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2B HALSEY WAY - BUILDING INSPECTION (2) The Commonwealth of Massachusetts ' Board of Building Regulations and Standards FOR Massachusetts State'Building Code,780 CMR, 7 h edition M-UNICIP . Ili Building Permit Application To Construct,Repair,Renovate O bemolish a' Rev&edJanuary . One-or Two-Famfly Dwelling 1, 2008 This 5 ' on F Oflcial Use *ding Permit Number to App ' Signature: Building Commistioner/Inspect8r of dings Date. SECTI INFORMATION 1.1 Pro Address: 1.2 Assessors Map &Parcel Numbers a d r`u��sf L0 4 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number. 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District . Proposed Use. Lot Area(sq ft) Frontage M - 1.5 Building Setbacks (ft). Front Yard Side Yards _ Rear Yard - - Required. Provided Requrrd Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information:.... 1.8 Sewage Disposal.System: Zone: Outside Flood Zone?•. Public❑' Private❑ — Municipal Cl On site disposal system ❑ Check if yes[3 SECTION 2: PROPERTY OWNERSHIP' 2.I Owner]of ReFordo Z�r7 (y R RO�r r�z 1 111 ttcow��c� ai :-t .4 (A ' t. Q fdA , VLt_C Name(Print) Address for Service t . Signature Telephone SECTION 3:DFSCRIPilON OF PROPOSED WORK kcheck all that apply) Nes'Eonst �'cu❑ Ex s :re B'ui#d n�O Ov:ner Occu ' d ❑ P airs s ❑ ;ai cnr } ❑' ddi oa ❑ �. Demolition ❑ Acccssnry Mde.❑ Number of!)nits_ Other ;�'3Fcciry:_, ., 0 yvq. Brief Description of Pro used Work'': Wr i SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: ].ten - . Official Use Only - (Labor and Materials) 1.Building $ ' S n�. O p 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee C1 Total Project.Cos?(Item 6)x multiplier 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 qfP ,Uo 0 Paid in Full 0 Outstanding Balance Due: _ SECTIONS- CONSTRUC30N SEFiGES 5-1 Licensed Construction Supervisor(CSL) �S��c, ✓� y�!\I.ScM - LicroseNumber Expiration Date Name of CSL-Holds 1� 0,lA OU.63 ListCSL Type(se--below) I No Add DMSM on U Unrestricted(UP to 35,000 Cu.Ft Signature - R Restricted 1&2 Family Dwelling '. I - ��' -�' h-( —U4�l,Z M Masonry Only Telephone. RC Residential Roofing Covering - - WS" Residential WmdDw and Sidni SF Residential Solid Fuel Burning Appliance,lnstallTb -" Residential Demolition 5 Registered'Homl_e impr(pwe nt Contractor(MC) _ iVl P w'.a � - �' Lw V-+✓l P ^St v'� ���(oC�l - . HICCompanyNameorHl R I Registration Number Addre i �P . . .. -6 li62 Expiration Date - Slgna u Telephone SECTIOIr b:WORKERS' COIYfi ENSATION INSURANCE AFFIDAVIT M.G.L.r-152_y 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 Atlidavit Attached? Yes:.. No... ......❑ SECTION lac O RI2 UTKOVJZ43TpId TO BE COMFLE BEN: OWNER'S AGENT f1IL CO1ITiACTOR APPLIES FO3Ll3UII,iiflNis pI R1NIiT . )� w Sp as Owner of the subject property hereby authorize_ rJV�v Lvtn\t��vj to act on my behalf;in all matters relative to work authorized by this building permit application. - Sr ature of Owner . .. Daum - }���u•-ti F'J�t✓�hA.?Scy�-) ,. a'e'fhrneCnYfctithcrti��d AePnt hetklivde4lAYC [list the etatcments and inforntatron oA the for e_eoing applicattun aretr'ut'acid accurate,-tti the best of my larowledec and - Frim Name Signature of Owner or Au o . Date (Signed underthe pains and penalties of a "u . . NOTES: I. 