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HomeMy WebLinkAboutBuilding Permit #530 - 44 OLD VILLAGE LANE 1/10/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 51-30. r0 - IQ Date Received IMPORTANT: Applicant must complete all items on this -oasze t13 1E., (� \ Print `rc PROPERTY OWNER UF-- • FUS( Print MAP NO: _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial P<epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other � � Septic ®�Welli � [®IFloodp in; �Q�Wetlaniis3 � _ �0 Watershed Dis r t i DESCRIPTION OF WORK TO BE PERFORMED: N OWNER: Please Type or Print Clearly) -(.Sa V X15 ,,3 Address: 1<(-k OBD Vk<< Rv_�U—NV,�F CONTRACTOR Name: /J iS G") Phone: Address: T�0- CI --� Mo Supervisor's Construction License: �'(��U% )Exp'. Date: Home Improvement License: / q %q Exp. Date: ARCH ITECT/ENG I NEE Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1 (�l FEE: Check No.: Receipt No.: vl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signafure of�Ag_e.`nt%Owiier. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH S COMMENTS I DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes, Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no 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 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 o Engineering Affidavits for Engineered products 40TE: 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 :fiat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording nust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi ui b' w°:1 c o 0 r. w° g a�' a U � w o H a w w2' w H Ow w�' v� w o o -CIS u, � � PQ z � o CO ui F-4. • z O U c) 1 LU VO LLI U) W W 12 ,,LUw Y♦ c o m c C y O G CJ L) • ac ev � m c c `off CD coo Ea : L m C ++ N E c c L r'0 y 4- �m C E �� y•v mMao a o L Z' N CD 3 cm a' o :tom �CC.C : N Oy O •� 9� =C� i m Q y m ; L = 12 O cm O O Cc C cm F. ON O. m c •C = m m`w o N W O_.., C _ ,_ •N O � •E. dt C +•' m •N � C7 Z O W v Of H a N 4CD b O:a O *CL O CID F-4. • z O U c) 1 LU VO LLI U) W W 12 ,,LUw Y♦ 101 Otis St„ Northborough, Mtn 0153'_> J&L WiNi)mN's, IN(;.. D/t3/A MA Home Improvement Contractor 303i 919-(19(11) • 1'ax:i%71 9f17 -:i01 i' License #149(;0] (Expires 1/24/2012) Renewal byAndersen. = Federal Tax ID #83-0404201 ., nIRaOW REPLAa EM ERt vn:\i,Jrraeirt;.•„l,any CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyerls) Nome Date of Agreement �= Buyer(s) Street Address, City, State, and Zip Code 73 E -Moil A dress Home Telephone Number Work Telephone Number Buyer(s) hereby jointly and severally agrees to purchase the prafucls and/or services of .1 & L Windows, Inc. d/b/a Renewal by Andersen ("Contractor"), in accordance with the terms and conditions described on (lie front and the reverse of this agreement and on the attached specification shect(s) (collectively, Ruycr(s) hereby agrees, to sign a completion certificate after Contractor has completed att work under this Agreement. Total Job Amount/",3�.�,. % t) Deposit Received (33%): 0a.a Estimated Starling Date: Method of Payment: ❑Check ❑CoshL,,02financed Balance at Start of Job (33%):.. ...... Estimated Completion Date: Credit Cards are accepted for deposit only — maximum 1/3 of the project cost. Balance on Substantial Completion of lob (33%):......