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HomeMy WebLinkAboutBuilding Permit #608 - 45 RUSSETT LANE 4/12/2010Permit NO: b S Date Issued: Gf - LOCA TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received • IMPORTANT: Applicant must complete all items on this pace fu Print PROPERTY OWNER JFW<—G,U Print MAP NO: 04 PARCEL:_ TY ZONING DISTRICT: Historic District yes no 11 Machine Shop Villacte ves 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OWNER: Name:�� //rig. ah /-4 A f; jrmcG-1,j Ili Phone: Address:{ -- CONTRACTOR Name:,,)-)nUL �tGey� �– Phone: (D Y 2 Address: �� � U? �`t\ ti � �� TVA - Supervisor's Construction License: Exp. Date: t Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. dG Total Project Cost: $ �CQa (, FEE: $ �� C10 Check No.: / 1 qcf Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner l S ' nature of contractoFQC,.�A�� 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water $ Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 FIRE DEPARTMENT - Temp Dumpster on site yes no, Located at 124:Main Street Fire Department signature/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 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 NU I t5 and UA I A — wor 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 ❑ 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 Li 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 L3 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 Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ,ts CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL s Check # 7,ele,,Jj Building Inspec W IV, o v w° v N73 p U A � o .r—co a2 �a i O U o2 w GG O W a C2 in w O io o2 w cUV) F+ W a_ w W z G cn Q o E cA c� 0 :•m C z 0 w w P-4 f R-1 a 22 O 0 O v V Z a3 CL O H 0 C C cm C G y G3m m O a3 CL I.— .0" C3 3.0 Cm G OL CL CMQ C CO2 Cc L c C.3 C CO2Z tsQ CL� V CO) C C� . C _c CO2 cm LLI Y/ UA U) W W oc W U) O ` C N O C C.) C.3 •dam pL C to e0 O C ;t O O L CD �Q D C O O �s w f/J CDCD= O O S. I cm m c mm y 0 0 3 t .• c o� Cc m i C H C y O O GO A :o CD aC.2 L- m y O '0 C: cm pf C oQ om m Cio `o 2 C 0 O C d m C •O Q = m ; or o k o. N Z •fyA LD W O.= Z m.� v call y O C.3 h- a m- �� g 2 ` y O 2 R z 0 w w P-4 f R-1 a 22 O 0 O v V Z a3 CL O H 0 C C cm C G y G3m m O a3 CL I.— .0" C3 3.0 Cm G OL CL CMQ C CO2 Cc L c C.3 C CO2Z tsQ CL� V CO) C C� . C _c CO2 cm LLI Y/ UA U) W W oc W U) 01/01/2006 00:01 9782785010 JOHN BEAVER PAGE 04/05 MA HIC License d119601 (expires 1/24/10) Renewal , � NEWAL $Y ,ANDERSEN Federal to. ID# 83-0404201 byAndersen. Ol' GREATER MASSACHUSF,17S ANT) NFw HAMPSHTR, 104 Otis Stircr • Northborourh, MA 01532 phone 508.919.0900 • Tax 508.919.0903 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Nome Date ei Agreement Sheer AddrAs, 0y,, Siar�ond Zia Codc (.'Mail Addrns Home Tele hono Number Work Tele hone Number 97�-�58�3��U Soar--la33�-(oZ�/�j Buyer(s) hereby jointly and sevr..ratlly agrees to purchagc the produrisand/or setviCcs of.j & T, Windows, Inc. dba Renewal by Andersen of Grcatrr Ma5R31.CI1'mttS and New Hampshire ("Coni actor"), in accordance with thc terms and conditions clescribcd on the front ailed the reverse of this a,gru.n i:rA and on the a.rracbed spccification shect(s) (cnllectivedy, this 'Agreement:" ). Buycr(s) hcrrby agrees to Sign a comce pletion rtificate aii:er (lonlx• actor has compdcird all work under flfls Agrccnrcnt. Method of Pymni: O Cash heck 0 Mostorcard 0 VISA Total Job Amount!. �..� . Estimated Starting ote: 0 Discover 0 Financed, g -)d p Deposit Received (33%):A.5 p 6 .... ____. Crd: 1. t Balance at Start ofJob (33%oZ):__- „S L7 Name on Credit a Estimated Completion Date: Credit Card Balance on Substantial a j 1-2- Oa S Completi 3%) Exp. Date: CC Security Code: Buyer Initi s A By itutialinghere, yoU ticknowledge that thr Bala ince at Starr oFJob and the Balance on Substantial Completion of,)ob mrinot be trl.adc by creclit: Card and must be made by personal check, bank check, or cash. Buyer(s) agree and a erstands that this Agreement constitutes the entire understanding between the parties, and that there are no verba understanding% changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreementwill he valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acicnowledges that Bnyer(s) 1) has read this Agreement, understands the terms of this A reement and has v completed, signed, and dated co of this Agreement, including Agreement, rccei ed a written above and 2) was orally informed of Bnyer's right to camel this Agreement. DO NOT SIGN THIS CONTRACT ICancellation, on the date F THERE ARE ANY BLANK SPACES. Renewal brdejrs, reat;cr MA and NH Buyer(s) 13y: ignadanarmr Si .ttutr. --!