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HomeMy WebLinkAboutBuilding Permit #573-2011 - 50 BRIDLE PATH 2/22/2011 t%ORTN BUILDING PERMIT o� t��o ,6gtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �I Permit NO: � Date Received eh � i r� SSACHUS� Date Issued: .2 Lz IMPORTANT:Applicant must complete all items on this page LOCATION 10&4-G k Print PROPERTYOWNER Pd MAP NO:lPARCEL; ZONING DISTRIC 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 _-F�epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: � � y Chi � ;�;�s Identification lease Type or Print Clearly OWNER: Name: . ,JC_A l � Phone: C - 6 �)� Address: UL7l t,0 ��. PA4� CONTRACTOR Name:-&, ; :iJ Phone: Address: Supervisor's Construction License: 7 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 OGN}$125.00 PER S.F. Total Project Cost: $ /(� �� FEE: $ �� 6 Check No.: �� S^2 Receipt No.: 23119 NOTE: Persons contracting with unregistered contractors do not have acces uaranty fund Signature of Agent/Owner'�-5; (� Signature of contractor Location No. 5�7 3 d�/ Date 2 �aR,M TOWN OF NORTH ANDOVER F • 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ sACHUSE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23910 /Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tan ningimassageBody 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: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ";FERE"DEPARTMENT Temp Duarnnps#er on sjte yes - no a Lvcated°at 124Tfiarn Street4 F Fire De'partrnent si'natuTe/slate 3 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 Li 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 o Certified Proposed Plot Plan o 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:Building Permit Revised 2014 J ORTfy TONM of 0 .. No. - _ a` dover, Mass. COCHICHEWICK 7�ADRATED p9 C5 S BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... r'........ '.:......1:?...vy�. 1� �. �' .. ................................................................................ Foundation has permission to erect........................................ buildings on...!.�`,..d....�61^!. �f...�. "t Rough ` ,.. l .................................... -yJICrG� 'VW'e_•e�... Chimney to be occupied as �� ........................................................................................................................................................................ 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BLJIL�ING 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 Smoke Det. 11/09/2006 02:58 9782785010 JOHN BEAVER PAGE 05/05 104 Ods St.,Dlorthbnrm gh,Mt1 Ui332 AT,Wim)ows,INC.,n/B/A MA Home improvement Contractor (.508)919-0900•T'as,(774)987.301.3eneVv[�I License#149601 (Expires 1/24/2012) R RA�lderse l Federal Tax IP#83-0404201 WINDOW e11PLAOta1ENT n,AW—C—M CUSTOM WINAOW AND DOOR REMODELING AGREEMENT "r(s)N bate of Agreement Buyer(s)Street Address,City,Stall,and Zip Coda IN E-Mail Address Home Telephone Number Work Tele hone Number Buyer(s)hereby jointly and severally agreos 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 shect(s)(collectively,this"Agreement").Buyer(s)herehy agrees lo sign a completion certifical:e after Contractor has completed till work under this Agreement. Total lob Amounr./kJ// Method of Poymcni: heck ©G-edit Cord ❑Cash ,5 `/• Estimated Storting pot: ❑Financed �046 - �. ..