9A INTERVALE RD - BPA-14-780 Z-7 5
' The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mdr 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date A ie •
Building Official(Print Name) - SignaTure a[e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 As ssors Map&Parcel Numbers
C1A lt�+er Vale Ed '� t 0a3ti - 0
a as 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(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? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwoer'of Record:
IL-0er F �<ol Zhu Salem. mR 01910
Name(Print) City,State,ZIP
C" Inkerya(t U at-?g 7H b9r)
No.and Street I - Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other Mi 'Specify: (L' pkACe.
Brief Description of Proposed Work': e— \ i et do
i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ -7 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 (ITVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
6.Total Project Cost: $ 4 ,rJ . O C> Check No. Check Amount: Cash Amount:
❑Paid in Full ❑Outstanding Balance Due:
IA, o ;
Y ` r
SECTION 5: CONSTRUCTION SERVICES
5. Construction Supervisor License(CSL) G C\01 1 1 _1 _ 1 lT 1
t rn.e_ of', o License Number Expiration Date
Name of CSL Holder
b (o ^ uw t n er S List CSL Type(see below)
No.and Street (� Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
n f" O p
lO5 R Restricted 1&2 Family Dwelling
Cityrrown,State,ZIP - M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Buming Appliances
G/ 7 96 � 0 T� �— I Insulation
Telephone Email address D Demolition
5.2 (Registered Home Improvement Contractor(HIC) 1 O 4 C.
wL(\LWG b I A'nCIP-CAR- !1 HIC Registration Number Expiration Date
HIC Compan Name oiHIC Registrant Name
�o 4 6r Sk
No.and Street Email address
Xy0AAA&0C>M MfN r)(�2n::
City/Town,State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 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 Affidavit Attached? Yes .......... d 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 G} rYl G m of., r)
to act on my behalf,in all matters relative to work authorized by this building permit application.
See 4
Print Owner's Name(El6efronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name( ctronic Signature) Date
NOTES:
1. 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 M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.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 halFbaths
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"
CITY OF &URINI, MASSACHUSETTS
BL'HMNG DEP�RT.%MNT
13(1 W ASHINGTON STREET,3"FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KIMBERLHY DRISCOLL
MAYOR THO&W ST.PIHM
DIRECTOR OF PUBLIC PROPERTY/SUMMING CO.%L\RSSIONER
Construction Debris Disposal Affidavit
(requir'ed 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:
�,tr�le�Ul �ti '�+ (1cle,�szn
(name of hauler)
The debris will be disposed of in :
(name of fa 7ity)
1 o zl O-h s S� N�r�'h�ord M� a 153a-
(address of facility)
sign a of permit applicant
�{ IS� I9
Ote
dcbrimlfda
Ron—e�. - -- - - -MA Home Improvement Contractor
License#170810(Expires 1 2/2 32 01 5)
by'Andersen. Renewal by Andersen Corporation Federal Tax ID#41-1 91 841 3
Woman
are smacar
104 Otis St. Northborouph,MA 01632
15081 351-2200 Fax(5013)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT -
(Bu er s Name Date:
ROBERT KOLSKY - CYNTHIA KOLSKY - MARCH 7, 2014
Buyer(s)Street Address city State Zip Code
9A INTERVALS RD SALEM MA 01970
lEmail Address Home Telephone Number Work/Cell Telephone Number
CDKOLSKY2NCOMCAST.NET 9787456987
Total Job Amount $ 7,475.00 kmount Flnmced$ 7,475.00 Est,Start Date Method of Payment
Deposit Received(33%)$ 0.00 - - Check/Cash
10-12 weeks
Balance Start of Job(33%)$ 0.00 oeposn at signing$ 3,737.50 Check#
Balance on Substanllal Est Install Time
u Substantial .% Credit Card
Compl
. Completion of Job(33%)$ 0.00 completion$ 3,737.50
1-2 days If credit card is selectee please
sea Credit Card Payment form
�Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and 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 Buyers)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has mad 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 Buyers right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation B - Buyer(s)1734
BY
- Signature of Project Manager Signature Signature
FRED BOUCHER ROBERT KOL KY CYNTHIA KOLSKY
Printed Name of Project Manager Printed Name Printed Name
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
- SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS NIGHT.
