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HomeMy WebLinkAboutBuilding Permit #779-14 - 328 MAIN STREET 4/30/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 4#b 14 - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1XIne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other SSeptic © Well `� - s'�®Floodplain �t,W`"`E`'{"_Yi..y.* ` ` __ Wetlands ''F �i. } 'moi �. «4 ®'Watehed;District I 3 h i f {;i.r•q:.✓4'�.�t . F„�❑Water/.Sewert'i�F - ,i +.+i+,?a 3'r t � i;., .� ,{� � �; • �.r,.��. syr s• t��x��':,:...�,�'�.,�f���- DESCRIPTION OF WORK TO BE 7FORIVIED: bye Rnjvv ti1Nv0 4) .� Zol l e e1,7 1 &/sa04/--'qc7 40,e 14 � °� 10V � i G�'2� �rtt-t c r tre t ��lJ+y�..^{^'r �i F.SryN_ ,�f. £t''x t f - 6 ,%.F C N RACT�OR�3Na"me��3t�oPhone p . %i r ---- �a 3 .+ .� ter= r �` x e w � r. ♦ -. y F yC;` ` �' �. ,.ti+� >Y �siti ,,, � � �'t . � '�" w ��( �.s k�l i,xy��i'n ,ti y � y �.}(�. fv �_t,_��L$c ,�� `t-fi ''�Z.;S4'f •,� s v f t !� .»•, �,3 �,�}F,a. o-a.''��{{._x ?�.r ��/ �A�r�i3 et {'�'!k 4':w a s.Y k✓:w,�+9r�.�� �{�E.t,�f�� f:Gp�Y�.�'t”'}�.+'���:;^�.i,ia ,F� i~ y� a S+�S�. s'�. j Co^d.^i2.c-. aSupervisorts nstruction License> . 4 Y�'� I ''Tt• i {,�I ,i'�;r4cw y s `.?' A ♦ i'�.{ tr��'a'rSf, rt`S 111 '��s?F'`a r�. 9 �#vk i. Snn t l'r ai4 ri h +tx { 1 f Home;I�mprovementLicense a , . t:Ezp I dDate%`x"'" J. ...•'l R. .•.'. .. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: FEE: $ Check No.: q (.�o cp—P5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access a guaranty fund "Sigriatu., of A"'* nt/Owrie. rn-- Sig atu:�e of coritractor.. . InI_ 1A,..:.., a n r+,,s:�:,,,� DL.� Dl.,r, I—I C4nrrer�nrl Dinnn I] Plans Submitted ❑ Plans Waived -0 Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF•SEWERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt El. - 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 PLANNING & DEVELOPMENT ❑ COMMEN CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes-.. Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection ermit DPW Town Engineer: Signature; Located EIRE •DEPARTMi _"N - Tomp Dumpster on site yes no Located at '124 Maih"Strdet . Fire Departinep t•sigiiatiu•re/date COMMENTS Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELECTRICAL: Movement of Dieter location, hast 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 Building Department The foli`owing 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 TOTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application Q 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 OPTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit fn 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 appal 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 Locations No — Check #* _0 27524 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $b� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector v U)' LU 0 O CD (D O CL 0o� �F CL �• � O 0 O v (D CD r -L cr2p. Sm (D (D O CDCDW EL 0 CD O = :3 C I � v O 0 z 0 � O 70 (D 3 CD � to 0O � (D C co �v rnH v. m T d � � � H O T d N < n Z m m 2 A m m '{O 0 T v a7 C 3 V C W 0 T N n S A = � m N N '6 n' chi, T O n N C m W °y O m m x in 0m c m C= cn nz 0 O Z Cl) //�A� Vr W v� z cn 0 O 70 . D 0 z h CD N O O (Q O S.W CL O c0 M CD C 0 0 2. cn N OO -0 O = < CD .a Cl) r CD CL � CD 0 C) CL 0 � rn o a �. � in rt �• o' � 00• 0. 0 m s0 rt y �� N O -I CD 0 = _Q 2) D O O O (Q Q O CD O 6 to O 0 cn O ® N CD O h Cr C MO — N a 0 NM Nr Nn •v � r� <D O .� O �- t� O 0 =r F CD =CD cn O N "Vv CD 0 0, T D 0 •` CD •0 O O" � O a NO to 0O � (D cn N �* O co �v rnH v. m T d � � � H O T d N < n A � � m m 2 A m m '{O 0 T v a7 C 3 V C W 0 T N n S A = � T 00 n. p' M W p z N n N '6 n' chi, T O n N C m W °y O m m x a NO OF enewa MA Home Improvement Contractor Andersen. Renewal by Andersen Corporation License #170810 (Expires 12/23/2015) WINOOW REPLACEMENT —Anile C—,—y Federal Tax ID #41-1918413 104 Otis St. Northborouqh, MA 01532 (508) 351-2200 Fax (508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Name Date: MARY ANNE BELIVEAU - EUGENE BELIVEAU APRIL 15, 2014 Buyer(s) Street Address City State Zip Code 328 MAIN STREET NORTH ANDOVER MA 01845 Email Address Home Telephone Number Work/Cell Telephone Number MARYAN N E B ELI V EAUOGMAI L.COM 978-682-5762 978-828-4393 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. Est. Start Date Method of Payment Total Job Amount $ 48,900.00 Amount Financed$ 0.00 SVCheck/Cash Deposit Received (33%) $ 16,300.00 10-12 weeks Balance Start of Job (33%) $ 16,300.00 Deposit at signing $ 0.00 Check # Balance on SubstantialTime At Substantial Est. Install 0 Credit Card Completion of Job (33%) $ 16,300.00 Completion $ 0.00 T.B.D. If credit card is selected, please see Credit Card Payment form 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 byAndersen CCoorporationQ Buyer(s) Buyer(s) , l�VSa:Gei�Zitlu�QmAti eaL+t, �•.