12 HIBERNIA LN - BUILDING INSPECTION The Commonwealth of Massachusetts RECEIVED
�►y Board ofBuilding Regulations and StandWECTIONAL SER ICE
�( Massachusetts State Building Code,790 CMR �s ALEhd Mo r 2011
Building Permit Application To Construct,Repair,Renov1W JJNk%n PmQ - 2 L
One-or 71vo-Family Dwelling
n This Section For Oflicw Use Only
`^Y Building Permit Naber' Da*Applied: —
Building Ot6ca1(Print Name) - 8*13aMe -- D
t SECTION is SITE Bvolitm TION
In 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
12 Hibernia Ln. Salem, MA 01970 07 07-0029-906
e l.ls is this an accepted street?yes 310_ Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
CONDO
Zoning District Proposed Use Lot Area(sq fl) Frontage(ft)
1.5 Building Setbacks(8)
Fhom Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Sapply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private 0 Zone: _ Outside Check if Flood Zone? Mrmicipal O On site disposal system O
SECTION 2: PROPERTY OWNERSHB?'
2.1 Owner'of Record:
Fred Miller Salem, MA 01970
Name(Prim) City,State,ZIP
12 Hibernia Ln. 781-581-0091 fremmiller@msn.com
No.and Street Telephone Email Address
;SIR01I ON 3:DESCRIPTION OF PROPOSED WORK?(check all that apply)
New Construction D Existing Building 16 Owner-Occupied lif I Repairs(s) Id I Aftmation(s) 0 1 Addition 0
Demolition 0 Accessory Bldg.0 1 Number ofUnits_ I Other lf Specify:Replacement
Brief Description of Proposed Work?- rep acing w+n ows- no s ruc urn c anges
SECTION 4:ESTIMATED CONSTRUCTION COSTS i
Estimated Costs:
Item OMcial Use Only,(Labor and
1.Building $ 10,800 1, Building Permit Fee:S" Indicate how fee is datmmimed:
2.Electrical $ 0 Standard City/Town Application Fee -
0 Total Pi o ed Coat'(Item 6)x mahipliw x
3.Plumbing $ 2. Other Fees: S
4.Mechanical (HVAC) S last:
S.Mechanical (Pine S Total All Fees:$
Suppression)
Chock No. Check Amount Cash Amount:
6.Total Project Cost: $ 10,800 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-6-16
Jamie Moirn LiceoaeNumber Exp ZonDate
Name of CSL Holder S List CSL Type(see below)
86 Gardiner St _
No.and Street type D
Lynn, MA 01905 U Unrestricted ui to 35,000 cu.R
R Restricted 1&2 Family Dwelling
City/1'own,State,ZIP M Masonry
RC Rooftrut Covering
WS Window and Sidinst
SF Solid Fuel Burning Appliances
508-351-2214 I Insulation
Te hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-15
Renewal by Andersen HIC Registration Number Expiration Date
INC Company Nome or HIC Registram Name
30 Forbes Rd
N.and Strrttghee , MA 01532 508-351-2214 Ems'l address
City/Town.State.ZIP Tel
_ SECTION 6:WORKERS'COM_PEN_SATION INSURANCE AFFWAVIT(M.G.L.c.152.4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will rcmh in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........T No...........O
SECTION 7a:OWNER AUTHORIZATION TO RE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby airdwrize Jamie Morin
to ad on my behalf,in all matters relative to work authorized by this building pmmit application.
Print Owner's Name(Electmaic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I stied under the pains and penalties of perjury that all of the information
contained in this application' true accurate to the bat of my knowledge and umdefatantbttg.
//-6 -I J�
Prim Owner's or A 's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an Metered contractor
(not registered in the Home Improvement Contractor(HlC)Program),will rung have access to the arbitration
program or guaranty fiord under M.G.L.c. 142A.Other important information on the HIC Program can be found at
Information on the Construction Supervisor License can be found at www.mass.eov/dos
2. When substantial work is plamr4 provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.fL) 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 eyatem Enclosed Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
CITY OF SALENI, MASSACHUSETTS
BL;RDWG DEPARrAIENT
120 W&SH ING Tort STWEEr,3m FLOm
TEL (978)74S-9595
FAX(978)740-9846
KIMSFAILEY DNSCOLL
MAYOR THOMAS ST.PlIEttts
D1Lmwmz OF Pusm PROPEm/i miNG coma55fomm
Construction Debris Disposal Affidavit
(required for all derrrolition and renovation we*)
In accordance with the sixth edition of the State Building Code,780 CMR section 111,5
Debris,and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting fi m
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111,S 150A.
