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HomeMy WebLinkAboutBuilding Permit #263-16 - 66 UNION STREET 5/1/2018 BUILDING PERMIT of No D TOWN OF NORTH ANDOVER 3� h APPLICATION FOR PLAN EXAMINATION H Permit No#: / Date Receivedr a " AC US Date Issued: IM�P/ORTANT: Applicant must complete all items on this page LOCATION (P(P7�- Print PROPERTY OWNER 2)e1vV S Ja rpSNP Print 100 Year Structure yes no MAPod 9 PARCEL: ©01- ZONING DISTRICT: �`f 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 repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic Elwell ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: P Ai't C� oo!' a irk c o(a Identification- Please Type or Print Clearly 9 P P 7f-G8s- S 9 9 OWNER: Name: � .✓ Phone: oy �� � r s Address: 640 64-y o ly- cS� Contractor Name:T—A t yk P M O R I K Phone: G / 7 Email: Address: D o,-12°S heD Dr elS Supervisor's Construction License: Exp. Date: Home Improvement License: Z20 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ & 8/,;L, OU FEE: $ 7-57000 Check No.: &�Q Receipt No.: 29 2R4 NOTE: Persons contracting with unregistered contractors do not have access t uaranty fund f Aa Pte° Sinnatu e of contractor 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes `Manning Board Decision: Comments u Conservation Decision: Comments Wafter& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR4TMEN:T - Temp ID-urn r,--site eyes_ nog f COMMENTS. _ r 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) LJ Notified for pickup Call Email Date Time Contact Name Doc.Building Penuit 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 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 OTE: 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/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4. 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Location No. 2 _ Date l /x, . - TOWN OF NORTH ANDOVER �u Certificate of Occupancy $ Building/Frame Permit Fee °s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#9AO-11-1plf (:2- Building I pector NORTf TO' w' n of 2 . ? E 1� Andover O ' h ver, Mass, ;' A- COC C641WICK 7�A00ATED 01? S` U BOARD OF HEALTH Food/Kitchen PERM -IT T LD Septic System THIS CERTIFIES THAT ......�<-:!Y <%s .., ...� J s`. /..t(..e.................. BUILDING INSPECTOR ................................................. �.!/4'f.�' Foundation has permission to erect .......................... buildings on . .... ...... :4r:LP....�/�........................................ Rough tobe occupied as ...........( 1. 1..4 . :.. ;"................................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCTIO S ARTS Rough .......... Service ......... ......... ....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. RenewalAndersen4 Renewal b MA Home Improvement Contractorl i+:''� License#170810(Expires 12/23)2015)1 ,�� WINDOWREPLaCEMENr W�L.kro..r . �,., y Andersen Corporation Federal Tax IDtr41-19t8413i 30 Forbes fad. Northborough,MA 01532 (508)351.2200 Fax(508)-986-7072 CUSTOMER N'INDOti1t AND DOOR REMODELING AGREEMENT IBuyer(s)Name Date: DENNIS DUFRESNE - JULY 8, 2015 Buyer(s)Street Address City State Zip Code 66 UNION ST NORTH ANDOVER MA 1 01845 ,Email Address Home Telephone Number Work/Cell Telephone Number ADUF2-5516VERIZON.NET 9786854899 9786094083 Buyer(s)hereby jointly and severalty agrees to purchase the goods and/or services of Renewal by Andersen Corporation("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 Jab Amount $ 6,812 kmount