HomeMy WebLinkAboutBuilding Permit #161-11 - 1327 SALEM STREET 8/22/2010 BUILDING PERMIT o1 "°erh q
TOWN OF NORTH ANDOVER s �
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received �4
Argo
�SSACHUS��
Date Issued: wa�o
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building - .One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Y, Repair, replacement Assessory Bldg Others:
Demolition Other
SeaicY 11et1 � z ; ood�ilaJri t f al�letlands z ; }j U1i'atersied'Drstrict
`ry .�. t si: -. �""�^s .' ' ''.x, ".y-`^? z r.. z
,v
....eater/sewer _,
DESCRIPTION OF WORK TO BE PREFORMED:
dentification Please Type or Print Clearly)
OWNER: Name: Phone: l
Add ress: \ S �A o f-
� f : .T'3 -�,d gu.� r q�; �, y v ;�,N xa :.��., � �. r k ,:�r -� t r t�,..t- �'' r s .•
i
CO RACTOF t.N
Sig
r`t` `" >,. r` kS. �+ - y.
b�^k� �y' idr e ,�.. $� a rsx-$
t "mN4 r° f a' �+'
SuperuJsflr s Consrt�c �o�a�Joen�e ����� � �� exp Da#e �� y �
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w ,*�'4 '-.,.. Y %� k s r � - _3x- � w•�. �_ .s 9 �^� 's .�:. r +a a i t C� K �,rF v
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: $ 6 FEE: $_ /•49 -.
Check No.: C . Receipt No.: 62 3_?S-
NOTEPersons contracting with unregistered contractors do not have access to the aranty fund
Signature of Agent/Owner = Sigma#ure of 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
❑ 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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07
Revised 2.2007
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
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zoning Board of Appeals: Variance, Petition No:. Zoning Decision/receipt submitted yes
P=lanning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
Located at 384 Osgood Street
:FIRE DE ARTMENT T_' Dempster on si#e fires no
Located at 124'Mam S#reet
g.
=Fire Department sjgnat dre, ate a s
COMMENTS :..
z,
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
i
i
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
I
Location
No. 1 Date
y�
NaRTh TOWN OF NORTH ANDOVER
0 9
+ ; , Certificate of Occupancy $
��s"•�°''tom Building/Frame Permit Fee $ —
JACNUSt
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
r
2 uilding Inspector
NORTH
TONM of Andove
..........
No. ao If
o dower, Mass., 2 �a
� � y
�.
COCHICHEWICK
7d ADRATED A'PC
Env 7S V BOARD OF HEALTH
Food/Kitchen
.PE� nMIT T D Septic System
THIS CERTIFIES THAT.................��.,�..� BUILDING INSPECTOR
�......��c/�/eco'7''.................................................................. ,,. . .:
Foundation
has permission to erect........................................ buildings on ... .. ..... .. .1i..... �......................:,. Rough
�.
•°''
to be occupied as -Y.(-�� � .................................................................................. Chimne.... y
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
...................:...................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the -Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT'
Until Inspected and Approved by the Building Inspector. Burner.
Street No.
SEE REVERSE SIDE Smoke Det.
04/28/2006 22:05 9782785010 -JOHN BEAVER PAGE 05/06
104 Otis St.,.Nortl,hni-migh,A4A 01532 J&L WiNuctW,S,.TNU,D/t;/A
(508)919-0900-Fax:(774)987-:3013 MA ttomc Improvement Contractor
Renewal Lic. Q cnsc#74,601 (}:xpit^es 1/24/2012)
byAndersen. Federal Tax(D##53-0404201
15,6W REPLACCWNT All Avinr.pnCA,,M,A1,
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Duyer(sl NO
Dote of A roemont
�ynr(fs1l Street Address,CIry,State,and Zin
BCodn
/ 3 a�— ofL4 )
E.Moil Address —a/
Home Telephone Numbor Work Tele hone Number
Buyer(s) hereby jointly and severally agrees to purchase the products anti/or scrvice.e of J&L Windows,Inc.d/b/a.Renewal by Andersen
("Conlnlctor"),in a.coordancc with [lie Lernm and conditions descilbed on the front and the reverse of this agreement and on file attached
specificaldon shcet(s)(collectively,this"Agreement.").Buyer(s)hereby agrees to sign a completion cerl'ificate after Conirador hrr_a completed
all work under this Agreement.
Method of Pymnt:❑Cash ❑Check astercard la VISA
Total Job Amount:_ ,•, rstinnated Sto ' 9 D te;
% U Discover CI Financed,A p#;
�_. ( r S
Deposit Received(33%): Q� �(/c✓ Name on Credit Card:
l/
Balance at Start of Job(33,0); 5�.� Estimatod C let on Dore:
P Credit Card#:
Balance on Subsl'antial
P l `1 - GC Exp.Dote: CC Security Code:
completion o Jo °/a:..._._.
