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42 RAVENNA AVE - BUILDING INSPECTION $-7 -7 The Commonwealth of Massachusetts t;ECE1ti SER ACES Board of Building Regulations and Stand r�E�(�OHA( C$$I�EOF WIT a Massachusetts State Building Code, 780h '1plIk,Mar 2011 00NI Building Permit Application To Construct, Repair, Renovateb� �� , _ One-or Two-Family Dwelling (� This Section For Of6plied.' se Only �{ 7 Building Permit Number: Dat tjO Kn Building Otlicial(Print Name). Signature- - Date t SECTION 1:SITE INFORNIATION 1.1 Property Addr s : 0.`/e rl^ c\ 1.2 Assessors blap$ Parcel Numbers I.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq tl) Frontage(It) 1.5 Building Setbacks(it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ClOn site disposal system ❑ Public❑ Private❑ Check if es❑ p y SECTION2: PROPERTY OWNERSHIP!' 2.1 Ownert of Record:�2 �Il L I/1) i0,mlr c� rvL k� 0)q to t��5me(Print) t City,state,ZIP y Pckder,n � Avg fig - Z 5a - d636 No.and Street Telephone Lmail Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Attemtion(s) ❑ Addition ❑ Demolition ❑ 1 Accessory WO Number of Units_ Other ❑ Specify: Brief D scription o Proposed%Vu k= t SECTION 4: ESTIMATED CONSTRU Tl OSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ -2 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard -.,,Town Application Fee ?. Electrical ❑Total Project Cost"(Item 6)x multiplier x 3. Plumbing $ 2`:"Qther Fees: S d. Mechanical (11VAC) S List: 5. Mechanical (Fire S Total All Fees:S Suppression) Check No._Check rlmount: Cash Amount:_ 6.Total Project Cost: S /D 7 �' Cl Paid in Full ❑Outstanding Balance Due: MN L-L-5o Q 2,9- 1 s I SECTION 5: CONSTRUCTION SERVICES 5.1 rstructionSupertist/jrLicense(CSL) Dqq b 1 a ` t —/� IK6baF bGZ Os b C + License Number Expiration Date Name of CSL Holder List CSL'fype(see below) W Type Description Nu. and Street �� Q n U Unrestricted(Buildingsu -l0 cu. Il. � Cl !y-D R Restricted I&2 Famil Dwelling Cityll'uwn,State,ZIP M Nfasonry RC Rooting Covering WS Window and Siding oSoli)Fuel Earning Appliances ( '( 1 v Q'� - � I Insulation ' Tole hone Email address D Demolition p 5.2 Registe ed Home Improvement Contractor(HIC) -D HIC Registration Number Expiration Date Dale fI C I tiny Nit a 0c 11 �iggisl a me N7rdfStr 6 WS J�JKrJ�'\ / ' n/ 4 01- r �' �3Y' Email address City/Town,State ZIP M T 7Teele hone SECTION 6:WORKERS'COMPENSATION 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 1 ua ce of the building permit. Signed Affidavit Attached? Yes ......... No........... 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED.WHEN OWNER'S AGENT OR CONTRACTOR nAPPLIES FO/R BUILDING PERMIT 1,as Owner of the subject property,hereby authorize t"" r° ' ✓ ( 14 r t9 act on my behalf,in all matters relative to work authorized by this building permit application. �-1, 2v -�5' Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this Kluoriz, tion is true and accurate to the best of my kno% dge and understanding. �14�K � � � Xf zC) Print Owner'sorA sN:uae(Elecuunic ignulure) Date NOTES: I. An Owner who obtains a building permit to Jo his/her own work,or anowner 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 bLG.L.c. I42A.Other important information on the HIC Program can be found at WWWAUSS.