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25 VALIANT WAY - BUILDING INSPECTION renewal BY ANDERSEN` window replacerreenx e To Whom It May Concern, Enclosed is a permit application package for a project we have been contracted to do in your town. Thank you in advance for receiving this package by mail. As we work in every town in the state, it greatly helps us in our process. We have also enclosed a self addressed and postage paid envelope and would request that when the permit application has been processed, that you would mail it back to us. Finally, if you would mail us back a blank new application we would appreciate it. Enclosed for you review in this package is: ❑ Permit Application ❑ Home Improvement Contractor License ❑ Construction Supervisor License ❑ Proof of Insurance ❑ Proof of Energy Efficiency Rating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) If you have any question regarding this application please call me at 508- 919-0990. Best Regard, Kathleen Blanchard Permit Coordinator 104 Otis Street Northborough,MA,01532 Phone(508)919-0900 Fax(508)919-0903 Website: www.renewalbvandersen.com - CITY OF SI11.Fm, TANSSACHUSETrS BUILDLNG DEPARTMENT 130%,,sHiNGTON STREET, 3' FLOOR TEL. (978) 745-9595 FAX(978) 740-98" KI),[BERI.EY DRISCOLL MAYOR THobtas ST.PiERRE DIRECTOR OF PUBLIC PROPERTY/BcmnrNG co%a isstoNER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the 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 transported by: (name ofhauler) The debris will be disposed of in : (name of facility) (address of facility) signature of permit applicant date debriulldm lrenewa - _ BV ANOSRSBN' ri,denrep Customer Service 800-573-7606 104 OUs St:Nortbbomugh.MA 01532 Mein:(508)919-0900 Fax:(508)919.0903 W J8 Windows,Inc.dba Renewal by A oe n.Canhador License#14NOI Expiration Date 092=000 ,, �/ WINDOW AGREEMENT f I SOLD TO: �1 'N�r �*11 t[T YO U N DATE: 7 10 0 ADDRESS: -/ PHONE-Home:('t ar-Nc _"7 CITY: aIQr1r, 1Sn`T^A.TnEPt- ZIP: 6 6 PHONE-W�r: (�j)--71( -S(SY 4 JOB SITE ADDRESS(If different): Jlii1^ E-mail: (-:AYOUP4 71J - O �Pt000.COO Approximate Start Date::-:,: 0 -1 Approximate Completion Date: �a SPECIFICATIONS Renewal by Anderseltapproved materials will be furnished and installed to these specifications: 1. Install total of. windows. 2. Quantity of windows: Double Hung(DB) E-Equal sash 0 Cottage sash(113 top.213 bottom) O Oriel sash(213 top,1/3 bottom) _Casement(CW) O Hinge right O Hinge left(as viewed from exterior):OStandard handle OMetro handle _Double Casement(CDW) OStandard handle OMetro handle -Casement/Picture/Casement(CPW) O 1:t:t or O 1:2:1 OStandard handle OMetro handle _2 Lite Gliding Window(GW) _Glider/Picture/Glider(GPW) O 11:1 or O 1:2:1 Awning Window(AW) Cf 1-PlctureRYn.Wing�{q��g w. I 11 l 11 'DL �OO♦` JI�C 0., �l.N.w: Litt Prvtna ntRti 3. Iff Yes O No #Windows to be Custom Fit Replacement: ® l 4. ❑Yes ExrNo #of sills to be replaced:_ 5. ❑Yes END #Windows to be New Construction Full frame(Includes new interior&exterior casings): Exterior casings:-0 Pine 0 Maintenance-free material O Factory applied 908 Flbrex brickmold 6. Glazing to be: 3'Pigh Performance O Other If other,please specify: 7. Exterior color to be: CfWhite 0Sand OCanvas OTerratone 8. Interior colorto be: E3'White O Sand 0 Canvas 0 Terratone 0 Wood Note:Interior Color can only be while,wood or same color as exterior. Wood Interiors need to be finished by cusl. 9. Hardware: eWhite 0 Stone 0 Canvas O Brass Double Hung: Install lifts? 0 Yes L9rNo 10. O Yes YNo Removal of metal frames or grilles If of Units: �^ 11. 