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31A-082 (2) BP-2023-0923 300 ELM ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 31A-082-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0923 0 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est. Cost: 30879 MILLWORK MASTE S 87532 Const.Class: Exp.Date: 04/17/202 Use Group: Owner: JESSIC BRAND Lot Size (sq.ft.) Zoning: URB Applicant: MILLW RK MASTERS Applicant Address Phone: Insurance: 104 SOUTH POMPERAUG AVE (401)935-2633 UB-IR019088 WOODBERRY, CT 06798 ISSUED ON: 07/20/2023 TO PERFORM THE FOLLOWING WORK: INSTALL 21 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 NORFHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 1 Signature: 61 • V s >2 . Tit, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner RECEIV i r The Commonwealth of Massach setts OR , Board of Building Regulations and `tand. ds JUL j 4 2023 UNI IPALITY {� • Massachusetts State Building Code, '80 @MR �, SE 1 Building Permit Application To Construct,Repair, eng o BUILDI INSPECTION$ is Mar 2011 One-Or Two-Family Dwelli': NORTHAMPTONNG,MA n,pgp - This Section For Official Use Only Building Permit Number: S/9—oZ 3 — gal_3 Date Applied: I4-0, - 72,3 .//�2 7-0•Zo23 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: „yin ) pyZ 1.2 Assessors Map&Parcel Numbers 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 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of t; rLitopiio pa��=� ` 7k-i) P, (2 pa) Name(Prin City,State,ZIP ,�., �a L ��' � a )7- � -yP4z No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ,,{/ / -l) Zf '�,� . E-A) Ptiviikok-z-d • P Tk 4 c_._ Pd 0:.X -v'jc 15 ' SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only _ (Labor and Materials) 1. Building $�947gl L,/ 1. Building Permit Fee: $ Indicate how fee is determined: / El Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ j Suppression) Total All Fees: $ Check No.1IA t'heck Amount: 4'-ft Cash Amount: 6. Total Project Cost: $ .79Q l7 ❑Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Sup�rvi License(CSL) p47*-- ., 2fr/72a1 C -p `pi , o CONAL0 License Number Expiration Date Name of CSL Holdey2 t)P (_;09XIA /y u L List CSL Type(see below) No. Stree J/ T.:„.. e Description �/�� I)I._{,( 9 Unrestricted(Buildings up to 35,000 Cu.ft.) // 7/ CR Restricted 1&2 Family Dwelling (y/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 7v )^.._;-23___/��� SF Solid Fuel Burning Appliances rI Insulation Telephone Email address D Demolition 5.2 Registered H n rp)ve nt Co t a or(HI C 1r' �/ 92 ?"jZ11 Pll��' /�U � v� HIC Registration Number xpiration Date HIC/P mpan OPY" Regi Name �, /� NQiVttSt o P /7 , /�, -52 /- _ Email address �City/T/o fwn,,,/Sta ,LIP !p �7//Telephoonne 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 Issuanc f the building permit. Signed Affidavit Attached? Yes 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 to act on my behalf in all atters relative to work author' this building permit application. \i eieli' --. fr?) k.19e7— --7-2-/-22- 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 ac ate t the_be of m kno ge and understanding. Od0d441 7-- --. 2 Pnnt Own s or Authorized Agent's Na (Electronic Si e) 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) 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 I 3. "Total Project Square Footage"may be substituted for"Total Project Cost'' City of Northampton '" Massachusetts �, x- � �� , DEPARTMENT OF BUILDING INSPECTIONS S 212 Main Street • Municipal Building Jti D Northampton, MA 01060 "J'ph TD, P 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: ki- / 49-4.- / The debris will be transported by: •.(I/ '4) )11/6 A7r0 Name of Hauler: Signature of Applicant: ?--- -".a-7't.-Date: -2-3 RAND 052623 `�� 300 ELM ST, NORTHAMPTON MA DAVID WRIGHTY MIILWORK MASTERS MDG SWANZEY 362 FLAT ROOF MILL RD SWANZEY, NH 03446-2706 Quote►i: EPXTUAY Phone:(603)358-3038 A Proposal for Window and Door Products prepared for: Email:dwright@millworkmasters.com Job Site: 03446 This report was generated on 5/30/2023 2:19:51 PM using the Marvin Order Management System, version 0004.02.01(Current).Price in USD.Unit availability and price are subject to change.Dealer Shipping Address: terms and conditions may apply. MILLWORK MASTERS MDG-SWANZEY 362 Flat Roof Mill Rd Swanzey, NH 03446-2706 Project Description: ELEVATE FIBERGLASS EXTERIOR WOOD INTERIOR, A COUPLE ARE ULTIMATE LINE ALUMINUM EXTERIOR WOOD INTERIOR, ALL INTERIORS PAINTED WHITE AT FACTORY, OWNER PULLED HISTORIC DISTRICT APPROVAL Featuring products from: MARVIN GG(o)e ( 6-fn4 dS2_toZ7 I .MF,-ilinA,„,,% LWORKMASTERS ri „�` MrYR . i .