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Building Permit #610 - 140 MARIAN DRIVE 4/12/2010
V10RTM BUILDING PERMIT O*.,t,,ED q TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ArID SSACHUSE Date Issued: PORTANT:Applicant must complete all items on this page ei1,i;jyrn`*,;.;�ssaJ+.z.'�j, 1�"'�Px iat�Yi'J'; s�r itv„-e•; ';� �,y c�Fa�' :: i*a �'"d,.*.�.I ' s.. ,er :*.,-r-,''ar4_ y i$r a.. yf'M" i �,i..Ea Z r,.r_i"a p f>d F �fa�'.}' '>` v t>_ _„ ss k ,* rJ "-t r.�cJ+ r 1'4 ,Ita a l ,- d 1 � '. �y ^xe*`W �Sf'Fr:F7, Ir.,r as t d1a �k q'k�:- 'T7 -m .r$- 'x °Jt p�r,-vtt�d,ar n _ a r wl y + s k a it-p��y -' Y 's .1,20GAIT 1 t Ak h3'S t y ,,k �, fav.�E. y_ ,} ,. k } 1 ly -� -'€-y-- ''. '� !'x-= rc i4 x (.,�F 9+✓'... .:` N �S+j,+'Y3`4 t d `.u_,.�" sy`A xt .i �,F'e :rsi - . f;, _; 4 r. +z� ;r x rr e.l�. >_�,y, '•�rc,FL[ ` 'i �y 'x gyyf„ r.�5.ta„e d 41 .�1.. _ i r f fiN yz 4yh.6 ��a A.,; Sr:3,;� r! , G p VMERS} 3 y �Txn 54 �.-s_,y ' �a 2�,r�r'k i5'F A a'sr�3*t y'.,,,:, , -...�a'r• :57., n. _' z p 'Ys� .,; k... fi,. -+. M •,k�L :�xz�,.—..„ 'b a:�'.^t s;� ,��f'»o- '� �i J e'! :rP'3.Si !•!1ti x TYPE OF IMPROVEMENT PROPOSED USE Residential Non—Residential New Building One family Addition Two or more family industrial Alteration No. of units: Commercial Repair, replace Assessory Bldg Others: Demolition Other r=r•--+' } nw= ..S'-i�,�mg gsr - Mr,'ms s`�';srzkh°-�` '�' y�„e::. � -� x�"kkJ.�.�h.V,�..4 r..�^r����. .;;u3 Ye 9L� 4 ,za I ,: a.i.-�-' IC. , : rel` � d _ ox�d ars Maas F Watershed D,,str� M ,Gn ± 'k+.� .5 `-^_ .Lr..�+. - z+x , t .cv '1!-E ^,. '�Y+s � iu ire. .a�i4-^'"C�S�Y��r��G.MYGl1�' 'r",��t l�,,�}fi_`j'^3..��y,;.% v�,.���..:. T.Tj',. '�§�'..`$tffi'd$..:-..:;��. �svSt�'.'�: ". '� ..�..�'�y}•p �G_���F;blrL�yK � J' f��'.'��I�, !'" �� ,3titN"fF:��i DESCRIPTION OF WORK TO BE PREFORMED: Qe, 1 G c,\r ( W S-t-r g c_-voL C,\t\van eS Identification Please Type or Print Clearly) OWNER. Name: A-T-r � 'c. Phone: 5S- lel Address: O AA t0 �C`� � �nJe,,- IPr ovooyS� 0— r, mm 'W N [ai: ,_ H.,,va 9 - .F"; ^stat'w{,e.',r*X_ hY1.,�-1„ 1'�^'d s 'd:.r'"d, "35,.� y,`.}S}_... rzt;.,,:., *.Yrn-�...1. --We;a^•-r.;f,,;: z� p � �w} .Aa � ,,'a h s p� _ want `� � �M ' 1 rs ., c`'r r Sr� Ykr„"G-H .*rr ."f�� 'N' "s,.�,,F � i."..r�Ytii Y�11. 9,4- ._'k ^c.a'x Fy .A r� "'Jv j �^n p xt.!„ ss n: .18✓ �,{ i1.s :RifS` sir:S s t*1 +s + r,?`'t."I �ua'�axrt �.131� �i. E"Sr'�-Y""*'k,fr{'gLr4.F4 Mt',`. "'`,' 'ti,tk'F,arry,-.. +;t�... 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'a 1r1ig 'fu r�.t�F,i,:,f^dfi 1 5 r Jtl r7.F Sok ,�} + .y'w ,rs�. :�„ i- ,. �' ' i.s !-� "tS'iC�kTr''riv� � ,Jf r'rn."'k3✓ ' 'i ,k''`PS11" '' r.'i...v a.�.a'r'n.'t, x., 9C• - f• r 3� kiy�.t+,• -, b' a ✓7ctk,� r�aijt .ul�, y9!� r:t� 4}�v.'+''S�:yµy ,; .'k-.p SlI'Jil3 f ade.123sG ��n 3 �m� �( ., �.�'���,.::fl�3x` f'"£'M�tA Y..'.'�w.l'1'k+1,'£•3•. �-C1p�r a� YY�I :r�.l+`.''r I.'�Y'r `'3 J 1} F .r.="4. .r y l-1", II.i+ "f n,:tlti"Ji{� �}riH;('�4�4`a^'L:5 f,!"Id s k rP...u Y^,A.r ��, E��'^�'a�4�..,r-rr�' `�t�'..r 4�i'y4.`-�, rl,'Eve. r�t),�.,y,�j�.�4.. �'�3.}'3-:�.tS'.d�,"�,P^at, �:, ,�k 7,'„� ;?fes+ z„t 7�'°•d:i>;�ic�.-yau+�' d .!)�i`r'^ °a: ur,�J�'-7.� .r,3, .yy:,�,�ip�;•.Y�V ' i1� C•kA{1t�; lrci��l�a^a`Yst�'R f TY C FeL£ ) �,�'�e. I k.b"SL'7� 4 '.,.niu r.i'!''+ 'i �'`3�' Mi.'al"t's«/'J:" �. ' f't£rtiSl. l'k .;�'�. ' �w c y _ »;..">✓: �' a"N'z wr $_5�r '�r,,t�.. e�'" #,� _;,,-. Y t �M. orl �re�la . �aceser? adt 4 �4. r �Eafie KI „. , ARCHITECT/ENGINEER Phone: r 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: $ FEE: $ Check No.: W6(�o CReceipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund r^i ^e"d"'z�T-,.r� :._a.