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24 NORTH ST - BUILDING INSPECTION (5) A fhe Commonwealth of Massachusetts Board of Building Regulations and Standards CITY ` !/ Massachusetts State Building Code, 780 CMR, 7"edition OF SALEM i11 Revised Jmroury Building Permit Application To Construct, Repair, Renovate Or Demolish a 'I One-or Two-Fumily Dwelling This Section or Official Use Only Building Permit Nu ber: 4 Date Applied: , Signature: Huildin)LSomintisiltibeirl psctor of Buildings 112te SECTION 1:SITE INFORMATION 1.1 Property gddress: 1.2 Assessors Map& Parcel Numbers awl h S�- 1.1 a 13 this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use La Area(sq 11) Frontage(11) 1.3 Building Setbacks(It) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public❑ Private❑ — Check if es❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 21 OwnerrojRecor 5u 5r4 n �\\Ptn � Cr. r-C^PY !-r�.r!' u�4 ,��nr�-L, ST- �e,M UVIt� 019� Name(Print) Address for Service: �} Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction O Existing Building❑ Owner-Occupied ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Repairs(s) ❑Number of Units_ Other WSpecify: Brief Description of Proposed Work': n ,.>_i 0 o r2 C_V , rem SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofllelal Use Only Labor and Materials 1. Building S (7 6 u o I. Building Permit Fee:f Indicate how fee is determined: ❑Standard City?own Application Fee 2. Electrical S ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) f List: 5. Mechanical (Fire S Suppression) Total All Fees:f Check No. _Check Amount: Cash Amount: 6. Total Project Cost: 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 LicenseddConstruction Supervisor(CSL) �(l� 1\r� �O�nGJ�c1 License Number lixpinttti�iun Italic I�;une u1l"CSL• I Iu1Jer ` \ ` ,,( List CSL Type(see below) Y` GI N)t f Descri ion .1 ss � U Unrestricted(up to 33,000 Cu.Ft. R Restricted IR2 Family Uwellin Signature M M Onl Ff'cleph4=ine RC Residential Roulin C'overin WS Residential Window and SiJinSF Rnidmtid Solid Fuel Bumin A liancc InstallationDaiJemial Demolitioneglstered Hospe Im vetr�eat Contractor(HIC) i 4G(OO pm Name ur HICK,gutrantNReginmtion Number apt, �- 0 -ay-t ress 1 Expiration Dale Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 1 2SC(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 ........ No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I A l , as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. - Signature of Owner Date SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION 1 as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application arc we and accurate,to the best of my knowledge and beh - ' i Print e Signature of Owner or Authorized Agent Dale (Simicd under the pains and penalties of 'u NOTES: 1. An Owner who ubtains 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 ad have access to the arbitration program or guaranty fund under M.G.L.c. 1.12A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.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 area(Sq.Ft.) Habitable room count Number of fireplaces - Number of bedrooms Number of bathrooms Number of half/baths Type of healing system Number of decks/porches T)peof cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for'•Total Project Cosl" i(J 40 6_UO CITY OF SALEM y s PUBLIC PROPRERTY a�Y r DEPARTMENT 12, \\.\9mm,.,,\S I!Ul T • NA I'V, )l.\ii.