�. Deposit Received 133%1:_J,��„-, Balance orStort of lob(33Ye1:�I�OQ Estimated Co tenon Dore: If payment is by Credit Card, please fill out Balance on Substantial 9 -3 the Credit Card Receipt of Deposit Form Comp on 0 3%j:---. By initialing here,you acknowledge that the AalAnce at Start o£,(ob and the Bala.nrc nn Substantial Compic6on Buyer tistls f i„b cannnt he marc by c.n dii.cord and must be made by personal check,bank check,or cash. Buyers)4rees and nude ds that this Agreement constitutes the entire understanding between the parties,and that there xre n.o erbal under dings changing or modifying any of the terms of this Agreement.No alteration to or deviation from Chit;AgIr ent be valid without the signed,written ennscot of both Buyer(s)and Contractor.Buyer(n)hereby acknowledges that uyer(s) 1)has read this Agreement,understands tete terms of this Agreement, and has received a completed,signed,and dated copy of this Agreement,:including the t”attached Nail of Cancellation,on the date filrst written above and 2)was orally Warmcd of Buyer's right to cancel this Agreement,DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. J&1,Win d/b/a Renewal by Andersen Ru r(s) Buyer(g) By: Si L�hu � ir. f �duccttjM%naago- 9 , 5i�r,IHt SiGna.ture Print Namc of Pmduct Manager Print Name Pant Name YOU, THE BUYER(S), MAX CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIIll OF THE THIRD BUSINESSDAX AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGITI'. - - - - - - - - - - - - - m;-- - - - - - - �- - - - - - - P<- -^ - - - - - - - - - -.- - -� NOTICE OF CE TION I DICE CIF OANCEUA Date of Transaction>;/ You may cancel I Date of Transaction - You may cancel this transaction,withoutany penalty or 6bligdfion,within this transaction,without any penalty or obligalion,`within three business days from the above date.Mf you sanest,any 1 three business days from the above date.If you cancel,any property traded in,arty 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 Sole,and any ne�ef"able instrument executed by you will be returned within 10 days following receipt by you will be returned within 10 days following reteipt by the Contractor ("Sell 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,N you cancel,you must make available to the Seller at your residence,in substantially as good condition Seller ctt your residence,in substantially as good condition as when received, any goods delivered to you under I as when received,any goods deliv red tb you under this this Contract or Sale;or you may, if you wish,comply I Contractor Sale;or you may,if you wish,comp) with fete. with the instructions of the Seller regarding the return inshvctions of the Seller regarding the return shtpriv"of shipment of the ggoods at the Sellers expense and risk. I the goods at the Seller's expense and risk.If you do m. ake d da drake ihe-goods available to the Seller and the I the goods available to the Seller and the Seller does not Seller does not peck rl,%T up within 20 days of the da” ; pick ilttern within 20 days of the date of Nafiee of bar wrN�eut furow ollga}to IF i oftfre. ty� __rf_ yptt-(prll�tt t wVilalrF' farlhel' .:If you fail to make the make a goods avail to the Bel or if you agree t geeds avaltable to the er,at if you agree to return the to return the ggooads to the Seller and fail to do so,then I goods to the Seller and fail to do so,the"you rt�ltllain liable you remain liutlsle for performance of all obligotions under I for performance of till obligations under the Contract, the Contract.To cancel this transaction,mail or deliver a l To cartel stets transaction, mail or del ver a signed and signed and dated cagy of this cancellation nlvtice or any l dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor:J