HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 8/4/2015 BUILDING PERMIT 01 TORY"
A
TOWN OF NORTH ANDOVER
01 ' -
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received
ArsD
Lf CH
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION am t,1- 2-3el-
I Print
PROPERTY OWNER �T4`y Ce 01-%FLrd^1
j a Print 100 Year Structure yes no
MAP d9W>- O60L/-
0 PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
-Residen 'al Non- Residential
❑ New Building ��ne family
El Addition 11 Two or more family 11 Industrial
11 Alt ion No. of units: El Commercial
�i<epair, replacement 11 Assessory Bldg 11 Others:
El Demolition El Other
fe
1 , r5, /,/ it r�/// / /� / l / r r lr /� / /%/ � ,
DESCRIPTION OF WORK TOB PERFORMED:
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i,-)t�oe;,j5 7 -2-
f L57 ClAtfl<Je LA-��( A4yR
Identification- Please Type or Print Clearly
OWNER: Name: J6 yr .9 �yo 4&sro^f Phone: a3 9— 9`7 7®-d- c7
Address:
Contractor Name: roe-,-' Phone: 6a 7 4�76 41411
Email: A
Address: 36
Supervisor's Construction License: -Exp. Date:
L Home Improvement License: —Exp. Date: J
ARCH ITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED'O $125.00 PER S.F.
Total Project Cost: $ 7 FEE: $—
Check No.: C A Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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FORTH
Town ofndover
Q �- �'' Y tel
No. -
?, h verass J5
O LANA
COC MIC.9WICK y�'
A°RAT&o P? C)
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BOARD OF HEALTH
PERMIT L D Food/Kitchen
Septic System
THIS CERTIFIES THAT ....... .. . .. BUILDING INSPECTOR
Foundation
has permission to erect ........................ buildings onqtr� .. ... B..;2"
�... ..00Rough
to be occupied as .... VACL..5.... ...,N. ...�........ .......�................... Chimney
provided that the person a cepting 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 CONSTRUCTION STARTS Rough
Service
r�,�............................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired to Occupy Building 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.
w
Renewa I
�A steam �.
WINDOW REFLACEMENT An
RE joyce Johnson
14 13 Mli€°r:tit.
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Thi"a;,sntr-7r-ted order and specifi+:adom ft.w thi.,abuvo t1101WIle tt"a"tUut tl>
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Ifyoo nood;.vuy[rsr(hor please r-a*a tacl me at 508-351-:x'231-
Thank ycm fiat yoror prompt rasion-,
Renewal by Ardersert
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Renewal Renewal by Andersen Corporation MA!-Home Improvement Contractor
b, ersen. " - 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015)
wrnooav aePt,AceeneNT :.,. :.-111,1,+<..:....,:,, (508)351-2200 Fax:(508)-986.7472 Fedaral IQ#41-1918413
Window Specification Sheet
1 uyvri-;)tianu, 11.114°of Agreenteau
JOYCE JOHNSON MON, APR 20, 2015
Ciir hu)e r(s't fisit'd ab(wv hrteby jointly anti m,verally aglet,to pturha"c fhr stomk alld/or services listed bdow in accordatice N01i tit(,pricr s and terms th-scribed
ort thr Specification Allh et and the fi,onl and iltr of the act^;trnl);utyiuj' CL:1'1`(At WINA)(3 V AND D001t R1?M )1)IAANG AGRI.L\llA"I tit'vOih ch
thtr Spvt ilication sheet is part.
