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HomeMy WebLinkAboutBuilding Permit #459 - 10 WOODCHUCK LANE 12/6/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: EMORTANT:Applicant must complete all items on this page LOCATION /6 � f 4�k LOC / �(�QQ � i /1 Print PROPERTY OWNER Print MAP -- MAP NO: PARCEL:b ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other � 5 p crWell t ®Floodplaui` Wetlands `® �Wat e heli District, • DESCRIPTION OF WORK TO BE PERFORMED: rva aA-- Identification Please Type or Print Clearly) OWNER: Name: C . �' � � ►` Phone������s— `��� Address: zd -� t�C�ic��� LA t,S Ey CONTRACTOR Name: 6aap�j i✓>✓l S�J,� Phone: 5'W S/f 9r� Address: IP& Crf C'A-f Supervisor's Construction License: —2 Exp. Date: Home Improvement License: (�_(�/ Exp. Date: L /0 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ DS asi FEE: $ (302! � Q i Check No.: Receipt No.: L�O 2 k NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund re natuofcontractor< .. Signatu�e�:of,�Agent/Owner k 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 Signature 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/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, 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.$10041000 fine n NOTES and DATA— For department use ® 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 ❑ 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 NOTE: 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 VOTE: 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 .hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording oust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location �G� Q�fil Gf� Gv No. Date 9 //'' NORTIy TOWN OF NORTH ANDOVER A ay Certificate of Occupancy $ •so � ' <�' Buildin /Frame Permit Fee $ 0 3 CHUSe 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24862 Building Inspector NORTIy o over . Town - 0 111111!'In . �- )'-� No. � _ _ o , lover, Mass., a COCMICMEWICK A0?ATED P, C2 S ` BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..............:......:. ................................ ... ....... .............................................................. Foundation has permission to erect............:........................... buildings on ......1.0......... ��! ....... .... Rough to be occupied as............. ...6............... .......... ...t""�1T 4.+...1.!1. /!!4�. ........................................ Chimney ........................ 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 3 03. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC2elS Rough �LService .................................................................................................... .......... 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. Sep 14 2011 8: 57PM MIKE SIDMAN 6039345514 p. 1 _ =r Via 104 dt St.,Nntthburuugh,AIA(11532 & WI.'VL(RYK,INC.,a/u/;1 MA Borne[mprovemcrit Contractor (5M)X119.0900•Fm:(774)987.9019 Renewal License 4149601 (Expires 1/24/2012) by/�fld!?mirt Federal Tax 1D 483.0404201 a'INIOW 441401MIar !4 CUSTOM WINDOW AND DOOR REMODELING AGRERMENT B Nom, Csraol rMMlyd Dyyodol iihoof Addraii,CitY,Stott and Zip Code la Qo JaWv AAt tMetlpddne Nome Tela woN)Mber, Work Taft honeNumbar Hur(9) hereby Jointly and xeveraliy agrees to purchase the prodiwo and/or services of J a 1,Wimlows,Inc.d/b/s Renewal by Anderson ("Contractor"),in acwrdiutec with the terms and conditions described on the front and tho reverie of thiseement and en the attached s cltiaation theet(s) (cvllectiveiy,this"Agreement").Bu�tefs)hereby agrees to 4n it completion ccrlificaleancr Contractor had completed all Hrork under this Agreeme,lt. Totol Job Amounrt Eetimaled Storting Date: Method of poynrunt eck OCoah OFinanced adlence at Skrrt of Job i33%)c �-1 / Credlt Cards are accepted for dapo$it 4/ Eshmoted vmplefl nGate: Only- maximum 1/3 Of the project cost, Balance on Substantial �° _1t / Please see Credit Card Payment Form. Completion of Job(33%1: - By aignWa this agreement,you acknowledge that the Balance et Start of f ob and the Balance on Substandal Completion of,Cob cannon be made by credit aaxd and mast he made by personal Check,bank cheek,or cash, Buyers) agrees and understands that this Agreement wdgtitutm the endre understanding between the pare,sad that there are uo vtrbal underotaxidlage changing or modifying any of the terms of this Agreement.No alteration to or de+detitm fi**%this Agreement wf11 be velid without the signed,"clan consent of both Buyer(%) and Ctontructor. Bnyer(s)hereby acknOw144611 that Buyer(s) I) has read th4 Agreement, underatunds the terwas of this Agreement, and has received a completed,signed,and dated copy of this Agreement,Including the two attached Nadees of Cancelletio»,on the date first written above and 2)was 6rally Informed of Buyer's right to cancel this Agrtement. b0 NOT 131GN THIS CONTOACT IF THERE ARE ANY BLANK SPACES. J do L Wladvws,Inc.d/b/a Renewal by Andersen Buyer(s) Buyez(s) By; ` Signmklir.Lit Praclurt Manager 4ganawc. Signature -&to/ S�ot Print Mimr-ul'Pruduer Alinaknt Rint Nalhe Print.Name VO'U, THE BUYER(S), MAX CANCEL THIS TRANSACTION AT ANY TIME" PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.BEE THE ATTACHED NOTICE OF CIANCELLATiON FORMS POR AN EXPLANATION OF THIS UGHT. <- - -- - - - - - - - - - -- - -- _ ear_ _ -�e NOTICE Of CANCELLATION T - ON Date of Transaction y-it , You may cants) Date of Transaction 9-1 - .You may Cance) this Ira nsactio out any Genal or obligation,within this trarlsadion without a na or obll n within n� I Pe three business d fy �y ayefrorh Cha oboes data.ff you cancel,any th tee bwin.ss e�ays}rout Mte abew data,if you cancel,an ppr'tlpbrty traded In,any payments mage by you under den i property traded in,any payments made fayou under the COnt ad of Gals,ottd any negotiable Instrument executed I Contract of tale,and any��ble Inshwi ent executed by you will 1, ratun+ed within f 0 days following recelpt i by you will be rehimed within 10 days following roosipt by the Contrpttpr ("yeller') of your cancellation natio$ i by the Centtrwttor 11"Sleller'l of your concellotion no4ca OW any security Interest arising nut of the transaction wif and any seautfty Interest arlsing out of the transaction calif In canceled,If you cancel,you mutt make ovalloble to the be canceled.If you tomcat,you must Maio available to the Sailor at your residence,in substantially as goad eanclition t Seller at your residence,In substantially as good condition as when recehr d, any goods delivered to you under t as when raeeivod,any goods delivered to you under this this Contract or sale; or yew may, If you wish, comply 1 Cont+tW or Sale ya+may if youwish,comply whFr the W% the Instructions'of the Steller regarding the return Instructions oft Seller"n;s ng the return sh pment d shipment of the psoas at the Setter's ex pen,s and rick, i the good,of the Seller's expense and risk.N you do make It�rou do main#te oods available to the Seller and-the i .the.$gods.avallable to the Biel) and the Gelltar dees.no+. Seller does not pit:kiham up within'20 days of the date i pick them upp within 'S'D clays of the date ofye�ur Nona of yyoouur Notice of Comalladon you may rota In or dispose i M Cartcellottan,you m retaln or ,p,.tsf the goods of the nods wttftotit any furl ;ob�lig�aation,If you fail to withaut any Further tab�I yatitwt, lF you Flail to mates tFae make the s ava(labie to the Wier,or If y tee goods oval' ble to the Seller,or If you acres ro rstturn the ro rtAurtl t � ggoods to the sellar and fall to do so,Nten t goads w the Sellar-and fail to do so,then you r main Ilable yov rornoln Mable for perFormanee of all ob0gations ynd6r i for pet'formoncet of all obligations .under the Contract, the Contract-To wncal this transaction,moil or do Iver a t To carr:d tf+►e