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16A-020-060 BP-2023-1087 415 FAIRWAY VILLAGE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16A-020-060 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1087 PERMISSION IS HEREBY GRANTED TO: Project# WINDOW 2023 Contractor: License: Est. Cost: 5965 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: PHILIPS GLENDA H Lot Size (sq.ft.) Zoning: URA Applicant: PHILIPS GLENDA H Applicant Address Phone: Insurance: 415 FAIRWAY VILLAGE LEEDS, MA 01053 ISSUED ON: 08/18/2023 TO PERFORM THE FOLLOWING WORK: 1 REPLACEMENT WINDOW 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 y99-''1 • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 44 The Commonwealth of Massachusetts o Board of Building Regulations and Standards 4'.•ev, Massachusetts State Building Code,780 CMR MUNICI USE a � '' • Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 201 ��y�,z, One-or Two-Family Dwelling 66o o4,s This Section For Official Use Only Building P 'it Number: 8a-a-3 /() 7 7 Date Ap lied: kevt � /l 8-18 -MO Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 415 Fairway Village Leeds,MA 01053 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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Hermine Antelman Leeds,MA 01053 Name(Print) City,State,ZIP 415 Fairway Village :(413)472-1833 hhkesher@earth1ink.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building II Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other RI Specify: WINDOWS Brief Description of Proposed Work2: TO REMOVE AND REPLACE(1)WINDOW LIKE SIZE. NO STRUCTURAL ALTERATIONS. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 5,969 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees:$ Check No 1/ A heck Amount: 110 Cash Amount: 6.Total Project Cost: $ 5,969 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 List CSL Type(see below) U 54 NOTTINGHAM RD No.and Street Type Description RAYMOND NH 03077 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-9524112 RENEWALBYANDERSEN@GOPERMITS.ORG I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/23 RENEWAL BY ANDERSEN HIC Registration Number Expiration Date HIC Com_pany Name or HIC Registrant Name 30 FORBES RD 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 ICI 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. HERMINE ANTELMAN 08/09/23 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 08/09/23 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 •'[ _. Massachusetts <� / i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building � \: Y• i� Northampton, MA 01060 ''!Pi r,'" 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: 30 FORBES RD NORTHBOROUGH MA 01532 Location of Facility: The debris will be transported by: Name of Hauler: WASTE MANAGEMENT,RENEWAL BY ANDERSEN Signature of Applicant: 5)cux-.e. 4.uz Date: 08/09/23 Page 1 of 1 DAINY AWRLf CERTIFICATE OF LIABILITY INSURANCE 9/ /20022 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 pollcy(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 Nidrest, Inc. c/o 26 Century Blvd (AH/C No.ExO: 1-877-945-7378 FAX No): 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates 8willis.cosi Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAILS INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC 30 Forbes Road INSURER C: Northborough, MA 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 ADDL