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5 FOREST AVE - BUILDING INSPECTION (3) renewal BY ANDERSEN' I window replacement 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,selfaddressed andpostage.paid envelope,and — - would request4hat 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,*4� �90-0-s Kathleen Blanchard Permit Coordinator 104 Otis Street Northborough,MA,01532 Phone(508)919-0900 Fax(508)919-0903 Website:www.mnewalbyandersen.com renewal ' BYANDERST- _ Customer Service 500-573-7606 104 ma St.Nomix rough,MA 01532-Max:SW)919�0900 Fax.(50019190903 J8L W1rd .Inc dba Renewal by A nen COMragar Umnu#149601 Expira8an Dale Og12L2008 / '''S' WINDOW-AGREEMENT �j ? //� =7 SOLD TO:`J ©4 AI V-e- ZA � z n � DATE: O �:J//// / [/p ADDRESS: S �- 5T V V PHONE-Home:��) 0 7 /S�/ / CITY Q STATFy/r.J�V,Zip: 0 / 7 0 PHONE-Work: (_) JOB SITE ADDRESS(ifdifferni E-mail: Approximate Start Dale: Approximate Completion Date: SPECIFICATIONS Renewal by Andersen approved materials will be furnished and installed to these specifications: 1. Install total of. a windows.. 2. Ouentity of windows: 3 Double Hung(DB)%Equal sash D Cottage sash(113 top,2/3 bottom) D Oriel sash(2/3 top,113 bottom) _Casement(CW) D Hinge night D Hinge left(as viewed from exterior):DIStandard handle OMetro handle Double Casement(CDW) OStandard handle OMetro handle Casement/Picture/Casement(CPW) O 1:1:1 or D 1:2:1 OStandard handle []Metro handle _2 Lite Gliding Wndow(GW) _Glider picture/Glider(GPW) O 1:1:1 or O 1:2:1 _Awning W ndow(AM _Picture Window(PW) Bay or Bow Window: - 3. 9Yes ❑No #Windows to be Custom Fit Replacement:_ 4. ❑Yes 8�e-�N d o #of sills to be replace Mi _ S. ❑Yes #Windows to be New Construction Full frame(includes new interior 8 exterior casings): Exterior casings: O Pine ❑Maintenance-free material O Factory applied 908 Fibrex brickmold 6. Glazing to be: B High Performance O Other If other,please specify: 7. Exterior color to be:J.Wbile O Sand 13-0anvas 0Tensions S. Interior color to be:A White O Sand O Canvas 0 Tenatone ❑Wood Note:Interior color can only be white,wood or same Color as exterior. Wood Interiors need to be finished by Cost. 9. Hardware:IMNhlte O Stone ❑Canvas O Brass Double Hung: Install lifts] Ye No 10. ❑Yes O No Removal of metal frames or grilles #of Units: - 11. ❑Yes ZI No Install new paint-ready or stain-ready casings. Inside or outside stops#of openings:_ Interior casing#of openings: Exterior CasingXoings: ❑Pine ❑Maintenance free material 12. Custo er aware that RDA does not do any painingst initials13. O Yes No Wrap exterior casings with aluminum color. Note:Requiretl with sl ow removal.Removewindows will leave screw holes in casing. - 14. New windows to have: orQFPibmWns Screens to be: ZFiberglass O Aluminum 15.Windows to have grilles WJY.SANo If Yes: O Gnlle Between Glass(GBG) O Removable Interior Wood(INT%V) O FUILDivided Light(FDL) Grille patterns: #: R R B ❑ M DH DH DH DH CW/Picture Glider o PW 'use additional sheet if needed Customer approved(InPoal 1Yes ❑No Insulate,caulk and seal windows with three-point system to prevent water and 17,11i Yes O No Remove and dispose of existing windows and stone 18,1SLYes ❑No Clean Up.,All job related debris removed.Vacuum nightly. 19.yh Yes ❑No Insurance. All workers Compensation and liability insurance maintained. 