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Building Permit #311-2012 - 28 MIDDLESEX STREET 10/12/2011
BUILDING-PERMIT of tIORTy'9 TOWN OF NORTH ANDOVER Cie APPLICATION FOR PLAN EXAMINATIONio Permit N0: Da to Received Date Issued: �d�i`i �SSgcHus���c IMPORTANT:Applicant must complete all items on this page :_c,3^=• v:f:,_ :1`etr.F:r-a•�_"ec=..;;,-r�n{J,_,.._ iea• :; r, - � . .. - _ - ani__..-F..:.•-nyww�'Y:,;e._ ..ti_al''-_-''fir i:to-l�t�- ARE, ' _.c,:y,^�.i-�!,J,....•._- !rv.4. ,:t_.; � -�1,� J'S' �'1...,• �{'tit���",y.� '_l`'i�-..:_."_�:� - is.�IL��1iS,-.,.a:;_.,��'�''i=--_ ;k i.' <:-',-.Pe.��,'..i"_'�.:-.,�1;:;,�.,.:.:`��r_ac:�-: _. .. ..:1.•'_ __ _ - - i^:t-•r.. _ _- y.',U..-��,:`:�,=p_-�'Yt.'.j''r+:- '-S_ .:.G w :y _ ;f.,��F Fr... :.2r.,.w.r",,,^� f" Y"•T.^'Jys`e _dv��JF,` - - _- - - ,:;. .:;r. -,moi. - .^1`. x'r - - "`.�. 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':�k�::.•'.;.._�, ���:.3ti����'.�N�' ':a". .�',:v��r�: .g.:.� _ r - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more.family Industrial Alteration No. of units: Commercial Repair, replacement✓ Assessory Bldg Others: Demolition Other .' �' i_ •.�_ n- F31• �,.s..ti`_. .-.s;a:M1 ,� -�'y._-c'�g�->-,,.- x; _ FK •q �� �. � Z 7� a d W.p: y.-•a-::.,�.^ <'.Ls'1'-:r='rs_ m.•. :,'s �. .ti='r A��� �. u• u m a „_., -��U�l/�Il d '_' .,,iY�J-.,•.t `� za�•�,^r+:�� � r •`-a"•'�A 4S'�`5�`�, Y•��d„ti. C k°- ��� �.s'�• r,S,.v"'�'�'e� ' �7 •,���0.�5������±"s•�'J Jt}dl�$�+�""=r._,_, ��z _F3•' c� �• c^f.: z•, n'r-*r'•��. �T� .� w '�-'kr4+'� L 7��f4f�-J�M ••n :.'�x'Y�4dd�„ lr.�iei +�� (`i,`r?�;'r,�x C�Jre�"-�3��'S,^�'� r-c- 9'�+r'�',+Tf�` s o -.�_.9 a>.•' �+,�. �r>L, F�a y:4s.s"tN:':t'�_a aa...r. .. ,_. _. __d,... _��_.�:.$<,_r�:_:4d.:'•�r�y'? 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"•Jatr �:: ,�;'t'et -.��t,,�.�=��rr" z'_ rae _ l'.ri�:'Sif�.', ::C•:��:ci:- .=„z. �',�.'_`_ ..'^,,.,.�:3.: '�4 �.: `�" aac^�"�� u f � �A .Fri .kT• �:i,•}+' _ �,Sj:�.r _ r��.��,�?=`" ��''�'{i: ..51'TiJ��=__-E �-",;�.�T•n=-..:Gv;H^rr•'y.F-1. 31:d�.a �i41�1VNiJ119�.1?I�r 471' �j�'+'�-�s''y �'�^�di•_:�n". ri�� ^� -i..3J'�te��i`Fi��S:.:>u :w�,m"�N �{.�'t:� �• ._,�n•'� - .'TZ.� .'a,:,,��......._.....�..sr,r,---^, r7 ���'1�:�,.;1:i?�'�J�"'i.F"•�;c:���a -.'-'S-a"� i _yrf.' (( _ M•'`yt:,.. �•••-m-�w. _.Y. ...._.o5v,;.��t<::txr�'�4 Cw^ .n..�1.r ! - •- rr:! -,'�-�r3�.� !�''�r�zti,, `_,vn; .' .� - �?i fir �r. ,�D�I•e': �� 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: $ l 3• FEE: Check No.: Receipt No.: 9 � f NOTE: Persons contracting wit nT e ' tered contractors do not have access to telae -uaranty fund t .yam�_> .'10 VIJngam _ Ignafure:__-.f��cori=.:ra�tDr Building Department The following is'a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of N.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 I 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ IVI "'ass 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 i New Construction (Single and Two Family) ❑ Building Permit Application r% . 1:r' R.._ 1 1 1 ElCei Liiied r'roposed Piot 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 ster ermits 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 2008 Pians Submitted Plans Waived Certified Plot Pian Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tann ing/MassageBody 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 CONSERVATION Reviewed on Signature uOlvIIvILN 10 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: ny:.. l .:. .. . . :...M::. Cl—� '•ISYt:, Located 384 Osgood Street .5 St . : - fR E ► lEff erwD,upster. o�attee t, � _.. ono ti ..T '[:: - 'moi-_• ' ...: _._..:__...,._ ..., .. _. .