Loading...
HomeMy WebLinkAboutBuilding Permit #216-2012 - 174 JOHNSON STREET 9/14/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: C — a012- Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER � nii��l•� /c` �.5 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �e family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other iSeptrc. !'We 1 !ptFloodplaui '®°Wetl_'ands ;`(] t7VatershediDistr`icf , j F o Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: t I Identification Please Type or Print Clearly) OWNER: Name: �- v�k r rev �S Phone: Address: ��`'� S7T-(-) Lsl -- CONTRACTOR Name: A-c`J /,J lS CJ,L) Phone: Address: �a �f �-- C�J Supervisor's Construction License: ?5``7Q� Exp. Date: /a Home Improvement License: `l C(,O( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ L_ - FEE: $ Check No.: Receipt No.: Aey NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signa#ure_of AgeWQWner Cid E' er. -: :Si of`contractor 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 COMMENTS HEALTH Reviewed on Signature COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine n NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Muss check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster p permits require sign off from Fire Department prior to Issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) L3 Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 :hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording nust be submitted with the building application I Doc: Doc.Building Permit Revised 2008mi i Location �L�3? .51� No. 216 �b�2' Date I MO^Th TOWN. OF NORTH ANDOVER A }�a ; • Certificate of Occupancy $ a Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check # ` 2 4 5 ( O Building Inspector NORTH And over TO" of o , dover, Mass., Q LAKE COCMICHE WICK ORATED PP BOARD OF HEALTH Food/Kitchen. PERMIT .T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... .....1 !�5.......................................... ........................................................... ..... ••••••••• Foundation has permission to erect......................... buildings on .../:7..y....J.6 A'�a 5 ............................. Rough ` tobe occupied as.... ��' ,�. .. /.�1. .. C�. ................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file iChimn Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO ARTS 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 SWE Smoke Det. 104 Otis St.,Northborough,MA 01532 J&L WimDows,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) 'I Andersen. Federal Tax ID#83-0404201 WINDOW REPLACEMENT mAndmmo,,V=y CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date of Agreement 1-51f,�� ,y I&) l II Buyer sl Street Address,City,State,and ip Code ;) D � E-Mail Address Home Telephone Number Work Telephone Number �-- Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersc ("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attache specification sheet(s) (collectively,this"Agreement').Buyer(s)hereby agrees to sign a completion certificate after Contractor has complete all work under this Agreement. Total Job Amount: Estimat d Starting Date: Method of Payment:❑Check ®'Cash ❑Financed I Deposit Received(33%): Balance at Start of Job(33%): � Credit Cards are accepted for deposit Estimated completion Date: only-maximum 1/3 of the project cost. Completion of Job(33%): Balance on Substantial -� Please see Credit Cd Payment Form. � ary By signing this agreement,you acknowledge that the Balance at Start of job and the Balance on Substantial Completion of job cannot be made by credit card and must be made by personal check,bank check,or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties,and th; there are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviatic from this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) herel acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date fir written above and 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT 1 T ANY BLANK SPACES. J 7&L mdo nc.d/ /a Renewal by Andersen Buyer(s) Buyer(s) B S of Pro Manager Signature Signature Priht Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIR BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. - - - - - - - - - - - - - - -x- - - - - - - - - - - - - - -<- - - - - - - - - - - - - - -: NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction . You may cancel i Date of Transaction . You may cans this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,withi three business days from the above date.If you cancel,any three business days from the above date.If you cancel,an property traded in,any payments made by you under the property traded in,any payments made by you under th Contract of Sale,and any negotiable instrument executed Contract of Sale,and any negotiable instrument execute by you will be returned within 10 days following receipt 1 by you will be returned within 10 days following receil by the Contractor ("Seller") of your cancellation notice, 1 by the Contractor ("Seller") of your cancellation notia and any security interest arising out of the transaction will I and any security interest arising out of the transaction wi be canceled.If you cancel,you must make available to theI be canceled.If you cancel,you must make available to th Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good conditia as when received, any goods delivered to you under 1 as when received,any goods delivered to you under