46 HATHORNE ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Q) Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or De olish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: . ' Date plied:
Building Official(Print Name) - Signature =. Date
SECTION 1: SITE INFORMATIO
1 1_} Propefty A�d}Iress: 1.2 Assessors Map& Parcel Numbers
fP ho�r�e, S� - Q5— 6��CS�— !�
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 ZptpV Information, I 1.4 Property Dimensions:
Zoni
ng Proposea Use \ Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front 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❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1per'ofRelCord: � !\
Name(Pant) \ - City,State,ZI
I I � i
yb {�r'ALAry� � S� - RCS'- :-yS- Sup
No.and Street Telephone
p Email Address
, SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupie `lam Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other Specify: l f
Brief Description of Proposed Work': 4V -9—
T
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees:
4.Mechanical (I1VAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: S
' Check No. - Check Amount: Cash.Amount
6. Total Project Cost: $,5, 3 33-w 0 Paid in Full 11 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
(o
1�
_b sc n� V e 7 R�h License Number Expiration Date
Name ofI11 C/I SLI I &
older/ i l U
I l Oa K , IUct„ 'List CSL Type(see below)
No.and Street Type Description ..
/1 1 ,p ,. a .�6 O U Unrestricted 1 (Buildings2 Fm u el ing cu.ft.
f�/h Y"�L' R Restricted 1&2 Family Dwelling
City/Town, S e, M Masonry -
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Sb C I Insulation
Telephone Email address D Demolition
5. Registered Home Improvement Contractor(HIC) J�j a/0 1 oZ a 3 -13
e Jw i.l t LU +- n J f t`,�C rn HIC Registration Number Expiration Date
HIC Compan Name or H Registrant Name
lbw O' � St .
No.and St�ee{ ( Email address
n�r�InV�aW Yl/�iA �IS3p;3S I-o210
City/Town, State,ZIP Tele hole X S
SECTION 6:'WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.§ MC(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 ........AL No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT
I,as Owner of the subject property,hereby authorize 6l pin, I,ES,)J,4 I6 S — 75�S'r-IA IZ e z�Z-c
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION - A
By entering my name ereby attest under the pains and penalties of perjury that all of the information
contained in Mns a and accurate to the best of my knowledge and understanding.
2 L!
Print Owner' Af r ze A ame(Electronic Signature) Date
' NOTES:
1. An O ' who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass. ovg /oca Information on the Construction Supervisor License can be found atmmy.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor 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 of bathrooms Number of halfibaths
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"
Renewal
byAndemn.
WINDOW REPLACEMENT an AndersenCon"ny
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 us in our process.
We have also enclosed a self addressed and postage paid envelope and would request that
when the permit application has been processed, that you would mail it back to us.
Enclosed for you review in this package is:
o Permit Application
o Home Improvement Contractor License
o Construction Supervisor License
o Proof of Insurance
o Proof of Energy Efficiency Rating
o Signed Contract from Customer _..
o Permit Fee (if accepted at time of applying)
If you have any questions regarding this application please call me at: 508-351-2200 X55285
Regards
Kelley Donahue
Permit Coordinator
104 Otis street
Northborougb,MA,01532
Phone(508)351-2200
Fax(651)-351-4807
Website:www.renewalbyandersen.rom
CITY OF SM.E1ti1, NIASSACHUSETTS
• BL'II.DING DEPARnMNT
120 WASHINGTON STREET,3' FLOOR
a TEL. (978)745-9595
FAX(978) 740-9846
Kl\f$ERLEY DRISCOLL
MAYOR T HOMAS ST.PMPM
DmE,crOR OF PUBLIC PROPERTY/BU IMING COMaSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
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 from
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:
�eV\CWLJ 6q 4n1",
(n the of hauler)
The debris will be disposed of in
QtncG 10a1 �' kApr.
(narlte of facility)
(address of facility)
sig Wtureqta-pplicant
-�>izl 11-3
date
Jcbrisaff.Joc
RenewalMA Home Improvement Contractor
/t,,,,J ��� - -— License#170810(Expires 12/23/2013)
bylll idersen. Renewal by ABQt`CSOtt Corporation
- Federal Tax ID#41-1918413
WINDOW REPLACEMENT an MdenenCompany
104 Otis St.,Northborough,MA 01532
(508)351-2200•Fax:(651)351-4810
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyer a Name Date of A,r' m
� �.�� O✓ -0`� G e :2G i
Buyer(s)Street Address,City,St and Zip Cade
lq4 ax, omen C C SV — V\ A OI1-76
EMoil Address Home Telephone Number Work Tele hone Number
Al . 7 -�vS-Sa; ill /l,ra
Buyer(s) hereby jointly and severally agrees to purc ase the products 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 sheet(s) (collectively,this"Agreement').Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed
all work under this Agreement.
