HomeMy WebLinkAboutBuilding Permit #021-16 - 17 SUGARCANE LANE 5/1/2018 BUILDING PERMITNORTH
O��t�eo agti0
TOWN OF NORTH ANDOVER 3
APPLICATION FOR PLAN EXAMINATION
�o
Permit No#: Date Received �q"�R�TE0�PP�eS
SSACHUS�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 7, - �0 C' �C. LAl
°.
9 h'
Prl
PROPERTY OWNER
F
Print ' -100 Year Structure yes no'.
`MAPPARCEL! ` ZONING DISTRICT,- Historic District ' yes no
Machine„Shop Village YeS: ... no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: 0 Commercial
msRepair, replacement ❑Assessory Bldg [I Others:
❑ Demolition ❑ Other
.w
r 0 Septic d.Well' g _' rta Floodplain I]'WeflandsJWateshedD]stnct=
. 4
p Wat /Sewer
��� DE� OPTION OF WO K/kT�O BE P�ERFORGEP:�A_ Q
A CSC
Intif ion/ IV
Please Type or Print Clearly �7� I �3—, S.?��
OWNER: Name: /G'�0' Phone:
Address:
Contractor NorrieJ'� Vi'`'e q��rl''”" Phone. l`7
Email.
Address
.Supervisor's Construction License Dµ90" �� Exp: Date :
Home Improvement License L 7 g f Exp;:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
D�42 FEE: $D O ���• ��
Total Project Cost: $ l
�60-9 7 7 E/ Receipt No.:
Check No.: p
NOTE: Persons contracting with unregistered contractors do not have access a guaranty fund
_ -
c-o
gtU
_ _ —_ -- -
-
— _ -- —P
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Sv'inun�g Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS '
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
I
Panning Board Decision: Comments
Conservation Decision: Comments
Wath)r & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature: ,
Located- 384 Osgood Street
FIRE DEPARTMENT Ternp ®umpster on site eyes . f no
Located at 1j�24 Macri Streets "'� p
Fire Deparfinen igri Lure%to
' P k
C a V kms'. 5 1? r,eai a t;:. ` :s a 'Y, £; p.: �..: fitr', ' •+,`c
COMA MGNT�7 p �,.,,,i,« f .' a •: ' i..r�pY' a'} •t r�_e..f`;`•k�* .. t Z'#- �..r '� * '� `s ,. a r
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
i
i
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
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
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
OTE: 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 Contra--
act
Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
Location
No. v`Z/—/ Date.. 7
TOWN OF NORTH ANDOVER
. � IYz '
SAM ,•
v Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee - $
Other Permit Fee F $
s�
TOTAL $ y
Check i W&1 2?� < y
j
,z.
Building Inspector
Yf t
F NORTH
own of ndover
o : - ..�..
No. bZ�" z 6� * w t
h ver, Mass,
coc"Ic"IWICK 1'
�A�RwTED PP�`y�y
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT .......... . ../, �,,, �,�:/V.1� „ , BUILDING INSPECTOR
.....................
has permission to erect .......................... buildings on .17..;.�CX�•.,Cc r;�'�./!f�.,.�,�!,,,,,,,,,,,,,,,,,, ,,,,,,
Foundation
/ Rough
tobe occupied as .....(............................' �......�x! G s:.......................................................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
Service
.......... ............
...................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin Rough
Display in a Conspicuous Place on the Premises - Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
..._
...N. ,tit�[sse tt1T�10f�P�»raj.
, dr; Ren�'by Antler en'Corporatton Filerit"faz tf)#41 19184M
w 40 W Of lR4£M1£KP lir€N
E Fat}Fort iii iVorthbth ll tJ1S32
Aw
t'�STC�A�R° QW AtVIIi`I!�(31C RE11�It)�TsLiNIC RE1:'AENT
s),N
.61GL'StL:1fA �- KEL�1!`$tLYi4�r MAY'u18,'2€y'1Pt
.. a .. Ir
"
17��3UCAlif»AN�,i.A; 111f}RTFI'A1Vt)t?V,ER 1UlA;, _ Q,1,$4
E ftN1R8 �11(ftl. .., aztlLt[t i
*001MA!000Ab3.60trt
ff, ppron(" actor"► with
the terttts end 6rooli lta&"tea a frit aretl a t YetSB`b t1& i?t ar i c the ►ecit►cat at sfi t{s Owedw�sly'it> 7#�et net�t"j
er s)beret}r to vmo atter hes� wwk ur�ar fAiB
it 4 763:ft;
hesACssFt+
t3aiaroCe ot.bti{�$' Q ft0 a
i Fes.
ISM
£ mit
s�dnr>� iaadeM ►�i['ai aa9d" �ffieaCke�t,grd' :ttirtn.