l notice,or send a telegram to Contractor.J&L Windows, &1,Windows,Inc,d/b/o Renewal by Andersen,104 Otis I Inc, d/b/a Renewal by Andersen, 104 Cutis Street, Street, Northborough A 1 32, BY NOt LATER THAN No bare h, 0:1532,SY NOT LATER THAN MIDNIGHT MIDNIGHT CIF �,�- (Date) OF _2_ HEREBY CANCEL THIS TRAM CTION. I HEREBY CANCEL HIS TRANSACTION. euyo,s StBnwme Print Nome Buyer',Signature Velar Nom9 Deln rshA Copy- White Buyer Copy.Yellow Buyer Copy-Pink 11/09/2006 02:58 97827B5010 JOHN BEAVER PAGE 04/05 J 104 Otis Sn•cct,Northbol'atySh,MA O 15,32 &L Windows,hic.d/b/a2 Renewal �HIC License#14960I(explraa 1124 112) Yhcme 508,919.0900-Fax 114,)17.3011 Federal Tax lD0 83-0404201 bAndersen.en WINDOW REPLACEMENT mAnd—C—v,v M GUAM 11'IA.SSACHI1.VE1'1S AND N6w HAMM MB W][NDOW SPECMCAnON SHBBF of 8uyer(s) a Date of Agreement Cif U The 94er(s)listed above hereby jointly and scvc y agree is pure hose the goods and/or services listed below,ill 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 Sp el&Rtion Sheet is a part. WN DOW DUALS 1. Contractor will Install a total of-Lli� _windows in Owner's home,psir4S the fallowing individual quantities: Double Hung(DB)P F,qual Bash Cottage sash(i/3 top,2/3 bottom) ❑pldel sash(2/3 top.1/3 bottom) Casement(CW) Hinge right LVHinge 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 2 Lite Gliding Window(GW) Glider/Picture/Glider(GFW) ❑ ):1:1 or❑ 1:2:1 b Awning Window(AW) Picture Window(PW) Bay or Bow Window alio Doors(sce separate Poor SpcoXicitdon Sheet) ILL 2. Yes❑ o Qty of WiHdowg te,be Custom N Replaa;men1: 3. LJ Y.,�v Qty of Sills to be replaced by Coniractor:_- _ 4. F1 Yes l�NI Qly of Windows to bo.Now Construction Full frame(includes new interior&exterior casings) Exterior c�ls s: Q Nne[] Maintenance-free materiai ❑ Factory applied 908 Fibrex briekmold S. GlMing to be; lQ HP lal EI Sm rl StlnTM (7F;x C7adlf Ekg7Z*) ❑Other if crthcr,please specify: 6. Exterior ootor to bo: 1 lite ❑ Sand ❑ Canvas ❑Terratone ❑ Ccoco.Roan 7. interior color to In: �mhitc ❑Sand ❑Canvas❑'l'crraronc[] Fine❑Maple❑ 0a1C D" Not: Into' r color can only he white,wood or same color as exterior. Wood interiors need to finished by Owncr. Q� 3. Hardware White[] Stone LI Canvas ❑ Bras❑ Wale tlardwarc..: Style: e 9. ❑ Yes ❑No Install Lifts with Double un HWindows Atli 10. Screens: windows to have: E] Half or Full screens Settens to bc: LlFiber);lass LlAluminum TruSocnc GR11.L1:DEfAIIS I I.Window,have grilles: JrYeS © No If yes;gUrillc 6ctwwn Glass(una)❑ Removable hiterior Wood(irk❑Full Divided Light(mu Qty: Qty: Qtr. Qty' Qty'-/Y— Qty: Qly: ov oda oN oN cw i 311d� c a c Drawgrillc patterns above `Usc additional sheet if needed Owner gVmvcd ADI)MONAL WORK DEFAIIS 12.[Yes V96 amtractor wi 11 remove metal frames of wi ndows. Qly of Units: 13.❑ YesNn lontractor will install new point-ready or stain-ready casings. Interior acing qty of opcnin;s: Exterior casings qty of openings: E] Fine ❑ Maintenance-free material 1.4.❑Yes No Contractor will install new paint-ready or stain- iside stops qty of openings: Interiors s qty of opchil'ss: Ester or ops peri ❑Fine.❑ Maiutcnanu.-free material 15. Owner is a that Contractor does not do any pain' er Initials 16.❑Yes No Contractor will wrap exterior casings with stock of color. � Wrappin,-q may be required with storm window removal;removal of storm windows will leave screw holes in casing. UG I7. s No Contrac.Kor Will insulate,caulk and seal windows with 3-point.system to prevent water and air infiltration. 