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HomeMy WebLinkAboutBuilding Permit #Exception - 19 CARTY CIRCLE 5/1/2018 BUILDING PERMIT 32�h No°T`�q�a M TOWN OF NORTH ANDOVER o , APPLICATION FOR PLAN EXAMINATION _ I b Permit No#: Date Received gcHus���y Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION __ _. _ _ _ _ - Print PROPERTY OWNfR - Print 100 Year Structure yes no MAP _ __PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: __❑ Demolition El Other p ❑ Septic ❑Well ❑ Flood Iain ❑Wetlands ❑ Watershed District ❑Water/Sewer - - --- - --- DESCRIPTION OF WORK TO BE PERFORMED: i f Identification- Please Type or Print Clearly i OWNER: Name: Phone: I Address: _ Contractor Name; Phone: Address: . Supervisor's Construction License: _ _ Exp. Date. _ Home Improvement License:_,_,, _ Exp. Date: - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaPanty fund E ignature of Agent/Owner _ - _ Signature of contractor f L � r O� pORT/1 q F BUILDING PERMIT "" "°Vag°� TOWN OF NORTH ANDOVER ° x .ti APPLICATION FOR PLAN EXAMINATION + - b Permit NO: Date Received Date Issued: / �9SSAC NUs�t�h I PORTANT:Apgficant must complete all items on this page LOCATION PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT:. Historic District yes no d I Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed.District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: `�'� G�GI Phone: 7 Address: ayA CONTRACTOR Name. 4 Phone: l</ Address: Supervisor's Construction License: / - Exp. Date: Home Improvement License: �7� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA D ON$125.00 PER S.F. Total Project ost: $ /d �y9� 00 FEE: $ 2 Check No.: 1 44 4 Receipt No.: NOTE: 'dirs g ith unregistered contractors do not have ace the g m Wnnty fund Signature of Agent/Owner •ea_ �gyee Signature of contractor ,. Location No. Date ///r//v . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ice -3 Foundation Permit Fee $ Other Permit Fee $ 'L, TOTAL $ Check# 1 G V 2 2 3 '---° ` Building Inspector 70 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 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 r Water & Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: 1 Located 384 Osgood Street FIRE APARTMENT - Temp Dumpster on site yes _ no Located at 1;44 ain Street Fire'Deparfinent 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 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. .1' 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 f ❑ 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 4 ❑ Photo Copy of H.I.C. And C.S.L. Licenses I ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster perm q g its 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 o 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) o 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 � t1 at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Im nst be submitted with the building application i Doc:Building Permit Revised 2014 I - i NORTf-� Town of A No. 4;3.o * t = - h ver, Mass, COC NIC Nl WICN goRATED PP��.�y s Ll _ BOARD OF:HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ...... ..... ..... ......:........... ..... . . !d... . . ... BUILDING INSPECTOR ................................... //11 Foundation has permission to erect .......................... uildings on ..... .. .......... ........ .... b to be occupied as ....... ... ......... ........ .............. ..�......... �> ......... ............................. Chimney Rough provided that the person accep g 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough 9 Service i ................. ...... .... ....... .................... Final BUILDING INSPECTOR 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. i Renewal -MA,.� -..._ Ho_____.____......._______, me Improvement Contractor; byA11dersen. { T Renewal b Andersen Corporation License# (Expires 12!23/2015)4 y r rti h Federal Tax ID#41-191844 30 Forbes Rd. Northborough,MA 01532 ! (508)351-2200 Fax(508)-986-7072 ! j CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT I lBuyer(s)Name Date: I MARGE GERRAUGHTY - OCTOBER 6, 2014 Buyer(s)Street Address city State Zip Code i 19 CARTY CIRCLE NORTH ANDOVER MA 01845 !Email Address Home Telephone Number Work/Cell Telephone Number RETMOM5C^YAHOO.COM 978-682-8849 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"). !Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. I E Est.Install Date Method of Payment Total Job Amount $ 10,693.00 &mount Financed$ 0.00 Deposit Received(33%)$ 3,564.33 Check/Cash 12 to 16 weeks € Balance Start of Job(33%)$ 3,564.33 Deposit at signing$ 0.00 Check# E Est.Install Time Balance on Substantial At Substantial ✓' Credit Card Completion of Job(33%)$ 3,564.33 completion$ 0.00 1-2 days If credit card is selected,please see Credit Card Payment form !Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings E ichanging 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 a ;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) Buyer(s) By: Bl rice PeclG ✓ �� I Signature of Project Manager Signature Signature BRUCE PECK MARGE GERRAUGHTY I j Printed Name of Project Manager Printed Name Printed Name i i I YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAV AFTER THE DATE OF THIS TRANSACTION. i 11 SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. I1._____________________________________:_______________________________________ NOTICE OF CANCELLATION NOTICE OF CANCELLATION t 1 Date of Transaction 1016/11 1 You may cancel this Date of Transa ID/6/14 .You may cancel this transaction,without any penalty or obligation,within three business days f m the t transaction,without any p alty or obligation,within three business days fromthe ,above date.If you cancel,any property traded in,any payments made by you under I above date.If you cancel, ny property traded in,any payments made by you under ,'the Contract of Sale,and any negotiable instrument executed by you will be i the Contract of Sale,and any negotiable instrument executed by you willbe returned within 10 days following receipt by the Contractor("Seller")of your I returned within 10 days following receipt by the Contractor("Seller")of your ncellation notice,and any security interest arising out of the transaction will be I cancellation notice,and any security interest arising out of the transaction will be I canceled. If you cancel,you most make available to the Seller at your residence,in I canceled. If you cancel,you must make available to the Seller at your residence,in I ;substantially as good condition as when received,any goods delivered to you under t 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 I 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. Seiler regarding the return shipment of the goods at the Seller's expense and risk. iIf you do make the goods available to the Seller and the Seller does not pick them upI If you do make the goods available to the Seller and the Seller does not pick them up I within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose - l;of the goods without any further obligation. If you fail to make the goods available I of the goods without any further obligation. If you fail to make the goods available Ito the Seller,or if you agree to return the goods to the Seller and fail to do so,then I to the Seller,or if you agree to return the goods to the Seller and fail to do so,then !you remain liable for performanof all obligations under the Contract.To cancel I you remain liable for performance of all obligations under the Contract.To ce cancel ,this transaction,mail or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a signed and dated copy of this canceration notice any other written notice,or send a telegram to Contractor:Renewal by Andersen,I or any other written notice,or send a telegram to Contractor: Renewal by Andersen,i '30 Forbs Rd Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF I 30 Forbs Rd.Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT OF i I E -.(Date) 1 HEREBY CANCEL TIUS TRANSACTION. I _.(Date) I HEREBY CANCEL THIS TRANSACTION. I I I _ 1 Buyer's Signature Print Name Date I Bger's Signature Print Name Dale 1 Renewal Renewal bV Andersen Corporation MA Home Improvement Contractor byAndersen. 4 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015) I WINDOW REPLACEMENT (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet lBu er(s)Name Date of A recmcnt MARGE GERRAUGHTY MON OCT 6 2014 i (Thc buyer(s)listed above hcrebyjointly and severally agree,to purchase the goods and/or services listed below,in accordance with the prices and terms ,described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM 1NNDO1N AND DOOR REMODELING �AGREEMEN7,of which the Specification Shcet is part. WINDOW DETAILS Approx. Exterior/Interior Color Hardware Hardware LowE4/ Grille Grille Glass Room # U.I. Window/Door S le Detail Casin 5 Ext-Int Color sle Screens Smansun Grilles Sash 1/3 Sash 2 Lifts O tions Family _L__8l DB sci rail equal insert sloped sill Ext.Wrap WH/WH White Standard HFG SmartSur INTW 4/2 4/2 No Bed 1 2 81 DB sq rail equal insert slo ed sill Ext.Wra HIM White Standard HFG SmartSur INTw 4/2 4/2 No Bed 2 3 81 DB sq rail equal insert sloped sill Ext.Wra H/WH White Standard HFG SmartSur INTw 4/2 4/2 No i I 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. Casings Angle Utes Interior Ext/Int Color Grilles sashes sashes Screens Smartsun Soffit Color SPECIALTY WINDOW DETAILS Full/ Approx. LowE 7 Specialty BAY/BOW ADDITIONAL WORK NOTES Room Count Style Insert U.I. SmartSun Grilles Grille S le ExuInt Color Cunou,cr that nigh ba/ 72 i,vh,, dmm wiil Ix�si ,ilieam lass In>r. ADDITIONAL WORK DETAILS: If:Jar •aill there