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29-485 (13) BP-2023-1051 584 BURTS PIT RD COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 29-485-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI ERED CONTRACTORS DO NOT HAVE ACCESS TO'THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1051 PERMISSIO IS HEREBY GRANTED TO: Project# WINDOWS/DOORS 2023 Contractor: License: Est. Cost: 17434 RENEWAL BY AND RSEN 090125 Const.Class: Exp.Date: 10/06/202' Use Group: Owner: LAMP'ON MELISSA J& ALAYNE E HEISHMAN Lot Size (sq.ft.) Zoning: WSP Applicant: RENE AL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC31415822 NORTHBOROUGH, MA 01532 ISSUED ON: 08/07/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOWS 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 Dri%eway 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: XI • Cg) Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner pit .6,� R.,r1 `x,,�;/ t pe-kl/ts L� g,fi-ef-,4-,Ys, 0r.5 The Commonwealth of Massachusetts ) Board of Building Regulations and Stand rds ��/ ,,, � CIP ITY C4 Massachusetts State Building Code, 780 M' USE Building Permit Application To Construct,Repair, Re vat Or I3golisVa20 'evi••d Mir 2011 One-or Two-Family Dwelling ""IT This Section For Official Use ! ' .. nun, _•Building Permit Number: [j P , 3,3- �Q,� Date Applied: Ton/_mA 0• _ rro s yIU/IJ 1 55 /� — "7?UZj Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 5:6"( ,3 kra Tit Rd cIorUrc /n'A 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Al a,n,c_ l4e;s'.,tn Flo, iwrq o 1°6 2- Name(Print) City,State,ZIP sgy 51.,1 PO- ga Li1-s-5-dy-1-z.a 01,10.yn_4eva.,kCP.•gria,:/,Cor, No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other QcifyieelRscint..'f i,,/fibd4is Brief Description of Proposed Work': 2Grna.4_ Go,4 eere c'C Z ...Ac1a.S a- ct 2 olo"/3 irk{ R, /,.fit w,.j-41 /Jd S a,/ GG,art o-S wLv t - c i . 3 0, SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /9.. Y3y OD 1. Building Permit Fee: $- Indicate how fee is determined: 2. Electrical $ / 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: la\ Check No.4t5DvCheck Amount: I"' Cash Amount: 6. Total Project Cost: $ /9 y3 y,i 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ©g—/Zc dz fa644.( Mir, IN License Number Expifation Date Name of CSL Holder V/S j0 l'ori'Cs R List CSL Type(see below) No.and Street Type Description r/flA No I r4 0(0)h OM p,CO- U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,AP M Masonry RC Roofing Covering Window and diyitiri:. SF Solid i :Appliances S- 952- V/0 L /Mi ts e 3" /Cir' '0� I Insulation Telephone C Email address D Demolition 5.2 Registered Home Improvement��� � Contractor(HIC) /?ONO 2 qCc.�� 41 l�Tlro�/SL•l HIC Registration Number E. iratio Date HIC Company Name or/HIC IIC Registrant Name Nn f /�1�1 �d Nvl�1�jDlo�1, //1,4 o/S3Z ,r fi '' e `� g€ci»;b,o - and Street r m il address ,thi 1 rokg(-, inft- 0/532— 040' 9-C 2 - W(Z City/Town, State.ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 12' No . 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 accurate to best of my knowledge and understanding. (nora1 c L . L'.fangr j/t.- 2-'----'-J— Z3 Pint Owner's or Authorized Agent's Name(Electro . ignat 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(leeks/porches Type of cooling system Enclosed I Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton oaY HAM ro. .\� i, ", tiu Massachusetts -- ''< ii`St 4 ��e o DEPARTMENT OF BUILDING INSPECTIONS yJ a, S 212 Main Street • Municipal Building A. C y Northampton, MA 01060 �5fp,, 3,�\1J 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: ,30 .