3 WILLIAMS ST - BUILDING INSPECTION (4) 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 71vo-Family Dwelling
This Section For Official Use Only
Building Permit Number: Appli4
Building Of 6tal(Print Name) Date 01
SECTION 1:SITE MORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3 WILLIAMS ST UNIT 2 35 35-0162-802
l.la is this an accepted street?yes no Map Number Pmcel Number
13 Zoning Information: 1.4 Property Dimensions:
CONDO
Zoning District Proposed Use Lot Area(sq ft) Prontage(it)
1.5 Building Setbacks(S)
Prom Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private O Zone: _ Outside Flood Zone? Municipal Check if es� M Fa1 O On site disposal system O
SECTION 2:,PROPERTY OWNERSHB'r
2.1 Ownerr of Record:
KATHLEEN GEIGER SALEM, MA 01970
Name(Print) City,State,ZIP
3 WILLIAMS ST UNIT 2 978-744-2667
No.and Street Telephone Email Address
;$EQ'b`OON 3:DESCRIPTION OF PROPOSED WORK(cheat all that apply) a
New Construction O Existing Building M Owner-Occupied N Repairs(s) (4 I Alteration(s) 0 1 Addition 17
Demolition O Accessory Bldg'.O Number of Units_ Other 6 Specify: REPLACEMENT
REPLAAEE Description INDOWS- NOST
SECTION 4:ESTIMATED(INSTRUCTION COSTS
Item Estimated Cow' Of8eia
anbor and Materials l Use Only
1.Building $ 3,987.00 1'.4 Building Permit Fee$ hulicate how See is determined:
2.Electrical $ O Standard Cilytrown Application Fee
O Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. O(hei Fees, $
4.Mechanical (HVAC) $ Lisk
5.Mechanical (Fire $
Suppression) Total All Foes.$
6.Total Project Cost: $ 3,987.00 Check No. Check Amount: Crib Amount:
0 Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-2014
JAIME MORIN License Number Expiration Date
Name of CSL Holder U
86 GARDI NER ST List CSL Type(see below)
No.and Street lype Description
LYNN, MA 01905 U Unrestricted(Building to 35.000 cu.ft.)
R Restricted l&2 Family Dwelling
City/town,State,ZIP M Masonry
RC Rooft Cavering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2200 X 55285 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(IDC) 170810 12-23-15
RENEWAL
yyBYANDERSEN HiC Registration Number ExprationDato
IC OTIS S Name or HIC Registrant Name
No.and Street Email address
NORTHBORO, MA 01532 508-351-2200 X 55285
City/Town, State,21P Tel one
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GlL c.152,4 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..........13 No...........O
SECTION 7a:OWNER AUTHORIZATION TO RE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BU LDING PERMIT
Las Owner of the subject property,hereby authorize JAIME MORIN
to act on my behalf;in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signaeue) Date
SECTION7b:OWNERr OR AUTHORIZED AGENT DECLARATION
By euteft,m e below,I by attest under the pains and penalties of perjtay that all of the information
contained in ' application is and accurate to the best of my knowledge and understanding.
f - ? -IL"
Print Owner's or s New(Electrime Signature) Date
NOTES:
1. An Own obtains a building permit to do his/her own work,or an owner who hires an umegisterod contractor
(not regiffired in the Home Improvement Contractor(IOC)Program),will sot have access to the arbitration
program or guaranty fund under M.G.L.a 142A.Other important information on the HIC Program can be found at
www.mess.gov/oce Information on the Construction Supervisor License can be found at mnnzmess.gov{dos
2. When substantial work is plamed,provide the information below:
Total floor area(sq.fL) (including gaage,finished basement/attics,decks or porch)
Gross living area(sq.%) Habitable room count
Number of fireplaces_ Number of bedrooms
Number of bathrooms Number of half/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" 3,987.00
CITY OF SALE1113, MASSACHUSEM
BLMMIG DEPMTaNT
120 W.WMGfoN STRM,r PLOGA
TEL(978)745.9595
PAX(978)740-98"
KIMBERLEY DRBCOLL
MAYOR THOMUST.PMUR
Dm scroY cw PuKX PROPERTY/DUUMMG COW US MIZ
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code,780 CMR motion 111.5
Debris,and the provisions of MGL c 40,S 54;
Building Pennit# is issued with the condition that the debris resulting from
this work shall be disposed of in a Property licensed waste disposal facility as defined by MGL c
t 11.S 150A.
