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HomeMy WebLinkAboutBuilding Permit #848-13 - 10 BEAR HILL ROAD 6/5/2013 pORTof 1,/ y BUILDING PERMIT cr 6�,.`S 0`` °o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION s 4 Permit NO: I Date Received Date Issued: 1SScNuS�� IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Print MAP NO:(?L,)q iPARCEL:00k,� ZONING DISTRICT: 2.j__,_Historic District yesrno Machine Shop Village es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2-0nie family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial elRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑Floodplain D Wetlands ❑ Watershed District ❑Water/Sewer ` DESCRIPTION OF WORK TO BE PREFORMED: 4-0 S`f-i`o cl-ol- G Identification Please Type or Print Clearly) OWNER: Name: US ee e Ari f- c- Phone: (463 Address: I eat r CONTRACTOR Name: 1'a s, Phone: 3 s7 I—_2Jo6 Address I 6-t (�� s IU ,� �� lA�_�, 6 i 1-3 Supervisor's Construction License: Exp. Date: cl- 22.3 yl Lf Home improvement License: c t v Exp. Date: I "a 3 " ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C4/3�-t 4 v u FEE: $ Jam. e av Check No.: g1 q�e Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Owner :;x� Signature of contract TOWN1017 NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page "'., ;- � �-n,--•- +�,r�j �- -z��- —--* -mux► 1L10CATI©N� � r a f� .. --� max- +�, ,....d-r,�,,,,_.�y..-,�z-.— rte-.;.,,-tg ,-�sp.�•,-� }:c� j `z, t, Print " t y *`• f 7, a 4 JPR©PERTTY O�VVNER . y t Vis,.-y3., �_ r ..+ssa-r..-.�'G.;��.k�.::'w+b.'•.7� �:.� .r..2-.-.a.�4 r+�.x.�.r .S,:i..�..+..-..... .r r ,�` ,y Pnnt + t100 Year Old Structure eyes n z tMAP�NO: PARCEL.___ '� yes ono) ti t ' Z© ING DISTRICT Historic Dls riot TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other y7, — ° *' t I y��'Ei14 iia C^.ss . t C I Via,.st gut hrs:x xs. Septic) ®Well Flood lam '®Wetlands ,{ 1'�®),Watershed District . =k � f ' *stt4'. "� gyp= .�tVllaterlSewer�.. t DESCRIPTION OF WORK TO BE PERFORMED: I Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: - �, `# ;�xs {^o-:„P" if t�`�._ 'S ' �: c ax.:.y 5-. xr 7 `- - "* x}°Is' ,-,rr • v7• 't .,. ��} �r • s +`' it F ,s� r t. r a t •r I dt y a t ? ryr+�' it kkt�. C©NTRAT®R �Name - � .� r�Phone i, °� l'�.at a}ti"" �,�' �•" *�' r �.fr}�-- r f'r+t T1.♦ `P �,��� 4� \. r '� Y`.� .�- a.` - y4`*i „ �+ � �_ � '^„N-z+ -i+-�-- ..,�.� _�-- �.�.. "4"^"'E=,•'iL`f .. E' Y 1. A L S �t l {i`e. � j 4 ✓y SupenrrpCo lsonstructlon`Lice se s f k ���_- _F��_ _ - , .. � •-sw ,v,.-,.+e, .vn ti 'af.}�f dY r .....ry.P........a- � :r CC C �F HomeImprovementlLlcenseExp Date,g _.. t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fund '.Signature I f.Agent/Owner Sig ature;of contractor.. . Q' Plane Ri ihmitfarl n Plane Wniuorl 1—I r orfifior4 171nf Pion F1 Cfomnorl Plone i—I Location L No. "1 Date h + F . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ *� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26488 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Ple`h"❑�` 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 ❑ ❑ CQMtML5RITS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 924 Main Street Fire Department signatureidate COMMENTS L � v Plans Submitted ❑ PlansWaivedf❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGEDISPOSAL Public Sewer ❑ Tanning(Massage/BodyArt Q. . Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF-U FORM I DATE REJECTED DATE APPROVED r PLANNING & DEVELOPMENT ❑ ❑ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 1 COMMENTS a Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water& Sevver Connection/Signature&Date Driveway Permit DPW Toiyz]Engineer: Signature: ; i Located 384 Osgood Street FIRE ®EPAPT V NT -Temp Dumpster on site yes no _ Located at-124 MairiStreet Fire ®epanieitigriature/date - COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of meter location, rust or service drop requires approval of lectrical Inspector Yes No )ANGER ZONE LITERATURE: Yes No AGL Chapter 166 Section 21A-F and G min.$100-$1000 fine a®TES and DATA—(For department use U Notified for pickup- Date )oc.BuUding Permit Revised 2010 Building Depar=tment The folowing 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 o Photo Copy Of H.I.C. And/Or C.S.L: Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products 10TE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan L3 Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Afifidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) u Building Permit Application a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses D Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products D-TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 11n all cascs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the RP!),al 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 2012 NORTH own of E �. Andover No. 