SUBR POUCY EFF POUCY EXP UNITS LTRINSD WVD (M MI POLICY NUMBER MIDD/YYYY1 (MDD/YYYYI, X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 GE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 A MED EXP(Any one person) $ 10,000 NNZY 314161 22 10/01/2022 10/01/2023 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO-JECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED WRITS 314159 22 10/01/2022 10/01/2023 BODILY INJURY(Pereoddent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X ST TUTE OTH- ER AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? No N/A MSC 314158 22 10/01/2022 10/01/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is requhed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance "/ bi-ot,"-- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SE ID: 23076070 BAres: 2676324 The Commonwealth of Massachusetts Department of Industrial Accidents r;) "�_ ' Office of Investigations Lafayette City Center 2.4ventte de Lafayette, Boston,MA 62111-17511 wwwnrass.Rov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Leeiblv Name iumowsourgmixatwn I lid HAidu.1I1: Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip:Northborough, MA 01532 phone##:508-351-2277 Are yen an employer?Cheek the appropriate hot: 7 y pc of project(required): 1.X1 1 am a employer with 30 4- ❑ 1 am a general contractor and I truction employees(full and/or part-lurk).* have hired the sub-contractors 6' New cons 2.El1 am a sole proprietor or partner- lined on the attached sheet. 7. Remodeling ship and have no employers "Item:sub-contractors have S. ❑Demolition working for me in anyi employees and have workers' capacity. 9. Building addition (No workers cons.insurance comp. insurance.; required.] 5. 0 We are a corporation and its 10.n Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.D Plumbing repairs or additions myself. (No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152,f l(4),and we have no t employees.(No workers' 13�[older comp. insurance required.] •:bus applicant that cheeks boa Mt must also fin out the st tiun below%filming their workers'compensation policy iofonnstian. I loinconliciN who submit this:arda%i ienhcatiag they me doing all work and then hue uuisitc cottractor,'MUM submita acw atrah►sit indicating such" l old 114 tew.11tat choLk this bus roust attached an additional slicet Mowing the Male or the.Ub-ctittlr:ctol.and date%IYCti ci or not those entities have empkroces. lithe sub-csawactors lease atyrloyixs.they most peen idc tlwer %veto's'comp.tulle}inunthce. i am an employer er that is providing workers'compensation insurance for my employees. Below is the policy and job site information. lttsurancc clnttpany Name: Old Republic Insurance Co. Policy U or Self-ins_ Lit.#: MWC 314158 22 Expiration Date:10101/Z023 Job Site Address: 415 Fairway village cit.!. State zip Leeds,MA 01053 Attach a copy of the worker.'compensation policy declaration page(shooing the poliry number and ewpiration date). Failure to secure coverage as requited under Section 23A of MGL c. 152 can lead to the imposition of crtnunal penalties of a tine up to S 1.500.1Nl and or one-year mtprt.ontaknt.as well as civil penalties in the fortn of a STOP WORK ORDER and a fine of up to S250A10 a day against the violator" lie advised that a copy of this statement may be li►rwardcd to the Otliwe of investigations of the I)I.k lur 1n.urati a st'scragc setttieataon. I do hereby ceril/i'under the pains and penalties of perjure"that the information provided above is true and correct. Signature. 