Loading...
HomeMy WebLinkAboutBuilding Permit # 10/13/2015............. t%O RTy BUILDING PERMIT a&��tiE� ,sptio TOWN OF NORTHA - PPLICATION FOR PLAN EXAMINATION o .. _ - AOL -t � o k 1ta Permit No#:) Date Received 9RA�RATEu �SSACeaus�� Date Issued: 14 t IMPORTANT:Applicant must complete all items on this page LOCATION 60 A,61-1 s e"z 51 Print PROPERTY OWNER1 e G� Print 100 Year.Structure yes' o MAP PARCEL: ZONING,DISTRICT: Historic District yes no Machine Shop Village ' yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther Map Wi »% DESCRIPTION OF ORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: uL-t Phone: Address: Contractor Name Email: Address: Qs— r ct e /k 32- ' Supervisor"S' Con's'tru'ction License: 'i�s Exp. 'Date:> w - Home Improvement License: ?k - Exp. Dater ` ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ - FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,ri tt®RTN 0,"Vv T ,I 01over O �•. No. 2.0061� _ �O LAKE h , mer, ass, COCMICMEMCK y1. AD'?ATE D P.Pp,`'�� S u BOARD OF HEALTH Food/Kitchen rERMIT D Septic System THIS CERTIFIES THAT t BUILDING INSPECTOR ................. .... .... .. ..... ...1...................... ........................................ has permission to erect .......................... buildings on .: ........ ........ar ...... Foundation Rough to be occupied as ................. .®....... ........ ................................ Chimney . ...... provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESSCTI SR TS Rough Service ............. .... . ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — o of Remove Final No LathingBe® or Dry all To Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Contract - Detailed i Pella Window and Door Showroom of Haverhill Sales Rep Name: Simpson, Jeffrey ® 45 Fondi Road r� [-7 Sales Rep Phone: 978-373-2500 Haverhill, MA 01832 ` Sales Rep Fax: Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: SimpsonJS@Pellaboston.com Customer Information Project/Delivery Address Order Information Julie Allard Allard,Julie,North Andover,MA,1609590 Quote Name: Kitchen Door 60 Middlesex St 60 Middlesex St Order Number: 741JS0380 NORTH ANDOVER,MA 01845-3807 Lot# Quote Number: 7061656 Primary Phone:(978)2042887 NORTH ANDOVER,MA 01845-3807 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: juliean_99@yahoo.com Quoted Date: 8/17/2015 Great Plains#: 9587012 Customer Number: 1007298693 Customer Account: 1003016008 Line# Location: Attributes 10 None Assigned Delivery/Setup-Delivery/Setup Item Price Qty Ext'd Price $199.75 1 $199.75 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 8/18/2015 Contract-Detailed Page 1 of 6 Customer:Julie Allard Project Name: Allard,Julie,North Andover,MA,1609590 Order Number: 741JS0380 Quote Number: 7061656 Line# Location: Attributes 15 None Assigned Pella Brand, Inswing Entry Door Right, 33.5 X 81.75, 511/16" Item Price Qty Ext'd Price $1,894.31 1 $1,894.31 1:3280 Right Inswing Entry Door �y PK# Frame Size: 33 1/2 X 813/4 General Information: No Fire Rating,No Fire Rating,Wood,Wood,Pine,5 11/16",5 11/16",Standard Sill,Nickel Finish Sill,Oak Threshold E, 718 Entry Door Panel: Glazed,Fiberglass,Smooth,Smooth,Twin 1/2 Light 9 a , Exterior Color/Finish: Unfinished,Primed Interior Color/Finish: Unfinished,Primed Glass: Tempered Low-E Viewed From Exterior Hardware Options: Latch Bore with Deadbolt,No Deadbolt Sensor,2 3/8",2 1/8",No Handle Set,Aluminum Adjustable,Satin Nickel Frame Size:33.5"X 81.75" Unit Accessories: No Bang Panel Grilles: No Grille Wrapping Information: Without Brickmould,No Exterior Trim,No Interior Trim,5 11/16",5 11/16",Factory Applied,Pella Recommended Clearance, Perimeter Length=231". ES—Single-Install Single Entry Door Qty 1 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. Project Checklist Review (Installed Orders Only) Before the Installation the Homeowner agrees to do the following: Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 8/18/2015 Contract-Detailed Page 2 of 6 Customer:Julie Allard Project Name: Allard,Julie,North Andover,MA,1609590 Order Number: 741JS0380 Quote Number: 7061656 Remove air conditioners Remove existing shades, drapes, window treatments, wall hangings, and personal belongings Move furniture at least 3 feet away from work area Tie or cut back trees, bushes and shrubs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following: Obtain Building Permit(When required) Prefinish products when purchased in contract During the Installation the Homeowner agrees to do the following: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract Place and remove drop cloths in work area then vacuum, and remove all debris at end of day Remove existing product, including storm windows, and dispose of it unless otherwise specified Install all products using method specified in contract per Pella Installation Instructions Replace interior and/or exterior trim only if purchased If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished. If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the