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28 NORTHEND AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and StandardsTaRevisedJanucry FOR ° mCIPALITY Massachusetts State Building Code,780 CMR, 7 editionUSE. wBuildina Permit Application To Construct, Repair,Renovate Or De One-or Two-Family Dwelling , 2008 �! This Seed n For O acial Use Only' . Building Permit Number. Date Applied: 1 Signature: Building Co issioncr hF- ro E ildings Date T ECTION 1:SITE II�'FORMATION 1.1 Pro erty.kddM s: 1.2.kssessors Map b Parcel Numbers 07 1.1 a Is this an accepted street?yes_ no Map Numbcr Parccl Number - 1.3 Zoning Information: 1.4 Property Dimensions: . Zoning District . Proposed Use Lot Area(sq ft) Frontage(fi) 1.5 Building Setbaelts (ft) _ Front Yard , Side Yards - Rear Yard Required Provided Required Provided I Required - Provided 1.6 Water Supply: (M.G.L c.40, g>4) 1.7 Flood Zone Information: 11.8 Sewage Disposal System- Zone, Outside Flood Zone'). Public❑' Private❑ — ' Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSI€II'' 2.1 Owner'of Record- LAC Name(Print) Address tos-Service: Signature - Telephone SECTION 3:DESCRIPTION OF PROPOSED`3JORKci(che6k all that apply) l.ie •CCn�4'�"ti Exis n ;.t;:n ri., n -•picd n P.c'p3ia(5) ❑ ^ ,.tl(.:(s) n i d.. -El utr.l,,c I .: ., pA, Denol,ilinn ❑ Acccssory Side. 0 Number ofllnits__ Other pcci(,•: Brief Description of Proposed Work'': s' TALI r-t tiPC"k ('�l1 c, yL-e- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building S 3t -I53-ao 1. Building Permit Fee:S Indicate how fee is determined: 2,Electrical S ❑Standard City/Town Application Fee s [I Total Project Cost (Item 6)x multiplier x - 3.Plumbing S 2. Other Fees: S 4..Mechanical (HVAC) S List 5.Mechanical. (Fire S Suppression) Total All Fees: S Check No.—Check Amount: CashA.mount: 6.Total Project Cost: S 3, L( S I'w ❑Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SEOTCES 5.1 Licensed Construction Supervisor(CSL) ,0�eL S a _ �a u i �bc f� _T - Licen'seNumber Expiration Date. Name of CSI'Holder . ` A W V�. \\ l List CSL Type(see below) 1 .SO�I�SI'W� A.�e antic .o M .. . . ss O1588 T ° '•' .i Description . U. Unrestricted(tip to 35,000 Cu.Ft) i�nature R Restricted 1&2 Family Dwellin - O M-. Masonry Only - ® RC Residential Roofing Covering - Telephone. WS' Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition , Registered Home Improvement Contractor(HIC) u HIC Co pany Name o HIC,gRegistra�t Name - Registration Number a-,t-iC. 6b.7-CA\9-OCM-3 Expiration Date ature Telephone SECTION 6:WORKERS' COMPENSATION Dl7SiPILANCE AFFIDAVIT(M[.G.L.c.152_ § 2S. C(6)) W orl, 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...........❑ SECTION 7a ;OWRTER 47JIIICi 2FZ ATIONCfih4PLETEB Sr IiEN `WNRG E NTOT::C0N\Tt_AC.T0RSPPLIESFORBInDI G O M 'SA 'PERA�i£I Q (-e S Yla fie.A as Owner of the subject property hereby authori e �� ri��tC to act on my behalf,in all matters relative to work authorized by this building permit application. .Signature ofOwner Date - S�FCTZQN77b -.OVrNER':'OR:4UTH'ORT�ED A EN Ib Ck4iti4?lE1Ift' ` '1•;.�1:::7.C.l.V.'�� -�"�'Lt l�!',f�FS4-�•'f iS:Otsv tpr:Aut1tnitzed At t � ent i� .rehv tt rHe':' ': .:�.:; ..-, Liat the=laten_ents aa?d 1P_3 J3711an0!a qn t1?e fql C4L lnfl HpphCaG011 art. l�Ind accurate, to ,the b-st of m� I:fim ledbe and . .be]: (� .'trio[iJ. . / / rA all 1 le Signat Owner or Autho ' ed Agent . I —Date (Sined under the painsand penaltiesofuerju - - . 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 Have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780'CIS Revelations I I O.R6 and I I0.