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Home My WebLink AboutBuilding Permit # 5/18/2016 �I BUILDING PER IT %AORrn TOWN OF NORTH ANDOVER ® - APPLICATION FOR PLAN EXAMINATION ` Permit No#: / °t` y -4, Date Received �R,TEo pQa R5 ��Saacaaus``R Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION SO 1�+c*'_6 y 40 _ Print PROPERTY OWNER 3S AjxiTEE�2 �° ►'�4 G Print 100 Year Structure yes no MAP 2-16; PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family El Addition ❑ wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se�ttc ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed Distract ❑Water„/.Sewer DESCRIPTION OF WORK TO BE PERFORMED: Nb Identification- Please'Type or Print Clearly OWNER: Name: Phone: Address: V4 t ►`� Contractor Name:IL, t1,� UA I IMahone' Email: Address: qa /-cti G e el' a Supervisor's Construction License: Exp. Date: Z6 rl Home Improvement License: z Lk-�_ Z9 Exp. Date: 9 ARCHITECT/ENGINEER 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: $ 2�C FEE: $ 6i Check No.: �� z 2L Receipt No.: 0 3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund FORTH Town of ) Andover ® T �AK� h Ver, Mass, COC HICheWIcw 1. ®S RATE® 11 BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System r _'` THIS CERTIFIES THAT .........`re,/V/v r /� � i CS� BUILDING INSPECTOR ......................................................... ...j.................. .............. has permission to erect !G . Foundation p ... buildings on / Rough to be occupied as ............................... �''.l�cs ........ ..�` .................................................. " ' v Chimne provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR UNLESS S RTS Rough Service ............. ...... ................ . . ... ............ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Contract - detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Kelly, Thomas 45 Fondi Rd Sales Rep Phone: 978-373-2500 Haverhill, MA 01832 Sales Rep Fax: Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: kellytl@pellaboston.com Customer Information Project/Delivery Address Order Information Jennifer Dibiase Dibiase,Jennifer,1713423 Quote Name: Dibiase,Jennifer,1713423 81 Hickory Hill Rd 81 Hickory Hill Rd Order Number: 741TKO059 NORTH ANDOVER,MA 01845-1114 Lot# Quote Number: 7805029 Primary Phone: (978)9790182 North Andover,MA 01845-1114 Order Type: Installed Sales Mobile Phone: County: Payment Terms: Fax Number: Tax Code: MA TAX 6.25 E-Mail: jennifercuozzo@hotmail.com Quoted Date: 4/29/2016 Great Plains#: Customer Number: 1007879226 Customer Account: 1003748032 Line# Location: Attributes 10 None Assigned Delivery/Setup-Delivery/Setup Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/30/2016 Contract-Detailed Page 1 of 5 Customer:Jennifer Dibiase Project Name: Dibiase,Jennifer,1713423 Order Number: 741TKO059 Quote Number: 7805029 Line# Location: Attributes 20 None Assigned Pella Brand, 2-Wide Entry Door Sidelight, 51 X 81.75, Early American,4 9/16" Qty 1 1:1280 Fixed Entry Door Sidelight LM PK# Frame Size: 13 1/2 X 81 3/4 784 Unit Type: Fixed Inswing,Standard Sill Dimension Options: No Cut Down General Information: 5 7/8",1 5/16",4 9/16" Panel Style: Full Light s Glass: Tempered Low-E Air Filled Viewed From Exterior Grilles: No Grille Frame Size:51"X 81.75" Panel Selection: Mahogany,Stained,Early American,Stained,Early American Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,White,Wood,Primed Hardware Options: Bronze Finish Sill Vertical Mull 1: FactoryMull,Standard Joining Mullion-Doors,Frame To Frame Width-0" 2:3680 Fixed Entry Door Frame Size: 37 1/2 X 81 3/4 Unit Type: Fixed Inswing,Standard Sill,No Fire Rating,No Fire Rating Dimension Options: No Cut Down General Information: 5 7/8",1 5/16",4 9/16" Panel Style: Craftsman Light Glass: Tempered Low-E Air Filled Grilles: Simulated Divided Light,7/8"Contour,Match Interior Panel Finish,Match Exterior Panel Finish,Traditional,Typical,3,2 Panel Selection: Mahogany,Stained,Early American,Stained,Early American Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,White,Wood,Primed Hardware Options: No Bore,Oil Rubbed Bronze,Bronze Finish Sill Unit Accessories: No Dentil Shelf,No Bang Panel Vertical Mull 1: FactoryMull,Standard Joining Mullion-Doors,Frame To Frame Width-0" Wrapping Information: Nail Fin,Factory Applied,No Exterior Trim,No Interior Trim,4 9/16",5 7/8",Factory Applied,Pella Recommended Clearance, Perimeter Length=266". Entry Trim Finish-Finish Paint/Stain Entry Interior Trim Only Qty 1 ES—Single with SIT-Install Single Entry Door with Sidelight and/or Transom Qty 1 PVC Upgrade>48-PVC Upgrade greater than 48 inches Qty 1 Line# Location: Attributes 25 None Assigned Entry Systems, Storm Door Fullview Interchangeable Unhanded, 36 X 80,White QtY (91025) 1 1:3680 to 81 Unhanded Storm Door PK# Frame Size: 36 X 80 General Information: Clad 784 Exterior Color/Finish: Standard