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06-038 (6)
BP-2024-0198 319 HAYDENVILLE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-038-001 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-2024-0198 PERMISSION IS HEREBY GRANTED TO: Project# WIDOWS 2024 Contractor: License: Est. Cost: 24596 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: GRUNWALD JANET F Lot Size (sq.ft.) Zoning: RR Applicant: GRUNWALD JANET F Applicant Address Phone: Insurance: 319 HAYDENVILLE RD LEEDS, MA 01053 ISSUED ON: 02/26/2024 TO PERFORM THE FOLLOWING WORK: 5 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: j4 Ti 1 . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner r� If possible, please email a copy of the issued permit to peal ` aperm:ifsrg. Thank you. The Commonwealth of Massachusetts i 1 W Board of Building Regulations and Standards FE6 2 6 2024FQR Massachusetts State Building Code, 780 CMR NIUNIoPALITY Building Permit Application To Construct, Repair,l!tenovate' `�>Dern ._-.gevise4'Mar 2011 One-or Two-Family Dwelling , This Section For Official Use Only Building Permit Number: A✓- V-/9 Date Applied: 4)1.J 12,5 /,/,. 7,a-zo29 BuildingOfficial(Print Name) �Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 3e9 ilikjelelwi7(.. A d L.tcWS /IA o/oS3 1.1a 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❑ Private Cl _Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: gaAG# 6rNn w'eC1J `fe'cIJ frV/ O/OS3 Name(Print) City,State,ZIP 3i4 f- j4nveIli.. Kd 01-32o-//90 e lam i,los a,mc037l, /let 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: RCMoYG and Pee? tee 5 w1»d s lae {- A,ke w, i ,70 ,ly,tcf wr.-0 r haA9C s a I<o far of. Z 9. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 29,67`,07 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 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.I 4t4Pheck Amount: O Cash Amount: 6. Total Project Cost: $ ot ti y/ 5 96,DO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 7O/Z5- /o%Gjz y /Mt Ann License Number Expiration Date Name of CSL Holder List CSL Type(see below) wS ao lei .s 4d No.and Street Type Description A U Unrestricted(Buildings up to 35,000 Cu.ft.) /V 111,orA M 3 Z. R Restricted 1&2 Family Dwelling City/Town,State,ZIP' M Masonry RC Roofmg Covering C_5„) Window and Siding / SF Solid Fuel Burning Appliances �6d- -Via Z ,efi4 e 0 pro4.O� I Insulation Telephone address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i �l�rw..!6 / 9/0 /Zf za f 2s' yy ei WSA HIC Registration Number Expiratioh Date HIC Company Note or HIC Registrant Name 30 Forbes Rd NaeAboro . pAa o,S3z ere,% D e ',or`'� No.and Stregt El airaddress / No eih b0r0'40(a of o 15- ,lob-cs2- IL 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 Issuanccee of the building permit. Sigeled Affidavit Attached? Yes .......... 113 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 accurat to the be of my knowledge and understanding. Cpecw// C. C crest ✓l 2- L 3- Print Owner's or Authorized Agent's Name(Electronic ignature) 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 I � Massachusetts F°`' ''�'' t // i DEPARTMENT OF BUILDING INSPECTIONS ' : 212 Main Street • Municipal Building �j CDC ram Northampton, MA 01060 ry,NW 3+7N^4� 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 1id4cs R I Nor Adoro.01, i'mA 0/53 L The debris will be transported by: Name of Hauler: (A/464 (114a`t jeii'1e4-7 Signature of Applicant: Date: Z- Z 3- Zy The Commonwealth of Massachusetts Department of Industrial Al ecidents • , Of e of Investigations 1 t-t • Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 wwuatass.gov/dia Workers'Compensation Insurance Affidan it: Builders/CentractorsiElectricians/Plumbers Applicant Information Please Print LcgibI Name , mines$anizaric lndiridua]?: Renewal by Andersen Address: 30 Forbes Rd. City/State/Zip:Northborough MA 01532 Phone #:508-351-2277 Are you an employer? ( heck the appropriate hot: I%pe of project(requires!): 1.14 lam a employer with 34 _ 1. 