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HomeMy WebLinkAboutBuilding Permit #424-16 - 210 ROSEMONT DRIVE 10/5/2015 iS- NORT. BUILDING PERMIT °�tt`Eo 16 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION �( Date Received—1� R ED Permit No#: ��SsgcHus���5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �/ Print PROPERTY OWNER �a AVIO`SSC��7� Print 100 Year Structure yes no MAP 091 PARCEL: 0"'I ZONING DISTRICT: �"" Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building &6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑a=11Vatershed ®istrt Septic t �rlNell ® Flo�otlpla,rp ®Wetlands. _ ®`Wates/Se_wer It iL - -- , DESCRIPTION OF WORK TQ BE PERFO MED: 4e �vd r v �'r�cv`w ^Identification- Please Type or Print Clearly OWNER: Name: �b 4/ in�cSc� Phone: �1�� bbl— ��/�' ' 1 Address: Contractor Name: U--A lyyff 16Rt1_1 Phone: k7 , ?-ee- 6 d`f�'�-- Email: Address 1 o.�..✓e < .lryct 10 Supervisor's Construction License: L/)'L?&12 /o -3� Exp. Date: /4 Home Improvement License: / 7!) IExp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ & 2:5 FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access"t guaranty fund e� a'. 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 m U FORA PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 4 i 4 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sevier Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street AFIRE D ». , Er- R~1'iViNT Temp ®umpsterdanxsifeYes ttLocated at 1024 Main Flr@ ®epartment sigUZI n �i F;g` �;' Xe` „ .:.�• t "` �f "xt ' c '; ' rstsr _ nU�e�d E' �4r`a f t 3� G* ' ►x e +�'.r ��='C��{";"�� i.f�]t "' _. ,�. °+aa.� €�z "Vt. '� �� `}�'�� 'j F n� r _-�, 'i ,.�•w �$l�e.d, �s.{ `�a � 7 i'� �'�r �� �••_ ;: !� c�a. w �'"-^'°'"'�.'-A'�'�_r,y �� "i ,•'t �y�.►!,a. ,S�;<,. c.a"t y � �'��Pa r�+.' ..+'1 �,� +: >,��.�'c�'�+ ''?k t� J�i��''�Z 9:7��t�: T' S E+{*'3�° -�g,'..`Zir, yi;',r� tt!^r��, � r`y� C®M WN NTSS �.-.1....r":+..,-�i,..'.a rr•V:{.JM1;�.ti.k-....:ieaa. �fi ,Y;ia`f �5 r �n��i `t{{• 'y�y�w�� ��{t,S.r.'d�.,��'�F..���,r.�.�tt� '# Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, rust or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes ISI® MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA— (For department use) ELI Notified for pickup Call Email Date - - - - '-`----��Time Contact Name Doe.Building Pen-nit Revised 2014 i 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 4, Building Permit Application 4. 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 OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) 4; Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 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 2012 IECC Energy code Engineering Affidavits for Engineered products permits require sign off from Fire Department prior to issuance of Bldg. Permit OTE: All dumpster p q g 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:Building Permit Revised 2014 I Location No.. Date • - TOWN OF NORTH ANDOVER ® Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee s Q 4 TOTAL $ — Check o by l r ry .g Building Inspector { � NORTN Town ofs EAndover No. �,o h ver, Mass,A. s" COCHICH&WICK%%, ADJ SATED r ,�5 `S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............ ......... •••• ••••• Foundation � buildings on 6s'r�y1 • :............................ has permission to erect g "..'""'..•................. Rough �t �yYr :.�.5� ...................................... Chimney to be occupied as . eA ••••••• •••• "' """"' ... ......................... ... 