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46 HATHORNE ST - BUILDING INSPECTION (4) a The Commonwealth of Massachusetts # ; Board ul'Building Regulations and Standards CITY ( / Massachusetts Slate Building Code, 780 C'MR, 7'n edition OF SALEM Rerisrr/Jmrrnrry Building Permit Applica n o Construct, R pair, Renurrte Or Demolish a /. IrNAY ne-rr Two-Family ellinl( ThiA Section Fo Olricial Use Only Building Permit Numbgr Dale Applied: $IgnalUft: �w Building C iss Inspect of Wings !Yale E ION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map di Parcel Numbers k e L l a Is this an accepted street?yes no Map Number Parcel Number IJZoning Informatb�no: 1.4 Properly Dimensions: �n Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(11) Front Yard Side Yards Rear Yard Rryuircd Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yesO Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner!oqf�Record: Na e Irv\ '1�,,..,.1. `1l� ��a��wr ne S Sint n� . ILv G lei Nome(Print) tAddress for Service: 9-3-8-3 Is-S Il s Signature Telephone SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repeirs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg.❑ Number of Units_ Other Specify: r- ( Brief Description of Proposed Work': i.J A'd C�-r , i-rf r- l CVVIn4r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: 011lelal Use Only Labor and Materials I. Building S �, (�(o a_o o I. Building Permit Fee:S Indicate how tee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x ). Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. Check Amount: Cash Amount: b. Total Protect Cast: S�,Ofo�-d` ❑Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Llcen1sed(fConslructlfoa Supervisor(CSL) j 6!a- 3 -tat \JLII�C J'A t-i I.iccnse Number I:xpiratiun Uate Name ut'CSL• IulJer List C'SL Type(see below) {� S 5v�n�tiIn Lt W�la'1N�.1�P�M� f Oescri ion u Unrestricted u to J3,0WCu.Ft. R Restricted 1d2 Family thsellin Signature M M Onl SZ�Z —Ct ICI —yGtG RC Residential Raulin Coverin I'clepMme WS Residrntial WinJow and Siding SF I Residential Solid Fuel Burning Appliance Installation 0 Residential Demolition "Ignal� [mpforemenI Contractor(HIC) N9 66 1 e t— y Registration Number HIS Expiration Date 5�1�1 'G 1�1'cY'I�i�'fclephune SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 192.1 23C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a:OWNER AUTHORIZATIO TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 \g L L fC l4'N , as Owner of the subject property hereby authorize /-d fZ to act on my behalf,in all matters relative to work authorized by this building permit application. - Si um of Owner Date (� 1 SECTION 71b: OWNER'OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. (� Print Nam 1 {( l�„f2�1 O 9i�rJI- Signalure of(honer or Authorized Agent Dale Si under the ains and naltia of 'u NOTES: I. An Owner who ubtains 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 rUg have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.145,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage, finished bmement/attics,decks or porch) Gross living area(Sq. Ft.) 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 J. "Total Project Square Footage**maybe substituted for"Total Project Cost" 7-'6 Ic 2-00 k DEBRIS FORM This form is to be submitted v¢ith buildingpermit applications whi never there is debris to be disposed of PropMtyAddress: In accordance with the pro-6sions of MGL cA0,§54,:a condition of the Building Peanit Number is that the debris resulting from this work shall be disposed of is a properly licensed solid waste disposal facility as defined by MGL c. 111 §150fi This debris win be disposed ofin: •• 1 . � Pnr .,i.l \�y �a�erco� l�N C���s Si NOr.k� Nti. v dl�'7a (L-ocation of Facility) Si of Permit Applicant 1d - 7 -ha . Date i i �1 104 Otis St.,Northborough,MA 01532 ^ J&L WINDOWS,INC.,D/B/A MA Home Improvement Contractor (508)919-0900•Fax:(774)987-3013 Renewal License#149601 (Expires 1/24/2012) byAnderser> FederalTax ID#83-0404201 WINDOW NEruceWENT u„wem,c O.m CUSTOM WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Dote of Agree e t b/ / o,> m�� �O Suyerlsl Sheet Address,City,Skk>>,and p Ode �� L o F n d �^�, G EMailgAddren ,,/ Home Telephone Number Work Telephone N/umleeerr�+ y�('f /a/JoJ A [c rtGz . !Yv , �q� I l-7- `/QU— ST dC Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of J&L Windows,Inc.d/b/a Renewal by Andersen ("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively,this"Agreement').Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. OQ� Method of Pymnt O Cash ❑Check RIMastercard ❑VISA Total Job Amount: Q Estimated Starting Date: -���i� e�� O Discover ❑Financed,Appri: Deposit Received(33%):a3�. % ��G 4,/t S / / _ 1l,) o¢ Name on Credit Card: /7 e Q Balance at Start of Job(33%):� Estimated Com lehon Dale: -7 Credit Card#: Balance on Substantial n y Completion of Job(33%): Exp.Date CC Security Code: By initialing here,you acknowledge that the Balance at Start of Jo and the Balance on Substantial Completion MFAM Bayer Initial of Job cannot be made by credit card and must be made by personal check,bank check,or cash. Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, Dad that there are no 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. - J&L Winnda.,Inc.d/O -b/a Rcemwal by Andersen /// Buy./r(s) Buyer(.) By: ,- ` 0 ` zZI /tsS Sign e of oduct ManagerSignamre Signature Print Name of Product Manager Print Narffe 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. �— — — — — — - - — — — - - — —}a- — — — _ - - _,_ - - — — — — .gam— — — — — _ _ _ _ _ — — — — _� NOTICE OF CELLATION X NOTIC �F CELLATION Date of Transaction _�. You may cancel Date of Transaction !'J . You may cancel this transaction,wifho any no or obligation,within this transaction,witho t ap Pena y or obligation,within three business days from the above ate.If you cancel,any three business days from the above dale.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 negotiable instrument executed by you will be retuned within 10 days following receipt by you will be returned within 10 days following receipt . by the Contractor ("Sellerl of your cancellation notice, by the Contractor ("Sel 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.R 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 Htis Seller regarding the return instructions of the Seller regarding the return shipment 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 the goods available to the Seller and the Seller does not Seller does not pick them up within 20 days of the dale pick them up within 20 days of the date of your Notice of your Notice of Cancellation,you may retain or dispose without aatrofu you may retain or dispose of the goods of the goods without any further obligation.If you fail to without airy further obligaton. If you fail to make the make the goods available to the Seller, or iF aQree goods available to the Seller,or if you agree to return the to return the goods to the Seller and fail to do so, then goods 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 or 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. J notice,or send a telegram to Contractor J &L Windows, &L Windows,Inc.d/b/a Renewal by Andersen, 104 Otis Inc. d/b/a Renewal by Andersen, 104 Otis Street, Street, Northbo u h MA 01532, Y NOT LATER THAN Northbo h,MA 01532,BY NOT LATERTHAN MIDNIGHT MIDNIGHT OF 7 (Date) OF (Date) I HEREBY CAll MACTION. I HERE CEL THIS TRANSACTION. Buyers signature Dole I Buyers signature Date RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink ti )&L Mrmdows,Inc.d/b/a . 