34 SETTLERS WAY - BUILDING INSPECTION (3) The Commonwealth of Massachusetts
WLBoard of Building Regulations and Standards E�e—rvfsed
Massachusetts State Building Code, 790 CMR, 7`s edition
Building Permit Application To Construct, Repair, Renovate Or Demolish a
7 One-or Two-Fami Dwelling
This Section Vr Cifficial Use O
(.� B 'ld ng Pern it Number. / I D to Applie .
Signature:
Building Commissioner/Insp-- or of uilding Date
SECTION]:S E INTFORMATION
1.1 Pro erty Address: 1.2 Assessors Map &Parcel Numbers
3w Spti��\ecs W k
1.1 a Is this an accented street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use - Lot Area(sq.it) Frontage(fi)
1.5 Buildin;Setbacks (ft)
From Yard Side Yards Rear Yard
Required Provided - Required Provided I Required - Provided
1.6 Water Supply: (M.G.L c.40,g i4) 1.7.Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?.
Public❑' Privet-,❑ — Municipal❑ On site disposal system ❑
' Check if yes❑
SECTION2: PROPERTY OWNERS=l
2.1 Owner'of Record:
L6Wet1 S� .i�. 3`I SP-Ot\eck �Ju.: M ads
Name(Print) Address for Service: -
Signature - - Telephone
SECTION S:.DESCRIPTION OF PROPOSED WORK ':(check all that 2pply)'
e:,Ccns4 clip:: ❑ Ezis' u:I I ; ❑ xn^:'G'xupi d ❑ epai,s(sj C 'ate tiL s) ^' .ddi ❑
Demrilition ❑ AccessoryS14. ❑ ldumbcrofUnits_ Otlier (� $pccify:_ QeA�j� �
Brief Description of Proposed -Work': 4W v, S /4� _
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building S 1. Building Permit Fee:$ Indicate flow fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2, O her Fees: $
4.Mechanical (HVAC) I S List:
5.Mechanical (Fire $
Suppression) Total All Fees:S .
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S R,a" ,2,00 0 Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number xpiration Date.
1Qame of CSL-HoldP l`
List CSL Types below)
O1 S'8P Vpe i Descr :tion
,e
U Unrestn d(iip to 35,000 Cu.Ft.)
Signature R Restricted 1&2 Famil Dwelling
�1)�1 (5CfC1� M. Masonry Only
R
RC Residential Roofing Covein
Telephone. - WS Residential Wmdow and Siding
SF Residential Solid Fuel Burning Anpianee Installation
D Residential Demolition
Registered HomeT-tTpreQvement Contractor(RIC) L1
HICComp``a(nyNaroeorHl`C'tt�eoistra�t\Name 1,t Registration Number
1—oN —l-LL . .
-C;2 Expiration Date
Signature Telephone
SECTION 6:WORKERS' COIvirENSA11ON 11\TSURANCE AFFIDAVIT(Mt.G.L.C. 152. § 2SC(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 lac O)AN-ER kIJTH4RTZLATFON TO BE�COIVe-U,
OWNER'S_IA-,G.ET�T O :CON�1ELACTOR,PAil18 FORbLZLi)3NG YERiCrIT
I, `C k 4 Ll S �� �� as Owner of the subject property hereby
authorize ��� r r �� to act on my iehalf,in all ma > s
relative to work authorized by this building permit application. . - - -
Signature of Owner Date
SECT•LON 7b:'.OWNER'-OOR_4TJTHGlR1�.T; 4 EIkT gE; r�4T 4TIaIT '
a:04iv rnr 2ki-t'hniized Agrnt'tPrebv d r16.it"
that tI;e statements and information-on the f_rtgoing appikcation bae true and acctu'si'e, to the best of niy harp T ledge and
CA C
h C1
Signature of Owner or Authorized Agent - Date
(Signed under the pains and penalties of perjury) -
NOTES:
1. An Ommer 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.infomiation on the HIC Program and
Construction Supervisor Licensing(CSL) can be found in 780`CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.). (including garage,finished basementlattics, decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalfJbaths
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"
i
K. w I SM44"
Anerse �
WINDOW REP-L&CEMEN =And Camp=:g
Whom It May Concern, .