The debris will be transported by:
RENEWAL BY ANDERSEN
(name ofbaWer)
The debris will be disposed of in:
RENEWAL BY AANDERSEN
(name of faeiiity)
104 OTIS ST NORTHBORO, MA 01532
(address of facility)
sigoa permit awlicaut
01/08/2014
date
d6ftfUm
Renewal MA Home Improvement Contras o
byAndersen Dcense#170810(Expires 12/23'J 13}
Renewal by Andersen Corporation Federal Tax ID#41-1 91 8413'
104 One St. Narthbomugh,MA 01532 i
(508)351-2200 Fax(50B)-988.7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name bane
I
KATHLEEN GEIGER - NOVEMBER 11, 2013
113u er s Slreet Adtlress,CI ,Slate and l Code
3 WILLIAMS ST/UNIT 2 SALEM MA 01970
Email Address Home Tele hone Number Work/Cell Tele hone Number
K eier49 mail.eom 978-744-zee? zmesossza
Buyer(s)herebyfolntly and severally agrees to purchase the goods and/or services of Renewal by Antlensen Coroarafion("Contractor'),In acorniance
with the terms and corWAlobe described an 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. I
Total Job Amount$ 3,987.00 Amours Rnencea$ 3,987.00 Est.Start Date Method of Payment i
Deposit ReceNed(33%)$ 0.00 Check/-Cash
B-11 weeks '
Bahama StandJCb(33%)$ 0.00 From oeposit(50%)$ 1,993.50
Est,Install Time Credit Card
Balance on Job( %)fia[ LionSub(50%)
Completion of Job(33%)$ 0.00 Completion (w%)$ 1,993.50 TB.D. f.raft CheitiCard Paymem F.
San that
t ere m m Form.
Buyer(s)agrees and understands that this Agreements of this A the entire No alteration
between the prom th and that there are a verbal
understandings changing or bothmodifying any of the warms of this Agreement d that Buyer(s)
uyo or r(s)1 from this Agrthis ement Agreementll,
be wbho O the
e
signed,written consent of both Buyer(s)and Contractor. Buyers)hereby cpyfMisacknowledges that Agreement,
Including
read this Agreement,understands the
terms of to f Agreement.and has received n completed,signed and dated copy cancel
Agreement,Including the two attached Notices of HERE AawE
on the AN first written above and 2)was orally informed of Buyer's right to cancel this Agreement. 00 NOT SIGN THIS CONTRACT IF THERE ARE
ANY BLANK SPACES.
Renewal by AAnnTdierreenn CCCoorrpora87on�I / \) Buyer(s) Buyer(s)
Signature of Prefect Manager Signature - Signature
Doc WALSH KATHLEEN GEIGER
Printed Name of Project Manager Printed Name Printed 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 NOTCIE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
-----------------------------T_----_______-_-_--______--____-
NOTICEOFCANCELIATLON I NOTICE OF CANCndAT10N
Date of Transaction HUH/B Youmayumeadds Date of Transaction 11nl/I3 Yon may ramceI"
transaction,withoutary pendtyurobligation,witbivthree uorneaction,without any penalty or obligation,withty due:
b ;.is drys from the above duce.H you cancel,any property I business days from the above date.H you cancel,any property
waded iv,my paymrss made by you coder the Contract of SQ., I traded in,any p.ymexua made by you meter the Co...o£Sale,
evdoo regotiableinstmmevtvemted byyouwgiberetmved Iand eeY vegotiahiei.tmmrst aerated by youwIDbermarned
within 10 days following receipt by the Cmtmctor("Seller') of I within 10 days following receipt by the Contractor("Seller") of
yovr^^-agetion votive,and any econt.,inteaest arising out of I your cancellation entire,and any.onrity intern[arising out of the
thetramactic-orMbecneceled. Hym canttl,you moat make I transaction wig be canceled. H yen erred,you ram[make
araDahie to,the Seger at your residence,in subseentiaRy as good I araRahie to the Seller at your residence,in subasntlagy m good
(madition.oehen received,sny good.delivered to you coder I medid. .when received,any good u s delived d to you matter this this Counteract or rile; ur you may,if you wish,amply with the Contractor Sale;oe ou ma0 H You w sh, ompyw th the
�imtructiovs ofth<Seger regard:vg the retuon shipment o£the i. Womofthe Se erregaedi gtheme sMpmentM the -
geods et the Seges's eapevae a�risk. Hyen eta make use 8^eds I goo le nt fl a ftellier'.experessr and risk. H you do mike the goods
