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38B-058 BP-2024-0501 289 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-058-001 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-2024-0501 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2024 Contractor: License: Est. Cost: 11214 RENEWAL BY ANDERSEN 090125 Const.Class: Exp.Date: 10/06/2024 Use Group: Owner: R NURENBERG STEPHANIE &DAVID Lot Size (sq.ft.) Zoning: URB Applicant: RENEWAL BY ANDERSEN Applicant Address Phone: Insurance: 30 FORBES RD 508-351-227 MWC314158 NORTHBOROUGH, MA 01532 ISSUED ON: 04/24/2024 TO PERFORM THE FOLLOWING WORK: 11 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: ":"/Z, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner If . . n , e. l_ ,: .:�s -emai a,copy of the issued permit to permits@gopermits.org. Thank you. 't--`'' The Commonwealth of Massachusetts 7 Board of Building Regulations and Standards FOR ir 'APR 2 4 2024 assachusetts State Building Code, 780 CMR MUNIUSEALITY Building Perm Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 P`'T or cuu nm-��-- ! One-or Two-Family Dwelling T r:tiaigrIr, 1SPEC'ION3 _ __'__k"^0"""' This Section For Official Use Only Building P rmit Number: /,31 •-*-5b Date Applied: Eui� �,s /��� Ll ZvZazy Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 289 S,w Street iv.),ihdi.fiko o 1 1960 1.la Is this an accepted street?yes V 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 ElZone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 54eioltanic Nu.ren her, Alas AAInylon Al O/oho Name(Print) City,State,ZIP 214 S0..444) Strref tit 3-S63- S2o* Si3r,285esk.oI,c'o.+A 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 Specify:t ,(a.e i!A/ ✓Memos Brief Description of Proposed Work': Rtnlez avid it,I*ce N ,vri'cldws /fire Rc Ake ws rJo Sf t►cs ral clout- tA f" of . q SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ,/ , ,,,, 0 1. Building Permit Fee: $ Indicate how fee is determined: / 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Total All Fees: $ Suppression) $ >1 �, Check No '""!Check Amount: 1,p Cash Amount: 6. Total Project Cost: $ a/ 7/v „fla 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) r-. 040 I25 <%f Z N )04 ALLMl(4 n License Number Expifation Date Name of CSL Holder 31 G e S List CSL Type(see below) Uo 5 No.and Street Type Description lade J lit O/S3 2 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering Cam) Window and Siding 1 SF Solid Fuel Burning Appliances rod —4520' S'/II ftnwnA b ,t„dezene9wera.41) I Insulation Telephone mail address w D Demolition 5.2 Registered Home Improvement Contractor(HIC) ( 12 22 2S RentwLl by AAderttA HIC Registration Number E iration Date HIC Compan Name or HIC Registrant Name 30 eA 5 Ad fCrKwakiracieWeRCn Q `peerv4Ti too No.and Street Email address`' pares itro"ti- riA or53z 110452- 4(,2 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 [ 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 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 th-0•-st of my knowledge and understanding. LIQ� /� • l,t eL,h.4i/ Jew f/C 7�21. Zy Print Owner's 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 N, Massachusetts " . :. ,� I DEPARTMENT OF BUILDING INSPECTIONS i 1.fir 212 Main Street • Municipal Building %,_ ,sr -"1 Northampton, MA 01060 Jrt,�y .� C' 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 /Its #el Af bo(.,4C, /4A O/511._ The debris will be transported by: Name of Hauler: Wa6ti, Mall-4'Y/ IA' I, i 41 Signature of Applicant: -4. Date: Y-2 3=Pf The Commonwealth of Massachusetts 1 '=30=" Department of Industrial Accidents Office of Investigations == Lafayette City Center =� 2 Avenue de Lafayette, Boston,MA 02111-1756 ;"? www.ntass.gov/rtia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apjlicant Information Please Print Legibly Renewal by Andersen Name (Boone,s ere.arozatie lndnvLdua]): Address 30 Forbes Rd. City,'State/`Zip:Northborough, MA 01532 Phone # 607-966=0412 Are you an employer? Cheek the appropriate box: Type of project(required): 1.1 1 am a employer with 30 4- ❑ 1 am a eencral contractor and I employees .