'll nciosed is a permit application package for a project we have been
retracted to do in your down. Thank you in advance for receiving this
ackage by mail. As we work in every town in the state, it greatly helps us in
ur process.
ire have also enclosed a self addressed and,p€rstage paid envelope and
fould request that when the permit application has been processed,_ that you
�rould Email it back to us.
unclosed for you review in this package ls:
❑ Permit Application
❑ Horne Improvement Contractor License
❑ Construction Supervisor License
❑ Proof of Ens€nrance
❑ Proof of Energy Efficiency Rating
❑ Signed Contract from customer
❑ Permit Fee (if accepted at time of applying)
_f you have any question regarding this application please call me at (508)
3 P g-E�39 Z.
lest Regardsr
'Xe€ley Donahue
Permit Coordinator
104 Otis Street 1
Northb=ngb,A/iA• 01532
Phone(509)919-0900
Paz(509)919-0903
Wehsltc xVWW.=ffWalbvandCm=.com
DEBRIS FORM
This form is to be sabnutted milli building pm-mit applications whenever theme is debris to be
disposed o£
Prbperty?,ddress. 3- C>-e-4`e
1a accofdance with the provisions of MGL c,40, §54,.a condition of the Building P=ftit
Number is that the debris resoltin;from this work shall bi disposed of.in a properly licensed
solid waste disposal facility a dz:7:=d by MGM c. 111 § 15 D-k
This debris will be disposed of ia:
(Location of Facil#)
9ieuature of P .. Applicant
Date
RUG-24-20le 11 :59 PM P. 01
&L Wwriows:In .,D/s/n MA Horne Ira srovement CJnlraetOr
n14 Otis St..Nnrthbornugh,MA l)153Y f c f
Lictll (Expires 1012)(5fIH)919.0900 Fnx (774)987-3013 Renewal FeaoralTax In 83•04
04201
byAndefsen
WI p00W v¢veM1CrYIM1I mMlmmCmrteny
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
6uverlsl Name Data of A r eat
I_Lxu�CL
gayer,)seeelermel Addrea,Cly,51me,aid zip Cade
>>_�>Gy7lc2F / �iFt /�/a cL-2/ 9 Ica
Email Addr_aw f Hema isle hone Number Work Llaphone Number
I1111er(5) hcrcby Kniltly and severally agraes to purchast fhe predutNs and/or services of I&L Windows,Inc-d/b/a Renewal by Andersen
(`Colitniclod'),in acmrdanet With the tarns and conditions described on the front and the reverse of this agreement and on the attached
spccifiaatiou sheet(s) (wllutivclg this`Agrcernene").Buyer(s)hereby agrees,to sign a eomplttlJtt Certil§cale after Contractor has eomplcml
all work raider this Agreement... - - - - -
/� Method of Pymrit:U Cash �U Check 91f astercard ❑VISA
Totol lob Amount. Cly Estimated Starting Date:
g��� �`�� El Discover U Flounced,APPA:
Deposit Received 133%. ✓._-.—.. Name on Credit C.,&LXU042 rV -! tQA
Bciance at Scarf of Job i33%i: 130-0
Estimated Completion Dale: Credit Card
Baance on Sebstanlidl - --�J.6,�Q'ry��'
Completion of Job 133%i:_-��60 / GC Ezp_Date: CC Security Code 10
By initialing here,you acknowicdgo that the Balance at Start of job end the Balance nn Suhatantial Completion
Buyer Initials _.. of)mks cannot be rrladc by rredit card and must be made by pen ittial check,bank check,at cash.
Buyers) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that
there arc no verbal understandings changing or modlfying 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(.) and Contractor. Buyer(s) hereby
acknowledges that Buyer(s) I) has read this Agreement, understands the terms of this Agreems otl and has received a
completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first
—ritte.n above and 2)was orally laforreed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF
THERE ARE ANY BLANK SPACES.
J&I.Wiadosr /b/a wet by Mderaea Huyer(s) Buyer(s)
�ignann'e of Pr, anagcr Signature Sipnazurc
e-hnelv w _S„rr-t,-
PI inr.Name of Pmdnc,A artagc, e T v Print Nam,. Print Nam,.
