HomeMy WebLinkAboutBuilding Permit #535 - 10 BEAR HILL ROAD 1/10/2012 I �1'
BUILDING PERMIT N°or"
TOWN OF NORTH ANDOVER 32 5 " '°6
APPLICATION FOR PLAN EXAMINATION r
* 0
e
Permit NO: Date Received "^ #
9SSACHUSE�
Date Issued: O
IMPORTANT:Applicant must complete all items on this page
L®CATION N��:1�: - —_
Pnnt`
tPR®PERT�Y,40WNER �-- = �tt�t. Ate_:
�MAFfNO: . �L .PARCEL * 'EZbNING1DISTRICT IHistor ciDistrict yes (M.P._
tiMachtnetShop village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building eOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0166 tic ®tlNell4Floodplain ❑tWetlands �'1NatersheticQist cf
[jtl%Vater/Sewe��.
DESCRIPTION OF WORK TO BE PREFORMED:
UJS
Identification Please Type or Print Clear y) f
OWNER: Name: IL. Q�MJ �-� Phone: �(�
Address: \O
+CONTRACTQR shame .t � NN �� ..IPhone;_ _
Supervisor:siConstrucfion iLicense7(J7 rExp: EDate ;
iHomeImprovementfLicense _ IreO( fExp
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: $ `��1le��O FEE: $ 2D0, CIO
Check No.: Receipt No.: `)_q° L6
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
SignatureoffAgent/®wner .�d, 1i - Signature fcontracto�T�`
Location !/
No. Date.
�ORT" TOWN OF NORTH ANDOVER
3? o
A
• � a
Certificate of Occupancy $
CIO
sACNUS Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
r � V
TOTAL $ U
I
Check # )sol
\ 3
24949
Building inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
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 DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Sianature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRELD,EPARTMENT TemplDum ste �on site es
p_ y..
Located at 124iWinAStreet
Fire€,Departmentisignature/date
F:
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.$100-$1000 fine
NOTES and DATA— For department use
0 Notified for pickup - Date
Doc.Building Permit Revised 2008
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
a 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
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o 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
a 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
NORTH
TO" of
. ,
o , over, Mass.,
COCMICHEWICK
ORATED
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
�- e +° fi'rr�
THIS CERTIFIES THAT........................................................ ............rN................................................................................ Foundation
has permission to erect................... .................. buildings on....../.Q...... !`�. � /�.......................
to be occupied as ........ Chimney` . . . � ./ � .. ...S..................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS LESS CO R!S l..J C T� Rough
..................... ................................................................................
..... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
104 Otis St.,Northborough,MA 01532 �l J&�WINDOWS,INC.,D/B/A —v.MA Home Improvement Contractor
(508)919-0900•Fax:(774)987-3013 .,icense#149601 (Expires 1/24/2012)
Renewal
byAndersen. Federal Tax ID#83-0404201
WINDOW REPLACEMENT mAndm Ccm y
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name - Date cf Agreement
'red I Lr nJ I Id-f 1 111
Buyer(sl Street Address,City,Slate,and Zip Cade
MA UI ��S'
E-Mail Address Home Telephone Number Work Telephone Number
Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen
("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.
Total Job Amount:A4_;� Estimated Starting Date: Method of Payment: heck ❑Cash ❑Financed
Deposit Received(33%): 5 F f1� LZ_
Balance at Start of lob(33%): Credit Cards are accepted for deposit
Estimated Completion Date: only—maximum 1/3 of the project cost.
Balance on Substantial p)Z
Completion of Job(33%): _ ' Please see Credit Card Payment Form..
By signing this agreement,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.
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.
J&L Windows,Inc.d/b/a Renewal by Andersen Buyer(s) Buyer(s)
By:
Si tore of P du// anager Signature Signature
Print Name of Product Manager Print Name Print Name
YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT,OF THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT.