BN+4T•,r fa}a n s I uhde it s tlt #Ets"A v6nsont sorsa ► e�t ni tieEWt f#he"p>srHea tow t it"axm rro�ierbst im afa�fdh+�s
chati10n ar airy df tha` nrra a@ this ho�n to ae devfatIon +this Agneerceertt rW�Fns vebd without dee Sigr n >rt,
ryr tenth t.oeNractlir Soy a) acknawtedges that t3tiyerfs}tj has read this Aoraemeitit u da eizm t trea ott#da awn,ared rias
repeved a fid,aimed and daft copy at ttrig�,i�dra'attarlwd Nutfees stf.C:eneeifa46ati,ari#tui dei6 first�eRittisn sbcri�aHfd 2t vires`
', titr�it.��tiufyer�s right�'car� GO tiOT.s�+i t�u�.����?H��ARt AtiY t3LAA1K st>a�s. ;
x
){, �ti'UC1<F�E61t Bt1:L.�$ILVAj [E1aL.Y$ LYA
Prad tlAarnB,cii Cra>s3�ilf®ftt:` P Alatne
to N2rr r
E
{
,: iYY`.-tAC�U�p1SAY"#a7 'frAFG AlIrLn?O�y/ �rRGH� SS E�AY I1Y,a GR6TMYAlG OF S:R1M�'CSA :
11l i.A ilV6i FOM ONbFµ
a
€ ` jxfJ l"�D IMRai--Cyi�_- 1 1G I Doz-Ld
ti'aaa,lYtfdbnlaag�iMM'Itt110ttV!l�.Rl�adzgs�laatt�tR I� •lYatIpllLaahgai9Ylt1@tl,t1�4�8 tl�te' e�dags 1}�ttlfe".
atAdcl ditC.II YOYC , e� °tfE} �fas_q's�° m1G�66��pyl Yade!` f�gM�itltR i.r'Je{ }' f t� 3°09IC1 '(
d�C�deaecaArs:ay.,Yl..ra�MecaNa +F�e�d�earty�t,,.,.�[ik{ I .r>teo�.acearea&,,s��ya�sa.6iC�ea� 1�ryen. v195M
exasaaao€ka,�i,ay�epr` ta�eledasoMwtof.iub��w�be , �a ,s��sda�rpt�Mrc:e�r�ootorrt�� bo,
nre�d. trcaaca,,•yeaunmsemsraa�a6feteder$a�r' acp�eerde>3:,I ' tr�anr •?�u+eMnci;iso�MearaflldemercSelfe..£y�s'eas "�::
oa4ataatlatiy as"goad it as whi'ze etVed;gay goads detivu�ed m yon nadex I Mu6Mtast[slt}aM goad coaditioUMM srti a receiuMd, goods dehvemd to you order '
it3octor orytiivanaifrrrmry�ifr�i$rYcis" af ;. I t1�1a'C+�ntrseRr `Ks1a�elr9sn�rn 3ES:aq�wi�h.ertaiiL:t6#�ia!• (.
gees+hgmr�6eteuttneBMc�oadcattl� eraeay�eeamliiif�.; � �feMes� a'��raai�ipmmt d�egeadAactla,eSrlier'rmrpeszraaitadatw
Ir Baer do t goodM eva9a61e toe fieffier sad the Reltee daeM�tpk3c thoan, I if haw#a mal a ehe i a auben;'tIfee tda tf�e 8e> reLtrrs nw p�ti�
wlfBin�dayM of d�dace of yarn lYatfee of Csnoetlades,Yan•oag ret3♦�ar dlspase' vRthia 2e dapet st'ti�date at yaarZieKfiuc oI Caar�Fadoaaa 7'a°�Y an' ;
of gaatlM Mritout aayit6erttns. if gas tae ea dro ga .vs9t.6ie ' of d`e goods trithoat aal tkesher e�. IP you fau tosLuk d av',
to ss z,aY tS yrrr aga Meru t etre+,s xo j�U' sit w7lo,Mo taa t;: ' m the 6e rr,air pen sgrie�nmar.tl�gm�c to rhe BrlFeraM
:yau.+w,nM3o'tiahrrr "'�"` "eoFuar"s'areL`anl:''ti. a�awecl remsair.Ltrrk�Sefim�pebriessaee�rd'attalgaaadertBeeaiiaeti.T6 ..d 'E
thtoceaer tEaeyma3lor teras#gaeda dd:udra tLiecseee atieeaatict ,' il�isteaaQace saolorde aaria edasddatedeopy tidacaace8sdouaniiee
arsrytrtDersrettteaoa�t4arreadaratataiu�wie+�lrygRmlrrreea:I ori,rtynil�er+wrteteseaBeearaerods��;er' "Iteaewaii!'yledrrsitr,,�
FamesItd N�,1NA015 , , 30FarbesMwL1 "oissZ '
,i ItEA�YY:AP7I..Ef�'IR3$7'RAN3u�R7RN.", � I>#EF�'Pl1lS�Alli$.4.CPiC)IIT....