__...,•.;Lk.. .r^.�:..a,....-_.:..�.. -.=..._:t.a.:-,�='=5ti§ia:ct.� _ _ �'xfE�;; - :va..__ ec-,...,r.'��; ..,-+•... -"=.mss. - - — - _. _ •_'�,._ ..,�:_ — _'�'.�'., :int -i-- 1;�=' - - 4 - X- — IC - �.N 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 - Date 1 Doc.Building Permit Revised 2010 Location 42!� it- No. /� 70/2— Date NORTH TOWN OF NORTH ANDOVER - 0 'Pow- kCertificate of Occupancy $ ACH Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # I ilding lnspectqr 692 24 NORTy And Town 2 O over .. of - .. No. }}(( �, o , pp( dower, Mass., T Q 'C LAKE �• T GOC MIC KE WICK 7�A�RA7ED �4�\ �C BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THISCERTIFIES THAT.................... '........................................................................................................................................ Foundation has permission to erect........................................ buildings on ..4�1 ....��!.tl �/F•SE .... ...................... Rough to be occupied as.......................... .... . ....`........ t''Q� ......................................................................... Chimney �-... e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 EX MES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ,. ''S Rough X..+..,............................ Service .................................. .. . . ........... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Mall To Be Done FIRE"DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 07/13/2007 22:44 9782785010 JOHN BEAVER PAGE 05/06 104 Oris St„Northborough,MA 01532 J&L WINDOWS,INC.,a/R/A MA Home Improvement Contractor (508)919.0900•Fax:(774)987-3013 Renewal License#141)601 (Expires 1/24/201'2) byAndersen. ti Federal Tax ID 1$83-0404201 byAndersen.w wmaOY. AMACRmervr nn Ander—Cemmy CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyor(s)Name Dale of A ranm nt , - . - l Btryer(s)Street Address,City,State,and Zip Co — 2 9 -- ,F � •C !1/r E-Mall Address Homo Telephone Numbor Work Tela hono Numbnr 7S- 3Sg..o� / Buyer(s)hereby,jointly and severally agrees to purchase the products and/or services off&L Windows,Inc.d/b/a Renewal by Andersen ("Contractor"),in accordance with the terms and conditions described on the frant and the reverse of this agreement and on the attached spccificatian,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: 7 3trtrmt�tod/S-to'ring DDale� Method of Payment: Check ❑Cash ❑Financed Deposit Received(33%):,,3��; -�"-. w�L/'•`s Bolonce at Start of Job(33%):3--( Credit Cards are accepted for deposit Estimated Completion bore; Balance on Substantial Z � Only—maximum 1/3 Of the project Cast. Completion oFJob(33%)33%) .:_3 �^ Please see Credit Card Payment Form. ' --- By signing this agreement,you acknowledge that the Balance at Start o£Job and the Balance on Substantial Completion of Job cannot be made by credit card and must be made by personal check,bank chccly or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties,and that theme 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)war orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE LANK SPACES. J&L Win Inc /b/a Renewal by Andesners Buyer(s) Buyers) By: S itui.of P duct Manager Signature 8il nature, 1eAntih/1 aor — Print Name or Product:Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE TRW BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - — — — — - — — — — --- — — — — — — — — — — — — — — — — — — — --- — — — NOTICE OF CANCE TION x )NOTICE OF CANCELfQN Date of Transaction You may cancel Date of Transaction 9 ?