Estimated Starting te:
Method of payment:
Total Job Amount Amount Financed, _ w C OCheck OCash
Deposit Received(33%): �- > OVisa/MC ODiscover
Balance at Start of Job(33%(: —� 0 (Financed OAMEX
Estimated C pletion Date: If credit card is selected,please
Balance on Substantial 9 /% fin, �:�. Q�S see Credit Card Payment Form.
Complerian of lab(33%):
Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that
there are vo verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation
from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor Buyer(s) hereby
acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a
completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date 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.
Renewal by Andersen Corporation Buyer(s) - Buyer(s)
By: /C /� -�Co/d013
Signat of PkIduct Manager Signature Signature
fir,"� 1. 7Ta�_c�A�eJ Ne/e2 v
Print Name of Product Manager Print N e 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.
g� _ _gc. _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _NC
NOTICE Of CANCELLATION NOTICE dF CANCE
Date of TransaLLATION I You may cancel Date of Transaction O/- You may cancel
this transaction,witho a penalty or obligation,within this transaction,with a y pena y 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 mode by you under the l property traded in,any payments made by you under the
Contract of Sale,and any neElotiable instrument executed l Contract of Sale,and any negotiable instrument executed
by you will be returned within 10 days following receipt by you will be returned within 10 days following receipt
by the Contractor ("Seller") of your cancellation notice, by the Contractor ("Seller") of your cancellation notice,
and any security interest arising out of the transaction will and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the
Seller at your residence,in substantially as good condition Seller at your residence,in substantially as good condition
as when received, any goods delivered to you.under as when received,any goods delivered to you under this
this 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 of the Seller regarding the return instructions of the Seller regarding the return shhpmem of
shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk.If you do make
If you do make the goods available to the Seller and the l the goods available to the Seller and the Seller does not
Seller does not pick them up within 20 days of the date pick them up within 20 days of the date"oi your Notice
Of
your Notice of Cancellation,you may retain or dispose of Cancellation, you may retain or dispose of the goods
Of the goods without any further obligation.If you fail to without any further obligation. If you fail ro make the
make e s available to the Seller, or if you agree goods available to the SeIMr,or if you agree to return the
to return the or
to the Seller and fail ro do so, then Roods to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligations under for performance of all obligations under the Contract.
the Contract.To cancel this transaction,mail orr deliver a I To cancel this transaction, mail or deliver a signed and
signed and dated copy of this cancellation notice or any dated copy of this cancellation notice or any other written
other written notice,or send a telegram to Contractor: notice,or send a telegram to Contractor.
Renewal by Andersen Corporation, 104 Otis - Renewal bVi Andersen Corporation, 104 Otis Street,
Street, Northboro 01532, BY NOT LATER THAN North MA 01532,BYNOT LATER THAN MIDNIGHT
MIDNIGHT OF - 1?+1/ .(Date) OF G/ .(Date)
1 HEREBY CANCE TH TRANSACTION. 1 HER BY EL THIS 71WJSACf10N.
0uyar'a Signature Pont Nome Date Buyer'a Signature Prim Name Dune
REA Copy- White Buyer Copy-Yellow Buyer Copy-Pink C18aP20o9sBAFh MANN
Renewal �'newal by Andersen COCpora11C MA Home Improvement Contractor
,IA►'�,,f 104 Otis St.,Northborough,MA 01532 License#170810(Expires 12/23/2013)
by ndersen' (508)351-2200•Fax:(65I)351-4810 Federal Tax ID#41-1918413
WINDOW REPLACEMENT en MdenenCmnyny
WINDOW SPECIFICATION SHEET
Buyer(s)Name Date of ree nt
JP An
The Buyer(s)listed abo a here jointly and severally agree to purchase the goods and/or services listed belo ,inliccordance 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 part.
WINDOW DLTAIIS
1. Co tractor will Install a total of windows in Owner's home,using the following individual quantities:
Double Hu (DB) /1 Equal sash_ e sash(1/3 top,2/3 bottom)_Oriel sash(2/3 top.1/3 bottom) Flat sill aM(canomcr o of
COS P P mcfclavloss)
_ '_—Square Check Rail-�f Curve Check Rail
Casement(CS)_Hinge right_Hinge left In viewed from exterior)
-� Double Casement(CD)
2 bite Gliding Window(G W)
Casement/Picture/Casement(CD_1:1:1 or_1:2:1
Glider/Picture/Glider(GPM 1:1:1 or_1:2:1
--- Picture Window —Bay or Bow
— Awning Window _#Lights Soffit/Roof Shingle/Copper
Specialty Window Patio Doors(so,sepemte door spec sheep Seal to be Primed/Oak/Pine
L17371 EE-1 0
2./Qty of Windows to be Custom Fit Replacement:
3.^ Qty of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS)
Exterior casings:_Pine_Maintenance-free material Factory applied 908 Fibres brickmold
4.Glazing to be:X HP Low-E-4 ru Tempered Other If other,please specify:S.Exterior color to be: Ito_Sand as_TerraOne_Cocoa Bean_Dark Bronze_Forest Green_Black
G.Interior color to bdCXMIILA—Canty Pine Maple_Oak_Same as Exterior Note:Wood interiors need to fi?ni�hed by Owner.
