11C-065 (3) BP-2023-0672
82 FLORENCE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
11C-065-001 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-2023-0672 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW/DOORS 2023 Contractor: License:
Est. Cost: 14520 RENEWAL BY AN‘SEN 090125
Const.Class: Exp.Date: 10/06/2024
Use Group: Owner: LAR EO WILLIAM
Lot Size (sq.ft.)
Zoning: URA Applicant: RENE AL BY ANDERSEN
Applicant Address Phone: Insurance:
30 FORBES RD 508-351-227 MWC31415822
NORTHBOROUGH, MA 01532
ISSUED ON: 05/23/2023
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT WINDOW AND 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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
fl • r i >9 t •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: '413)587-1272
Office of the Building Commissioner
i�. \` iJ
/ yqy
1
n- 9 ,
The Commonwealth of Massachusetts .Tor cC
OR
Board of Building Regulations and Standards ��'" �'%o,, MUNICIPALITY
Massachusetts ALITY
Massachusetts State Building Code, 780 CMR �+' ti'4/
i> E ,.... USE
Building Permit Application To Construct, Repair,Renovate Or Demolish° °4,evised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building P nnit Number: ' I2 A 3- a 7,1 Date Applied:
(Z., / Z 5-13-2623
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
(2. Fiur€ace S'1- L.eeas i PtA. yisS3,
1.la 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
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public 0 Private 0 Check if yes': Municipal 0 On site disposal system CI
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ertl L.ura. J-CedS' , 41A a/bc1
Name(Print) City,State,ZIP -�J�,,
$L •Fl ote,e6 S 1L t(3 • SYt^ I1 I �j 41-3, Tty co CA&4 r-, »et
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 Erlpecify:fe' ''are nei tJa4Q-'/J
B 'ef Description of Proposed Work2:
Viltvq, pMd kf(ate lwiaw- 2 4o/3' /, 6r ('kc ta•i no
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ /i/ coo,p„ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: .
5. Mechanical (Fire $
Suppression) Total All Fees: $ yo
6. Total Project Cost: $ Check No.97969Check Amount: Cash Amount:
YI SZa . 11:1 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) eio 1 c L z '
J ,
,M;e /i1 -in License Number Expiration ate
Name of CSL Holder RO' List CSL Type(see below) Gas
30 I .s ({a 4J
No.and Street Type Description
r/e �v^®.r�,L A D(5---) Z U Unrestricted(Buildings up to 35,000 cu.ft.)
t J R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
R . Roofing Covering
INC. S Window and Siding
1 SF Solid Fuel Burning Appliances
760. Q--Cif t Z tG Cw 4)er4tse4 f`€,' 5:c') I Insulation
Telephone Email address( ./ D Demolition
5.2 Registered Home Impro -ement Contractor(HIC) i ��'"f1 /42t e3
ifed4" re
t A C- HIC Registration Number Expiration Date
HIC Comp Naor HIC Registrant Name
Si f'v''( S /Q c! Te46,,. 'c%1 4-,L 4a.39•1 ea7,Iis arV D
No.and Street Email addr ss VD
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 CY 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
to act on my behalf.in all matters relative to work authorized by this building permit application.
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 true and accurtb e best of my knowledge and understanding.
r'1
( (ce G. C 0 2- . —f i— Z 3Print Owner's or Authorized Agent's N Elec oni ignatu(45:?(M4-)
- 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
ww'w.mass.govioca Information on the Construction Supervisor License can be found at www.mass.govidps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,fmished 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"
City of Northampton
Massachusetts �4. •
it A Ss .. "
C.
up
j DEPARTMENT OF BUILDING INSPECTIONS (,t,
4, 212 Main Street • Municipal Building SJ�. CDC
.-�f Northampton, MA 01060 0, 3�`�J
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:
Location of Facility: 1LS ,:>� s 7eci �� � 01�3 Z-
The debris will be transported by:
Name of Hauler: (,14 fr(4-/A-'�
Signature of Applicant: Date:
The Commonwealth of Massachusetts
Department of Industrial.-accidents
Office of Investigations
=�4 Lafayette City Center
= 2 Avenue de Lafayette, Boston,MA 02111-1756
www.mass.gor/dia
Workers'Compensation Insurance Affidavit: Builders/('ontractorslElectricians/Plumbers
Applicant Information Please Print Legibly_
Name tBusiness,Organitationlndividuall:
Renewal by Andersen
Address: 30 Forbes Rd.
