10 LYME ST - BUILDING INSPECTION (2) i
1 .
The Commonwealth of Massachusetts
✓ OF
Board of Building Regulations and Standards SALECITY M
h�1 Massachusetts State Building Code, 780 CMR Revised Mar 2011
QV vv 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 Appl' :
Building Official(Print Name) Signature _ Date
SECTION 1: SITE INFORMATION
1.1 Property Address; 1.2 Assysssors Map& Parcel Numbers
1.1a I�accepted street?yes no Map Number Parcel Number
1.3 Zooning Information 1.4 Property Dimensions:
C. u vttit
Zoning District Proposed Use 11 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[
2.10Owner[of R�eford: _
d1IAA.e ffLOI- `LSM Sa\r;vt,., , emu, 61�1�a
Name(Print) City,State,ZIP
► h L4g&e sa . 9�+g-HC- IW3
No.and Sur et Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2.(cheek all that apply)
New Construction[37 Existing Building Owner-Occupied Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other O Specify:
Brief Description of Proposed Work : t
rir
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: _ Official Use Only
Labor and Materials
1.Building $ 16 cl 3 S,p I. 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 (HVAC) $ List:
5. Mechanical (Fire $
Sup ssion) Total All Fees: S.
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $'b Cj 3S _uJ O Paid in Full 13 Outstanding Balance Due:
f
J
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
1(k ke License Number Expiration Date
Name of SL Holder
List CSL Type(see below) U
No.and Street Gt Type Description
1- U Unrestricted(Buildings u to 35,000 cu.ft.
A
-f,,����IP Vfiy t yv-U z),?ala U R Restricted l&2 Family Dwelling
City/Town, State,ZIP M Masonry
-v RC Roofing Covering
WS Window and Siding
`
SF Solid Fuel Burning Appliances
�8 3F_\ A X 5548 I Insulation
Telephone Email address D Demolition
5�Registered Home I rov meat Contractor(HIC)mp� I� glo
V1 y�✓Q 1 a, *+A e f Ca✓t HIC Registration Number Expiration Date
{I1CC Com�anv Name Qr HIC Registrant Name
I ` - (� 1t- JT
No.and tr et I 1,� ,� �, tt Email address
xo
City/Town, State,ZIP Telephone S $
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 .......... No........... ❑
SECTION 7a:.OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT n
I,as Owner of the subject property,hereby authorize S k K e ti
to act on my behalf,in all matters relative to work authorized by this uilding permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW 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 applicytir and accurate to the best of my knowledge and understanding.
Print Owner's or thoKfe gent's Name(Electronic Signature) l5ate
NOTES:
1. An OwnerVvho obtains a building permit to do his/her own work,or an owner who hives 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 at www.mass.gov/dpss
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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
3. "Total Project Square Footage"may be substituted for"Total Project Cost" QJ3 J p S
CITY OF S.0 Eitil, NI sAcHUSETTS
• BLnnwG DEPARTJt&NT
120 W.ksHINGTON STREET,Yo FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KINCBERLEY DRISCOLL
NUYOR T HOMAS ST.PIERRH
DIRECTOR OF PUSUC PROPERTY/81 11DI SIG COWNCISSIONER
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:
�elnw�A �, � l cl� r-N
(name of hauler)
The debris will be disposed of in :
�CVICw p.� �4 AA JffxCIA
(n me of facility)
(address of facility)
sig tur permit applicant
5�ibll3
date
Jcbrisuti.Joc
Renewal
by
Andersen
WINDOW REPLACEMENT =Ax&ran ouTmny
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 Fa(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 skeet
Norlhboioegh,MA,01532
Phone(508)351-2200
Fax(651)-351-4807
Website:xmLrqNwdbmd=eon=
RenewalMA Home Improvement Contractor
w Renewal by Andersen Corporation.k License#170810(Expires l2/23/2013)
WINDOW REPLACEMENT .nana.r:.ncnmP•ny Federal Taz ID#41-1918413
104 Otis St.,Northborough,MA 01532
(508)351-2200•Fax:(651)331-4810 -
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyers(Name Dote of Agreemert
91 q I---,s
Buyer(s)Street Address,City,State,and Zip Code
Ito L, S
EMoil Address LJHam.Telephone Number Work Telephone Number
g�-? 5'-l?A-'3 I -5<0S--sq6-�4�
Buyer(s) hereby jointly and severally agrees to purchase 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 Date: Method of Payment:
Total Job Amount: b ,r/� Amount Financed s� )Q�1__ pCheck. .cash
Deposit Received(33%):��__ .ram) O^ �? 13visa/MC DDiscover
LIFinonced LIAMEX
Balance at Stan of Job(33%): D Estimated Completion Date:
If credit card is selected,please
Balance on Substantial /�, I q a. I day$ see Credit Card Payment Form.
Completion of Job(33%): �
Buyer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that
there are no verbal anderstandings 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) I) 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 Ande tion Buyer(s) Buyer(s)
tgnature of Product Manager r Signature1 Signature
Print Name of Product Manager Print Name 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.
