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Home My WebLink AboutBuilding Permit #511-13 - 29 BLUEBERRY HILL LANE 1/14/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: — ) Date Received 11 Date Issued: I IMPORTANT: Applicant must complete all items on this page LOCATION Q0k .a,,\ 0'`'� t- '.�� -n �`i� r 1r� r�C�&)c PROPERTY OWNER(��, �Ol U (le r' Print 10o Year Old Structure yesno MAP NO: C��. C. PARCEL:0I Q3 ZONING DISTRICT: K23 Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Resiftntial Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ AI ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands D Watershed District, ❑ Water/Sewer j DESCRIPTION OF ,WORK TO BE PEKFUKMtU: f n J A Identification Please Type or Print Clearly) OWNER: Name: �Jc�t�Lc� ��`v�� Phone: q4'9 -'(Sy -61(o� Address: o��\v��Qt`J�^ �� ,v�-e_ I�o�r�� l�n �O�e� Si" 0 ( 8y CONTRACTOR Name: [' -\a,^ kvV\'�56A Phone: 66$ -- 32 -,900 X 5a� Address: C4 -k3_ 31 li Supervisor's Construction License: Exp. Date: Home Improvement License: _9701-8 (C$ 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: $ 3 H ,ob Check No.: S'� Receipt No.: 2l9 NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner Signature of contractor.. _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location Z No. J 1 � ^ � 3 Date Check # 2 t3�2, 26087 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3IL4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ (t—_.K_. Building inspector t Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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: Located 384 Osaood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main Street Fire Departinent 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.$10041000 fine NOTES and DATA — (For department use B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fohowing 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 E9 M WpW- = LL D a' a co v Y O LL � a Q0 a). '(n of Z Z m C 7 LL b0to r0 O d H Z Z m J d to O d Lf Z V W OD U •` ;N co LL O U ui CL Z Q by d' co LL CW c °C a W 0 W 5 LL v L m O N v • N v Y O N T'wwn r, p Cc C .Q N r S E cL L CD d 440 <v W Z. O vE cm . u o Pa 62 v, = F O P o e,4G- O L V 3 !r Cc T d* L m a p� -a Mn : N �R > C N •i c =_ )c c tm - cc > svv=�a 13 y O -0V av>Z. rn CD'> a CL 0 L - --N p s+ C -o _ c / ~ N C N,t7 m 01 I4)=CN C O on w- -v = 5 O �— C V m d'a o N J N � .o o `~ = O H t .. a0C> > A� 0 to RenewalMA Home Improvement Contractor QNbYAndersen. License #170810 (Expires 12/23/2013) o Federal Tax ID #41-1918413 WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation 104 Otis St., Northborough, MA 01532 (508) 351-2200 • Fax: (651) 351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Nome Date of Agreement -DQ,Vt� G-( V h l- 1Z- j ,z Buyer(s) Street Address, City, State, and Zip Code 29 Gi U.T E -Mail Address Home Telephone Number Work Telephone Number Buyer(s) her jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement"). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. l Estimated Starting Date: Method of Payment: Total Job Amount: 7 /�� Amount Financed Deposit Received (33%): ` W W(,✓C� ` ✓ ❑Check ❑Cash Ovisa/MC ❑Discover this transaction, without 6nyOenalty or obligation, within Balance at Start of Job (33%): D Estimated Completion Date: ❑Financed VAMEX Balance on Substantia4 q n Completion of Job (33% / l•� property traded in, any payments made by you under the If credit card is/elected, please see Credit Card Payment Form. Contract of Sale, and any negotiable instrument executed Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation I By: Signature of Product Manager ✓t'E t (rLr� 1 �_ In fi ��r.