10 SETTLERS WAY - BUILDING INSPECTION (3) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official U Only-
Building Permit Number: . Date Ap ted -
Building Official(Print Name) - Signature :Date
SECTION 1: SITE INFORMATION
1.1 Pro-- erty �$ress: 1.2 Assessors Map&Parcel Numbers
r_O P A `Ia OOoS — &1 b
Lla Is this an accepted street?yes no o Map Number Parcel Number
1.3 Zoning Information On C 11 1.4 Property Dimensions:
seZoning District Proposed Use Lot Area(sq ft) Frontage(fit)
1.5 Building Setbacks(ft)
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?
Public❑ Private ❑ Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of ord:
of R ov\O'V\
Name(Print) City, State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply).
New Construction❑ Existing Building Owner-Occupied _Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ I Otherils—specify: e
Brief Description of Proposed Work : L t
1 '> 'T .� ✓-tCj C_
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ ya� L'Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Five $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ yd rl oo 0 Paid in Full 0 Outstanding Balance Due:
n
SECTION5: CONSTRUCTION'SERVICES
5.1 Construction Supervisor License(CSL)
0 4
JosenL e(? q:Cn License Number Expiration Date
Name Hol er U
LD +<e ILI n f U List CSL Type(see below)
No.and Street 1� Type Description
y� 'n" U Unrestricted Bulldm s u to 35,000 cu.ft.
1\' `�O , 1 y y[n t�a `7'�n y R Restricted 1&2 FamilyDwelling
Aty/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
\'` _ SF Solid Fuel Burning Appliances
I I Insulation
Telephone Email address D Demolition
,[n5.2 Registered Home Improvement Contractor(HIC)
PAP h e wa k �, 4/1 c�r Sr-A )�s �c � 1 E oz on D te
IC Company ame or IC Registrant Name HIC Registration Number Expiration Date
%� j n-�ts SI -
jnd S Email address
on OrotVl/1G D/.f � .5 r1'_Ik l_s2
City/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCEAFFIDAVIT(M.G.L. c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION,7a: OWNER AUTHORIZATION TO BE COMPLETED.WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING-PERMIT
i- ff
I,as Owner of the subject property,hereby authorize OS� D h e a zza,
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b6 OWNER' 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 applica ' n�e and accurate to the best of my knowledge and understanding.
Print O er's o orized Agent's Name(Electronic Signature) Date
NOTES: '
1. er 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 can be found at
inn .mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dns
2. When substantial work is planned,provide the information below:
Total floor 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 balf/baths
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" L c� �,u
r
CITY OF SM EINI, NLA ssAcHusETTS
BUMDLNG DEPARTMENT
130 W iSHINGTON STREET.31D FLOOR
•or TEL (978) 745-9595
FAX(978) 740.9846
KIMBERLEY DRISCOLL
MAYOR THOM"ST.PIERRE
DIRECTOR OF PL BUC PROPERTY/131:1I.DING CONMaSSIONER
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 c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
1 \eV1L'U rl t lit r1 Je-r SC,,,
(nanle of hauler)
The debris will be disposed oI f in :
_Lh e-wL. ` \014 t�4ndPrs en
(narne of facility) �
u� C1�1 S sr . .r'I"t'l
f
OW6
(address of facility)
s' a of permit applicant
L" /S1 -3
date
dcbrivffdm
ReneWal. , MA Home Improvement Contractor
••• C! License#170810(Expires 12/23/2013)
byAndersen.
• Federal Tex ID#41-19189]3
cot„aaw aBreAarnr«T mMdmenComP.ny Renewal by Andersen Corporation
104 Otis St.,Northborough,MA 01532
(508)351-2200 e Fax:(651)351-4810
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyerls)Name gyp, - Date of Agreement -
U0 �/ll/2�11 I
Ur/ -/
Bvyerls)street Address.City,Slate,and zip Code
o � O 19
EMail Address Home Telephone Number W.F Telephone Number
710
Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation
("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached
specification sheet(s) (collectively,this"Agreement"),Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed
all work under this Agreement.
Estimated Staling Date: Method of Payment:
Tarot Job Amount: Amount Financed
- / _ �.,Ois O O Check Cash
Deposit Received(33%): oc eZ a f //�'o c) /O "CVG - .OYso/MC ODiscover
Bolance of Stad of Job(33%): [�ue9 - OFinanced OAMEX
Estimated Completion Date: If credit card is selected,please
Bolance on Substantial see Credit Card Payment Form.
Completion of Job(33%(: L)6
Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties,and that
there are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation
from this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) hereby
acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a
completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first
written above and 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF
THERE ARE ANY BLANK SPACES.