YOU, THE BUYER(S), MAY CANCEL THIS,TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE:ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT.
NOTICE OF CANCELLATION H EfQTLS,E.SLCANCELLATION
Date of Transaction You may cancel Dale of Transaction You may cancel
this transaction,without any penal y or obligation,within this transaction,without any pet�ely or obligation,within
three business days from the above date.If you cancel,any three business days from the above date.if you eancel,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 Comrade of Sae,and say 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 emueled.If you camel,yell must make available to the
Seller at your residence,in substantially as good condition Seller ot 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 Comma or Sale; or you may, N you wish, comply Contract or Sale;or you may,if yes 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 ids of the Sellerh expense and risk. I the goods at the Seller's expense and risk.If you do make
If you do make the goods available, o
to the Seller and the the goodsvo{fabe Nee
e Seller and the Seller does not
Seer does not pick them up within 20 days of the date pick them up within 20 days of the dale of your ice
of your Notice of Cancellation you may retain or dispose of Catxellalon,you = retain or dispose of
of the geode without arty furt�ner obligation.If you fail ro without arty further obBgation. N you fail to make No
make the goads available ro the Seller, or 'tf you are goods available ro the Seller,or if you agree to return the
ro return the goods to the Seller and fall to do so, then goods to the Seller and fail to do so,then you remain liable
you remain liable for perfennonce 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 dated copy of this cancellation notice or arty other written
other written notice, or send a telegram to Contractor: 1 notice,or send a telegram to Contractor, J&L Windows,
&L Windows,Inc.d/b/o Renewal by Andersen, 104 Otis Inc, d/b/o Renewal by Andersen, 104 Otis Street
Street, Northborough, MA 01532, BY NOT LATER THAN Nonhborough,MA 01532,BY NOT LATER THAN MIDNIGHT
MIDNIGHT OF�- •(Date) OF .(Date)
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
I
BuyerY sionalure Lie" .". - i 0vysr9 signature Dale
Rbt;:Copy.' White fluver Copy-YellSdr euyet"Copy-Pink - .
RUG-25-2010 12 :01 AN P-02
J a:L Windows,Inc.d/b/a
104 Otis Street,North borough,Ma 01532 R�newal MA1410"Cnsea 141601(expires 1/24/12)
Fhonc+OA.OI n.0000-Fax 7 i 43A;.30I S Federal lax 109 A3_0404201
� ndersen.
WINDOW- RIPLA01014147 mMaem mWV
OF Gx xaraD MAaaACMlarrrs AND New YLVAPaRin
WINDOW SPECIFICATION SHEET'
BuyersI)Name Date of Agreement
j r—)
'rn Buyrr(,)hated above here by Jointly and several Ty ggraa to purchase the goods and/or services listed below,in accordance with the prices and terms
dc'61"d tin the Speciticalion Shell and the front and the reverse of❑ice accompanying CUSTOM WINDOW AND DOOR REMODELING.4GREEMEIYF,
of which this Specification Sheet is a part.
WINDOW DEEABS
1. CL"ji"clor will install a total of'�windc.in Owner's home,using the following individual quantities:
�_,._Double Hung Q)N) ❑ £xlual sash ❑ Coliag¢c sash(1/3 top,2/5 bottom) ❑ Ch'iel sash(2/3 top. 1/3 bottom)
Casement(i:W) ❑ Hinge right ❑ I'linge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle
Deublc.Casement(COW) ❑ Standard handle ❑ Metro handle
_ Casement/Picture/Casement(CM ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle
�— 2 Lite Gliding Window(GW)
._ Glider /Mcture/Glider (GPW) ❑ 1:1:1. or L❑' 1:2:1
Awning Window(AW)
Picture Windowr(17W)
Bay or How Window
atio Doors(sec sepetnfe Onor Specifi"alion SheeU - .- -
2. av ❑ No Qty of Windows to be Custom Fit Replacement:
3. ❑ Yes U;4,o Qly of Sills to be repl.ccd by Contractor:
4. ❑ 1'as ® L Qty of Wind.to be New Construction Full Brame(includes new Interior&exterior casings)
Exicaier ens ': ❑ Pinc ❑ Mxinte tanec-free materiel ❑ Factory applied 908£ibrex brickmold
5. Gl aing to be: -IP marttnmr• (75c,Clre ltEl(glble) ❑ Other If other,please specify:
6 Fxtcrior color to be: itc ❑ Sand ❑ Canvas ❑ Terr¢tonc ❑ Cocoa Bean
7, intet'iorcolortobc White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak
Note: Inlet' color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner.