Financed S 6.812 Est.Start Date Method of Payment Deposit Received(33%)$ 0.00 Deposit at sigrttg S 3,406.00 ChecklCash 8-i0 weeks Balance Start of Job(33°"x)S 0.00 Check r I Balance on Substantial At sue=s*al Est.Install Time Credit Card Completion of Job(33%)S 0.00 C-4Ae—S 3,406.00 t-2 days tf credit card is selected,please No anal WO be denaneetl trot a' ere eatahea see Credit Card Payment form Buyers)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. Buyers)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)was orally informed of Buyees right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation Buyer(s) Buyer(s) Signature of Consultant Signature Signature x GREG DEMPSEY DENNIS DUFRESNE Printed Name of Consultant Primted Name Printed Name i YOU.THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDMGNT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. --------------------------------------------------------------------------- i NQTICEOF CANCEGI.t`nON � � NOTICE OFI`.ANCEILtT10N I I Date of Transaction I 7WI." .You may caucet this Date of Transaction 7/8/15 You may caned this transaction,without any penalty orobligation,Within three business days(rout the �.. transaction,without any penalty or obligation,Within three business days from the above date.If you cancel,any property traded ln,any payments made by you under �. above date.if you cancel,any property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument exectned by you w1D ire �. the Contract.of Sate,and any negotiable instrument executed by you.0 be remensed within 10 days following receipt by the Contractor("Seller")of your returned within 10 days following receipt by the Contractor("Seller")of your cutcelladm notice,and any security Interest arising out of the transaction Will be cancellation notice,sad any security interest arising out of the transaction will be canceled. If you cancel,you most make available to the Seller at your res.klenoe,in I canceled. If you tsmcel,you must make available to the Seller at your residence,in substantially as good condition as wkm received,any goods delivered to you under I substantially as good condition :x when recdted,amy goods delivered to you under this Contract or Sale,or you may.if you wish,comply with the instructions of the I this Contract or Sale,or you may,if you crash,comply with the Instructions of the Seller regarding the return shipment of the goods at the Setteres"pease and risk. I Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up I If von do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your:Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. U you fail to make the goods mailable I of the goods without any further obligation. If you fail to make the goods available to the Seller,or If you agree to return the goods to the Seller and fallto do so,then I to the Seller,or if you agree to return the goods to the Seller and fall to do so,then i you remain liahle for performance of all obligations under the Contract.To cancel you remainliable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and datedcopy of this cancellation notice I this transaction,mail or deliver a signed and dated Copy of this canreltation notice or any other written notice,or send a telegram to Contractor'Renewal by Andersen,I or any other written notice,or send a telegram to Contractor: Renewal by Andersen, 30 Forbes Rd. 1N orthboro DEA 01532. 30 Forbes Rd.Northborough,MA 01532. � i 1(HEREBY CANCEL THIS TRANSACTION. I I HEREBY ClNCELTMS TRANSACTION.. 