Loading...
HomeMy WebLinkAboutBuilding Permit #484-16 - 250 BLUE RIDGE ROAD 10/15/2015Permit NO: BUILDING PERMIT 3�°4`�� h°'��°� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * - Date Received '�;°4 `�;� ::�., '` Date Issued: —If IMPORTANT: Applicant must complete all items on this LOCATION 250 Blue Ridge Rd North Andover, MA 01845 Print PROPERTY OWNER Sonya Terra Print MAP NO: 065.0 PARCEL -.0183 ZONING DISTRICT: R-1 Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ItOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Replacing 8 windows, no structural change OWNER: Name: Address: Identification Please Type or Print Clearly) Sonya Terra Phone: 860460-8506 CONTRACTOR Name: Jaime Morin Address: 30 Forbes Rd Northborough, MA 01532 Supervisor's Construction License: 90125 Home Improvement License: 170810 Phone: 508-351-2214 Exp. Date: 10-6-16 Exp. Date: 12-23-15 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: $ 20,056.00 FEE: $ Check No.: 2 Receipt No.: NOTE: Person contracting with unregistered contractors do not have a ss t guaranty fund Signature of Agent/Owner Signature of contractor A K Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this LOCATION o� SU 3Z e /2► w4p- -� Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_HistoricDistrict yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Industrial El Addition ❑ Two or more family ❑Commercial ❑ Alteration No. of units: ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ..3 _ ,r ❑ Other _ �tFlo'odpla rn, Wetlands +❑ 1Watershed 9),;gtric r 0p,,tic �hlNell. * Water/Sewedr% inn p[=00r1D1111r:r)- DESCRIP I IUN ur VVUKM 1 V 0G r1-1-11 vlx1`-- Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email' Address: Supervisor's Construction License: Exp. Date: Home Improvement Licen ARCHITECT/ENGINEER, Date: Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ EE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location �� 61614 T� i % �r�•-' No. V Date I Check #' 0- TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector J Pians Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFFS m 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: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Fater & Sewer Coflnedion/Sic nature Efate Driveway Permit ]DPW Town ]Engineer: Signature: Located 384 Osgood Street FIRE7.f EPAR�TMEN;T - Te_ rnp0ft stet an site es g p Y- Locatci at 12,4MainSt'" t. Y- ,^ tee Frc �De0rltmenf sigr�afiure/dale , 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 N® DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1oo0 fine Doc.Building Pernvt Revised 2014 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 ®TE: 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) Engineering Affidavits for Engineered products 10TE: 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 4- Engineering Affidavits for Engineered products ®TE: 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: Building Permit Revised 2014 U Lf. 0 O di V o W > :a CO CL R r Z E G1 Q L (� O 0.2 0 O V Qi E n :� Z Q _ • m O �e .c to GD tm �—. Ear 2� d�� ^ter Z Q U) 0 �' OC v .CD a� N 3 G Z O a L A+ Q� Y/ ca `: >_ Cl)Lu � 0 �> _ o c 0 -0 > Cl)v O Q a N mQ c W O a 0 CL cm oS �Q�z t ~C'N y 0 N O o c CO ;_ .y = W ca .r . 3 = W J v v J 'a �' :aim -0a Z CLO �. C m M Z V O O. ti =o c •r = O O a>AW H o vs (D v popU) cc m �� N °' a 0= o Q F- y :E z N W U m N Q 0 •>c J cc o O 1�- t .Or a0U > cc z J U W W O W CLU d HIL N U F x Z z z a LL a 0. z z U Z W LU O C7 mE J LL m J cu N C d W t �'•' Y N v N Z u o s cu s t Y _ _ _ _ LL (n LL. w U LL or LL d' N LL w LL m (n (n Lf. 0 O di V o W > :a CO CL R r Z E G1 Q L (� O 0.2 0 O V Qi E n :� Z Q _ • m O �e .c to GD tm �—. Ear 2� d�� ^ter Z Q U) 0 �' OC v .CD a� N 3 G Z O a L A+ Q� Y/ ca `: >_ Cl)Lu � 0 �> _ o c 0 -0 > Cl)v O Q a N mQ c W O a 0 CL cm oS �Q�z t ~C'N y 0 N O o c CO ;_ .y = W ca .r . 