�, �. G(friysskTG tt0)40,4'1 to 0C1cie3- NI WWW.MILLWORKMASTERS.COM Installation Services Window and Door Agreement JESSICA BRAND 5/30/2023 Buyer(sl Name: __ Date of Agreement 300 ELM STREET APT 2, NOR.THAMPTON MASS 01060 Buyers)Street Address,City,State,Zip Code r}elm13@gmail.com 917-545-4082 Email Address Home Phone Mobile Phone Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of"MILLWORK MASTERS,A DIVISION OF WOODBURY SUPPLY CO INC." ("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attachea specification sheet(s) collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job$30 U8 a 79 04 Estimated Starting Date: Method of Pay`'ttont:Cash°. Check.0 Visa m Aount: AUG 1 2023 _i Discover!: AMEX Financed Appft: i — Deposit Received(33%) $1 0,000.00 Estimated Completion Date: Name on Credit Card: ,. Balance at Start of Job(3390: OCT 20, 2023 Credit Card th $10,586.02 CC Exp.Date: Balance on Substantial Completion of Job CC Security Code! ,_ (33%) $10,293.02 L Buyer Initials: JB Buyer Initials: Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent of both 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. "MILLWORK MASTERS,A DIV.OF WOODBURY SUPPLY" Buyer(s) Buyer(s) py:_lbriPie 7tire-tiffie—' - X X Signature of Product Manager Signature Signature David Wright x Jessica Brand Print Name of Product Manager Print Nam Prin;Name YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. i NOTICE OF CANCELLATION NOTICE OF CANCELLATION ate of Transaction , You may cancel this Date of Transaction , You may cancel this transaction,without any penalty or obligation,within two business transaction,without any penalty or obligation,within two business days from the above date. If you cancel,any property traded in,any days from the above date. If you cancel,any property traded in,any payments made by you under the Contract of Sale,and any payments made by you under the Contract of Sale,and any negotiable instrument executed by you will be returned within 14 negotiable instrument executed by you will be returned within 14 days following receipt by the Contractor("Seller")of your days following receipt by the Contractor("Seller")of your cancellation notice,and any security interest arising out of the cancellation notice,and any security interest arising out of the transaction will be canceled. If you cancel,you must make available transaction will be canceled. If you cancel,you must make available to the Seller at your residence,In substantially as good condition as to the Seller at your residence,in substantially as good condition as when received,any goods delivered to you under this Contract or when received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of the Sale;or you miy,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller expense and risk. If you do make the goods available to the Seller and and the Seller does not pick them up within 20 days of the date of the Seller does not pick them up within 20 days of the date of your your Notice of Cancellation,you may retain or dispose of the goods Notice of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods without any further obligation. If you fail to make the goods available available to the Seller,or if you agree to return the goods to the { to the Seller,or if you agree to return the goods to the Seller and fail Seller and fail to do so,then you remain liable for performance of all to do so,then you remain liable for performance of all obligations obligations under the Contract. To cancel this transaction,mail or under the Contract. To cancel this transaction,mail or deliver a signed deliver a signed and dated copy of this cancellation notice or any and dated copy of this cancellation notice or any other written notice, other written notice,or send a telegram to Contractor:MILLWORK Or send a telegram to Contractor: "MILLWORK MASTERS,522 AMHERST ST MASTERS,.522 AMHERST ST NASHUA NH",BY NOT LATER THAN j NASHUA NH", BY NOT LATER THAN MIDNIGHT OF MIDNIGHT OF . (Date) . (Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Date ' Buyer's Signature Date MILLWORK MASTERS,A DIVISION OF WOODBURY SUPPLY:522 AMHERST ST,NASHUA NH 03063 603 880 3212PH/603 880 3362 FAX ADDITIONAL TERMS AND CONDITIONS "I","my",and"me"means each person who signs this Agreement as a Buyer. "Contractor"means"MILLWORK MASTERS". "We"and"us"mean bcth the Buyer,or Buyers if more than one,and the Contractor."MILLWORK MASTERS,522 AMHERST ST,NASHUA NH"is an authorized and independent dealer of Marvin and Integrity Windows. You are entering into a contract with"MILLWORK MASTERS,522 AMHERST ST,NASHUA NH". Warranties/Intended Use: I understand that Marvin Windows and Doors("Marvin")is providing me with a warranty in connection with my purchase. I understand that I should read Marvin's written warranty for complete details of my warranty coverage and that the Marvin warranty is available for my complete review before I sign this Agreement. I understand that the Marvin warranty will not be effective or enforced while a balance due remains on this Agreement. Contractor's Promises:Contractor promises to perform all work in a professional manner and within industry standards. Contractor will remove and transport away from the premises any debris and waste materials that are generated by Contractor. Contractor shall obtain all building permits for the work to be performed under this Agreement. Contractor shall maintain worker's compensation insurance and liability insurance during the term of this Agreement. My Promises: I promise to Contractor that(a)I will provide Contractor with reasonable access to my property and the area in which the work is to be performed,including