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HomeMy WebLinkAboutBuilding Permit #528 - 7 FULLER MEADOW ROAD 1/10/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: 16 �- Date Received IMPORTANT: Applicant must com Tete all items on this LOCATION_ n PROPERTY OWNER_ yv JCS /WS £r��.. Print MAP NO: —10LI PARCEL: ;� ZONING DISTRICT: �listoric District Machine Shop Vil TYPE OF IMPROVEMENT ❑ New Building 0 Addition ❑ Alteration impair, replacement ❑ Demolition ❑ Septic ❑ Well ❑ Water/Sewer OWNER: Name: Address: CONTRACTOR Name: Address: PROPOSED USE Residential. O We family ❑ Two or more family No. of units: 0 Assessory Bldg ❑ Other ❑ Floodplain ❑ Wetlands yes( no e ves \ nn Non- Residential ❑ Industrial ❑ Commercial ❑ Others: ❑ Watershed District DESCRIPTION OF WORK TO BE PREFORMED: i!d�C� Gni Identification Please Type or Print Clearly) sir- 1/1--r —i /I, F'r 0UWS A /J C / F;N/AJ (-DJ p e: S6'y - ---------------- Supervisor's Construction License:_ Exp. Date: 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. Total Project Cost: $ 73 (,3 g- , C5 C) FEE: Check No.: `� SG (� p Recei t No.: NOTE: Persons contracting with unregistered contractors do not have access to theuaran g ty fund Signature - Agent%Owner i, l-' _ CGS -- Signature of contractor - Location 7 4 l/ed Ilelg egencl ;qO No. °� Date / - le _12 NORTIy TOWN OF NORTH ANDOVER f �,y �? • . • O F s 9 s i Certificate of Occupancy $ • e� 4 3 Building/Frame /Frame Permit Fee $ qq, s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ `TOTAL $ Check # �o 1 -K� 24941 Building Inspector 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 CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Comments Water & Sewer Connection/Si-qnature & Date Driveway Permit DPW Town Engineer: Signature: Locatea ;R54 Usgooa 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 2009 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 o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan L3 Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 2008 CA m X m CA m mm C3. y C � CO) Cl) CD n Z CA CLO �. r =r O CZ - CO) nco -0 O CD CD o CLQ CD CCD O CD C CD y. CD CZ CD O CO) co cc, � v COD O 1 z CD C, oCD 0 C CD W F,, CD V J n O cn C 0 V J 2 ON 0 Cn C_ O O 0 W O m O W c m CD CO o: 0 N de - S. 0 CLN N CD c?�� m Z CZ N < O N CO) OCW nm C"3 N m d C =r-0 -. m c m d y N O ...� 'L' O C a O ,O = CR ~` O Z CA O m =r a N � CL � m m N 'om CDC N d co, agr W EL - CD . � CD F CD CAm N _ m CD o C0 = - 7 N co 'O O - CD :� O •O-► CD N CD S:� C� C O � Co v I z 0 y 0 a L 91 � o - w c x c C 0 b o a v I z 0 y 0 10/11/2007 07:38 9762785010 JOHN BEAVER PAGE 05/06 ` 104 Otis St., Northborough, MA 01532 J&L Whvurnv.s, IN(:,, n/lc/A MA Horne Improvement Contractor. yc�C (508) f119 -09p0 • Fax- (7 74) 987-3013 Renewal License 4149601 (Expires 1/24/201.2) byAndersen. Fedcral Tax tq #83-0404201 wreoew ner LAaeNgey rn AMin.,,t„m, y CUSTOM WINDOW AND DOOR REMODELING AGREEMENT &Mall Addre,,s _ Home Telephone Number Work Telephone Numbr,.r Buyer(l) hereby jointly and severally agrees 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 condilions described on the front .and the reversec of this agreenten.t and on, the atltiched specification shect(s) (collectively, this "Agreement"). Buycr(s) hereby k;rccs to sign a cornplelion certificate after Contractor has completed all work under this Agreement. Total Job Amount:.3�93.. Deposit Received (33%):_r2--z9d' Estimated Starting Date: Method of Payment: heck ❑Cosh ❑Financed Balance at Start of Job (33%): / Z.o U_ Balance on Substantial-_� Completion of Job (33%): ' Esrlmated Completion date: Credil Cards are accepted for deposit only — maximum 1/3 of the project cost. Please see Credit Cord Payment Form. By signing this agreement, you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion o£ 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 pstrties, and that there are no verbal understandinggs changing or modifying Any of the terms of thin 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) I) has read this Agree.nent, 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 Boyer.'