-�_ J - r r I :iia lillie'��Df TGO.1r�etOr k tii:'dr SI r�atar�e��I�J'F�A e�nOwraer � :� ,- `m 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 BuildingPlans 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 DEPARTMENT:BPFORM07 Revised 2.2007 i P/anS Sdbm, e d Pub EOp SEWERAG Pf ans waived lic Sewer E DISPO Well SCertlf1ed P/ot P is n nvate(sePhc nk e� Tanriing��sageB $tamped P l I Tobacco Sale odY'qn /anS I s Per'n'anclIt D Sw 111 9 Pools Pster o F Y n Site ood ka ` Pac k TyE F gingjsal�s , t /IV TFR DEP W/NG S PLANNING ARTMENTgrIONS FpR � pEVFLpp � SIGN pFFpFFjCE E COM MENT -DAT V FORDS pNLr MENT$ F RE�ECT�D M DATE APPR OWED N CONS FRVATIpN i COMMRNTS NO DATE REdECT�D DATEAPP ROBED I 'Iek7kf cOMM�NT$ DA TF RE�FCTRD r R DATE APPR I r+ OVED Zoning Board of Appeals: p/a variance, Ntit, . oard Decision: n No. Conservation DZoning ng Decision/ �/ receipt s ecrs�on, COm ater ments Located at 8ewer Coh lIbrnitted Yes Osgood Sth�otiph/S; nat Comments \ Ur �0�ated Rr!,�I a Date y t j �<���s�eT�� , , pn�ewa FT fiej��ae 4 srte 1+'es Permit otified for p k E r ry q Doc.BWldi ti ng Pe x nn�t Revised 2 ppb N.9 ky 1 v! erg`' . . PQ dV °�s4e ve aja4Y`� wee yet apo XAO 0 r av e ees�Q4e��e �'tbtb �I�C�So�4�� } 1 mat be Sub Sal S4� Oo�,� aOgTH qti O��t�°� .•6�6 OOL o � P`1GAU►�D► RPIeANA. NED oMNgOTN TOWNR TONFOp,T10N ''AssA�Hus�� h ed pate Re�e'v E sonispa 9� x15 ta'F z2a{iP�x+3"ai • r to al Sx, °'yk'..i° vC�J.� ¢ „x.. �` ,� , Y G {°.a,`y"1{,fir M� / t co '� t•rY�us �2il�f � �,�i,�:� ^�.,'^�36+. C � z t �K.,+ a}f�� � 3 a �?h, n r(`:Ap '` ��"'t�{�.�'�•.�-u�=r�^.•c��{r'rt7�� xE9,�x x,�lK'"y.'�pyp�4e�ry {'�u. $y, r Yp •Y �{d4.,�Y{���k '�d'a} t k,�.�i�, N t` " sr2tror C4L3u?� y Q ASM 1 rp S GyuY F ?c �td 9m �v � !W r t �v h rue a `Oh `K � s` •�'' s rth'" � .�`wd '� ���t:tiryk�ei a`�-'`�. �i�` } y�C R e sk r Pr��S rS �4 ,� { ,3} 1 ijs 4r15 fu'%r•. ' -sa \ d r Lx%x•,,3t � �' � s;S fi K'4 Uzi t1��F�='� c e tt�}�\ f "a"ypG� F✓1�Ay��i {� Itp� 3�' �r s._ ,s{,,. r°/ Nq tol n 1 s ��i� Cq 9v noustr Mai ars f°� lGOmmer��a� pe�tOre�e•/t f of 4I°° ethers $fi yr 7; y ptej�sO�F Of 4f, r F o , ba u � GO / s FItr '" Cry . C @ rtF a� 1 ,FS 2rq Ye at/On d °v� andOq ana�� s � mast O Tq F n 5100 neo semi diens /� f O�deAah" ��f�e 4(o O,p I, /Ons �eht e9v/�e �i 4se No Of ' t , RM, Of 41P-M "r�r`�y .t r k''r"rJ.a�� �'+�,n'fri �� F X ,,7'F eu^"\ >•} kk j One. Ph �� No• 125A0 PER S.F ,r; RegD COST BASED O$� TOTAL ESTIMA JF THE TO arae fund c Rece�P'k oe access to the g actors do not , iste1'ed coni ,t eg rt --7.� Te�a �a� kiln Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools aoto 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 �I J DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS y Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street . FIRE OEP ►RT�M1 NT' Temp r ps eT�n site des ; rid ne , ,. Loca#ed at i12la�ri street f is t: t -- . z � xE� >Ft,a r u .� r. r x r F�r� epartrer �gnat�areae :f i , x 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 - Date Doc.Building Permit Revised 2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Cc f-f; �,J M - Print MAP NO; O�PARCEL: ZONING DISTRICT: Historic District yeso Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building gene family Addition Two or more family Industrial Alteration No. of units: Commercial ,--Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: G a,. Identification Please Type or Print Clearl OWNER: Name: PhoneR- — (SSS C/( Address: CONTRACTOR Name: kvd A00-j Phone: _Address: ., Ch Ks £ A11' Supervisor's Construction License: _` OZ_ Exp. Date: ' LHome, Improvement License: Exp. Date: � km Ile-4- ARCH ITECT/ENG I NEE Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 R S.F. Total Project Cost: $ ��'�� FEE: $ Check No.: f Receipt No.: O� NOTE: Persons con racting with unregistered contractors do not have access to the g aranty fund signature of Agent/Owner � t=*--i_ Signature_of contractor m I 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 o 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 o 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) o 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) ❑ Building Permit Application o Certified Proposed Plot Plan o 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) o 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 2008 i I 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 i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ii Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1r