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31A-279 (5) BP-2021-2322 88 WASHINGTON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-279-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2322 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 10992 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2022. Use Group: Owner: HUSZAR ANDREW C& SIYANA HUSZAR Lot Size (sq.ft.) Zoning: URA Applicant: RENEWAL BY ANDERSEN Applicant Address Phone:, Insurance: , 30 FORBES RD 508-351-227 MWC31415820 NORTHBOROUGH, MA 01532 ISSUED ON:12/17/2021 TO PERFORM THE FOLLOWING WORK: 5 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. Signature: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DEC 1 6 2021 r)FPT,OF FII I(1 nintr_ihISPECTIONS SJ The Commonwealth of Massachusetts NCRTHc'-7nr, MAn,osa Board of Building Regulations and Standards FOR / Massachusetts State Building Code,780 CMR' MUNICIPALITY USE USE Building Permit Application To Construct,Repair;Renovate Or Demolish a Revised Mar 2011 • One-or Two-Family Dwelling ' • . This Section For Official Use Only • Build' Permit Number: 6R--z i'a�, 3 Date Applied: • „,,,, /i- 55 �� t • I IZv 2- 7- z� . Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: • 1:2 Assessors Map&Parcel Numbers . 88 Washington Ave. 31A 279-001 • 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: • _ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) . . Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided k. 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private CI Zone Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSBIP1 • 2.1 Owner'of Record: Siyana&Andrew Huszar • Northampton, MA 01062 Name(Print) City,State,ZIP . 88 Washington Ave. 678-386-4536 . • siyanahuszar@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) • New Construction❑ Existing Building JR Owner-Occupied ❑ 'Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other Ex Specify: Replacements Brief Description of Proposed Work2: SReplacement of 5 windows. No structural changes. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only • 1.Building $ 10 992 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee - 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing S -2. Other Fees: $ • '4.Mechanical (11VAC) $ . List: 5.Mechanical (Fire Suppression) $ Total All Fees•S • Check No 4 Check Amount: ' Cash Amount: 6.Total Project Cost: $ 10,992 '0 Paid in Full 0 Outstanding Balance Due: • • • 'SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-090125 10/6/2022 Jaime Morin License Number Expiration Date • • Name of CSL Holder 86 Gardiner St. List CSL Type(see below) U . No.and Street Type Description Lynn, MA 01905 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling • City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel.Buming Appliances 508-351-2277 rbabostonpermitting@andersencorp.com I Insulation Telephone Email address V D Demolition ' • • 5.2 Registered Home Improvement Contractor(HIC) 12/22./2021 170810 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name V • 30 Forbes Rd. rbabostonpermitting@andersencorp.corn No.and Street Email address Northborough.MA 01532 508-35,1-2277 • City/Town,State,ZIP • Telephone • SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) . Workers Compensation Insurance affidavit moat 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 D • • • SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT • I,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. .• •• Siyana&Andrew Huszare(See signed contract attached) 12/15/2021 • Print Owner's Name(Electronic Signature) Date • SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION • By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true curate to the best of my knowledge and understanding. • Jaime Morin 12/15/2021 • Print Owner's or Authorized Agent's e(Electronic Signature) • Date V • NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor . (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at . www.ntass.aov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dos 2. When substantial work is planned,provide the information below: ' Total floor area(sq.fr.) • (including garage,finished basement/atticgrt porch) Gross living area(sq.ft.) ' Habitable room count Number of fireplaces Number of bedrooms • Number of bathrooms - • Number of half/baths • Type of heating system Number of decks/porches • ' Type of cooling system • Enclosed Open • 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" • • I , • • ` � 1 CITY OF NORTHAMPTON SETBACK PLAN MAP: _ LOT: • LOT SIZE: • REAR LOT DIMENSION REAR YARD • • •SIDE YARD • SIDE YARD • • 1 • • FRONT:SETBACK - 4 • FRONTAGE • • i � ` 1 1 ,rw� .0"._ The City of Northampton �,,.4 .yy.s,°z `"" Building Department 1a f 212 Main Street `;;- ; Northampton,Massachusetts 01060 • Phone(413) 529-1402 Fax (413) 529-1433 • CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. • The debris will be disposed of in: Location of Facility_20 Forbes Rd.,Northborough,MA 01532 The debris will be transported by: • , • Name of Hauler Renewal by Andersen Signature of Applicant:__ ____ _ ___ ___ ___ _Date:_$t12/2021 The Commonwealth of Massachusetts "` Department of Industrial Accidents e jiff-. l 1 Congress Street,Suite 100 Boston,MA 02114-2017 V+n',w�,s`~ www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. . Applicant Information Please Print Legibly• Name(Business!organization/Individual): Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip: North borough, MA 01532 Phone#: 508-351-2277 Are you an employer?Check the appropriate box: Type of project(required): LEI am a employer with 30 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. O Remodeling any capacity.