71/1021.40t✓ 1 l.tt. 08/09/2023 Phone rf. Official use unlr. Do not write in this area.to he completed by city or town official City or I own: Permit License U Issuing.tuthurity (check one): 1011oard of health 20 Building;Department 35'ih Tuan Clerk 4.0 Electrical Inspector SE3lumbint; Inspector 6.00lher — -- — ---- ( outlast Person: Phone tr: U.S. Canada ENERGY ENERGY C g STAR STAR Andersen* Andersen NFRC Certified rU 3 u V m w v 6.0 v 4.1 Product Line A Glass Grills Type Products . a j p2 $ c Product Type Type Directory Number 4 '4. or w . ry nil 2 N ee A simulated Divided Lite or Installed Interior Removable AND-N-63-008850003 0.26 1.4$ 0.38 0.46 20 <0.2 NC - - - Y Full DMMd Lite AND-N-63-00891-00001 0.20 1.3$ 0.36 0.46 26 <0.2 r4C" - - - i 3 Flnelight'(ori0es-between-the-glass) ANDd1.63-00807-00001 0.27 1.63 0.43 0.52 31 <0.2 - - - - 3.0 Annealed or 3.1 Tempered Glees-wl No Grilles end Grilles Less Than 1" No Gnaee AN0t4.63-00792-00001 0.30 1.70 0.32 0.64 20 <0.2 - NC - - - - - um Shredabd Divided Lae or Installed Interior Removable AND N'3e0782.00002 0-30 1.70 0.26 0.44 16 <0.2 - - - - - - 3 Full Divided Ut. AND-N433.00798-00001 0.31 1.76 0.20 0.46 17 <0.2 Y ` Finale g ^'ors) AND"63 00810-00001 0.31 1.76 0.29 OAS 17 <0.2 - - - No Grilles AND-N-0340793.00001 0.30 1.70 0.20 0.30 14 <0.2 - • - - ~ Simulated Divided Lite or Installed Interior Removable AND-N43-00793-00002 0.30 1.70 0.18 0.27 12 <0.2 - - - - 3 Full Divided Llle AND-N-63-00799-00001 0.31 1.76 0.18 0.27 11 <0.2 - 4.11111111•11111111101111 - - Ell • - 7 I Simulated Divided Lite or Installed interior Removable AND-N-6340794-00002 0.29 1.65 0.19 0.43 14 <0.2 - • Full Divided Lite AND-N.63.00600-00001 0.30 1.70 0.19 0.43 13 <0.2 MIIIIIIMINIIIIIIIMM - - - - - No Grilles AND-N43-00791-00001 0.31 1.76 0.52 0.00 31 <0.2 r v, Simulated Divided Lite or Installed Interior Removable AND44413410791-00002 0.31 1.76 0.46 0.53 27 <02 - - I - - . 3 S Full Divided Lite ANDa4-03-00797-00001 0.32 1.62 0.46 0.53 26 <0.2 - - - i Findight'"(prices-between-the-glass) ANON-63-0080P906N 0.32 1.62 1546 0.63 26 <02 - No Grilles AND44-6300901-00001 0.26 td6 0.31 0.53 25 <03 r: - I - 11 va ; Simulated Divided Lite or Installed Interior Removable ANDtd-0300901-00002 0.26 1.46 0.211 0.47 23 <0.2I I - 3 i Full Divided Ute AND-1-8300904-00001 036 1.69 0.28 047 21 <0.2 - FinalightT1(grilherbehmerethe•glasa) AND-N413.00910.00081 0.27 1.53 0.2e 0.47 22 <0.2 N - 200 Series Gliding No Grilles AND-N43-00902-00001 0.26 1A8 0.21 0A7 19 <02 N - - y, a 4 Simulated Divided Lite or installed Interior Removable AND-N413-00902-00002 0.26 1.40 0.19 0.42 16 <0.2 N 3p f, 0 3 E 2 Full Divided LJle AND-N-07.0090'S00001 0.2t 1.89 0.19 0.42 16 <0.2 t. v, ; Fln.Oght'"(grglesbetween4M-glass) AND41-0300911-00001 0.27 1.63 0.10 0.42 17 <0-2 'I - - _ No Grilles AND4443410900-00001 027 1.53 0A7 0.96 33 <0.2 rI - I - c•e a 3 Simulated Divided Lite or installed Interior Removable ANDN-6300900-00002 0.27 1.53 0.42 0.67 30 <p2 N - - r. 3 1= Full Divided Lite AID-N63.00903-00001 0.29 1.115 0A2 0.82 27 402 rI - - - - 3 II _ Flnea b phtTM(gr111esatwMM es -gWs) AND-N-63.00909-00001 030 1.69 0.42 0.67 29 <02 N - - 3.0 Annealed or 3.1 Tempered Glass-WI Grilles 1"or Greater SImulated Divided Lite or Installed interior Removable AND-Nl3-00702.00003 0.30 1.70 025 0.42 16 <0.2 - ®. - - Full Divided Mir ID-N A -63-00tiO4-00001 0.31 1.76 6.26 0.42 16 <0.2 - - - - - FlneNgh0' (pdDestMweeMhe-pals) Na Na n/a Na Ne n/a Na �Sinallatad DM UM ded L or installed Interior Removable A -Nfi300793-00003 0.30 1.70 0.14 0.24 11 <0.2 - ' - - N Full Divided Ut. AND446350005 00001 0.31 1.76 0.16 0.24 10 <0.2 - - - - I Flnelight°(prt eebetweenth.