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.). (including garage, finished basemenUattics, decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathroom; Number ofhalflbaths Type of hearing system Number of decks/porches ' Type of cooling system Enclosed Open 3. "Total Project Square Footape"may be substituted for"Total Project Cost" 45 9,oi DE&RIS FORM n-dS form is to be submitted with builaing permit applications wlieoever there is d bris to be disposed of Property Address: Pi A,)e in accordancz with the provisions of MGL c.40, §54,.a condition of the Builcl_in,Peaait Number is that the debris resulting from this work shall b disposed of.in a properly licensed solid waste disposal facility as dei» d by A4GL c. ill §350A n• This debris vdHbe disposed of in: - 1�o hm , ii,` V�ti �•ccsa� �O`1 ©�� SZ , l�Jf`t�n�fJ_ N��, V IS3a (Location of Fampity) --signature ofP •t Applicant Date • Fax sent by : 6172543535 THE UPS STORE 07-30-10 09:02 Pg: 4/8 101 Otis St.,Nnrlhborough,11(A01532 JrktL WINlxttup,INC.,n/B/A MA Home Imprnvement Cutnraefor '108)919-090h•kax:(774)987-3013 Renewal L,,a,se#149601 (expires 1/24/2012) byAJ1delserL Falerul'Fax iD t9,9-0404201 winraw auuctwr.. .�..,,,,a,�c.s.,nv a CUSTOM WINDOW AND DOOR REMODELING AGREEMENT s.r�l+I Na D.ro of ng.toment i - Q a se, Sr ;b V, 2.-N LD suyerbl Strut Address,City,Sinn,and Lp Code ENail Arld,n,. Home Tde lane Nbe, Work ielsplane Numbs, c\� r ryf.cess l`i Wig„ �1��- L106`3a9't �) ��l 1, 3a 01 ?�1 filwr(s)hereby jointly and.severalty:igrses to pumlism the products and/or serviecs of J&L Windows,Its,d/b/a Renewal by AtsdC,,cn (`Contractor".),in accordance with the terms and conditions described on the fmat and the reverse of this ggoannent and on the attached sr.ificalion gh2et(s)(collectively,this"Agreement").Buycr(s) hereby agrees to sly;rt a completion certificate after Contractor has Completed all work under this Agnaemenl. -3j-,t,tJ'3 Method of Pymnt:OCash aCheck ❑Maslercord ISA Total Job Amount: �. Eslimcted Starting Data 1n J Discover !J Financed,A ) / PP#: Deposit R¢e¢ived 7 I Nome on Credit Card: Balance of Stott of Job(33%): 1 Eaimmcd Cam IeAon Dena: yykt p Credit Cord r; Balance on Sabamntiol yy l \5' `-� Completion oI Job(33%): / ,._ CC Exp. Date: CC Security Code: By uritialiug hem,yin acknowledge that the Balanrc at Start of Job and den BAanm nn Substu atial Clompletion Royer Initials oCJuh coon.he made by rredil coral and most be made by lx;punal cheek,hank check,or Cash. Buyer(.)agrees and understuds that this Agreement Constitutes the entire mderstanding between the parties,and that there are no verbal understandings changing or modifying any of the term.of this Agreement.No alteration to or devimiva From this Agreement will he valid without the signed,written consent of both Buyer(m) and Contractor, Buyers)hereby acknowledges that Buyers) 1) has read this Agreement, understands the terms of this Agreement, and has mcciwd 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 BLANHSPACES. J&,L Windows,lac.d /a Renewal by Andrmen Buyer(q) Buyer(s) b/ By: .Qr� A. � Signature of Product blansgcr Si ramie Si S' gnaturc M "_ \ V'aXiA o' L e,aresnAban Print Name.of Product Manager PouL Nnma Prod Nsmc 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. NOTICE OFr-29 CAN4ELLATION X blOT F CAN.ICE OF cti Date of Transaon T .,I Lam. You may cancel Dale aF Transaction You may cancel this transaction,without any pens or obligation,within this transaction,without any penalty or obligation,within three business days from the above tyou Camel,any three business joys from The above dale If you