HomeMy WebLinkAboutBuilding Permit #416-2011 - 370 SALEM STREET 11/15/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: `v?D// Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION i
_ Print
,PROPERTY OWNERC„r 't
Print
MAP NO;: ' . PARCEL: ' ZONING DISTRICT: Historic Disfirict yes no
n
Machine Shop;Villagea yes
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
Septic Well .Floodpiain,Y Wetlands t 1Natefshed District;
WateT/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
to <2r
Identific tion Please Type or Print Clea y) p
OWNER: Name: � �I1rJ LSC ii sr- Phone: l 7�`� 6-
6�q
Address: ,�7U SIA-
'CONTRACT=OR Name: /'� Phone: "
,Addtess: 7`t9, Ce
K
r,
.s
��„� =-.
supe, so s Construction License.
'� r .�. . � ' . � � ..Exp. �L�ate: �
Horne lin rovement±License: Ex Date r / �
b-
p
i a .
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.
6�
Total Project Cost: $ X33. FEE: $
Check No.: /A b3 Receipt No.: 7 6 �
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ignature of AgentrOwner is m G� f �c - ignature ofrcontractor .-�
i
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
i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
� Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
:FIRE DEPAi�, ME T -Temp Dumpster oh Lite` ayesAi
'Located-at 124 Main Street- F�
T.
fire Department=si jnature/date 3 ,
fi.
COMMENTS
i
}
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 2008
I
{
_ Building Department
i� The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
1
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
o 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
I� Addition Or Decks
❑ Building Permit Application
o 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 2008
r_
Location 70 Sc�F If"
No. y/G— o// Date
NORT1y TOWN OF NORTH ANDOVER - €
OL
a,
0 .
;s Certificate of Occupancy $
sEta' Building/Frame Permit Fee $ y��7"
Mus
Foundation Permit Fee $ n
Other Permit Fee $
TOTAL $
Check # o? 3
23700
/Building Inspector ector
ORTH
TONNM of ,..�,. O ®we r
0
(10 l A K E o dover, Mass.,
COCKICKEWICK V
I� 0
7�S RATED P'P �CCl
S BOARD OF HEALTH
PERMIT T Li Food/Kitchen
Septic System
�,
THIS CERTIFIES THAT........................... BUILDING INSPECTOR
....:....:................. �.........................................................:........................................
Foundation
has permission to erect..............:......................... buildings on ..��� ...55d'..................:................... Rough
to be occupied as........................ate E .1
r.�. sChimney
....................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations'Voids this Permit. Rough
PERMIT EXPIRES I 6 MONTHS Final
�
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TARTS
Rough
................ .... .. e ,n............................................. 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 J1 Smoke Det.
I,.
104 Otis St.,Northborough,MA 01532 J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor
(508)919-0900•Fax: (774)987-3013 Renewal ,;;, License#149601 (Expires 1/24/2012)
byAndersen. Federal Tax ID #83-0404201
WINDOW REPLACEMENT an Andersen Com y 11J4
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
B (s)Name y Date of Agreement
Tj��
Buyer(s)Street Address,City,State and Zip Code
E-Mail Address Home Telephone Number Work Telephone Number
I
1 ?M
Buyer(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
all work under this Agreement.
i
Method of Pymnt: O Cash ❑Check astercard ❑VISA
Total Job Amount: Estimated Starting Date:
❑ Discover ❑ Financed, App#: ,
Deposit Received (33%): /V j
Name on Credit Car
Balance at Start of Job33% :
( )
Estimated Complet n Date: CJL redit Card #:
Balance on Substantial
Completion of Job (33%): A 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 Initials 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) I) 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 a o e and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF
THERE LANK SPACES.