The debris will be transported by:
Renewal by Andersen
(num of hBuW
The debris will be disposed of in :
Renewal by Andersen
(nom of Timmy)
30 Forbes Rd, Northborough, MA 01532
(norm of facility)
of permit applicant
�na�
ome
Renewal MA e#170810(Expires I W 2015)
byAndet•sen. '° Renewal by Andersen Corporation
License#170810(Expires 12/232015)
• w,«dew tn..erpr«. .,,.«,.k,..c...... y � Federal Tag ID N41-1918413
30 Forbes Rd. Northborough,MA 01532
(508)351.2200 Fax(508)-986.7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
;Buyer(s)Name Date:
FRED MILLER - SEPTEMBER 30, 2015
{Buyer(s)Street Address City State Zip Code
12 HIBERNIAN ON SALEM MA 1 01970
Email Address Home Telephone Number WorktCell Telephone Number
FREMMI LLERQMSN.COM 781-581-0091 781-581-1103
Buyers)hereby jointly and severally agrees to purchase the goods 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 sheets)(collectively,this-Agreement").
Buyers)f hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Est,Start Date Method of Payment
Total Job Amount S 10,800 am RnatcaaS 0
Deposit Received(33%)S 3,600.00 Deposit 4 dgryn S 0.00 Check/Cash
10.12 weeks
Balance Start of Job(33%)S 3,600.00 - Greek d
Balance on Substantial ms,matarcial Est.Install Time Credit Card
Completion of Job(33%)S 3,600.00 contention engin S 0.00
1-2 days If crelftaCr0card ftCwddcctcd,Pbas1
No trod c,u eemmpmea uwn msr¢siN see CreditGard Payment form
I)Suyer(s)agrees and understands that this Agreement cwutilutea the entire understanding between the parties,and that there are no varied understandings
changing or modifying any of the teens of this Agreement No alteration to or deviation from this Agreement will be valid without the signed,written consent
of both Buyers)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the temp of this Agreement,and has
received a completed,signed and dated copy of this Agreement,Including the two attached Nodees of Cancellation,on the date Brat written above and 2)was
orally infamrad of Buyees right he cancel this Agreement DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation Buyer Buyer(s)
717///�
Sy- JLntGL /�t.11i0tttel'
Signahaeof Consullanl ____—__— —. •ynaNre--___ Signature
g JAMES KASSIOTIS FRED MILLER
Printed Hama of Consuaanl Printed Name Printed Name
YOU,THE BUYER(S),DAY CafICELTHIS TRANSACTION AT ANY MINE PRIOR TO DRNIONT OF THE TIURD SUSaiESS DAY AFTER THE DATE OF TNS TRIM ACTION
SEE nee ATTACHED NOTICE OF CANM1.13MON FORDS FOR AN E%PIANATION OFTH1S RG1R.
------------------------------------------------------ ----------------------
NOTICE OFCANCEIlA120N I NOTTCEOFCANCt1L1TION ,
1
Dmeef Trtmarlren 913;110 YovmryoaMdde Date of Tramtrdon M:uV35 T...'erm,lthis
r,tnrvaloq widvwr trey Woolry or obligation,within duce bminees days from the 1 trumactim,without my penalty or oldiptdn,within duce bpeinmt doge 4dm the
teener dun V yea meted.tley Property needed le,ney Peymems made by tele under , .born dare.V you caned,any".Pony traded m,my Paymmte made by yds under
the Covtram a Sol,and any negoriaMe Ills ant executed bytem wards , theCmvtm of Sat,and any sagoriaWelmtrument eannred bir,li. ter
retsmaon tuaie it any areeniq Intrne rhe Contra coo("Seen^)ef yes , rervmed wirnotNdays an,neileg,ecIntrne'rbc Cum mate. lir erse^)afyno
etmrer. I vetice.and any ent.re Imeeesr e,iedvg aur of rho r,rmasr:ov wmbe , ea le,Len coria,,and my tensity imerrsr ssiat�mr of rhe rrwtarim not be
em-lol V yea meal.yap m,,..matte artared,a the Seanat,due aesthete,er 1 evroold .'temondrooyou amt matte—.lend,ro rhe Sneeruterm nsidmn.ie
avMunWey mgoad condition to wbm ronheb my goodedetlreeed ro tem wade i mbcmvtiaey os Boca rotdiam m win ro,eired,my goods detlserrd m yds the,e,
State
ta eeevrer err Sale:pr allip of Me4 en
de, brine imwree o.of ria this r else n or Sale: m yw mr„if Y f wive romPly wiO rine i.,.rad rilro
SeM,ga.ding the ream ahlpmmt of din goodsa rbc Sellertetprme andrteY. sea s.do r.di- the corse aunMe1a de dee Sandsand
the Sneersn,-1 eandrote.
