/01/2019 10/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acadent a UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE i _ DED I I RETENTION E i WORKERS COMPENSATION X P OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? No /A MOC 314158 19 10/01/2019 10/01/2020 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mora spa"Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SR Io: 18532909 BATCH: 1372547 G}�3F3S4000-004 vrrwcdwo a s - .9E':7-�Ftl�d do- ..nwucs�urreawiev�n'.m.tr�' . 1 ' y��l�flr11�11{�Yf�Yll�w i 4/rs.r�lls�l��ta�r�..YIl��ilY��1rd.J -Jk� . aous�p�u,a�e,�Qin ro .. SoA1L�ltl 3711YIQ1lo�IH1i lVN�111aaY _ 4Ao •"•�pna 1 wsroul w>�Pmrri mios s�►nlant s�nvrceo i A WMG �PA9 :adllmnP�d ' ung ,, �uL&m-� �[7 �L IQ•�141 - rrq.�-� tpYswim rwwW .• .�m..yww,r�cu•T,-L ,.mYsr. �- . �-_ cast/ t u it P9q C lal OR a"- °d p Z Comrnonweatth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor Constr. a Unrestricted-buildings of any use group which contain i ,yztiSpervisor less than 35,000 cubic feet(991 cubic meters)of enclosed i space. C5-090125 L Wires: 10/06/2020 ' JAIME L MORIN .^ 86 GARDINER- TREET LYNN MA 01906 i t j fl ® a v Failure to possess a current edition of the Massachusetts 0"tsmmissioner State Building Code Is cause for revoc!•tion of this license. _ 1 For information about this Scense Cad(617)727-3200 or visit www.mass.gov/dpl �� G'� ��'CJLZr�fl��• Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement C2ntractor Registration Type: Supplement Card RENEWAL BY ANDERSON LLC. `��" ! Registration: 170810 30 FORBES RD I Expiration: 12/22/2019 NORTHBOROUGH,MA 01532 'r• i2 Update Address and Return Card. SCA 115 2OM-OW117 .�f �onv��i✓tt�eYr.,�1t�_��f.�i10t��J.,^ffJ r Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration lon Office of Consumer Affairs and Business Regulation 170810 12/22/2019 1000 Washington Street -Suite 710 RENEWAL BY ANDERSON LLC, Boston,MA 02118 JAIME MORIN 30 FORBES RD ,r..efGL NORTHBOROUGH,MA 01532 UndersecretaryNot valid ithout signature Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal by dersen of Boston Alice Sadlowski ".1. Legal Name:Renew I by Andersen LLC 14 Acrebrook Drive HIC#170810 Florence,MA 01062 30 Forbes Road I Northborough,MA 01532 H:(413)584-8072 Phone:508-351-2200 1 Fax:(508)986-7072 1 rbabostonbookingeandersencorp.com I Buyer(s)Name: Alice Sadlowski Contract Date: 10/12/19 Buyer(s)Street Address: 14 Acrebrook Drive, Florence, MA 01062 Primary Telephone Number: (413)584-8072 Secondary Telephone Number: Primary Email: alicesadlowskil* mail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"),in accordance with the terms 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 to by the parties and incorporated herein by reference(collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total job Amount: $6,536 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $2,179 Balance Due: $4,357 Estimated Start: Estimated Completion: Amount Financed: 0 8 Weeks 2 Days Method of Payment: Cash/Ch k We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date 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 extreme weather are the most common causes for delay. Notes: Discover 8/20 $2179; 1/3 Start $2179; 1/3 Sub Comp $2178 Buyer(s)agrees and understands thatr is Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifyin any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written cons'nt of both the Buyers)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of i is Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellati on,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER Do not sign tl as contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 10/16/2019 OR THE THI BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATEIL SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name•.Renewal by Andersen LLC dba:Renewalbb Andersen Buy-(a) Signature of Sales Person Signature Signature Tara Blore Alice Sadlowski Print Name of Sales Person Print Name Print Name UPDATED: 10/12/19 Page 2 / 25 Renewal Itemized Order Receipt bAndersen. dba:Renewal by Andersen of Boston Alice Sadlowski �� Legal Name:Renewal by Andersen LLC 14 Acrebrook Drive � HIC#170810 Florence,MA 01062 wINUUw NE LACEM ENr 30 Forbes Road I Northborough,MA 01532 H:(413)584-8072 Phone:508-351-2200 I Fax:(508)986-7072 1 rbabostonbooking@andersencorp.com ROOM: 101 Dining Room Window: Gliding, Double, 1:1, Active/ Passive, Full Frame, EJ Frame, Exterior White, Interior Pine, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: TruScene, Full Screen, Grille Style: No Grille, All Sash: , Misc: None 102 Bedroom Window: Gliding, Double, 1:1, Active/Passive, Full Frame, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: TruScene, Full Screen, Grille Style: No Grille, All Sash: , Misc: None WINDOWS:2 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL $6,536 'lDRenewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 10/12/19 Page 3 / 25