______________________________I
NMCE OF CANCELLATION ( NOTICE OF csav osr
I
Data a Trammed.. 3/7/14 ( You may concelthis Date a Tramettiov 3/7/14 You maye—celfhfs
ltr+vnvctiaq wideom any penalty or obligation,within three handsome days from the I tennumdon,without any penalty or obligation,witbiv three business days from the
aboee date,If you cancel,any property traded u,any payments made by you under I above data.If yea coned,any property traded in,any payments made by you under
' the Gonave,ofSale,and my,namiable bammuum uernted byyen wr'g be I theCuntrvct aE Silq and uny aegotiable:mwmmt eeemted by youwiBbe
returned within 10 day.fallowhT receipt by the Contractor("Seger") of your I .etmned within 10 days fopeo i g reee.p,"a Contcoemr("Seller") of your
I..Oation vodcy and anysecur tyivteras,aruiag oat of the tramactiov wal be I macellation notice,and any secsriry interest arming our a the transaction uriH be
cauceled. If you sense,you must mate asarTab4 to the Sell¢at your rosldmce,to I canceled. X you tinsel,you most make areilvble m the Seger at yow reaidmee;he
iaub.t.,a ,as good conditioa u when rocdeed,any goods delivered to you under substantially as goad cendidan as when received,any goods delivered to you under
rhu Cova-act ar Silq oc you may,if you wish,c®ply with the Instructions of the this Contractor Sale;aryou may,if you wuh,comply with the ivstructiova of the -
SegerregardingthereturnshipmentofthegoodsattheSeller's erpeme and Ault. Sager regarding the remeashipment of the goods at the Seller's repress and risk.
Ilf you do make the goods avaaabld to the Seger and the SeBee does not pick them up if you do make the goods avagable to the Seger and the Seger does not pick them up
Iwithm 20 days of the time of your Notice of Cancellation,yen may retain or dispose within 20 days of the data of your Notice of Camara on,you may retain or dispose
o£the goods withom anyfvrther obligatiun. IE you fall m make the good,avogable of the goods without any fiather obligation. if you fall to make the goods a zDable
Ito the Sager,or if you agree torentrn the goads,to,the Sam and fall to do so,than I to the Seller,ur if yen agree to return the goods to the Seller end foil to do so,then
Jyrn amain Hi far performance a all obggatiom under the Candrum To eased you remain gable forperf ce of all obl:gadom order the Coatrart.To conedl
,6i.tromaction,mall oe definer a eigaed anti dated copy of thre mcegatiov vo,ue I thv tmmaetion,mall or definer a.signed end dated copy of this caacellation notice
oranyotirerwrittmno&C orsmdateteg wCoao-actor.Renewal by Avdwm,l aranyotberwrfaenv dce,orsendatele wCmtrvmn Rmeve lby Mdrnm,
104 Ods St. Norehboeagh,MA 01532,BY NOT LITER THAN MII)MGHT OF I 104Otie St.Nmthborongh,MA 01532,BYNO'I'IATER T N MEDMGBT OF
33// .(Dote) I EDERBBY CANCEL TRIS TRANSACTION. 3/10/14 .(Date) IBBREBV CANCH.THE TAANSACI]ON.
I
&pale SlpuWn RWNam tom a esijesen Pon Nee Dan
eA^neH/a� Renewal by Andersen Corporation MA Home Improvement Contractor
byN Ide(5en�. 104 Otis St. Nonhborough,MA 01532 License#170810 (Expires 12/232015)
woow aare.naaerxr. „w m+.,c..mr•r (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 _
Window Specification Sheet
Buyer(s)Name Date of Agreement
ROBERT KOLSKY CYNTHIA KOLSKY FRIr MAR 7, 2014
The buyer(s)Bsted above herebyjoindy and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms
described on the Specification Sheet and the from and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT,of which the Specification Sheet is pan. -
WINDOW DETAILS
Approx. EatetiorAttterior Color Hardware Hardware _ Low"4/ SaGrille Grille Glass
Room # U.I. Window/DoorS Is Detail Cxsin s EH-Ina Color Style Screens Si G611es sht/3 Sasn2 Una options
Dining 2 78 DB sq rail equal insert sloped sill No WHIWH White Standard FFG 3,unts.r Gee are 3/2 Yes No
Urying 3 87 DS square equal full frame Eat.MF Flat WFVWH White Standard FFG 3,nansur GBG M 3/2 Yes No
Total 5 BAY&BOW DETAILS *See Ba B.Measure Sheet
Style Detail/ Approx. ApF,. Numher Frame Widow Find ' Center L.E/ Roof/ Hardware
Room Count Sty. Flankers U.I. Galin An le L'Res Interior I Ext4nt Color Grilles has sashes Screens Smertsun soffit Color
SPECIALTY WINDOW DETAILS
Full/ Approx. L.E/ Specialty BAY/BOW ADDITIONAL WORK NOTES
Room Count S e Insert U.I. SmartSun Grilles Grille Style ExNnt Color Cu mvuaffix� Sa/bowwindowsunder72inches
there wJl beri t lav lose.