•�,wo n n,:r�-a..-, n.(y �. By: Signature of Project Manager Signature Signature WILL SALEM MARY ANNE BELIVEAU EUGENE BELIVEAU Printed Name of Project Manager Printed Name Printed 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. -------------------------------------------------------------------------- NOTICE OF CANCELLATION NOTICE OF CANCELLATION I Date of Transaction 4/15/14 .You may cancel this I Date of Transaction 4/15/14 ,You may cancel this transaction, without any penalty or obligation, within three business days from the I transaction, without any penalty or obligation, within three business 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 made by you under the Contract of Sale, and any negotiable instrument executed by you will be I the Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor ("Seller") of your I returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will be I cancellation notice, and any security interest arising out of the transaction will be canceled. If yon cancel, you mast make available to the Seller at your residence, in 1 canceled. If you cancel, you most make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you order I substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the I this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up I Ifyou do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any farther obligation. If you fail to make the goods available 1 of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then I to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel I you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice I this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Contractor: Renewal by Andersen, I or any other written notice, or send a telegram to Contractor: Renewal by Andersen, 104 Otis St. Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF 1 104 Otis St. Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF 4/18/14 . (Date) I HEREBY CANCEL THIS TRANSACTION. 4/18/14 , (Date) I HEREBY CANCEL THIS TRANSACTION. I Buyer's Signature Prim Name Date I Buyer's Signature Print Name Date RenewalRenewal by Andersen Corporation MA Home Improvement Contractor Andersen. �� , 104 Otis St. Northborough, MA 01532 License #170810 (Expires 12/23/2015) WINDOW REPLACEMENT a Anderse Cortpany (508) 351-2200 Fax: (508)-986-7072 Federal ID #41-1918413 Window Specification Sheet Buyer(s) Name Date of Agreement MARY ANNE BELIVEAU EUGENE BELIVEAU TUE, APR 15, 2014 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 the Specification Sheet is part. WINDOW DETAILS Approx. Extedor/Irlterior Color Hardware Hardware LowE4 / Grille Grille Glass Room # U.I. Window/Door S le Detail Casin s Ext-Ird Color le Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts 0 tions Kitchen 1 70 DB so rail equal insert sloped sill NoWH/WH White Standard FFG Low -E4 None ----- ----- ----- No Kitchen 1 70 CD insert NoWH/WH White Standard FFG Low -E4 None ----- ----- ----- No Family 4 • 70 DB sq rail equal insert sloped sill No WH/PN Stone Standard FFG Low -E4 None ----- ----- ----- No Family 1 1 120 FWH No WH/PN Brt.Brass Whftmorel FFG I Low -E4 None I ----- ----- ----- I No Bed 1 3- 70 DB sq rail equal insert sloped sill No H/WH White Standard FFG Low -E4 None ----- ----- ----- No Bed 2 3 70 DB so rail equal insert sloped sill No H/WH White Standard FFG Low -E4 None ----- ----- ----- No Bed 3 2 70 DB sq rail equal insert sloped sill No H1WH White Standard FFG Low -E4 None ----- ----- ----- No L level 9 70 DB sq rail equal insert sloped sill No H1WF White Standard FFG Low -E4 None ----- ----- ----- No L level 1 • 70 AN full frame No H/WF White Standard FFG Low -E4 None ----- ----- ----- No Gara e 2 70 DB sq rail equal insert sloped sill No wH/WF White Standard FFG Low -E4 None ----- ----- ----- No Total 32 BAY & BOW DETAILS *See Ba /Bow Measure Sheet Style Detail / Approx. Approx. Number Frame Window I End Center LowE / Roof / Hardware Room Count Style Flankers U.I. Casings Angle I Lies I Interior Ext/IntColor Grilles sashes sashes Screens Smartsun Soffit Color Living 1 Bow ALL CS 150 IM / Ext 20-25 1 5 Whfte WH/Whl None ----- ----- FFG Low -E4 Roof White 0 SPECIALTY WINDOW DETAILS ecialty BAY/BOW ADDITIONAL WORK NOTES Fun / Approx. LowE / =Elpnt Room Count ' e Insert U.I. SmartSun Grilles Grille a Color Customer is aware that with ba /bow windows under 72 inches Family 4 Trapezoid Insert 80 Low -E4 No WH/PN there will be significant glass lose. ADDITIONAL WORK DETAILS: Cut down bow window o enin cs/ fw/fw/fw/cs Bring in small trap leg to meet min. I No Contractor will wrae exterior casings with coil stock color of 2 Owner is aware that contractor does not do any painting/staining or removal/installation 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 installation. We make no guarantee as to whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is, the amount will be dependent on the type of existing windows, type of installation and window style. We make no guarantee as to the amount of glass loss. Customer is aware and understands any and all unseen rot is not included in this contract. Should any rot be found there will be an additional charge for time and materials unless so stated in this contract. 3 yes Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. Removal and disposal of all job related debris, windows, doors, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued. 4 Yes Building Permit --Contractor 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. Check # 2360 $ 588 5 Yes All discounts have been applied to this agreement. 5 �; 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 NVINDOW 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 Buyers) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen Corporation Buyer(s) Buyer(s) n .J.I.:�, n.h n. lay Signature of Project Manager Signature Signature WILL SALEM MARY ANNE BELIVEAU EUGENE BELIVEAU Print Name of Project Manager Print Name Print Name i Renewal by Andersen Corporation MA Home Improvement Contrator 104 Otis St. Northborough, MA 01532 License #170810 (Expires 12/23/2015) (508) 351-2200 Fax: (508)-986-7072 Federal ID #41-1918413 I i Entry Door Specification Sheet !Buyer(s) Name Date of A cement MARY ANNE BELIVEAU EUGENE BELIVEAU Aril 15, 2014 I The buyer(s) listed above herebyjointly 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 i the Specification Sheet is part. ENTRY DOOR DETAILS i Location Basemnt Family i width 36" 32" Height 84" 80" Jamb depth 49/16 49/16 49/16 49/16 49/16 49/16 Inside style ley 430 Her 460 Outside style leg 430 Her 460 Sidelite style None None j Ins;de color i Snow Mist Amer. Cherry Outside Color Snow Mist Snow Mist R / size sidelite t No No Glass style Clear w/lowE Clear w/lowE Gaming I None None j Add grid No No Door skin Smooth Textured Grid options None None Operation HRFI HLFI Grid Inside color SAME SAME Outside Color I SAME SAME Int lockset Georgian Georgian Int Finish Bri htBrss Bri htBrss Ext. lockset Geor 'an Geor 'an Ext Finish Bri htBrss Bri htBrss Threshold Silver Silver i Kickplate No No Peephole Mail Slot No No Claddingcolor White White Transoml No No STORM DOORS Door Style 397 Storm Color Snow Mist Handle Style Sierra Handle Color n htBrss Additional i Job Notes: i f 6 i j Owner is aware that Contractor does not do any painting/staining or removalfinstallation of alarm system and door treatments/hardware. It is the responsibility of the homeowner to have the alarm system and door treatments/hardware removed prior to installation. We make no guarantee as to whether alarms, door treatments or hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If thereis, the amount will be dependent on the type of existing doors, type of installation and window style. We make no guarantee as to the amount of glass loss. Customer is aware and understands any and all unseen rot is not included in this contract. Should any rot be found there will be an additional charge for time and materials unless so stated in this contract. 