-. right to cancel this Agreement. DO NOT SIGN THIS CON'T'RACT IF THERE ARE BLANK SPACES. J & L W' w. In . d/b/a Renewal by Andersen Buy {s) Buyer(s) tiy, 'S' aturc of ' iI a Nlanagr..r Sign: irc / Signanrrc CarucLe. I n s4*_ Z' Print Name of Product Manager Print Name. Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE TI13RD BUSINESS DAY AFTER THE DATE OF TITIS TRANSAC'T'ION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. NOTICE OF CANCELLATION Date of Transaction / Z— /7--/ / . You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor ("Seller 7 of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goodsat the Seller's expense and risk. -If-you-do-make-the-goods-ovailable-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 of the goods without any further obligation. If you fail to make the goods available to the Seller, or if jou a ree to return the goods 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 dated copy of this cancellation notice or any other written notice, or send a• telegram to Contractor. J & L Windows, Inc. d/b/o Renewal by Andersen, 104 Chis Street, Northborough, MA 01532, BY NOT LATER THAN MIDNIGHT OF l 2 r��_. (Date) I HEREBY CANCEL THIS TRANSACTION. _.?C — _ _ _ _ _ _ _ _ _ _ _ _ _ _ o G NOTICE OF CANCELLAMON Date of Transaction Z— /'7 /„��, You may cancel this transaction, without any penalty aro igo n,within 1 three business days from the above date. If you cancel, any property traded in, any payments made by you under the I Contract of Sale, and any negotiable instrument executed I by you will be rewmed within 10 days following receipt by the Contractor ("Seller'l of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of I 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 ujp within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the F dsavailable to the Seller, or if you agree to return the ds to the Seller and fail to do so, then you remain liable performance of all obligations under the Contract. I To cancel this transaction, mail or deliver a signed and I dated copy of this cancellation notice or any other written notice, or send a telegram to Contractor, J & L Windows, 1 Inc d/b/a Renewal by Andersen, 104 Otis Street, Northborough, MA 01532, BY NOT LATERTHAN MIDNIGHT OF)O7 (Date) I HEREBY CANCEL THIS TRANSACTION. I Buyar's Signalum print Name Darn I Suyor'. slgnatury Prior Name-- RbA Copy - White Buyer Copy - Yellow Buyer Copy Pink 10/11/2007 07:38 9782785010 JOHN BEAVER PAGE 06/06 10.10ii, Slrco, Norlliborotl,kh, MA 01841 1'hanc 508.9 19.0900 - Fax 774.1)97.301:1 tiltyer(s) Name. J & I. Windows, lac. d/b/a Renewal byAndersen. az WINDOW REPLACEMENT- nn And—n Cnmine, Or CUATU MASSACHU..M7N AND Nrw HAMPSHIRE WINDOW SFECUXATION SHEET MA HIC License # 141)(401 (expires 1/24/)2) Fodcral l'ax ID# A;i_0404201 Date of Agreement F re Iluycr(s) listed a1iovc hcrebyjointly and severally taSree io pe7dhase tAe goods and/or services listed below, in aecorda.tice wkth the prices and terms described on the CpcciricAlion Shcci. send the front and the rcvctsc of the aecompanying CUSTOM WINI)C7W AND DC�R REMODEhe rr AGRF.F.MF. rnq of which this SFX"cification 5heet ili N part. WINDOW DETAILS 1. Contractor will install a total