av WemtheS errsduseS erdoeseotpickusemupwithin I avaaeble to the Seger and the Sean does not pick them up within
20 days of the done of year Notice of Cameamim,you may 20 days of the date M your Notice of Cameliation,you anry resin
ret Anon fiiepose of the goads withmt any further obggatiom IT or dispose of the grade without any,further obggation. Hyou fag
you fea to make the goads avagahle to the Setler,or you agree mmake thegoodsavailaMemthe SeUe,,orUyenagreewreturn
m retmu the goodsmthe Seller andfaUm do w,thes your®atv I the foods.the Seller and fall to do so,uses you remain gable for
liable for performance of aU obligations under the Carman.To I performance of a obligation under the Contract To cored this
camel this transan4m,Seoul or deliver a signed and dated copy I transaction,mvU or deliver a signed and dated entry of this
of the cancegation notice or any other writers notice,or send a I caocelation antler cer any adeer writers notice,or send a telegram
telegram to Con-cumn. Renewal by Annie.,104 Otis St I m Controcec Renewal by Andmen,104 Otis St.Nord.rent h,
Northboroveh.MA 01532.BY NOT LATER THAN KNIGHT I MA 01532,BYNOTIATERTHANOfIDNIGHT
OF 11n4/13 ,(Dale) I HEREBY CANCEL THIS TRANSACTION. i OF One/u .(Date) I HEREBY CANCEL THIS TRANSACTION
I
arw*Stream PdaN— am. I awns St. P.N— Om.
--- -
Re_newal , --- Renewal by Andersen QOfpOEBSIOD MA Home Improvement Contractor
bYA Ider$en- 104 Otls SL Northborough,MA 01532 License#170810 (Expires 12/23/2013)
ws.paw .c.r.......r ma:..k,..,.,;.,;,.m (508)351-2200 Fax:(506)-986-7072 Federal lD#41-1918413
Window Specification Sheet
Buyer(s)Name - Date of reement
KATHLEEN GEIGEft - NGVamher ll 2013
The buyer(s)listed above herebyjoindy and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described
i on the Specification Sheet and the front and the reverse of the accompanying,CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of
which the Specification Sheet is Pam
WINDOW DETAILS
Style Full/ Approx. Exlador Interior Hardwsre Hardware LowEd/ Gdlk Grille Glass
Room p b Deleil lived U.I. Cesln Matta Color Color ColorIe Sveena smamun 36".. sashl/3 sasM12 Ufla 0 Mons
Half 3 DB:S uare Equal Insert 1 90 No ISIoped WH WH White Standam HFG Low-En Goo 3/1 yes No
Tacat 3 BAY&HOW DETAIIS *See Ba /Bow Measaue Sheet
Style Osten/ Appmx. Apo.. Number Exterior Intnmr End Canter Lowir Feel/ WNware
Room Court le Flankers U.I. r-.rn s An le Liles Color Color Gdlles sashes <•<M1n Screens Smertsun Soak Color
0
g
Full/ Appon. Lowe/ Exterior I Interior ADDITIONALWORK DETAIL NOTES
Room Count style Inset U.I. a,rert$un Gtllles Grilles a Color i Color Durtomeruaware that with bra/bowwmdwn under)R i.¢M
0 tiber,voBardiandkonalanke,
0
0 liChock picture of grids special order. Customer has tv
0 1 't o mar edNtiorul w�ndawe tiN time diuoum
ADDITIONAL WORKDETADS
( I No Qty of 0 Sins 0 Sill noses to be replaced by Contractor.
2 No Contractor will mmme metal Games of wend.
S No Contractor will inmul new 0 paint-ovdyor 0 Stain-ready 0 Interior 0 Exmncr wings in 0 P. 0 hfam[manmGee matmid
( 4 No Conrtacmr will Nstali sew 0 paint-mady or 0 Spin-ready 0 Interior 0 Eumnorstouin 0 fine 0 Mamtrnance-f malenal
5 No Contractor will wen exterior carrinp with coil stock of color.
Owner is aware that Contractor does not do any painting/sledning or removal/installation ofalarm systesm,wiodow freaVnenfs/hardware.It is the
responslbsty of the homeowner to have the alarm system,window freatments/herdwars removed prior to installation. We make no guaranfoe as to
6 r whetheralamrs,window trachrents,hardware will fit aftern;placement Customeris also aware in some cases Hera will be glass toss. If there is,the
amount will be dependent on the type of existing windows,type of installation,insert or PoII frame and window style.We make no guarantee as to the
amount of glass loss.Customer is aware and understands any and oil unseen mf is not included in Mis contract.Should any rot be found there will be
an additional charge for time and materials unless so stated in this contract.