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(HIC)Program),will not Have access to the arbitration program or guaranty fund under IvLG.L c. 142A-Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780`CMR Regulations 110R6'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 of bedrooms Number ofbathrooms Number ofhalflbnths Type of heating System Number of decks!porches ' Type of cooling system Enclosed peen 3. "Total Project Square Footage"maybe substituted"for"Total Project Cost" �Gl(� U J" 03/e3/2007 21:11 9782785010 JOHN BEAVER PAGE 09/09 104 Orin Si.,Norrhhomu,Gh,MA 015:32 J&t.WINDOWS, INC.,D/1i/A MA Homc lmpmvmncnt Contractor (506)9 1 9-118 611•Tax,(77,4)987-30I3 Renewal Licansc#1408o1 (F,xpires 1/24/2012) byAndersen• Fufcral Tax ID#53.0404201 mxoon nc,nUft of nnn111n.,nC.11 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT 6aynr, Dote of Asreemem a eq,l so-eM Addreu,Ci .Sion,and Z Cede is SU/I �9-70 EMoll Addreu Homy Qh.r.Number Work lslephone Number Buyer(s) hereby jointly and severally agrees to pumhim the products and/or services of I A L Window,,Inc.d/b/a Roncwal by nndcrsen ("Con tractor"),in accordanec With the icons and conditions described on the front and Lhe reverse of Lhis Agrccment and on the attached specification sheel(s) (Collectively,this"Agreement").Bilyer(s)hereby agrees to s;gn a completion cetnifieate after Contractor has completed all work under this Agreement. �✓p l Method of payment: OCheck ❑Credit Cord ❑Cash Total Job Amount:_..... L..F� E,limnred Slonin9 Dom, Vr'lFinanced Deposit Received(33%):._._^---.. '-""-"" w� � Balance of$tort of Job(33%):_-PC_-- Enimatnd Cnmplennn tints: If payment is by Credit Card, please fill out Balance on Substantial the Credit Card Receipt of Deposit Form Completion of Job 133%I:-,tG/—_. --- -/ -- By signi nK��is aptcement,you acknneled,Gr.that the Beluncc.at Start of,Jnl>and the BalA.nrc an Suhsnuvial Completion of Job cannot.he made by credit.caul and must he made ny perxonal check,bank chn+k,ur cash. Buyer(s) agrees and understands that this Agreement constitutes the entire nnderstanding between the parties, and that there are no verb.]understandings changing or modifying nay of the terms of this Agreement.No alteration to or deviation From this Agreement will be valid without die signed,written consent of both Bayer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) I) has read this Agreement, understands the terms of this Agreement, and has received a completed,signed,and dated copy of thin Agreement,iocludmg the two attached Notices of Cancellation,on the dace first written above And 2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. J&L Window, nc.d/b/a Renewal by Andtn—.. Buycr(s) Buyer(9) By: •Gi aa,rr491duct Mnnngrr Signature I Si,Qnmum ,�bllh I�siaVet2 `� /S6/.tr..'f'.f W4,`I ecrVJ Print Nnmr, of Product Manager Print Namc Print Name YOU, THE BUYER(S), MAY CANCEL-THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. yc _ - _ _ _ _ - - _ --- _ _ _ _ _ _ _ _ _ _ - ^ NOTICE OF CANCELLATION k NOTICE OF CANCELLATION � Date of Transaction S-/ L You may cancel Date of Transaction S-.