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HomeMy WebLinkAboutBuilding Permit #848-12 - 225 MARBLERIDGE ROAD 5/24/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: -I,;: �11e- I IMPORTANT: Annlicant must comblete all items on this pane LOCATION M&r Print MAP NO: (23, n PARCEL: ZONING DISTRICT: 2 Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 4S�e -tYi® Well ,.��,(� V� MMUql � ' •'®�Flooclpitilm D Wetlands .�:� y'KS. ®Wj„atershedD sffiW ','!{q {.'j S�A••�. � � ®Water/Sewers � M DESCRIPTION OF WORK TO BE PERFORMED: 'R e k(A A ,_ , - (),o W uA' Ant 6-( - rl n S---V-T\0c: OWNER: N `(Identifi/catign lase T"e or Print Clearly) JDV�✓� � YN ��L�e � t_6 J�, Address: S- maw �1� Q AA -e- i2c� --�39- oHa --) CONTRACTOR Name: Phone: S-DO- 3> 5 \ - O s oo V-,5-5,) S b Address: 6 l S') Supervisor's Construction License: q S4-6 Home Improvement License: 1q6?t o Exp. Date: 67— ?— ( a Exp. Date: 1 .23 - k -3 ARCHITECT/ENGINEER )Q l Ar Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ q to .q , FEE: $ ��o S!•Oa Check No.Receipt No.: ?�r , NOTE: Persons contracting with unregistered contractors do not have access to the gKaranty fund i� a a Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits.for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 200 8m W Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ ' Tanning/Massage/Body Art ❑ Swimming P0018 ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature - COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes u Planning Board Decision: Comments a Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes_ Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$1o0-sl000 fine NU I t5 and vA I A -(t-or department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location J ";I �— , Z// / W, " W ,e -12 f No.— Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $--�a9 Foundation Permit Fee Other Permit Fee TOTAL Check # 25340 13,dilding Inspector .. No O z i co Q E Q L Q Q v Z CD Q. Q y ® C CD cm o .0 C yC .ff m m CD co L- 93- Cm .C Q Q L m Q d m: cmcc C Q Q Q Q C.3ca Q J .� Q Q CL C3 VD m C C 4r � C _Q C* LLI 0 V/ U) ItW W C9 ,,Www W (U o o A as c a a A C H O c ' � o w° �, CO O CO.t L� Or. G w° a°' U ca w x :3 a° w w x c2 u U) —cow d �ocd Pd w W r rq cn cn i co Q E Q L Q Q v Z CD Q. Q y ® C CD cm o .0 C yC .ff m m CD co L- 93- Cm .C Q Q L m Q d m: cmcc C Q Q Q Q C.3ca Q J .� Q Q CL C3 VD m C C 4r � C _Q C* LLI 0 V/ U) ItW W C9 ,,Www W o as c C H O c ' � O CO.t L� W m c Ecia m� = C3 b' oa �3 Ec O O CS o me E o. , y �p O Mo C* = 12, my '� •= O• � m a o ev �sy C c ev m 0 �i ECD _ - CLU b.:m y m O ED C c cm C3 rC+ y six �.O 7 rnZ. CIO `o o ,.. cm Q ® C2 CLc i m c •p = m d"_"'p N rr 'Dm COD LJJAR +•+ •O s Z a+ Oc ,y O O W E C.,C C Z O -0N- Q CO.i.y cn CJ o O'O 0,�O C h C. m .0 2 R o y '� O f- s C.�m i co Q E Q L Q Q v Z CD Q. Q y ® C CD cm o .0 C yC .ff m m CD co L- 93- Cm .C Q Q L m Q d m: cmcc C Q Q Q Q C.3ca Q J .� Q Q CL C3 VD m C C 4r � C _Q C* LLI 0 V/ U) ItW W C9 ,,Www W '= �Iassachusctt> Dcfru7mcnt of Public S:tfctN Board of, Buildin' Rendations and titaridartfs Construction Supervisor License License: CS 95707 BRIAN DENNISON 4cP 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/82042 C nuniaiuncr Tr,: 2622 ,per J,lze -Pon�ma�ncue� o�✓%/�aaa¢r�r�ae�`a �\ Office of Consumer Affairs & B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: 70810 Type: Expiration: 1s2l2013 Corporation R VIAL BY Allaf_l}I�,ORATION BRIAN DENNISON; 1D4 OTIS ST. NORTHBOROUGH, MA. 01 �� Undersecretary GERTIFICA TE OF LIABILITY Y INSURANCE (MMIODIYY" 01/11/2012 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 poficy(ies) must 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 1-612-333-3323 CONTACT Jonelle Hargrove or Katie Psimos NAME: PHONE FAX AIC Nn Ext: 612-333-3323 "."No: 612-373-7270 Hays Companies E-MAIL ADDRESS: 80 South 8th Street PRODUCER cusTO E ID Suite .700 Minneapolis, MN 554D2 INSURERS AFFORDING COVERAGE - NAIC ' INSURED INSURERA: OLD REPUBLIC ZNS CO 24,147 INSURER B: NATIONAL D11=N FIRS ZNS CO.OF PITTS 19445 Renewal By Andersen Corporation - INSURER C: 104 Otis Street - INSURER D: ' Northborough, MA 01532 INSURER E: ' INSURER F: PERSONAL BADV INJURY. $ 1,000,000 COVERAGES CERTIFICATE NUMBER: 25114267 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. NOTWFFHSTANDING 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 LTR TYPE OF INSURANCE ADDL SUER PLIC POLICY EXP S POLICY NUMBER IMM/DOY EFF fMMIDDNYM LIMITS - A GENERAL LIABILITY MWZY 55313 1.0/01/1 10/01/12 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Anyone person) $ 2-01000 CLAIMS -MADE IT OCCUR PERSONAL BADV INJURY. $ 1,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'LAGGREGATELIMIT .APPLIES PER: -PRODUCTS - COMP/OPAGG S 3,000,000 - S _ X POLICY PRO LOC A AUTOMOBILE LIABILITY MAI'B 21377 10/01/1 10/01/12 COMBINED SINGLE LIMIT $ 3,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ • X SCHEDULED AUTOS HIRED AUTOS DAMAGE (Pena cident) $ $ X NON -OWNED AUTOS $ B X UMBRELLALVAB X OCCUR 25030519 10/01/1 10/01/12 EACH OCCURRENCE $ 25,DOO,ODO AGGREGATE $ 25,000,DDD EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ S X RETENTION S 25,000 A WORKERS COMPENSATION MPTC 117140 00 1D/01/1 10/01/12 X WC STATU- "ETR ANYEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE� OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N / A _ EL EACH ACCIDENT $ 1,000,000 E.L DISEASE -EA EMPLOY $ 1, DDO, DDD E.LDISEASE- POLICY LIMIT $ 1,DDO,DOD be under It yes, ESCRIPTIONOFO DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES ACORD 101, Additional Remarks Scheduie, it more space is required) . _(Attach Fvidence of .Insurance. l../iN4CLL'H 1 IUItl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE F'vidence of Insurance THE .EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE )-_Dsimos - © 198B -2D09 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name'and logo are registered marks of ACORD 251142.67 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston, M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contra.ctors/Flectriciains/Plumbers A-Pl2licant Information Please Print Legibly NaMC (Business/Organization/lndividual): e 11 P Address; City/State/Zip: 0()C-�A �,cc), In2�; C 153 Phone #: 5 Are you an employer? Check the appropriate bog: 1, [ I am a employer with D 4. ❑ I am a general contractor and I employees (full and/or part-time). T have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their . 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' . -comp. insurance required.] Type of project (required): 6. ❑ New construction 7.. remodeling S. �❑ Demolition 9. ❑ Building addition 10.7 Electrical repairs or additions 11.❑Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other `Any applicant that checks box #1 must also fill out the section'below showing their workers' compensation policy information, t.Romeownms who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractars that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an .employer that is providing workers' compensation insurance for my employees. Below is itze policy and job site inf orrrzatGon, r In.eirrance Company Name:_ L/ (� f' p C \ C r1 S , -b Policy # or 5e1f ins, Lic. #: > , 1 �I Expiration Date: Job Site Address: �� 1 y V�rV1'1P �� �C4 e— City/State/Zip: ly ✓1C�t�� ©( B�4 S� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a' fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be. forurarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby.certify