J&L in s,Inc.d/b Renewal by Andersen Buyer(s) Buyer(s)
BAy:
t re of Product Manager r 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.
x— — — — — — — — — — — - - - - -- — — — — — — -- — — — — — — -�— — — — — — — — — — — — — — —
x
NOTICE OF C NCELLATION NOTICE OF CANCELLATION
Date of Transaction . You may cancel Date of Transaction . You may cancel
this transaction,without any enalty or obligation,within this transaction,without any penalty or obligation,within
three business days from the bove date.If you cancel,any three business days from the above date.If you cancel,any
property traded in,any payments made by you under the I property traded in,any payments made by you under the
Contract of Sale,and any negotiable instrument executed I Contract of Sale,and any negotiable instrument executed
by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt
by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will I and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to theI be canceled.If you cancel,you must make available to the
tion Seller at your residence,in substantially as good condition
Seller at your residence,in substantially as good condi
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 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 thegoods 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 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 the goods without any further obligation. If you fail to I without any further obligation. If you fail to make the
make the goods available to the Seller, or if you a ree goods available to the Seller,or if you agree to return the
to return the goods to the Seller and fail to ds g
o, then oods to the I
g Seller and fail to do so,then ou remain liable
you remain liable for performance g y
y p ante of all obligations under I for performance of all obligations under the Contract.
the Contract. To cancel this transaction mail or deliver a
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:Contractor. J I nonce, or send a telegram to Contractor: J & L Windows, �
& L Windows, Inc. d/b/a Renewal by Andersen, 104 Otis I Inc. d/b/a Renewal by Andersen, 104 Otis Street,
Street, Northborough, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT
MIDNIGHT OF . (Date) OF . (Date)
I HEREBY CANCEL THIS TRANSACTION. i I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature Date I Buyer's Signature Date
RbA Copy- White Buver Conv- Vellnw RT7VPr(nnv- pi„b
104 Otis Street,Northborough,MA 0 153 J&L Windows,Inc.d/b/a� RenewalIMMA HIC License#149601 (expires 1/24/12)
Phone 508.919.0900•Pax 774.987.3013 Federal Tax ID# 83-0404201
byAndersen®
WINDOW REPLACEMENT an Andersen Company
OF GREATER MASSACHUSETTS AND NEw HAMPSHIRE
WINDOW SPECIFICATION SHEET
Bu� ; Name Date of Agreement -
�. ii
Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance h the prices and terms
described on the Specification Sheet and the front,and the reverse of the accompanying CUSTOM WINDOW AND DOOR REM DELING AGREEMENT,
of which this Specification Sheet is a part.
' WINDOW DETAILS
1. Cactor will Install a total of windows in Owner's home,using the following individual quantities:
Double Hung(DB) Equal sash'❑ Cottage sash (1/3 top,2/3 bottom) ❑ Oriel sash (2/3 top. 1/3 bottom)
Casement(CW) Hin
( W) ❑ ge right F] Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle
Double Casement(CDW) ❑ Standard handle ❑ Metro handle
Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle
i—2 Lite Gliding Window(GW)
Glider/Picture/Glider (GPW) ❑ 1:1:1 or ❑ 1:2:1
Awning Window(AW)
Picture Window(PW)
ay or Bow Window
Patio Doors (see separate Door Specification Sheet)
2. U Yes ❑ o Qty of Windows to be Custom Fit Replacement:
3. ❑ es VNo Qty of Sills to be replaced by Contractor.
4. [ Yes ❑ No Qty of Windows to be New Construction Full frame (includes new interior&exterior casings)
Exterior cas' gs: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold
5. Glazing to be: HP Low-E®SmartSunTM (Tax Credit gih1e) ❑ Other If other,please specify:
6. Exterior color to be: ❑ White ❑ Sand ❑ Canvas MTerratone ❑ Cocoa Bean
' 7. Interior color to be: F1 White F1 Sand ❑ Canvas �erratone ❑ Pine ❑ Maple ❑ Oak
Note: Interior color c n only be white,wood or same color as exterior. Wood interiors need to finished by Owner.