ADDITTONAL WORK DETAILS: -
I No Contractor will wrap exterior casings with coil stock color of
Owner is aware that Contractor does not do any painting/staining or removal/instahau'on of alarm system or window tmatments/hardware.It is the
responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to
2 whether alarms or window treatments/hardware will fit after replacement Customer is also aware in some cases there will be glass loss. If there is,the
amount will be dependent on the type of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.
Customer is aware and understands any and all unseen rot is not included in this contract.Should any rot be found there will be an additional charge for
time and materials unless so stated in this contract.
3 Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris,
windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
4 Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permits)is not included in the Contract Price and a separate
check is required at the time of sale for this fee. Check# 4913 $ 61
5 Yes All discounts have been applied to this agreement.
6 ' Yes Q No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance fonn(s). '
It is agreed and understood by and between the pardes that this Specification Shen,along with the CUSTOM WINDOW AND DOOR REbIODELING AGREEMENT,constionma the
entire understanding between the parties,and there arc no verbal understandings lunging or modifying any of the terms. This Specification Sheet may not be changed or its terms
modified or varied in any way unless suds changes are in writing and signed by both the Buyers)and Contractor. Buycr(s)hereby acknowledge that Buyer(s)has read this Specification
Sheet - - -
Been ewalbyAndereeaCorpbaatlon Buya{s) Buyers) I� ✓" J
Signature of Project Manager 'Signature Signature
FRED BOUCHER ROBERT KOLSKY CYNTHIA KOLSKY
Print Name of Project Manager Print Name Print Name
�"•MassacK440 s Depa trrient of Public Safety
9 ding
oard of Bui( Regulations and Sta ards ry
Ci,-ntitructlon Su,�enisor y,•
License. CS-08O125
JAA1E
86,GARDINER SF
LYNP MA.0190r -
Expiration '
.a..«...
,,-:Commissioner 1O106/2014Y.;
I
SCA 1 0 20M-05/11
flice of Couaumer ARairs&Business Aeguladou
OME IMPROVEMENT CONTRA CTOR
Registration 170810_
Expiration t.1y23f201$' Type'
RENEWAL BY ANDE Supplement 1:
RS,ON'CORPO
{ RATION
JAIME MORIN
104 OTIS STREET '
NORTHBOROUGH, MA 01532
Uuders� —
The Commonwealth of massachuseus
Department ojlndustrial Accidents
Office of Investigations
WJ 600 Washington Street
Boston,AM 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers
Applicant Information j� (� Please Print Leeibly
Name (Business/Oro nization/Individual): f 6rl QW C, A�e,�'SC✓�
Address: ) b LA . C t S
City/State/Zip: 1A LR (` )�\ Yj,,-,) ()4S3>hone#:_ S)D S - 3S
Are you an employer?Check the appropriate box:
Type of project(required):
1., 1 am a employer-with 17 c) 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. El New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity, employees and have workers'
[No workers' comp.insurance comp.insurance.; 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ Lama homeowner doingall work officers have exercised their
11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. Roof re ans
insurance required.]t c. 152, §1(4),and we have no ❑ p ;
employees, [No workers' 13.❑ Other
comp.insurance regdired.] -11
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affrdavitindicating They are doing all work and then hire outside eomradtors must sub' it`a hew affidavit indicating such.
'Contractors that check this box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors.bsw employees,they must provide their workers'comp policy number
Jr am an employer that is providing workers'compensation bmurance for my o employees Below"'is the p
information 1 licy'iihdjobsite
Insurance Company Name:
Policy#or Self-'ins.Lic::#: q 0 6 Expiration Date:
Job Site'Address: -\_R , 1Y�C!' V Cc( e- f Z City/State/Zip: Da lCm m(4 Oj q'1d
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify nder the pabrs and penalties of perjury that the information provided above is true and correct
S ature: Date: 4 _5 4
Phone#: g is 1— ,)4 O D
Official use only. Do not write in this area,to be completed by city or town oKwiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone M
CERTIFICATE OF LIABILITY INSURANCE DATE 1/213 10/Ol/3013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTNORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: t the certificate holder is an ADDITIONAL INSURED,the Policypes)must be endorsed. N SUBROGATION IS WAIVED,subject to
me terms and conditions of the policy,certain policies may require an endorsement. A statement on this cerORcate does not corder rights to the
certificate holder In lieu of such endomemengs. .