104 Otis Street,Northborough,MA 01532 ^�����' _ MA HIC License 11 149101(expires 1/24/12) Phone 508.919.0900•Fax 774.987.3013 K Federal Tax ID# 83-0404201 byAndersen. • , WINDOW REPLACEMENT mAM�C m Or GREATER MAEEACHDatTrs AND NEw Hen.mRlNRr WINDOW SPECIFICATION SHM*r Buyer(s)Name Date of A ant d d The uyer(s)listed above liscillypintly and severally agree to purchase the goods and/or services listed belo ,in ordauce with the prices and terms N described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AT OOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home,using the following individual quantities: bb Double Hung(DB)iZ Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 top.1/3 bottom) �r Casement(CW) ❑ Hinge right ❑ Hinge left(as viewed from exterior): ❑ Standard handle ❑ Metro handle �— Double Casement(CDW) ❑ Standard handle ❑ Metro handle - �r Casement/Picture/Casement(CPW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle ^ 2 Life Gliding Window(GIN) Glider/Picture/Glider(GPW) ❑ 1:1:1 or ❑ 1:2:1 i� Awning Window(AM Picture Window(PW) Bay or Bow Window —� Patio Doors(see separate Door Specification Sheet) / 2. Yes ❑ No Qty of Windows to be Custom Fit Replacement: (J 3. ❑ Yes M No Qty of Sills to be replaced by Contractor: 4. ❑ Yes ® No Qty of Windows to be New Construction Full frame(includes new interior&exterior casings) Exterior casings: ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 Fib=brickmold 5. Glazing to be: ELHP Low-E®SmartSuI (Tar C}rdif Eligible) ❑ Other If other,please specify: 6. Exterior color to be: ® White ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: R White ❑ Sand ❑ Canvas ❑ Terramne ❑ Pine ❑ Maple ❑ Oak , Note: Interior color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner. - 8. Hardware: [K.White ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style: 9. ❑ Yes ® No Install Lifts with Double Hung Windows 10. Screens: windows to have: ❑ Half or [RI Full screens Screens to be: nFiberglass ❑ Aluminum ❑ TruScene GRIL.T.F.DETAILS 11.Windows have grilles: ❑ Yes 0 No If yes:❑ Grille Between Glass(Gael ❑ Removable Interior Wood(Nnw)❑ Full Divided Light emu Qty: Qty: Qty-. Qty: Qtr. Qty Qty-. ll 'DH DH DH Cw/PlcWle Gfper GPJJ orG Draw grille patterns above 'Use additional sheet if needed Owner approved(initials):( ) ADDITIONAL WORK DETAILS 12.❑ Yes R No Contractor will remove metal frames of windows. Qty of Units: 13.❑ Yes E�'No Contractor will install new paint-ready or stain-ready casings. Interior casing qty of openings: Exterior casings qty of openings: ❑ Pine ❑ Maintenance-free material 14.❑ Yes © No Contractor will install new paint-ready or stain-ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior stops qty of openings: ❑ Pine ❑ Maintenance-free material 15. Owner is aware that Contractor does not do any painting.A �p Owner Initials 16.❑ Yes 0 No Contractor will wrap exterior casings with aluminum coil stock of color. Note: Wrapping may be required with storm window removal;removal of storm windows will leave screw holes in casing. 17.1 Yes ❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 18. Yes ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 19.K Yes ❑ No Building Permit—-Contractor will secure any and all necessary permits. The fee for the permit(s)is not included in the Contras{Price end a sepprr to heck is r�9Lumd at th pine of sale for this fee./ ./ 20. Additional job detail : 4/,/ ,ro5 /2Q/.a/t% cIC'e P/C t.,i�/ LEA ke ^*F,l(' d , Aa cJ GO.nv. P'V( (en A� /•'e rc C r'/a �5 l�cC 21. LYes ❑ No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final payment shall be demanded until the contractis completed to the satisfaction of all parties. 