2 TYBEE LN - BUILDING INSPECTION g� The Commonwealth of Massachusetts
— Board of Building Regulations and Standards FOR
MUNICIPALITY
Massachusetts State Building Code,780 CMR, 7 b edition 'USE.
Building Permit Application To Construct, Repair,Renovate Or Demolish a' RevisedJarruary
One-or Two-Family Dwelling 1, 2008
This'Seation For Of5cialUse Only .
Building Permit Number. Date Applied
Signature: 2S ^ ' loll 4
Building Commissioner/lnspectorofBuildmgs Date '.
SECTION 1:SITE INFORMATION
1 Property Address: 1.2 Assessors Map&Parcel Numbers
L� la7bo63- 8s 1
1.1 a—Is 'thi's an accepted street?yes_ no Map Number Parcel Number
1.3 toning Informatioty� v 1.4 Property Dimensions
Zoning District Proposed Use. Lot Area(sq ft) Frontage(fl) '
I.S.Building Setbacks (ft).
-Front Yard Side Yards Rear Yard -Required. Provided Required - Provided - Required Provided
I:6 Water Supply: (M.G.L c.40,§54) LT Flood Zone Information: 1.8 Sewage Disposal System: -...
Zone Outside Flood Zone?•.
Public❑' Private❑ — -Municipal-0 On site disposal system ❑
Check if.yesC
SECTION2: PROPERTY. owNxRsaIP'
2.1 Owner'of D-cord:
5w�� Gr.t� f ee L� APA., &(A �14�
Name(Print) Address for Service
Q 49 -0(01�K-690g
Signature Telephone
SECTION 3;.D'ESCRIPTION OF PROPOSED WbR1e-tcbebl all that apply)
Nez•'Constry ❑ C,_'iS ng Bn11E n^c,❑ w;ner-•0='-picd ❑ Pepairs(s)'.Cdos) 1dh:o C
Demolition ❑ •AccessnryBld2: ❑ TJumberofllnits_ Other( q_PCCir'y:_. ke ke'Lc"k 1
Brief Description of Proposed W orL:: dly o
.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
3�t
1.Building $ 3(C .Uo 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Cityrl own Application Fee
2.Electrical $
❑Total Project.Cosf(Item 6)x multiplier. '- x -
3.Plumbing $ 2, Other Fees: $ ""
4.Mechanical (HVAC) $ List
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount
6.Total Project Cost: S G_QV
3 3 C Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRU.MQ.N S1 1RVTCES
5.1 Licensed Construction Supervisor(CSL)
—4�(`V, ✓\ I-.JQ�/\\��n Lixuse.Number .Expiration Date.
Name of CSL-Hold
gA, U� ListCSL Type(seebelow)
U Unrestrieted(tip to 35 000 Ca.Ft
t ature - .: R Restricted 1&2 Farm"] Dweilin
_ B•RIg=p2�� M Masonry Only
Telephone. RC Residential Roofing Covering - - .
WS' Residential Window and Siding,
SF Residential Solid Fuel Burning A_pplian=Installation .
D Residential Demolition -
5.2 egistered Hom Ito mend Contractor(HIC)
(S n
HIC Compa�ny''�` me or HI Registry N�r�e� n. Registration Number '
LTi-t .1 .� . - �A.lo l�-1'h 0/'6 IYt_ �S�a.
�� �{(�.(. •(xj Ct� Expiration Date
Stgrrntur�? Telephone ..
SECTION 6:WOMMRS' COMPENSATION!NSURANCE A TMkVIT(M.G.L.c.152.g 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 TO BE COMPL�ETFD:V HEN'. .
OV,'NER'S AGEN (}R CONTRACTbR APPLIES:F.ORBDII 7iI1�T PRIVET
I, iv y/V i 1 as Owner of the subject property hereby
authorz a (� (°t ^ n/\j Spn to act on my behaA in all matters
relative to work authorized by this building permit application
Signature of Owner .. Date - -
SEC3/COPT 7bt Q I $'9_RAUTHmRL "A sF24�P•, •A OI777::: -
aeilnver or Atthorized Agent iierrbv Becla#C
that die staatcments and information eti the fo"teem_ apphcation are t ue:and aci:ut;te, to the best of my iowledgc and
behalf. .