Enduraclad,White Sash/Panel: 1 5/8"Extruded k, Glass: Clear 1 Hardware Options: Standard,Oil Rubbed Bronze Viewed From Exterior Model: 4601 Frame Size:36"X 80" Wrapping Information: Perimeter Length=232". ES-.Storm Door-Install Storm Door Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products, visit the Pella®website at www.pelia.com Printed on 4/30/2016 Contract-Detailed Page 2 of 5 Customer:Jennifer Dibiase Project Name: Dibiase,Jennifer,1713423 Order Number: 741TKO059 Quote Number: 7805029 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pella.com /performance, Project Checklist Review (Installed Orders Only) Before the Installation the Homeowner agrees to do the following: Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings Remove air conditioners Remove existing shades, drapes, window treatments, wall hangings, and personal belongings Move furniture at least 3 feet away from work area Tie or cut back trees, bushes and shrubs in the work area For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/30/2016 Contract-Detailed Page 3 of 5 Customer:Jennifer Dibiase Project Name: Dibiase,Jennifer,1713423 Order Number: 741TKO059 Quote Number: 7805029 Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following: Obtain Building Permit(When required) Prefinish products when purchased in contract During the Installation the Homeowner agrees to do the following: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract Place and remove drop cloths in work area then vacuum, and remove all debris at end of day Remove existing product, including storm windows, and dispose of it unless otherwise specified Install all products using method specified in contract per Pella Installation Instructions Replace interior and/or exterior trim only if purchased If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished. If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the following: Be available for completion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments,wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and tax purposes Wash all interior&exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased jad Project Checklist has been reviewed Customer initial Product Only Addendum has been reviewed Customer initial Credit Card Account#: Last 4 Digits 4 6 4 3 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/30/2016 Contract-Detailed Page 4 of 5 Customer: Jennifer Dibiase Project Name: Dibiase,Jennifer,1713423 Order Number: 741TKO059 Quote Number: 7805029 Expiration Date: 0 1 / 1 9 Charge final payment to same account jad (Upon substantial completion) Customer initial Project Checklist has been reviewed Jennifer DiBiase Thomas Kelly Customer Name (Please print) Pella Sales Rep Name ( lease print) Order Totals ,�1717j fe% 'D Ewe � Taxable Subtotal $3,225.30 Customer Signature Pella Sales Rep Signature Sales Tax @ 6.25% $201.58 4/30/2016 4/30/2016 Non-taxable Subtotal $1,573.20 Date Date Total $5,000.08 JennifeY Xli&i ue Deposit Received $2,500.00 Credit Card Approval Signature jAmount Due $2,500.08 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/30/2016 Contract-Detailed Page 5 of 5 PELLA WINDOWS AND DOORS CONTRACT 7. PAYMENTS 1. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part of the contract set forth on the failure to pay Pella the amount due within seven days after the date payment is Product Order(the"Contract")between New England Window and Door LLC due. dba Pella Windows&Doors,Inc.("Pella")and the person(s)identified on the Product Order("DRVIer")to supply the products(the"Products"),and perform 8 CORRECTION OF WORK the work(the"Work")described or referred to in such Contract. For Product Only purchases,a signed"Product Only Addendum"is a required part of the Pella shall correct installation Work not in conformance with the requirements contract. of the Contract,if notified in writing by the Owner within two years after the Completion Date or,if earlier,the date on which the Work is substantially 2. OWNER completed and payment of the Purchase Price made subject to a holdback as provided above.Correction of Work as herein provided shall be Owner's sole Pella is not responsible for any existing security systems.Owner shall remove remedy for defective workmanship,and is provided in lieu of any and all other all shades;verticals,blinds,curtains,drapes or window mounted air remedies.Pella's obligation to correct Work is conditioned on Pella's prior conditioners,prior to the installation of the Products.Pella's installers are not receipt of all payments then due. responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella9. LIMITED PRODUCT WARRANTYwindows. Pella shall warrant all Pella products,but only in accordance with the Pella The Owner shall provide complete access to the work site between the hours Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL of 7:00 a.m.and 6:00 p.m.