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10 SETTLERS WAY - BUILDING INSPECTION (4) The Commonwealth of Massachusetts ' 'Board of Building Regulations and Standards FOR Massachusetts State Building Code,7.80 CMR, 7 s edition �NICTALITY Building Permit Application To Construct,Repair,Renovate Or.Demolish a' Revfsediaauary. ' it elliri 1, 2008 _ - One-or 7ivo-Fam Dw 1J _ This-Swtion For official Use Only' . Building Permit Number PPlied n. Signature: / ��� Building Commissioned Inspectorof Date. SECTION 1:SITE INFORMATION 1,1 Pro e . ddr s: E11Assqssors Map&Parcel Numbers � �� i )na �b� evo 1.1 a Is this an accepted street?yes_ no ber Parcel Number1.3 ZoningInformatiopt: - . perty Dimensions:ZoningDistrict ProposedUse. (sq it) Frontage.(ft) ' I.S.Building Setbacks (ft). Front Yard - Side Yaids Rear Yard: - Required. Provided -Required = PMvidcd Required Provided L6,W ater.Supply: (M_G.L e 40, §54) 1.7 Flood Zone Information:_.., 1.8 Sewage Disposal Sysfemc .:--- Zone: Outside Flood Zone?-'. 1Jiuoici al❑ On site disposal stem -❑ Public❑' Private — - P s2 sy . ' Check if SECTION 21 TROPERTY 0VniFR4H3P' 2.1 O nerr of ecorrl: 50\-\ , or�iin �O �e �es� l l�_�1ewlJVu OMIT Name(Print) _ Address for Service: . - a��-NHS- oa3D, Signature - - Tdephdne SECTION 3;D'FSC.RIPTION OF YRtOPOSED WORKe-(chehk all that apply) ]sew'CcnsCuction C "E;:isdng-Suiirliiig. O.:hiSr-�^^up;cd :n. pairs(s;'. -�1'e �tioa(s) L-�' :ddition.0 . Demolition ❑ •Accessnry Bldg:❑ 1Jurtber ofLlnits other � y�ccifr_ e Brief Description of Proposed Work=: k' . . n D ST(�J c.TiJ✓'u. C SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building F 8% vo 1. Building Permit Fee:$ . Indicate how fee is determined: 2 Electrical $ ❑Standard City/Town Application Fee 13 Total Project Costi(item 6)x multiplier x . 3.Plumbing $ 2. 'Other Fees:.$ 4.Meclianical .(HVAC) $ Last 5.Mechanical. (Fire $ Su cession Total All Fees:$ Check No. Check Amount Cash Amount 6,Total Project Cost. $. L a J_ p Paid"ut Full ❑Outstandmg Balance Due: r • < SECT-IONS: CONSTRII.CQN'S�?R ;CES S.I Licensed Construction Supervisor(CSL) �Licensc NumbQ EXPURtiDn Bate. Name of CSL-Holder n r ListCSL Type(secbelow) — Jhc DIG,cl3 _ - - n ton Address - - 11 Unresh-ieted(tip to 35,000 Cu.Ft Sfgnaturo - .. R Resufcted 1&7 Fmni) Dwc11mS 7 - . M .Onl. - .. c RC - Resdential Roofing Covenn - - Telephone. WS- Residential Window and Siding,_ `SF li s amfiel NOW Fuel Bumin A liance Installation Residmtial Demolition 5y2 Registered' nine inn- Tent Contractor(MC) , GACWn�-�� tl�-'t El`S ✓C - HIG Cpmpan Name orH1C Re istran a Registration.Number erw y�I D�Saa Address -. . _ .; .a ' 3 25 . . ,tjbg- �-o oo �Expiration Date . Srgnature. TelcpMne� SECTION 6:WOREMR,5' COIv ENSAt"TiON DTSURANCE AAMAVIT(M.GL.e ;57_r g 35C(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 A dayitAttachcd? Yes :;:...•--- 0]!— No. ❑ SECTION U.,0 . ER' 7JTf3S3Fi7ATIPN TO BE COIVIPI EEA,WN.. OWNER AGENT. IL;CONTRA---TOR APPLIES iTOR-i III D P�}RTSLI as Owner of the subject property hereby . authorize .rw� h A r Sti ri to act on my be• hali;in all matters relative to work authorized by this building permit application. . Signature of Owner .. Date - SECOI�` bt•A4riIf 4RAUEHQNIi??