- .Print Name - . . .
Signature of Owner or Authorized Agent . Date IE�
(Signed underthe pains and penalties of a "u -- - -
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 liave access to the arbitration
program or guaranty fund under NvLGJ— c. 142A.Other important.information on the H1C 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 basement/attics, decks or porch)
Gross living area(Sq.Ft) Habitable room count
Number of fireplaces Number ofbedrooms
Number ofbathrooms Number ofhaMaths
Type ofheating system Number of decks/porches '
Type of cooling system Enclosed Open
3. Total Project Square Footage"maybe substituted"for"Total Project Cost" 3 06
a
DE13S FOB
This fora is to be mbmitted,Ma building pemut applications whI m.verthm e is d bris to be-
disposed of
P;operlyAddress: 02 ����jee �.--✓1 .
. In�ecordaac nth the gmvisioas of I�iGL c,40, g54,:a condition of the BvilcFin,Permit
Numb=is that the(J:bris resulting from this wo:1,shzH b-disposed of in a properly H=ii ed
solid Rasta Esposal faeHity u den".nsd by'MGL c. 111 § 15D.a
nn This d?3ris va71 be ai,-posed of i= .
1Cehewa l L, �rt�er�c� � b�t b i� �T: o�11� VLA- , . .
(Loca:LmofFacdiiy) cl 1,32
Si_mar=of Pemi t Applicant
Date
04 Otis St.,Northborough,MA 01532 --1 J&L W1Tmows,INe.,D/B/A �-1 MA Home Improvement Contractor
(508)919-0900•Fax:(7,74)987-3013 .- Renewal License#149601 (Expires 1/24/2012) -
by it_demo Federal Tax ID#83-0404201
wixlolo lr
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
uyerlsi Nome - Date of Ag mein
v 44, e rr' S-
,erls)Street Address,City,Smte,end Zip code
Moil Address Home Telephone Number 4 P Vrbi?Tdeph—Number
uyer(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").Buyers)hereby agrees to sign a completion certificate after Contractor has completed
it work under this Agreement.
(� 0
Total Job Amount:3� I • Estimated Starting Date Method of Payment:OCheck OCash EfFinanced
im
Deposit Received(33%l: "'''ems- ` `���`�
Balance at Start of Job(33%l: �'FQn d Credit Cards are accepted for deposit
Estimated Completion Dare: only— maximum 1/3 of the project cost.
Completion off lob(33%):
Balance o Substantial/�/14^ / d-E!m Please see Credit Card Payment Form.
By signing this agreement'you acknowledge that the Balance at Start o£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.
;uyer(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
rom this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) hereby
cknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a
ompleted,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first
mitten above and 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF
'HERE ARE ANY BLANK SPACES.
&L Windows,Inc.d/b/a Renewal by Andersen Buyer(s) Buyer(.)
y k ,'c.c.s
Signat of oloduct Manager Signature Signature
r; 2 TA SurA, F'Fc o ,f
Print Name of Product Manager Print Name Print Name
T
'OU,THE BUYER(S); MAY CANCEL THIS TRANSACTION AT ANY TIig PRIOR TO MIDNIGHT OF THE THIRD
'USINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS
OR AN EXPLANATION OF THIS RIGHT.