kit* .a windows in Owner's home, using the following individual quantities: Double 1-11.1 rig (DB) 2'flqual sash ❑ Cottage sash ( ) /3 top, 2/3 bottom) ❑ Oriel sash (2/3 lop. 113 bottom) Casement (CW) ❑ Mingo right ❑ Hinge left (as viewed from exterior); ❑ Standard handle ❑ Metro handle Doublc Caacnncrtr (COW) ❑ Standard handle ❑ Mctro handle Casement / Pichlre / Casement (cPW) ❑ 1:1;1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (C;W) Glicler / Picture / Glider (GPW) ❑ 1:1:1 or ❑ '1:21 Awning Window (AW) rietury Window (PW) Bay or Bow Window Patio r)oors (See scp'rate DCbr Specificai:.ion Sheet:) 2. Yes ❑ jXo Qly of Windows 10 be Custom Fil'.Rcplacctncrtt: _ 3. ❑ Yes YNo Qty of Sills to he replacul by Contractor: _ 4. ❑ Yes ❑ No Qty of Windows to Lc Ncw COnslrr7etion Full frame (inchados new interior & exterior casings) and actual Exterior cos qs: ❑ Fine ❑ Mai ntell an.ce-free. ma.tcrial ❑ Factory applied 908 Fibvex briekmoId 5. Glaiittg to hc: H P Low- F-4 1 ❑ Other if ol:hcr, please spccjfy: 6. Extcrior color to be: While ❑ sand ❑ Ctttivas ❑ Tcfralone ❑ Cocoa Bcan 7. interior color to be: White ❑ Sand ❑ Canvas ❑ Tcrratonc ❑ Pine ❑ Maple ❑ Oak Note: lnl �ior color can only be while, wood Or same color as exterior. Wood interiors need to finished by Owner. 3. llardwace: Whilc ❑ Stone ❑ Canvas ❑ Pross ❑ FstaleHardware: Style: 9. ❑ Yes VNo Install Lifts with iblc })un;; Windows 10. Screens; windows to helve; _, Half or ❑ Full screens Screcns to Ix: ❑ Pilxrgla.as Aluminum ❑ TnxScene GRiI.LE DETAILS 1 1 . Windows have grilles: _ Yes ❑ No if yes; Grille Between lilacs (cnu) ❑ hcmovable Interior Wood oNTw) ❑ Full Divided Light (mi,) Qty Qty: Ql:y: Qly Qty: Qty; Qty: Dri 0 OH DH CWip chine Glider Q(initials); r)rAwgrille paltcrns above '"Use Hdditiona) $heel. if needed Owne:r. approved ADDITIONAL WORK DETAILS 12 -❑ Yc$ �,/�o Contractor will remove metal fi atne Of windows. Qty of Lhtits: 13. ❑ Yes Ln No Contractor will install new p;lint-ready or stain-ratdy casin`s. htleri0 acing qIy OF openings: Exterior easings qty of openings: ❑ Pine ❑ Maintenance -free material 14. ❑ Yes 0 NO Contractor will hislall new painl.-ready or stain-rea inside or outside stops qty of openings; lttterior slops qty of open i n;ts: f:xter kir sto P"', S: Fine15. Owneris A e that Contractor does not do any pain ❑ ❑ MAinti narnce-freem.atet ial tiR3 Owner initials 16, ❑ Yes No Coniractor will wrap exterior casings with ahtminuck of color. 17. �Note: Wrapping may be requjr'cd with .storm window removal; removal of storm windows will leave screw holes in casing. 18.�''s ❑ No Contractor will insulalc, caulk and $cal windows with-iniint system, to prevent water and air infiltration. s ❑ No (/lean uP alljoh related dr.bris including old windows will ho removed. Vacuum nightly. es ❑ No A Ilmited warranty shall be issued to Owner upon completion of the,job and payment in full. 2(1. Ye ❑ No Buil irlgFermit—Contractor will secure any a.nd all nccc$Sary permits. The Pee for the permits) is nol: Included in tho Contraci Price end a separate check is required at the time of sale for this fee. 21. Yes ❑ N.. .All discnenis huvc bcct >>licd to this'). r ,orient price. �d 22. Additional dclails: �/T�' 1 1 / 4 �-� / .