'I n h " �f. ver, Mass, �� � coc«ic«ew�c« X01 U BOARD OF HEALTH Food/Kitchen PER IT L D Septic System r BUILDING INSPECTOR THIS CERTIFIES THAT .............. ... ..t...... .......... .....................4"11 ...... ... .............. has permission to erect.......................... buildings on .....�ll.... � Foundation • Rough 3 to be occupied as ............1 ... �.�. I�....................................:....................................... Chimney 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAF7 Rough Service ........................................................ .... .... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE Renewal ?% MA Home Improvement Contractor bYACId@CS@Cl. �,� License#1708I0(Expires 12/23/2013) WINDOW REPLACEMENT an AndenenCompmy Renewal by Andersen Corporation Federal Tax ID#41-19184I3 104 Otis St.,Northborough,MA 01532 (508)351-2200 a Fax:(651)351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyers)Name Dote of Agreement Buyer(s)Street Address,City,State,and Zip Code 11 I ✓r vH `f EMail Address Home Tele hone Number Work Telephone Number 7f 6-k 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. (� Estimated Starting Date: Method of Payment: Total Job Amount -I Amount Financed • �/���� heck ❑Cash Deposit Received(33%) 11A, OVisa/MC ❑Discover D ❑Financed L(AMEX Balance at Start of Job(33%)• Estimated Completion Date: J If credit card is selected,please Balance on Substantial 'J0;ogr � see Credit Card Payment Form. Completion of Job(33%) 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 AlLdersen Corporation Buyer(s) Buyer(s) By: Signature of Product Manager Si ature Signature �lt C»iL.""L i�co� US7c 13ey na)ld 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. — — — — — — — — — — — X- — — — — - - — — — — — — — -X— — — — — — — — — — — — — — —`}c NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction .You may cancel Date of Transaction You may cancel this transaction,withouf 6riy penalty or obligation,within I this transaction,without any 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 I property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument executed I Contract of Sale,and any negotiable instrument executed by ou urned erhin 10 rcn receipt ou will be returned urc �lnebthe Contractobe r ("Sell") of youanccellationotice, bthe Contractor ('Seller") of yallationotice, 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 Sefler at your residence,in substantially as good condition as when received, any goods delivered to you under I as when received,any goods delivered to you under this this Contract or Sale, oryou may, if you wish, comply I Contract or Sale;or you may,if you wish,comply with the with the instructions c 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 If you do make the goods available to the Seller 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 ofyour Notice of your Notice of Cancellation,you may retain or dispose I 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 or if u agree goods available to the Seller or if you agree to return the to return the goods to the Seller and fail to do so,then to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations under for performance 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 signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor notice,or send a telegram to Contractor. Renewal by Andersen Corporation,104 Chis Renewal by Andersen Corporation, 104 Otis Street, Street, NorthboTutgh, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF ��111 /)3 .(Date) OF .(Date) I HEREBY CANCEL THIS TRANSACTION. I I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Nome Date I Buyer's Signature Print Name Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink BIBILP2009.RBA-Ph MANN neural by Andersen Corporatio. MA Home Improvement Contractor Renewal b CA 104 Otis St.,Northborough,MA 0]532 License#170810(Expires 12/23/2013) yAndersen. (508)351-2200•Fax:(651)351-4810 Federal Tax ID#41-1918413 WINDOW REPLACEMENT an Andersen Company WINDOW SPECIFICATION SHEET Buyer(s)Name Date of Agreement n he Buyer(s)listea 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 o _windows in Owner's home,using the following individual quantities: Double Hung(DB)_)POEqual sah_Cottage sash(1/3 top,2/3 bottom)_Oriel sash(2/3 top.1/3 bottom)_Flat sill .