un er..the painsYnd penalises ofperjury that the information provided above is true and correct Sitrnature: � i� / Date: Phone#• .3 Official use only. Iso not write in this area, to be completed by city or town officiaC City or Town: PermiVLicense # Issuing Authority (circle one): 1. Hoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector .6. Other Contact Person.: Phone e n e w a I -..., Ck .ewal by Andersen Corporation MA Home Improvement Contractor byAndersene • 104 Otis St., Northborough, MA 01532 License # 1708 10 (Expires 12/23/2013) WINDOW REPLACEMENT an Mdenen Company (508) 351-2200 � Fax: (651) 351-4810 Federal Tax ID #41-1918413 WINDOW SPECIFICATION SHEET Buyer(s) Name Date of The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of — Xe _ windows in Owner's home, using the following individual quantities: X Double Hung (DB) ❑ Equal sash ❑ Cottage sash (1/3 top, 2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom) Casement (CW) ❑ Hinge right ❑ Hinge left (as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement (CDW) ❑ Standard handle ❑ Metro handle Casement / Picture / Casement (CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) Glider / Picture / Glider (GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) Picture Window (PW) Ba or Bow Window Patio Doors (see separate Door Specification Sheet) 2. es . No Qty of Windows to be Custom Fit Replacement: ' ��"" 3. es ❑ N ty of Sills to be replaced by Contractor: I� CawrJti."c. .T/�l 4. ❑ Yes El of Windows to be New Construction Full frame (includes new interior & exterior casings) and actual Exterior casin Pine ❑ Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be:HP Lo -4 TM E]Other If other, please specify: 6. Exterior color to be: E]Sand ❑ Canvas E] Terratone ❑ Cocoa Bean 7. Interior color to be: Ln—White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: interorSlor can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware : [' White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes /XNo Install Lifts wit Double Hung Windows 10. Screens: windows to have: 2 Half or ❑ Full screens Screens to be:IO/Fiberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11. Windows have grilles;�Klles [INo If yes: E]Grille Between Glass (GBG) ❑ Removable Interior Wood Unmv Full Divided Light (FDL) Qty:__ { (R Qt' Qty: - Otv: Otv. n,,,• 1 //e r,`,,. DH DH [E' DH CW/PicNre der1 CPW or G Draw grille patterns above "Use additional sheet if needed Owner approved (initials): I ti ADDITIONAL WORK DETAILS 12. ❑ Yes Q No Contractor will remove metal frames of windows. Qty of Units: 13. ❑ Yes 4�5, No Contractor will install new paint -ready or stain -ready casings. Interior casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance -free material 14. ❑ Yes .�4—No Contractor will install new paint -ready or stain -ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty of pgenings: ❑ Pine ❑ Maintenance -free material 15. Owner is aware that Contractor does not do any painting. ( 1� ) Owner Initials 16. ❑ Yes No Contractor will wrap exterior casings with aluminum coil stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. 17. Yes E]No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 18Yes ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly. 19 Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20Yes ❑ No Buildin Permit --Contractor will secure any and all necessary permits. The fee for the permit(s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. 2>'es ❑ No All discounts have been applied to this agreement price. 22. Additional job details: 23..1es ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by An er an Cox orati By: Signa of Product Mana er Print Name of Product.Manager Buyer(s) Buyer(s) j1v -C— Signature 1_kk chE, yl F-.