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HomeMy WebLinkAboutBuilding Permit #154-13 - 19 CARTY CIRCLE 8/24/2012 TOWN OF NORTH ANDOVER ` APPLICATION FOR PLAN EXAMINATION Permit NO �' J Date Received Date Issued: '► 2. IMPORTANT:Applicant must complete all items on this page LOCATION 1 0� �G•f r ��. nn Print PROPERTY OWNERUnit# Print MAP NO: PARCEL:0019- ZONING DISTRICT:R Historic District yes o Machine Shop Village yes 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Rlf�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other *-,r,-'w•`^�,t ..FW . qr."'- C«�.1`iC -r= *_,, .�; r. Yr-�........q D ejrr�/t��ic [7 We11 ®�Floodplaint. etlands _ }T} 0 WatershedlDistnct, F�' i v l^1 si 1­.a..pP...,T vW_ra . 0 Water/Sewer`' DESCRIPTION O WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: (Y\ CO e r Phone: Q 1- P9 nt-t Address: (� a J� ., ��I��_lt �o C', D\8°-1 S CONTRACTOR Name: Phone: Address: 10 -\ Supervisor's Construction License: q.51-b-3- Exp. Date: i a Home Improvement License: I ?10 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. F FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3(CP , u,� FEE: $ ,u�3 Check No.: a�g N 9q Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SiynatureaofAgent/Oinrne _ Signaturerofcontractor 5.,_` Location No. Date fid^ • - TOWN OF NORTH ANDOVER e l�yt"ED'I e Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �` r 25646 Building Inspector 1 I 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 . t I CONSERVATION Reviewed on Siqnature COMMENTS 1 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/Siqnature& 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.$100-$1000 fine I NOTES and DATA— For department use I' ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application a 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 ❑ 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: Doc.Building Permit Revised 2008mi NORTH T% own of t ndover No. hver, Mass, coc«�C«, K 1 7� �R�t7E� I.P���S _ T T S U LDBOARD OF HEALTH Food/Kitchen PERMI Septic System THIS CERTIFIES THAT „® �ti�%� ............ BUILDING INSPECTOR ....... Foundation has permission to erect .......................... uildings on ...� .......C.�j�,.�!!. .! i. . Rough g to be occupied as ......... �...��j ..�. ..o............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN ONT S ELECTRICAL INSPECTOR UNLESS CONSTRUC 6 TS Rough Service ............ ............................................... — BUILDING INSPECT Final GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE `I RRO®UCT PERFORMANCE Up Y. Andersen' MFR- C Certified Tial Unit Performance (coDiynDed) 3 Andersen*:Product. Glass Type U-Factor' SHGC' VrI 200.Senes _ Gear Dual Pane 0-45 0-60 063 - Clear Dual Pane•.vdh Grifles 0.45 0-54 0.56 - Tilt-Wash - - Low-E 0.30 032 0.55 Doohle-Hung.Window,. Low-Ewith Gilles 0.30 029 0.49 HP tmv-E4 SmartSun 0.30 021 0.49 =.d .' HP Lmv-E4 SmartSun•.v/Galles 031 0.19 0-43 Clear Dual Pane 0.45 0.61 0.64 - Narrolme Clear Dual Pane rnth Gilles 0.45 0.54 0-57 - Douhle-Hun;Window