;i Btr,er8 S4 Pt6dME�rta_': DMtv'. ;' H ;¢ PON
t
z�enewa 1
Ronewat by Andemen Corporation :MA Home impraverrI4iA Contractor;'
inde�n 3o Forbes rd Northborough MA 01532 Ucense#170810 (Eitprre&12(23/2015)
wrnaaw,+fie axasssr set', A;R �f, :'(508)351=2200'. FEU':(50 SW4072 l eder8l 1�} f 918!113¢
'YYlndo'ar Sp�cllfiitin=SiFe+et
I.
_. ._........ BtE L !L'VA .___ KELLY 911.VA 1111.. MQNy M !8i 201
Ai% $'
I he huter(ci list tl alxx<.Itef l t',ln't"iitlti slits sot rail t ay;rcca t ptlrrha i1ir.gaari andlnr st eters Iisi{d t�etrsr,"in a cot Lnce k6tl the plies=A i�rrnl;A,�sc bvd
in the Specification 4hr et and �,.trent and the star r sr at thr ac<�trt rtrttrtx ('t S IY)1�1�l�t)t) �c N ' ids
p , . �t VNI)�)OOR��<n�c�laNt
Specification"xhee is l�
VMDOw et DMdR:DETAus
,a:.sac :nFw . EatetlartMtt C.a« Elaedti are ire t.cwEsd c6;; {sips ai�as
Roorr N eta+"haters , U t UYrr21aw1t)oar+ GBtatl.... ,. Ext 3nf Cour $rg6„ a SINih rr+ I.Seshl13" "�Ssh 9 lifts. " itiere
Kitdwn 101 ; A10 0." P.S;iafb. Int/ExtMF80&:wKWH White Tiib&a, ,HF.G; ws 3t5_ : Tamper
., ., ::., ,,1111 ..
S rroani" l{Y2 G:._ ,l1{t, ,fl' Ps Wo IntlSXtRAF9 White Trttreea, HFCd:SmartSuv tarp
915 Tarn
flo#sl' BawX`>BOw.lk BVIM OCPs'O ETAILS
t; 'wart Niatt6sr, Fi�rte `!Atw" Crurtsr. iisnvEJt Resgff Via:
Room Cctsri, �': ". �, �Lites Intafor EkfMtCvkx °f7rNt ;_„ s�freai s-asedriaY Scrssnxafstin *:3otSPt ,.Coos `
SMCU LTY wtNDOw DETA S
FUlf Apprpx. t wE t Y BAY/BOW AMItf"Tlt)NAL WORK*NO''M S
",,,C+ra. .,,...(3tiN®: 6iV1Ctf'{,ttWr., ,l,ud airixaw ma&sera,aril.rvJiaawwiax4Kva urx6�r.7�T,i1u,'3uf.>
A.
ADDIT O'ML;WORKDTnU.%,
t TdP Contra dco wrill e%terior rasl wtth cog stock odfor Of.
Owner is aware that Contractor does•not-do anv priintingfstafrting or removaittnstaW.0on of alarm system or viindaw[reatmentsthanfwara.tt is Me raspansibitity of
the tiorrieotarrer 3q°have the a6anrt,sysrert and window treatmerrtsfrrarctwate removed prku fo ersfa�atiGh;tt make rio gliertutdee es;to whettrene/erms tar ovindaly
2: trtinetiisltvatis wtN fit atter�nf Ltistotrxv is atsQ awaia"tr?Sema rases xttuva iv�ibe glass tars tf itr 1s tie anuti»t trlk be�rrP on tt>e ty�Zs
of eirtsfktg wrrtiioas,tYPe of tnstattatfon
and wtndcw t" Mr make na gte&rarrtee as to ft amourrf at gfasa ksss distomer is aware and tindarstands any and elf
unseen rof is not tndrrdad in-,this tomract.Strairtdany rot b. 6und there wttt be an additnat charge for.(rrre acrd materfats t)ntrsss"so stated in tits:borfta
s:, ,•Yeei Con9actor wgl htsttlete catrNt stat seat wettlrs+va witlr S-Potrlt system to prevent water turd ak it Eahation ftemowat And,&%WSW of ag jab catered Vis,
j 1 windows;door's,.storm nwhtiiiiaYs"ants uruin nor tnotuded t,tpors casnptetiori ofttte.joti'snd payrr�nt in ftrl#,a�ri�ltad warranty shalt Fie issued.;
I�h:, Yew' '8ugd�g i�errtiit--G(tniractur wgl 8eolve ally a€nc3'a!1 neoess8e}t permfts. 'Pfie iae for the�t'rrti;(s)'is InCltideY9 to the tdtaE`cxtntraot prkie
rr, Yes Atl iliScairirta heap been applied to this agreerift:
Air V yvs No Owner agrees to.be present on tate final day of installation for final inspection and to deliver tinal payment/finance form(s)..