1=1 1 am a general contractor and l employees(full and/or part-time).* hate hired the sub-contractors 6_ No, conaructbn 2.D lam a sole proprietor orpartner- listed on the attaclr.:d sheet 7. ❑Remodeling ship and hate no emplo.,ces These sub-contractors have g Dcn lition workingfor me in anycapacity.i employees and have v.otters' p tY 9. Build ng addition [No worker.' comp-insurance comp- insurance. required.] 5. [] We are a corpotat on and its 111.0 Iaectrical repairs or additions 3.[] I am a homeowner doing all work officers have exercised their 1 in Plumbing repairs or additions mYself [No v orkers'comp. right of exemption per MGL 12.0 proof reps rs insurance required.] c. 152.11(4),and we hat c no Replacement employees. (No workers' 13.j$[tkher comp insurance required.] *Any appki sat tat chocks box t moat also fill owl the s ttiunt basic showing then +.txkct canpcnsati0n policy informal on. Hotitcouucts who submit this affidavit i nth.atutC the) are doing all w.at and then hoc amidecotxractoni must dubs a a net,affrdavti wnd.Jiro!w.It Ct»ilaa.tur,that eI tt this hot(must atl.w lti.t ata additional sheet Ji.na writ the Waite u:the sub cotltra tors and slate Whether or not thD,c entitle.has; nnployees. If tbt lob-oonitact.n,141l a it!A rl.. pi. idc their a.Kkats'�nttip.pellet nuinthet. I r+n lit employer that is proitrdint; workers'compensation insurance for mt employee'.. Below is the police and job site information. Insurance t ompan\ Name, Old Republic Insurance Co. _ Polley#or Self-ins. Lie. MWC 314158 22 I xpirat on Date 10/01/2024 Job Site Address. 3/ i tjciena e /lt. �d city site Zip Leeds ,If} o/os 3 Attach a(opt of the worker.'cuogx'ntation ptedics declaration page(shooing the policy number and etpisatiun date). 1•ailtue to secure cut eratre as required under Seettun 25:%of M6L e. 152 can lead to the imposition of criminal penalties lot a tine up to S 1.51X).t$)and or one-year imprisonment. as ttcll as civil penalties in the torn of a STOP WORK ORDER and a tine of up to S250_0t1 r.Let a_rattst the ♦tolator. Be ads iced that a copy of this statement mot be lonsardcd to the Office of In:c.tigations of the DR tot atsttran.e ec+'.et:r_e telt ilk.J11011. I do hereby certify under the pains and penalties ul perjury that the information pror•ided above is true and turret' Signature ;(492. 0V 1 tort. 10/02/23 t'httite n. 8660 -7S2 - V//?i Official use only. Do not write in this area,to be completed by city or town official. (-it or 1 non: Permit License $ issuing tuthoritt teheck lone): 101ioaril of Ilealth 20 Building Ocpartntrnt 313('itt 'posit( seek 3.Dh.Icrtrical Inspector 5f'lunrhing Inspector G.QUIhc•r ( antstcl Person: Phone es: Page 1 of 1 A!'C)Rd' DATE(MMIDD/YYYY) lll.....__IJVVJ/� CERTIFICATE OF LIABILITY INSURANCE 09/21/2023 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. FAX c/o 26 Century Blvd (A/C No.Ext): 1-877-945-7378 No): 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LIC 30 Forbes Road INSURERC: Northborough, MA 01532 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W30224860 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 POLICY EFF POLICY EXP LIMITS LTR, INSR WVD POLICY NUMBER (MM/DDIYYYY) IMMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 DAMAGE TO RENT CLAIMS-MADE X OCCUR PREMISES(Eaoccurrrrence) $ 500,000 A MED EXP(Any one person) $ 10,000 MWZY 314161 23 10/01/2023 10/01/2024 PERSONAL BADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 X POLICY PRO- 6,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 23 10/01/2023 10/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ 'WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDEDI NO NIA MWC 314158 23 10/01/2023 10/01/2024 (Mandatory in NH) EL.