200A Yes O No Warranty.Given to Customer upon Completion and receipt of full payment. / S 2 .Additional information: 5T/,y/��/ TAJL e- // Y Lti i D-C — N -�A.a �/ 22. Regular Retail Price:$.Z 2� 23. Total Project Amount$ ,/Sg All available discounts have been applied: Ye ❑No 24. Is Project to be paid in O Cash �Financed O Combination of Cash and Finance 25.Gash Deposit(1/3):$ 1/3 of balenm due at start of job and final 113 due at completion of job. If remaining 213 payment is made by credit card,an additional lee of 3%will be added to coverfee charged by Cradit Card 26M. Yes O No Financed. If Yes,Amount Financed!3 />P 9 (Account#: ) lT 27 XYes ❑No Customer agrees to be present on the final day of installation for final Inspection and to deliver final payment. r 8 Y „ es ❑ No Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure. 17, , �- 29. es ❑No Building Permit-As a Convenience the Company will secure the building permit.The fee for the / �y s permit is not included in the agreement prim and a separate check is required at the time of sale for this fee. -RENEWAL BY ANDERSEW 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 CONOmMERS.AND ANY 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 HEMS.'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 MADE TO,OR RELIED UPON BY-OWNER.-YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT ONTRACT EJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN CONSTRUCTION OEPARTME ERMS AND CON IONS GOV IS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract la,a legal dmumen Your ewalb ntlkr protlu Im ly mwei order for you UNDER NO CIRCUMSTANCES WILL III FOR THE REA R200i ICTS YOU ARE ORDERING ARE CORRECT. RDA Rep.Signature Date: Customer Signature: Customer Signature: enewel aY nderaen Yellow-Inahsirlon Pink-Homeowner Ths Corn>itonx'ealrhl ojMassachusnYs - Deparfrnenf of lndYtslCtal fl ccidenfs Ofu:of Investigations: 600 Waahinglori'Street Boatonr MA:02111 . . wwKmdsSgov/d10' Workers' CorPensation Ins0raoee Alfida.vit- Builders/Contractors/Electridans/Plumbers Please Print l e ibl licant fnfo3n►ation �2$c'(Husines3tOtbjrjizAnon/Individu10: - - ddress 'Ify/State/Zip:_ �lf)f Phone 'eyou an rmploxerT Check(be-approptiate box: ': Type of project (required) C ❑ Kiln a general oatractar aPd l 6, Q Ne construction 1 I am a ezVIO)ecrwi[h _; Dave Lirad tLc sub-contractors c.nwloyccs,(full androzyart->;rrlc)- 7. odclwg , attract- • 'listcdoatLaatiachcd-slicct 1 '.; � I`Ird2.soliproyrictoror.p, Tpcsasuti;con¢actorsbavc $. OD.crpolitiori'. , . Aip and Dave tao.ernployces . insuuance Worlawi. for mein any cbpacity,. Woikcrs' comp- 9 Buildingaddiaon S, Q Vye.are a corponoctt gad its [NQ wOi�. e�p: igSwAncc . , ' IO:Q ]3lcctrical repays oz additions'' rtquiicd,j; offcir3Laveexorcised tDcir, ri iofezcmptioupetMGL 11.0 Plualbingrepaus.�r additiotu ]I als abom6owncr.doiogal1Work and wc'hSyc>ao 12:[] Rooficpam. myself. (No Workers' coup c. 152, §1,(4), - :instll:anCe regUirud.j cinPloyecs (N0. orkers.'- 13.0 Other c?mp:insurance require tpplie.ni that cT<ets 2nR 1 murt>,lto fill .ottLa section Lc1Vr+aA°r•'ula t)teic rtnkera'cort+penL,oen pohoymCa.trn►notF �it5d.vie a+di2ati Ihc, ert doing ill �'.ork and the0-Lin outtift teLhzc(vti mutt subpvt new d�yil inm e�t'i.7ta such: ieo+.