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ..... . ... ............................. Final BUILDING INSPECTOR GAS INSPECTOR _Occupancy Permit Required to Occupy Buildinz Rough Final Display in a Conspicuous Place on the Premises — Do Not Remove FIRE DEPARTMENT . No Lathing or Dry Wall To Be Done Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. Renewal" MA Home Improvement Contractor �Ar�dersen. _ License#170810(Expires 12123/2015) Renewal by Andersen Corporation Federal Tax ID#41-1918413 wINnOW ptrtAtlrMCMt eui A.ul. "G+�mrmv 30 Forbes Rd. Northborough,MA 01532 (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Bu er(s)Name Date: JOHN HASSETT - AUGUST 12, 2015 Bu er s Street Address CI State Zip Code 210 ROSEMONT DR N ANDOVER MA 1 01845 Email Address Home Telephone Number Work/Cell Telephone Number 978.687-7212 978.390.4356 Buyer(s)hereby jointly and severally agrees to purchase the goods 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 a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 6,520 mount Financed$ 0 est.Start Date Mpjad of PayMen DepositReceived(33%)$ 2,173.33 Deposit at sigr&V$ 0.00 5-10 weeks 0 Check/Cash Balance Start of Job(33%)$ 2;17$.33 Check Ir Balance on Substantial gst.Install TlmeInstall Time �, Completion of Job(33°k)$ 2,173.33 Atc mp w�$ 0.00 ( � Credit Card 1-2 days If txedlt card is selected,please No float .shall be demanded atoll all parties are eertsiied -._.. —_ See Credit Cord Payment tole Buyor(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. Buyor(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. Renewal by Anderson Corporation / Buyer(s) Buyer(s) !(/l-C"lit, CC S Signature of Consultant � � Si a Signature' X DUNCAN FIELDS JOHN HASSETT Printed Name of Consultant Prhttod Name Printed Name VOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANYTIME 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. --------------------------------------------------i----------------------- t NOTICE OF CANCELLATION AO'CICE OF CANCELLATION I Date of T mnwictlen 013$/15 . You may cancel#hisI Dote or Transoction 11/12/14 .You may canted this trunsacdon,without any penalty or obligation,within three busdnesa days from the transaction,without any penalty or obUgadon,within three business days from the above date.If you cancel,any property traded In,any payments made by you under t above date.If you cancel,my property traded in,say payments made by you under the Contract of Sal,and any negotiable iastrmneat executed by you will be t the Contract of Sale,and any negotiable instrument es—ted by you will be returned within 10 days following receipt by the Contractor("Seller")of lour I returned within 10 days following receipt by the Contractor("Seller")of lour cancellation 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 canceled. 1r you cancel,yet#must make available to the Seller as your residence.,In I canceled: If you cancel,you must make avalinble to the Seller at your r"Ildmees In sulsstantially as goad condition as when received,any goods delivered to you under I aubstandally ns good condition as when received,any goods delivered io you under this Contract or Sale;or you may,if you wish,comply with the instruedons of the I this Contract or Sale;or you may,if you wish,comply with the instrutdons of the Seller regarding the return shipment of the goods at the Seller's expense and Ask. I Seller regarding the return shipment of the gouda at the Seller".expense and risk. If you do