(full andior part-time)." hake hired the sub-contractors (' ❑ hew consntetion listed on the atiachA sheet. 7_ ❑Remodeling 2 ❑ 1 am a sole proprietor or partner- ship and hat c no employes I`he a sub-contractors have X. ❑Demolition workingfor me in anycapacity employees and have workers' P t!` 9_ ❑Build ng addition [No workers' cornp_insurance comp_ insurance. required.] 5. 0 V1'e are a corporation and its j ( li.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised tltci: 1 i.l plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152. §l(4),and we ha%c noReplacement employees. [No workers' 13.] other comp. tt.surance required.] 'Any applicant that chats boat TY I mast al~,fiti out t c eutkm below hitoNsittg then workcn'coanpcnsation policy information_ t Haii owners who submit this affidavit indicating the)are doing ail Butte aril then hire outside contractors must submit a new. affidavit ind;Jatinssu:h_ ;Contractors that 4.!we k this tau\must atuj:tted an;Winona!iot sheet,Iiou ut the thane Li!.the'hub-contractors and slate wt rher or not those entitics has. employees. If thesuI+-cantnacor.,I;.i c:rnpltirweN.the u,E„t heir tide thsli 4wtkCth''u.np.t oli:�elelttt t. awe an employer that is proridinx workers'compensation insurance for my employees. Betos'is the ponce-and job site information. Insurance Company Nagle:_Old Republic Insurance Co. Policy#or Self ins. Lie. n: MWC 3141.58 22 _., Expiration Date 10/01/2024 Job Site Address. Z8' 5'o . Sfirte-f „Citylslate'xip ii/p/A401p ►n MN b/o o Attach a copy of the ss takers' compensation lwliry declaration page(showing the polio'number and espiriitrun date). Failure to secure coverage as required under Section 25A of MGL c. t S2 can lead to the imposition of criminal penalties of s tine up to S1.500.00 and`or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the ♦iolator. Be ad'.ised that a copy of this statement may be forwarded to the Office of Investigations of the DlA for toque m e rrttication. 1 do hereby certify under the pains and penalties of perjure that the information provided above is true and correct. -t./ t-ti c94.u� I),tc. 3/18/2024 Phone (bO - 4152- "!/i j- Official use only. Do not write in this area,to be completed hr city or town official. Cit or Town: Permit'license It Issuing Authority (check one): I❑Hoard of Ilealth 20 Building Department 3 1('itti "loon Clerk 4.0 Electrical Inspector 5r:I'lumhin2 Inspector 6.00ther ( ontact Person: Phone n: aif RENEWAL brANDERSEN �ff FOIL OWE WINDOW 8 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 U.S. Canada ENERGY ENERGY 12 Andersen" Andersen NFRC Certified o o_u Co m'a IP STAR STAR W v5.0 v4.1 .1 Product Line S la Glass Grille Type Products a y S > 2 'E Product Type Type Directory Number rd < a i3 . c � , o e e 2 0 hi hl N 2 N 2.2 Annealed Glass-w!No Grilles and Grilles Loss Than 1" No Grilles AND-N-59-00849-00001 0.29 1.85 0.32 0.55 22 <02 - ly Simulated Divided Lite or Installed Interior Removable AND-N-59-00849-00002 0.29 1.65 0.29 0.49 20 <02 - - - - - - Full Divided Lite AND-N-59-00855-00001 0.31 1.76 0.29 0.49 17 <02 - II - - - - - Flnellght*a(grilles-between-the-glass) AND-N-59-00667-00001 0.90 1.70 0.29 0.49 19 4 0.2 - No Grilles AND-N-594085D-00001 D.30 1.70 0.20 0.30 14 4 02 - - - - c Simulated Divided Lite or Installed Interior Removable AND-N-59-011850-00002 0.90 1.70 0.18 0.27 12 <02 - - - - 9 ' Full DMded Lite AND-Nd9-00856-00001 0.31 1.76 0.18 0.27 11 4 0.2 - - - L Fin II rilles-between-the-gleesl AND-N-0944948 1 1.7g 0,16 0.27 t 11 <0.2 - - - WI ill III II Oil - / } Simulated Divided Lite or Installed Interior Removable AND-N-59-00851-00002 0.29 1.65 0.19 0.44 14 <0.2 - - - - - 3 Full Divided Lite AND-N-59-00857-00001 0.30 1.70 0.19 0.44 13 <0.2 - 0.19 ®7 • _ - - - e iu,3 Simulated Divided Lite or Installed Interior Removable AND-N-59-00848-00002 0.90 1.70 0.47 0.54 29 <02 N - - o ;! Full Divided Lite AND-N-59.00854-00001 0.31 1.76 0.47 0.54 28 <0.2 - - - - 6 Finelight*•(grille.