-hes cQd/ No 6e,-0 1,... (ram o,S3- The debris will be transported by: Name of Hauler: (t)(z_ctz, /‘,1ei, iA Signature of Applicant: Date: F'- Z3 The Commonwealth of Massachusetts Department of Industrial Accidents t7fice of Investigations Ra= Lafayette City Center - 1 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gor/dia Workers'('ompcnsation Insurance Affidavit: Builders/Contractors/Electricians,Plumbers Applicant information Please Print I.egihlv Name(BusinesstOrganizationindivtdual): Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip:Northborough, MA 01532 Phone#:508-351 2277 Are you an employer'! (heck the appropriate hot: Type of project(required). I.14 1 am a employer with 30 a ❑ l am a general contractor and 1 6. ❑New construction employees(fatl and/or part-time).' have hired the sub-contractors listed on the attached sheet. 7. El Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in anycapacity. employees and have workers' aP n` 9. 0 Building addition [No workers' comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its lost]Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' right of exemption per MGL Y comp. 12.0 Roof repairs insurance required.] ' c. 152,$1(4),and we have tto Replacement employees. [No workers* 13.�otherP comp. insurance required.] ..Any applicant that chocks box NI must also fill out the section below showing their workers'compensation policy information_ i Homeowners who submit this aflidatrt indicating they are darns all wort and then hire outside contractors must submit a new affidatit indicating such. ;Contractors that check this box must attached an additional shah showutg the name of the sub-contractors and slate whether or not those entities hate employees. If the.uh-rotnractoes have employees.they rnn't pr.Rrdc tiau w'akcr.'comp.poticcy nurzt ci. I am an employer that is providing workers'compensation insurance for my employee's. Below is the policy and job site information. Insurance company name_ Old Republic Insurance Co. _ Policy#or Self-ins. Lie.#: MWC 314158 22 Expiration Date: 10/01/2023 Job Site Addre., 584Burtspit Rd Citystatc hp: Palmer MA 01906 Attach a cops 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 S 1.500.00 and/or one-year imprisonment, as well as civil penalties ire,the form of a STOP WORK ORDER and a fine of up to S25.0.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. t I do hereby certify under the 9pains and penalties of peryurm that the information provided abort.is is true and correct. Stgtuturc /I 't1� I)atr 8/2/2023 Phone $bo- 96. 2 - `//72 - U/Jfflal use only. Do not write in this area.to be completed by city or town official (itv or town: Permit license N Issuing Authority (check one): If:Board of Health 20 Building l)cpartinent 33 it%::l un n( ierk ..❑t.lcetrical Inspector 51J1unihing Inspector 6.fJOther i ('untact Person: Pima Is 1rii, RENEWAL ts byANDERSENN FULE-SERNCE WINDOW 8 D00R REPLACEMENT 1 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 RAw Owner or Builder /� DIA:RENEWAL BY ANDERSEN OF BOSTON Alayne Heishman RENEWAL Legal Name:Renewal by Andersen LLC 584 Burts Pit Rd HIC#170810 Florence,MA 01062 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)584-7288 Ai MAC WIDOW[DOOR nnMErtt Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston®gmail.com C: (413)320-6449 Owner Or Builder (As Agent Of Owner) Must Complete & Sign This Section I, as Owner/ Authorized Agent hereby declare that the statements and information on the foregoing application for the property/address indicated on this agreement. JAA-1 -)\ - SIGNATURE Of SALES PERSON SIGNATURE SIGNATURE Michael Richardson Alayne Heishman PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 07/29/23 Page 15/ 19 RENEWAL BY ANDERSEN SPECIFICATION &TECHNICAL MANUAL TECHNICAL INFORMATION PERFORMANCE RATINGS AND TEST DATA NFRC Total Unit Performance (continued) U-Factor Renewal by Andersen High Performance Glass Type (BTUI(hr ft2 oF)) UGCvr Product Air HP Gas Blend Air HP Gas