_ .................... • . ;,p f-' C - —a ,_ Please see Credit Card Payment Form. By signing this agreement, you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion 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 parries, 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) s orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BISAACES. J & L Windows, Inc. /b/. Be r wal b ders Buyer(s)� Buyer(s) fav: (yli,tt/1 �c./I at7 SiguatUR' of I I'MIM t \Qen r 5i�nautre Signature Print Hann. of .Product \tanaLer Print N;une Print Namc 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. ——-——---————---—g<-—--——— — — — — — —— <——— — — — — —— — — NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction , You may cancel Date of Transaction ,-__ D 2e /) . You may cancel this transaction, without any penalty or obligation, within I 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 by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, by the Contractor ("Seller") of your cancellation notice, and any security interest. arising out of the transaction will 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 as when received, any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply 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 Sellers 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 pick them up within 20 days of the date of Your Notice of your Notice of Cancellation, you may retain or dispose of Cancellation, you may retain or dispose of the goods of the goods 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 you 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 I :ods to the Seller and fail to do so, then You remain liable you remain liable for performance of all obligations under I ?:ads 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 Sed 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 Chis i Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northborough, MA 01532, BY NOT LATER THAN Northboro gh, O1 S32, BY NOT LATER THAN MIDNIGHT MIDNIGHT OF . (Date) OF ��. (Date) 1 HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyer'r Signal— Print Name Data Bvyer's Signalure Print Name Date RbA Copy - White Buyer Copy - lrcllow Guyer Copy - Pink C'd 8Lb901b8L6I ueA!IInS P1Ae0 db0:60 1,1, CL 080 104 Otis Street, Northborough, MA 01532 Phone 508.919.0900 • Fax 774.987.;3013 Buyer(s) Name & L Windows, Inc. d/b/a Renewal byAndersen. •= WINDOW REPLACEMENT an Andersen Company OF GREATER MASsACHUSE,4'S AND NEW HAMPSHIRE WINDOW SPECIFICATION SHEET MA HIC License # 149601 (expires 1/24/12) Fcdcral'rax ID# 8:3-0404201 Date of The Buver(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1: Contractor will Install a total of windows in Owner's home, using the following individual quantities: Double Hung (DB) N 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 handle ❑ Metro handle Casement / Picture / Casement (CFW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) —Glider/. Picture /Glider (GPW) ❑ 1:]:] or ❑ 1:2:1 Awning Window (AW) �_ picture Window (PW) Bay or Bow Window Patio Doors (see separate Door Specification Sheet) 2. A Yes ❑ No Qly of Windows to be Custom Fit Replacement: 3. ❑ Yes No Qty of Sills to be replaced by Contractor: 4. El Yes No Qty of Windows to be New'Construction Full frame (includes new interior & exterior casings) and actual Exterior casings: ❑ Phte ❑ Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to bL--'�] HF Low- E-4 T"' ❑ Other R other, please specify: 6. Utetior color to be:.