HomeMy WebLinkAboutBuilding Permit #Exception - 36 SAWYER ROAD 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone: �
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: 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.
a
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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 Siqnature
COMMENTS
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Siqnature& Date Driveway Permit
DPW'Town Engineer: Signature:
Located 384 Os-ciood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Deparfinerit 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.$100-$1000 fine
NOTES and DATA— For department use
B Notified for pickup - Date
I j
Doc.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
❑ 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: Doc.Building Permit Revised 2012
Location
No.—S(4 Date 1 0Z`4 �'Z„'
• ' TOWN OF NORTH ANDOVER
• �,�'�I,f;D X�q6 1
. ' Certificate of Occupancy $
Building/Frame Permit Fee $17"ME Zv�IK5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# �� +
25875 Building Inspector
NORTH
Town of tAndover
No. _T :
h ver, Mass, I law.,o
0 0"40
coc Ic"2W.Cn
AOR�TEO
S V
BOARD OF HEALTH
Food/Kitchen
PER T LD Septic System
THIS CERTIFIES THAT ..4^ ... �'� BUILDING INSPECTOR
................ .. .......................... ... ....... . ... ........................................
has permission to erect ...........................buildings on ....11 3.4....... �� , Foundation
hh
Rough
04 dot-d 6.4
to be occupied as .........I! .�........ ......... ........... ........... .1 !! ...................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTR 10 RTS Rough
Service
........... ..... ... ............................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
SEE REVERSE SIDE
RenewalMA Home Improvement Contractor
�AnderSen. - License#170810(Expires 12/23/2013)
Renewal b Andersen Corporation Federal Tax ID#41-1918413
WINDOW REPLACEMENT anAndersrnCompany Y Y
104 Otis St.,Northborough,MA 01532
(508)351-2200•Fax:(651)351-4810
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Nopq Date of Agreement
BuyerK)Street Address,City,State,and Zip Code
E-Mail Address V Home Telephone Number Work Telephone Number
Buyer(s)hereby jointly an 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.
Ie Estimated Starting Date: Method of Payment:
Total Job Amount: Amount Financed � �
'rtWEft€�^ ❑Cash
Deposit Received(33%):— , G l! l7Visa/MC iscover
---'�' D anted OAMEX
Balance at Start of Job(33%): Estimated Co pletion Date:
If credit card is selected,please
Balance on Substantial _�+ ^' , see Credit Card Payment Form.
Completion of Job(33%):
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.
Renew by Andersen rporation Buyer(s) Buyer(s)
By: �
i to e f Product Manager Signature Signature
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.
�— — - - - - - - - - - -�,<- - - - - - — — — — — — — -�<- - - - - - - - - — — — — - -�
NOTICE PF CANCELLATION X NOTICE OF CANCELLATION
Date of Transaction - i You may cancel I Date of Transaction . You may cancel
this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within
three business days from the above date If you cancel,any I three business days from the above 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, I by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will I and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to the I 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 as when received,any goods delivered to you under this
this Contract or Sale; or You may, if you wish, comply I Contract or Sale;or you may,if you wish,comply with the
with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of
shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk.if you do make
If fou do make the goods available to the Seller and the I 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 up within 20 days of the date of your Notice
of your Notice of Cancellation,you may retain or dispose I of Cancellation,you may retain or dispose of the goods
of thegoods without any further obligation.If you fail to without any further obligation. If you fail to make the
make the goods available to the Seller, or if ou agree I goods available to the Seller,or if you agree to return the
to return the goods to the Seller and fail to do so,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 I To cancel this transaction, mail or deliver a signed and
signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written
other written notice,or send a telegram to Contractor: notice,or send a telegram to Contractor.
Renewal by Andersen Corporation, 104 ChisI Renewal by Andersen Corporation, 104 Chis Street,
Street, Northborough, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATERTHAN MIDNIGHT
MIDNIGHT OF .(Date) OF .(Date)
I HEREBY CANCEL THIS TRANSACTION. i 1 HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature Print Name Date I Buyer's Signature Print Nam a Date
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 0tBLLP2009.RBA7h.MANH
Renewal _ MA Home Improvement Contractor
�.,� .enewal by Andersen Corporati p
bYAnderSen.
C104 Otis St.,Northborough,MA 01532 License#170810(Expires 12/23/2013)
WINDOW REPLACEMENT an AndersenCnmpany
(508)351-2200•Fax:(651)351-4810 Federal Tax ID#41-1918413
WINDOW SPECIFICATION SHEET
Buyer(s)Name Date of Agreement
2f Z.-
The Buyer s)listed above hereby jointly and severalty agreq 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.