(Monday through Friday)for Pella's installers to BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND deliver the Products and perform the Work. PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED,WRITTEN OR ORAL(INCLUDING WITHOUT 3. PELLA LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means, FOR A PARTICULAR PURPOSE), methods,techniques,sequences and procedures and for coordinating all portions of the Work.Pella will be responsible for the Work of its Pella 10. NO CONSEQUENTIAL DAMAGES Contractors who will install the Products. UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR Unless provided otherwise in the Work description,Pella will provide and pay CONSEQUENTIAL,INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES, for all labor,materials,equipment,tools and machinery,transportation,and WHETHER FORESEEN OR UNFORESEEN. other facilities and services necessary for the proper execution and completion of the Work. it, HOME IMPROVEMENT CONTRACTORS The materials and equipment furnished under the Contract will be good quality All home improvement contractors and subcontractors shall be registered with and new unless otherwise required or permitted,the Work will be free from the director of the Home Improvement Contractor Registration Program defects not inherent in the quality required or permitted,and the Work administered by the Board of Building Regulations and Standards. Pella and conform with the requirements of this Contract.Pella shall not be responsible any of its subcontractors identified in this agreement have been registered. for damages or defects caused by abuse,modifications not executed by Pella, Any inquires about Pella or any of its subcontractors relating to registration improper or insufficient maintenance,improper operation or normal wear and should be directed to:Director,Home Improvement Contractor Registration, tear. Pella will keep the premises and surrounding area free from 10 Park Plaza,Room 5170,Boston,MA,02116,617-973-8787,888-283-3757 accumulation of waste materials or rubbish caused by performance of the or visit the HIC website at http://v�mw.inass.gov/ocabar/ Work. 12. PERMITS(MA customers only) 4. CHANGES Pella is obligated to and will obtain the following permits for this project: _Building . Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excluded from the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall chapter 142A. include an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any In addition to the rights and warranties enumerated in this agreement,you may Change Order and any such Change Order must be signed by both Onmer and have additional rights under Massachusetts General Laws,chapter 142A and Pella to be effective. 780 Code of Massachusetts Regulations R6. 5. SUBSTANTIAL COMPLETION 13. NOTICE OF CANCELLATION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a party estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which extended to allow for Change Orders requested by ONviler or if the time to may be his main office or branch thereof,provided you notify complete the Work is affected by conduct ofthe Owner,weather,labor disputes,availability of subcontractors,acts of God,fire or other causes the seller in writing at his main office or branch by ordinary reasonably beyond Pella's control.If for any reason the Work is not fully mail posted,by telegram sent or by delivery, not later than completed by the Substantial Completion Date(including any extensions midnight of the third business day following the signing of this contemplated above),but is substantially completed by such date,i.e.,the agreement. Product has been installed,but minor parts or components are missing or need to be replaced or repaired,a hold back proportionate to the cost of remaining See the attached Notice of Cancellation for an explanation Of parts or work to be completed is acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid this right. balance of the Price,whichever is less. 6. FINANCING Do not sign this contract if there are any blank spaces, If payment of the Price is financed with a financial institution through Pella,all —]��/'/�Y �r / e financing paperwork must be completed upon signing of this Contract and the (J T requisite approvals and authorizations for the full amount of the requested Customer signature financing shall have been received from the financial institution. 04/30/2016 Date DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Pella Windows & Doors Contractor Jelrni fe- A'FIaUe Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. NOTICE OF CANCELLATION Date of transaction: 04/30/2016 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; 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 twenty 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 Pella Windows and Doors, at 45 Fondi Rd., Haverhill, MA 01832 not later than midnight of 05/04/2016 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) The Commeonwealgh dof A&v sn7c.hiesei& r�ttr�i�rrn Department of Industrial Aceidems - Office of Investigations I Congress sereet, suite 100 Boston,MA 02114-2017 ra�ev<r�ass.