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7 RED JACKET LN - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR MUNICIPALITY, Massachusetts State'Building Code,780 CMR, 70'editions S Buidiling Permit Application To Construct,Repair,Renovate O emolish a' RevisedJarruary. One-or I'Wo-F eMng 1, 2008 " This' ecti For 0 cial Use /ZuZumber pp ' d: Ll ((f i g Commissioner/InspectorofBuild Date SECTION I: INFORMATION Pr perty Addr 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yeses no Map Number "' Parcel Number 1.3 ZonmgInformation• - 1.4 Property Dimensions:. - COV; Zoning District - Proposed Use. Lot Area(sq ft) Frontage(A) - 1.5.Building Setbacks (ft), Front Yard Side Yards Rear Yard- - - Required Provided Required::::Rcquirtd::::T Provided Required - Provided - - L6 Water Supply: (M.G.L c.40, §54) 1.7'Flood Zone Information:_ . 1.8 Sewage Disposal System: - -.- Zone OutsidcFloodZone?•. Public❑' " Private❑ — `Municipi D On site disposal system -❑ Check if"yes❑ SECTION2c PRO-PERTYOWNERSHIF' 2.1 Ownert of Re d nn II II" C I ` S4�1vn6e � eJ �G� YCrdclGe.� LN JA /g V . �1�� Name(Print) Address for Service Signature Telephone - - - - SECTION 3s.DFLSCkllinON OF PROPOSED VJORIC2`(check all that app)y)" ;Ies'C _ 3llrng .❑ 0' Addition ❑o ' Demolition ❑ Accessory Bldg: ❑ Number of Units_ Other Spccifi•:_. - .' [r _..+ Brief Description of Proposed Work'-: Ht IJr3 S'TYa.,)C l UfG SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) ' I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: fib, h O., ❑Standard City/Town Application Fee " 2.Electrical $. QTotal Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Su presSion) Total All Fees: $ CheckN"o. Check Amount: Cash Amount 6,Total Project Cost: $. 6 r SL(d Uv 0 Paid in Full 0 Outstanding Balance Due: ` SECTION 5: CONSTRUCMpN sFr"mS 5.1 Licensed Construction Supervisor(CSL) �S �J� g"��•la . Y` (A en \ erjinlIon- lrcenseNumber Expiration Date. Name ofCSL-Holder s List CSL Type(seebelow) r Add _ ..'i:'.•..:J-;y�., ;,.:.;•-c . C' .Des U Unrestricted(' to 35 000 Cu.Ft Signature - - -. R r-=Mcizd 1&.2 r=jv Dwelim LbA^a lr{.{Y-t ef M Masonry Onl Telephone. RC Residential Roofing Covering- . WS' Residential Window and Siding, - _ _ SF Residential Solid Fuel Burning Appliance Installation Residential Demolition 5.2, fCv fegistered Home Im ovemment Contractor(RIC) HIC inFtJ , 1 1.� 1�-FActe✓�tn I�q�C1( - Co(nnRanYNa��rH Cegistratltillame - Registration.Number (JJ 1111 11lnnll �1dyU A I/i Lo !)Iti . . . t✓�� 'C(19 -U`(C17 ' F,xpira[ion Date Signature. . . . Telephone .. - SECTIOI-I 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e:152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide . - - ' this affidavit will result in the denial of the Issuance of the building permit - Signed Affidavit Attached? Yes ....-- No..........❑ SECTION7a:•O:Pt?h(ER I)TRb a3-IONTO$E•CoMel n Yd#mN.. owls R11'Tu'AGENTbILCON11Tk 4!CT4DR dPPLIES F.ORBI7JI i? NG F11'Itll'�I as Owner of the subject property hercby authorizer;��� /I jet_'Son to act on my behalf;in all matters relative to work authorized by this building permit application. . - Si store ofOwner .. Dam . - :. _s�/c���ort�n <��R��oxA�riiamiz ,a�? nP���;� r��©i>i'.... ,-; �.:•;'-. ::...;.