Loading...
11C-069 (5) BP- 022-0782 81 FLORENCE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 1 1 C-069-001 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-2022-0782 PERMISSIONIS HEREBY GRANTE I TO: Project# DOOR Contractor: License: Est. Cost: 8063 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2022 Use Group: Owner: L BURQUE RICHARD C &LINDA 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:07/01/2022 TO PERFORM THE FOLLOWING WORK: PATIO DOORS 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 VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: (` • )2 . / � �l Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner he ommonwealth of Massachusetts JUL ' 1 2022 B 1 rd o Building Regulations and Standards FOR Ma sack setts State Building Code, 780 CMR MUNICIPALITY \i USE rar of i>mn t>i pplic tion To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 Noar_,aMr�ro .Ma 01060_ ne-or Two-Family Dwelling This Section For Official Use Only Buildin PermittNNumber: Date Applied: Kevii—)' 1�0 5s 7- i-Zo 7 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Ass i �sso (, ors Map&Parcel Numbers o p 81 Florence St 1.1 a Is this an accepted street?yes X 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 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system C] Check if yes❑ f SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Linda Burque Leeds,MA 01053 Name(Print) City,State,ZIP 81 Florence St 413-335-7220 rburque@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:replacement Brief Description of Proposed Work'-:Replacement of 1 patio doors no structural work 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $8063.00 1. Building Permit Fee: $ Indicate how fee is determir ed: 2.Electrical $p ❑Standard City/Town Application Fcc ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5. Mechanical (Fire Suppression) $0 Total All Fees: ley Check Noll Check Amount: 7 U Cash Amount: 6.Total Project Cost: $8063.00 ❑Paid in Full 0 Outstanding Balance Due: r— 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 86 Gardiner St List CSL Type(see below) U No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. .) Lynn,MA 01904 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry 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(HIC) 170810 12/22/2023 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 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 0 No 0 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. Linda Burque see contract 06/27/2022 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'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 tru a ate to the best of my knowledge and understanding. Jaime Morin 06/27/2022 Print Owner's or Authorized Agen ' ame(Electronic 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage, finished basement/attics,decks or porch)I 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton of HiiM oa- P>o . +w v' '' Massachusetts S., a VA g 'lx DEPARTMENT OF BUILDING INSPECTIONS .� 212 Main Street • Municipal Building J \� ,'�.� Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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: 4 Technology Dr Westborough,MA 01581 Location of Facility: The debris will be transported by: Name of Hauler: Waste Management Signature of Applicant: Date: 06/27/2022 Wit\ The Common wealth of Massachusetts lam:=r Department of Industrial Accidents _,1. 1 Congress Street,Suite 100 31• 7 R t Boston, MA 02114-2017 www mass.gov/dia % im-kers'Compensation Insurance AMilaylt:Builders/[:ontractors/Eketrieiansfi lumbers. TO BE FILED WITH THE PERMITTING AUTHORTIV. Applicant Information Please Print Legibly Name(Husiness Organtratioretndividuaty: Renewal by Andersen 1 Address: 30 Forbes Rd City/State/Zip: Northborough, MA 01532 phone#: 508-351-2277 I Are you au employer?Cheek the appropriate hit: Type of project(required): l.