— — — — — — — — — — — — — — —X_ _ _ — — — _ _ — — — — — — .ga_ _ — — _ — — — — _ _ _ — — —gam
NOTICE O CELLATION K NOTICE CELLATION
Date of Transaction You may cancel Date of Transaction o r You may cancel
this transaction,without y penalty or obligation, wilh within this transaction, o ny erahy obligation,wilFtin
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 nesotiable 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
Seiler 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 shipment of
shipment of the goods at the Seller's expense and risk. I the goads 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 date pick them up within 20 days of the date of your Notice
of your Notice of Cancellation,you may retain or dispose of Cancellation,yin+ maayy retain or dispose of the goods
of the goods without any further obligation.If you fail to without any further obligator.. If you fail to make the
make the goods available to the Seller, or if u a ree 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 goads to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligations under fior 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. notice,or send a telegram to Contractor.
Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street,
Street, Northbomygh, 01532, BY NOT LATER THAN North ug , 01532,BY NOT LATER THAN MIDNIGHT
MIDNIGHT OF�;J 1`T.(Date) OF�A .(Date)
I HEREBY CANCEL IS SACTION. I HERE CEL THIS TRANSACTION.
Buyer's Signmure Print Nam. Date Buyei,Signature Print Name De
I.
Copy- White Buyer Copy-Yellow Buyer Copy-Pink 0,19aP2009 REAPh.MANH.
Renewal mewal by Andersen Corporatic MA Home Improvement Contractor
License#170910(Expires 12/23/2013)
byAndersene -0 (50 Otis 8t.,Northborough, 51-4810A 0 Federal Tax ID#41-1918413
WINDOW REPLACEMENT =n enenCbmpany (508)351-2200•Fax:(65l)351-4810
WINDOW SPECIFICATION SHEET
Buyers)Name Date of Agr ement
41
The Buyer(s)listed above erebyjoinlly and severally agree to purchase the goods and/or services listed below,in ass ordance 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 DETAILS
1. Contractor will Install a total of windows in Owners home,using the following individual quantities:
_1„3_Double Hung ME Equal _Cottage sash(I/3 top,2/3 bottom)_Oriel sash(2/3 top.1/3 bottom)_Flat sill Nw(fsr,uee cieva d
XSquare Check Rail_Curve Check Rail
_ Casement(CS)_Hinge right_Hinge left(as viewed from exterior)
Double Casement(CD)
2 Lite Gliding Window(GW)
Casement/Picture/Casement(CD_1:1:1 or_1:2:1
Glider/Picture/Glider(GEM_1:1:1 or_1:2:1
Retn a Window Ray or Bow
Awning Window _#Lights Soffit/Roof Shingle/Copper
Specialty Window Patio Doors(sec separate aster spec sheet) Seat to be Primed/Oak/Pine
2. Dry of Windows to be Custom Fit Replacement:
�� Div of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR St EXTERIOR CASINGS)
Ex i s: Pine Maintenance-free material_Factory applied 908 Fibrex brickmold
4.Glazing to HP law-E- N Tempered —Other If other,please specify:
5.Exterior color to be: hite Sand Canvas_Terratone_Cocoa Bean_Dark Bronze_Forest Green_Black
6.Interior color to be White_Canvas_Pine Maple_Oak_Same As Exterior Note:Wood interiors need to finished by Owner.
7.Hardw_arDy White_Stone_Canvas—Estate Hardware: Style:
�
S.�Y�`Q Install Lifts with Double Hung Windows v
9. Screens:windows to have:_Half or Full screens Screens to :4 Fiber as Aluminum TruScene
GRILLE DETAILS
10. Windows have grilles:_Grille Between Glass(GIG)_Removable Interior Wood(INTW)_Full Divided Light(FDD
( )Owner approved(initials) Draw grille patterns below `Use additional sheet if needed
Qty: Qty: Dry: Qty: Qty: Qty: Qty:
ADDITIONAL WORK DETAILS
11. Cry of—Sills_Sill noses to be replaced by Contractor
12. Contractor will remove metal frames of windows
�s
13. —Contractor will install new_paint-ready or_slain-reedy_Interior_Exterior casings in_Pine_Maintenance-free material
1 Conhaztor will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine_Maintenance-free material
15 1 Inns-Owner is aware,contractor does not do any painting or removal/installation 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 w16 insulate,caulk and seal windows with 3-Point system to prevent water and air infiltration. Removal and disposal of alljob related debris,win-
bydo ,storm windows and vacuum nightly includd. Upon completion of thejob and payment in f ll,a limited warranty shall be issued
es❑No Building Permit—Contraztor 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. Ck# S
19 Yes El All discounts have been applied to this agreement price.
20.A tional job details:
21. Yes❑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 read this Specification Sheet.
Rene alb rider^ ratton Buyer(s) Buyer(s)
uA
By.