��; , . . -- }�. �tlli ir✓'(. . '1T.'FY-✓l '1.'k�tl � - ai-04�verpr'kOikbrizcd Agent ttetehv BeFlrtte; hat the =Ct tch+ents¢nd inPormation'en Lhe foreeemg app capon arttrme acid accurafr,to the best od my Ltto-w]edg�and . behalf. �. .Fnnt Name . Signature of Owner or Authorized Agent Date ft (Signed under the pains and penalties of perjury) - 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(MC)Program),will not have access to the arbitration program or guaranty fund under IvLGJ— c. 142A.Other important,information on the HIC Program and Construction Supervisor Licensing(CSL) can be found in 780'CMR Regulations 110.116'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 ofbathmoms Number ofhal aths Type of heating system Number of decks/porches ' Type of cooling system Enclosed Open 3. "Total Project Square Footage'may be substituted for"Total Project Cost" JC O 04 Otis St,Northborough,MA 01532 '�, J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal - License#149601 (Expires 1/24/2012) t byAndersen. Federal Tax ID#83-0404201 w,xoaw e....eexes. a�cw.tm CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ,o,lsl Name �-� p oak at Agreemem 56( 'na wtlt�ler icy 5� 13� II uyer(s)Street Address,Cary,Slate,and Zip Code ? fe SAt 5�}Ier. (h�l . 01970 Mail Address Home Telephone Number Work Telephone Number 5 ��e2tr co�v �1�8 iuyer(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 .pecification sheet(s) (collectively,this"Agreement').Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed It work under this Agreement. / f Estimated Storlm Dale: Method of Payment: OCheck OCredii Card ❑Cash Total lob Amount_ISP_'23_V e frinanced Deposit Received(33Y):- �� lit-eke Balance at Start of Job(33%).6 L Estimated Come etioa Date: If payment is by Credit Card, please fill out Balance an Substantial G\y5N the Credit Card Receipt of Deposit Form Completion of Job(33%): By signing this agreement,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. auyer(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 From this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) hereby. acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a oompleted,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 FHEREAREANYBLANKSPACESdfSF ShSF'411 rY Yion is No+ FSPPfT1(.Q,2 6� ^�° p1SSaC(rt Yjon�T�ff Gonkrac,4 t:nZ [:n5ntc.r'n i5 n�l� unGr'. Vul J&L Windows,Inc.d b/a Renewal by Andersen Buyer(s) Buyer(s) By: Sign titre �• Signature of Product Manager Signature S��rf 1 ql��l"Yil S��flnh t-(`Z�ef��Lp Print Name of Product Manager Print Name Print Name 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. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ — — _ _ _ . _ _ — — g� NOTICE OF NC TION x NOTICE OF CA CELLATION Dote of Transaction I You may cancel Date of Transaction You may cancel this hnnsaction,without any pens or obligation,within this transaction,without y e ahy or obligation,within three business days from the above ate.If you cancel,any three business days from the above date.If you cancel,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 negotiable instrument executed I Contract of 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.R 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 Sole; 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 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 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 goods 