7 yes Contractor will insulate, caulk and sea] windows with 3 -point system to prevent water and air infiltration. Removal and disposal of all job related debris, doors, storm doors and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be issued. i 8 Yes Building Permit—Contractor 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. Check 1 $ 9 Yes All discounts have been applied to this agreement. ho VYes ' No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment / finance form(s). iNo 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 Buyers) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renewal by Andersen Co400r. a -tion Buyer(s) Buyer(s) By Signature of Project Manager Signature Signature WILL SALEM MARY ANNE BELIVEAU EUGENE BELIVEAU Print Name of Project Manager Print Name Print Name RBA - Town Permit Information RENEWAL BY AMDERSEte I" - 3Lus Application Notes Must Hand Deliver Monday 7-9pm Tues 9-1 lam Wed 9-11am Building Inspector PatSchena 183 Main St. Main Town Hall Groveland MA Phone: (978) 556-7200 Fax: (978) 469-5003 X209 Final inspections: Appt needed, owner does not need to be present. Pat Schena does inspections whenever he gets the messages at his home #. 978-373-0965. 8/22/07 mac Inspector works out of his home: 978-373-0965 Pat Sullivan - Town Clerk 978-469-0005 or 5005 Tax Collector 978-372-6861 Conservation: 978-374-1863 7-8:30 Monday Only Page 1 of 1 Town Permit Information Groveland MA Egress Information Not Required Permit Fee $75.00 flat Production Notes http://boston.enabledplus.com/TownPermitPrint.aspx?town=Groveland MA 4/29/2014 Last Name: BEL; V FfiU MARY gr*ye_ Address: Sag M'Ai N S� City/Town: Noy,Th AwtbJek. State : MA Zip: 01915- Phone:- 1915. Phone: q17- 6 g �- 5762. Job#: S9-14_ 94591 RTR FRT Building Width: At Building Length: N�fa Distance to Center Carrying Wall: A/ Wall Construction: o y� Carrying Load: A/hq Snow Load Zone: X11 PSF Load Bearing Wall: —Y—N N 4 New R.O. Size: 191 X 1 S Max Header Size: E x i5XW„ q AVoT Sure, . # of Jack Studs: A,-Iq Pitch of Roof IYM Best Estimate JOB NOTE: � 0 W F12iNe? GX Stwf R.O, w, Ai✓,,tj4 Roott (44*A�. E)(i4wy P110.191 010 A(&A,) R,o. To &e 191")e 43" 7-0ACCy1 Ne -0 1505).ik 60W W/44 pool. TECH'S ATTACH FOLLOW INFO: PICTURES (COMPLETE FRONT, SIDE & REAR), 2 COPIES OF COMPLETE WALL/SIDE WHERE NEW HEADER AND CIRCLE AREA ON PHOTO RENEWAL BY ANDERSEN �-IEIADe12To s�-a� �ls'�s . EXi5�jPo R.O. 4 6„ u rve'%0 N,agbf 43 Nea.� a k SILL. New R.O. Size: 191 X 1 S Max Header Size: E x i5XW„ q AVoT Sure, . # of Jack Studs: A,-Iq Pitch of Roof IYM Best Estimate JOB NOTE: � 0 W F12iNe? GX Stwf R.O, w, Ai✓,,tj4 Roott (44*A�. E)(i4wy P110.191 010 A(&A,) R,o. To &e 191")e 43" 7-0ACCy1 Ne -0 1505).ik 60W W/44 pool. TECH'S ATTACH FOLLOW INFO: PICTURES (COMPLETE FRONT, SIDE & REAR), 2 COPIES OF COMPLETE WALL/SIDE WHERE NEW HEADER AND CIRCLE AREA ON PHOTO RENEWAL BY ANDERSEN The Commonwealth of Massachusetts Department of Industrial Accide>sts Office of Invesdgations k' 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Couapeusation Insurance davit: Builders/Contractors/Eleet>"icaans/I�luobers rmliesint Infnramsattinn Name (Business/Organizatiowbdividual): {\6n 9,W G ` `p Address: LA .- � 9 - Are you an employer? Check the appropriate bog: 1.� am a employer with 7 J 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insurance: required.] 5-E] We are a corporation and its 3.[] I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required] t c. 152, § 1(4), and we have no employees, [No workers' comp. insurance reduimd_l C) Type of project (required): 6. Q New construction 7• 21trmodeHrng S. [-]Demolition 9. [] Building addition 10. ❑ Electrical repairs or additions 11. Q Plumbing repairs or additions 12. Q Roof repairs 13.E] Other *Any applicant that checks box #1 must also fill out We section below showing theirworkers' compen§ation policy information. t Homeowners who submit this affidavit indicating they are.doing all work and then hue outside contractors must submit anew affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors lave employees, they must provide their workers' comp;, policy.number. am an employer utat is providing workers' compensation insurance for information. my er►rloyees. Below is the policy job site n Insurance Company Name: Policy # or Self -ins. Lic. #: G[ . ®� EXpiration Dom: [ �� Job Site Address: City/State/Zip Attach a copy of the workers' compensation policy declaration page (showing the policy number and Upiration 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 penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here6y� un