Loading...
HomeMy WebLinkAboutBuilding Permit #842-11 - 171 LACONIA CIRCLE 5/1/2018 r BUILDING-PERMIT of µORT({ TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4 �` • Date Issued: • . �SSgcHus�� • IMPORTANT:Applicant must complete all items on this page �i�i�=i.,'64+.'9.•�^m�.3' :ie.ms:�.: � ..S.IS.<._::I:"am"'u'C:,;u-�yr�.. .•.>f-.r__._ ...:.��,ira...,».�.._V-n�.:...--..rv'.i�rr^-r�._ti. _ - - s •ris1,•�-�3_ !•s _-l:...•.'��... .•F. R } 1117 ..1•_.,...�: 1' YL. ,,,{,.r•-+'+,".-�K-y'Y:::�i:S-F:HL:''�'.f.'-.�F._:v+ti4.Yr ,,r��-i U r 3c ,Yel 4 .� {fig .p. �''�_•� as.-�-: -C•r`�':+ `�}i'"- S'3 ..r�:+'r.'PwPI� .�rs.n•. .-�.,.�:, .c .., -.-':�;: ':ati• 5 s•>r,. ,,;�.�C ^^Y._ - �<:_ -•ri't .�. �...1,_tc*C�....f:.'_v1 -S...Y:�•:-�c--.�.r�._-;;- may,_.. 1Sf,�,J'.'1_ �`'r_ - kL.01 :Y' - °,1'..:: ,"�f_•n s .e,.f.,�:?_rS_'�``:r. �,'1.;v.. � !•+ a� T rr,7-•"�`i � `�-`=-'''- 3,l' �'`'ice;_.Z"=1• `-s�� '-ii;��« L.,!. :Y .-�.�J'-`� �f ..�C � i -=C•,_oma:�4`i..,�y.��;....:..r_'-r,..._.'.,�:.� ly,. ...'�.n�D - v*' ;. ^�•c"'1�"r,.L. .z,. aL9iN C�i9i4`s'••:s"r.`- 'is �� �.'.':f'•43:'. '4 i' •ii - - Z:�u���kr:�-?.,s�::t.::..;1._�w.:::.�^.�.:.+'.-a�7:.:: _ -rF�yr.:rrs=•.c,c, ',r.•�'i'. �.n-� :,LLw... .-_;ry:.•.dti.. 4s;'ee^:-,.- - -"'- - - _ ,:.e,,.. - - -F::�;�':' ,;.�..c. •ra� ita�,, "c'1 [v�Zr .•1. ,r`�__a�LE,.•y�`�' :ci'" ;•_7rY.+m';' .. ? .yv; T.'�;,Sror" d�:,:.�z; yr,.tisnr,:,w"h c s,-,,. -.;ua` n•....u.i,; a Lcrd. ?.y�Saflflt � i�" e.,m 1cd' >,z�„ 5..• 0 1. i.t„ew'^_ c4-rt� rTr ?r >i`t'�ic-F .vti• �•C'h-' , ) r�., '.`.� r 1G,?c•rtT,+wrs :.�it.,LSrcL.i3'. -ry�-r.`s�r�-'r3 C��'- .--.::' - i+ r.Piu;... i' a:c•• �, Gt'fx- t.R u.:. _•.� _ sa `'::x :'�� - z �-_ _ ?r .,� ,F.r'� �',I_S3 ':ti;�t,�,•.-'�t^'.5: ''"`'' �w _4; ''�.y'`,✓t,,,�' ,;3�: ;r.,_:K ,!r�4rct3�� z5i..��Yr _ 5.rj�:'�.: Vii'•I. ;i:;.�x:72;�:�'r, _ �.3C•"5'�T-"•'_Y'u:'r.�^-- ''�,"�.''s:F' •Ca'.,�y.. rn�i;�3E��-'�'_ .,cf,,���•-a,sr,;-: r.e:.c .,:.�•.L.'�r-'�k;;�r.,,� ,>.-.vn�: - r F �=.-i+cT',u,,���ra",7= 'rs`� vLr� �nfi,p �':ry_ n•Ly-:rz,���"`i=.� L� Y ..:e' --r. f'� .,:wr,.:1��a;.,._ re"e`hx.�°.��-'-':rr."3^�. :oz.s•.:. 'lr: - - �.,L3. .°:i�s.-a�'T�..,:.i�:i-,_<:�,y`^-0�1'.P�,`,r'..v..>� - yr"•_ar�_:a•�:W-� -�v:�R.rFtt�e:�'=��P:*•...v_r''�p^`.-�`; rw'y�1Lr" •`��.'.i. '.Y'�--c'.-^'_=zee'. .,rz!'r'",ke 1 r�i4:.-C`.�'f'•i+`+�'> Q'T�?=.- �- �.7+'.:z':v4n5-'u5'�.d1^m- 1 - _ •:�.. .,'�-:+i1:L�r,.�...r ._:>.�1,•rv.4r .�;,:. I Y:C•-E:..-sr l r ri,:t r 1 �•f�,i-,-v�::. � rl'y�� :� 3-r�� '.'.'-`�'t-. ,,.� _ _") _ �i �+J r '.Y[lUw�t_ ct;::�y�:�h �=,:'=:.ie�� 1r•:?.M_rr.:,hi:u-•.ru�;,c?i z ���F_I��fc�p,* :LL'4-.�.ri �" t`�^'- L.�YI•s• �::�_,..'�l. �i��rs►�'�.�, °^,�tN�II'� r y�° �+�t��,�f��`�i=i5"''- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more•family Industrial Alteration No. of units: I Commercial Repair, replacement Assessory Bldg Others: Demolition Other Y` mr ..,-v,st ;:. ,h. ::. - �•'T t,s : 5L,;�;'r.`. -4�-., ..,�; •`.�•..s--i*` r'.i .i_,. 7'�=!mter-"r ::>r,,r,: �;;.:.re:....,.a^;.':'ua; 1"•` 1^' ?_iF�. ry -rY�. E�. g -,y rz�'- yx,r,• :` �5,:":i�1S fit:.�i+L sn_•,.,3�}:i.-'°L,S�,- r i.iFxkr. �'' .ry_ r.^: �- " Fa 1L�� 1J r�y��' F.p„ •y t r'• �e_ _.r,�'' w. d• ''£. '" a NMI^�' .vY:te�C"*.