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 u aggree _goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so,Olen Dods 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 signed and dated copy of this cancellation notice or any I 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, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis Inc. d/b/o Renewal by Andersen, 104 Otis Street, Street, Northborou 01532, BY NOT LATER THAN North h 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF .(Date) OF (Dale) - I HEREBY CANCEL THIS TRANSACTION. I HEREBY L IS TRANSACTION. Buyar',sign-tun Print Nome Date B,-',siu,w— Print Nome Dab RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 49601 renewal RENEWAL BY ANDERSEN Ma uc6 fnres 1 24/12) Ot 6REATER MASSACHUSI T is AND NEW HAMP,..,RE Federal Tax ID# 83-0404201 Andersen. iaaaw P'PUCEMEXTtmMdmmCnmpny 104 Otis Street•Notthborough,Massachusetts 01532 Phone 508.919.0900•Fax 508.919.0903 - SPECIFICATION SHEEP uyer(s)Name Date of Agreement �i nc. e-6%Go The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance 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. PATIO DOOR DEEABs - 1. Install total of: Permashield Glidu Patio Doors Ate/' Awn 5 ) ri) 6'8" ❑ Other(not ble in 8069) Op.panel i left(D"t(as viewed from c Crior) VpSInterior and Exterior for to White ❑ Canvas ❑ Sandstone ❑ Terratone (Color same inside and out on PS)Hardware: Hite ❑ stone ❑ Bti_gktt Brass ❑ OtheSpecify ❑ Yes o Gliding Patio Door to have sidelight? Si. ❑ Yes Grilles? If ye GBG ❑ HIM ❑ FDL(Pattern is standard as viewed in book for all doors) 2. Install total of: Narrowline Gliding Patio Door(s) ❑ 610"x 08" ❑ Op.panel is❑ left ❑ right(as viewed from exterior) Exterior Color. ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone (Interior is WOOD and customer must paint or stain) Hardware: Metro: ❑ White ❑ s ❑Canvas; Stone ❑ Bright Brass ❑ Othet—Specify-. ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? I GBG ❑ INTW ❑ FDL (Full Divided Light) 3. Install total of: FYenchwood Gliclum Patio Door(s) ❑ Go"x 08" ❑ err Op.panel is❑ left ❑ right(as viewed from exterior) Exterior Color: ❑ White ❑ Canvas ❑ Sandtone ❑ Terratone Interior Wood: ❑ Fine ❑ Oak ❑ Maple Interior Finish: ❑ Pref nished White(Available only with white exterior) ❑ Unfinished(Paint/stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel ❑ Yes ❑ No Gliding Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? GBG ❑ INTW ❑ FDL (Pull Divided Light) - 4. Install total of: [ Prenchwood HmW Patio Doors) ❑ GO"is 08" ❑ Other: ❑ Yes ❑ No Active/Passive Panel?: ❑ Left ❑ Right(viewed from ext.which is active) - OR ❑ Yes ❑ No Active/Stationary Panel?: ❑ Left ❑ Right Door SwinE: ❑ Inswing ❑ Outswmg Exterior Color. ❑ White ❑ Canvas ❑ Sandtone ❑ Tetratone Interior Wood: ❑ Fine ❑ Oak ❑ Maple Interior rnush: ❑ Pretitushed White ❑ Unfinished(Paint/stain done by customer) Hardware: Metro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel *NOTE: Canvas hinged screen frame N/A—must choose white or stone if exterior is canvas' - ❑ Yes ❑ No Hinged Patio door to have sidelight? Size: ❑ Yes ❑ No Grilles? If yes: GBG ❑ IN1W ❑ FDL (Fa Divided Light) STORM DOOR DETAILS 5. Install total of: Storm Doors) 6. ❑ Full View❑ Mid View 7. Color to be: ❑ White ❑ Canvas ❑ Sandtone ❑ Bronze ❑ Forest Green 8. Size to