1 Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris
windows,doors,storm windows and vacuum nightly included. Upon completian of the job and payment in full,a limited warranty shall be issued.
s Yes Building Permit--Contractor will secure any and all necessary permits. The fee for Me pennH(s)is not included in Me Contract Price and a separate
i check Is required at the time of sale for this fee. Check fl 1334 $ M
i 9 Yes All discounts have been applied to this agreement.
1l10 Z Yes U No Owner agrees to be present on the final day of Installation for final inspection and to deliver final payment/Mane form(s).
1,isagreed and understood by and between the parties that this SpeN lion Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT;constitutes the entire
understanding between the parties,and there srt no verbal understandings roonging or modifying any of the terms This Specification Sheet may not be dmvged or in terms modified or varied in
lacy way urilen such change arc in writing and signed by both the Buyers)and Cormart i.Ruyesu)hereby acknowledge that Buyub)has read this Specification Sheet.
iRenewal by Andersen Corporation B yer(s) - Burns)
j Signature of Project Manager 7`:`: .Signature ;^„^w t -:.._. .Signature--R"
DOC WALSH KATHLEEN GEIGER
Print Name of Project Manager Print Name Print Name
Renewal .:.,
byAndersen® -5%
WINDOW REPLACEMENT an AndeTsen'Company
CONDOMINIUM PERMISSION FORM FOR BUILDING PERMIT
3 Wi,U.i,cuwy Sfrezt Un.i,f-2 SaAzow, MA 01970
We; Iyei.wg fke,duly av-f korirzeol, refresewfa-L ,
Have- re v zwed, for i,v�&vt w�e*vty to
3 W iAlZ4* p$freer Un i,r 2 Sa UAw, MA 01970
Owned, IyyrKafitilzewGeizr. r
Tke Cowdo-Azoci.atiow.or Ma+l &mewt-Cow " above oww.ers,kave,perm.t, yi
fo stele permi{ a.o,.d,fo carry ow! fi p ropoyed work
S' of Ca+d ociafi.m�Represe.w{a{i,v�w+d Tine - G Da}t
Saa--1 .4-Ur-n`
PYZAv Na.w-e -
(1w UZ4A,Of fki3,%mKn, a tt4 2 .',fM vtg flte saw rywrpoie aY above, ow fkxe Cov,down K tn.
Ma.wa e -e*L.f Co� vtaFi.o q way lye iubSti F��fea�)
104 Otis Street
Northborough,MA,01532
Phone(508)351-2200 _
Fax(508)986-7072
Website:www.renewalbyandersen.com
The Commonwealth ofMassaehuset[s
Department of lndustrW Accidents
Office of Investigations
WJ 600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information (� Please Print Legibly
Name (]Business/Organization/individual): C(1 P-W c,` `per I—� J� �Q rSC ,\
Address: o Lk o�t S S�
City/State/Zip: LO (` Q06a Q(,S3>hone#: 1)0 S - 26-
Are you an employer?Check the appropriate box:
Type of project(required):
1..2 f am a employer with �J 4• ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6• ❑New constriction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. modeling
ship and have no employees "These sub-contractors have g. ❑Demolition
working for mein any capacity. employees.and have workers' y Building[No workers' comp.insurance comp. insurance.: ❑ g addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doingall work officers have exercised their g pairs or additions
11.❑Plumbing re
myself.,No workers' comp. right of exemption per MGL 12.❑ Roof repair
insurance required,]t c. 152, §I(4),and we have no
employees, [No workers' 13•[1 Other
comp.insurance iegdired.]
*Any applicant that checks box#1 must also fill out the section Below showing their workers'c"ompen.§ation polity information.
t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must sub'mit'a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. lfthe sub-contractors have employees,thry must provide their workers'wmp.policy-number.