access to electrical outlets;(b)I will be responsible for preparation`moving,and reinstalling of any materials,personal property,cars,or equipment as may be needed for Contractor to perform its work;(c)The ails and surfaces upon which the work is to be performed are sound and suitable for the work being performed;(d)When the work is"su stantially complete",I will pay Contractor the balance due on the purchase price. I understand that "substantially complete"means the work has been materially finished and is functional as intended; (e)In the event that I disagree with Contractor that the work is substantially complete,I ag e that I will not withhold more than 10%of the Agreement price;(f)If taxes and/or permitting fees are necessary to complete the work, I ill pay them unless the law requires Contractor to pay them;and(g)Contractor may place a small advertising sign in Buyer's yard at the time of in tallation. Measurements: I understand that all dimensions referred to in this Agreement are conside ed estimated measurements and used only for the purpose of arriving at the contract amount in this Agreement. I understand that the actual easurements will be determined during a follow up visit by a qualified measurement technician employed by Contractor. I understand that if Contractor must make changes to the estimated measurements,Contractor may ask me to sign an addendum to this Agreement. e Cancellation:I understand that I have 2 business days to cancel this Agreement,as described on the previous page of this Agreement. I nderstand that if I want to cancel this Agreement after those 2 business days,Contractor Y , i actor does not have to allow that. I understand that if the Contractor does let me cancel,however, I will have to pay to Contractor a late cancellation fee equal to 15%of this Agreement's purchase price for Contractor's labor,administrative,and material costs. Delay/Unknown Conditions: I understand that if Contractor determines that Contractor cannot perform the work according to Contractor's normal professional standards, then Contractor cancel this Agreement,notify me in writing of the cancellation,and return my money to me. I understand that some of the things that could cause Contractor to cancel this Agreement would be incorrect pricing,unforeseen structural defects, or unknown pre-existing conditions to my property. I understand that Contractor is not responsible for structural or other defects in my property, and that Contractor's products do not cure those types of problems. I also understand that the work could be delayed by events that Contractor does not control,and that Is acceptable to me. Some of the things that could cause the work to be delayed would be acts of God,labor strikes, inclement weather,material shortages,and my inability to qualify for or obtain financing,delays by local government authorities in Issuing or otherwise approving inspections, permitting,or other required authorizations for the work. Rot repair,Structural issues,etc. Unforeseen conditions upon progress of installation: If it's determined that the unforeseen concerns,can be addressed by the installing contractor. i agree that the billable hourly rate from Time minus additional materials needed will be at a rate of$90.00 per hour and the additional labor rate and materials will be added to my final invoice. INITIAL: JB time frame may be quoted, but it's not exact based on actual time needed to correct the issue. An approximate Late Payment/Default: I agree that if I do not pay Contractor any of the money owed when it is due, I can be charged a late fee of 1.5%on the amount owed for each month the money is owed and not paid. I also agree that if I default on my promises under this Agreement,and Contractor hires an attorney to enforce this Agreement, I will pay Contractor its reasonable legal fees and related costs or expenses,as long as it is legal for me to do that. I agree and understand that in the event that I do not pay Contractor any of the money owed when it is due,Contractor may have a claim against me,which may be enforced against my property in accordance with the applicable lien laws. I also understand that if I finance the work with Contractor or a third party,my separately provided financing documents may include a security interest. I understand that I should read those documents closely. Arbitration: The parties hereby mutually agree in advance that should a dispute arise dispute to a private arbitration service that has been approvedyeP regarding this contract,Contractor may submit such required to submit to such arbitration as provided in MGL c. 142A.tTheOparties fce of urther agree that nsumer Affairs aif either Contractor nd Business aoroBuye (s)submitn,and s a claim to arbitration,(i)the non-prevailing party will ultimately pay the cost of the arbitration,including reasonable attorneys'fees and expenses,(ii) the award of the arbitrator will be in writing and will contain findings of fact and conclusions of law,and(iii)that judgment to enforce the award may be entered in any court having proper jurisdiction. Contractor Signature: (/i 'se�+Y?