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 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 REPRESENTATIVE � Evidence of Insurance n4., ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24694639 EAT OM 3138744 Commonwealth of Massachusetts COAaY11C�i0tr 1111/�friaOr Division at Occupational Licensure -0101dirigsof seri gm group NltiCb contain Board of Building Regulations and Standards lass than 3S 000 cubic feat gal cubica :or�s t{tn=' uOiYYS\.IOesv,s0• aMbf� r CS-090125 Empires 10r0612024 JAIME L MOWN — S4 NOTTINGWAM RD RAYMOND NM 03071 r i >r� 414. hu/.LVA 3. n Failure to possess a current edition of the bbissachuMtb State Strung Code is cause tier revocation of dui license. . .,.s,:o rcr ,2 > , tf. SiEn7,;,t.:- For untarrnation about ibis license Cab(617)777-3200 or visit www-nu I$.QOi$a{ Unice of Uonsumer Attai and tiuslness Kegulation 1000 Washingtt }airwt - Suite 710 Boston,-Massachusetts 02118 Home ImQro 1.1 ;ur,. actor Registration t z ..�...._-_. ,.._.....mo X re :: o, Type: Supplement Card ation: 170810 RENEWAL BY ANDERSEN LLC '" =LI- E ' Lion: 12/22/2025 30 FORBES ROAD ';k lea ._ _ NORTHBOROUGH. MA 01532 ......r„r ;,0, 'Zi err r'�r ._ � Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Gard Office of Consumer Affairs and Business Regulation Regj.stratipn EXBiratiQit 1000 Washington Street -Suite 710 170810 12/22/2025 Boston,MA 02118 tENEWAL BY ANDERSEN LLC _; :1.61i. AIME MORIN � ,p r i0 FORBES ROAD i' '.'12 " ",,`, 7 L l /72/, i_ -- ,--,-„, jL- JORTHBOROUGH,MA 01532 ..; � Undersecretary ` Not valid with6ut signature U.S. Canada ENERGY ENERGY Andersen* Andersen NFRC Certified `o o u IIli Y ° STAR STAR Product Line 8 Glass Grille Type Products m u E.' = 4 c v B.0 V 4.1 Product Type Type Directory Number 3 I ut n ` NU a C "p c . a o 0 Z U C7 0 N M N Z a1 2.2 Annealed Glass-w/No Grilles and Grilles Less Than 1" No Grilles AND-N.59-0084940001 0.29 1.65 0.32 0.55 22 <02 - - - - - - Simulated Divided Lite or Installed Interior Remorse.. AND-N-59-00049-00002 0.29 1.65 0.29 0.49 2D <02 - - - - - - 9 Full Divided Llte AND•N•59-00955-00001 0.31 1.76 0.29 0.49 17 <02 - FindightTM(grilles-between-the-glass) AND-N-59-00567-00001 0.30 1.70 0.29 0.40 19 <02 No Grilles AND-N-59-00850-00001 0.30 1.70 0.20 0.30 14 <02 - - - - Simulated Divided Lite or Installed Interior Removable ANO-N59-00850-00002 0.30 1.70 0.10 0.27 12 <0.2 - - - - 1 ` - - Full Divided Lite AN0-N39-00856-00001 0.31 1.76 0.18 0.27 11 <0.2 F ildi}+•(9rllles-between-th0-elas3rJ AND-N-59-00988-00001 1.78. MIL 1027 11 <0.2 - - - - sr•.»:. •,ems. No G - ., R III GB WI• III IIIII - 1 U1 a Sin ed Divided Lite or Installed Interior Removable AND-N-59-00851-00002 0.29 1.65 0.19 0.44 14 <0.2 - - - - o r E Full O,vided Lite AND•N-59-00857-00001 0.30 1.70 0.19 0.44 13 <0.2 - I I Hill" F - - - - - III - - i I0 - - Simulated Divided Lite or Installed Interior Removable AND-N-59-00548-00002 0.30 1.70 0.47 0.54 29 <02 N - - 9 1 Full Divided Lite AND-11.59-00854-00001 0.31 1.76 0.47 0.54 28 <0.2 - - . - 6 Finallghtr"(grilles-between-thrills.) AND-N-59-00866-00001 0.31 1.76 0.47 0.54 28 <0.2 - - - "No Grilles AND-N59-00969.00001 0.28 1.59 0.31 0.54 22 <0.2 - - - - Y L. Simulated Divided Lite or Installed Interior Removable AND-N59-00959-00002 0.28 1.50 0.26 0.48 21 <02 - - - - 3 y err J = Full Divided Lice /WD-N-59-00972-00001 0.28 1.59 0.28 0.48 21 <02 - - - - Finelight"(grilles-between-theglaes) ANON-59-00975-00001 026 1.59 0.28 0.46 21 <0.2 - - No Grilles ANON.59-00970-00001 0.28 1.59 0.21 0.48 17 <02 - - - 7 -.