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HomeMy WebLinkAboutBuilding Permit #Exception - 15 GREENWOOD EAST LANE 5/1/2018 NORTH TOWN OF NORTH ANDOVER '� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received: Date Issued: IMPORTANT: Applicant must complete all items on this page C-W eew�(^I d 22 a 3�- .r►r� LOCATION _ 11rint�e- - PROPERTY OWNER fPrint MAP NO.- �i PARCEL: �S� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 05,0ne family u Addition E Two or more family ID, Industrial L-1 Alteration No. of units: WRepair, replacement 0 Assessory Bldg ❑Commercial U Demolition E Moving(relocation) ❑Other C Others: D Foundation onlyy DESCRIPTION OF WORK TO BE PREFORMED o� *7 Ilelpt ce_K.-e-4 j,')S:.. Identification Please Type or Print Clearly) colir O � Phone: 41— OWNER: Name: Signature � �/ A n f Address: CONTRACTOR Name: '^' "S` Phone: Address: `�S �OKJ L Supervisor's Construction License: Exp Date: s Home Improvement License: � Exp. Date: b! L� o Z i ARCHITECT ENGINEF.,R Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIwTED COST BASED ON $125.00 PER S.F. SO +% l�•� Total Project Cost :$ 3 . 7 FEE:$ Check No.: //e 2 Receipt No.:-� I I TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Swimming Pools Public Sewer u _ Tobacco Sales — Food Packaging,S Well ales i_ Permanent Dumpster on Site Private(septic tank,etc. NOTE: Pers contrac•tini j /it r egis red contractors rlu not have access!01zStamnpedPla;m Signature :igen er tg Pure of C titract Plans Submitted ❑ lans Waived-.❑ Certified Plof Plan ;E1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED, DATE APPROVED CONSERVATION ❑ ' COMMENTS i 9 DATE REJECTED DATE APPROVED HEALTH ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments. 1 Conservation Decision:_ Comments Water& Sewer connection signature&date J Temp Dempster on site yesno Fire Department signature,'date Building Permit Approved and Issued by: i Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) li G � I r Doc:INSI EC"I IONAL.SERVI(TS DGPAI(YMLN'L:IJPF(AM05 Creatcd.MIC Jan?(iriu 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 I ❑ Building Permit Application ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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) New Construction (Single and Two Family) ❑ Building Permit Application --- -------- .❑.- Form.U._.- ❑ 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 Hydrauli Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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:BPFORN105 Location/5- erA�z7 ")4 I /lines No. 4 Date �ORTM TOWN OF NORTH ANDOVER r O s Certificate of Occupancy $ s�cMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL _ $ Check 19905 Y 2A w Building Inspector AORTii TO" Of over 0 No. Mass.,Flo^ • COCHICHEWICK 0 dover, C' .00 It. V Of?ArED 1kV C7 BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System THIS CERTIFIES THAT.....�Iw ��.....11.6BUILDING INSPECTOR & ........................................................................................ Foundation has permission to erect........................................ bUildings,on -11T, ......&A"hwolb.4.....told-r.....kkoft.JL Rough to be occupied as...... . ...........w^d#"J.z.....