—
- - — - - - - — — — — — — —&�- — — — — — — — — — - - — -�— — — — — — — — — — — — — — —
ems
NOTICE O C CELLATION X NOTICE OF CANCELLATION
Date of Transaction ) . You may cancel Date of Transaction . You may cancel
this transaction,without any penalty or obligation,within I this transaction,without a y penalty or obligation,within
three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any
property traded in,any payments made by you under the property traded in,any payments made by you under the
Contract of Sale,and any negotiable instrument executed Contract of Sale,and any negotiable instrument executed
by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt
by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller'') of your cancellation notice,
and any security interest arising out of the transaction will i and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the
Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good condition
as when received, any goods delivered to you under as when received,any goods delivered to you under this.
this Contract or Sale; oryou may, if you wish, comply Contract or Sale;or you may,if You wish,comply with the
with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of
shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk.If you do make
Ifyou do-make the goods available S
to the eller.and the I the goods available-to the-Seller and-the-Seller does not.
Seller does not pick them up within 20 days of the date pick them up within 20 days of the date of Your Notice
Of
your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the goods
of the goods without any further obligation.If you fail to without any further obligation. If you fail to make the
make the goods available to the Seller,l if you agree 5rperForirnance
s available to the Seller,or if you agree to return the
to return the goods to the Seller and fail to do so,then s to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligations under I of all obligations under the Contract.
the Contract.To cancel this transaction,mail or deliver a I To cancel this transaction, mail or deliver a signed and
sred and dated copy of this cancellation notice or any i dated copy of this cancellation notice or any other written
othr written notice,or send a telegram to Contractor i I notice,or send a telegram to Contractor.J&L Windows,
&L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis Inc. d/b/a. Renewal by Andersen, 104 Otis Street,
Street, Northbo h, 01532, BY NOT LATER THAN Northq01532,BY NOT LATER THAN MIDNIGHT
MIDNIGHT OF .(Date) OF (Date)
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
I
Buyer's Signature Print Name Date Buyer's Signature Print Name Date
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink
�.
104 Otis Street,Northborough,MA 01532 J 8c L Windows,Inc.d/b/a- Renewal MA HIC License#149601(expires 1/24/12)
Phone 508.919.0900•Fax 774.987.3013 Fcdcral Tax ID#83-0404201
byAndersen. _
WINDOW REPLACEMENT en AndmmCompany
OF CHATER MASSACII SEM Arra NEW HAMPSHM
WINDOW SFWIRCA71ON SHEET
Buyer(s)Name Date of Agreement
p«,,,eaC, ia t 1 1
The Buyer(s)listed above herebyjointly 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 DEMILS
1. Cpntractor will Install a total of /U windows in Owner's home,using the following individual quantities:
Double Hung(DB) ual sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottoms
,-- �Casement(CW) ❑Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle
GDouble Casement(CDW) ❑ Standard handle ❑Metro handle
Casement/Picture/Casement(CPW) ❑ 1:1:1 or❑ 1:2:1 ❑ Standard handle ❑ Metro handle
_C2 Lite Gliding Window(GW)
-'- —Glider/Picture/Glider(GPW) ❑ 1:1:1 or ❑ 1:2:1 p /7
wiling Window(AW) _Picture Window(PW) Lf�'��" tz J
or Bow Window ------Patio Doors(see separate Door Specification Sheet)
2. Yes ❑ ty of Windows to be Custom Fit Replacement: .
S. ❑ Y No Qty of Sills to be replaced by Contractor: _
4. Yes ❑ No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings)and actual
Exterior casco FineQaintenance-free material ❑ Factory applied 908 Fibrex brickmold
5. Glazing to be: F Lo 4 Tm ❑ Other If other,please specify:
6. Exterior color to be: �e ❑ Sand ❑ Canvas ❑Terratone❑ Cocoa Bean
7. Interior color to be: ite ❑ Sand ❑ Canvas ❑Terratone ❑ Pine ❑Maple❑ Oak
Note: Intet color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner.
S. Hardware: ite ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style:
9. ❑ Yes No Install Lifts with Double Hung dows
10. Screens: windows to have: L] Half or Full screens Screens to be: fiberglass ❑ Aluminum C TruScene
GRTIJ DETAIIS
11.Windows have grilles: Yes ❑ No If yes:❑ Grille Between Glass(GBG)Rrlemovable Interior Wood nn rm❑ Full Divided Light(FDL)
Qty: 1 Qty: Qty= Qty Qty: Qty: Qty: .