3 = W J v v J 'a �' :aim -0a Z CLO �. C m M Z V O O. ti =o c •r = O O a>AW H o vs (D v popU) cc m �� N °' a 0= o Q F- y :E z N W U m N Q 0 •>c J cc o O 1�- t .Or a0U > Renewal byAndersen, •y Renewal b Andersen Gn Ara'it±llOn License #170810 (Expires 12/23/201! i Federal Tax ID #41.191841 30 Forbes fid. Northborough, MA 01532 I {� (508) 351-2200 Fax (508)-986.7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Name Date; SONYA TERRA - AUGUST 21' 2015 Buyer(s) Street Address city State Zip Code 250 BLUE RIDGE ROAD NORTH ANDOVER MA 1 01845 Email Address Home Telephone Number Work/Cell Telephone Number 1STj8RA74QgMALL,,COm 8604608506 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. �st._Starl Date Method of Payment Total Job Amount $ 0 mount Financed $ 0 CheckfCash Deposit Received (33%) $ 0.00 Deposit at signav $ 0.00 8-i0 weeks Balance Slant of Job (33%) $ 0.00 Chock s Balance on Substantial At Subalanuat Eal, Install lme Credit Card Completion of Job (331.11.) $ 0.00 Compietion S 0.00 2-3 days Ir txedi[ card is selected, please No final Payment shall be demanded unN at parties ate eeaafied see Credit Card Payment leen, 1Buyor(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 auyer(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 Andersen Corporation Buyer(s) Buyer(s) 1 Signature of Consultant Signature x KEVIN MONAHAN SONYA TERRA Printod Name of Consultant Printod Name Pritnod Nome YOU, THE 9UYER(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 NOTICE OF CANCELLATION I NOTICE OF CANCELIATTON I Dateor7riwouttlon a/;1/15 You may eancelthhsI Date ofTranaaction II/:1/1,5 Youmayconctlthls transaction, without any penalty or obligation, within three bualness days from the tranaaction, without any penalty or obUgadnn, within three budneas days from the above date. If you cancel, any property traded in, any payments made by you under I above date. If you cancel, any property traded in, any payments trade by you under the Contract of Sale, and any negotiable instrument executed by you .will be I the Contract of Salt, and any negotiable Instrument executed by you wM be returned within 10 days following reeelpt by the Contractor ("Setter") of your I returned within 10 days fallowing receipt by the Contractor ("Seller"} of your cancellation notice, and any security Interest arising out of the transaction will be 1 cancellation notiee, and any security Interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence; in I canceled. If you cancel, you must make available to the Seller at your residenent In autx.tandully as goad condition as when received, any goods delivered to you under I substantially, as good condition as when recrlved, may goods delivered to you under tbha Contract or Sale; or you may, if you wish, comply with die instructions of tine I this Contract or Sale; or you may; if you wish, comply with the instructions of the Setter regarding the return shipment of the goads at the Seller's expense and risk. t Seller regarding the return shipment of the goads at the Setter's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up I if you do make the goods available to the Seller and the Seller does not pick them up within 20 clays or 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 of the goods without any further obligation, If you fail to make the goods available I of the gouda withoutaey further obUgation. 