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31C-002 (16)
BP-2023-1101 48 WARD AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31C-002-001 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-2023-1101 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est. Cost: 22650 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: A. BULL,BROOK Lot Size (sq.ft.) Zoning: RR/URA/WP Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC31415822 NORTHBOROUGH, MA 01532 ISSUED ON: 08/17/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: i y� - ' ' 1 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner PLEASE EMAIL CSC j PERMIT TO: I/ PERMITS@GOPERMITS.ORG 400 �O 1A The Commonwealth of Massa e 'r 4 ' ti Board of Building Regulations and Sta A'%/I F e Massachusetts State Building Code, 780 C �M 0/4, c,Nsp UNI r PEALITY F Building Permit Application To Construct,Repair,Renovate Or De ' Iis onks Revi.ed Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I o—A 3-- l 1 Date Applied: /2c-v,) �Ito->s /,%G 817-2oz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 48 Ward Avenue,Northampton,MA 01060 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 Record: Brooks Bull Northampton,MA 01060 Name(Print) City,State,ZIP 48 Ward Avenue (505)440-8822 brooks.bull.lmft@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building SI Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other an Specify: WINDOWS Brief Description of Proposed Work': TO REMOVE AND REPLACE(4)WINDOWS.LIKE SIZE. NO STRUCTURAL ALTERATIONS. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 22,650 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees• t Check No.tot ;, ' heck Amount: 14 Cash Amount: 6.Total Project Cost: $ 22,650 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-090125 10/06/24 JAIME MORIN License Number Expiration Date Name of CSL Holder u List CSL Type(see below) 54 NOTTINGHAM RD No.and Street Type Description RAYMOND NH 03077 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-952-4112 renewalbyandersen@gopermits.org I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/23 RENEWALny Name BY ANDERSEN HIC Registration Number Expiration Date H or HIC Registrant Name 30 FORBES renewalbyandersen@gopermits.org No.and Street Email address NORTHBOROUGH MA 01532 860-952-4112 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 . lB No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize JAIME MORIN/RENEWAL BY ANDERSEN to act on my behalf,in all matters relative to work authorized by this building permit application. BROOKS BULL 08/10/23 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 the best of my knowledge and understanding. JAIME MORIN 08/10/23 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) 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 (r— Massachusetts �� << ,� DEPARTMENT OF BUILDING INSPECTIONS S v17.)