[No workers'comp.insurance required.]. 3.01 am a homeowner doingall work myselft • 9• ❑Demolition y (No workers'comp,insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all wont on my property. I wt7l 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and 1 have hued the sub-contractors listed on the attached sheet 13.a Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We area corporation and its officers have exercised their right of exemption per MGL a 14.®Other Replacement 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. •i b 1 " • Policy#or Self-ins.Lic.#: MWC 31415820 . Expiration Date* Job Site Address: 88 Washington Ave. city/state/zip: Northampton, MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy 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$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains hies of perjury that the information provided above is true and correct Signature: Date: 12/15/2021 Phone#: 508-351-2277 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector • 6.Other Contact Person: Phone#: • City of Northampton -‘s ,Shp /y Massachusetts i4 a tG�. =�Ini ='•�. L�� t.i DEPARTMENT OF BUILDING INSPECTIONS a= S�' 'x1 ' �;•--- '"� 212 Main Street • Municipal Building .0%, b i Northampton, MA 01060 ash^a ' • HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT • I, .(insert full legal name), born (insert month, day,year),hereby depose and state the following: • 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or • work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'. exemption, does not involve the field erection of manufactured.buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4.. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualifij for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. • Signed under the pains and penalties of perjury on this day of • ,20_ • (Signature) 4II Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF BOSTON Siyana&Andrew Huszar Legal Name:Renewal by Andersen LLC 88 Washington Ave RENEWAL R E N RENEWAL L HIC#170810 Northampton,MA 01060 nuxnCtMON&brA RSECIIIIIACIMNOri 30 Forbes Road I Northborough,MA 01532 H:(678)386-4536 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(917)922-7672 Siyana &Andrew Huszar 10/04/21 BUYER(S)NAME CONTRACT DATE 88 Washington Ave.Northampton . MA 01060 (678)386-4536 (917)922-7672 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER siyanahuszar@gmail.com ahuszar@gmail.com PRIMARY EMAIL 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: $10,992 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: $0 BALANCE DUE: $10,992 Estimated Start: Estimated Completion: 18 Weeks 1 Day AMOUNT FINANCED: $10,992 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Financing 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: Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the 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. NOTICE TO BUYER:Do not sign this 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 10/07/2021 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. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Tara Blore Siyana Huszar Andrew Huszar PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/04/21 Page 2/ 24 Itemized Order Receipt IN DBA:RENEWAL BY ANDERSEN OF BOSTON Siyana&Andrew Hussar RENEWAL Legal Name:Renewal by Andersen LLC 88 Washington Ave NL HIC#170810 Northampton,MA 01060 E ILLLSEVI[E'DE 01 "r, 30 Forbes Road I Northborough,MA 01532 H:(678)386-4536 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(917)922-7672 ID#: ROOM: DETAILS: 101 Living Room Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern, All Sash: Colonial 2w x 1h, Misc, None 102 Living Room Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern, All Sash: Colonial 2w x 1h, Mlsc, None 103 Living Room Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern, All Sash: Colonial 2w x 1h, Misc, None 104 Living Room Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White, Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, Fiberglass, Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern,All Sash: Colonial 2w x 1h, Mlsc, None 10/04/21 Page 3/ 24 yw Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Siyana&Andrew Huszar RENEWAL Legal Name:Renewal by Andersen LLC 88 Washington Ave HIC#170810 Northampton,MA 01060 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(678)386-4536 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(917)922-7672 ID#: ROOM: DETAILS: 105 Playroom Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame, Traditional Checkrail, Exterior White. Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware,White, Screen, Fiberglass, Full Screen, Grille Style, Grilles Between Glass (GBG), Grille Pattern, All Sash: Colonial 2w x lh, Misc, None WINDOWS: 5 PATIO DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $10,992 '-- Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 10/04/21 Page 4/ 24 ` � ` If Using a Builder �':J;` M1 DBA:RENEWAL BY ANDERSEN OF BOSTON Siyana&Andrew Huszar RENEWAL Legal Name:Renewal by Andersen LLC 88 Washington Ave RENANEWAL HIC#170810 Northampton,MA 01060 byD oRSEN 30 Forbes Road I Northborough,MA 01532 H:(678)386-4536 maim Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(917)922-7672 Property Owner Must Complete&Sign This Section If Using A Builder I,as Owner of the said property,hereby authorize Renewal by Andersen LLC to act on my behalf,in all matters relative to building permit application for the property/address indicated on this agreement. �,'` CV- _ /t__ — SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Tara Blore Siyana Huszar Andrew Huszar PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 10/04/21 Page 11/ 24 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: 88 Washington Ave., 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 12/15/2021 Date Signature of Permit Applicant /_ Page 1 of 1 ACORE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) �.-- 09/29/2021 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(ies) 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Midwest, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (A/C.No,Ext): (A/C,No): E-MAIL «rtificates@willis.corn P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIL• INSURER A: Old Republic Insurance Company 24147 INSURED INSURER 8: Renewal by Andersen LLC — 30 C Forbes Road INSURER C: _ Northborough, MA 01532 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W22288053 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MWDDIYYYYI OMITS X COMMERCIAL GENERALUAB(UTY EACH OCCURRENCE $ 2,000,000 I X� DAMAGE TO RENTED j CLAIMS-MADE 1 J OCCUR PREMISES(Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 MWZY 314161 21 10/01/2021 10/01/2022 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY jECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT --- (Ea accident) $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED MWTH 314159 21 10/01/2021 10/01/2022 BODILY INJURY(Par accident) $ AUTOS ONI Y AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE, AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION 1X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 ,OFFICER/MEMBEREXCLUDED? No NIA )O!C 314158 21 10/01/2021 10/01/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERA I IONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space 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 I At , �t, ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR In: 21636556 BATCH: 2252220 • commoriv eWth of MaiismeteuN{ts Construction Supervisor I St Division of lrrotessioral i.icensure ' Unrssfrict d-Buldinps of any use group which contain Board of Building Regulations rtW Standards I less than 35,000 cubic fest(111 cubic meters)of unclosed '•c 'Ht lttC►t � � S-ii i2t23 4 ' . *Dam-10t00Y20?1 LYt*M11 01 ri ,f- , `t. 1 6. ;.04:1 itle6 ,vithilibilia ja Failure to possess a arrant edition of the Massachusetts eels Building Code is cause for revocation of this Boras. 1 Oomodsalpnar daija K. cmwa.. , For mien tton about Ode Banes I Call(SMT)727-3200 or visit www.mess g"im i , .- _ ......� Q! 7(�/ 11e'�!^���IGT!/�TJC��%GI V ���:%�����/4idF/aL'T/ &teta Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration = Type: Supplement Card RENEWAL BYANDERSEN LLC t) 7' ! ; RapletraNcl: 170810 90 FORBES RD -,"u : 12 1 `at NORTHBOROU©H,MA Oi1182 ., t-_-, -14.., a itgA ;�F` scr A so►n Dore r UpdMe Address end Return Card. Pima Consumer Mal s&aua.iea Ragi6aoor MOMS IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Sucuiir.ivit Card before the expiration date. if found return to: Reaistretion Elldritilon Office of Consumer Affairs end Business Regulation 17O to 12/22 2021 1000 Washington Street -Suite 710 RENEWAL BY ANDERSEN Li C Boston,MA 02115 ,WME MORON 90 FORBES RD 46,...to geeaforE• -' NORTHBOROIJGH,MA 01582 llnrla.eft-rd.ev Not valid Ithout signature -,; D o u b 1 e H u n g 4- � r j Ptlevval , ade �,� ' byAndersene ;: _ ,• r Apri WINDOW• REPLACEtitttn omAsit^ol tCom=aoo { r4„ WoodMnyl Composite iF is Dual Argon Low E4 StnertSun Double Rung ,� 100-00173518-01 0 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient IL2L__019 ADDtTIOHAL PERFORMANCE RAVINGS Visible Transmittance • 0 . 42 . MrdmemrMMwAuw Iran ssdllpaaaker leappiarhie WPC pm:adore,Istso iakgwfol product asfirmssss.DIM NNW Niti OMMaitl/uraOwl aet ofeavironmaatN ooadiiu sad a spsciro protect fobs. IFRC Aostwit taasam eed Styprefhtct rid demo,Yautast the reistity of say product for may spseNio ese. OoasM naaabMan4 ilaraturs for other maw paarusrris.ialofwelbs. �r 0WWW.O if psi . Ilf 1 Th's pr�arrsaaYsatM : #' �^ ( f ''Aim SNds srolfa/Nlild y�,� ,, i standaMrtpeMniyarmy aid a. 't'.., �,.z 42 ..i.sey.....,sfaaabrr '� 'r''the frame Wal& .,a.__.h• •. OmatariA phobia.sad __... '''._- • - , 3/4 cossuawr agsasNaW DESIGN PRESSURE(PSF) ,40. on* ,5 mI ! • RbA D8 Sloped Sill DH IN i helOSOO SBIrNWwIDDANOSIOUSTAS-06. Ms s,sre Io1Ua ets a, *sow or exceeds M.F C.C.I.O.&MC.C.,Air tatilhatioe rptiymama WOKS nom.rkCMNeatiw Program-