-between-the-glue) AND-N-59-00866-00001 0.31 1.78 0.47 0.54 28 <0.2 - - - - - No Grilles AND-N5940969•00001 0.28 1.50 0.31 0.54 22 <0.2 - - - - - s Simulated Divided Lite or Installed Interior Removable AND-N59-00969-00002 0.28 1.59 0.28 0.48 21 <0.2 - - - - - o = Full Divided Lite AND-N-59-00972-00001 0.211 1.9 0.2B 0.48 21 <02 - - - - - FineligMT`(grilles-between-the-glass) AND-N-5940978-00001 0.28 1.59 0.28 0.48 21 <02 - - . - - No Grilles AND-N-59-00970-00001 0.28 1.59 0.21 0.48 17 <02 - - - u g o Simulated Divided Llte or installed Interior Removable AND-N-59-00970-00002 D.2B 1.59 0.19 0.43 15 <02 - - - m 200 Series E = Full Divided Lite AND-N-59-D0973-00001 0.28 1.9 0.19 0A3 15 <02 - Tilt-Was a 3 Double Finelight (grilles-between-the-glass) AND-N-59-00979-00001 0.28 1.59 0.19 0A3 15 <02 - - t No Grilles AND-N59-0098800001 0.26 1.48 0.48 0.9 35 <0.2 N - - - I 23 e c LLI . � Simulated Divided Lite or Installed Interior Removable AND�1-59-00968-00002 0.26 1.46 0.4E 0.52 32 <0.2 N - - - - 9 D i Full Divided Lite AND-N59-00971.00001 0.29 1.83 0.43 0.52 26 4 02 N - - - - - a 3 FInNIghtT"(grilles-between-the-glass) AND-N-59-00977-00001 0.29 1.85 0.43 0.52 28 <02 N - - - - - 2.2 Annealed Glass-w/Grilles 1"or Greater Simulated Divided Lite or Installed Interior Removable AND-N-59-00849-09003 0.29 1.65 0.26 0.49 18 <0.2 - ,S Full Divided Lite AND-N-9.00861430001 0.30 1.70 0.28 0.43 17 <02 I. Fineight"(grilles-between-the-glass) AND-N-59-00873-00001 0.31 1.78 0.29 0.49 17 <02 Simulated Divided Lite or Installed Interior Removable AND-N-58-00850-00003 0.30 1.70 0.18 024 11 <0.2 - " - - - Full Divided Lite AND-N-59-00862-00001 0.31 1.76 0.16 024 1D 402 - - - - - - O N Finelight*•(grilles-between-the-glass) AND-N59-00874.00001 0.32 1.82 0.18 0.27 10 40.2 - - - - - - i Simulated Divided Lib or Installed Interior Removable AND-N-59-00851-00003 0.29 1.65 0.17 0.39 13 <0.2 - - - - c '� Full Divided Lite AND-N59-00863-00001 0.30 1.70 0.17 0.39 12 <02 - - - m FinelightTv(grilles-between-the-glass) AND-N-59-00875-00001 0.31 1.76 0.19 0.44 12 <02 - - - - - - e Simulated Divided Lite or Installed Interior Removable AND-N•940848-00003 0.30 1.70 0.42 0A7 28 <02 © - - - - 5 0 � Full Divided Lite AND-N-59-00860-00001 0.91 1.76 0.42 gA7 25 <02 - - - - a F I nelIghr.(grilles-between-the-glass) AND-N•59.00872A0001 0.32 1.82 0.47 0.54 27 <02 - - - - - .rit Simulated Divided Lite or Installed Interior Removable AND-N-59-00969-00003 0.28 1.59 0.25 0.42 19 <0.2 - - - w tS Full Divide!Lite AND-N5940975-00001 0.28 1.590.25 0.42 19 4 02 - - - • Flnelight"(grilles-between-the-gloss) AND-N59-00981-00001 0.28 1.9 0.28 0.48 21 s 0.2 - - III - - - r .e Simulated Divided Lite or Installed Interior Removable AND-N-59-00970.00003 0.28 1.9 0.17 0.38 14 <0.2 - - - � ` 1 'tl : Full Divided Lite AND-N-59-00976-00001 0.28 1.59 0.17 0.38 14 <02 - - - FInsll ht' (grilles-between-the-glass) AND-N-59-00982-00001 0.28 1.9 0.19 0A3 13 402 - - - - This information is for reference only. Date le current se at December 15,2014 and Is subject to flange. Performance varies by unit size and options selected. Paget ot55 See 1M0e 1 for more Information. For specific unit performance information,please contact your dealer or Andersen Sales Representative. Commonwealth of Massachusetts Cj..