-glass) Na Na Na Ne Na Na Na - - pPrided Dded Lite or Installed Interior Removable AND•443-00794p0003 0.29 1.06 0.17 0.35 13 <93 I I' - - - A V. Full Divided r D ded Lae AND-N-83-00006.00001 0.30 1.70 0.17 0.36 12 <63 • - - 1r FInNIgM"'(piYlsebawesn4MyW.) n/a Na Na Ns Na Ns Na - - - c Simulated Divided Lite or installed Interior Removable AND-N-63-00791.00603 0.31 1.76 0.41 0.47 24 <0.2 W n3 3 2 D Full Divided UI. ANN.63.0060Y90001 0.31 1.76 0.41 0.47 24 <0.2 3 •« fp o Finellght'Igrples belweenthsylas.) Na Ne Ns Na Ne Ne Na - - Sr Simulated Divided Lea or Installed Interior Removable AND-N-6300901.00003 0.26 1A5 0.25 0.41 21 <03 I - - aADividedFull Divided Lite AND-N-6300907410001 0.29 1.60 0.25 0.41 19 <0.2 - = Finagle"'(grpiesbslwssretheiOasel Na Ne Ne Ns Ne Ne Na - - -_ This information is for reference only. 14 Performance varies by unit size and options selected. peep 21 e1 56 Data I.currentee a December+See page a pa age 1a 1.mom to change. ,for more rtdonnatlon. For specific unit performance information,please contact your dealer or Andersen Sales Representative. Commonwealth of Massachusetts 111 Division of Occupational Licensure Board of Building Regulations and Standards t t7nst.kutt on Slicer ,s�- CS-090125 Expires: 10/06/2024 JAIME L MORIN -, 54 NOTTINGbIAM RD RAYMOND NM 03077 't• delta Con truction flupenMao► Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(WI cubic meters)of enclosed space \, Failure to possess a current edition of the Massachusetts Stale Building Code is came for revocation of this license. For tnfornfstton about this*cense Call($17)727-321/11 or visit www.nasss.goWdpf 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 Regulatio Registration Expiration 1000 Washington Street -Suite 710 170810 12/22/2023 Boston,MA 02118 RENEWAL BY ANDERSEN LLC JAIME MORIN 30 FORBES RD > r.r' ; ,!.S•f NORTHBOROUGH.MA 01532 Undersecretary Not alid without sign Go Permits, LLC 105 Buttonball Lane CIICA 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(a7gopermits.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 PagN 1 of 1 A`ORIJ CERTIFICATE OF LIABILITY INSURANCE W09/ E MARo� 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 MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the poliypss)must have ADDITIONAL INSURED provisions or be'mimed. If SUBROGATION IS WAIVED,sugect to the terms and candidates of the posry,certain polices may iequrs an endesome n. A elliement on this certificate does not confer rights to the certificate holder In Neu of ouch anddoreament(s). PROOUCEA y�. Kills Towage Nataoi CertAlleate Cantor Wallis ?ONO CIS fiauiun Ni+hwyl., Inc. c/u 26 Camtusy alvd aO�E Nw 1-n77-545-737a I c. 1-5O-a67-237■ R.O. bus 305191 oacutioatosPoLLI.La.oam N aahvalla„ III 37230 5191 USA IIIMURDINSI AFF COVERAGE WAX I w iERA:Old &sPub11c Insurance Company 24147 MU ES MOUSERS: mum.1 by Anderson L.L 30 ►orb.a weal IRMI ERC: N os tbbor®upb, NA 01532 eOMERe: R▪OWER F: COVERAGES CERTIiCATE NUMBER:N24;007551 