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 read this Specification Sheet. Renewal by#ndersen of Greater MA and NH Buyer(s)� Buyer(s) Signatikl.of nduct Manager / Signature Signature /l2A", Print Name of Product Manager Print Name Print Name The Common- ealtk of Massachusetts Department of Industrial Accidents Office of Investigations 600 Tashington Street Boston,MA 02111 www.mass.gav/dia vWe.rkcers' Compen nation Imur'ance Affidavit: Brr�ldess/Contralct€rrs/Eleetricians/Piumbers A�Pwlicant Information Please P 7lmmt Lemb Name (Business/Oreanixation/Individual): ?en eL-J rJ v 4n d e.Y.3 e in Address: 5 city/state/Zip: /Vorl{ & ra, 1 Cf 15-ML Pone#: Are you an employer? Check the appropriate bur. Type of project(required): 1.EI I am a employer with 00 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 7. odeliag ship and have no employees These sub-contractors have B. n Demolition working forme m any capacity. wormers' comp.insurance. 9. ❑ Buildinc addition [No workers' comp.inartranre 5. 0 We are a corporation and its required.]' offices have exercised feir 10.❑Electrical repairs or additions 3.ElI am a homeowner doing all work right of exemption per MCrL I LEI Plumbing repairs or additions myself: [No workers' comp.' a 152, k1(4),and we have no 1 ❑go of repairs insurance required.]Y employees. [No workers' 13.0 Other comp.insurance required.] . °Any applicant that ebecls box R1 Est also M oat the scadcabalow showing thaw woslas'enmpe-n�ina polieY mfo®etioa. t Hnnicownes who sah nit this affidavit indlCabIIg they an:doing aU work and thenhha outside aor+r+cknt mast submit anew affidavit indicating Bach. iConteefna thaf eheak this box must atmeheA as addidanal shear showing the name of the sob-conoacma and their wodo:s'comp.policy information. I am an employer that is providing workers'conpensadon insxrance}br my employees. Below.is the policy and job site Fr,fQrntatiaa / �,/� I/ ] ' Insurance Company Name: I �I ,/!/r, Ke—I--1) `)n Cr�G n C Z Policy or Self-ins.Lis. ,, \\ 3 J� ( /�(� r /`{i J Expiration Date: -ZI JV n Job Site Address: City/StatriMp: (�-Ar wn. AA Ok 9-46 Attscli a copy of the workers' compensation policy ded •ration page(showing the policy ut®ber and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a free np'to $1,500.00 and/or one-year imprisoemmt 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 mi s*•race coverage verification. ' I do hereby er the pains and penalties {perjury that the infarmadun provided above is due and cari�ect Sizaamre: c (` \ Date: Phone 0 Y,/ Offlo l use only. Do not write in this area, to be completed by elfy or town 0.07daL City or Towtt: Perimit/Ilcewe# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerks 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# iF zN9ssachusetts - Department of Public Sufetc a Board of Building Rc��ulations and Standards Construction Supervisor License License: CS 101952 Restricted to: 00 DAVID BANCROFT 5 JOHNSTON AVENUE WHITINSVILLE, MA 01588 Expiration: 3/192012 (Lmmisincr Tr#: 101952 IL ✓/se -fo'am9nanureoLUx o�..