16Yes O No Install new paint-ready or stain-ready casings. Inside or outside stops#of openings: Interior Casing#of openings: ( Exterior casings f rings: 1 ❑Pine E�Maintenance free material 12. Customer aware that RbA does not do any painting Cust.initials 13. O Yes E'1No Wrap exterior casings with aluminum coil st color. Note:Required with storm window removal.Removal of storm windows will leave screw holes in casing. 14. New windows to have: O Hplf or 17Full screens Screens to be: O Fiberglass L9 Aluminum 15.Windows to have grilles: RrYes 0 No If Yes:{Grille Between Glass(GBG) 0 Removable Interior Wood(INTW) ❑Fyll Divided LightSFDL) Grille patterns: - F-1 ❑ M OH DH DH DH CW/Picture Glider (±E�p�'A/GPW 'use additional sheet i needed Customer approved(initials): W"6p- �. 16. IF] es 0 No Insulate,caulk and seal windows With three-point system to prevent water and air in Itratl n. 0 17. L es 0 No Remove and dispose of existing windows and storm 18. 1J3 Yes 0 No Clean Up. All job related debris removed.Vacuum nighty. 19. Yes O No Insurance. All workers compensation and liability insurance maintained. J_ 20. �jj Yes 0 No Warranty.Given to customer upon Completion and receipt Of full payment. 21.Additional information: _�1 coolI'el�lude. 6�Aft(l�ivaL- t1.301'K of 2M), U.� a 22. Regular Retail Price:$ ,ygUS _ 23. Total Project Amount:$ 12 073 All available discounts have been applied:NJ Yes O No `1 24.Is Project to be paid in 0 Cash ❑Financed Gi Combination of Cash and Finance 25. Cash DeposiH401R):$ 12A7 _ ue-S2OmpteHDRof9ob. Ifmmaining2/3paymentmmadebycrad#ce ,,anadditionalI of3%Wilbeaddedtocover teethe dby Credit Ceml 26. E3ties O No Financed, If Yes,Amount Financed: 5j1�(�- (Account#:04 6r07.3VQSc0v�) 27. �es ❑No Customer agrees to be present on the final d y of installation for final inspection and to deliver final payment. 28. yes ❑No Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure. 29. as ❑No Building Permit-As a convenience the Company will secure the building permit.The fee for the permit is not included in the agreement price and a separate check is required at the time of sale for this fee. 'RENEWAL BY ANDERSEN-IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE BEEN SEEN PRIOR TO OPENING THE WALLS. PLEASE REMOVE ALL SHADES,VERTICALS,BLINDS,CURTAINS,DRAPES OR WINDOW MOUNTED AIR CONDITIONERS,AND MY FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS PRIOR TO THE INSTALLATION OF YOUR NEW WINDOWS. INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. -SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND-OWNER'REPRESENTS THAT NONE HAVE BEEN WOE TO,OR RELIED UPON BY tlWNER.'YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT.'CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN CONSTRUCTION DEPARTMENT.TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE."is warned is a legal document Your Renewal by Anderson pmduda vul be eswNel)y made-toorder for you.UNDER NO CIRCUMSTANCES WILL REV S O $OR CANCELLATION BE POSSIBLE BLE BEYOND THE T IRD B 0.THE CONTRACT DEPOSIT PAID.BY SIGNING BELOW.YOU ARE ACKNOWLED IN-T e ! ABO cp C TS YOU ARE ORDERING ARE CORRECT.RDA Rep.Signature'. _J U _ Data: 2461107 Customer Signature/ Culu er Signature: Ile -Renawslby Md en YBIN Inallefion Pink-Homeowner 02-0Z-01 . _The; eontntonwealth of Massachusetts Department of Industrial Accidertts' Opu:of Investigations _ 600 Wa`shinglon'Sireet Boston, M4 02111 tvww mttssgov/dizi' Workers' Compensation Insurance Affidavit: Builders/Contra.ctors/Electricians/Plumbers Please Print Le ibl A licant hafoictnatiOld Na$e'(Business/Otgaa+zafionilndividnal): address n• M �ity/State/zip:_ Phone #:� � �Q :re you an employer? Check lbaappropriate box: - Type of.project (required). �am a employer with._ 4. I am a general. contractor