LLIA
DH DH CW/Pxtxe Glider CPWorG
Draw grille patterns above 'Use additional sheet if needed Owner approved(initials):( )
ADDITIONAL WORK DETAILS
12.❑ Y No Contractor will remove metal frames of windows. Qty of Units:
13. )'cs ❑ No Contractor will install new paint-ready or stain-ready casings. )
I erior casing qty of openings: l Exterior casings qty of openings: I ❑ Pine El Maintenance-free material
14. es ❑ No Contractor will install new paint-ready or stain-ready inside or outside stops qty of open'
Interior stops f openings:�_ Exterior stops ty of openings: ❑ Pine Maintenance-free material
15. Owner is aw that Contractor does not do any painting Owner Initials
16.❑ Yes No Contractor will wrap exterior casings wit aluminum coil stock of . color.
e: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17.�Lfr_ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
8. No Clean up all job related debris including old windows will be removed.Vacuum nightly.19.� No A limited warranty shall be issued to Owner upon completion of the job and payment in full.
20.�'1'es ❑ No Bui1din4 Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not
luded in the Contract Price and a separate check is required at the time of sale for this fee.
21.y Yes ❑No All discounts have een applied to this agr emej�t 'ce. ` , f
22. Additional job details: D {��. 6�
v /t! /
e
23. es ❑ 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 m writing and signed by both
the Buyer(s)and Contractor. Buyer(s)hereby acknowledgethatBuyer(s)has read this Specification Sheet.
Renewal sen of G and NH Buyer(s�M/y I �/� Buyer(s)
By: l/ Ll
Si tore of oducE tager Signature Signature
r
Print Name of Product ManagerPrint Name Print Name
e
: e Coairnoxwdah*of hlas�uckusef�
DeParrtmild of�icdu�trial Acczdeaf�
ofa of FnPestzg¢tian�
bDU j�a~rlurt�tan Etrart
BOS�aJLj K4 U2111
. .• .. ,ittagrs.gapf�a ,
ssfionfnsur$ncefidsPitt Srir�ders/CanizactrsfIec �srinnte f
Workerr Camp Peas
k Iicsnt or an'
er
sr"".
City�S�ta�Zig,• �(•�'� e to � t ,,
�T Type of proi]eet
Are you en em?layer?Check fh.e epproprir-tz bn�
4. ❑'I am a gcnaral confractar end.i fi, []New oonstxuctinn
L.�t tun a rsnplQyor�if�: r hired the sub-eontraotc �� AMR=,
employees (fsiltaaiilor part-ti�mej, ' listed rm$e effacbt:d sheet x
Z.[� I am a sole Pmpriot�arptirin�t- nwr.mb.•con=tm IssvG D Qn
ship eab haP°n°cmpl°ycos �C - ' comp.insu r—a 9. ❑$v�7ding addrflaa
kr mfl in auy capers S Wo is vorposa t tts Ip.[]flncfriaal=epaua or atidi(incu
[1ho �►�rkt+a'comp.inetpBace =o
o$>Goa have ressed Choir_ or eddific�s
CQ�'°d-]• .rift of cptign Por MGL, I l.[]Rlumbiag.nPaia
I,-C3
,[3 f am m haiammes doing zi t�*ork and wo hSve nD 12.[]Raaf=Pa ll
END wark�' crn�
mysrli[N emplapees.�Io v im' •19.0 Dec '
insurance txquired]t �P ins¢rancc rognired-]
-scir ramp s p°v� anew e5ida indioahaE
k�ay eaptira�t�et ehec�t l lei
=It alio fm and flu ate m �d�� c outsiao or�ersl�a
t gnaneoxnva wba�v6mltt�it�davQm C O! sad thrawoli' eamp PoLcy X06
�ontrsda�[ihaf IhM*t 3k bat MUd db'd d as eddifirmal abeetd iaE the same of the��h am
I¢rn as ctmcplvfrrr th#is pra�'idusg.