camel,any 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 no rtiahle instrument executed f Contract of Sale,and any ne$otiabk:Instrument executedby you will be returned within 10 days following receipt by you will be rt-Homed wiBtm 10 days following receipt by the CarmaClar ("Seller") of your cancellation notice, by the Cant cc at ("Selki of your mnmllotion notice, ity interest arising out of the transaction will ! and any security interest arising out of the transaction will and airy secur 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 gird send-dion Seller at your residence,in subsrirttially 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 !, Conrad or Sale;or you may,if you wish,comply with the with the instructions of iha Seller regarding the return instructions of the Seller regerding the return shipment of shipment of the goods all the.Seller's expense and risk. ffie goods at If ie'Selleri expense'ond risk.If yau do make If you do make the goods available to the Seller and the 'available'to life Seller and the Shlet does not Sellerdoes not pick them up within 20 days of the daft pick them up within 20 days of the date of your Notice of your Notice of Cancellation,you may retain or dispose of Concellohnn,you may retain or dispose of the goods of the ggoods without an further tlbEgahon.t you fail To without any further obGgahon. t you fad to make the make the evadable to the 5eger, or it you agree goods on ailable to the Seller,ar if you agree to return the to return the goods ro the Seller and fail to do so,then goods to the Seller and fail to do so,then you remain liable you remain liable for performance of all oblgations under far performance of all obligations under the Contract. the Contrad.To cancel this transaction, mat or deliver a I To Cancel this transaction, mail or deliver a signed and sigrsed and dated copy of this m.mcellotiom notice or any I dared copy of this cancellation notice or any ether written other written notice, or send a telegram to Carthochm J ! notice,or send a telegram to Contra~.J&L Nfndows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis ! Inc. d/b/a Renewal by Andersen, 104 Otis Street, street, Nerthbomuol4 MA 01532, BY NOT IATER THAN Northborough,MA 01532,BY NOT LATER nM MIDNIGHT MIDNIGHT OF_15 7 a t O ,(pate) OF_.,, .(pole) 1 HEREBY CANCEL THIS TRANSACTON. 1 HEREBY CANCEL THIS TRANSACTION. Euyer's SienaW_ pis Bvyer'r Signature pde RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink Fax sent by : 6172543535 SHE UPS STORE 07-30-10 09:83 Pg: 5/e 104 Ou Street,Nwillio uugl h A 015(52 I ffi L Windows,Ire,d/b/a Ihmm 308,919A000-Fx 774347dll1 sIA HIC Ii.iSe 4 144601(cxpircs I/24/12)Renewala' federal l ax ID# S3.0404201 byMdersen. wIXOVN XEVLLLEYExT mAnleem(iml^ny OF Gtrwica Ma55AtxusLTn u+n NE'w Ranarsiax, • WINDOW SPECIFICATION SHEET Bl1ym(a)Name Uale of Agmctnenl Z-0— e C— I\2-�Na.\ —) The BUYar(s)listed abo e hcn:tryjointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms descrihed On the Specification Sheet and the front Mid the roverre 01 the accomparlyim;CGS]'OM WINDOW AND DOOR RCMODFI.ING AGRrEMFW, Of which this Specification Sbed is a part. '}WINDOW DLTAIB 1. Contractor will Install a total of windows in Owner's home,using the following individual ilusntitis : Double,Hung(DB)• Equal.sash,❑ Cottage 10111/3 top,2/1 tv- m6il), ❑•Oriel sush'(2/3 kip.il'/3'botioni) - Casement(C1i'1 ❑ Fiigge right.❑ Hinge left(as viewed from exterior): ❑Standard laokdlc'❑ Memo handle Double Casement(COW) ❑ Standard handle.[I McLM handle l.asOment/Picture/Casement(CI'W) ❑ 1:1:1 or❑ 1:2:1 ❑ standard handle.