Conservation Decision: Comments l Water & Sewer Connection/Signature & Date Driveway Permit I. DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire,Department signaturetdate 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 � i NOTES and DATA— (For department use I i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 i y Location d I n No. Date a ` NORTH TOWN OF NORTH ANDOVER F A *00 9 }--a ; : Certificate of Occupancy $ sCHusE`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / w 23911 Building Inspector r s Location ` No. Date '- rel NORTh TOWN OF NORTH ANDOVER 9 • i a Certificate of Occupancy $ r. 4 w Building/Frame. Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ <m TOTAL $ b Check # ����� c 22921 1 � Building Inspector ORT#q Town of oAndover0 f jj� X= - �_ C� Y ZO ' LAKE -O doves, Mass., I� COCHICHEWICK A. 7�ADRATED PP�t�� BOARD OF HEALTH Food/Kitchen -PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT U.! ........... .........b............................................................................................. Foundation has permission to erect........... ..:......................... buildings on ...1.` b..... ��.f`..(c✓ - .............................................. Rough to be occupied as ( doI�o Chimney provided that the person a cepting 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 CONSTRUCTITARTS 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 ball To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 104 Otis St.,Northborough,MA 01532 J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 RenewalLicense#149601 (Expires 1/24/2012) �Andefsen. Federal Tax ID#83-0404201 WINDOW REPLACEMENT an Andm.Company CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyerls)Name Date of Agreement Buyer(s)Street Address,City,State,and Zip Code / d �' ,CJS ov�� /►/►f i Y E-Mail Address Home Tele hone Number Work Telephone Number 5 Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen ("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: % Method of Pymnt❑Cash C3 Check ❑Mastercard ❑VISA Total Job Amount: tQ7S. Estimated Starting Date: ❑Discover ❑Financed,App#: Deposit Received(33%�: Name on Credit Card: Balance at Start of Job(33%(: �J� Estimated.Completion Date: Credit Card#: Balance on Substantial �c Completion of CC Exp.Date: CC Security Code: i By initialing here,you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion Buyer Initials 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. J&L Windows,Inc.d/b/a Renewal by Andersen Buyer(s) Buyer(s) By: ture f Product a er Signature Signature Print Name of Product anager 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. - - - - — — — — — - — — — - - - - - - - - - - � - - - - -9c- - - - - - - - - - - - - - -� NOTICE OF CANCELLATION. X. NOTICE OF CANCELLATION Date.of Transaction ,You may cancel Date of Transaction . You may cancel this transaction,without any penalty or obligation,within I this transaction,without any,penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument executed I Contract of Sale,and any negotiable instrument executed by 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,insubstantially 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 I 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 pick them up within 20 days of the date ofYour Notice of your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the goods of the goods without any further obligation.If you fail to without any further obligation. If you fail to make the make the goods available to the Seller, or if ou agree goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so,Zen goods 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 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.J notice,or send a telegram to Contractor.J&L Windows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Chis I Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northborough, MA 01532; BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF .(Date) OF .(Date) . , I HEREBY CANCEL THIS TRANSACTION. 