�F-NT' -xT't, iAT1©Itf ':.' l.. t r"I%lt azi7uro-t nridl h and Agent it'etel y,8eslrte drat tTte ttateaaenis and information on th•iore�ein apphcation arefrue_and accurair,to the best of my Uowledgc and behalf ` .Print Name: Signature of Owner or u prized Agent . Date - (Signed underthe pains and penalties of -u - NOTES: 1. An Owner who obtains a building-permit to do his/her own work,or an owner who hoses an lmregistmcd contractor (not registered in the Home Improvement Contractor CHIC)Program), will not liave access to the.arbitration program or guaranty fund under M_G.I_ c. 142A_Other important information an the MC Program and Construction Supervisor Licensing(CSL) can be found in 7g0`C'MR Regulations 11 O.R6 and.11oa5,respectively. 2. When substantial woik is planned,provide the information below. Total floors area(Sq.Ft.) (inclu ding garage,finished basemmt/atti c s, dek or M pomh) Gross living area(Sq.Ft) habitable mom count Number of fireplaces Number ofbedrooms Number ofbathmo= Number ofhalf7baths Type of heating system Number of decks!porches Type of cooling system Enclosed Open - - --_ 3- 'Total Project Squan:Footage"may be substituted for"Total Project A'^.a°f1.:+r+.�wMewnnT;.*y .v�'.a+s'm+.n+-��mer ^• _ • u 5 FORM ; This fora is to be submitted with busldiag pmi�it appErafions whi=vw gi= is debris to be. disposed of Pragty Address: 4^k Ie c S Cy `.� , In accordant with flu pravisiaas'of MM r.40,§54,:a coadi iaa of tht B•i1—Pewit - Numb= s that fv,aybiis resulting from this wart:sbzIl be disposed of m a groperip fic�used solid caste disposal facu"iiy u canned tsp'MGL e. III § 15D-A This debris dill be dispasbd CfIII vA-.r, cat s3 a (L•ocatioa of Faclty) CC�y/5i-amatum of Permit Applicant ' Date Rpn�\A/ I MA Home Improvement Contractor 1.,,, V a i�i� License#170810(Expires 12/23/2013) byA Idersen. rol Federal Tax ID#4 1-1 91841 3 WIND.. REPLACEMENT ;n M&rr-Comp,ny Renewal by Andersen Corporation 104 Otis St.,Northborough,VIA 01532 (50B)351-2200•Fax:(651)351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyerlsl Nome Date of Agreement `--J Q !u fq N �j a -lose Buyerlsl Street Address,City,State,and Zip Code Q Lg-)LI F} D/q 70 Entail Address H me ae hone Number Work Telephone Number 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 shcet(s) (collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: ..,a_ Estimate d Starting Dale: M(e�,thoodd o Eoymenf: Deposit Received(33' _ X2 ���K ' necK OCosh ❑Financed Balance at Start of Job(33 o):5 I �VSa/MC ❑Discover OAMEX btimoted Completion Date If If credit card is selected,please see Credit Card Balance an Substantial — J,b oL Payment Form. Completion of Job(33%):Cqy� 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 en Corporation p Buyer(s) Buyer(s) Signature of Produ r Signature Signature riot Name of Produc[h anager - 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. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _,— _ _ _ _ _ _ .gam_ _ _ _ _ _ _ _ _ — _ _ _ _ NOTICE OF CANCELLATION X NOTICE OF CANCELLATION Date of Transaction . You may cancel Date of Transaction You may cancel this transaction,without any penalty or obligation,within this transaction,without any penalty or obligation,within. three business days from the above date.