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HomeMy WebLinkAboutBuilding Permit #580 - 89 CHRISTIAN WAY 1/31/2012 0� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must com lete all items on this page LOCATION �� �.�K,t.�ia,.� �1J P / Print PROPERTY OWNER aO E&4- Unit# Print MAP NO:�_PARCEL:�ZONING DISTRICT: Historic District yes o Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 216ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑�W.ell' r 0�Floodplain, QI'Wetl'ands Watersh_ed1Distr ct 11'Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: UIJ914CL S' ft v�-�v {�✓� (IdentifiT ion Please Type or Print Clea ly) OWNER: Name: 9.06F,4 i h,..(•` Phone: q`7�-�2 1 - 5-3/Q Address: 4't,-;s*; n v,-i (,U A CONTRACTOR Name: I)hr(.8-&,-):2 I <-c--J Phone: Address: $ - A-2-; s1- (1 �( 0110 ► �cf�l�- l/l��} Supervisor's Construction License: �'(S�7Q7 Exp. Date: Home Improvement License: 0 T(() Exp. Date: o 1031,,10 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: $ % ,57. `@ FEE: Check No.: 2 5r) Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty unci Signatur-e:of+Agent/,Owne c Otsk +��- .Signature.ofdcontraetor j Location �6 -j [' (� ► S��--+ W - No. Date -31-12- NO0 TOWN OF NORTH ANDOVER O F w 9 • Certificate of Occupancy $ sCMUs<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 4 J 14 Building Inspector e I 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEA'-TH Reviewed on Signature - COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Snature& 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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 ❑ 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 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: Doc.Building Permit Revised 2008mi 14ORTH _ over . 0 of _ 0 o , dover, 1VMass., • o L AKE COCMICMEWICK 0):? T E D P �C7 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.................... .......... ............ ............. .............. ............................................ Foundation has permission to erect........................................ buildings on .......64.........G......0.j....... ..... ...'' Rough tobe occupied as................... ..�....�......... ... ... .... r......T........ �I1i0.............................................. Chimney provided that the pers"o"n" acc�tin this ermit s II in eve respect conform to the terms of the application on file in Final- p P P g P very 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 CO.N' STRUCTIPV T TS Rough .......................... ............................................................: Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building . GAS INSPECTOR Rough Display in a Conspicuous Place on.the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. NORTH TONM Of Andover . No. A K E o dover, Mass., COCMICMEWICK �ADRATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR �`THIS CERTIFIES THAT.................R#UW'W4r.=r ............ ... .............. ............................................ Foundation 4 has permission to erect............:........................... buildings on ... G �l ..`..! Rough to be occupied ash Chimney �..... ......... ... ... 'T........ . t the erson accj this perm shill in eve respect conform to the terms of the application on file in Final provided that p p g p every 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 PERM i EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR NSTRUC T TS h UNLESS CO Rough .......................... ............................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Ocaipy 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. 104 Otis St.,Northborougli,MA 01532 J&L Wtrmows,INC.,D/B/A MA Home Improvement Contractor (508)919-0900 e Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) �'ACldersen. Federal Tax ID#83-0404201 WINDOW REPrACEIeEMT anMdc�C.mmsny CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date of Agreement x7&=r r7� I I)II71gil Buyer(s)Street Address,City,State,and Zip C de re� / E-Mail Address Home Telephone Number Work Telephone Number 042, K;r -(� ' 97? Buyer(s) 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 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 Amounts I Estimated Starting Date: Method of Payment: eck ❑Cash ❑Financed Deposit Received(33%): 00_� J` Balance at Start of Job(33%): % Eonly ards are accepted for deposit Estimated Completion Date: ximum 1/3 of the project cost. Balance on Substantial �� 1-7 �i S e Credit Card Payment Form. Completion of Job(33%): 7 y 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, 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 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 Buyer(s) B r Bv: I Signally f P, duct Manager iatur/le Signature T,4,-- Aa&c / A)"/- ,k 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 THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. - - — — — — — — — — — — — — —dam- — — — — — — — — — — — — — -X— — — — — — — — — - -� NOTICEF ELATION X NOTICE OF CAN ELLATION Date of Transaction 1 . You may cancel Date of Transaction I . You may cancel this transaction,without c ny enalty or obligation,within I this transaction,without ny enalty or obligation,within three business days from the above date.If you cancel,any I three business days from the above date.If you cancel,any property traded in,any payments made by you under the I property traded in,any payments made by you under the Contract of Sale,and any negotiable instrument executed 1 Contract of Sale,and any negotiable instrument executed by you will be retumed within 10 days following receipt I by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, I by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will 1 and any security interest arising out of the transaction will be canceled.If you cancel,you must make available to the I be canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good condition as when received, any goods delivered to you under as when received,any goods delivered to you under this this Contract or Sale; or you may, if you wish, comply 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 Sellers expense and risk. i the goods at the Seller's expense and risk.If you do make -f ��:si afoL S.E�3�3SiSiFd3i1ao.4C ..ciser and the I the 9c.