—,e"'O cuss ions) Square Check Rail urve Check Rail Casement(CS)_Hinge right_Hinge left(as viewed from exterior) Double Casement(CD) 2 Lite Gliding Window(GW) Casement/Picture/Casement(CF)_1:1:1 or_1:2:1 Glider/Picture/Glider(GPW)_1:1:1 or_1:2:1 Picture Window Bay or Bow Awning Window _#Lights Soffit/Roof Shingle/Copper Specialty Window Patio Doors(See Separate door spec sheet) Seat to be Primed/Oak/Pine 11 11D 1 11 1E1 1 11 11 11 2. Qty of Windows to be Custom Fit Replacement: 3.707 Qty of Win s to be Custom Fit Fall frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS) Exterio asings:-Pine_Maintenance-free material Factory applied 908 Fibrex brickmold 4.Glazing to be:_HP Lo 4 T _Tempered _Other If other,please specify: 5.Exterior calor to be' ite Sand—Canvas—Terratone_Cocoa Bean—Dark Bronze—Forest Green--Black G.Interior color e:_White_Canvas_Pine_Maple_Oak_Same as Exterior Note:Wood interiors need to finished by Owner. 7.Hardware:_White_Stone_Canva�uft-rv, to Hardware: Style: 8. Install Lifts with Double Hung W9. Screens:windows to have:_Half or ns Screens to be: 4- Fiberglass_Aluminum_TruScene GRILLE DETAILS 1 ows have grilles:_Grille Between Glass(GBG)_ ,movable Interior Wood(INTW)_Full Divided Light(PDL) ner approved(initials) Draw grille patterns below `Use additional sheet if needed Qty: Qtyl 3 QtyQty Qty QtyQty: ADDITIONAL WORK DETAILS 11. Qty of_Sills_Sill noses to be replaced by Contractor 2. Contracror will remove metal frames of windows. 13. Contractor will install new_paint-ready or_stain-ready—Interior—Exterior casings in—Pine_Maintenance-free material 14. r will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine_Maintenance-free material 15. )I s-Owner is aware,contractor does not do any painting or removal/installation of alarm system/hardware. It is the ,,�� � responsibility of the homeowner to have the alarm system/hardware removed prior to installation. " I G.�Contractor will wrap exterior casings with coil stock of color. Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17.Contra/or will insulate,caulk and seal windows with 3-Point system to prevent water and air infiltration.Removal and disposal of all job related debris,wir- dWKstorm windows and vacuum nightly included.Upon completion of the job and payment in full,a limited warranty shall be issued. 18. Yes No Building Permit�ontractor will secure any and A necessary permits.The fee for the permits)is n t f � included in the Contract Price and a separate check is required at the time of sale for this fee. Ck# �$�fl<t'/' 19. es❑No All discounts have been applied to this agreement price. 20. dditicnal job details: 21. Yes❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). 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 Ande}sen Corporatiod Buyer(sr---\ Buyer(s) By:_g,li ignature of Product Manager Signature Signature Print Name of Product Xlana;ger Print Name Print Name The Conwwnweaith ofMassaehusetts Deparment oflndrs&W Accidents Office oflnve*adons . 600 Washington Street, Boston,MA 02.111 wwK.ntassgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pimube A Reant Information rs Please Print L e Name(Business/organization/tndividual)_�P_,r10�,�a,1 A Qy� Address: City/state/Zip: I Sia Phone#•_ Are you an employer?Check the appropriate hoz: 1.( I am a employer with 3 o 4. Q I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I an a sole proprietor or partner- listed on the attached sheet. 7. 'Remodeling ship and have no employees These sub-contractors have 8. Q Demoliti working for me in any capacity, employees and have workers' on [No workers'comp.insurance comp.insurance.= 9. ❑Building addition required.) 5. We are a corporation and its 10.❑Electrical rept or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing re myself. [No workers'wmp. right of exemption per MGL P or additions 12.E]Roof repairs insurance required.]t a 152, §1(4),and we have no employees.[No workers' 13.❑Other COMP.insurance required.] =`Any applicant that checks box*I must also fill out the section below showing their workers'compensation policy � Homeowners who submit this affidavit indicating they an doms all work and then hie outside coahactors must submit a new affidavit in tyo�actors that check this box must attached an additional shat showing the name of the sub.co� and t not those enhpes�ha e� employes. If the sub-contractors bave.employees,they must provide their workers'comp•policy number. Ion an emfrloyu deaf isprovidbrg workers'compensation brsurance for my pnp/oyees Below is the o information. P.ft1'and fob site Insurance Company Name: C Policy#or Self-ms.Lic.