• ¢A 23. M Yes ❑ NO Owner agmcs to be present on the tina.l any of installation for final inry>lction acid to deliver final payment. NO /yne711?;1,) n7Cn1,r/1,YLI L7C 4iB171X11dGd 11171%1117E Li711/ITiC11.F COMpjC,?t&_ /(1 /he'.SAh$/gch6n OI'nl/ pvrtz'ss. It is agreed and understood by and between tlic parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there arc no verbal undorstandfrW Chili or modifying any of the terms. This Speci&cation S.hect may not bo changed or its terms modified or varied in any way unto$$ such changes arc in writing (tad signed by both the Buyer(s) and Contr /Ir. Buyers) hereby acknowledge that Buyw(s) has trod this Speciticntion Shea, Renewal by eiflIreater MA and NH Buyers YY//lt99 Buyer(s) Illy — / -- S re of uct Manager S• a Signature ae- Prim. Name of Product Alanager Print Name Print Name 7'fse Camrnm�wea&fs Of DepdrEmand of Indust ial Accid�ni ulQfjtca of IrtPecti�'¢iians' • • SOD IF9191APa �ireef Basion, Ie�i VIII . .atars.gapfiiia . C � o anssfian �irrsnce Affids� Sv�dars/Caatraetar�C�Iee Print Lebe f warkart; mp Fleas ' NmnLO DnlfndividnaIl� a er (g�inrrs►Drgeaizafi Type ofprdjeet (riqutr'•ed), )TOW CtlnstxmtbL �t dLhag g,Fiiian �, � rlrlfn addifion . •la -El Taal tcpaiza Or" ll.[] Plumbing nP or addiEiDne IZ.❑ R.Dafi-cpe-?� - ' kAny eapiim� t rher.Ez bcs #I nnut alae ft11 mt fhb =film 6elnr �� heir Aod�' onmpmndinn poTi� Safina t F�nmeownra wbn Fvhmltfai[ �{dai indimfmB } g° � ellrecd lmd131m hiieeaulsid�nonhad � taea' si�gvindiea=U inch . -tray and fhrs' n=P Pol'�i iafaion ont:ad� ehrr.Y this bra mut atbnhri as Adm mal �etShKkr the name of fist mb-edntn ob Site rre tNarkara' eampearcfiatc iresry-truce far my encployees. �alafv.is the Po*and j I am as amp that is prayid g. ircfarrn¢�ivn. � c � _ Insurance Ccmpeny I•,lamc' � � PDHq or 5cl€ ins, Lia. #. 3Db bite Adr}rese,T o%c umbar end elpirstin'L aE ). Attach a ropy of &a Work=' eDurpensa€ian poIicT declsrefian p$;e (sho�g f� P p' c, I52 Dere lard to impDsifian of od.=inel pmim6cs of a Fina= tD eooure Dtivarage as roquitnd tmdrsSration_ nfM�rL m fico fnim of a 5'ILDP WDRX DRDER and a fins find tip -in SI,r5DUO andlar Dno-ycar imprismamme, as wcil as Divn pcnaibrs ' ' •Dftxp to S25a.D17 a day agains t vinbttnr. Be ad-•rieodbd a Dopy.of this statement mai' ba {nrWardad to fbL Office of Iz<vcsfigatiflns of 6D DIA for ins�o Dtrmgo v adfia I da hcr'eby R ar the pairs a nd penaffic� �r!►rrf f�sat the iafarm¢tiaa provided u6//m�e is tr rec'a nd carrecG Dain' .. giFncfnrc- . Ph= # pial use unlj. Da rwtwr iie in this area, to be completed by eery ar taH�n o�tcial • • • • p�tlL,ir,�nae # '� MY or Toes sttiag Au�nrity (circla ane , ertur 5, Pl-ttmiuiab Inspectnr L BDer� of Hcaifh Z �ur�dmli Depsrtnt k. 4. IIec CL {ricalp , 5, Dyer Ctm�ct Parson City�Staf'afZig; • Df �o �'a r d � '____— Are 719311MetIIplayer7 Cho& fhe appropri$ buz ' 4. [�•I am a i==Rl ooniraatnr ad L I am a r.mpioyor�ezfit �_4_ haw kited &M sub-cDntmr nta employoos (faf and/or part -funs). usiod cm ft efibDbed sheet $ Z❑ I am a stile propdrtir orprtaw- ', hmr..sub-•emt=tm have J* and bane no troployoos i Valk=I eomg. b=raar"e. �ari7ng fDr mo in eny capealty. We ate a oorpa5�011 and ifa . . 5' ❑ ' �iiD t�.orkcrc' pomp, insursrice of�m �.� e�otcised tbniz roZ tTT Cd.).' T* Df cs�cpiiaa Por bdGL ' 3. Q I em a hmom aor'Ding an WDrk a IS2, @I(4), and We bsvc no lIIY6C.l>r [ND wDr 'Comp. Omploi=iL, SSD rn rarer o StpilLLd j t .130, filmr3 oe rcquu=d.j Type ofprdjeet (riqutr'•ed), )TOW CtlnstxmtbL �t dLhag g,Fiiian �, � rlrlfn addifion . •la -El Taal tcpaiza Or" ll.[] Plumbing nP or addiEiDne IZ.❑ R.Dafi-cpe-?� - ' kAny eapiim� t rher.Ez bcs #I nnut alae ft11 mt fhb =film 6elnr �� heir Aod�' onmpmndinn poTi� Safina t F�nmeownra wbn Fvhmltfai[ �{dai indimfmB } g° � ellrecd lmd131m hiieeaulsid�nonhad � taea' si�gvindiea=U inch . -tray and fhrs' n=P Pol'�i iafaion ont:ad� ehrr.Y this bra mut atbnhri as Adm mal �etShKkr the name of fist mb-edntn ob Site rre tNarkara' eampearcfiatc iresry-truce far my encployees. �alafv.is the Po*and j I am as amp that is prayid g. ircfarrn¢�ivn. � c � _ Insurance Ccmpeny I•,lamc' � � PDHq or 5cl€ ins, Lia. #. 