Vym mmahe rine goeda vreila.Wemthe Seller and We SeOe done cot pee them vp� If yav do mate rbc gonds ardlab4m the Store ma Me Seth done—1 Peril them up I,
within 20 drys of the due of yes Naim a Capttllation,you may retain or
diepoee vithip 20 eeys of the due of tens No W,ofCmeeeatho,ymr may rennin lir dupes. '.,
a the goods wit my fmvher obegnr . V tem Ga t0 mtYe rhe geed+traaebte ' of the goods without my fpeWee obligation. V you fail to makr rhe goods erasable
in the Will,ler Vyen agroemnrum ren goods re the Win cot fa0 on do tq than ' in ch,seen,or Vymr a gree to .ran goo0a m d,e Seaer and 411 to do m,rem
tem remain eeb4 icer pe,f�rmance o[tDobegarlom order the Content. Toesnrd yep remdo liable 4r performance or a0 ebeprime enter the Cdvtrtn.To eneeel
this rden,mail or defier a sigma and dated ropy of thin ente.ee".antic, , thio rrtsardon,none ler little.,asiglerd and dared eoq a cele emceum:on leader
myotherwdnmmtiMssevderdegrammteetraason Renewal by Aedeneq, or any aene"teen wrier,or teed a telegram to Comrammt Reverent by Avdene4
]-0 Frohn Rd. Nmrhbmaugh.MA0151L , 90 Forbes Rd Newhboreugb,SIA 0102.
IIRAEBY CANCF111�TaANSACnON. � 116AFAY CA\CFITIOS TRMfStCrlO\. 'i
� I
1 _
vyaS Sgmm nee. on, i vurerYS®mm ,re Nap em
Ne-newal a Renewal by Andersen Corporation MA Home Improvement Contractor
b,N Idersen- - 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 1212312015)
wanner Rrrrwcrnrna .,,m,l,.<,.a..w.,. (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
1ptrrr(s)Norrie D:uc of/�gm:cmcnl
FRED MILLER WED, SEP 30, 2015
'rhe burr.!{s)listed ah we listed INauwt in acowlance with Ike prices and terms dcscrilwd
on the.Slxxifirmion Shce1 and Ihc rmnt and Ihr.rrrerse ol'thr.arcnm(xmying CUSTOM WINDOW AND DOOR REA10DELING AGRF.EMEA I',4 which
Ihr.Specification Stwo is pan.
WINDOW&DOOR DETAILS
,/pry E crior/Imcrin Crim H=.0 tui — Inw 1 (aim (Lice Glasz
Rmm a .uy, IWW un. Window/DoorStyle Detait C r,p Ext-Int Color srym Saee,n STPGW GnlXs SnsX In S 2 UML Options
HerCsw I ro 30 go GWinsed laf, Fitt.MF 908 White Standard FAL XLm
Living 2 62 46 108 GW Insert talo L-Trim NHfVVH While Slandan! FAL MSsrHund
Bath 1 203 tit :10 98 GW Insert mfo L-Trim NHAVH White St i dad FAL !roar Tem
Mst Bbd 204 72 79 151 PS info None NHANH Stone Standad HAL 1,nsc3s, Itaie
Bed 1 205 72 79 151 PS rab None NHAVH Stone Standard HAL Nara
Tota 5 BAY BOW&BUILD OUT DETAILS
p ox
SA OoaJl wlaW APMox. Nwnbor Frame WXdow End Centro LowE/ Root/ Hardwdre
Room Calot at& RaMon Gaal a An to Uto Intoria atMt Cdor Grillo soh. sasho Saans Smanam S ffit Odor
SIIECIALTY WINDOW DETAILS
Ful/ Approx. t / Spoclalry BAY/DOW ADDITIONAL WOMNOTYS
Roan Count St o Irnal U.I, snens,n GriOn Grlma exWn Cola (ioennn.m.,nr�Xv oLX lav/Inn.uin4m,nuAr J2 Xu Xr.
:Iv�xill lr�ienileaw RL..I,v.
ADDIT70NAL WORK DETAILSt
I No Contractor will wrap exterior casings;with coil stock color of
Owner is aware that Contractordoes not do anypainting/stainirg w removal/installation of alarm system or window treatments/hardware.It is the responsibility or
the homeowner to/lave the alarm,system and window treatmentsrhtlnTvala removed pow to installation. We make no guarenfee as to whethera/amis or window
treatments/hardware will It afterrepracement Customer a also aware M some rases Nara wgl be glass loss. If there is,the amount will be dependenton the type
�• of existing windows,type of tnits0etion and window style.We make no guarantee as to the amount of glass loss Customeris aware and understands any and all
unseen mt is not included in this contact.Should any rot be found there will be an additional charge for time and materials unless so stated in this contact
I yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and at infiltration.Removal and disposal of all lob related debris,
wkdows doors,storm windows and vacuum nightly included. Upon completion of the job and payment In NII,a limited warranty shall be issued.