and I 6. lve eoTJitrucbon L ave hired the sub-cOntractars errrployeis;(full and�oa part-time) 7. _ odding lisrcdoathcatiacbcdshccT_ 1 ' I aru a,solcptoprietnr or.partoer These sub-contractors bave $. E] Demolition . slip andbavc no eirtployccs . avoikas' comp- insurance_ 9_ Buildingaddltion working. for rrac in any capacity. iNq vwrk'trs' comp: insurance S, ❑.Wane a corponcoaaad iu 10:j] Blcctrical repave-or additions officers have cxetcistd their, : required,], 11.0 Plumbing repairs or additions T aril a berndownci.doing all work. right or exemption per MGL. myself. (No workers' comp. . , c- 1.52, §1(4), and wchaYcno 12:❑ Roafrepairs. , ` insurancq[equirod.] 1 elm oyees. (No workers' 13.� Other c?mp:insurance required.) y epplic.nt that erects box*I trwriaW filI outthesection belpwaliowing ca workers'wrnpcnl+Aon➢oucy infoittrnon - - Two". rlso.iutimit this•M&i it indicating they an doing all vorY'utd then Lve outddc'cilnkactorti must submit a new.affdaVfl mdiuCiiti suer ibacbrs ttsar,nhev k Ihis box`muri attiol,d an additional sheet sboHing the nuee o[ihe euswnvsi:tbn.and.Nev aorlien'.wrtp:policy infott'stWion. - ipntrnployerihot irproyidingworkerr'compensaFionznsuranceformytmployFes, BelowLsythe'➢o[icyand�obrire iraa6tCozupabyNarno: i4or Self--ins Lid'. Site Aaaras' ' S ail city/s4te(zip— 21 tcb a'copy ortbeworkers' eomp.ea sad onpoli cy eclatationpage (sbo.wi13g (he policyn,umber aad exptrat>ioo elate]. u�to seeuie coveraSt as rcquired>lnder Section 2SA of MGL e• 152.can lead's the irepos?noII of criminal pczxaloes of r ' up to S 1,100.00 alld(ot one-year imprisonment, as wel).as. civil penalties in the forin of a STOP vi.6AK ORDER and a fine . tto$250.00 a day-against theviolatot- Be advised that a copy.6fthis statementmaybe forWazded to the Office of Sdgations_df the DIA for insurance coverage vcrifkabon hereby ce uz} r the q!at s an Qen pities Ojpirjµry Thal the iriformaiionproytded above is titre qnd corre�- afore: Date.. . (fleia:l uge;orefy. Do-not ivYite iriYhis area, to be comPleted by city 0 r ro Wn Officiat. -. .InforMition and Instructions Massachusetts General Laws chapter 152 requires all.ernployers-to providcivoikas' compensation for their cr�iloyees. puisuaot ia.tbis stature, an•employee is defined as." ..every person in the soviccof another underany contract of hire, catpress or jrrrplicd; oral or written," An employe' is defined as "an individual,partnership, association, coipontion or other legal entity, or any tWo.ortnore. of the foregoing engaged in a joint enterprise,and including the legal iepresco U 6Ycs-of a deceased errtployci or the receiver or trwtee of as individual;partncrship, association or other legal entity,employing employees.:However.the ownerofa dwclling house havingnotmofe than three apartmcnTsand whoresidcs.tbczcih, or the Occupant of the . dwelling houscofanothcr-wbo cmployspgrsoas to do'maintenance, construction Or.repair Work On such dwelling house oz on the grounds.orbuildingappurknaat thereto:shall-notb coauscofsuchemploymentbe deemed tobc an crriployer_ MGL chapter 152, §25 C(6)also States that"every stag of local licensing agency shall'withhold the issuance or rendwal ors license or permit to operate a business or to coustrµct bWdiogs io'the commonwealth, for'.any- . 