\I :Ir. ii I .I I Construction Debris Disposal Affidavit (required lur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CNlR section 1 1 L5 Debris, and the provisions of MGL c 40, S 54; Building Permit It _ is issued with the condition that the debris resulting front this work shall be disposed of in a properly licensed waste disposal Facility as defined by MGL c l 11. S 150A. The debris will be transported by: , �Qn A ,. A 4AL/308 (na to of hauler) I he debris will be disposed of in (name of facility) ` 1 Sl �k,rJrinY�in,t � 6151� (address of facility) ,iu 1aluj'c of permit applicant 3� l� date — - D4 Otis St.,Northborough,MA 01532 J&L WtNDows,INC.,D/B/A - MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) bvAndeTsen. Federal Tax ID#83-0404201 winnow aeeueexexr .,Mda.m�., CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ,yerisi Nama ///I Dare of Agreemem syerisi Street Address,City,Stare,and Zip Code 1 6,J S Mail Address Hame Telephone Number Work Telephone Number 'cYe �sue�P� / 1 N� I 77,- 7yy— 0_71 / uyer(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 oecificafion sheet(s) (collectively,this"Agreement).Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed It work under this Agreement. Method of Pymm:0 Cosh ❑Check ❑Mastercard 0 VISA Total Job Amount:/G 76 L x; Estimated Storting Data: ❑biscover U Financed,App#: Deposit Received(33'/)o ,d 4�-LP ~ S N me on Credi ard: Balance at Start of Jab(33%))E 4 11 Estimated Completion Data: Cre it Card Balance on Substantial -� Completion of Job(33%):/"'a 4.c1 Cfi CC Exp. Data: CC Security Code: Buyer Initialsi6� By initialing here,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. luyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that here are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation rom this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) hereby cknowledges that Buyer(s) I) has read this Agreement, understands the terms of this Agreement, and has received a ompleted,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first rritten above and 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF 'HERE ARE ANY BLANK SPACES. &L Windows,Inc.d/b/a Renewal by Andersen Buyer(.) Buyer(s) ;y: _eA Siiggnnatur &Pro ct Manager Signature Signature t Print Name of Product Manager Print Name Print Name .'OU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD IUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS 'OR AN EXPLANATION OF THIS RIGHT. _ - - - - - - - - _ _ _ .}c- - - - - _ _ _ - -� NOTICE OF CANCELLATION K NOTICE OF A T El1AT1ON )ale of Transaction You may cancel Date of Transaction ` i 1�� . You may cancel his transaction,witho any enahy or obligation,within this transaction,without ny enaly or obligation,within tires business days from the above date.If you cancel,any three business days from the above date.If you cancel,any )roperty traded in,any payments made by you under the property traded in,any payments made by you under the ;ontract of Sale,and any nellotiable instrument executed Contract of Sale,and any nesotiable instrument executed ry you will be returned within 10 days following receipt by you will be returned within 10 days following receipt ry the Contractor ("Seller'l 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 m canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the ieller 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 his 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 'hipment of the goods at the Seller's expense and risk. i the goods at the Seller's expense and risk.If you do make f you do make the goods available to the Seller and the the goods available to the Seller and the Seller does not Wier does not pick them up within 20 days of the dale pick them up within 20 days of the date of your Notice if your Notice of CaI Cancellation,t you may retain or dispose of Cancellation,you may retain or dispose of the goods >f the goods without any further obligation. M you fail ro without airy further obligation. If you fail ro make the Hake the goods available to the Seller, or if ou a ree goods available to the Seller,or if you agree to return the o retom the goods ro the Seller and fail to do so, then oods to the Seller and fail to do so,then you remain liable