!am an employer that is providing workers'compensation insurance for nV employees. Below is the o '
information. cy and Job site
Insurance Company Name:_Vn P hkI �t lc n S C o
Policy#or Self-ins.Liic.#:ILwc, �(� '� � . Q(� Expiration Date: I (7— ) —
Job Site Address: , (.t ) �,l l /1 Mai J� City/State/Zip: S J c.," , (Ltd of _�zl
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 her a under the pains and penahles of perjury that the information provided&hove is true and correct
Siena 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 D/ 2/""�3
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 POLIGES
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 ITS an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to
me terms and conditions of me policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to Me certificate holder In lieu of such endorsement's).
PRODUCER 1-612-333-3323 COAT
Bays Companies N E:
PNa1E 3323
80 South Bth street aWL 613-333- j xe, 612-373-7370
Buite 700 AOOREBS.
Mimeapclie, AIR 55402 INSURERS APFORWNGCOVEBASE NAICO
EMSULD REPUBLIC INS CO 241E7
INSURED ATIONAL ONION PIES IAB CO OP PITTB 19Ee5
Renewal By Andersen Corporation
10E Otie street
Northborough, MA 01532
COVERAGES CERTIFICATE NUMBER: 36122490 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N 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 W ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CM&
IYSR T ECFWSURANCE am, pDIICYEFF PoLA'Y p
Pol1CY NUMBER WRa
A GENERAL LABILITY HWZY 300361 10/01/1 10/01/24 EACHOCCURRENCE f 1,000,000
a COMMERCIAL GENERAL LABILITY FTaT 500.000
EMIS S acme n f
CIAIMS.w1DE OOCCUR MEDEZP am f 10,000
PERSONAL nADV IwUgY f 1.000,000
GENERALAGGREGArE f 4,000,000
GENT AGGREGATE LIMN APPLIES PER PRODUCTS-COMPIOPAGG $4,000,000
X POUCY PRP LOC f
A AUTOMOBILE LA91"( K 300026 —Tr/F,7r INED61 LE N
Z ftwv t 5,000.000
ANYAUTO 600ILV WJLRIY(Perp ) f
A LLNr OEO ED
AUTMOS AUTOS BODLY Y(Pwsmxd) i
AUTOS R
Z HIREDAUIDS Z N �ED PROPERTY E
f
f
B X UMBRELU WB Y OCCUR 20562235
10/02/1 10/01/14 EActiocc IARENCE f 25,000,000
� CLAIMSMADE AGGREGATE f 25,000,000
EXCESS
DED I a I srrEvrIoNz 25,000 f
A WORKERS COMPENSATION MC 300359 00 YYC BTATLL OTH
ANDEMPLOYERS-1ABURY YIN 10/O1/1 10/O1/IE X
ANY PROPRIErORPARTNEWEYECUME f 1,000,000
OFFICERAIEMBER EXCLUDEOi O NIA EL EACH ACCIDENT
BINNN"A NH) EL.WSEASE•EA EMPL SL,000,000 WYnCmPTION V Nunder
DES OF OPEMTbNS tdoN E.1-N E E-FOUCYUNUM 1,060,000
DE6CRIPlION OF OPERARpxS ILOCARON6l VEHICLES(AURA ACORD 101,AddnbrW RIIINrFr erMdVU,Amen Fps b rpubed)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
To Irham It May Cepeern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Insurance Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS.
AMORRED REPAE6ENTATNE
V
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered made of ACORD
ihargrow
36222490
Massachuse'tts Department of Public Safety
'Board of Building Regulations and Standards?
Construction Supenqsor ,.
License CS-- .I
JAIME L MORIN
86 GARDINER0tR0�SZ
LYNN MA g
Expiration
,'-Commissioner 10/06/2014 1
I
i
SCA 1 0 20M-05/11
trice of Consumer Affairs&Business Regulation
OMEIMPROVEMENTCONTRACTOR
Registration 170810
Expiration 12/23f2015 Type:
, RENEWAL 13YANDER NCpRPORATION Supplement
JAIME MORIN v'
104 OTIS STREET -+ -
NORTHBOROUGH,MA 01532
Usderse1
Renewal
byAndersem
WINDOW REPIACEMENt �aMden.nCavpmy
'WOW
WOOWFf l Composite IF
ra EYSRE00 Duel Argun
H low E4 SmanSuO
' 100-00473518-010
ENERGT PERFORMANCE RATINGS
U-Factor(U.S)A-P Solar Heat Gain coefficient
wZ2 9- Owl 9'
ADDITIONAL PERFORMANCE RATINGS .
Visible Transmittance .
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