®1 ant a employer with 30 employees(full and'ur part-time)l 7. ❑New construction 20 I ant a sole proprietor or partnership and have nu engsloytx-s working forme its g. 13 Remodeling any capacity_[Nu workers'cuinp.insurance required] 9. 0 Demolition +7J Lane a humoa sru--r doing all uurl melon.(No wurltus'comp.insurance require:11 f a.®I am a honxowncr and well be hiring cxintracturs to conduct all work on My property. I Willi I Building addition ensure that all contrueturs either hare workers'compensation imuranee or an sole I I.]Electrical repairs additions proprietors with no employees. 12.0 Plumbing repairs addition, f 1 I i atn a general contractor and l have hired the sub-contractor's Listed on the attactu.+d sheet �J 13.3 Roof repairs 1 hcse sub-contractors have employees and have Workers'comp.insurance.: 6.0 w,area corporation and its officers have exercised their right sit-exemption per MGL c.. I4.64Other re lace ent l.322. 1141.,and we have no employees.[Nu workers'comp.insurance required.) 'Any applicant that cheeks hox al must also till out the section below showing their workers"compensation policy-information_ t Romeo%nxn Abu submit this affidavit indicatine they arc doting all work and then hire outside contractors mint submit a new affidavit indicat g such. It ontractors that cheek this box must attached an additional sheet showing the name of the sulrcontractun and state whether or nut those enhtieb have employees. tithe sub-euntractcus 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'oh site information. Insurance Company Name: Old Republic Insurance Co Policy#or Self-Ms.Lie.#: MWC31415820 _ Expiration Date: 10/012021 Leeds , MA 01053 Job Site Address: 81 Florence St City/State/Zip! Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirat on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S ,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to .00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for i ur'ance coverage. verification. 1 do hereby certify anti' rr in...and penalties of perjury that the inforrnation provided above is true and correct Signature: l)alc 06/27/2022 Phone#: 508-351- 277 Official use only. Do not write in this urea.to be completed kr city or town official li n ('ity or Town: Permit/Llcense# ______A_ i. ' Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ' 6.Other Contact Person: Phone#: i City of Northampton ?ice,.✓! 1'p SAS SSG Massachusetts t1 DEPARTMENT OF BUILDING INSPECTIONS P � `� Iry` 212 Main Street • Municipal Building yv�. �a ,,.e, -,`s Northampton, MA 01060 ss!w D‘ � HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners' exemption to the permit requi ents 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 CIVIR 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 accessor' 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. 1 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 roject or work on my parcel, I am not engaged in construction supervision in connection with any project or ork involving construction, reconstruction, alteration, repair, removal or demolition involving any activity re lated 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 . i(S gnature) 41. Agreement Document and Payment Terms DBA:RENEWAL BY ANDERSEN OF BOSTON Linda Barque RENEWAL Legal Name:Renewal by Andersen LLC 81 Florence St HIC#170810 Leeds,MA 01053 byANDERSEN 30 Forbes Road I Northborough,MA 01532 C:(413)335-72210 RUM(Mal 0001MallUll Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Linda Burque 06/10/22 BUYER(S)NAME CONTRACT DATE 81 Florence St, Leeds, MA 01053 (413)335-7220 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER rburque@comcast.net PRIMARY EMAIL SECONDARY EMAIL NOTES: 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. 