Renewal by Andre n Corp ation Buyer(s) Buyer(s)
y: i
Signature of P anager Signature Signature
Print Name of Product Manager Print Name Print Name
YOU, THE BUYER(5), MAY CANCEL THIS TRANSACTION AT ANYTIME 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: -
�_ _ _ _ _ .— _. _ _ = _ w - _ _ _ _ - _ _ - - _ _ - - _ _ _ _ _�
NOTICE OF CANCELLATION 0 - 'K ' I -NOTICE OF CANCELLATION
Date of Transaction i—/5—/3 . You may cancel Date of Transaction You-may cancel
this transaction,without any penally or obligation,within this transaction,without any pens or obligation,within
three business days from the above date.If you cancel,any three business days from the above are.If you cancel,any
property traded in,any payments made by you under the property traded in,any payments made by you under the
Contras of Sale,and any negotiable instrument executed Control of Sale,and any ne$oKable 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 ("Seiler") of your cancellation notice, f by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the
Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good condition
as when received, any goods delivered to you under as when received,any goods delivered to you under this
this Contract or Sale; or you may, if you wish, comply Contract or Sale;or you may,if you wish,comply with the
with the instructions of the Seller regarding the return instructions of the Seller regarding the 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 maayy retain or dispose of the goods
of the goods without any further obligation.If you fail to without any further obligation. M you fail b make the
make the goods available to the Seller, air if u agree goods available to the Seller,or if you agree to return the
to return the goods to the Seller and fail to do so, then goods to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligation 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 dated copy of this cancellation notice or any other written
other written notice, or send a telegram to Contractor. notice,or send a telegram to Contractor.
Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street,
Street, Northboroygh, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATERTHAN MIDNIGHT
MIDNIGHT OF ,(Date) OF - -iS-/4 .(Date) -. .
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signature trim Noma Dore Buyer's Signature Prim Name Data
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink ®JB„P2009 r us-0 MANH
Renewal _,enewal by Andersen Corporati, ( MA Home Improvement Contractor
- 104 Otis St.,Northborough,MA 01532
wAndersen. License#]70810(Expires 12/23/2013)
(508)351-2200-Fax:(651)351-4810 Federal Tax ID#41-1918413
WINDOW REPLACEMENT anA ene G, M
WINDOW SPECIFICATION SHEET
Buyers)Name Date of Agreement
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance rn a 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 DErARS
1. Contractor will Install a total of_windows in Owner's home,using the following individual quantities:
Double Hung(DB)_Equal sash_Cottage sash(1/3 top,2/3 bottom)_Oriel sash(4/3 top.1/3 bottom)_Flat sill a ere or class f
Ivo
Square Check Rail_Curve Check Rail
Casement(CS)_Hinge right_Hinge left(as viewed from exterior)
Double Casement(CD)
2 Lite Gliding Window(GW)
Casement/Picture/Casement(CO_1:1:1 or_1:2:1
Glider/Picture/Glider(GPN)_I:1:1 or_1:2:1
Picture Window Bay or Bow
Awning Window _#Lights Soffit/Roof Shingle/Copper
Specialty Window Patio Doors Isee separate door spec shed) Seat to be Primed/Oak/Pine
2. 0:2- Qty of Windows to be Custom Fit Replacement: !,
3. Qty of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS)
lxterigr casings:_Pine_Maintenance-free material_Factory applied 908 Fibrex bnckmold
4.Glazing to be: HP Low-E-4 rsl Tempered —Other If other,please specify:
5.Exterior color to be: White_Sand_Canvas_Terratone_Cocoa than_Dark Bronze_Forest Green Black
6.Interior color to be: White_Sand_Canvas_Fine_Maple_Oak_Same as Exterior Note:Woad interiors need to finished by Owner.
7.Hardware:�te Stone Canvas—Estate Hardware: Style:
S. Install Lifts with Double Hung Windows �
9. Screens:windows to have: Half or_Full screens Screens to be:zoe. rglass_Aluminum_TruScene
GRILLE DETAILS
10. Windows have grilles:_Grille Between Glass(GBG)_Removable Interior Wood(INTW)_Full Divided Light(FDL)
N71 Owner approved(initials) Draw,grille patterns below 'Use additional sheet if needed
QtY Qty: Qty' Qty: Qty Qty: Qty:
F-10FIF-11F ][:]'I I
ADDITIONAL WORK DETAILS
11. N 0 Qty of_Sills_Sill noses to be replaced by Contractor
12.1f Q Contractor will remove metal frames of windows.
13, &J0 Contractor will install new—paint-ready or_stain-reedy Interior Exterior casings in_Pine_Maintenance-free material
14.y�AJ''� Contractor will install new_paint-ready or_slain-ready_Interior_Exterior stops in_Pine Maintenance-free material
15. )Inds-Owner is aware,contractor does not do any painting or removal/installation of alarm system/hardware. It is the
responsibility,of the homeowner to have the alarm system re/hardwa removed prior to installation.
ntr 16. /V 0 Coactor will wrap exterior casings with coil stock of color.
Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17.Contractor will insulate,caulk and seal windows with 3-Point system to prevent water and an infiltration. Removal and disposal of alljob related debris,win-
dow windows and vacuum nightly included. Upon completion of ihejob and payment in full,a limited warranty shall be issued.
is. Yes 0 No Building Permit--Contractor will secure any and all necessary permits.The fee for the permits)is not
included in the Contract Price and a separate check is required at the time of sale for this fee. Ck# $
]9. es 0 No All discounts have been applied to this agreement price.
20.Additional job details:
21.tIII5970 No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
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.BYyerls)hereby acknowledge that Buyers)has read this Specification Sheet.
Renewal r en CoFptr ion Buyer(s) n Buyer(s)
�Signatu of Product nager Signature Signature
�C y%,J �;G�i JT�onyJ
Print Manager Print Name Print Name
iy
a
w
COLLINS COVE CONDOMINIUM ASSOCIATION
37 Settlers Way, Salem, MA 01970-5269
Ms. Megan White July 17, 2013
Renewal by Renewal by Andersen
Dear Ms. White,
The Collins Cove Board of Trustees have approved the
installation of two lite gliding windows in unit #10. As you know,
any exterior trim than needs to be removed must be replaced with
white azec trim. Work cannot start before 8am.
e o nan Sincerely yours,
10 WC"
Jeffrey W. Conley
President
Collins Cove Condo Assoc.
n/a Com mstweo(tk ofmmwwkttaetls
DeP&*N.etteofIxdtta*W-4=(dents "
,07"ojlnvea*advns
. 600 Woskington Sid+cet.
Boston,MA 02111
w'ww:ntdraagov/dle
Workers' Compensation Insurance AtSdav&. BUider /ContatrsEi
jsP Applicant Information lumbers
jsie�se 1'sint b
Name(Busincss/O►gmization/Isam&w):�p:t1 �-
Address: 1 0 s 5 r .
city/state/zip: n I` S a Phone#:
Are you sir employer?Check the appropriate box
1. I am a employer with 3 I� 4. I am a genax{contractor and I �of project(required):
employees(full and/or part-time).e have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole'proprietor or parmer- listed on the attached sheet. 7. `/�Remodel ship and have no employees These sub-contractors have
working for me in any capacity, employees and have weeicers' S. ❑Demolition
[No workers'comp.insurance �.msumace.t 9. El Building addition
a
] 5. [] We are a corporation sad its ]0.❑Blectricai repairs 3.❑ meowner doing all work officers have exercised their or additions
No wgdoers'comp. right of exemption per MGL I LQ Plumbing repairs or additions
required.]t C. 152, §1(4),and we have no 12.❑Roof repairs
employees.[No workers' 13.Q Other
�P•iownmce requa�ed.]
'Any applicmttbat abed:box#t niw Wo Sec om the"CbM below WnMMUan policy ,
t Homeowvms who s d"adei6 Wfi&Va md+ratma dreg WO&MI as natal Poan doe mmide Maaeoma nM�aemss shot check this boot too umcbed an dditi=d sheet dWWW the acme ofei. mbmit a new do&*i.dimeq suo4
employm. tribe sub-oontraMon have employers,l6eY�tmvide tbev wmkmx• ss6•oostrwtwe and aloe whether or amrbose mmW have .