By initialing here,you acknowledge.that the Balance.at Start of,Job anc Mo.BalaneC nn Substantial Cbmplction
Buyer i>x' als_ of Joh cant heynicle by credit card and rrnrst be made by personal chock,hank check,or cash.
Buyer(s) a es and erstands that s Agreement constitutes the entire anderytanding between the parties, and that
there are no ver a]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. Bayer(s) hereby
acknowledges that Buyci(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 Cancellaiion,on the date first
written above and 2)was orally informed of Buyer's right to cancel this Agreement DO NOT SIGN THIS CONTRACT IF
THERE ARE ANY BLANK SPACES.
J&L AN�cc. newal by Andersen Buyer(s) Buyer(s)
Si iture of Pr lum..Manogcr Signature Signature
`T � v
Print Name.:of Product Manager Print Name Prim Name
YOU, THE BUYER(S), 1VIAY 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.
<< _:— — — —.— — — - — — — — -- — — — — — — — — — — — — — •�•_ _. _. _ — — — — — — — — —�c
NOTICE OF CANCELLATION NOTICE OF CANCELLATION
Date of Transaction . You may cancel Date of Transaction -7-2-.1 O . You may cancel
this transaction,without any penalty ar obligation,within this transaction,without any penalty or obligation,within
three business days from the above date.If you obi 1,any three business days from the above dote.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 I Contract of Sale,and any negotiable instrument executed
by you will be returned within 10 days following,rrreint.:" byr you, vAll be returned within 10 days following receipt
by the Contractor ("Seller") of your cancellation notice, by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will 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 of your residence,in substantially as good condition
as when received, any'goods delivered to you under 1 as when received,any goods delivered to you under this
this Co.imo or We; or yyou may, if you wish, comply I Contract or Sale;or you may,if you wish,comply with the
with the instructions of tyre Seller regarding the return instructions of tate Seller regarding the return shipment of
shiptttent.af+the:- s_trf the;:tallet''s.expense.and.;ldsk. 1: 31te gucxMs?at=tbeSealer4szeacpepse and risk_If you do,make..,.
If you do make the goods available to the Seller and the I the goods available to the Sefier and the Keller does not
Seller does not pick them up within 20 days of the date pick them up within 20 days of the date of your Notice
of your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose at 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 ou agree 1 goods available to the Seller,or if you agree to return the
to return the goods to the,Seller and fail to do st►; then I oods 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 To cancel ibis 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.J i notice,or send a telegram to Contractor:J&L Windows,
&L Windows,Inc.d/b/a Renewal by Andersen, 104 Chis Inc. d/b/a Renewal by Andersen, 104 Chis Street,
Street, Northborough, NIIA,01532, BY NOT LATER THAN Northborough MA 01532,B7 NOT LATERTHAN MIDNIGHT
MIDNIGHT OF '7-)O .(Date) OF `7J C7 —16 .(Date)
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
Buyers Signoture Date I Buyer's Signature Date
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Fink
04/28/2006 22:05 9782785010 JOHN BEAVER PAGE 06/06
104 OHp Strcct,No,11lborough,MA J&L Windows,Inc:A
F hone SOR.019,0900•Fax 774.987os0192
Rene{l� al MAlifClerose#149TO.t(cxt 831/24/17)
� 1 wMG1 Fedcral'I'ax ID# R3•l)A0426t
byAndersen.
WINDOW REPLAC,, E.. an Andersen C�npnny
•ljf GR£I17;R AMASSACHUS.MTS AND N11ty HmFsj IRh
Buyer(s) in WINDOW SPECIFICATION SKEET
t
.-_._.
The
described on
listed aUcvc hereby,jeintiy and severally agree to purchase the goods and/or servicee listed below,in accordance with the prices and terms
described on the Specification Sheet and tktc front and the t?veegc of the accompanying CUSTOM WiNDOW ANT)DOOR REMODELiNG AGREEMENT,
Of which this Specificatfpn Sheet is a putt.