transaction, mail or deliver a signed and d8nod and dated copy of this eanceliatlorl Motice,or any i dated copy of this cancellation notit'e or any other wrinen e titer wrHMn nasticea, ar send a halegrom to Contractor;J notice or send a telebggram to Contme wi J R L Windows, A L Mrndows Inc.4141 Renewal b Andewen, 104 CHs I Inc. J/b/a liwnewat Andersen, 104 Otis Street, street, Northboro h, fMA O1 3321 Y)NLN LAi SIt THAN oPorthborou h MA 01 SS4,SY NOT LATER T9�AN MIDNIONT MIDNIGHIT OP -t �,(Date) 1 HERESY CANCEL THIS TRANSACTION, { I HERIS'Y CANCd?L THIS TRMSACTION. buylr'I blpnahrn prFr,l oT• Pall Aurae, itnalVia eMs pals RbA Copy- Whltc Buyer Copy-fallow Buyer Copy-Pink Sep 14 2011 8: 57PM MIKE SIDMAN 6039345514 p. 2 104olb SU-Cet,Nenllber0ugh,MA O1t;32 %by 'dersen.cm f R L Wintlewlltrle.A/b/a phone 508.91 B.0`a O-NX T 74,99Y.s0 to IL Y r GI� MA RC License#144601(exgim 1/24/12) e�r Fem'dl'i'ex ID#8:]•0404201 WINDOW IttOtaolNINT %i,Ande:stnC, ,m Of GMAT MAfanCHUSEITs AND NAW HAMPW= W>NfDCI W SPECIPICATION SUET Httyer(a)Name .L� Date of Agreement a r0 /'a.r 7� Tie Du)-or(A)IJAted above herebyjoinlly snd severally agree m pvrchnsa the goods and/or setykes listed below,i1faccbManct with the prices and kerma described on the Specification 5hact and the.front and the rtwrse of the aororhpanying CUSTOM WINDOW AND DOOR REMODELING AQ1UMFA\7, of which this Specification Sheet is a part. s / WNDPW MAU l 1. Cat elector will lttSWI a total of window&in Owner's home,using the fCllowing individual qua„titles; Double Hung(D9) ❑ Equal mah ❑ Cottage slash(1/3 top,2/g bottotu) �] Driol sash(2/3 top,1/3 bottom) casement(CM ❑ Hlrge right ❑ Hinge left(as viewed from exterior): ❑Standard handle❑ Motro handle rouble Gasettrcnt(CDW) ©Standard Odle.[j Metra handle Caberrtenl/picture/Casement(COW) 1,1;1 or❑ 1210 Standard handle X Motro handle 2 41te gliding Window(GW) Glider/Photon/Glider(0-FW) (❑ 1;1;1 or ❑ 1;2;1 Awning Window(AW) / Pichnr Window(PW) Bay at'Bow Window Patio Doors(see separate Door Specification Slteet) 2, ( Yes ❑ No Qty of Wlndowt to be Custom Fit Raplac(srtl=tt: _ s. ❑ Yes®,No Qty of Silts IO lx replaced by COntraator; 4. [R yes ❑Flo Qfy of Windows to be New Conslruetion lull fr=c Uncludcd new lVerior&exterior Casings)and coral 1 1 - Exterior caain,y; ❑ Fine ELNt4lnirxlancc-Free m$trrial [] Factory applied 908 F1C] int rcx brickmold /��TS 5, Clazing to be; HP Low.E-4 Other If other,please apm4—,, tr [r 6, Extorlor Color robe: ❑ White ❑ Sand Q Canvas ❑ 'refralbne ❑ Cocoa Bean 7, Interior color to lk; ❑ White ❑ Sand Z Canvas ❑Terrat9ne ❑ Pine ❑Maple [] Oak Note: lnterlor I:olor can only�be white,wood or same color as exterior. Wood Interiors need to finished by Owner. s, Hardware: C: Whllc E] Stone 06 Canvas [] Brass© Fatale Hardware 8, 21'es❑ No Install Lifts with Double Hung Windows 10. Screens; windows to have; ❑Half or XFull screens Screens to be;R flbcrglass❑ Alutninurn ❑Truseane Ulyd,£=AU 11,Windows have gtillce:I-Yes❑ No If yea;, Grille Between Ghat(Cau)❑ Aomovable interior Wood armvl© Full Divided Light Iruu " Rt ' t ; -- qty; of - Qt 4�tv; H ax nal u,te aids, Draw grille patteana abtive 'Use oddiflonal sheet if needed Owner approval(utlti bl ADDITIONAL,WORK DETAILS 12•❑Yes gid NQ Contractor will rcntove metal frames of windows. qty of units: 19-❑ Yes M NC COntratlIOT Will uutall new paint-ready or stain-heady casings, lllteriorcasing qly M openings;_ Exteriot*ashtga qty of openings;_ ❑ line ❑Main tenance•frce material 14,❑ Yes Qk'1`10 Contractor will uv;tall new paint-ready or atallt•rendy inside or outside stops qty of openings; Interior stops qty of openings _ Extarlov slops qt rt:hings; ❑Pine ❑htalntenance•free ntaterlal wl B. Owner is aware that Cahlrogtor does Wt do Ow painting, . Owner Wdale 16.❑ yes JLNo Contractor will wrap exterior casings with alum n co11 stock of Color, bots Wrapping tray be required with storm window rernpval;rentcma of storm windows will leave screw hales in casing. F 7.