^ Buyer Signature(s):X NOTICE: The signatures of the parties above apply only to their agreement to alternate dispute resolution initiated by Contractor. Owner may initiate alternate dispute resolution even where this section is not signed separately by the parties. Interpretation of the Agreement: I agree that this Agreement will be enforced under the laws of the state where the work is being performed. If any part of this Agreement is determined to be invalid or illegal, then I agree that the rest of this Agreement will stiff be valid and enforceable. We both understand that this Agreement, and any attachments, makes up the entire understanding between us about the work Contractor is doing. There are no other oral or written agreements or representations on which we are relying. We both agree that any change to this Agreement must be in writing and signed by both of us. The paragraph headings contained in this Agreement are for convenience not affect the meaning or interpretation of the Agreement. only and will Massachusetts Sales Only: Any deposit required under this Agreement to be paid in advance of the commencement of work i shall not exeed greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made naturrecwhich the must be ordered in advance of the commencement of work,in order to assure that the project will proceed on schedule. No Final payment shall be demanded until this Agreement is completed to the satisfaction of the parties. In Massachusetts,all contractors and subcontractors must be registered by the administrator of the Board of Building Regulations and Standards and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,Massachusetts 02116 Telephone:(617)973-8700. In Massachusetts,the HOMEOWNER is responsible for ap lying for and obtaining any and all necessary permitting. Homeowners who secure their own permits or deal with unregistered contractor shall be excluded from the Massachusetts Residential Contractor's Guaranty Fund. Condensation and Environmental Conditions: Condensation,which can form on or within wills,siding,tiles,or other surfaces results from pre- existing conditions in a home and internal or external temperatures. Reducing the humidity in a home will often remedy any condensation problems. I agree that Contractor is not responsible for condensation or existing or developing spore or mold growth,which can be the result of condensation. ppippr.0004.02.01(Current) BRAND 052623 ct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY UNIT SUMMARY The following is a schedule of the windows and doors for this project. For additional unit details, please see Line Item Quotes. Additional charges, tax or Terms and Conditions may apply. Detail pricing is per unit. NUMBER OF LINES: 17 _ .__ TOTAL UNIT QTY: 22 EXT NET PRICE: USD 32,841.80 UNE MARK UNIT PRODUCT UNE ' ITEM NET PRICE QTY EXTENDED NET } _ PRICE— 1 APT 2 LR . Elevate Double Hung Insert 928.20 2 __ 1,856.40 10 18 1/2"X 69 5/16" Entered as i _ Inside Opening 18 1/2"X 69 5/16" 2 APT 2 LR Elevate Double Hung Insert 928.20 2 1,856.40 10 21 5/8"X 69 5/16" Entered as Inside Opening 21 5/8"X 69 5/16" 3 APT 2 BATH Elevate Double Hung Insert 1,133.16 1 1,133.16 10 23 1/2"X 64 7/8" Entered as _Inside Opening 23 1/2"X 64 7/8" , 4 APT 2 BEDROOM Elevate Double Hung Insert 1,116.36 1 1,116.36 10 31 7/8"X 65 3/8" Entered as Inside Opening 31 7/8"X 65 3/8" S APT 1 UV RM FRONT Ultimate Double Hung Insert G2 2,314.89 1 2,314.89 10 55 1/2"X 69 1/4" Entered as . __ Inside Opening 55 1/2"X 69 1/4" 6 APT 1 LR Elevate Double Hung Insert 939.96 1 939.96 10 23 3/8"X 69 1/4" Entered as 1 Inside Opening 23 3/8"X 69 1/4" 7 APT 1 BEDRM Elevate Double HungInsert 998.76 2 1,997.52 .' 10 29 3/8"X 69 1/4" I Entered as 1 Inside Opening 29 3/8"X 69 1/4" 8 APT 1 BEDRM Ultimate Double Hung Insert G2 2,416.35 1 2,416.35 1 ' 10 48"X 69 1/4" Entered as Inside Opening 48"X 69 1/4" 9 APT 4 LR __ Elevate Double Hung Insert 916.44 2 1,832.88 10 18 1/2"X 65 9/16" Entered as Inside Opening 18 1/2"X 65 9/16" 10 APT 4 LR Elevate Double Hung Insert 916.44 2 1,832,88 10 21 1/2"X 65 9/16" I • Entered as Inside Opening 21 1/2"X_65 9/16 __ 1 11 APT4 KITCHEN Elevate Double Hung Insert 886.20 1 — 1-- - �_ 886.20 10 23 1/2"X 61 3/8" Entered as Inside Opening 23 1/2"X 61 3/8" _ 12 APT 4 KITCHEN Elevate Casement Narrow Frame 733.32 1 733.32 10 23 1/2"X 32 5/16" Entered as _ Inside Opening 23 1/2"X 32 5/16' OMS Ver.0004.02.01(Current) Processed on:S/30/2023 2:19:51 PM Page 2 of 12 "Fr.0004.02.01(Current) BRAND 052623 availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY 13 APT 4 BATH Elevate Double Hung Insert 1,054.20 1 1,054.20 10 23 7/16"X 61 5/16" Entered as Inside Opening 23 7/16"X 61 5/16" 14 APT 4 BED Elevate Double Hung Insert 1,071.84 1 1,071.84 10 32"X 61 3/8" Entered as Inside Opening 32"X 61 3/8" 15 3R0 FLOOR BALCONY Elevate Casement Narrow Frame 1,224.72 1 1,224.72 10 24"X 48 1/4" Entered as Inside Opening 24"X 48 1/4" 16 , 3RD FL BALCONY Elevate Casement Narrow Frame 1,224.72 1 1,224.72 10 24"X 48 1/4" Entered as Inside Opening 24"X 48 1/4" 17 INSTALLATION+PERMIT Non-Marvin Labor 9,350.00 1 9,350.00 WE WILL REMOVE EXISTING SASH, WEIGHTS AND