WIIVDOW DETAILS
1. Contractor will Install a total of ndows in Owner's home,using the following individual quantifies:
4'ZeDouble Hung(DB) Fyual sash_Cottage sash(1/3 top,2/3 bottom)_Oriel sash(2/3 top.1/3 bottom)_Flat sill aware Gies of
Casement(CS)_Hinge right_Hinge left(as viewed from exterior)
Double Casement(CD)
2 Lite Gliding Window(GW)
Casement/Picture/Casement(CT)_1:1:]or_1:2:1
Glider/Picture/Glider(GPW)_1:1:1 or_1:2:1
Picture Window Bay or Bow
Awning Window _#Lights Soffit/Roof Shingle/Copper
Specialty Window Patio Doors(see separate door spec sheet) Seat to be Primed/Oak/Pine
2.��of Windows to be Custom Fit Replacement:
3. _Qty of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS)
Exterior caser:_Pine_Maintenance-free material_Factory applied 908 Fibrex brickmold
4.Glazing to be:�1-fP Low/-E 4 Tm _Tempered _Other If other,please specify:
5.Exterior color to be: k< ite_Sand_Canvas_Terratone_Cocoa Bean_Dark Bronze_Forest Green_Black
6.Interior color to be: hite_Sand_Canvas_Pine_Maple_Oak_Same as Exterior Note:Wood interiors need to finished by Owner.
7.Hardware: rte_Stone_Canvas Estate Hardware: Style:
8._,ta-6—Install Lifts with Double Windows
9. Screens:windows to have: alf or_Full screens Screens to be: tberglass_Aluminum_TruScene
GRILLE DEEAI S
10. _Windows have grilles:_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 Qty:
Ell 11 1�1 I
ADDITIONAL.WORK DETAILS
11. Qty of_Sills_Sill noses to be replaced by Contractor
12. ')0 Contractor will remove metal frames of windows.
13. 4!)Contractor will install new_paint-ready or_stain-ready_Interior_Exterior casings in_Pine_Maintenance-free material
14. ntractor will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine_Maintenance-free material
15.( )Intls Owner is aware that Contractor does not do anyp
16. Contractor will wrap exterior casings with coil stock o� GT Zlcnr.
Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17.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. es❑No 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. Ck# $
19. es❑No All discounts have been applied to this agreement price.
20.Additional job details:
21. es❑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 Andersen C rporation Buyer(s) Buyer(s)
B .
Si natur 'o Product Manager Signature Signature
Print Name of Product Manager Print Nam Print Name
The ColfiJ/W"MLt'U Of hfaasac�V�
Deparftna.of F =trid Acciderrls
Of ce of 1m►es alio&
ADO Waih*gton A-ed
'Boston;M4 0111
• ' w►vr�.massgai►l�ia . •
Worker ' 'Compensation IRR ranee ASidsQit $mlders/ContractDrs/Meetricisns/P�ambers
Av�Iicant lafarma4ian Please Prbit Leeffify
1�T8me($vsmesslorg�iz�adln�viauatl: 1�'e l�P l��o.'1 �u � tt('�Et'Ce r� .
0153 D�- Phone#: Sd ' - S S P 06,
Art you an employer.? ChwI the aPPMPdate,bar Type of pro}eet(required):
I'-p,I am a errrplayCr with -3 y 4. ❑ I Min a general cattrt nix and I 6, []New comstzvatian
employees (fan amwor pact-time),* have bund the snb-coatzactass �R�,�,,,
2,D I tem a sole privpQietnr aspatmer- bstmd on It attechnd shit
Zh
ship and have no rmployaes ese sib-co ectras Issue s• ❑Dcmolilicm
WMIang for ane m tmy capacity, wa�zaa' camp.MSE-e = g D$ addition .'
[No wmicrrr' DOMP, inmMance 5. ❑ We ars a eocporaban and its 10.❑ repairs or aiir3it ani
offio=hmn wised thea . -
3.❑ I am a homeowner doing aR wtiric �of==ption per MGL 11-D Phsssibisg��Cr additions
myself [No worl=)-*asap. c. 151, ¢1(4),and'v m have no 12-ElPodrepsim
t a nployees. [No warps ❑
snsaraace rrgrsrreti] Camp,inMMMM i quked,j 13. Ofhtt
°Ari•apph t tbk aheriz baa#1 mmt aim 01 m4 for oatim below AwwiDI ficir woamle wmP= po Y 0°
t Hameaw =who=bmir shit aunt i,,fi g&I I=dome dl waste=d&=him oodrido oo moat enbdt_a naw Zffdsvh MdiCl ag tmnh.
ICanusctm,dw abut flat bar mit Mahn'im.dtfifi—I&ar dwwmg the same of tie=b4mahsaw®d$air Waalm,CMM;L P6CY itsf wi®
ram an znpZgper Scat isprovidbT war�xrs'eomperrsion&mvwwe far my empty peva Below is&e paFicy rrrtd job awe
,i�rrreaSan. �� � ' K !? �'l��� c ��1 S •�
Insur=e C�tmy Name; a_ n
13 .