-1 Ylou may cancel this transaction,without or 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 wage.If you cancel,any property traded in,any payments made by you under the property traded in,any payments made by you under the Contract of Sale,and any ne1oiiable instrument executed I Contract 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 I and any security interest arising out of the transaction will be canceled.If you cancel,you must make available to theI be canceled.If you cancel,you must make available to the Seller of your residence,in substantially as good condition Seller at your residence,in substantially as good condition as when received, any goods delivered to you under as when received,any goods delivered to you under this this Contract or Sale; or rou may, if you wish, comply I Contract or Sale;or you may,if you wish,comply with the with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expense and risk. t the goods at the Seller's expense and risk.If you do make If you do make-tire-goods-available-twthe•Seller-and•the--I,�-the ejadds-tivdilabl Seller does not pick them up within 20 days of the date I pick them within 20 days of the date of your Notice ofyour Notice of Cancellation,you may retain or dispose I of Cancellation,you mcry retain or dispose of the goods of the gI )ds without any further obligation.If you fail to without an further obligabort. If you fail to make the make the goods available to the Seller,or if you agree I goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so, hien I oods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations under I far 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 I dated copy of this cancellation notice or any,other written other written notice, or send a telegram to Contractor:J I notice,or send a telegram to Contractor:J&L Windows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis I Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northborough, MA 011532, BY NOT LATER THAN Northborou h, 532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF =Z N .(Date) OF Wr (Date) 1 HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL T IS TRANSACTION. I suyer's Signature Print Noma Data Gynr'.Signaturo Prim Nome D°la RbA Copy- White Buyer copy-Yellow Buyer Copy-Fink 07/13/2007 22:44 9782785010 JOHN BEAVER PAGE 06/06 1 U4 OHS Strecl,Northborough,MA 01952 J&L WItWuWs,me.d/b/a Phonc;O8,819,0110o•rax 774.987.3013 Renewal MA HIC 1,iccnsa#149601(cxpirds 1/24/12) Pcdcral Tax ID# 83-04.04201 byMdersen. w,N00W R4oLA0EM r,N7 nn AndcmnC,imrnrm or GREATER MAssncayssrrs AND New HAMPStIME 131Ay s) WINDOW SFECIFICATION SHEET Date of Agreement The ouycr(s)listed�ov, and severally agree to purchase thee goods and./Or services listed below,in accordance-,kith the prices and terms described on the Specification Sheet and the front and(he reverse of the aceOtttpanying CUSTOM WiNDOW AND DOOR REMODELING AGREEMENT, Of which this Specification Shect is a part. WINDOW DETAILS nt�ractOr tyle]Install a total of_ —windows in Owner's home,using the following