WINDOW DETAILS
I. Contractor will Install a total of�_windows in Owner's home,using the follow
,ter t1$ irtq individual quantities:
Uouble IYuttg(DB) Lig Equal sash ❑ Cottage sash(1/3 top,2/ bottom) ❑ Oriel sash(2/3 top.1/3 bottom)
Casement:(CW) ❑ Hinge tight ❑ Hinge]eft(as viewed from exterior): [] standard handle []Metro handle
DOuble Casement(COW) ❑ Standard handle []Metro handle:
Casenzelrt/Picture/Casement(CPW) ❑ 1;1:1 or ❑ 1:2:1 ❑ Standard handle ❑Metro handle
2 Lite Gliding Window(GW)
Glider/Picture/Glider(GPW) ❑ 1:1:1 or ❑
Awning Window(AW)
Picture Window(PW)
Bay or Bow Window
alio Doors(see separate Door Specification Sheet)
2. es E] No Qty of Windows to be Custom Fit Replacement; p /y
3' as ❑ Qh of Sills to be replaced by ContractorGYL
4. ❑ Yes GZNo Q:y of Windows to be New Construction Full frame(includes n.ew interior, exec tenor casings)
Exterior Iasi , Pine [] Maintenance-tree material ❑ Factory applied 905 Fibrcx brickmOld
5. Glazing to be: HP iA E0� GY
SmartSunTm (7axx&f AVh/e) F-1 Other if other,please specify;_
G. Exterior color to be: Xto ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean
7. Interior color to be: White ❑ Sand ❑ Canvas ❑ Terrafone ❑ Pine ❑Maple❑ Oak
p
Note: ince• r color can only be Whitc,wood or same color as exterior. Wood interiors need to finished by Owner.
g. Ha are: White 0 Store [f Canvas 0 ]3ra3s,[] Estate I•Iardware: Style!
9. Yes ❑ No Install Lifts with Double Hu4Vindows
10. Screens: windows to have: ❑ half or FuU screcirs screens to bc: Fiberg ass ❑Aluminum ❑ lYuScenc
GRILLE DETAILS
]1.Windows have grilles: Ycs ❑ NO If yes:VCrille 13etwccn Glass(GBG)❑ Removable Interior Wood aNTwt❑ Full Divided Light(mu
Qly: Qty Qty Qty: QtyQty Qty;
c�
4:�DH off vtt cwrP�cnRe oitaer c ,o
Draw grille patterns above
Use additional sheet if needed Owner approved
ADDITIONAL WORK DETAILS
12.❑ Yes 5N Contractor will remove metal frames of windows. Qty of Units.
13,❑ Yes o Contractor will install new paint-ready or stain-ready casings.
Interto asmg qty of openings: Exterior casings qty of openings: ❑ Pine
14.❑ Yes No Contractor Will install new paint-read or staff ❑ Maintenance-free material
Y e or outside stops ql:y of openings:
Interior stops qty of openins: F,xtcr ors ircma=va;
t openin [� Pine [� Maintenance-free material
13. Owner is a that Contractor does not do azty pain O er Initials
16.[� Yes No Contractor will wrap exterior casings wit inunl coil s t of color.
Note 1A`rappiztg may be required with storm window emoval of storm windows will leave screw holes incasing_
17.i�J *es ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
1 S,,�e5 ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full.
19.U Yes ❑ No P_WIPC • Contractor will secure any and all necessary permits. The fee for the permit(, is not
included in the CantWt Price a a cepa ate check is required at th 'me of sale for thisfee.
20. Additional job details: // Gi -C 5
u,
21. Yes ❑ No Owner agues to be present ori the finat:cl ty of 0-I fr_,,fiir eel i.nspcction and to deliver finai payment.
No final pevment sl7all6e demanded uptil fhe eonfloct Is complcfed to 1170.0d.v.9ctfon ofall psrfiec
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 arc in writiriS and signed by both
Elie Buyer(s)and Contractor. Buyers)hereby aclmowlulge that Buyer(s)has read this Specification sheet.
Renewal a of Greater MA and NH Buyer s) BuyerW
By:
S' lure uct Manager sign
Signature
�
Pririt Name of Product Manager Print Name Print Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investiptions
600 Washington Street
Boston,MA 02111
wmmass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information' Please Print Legibly
Name(Business/Organizadon/individual): 11 et)eij G,1 , ide_rS e_4
.Address:. &rerJ-
City/SfaWZip: /VOf bo 1`0 , Al Phone#:
Are you an employer?Check the appropriate box: Type of project (required):
1.E�I am a employer with D • 4. ❑•I am a general contractor and I 6. ❑New construction
employees(f ilf and/or part-time).' have hired the sub-contractors
2.El am a sole proprietor or partner- listed on the attached sheet. # 7� modeling
ship and have no employees These.sub-contractors have S. Demolition
working for me in any capacity. workers' comp.insurance. g. Building addition
5. We are a corporation and its
�worker coin 'ce rP
[N s p.m�ran '10.0 Electrical repairs or additions.
required.]. officers have exercised their.