th this Contract or Sale; oryou may, if you wish, comply 1 Contract or Sale;or you may,if You wish,comply with th 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 mak Ifyou do make the goods available to the Seller and the I the goods available to the Seller and the Seller does ni Seller does not pick them up within 20 days of the date 1 pick them ujp within 20 days of the date of your Notit of your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the ooc of the goods without an further obligation.If you fad to without any further obligation. If you fail to make th make the goods available to the Seller, or if yyou agree . goods available to the Seller,or if you agree to return th to return the g000 the Seller and fail to do so,then 1 goods to the Seller and fail to do so,then you remain liabl you remain liable Zrfoperformance of all obligations under I for performance of all obligations under the Contrac the Contract.To cancel this transaction,mail or deliver a I To cancel this transaction, mail or deliver a signed an signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other writte other written notice,or send a telegram to Contractor.J 1 notice,or send a telegram to Contractor:J&L Window: &L Windows,Inc.d/b/a Renewal by Andersen, 104 Chis I Inc. d/b/a Renewal by Andersen, 104 Chis Scree Street, Northborough, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGH MIDNIGHT OF .(Date) OF ,(Date) I HEREBY CANCEL THIS TRANSACTION. i I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Dote 1 Buyer's Signature YPrint Name Da}a RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 104 Otis Street,Northborou MA 01532 J&L WCows,Inc.a/b/a Sh, m Renewal MA MC License#149601(expires 1/24/12) Phone 508.919.0900•Fax 774.987.3013 Aii Federal Tax ID# 83-0404201 Andersen. WINDOW REPLACEMENT an Ando Company OF GREATER MAssACHusErrs AND NEw HAtv1pmn WINDOW SPECIFICATION SHEET Buy r( Nam Date of Agreeme yl The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in aicoybance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) ❑ Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement(CDW) ❑ Standard handle ❑ Metro handle Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑ 1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or w Window Patio Doors(see separate Door Specification Sheet) 2. ❑ Yes —Wo Qty of Windows to be Custom Fit Replacement: 3. ❑ Yes & o Qty of Sills to be replaced by Contractor: 4. Ves ❑ No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings)and actual Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: ❑ HP £-4 T"� El Other If other,please specify: 6. Exterior color to be: ite Sand Canvas Terratone Cocoa Bean 7. Interior color to be: White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: Interior color c only be white,wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware:Z White Z Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style:' 9. ❑ Yes VNo Install Lifts with Double Hung mdows 10. Screens: windows to have: ❑ Half or Full screens Screens to be: E] Fiberglass ❑ Aluminum E] TruScene GRILLE DETAILS 11.Windows have grilles: Yes ❑ No If yes:❑ Grille Between Glass(GBG)❑ Removable Interior Wood aNrw) Full Divided Light(FDL) Qty: Qty: Qty: Qty Qty- Qty Qty: 1V 1' OH DH DH DH CW/Picture Glider CPWorG Draw grille patterns above `Use additional sheet if needed Owner approved(initials): ADDITIONAL WORK DEFAIIS 12.❑ Yes o Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes ff No Contractor will install new paint-ready or stain-ready casings. Interio casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes No Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty o .' gs: ❑ Pine ❑ Maintenance-free material 15. Owner is ay/are that Contractor does not do any painting. I Owner Initials 16.❑ Yes L7 No Contractor will wrap exterior casings with aluminum coil stock of color. Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17. s E] No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18. es ❑No Cleanup all job related debris including old windows will be removed.Vacuum nightly. 19. es ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20.LJ Ye E] No Building Permit—Contractor will secure any and all necessary permits. The fee for the permits)is not Ye in the Contract Price and a separate check is required at the time of sale for this fee. 21. ❑No All discounts have n applie to this agreement price. 22. Additional job details: 4 Ar –:: V 23. ❑ Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and r. Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by of ter MA and NH Bµ����a�'"✓'" l� (s) Slgna, uct Manager P��>�'/P/ gn Saature Print Name of Product Manager Print Name Print Name The COMMoJLvialth of hsassachusetts ' Department of fnduatrial Accidents D&C of invesaffoons 600 W41sington Street Boston,MA 02111 ►.mass.govtdla R'arkers' Compensation Insurance Affidvit:$rulders/Contractors/Electridme/Plmabers A licant Information' Please Print Le�b1P Name(Bvsinmdorga andonadividna): J)e ►J G.' f✓y Nnr�er'S e YI Address: ID ` Citg/Stat?Zip: Are you 8n employer?Check the epproprts to baz: Type of project (required): 1. Iem a ar arifi� D . 4. ❑'I am a genen j contractor end I g, �]New construction employees(fulland/or part--time),*: "=,M hued the sib-contractors �` dLliszg 2.