ITt-%{a}fneecf�>ui vnrfrt ttxxf tfx attd fxvivxv rr tit chat r}ric Spt2af ttbur ifrt t nitivg wrtft thc`;t E 4"FCI tf 4L\1)t)tti rlttt)1)*)0 I(&X40 El TXG;l([tE NIEN i t iktitxitm tim 66il,
#iii ivt start,nkh tax N tht jl rt ;atul tlrrir m tin x iYtit.ir r rr�tstiukin r tr rnttivt n hu rt std#sroy rat tttt:{i:rrric This S e f t mi ai cluv 'rvoti';rnll trr char and tlr iia t i vza vrr ail€eta trr isrir ai in
tons x�xy vaita -hums 41kalt anr"iv'+rritav atui Affix of tt taaxef tbu itukx -mal{iaErtr a i<rr. IGat } n elaaxslrtf r't6ku 8ta a t e;ixan irarl tYus t tx titit;rstar n+irtrr_
;Renewal by 11adc�aet�Caeparation y�;i f3rn+r`g
M
<.
Signature of C ttant a " igrrp Signature--,-
l9RUCE"PBC12`; BILL;StLVA KELLY°SiLVA:
Print Name of Consultant Print Name Print Name
on-
In t �. a i 1�, i L ` ,1 r �r tm,
it
en pora lb
�nM c' e t (v i�# I I�2� *Fax�:150's;6 86 X6'7
'.1A°I�IpfilA� N&PLdEM[IYT.•:ss<'� e �tixa�a ;:. rat$ XtL.R�
llf '.ttt kli'. 4.� .O t 4€t'�►kt '. t u t t€i�� b 00 �I~�<a R►IR49[ 4(XIt ; .�iikk'��L s ���k ;!!*Artd
rr l l °tx% rn7 R d ted '
t i nt I rtdt ti f t�tt r L�. �t� lti t.. t Wil, ,1 t # t a i tt �I i ars �i t t . "Wrl,w k tit tw �
°itk� uistietitni` tItl� `trnt Aii ► i �t'' In ` Itu*t"rktttk ':
crow V J teqi �r�lc�o���t t��rm.�m oft �L, tcl ��hr3L �g
lat
77
tit
J 0 2W,
, Pay` �A Ilr�tle'
t
U.
3
t
1l� n k° t tom+
s
It if +md. -;Atd a 11 '�`t14t4►dlGbb C tMM6. 'blo-
A All
i'ft'I!�1C www- xfk It .:
-DeT"' emt 10fli WridAcc encs
ur I Congress 9&eef, skfte Igo
R®"04 MA 02-114-2017
1 W- g ffov1dr&
Workers'Campe>fsatfou insurance davit: Betide1q/Co®t°ar-tors/Eleetriciang/plal b,,,
iie'sat IMfo at o>
�,T RENEWAL BY ANDERSEN
1���(Business/Organira4ion/bndividual):
Address:30 FORBES ROAD
Cjj , tge/Zi :NORTHBORO, MA 09532
Phone#:505-351-2200
Are you an employer?Check the appropriate box:
Type
1.0 I am a employer with 30 4• Q I am a general contractor and I ®fi pr®]ect(required):
employees (full and/or part-time).# have hired the sub-contractors 6- Q New construction
2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. employees and have workers' ®DemoDition
[No workers' comp. insurance comp. insurance.: 9- Q Building addition
3.Qrequired.] 5. ® We are a corporation and its 10.®Electrical repairs or additions
I am a homeowner doing all work officers have exercised their
myself. [No workers' comp. right of exemption per MGL 11 Q Plumbing repairs or additions
insurance required.) t c. 152, §1(4),and we have no 12.E]Roof repairs
employees. [No workers' l3.®Other
comp. insurance required.]
"Any applicant that checks box Ili must also fill out the section below showing their worloers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit s new affidavit indicating:Contractors that check this box must attached an additional sheet showing the name of the sub contra to and state whether or not those eating such.
employees. If the sub-contractors have employees,they must provide their wurkas'gyp.policy number, entities have
ram an employer uerrt isprovMireg workers'compenwioainmmncefor ny epfoyee� �riow rs:feinformatom ®&
aredjog site
lAsurance Company Name:OLD REPUBLIC INS. CO.
Policy#or Self-ins. Lic.#:PvlWC 30293800 10/01/15
./ Expiration Date:
Job Site Address: 7 t: Oti Ct1e �—'/Y City/State/Zip: / l�yp� �/�yq
Attach a copy of the workers'compensation policy derma at�are page(showing the policy number and
expim
Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the i �®n date).fine up to$1,500.00 and/or one-year imprisonment, as well as civil mposition ofcrimina[penalties of
of up to$250.00 a day against the violator. Be advised that a copy of this sfttementf may be forwarded to the Of a STOP WORK ORDER
d afin
e
Investigations of the DIA for insurance coverage verification.