g. Hardware: Ngrite ❑ Stonc ❑ Canvas ❑ Brass ❑ Estate Hardware: Style:
9. ❑ Yes ❑ No Install Lifts"nth Doubt.Hung\ dows /
10. Scrre)m windows to have: El Half or Il screens screens to be: 2"K glass ❑ Aluminum ❑ TruScer e
GRILLE DETAILS
11.Windows>e grilles: ❑ Yes Q No If ycs:❑ Grillo Between Glaxs(ca.);
ca.) Removable Interior Wood a—)❑ Full Divided Light tuna
Qty: City: Qty, Qty: Qty: Qty: Qty:
IL
OH off nH PH JLJLIE::]
Uraw;rifle pallerns oFxece 'Use additional sheet if needed Owner approved
ADDITIONAL WORK DETAILS — -
12.❑ Yc Contractor will remove metal fYantes of windows. Qty of Units:
13.❑ Yes V Contractor will install new paint-ready or_elain-ready casings.
Inte�rior1L'p sing diy of openir_;s:_ __ Exterior casings city of opermt :_t. ❑Pinc ❑ Maintenance-free material
I A.❑ C 1 Yes d •Contractor will install new paint-ready or stain-ready inside cr cntsid,jstotm qlv of orettin$a:
Gnerior stops qty of openings:— Exterior stops city of openings: ❑ Pine [] AMin criance-free material
15. Owner issaw/n that Contractor dcee not do any p�tug. ( 4 tea'Initial,
❑ Yes E&416 Contractor will wrap exterior casings with aluminum mil stock of color.
�,!Aote: Wrapping may be required with storm window removal,removal of storm windows will leave screw holes in casing,
�3'
17. t, ❑ No Contractor will insulate,caulk and sent windows with 3-pohit system to prevent water and air infiltration.
t g. F'YL-. ❑ NO A limited warranty shall be issued to Owner upon completion of the Job and payment in full.
19.j_ "es ❑ No Build lIT Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is not
included in the Contract Price and a separate check is required at the time of sale for this fee.
20. .4dditional lob details:
21. 1'cs ❑ No Owner nvrecs fo be present on the final day of installation for final inspection and to deliver final payment.
r\'o tins/par}¢rrCnt.hn(1 d>'desn 1ndeAutrlil Ufa—hWCt is M"'Pleted to the satisfaction ofn/!p+rtiee.
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 arc no verbal understandLeSs changing or modifying any of the
terms. This Specification Sheet may not be eharyged or its terms modified or varied in tiny way unless such charlgea are In writing and signed by both
the Buyer(s)and Contractor. Buyer(s)hereby,acknowledge that Buyers)has reed this Specification Shut,
Renew And" /Gres a td NH Buyer(s) BUyer(s)
Liz
S of Product Man Signature
Wr�(� Signature
oon U`a ( . 5 ,
t Name f Product alter Print Name 1'rlttt Name
AUG-25-2010 12p02 AM : .., •- P. 04
Renewal
byAndersen. '
WINDOW REPLACEMENT an Andersen Company
PROPERTY OWN/ER MUST COMPLETE F9 SIGN THIS SECTION IF USING A BUILDER
as owner of the subject property hereby authorize
Renewal by Andersen (d.b.a. -J & L Windows) to act on my behalf, in all matters relative to
work authorized by this building permit application for:
� �� Addreea o£Jvb
Homeowner Signature Date
OWNER OR BUILDER (AS AGENT OF OWNER) MUST COMPLETE&L SIGN THIS SECTION
I, �atOA nc✓�,� as Owner / Authorized Agent hereby declare that
the statements and information on the foregoing application for —�
Address of Job
Signed under the pains and penalties of perjury.