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 l property traded in,any payments made by you under the Contract of Sale,and any neSotiableinstrument executed. Contract of Sole,and any nesotiable 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, l 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 l 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 Sole; or you may, if you wish, comply Card. ct 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 ro the Seller and the I 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 l 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 ro make the make the goods available ro the Seller, or if ou agree l goods available ro the Seller,or if you agree to return the ro return the goods to the Seller and fail ro do so, then goods to the Seller and fail ro 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 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,cur 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, Northborough, MA 01532, BY NOT LATER THAN Northborough,MA 01532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF .(Date) OF .(Date) - 1 HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Buyei s signvmre Prim Nome Date Buyer's Bignmure Pdm Nama avre RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink 01BBP2009.RBAfhNA1411 Renewal RE , wal by Andersen Corporation MA Home Improvement Contractor -ice- License#170810(Expires 12/23/2013) byAndersen. (5 O is 1-2 00 ihboro651)ugh,MA 01532 Federal Tax ID#41-1918413 (508)351-2200•Fax:(651)351-4810 WINDOW REPLACEMENT anAMn[enComgm' WINDOW SPECIFICATION SHEET Buyer(s)Name Date of Agreement The Buyer(s)listed above herebyjointly 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. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantifies: Double Hung(DB) Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top. 1/3 bottom) Casement(C W) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle Double Casement(CDW) ❑ Standard handle ❑ Metro handle Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window Patio Doors(see separate Door Specification Sheet) 2. eyes ❑ No Qty of Windows to be Custom Fit Replacement: 1-5-- 3. ❑ Yes ❑ No Qty of Sills to be replaced by Contractor: 4. ❑ Yes ❑ No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings)and actual Exterior cas. s: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: Q HP,�L,oww--E-4 nt ❑ Other If other,please specify: 6. Exterior color to be: Lg while ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: ite ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: Inteno olor can only be white,wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware: hire ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes ❑ No Install Lifts with Do le Hung Windows / 10. Screens: windows to have: alf or ❑ Full screens Screens to be: �—rtberglass ❑ Aluminum ❑ TruScene GRILLE DETAILS 11.Windows have grilles: es ❑ No If yes:❑ Grille Between Glass(Gsc)❑ Removable Interior Wood(mm+o Elfull Divided Light(Too Qty:�av Qty: Qty: Qty: Qty: Qty: Qty: �3 K "D. off LJcwmino,a cuee, ePw o,c Draw grille patterns above `Use additional sheet if needed Owner approved(initiates):( 1 ADDITIONAL WORK DEFAILS - 12.❑ Yes No Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes o Contractor will install new paint-ready or stain-ready casings. mtenor��fng qty of openings: Exterior casings city of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes [�No Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty of openings: ❑ Pine ❑ Maintenance-free material 15. Owner Ii-s aware that Contractor does not do my painting. ( )owner Initials 16.