STORMS AND STOPS FOR RE-USE, INSTALL NEW INSERT WINDOWS WITH FOAM INSULATION,RE-APPLY INTERIOR STOPS AND CAULK IN PLACE. WE WILL DISPOSE OF OLD WINDOWS AND DEBRIS,ALL PAINTING BY OTHERS. WE WILL FOLLOW EPA LEAD SAFE GUIDELINES AS PART OF THIS WORK AND WE WILL PROVIDE PERMIT FOR WORK. OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 3 of 12 r.0004.02.01(Current) BRAND 052623 ppjct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY LINE ITEM QUOTES The following is a schedule of the windows and doors for this project. For additional unit details, please see Line Item Quotes. Additional charges, tax or Terms and Conditions may apply. Detail pricing is per unit. Line#1 Mark Unit APT 2 LR Net Price: 928,20 Qty: 2 . ' ,, _ Ext. Net Price: USD p _Y 1,856.40 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 18 1/2"X 695/16" 8 Degree Frame Bevel Top Sash V Ebony Exterior White Interior 1 IG 1 Lite I Low E2 w/Argon Stainless Perimeter Bar '—U1' .? 1 Bottom Sash Ebony Exterior White Interior IG•1 Lite Low E2 w/Argon Stainless Perimeter Bar White Weather Strip Package As V iewed From The Exterior i White Sash Lock Entered As:10 Exterior Aluminum Screen F5 18 1/8"X 69 7/16" Ebony Surround 10 18 1/2"X 69 5/16" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 5 "`Note: Unit Availability and Price is Subject to Change , Line#2 1 Mark Unit: APT 2 LR rNet Price: . 928.201 i Qty: 2 it Ext. Net Price: J USD ; � 1,856.40 L MARVIN Ebony Exterior White Interior Elevate Double Hung Insert I Inside Opening 215/8"X 69 5/16" 8 Degree Frame Bevel Top Sash C Ebony Exterior White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar Bottom Sash 1 Ebony Exterior G White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar i White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 21 1/4"X 69 7/16" Ebony Surround 10 21 5/8"X 69 5/16" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 4 of 12 Vvauabhltv 0004.02.01(Current) BRAND 052623 and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number: EPXTUAY Existing Sill Angle 5 ** Note: Unit Availability and Price is Subject to Change 1 Line#3 Mark Unit: APT 2 BATH Wes, Net Price: 1,133.16 i Qty l Ext. Net Price: USD 1,133116 MARVIN Ebony Exterior White Interior - Elevate Double Hung Insert Inside Opening 23 1/2"X 64 7/8" 8 Degree Frame Bevel _ Top Sash ✓' Ebony Exterior White Interior J , IG-1 Lite Tempered Low E2 w/Argon _ `' Stainless Perimeter Bar Bottom Sash Ebony Exterior J White Interior IG-1 Lite Tempered Low E2 Obscure w/Argon Stainless Perimeter Bar r—^ 'S White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 23 1/8"X 65" Ebony Surround 10 23 1/2"X 64 7/8" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 5 '`"Note: Unit Availability and Price is Subject to Change ; Line#4 '' Mark Unit: APT 2 BEDROOM Net Price:1 1,116.36 s Qty' 1 ® .. ,�_ Ext. Net Price: USD 1,116.36 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 31 7/8"X 65 3/8" 8 Degree frame Bevel Top Sash Ebony Exterior White Interior IG Low E2 w/Argon Stainless Perimeter and Spacer Bar 7/8"SDL-With Spacer Bar-Stainless Rectangular 2W1H A Ebony Ext-White Int Bottom Sash Ebony Exterior White Interior - __ IG As Viewed From The Exterior Low E2 w/Argon Entered As:10 Stainless Perimeter and Spacer Bar FS 31 1/2"X 65 9/16" 7/8"SDL-With Spacer Bar-Stainless 10 31 7/8"X 65 3/8" Rectangular 2W1H Ebony Ext-White Int White Weather Strip Package 1 White Sash Lock Exterior Aluminum Screen Ebony Surround OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:S1 PM Page 5 of 12 pppr.0004.02.01(Current) BRAND 052623 availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 6 ""Note:Divided lite cut alignment may not be accurately represented in the OMS drawing.Please consult your local representative for exact specifications. ***Note: Unit Availability and Price is Subject td Change Line#5 1 Mark Unit APT 1 UV RM FRONT Net Price: 2,314.89 A.�. .. �.� Ext. Net Price USD 23 14.89 Qty: 1 MARVIN Ebony Clad Exterior Painted Interior Finish.White-Pine Interior _ __`___;---__ Ultimate Double Hung InsertG2 Inside Opening 55 1/2"X 69 1/4" 0"Degree Frame Bevel Top Sash V Ebony Clad Sash Exterior Painted Interior Finish•White-Pine Sash Interior IG Low E2 w/Argon Black Perimeter and Spacer Bar 7/8"SDL•With Spacer Bar-Black Rectangular-Special Cut 2W1H Q Ebony Clad Ext-Painted Interior Finish-White-Pine Int Ogee Interior Glazing Profile Bottom Sash Ebony Clad Sash Exterior Painted Interior Finish-White-Pine Sash Interior As Viewed From The Exterior IG Entered As:10 Low E2 w/Argon FS S5 1/8"X 69" Black Perimeter and Spacer Bar 10 55 1/2"X 69 1/4" 7/8"SDL-With Spacer Bar-Black Rectangular-Special Cut 2W1H Ebony Clad Ext-Painted interior Finish-White-Pine int Ogee Interior Glazing Profile White Interior Weather Strip Package Black Exterior Weather Strip Package White Sash Lock White Top Sash Strike Plate Assembly Color Extruded Aluminum Screen Ebony Surround Bright View Mesh "'Screen/Combo Ship Loose 3 1/4"Jambs ""Note: Unit Availability and Price is Subject to Change 1 Line #6 1[ Mark Unit: APT 1 LR Net Price: 939.96 LQ.,.......:-,,—....-1.—... .