24A-019 (2) BP-2022-0452
135 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-019-001 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-2022-0452 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 9976 RENEWAL BY ANDERSEN 090125
Const.Class: Exp.Date: 10/06/2022
Use Group: Owner: M MCCAFFREY CARA
Lot Size (sq.ft.)
Zoning: URB Applicant: RENEWAL BY ANDERSEN
Applicant Address Phone: Insurance:
30 FORBES RD 508-351-227 MWC31415820
NORTHBOROUGH, MA 01532
ISSUED ON:04/28/2022
TO PERFORM THE FOLLOWING WORK:
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
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
1 Fr—TE—C-7-77---. EIVE' .
APR ..2 7. 2022' . •
0 APR 2 7 2022
i
�,_ The Commonwealth of Massachusetts '- k
• `"-`-..__w D«T •..1�E 11UILbING INSPECT-IGNSf� -�
• i 'M MA 01060 Board of Building Regulations and Standards -"T Or`; '
} Massachusetts State Building Code,780 CMR fl
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 '
Building ern it Number:�P- a>-- g. - Date Applied:
i0 /0Z5y-Ze,Zo22
Building Official(Print Name) Signature Date .
SECTION 1:SITE INFORMATION .
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers ••
135 Prospect Ave. 24A 019-001
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 Sidi Yards Rear Yard
Required Provided Required Provided Required Provided .
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ • Zone: Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
' SECTION 2: PROPERTY OWNERSIfIP1 •
2.1 Owner'of Record:
Cara McCaffrey Northampton,MA 01060
Name(Print) City,State,ZIP .
135 Prospect Ave. 917-865-1445 , • cczelus@gmail:com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction Existing Building li( Owner-Occupied 0 'Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other lR Specify. Replacements
Brief Description of Proposed Work2: Replacement of 4 windows. No structural changes.
- SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) .
. 1.Building $ 9,976 1. Building Permit Fee:$ . Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee -
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
• .4.Mechanical (HVAC) $ . List: - '
5.Mechanical (Fire $
Suppression) Total All Fees:$ l
ijri
• Check No. Pi Check Amount - Cash Amount
6.Total Project Cost: $ 9,976 ❑Paid in Full 0 Outstanding Balance Due: •
i
•
•
•
•
•
•SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-090125 10/06/2022
Jaime Morin License Number Expiration Date • •
Name of CSL Holder
30 Forbes Rd. List CSL Type(see below) •' U
No.and Street Type Description
•
Northborough, MA 01532 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restric l&2 Family Dwelling
• City/Town,State,ZIP M Masonryted
• RC Roofing Covering
WS Window and Siding
• SF Solid Fuel.Burning Appliances
508-351-2277 rbabostonpermitting@andersencorp.com I Insulation
Telephone Email address • D Demolition • •
5.2 Registered Home Improvement Contractor(MC) •
170810 • 12/22/2023
Renewal by Andersen MC Registration Number Expiration Date
HIC Company Name or HIC RegistrantName
30 Forbes Rd. rbabostonpermitting@andersencorp.com
No.and Street Email address
Northborough, MA 01532 508-351-2277
City/Town,State,ZIP • Telephone •
SECTION 6: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 12( . No ❑ •
• 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. .
Cara McCaffrey(See signed contract attached) 4/22/2022 •
Print Owner's Name(Electronic Signature) • Date
SECTION 7b:OWNERI 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 and accurate to e best of my knowledge and understanding. •
Jaime Morin 4/22/2022
Print Owner's or Authorized Agent's Name(E nic Signature) Date
• 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.mass.uov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or 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"may be substituted for"Total Project Cost"
•
•
•
� � 1
CITY OF NORTHAMPTON
SETBACK PLAN
.
MAP: LOT:
• LOT SIZE:
REAR LOT DIMENSION
REAR YARD
•
•
•SIDE YARD SIDE YARD_ _
•
•
•
•
•
FRONT:SETBACK_ _ J
FRONTAGE •
1
i
,4 µ ro , The City of North ampton
�. ,
T ''
: Building Department
ix
41
y 212 Main Street •
n Northampton,Massachusetts 01060
ZF'..P•r...