Low-E 090 032 0.56 Low-E with Gilles 0.31 0-29 050 1 Gear Dual Pane 0.44 0-63 0.66 - - NarroDne _ - - Gear Dual Pane with Galles .0.44 0.57 0.59 - `.Transam.Window Low{ 027 034 0.58 29 Lo-E wb Galles 027 030 0.52 r Clear Dual Pane 0.45 0.60 0.63 - Clear Dual Pane wlh Galles 0.45 054 .0.56 - . Low{ 0.30 032 0.55 . Gliding Window Low-E ith wGrilles 0.30 029 0.49 g Ej Low{SmartSun 030 021 0.49 Lo -E SmariSun with Grilles 0.31 0.19 0.43 E9 Gear Dual Pane 0-43 0.61 0.65 - -'1 Clear Dual Pane with Galles 0.43 Q55 0.58 Fued Transom Low-E 028 033 0.56 '�Circle.Top`Winitow i- Low Ewith Galles 028 030 0.50 `-`I Low-E SmartSun 0_7 022 0.51 Low{SmartSun with Grilles 027 020 0.45 Clear Dual Pane 0.44 0.61 0.64 - Clear Dual Pane with Gnlles 0.45 0.53 0.56 - Lmv-E 029 032 0.56 - Narrohne Low{with Grilles 0.30 029 0.49 >6110ing:Patio Doors Low-E Sun 029 020 0.31 :�3 M Low-E Sun with Galles 031 0.18 027 Low-E SmartSun 028 021 0.50 - W-E SmartSun with Galles 0.30 0.19 0.44 - - Gear Dual Pane 0.43 0.61 0.64 - _ _ Clear Dual Pane with Galles 0.43 054 0.56 - Lnw-E 028 032 0.56 - Perms-Shield - Lov E with Galles 0.30 029 0.49 Gliding Patio - Low-E Sun 029 0.19 0.30 -- Law-:Sun with Galles 0.30 0.17 027 Law-E SmartSun 027 022 0.50 a Lmr-E SmartSun with Galles 029 0-19 0.44 Clear Dual Pane 0.43 0-45 0.47 - Clear Dual Pane whh Galles 0.43 039 0.40 - LmrE 032- 024 0.41 Hinged.Inswing.. Low-E with Grilles 0.33 021 035 - 'Patio.Doors Low-E Sun 032 0-15 am -_ Low-E Sun v th Galles 034 0.13 0.19 - La E SmartSun 032 0.16 0.37 _] -_ Low{SmartSun with Galles 0.33 0.14 031 - A I ,Mderasenm .i Andersen NERC Certified Total Unit Performance (continued) Type f 7 Andersen,;Product' Glass U-Factor SHGC' Vf' Andersen Product Glass Type UFactor' SHGCz I Vl3 l Architectural .'.'.) 400 Ser e3' HP Low-E4 0.27 0.35 0.60 HNP Low-E4 0.32 t•028 0.47 HP Low-E4 with Grilles 0.28 031 0.54 P Lmv-E4 with Grilles 0.32 025 0.42 : HP law-E4 Sun 0.27 021 0.33 [-1 ',? HP Lou-E4 Sun 0.32 0.17 0 26 `_ (G Circle Top Casement Window r. HP Lour-E4 Sun with Grilles 0.32 0-16 0.23 a' Casement wi wind":' ,:; HP Lox-E4 Sun with Grilles 0.29 0.19 0.30 [ :.: ria HP Law-E4 SmartSun 0.31 0.18 0.42, G.'f i 1I� HP Lox-E4 SmartSun 0.26 023 0.54 .. HP Law-E4 SmartSun w/Grilles 0.28 021 0.49 HP Lurr-E4 SmartSun Jr/Grilles 0.31 017 0.38 ?F ;a HP Low-E4 0.27 035 0.60 HP Low-E4 0.32 028 0.47 °I HP Low-E4 with Grilles 0.28 031 0.54 HP lour-E4 w th Grilles 0.32 0.2 0.42 " ` 'F! - HP law-E4 Sun 0.32 0.17 0 26 HP Lor-E4 Sun 0.27 021 0.33 .® French Casement - Clrcle&Oval Window f'? Window HP Law-E4 Sun wM Gnlles 0.32 0.16 0 23 'I :I HP Law-E4 Sun with Grilles 0.29 0.19 0.30 f� HP Low-E4SmanSun 0.31 0-18 0.42 ; j HP Law-E4 Sma tSun 0.26 023 0.54 art5un w/Grilles 0.28 0.21 0.49 t I ® HP tow-E4 SmartSun w/Grilles 0.31 0. 