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIC INSt1RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREBENT,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 LAIITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS. INsR AMILSUaR POLICY Err POLICYmP LR TIME OFNMLWICE MOO,woo POLtrtaMNER MNBNNYYYYt O ORIDITYYYI, LAMS X COMMERCMLOEIE*ALLNaal1Y EACHOCCUIENCE S 2„000,000 IQADISDA E El oaafRt PREMISES Ea 1 so0,000 A LED E m Mir att00 s 10.000 OM 3141E1 22 10/01/2022 10/01/2023�PERSrti.IA.',Amm a. s 2,000,000 GENT AGGREGATE MIT APPLES PEi. GENERAL.AGGREGATE ,1 A.000.000 XPOLICY CI Ira CI LOC PRODUCTS-COAN1'OPAGO ,1 1,000,000 OTHER I AUTOMOBILEUMWTY ENCOMMED SINGLE LW 5 5,000,000 x ANY AUTO BODILY KAFIR per mom) $ A OttrED `DER Own 314159 22 10/01/2022 10/01/2023 BOOAr AWRY pm ARRIANIN S AUTOS(MY ��AIMS `�WED IIOKOIMED F'RJ1.tK n'CIAI IE _ ^�AUTOS ONLY AUTOS ONLY JP,J a:.:.ncntf a INIBTELULL AI H occult - EACH OCCURRENCE I MARMALADE LIAR AOOREOATE S DE0 1 I RETENTION$ T• SORIERSCOMPENBASON Ato EEPLOYEI$maim rin X I STATUTE I I FOR A LAyoroPPIETORP RTNENAUECUTMME ELEACHACCIGOIN s 1.aoo.o00 OfFCERAMINIEREAMUM07 EllN/A WC 31e15e 22 10/01/2022 1e/01/2023 XWIIYaryY RR EL DISEASE-EA EMPLOYEE $ 1.000,000 Ira eaaadM uI 1,000,000 OEsO�tanOF OPERATORS teem ELd 9E-POIICY LOW DESCRIPTION OF OPERATIONS ILO/CAMEL VBIIICLES*CORO Iet..AddltloeN Inowle OMER%m4In else ua Nome seam leremMaA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLtC7Es BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WLL BE DELIVERED NI ACCORDANCE WITH TIE POLICY PNONmOML_ AUTNORIZEDREPRES tAtA1NE EvaAeoa Of Insurance .R7f � '/ter~ .I to 11SS-2016 ACORD CORPORATION. AN rights reserved. ACORD 25(2016f03) The ACORD nanw and logo are Registered marks of ACORD 54 IL. 23076070 UAW. 2676324 Commonwealth of Massachusetts CorlsVtncOoft Spa Umestrlded- it Commonwealth of Occupational Licensure Buildings of any use group which contain Board of Building R on S"ores and Standards less than 35,000 cubic feel(111 cubic meters)of enclosed -n stz, tf`Cin Supervisor spice .: 1 CS-090125 Eris: 10106/2024 JAIME L MORIN • :_., 64 NOTTINGNAM RD. RAYMOND NM .. ... fitiva.>>,l Failure to possess a current edthon of the Massachusetts Cc:-:m:ts:or•.s_r ;;,a,.1,-, X. atnd.i:.. St+Ms f Cods is cause for revocabon of this license. O For information about this license Cad(617)7273210 or visit www..ass.govwpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration rt Type Supplement(;and 1 Reglgttabon 17t8810 RENEWAL BY ANDERSI N'_LC tltpiration 14122'2023 30 FORBES RD \:s. . - NOUTHBOROUC H MA 01532 , ti ,t Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs i Business Regulation Registration valid for individual use only before the .ape el.....el at If Mond return to HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulabon TYPE.Sul ndertrent Card 1000 Washington Street -Suite 710 tt 1 10itIgilifIBL 1 3 Boston.MA 02111 RENEWAL BY ANDERSEN LLC JAIME MORIN :K>IORBES RD ,i;;a,..w•-< <.,:v.n f NOR'HBCROl1GH.MA 01532 Urtdersecrctnry Not lid without sigil>ttuee RENEWAL lig 11 pbrANDERSEN .ru;tcvc Moan i.LOA littriailEir To Wnom It May Concern This letter will authorize 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 permits and Inspections with respect to the installation, maintenance and repair of windows and entry rinnrc !Ender Maccachiicetts State Home Improvement Contractor license number 170810 