WINDOW&DOOR DE'rAILS
A;- Ara At,,Y, €'xteriorflntcaor Color Harotea,l to ftrrs t.ov-Ee; 60110 C,rtw Glass
Room At .1101h h0ght u.t. Window/Door Style Detail Casings Ext-Int color Style S-lr is sntartun Gnffes Sash 113 Saah 2 Lifts Options
Livin 10o 31 F:i 79 DEQ s rail ual insert slo ad sill Ext.Wrap WH/VVHJ White 6laridn.+d FFG Low-Ea Cat; 3112 3/2 No No
Lfv rip 101 :i t -t."r 79 OB sr ra"rl equal insert stied sill Ext.Wrap WRAWH White Standard FFG Low-E-iGst= 3.12_ 3/2 No No,y
1 tit :tot -10 70 DB s rail equal insert stoped sill Ext.Wrap HMtH White Standard FFG Low-Ea ori µ3r`2 W 312 No_ Na
Bed t 10 i :Si1 •t« 75 DB sq rail equal insert sloped sill Ext.Wrep NHA"1H White Standard FFG Low-[d cisG 3/2_ 3t2 No No
Bad l If)t :iti tit 75 DB sq rail e uai irtaert ata ed s,If Ext.Wrap HAVI-I White Standard FFG L.--E4 citta 3�2 3,12 No No
.,.� ... E m _.- -._
Livia I()') 31 M0 A-FWHC, Ext Wrap .VHAIVH Brt.Brass ' vint tor FFG mms.,,r Gsc, 315 No Temper
MSt Bed 106 6080 A-FWH C lafo Ext_Wrap VH1WH Brt.Brass Quin tar FFG amsn5ur ,€3c; 3 5 2G No Tam tr
EE
Total 7 _ RAY,HOW&SUILD OUT DETAIIA _
Stylo Dalml f A��x App ox. Number Fmna Wi troy �L'nd Center T� Lowll r Roof! Hardware
Rtnrrri CoEutt 6Clio Fftatkers he ht casiligr Alxla Litou Intel€er Ext+Ini Color Grii?n %isbas ii mtrea 6cwtills &rnralsun Soffit Color
SPECIA FY WINDOW DE`MLS
Fill r Approx. L riv Spcontty RAY/BOW ADDITIONAL WORK NOTES
Room GotintSt I� -m tn:w u.L Smrinsun Grilles Gti,iA S !e Ext/Int Color r.s,-r�sr r ......EE t r i F.h:,rfh f:+r••.r,t h^s;?i,tt h<>
•µ �... m iiae�l t 1:• :l i ':I=��
ADDITIONAL WORK DETAILS;
No Contractor will wrap exterior casings with coil stock color of White _
Owner is aware that Contractor does not do any painting%staining or removallinsfallation of alarm system or window treatmentsihardware:It is the responsibility of
the homeowner to have the alarm system and window freatmentslhardware removed prior to installation. We make no guarantee,as to svhether atarns or window
traatmentslharsPware will tit 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 materiats unless so stated in this contract.
3 Yes Contractor will insulate,caulk and seal windows with 3-paint system to prevent water and air infiltration.Removal and disposal of all lob 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.
I Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the parmit(s)Is Included in the total contract price.
Yes All discounts have been applied to this agreement.
1,-, No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment 1 finance form(s).
It is ako ed.urd kilidrtxuwttl In wid hrlueel,d",portio that du:Slzixilicau+>u hit,€,ulun;t itiith the(t'!S't'C)1f WINI)(.AV AN 1)DOOR Rt�1f(1t1f,l.T\t;AliRFI'MEN t;k tmiwtc,rhr cine+
'140I'landingN -mv,-n the flat lit'v,.nldill,xe*:uro'it,,l,',IV'll tlnd(I�I:IIII!lnr sCflin.til;�i w it hxlifl nrv,'mN it ill'w l ni, Ihi,1;Iwili"mi,it Slil•t-1f,lit"ill llit lli:ttrpf+'LI,l,it,holt,nhdint•<I CFk�Ii'it'tl ltl
utc tiny tmles,.<n,it<h;lltilrI.In`it)a ilitl,;:ltd,u;artl tit!lull!tfi Itnt'4311;anti l`ollw liar iLaI ;11"i,f)"mrl,ll ��I .b ih:,l tient teal ll;,,real Ilii:,*lw tifi,"itigtt;illtl-l.
MeneavalbyAndersen
//Corporation
// Bti t'+ ISuctr`.i.
f!'(Clic'^Al del`
Signature ofConsultant Si ature Signature
MIKE BUTLER JOYCE JOHNSON
Print Name of Consultant Print Name Print Name
MA Home Improvement Contractor
Ral
':�Aenewnders,enl y 1 Renewal by Andersen Corporation License#170810(Expires 12123/2015)
Federal Tax ID#41-1918413.