❑ Metro hand]., 2 Lit.Gliding Window(CW) Glider/Retire/Wider(GPW) ❑ 1:1:1 or ❑ AwnhiA Window(A W) Picture Window(PW) tiny or Bow Window Patio floors(see separate Docr Spccil ication Shirt) ❑ No Qty of Windows to he Custom ell Replacement: 3. ❑ Yes dNo Qfy of Sills to be repleioed by Contr..lor: _. 4. ❑ Yes 2 Ne Qfy(If Windows to be New Construction Full frame tincl odes new macri.1&exterior casings) Exterior oas�nyy''��s: El fine ElMaintenance-frecmatcrial ❑ Factmyapplieci9og Fibrcx In,,Olmold 3. Glazing to be: [Jj'HP I.ow-lX(.,SmartSunr,i (Tax CSrdit Ekspble) ❑Other If other,please spccityf G. Exterior color to be: ER5yhite ❑ sand ❑ Canvas ❑ Terintonc ❑ Coroa Bean 7. mhsriorcojcr to bc: LL-%T/Vhite [_1 Sand ❑ Canvas ❑ 'ferralone ❑ fine ❑ Maple ❑ Oak Note: Interior color call only Is-white,wood or Same.color as exterior. Wood interiors need to finished by Owner_ S. Hardware: b .White ❑ Stone ❑ Canvas ❑ Rri Cs ❑ Estate Hardware: Style: 9. ❑ Yes TNo Install Lifts with oub]e Hugg Windows � 10. Screens: windows to have: [Half of ❑ Full.sercena Scremstobe I5j/E!beigasa ❑ ,Aluminum ❑TruSeene GRILLE DETAILS 11_Windows have gnllcs: ❑ Yes Yxii If yes:❑ Grille Between Glass xa,;)❑ Re-ovable Interior Wood omwi❑ l7k,11 Divided Light muU Qty: QtY Qty: Qty: Qt.Y: Qty: QLY: J1 ]IF ELDD ou dvc', Glare cfww Draw grille pntlerns aLx+vc 'Use additional shock if needed (wdu approved(irufial ADDITIONAL WORK DETAILS 12.❑ Ycs E�, o Contractor will remove metal frames Ot wiudows. Qty of Units: 13.❑ lees IJ No Contractormil]insfa It new paint ready or slain-ready casings. Interi or casing city of openfnxs: Exterior casings city of Openings: ❑ Pine ❑ Ma,rtcnance-free material 14_❑ Yes RN, Cembsotorwdllitlstallnewpairn readyorstairl- c dyinsidcorotuside.stor gtycfopeirziis: Interior stops qly of oPeahlgs: Cxterior stops iffy of openftlgs: ❑ Fne. ❑Maintenan<e-ClYe material 15. Owner b aaXan:that Contractor does not do any painting. ( L )Owner Hiltials .. 16 ❑ Ycs NO Contraclor will Wrap exterior casings wit),aluminum coil stock of color. /Note: Wrapping may be required with srm window removal;removal of stor r m windows will leave screw holes in casing [ to , 17. v ❑ No Contractor will insulate,caulk and seal windows with 3-point syslenl W prevent water and air infiltration. ❑ No A limited warranty she[the issued to Owner upon completion of the 0h and payrrkcnt in full. 19. 1'cs ❑ No Building Permit--Contractor will so:urc any and all necessary permits. The fcc for the permft(s)is not included in the Contract Price and a separate check is required at the time of sale for this fee. 20. Addillonaljobdetails: 21. lees ❑ No Owner agMCS to be plesetll Ott the final day of installation for fund inspection and to deliver final payment. A'otinvlhrlyvneni shof be demandczl v,hl Mr.cvfstrnt is cwnj*hed to the mtG:sfac0on mall parffes. It is agreed and understood by and between the parties Thal this,Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODULING AGMEMENr,conatltutee the=tire unden:unding between the peeties,and there ate no vestal undersuindings changing or modifying any of the Seoul. This Specification Sheet may trot be changed or its tunes r>odiffled or varied in any way unless such changes min writing and signed by both the Buyer(s)and Contractor. Buyer(g)heroby acblcwledge that Boycott)has read this Specification Sheet Renewal by�Anderson of Greater'^and NH Buyer(s ry � -• � Buyor(s) By: CJwC Y co JG J Signahu<.Of -edict r Signature Signahsrc 2tt ado r,uke.Rf �c,�-an _ Print Name of Product Manager Print Name Print Name Fax sent bg 6172543535 THE UPS