1f you fail to make the goods avaaable to the Seiler, or if you agree to return the- goods to the Seller and fall to do so, then I to the Seller, or If you agree to return the goods to the Seller and fall to do so, then you remain liable for performance or dl obligations under the Contract. To cannel you remain liable for performance of all obligations under die Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice I this transaction, mail or deliver a signedand dated copy of this cancellation notice or any otter written notice, or Read a telegram to Contractor. Renewal by Andersen, I or any other written notice, or send a telegram to Contractor. Renewal by Andersen, 30 Forbes Rd. Northhorough, MA 01532. i 30 Fortes Rd. Northborough, NIA 01532. �1HEREBYCANCEL THIS TRANSACTION. ; 11iMMVCANCELTHIS TMNSACTTON. I nuysrw sq aWra PAnt Name Ona 1 nurara sgnaars PAM Name Dim I Renewal Renewal by Andersen Corporation MA Home Improvement Contractor �fi byRndersen. 30 Forbes rd Northborough, MA 01532 License 0170810 (Expires 12123/2015) WINDOW REPLACEMENT ...:1.ak­Gv..,,. (5508) 351-2200 Fax: {508}986-7072 Federal ID #41-1918413 Window Specification Sheet Bu}•er{s) \are Date of Agreement SONYA TERRA FRI, AUG 21, 2015 The bu)er(s) listed above herehyyointly aid severally agree, to purchase the goods and/or ser, ices listed below. in accordance %%ith the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM 1VLNDONV rteD DOOR RMODELING AGREE.\LEN r, of which the Specification Sheet is part. WINDOW & DOOR DETAILS App. '. Alp. Apex FxterimArterior Gobi Hardware Hardware Lo.rE4 / Grille GrMe Glass Room R width .nom til. Window/DOor S le, Detail Cast Ext -Int Color Style Screens Smartsun Grilles Sash In Sash 2 Lifts Options fOtchen 100 .59 40 99 CD full frame Int/Ext MF 908 AiHAvH White Standard FFG Srnan&r None 0 0 No No Family 101 32 fi0 92 DS all equal insert sloped sill L -Trim mHAqH White Standard FFG ginartSur Nelle 413 0 No No Family 102 32 fi0 92 08 W all equal insert stoped sm L -Trim AfHAeVH White Standard FFG SmanSur Nom 4/3 0 No No Sunroom 103 58 58 116 GW ftA frame lafo Int/Ext MF 908 White Standard FFG priartsur Nene 0 0 No No Su morn 104 58 58 1I6 GW hd frame lafo Int/Ext MF 908 mvml White Standard FFG martsu trwm 0 0 No No Sunroom 105 58 58 116 GW ILA frame Ido Int/Ext MF 908 White Standard FFG smartsur None 0 0 No No Sunroorn 106 58 58 116 GW iLA frame talo Int/Ext MF 908 NHRNH White Standard FFG smrtsLr None 0 0 No No Total 8 UY BOW k BUILD OUT DETAILS Stybtkfiaill widtt/ Approx Ntrmbor F—.Wntfow End Center LOWE/ Roof/ Hardware Room Count Style Bankers hat t Cesiigs Angle Utas InteriorFxt/Int Color Gil les sashes sashes Scrcens Smartsun Soff Cola Family 107 Say 12:1 08.PW.DBso 103 59 Irtt/Ext 31.35 3 Birch W 11 GBG 2/2 7/4 FFG smertSun Row White SPECIALTY WINDOW DETAILS Fuji/ Approx. LOwE/ �, BAYIBOWADDITIONALWORKNOTES Room Court style insert 1.11 smarsun Grilles Wr a style Ext4nt Color CtnkY r is marc that %vide bay/b­ s.imiaws uudrr :2 iwj— dear. Min he ' rifirenl )tla�s lose ADDITIONAL WORK DETAILS: Customer is ausare they, will have to paint or stain interior casbigs on me chartPes I No Contractor will wrap exterior casings with coil stock color of - ✓ Owner is aware that Contractor does not do any painting/staining or renwvallinstallation 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 instaflagon. V* make no guarantee as to whetheralarms or window treatments/hardware wr71 fit after replacement Customer is also aware in some cases there wig be glass foss. if there is, the amount wip he dependent on the type of existing windows, type of installation and window style. We make no guarantee as to the amount of glass foss. Customer is aware and understands any and all unseen rot is not included in this contract. Should any rot be found there wig 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 payarlent in full, a limited warranty shag be issued. 