following: Be available for completion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments, wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and tax purposes Wash all interior&exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased AJ" Project Checklist has been reviewed Customer initial Product Only Addendum has been reviewed Customer initial For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella®website at www.pelia.com Printed on 8/18/2015 Contract-Detailed Page 3 of 6 Customer: Julie Allard Project Name: Allard,Julie,North Andover,MA,1609590 Order Number: 741JS0380 Quote Number: 7061656 Credit Card Account#: Last 4 Digits Expiration Date: / Charge final payment to same account (Upon substantial completion) Customer initial Project Checklist has been reviewed Julie Allard Jeff Simpson Customer Name (Please print) Pella Sales Rep Name (Please print) Order Totals' r— �eJC erz9i Taxable Subtotal $1,001.81 Customer Signature ,,090tE5KRW8ignature Sales Tax @ 6.25% $62.61 8/18/15 8/18/15 Non-taxable Subtotal $1,092.25 Date Date Total $2,156.67 Deposit Received $2,156.67 Credit Card Approval Signature Amount Due $0.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 8/18/2015 Contract-Detailed Page 4 of 6 Customer: Julie Allard Project Name: Allard,Julie,North Andover,MA,1609590 Order Number: 741JS0380 Quote Number: 7061656 Lead Safe Installation Customer Performance Expectations In order to ensure a proper Lead Safe Installation, it is essential that we have you complete the below tasks prior to your installation: PALL furniture needs to be moved at least 8 feet away from any window or door being replaced [ ALL personal items, wall hangings, and collectibles must be removed prior to your installation date [ All blinds and any interior window treatments need to be removed prior to your installation date []/Any non-movable furniture (for example: pianos, entertainment centers, built in cabinets, etc) must be cleared of items and be surface dusted prior to installation You will be responsible for replacing all furniture and personal items after your installation ❑ Other items: What to Expect the Containment/Work Area to Look Like Vin order to ensure your safety, we will be taking measures to minimize dust/debris does not spread beyond our work area. This may include the use of plastic sheeting on the floors and/or walls, caution signs, sealing of heating and cooling air vents, and asking that you turn off your HVAC system during our work. During your Lead Safe Installation, you may also see your installation professional wearing Personal Protection Equipment. For your own safety, we are not permitted to allow you inside the work area during the removal of your current product or the installation of your new windows/doors. By signing the form below, I am affirming that I understand all the expectations noted above and that I have agreed to have all items completed prior to my installation commencing. I understand that failure to have these items completed will result in the re-scheduling of my installation and that my installation date will be scheduled for the next available date. (� 8/18/15 Customer Signature Date For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 8/18/2015 Contract-Detailed Page 5 of 6 Customer:Julie Allard Project Name: Allard,Julie,North Andover,MA,1609590 Order Number: 741JS0380 Quote Number: 7061656 Pre-Renovation Form Occupant Confirmation Pamphlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. Julie Allard Printed Name of Owner-occupant 49-,01 49, z8/18/15 Signature of Owner-occupant Signature Date Renovator's Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator.-If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. Declined -I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. Unavailable for signature- I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by: (Fill in how pamphlet was left Printed Name of Person Certifying Delivery Attempted Delivery Date Signature of Person Certifying Delivery Unit Address Note Regarding Mailing Option --As an alternative to delivery in person,you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least 7 days before renovation. Mailing must be documented by a certificate of mailing from the post office. For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 8/18/2015 Contract-Detailed Page 6 of 6 NOTICE OF CANCELLATION Date of transaction: 8/18/15 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 agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. 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 agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty 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 you agree 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 Pella Windows and Doors, at 45 Fondi Rd., Haverhill, MA 01832 not later than midnight of 8/21/15 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) PELLA WINDOWS AND DOORS CONTRACT 7. PAYMENTS Pella shall be entitled to stop the Work upon written notice to Owner for any 1. TERMS AND CONDITIONS material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part of the contract set forth on the failure to pay Pella the amount due within seven days after the date payment is Product Order(the"Contract")between New England Window and Door LLC due. dba Pella Windows&Doors,Inc.