— Print Name Signature Print Name Renewal LA MA Home Improvement Contractor License #170810 (Expires 12/23/2013) byAndersen, Federal Tax ID #41-1918413 WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation 104 Otis St., Northborough, MA 01532 (508) 351-2200 • Fax: (651) 351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Name - Date of Agreement Buyers) Street Address, City, State, and Zip Code E -Mail Address HorDe Telephone Number Work Telephone Number i70 q3J-- G W" reit ( 5-7�4 Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement"). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. �I Total Job Amount:—Estimated Starting Date: Method of Payment: Deposit Received (33%): 1370V -2? ❑Check ❑Cash ❑Financed Balance at Start of Job (33%): %3 7� Z/ ❑Visa/MC ❑Discover AMEX ' Balance on Substantial' �U 5Z Estimated Completion Date: )- "- �'IJ If credit card is selected, please see Credit Card Payment Form. Completion of Job (33%): -7—I Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Sig ture of Product nager Print Name of Product M2,—g. er Buyer(s) nw�— Signature Print Name Buyer(s) Signature Print Name i YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BLISINESS,DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. �- - - - - - - - - - - - - - -x - - NOTICE OF CANCELLATION Date of Transaction . You this transaction, without any penalty or obligati three business days from the above date. If you c property traded in, any payments made by you Contract of Sale, and any negotiable instrument by you will be returned within 10 days Wlovei by the Contractor ("Seller") of your cancellati and any security interest arising out of the trans be canceled. If you cancel, you must make avail Seller at your residence, in substantially as goo as when received, any goods delivered to this Contract or Sale; or you may, if you wis with the instructions of the Seller regarding a return shipment of -the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Otis Street, Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF , (Date) I HEREBY CANCEL THIS TRANSACTION. — may cancel I Date of on, within this trensacti ancel, any three busine under the 1 property tra executed I Contract of 5 ng receipt I by you will on notice, I by the Con action will I and any sec able to the be canceled. d condition Seller at you you under as when rec h, comply Contract or th ' -x- - ---- - - - - - � NOTICE OF CANCELLATION Tran . You may cancel on, without any penalty or obligation, within ss days from the above date. If you cancel, any Jed in, any payments made by you under the ale, and any negotiable instrument executed be returned within 10 days following receipt tractor ("Seller") of your cancellation notice, urity interest arising out of the transaction will If you cancel, you must make available to the r residence, in substantially as good condition eived, any goods delivered to you under this Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice Of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable fOr performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Otis Street, Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF . (Date) I HEREBY CANCEL THIS TRANSACTION. Bu Signature Print Name Date I Bu Si ture Print Name Dote Buyer's gna Buy." s gnv RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink QBI1P2009.RBA-Ph.MANH 91A Berlewa"I, b y��.e�rs�r�. WIKDOW RERLhGEMENT atLMdersrnCompxny DESlGN.PF(E55UF[E(PSF) Wood/Onyl Compasite IF RIM "I mer Dual Argon Low E4 smart5un H- Double Hung - 106-00473518—Q10 ;ERERGT PERFD,RNIANCE RATINGS U -Factor (1U.5)/I-P Solar Heat Gain. Coefficient. 