•h crs Ybo w6m'itthis. ^� Y - :cony:po, �• rtctoT7 thet,oheck Ihit Doi'rnu st�tdohcd�n.ddifionel'thetl tlpYltnr ore name.eCille tubcantni:lbnend thnc roan' ttq enrol-+>tirt an srnPloytr rh at is proyidina»orkers'compenta4a,% j i rurarteefor 7liy�TPlOyFer BCIO» CJ fhC�o(1Gj /r!d olt JllC malign n /•� 'r - •- aaca'CortspanyNaioe: --� ' Q 44 b iraoon Date,. � �'� yorsclfms Lic:�l; �.�.► 1� � G✓tCO�L ) ite Andress ('e��- - atyfstat�z>p ,�Lk p a copy ofthe1.vroiken' comp.ens>,tionpolley,dcelarali pllge (sbo.wsng.lhepP ityn,umber and sxpiratlioli date). •cto seeurt 00yeragd as requiredwhaei Section23A ofMGL'' e. 132.c?ii164'V t�e�pasiopL oferiminalpeaalties otr p to T1,500.00 at3d(vr one year itgpriaotlrnetil, as wdl.as t ivl�Penalnes in the fbon.pf a $TOP WORK ORDEg and a brae to S250,00 i day.againsttliaviolotor. Ile adyiscd'tbata copy 6ffthis ttatcmcutmayLc fortil zrdcdtn the OfScG of igations_df tbl' DIA for insurance 0OVcrigc vcrifuation . ercay c< tar} r the ni $ and persplties pfptrjµry fJral ijl<rrtforrnairoftptavldrd above is trt{e gn�corr�tt urcc 6L�� � C/ Date: .' I oil, f icial Ksc,ohCy.•.Do not ivriie iriYhtf ar.ea;io be completed'by city 0r iowry ofaciat. . ...,. Information and Instructors MasspchEA CCM Gen-121•Laws chaptcr152 roquiret all.cmployess taprondcwoikus' comp.cnsatiohfortheir employees: Pursuaot6 lEbisstatafc, an.•chrptoyeeisdcfinul as," .:'every. persopin the sdvicc'ofpnothczundcr any contract ofhire; express or iTrrplicd;!oral or written," An.empi er is defined as "an individual,part icntip,.association, corpoia0oa or oilier legal entity, or any ttivo.or tiwte . of the foregoing engaged in O joint eaterprise,and in chiding tb t legal iepresw v tivcs'of.a deceased errployez, or the rccdiveros uustec ofap.individuil;p arm efsbip; association orothrrlcgal eati•ty, employing employees.; However the, owner of a dwcllinghousehayingnotmotc thai) threw apar4nentsand.wbo.residig tbcreib, or the occupant ofthe dweiling $ousc of another wbo'ctnploysprm'us-to de mainteaancy construcnon or repair_yrorkon such dwelting bousc - or on the gro undi.or biai►ding appurtrnaat tb ctcto_shall.not b aoaus a of such employment be deemed b>b c an ciriploy er_" MGL chapter 15Z §25C(6)also states tba.t"tvcry state ot..local Iicensiny agcncyshall:with hot d (be,iasuance bi••' renewal ofa licEnse or permit to operite.a business or to,c.ontt►uct buildioysin'tb0 corn moowealth, fqr:.any 'applicon't wb6 bis.bot producid:&cceptible evidence of,compl fan ce:witb the ibsuraace cove rage regttlred." Additiopally;.MdL chapter 152,•§25C(7).states"Neither the commonwealthnor`pny of.its po'litiealsubdivisio= sball . , cntirr into:any contact for tlic performance ofpublie work until pcceptablc cvidcuod of compliance witb tb insuranco- rcquircmcnts ditbis chapterbavabccnprescntdm the contractingautbority Appii.eim is Please f}I'out the workers'cormcnsation affidavit completely,by chccking the boxes that apply to youi aititatioa and,'it necessary, supply sub-eootractor(s)oamc(a) address(es) and'pbonenurnber(s) along with theircertifeate{s) of iosuiamce. ,Limited Liability Cott>Danies(LLC)otLinited Liablit'y Paimttsbips (LLP)with no employees othes than.the . merh ers orpartncrs;and 10 reyuitad to parry vlorYnrs' eortrpeasation'insur.