//-// You may cancel this transaction,without any penally or obligation,within this tronsoctim,without any penalty or obligation,within three business days from the above date.If you cancel,any three business days from the above date.If you cancel,any property traded in,any payments made by you under the property traded in,any payments made by you under the- Contract of Sale,and any negotiable instrument executed Contract of Sale,and any nh gtwble 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 tromsoction will be canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the Seller at your residence,in substantially as good condition Seller at your residence,in substamidily as good condition as when received, any goods delivered to you under as when received,any goods delivered to you under this this Contract w Sale; or you may, if you wish, comply Contract or Sale;or you may,Lfyo u wish,comply with the with the instructions of the Seller regarding the return instructions of the Seller rego Ing the return shipment of shipment of the goods at the Seller's expense and risk. i the goods at the Sellers expense and risk.If you do make If you-do.make-the-goods ovaflabIn fo--the Seller and the I the goods.ovailable to the Seller and.thw Seller does-not Seller does not pick them up within 20 days of the date t pick them ujp within 20 days of the date of your Notices daF your Notice of Cancellation,you may retain or dispose t of Cancellation,you maayy retain or dispose t>f the goods of the ggoods without any further ebIi n.If you fail to without my further obligation. If you fail to make the make tha goods available to the Seller, m if ou agree 1 goods available to the Seller,or if you agree to return the to return the goods to the Seller and tail ro do so, then 1 geeels ro the Seller and fail to dO so,then you remain liable you remain liable for perforrname of all obliga'ans under t for performance of all obligations under the Contract. the Contract.To cancel this transaction, mail or deliver a t TO cancel this transaction, marl or deliver a signed and sgred and dated copy of this cancellation notice or any dated copy of this mncellatian notice or any other written other written notice,or send a telegram to Contractor.J notice,or send a telegram to Contractor:J &L Windows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis 1 Inc. d/b/o Renewal by Andersen, 104 Ohs Street, Sheet, Nortfiborou h, MA 01532, BY NOT LATER THAN Northborough,MAO)532,BY NOT LATER THAN MIDNIGHT MIDNIGHT OF S�.(Date) OF _/y-// .(Date) I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. 8uyer'e Sitnamm Nnme m Nomn Dine '8uyer9 SlAnowm Print Ptl Deb 03/03/2007 21:11 9782785010 JOHN BEAVER PAGE 08/09 104 oh,Slmd,rvonl,hansish,ari o I s;:e Mn we uadnse tt I asset (exp;n`s v2a/t a) Fhonc SOR71 N.ONoo.FPz ii4.7A7.301Y Renewal federal Tax IT19 8:1.0404201 MAndersen. ....ow FllUCRMrXr nnAMmen CaMMq OF(:,,, F MASeAel,,=Awn Nr.W HAbirmfmte WINDOW SPECIFICATION SKEET Bnycr a Date of Agreement The buyer(s)distal alove hembyluinlly cod severally knot to pumlmsc the gc.xls and/or services usted below,in ueeordimee with the priers and terms described on the Specification Sheol tutus the froal.and the mwmu of the acmmpavytng CUSTOM WINDOW AND DOOR RF.MODEUNC.AGREEMENT, of which this Specification Sheet is a part. WINDOW DEFAIIS 1. fnlntraclor will lnst:fll u Point of windows in Owner's home,using lice following individual