Loading...
HomeMy WebLinkAboutBuilding Permit #635-12 - 105 HICKORY HILL ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age �� JAjL�J"14 LOCATION VCZ L Lcl �` ` Print PROPERTY OWNER �J W V'J Cx Unit# Print MAP NO:_Jk�1_PARCEL:_ Iq ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alter tion No. of units: ❑ Commercial U-Ke-pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other rr DAppticl `:�We �(]iFlobd ain� OUVetlaii s Yy -�I�p�Waters}iedlDistrct .- DESCRIPTION OF WORK TO BE PERFORMED:1 a � (Identification .Please Type or Print Clearly) OWNER: Name: J) Phone: Address: CONTRACTOR Name: x0 ('"L �oJ ��,J Ser Phone: Address: U Supervisor's Construction License: S O Exp. Date: 6E&/c Home Improvement License: U Fs L U Exp. Date: L& ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_3(Q FEE: $ Check No.: Receipt No.: R, -o NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofjAge6 Signature;ofcontractort T it 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 f 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.$100-$1000 fine i NOTES and DATA— For department use i i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi I l 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 o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ' o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And { Hydraulic Calculations (If Applicable) ❑ 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 o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location No. ?� Z-- Date ��- • ' TOWN OF NORTH ANDOVER t • Certificate of Occupancy $ ' X G' Building/Frame Permit Fee $ �l O— " � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# '2 S �� 25069 Building Inspector NORTH 0 T "- o over .. _ dover' Klass. O . > > Q LAKE COCHICMEWICK S RATED p �C. U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........E ... N. ..G�...........................................a................................... .................... Foundation has permission to erect........................................ buildings on ./0,5 ..�T!c,... 0 ..... ...�...//�`........................ Rough to be occupied as ��/=�.l�l.-�.����P.�.�Z�.t��:.......... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough y0" 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 (Nall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. RenewalMA Home Improvement Contractor bYAndersen. J I License#1708 10(Expires 12/23/2013) WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation Federal Tax ID#41-1918413 104 Otis St:,Northborough,MA 01532 (508)919-0900•Fax:(774)987-3013 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date of Agreement Al 4-- 2 Buyer(s)Street Address,City,State,and Zip Code 1 o S ►' cam% '1 �� l� ave r -� E-Mail Address a Tele one Number Work Telephone Number _ g 7 94 99 I 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. Total Job Amount:36C Z Estimated Starting Date: Method of Payment:❑Check []Cash !