(] I em a sole proprietor or partner- listed Da ft attached sh=t f P10Pn R. Dmnclition ship and have no employees These.sub-contractors have ` 1wodo rs' comp.insurance. g. RmIding a.3ditioa vMrking for me in Day capacity. [No w-orkers'comp.hmzz tice S. ❑ We are a corporation end its '10.0 Electrical repeira or addifiDns- roquimd.] ,. officers have axe isod their. airs or additions 3:0 I am a homr.Dwner doing all work of ezamptioa per MGL 11.❑Rlnmbing.rep myscl£[No warkcrs'comp: a.1512,,,JI(4),and we have nti 12.0 Roof tepmin tnsurence fxquim!]t employees.[ND worl'ers' 13.[]OthGt . Damp,ft.mm IICe rpquimd-3 *Amy nppliexut that ebeeLs brit g1 aaut also fill out the section baht ahnv 41heQ wads'omnpea eMn pansy mfn=sfina• t Flemeownen who submit this affidavit%dir�iae they ere doinj sRwmi and$en hire outside ooatractnas inert bvbmit t aeav affidavit indieafiee sack DF te fCa onWWt=that oheak this bo=anut attached an additional sheet hoRtiaY the name hsub-aoatrcat�s and$ie'swerL'es'emap Policy iafarmatimL I=an entployer thrit is providing workars'campensatiax insurance far my employers d C1v)f.is the pofuy and joh site ircforrnation. ��,nn (/ Insurance Company Nems: - Policy#or Self-ins;Lic.#: ��� �"' Expiration Date: Job.9h:AddrC56: �l �f� S4— fi Attach a copy of the vrorkers'compensation.policy declaration page(shovdug the policy number and erpiratfai date). J Fafqum to securo cDvtuage as required vadw section?5A of MGL c. 152 can lead to the imposition of criminal penalties of a fne tip'to$1*500.00 endlor ono-year imprisonment,aswell as civil pcnalties in the fD=•of a STOP WORK ORDER and a f= -of up to S250.00 a day againe violator. Be advised that a copy of this statcmant may be forwarded to the Office of st tin Investigations of the DIA for in urame,cov=ge veafim ion. I do hereby ce u r the pains and panahL-rAfperjury that the informatfax praYided abnv is trueand correct. . ' sienafurf: �7� D Phone#' O,ficial use only. Do rwt write in this area,to be eomplefmd by city or torn o{fzcinL City or Town: Permit/License# Issuufag Authority(circle one): L B=1 of Health 2.Building Department 3. 'C,ttl' /Town Clark 4.Electrical Impactor S.Plumbing Inspector 6.Other Pham#; Contact Person Massachusetts - Department of Public Safet'N Boai-dlof Building Re�uulations and Standards Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ( ummissiuicf Tr—,: 2622 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Regfsti-ationr)01' F-xplr 12-i` int Card RENEWAL BY151 BRIAN DENNIS e f l 104 OTIS STREE P! , NORTHBOROUGH,'M0T532 Undersecretary '4� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"YYY) Q2/09/2011 .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(iss) 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 PHONE FAx JP McKeone insurance Agency, Inc. E-Ma� 734-662-5100 A>c Ne: P.O. Box 333 ADDRESS: _ INSURER AFFORDING COVERAGE NAIC Ann Arbor, MI 45106-0333 S INSURER A: 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. INSR ADD s LTA TYPE OF INSURANCE POLICY NUMBER PM/DD�1 Y MM OD� - LIMITS B GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 COMMERCIAL GENERAL LIABIL17Y NC956461' 10/01/2010 10/01/2011 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE ©OCCUR MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1 000 000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- MP/Op AGG $ 2,000.000 POLICY PRO. LOC JECT $ A AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2010 10/01/2011 COMBINSINGLE LIMIT Ea a.IdenED 1,000,000 ANY AUTO BODILY INJURY(Per person) $ x ALLOWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON- HIRED PROPERTY DAMAGE Per acdde $ UMBRELLA LIAR I $ OCCUR EXCESS UAB IEACH OCCURRENCE S CLAIMS-MADE AGGREGATE Is DED RETEN f ION S S WORKERS COMPENSATION A AND EMPLOYERS'LIABILITYY/N 35 WECPP1444 02/17/2011 02/17/2012 WC STATU OTH- LIMrT8 PR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A EL EACH ACCIDENT $ 500,000 (Mandatory in NH) "96R" f yes describe under EL DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION INSURED COPY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA- 0 1968-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2D10/05) The ACORD name and logo are registered marks of ACORD Do not remove until final code inspection. Save label for future reference- Quatiett ior area ' 19 ;� , , Canada .' t tM 411 R Z QtM c in q E U W y U.S /E.U. •-� enefgystargoV ®�Quarried/Admissibis Renewal bYAndersen WINDOW REPLACEMENT nn f•ndoramCw.mpuny AND-N-37 5 % E :isS+ aa Vinyl/Wood Composite Material � - ual Argon Low-E4 SmartSun D Product Type: Picture ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0 .27 1 . 53 0 . 22 U.S.n-P Metric/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 51 _ - Manufatturer stipulates matmde rat contann m aPpli..ol.NFRC procedures for aetarmining Wnale proautt performance.NFRc radngs are aeterminen tar a vireo set at environmental conoltlano NFRO noes not recommend any proauct ana noes nor warrantin? nutttar ant i dairy specmc use. namme suttsblllty of any p. Consul manufacturers aterature for Omer proauct performance Inmrmatlon. www.nft.org a rx.W w W a ' -/ - Andersen Co oration:RbA Picture Window —Va-humichiner Pu a es conformance a to owing standards Standard Rating NAFS-02 orAAMA WDMNCSA 1014.NA40.05 DP psf F-050 , 14i g t Tn6proauctmade jk t Green Smalls ? errdronmental stanaaros' ilmming energy etgclency,heavy metals ' In ma trome ana seen �� materlel,pscimging,ano consumer materials. eaucatlonal 100-00511006-001 Masa or ezum M.E.C.,CE.C,L I.E.C.C.Alr IMlaaatl in requirements Womk Hallmarx cerlm itlon Program• .