1 HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Date I Buyer's Signature Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink _ J&L Windows,Inc.d/b/a 104 Otis Street,Northborough,MA 01532 MA HIC License#149601(expires 1/24/12) Phone 508.919.0900•Fax 774.987.3013 Renewal byAndersen.MFederal Tax ID# 83-0404201 WINDOW REPLACEMENT en Andersen Company OF GREATER MAssacHusrm Arra NEw HAMPSHIRE WINDOW SPECIFICATION SHEET' Buyer(s)Name Date of Agreement Ci✓ten; , //—�-- %U The Buyer(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 REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DEMMS 1. Conjractor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) ❑ Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement(CDW) ❑ Standard handle ❑ Metro handle Casement/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 ❑ 1:2:1 Awning Window(AW) Picture Window(FW) Bay or Bow Window P o Doors(see separate Door Specification Sheet) 2. es ❑V0QlYY f-Windows to be Custom Fit Replacement: 3. ❑ Yes E�- f Sills to be replaced by Contractor: 4. ❑ Yes I� f Windows to be New Construction Full frame(includes new interior&exterior casings) Exterior casings: Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: Low-E®SmartSunTM (Tax CvditEW1c) ❑ Other If other,please specify: 6. Exterior color to be: h ❑ Sand ❑ Canvas ❑Terratone ❑ Cocoa Bean 7. Interior color to ite ❑ Sand��Canvas ❑ Terratone E] Fine [J Maple ❑ Oak Note: to or color can/Duble ite,wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware White ❑ Stvas ❑ Brass F] Estate Hardware: Style: 9. ❑ Yes ' No Install Lifts wung Windows 10. Screens: windows to have: ❑ Full screens Scre s to be:T�:r Fiberglass ❑ Aluminum ❑TruScene GRILLE DEFAI S 11.Windows have grilles: Yes ❑ No If yes: " rille Between Glass(GBG)❑ Removable Interior Wood aNTw)❑ Full Divided Light(FDL Qty: Qty: Qty: Qty: Qty Qty: Qty: DH H DH DH CW/Picture Glider CPW or GFM Draw grille patterns above "Use additional sheet if needed Owner approved(initials):( ) ADDITIONAL WORK DETAILS 12.❑ Yes o Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes [f No ontractor will install new paint-ready or stain-ready casings. Intericasing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes F1 Zreptsl ntractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Interiqty of openings: Exterior stops qty of openings: ❑ Pine ❑ Maintenance-free material 15. Owner isat Contractor does not do any painting. ( )Owner Initials 16.❑ Yes No Contractor will wrap exterior casings with aluminum coil stock of color. Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17. es ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18. es ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 19.Hes ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not included in the Contract Price and a separate check is required at the time of sale for this fee. 20. Additional job details: 21. 04es ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of 811 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 Andersen of Greater MA NH Buyer(sBuyer(s) / By: )5/ `TA GUJ Signa trProduct Manager Signature Signature Print Name of Product Manager Print Name Print Name The Comrurwealth of hlassachusetfs Department of fn.dustrid Acddents Offla of fr vadgat mu 600 Fi'aslungton Street Bastony MA 02111 WWW.mass gav/din Workers' Comp6nsaiion Insurance Aldvit: BdIderG/CantractarslEIect Id&MslPIMMbers A licant Fnformafian' Please.Print Lembty Name(Business/Organizsfionffndividnat}: 1 en U 1 i✓ �Te)ers e n Address: I D CitylStatedZip: l�f o/a 41��3� Pbontr Are you Ea employer?Check the Epproprinte bom Type of pt (riquired): I. -I Bm a employer with 3 0 . 4. Q•I am a genual contractor Bad I 6, ❑New constxuctina employct a(B Il'and/or part-time),*' hirod the snb-contractors 7; delling Z Q I am a sole proprietor orpeztaw- lista oa the attacbed sheet t ship rad have no employees These snb-contractors have 8, Demolition working far mein tray capacity, watio nns' camp.iasursace. g, Q BmIding addition (No warkets'comp:iustzzauce S. Q Waam a corpoiata m and its Eloectrical repairs ar addifiama• �), . o$tcets bane emarcised thou. miss' or additions 3;Q I am a homeowncr doing eII work 'liftof=MIP#pet MGL 11.