1 TOTAL JOB AMOUNT: $8,063 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: $2,687 BALANCE DUE: $5,376 Estimated Start: Estimated Completion: I 26 weeks 1 day AMOUNT FINANCED: $0 We schedule installations based on the date of the signed contract and secondarily on the date METHOD OF PAYMENT: Credit Card in which we complete the technical measurements.The installation date that we areproviding at this time Is only an estimate.We will communicate an official date and time at a laer 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 06/14/2022 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. P-IA, SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Jesse Kaminski Linda Burque PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 06/10/22 Page 2 / 30 Itemized Order Receipt LJ - DBA:RENEWAL BY ANDERSEN OF BOSTON Linda Burqus RENEWAL Legal Name:Renewal by Andersen LLC 81 Florence St RENANEWAL HIC#170810 Leeds,MA 01053 byD�mo°tlnEN 30 Forbes Road I Northborough,MA 01532 C:(413)335-7220 /4111)11 Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonegmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 101 living room Patio Door, Gliding, 200 Series Perma-Shield, 2 Panel, Active / Stationary, Exterior White, Interior White, Performance Calculator, Performance Data Unavailable, Glass, All Sash: Tempered High Perf. SmartSun Glass, Hardware, Albany, Black, Exterior Keyed Lock, Auxiliary Foot Lock Color Matched, Screen, Gliding, Full Screen, Grille Style, Interior Wood Only (INTW), Grille Pattern, All Sash: Colonial 4w x 5h, Misc, None WINDOWS: 0 PATIO DOORS: 1 SPECIALTY: 0 MISC: 0 TOTIAL $8,063 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 06/10/22 Page 3/ 30 If Using a Builder DBA:RENEWAL BY ANDERSEN OF BOSTON Undo Burque RENEWAL Legal Name:Renewal by Andersen LLC 81 Florence St RENEWAL HIC#170810 Leeds,MA 01053 by ANDERun,�uN 30 Forbes Road I Northborough,MA 01532 C:(413)335-7220 HAL C NON CA1911 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. f,„ SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Jesse Kaminski Linda Burque PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 06/10/22 Page 22/30 The Commonwealth of Massachusetts Department of Industrial Accidents ' x Office of Investigations '' =i'= Lafayette City Center " a ray 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Renewal by Andersen Name (Business/Organization/Individual): Address: 30 Forbes Rd. City/State/Zip: Northborough, MA 01532 Phone #:508-351-2277 Are you an employer? Check the appropriate box: 4. I am a general contractor and 1 Type of project(required): 30 1. 4 I am a employer with ❑ employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. Remodeling❑ 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addi ion [No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repirs or additions P.[No workers myself. ' com right of exemption per MGL y 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.1g Other Replacement comp. insurance required.] *My 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 31415821 Expiration Date: 10/01/2022 Job Site Address: 81 Florence St City/State/Zip: Leeds , MA 01053 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 dffice of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penal ' rjury that the information provided above is true and correct. Signature: i�`(-64-.