'applicant wbO has not produced acceptable evidence of complf"myvith the insurance cuverageregtsired. Additionally; N1G4 cDapur 152, §25C('i).states "Neither the commonwcaA nor any of its po'liecalsubdivistorss sLdll enter into any contract for.the pidbrinancc of public work until acceptable evidenoe of compliaiiccwith th -insuranco requirements dithit chapter have been presented to the contracting authority Appli.c.ints Please fill out the workers`compensadon iffsda3it complctejy,bychccking the boxes that apply'to yoursintatioa and, if necessary, supply sub-eoatractor(;)namc(s), addresses) and'phon .numbers) along with their ceitificate(s) of " insurance. ,Limited Liability Companies (LLC)orI.,i�ited Liability Partnerships (LLP)With Do employees other than..tbc. meritbets orpartnas;are notrcquiiod to carry workers' eompeasatioo insurance. Ifan LLC'orLLP•does bave. etrrp]oyees;,a policyis required.. Be advised that this affidavit maybe suDnuged to the Dcpartmentof;lndustt'al Acci'dcnta:for confirmation ofiwuranoc cgvcrago. Also.baaurtJo sign and date the-aMdavit:. The affidavit should be ieturnod to the city or town that the application for the parri't1or license being cqucsted, n'ot theDeparirnie nt of Indtittnal Atciden•ts.. Should you havcany'guations regarding thelaV�or.ifyoii arciequircd to obtain ,jwoikers'. corWensaboo policy;please call 0c Dcpartrgcnt,at the number listed below.. Self-insured companies should enter their' self-insurance license number on the appropriate line Clty'or,r6wA Ofllclals Please be sort that the afbdaviiis complete and'printtd iegribly. Thcbcpar tncnthas provided i space at th b 1.oCtoiri of the affidavit for-you to fill outin the eveaithe Office oflnyestigations bas to contact you regarding the applieanf flc&c be-sure to fill in the,permit/lic CELSc tlirfib cr whicb will be.used as a r4;fcrcncc number, Inaddition, am'applieant lhalmust submit multipleperrnit/license applications:inanygivcnycar,teed onlysubmit one affidavit indicating,current Polley information,(ifneccssary)and under`job Site Address"thcapplicant'sbould write "all locations m . (city or, town)."-A,copyoftbe af•Tida' * (bat bas bew offefallystatnped oimarkedbythc city or tovv may be ptovided to thc. applicant as,proof,tLat a,walid.affidavit i"s>on fit to futtpopctmits orlicenscs. A te:*affidavit must be filled out each ' year_Where a.home owner or.citieen.is obtaining a license orpermif dot related to any buiineas or commercial Yenture (i•�- a dog license or pomtitto burp l"yu etc.)said.person is No tequiied to'complett this affidavit The Office onxivestigations would like to thank you in advance.foryour cooperation and should you have any gisestions; Llcasedonotbesitatetogiyeusa.call: . be Dcpartmenf.s address, telephone and faxnumbu: - The CoLdmonwealth of Massachusetts Department of Industrial Accidents Otftce of Iitvestigatioris 600'Washington.S treef $ostori_MA 02111 �i/ee' �oaeamco�ntrreolti pyD..i�nct6d�,1,�d . Board of Building Regulations and Standards Construction.Supervisor License License:- CS 74251 F Birtfiddle. '379tl 963 - - E>pi abon 3/9/2009 Tr# 'T1065 Rests cllon. OQ ^_:oL ' JOHN K ESLER 104 OTIS ST NORTHBORO,MA 01532 Commissioner !Q\ Board of Building Regulations and Standards F. HOME IMPROVEMENT CONTRACTOR Re istspjr.attort 149601 /24/2 Exp �atron. T[24/2008 Type Supplement Card - RENEWAL BY ANDMSOQ r AIVAH MACDOPIAF6`=� T 104 OTIS STREET NORTHBOROUGH,MR'07:SR2 Administrator Jan 02 2007 15iZ6 JPAM,cKeone#I'nz - 734 662" 8101 " p Z. AC-Q:D,. CERTIFICATE OF LIABILITY INSURANCE 09/12/2008 wIODUCEM - - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MclCeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP MGCeone Insurance A ency, Inc. HOLDER THM CERTIFICATE DOES NOT AMEND, EXTEND OR - 9 . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE ' MAC N E°IaED Renewed by Anderson INSURER A: Haifford In3urance J&L Windows, Inc. INSURER O: 104 Otis St 16USER C> NDrthborough, MA 01532 E6URER o: COVERAGES t THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THEANSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTIMTHSTANOING 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 MALL THE TERMS, EXCLUSIONS AND CONOMNS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAW. - - - 1 POLICY NUROIR POLICY fiiECTNE� POUCYEXPMWW uEna B DEgRALlL1OUTV HER8858050 9/7106 9/7/07 EACHOCCURRENCE .: j 1 COMMERICAL(FUNERAL AwitiTY - PREMISES wo - t '100.000 O CWMSMADE Q.000UR - MED EXP Iir en i 10000. PERSONALMAOVINJURY i t000mo GENERAL AGGREGATE S ' 2 ,000,000 GEH%AOOREGITE UMn APPLIES PER. - PRODUCTS-COMPgPAGO t - 2OD0000 POIICY PRO.jFQTLOc. 1 . A AOTOMOSRIA W DUTY 35 MCC XD 6388' 1011/05 10/1/07 COMBINED SEIOLELEET i.' 1,OOD,000 ANYAUTO fELonMIn7 Al40WTME0 AUTOS. .. BODLY AUURY SCMEDULEO AVTOS- - . . D°^a`) S -M�RFD AUTDS - - - - BODILY INJURY, i - NON.04R�/UT06 - (Pr lwnAnQ - .. . - PROPERTY&WAGE . OARAOELU,MRRY - AUTO ONLY-EA ACCIDENT' t ANY AUTO OTHER THAN EAACC i AUTO ONLY; - A00 _ - - EXCtlENyRdLALW0.nY. ` - EACH OCCURRENCE I OCCUR CUMS WOE - ACAIEWTE j OEDUCTIgE IF . RETENTION - I - $ . A TYWOODOlRNSATWLAND '35VVBGNC8861 1/1/07 llll08 vcsr'mlu. . . O - ffwLOvwwLJAEIUtY - - MY ANY PAOPRIETORMARTHEbEXELLSNVE - - E.L.EACH ACCIDENT S 500,000 Otflt'EMi.NlER lkCLIlOEOT E.L.DISEASE-EA EMPLOYEE N slab MMN - - ALPRW.ION9blwr E.L.DISEASE-POLCYLIMIT .S 500,000 OTHER - OISR:W PTXII OF ORMTONI/LOCATIONEI VEHICLES IFACL=DME RDOED EY ENOOI UMMI SPECAL FRONSOM - CERTIFICATE HOLDER - - CANCELLATION MDOLD ANY OP M AOOVI DESCOGEO POLAXES EE CAtI MJUM OEOPE TMS WPATM .INSURED COPY .. DATE TAXI MEW,TO 13MMO ISSISIPA WILL INOIAVOR TO SIMI. 10 'DAYS 1YMITTIH NONCE TO THE CERTINCATS HCLOIII NMLO TO THE LEFT,OUT FAILURE TO 00 IO SMALL - . - IRA► O OIILIDATDN.OR UANUTV Of ANY 900 VON TW IMPAIRS,ITS AGENT M . IIEY TART. .. ORR RIPAPJIIIIT THE 94 ACORD-7,6 I2007,/OB) _ - _p = m.ACORD- RATION 19188 -, re al WoodNinyl Composite Frame Rnli gC&AViO Dual. Argon Low _ - Double Hung ENERGY PERFORMANCE RATINGS U-Factor(U,S)/I-P Solar Heat Gain Coefficient 032 133 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 54 MrnulncWrrr rtllwMM1a vnt Mru nC."c.nft—to rPgk.W WACp1ePrUYnr let d.%rrW n .4 PrPdPc ' Prdvn'k'nr+.NFRC.0",.n.1*r d.1.Nnd..1.1 rnr"uvlmrnkl ceMldenr tlnde rpcif pedwtfhr - Nfnvujl notncammrM rnr PorauctrnJ Jorr not N'rrlrc.i4r cMftm.rlrnY PmAklbrrAyrprclfic urr. . Cenmlt mrnvGCWory finndnlereMvinadatt prrlvrrtino nlMnrMtlrn. _T '1 DESIGN PRESSURE(PSF) - -H L C 25 00-0027o ' lN<JNAI'0'L'Mtll\ 'Nl1\IUI!LS]-0i�TNAIl'Ul M,ndnvmv 4truwfum.uiu lv Je M..nmr¢..dA ME.C.,CE.C,AI.E.C.p.AL IMNtatlan ngnFrmmk"MA NGIImrIY Call W.Pmp., - - - PUBLIC PROPERTY DEPART I%MW .w� APZ&JCAILQM FOR TNT arm Arm �3orr�,o,�,es��4�s�uu�Ww.oaans o�rr� D UM D 1.0 arm INFOMAMON Locadon Namae 0y11�� �3 V P►v0ub ki bea1N Ina;Caranallon Arse YM�_IN�Ioeb pyMlat YM 2.8 Olmmame V IWOR"TION 2/ Owner of Land <cQ w d 1�Q Address Taw GJ aL - -7 - 9 7 s.ocowf s THIS sEcnoN Irolt woRu IN � No$ONLY Add dm Renova*m Number of Stories RenovaW Change In Use New DemoUtkm Approximate year of Area per flaw a Exhow coil an Ofranovabon ( 0 Renovated of exrstwg buildfrp Now Wd 0esuipdon of Proposed Work: ce wine9.s� �s � � -- -Mad Permit 1( ��-�, r � What is the outrenl use of the ou"M7 M dwelin0•hold any`unb9_-_ Matadr of suitdYv, ssta Asb ? WIW ra&Adno cAri is lavil► nn M.hft-ft t�an+e Add►om and Pha+b Mew%Nam• - Addm"and PAa dl r .. . �.. HIC Rpwason 0 Ca�don S"0" t icertse Pwni fM C—''"wl°" Estes Coi s l E,IN,.nd Cod X 6741000 Reaidentli1 End Coal X SH1:1000 Canwnerclolk- An Addido"WOO is added M an Mam sue dug as?A*b we powti and Ipibiy VAM to avoid delays In DvcssdrO The dyad doss hNOW aPPV for a BulldbV ,to to the above stabd s goons. sWwd uncle►Dsnaft of Perry dsto 7- 1 ON � of 3 � A