1 I &,I-,Sgaare Pict N— eIW I e fEr�1 Berman Ant Na Orr RenewalV11it.1-2-0--_ Renewal by Andersen Corporation MA Home Improvement Contractor byA NLdersen. 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015) WINDOW REPLACEMENT ..,.,,u..,.,,c..,,­... (508)351-2200 Fax:(508)-986.7072 Federal ID#41-1918413 Window Specification Sheet Buyegs)Ntune Date or Agmement. DENNis DUFRESNE WED, JUL 8, 2015 11te bdiwr(s)listed shove her•byjoindv and sthrrally agree to pulY'h3SP die goods and/a'set- ices listed bclntt;in accorclana•with the prices and terms dcscrihed on clue Specification Sheet and the I'mnt and the reverse of the accompanying GCS10-NI 41'1NDOW AND DOOR 1•LEN40DELING AGREENIE.P,of which the Specification Sheet is pan. WINDOW&DOOR DETAILS ADD. APD. APP ExtencrAntena Cola Hardware Hardware I.ovrEa/ Grille Grille Glass Room N Nam height 1.11 window/Door Style Detail Cas:,s Ext-Int Color Style Streets Smadwn Gdtles Sash i/3 Sash 2 Utts Options uving 101 70 78 148 A-FWG C lafo Ext.Wrap WH/PN Black Newbury FFG 3martsurl urrw 315 3/5 No No Tocol 1 BAY BOW&BUILD OUT DETAILS Style Deutli/ widthtx Approx. Nutnbor Frame Window End Center LowE/ Roof I Hardware Roan Count Style Flankers rte ht Cnsatgs Angie' Lues interior (xtAnt Gofa Grilles; sashes sashes Screens Smartsun Soffit Cola SPECIALTY WINDOW DETAIIS Fun/ Approx. L we r Specialty BAY/BOW ADDITIONAL WORK NOTES Room Count Style Insert U.I. SmartSun Gates Grime Style FxtAnt Color t.IBlnn]rC i,I,—thm Kith hav/lxes w1IXi—,undc,72 iw hn Ilvrc teitl♦>r si titirant. hcv loxr. ADDITIONAL WORK DETAILS: rl ewba r hardware in.black.Custorn sized Frenchwoodgliding patio door.Match interior colonial ca±-T fine interior white exterior.Removable wood Tiller intw I No Contractor will wrap exterior casings with coil stock color of Owner is aware that Contractor does not do any painting/staining or removai/instaNation of alarm system or window treatments/hardware.It is the responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the amount will be dependent on the type ✓ of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all unseen rot Is not included in this contract.Should any rot be found there will be an additional charge for time and materials unless so stated in this contract. Yea Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration,Removal and disposal of all job related debris, windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued. t Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permit(s)is included in the total contract price. Yea All discounts have been applied to this agreement. to ✓ Yes No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s). it k agreed mKI under t—d by and ix•twrrn ihr Ixtrtiec that diis Sls•cifxhtuan Sheet,along witll the CUSTOM ININ)OW AND DOOR REMOI)PTING AGREFAIEN-l.consultors the entire• mxkntandinR hemeen dtr lxlyde,and them an-tic,tubal andersiandin is rltang ng ur modifying at W(Ir the tem,'riiis sK ifwatinn Shtx,t may not he changed tor its wrma modified or w,ricd in .any way Itvivs such rhangrs an-in wrid ng and signed try Ixtth rix•Su)rnst and(;im acwr. Buyena hrrelnto#nrnth+dge that&ntrrt�t has read dtia Slx•rtititatinn Sherr. Renewal by Andersen++Corporation BUNIM,, liuprr sl B, 0—vin/ Del,1,,�,Sezl `-fur`"'^ Signature of Consultant Signature Signature GREG DEMPSEY DENNIS DUFRESNE Print Name of Consultant Print Name Print Name WINDOWS-DOORS Andersen® Andersen*NERC Certified Total Unit Performance (condaued) em Andersen'Product ' Glass Type U-Factor' I SHGC' VP Andersen'Product Glass Type 1.1-Factor' SHGC' ! VF' .Architectural 1 400 Series' HP Law-E4. 