1S• ❑No A limited warranly,shall be issued to Owner upon complctien of the job and payment in full. 19.VYcs ❑ No Building Permit-Contractor will secure any and all necessary permits. The fee for the permif(s)is not included in the Contract Price and separate check is aired at the time of sale for this fee. 20, Additional job details; hfr 7'o f�C �e 0-52- 2t. n 21. Ves❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. Nn finnlr'1'm�f•/rf!//i'k'(7�dit1171t(a'f4/I✓n/•i!!he cr,�nlrnc!ig c�rmplc Mv'//V(hC vtti.'fNcliolt vfvllpatfi'cs. It is agreed and tutdetstood by and between the parties @int this Specification Sheek along with fire CUSTOM WDWW AND Mop R9MOT)OLING AGRrXAWI'F,eomfifutes the erdire understanding between the par&sa and there azo no verbal understandiggs Changing or modifying any of the terns. This 9pacificatim Shit may not bo ehu%pd or its forma modified or varied in any way unless such changes mein writing and owed by both the EVYW(s)and .Buyer(s)hereby acimow)Ose$tat Buye(s)has read this Spccifrcmtiun Sheet. Renewal by Greater MA and NH Bayer s) i Buyer(s) By: S' of Manager Sign signature art W�S/.- v �� �, 'z d IPrint Name of Product Manager Print Name Print Name . The Commorweaftft of M2assachoetts ; Departinent of Industrial Accidents Office of Investigations 600 Facluagtaa Street Boston,MA 02111 •TwivFu.atass.gav1dia Work=' Compens$tion Insurance dffidsv�$ceders/Cantractorsl�IectriciaaslPlnmbers A:13plitlnt Iaform6on• Please.Priest Lem F NaM-.(BusinmW0rpeizet mrMdivviduat): �e� v Anr�ers e n' Address: l 0r` S � � Ci /Sp: IVD o ra i� ne Pho .��-, 1� Are you=employer?Check the sppropriste ba:~ Type of project (regvis°ed); 1. -I am a employes with• U�D 4. [],1 am E g=mal contractor cad I []liew coastw of • employees(fnIf®d/orpart-time), have himd the spb-coatraotois 7` ��g , 2.❑I am a sole pmpriatm or partner. c listed on�a atfaaI sheet t ' -ship cad have no employees .1'nese.svls-contrators kava B. Domoliaioa _ working forme.a, Cay capac%t5' w 'camp.ias¢reace. . g, (�$tulding addiiioa [No workers'comp:insnc&tce 5. ❑Wean a corpazation and its I0.[]Elertdcal repeus or additicas offccn have==06tboit of ezzem�tion.perMGL il.�Rlnmbiag rrpsirs or additions 3: I am a homeowaea doiag an wank , myself[No work=,romp: e,152,L1(4),and we have no ILL]Raaf repairs t amplorm•[No 7=1=9' 13.D Qii>cr insarsnce raquitt~d.] ro*iosuraace regdmd.] `Any gomnt tbd Che bot€I not silo IM out the seetim bcbw dawing,7ti r wvz~�e'comp—ion p cy e�davit indieatiae such t mune m=who=bmtt this a�avit indicnimE they moe doing aflwod and thea hse outside eoatraet� sobmit oIi iafomu�ioa ' �ontzacto�s tbet chefs Svs hoz mutt atlaelaed�addtiimu<1 shed shmriog$�e acme of the�-eonlactoa®d thea wo¢�s ooasp.P .c}' I am an emptaper that is pra}ddmg warkdra'corapeaaaititre insrv'anae far eery employees �elaw,ia the pafsry and jab s� Iasnraaac Company Name, ?�#r Self ins;Lit:.#: Egg ration Daft, roe Bite Add=ss;�b Attach a espy of the workers' compeasgtion policy declarLdon pave(Showing the policy giber and expiration date). Fat7urc to aceto c coverage as required tmdar Section 23A of MGL c.L52 can lead to size imposition of criminal pcnalfics of a PM up•to$1,500.00 ancVor ono-year imprisonment,as W011 as cion pmz if ms in t'aa farm of a STOP WORK QRDER and a fine -of ttp to S250.00 a days T*�.t 6e violator. Sr advised that a copy of this statement may be forwarded to a Office of Investigako=-of the DIA for,nar,r wo rov=gr,vmffhfi=n I do hereby the pains rand penaEtlea erjruy that the it forrnadaa prided m�e is tens and earre� .