I Yes Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s)is included in the total contract prIce.
15 Yes All discounts have been applied to this agreement.
a 'i li' ; \o Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/Mance font(s).
h:.agr.asl:a.d udenu.xl try coal Iws...:cn ILe Ixmor dui d.i.Six:caundv.Shfcl.almrx.dub J:c l:Ul'f0\I\YLND04'a\U M'x)R ItF\IODISIJXC:AG8[iP:\IFi\'f,.wnaimun she e:nim
uuhvela,Jiug Ix:r.viceu dm lunics:uul dmm am no a:rlul undaelmutg4o rleml5'vyt or u:,.81j•inµ:mc,d rhu Xane.'I'bis Slxsamarinn llu+n may bin In:dmlrpal ur iXf¢ons nexlitirA mra,i.:d iu
antro r,nd,clu:yp:are in wining coal,ig�evl Iw IxnL tic Itu.v:lt+l vv1 f,nlree,:c I{urall.)Iwndry urbrmd.:As,.rban IAger(r)by rrvd d:i.ti{s:ciPoalum Sb.ye.
Renewal by Andersen Corporation I{urcr(s) Miner`s)
Signature of Consultant Signature Signature
JAMES KASSIOTIS FRED MILLER
Print Name of Consultant Print Name Print Name
The G'onramxtcralNlr of Marsachoew
DVato east of IndnoW Ace dents
Office Oflnl atior S
600 WashingWn&red
Bas on,MAIV OZI11
ww"t-UM a gor' k
Workers' Competwation Insurance Affidavit.Builders!Contractors/Electrlcians/Plumbers
Aonlicant.Ialtbrmarioit Pleass,Print IAgwly
Nellie(Bush=&/Orl a ndounndividual): RENEWAL BY ANDERSEN
Address: 30 FORBES ROAD
City/State/7.ip: NORTHBORO,MA 01532 Phone I': 508-351-2200
Arejw'all an employer?Check the appropriate bow Type of project(require
ft
d):
1. 1 run a eaipioyer with 30r, 4. ❑ I ark a Qamral oontractor and I 6. Ns corsnnedon.
employees(full and/or part-time)." have hued the moors
2.❑ 1 am a sole pnrprietw or partner- listed on the attached sheet.t 7, 171tentodolinR
ship and have no employees These sub-contractors have 8. ❑Danoutim
working for me in any'caPacity. workers`cep.insurance. 9. ❑lloildhrg addition
[No workers'comp.insurance 5. ❑ We are a corporation and its I O.Q P,kcbiaal rapaira or tuittitions
,) officers have exercised their
3.❑ 1 am a homeowner doing all work right of oxemptioo per MGL 11.[]Plumbing repairs or additions
myself.[No wurkera'comp. c. 152,.81(4 and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers, 13.[]Ckher
comp.insurance required.] —
"-�Y eeI dim dCeks Mux fll Mont eiso flu out the Maine Udo showing lair warners' P Jjq .
.t Flariowmn wfio submit this affidavit ladicr.erg dei tae doing as work and ohm hive outride oaamMors murk satrea areae AffidwitladkAing such,
w
tConvaa s dtat etea th6 box mast atmdred an additional sheptshowingtM now of the aub,00ann auro and Hwa werkm,comp.poliq Mo minion.
lam oa employer drat h provldlug workers'eoaremsadan hnan weeforrty MpAwars. Below h toe pully mid job she
Insurance Company Name: OLD REPUBLIC INS. CO: _-
Policy#or Self-ins.Lic.#: MWC 305437QQ� v _._ t5xpitatiomPate: 10-01-16
12 Hibernia Ln Salem, MA 01970
Job Site Address: city/5tai0Op:_ _
Attach a ropy of the workers'compensatim polky declaration par(showing the poLky number and exoratlon date}
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pe mhfes of a
fine up to$1,-400.00 and/or one-year imprisonment,as well as cKill penalties in the firm 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,
Ido hereby wader the Int a tdpena Nee ofpeyary rum the Woraisadon provided above s true and coerce
FfM d: 508-351-2200
Ophrl we only. Do not wrhe In tuffs em^to be rao rtced by c*or roan o�IclaL
City or Town: permitlike"o,#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Penson: Phone#:
ANDECOR-01 YADAWO
CERTIFICATE OF LIABILITY INSURANCE
1a1rm1s
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),AUTHORUED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the Certificate holder is an ADDITIONAL INSURED,the pollay(las)must be endorsed. NSUBROGATION 13 WAIVED,subfecl to
the tarns and conditions of the policy,Certain policies may require an andorsarramL A statement on this certificate does not confer rights to the
Certificate holder In lieu of such end a).