�.:er,.fif0'ro';='t.. h� :s�-,r, srr •r^''�-�X-:b�' .' ' a _ _�: =:'a;- `' 7k`'x v ..p. i n;����}•r 3" _eF' pp �-°'a;F; Tl:s..:`t:,rd.,,w•---�^"�--X - rzr`� t r �s F� - ���. 3z�'3k{ Ora '��''S*�"`4t•.4" �'r'' 1`''';�i ra„",;��� �a';"',:.�fi=;�°�_E,�� :.c,. ..�._..._._..,_.:_..._......r. �_.�...2•__..r_ .�:i.,.�a5.:__:,R;�::_._s.r�r•,�,..r.:;.;.9• ,-.�X_,.r:k:G-^t+= ._.r..� ,�.•kf.- �i.�.� 't�{w� �x-'ti,'��� �•�f DESCRIPTION OF WORK TO BE PREFORMED., lvo S Identification PIease Type or Print CLeariy) g OWNER: Name: i"r n �y J r' Phone: �(o S 1 Address: ...r.r a. :::i�r1+�i• a 5u,,,=','� ••=;:'4'6r-: w..t'�,"'"" �'i^� ""YrN}'t'Gia?%f.•;r;:.- .::i<W3i^:`L •:+.�e siL�' _:vu.:�- _ , , "��.rt� .d,�•5,y'• *'X`tl�`'�5i, _ - •fq�cti�.�7'�i:''�'.'J:�`�,� =-�^._ �+:+•""r .:_�i��r'=�t'F" J�-v-'�',1•,,,_�..,yrr:a:u'�'_Trs:�7.`�`G.-!.�.,,, H:�L�[.:.4.=fn•�<^. - _�!`ai."=Jam'�•[?T';;is. �dsS �- 8'n• t�:`TS '" "P ? �, 1 l•-:_16011"�: ,k�5: ^ir � ra�tF--�T' "�"' 'e`tr. `4 h• '�,�`•t, � �e�'-S,r�'�.� �'�FS [ Ic=-+s a, tirr*N-•,�rwV<v`' �.s` o ii ,1-0.z./�,h�' _ mL'R` ..�'�r�"�ga.,r } •.�.�.'i's ry � +r#' v ? �"r' r i4'iy § fir. -� L{ .LY �. - Y � .�i "�.'C '•i .rt• .1 �'4� $-tl 1 p �"�?�"r•`[`,',YL`^S"", L =•'rs. . m�i•� ='•,,'Y�`. �k,<`"a«S''s� 5"',.�'-^-ya.L ti"'+' Lt': `a"'r.!'.;z •r' •.v- ",..x`x'm. ,,,,±� � r t a' p.. "f i� :��-'+sk-L!!�"�"'7''�r� �"' ,-, g-r„•�iY' �� ty� ��Y �.�r.�.�,"`^,���+�. �e-ria• e�"��r �'r � �yi i�`.Y,v sr' r-�'r��'ii�y.� s:a<�-..si.•'i, L. �'.�.. r f`'-• +7 _S�e 1.�dh��"1`'}ly'3n �� ,. "`;z,� � �F �' 'u� � � �,,� gra,,�a,.•'-� k ;w..- .,,r'�w`ji-c„-s,�a�i�.t��.7}-.0-'u�ru`.�'r�"�� , s u`�'"'P'' _� -�;'y�,�L'ts?6n'--' �i'-g'fy .-_yy�xrs_,_.'N-fry � •^"> r�•.� ,rst-I�;:x"-gr: iz:.r. 'F fir. - ��,i.�., _ ..F �rr'•:�. 1�.'_ �4={.: •���-.i-,Y,. : �.�,'yk$�_,��(�^,�,�1i-�l'��;1l.-'s�rt�i_-,�i7 N�,`�'�`�'`+,$E'':'�ri"ya.�>?•�S-`=,'•`1''�1•=W�-��"�'�ti3O.vi`'Ly�7'f,r�r�a.trT'K.S:'�l'�''��II:�r�i���.�-f}'Lr•'x�$s7.`h.��',qy�_��,„E`4E:{�Lv�3r.-.s':� r 2r��ioa�. PMNN. `J'�'��c"Y��ur$�-.vTM.'�L,•'`,�z��f�.'-Yraryr✓.kL"uz4�>'�"6��'p{r`.,���r'�z.r�--,.rnG��s:�=,i:�`fr•F�-'r,�..2.sr.Lacfi9��+�i+.iE�-iY-'^'7•''.:',-m`orr�?J•�r�ra.,�,.�;-L„!�'-�11�'_�a-.-'r��p?s;'�y�`�"•a^•••�-e-�yn�°..r,"r!?Y,'�°rArvbr:{.;-;�a7r'ri';d�}g�•^f crr'+:Ytii�6'X_.".'y.F.'->;1e"�`��{r�r.'jrYtrMx,i�;�x�r'Y'fJ,S1.�yfrif3d'�'�z4���.�a3.r.t�_„�"v4'S"z •:°' J�.+��•_C�^1 eR:..1,' 1•i. r�'� � 3] ^ JtS�L."I.�'rj,C�lT'S�����d.V.IIM1'G.•'-'�'v��(''K�.a' H�. � -L�'/''� R<C�'-�� ,;.A"� .�"�iT^'1.=b'❖•�2•�r 5_rl•: � �1=.-rr;xw>•�_>,; �•� z ;;: y;��:.::r ... -z=;ti!F� ty�*��1=`"��s:_ 6 vro..� _ az d:-i'?�.a7.7'D-F:.=s,.`6"�-'`r�s'•t,aH"�-�,-�:1! �ci G,a'••„-a>z=c'r:a'�T�4�'�`c�^.�u�".��•'r��G':�.L.fi�:x-�]d��--2,_[A>A.'S'��'w.��-;3•:�.r.,r::;ri.1:C,�1H•.-..:l�;'1)1','.�"�;r__�1'*,1^•wrr�^�r,'x.��Vm'-[a��'.�;'rS'.'.!,.l��:•ug'4.,y�,r_,Z.-."�.�.',''y�,z4n��-�S'•r t.:1'•r+.�=y/,�:�f-`rrJ�r�'�'l�'a:e"�,.`y:a'��^^3''Lrt`+,.;y=oL��'rfY"'...-Y x'k:,.-:.°w,9,-..Y':,`�.Isi.,::1.rr:r):.'a.'F„'�'�_�r-rtc3<•.--.,'.s.'a.-ci:'i,�..,:.i+x�r.Y�.:i.,�`.jZ_1�acrFiJ�;5,�v�.{..4 e�i,:!�"�,:.3;L,i�y:<,:[�i'3.`r'�,'�t'4^.�•_'.�`ql,.,'r`v'yuu'-r�F,.°r�7r`,.