„t3212 Main Street • Municipal Building if Northampton, MA 01060 sb�y V�‘� 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 FORBES RD NORTHBOROUGH MA 01532 The debris will be transported by: Name of Hauler: WASTE MANAGEMENT Signature of Applicant: 71i-eurL Date: 08/10/23 The Commonwealth of Massachusetts . - ' ( Department of Industrial Accidents t I Congress Street.Suite 100 '>silk Boston.MA 02114-2017 -rl_� -‘''' www.nutss.go►/die Viiokers'Compensation Insurance AflidasiC Builders'("ontractors/Electricians,'Plund►ers. I U Ill.I:11.1:I)141111 THE PER%II f I IM:Al I HOR171. Annlicant Information Please Print Eyelids Name lHusincss:tilrl;anrmti ntndividual). RENEWAL BY ANDERSEN Address: 30 FORBES RD City/State/Zip: NORTHBOROUGH MA 01532 Phone p: 508-351-2277 Are you an employ re!t'bre&tileeMpvprare bet: Type of project(required): I.fii I ant a empkwer w oh 30, employees(full Jailor part-61ne l.• 7. 0 New construction 2.171 I am a:sole proprietor or partnership and have no employees working fur me in II. CI Remodeling an capacity..INt,workers'curer.ie.uranei required" 9. ❑Demolition 3.n I am a lurlleYrttrhl doing all work myself.[No wurkus-corny.imur.etee required-" •La I ant a lionpaPV1ee n and will the hiring contradors to conduct all work on nn property. I will 10 CI Building addition enure that all contractors.either have wrukcn.'er Ir1w u1 nsaiusit insurance or an:role 1 I.a Electriad repairs or additions prc.pneurs w oh no elttpluytea_ 12.0 Plumbing repairs or additions ti0 I ant a general cuntrarinr and I have hind the soh-contractor listed on the meteeheal akertt IND Roof repairs es w .m iu I lees hate employees aril have wtukn insurance) cony. urance• �j h.D w c an:a corporation and its officers hate c3tcn-no1 their nevi of if per liki1.c. 1�•LJ REPLACEMENT S2.511ai.and we have no enykwecs.[NO works.'comp.instuance r-quind.l •Any applicant Utah chocks hum a1 rani also fill out die section below slaws ing their wicker.'compensation policy irfunnabuii- o l looncow Mrs w ho submit din atlitkatit indicating icating they an:doing all work and then hue outside contractors art submit a new affidavit indicating touch. 4..ontromors that check this hos inusl attached au additional sheet slow in the naune of die subs-cootracturs and state whether or nut those entities have employees. It the sub-ctmlracturs Irate employees.they must pros Mc their workers'comp.policy ntrnbcr. I am an employer that is providing corkers'compensation insurance for my employees. Below is the policy and job site information. Insuruxc Cutnitwm Name: OLD REPUBLIC INSURANCE CO. policy#or Scli=ins.Lic.#: MWC 314158 22 Expiration Date: 10/01/23 48 Ward Ave Northampton,MA,01060 Job Site Address: city/state/hp: 1 Attach a copy of the workers'compensation policy declaration page ishow ing,the policy number and espiratios date). Failure to secure coverage as required under M1(,L c 152.*25A is a criminal a iolation punishable by a fine up to 51.5(KI-(KI and'or one-year imprisonment,as well as civil penalties in the firm of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be fi►rwarlkd to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the painspains and penalties of pet jury that the information provided above is tree and correct 9azfrtiz, Sianaturc: �i�a4uL Dart_ 08/10/23 Phone x: Official use only. Do not write in this area,to be completed by city or town official City or Tone: Permit/License I Issuing:►uthority(circle one): I.Board of Ilealth 2.Building Department 3.