individual quantities; Double Hung(DB) ❑ Equal sash ❑ Cottage sash(1/3 t0p,2/9 bottom) ❑Oriel sash(2/3 top.I/3 bottom) 06- Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement(CDW) ❑ Standard handle. ❑ Mctr handle L _ Casement/Picture/Casement(CPW) ❑ 1 1:'1 or 7171 Standard handle ❑ Melro handle Z Litc Gliding Window(GW) �lf Glider/Picture/Glider(G1'W) ❑ 1;1:I or❑ 1:2:1 wninLg Window(AW) _( Picture Window(l'W) Bay or Bow Window Patio Doors(sea:sepirste Door.Spceirica.iion Shcct) 2. Yes ❑ Qty of Windows to be Custom Fit Replacement: Sp 3. ❑ Yes LOX Qty of Sills to be replaced by Contractor: 4. ❑ Yas NVIH� Windows to be Ncw Construction Full frame(includes new interior&exterior casik,Qs)and actu:il_ txlerior ❑ Fine ❑ Maintenance-free material ❑ Factory applicd 908 Fibex brickmold5. Glaring to be: 0 -E-4 tw ❑Other if other,please specify; G. Exterior color to be: (, ite ❑ Sand F-1Can.vas ❑ Torratone ❑ Cocoa Bean "r. Interior color to be: White ❑ Sand E] Canvas ❑ Terratone ❑ Pine E] Maple EJ Oak. Note Into � r color can only be white,t ,w cad or same color acod interiors exterior. W� nt. r' ors need t0 finished by Owner. 8, Tiler are: Whitc ❑ SIM ❑ Canvas ❑ Brass ❑ Estate T.lardwtt�C- Styl / 9. Ycs No install Lifts with ble Hung Windows Q IV G'1l' D�/ �5� y)S�K I/ 10. Screens; windows to have; Half t?r ❑ Full screens Screens t0 be: Fiberglass ❑ Aluminum © Tru Scene GRILLF,DETAILS I I.Windows have grilles: VYes ❑ No t(yes:VGr1l1c Between Giasa((',W)❑ Removable Interior Wood(ipm9 Full Divided I,ight mn.) Qty: Qty: Qty:: Qty!, QQtty; Y:` Qty: DH DH DH yV DN ICU G dar CFW ar(a Draw grille patterns above 'Else additional sheet if needed Owner approved(initi ADDITIONAL WORK DUMES 12.[] Yes M,�o Contractor will remove tnetal fi-ames of windows. Qly of Units; 13.❑ Yes YNO Contractor will install new paint-ready or stein-ready casings. s. Tntcrio• asing qty of openings; Exturior easings qty of openings: Fine ❑ ❑Maintenance-freo material 14.❑ Yes N0 Contractor will install new paint read or stain-X C or outside stops qty of openings: T.ntCrior stops qty of openings: Exteriors s qty of oI n�•, Fine 15. Owner is aw that Contractor does not do any pain' er Initials❑ ❑ Maintenance-free mal:eriai 16.❑ Yes N0 Conl:ractor will wrap exterior.Casings wi , 4iinu� of color. 17.VNoto: Wrapping may be required with storm window tc noval of storm windows will leave screw holes in casing, 1 A.�es ❑ No Contractor will insulate,caulk and seal windows with 3-point.•system 10 prOvent water and air infiltration. Cs ❑No Clean up alljob related debris including old windows will be.removed,Van)u n nightly, 19.V'41 NO Alilmited wan•anky shall be issued to Owner upon completion of the job and payment in full. 2U. es No I3 ditlg p fir—Contractor will sccure any and all necessary permils, rNie fee for.the permits)isnot /included in the Contract Price and a separate check is required at the time of sale for this fee. 21.LV 1'es ❑No All discounts have been a ed to this.prccm t Price, t 22. Additional job details: Ll p I 1 L- 2:3. Vryc3 ❑ No Owner agrees to be present on the final day of installation for,final inspection and to deliver final payment. No final papnent vital!be drinrmded unt,U the contract is corrtpleted to lite&9tistac1i0l1 ofe/I p ttyics. It is agreed and understood by and between the parties that this Specification Sheet,aloftg with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and there aro no verbal understandings changing or modifying ally of the terms. 