Blend Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full DMded light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E48 Full Divided Light Grilles 0.34 0.31 0.28 0.28 Double-Hung DB Without Grilles 0.33 0.30 0.19 0.19 .40 Low-E4®Sun (Full Frame) Full Divided Light Grilles 0.35 0.31 0.18 0.17 Without Grilles 0.33 0.29 0.21 0.21 .65 Low-E0 SmartSunTM Full Divided Light Grilles 0.34 0.30 0.19 0.19 Low-E4®SmartSun Without Grilles 0.28 0.25 0.20 0.20 .63 with HeatLockT" Full Divided light Grilles 0.28 0.25 0.18 0.18 Without Grilles 0.46 0.44 0.57 0.57 .82 Clear Full Divided light Grilles 0.46 0.44 0.51 0.51 Without Grilles 0.33 0.30 0.31 0.31 .72 Low-E4® Full Divided Light Grilles 0.35 0.31 0.28 0.28 Double-Hung DB ® Without Grilles 0.34 0.30 0.20 0.19 .40 Low-E4 Sun (Insert Frame) Full Divided Light Grilles 0.35 0.31 0.18 0.18 Without Grilles 0.33 0.29 0.21 0.21 .65 -E4'SmartSunTM Full Divided Light Grill0 0.34 0.30 0.19 0.19 Low-E4"SmartSun Without Grilles 0.27 i. 0.20 0.20 .63 with HeatLockl" Full Divided light Grilles 0.27 0.25 0.18 0.18 Without Grilles 0.47 0.45 0.59 0.59 .82 Clear Full Divided Light Grilles 0.47 0.45 0.53 0.53 Without Grilles 0.34 0.30 0.31 0.31 .72 Low-E4" Full Divided Light Grilles 0.35 0.32 0.29 0.28 // Without Grilles 0.34 0.30 0.20 0.19 .40 Gliding ( Low-E4®Sun Full Divided Light Grilles 0.35 0.32 0.18 0.18 1 (Without Grille? 0.33 0.29 0.21 0.21 .65 Low-E4°SmartSun"' - -- Full DMded Light Grilles 0.34 0.31 0.19 0.19 Low-E4®SmartSun Without Grilles 0.27 0.25 0.20 0.20 .63 with Heatlock"" Full Divided Light Grilles 0.27 0.27 0.18 0.18 nq-in COMPANY CfINFII)FNTIAI - RFVISION AA-rll Agreement Document and Payment Terms /may DBA:RENEWAL BY ANDERSEN OF BOSTON Alayne Heishman RENEWAL Legal Name:Renewal by Andersen LLC 584 Burts Pit Rd HIC#170810 Florence,MA 01062 brANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)584-7288 ruuu"xE MAW.naaEIUW*n Phone:(508)351-2200 I Fax:(508)986-7072 rbaboston@gmail.com C:(413)320-6449 Alayne Heishman 07/29/23 BUYER(S)NAME CONTRACT DATE 584 Burts Pit Rd, Florence,MA 01062 (413)584-7288 (413)320-6449 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER alayne6mail@gmail,corn 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. TOTAL JOB AMOUNT: $17,434 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: $17,434 Estimated Start: Estimated Completion: 16-20 weeks 1 day AMOUNT FINANCED: $17,434 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: GS 1/3 start, 1/3 install, 1/3 sub complete 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 08/02/2023 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,WHICHEVER DATE IS TATER. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SIGNATURE Of SALES PERSON SIGNATURE SIGNATURE Michael Richardson Alayne Heishman PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 07/29/23 Page 2/ 19 / Itemized Order Receipt W / ` ' DBA:RENEWAL BY ANDERSEN OF BOSTON Mayne Heishman RENEWAL Legal Name:Renewal by Andersen LLC 584 Burts Pit Rd HIC#170810 Florence,MA 01062 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)584-7288 HE AM([1.11001V t DJR WtMEWCE Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston®gmail.com C:(413)320-6449 ID*: ROOM: SIZE: DETAILS: PRICE: Misc Misc, ProVia, Entry Door System, Quantity 1, See attachment for details. 1 side entry Misc Misc, ProVia, Entry Door System, Quantity 1, See attachment for details. 