STORE 07-30-10 09:03 Pg: 6/0 enewal byAndersen: WIN DOW OW REPLACEMENT an AndersenComnan - Y PROPE�R/T { X Y OwNEi .MUST COMPLETE&�STGN TffiS SE=ON IF USING A BUILDER T, L, 11Q, GSn l�—An` as,D'✓ner,of the subject property hereby autlAopze Renewal by Andmeu (db.a. -J &L Windows) to act on my behalf, in aIl matters rdative to work authorized by this build-mg permit application for. Z L )cs Fl crnl,l, /oven oo, SWon , .r\t- O ) 1 )d Address ofJob Homeowaer Signature — — —-- ate OWNER OR BUILDER(A5 AGENT OF OWNIR) MUST COMPLETE&SIGN 7FRS SECIMON I 06 y�l as Owner/Authorized Agen[ hereby dec]are that the statements an``dm;or\marion on the foregoing applilicatioa lor: AcA Address ofJob Signed under the pains and penalties of perjury. Print Name. Sigmture o Owner/Ag;n Datle IN Otis Sint Norr bmtugk,MA 01532 Ph= (50s)979-0900 F= (508)-019-0903 wwwJ'mewalbyandCm=Com The Commonwealth. of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,HA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: B>ail€lers/Contractors/Electriciaiu/Plumbers ARtslacant Information a � Please Print LemblV Name (Business/Orgmizafionlladividoat): W enp-Oj 4nde-rS e-n Address: S Ll�Yecf' city/Sfate/zip: AL4 bo ro,, A4 LD-2- Phone#: Are.you an employer? Check the appropriate box: Type of project(required): 1.T I am a employer with 00 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 x 7. mode}ing ship and have no employees These sub-contractors have S. t Demolition worldng for me in any capacity. workers' comp. :nsur-mce 9. ❑Building addition [No workers' comp.insurance S. ❑ We are a corporation and its required] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑Plumbing repairs or additions myself [No workers' comp: a 152, ¢1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other Comp.insur-Ante required.] `Any applies that cbwlm box Rl mast also fill out the section b-1ow showing their workes'oompeosetion policy iafermadoiL t Homeowners who submit this affidavit indicating they am doing an wo3 and then him ouisde comrecros mast submit a new affidavit indicating such lr- mracmnt that eheolc this box must atteebrd an edditimo cheat showing the name of the aub-eomractoa and the wad='comp.policy infbrmatim I am arc employer that is prodding workers'compensation insu ance for my employees Below.fs the policy and job site information. Insurance Company Name: »e- /f7Cr4 K-GnCe- Policy#or Self-ins.Lie.P. 131'J� �1�C�� !i{�i`L� Expiration Dat---: 2-1�'7' I ,I lob Site Address:42 4 �U J�-1't�en tl A J e- City/Statwzp:c��p , M, Attach a copy of the workers' compensation policy declaiation page(showing the policy number nand 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 fire 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 er the pains and penaldes.ofperjury that the information provided abov is true and correct Simatare: Date: Phone# l J U g /��/l a C.lTwial use only. Do not write in this area, to be completed by city or town offlciaL 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# Massachusetts- Department of Public Safeh- �1 Board of Building Regulations and Standards �•f Construction,Supervisor License License: CS 101952 Restricted to: 00 DAVID BANCROFT 5 JOHNSTON AVENUE WHITINSVILLE, MA 0158B Expiration: 3119/2012 Commissioner Tr,": 101952 i t ✓/rs Yoom�noow�aldi o�"�/� Office of consumer Arrairs&Business Regulatiou b OME IMPROVEMENT CONTRACTOR Registration $,01I W9 1 Expiraf-- . .12 E t Card RENEWAL BY _— DAVE BANCRO , QQ i NORTHBOROUGH, IA�D_4 Underseemtary s j 2co ®„ . CERTIFICATE OF LIABILITY INSUK.Nr oti�oizo�o THIS CERTIFICATE l5 ISSUED AS A