-y,.:.e2-`.ti;.Y,:,�»"'r�E4cY,c-�=,,��"-?.'':7;'S,:'-:f,�'�..'rcF`ir��T.,-t^'.Zyz-9T:T.i�,k:�-_t'?"-'_JrgL,:..l3•��rr`--e"�..'_r�.k„,�,�y}•�t['-�:•.-.:,"11_^p}�-t..,a=y�-rF•,•f'.'.'a_�.rLi''.1'�snf'=.",.•-'K,�L'{-,4.rY�fMi--�,,i-1_0•e_'c ,ia`5•�„0at, : 15l��-ILu_9-•a„,•�•_a�n-n+-r --'";:,�:`�✓'.<3�c'.[.'.K•3...rv:�-i,-}'.G;uu�"_+.�rte.? ,-.�•d'•rz„• S,i'��!.."_•�,ljr 3' :�---' ,J..•��...:�•:�� .�»=��x',�-w:�`���s`�'����y:;y.:.>_r�<•^ �.�.,.�-• :1sx. � �- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.$12,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Tota( Project Cost: $ 3 FEE: $ -50 Check No.: I a::�2 2 Receipt No.: NOTE: Persons contracting with unregistered contractors do not haveac •anty fund T ,.. - > , �1 �L�Tze: t � y fAgent/Oaruner:- r:� ��nature_ .. ._�..., tqr� _ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools 'Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED- PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature UVIVIIVILIN 10 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i Conservation Decision: Comments Water& Sewer Connection/Signature 8<Date Driveway Permit bPW Town Engineer: Signature: Located 384 Osgood Street �sf:R ���MET �p D,u r�pster nn�tte �e� --�.m r�o=��t. .T��,.....,_.._.......:{• _-- _-=_�-:ti.>r, 1" I{ I - I i- "s--'-••: .-t a;-- �^.i�??-r'�- +, s � - - •.�i:Y{` 'v.`. -.- t7u.s.•.^.'- r- '' •v by�r Tz .C�fJ�Vlill1�1� 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 Doe.Building Permit Revised 2010 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 in 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 ❑ Celfied Proposed Plot Plan. ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products I NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Location / 7 / ��G aA'(a' . No. ��f 2 Date r NoRT1y TOWN OF NORTH ANDOVER 3? 0 , •goo i }�e Certificate of Occupancy $ ss,KNOs Building/Frame Permit Fee $ °© Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check. # ? 7 A 2 Building Inspector i NORTH Tov- m of Andover .. No. X 1o" dover, Mass., (} LAKE I� COC MIC ME WICK � ORATED D'P�,`�� U BOARD OF HEALTH PERM IT -T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR T........................ ..... �e4•�... ... .......::....: Foundation hasermission to erect.........................................buildin s on ../Z/P 9 ...........`.`..%.�+..........'........f............................. Rough j res ,,�� eas -vC�o ri Chimney to be occupied as 4&42 provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Altefa'tion and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the. Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN .6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ........................ ............ ....... . ..................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove. Final No Lathing or Dry. Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SORE Smoke Det. 05/10/2011 11:45 150291909143 RBA WM 555 PAGE 02/11 10qOtis SC„Northborough,MA 01 92 J&L WiN OWS,INC,,D/13/,t MA Home Improvoment'Contractor (508)919.090(1•Pax;(774)987,3013 RenewalLicense#149601 (Expires 1/24/20[2) h„�� _ Pcdcral Tax IP#n-0404201 rA N1NnnW *KPLACUMCNT nn AndctrnG•n11MW CUSTOM WINDOW AND DOOR REMODELING,AGREEMENT @uvntll Naha _ ;- Dorn of A rcomont Pa,nrlsl Srrnnt AddrmN,Cily,SIalm,and ZI C41-1- f-Moll Address Homo Toloph—n NumL•or Work Td-phenn Slumber fiuycr(s)hereby Jointly and wvcrsally agrees to purChMe the products and/o1'Services of J&L Windows,Inc,d/b/a Rettewai by Andersc ("Contractor"),in accordance with the terms and conditions descrl'bad on the front And the reverse.of thin agreement and on the attach( 5peCIf1Cl7tiQJt.9hCCt(S) (ccllectively,this"Agrccment,").fiuycr(s)i errby agrCes to Sign A CCrftr11 t:lon certificate after Contractor Itis Comp1 et( all work undoT this.'t;;rccmcnt, Mr shod of Payment;❑ heck ©Credit Card MCash -Iatal Joh Amcunt;_, Estirnat Simting D k: F' Cod Deposit Rc=rived(33%}:_ / 30/6& a_50 Dolonar of Start ofJob(33%1; Esflmatod C mryletlon ate If payment is by Credi'I'Card, pleas ftii OUT 6elancr..on p Phe Credit Card Recei f of osit Form SuhsPantlal p De Compietion of Job(33%}!_ Byg rhis��rrecmcnt,you aclmowlnda tlta.t the Tlalance at$t re of Job and flit T; Ianr;n on Substantial Completion of Joh cannot he made by credit caret;}nil must be made by pc.rzortil check,bank check,or,et�h. guyer(s)sagreas and understands that this Agreement rnnetitvttes the entire understanding betwrrn the parties,and th there are no verbal nnelerstarttUngs changing or modifying any of thr terms of this Agreement.No alteration to nr deviati, from thio Agreement will hr valid without the signed,written consent,of both Buyer(s) and Contractor.Buycr(s)hrre' acknowlodgrs that Bayer(s) I) bas rrad this Agreement, nndrrstand9 the terms of this Agreement,, n..d has received completed,signed,rind dated copy of tl'lus Agreement,inelndieng thr,two attached Nodcrs of,Cancellation,On the.date fv written above and 2)WAS orally,informed of Ifuyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT TI-MME ARE ANY BLANK SPACES- J&L Wi"do.7 F,lac.d/b/n Renewal bye Andorse" ` Buyer. ) � e B yer(s) P,y: ' ;Ret..,are or fr uct Manager Sipnat:ure $ignahirC Print Nnmc of Pro, )ct,Manager Print Nares. Print amc YOU, TW— RUVER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THII BUSINESS DAX'ATTER T11E DATE OF THIS TRANSACTION.SEE THE AT7i'ACIiED NOTICE OF CANCrLLATION FORD I'OR AN EXPLANATION OF THIS RIGHT. ±s— — — - - — — — — — — —" - - - - -- .— - - - - - - — .,<- — — — — — — — .- - — — — — — NOTICE, FCA ELLATION x +10T�CE OF CAIliC Q� Datta of Transaction T a,[/ .You may cancel naft of 7kansaction You may can this transaction,without any penalty or obligation,within this transaction,withi6liitt aii-k penalty or obligation,will three business days from the above date.If you cancel,any I three business days from the above daft.if you Cancel,a property traded in,any payments made by you under the eiroperty traded in,any payments made by you under t Contract of Sale,and any negotiable instrument executed I Contract of Sale,and an negotiable instrument execut by you will be returned within 10 days following receipt I by you will be returned within 10 days following rete by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller") of your cancellation noti and any security erest