2 Kitchen Window Awning Base Fram , Exterior Sandtone, Interior Sandtone, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass,All Sash: High Performance SmartSun Glass, No Pattern, Tempered Glass, Hardware, Stone, Screen, Fiberglass, Full Screen, Grille Style, No Grille, Misc, None , 3 Kitchen Window Picture Base Frame, Exterior Sandtone, Interior Sandtone, Performance Calculator PG Rating: 50 I DP Rating: + 50 / - 50 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Grille Style, No Grille, Misc, None , WINDOWS: 2 PATIO DOORS:0 ENTRY DOORS:0 SPECIALTY:0 MISC: 2 TOTAL $17,434 ``' Renewal by Andersen is committed to our cus�omers'safety by °` complying with the rules and lead-safe work ractices specified by the EPA. 07/29/23 Page 3/ 19 '�./��� Payment Authorization Form DBA:RENEWAL BY ANDERSEN OF BOSTON Alayne Heishman Legal Name:Renewal by Andersen LLC 584 Burts Pit Rd RENEWAL HIC#170810 Florence,MA 01062 byANDERSEN 30 Forbes Road l Northborough,MA 01532 H:(413)584-7288 NqN NU MOONOOOMMILVEMW Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)320-6449 Alayne Heishman BUYER NAME 584 Burts Pit Rd Florence ADDRESS CITY MA 01062 (413)584-7288 (413)320-6449 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 greensky 4521 $17,434 FINANCE PROGRAM' FINANCE PLAN** CONTRACT BALANCE Michael Richardson 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 ($17,434) CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION (4) FINANCING $0 $5.811. $5.811 $5.812 (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 II Borrowers of the Loan Agreement. 3. Instruct the Lender(if applicable)to disburse the proceeds of the loan to Renewal t y 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. Alayne Heishman ---"" """lllT P-D 07/29/23 BUYER NAME SIGNATURE DATE 07/29/23 Page 4/ 19 Go Permits, LLC 105 Buttonball Lane Ga, Glastonbury, CT 06033 PERMITS Scott Doughman • Phone: 860-952-4112 Fax: 860-430-6719 scottdoughman@gopermits.org Re: Building Permit Application - Licenses Good day, Please find attached permit application, licenses and supporting documents. Renewal by Andersen sold the job and is the G.C. and CSL - CSL #CS-090125 -- Exp. 10/06/24 - HIC #170810 -- Exp 12/22/23 - Workers Comp - #MWC 3145822 — Exp. 10/01/23 Old Republic Insurance Co All licenses and insurances are attached. Once the permit is ready: • Please fax or e-mail a copy of the permit and receipt to the below address and mail the original to the homeowner: Fax: 860-430-6719 Email: renewalbyandersent gopermits.orgl • If you unable to mail the permit to the homeowner please send to the below address and we will ensure the permit is at the home posted at the time of installation: Go Permits, LLC 105 Buttonball Lane Glastonbury, CT 06033 If we are required to pick up the permit in at the building department, please call 860-952- 4112 once it's ready and we will come to get it. Thank you, Go Permits Page 1 of 1 A(T )R0" CERTIFICATE OF LIABILITY INSURANCE GATE,LM0130/YYYY, 09/21/2022 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 cartlftcebe holder is an ADDITIONAL INSURED.the po6cylles)must have ADDITIONAL INSURED provisions or be endorsed. It 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). Cai PRCOUC ER ?ACT 11111.3a Towers Ration Cartlflcata Cantor w_11,• T_wza Yataoo Nadr.at, 1oc. PHONE FAX :ustury Blvd ws c..r. 1-a77-615-737a warm.MaL 1-Dee-�E'-Z3'8 dee 305111 ApDRE51, oar tiflaataape1111s.Dos wa•I:v.3.11.. l7t 372305191 USA 1N*IRER(51 AFFORDING COVERAGE NAMr _ *I ,r SURER A Old Retell' Laser&ace Cowepany :a1a' INSURED INSURER B a.mwal by Aadersee LLC 30 rerbe• Road *I SURER C. Par tEbora.gb, iwR 01532 NSURERD INSURER E INSURER COVERAGES CERTIFICATE NUMBER:W26007501 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAAED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIP{THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO JUL THE TERMS, EXCLUSIONS AND CONEXTIONS OF SLCn POLiCtES LIMITS SHOWN MAY RAVE(tEEN REDUCED BY'Atil CLAIMS NSA 3.4l3DL10ER l ICY�F._ POl1Clyer LIS TYPE OF INSURANCE i W`r0 WVO POLICY NUMBER 1{ MRS X COIRIERCLALDEIERALLUWTY EACH OCCURRENCE s 2,060.000 ILXAIMSaILOf a OCCUR PREMISES,tEat occurrence' { Sa0.000 A ! LOD EXP Ore ore Rsrsoni 1 10.000 MIX 314161 :2 10/01/2022 10/01/2023 PERSONAL,,,,,IN.3,R1 { 2.000.000 OEM AGGREGATE UIST AMP—ES PER. GENERAL AGGREGATE f 4 000 OOC. 51 POLICY p ffC' ❑LOC PRODUCTS-COMP.OP ADD { 4.000.000 OTHER { AUTOY13111a,ELIRRLJTV countiowSINGLE LW S 5 000 000 Ea acridara X ANY AUTO ROOD Y INA/RY.Per cum•• S 1 ~OW11ED $OEDIAED IarIS 314159 :_ 10/01/2022 10/01/2023 BODILY IR5JRY IRb Auden, AUTOS ONLY ALIT06 - ��"t�$O 1CNCMNE0 PROPERTY Da,TAGE { AUTOS ONLY AUTOS Ow!0 ars-n.ml { USIIIIIEU.ALLAB DCCv61 EACH OCCURRENCE { masa Ludt CLAAIS.MADE AGGREGATE I CEO I 1RETENT.ONe I { PFOR_tERIS COMPENSATION X I STATUTE I OT ER AND EMPLOYERS`LNOIUTY A AN t.F0✓FRIE ro P+fiTNET..EAECUTh'E —i EL EACH ACCIDE►T 5 1.000.000 OFF CER VE.USERE2CL,.LEC" Ilo N.'A MSC 314150 22 10/01/2022 10/01/2023 - -- --- 1.000.000 rwndai ry N Mel EL DISEASE•EA EMPtO'rEE { Y4S dsw6wLnon 1,000.00e DESCRIPToON OF OPERATIDIM tee. EL DISEASE•POLICY UNIT { DESCRIPTION OF OPERATIONS/LOCATIONS r V4RCLE5 IAODRD tat Additional Rem.Ns 0aeetee mar 64 reached.1.e0 toms O rp re/l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE VAIN THE POLICY PROVISIONS. AU THORi2FDD*SSP,R0WTAT W E Mindanao Of lnauranaa 1111-2016 ACORD CORPORATION. All rights reserved ACORD 25(201103) The ACORD name and logo are registered mait*o ACORD In 23076070 wr-II 2614324 Commonwealth of Massachusetts COIr/�C7Y0/1 Supervisor �', Division of Occupational Licensure Unrestricted-Bu w of arty use group which contain Board of Building Regulations and Standards less than 35,000 cubic hat(IS1 cubic ateliers)ofaErroba/ C.ensLootoilttm1SVOtervisor space CS-090125 empires 1O'06 2024 JAIME L MORIN '° — 54 NOTTINGHAM RD r RAYMOND NM 03071,' 0 y Oilvdal Failure to passim a current edition of the Massachusetts ..w, Comm zs:o ,pp ,�/,. ��"� Slate Building Code is cause for revocation of this license. .,,.ii.rivTit'.i' r.z_1 71. w�i4t�c.r.1,. For information about this license `C�/''` Cal MT)7 7-325Y or visit www.tnsss.0ovtdpf THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massadwsetts 02118 Home Intront • tractor Registration + Type. SupPlent Card t. ;� f2egt5Ul<ttiult: 17081 Q RENFWAL BY ANDERSEN LLC E.stpiration 17'22 2023 30 FORBES RD NORTtt80ftOUGH.MA 01532 ." it 41.7,1 Update Adctreae and Return Card. THf.COMMONWEALTH Of MASSACHUSETTS Office of Consumer Affairs R Business Regulation Registration valid for individual use only before the a„pir„bort Ash. if found return to: HONE IMPROVEMENT Su ENT CONTRACTOR TtJtt Office of Consumer Affairs and Business Regulation TYPE.Sri tihrrrtettl Card 1000 Washington Street -Suite 710 Rem Boston,MA 02115 17t1K10 72'22J20i3 KtNit-01AL BY ANDERSEN LIA: JAIME MORIN :io FORB S RD r"ej,.".N.t ,4.4r41' r - - NOFt HBOROUc,l1,MA 01532 underse crrter�, Not lid without sign-bttatrre RENEWAL **ANDERSEN warm mitictiacoM Pt t E4W To 'Wnom it May Concern: This letter will author a the followjr:g t e,sonls) to act as a nt(sl on behalf of Renewal by Andersen LLC, 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for per^^.its and inspectio tS with respect to the Installation,maintenance and repair of windows and entry rinr rc irr+ripr Massachutettc State Home improvement Contactor license nwi v ber 17t t1n and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508=351.2277 ext 6. Authorized personsl. Go Permits LLC Sarah Hammad David Ande Maureen Kivel Scott Doughman Ryan Btondo Sovannara y Mark Foster Glynn Norgan lenniret winke wenoy Kai n Gerald Cramer Nick Ratio Dane,',Ackerman Stephen,Wit: er Katie Grcrcatt Bonnie Myers Carrie Fokgno Michael Rogers Rachel Orloff " amie Morin Renewal 17,y Andersen LLr H IC 170810 CSL—CS090125 Local District Office Address 30 Forbes Rd Northhorough, MA 01532 ?enewai tw Arcler:.en t:C Lr)larna►a:abye South CrAraog..Grain MN S5G16 ^ Page 1 of 1 ' 1 ® DATE(MM/DD/YYYY) A`ORO CERTIFICATE OF LIABILITY INSURANCE 09/2l/zoz2 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 ' FAX c/o 26 Century Blvd INC.