('ily(Iowa Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone I: _ Page 1 of 1 ACCORD CERTIFICATE OF LIABILITY INSURANCE 09(MMIDONYYT 0 Y) 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 POUCIES 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. c/o 26 Century Blvd PHONE.Eat): (A/C.FAX Net 1-886-467-2378 P.O. Box 305191 ADDRESS: cartificatesewillis.coo Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICO INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B Renewal by Andersen LI.0 ----- 30 Forbes Road INSURER C: Northborough, 1°► 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W26007651 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 two SUER POUCY EFF POUCY EXP LIMIT'S LTR, INS° ° POUCY NUMBER IMMIDDIYYYYI (MMfDWYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 D CLAIMS-MADE X OCCUR PRMAREMMISES(Ea occurrence) $ 500,000 A MED EXP(My one person) $ 10,000 DOZY 314161 22 10/01/2022 10/01/2023 PERSONAL BADVINJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY !MT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 JEC OTHER: $ AUTOMOBILE LIA&UTY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED )WITH 314159 22 10/01/2022 10/01/2023 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE No NIA MC 314158 22 10/01/2022 10/O1/2023 E.L.EACH ACCIDENT 1,000,000 $ OFFICER/MEMBEREXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRREESENTATIVE Evidence of Insurance %- ��~ ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 23076070 aarCa: 2676324 U.S. Canada ENERGY ENERGY AR Andersen. Andersen NFRC Certified E ISG cc a STAR.0 vS 4.1 Product Linea Glass Grille p e Type Products u u S O $ C . Product Type Type Directory Number i on 2 c u 1 e` Q Z t io N N N f o y ! 8lnuleted Divided Lite or Metalled Interior Removable AND-141-01262-00003 024 1-16 0.17 0.39 20 <0.2 - 8 ' Full Divided Lite ANDd41-0127140001 026 1.411 0.17 029 17 c 0.2 - - @x N; FMeIgM"(yANs-belweentlnyless) Na Ns Ns Ne Ne Ne N• - - • r &mutated DNMted Live or Installed Interior Removable ANON-1411200.00003 026 1 A2 OM 0.47 31 <02 3 Full Divided Lite AND-N-141269-00001 0.27 1.63 029 0A7 b <02 - _ 3 x s 3 Finalist*t"(Grilles-between-IMglw) Na Ns Na Ne Na Ne Na 3.0 Annealed or 3.1 Tempered Pattern Gloss-vd No Grilles and Grilles Less than 1" No Grime A9D-0L1-0117600004 0.29 1.66 0.31 0.64 22 <02 - 91C - - - - - te Simulated Divided LIN or metalled Interior Removable AND41-1-01176-00006 029 1.66 029 OAS 20 <0.2 - ® - - - Full Divided Lite Ne Ns Ns Ns Ns Na Ns Finalist*"(Orllee-betweenhegW.) Ne Ns Ne Ns Na lea Ne - -No Grilles AIOAF1-0117600004 029 1.6II 0.20 0.30 16 <02 I l &nerl.Nd Divided Lite or installed Interior Removable N -N-1-01176-00006 029 1.66 0.11 0.27 14 <0.2 - - - A- Full Divided Lite We Ne Ns Ns We Ns Ne - -• r Flneasht`a(grilles-0Mween-thagWs) Ne Ns Ns of. Na Ne Ns - - - _ _ Ili . . - - _ IIII = ° &n ll ued Divided Lite or installed Interior Removable AN41.01177-0OM0006 0 1.N 0.19 0A4 16 <0.2400!sees Ile Fue Divided LIN Na Ne Ne Ne Na Na Of. No Grilles AN0-NA-01174-00004 029 1.66 0.61 0.N 33 <02 I I a 3 SMailaled Divided L1te or installed Interior Removable AND-rl-0-0117400006 029 1.N 0.47 0.N 31 <03 - 3 A FuN Divided Lite Ns of. Na Ns Na Ns Ns Fimneht'•(srOMs-between-theglees) Ns Ns Na Na Na We lee - - 3.0 Annealed or 3.1 Tempered Pattern pass-1d Grilles 1"or Greater Simulated Divided Lite or Installed Interior Removable ANON-1-01176-00009 029 1.66 026 0A4 19 <02 - Ill - - - - - 2 Fun Divided Lit* Ne Ns Na Ne Na Ns Ne - - - Finelight"'(srilNNwlween-thegless) Na of. Na Na Na Na lea iiir Simulated Divided Lae or installed Interior Removable ANDA-1-01176.0000S 021 1.66 0.17 024 13 <0.3 1 r i I 3 Full Divided Lit* Na Ne Ne Na Ne Na Na p e J Fiwneht'Igrillea-0etween hegWs) Ns Ns Na We Ns We Na ! Simulated Divided Lite or Installed Interior Removable AND44-1-01177-00006 0211 1.N 0.19029 16 <0.2 g' - - - LSf 3{I Full Divided Lite Ns Ns Na Na Na Ns Na - - - lei FinelgM.