�L Ne 4/' V4 Print Nmne of Product Manager Print None . Buyer(s) Signature Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER TM, DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN FXPLANATTON OF THIS RIGHT. ,°,K — —. _ _ _ .— _ _ _ _ _, .— — — —g <. — — — — .— —. — _ _ — — _ _ ?,C... '.- _ _ — — _ _ _ _ _. — _ — _ i7C WORN OF CANCELLATION NOTICE Off' CANCELLATION Date of Transaction _3 - 3 -) D . You may cancel I Date of Transaction 3 -3- 10 . You may cancel this transactiowithout any pens or obligation, within this transaction, without any I eenmity or obligation, within three business gays from the above ate. 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 roperty traded in an Contract of Sale and any negotiable instrument executed I � y payments made ru you under the ontract 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 Seller of your cancellation notice, and any security I by the Seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. I interest arising cut of the transaction will be canceled. If you cancel, you must make available to the Seller at If you cancel, you must make available to the Seller at your residence, in substantially as good condition asi your residence, in substantially as good condition as when received, any goods delivered to you under this when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the I Contract or Sale; or.you may, if you wish, comply with the instructions of the Seller regarding the return shipment of instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If ypu do make the goods at the Seller's exaense and risk. if you do make �II..........1- �_,er_u _ . _ .r. .. - �.. yr ♦ennui ,cv mays oT me pare OT your Notice �f Cancellation, you maretain or dispose o the goods "ithout any further obit, If you foil to make the ,00ds available to the Seller, or if you agree to return the foods to the Seller and fail to do so, then you remain liable or performance of all obligations under the Contract. ro cancel this transaction, mail or deliver a signed and fated copy of this cancellation notice or any other written lattice, or send a telegram to Renewal by Andersen )f Greater Massachusetts and New Hampshire, 104 Jtis Street, Northborou h MA 01532, NOT LATER THAN MIDNIGHT OF 3 • (o -'1 0 . (Date) HEREBY CANCEL THIS TRANSACTION. bnwrnor"s Signature Data llreach uY w111111d Lu aayS OT Tne aate or your Notice of Cancellation, you may retain or dispose of the goods I without any further obligation. If you fail to make the I goads available to the Seller, or if you agree to return the cods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and d dated copy of this cancellation notice or any other written t notice, or send a telegram to Renewal by Andersen I of Greater Massachusetts and New Hampshire, 104 1 Otis Street, Norbo�rough, MA 01532, NOT LATER THAN MIDNIGHT OF 5 -�— / a , (Date) X I HEREBY CANCEL THIS TRANSACTION. consumer's Signature DRIO b1,A I-- Asn_:._ __ .. 