•aL �Zi Information on the Construction Supervisor License can be found at www.nas.gov�!dns 2. When substantial work is planned,provide the information below: 'total tloor area(sq. it.) 'a ,(including garage, finished basementlattics,decks or porch) Gross living area(sq. 11.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches I'ypeofcoolingsystem Cnclosed Open_ 3. -I'olal Project Square Footage'may be substiurtcd for"rutal Project Cost" z The Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations a: ± 600 Washington Street � I ,, s� Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /Plleeas_e Print Legibly Nam e (Business/Organizzation/Individual): dMle /he..' �'�' wm'e- —i/Yt��rJ Address:_ Rog 6 0 5 KEN 111i 7I1Q/f e� City/State/Zip: S yLfj4 . 0/45`/S� Phone #: 508- 9,d a� — ( 9y,2 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. M 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.: 7- ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ 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 I LEI Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13Other comp.insurance required.] I W lit ,�j- *Any applicant that checks box#I 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. -Contractors that check this box must attached an additional sheet showing the name of the sub-conunctors and their workers'wrap.policy information. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: J V`e'U/ Jr�/'�r( J2�y`��jJrrLCy. $ O . Policy#or Self-ins.lL'ic.#:_�C b / / d 7 ! Expiration Date: Job Site Address: I C;L✓ txA a, V0rV-- City/State/Lip: Sq, 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 cer ' nder the pains and enahierof perjury that the information provided above istrue and correct Signature: 0 V, -M'`-� C` Date: �/ 2 O Phone#: �g b �- 6 7�2- 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): I.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 o022420N15Dmri) 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 endomement(s). PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAX 3560 LENOX ROAD,SUITE 2400 E-MAIL E AI No ATLANTA,CA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAICd 100492-HaneELGAW-15-16 INSURER A:Steadfast Insurance Company 26387 INSURED THD AT-HOME SERVICES,INC. INSURER B:Zurich American Insurance Co 16535 OBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,CA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATLm3242685m 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. ILTR TYPE OF INSURANCE INSRLSUBR POLICY NUMBER POLICY EFF MhllDOY FXP LIMITS. A GEN ERAL LIABILITY GLO4887714-05 03/012016 03/01/2016 EACH OCCURRENCE $ 9.0D,WO X COMMERCIAL GENERAL LIABILITY PREMISES .occurrence S 1.000,000 cLAIM3-MADE F_x1OCcuR LIMITS OF POLICY XS MED IXP(Any one person) $ EXCLUDED OF SIR:SIM PER OCC PERSONAL a ADV INJURY $ 9•000•ono GENERAL AGGREGATE S 9•000•000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ - 9.0m.000 X1 POLICY PE a LOC S B AUTOMOBILE LIABILITY BAP 293886312 03/012015 03/012016 COMBINED SINGLE LIMIT 1 Ea amideM $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Peraaklerd) $ HIRED AUTO$ NON-0WNED PROPERTY DAMAGE AUTOS