31C-002 (17) BP-2023-1327
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-2023-1327 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW 2023 Contractor: License:
Est. Cost: 5495 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: A. BULL, BROOK
Applicant Address Phone: Insurance:
48 WARD AVE
NORTHAMPTON, MA 01060
ISSUED ON: 09/25/2023
TO PERFORM THE FOLLOWING WORK:
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 )2 . '►
f
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
S-3i7itifj . £12kl gicaLy
•
The Commonwealth of Massachusetts <<\/^
FOR
iwt Board of Building Regulations and Stan..rds (�' ICIPALITY
Massachusetts State Building Code, 7:i CM' cSF
o USE
Building Permit Application To Construct, Repair, Ren• ar' t Demo A ar 2011
One-or Two-Family Dwelling °'9, o6, 40
c0
P, .1-3 This Section For Official Use Only 'yam 4.
Building Permit Number: v -► 1 3).7 Date Applied: ii.tip;so
4_-‘)11,-.)(z...., //./z 06,z"s 9 25 Z Z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Addre s: 1.2 Assessors Map&Parcel Numbers
4 8 1!/a'S AvA., ilk diks4r1,n //$Ofrvrs,
1.la Is this an accepted street?yes t/ 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 Cl On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1
2.1 Owner'of Record:
15c vI(.s 6411 ,AAi'-/-4 %^ ,I A 0/Po 0
Name(Print) City,State,ZIP
Ye 4/a/c/ ,u '. 5 S- - No -On- ifz.yks..ial1,lni174)y01i,/.‘d,n
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 1 Specify:/[DMer 1.�lw4
B f Description of Proposed Work': ii►t
r1 .4 a.. d /(4 c; - 0°✓,�qs h 0-1,'Pc.e
wea- ^o Sett,cl Lt f „ .,r ,, 'Z cl
SECTION 4: ESTIMA liver
CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ gO 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All F $
Check No. Check Amount: 45 Cashh Amount:
6. Total Project Cost: $ y(/, ' a 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
30 Forbes Rd
No.and Street Type Description
Northborough MA 01532 U Unrestricted(Buildings up to 35,000 cu.ft.)
g R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofmg Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
860-952-4112 renewalbyandersenggopermits.org I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12/22/2023
Renewal by Andersen LLC HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
30 Forbes Rd renewalbyandersen@gopennits.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 .......... Cl 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 the best of my knowledge and understanding.
z3
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
..th
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www mass.gov/den
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Renewal by Andersen
Name fBusiness?Organirationhlndividuall:
Address: 30 Forbes Rd.
City/StaterZip:Northugh, MA 01532 Phone#:508-351-2277
Are you an employer?Check the appropriate hox: Type of project(required):
1.M I am a employer with 30 -} ❑ lama general contractor and 1
employees(full and/or part-time)., have hired the sub-contractors 6 ❑New constntcteon
listed on the attached sheet. 1. El Remodeling
2.❑ 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. 0 Demolition
workingfor me in anycapacity. employees and have workers'
P �` 9. El Building addition
[No workers' comp. insurance comp. insurance.:
required.) 5. D We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. workers' right of exemption per MOL
Ys [No comp. 12.0 Roof repairs
insurance required.]1 c. 152,Q1(4),and we have no Replacement
employees. [No workers' 13.�Other P
comp. insurance required.]
'Any applicant that checks tout#1 mug also fill out the section below fhowirtg their workers'compensation policy information.
+Horneowncrs who submit this affidavit indicating thew arc doing all work and then hire outside contractors must submit a new affidavit irtdieati io u i
:Contractors that check this box roust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
cziipto4ees. If the sub-conttractors have entplune.'es.the!, must ptu..idc then wurkers'cornp.pulley number.
i am an employer that is providing workers'compensation insurance for my employees. 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
_ _ _ _ City/State Lip. Northampton MA 01060
job Site Address: 48 Ward Ave
Attack a copy of the workers'compensation policy declaration page(then ins the policy number and expiration date).
