HomeMy WebLinkAboutBuilding Permit #256-11 - 29 COLONIAL AVENUE 9/24/2010 bUILUiNV rr-mivi11 , .. u
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * ;_
Permit NO: Date Received
SACH
Date Issued:
IMPORTANT: Applicant must complete all items on this page
x
LO1ATI—77
N
IA N
RIC7 Hasa` Distr! des ` ro
s s Maclir Vallage es ro
4�. _ t
TYPE OF IMPROVE_MENT PROPOSED USE
Residential Non- Residential
❑ New Building ('One family
11 Addition [I Two or more family ❑ Industrial
❑ Alteration No. of units: 0 Commercial
J-Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
eptrrt~ 11�Ue11 ', '' > Fl d � �etl t�rls I titer ed iDJ-R'dt
IIlllatetlSwr h ,
DESCRIPTION OF WORK TO BE PREFORMED:
--y,ry L ,
Identification Please Type or Print Clearly)
OWNER: Name:--V \ a Phone:
Address: ` �'0 e���� .�� tx . �� " c-r C\ 1 ��
r
ONTRTO`R NIx�e� t,
Plar�rae
�ddrpss
y
/+�
trut";Ibn
rour� xat"Ltl�ense, Ip Date„ ` . :: I
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $�
Check No.: loez gf-- Receipt No.: �) 7 i
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund
Snatre of \ ent/zC)Wraer ;!11J111111nSl nature of ;77
;A
11
9 9.. . . .�u....,£. ... .�,._.
Location� d--
No. Date
NORTH TOWN OF NORTH ANDOVER
3?Oi�•�•o '•,h�0
Certificate of Occupancy $
s�cNustt� Building/Frame Permit Fee $ ve
Foundation Permit Fee $
Other Permit Fee $
�) 1 TOTAL $
Check #
2Jf' � �
Building Inspector
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
DATE REJECTED DATE APPROVED
CONSERVATION ❑ . ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
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
Located at 384 Osgood Street Driveway Permit
FEPgRTMENT Temp Dmpstern sit ' ye no
Loca�ed'at 1.�4'Ma�n'S�reet `�`
Frye De
parraaet �gr attare/dale rM,
M
WMENTS
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
Doc.Building Permit Revised 2007
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 H.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
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/Crossection/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
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
❑ 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
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
F QRTH
TONM of _ Andover
LAK O dover, Mass.,
I� COCMICMEWICK y�.
7A ADRAT E D
S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.....��.�!�w... .... ...... .......................................................................................... Foundation
has permission to erect.................:...................... buildings on . ol.f...... � �/.4 •.
.............. Rough
to be occupied as...1�. ...... ...... ..7....... /K......... `✓'�... ! -...........................J.. Chimney
provided that the person accepting t is 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
L11 0,
PERMIT EXPIRES IN 6 MONTHS
716
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S TS Rough
It
.............. ................................................................................................
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 Wall To Be Done FIRE DEPARTMENT
Until Inspected' and Approved by the Building Inspector. Burner.
Street No.
SEE REVERSE SIDE Smoke Det.
04 Otis St.,Northborough,MA 015' J&L WINDows,INC.,D/B/A MA Home Improvement Contractor
(508)919-0900•Fax:(774)987-301. Renewal License#149601 (Expires 1/24/2012)
b Andersen. Federal Tax ID#83-0404201
WINDOW REPLACEMENT =Mdc C—,-y +(C
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT �I
fuyer)s)Name - - - Date of Agreement
/o
Suyer(s)Street Address,City,State,and Zip/Code n ' /�.,
:-Mail Address Home Telephone Number Work Telephone Number
y7k--4U-� Y-S-( 127r- 10
3uyer(s)hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen
"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
ill work under this Agreement.
L/ G Method of Pymnt:O Cash O Check astercard O VISA
Total Job Amount: / 0 Estim"St9 Date:i ` / � O ID Discover El Financed,App#:
Deposit Received(33%):'//14
fV
I Name on Credit Card: 7 S �^
Balance at Start of Job(33%i
r Estimate)Co pletion Date: Credit Card#:
Balance on Substantial /E S' t0
Completion of Job 3%)` CC Exp.Date: CC Security Code:
By initialing here,you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion
Buyer Initial of Job cannot be made by credit card and must be made by personal check,bank check,or cash.