01/01/2006 00:01 9782785010 JOHN BEAVER PAGE 05/05 Renewal I � RFNEWAi, RY ANDFRSFN MA Ii1C License # 141)(401 (expires I /z4/ 10) byAndersen• tedonl'I'm it)# 3'•0404201 wINnOW REPLACEMENT OF GRFATFR MASSACHUSE'I'S AND NEW HAMPSHiRE ' 104 Otis Street • Norihborough. Massachusetts 01532 Phone 50X.9 19.0900 • Fax 509.919.0903 SPECiFICA"PION SHEa Buyer(s) 1+$1111e Date of A.SmcmenI The. Puydr(s) listed above hereby jointly and sevcrally ;agree to purchtwc the goods said/or servicaa listed below, in raccordance with the prices and leans described on the Speciticalion Sheet and the front and the. reverse of the accontpsinyirtg CUSTOM WiNDOW AND DOOR REMODELING AGREF:Mt Yt•, of which this Specil'icauion Sheol is it pail. WINDOW DETAILS 1. Coil tractor will Insl:alll a tolnl of windows in Owner'., horns, using the following individual quantities: Double Huns (DI4) ❑ F IUN1 welt ❑ Collage sash 0/3 lop, 2/3 Lx7ttom) ❑ Oriel sash (2/3 top. 1 /:3 bottom) Cascmcnt (CW) ❑ Hingc. right ❑ Hinge left (as viowed from exterior); ❑ Standard handle ❑ Metro handle Double casement (COW) ❑ Slandard handle ❑ Mctro handle Casement / t'icture / Casement (CPW) ❑ 1:.L' 1 or ❑ 1:2:1 ❑ Standard handle ❑ Mciro handle 2 Litc Gliding Window (GW) Glider / Picture /Glider (GF'W) ❑ I:I : I or ❑ 1:2:1 � 3 � jyp—,O— W� Awning Window (AW) 1"', r Window (FW) (( 1�'/,_,, Ba or laity Window `G -'M•P 7 r.•ltio floor's (Ac(,ScpaYNl:c 1.)oordpecificalion Sheol) 2• ❑ Ye81[�e�iNo Qly of Windows to be crlstonl Fit Replacement: 3. ❑ C.,'tkr r�o `\ly of Sills to be replaced by Coranielor: 4. v 1'es ❑ No `1.y of Windows to be New Construction Full frame (includes new interior 8c exterior casings) Exterior"', qs: ❑ Fine ❑ Maintenance -Piece material ❑ Factory applied 908 Fibrex briekinold 5. Glaritr;; 19 be: Z hit' Lo IR15n1tu115un'''" (TsxCre&fFb"S7b)e) ❑ Other if other, please specify: 8. Exterior color to hc: rlc ❑ .5a.nd ❑ Canvtrs ❑ Tc1)'atoric ❑ Ccx.oa T.icart 7. inler•ior color to bcx EprMiitc ❑ Send ❑ ciivas ❑ 're:rralone ❑ Pine ❑ Maple ❑ Oak Notc; Inte or calor can only be white, wood or sm ae color as exterior. Wood interiors need to finished by Owner, R. Hardware While. ❑ Stone; ❑ Canvas [] Grass Double Hung-- !). ❑ Yet t❑' No install Lifts with Double Flun Windows 10. Surccns: windows I0 have' ❑' 1-1011' O/' ^zrilll scrccris Screens to lx: Fibcf„Lass ❑ Aluminum ❑ Truscene GRILLE DVA)( -9 I I . Windows have grilles: ❑ Yes No if yes: ❑ c-illc nelwcen Glsras ((;nC.) ❑ Removable Interior Wood Draw) ❑ Frill i)ivided 1,;<ght (mr,l Qty; QIY Qty Qly Qtv: City: Olv: I'l - I -I pH OHE[:Il OH CWlpicluro C+IIcm CFW or G DrawKrille i?rtllerns aboveUse ttdditiontil sheet if needed Owner approved (initials): ( ) ADDITIONAL WORK DETAILS 12. ❑ Yes Vw Ltd'>` conteaelor will remove metal frames of windows, Qty of Llrrtts: l 8. ❑ \'cS 'o Contractor will install new paint -acedy or stain -ready casings. I11tCi'ID casin;, qty of openings; ENlerior carsirrgs qty of openings: ❑ Pine ❑ Maintenance -fees materia( 1 d • ❑ \'e3 _ _ No Coil trac[or wi II install new paint -ready or stain •read inside or outside Slops qi:y of openings: interior stops qty of openings: _ Exterior pS qty of penins ❑ fine ❑ Maintenance -fire material 1.5. Owner is a that Contractor does not do any pain • caner _Mt -is 16'. ❑ Y s EVNo Contractor will wrap exterior casings with a 011 stock of color. Note: wrapping may be requ irccl with storm window rernevnl; reiltoval of storm windows will leave screw holes in casing. 17. cs ❑ No Conlraclor will insulate, caulk and seal windows with 3,poinr system to prevent watts and air infiltration. I S.I yr ❑ No A limited warranty shall be iSSUM to Owner uprnt completion of Ihejob and payment In fall. 19. Yas ❑ No Building Permit Contractor will ,Sccu.r'c any and till necessary permits, '[lie fee for the penin il(s) is not included in the co racl Price and " s aratc check is requJ%rd al the limf-, or Sale for .hiS fee:, 20. Additional 1o, ctails' — --te t.//�LY — A,/D�� ii 2 - 1 7C�P 5 2 1. Yes ❑ No Owncr agrees to be present on the final day of installation for final inspection and to deliver final payment. iVt7llJlnll7lll!11c11tS%L9�/ZXefC andetilintilthecolit..r;Ye1isconfpjefcd1od1c•.vitisfachollofRlll7nllics. It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGRF,F,M;NT, constifvles the entire understanding between the parties, and there arc 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 wri ' and s• edbyboth the Buyer(,q) and Contractor. Buyer(s) hereby acknowledge. that Buyer(s) has read this Specification Sheet. Ren al by rscpq.of Greater MA and NH Buycr(s) B-y er(s) fly: 1"ex a e of uct Manager /, ' aatuffre J Signature /'r Arl�Ca (/(/� n, C U 4- Print Name of Product Managcr Print Name Print Name RbA Copy - While. Customer Copy - Yeilow The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 k1j, www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive (Business/Organizadon/Individual): Address: /0,I OL S k &er_P- City/State/Zip: A/ar�bor,, Aj Phone#: (' Ua) %* 000 Are you an employer? Check the appropriate box: 1.aI am a employer with 0 D 4. []'1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet x ship and have no employees These. sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.]