• 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__30 Forbes Rd.LNorthborou_gh, MA 01532
The debris will be transported by:
Name of Hauler Renewal by Andersen
•
Signature of Applicant:_ ___ ___ ___ ___ Date: 4/22/2022
•
The Commonwealth of Massachusetts
t►l, Department oflndustrialAccidents
tf
q iM 1 Congress Street;Suite 100
,..1117).
Boston,MA 02114-2017
trar • www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERNIITTING AUTHORITY.
Applicant Information Please Print Legibly•
Name(Business/Organization/Individual): 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):
LE I am a employer with 30 employees(full and/or part-time).* 7, 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working forme in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.)
3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]:
9. _[�Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 1.0❑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.Q Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14.12 Other Replacement
152,§I(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.
Policy#or Self ins.Lic.#: M W C 31415820 Expiration Date: 1/15/2021
•
Job Site Address: 135 Prospect 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 cert4t.,under the pains enalties of perjury that the information provided above is true and correct.
Signature: Date: 4/22/2022
?bone#: 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: •
City of Northampton
r1-4 � S;s '
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ?'
212 Main Street • Municipal 4 al Building
V4 '' �b`
Northampton, MA 01060 SF%`—�"'•l'!
•
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 I10.R3.
3. I qualifij 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 Iand 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
qualify 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. IfI engage otherperson orpersonsfor hire in connection with the aforementioned project or work on
any f
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 I-) day of 20 r
(Signature) �_
d,-
a 4 Agreement Document and Payment Terms
' DBA:RENEWAL BY ANDERSEN OF BOSTON Cara McCaffrey
RENEWAL Legal Name:Renewal by Andersen LLC 135 Prospect Ave
HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(917)865-1445
MOM!MOW KO/pflAWART
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Cara McCaffrey 03/07/22
BUYER(S)NAME CONTRACT DATE
135 Prospect Ave,Northampton, MA 01060 (917)865-1445
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
cczelus@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: $9,976 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: $3,325
BALANCE DUE: $6,651 Estimated Start: Estimated Completion:
22-26 week 1-2 days
AMOUNT FINANCED: $0
We schedule installations based on the date of the signed contract and secondarily on the date
METHOD OF PAYMENT: Check 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: 1/3 now; 1/3 start; 1/3 completion
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 03/10/2022 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.
cQ C -),)-i
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Hanna Sihvonen Cara McCaffrey
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
03/07/22 Page 2 / 29
Itemized Order Receipt
DBA:RENEWAL BY ANDERSEN OF BOSTON Cara McCaffrey
RENEWAL Legal Name:Renewal by Andersen LLC 135 Prospect Ave
HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(917)865-1445
NU SEMR AWN t 0009 ul Ww MI
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
ID#: ROOM: SIZE: DETAILS: PRICE:
201 Master Bed Closet Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame,
Traditional Checkrail, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Hardware, White, Screen, Aluminum, Full Screen,
Grille Style, No Grille, Misc, None
202 Bath Room Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame,
Traditional Checkrail, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Tempered Glass, Hardware, White, Screen,
Aluminum, Full Screen, Grille Style, No Grille, Misc, None
203 Bed Room 1 Window, Double-Hung (DG), 1:1. Slope Sill, Insert Frame,
Traditional Checkrail, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Hardware, White, Screen, Aluminum, Full Screen,
Grille Style, No Grille, Misc, None
204 Bed Room 1 Window, Double-Hung (DG), 1:1, Slope Sill, Insert Frame,
Traditional Checkraii, Exterior White, Interior White,
Performance Calculator, PG Rating: 40 I DP Rating: + 40 / -
40, Glass, All Sash: High Performance SmartSun Glass, No
Pattern, Hardware, White, Screen, Aluminum, Full Screen,
Grille Style, No Grille, Misc, None
WINDOWS: 4 PATIO DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $9,976
inn-sAF Renewal by Andersen is committed to our customers'safety by
' :
oFa r` complying with the rules and lead-safe work practices specified by the EPA.