®Yes 0 No Contractor will ltlaulate,Caulk and seal KNndow&with 31011it system to prevcnl Witter and air infutratlon. I B. Yes ❑No Cleanup 41job related debris including old windows will be rrmewed,Vacuum nightly. 19, Yes [] No A limited warranty shall be issued to Owner upon COMI leHon of the Job and payment in full. 2R, Yes❑ No RUilding hml Cantrautor will secure any and all necessary pennits. Tile fee for the penWt(s)is not included in the Contract Prk:e xnd a adparatc check is required at the time of sale for this fee. 21. yes ❑Nn Nl din!uunlA have been applied to chit agmcment price, 22, Additional job details: 23,KYes❑ No Owner agrees to)x present on thu final day M IIISWIAtial for final inspection and to deliver final payment, No fynert fiffXM rt shall tv denumded until the t-otl"et is counplered to the AtjAMotion ctPWITartier. It to sgreW and WWastood by send between the parties that thus 6pecifwatten Sheet,alostg with ft CMOM W1111riC)W&D DOOR RMAODP,LING AGRE«42d>+N't'I 00rulitutda the entire uudorstandlttg bctwwn the parties,tuld there are no verbal understutdlnys dw%ttg of modtfytng of the W= That spentscation shaft may sot be ohdnged or its tern tttodltied or vuied in MW way 11ra ss 9tlfdt ohting>K are in wr(tin&and elgtm ally by froth fhe INOW(s)and[emraotor, auyar(s)hereby acknowledge that SuM(a)hate trod tltla Speeifioegeg Shwi, ReAMAl bb/y Anda]beet of];,mats MA and NH Buyer(s) 8uyer(s) By Stgnaturo of Product ManAger signature S4111101urs Or4Re- 0 -10A, Print Name of Product hunig a Print Nam& Mt Name The CoatM&Ipeafji of lc�assachu.�etts Departmild of�izdus6 cal�4cccdeats Qftcc of fnPestzgafiQns ' . . bD0�askia�tnn street •, Boston,hd4 02111 • y�,mass.go�tr�ia , n ursnce AffidsQitt B Leg -atridEns/Flumbe r War�er� Compense�o please 'rtn A Iicsnt fnfarmsfian' NE=(Bu6n=.dDrgnd=iaallndividuAl •' 7►?e ofprdjeet (Ovire�, Are you an BMpIgw?Check die egpropriste boy I rMtzact=end a. []23aw construction �r , 4. �'Iam a gcnaral. L L7TI am e.amP 'ct w � _ hived ampjayeos(bfandfarpart-fimc),�" an fe attaabed shat �` a g a sou propdatcc wpnt=- g, DamnMon ,'1'nesa•sab-aOntxactaza have ship end bevo nD amplopeas i , Do=„insurance. g, ❑$a�7ding addifioa working fiDr me is day capacrty. [I Wp ffro a r paiz6oa anti ite Ip.(]Elc 6l al rapeirs ar addifiOns [ND wnrkcrr'comp• ° afne=have Mbit isod than, eta ar additions Ift of CiMiptidn per MC3"L, 11.E]Rlumhing rop 3:[Q I am a hO=Dwnor doing aIIwork a IS2�,�,�,,1.(�),a�wa bavo n6 12.0 Roof i PLEI mysba[ND wO*=, comp. �plDyces,•[No war==s' 13.❑p insui8nce requrrLd.]t 0 �vnsiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii­ 'o�p��ina pn3i� sfina «may enpii�aat tb��boi K=ut 990 fall rnt flu rmd$trm hsc outside oonfre �t taeav sffidavlt indi�at ae . t gtimeawneot who M*Mm fhu affide��mdimfmr$�7 of the tj-ooat�end mr rvorkas'eomp Po��7 0m • iContmetoa that:ohek fhu bo=mmol etbusb��eddifim�l�beetsbon'ioL�nenle . I arm an crrtploper tkarisproyrdrnrWorkrrs'camp e,uofinn irc=ance far my employees �eloio.is the policy and job site irsforreatian. I „^ �� 11 — II1stlranGO Ccanpany Idema l. FLgiratinn Date, - Policy#or Sri ins,I.ie.#; '� �,�('•�f�I�'T"L_- Sob Site Addrass, Qe sbo the Dlicy n�ber end arpirafinndate). Aftacli a copy of the VMrkers'cDrrtpenssfinn.p�Y dB*rsfinn PL � � P cnREDS of a 0. 152 can load to tho impo6ifiDn of==imine p para=to scaum covarago as req=6 uadar ScDfioa2SA of MrrL h �f�•Df n 3TIQP WORIC QRI]ER and a Etna 5ne tipin SIAUD and/or Ma-ycer imprisonmaOt,as wall as civil pcnalfi�s' t fho violater. Bo advisod$gat a copy.of this statrmcnt�p bo forwarded to fibra Q$ce Df vfi;p tD M50.00 a day agains IIrPC6 of fio DTA for ln6aL D aDvaago'vcafimfim Ido hereby c u the pains andp= erjury that the information prmrided above is frtea'rrnd ca=t De#a' l Pbonc# Dcfu!tzsa ar[fy, Da rwt in this area,to be esmplefed Fry city 17F tax'n aciaL p�itlLicanse# . City nr To4ru; soiag Aufbor4(vada nne)eeetar 5,ph mlDm;Inspector L BDQrd of Health Z..Big Dep�mt 3.C 417To�en(perk 4.