�ov/disc Workers' Compensation Insurance Affidavit- ]pati#de>rs/Co>rnl ir,%ctors/Electric0a es/Pluanbeirs AppHcant Information Please Print Legibly Name (Business/Organization/Individual): I ,C�/,ll� Address: City/State/Zip: ' v ere, t( 1 663Z- Phone#: Are you an employer:'Check the appropriate box: 'Type of project(required): 1.M,,1 am a employer with 7-,i 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Wernodelingg ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.+ required.] . 5. We are a corporation and its 10.[]Electrical repairs or additions ® � 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' rigbt of exemption per MGL Y � comp. 12.F Roof repairs insurance required.]' c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for ucy employees. Below is the policy and job site information. Insurance Company Name:_ `e ;Qv, co . Policy#or Self-ins. Lic. Expiration Date: Job Site Address: City/State/Zip: 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 e. 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do Hereby certify under the pains and penalties of perjatry that the iPafaf'lnation provided above is true and correct Signature - - -"` - � -- -- - _ - — Date: c `L��/ Phone#: Of use onlj1 Ido not write in this area, to be completed by citt,or town officiat City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2. Building Department 3.at r/Tol inn Clerl; 4El,eetrical Inspector 5. Plumbing lompecNr 6. othea- min...,,, u. CERTIFICATE F LIABILITY INSURANCE W29015 THISTHIS CERTIFICATE IS ISSUED AS A MATT t R OF INFORMATION ONLY AND CO GERNFf RS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE[)GES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE IPOUcIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{Sj,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. IF the certificate holder is an AD®ITIONAL INSURECt,the►solicy{ies)must he endorsBd, If SUBROGATION IS WARTED,subject to the IFIL and conditions's the policy:certain paticies Tn,y require an endOW581neat: A sWeenent an this C�fiC3te does notcanfer eights to the certificate holder to lieu®f sL!ch endersement(sj. PRODUCER Fred C.Church,Inn NA FACT OhpA CodaQ,C1C,RPLU 41 WeDMA Dia5iL PHONE Lowe0,MA01B51 u� . 970347231 FAIL (910)454-1085 [000)225-1865 0UC No; ADDRESS: r0�0edcchwdr ram 11ffiUREfl AFFORDING COVERAGE NA1C0 INSURED INSURERA: CllirerrshrsuranmCmnpanyorAmadca 31534 NelvEaglendwiindowgDoorLLC INSURER B.: NewHamlilraEmployers Insurance company 13003 45 Fondl Road INSURER C Haverhill,MA 01037.1302 INSURER D: INSURER E: COVERAGESINSURER F: CERTIFICATE�lul>n®ER:54457 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L15TEp BELOW HAVE BEEN 15SUE0 Tb THE INSURED NA SMEO ABOVEION ®q 7}IE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT INftH RESPECT TO WI,IICH 77715 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PORINS DESCRIBED HEREIN IS SUBJECT EC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. INS LTR TYPEOFINSURANCE ADOL SUER POLIMMIODCYNUMBER POIICYEFF POLICYEP GENERA LLIABILITV NIDD LIMITS x COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $1.600,000 DAMAGE TO RENTED CLAIMS-MADE It OCCUR REMISES IEa occunenca S 100,000 A X CG0001 7 MED EXP[Any one pawn) S 10,000 �N016190T 7/1/2015 7I1I2016 PERSONAL aADV INJURY $ 1,000,000 ------------ GENLAGGREBATELIMITAPPLIESPER: GENERALAGGP,EGATE $2000,000 POLICY X J C X LOC PRODUCTS-COMPIOPAGG $2,000,000 AUTOMOBILELUIBILITY S COM BINEDSINGLEUMIT ANY AUTO Ea acddo I g ALL OWNED SCHEDULED BODILY INJURY(Perperson) i AUTOS AUTOS HIRED AUTOS NON-OWNED BODILY INJURY(Pcracadeni)AUTOS $ PROPERTY DAMAGE S Pa awdenl UMBRELLA LIAR S OCCUR EXCES5LIAO CLAIM34AADE EACH OCCURRENCE $ DEO RETENTIONS AGGREGATE $ WORKERS COMPENSATION S AND EMPLOYERS,LIABILITY 1I V� � E� 9 ANYPROPflIETORIPARTNERMXECUT[VE YIN ? DFFICETVMEMBEREXCLUOEDT NIA 900040101 711/2016 EL EACHACCIDENT $500AD0 IMandataryln NN) Ili/2015 13 IPT1408, IONOFOPERATIONShdaw EL DISEASE-EA EMPLOY $500,00U E.L.DISEASE-POLICY LIMIT $500A00 DESCMPi1ONOFOPERATIONS[LOCATIONS IVEHICLES[ATiachACDR0161,AddiOonainemadrs5chedule,Trrno2space hrtquired) CERTIFICATE HOLD- OANCELLATION SHOULD AMV OF THE AU�L)11E DESCRIBED POLICIES BE CANCELLED OEFGS;E PifOlSJ0.Tanc1 - I CS-089853 WILLIAM R NICHOLS $7 PEARTREE RD HAVERHILL MA 01530 =, 10/26120'16 ice of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: E IMPROVEMENT CONTRACTOR p ` Office of Consumer Affairs and Business Regulation registration: 183279 Type: 10 Park Plaza-Suite 5170 Expiration: 9/24/2017 Supplement C' ird Pp Boston,MA 02116 NEW ENGLAND WINDOWA DOOR, LLC. PELLA WINDOWS&DOORS William Nichols 45 FONDI ROAD HAVERHILL,M/ 01832 Undersecretary Not validwithout signature