0 2-9v% ADDITIOM PEUDRMANCE RATINGS Visible Transmittance U m 4Z.' Atanute_tvrar stipvta,a that tnaa rstin_rs evnlvrm ,a appfcabk NFRD p reaadvras,nrdecantunhtg tuhok produol NFRO rstfngsara aaamilnad forefxad sal of anJvonmanral �ndlY'nacand espsedc prvduel s¢:. padammnva. . NFgC doa_- nrn rcevmmend any praduc[ and doa^_ not warnnc tha suhabiliry of any produn fnrany specrie urs ConsuA mmtuherurar's Ihamture fdr athar product periomrance infvmsuon. aaccGraen it ThL pradr._l .—M- Saal`n envirvnmamal' 'w�'. 1 vandares mvamina nergy ,. aficiancy, •he vym cabin .:5 ='-tha i and sesh 02 _ i._ :("" r`°"�-"" ti. _ 4 � � •, 1 �rFf �5a^'^�-i^`, ci;..r;�.;�":',<g 1 �. „ ,�;t4,. ., :rte• r�� I DESlGN.PF(E55UF[E(PSF) a� i 6anvfaeW2RA;mrs(cn a : �� 1 t H- www.wemacmn RbA DB. Sloped Si11 -DH ilk . lestto Nl{{���.m%JddAlCrdA1�5G10t,t5/h{SaA AiaRnaet E•slloCrdllc wnfarrrrazrsw 416 aoo1:a45,searnuo= daets Taraseeds LECZ-Ail lnlftnn(ian rzqui2mants VMMK Hallmark Cartne ibn Prmmm - '12 c uj r Renewat cn LciviLE-4 SmarSull Dual product TYPE:. Glidar UFactor Solar HE::± GaIn C;D- allt U.19 C- P 71 p NRasS -off"43 =�D�rrammarD IQFF�ouc "o .. irenctllic-u�p 0 Al DP — wSats mAro mm= scaW� mt6m,4, CL in alEtPmTW---- --It At m no t IDD-OD5114M ror= RE't1eWC�I Renewal b Andersen Corr1 oration MA Home Improvement Contractor Y Y MA License # 170810 (expires 12/23/2013) Andersen. 104 Otis Street • Northborough, Massachusetts 01532 Federal Tax ID# 41-1918413 w NDow REPLACEMENT an Ami penCbmr;iny Phone (508) 351-2200 • Fax (651) 351-4810 CONTRACT AMENDMENT This Amendment ("Amendment') is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ("Agreement") by and between Renewal by Andersen Corporation and MICHELLE FOX ("buyers"). Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and conditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions, alterations, or deletions to the products and services Buyer(s) ordered are being made: ADD (1) WINDOW UNIT ADD (10) EXTERIOR CASINGS CHANGE TO PINE INTERIOR ON (18) DH UNITS & 1 PW UNIT ON EXISTING CONTRACT $5838.30 As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or marked as "N/A", indicating that no change applies: NEW Total Job Amount: $46951.30 New Estimated Method of ✓ Cash ✓ Check ❑ Finance Starting Date: Payment: New Deposit Received (33%): $13704.00 ❑ Credit CUSTOMER Card New Balance at Start of $16623.65 New Estimated Job (33%): CUSTOMER Completion Date: **If credit card is selected, please see Credit Card Deposit Form.** New Balance on Substantial Completion of $16623.65 Job (33%): CUSTOMER By signing this contract amendment, you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion of Job cannot be made by credit card and must be made by personal check, bank check, or cash. It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowledges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date written below. By: Renewal by Andersen Corporation Buyer(s) Signature of Product Manager SHAWN MAYNARD 5/25J2012 . Date Print Name of Product Manager Signature Date Doc ID: 20120517133556375 Sertifl Electronic Signature iAb To all Building Departments: To whom it may concern: Please accept this letter as notification that I am authorizing Michael HIebanoff as my representative to conduct business with your building department. This would involve the submitting of applications for building permits and the picking up of the same. He can conduct any business in my name that is permitted by your department. If you have any questions please feel free to call me at: 774-545-0329. Thank you, Brian Dennison MA CSI. -X957( Renewal by Andersen 104 Otis St. Northborough, MA 01532. 508-351-2200 X 55285 104 Otis Street Northborough, MA, 01532 Phone (508) 351-2200 X 55285 Fax (508) 774-987-3013 Website: www.renewalbyandersen.com