30 Forbes Rd, Northborough,MA 01532
(508)351.2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
'Buyer(s)Name Date:
JOYCE JOHNSON APRIL 20, 2015
Buyer(s)Street Address city State Zip Code
F148 MAIN ST UNIT 234 BRADSTREET EILD� NORTH ANDOVER MA 01845
Email Address Home Telephone Number Work/Cell Telephone Number
JOR0470EMEI&RQMAIL.COM 239-877-2805 T
.Buyef(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewai 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 sheat(s)(collectively,this"Agreement").
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Total Job Amount $ 18_975 mount FinancLW$ 0 Est.Start Date Method of Payment
Deposit Received(339b)$ 6,325-00 Dpmit.t oq—up S 0.00 / Check'Cash
12-16 reeeks
Balance Start of Job(33%)$ 6,325.00 Check
Balance an Substantial At8ubsWiti-J Est.Install Time Credit Card
Completion of Job(335)$ 6,325.00 Cvtnp ee3 S 0.00 1.2 day,-
If credit card is sel&cted,please
-see Credit Card Payment form
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 attention to or deviation from this Agreement will be valid without the signed,written consent
of both Buy4sr(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.
Renewal by Anderson Corporation Buyer(s) Buyer(s)
BY: TI/
ve
Signature of Consultant S aturo S;gnature
x MIKE BUTLER JOYCE JOHNSON
Prinled Name of Consultant Printed Namo PrFnted Nartv
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 EXPLANAMN OF THIS RIGHT,
-
------------------------------------r-------------------------------------
--
NOTICE OF C-104CELLU IOS NOTICE OF CANCELLATION
Date of Trtnsacdou You may cancel this I Date of Tiansaxtloa Vo.—ay taneid this
t-c(1013,without any penalty or(ilditAti(m,within three busbu,sA dA**from the I transaction,without any penalty or obligation,within that t—i—a dy> from the
abate dite.If you cancel,any property traded in,any p.}meats made by you under ahtn-t,date.It you—neel,any property traded I.,any p.yineatA made by you under
the Contract of 89e,and any stegotiabb,instrument executed by you will be I the Coniraet of Sale,and any negntaabte instrument execmed byyou iUbe
'',returned vvil)rin 10 days fgRowing receipt by the Cnntractnr("SeITer'"}of your I "turned within 10 days following mivIp1by the Contractor("Seller") of your
moteflar—notice,and—y security Interest arising nut of the triuLs—thut will be notice,and any security lot.—[arising out of ilk transaction win be
tauteled. If you cantet,you in.*(make available to the Seller at your residauce,in I tanceleil. 1l'y»u sauce/,rou mast make ata3laVle to thr Seller at yvrar residence,In
atihsta.tially,..good condition as when retai,,cd,any goods del6ored to you under I substantially asgood rtoulld.a as whin retelved,any#.ads delivered to y..—,let
this Con,"et ote Sate;at you",Ifyintw6h,comply,with the Instructions of the I this(16.,reacr or Sale;or you may,if i0n wish,catuply with 11ts instructions of the
Seller regarding the return Alptuent of the goods at the Seller's expanse and risk. I Seger regarding the return shipment of the goods at the 8.1ter'A expense and risk.
It you do make the goods avflahle to the Seller and the seller doe.out p"them up I It l.0 do make the gand,i avaltahle to the Seller unit the seller does not pick them up
nithm 20 days of the date of your Notice or Cmcellatioa,)on may"Islo or dispose I %4 "20 days of the date of your Notice of Cautellation,you may retain or disperse
of the goods without any further obligation. if you fa0 to make the.goods at sitaltle I of the goods without any further obHgAdon. If)uu
to the Settee,arif yintagree lotetura the goods tathe Seiler and fail Latin so,the.n I to tie Stater,or if you agree
u.t-emain liable for perforivaitte of all abligatiotui under the Contract.To cancel to returo,the goods to the Setter and fait to do so,then
yo
you remain liable for performance of all ahugationa under the Contract. To runnel
this transaction,mall or deliver a signed and dated copy of this cancellthirt notice I this transantioo,man a,deliver.signed and dated cap),of this caaceflati.n notice
or any other writttu,tuidee,or send.t.lv
g—n to Contractor:Renewal by Andersen,I or any other written outike,or send telegram to Cootrat-tori Hene.8valb"Andemen,
3OForbes ltd. Nn"hbrr,ugbAIA 0I3J2. 30 Forbes Rd.Nurdthorough,NIA 01532.