0.38 HP Low-E4 Sm HP Low-E4 0.28 0.33 0.58 ..I HP law-E4 0.32 028 0.47 f HP lour-E4 with Grilles 0.29 0.30 0.52 RHP law-E4 with Grilles 0.32 025 0 42 r i t® a HP lav-E4 Sun HP Low-E4 Sun 0.28 0.20 0.31 0.32 0.17 0 26 {' Are Window i,. Awning Window HP w_E4 Sun with Grilles 0.32 0.16 0.23 ! HP Low-E4 Sun wdh Grilles 0.29 0.18 0.28 - I bi HP Law-E4 SmartSun 027 .023 0.52 11® HP Low-E4 SmartSun 0.31 0.18 0.42 !:? ' HP Law-E4 SmartSun w/Grilles 0.31 0.17 038 !' HP Low-E4 SmartSun w/Grilles 0.28 021 0.46 TEE R - HP Low-E4 0.31 032 0.55 HP Low-E4 0.27 0.33 0.58N,i - 'I :.l ( HP Law-E4 with Grilles 0.31 029 0.49 '-i Ell t .I HP Low-E4 with Grilles 0.28 0.30 0.52 [� I 1,.i HP Lox-E4 Sun 0.31 020 0 31 HP Law-E4 Sun 0.27 020 0.31 Caiement/Awning ! Flex iframe!Window ''', HP Low-E4 Sun with Grilles 0.29 0.18 0.28 r 1® '.Picture Window HP Low-E4 Sun with Grilles 0.31 0.18 0.28 i ?I HP Low-E4 SmartSun 0.26 023 . 0.52 s. HP Low-E4 SmanSun 0.31 021 0.50 `{ Hmar[Sun w/Grilles 0.28 021 0.46 I:i - j HP Law-E4 SmartSun w/Grilles 0.31 0.19 0.44 [ HP lou-E4 0.30 037 HP Lou-E4 0.31 033 0.58 0.64 i P Low-E4 S j HP Law-E4 with Grilles 0.32 030 0.52 � HP Lou E4 with Grilles 0.30 033 0.57 ? _�' HP Low-E4 Sun 0.31 020 0.31 l` HP Lor-E4 Sun 0.31 022 0.36 SpdnglmeWindow - Specially Window HP Low-E4 Sun with Grilles 0.31 020 0.32 ' gill® HP Low-E4 Sun with Grilles 0.33 0.18 0.28 .I HP Low-E4 SmartSun 0.30 024 0.58 fv4 •. I HP Low-E4 Smartsun 0.30 023 0.52 (t] t` HP Lux-E4 SmartSun w/Grilles 0.32 021 0.46 i HP Low-E4 SmartSun w/Grilles 0.30 012 0.52 i' G,ii NP Lor-E4 032 012 0.37 i HP low-E4 0.30 027 0.45 1 i HP Low-E4 with Grilles 0.33 020 033 HP Lox-E4 with Grilles 0.32 023 0.39 HP Lox-E4 Sun 0.33 0.14 0.21 - Frenchwood HP Low-E4 Sun 0.31 0.16 0.25 Mil -El Hinged Inswing.c Galles 0.34 0.13 0.16 - Gliding PaUo Door �I HP Low-E4 Sun with Grilles 0.32 0-14 0.22 R (roil� French Door HP Law-E4 Sun with li HP Low-E4 SmartSun 0.30 0.18 0.41 HP lou-E4 SmartSun 0.32 0.15 0.33 i�?? -j HP Law-E4 SmartSun w/Grilles 0.33 0.14 0.30 HP Low-E4 SmartSun w/Grilles 0.31 0.16 0.35 3i• "" Hp lnvr_E4 0.33 025 0.41 HP Low-E4 0.31 024 0.41 I'a� m� _ HP Law-E4 with Grilles 0.34 022 0.36 m E HP law-E4 wdh Grilles 0.32 021 0.35 1`i i.! Hp Lprr{4 Sun 0.33 0.16 0.23 `o Frenchwood Hinged :j HP lou-E4 Sun 0.31 0.15 0.23 Hinged Outswing - o Inswin Pdtro Door i French Door HP Low-E4 Sun with Grilles 0.35 0-14 0.20 _d g HP Lor-E4 Sun with Grilles 0.32 0.13 0.19 HP Lox-E4 SmartSun 032 0.17 0.37 HP Lor-E4 SmartSun 0.30 0.16 0.37 { ® _ ' HP Low-E4 Smaltsun w/Grilles 0.34 0.15 0.32 E o c`�� HP Low-E4 SmartSun w/Grilles 031 0.14 0.31 Hp {q 0.33 023 0.38 - a=aa HP Low-E4 0.31 025 0.41 R i - r ._. 1 HP lux-E4 with Grilles 0.33 021 0.34 HP lou-E4 with Grilles 0.32 011 0.35 CF�i ® HP Low-E4 Sun 0.33 0.14 0.21 Frenchwoefi Hinged HP Low-E4 Sun 0.31 0-15 0.23 f� Fued French Door S r r,. ,Sidelight HP lou-E4 Sun with Grilles 0.34 0.13 0.19 - outswing,Pab4 Door ;l HP Lor-E4 Sun with Grilles 0.32 0.13 0.19 HP lux-E4 SmartSun 0.32 015 0.34 - i' HP Low-E4 SmartSun 0.30 0.17 0.37Y _ HP law-E4 SmartSun vi/Grilles 0.33 014 0.30 . HP Low-E4 SmartSun w/Grilles 0.31 0.15 0.31 M `N M _ HP Lox-E4 0.32 015 0.41 HP law-E4 0.31 0.22 0.37 ftp 1'1® I ` - HP Lox-E4 with Grilles 0.33 0.22 0.37 r i HP Lou-E4 with Grilles 0.32 010 0.33 +� r^® .! HP Low-E4 Sun 0.32 0.15 0.23 - Frnnchwobd 'I HP Lor-E4 Sun 0.32 0.14 0.21 t-'. Fued Transom: i French Door- HP Low-E4 Sun with Grilles 0.33 0.14 0.20 Patio Door Sidelight 'f HP Low-E4 Sun with Grilles 0.32 013 0.18 - I": - HP Low-E4 SmartSun 0.31 0.15 0.33 HP Lux-E4 SmartSun 0.32 0.16 0.37 - !, HP Law-E4 SmartSun w/Grilles 0.32 0.14 0.29 �fl !