quantities: C.D Doublet Hung(DR) vrqual sash ElCottage sash(t/3 top,Z/3 bottom) ❑ On sash(Y/3 lop.113 bottom) Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Mctm handle Double Casement(COW) ❑ Standard handle ❑ Mciru handle Casement/Picture/Casement(CFW) ❑ 1:1:1 or❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lilc Gliding Window(GM Glider/Picture/Glider(GpW) ❑ 1:1:1 Or ❑ 1:2:1 Awning Window(ANT) Picture Window(M) Noy or Bow Window Pure Doors(scz sc Irate Door Specification ShaoU 2. Yas ❑ o Qty of Windows to be Custom Pa Replacement: 3. ❑ Yes o Qty of Sills to be replaced by Contractor: 4, ❑ yes No Qty m Windows W be New ConstruCllen Pull frame(includes new interior&exterior Casings)and adu.d Fxtcricr cast gs: ❑ fine ❑ Maimanoncc-ftec material ❑ Faertny applied 908 Fibre.briekmold 3. Glaring to be: [HP hi E.-4 Tu ❑ Other If other,plussc specify: 6. Exterior color to be: �✓White ❑ Sand ❑ Canvas ❑ Tcallone ❑ Oa Rean 7. lmeriorcolortobc: ❑ White ❑ Sand ❑ Canvas ❑ 'Fetratone Pine ❑ Maple ❑ Oak Note: Interior eolnr r t only be white,wood or same color as exterior. Wood inferiors need to finished by Owner. 3. Ha arc: [IWhite VStonu ❑ Canvas ❑ brass ❑ Estate Hardware: Style: 9. Yes ❑ No Install Lift with Double Hung 'ndcws 10. Screens: windows to have: ❑ Half or Fu11 screens Screens to be: Fiberglass ❑ Aluminum ❑ TruScenc GRILLE DEFALLS 11.Windows have Srillel: Q Yes No If yes:❑ Grille Between Glass,16ma❑ Removable Ination Wood(row)❑ Full Divided Ught(raw Qty: Qty: Qty: Qty: Qty: Qty: Qty III on off on on owmm�,eP am Drawgrille patterns above "Usc additionalsheet if needed (ird' s): ADDITIONAL WORK DETAHS IY.❑ Ycs O ontracto'will mmove metal frames of windows. Qty of Units: 13.❑ Yes 0 ntractor will instali new paint-ready or stain-mady Casings. Interior virsg qty of openings: Exterior CasilISS qly Of operungs: ❑ Fins. ❑Maintenance-(fee material 14.❑ Yes No Contractor Will install new paint-ready orstain- door outside stops gfy of openings: interior stops qfy of openings: Exlcricrsto q c rim ❑ Pine ❑ Maintenance-frccsnatel'lal 15. pµmer is a that Contractor does net do any painting, wneC]nifinls 16.❑ Yes o Contractor will wrap exterior casings with a k of rotor. 17.�te: Wrapping may be required With slorm window removal;removal of storm windows will leave screw holes in casing. ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 8.ry�,/(�es ❑No Ciean up all joh related debris including uld windows will be removed.Vacuum nightly I().YXs ❑ No A limited warranty shall be issued to Owner upon cumplch011 or thejob and payment in full. 20. Ye ❑ No gulditlRPeQn —iContractor will sam necessary re any and all necary permits. The fez for the permit(s)is not ncluded in the Contract Price and a separate check is required at the time of sale for this fro. 21. Yes ❑Nu All discounts yslheen ap d to ti�"�Qlr mcrit P,.c. 22, Additional job details: {� 2S. Vex ❑ No Owner agrees to be:present on the final day of installation for final inspection and to deliver final payment. No f1naliwyrnusl Jrsil be denrnnded unfil the contract it cvmpicted fn the S+lisfaction ofiFll ro lass. It is agreed and understood by and between the pasties that this SpeClficatien Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,eanstina s the entire undeesuurding Itinerate