__y xt. Net Price: USD 939.96j MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 23 3/8"X 691/4" 8 Degree Frame Bevel Top Sash Ebony Exterior White Interior 1G-1 Lite Low E2 w/Argon Stainless Perimeter Bar Bottom Sash Ebony Exterior OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 6 of 12 er.0004.02.01(Current) FBRAND 052623 uct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY White Interior IG-1 Lite Low E2 w/Argon Q Stainless Perimeter Bar White Weather Strip Package 1 White Sash Lock Exterior Aluminum Screen Ebony Surround Bright View Mesh 3 1/4"Jambs Thru Jamb Installation A Existing Sill Angle 5 "'Note: Unit Availability and Price is Subject to Change As Viewed From The Exterior Entered As:10 FS 23"X 69 3/8" 10 23 3/8"X 69 1/4" �Line #7 1 Mark Unit: APT 1 BEDRM Net Price: . 998.76 QtYa 2 __ li Ext. Net Price: 1 USD 1,997.52 1 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 29 3/8"X 69 1/4" 8 Degree Frame Bevel Top Sash V Ebony Exterior White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar Bottom Sash Ebony Exterior v White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 29"X 69 3/8" Ebony Surround 10 29 3/8"X 69 1/4" Bright View Mesh 3 1/4"lambs Thru Jamb Installation Existing Sill Angle 5 **Note: Unit Availability and Price is Subject to Change 1.--- —_ Line#8 Mark Unit: APT 1 BEDRM �6 Net Price: ii 2,416.35 !Qty: 1 a Ext. Net Price: USD 2,416.35 G MARVIN Ebony Clad Exterior Painted Interior Finish-White-Pine Interior Ultimate Double Hung Insert G2 Inside Opening 48"X 69 1/4" 0°Degree Frame Bevel Top Sash Ebony Clad Sash Exterior Painted Interior Finish-White-Pine Sash Interior IG OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 1 of 12 r.0004,02.01(Current)pp p BRAND 052623 ct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number' EPXTUAY — - Low E2 w/Argon Dl_----Jr❑— Stainless Perimeter and Spacer Bar I 7/8"SDL-With Spacer Bar-Stainless L Victorian Prairie•Special Cut 4W4H 13 Rect Lites 4"X 4"Corner DLO O Ebony Clad Ext •Painted Interior Finish-White-Pine Int Ogee Interior Glazing Profile Bottom Sash Ebony Clad Sash Exterior Painted Interior Finish•White-Pine Sash Interior t. IG Low E2 w/Argon Stainless Perimeter and Spacer Bar 7/8"SDL-With Spacer Bar-Stainless Rectangular-Special Cut 2W1H As Viewed From The Exterior Ebony Clad Ext-Painted Interior Finish-White Pine Int Entered As:I0 Ogee Interior Glazing Profile FS 47 5/8"X 69" White Interior Weather Strip Package 10 48"X 69 1/4" Black Exterior Weather Strip Package White Sash Lock White Top Sash Strike Plate Assembly Color Extruded Aluminum Screen Ebony Surround Bright View Mesh **'Screen/Combo Ship Loose 3 1/4"Jambs """Note: Unit Availability and Price is Subject to Change Lint' #9 Mark Unit: Ext. .t. — - 4_ J APT 4 LR Net Price: 916.44 Qt : 2 Net Price: USD 1,832.88 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 18 1/2"X 65 9/16" 8 Degree Frame Bevel Top Sash V Ebony Exterior White Interior IG-1 Lite Low E2 w/Argon `y Stainless Perimeter Bar Bottom Sash Ebony Exterior tL White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar .mmiamimmai White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 18 1/8"X 65 11/16" Ebony Surround 10 18 1/2"X 65 9/16" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 5 ***Note: Unit Availability and Price is Subject to Change Lid ne #1u I Mark Unit: APT 4 LR I Net Price: 916.44 � Qty:_2 . _ _.1,._ i Ext. Net Price: USD 1,832.88 I OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 8 of 12 r.0004.02.01(Current) BRAND 052623 ct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number: EPXTUAY MARVIN Ebony Exterior While Interior Elevate Double Hung Insert Inside Opening 21 1/2"X 65 9/16" 8 Degree Frame Bevel Top Sash V Ebony Exterior White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar Bottom Sash Ebony Exterior Q White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar -' - I White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 21 1/8"X 65 11/16" Ebony Surround 10 21 1/2"X 65 9/16" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 5 •*Note: Unit Availability and Price is Subject to Change h Line#11 Mark Unit: APT 4 KITCHEN Net Price: 886.20 II �..__ Ext. Net Price: .' USD • 886.20 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 23 1/2"X 613/8" 8 Degree Frame Bevel Top Sash r Ebony Exterior v I White Interior IG•1Lite Low E2 w/Argon 1._.-_ ! Stainless Perimeter Bar !' Bottom Sash Ebony Exterior 1 I White Interior IG-1Lite Low E2 w/Argon [__._ Stainless Perimeter Bar J. White Weather Strip Package As Viewed From The Exterior 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 23 1/8"X 61 7/16" Ebony Surround IO 23 1/2"X 61 3/8" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 4 ***Note: Unit Availability and Price is Subject to Change Line#12 Mark Unit: APT 4 KITCHEN Net Price: 733.32 gty: 1 Ekt. Net Price: d USD 733.32 MARVIN Ebony Exterior White Interior Elevate Casement Narrow Frame-Right Hand K OMS Vet-,0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 9 of 12 er.0004.02.01(Current) uct availability and pricing subject to change. BRAND 052623 300 ELM ST,NORTHAMPTON MA Quote Number:EPXTUAY --.. --] Inside Opening 