® White ❑ Sand ❑ Canvas ❑ 'ferratone ❑ Cocoa Bean Wf pQ /%% 7. Interior color to be�] White E] Sand El Canvas ❑ Terratone-a,Pine ❑ Maple ❑ Oak O +tT � ` Note: Vtterior color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. S. Hardwar White,® Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes ❑ No Install Lifts with Double Hung Windows 10. -Screens: windows to have: [t Half or -M Full screens Screens to be: ❑ Fiberglass ❑ Aluminum ❑ Trusc:ene GRILLE DETAILS 11. Windows have grilles: tYes ❑ No If yes: ❑ Grille Between Glass (G11G) ❑ Removable interior Wood an w) ❑ Full Divided Light ffOl) Qty: Qty: � Qty: Ory: Olv: City C)tv' _.. _..._ OH DH/ - DH DH C icture Glider 1CPW or G Draw grille patterns above 'Ilse additional sheet if needed Owner approved (initials): ADDITIONAL WORK DETAILS 12-N Yes U No Contractor will remove metal frames of windows. Qty of Units: 1- I 40.1K Q 2 IYes ❑ No Contractor will install new paint -ready or stain -ready casings. N6� Interior casingt of o nin x Exterior Basins qty of openings: _ 2 ❑ FiA Mamt�na ce-f��natcri�� qY [x g g, 0.) 14. ❑ 1'es� No Contractor will install new paint -ready or stain -ready inside or outside stops qty of openings: htterior stops qty of openings: Exterior slo , qty f o ❑ Fine E]Maintenance-freematerial 15. Owner Is aware that Contractor does not do any paintin . Owner Initials 16. E]Yes-n No Contractor will wrap exterior casings will, oil stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. IYes E]No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. ] Yes []No Clean up alljob related debris including old windows will be removed. V,zcuum nighll}: 19. Yes E]No A limited warranty shall be issued to Owni r upon completion of thejob and payment in full. 20 Yes ❑ No Buildin Pg erntit—Contractor will secure any and all necessary permits. The fee for the pennit(s) is not included in the Contract Price and a separate check is required at the time of sale for this fee. >U_k Yes ❑ No All discounts hair heen applied t("tis agreement price- 22. Additional job details: r+/ zt-.t 'd :♦ ,� r j % J tJ /� /Z, %` (�) W /� ) J 1Z.S 23._Q Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No 1in:11 p:�vnt�nt shall �e demanded until the contract is completed to ol'ell17"11-ties. 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. Ren alby An ers nof G�ea MA NH Bu e ) Buyer(s) IN Signature of oduct Manager Signature Signature Print Name of Product Manager Print Name Print Name b'd 8Lb901,V9Z61, ueA!IIDS P!Ae4 db0:60 l L £l ora The Coma riawl of hlassackusei . . Department of �dtt�i-ial tl.ccii{ents , . . ulQcc of fnt�estigaiiort . . bDO J�asfungtrrn �tre�f . BasEan,1�4 Q�111 ' , . 'gt'Drkerr' trnmpensafion fnsus'nnee �dg� $rii�d.erslCanfrecfxsrsl�Ie �trici�-sem{rbc bl' Deme(�vrinrs.,►Orgnu'szafioNindrnaua�}. .. �-. . ` te .. 4 Fly-d�dd — Typa ofpruject (ri#raO: fi, ❑ 2�Gw const rnctinn &. I)mnciifirzn 9. ❑ BvAft as ion ip,t] ctrieel rePeira ar eddifimm- LL.[J P-lumbing rzPzia or addifiane 12.