City/State/Zip: Northborough, MA 01532 Phone #:508-351-2277
Are you an employer?('heck the appropriate(xis: Type of project(required):
1N I am a employer with 30 4. ❑ i am a general contractor and 1 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ID Remodeling
2.El 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. 0 Demolition
workingfor me in anycapacity. employees and have workers'
ry 9. 0 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. 0 We are a corporation and as 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised then 11.0 Plumbing repairs or additions
myself. [No workers' corrvp. right of exemption per MGL 12.0 Roof repairs
insurance required.] ' c. 152,§1(4),and we have no ��e Replacement
employees. [No workers' 13. otherP
comp. insurance required.]
•Any applicant that checks box#1 must also fill uui'the-section below showing their workers'compensation policy information.
+tionieusvners who submit this affidavit indicating they arc doing all wort and then hire outside contractors must submit a new of idas it indicating such.
:C untcicturs that check this box must anti-:bed an additional shah showing the name of the sub-contractors and state whether of n.those entities has c
cmpk'sccw. lithe sue<:iiitractors haseerripktyces.thew must piuside thou uurkers'comp.perky numb r.
I am an employer that is providing workers'compensation insurance for nip employees. Below is the policy and job site
in formation.
lnsurancc Cuinpar”, Natnc: Old Republic Insurance Co.
Policy#or Self-ins. Lie.#: MWC 314158 22 Expiration Date/:'10101/�23
Job Site Address: `'2 (o/eA<C J 2YC c'ity/Sta e/Zip: Gees /144 D/os 3
Attach a copy of the workers'compensation policy declaration page(showing the policy amber 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 S1.500.00 and or one-year imprisonment. as well as civil penalties in the form of a STOP WORK ORDER and a Eine
of up to S250.00 a day against the violator. Be ads ised that a copy of this statement may be forwarded to the Office of
Investigations of the [)IA for insurance cos.race s eriticatron.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Stgnaittrc: 9414.11-42- u l)atc 03/31/23 .,.., _.
Mon,: 9 Z - /(z
Official use on!y. Do not write in this area,to be completed by city or town afficia!
( its or town: Permit/LicenseIssuing:authority (check one):
l❑Board of Health A:Building I)epartnwnt 33'its 'town Clerk 4 Ehetfieal Nq*edsr 5E 'lumbing
Inspector 6.00ther
('ontact Person: ('hoar M:
,.._ , RENEWAL
brANDERSEN_
/ , FULLSERVICE WINDOW&DOOR REPLACEMENT
p
Re: Massachusetts Solid Waste Affidavit
Good day,
Please find attached location where the installers will bring their debris from the jobs.These
are all Renewal by Andersen location.
• WASTE MANAGEMENT—30 FORBES RD, NORTHBOROUGH, MA 01532
When filling out any solid waste affidavit, it's the installer whom will be removing the
garbage and dumping the trash at the Renewal by Andersen dumpster locations
closest to that job.
Thank you,
Go Permits
Agreement Document and Payment Terms
DBA:RENEWAL BY ANDERSEN OF BOSTON Bill Lot-area
RENEWAL Legal Name:Renewal by Andersen LLC 82 Florence Street
HIC#170810 Leeds,MA 01053
ENL
a;�(., D a�ririu,N 30 Forbes Road I Northborough,MA 01532 H:(413)582-1881
MEW
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)923-2956
Bill Larareo I 05/16/23
BUYER(S)NAME CONTRACT DATE
82 Florence Street,Leeds,MA 01053 (413)582-1881 (413)923-2956
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
blarS76@comcast.net
PRIMARY EMAIL SECONDARY EMAIL
NOTES: 1 window& 1 SGD& 1 entry door
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: $14,520 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: $14,520 Estimated Start: Estimated Completion:
18-20 weeks 1-2 days
AMOUNT FINANCED: $14,520
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 05/19/2023 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.