arising out of the transaction will and any security interest arising out of the transaction v be canceled.if you cancel,you must make available to the I be canceled.If you cancel,you must make available to i Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good eonditi as when received, any goods delivered to you under I as when received,any goods delivered to you under t this Contract or Salo; or you may, if you wish, comply Contract or Sale;or you may,if)mu wish,comply with i with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment shipment of the goods at the Seller's expense and risk. i the goods at the Seller's expense and risk.If you do me if you do make the goods available to the Seller and the I the goods available to the Seller and the Seller does u Seller does not pick them up within 20 days of the date pick them up within 20 days of the date of your Not of your Notice of Cancellation,you may retain or dispose I of Cancellation,you may retain or dispose of the got of the goods without any further obligation.If you fail to without any further obligation. If you fail to make i make the goods available to the Seller, or if you agree I goods available to the Seller,or if you agree to return i to return the goods to the Seller and fail to do so, then I oods to the Seller and fail to do so,thnnu remain tial you remain liable for performance of all obligations under I for performance of all obligations under the Contra the Contract.To cancel this transaction,mail at deliver a I To cancel this transaction, mail or deliver a signed a signed and dated copy of this cancellation notice or any f dated copy of this cancellation notice or any other writ) other written notice,or send a telegram to Contractor, d I notice,or send a telegram to Contractor.J &L Windoi &L Windows Inc,d/b/a Renewal by Andersen, 104 Otis l Inc. d/b/a Renewal 6y Andersen, 104 Otis Strc Street, Northi; ro 2, BY NOT LATER THAN Northb` rr7i2cMiS 532,BY NOT LATERTHAN MIDNIG MIDNIGFI OF�� (Pato) OF "" .(Date) I HEREBY CANCEL7WI `tR SACTION. I I tt4RRt3Y TRANSACTION. ftuyn,',Signature Prim Noma Dara Suyar'.Signature Prlm Name onM RbA Cow- Whitc Buyer Cmy-Yellow Buyer Copy-Pink 10 '2011 11:46 15089190903 RBA IrM 655F'�u,t� E F1;;''11 J&;L W3ndotvs,Inc.nib/a 104 o 5 stcoet,,0500-r ugh, 9A 091 ��Wa� MA MIC Llccnea#14Dfi01(cxpiras 1!21 Fhunc 308.919.0944•Fhx 774.987.3011 Fedaral Tax 11J# 53.040 byAindersen. Ninoow ncrumama ft nn.ladmcnraaipAM Or GRrAM MASSACIV7,17 tF AND NEW 1111AMP5FM WINI70W CiFFICATION SIM15T 8uyer(s)Name ~ Date of Agreement zz Tl c,uycr(o bared abnve hemby.joindy and amrer ll agree to purchase the goo an cr services listed gclow,in accordance with the prices and ter dc,cribed on the specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR£.FIVIODEUNG AGRELMV of wl,ieh fhif spdei{ication shtct Is a part. WINDOW DETAILS 1. C uraclor will install it total of windows in Owner's home,using the following Individual quantities; 1 Double Hung(DB) Qqual sash Q Cottage sash(l!3 top,2/3 bottom) ❑ Oricl sash(2/3 top, 1/3 bottom) Cascmcnl(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle❑ Metro handle Doi'We Cnsemettt(CT)W) n Standard handle ❑ Metro handle Casement/Picture/Casement(CPW) ❑ 1;1;1 or❑ 1:2:1 ❑ Standard handle ❑ Mctm hnrtldle 2 Lite Gliding Window(G1A) 4Glidcr 1 Picture/Glider(GPW) [11:1:1 or F] 1:2:1 Awaing Window(AW) Pic'wre Wiridpw(T'W) Ga:'?r Ylc'vl 11dow Patio Doors(sec scpa ate Door Specification Sheet) 2Yc,:�L�� �oo�Q�y of Windows to be Custom Fit Replacement: .i, ❑ YLS Lti,I_No ',Ills to be replaced by Contractor: it 4. ❑ Yes cI� qty of Windows to 1>e New Construction Pull frame(includes now interior&extcricT casings)and actual Exterior casings; ❑Piric❑ Maintcnancc-fmc mntcriai ❑ Factc,yy applied 308 Plbrcx brickmold 5. Glazing io bo: F_1q- int'•P.-4 TM ❑ Othcr If other,please specify: 9. Exterior color to be; hitc ❑ Sand F Cn.nvnq ❑Terrat:one ❑ Cocoa Bean i. Interior color to be: ite n Sono n Cnttva.¢ ❑Terratonc ❑ Pine p Maple ❑ Oak Note; lntcrio;;5le c y be white,wood or same color its exteHof, Wood Iriicriors need to finished by Owner. $. Hardt' Stone ❑ Canvas ❑ Brass © Fstatc Hardware: Style; 3. cs © No Install Liftswith Double Rune,Windows r 10. Screens: windows to have: ❑ I-ta.lf or 0.a'+tlt'F��cens Screetta to be: bcr;,lass ❑ elluminum 71 Trusccnc CRELLE DET-4II.S 11.Windows have,silica: ❑ yes PIo If vcs:Q Grille Betwcen Glaw(tinct❑ Removable Interior Wood aNTw)n Full T7ividad Light(mi. Q'3'! Qty: Qty Qty:4tJ Orr: Qtl'' _ D}i OH DH DH Cw,Platun C+rtN,r crwn'c Draw grille patterns above 'Tjsc additional sltcet if needed Owner approved(i-40;( C ADDMONAL WORK DETAILS 12.n Yeswill remove metal frames of windows. Qty of Unita: 13.❑ Yes o Co Tactor will install new paint-ready or stain-ready ca.ings. interior mg qty of openings; Exterior casings qty of Openings: _.... ❑ Pine❑ Maintenance-free material 14.❑ Yon o Contractor will install new psi-tut-randy or staim-rcady inside or outside stops qty of openings; Interior stops qty of opet?ivgs: EXt.crlor stops c ❑ Pinc ❑ Mainteztance•frCe zttaterlai 1 S. Owner is a at Contractor does not do any tie�g.A, Ovrtter Teti Isis (�tis (1jj IG. Ycs o Contractor will wrap exterior casi s with alumu stock of olor.�+ u Note; Wrapping may be required with storm wi.tidbw removal;removal of,alarm windows will leave screw holes in casing. 1'r.^[ �❑ .b74 Contractor will insulate,caulk and seal windows with 3-point system to prevent water and oar inflltrntion, 18.L� Y ❑NO Clean up--ll jab rc.la.ted dehria including old windows will be removed..Vacuum niglatly, 19, Ycs © No limited warranty shall be issued to Owner upon completion of the,job and payment in full. 20.© Xes 0 T;uild $Permit�onrrnetor.v*i1i secllre any and all necessary permits. The fee for tlyc1PC it()i otl t_ _ 1 icludcd ht the Contract Price and a separate check is required at the time of sale for this fcc. l(rLll''11 21. Yc-3 in 1Vc ,`>J.l[11.Grn.1??t3llBvr,brrp a..)leCl Is)thin a rrrmrnt. ri(: . ❑ h. c rr s -� p 22. Additiotial,jobdetails; e op e 23, eYcs U No Owner agrees to be present on the final day of installation for final invcction and to deliver final payment, Nn Jinnipajm?ent 517411 br,demanded until the rr;wr-de't;.,completed to the.satisfactinn Ofall parties It Is a__xed and understood by and between the parties that this SP--cation