[1 Roof imPaits *Amy mapB r1.. F e h� #I m �o fill dt� t5e Few 6c1d[ GbrtYing thrsr erg` dompmc�ina p6Iid� ut Zm s%dgvt i-6- 6rs MOL . aro bring d wmL ed �m outside rdafn smut , D4qt t 5'='wnen with wbmitfhit B E Y Am�ft a= di'4=-=n-^= nrd theirs =P P �i �C�mtLadiorc tfret r1srrk this bd= neat atbmbed x. ad&fimg oh Cite I am an crrtplaf►cr fhb is praYidcrrg.arkrr'a' camp ctrscfian utsTcrance far my employ er� �elmQ.ia the pvFscy rrnd j ' � ' • � � Sri t—�— Insuffiaae ' ' ��� � ��� • r'�7" � _��'tina 11atc� ?DHCy � dr S' 0� tom, Lit, N W-. J . • � City/Stafr�Z�ip. �— � JDb' ghm Address. i4 p a � pip giber end espira. inn dste). AftBcIi a to of the trnrkars' enurpGnsatinnpnficY deri$rgfiun p tr pY osifim of criminal penaifics of a PEE= to SD=,.Obvm9r' as rcqunzd under SGGfion25A of c, 152 Gan icad to ; imp Q0 aadlor ono- ar imgasonmrmi, ds well as civil penalties in fine fzum•of a $'ISP WORK QRI3ER and a fine fin6 lip -in SI,5DQ. YG PY ba fhrarar'dcd to tl n D.ff of •ofu to 525�.D0 a day against the vifllainr Fc a dvisod that a ca of this s ' Snvesspticma of fin DLA for inmmanco Dnm go vmifimdiOIL • - uc•¢nd carred , dad abm'e is tr tkat the zrcformatiaa prma . . I da hereby a R ar the pains and pert ¢fiYca )a'3 . (C) } Data. • 'phone #; �J v � 9 . - 4 - � • 0 cia1 rise anE '* Da rwtxrit: m this =a, tb be camplated by cciy ar tarn nfflcial . • • • permztlliGenae # . Cify or To= g Aaffiorify (dircia nuc)tP mtnr S. Pl mhin; lnspectnr 1.8oerd of $ealfh Z $ung Depsrtmeut 3, C1Toegn (3erk 4, Hecfrical, . Phone �' C=tlkct Ptrsorc CLfj��Ste.�C►�Zig; �u r � � �,e f'n ,-� � d � __-- Are you an enzpluyet? Cheek ' 4. Iam a gcamml confracirsr endI D L. EZ -1 an a =PbyerWit ii 3--.� ; haw hitzd t:. sub -contract= emp�yGeS (folf and/or pert-flmG), Rskd m $to a#tacl�Gd sheet x 2. I en -a soin pmpriotor orpertner- ; Tnrso.sab-aontraGto� have ship and have w GmployG06 � �,�q' DOMP. � wari�ng far me m say capacity. S. EIWe arc a Gorporafion and ita ' [irTo �a�rkrrY' comp. insuserico . okra havo rxo�isGd their. Wight of =am .ption per hJfGL 1.-7 I am m holozmw doing au work an�d wo have no' ' IIIy6Glf< �Q SPOShGSF' eDIIIp. : ���d, .�No YNU�-moo ' ; s to rRn�0 rnclatrcd j t 0o= mSM3M- t r. quir"d.] Typa ofpruject (ri#raO: fi, ❑ 2�Gw const rnctinn &. I)mnciifirzn 9. ❑ BvAft as ion ip,t] ctrieel rePeira ar eddifimm- LL.[J P-lumbing rzPzia or addifiane 12.[1 Roof imPaits *Amy mapB r1.. F e h� #I m �o fill dt� t5e Few 6c1d[ GbrtYing thrsr erg` dompmc�ina p6Iid� ut Zm s%dgvt i-6- 6rs MOL . aro bring d wmL ed �m outside rdafn smut , D4qt t 5'='wnen with wbmitfhit B E Y Am�ft a= di'4=-=n-^= nrd theirs =P P �i �C�mtLadiorc tfret r1srrk this bd= neat atbmbed x. ad&fimg oh Cite I am an crrtplaf►cr fhb is praYidcrrg.arkrr'a' camp ctrscfian utsTcrance far my employ er� �elmQ.ia the pvFscy rrnd j ' � ' • � � Sri t—�— Insuffiaae ' ' ��� � ��� • r'�7" � _��'tina 11atc� ?DHCy � dr S' 0� tom, Lit, N W-. J . • � City/Stafr�Z�ip. �— � JDb' ghm Address. i4 p a � pip giber end espira. inn dste). AftBcIi a to of the trnrkars' enurpGnsatinnpnficY deri$rgfiun p tr pY osifim of criminal penaifics of a PEE= to SD=,.Obvm9r' as rcqunzd under SGGfion25A of c, 152 Gan icad to ; imp Q0 aadlor ono- ar imgasonmrmi, ds well as civil penalties in fine fzum•of a $'ISP WORK QRI3ER and a fine fin6 lip -in SI,5DQ. YG PY ba fhrarar'dcd to tl n D.ff of •ofu to 525�.D0 a day against the vifllainr Fc a dvisod that a ca of this s ' Snvesspticma of fin DLA for inmmanco Dnm go vmifimdiOIL • - uc•¢nd carred , dad abm'e is tr tkat the zrcformatiaa prma . . I