• 5teaetnre' . DEL. Phone#' Of csal use D*,Do Wtwrrte in this area,to be Completed by eity ar tmnn afrieial City or Tovra: PermitlLicense# T.sstziag Aathority(circle nae): ' ertnr L Board of Health 2.BdI ing Depir invent 3,My/Town Clerk 4,IIectri v l InspCesar 5,Plumb m,�asP , 6,Other Coutset Person: Massachusetts - Department of Public Safety -Board of Bdildin- Regulations and Standards Construction Supervisor License License: CS 95M BRIAN DENNISON. 86 CREST CfRCLE WORCESTER, MA dl6O3. " Expiration: 9WO12 C'omnu,smoner Tri: 2622 s�orDwrnoruaea o�. aref ' Dmee or Ccnm=cr Affa4s e&$asiness egnl:fiQa OM's MpkIT CONTRACTOR • Regisiradoz01 Explra 12 4 t Card , RENEWAL EY BRIAN DENNIS _ 104 OTIS S NOR1N90ROUGH; Underseerrbu7 ATE ACC>RbPCERTIFICATE OF LIABILITY INSURANCEF02/09/2011° "' 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: ff 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 CONTACT Joseph MCKeone NAME,PHONE FAx N : 734-662-8100 A/C Nol: JP McKeone Insurance Agency, Inc. ADDRESS: P.O.Box 333INSURER(S)AFFORDING COVERAGE NAIC# Ann Arbor, MI 48106-0333 INSURER A:Hartford Insurance Company INSURED J&L Windows,Inc. Renewal by Andersen INSURER B:Nautilus 104 Otis St. INSURER C: Northborough,MA 01532 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INTRR TYPEOFINSURANCE A POLICY NUMBER MMIDDNYY MMID�/YYXY I LIMIT B GENERAL LU1611JT'Y EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED COMMERCIAL GENERAL LIABILITY NC958461 10/01/2010 10/01/2011 PREMISES Ea occurrence $ 100.000 CLAIMS-MADE ERI OCCUR _ MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1 000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY iPERoT F7 LOC $_ A AUTOMOBILE LIABILITY. 35MCCXD6390 10/01/2010 10/01/2011 EO aBINED SINGLE LIMIT 1.000,000 ANY AUTO BODILY INJURY(Per person)) $ ALL OWNED SCHEDULED X AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSUTAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION - 35 WECPP1444 02/17/2011 02/17/2012 I WC STAT U- OTH- A AND EMPLOYERS'LIABILITY Y/N YLIMITS ER ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA and If yes,describe under (Mandatory in - E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION INSURED COPY 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 ©1••988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD wV�'.-JC�,�, •:�:;:"•tit-- - 3 cnoA . er .. ••rMonorFomift Cor a i Parw.-Low R4kZW Ah Arps ENEJRGY PERFORMANCE.RATINGS tJ-Facer�U. . • tai Hast Gari Cosoclaat >R1Di3M9NA:PF RFORMANPERAT N{GS Alenuta�tunntlpulatk chat erose abpe molal taapp4 lg NRIC proc bw is delmNninp Wb* - P� pe�latrtomca I AV raEnpe.en doryndrmd for a W$R of a tmto4l�nammrc and i _ ' >pem'�aProi4a3a6e.CalaW[tuent�tasfimt'eetela4aahxoUNrptoduotPutmmuatiatfmumirn. . Design Pry Etta(PSFJ _ • Meebarn�eed�M:Erti,GEG,SLE•C•G.A1r1e111�OrtF�gtd�en�,1N061HiMIMukC�611C+11urtPmpntq . • h �' 4 fir/�K �' {'�. , ,• ,}, �tLnnt•eSCNr 'y '_ 4 ydoodNnyl Csr>?esltt frame Ai*q� Caw Dual Pane R't C: .Cow E Gasmen RES97 t S,''�� t`='= �r� l SCS, • � '•' •. � • Sofar`E�aai.Caln �05f�GIBr1L U-Factor I 0. ► rear A`Qt.+' i 5r�'a 1 NGS. RAL PEM ADDITIO � . Vlsible'T�ans ltt'ance: i 9 '. pt,@at°rtunMO photo a Ihaa tatl�gs eoPic Eppl{p;bla p!c^r�C Pr~�d,nentai pn6lhoN end t' • 'Kamm=lVter;UpuhR:lhal n s at<gtymlhad tot t fi=:d,sa4dt:eta ' P1d�el perionnarid,,lEi�C ntl B (.pa o n��IpIOIiDA7�'., . tp:citlrptod'udslnCons�ilmawDesignlaplui:�tl�rtatu%tor otherprnd� rt r r nr sf s .S.oOi INWIpt LO i of d+rnte WDML Aalim F oedl(V:allon pt,psam or reds Mw,D i =D 6 I SGA Alrinilltithon Ano ro t