("Pella")and the person(s)identified on the Product Order("Owner")to supply the products(the"Products"),and perform 8. CORRECTION OF WORK the work(the"Work")described or referred to in such Contract. For Product Pella shall correct installation Work not in conformance with the requirements of Only purchases,a signed"Product Only Addendum"is a required part of the the Contract,if notified in writing by the Owner within two years after the contract. Completion Date or,if earlier,the date on which the Work is substantially completed and payment of the Purchase Price made subject to a holdback as 2. OWNER provided above.Correction of Work as herein provided shall be Owner's sole Pella is not responsible for any existing security systems.Owner shall remove all remedy for defective workmanship,and is provided in lieu of any and all other shades;verticals,blinds,curtains,drapes or window mounted air conditioners, remedies.Pella's obligation to correct Work is conditioned on Pella's prior prior to the installation of the Products.Pella's installers are not responsible for receipt of all payments then due. the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella windows. 9. LIMITED PRODUCT WARRANTY The Owner shall provide complete access to the work site between the hours of Pella shall warrant all Pella products,but only in accordance with the Pella 7:00 a.m.and 6:00 p.m.(Monday through Friday)for Pella's installers to deliver Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL the Products and perform the Work. BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, 3. PELLA EXPRESS OR IMPLIED, WRITTEN OR ORAL(INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means,methods, FOR A PARTICULAR PURPOSE). techniques,sequences and procedures and for coordinating all portions of the Work.Pella will be responsible for the Work of its Pella Contractors who will 10. NO CONSEQUENTIAL DAMAGES UNDER NO install the Products. CIRCUMSTANCES SHALL PELLA BE LIABLE FOR CONSEQUENTIAL, Unless provided otherwise in the Work description,Pella will provide and pay for INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES,WHETHER all labor,materials,equipment,tools and machinery,transportation,and other FORESEEN OR UNFORESEEN. facilities and services necessary for the proper execution and completion of the Work. 11. HOD7E IMPROVEMENT CONTRACTORS All home improvement contractors and subcontractors shall be registered with The materials and equipment furnished under the Contract will be good quality the director of the Home Improvement Contractor Registration Program and new unless otherwise required or permitted,the Work will be free from administered by the Board of Building Regulations and Standards. Pella and any defects not inherent in the quality required or permitted,and the Work conform of its subcontractors identified in this agreement have been registered. Any with the requirements of this Contract.Pella shall not be responsible for inquires about Pella or any of its subcontractors relating to registration should be damages or defects caused by abuse,modifications not executed by Pella, directed to:Director,Home Improvement Contractor Registration,One improper or insufficient maintenance,improper operation or normal wear and Ashburton Place,Boston,MA 02108,617-727-8598 tear. Pella will keep the premises and surrounding area free from accumulation of waste materials or rubbish caused by performance of the Work. 12. PERMITS(MA customers only) Pella is obligated to and will obtain the following permits for this project: 4. CHANGES B U I ld ICl . Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excluded from the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall include chapter 142A. an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any Change Order In addition to the rights and warranties enumerated in this agreement,you may and any such Change Order must be signed by both Owner and Pella to be have additional rights under Massachusetts General Laws,chapter 142A and 780 effective. Code of Massachusetts Regulations R6. 