snake the goods available to the Seller and the Seller does not pick theta up I If lou do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose or the,goods without any further obligailrtn.. If you fail to snake the goods available I of the goads without.any further obligation if you fall to make We goods avallalile to the Seiler,or it you agree to return the goods to the Seller and fail to do so,then I to the Seller,or if you ngere to return the goods to the Seller and fall to do so,then you remain liable for performance.of nit obligations under the Contract.7h cancel you remain liable for perrormance of all obllgntlona uadar the Contract.To,cancel this transaction,mail or deliver a iigned and dated copy of this emttantioa notice. I this transattlon,mall or deliver a signedand dated ropy of this cancellation notice or any other written notice,or send a telegram to Contractors Renewal by Andersen,t or any other written notice,or send a telegram to Contractor. Renewal by Andersen, 30 Ferbea Rd. Northborough,MA OI532. I 30 Forbes Rd.Northhorough,MA 01532. t HEREBY CANCELTRIS TRANSACTION. I I THEREBY CANCELTHIS TRANSACTION. I I . nw r.5vw" Pilin Nome eve � n,go,h LYrgm * _..OAtl NnM*_.. -- -OMs... RenewalRenewal by Andersen Corporation MA Home Improvement Contractor byAndersen.m 30 Forbes rd Northborough,MA 01532 License.;g170810 (Expires 12123/2015) ,10VIVIDOW R£PL CEMErrT (508)351-2200 Fax:(508}986-7072 Federal ID#41-1918413 Window Specification Sheet Buyer(s)Name Window of Agreement JOHN HASSETT WED, AUG 12, 2015 The buyer(s)listed above hereby jointly 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 WENDOW AiND DOOR RF IODELdNG AGREEM NT.of to hicb the Specification Sheet is part. WSNDOW&DOOR DETAILS App I App• APP[ - ExtenorAnterior Color Hardware Ha.2h%We LweE4/ _. . . Grille Grine Glass. Room--.--._--tt wlxh '.height Ul. Window/Door3 le Detail cast Ext-IntCola Style Sweets smarts,,, Griues Sash 113 Sa h2 Ufts Options Mchen 101 60 180 140 A-SERIES CUSTOM DOOR Ext.MF 908 WH/FN Sat.N Ckl Anvers FFG smartsur Nora Total 1 RNY,BOW&BUILD OUT DETAILS style Detail I w'edthr Approx- Number Frame Window End Center LowE/ Root/ Hardware Room count Style rlankers he', s Angle Lites Interior Ext4nt Color G61M sashes sashes Screens Smartsen Soffit Cola SPECIALTY WINDOW DETAI]S Full/ Approx. Lowe/ Saeaalty BAY/BOW ADDITIONAL WORK NOTES Rooet Cant style insert U.L smans- Grilles Grine Style Etdflnt Color (:tomtomer iso ,hat.ith inyi6cm•vvtdants under 72 ianc� Thar,roll t­.itirticnntAh:.1.W_ ADDITIONAL WORK DETAILS: I No Contractor will wrap exterior casings with coil stock color of Owner is aware that Contractor does not do any paintinglstairming or removallinstallation of alarm system or window treatments/hardware.It is the responsibility of the homeowner to have the alarm system and window treatmentslhardwam removed prior to installation. We make no guarantee as to whetheralarms or window r^ treatmentslhardware wilt Tit 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 �j 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 well be an additional charge for time and materials unless so stated in this contract s Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal',of all job related debris, windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in Tull,a limited'warranty shalt be issued. 4 Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permit(s)Is Included In the total contract price. 3 Yes All discounts have been applied to this agreement. 