HomeMy WebLinkAboutBuilding Permit #167 - 87 SUGARCANE LANE 8/30/2007 BUILDING PERMIT NORTH
O�StLLD
., °
TOWN OF NORTH ANDOVER �
APPLICATION FOR PLAN EXAMINATION
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Permit NO: / l / Date Received y p�R7.p PPP �y
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Date Issued: U7
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family n
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
>flkepair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESC IPTION OF WORK TO BE PREFORMED:
tvi
Identification Please Type or Print Clearly) --77
OWNER: Name:e V a, I C;Je2�T Phone:
Address: Su Lrl
1 J
j y� rte+
i
�4q.w.....:..
Phone:
ITE
0
ARCH T/ENGIN
EER C
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: $ 0 ,)o FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting ith unregistered contractors do not have access t the guaranty fund
Signature of Agent/Owner i Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH El—
COMMENTS COMMENTS
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 ❑
r
r
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
Located at 384 Osgood Street
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Locate at24 Mai ire t.. �� �
a, '�' - ,
Fire
X-1 MT s>IgnatureJ
x:
11,41
X1011k
� d . '� 6�
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
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
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
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan
And Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
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: INSPECTIONAL SERVICES DEPARTMENTMIZORM07
Revised 2.2007
C R
Location a / ale, CIc/s4e
No. �b Date
NORTH TOWN OF NORTH ANDOVER {
' Certificate of Occupancy $
s i a
'��s'^�•° t<� Building/Frame Permit Fee $ �2
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 71
20552 /0" y '.
Building Inspector
'i
NORTIy
own ® t Andover
2
0
No.
o' , dover, Mass., 0 c� 7
T Q - LAKE
COCMICMEWICK V
7�ADRA7ED
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
y"��� /�.c„�l BUILDING INSPECTOR
THISCERTIFIES THAT................................................................................................................................................................ Foundation
has permission to erect........................................ buildings ............................... Rough
to be occupied as '�w� r?� tl Chimney
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. ARTS Rough
.. ...................... ......................
Service
BUILDING ECTOR
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.
BY ANDERSEN Iwi.d.i,repl
renewalremrnr
Customer Service 800-573-7606
104 Otis St.-Northborough,MA 01532-Main:(508)919-0900•Fax:(508)919.0903
J&L Windows,Inc.dba Renewal by Andersen-Contractor License#149601-Expiration Date 09/23/2008
WINDOW GREEMENT
SOLD TO:Ek-,'c a n/ Uyt DATE: G q- n�+o'I
ADDRESS: moo/'� SUG 4W(G�nO. r' PHONE-Home: 6X 9f- 27 4 Fj
CITY:11 U N 161/0%i✓ STATE:�ZIP:;01rPHONE-Work: ) r� 0 JC 108
JOB SITE ADDRESS(if different):
Approximate Start Date: .(�7 1A J Approximate Completion Date:
SPECIFICATIONS
Renewal by Anders approved materials will be furnished and installed to these specifications:
1. Install total of: windows.
2. Quantity of windows:
Double Hung(DB)45Equal 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(GPW) ❑1:1:1 or ❑1:2:1
_Awning Window(AW)
_Picture Window(PW)
Bay or Bow Window:
3. $Yes ❑No #Windows to be Custom Fit Replacement:
4._-Z Yes ❑No #of sills to be replaced:
5. RYes ❑No #Windows to be New Construction Full frame(includes new interior&exterior casings):
Exterior casings: ❑PineQ Maintenance-free material ❑Factory applied 908 Fibrex brickmold
6. Glazing to be:a High Performance ❑Other If other,please specify:
7. Exterior color to be: QMhite'❑Sand ❑Canvas ❑Terratone
8. Interior color to be:,2 White ❑Sand ❑Canvas Cl Terratone ❑Wood
Note:Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by cust.
9. Hardware: litWhite ❑Stone ❑Canvas❑Brass Double Hung: Install lifts? ❑Yes ❑No
10. ❑Yes $No Removal of metal frames or grilles #of Units:
11. [;Wes ❑No.Install new paint-ready or stain-ready casings. tpKide or outside stops#of openings:_
Interior casing#of openings: Exterior casings N enings: ❑Pine 11 Maintenance free material
12.Customer aware that RbA does not do any painting. Cust.initials
13. ❑Yes 9 No Wrap exterior casings with aluminum coi s ck: color.
