HomeMy WebLinkAboutBuilding Permit #884-14 - 173 COACHMANS LANE 6/5/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION I
Permit i ' N0:' " Date Received `
Date Issued:
IWORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT
PROPOSED USE
N.
Residential
Non- Residential
❑ New Building
Pne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
IrRepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
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5 i'S � �i�'• '� "R .�.. 4 •. .; .� 1
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rvr 'H "lr .^� 1 -�:". ,{ 1 ..� f '•
i{�„0 Watershed,District
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DESCRIPTION OF WORK TO BE PERFORMED:
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/L/o sel-*k e- -je-utea-.e
Identification Egase Type or Print Clearly)
OWNER:
Address: 17.3 C;D� awn
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Supeiii 1.rvisorisorstruction Llcense�rZar�tExpf Date-, .}t ayg
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Home}Improvem+e+'n{RLc�e�n�KT'i�r�,E7
ARCHITECT/ENGINEER Phone:
Address:
Reg. No
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BAS1EDL ON $925,00 PER S.F.
Total Project Cost: $ /7 O /O , 649 FEE: $„
Check No.: `� �o�`t I Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access a aranty fund
!S.igr atureof:A' nVOWhe' r ..:.. S�g nature'of contract
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Locat* n
No. N -� I � D ate
CD
Check # 110bbq4t
27660
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TOWN OF NORTH ANDOVER -
Certificate of Occupancy
Building/Frame Permit Fee $a
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Plans Submitted ❑ Plans Waived*❑ Certified Plot Plan ❑ Stamped Plans ❑
. TYPE OYSEWERAGEDISPOSAL
Public Sewer ❑
Tanning/Massage/BodyArt El.
swmmmng Pools ❑
Well ❑
Tobacco Sales ❑
FoodPackaging/Sales ❑
Private (septic tank, etc. ❑
Permanent Dumpster on Site ❑
'
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
ro
DATE REJECTED DATE APPROVED
❑ ❑
Reviewed on Signature
Reviewed on Signature -
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes .
Planning Board Decision: Comments
Conservation Decision:
Comm
Water & Sewer Connection/signature & Date Driveway Permit
DPW T oiv>! ]Engineer: Signature:
- Located 384 Osgood Street
FIRE -DEPARTIt
Located at'Ik Mai.
Fire Deparim"'m
COMMENTS
- Temp Dumpster on site yes -_no,
ate � •
dimension
qumber of Stories: Total square feet of floor area, based on Exterior dimensions
Total land area, sq. ft.:
HLECTRICAL: Movement of Dieter location, mast or service drop requires approval of
lectrical Inspector Yes No
)ANGER ZONE LITERATURE: Yes iso
AGL Chapter 966 section 21A -F and G min.$100-$9000 fine
►oc.Building Permit Revised 2010
Building Department
The fol►`owing 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
10TE: 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
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
Q Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
00TE: 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 apt), al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
roust be submitted with the building application
Doc: Doc.Building permit Revised 2012
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iewat MA Home Improvement Cont
dersen.ram Renewal b Andersen Corporation License Federal
(Expires 1 -191
gePUtCEg1ENr n� 4,wle}.cn(:"r.,nm � � Federal Tax ID #41-191
104 Otis St. Northborough. MA 01532
(508) 351-2200 Fax (508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
iver(s) Name Date:
DICK ISSENBERG - PEGGY ISSENBERG
I
APRIL 15, 2014
Buyer(s) Street Address City State Zip Code
173 COACHMAN LA.
NORTH ANDOVER
MA
1 01845
;Email Address Home Telephone Number Work/Cell Telephone Number
PEGGY] SS ENB ERG@COMCAST. N ET 978-857-1866 978-689-3738
j Buyer(s) hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with i
the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement"). j
Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
l
Est. Start Date
Method of Payment
Total Job Amount $ 17,010.00
kniount Financed $ 0.00
Check/Cash
Deposit Received (33%) $ 5,670.00
10-12 weeks
Balance Start of Job (33%) $ 5,670.00
Deposit at signing $ 0.00
Check #
Balance on Substantial -
At substantial
Est. Install Time
V Credit Card
Completion of Job (33%) $ 5,670.00
Completion $ 0.00
T.B.D.