I do hereby certify 16RXke pairas and pence of perjury that the inforore&x providedabove is hVe and corm.
Date: �Phone M
Qfjield rose only. Do not write in this area,to be campfeted by C& or tower ofjrcia!
U
City or Town: Perrnit/Ucense#
Itssuing Authority(circle one):
1i.Board of health 2.Building Department 3. City/Town Clerk 4.IEDectrical Inspect®r S.Plumb juspector°
6.Other
Contact Pemon• Phone#:
AR'DECOR41 YADAVYO
THOS CERTIFICATE IS ISSUED AS A BATTER OF 'MFORIATI066 OWLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HoLDER.THIS
C€IMFICATE DOES NOT AFFIRUATIVELY OR NEGATIVELY AMEND, EBTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING lNaURER(S),AUyNORMp
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
I
MPORTANT. It IIf?re cerfflcsb holder Is an ADMTIONAL IRSURED,Ilk PC ft(Is1:R)mW be endor%W. N SUBROGATION IS WAIVED,atlb)ed to
Bwses>s and condif�loss of the policy,ce;ae>Mn polldw roeluiee EA embrwnmrr& A stdv r Fd ore 0111D Corte dolma root confer H®hte to the
fteb holder in ljou of such endor"menge.
IR OWTACT
Willis �' to Inc. NAM caE"Ca ok.com
Co ftrry�B#wd �M0`No F.0:(6�""Sys
205161
Nseksel(�,TIC 27230.5191 �`
AFFIRM=OObERAOE IdliBC D
II wtmA:Old$'Ropalbllc insurance Dori ° X147
IN6rll� INSBIOEr 9:
Rmo=V 14P Anderwn Corpowdon 011>SUI�C c:
30 Forbes Road IN�uRERa:
Norlhbor�ouph,0A 01638
fd5r1105@ E
C�IIR6i F
cOVERACrES CERTIFICATE NUMBER: ROMOK h9UfiMER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NWED ABOVE FOR THE POLICY PERIDo
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF AMY COK RACT OR OTHER DOCUMENT WITH RESPECT TO VMI THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AMD CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
-TR WTYFEOF>4'ILNRCJIICE
P'DL{S:Y WJWAER Amobawym LAM
COM91ERC1AL GENEML UAR I-TrY
FACHOCCNtRENI� $H-j
cLANAS ®OCCUR +Stfr!Y4�b021De10 10/011$096 1010912®46 PCO r�G=Mw= a 600,
M9Eb EXP(XOP arra PSI) $ t0,
IWURY i
MGE?OTHM
dL AGGREGATE UrrITAPPLESPEfY9,000,00
&AVVcoo
PSC ❑PRO.JECT LOC MaRALAGGREGATE f 6,000,00
PRODUCTS- A f 4,000,00
AUTOMOBILE LNWIL17Y f
� f 6.000,
A $ ANY AUTO 2676 9ftl09s 094 10109/2096 8wILY INJURY(Pwr pmrM) f
ALL ONAJEDSCHEDULED
AUTOS AUTOSNONE BODILY INJURY(Ib aoodgly f
HIRED AUTOS AUTOS E f
i
U12DREJALJAR OCCUREACH OCCURRENCE $
EX""UAB CLAMRS-MADE
AGGREGATE f
DED I I RETENTIONS
1101111 IR COMPENSATM E
Aro 07LO VIEW UAWLITY
A MIYPROPRIETORIPARTNERIEKECUTIVE Y1N ® 10f01/209k 1Q°011Z096 SrartJTE + f 1.000
h EXCWDEDT ®N/A EL
�a E.L.OMEW_EA
OESCRI OF OPERATIONS below E LDISEASE-POLICY UIr1T i 1,000,
MSCKVMW OF OPERATHM I LOCATI WI VE"PCLM(A==104,Ad#A'oW R�enorCa Borrdldo, e1K6 6 rms®��E npLradl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ADM DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IM
ACCORDANCE WITH THE POLICY PROVIs K=.
AUTNOR�D IrEP10>�NTATWI@
I
aWnce ofI nce
ACORD2&(201la101) The ACORD nsrrse sand Soso sane ®1999.2014 ACORD CORPORATION;. Alf rim resorvcd.
r+cglastoi'red rrurke of ACORD
Massk--husetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supeni%or
License:CS I25
ti i-Af
.Bifem Lel? Tx-sl.`:_
96 GARIDINIM S7i' :xi1ry Kt
LYNN lA 01905:
a-
Expiration
Commissioner
° ®'60
. � c�i(ce�Posnono ,��'�aesac�uaelti
Of COUveler Affairs&Business Regntadon
E IMPRovwENT CONTRACTOR
Reammuon. : 170$1B
EvIratIOU: 12l29015 Supplement,
RENEWAL BY ANDERSON CORPORATION
JAIME MORIN
104 OTIS STREET
NORTHBOROUGH,MA 01532
Undersecretary
e
i
tft
1
i
PRODUCT PERFORMANCE
.I.
j Andersen'NRC Ca ailed-10' 1 UnI rs°e�3�zel®flCe (rnnlvLued)
1
Andersen'Praduci. Glass Type U FdCIOft SHGV VP
.200 Series.
