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4 MESSERVY ST - BUILDING INSPECTION (2) ILI The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR W IMassachusetts State Building Code,780 CMR, 7" edition MUNICIPALITY . 'USE. Building Permit Application To Construct,Repair,Renovate Or Demolish a RevfsedJanuary One-or Two-Fami5y DweMng 1, 2008 Tbis'Sectioa Offi al Use Only. . BFi4noennitNumber I DatjApplitd. S gnature: '+1 Building Commissioner/Insp Buildmgs ate V/•TJ�' sE O : ORMATION L1 Property Address: ST .2 Assessors Map &Parcel Numbers 33 1.1 a Is this an accepted street?yes_ no Map Number - Parcel Number. 1.3 Zoning Information: 1.4 Property Dimensions: � - � ✓I ktl Zoning District Proposed Use. Lot Area(sq ft) - Frpntage(h) - I.5 Building Setbacks (ft). Front Yard Side Yal-ds Rear Yard - Required Provided Required Provided Required Provided - L6.Water Supply: (M.G.L c 40, §54) 1.7'Flood Zone Information:. 1.8 Sewage Disposal.System: Public❑' Private❑ Zon= — Outside Flood Zone').. Municipal.❑ On site disposal system ❑ T7 Check if yesO SECTION 2: PROPERTY Oat NERSH3P' 2,(3�Owner,of Recor i1 -Aoc .c. 11111.1P5 t( A e SSC V ST- Name(Print) Address for Service: . °pax-3LJs- aoag Signature - Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK':{cheek all thatapply) 1•;ea'CcasC �q^ ❑ "E stu:= auifdin^!7 O::^ :Occu^:^d ❑ ' P a rs s`''.0 ' --ticnfw ^' :ddhicr ❑ Demolition ❑ 'Accessory Bld_o: ❑ Number of I)nits__ Other SL.%Pccify:_.�e _ Brief Description of Proposed Work'': (0A, c e1 + •SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ 4 a 1_ Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Pown Application Fee ❑Total Project.Cost'(Item 6)x multiplier X 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) S List 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount:. Cash Amount: 6:Total Project Cost: $ ) q r 14c),4 o 0 Paid ut Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCU0i4 S�,kV,,,CES 5.1 Licensed Construction Supervisor(CSL) �'���"'� tl. J C Vl✓\t S c�✓� - License Number :Expiration Daze.Name of L-Holder n ,o VPJ� ��C )D✓C lvls U1Ep3 UstCSLType(seebelowl Add ..T e :J.= U unrestricted( to 35,000 Cu.Ft R Restricted 1&2 Family Dwellm '. M -Masonry Only Telephone. - RC Residential Roofing Cover i - . WS" Residential Window and Siding., " SF Residual solid Fuel 1313min Appliance Installation D- - Residential Demolition - 5_jz Registered 'Home imps vemgqnt Contractor(HIC) YCP-l�Pl-J�x \ �. ntyartP I HQ AA HiuL; yName rHl Re istrant a Registration Number 10� 5 �� . t.�r,s � Ica nls�a I _ y, Address. - t (Ci� Expiration Date $ignazure_"---ate Telephone SECTION 6:WORKERS' COIrI'rENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) . Workers Compensation Insurance affidavit must be completed and submitted with"this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit- Signed Affidavit Attached? ' Yes .,.......�^K' No.......... SECTION lac O44ERaI1THC� p.TIPN TO BE:Cp1VF�T ETFID,WHEN. OIL'NER'�uAGENTfiR-GONTR:4C.TORAPPLII`:S:E.OR'SIIII.31n'G'F,!_3t11'Si7' . . . I. cn !,L \ V off- 0.t_!P--Is I as Owner of the subject property hereby authorize C vi n t-5 y i1 to act on my behalf,in all matters relative to work authorized by this building permit application " Signature of Owner .. Date S C3L©P� bt QWNER'QR A�]I HORI F3"A1s 1 (rii, vl F v(✓�,c cS `T Ounerorfct thnrizsd n,_. er n�rebv[tdc.Ure _ that the stdfinzents and information on the fore uiva'applicatron aretiiie ancF accurate, to the best of my k io-erled�e and behalf. - �an �ePeiwe\ . .Print Name . � Signature of Owner or Authorized Agent � Date (Signed underthe pains and penalties of 'u - - - NOTES: 1. An Owner who obtains a building-permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not liave access to the arbitration program or guaranty fund under NLG.L- c. 142A-Other important.information on the HIC Program and Coushuction Supervisor Licensing(CSL) can be found in 780`CMR Regulations 11 O.