If credit card is selected, please
see Credit Card Payment form s
i !
Buyers) 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
l
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.
!Renewal by Andersen Corporation Buyer(s) Buy r(s)
Signature of Project Manager
BRUCE PECK
Printed Name of Project Manager
Signature L/ " Signature v
DICK ISSENBERG PEGGY ISSENBERG
Printed Name
Printed 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.
SEETHE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
--------------------------------- ( - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTICE OF CANCELLATION i NOTICE OF CANCELLATION
Date of Transaction 4/15/14 You may cancel this 1
transaction, without any penalty or obligation, within three business days from the 1
above date. If you cancel, any property traded in, any payments made by you under I
the Contract of Sale, and any negotiable instrument executed by you will be I
returned within 10 days following receipt by the Contractor ("Seller") of your I
cancellation notice, and any security interest arising out of the transaction will be I
canceled. If you cancel, you must make available to the Seller at your residence, in
substantially as good condition as when received, any goods delivered to you under
this Contract or Sale; or you may, if you wish, comply with the instructions of the
Seller regarding the return shipment of the goods at the Seller's expense and risk.
If you do make the goods available to the Seller and the Seller does not pick them up
within 20 days of the date of your Notice of Cancellation, you may retain or dispose 1
of the goods without any further obligation. If you fail to make the goods available 1
to the Seller, or if you agree to return the goods to the Seller and fail to do so, then
you remain liable for performance of all obligations under the Contract. To cancel 1
this transaction, mail or deliver a signed and dated copy of this cancellation notice 1
or any other written notice, or send a telegram to Contractor: Renewal by Andersen, I
104 Otis St. Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF 1
4/18/14 .(Date) I]HEREBY CANCEL THIS TRANSACTION.
Date of Transaction 4/15/14 You may cancel this
transaction, without any penalty or obligation, within three business days from the
above date. If you cancel, any property traded in, any payments made by you under
the Contract of Sale, and any negotiable instrument executed by you.wM be
returned within 10 days following receipt by the Contractor ("Seller') of your
cancellation notice, and any security interest arising out of the transaction will be
canceled. If you cancel, you must make available to the Seller at your residence, in
substantially as good condition as when received, any goods delivered to you under
this Contract or Sale; or you may, if you wish, comply with the instructions of the
Seller regarding the return shipment of the goods at the Seller's expense and risk.
If you do make the goods available to the Seller and the Seller does not pick them up
within 20 days of the date of.your Notice of Cancellation, you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available
to the Seller, or if you agree to return the goods to the Seller and fail to do so, then
you remain liable for performance of all obligations under the Contract. To cancel
this transaction, mail or deliver a signed and dated copy of this cancellation notice
or any other written notice, or send a telegram to Contractor: Renewal by Andersen,
104 Otis St. Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF
4/18/14 . (Date) I HEREBY CANCEL THIS TRANSACTION.
Buyers signature RW Name Date Buyers Signature Prim Name Date
�enevval----- Renewal by Andersen Corporation MA Home Improvement Contractor
Andersen. a�._-
104 Otis St. Northborough, MA 01532 License #170810 (Expires 12/23/2015)
_WINDOW REPI.ACEMENT wn.+:n:ra:k-„<::w++r+,ns (508) 351-2200 Fax: (508)-986-7072 Federal ID #41-1 91 841 3
jJ Window Specification Sheet
!Buyer(s)Name Date of Agreement
DICK ISSENBERG
PEGGY ISSENBERG
TUE, APR 15, 2014
IThe buyer(s) fisted above hereby jointly and severally agree to purchase the goods and/or services fisted 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 the Specification Sheet is part.
