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HomeMy WebLinkAboutBuilding Permit #534 - 180 MARBLERIDGE ROAD 1/10/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 3 Date Received SSS CA H Date Issued: % ��� IMPORTANT: Applicant must complete all items on this page PMft IPRPER�Tr�Y OWNER k � A- - _ t P,nnt {MAP{NOPARCEL�ZONING:DISTERICT -: lFtiisto�ic�Dis"t_"nct ayes tno �` - c T. yes, _ o - - _. oni TYPE OF IMPROVEMENT PROPOSED USE Address: `fib Residential Non- Residential ❑ New Buildingne family fAdtlress ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial air, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .-_- --_ .... ---._ ?. '�, Sep it c ►®1Vllell Rye== - - ,�.T..�_ry„E .-..._ —�- -w 'O4FLoodplain . ���Wetlands.,. E ".Y,T._—.Z.- -' 2` r. -• __. _.-+. q' Watershed _D.istnct; OWNER: Marne:_ Address: `fib tCONT1R'ACTt-OR CC fAdtlress �:�- SUP- wl ores Gon DESCRIPTION OF WORK TO BE PREFORMED: I-5FP(pf:.F— I i t,J It n oac)J-S Nc) Identification Please T pe or Print ,A• 1t:�4 \ PsJ�I f 'F,�f�J�l BSc j, .6rilLicense Phone: 'hor1e �5.O Sit i---1 ARCHITECT/ENGINEER Phone: Address: _ Reg. No. q48 •/ A -6` FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ I . 6� FEE: $_% �S 3 Check No.: (c) Receipt No.:��(�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r-� 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 ❑ 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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 Sianature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 FIREDEPARTMENT Ttempd_Dumpster::ontsite dyes R �fn }� -- ��_ Locatedtat 41241MaintStreet o !F1reDe artment s� nature/'date; s __ 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 Doc.Building Permit Revised 2008 Location yNo. 3 / Date /U Z �aRTh TOWN OF NORTH ANDOVER F - v- 41 i y Certificate of Occupancy $ CM�s <�' Building/Frame Permit Fee 0 c2 $� 3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24948 Building Inspector \cc^s LAJ Y) z om as L l CL L3 L.: O _. ® N m C: C', O cm O W^� _ —41 m O O w I. C. N C1 Z x z w W O U o L2 N a v cn A or. o w O aG ate, U ro G w a p r� q w w WO 0 w mo coG w" �® 0 c� w w w a�q o z �i cn Q v 0 cn • c� o d C Com.! O ` c co O C C., VCD V ..►.Q c N ea ICY m C �t O O � N EQ CF j Spa y /`--1 7 EE O V C s cm mi C c n N E CD � O N N N 3 m O CA N O G ECOD W ®CDCD Lcm CL L3 L.: m _. ® N m C: C', O cm Co W^� _ —41 m O F-1 N C. N C1 Z O CO O ai ■ L _ O O v Z o C. CD y � G s CM I o y m m 0 CD y.r CD O D o mo a M: cm< y c CD ♦-�+ CcG v`Y J .� a o: c Z 4D C..) h c G C , � cc CLy is c 45 _ ® : m 3o C. N W CD Z •N W O W'E dt C i., 'p v N Z . C.3 a �® g w :e M CL y=. m Z ' W CO O ai ■ L _ O O v Z o C. CD y � G s CM I o y m m 0 CD y.r CD O D o mo a M: cm< y c CD ♦-�+ CcG v`Y J .� a o: c Z 4D C..) h c G C , � cc CLy is 104 Otis St., Northborough; MA 01532 J&L WINDOWS, INC., D/B/A MA Home Improvement Contractor (508) 919-0900 • Fax: (774) 987-3013 License #149601 (Expires 1/24/2012) byAndersen • Renewal � ;.. Federal Tax ID #83-0404201 WINDOW REPT CEWENT mMda.maomryvy CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) hereby ,jointly and severally agrees to purchase the products and/or services of J & L Windows, Inc. d/b/a Renewal by Andersen ("Contractor"). in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement"). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount:./ rS Deposit Received (3 3%): Balance at Start of Job (33%): SO 7 � D.F. Estimated Starting Date: Method of Payment: &fCheck ❑Cash ❑Financed Credit Cards are accepted for d deposit e p p Estimated Co pletion Date: �o only — maximum 1 /3 of the project cost. Balance on Substantial /0,9/ Completion of Job (33%): J � � Please see Credit Card Payment Form. 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 personall check, bank check, or cash. Buyer(s) 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 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. J & L Windows, Inc. d/b/a Renewal by Andersen Buyer(s) Buyer(s) By: ` . �1—w F-9,771-11- — �,N e of- �'}lc � Signal roduct Manager Signature Signature /.��✓t JA��n���liSYc/��L(rt Print Name of Product Manager —Print Name Print 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. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. --- — — — — — — — — — — — — — —X- — — — — — — — — — — — — — -x— — — — — — — — — — — — — — � NOTICE OF/f.ANCELLATION X NOTICE OF CANGELLATION Date of Transaction /1 4�dl . You may cancel Date of Transaction C �71 . You may cancel this transaction, withoulf any penalty or obligation, within this transaction, without any enalty or obligation, within three business days from the above date. If you cancel, any three business days from the above date. If you cancel, any property traded in, any payments made by you under the property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed Contract of Sale, and any negotiable instrument executed byyou will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled. if you cancel, you must make available to the be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition i Seller at your residence, in substantially as good condition as when received, any goods delivered to you under as when received, any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply Contract or Sale, or you may, if you wish, comply with the with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expense and risk. i the goods at the Seller's expense and risk. If you do make If you do make the goods available to the Seller and the I the goods available to the Seller and the:Isr des rct- Seller does not pick them up within 20 days of the date pick them up within 20 days of the date ofYour Notice of your Notice of Cancellation, you may retain or dispose i of Cancellation, you may retain or dispose of the goods of the goods without any further obligation. If you fail to without any further obligation. If you fail to . make the make the goods available to the Seller, or if you ' agree goods available to the Seller, or if you agree to return the to return the goods to the Seller and fail to do so, then goods to the Seller and fail to do so, then you remain liable you remain liable for performance of all obligation under i for performance of all obligations under the Contract. the Contract. To cancel this transaction, mail or deliver a I To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any dated copy of this cancellation notice or any other written other written notice, or send a telegram to Contractor. J notice, or send a telegram to Contractor. J & L Windows, & L Windows, Inc. d/b/a Renewal by Andersen, 104 Otis i Inc. d/b/a Renewal by Andersen, 104 Chis Street, Street, Northboroug t 01532, BY NOT LATER THAN Northborobgl /MA 01532, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF / (Date) OF 1 (Date) I HEREBY CANCEL 1 TRANSACTION. I HEREB CEL THIS TRANSACTION. Buyer's Signature Print Nome Date - Buyer's Signature Print N RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink 104 Otis Street, Northborough, MA 01532 J & L Windows, Inc. d%b/sRenewal - � MA HIC License # 149601 (expires 1/24/12). Phone 508.919.0900 •Fax 774.987.3013 K ;, Federal Tax ID# 83-0404201 byAndersen. '- WINDOW REPLACEMENT an Andean Company OF GREATER MAssAceuserrs AND NEW HAmysHtE WINDOW SPECIFICATION SHEET gB�,uyer(s) Name - - Date of A L empnt �/9Al� i 1. f'i�A/10CCtmo i,//pr Ar. .1 Q�� i drnnnitf 1 I /% *?l/ '7 t) /I Th6 Buyer(s) listed above her-,6yjointly and severally agree to purchase the goods and/or services listed belo , in acc rdance 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) tX Equal sash ❑ Cottage sash (1/3 top, 2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom) "7 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) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) Picture Window (PW) Bay or Bow Window Patio Doors (see separate Door Specification Sheet) 2. ® Yes ❑ No Qty of Windows to be Custom Fit Replacement: 3. ❑ Yes No Qty of Sills to be replaced by Contractor: 4. ❑ Yes 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: Z HP Low- E-4 - ❑ Other If other, please specify: 6. Exterior color to be: X White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: R White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: Interior color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware: X White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes RNo Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or CK