6✓2,41_ors
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Randy Buck Bill Larareo
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
05/16/23 Page 2/ 35
Itemized Order Receipt
Ai+RN
DBA:RENEWAL BY ANDERSEN OF BOSTON Bill Larareo
RENEWAL Legal Name:Renewal by Andersen LLC 82 Florence Street
EN HIC#170810 Leeds,MA 01053
,wcw�m+DERSE+N 30 Forbes Road I Northborough,MA 01532 H:(413)582-1881
Phone:(508)351-2200 I Fax:(508)986-7072 I rbabostonegmail-com C:(413)923-2956
ID#: ROOM: SIZE: DETAILS: PRICE:
101 sunroom 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, Standard Color Extra Lock, Screen,
Aluminum, Full Screen, Grille Style, Grilles Between Glass
(GBG), Grille Pattern, Sash 1: Colonial 4w x 2h, Sash 2: No
Grille, Misc, Standard Maintenance Free, Replacement of
exterior casing from standard options (insert application).
102 living room Patio Door Gliding 200 Series Perma-Shield 2 Panel Active /
Stationary, Exterior White, Interior White, Performance
Calculator PG Rating: 25 I DP Rating: + 25 / - 25 Glass, All
Sash: Tempered High Pert; SmartSun Glass, Hardware,
Tribeca® , White, Exterior Keyed Lock, Screen, Gliding, Full
Screen, Grille Style, No Grille, Mlsc, None
103 ProVia Sunroom Misc Misc, ProVia, Quantity 1, See attachment for details
entrance
WINDOWS: 1 PATIO DOORS: 1 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 1 TOTAL $14,520
Renewal by Andersen is committed to our cusfomers'safety by
cLiEPA complying with the rules and lead-safe work Practices specified by the EPA.
05/16/23 Page 3/ 35
5
Payment Authorization Form
:y 4......., .
DBA:RENEWAL BY ANDERSEN OF BOSTON Bill Larareo
RENEWAL Legal Name:Renewal by Andersen LLC 82 Florence Street
E HIC#170810 Leeds,MA 01053
N SE 30 Forbes Road I Northborough,MA 01532 H:(413)582-1881
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)923-2956
Bill Larareo
BUYER NAME
82 Florence Street Leeds
ADDRESS CITY
MA 01053 (413)582-1881 (413)923-2956
STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2
4521 $14,520
FINANCE PROGRAM' FINANCE PLAN R' CONTRACT BALANCE
Randy Buck
SALES REP APPLICATION ID OFFER EXPIRATION DATE
*If your financing is pending,the Finance Program and Finance Plan Number are subject to change
PAYMENT SCHEDULE ($14,520)
CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION (4)
FINANCING $0 $4.840 $4.840 $4,840
(1) CASH DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or in whole by cash,check,or credit card
("Cash Deposit").
(2) FINANCE DEPOSIT: 1/3 of the purchase price is due at Contract Signing. This may be paid in part or in whole with financing("Finance
Deposit").
(3) START OF JOB: 1/3 of the purchase price is due at Start of Job.
(4) SUBSTANTIAL COMPLETION: Final payment is due on the day of installation when all windows and/or doors included in this agreement
have been installed into their openings and any interior and exterior trims have been applied("Substantial Completion"). If there are any outstanding
warranty claims or service items,customer may retain an amount equal to the value of the outstanding item(s)or work to be done,not to exceed
10%of the total purchase price. Due to project changes after Contract Signing,the final payment is subject to change.
BY SIGNING BELOW, I/WE,THE BUYER(S):
1. Authorize Renewal by Andersen to transact payments based on the amount(s),form of payment(s),and timing specified in the Payment
Authorization Schedule above.
2. Acknowledge the use of the loan to make a purchase will constitute acceptance by all Borrowers of the Loan Agreement.
3. Instruct the Lender(if applicable)to disburse the proceeds of the loan to Renewal by Andersen as identified above in the amount(s)
and timing specified in the Payment Authorization Schedule.
4. Understand that Renewal by Andersen must be notified in writing of a change in payment method in advance of the respective payment.
Bill Larareo u/O2-a_ 05/16/23
BUYER NAME SIGNATURE DATE
05/16/23 Page 4/ 35
RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION
PERFORMANCE RATINGS AND TEST DATA
NFRC Total Unit Performance
t1-Factor
Renewal by Andersen" =;•` ., (BTUI{hr ft2 OF))W..