*i.ction Supervisor�" Division of Occupational Licensure Unrestricted-Buildings of any use group which confab Board or Bundmg Regulations and Standards less than 35,000 cubic t(t21 cal c:":eta)c4 enckfmad Ccnst{r,PG�fbin tSlfpervtsor space r CS-090125 u ii'r ESpires: 10/06/2024 JAIME L MO' N i $4 NOTTING RAYMOND M1 is s I P v l ,�.kfrf4tV41 3a Failure to peas a current edition of the diessachuselill 1 g Cods is cause for revocation or dus ncanrre. Csmrnisssoncr dr� 4 t ncit az. For mtormatiort about Sirs license Call(011)7'27.3200 or visit www.rwess.govidpt Page 1 of 1 ,�c�oRo°' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (AJO._N9i+ F�tt1. {AIC.NoI: P.O. Box 305191 E-MAIL DRESS: certificates@willia.cam Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICO 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: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 AWL SUBR POLICY EFF POLICY EXPMI LIMITS LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MDDIYYYYI )( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 -DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 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 L l PECOT- 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 AUTOS ONLY AUTOS (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 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 EL.DISEASE-POLICY LIMIT $ it DESCRIPTION OF OPERATIONS I 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 "-'"' [, IT`'^'� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24694639 EA.Tcx: 3138744 uttice of Lor 10( Home I RENEWAL BY ANDERSEN LLC 30 FORBES ROAD NORTHBOROUGH. MA 01532 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: 5uppremerit Gard Regitfsation fallitsti411 170810 1222/2025 ENEWAL BY ANDERSEN LLC ,::' AIME MORIN 0 FORBES ROAD ' ORTHBOROUGH.MA 01532 '' 401- Undersecret, Page 1 of 1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 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. c/o 26 century Blvd tPHONE N,Ext): 1-877-945-7378 FAX Not: 1-888-467-2378 MAIL c P.O. Box 305191 ADDRESS: ertificates@willis.corn Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIL* INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC - - - -- -- - - ----- 30 Forbes Road INSURER C: Northborough, t 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXPM/ LIMITS LTR INSR WVD POLICY NUMBER (MDDVYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAIMS-MADE X OCCUR DAMAGERENc ED PREMISES(Ea occurrence) $ �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 ECX POLICY JT 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(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Pe accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION se X PERTUTE OTH ER AND EMPLOYERS'LIABILITY 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE No NIA MWC 314158 23 10/01/2023 10/01/2024 EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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 LIMIT $ DESCRIPTION OF OPERATIONS I 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�� 'VE egrtn Evidence of Insurance 4141; ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 24694639 BATCH, 3138744 uttice of uonsurner Attatjs and business Kegulation 1000 Washingtc - ret - Suite 710 Boston;-Mass setts-•02118 Home Imarovement Contractor Registration ti V r .... i Type: Supplement Card .........,.,.te �........�. ,w, RENEWAL BY ANDERSEN LLC ro _x: _____ anon: 170810 wr -- - E �ifation: 12/22/2025 30 FORBES ROAD a •; -= r •'""""" ' NORTHBOROUGH. MA 01532 """' __ +ar 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 Garr) Office of Consumer Affairs and Business Regulation RRgljtratiQD. .i EAPi itiQrl 1000 Washington Street -Suite 710 170810 it::12:22;2025 Boston,MA 02118 ENEWAL BY ANDERSEN LIG t` 41ME MGRiN �.4. err � 3 FORBES ROAD Ir..,:' " ,A11 A `- - /( r' / ORTHBOROUGH.MA 01532 Undersecretary Not valid with ut signature Go Permits, LLC 105 Buttonball Lane ASCII_ 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: renewalbyandersenAgopermits.