0.27 035 0.60 ,_•' - HP Low-E4 032 028 0 47 HP Low-E4 with Galles 0.28 031 0.54 '! - HP Low-174 with 0.32 025 0.42 HP Law-E4 Sun 0.27 021 0.33 (' HP Low-E4 Sun 0.32 0.17 0.26 r Circle Top _ Casement Window Window - HP Low-E4 Sun with Grilles 0.29 0.19 0.30 3 - - HP Lor-E4 Sun with Grilles 0.32 0.16 0.23 HP lox-E4 SmartSun 026 023 0.54 � i HP Law-E4 SmartSun 0.31 0.18 0.42. #"< 0.31 0.17 0.38 HP Lox-E4 SmartSun w/Grilles 0.28 021 0.49 ''� HP Lor-E4 SmartSun w/Grilles =1 e i HP Low-E4 0.27 035 0.60 HP Low-E4 0.32 028 0.47 '1 HP Low-E4 with Galles 0.28 031 0.54 - HP Law-E4 with Grilles 0.32 025 0.42 HP Low-E4 Sun 0.27 021 0.33 11 French Casement HP for-E4 Sun 0.32 0.17 0.26 ' ' e Circle&Oval Wiind.ow : HP Law-E4 Sun with Grilles 029 0.19 0.30 r Window HP Low-E4 Sun with Grilles 0.32 0.16 023 HP Low-E4 SmartSun 0.26 023 0.54 eke HP Low SmartSun 0.31 0.18 0.42 {? Fri E HP Law-E4 SmartSun w/Grilles 0.28 021 0.49 G [,' - - HP Lax-E4 SmartSun w/Grilles 031 0.17 0.38 r' HP Law-E4 028 033 0.58 HP Low-E4 0.32 028 0.47 HP Low-E4 with Galles 0.29 0.30 0.52 F1 (` HP fo-E4 with Grilles 0.32 025 0.42 HP Lav-E4 Sun 028 020 0.31 �``(M HP Low-E4 Sun 032 0.17 026 . Awning Window Arch Window HP HP Low-E4 Sun with Grilles 0.32 0.16 0.23 i A HP Lox-E4 Sun with Grilles 0.29 0.18 0.28 HP Low-E4 Smar[Sun 0.27 023 0.52 9..11 HP Low-E4 SmartSun 0.31 0.18 0.42 t-P HP Low-E4 SmartSun w/Grilles 0.28 021 0.46 }1. - - HP Low-E4 SmanSun w/Grilles 0.31 0.17 0.38 HP Low-E4 027 033 0.58 { HP Low-E4 0.31 032 0.55 HP Luw-E4 with Grilles 0.28 0.30 0.52 [ ' - HP Low-E4 with Grilles 0.31 029 0.49 fit HP Low-E4 Sun 0.27 020 0.31 1 8 f`� casemeni/Awning HP Lor-E4 Sun 0.31 010 031 r3m Flexifrome'Window HP Lox-E4 Sun with Grilles 0.29 0.18 0.28 �"; Picture Window - HP Low-E4 Sun with Grilles 0.31 0.18 0.28 .110 I HP LDx{4 SmartSun 0.26 023 0.52 F HP Low-E4 SmartSun 0.31 021 0.50 ''"no HP Low-E4 SmartSun w/Grilles 0.28 011 0.46 • '® HP Low-E4 SmartSun w/Grilles 0.31 0.19 0.44 !. HP Low-E4 031 033 0.58 HP Low-E4 0.30 0.3 0.64 ! t i - HP Lox-E4 with Gnlies 0.32 030 0.52 - HP Low-E4 with Grilles 0.30 033 0.57 13' ' ( HP Low-E4 Sun 0.31 020 0.31 n'0 HP Low-E4 Sun 0.31 022 0.36 f FIE Spdngline Window Specialty Window HP Law-E4 Sun with Grilles 0.31 020 032 ,RM HP Lav-E4 Sun with Grilles 0.33 0.18 028 rpt r- HP Low-E4 SmartSun 0.30 D24 0.58 0 €3■ HP low-E4 SmartSun 0.30 023 0.52 - HP Low-E4 SmartSun w/Galles 0.32 021 0.46 171 HP Lox-E4 SmartSun w/Grilles 0.30 022 0.52 P.1 h [- HP Low-E4 0.30 027 0.45 f HP Low-E4 0.32 022 037 NP Low-E4 with Grilles 0.32 023 0.39 I'' HP Lov-E4 with Galles 0.33 020 033 - Frenchwoohl' HP Low-E4 Sun 0.31 0.16 0.25 F' -Hinged Inswing. HP Lori-E4 Sun 0.33 0.14 0.21 - Gliding Patio Door HP Low-E4 Sun with Grilles 0.32 0.14 0.22 k`+® French Door HP for{4 Sun with Grilles 0.34 0.13 0.18 HP lav{4 SmartSun 0.30 0.18 0.41 F' )'' HP Low-E4 SmartSun 032 0.15 0.33 ' ?' HP Law{4 SmartSun w/Galles 0.31 0.16 0.35 HP Low-E4 SmartSun w/Galles 0.33 0.14 030 - HP Low-E4 0.31 024 0.41 ('[ ' HP Low-E4 0.33 025 0.41 Co w ( W HP low-E4 with Galles 0.32 021 0.35 I:! r ® HP low-E4 with Galles 0.34 022 036 - Frenchwood'•Hinged I HP Law-E4 Sun 0.31 0.15 023 IiH } Hinged outswing . : HP Low-E4 Sun 0.33 016 023 Inswing Patio Door j HP Low-E4 Sun with Galles 0.32 0.13 0.19 �)® French Door -- HP Low-E4 Sun with Galles 