6 ✓. Yes L 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 urxlentmi by and between the parties than this Sperifrrition Sherr.along with the CUSTOM AVINDO[y AND DOOR REMODFLING AGRFFMCNr.cmiaitmes the entire widerstanding between the ifmairia,anal then:an:nn wrhai utuler.tandiop changing or n)(AiRing any cif the terms.This Speeifrration Sheet Tway not he changed or its icnitsrnodified or varied in anyway unless writ dtatrges are in%%riling and signal in,'Ix)th the Hti e;t(+)and Cmrtrx tor.BtryM—)heretn-ackaicnvItAr.that Bugs)has rod Aric Sprrifrca»nn Shut. Renewal by Andersen Corporation Buyer(s) Buyers) Dimclut,Fie `7 Signature of Consultant Signature Signature DUNCAN FIELDS JOHN HASSETT Print Name of Consultant Print Name Print Name / I dersen. Andersen NFRC Certified Total Unit Performance (cdnGnted) 4. ' I ' I Andersen.Product Glass Type 1-Factor' SHGC' VP r'i Andersen'Product Glass Type 1-Factor' SHGC' VF' Architectural 400 Selle f i Arc . HP NPLaw-E4wdhlEes•• 032: .. ,025 .:_..0.42 utif4®I ,. 4 032 0.28 HP Low-E4 0.27 035 0.60 HP Low-E4 with Grilles 0.28 0.31 0.54 HP Low-E4 Sun 0.27 021 0.33 f) '"i HP lux-E4 Sun 0.32 0.17 0.26 f; 0 Circle Top- Casement Window HP Law-E4 Sun with Grilles 0.32 0.16 0.23 },a:R.13 Casement Window HP Low-E4 Sun with Grilles 0.29 0-19 0.30 a HP tux-E4 SmartSun 0.26 023 0.54 fit HP Low-E4 SmarLSun 0.31 0.18 0.42.. t •j 13 Hp tux-E4 SmartSun w/Grilles 0.28 021 0.49 ti- -; HP Low-E4 SmartSun w/Galles 0.31 0-17 0.38 HP tux-E4 0.27 035 0.60 R :- HP low-E4 0.32 028 0.47 t'1 'I NP Low-E4 with Grilles 0.28 031 0.54 - HP Low-E4 with Grilles 0.32 025 0.42 HP law-E4 Sun 0.32 0-17 0.26 HP Lmr-E4 Sun 0.27 021 0.33 IV, Ir;L French Casement i Circle&Oval Window'."� t•'! Window HP Low-E4 Sun with Grilles 0.32 0.16 0.23 I HP Low-E4 Sun with Grilles 029 0.19 0.30 . HP low-E4 SmartSun 0.26 023 0.54 e i 1 M HP Low-E4 SmanSun 0.31 0-18 0.42 t ' 1j HP Low-E4 SmartSun w/Grilles 0.28 0.21 0.49 ` HP Law-E4 SmartSun w/Grilles 031 0-17 0.38 F'if Ti.(13 - NP Low-E4 0.26 0.33 0.58 HP Low-E4 0.32 028 0.47 '-_! HP Low-114 with Grilles 029 030 0.52 1p . HP law-E4 with Galles 0.32 015 0.42 A HP Low-E4 Sun 0.28 0-20 0.31 P f1i - HP Low-E4 Sun 0.32 0.17 0.26 . Awning Window. Arch Wlddow ,f HP lax-E4 Sun with Grilles 0.32 0-16 0.23 '`;fP ' HP Law-E4 Sun with Grilles 0.29 0.18 0.28 �.f ��. !! HP Low-E4 Smar[Sun 027 023 0.52 91 ® HP Law-E4 SmartSun 0.31 0.18 0.42 i"f{ r^ - HP Low-E4 Smar[Sun w/Galles 0.31 0-17 0.38 1:7 A NP Low-E4 SmanSun martSun w Grilles 0.28 021 0.46 +• HP Lour-E4 0.27 033 0.56 #+; i' HP law-E4 0.31 0.32 0.55 •� HP Low-E4 with Grilles 0.28 030 0.52 HP Low-E4 with Grilles 0.31 029 0.49 ! HP Low-E4 Sun 0.31 020 0.31 Bel - - - HP Low-E4 Sun 027 020 0.31 P:f Casement/Awning Sun with Grilles 0.31 0.18 0.28 !''.Fin • ndoir Hp Low-E4 n ow ' 'cWre VIR Wi d PI Flehhifreme _ 029 0.18 0.28 � �.;� .. I HP Low E4-Sun.M Grilles I'I HP Law{4 SmartSun 0.26 023 0.52 HP law-E4 SmartSun 0.31 021 0.50 t HP law-E4 SmartSun w/Galles 0.28 021 0.46 R ;f'® HP Low-E4 SmartSun w/Gnlles 0.31 0.19 0.44 ':,� 13 NP law-E4 031 033 0.58 HP tow-E4 0.30 037 0.64 I ( HP law-E4 with Grilles 0.32 030 0.52 Fr. HP tow-E4 with Grilles 0.30 033 0.57 f9I i HP Low-E4 Sun 0.31 0.Z0 0.31 (fl HP Law-E4 Sun 0.31 022 0.36 Spdngline'Window !Specialty odow Hp -E4 Sun with Grilles 0.31 020 0.32 0 HP Low-E4 Sun with Grilles 0.33 0-I8 0.28 'r'' HP Low- E4 Smar[Sun 0.30 023 0.52 I'r..'j V, HP Law-E4 SmartSun 0.30 024 0.58 !F 0 •� HP Low-EllSmartSun w/Grilles 0.32 021 0.46 .lit '' HP law-E4 SmartSun w/Grilles 030 022 0.521 ! 