rou remain liable for performance of all obligation under for performance of all obligations under the Contract. he Contract.To cancel this transaction, mail or deliver a I To cancel this transaction, mail or deliver a signed and J ned and dated copy of this cancellation notice or any dated copy of this cancellation notice or any other written other written notice,or send a telegram to Contractor.J notice,or send a telegram to Contractor.J &L Windows, 4 L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis Inc. d/b/a Renewal by Andersen, 104 Otis Street, itreet, Northbo 01532, BY NOT LATER THAN North u MA 01532,BY NOT LATER THAN MIDNIGHT NIDNIGHT OF (Date) OF _ t (Dale) HEREBY CAN ME I SACTION. 1 HE Y , \CEL THIS TRANSACTION. Iuyere signature Dot I Buyer'ssignature Dale RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink J&L Wmdows,lac.d/b/a 24/12) Phone104 s Street,9.0900 or Fax 77 MA 01532 Renewal MA HiC License#entl Tax (expires,83- 404201 Phone 008.919.0900•Fax 779.987.3013 K Federal Tax[D# 83-0404201 byAndersen. WIXRCW REPLACEMENT mAe =Coap OF GRFAnR Massacauserrs nno NEw HnIrlPafmlE WINDOW SPECIFICATION SHM uyer(s)Name Date of Agr crn �� «n // C /1 terra f ! (� /L ���o •The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,iA actor rice 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 I. Co actor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) 0'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(CPVJ) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Late Gliding Window(GW) Glider/Picture/Glider(GFW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window(AM Picture Window(PW) Bay or Bow Window Patio Doors(see separate Door Specification Sheet) Z. Yes ❑ No Qty of Windows to be Custom Fit Replacement: 3. Yes ❑ No Qty of Sills to be replaced by Contractor: 4. ❑ Yes a No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings) Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be:4L,HP Low-E®SmartSunr (Taz L)edlt1Ag3b1e) ❑ Other If other,please specify: 6. Exterior color to be: E�White ❑ Sand ❑ Canvas ❑ Termnone ❑ Cocoa Bean 7. Interior color to be: F_,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. 8. Hardware:IL White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes&I No Install Lifts with Double Hung Windows 10. Screens: windows to have:cE;.IIalf or ❑ Full screens Screens to be: Fiberglass ❑ Aluminum ❑ Truscene GRIPE DETAILS 11.Windows have grilles: 0.Yes ❑ No If yes:E. Grille Between Glass(GBG) ❑ m Removable Interior Wood cr ❑ Full Divided Light(mu QQty: L i Qty- Qty Qty Qty: Qty: Qtr M-17F-71LOIe..s. I'l Glider cPN erG 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 city of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes Z-No Contractor will install new paint-ready or stain-ready inside or outside stops city of openings: Interior stops city of openings: Exterior stops q of openings: ❑ Pine ❑ Maintenance-free material 15. Owner is aware that Contractor does not do any painting. .- Owner Initials 16.❑ Yes Eg 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. Yes ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. I& Yes ❑ No A limited warranty shall be issued to Owner upon completion of thejob and payment in full. 19.5�'Yes ❑ No BuildirtR Permit Contractor will secure any and all necessary permits. The fee for the permit(s)is not included in the Contract /rice and a se arat check i$required t the time of sal for this fee. 20. Additional job details: �� / fJ I se 1 //: !l F�! i L..,�I n "`'u)� e6/� o! �lo�/ /P�/J / 21...Z/Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No fmal paymentshall be demanded until the contract is completed to the satisfaction of ell 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 teems. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are m writing and signed by both the Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet By-.newer Artdersen of Greater MA and NH B ( _ Buyer(s)/J Signature. duct Manager Signature Signal= S'vs f) A/In.h Co`© �.'le'- der Print Name of Product Manager Print Name Print Name Renewal byAndersem WINDOW REPL&GEESEIET mAm&=Comp=y PRDPEILTY C)W2,1M MUST COMPT=&L SIG?;Tffis SF.CTIDN TF USING A B=Q—M . ow=of the mbjeat FtopeMh=r--by=bal 8raewal by Avdasm (d ba-j Sz L Windows) to a=rm my behalf,tEL eIl msrr�teldt�ce W wcck mhkmt=dbyAddrms t�fs OfJcb S Ovol B OR 13r=EE&(As AcmS OF OWNM)MUST EOMPLFLE CsY SIGN TffiS SEL T- N the s s snd M=g=g apphrannafnz Addtffis ofJob . sips =datbeFemsendFinalauOfFQ7='9' PontNx= 5ignanue of owns/Ag v Datc Ina Ocis Smm c Nmrhb==91k MA MM ph® (503)919-NDO F= (5OS)M-003 wc�clmra iF�anr7..c.n rnm The CommonweaUh ofMassachuseffs Department oflndrrsh-iaIAccidents Office of Investigations 600 Tashington Street Boston) MA 02111 www.mass govldia Workers' Compensatirtn Fasuranee A-Miivit: BiEdI£ers/C€ntracters/EIectricimis/riuembers A.pt>iicant Informsdon /� Please Print Le23ly Name(ansiness/ore"*�azion�tndividoat�: Rena_U0 � y 4ndense.n .Address: /Oft �r` S ��fre�� City/state/zip: /l�orjLo r, A , Phone#: C�'iG�) July o9�G �.se you an employer? Check the appropriate bex: Type of project(required): 1.al am a employer with 00 4. ❑'I an a general contactor and I 6. ❑New, contraction. employees (full and/or part-time).= have hired the grab-contractors 2.❑ I sear a sole proprietor or partner- listed on the attached sheet t 7: doling ship and have no employees These sob-contractars have s. Demolition worldug forme in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We area curporatdon and its required] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing 0 work right of exemption per MCL I LF1 Plumhing repairs or additions myself [No workers' comp.' c. 152, gI(4),and we have o 12.❑Roof repairs insurance required.]t employ to employees. [No workers' 13.❑ Otbes comp.insurance ragrdred.] `!+nY applicant ttmt motif^L box M mist also M our the section below showing their workers'compeosafion policy iafnnsetion. t idomeown¢s who submit this n5Azvit indicating they art doing aZ wo3 aed thm hi=outside cow ma I sahm$a new a$davh indicating such. $Conrraetvn;that eheak tins box mast attn�h.a ea addriiur a sheet shaving the same of 9n:sob,-ootraetaa and their woricers'comp.policy iafnzmatioa I ara an employer that is providing workers'eanpensatdon ins=ance jar my employees. Below,is t he policy aced job site ircforrtcafiorr. ^/� ) Insuranee Company Name: I /I/t? � t»- ��InCr JAGnC Policy#or Self=ins.Lie.m'' 11 3 Jacc G 1 FCC �� /`{i/ Expiration Dater Job SiteAddress:_im )J�ryk chTr City/State/Zip: ,ems. /"Vn ��� Attach a copy of the workers' compensation polecy declaradan page(showing the policy zemanber and expiration date). Failure to secure coverage as required under Section 25A of MCrL c. 152 can lead t o the imposifion 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 f fie -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 veriiioation. ' I do hereby or the pains and parzaltfesp j perjury that the inform_ ation provided�above is true and carrect Simature , n Date: phone#: J� (,az) Official use only. Do not write in this area to be completed by city or town ajftciaL City or Tovim: Permit/License# Issuing Authority(circle Dine): I.Board of Health 2.Bu€Ildfr?g Depsatnent 3.City/Town Clerk 4.Electrical IsspeetDr 5.FI¢mbing Inspector 6,other Contact Person: Phone# *-' N[assachusetts - Department of Public S.tfetN Board of Building Regulations and Standards Construction Supervisor License - License: CS 101952 Restricted to: 00 DAVID BANCROFT 5 JOHNSTON AVENUE WHITINSVILLE, MA 01588 Expiration: 3/1 912 01 2 ('ommivsioncr Tr#: 101952 �lre,;�oax!nxomu+enll�a o�.