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HomeMy WebLinkAboutBuilding Permit #576-15 - 125 MIFFLIN DRIVE 12/29/2014 BUILDING PERMIT pFp10RTF{�iLeo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION f- ^ +11 {\ h Permit No#: Date Received 7 �RAre �SSACH�`-'�� Date Issued: 7— -L IMPO TANT: Applicant must complete all items on this page LOCATION Port PROPERTY OWNER Z/ Print i 00YearStructue yes no MAP' FARCEL: !>ZQNING DISTRICT": /'Historic District yes no - - _ _ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial B1epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑Wetlands 0 Watershed District Q Water/Sewer DESCRIPTION OF WORK TO B PERFORMED: Dila Identification- Please Type or Print Clearly OWNER: Name: C12av�oS f-��e��4li ���'� �y%� Phone: 9 Address: /o2s /101110r_fZl," Contractor Name3;1*e Phone:. _. Address: Supervisor's Construction License: 4191140 Exp. Date: _l�'"oG /w Home Improvement License: ,-.-/76) Exp. Dates 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. 2 Total Project Cost: $ c30, ��cS. oy FEE: $ j' 1 Check No.: Cl �101 & Receipt No.: .. NOTE: Persons contracting with unregistered contractors do not have access e guaranty fund Signature of Age nt/Ownererd� Signatureof contractor~ -. . - . 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 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:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location 7 j/i ty 1 t-!l ►/'� f No.��' k — ( Date . - TOWN OF NORTH ANDOVER � a:n 16q�4 Certificate of Occupancy $,r7--) � Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ` 14T kms. TOTAL $ Check# it/02 C' , !! Building Inspector NORTH Town ® :' : ,, ndover ' C to 0-No. 616 * - _n soh ver, Mass, �J COC NICKlWICK yOt' 79 A04.t7ED ►'P ,�y S U -D BOARD OF HEALTH Food/Kitchen Septic System PERMIT T L THIS CERTIFIES THATC.414rmllkzBUILDING INSPECTOR .11.r....... �. ... .. .�. .z ....... Foundation has permission to erect .......................... buildings on .... Rough T to be occupied as ......... .. ....... ........ ........1........W l.Nd .......................... Chimney provided that the person accepting this pe it 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 S Rough Service .......................... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Renewal MA Home Improvement Contractor byAndersen. ' ' License#170810(Expires 12/23/2015) Renewal by Andersen Corporalltion wtxeew alALAQ[M[M7 n,tuJ.,wM:a,.tw,v 30 Forbes Rd, Northborough,MA 01532 Faders!Tax 10#41-1918413 (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Bu er S Name Date: DEBORAH & CHARLES PAPALIA - OCTOBER 9, 2014 18uyer(s)Street Address City State Zi Code 125 MIFFLIN DRIVE NORTH ANDOVER MA 01845 (Email Address Home Telephone Number Work/Cell Tele hone Number PAPAL IA.DEB@GMAIL.COM 978 682-2322 978 490-5302 Buyer($)hereby jointly and severally agrees to purchase the goods 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 cerVficate after Contractor has completed all work under this Agreement Total Job Amount $ 0.00 Amount Finencod$ 30,685.00 Est.Start Date Method of Payment Deposit Received(33%) Cheek/Cash 12-14 weeks Balance Start of Job(33%) Deposit At SID"$ 15,342.50 Check w Balance on Substantial At Subsl.Wlal Est.Install Tune Credit Card Completion of Job(33%) Completion$ 15,342.50 1.2 days c tea s ae ted,please ace CrodR caroPaymnt form 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 Buyers)and Contractor. Buysr(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 Buyees right to cancel this Agreement DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Anderson Corporation Buyer(s) Buyer(s) 8y: r0121X �P Signature of Project Manager Ign lure Signator TOMMY KELLEY DEBORAH 8t CHARLES PAPALIA Printed Nemo of Pnoloct Manager Printed Name PjknU Name YOU.THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TME PRIOR TO MIDNIGHT OF