&ds u-vai.uvsE w ssre GAje and tyle Seiler does not- Se ot Seller does not pick them up within 20 days of the date 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, thengoods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligation under for performance of all obligations under the Contract. the Contract.To cancel this transaction,mail or deliver a I To cancel this transaction, mail or deliver a signed and signed and dated copy of this cancellation notice or any 1 dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor.J I 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, Northbomo h, 01532, BY NOT LATER THAN Northbo ug y MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF / —.(Date) OF ) .(Date) 1 HEREBY CANCEL THIS SACTION. I HEREdY CAACEL THIS TRANSACTION. Buyer's Signature Print Name Date Buyer's Signature Print Name Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink ..� J dt L Windows,Inc.d/b/a Ph Otis Street,Northborough,MA .3013 MA HIC License#149601(expires 1/24/12) Phone 508.919.0900•Fax 774.987.3013 _ Renewal �i Federal Tax ID# 83-0404201 Renewal ♦ byAndersen. WINDOW REPLACEMENT -And—Com,-y OF GxB Tm MAssaclluzm AND NEW HAmmm WINDOW SPECIFICATION SHEEP Buyer(s)Name ^ Date of A;—me-)it Xoto rl 1 G d-G i 1 The Buyer(s)listed above he y jointly and severally agree to purchase the goods and/or services listed below acro dance 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 DEFAI S 1. Contractor will Install a total of=windows in 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(C W) ❑ 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(GPM ❑ 1:1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window Patio Doors(see sep8rate Door Specification Sheet) 2. (Z Yes ❑ No Qty of Windows to be Custom Fit Replacement: /6 3. 50 Yes ❑ No Qty of Sills to be replaced by Contractor: /fe S p rti/� 4. ❑ Yes No Qty of Windows to be New Construction Full frame(includes new in4erior&exterior casings)and actual Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: ® HP Low-E-4 TM ❑ Other If other,please specify: 6. Exterior color to be: White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: White ❑ Sand ❑ Canvas ❑ Terratone ❑ Fine ❑ Maple ❑ Oak Note: Interior color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware: R,White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes N No Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or �4 Full screens Screens to be: M Fiberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11.Windows have grilles:t® Yes ❑ No If yes:[0�Grille Between Glass(GBG)❑ Removable Interior Wood mw❑ Full Divided Light(FOL) Qty: Qty: �- Qty Qty: Qrn Qty: Qty: DH DH DH CW/Picture Glider CPW orG Draw grille patterns above "Use additional sheet if needed Owner approved(initials): ADDITIONAL WORK DETAILS 12.❑ Yes No Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes No Contractor will install new paint-ready or stain-ready casings. Interior casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes�]i 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 qp nings: ❑ Fine F-1 Maintenance-free material 15. Owner is aware that Contractor does not do any paintinga( Owner Initials 16.❑ Yes 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.C�Yes ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18LV Yes ❑No Cleanup all job related debris including old windows will be removed.Vacuum nightly. 19.M Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20.Py Yes ❑ No Building 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. 21.1K Yes ❑No All discounts h been a lied to this agreement n 22. Additional job details: C- —� � Ar,/�!(� ( [ � (�( !�Cj„/ 23.%Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. final payment shall be demanded until the contract is completed to the satisfaction of all 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. 1 Renewal by Andersen of Greater MA and NH Buy") Bi ye '1 By: , Signa of Fghxt Manager_ l S—ig�na 1 Sig- Print Name of Product Manager PrinttNN'ame ��� Print Name MA License#149601(expires 1/24/12) enewa � RENEWAL Bi" ANDERSEN Federal Tax ID# 83-0404201 p ,. byAndersen OF GREATER MASSACHUSETTS AND NEW HAMPSHIRE WINDOW REPLACEMENT .,n:ar.