8. Hardware V0 White YStone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style-,
9. ❑ Yes Lij`KNo Install Lifts with Double Hung indows
10. Screens: windows to have: [Half or Nr Full screens Screens to be: /Fiberglass ❑ Aluminum ❑ TruScene
v GRILLE DETAILS
11.Windows have grilles: ❑ Yes ❑ No If yes:V Grille Between Glass(GBG) ' Removable Interior Wood(iNrw)❑ Full Divided Light(FDL)
Qhr�
Qh' Qty Qty Qty Qty:
�fVDH 4 DH T]FDH CW/Picture Glider CPW or GP
Draw grille patterns above *Use additional sheet if needed Owner approved(initials): ( tiles )
ADDITIONAL WORK DETAILS
12.❑ Yes 25INo Contractor will remove metal frames of windows. Qty of Units:
13.❑ Yes in No Contractor will install new paint-ready or stain-ready casings.
Int Vricasing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material
14.E] Yes o Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings:
terior stops qty of openings: Exterior stops qty of openings: E] Pine F-1Maintenance-freematerial
15. O er is aware that Contractor does not do any painting. ( J t- ) Owner Inih s
16. Yes ❑ No Contractor will wrap exterior casings with aluminum coil stock of '�%J !P–color.
ote: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17. es ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
18. Y.s ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full.
19. 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.
20. Additional job details: "
/1J, xlpf
i
21. Yes [:],No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.
No final p ent shall be demanded until the contract is completed to the satisfaction of all parties.
It is agreed a derstood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT con 'tutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the
terms. This pecif. ation 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 C)ntractor. B' yer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet.
Renewal y e se f reater MA and NH Buyer(s) Buyer(s)
By:
of duct Manager Signature Signature
Print Name of Product Manager Print Name Print Name
y7te Commamvealtlt of Alassaclzusetts
Department of Industrial Accidents
Office of Investigations
600FPashington Street
Boston,MA 02111
www.mas&gav/dia
Workers' Compensation Insirrsnce Amftvit gmlders/Caniractars/ IeciriciartslPlumbebr�
Ap hcant Information' Please Pry Ly
Name(Business/OrgauizadonitndividunI:
Address:
Gi /StatedZip. ora d YJaL Phone
ty D
Are you as employer?Check the appropriate box Type of project (required):
1. -I am a employer with ;0 . 4. Ell am a general contractor cad I �, �]New rmst ractina
*' • lave hired the sub-contractors
DdGIiI1
• or apt-time. 7ti g
e Io ees foIl'aad/ )
Y ( P
mP t
Z.❑ I am a sole proprietor or partner- .listed on.the attached sheet .
•ship and have no amployoes These sob-contractors have B. Demolifioa
-
working for ma ln.day capacity. wod =' comp.insu ncn. g, ❑Building addition
5. Weare a c oration.end its � •
❑ DrP tzical `airs Dr
'ce 10.
FICC
[ND workers comp.instusn o$iceta havC exarcisCd their. ❑ . nP
required.]. ert<2CrI� 11.❑plumbing repairs or add,
3.-El I am a hameowaar doing ell Work of ozomptioa P
mysClf[ND wmk='comp: a 152,j1(4),and we have no 12.0 Roof repmin
Insurance rmquimll t employ %.IND work= 13.0 O rr
coaig.iasaranme required.]
'Any appfica�that cbeelz hoz i€1 must also fiIl otrt the section beloor c6ewingtheir wnsl�s'compensafiaa 136BOT iainsmation
t)romeownes who suhmit this affidavit indicating the}'an doing shwa±cad�m huz outside contractor mmt sabmit a nen aindavit indicating such,
tamtaatott that ch=k this b=must attached as additional sheet shoa�sg the same of the sob-eo�actou and their wocLas'comp PDIicI in s
I am an emploj►er that is prayrding t+►orkera'compeasaiian insurance far my eutpinyeM Belaw.ia the PO MY and job gig
Insurance Company Namur: Lk Policy#or Self ins;Lim.#: � !�l �� rzpiration Date:
Sob Site Address- l� �vn City/Stst Mp: AJ l AbaJF_� L9—_
Attack a copy of the workers'compensation policy declaration pave(sbaveing the policy nmmber and erpiratian date
Failure to secure covmragc as required under Section 2A of MGL c.152 can Iced to rho imposition of criminal penalties of a
fine up't p$1,500.00 andlor one-year imprisommmp won as chl pcnalttps in the fnmi•Df a STOP WORK ORDER and a fine
.of up to$250.00 a day against the violator• Bur advised that a copy of this statement msy be forwarded to the Office Of
Investigations of the DIA for insurance caverage verification.