K/tip yc.
Print Name
Signature of Owner/Agent J Date
104 Otis Street
ATorthborough,MA 01532
Phone: (508)919.0900
Fax: (508)919.0903
www.tenewalbyandersen.eom
The Commonwealth ofMassach=em-,
Department of 1'ndststrial Accidents
G1 J i e of Fnves-d'gations
600 Tashington Street
Boston, MA 02111
www.anass.gov/dia
Workers' Compensa:4icn lnsass'amrs Affidavkt: B¢ilders/C€sntractors/FIeetraei-ins/plu-tubers
Amulicant Fnfar'saatiam Please Pried Lembly
Name (Bx in=slbrgaaizatim0milividual): Rer)a�a I By pn de rs e n
r
Address: ^/0�/ r` S
C:ity/§t te/zip:_Nar be ro , A phone C�G�) fly aro0
.se you as employer? Check the appropriate bow Type of project (required):
.EnLiamammployorwitil j o 4. F'I am a general contractor and I 6. ❑New construction
employees (Laand/orpart-time).* have hired the sub-contractors p�
❑ I am a sole proprietor or partner- listed on the attached sheet t 7, modeling
ship and bave no employees Tbese sub-contractors bave 9. []Demolition
working forme in any capacity. worlors' comp. insurance. 9. Building addition
[No workers' comp. insurance 5. We are a corporatina and its 1D.❑Electrical repair or add ldans
re?*'*ed.] officers Lave exercised their
❑ I am a homeowner doing an work right of exemption per MQ, ILEI Pltunbing repairs or additions
myscl£ [No workers' comp: o. 152, gI(4), and we have mo 12 M Roof repairs
insurance required.] t employees. [No workers' 13.El Offier
romrrL insurance required.]
UW Vph==that r2 a box 91 must also;ffi oar the section brlow showing&e works$'comp=mrtinn policy ixdormatioa.
5nmmownes who submit fah afdm t indicating thq axe doing on vmk and t=h=otsadc coneaejr s xmut sabmix a xow a{davit indicaticg such.
;ontactoxs&at chrzk this box must affirh�as adSdi�el sheet showing the name athe suba=ntn�s and the wodnss'c oli mfnrmafioa
o�P My
am an employer that is provWing,workers'conrpensadon ins uranca j ar my employees Belarp,is axe paltry and job sire
farrsa€ion. - .
,anranzr Company Name: (+lr/ K�en-P- hiCrfre7nCL
o]icy#or Self-ins.Lie _ 3'J� G1 F(� y�•!'{ Expiration Date:
cb Site Address:3`` J t \e t �l et City/state/Zip: Ip.nn_ Ae, D\ 0 c,
&ach a ropy of the wvorkers' eomapexsataom pDY=y declaration page(showing the poncy=mbar and expiration date).
ac'In tD &ease ooverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
me up'to S 1,500.0D and/or one-year imprisonment as well as civil penalties in the farm of a STOP WORK ORDER and a fine
f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
ivestigations of the DIA for inanranre coverage vexivcati=
do hereby under the pains and penoLEiea erjur�,that the information provided�aybove is true and correct
rmatare Data GIt3�ly
'hone#-.
tl cial use only. Do not write in ads area, to be completed by city or mwn officiaL
City or Town: PermItUcense#
Fssnoag Authority(circle one):
L Beard of Health 2.Big Department 3. City/Town Clerk 4.Electrical hispectnr 5.