0 i HP Low-E4 0.30 027 0.45 HP Low-E4 0.32 022 0.37 HP lax-E4 with Gniles 0.32 023 0.39 r HP Law-E4 with Grilles 0.33 020 033 - Frenchwood HP law-E4 Sun 0-31 0-16 0.25 I-^j w Hinged Inswing. i HP law-E4 Sun 0.33 0.14 0.21 = Gliding.Patio Door t HP Law-E4 Sun with Grilles 0.32 0-14 0.22 V-`4 French Door _ NP law-E4 Sun with Grilles 0.34 0.13 0.18 HP Law-E4 SmartSun 0.30 0.18 0.41 I , . h HP Low-E4 SmartSun 0.32 0-15 0.33 ! . HP Low-E4 SmanSun w/Grilles 0.31 0.16 0.35 r"!® ! HP low-E4 SmartSun w/Galles 0.33 0-14 0.30 - - r r HP Low-E4 0.31 024 0.41 !_ HP law-E4 033 025 0.41 I HP Low-E4 with Galles 0.32 021 0.35 t'•'® HP law-E4 with Grilles 0.34 022 036 - m Frenehwood Hinged, HP Low-E4 Sun 0.31 0.15 0.23 j'N Hinged Ontswing HP Low-E4 Sun 0.33 0-I6 0.23 - o Inswing Patio Door ,! HP Low-E4 Sun with Galles 0.32 0.13 0.19 P French Door HP Low-E4 Sun with Galles 0.35 0.14 0.20KIL HP lmr-E4 SmartSun 0.30 0.16 0.37 jts HP Lux-E4 SmartSun 0.32 0.17 037 !.-f'Tp li NP Low-E4 SmartSun w/Grilles 0.31 0-14 0.31 S f HP law-E4 SmartSun w/Grilles 0.34 0.15 0.32 0 0 HP IovaE4 0.31 025 0.41 11'.® HP Low-114033 013 0.38 HP lax-E4 with Grilles 0.32 021 0.35 HP Lux{4 with Galles 0.33 021 0.34 - HP lax-E4 Sun 0.33 0.14 0.21 - FrenhihttlooA Hinged ,? HP Law-E4 Sun 0.31 0-15 023 � Fixed French Door - i, Sidelight HP Law-E4 Sun with Galles 0.34 0.13 0.19 Outswidg Pane Door.., HP Low-E4 Sun whit Grilles 032 0.13 0.19 - HP law{q SmartSun 03D 0.17 0.37 HP low-E4 SmartSun 0.32 0-15 0.34 HP tour-E4 Smar[Sim w/Grilles 0.31 0-15 0.31 HP Imv-E4 SmartSun w/Grilles 033 0.14 0.30 - HP Lmv-E4 0.31 022 0.37 HP Low-E4 0.32 025 0.41 - j HP Low-E4 with Galles 0.32 020 0.33 HP lax-E4 with Grilles 0.33 022 0.37 = HP tow-E4 Sun 0.32 0.14 0.21 fir`LI ;FixeA Transom HP Low-E4 Sun 032 0.15 0.23 Frenhihwood - h! ' French Door HP tmv-E4 Sun with Grilles 0.33 0.14 0.20 Patio Door Sidelight`-• HP low-E4 Sun with Grilles 0.32 0.13 0.18 ( _ - HP Low-E4 SmartSun 0.31 0.15 0.33 am i' - HP tow-E4 SmartSun 0.32 0-16a.37 i.d - HP Imr-E4 SountSun w/Galles 0.32 0-15 0.33 - HP Low-E4 SmartSun w/Grilles 0.32 0.14 0.29 .`: HP Lax-E4 0.30 024 0.40 E• HP Low-E4 0.35 026 0.44 - HP Low-E4 with Grilles 0.30 021 0.35 HP Low-E4 with Grilles 0.36 013 0.38 - Frenchwood HP taw{4 Sun 0.30 0-15 0.22 ."r'"= HP low-E4 Sun 0.35 0-16 0.24 = Folding Door HP lax-E4 Sun with Galles 0.36 0.14 011 Patio Door Transom '' HP lmr-E4 Sun with Grilles 0.31 0-13 020 ha Fla M HP Low-E4 SmartSun 0.29 0.16 0.36 11 ",71.13 HP Low-E4 SmanSun 0.34 0.17 0-39 - HP lour-E4 SmartSun w/Grilles 0.30 014 0.32 F;i. HP Low-E4 SmartSun w/Galles 0.36 015 0.34 - continued on out page •For NFRC certified total unit performance on units with capillary breather tubes for high altitudes,please visit andersenwindows.com- •'High-Performance'Law-E4"(HP Low-E4),-High-Performance"Low-EX SmartSun"'(HP Low-E4 SmartSun)and'High-Performance-Low-E4'Sun'(HP Low-E4 Sun)are Andersen trademarks for'Low-E"glass. ' U-Factor defines the amount of heat loss through the total unit in BTU/hr sq-fL°F The lower the value,the less heat is lost through the entre product.Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com for specific performance values.Door values 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- Visible Transmittance(VT)measures how much light comes through a product(glass and frame).The higher the 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 in compliance with NFRC program and procedural requirements- pecified by NERC for •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 overtime.Ratings are for sizes s testing and certification.Ratings may vary depending on use ortempered glass,different grille options,glass for high altitudes,etc. •PassiveSun-glass values are available online at andersenwindows.com- 277 The aConwwnweauh of Massacha'setis Department of Industrial Accidents Office of Investigations 600 fflashington Street ;Boston,AIA 02111 wvw.massgvvldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBOROVA 01532 Phone#. 508.351-2200 Are ou an employer?Check the appropriate box: Type of project(required): r__ LM 1.am a employer: with 30 4. ❑ I am a general contractor and t - 6. ❑New construction. employees(full and/or part-time).* have hired the sub-contractors 2.❑ l am a sole proprietor or partner- listed on the attached sheet.t 7. VRemodeling ship and have no employees These sub-contractors have $. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑:Building addition: [No workers' camp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10 ❑,Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l LEI Plumbing repairs or additions mysel€.[No workers'comp. c. 152,§1.(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 131-1 Other camp.insurance required.] `Any 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.bire 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 their workers'camp,policy information. 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. Lie.#:MVI/C 30543700 Expiration.Date: 110-0,11--16 Job Site Address: c1/I) Re selyt-V �� �� City/State/Zip: Mq Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisotunent,as well as civil penalties in the form of a 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 hereby cert fy nd the pains andpenalties ofperjury that the information provided above is true and correct, i nature: Date: Phone#: 51-2200 Official use only. Do not write in this area,to be completed by city or town o�ciaL 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 M ANDECOR-01 YADAVYO A RLX CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 10/1/2015 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 NAME: Willis Certificate Center Willis of Minnesota,Inc. PHONE xt c/o 26 Century Blvd A/c No E :(877)945-737 q/C No: (888)467-2378 P.O.Box 305191 aoDRess:CertItIcates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE MAIC# INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC 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 POLICY EFF ii0 CY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR MWZY 305440 10/01/2015 10/01/2016 PREMISES RENTrrence $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑PE� LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: AUTOMOBILE LIABILITY CO aBINEU SINGLE—LIMIT E $ 5,000,000 A X ANY AUTO MWTB 305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X I TA STUTE EORH A OFFICER/MEMBER ANY /EXCLUDED?ECUTIVE r� N/A MWC30543700 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) I-] E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 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 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 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-090125 JAIME L MORIN!` %. 86 GARDINER ST s LYNN MA 01905 Expiration Commissioner 10/06/2016 1 -`--.tBceotCousainer A•ffa�r>,'&Brupness�AegaiSataou E > 5sa0�lement 6 f�E1.iE1�ilAldBY AN rr p , AM ` 104 O,NTIS'STREEfi faIORTN6OFttDIJCH 11i1 'a532 "I(1ni�ersecretary i