Shcet,along with the 01STOM WINDOW AND DOOR REMODL'LI Ar.FSYMENT,constitutea tate entire understanding brtwcen the parties,and thcrc nre no verbal miderstmelitigs eha»gin or mollifying any of c terms, 7,11is Rpedfication,sheat may not im ehnn Wd or Hn tc;ms modified or vartod in any way unless such changes are In wrlting and Arned by b the fhtyat'(•a)nrDd,CdotMcfar,Btryer(a)lhera)ry aaknmvled,,d that Buyer(n)hon read thia Specification Shect, Renew I Andcnan of and BuycT(s) mT Buyer(s) IIs" M L� Sl¢natnro 'Pr, uct-Mannpor g9gnaturD S�grtdttlrc Print NaAc of;product,Manager Phnt Ntutto �stt a N m.c The CommrGweaF h of MTassachussfts enf o bndustrial Accidents , CADepartm f : office of lnpestigations 600 Faglurigton.Street Boston,MA 02111 ww.m ass gavhdia Workers' Compensaiian Insurance A.ffrdEvit:$m�ders/CantractarsC�Iec�'e��lplIImbers A:1313 Iieant Idormeian' Please.Print Leafy Herne(Snsiaecs<organizatienkadividneIj; �en�►� v �nr�e!—S e n Address: ' l D� ��` S ��t��" • • 1 . Are you En Bm*yw?Check tine appropriate ban Type of prof amt (regrireo): 1. I em a w wffh D 4. []'1 am a geaeral coatactm end I 6 [�Kew coastraction empla aad/ar pa 1,*' Im bund the sob-ceatmctnrs 7t 2.El am a sole propaator orpertaet- ,iis�d��attached shed , , ship cad have M.amployees .These.sub-coatiactass have g, Damaliliea woddag fm mfl.in nay capacity. waders' camp.inss:rence. g, ❑Bvndiag adriitioa [230 rata' camp:iastusaca S. ❑ Weare a corporatiea and its ID.C]Elactrir l repairs or addifiioma offmma but e�rcised f=it rogtzimij.• 11. Riambing repairs or additions of rs cion et MGL • 3;❑I am a homao�doing eIl work •'� � P raysta Dla.w=J=s' camp. c.I$2,$1(¢3:and we hmvo no IZ.❑Pmofrepain }nom,rr=a Mquimij t eq*=L•L O worlxre 13.❑O ar camp•imsur m ragair L3 k1.nf l O=Mt tbtCh1 s bdi r-I=it Lin fin mt f=C 6CGf10a 6C1C1f C�101A'Sag SCS W6I�IC'CL�G�L�OII pC�1Ct��Ob ' +tI��OmC==who=bmL e&zmdzVI ir1-f;- W•J &in dwmt ld OL=him autsiai CC*=tam mist xab=&LUM SffdMTi b&8ft=IL , Catmetors thef CbrsE 6m moil Sttad�ed Im tonal rbeet P�e L6�C of C[�-0OL�C�!d 6i =e C7IDp POIICf t [m I am an ernplcye7 that is prong Varkdra'catxpeasadna inarcr=w far my employees -Belum,it the pof cy anal job site ' infarraation. Iasm me Compazry MM. ; Dat� iratzan Pok �i y or Sns.Lia,P .�.. =1 Tob'Bite Address; Attach a copy of the warkers'compeusetinnpolicy declare.tian page(sho hg the policy amnber snEi epirsiioa date. Faure to sectuo covaragc as required vada Sectina?SA of MGL c, L52 can Iliad to�.e imposifiaa of c�iaal panaNies of a . ono uP�$1rSDD.DD eadfor ono-yeer impIIsaamcnt,as well as civic pcaelfies in the frum•af a STOP WQR.g QRDER and a fine . •ofvp to WC1.00 a day against the Violator. Be advised fist a copy of this statnmentmay ba forWardad to Qfnce of lnvmt ptlo=.of the DIA f=Tnct7f Rn Ge oovcrap Va OM6, n. I do hereby car the Pala and penalfica erjury that the information provided above' trot and correct � • , �; Cry . Si�aefmrer D Phone 4- O, icial use 0 . Da not write in this area,to be eampleted by city ar tafrtt a,�tcial Cify or Tovea: permitlLicense# TssIP.g Authority(rar&area): L Board of Health 2.Biding Depatment 3,Otp/Tawn Cisrk 4, 5ectried Iwpectar.5.P ia;Inspector 6.Omer ContRct Pwaaa: Piza� MaSsachasetts - Department of Public Safety Board of Buiidin; Regulations and Studarda Construction Supervisor License License: CS 25707 t ; BRIAN DENNISON . 