HomeMy WebLinkAboutBuilding Permit #537 - 514 WINTER STREET 1/10/2012Q� TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: J Date Received
Date Issued: r 0 T Zl
IMPORTANT: Applicant must complete all items on this page
LOCATION S, q OJ T A��
Print
PROPERTY OWNER iF i rA N F &-P�,
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
ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
u4iZe6pair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
®Septic®We 1
r
[® Floodpl [0 Wetl�an`ds1
` ® �Waterslied Disfict;
t
�®�Water/Sewer..: ..a
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Identification Please Type or Print Clearly)
OWNER: Name: �! ��`F ftgA n Vet i&,a Phone: 9 -g 75-,
Address: S i
CONTRACTOR Name
Address:
Gri,""i ple� SG- Phone:
bi 0
Supervisor's Construction License: _9!T - Q% Exp. Date:
Home Improvement License: l -( & G/ J3xp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
) 6_��& - -
FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ FEE: $ c1,6,6'
Check No.: 9-5"6/c, Receipt No.: 1), J "'
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
1TA tAf':`�
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
a Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o 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
MOTE: 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
:hat 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
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
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED
0
DATE APPROVED
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
a
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comme
Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No,
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — For department use
® 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
a Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
VOTE: 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
:hat 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
�� TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: J 3 -T- Date Received
Date Issued: 0 2L,—
EWORTANT: Applicant must complete all items on this mage
LOCATION 31/
Print
PROPERTY OWNERS (Y\I\N PkPA,
Print
MAP NO:PARCEL`2� ZONING DISTRICT: Historic District . yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
SS p®Well
v
®Water%Sewer �_
•. Floo Alam ®Wetlands
.. ._ : _.,.� -_
ate he�dtDist�rict'
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: '77�1�;-`(- C- n Phone: g % -g ?,5-- 4r)
Address: �51 q (, i n -i :r
CONTRACTOR Name: 13ri,,)I\j Phone: s(j�-CS�G�Po
Address: l� GlfSi' C'.r�.f W oLct-S+TS V -MT
Supervisor's Construction License: ,�9�% 6% Exp. Date:
Home Improvement -t License: � (eG/ Exp. Date: � b q!/�
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $�� a(o FEE:
Check No.: Receipt No.: d��[
NOTE: Persons contracting with unregistered contractors do not have access guaranty fund
Location
No. r Date
NORTq
TOWN OF NORTH ANDOVER
F s
A
Certificate of Occupancy $
sCM <�
Building/Frame Permit Fee $
Foundation Permit Fee $ A
Other Permit Fee $
Go
TOTAL $
Check #����
24950
Building Inspector
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104 Otis St., Northborough, MA 01532 J&L WINDOWS, INC., D/B/A _ to Home Improvement Contractor
(508) 919-0900 • Fax: (774) 987-3013 RenewalL. apse #149601 (Expires 1/24/2012)
byAndersen. , Federal Tax ID #83-0404201
WINDOW REPLACEMENT an Andersen Comm, Vo Vr
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Name
Date of
�J e e� M"„ f-��1 `;sem
Buyer(s) Street Address, City, State, and Zip Code
E -Mail Address Home Teleohone Number Work Telephone Number
Buyer(s) hereby jointly and severally agrees to pu chase the products and/or services o J & 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.
Total Job Amount: SoZ ki
Deposit Received (33%): See -B&A ct
Balance at Start of lob (33%):
Balance on Substantial
Completion of Job (33%): r -t ��4��-F
ESrlm1ared Starring Dare:
Method of Payment: OCheck ❑Cash r8<2nced
Credit Cards are accepted for deposit
only — maximum 1/3 of the project cost.
Please see Credit Card Payment Form.
Estimated completion Dare:
�. �/ ci'
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 parties, and that
there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation
from this Agreement will be valid without the signed, written consent of both Buyer(s) and. Contractor. Buyer(s) hereby
acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, cement, and has received a
completed, signed, and dated co of this A reement including the two attached Notices of Cancellation on the date first
'' PY Agreement, g ,
written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF
THERE ARE ANY BLANK SPACES.,
J & L Windows, Inc. d/b/a Renewal by Andersen
By:
Signature at Product /Manager
Print Name of Product Manager
Py(s)
/ I e
a 9�o,
Print Name
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 THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT.