a pains and penalties of perjury that the btformatlon provided above is true and correct Official use only. Do not write in this area, to be completed by eity'or townofjtcia[ City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector' 5. Plumbing Inspector 6: Other . Contact Person: Phone #: CERTIFICATE OF LIABILITY INSURANCE 20/02/2013 ' '~I 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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 CONTA says Companies PNONE 612-333-3323 FAX �; 612-373-7270 80 South 8th Street er1UL Suite 700 ADDRESS' Ninnaapolie, MN 55402 'NSU AFFORDING COVERAGE MATO INSUREDINSURERA: OLD REPtIBLIC INS CO 24147 Renewal By Andersen Corporation INSURERS: NATIONAL ONION FIRE INS Co OF pITTB 19445 INSURER C: 104 Otis Street INSURER D: Northborough, MA 01532 IWSURER VYCRFK7G�1 CERTIFICATE NUMBER: 36122490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. p TYPE OF INSURANCE I POLICY ECF aera_v era A GENERALLWBWry - --- NNZY 300361 10/01/1 10/01/14 Lan EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY $2.000.000 CLAIMS MADE a OCCUR MISS aoou ce $500,000 MED EXP ani mM $ 10,000 PERSONAL &ADV INJURY &2.000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $4,000,000 XPOLICY PRO- JECT LOC A AUTOMOBILEW�BILITY MNTB 300026 1 1$ *PRODUCTSMiacdderd) 5,000,000ANYAUTO (PaS ALLOWNED SCHEDAUTOSULEDAUT09 NON-0NMED Ix (Per 6 HIRED AUTOS X AUTOS PROPERTY DAMAGE _ 8 X UMBRELLA I" Y OCCUR 20562235 10/01/1 10/01/14 EACH OCCURRENCE EXCESS LIAS CLAIMS -MADE =25,000,000 AGGREGATE f 25,000,000 DED I % I RETENTIONS 25,000 A NDERLCOMPENSATION OYERVLIABILRY MNC 300359 00 10/O1/i 10/01/14 t % WCSTATU. OTH YIN ANY PROPRIETORIPARTNERIEXECUTNE EI EACH ACCIDENT t 11000,000 OFFICERIMEMBEREXCLUDED? FN atar>I M NH) N!A K desaibe under gg;a F.L. DISEASE • EA EMPLOYEE 5 1, 000, 000 DESCRIPTION OF OPERATIONS tallow LL DISEASE- POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Addwoml Remarks seMdale, R mem space k wqutnd) To Nhasl It May Concern For Insurance purposes Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE ©1888-2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD jbargrove 36122490 , � 60 Massaclauselt5 - t�dpar,6 ent of Public Safe Board of Buridnt Regulations and S6 anis'" Cunstructic►n Sunisur License: CS490125 gib. JAIME L MOMN = " 86G ARDINER sr. a Expiration d' Gommissroner 10106/201.4 SCA 1 t'e 20M-05/11 trice of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR Registration 9084Q Expirationi.,12%23f10i ' Type: Supplement is RENEWAL BY ANbERSON'±ORROORATION JAIME MORIN 104 OTIS STREET NORTHBOROUGH, MA 01532 Undersecretary deism. Andersen' NFRC Certified Total Unit Performance (continued) • For NFRC certified total unit performance on units with capillary breather tubes for high altitudes, please visit andersenwindows-com- • 'High -Performance' Law -E4" (HP low-E4),'High-Performance' Low -E4' SmartSun-- (HP Low -E4 SmartSun) and'High-Performance" Low -E4" Sun- (HP Low -E4 Sun) are Andersen trademarks for "Low -E' glass. ' U -Factor defines the amount of heat loss through the total unit in BTU/hr sq. fL•F The lower the value, the less heat is lost through the entire product window values represent non -tempered glass. Use of tempered glass can increase U -Factor ratings. See andersenwindows.com for specific performance values. Door values represent tempered glass - Solar Heat Gain Coefficient (SHGC) defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward. The lower the value, the less heat is transmitted through the producL . ' Visible Transmittance (VT) measures how much light comes through a product (glass and frame). The higher the value, from 0 to 1, the more daylight the product lets in over the products total unit area. Visible Transmittance is measured over the 380 to 760 nanometer portion of the solaf spectrum. • NFRC ratings are based on modeling by a third party agency as validated by an independenttest lab in compliance with NFRC program and procedural requirements. • This data is accurate as of December 2010. Due to ongoingproductchanges, updated test results or new industry standards or requirements, this data may change overtime. Ratings are for saes specified by NFRC for testing and certification. Ratings may vary depending on use of tempered glass, differentgrille options, glass for high altitudes, etc- - PassiveSun' glass values are available online at andersenwindows.com. 277 " I Andersen' Product ' Glass Type U -Factor' I SHGC' I VF' ! Ia; Andersen' Product Glass Type U -Factor' SHGC` ! VP 40D SeHes ' I Architectural HP Lar{4 . 