m insult disarm:md rcnuwe. I No Contractor will wrap exterior casings with coil stock color of 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 1 V, whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,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, j windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued. I 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# 1611 $ 132 s Yes All discounts have been applied to this agreement. I 6 ✓ Yrs No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). ,It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR RENIODBLING AGRITN1GNT constitutes ttnc ,ontim understanding between the parties,and there arc no verbal understandings changing or modifying any of the terms.']'his Specification ;tiny ay Lot be changed or its terms ;modified or varied many way unless such changes are in writing and signed by both the Buyer(s)and Conuncto: Buyers)herel)y aclmovlcdge that Buyet'(s)has read this Specification Nicet. ,Renewal by Andersen Corporation Buyrr s) Buyer(s) i-t/ce 7 u' r Signature of Project Manager Signature Signature BRUCE PECK MARGE GERRAUGHTY Print Name of Project Manager Print Name Print Name The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations I Congress Street, Suite 100 �= Boston, MA 02,114-2017 " www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip: NORTHBORO, MA 01532 Phone#:508-351-2200 Are you an employer?Check the appropriate box: Type of project(required): I.n I am a employer with 30 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E-]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ©Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' insurance.$ 9 ❑Building addition comp.[No workers' comp. insurance P• required.] 5. Q We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their ]].❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E3 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'My applicant that checks box 41 must also fill out the section below showing their workers'compensation 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic. #:MWC 30293800 Expiration Date: 10/01/15 Job Site Address: City/State/Zip:/�!vr�� Attach a copy of the workers' co pensation 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 criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb i nder the pains and penalties of perjury that the information provided above is true and correct. D Sianatu at re. e: pho 08-351-220 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• i ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Willis of Minnesota,Inc. NAME: certificates@wiliis.com c/o 26 Century Blvd (A/C PHONNo Exit:(877)945-7378 P.O.Box 305191 EMAIL FAX No):(888)467-2378 Nashville,TN 37230-5191 AooREss: INSURERS AFFORDING COVERAGE NAIC q INSURERA:OId Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 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 TYPE OF INSURANCE MM/DDDY/YYYY MM/DD EXP LIMITS LTR POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE y 1,000,00 01 CLAIMS-MADE T OCCUR WZY302940 10/01/2014 10/01/2015 PREMISES Ea occurrence $ 500,00 MED EXP(Any one person) $ 10,00 _—— PERSONAL$ADV INJURY $ 1,000,00 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X POLICY❑JE. LOC PRODUCTS-COMP/OPAGG $ 4,000,00 OTHER: a AUTOMOBILE LIABILITY Ea acrid COMBINED LIMIT $ 5,000,00 A X ANY AUTO MWM302575 10/01/2014 10/01/2015 BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED D PROPERTY DAMAGE 6 HIREDAUTOS AUTOS Peraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LU18 CLAIMS-MADE AGGREGATE $ OED RETENTIONS WORKERS COMPENSATION a AND EMPLOYERS'LIABILITY Y/N X STA UTE ERµ A ANY OFFICER/MEMBER F-l( UDEPROPRIETOR/PARTNER/EXECUTIVE ® N/A MWC30293800 10/01/2014 10/01/2015 E.L.EACH ACCIDENT y 1,000,00 (Mandatory in NN) E.L DISEASE-EA EMPLOYE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks schedule,may be amctred If more space is required) CERTIFICATE HOLDER CANCELLATION 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 &0 Evidence of Insurance � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a a� Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers isor License: CS-090125 r JAIME L MORIN 86 GARDENER ST. ' LYNN MA 01".'F i Expiration Commissioner 101OW2016 i �\ Rice of Consumer Affairs&Business Regulation r OME IMPROVEMENT CONTRACTOR Registration: 1709'1:4 Type:,f Explratton: 12/23/2015 Supplement r: ; RENEWAL BY ANDERSON'bORPORATION JAIME MORIN 104 OTIS STREET ? a NORTHBOROUGH,MA 01532 — f' c. Undersecretary e newa . ode WINDOW �t4FLACkf��1C0 �pAudeor�4p�fi WOO E4 Dome "10 ENERGY PERF® CE U-Factor(U.S)A-P Soar Heat Gain C®sficient PES Visible Trottserliti�t Mem.low U*Fmm dmb"k" hwERir,sleglf ��lMil�j061e�� KwVIM�rWfc►MV��6 MMNlJIhi!(�j DESM PRESSURE(pg� -L 25 RhA DR Sloped Sill D!�Yk iMWr1K�wl�gd few&wom.aNEC.,cur BIE�c,A6h aplPol �Slr�q/