be: ❑ 32" ❑ 34"(White only) ❑ 36" ❑ Custom(10 week lead time) Size: 9. Hardware to be: ❑ Bright Brass ❑ Nickel 10. Additional job details: t'5 kr;RATVl q t S no t Pf 00 r»'o'/1 �'� �') 3o S�G`r�Y� ia rdr 1, { 1`\JL1 and VCRl1G _ S. f I I Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. o iral payment shall be demanded until the contract is completed to the satisfaction of all 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 terms. This Specification 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. Buyer(s)hereby acknowledge that Buyer(s)has read this Specification Sheet. Renewal by Andersen Greater MA and NH Buyer(s) Buyer(s) By Signature of Product Manager signal— ` Signature Print Name of Product Manager Print Name Print Name Renewal byAndersenw a WINDOW REPLACEMENT an AndenanQvnrony CONDOMINIUM PERMISSION FORM FOR BUILDING PERMIT 7 Red Jacket Lane Salem, MA 01970 We, Crowninshield Management, being the duly authorized representatives of The Hamlet Condominiums, have reviewed the specifications for improvements to 7 Red Jacket Lane Salem, MA 01970 owned by Sabrina Federico. The Condo Association or Management Company agrees that the above owners have permission to seek permits and to carry out the proposed work. ri \ Si n tu.$�C`Dodo({9qi I`e`t`Iop�6Entry en I➢R� J ❑ate Print Name , (In lieu of this form, a letter stating the same purpose as above, on the Condominium Management Company stationary may be substituted.) 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 1 Please Print Legibly Name (Business/Orgmization/Individual): �jP nE UG IL I 41)det" en Address: jb,� 61iS Dree I City/State/Zip:A/o r A b 6 ro fA A d a,91- Phone#: ( U 0 t�� 71 f-d?D O Are you an employer? Check the appropriate box: Type of project(required): 1.aI am a employer with 30 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. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their M❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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.❑ Other comp. insurance required.] 'Any applicant that checks box#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. :Contractors that check this box most attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J 11),341/,1t 1J C e_ f 1 Policy#or Self-ins. Lie.#: ,�:911 �1���� jyN� Expiration Date: Job Site Address: R P.1� �C+[ y + L u1 City/State/Zip: \e M, VUI�, O tq-4 F) 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 rjury that the information provided aboveis true and correct. Si nature: Date: 10b o t 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 #: AM(MMMONYYY) aco CERTIFICATE OF LIABILITY INSURANCE °02/092011 o2iosizoll 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 NAME: Joseph McKeone PHD NE 734-662_81 OO c Na: JP McKeone Insurance Agency, Inc. E-MAIL ADDRESS, P.O. Box 333 INSURER(S)AFFORDING COVERAGE NAICR Ann Arbor, MI 48106-0333 INSURER A: Hartford Insurance Company INSURED J&L Windows, Inc. Renewal by Andersen INSURER B:Nautilus 104 Otis St. INSURER C: Northborough, MA 01532 INSURER D: INSURER E: INSURER 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. MISS rypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP DMRS LTR POLICY NUMBER MM/OD/YYYY MMMDIYYV B GENERAL LIABILITY EACH OCCURRENCE s 1 000 000 COMMERCIAL GENERAL LIABILITY NC958461 10/01/2010 