Note:Required with storm window removal.Removal o rm windows will leave screw holes in casing.
14. New windows to have:❑Half or 'MFull screens Screens to be: ❑Fiberglass 41rAluminum
15.Windows to have grilles:'J�Yes ❑No If Yes ;@ Grille Between Glass(GBG) ❑Removable Interior Wood(INTW)
❑F 1 Divided Light(FDL). Grille patterns:
TO
DH DH DH DH CW/Picture Glider CPW or GPW
use additional sheet if needed Customer approved(initials):
16.E Yes ❑No Insulate,caulk and seat windows with three-point system to prevent water and air infiltration.
17.-'Yes O No Remove and dispose of existing windows and storm
18.4R'Yes ❑No Clean Up. All job related debris removed.Vacuum nightly.
19Anes ❑No Insurance. All workers compensation and liability insurance maintained.
20.q Yes ❑No Warranty.Given to customer upon completion and receipt of full payment.
21.Additional information:
_5112-2-AVV
22. Regular Retail Price:$,
23.Total Project Amount:$ 0 All available discounts 1 uu is h ave been applieriAYes ■No
24,is Project to be paid in❑Cash Fin nced U Combination of Cash and Finance
25. Cash Deposit(1/3):$ C> 1/3 of balance due at start of job and final 1/3 due at completion of job. -
tfremaining 2/3 payment is made by credit card,an additional fee of% 'll be added to cover fee a ed by Credit Card
26.a Yes ❑No Financed, If Yes,Amount Financed: (Account#:_() Lo fz3y ��JZ)
27.ARYes ❑No Customer agrees to be present on the final day of installation for final inspection and to deliver final payment.
28.)WYes ❑No Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure.
29.. es ❑No Building Fermi t-Asa convenience the company will secure the building permit.The fee for the
permit is not-included in the agreement price and a separate check is required at the time of sale for this fee.
'RENEWAL BY ANDERSEN'IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE
BEEN SEEN PRIOR TO OPENING THE WALLS.PLEASE REMOVE ALL SHADES,VERTICALS,BLINDS,CURTAINS,DRAPES OR WINDOW
MOUNTED AIR CONDITIONERS,AND ANY FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS PRIOR TO THE
INSTALLATION OF YOUR NEW WINDOWS, INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES
OF ITEMS.'SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN
THIS AGREEMENT AND-OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO.OR RELIED UPON BY"OWNER."YOU ARE ENTITLED TO
A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT.*CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN
CONSTRUCTION DEPARTMENT.-TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This
contract is a legal document.Your Renewal by Andersen products will be especially made-to-order for you.UNDER NO CIRCUMSTANCES WILL
REVISIONS OR CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER TH CONTRACT HAS BEEN SIGNED AND
DEPOSIT PAID. Y SIGNING BELOW,YOU ARE ACPOWLEOGING THAT THE ABOVE SPECIFICATIONS FOR THE RBA PRODUCTS YOU ARE
ORDERING ARE CORRECT. (,// ✓J�y�'J
RbA Rep.Signature: Date:
Customer Signature: Stomer Signature:
e- new by Andersen Yellow-Installation Pink-Homeowner
05-11-06
fF*-
Ths Corniiro�tkalfh'oJMossachusetls ,
A
D.epar>meni of rndi<strial Accidents
0jfrcc:of lnveslrrgchons: .
600 Washingjori•Street
Bos101j, 11�4.OZ111 ;
w".and ssgov/did :
rktrs' Co�PeDsatioujn-surance Affidavit: Builders/Con.tra:ctors/Electricians�PluQabers.
:AVO Please Pnnt Le Bbl
li can t Infti�m ation
Ike'tausinesvUc a�zationilncivieuiij: —77:
address:
eyou an cm. to er? Checkot-appropr iate bo�c: :• Typ.'e.of project(required).- -
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am a ctnp'loycr.vvith �:' I am 2 goner-al.contiacfar"aad'f 6. 0' c : co'structioa
havc Dircd the sub-cOntractor-s
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Thcsc sub-con mactors havc
sDip'aad bivc no".cmploytcs ,. insu7ance '
for:tRcin aay cipaciry.: �voikcrs corup. 9. .p Bu;laing Qaaiaon
M& -0,fly ' a corpoTatiotL iad
[Np wotktts' comp: i>?sur�ncc ;, S, c.ztt: 160 Blcctricalrcpays.oT adi3itioos"
officcri bavC cxctc'j' tJ;cii
rtquiiul-) : 11.0 Pluai*g repairs �r'idditio'ns '
right o-f.czcrnppod pcT MGL.