WINDOW DETAUS
Approx. ExteriorMterior Color Hardware Hardware LowE4/ Grille Grille Glass
Room # U.I. Window/Door Style Detail Casin s Ext -Int Color Style Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts Options
Bed 1 2 112 CD full frame Ext./Int. MF 908 wH/wWhite IStandard FTS SmartSur None
Office 1 107 CD full frame Ext./Int. MF 908 IN I H/WF White Standard FTS Sm.rtsur None ISee note
Living 2 109 PW full frame Ext./Int. MF 908 wwwWhite Standard SmartSur None
Play Rm 2 67 AN full frame Ext./Int. MF 908WH/WH White Standard FTS martSur None
Total 7 BAY & BOW DETAILS *See Ba /Bow Measure Sheet
Style Detail / Approx. Approx. Number Frame Window End Center LowE / Roof/ Hardware
Room Count Style Flankers U.I. i Casings Angle Lites Interior Ext/Int Color Grilles sashes sashes Screens Smartsun Soffit Color
SPECIALTY WINDOW DETAILS
Full/ Approx. LowE/ Specialty BAY/BOW ADDITIONAL WORK NOTES
Room Count S le Insert U.I. SmartSun Grilles Grille Style Ext/Int Color Customer is aware that with ba /bow windows under 72 inches
there will be significant gins lose.
ADDITIONAL WORK DETAILS:
Casement double in office to have egrrss hi i es
I No Contractor will wrap exterior casings with coil stock color of {
2
i
Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments/hardware. It is the
responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to
whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If thereis, the
amount will be dependent on the type of existing windows, type of installation and window style. We make no guarantee as to the amount of glass loss.
Customer is aware and understands any and all unseen rot is not included in this contract. Should any rot be found there will be an additional charge for
time and materials unless so stated in this contract.
3 Yes Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. Removal and disposal of all job related debris,
windows, doors, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued.
4 Yes 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. Check # .2167 $ 216
1 5 yes All discounts have been applied to this agreement.
6 ✓ Yes No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment /finance form(s).
I
'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 Buyers) and Contractor. Buyers) hereby acknowledge that Buyer(s) has read this Specification
ISheet.
Renewal by Andersen Corporationr(s) Buyer(s)
I B,. PU
By
1 Signature of Project Manager Signature Signature
BRUCE PECK DICK ISSENBERG PEGGY ISSENBERG
Print Name of Project Manager Print Name Print Name .
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street.
Boston, MA 02111
www mass gov/dia
Workers' Compensation Insurance davit: Buffders/Contractors/Electricla»s/Plumbers
o»liennt Infnrmnt nn
Name (Business/Organization&dividual): &n ew C, �.
Address:LA
0
M. '! ? -
Are you an employer? Check the appropriate box:
1.21 J
am a employer with
4. [] I am a general contractor and I
employees (full and/or part-time).'
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.:
required.]
5. ❑ We are a corporation and its
3. ❑ 1 am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees, [No workers'
comp. insurance reauired.l
Type of project (required):
6. ❑ New construction
7. Qemodehng
8. ❑ Demolition
9. [] Building addition
10.❑ Electrical repairs or additions
11. [] Plumbing repairs or additions
12.❑ Roof repaiD
13.[2-Oiker
. X4014 _W
*Any applicant that checks box #1 must also fill out the section below showing their workers' compengation 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.
tContractors that check this box must attached an additional sheet showing the name of the sub -contactors and state whether or
employees. If the sub -contractors have employees, they. must. provide their workers' comp. policy number. not those entities have
I am an employer that is Providing workers' compensation insurance for my employees Below is the oli andob site
information. ' P cy j
Insurance Company Name:_ �d Qe c_ ,n C n
Policy # or Self -ins. Lic. #:��, �(� (� a 'GC Q 6
Job Site
M
Expiration Date: 10— 1 _ I H .
City/State/Zip: d It/VQgiL,_
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 and a fine
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 ORDERa
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a
Investigations of the DIA for insurance coverage verification.