0.27 035 0.60 i :) HP low -E4 032 028 0 47 " HP Low -E4 withGrilles 0.28 0.31 0.54 ' HP Imo -E4 with Grilles 0.32 025 0.42 {'! Circle Top' HP to -E4 Sun 0.27 021 0.33 i + Window HP Low -E4 Sun 0.32 0.17 0.26 ' r '� Casement Window Wi HP Low -E4 Sun with Grilles 0.29 0.19 0.30 F't `�' � Casement HP Lor{4 Sun with Grilles 0.32 0.16 023 (^'i 13 HP Lux -E4 SmartSun 0.26 023 0.54 rr Y r'` HP Low -E4 SmartSun 0.31 0.18 0.42. 5 t R13 HP Low -E4 SmartSun w/Grilles 0.28 021 0.49:r M HP Lmv-E4 SmartSun w/Grilles 0.31 0.17 038 L;,, 1 NP Low -E4 0.27 035 0.60 I HP Low -E40.32 028 0.47 F� HP Low{4 with Grilles 0.28 031 0.54 HP lmv{4 with Grilles 0.32 025 0.42 �t HP Lrnr{4 Sun 0.27 021 033 f , French Casemeirt HP law -E4 Sun 0.32 0.17 0.26 Circle &.Oval Window;, HP law{4 Sun with Grilles 029 0.19 0.30 f . Window HP Low -E4 Sun with Grilles 0.32 0.16 023 HP Low{4 SmartSun 0.26 023 0.54 S j t F"I HP Low -E4 SmarlSim 0.31 0.18 0.42 HP low -E4 SmartSun w/Grilles 028 0.21 0.49 HP Lux{4 SmartSun w/Gnlles 031 0.17 0.38 I HP Low -114 028 033 0.58 FF HP Low -E4 0.32 028 0.47 r HP lnvr-E4 with Grilles 0.29 030 0.52 ;?'' L - HP Low -174 with Grilles 0.32 025 0.42 " HP Low -E4 Sun 0.28 020 031 6 ' Awning Window. HP Low -E4 Sun 0.32 0.17 0.26 Arch YVlndow HP Low -E4 Sun with Grilles 0.29 0.18 0.28 a + °•' HP Lux -E4 Sun with Grilles 0.32 0-16 023 " HP Low -E4 SmartSun 027 013 0.52 [. C"; HP Lox -E4 SmartSun 0.31 0.18 0.42 ? - .t'%, 0 HP Low -E4 SmartSun w/Grilles 0.28 021 0.46 Fr. ':. + HP Law -E4 SmartSun w/Grilles 0.31 0.17 0.38 HP Lor{4 0.27 0.33 0.58 HP Low{4 031 032 0.55 NP Low -E4 with Grilles 028 0.30 0.52 HP Low -E4 with Grilles 0.31 029 0.49 HP Low -174 Sun 027 020 0.31 -* '`' r Cosemetd%Awning . ' HP Low -E4 Sun 0.31 020 0.31 R. Flexiframe`. Window HP Invr{4 Sun with Grilles 0.29 0.18 0.28 ;.5 �". [`� 'Picture Window -" NP Law{4 Sun with Grilles 0.31 0.18 0.28 .. - ' NP Low -E4 SmartSun 026 023 0.52 HP Law -E4 SmartSun 0.31 021 0.50 HP Lmv-E4 SmartSun w/Grilles 0.28 021 0.46-E4 SmartSun w/Gnlless 0.31 0.19 0.44 '''. • HP Lor -E4 031 033 0.58 ` HP luw-E4 030 03T 0 64 0.57 f HP Lor -E4 with Grilles 0.32 030 0.52 f + /"'" HP tow -E4 with Grilles 0.30 033 - HP Low -E4 Sun . 0.31 020 0.31 '�; - HP Lour -E4 Sun 031 022 036 I 1'� LA Spdnglin'e Window- . 0.33 0.18 028 '. ` ; Specialty Window " - HP Low -E4 oath Grilles l 031 010 0.32 K? I " HP Law -E4 Sun with Grilles I HP Lar SmarlSun 0.30 023 0.52 F) )" Uj V HP Law -E4 SmartSun 0.30 024 0.58 E' a -E4 I HP Law -E4 SmartSun yr/Grilles 0.32 021 0.46 ET. `� I E� - j' � HP Low -E4 SmartSun w/Grilles 0.30 022 0.52 �1 F 2 HP Lor -E4 0.30 027 0.45,: HP Imo -E4 032 012 037° HP lux -E4 with Grilles 0.32 023 0.39 IF.'! PV / HP Low -E4 with Grilles 0.33 020 033 - Frenchwood' HP low -E4 Sun 0.31 0.16 0.25 R r- M ed/Inswing. HP Low -E4 Sun 0.33 0.14 0.21 - Glfding.Petto Door HP Low -E4 Sun with Grilles 0.32 0.14 022 "i ® French Door HP Low -E4 Sun with Grilles 0.34 0.13 0.18 - HP Low -E4 SmartSun 0.30 0.18 0.41 l'.1 gK HP Low -E4 SmartSun 0.32 0.15 0.33' j HP Law -E4 SmartSun w/Grilles 0.31 0.16 0.35 ? +•: � HP for{4 SmartSun w/Gnlles 0.33 0.14 0.30 - HP Low -E4 0.31 024 0.41 °' ® HP low -E4 0.33 015 0.41 FMON /"' , ,• . � I HP Lar -E4 with Grilles 0.32 021 0.35 {• ,r HP Low -E4 with Grilles 0.34 022 036 - -yr a Frenchwood' Hinge ! HP tar -E4 Sun 0.31 0.15 023 r' r i Hinged Ootswing HP Low -E4 Sun 0.33 0.16 0.23 O o m Inswing N 6 Do HP Law{4 Sun with Grilles 0.32 0.13 0.19 +.! French Door .. HP lar -E4 Sun with Grilles 0.35 0.14 020 - HP Low -E4 SmartSun 0.30 0.16 037 sx i'l. - HP Low -E4 SmartSun 1: 032 0.17 0.37 :t' Ig %6 " - HP Lmv-E4 SmartSun w/Grilles 0.31 0.14 0.31 ii- r'' HP Imo -E4 SmartSun w/Grilles 034 0.15 0.32 - 0 0 --"` HP Imo -E4 0.31 025 0.41 VP IT' - NP lux{4 0.33 023 0.38 - od - HP low -E4 with Grilles 0.32 021 0.35 � " ' . HP lux{4 with Grilles 0.33 021 0.34 - Frenchtvond' HingeA' HP Low -E4 Sun 031 0.15 023 f!