5. SUBSTANTIAL COMPLETION 13. NOTICE OF CANCELLATION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a patty estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which may extended to allow for Change Orders requested by Owner or if the time to complete the Work is affected by conduct of the Owner,weather,labor disputes, be his main office of branch thereof,provided your notify the availability ofsubcontractors,acts of God,fire or other causes reasonably beyond seller in writing at his main office or branch by ordinary mail Pella's control.If for any reason the Work is not fully completed by the posted,by telegram sent or by delivery,not later than midnight of Substantial Completion Date(including any extensions contemplated above),but the third business day following the signing of this agreement. is substantially completed by such date,i.e.,the Product has been installed,but minor parts or components are missing or need to be replaced or repaired,a hold See the attached Notice of Cancellation for an explanation of this back proportionate to the cost of remaining parts or work to be completed is tight. acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid balance of the Price,whichever is less. Do not sign this contract if there are any blank spaces. 6. FINANCING If payment of the Price is financed with a financial institution through Pella,all financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Date 8/18/15 /18/15 �� ( (J Customer signature DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Pella Windows & Doors Contractor c� y q-p-y—s Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. The Commonwealth of Massachusetts =1�rTint °tom _ Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiott/Individual): PtLt� �i�C:t?� LLQ' _ Address: City/State/Zip: _r` t i Phone#: Are you an employer? Check the appropriate box: Type of project(re(required):1.N.,1 am a employer with � 4. ❑ 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' 9. F] Building addition [No workers' comp, insurance comp. insurance. ❑ We are a corporation required.] 5. oration and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. 'No workerscom . right of exemption per MGL y [ p 12.❑ Roof repairs insurance required.] ' c. 152, §1(4),and we have no 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. 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 boa 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 andjob site information. Insurance Company Name: N(-t( F AA 0 Lc q-,e t; A T;\4% 01c . Policy#or Self-ins.Lic.#: UoA o to 1 Expiration Date: Job Site Address: City/State/Zip: 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. I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct. Signature: -- —�'` —=— ---- ---- — —- ---—-------!Date -- 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#: CERTIFICATE OF LIABILITY INSURANCE 06129ApE5MMIDDIYYYY) 11 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 endorsemenL A statement an this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER ONI—* CT Dom ihy A.Corlett,CIC,RPLU Fred C.Church,Inc. 41 Wellman Streal PHONE 9783127231 AXIC (97B)454-1865 No Laweq,MA01051 a FA : (000)225.1865 ADO ESS; dearlelt@fiefthurch com INSURERISLAFFORDING COVERAGE MAIC 9 INSURERA: G7aamInsurance company orAmedca 31534 INSURED New England Window Door LLC INSURERB; New Hampshire Employers Insurance Company 13003 !4 45 Fond!Read INSURER C Haved ll,MA D1832-1302 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:54457 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 REDUCEDBY PAID CLAIMS. INSR ADDL SUER POUCY EFF POLICY EXP LTR 7YPEOFINSURANCEIm JAM POLICY NUMBER MMIOO MM/DDLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED E 100,090 CLAIMS-MADE OCCUR. PREMISES a occurrence) 10,000 A X CG0001 MED EXP(Any one person) E BN8161407 7/112015 7/112016 PERSONAL F,ADV INJURY E 1,000,000 GENERAL AGGREGATE g 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG E 2.000,009 POLICY PRO- X LOC E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) E ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS AUTOSWIVED PROPERTY DAMAGE § Per accident E UMBRELLA UAB OCCUR EXCESS LIAR EACH OCCURP.ENCE S CLAIMS-MADE AGGREGATE E DED RETENTION E E WORKERS COMPENSAIION X WCSUATU- OEH- AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT E 500,000 OFFICERIMEMBER EXCLUDED? N 1 A 400040101 711112-015 7/112016 (Mandatory In NH) ELOISEASE-EA EMPLOY § 500,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT g 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remartm Schedule,it mom spacelsrequired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Client rt Msl O Cert Holder# © 90U-2010 ACORD CORPORATION. AI8 rights reserved. A,CClPD 2ry 19fifiblora Tha nr rtoev c !9 an!moi a to r� it?Prµ1 ?UiJi Jc7'ir Ct/ Ta -T �4 u. L slat' il4"C, Mations and Jai $lµCi?CIS i 6 Lige.n5'a: CS-089853 WILLIAM R NICI OLS t .� 57 PEARTREE RD- IIAVERMI I.MA'01830, Gor trnissioner 10!26/20'16:. j — Ulze (panvr�.aarzweyrf o���cca�cccicceeClrr e Officesaf Consumer Affairs&Btistness Regulattoo License or registration�talid,for mdrvadul use only MEIMPR017EMENT CONTRACTOR before the expiration:date If foBnd?return to - egistration: j7g383 TYPe f ®ffice.of Consumer Affairs andSusiness Regulation': xpiration 4l]df2Qlfx Corporation 10 Park Plaza-Suite.5170 — Boston,MA 02116 RELLA WINDOWS AtqDqfl OF2l WILLIAM NICHOLS _45 FONDE RD "��` I .,. ✓iJ /� Raj HAVERHILL;MA 01832 Undersecretary l Not valid without signature i I