da hereby a R ar the pains and pert ¢fiYca )a'3 . (C) } Data. • 'phone #; �J v � 9 . - 4 - � • 0 cia1 rise anE '* Da rwtxrit: m this =a, tb be camplated by cciy ar tarn nfflcial . • • • permztlliGenae # . Cify or To= g Aaffiorify (dircia nuc)tP mtnr S. Pl mhin; lnspectnr 1.8oerd of $ealfh Z $ung Depsrtmeut 3, C1Toegn (3erk 4, Hecfrical, . Phone �' C=tlkct Ptrsorc 4j Massachusetts - Defrrrtment Of Public Sufen Board 'of Building Ret-RllationS and Standards Construction Supervisor License Licenser CS 86707 BRIAN DENNISON 86 CRE.ST'CIRCLE WORCESTER, MA 01603 �—G = Expiration: 8/8/2012 C'urnmi,. i finer Tr,: 2522 4. Office of Consumer Affairs & Business Regulation '• HOME IMPROVEMENT CONTRACTOR Reglstiadlo12 �pS Expi �� t Card RENEWAL BY "BRIAN. DENNIS f '104 071S STRE NORTHBOROUGH, ` Undersecretary f -1® CERTIFICATE. OF LIABILITY INSURANCE °A 0/04120111 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(ies) 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 - - J.P. McKeone Insurance Agency Inc JP McKeone Insurance Agency, Inc. P.O. Box 333 CONTACT NAME: . PHONE (734) 662-8100 FAC No Arc NoEt: ADDRESS: INSURERS AFFORDING COVERAGE NAIC R Ann Arbor, MI 481060333 INSURER A: Nautilus 19682 10/01/2011 INSURED J&L Windows, Inc. Renewal by Andersen INSURER 8: Hartford 37478 104 Otis St. Northborough, MA 01532 INSURER c INSURER D: INSURER E: INSURER F: rnn1100 Ar=L' P1OCr1=1e1 Are Alt 11=200. RFVICInN NIIMRFR- 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 LTR TYRE OF INSURANCE - ADDL SUBR . POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/ LIMITS A GENERAL LIABILITY NC958461 10/01/2011 10/01/2012.! EACH OCCURRENCE $ 1,000,000 DA GE TO 1 OO,D00 COMMERCIAL GENERAL LIABILITY P EM SES Ea occccunence $ CLAIMS -MADE OCCUR MED EXP (An one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 I GENERALAGGEGATE $ 2,000,000 - PRODUCTS - COMP/OPAGG 3 2,000,OOD GEMLAGGREGATELIMITAPPLIESPER: POLICY PRO LOC $ AUTOMOBILE LIABILITY 35 MCCXD6390 10/01/2011 10/01/2012 COMBINED SINGLE LIMIT 1,000,000 Ea accide t ANY AUTO j BODILY INJURY (Per person) $ ALL OWNEDSCHEDULED I BODILY INJURY (Per accident)] $ AUTOS AUTOS NON -OWNED' ROacddenDAMAGE $ HIRED AUTOS AUTOS _ i $ UMBRELLA LIAB OCCUR i EACH OCCURRENCE $ EXCESS LJAB CLAIMS -MADE I I AGGREGATE $ DED RETENTION. $--------- I $ A WORKERS COMPENSATION 35 W ECPP1444 02/17/2011 02/17/2012 1 WC STATU- OTH- AND EMPLOYERS' LIABILITY 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE �N ` E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) / A E.L DISEASE - EA EMPLOYEE $ 500,000 It es, describe under 500,000 DESCRIPTION OF OPERATIONS below E.DISEASE - POLICY LIMIT $ LB PEOOH55500 0507 09/27/2011 09/27/2012 i j. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Gt.ti 1 It-IGA I t r7ULUtt1 l.ArvI.CLLN I IUry 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 - ©1968.2010 ACORD CORPORAI IUM. An ngnts reserves ACORD 25 (201 D/D5) The ACORD name and logo are registered marks of ACORD Do not remove until final code inspection. Save label for future reference. Renewal byAndersen ' KI:')m WINDOW REPLACEMENT b+�nJarsenC:uny9 AND -N-37 M�:str,:: Vinyl/Wood Composite Material �3 Dual Argon Low -E4 SmartSun Product Type: Picture ENERGY PERFORMANCE RATINGS U -Factor Solar Heat Gain Coefficient 0.27 1.53 0.22 U.S.A-P Metric/S1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance • 0.51 _. Manutaeturer stipulates tnatmese Bting.