(sr9Na-bMwv eMheglass) We Ne Na Na Ne Na Na - - - • ne Sirleeed Divided Lite or Meta �1 Metalled Interior Removable AND .1-0,174-00009 029 1.66 0.43 OAS 29 <0.2 0 - - - 1' , 1 Full Divided Lite Ne Ne of. Ns lee Na We - -a. Fin.Opht'•(OriWs-betweenahegIan°) Na of. Ne rile of, Ns Ne - This information is for reference only. Performance varies byunit size and options selected. 4or1N Daeie currant es of December 15,201/a0or mandtoMan9e P Page See papa,1«m«e i,1«man«,. For specific unit performance information,please contact your dealer or Andersen Sales Representative. U.S. Canada ENERGY ENERGY o STAR STAR AnNrun• Andersen NFRC Certified o o u L zi v 6.0 v 4.1 Product Linea Glass GAIN Type Products X §I g w a c c Product Type Type Directory Number w e C N h Z U U ii el N N N 2 t 1:}}t Simulated Divided Lite or Installed MYrbr Removable AND-N-6e-02161-00003 023 1.31 042 0.01 36 c 0.2 - - - 23 FineO0M"(gmNles-betweenOugless) AND-N-3402160-00001 023 131 0A7 0.67 30 <02 - - - 23 s 1 FuN Divided Life AND-N64-02166-00001 026 142 0.42 011 33 <0.2 - - -3.9 Annealed or 3.9 Tempered GMea-of No Gmee and GA N*Lois Than 1' No Grilles AND-N 54-0192FO0M9 024 1.40 0.34 0J9 27 <01 • - - - - Sbmiebd Derided Lite or installed Interior Removable AND4N-66-01926.00020 023 1.46 0.31 0A3 26 402 Fes"(gdl +fiwleee) AND-N-6401931-00007 026 146 0.31 0.63 26 <02 - _ Full Divided Lite AND4143401943-00007 026 1.0 0.31 0.13 23 <02 5 - - - - No Grilles AID4444O102600019 027 1.63 021 0.32 16 <02 I I - W a Simulated Divided Lite or Metalled Interior Removable AND-N-64-01926-00020 027 1.63 0.10 020 17 <0.2 I I I - - A~ FInNfOM"'(Omles-aNween4hagWas( AD4444-01932-00007 027 1.53 0.19 029 17 <02 • I II Full Divided Lib AID44.64411944-00007 02a 1.611 0.19 029 16 <02 ■ I I - - NEM - _ _ _ _ N - - Sinulebd Divided Lib or kneeled inbrfor Removable AID4441401927-00020 026 1.46 021 046 20 <0.2 N Finall0M"(9rales-belween- Olaee) AND668401933.00007 026 1.46 021 0AS 20 <02 N I _ _ ® � • = ni • . _ N I l . : No Grilles AND4466.1924-00010 027 1.63 0.66 0.66 39 <02 N I Z3 c !: er Simulated DividedLibor Installed interior Removable AID-N-06O1926-00020 0.27 1.D 0.60 0.p 36 <0.2 N - 23 c„ FinallpM"(grilles-between-the-glass) AIID44-66-01930-00007 027 1.63 0.60 0.66 36 <02 N - 23- a Fu0 Divided Lite AND-N-64-01042410007 020 1.06 0.60 0.00 33 <02 N - i 1 No Grilles AND-Ii4412140-00007 0.22 126 0.33 0.00 31 <0.2 N - i Simulated Divided Live or installed Interior Removable AND44-64-02140-00006 022 126 0.30 012 30 <0.2 N - A= FMNght"(grilles-betweenNM-glass) AND44-64.02143-00003 0.22 126 0.30 042 30 <02 N Full Divided Lite AND-N64O2149-00003 024 1.36 0.30 0.62 27 <02 N - 409 N.Aea Plotja r No Grilles AND#64.0214140007 022 126 022 0.62 26 <0.2 N - 2 °1 Simulated Divided Lib or installed Interior Removable MD446402141430008 0.22 126 020 O47 24 c 02 N I - 3 E i FineNOM"(Orilwbetweei4rgWs) 4/404464O2144-00003 022 126 020 0A7 24 <02 N II - re 3 Full Divided LIb AND61.64-02160-00003 0.24 1.311 020 047 22 c 02 N , r • No Grilles AND4461-02139-00007 023 1.31 0.80 0.64 40 <0.2 N - - W1 Q Simulated Divided Liteor Installed Interior Removable A►D•N•64-02139-00006 023 1.31 0.46 0.67 37 <02 N - - - 1:=111 FMNght"(Ori1W-Wlwee-lhe-glase) A D6i•i4O2142-00003 023 1.31 0.46 0.67 37 <02 N _ _ _ a.I. Full Divided Lite AND-N44.02146-00003 026 1.42 0.4E 0.67 36 <0.2 N - - - 11. 