1 Yes Building Permit --Contractor will secure any and all necessary pemits. The fee for the perrnit(s) is Included in the total contract price. yes All discounts have been applied to this agreement. c ✓ lee \o Owner agrees to be present on the final day of installation for final Inspection and to deliver final payment/ finance form(s). It is Agreoi and utxkntmd by ind lwwcen the I-AAnies 111.11 this Sixrifxation Sheet, along %ith the CUSTOM 1t7NDOW A -N1) DOOR REMODELING ACR F,E\ CNC. mi minor the entire undemanding between the Ixtrtir 3, aril there are no \rTbA tuxlennndings char>q or modif, ' arty of the. ternis. This Slw ifirmion Sheet may, not he changed rn its terms modifiixl or varied in an} .sat unlrati $neh [jl lll$P5 iAn in stTlln x and 57{ 1Kl tA' lxnh the Au1rr(1 an i ; t tnr. Rtnerfsl i"."' arktXAAe e. that Buycr;sl ha, read tldi Specifimfinn Short. Renewal by Andersen Corporation ,ill ) Buyer st Signature of Consultant Signature Signature KEVIN MONAHAN SSONVA TERRA Print Name of Consultant Print Name Print Name RenewalRenewal by Andersen Corporation bAr 30 rmbes Ra:A . Northbmugh. �v13murhuxenu 0.133. nMsen. - Phome (50-9.1351-2200 * Fax (508) 86 072 WIIWDCrW M11P ACEMEER en �.a3r aClahmy X54 Wnig "OWY ert Q!epwev redeMt rM 11.)Zt 4 L •1J 19413 T169 1:17tS'ndinest( (`�?�.lEh'.11drr`M-) jet [a 1110, L.S �t i��. T M�%i'skS4'� i Knoween ewal la', Aik rse7t C+5rpar1t"k W1d'.;0tY3. TO'.rd (4iUVCXS'). toitba-tar mid. PuvorfSl fi�ert+} .dguiv tv am,-M.md ttaNiify the rk,KrL�rxiknl it tt,�i i 'p Other tEt:tn �S3.twifie lly ie►r1l�K'-d Ev �.;tll IIi lt�lxtistuts� lnidit[ its rlhc`Pt,+ l l:ittlt 'LI! It 1tl�i; irl rull Lowe and effect. Thd ,mend uj is suljtxt to Lite !enrts and covAlionts gat the ,4gm", t mi.. 'Ate fbfl"itn f; additlimm alteralians, or dek-bani to the pr4x1t eN arA servievs guyer(s) oftie LYJ :tri' tar_ ng nude: Rrrast was, clone w btre It shows this custamrr is owed S51 do0ars which chanWs the jqb ,ua/nant to 200S6. Finance an30UDt'%jII alto need to'be chaoRed to 2DO56. As,a result of these eE tea kes. iltefbHowing terms of Lite ,\,,,me7tlent tI v also clnangiN iif there is no chmge, stn Jtetn w L'll kx left. ;blank or rk naed ss " t/At", . End�egtiat UI;Lt na chary sr4A—>s: l+M Talal la'ab Atrxaotll< Payumt P4'Jiethod- �- ! L r:txxrit 6ra�ei .: S tt�J4_t,. GmcnSky Firunce "New U.3LMLCnt stmtof fjb; N,--x>a.MLMI,-e Subsiu blCompk-tion of jab :: $ i.c,.028,00 GreenSkk Novice -his W",=d um&rdnod by and brwaccn tba pwtira &d this Amm&dtnt aid the m�pd.Ap=wmi wnstfiuta: tl6c enidns mWemmubg bc - tw= flhe , MW ft= W no vCftI a7v*&,* lditW cftqft a Fw&ftws xm of ft ice. of #tis Anmdm= Bir�tz�jr &*W%gi'- c�l,�ls 11= md thio JtmElt nrt,Land rots tss>n "d x csavnialcl 4 ei cd„ xnd..dl�c+ d opIT c(Ws �t cast d>I wfiftn be uw, BY:. SI�t:Lttl.r` orPe��ltei Ai�xt:���.r -- - prrrtt il"aate of 6 11�'i a1i�ll�t�r'r E -Signe : n 1z ; zai3 a� s t 1 Sonya Terra saterra7prnai1.can 3 T si.1mattu+l: Pale Ds!0 } ` . way LM IbYApderscm Vlny ':�Zm. , ertSun Solar Heirt Gain Coeftlent 0.27 11.53 0,22 0.51 armn saws } ` . a Do nid Iemdu wm ind code Inspeollon. 9m la6d brftre rofaence 3 t C4 e � LMO .� c n a V • � � ■ • a�.on.amdmrm. Renewal byAnders wleeaw .vuananv 'AND -N•35 WoodAnnyl Composite FF Dual Argon Low -S4 SmartSun PmductTyps: Gilder ENERGY PERFORMANCE RATINGS U -Factor Solar Heat Gain CoeMolent b.