. officers have exercised their 3. -El I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §.1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction T.modeling 8. Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.7 Plumbing repairs or additions 12.❑ Roof repairs 13.0 Other . *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insurance for my employees Below.is the policy and job site information. Insurance Company Name: �' % /r/C fl Zn r� /i1 St, fa nC Policy # or Self -ins, Lic. #: �vy %�c /`�``f Expiration Date: , c. Job Site Address: /t✓(fJ cs �i t )� City/State/Zip:171tA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil 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. Ido hereby cerger the pains and penalties.pfperjury that the information provided aboveis true and correc4 F) Ali- ofo Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Massachusetts - Department of Public Safet} Board of Building Regulations and Standards Construction. Supervisor License License: CS 101952 Restricted to: 00 DAVID BANCROFT 5JOHNSTON AVENUE WHITINSVILLE, MA 01588 . Expiration: 3/19/2012 Commissioner Tr#: 101952 r ✓iie �omrmzoauueal,�/a �✓lilczaacrcfwarlta Office of Consumer Affairs & Business Regulation I ' OME IMPROVEMENT CONTRACTOR b C Registration' A;&01 1 Expirat :" — I _M12 le'; wnt Card RENEWAL BY p 1 DAVE BANCROF r 104 OTIS STREET •,~�/ I NORTHBOROUGH,11fJ4`a32 Undersecretary ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE ' PRODUCER Joseph MCKeone JP NIcKeone Insurance Agency, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS, NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC # INSURED Renewal by Andersen INSURER A: Hartford Insurance an INSURER B: Nautilus J and L Windows, Inc. 104 Otis St INSURER C: _ INSURER 0: Northborough, MA 01532 INSURER E: I GaVERAUt5 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED BELOW TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REOUIREMENT, 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 MDI.LlPOUCYNUMBER TYPE OF INSURANCE POLICY EFFECTIVE ffn POLICYEIIPIRATION DATE IMMIDDTM LIMITS B - GENERAL NC958461 10/01/2009 10/01/2010 EACH OCCURRENCE S 1.000.000 —` PREMISES Me,ooxnence S 100.000 COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) S 5,000 CLAIMS MADE F� OCCUR [f— PERSONAL & AOV INJURY $ 1.000.000 - 000 000_GENERAL GENERAL AGGREGATE S 2.000.000 PRODUCTS • COMP/OP AGG S 2,000,0000 GENL AGGPC,;ATE UMIT APPLIES PER: POLICY PRO- LOC A AUTOMOBILE LIABILITY 35MCC XD 6390 10/01/2009 10/01/2010 COMBINED SINGLE LIMIT I S 1,000,000 I (Eo accident) - ANY AUTO X ALL OWNED AUTOS BODILY INJURY S (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Por accident) _ NON OWNED AUTOS i PROPERTY DAMAGE S (Por &=dent) AUTO ONLY • EA ACCIDENT 11 OARAOE LIABILITY OTHER THAN EA ACC $ AUTO ONLY: AGG I S pNY ALRO EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE RETENTION S' S WCSTAT0TH. A wORKERS.COUMSATIONAND 35 WECPP 1444 02/17/2010 Tu 02/17/2011 EMPLOYERWUAB!LirY E.L. EACH ACCIDENT S 501),000 ANY PROPRIETORIPARTNER/EXECUTTVE j E.L. DISEASE - EA EMPLOYEE S 500.000 OFFICER/MEMBER EXCLUDED? M get. describe under E.L. DISEASE -POLICY LIMIT S 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLIIStONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS INSURED COPY At. umu to TLYV I/UO) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1888 re al F{PR C ' • • ' wra„I�%�Mas • • Woo dNipyl Com.posi�i Frame . IN da Duakl. kfM low E •• • . Pi�lur� _ ENERGY PERFOOMUCE :CJI rINGS '+ U -Factor (.U,S)l1-P gofer Heal G'ain Coetfii tent -3 :3.2 .0-- -2 • ADDITIONAL PERFORMAICE aTIMGS