�� Print Name of Product Manager Buyer(s) Signature �-,V Print Name Buyer(s) Signature Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. —— — ——————— �<-——————--- ——————---———— — — — — —— �c NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction . You may cancel Date of Transaction . You may cancel this transaction, without 6nyOenalty or obligation, within this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any three business days from the above date. If you cancel, any property traded in, any payments made by you under the I property traded in, any payments made by you under the Contract of Sale, and any negotiable 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, by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the be canceled. if you cancel, you must make available to the Seller at your residence, in substantially as good condition 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 you may, if you wish, comply I with the instructions the Seller the Contract or Sale; or you may, if You wish, comply with the instructions Seller of regarding return of the regarding the return shipment of shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk. If you do make Ifyou do make a goods available to the Seller and the I Seller does not them 20 days the date the goods available to the Seller and the Seller does not them 20 days date pick up within of I Notice Cancellation, dispose pick u.p within of the of your Notice Cancellation, of your of you may retain or I of the goods without any further obligation. If you fail to make the goods available to the Seller, or ifagree I of you may retain or dispose of the goods without any further obligation. If you fail to make the available to the Seller, or if you agree to return the lou to return the goods to the Seller and fail to do so, then I liable for I to the Seller and fail to do so, then you remain liable F�ss you remain performance of all obligations under the Contract. To this transaction, deliver rformance of all obligations under the Contract. cancel mail or a I To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any I other written notice, or send a telegram to Contractor: dated copy of this cancellation notice or any other written I notice, or send a telegram to Contractor. Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street, Street, Northbo a 01532, BY NOT LATER THAN Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF . (Date) OF . (Date) 1 ERE Y CANC L I TRANSACTION. I ;,-e--/ 1aj3q ��o►� I I HEREBY CANCEL THIS TRANSACTION. Buyer's Signature Print Name Date RbA Copy - White Buyer Copy Buyer's Signature Print Name Dale - Yellow Buyer Copy - Pink ®JBLLP2009.RBA-Ph.MANH Renewal ..enewal by Andersen Corporatic MA Home Improvement Contractor 104 Otis St., Northborough, MA 01532 License # 170810 (Expires 12/23/2013) bY�inderSen® WINDOW REPLACEMENT an Andersen Company (508) 351-2200 • Fax: (651) 351-4810 Federal Tax ID #41-1918413 WINDOW SPECIFICATION SHEET Buyer(s) Name Date of Agreement I vyg c� g 4/ a - 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 WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home, using the following individual quantities: Double Hung (D6) ual sash _ Cottage sash (1/3 top, 2/3 bottom) _ Oriel sash (2/3 top. 1/3 bottom) _ Flat sill aware to er is of Casement (CS) _ Hinge right _ Hinge left (as viewed from exterior) Double Casement (CD) 2 Lite Gliding Window (GW) Casement / Picture / Casement (CO _ 1:1:1 or _ 1:2:1 Glider / Picture / Glider (GFW) _ 1:1:1 or _ 1:2:1 :_ Picture Window Awning Window Specialty Window Bay or Bow # Lights Soffit / Roof Shingle / Copper Patio Doors (see separate door spec sheet) Seat to be Primed / Oak / Pine 22SL_ Qty of Windows to be Custom Fit Replacement: 3._0 Qty of Windows to be Custom Fit Full frame (INCLUDES NEW INTERIOR & EXTERIOR CASINGS) Exterior etleings: _ Fine _ Maintenance -free material _ Factory applied 908 Fibres: brickmold 4. Glazing to be :P Lo E-4 TM _ Tempered _ Other If other, please specify: 5. Exterior color to be: hite _ Sand _ Canvas _ Terratone _ Cocoa Bean _ Dark Bronze _ Forest Green _ Black 6. Interior color to � _ White _ Sand _ Canvas _ Pine _ Maple _ Oak _ Same as Exterior Note: Wood interiors need to finished by Owner. 7. Hardware: White _ Stone _ Canvas _ Estate Hardware: Style: 8. Install Lifts with Double HuWind s 9. Screens: windows to have: _Half ag ull screens Screens to be:berglass _Aluminum _ TruScene GRILLE DETAILS have grilles: V Grille Between Glass (GBG) _ Removable Interior Wood (INTW) _ Full Divided Light (FDL) Owner approved (initials) Draw grille patterns below 'Use additional sheet if needed Qty: _— Qty: Qty: Qty: Qty: Qty: ADDITIONAL WORK DETAILS 11. 