Failure to seem coverage as required under Section 25A of MGL c. 152 can lead to the rmpusttton of criminal penalties of a
fate up to S1.500.00 an `or one-year tmprisunment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the ti►o1►tor. Be ads ised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for Insurance co%erage crification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
stf4rs.sititc- )446:frkUZ- 7WA91-1-4-' late 09/18/23
lilttltte r/K/l <��j /P Zj
Official use ono►'. Do nor write in this area.to be completed by city or town official.
( its or lawn: Permit/license#
Issuing authority(check one):
I❑Board of Health 20 Building Department 3❑('ity/Town Clerk 4.OElectrieal Inspector ct)lumbing
Inspector 6.0Othcr
Contact Person: Phatlte 1:
City of Northampton
1.4
sus...r _sic
;� • Massachusetts mow? �- '
hi G
f i `� DEPARTMENT OF BUILDING INSPECTIONS 4
w "r 212 Main Street • Municipal Building JtispD
"' V.-.' Northampton, MA 01060 sI'y .go%
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 l S /c/ ,A''J 6p4)-(56 /#1,4- dis--3 Z
The debris will be transported by: 'Taint - / 6:A
Name of Hauler: bjja.S net/tell...et-7PS
Signature of Applicant: Date: 7--ZZ J �3
RENEWAL
-too byANDERSEN
Arkw../
RNL-SNYIU WINDOW&DOOR REPLACEMENT
•t t
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
U.S. Canada
c ENERGY ENERGY
2 o STAR STAR
Andersen. Andersen NFRC Certified o o i w v 6.0 v 4.1
Product Line& Glass Grille Type Products m e 12 5
Product Type Type Directory Number 'r w in - m @ C Q e c $ e w c c
z U 8 rn N N N
ei
c it Simulated Divided Llts or Installed Interior Removeble AND-N-63-00885-00003 0.26 1.48 0.38 0.46 29 <0.2 NC - - Z1 22 -
0
N
e � u Full Divided Lite AND-N•83•00891-00001 0.28 1.59 0.38 0.4628 <02 NC - - Zt - -
x
a; FlneightT"(grilles-between-the-glaes) AND-N-63-00897-00001 0.27 1.53 0.43 0.52 31 <0.2 - - - 21 72 -
3.0 Annealed or 3.1 Tempered Glass-wl No Grilles and Grilles Less Than 1"
No Grilles AND-N-63-00792-00001 0.30 1.70 0.32 0.54 20 <02 - NC
Simulated Divided Lite or Installed interior Removable AND-N-83-00792-00002 0.30 1.70 0.28 0.48 18 <02 - NC
2 Full Divided Lite AND-N-63-00796-00001 0.31 1.76 0.28 0.46 17 <0.2
FlnelightT'(grilles-between-the-glass) AND-N43.00611340001 5,31 1.76 0.28 0A8 17 .402
No Grilles AND-N-63-00793-00001 0.30 1,70 0.20 0.30 14 <0.2 - NC SC - - -
Simulated Divided Lite or Installed interior Removable AND-N-63-00793-00002 0.30 1.70 0.18 0.27 12 <0.2 - NC SC - - -
3 .
o
-' Full Divided Lite AND-N-03-00799-00001 0.31 1.76 0.18 0.27 11 <0.2 - - - - - -
L o G AND-N-63A0794-0000�.29 1.65 0.21 0.49 15 <0.2 - NC sq - -
tilleSimulated Divided Lite or Installed Interior Removable AND-N-63-00794A0002 0.29 1.65 0.19 0.43 14 <0.2 NC SCC
Full Divided Lite AND-N-63-00800-00001 0.30 1.70 0.19 0.43 13 <0.2 - NC SC - -
FlnelightT"(grilles-between-the•glass) AND-N-03-00812-00001 0.31 1.76 0.19 0.43 12 <0.2 - - - -
No Grilles AND•N-63-00791-00001 0.31 1.76 0.52 0.60 31 <0.2 - - - - '1 I -
c
w 7, Simulated Divided Lite or Installed Interior Removable AND-N-63-00791-00002 0.31 1.76 0.46 0.53 27 <0.2 - - - Z1 - -
H
3 i
▪ '" Full Divided Lite AND-N-63-00797-00001 0.32 1.82 0.46 0.53 26 <0.2Cr*.