�lanaac/.ueetg . Office of Consumer Affairs&Business R-ulatiun V19OME IMPROVEMENT CONTRACTOR Registrations�601 Ezpira t�iyf112 - ' rn Ent Card - h . RENEWAL BY AIfTl�4-aO,l; r DAVE BANCRO i £ /r'i 104 OTIS STREt - ,�{ NORTHBOROUGH, iA-0(�'Ta32 Undersecretary F e ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMOM-YT 02/10/201 O PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC# INSURED Renewal by Andersen INSURER A: Hartford Insurance Company J and L Windows, Inc. INSURERS: Nautilus 104 Obs St INSURER C: Northborough, MA. 01532 INSURER D: INSURER E COVERAGES 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.AGGREGATE LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TNSR ADVL POUCYEFFECTIVE POLICYEKPIRATION INSR POLICY MIMSER (MMIDD LIMITS B GENERAL DABILRT' NC958461 10/01/2010 10/01/2011 EACHOCCURRENCE t 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES fa..rere.l $ 100000 CLAIMS MADE = OCCUR MED EXP(AM one person) S 5,000 PERSONAL S ADV INJURY E 1,000,000 GENERAL AGGREGATE $ 2,000,000 GWl-AGGREGATE OMIT APPLIES PER: PRODUCTS-COMPOP AGG S ZOOOODDO POLICY PET LOC A AUTOMOBILEUABILITY 35MCC XD 6390 10/01/2010 10/01/2011 COMBINED SINGLE LIMB $ 1,000,D00 ANY AUTO (Ea.c enq X! ALL OWNED AUTOS BODILY INJURY SCHEDULEDAU0S (Perperson) S HIRED AUTOS BODILY INJURY. NON-0WNEDAUIOS IPer.1denq S I P E (Per and.erIt) $ AGE LIABILITY _ AUTOONLY-EAACCIDENT $ ANY AUTO 1 f OTHER THAN EA ACC S AUTO ONLY: AGO S EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION 5 S A WORKERS COMPENSATION AND 35 WECPP 1444 02/17/2010 02/17/2011 We sLjIER TATU oTH- EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIIXECULNE Fy EACH ACCIDENT $ 500,000 OFFlCERIMEMBER EXCWDEDI El DISEASE-EA EMPLOYEE $ 500 DOO If SPECIAL P PROROunderVISIONS below SPPECI EL DISEASE-POLICYLIMB S 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY EMORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE.CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL NAPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ACORD CORPORATION 1988 i Renewal byAndersen. • WINDOW REPLACEMENT an AndmmC:nffW, ;xe;r<rR,a et; WoodAfinyl Composite IF F gC x ;g Dual Argon Low E4 SmanSun Double Hung 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient ON29 OA9 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance OA2 Manuluwmr nipuWen xw Ih.rafiy c Ib.to appliae4 NFPC prm.Guree baatafminiipwMb pnivt paHermvme.NfpC mime ara Hafavma0 bra 5rea nI M--o mnmanral cmwucv and a yfw'lc preCucf ee. NFHC Ceaa nm fammmeoa anY proGUCImM Evv rot w m,M nu aky nl airy prcUuct mr anYapa:ilL-uw. CovuC manulatunYa faanture bfmMrprWum p.rbfinenca hNommtun. �. wwwnllcAlg The p,Eucf maafa Gran .i ' :. {4. 9aah anwvmanxll e m �.. (�; )tlaMarW lPwmM enaRy • ).��r..�', yE�.•�.:.'4_f1a, f5' aXcenry.a+aW mama .,:�.,+.•• . ^•malm.ana ann � ���^' 1 py�warul PY�aena �. .r�b':z% :y!'ss`S�^W �CGInIMfaGu4lDNl ® 4+Yy)�ij�<4�,�• i DESIGN PRESSURE(PSG ' Muti�u tieoe oleo H-LC25 RbA DB SlopedaSill DH TN TmN1 mNN5Mrc[WMKMM3110MSIMmM MyfppGyta.t tef pmmrmvwmpgp I'uoY ntlMxnx. ' `Aeafaw avtaa6s M.E:C.,C.E,0.A LE.QQ.Ae I'Mmtcn"uiramantn MDMA HaOnvk Ganfmion Pfapm�n. Re newal rse � An - ENDOW REF L&CEMS"T aAndetseaCem{�zF o Whom It May Concern, _ .nclosed is a permit application package for a project we have been orntracted to do In your town. 'Shank you In advance for receiving this ackage by mail. As we work In every town In the state,. It greatly hells us in our process. ' ,ve have also enclosed a self addressed and postage said envelope and would request that when the permit application has been processed, that you vould mail it back to us. �nclEesed 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 (i€ accepted at time of applying) If you have any question regarding this application please call nine at (508) 9Sg-o332. Best Regards, Kelley Donahue Permit Coordinator 104 Otis Street .1 N=thborough,MA, 01532 Phone(509)919-0900 Fa (508)919-0903 Webshm www.rmewalbvanderseacom