{•r,r :,•:;:.:: 104 Otis Street•Northborough,Massachusetts 01532 Phone 508.919.0900•Fax 774.987.3013 CONIRAcr AMENDMENT 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 ROBERT KIRK("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 conditions of the Agreement will remain in full force and effect. This Amendment is subject to the terms and conditions of tine Agreement. The following ad- ditions,alterations,or deletions to the products and services Buyer(s)ordered are being made: REMOVED(6)WINDOW UNITS FROM EXISTING CONTRACT CHANGED GRIDS TO MATCH ENTISTING NO CHARGE FOR SILL NOSES (-S8914) 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: $12587.00 New Estimated Method of ✓ Cash ✓ Check Financed Starting Date: Payment: New Deposit Received (33%)' $4196.00 RECEIVED New Balance at Start of job Credit cards are accepted for deposit (33%): $4195.50 New Estimated only—maximum 1/3 of the project cost. CUSTOMER Completion Date: Please see Credit Card Payment Form New Balance on Substantial Completion of Job(33%): $4195.50 CUSTOMER By signing this contract amendment,you acknowledge that the Balance at Start of job and the Balance on Substantial Completion of Job cannot be made by credit card and must be made by personal check,bank check,or cash. It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowledges that Buyer(s)has read this Amendment and has received a completed,signed,and dated copy of this Amendment on the date written below. Renewal by Andersen of Greater MA and NH Buyer(s) By: E-Signed: 12!22 2411 4:24:.45 prl CST 12/22/2011. Signature of Product Manager Robert D. Kirk Date robert..kirl:eip-s oft.net BRANWCQUE$ IP;12.1E4.144.?: , I tC.7E)2 fl Z£i9.# [i id.i Print Name of Product Manager Signature Date Doc ID:20111222093418193 Sertifi Electronic Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information \ _ (� Please Print Legibly Name(Business/Organization/Individual): V\e )Ck\ 1()g Df 1\ACi-SC✓\ Address: City/State/Zip: �Do gr" bpo , M6, DV1 3D Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.P,I am a employer with D . ❑ I am a general contractor and I � 46. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.L]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑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 a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. aa Insurance Company Name:_ 0 � l`r Policy#or Self-ins.Lic.#: \.O C_ Expiration Date: Job Site Address: "9 / City/State/Zip: AJ d'✓,0GU€,_ IM 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 Investigations of the DIA for insurance coverage verification. n Ido hereby certify er the pa' and penalties of perjury that the information provided a ve is true and correct Simature: / Date: c�- Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# 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 I �iassachu,ctt, - Dep:u-tincnt of Public Safet-, Board of Buildin, Rc,,ulation, and Standard, I Construction Supervisor License i License: CS 95707 AWft BRIAN DENNISON 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ( unuui..i uur Tr.: 2622 -_ ✓fie -Va7nrreoreeuea�ft a�'./�czaaaclzuaelta ' Office of Consumer Affairs&Business Regulation THOME IMPROVEMENT CONTRACTOR Registration: 170810 Type: Expiration: -12/23/2013 Corporation �RE�LIL BY ANDERSEN CORPORATION BRIAN DENNISON, 104 OTIS ST. NORTHBOROUGH MA(01532... Undersecretary .4C.CTltDATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/11/2012 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 to the certificate holder in lieu of such endorsement(s). PRODUCER 1-612-333-3323 CONTACT Jonelle Hargrove or Katie Psimos NAME: g AIC, -373-7270Hays Companies PHONE ANo:fAIC No - - 612 E-MAIL 80 South 8th Street ADDRESS: Suite 700 PRODER Minneapolis, MN 55402 CUT O UCER ID INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: OLD REPUBLIC INS CO 24147 Renewal By Andersen Corporation INSURER B: NATIONAL UNION FIRS INS CO OF PITTS 19445 104 Otis Street -INSURER C: INSURER D: Northborough, MA 01532 INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER: 25114267 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. INSR TYPE OF INSURANCE ADDL S VD POLICY NUMBER POLICY EFF POLICY MMIDD EXP LIMITS LTRINSIR A GENERAL LIABILITY MWZY 59313 10/01/1 10/01/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCLALGENERAL LIABILITY PREMISES Ea occurrence $ 500,000 CLAIMS-MADE a OCCUR MED FRCP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 4,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 3,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY MWTB 21377 10/01/1 10/01/12 COMBINED SINGLE LIMIT $ 3,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ B X UMBRELLA UAB X OCCUR 25030519 10/01/1 10/01/12 EACH OCCURRENCE $ 25,000,000 EXCESS LWB CLAIMS-MADE AGGREGATE $ 25,000,000 DEDUCTIBLE $ X RETENTION $ 25,000 TATU $ A WORKERS COMPENSATION MWC 117140 00 10/01/1 10/01/12 X WCSLIMIT EB AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000d If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE kpsimos ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 25114267 Renewal *- �: byAndersen .,;~ WtNPOW REPLACEMENT anAnderstn(:at MOY WoodNinyl Composite IF .�,c-_�; , x•G:. Dual Argon Low E4 SmartSun r""` `"^ '`2 Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient - 1 • . 29 . 9 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance ■ 42 hi...facmrer mipuhte"hat these ming.conform to appr en NFAC procedures for datarmining whole product penormance,NFRC mGigs are detarmined for a roved set ofenveonmental cendilions and as pecir-product.¢-. NFRC does not recommend any product and dots not warrant the-uitahilhy of any product for any sp-cWk-use. Consun manutacturar',Idaroture for other product petfonilane-information. p www.nlle.org 11 ��ra'� This product meals Green .��N+-h+1e--�'• Sears environmeuml p-n�-- %?,, '_�•� +�^'y•-:.^;-r.x„ =standards governing energy ^rw. •a.a t:•.i ••:••• '{''the(roma and—h �� ti. '±•"�'�-:c'rf."''tF% materal,p-cloging,and c:�;=�••k_ consumer aducalional � '�;.,,,'.;_;;:;•'.;,�;;;• i;y �`s., maferatr. .a.v-. r a f;.:e..,n...ra.,.i.o.». DESIGN PRESSURE(PSF) O t 1 W,clum and Door - ' nnnufaeYwasme�co tnt H-LC25 RbA DB Sloped Sill DH IN Test6diotiAFS-02of AAFn/tVOI !tAICSA101;1SfA140-0S hlartAactllel sli dales wnfonnarro-W Vl-a I1La019 slafxlards. denser exeeetls A1.E.C.,C_E.C,61.E.C.C,Air Inllin ration requirements WDh1A Nalhnark Canilication Program. � ' f