FlnelightT"(grilles-between-the.glass) AND-N-83-00809-00001 0.32 1.82 0.48 0.53 28 <02
No Grilles AND-N-63-00901-00001 0.26 1.48 0.31 0.59 25 <02 N NC - - Z1 - -
u , Simulated Divided Lite or Installed Interior Removable AND-N-63.00901-00002 0.26 1A8 D.28 0.47 23 <02 N NC - - Z1 - -
3
ti
2 = Full Divided Lite AND-N-63-00904-00001 0.28 1.59 0.28 0.47 21 <02 II NC - 21 - -
FinelightT"(grilles-between-the-glass) AND-N-63.00912-00001 0.27 1.53 0.28 0.47 22 <02 N NC - - Z1 - -
200 Series Gliding No Grilles AND-NS1-00902-00001 0.26 1.44 0.21 0.47 19 <02 N NC SC Z1 - -
r 1
y+ N 3 Simulated Divided Lite or Installed Interior Removable AND-N43.00902-00002 0.28 1.48 0.19 0.42 18 <0.2 N NC SC 21 - -
E = Full Divided Lite AND-N-63-00905-00001 0.28 1.59 0.19 0.42 15 a 0.2 - NC SC - - -
iA 8 FlnelightT•(grilles-between-the-glass) AND-N-63-00911-00001 0.27 1.53 0.19 0.42 17 40.2 N NC SC 21 - -
r No Grilles AND-N-53-00900-00001 0.27 1.63 0.47 0.68 33 <0.2 N - - - Z1 -
IL
it ,r, Simulated Divided Liteor Installed Interior Removable AND-N-83-00900-00002 0.27 1.53 0.42 0.52 SD <0.2 _ -NZt -
= Full Divided Lite AND-N-63-00903-00001 0.29 1.66 0.42 0.62 27 <02 N - - - Z1 - -
2
FinelightT•(grilles-between-the-glass) AND-N-53.00909-00001 0.28 1.59 0.42 0.52 29 <02 N - - - Z1 II -
3.0 Annealed or 3.1 Tempered Glass-w/Grilles 1"or Greater
Simulated Divided Lite or Installed Interior Removable AND-N-83-00792-00003 0.30 1.70 0.25 0.42 16 <02 - NC SC - - -
c Full Divided Lite AND-N-63-00804-00001 0.31 1.76 0.25 0.42 15 <0.2 - - - - - -
Flnellght'"(pollee-betweentheglass) Na Nei MI Na n/a nisi Ne - - - - -
Simulated Divided Lite or Installed interior Removable AND-N-3-00793-00003 0.30 1.70 0.16 0.24 11 <02 - NC SC S - - -
a Full Divided Lite AND-N-63-00855-00001 0,31 1.76 0.18 0.24 10 <0.2 - - - - - -
9 FInNIght0 (grilles-between-the-glees) n/a No rile No rile Ns NO - - - I - - -
Simulated Divided Lite or Installed interior Removable AND-N-63-00794-00003 0.29 1.85 0,17 0.38 13 <02 - NC SG - - -
A▪ ,e - -
Full Divided LiteLib ANDS/-63-00806-0D001 0.30 1.70 0.17 0.38 12 <02 - NC SC -
NFInelightT"(grilles-between-the-glass) n/a Na nle n/a nle Na n/a - - - - - -
•c Simulated Divided Lite or Installed Interior Removable AND-N-63-00791-00003 0.31 1.76 0.41 0.47 24 <0.2 - - - - -
4' N
Full Divided Lite ANDtl-03-00803-00001 0.31 1.78 0.41 0.47 24 <0.2
i FlnelightT•(grilles-between-the-gless) rile Na rile Na Na Na n/e - - - . - -
Y
Simulated Divided Llte or installed Interior Removable AND-N43-00901-00003 026 1.48 0.25 0.41 21 <0.2 I NC SCI Z1 - -
i Full Divided Lite AND-N-63-00907-00001 028 1.59 0.25 0.41 19 <0.2 - NC SC , Zt - -
.8
S
! FlnelightT•(grilles-between-the-glass) ribs Na !Ye n/a Ne Na n/a - - -
This information is for reference only.