— — — — — — — — — — — — — — —�<- — — — — — — — — — — — — — - 91<— — — — — — — — — — — — — — —ems
NOTICE OF CANCELLATION XNOTICE OF CANCELLATION
Date of Transaction /.1 -/ `/'l( . You may cancel Date of Transaction !Z -I Y-!( . 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 three business days from the above date. If you cancel, any
property traded in, any payments made by you under the property traded in, any payments made by you under the
Contract of Sale, and any negotiable instrument executed 1 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, by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will 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 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 the goods 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 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 Dods to the Seller and fail to do so, then you remain liable
you remain liable for performance of all obligations under I rods
of all obligations under the Contract.
the Contract. To cancel this transaction, mai or deliver a I To cancel this transaction, mail or deliver a signed and
signed and dated copy of this cancellation notice or any I dated copy of this cancellation notice or any other written
other written notice, or send a telegram to Contractor: J notice, or send a telegram to Contractor: J & L Windows,
& L Windows, Inc. d/b/a Renewal by Andersen, 104 Otis 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 /'d- -!7 -/1 . (Date) OF /1 -t -7--/l _(Date)
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature Print Name Date Bayer's Signature Print Name Date
RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink
L
104 Otis Street, Northborough, MA 01532
Phone 508.919.0900 • Fax 774.987.3013
Buyer(s) Name
J & L Windows, Inc. d/b/a
Renewal;-
byAndersen.
WINDOW REPLACEMENT an Andersen Company .
OF GREATER MAssacHuserrs AND NEw HAMPSHIRE
WINDOW SPECIFICATION SHEET .
MA HIC License # 149601 (expires 1/24/12)
Federal Tax ID# 83-0404201
Date of Agreement
The Buyer(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 I windows ih 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) ❑ Hinge right ❑ 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
2 Lite Gliding Window (GW)
Glider/ Picture/ Glider ❑ 1:1:1 or ❑ 1:2:1
Awning Window (A Picture Window (FW)
Bay r Bow Window s Patio Doors (see separate Door Specification Sheet)
2. J- Yes ❑ No Qty of Win ows to be Custom Fit Replacement:
3. ❑ Yes [g No Qty of Sills to be replaced by Contractor:
4. U&Yes ❑ No Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) and actual_
Exterior casings: ❑ Fine Q Maintenance -free material ❑ Factory applied 908 Fibrex brickmold
5. Glazing to be: ❑ HP Low- E-4 TM Other If other, please specify: Cry sc/^
G. Exterior color to be: ®, White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean
7. Interior color to be: ®. White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak
Note: Interior color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner.
8. Hardware: X White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style:
9. ((Yes ❑ No Install Lifts with Double Hung Windows
10. Screens: windows to have: ❑ Half or X Full screens Screens to be: Fiberglass ❑ Aluminum ❑ TruScene
GRILLE DETAILS
11. Windows have grilles: X Yes ❑ No If yes -.,K Grille Between Glass (GBG) ❑ Removable Interior Wood amw) ❑ Full Divided Light VDL)
Qty: Qty: Qty: Qty: Qty: Qty Qt':
H DH DH DH C Glider CPWorG
Draw grille patterns above `Use additional sheet if needed Owner approved (initials):
ADDITIONAL WORK DETAILS
12. ❑ Yes AL No Contractor will remove metal frames of windows. Qty of Units:
13.4. Yes ❑ No Contractor will install new paint -ready or stain -ready casings.
Interior casing qty of openings: / Exterior casings qty of openings: ❑ Pine a Maintenance -free material
14. ❑ Yes & No Contractor will install new paint -ready or stain -ready inside or outside stops qty of openings:
Interior stops qty of openings: Exterior stops �ty�of oRenings: F] Pine F1Maintenance-freematerial
15. Owner is aware that Contractor does not do any painting. (� t /fit ` ) Owner Initials
16. ❑ Yes X No Contractor will wrap exterior casings with aluminum coil stock of color.
Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing.
17.X Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration.
18. Yes ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly.
19. [i Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full.
20. [&Yes ❑ No Build'—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.
21.[R Yes ❑ No All discounts have been applied to this agreement price.
22. Additionaljobdetail,A, n 0=1 I f t �. 1 i -
23. R Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.
No final payment shall be demanded until the contract is completed to the satisfaction ofall parties.
It is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the
terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both
the Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet.