`i , HP lox-E4 Smartsun w/Grilles 0.32 0-15 0.33 It:, HP law-E4 035 026 0.44 HP Low-E4 0.30 024 0.40 _ HP Low-E4 with Grilles 0.30 021 0.351 f'® _ HP Low-E4 with Grilles 0.36 023 0.38 - - - HP lav-E4 Sun 0.35 0.16 0.24 Frenchw' HP Low-E4 Sun 030 0.15 0.22 � +� i Folding Door 1: - t=, HP lou-E4 Sun with Grilles 0.36 0.14 0.21 Patio Door Transom HP LOW-E4 Sun with Grilles 0.31 0.13 020 - ® HP Law-E4 SmartSun 0.34 0.17 039 - HP Low-E4 Sm rnSun 0.29 0.16 036 "� Hp Low-E4 smart5un w/Grilles 0.36 0-15 0.34 - ':1 HP Low-E4 SmanSun w/Grilles 0.30- 014 032 . r`i® continued on Bed page •For NFRC certified total unit performance on units with capillary breathertubes for high altitudes,please visit andersenwindows.com. •-"High-Performance"Low-E4'-(HP Low-E4),'High-Perfoanance-Low-E4'SmartSun`(HP Law-E4 SmartSun)and'High-Performance'Low-E4'Sun-(HP Law-E4 Sun)are Andersen trademarks for•Low-E glass. ' U-Factor defines the amount of heat loss through the total unit in BLU/hr sq.ME The lowerthe value,the less heat is lost through the entire producL Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com for specific performance values.Doorvalues represent tempered glass =Solar Heat Gain coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward.The lower the value,the less heat is transmitted through the product 3 Visible Transmittance(VT)measures haw much light comes through a product(glass and frame).The higherthe value,from 0 to 1,the more daylight the product lets in over the product's total unit area:Visible Transmittance is measured over the 380 to 760 nanometer portion of the solat spectrum. •NFRC ratings are based on modeling by a third party agency as validated by an independent test lab ine industry with ands program and procedural requirements. •This data is accurate as of December 2010-Due to ongoing product changes,updated test results or new industry standards or requirements,this data may change over time.Ratings are for sizes Specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different grille options,glass for high altitudes,etc •PassiveSun-glass values are available online at andersenwindows-com. 277 E �Iassarhusetts Dcluu"tIII cnt of Pill)lic ;tFct� Board of Buildinu Rc'ulations and .standards i Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST CIRCLE WORCESTER, MA 01603 now J-- Expiration: 9/8/2012 (ununi si"°c i' TrY: 2622 Office f Consumer ,,�✓�taa�cac/uce Affair&giness Regulatio❑ HOME IMPROVEMENT CONTRACTOR Registration: .x,70810 Expiration: _x/2013 Type: R ___, Corporation WAL BY AND, RATION fi j; BRIAN DENNISO 104 OTIS ST. � '` ' j NORTHBOROUGH,Il(��0�53'�.