$Financed Deposit Received(33%): � W e-e-K1� e Balance at Start of Job(336/o):- Credit Cards are accepted for deposit Estimated Completion Date: p p only—maximum 1/3 of the project cost. Balance on Substantial 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. Renewal by Andersen Corporation ,Buy r 7) Buyer(s) Signature of Product Manager Signature Signature `Om 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- - - - - - - - - - - - - - - NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction Q—I 3--I 2-. . You may cancel I Date of Transaction . You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within three business days from the above date.if you cancel,any 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 I Seller 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; or you 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 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 I 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 If 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 ifyyou agree I 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 I oods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligation under I 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: I notice,or send a telegram to Contractor. Renewal by Andersen Corporation, 104 Chis I Renewal by Andersen Corporation, 104 Otis Street, Street, Northbo ughMA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF M— 1,�—/'_.(Date) OF .(Date) I HEREBY CANCEL THIS TRANSACTION. I I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Date I Buyer's Signature Print Nome Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink QBLLP2009.RBA-Ph.MANH Renewal ,;., MA Home Improvement Contractor '.License#170810(Expires 12/23/2013) byAndersen. ••;•� Federal Tax ID#41-1918413 WINDOW REPLACEMENT anMde—Company Renewal by Andersen Corporation 104 Otis St.,Northborough,MA 01532 (508)919-0900•Fax:(774)987-3013 SPECIFICATION SHEET Buyer(s)Name Date of Agreement G -2- 13-/2- The uyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REiMODELING AGREEMENT,of which this Specification Sheet is a part. PATIO DOOR DETAILS 1. Install total of: PennashieId Gliding Patio Door(s) X 5'10"x 6'8" ❑ Other(not available in 8068) Op.panel is❑ left 'right(as viewed from exterior) Interior and Exterior Color to be: ❑ White ❑ Canvas ❑ Sandstone ❑ Terratone (Color same inside and out on PS) Hardware: Metro: ❑ White V Stone [X Bright Brass ❑ Other—Specify ❑ Yes [ No Gliding Patio Door to have sidelight? Size: ❑ Yes No Grilles? If yes: GBG ❑ RgTW ❑ FDL(Pattern is standard as viewed in book for all doors) 2. Install total of: Narrowline Gliding Patio Door(s) ❑ 6'0"x 6'8" ❑ Other: Op.panel is❑ left ❑ right(as viewed from exterior) Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone (Interior is WOOD and customer must paint or stain) Hardware: Metro: ❑ White ❑ Canvas ❑ Stone ❑ Bright Brass ❑ Other—Specify: ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ I1,Tl W ❑ FDL (Full Divided Light) 3. Install total of: . Frenchwood Gliding Patio Door(s) ❑ 6'0"x 6'8" ❑ Other: Op.panel is❑ left ❑ right(as viewed from exterior) Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone Interior Wood: ❑ Pine ❑ Oak ❑ Maple Interior Finish: ❑ Prefinished White(Available only with white exterior) ❑ Unfinished(Paint/stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ INI W ❑ FDL (Fall Divided Light) 4. Install total of: Frenchwood Hinged Patio Door(s) ❑ 6'0"x 6'8" ❑ Other: ❑ Yes ❑ No Active/Passive Panel?: ❑ Left ❑ Right(viewed from ext.which is active) OR ❑ Yes ❑ No Active/Stationary Panel?: ❑ Left ❑ Right Door Swing: ❑ Inswing ❑ Outswing Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone Interior Wood: ❑ Pine ❑ Oak ❑ Maple Interior Finish: ❑ Prefmished White ❑ Unfinished(Paint/stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel 'NOTE: Canvas hinged screen frame N/A—must choose white or stone if exterior is canvas' ❑ Yes ❑ No Hinged Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ BVTW ❑ FDL OU Divided Light) STORM DOOR DETAILS 5. Install total of: Storm Door(s) 6. ❑ Fall View❑ Mid View 7. Color to be: ❑ White ❑ Canvas ❑ Sandtone ❑ Bronze ❑ Forest Green 8. Size to be: ❑ 32" ❑ 34"(White only) ❑ 36" ❑ Custom(10 week lead time) Size: 9. Hardware to be: ❑ Bright Brass ❑ Nickel 10. Additional job details: 11. Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. o final payment shall be demanded until the contract is completed to the satisfaction ofall parties. It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by And sen Corporation Buye Buyer(s) Signature of Product Manager Signature Signature Print Name of Product Manager Print Name Print Name - The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston, A 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu-tubers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): Y) Address: City/State/Zip: ���4r���,�n� �n1�� (�IS3,� Phone#: Are you an employer? Check the appropriate bog: Type of project(required): 1.EJ I am a employer with ­�D _ 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/orpart-time),* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ �. Remodeling- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp,insurance, g. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required,] officers have exercised their 10E Electrical repairs or.additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c, 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees, [No workers' 13.7 Other comp. insurance required-] `Any applicant that checks box Al must also HE out the section below showing their workers'.compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ v I E?- Policy#or Self-ins.Lic.#: / \ VJ I 1 � ' I Expiration Date: l — i Job Site Address: �y �� Y � VA City/State/Zip: ✓ VAC r '►�� Attach a copy of the workers' compensation policy declaration page(shopping the policy number and expiration d e). Failure to.secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER'and a fine of up to $250.00 a day against the violator. .Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification n I do hereby certify :thepa' and penalties ofperjury that the information provided above is true and correct Signafore: / Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector.. -6. Other Contact Person: Phone#: I '— `Iass-khusctts - Dep ar-tmcnt of Public Safct� Board of' Buildin , Rc��ulations and $tandai ds Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST'CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 C' nunissiuncr Tr--: 2622 �,lxe 'L�ayvrrwmu�e¢�i ✓�/�aeaacfzu.6elZ6 i Office of Consumer Affairs&Bdsiness Regulation r HOME IMPROVEMENT CONTRACTOR Registration: 1,.70810 Type: 1 . Expiration: 42023=13 Corporation J R cWALBYANDE�RSENZ--QRPORATION BRIAN DENNISON';— -r .r 104OTIS ST. NORTHBOROUGH, NIAOfS32 Undersecretary . 0 1 i r 70 DATE(MMIDDrr'YYY) CERTIFICATE OFLIABILITY.INSURANGE 0 1111/2012. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS'CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT.BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE DR-PRODUCER,AND THE CERTIFICATE HOLDER. , IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.Af SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies May require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-612-333-3323 CONTACT ,Tonelle Hargrove or Katie Psimos NAME: ar g Hays companies 'PHONE 612-333-3323 FAX 612-373-7270 A/C No Ext: A/C,No BO South Sth Street E-MAIL ADDRESS: Suite 7DO PRODUCER Minneapolis, MN 55402 CUSTOMER ID P. INSURER(S)AFFORDING COVERAGE NAIC 9 INSURED INSURERA: OLD REPIMLIC INS CO 24147 Renewal By Andersen Corporation INSURERS: NATIONAL UYION FIRE INS CO OF PITTS 19445 104 Otis Street INSURER C: - I Northborough, MA 01532.. INSURER D INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: 25114267 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 IXP LTR TYPE OF INSURANCE INSR.WVD POLICY NUMBER MM/DD MMIDD LIMITS A GENERAL LIABILITY MnY 59313 10/01/1 10/01/12 EACH OCCURRENCE $ 1,000,ODD g - COMMERCIAL GENERAL LIAeILnDAMAGETO RENTull."..)Y PREMISES Ea $ 5OO,00.0 CLAIMS MADE D OCCUR MED EYP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,ODD,ODD GENERAL AGGREGATE "'$_'I,DOD,000 GEN'L AGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/DP AGG $ 3,D 0 0,D D 0 - - X -POLICY PRO- LOC - $ A AUTOMOBILE LIABILITY MWTB 21377 10/01/1 10/01/12 COMBINED SINGLE LIMIT 3,000,000 X ANY AUTO (Ea accident) BODILY.INJURY(Per parson) $ ALL OWNED AUTOS BODILY INJURY(Per accident) '$ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Peraccident) $ - X NON-OWNED AUTOS $ B X UMBRELL.ALIAB X OCCUR 25030519 10/01/1 10/01/12 EACH DCCURRENCE $ 25,000,000 IXCESsLIAB CLAIMS-MADE AGGREGATE $ 25,000,000 DEDUCTIBLE $ X RETENTION $ 25,0 D 0 $ A WORKERS COMPENSATION MWC 117140 DO 10/01/1 10/01/12 X WCSTATU- DTH- AND EMPLOYERS'LIABILnY ANY PROPRIETORIPARTNER/EKECUTTVE YIN EL EACH ACCIDENT $ L,D00,000 OFFICER/MEMBER EXCLUDED? F N I A (Mandatory in NH) E.L DISEASE-EAE'MPLOYE $ 1,000,000 If yes,describe under 1,0.00,ODD DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 161,Additional Remarks Schedule,it more space is required) Hz,idence of Insurance. I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . AUTHORIZED REPRESENTATIVE . s'm°B ©'1988 2009 ACORD CORPORATION. All rights reserved. ACORD 25.(2009/09). The ACORD name and logo are registered marks of ACORD. 25114267 �- WI x0.1 W1 0 a a as - s Andersen. WV cP!n� Glass Type' U-Faclne SHGC' VP 12-1- _..3` Gla sTyPa. U-Facmla SHGc- VP 1.111-5 t�eRtM-1111 I I I I N Atideiseli?`400Sen`es.` r ar_'<xT; ��' e _,-F = _ `r_ K1�, r...•ileiiER.'ItrcfiifecFr+f � 5� SF>:y - =,. �_ Thur a' __. - ._ '?:'•;',i.-,•-.�rh�."4„�i`:'=F1•+�^s ._.,.:,-32.x'.. tr`=rss-'.. _ _ .� cr�r�.s�u-�1.^t�s-• �- _Ic.-.w`• s..- �t;- :(a� HP Ln*-E4 028 033.` 058 z � HP Law-154 032 028 0.47 > jOy1., Grilles. HP Low-E4 with Grilles 032 025 0.42 „y 3 ti HP low-E4 with GM 030 'a52 -�-?:��•'�„; HP Low-E4 Sun 028 020 031 �,.1 � �_>�.-_•vs--�:,� -� '�HP Lvw-E45un 032. 017 026 -Aielr�llfnddc"tic �IwnfnfWlt!d ' HP Law-E4 Sun w@h Grilles 029 018 028 �''u id 7 Fs--=• t c HP Low -E4 Sun with Grills 032 016 0?3 HP Low E4 3mertSun 027 0.23 am ] . HP Lvw E4 SmartSun 031 018 0,42 ; " - I;;.:���•s=�=G�r ' HP Law-E4 SmartSun w/Gulls 028 021 0.46 HP Law-E4 SmartSun w/Grills 031 017 0.38 �7 UPLvw-E4 0.27 033 '058 �:;� `�-' UPLnw-E4 031 032 0,55 c^ x € Iggs Ez' HP Low-E4 with Grilles 028 030 052 !�. s HP Law-E4 with GnlUs 031 029 0.49 ]]a HP Law-E4 Sun 027 020 031 I:� ' :� 'Ca"semnn�lfwriivf UP Lcw-E4 031 020 031 Flealframe'•.YlMdme.- 13--�-" . r.•..