035 0.14 0.20 - M6 HP Lou-E4 SmartSun 030 0.16 037 t. C - HIP LDx{4SmartSun 0.32 0.17 037 L'. R0 'w rilles 0.34 0.15 0.32 HP Low-E4 SmartSun w/Gnlles 0.31 0.14 0.31 �(1 1;L HP Low-E4 SmarlSun w/GO o I HP Low-E4 0.31 025 0.41 - HP LDw{4 033 023 0.38 - cad HP lox-E4 with Grilles 032 021 0.35 19 M - HP Lox-E4 with Galles 0.33 021 0.34 - HP Low-E4 0.31 0.15 0.23 Fuedfrench Door- HP low-E4 Sun 0.33 014 021 - Frencbwood'Hinged" - _ outswing Patio Door HP Low-E4 Sun with Galles 032 0.13 0.19 "1 Sidelight HP Low-E4 Sun with Galles 0.34 0.13 0.19 - HP Low-E4 SmartSun 030 0.17 0.37 N -'�; - HP Low-E4 SmartSun 032 0.15 0.34 t'r HP Low{4 SmartSun w/Grilles 0.33 0.14 0.30 - HP Low-E4 SmanSun w/Galles 0.31 0.15 0.31 13 -: HP IDw-E4 0.31 012 0.37 t"" HP Law-E4 0.32 015 0.41 - HP for-E4 with Galles 0.32 020 0.33 EH !'® 1 HP low-E4 with Galles 0.33 022 0.37 - HP low-E4 Sun 0.32 0.14 0.21 M 1'`. Fixed Transom HP lav-E4 Sun 032 0.15 023 - Frenolhwood'' - Patio Door Sidelight HP Low-E4 Sun with Galles 0.32 0-13 0.18 iq_ "1® French Door HP lav-E4 Sun with Galles 0.33 0.14 0.20 - HP Lor-E4 SmartSun 0.31 0.15 0.33 �4 Sit� � � - HP Low-E4 SmanSun 0.32 0.16 0.37 HP low-E4 SmartSun vi/Grilles 0.32 0.14 0.29 !' HP Low-E4 SmartSun w/Galles 0.32 0.15 033 0.35 026 0.44 = HP Law{4 0.30 024 0.40 F"• HP for{4 HP Low-E4 with Galles 0.30 021 0.35 R F.' - HP Low-E4 with Galles 036 023 0.38 - HP Low-E4Sun0.30 0.15 0.22 thl.. 1' HP Low-E4 Sun 0.35 0.16 024 - Frenchwvod' - Folding Door - Patio Door Transom HP Law-E4 Sun with Grilles 0.31 013 020 !{ i-'� - - HP Lux-E4 Sun with Grilles 0.36 0.14 021 HP Low-E4 Smartsun 0.29 0.16 0.36 fin "1.10 HP Low-E4 SmanSi m 0.34 0.17 0.39 - HP Low-E4 SmartSun yr/Grilles 0.30 0-14 0.32 �i '. M � HP Lor-E4 SmartSun w/Galles 0.36 0.15 0.34 - con6nued an next page •For NFRC certified total unit performance on units with capillary breather tubes for high altitudes,please visit andersenwindows-com. •"High-Performance"Low-E4'"(HP Low-E4),-High-Performance'low-E4'SmartSun"(HP Low-E4 SmartSun)and'High-Performance low-E4'Sun'(HP Low-E4 Sun)are Andersen trademarks for'Low-F,glass. ' U-Factor defines the amount of heat loss through the total unit in BTU/hr sq-ME The lower the value,the less heat is lost through the entire product Window values represent non-tempered glass.Use of tempered glass can increase U-Factor ratings.See andersenwindows.com for specific performance values.Door values represent tempered glass. 'Solar Heat Gain Coefficient(SHGC)defines the fraction of solar radiation admitted through the glass both directly transmitted and absorbed and subsequently released inward-The lower the value,the less heat is transmitted through the product from 0 to 1,the more da h [the mduc[lets in aver the product's total unit area.Yisibte Transmittance 'Visible Transmittance(Vr)measures how much light comes through a product(glass and frame).The higherthe value, daylight P is measured over the 380 to 760 nanometer porton of the solaf spectrum. •NFRC ratings are based on modeling by a third party agency as validated by an independent test tab in compliance with NFRC program and procedural requirements. •This data is accurate as of December 2010"Due to ongoing product changes,updated test results or new industry standards or requirements,this data may changeover time.Ratings are for saes specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different grille options,glass for high altitudes,etc. •PassWeSun"glass values are available online at andersenwindows-com. 277 The Commonwealth of Massackuselis Department oflndustrialAccidents VOffice oflnvestigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip:NORTH BORO, MA 01532 Phone#:508-351-2200 Are you an employer?Check the appropriate box: Type of project(required): 1. ■❑ I am a employer with 30 4. ❑ I am a general contractor and 1 employees(foil and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' con insurance.