PRODUCER NAME: Willis Certificate Center
Mille of Minnesota Inc. 8 845-7378
do 26 Century Blvd .C 177 Ille.com N° 688 467-2378
P.O.Bns 305191
Nashville,TN 372305181
SBU PB AFFORdNG COVERAGE IuUC#
INWRERA:Old Republic Insurance Company 24147
INSURED
IxsuloBl 0:
Ren
-
Ren wral by Andersen LLC INSURER C;
30 Forbes Road INSURER 0:
Northborough,MA 01532
INSURER E:
IN&URER 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 PERI00
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.
LTR TYPE OF weURANCE =w rv= POUCYNUMSER
uMna
A X ODMMERCUILGENERAL LIABILITY EACH OccIRRRErx.E & 1,
CUIM&MAOE �X occua _MWZY 305410 10/018016 1tV018018 PREaSEs aeOa,vq i 600,000
MED EXP Amoro pmaon) S 10,000
PERSONAL&ADV INJURY t 1,0
GENL AGGREGATE LMR APPLIES PER; GENERAL AGGREGATE g$ 4,0701*0
X POLICY❑JECT El Lac PRODUCTS-COMYOP AGG OTHER AUIX) 6 E lJA&DrY M
A X .ASG MWTI3 305438 10/018015 101078018 BODILY INJURY(Per Pwaon) i
ALL OYMED SCHEDULED
AUrOB AUTOS BODILY INJURY(PerwMart) r
PROP
HRREO RATIOS NON-0 EO
AUTOS jp= t i
i
NISREJA LW3 OCCUR EACH OCCURRENCE r
E1(C69a WB CLAMS�AADE AGGREGATE i
DED RETENTION ai
WORKERS CDMPENSATK)N
ANDEMPLOYEVIUMUrTY YIN X BTRTUTE R
A ANY O ICERAIEMSERBER EXCLUDED? NIA IN] NIA '30543700 10/018015 101018018 E.L.EACH ACCIDENT i 1,000
,111010
wi1tlitminINN) E.L.DISEASE-EAEMPLO d 1,000
.0011
ya
DESCRIPTION OF OPERATIONS below EL DISEASE-Policy LMR i 1,000,
DrJSCRIP1gNOPOPERATIONSRLOCATWNSIVENICLa6(NCOROJM,Addo,rdRe "SeboduKnoybatl d"Smmepeehreeuwm
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Au7xDR®R/EyP�R�68ERATVE
Evidence of Insurance-
®1968.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts-Department of Public Safety
Board of Building Regulations and Stand_a_rds _
Construction supenimr
Licence:C34*9128
i H
JABARLMORM.-`
86 CAR1tii M Sir L
LYi!IIsi MA 0198E
:y
J.�.+.d.6t • Iris" Expiration
Commission" 101)MM8
Y
' - - - if C Aw"sis 6.s'1lat�eefit�lsNe. 'i
. BIRN1'GONtti . . Ni
I + 'Rl0mai' Sup06m'on1!$
;18SNEWsid_BY JVN *4 I( AI
dlAlilE.`llf MN �-
101 Oi1S 87RFEt '1 ''' .•_-'a.. --
M*TABOMAH.!MA:01832
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1
Do nM mote m04nol cob h gmdm R®e WW pc15ue mfnmm
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_ dam
. tl�ZiMpm'eRa AND-N-M
apy,
WwdMnylGompwftBFF
Oual Mon l.ow E4 9m rtSun .
Redact Type: Glider
ENERGY MWORMUCE RATINGS
- U-Factor - Solar Hook Galn CmMclent
0:29 . 1.65 0.21
.R.A-P eh7rJBl
nnomoxn�rsRFaRMax�Ranxms
Vleible,Tianemitlartoe
0.49
M
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mam ac
. . ♦ RR®.NYNNYWMNYI9M0 ..OF pSf IIB��nR. ,
- 1aDaafi1�R36-07fi '
- I
PRODUCT PERFORMANCE
Andersen' NRC Cartifled Total Unit Performance (onunced)
Andersen Product Glass Type I Fac= SHGC' - vr'
-2005enes.