THE T141RD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT, ------------------------------------ NOTiOE OF CANCELLA7tOb' *_.._....... NOT1C1:OF CANCELLATION Date of Tnasaetioa IDl11/1e .You may cancel this I Dots of Transaction WPM .You may ewneet this 1 transaction,without Any penalty or obiiaatiaa,within three business days from the I transaction,without any penalty or obilgwtloa,widda three businese days from the above date.if you cancel,any property traded in,any payments made by yon under 1 above date.If you cancel,any property traded in,any payments made by you under the Contract of Stile,sed may negotiable instrument executed by you will be 1 the Contract of Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor("Seller")of your I returned within 10 days follewlng receipt by the Contractor("Sento")of your cancellation amtce,and any eecurity interest arising out or the transaetloa win be I cancellation notice,and any security interest Arising out or the transaction will be canceled. 1f you cancel,you must make evadable to the Seller at your residence,in canceled. If YOU Cancel,you must make available to the Seller at your residence,in substantially as good condition as when mewed,any goods delivered to you under I substantially as good condition as when received,any goods delivered to you under this Contract at Salt;or you may,If you with,Comply with the instructions of the I this Contract or Sale;or you may,If you wish,comply with the instruction*of the Seller regarding the return sklpmeat of the goods At the Seller's expense sad risk. I Seller regarding the return shipment or the goods At the Seller's expeaee and risk, if you do make the goods available to the Seller and the Seller does not pick them op I If you do make the goods available to the Seller and ore Saner dots not pip ck them li within 20 days of the date of your Notice of Cancellation,you may retain or dh*pece I within 20 days of the date of your Notice of Cancellation,you may retain or dispose or the goods without any Ihrther obligation. If you flan to make the goods Avallabie I of the goods without any further obligatlon. If you fan to make the goods available to the UUM or if you agree to return the goods to the Seller and fall to do so,then I to the Sellers ar if you agree to return the go*"to the Seller and fail to do so,then You remain liable tar performance or telt obupdons under the Coalract.To cancel I you remain Liable for performance or all obligations under the Contract.To cancel this transaction,man or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a 24p ed and dated copy of this cancellation notice or any other written notice,or send a telegram to Contractor.Renewal by Andersen,f or any other written notice,or send a telegram to Contractor. Renewal by Andersen, 30 Forbes Rd Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF � 30 Forbes Rd Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF 10113tt4 .(Date) 111EREBYCANCELTHIBTRANSACTION. 1 10/13/14 .(Date) IHEREBY CANCEL THiSTRANSAC ION. I a yera Sir— Pd*e trans flan I e,yer4Spn+hra Palm Mame t)nt _MA Home Improvement Contractor'Renewal by Andersen Corporation - byAndersen, 30 Forbes rd Northborough,MA 01532 License/17081 O (Expires 12!23/2015) WINDOW REPLACEMENT .,.A.,,k,..,,e:.,�,,,�, (508)351-2200 Fax:(506)-986.7072 Federal ID#41-1918413 Window Specification Sheet late rr(s)�'artte Dare of Agreement DEBORAH & CHARLES PAPALIA THU, OCT 9, 2014 The buyers)listed above herebyjointh,and sevemlhr agree to purchase the goods and/or senices listed below,in accordance with the prices and terms described on die Specification Sheet and the front and the reverse of die accompanying CUSTOM IVL\'DOt%r A\D DOOR REMODEUNG AGREL iENT of%tfiich the Sped&cation Sheet is part. WINDOW DETAILS Approx. ExtelohlMoxior Coto HardVare Hudware tawE4/ MCS &1112 Gbss Boom s U.1. Window/Door SW Deta3 