< fir o Simulated Divided Lite or Installed Interior Removable ANON-59-00970-00002 11.20 1.59 0.19 0.43 15 <02 - - - 3 =m Full Divided Lite N ANO-N-59-00973-00001 0.26 1.59 0.19 0A3 15 <02 3 FinelightT"(grilles-betweenhrglass) AND-N-59-00979-00001 0.26 1.50 0.19 0.43 15 <02 - - - t No Grilles AND-N-09-00988-00001 026 1.48 0.48 0.59 35 <02 N - - - I 23 c Simulated Divided Lite or Installed Interior Removable Te▪ lANOai-SB-0O98i1-00002 0.26 1.46 0.43 0.52 32 <0.2 N - - - -1 = Full Divided Lite AND-N-59-00971-00001 0.29 1.� 0.43 0.82 28 <02 N • FInellghtTM(grilles-between-heg lass) ANON-59-00977-00001 0.29 1.65 0.43 0.52 26 <0.2 N - - - - - 2.2 Annealed Glass-w/Grilles 1'or Greater Simulated Divided Lit,or Installed Interior Removable ANDal-59-00849-00003 0.29 1.55 0.25 0.43 18 <0.2 - 4. 3 Full Divided Lite AND-N.59-00061-00001 0.30 1.70 0.26 0.43 17 <02 - - - - - - s Flndlght'"(grillesb.twe.n-the-glass) AND-N-59-00573-00001 0.31 1.76 0.29 0.49 17 <0.2 - - Simulated Divided Lite or Installed Interior Removable AND-N-59-00850.00003 0.30 1.70 0.16 0.24 11 <02 - - - - N 9 3 Full Divided Llte AND-N-59-00862-00001 D.31 1.76 0.16 024 10 <02 - - - FinelightT•(gniMsbetween-the-plea) AND-N-559430874-00001 0.32 1.82 0.18 0.27 10 40.2 - - - - - t Simulated Divided Lite or Installed Interior Removable AND-N59-00851-00003 0.29 1.65 0.17 0.39 13 <0.2 - - - - c 3 V Full Divided Lite AND-Id9-00863-00001 0.30 1.70 0.17 0.39 12 <02 - - - s in Flndight'"(grillesbetwn-IMglaee) AN04-59-00675-00001 0.31 1.76 0.19 0.44 12 <02 - - - - Simulated Divided Lite or Installed Interior Removable AND-N-59.00848-00003 0.30 1.70 0.42 0.47 26 <02 © - - - - - w ei a ig Full Divided Lite ANON-59-00560-00001 0.31 1.76 0.42 0.47 25 <02 - - - - 2 '5 a FinelightT•(grilles-between-the-glass) AND-N-59-00872-00001 0.32 1.82 0.47 0.54 27 <02 - - - - - Y Simulated Divided Lite or Inetalled Interior Removable AND-N59-00969-00003 0.28 1.59 0.25 0.42 19 <0.2 - - wt 5 "u Full Divided Lite AND-N.59-00975.00001 0.28 1.59 0.25 0.42 19 <0.2 - I - - 3 FI nod ightt(grll lee-between-thegtasa) AND-N59-00981-00001 0.28 1.59 0.28 0.46 21 <0.2 - - - t or Simulated Divided Lib or Installed Interior Removable AND-N 59 00970-00003 0.28 1.59 0.17 0.38 14 4 0.2 - - - • qq 33 ,. Full Divided Lite ANON-59-00976-00001 0.20 1.511 0.17 0.38 14 <02 - - - E 2 a 31 FInNlght"'(grilles-between-IMylaas) AND-N-59-00982-00001 0.28 1.59 0.19 0.43 15 <02 - - - - This information is for reference only. Performance varies by unit size and options selected. Pegs 2o155 Data is canon.on of Dxember 15,e0a14 eMo mereInorltaton. Sea page 1 for mare Inlorrnadm. For specific unit performance information,please contact your dealer or Andersen Sales Representative. 1,a, _ „. RENEWAL brANDERSEN FINI-SERVICE WINDOW&DOOR REPLACEMENT •� 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 MI' Agreement Document and Payment Terms / DBA:RENEWAL BY ANDERSEN OF BOSTON Janet Grunwald Legal Name:Renewal by Andersen LLC 319 Haydenville Rd RENEWAL R EN A EL HIC#170810 Leeds,MA 01053 byA30 Forbes Road I Northborough,MA 01532 H:(413)320-1170 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com C:(413)320-1170 Janet Grunwald 02/20/24 BUYER(S)NAME CONTRACT DATE 319 Haydenville Rd, Leeds, MA 01053 (413)320-1170 (413)320-1170 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER flamingos7@comcast.net 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 fisted 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: $24,596 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: $8,197 BALANCE DUE: $16,399 Estimated Start: Estimated Completion: 10-12 weeks 1-2 days 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 02/23/2024 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. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Antoine Tannous Janet Grunwald PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 02/20/24 Page 2 / 37 f _ Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Janet Grunwald L Legal Name:Renewal by Andersen LLC 319 Haydenville Rd RENE WA N L HIC#170810 Leeds,MA 01053 E NnD EDOW R S EN 30 Forbes Road I Northborough,MA 01532 H:(413)320-1170 IIIII Phone:(508)351-2200 I Fax:(508)9867072 I rbaboston@gmail.com C:(413)320-1170 ID#: ROOM: SIZE: DETAILS: PRICE: 101 Foyer Mlsc Misc, ProVia, Entry Door System, Quantity 1, See attachment for details. 102 mudroom Window AcclaimTM Double-Hung (DG) 1:1 Flat Sill, Base Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, TruScene, Full Screen, Grille Style, No Grille, Misc, Standard, Replacement of window frame and sash, includes casing from standard options., 103 mudroom Window AcclaimTM Double-Hung (DG) 1:1 Flat Sill, Base Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware,White, Screen, TruScene, Full Screen, Grille Style, No Grille, Misc, Mulled Unit, Replacement of window frame and sash, mulled to other units., 104 mudroom Window AcclaimTM Double-Hung (DG) 1:1 Flat Sill, Base Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, TruScene, Full Screen, Grille Style, No Grille, Misc, Standard, Replacement of window frame and sash, includes casing from standard options., 02/20/24 Page 3/ 37 Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Janet Grunwald RENEWAL Legal Name:Renewal by Andersen LLC 319 Haydenville Rd HIC#170810 Leeds,MA 01053 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)320-1170 Phone:(508)351-2200 i Fax:(508)9867072 I rbaboston@gmail.com C:(413)320-1170 ID#: ROOM: SIZE: DETAILS: PRICE: 105 mudroom Window AcclaimTM' Double-Hung (DG) 1:1 Flat Sill, Base Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, TruScene, Full Screen, Grille Style, No Grille, Mlsc, Mulled Unit, Replacement of window frame and sash, mulled to other units., 106 mudroom Window Acclaim Double-Hung (DG) 1:1 Flat Sill, Base Frame, Traditional Checkrail, Exterior White, Interior White, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, White, Screen, TruScene, Full Screen, Grille Style, No Grille, Mlsc, Mulled Unit, Replacement of window frame and sash, mulled to other units., 107 mudroom Misc Misc, Construction Charge, Lower/Build-In Opening, Quantity 1, Includes framing, siding, drywall and one coat mud & tape. WINDOWS: 5 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 2 TOTAL $24,596 Renewal by Andersen is committed to our customers'safety by 6EFY1 complying with the rules and lead-safe work practices specified by the EPA. 02/20/24 Page 4/ 37 Payment Authorization Form DBA:RENEWAL BY ANDERSEN OF BOSTON Janet Grunwald RENEWAL Legal Name:Renewal by Andersen LLC 319 Haydenville Rd HIC#170810 Leeds,MA 01053 brANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)320-1170 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@grnail.com C:(413)320-1170 Janet Grunwald BUYER NAME 319 Haydenville Rd Leeds ADDRESS CITY MA 01053 (413)320-1170 (413)320-1170 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 Antoine Tannous $24,596 SALES REP CONTRACT BALANCE PAYMENT SCHEDULE (S24,596) CASH DEPOSIT(1) FINANCED DEPOSIT(2) SUBSTANTIAL COMPLETION (3) CREDIT CARD $8.197 $0 $16.399 (1) CASH DEPOSIT: Renewal by Andersen