-w.................................... Chimney provided that the person accepting this pbrmit 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 y �- PERMIT EXPIRES IN 6 MONTHS Final T ELECTRICAL INSPECTOR UNLESS CONSTR� N S S A Rough ............. ....I .......... ....... Service BUILDING INSPE 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�i Smoke Det. Contract Pella Windows&Doors, Inc. 45 FONDI ROAD f HAVER 4ILL MA 01832 Phone: 978-373-2500 Fax: 978-373-7274 CustorPrdiect 1:Ship-To Order DIADAlMilO CLARKE clarke/wme/nandover Date 00/00/00 to 3016& Quote No. CLARKE 15 Greenwood East Lane 15 Greenwood East Lane Order No. IMWoTOCo/ Need Date 00/00/00 N ANDOVER, 01845 N ANDOVER, 01845 Sales Rep. Name Johnston,Andrea/WME ESSEX ESSEX Prepared by 1 Payment Terms COD/WELLS Owner: heather clarke Architect Bus.Phone: ( ) - Bus. Phone: ,Iamb Depth Bus. Fax: ( ) - dome Phone: (978)794-0820 P.O. No. Cellular: (978)886-0602 Branch Order No. Home Phone: (978)794-0820 Order Type Installed Sales Order Glazing Design 20.00 psf. Pressure Branch Name Pella Windows&Doors,Inc. Branch Address 45 FONDI ROAD Phone 978-373-2500 City HAVERHILL Fax 978-373-7274 State MA 01832 Comments: Project total 33,750.43 N� Initial deposit 15,000.00 wells Fargo Upon subsatanial completion 18,750.43 will be paid by Wells Fargo or by Chq depending on Wells Fargo credit limit. Customer has agreed to go forward even with Wells Fargo taking excess time to pass the addtional 18-19K. They will pay by Chq or credit card if Wells Fargo does not approve addtional funds. All product painted Linen white Pella will pull permit on behalf of client. $467.00 For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at www.pella.com. Printed 09/11/06 Contract-Page 1 oft s � Contract for Custom=er DIADAMO CLARKE Project: clarke/wme/nandover Order No.: J Contract-Page 2 of 1 Contract for Customer DIADAMO CLARKE _ Project: clarke/w.me/nandover O Gide View Q�v Summary D ri�tion Unit Price Item#5 Extended Price Qty: I 2-Wide Casement. ,J Location: upper loft A: Left Hinge Casement,Frame:23 X 53-1/4: Architect Series it R.O: 3' 10-3/4" X 4'6" Clad, Model 2, White, 5/8"InsulShld IG Glazing, White Rolscreen., �FB� WaIlCond: 3-11/16" White Hardware -_� ,Ems(per design), Std Primed Interior B: Right Hinge Casement,Frame:23 X 53-1/4: Architect Series, Clad,Model 2, White, 5/8"InsulShld IG Glazing, White Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items:2-Unit Composite Install -Qty 1 Disposal per Unit-Qty 1 Paint Window-Qty 2 J Notes: ut ide View Fite; woe Otv &mWary De cri tion Unit Pri e _ Item# 11) Extended Price Qty: 1 Right Hinge Casement,Frame:23-1/2 X 39:Architect Series, Clad, LLL Location: masterbath Model 2, White,5/8"InsulShid Temp IG Glazing, White Rolscreen, R.O: 2'0-1/4" X 3'3-3/4" White Hardware,Fins(single unit per design), Std Primed Interior Wal]Cond: 3-11/16" Value Added Items:Disposal per Unit-Qty 1 Single Window Install-Qty 1 Paint Window-Qty I Notes: Or xnformation regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at vrtvw.pella.com. Contract- Page 3 of 2 Contract for Customer DIADAMO CLARKE Project: Clarke/wme/nandover Order No.: Outside)aedv_ _1 m-N - Otv. Summary D_escxi�rtip IJnit Price extended Price. Item# 15 Qty: 1 3-Wide Casement Location: master front A: Left Hinge Casement,Frame:23-1/4 X 60-3/4:Architect Series, Dl��j 1 BI�' C lu R.O: 5' 10-1/2" X 5' I-1/2" Clad, Model 2,.White, 5/8"InsulShld IG Glazing,White Rolscreen, �_� WallCond: 3-11/116" White Hardware,Fins(per design), Std Primed Interior ` B: Fixed Casement,Frame:23-1/4 X 60-3/4: Architect Series,Clad, III Model I , White,5/8" InsulShld IG Glazing,.Fins(per design), Std Primed Interior C: Right Hinge Casement,Frame:23-1/4 X 60-3/4: Architect Series, Clad,Model 2,White, 5/8" InsulShld IG Glazing,White Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items: Disposal per Unit-Qty 1 2-Unit Composite Install-Qty 1 Paint Window-Qty 3 Notes: Outside View tern �To._. (' .j. Summary Desuigfiaa Unit Price Extended Price Item#20 Qty: 2 2-Wide Casement Location: masterbed A: Left Hinge Casement,Frame:23 X 60-1/4: Architect Series, q�7' l R.O: 3' 10-3/4" X 5' 1" Clad, Model 2,White, 