I.HEREBY CANCEL,THIS TIUNS�CTIONL
P;")N- Dal
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Renewa
byAndersene
WINDOW REPLACEMENT a a AndetsenComp.wy
WoodNinyl Composite IF
Dual Argon Low E4 SmartSun
Double Hung
100-00473518-010
ENERGY PERFORMANCE RATINGS
1,11-Factor(U.S)/I-P Solar Heat Gain Coefficient
19
0 . 29 On A
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
UA2
Alanufaeturar stipulates that these ratings conform to appFcabla NFRC procedures for detarMining whOM product
performance.NFRCratotgsara detanninedforarmadset ofenvimnmentalcondilionsandaspecAi:product sea.
NfRC does not recommend any product and does not warrant the suhabd'ey of any product for any specilic use.
Consult manufacturer's literature lorolher product perfomtanee information.
L�
www.nfrc.org
This product meets Green
Sears environmental
Y standards govaininganargy
effioiancy,heavy metas
the Mama and sasA :'`%'4"'•'�'X• •r sY-
^f„acons.r r,packaging,and
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TelWtol1AFSMOfM..IA504AXSAtt1IAS'A4" Alarufaohfer stipulates wnfomtar"to the 2ppfiWAa stamaras.
Beats or exceeds M.E.C.,C.E.C,81.E.C.C.Air Inffihmtion requirements WOMA Hamark Candcation Program-
WINDows-aaaRS
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Andersen' NIFRU Certified Total Unit Performance (continued)
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Glass Type U-Factor' SHGC'
Andersen'Product Glass Type U-Factor' SHGCr I VP
Andersen*Product
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400 SeriesArchitectural
HP Low. D.21 035 0.60 - HP Low-E4 0.32 028 0.47 ('
tip Low-E4 with Gall032 025 0.42
HP Low-E4 with Grilles 0.28 031 0.54 es
HP for{4 Sun 027 021 033 f:� HP Low-E4 Sun 0.32 0.17 0.26
Circle Top" Casement Window HP Low-Ell Sun with Galles 0.32 0.16 0.23 `�; -
casement window HP Low-E4 Sun with Grilles 0.29 0.19 0.30 i! r
HP tux-E4 SmartSun 0.26 023 0.54 F.' HP Low-E4 SmariSun 0.31 0.18 0.42 f'1
HHP Low-E4 Smamsun w/Grilles 0.31 0.17 0.38
P lux-E4 SmartSun w/Galles 0.28 021 0.49 '
HP Low-E4 0.32 028 OA 1 "_`9
Low-E4 HP L -E4 0.27 035 0.60 •-, -
HP Low{4 wish Grilles 0.28 031 0.5M1 HP Imr-E4 with Grilles 032 025 0.42
HP Low-E4
Lor-E4 Sun 0.32 0.17 026 r.!R4 Sun 0.27 021 0.33 � French Casement -_, i
Circle&Oval window HP Low-E4 Sun with Grilles 029 0.19 0.30 l window _ lip low-E4 Sun with Grilles 0.32 0.16 023 is V
HP Lux{4
SmanSun 0.26 023 0.54 HP lor-E4 SmanSun 0.31 0.18 0.42 i ) {+
r, t1P Lox-B SmanSun w/Gnlles 0.31 0.17 038 F:1]
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' HP Lmr-E4 SmadSun w/Grilles 026 0.21 0.49 �., 3
ryPinw-E4 028 0.33 0.58 HPlor-E4 032 028 0.47 1 ?
tIP Lor{4 with Grilles 0.29 0.30 0.52 ;`� HP for-E4 AM Gilles 0.32 025 0.42
r. ,.