_gs_ _._ _ _ _ _ _ _._ _ _ _ _ - - - _ _ _ _. _ _ _ _ _ _ _ _�
NOTICE F E III
K NOTICE F ELATION
late of Transaction . You may cancel Date of Transaction "� You may cancel
his transaction,without ny naly or obligation,within this transaction,without ny p tall or obligation,within
hree business days from the above date.If you cancel,any three business days from the above date.If you cancel,any
iroperty traded in,any payments made by you under the property traded in,any payments made by you under the
:ontract of Sale,and any negotiable instrument executed Contract of Sale,and any nesotiable instrument executed
ty you will be returned within 10 days following receipt by you will be returned within 10 days following receipt
iy the Contractor ("Seller'l of your cancellation notice, by the Contractor ("Seller") of your cancellation notice,
ind any security interest arising out of the transaction will and any security interest arising out of the transaction will
to canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the
'yeller at your residence,in substantially as good condition Seller at your residence,,in substantially as good condition
is when received, any goods delivered to you under as when received,any goods delivered to you under this
his 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 ol the Seller regarding the return instructions of the Seller regarding the return shipment of
hipment of the goods at the Seller's expense and risk. i the goods at the Seller's expense and risk.If you do make
F you do make the goods available to the Seller and the the goods available to the Seller and the Seller does not
feller does not pick them up within 20 days of the date pick them up within 20 days of the date of your Notice
if your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the goods
if the goods without any further obligation.R you fail ro without any further obligation. R you fail ro make the
nake Hte goods available to the Seller, or if u agree goods available to the Seller,or if you agree to return the
o return the goods to the Seller and fail ro do so, then goads tothe Seller and fail todo so,then you remain liable
rou remain liable for performance of all obligations under for performance of all obligations under the Contract.
he Contract.To cancel this transaction, mail or deliver a I To cancel this transaction, mail or deliver a signed and
lined and dated copy of this cancellation notice or any dated copy of tins cancellation notice or any other written
dher written notice, or send a telegram to Contractor.J notice,or send 'telegram to Contractor.J&L Windows,
4 L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis Inc. d/b/a Renewal by Andersen, 104 Otis Street,
itreet, Norlhbarou 01532, BY NOT LATER THAN Northbogbu h,MA 01532,BY NOT LATER THAN MIDNIGHT
dIDNIGHI OF 9 /, .(Date) Y// .(Date)
I H
HEREBY CANCEL TRANSACTION. � HE CANCEL'THIS TRANSACTION.
Buyer's Slgnvmre Print Name Dale Buyer's Sipnaturo Print Nome
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink
:enewa! RENEWAL BY ANDERSEN MA Bc(ec a picas 1/24 601
)4sso)
Andersen
ense
A Idersen 01 GREATER MASSACHUSEITS AND NEW HAMPSHIRE Federal Tas M# 83-0404201
Iaaow aeruearaaar ."n"de Cn 104 Otis Street•Northborough,Massachusetts 01532
Phone 508.919.0900•Fax 774.987.3013
SPECIFICATION SFIEET
luyer(s)Name Date of m nt
ry
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services fist belo ,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 Pont. '
PATIO DOOR DETAILS
1. Inst 1 total of: [_ Permashield Gliding Patio Doors)
5'10"x 618" ❑ Other(not available in 8068) Op.panel is❑ left gright(as viewed from exterior)
Interior and Exterior Color to be:A White ❑ Canvas ❑ Sandstone ❑ Tenatone-(Color same inside and out on PS)
Hardware- Metro: 0 White ❑ Stone ❑ Bright Brass ❑ Other Specify
❑ Yes �No Gliding Patio Door to have sidelight? Si=