3.9 A nealead or 3.9 Tempered Glass-w/Grilles 1"or Greater Simulated Divided Lib or installed Interior Removable AND-N-64-01926-00021 0.26 1.46 0.25 0.47 24 <0.2 N - I - - A Finelight" e (Grill -beewe ehe-glew) M -N•64 09 D -01937-00007 026 1. 0.31 0.63 23 <0.2 I - I Full Divided Lite AID-N-64-01948-00007 026 1.08 0.20 0.47 21 +<0.2 I I - - Simulated Divided Lite or installed!Mader Removable AND4664-0192640021 0.27 1.03 0.17 026 16 <02 N I I - irir, Finene t"(grille.-beween4meglass) AND4144-01936-00007 02E 1.00 0.19 029 16 <0.2 Y Full Divided Live AlD-N434O1960 .M-00007 023 1 0.17 021 16 <02 5 - r Simulated Divided Lite or Installed Interior Removable AND411414-01927-00021 026 1.411 0.19 042 16 <02 N a ' ii4 FlneigM"(grilles-belwwem-lee-gW D-N s) ANi401939-00007 027 1.63 0.21 0A6 16 <0.2 N - - N Full Divided Lis A D64-N-01361-00007 027 143 0.19 0.42 17 <02 N I I - - Simulated Divided Lib or instilled interior Removable AND-N-61-01924.00021 027 1.63 OAS 012 32 <02 N - -I I - iFirelight.'(grilles-between-the-glass) AND•I.64.1036-00007 028 1.69 0.60 0.6t 34 <02 N - I e. FuN Divided Lite AND-N.64411948-00007 028 1.00 045 0.62 31 <02 N - - - r Ir Simulated Divided Lite or Installed Interior Removable AID-1464O2140O0009 0.22 1.2526 0.27 0.46 <0.2 N - - 1 Finelglit"1pr11W-bslwenLmeyWs) AID-1/-64-0214600003 0.23 1.31 0.30 012 26 <02 N 3 Full Divided Lib AND-N44-02162-00003 024 1.36 027 0.46 26 <02 N - - - This information is for reference only. Performance varies byunit size and options selected. 1gor1gg Date as current ass Dezember 15,2074eMor is more information Mange. P � see pope 1 I«m«e iM«mean. For specific unit performance information,please contact your dealer or Andersen Sales Representative. Page 1 of 1 ACCJI? CERTIFICATE OF LIABILITY INSURANCE ;EINTAD off` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MO 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 GOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURERISE AUTHORIZED REPRESENTATIVE OR PRDDUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the minicab holder Is an ADDITIONAL INSURED,the podcy(les)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 Mau of such srdereewad(s). PRODUCER immiL1,11118 foram Ration CotttfLcato Conte 111i1112lete.A SaeAwn Nidwast, 1n1:. cat/ 26 Cunt..y bled YY jla a.n 1-677-ees-737a 1-B9e-167-23'Ta Y.u. Aux 305191 ameaa•: oac tit loatgeolltla_0ow Masbvslla, YR 372305191 USA a1Mmanss Arrom.m UNMADE NAICA iA:OlA IsPubllc Insuraaoa Compaey 2414v MIMEO M RlIA as.n.ral May APdo:.an Lac 30 rozbaa Axaded eltie191C baztbbozemvb, NA 01532 MENEM 0: elwKFa e RISINER F COVERAGES CERTIFICATE NUMBER:N26007551 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY RCOUIRE ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED WREN IS SUBJECT TO ALL TIE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LERR TYPEOF AMCJE MCP gwoo POUCY MINER aril OMMCDIYYrij SNITS X OONNICML09ARLUMILITY Eaci.