requires thirty-three percent(33%)of the purchase price paid at Agreement Signing. Buyer(s)may pay through the following payment methods:cash,check,debit card,or credit card("Cash Deposit"). (2) FINANCED DEPOSIT: Renewal by Andersen requires thirty-three percent(33%)of the purchase price advanced at Agreement Signing. For Buyer(s)that receive approved financing through a Renewal by Andersen lender("Lender"),the Lender will advance this required amount directly to Renewal by Andersen("Financed Deposit"). For open-end credit loans,the Lender will not extend credit to the Buyer(s). For all financings,the Buyer(s) will not owe any payments until Substantial Completion(as defined in item 3 below)and the Lender has advanced or otherwise delivered the remaining balance to Renewal by Andersen. (3) SUBSTANTIAL COMPLETION: Renewal by Andersen requires the final payment(which shall be delivered by the Lender in the case of projects financed through Lenders)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 Change Orders associated with the project covered by this Agreement,the difference in the Job Amount will be reconciled in the final payment requested from the Buyer(or the Lender in the case of a project financed by a Lender)upon Substantial Completion. BY SIGNING BELOW, I/WE,THE BUYER(S): 1. Authorization for Direct Payment Via ACH: The Buyer(s) acknowledges providing Renewal by Anderson a check or designating a checking or savings bank account at a depository financial institution by providing Buyer(s)' account and routing number information for the payments listed above at Agreement Signing and Renewal by Andersen entered the account information into its payment system. Buyer(s) authorizes Renewal by Andersen to electronically debit the designated account(and, if necessary, electronically credit the account to correct any erroneous debit) based on the amount(s),form of payment(s),and timing as specified in the Payment Authorization Schedule above. Buyer(s) acknowledges that Renewal by Andersen may reattempt any payment that is returned unpaid. 2. Authorization for Card Payment: The Buyer(s) acknowledges authorizing Renewal by Anderson to apply the payments listed above to Buyer(s)' credit or debit card that Buyer provided at Agreement Signing and Renewal by Andersen entered the card information into its payment system. Buyer(s) authorizes Renewal by Andersen to charge the Buyer(s)' credit or debit card based on the amount(s),form of payment(s), and timing as specified in the Payment Authorization Schedule above. Buyer(s) acknowledges that Renewal by Andersen may reattempt any payment that is declined. 3. Buyer(s) agrees that any payment transactions that Buyer(s) authorizes comply with all applicable laws. 4. Buyer(s) acknowledges that this payment authorization will remain in full-force and effect until Renewal by Andersen has received written notification from Buyer(s)that Buyer(s) wish to revoke this authorization at least three (3) business days' prior to the scheduled payment date. For any change orders that affect the payment amount set forth above,Renewal by Anderson will notify Buyer(s) of the payment amount that will be debited or charged at least ten (10) calendar days prior to the transaction date. Janet Grunwald i/G '� " 02/20/24 BUYER NAME SIGNATURE DATE 02/20/24 Page 5/ 37 Go Permits, LLC 105 Buttonball Lane OCIVIL 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 12/22/2025 - Workers Comp -#MWC 314158 23 — Exp. 10/01/24 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 RENEWAL bYANDERSEN Fit I WWI COM tett:DOI To Wnom It May Concern! This letter will authorize the following person Is) to