camp.polirymtmhm. '
Inn an aap.Ioye/dwkpmwldbrg woikns'cornpenserllaal brsaon+rexjorAO enlpleytta Blow tr#ie byornwtbrn policy oadM alto
Insurance Company Name: c� p ,o� e Zn C�,
Policy#of self-ms.Uc.#: M t 1.) C I 1 R `�o Bxpiration Date.Job :_/
AttacheAopyO:'n .�P` \pr5 �ln ChYiStatdziP:S m IM�A OI i�o
Attach a copy of the worker'compeasattou I Het declaration page(showing the potley number and
Failure m secure coverage as required under Section 25A of MGL c. 152 can lead m the ' expiration date)
tine up m$I,500.00 and/or one-year imprisonment as wen as civil °�°a of eiminal penalties of a
Of ep m o$115 0 a penalties in.the form of a STOP WORK ORDER and a fine
day against the violamr. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification,
. n
w do hereby cerethe pubes end parerbbx ojpeojory Aber[the bejornadlorr provldnd about true con"
s• 4
Phone
oljeidl rrae Daly. Do not wrbe in this area,to be cornpleW by elty or town VAzchd
City or Town: PermitAucense#
Issaing Authority(circle one):
I• Board of Health 2.Banding Department 3.City/rowa Clerk 4.Electrical Iaepector S.PE
6.Other
Contact Person:
Phone#:
CaR CERTIFICATE OF LIABILITY INSURANCE a 25/2012'""'
TWS CERTIFICATE IN ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RKNHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE 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 INSURERM), AUTHORM
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: I the artllnb holler Is an ADDITIONAL INSURED.the Polk (Ms)must be sMom Pd. N SUBROGATION IN WANED,sub)sci to the Iemis end conditions of the Policy,earfein policies may regain en andomemanl A s40smeM on this grUllCab doss not AIM certlflesta holder In Neu of such s d9hM to the
PRODUCER 1-612-333-3323 Jonelle mr9rove or Eric Johnson
Hays OompAniea F . 612-333-3329 Ax
Me:612-373-7270
so south ech street
suite 700
Einneapolis, HE 55402INSURED -
0mU ATPORD 10 COVERAGE NOW 4
ReaerueExw: OLD REPUBLIC Me CO neural By Andersen Corporation an 34147
104 Otis Street INSURERS. l01y10101I. D=OM P3RE Xxs CO OP PITTS 29443
NEINERC:
EOrthborOu9h, IOU 01532 NSURERD:
NEURERE:
NEURBIF:
COVERAGES CERTIFICATE NUMBER: 29229436 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 PAW CLAOAS.
LisISISR TYPE OF INSURANCE POISYRUMBER EFF POUCYHP
A OEMERAL UAINUTY 1BIEY 5962E 10/01/1 20/01/19 LAM
CO
x � �" �+� a 1,aoo,000
x f $00,000
CIANS#IADE OCCUR MED E1P ono f 10,000
PERSONAL a ADV INJURY f 1,000.000
GENERAL AGGREGATE f 4,000,000
G9R AGGREGATE LIMIT APPLE PER PRODUCTS-COMPNP AGE f 3,000.000
x PPOU FWIr R6 Loc
A AuroMOsaE LIABelIY f
M71TB 21700 10 0l 1 to 01 13 DOAmaxGSaJGLEUMn
z ANY la ee ere) f 31000,000
ALL OWNED AUTOS EDGILY NAVY(Per pa ) f
SCIEOIAFDAUTOS BODILY DUURY(Per eoddwQ f
x HNEDAUTOS DAMAGE .
f
x NON-GVNED AUTOS
f
i
B z ureaEiLwuAe z OCCUR 13273355 20/01/1 10/01/13
EXCESS IMe EACH OCCURRENCE f 2s,000,000
CLAIMSUADE
AGGREGATE f 2s,000,000
DEDUCTIBLE
zRETENTION S 25,000 f
A AND COMPENSATION Y/N AMC 117948 00 10/02/2 10/01/23 x WG ATu' 07H•
AmYPROPRIETORi
2: CUTTVE� N/w ELEwdl/ ENi f 1,000,000
Les EA-DISEASE-EAEMP f 1,000,000
OEeC OPTION OFFOOPERATIONS bdow
E.L.GEEASE-POLICY LWR f 1.000,000
aEfCRIPTION OF OPERA7NNe/I.OdL1K1N5/YflOCIEE (AeAet ACORD 1a1,AdeltlelW Reaaft eeMtlW.anwe epees b reEeeeq
Evidence of iasuroaee.
CERTIFICATE HOLDER CANCELLATION
Evidence of insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTIgNMED REIREEE1dTAliYE
erica ®IeaE,2oo8 AcoRo CORPORATION.
?Y All Hehte ne.wr
ACORD 25120091091 The ACnr7n nam....I L..._�_��—�__.-- ____
. 1 cT/re �pomnnanwea�l�o�P/�noaar.�iusclld
i Rict of Coosamer ARairs&Baaintas Regula8on
' - i _ ME IMPROVEMENT CONTRACTOR
egietratlon:.1Z081t1: TYpe
Expiraflon: 12@312013- Supplement,
RENEWAL BY ANDERSON C012PORATION
JOSEPH REZZA - .
104 OTIS STREET - �---o
NORTHBOROUGH,MA 01532 Undersecretary
i
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-065272
JOSEM P RE7.W
168 EELLEY BLYD
N ATTLEBORO NA �
Expiration
04/25/2014
Commissioner i
i
Du nid remora m�ERd node Insp�on. Srve IRhd fmithRe retNencn
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Renewal.
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ANU-N-35
• W. Mnyl Co -lh.FF• -
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Pmdu-mo: Glider
i
ENERGY PERFONNANCE RATINGS
U-Factor Solar Heat Gain CoelDolent
0.29 1.65 0.21
.s.n-F el cm �
• AOO171ONAL KRMRMANLE RATINGS
Visible TransmlRance
0,49
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