#: M t.� C l Gj `�0 Expiration Date:_ Job Site Address: /A City/State/Zip: / An of g s— Attach ecopy 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 penaltiesof 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 viohitor. Be advised that a copy of tbis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer49 the pabts and penaider of perjury that the information provided above is pyre and coryrea S Phone# f ' Oficial use only. Do not write in this area,to be completed by city-or town o .>�iciaL City or Town: PermitUcense# Issuing Authority(circle one): L Board of Health 2.Building(Department 3.City/Town Clerk '4.Electrical lnspector 5.plumbing inspector 6:Other . Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCEa;2"'/ z""' 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 P0LR3ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. N SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorssmen s PROIDUCER 1-612-333-3323 CONTACTJO-114 Hargrove or grit Johnson Hay® CompaniesPHONE Exn. 612-333-3323 FAX Ne:612-373-7270 80 South 8th Street Suite 700 Minneapolis, MIR SS402 ER ID INSU S AFFORDING COVERAt1E NAIC e INSURED Ren INSURERA: OLD REFDSLIC IHS CO 24147 104 Otiwals by Andersen Corporation INSURERS: NATIONAL UNION FIRE IHS CO Op pITTS 19445 104 tie Street INSURER C: Northborough, Mh 01532 INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 29229436 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. SA LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICYEXP _Mmonmm-MLIMITS A GENERAL LIABILITY MY 59828 ")/01/1; 10/01/13 EACH OCCURRE NCE S 11000,000 Z COMMERCIAL GENERAL LIABILITY D D PREMISES Eaocoumence S 500,000 CLAIMS#1ADE OCCUR MED EXP one p non $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE is 4,000,000 GETI1 AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPIOP AGG S 3,000,000 Z POLICY PRO-JECT —1 LOC S >► AUTOMOBXE LJABILRY MNTB 21700 101011144 10/01/13 COMBINED SINGLE LIMB Z �,�0 (Eedoddent) S 3,000,000 ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULED AUTOS BODILY INJURY(Per so*.t) S ]L PROPERTYDAMAGE $ HIRED AUTOS (Par aeolderd) Z NON-OWM AUTOS OLCAG1MlRSatADE 10/O1/1 i 8 Z UMBRELLA 355 $ EXCE8LLAB 1 /01/13 ECOCU $ 25,000,000 .AGGREGATE $25,000,000 DEDUCTIBLE Z RETENTION $25,000WORKERS S A AND EMPLOY�EREENSATION LI48LM YIN MKC 117948 00 10/01/1 10/01/13 Z wcSTATU 1K S ANY PROPWETORIPARTNERIE»CUTIVE OFFtCERIMEMBE R EXCLUDED? ri� NIA E.L.EACH ACCIDENT $ 2,000,000 Oyes. torydeny b NH) nd EL DISEASE-EA EMPLOYEE $ 1,000,000 Ryes deaeitbounder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEItiCLEB (AMaO ACORD 101,Additional Remarlw Sdrdi k,IF More space Is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION Evidence of Insurance 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 eric j ©1988.2009 ACORD CORPORATInw an.mi le I mce of Consumer Affairs&Busloe s gcgulation ac�urae ME IMPROVEMENT CONTRACTOR egistration 170810 Expiration 12/23/�o 13: Type. RENEWAL BY ANDERSON •' `' Supplement r CORPORATION JOSEPH REZZA X ` 104 OTIS STREET NORTHBOROUGH, MA 01532 1 Undersecretary i r f. 1 3 t f i i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor c License: CS-065272 JOSEPH P REZW 168 KELLEY BLVD s N ATTLEBORO NIA b Expiration Commissioner 04/25/2014 renewal bYAndersene WINDOW' REPLACEMENT a1%&&tecnC0M"%1y Wood/Vinyl Composite IF Dual Argon Low E4 SmartSun Double Hung ' 100-00473518-010 'ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0029 0M,1 9 r ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Om42- mar,facturer nipublee d-thaw ratiegsconlam to app4:aola NERC procedures for determi8k q whols produce t pedormaftce.NFNC retlho are datermised for a feedsee of anvironmenlalcondfions and a spacfic product sae. NfpC does trot recommend any product and does not warrant the sufahffy of any product for any specihc use. Comae manufacturer's literature for other product padormanoe inlwmal'an. www.nfrc.org I R This product meets Green ,,, •. 4;r.i Seale savironmanlal aeneee etandardsgovemingenerW r, r.:do'4°:• !` r e(lieiary,heavy metals in <''•;"the frame and sashPackaging.aMf sumer educational materials. us:rR,a int .nr.un•nr •� ^•e e.»»ws.»i.ae» i i. DESA SSURE(PSF) t witdowta9ot 1 H-LC25 WdmaS {. RbA DB Sloped Sill DH IN . iesad mnAFSd2aANAAA4IM#UCSA 1g14SAelUM MantatNet at tes Wnlarmance to Ina a tlMM aWdaf(k Neste or exceeds M,E.C.,C,E.C,B I.E.C.C.Air lnaflration requirements WOMA tlaaaark Certification Program. s 1 I II �I � II �I I I,