EsIATTER OF INFORMATION =ER ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE Joseph AficKeone HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP M1cKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P..O. Box 333 NAIC N Ann Arbor,MI 48106-0333 INSURERS AFFORDING COVERAGE JRED Renewal by Andersen INSURER A: Hartford Insurance Co an _ II6uRERe: a ilus J and L Windows,Inc. INSURER G 104 Otis St NSVRERD NoRhborough,MA 01532 INSURER E JVERAGES POLICY Ame NY OUCIREMENT,INSURANCE CONDITIONLISTED OF ANY CONTRACTEEN NG ISSUED OR DTH=R DOGUMEFIT WITAH RF-SPECT TOE WFUCH THIS SDCERTIFICATE. E 1V.0.Y 9E ISSUED IOR MAY PERTAIN.THE INTERM SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSION. AND CONDRIONS OF SUCH PDLICIES.AGGREGATE Luarrs SHOWN L%Y HAVE BEEN REDUCED BY PAN CLANS' POu=T EXPIRATION LIMITS �R tYL N � POIICV NUMBER EACKOCCURRENCE s 1 DDD DDO cETiERALLIASILRY €dC956461 1Dl01120Q9 10/01l2010 PREMISEBrEs�R= f 100DDD CDMMERGNL GENERAL LIABILRY MED EJ r em POR^r0 S 5 ODQ CLAIM,MADE' C]OCCUR PERSONALLADVINJURY 5 1000000 GENERAL AGGREGATE s 2 DOD 000 PRODUCTS.COMPIOP ArG S 2 DDD DDDD GENL AGGPEaATE LOSII MPLI-S PER: PRD- lAr I AurossLICY AeRJrY 35MCC XD 5390 10101l2OD9 1D1011201D osooa�N�ng NGLELwNT s 1,DDO.... A ANY AUTO BODILY INJURY f I k ALL OWNED AUTOS IPRf pcnonl SCI¢OUIID AUTOS BCDLY INJURY MRED AVTOS f (Per¢yR0 I NCN-0wNEGA Oi PROPERTY DAMAGE S JPW Ay49nq pUTOONLY•EAACCIDENi S I OARADELISLLRY OTIIERTHAM EAACC ANYAIfTO AJTD ONLY: AM I S EACH 0=1111:ZiDE f ECCESSILUSIOLLAUAWLITY AGGREGATE S CCCUIR CLAWS MADE t _ ' S DEDUCTIBLE S RETENTION S' VICSTATU• OTH•I - A LyDBr�RSCOMPEJSAnNAHo 35VtrECPP1441 02/17/2010 0711712011 ILL.��D s 5t)D009 EMPLOYEPs uA%Li IR 'E1.DISEASE-EA EMPLDYEE S 500000 0-'C wzMvR�E=LUD x2UtNE E.L.D=SEABE-POLICY LIMB S SDO ODD If roc tlesPOo mw SPEC NL PRDVISIDNSWs I OTHER pESCRBRION OF OPERA.TIONSr Lo.:4TlON5 f V3SU:Lf3 A e.r..,e.nNS ADDSD 6Y p♦DORBSM MI., PROVISIONS CAFICELLATEoN CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ELPIRAnOM DATE THEREOF.THE ISBUING INSURER WILL ENDEAVOR TO MAIL 10 DAY, WRITr" INSURED COPY NOTICE To THE CEI nFlCATE HOLDER HAME'D TO THE LEFT'BUT FAILURE TO DO So SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY KM UPON THE.MSUREX ITS AD'SM OR REPRE,ENTA S. AurHOR'LDREPRESEI6TATIYE A / p ��/•."( ©kCORD CORPORATION 1568 ACORD 25(20011DS) Rei�:' J 1" t Are&rsem I M?IDDW- P-PLAZEMEHT =AS ,L C-,,Fw I t Duel .. . ^4a�� DoublaHimg Inw E 1DD-DD414595-DO7 -Ef5"e.RGY PER D GE RA ING& 11-rap or(U S)/l-P Soi3r Heat Ga1n Cosnofsnt e7Fii� i4LP �6 CER.,ea1sS- - � Vsbls Transmitt�n69 _ . . 6.m Da - P�•NrZi -WbpNtlWllllb.(b�LtvlIRNN9Nn.Mlce®IN W..P.�Pedv-'.�. ' �dCO®LW�1N2.��C"'+�tI.YYiINi@�11.IES�•Cli�•�Iim¢310Ip�'¢LbYR G®.,1@�py�' [Q�upS p�mliP�Pd®®pq� y '"4 SsvltetedlntaDetCa • , muls Isash Rtts d I �EE4��`tr•Pa—�'�°TM-d and � . I edueetlen me�dalt- 68nRGtl�G`lfet: . I •DESIGN PR=-agUr'}_'-(?57 MIN _ - Ing NOR � IElwt�CE�l6^�I + i � • .0 C25 .abA D3 SSop>-d Si D8 =N . � icam,u-saw.wm�iorrariume< u�..�.n�t.��mrt.�r�N,a�. M`"°@�•,`• •°•.Arsa�rD�Dmw�m�wowwo�v.�m�m,PAumc- i 1 ew Anealt!oazw ► inDow REPLACEfi BUT =AridersenConapfittg 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 mall. As we work in every town in the state, it greatly hells us in our process. We have also enclosed a self addressed and postage pall 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 regarding this application please call me at (508) .9 P9-0992. Best Regards, Kelley Donahue Permit Coordinator 104 Otis Street 1 Northborough,MA,01532 Phone(508)919-0900 Pax(508)919-0903 Websitc:www.renewalbyandmsim.com