�� —x Undersecretary !f II i I Renewal Re,,4wal by Andersen Corporation w MA Home Improvement Contractor CA ,104 Otis St.,Northborough,MA 01532 License#170810(Expires 12/23/2013) by dersen. (508)351-2200•Fax:(651)351-4810 Federal Tax 1D#41-1918413 WINDOW REPLACEMENT an AAe Cmv y WINDOW SPECIFICATION SHEET Buyer(s)Name Date of Agreement The Buyer(s)list above hereby jointly and sevlly agre purchase the goals and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and thl reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. 066— WINDOW DETAILS 1. Contractor will Install a total of 1 wigs 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(GPM ❑ 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 Qty of Sills t replaced by Contractor: 4. ❑/]fes El No Qty of;=s toriNew Construction Full frame(includes new interior&exteor casings)and actual_ Exterior casings:❑Pine Maintenance-free material❑Factory applied 908 Fibrex brickmold 5. Glazing to be:V HPLo -E-4 T"' E3Other If other,please specify: 6. Exterior color to be:[}White❑Sand❑Canvas❑Terratone❑Cocoa Bean 7. Interior color to be:[Q�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. VJ 8. Hardware: White❑Stone❑Canvas❑Brass❑Estate Hardware: Style: 9.❑Yes[�No Install Lifts with Double Hung Vindows 10. Screens: windows to have:E]Half or [ 11 screens Screens to be:❑Fiberglass❑Aluminum❑TruScene GRILLE DETAILS 11.Windows have grilles:❑Yes Y, No If yes:❑Grille Between Glass(GBG)❑Removable Interior Wood uNT\v)❑ Full Divided Light(FDL) Qty. Qty. Qty, Qty: Qty: Qty: "Qty: Ll L ON DH DH OH cWIPi— I GW C..'. Draw grille patterns above 'Use additional sheet if needed Owner approved(initials):( ) ADDITIONAL WORK DETAILS 12.❑Yes No Contractor will remove metal frames of windows.Qty of Units: 13.❑Yes[INo 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 E�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 ppenings: ❑Pine❑Maintenance-free material 15. O�mer is aware that Contractor does not do any painting. Owner Initials 16. Yes❑No Contractor will wrap exterior casings with aluminum oil stack of A color.UAt t Note: Wrapping may be required with storm wfndo sal;removal of storm windows will leave screw holes in casing. 17.des❑No Contractor will insulate,caulk and seal with 3-point system to prevent water and air infiltration. 18.ZJ Yes❑No Cleanup all job related debris including old vin W will be removed.Vacuum nightly. 19.E]Yes❑No A limited warranty shall be issued to Owner n completion of the job and payment in full. 20.❑Yes❑No Building Permit—Contractor will secure any and all necessary permits.The fee for the permit(s)is not cluded in the Contract Price and a separate check is required at the time of sale for this fee. 2J.,;, 1. es❑No All discounts have been applied to this agreement price. 