Renewal by Arl ersen of Greater MA and NH
By: JV7�
Signature of Product Manager
Print Name of Product Manager
Buyer Buyer(s)
J.l
iv S' tore
r
Print Name
Signature
Print Name
MA License # 149601 (expires 1/24/12)
RenewaL-00_0_1
RENEWAL BY ANDERSEN Federal Tax ID# 83-0404201
byAndersen,OF GREATER MASSACHUSETTS AND NEW HAMPSHIRE
WINDOW REPLACEMENT mA d<r=c:,mph „ 104 Otis Street • Northborough, Massachusetts 01532
Phone 508 919.0900 • Fax 774.987.3013
CONMAAcr AAENDMSrrr
This Amendment ("Amendment") is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ("Agreement") by and between J&L
Windows, Inc. dba Renewal by Andersen of Greater Massachusetts and New Hampshire and flH &LISA MANFRA ("buyers"). Contractor and
Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and con-
ditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The fol-
lowing additions, alterations, or deletions to the products and services Buyer(s) ordered are being made:
ADD (1) GW UNIT TO EXISTING CONTRACT
DUAL COLOR
WRAP EXTERIOR TRIM WITH COIL
GBG GRILLES & SMART SUN GLASS
51883
As a result of these changes, the following terms of the Agreement are.also changing (if there is no change, an item will be left blank or marked
as "N/A", indicating that no change applies:
NEW Total Job Amount: $9409.00
New Estimated
Method of ❑ Cash ❑ Check ✓ Financed
Starting Date:
Payment:
New Deposit Received
(33%). $3763.00 Finance
RECEIVED
Credit cards are accepted for deposit
New Balance at Stant of Job
(33/0):
New Estimated
only—maximum 1/3 of the project cost.
N/A
Completion Date:
Please see Credit Card Pa ment Form
New Balance on Substantial
Completion of Job (33%): $5646.00
FINANCE
By signing this contract amendment, 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.
It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding
between the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby
acknowledges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date
written below.
Renewal by Andersen of Greater MA and NH Buyer(s)
By:
Signature of Product Manager
MIRE SIDMAN
Print Name of Product Manager
Doc ID: 20111219135435560
Sertifi Electronic Signature
E -Signed 12;2 2C11. 7:31¢52 AM CST
Jeffrey J. Marlfra
jmanfra��astvnprcp:±reies,cam
IP �B,�'.lin.lg
r:�tru: aes�a.�r_rsxssa; xsea
Signature
12/20/2011.
Date
Date
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Rob $tic Address, j I t j .� n¢mber and eirainn date).
declsrafian p�;e (shawing the pDk9
Aftacii a espy of the �rarla3re` coarpensafinn pQi�y 15� can Iced tD impoaifinn of criminal pcnBlficcs of a
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foie tip to $L�SDl1.DD sndl yc ba �rwarded to . p{me of
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' It<vesfi�afi.cma of � DIA far insarsnao covcrnge � .
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Q�cia! tzsi artfp,
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• p�ifllic�nse �
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�ssf�iag AufhnritT (ch'cie onc�t yns et:tnr 5, Pine �spef tnr
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• Massachusetts - Del3ar-tment ref Public Safch
-Board�of Buildin,,-r Rcuulatinns and Standards
Construction Supervisor License
License: CS 95707
BRIAN DENNISON r
85 CREST'CIRCLE
WORCESTER, MA 01603
Expiration: 3/8!2012
(bnuntiasirnner Trr; 2522'
' . Offico of Consumer Affaifs Business Reguiafion �.
HOME IMPROVEMENT CONTRACTOR
Regisfiatia X01.
Ex pi �At Card
RENEWAL BY
I•
BRIAN. DENNIS � !
• '104 OT1S STREE T; ��/,�%• .
NORTHBORDUGH, Undersecretary
A� LY CERTIFICATE OF LIABILITY INSURANCE
° 0/ 4/2011
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: If the certificate holder is an ADDITIONAL INSURED, the poficy(ies) must be endorsed. If.SUBROGATION IS WAIVED, sub)ect 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 FAX
A No . (734) 662 8100 ac No:
ADDRMAIESS:
INSURERS AFFORDING COVERAGE NAIC #
Ann Arbor, MI 481060333
.INSURER A: Nautilus 19682
10/01/2011
INSURED J&L Windows, Inc. Renewal by Andersen
INSURER B: Hartford 37478
104 Otis St.
Northborough, MA 01532
INSURER c :
INSURER D
INSURER E:
INSURER F
�t1\I AI+ n rn=0rrn1% Arc Au 111aQC0. RFV!¢Ir1N 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.
INSRR.