- Cdntarm to appllcaale NFRC procedure.- tar determining whole product peridtmance. NFRC ratings are determined tar a rmo set at erNironmen con M P.- and a spe cpe rodua sig. NFRCCanud manufactures lgeraNRf oroother pradua p rtannance Imormallon, ata rotluatar a s .-cmc use. www.nrrc.org Standard Rating NAFS-02orAAMAWDM&=A10U.MA440.05 DP psf F-050 1J�1 g l This product meets Green Sears 412-> erNironmentelstentlaros rte governing energy ' etticlenry, neary metals •� In the trame and sash x•40 metedal, padlreping, and matenala.PAucatlanal 100-00511006-001 Canada g energyslarnrcam rnean.gc.cn 1 I • .. T>^v ^ F f to Q .lL i a m U = E W E.U. energystergnV ®= Qualified/Admissible Renewal byAndersen ' KI:')m WINDOW REPLACEMENT b+�nJarsenC:uny9 AND -N-37 M�:str,:: Vinyl/Wood Composite Material �3 Dual Argon Low -E4 SmartSun Product Type: Picture ENERGY PERFORMANCE RATINGS U -Factor Solar Heat Gain Coefficient 0.27 1.53 0.22 U.S.A-P Metric/S1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance • 0.51 _. Manutaeturer stipulates tnatmese Bting.- Cdntarm to appllcaale NFRC procedure.- tar determining whole product peridtmance. NFRC ratings are determined tar a rmo set at erNironmen con M P.- and a spe cpe rodua sig. NFRCCanud manufactures lgeraNRf oroother pradua p rtannance Imormallon, ata rotluatar a s .-cmc use. www.nrrc.org Standard Rating NAFS-02orAAMAWDM&=A10U.MA440.05 DP psf F-050 1J�1 g l This product meets Green Sears 412-> erNironmentelstentlaros rte governing energy ' etticlenry, neary metals •� In the trame and sash x•40 metedal, padlreping, and matenala.PAucatlanal 100-00511006-001 •..^�.+. ..�-..os ns.c �.c.t.. s s.ca=.r. /use smuamton raqueamants WDMA tialmark Gnfimation Program. Renewal X� byAndersen. WINDOW REPLACEMENT anr#ntieTsenC omyany ' 6`:ai>'^utr"C Wood/Vinyl Composite IF Dual Argon Low E4 SmartSun x���.... Double Hung 100-00473518-010 OR= Z14MI PERFORMANCE RATINGS -ENERGY U-Factor (U.S)/I-P Solar Heat Gain Coefficient 0n29_ 0019 1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0'...42 Manutacturar stipuhtna that these ralingaconforrn toapp6ahle NFRC procedures for determinirgwhole product padormancAL NFRC ratings are datermsud fora tooted set of environmental conditions and aspecic product sae. NERC does run recommend any product and does not warrant the su'aabMty at any product for any specirc use. Consult manufacturar's rseratura for other product pedomrance irtomratkm. ' www.nfm crg This product mates Green 9h! Sears environmental {r standards governing energy ,;,,�.,,_ `�`•�.�;,.-,• fd$• efrciancy, heavy meek kr r�:•, �.., r .the frame and sash ,ermatsriat packaging, and eonerwar aducatioml ® DESIGN PRESSURE (PSF) ■KIIII //�� T � C2 s a r 'wnaow am poor alnuhcfuera/se www.wdma • RbA DB . �.1 Soc�thn Sloped Sill DH IN Truro M FLAMM orAWM, aU =JOIASlA" Museacl re stipukatat dontormaroe r rta 20vfi=nj& sotwarft. •..^�.+. ..�-..os ns.c �.c.t.. s s.ca=.r. /use smuamton raqueamants WDMA tialmark Gnfimation Program. Location v /y ,/���- 11411,111le-- No. .� C� Date /^ „pRTq TOWN OF NORTH ANDOVER t • Certificate of Occupancy $ s,cMusE< Building/Frame Permit Fee $ 1�? Foundation Permit Fee $ Other Permit Fee $ —: TOTAL $ Check # �5�r 24943 Building Inspector