❑ Yes ['No Gtilles7 If yes: GBG ❑ HTI W ❑ FDL(Pattern is standard as viewed in book for all doors)
2. Install total of: Natmwline Gliding Patio Door(s)
❑ 6'0"x 6'S" ❑ Other Op.panel is❑ left ❑ right(as viewed from exterior)
or Color. ❑ 'te ❑ Canvas ❑ Sandtone Terratonc (Interior is WOOD and customer must paint or stain)
and afire: ❑ Wks Canvas ❑ S ❑ B tBrass ❑ Othet� pacify
Uf Y No Gliding Pafo doo ve si t7 Size:
❑ ❑ No Grilles? If yes: GBG.❑ INTW ❑ FDL (Full Divided Light)
3. In tall total of: Frenchwood Gliding Patio Door(s)
❑ 6'0"x 6'8" ❑ Other: Op.panel is❑ left ❑ right(as viewed from exterior)
r Color ❑ White ❑ Canvas artdtone ❑ Terratone
Interio ood: ❑ e Oak aple
Intenor k Prefutish zeta(Available only white Unfinished faint/stain done by customer)
Hardware: etro: ❑ White ❑ Stone ❑ Bright Brass ❑ Satin Nickel
❑ Yes ❑ No Gliding Patio door to have sidelight? Stu:
❑ Yes ❑ No Grilles? If yes: GBG ❑ INTW ❑ FDL (Full Divided Light)
4. Install total of: Frenchwood Hinged Patio Door(s) -
❑ 6'8" ❑ Other'
❑R ❑ ctive assive elPa� 7: ❑ Left ❑ Right(viewed from ext,which is active)
Yes ❑ No Active/Stationary PaneI?: ❑]Left ❑ Right
Door Swine ❑ brawling ❑Ouswigq
Exterior Color. ❑ ❑ Canvas ❑ Sandtone ❑ Terratone
Pd
4NoHmge:d9Fafiodcor
in ak ❑ Mapleed "te ❑ Uri6nished aliilXstaiti done customer❑ e ❑ Sto Bright Br s ❑ Sa r Nickeln frame N/A— se white or re if exterior is canvas'
to have sidelight? Size:
❑ Yes ❑ No Grilles? If yes: GBG ❑ RfFW ❑ FDL (Full Divided Light)
STORM DOOR DETAILS
5: . ¢istall total of: Storm Doors)
6. r`Y Full View❑ Mid View
T Color to be- White ❑ Canvas ❑ Sandtoi Bronze Forest G
8. S to ❑ 32 'While 6" ❑ Custom(10 w ead time) Size\
9. lobe: ❑ Bright Brass ❑ Nickel I /J
10. Additional job details: All Tpc't �Q �?1�C,t�7 C�Q f`.� I•�1�,1 t_,�� �e-�o,�e�1. e �J
11. Yes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment.
o final payment Shall be demanded until the contract is completed to the satisfaction ofall parties.
It s 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 is terms modified or varied in any way unless such
c ranges are L-1 v.-: ng and signed by bath the Buyer(e and Contractor. Buyers)hereby acknowledge that Buyers)lies read the
Specification Sheet.
Renewal
lbyJ.Anndersenn oof�—Grrea�ter MA and NH.ABuyer(s) � Buyer(s)
Signature dPirixbrct Manager Signature Signature
Print Name of Product Manager Print Name Print Name
.Renewal � �.
Andersen.
WINDOW REPLACEMENT anAnderstnCotnrnny
CONDOMINIUM PERMISSION FORM FOR BUILDING PERMIT
2 Tybee Lane Salem, MA 01970
We, Crowninshield Management, being the
duly authorized representatives of The Hamlet Condominiums,
have reviewed the specifications for improvements to
2 Tybee Lane Salem, MA 01970
owned by Keith Farris.
The Condo Association or Management Company agrees that the above owners have
permission to seek permits and to carry out the proposed work.
Sia f Condo,Assoc tion�epreglyitati •en Tltle Dnte
prim,Name
(In lieu of this form, a letter stating the same purpose as above, on the Condominium
Management Company stationary may be substituted.)
vt�L,)" (l�i�lCJ �OTL
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Ulf www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information n Please Print Legibly
Name (Business/Organization/Individual): Pn E t•JLi ' 1 //)�C Y'SPn
lb -1
Address: 7i S W rtff IL
/
City/State/Zip: A/17 r A b 6 rb I AA dd31- Phone M (,!J d lf) f�/`'�9�6
Are you an employer?Check the appropriate box: Type of project(required):
rr
1.y�I am a employer with �90 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. 1 7. ,FV1 Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers'comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its -
required.] officers have exercised their 10.❑ Electrical repairs or additions
re
q ]