❑ .Yes �t.o Contractor will wrap exterior casings with aluminum coil stock of color. ,,, Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17.U?/ray ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18.®•¢s ❑No Cleanup all job related debris including old windows will be removed.Vacuum nightly, 19.PPYes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20.PP yaa ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not t eluded in the Contract Price and a separate check is required at the time of sale for this fee. . 21. es ❑No All discounts have been applied to this agreement price. 22. Additional job details: 23. Q;, es ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.NO final paymentshall be demanded until the contract is completed to the satisfaction ofatl parties. - It is agreed and understood by and between We parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the parties,and them 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. Renews CZi Co1�lo" rout+t Buyer(s) Buyer(s) i Signature of Produc tanager Signature Signature V taer/V / P0A1,4oJL - Print Name of Pro uct Manager Print Name Print Name r Page 1 of 1 ',,,�eacy, Shannon From: Jeff Conley[s-]conley@comcast.net] Sent: Tuesday, June 05, 2012 1:03 PM To: Lacy, Shannon Subject: RE: Update -John Ronan Shannon, The Trustees met last evening and the Ronan request is approved. From: Lacy, Shannon [mailto:Shannon.Lacy@andersencorp.com] Sent: Tuesday, June 05, 2012 8:57 AM To: Jeff Conley Subject: Update -John Ronan Importance: High Good Morning Jeff, I just wanted to touch base with you and see if there is any update on the approval status for John Ronan. If you could please let me know that would be great. Thanks, Shannon Lacy Sales Administration & Residential Development Relations Renewal by Andersen Corporation 104 Otis Street Northborough, MA 01532 Office: 508-351-2200 X55300 Fax.651-351-4810/855-855-7564 Shannon.Lacy@ondersencorp.com 6/5/2012 i di The Gommorwe¢£th of Massachusetts �\ Department of fndu&trial Accidents O}face of Investigations 600 Washington Street Boston, AL4 62111 k1ri I - . ww w.mass.gav/dia Worker-s' Compensation Insurance Affidavit: Suildars/Contractors/ leetricians/Piumbers ARRbcant b €or>nation Pleas Print Le=ibt Name(Business/Orgaaizaticn/tndividuaI): lr. \�)T 11�C S-CC Address: City/State/Zip: �r�. ����v 0 4rv2(� (1S 33 Phane k 5 - S 1 - 2cPLO Are you.an employer? Check the appropriate bar: Type of project(regiAred): 1 I am a employer with -3 D 4. ❑ I am a general contractor and I 6. ❑New construction em toime .. have hued the sab-coatractors P Yes (full and/or ) 7 Remode ng 2.❑ I am a sole proprietor or art-t listed on the attached sheet t parfner- - ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, workers' comp.insurance, q ❑ Bafidigg addition . [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have ez=ised then . ri t of eze lion er le4GL 1 I.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work P myself [No workers'.comp. e 152, §1(4), and we have no 12.