#'. '-• . " Fixed French Door - HP law{4 Sun 0.33 0.14 011 = outswing Patio Door HP Low -E4 Sun with Grilles 0.32 0.13 0.19 i Sidelight HP Low -0 Sun with Grilles 0.34 0.13 0.19 HP Low -E4 SmartSun 0.30 0.17 037 `#> _ HP Low -E4 SmartSun 0.32 0.15 0.34 - " HP Low -E4 SmartSun w/Grilles 0.31 0.15 0.31 J�= ` ` HP Low -E4 SmartSun w/Grilles 033 0.14 0.30 - HP for -E4 0.31 022 0.37 F� HP Lan -E4 032 015 0.41 - HP Law -E4 with Grilles 0.32 020 0.33 P HP Lax -E4 with Grilles 0.33 0.22 0.37 - Frenchwoad - HP Law -E4 Sun 0.32 0.14 0.21 • " ` F Fixed Transom HP Low -E4 Sun 0.32 0.15 0.23 = Patio Door Sidelight HP Law -E4 Sun with Grilles 0.32 0.13 mil ) � � French Door HP Low -E4 Sun with Grilles 0.33 0.14 0.20 - HP Lar -E4 SmartSun 0.31 0.15 0.33? . t" �� I HP lax -E4 SmartSun 0.32 0.16 037 - ' { HP Low -E4 SmartSun vi/Grilles 0.32 0.14 029 ' HP lax -E4 SmanSun vi/Grilles 0.15 033 - HP law -E4 0.30 014 0.40 F HP lmv{4 035 026 0.44 - HP law -E4 with Grilles 0.30 021 0.35 ! � . '' . "! HP Imo{4 with Grilles 0.36 023 0.38 - '' HP Low -E4 Sun 0.30 0.15 Q224 %. - HP Lon -E4 Sun 0.35 0.16 024 Frenchwood' " " 0.31 0.13 0.20 `) +' Folding Door HP lax -E4 Sun with Grilles 0.36 0.14 021 = Patio Door Transom HP Lor -E4 Sun with Grilles . `" r R HP law -E4 SmartSun 0.34 0.17 039 - " - HP law - E4 SmartSun HP Lour -E4 Stow- n w/Grilles 0.29 0.30 0.16 0.14 0.36 0.32 1 L. I . M- HP Lar -E4 SmartSun w/Grilles 0.36 0.15 0.34 - ronUnued an next page • For NFRC certified total unit performance on units with capillary breather tubes for high altitudes, please visit andersenwindows-com- • 'High -Performance' Law -E4" (HP low-E4),'High-Performance' Low -E4' SmartSun-- (HP Low -E4 SmartSun) and'High-Performance" Low -E4" Sun- (HP Low -E4 Sun) are Andersen trademarks for "Low -E' glass. ' U -Factor defines the amount of heat loss through the total unit in BTU/hr sq. fL•F The lower the value, the less heat is lost through the entire product window values represent non -tempered glass. Use of tempered glass can increase U -Factor ratings. See andersenwindows.com for specific performance values. Door values represent tempered glass - Solar Heat Gain Coefficient (SHGC) defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward. The lower the value, the less heat is transmitted through the producL . ' Visible Transmittance (VT) measures how much light comes through a product (glass and frame). The higher the value, from 0 to 1, the more daylight the product lets in over the products total unit area. Visible Transmittance is measured over the 380 to 760 nanometer portion of the solaf spectrum. • NFRC ratings are based on modeling by a third party agency as validated by an independenttest lab in compliance with NFRC program and procedural requirements. • This data is accurate as of December 2010. Due to ongoingproductchanges, updated test results or new industry standards or requirements, this data may change overtime. Ratings are for saes specified by NFRC for testing and certification. Ratings may vary depending on use of tempered glass, differentgrille options, glass for high altitudes, etc- - PassiveSun' glass values are available online at andersenwindows.com. 277 .: _:.. •w, _: " , - ,: �- " � .;, ®�..., a�,..,�,�-.row r - , .� �. • .�.:,k rrws:+faz<� �:,.�. ,��:.:: •., •:.ia � x <. *�ca � �xr ,, �- . � _ant, ^rzr.: rrr„ crra. TMi, �.t�* rs - PRODUCT PERFORMANCE Andersen' NFRC Gerdifled Total Unit PerfsrMance (o nfinDed) i. Andersen Product': Glass Type Ll -Factor' SHGV VP 200 Series Gear Dual Pane 0.45 0.60 0.63 - - - Clear Dual Pane with Gnlles 0.45 0.54 0.56 - .Tilt -Wash.": _'..' '. 1Dw-E 0.30 032 0.55 Douhi_�Hung•Window-" ; Low -E wdh Wes 0.30 029 0.49 W Lmv-E4 SmartSun 0.30 021 0.49 s y -- - .. HP Lmv�R Smar6un w/Gnlles 0.31 0.19 0.43 Clear Dual Pane 0.45 0.61 0.64 - :, Narmline' Clear Dual Pane with Gdlles 0.45 0.54 0.57 - "ilouble-Hung'Windaw _ Lmv-E 0.30 0.32 0.56 Low -E ,+ith Gd➢es 0.31 029 0.50 ' Clear Dual Pane 0.4 0.63 0.66 - . Clear Dual Pane with Galles 0.44 057 0.59 - - `. Teansom.Window Lnvr-E 027 034 mlii ' - Lmv-E •aith Galles 027 030 0.52 _ Clear Dual Pane 0.45 0.60 0.63 - - Clear Dual Pane wrlh Galles 0.45 054 . 0.56 - -Low-E 0.30 032 0.55 6Lidirig"wndow '- Ln%�E Y th CAlles 0.30 029 0.49 - - Lmv-E SmartSun 030 021 0.49 . Ln v -E SmartSun with Galles 0.31 0.19 0.43 3 Clear Dual Pane 0.43 0.61 0.65 - Clear Dual Pane vrith Gnlles 0.43 0.55 '= 0.58 - ' Faed 'Transom;. ` :.: "' Lm+ -E 028 033 0.56 : Circte.Tap Whndow Lov E with Galles 028 030 0.50 Lmv-ESmartSun 027 022 0.51 2 3M Lmv-E SmartSun with Grilles 027 02D OA5 Clear Dual Pani 0.44 0.51 0.64 - Clear Dual Pane wb Grilles 0.45 0.53 0.56 - - -_ Low -E 029 032 0.56 - NarmBne`: Ww-E with Grilles 030. 