7.Hardware: 7-Sw Whit _Con L H E' Fy UP S A;"—s 01-f)C C%
8. '10 Install Lifts with Double Hung Windows
9. Screens:windows to have:_Half or4 Full screens Screens to be( glass Fiberglass Aluminum_TruScene
n CRIIJE DETAILS
10.yO -Windows have grilles:_Grille Between Glass(GBG)_Removable Interior Wood(INIW)_Full Divided Light(FDL)
I
( �2 rOwner approved(initials) Draw grille patterns below "Use additional sheet if needed
Cry: Qty Qty: Qty' Qty Qty: Qty:
DD1E'E[E'=—
ADDITIONAL WORK DETAHS
11. Qty of_Sills_Sill noses to be replaced by Contractor
12. Contractor will remove metal frames of windows
13. Contractor will install new_paint-ready or_stain-ready_Interior_Exterior casings in_Pine_Maintenance-free material
14. Contractor will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine Maintenance-free material
) fulls-Owner is aware,contractor does not do any painting or removaVinstallation of alarm system/hardware. It is the
responsibility of the homeowner to have the alarm system/hardware removed prior to installation.
16. Contractor will wrap exterior casings with coil stock of color.
Note:Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing.
17.Contractor will insulate,caulk and seal windows with 3-Point system in prevent water and air infiltration. Removal and disposal of alljob related debris,win-
dows,swum windows and vacuum nightly included Upon completion of thejob and payment in full,a limited warranty shall be issued.
18.PrYes❑No euildiny Permit-Contractor will secure any and all necessary permits.The fee for the permits)is not O
included in the Contract Price and a separate check is required at the time of sale for this fee. Ck# I $ 7
19.kA Yes❑No All discounts have�b�e)ep applied to this agreement prim /7
20.Additionaljob details: L UC (: �.ar Q6 C
21.gyes❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT,constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the
terms.This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both
the Buyer(s)and Contractor.Buyer(s)hereby acknowledge that Buyer(s)has Tend this Specification Sheet.
Renewaalll bbbyyr�111 Andersen
��Corporation Buyer(s)
Buyers)
Signal of Pyq uct Manager nager -�ignature Signature
Print Name of Product Manager Print Naai a Print Name
The Commonwealth ofMassaehusetts
Department oflndustrialAcculents
Offrce of Investigations
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
NaMC (Business/Organization/Individual)_gP,P1 P,l.Ja,� i-i✓� c.��
Address: l p y . 7) i s Sic
/State/Zi : .
Ci �� r tY P r S3a Phone#:
R .3
Are you an employer?Check the appropriate box: Type Of Project(required):
1.0 I am a employer with 3 0 4. ❑ 1 am a general contractor and I T
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole'proprietor or partner- listed on the attached sheet. 7. [ "Remodeling
ship and have no employees These sub-conusctors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp•insurance.
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repays or additions
myself. [No workers'comp. right of exemption per MGL
insurance required.]t C. 152, §1(4),and we have no 72.0Roof repairs
employees. [No workers' 13.❑ Other
comp.insurance required.]
"Any applicant that checks box#1 must idso fill out the section below showing their workers'compensation policy information
.t Homeowners who submit this affidavit radiating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box most allnbed an additional sheet showing the name of the sub-co ntractos and state whether or not those entities have
employees. if the sub-contractors have employees,they most provide their workers'comp.policy number. _
lam an employer that lr providing workers'compensation insurance for my employees. Below&the policy andlob she
htformadon. ``
Insurance Company Name: C� \O c. Zn S - C 3 .
Policy#or Self-ins.Lic.#,: Ln It,, G ( 14 C r?U 6 Expiration Dates I O= I— 13
Job Site Address: 1�- l/1 p rAn e_ cS 1' • City/State/Zip_J (to, VbL6s.
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.
do hereby cerddfy d the pabu and penaties ojperjury that the Information provided above is due and correct
Suture: Date 3
Phone#: ,2:)()
QJ)'rcial use only. Do not write in this area,to be completed by shy or town oKwial
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 M
coRr5' CERTIFICATE OF LIABILITY INSURANCE DATE`5/20 2
THIS CERTIFICATE 13 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(ies)must be endoreed. N SUBROGATION IS WANED,subject to .I
the terms and conditions of the polity,certain policies may require an endorsement. A statement on this certificate does not Confer rights to the
certificate holder in lieu of such endoreemen s.