'Phis Specification Sheet may not be clianSW or its terms modified or varied in any way unless such chansm Art in wrl.ting and signed by both the Buyer(S)and etor• Buyer(s)hereby acienowledge that Buyer(a)has read this Specification Sheet, Renew&, eP'o�fGteatcrMA and NH Buyers) Buyer(s) By: t Manager Signature t)1) _,r✓ Print Name of Product Manager Print Namc Print Name The CortcrnowealtJs of Massachusetts DepartmiNf of frcduatrid Accidents Df Investigatiaas 600 Faslsilsgtan,street Bnsta�,MA 02111 y .Inas gavIdia • + easatton Fngurance Affid.svit i$�derslContractarsl�leetricia�.slPlIImbe� . Workers Comp Please Print A Iic$.nt fnformaiian' nnllndividuelj` Name(Bueineca�Organizad . Address;. � �` ��• .. I&L--7Lr �bnz- . 'pype of project (required); , Are you au ernployer?Check the approprie[]'1 am a gena�al contractor and I �, []Now construction 1. "I am a empkryer vrifh_S3 0 conixactnrs odafing * ' have hired thm sub- 71 , employmms(fig M&JOr part-tima). ' 3istod oa•die attdcbmd shoat# Z.❑ I am a sole proprietor arperiner- Tbese.sub-contractors have B. D�olifion ` ship and havo no employmms j wCam, comp.incur=& g, [7 Bvs'lding aMticn working for mD in aay capacity. �, We arc a catpara ll and its $lnctriaal rapeirs or addifioas END mnrkmil camp.insareaoe o��have r.�cdmkod thou 10. . lift of ezaaiptid per MGL, 11.0 Rlnmhing repairs or&060M3: I am a homcowae¢doing all•work aght ft,g1(4),and we have no 12•E]Roof i-mpLin mysrlt END work=, camp: t mmp�y�es [No wmi=m' insurance mquirod.� Comp. :nue required.] ' • � onion pnliey mintm�ti°a '�Aay„�,iieeat ti,�ebee�b�#I m�ado ffi unt�tth�y��E�r�emd♦;,m hoe ouis,a�oonu'e�s���taew efndavfSt�iadieatiag� . t gOmeoA'aen vimNbmit} effi�avit i9�iG6tm�,W i p�thCS vwkm �G�ID�S S��IOII � �oa�etotC thef eheeti tbir bo=moil atbeb�ea ed3itiomnl�`d1°"`J6`the creme of the�ti . ' rWarkere eampen dvn ursuranee for my employ ees �elow.ia the pD*and job cite I am an emploj er the p�mg . ' ufcoraatFoa. }�C t° ' InMMOr,CDMPMy No= ��l �����•�'`� pz:pirldm Data, policy#or So f ins;Lin.#: . . .�� r bb Siic Address, er and.ez, iratinn date). declar•atinn pg.�(shovrnag the po�3'�' P Attach a Copy of the workers coaipensatinn-po Y og&n of criminel penal itS of a Fa km to or,=m average ea rmq=d m6w SCctb'L 2-%of MGL r" can lead to$f a imp or ono- ar imprisanmcaf as wcIl as civil penalties in tine of a STEP WORD QRDER and a fine fmc up to$1,5DO.D0 and/ 3'c ap ma• be forwarded in thz Qffioe of dup to S25Q.D0 a day against lhe violator. Bc advisod that a c p.of this statement Y Investigafiams of f u DIA for insm mr,covcIgm vaif ccaf Ido here cc pcras cadperealt�ca Df plat fhe ixfarmaiapradabove is truc.and correctO. is rine to 6e completed by�ar tox+a officfrd dffrelrrl use only. Do not verde in this Q City or Town ' . • Permitllicenee# lanbg A_udmr4(circle ane)cector S.Plambing Inspector L Boerd of Health L Building Deparbment 3,Cat3dTovfa Clerk 4.IIECtric®1lnsp , 6.Othez, Phan Contact Persom • `i:assachusems - Depat-tment of Public Safeth Boar-d'of Buildin1s g- Reuulations and Standar( Construction Supervisor License License: CS 95707 BRIAN DENNISON ge 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ( nnmi siimer Tr#: 2622 i • ..�:�`✓�ieu'IOOmmcO�Furelt��l O�✓l�Ca4�a�u�be�...:. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTbk Regist i atioll!i*nb501' '• • ' •Ex 12r���� t Card • • RENEWAL BYj. 7. • BRIAN DENNIS� - h '104 OTIS STRE NORTHBOROUGH;�`M {�32 Undersecretary . t '4 CERTIFICATE OF LIABILITY INSURANCE °A'�( "'°°'YY'�' 02/09/2011 .THIS CERTIFICATE.i5 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(iss)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 net confer rights to the certate iticholder In lieu of such endorsement(s). PRODUCER CONTACT Joseph McKeone "A"rE` PHONE • 734-662-8100 FAX JP McKeone Insurance Agency, Inc. E-MAIL ac"° P.O.BOX 333 ADDRESS: Ann Arbor, MI 48106-0333 INSURERM AFFORDING COVERAGE NAIC/ INSURER A.: Hartford Insurance Company INSURED J&L Windows,Inc.Renewal by Andersen INSURER e;Nautilus 104 Otis St. INSURER c.; Northborough,MA 01532 INSURER D: INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED, POLICY PERIOD 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, IXCLUSIONS INSR AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICE NUMBERPOLICY EFF POLICY Exp B GENERALLIABWTY M/DO/YY MM/DDrfYM LIMITS EACH OCCURRENCE s ' 1.000.D00 COMMERCIAL GENERAL UABILITY NC958461 iD/Di/2Q10 10/01/2011 AEMIS E�occurrence s 100000 CLAIMS-MADE ©OCCUR MED EXP(Arty one penton s 5 000 PERSONAL&ADV INJURY s i 000 000 GENERAL AGGREGATE s 2 000 000 GEN'L AGGREGATE UMrr APPLIES PER: PRO- PRODUCTS-COMP/OP AGG i P-000.000 POLICY LOC s A AUTOMOBILE LIABILITY BNCOa acuideANYAU7D 35MCCXD6390 10/01/2010 10/01/2011MED SINGLE UMR 1 000 DDD ALL OWNED SCHEDULED BODILY INJURY(Per person s X AUTOS AUTOS BODILY INJURY(Par accident) s HIRED AUTOS NON-OWNED AUTOS I PROPERTY DAMAGE $ or acclderd UMBRELLA LIAR OCCUR $ EACH OCCURRENCE s EXCESS LIAR CLAIMS-MADE AGGREGATE s DED RETENTION s WORKEFIS COMPENSATION s A AND EMPLOYERS"LIABILITY 35 WECPP1444 02/17/2011 02/17/2on+ ANY RRU� Y/N 012 I�ERIMEBBEEXCLUDED? N/A EL EACH ACCIDENT s 500 000 (Mandatory In NIS D13 yyeess describe under E.L DISEASE-EA EMPLOYEE s 5OD DDD ESCRIPT10N OF OPERATIONS below .EL DISEASE-POLICY LIMIT s 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schaduke,it more space is required) CERTIFICATE HOLDER CANCELLATION INSURED DOPY 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 % 01[[988-2010 ACORD CORPORATION. All rights reserved. CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i PIgum- • �° `� i�¢ T SUE $LTUbS u • u•-Fac([1,.54-.p kir-liEa#.C�ah� Co�ipierrt .. • • .�7tICI70S��I.PE�Fa �E B�'i��. � • • � �--j-�-�'�4•�—s------Wit*-+r'�+-!rsr-e-'-�:���== ' ����.��--.��s�..c �•••�-tet s- - 1 . .. � ns ss.��e•�•:�.s. pK ra •r�..mtp.-...s.......�..,.....�.r ;�esv�mecemcir se.�a� •ter- r .- — - �. . Do not remove until final code inspection. Save label for future reference. Qualified for hiqlilighted area. w Canada 1 800 387-2000 � enerAyetarpc.oe N C tM O � d Q W a o, cn m III mmm=91 U W WU,Sn l E.11. MOW 1888782-1937 C anergyetargav Renewal byAndersen, WINDOW REPLACEMENT wt Anclmvj Cinopony `tet+s�ratAND-N-102 Wood/Vinyl Composite ..................... Dual Argon Low-E4 Product Type: Casement ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0. 29 1 . 65 0 . 