Peraccident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DELI i I RETENTION$ S C WORKERS COMPENSATION WCOITT31493(AOS) 03/012015 031012016 WC STATU- OTH- AND EMPLOYERS LIABILITY YIN TORY 1 IT R C ANY PROPRIETOR/PARTNER/IXECUTNE WC017731495(AK,KY,NH,NJ,V17 03N12015 03/012016 1,000,000 OFFICERMEMBE EN NIA E.L.EACH ACCIDENT $ D IMandatory In NH) WC017731494(FL) 0310V2015 03/012016 E.L.DISEASE-EA EMPLOYEE $ 1.0%000 If yes,describe under - Conitnued on Additional Page DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ 1.0m.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space Is requl d) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,CA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee .1yLa�nJao1.�: ecr.�,d-u. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD h x � �l/T%1LdiLG/1£C1L `L C� ( �CL1JfYCl0111jeilt7i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvem,pp0qontractor Registration Registration: 126893 Type: Supplement Card r Expiration: 8/3/2016 THD AT HOME SERVICES, INC MARK NIADNA 2690 CUMBERLAND PARKWAY SUITE_3.00„ .. -- - — ATLANTA, GA 30339 Update Address and return card.Mark reason for change. SCA 1 ., 20M-05/11 I] Address (J Renewal Employment Lost Card Office of Consumer Affairs&Business Regulation License or re gistration egistration valid for individul use only F before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOROffice of Consumer Affairs and Business Regulation Registration:. 126893 Type 10 Park Plaza-Suite 5170 Expirauon;,.6/3/2016..:: Supplement Card Boston,MA 02116 THD AT HOME S RVICE,S;`INC , . THE HOME OEPOT.AT,HOME`SERVICES MARK NIADNA n n 2690 CUMBERLAND PAOKWAY S ATLA1M,GA 30339 Undersecretary — -llr-pt valid withou signature j }� Massachusetts-Department of Public Safety �J Board of Building Regulations and Standards Construction Supers Ivor Specialty License:CSSL-09�899 µ ROBBRT PMZOgtTt - Y Salem MA 01470= 311 Expiration' Commissioner 021101M10 t IIOMB IhIPROvEAtwir t'flhffRAC7 Sold,Fumhh„f sal InIoaffol by Rrnlrch Nadler.Rodma Nosh A Smth Ih1te: l Tiff)M.lhaur 4rat.e.Ira. tVNu The lkmr fkf.a A616anr Sa.itte RrnMh Nlunhen tl and,Cl. 'AM{Melon Tunlplke,Unit f,Sluc, ymry.hti UM5 T.dl Free h77.P(11-170g f edn.r fD a 7.1.20946o:hIC•la.a C o>a yo,RI('•n1.I a.r tfd? �J ,�[��.p1 (CST hh�I alll't11h,5?2 hM-A,fl.r h.gm.,wrnies,Gnua�birW,I,I:WA ImlWlatlm A/Wfrm. _.1 l_T�'1."HIV ._, L_'-IC..., V\._...!`r_Y1_._."0-5" .710 City Sant tap I Purcbwnnl Nark Phan II®r Phobia. Cfi P¢anr± Hume Addreu. I It different faun In,ollmum AddMw Cily Swlr E•nall Addrt„r lul ma,Y prajcd cnnmlmKmims nnJ Hnme Ikpra upd:nal:_- ,_ ❑I UCI NO'f wl,h In r,zcmt any makamg cnudx from'Iht Htmre[kpa W -�--' 1•rniccl Inronnnfion: linda,tgned 1-Cwlnmer"i,she owner,of the rwopwy located at the show infallu ban aAYear.agar,mfwy. and I I A,d I.aw Strr¢us.In,.('91le Ilnnic HvIsic)agna,to fumith.Jdim and omnge flr the In,allaam 4-InslaRa1Hn"1-Y all niataials de -abed on dre beluw and tan the referrn,nl Spar Shm(,t. all,If,Mlrh ate m.uPwmnf Inlu NH(Jnnr t h) this r fefaence,along with any applicable Stare Suppleo,ml—1 Rtprrnt Sunn wy dn,hrd Kann and any Change Order,IL.41,%urtly, '17a11I.CC) i 1} Job I: I�rr„�t Pinlu,Iw Rlnfing Siding Wimhwy tmuleum - Sl�tc((11g� ptp A y'•'"'1 ` QCiuucN1cnwcf1 QfxlryfT.rt❑ �� S 'O Ntrding Siding Wim6w, Inwlmim Qetmten I C,ntn QFntrl Dnw,❑ I S k Rm,bltg Siding Wimluw, Inwlxtm~ Qlanlm/Cann Qtstry Ikm Q S 1 Rmahtlg Sling WlnJiwy 1lrednwn Q(ivamlCar.a,QFntry ll.n Q."