Product { b r
vr
Air HP Gas Blend Air HP Gas Blend
Without Grilles 0.42 0.41 0.51 0.51 .82
Clear
Full Divided Light Grilles 0.43 0.41 0.46 0.46
Without Grilles 0.31 0.28 0.28 0.27 .72
Low-E4®
Full Divided Light Grilles 0.32 0.29 0.25 0.25
Casement Without Grilles 0.32 0.29 0.17 0.17 .40
E Low-E4®Sun
Axed Full Divided Light Grilles 0.33 0.30 0.16 0.15
Without Grilles 0.31 0.28 0.19 0.18 .65
Low-E4®SmartSun'"
Full Divided Light Grilles 0.32 0.29 0.17 0.17
Low-E4a SmartSun Without Grilles 0.26 0.24 0.18 0.18 .63
with HeatLock"' Full Divided Light Grilles 0.26 0.24 0.17 0.16
Without Grilles 0.43 0.41 0.51 0.51 .82
Clear
Full Divided Light Grilles 0.43 0.41 0.46 0.46
Without Grilles 0.31 0.28 0.28 0.27 .72
Low-E4®
Full Divided Light Grilles 0.32 0.29 0.25 0.25
Without Grilles 0.32 0.29 0.17 0.17 .40
Awning Low-E4®Sun
Full Divided Light Grilles 0.33 0.30 0.16 0.15
Without Grilles 0.31 0.28 0.19 0.18 .65
Low-E4®SmartSun'"
Full Divided Light Grilles 0.32 0.29 0.17 0.17
Low-E4®SmartSun Without Grilles 0.27 0.25 0.18 0.18 .63
with Heatlocku Full Divided Light Grilles 0.27 0.25 0.17 0.16
Without Grilles 0.46 - 0.58 - .82
Clear
Full Divided Light Grilles 0.46 - 0.52 -
Without Grilles 0.33 0.30 0.31 0.31 .72
Low-E4'
Full Divided LiQht Grilles 0.34 0.31 0.28 028
ir .
Double-Hung Without Grilles 0.33 0.30 020 0.19 40
(All Frames) Law-E4®Sun
Full Divided Light Grilles 0.35 0.31 0.18 0.17
Without Grilles 0.32 0.29 0.21 0.21 .65
-RR SmartSue
Full Divided Light nes 0.34 0.19 0.19
.1._-CI`1..oMO_o WJrhNirrrlupc WV n25 n2r1
with Heatt.ock"' Full Divided Light Grilles 0.30 0.27 0.18 0.18
09-9 COMPANY CONFIDENTIAL-REVISION AA-01
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CERTIFICATE OF LIABILITY INSURANCE 09/21/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY APO 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 NNSURER(S). AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the poilcy(IasJ must have ADDITIONAL INSURED prwfshons or be endorsed_
If SUBROGATION IS WAIVED,subject to the terns 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 anorsement(s).
PRODUCE* CMTACT 11111a Tonere Matson Car tifteats Center
Millis Towers Ratsea MLdttaeet, lee.
C/e 25 Caetery Sled Ayr MMONE,a.e.. 1-977-953-737e I FAX
Nw. 1-see-4E7-2378
P.O. sea 305111 E COEtltioattapv1111s_can
'Iseaville, TN 372303101 Doi NtSRI6U61AFFORDara COVERAGE RAICa
Name A. Old 5spuhlAC lasurasce Company 24147
WHINED POORER a-
nweal by Aadee*sn LAC
35 rorbsa Lead NNR1ER C:
IbrtAbaxeneb, IY 01532 NB*RERD:
NNMIER E
INSURER F.