Ido hereby c nder the pales and penaltles ofperjury that the information provided above is true and correct
Official use only. Ito not write in this area, to be completed by clay or town official
City or Town:
Permit/License #
Issuing Authority (circle one):
L Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6: Other
Contact Person: Phone #:
— 7-. --
A � CERTIFICATE OF LIABILITY INSURANCE 20/01/2°' 3"'
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: N the certificate holder Is an ADDITIONAL INSURED, the pollcy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to
the teens 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 1-612-333-3323 CONI
Saye Companies
A
SO South Sth Street
PHONE
yg. Exp -612-333-3323 FAX
J No
a1Alt AR Ne: 612-373-7270
Suite 700
ADDRESS'
Xiaasapolis, MR 55402
INSURERS AFFORDING COVERAGE
RAIC0
DNSURERA: OLD REPUBLIC INS CO
INSURED
24147
Renewal By Andersen Corporation
INSURERS:KhTIONAL Drou FIRE INS CO OF PITTS 194!5
INSURER C :
104 Otis Street
INSURER D:
Northborough, INA 01532
INSURER E:
....•a R.+��� UtrinFlcATE NUMBER: 36122490 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.
MSR TYPE OF INSURANCE 1MSRIWVDI POLICYEFf P.OLIC1fEXP
POLICY NUMBER LIMIT
A GENERAL LIABILITY XNTZY 3D0361
CLAIMS -MADE I w I OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY I 1 JEC_TT I I LOC
AUTOMOBILE LIABILITY
E ANyAUTO
ALL OWNEDSCHEDULED
AUTOS AUTOS
X HIRED AUTOS X ALIT
8 X UMBRELLALUUI
I
X OCCUR 20562235
EXCESS LIAR CLAIMS -MADE
DECE RETENTIONS 25, 000
A WORKERS COMPENSATION XIPC 300359 00
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/IXECUTNE YIN
OFFICERAAEMBER EXCLUDED? NIA
=Z=M E
30/01/14
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANeeA ACORD 101, Addillmnl Ramada SoMdub. N men space is rogelnd)
S 1,000,000
$300,000
$ 10,000
$ 1,000,000
S4.000,000
$4,000,000
i
BOOILYINJURY(Perpemm) fs
SODILY INJURY (per socbeM) _
PROP TY DAMAGE S
S
E.L.
,000
000,000
1,000,000
To TrIno Zt Kay ConcernPOLICES SHOULD ANY OF THE ABOVE DESCRIBED BE CANCELLED BEFORE
For nsTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
urance Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01888-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
jhargrove
36122490
Massachusetts -Department of Public Sii#fit .
'Board
of Building Regulations and
Sta:ncfard`
Construction Supen icor
License: CS-090125SIN
+? f
JADE L MORIN
�.
86 GARDINER ST
qt
LYNN MA' 0190$r
.
Expiration
Commissioner
.
10/06/2014 ,
SCA 1 t',� 20M-05/11
ffice of Consumer Affairs & Business Regulation
OMEIMPROVEMENTCONTRACTOR
Registratioh; . 1d
Expiratioh 12123api6' TYPe:
RENEWAL BY ANbE N`C( ORATION Supplement r;
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JAIME MORIN
104 OTIS STREET
NORTHBOROUGH, MA 01532
Undersecretary
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ENERGY PERFORMANCE RATINGS
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ENERGY PERFORMANCE RATINGS
U-Factor Solar Heat Gain Coefficient
0.2 9' 1.65' ..002-8
U.SJI-P (Metric/Sl)�.
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0A4
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penormaree. NFRC ratings are detenn ned tar a moo set N envannmental condmons and a specm product ate.
NFRC door not recommend any product and does not warrant the sunahtety or any product for arty spevnc use.
Cansul[ manutacti ns•s Ilteraoae for other pmdoct pWannance Wormation•
Standard Rating
NAFS42orMMAWDMAtCSA1014S?/A44D-05 DP psf DP40
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ENERGY
PERFORMANCE RATINGS .
U-Factor
3Di� Heat Gain Cctioiartt
0.27 1.53
0.22
ADDITIONAL PajiFogMMCE RATINGS
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0.51
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