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.
J&L Windows,Inc.d/b/a Renewal by Andersen r(s) Buyer(s)
By:
Sign/a�ture of Product Manager Signatures Signature
04
Print Name of Product Manager Print Name 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 I NOTICE OF CANCELLATION
Date of Transaction Irr-S /0 . You may.cancel Date of Transaction F -S-/0 . You may cancel
this transaction,without any penalty orobligation,within this transaction,without any penalty or obligation,within
three business days from the above date.If you cancel,any 1 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
Contrail 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, I by the Contractor ("Seller'l 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 the be canceled.If you cancel,you must make available to the
Seller at your residence,in substantially as good condition I Seller at your residence,in substantially as good condition
as when received, any goods delivered to you under I as when received,any goods delivered to you under this
this Contract or Sale; or you may, if you wish, comply Contrail 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. I the goods at the Seller's expense and risk.If you do make
If you do make the goods available to the Seller and the l the goods available to the Seller and the Seller does not
Seller does not pick them up within 20 days of the date I pick them u,p within 20 days of the date ofyour Notice
of your Notice of Cancellation,you may retain or dispose I of Cancellation,you may retain or dispose of the goods
of the goods without any further obli anon.If you fail to without any further obligation. If you fail to make the
make the goods available to the Seer, or ifou agree I goods available to the Seller,or if you agree to return the
to retum the goods to the Seller and fail to do so,then Is to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligations under I for performance of all obligations under the Contract.
the Contract.To cancel this transaction,mail or deliver a 1 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 Offs Street,
Street, Northborou h, A 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATERTHAN MIDNIGHT
'
MIDNIGHT OF '7M-/o .(Date) OF e-7-tv ,(Date)
I HEREBY CANCEL THIS TRANSACTION. i 1 HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature Date I Buyer's Signature Date
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink
J&L Windows,Inc.d/b/a _
104 Otis Street,Northborough MA 01532 MA HIC license#149601(expires 1/24/12)
Ph a 508.919.0900•Fax 7 4. 87.30.13 Renewal w_ Federal Tax ID# 83-0404201
Hca �y byAndersen.
WINDOW REPLACEMENT -Anda Company
OF GxenTER MAssAcxvssrrs AND NEw HAMPSHIRE
WINDOW SPECIFICATION SHEET
uyer(s)Name Date of Agreement
I-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 DETAUS
1. Contractor will Install a total of��windows in Owner's home,using the following individual quantities:
Double Hung(DB)"8r Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom)
Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle Metro handle
Double Casement(CDW) ❑ Standard handl Metro handle
Casement/Picture/Casement(CPW) 1:I:1 or ❑ 1:2:1 ❑ Standard handle � etro handle
2 Lite Gliding Window(GW)
Glider/Picture/Glider(GFW) ❑, 1:1:1 or ❑ 1:2:1
Awning Window(AW)
Picture Window(FW)
Bay or Bow Window
o Doors(see separate Door Specification Sheet) /.
2. es El No No Qty of Windows to be Custom Fit Replacement:
3. fEr�❑ No Qty of Sills to be replaced by Contractor:_J6
4. ' Yes ❑ No Qty of Windows to be ew Construction Full frame(includes new interior&exterior casings)
Exterior casin ❑ Pine tenance-free material ❑ Factory applied 908 Fibrex brickmold
5. Glazing to be: Plow ®SmartSunTm (TkX arditL&�7h1c) ❑ Other If other,please specify:
6. Exterior color to be: to ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean
7. Interior color to be: 1te ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑Maple❑ Oak
Note: Inter' color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner.
8. Hardware: to ❑ Stone ❑ Canvas [J Brass p Estate Hardware: Style:
9. ❑ Yes g0lNo Install Lifts with Double Hung W' ows
10. Screens: windows to have: E] Half or [gel Screens to be: iberglass ❑ Aluminum ❑ TruScene
GRILLE DETAILS
11.Windows have grilles: Yes ❑ No If yes: Grille Between Glass(GBG)❑ Removable Interior Wood ❑ Full Divided Light am)
Qt: QtyQt': Qty: Qt': Qt:
H DH DH DH cw/Pim.