=ce. If an LL C or LLP.does baye aryl oyccs;,a p oli cyas roq uircd., B c,advi s od tb at ihis affi davi t may:b a su ti7iii gcd to th c Dcp aiuncnt o f;Industrial Accidents%for eonfirvtation ofiastitanoc coverage. Also.be sure'to sign acid date the aftldayit:.•'The affrdavii should ` bcictarrnpd to the city oT town that the application&jtbe'pdTr tpr license is bp—ugrcquested, b'ot thcDcparirsscnt.of hduitrtal"Accidents "Sho.uld.youbaveany'qucstions regarding thclalvbr..ifyou grcrcquired to 0 tain9,yoikrrs' compcnsalioa ¢nitcy;,please call (he Deputmen(atthe'tiumberJistcdbclgW, Self-iusured.cOTr.Tanics should cnteitheit sclf-insu ct license nurnbcr on me appropriatc;line: laty'or Tow•u"Offidals • - ' - Please be Sure that the aibdayiiis complete and' ttd legzibly. Tbc DcpartYncbr.h4s provided i space•at the'bot?oni of the affidavit for.you to fll out in the eveoi'the Office offfi,ostigations bas to contact you.regarding the ppplicauC'. Plcate'be.sure to fill-in the permit/)icetue ourtibez Wb3oh v i)IDc-use:d as i rcfvmccnumber. In addition, an'applaeant that.must submit multiple,yext Vlicensea ppliytions:ivanygivcnyear,n'etdO nlySutirrtitoneaffidayitindieatiagri+rrint policy information•(ifncccssiry)8Trd undcr'JoE.Sitc 4ddress"thcapplicantshould yvtitc "alllooationsin. . {city or circa)."A:copy o Cthd a fFiidavit that bas beco'ofl5ciaby stamped ormaiked bythe city or town may beprovided w5 the Dphca'Dt as proof.that a,"wlid.affidaIM is:on file.for &t4icepermits orlicenses..AvCjv affidavit must be filled oui ocb 'a!•R?bere,a.bome oY✓neT of citiren.is obtaining i license OrperlrVf oat related tn,any bu3iness of commercial ScGOnue dog licens c or p crrnit to burp,lea vcs cto.)s aid person is NOTrcquvcd to complete this:affid avit be Office ofTnvestigationi would like to thank you iL advarico,foryour w6p'tration and should you.baye any ,q, now; lease donothesitate too giyc us a.cill: . e D ep artm ep fs,i ddres s, telephone and-fax h'urnbor: - . The Commonwealth-of Massachusetts Department.bf lndustrW Accidents Offike of Investigations 600 WashiAjton.Shreet ' - Eostoli_IVfA 02111- _ . . • .Fe Board of Building Regulations and Standards Construction.,Supervisor License Licens'e:`CS 74251 . Blrthdate,` 3/9%1963 EXPrrabon 3{9/2009 Tr# 11065 Rest[Icbon i' JOHN K ESLER 104 OTIS ST NORTHBORO, MA 01532 Commissioner TP �an�noouuroLl/ �✓Gls \ Board of Building Regulations and Standards TO HOME IMPROVEMENT CONTRACTOR Regislralrori 149601 EXpirallon e11124/2008 4 - 3ppfement Card RENEWAL BY ANpERSOrt-_ � i�?! KATHLEEN BL ---7J 104 OTIS STREET NORTHBOROUGH, MA 07332� Administrator x ACOM CERTIFICATE OF LIABILITY INSURANCE D0'8/29DD007 os/2s/2oo7 PRODUCER ; THIS CERTIFICATE IS ISSUED AS A MATTER OF -INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 'BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC III INSURED Renewal by Anderson - INSURER A: Hartford Insurance Company J&L Windows, Inc. INSURERS: 104 Otis St I INSURER C' Northborough, MA 01532 NEER D. NSURER E: COVERAGES 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 ANYCONTRACT OR.OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I DAD POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBERXXL_ LIMITS B GENERAL LIABILITY HER8858850 - 09/07/2006 09/07/2008 EACH OCCURRENCE S 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Es oorunm. $ 100000 CLAIMS MADE ©OCCUR MED