-y�k;-: "' +- -. HP Law-E4 Sun with Gdllef 029 018 028 �'_3® Klemm WhduWs Y. HP lnw-E4 Sun with Grills 031 0.18 028RAN �. ; , y HP Lo* SmartSun 026 023 052 = � I HP Law E4 SmertSun 031 021 0.50 A:7 3 2 1 h 'K.. HP Low-E4SmartSun w Gulls 028 - 021 0,46 ,y )�' FR HP Law-E4SmartSunw/Grills 031 0.19 0.44 11 Mim ?- % NP LmrE4 .031 033 0.58 =- -'r HP Low-E4 030 03T 0.64 #" =" HP Ln*-E4wb Gulls 032 030 052 ] try _ HP Low-154 with Grills 030 0,33 0.57 -0.3 HP Low-E4 Sun 031 020 031HPLaw-E4 Sun 031 022 03fi .^.SprinQBre�`-;41Nledoii% .. PedaltXpticdaw: �� � ��F�',.}�,-rte,•. -HP Law-E4 Sun with Grilles 033 � �0_S8 028 .]� P���r����oyC���:•t�'A` HP Law-E4 Sun with Grilles 031 020 032 F �' !1,; HP Low-114 SmartSun 030 023 0.52 3t f)� `^ " HP LuwE4 SmarLSun 030 024 0.58 HP Lnw-E4 SmartSun w/Grills 032 021 0.46 �-�,�� ;.•;.r_�.a�-a:�-:�•2� HP law-E4SmartSon w/Grills 030 022 0.52 r�-i_k�""*� HP Law E4. 030 a17 0.45 '_1.•. HP Low 032 0?2 037 x �r=�+-FN" =rte^' Asa HP Lmi-.Rwith Grills 033 020 033 - ��. HP Lo*-E4 with GAils 0.32 023 039 '� ® .. * `. �v 4"Fmnahwvdd,•�'`'_ ' UP Low R Sun 031 0.16.- 025 -;,E��. F:iHin{ed'Fie0ch Dial .;' UP Lvw-E4 Sun' 0.33' 014 021 I$Ifdfri pale Oao T® flu eln(��U HP LmwE4 Sun with Gulls 034 0.13 0.18ipk - ___,. � HP Low-E4 Sun with Gdlis 032 0.14 022 .� �' HP Law-E4 SmartSun 0.32 0.15 033 _ . HP Low-E4 SmartSun 030- 0.18 0.41 ._fig° ty „ r_ !�� :� / as -3 >�=„a:. HP LowE4 SmartSun w/Gdlles 033 014 030 - s� s4.;-A, ;i. _ HP Low-Ed SmartSun w Grills 0.31 016 035 _s ® M_ = R c - r" w-'.t,.;. ty' UP Lm 032 0.22 037 y, HP Low E4 031 024 0.41 �� ® r- ` �• any T" QIP Low-E4 With Grilles. 031 am 035 �_�� �i�� HP Low-E4 with Gnllei 033 020 033 - k`�'�--^''.�iY:L �,J :• L'E'+& •+�M1',•• •-ytMF.^r.?. ��FieYe^rJiwv'a'd_-:NMmOed.' HP Lcw-E4 Sun 031 0.15 013 ` Q LFrHIngWir. a }g HP La*-E4 Sun 032 0:14 021 _l ,P.ativ�eer„ iris:: HP Lcw-E4 Sun wfth Grills -032 0.13 G.19 .- ?t3 I FOuifwnnC: 'S 'HP Low-E4 Sun whh Grille: 033' 0.13 0.18 - 4`"i HP Low-E4 SmartSun' 030 0.16 037 _,•"�,'® �`a"� HP LnwE4 SmartSun 032 015 033 0`�",^,', II - ,,,;,,:; � HP Low-E4 SmartSun w/Grills ... 031 0.14._ 031 .'� �•.:I� �ic�.z;=+n_�.`r._-i0i' - � HP Law-E4 8nrad5un w/Grills 035 0.14 030 - ;�:_- 'r' s HP Low-E4 031 025 0.41 '; ® •-; � •-�, •HP Low-.E4 035 015 024 - V HP Low-E4 with Grills 032 021 035 = i' -eat} _ HP Law-E4 with Grills 035 0.16 0.25 - k Nlhfed. HPlnw-E4Sun 031 , 0.15 023 '$'=+�� G'ffaed;Faanr]L;Daac;- HPLow-E4Sun 035 O.SD 0.14 Patfe:0o vuhswtn� HP Law-E4 Sun with Gulls 032: 0.13 019 =s�® - Irin 5idefi � NP Law-E4 Bun.with Grills 035 0,]D 0.14 - ' _cy r.,�• ^ie;"•.. UP LowE4SmartSun 030 0.17 037 ${_ ® ` �._. -, '.-HPdnw-E45madSdn 095 Q.11 022 - „�•arn �_. HP Lvw-E4 SmartSun w/Grills. 031.. . 0.15 031 ". ® �? HP Low MOM, 035 010 020 a.s HP lrnwE{ 031 022 037w1�'���, HP Low-E4 034 0.15 0.18 - ,:•-- �- ,,,.. HP Law-E4 with Grills 032... 020, 0.33 HP Law-E4 with Grilles 034 O.ifi 025 - •'+ •. 'Fie-ehroede'hOv.: HP law-E4 Sun 032 0.]4 h21 � =]�..' FTad'mnn�t{Coiu ': NP Iow-E4 Sun 034 0.10 0.14 - ir0vvr53i HP Low-E4 Sun wb Grills 0.32 0.13 O,IB � ,� TDutMiring-Ar ldellot.; HP Lm-E4Sunwith Grills 034 � 0.10 0.14 - - �r-' y''ru,r• ,.��,,.•-�` :� HP low-E4 SmanSun 031 0,15 033 �ti�� +�++` �+`!r•=•".-r.<' HP Lnw-E4 SmartSun '- 034 0.10 022 r � y�`�'•� HP Low-E4 SmartSun w/Gdlls 032 0,14 029 y'�• •'� ' cn..`= 1:. HP Law-E4 SmartSun w/Grills 034 0.10 021 ••^� -y.+l-c:•:_--a-: �..:c'c-4 .��:-rte'•';'•,`, HP Lim 032 0.22 037 HPLow-E4 030 U24 0.4D = ® t»�•%'.••..s.; -j,c"�.`'.'