PW PG 1-1
r Draw grille patterns above 'Use additional sheet if needed Owner approved(initials):
ADDITIONAL WORK:DETAIIS
12.❑ es [�No Contractor will remove metal frames of windows. Qty of Units:
13.1 Yes ❑ No Contractor will install new paint-ready or stain-ready casings.
Interior g qty of openings: Exterior casings qty of openings:_( Z E] Pine tenance-free material
14.F-1Yeso Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings:
Interior stops of openings: Exterior sto' gs. ❑ Fine ❑ Maintenance-free material
%i 5. Owner is aw t Contractor does not do any painting. Owner Initials
16.❑ Yes o Contractor will wrap exterior casings with al m coil stock of color.
ote: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17. Y_os 2 No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
18. 5dFj No A limited warranty shall be issued to Owner upon completion of the job and payment in full.
19. Yes ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not Q
included in the Contract 'ce and a separate chec is required at t e time of sale for this ee. or l
20. Additional job details: .(C da I 3 C"rr—.e 7'6 F'.2C l`� f,/ L-14
r !e—
"A-
21.ZYes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.
No fmal 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 m 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 Ts ;10 Greater MA and Buyers) Buyer(s)
By:
��!7
Signature-of Product ManagerS>g� Signature
Print Name of Product Manager Print Name Print Name
The Commonivealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
wmmass.gov/dia
•Workers' Compensation Insurance Affidavit:Builders/Contractors/Electridin s/Plumbers
ADDlicant Information' Please.Print Legibly
Name(BusinessiorganizadorAndividuan:
Address:. /0,q Qj�
City/Sfate%Zip: �Df _bo>"a , y 1. �� Phone t
Are you an employer?Check the appropriate box: Type of project (required):
1.E�'I am a employer with • a 0 4. ❑ I am a general contractor and I 6, 0 New construction
employees(full•and/or part time).* bavc hired the sub-contractors ? odeliag
2.❑ I am a sole proprietor or partner- listed on the attached sheet
ship and have no employees Thesc.sub-contractors have 8. Demolition
working forme in any capacity. workers' comp.insurance. 9. ❑Binding addition
[No workers'comp.insurance 5. ❑ Weare a corporation and its 10 ❑Electrical repairs or additions-
required.].- officers have exercised their.
re
3:❑ I qu a homeowner doing all work right of exemption per MGL _ I L❑Plumbing repairs or additions
myself[No-workers'comp: a 152,x.1(4),and we have n6 12.[—]Roof repairs
in nrQ.nee required.]t employCCs..[No workers' 13.0 Other
comp.insurance required_]
'Any nppIieant that cheep bcz#1 must also fill out the section bdow showingiheir wnrI='compeasation policy mfnrmction.
t gomeowners who submit this affidavit indicating they are doing all wort and then hire 6utside amt=toa must submit anew affidavit indicating such.
IGontraotors thaf check this box must attached an additional sheetshning them=of the sub-contractors and their workers'comp.policy information.
I am an emplgei that is providing workers'compensation insurance fur my employees -Below.is the policy and job site
information. ^^nn
Insurance Company Name:
Policy#or Self-ins;Lic.#: I�J�C. Expiration Date:
Job Site Address: 2 UG�-� ( /f City/State zip: lu- t4 n/,))('JU�/
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 imprisonment,as well as civil penaltips in the foim of a STOP WORK ORDER and a fine
-of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce u er the pains and penalties of perjury that the information provided above/is true and correct
J
Simature:
Date: ! 3
Phone#' I t'J U 0 f
Official use only. Do not write in this area,to he completed by city or town officiaL
City or TovI'n: Permit/Llcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone#:
i
i
Aa Massachusetts - Department of Public Safety
Board of Building Reg=ulations and Standards
Construction Supervisor License
License: CS 95707
S AN DENNISON . a
86 CREST CIRCLE ,t i°•'
WORCESTER, MA.01603.
Expiration: 9/8!2012
C'ummm' caner Tr#: 2512
Office of Consumer Affairs&Business$egulatiaa
HOME IMPROVEMENT CONTRACTOR
Reglstratiorig6001 • .
SPI — 12
e t Card
RENEWAL BY .