EXP(Any one person) S 10,000 PERSONAL S AOV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,060,006 GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS-COMPA)P AGG S 2000000 . POLICY PR0. LOC A AUTOMOBILE LIABILITY 35 MCC XD 6388 10/01/2006 10/01/2007 COMBINED SINGLE LIMIT s 1,000,000 ANYAUTO (Ea ecddenl) X ALLOWNEDAUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) - - HIRED AUTOS BODILY INJURY ' NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANYAUTO OTHE THAN EAACC $ AUTO ONLY: AUTO O pGG S EXCESSNMBRELLA LIABILITY - EACH OCCURRENCE is. OCCUR CLAIMS MADE 'AGGREGATE _ S S DEDUCTIBLE 1 f RETENTION S - Is TAT TH'� A INORKERS COMPENSATION AND 35 WBGNC8661 01/012007 01/01/2008 WC S TU- EMPLOYERS'LIABILITY _ E.L.EACH ACCIDENT S 5OO OOO ANY PROPRIETOR/PARTNERIEXECUTIV E OFFICERAIEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S SOO OOO N yes,AL PR a ISIO _ SPECIAL PROVISIONS EeIav - E.L.DISEASE-IDIOCY LIMIT f 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate Holder is Additional Insured. CERTIFICATE HOLDER CANCELLATIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER V/ILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND WON THE INSURER,ITS AGENTS OR REPRESENTATIVES. -- AU ED REPRES E ACORD-25(2001/08) CORPORATION 1988 ; Erna �sfl�.v- ' k v z .�., t reMal . *,. dN Wooin I Com � NaronalFene&abon Y PositelF '.Rel.ngCa>nal®.. Dual Argon Low - - Double Hung ENERGY PERFORMANCE RATI ua U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0x33 0 . 30 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0AB MSnuhctumrptlpuNW draft mace mtlnpa conform to applisaEN NFRC procedurvs for determining whom product podormance.NFRC ratings am detamrined lou flsad sm"fi,nAmmorintal conditions and a sp ine product she NFRC does not meommand any product and does not Warrant tha fir 011lty of any prod, 'WrIc produ use Consort manukdume,ltarstum for.0i product padamynce Infooration. )k WWW.nfro.0 k. y . ® _ 8 Y DESIGN PRESSURE(PSF) 14 n ed H - LC25 100-00336847-047 -I Tarctlb MS XDq lgl 5]-0>or NAB a, Meoofxrurtrs'ulNumvfomuwubihen 4WIc RmdnNs )Moab of...ad,M.E.C.,C.E.Q6I.E.C.C.Air Infiltration mqulmmmry WDMA ImlooM CeN!ibn Pmgmm. - PUBLIC PROPERTY DEPART�,iT wro. ------------- 12srrw,ow,�s,��sKa��e�sOH'!a �m�estss�►s+r►»a+w D 1IC1VRw O Tun • 1.�31TE iNfORMA7WN . Lxadon Noma . � r P►opergr M bea/M fn a;Conawa►al Area YM___���plMlat YM 23 OWNERS INFORMATION . 21 Owner o1 Land NOW Address; TMephone; 3.000MP1601 t TMIN SECTION FOR WORK IN 9UILDIN44 ONLY Addttlon Renovaum Number of Stories Renovated Change in Use Demolition New Approximate �� you of Area per Aoor s Conatrucdon or renovation Renovated Of saistkw building New t�el Dexription of Proposed Work: OIS3 yytsat is ur ouesm wG d th*sui,"7 --- --........... ...................................................... .................... v a nos now d9uYdM+4 Ca+b^to LaMR �bptos? M&Aao[s Name l A�adt!!!�!ns Ff+aM Mdra.s aed F1ta+s C..lnwion SuP'row°"Llcw" WIC R.pMtOOn � •� � gq panic FN C---'�"'�•11°i� ES* mi-a Coat d Fri Eatln.Wd Cad X$71$1000 R..� pow*Fs.S— —'. . gin l.d Cod X:/1161000 cwmn@m .- M MOW#=8.00 it add d ar to make awe Qua an flow ar. and�yby w men to avoid d~in vn= hanby aPP fOr Bulk**s Bulk** Pon*to to to aba. 7h.�tpn.d does atabd Dom, sW*d under D� d terry s � I a � -- - - � `