5/8" InsulShld IG Glazing,White Rolscreen, _ WallCond: 3-11/16" White Hardware,Fins(per design), Std Primed Interior B: Right Hinge Casement,Frame:23 X 60-1/4: Architect Series, Clad, Model 2, White,5/8" InsulShld IG Glazing, White Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items:Disposal per Unit-Qty 1 2-Unit Composite Install -Qty 1 Paint Window-Qty 2 Notes: For i iformation regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at www.pelia.com. Contract-Page 4 of 2 Contract for Customer DIADAMO Cj-ARKE Project Clarke/wine/handover Order No.: Ostsi E Vi evt1a �:4? �.. S 'v Descrintpl Unit Price Extended Price Item#25 Qty: 1 3-Wide Casement Location: kitchen A.: Left Hinge Casement,Frame:23-1/4 X 38-1/4:Architect Series, ;� � R..O: 5' 10-1/2" X 3'3" Clad,Model 2,White, 5/8" InsulShld lG Glazing, White Rolscreen, liH i ��IC I, WallCond: 3-11/16" White Hardware, Fins(per design), Std Primed Interior u B: Fixed Casement, Frame:23-1/4 X 38-1/4: Architect Series, Clad, Model i ,White,5/8"InsulSh.ld IG Glazing, Fins(per design), Std Primed Interior C: Right hinge Casement,Frame:23-1/4 X 38-1/4:Architect Series, Clad,Model 2, White, 5/8"InsulShld IG Glazing, White Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items: Disposal per Unit-Qty 1 3-Unit Composite Install-Qty 1 Paint Window-Qty 3 Notes: Item#30 Qty: 1 2-Wide Casement Location., girls back bed A.: Left Hinge Casement,Frame:23 X 60-1/4:Architect Series, A R.O: 3' 10-3/4" X 5' 1" Clad,Model 2,White,5/8" InsulShld IG Glazing, White Rolscreen, WaIlCond: 3-11/16" White Hardware,Fins(per design), Std Primed Interior --= B: Right Hinge Casement,Frame:23 X 60-1/4: Architect Series, Clad,Model 2,White,5/8" InsulShld IG Glazing, White.Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items: Disposal per Unit-Qty I 2-Unit Composite Install-Qty 1 Paint Window-Qty 2 Notes: F,or iinforma t€lin reg6rding the finishing, maintenance, selTice, and warrant;-R.I.-all fella products,visit the Pella Website at www.pella.com. Contract-Page 5 of 2 Contract for Customer DIADAMO CLARKE Project: clarke/wme/nandover Order No.: O &Y. - tQRN, = ya��_ Summ ry Dec ri ,t�e� ., � �. ��' 1J.ait prirE atended rice Item#35 Qty: 1 Right Hinge Casement,Frame:23 X 61: Architect Series, Clad, lLocation. back bed Model 2, White,5/8" InsulSh1d IG Glazing,White Rolscreen, White R.O: 1' 11-3/4" X 5' 1-3/4" Hardware, Std Primed Interior WallCond: 3-' 11/116" Value Added Items: Single Window Install-Qty 1 II Paint Window-Qty I -j Disposal per Unit-Qty I Notes: Outside View No. Otyi Summary Descrilp iM Unit Price Extended Price 9tenn#. 40 Qty: 1 left Hinge Casement,Frame:23 X 61: Architect Series,Clad,Model JI Location: back bed 2, White, 5%8"InsulShld IG GIazing,White Rolscreen,White 1 R.O: 1' 11-3/4" X 5' 1-3/4" Hardware Std Primed Interior WallCond: 3-11/16" Value Added Items: Single Window Install-Qty 1 Disposal per Unit-Qty 1 -- Paint Window-Qty,-1 Notes: (2e�tsid �7iev✓ A91 O iemmary Description 'Unit Price Extended Price Item#45 Qty: I Right hinge Casement,Frame:23 X 61: Architect Series, Clad, i;r-7 Location: front bed Model 2, \'Jhite, 5/8"InsulShld IG Glazing,White Rolscreen, White I� II R•O: 1' 11-3/4" X 5' 1-3/4" Hardware, Std Primed Interior JVallCond: 3-11/16" Value Added Items: Single Window Install-Qty 1 Disposal per Unit-Qty 1 Paint Window-Qty 1 Notes: nkii Ym tion, 4'.ga r flag h- ar_:?i?ing Maintenance, Service and-wa rr a; at`, � � ,r �' 3 s e b� 9 � g �� � ,� =z�r al.Fella products,visit the Pella Y�el3�it� at vvwvw.pellaxom. Contract-Page 6 of 2 Contract for Customer DIADAMQ CLARKE Project: Clarke/wme/nandover Order'Jo.: Rt�....Tk y�J ,., E_ ► 't •icy _ Item#50 arty: 1 Right Hinge Casement,Frame:23 X 61:Architect