the pmfios,and there are no verbal understandings changing M modifying my of the terms. This,Spcdficallon Sheet soy not be cj uunSed M it firma,modified or varied in any way mile to such changes arc in writing and stgrted by both the guyerb)and Contractor. lmyer(s)hereby acknowledge that Buyer(3)late,reed this Specuication Shoe! Renewal by n 2Gteater MA and 7 uyer(s) Buyser(s) Ry: S, nature of duct Manager Signatum 9i<gnatuxls Print Name of Product Manager Print Name Frint Name NRY-9-2011 20:42 FROM: TO:17749873013 P.2/4 Renewal AnC.,p,,y bvAndersen9 WINDOW REPLACEMENT ao A,,J'o F 29 Halsey Way Salem, MA 01970 We. American properties Team, being the duly authorized representatives of Pickman Park Condominiums, have reviewed the specifications for improvements to 20 Halsey Way Salem, MA. 01970 owned by Earl Whitcomb. The Condo Association or Management Company agrees that the above owners have ermission to seek permits and to carry out the proposed work, Si ' t Btu e o Condo ssdTv16 10 Date rr.Na the �-Ae fin lieu of this form, a letter stating the same purpose as above, on the Condominium Management Company stationary may be substituted.) I i I I i I I i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations k1ri 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Orgmization/Individual): T n e U2lam/ S�i1 Address: pp 1611 �l`S p rc e City/State/Zip: j`/a r D 6 f y r AA Gd,9.2- Phone Are you an employer?Check the appropriate box: Type of project(required): 1.�&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. t �• 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 thew 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l 1.❑ 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' 13.0 Other comp. insurance required.] Any applicant that checks box#1 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 hire outside contractors most submit a new affidavit indicating such. tContracton 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: �J 14 3u/C/1 C e— / Policy#or Self-ins.Lic. #: 1:9 W�C.� ✓'/�Y Expiration Date: Job Site Address: ��t S�L4 14/CitA City/State/Zip:cCyr `t°int ILI[� (j(ri?y-0 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 rtiJy under th pain and penalties o rjuty that the information provided above is true and correct. Signature: Date: Phone#: L 0 / Q 9 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#: �s •. ILQE(Ia01®RYTSJ CERTIFICATE OF LIABILITY ItdSU ANCE avQ9r�i i KEIRC47E IS OEg5 AS-A MATTER OF pC-OEN5ATION ONLY AND'CONFERS-No EQM-TS UPON THE CER'CF'C47E HOLDEFL THIS :A1n DOE S .NOT AFFQ:EGk7yVELY OR NEi.&TRrElY AMEN11, E XTaV OR ALTER THE CDMFP.ASE AFF43KOm SY THE POU= - 'n-M CER-r n= OF QSUFiANCE DOES NOT.COh6TIM E A CONTP.ACT 3ETWEE=N THE.SSIM S P SURE IPL-AUTHOEv� EWCAT WE OR PROOUCEE;AND THE-C�MkTE HOLOE3t ANT: B f1Ge m m®1t'huider is = AOOETIONAL rAccnra�the paN �) mvs[to enders: IF SUS IRO6.ETION I.S NCAIYEC, suhjet m . s and CnndTl InI6 of 8re panty, i I I palko may require azl endarsmernen+ A StAurnow qn this=muftease fides not enrdw fight;m the tie hdida m Tim al such end�M%6( . - .. - •.xna� rAL Joseph McKeon 734-M2-E3100 - JP McKean insurance Agency, inc- AD P.O. Box 333 " nrw-vtmwc cnvan� Noss Ann Arbor, W 48106-1T333 a�Gsa=n a:.Fiartsnrd hvz'c�anc� Cu JEL Windows, Inc