10/01/2011 PREMISES Ee=rUnce $ 100000 CLAIMS-MADE ®OCCUR MED EXP(Any cne arson) $ 5,000 PERSONAL B ADV INJURY $ 1 000 D00 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 - POLICY DPRO- F7 LOC $ JECT A AUTOMOBILELIABILRY 35MCCXD6390 10/01/2010 10/01/2011 E.eecmeDt51NGLE LIMIT 1 000000 ANY AUTO BODILY INJURY(Par person) $ ALLOWNED SCHEDULED BODILYINJURY(Peraccitl.rO $ X ALTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Perawiben $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS OAS CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION 35 WECPP1444 02/17/2011 02/17/2012I We sTAru- OTH- A AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE N/A I EL EACH ACCIDENT $ 500000 OFFICER/MBIBER EXCLUDED? (ManEatory In NH) EL DISEASE-E4 EMPLOYEE $ 500,000 If yea,tlesc,ibe 0nber DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Atltlitiorel Remarks SchedWe,if 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. AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD a . i.. Massachusett> - Depamment of Public Safer . �yyy Boartlluf Buildin_ Re_ulations and Standards Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 (-umni isi„. Tr-9: 2622 . �-We �iomza...aarscoealFl o�.,i�aaaar/eu�elsQ !� g Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registratior(;"y.� woi .Expi on. 12 rypP-' I Card RENEWAL BY BRIAN DENNISy.�� �/ { 104 OTIS STREE'[, . NORTHBOROUGH�Mq_0'i332 — Undersecretary ., PRODUCT PERFORMANCE Andersen' NFRC Certified Total Unit Performance (continued) 1 N EPmducf r Glass Type U-Factor' i SHGC' Vf' Clear Dual Pane 0.45 0.60 0.63 - ''; -s. - ,.: 'L- Llear Dual Pane with Gtllles 0.45 0.54 0.56 Gil�d[ngndnw f! Low-E 0.30 0.32 0.55 E3 - - `' Low-E with Grilles 030 029 0.49 Clear Dual Pane 0.43 0.61 0.65 - �yF.ged Tmnsom� Clear Dual Pane with Grilles 0.43 0.55 0.58 - Clihle Top Window - Low{ 0,28 0.33 0.56 " g '- low{with Grilles 0.28 0.30 0.50 _j Clear Dual Pane 0.46 0.59 0.63 - Et�� Clear Dual Pane with G'lles 0.45 0.52 0.55 - I��-�++-��' Low-E 0.29 0.32 0.55 - N'''r" Low-E with Grilles 0.31 028 0.48 4Nprmlme Glidl�n-g Papa Deors"E � . �� Low-E Sun 029 0.20 0.30 - p'� -, Low-E Sun with Grilles 0.31 0.17 0.26 Low{SmartSun 0.28 022 0.50 3EI E'M Low-E SmartSun with Grilles 0.30 0.19 0." Clear Dual Pane 0.44 0.61 0.64 - - I,�s �- - Clear Dual Pane with Grilles 0.44 0.54 0 Sfi a k. Low-E 0.28 032 0.56 - 5 Low-E with Grilles 0.30 0.29 0.49 � '. �PenoxShreld p Low-E Sun 0.29 - 0.19 0 30 1 J ry n Low-E Sun with Grilles 030 0.17 0.27 n ij'-�SF E Low-E 6martSun 0.28 0.22 0.50 J Low-E SmartSun with Grilles 0.29 0.19 0.44 _ �.L' Clear Dual Pane 0.43 0.45 0 47 - h Clear Dual Pane won Grilles 0.44 0.39 0.40 - F'µ„,$-` _..'+? _ ,;r_t Low-E 0.32024- 0.41 .....:33® ,}Zinged Peho Doors Low-E with Grilles '0.33 0.21 035 Idsnng `f=� lmw-E Sun 0.32 0.15 0.23 Fmc'vai '�;: ti Low-E Sun with Grilles 0.34 0.13 0.19 ° y zF:1 - Law-E SmartSun 0.31 0.16 0 37 Low-E SmarSun with Grilles 033 0.14 0.31 - I i .I And ersen% a•(NFRC snel Glass Type 0{acmr' SHGC YP FiNRidG Glass Type I U-Facmr' SHGCa I YP o Andereen`400 SenJes - _ _ _'- _-_ ;'k,� �.Agtlersen•Aiehitechrrsi •:'- HP IurEd am am 0.58 T„� 1 t.Sw _ y HP WwE4 032 028 0.47 5 Y HP lvw-E4 with Gen. 029 030 0.52 HP Inw{4 win Gal. am 025 0.42 ® HPI E4 Sun am 020 0.31 ] _'� �' HP 1nw-E4Sun am 0.17 026 ].