and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508 351.2277 ext 6. Authorized person(sl: Go Permits U.0 Sarah Hammad David Anderson Maureen Kivel Scott Doughman Ryan 8,ondo Sovannara Kuy Mark Foster Glynn Norgan Jennifer Wirke Wendy Holden Gerald Cramer Nick Rago Dane!VVckerman Stepher Wilder Katie Grocott Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff .etPtt.4-.1*.17711,7462/,- ; ' amie Morin 07 Renewal by Andersen LLC H IC 170810 CSl—C509012 5 Local District Of-Ice Address 30 Forbes Rd Northborough, MA 01532 Renrwal by Andersen LLC•9900 Jamaw Acre South,Cottage Grove MN SS016 Page 1 or 1 AWRD CERTIFICATE OF UABILITY INSURANCE o;/21/'IN°202`I�..f THIS CERTIFICATE IS ISSUED AS A BATTER 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 INSURERS', AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: I the certificate holder is an ADDITIONAL INSURED,the policy(I *must have ADDITIONAL INSURED provisions or be endorsed_ If SUBROGATION IS WAIVED.subject to the terms and conditions of the poky,certain polcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endonatRINIII s). PRODUCER 9 NTACT•Hill. Teresa Matson Coat-Mesta Coates Walla Teresa NAtoco Naclrramo L, Lou. z/u 26 Costars blvd. oar 1-077-1ES-YY/0 1-EaE-167-237E Y.O. Boa 305191 ADoit asstiSlastaslr111ls-can Nottorillo, TN 37230 S191 U5A IIIIIIINIMMIAPFORINN4 COMM* M X Old Lc Insusaaoa 24147 1 N BUBERA: �rb1 �T uumo 114110RB1s: w.a�..1 by aano.sea LLC 30 ►arb.a bed MAIM C: NostWocwq►, NA 01532 ROMER N SUIER _NalaE11F: COVERAGES CERTIFICATE NUMBER:W26007651 REVISION NUMBER: TIIIS Is TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE MSURED NAILED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WINCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.TIE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN B SUBJECT TO ALL THE TERMS, C XCLUSIONS AND CONDITIONS OF SUCH POLICES_LOUTS SHOWN NAY HAI&BEEN REDUCED BY PAID CLAIMS. I LTR TYFEOF INSURANCE POICYB •IYyyn YYry1 EMITS R X COMMERCIAL GENERAL I.IABsny EACHOCCl/IENCE 5 2,000,000 ]CLAIMS-WADE El OCCUR S ppylaNIati 1 S00..000 A ► DEXPeleAy paeortI I 10,000 MIT 314161 22 10/e1/2122 1a/01/2°23 PEMLllOV@NUR, S 2,000,000 GE NI AGGREGATE LAST APPLES PER GENERAL AGG EDATE S •.000,000 X POLICY El y El LOC PRDOUCCS-COMPCP ACC 1 •.000,000 OTHER AUTOMOBILE LIABILITY COONE°SINGLE LIMIT S.000.000 tEa dmle X ANY AUTO BODILY PLAIRY Ear FNTaeA 5 A '—'OWNED SCHEDULED lIEE 314155 22 10/01/2022 10/01/21123 MOLY PLUM'Ear acctlnfl S AUTOS ONLY AUTOS NEED NOISOINE0 PROPER IT DAMAGE f AUTOS ONLY AUTOS ONLY War alone del♦1MB OCGUt EACnOOCURENCE f EXCESS UAB n AEen IMLIE AGGREGATE S DED I I RETENTION$ i WORKERS CI €IS1ATIOM X',STATUTE t iFR- ANt1 EMPLOYERS'LMSILNT A ANVPROPRIETORrPARTNER:EXECUTIVE YfN EL.EACHACCIDENT 6 1,400.8011 OFF ICERAEMIERESCLoOED' NIA IOC 31/1513 22 10/01/2022 141/01/21123 1.000.NB PAM illear La NUJ ELOBEASE-EA BitOYEE $ It yes.desalts under 1.000.100 DESCRIPTION OF OPERATIONS babe EL.MEW-POLICY ALIT $ DESCRIPTION OF OPERATORS/LOCATIONS(YBBCIES HACORD 10l.AeOlue ul Remarks 9ce.1d4iH..inArg Se aaarao0 if ammo ease sro eeaN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE POLL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED,REPRESEATATNE /71 Evidence oT Insurance ,Ft f�' "� 1988-2016 ACORD CORPORATION. AN tights reserved_ ACORD 25(2016103) The ACORD name and logo ars rpistsred marks of ACORD 5A II. 23076070 DATcll 2676324