-rL Date: 06/27/2022 Phone#: 4'08-3512277 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1❑Board of Health 20 Building Department 31:City/Town Clerk 4.1:Electrical Inspector 5Elumbing Inspector 6.DOther Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any Iwo or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." I Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your si ation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees ther than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. i City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit ind.cating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Revised 7-2019 Fax (617) 727-7749 www.mass.gov/dia a Unresateaa• s et a ty teed, ttrf Wpm, boo then 34,000 1 cubic melons)c enclosed Sisal°� —' � � j 11.080128 0 1 N HMO , ,fr,4. , LYNN MA 1 1 .c: Fawn is possum a tanned mass at the Mo ssinisiit+ �� gam errsiear=itrnlsaiWs Olds Moines. CfrilakalaWFes^ K atrcb.. ilr_xtl.OA Owl he Sams CNN owl WAIN sr vloi w wrattses.CsoA*1 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration — to ^ '• - Type: Supplement Card .0) RENEWAL BY ANDERSEN LLC et .c� _ I+:e apoatlon: 120810 30 FORBES RO Expiration: 12l22l2023 NORTHBOROUGH.MA 01532 ~ `"" - ^hIF,`'V V Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair*A Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date.R found return to: TYPE:Supplement Card Office of Consumer Affair*and Business Regulation Registtattp9 Eoni.t y 1000 Washington Street-Suite 710 170810 • 12/22/2023 Boston,MA 02118 RENEWAL BY ANDERSEN LLC JAIME MORIN 30 FORBES RD (d.1'L ' NORTHBOROUGH,MA 01532 Undersecretary Not�thout sign5'8Mre �., Page 1 of 1 ACORLf CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �„-- 09/29/2021 I 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 INC.No,ExD: (A/C,No): P.O. Box 305191 EMAIL ADDRESS: CertifiCatea@willia.CCa9 Nashville, TN 372305191 USA INSURER(5)AFFORDINGCOVERAGE NAICN INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: 1 Renewal by Andersen LLC - -30 C Forbes Road INSURERC: Northborough, MA 01532 INSURER D: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYYI Min X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 r DAMAGE TO RENTED CLAIMS-MADE 1 X I 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 GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 21 10/01/2021 10/01/2022 BODILY INJURY(Per accident: $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY ^ AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANYPROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? pi E.L.MC 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-OPERATIONS below E.L.DISEASE-POUCY 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 it 1. vt/`- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21636556 BATCH: 2252220 U.S. Canada ENERGY ENERGY ¢ o U.S. STAR Andersen" Andersen NFRC Certified o 0 u v "' m v G.0 v 4.1 Product Line& Glass Grille Type Products m a m t9 S v = Product Type Type Directory Number ' %f y c c H A '', 1c c c u U Q 2 e ( y IS O 0 N N N 21 u1 3.1 Tempered Glass.WI No Grilles and Grilles Less Than.1" No Grilles AND-N-13-01352-00001 0.28 1.59 0.32 0.55 23 <0.2 N NC - - .:-,. - - yi Simulated Divided Lite or Installed Interior Removable AND-N-1301352.00002 0.28 1.59 0.28 0.48 21 c 0.2 N NC - Full Divided Lite AND�I 13-01358-00001 0.30 1.70 0.28 0.48 19 <0.2 N NC - - - - Flnellght^'(grilles-between-the-glass) AND-N-13-01370-00001 0.25 1.59 0.28 0.48 21 <0.2 N NC - - - - !ii No Grilles AND4Y13-01353.00001 0.29 1.65 0.20 0.31 15 4 0.2 I I NC - - "/ Simulated Divided Lite or Installed Interior Removable AND-N-13-01353-00002 0.29 1.65 0.18 0.27 14 a 0.2 a NC V? - - - -�� Full DWfded Lite AND•II.13-013594)00p1 0.31 1.76 0.18 0.27 11 <0.2 - - - Finellght'"(grilles-between-the-glass) AND-N-13-01371-00001 0.29 1.65 0.18 0.27 14 <0.2 N NCl - - - - r No Grilles AND-4-13-01354-00001 0.28 1.59 0.21 0.50 17 <0.2 N NC y's - - a ',, e 5 Simulated Divided Lite or Installed Interior Removable AND-N-13-01354-00002 0.28 1.59 0.19 0.44 16 <0.2 N NC lip l - - i 3 E Full Divided Lite AND-N-13-01380-00001 0.30 1.70 0.19 0.44 13 <0.2 .. NC - - N Finelight'Y(grilles-between-the-glass) AND-N-13-01372-00001 