86 CREST CIRCLE - L WORCESTER, MA.Q1803, - Expiration: SWO12 Commissioner Tri: 2622 029 �. Me:of Comma Affair:&nusmeas$eguufiaa DUE UPRO TR ENT CONACTOR R4strafio �t71 Expfra •12 t Card RENEWAL SY - MAN DENNIS _ 104 OTIS SIRE NORTHBOkU H, Undersecretary ,ACR CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) `'� 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(ies) 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 Joseph McKeone P ONE FAX JP McKeone Insurance Agency, Inc. E-MANL • 734-662-8100 Arc No: P.O. Box 333 ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# Ann Arbor, MI 48106-0333 INSURERA: Hartford Insurance Company INSURED J&L Windows, Inc. Renewal by Andersen INSURER B:Nautilus 104 Otis St. INSURER C: Northborough,MA 01532 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. INTR TYPE OF INSURANCE INSRADD 5 POLICY NUMBER FOLIC YYYYY EFF FOLIC EX LIMITS -MaLB GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITYDAMAGE TO RENTED NC95B461 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 17 PRO LOC $ A AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2010 10/01/2011 COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO I BODILY INJURY(Per person)) $ ALL OWNED SCHEDULED X AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ I $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC ST U- OTH- A AND EMPLOYERS'LIABILITY Y/N 35 WECPPI444 02/17/2011 02/17/2012rR ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000. OFFICERIMEMBER EXCLUDED? N/A (Mandatory in MN If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below i EL DISEASE•POLICY LIMIT s 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION INSURED COPY 'l 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 Rene w* a I x � byAndersena WINDOW REPLACEMENT mMder=Compatiy ' reVaIr Woodnlrryl Composite IF Dual Argon Low E4 SinartSun Double Hung 100-00473518-010 -ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0n29 0019 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0A2 Manuheturarstipufatasthot these ouifgtconmrm taapprrohla NERC procaduras tar detarminng whole product - pedormaoc-C NERC relings ala detarmined fora lured at of amimnmantal conditions and aspacirc product ske. NERC does not recommend any product and doss not%wmnt the avmhr7ty of arty product for any speaft use. Consul manuhacturals raereturs for other product pedomrence intomretbn, Www.nfmmrg SEA> ThiproductmaalsGrean 9eara environmental �� •,;o•• •x� „ -Qr r standardsgnvamingenergy «w"a..e:.. `�••,,;�•?' •% cT;n- • elfcisnay,heavy matalc in c4, �.•, �<:A f'•the frame and sash 4;%+:'' '..�;.. •,+:,'it'" ' X�(consumer educational G@Msnqm c�4 matarals. u x,`ev�;.y.•::�y..•.� DESIGN PRESSURE(PSF) � l e f Mtnu nueaW'weni11eaanlen H-LC25 . opedmaS RbA DB Sloped Sill DHJN TeetatmflAF'Sffi trAAMAIyRyA,VCSA10tnglNpd, Maretaenre sfi tas ooruermammhtea rt�hla:atnarts. , Heats of+xeaads M.E:C.,C.EC,8 LF-C.C.-Air 1NWration requirements WOMA tlalnurk Cart&atlon Program. _