act as agent(%)on behalf of Renewal by Andersen LLC, 9900 Jamaica Ave Soutn, Cottage Grove MN 55016 to pull for per-nits and inspections with respect to the installation, maintenance and repair of windows and entry doorsdirundc iviAccAr,-,ircprts State Home Improvement Contractor license number 170810 and Construction Supervisor License number CS-000125. If you have any questions, please call me at 508 351 2271 ext 6 Authorized person(sl, Go Permits LLC Sarah Ha mrn ad David Anderson Maureen Kivel Scott Doughman Ryan 8,0-nd° Sovannara Kuy Mark Foster Glynn Norgan Jennifer Wirku wency Holden Gerald Cramer Nick Raw) Dane Vickerm an Stephen Wader Katie Grocott Bonnie Myers Carrie Foltgno Michael Rogers Rachel Orloff /' amie Morin Renewal h)y ilralerser LLC HIC 170810 CSI.- C5090125 Local District Office Address 30 Forbes Rd North borough, MA 01532 Renewal by Andenen It( WO Jamaica Ato•e South Cottage Grave Mk FaCi1f3 Office of Uonsumer Attat(S anp business Kegulatlon 1000 Washing1 a t- Suite 710 Boston, M usattis--02118 Home Improe ent ;7• - e*istration ' tll�rr111eer�rriti 1' Type: Supplement Card RENEWAL BY ANDERSEN LLC ; ation: 170810 �"4 =i "`"" " E %anon: 12/22/2025 30 FORBES ROAD -� — -»— NORTHBOROUGH, MA 01532 ,. `'r 111141 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Gard Office of Consumer Affairs and Business Regulation Registration tien 1000 Washington Street -Suite 710 110810 - 12122/20?5 Boston,MA 02118 IENEWAL BY ANDERSEN LLC } AIME MORIN ?? 0 FORBES ROAD . 5 ._--fr IORTHBOROUGH.MA 01.532 �f/ Undersecretary ` Not valid with ut signature 4:..7 141 RENEWAL hiANDERSEN CiNir To Whom It May Concern: This letter wiil authorize the following person(s) 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 and c Maccarhtisetts State Home improvement Contractor license number 170810 and Construction Supervisor License number CS-090125. If you have any questions, please call me at 508451•2277 oft 6. Authorized person(s): Go Permits LLC Sarah Hammad David Anderson Maureen Kivel Scott Doughman Ryan B ondo Sovannara Kuy Mark Foster Glynn Norgan Jennifer Wir'ke Wendy Hoiden Gerald t.ramer Nick Rago Dane{V,+ckernan Stephen Wilder Katie Grocott Bonnie Myers Carrie Foligno Michael Rogers Rachel Orloff Jamie Morin Renewal by Andercer LLC HIC 170810 CSI—CS090125 Local District Office Address 30 Forbes Rd Northborough, MA 01532 0.tnrwril b4e Ar drrscn L: ( tarnitL.:a Ave a South ( Re Grave MP S5016 ' \ Page 1 of 1 ACCORtJ CERTIFICATE OF LIABILITY INSURANCE DATE(M 09/21/202YY) /2023 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 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (AIQ.No,Ext); (AIC.No): E-MAIL can P.O. Box 305191 ADDRESS: ertificates@willis.co Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICX INSURERA: 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: W30224860 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 POLICY EFF POLICY EXP LIMITS LTR, INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 10,000 MWZY 314161 23 10/01/2023 10/01/2024 PERSONAL&ADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 X POLICY LJ JPERcf LOC PRODUCTS-COMP/OP AGG $ 6,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 23 10/01/2023 10/01/2024 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- 'AND EMPLOYERS LIABILITY STATUTE ER YIN A ANYPROPR IETOR/PA RTN ER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? No NIA MWC 314158 23 10/01/2023 10/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY UMIT $ 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 �REPRESENTATIVE Evidence of Insurance 6n/1A �r z ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24694639 010CH: 3138744