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 t RENEWAL 191 byANDERSEN 4111Xeli toi iffiklitir To Whom It May Content This letter will authorize the following person(s) to act as agent(s)on behalf of Renewal by Andersen LLC, 9900 Jamaica Ave South, Cottage Grove MN 55016 to pull for per its and inspections with respect to the installation, maintenance and repair of windows and entry dont%iindpr ivipc:Arhusetts State liome impriyuement Contractor license ni.irnb€r 170810 and Construction Supervisor license number CS-030125 If you have any questions, please call me t 508.351-2277 est 6 Authorized person(sI: Go Permits LLC Sarah Harnmaci David Anciersoh Maureen Kivel Scott DoLghman Ryan B,ondo Sovannara Kuy Mark Foster Glynn Nor.gan Jennifer winke wency Hidden Gerald i..ramer Nick Raeo Danel Vpckerman Stephen Wilder Katie Grocott Bonnie Viers Carrie Fol gno Michael Rogers Rachel Orloff amie Morin Renewal by Andersen tIC HIC 170810 CSL -C5090125 Local District Office Address 30 Forbes Rd Northboraugh, MA 01532 renewal by Andierlell Ui.. eA'A)JaMiteLli Ave South.<ottabr Carom MV' 55014 Agreement Document and Payment Terms ' DBA:RENEWAL BY ANDERSEN OF BOSTON Stephanie Nurenberg Legal Name:Renewal by Andersen LLC 289 South St RENEWAL HIC#170810 Northampton,MA 01060 brANDERSEyN 30 Forbes Road I Northborough,MA 01532 H:(413)563-5207 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmaiLcom Stephanie Nurenberg 04/17/24 BUYER(S)NAME CONTRACT DATE 289 South St, Northampton, MA 01060 (413)563-5207 BUYER(S)STREET ADDRESS PRIMARY NUMBER SECONDARY NUMBER sjgn289@aol.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 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: $11,214 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: $500 BALANCE DUE: $10,714 Estimated Start: Estimated Completion: 7-8 wks 1-2 days AMOUNT FINANCED: $10,714 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 Financing 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 04/20/2024 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. 41_ 4.1.4I ickw44 SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE TJ Gentry Stephanie Nurenberg PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 04/17/24 Page 2 / 35 4SK5w./��-y Itemized Order Receipt =—� DBA:RENEWAL BY ANDERSEN OF BOSTON Stephanie Nurenberg RENEWAL Legal Name:Renewal by Andersen LLC 289 South St HIC#170810 Northampton,MA 01060 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)563-5207 RC SEM WON t ODuurtw.[n Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 101 Room 1 Window Acclaim Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior Terratone, Interior Terratone, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, Stone, Screen, Fiberglass, Half Screen, Grille Style, Interior Wood Only (INTW), Grille Pattern, Sash 1: Colonial 3w x 2h, Sash 2: No Grille, Misc, None , 102 Room 1 Window AcclaimT" Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior Terratone, Interior Terratone, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, Stone, Screen, Fiberglass, Half Screen, Grille Style, Interior Wood Only (INTW), Grille Pattern, Sash 1: Colonial 3w x 2h, Sash 2: No Grille, Misc, None , 103 Room 1 Window Acclaim Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior Terratone, Interior Terratone, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, Stone, Screen, Fiberglass, Half Screen, Grille Style, Interior Wood Only (INTW), Grille Pattern, Sash 1: Colonial 3w x 2h, Sash 2: No Grille, Misc, None , 04/17/24 Page 3/ 35 fig] Itemized Order Receipt DBA:RENEWAL BY ANDERSEN OF BOSTON Stephanie Nurenberg RENEWAL Legal Name:Renewal by Andersen LLC 289 South St HIC#170810 Northampton,MA 01060 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)563-5207 umu*MONI DO usurer. Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com ID#: ROOM: SIZE: DETAILS: PRICE: 104 Room 1 Window Acclaimm, Double-Hung (DG) 1:1 Slope Sill, Insert Frame, Traditional Checkrail, Exterior Terratone, Interior Terratone, Performance Calculator PG Rating: 40 I DP Rating: + 40 / - 40 Glass, All Sash: High Performance SmartSun Glass, No Pattern, Hardware, Stone, Screen, Fiberglass, Half Screen, Grille Style, Interior Wood Only (INTW), Grille Pattern, Sash 1: Colonial 3w x 2h, Sash 2: No Grille, Mlsc, None , WINDOWS: 4 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 0 TOTAL $11,214 Renewal by Andersen is committed to our customers'safety by IPA complying with the rules and lead-safe work practices specified by the EPA. 04/17/24 Page 4/ 35 Payment Authorization Form i•41 DBA:RENEWAL BY ANDERSEN OF BOSTON Stephanie Nurenberg RENEWAL Legal Name: Renewal by Andersen LLC 289 South St HIC#170810 Northampton,MA 01060 byANDERSEN 30 Forbes Road I Northborough,MA 01532 H:(413)563-5207 RICAMu nVOW 000111111(11ff Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Stephanie Nurenberg BUYER NAME 289 South St Northampton ADDRESS CITY MA 01060 (413)563-5207 STATE ZIP CODE PHONE NUMBER 1 PHONE NUMBER 2 180 mo.OP 6.99 0 $11,214 FINANCE PROGRAM* FINANCE PLAN** CONTRACT BALANCE TJ Gentry 0 04/17/2025 SALES REP APPLICATION ID OFFER EXPIRATION DATE *If your financing is pending,the Finance Program and Finance Plan Number are subject to change PAYMENT SCHEDULE ($11,214) CASH DEPOSIT(1) FINANCED DEPOSIT(2) SUBSTANTIAL COMPLETION(3) CREDIT CARD $500 $0 $0 FINANCING $0 $3.071 $7.643 (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 purchase price advanced when the windows and/or doors are ordered. 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)and. For all financings,the Buyer(s)will not owe any payments until Substantial Completion(as defined in item 3 below)and the Lender has 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. Buyer(s) authorize Renewal by Andersen to transact payments, including with Lenders, based on the amount(s),form of payment(s), and timing as specified in the Payment Authorization Schedule above and, if applicable,final payments in the amount requested by Renewal by Andersen upon the execution of a Change Order. 2. For Buyers that finance a project through a Lender, Buyer(s): (i) understand that the Lender will disburse the Financed Deposit and final payment at Substantial Completion to Renewal by Andersen as specified in the Payment Authorization Schedule,(ii) understand that the Lender will not extend credit to the Buyer(s)for open-end credit loans,(iii) the Buyer(s)will not.owe any payments until Substantial Completion,and (iv) acknowledge the use of the loan proceeds for payment upon Substantial Completion will constitute reaffirmation by all Buyer(s) of the loan agreement with the Lender. 3. Buyer(s) agree to notify Renewal by Andersen in writing of any change in payment method at least three business days' prior to the respective payment due date. 4. 04/17/24iie Nurenberg /Vl�l/L 04/17/24 Page 5/ 35 BUYER NAME SIGNATURE DATE Na If Using a Builder -- - - j DBA:RENEWAL BY ANDERSEN OF BOSTON Hannia Gonzalez&George Martin RENEWAL Legal Name:Renewal by Andersen LLC 1411 Westhampton Rd RENANEWAL HIC#170810 Florence,MA 01062 byDERSEN 30 Forbes Road I Northborough,MA 01532 Phone:(508)351-2200 I Fax:(508)986-7072 I rbaboston@gmail.com Property Owner Must Complete & Sign This Section If Using A Builder I, as Owner of the said property, hereby authorize Renewal by Andersen LLC to act on my behalf, in all matters relative to building permit application for the property/address indicated on this agreement. SIGNATURE OF SALES PERSON SIGNATURE SIGNATURE Victoria O'Day Hannia Gonzalez George Martin PRINT NAME OF SALES PERSON PRINT NAME PRINT NAME 04/16/24 Page 15/ 20