Clear Dual Pane 0.45 0.60 0.63 -
ClearDualPanewithGrilles 0.45 0.54 0-56 -
. Ttlt-Wash Loy-E 0.30 0_32 0.55
Double-Hung Window Low-E with Gdtes 0.30 019 0.49 .]
HP LmaR SmartSun 0.30 021 0.49
HP Lmv{4 SmartSun w/Galles 091 0.19 0.43
Clear Dual Pane 0.45 0.61 0.64 -
NarruHee. - Clear Dual Pane with Grilles 0-45 0.54 0.57 -
Double-Hung Window Lnw-E 0.30 0.32 0.56 a
Lmv{^Grilles 0.31 029 0.50
Clear Dual Pane 0.44 0-69 0.66 -
Narraline` Clear Dual Pane with Gnllr3 0.44 0.57 0.59 -
Transom Window Low{ 0.27 0.34 0.58
Low-E with Galles 027 020 0.52
Clear Dual Pane 0.45 0-60 0.63 -
C -r Dual Pane,.ft Galles 0.45 0.54 . 0.56 -
Low-E 0.30 032 0.55 .T
Gliding Window -�-i
. Law{with Grilles 030 029 0.49
Lmv-E SmartSun 030 021 0.49 er'
Low-E SmartSun with Grilles 0.31 0.19 0.43
Clear Dual Pane 0.43 0.61 0.65 -
- Clear Dual Pane with Galles 0.43 153 '' 0.58 -
Fded,Transom;. Law-E 028 033 0,56
Clrcie Top'Window Low-E with Grilles 028 0.30 0.50 L
Luw-E SmanSun 027 0.22 0.51-------------------
Lmr-E SmartSun with Galles 027 020 0.45
Clear Dual Pane 144 0.6l 0.64 -
Clear Dual Pane w t Galles 0.45 0-93 0.56 -
Low-E 029 032 0.56 -
.Navnline' - _ Low-E with Gilles 0.30 029 0.49 T-7
Gliding Patio Oaors Lmv{Sun029 010 0.31
Low{San with Galles 031 018 027,
lmv{SmartSun 028 023 0.50
. Lmv-E SmartSun with Galles 0.30 0.19 0.44 "]
Clear Dual Pane 0.43 161 0.64 -
Clear Dual Pane with Galles 0.43 034 0.56 -
Low-E 028 0.32 0.56 -
.Perma-Shield'. Law{with Galles 0.30 029 0.49
Gliding Patio Doors Low{Sun 029 D.19 030
.. - Low-E Sun with Galles 0.30 0.17 027
._ Lmw{SmartSun 027 022 0.50
Low{SmartSun with Galles 029 019 0.44 12
Clear Dual Pane 0.43 0.45 0.47 -
Clear Dual Pane with Galles 0.43 039 0.40 -
- - Lm+-E 032 024 0.41
Hinged-Inswing Low-E with Grilles 0.33 021 0.35 -
Pall oBoom Low-E Sun 0.32 0.15 023
_
Low-E Sun with Galles 0.34 013 0.19 -
- Low-E SmartSun 0.32 0.16 0.37
.. Low{SmartSun with Gnlles 0.33 0.14 0.31 -
w
l
p?
P
An, r we'N rDo
IRDO WS-DOOS
I �S
FRw
�4
, ro
/Andersen NFRC Certified Total Unit Performance (conunued)
z Andersen'Product Glass Type
LI-Factor' I SHGCr �'
Andersen:Product ' Glass Type U-Factor SHGC Yi'
Archltg!ural - s, I
400 Series - - IIP Lmv-E4 032 028 0.47
HP Low-E4. 0.27 '035 0.60
tip Lmv-E4 unlit Gilles 0.32 025 0.42
HP Low-E4 with Grilles 018 031 0-54
HP tar-E4 Sun 0.32 0.17 0-26 i3-
HP
4 S 0
Circle Top" HP Low-E4 27 021 0.33 '' Casement Window
_ HP Low-E4 Sun with Gn0.23
lles 0.32 0.1 6 s w
Casement Window HP ton-E4 Sun with Grilles 0.29 0.19 030 -- Hp {q SmanSun 0.31 0.18 0.42
HP Iax-E4 SmarlSun 0.26 023 0.54. 0.31 0.17 0.38 g "
HP low-E4 SmartSun vi/Grilles
HP Law-E4 SmarlSun w/Gnlles 0.28 021 0.49 • -� HP low-E4 0.32 028 0.47 r-'
r . `
HP lav-E4 0.27 035 0.60 025 0.42
HP Low-E4 with Grilles 0.32 ' rN
HP Low-E4 with Grilles 0.28 031 0.54 '
French Casement HP Low-E4 Sun 0.32 0.17 0.26 ;:
HP Low-E4 Sun 0.27 021 0.33 r ' i
Circle&oval Window'- HP Low-EQ Sun with Grilles 032 0.16 023. f "
HP Low-E4 Sun with Gillies 0.29 0.19 - 0.30 Window HP Lor-E4 SmarlSun 031 0.18 OA2 -� "'t•'
HP Low-E4 SmanSun 0.26 02.3 0.54 0.17 03B
HP torn-E4 SmartSun w/Gnlles 031
HP Low-E4 Smarl.Sun w/Grilles 0.28 021 0.49 HP low-114 032 028 O.q7 I''`
HP low-E4 0.28 0-33 0.58 .*
HP lar{4 with Gnlles 0.32 025 0.42 ''�
- -
r,e
.2
:3
9
0.3D 0 5 7 026 ,..�`
IP Lour-E4 with
Grilles �0.2 -E4 Sun 0.32 0-1 ..•�.�.