_�.,T S a S9tdna1m2tilkpa4dl',aalwt AltaraaJur upnuu„akeddlh lnarat S1ebr Rurlreast,eT,af,kPd,moalhm,atelhirddlheCuarw Amount, Taal Cnatraet Amount $ (0 3 . Cudana agra,that. annpohacly up"C..nplan ar td the i h+ ,eh 1b da.1.cu.1.ntn rdi...luau C.uoiuNun Ccn,r,,d (me Flat aah Ndua a,drfinod by an individual Site Shmi)and Iqr am Palantir due M aflplisaMc.ear11(",assay undo dea. r` ColUlICl agraa w heimnlly and.esaally Mligalal and habit h ma akr The Ibmr Dcp1a rncne,the right in Is ue a Cltmpe Order tv tamnute shl,C,rltr;M as any mdt•hhaal Rt%hwk%y sn,hded hemp•a 1 n,ih,ye,n.if The IttAte Ikpia a it,au(hrvel„y,Icc pnn„le,Mannm,that it;rmma pobnn n,Ml,gab•m,doe I.,a,h'liturd .. pnaMem unn the Mmlr,,m,a.nntsmtal IufmJ,,ueh ar nsd,.f.a•Mnw.r Irud Ina,m,to u,tny Ctn„yna,pseo$Weirs a Aixa.e a,,ri reyuntd to c.mrploc the rid'nas na lneludm m the�( Wn 1. � ( Ya,ment Suntmvy: The Payracid Sumnutr) a.�,D_kT9 D 7_—.., ins,fuded as pan,.4 on,cmirat ,as!trffi tk k'W Caavaat anhnntt unl psyorttlla reytarasl fa Ihe,klSnits aml final fuyiixwl by Pnthtrt tat,apliharttl., \CITICE TO CI NT4IMFR 1 an an etdilkd to a ranpklely Nkd•In rnpy of the C oibraci at tM droe-tw qM I"nod sign a C omphlim Comitimar(w titre i,late('arnpletlm C'ertilkvlr fir each laded ProdwI as delltsed I)y 11 c,anplMe. indl,{d,od Spry tiheetar 4efnrr rarL to Ihal Ihod,ct In the r,rnl of Rrndmt$a of this Contrarl,Ctwtomrr aanra to pay The Han nrpw ahr rota of oaterfal•,kvbw rgtre,es and ser+Ire,pro,idrd fit 'rM Ilan Ikp1q ar.luthorurd Seni,r I•rmidrr lhrwah the date of teagfmua ph"ans ghee alrarilnt<wo firth In this Aarcrtneul nr ullnned under applicable I.-. THE.IIUAiI,. DEK)111\y IL ITHtlb 1.l 1) %%it it 1% W41) 'TO Ili,: HONE. I)FK)T FROM THE Dl-PUSIt MINIFNI' OR UfIIER I`\1111:\"1\ Nlalrk, NI1I0.11T LIMITING rlit:HC111E DFK)T'S OTHER REMEIN,:%FUR RECOI'FRI UFSI CH ANUC\TS, \crr rtr and.\ahorlralim_ C"n""C'I+grte,an.l aSltuu,ls shx(111,Akleeoknt I,du erase P ,eylarst f +e Czwhvxr'^c Lm 1,lsa„nh t;r.e,J to the PlAhM,and in"Ltthv:.mn•,,and,at�y,nk.a.R,,r , aal,grnv,rnr..•,..r�. ail ar.r.rro.retxm r,•.a,d H,rluea u,l Fru.tliann lhr*.lrmmatnt.xnwa tt a„grd,w+'m' aq,I."F::aw,xr„C,:Qatti b, Cu cuter and the tkwne lklr.a l,aw.ynr w4taw k,b, aml asm.oaa la,a.m,'<tu,msd un,ii,tang,,aoarardy Ait'Te ,e cane,of and lb`ray awl a otpy,q thn.Agnmoma, Q ' Wr Acr�yrd.Jl� t,Go% .t , •. s tY Lrl —.-�...... bat t'aW.rwr{I'siStaaturr�-.-..��LWe SaLra Cswawhxt r.wvrt+t�,a TiflisI \(.Rt IiMFI%I NIIIRN.1 PE\\I'll ORIIRIII,A1111\ Rl lb"'111"14ING 1ARITtt\ \ortl'F fib lilt Imgll. IH:Kaf R1' N is%itarr of,. 'tilt 1'NIRb nil a!'IF8 Sh:\I\Li TNk\ '\t THF + s`rirt; FCPYI l%it,vr \TTN`1111) fit RF'r,0 C'1t\I ilVi i FORM TO M; IF U\!.. 0, VYI "It'%I.II PRI'_K'R)Bkn at WI, UN l'Ii�IAINER'S;:TU F_ Milk C wtgmlth,\L ft*,%\4prlkM4lttalS\era.,t'\Iap1P{1t n.1►lqa Npa.