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job Site Art&=. 3 [v S x w' t r �G CayI�JT�; �r � � die� ►1'icc Q 1 ��(
.Attach a copy of-vise workmT' miapensafi om'policy declararSnn gage(tehwwImg the policy namber sad CxPft'at7nn have).
Fdmm'tosecare co**nge'as required mnilm Sachem?SA of MGL a 152 can lead to lhe mmposifim.of-Mall penalties of a
fine-up m�1,500.00 and/or one-year 3prisavmzent,as well as civil pasatties in the form of a SMP WORK ORDER and a fine
of up in 5250.00 a day against the violate L Be advised that a copy o-ftlis ststemwt may-be forwmded.to the Office of
ins of the DIA for msoiaacc coveasge vrafficatiML
n
.I do fremby. ' rrrf3te penaTtua ofprjrer7,Scat tatfarncatidairrovided�above is twee a>rd coirect
: HitRf7T77• , Daft;
Df ZciQl tzn on1'IL Do nor write us twmrA tn-be campleti d by city or ftrm,e ld .
{qty ar Tow=
Itsaiag A>amorftp-(circie.on�):
I Bear&of H=I& z.Bioaiding Ile mrtmerzt.3. Oty/Ta.M 4;$electrical taspectnr S.Ph'<aosbiuteg uptxmr
-Coat Preens el'hane
.4coR�° CERTIFICATE OF LIABILITY INSURANCE DATE 1D/2t'Y)
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(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terns 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 ;14006s:
E Jonelle Hargrove or Eric Johnson
Hays Coampanies NE . 612-333-3323 FAX 612-373-7270
80 South 8th StreetA!C NoSuite 700 CE
PRODUCER
Minneapolis, MN 55402 CUSTOMER -
INSURER(S)AFFORDING COVERAGE NAIC d
INSURED
A: OLD REPUBLIC INS CO 24147
Renewal
pal By Andersen Corporation INSURER 8: NATIONAL UNION FIRE INS CO OF FrTTS 19445
104 Otis Street INSURER C:
Northborough, MA 01532 INSURER D:
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 29229436 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.
INSR ADDL SUBR POLICY EFF POLK:Y EXP
LTR TYPE OF INSURANCE Wyn POLICY NUMBER MIDD MMIDD LIMITS
A GENERAL LIABILITY . NWZY 59826 10/01/1 10/01/13 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 500,000
PREMISES Ee occurrence $
CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ 10,000
PERSONAL dADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 4,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 3,000,000
7X POLICY PRa LOC $
A AUTOMOBILE LIABILITY MNTB 21700 20/01/11 10/01/13 COMBINED SINGLE LIMIT
X ANY AUTO (East) E 3,000,000
ALL OWNED AUTOS
BODILY INJURY(Per person) $
SCHEDULED AUTOS BODILY INJURY(Per accident) S
X PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
X NON-OWNED AUTOS $
S
B X UMBRELLA WB X OCCUR 13273355 10/02/1 10/01/13 EACH OCCURRENCE $ 25,000,000
EXCESS CLAIMSMADE AGGREGATE' S 25,000,000
DEDUCTIBLE
$
X RETENTION 25,000
A WORKERS COMPENSATION NKC 117948 00 OTH- S
AND EMPLOYERS'LIABILITY 10/Ol/110/01/13 X
,IN I TORY LIM ER
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? N❑ N/A E.L.EACH ACCIDENT $ .1,00i_,-000
(ManDies toryhNH) E.L.DISEASE-EA EMPLOYE $ 1,000,000
It yes,desalbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCA11ONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K mon space is requbvd)
Evidence of Insurance.
CERTIFICATE HOLDER CANCELLATION
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
?If ..............
eiici n•nae ennn a n,�ww wwww..w.�..... ......_..
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supers icor
License: CS-095707
BRIAN D DENNION
7 LAMBS POND CIRC A
Chariton MA 01507
Expiration
Commissioner 09/08/2014
i - -
Office °Consumer Affairs&Bdsines gu a1
HOME IMPROVEMENT CONTRACTOR
Registration: ,.,470810
Expiration: .12X23!2013 Type:
Corporation
VRRWAL BY ANp)#ZStCO 'aRATION I
C { F
BRIAN DENNISON
104 OTIS ST.
NORTHBOROUGH,
Undersecretary
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WINDOW REPLACEMENT �nMdcc�mC
p WoodMlgli Composite IF
i� Dual kM Low E4 SmwtSun
100-00473618-010
ENERGY PERFORMANCE RATINGS
U-Factor•(U.S)/I-P Solar Heat Gain coefficient
11 all
0
29
w UM19,
ADDITIONAL PERFORNfANCE RATINGS
Visible Transmittance
0 . 42
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