[]Rhrmbing repmin myself[Ne workers' comp: a 152,¢,1(4),and we have no 12.[]Roof rapain insurance required.]t employees.-[No 7wbms' 13.[]Otters camp.insmaflce required.] pian p6 infnrm�iois *,+,ny nPPfie�'t�ehe:lz hoz ill=Htnko 511 out the section beloor chewiagffieir 9varlose'comp 3.16' t gomeowaea who iahmit this affidavit indicafiae they ax dmag aIlwad and then outside ooataetmz n>nct rohmit a new aindevit iadieatine snc� . ontrartaA thaE sheet{this hoz mail attached as edditioael sheet 6m*the name of t� and their weirLss'romp.policy ML I am art employer Elsa!is prayidmg markara'comperisadan&aurartce for my eatpIoyem $CIO W.'s the-Pang art'job site ' znforraa:tian. . Insoraace Company l m=-, 7 Z / r� Espiraiion Date,,• (9 �- 2elzcy Tob bite A ddress� I LC O ► �l)l , .sty/StatelZig; 11 D 0 J S L Atfu i a ropy of the workers' comp=&fionpc&7 dedmtfnn pave(showing the policy umnber End erpirafion datt). Fail=to secure covarage as rcquimd under Section 25A of MGL c.1$2 can Iliad to fhb imposifion of criminal penalfics of a ane vp�fn$1,SDD.DD 8adfor one-year imprisonmcat,es well as civil PmIt>cs in fho farm of a STOP�TC?RK QRI}ER end a Erne Df up to S250.00 a day against the violator. Be advised that a copy of this statement msy be,forwarded to the Dfiiee of Invm igafions-of du DIA for incrm o cov=go veafioation. I do hereby r the pains std penalties erjtuy that die ixfor unto on prodded abolINe is trlIua'artd correct • • 5iaaefnceDate, �l� i�l • Phone 0. Q f f=W use only. Do evt write in this ores,to be completed by city or tom o,f j3cia1 City or Toys: Permit/License# Issuing Aufhority(circle one): 1,Boaof Health 2.Dm'Iding Depxrtmeat 3.6ty/Town Clerk 4.E�leciricel laspecfor 5,PlumLing Inspector rd , 6.Dthw Phone#h Contact P ers[in: ; i YIa.�sachusetts - Department of Public Safetc -Board of Building Regulations and Standards "Construction Supervisor License License: CS 25707 • BRIAN DENNISON . 86 CREST CIRCLE i - ` ' WORCESTER, MA.dl 603, - Expiration: SWO12 Commissioner Tri: 2522 Oifiee or Consumer Affa n&Business B.egul:fina OMS 1MPRO ENT CONTRACTOR Reglstrafio0 Ezpi 'i2 e t Card . RENEWAL BY BRIAN DENNIS _ 104 0M SIRE �� -•�Esq• _ NORTHBOROUGH, _ T3nderseeretu7 , t A CERTIFICATE OF LIABILITY INSURANCEDATE(MM'DD"YYY) 02/09/2011 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(les) 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: Joseph McKeone PHONE FAX JP McKeone Insurance Agency, Inc. E-MAIL 734-662-8100 ac No: ADDRESS: P.O. Box 333 INSURERS AFFORDING COVERAGE NAIC# Ann Arbor, MI 48106-0333 INSURER A: Hartford Insurance Company INSURED AL Windows, Inc. Renewal by Andersen INSURER B:Nautilus 104 Otis St. INSURER C: Northborough,MA 01 532 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. INY EXP TR TYPE OF INSURANCE ADD S POLICY NUMBER MM/DD/YYYY MM/DD/YYY LIMITS B GENERAL LIABILITY EACH OCCURRENCE $ 1, 00,000 COMMERCIAL GENERAL LIABILITYNC958461 10/01/2010 10/01/2011 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE ©OCCUR MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJEC- LOC $ A AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2010 10/01/2011 COMBINED SINGLE LIMIT IEa accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED AUTOSSCHEDBODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012 i WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N pgyER ANY PROPRIETORTARTNER/EXECUTIVEACH ACCIDENT $ '5500 000 OFFICER/MEMBER EXCLUDED? ❑ E.L.L NIA A (Mandatory in NH) If E.L DISEASE-FJ+EMPLOYEE $ 500.000 yes,describe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) CERTIFICATE HOLDER CANCELLATION INSURED COPY 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 i A Ism Renewal byAndersen. WINDOW REPLACEMENT srAndarunCnaplitiy ' Wood/Vinyl Composite IF .oGJ=1, Dual Do 6e Hun Low E4 SinartSun 100-00473518-010 -ENERGY PERFORMANCE RATINGS LI-Factor(U.S)/I-P Solar Heat Gain Coefficient 0m29 19 ■ ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 42 _ Manufacturer stipulates that then ratings conform to appfialla NERC,procedures for determining whala product performer" NFNC atmgt are determined fora rwAd ret of environmental conditions and aspacFe product sea. NFNC dost not recommend any product and does not WWM the suaaCrlity of any product for any speoft.ass. ' Consul msnuhctursr's rseretura for other product performance information. www.nfm oig • ,�t SEA This product masts Green �•• n Sears environmental - -(�. standardspowmingenergy . affciancy,heavy matak in IT� r $.A �'^ V >• . fi•the frame and snh ;, • l�matarlal,paeloging,and ® `:,i:,;,:::F`,'s�'ifw4' . Yrf consumareducational COY materGlt "SLR p.�'�4:C w'•': �Yno DESIGN PRESSURE(PSF) ret wdaaerstaneaf INN HLC25opeSRbA DB Sloped Sill DHMaMaelre set carnarman em mea Iltaala sta ' Naw or axceads M.E:C,C.E.C,L LF-C.C•Air laffilotion aquiramants WDMA tlalmark CartF ion Progrem. AORTH Town of over No. O — �A dover, Mass., I� COCMICHEWICK V 7� ORATED `s E BOARD OF HEALTH Food/Kitchen Septic System PERMIT . . T D BUILDING INSPECTOR THISCERTIFIES THAT.......................... ........... ................................. ................................�.:...................... Foundation ........ Rough has permission to erect........................................ buildings on ..�.. ... ......... . . ,,....... -40� Chimney to be occupied as.... �... provided that the person ac ting this permit shall in every respect conform to the terms of the application on file in Final 00 this office, and to the provi ' ns 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 CONSTRUCTIONS TSa. 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 j Smoke Det. 104 Otis St.,Northborough,MA 01532 J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 _ ReneWa' �� License#149601 (Expires 1/24/2012) byAndersen. , Federal Tax ID#83-0404201 WINDOW REPLACEMENT an Ando Co P:ny _ CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyers)Name Date of Agreement A kai Buyer(s)Street Address,City,State,and Zip Code V , E-Mail Address Home Telephone Number Woffi one Number `77& l S/ 333—si-I -Z Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen ("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. Method of Pymnt:❑Cash ❑Check 0 Mastercard 0 VISA Total Job Amount: /-� Estimated Starting Date: (,/�/ / ❑Discover ❑Financed,App#: Deposit Received(33%): ` / Y1 Name on Credit Card: �rC 70 Balance at Start of Job(33%): Y3 Estimated Com'pl�etion Date: Credit Card#: �`C Y/V z y Balance on Substantial L/ 73( 9 J Completion of Job(33%): 7CCEp.Date: CC Security Code: By initialing here,you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion Buyer Initials 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. J&L Windows,Inc.d/b/a Renewal by Andersen Buyer(s) Buyer(s) By: KAL) z` _ S�Katur of o uct Manager Signature Signature Print Name of roduct Manager ., Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - — — — — — — — — — — —X- — — — — — — — — — — - — — -X— — — — — — — — — - — — — — — � NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction . You may cancel Date of Transaction . You may cancel this transaction,without any penalty or obligation,within I this transaction,without any penalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument executed 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 I 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 l 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 ofyour Notice of your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the goods of the goods without any further obligation.If you fall to without any further obligation. If you fail to make the make the goods available to the Seller, or if ou agree goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so,then lgoods to the Seller and fail to do so,then You remain liable you remain liable for performance of all obligations under l for performance of all obligations under the Contract. the Contract.To cancel this transaction, mail or deliver a l To cancel this transaction, marl 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 Otis Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northborough,'MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF .(Date) OF .(Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Date I Buyer's Signature Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 104 Otis St.,Northborough,MA 01532 J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) byAndersen. Federal Tax ID#83-0404201 WINDOW REPLACEMENT =Ando Compaey WINDOW SPECIFICATION SHEET V!� cv 41 Buyer(s)Name Date of Agr ement r G d ?C� The Buyer(s) listed above hereby jointly and severally agree to purchase from J&L Windows,Inc.d/b/a Renewal by Andersen ("Contractor")the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of_tL_windows in Buyer's home,using the following individual quantities: !/ Double Hung(DB) aEqual sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.i/3 bottom) Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement(CDW) ❑ Standard handle ❑ Metro handle Casement/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 ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window T Doors(see separate Door Specification Sheet) 2. Yes ❑ of Windows to be Custom Fit Replacement: 3. ❑ Yes ET ty of Sills to be replaced by Contractor: 4. ❑ Yes No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings) Exterior casco Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: HP Low- O SmartSunTM (Tax Cre&LZE rble) ❑ Other If other,please specify: 6. Exterior color to be: [ ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: terior color can only be white,wood or same color as exterior. Wood interiors need to finished by Buyer. 8. Estate Har are:Style 9. ❑ Yes No Install Lifts '*.If ouble Hung Windows 10. Screens: windows to have: or ❑ Full screen Screens to be: [4 Fiberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11.Windows have grilles: Y Yes ❑ No If yes:VGrille Between Glass(GBG)❑ Removable Interior Wood aNTm❑ Full Divided Light(FDL) Qty: Qty: Qty: Qty Qty: Qty Qty: DH DH DH DH cW/Picture Glider CPW or G DH DH DH Draw grille patterns above 'Use additional sheet if needed Buyer approved(initials):( ) ADDITIONAL WORK DETAILS 12.❑ Yeso Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes 1No ontractor will install new paint-ready or stain-ready casings. Intaigp6asing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material - 14.❑ Yes L No Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Interior sto qty of openings: Exterior sPoval;momoval gs: ❑ Pine ❑ Maintenance-free material 15. Buyer is aw that Contractor does not do any painting. Buyer Initials 16.❑ Yes No Contractor will wrap exterior casings wittock of color. Note: Wrapping may be required with storm windo of storm windows will leave screw holes in casing. 17.�es ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18.[ ❑ No A limited warranty shall be issued to Buyer upon completion of the job and payment in full. 19.Fr Yes ❑ No B191ding Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not included in the Contract Price and a separate check is required at the time of sale for this fee. 20. Additional job tails: 21. Yes ❑ No Buyer agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of all 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. J&L Wind „Inc.d/b/a Ren_ by Andersen Buyer(s) Buyer(s) BY'. Signature of Wuct Manager Signature % Signature t Name of Product ger Print Name Print Name RbA Copy- White Buyer Copy-Yellow The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizadon/Individual): ��h���� -3 V Al de-r3 e n Address: l m Q11 S &free City/State/Zip: Al -o ,� D 1.��3� Phone Are you an employer?Check the appropriate box: Type of project(required): L'aI am a employer with 00 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t modeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E]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.