],I ati-t abom�ow+rncr.dozng all Work., - - - - .
myself. [No workcis':coicv,,• e. 152r §l.(4), a?,de 6ayc,ilo' 12.0 Roo.f.rcpairs..
insuiaoea'tequirod.1 t : c>txployccs, [Nbvorkctt' 13.❑ Other
;camp inslir litc required
� OkAi ni that ciieeksbox*1 trwsttilw fill oulthC section bclpNal►owtn�tAeir waken'eomp�ns►poapo?►oyinCo,irr►tio�'
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ncavr7 tAar,ohcck this box°must.�ttio?tcd�n:additi6nal`skctt aTw?/U+[Clic name oftl,a t4b coax+Nors.�r+d,tTcv r6ACM, comp:policyr<+foZ's?���+• `
an srnploytr thal.i's proYidwj»'or*QrJ'comQcn ralEon insurancaforyity' 4loyres, Bclow.4,Yhi pou4 Oyd�ob >rili
MaiivR .l
loco.cOrup any r -#D0, or
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ite Address / A
:D a copy'oCtdcWorkers'"comp.en.s»tioapolicy diclotatio.n Doge(sDowicg thcpolicy.n•umber aed cicpirat>ion dile):
•c,to sccu2e Coyctage as tcquired�laaer Section 2SA of MGL c• 152.c2ii 16416. c imPosa;. of�rirtun�l pen arcs of
cc S1 So oum�a as wcll.as civij ptnaltics in the ronin Qf A'$�TOP W-OAK ORDER aid a fine
P. 0_Qp a4d(ai one-yeu irr�pris" k
p. -
tv$2So:OQ a day againstlhcviolatol._ 1 i6 adriscdtbat a: py_ofrhiS starcmcriimaybts fozwardedtn tb'e office of
igahops df'tbc mA for insurance coycragc Ycrificition:. .
i►cby cc i the of t ff'Q eh' 'dei pfp-irjµry Thal fT��'tn ormattoriptoyldtd above is(Ne gn4/corrgr��,
ictal kSc;only...Dfl riot-ivy,"►re>�i X&�.r area;•:lo b.e co„�pleted'6y erly o>,town official-. , .'.,. . '. : ;• � - .
Iaqformation an dl hstrucNOnsr
Massacbus�rm m�r2l Laws cbaptcr l -2 requires all.6mploycis'to proYideivoikcrscomp.cnsation for t>le r engi(oycCS,
p suint to Ibis 'statute, an employee is d.cLad as."_..every. perso�in'the sdoccbf anothcrundtrany contracto f bite;
eJcpr0SS oI irpylitd'-OTal OT Wnttet, _
Aa cmploye,r Ls dcfiped as "an indiridWl,partnembip, asso.ciatan,•coipoia6o '6 other legal entity, or any tyro.or mote.
of the forego tog aged in'9 joint iattrprise,and.inOu4g tb6 leggy iepieswvtiyesof.a deceased enployefi; o' the
Tccdiv-cr or trustca of an'.individu�7;partnership; asroeiation or-other legal intity,-crnploying employers.;Howtvet.th
ownrr of a dw0lmnghpurc,hayutpotmorc thm) thY66 apartmcntsand.wbo.residct:thcrcin, of tb� occupant ofthe..
drvcJling house of.another,wbo'cmnployspersow-to do.'maibtcnancc; construction ot.repair.workonsoch dwelling boost
or on the grquDds.arbuild ngapputtiDant thcrcto_sD.271.notbc.dausc ofsuch cmploymcntbe deemed tabc ao eTriploy-cq:#t
MGL cbaptcr JS% §25C(6)also to cs;ht"tray statcoi'.local IiceDsia�agency shall�*ithhold tDi,isslraace or.'.
•re.ncwai ofa JjgGle_otr permit.to operate a buslDess or to constrµct bWdiojs in-tbc commob w'calte to '.aay
='applican't wb r,bas._6ot proOuccd�..icceptae ble evidence-of complrabceavitb t!<t: osur'atice covtraeeregtt cd.''