22.Additional job details: toe AA I () 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 er its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and Con or Bu r(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by de r 'on Buyer()j / Buyer(s) S' lure of tint Manager / Signal= P Signature 6�:; Print Name of Product Manager Print Name Print Name I I Y"Re COMMUXT'Veakh of Ha&war-Yr 'atts Depo twee of rr�dustrial Ac:. �idcntg 600 WaRiTingt6'.1 S reef . Bastpn; 1r�4 QZIZI ass.go�fdia workers' -Compen.smdon F gvrance Af 2Vit hers/Co�rfrae�ars/ eetrieiarz,/��p�n�ers A-pplicmt�orl�atian p'�ease Print Le blFr -N3ID-e(Baine&s/Orgauimion/3ndividi4: 1 (tee\mac r1 A dreSS; �tty/Sita/Tip: �Jr���- ����t� --3D- Fhone j-re you an employer? Check the appropria bur, Type of pro}ect(ret reds: L. I am a employer with '3D 4, ❑ I am a general contractor and I G. ❑New c0nst7Uc5on cinpto ees full and/or art-time, hgve hired the sm-contractors 2•❑ II am a sole prvpnemployees ator orpartam- y Hgts,d an the attached sheet $ 7'' and hate no These subntractors hate 9• ❑Demolition ship -co- y working for me in any capacity, wor mrs' Comp.'insurance. .9. ❑Bus7ding addition . [No worimm' comp, mar=t:= 5• ❑ We are a corporation and it 10.0 Electrical repairs or additions required) - have c:ercised their . 1. Plusnbisg repairs or atltiitions 3,❑ I am a.homeowner doing all work right of e�emptian per Zed l ❑ myself [No workers'.comp. c• 152, §1(4), and we have no 12.❑RDof repairs t employees [No workers' L3, Other insnr�nr_e required.) ❑ :Coilp.iamm ce required,.) °Auy applicant that ehecla;box 91 must also fu out flat station below showing their worl=r'comp—ation policy-iufuffiahon. t Homeowners who submit fhis affidavit iudicaEing fey arc doing all work and fhm hire Muck cant zcb:IM M=t suhmit a new affidavit indicating such. �Cantmctms'that check this box must attached an additional sheet shoamig thr mama of tht'sab cogs=toys and their warluat'coin.policy uiformarioa I ern ea.ernplgper than is pr©uiding-workers-'eompenTation im&=7-ame for my emplayees. Bp-Luff is the poky rand job sae Insurance Company Name;_ �/ E' .p U`\ apiration Dates: Policy#or SaLf-ins• Lit, :p. Job.Site Addr-ess; CGl-/-,A, �� n"Y /Z:iF' , _k'L-tach.a copy of the workeers' r-nMpeasstion pDhr-y declaraAon Mage(shaw�g the paiiey number made Fr afion rizt e}, )"aLrt to secure coverage as required under Section 25A of-MOL c, 152 can lead to the imposition of coal pemltim of a fine•up to �1,500-00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WOPK ORDER and a foie of up to X250.00 a day against the violatnt. Be advised that a copy of fhis statement maybe farwarded.to the Orli.c(,of 10,eRtigi ions of the.DLk for mgarsnre covaratr ve Roation_ -------------n ' rat tie in orma ion oNided abope is&ae omd carrpcL .I do hereby:ee7 f) zoder;°tFre pram persfflties open )� f pr I?ale' � c��I1 �•- phone# ��� a QJ�Rcial pose unp. Do not write in tFz&area, tv be cumpleted bry cl#or€rrx n ufficiaL . 4aty Br Tuw= P eLTF€IfIL��f=RSE# �s�eg Aufharitp(eu�c're.one�; 1 B•asrd 6f Heslih 2, Sig Deparf�ent.3. Citg/Toi Clerk 4;IIectzicallzspectar S.Pk�iag°Inspector .L �fher C€r at Aei son miDue ` ❑fitE(MMroDmYY FE ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ND [LIGHTS UPON THE CERTIFICATE HOLDER THIS , FIC 4TE DOES NOT'AFF[RMftT!\tELY QR NEGATIVELY AMEND, ECTEND END-OR ALTER THE'COVERAGE AFFORDED BY THE POLICIES . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CDNTRADT BETVVEEN THE ISSUING INSURER(S), ACITHORI=ED SENTATIVE•DR PRODUCER,AND THE CERTIFICATE HOLDER... TA[N'T: If the cerfificate hoider'is an ADDFTIDKAL INSURED, the poficy(ies) must be endorsed. If SUSPDGkTIDN IS WARVED, suh)ect'LD ms and conditions of.the policy,certain policies may require an endorsemenE A statement on this certificate does nat confer rights to the ;ate hoider in Fieu of such endorsement(s)• 1-E12-333-3323 MA� 3oneeHargrvv or M-—e P6imDs m_naaias P4CNNn 61E-MAIL Sth Otteat ADDRESS: Suite YDD PRODUCER ?Si].IIIIEapn Lits, MN.556D2 CUSTOMER ID ti INSURERS AFFORDING COVERAGE NAIL P 1wruFEL .' INSURf3t,t: OLD •-REPT IBI= IKE CD 2 E 167 kemewal By Hnderaen CaLporatjcm INSURER B: N9 T2ONT T, mLOF INS CO OR FSTTS 19665 LD¢ Otis S`trae.t INSURER C: INSURER D: Rarthboraugh., NX DLE32 thlsuR3ZE: ' MURE?F COVERAGES CEFt'.TIFICATE NUMBEFt- 251.4267 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PDUCIES OF INSURANCE LIST-ED BELOW HAVE.BEEN ISSUED TO THE INSURED NAMED•ABOVE'FOR THE POLICY PERIOD INDICATED.. NOTWFTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TD WHICH THIS CERTIFICATE MAY BE ISSUETD•OR MAY PER-i AIN, TH'E INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN•IS SUBJECT TO All THE TERMS, , EXCLUSIONS AND CDNDIIIONS'OF SUCH POLICIES..LIMFTB'SHOWN MAY HAVE BEB\l REDUCED71'PAID CLAIMS. [NSTR ADOL-SUER POLc:r EF, .PODGY E57 .LIMITS LTR TYPE OF INSURANCE S POLICY NUMBER TM ❑ MMID❑ A GENERALLLA3tL:ITY MAEY 5931.3 LD/DL/L G' D-o/DL/� EACHOCCURREIJCE b L,DDD,DDD ' DAMAG O Inca S SOD,O D D COMMERCIAL GENERAL LIABILffY CLAMS-MADE M OCCUR MED E7D''(Any one pen;an) LD,D D D PEFGONAL E.ADV INJURY b 1,DDD,DDD . GENERAL.AGGREGATE b s,DDD,DDD GEN'LAGGREGATEUMMAPPLIF3 Pc'-'P�' •PRODUCTb-COMP/OP AGG 6 3,DDD,DDD % POLICY PRD- LOC S A AUTOMOBILE LIABILITY XVIT'B 21377 - LD/DLI 10/DL/12 COMBINED SINGLEUMIT �.3,DDD,DDD - (a aQadmll ANY..AUTr0 BODILY.INJURY fPerpen=l) F ALL OWNED AUTOS - BODILY INJURY fPeraccidenl) b SCHEOULm AUTOS - - PROPERTY DAMAGE .6 HIRED AUTOS (PeracxidenQ - '% WON-OWNED AUTOS - b b B % UMESVBELL LALUaB % CCCUR 25D3OSL9 lq/OL/ 10/02-/]2 EACHDCCURREIUCE 6 25,DDD,DDD E=Ea 6.LIAB CLAIMS-MADE AGGREGATE $ 25,DOD,D O D b DE77uc7TBLE s % RET-d MON 6 25,DDD we srATu DTH_ A MRh.P,SCDMPENSATTON MKC L17L4D DD lD/D1./ LD/DL/12 g AMD EMPI-DYERS"LIASILirY Yl N ANY PROPR[Eli7FUPARTNc"ftlr"�E.DU71VE F�EACHACCIDENT b L,DDD,'DOD DF TCEF'JMEMBER.EXCLUDED? N/A - (N—datnryinNH) E-LDISEASE-Fh FMPLO .$ L,DDD,ODD fhyes,deacrf6e-under E_L DISEASE-POLICY LIMIT b 3-,DDD,O D D DE�;CRIPTJON OF OPE IiZATTONS 6ebw I RIFi1DN of OPER&-n0NS/EDET55NS/VEHICLES (AfYaeh ACOR:D 1 PL,Addmuml P Scheduke,•ir mere space is required) _ Ti.tLnce .a1. Tj'uL',,.e, EIi TIFICATE:FIOL.DER CANCEL•LATTQN SHOULD ANY 13FTHE.ABDVE D8S;C: 9.ED POLICES RE,CANCELIF7 BEFORE illem=e of T a**—*ae THE 'EI7'IRAT7DN DATE THETZEDF, NDTICE "WILL HE DS VSZ D IN ADaDMANCE WrM HE POLICY PRDVISIDNS AUTHORrE D FMMESEEN'rA.TIVE - Mw _3mas ®"45H&-�f1R4 ACOC�D COR?D.F DOR. All rights I�selvea C�kD 2+5 ��tZQ9/1.'9) The ACOI�D riame'and iagD are regisiBrad rear- Of AC:DF�.,D lQ�..