I IIP Low
HP Law-E4 Sun 0.28 020 0.31 't .'V: Awning Window
HP Low-E4 Sun with Grilles 0.32 0.16 0.23
Marlow. 8 0.28 0.42
Arch Win ow � HP Lai-E4 Sun with Grilles 029 0.1 , VI
HP Low-E4 SmartSun 027 ,023 0.52 i
f� HP Low-E4 SmartSun 0.31 018 _
HP Low-E4 031 0.17 0.36 •i3 r,.
HP low-E4 SmartSun w/Grifles 0.28 021 HP Low-E4 0.31 0.32 0.55
HP Low-E4 0.27 033 0.58 "�? I-"�
IIP lar-E4 with Grilles 0.31 029 0.49 ;
HP Low-E4 with Grilles 0.28 0.30 0-52HP low-E4 Sun 0-31 020 031 1
HP lar-E4 Sun 027 020 031 &i( Casement/Awning
FlexHrame-Window,, Hp Lor-E4 Sun with Grilles 0.29 0.18 0.28 ,. picture Windom - HP lavP L Sun with Grilles 0.31 0.18 0.28 U.I.. J
• F°I HP Low-E4 SmanSun 0.31 021 0.50
HP Lav-E4 SmartSun 026 023 0.52
6 011 0.46 IIP tow-E4 SmartSun w/Gnlles 0.31 0.19 0.44
0.2 037 0.64 +�
w Grilles 0.30
' HP
Low-E4 SmartSun / HP low-E4
HP Low-E4 -0.31 033 0.56 - Hp�w{q with Gnlles 030 033 0.57
HP Low-Ell with Gnlles _0.32 030 0.52 Hp lmv{q Sun 0.31 022 '-
HP Low-E4 Sun 0.31 020 0.31Specialty Window Hp Lav_E4 Sun with Guiles 0.31 020 0.32
ine"Window - 0.18 028 24 0.58 a
Springs Gnlles 0.33 _ -- 030 0
with dSun
tIP Low-E4 Sun HP Low-E4 Sma `�'
HP low-E4 SmartSun 0.30 023 0.52 HP low-E4 Smar[Sun w/Grilles 0.30 022 0.52 1. 'm
lip Low-E4 SmartSun vi/Grilles 0.32 021 0.46 ` 037
` HP lav-E4 0.32 02 2
HP Low-E4 0.30 0.27 0.45 -
HP lav-EA with Grilles 03 020
3 033
HP lav-E4 with Grilles 0.32 0.23 0.39 "`' '" HP for{4 Sun 0.33 0.14 0.21 -
HP Lav-E4 Sun 0.31 0.16 0.25 Hinged inswing
Frenchwood' French Door HP lav-E4 Sun with Grit as 034 0.13 0.18 -
Gliding Patio Door HP Low-E4 Sun with Grilles 0.32 0.14 0.22 "°' HP Lav-E4 SmarlSun 032 0.15 0.33
HP Low-E4 SmartSun 0.30 0.18 0.41 -
HP lav-Eq SmartSun w/Grilles 0.33 0.14 030 w$
N
HP Law-E4 SmanSun w/Gnlles 0.31 0-16 035 -'? ( HP loW-EA 033 025 0.41
Grilles HPLor-E4 0.3i 024 0.41 f` i - ;{p(ow - va
. . Low-154 will 0.34 0.72 0.36 m�
HP for-E4 with Gnlles 0.32 0.21 0.35 9 Hp(flw{4 San 0.33 0.15 ULM _
0.31 0.15 023 ' ' Hinged Dtrtswing - S0.