Ido hereby c u er the pains a�td penalties erjury that file information provided above is true—ani correct
5imature.
Date: s
Phone 4.
Official use anF.' DD not write in this area,to be earnpleted by city or to rn official
'. City or Toww Permit/Licease#
Issuing kufhority(circle one):
1.Board of Health 2.Braiding DepLrtment 3,aty/Town Clark 4.Electrical Inspector 5,Plumbing Inspector
6.Other
Couteet Person: Phane B.
Massachusetts - Department of Public Safety
-Board of B6ilding Regulations and Staxidards
Construction Supervisor License
License: CS 85707
BRIAN DENNISON . a
86 CREST CRCLE
° WORCESTER, MA•01603.•
Expiration: 9/8(2012
C'ommhmioner Tr4: 2522
Oi£ee or Consumer Affairs&Ansluen$egnlztian
HOME IMPROVEMENT CONTRACTOR
ReglstrafioDl
Expl 12
e Card
RENEWAL BY
• BRIAN DENNIS _
. 104 OTIS S K . - --;�E�. •—
NORTHSOROUGH, T3ndersecretary
ACORD CERTIFICATE OF LIABILITY INSURANCE TO02/10/2010
02/10/2Q10
PRDDucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JP McKeone insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 333
Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC#
INSURED Renewal by Andersen INSURER a Hartford insurance Company
J and L Windows, Inc. INSURER e: Nautilus
104 Ofis St INSURER c:
Northborough,MA. 01532 INSURER D:
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.
INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION
LTR IN!;R.l TYPE OF INSURANCE POLICY NUMBER LIMITS
B GENERAL LIABILITY TE
10/01/2010 10/0112011 EACH OCCURRENCE i 1 O00 000
COMMERCIAL GENERAL LIABILITY PREMISES Fa occurenmel 100,000
CLAIMS MADE F7 OCCUR MED EXP(Any one person) i 5,000
PERSONAL&ADV INJURY i 1,000,000
GENERAL AGGREGATE a 2,000,000
GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG i 2,000,0000
POLICY 7
PRO LOC
A AUTOMOBILEUABILITY 35MOC XD 6390 10/01/2010 10/01/2011 cOMBINEDSINGLE"LIMIT s 1,000,000
ANY AUTO (Ea aecidenQ
Xi ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per Pcrson)
HIRED AUTOS
BODILYINJURY. i
NOht OWNEO AUTOS (Per ewldenl)
i PROPERTY DAMAGE a -
(Per acadent)
GARAGE.LIABILITY •. r AUTO ONLY-EA ACCIDENT i
l ANY AUTO EA ACC i
OTHER THAN
AUTO ONLY: ASS a
EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE a
OCCUR F CLAIMS MADE AGGREGATE a
i
DEDUCTIBLE a
RETENTION S S
A WORKERS cOMPENSATONAND 35 WECPP 1444 02/17/2010 02/17/2011 WCSTATU I OTT�-
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYEE s 500,000
it yea,describe under E.L DISEASE-POLICY LIMIT i 500 000 -
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICI M 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 ISSUING 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 LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
.•
AUTHORIZED REPRESENTATIVE
r
ACORD 25(20D1/08)
0 ACORD CORPORATION 1988
fir-- _- �-= .�,-'•�-• `M=`•.� -
w
x
Andersen-.
ENERGY PERFORMANCE.RATINGS ,
D-Factor(U.S.). Heat Ga hi-Cdedcbint
0-83U. .019vau
ADDITIONAL PERFORMANCE.RATINGS '
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Mamdactumr stipulates that these r&gs cordons to applmbie NFAC procedurs for determining whole .
product perto.mance.W rabps.am detertrnned for a faced set of environmetrtal condit(or>s and a
specific product size.Coraft manufacturer's&a m for oftr product pertomwo informdom
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