— a' MA Home Improvement Contractor nle 1l)VV 2 Renewal by License#170810(Expires 12/23/2013) byAndeArsen.0onto acampony Andersen Corporation Federal Tax ID#41-1918413 WINDOW REPL104 Otis St.,Northborough,MA 01532 (508)351-2200•Fax:(651)351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Bayed,)Name Date of Agreement mGet, O U Buyer(s)Street Address,.lty,State,and Zip Code 0 - i q N. W(;Ile mo , df / E-Mail Address Home Telephone Number work Telephone Number 910 Fez as y Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation ("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 oat tion;rtificate Er Con ctor has completed all work tinder this Agreement. Total Job Amount:3 C,6 2 Estimated St riing Date: Method of Payment: O Deposit Received(33%): ' IZ' ,eCeck OCash OFinanced isa/MC ODiscover OAMEX Balance at Start of Job 133*4 Estimat d C mpletion Date: If credit card is selected,please see Credit Card Balance on Substantial Payment Form. Completion of Job(33%): 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 1F THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyer(s) Buyer(s) By tf //1fL�Q/L XLLi✓ ttp�� Signature of Product Inager Signature Signature Print.'ame of Product NMager 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. --- — — — - — - — - — — -- -�<- — — — — — - — — — — - -- — — — — — — — — — — — — — — NOTIgff CELLATION X NOTICE OF CANCELLATION Date of Transaction .You may cancel Date of Transaction .You may cancel this transaction,without any penalty or obligation,within I this transaction,without any penalty or obligation,within three business days from the above date.if you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract of Sale,and any negotiable inshument executed I Contrail of Sale,and any negotiable instrument executed by you 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 I as when received,any goods delivered to you under this this Contract or Sale;or you may,if you wish,comply Controct or Sale;or you may,if you wish,comp.1y 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 Seller does not Seller does not pick them up within 20 days of the date I pick them yp within 20 days of the date of your 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 an 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 ou agree I goods available ro the Seller,or if you agree to return the ro return the goods ro the Seller.and fail ro jou then I Dods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations under 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: notice,or send a telegram to Contractor. Renewal by Andersen Corporation,104 Otis Renewal by Andersen Corporation, 104 Otis Street, Street, Northbo gh 01532, BY NOT LATER THAN Northborough,MAOI BY NOT LATERTHAN MIDNIGHT MIDNIGHT OF .(Date) OF .(Date) 1 HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buye:s sigma,i Print Name Dare I Buyer's Blgnoture Prim Nerve Dale RbA Copy- White Buyer Copy-Yellow Buyer Copy-fink CJ30200923APh.MANH i i