` " -�,i•, HP Law-E4 with'Gdlls 030 021 035 i 1 :et, .-: HP Low-E4 with Grilles 033 020 033 ' ` HP InwE4 Sun 0.32 0.14 021 LFmjrchwaod!; �iml� - HP'low-E4 Sun 030 0.15 022 �_:�� r0emmarela4Doer"-.,_. �� ,pg�,.�!wPmm.�.�•�,��r HP Low-E4 Bun with Grilles 031 0.13 020 �,_�]� � -I��Oa`iswioe',.�.' ^•r.•, HP Law-E4 Sun wi0i Grills 033 0.13 O.SB HP'Low-E4SmartSun 029 0.16 036 NP Law-E4Smed5un 032 Q15 033 HP Low-E4 SmartSun w/Gulls 030 014 032 -'-:IN rsta" HP Low E4 SmedSun w/GdOs 0.35 014 0.30 - :4.:� �:4:�C=('•��•-.n:•iM.:4:.'._ ?-J}aa. :'+F,;:"��L:=r'Uv'F;:.: _ `� `T. E t--. ^� �r4.,�4�_ . f"_�v1�l.:y_-r� •N m _ ,^,Ahdersed'-20U:Se�es:.:"-•.�6•='_�;��„�+-. A, .; 'L„`=f::.�.->_"M=2:-, _ :.,.-.._,r'E-e�•r:� e o HP Law-E4 032• 028 0.47 ::71 C 1 Clear Dual Pane 0.45 0.60 m 0.53 - o HP Low-E4 wifn GAIs 032 025 0.42 M:- T1L�11ai1� ' Clear Dual Pane with Grills 0.45 054 0.56 - `a 'r ,tom �® ! c :g o m j'i-- r. +, t- HPlnw-E4Sun 032 0.17 02fi ? ® Dov6l�lim�NOvdmr; Um-E 030 032 0.551 a Casemevt:llVlvdme a x� ,+?3 ' a.• ie y, _ HP Low-E4 Sun wb Grills 032 0.16 023 _j�® ,:.:�q�a��'-_,a LawE with GdIIs 030 029 0.49 '•�]'. 1� c a a� e-��. �k HP Low-E4 SmartSun 0.31 0.1B 0.42 _I 52 J�u;s y+ a•� Clear Dual Pane 0.45 0.61 0 64 - 0 0 HP low-E4 SmartSun w/Grills 031 0,17 038 =:J 116go�(ne..'"-�'�i'. Clear Dual Pane wb Grills 0.45 0.54 0.57 - v o- 'y� HP Law-E4 0.32 028 0.47 lnwE 030 032 0.56 ;?9 r w 1 HP Low-E4 With Grills 032 026 0.42 �, ® "- °J1:�': >i,_ Law E wflh Grills 031 029 050 1 , rte::tit Clear Dual Pane 0.44 0.63 0.6fi -oE^iene8.Casamen�:.-� HP Law-E4 Sun 032 017 02fi ,i•�® 0��,�g ,E�. _ - itL�da:" - HP tnvrE4 Sun wb GdOs 032 016 023 3� Naiv°Iin" � ' Clear Dual Pane wb Mies 0.44 0.57 059 - :t-�. UPLaw-E4SmedSun 031 - 0.18 0.42 -i3M "'=7 Nom= �01�`y Law"E 028 C34 05B .-3i1'� HP Low-E4 SmartSun w/Grills 031 0.17 038 =)D .;.,�_ ,_1G=� Low-Ewith Gdils 0211 0.30 052 . - conthadannetpade . PRODUCT PERFORMANCE Andersen' NFRC Certified Total Unit,:P.erformande.(continued) � Glass Type I U-Factors 15HGC1 VT' ... . • - I�,' �• _.-.tc• Clear Dual Pane 0.45 0.60 0.63 - c � Clear.Dual Pane with Grilles 0.45 •0.54 0.56 - . _ �.��.�•. Low-E 0.30 0.32 0.55 . Low--with Grilles 0.30 029 0.49 Clear Dual Pane 0.43 0.61 0.65 - - vE;tZk; ,,,,°�,F�omd;•7 nsom-�,�� -Clear Dual Pane with Gnlles 0.43 0.55 0.58 C1esToR Wfndori: Low-E 0.28, 0.33 0.56 0.30 D.5D ' Law-E with Grilles 028 r� Clear Dual Pane 0.4b 0.59 0.63 - _ Clea r Dual Pane with Grilles 0.45 0.52 0.55 - R Low-E 029 0.32 0.55 - - - _ rr•,: Low-E withGnlles 0.31 02B 0.48 ,a oa]oorsH•_r`= ;p. Low-E Sun 0?9 020 . 0.30 Low Sun with Grilles 0.31 0.17 026 =' 7 WS r Lo Low-E SmartSun 028 0.22 "0.50 � ,� nc����• Low-E SmartSun wRh Grilles 0.30' 0.19 0.44 •� •5:� J. J Clear Dual Pane 0.44 0.61 0.64 - _ �•�' � � Clear Dual Pane with Grilles.. 0.44 0.54 0.56 -Low-E. 028' 032 0.56 - ! lye 5 seld�:N, Low-E with Grilles 0.30 0.29 . 0:49 G88Iog P"t1i 'D Law-E Sun." 0.79 0.19 . 030 -A " t Low-E Sun with Grilles' 030 0.17 027 3 1:, Low-ESmartSun 028 0.22 0.50` u, _ _ Low E SmartSun wlth Grilles: 029 0.19 0.44- Clear .44 Clear Dual Pane 0.43 -0.45 0.47 _ -Clear Dual Pane with Grilles 0.44 0.39 0.40 - := z Low-E 0.32 024 0.41 , xas.>n ' • 0.3 5 - Grilles 0.33 021 _T.atin: cors-. Low-E with .•iriged P.. _ - � :-•--r-� Low-E Sun 0.32 '0.15 023 Instinng'^��_. Law-E Sun with Grilles . 0.34 0.13 0:19 - - Low-E SmartSun 031 0.16 0.37 nr Low-E SmartSun with :Grilles 0.33 .0.14 0.31