Full screens Screens to be: K Fiberglass ❑ Aluminum ❑ TruScene GRMLE DETAILS 11. Windows have grilles:Z Yes ❑ No If yeso Grille Between Glass (GBG) ❑ Removable Interior Wood aNTW) ❑ Full Divided Light (FDL) Qty: / l Qty Qty Qty: ON: ON: Otv: DH DH DH DH CW/Picture Glider CPW GPVY Draw grille patterns above `Use additional sheet if needed Owner approved (initials): j ADDITIONAL WORK DETAILS 12. ❑ Yes QJ No Contractor will remove metal frames of windows. Qty of Units: 13. ❑ Yes [ No Contractor will install new paint -ready or stain -ready casings. Interior casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance -free material 14. ❑ Yes Q 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 of op ngs: ❑ Pine ❑ Maintenance -free material 15. Owner is aware that Contractor does not do any painiir in F Owner Initials 16. ❑ Yes �3 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. 17.2 Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 18.2d Yes ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly. 19.6a Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20.6 Yes ❑ No Buil ' 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. 21.[2 Yes ❑ No All discounts hve b n a2,?lied to this a eemen price. 22. Additional job details: Gr/S � � i&1 r �, C. A[-�- I -Of C 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 Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen of Greater MA and NH Buyer(s) \\ Buyer(s) ByczXc m 1Tt Si ��P��r dduct Manager Signature /} y Signature 1"t 17/1 Print Name of Product Manager Print Nate Print Name , ?3ii Camrnat�wdaitft of I�asackusett� Departtmint of ccidenfs FscPestigrriiatr.s f � frac n Baa�a�, h-4 62111 . y,rttass.goPf�a . Warker�' Comp6nsitbn lw=znte fids Srii�ders/Cantraet r�I ie rint Le e A iicsat fnfor Lotion' NB= pusin=dOrgnnbmannlindividue17; Tppa ofprpjer-t (r�grz<r•a* fi, ❑New donstructian �t�rFtng • gD=mlicn g; [] Bvs7ding eddificm UZI $icdtEj 4 rc,2 a of addrti=. LL.[] Plumbing repose or addifiaat 12.❑ Rflof=epe+� . k�+ nv tied bei #I t elan fill ns� the eeLfioa beim aha fhb woL�ss' oompm�en poy� near sfiidsvft indiraEiae =CIL . �y am �c elt�rmi end thm � dp}side ona� nit aehm>t t E�nmeox�nen �n Fubmltthtc _.�..,+.. �n� � eddifi®LI� +tr�n�e¢ut mnucu ... u .. ....._-- Ob Rag I ani as cmp4v cr that ca prayid"trsg. �arlrrrs' campenraiiaa insiv'ance far my empla,�er.� ;�elmv.ia the pv 1 frsfcmattam .. ' . ) N fi Insrr�nce Company bTemet ?? t �7 L_ �reSan Datc; Policy# ar Soi€ ins, Lit. # __ pity/stip; 1V�I��Ui Iob Or, Address;_ (sh.ovring the p oiie) =bar end esrira�inndslE1. deelsratian A aeii a eapy of flim Vnrlssre' enurp &t1°n pn psi osifian of criminal p=BhitS of a F`wl= tD 13c..= cov=ge u rcgaim 1ID�ar ueGtifla of G L52 GHIl in to �]G IIDp ❑nmemt, as well e.s ciril pcnattirs in kfi�e � •af a 5'Ii]P T�C�� DRI3ER end a Erne frac lip-tn $L,5Da.D0 andlor �-Yezr imgas bo fnrwardcd to fbt Office of ofQp to M5100 a dgy against the vinlstat. Se a$.vssed riot a copy.af tins statement may Invoafigafiana of tha'nik far inMmM=e co ge v the paras and pcn hereby c a aitica erjury that the kftrmafian prarided ab"4 it irue•¢na carred I • .da . �ismetnrc .. Dfj'tcirr! szsa arrE,y. Do isat in this arca, to be eomplefed by eery ar taxes acid City or Tavim: PermitlLicense # siring A-vfhoriY (rir'rI5 ane)t ins eclat 5. Piamiamg Fnspeator L $nerd. of Had & 7.. $fig DeParlmeat 3' C�tty/Toera Qerk 4. �ect�cal P , . fi, Ofber • .. Phdna � . Cmzt:<ct Person; .' • ' Are you as eatplapertP Mork fila eppropriste ban ' . 4, DIM am a �neaal cantradtar end I =P}DyW�Y. 0 , �3C" hired *. sub-coatrmat= employees (fnff amd/ar part -nmol. listod m &Z attsei=d shrzt . t 2. [l I am a sole proprietor orpsrtncr' Tbisr•sab-mntraetars have ship end hsve nn empiayooe i val61+1i I comp. ins¢reuca. w walking forme is any capacity. S. ❑ Wp arc a Do poufioa anfi its [No tiworkere' comp. msuzsado often hat cxbi 4 cd tiler. 3r� I am m homnowncs doing an work 7iftof :m=0#. ar McKe ' and we have no mysba [Nc warbF, cmnp.��yeas.. No wad=e innrrre�e ILC�IVLd t n=P. a Tppa ofprpjer-t (r�grz<r•a* fi, ❑New donstructian �t�rFtng • gD=mlicn g; [] Bvs7ding eddificm UZI $icdtEj 4 rc,2 a of addrti=. LL.[] Plumbing repose or addifiaat 12.