0.28 1.59 0.19 0.44 16 <0.2 `1 NC - - - No Grilles AND-N-13-01351-00001 0.29 1.65 0.53 0.81 34 <0.2 - - - mk 23 W i Simulated Divided Lite or Installed Interior Removable AND-N-13-01351-00002 0.29 1.65 0.47 0.53 31 <0.2 - - C - • 2 �g� 3 p Full Divided Lite AND -13-01357.00001 0.31 1.76 0.47 0.53 28 <0.2 - - Ygl - --N - Finelighttee(grilles-between-the-glass) AND-N-13-01369-00001 0.29 1.65 0.47 0.53 31 <0.2 - - - - R No Grilles AND-N-13-01522-00001 0.24 1.36 0.32 0.54 28 <0.2 1 NC - - i - 41$ Simulated Divided Lite or Installed Interior Removable AND-N-13-01522-00002 0.24 1.36 0.28 0.47 26 <0.2 N NC i - - A i Full Divided Lite -N AND -13-01525-00001 0.28 1.59 0.28 0.47 21 <0.2 N NC 1IIII 3 Finalt ht*"(grilles-between-the-glass) r - - q (g eylssa) AND�1-13-01531-00001 0.24 1.36 0.28 0.47 26 <0.2 N NC�, lNo Grilles AND-N-13-01523-00g01 034 1.38 0.21 0.49 22 <0.2 � NC - W C r.ai,,�, 04 Simulated Divided Lite or Installed Interior Removable AND4W13-01523-00002 0.24 1.36 0.19 0.43 21 <0.2 N NC 1#"' 9' A 200 Series 3 9 2 Fun �1 Divided Lite AND -13-01526.00001 0.28 1.59 0.19 0.43 16 <0.2 N NC.'` I - E Gliding Patio Door FlnelighP"(grilles-bNween-the-glass) AND-N-13-01532-00001 0.24 1.36 0.19 0.43 21 <0.2 N NC'' {4i m - i'' No Grilles AND-N-13-01521-00001 0.25 1.42 OAS 0.60 36 <0.2 - - - - -, Z3 n R la N 3. Simulated Divided Lite or Installed Interior Removable AND-N-13-01521-00002 0.25 1.42 0.43 0.52 33 <0.2 - - - - - 3 i A i Full Divided Lite ANPN-13-01524-00001 0.29 1.85 0.43 0.52 28 <0.2 - - a.3 -.. FInallghtm(grlliabetweendheeglass) AND-N-13-01530-00001 0.25 1.42 0.43 0.52 33 <0.2 - - - ''' - 3.1 Tempered Glass•w/Grilles 1"or Greater Simulated Divided Lite or Installed Interior Removable AND-N-13-01352-00003 0.28 1.59 0.25 0.42 19 <0.2 N NC`� "/ 33 Full Divided Lite AND-N-13.01384.00001 0.30 1.70 0.25 0.42 17 <0.2 N NCI - - Firelight.(grillesbetween-the-glass) AND-N-13-01376-00001 0.28 1.59 0.28 0.48 21 <0.2 N NCI - • ;,.. - - Simulated Divided Lite or Installed Interior Removable AND-N-13-01353-00003 0.29 1.85 0.16 0.23 13 <0.2 N NCI - - - "/ e a Full Divided Lite AND-N-13411365-00001 0.30 1.70 0.16 0.23 12 <0.2 N NC igt/in - - - Finelightm(grilles•between-Ms-glass) AND-N-13-01377-00001 0.29 1.65 0.18 0.27 14 <0.2 r, NCI - - - I Simulated Divided Lite or Installed Interior Removable AND-N-13-01354-00003 0.28 1.59 0.17 0.38 15 <0.2 N NCI,. - - - W A - - - �3 Full Divided Lite AND-N-13-01366-00001 0.29 1.65 0.17 0.38 13 a 0.2 Fi NCI en Flnellght"'(grilles-between-the-glass) AND-N•13-01378-00001 0.28 1.59 0.19 0.44 16 <0.2 NC - - e Simulated Divided Lite or Installed Interior Removable AND-N-13-01351-00003 0.29 1.65 0.41 0.46 27 <0.2 - I # - - 3'3 Full Divided La AND -N-13-01363-00001 AND -13-01363.00001 0.31 1.76 0.41 0.46 2S <0.2 - a Finelight"'(grilles-between-the-glass) AND-N-13-0137500001 0.29 1.65 0.47 0.53 31 <0.2 - le Simulated Simulated Divided Lite or Installed Interior Removable AND-N-13-01522.00003 0.24 1.36 0.25 0.41 24 <0.2 N NC - nV Full Divided Lite AND-N-13-01528-00001 0.28 1.59 0.25 0.41 19 <0.2 N NC ,.v II - S 3 Finelight1ee(grilles-between-the-glass) AND-N-13-01534-00001 0.24 1.36 0.28 0.47 28 <0.2 N NC II C le Simulated Divided Lite or Installed interior Removable AND-N-13-01523-00003 0.24 1.36 0.16 0.37 19 <0.2 N NC.,�.. # e 11 Full Divided Lite ANO-N-13-01529-00001 0.28 1.59 0.16 0.37 14 <0.2 N NC 1 - Finellphl1e'(gritMbN(grilles-between-the-glass) AND-N-13-01535-00001 0.24 1.36 0.19 0.43 21 <0.2 l NC et4 _ `1 This information is for reference only. Performance varies by unit size and options selected. Page40o/55 Date is current es or Decembers 2014 end is subinct to change. page 1 for more Information. For specific unit performance information,please contact your dealer or Andersen Sales Representative.