PRODUCER TIN 1133-3373 AC
Bay, Companies
PHOME
BO South 8!h street alA1L . 611-333-3323 FA%Ne: 6]1-373-7170
Suite 700 DRm'
Minneapolis, MT 55602 INSURER MFO GCOVERAOE mcs
INSURMA: OLD REPUBLIC IRS CO 34167
W6URFD MSURER a:RATIONAL UNION FIRR IRS CO OP PITTB 19a65
Renevel By Andersen corporation
INSURER C:
106 Otis Street
INS
URER D:
Noethboreugh, MA 03532 INSURER E: .
INSURER F
COVERAGES CERTIFICATE NUMBER: 36177490 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
CLANS.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 CMS.
VIER 7YPE OFINSURAMCE POUCYEFF P NR
POl1CY NUMBER LMRS
A GENERAL WBOJTY ENSY 300361 10/01/1 10/01/16
E FJ,CM OCCURRENCE 51,000,000
COIAMERCIALOENERAL UABILRY s - f500,000
CVJM9-MADE Fil OCCUR MEDIXP mre rsan f 10,000
PERaoNALeAOv nNURY f 1,000,000
GENERALAGGREd1TE f 4,000,000
GENY AGGREGATE IDARAPPLIEB PER PRODUCTS-COMPW AGO E 4,000.000
E POLICY PRO' LOC f
A AUTOMOBILE YABORY 101T6 30007 R NEON M
Ea 5,000.000
E ANYAVIO BOOaV RMURYIPV PAmmi) f
A OWNED SCHEDULED
AUTOS AUTOS SODILYIILURYIPweaYSaM) f
E µ HIRED AUTOS R
n0 �Eo
I PROPE aTY DAMAGE f
s
B E UYAREW LW E pCCUR 70567735
��� 30/01/1 10/O1/36 EACH OCCURRENCE f 33,000,000
CWMSMnOE AGGKGAIE f 25.000,000
On I E I REIENTows 25,000 f
A WORKERS µ ��S• I YIN
MR! 300359 00 10/01/1 10/01/14 E MSTATLL OTH-
ANYPROPRIETOWPARTNERIIXECUTNE f 11000,000
AIDU OFFICERBER EECLUDEOi is NIA E1.EACH ACCIDENT
Mnanory M NN)
;;:' EL DISEABE-FA ENKOYDE 61,000,000
E.L.DISEASE-MUCY UNIT 61,000,000
DESCRIPMON OF OPERATIONS ILOCATONS IVEWCLES IAnegi ACOPD 10t,AV6Nbim114mNAF SdaauM,NRNn FPAG M mEWmdJ
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
To Nhom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Yor Insurance Purposes only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIDED REPRESENTATIVE
01888.2010 ACORD CORPORATION. All rights reaerved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
ihargrove
36122490
Renewal
byAndersena A-Z
WINDOW REPLACEMENT aaAAdmMC0MPh0Y
e - n WoodNinyl Composite IF
Dual Argon LOW E4 Smar[SOn
F�::�:9C:xuxri<3 Double Hung
100-00473518-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
0 . 29 OA9 -
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
Om42
ManuNClurermYuhlearMl.Mx Meirp[Mlxm reapPhaCN NiflC PrxeEurya W YelarmbYi9 Wl,ab pKGUC1
perrarmaxa.NFIIC NNPa am Egn NF a =1 P eE br efwe xl el eMOMmentelconEhiomanC anpxYc praExl a¢e.
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,leeu dexceeee ltE.C.,Qf.QILECG.N IMBImin nqueamenra WGhlPNahmrk CenYUlbo Pro9em. "'
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RenewalWriaARFIR
E I SERVICES
byAndersen.
WINDOW REPLACEMENT a -8 A 8: 5b '
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:
❑ 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 questions regarding this application please call me at: 508-351-2200 X 55285
Regards,
Kelley Donahue
Permit Coordinator
104 Otis Street
Northborough,MA,01532
Phone(508)351-2200 X 55285
Fax (774)-987-3013
Website:www.renewalbyandersen.com
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