Data Is current as of December 15,2014 end Is subject to dange.
Performance varies by unit size and options selected. Page 21 of55 See papal for more Information.
For specific unit performance information,please contact your dealer or Andersen Sales Representative.
, .
Agreement Document and Payment Terms
V.
' �� DBA:RENEWAL BY ANDERSEN OF BOSTON Brooke Bull
RENEWAL Legal Name:Renewal by Andersen LLC 48 Ward Avenue
HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 C:(505)440-8822
ISI sem MOM DO RIIIN UM,
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com
Brooke Bull 09/18/23
BUYER(S)NAME CONTRACT DATE
48 Ward Avenue, Northampton,MA 01060 (505)440-8822
BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER
brooks.bullimft@gmail.com
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: $5,495 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: $1,514
BALANCE DUE: $3,981 Estimated Start: Estimated Completion:
12 weeks 14 weeks
AMOUNT FINANCED: $0
We schedule installations based on the date of the signed contract and secondarily on the date
METHOD OF PAYMENT: Credit Card in which we complete the technical measurements.The installation date that we are providing at
this time is only an estimate.We will communicate an official date and time at a later date. Rain
and extreme weather are the most common causes for delay.
NOTES:
Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal
understandings changing or modifying any of the terms of this Agreement. No alterations to or deviations from this Agreement will be valid without the
signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the
terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on
the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement.
NOTICE TO BUYER: Do not sign this contract if blank. You are entitled to a copy of the contract at the time you sign.
YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 09/21/2023 OR THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER. SEE THE ATTACHED NOTICE OF
CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.
' N)\)/1)\
Cade\
SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE
Bruce Peck Brooke Bull
PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME
09/18/23 Page 2/ 34
Itemized Order Receipt
4-
' J
5 DBA:RENEWAL BY ANDERSEN OF BOSTON Brooke Bull
RENEWAL Legal Name: Renewal by Andersen LLC 48 Ward Avenue
HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 C:(505)440-8822
IW SEMR MOM{POOR REPLA IINI
Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmaiLcom
ID#: ROOM: SIZE: DETAILS: PRICE:
101 Kitchen Window Gliding Double 1:1 Active / Passive, Base Frame,
Exterior White, Interior White, Performance Calculator PG
Rating: 30 I DP Rating: + 30 / - 30 Glass, All Sash: High
Performance SmartSun Glass, No Pattern, Hardware, White,
Standard Color Extra Lock, Screen, Dual TruScene, Grille
Style, No Grille, MIsc, Standard, Replacement of window
frame and sash, includes casing from standard options.,
WINDOWS: 1 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $5,495
' `'' Renewal by Andersen is committed to our customers'safety by
crF{ complying with the rules and lead-safe work practices specified by the EPA.