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 HI 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 hive outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors 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:_( /�' !�/"l-4ed/)�/e_ l/)S(//,C1/)C-e---
Policy#or Self-ins.Lic. #: I1--J J fW'( I V? / Expiration Date: DZ 1 a
Job Site Address:!)2 e 1.✓%. City/State/Zip: S6 L LAA, wk5. 01�l v
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 r[ify under th pain and pena[6es o rjury that the information provided above is true a d correct
Signature: Date: /(
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#:
CERTIFICATE OF LIABILITY INSURANCE °ATE'MM'°°""Y"
02/09/2011
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(les) 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 NAM CO T
EA
CT
Joseph McKeone PHONE FAX
N 734-662-6100 AIC No:
JP McKeone Insurance Agency, Inc. E-MAIL
ADDRESS' ,
P.O. BOX 333 INSURERS AFFORDING COVERAGE NAICIf
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,
INSR POLICY EFF POLICY EXP
LTR TYPE OFINSURANCE INSR IWO POLICY NUMBER M DDIYYYYI (MMIDDNYYYI LIMITS
B GENERALUABIUHY EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY NC958461 10/01/2010 10/01/2011 PREMISE $ 100000
CLAIMS-MADE �OCCUR MED EXP Anyone person $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG $ 2000000
POLICY PRO- LOC $
A AUTOMOBILE LIABILITY 35MCCXD6390 10/01/2010 10/01/2011 COMBINED
SINGLE LIMIT 1 000 000
ANY AUTO
BODILYINJURY(Per person) $
ALLOWNED SCHEDULED BODILY INJURY(Par...ldent) If
X qU OS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEC I I RETENTION$ $
WORKERS COMPENSATION 35 WECPP1444 02JI712011 02/17/2012 wOSTATU- DTH-
A AND EMPLOYERS'LIABILITY
ER
ANY PROPRIETORIPARTNERIEXECUTIVE � NIA E.L EACH ACCIDENT - $ 500000
OFFICERIMEMBER EXCLUDEDP
(Mandatory in NH) EL DISEASE EAEMPLOYEE $ 500000
If yes,da indba under I
DESCRIPTION OF OPERATIONS below IE.L.DISEASE-POLICY.LIMIT S 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addlllanal Remarks Schedule,it more space is required)
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
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
e
i
Nlassachuscttn - Dcp: jimcnt of Public Balm
.Board of Builtlin_ Rc_ulutions anti st:mdal-tls
Construction Supervisor License
License: CS 95707 -
BRIAN DENNISON -
86 CREST CIRCLE ` ,
WORCESTER, MA 01603
Expiration: 9/8/2012
(tnumiasi... Tr-- 2622
' ..� �✓�ie lOommea?xu�ealUz o�./N.aea¢c�%�idet76 :U�
>( Office of Consumer Affairs&Business Regulation i
e HOME IMPROVEMENT CONTRACTOR
i9j.
h�
Registratlorl�.'L49501-
1 -
.Expv:�ttDO
�h � t Card 1
1 �P (:I F eJ(t
RENEWAL BY q�ESi7 -
BRIAN DENNIS� _ --
104 OTIS STREET;
NORTHBOROUGH MYt0� 32 Undersecretary
PRODUCT PERFORMANCE
Andersen' NFRC Certified Total Unit Performance (continual
g tlo z rhMType ll-Factor' I mw .Vf' I '
Clear Dual Pane 0.45 0.fi0 - 0.63 1
Clear Dual Pane with Grilles 0.45 0 54 056 -
Glf rndha': Low-E 0.30 0.32 fL55 u
Low-E with Grilles D30 am 0.49 1A -a
Clear Duel Pane 0.43 0.61 0.0 -
e.- °�� M' Clear Dual Pare with Grilles 0.43 055 058 -
a .'LYfndaw " Lmc-E 128 0.33 156 �
Lnw-E with Grilles 028 030 0.50 .
Clear Dual Pane 0.46 059 0.63 -
Clear Dual Pane with GrNes D.45 052 C55 -
` - Lial 029 - 032
lnw-E with Grilles 031 02S a 48 :1@ _
armG'e:'GD"mp
Sao nw E sun 029 0.20 0307
low-E Sun wh Galles 031 017 026 TJ''�'-Z
SmartSun 0.28 0.22 050 'sA
Law-E SmartSun with Gn11es 030 0.19 0.44 :s A
Clear Dual Pane 0.44 0.61 0.64 -
Clear Dual Pane with Grilles 0.44 034 0.56 -
- - Lai 028 032 - 0.56 -
Mcld•::_?'.- Low{wb Grilles 0.30 D29 CAS .:
GD81' Rqh_ " Low{Sun In - C:19 030 :J
Low-E Sun with Gn11es 030 0-17
x._ Lal Smal 028 022 ISO J
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Clear Dual Pane 0.43 0.45 0.47 -
Clear Dual Pane wit Gr0les 0.44 0.39 0." -
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- Irk with Galles '033 021 0.35 -
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