Clear Dual Pane 0A5 0.60 0.63
- Clear Oval Pane•% tGapes OAS 054 056
014Wasn Wn 0.30 032 055
UPanle-Hung W6ddow W E• Gales 0.30 029 0.49 Fa
HP Ira RSmzr un 030 021 0.49
HP W 4 5mar6un W Galles 031 019 G.3 J t�
Clear Dual Pane 0A5 0.61 084
Nartoline[ Clear Dual Pane nHlh GOOAS 051 0.57
Oounlo-Hung Wind. low{ 0.30 GM 0.56
- Iml-E rriN GAI. 0.31 Oi9 OSO >I
Gear Dual Pane 0A4 0.63 0.66
Na mline: Gear Dual Pan, Gnllrs 0.44 OS7 059
T...Window We 0.27 034 058
l ,E aM Galles 027 030 052 _
Dual Pane 045. 060 Obi
Grr0ual Pane nbn Galles 0.45 054 . 0.56
GlidinSWlndow �o`E 0-30 032 0.55 -
Imv-E aiN Grilles 030 029 OA9 J
ImrE SmadSun 030 021 0.49 TJ
Inr.E Smartun wiN Galles 031 019 OA3
pear Oual Pane OA3 061 0.65
Gear 0ua1 Pane w Gales 0A3 055 = 058
" Fuer,Transom;, W E 020 am 0.56 M
U.J.TOP'Window 1 W E x G flu 018 030 0.50 E
"- WrrE
S. v 027 022 0.51 rf �M
low-E Sm un wRn GAgm 027 020 0.45
' Geer Dual Pane 0.44 O6] 0.64
C:ear Owl Parra udM GO. OA5 0.53 056
Imv{ 029 032 0.56
.Mmline'. low{wilh Wlles 0.30 029 0A9 Fj 'i tN -
'GOdng Pan.BPors Imv-F S. 029 020 0.31
low{Sun ugp Gales 031 0.1E 0271 e.7
WmE S.am 020 021 050 ]A
tnw-f
S. .n a Gnlies 030 0.19 0."
Gear0ual Pane 0-43 0-61 am
Clear Owl Pane wiN Gnlu 0.43 054 056
Imv-E 020 032 0.56
tSfidMg
ield'. Ww-E won 6nlles 0.30 039 0-9
ada 94 Ww Sun 029 0.19 0.30
Inwf Suna Galles 030 0.17 027
InrrES .a un 027 022 0.50 a �
low-E SmarLun wiN Gales 029 0-19 044 3 �
Gear Dual Pane 0.43 0-45 147
--
0aar0ual Pane wiN Gales 0.43 039 0.40
IssE 032 024 OAS
Bingedlnswing - lmrE whh Gd033 021 035
Padv DPors Iow-ESun 032 015 023
.. Ime-E Sun aM G Hes 034 013 0.19 -
_ - I E Sm .n 032 0-16 037
Im.E Sn un wiM Galles 033 014 031
iCO�
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i
. i
Andersen' NFRC Certified Total Unit Performance (mnOmmd)
I I
Anderson'Product Glass Type U-Factor' SHGC' I! VP l A11 Andersen•Product Glass Type ILFacmr' SHGC' VP iMC'EL
900 Seiea - Amhilecmlml NP MaiHPLax La who 8uan 0.32 0 2] 0.26
UP lire E4. 0.21 0.35 0.60 l-: IIP Lmr-E4 032 028 0.47
He May E4 with Golan 0.28 0.31 0.54 Y1
0.32 025 0.42
Circle Tap IIP Low E4 Sun 0.27 0.21 033 Casement window "--
Casementwndovr He Low E4 San with Grilles 0.29 0.19 0.30 ,rel HP lira-E4 Sun with Gnlim 0.32 9.16 0.23 r pg '
NP ma-E4 S morgirn 0.26 0.23 0.54 IlA '''i He lax-F4 Smar un 0.31 0.18 0.42 •'^!F4
i HPtimEASmadSunw/Grilles 0.2B 021 0.49 il' %� He IamE45marl5un w/Ga11r3 031 9.18 0.38 TRU
HP ImrE4 0.27 035 0.60 HP Law B 0.32 0.28 0.41 'I SH
HP Lmv-E4 with Grilles 0.28 031 0.54015 with Grilles 032 025 0.42ME
Ie�
HP tmi-E4 Sun 0.27 021 033 - ( french Casement XP Iuw-E4 Sun 0.32 0.11 036 Go
Circle 8 Mal window ---f- -- hiox IIP Low-E4 Sun with Grolier 0.32 0.16 0.23