23 1/2"X 32 5/16" 0 Degree Frame Bevel Ebony Exterior White Interior IG-1 Lite Low E2 w/Argon Stainless Perimeter Bar White Folding Handle 77. Interior Aluminum Screen Bright View Mesh �� White Surround 3 1/4"Jambs // Thru Jamb Installation / 1"Frame Expander "`Frame Expander Ship Loose j "*Note: Unit Availability and Price is Subject to Change As Viewed From The Exterior Entered As:10 FS 23 1/8"X 32 1/16" 10 23 1/2"X 32 5/16" Line#13 v Mark Unit: APT 4 BATH Net Price: 1,054.20 Qty: l Ext. Net Price: L USD 1,054.20 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 23 7/16"X 615/16" 8 Degree Frame Bevel II Glass Add For All Sash Top Sash Ebony Exterior White Interior u_.. .. IG-1Lite Tempered Low E2 w/Argon Stainless Perimeter Bar Bottom Sash Ebony Exterior White Interior IG-1Lite Tempered Low E2 w/Argon —— Stainless Perimeter Bar As Viewed From The Exterior White Weather Strip Package Entered As:10 1 White Sash Lock FS 23 1/16"X 61 7/16" Exterior Aluminum Screen 10 23 7/16"X 61 5/16" Ebony Surround Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 5 "'Note: Unit Availability and Price is Subject to Change li Line #14s Mark Unit: APT 4 BED _ Net Price: 1,071.84 11 Qty: 1 , — Ext. Net Price: USD 1,071.84 MARVIN Ebony Exterior White Interior Elevate Double Hung Insert Inside Opening 32"X 61 3/8" 8 Degree Frame Bevel Top Sash Ebony Exterior White Interior OMS Ver,0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 10 of 12 r.0004.02.01(Current) BRAND 052623 Fr availability and pricing subject to change. 300 ELM ST, BRAND0NORTHAMPTON MA Quote Number:EPXTUAY IG Low E2 w/Argon Stainless Perimeter and Spacer Bar 7/8"SDL-With Spacer Bar-Stainless Rectangular 2W1H Ebony Ext-White Int C Bottom Sash Ebony Exterior ----1 White Interior 1G /1. Low E2 w/Argon • ZS. Stainless Perimeter and Spacer Bar 7/8"SDL-With Spacer Bar-Stainless i Rectangular 2W1H — Ebony Ext-White Int As Viewed From The Exterior White Weather Strip Package 1 White Sash Lock Entered As:10 Exterior Aluminum Screen FS 31 5/8"X 61 7/16" Ebony Surround 10 32"X 61 3/8" Bright View Mesh 3 1/4"Jambs Thru Jamb Installation Existing Sill Angle 4 •**Note:Divided lite cut alignment may not be accurately represented in the OMS drawing.Please consult your local representative for exact specifications. "`Note: Unit Availability and Price is Subject to Change Line#15 Mark Unit: 3RD FLOOR BALCONY Net Price: — 1,224.72 Qty: 1 Ext. Net Price: r USD i 1,224.72 MARVIN Ebony Exterior White Interior --"" Elevate Casement Narrow Frame-Right Hand \—— Inside Opening 24"X 48 1/4" \ 11 0 Degree Frame Bevel I Ebony Exterior White Interior IG . low E2 w/Argon Stainless Perimeter and Spacer Bar 7/8"SDL-With Spacer Bar-Stainless Rectangular Special Cut 3W4H Ebony Ext-White It White Folding Handle Interior Aluminum Screen uD, Bright View Mesh I+ I j White Surround L'-.� JJ 3 1/4"Jambs As Viewed From The Exterior Thru Jamb Installation Entered As:10 1"Frame Expander FS 23 5/8"X 48" ***Frame Expander Ship Loose 10 24"X 48 1/4" "`Note:Divided lite cut alignment may not be accurately represented in the OMS drawing.Please consult your local representative for exact specifications. •"Note: Unit Availability and Price is Subject to khange Line #16 Mark Unit: 3RD FL BALCONY Net Price: p 1,224.72 `' Qty: 1 —1 Ext. Net Price: USD i 1,224.72 MARVIN Ebony Exterior White Interior Elevate Casement Narrow Frame-Left Hand Inside Opening 24"X 48 1/4" 0 Degree Frame Bevel OMS Ver.0004.02,01(Current) Processed on:5/30/2023 2:19:51 PM Page 11 of 12 er.0004.02.01(Current) BRAND 052623 uct availability and pricing subject to change. 300 ELM ST,NORTHAMPTON MA Quote Number: EPXTUAY -'"`�""s"1 Ebony Exterior 1 White Interior IG Low E2 w/Argon Stainless Perimeter and Spacer Bar i 7/8"SDL-With Spacer Bar-Stainless r: Rectangular-Special Cut 3W4H N Ebony Ext-White Int White Folding Handle Interior Aluminum Screen Bright View Mesh White Surround 3 1/4"Jambs Thru Jamb Installation 1"Frame Expander .i As Viewed From The Exterior • '`'Frame Expander Ship Loose '` Note:Divided lite cut alignment may not be accurately represented in the Entered As:10 OMS drawing.Please consult your local representative for exact specifications. FS 23 5/8"X 48" '"Note: Unit Availability and Price is Subject to Change SO 24"X 48 1/4" ILine #17 ( Mark Unit: INSTALLATION+PERMIT Net e: 9,350.00 Pric Qty: 1 Ext. Net Price: " USD 9,350.00 Labor WE WILL REMOVE EXISTING SASH, WEIGHTS AND STORMS AND STOPS FOR RE-USE, INSTALL NEW INSERT WINDOWS WITH FOAM INSULATION, RE-APPLY INTERIOR STOPS AND CAULK IN PLACE. WE WILL DISPOSE OF OLD WINDOWS AND DEBRIS, ALL PAINTING BY OTHERS. WE WILL FOLLOW EPA LEAD SAFE GUIDELINES AS PART OF THIS WORK AND WE WILL PROVIDE PERMIT FOR WORK. _ _ _ Project Subtotal Net Price: USD 23,491.80 Non-Taxable Labor: USD 9,350.00 6.250%Sales Tax: USD 1,468.24 Project Total Net Price: USD 34,310.04 10%off with payment by cash/check for Project total=$30,879.04 * Payment plans available—with forfeiture of discount INCLUDED-- 10%off with payment by cash/check/or card for Project total * Payment plans available—with forfeiture of discount (NO Interest, 4%payment per month) OMS Ver.0004.02.01(Current) Processed on:5/30/2023 2:19:51 PM Page 12 of 12 ] t{"�. .0."'"