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below - Total floors area(Sq.Ft). (including garage, finished basement/attics, decks or porch) Gross living'ama(Sq.Ft.) Habitable room count Number of fireplaces Number ofbedroorns Number of bathrooms Number ofhalfhaths Type of heating system Number of decks/porches ' Type of cooling system Enclosed Open 3. Total Project Square Footage"maybe substituted for"Total Project Cost" DEBRIS FOB This form is to be submitted via busldi gp=mut app nations why. cr th= is debris to be, disposed of. Proge ty Address: y AA e Ss,e c`V in accordance wath the prmisions of Mr-TL c,?0,§54,:a condition of the BuiL g Permit Number is that the debris resulting arm this wo.1i shall be disposed of is a properly Iicsed solid waste disposal fic tfty as defined by'MCrL c. I l§150_A, This debris ieill b(e disposbd of in: (Location of Faml#) 5iena=e of Pewit Spp4cent Date 104 Otis St.,Northborough,MA 01532 J&L WINDaWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 — Renewal .License#149601 (Expire 1/24/2012) MAndersen Federal Tax ID#83-0404201 .meow .e.ueewam m,w�,e,eomw,,, CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyerlsl Name Date at Ag mein - Buyerlsl Street Address,City,Sate,and Zip Code E4o it Address Home Telephone Number Work Telephone Number -7 - 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. q � Method of PaymentAMireck ❑Credit Card ❑Cash Cars. Total Job Amount: / Estimated Start Da ❑Financed Deposit Received Balance at Start of Job(33%): 'V Esttmmed Comple on Dare: If payment is by Credit Card, please fill out �` the Credit Card Receipt of Deposit Form Balance of Substantial SOiC3 — 3�Q�y S P P Completion of Jab 133%): Bysigning this agreement,you acknowledge that the Balance at Start of fob 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) bereby 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) Buyer(s) Signacureg P uct Manager YYY Signature '- / Signature 61 "G—�'lna�� NOYP� /Of,�o (`�G3L/Pf Punt Name of Product Manager Print Na,� Print 1,Yame 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. gc_ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ -i-:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _gs NOTIC ELLA710IN K NOTICE O CA CE TION Dale of Transaction U . You may cancel Date of Transaction C 1 + . You may cancel this transaction,with. any no or obligation,within this transaction,without any eholly or obligation within three business days from the above .If you cancel,any three business days from the above date.If you cancel,any ICI property traded in,any payments made by you under the property traded in,any payments made by you under the Contract of Sale,and any nesotiable instrument executedI Contractof Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by you will be returned within 10 days following receipt_ by the Contractor ("Seller") of your cancellation notice, by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled.if you cancel,you must make available to the 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 retum shipment of shipment of the goods at the Seller's expense and risk.. i the goods at the Seller's expense and risk.If you do make If you do make the goods available to the Seller and the t the goods available to the Seller and the Seller does not 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 of Cancellation, you may retain or dispose of the goods of the goads 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 ou agree goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so, then cods to the Seller and fail to do so,then you remain liable you remain liable for performance of all obligations 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 stgned and dated copy of this cancellation.notice or any dated copy of this cancellation notice or any other written other written notice, ar send a telegram to Contractor.J notice,or send a telegram to Contractor.J& L Windows, &L Windows,Inc.d/b/o Renewal by Andersen, 104 Otis Inc. d/b/o Renewal by Andersen, 104 Otis Street, Street, Northboro 01532, BY NOT LATER THAN Northbo p� MA01 532,BY NOT LATER THAN MIDNIGHT MIDNIGHT ' " u/ OF 7.1G1/ .