�¢uaor/eiieetY4�' WR� &oard o,`Luddasg Regcia uns and-S:a dar.,s , HOME IMPROVEMENT CONTRACTORR � RegistraLotn, 149601 EYuation -24/2010 -; ype'-'-'Iement Card _ RENEWAL BY AND�RSQPJ DAVE BA?.JG 104 OTIS STREET NORTH13OR0UGH,MA 0 532 - — . _ AdminiAnt. -o -- 1 . F ,0R®. . CERTIFICATE UV LIAMILI I c��� s��tm m LIII:I, THIS CERTIFICATE IS ISSUED _ A FLATTER H iNFDTFICION R ONLY AND CONFERS NO. RIGHTS UPON THE CERTINO L F' JOSepf1 flllCKeOne - HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP SIItCKeDne IRSUC3nCe Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POL'2 BEL01N. P-.O. BCX'333 INSURERS AFFORDING COVERAGE NAIC A Ann Arbor, MI 45106-D333 Renewal by Andersen INSURERti Ha Ord Insurance Co an - INsuRERa: Nautilus J and L WiindOws,Inc. INSURER I-. -- 104 Oils St INSURER D-. Northborough,MA 01532 INSURER e DING RAGES PEQCUIRE OF INSUTERNI DR S.E D 13EL OF A E GEFN O (TRACT OR OTHER DDGU EENT WITH RESPECT TO WHICH TH SDCEFtTIFICATE M4Y BE ISSUED OR PERTAIN.THE,TERM NCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN l5 SUBJECT TO ALL THE T ERN15,EXCLUSIONS AND CONDITIONS OF SUCH ICIES.AGGREGATE LUMTS EHDWN TJLAY HAVE BEEN REDUCED BY PAID CLAMS.IY�PEcrA� ���TsrllcanON LIMITS ,�L N PoucYNUMBm EAerGoCelrsREHeE s 1 DDD Ono GJIERALLIASRFTY €JC95B461 iDl01120Q9 i0/01l2010 � s 100 DDD PREYlSES fEE e�tmee COMWERGAL GENERALLK ILTIY AIED EJ9 IA,rya P ro s 5 ODD CLAHJS MAD•' OCCUR PERSONAL A ADVIRJURY S 1 000 ODD GENERALAGGREGATE S 2 000 000 PRODUCTS•COMPTJP ACC. S 2 DDO ODD0_ �G'E'N�L AO'+PE.SATE UMR APPLIES PER: I PDUDY .PT'-- LOr AUrDAsoslle,.,cILTFY 35MC;C. Y.D 6390 161Q1l20D9 10101P201D poB�HmT11NGLEIJPIn I s 1,D00,DD0_ RkY AUTO BODILY INJURY S X ALL OWNED AUTOS (Par P-c SCHEOULED AUTOS BODILY INJURY i HIRED AUTOS i H09OWNFO ALTTOta PROPERTYDA Ar IPm a=OAany AUTO ONLY-EAACCIDENT F I I DARADE UABILTT p . THAN EAACC I s ANY AUTO AUIDO - AGO I i EACH OCCURRENCE S ELCE55NF'SR--LLA LIABILRY AOOREGATE S CCCUR CWMS"J'= S _ ' E DEDUCTIBLE E RETENTION FUANo 35 WC STATU OTH- D217201D 01712 WECPP 144 E.L�ACODENTI 50D D0_0 DISEASE EMPLOYEE E SDD DDDW ASuRnN O�CSWDA9ER EXCLUDEDT El-DISEASE-POLICYLINIIT E 500 DDD Pm bmd.mw SPECIAL PP.OVI5ICNE below I OTHER EECRm=w CF OPERA.nONSI LD.:ATONE T1.E.HICLES I ESCLDSIDNS ADDS BY Etl6DRGFSi@Ir f SF cGU1LPROV6IOP3 CAWcELLATOON ED BEFORE THE ELPIRATT SHOULD ANY OF THE Aa0VE DESCRIBED POLICIES BE CANCELL :ERTIFICATE HOLD'cR DATE THEREOF,THE ISSUING INSURER WILL aNDEAVOR To MAIL 1D DAYE WRITTEN INSURED COPY NDSICE TO THE CERTIFICATE HOLDER NWW TD THE LEFT,BUT FAILURE TD DD SD SRALL srBaSE ND OaWMLnOx OR L1 LnY OP ANY tOND UPON THE.WSURER,ITS AGENTS OR REPREEEOfTkwas. 0.UTHORL'ED PUEPRESFATAxwe (D ACCORD CORPORATION iRES &CORD 25(20DUDS) I ReneWal mcdr DulWcc3/Vloyl 6mpmb G Arpa Law E. —� DDubie Pomp 1D6-DD414BBS-D07 -EM?.RY PEFFEMOCE P&TMM U-F for N s}/E-P SDI3PAaal GaII1 CDa lDIB17't Q. � O:ll3. ADD- tD—NAL?:—qpo?m WEMi emsS- V'I,slbl3 T=smiz;'165 � +[ 53 wIIea - �O�aTtlil��lOO®i�i . WY.2YCC��mII�P�LIbY�I®@♦�CIoO•PCmC���R S � •opl " mtafs trl 8e frame .E' . �a �m� •DESIGN?P=—RRu?,_'—I?SFI• fser • � f:By �'a� I€IwFdpEklk'dl _ y H3 -L'G25 Sio,P_d Si71 DH _H . 1 'S➢r�liueg Ym�eiwh��i¢�e�meE�Wmv�b. . - 1 YWcerm¢CaCj=e1•.ELGL.Atr4�ymn... _ - wag.. ' . i IVw SEE An WINDOW REPLUC51RENT sa 4nd�se�Ccmp�F i o Whom It May Concern, - '-nclosed is a permit application package for a project we have been :ontracted to do in your town. Thank you in advance for receiving this xackage by mail. As we work in every town in the state, it greatly helps us 6n cur 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 Rating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) if you have any question regard-Ing this application please call sae at (SOB) .919-0992. Best Regards, Kelley Donahue Permit Coordinator 104 Otis Street 1 Northbormga4 MA, 01532 Phone(509)919-0900 Pas.(509)919-0903 Website:www.renewaibvanders=.com