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
.Des
t ample o workers'
insurance required.] P y � k ' 13.7 Other .
comp.insurance required.]
'Any applicant that checks boz#1 must also fill out the section below showingtheir 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. .
3Gontractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information,
lam an employer that isproviding workers'compensation insurance for my employees Below.is thepolicy and job site
information.
Insurance Company Name: ��•e_o»_P_ 1 i1 Sri►ted n C e_
Policy#or Self-ins.Lie.#: 'f—q Expiration Date:„_.a
,
Job Site Address:_/3d2 i-)1—”— City/State/Zip:-
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
I do hereby cer10FU_,A4er the pains and penalties.ofperjury that the information provided above is true•ani correct
Sienature: Date-.
�•
Phone#'
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6,Other
Contact Person: Phone#:
' —}�..�.a:tI'�':.�1 Y./jl8'(DOf7147t4�1l�JBGK�4�✓l�G�dd� 1 .
1: Board of BmldingItegulstiom and$tapdorda
i Construction•Supervisat Licansa•t�,,;, ;�•
LicaUb,' CS •99707
' Birth�a`felif11982 `
Trd 95707
.•:, t�. •� pihatiarl�g612010 I•
' to � :
. ' BRIAN DENNISOI"I
86 CREST CIRCLE
WORCESTER;MA 0160 Colnmtissigner; ,
07
Office of Consumer Affairs&Business Regulation
HOME IMPROV MENT CONTRACTOR
Registratio ` 001 ,
Expl — - .12 .
N nt Card
RENEWAL BY
"+ BRIAN DENNIS,r
104 OTIS STREEfi`
NORTHBOROUGH,M9 Undersecretary
ACORD�, CERTIFICATE OF LIABILITY INSURANCE 02/1012010 l 1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Joseph MCKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
JP IvlcKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 333
Ann Arbor, M1 48106-0333 INSURERS AFFORDING COVERAGE NAIC#
INSURED Renewal by Andersen INSURER A: Hartford Insurance Qmpany
J and L Windows,Inc. INSURER B: Nautilus
104 Otis St INSURER C.
Northborough,MA 01532 INSURER D:
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED.BY PAID CLAIMS.
WSRD'L POLICYNUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS
INSFITYPE OF INSURANCEQATE-
B GENERAL UABWY NC958461 10/01/2009 10/01/2010 EACH OCCURRENCE S 1000000
COMMERCIAL GENERAL LIABILITY PREMISE En ooxrrenoe S 100.000
CLAIMS MADE F]OCCUR MED EXP(Any Orn Person) i 54000
PERSONAL i ADV INJURY S 1,000,000
GENERAL AGGREGATE $ Z000.000
000
GENL AGGPC,"TE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO S 2 000 0000
POLICY 7
PRO-
ECT 7 LOC
A I AUTOM0131LELIABILITY 35MCC XD 6390 10/01/2009 10/01/2010 COMBINED SINGLE LIMIT s 1,000,000_
ANY AUTO (ED Dceldenq
X ALLOWNEDAUTOS BODILY INJURY S
SCHEDULED AUTOS (Per Person)
HIRED AUTOS BODILY INJURY S
NON-0WNED AUTOS (Por amdent) —
PROPERTY DAMAGE S
(Pareeadenq
GARAGE LIABILITY AUTO ONLY•EAACCIDENT S _-
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG I S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR 7 CLAIMS MADE AGGREGATE S
. S
DEDUCTIBLE S
RETENTION S' S
i WC STATU• OR wORKERs-corrlPENsanoNaxo 35 WECPP 1444 02/17/2010 0211
7/2011
A •
E�LOYERS'L�NV rY E.L.EACH ACCIDENT S 500,00
ANY PROPRIETORMARTNER/EXECUTIVE
OFFICERMEMBER EXCLUDED9 E.L.DISEASE-FA EMPLOYEE S 500,000
It qet.deWbo under E.L.DISEASE-POLICY LIMB S 500 000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION
INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 4*n (+�/vV,�G►�
ACORD 25(2001f08) ,r('��(/`/ `CCACORD CORPORATION 19118
A RM
Rene w* a l
x :164byAndersena
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PERFORMANCE RATINGS
U-Factor(U.S)II-P Solar Heat Gain Coefficient
0n29
0019
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
OA2
Manulacwrer stipuletas that hese ratings confomr to appG-able NFRC Procedure$for determining whole product
padormanca.NFRC ratings are determined for a fixed sat of anvironmantal cond'it'ions and a specific product size.
NFRC does not recommend any product and does not warrant the sukahBky of any product for any specific use.
Conus manuhacturar's Ikaratura for other product performance information.
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