1Y Qty of _ Sills _ Sill noses to be replaced by Contractor / 12. IgC 5 Contractor will remove metal frames of windows. J5 0/ `"S 0"? /y 13. Contractor will install new _ paint -ready or _ stain -ready _ Interior _ Exterior casings in _ Fine _ Maintenance -free material 14. ctor will install new _ paint -ready or _ stain -ready _ Interior _ Exterior stops in _ Pine _ Maintenance -free material 1 ( nils Owner is aware that Contractor does not do any painting. 16.P0 Contractor will wrap exterior casings with coil stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. 17.V C% 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, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued. 18. �j Yes ❑ No Building Permit�ontractor 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. Ck # $ 19.Yes ❑ No All discounts have been applied to this agreement price. % 20 Additional job details: :4n olE 6� , } 19"114 j 21.A Yes ❑ 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 REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Aydersen Corporation Buyer(s) Buyer(s) By: b ,f 4 t. C&�% b,—, q l v Signature of Prod ct Mand ager Signature vR-1 �c �� l CIA � ��r�.rr 1 Vif) ()_ 6V VID4 Print Name of Product Manager Print Name Signature Print Name Renewal_ MA Home Improvement Contractor �� License #170810 (Expires 12/23/2013) �i byAndersen® �� Federal Tax ID #41-1918413 WINDOW REPLACEMENT an Andersen Company Renewal by Andersen Corporation 104 Otis St., Northborough, MA 01532 (508) 351-2200 • Fax: (651) 351-4810 SPECIFICATION SHEET Buyer(s) Name Date of Agreement I %rI 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 WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. PATIO DOOR DETAILS 1. Install total of: Permashield Ghding Patio Door(s) ❑ 5'10" x 6'8" ❑ Other (not available in 8068) Op. panel is ❑ left ❑ right (as viewed from exterior) Interior and Exterior Color to be: ❑ White ❑ Canvas ❑ Sandstone ❑ Terratone (Color same inside and out on PS) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Other—Specify ❑ Yes ❑ No Gliding Patio Door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ INI'W ❑ FDL (Pattern is standard as viewed in book for all doors) 2. Install total of: Narrowline Gliding Patio Door(s) ❑ 6'0" x 6'8" ❑ Other: Op. panel is ❑ left ❑ right (as viewed from exterior) Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone (Interior is WOOD and customer must paint or stain) Hardware: Metro: ❑ White ❑ Canvas ❑ Stone ❑ Bright Brass ❑ Other—Specify: ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ urw ❑ FDL (Frill Divided Light) 3. Install total of: Prenchwood Gliding Patio Door(s) ❑ 6'0" x 6'8" ❑ Other: Op. panel is ❑ left ❑ right (as viewed from exterior) Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone Interior Wood: ❑ Pine ❑ Oak ❑ Maple Interior Finish: ❑ Prefinished White (Available only with white exterior) ❑ Unfinished (Paint / stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ 110W ❑ FDL (Full Divided Light) 4. Install total of: Frenchwood Hinged Patio Door(s) ❑ 610" x 6'8" ❑ Other: ❑ Yes ❑ No Active / Passive Panel?: ❑ Left ❑ Right (viewed from ext. which is active) OR ❑ Yes ❑ No Active / Stationary Panel?: ❑ Left ❑ Right Door Swing: ❑ Inswing ❑ Outswing Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone Interior Wood: ❑ Pine ❑ Oak ❑ Maple Interior Finish: ❑ Prefinished White ❑ Unfinished (Paint / stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel 'NOTE: Canvas hinged screen frame N/A—must choose white or stone if exterior is canvas' ❑ Yes ❑ No Hinged Patio door to have sidelight? Size. ❑ Yes ❑ No Grilles? If yes: GBG ❑ INTW ❑ FDL (Full Divided Light) STORM DOOR DETAILS 5. Install total of: Storm Door(s) 6. Full View Q Mid View 7. Color to be: ;KWhite E]Canvas E]Sandtone ❑Bronze ❑Forest Green 8. Size to be:3iq 32" ❑ 34" (White only) ❑ 36" ❑ Custom (10 week lead time) Size: 9. Hardware to be: ❑ Bright Brass ❑ Nickel lit'% j }-e 10. Additional job details: 11.Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen Corporation Buyer(s) Buyer(s) By: Signature of Product Manager Signature Signature Print Name of Product Manager Print Name Print Name Renewal Renewal by Andersen Corporation bYAnderSenm 104 Otis Street • Northborough, Massachusetts 01532 Phone (508) 351-2200 • Fax (508) 986-7072 WINDOW REPLACEMENT an Andersen Company CONTRACT AMENDMENT MA Home Improvement Contractor MA License # 170810 (expires 12/23/2013) Federal Tax ID# 41-1918413 This Amendment ("Amendment") is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ("Agreement") by and between Renewal by Andersen Corporation and Diana Givner ("buyers"). Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and conditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions, alterations, or deletions to the products and services Buyer(s) ordered are being made: Subtracting $2336.00 As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or marked as "N/A", indicating that no change applies: NEW Total Job Amount: $26,135.00 Payment Method: New Deposit Received (33 ): $9,490.00 Amex New Balance at Start of Job (33 ): $8,322.50 Check/Credit Card New Balance on Substantial Completion of Job (33 ): $8,322.50 Check/Credit Card It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowledges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date written below. By. Renewal by Andersen Corporation Buyer(s) Signature of Product Manager Signature Date E -Signed - t}1/.03/2013 06.54 PM CST Michael Christopher David G'ivner 01/03/2013 d g ivn a rwie'm s rl a» .oto m IN 98.229.33.H4 Print Name of Product Manager Dot1D:201301Q3089528414 Date Doc ID: 20130103080528414 The Qm ma"eau of 1fas=i Wj. b' Department.of lnifuarid Ar:q d xU - D,�ce of fm►esrtigat5ioris 600 Wash*gton S&reef Boston; A 0111 " . ww► nu=gvv1iia W6rkersCompemation Iasgrance AffdIvit Bceders/Contmeinrs/ElectricianslPiambers ��Iicant InformMdon Please PrizFt Letlffiiv Dame (sns;n�s�orgaz�a1; �•e -t� P l�) G. � � u �•? >1 r�e t�c e n . . Address: b L-( Are you an an4dayer.1 Check the. aPPmPdIb•bax am a ea4)ioprr wiffi y 4• ❑ I am a general cofactx srid I �• employ= (f dI mvVarpmI-timc),e have hired the smb-oontractm 2, ❑ I am a sole pmpaietm arpartier- listed an the stlechod sleet t A4 and have no =3ployam Thew sib-aoutractnts hove working far me in any capacity,' � �• ice [No vnak=' emsce , hmaz 5. ❑ We art a omnporaiiaa and its raquired) officers hmm extacised their 3 . ❑ I am a homeownat doing an work figbt of mmmpticm per MGL MYMIL c• M., j 1(4), md'we hime no [No warms cam o workers' insazamce requited_] t e pbyees. ramp• msozeax requirm ..j 90 00' Trype of project (regdrme : 6. ❑ New camatrictioa 7, M�Omodbling R. IEID=aBsrm 9. ❑ Bonding addition . , 10,[] Blectacat =pairs or adrkana 1 I.❑ *?I m-hin Tope's or additiaas 12.0 Roof Tepshs 13.0 Dd= '/say er that d=jm box #1 masteo � iland the ztoa below �B their wmils'' Pf7' �O0' t HmaW=.wbo sahmit this of davit i-rfi &V m &=P etc we=d tlm hoe amide LWA M&A t now e$dript mplinlog mrk 4CeCft&cb=-dw ch -1- tka b= most Michad as adddiaaal dot dOwkW the acme of t3e=b-c a and ffieQ wCd=''=oop Pdi4 I MR an nrrplo W age it provi bT worker'' compawA tion aur for my employ= Below is the POIL7 aPrd job site bZ== CampaWy 3damG:_ l/ e C�C r'� S D Policy # or S& - ins. 3o -b Mft Adlr='City< .Atfarh a tJwpy of the wwk=' comPM=fiton Dbq drel.msnn page (CbDw*g the potty nmmber and expklLtiDZ dzt-),. pzl} zrt 'to ¢ecnre covtxage' m required mnAm $tx:tian 25A of MQ, c, 152' can kzdtn the imposition of apt penalties of a fie -up to $1,500.00 mxVcff amt: -year impr ain em as well as civflpeaeltiex m the fay of a M? WORK ORDEK and a fine of np to $250.00 a day against the vrolatnr, Be advised •that a copy oif'this statement may -be f oar&d.to the Df = of Iaat galtans of the DIA fxr msmaact eovtaege TzCffirAft= .I dv Eby op r Jt e p af.Pelm7' i� the ircforaation providrd above TS trot ,and mn4et Q S=d tzar vmj5L Do not writ is *i =ea, m -be coanpLeftd by city or inw:c•qffimd {Xy or Tow': Penmidl =9i # �a�ng {rirrip.one�: • . . L Baar� of Seatt�t Z BmWW _D ar Emmg 3. Mr Town C A 4, ffie� bzq ednr S Piambing b2gMe Jnr CERTIFICATE OF LIABILITY INSURANCE DATE 25/20°12""' 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(los) 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 1-612-333-3323 1 CNALNITEACTJonelle Hargrove or Eric Johnson Hays Companies PNONE di:612-333-3323 u.i•612-373-7270 80 South 8th Street Suite 700 Minneapolis, MN 55402 INSURED Renewal By Andersen Corporation 104 Otis Street Northborough, MA 01532 COVERAGES CFRTIFICATF NIIMRFD• 29229429 INSURER A: OLD REPUBLIC INS Co 124247 INSURERS: NATIONAL UNION FIRS INS CO OF PITTS 112445 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. INSLTR OF INSURANCE L SWM UER POLICY NUMBER POLICY EFF Pip EXP ADDTYPE LIMITS A GENERAL LIABILITY MNZY 59828 10/01/1 10/01/13 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY IRENTED PREMISES EDoccurrence1 E 500,000 MED EXP (Any one Person) S 10,000 CLAIMS -MADE 0 OCCUR PERSONAL & ADV INJURY $ 1,600,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS -CO MP/OP S 3,000,000 Z POLICY PRO- LOC i A AUTOMOBILE LIABILITY MINT$ 21700 10 Ol 1 10 O—Irl 3 COMBINED SINGLE LIMIT $ 3,000,000 (Ea socident) X ANY ALTO person) BODILY INJURY (Per S ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS $ $ B E UMBRELLA LIAO X OCCUR 13273355 10/01/1 10/01/13 EACH OCCURRENCE $ 25, 000, 000 EXCESS UAB CLAIMS -MADE AGGREGATE S 25, 000, 000 DEDUCTIBLE S ` X RETENTION S 25, 000 S A WORIXERSCOMPENSATION MCC 117948 00 10/01/1 10/01/13 X WCSTATU orAND EMPLOYERS' LIABILITY Y I N E.EACH ACCIDENT $ 2,000,000 ANY PROPRIETO"ARTNERMTCUTIVE OFFICERMIEMSER EXCLUDED? F NIA (Mandatory In NH) ff under E.L. DISEASE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DES IPTIONescribe DESCRIPTION OF OPERATIONS tn:bw DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atlach ACORD 101. Add*l—.r R.,.. i- e„w.d.d. w...... Evidence of Insurance. Evidence of Insurance 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 erica n •was ww Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SupervisorARM License: CS4395707 BRIAN D DENMON 7 LAMBS POND CIRC Charlton MA 015b7 Expiration Commissioner 09/08/2014 71. � w7uoea�/i o�✓�aaoar�u tea Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: ,;170810 Type: Expiration: _427!23/2013 Corporation R WAL BY ANDERSirN CORPORATION BRIAN DENNISON, 104 OTIS ST. NORTHBOROUGH Mq Oi532 l Undersecretary deers or exceeds M.E.C, CX -.C, A I.E.C.C. Ak Infallretioo regeirements WDMA NaMtarkCedikation Program Renewal;;;. byAndersen, -:� WINDOW REPLACEMENT Au AndeTdeilOiff"ny �,. • . >.aEsyr:t�sr WoodMnyl Composite IF Dual Argon Low E4 SlnartSun Double Hung 100-00473518-010 11' NOW 1 PERFORMANCE RATINGS ENERGY U-Factor (U.S)/1-P Solar Heat Gain Coefficient 00-29 0.19 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance OA2. Manufacturer stipufates that these retinas cenf rrn to appFah" NFRC procedures hr determineg Who%prodsot pedomanoe. NFRC minas aro determined to a food set ofe—i anmentaleoodiione ora • m"Tc produot ske. NFRC does W reeomand any product and does not Warrant the svAabiiy olany product fo my specira use. consua manufacturers 6erature for other product pedormanea inlormation. www.tdts.oig t� xA+�s 7ha product meets Green Smog environmental� atsndards governing energy a foisucy, Mata meta" in 't'• the home and sash lv,,� !•ntatedat, packaging, end?t•Yi•$ rem �,�„ �.., .�"'.tY�� t .� +•yer�� . (. f q. �!t• Y.. eoraumer+dueatioml / 4TR t`.0 >.Sy k'9 , �'fi64:t$iy.•i materia". 1 0.1. / .0. S%:1 %/�{yi 4 - +3.e..wwnwn.rr DESIGN PRESSURE (PSF) RbA DB H-LC25 SlopedSillDH IN Tested to11Af802aANAMVOMAfC5A101AS1A11U4i MaMacVr st a tss onrNomce so f" s o" stattlards. deers or exceeds M.E.C, CX -.C, A I.E.C.C. Ak Infallretioo regeirements WDMA NaMtarkCedikation Program 'Do nal nmave ung fid code )nspea6oA Save heel fa' ek 19 Ar d w t m LZ w Duy}n�yl/�hlood n i�w �4 SrriariSuh - .... product Type; Fries ENERaY Pa�VMANc R�T1Nc (�emcleiit y LJ -Fader , : 5aiar tib Gale 0.2� 1.53 0�� , • • , . 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