$ 9. E]Building addition [No workers' comp.insurance P• required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] 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 anew affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic. #:MWC 30293800 Expiration Date: 10/01/15 Job Site Address: 66 Union St City/State/Zip: North Andover, MA 01845 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 1 Investigations of the DIA for insurance coverage verification. Ido hereb certify nder the pai�andp� enaffies of perjury that the information provided above is true and correct Date: 508-351-2200 Offlcial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# i 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 M ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCEDA SIMM DDI4) 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: N the certificate holder is an ADDITIONAL INSURED,the pollcy(les)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 NAME: cerdflcates@wlilis.com Willis of Minnesota,Inc. PHONE g�/ 945-7378 FAX CIO 26 Century Blvd No Eat:( ) x No:(888)467-2378 P.O.Box 305191 ADDRESS: Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC ft INSURER A:Old Republic Insurance Company 24147 INSURED INSURER 0: Renewal by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 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. !LTIR NSR TYPE OF INSURANCE ADD F im JIM POLICY NUMBER MIOD MM DDS LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAIMS-MADE a OCCUR MWZY302940 1010112014 10!01!2015 DAMAGE TO RENTED- PREMISES Ea occurrence $ 500,40 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X POLICY❑JECT F—]LOC PRODUCTS-COMPIOPAGG $ 4,000,00 OTHER: $ ED AUTOMOBILE LIABILITY EO,82deerriI SINGLE LIMIT $ 5,000,00 A X ANY AUTO TB302576 10101/2014 10/0112015 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Par accident) S AUTOS AUTOS NON-OWNED ROPE TY DAMAGE S HIREDAUfOS AUTOS (Per accident) S UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STAPER OTH- AND EMPLOYERS'LIABILITY TUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN MWC30293800 1010112014 10/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBEREXCLUDED? FN-1 NIA (Mandatory In NH) E.LDISEASE-EAEMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERAI IONS below E.LDISEASE-POLICY LIMIT $ 1.000,0 DESCRIPTION OF OPERA71ONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schad Ile,may be attached M more space is required) CERTIFICATE HOLDER CANCELLATION 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 REPRE SENTA TIVE Evidence of Insurance GS � Is�slrr 01966.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Im Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS4W25 f I JAIME L MORIN 86 GARDINER Si y� LYNN MA 0190f 6xi.'T r r F Sr'Nct.. Expiration Commissioner 10/06/2016 gdo�ntfice of Consumer Affairs&Business Repiation E IMPROVEMENT CONTRACTOR Registration: 170810 Type: Expiration: 1212=015 Supplement I RENEWAL BY ANDERSON CORPORATION JAIME MORIN 104 OTIS STREET NORTHBOROUGH,MA 01532 Undersecretary I I