PRODUCER - 1-612-333-3323 NAME: Jonelle Hargrove or Eric Johnson
Hays Companies PHONE . 612-333-3323 FAX
AIC No: 612-373-7270
BO South eth Street �L
Suite 700 PRODUCER
Minneapolis, MN 55402 CUB OMER ID
INSURED INSU S AFFORDING COVERAGE MAIC•
Renewal By Andersen Corporation INSURERA: OLD REPUBLIC INS CO 24147
INSURER B: NATIONAL UNION FIRE INS CO OF PITTS 29445
104 Otis Street INSURER C:
Northborough, MA 01532 INSURER D:
INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 29229436 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.
LTR TYPE OF INSURANCE LSU R POLICY NUMBER ummo FF POMLOICY EIW LIMITS
A GENERAL LIABILITY SSNZY 5962E 30/01/1 10/01/13
MEa� �
ENCE E 1,000,000
R COMMERCIAL GENERAL LABILITY E OR PREDear Dnm S 5E
00CLAIMS-MADE �OCCUR orepe n) S 100DV INJURY S 1, ,000REGATE S 4, ,000GEN'L AGGREGATE LIMIT APPLIES PER: OMP/OP AGG S 3, ,OLIO
R POLICY PRO- LOG S
A AUTOMOBILE LABILITY MINTS 22700 10 Ol 1 10 Ol 13 COMBINED SINGLE LIMIT S 3,000,000
R ANY AUTO (Ea ecddrd)
ALL OWNED AUTOS BODILY INJURY(Per person) E
SCHEDULED AUTOS BODILY INJURY(PereoddeM) S
R HIRED AUTOS PROPERTY DAMAGE S
(Perecdderd)
R NON-OWNED AUTOS $
S
e 8 UMBRELLA llpB R OCCUR 13273355 10/OS/1 10/01/13 EACHOCCURRENCE $ 25.000,000
EXCESS UAB CLAIMS-MADE AGGREGATE $ 25,000,000
DEDUCTIBLE E
R RETENTION 25,000
A WORKERS COMPENSATION MKC 117940 00 WC STATU- OTK S
AND EMPLOYERS•LABOITY VIN 10/O1/1 30/O1/13 :
ANY PROPRIETORNARTNERIEXECUTNE EL.EACH ACCIDENT 1,000,000
OFFICERAIEMBER EXCLUDED? N NIA S
(landOwy In NH) E.L.DISEASE-EA EMPLOYE E 1,000,000
Iyes desaiba under
OESCRIPTIONOF OPERATIONS below EL.DISEASE-POLICYLIMIT000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES OUuch ACORD 101,Addmoml Remarlu Schedule,amom spew b requlmd)
Evidence of Insurance.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
V
erica 01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
29229436
M466,dice of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egistration:-.170'8]0 Type:
Expiratlon 1-=3a013 Supplement t
RENEWAL BY ANDERSON CORPORATION
JOSEPH RF77A - - - -
104 OTIS STREET 4 L-
NORTHBOROUGH,MA 01532 Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen isor
License: CS-065272
JOSEPH P REZW
168 KELLEY BLVD
N ATTI.EBORO MA �1 -
� r,
J�r•� � ,� �" �> Expiration ,,
Commissioner 04/25/2014
li
71004104736118-0,10
IK
ACENENT
MI Composite IF
Rath crimeawla�ilwl Low E4 SvanslmENERGY PERFORMANCE RATINGS
U6-Factor(U.S)A-P Solar Heat Gain Coefficient
m2 0019
ADDITIONAL PERFORMANCE RATINGS
Visible Tmnsmitmnce
o _
YYldeq�b,bT♦WY�C�pYW rip'mdanlbypNGb YgIC VwMw4 ! .
sAr
IIM�slbbCObbYYY YwIWabYWrMm4msYYm�iyrY1G�4.��I1M�n.Y�
. faeM bmAe1wb11wY1Yi bYYvpMsl Wkl�woMwY��aM'ilaY.el bril'�s. '
1
.. R�tr YYNJYIbblp
W Yawwr "J,
4o+Yb1.e.Y.allaw
DESIGN P7gR�ESSUFIE"F)
H-LC25 RbA DB Sloped Sill DH ZN
TYW b4MQbAlYMpYYBAVYtYYG[ YYYYw� Y01WbYW bYb bbbrd.
Yrbarbm.YY,YIL.CEt,•IECL,Yi11YMYlYYIYYYeY1.9Y111bblbrkCblB4lin YYpYln I
. i.
i
I
1