6.Other Fi¢mhixtg Faspector
Comtlet Person: Phone#
jr
Ntassachusetts - Department of Public Safm
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 101952
Restricted to: 00 -
DAVID BANCROFT
5 JOHNSTON AVENUE
WHITINSVILLE, MA 01588
Expiration: 3/19/2012
('onm�issioncr Tr#: 101952
AA ✓/ie -oomrmao,xueaClh ol•./Llaae¢cl+uaelfa _ .
ate\ Office of Consumer Affairs&Business Regulation _
IFOME IMPROVEMENT CONTRACTOR -
Registration! 8o1
` EzPiratf�--"— 12
FOUR;, }'ant Card -
RENEWAL BY
DAVE BANCRO \ •�
1040TI5 STREE-I�k, -_- /• —�"'�-a I
NORTHBOROUGH,19J832 Undersecretary
A
i
i
®. E UA w Ean-i p TFils CERTFIGATEs IS ISSUED As A l liTTER of INFORMATION
Joseph fJicKeone ONLY fsND CONFERS N0. RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
JP tvICKeone insurance Agency. Inc. ALTER THE COVE GE kFFORDED BY THE POLICIES BELOW.
P,O. BDz 333 NAIC 9
Ann ArbDr, fL�l 46906-D333 INSURERS AFFORDING COVERAGE
Renewal by Andersen IKSURERh 'Hartford insurance CO an
INSURER6: Naul us
J and L l�FindDt�s,Inc INSURER c _-
1D4 Dos St
r.
NDrthboraugh,MA Di532 ISURERO
INSURERB
AGES
OLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED HAF5E0 ABOVE FOR THE POLICY PERIOD WOiCATEO,NOTWITHSTANDING
:EDLJIREMENT, TERM OR CONOMON OF ANY CONTIll OR OTHER ODCUN{ENT WITH RESPECT TO WHICH THIS CERTIFICATE WAY IO ISSUED OR
'ERTAIFL THE INSURANCE AFFORDED BY THE PDUClES DESCRIBED HEREIN IS SUBJECT TD ALL THE TERMS,EKCLUSIONS AND CONDITIONS OF SUCH
IES.AGGREGATE LIMrM SHOWN SAAY HAVE BEEN REDUCED BY PAID CL4�u��ECTnE �trR EzrIRATIaN LIMITS
1 u e POLICYNIJA®ER EAGK.6CGt1RREKCE I s 1 DOD ODD
aE�iAL LWABILBY €JC95B461 iD101lZOQ9 i0/D1I2D10 PREu6Es fEs s 1DO.ODD
=MWEReuL DEKERALucsn}TM MED EJ9 ew+yeneP—ro s 50DD
rL'U' DE' •❑ OCCUR PERSONALLADYIVURY s 1 DOD ODD
GENERALpGG}LEGi,TE S 2 ODD DOD
PROWLTS-DOMPAP AGO s 2ODD DDDO_
GENL AG+PE.:ATE UMIf APPLES PER
PRb
PODGY L=
AVTDIdDBILELIABILIFY 35AhGC Y.D 6390 1D/D1l20Q9 1010112010 (�oB�Enq NGLEUMR I s 1,DOD,DDD
ANY AUTO BODILY INJURY
ALL OWNED A S IPn P..w4 S
SDHEOULS AUTOS
BODILY II S
HIRED AUTOS {Pvr c�enq
KDN-OMED AUTOS .
PROPERTY DAMAGE S
I jPm=lnen4
AUTODNLY.EAACCIDENT
DARAMLIABRJTY DTHERTHAN EA ace s
ANY AUTO ACJsooNLr. Am Is
EACH D=I1REHCE
ESCSSGIISG'RELLA LIA-RILRY AG:REG4TE S
axuR 0 cin»ME WADE s
s
DEwrneLE _
REiEKDDN s' v y STATU- Om•I _
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ATE HOLDER CANCELLATION
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SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE GANGEf-LED BEFORE THE ECPRtATION
DATE THEREOF, THE ISSUING INSURER WILL ENOWYOR TO MAR. 10 DAYS WRITTEN
INSURED COPY Mal TO THE CERMCATE HOLDER MAI TO THE LEFT,BUT FAILURE TO DO SO SHALL
RVOSE No OBLIGATION OR LL&WZ Y OF ANY WUNB UPON THE.WWSURER,GS AGem OR
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AUTHOI REPRESENTATIVE
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ENERGY PERFORMANCE RATINGS
U-Factor(U.S)A-P Solar Heat Gain Coefficient- t
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ADDITIONAL PERFORMANCE RATING
Visible Transmittance
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