Casstgs 61-ht Color style Sueem Smwiun Was sasnl/3 suh2 Lifts 100— Dining 2 79 DB square equal full frame ExtJlnt MF 908~ Stone Standmd FFG 51Y=Zur Fix_ 212 No Dining 1 96 PW full frame Ext/Int-MF 908 Stone Standard 3inedSur mora No Den 4 89 DB equal full frame ExUlnt MF 908 MwF Stone Standard FFG knartSur FOL 32 NO Bed 1 1 1 1 97 DB so rail equal insert sloped sM No Stone Standard FFG "ur FoL 3312 No Bed 1 2 89 DB square equal full frame Ext./Int MF 908 Stone Standard FFG u FOL 32 No Living 2 89 DB re equal full frame EdJlnt MF 908 Starve Standard FFG u FDL 32 No Living 2 97 DB rail teal insert si sel No Stone Standard FFG u FOL 302 No Kitchen 2 81 DB rail oral insert sl skin No Stone Standard FFG u FDL 32 — No Bed 2 1 89 DB sq rail equal insert sloped sti3 No Stone Standard FFG u FDL 302 _ No Bed 2 1 81 DB rail equal insert s1 sa No Stone Standard FFG u FOL 32 No Bath 1 1 81 DB sq rail equal insert stoped sil No F Stone smndard FFG u FOL art - — Temper Hal 1 81 DB sci rail equal insert sloped sig No Stone standwd FFG ur FDL 32 No Mast bed 2 81 DB square equal full frame Ext/Int.MF 908 Stone lStend2rd FFG Ur FDL 3M No Mast bed 1 81 DB sq rail equal insert sloped sal No Stone Standard FFG Ur FOL 32 No Total 23 SAY&BOW DETAiIS *See Ba /Bow Measure Sheet St*Dotad/ Approx. Roam Count Style F[2nkem . Casinz Argb U es kCerior 6uArrt CoEor Crc= sashes sasties Steens Smatsun SO= H Calor SPECIALTY WINDOW DETAII S FuG/ Approx- tom/ malty BAY/BOWADDPPIONALWORKNOTES Room Count lawd U.I. sm=mm Was GrCb Style ExVkd Color rkwmom isawam that wuh Fin nom witdtewv under 72 kwbrs that%ill be ognirenatt gLra hxc. DLTIONAL WORK DETAILS: M the fid Game%indw banana tore emayor and interior eminp are to arch what the aummeroxmrd tai The oacrior euxirr err m he a.%ser like mirdaL I No Contractor will wrap exterior casings with cot]stock color of 0wrwis aware that Contractor does not do any patntdngdstaxtfng or removalliitsfaAation of alamn system or window treatments/lt idwere.It is the responsibiMy of the homeowner to have the alarm system and window treatments/hmAvare removed prior to bnstaMition. ft main no guarantee as to o whether alarms or window tmatments/hardware wil fit after replacement Customer is also aware in some cases there wr3 be glass loss. tf there is,the amount wiff be dependent on the type of existing windows,type of instaAfto and wh7dow style.M make no guarantee as to ft amount of glass loss. + Customer is aware and tat Wsfands any and all unseen tot is not included in this contract.Should any rot be found there will be an adtTrt bnaf charge for time and materials unless so stated in M contract 3 yes Contractor w71 insulate,cautk and seal windows with 3-point system to prevent water and air intliation.Removal and disposal of all job related debris,. windows,doors,storm windows and vacuum rightly included. Upon completion of the job and payment in hal,a lanited warranty shag be issued. G 4 Yes Bulking Permit--Contractor will secure any and an necessary pernuts. The fee for the permit(s)is not included in the Contract Rice and a separate check is required at the time of sale for this fee. Check k 738 $ 372 15 yes All discounts have been appited to this agreement 6 / Yes No Owner agrees to be present on the final day of installation for final inspection and to drover final payment Ilinarnce fmrrh(s). It ie agreed and understood by and Nturen the parties that If&Specifncatioo Shen,along with the CUSTONI NVUDOU'A'D DOOR REIIODELLNG VGREEIN iN—C constitutes die entire understanding butt*ten the pathim and there we no woiml undeerbum inRs chant*or ttttxliRing ally of the wrnm Thu Specification Sheet may not be.chariged or its tunas Inuxlifred or varied in any nay unim such changes are in treiiittg and sips d by both the Uuyerfs)anti Contractor. Ruyefis)hemby acknowledge that Bttyehts)has read this SpeArxatian Sheet Renewal by Andersen Corporation nu}r(s) 11-er(s) a 7,Hitafy Keifey C14,,J_ Signature of Project Manager Q-Signature Sigilidwe TOMMY KELLEY DEBORAH&CHARLES PAPALIA Print Name of Project Manager Prim Name Print Name Renewal Renewal by Andersen Corporation bYArt&mn.1Q9 104 O is Sant+Ncrthbomu$6.Massachusetts 01312 Kaftw tm fa were tmtriaor No=MPS 1-}'Nk+Fax(509)986-7072 INIA 6V=#t 7M30 W%ptm TANOW srrueraAnrr ,a..