❑ Roof repairs insurance required] t employees. [No workers' 13 ❑ Other aomp. insurance required] - `Airy ant applic that check box#1 must also a out the section below shewdng thejr wort-='comps ation pDhoY inioona;iea t Homeowner.who subox r this affidavit indicating fh-y an doing all work and thm bite outside cooba=n must submit a new affadavif indicating such �Conrtactou that chck this box must attached an additional sh---showing the name of the mb-combo=and they worlus'comp.pone;'information I ern an.employer that is providing worY-ers'compensation iresarance for try ampLayee&.. BeLow is the poH.cy owed job Site ll=ance Company Name:_ . f, n— �-'1 `l.l l 1 1 1 LI c. () E.-piradoa DatE, Poficy'#or Self-ins.Lic, �'': (' \ (�. Job Site Address: l S't� 1 I r Lit City/StatE[Zip: J/.1t Vl v161 }6 Attach a copy of the workers' compensation policy declara 'on page(shorviug the policy number and e)Tkafdon date). Failure to secure coverage as iequimd'under Section 25A of MCYL c. 152 can lead to the imposition of r-iminal penalties of a fine up to $1,500.00 and/or oue-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.tat violator. Be advised that a copy of this statement may be forwarded.to the Office of fnvesvgations of the.DI k for insurance coverage verification n - I do hereby cerft ithe paitrs)dndpenal£ies ofperjury that the irfor matiorz provided-above is true and correct :Si�atrme; t Dais: . 49 -� ( Z- Phone# �v 3sl-aa�� O trial use oniy. Do not write in this.treg to be completed by city or town uljicial City or Town Permif/License# hgamg Authority(circle.one): L Board of Health 2. Sufiding Depattmenf S. Citg/Toorn Clerk 4.Electrical hmpector S. Pinmbiag Inspec or Ccutact Person: Phone CERTIFICATE OF LiAB[LfTY INSURANCE DAIE(nMmDn m� 01/11/20I2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND, EJ."TEND-OR ALTER THE-COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUT'HORIEED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.. IMPORTANT: If the certificate holdefis an ADDITIONAL INSURED, the poiicy(ies) must he endured. If SUBROGATION !S WAR/ED, suhjed to fim terms and conditions of.the policy,certain policies may require an endorsement A statement on this certfficate does not Donfer rights to the certificate holder in fieu of such endDmement(s). PRODDCER" 1-612-333-33 Z3 NgCT Jo»eLle Hazyave or P.a.tie Psisios Bays Companies PHDOE 612-333-33Z3 jF p,No: 612-373-7270 EHMI SO S=th Sth Stl=eat _ ADD 6. M.S to .7DO PROOUCER Diit>aeapolla, MN CD51T]MIR 55402 ID NAICR INSURERS AFFORDING COVERAGE INSURED INSURERA: OLD PLIM=C IRS CD 2,1147 R. l By Andersen CJipunatl.h - INSUR,2e: NATIONAL OR20S FCRB ZA*S DO OF PUTS 19445 LDe Otis Street - INSURER c: INSURER D: ' Northboraugli, ffi 01532 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 2512A267 iZEVISIDN 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,TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT70NS'OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED'BY PAID CLAIMS. IN'R ADOLSUBR POLICYEFr PoDCY LIMnb LI=R TYPE OF INSURANCE POLICYNUNISER IMMmD rMMMD _ A GENERAL LIABUUiY NINZY 59313 LO/01/i - lU/Ol/12 EAOH OCCURRENCE b 1,ODD,DDD % DAMAGE MR= b SOU.ODD COMMH2CWL GENERAL OABILRY PREMISES DEe odu �ws CLAIMS-MAD- ODCCUR MEDE [Anyone Pe.,I) $ 1D,DOD PERSONAL t.ADV INJURY 6I.,ODD,000 GENERALAGGREG TE' S 4,ODU,DDD GEN'LAGGREGAT UMMAPPUES PtiR: -PRODUCTS-COMP/OP AGG 5 3,DOD,000 b - % POLICY PRb LDC 10/01/1 10/01/12 COMBINED SINGLE LIMB _ Mq^PH 21377 1.3,ODO,ODO A Avtnmoal�Lu.BILnv tEee©deep. AN\'-AUTO _ BOUILY INJURY(Per Person) $ ALL OWNED