Renewal by Andersen aesdaa+e: IJauulus 1 D4 Offi St Nor9,borough,MA. Crl sm ws+arl� asnmi E: pC:SRxiER F: - �6 cFxT�icATE NL]MEE3i FavisloN NunaaEEx: - TD CaMFY THAT THE POLICIES OF WSURANCE LISTED 913OVF HAVE BEEN ISSUE)TO THE INSURED N4N®ABOVE FOR THE POLDLY PERIOD T➢. NOTW[T STM DING ANY RMLIFUSVENT,TE3iM.OR c77mOn- IN OF ANY CONTRACT OR OTFIeR ODCIMIT'T WITH FIESPE cT To WHICH THS IGATE MAY BE ISSUED OR MAY PERTAIN,THE INISL1RANCE AFPOFDR0 13Y THE POLICES DES30Rffi® HE IS SL16.E3;T TO ALL 7HS TERMS, MON5 AND COND7EIN5 OF SUCH POLICIES.L.IDMS SHOWN MAY HAVE SEEN RmUCm SY PAID CLAIMS POL¢x as �L1CY E� Lars nrPE�egnAANr� PmILYxnrl�A ��� pCC SCE c 1 DDn DDD conm�r�RcwLGB�ALLIAsa.rrY SIC 95B461 1D,D5l2II1D 1Dm1l2D11 F'Rams6 c 100 000 oArM;-wAnE © occuR a,®�a ram=aa�n G 5_000 F'HiSONl1LEAw,N.IURY c 1.ODD.ODD - m,>OagL,ATE C 2.DOn DDo .. F'FIDCl1CFB-Q9.1P AGE i DDn DDD 1. IJMIT A-^PLLB PEfL. pCUCY Pam' 1pC vmaa"=UARI-ITY 39JIGCXDS�9� 1DFD12[i'10 1D/Dll2D11 a>em,n®sm,[3.E LIMB c 5AOn Ao0 .ANT AlIi9 rat owr� '1 9®D_Y W.R.V2T iPer®dv,p G . per oAMnc-.E G HIFCD HC196 ALRL]5 G mIsee wLIAs OCCUR FKHC[zl1fSL9Jf'c S E E,z , OJJIi SMnE AGCfM+4-IE G i .CED I I FETEN1Cv I =STATIL DFF4 - ,Rrss raGpE,slama a5 VVECPP1444 am 7f2II11 627f7l2D12 D E]OPLDPEBS LVlso.nY •r N EJ_EACH A(�=NT c 500.000 �shr 'aR�Amrx3'r�Erlm'r` O xia EL daEABE c 5DDDOD SDn_DOD 3Y:421PnCN�OP6ikTIDNS baba =ti-�oFOPa,monsl •,-•-•••••,�ivavoa P�nAmcm in.aa�s�a��aam���,�.r�� TRCATE HOLDER CANCEL.LAT7ON R35URID COPY sHa nn ANYd THE ABOVE OE2HI6FD POUCES ae IlAld� s�vRE TT-E E.XPRAMUM DATE THEI£MF, NOTICE WILL EE De-IVERED IN ACSLRDAM'c VCM 7I3E POUCT PROV15IOMES . A[f[ita>72m hL-PF�iiATIlc - ®t966-2UTU ACORD COEU-OE;ATION. All ng=rper.HwH 3m 25(m DID The ACORD dame and iogc are mutstered marks at ACORD - Mil]S:lCllll]Ct N - Dcpar mcnt of Public Safct) Boardluf Builtlin_ Rc_lilations and Standards Construction Supervisor License License: CS 95707 aim BRIAN DENNISON 86 CREST CIRCLE - WORCESTER, MA 01603 Expiration: 9/8/2012 (lnumia�iwur TY': 2622 a 74 o lu if a�u�r�a . Office of Consumer Affairs&Business Regulation 1� UlHOME IMPROVEMENT CONTRACTOR Registiation`. 49601 u .Expi q}Q12 }3l�tSt=nt Card RENEWAL BY 1 ' j . BRIAN DENNIS 104 OTIS STREE'.. - = '^ NORTHBOROUGH"M3+L'b'f532 — Undersecretary t. i a > , 03 ir or` �. won JIL 7 n � . Renewal WINDOW REPLACEMENT -,,An ersenCoinpng To Whom It May Concern, Enclosed is a permit application package for a project we have been contracted to do in your town. Thank you in advance for receiving this package by mail. As we work in every town in the state, it greatly helps Lis in our process. We have also enclosed a self addressed and postage paid envelope and would request that when the permit applications has been processed, that you would mail it back to us. Enclosed for you review in this package is: ❑ Permit Application ❑ Home improvement Contractor License ❑ Construction Supervisor License ❑ Proof of Insurance ❑ Proof of Energy Efficiency Rating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) if you have any question regarding this application please call me at (508) 919-0992. Best Regards, Kelley Donahue Permit Coordinator 104 Otis Street 1 Northborough,MA,01532 Phone(508)919-0900 - Fax(508)919-0903 Website: www.renewalbvandersen.com