�ctrlcallnsp , Phare COatact Person 4 Massachusett> - Departmc nt of Public Safet) -Boardiof Building- Reuulatioris and Standards Construction Supervisor License License: CS 95707 BRIAN DENNISON r 86 CREST'CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ('ummissi finer Tr,: 2672 .i`•, • .✓A'.CY ZDO�f?7L49,LlOP.dGUl o�✓�'LQG66�lU6e�6.:.,. Office of consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registiatio `• 501' Ex pi 12 • r�-��� t Card RENEWAL BY 'BRIAN DENNIS� e r '104 OTIS STREE NORTHBOROUGH,M 'Ta32 Undersecretary aco CERTIFICATE.OF LIABILITY INSURANCE °A 0/04/0' 1 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 CONTACT NAME: J.P.McKeone Insurance Agency Inc PHONE (734) FAX JP McKeone Insurance Agency, Inc. A/C No. 662 8100 A/c No): P.O.Box 333 ADDRESS: Ann Arbor,MI 481060333 INSURERS)AFFORDING COVERAGE NAIC# INSURERA: Nautilus 19682 INSURED J&L Windows,Inc. Renewal by Andersen INSURER B: Hartford 37478 1 D4 Otis St. Northborough,MA 01532 INSURER c 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 ADDTYPE OF INSURANCE NSR SUER POLICY NUMBER POLICY EFF POLICY EXP I LIMITS LTR WVD A GENERAL LIABILITY NC958461 10/01/2011 10/01/2012,EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL UABILnY I PREM SES Ea occurrence $ 100,000 CLAIMS-MADE V OCCUR MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: `PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY F PRO- LOC $ AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2011 10/01/2012 COMBINED SINGLE LIMIT 1,000,000 Ea accident ANY AUTO j BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i BODILY INJURY(Per accident). $ AUTOS AUTOS NON-OWNED I PPPROPERTYDAMAGE $ HIRED AUTOS AUTOS I $ er accident) UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I 'AGGREGATE $ DED RETENTION$------ — �---- $ A WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012 1 WC STATU- I I OE- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � NIA A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) ;E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ B PEODH55500 0507 09/27/2011 09/27/2012 1 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Do not remove until final code inspection. Save label for future reference. Qualified for hilpitliq1tNd area. m Canada 1 Sao 387-2oco zenerpyetarpc.oa N C OI O M N jX a >, 'w ` � W 1 888 782-7237 C anergyatargov Renewa l byAndersen, WINDOW REPLACEMENT wr.'lndetswtO,mpany AND-N-102 Wood/Vinyl Composite Dual Argon Low-E4 Product Type: Casement ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0. 29 1 . 65 0 . 28 U.S./I-P Metric/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 48 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product ,performance.NFRC ratings are determined for a Axed set of environmental conditions and a specific product she. NFRC does not recommend arty product and does not warrant the suitability of any product for any specific use. Consult manufacturer's literature for other product performance Information. wwwnfrc.org . vmm�r.rw m. ' _ Wnubs�m-.1.mY.en wnn.udim.mm Andersen Corporation:RbA Casementnow Manufacturer Stipulates con ormance to me ronowng standards Standard Rating NAFS-02orAAMAWDMNCSA1014.S.7/A440-05 DPpSf DP35 C• This product meets Green Seal's environmental standard N. governing energy efficiency.heavy metals In the frame and sash material,packaging,an consumer educational n materials. 100-00513972-001 Meets or exceeds M.E.C.,C.E.C,81.E.C.C.Ar Infllibetion requirements WDMA Hallmark Certification Program. ' Luff fa Et ' T�E ��E F�TII�� . • . . . • U-Fa�ar�r�-•P _ Ear-1-��at t�a:ua L��ptet�t .. • 9--x ' ': ..�RlCl1�AI.PEEVE'-Di��,S�?��. .i • ' i ISE IF PFESSUM EPSf� f na 52.ape.•ck s�11 ' �r� 1LFL.r-G-" r tai-•r• ��,�..d..�.�.L.�.�e-- -- - - • t '16