\Vs Naa l"101 LI►fMu`r IHT\:N7 e,r r•, 1 . Simonton Windows 6500 VantagePointe g Double-Hung -'ny 1/8"G!aas Argon-Ls•: E No Laminated Glass' �� With Grids ha;ona'Frmsaabn 'Ventana de d0ole guil,o?Ina Vindo 3.18 mm Vidrio Argon Loll Sin R^lcg,C>y..miLt7, vidrio laminado Con rejil!as r�1 CPD:SSP-A-44-21042-00002 07-75 DH ENERGY-PERFORMANCE'RATINGS EVALUACION-DE RENDIMIENTO ENERGETICO - U-Factor Solar Heat Gain Coet!,,mrt - .-aatsr-e Coefi;151!s Gaoarda ae 5'er'ie.F.,n>.� 0.29 1 .651 11 0.24 :erxm�o I Ili ADDITIONAL PERFORMANCE RATINGS c EVALUACION-SUPLEMENTARIA DE"RENDIMIENTO Visible Transmittance - 7a lm -"-5 de:3It5ibla 0.45 P1ar,�,6a:r. li. dales met.I'. eln ing,w.0rm; „plcable:'.Fk,:pr e:u. ;or tlelr,.nhng euh,la product'yeNr^sme.!tlFEC'alic'pare dl cT.'.ra1 tt.a rxed eat of amq. 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CITY OF SALEA MASSACHUSETTS 1 BUILDING DEPARTMENT 120 WASHINGTONSTREET,3'DFLOOR TtL.(978)745-9595 FAX(978)740.9846 KIlvIBERLEYDRISO�LL MAYOR TrIOMAs ST.FIERRE DIRECTOR OF PUBLICPROPERTY/BUn DING OC)AMSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit#i is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: 6(4( Sha-d-- (name of hauler) The debris will be disposed of in: o4 . b„, , p-rrF Z (name of facility) lu• �'idod�/ (address of facility) Signa ure of applicant y - 0 3 —/S" Date r Simonton Windows 6500 VantagePointe NFRC Double-Hung Vinyl 1/8"Glass-Argon Low-E No Laminated Glass No Grids e, 'aioeal Pereshat„r, Ventana de doble guillotina Vinto 3.18 mm Vidrio Arg6n�Low-E Sin Rvir:Bcwwkti vidrio laminado Sin rejillas r - CPD'.SBP-A-44-21042-00001 " 07-75 DH ENERGY PERFORMANCE RATINGS EVALUACION DE P.ENDIMIENTO ENERGETICO U-Factor Solar Heat Gain Coefficient Factorll Coofid arde.Ganeucrz de Enenie Foley - 0.29 1 .65 0.27 (us6P) lNevicolsq - ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDIMIENTO Visible Transmittance Tram mc-Nn de Luz%irchle 0.50 Pdanufaclurer shpulales Nal theca relines conform to applicable NFRC procedures for d&Iarmininp mmolo product pe do,mawe_NFRC redoes are tlHermined for a rued net dreuronmental condiVom and a specific product site.NFRC does nor rcom mend am/product and does not warrml the svllabidity of airy product for mryspno,use.Consult man Ad hirer's Neratue for other pmdu:t part,...mo inlorma6nn wmvnlro.on '. Este tatrbnra estipula que valores cumpden coo Iw procedimienl s aproalas de NFRC pars determiner el rendimoolo total del producle Los oelores u idos por NFRC son deterrninedos por un ewlunro Ole de condiciones ambientaln yun tameno de product especPmo_NFRC no racernienda noun produdy no muranl¢a qua el product sea adecuade pare on use especircv Coramile con el lellelo del fabneante pare el lee apmri A aide product wuw_nficorb i Unit qualifies for ENERGY STARS region(s): Northern, _y / North Central,South Central, ,�q�� Southern. - �y.- -STC;28--- 4' rSi.OaEGFifd DP:+25/-25 ND:Rein sted Size:4A on An" Florida Product Approval:FL5167 Applicable Test Standard(s): ANSI/AAMA/NWWDA 101/I.S.2-97,AAMAANDMA/CSA 101/I.S.2/A440-05,AAMAANDMA/CSA 101/I.S.2/A440-08, A440S1-09 Canadian Suppl 8971158/03 g0465 HS Gerlach 6860223 Keep!his label for possible ENERGY s'TARF rebates.To team more visit www.energystar.gov. Guarda esla aliquefa posibdes reembolsos ENERGY STAR@ Pare conger mad acema de esto,visile wwwenergystar gcv.