BRIAN DENNIS _
104 OTIS STRE —
NORTHBOROUGH, _ Undersecretary .
w
t
° )
ACORD. CERTIFICATE OFLIABILITY INSURANCE 0211012010
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
JP McKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 333
Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE MAIC#
INSURED Renewal by Andersen INSURERA: Hartford Insurance dmpany
J and L Windows,Inc. INSURER B: Nautilus
104 Otis St INSURER C: _
Northborough,MA 01532 INSURER M.
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED-BY PAID CLAIMS.
!NSR&DOLPOLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
B
GENERAL NC958461 10101/2009 10/01/2010 EACH OCCURRENCE S 1.000.000
DAMAGE IOFtENT ED
COMMERCIAL GENERAL LIABILITY PREMISE (Ea occuref=1 S 100,000
CLAIMS MADE 7 OCCUR MED EXP(Arty ON Person) S 5LQkQ
PERSONAL S.ADV INJURY S 1,000,00D
GENERAL AGGREGATE s 2.000.000
GEML AGGPE.4ATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO S 2,000,0000
POLICY 7
PRO•JECT LOC
A I AUTOMOBILEL.JABILITY 35MCC XD 6390 10/01/2009 10/01/2010 COMBINED SINGLE LIMIT S 1,000,000
(Eo orddenq
ANY AUTO
X ALL OWNED AUTOS BODILY INJURY S
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY S
(Par aeidenq
NON-OWNED AUTOS
PROPERTYDAMAGE S
(Pareeaaenq-- � -
AUTO ONLY•F-AACCIDENT S
GARAGE LIABILITY '-- -
ANYAU10 OTHER THAN EAACC S
AUTO ONLY: AGO S
EXCESSAJMBREUA LIABILITYEACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
• s
' s
DEDUCTIBLE
. � S
RETENTION S' VJCSTATU• ISER
A wORKERs-cOMPENSAnONAND 35 WECPP 1444 02/17/2010 02/17/2011
EMPLOYERS'LIAIPU rY E.L.EACH ACCIDENT S 5DO,00Q
ANY PROPRIETOR)PARTNERIEXECUTNE i El,DISEASE-EA EMPLOYEE S 500.000
OFFICERMEMBER EXCLUDED?
11yet,desa@o under E.L.DISEASE-POLICY LIMIT S 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
INSURED COPY DATE THEREOF,THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR UABUM OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES. �•y�
AUTHORED REPRESENTATIVE C� ��-�v i s_^'G�•
ACORD 25(2001108) C ACORD CORPORATION 1988
AIM
Rene w* a
byAndersena
WINDOW REPLACEMENT anMdemn(:ompeny
i'••'aE>'s".Lt; +� ,��: Wood/Vinyl Composite IF
Dual Argon Low E4 StnartSun
Double Hung
100-00473518-010
-ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
0n29
0 ,019
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 42
Manufacturaretipuw"that the"afing2contOrmloapplicable NFRC procedures for datarminingwho,product
performance.NFRC ratings are dalarmined for a fixed sat of environmental conditions and a specific product size.
NFRC does not racommand anyproduct and does not warrant the aukaETsy of any product for any apecNic uea.
Consuh manufacturer's Iearatura for other product performance information.
www.nfrc.org
N SE-4t t This product maces Green
seats environmental sa.aa .. .x
;standardz govaming energy r +r >.'�-..•:;Y r" >;,-�`;�??..
Cob
affciancy,heavy matak in
>the frame and sash
£�matariat,Packaging,and
l:consumarreduatbnal
DESIGN PRESSURE(PSF)
s, r a wnmwanamor '
hhnulacseersAss]Caton
H LC25 RbA DB Sloped Sill DH TN �.
TasteatolWS020r"'M1S�ONA/=lol,9SrMr0US Msndactuu ati tas atnformarce to mea Ikaok stunsrtl:.
�Neats or exceeds M.E.C.,C.E.C,&I.E.C.C.Air InfNtration requiramems WOMA NaVmark Cadifi:ation Program.
l Dual Pane Low E
RESS]
U•Factof(t� 3
/(.p SbIar Seat�'�in Coafficient
NGS
ADDik 10 L PERM
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