AUTOS BODILY INJURY(Par ecdtlanU b SCHEDULED AUTOS - PROPERTI'DAMAGE S HIRED AUTOS (Pcemdenp 6 % NDN-0WNED AUTOS S , B % uMBRE1IA LIAR % pCCUR 25030519 10,/01/11 10/011/12 = HOGCUR DEN CE F 25,DD0,ODO EY CESS LLAB CIAIMS-MgDE AGGREGATE 625,00D,ODD S DEDucnaLE S % - RE"reNT1ON 25,DOD b WC STATLL DT1i- p AND MPS YDRs,LCATON 3SNC 11714U 00 10/01/1 iD/Ol/12 % . AND FJNPLOYERS•LIASILIiY TIN 1,000,DOD ANY PROPRIZOR/PARTNe�ft rrXECDiNE EL EACH ACCIDENT b DF CERIMEMaPR IXCUJDEO? O NFA EL DISEASE-EA EMPLO S 1,00D,000 IMdnded ry in NH) k yec,deccdbe ender El DISEASE-POLICY LIMIT 51,000,DOD DESCRIPTION OF OPERATIONS beI.W DESCRIPTION DF DPERAOONSfLOCATIONS/VEHICLES (At UACORD tDt,Adfiaonal P.enmda&d. Ole,R more c)eM lc squired) R''Uses OF Snav_—ante. . CERTIFICATE.HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED PODUCIES BE.CANOELIPD SORE Y_ ide>�e of Zsavf�^^= THE '.EXPIRATION -DATE THEREOF, ND'TICE -WILL BE OFInrERFD IN ACCORDANCEWITH'THE POLICYPROVISIONS . ... AMDR®RBPRESENTATIVE .. - - it .. raeimos - �1666 2.DD4 ACORD'CORPORATION. All rights reserved. CORD 2s (2DR9/09) The ACORD-name and logo are r,gisiarad mares of ACORD r .f-. Nl asstchu.ctts - Dcpartmcnt nl Public >afcn - f Board of Buildin-, Rc_ulation. anti standart6 .Construction Supervisor License - License: CS 96707 BRIAN DENNISON ' 86 CREST CIRCLE- WORCESTER,MA 01603 Expiration: 9/6Y2012 ('n nuniaiwmr Tr—, 2622 ✓tic "l0omvnwicwv.¢�y ¢c�euae//b Office of Consumer Affairs&B siuess Regulation HOME IMPROVEMENT CONTRACTOR Registration 170,10 Type: ' Expiration 12/23/2D13 Corporation c - R u AL BY ANDERSEMSORPORATION i_ BRIAN DENNISON, 104 OTIS ST, NORTHBOROUGH Undersecretary i I Penewa tt �G bAndersen. `ter tRVNPP'w' P.EPLhe EMENT anMdefarn Cumin^Y � PdouillVinyl Compusite IF Dual Argun Low Ed SmartSun 700-004735t8-010 ENERGY PERFDWf NCE RA-UNBS U-Factor (U.S)A-P. Soiar Heat Gain.Coefficient,. AOO[TIONAI PERFORMANCE RlLT[NE'SS \/isihle Transmittance �N=[m aa�Pfenh NFfl[Pma•^•^�=cdnemnn s.u4=4 Yim i - LLawF urER��y[I`v a' mined lerx fvid ale amndX'nmu: e�sede prm^ parlour.. x PFiI� In¢mena a v,rtu[Ihv• v.VnYal�nl'P'°d"alf u�YaP•cneu ' ' .NFFG'tlea_- murnmma den�P�^�uCand deenadom mlcmwn Gcnml mu^ulaewnM1lhamu le'-ofherpmdurlp P^m - - wwrnlrsl¢ I . DES IGN.PRESSUFlE(PS F) �wnna..ml�mm E � � I 62, 1,.6A ])B. Sloped Sill DH EN . t dNIlA4Lt¢la3AA'62AAI3X101M1t'AHPfS FbMac+za sll'tilic mnum[ua@w uF ob•umv � wpuAMWmark LUM1FcI'm:Prapnm � � tlae[cm aa"e•aK•..cn.Gy.eIFS.L_AV InIMsalon Nqu[amen¢ _ I I Renewal . . byAndersen. ����� �E�L��e�e�E z�:4`Fclera�CrnnpaII.v To Whom.lt May Concem-: Enclosed is a permit application.package for a proj ect we have been contracted to do in your town. Thank you in advance foz receiving this package by mail. As we work m every town in the state, it gr,eatly 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 Applicaon ❑ Holne Improvement Contractor License ❑ Constrecdon Supervisor License ❑ Proof of Ensuranre ❑ Proof of Energy 'Efficiency Rating Signed Contract from Customer ❑ Permit Fee (if,�-ceepted at time of applying If .you have any questions regarding this application please call me at: 50&-3 51-2200 X 55205 Regards, . �eIley Do*�ahuz P=t Coordinator 104 Otis Stcd - - ] mtbborongh,lid 4. 01532 - Phmc(508)35'I-22DD.X55255 - _ - Fac(509)7.74-997-3013 - - - - .. S�ebsi�: www.renewalbvandersen-com _ .. j