IP L-mv-E4 Sun with Grilles 0.29 0.19 0.304'q '"'(df w
IIP taw-E4 SmaaSun 0.26 U23 0.54 rtd '"® IIP 1mv-E4 SmadSun 0.31 0.18 0.42 _In
HP Inm E4 SmanLSun w/Culla 0.28 0.21 0.49 RE 'r� - HP Hrx-Ed SmmlSrn w/Gallas 0.31 0.17 0.38 "rN®
lIP Inw-E4 0.28 033 05B He law-E4 0.32 _028 0.47
HP LuwE4 wish Culla 029 030 0.52 NP troy-E9 with Grilles 0.32 025 0.42 G
IIP Lmn-E4 Sun 026 0.20 031 "1 - HP Imv-E9 Sun D.32 0.17 026
Arch Md. - l-V Aw�g Md. ---Up lax-E4 Sun with Giles 0.32 0.16 0.23
HP Lao-E4 Sun with Gail_ 0.29 OAR 0.28 E @� -
IlPlow-Ed SmmHLM 0.2i 023 11.52 "'�® He tan-E45mahSun 0.31 0.18 0.42
Pin
He L"w-E4 Smmmm w/Galles 0.28 021 OJ6 I{( `1® HP lire-E45manat w/Gdlla 0.31 0.17 0.38 `
He Low-E4 0.27 033 0.56 ieY HP1aw-E4 0.31 032 055
-- IIP Imv-F4 with Galles 0.28 030 0.52 '01 HP Iarp4 such Gila 0.31 029 OA9 Ini
IIPmw-ESUSun 0.27 0.20 0.31 aA +';.r}] GsemenVAwning lip lam E4 Sun 0.31 02D 031 .td®
Flesifreme'window HP Law E4 Sun with G611es 029 0.18 0 28 SF7 Fd[tit Phare wmaow HP Law-E4 Sun stir Grilles 0.31 0.18 918 w
HP Ina-E4 SmatSun 0.26 0.23 0.52 fn1 'P41 IIP Gait Ed SmaaSun 0.31 021 0.50 +'
HP IamE45marlSun w/Galla 026 021 0.46 C5 �'� NP lire{4 SmarlSu"w/Clines 031 0.19 0.44 ep®
HPlmv{4 0.31 033 0.58 He lax-E4 0.30 037 0.64 67
Iip-Les E4 with Glia 0.32 030 0.52 IIP Luw-E4 with Galla 030 033 0.5T 1]'
IIP Lao-E4 Sun 0.31 020 031 "l{ 9peclalry Wndon He LW-E4 22 Sun 0.31 0 0.36 k`7®
6pdnglina window .--IIPLmrE48unwiN Gana 033 0.18 026 - ` He Lax-E4 Sun moth Glias 0.31 020 0.32 NO
HP Lax-E4 Smad5un 030 023 D.52 HP]mv-E4 SmarlSun 0.30 024 0.58 Cj' FPe
IIPIumE4SmmUhUm,,/Gila 0.32 021 GAG ZI '+@� HP pra- Smar15un w/Galla 0.30 022 0.52 17, Pwi�
_HP Ma E4 030 Ora] 0.45 54 1WR HP Goat Ed 0.32 022 037 1-9 ''wa
IIP Ian E4 with Gabes 0.32 023 0.39 RFi ''^7pH HP lire-E4 wiW GNla 033 020 033 -
Frenchwood' - HP rays E4 Sun 0.31 0-16 0.25 ON S'. Hinged Inswing NP 1ax-E4 Sun 0.33 0.14 0.21 -
Gliding Patio Vast HP Lox-E4 Sun with Gulf. 0.32 0.14 0.22 i? aIle Fre.0 Door IIP 1mv-E4 Sun aHh Grilles0.34 0-13 0.18 -
LIP tow-E45marl5un 030 0.16 0.41 F] SCI$i He 1.x£4 SmaHun 0.32 015 0.33 is
HP tan-E45maaSun w/Grilles 0.31 0-i6 035 ¢� 8am RPW-E4S=a unw/GnTm 0.33 014 030 -
HPLaw-E4 0.31 0.24 0A1 I'M late _ HP IawE4 0.33 025 0.41 bac
HP Iam14 wig,Giles 032 021 035 P19 ii f,� HP tax-F4 with Giles 034 022 0.36 LIP they-F4 San 0.31 0.15 023 _ia U.r Rj Hinged(removing He InvaE4 Sun 0.33 0.18 0.23 e€
Frenehnood Hinged t
Inuring PAUD Door HiLow Sun with Glla 0.32 0.13 0.19 q Fl Is Frmoh Door NP Lax-E4 Sun with Gi es 0.35 0.14 0.20 - Si
LIP rea-M Smm tum 0.30 0.16 037 N rim IIP IoxE45ma,Sun 0.32 0.17 037 EP its ..