�E : 1-877-945-7378 (NC.No). 1-888-467-2378 E-MAIL oertificates4willis.00m P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA P4SURER(S)AFFORDINGCOVERAGE NAICO INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC 30 Forbes Road INSURER C: Northborough, NA 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:4726008011 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 WEIR vivo POLICY EFF POLICY EXP 'MI LIMITS LTR INSD POLICY NUMBER IMDDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 Y MWZY 314161 22 10/01/2022 10/01/2023 2,000,000 PERSONAL&ADV INJURY S GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY L I JE LOC PRODUCTS_COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S A OWNED — SCHEDULED MWTB 314159 22 10/01/2022 10/01/2023 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH Or-URRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? NO NIA MWC 314158 22 10/01/2022 10/01/2023 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POUCY OMIT S 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Westford is included as an Additional Insured as respects to General Liability as required by written contract. 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 Town of Westford 55 Main St. (I_a A14 Westford, MA 01886 k7 .i/- ©1988-2016 ACORD CORPORATION. All rights reserved. 117 Commonwealth of Massachusetts COrlawrllael Supervisor of Occupational Licensure Umastneted_Building'et any use group which contain Board of Building Regulations and Standards less than 35,000 cadet NSN(1101 cubic meters)or enclosed ,:enstryt4iVsltS Jvisor e i CS 090125 ..Expires; 10106/2024 t JAIME L MOI 4N ', t r 54 NOTTINGNAM RD RAYMOND Nil 03077 :I 2 le/Rlw► J 'oxsva ' Failure to possess a curved edition of ties Massechua.tb 4a:"—:;S CnCr „l�s State thilidlitg Cools is cause fat revocation ot this license. For tx*rsIon about tales•c risc Call iS171777-3XIS or Moil www.isses.govnipl t THE COMMONWEALTH OF MASACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home lmproyernent ► ctor Registration 1:4, "; 4. � II ,r 'Type'. Supplement Card """ ,_, Reglgttatiurl: 170810 RENEWAL BY ANDERSEN LLC ." eitpirati n 171221023 30 FORBES RD NORTI.tSOROUGH.MA 01532 . .: - :a t . Update Aduress and Return Card. THE COMMONWEALTH Of MASSACHUSETTS Registration valid for individual use only before the Office of HOME er'IMPROVEMENTAffa CONTRACTOR Business Regulation boon dorm K fecund return to: TE.SuppleCI CaRACTQH Ole of Consumer Altair*and Business Regulation Fttaissatipo TYPE,Supplement Cmrd 10 Washington Street -Suite 710 �° 00 Boston,MA 02118 REptEW.*L Fit ANDEftSEN 1.0 JAIME MORIN • :!U FORl3!S RD .;,,,,,,,or ; =^u+"ri - NI?fdTN8C3ROfJGH.MA 01532 Undersecretary Not lid without sit- [are RENEWAL ‘P brANDERSEN FIttii MX*i EOM OPIATAIFIC To Whom It May Concern: This letter will authorize the following persons) to act as a ent(s)on behalf of Renewal by Andersen LLC, 9900 Jamaica Ave Soutar, Cottage Grove MN 55016 to pull for permits and Inspections with respect to the installation, maintenance a d repair of windows and entry doors i inr1ar Massachusetts State Nome improvement Con ractor license number 170810 and Construction Supervisor license number CS-090125. If you have any questions, please call me at 508.351.2277 xt 6 Authorized erson s A II Go Permits L.0 Sarah Hammad David Andetson Maureen Kive4 Scott Doughman Ryan Rancdo Sovannara Kuy Mark Foster Glynn Norgan Jennifer winke wendy Holden Gerald Cramer Nick Rago Dane! Vickerrnan Stephen Wider Katie Grocott Bonnie Myers Carrie Fol,gno Michael Rogers Rachel Orloff r Jamie Morin Renewal by Andersen LLC H IC 170810 CS1-CS090125 Local District Office Address 30 Forbes Rd Northborough, MA 01532 ?rnrwal kw Arder:en UC 9900 Jamaica Awe South.Celraae GrOvre MN S5016