3Db bite Adr}rese,T o%c umbar end elpirstin'L aE ). Attach a ropy of &a Work=' eDurpensa€ian poIicT declsrefian p$;e (sho�g f� P p' c, I52 Dere lard to impDsifian of od.=inel pmim6cs of a Fina= tD eooure Dtivarage as roquitnd tmdrsSration_ nfM�rL m fico fnim of a 5'ILDP WDRX DRDER and a fins find tip -in SI,r5DUO andlar Dno-ycar imprismamme, as wcil as Divn pcnaibrs ' ' •Dftxp to S25a.D17 a day agains t vinbttnr. Be ad-•rieodbd a Dopy.of this statement mai' ba {nrWardad to fbL Office of Iz<vcsfigatiflns of 6D DIA for ins�o Dtrmgo v adfia I da hcr'eby R ar the pairs a nd penaffic� �r!►rrf f�sat the iafarm¢tiaa provided u6//m�e is tr rec'a nd carrecG Dain' .. giFncfnrc- . Ph= # pial use unlj. Da rwtwr iie in this area, to be completed by eery ar taH�n o�tcial • • • • p�tlL,ir,�nae # '� MY or Toes sttiag Au�nrity (circla ane , ertur 5, Pl-ttmiuiab Inspectnr L BDer� of Hcaifh Z �ur�dmli Depsrtnt k. 4. IIec CL {ricalp , 5, Dyer Ctm�ct Parson `iassachusetts - Depar-tment cif Public Safeth -Board'of Builtlin�tr Reuulatinns and Standards Construction Supervisor License License: C'S 95707 BRIAN DENNISON 86 CREST'CIRCLE WORCESTER, MA 01603 Expiration: 9WO12 •= C I�rnmivsil/ncr Tr—,: 2622 t 07 Office of Consumer Affairs do Business Regulation '• HOME IMPROVEMENT CONTRACTOR t Registi-atiotn-lh501 ' ExPI 12 t Caryl RENEWAL BY :BRIAN. DENNIS (� 104 OTIS STREE T: a ���• �, j NORTHBOROUGH,r ` t3ndersccrctary J t -1 ® CERTIFICATE OF LIABILITY INSURANCE °A O/ 412011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If.SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on "this certificate does not confer rights tb 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 PHONE FAx A/c No (734) 662 8100 A/c No: ADDRESS: INSURER AFFORDING COVERAGE NAIC M Ann Arbor, MI 481060333 .INSURER A: Nautilus 19662 10/01/2011 INSURED J&L Windows, Inc. Renewal by Andersen INSURER 8: Hartford 37478 104 Otis St. Northborough, MA 01532 INSURER C: DAMAGE TO R'NTED 1 00,0D0 INSURER D: INSURER E: INSURER F: rn1rFRAns=c r P[ITIRIrATF MIIKARPR• RFVISION 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER POLICY EFF MM/DD/YY" POLICY EXP MM/DD/ LIMITS A GENERAL LIABILITY NC9513461 10/01/2011 10/01/2012 ' EACHOCCURRENCE $ 1,000,000 DAMAGE TO R'NTED 1 00,0D0 COMMERCIAL GENERAL LIABILITY I PREMISES Es occurrence $ CLAIMS -MADE 1 OCCUR MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2.,000,000 - PRODUCTS - COMP/OP AGG $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC $ AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2011 10/01/2012 COEMBcciINEDSINGIFUMITdent 1,000,000 _ a a ANY AUTO I BODILY INJURY (Per person) $ ALL OWNED SCHEDULED I BODILY INJURY (Per accident) . $ AUTOS AUTOS NON -OWNED I PROPERTY DAMAGE $ HIRED AUTOS AUTOS - Per accident $ UMBRELLA LIAB OCCUR i EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE I I AGGREGATE $ DED RETENTION $ ----- . -- �-- $ A WORKERS COMPENSATION 35 W ECPP1444 02/17/2011 02/17/2012 I WC STLAIM OTW AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/IXECUTIVE ' E.L.EACH ACCIDENT $ 500,000 OFMCER/MEMBER EXCLUDED? N / A 500,000 (Mandatory In NH) E.L.DISEASE - EA EMPLOYEE $ If yes, descdbe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ B PEDOH555DO 0507 09/27/2011 09/27/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICI ES (Attach ACORD 101, Additional Remarks Schedule, it 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. AUTHORVM REPRESENTATIVE - ©1988-2010 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD c E �y W '7 0 of I � Or i� Z CSIfY ^ l W O M Wra Tll Wim, OO 0 3 p � -0iz . 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