TYPE OF INSURANCE
ADDL
SUER
VND
POLICYNUMBER -
POLICY EFF
MMIDD/YYY
POLICY EXP LIMI
MM/DD/ TS
A
—Jul
GENERAL LIABILITY
NC958461
10/01/2011
10/01/2012, EACH OCCURRENCE $ 1,000,000
I 100,000
COMMERCIAL GENERAL LIABILTIY
PREM SES Ea occurrence $
5,000
CLAIMS -MADE 12 OCCUR
MED EXP (Any one person) $
PERSONAL & ADV INJURY $ 1,000,0001
I GENERAL AGGREGATE $ 2,0DO,ODD
PRODUCTS - COMP/OP AGG S 2,000,OOD
GEN'LAGGREGATE LIMITAPPLIES PER:
POLICY PRO- LOC
$
AUTOMOBILE LIABILITY
35 MCCXD6390
10/01/2011
10/01/2012 COMBINED SINGLE LIMIT 1,000,ODD
Ea accident
ANY AUTO
j BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
I BODILY INJURY (Per accldent) . $
AUTOS •. AUTOS
NON -OWNED
PROPERTY DAMAGE
iPer
HIRED AUTOS AUTOS
accident)$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MAGE
— —
AGGREGATE Is
DED RETENTION $ ----
�---$
A
WORKERS COMPENSATION
35 WECPP1444
02/17/2011
02/17/2012 i W0C STATU- OTH-
AND EMPLOYERS' LIABILITY
500,OOD
ANY PROPRIETOR/PARTNER/IXECu "vc H
ELEACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N
In NH)
/ A
500,()00(Mandatory
E.L DISEASE.- EA EMPLOYEE $
I= describe under
POLICY LIMrr $ 500,000
DESCRIPTION OF OPERATIONS below
E.L DISEASE -
B
PEOOH555DO 0507
09/27/2011
09/27/2012
i
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER GAIVGCLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE . WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
U 1966-2U7 U ACUKU GUttt-UKA I [Uri. AR rlgnrs reserveu.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Do not remove until final code inspection. Save label for future reference.
ICanada �;
7 1 energystarnrcan- 1 I-�.�_•� -� `(.y,1..
N S >� �
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100-00511408-012
MEEL• Or excEeas M.E.C., C.EC, S IE.C.C.Air mtlilmation regWremEnE WDAIAHEIImarK Cart=511011Progrem.
�F
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byAndersen.
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':s�t� �ESY dsxa:r.
AND -N-34
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Dual Argon Low -E4 SmartSun
E M
Product Type:. Glider
ENERGY PERFORMANCE RATINGS
U -Factor
Solar Heat Gain Coefficient
.4 0-
- - 0.19
U.S.A-P Metric/Sl
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0.43 .
Manufacturer 1pulare•, marmese ratings confolin m applicaNe NFRC proceoures for aerennlNng whole pmoua
performance. NFRC ratings are aetartninea for a %on sec of environmental conaltone ana a epetlflc proautt 21m.
NFRC 0oes'nar recammena any proautt 3110 ones norwarfanr me sultaolllty at any proauc[for any spacttic use.
Il�raaxc4aromerprea[•pnrtortnaneeintartnaoart:-----•----'.
Co,.uttran:.aacwr¢
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r� 61 SANWE
Wlnaow ana' ,no
Andersen Co oration: RDA Glidin Window
enurac rar _ pu s ae conrortnancE aro ovang n a s
Standard
Rating
NAFS-02 orAMWwDhWCSA 1014 S2Aaao-gs
DP psf HS -C35
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• :2 In me freme sna satin
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100-00511408-012
MEEL• Or excEeas M.E.C., C.EC, S IE.C.C.Air mtlilmation regWremEnE WDAIAHEIImarK Cart=511011Progrem.
Do not remove unfil final code inspection. Save label for future reference.
Canada L
rnean.ge cn
zM
CM C
V C �
UJ = 0.5.1 EA.
energystergoV = QuardiealAdmissble,
Renewal
byAnderseri.
VY[NDOW REPLACEMMXT ui /•n iaiunCuniP+^�T
AND -N-37
Vinyl/Wood Composite Material
�a3 Dual Argon Low -E4 SmartSun
Product Type: Picture
ENERGY PERFORMANCE RATINGS
U -Factor Solar Heat Gain Coefficient
0.27 1.53 0.22
U.SJI-P Metric/S1
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
. 0..51
Manufmrer stlpulates mail] rtlngs conform to appOcanle NERC praceouree fir a nartmmng c Mrwie pr s
pertarmance. NFRC ratlngs are apse mmea tar a rola set at env1"nmamal f arty �� ata 9e� SPeCMD usL
NERC tloes not reeammena any praaua ana tloes riot warrant me suaattmty of arty p.
Consu¢ manutac ram Orerature for amer ptaeuct peaannanea Imonaatlon.. _
wwwtarc.mg
Standard Rating
NAFS-02orAAMA+W MkWAIMAXIA40-05 DP psf F-050
X11 g>* t Ms ptoaucr main
{k Green Sears
erMrtlnmantal stantlsras
�y gaveming energy
aMency, n Wfnetea
. � N me name and $ash
a3 �1VO materiel, pacaging, one
ronsurMawrlier enucaaorul
s.
100-00511006-001