029 0.49 J "dr, d"iog.PatioDoars -; Lmv-ESun 029 020 0.31 MM Law{ Sun with Grilles 0.31 0.18 627t :may - _1 Lmv-E SmartSun 028 021 0.50 ' -z Lmv-E SmartSun with Galles 0.30 0.19 0.44 . - - Clear Dual Pane 0.43 0.61 0.64 - ' Clear Dual Pane with Galles 0.43 054 0.56 - - - Low -E 028 032 0.56 - Perma-Shield".. _- -` - Lmv-E wah Galles 0.30 029 0.49 ~'gliding Patio Doors ;.` Law -E Sun 029 0.19 0.30 _ - Low -E Sun with Galles 0.30 0.17 027 - - - - Lmv-ESmartSun027 0-22 0.50 a - Low -E SmartSun with Galles 029 019 0.44 " - - - - Clear Dual Pane 0.43 0.45 0.47 - -_ - - -- - - - Clear Dual Pane with Galles 0.43 039 0.40 - Law -E 032 0-24 0.41 . g Hinged.inswing- : -.-" Lmv-E with Gnlles 033 021 0.35 - Patio Doors ; Low -E tow -E Sun 032 015 023 - _ - Lmv-E Sun with Grilles 034 0.13 0.19 - Lmv-E SmartSun 0.32 0-16 0.37 . J - - -- _ Lmv{ SmartSun with Galles 0.33 0.14 031 - Thank You for choosing ProVia Door products. This product has been specifically designed to improve energy efficiency and the appearance of your home. Does this door meet the criteria for its glazing level? (Check only one box) For: 1.11 -factor SHGC Yes Opaque s 0.21 Any % or 14 Lite s 0.27 s 0.30 'Y. or Full Lite s 0.32 s 0.30 ProVia Door NFRC Heritage Fiberglass Entry Door in Wood Frame 230DLA 1/2 Lite National Fenestration Rating Council® Double Glaze Low -E Glass w/Argon PRD -K-2-00299 ENERGY PERFORMANCE RATINGS U -Factor (U.S/1-P) Solar Heat Gain Coefficient (SHGC) 0.19 1 0.1 ADDITIONAL PERFORMANCE RATINGS 1 Visible Transmittance 0.18 1 - Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a fixed set of ernironmerdal conditions and a speck product size. NFRC does not recommend any product and does not warrant the suitability of any product for any specific use. Consult manufacturers literature for other product performance information. - www.nfr:.org a To register this product, go to our website and click the warranty registration tab. Fill out the requested information including the product identification number listed below. Product ID 2160587.001 Qualifies For Tax Credit! ProVia certifies this product qualifies for the 2011 Energy Tax Credit. (As determined in accordance with The Tax Relief, Unemployment Insurance Reauthorization and Job Creation Act of 2010.) ProVia Door 2150 State Route 39 Sugarcreek, OH 44681 www.proviadoor.com -.i_ - _•i.. -�.� �,,�:r.__ - �•�. +...�...- 'w�r+a.M�,�,,,.��r,r„ �-�ue,.a,� �.,,. q, ,�,�•r„ _nye: �.ew—,.r�...r..:..s.k -rte-: aR �=�•.Y' — - � ti.:�._ .y..?„�-�_,.�,':�_ _ry.. _�•�,•}�'�� r tr "SIL ' Doi *- w I " DOW AnM Tom, ` U FB*lr : •solar H 675 0 9 vwb)e. Trammdnce pow 0 A3 CCL :. moa • '. ," ., - •NAFCm.arA � DPps€f•G5•{35 . ' mom o is IM-Mbl 14W= i}� 0) Canada- l I sac 367-2oon Cr anotpyshrpr.oa ' I c w lM �L U W aEI U 181111'70-7937 anergyatargov Renewal byAndersen� • WINDOW REPLACEMENT anAodamanQrmparq AND -N-1 03 Wood/Vinyl-composite - Duai Argon Low -E4 ' Product Type: Awning ENERGY PERFORMANCE RATINGS U -Factor Solar Heat Gain Coefficient • 0.29' 1.65 0828 U.SJl-P Metic/s �. ADDITIONAL PERFORMANCE RATINGS Visible Transmittance .0. R Mar urachrter shpubdas that these raangs mn" to applicable NFRC promdures for detemmning whole product penonnarlm. NFRC ratings are daWnNned for a Ned set of environmental cond1bons and a spnMc product sip NFRC does not recommend any product and does not warrant the wbbWW of any product for arty sp=Mc use. Consort manutacWrer's Iitendvre nor other pmdurt performance th onna ton www.mrt.mm Standard Rating NAFS 2orAWAMMAWAMAS2nacaos DP W DP40 This product meets Omen sears BnAronmental U, govemtnp energy ' etf clanry, heavy metals ' In the pane and sash matmMl, padaglnp, an laummW> materfad eduratlonal 10D-00518940-015 Mem dr-eQeeds MEC„ C.E_C, d IEC.C. Nr mnllt aeon mqulreMWM WOMA Nandoux Certmanon Program May 8, 2013 TH ERI0P811OO.ICel3IEDHAflflG ROUPo FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1358609 Insured: EUGENE A BELIVEAU Address: 328 MAIN ST, NORTH ANDOVER, MA Policy No.: F0118492 Loss Date: 05/06/2013 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street, P.O. Box 9109, Dedham, MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone: (800) 688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax: (781) 329-1818