❑ Rflof=epe+� . k�+ nv tied bei #I t elan fill ns� the eeLfioa beim aha fhb woL�ss' oompm�en poy� near sfiidsvft indiraEiae =CIL . �y am �c elt�rmi end thm � dp}side ona� nit aehm>t t E�nmeox�nen �n Fubmltthtc _.�..,+.. �n� � eddifi®LI� +tr�n�e¢ut mnucu ... u .. ....._-- Ob Rag I ani as cmp4v cr that ca prayid"trsg. �arlrrrs' campenraiiaa insiv'ance far my empla,�er.� ;�elmv.ia the pv 1 frsfcmattam .. ' . ) N fi Insrr�nce Company bTemet ?? t �7 L_ �reSan Datc; Policy# ar Soi€ ins, Lit. # __ pity/stip; 1V�I��Ui Iob Or, Address;_ (sh.ovring the p oiie) =bar end esrira�inndslE1. deelsratian A aeii a eapy of flim Vnrlssre' enurp &t1°n pn psi osifian of criminal p=BhitS of a F`wl= tD 13c..= cov=ge u rcgaim 1ID�ar ueGtifla of G L52 GHIl in to �]G IIDp ❑nmemt, as well e.s ciril pcnattirs in kfi�e � •af a 5'Ii]P T�C�� DRI3ER end a Erne frac lip-tn $L,5Da.D0 andlor �-Yezr imgas bo fnrwardcd to fbt Office of ofQp to M5100 a dgy against the vinlstat. Se a$.vssed riot a copy.af tins statement may Invoafigafiana of tha'nik far inMmM=e co ge v the paras and pcn hereby c a aitica erjury that the kftrmafian prarided ab"4 it irue•¢na carred I • .da . �ismetnrc .. Dfj'tcirr! szsa arrE,y. Do isat in this arca, to be eomplefed by eery ar taxes acid City or Tavim: PermitlLicense # siring A-vfhoriY (rir'rI5 ane)t ins eclat 5. Piamiamg Fnspeator L $nerd. of Had & 7.. $fig DeParlmeat 3' C�tty/Toera Qerk 4. �ect�cal P , . fi, Ofber • .. Phdna � . Cmzt:<ct Person; .' • ' Massachusett.N - DeiMr-trtirnt of Public Safet` •Boardiof Buildinl- Re,-,ulatinns and Standcu-tis IVConstruction Supervisor License License: CS 95707 BRIAN. DENNISON r 86 CREST'CIRCLE WORCESTER, MA 01603 �—G— Expiration: 9/B/2012 ('ummivciuncr Tom, 2522 ` Office of Consumer Affaii-s do Business Re g, ulafion 4. ,a ' HOME fMPROVEMENT CONTRACTOR REgistratior��01 ' *. - Expi 12 r� t Card RENEWAL BY. BRIAN. DENNIS 104 OTIS STRE NORTHBOROUGH,�'M Undersecretary J aCCOR LY CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYr 10/04/2011 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 J.P. McKeone Insurance Agency Inc-NAME: CONTACT ' PHONE FAX A/c No . (734) 662-81 DD AIC No, JP McKeone Insurance Agency, Inc. ADDRESS: P.O. Box 333 INSURER(S) AFFORDING COVERAGE NAIC # Ann Arbor, MI 481060333 INSURERA: Nautilus 19682 INSURED J&L Windows, Inc. Renewal by Andersen INSURER 8: Hartford 37478 104 Otis St. Northborough, MA 01532 INSURER c • INSURER D: " INSURER E: INSURER F: PREM SES Es occAGE $ fill ll-- /+COTICIf+A= Arl 111101=M. . wlFvr\I11N NI IMMI'K. 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 WfTH 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 LT' TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP - MM/DD/ I LIMITS A GENERAL LIABILITY NC95B461 10/01/2011 10/01/2012: EACH OCCURRENCE $ 1,000,000 TO urrence 100,000 COMMERCIAL GENERAL LIABILITY PREM SES Es occAGE $ S,OOD CLAIMS -MADE IV OCCUR MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,OQD GEWL AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT I $ AUTOMOBILE LIABILITY _ 35 MCCXD6390 10/01/2011 10/01/2012 , COMBINED SINGLE LIMIT 1,000,000 Ea accident ANY AUTO j BODILY INJURY (Per person) $ ALL OWNED SCHEDULED I BODILY INJURY (Per accident). $ AUTOS AUTONON-OWNED PPRO gR7 DAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAS OCCUR i EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $—_------ $ A WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012 1 WC'STATU- I OTH- ER AND EMPLOYERS' LIABILITY 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE �N E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) / A E.L DISEASE - EA EMPLOYEE "$ 500,000 It yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMrr $ B PEOOH55500 0507 09/27/2011 09/27/2012 i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GtK I It-IGA I t= HL)LUtH UAIVGCLLA I IUIY 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 .. - e4 ©1968.2010 ACORD CORPQRAI IUM. All ngnts reservea ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD LLJ C) 4.0 2 a CL R a c o� t0 ® W V u> g V4 3 cxfn yJ �IE 1 V v � LLmo T^ � aou e " y D � p _ ° p 'c \ij 0 OC O r =M 1C p {L a 3 gcEEg915 3 05 LLJ LU M CL CL 74 .- cn pE -8� nm°q'°pE c N N1 �O ■ U' - tIi Q Q '' ■ ~ � V. M. o.� u S[!p N W � t: W , oo ra? z 0 _ A P' �■h� e L