COVERAGES CERTIFICATE NUMBER:W26007631 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF RNSUR/NCE 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 PERTABL TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY
�. TYPE OF INSURANCE POLICY tlpleEl a Y+r II ;� LOWS
X OOIMIEROAL GEERALLMaRAY EACH OCCURRENCE. f 2,000,000
tD
I CWMS ACE QOOCLAR PREMISES 11400t0T 500,000
PREMISES IEA i>CK1rnMtOe1 t
A — APED Eww U one owrcr , 1 10.000
NM 314151 22 10/01/2022 OR/01/2023 Pt3#90NAL SADY DtAIRY f 2,000,000
CENL AMP/AGATE L.1111T APPLES PER: GENERAL AGGREGATE 1 i,0E0,000
P01ICY a.ECT LAC PRODUCTS-COTAPOP AGO $ 5.000.00E
OTHER
AUTOMOBSELiesaRY C SINOI.E LSaT f 5,000,000
X ANY AUTO SCALY INAIRY(Par Pwean) f
A CRIME SCHEMED 111131 314139 22 10/01/2022 10/01/2023 RODE7 0AuttRy Mer actiden0 f
AUTOS ONLY — AUTOS
paRED NOALO NEO PRiFERTY DAMAGE
.� AUTOS ONLY AUTOS CRLY oPiN airRentt
UNSPELLALIA8 J C ccuR EACH OCCURRENCE f
�.EXCESS LIMA —Il ri Amisattanc AGGREGATE f
DED I I RETORTl'N f
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AND!?rLOYEK'LMrtlIY X STATUTE FR
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A NOPNOPRIETCR'PARTNOSEXECUTNE E.L.EACH ACCIDENT f 1,008,00E
OFFCERAIESSERFYrWUCEO7 Q VIA NEC 3141S6 22 10/01/2022 1e/01/2023
Odsolnae,Is lee EL DISEASE-EA BPLOYEE f 1,000,000
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oE'SCRMTbN OF OPERATIONS bate EL DISEASE•POLICY LIMIT f Loco,000
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TIM EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERRED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORIlfO UEPRESE13ATTlE
evidence of Insurance '- '1Yg.
N31g5$-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
113 230760/0 eucs: 2676324
Commonwealth of MassachusettsIIrK }
�; Division of Occupational Licen sure thwestrictad.itaillilies aft mg me rasp which coRaIMI
Board of Building Regulations and Standards less than 38,100 colic fest WI cubic taws)of enclosed I
CCnsi(',1410111S\ vi%or SWIM
.ti
CS-090125 l ires: 10/06i2024
JAIME L MOt N f
54 NOTTINGNAM RD
RAYMOND NM 03077
il
!�'orJ:va�o'o F.ilufe a posse.s a assent seem at Me Massachusetts
CCrnr. ss:cncr ligistA t;. tsc.1/A.. Ibis sallding Cods is cause tar revocation at this llm.nstl.
Far aaora dof1.eout Mrs lcense
Cad 8817►772.>a•11 or of it lttww.tnaasgatrldp
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home tmproyernent Contractor Registration
if i ,(04,
."'10 - "" merit Card
71w1 Type: SUMee
t egistfation, 170810
RENEWAL BY ANDERSEN LLC " 12R2�2023
30 FORBES RD .0 t�. s , :
NORTHBOROUGH.MA 01532 "
:\..."K:iiiif,/,'
Updiall tt loses and Return Card.
THE.COMMONWEALTH OF MASSACHUSETTS R strauon valid for individual use only before the
Office of Consumer Affairs i Business Ragulalbn e�.�n Arta N found return to:
MOMS IMPROVEMENT Supplement
nt Card CONTRACTOR OfHca of Consumer Affairs and Boskres Regutahon
TYPE:SupPlw+rtanl Card t000 Washington Street -State 710
t� !El sa 7 1212212423 Boston,MA 02110
REYti WAL Hv ANDERSEN Lit;
JAittt-FA:)RIN / 1*
:g>it/R131-,;RD t .,,.aal.r•.ge+4 L
NOR'NftC;Rr_•:)CAi,MA 01532 �,r Not lid wNt►out signature
REELlig
q bYANDERSEN
To Wnom It May Concern:
This letter will authorize the following personfs)to act as agent(s)an behalf of Renewal by
Andersen LLC,9900 Jamaica Ave South, Cottage Grove MN S5016 to pull for permits and
inspections with respect to the installation, maintenance and repair of windows and entry
floors i.tnder Macc rbi mem Stare Home lmprovernent Contractor license number 170810 and
Construction Supervisor license number CS-090125.
If you have any questions, please call me at SO8 351.2277 ert 6
Authorized person(sl:
Go Permits LLC Sarah Hammad David Anderson Maureen Kivel
Scott Doi ghman Ryan 8iondo Sovannara Kt y Mark Foster
Glynn Norgan Jennifer Welke We?ICY H Old`1 t erak t framer
Nick Rago Dane!lfrtkerman Stephen Wilder Katie Grocott
Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff
r
amie Morin
Renewal by Andersen tie
H IC 170810
CSL-CS09012S
Local District Office Address
30 Forbes Rd
Northborough, MA 01532
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