Additiopally;.M* CzL cbapttr B4,'•42X(7)sta tes"Neither sloe commqu:wulth nor'�ny of its po'l tical subdivt`s{nus spall
enter in.6:any coptpct for.the performance ofpilblic work until acccptablc cvidcnot of compliants wifD the insurance-
rcquircinGatr dithi3 chaptcr.bavc Acca prEscnttd to.the contiactiag authnriry," '
App li.c.in is
Please All'out tbc•.worlctrs'coTmansation affidavit completely,by chcckis t]icboxes tbitap➢ly'to yoursititation and,,if
necessary, supplysyb-c' 0actor(s)namo(s),,address(es) and'•pboAcnuinbec(s) along with tbei ccitifiette(s)of
insluabcc: LimiteA iabitity'Cor�anics(LLC)o.tLi�mited.Liability PaiIDEcships (LLF)with Do eiaployces od>t x tba_a•tbe.
mertsbcii'orpartn rs, aTt pot7rquirod to earty-kcirYers' corrzpensation insu angio. If an LI C oTLLP.does taut '
etrtployces1 2 ..eyis required. Ee.,adyisedthat ihis z'Mdavitmay:be submit cd totho Dcpai�nentof;ludustriaal
Ac6delatslbi eonfumaiioi3ofint•tiranoe cQvcragc, Also.bt surtTo sign mind dale tbe:aftfdayit.%,Ile a$•i'davft should.
boicturnc+� to the city oT sawn th4-tbt applicatioD for tD't patriit,pt 11CCILSC 1s br ng-Tcqucsttcdy blot tbaDcpiilb7ii nm(of
Industrial Atcidcn4,.7'Sho.iild.youbayc any'gu�stions tcgarding the Iii br..ifyoU arcI.c9uircd to obtain I•}yoic�rs' %
coropcnsation piaTicy;:plGase call the Dcputngcnt.actl a tiumbcr Jistcd below SclE-itisurca corimanics-should enTci tbeir•
sclkniuraacc license nuinbcr on ttic ajtpropriatc;linC;
city:*r Torib'tJRi;Jas
Please be Surc tbir the atidavicis cornplcfc'and;Driutid.lc -ibly. IleDepartficnt:bas provided i space st the'bovt=
of the affidavit for-you to i ll"out sloe cveAft]ie Office oflflyestiptions bas so contact you rcguding sloe applic C
Please be.sure to ftintbc.permit/license`auT iberWYgb wi)lbo•used as i refereaeenumber. In iddition, au-app]1ean'r
that-(mist-submit multiplcpermit/lic.0me app 1ications:ia atiygivcnycaT,ilctd only Subrmt one a[fidtvn indicating t
?obcY itaformation•(ifneceisiry)and under 1`lob.SitcAddress"thcapplicant'sbould Mite"alllocatiousin _(city or
bWn)."•X-.c6py.oCtDc a[fidayit�,tbis beta of iciallystarrlpcd orm�r3ccdbytlie c�tyor to�vntruy beptoridod to ��
,DPIicap.c*as.pioof,that a vvalid•afhdaYjt is>'on f lc.foufut47opermio orlicenses..A Dcyv af8davit>ztust be,filled ou-i"e?
car_.'VVbere.a.bome o„wncrby"citizen.is obtainiogi license oTperpZit-bat.telated to,anybusines of ccmrriercial yG4t4rc
dog kcaaso air perry itto burp:lWO em)said•pciwu is NQ1'raquvcd.to complete this affidavit
lotO&o of IDnsycstigatiowoWdlikc in thank yon in advazicc.foryour cooperat on aad'should you.bavcany qt
1 Clnow-
Icase,dodotbcsibtcto glrcus.9•call: ;
e Oepartmeo'f-s-address, te1ephoric and:foxir'utnbcr: _
The Conimonwealth-'6,fMassaehusetts
Department Of Industrial Accidents
: Office of Ittvesdgatiori
600-Washington,S treet
$ostoii_ MA 02111 ` ' .:
fe eam�a a�✓�iraoczc�uae�b
Board of Building Regulations and Standards
Construction,,Supervisor License
License:CS 74251
B r3hdate 3/g/1 g63
expiration 3/9%2009 Tr# 11065
c z_
- Restriction
JOHN K ESLER
104 OTIS ST
NORTHBORO,MA 01532 Commissioner
Lr o,s�m�oouuea`b�z o�� ccc�ucaea
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registrafign,; 149601 e
Exp1.irat►owaij /, 008
i
tTy3lie S_upiilement Card
RENEWAL BY ANDERSON =x
KATHLEEN BLANCHA`RDr�
104 OTIS STREET'.
NORTHBOROUGH,MA 0132
Administrator
Jan 02 2007 15:26JF'AM.cKeoneB°Tns 734 6.62" 8101
ACORD„•' .CERTIFICATE OF LIABILITY INSURANCE 9/1Z
PRooucei THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION
Joseph MCKeme ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JP McKeon Insurance Agency, Inc. ALTER HE COVERAGE P_ THS AFFORDED BYE DOES OTHENPOUCIES BELOW
P.O. Box 333
Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE "Co
"'�1ALD Renewal by Anderson InsuaER A: Insurance
J&L Windows, Inc. INSURER E:
104 Otis St 04LMR C:.
Northborough, MA. 01532 WURER 0:
INSURER E:
COVERAG
THE POLICIES OF INSURANCE LIVED 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 WHCH 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 SUOi
POLIpES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW.
INSA i POUCYNIMMtR POLKYUPECTNE POUCYEXPRIITRX.1 UIgT!
B MU#AIJTY HER8858850 .9/7106 9/7107 EACMOCCURRENCE i 1,000,000
COMMERCIAL OENMAL-ABILITY PR I EMISES Me o e 100,000
CW MS MADE Q.00CUR MED EXP onr' en i 10.0m
PERSONAL aADV14JURY 1 1.000,000
GENERAL AGGREGATE f 2,000,000
GEN1.AGGREGATE UMR APPLIES PEFt. PRODUCTS-COMP)OPAGG ! Z 000 000
POLICY PRa' LOC
A ABTOMOBR.ELIAOLM 35 MCC XD 6388 10/1105 10/1/07 COMBINE) LIMIT 1,000,000
ANY AUTO (EE W@WWq
ALI,OWNED AUTOS. BODILY-INJURY S
SCHEDULED AA T.OS. _ (P-peep^)
HIRED'AUTDS
BODILY INJURY'
NOf1.OEME AUTOS
IPorfoe�enq 3
PROPERTY CAMAGE f t
(Pr sodOtnQ
OAMOE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC f
AUTO ONLY: AGO i
QC=JUM@RaLLALYIBILrrY - - EACH OCCURRENCE- f
OCCUR F C'AENS A AOE AGMEGATE ;
OE OUC11BLE f
RETENTION E f
A IWORKIMAS dOmkmATtmAND ' 15 V BGNC8.861 1/1/07. 1/1108 X I=U- fNi
EARavww LIABILITY EA.EACH AGWENT f 0
ANY PROPRIETORIPARTNEWEXELUTNE E.L dSEASE-EA EI/PLOYEE !tbe wMer
'
OFFIOEPMEMSER EXCLUDED?
500,000,
B IAL PROV BIONS t.Ior E.L DISEASE-POLICY LIMIT. t
O'T11ER
Dl3CRIPTION OF MPATDNS I UXATIC"I VEMICLES I LXQM IONS ADDED YY ENDOFW MENTI SPECIAL PRMMONI
CERTIFICATE HOLDER CANCELLATION
WIDULD ANY OF M ABOVE DESCRIBED POLICIES W CANCMIM BEFORE TW.EXPIRATION
INSURES COPY UTZ TMSS�'Tire iSINING WUIER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOME TO'THE CERTIFICATE HOLDER MANED TO THE LEFT,SLIT FAILURE TOW SO*MALL
IMFO OB IGATI0N.OR I!NREII
UAWuTV OF ANY KIND UPON TSU ,ITS AOENq'OR
RISE TNED..
s ORItE REPRESBfT TIME
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ENERGY PERFORMANCE RATINGS
U-Factor(U,S)/I-P Solar Heat Gain Coefficient ,
0
33
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ADDITIONAL PERFORMANCE RATINGS
• Visible-Transmittance
V m :5 4 .
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DESIGN PRESSURE•(PSF)
IAtn/•eslM fW.�lsn
H L C25 100-00270239-a01 2
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