28 U.S./I-P Metric/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 .48 Manufacturer stipulates that Nese ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental condltlons and a specific product stre. NFRC does not recommend any product and does not warrant the suitability of any product for any specillc use. Consult manufacturer's literature for other product performance Information. wwwnfrc.org ' WnJutm-Mmohbn w-..Wlnv.mm Andersen Corporation:RbA Casementnow Manufacturer stipulates con ormance to Ene following s n ar s Standard Rating NAFS-02 orAAMArWDMA1CSA101A.S.21A44H5 DP psf DP35 f:u rSn" This product meets f� 1 Green Seal's W environmental standard q goveming energy 'YIemciency,heavy metals 4'In the frame and sash 1:!I, material.packaging,an �£,' q yQ consumer educational materials. 100-00513972-001 Meets or exceeds M.E.C.,C,E.C,81.E.C.C.Air Infllltratlon requirements WDMA Hallmark Canmcation Program. Do not remove until final code inspection. Save label for future reference. . Qualified o, 12 pour Jos r6gions indigudes. CanadaCD , � , enemystarnrcan- 1 '� t%•; tom, rT rncan.gc.caf O � N LU I e[gystargov .`'}`��"1��z�i� ,, ••tri � is is 4 .��4 •� `r • vii rE! I � �. ,t\♦ Note �- �_Qualified/Admissible Renewal byAndersen. '- tJtrEk�OW--R£P!4C ENtF.A�T—unl�.EonenC:umpany AND-N-34 WoodNinyl Composite IF ............................ Dual Argon Low-E4 SmartSun Product Type:.Glider ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient � - -4.19 ic v. y i.a� - - U.S.A-P Metric/Sl ADDITIONAL PERFORMANCE RATINGS • Visible Transmittance 0.43 Manufacturer stipulate✓that Vlese,ratings conform[o applicsdle NFRC procedures for determining wnole product performance.NFRC ratings are determined fora fixed se[of ermnonmentil condition.-and a specific product size. NFRC does not recommend any product and does not war rant sutmallity of any productfor any spacmc use. ' Cdrrw.adnutdru:erslhc-rad+ratdrotnerpnrea[•pdtfomi wwwnfrc.org window ana'Foor Andersen Co oration:RbA Glidin ndow enurac tar pu a,as oaconrormencs ro ovnWing s5naaras Standard Rating Nags-os oraAMAWMAICsAfof0.v;aao-os DP psf HS-C35 . ��'�.aJ��t Thlsprtltluccmeets Green Sears errrironmentmeat al standaros fg •„governing energy " amciency,neavy metals 4M in me frame and seen material,paclrsging,and mrnals. ucanonal 100-00511408-012 Meats or exceeds M.E.C.,C.E-C,11273.air mgimiton requiremems WOMa maumix Cartincation Program. Do not remove until final code inspection. Save label for future reference. Qualified fu area indicated. 19Admissible PlItur les TigiOns ind Canada a.,L ---, energystarnrcam ' r a ! Wit• ` x • N C Of w ` R �W / r LU d errergystergoV ®�Qualified/Admissible Renewal byAindersen WfNDCW REPLACEMENT wAn.l-T;'~ v AND-N-37 . %04._4:m:AdiM Vinyl/Wood Composite Material R 'R3Cs t Dual -Argon Low-E4 SmartSun Product Type: Picture ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0.27 1 . 53 0 . 22 U.S./I-P Metric/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 51 Whale pmtlua manufacturerstlpulates inatthations antl a specmc protluashe. de rsonps contonn to appllcaole NFRC procetlures for aeterminlnp performance.NFRC ratting;are oeterminea tar a Oxen set of environmental conNFRO Consumes nor r recama Bnoa any for uct sna ones not war nee Ie sullsuo�of ery pmoucrtor any spectre use. per wwwilm.org CU -/ - Andersen Co oration:RbA Picture Window enurac rer Pu e s conrormence o e ro ovanB n er s Standard Rating NAFS-oz orAAMAANDMNM mle XA44ao5 DP psf F-050 1hL g9`' t Tnlsproauctmeats Green Sees otent • ¢� i erNimnmenml stantlaras governing energy x elQclenty,neavymrtals In me treme anti sash w matartm,pacttaging,ano consumer M312111112.�ucetlonel 100-00511006-001 ' MeeL•of nw•oatle ME.C.,C.E.c,61EEE Air infmiraaan requirements WOMA NallmerK certlrcatmn Program.