Arkera'camperustinn fnsi rme far:rty eacplvyees �GLuw,is the pvfiep and job site
ircfcme¢tfan. )
e Co�mpenp 2vIama; g��flnsil?atc�
or Sri€ r
and esirafina date)
derlaratinn page(sh.oRg the PukY nam ?er
Aftacli a espy of r'he mmrkarr'eompanse€i L?OicT c.LS2 can icad to flm imPosifina of criminal penalties of a
paw to gr,=-O.mv' .ge as required nndnr SrGtIIt v ofliSC`Ls m the�•of Q 5'mp• C)R:K DR-DER and a
fin6 upon$1�5DQ.00 endlor ano-yoar impasomm�nt;na wGTi e s cs�t1 pentsli>Gs be forwarded to-ffn Dffice of
fup to S2Sa.DD a day against fl o vinlato. Bo e$vssod hd a ocgp of this mal'
mffiatim
hmr,igsf=of NDTA for incur m coverago v
Ido here a r the pains a�td pcaalfies that the korHmtign proi,►lded abm'e rs irar.and correct
Dais;
None# ! �J U� 9• - 0 �
in
Q�ia!CX nnfy.'Da riot Chia crag to be c,mplt:iad Iry citJ ar tox+n a�tcial
- . ' Permitr'Lieenae# .
City or Taxis
sating Assfitnriky(tdt'eie aneltJnr actor 5.pltrmhing F�rper#ar
L$oars of HeaaA L Daparfineut 3,6tyt)~own ClEric 4, ecfricaT
Ca>¢tact pareate
Massachusetts- De[WI-tment of Public Safety
Boardjof Building Rc'-rUlatiOns ftnd Standards
Construction Supervisor License
License: CS 95707
BRIAN DENNISON r
35 CREST'CIRCLE
WORCESTER, MA D1603
�—G— Expiration. 9/812012
C bmmi�siunrr TrR: 2522
}
. ' Office of Consumer Affairs r&.Business Regulation :a
J. HOME IMPROVEMENT COKTRACTOR
Registiatiorn-- � 01'
Expi12
t Card
RENEWAL BY y
BRIAN. DENNIS J f
'104 OTIS STRE
NORTHBOROUGH,M Undersecretary • J
A CERTIFICATE,OF LIABILITY INSURANCE °of 4120111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CON i T _
J.P McKeone Insurance Agency Inc PHONE FAX
JP McKeone insurance Agency,Inc. AC Na . (734)662-8100 A/c No,
P.O.Box 333 ADDRESS:
Ann Arbor,MI 481060333 INSURER(S)AFFORDING COVERAGE NAIC A
.INSURER A: Nautilus 19662
INSURED J&L Windows,Inc.Renewal by Andersen INSURER B: Hartford 37478.
104 Otis St.
Northborough,MA 01532 INSURERC:
INSURER D!
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN' ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUER . POLICY EFF POLICY ERP LIMITS
LTR - TYPE OF INSURANCE POLICY NUMBER - MMIDDIYYY MMIDDI
A GENERAL LIABILITY N0958461 10/01/2011 10/0112012 EACH OGGURRENCE s 1,000,000
COMMERCIAL GENERAL LIABILITY 'D
SES Ea occurrence $ 100,000
CLAIMS-MADE IV,OCCUR MED EXP(Any oneperson) $ 5,000
PERSONAL&ADV INJURY $ 1-,000,000 .
1 GENERAL AGGREGATE. It 2,DD0,000
GEN'LAGGREGATE LIMIT APPLIES PER PR
L ODUCTS•COMP/OP AGG $ 2,000,000
POLICY PRO-jECT F7 LOC I $
AUTOMOBILE LIABILITY 35 MCCXD6390 10/01/2011 10/01/2012 COMBINED SINGLE LIMIT 1,000,000
(Ea eo',ont)
ANY AUTO I BODILY INJURY(Per person) S
ALL OWNED SCHEDULE ;BODILY INJURY(Per acddent)- $
AUTOS AUTOS ,PROPERTY DAMAGE
HIRED AUTOS NON-OWNED
Arg �(Per accident)
$
UMBRELLA LIAR OCCUR i EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE I AGGREGATE $ ,
DED RETENTION$ I $
A WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012 WCSTATU- OTTi-
AND EMPLOYERS'LIABILITY ��
ANY PROPRIETDRIPARTNERIEXECUTIVE � NIA 'EL EACH ACCIDENT $ 500,000 -
OFFICERIMEMBER EXCLUDED? - E.L DISEASE•EA EMPLOYEE $ 500,000
(Mandatory in NH)
Ih yes,describe under - I 500,000
DESCRIPTION OF OPERATIONS below - E.L.DISEASE•POLICY LIMIT 1$
B PEDOH55500 0507 09/27/2011 09/27/2012
i
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLFS(Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE .WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE .
Q� ee�n�.
m i9B&2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Renewal
byAndersenn
WINDOW REPLACEMENT anAndernn(.ouvatn
WoodNinyl Composite IF
;;e8prrxcs. Duet Argon Low E4 SmartSun
Double Hung
100-00473518-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
OE29 019
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0042
h9anuhacturer stip.tatas that thaw otings eon/orm to appf-bM NFRC prooeduras/or datermindrg wnola prodaet
performance. NFRC slings ora delarminad tot a t6[ed set of env.emaantal oenditions and a spaeil'c produot sqa.
' NfRC dws not recommend any product and does not warrant the sudandt7y of arty product for any speeilio use
C..—ft manulacturar's Iherature Igr other product Pedotmanee information.
www.nfm.org
t Thi.prod-l'
—tsre n aG
IRF $aal'senVironmant 1 a 0�iwaa�ma :;�,- j�•r>,�•:;?-,y,
standard.govarning
y'
�`" efciancheavy matate in r"', qr^;. ^ .• r``�r
- - •=tha lrama and sash
-maiarel,Pacloiging.an ;;:[2;;i$�;%%s-:tc;•.(-�:r�
conswnzr ad.m i..al .
ry.
DESIGN PRESSURE WSF)
t a Wnaow1alM Ooar e ,
Fb WNtw wtlm�wnt'rm
H-LC25 RbA DB Sloped Sill DH IN
Teslas lotlAFS-02 W AN,tM•A ilAi SQA lM lSJA4<a4S ht:uviacnrtt sli-latae wWOM W"M ats a Ik2hla sUMMas.
Heats or—ceads ALE.C-G.E.C.A I.E.C.C.Air Inflillration requirements WDhIA Hallmark Cadf k—tion Program.
r
MMEMMV Do not remove until final code inspection. Save label for future reference. -`
awified
for a
'
19
Canada a.�Lam'\7
ID
m
�.
O 4!
Q c
U W y
9 U.S./CD
errcrgy5targoV ®�Ouarified/Admism 1.
Renewal
byAndersen. m,.nter.m,C.,awmv
WINDOW REp"
AND-N-37 _
ti �P sir t Vinyffiood Composite Material
Dual Argon Low-E4 SmartSun
Product Type: Picture
ENERGY PERFORMANCE RATINGS
U-Factor Solar Heat Gain Coefficient
0.27 1 .53 0 . 22
' U.S.A-P Metllcl5l
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 51 _
Manuhewrer atlpulams macmeae raenBs contorm to 11 till NFRC proceoures fir aeIDnnlning,Mme product
penrod lm,NFRC ratings are aelermined tar a rima sec at armnanman�eon P and a speenc product at'
MrmntCons:down of rawalmenoadrre tar omeanu ones not ronon ti rrto matlon.ata roouafora ty spec nc use.
aMMJme.drg
a A aYrr aY Yi a ' ,
r..�.ti..T
Andersen Co oration:RbA Pictfre Window
enure r pus s eonmrmanee e ro ownB titer �o`
Standard Rating
NAOS42oraMAWDMAcsA+0ies2Aa4B-05 DPpsr F-050
,f►SEAL TNs product Olsen,
Green sears
4 emAmnmenud scanaarw'
to „goveming energy.
emclency.nasoYnEmis
_ •Q In me trema and sasn
olowAK pacagIrla.ant
consumer
educational
100-00511006-001
Meee w eaeeeds ME.C.,CF.C,61F. .C.M IrmUdatlan requlramems WDMkMaa nanc Cenldcermn Program.