IIP Low-E4 Sun 028 0.20 0.31 F' IIP Lmv-E4 Sun 1132 0.17 0.26
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Arch Window - ning Window HP lox{q Sun with Galles 032 0.16 023 i
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HP Low{4 SUn wiN Galles 0.29 0.16 0.28 i
HP Lox-E4 Smansun 027 023 0.52 i (') HP Lax-Eq SmariSun 031 0.18 "2 i-_
HP low-E4 SmartSun w/Galles 0.28 021 0.46 ? ' �L° HP Law-E4 SmartSun w/6nlles 031 0.17 0.38 i
HP low-E4 0.27 033 0.58 HP Lux-E4 031 032 0.55
1 IIP lux-E4 vitt Galles 0.31 029 0.49 F ,�
HP Low-E4 with Galles 0.28 0.30 0.52
HP law-E4 Sun 027 020 0.31 A S Casement/Awning HP Law-E4 Sun 031 020 031
Flexiframe'Widdoiv Hp Law-E4 Sun with Galles 029 0.18 0.28 Picture Window HP Low-E4 Sun with Galles 0,31 0.18 0.28 a
lip Low-E4 SmartSun 0.26 023 0.52 HP Lor-E4 SmartSUn 0.31 021 0.50 F".
HP Lax-E4 SmanSun w/G611as 0.28 021 0.46 ['j LIP Lox-E4 SmartSun w/Grilles 0.31 0.19 0.44
HP Low-E4 031 033 0.58 HP for-E4 030 037 0.64
HP lor-E4 with Grilles 0.32 030 0.52 HP Low-E4 with Grilles 030 033 0.57
HP Lair-E4 Sun 0.31 0.20 0.31 [-' HP lmv{4 Sun 031 022 0.36 -'
Specialty Window HP Low-E4 Sun with Galles 031 020 0.32 ,
Springline Window - HP for{4 Sun with Grilles 0.33 0.18 0.2 r=
HP lox-E4 SmartSun 030 023 0.52 %�� Fj HP torr-E4 SmartSun 030 D24 0.58 ''. �'•.
liP Lax-E4 SmartSun w/Gfilles 0.32 021 0.46 -F; HP LmaE4 SmartSun w/Grilles 0.30 022 0.52 j7
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th Grilles 0.32 023 0.39 :=l •Fri
HP Imv{A with Grilles 0.33 020 0.33 -
-E4 Sun 0L31 0.16 0.25 ' Hinged Inswing HP Lurr-E4 Sun 0330.14 0.215nch.woodl'
French Door NP law{4 Sun with Galles 0.34 0.13 0.16Ih Grilles 014 0.22 .martSun 018 0.41 Mr 'l') lip Law-E4 SmarlSun 0.32 GAS 0.33LIPLmv-E4SmarlSun w/Grilles 0.330.19 030 - Cisw/Grilles 016 0.35 'F HP Low-E4 033 025 0.41
HP low-E4 024 0.41 '--
HP lux-E4with Grilles 0.32 021 0.35 HP Low-E4 wth GAMES 0.34 022 0.36 - o W
--} HP LuwE4 Sun 0.33 0.16 0.23 0.I HP Low-E4 Sun 031 0.15 023 _ '�i Hinged Outgoing - -
Inswing Patio Door .I HP Luff-E4 Sun with Grilles 0.32 0-13 0.19 i '13French Door HP lux-E4 Sun with Galles 035 0.14 020 _0.