❑ Other comp.insurance required.] *Any applicant that checks box#I must also fill 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. $Contractors 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: z!& �o n� l n su a Y1 C e' Policy#or Self-ins.Lic.#:' ��/ Ut/ L � j`�`/ Expiration Date: Job Site Address: 1 Afl-r 1 8 _ City/State/Zip: N , 1 Clef 1 6) 9 Y� v i 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 ce er the pains an�d^ enalties pferJurY that the information provided abo a is r a and correct.uDate:Si nature: /i Phone# r 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#: . FS Massaehusetts- Department of Public Safeh Board of Building► Reg ` emulations and Standards Construction.Supervisor License License: CS 101952 ---_ Restricted to: 00 DAVID BANCROFT 5JOHNSTON AVENUE WHITINSVILLE, MA 01588 Expiration: 3/19/2012 Commissioner Tr#; 101952 r ✓!� '�orriii�:�a,zcw.,:.�t/a ��'✓Llaaeacluc�t7a Office of Consumer Affairs&Business Regulation L OME IMPROVEMENT CONTRACTOR 6 C Registratio ,n; 6o1 1 Expira#i _--,12 _feint Card RENEWAL BY DAVE BANCROF 104 0 I STREE •., g -- NORTHBOROUGH, Undersecretary ACORD rm . CERTIFICATE OF LIABILITY INSURANCE °02/10/20' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP A+1cKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 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 an J and L Windows,Inc. INSURERS: Nautilus 104 Otis St INSURER C: _ Northborough,MA 01532 INSURER 0: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TH 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. ^ INSR D'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONSRO rYPEOFIRSURANrg LIMITS B GENS LIAZILIT" NC958461 10/01/2009 10/01/2010 EACHOCCURRENCE S 1000.000 COMMERCIAL GENERAL LIABILITY PREMISES-0 oaumnce S 100.000 CLAIMS MADE' ❑OCCUR MED EXP(Any ane person) S 5,1000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT AGGP&.iATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,0000 POLICY F1 PRO-JECT LOC A I AUTOMOBILE LIABILITY 35MCC XD 6390 10/01/2009 10/01/2010 COMBINED SINGLE LIMIT I S 1,000,000 ANY AUTO (Ea neddenl) X ALLOWNEDAUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per omdenq PROPERTY DAMAGE (Poracdaenq S OF LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN EA ACC I S AUTO ONLY: AGG IS EXCESSIUM8REL.LA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S' S ATUA WORKERSc0mPENSATIONAND 35 WECPP 1444 02/17/2010 02/17/2011 ._ GRSTIMIT _EI EMPLOYERS'UAB!UrY E.L.EACH ACCIDENT S 500,000 ANY PROPRIETOR/PARTNERlEXECVTNE OFFICERrMEMBER EXCLUDED? j E.L.DISEASE•EA EMPLOYEE S 500 000 H af.desaibo Under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500.000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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 REPRESENTATNES. AUTHORL'ED REPRESEMATNE ACORD 25(2001108) ! /�(�` '(,©ACORD CORPORATION 1988 k Ren ; va r rr 1%FP.0 r r t bye , s WINDOW REPLACEMENT MAad iCoatpanq i h' nslrr=stra�nb W00101171yl Composite IF Rel(nganciri� Dual Argon Double Hung W E fP 10D-OD414595-007 ENERGY?ERFO����I��E €Il�rs U-Factor(U•S)/I-P Solsr.Heat Gain Coy " fTicignt 3U, 3.1 ADDITION, L MFORM-ANCE o c uS. Usibl9 Transmittance Ask 0,253 Manulaeturerstlpulatas that thaaa ratings eoninm,fDapplla6te NERC preestlutas for tletenntning whole produ:t pada�nca.t&jO Mannas are datamttnad}ora ti[atl serol envlmnniantal eondNons antl a bpa:lll:produ:t slxa. NFRC tloas not recommend any product and does not warrant the sultabuiy of any product Jaren}'apaclfr.use, Conauttmenufeaure!alltarmtumtorotharproduelpedarrnanoeyfotma, - , wwue.nfr.o . • �4 This IDdu meet Gr. k nvim ' Eb.^^�� $cal a nmenial t' t ir. im.n�Lc.1i 1r,,,� F . standards v 'e go emin,., , energy efficiency,ha metals in the frame an. a sash materials, Paola;rig,anconsu � •education materials, 'I�1 t:•f..�,`��• ,� o�` DESIGN PPESSUPE(PSF- I 1. {q P Fl�kl ,W� t WiwowmWlWln Vt i. Matuladu d aedatian COMMF L wwe:.wome.eam . ' RbA D3 Sloped Sill DHis ,r 7aed m NAFS.p'+m IY - AAMA . i M14'DN,AI:SA SOIIISIAa40.a5, Mmufr.GNR!ttianinitT mn( Masts oiazeaeds &—4.Alrinflattetbn ra abamanta WD en )stnndnrdc 9 MgHallmad;Cetnflceflonpmgmroprmm. f i a