-.Lr_ncuV2�j t:/Z3r"rt i) F`�tetmlt'a:t1Ar� st.tysxst� QNTMaAMXK&WT 'rltis ArnerWinind(-Ai inCl2urt l Is to the L'Ltti'1oNt%,ZVOW A.. a 710 l 3C1 LL GAGt4t>~VC("A,�tw=1tt") and between itmews7 In rst*n Corporation m:d Debmshfi"bu}'cre"_ Cmetractr r and Buy-er(s)hemk,c 3tw to tend and rtnaA•thr UNCO cn!91 Jf ds.ttad WO.Ow. Other lh to as SY'Ar' r3GY 141cut ld W10WAN thu'tcrMs Aftf C07%11110r S of the&#Wuum will rs* ifl In Nu tome and Mect. 't'1:i+.A mer-:drunl i4 su4Xt to 13V t terms 9tt:i�x�¢eiit�r�of t3ic��� art tutl,�win,,jui,i;tl��u al�ratsons,Qr cile6r�lurcv t�the prn►t;�^ts ttr�I s�i+�es E3u��ri�r ond�.�ti:u�b�n�y,nth We are nct doing the S full fratrfes wW are doing an 23 windows as fiat still Inserts but are now,replacing 22 exteftor casings which are rotting. As s mull of the a chntgm i3t2 k&-Ya itkg hamm cif the. t tire do chingIn iil there is no change,en Item wlJI be iefi blank or nL",!d'asLodicumg 01st nuChWW appu& 1qF1W Tubi k►b xut1_ $30095.00 Payment Method:Greem c}•FlnanWCre t CardCbacfk Now Dqusit Mwxi ed:$15,342-W GrwrLt y nn=oel MM rzf�at Stftrt OfJob .'sir.-x rs►vt&v,_—t GroemI y F1wncvCrcdh Cud'Chi subftmt W Camp.-E=of job:$35.34-7.57{ � 3=40 49ma.coda dMdO ` lease Dote—Your job+wal be delayed Until amendment Is sfg.r'tod and nx4hied. >ft a a�,eeed�: 3�g�d tr t�p�that nils t�ttsc l t cnn.tfttime l6e e�rmdtaulaadttalg 6o- 1�R�[t tted th::re�n+G>qo vrxlrttl� �imodt$itt�uq►�mt:i�of�� � �Itnwari- 1�r�eod�;,Jtmerrl�>�taocitexl a�, „real tir�bad oo�r+�fthia � �w ixlere; Rawwal by An&r=CWpm%fi= , y E Sned t -1WzW2u4 utas nn CST 3lgtUwe ofPhxluct her Deborah A. Flapalia t3s:e PaPoC2.daI2, m2il.ccri ]N 173A&152.6` Y Ee37t<Or ,� ' 1 Ql2P9/201 d Prhit Manzi .xt nixMot 3tnt:;wr , naturti E]stc ° The Commonwealth ofMassaehaseft Department of Indastriial Accidents O ee of InvesUgadens 600 Washington Street Boston,MA 02111 www.masr-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrickns/Flnmbers Aaplicant Information Please Print LeWiblv Name(Business/Organization/ln"dusl): et.,j c,\ �Q �� Jl�ivr e✓� Address:_ 3 C-;� �:or b es 9, City/State/Zip: r �ok Whone#: Are you an employer?Check the appropriate box: Type of project(required): 1„IBJ 1 am a employer with 3 J4. n I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, (]Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.= 9. 0 Building addition required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.[:11 am a homeowner doing all work officers have exercised their 11.0 Plumbing myself.[No workers'comp. right of exemption per MGL a repairs or additions 12.❑Roof repairs insurance required t c. 152,§1(4),and we have no employdes.[No workers' 13.0 Otter COOP.insurance required.] 'Any applicant that checks box M I must also 511 out the section below showing their workers'compen3ation policy mfomu ion. t Homeowner who submit this affidavit indicating they are.doing all work and then bhe outside contractors anal submit a new affidavit indicating such. ZContndors that check this box mast attached an additional sheet showing the name oftbe sub conhaetona and sate whether or not those entities have employees. If the sub-contractors have employees,they.must provide their workers'comp.policy number. law an ewtoyer that is pmvidbig workers'comlpensaAon bisarance for MY OVOYeta Below 1s thepolicy and job slle infornurtion. Insurance Company Name:-DU lc, to et �a Policy#or Self-ins.Lic:#: MW[, Expiration Data: L CY — Job Site AddressCitymtate/Zip: �d