+cUHE,ICE s 2,000,000 ICUM111JltM0E ID OCCUR{ PREMISES'Ea ao arefluel S 500,000 A MED E OP,.+Ley a^e person l s 10,000 14w'24 314141 22 10/01,/2022 10/01/2023 PE55OII1AL5 AM,'11114.1R'K s 2,000,000 CEPS AGGREGATE LYT APPLES PER. GENERAL ACQRECATE I 4.000,000 POLICY ELPETT ED LOC PRODUCTS-COan%7P ACC I 4 000,000 THER: I AUTOMO.ELUAeY1Y COSIDIMO Ea SINGLE LIFT f 5,000,1100 X ANY AUTO BODILY RIMY(Peer os+ssal s A ^DIM® sow OILED HDRlSS 314153 22 10/111/2022 10/01/2023 0 Y PUNY GPer arcidb+dl f HINEO AUTOSONLY � AUTOS otlORIIED WI'DAMAGE AUTOS ONLY AUTOS OrLY tPor accident s UNINELLAUNI OCCUR EACH OCCURRENCES MOEN LIAR CLANSMAN AGGREGATE $ DED I 1 RETRAINS 77 eaONK91sc juaa7NON %3 STATUTE ER AND air LOVERS' WINUAINti Y 1,000,000 A AAMPROPRATORWPARTNERA]EOUTIIE EL EACH SCCIOBIT f OFF CERIU BEREACLoCIEM Q CIA fe!314155 22 10/01/2022 10/01/2023 1,000,000 Nandamay w NE E L DISEASE-EA EMPLOYEE,s 11 yes destnae under DESORPTION OF OPERATIONS Ge10e EL DISEASE POLICY LIMN' I 1„008,000 OEUC11RDONOF OPERATIONS!LOCATIONS SINK LES AACUR0101..ANIMA Ramslas eraaa"wry M 451AM Moro epee WOes. 5 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 POUCY PROVISIONS.. INTHOMEDIIERIESNITATTME tvldence of Insurance �. F Wit~ ID 1l1R-201S ACORD CORPORATION. AM rights reserved.. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1w m: 23076070 4142ce: 2676924 Commonwealth of Massachusetts Construction Supervisor Division of Occupational Licensure Unrestneted-Bulldogs of any use group which contort Board of Building Regulations and Standarn, less than 35,000 cubic feet Mel cock matters)of endosad :onset k111 S1tpt�rvfso %foci CS-090125 E*4:nes: 10/06/2024 JAIME L MOFON � 54 NOTTINGWAM RD RAYMOND NM 03077 40p i J�` A "nt- 4.611Yd:133 Failure to possess a current edlbon of the Massachusetts Corr::ss:ancr ,s :1:!� state(wilding Code is cause to revoeiron cedes teener. For reformation about dies Scenic Car(017)T27.3200 or vomit www.mess.go hdd THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration T ype Suppiernent Card t F2rg15tration 17J810 RENEWAL BY ANDERSEN LLC t:tpnatron 12/22)2023 30 FORBES RD NOItTHBOROUGH MA 01532 t L.t,' Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of consumer Affairs•Buenose Regulation Retpstreson valid for individual use only befoto The s.p,,.t...... If found return to: HOME IMPROVEMENT CONTRAC70N Office of Consumer Affairs and Business Regulation TYPE.Suppletnem Gard 1000 Washington Street -Suie 710 ReMlpn EMATEMD 170010 12212 6ostot,MA 02111 1708 ,2Ul3 R1-NFWAL BY ANDERSEN t1C JAIME MORIN30 FORBES _ Dw.A. , .. UWHBORRDIIGH,MA 01632 • `Undersecretary Not lid without s t1AttNo Page 1 of 1 ACC)RO LI CERTIFICATE OF ABILITY 09/21/2022 INSURANCE � 9 ` 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 AID, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: B the certificate holder is an ADDITIONAL INSURED,Me policy(Ns)must have ADDITIONAL INSURED provisions or be endorsed_ If SUBROGATION IS WAIVED.sub)ect to the terns and condNmu o1 Me poky.certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate hdder M Neu a1 such ems). PRODUCER CONSAcT wow ■1111a Towera lrateee Certit/oats Center Nal/ia Suer:a Bataan Madrrat, . PROM cA'u 26 Oda*. y Blvd r.r.sw 1-a77-gas-737e I 1-1M-av-Y37a 3%0. Bus 305191 AD00505 oar tldicatesPrlilis-cola