-29.11.6 5 0.21 SJI-P etrlcls ADDmONAL PERFORMANCE RATINGS Vlslble.Tmnsmftnce 0.49 wpm �... �+tnrs+er sr.M.ws v� ww+.rre ern � �u �++Imwr ap•�+.CaA � n<w�.+v.�++y�M t�sMA� na car�rrym.a �fnl.aAu I.�.�rs Y1.ir.YL Andemn orcimUg vmnaow ' amm�.rw. p Standard Raeng .nom-mrnu�a�w�+.usswo •• DPpsfHS•G36- YM!_e.. 10D-0051ZD36-0ifi d Do nat remove until final code Inspedon. Save label ioriubp reference. I C-1 P3 --U • ' m eae.a. ill = r.00aa-a000 ®rk,% Renewal byAndersen, WINDOW IErLADIYIIIT .�dnd�O.00avpuq. AND-N-102 :�Lypagjo: WoodMnyl Composite Dual Argon . Low -E4, Product Type: Casement ENERGY PERFORMANCE RATINGS LI -Factor Solar. Heat Gain Coefficlent 0.29 1.65 0.28. U.SJI-P Meticial ADDITIONAL PERFORMANCE RATINGS I Visible Transmittance • •.• 0.48 .."' .. .I temr�aa.cte.a�1:c.�rtiumaon�mraoeawoN�xrnrn�c�DesemPmyran. d ersen o on: hr Casement eonOmm.m. �d� Rdng N�u,nvvuuwoNNcs�tauswa4o-a6 DP psf DP36 41A,( � AX -aane.a 4 .� lot", I-qmdae '0 i1 e-ii6-Rd—h yy �`~ ODf1�11WA�d 100-Ob513972-0D1 temr�aa.cte.a�1:c.�rtiumaon�mraoeawoN�xrnrn�c�DesemPmyran. d Renewal,;-. byAndersena �% WlfflpoW, REPLACEMENT anAAdetsen(>MP`)Y Wood/Vinyl Composite IF Dual Argon Low E4 SmartSun Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U -Factor (U.Syl-P Solar Heat Gain Coefficient 00-29 0u19_. ADDITIONAL PERFORMANCE RATINGS Visible Transmittance .4 2 Manufacturer nputatos ihet these M1.9.conform to applicable NFRC Procedures la determining vrhok Product PaAormam:a. NfHC ratigs ars deduct and does d vamnt tlhe susue hx y ot anY Product fo eny ap-Cft use. cl e- - does not recommend anY P Conus manufacturer's 6erature for other product performance intimation. .$L ^ EAt This product meets GweM. n Sears environmental i standards governing energy iam`�%+.t)�:"; � �•••� �, t efficiency, heavy metals in /"`1 g+y.: . ivs•', r"ir the trams and sash TT $; -, 4materak pactmging, end cef iii! consumer educational '�.•.;::{,.:,;r.;r.}Z �Qz e's materials. DESIGN PRESSURE (PSF) t Mrw"bantstbn 1 co H-LC25 RbA DB Sloped Sill DH IN Testes WIUFSD2aAAtAlaRlOMAffS�t01ASU11t1OS ►,lXI#XUe+s' fes oDrlkxmsrce W the a Dls atlrhdarde. deers or exceeds M.E.C., C.E.C, & I.E.C.C. Air lof aralion requirements WDMA Hallmark CedticaYuin Program. The Comm awe4 th of ManachaseW Depndwat of InAntraial Aceideitarts G,,r1ce of Invesdeatioas 600 Nlaskinglen Sirred Boston, MA 02111 www l s govld1d Workers -Compensation Insurzftee Affidavit:.ituilders/Contractors/Electriciaas/Piumbelrs Applicantbh-rm>adon Plan Print!g b, Name(BusinesstOrganizatirnvindividual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBORO,MA 01532 __- Paton 4: 508-351-2200 Arejou an employer9 Check the appropriate bore: Type of project (required): l.'Yj I ma a anployer with 30 4. © 1 am a general eonuwar and I 6.❑ New construction.employees (faII and/or part-time).* have hired the cub -contractors 7. Remodeling 2. [] I am a sole proprietor or partner- listed on the attached sheet, t VLj ship and have no employees These sub-contwors have 8. ❑ Demolition w for mein i o�i� . �' �'• [bio workers' comp, insurance workers' comp insurance. S. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised their 10.0 Flertriral repairs or additions 3. ❑ 1 am a homeowner doing all work right of irnemp. tion per MM 1 I U Plumbing repairs or additions myself [No workers' comp. c. 152, § 1(4), and wee have no 12,E] Roof repairs insurance required,] t emplovees. [No workers' 13 [1 Cir comp. insurance required.] *Any applicant that checks box # 1 must aisr fill out the section odow showing their workers' compensation poliq information. I Homeowners who subinit thin affidavit indica;.ing Otey are doing all work and then hire oursi* cWtrattors must sftta ries► Adsv4 1A&.49ing shah. +i ontraotors that eneA this box must atta hed an additional meet showingthe name of the sub t;oauaawrr, and shear wotim, m np. policy itt#smatiort. I am an employer that is providing workers' ces"nsadon insurance for O+ emplvyM :below is toe policy andjob site information. insurance Company Name: OLD REPUBLIC INS. CO: _ Policy # or Self -ins. Lie. #: MWO 30543700__-__ _ _— Expiration Dam: _10_01-16 Job Site Address: 250 Blue Ridge Rd _ City/Stat0VZip; North Andover, MA 01845 Attach a copy of the workers' comprusation policy declaration page (shoving the pos ey 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 fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the term of a STOP WORK OR.a.6It and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be ,orwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby S�rtature: - Phon AX8-351-2200 pains and penalties of pedury that the information provided above is true and correct, Official use only. Do not write in this area, to be ronleted by cl# or town of eiaL City or Town: Permit/License # Issuing Authority (circle one): 1- Board of Health 2. Building Department 3. City/rown Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone M. ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) 10/112015 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()es) 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 endorsementtsl- PRODUCER OONTACT NAME: Wllhs Certificate Canter Willis of Minnesota, Inc. PHONE 877 945-7378 CIO 26 Century Blvd Arc No,E . t ) FAX C No : 888 467-2378 P.O. Box , TN 37 �REESS: Certifica 'Ilia.com Nashvllie, TN 372305191 INSURMS1 AFFORDING COVERAGE NAIC� 1NSURERA:0Id Re ublic Insurance Company 24147 INSURED INSURER B Renewal by Andersen LLC INSURERC: 30 Forbes Road INSURER D: Northborough, MA 01532 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: nm.rerr•.r .r.,........_ -- -- Rcrwlun numaCK: 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 LTR A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY ADDLSUBR INSD WVD POLICY NUMBER MMIDD EFF MPMIDDlYYYY LIMITS CLAIMS -MADE ® OCCUR MWZY 305440 90/01/2015 10/01/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Esoccumence $ 500,000 MED EXP (Any one person) $ 10,00 — PERSONAL &ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- ❑ JECT LOC GENERAL AGGREGATE $ 4,000,00 PRODUCTS - COMPIOP AGG S 41000,00 OTHER $ C MaB�IN�Ee5SING MIT $ — 5r0((,0(( A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS MWTB 305438 1010112015 10/01rill /2016 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY D Per accident $ UMBRELLA OCCUR EXCESS LIAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN A ANY PROPRIETORIPARTNER/EXECUTIVE I I -I NIA MWC30543700 10101/2015 1010112096 OFFICERIMEMBER EXCLUDED? ,J nd er Mandatory In Iyes, (f describe unda DESCRIPTION OF OPERATIONS below $ X STATUTE ERS E. L, EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ 1,�QrQ 1,000,00( 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Ir more space Is required) TE 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 s-9 bt-4��- ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen'Nor License: CS -=125 I JAIlViL+ L MORIN -` 86GARDINERS7F LYNNMA 01905 .X1'..j ; i. - 55/ Expiration Commissioner 10106/20116 (92. f fTce of Consnwer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR Registration: 170840 Type: i Expiration: 12/23/2015 Supplement f RENEWAL BY ANDERSON CORPORATION JAIME MORIN' 104 OT)S STREET 7 S NORTHBOROUGH, MA 01532 r. Undersecretary r