MP lav-E4 Sun
Frenchwood'Hinged '_ French Beer HP Low-E4 Sun with Grilles 035 014 0.20
brewing Patio Door 1 Hp Low-E4 Sun with Grilles 0.32 0.13 0.19 `*°r lip low,_E4 SmartSun 032 0.17 037
1
HP Low-E4 SmartSun 0.30 0.16 0.37 �'( -
IIS. �, r;y � - IlPtmr-E4SmanSunw/Gnlles 0.34 0.15 03Z - Eo
HP Low-E4 SmartSun w/Gnlles 0.31 0-14 0.31 HP Lpw{4 033 0.23 038 cad
HP Low-E4 0.31 025 0.41 Hp tpx{4 with Gnlles 033 021 034 -
HP Low-E4 with Grilles 0.32 011 0.35 r`i HP Lor-E41 Sun 0.33 0.14 021 -
'^ +%ir+"-4 Fixed French Door- _
Frenehwrood'hinged':, HP lav-E4 Sun 0.31 0.15 0.23 5 9 Sidelight � � HP lar-E4 Sun with Grilles 0.34 0.13 0.19 -
Detaining Patio Door HP Imv-E4 Sun with Grilles 0.32 0.13 0.19 . '
ItP lar-E4 SmartSun 0.32 0.15 0.34
HP Low-E4 SmartSuo 0.30 0.17 0.37 ;;,; ',f+"'i LSP Low-E4 SmanSun w/Gnlles 033 0.14 0.30 -
HP Law-E4 Smar4Sun w/Grilles 0.31 0.15 0.31 % ' ' $ HP Lrnv-E4 032 015 0.41 -
HP Lor-E4 0.31 022 037 '�`-'�+ _ HP Lar-E4 with Grilles 033 022 0.37 -
j Hp tar-E4 with Grilles 0.32 020 0.33 r"++_`. • - HP Low{4 Sun 032 0.15 0.23
Fixed Transom 0.14 020 -
Frenchwood" HP Low-E4 Sun 0.32 0.14 0.21 Pt!; -
French Door HP- 1a+�4 Sun with Gilles 033
Patio Door Sidelight. lip Low-Ell Sun with Grilles 0.32 013 0.18 HP low-E4 SmartSun 032 0.16 037
HP Lor-E4 SmartSun 0.31 0.15 0.33 "^' !' HP low-E4 SmartSun w/trifles 032 0.15 0.33 -
HPtau-E4 SmartSun w/Grilles 0.32 0.14 029 "� HP Law-E4 0.35 026 038 -
0.30 024 0.40 :` ` nIles 036 023 038 -
HP Low-E4 _ HP Lav{4 with 16
HP Lav-E4 with Grilles 0.30 021 0.35 -'` HP law-E4 San 0.35 0.16 024 -
HP lav-Eq Sun 0.30 0.15 0.22 "!� )'`'� Folding Door Hp l {q Sun with Gnlles 036. 0.14 0.21 -
Frenchwood' -- _ _
0.13 0.20 %`9 IN
Patio Door Transom IIP Lar-E4 Sun with Grilles 0.31 „i -.,F" HP tmv-E4 SmartSun 0.34 0.17 039
HP Low-E4 SmartSun 0.29 0.16 0-36 - -
--- HP Low-E4 SmartSun w/Gnlles 0.36 0.15 0.34
HP La,,-E4 SmanSun w/Gnlles 0.30 0.14 0.32 !_I - conUmred on next page
•For NFRC certified total unit performance on units with capillary breather tubes for high of Ludas,please visit and ersenwindows-com-
•'High-Performance"Low-E4-"INP Low-E4),"High-Performance'Lon-E4'SmartSun-'(HP Low-E4 SmartSun)and-Itigh-Performance"Low-E4-Sun"(HP Law-E4 Sun)are Andersen trademarks for- E'glass.
' U-Factor defines a amount of heat loss through the total unit in BTU/hr sq-ft°F-The lower the value,Ne less heads lost through ll,e entire praducC Window values represent non-tempered glass.Use of tempered glass can
increase U-Factor ratings.See andersenwindows.com for specific performance values.Door values represent tempered glass-
- 'Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward.The lower the value,lite less heat is transmitted
through the praducC
'ViTransmittance(V11 measures how much light comes through a product(glass and frame)-The higher the value,from o to 1,the more daysightthe product lets in over the product's total unit area.Ysibfe Transmittance
siblemeasured over the 380 to 760 nanometer portion of the solar spectrum.
•is me ratings are based an modeling by a third party agency as validated by an independent test lab in compliance with NFRC program and procedural requirements:
is
•This data is accurate as of December y a tit rue to ongoing product changes,updated lest results or new industry standards or requirements,this data may change overtime.Ratings are far sizes specified by NFRC for
testing and certification.Ratings may vary depending on use of tempered glass,different grille options,glass for high altitudes,etc-
•passiveSun-glass values are available online at andersenwindows-com. 77