Llreavi11.. TN 3 7 210 5191 USA INSUFURRNAFFDIOaiocoYERAGE once WSURERM. Old Republic Insurances folepeny 24147 INSURED INSURERS. Rsaaeal by Ands rasa LLL 90 rarb.a woad NSURER C. ■ortbboraugb, NA 01532 RIn ERD. NOMA E Nelal9l F COVERAGES CERTIFICATE NURSER:•2e0076S1 REVISION MILER: THIS IS TO CERTIFY THAT THE POLICES Of NSURANCE 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 CERTFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS, EXCLUSIONS AND CONDITIONS Of SUCH POLLCICS UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LIR TYPE OF INSURANCE Ir.n POLICY 05 IDLILW9 1111MOPOUC EY! Mn aAMpD,YYYYE aeIBdYYY7fl X COIIIIERCIAL GENERAL LABILITY EACHOGCURRENCE S 2,000,000 DMILOETO05NTED CLAMS-MOM EOCCUR PRFJA 5ES[Ea morwn:n t' S 500,000 A tam ESP IA,5 we gersoni f 10,0W0 ITNIY 31e1£1 12 10/01/2022 10/01/2023 PER80MLAADV mow s 2,000.000 GENT AGGREGATE WAY APPLIES PER: GENERAL AGGREGATE fi a.000.000 POLICY Q Tar LOC PRODUCTS-CGFR'POP ACC 5 i.000,000 JJ OTHER AUTOYdeEILaaaITY CONISSED SINGLE LIST s 5.000,,000 X ANY AUTO 00111LYNARY IPUrperson S A ° ED 9C ED1LEO LarTw 3141 S 9 21 10/01/2022 1a/01/2a23 SODEN MLOIRT ref atom nt:, 5 AUTOS ONLY 0i a31 PROP RTYLIASBIGE AUTOS ONLY .�AUTOS OILY aorklr(6 D11111EL1AlMa mom EACaIOCLURRENLf 5 - EWERS LAW a am-u OE AGGREGATE c OED L 1lwlsnIQlf I 10meUIRBCOMPERSATION X I_&7Aii1'E I I FR . R- affiDMESS LMBNJTY A OFFEROA0105WJIOLOOiiERE0II1gE Yr EL EACH ACCIDENT S 1,DOe,000 DFFYCERAEe1BERFJtCtUOED' RIA mix 311n6 10,'01r'1022 10/01/2e23 1,000.000 anent ley a■reW E10s6AM-EA EM LOYEE,I rc Yes desalts under 1,000,000 DESCRIPTION OF OPERATIONS Moo EL.OI EASE-POLICY LIMIT 5 GEaO111FlLDM OF OPERATIONS A LOCATIONS I'VEHICLES!ROOM HI.AJAUiunil Ranu4M5 Bras.,ewr be maenad Prow ewe Saeaayssal CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE C*a0rEU En BEFORE THE EXPIRATION DATE THEREOF. NOTICE WALL BE DELIVERED IN ACCORDANCE W TH THE POLICY PROVISIONS_ AUTWORREOREPRESENTAIRIE C' Evidence of Insurance '" 1. fr&' 431888-201i ACORD CORPORATION. All rights reserved_ ACORD 25(2016/03) The ACORD name and logo me registered marks of ACORD sa sm: 23076070 DAT.1 2676324 Go Permits, LLC 105 Buttonball Lane GC"I 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: renewalbyandersen(a gopermits.orq • 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 1.� RNEWAL �i� brANDERSE E N Fill hill NNW DON tfkk ifir 1111 To Whom It May Concern This letter will author.ze the following personls) to act as agent(s)on behalf of Renewal by Andersen LIC, 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for per"nits and Inspections with respect to the installation, rnalntenance and repair of windows and entry rinnrc urnrlar MAccarhimettS State Home Improvement Contractor license n&irnber 17alti0 and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508.351 2277 ext 6 Authorized person(s): Go Permits LLC Sarah Hammad David Anderson Maureen Kivel Scott Doughman Ryan B ondo Sovannara Kuy Mark Foster Glynn rvorgan Jennifer wrnke Wendy Holden Gerald (tamer Nick Rago Darrel Vickerman Stephen Wilder Katie Grocott Bonnie Myers Carrie FoI=gno Michael Rogers Rachel Orloff ,441gaii 47 rrey'lfIres. �' amie Morin Renewal by Andersen I.LC HIC 170810 CSl —CS090125 local District Office Address 30 Forbes Rd Northborough, MA 01532 Renewal by Andersen L