Im Low-Ed SmaaSunw/Grilles 0.31 0.14 0.31 RP Rim IlP tiro-E45mailSunw/Gallas 034 0.15 0.32 - des
He Iuw{4 0.31 025 0.41 Fq IRS - flilrad E4 033 0.23 0.38 - gym,
lip lax-E4 wire Glles 0.32 021 0.35 k¶ V%!poli - HP lax-E4 who Galla 0.33 021 0.34 -
Frenchwood-Hinged. HP tau-E4 Sun 0.31 0.15 0.23 LLetl French Door- XP Ian-E4 San 0.33 0.14 D.21 -
Lambert PMo Door He I mr-E4 Sun wtlh Guiles 0.32 0.13 0.19 }7 =p JR1 Sid"Ogrt He Ims-E4 Sun with Galles 034 0.13 0.19 -
HPImBSrrall n 030 0.11 0.37 1'J '•rl'p?J He thei Smarmun 032 0.15 0.34 -
HP Law-E4 SmadSu,w/Gnlla 0.31 0.15 0.31 iq HP Law E4 Smad6un w/Ganes 033 0.14 U.30 -
HIP ImaE4 031 0.22 0.37 F� i:; " IIP Ido-E4 0.32 025 0.41
HP lmr£4wim Galles 0.32 020 0.33 p» l?( HP Ica,Ed wM Gotten 033 022 0.37 -
Frenchlrootl` flPlmaE45un 0.32 0.10 0.2] Fid Iaim Fired Tmaom HP]ax.E4 Sun 0.32 0.15 _ 023 -
Pella Da"r Sidelight HP Lax-E4 Sun with Grilles 0.32 0.13' 0.18 k'f1 I i F9 French Door HP Tani San war Grilles 0.33 0.14 0.20 -
HeF;-E4 SmaASun 0.31 OAS 0.33 °7 r.„�i NP LawEdSnert.9un 032 0.16 0.37 -
VP Low-E4 numtavn w(Giles 0.32 0.14 0,29 lat .4 He lax-E4 SmorlSun w/Giles 0.32 0-15 0.33 -
HPLax-E4 030 0.24 0.40 PA K., HP Imi 035 0.26 OA4
HP Law-E4 with Gula' 030 0.21 0.35 F) °'.� - HPIawE4aMGNles 036 023 0.38
French...i' HP lnw-E45un 0.30 0.15 0.22 41N HP Lee-E4Sun 0.35 016 Oil -
Plip D.o.I... IIP Law.E4 Sun with Gml.-0.3 1 0-13 020 (FiJ try IR Fpiing Door HP LowE4 San with Giles 0.36 0.14 021
NP Low-E45man6un 029 016 0.36 ld% - 1.1 HrI EISmmISun D.34 0.17 0.39
HP wSo 9mme3re w/Giles 0.30 014 0.32 ! t.:P
laUP] -E45marLsun w/Grilles 036 0.15 0.34 -
ourcamedon rarf page
•Fm NFRC certifiedtotal unit performance on units with capillary breather Wbes for high WUmdeS,please visitanderear.m meal are
•'High-Pefteme ce-Low-E4'"01P Lima-E41.'I igh-Perommnce-Loa-E4'Sm UoSun'INP Lnw-E4 Sma ffi n)and"Illgh-Peffmmance"Low-E4'Sun'(HP Low-E4 Sun)are Andersen trademarks tot-lm,F glass.
0-Fincter defines the amount oftener toss through the total all in 6TU/ter tc.tL"FIt.I v+erthe value,Lite less beat is lostNmugh Ne enure pmdrel Word.w values represent non-tempeed glass.Use of tempemd glass can
increase0-Factor ratings.See malmsenwindows.coir for specific permnnance values.0ru inlues repmsenttempered glass.
' Solar treat Gain Coefficient(SHGQ defines the fraction Dfsolar ralumme admitted through line glass hum Hardly transmitted and absorbed and subsequently released inward.Me lower Ne value,me less heat is transmitted
mmugh me product.
'Visible Tmnallillance pill)measures how much light ..as through a product(glass and area).Me higher me value.farm 0 to 1.me more daylight me partner lets in merme productt s total unit area.Visible Transmittance
is measured"ver the 360 W 760 nanometer portion of the solid specimen.
•NFRC ratings are based on modeling by a mind party agency as validated by an independent test lab in compliance with NFlIC program and imcetlrral requirements.
•This data is accurate as of December 2010.Due to.,going product changes,Updated lest results or new industry standards or requimmeals,this data may change over Ume.Ratings are for sizes specified by NFRC for
tesmg and cernficatirn.Ratings may vary depending an Use"I Lowered Rless,different grime op hmet,glass fm high altitudes,etc.
•Passive5un'glass values are available online at andersene i"dows cam.
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