(Date) I HEREBY CANCEL CEL IS SACTION.ON. I I Hi Y CEL 71i15 TRANSACTION. I Buyer's Signature Print Name Dole Buyer',Si,mdure Prim Noma Do,e RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 104 0fis Sm et,Northbomugh,MA 01532 J&L Wltldows Inc.d/b/e Renewal MA H1C License#149601(explrea 1/24/12) Phone 508.919.0900•Fax 774.987.3013 Federal Tax ID# 83-0404201 MAndersenrm WINDOW REPLACEMENT vnAMa,mCuvyvwy OF Glvxasa MASRAC11nREr3 Alm Nrw HA[.trs1®s W WDOW SPECIFICATION SHEET Buyer(s)Name Date of Agreement e Reverts)listed above hereby omfly and eve4y agree to purchase the goods and/or services listed below,in.6rdancce 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 DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantities: 7 Double Hung(05)jZ Equal 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) i Glider/Picture/Glider(GPM ❑ 1:1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window Patio Doors(see separate Door Specification Sheet) 2. Z� Yes ❑ / No Qty of Windows to be Custom Fit Replacement: n _ 3. ❑ Yes 4a'No Qty of Sills to be replaced by Contractor: 4. ❑ Yes R No Qty of Windows to be New Construction Jill frame(includes new interior&exterior casings)and actual Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be:CZ HP Low-E-4— ❑ Other If other,please specify: 6. Exterior color to be:JZ White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note; Interior color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner. S. Hardware:X White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. 91 Yes ❑ No Install Lifts with Double Hung Windows 10. Screens: windows to have:6M Half or ❑ Full screens Screens to be:PQ Fiberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11.Windows have grilles: ❑ Yes&r No If yes:❑ Grille Between Glass(GRc)❑ Removable Interior Wood amwl❑ Full Divided Light emu Qty Qty Qty: Qty Qty Qty Qty: i- oM oN E.. eft E...— Gnaer eRNme Draw grille patterns above "Use additional sheet if needed Owner a- pptnved(initials):( 1 ADDITIONAL WORK DETAILS 12.❑ Yes EY No Contractor will remove metal frames of windows. Qty of Units- 13.❑ Yes No Contractor will install new paint-ready or stain-ready casings. Inte or casing city of openings: Exterior casings city of openings:' ❑ Pine ❑ Maintenance-free material 14.❑ Yes 12 No Contractor will install new paint-ready or stain-ready inside or outside stops city of openings: In erior stops city of openings: Exterior stops of openings: ❑ Pine ❑ Maintenance-free material 15. Owner is aware that Contractor does not do any pain Owner Initials 16.❑ Yes [g-No Contractor will wrap exterior casings with alum um coil stock of color. Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17. Yes ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18.1 Yes ❑No Clean up all job related debris including old windows will be removed.Vacuum nightly. 19.J4 Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20.P Yes ❑ No Building Perrttit—Contractor will secure any and all necessary permits. The fee for the permits)is not included in the Contract Price and a separate check is required at the time of sale for this fee. 21.DEYes ❑No All discounts hie bCr peed to this agreement pn 22. Additi nal jop details:r l/ -/_ - A,. A/Q O Z� 4,AfCIre6 Z4;5 ZEEn -q > 23.,ET Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shell be demanded until the confract is completed to the satisfaction of all parties. It a 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 terns. This Spectfiodwar 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. Buyers)hereby acknowledge that Buyer(s)has read this Specification Sleet Renewal by Andersen of Greater MA and NH Buyer(s) BluIIyer(s) By: hk)maji Siga re of 41dud Manager . I9 Signat/use sigtature —J'QA T cqt CS &/7XX) IL/,4'A IJAVC Print Name of Product Manager Print Name ' t Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U1V www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): TEn� ndcrsan Address: f Jb �iS ye ree Iy r/n C\ City/State/Zip: Ala 616 i �� �i/�302 Phone #: V 0 Are you an employer?Check the appropriate box: Type of project(required): re�tt 1.Y�I am a employer with �90 4. ❑ I am a general contractor and I 6. ❑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. t ?• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp. insurance 5. [:1 We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work - right of exemption per MGL I I.❑ 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' 13.0 Other comp. insurance required.] •Any applicant that checks box p 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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.Insurance Company Name: �J /'I C�PGn� JM341 CG n C�- n Policy#or Self-ins.Lic.#: g / W C Expiration Date:/ 0 Job Site Address: �C S\. City/State/Zip:���t1fiA , VA ctOkq9-6 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 c rtify under th pain and penalties o r' ry that the information provided above is true and correct. Signature: Date: gill,SIt 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#: ac R CERTIFICATE OF LIABILITY INSURANCE °"TE`MM'°°"""Y �� 02/09/2011 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 _ - CONTACT Joseph McKeone NAME:ONE FAX 734-662-8100 uc No: JP McKeone Insurance Agency, Inc. E-MAIL ADDRESS: P.O. Box 333 INSURER AFFORDING COVERAGE NAIC# Ann Arbor, MI 48106-0333 INSURER A: Hartford Insurance Company INSURED J&L Windows, Inc. Renewal by Andersen INSURERS:Nautilus 104 Otis St. INSURER C: Northborough, MA 01532 INSURER D: MSURER E NSURER 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. 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 A DL SUBR POLICY EFF POLICY EXP DMRS LTR POLICY NUMBER MMIDDIYYY MM/DDIVYYY B GENERAL UABIUTY - MAGGREGATE RENCE s 1,000,000 DAMAGE COM RENTED MERCIAL GENERAL LIABILITY NC959461 10/01/2010 10/01/2011 PREMISES Omunence $ 100000 CLAIMS-MADE � OCCUR One Person) $ 5,000 ADV INJURY $ 1,0D0,000 GREGATE $ 2 000 000 GEN-L AGGREGATE LIMIT APPLIES PER: OMP/OP AGO $ 2000000 POLICY PRo- LOC $ A AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2010 10/01/2011 EOMaBBII EDtSINGLE LIMIT 1 00,000 ANY AUTO BODILY INJURY(Par person) $ y. AUTOS NED gOHEDULED 80OILY INJURY(Per accitlent) $ HIRED AUTOS AUTOSSWNEO Parr a cden DAMAGE $ $ UMBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012 , We srnru- OTH- A AND EMPLOYERS'LIABILITY ANY PROPRIETORTARTNER/EXECUTIVE � I E.L.EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? N I A (Mandatary In NH) I E.L DISEASE-EA EMPLOYEE $ 500,000 II yes,Cesctlbe miner DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMB $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ANach ACORD 101,Additional Remarks Schetlule,11 more space is requlretl) CERTIFICATE HOLDER - CANCELLATION INSURED COPY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOREED REPRESENTATIVE ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t +=. Massachusetts - Department of Public Safer Boardmf' Building ¢Rculatiuns and Standards Construction Supervisor License License: CS 95707 BRIAN DENNISON V. . 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/82012 ('on uu issiwmr TB: 2622 ��p.� �� ..✓�ee lO �r/� o�✓ ude�d :al Office of Consuomer Affairs&Busmess Regulation i HOME IMPROVEMENT CONTRACTOR ; Registrdt(orl:,,gt49601- .Expi2Q'172t - U6'�1�eJt�Sent Card RENEWAL BY�f4D- �0�„� BRIAN DENNIS .9 104 OTIS STREW, IN NORTHBOROUGH�M09T332 — Undersecretary '.. Renewa byderse . -� WINDOW REPLACEMENT anAsrdersenCetnpany To Whom It May Concern, . Enclosed is a permit application package for a project we have been contracted to do in your town. Thank you in advance for receiving this package by mail. As we work in every town in the state, it greatly helps us in our process. We have also enclosed a self addressed and postage paid envelope and would request that when the permit application has been processed, that you would mail it back to us. Enclosed for you review in this package is: ❑ Permit (application ❑ Home improvement Contractor License ❑ Construction Supervisor License ❑ Proof of Insurance ❑ Proof of Energy Efficiency bating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) if you have any question regarding this application please call me at (508) 919-0992. Hest Regards, Kelley Donahue Permit Coordinator 104 Otis Street _ 1 II Northborough,MA,01532 Phone(508)919-0900 Fax(508)919-0903 Website: www.renewalbvandersen.com