0.30 U-16 0.37 7 F HP Lnw-E4 SmartSun 032 0.17 0.37
HP for-E4 SmartSun `�I �•�
HP Low-E4 SmartSun w/Galles 034 0.15 0.32 - g
HP Low-E4 SmartSun w/Galles 0.31 0.14 031 ':(••:3 HP Low-E4 033 023 0.36 -
HP low{4 0.31 025 0.41 MHp Law{q with Galles 033 021 034 -
lip for-E4 with Galles 0.32 021 0.35 1PI ` HP lour-E4 Sun 0.33 0.14 021 -
Frenehwaod'Hinge[ I HP Low-E4 Sun 0.31 0.15 0.23 'i'� Fixed French Door- -
Sidelight HP Low-E4 Sun with Galles 034 0.13 0.19
Outgoing Patio Door lip Lor-FA Sun with Galles 0.32 0.13 0.19 Lip fuw-E4 SmarlSun 0.32 0-15 0.34 -
HP Low-154 SmartSun 030 0-1T 0.37 f.1 f-i : Hp LO,v_E4 SmanSun w/Gdlfes D33 0.14 0.30 -
HP Low-E4 SmartSun w/Grilles 031 0-15 0.31 f"' ''P -
HP taw-E4 0.31 022 037 �' '
HP Law-E4 0.32 025 0.41
y;, HP Low-E4 with Grilles 0.33 022 0.37 -
Hp lax{4 wilt[Galles 0.32 1120 0.33 ' Hp tow-E4 Sun 032 GAS 023 -
Frenchwood'- HP Low-E-4 Sun 0.32 0.14 0.21 Fixed Transom -
^ French Door HP Low-E4 Sun with Grilles 033 0.14 0.20
PaUrr Door Sldelighi lip law{4 Sun with Galles 0.32 0.13 0.18 ' -
HP Inw-E4 Sm ortSun 0.32 0.16 037
HP Low-E4 SmartSun 0.31 0.15 0.33 .� F.1 HP
FSP Lor-E4 SmanSun w/Gnlfes 0.32 0.15 033 -
HP low-E4 SmertSun w/Gilles 0.32 014 029 `i�"i 40 `°' HP Lux-E4 0.35 026 0.44 -
HP Low-E4 0.30 024 U.
HP low-E4 with Grilles 0.30 021 0.35 {?>; HP Lan-E4 with Grilles 0.38 023 038 -
•I lip Law-154 Sun 0.35 0.16 024 -
Frenchwood' HP lour-E4 Sun 0.30 0-15 0.22 Wiling Door -
0.13 0.20 HP Low-E4 Sun with Galles 0.36 0.14 021
Patio Door Transom IIP Low-E4 Sun wilt Galles 0.31 -
HP Low-E4 SmartSun 0.29 0.16 036 ,�� �� __ HP Imv-E4 SmartSim 0.34 0.17 039 -
lip Low-E4 SmartSun w/Galles 0.30 0.14 0.32 �i {'� HP Low-E4 SmartSun w/Galles 0.36 0.15 0.34
continued on nerl page
•For NFRC certified total unit performance on units with capillary breather tubes for high altitudes,please visit andersenwindows.com.
•-High-Performance"Low-Eli-(HPlow-E4),'High-Performance"Low-E4'SmanSun-'(HI`Low-E4 SmanSun)and'Ifigh-Performance Low-E4'Sun-(lip Low-E4 Sun)are Andersen trademarks for'Low-E"glass.
' U-Factor defines the amount of beat loss through the total unit inBTU/hr sq.METhe lower the value,the less heat islost through the entire product-Windowvalues represent non-temperedgloss.Use oftempered glass can
increase U-Factor ratings.See andersenwindows.com for specific performance values.Door values represent tempered glass.
'Solar Heat Gain Coe fficient(SHGC)d arm as the fraction of sale rred fation admitted through tha glass both directly berismitted and absorbed and subsequanty released inward.The lower the value,tha less hea t is tra nsmitted
through the product.
'Visible Transmittance(VT)measures how much light comes through a product(glass andframe).The higher the value,from Oto 1,the more daylightWe product lets In over the product's total unitarea.Visible Transmittance
is measured over the 380 to 760 nanometer porton of the solaf specuum.
•NFRC ratings are based an modeling by a third party agency as validated by an independent test lab 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 change over Ume-Ratings are for sizes specified by NFRC for
testing and certification-Ratings may vary depending on use of tempered glass,different grille options,glass for high altitudes,etc
•PassiveSun-glass values are available online at andersenwindows-com.
277
The Commonwealth ofMassachusetts
Department oflndustrialAccidents
R Office of Investigations
d
1 Congress Street, Suite 100
Boston, AM 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LM bly
Name (Business/Organization/Individual): RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip:NORTHBORO, MA 01532 Phone#:508-351-2200
Are you an employer? Check the appropriate box: Type of project(required):
1.Q I am a employer with 30 4. R I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction
2.❑ I 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'
comp. insurance.$ 9• ❑ Building addition
[No workers comp. insurance P•
required.] 5. EJ We are a corporation and its 10.0 Electrical repairs or additions
3. officers have exercised their I am a homeowner doing all work l 1.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12-El Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.El Other
comp. insurance required.]