09/18/23 Page 3/ 34
;$ Payment Authorization Form
DBA:RENEWAL BY ANDERSEN OF BOSTON Brooke Bull
RENEWAL Legal Name:Renewal by Andersen LLC 48 Ward Avenue
HIC#170810 Northampton,MA 01060
byANDERSEN 30 Forbes Road I Northborough,MA 01532 C:(505)440-8822
1.1 SIMI N/11WIt WOR unwrn
Phone:(508)351-2200 Fax:(508)986-7072 I rbaboston@gmail.com
Brooke Bull
BUYER NAME
48 Ward Avenue Northampton
ADDRESS CITY
MA 01060 (505)440-8822
STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2
Bruce Peck $5,495
SALES REP CONTRACT BALANCE
PAYMENT SCHEDULE ($5,495)
CASH DEPOSIT(1) FINANCE DEPOSIT(2) START OF JOB(3) SUBSTANTIAL COMPLETION(4)
CREDIT CARD $1,514 $0 $1,990 $1,991
(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 initiate debit or credit entries for payments based on the amount(s),form of payment(s),and timing
specified in the Payment Authorization Schedule above.
2. Acknowledge that this Authorization is to remain in full-force and effect until Renewal by Andersen has received written notification
from the Customer of its termination in such time and manner as to afford Renewal by Andersen and their Depository Institution a
reasonable opportunity to act on it.
3. Acknowledge that the origination of a ACH transaction (recharging of checking account)or recharging of credit card to Customer's
account must comply with the provisions of US Law.
4. Understand that if there is a change in the set date of a debit or credit entry, Renewal by Andersen must notify the customer minimally
7 days in advance.
Brooke Bull C9,iJS 09/18/23
BUYER NAME SIGNATURE DATE
09/18/23 Page 4/ 34
Go Permits, LLC
GO` 105 Buttonball Lane
In Glastonbury, CT 06033
t 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 31415822 — 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
Page 1 of i
DATE IOQ YD
YYY
ACORLf MM'CERTIFICATE OF LIABILITY INSURANCE 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 certificate holder is an ADDITIONAL INSURED.the policyllea)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 bottler in lieu of such endorsement(s).
PRODUCER 'ACT Ni111s Towers Watson Car Liricala Cr1.Car
I WSW
1111.11.1s Tr.r• Watson Stid`rwat, it, PHONE
2/o 26 Ceetusy bird se F.I 1-B77-945-73713 Nor
,ck 1-S813-467-2378
AC.
P.O. e 305191 Ant£Um S,5 car UK icatasAN111 is.coot
Nashville, TO 372305191 USA INSURERI8i AFFORDING COVERAGE NAIL a
NSa, 1RERA. Old Erpubllc Insurance Company 2414T
INSURED NSURER 8
R•o.,r.l by Andersen LSC
39 rorb.• Co.d INSURER C.
Na stbborcAapb, MS 01532 INSURER
SIMMER E
INSURERS.
COVERAGES CERTIFICATE NUMBER:X26007651 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 FS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE FSEE%REDUCED BY PAID CLAIMS
INBR TYPE OF fNBURANCE ADOL'SUB1C POLICY NUMBER POsC'r EFF POUCY EX► 11141TS
LTA. .SM+D NVD IMM.QDYYYYI IMIIMXVITYY1,
X COMMERCIAL GESERAL LIABSJTY EACH OCCUPFENCE S 2.000,000
DAMAGE,Lt NTED
CLAIMS-MACE X OCCUR PREMISES Eaac,;./.6 snLc, S S00,000
A MED EV..Ail,rc parson) $ 10.000
I---,
WET 31416: 22 10/01/2022 10/01/2023 pERfiONALX ADY INAIRY $ 2.000.000
CC II L AGGREGATE L5T T APPL ES PER f GENERAL AGOREOATE $ 4,000,000
X Aour/f 1 PflG
L_J lEC• LCr i PpJDU^5.CONpvP AGG S 4.000,000
OTHER S