Series,Clad, Lesation: h•o it bed Model 2, White, 5/8"InsuiShld ICY Glazing, White Rolscreen, White R.O: VI 1-3/4" X 5' 1-3/4" Hardware, Std Primed Interior ,I: IIS WallCond: 3-11/16" Value Added Items: Single Window Install -Qty I III�� Disposal per Unit-Qty I =-J� Paint Window-Qty 1 Motes: k a i d e._lL_y �kY�+,�ste�t_y.T Summary ary ULUX10b"a i nit Pried Extended Priee Item#55 Qty: I Left Hinge Casement, Frame:23 X 61: Architect Series, Clad,Model Location: front bed 2, White, 5/8"InsulShld IG Glazing, White Rolscreen, White R.O: i' H-3/4"/4" X 5' 1-3/4" Hardware, Std Primed Interior �I ilk WallCond: 3-11/16" Value Added Items: Single Window Install-Qty I Disposal per Unit-Qty I Paint Window-Qty 1 Notes: t 'a-yrav: tit"em.," __ _f?¢y. umm.ary d� t'r r1y brn��tris Ext nded rim Item#60 Qty: 1 Right hinge Casement, Frame:23-1/2 X 39: Architect Series, Clad, ice=i Location: mainbath Model 2, White, 5/8" InsulShld Temp IG Glazing, White Rolscreen, R.©: TO-1/4" X 3'3-3/4" White Hardware,Fins(single unit per design), Std Primed Interior I� Wal,'Cond: 3-11/16" Value Added Items: Disposal per Unit-Qty 1 Single Window Install-Qty l Paint Window-Qty 1 Notes: re-g-ol dirag 11he f n; hil-Mgy Maintenance, seryl;x, and�z'ai'"s aa�°.trr for all Pella products, visit the Pel!a 4�7�nchsit'e, -t 44 www.pella.com. Contract-Page 7 of 2 Contract for Customer DIADAMO CLARKE Project: Clarke/wme/nandover Order No.: n°��a .?�.e.V���� �.f���_i�;��, .e-.�_r.•.,,...�..,.,�_z_O...'v �a�.lp�marv___vcir+'rr i t ]Pr' n F', reF !. Item#E5 Qty: 2 2-'Wide Casement qF--- Location: basemcr�t A: Left Hinge Casement,Frame:23 X 30-1/4: Architect Series, A a i Clad, Model 2, White, 5/8 InsulShld IG Glazing, White, olscreen, WallC'ond: 3-111/16" White Hardware,Fins(per design), Std Primed Interior P: Right.hinge Casement,Frame:23 X 30-1/4: Architect Series, Clad,Model 2,White, 5/8"InsulShld IG Glazing, White Rolscreen, White Hardware,Fins(per design), Std Primed Interior Value Added Items: 2-Unit Composite Install-Qty 1 Disposal per Unit-Qty I Paint Window-Qty 2 Notes: Quisidg—YkaWe _ Otv. Summary? escirtic" jjn9t price Exterded Price Item#70 Qty: I Right Hinge Casement,Frame:23 X 31: Architect Series, Clad, _. . ,Location: garage Model 2, White, 5/8"InsulShld IG Glazing, White Screen, White II Il R.O. F 11-3/4" X 2'7-3/4" Hardware,Fins(single unit per design), Std Primed Interior LL ' V6'a1lCond: 3-11/16" Value Added Items: Single Window Install-Qty I Disposal per Unit-Qty 1 Paint Window-Qty I Motes: -S Fol- Interni t9t...'.tn regard-Mg thefl.-jish_jngy u cit Y5„L1czb F'�.'; sej::';cC, an,Fg' i3v i0:}' WSY Pella p?Y"23'dli?aCtuy visit the Pella dF'jea93iie at www.pella.com. Contract- Page 8 of 2 Contract for Customer DIADAMO CLARKE Project: clarke/wme/nandover Order No.: 121 Nn- Item#75 Qty: I Left Hinge Casement,Fram,-:203 X 31: Architect Series, Clad,Model 'location. garage 2,White, 5118" InsulShId IG Glazing, White Screen,Wifte Hardware, R..O: V 11-3/4" X 2-1-3/4" Fins(single unit per design,, Std Primed Interior W a fl,C o r,d. 3-11/16 Value Added Items: Single Window Install -Qty I LJ Disposal per Unit-Qty I Paint Window-Qty 11 Notes: Thank You For Purchasing Pella Products Taxable Subtotal $33,095.65 Omer_ gi,n attu re Pella Sales Representative Signature Sales Tax at 5.0000% 1,654.78 ofo Non-taxable Subtotal 0.00 Total $34,750.43 Date Date rpeeosit Received $ 0.00 WARR-AXTY: Pella prodt.icts are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a par, of this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system. Neither Pella Corporation nor Pella Windows &Doors, Inc. will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening (egress) information does not take into consideration the addition of a RoIscreen [or any other accessory] to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. "ce, and.