*Any applicant that checks box 41 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,
tContractors 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 is providing 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. Lie. #:MWC 30293800 j Expiration Date: 10/01/15
Job Site Address: zw> &)d/" Sol-Sol- 6 ",�, " T City/State/Zip: lax
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 STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb certify der the pains and penalties of perjury that the information provided above is true and correct.
Si ature: Date:
Phone 8-351-220
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ANDECOR-01 YADAVYO
CERTIFICATE LIABILITY I U ' INCE �T /112O/yYYy)
1 0/11zo14
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFO TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: 9 the certificate holder is an ADDITIONAL INSURED,the polk:y(les)must be endorsed. If SUBROGATION is WAIVED,subject to
the termly and conditions of the policy,certain policies may require an endorsement. A statement on this certffICgW does not confer rights to the
CwWk ate holder In lieu of such endorsement(s).
PRODUCER CONNONE CT cettiflCa IffS.COfn
Willis ofnury Blvd
Minnesota,Inc. PHowe 8 946-7378 F
c/o 28 Cantu Blvd No Etl:( � No.(888)467-237»
P.O.Box 30581 Mss,
Nashville,TN 37230-5101
INSUR S AFFORDING COVERAGE NAIL R
INSURERA:Old Republic Insurance Company 24147
INSURED INSURER 0:
Renewal by Anderson Corporation INSURERC:
30 Forbes Road INSURER D:
Northborough,KA 01632
nlsurrusl 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. NOTWTHSTANDING 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 OFNISURANCE ADUL BUSH E" POLICY EV
LTRPOLICY NUMBER MVdDONYYYI (KIMIRDIMM L WTS
A X COMMERCIAL GENERAL UAELI Y EACH OCCURRENCE ; 1,000,000
CLAIMS-MADE ®OCCUR 302940 10101=14 10101!2015 PREMI�Ea ggqL nos S 500,000
MED EXP(Any one penton) S 10,0
PERSONAL AADV INJURY S 11000,00
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00
X POLICY❑JECTT ❑Loc PRODUCTS-COMPIOPAGG $ 4,000,00
OTHER: $
AUTOMOBILE LLURMY $ 6,000,00
A X ANY AUTO MWTB302676 10101/2014 10/01/2015 BODILY INJURY(Perpa4wn) ;
ALL AUTOS ED AUTOS
SBODILY IWURY(Parao*Ierd) ;
HIRED AUTOS0 � PE AGE f
S
UMBRELLA LIABOCCUR EACH OCCURRENCE ;
EXCESS UAB CLAIMS-NIADE
AGGREGATE ;
DED I I RETENTION $
WORI(OlS COMPENSATION PER
AMEWLAYERWUAWLnY YIN, X STATUTE ER
A ANY PROPRIETORMARTNERfEXECUTIVEMWC30293900 10/0112014 10/01/2015 E.L.EACH ACCIDENT ; 1,000,00
OFMCERNEMBEREKCLUDED? ®N!A
{MaroWatarYNn ) E.L DISEASE-FA EMPLOYE ; 11000,
DESCRKIM
IIP IOONNOFOPERA110NSbdow E.LDISEASE-POLICYUMIT $ 1,000,0
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLO(ACORO 109,AddSbrtal Ramerka Schedule,may M al shad F mere space le mquYod)
t
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Vkiencg gl In nee
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
d,
Mms"husetts -Department of public Safety
DoRrd of Building Regulations and Standards
Construction Supen•icor
License: 125
JABS L MORM
LYNN MA 0190rr �pkf LL•L�,ci
Expiration
Commissioner 1010 1B
IY:ce of Consumer Affmirs&Buaaess Regulation
IMPROVEMENT CONTRACTOR
R"Ieftuon: 170810 Type:
Expiration: 12/2312015 Supplemem/ s
RENEWAL BY ANDERSON CORPORATIOPI
,a.
JAIME MORIN
104 OTIS STREET
NORTHBOROUGH,MA 01532 N
iJsdersecret8ry
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