AUTOMOBILEUABLITY CCMB 6ADY SINGLE LiIE $ 5.000.000
`^ iEa untltr,)
X AN.AUTO BCOILY IN.fURv..Pe parlor'.) S
A ~ OWNED -SI3rE13ULED NIPTSt 314139 22 10/01/2022 10/01/2023 BODILY IN24JRY.;P4r acroent:1 I
`..AUTOS ONLY .� AUTOS
:^4RE0 NCN.O NED PROFIt1i r•CAT.fAuE 1
r.,AUTOS CHET AUTOS ONLY rPe anaa!di
I
U1fBREL1.A UM H OCCUR EACH OCCUF31ENCE S
EXCESS use CLAa4S-MACE ADORED/OE S
CEC I 1 RETES'DH S S
WOWLERS COMPENSATION X I STATUTE t I FRH
AND EMPLOYERS'LIABILITY 1,000.000
A AIN YPPOFRIETCRr'ARTNEFuE.AEC UT WE l EL EACH ACCIDENT S
CfYLARMEASsE RE 4CL.CEC' No N;A WIC 314156 22 10/01/2022 10/01/2023
IManesbry I 1I41 E L DISEASE-EA EMPLOYEE t 1.00 0,000
If yes OH{dt*onJs 1.000,000
DE SCRIPT ON OF OPERATIONS GaaD. E L DISEASE-POLICY LIMIT $
DESCRIPTION Or OPERATIONS,'LOCATIONS I VEHICLES IACORD 191 Additional Ratio**S(saeEAt mail 6a at.Md it mum wxs+a raquet11
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
BY ldenp Of Ina lira aimed, '
ti 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
so, in. 23076070 nAT::n E.r6.3[4
Commonwealth of Massachusetts Comutroolisa ��
Division of Occupational Lrrensure Unrestricted-Sllrrl_s el ally am group which contain
Board of Building ){flagons and Standards �s than35,000 cubic feet
1 cubic meters)of enclosed
Consttt ligepetsor Voce
CS-090125 Spires: 10/06/2024
JAIME L MOON --
64 NOTTINGItAM RE1
RAYMONO NM 030 1,/
•
aflfl►
�O11y1�� Failure to
possess a airiest*Man at the Commissioner it , ,per Stale Building Code Is calms vocation d�.
t✓r i T�. .artt 4. For information about this loam
Cal($17)727-32W er Mel trww.ars.govtdp
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type Supplement Card
RENEWAL BY ANDERSEN LLC Registration. 170810
30 FORRES RD L ratran 12l27J2023
NOR THBOROUGH-MA 01532
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valet for individual use only before the
HOME IMPROVEMENT CONTRACTOR arpir Aral. it found return to:
TYPE,Suiipl isnt Gard Office of Consumer Affairs and Business Regula1 on
t0
R A sflgq 00 Washington Street -Sune 710
170810 1212/2023 Boston,MA 02118
RENEWAL BY ANDERSEN tic
JAIME MORIN
30FORBESRD „9,.•.r
NORTHBOROLIGH,MA 01532
Undersecretary Nat IW withotrt signBR:re
11111
RENEWAL
byANDERSEN
liPtb,-W
To Wr om It May Concern:
This letter will authorize the following personis) to act as agent(s) on behalf of Renewal by
Andersen LIC, 9900 Jamaica Ave South. Cottage Grove MN 55016 to pull for permits arxi
Inspections with respect to the instaliationa maintenance and repair of windows and entry
doors undo+MassAchusetts State Nome Improvement Contractor license number 170810 and
Construction Supervisor License cumber CS-090125.
If you have any questions, please cal me at 508,351.2277 ext 6:.
Authorized person(si,
Go Permits UC Sarah Hamrnad David Anderson Maureen Kivel
Scott Doughman Ryan Brondo Sovannara Kuy Mark Foster
Glynn Norgan Jennifer Winke Wendy Holden Gerald Cramer
Nick Raga Dane! Vrckerman Stepher Wilder Katie Grocott
Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff
amie Morin
Renewal by Andersen(IC
HIC 170810
CSL—CS090125
Local District Office Address
30 Forbes Rd
Northboraugh, MA 01532
qr,~irwnl try Andersen 11( 9900'ama►:aAve Scutt, [map.Grave Mk SSC11G