-,varrant-,- f01- 11! PCIIII. products,v;.sif the Pella Vvebsite at f�D t-M_a t i re-a i 1 df-n g rn Ik S h.i n g. m?.;.n t e ra""n_c;:; SC17,,7. www.pella.com. Contract-Page 9 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit.: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationadividual): Address: yS Fyrl c� lam. City/State/Zip: A(d Phone#: q fig'_ 6 S-7L SS Are you an employer?Check the appropriate bog: Type of project(required): . 1.X I am a employer with '2 S 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 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.]. officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1.1.❑ 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' 13.0 Other comp.insurance required.] *Any applicant that checks box#1-must also fill out the section below showing their workers'compensation policy information: #Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors 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. _A Insurance Company Name: +for``' A),rJ Ins UlriCi,o1Ge 6:1r!par►y Policy#or Self-ins. Lic. #: )dN4 5 7y2. Expiration Date: Job Site Address: f .- �` "'� 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 insuran a coverage verification. I do hereby rtify unde the pain nd penalties of perjury that the information provided above is true and correct Si atw . /' - Dater O 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 11 Contact Person: Phone#: ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE SD 07!05/200613::5454 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street Connector Park HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell, an 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Insurance Company New England Window&Door Inc. INSURER B: Hanover Insurance Company 45 Fondi Road Haverhill,MA 01830 INSURER C: Mass Bay Insurance 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. INSR ADO'L POUCYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPEGENERALUABILITYEACH OCCURRENCEDAMAGE TO-RERTW $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occuren e $500,E CLAIMS MADE OCCUR MED EXP(Any one person) $10,000 B ZBN8161407 7/1/2006 7/1/2007 PERSONAL a AoV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000.00 ANY AUTO (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ C SCHEDULEDAUTOS ADN8162169 7/1/2006 7/l/2007 (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $.9,000,000 _ X OCCUR a CLAIMS MADE AGGREGATE $ 9,000,000 B UHN8167305 7/1/2006 7/1/2007 $ HDEDUCTIBLE $ x RETENTION $ $ WORKERS COMPENSATION AND —FTWC STL U S TH- EMPLOYERS'LUIBILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE 08WBNL5742 7/1!2006 7/1/2007 E.L.EACH ACCIDENT $500,000.00 OFFICER/MEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEEI$500,000.00 - Ir yes,desrnbe under 500,000.00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER Blanket Building&Contents B Property ZBN8161407 7/1/2006 7/1/2007 $5,540,000Deductible$1,00OBlanket Business Income$4,500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION New England Window&Door,Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN dba Pella Windows&Doors,Inc. - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL 45 Fondi Road, Haverhill,MA 01830 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , ACORD 25(2001/08) Client# 2960 Mst# 0607 all lines Cert# Evidence of INsurance 0 ACORD CORPORATION 1988 �pp I k xc a�x r £ k ���l„ i� �;• moi-�` _ -���!' . Yia h3 !i � v ,a<*. � a'-._��'- � ��' Mhz �4�f• "I f$ MIN 42,01. Ilk um rds olt bol XIDO 4AM 5 FON4 FtD: KC r sem.