` il- t — �G The iCaoitnt rtmeoin Owjeailtdl uosftl lllfAscaCclidwetstets s lEcl] X Congress Street,Suite 100 T'4:i=/ Boston,MA 021144017 tvww.r�nrss.goi/dia Workers'Compensation Insurance Affidavit:Bulldot's/Contrnctori/Efectricirns/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY. • APIllicati lnfii'ma1IQIt r ., . .,._. — ._,_ ..�-.__.__. - ...__ . i!F nt Lep,thJ Name(Business/OrganizationhIndividunl): �'"•ji . _—._-----r— Address: �� ____._. City/State/Zip: . 4,,, , ,�1 _ 1 ,; , one#: _ a -.:.zi ;,....,., - . Are you nu employer?Check the appropriate box; Type of project(required): I. I am a employer with 0 employees(full and/or part-time)•Q 7. New construction 2 I am a sole proprietor or partnership and have no employees working for ma 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.]t 9. ❑Demolition 4.01 em a homeowner and will be hiring contractors to conduct all work on my property. i will 10 J j 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 I have hired the sub-contractors listed on the attached sheet. 13.0 R f repairs These sub-contractors have employees and have workers'comp.insurance.' 6.0 We arc a corporation and its officers have exercised their right of exemption per t,4GL c. 14. Ot11er 1�) 0 152,§I(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box it I 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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing worker's'compensation insurance for my einployeas. Below is the policy and Job site litf0l'f1lahOlt, Insurance Company Name:_ j p Policy#or Self-ins.Lic.#: pi q .,z7- a Expiration Date: .,.a., r Job Site Address: %� �� Apri City/State/Zip:/ I� 4 ' i. //�" ' Attach a copy of the workers'compensation policy declaration page(showinjkthe policy number and exph•r'ion date). `�`"" Failure to secure coverage as required unde-MOL 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 ns and penalties a etjuty that the i Iformation provided above is true and correct, Signature: - ‘,-71 Z 3 Phone#: 1 t Official use only. Do not write in Ibis area,to be completed by city or town official I: 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#: • -._:. ...--..._... --____-___._._._ -- ..._.—.====_._—.-____ - THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration .... - " Type: Supplement Card is __NI Registration: 199691 WOODBURY SUPPLY COMPANY. INC. wommossmo i Expiration: 09/24/2024 D/B/A MILLWORK MASTERS 4111MINNIMI.44 SI - 104 S POMPERAUG AVE ;_ WOODBURY, CT 06798 M .: Update Address and 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: Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 199691 09/24/2024 Boston,MA 02118 WOODBURY SUPPLY COMPANY,INC. D/B/A MILLWORK MASTERS CHRISTOPHER O'CONNOR_ J 104 S POMPERAUG AVE, " Chri4tophe4-('Colin r WOODBURY, CT 06798`'4.1,� ,.•` Undersecretary Not valid without signature AC o� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/31/2022 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 NAME: Rochelle Remillard John M. Glover Agency PHONE FAX 456 Birge Park Road (AMA No.ExH:860-259-1428 U/c,No):860-780-8234 Harwinton CT 06791 ADDRESS: rremillarc(@johnmglover.com INSURERS)AFFORDING COVERAGE NAIC S INSURER A:The Charter Oak Fire Insurance 25615 INSURED WOODSUP-01 INSURER B:Phoenix,Insurance Company 25623 Woodbury Supply Company, Inc. INSURER C:Travelers Property Casualty Company of America 25674 Millwork Masters, a Division of Woodbury Supply Co 104 South Pomperaug Avenue INSURER 0:Farmington Casualty Company 41483 Woodbury CT 06798 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:465587025 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 —" TADbL SUEN —" POLICY EFF POGCY EXP _ L_TR TYPE OF INSURANCE 'INSD NND POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY Y-630-1R018701-COF-22 9/30/2022 9/30/2023 EACH OCCURRENCE $1,000,000 I CLAIMS-MADE X OCCUR DAMAGE E PREMISES S t RENTED [Ea occurrence) 3300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY I S 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X jE o- X LOC PRODUCTS-COMP/OP AGG $2,000,000 II OTHER: $ B AUTOMOBILE LIABILITY BA-1 R018240-22-14-G 9/30/2022 9/30/2023 COMBINiden►)ED SI NGLE LIMIT $1,000,000 (Ea acc _�__ X ANY AUTO BODILY INJURY(Per person) $ ---- OWNED SCHEDULED BODILY INJURY(Per accident) $ .. AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ C UMBRELLALIAB j X OCCUR CUP-3R463017-22-14 9/30/2022 9/30/2023 EACH OCCURRENCE f10,000,000 X EXCESS LIAB ' CLAIMS-MADE AGGREGATE f 10,000,000 DED 1 Xl RETENTIONS iQ.gDn $ D WORKERS UB-1R019088-22-14-G 9/30/2022 9/30/2023 X AND EMPLOYERS'LIABILITY STA UTE ER CT MA NH AND EMPLOYERS' Y ANYPROPRIETORJPARTNER/EXECUTIVE YN E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excluded Officer: Paul Niland CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Permit Services LLC ACCORDANCE WITH THE POLICY PROVISIONS. 1525 Old Louisquisset Pike Suite B101 AUTHORIZED REPRESENT' AWE Lincoln RI 02865 ()„4e ,4g.,..0.;- ©1988-2015 ACORD CORPORATION. All rights reserved. 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