03/07/22 Page 3/ 29
If Using a Builder
S►.F/ DBA:RENEWAL BY ANDERSEN OF BOSTON Cara McCaffrey
Legal Name:Renewal by Andersen LLC 135 Prospect Ave
RENEWAL HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(917)865-1445
MI 5([HQ weave'&D001!Meal
Phone:(508)351-2200(Fax:(508)986-7072 I rbaboston@gmail.com
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.
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Hanna Sihvonen Cara McCaffrey
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
03/07/22 Page 16/ 29
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston,Massachusetts 02118
Home Improyement Contractor Registration
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++ '�_ �1. � t'!Type: Supplement Card
RENEWAL BY ANDERSEN LLC _ =e tration: 1272 W
30 FORBES RD - irahon: 1 212 212 0 2 3
NORTHBOROUGH,MA 01532 A 'w.
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�<1. ji. '': - Update Address end Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date.If found return to:
TYPE:Su➢Oiemenl Gard Office of Consumer Affairs and Business Regulation
Rnsmtfatie➢ E■Wratio➢ 1000 Washington Street-Suite 710
170810 12/22/2023 Boston,MA 02118
RENEWAl.BY ANDERSEN LEG
JAIME MOWN
30 FORBES RD ,,,4,,,n.N!!.j' t
H.NURTHBOROU, MA 01532 Undersecretary Not Id without Anton
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: 135 Prospect 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
4/22/2022
Date Signature of Permit Applicant
D o u b 1 e H u n g - r
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The Commonwealth of Massachusetts
Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
V` •
Qz Building Permit Application to Construct,Repair,Renovate or Demolish a
State Owned Building
Requirements for Building Permits
The Office of Public Safety and Inspections has issued this building permit application form to be consistent with the
permit requirements of the MA State Building Code, which are specified in Chapter 1 of the Code. The applicant is
advised to review and be familiar with these requirements in order to avoid some of the common permit application
problems.
Filing Instructions
Please complete and submit the attached application to the appropriate District State Building Inspector for review.
For a list of district state building inspectors and contact information go to the Office of Public Safety and Inspection's
website https://www.mass.gov/orgs/office-of-public-safety-and-inspections.
All applications shall be considered complete and will be reviewed if construction documents,specifications,fee,and
other materials that may be required as indicated in the building permit application are included with the application.
Important Note: All materials shall be submitted electronically on a compact disc(s) in addition to three (3) paper
copies. Also check if the state inspector requires construction control forms (see section 107 in the code) with this
application.
The permit application is available in two file formats;Adobe PDF and MS Word.The applicant may print the PDF,fill
out in pen,and then scan the document for submission.Alternatively,the applicant may use the MS Word version and
fill it out electronically*.With submission of the application in this manner,the applicant affirms under the pains and
penalties of perjury,that all information is true and accurate.
All applications shall include a check for the building permit fee.The fee may be calculated using the information to be
supplied in section 12 of the building permit application. Make the check payable to The Commonwealth of MA. The
notes below pertain to the information in Section 12 of the application
1. The contract amount shall include the entire scope of work of the project and shall include all incidental
constructions,but shall exclude the cost of plumbing and electrical work.Contract amounts for projects at the
Boston Convention&Exhibition Center and Massachusetts Water Resources Authority projects shall include
the cost of electrical work. Design fees or any other professional fees associated with construction
observation,supervision or construction management need not be included in the calculation. Pursuant to
G.L.c.161A,§24,the META shall not be required to pay any fee.
2. Application fee per building or structure(fee includes plans examination,construction inspection,issuance of
building permit,and issuance of certificate of occupancy):
a. Fee=0.005 times the contract amount up to first$10 million of contract amount+0.0025 times any
contract amount over$10 million. For example the fee for a$12 million contract is$55,000.
b. Maximum fee per project=$150,000
c. Minimum fee per project=$25
Please direct any questions you may have to the Boston Office at 617-727-3200
*If this is done,navigation through the form and filling in the fields is done differently depending on the version of MS
Word that you are using.For example,in MS Word 2007 drag the cursor over the checkboxes and then type'x'for
your selection. If you have difficulty with inputting information in any fields please describe the issue via the phone
number above,and DPS will correct the problem as soon as possible.