Aj/l)a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido h eby c under the pabis and pendMa ofperjury that Ate 1nforniaAon provided ab0Ve Is due and eorrea S' stun: Phone OJyieial use only. Do not write in this area,to be completed by clty'or town ofj deL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspecto 6:Other r S.Plumbing Inspector Contact Person: Phone#• ANDECOR-01 YADAVYO A►�ORt� CERTIFICATE OF LIABILITY INSURANCE �10fl,200114 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. ORPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poky(ies)must be endorsed. U SUBROGATION IS WAIVED,subject to the berms and conditions of the Policy,certain policies may require an endorsement A statement on this certificate dogs not confer rights to the certificate holder in lieu of such erdorsement(s} PRODUCER REACT Certificates@willis.corn Willis of Minnesota,Inc. PHONEFAx do 26 Century Blvd Na (877(945-7378 No:(8$8)467-2378 P.O.Box 305191 E Nashvm�le,TN 372305191 olstrRERs)AFFDRneIc COVERAGE NAIC s INSURER A,Old Republic httsurance Company '24147 INSURED INSURERB: Renewal by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 INSURM 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 CONTRACTOR 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_ DISR POLI LTR TYPE OF INSURANCE yrip POLICY NUS POLICY EFF1MIDO MM EXP LlmiS A X I commEnciALGENERALuAssm EACH OCCURRENCE $ 1.000. CLAUZAMDE T OCCUR MWZY302940 10N01/2014 10/01/2015 PReatSEs „ $ 500,004 MED EXP(Anyone person) $ 10, PERSONAL&ADW INJURY $ 1s0ws GENT AGGREGATE UINT APPLIES PER: GENERAL AGGREGATE S 4.000s X POLICY F JPE"C)T- F-1 LOC PRODUCTS-COPAPiOP AGG 1 $ 4sOWs OT HER: : $ IUIToaIOBa E LIABAJTY COUBMED SINGLE LIW $ 5,000 aaafden A X Ally AUTO MVVTB302575 10101/2014 10101!2015 BODILY KAIRY(Per person) $ ALLOV#NED SCHEDULED BODILY KR RY(Iserao*kno:, $ AUTOS AUTOS NON-OV19ED PROPERTYDAtuAGE $ HREDAUTOS AUTOSS ImMMLiA LIAR OCCUR EACH OCCURRENCE $ EKCES.4HH8 CLAA MADE AGGREGATE S DED I I RETENTION$ $ WORIUM COMPENSATION X S AND EOPLOYERT LIABHIATY STATUTE ER A AW PROPRiETORrPA�ER�CUTIVE YIN 030293800 IOMM014 101M/2015 ELEACHACCIDENT $ 1,000 OFFICER1fEMBER EXCLUDED? ®N IA. (Mandafny it►N) EL DISEASE-EA EMPLOYEE $ 11,0MAK tf yes,desalt Winder DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LWT S 1 s000s DESCFWnION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddWaral Remarks sdiedu*aW be aNadzed V more space is owed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLE BE CANCELLED iBEtFO1tE THE EXPORATION DATE THEREOF, NOTICE WILL. BE DELIVERED N ACCORDANCE WITH THIS POLICY PROVISIONS. AUTHOR®REPRESENTATIVE vidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ReneWaf idem . � IAI�fdOQ� R�PLAC�F�kY BnAn�(�pPGnY WOOd F Duw AWn LOWEt&Wrfes) 9 D0�-009T.151�8-010 ENERGY PERF® CE IRGG U-Factor(U,S)A-P Solar Heat Gain Coefficient RDDMM&PEES' CE PATROS Visible Tmnstnitbgw "/11 �� °� leralP+sesyN �� l�M�ro , Gee MCs�q �aN'lw�Naafarageyee��—� - Mpne'Jd� eel DESMN MW9SUM OPSF "LC2 RbA Do Sl pad Silt DR*11- 1ee1yt�11�KAiMINq�igdR161�q� w..�«�+a�+a.c�attr.,c,w„ tip° •� . ��upp6oiersr� � F7 � 131 oit+► T11 P AN06 J7 "An opd COMP061be Majerial a ' Product monz i wrE Smart6urt ENERGY PERpORMANCE RATOW S , U-Factor 801ar Heet Gain Coemoient 0.271 .53 C, 22 U.S P --LI ADDITIONAL PEFiFOAMApjM RATINGS Y eN6 Trac rnftnoe 0 I Q tee. ax bbd WMM WAWAMO&MA 19MA UMM DP puf F C50 am the so" ,,� eraArowmmm 10G-0QSttO�-0Dt � Maes , ,� wr ,eq,rero„®wa„ti i f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supere isor License: CS-M125 JAIME L MORIN,-` f . 86 GARDINER ST LYNN MA 01905• 7i Expiration Commissioner 10/06/2016 � fie (paryrun2o�zurea�o�C�/L�a��ac>liuoell.� WWiice of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR — Registratlon: 170810 Type: Expiration: 12!2312015 Supplement RENEWAL BY ANDERSON CORPORATION JAIME MORIN 104 OTIS STREET �� -- NORTHBOROUGH,MA 01532 ` Undersecretary i•