�® Arth YOntlww - AwN gWi°tl°°r-,^a HP lax-E4 Sun win Gales am 0.16 am A HP Lmv-E4 Sun wire Guiles am0.18 am .:;i n . a,,: s x�'t= HP Inw{4 Smardlun 031 0.18 0.42 -J HP Low-E4 SmarSun 0.27 am 0.52 ^ ... 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O35 0.1E am F fixwatl .NNE` HP Law{4 Sun 031 0.15 023 ® CEimtl Ranch 06F-"S HP Iax E4 Sun US 0.10 0.14 - - ,�aN D.. ovtswt g HP Iaw{4 Sun wM Gal. am 0.13 p.19 : ® BasvMg gl.9EeRght__ HP lnw-E4 Sun win Sell. 035 0.10 0.14 - HP lax-E4 SmaM1Sun 030 0.17 037 tIta�. �qy w 1 HP lnw-E4 SmertSun 035 0.11 am - S>.:.;:;--s HP lmr-E43martSun w/Gull. 031 0.15 031 .- �J HPl RSmanSue w/Gnll. 035 0.10 020 I `�.'C- 3�y ,•d HP lax-E4 031 am 037 HP IDN-E4 034 0.15 0.18 - _ Y3-'ry. a HP ow-E4 win Grilles 032 CM US �_:.��- �`-'� " tiM HP I ow{4 wan Galles 0.34 0.16 am - 'Frenchwvtl Pa8 HP law{4 Sun am 0.14 021 •_LIN FimtlF fi:P r' HP 1m 4Sun 034 US 0.14 - - I v0ovr Sitl Il�k-F HP 1aw{4 Sun win Grill. 032 0.13 0.2 _ Vhwing ASILeIikhF HP Law-E4 Sun wIth Sell. 034 0.10 0.14 ^p 4 YL F4 HP Taw{4 SmarySun 031 0.15 0.33 'y + jz HP 1a 114 Sma tSun 034 0.10 am - i HP law-E4 Sman5un w/Gail. am 0.14 am }]..;N� `.-_ •aw• 'f' HP lawE43mart5un w/Gdil. 034 0.10 021 - ;- HP E4 030 014 0.40 :y® r`^ Nam' HP Iaw-E4 032 am 0.37 S NP Inw-F4 win Gnlln 0.30 021 0.35 HP 1aw{4 wXh Gelllea am UG am - y.. F¢Imhnvod Pao - MP Imv{4 Sun 0.30 0.15 O.Z2 T,.] -°+,� Cmn rtlal Poor •° HP law-E4 Sun p32 0.14 021 HP law-E4 Sun win Gell. 031 am 010 HP 1m 4 Sun win Gnll. 033 0.13 0.18 - "� HP Inw E43mart5un 029 0.16 0.36 HP lux-E4 Sman5un 032 015 033 HP lux E4 SmartSun w/Gull. 0.30 014 032 ] HP lax-E4 Smarl6un w/GNl. 035 014 030 i Andersen Atelutectural 1Jr.�' "' ° _- I j ^Andersen•2005enes -: t 1?..,;L•%_4 3„ _^^'�i K r �-:.=,._E�...t t'L"'� w m HP Inw-E4 0.32 028 0.47 Clear Dual Pane 0.45 0.r 0.60 0.83 HP law-E4 win Grilles am p25 0.42 ]® 1T tmsti -1: Clear Dual Pane wBh Gnlln O.dS 054 0.56 - o= '� '`>i - t-:: HP Taw{d Sun 032 0.1] 02fi "lit® DouhlnN cYAntloiw'� - ImwE 030 0.32 0.55 _i 3y Cass evt 911ntl?w HP lav{43un weal,Galin 032 0.16 am .ice® 4 :.ta'r ^r Inw-E win Grill. 0.30 US 0.49 J.$'= Su '•- He luw{4 SmanSun 0.31 0.18 0.42 !30 st" -S Clear 0.1 Pane 0.45 0.61 0.64 .' HP 1m 4Surar19un w/Gales 031 0.17 038 ':Ja SNarmPC "� Clear Dual Pane with Gall. 0.45 0.54 0.57 - ciai 1 . { MP lax-E4 032 0.28 0.47 _ '+pouhl ryhnC Wl tivw _ Inw{ 0.30 032 0.56 HP law-E4 w8h Gal. 032 US 0.42 -: ® � .,ems "T-.£:_ lax-E wan Gen. 0.31 am 0.50 F h puemeid 1 HP l E4 Sun 032 0.17 026 Clear Dual Pane 0.44 0.0 0.66 - WI HP W E4 Sun wM Gdil. am 0.16 013 0.41 l57 059 HP 1aw-E4 SmertSun 031 - 0.18 0.42 __]® Tm Own m.MO.- W E 028 034 0.58 HPlax-E4Smartu.nw/Gal. 031 0.17 038 win G.R. 018 0.30 052 R.J' amgn.d.ener" Renewal byAndersert, -- WINDOW REPLACEMENT znAndersenCompany To Whom It May Concern, . Enclosed is a permit application package for a project we have beers contracted to do In your town. Thank you in advance for receiving this package by mail. As we work in eve 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 Rating I ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) if you have any quest!on regarding this application please call me at (508) 9 59-0992. Best Regards, Kelley Donahue Permit Coordinator 104 Otis Street 1 Northborough,MA 01532 Phone(508)919-0900 Fax(508)919-0903 Website:www.renewalbvandenen.com