Signature of Pl!tNi�uct Manager \ Sfgntnyture� � Signature
Print Name of Product anager Print Nam—e��--•��-� Print Name
RenewalRenewal by Andersen Corporation
���i MA Home Improvement Contractor
���� 104 Otis Street•Northborough,Massachusetts 01532 MA License#170310(expires
byAndersen. Phone(508)351-2200•Fax(508)986-7072 12/23/2013)
WINDOW REPLACEMENT an Andersena)Mpnny rederal Tax ID# 41-1918413
CONTRACT AMENDMENT
This Amendment ("Amendment') is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT("Agreement') by and
between Renewal by Andersen Corporation and Diane Morrison("buyers"). Contractor and Buyer(s) hereby agree to amend and modify the
Agreement as indicated below. Other than as specifically indicated below,all the terms and conditions of the Agreement will remain in full
force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions,alterations,or deletions
to the products and services Buyer(s) ordered are being made:
Subtract one small window and add top and bottom GBG grilles.
As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or
marked as"N/A",indicating that no change applies:
NEW Total Job Amount: $16935.00 Payment Method:
New Deposit Received(33%):$5460.00 Received Check -
New Balance at Start of Job(33%):$5737.50 Check/Credit Card
New Balance on Check/Credit Card
Substantial Completion of Job(33%):$5737.50
It is agreed and understood by and between the parties that this Amendment and the or),gind Agreement constitute the entire understanding be-
tween the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment Buyer(s) hereby ackriowl-
edges that Buyer(s)has read this Amendment and has received a completed,signed,and dated copy of this Amendment on the date written below.
Renewal by Andersen Corporation Buyer(s)
By:
Signature of Product Manager = Signature Date
Duncan Fields 5/1/2013
Print Name of Product Manager Signature Date
TkeConJ/nOxieseaftofHarsischureft
Deparpnenf oflndxMrW-4cdidex&
O,f9t:e ofinva gadons
600 Watshjngtoe Sdrtt.
Boston,MA 02111
www.»MU-Sop/dle
Workers' Compensation Insurance AiTdavit: Byilders/Cont actors/Electr[chmwPbmbers
Anolicant Information Please Pa,n*Lesably
Name • •dual): r Al e Ja Q
Address: 10 Ii
City/Siate • : s aPhoTj�
6-b - s -agoAreyou an employer?Chan the appropriate be=
1. Iam aemployer with 3 a 4. ❑ I am a g�aal car and I Type°f Pro1 (required):
employees(full and/or pail time).* have liked the suacturs 6. ❑New conshue ft2.❑ I am a sole'proFietor or parmer- listed on the attaceet. 7. ;?Remodaliog
ship and have no employees These sub-contrave 8 ❑Demolition
working for me m any capacity. employees and hkers' p,„��(No workers'comp.instusnee Comp.inmvsnce9. ❑Building addition
n4 I 5- ❑ We are a corpora its 10.❑Electrical nPeIIser additi°m3.❑ I am a homeowner doing all work olBcens have exereir I I.0 per•myself [me woily rs'comp. right ofexemptioGL rcPe�er additions
insurance required]t c. 152,fl(4),ande no 12.Q Roofrepain
cmPIoYMO. [No workers' 19.❑Other
comp.insurance required.]
*Any aDP� Qyeecl box ate, *indto annotacyamdn an
odcogambl COI
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Insurance Company Nane:�� P.t0U�o� G Zn C 6
Policy#or Self-ms.Lie.#: M t A C -b*ation Dale: /0
Job Site Address:_) Cihr/SZaOdZiP �4'eti . Vk to
Attach a Dopy of the r►orhen'eompenudon policy declaration Page(showing the Polley number and
face upiration destel
Failur to to se 5, re co eMe �u�under Section 25A of MGL c. 152 can lead to the imposition of criminal penaltiesof a
Year Imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this sbdm3em may be forty areied to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cehyh' dFepabv and persaMes ofpeynry that Ore bt/onxaoonprvwkwabow&pee mrd correct
s re.
Phone# 8
OAklal use only. Do not wMe In this area,to be completed by dry or town of kW
City or Town: PermitUcense#
I "bq Authority(circle one):
I• Board of Health 2.Betiding Department &City/Town Clerk 4.Electrical
6•Other • Inspector S.Pinmbiug Inspector
Contact Person: Phone#:
CERTIFICATE OF LIABILITY INSURANCE e9/25/2D32
TIES CER71 mTE M ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HINDER.THIS
DOES NOT AFFIRMATIVELY OR NEOATNELY AMEND. EXTEND OR ALTER THE AFFORDED BY Tiff POLICIES
BELOW. THE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSURERM), AUTHORMED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
NPORTANT: N the pMfinb holler Is an ADDITIONAL INSURED,ENthe polkypu)mud a erMdoresd. N SUBROGATION ff WANED,suhJad fe cm Sums and conditions In Hsu
suchf#w molapolicr,sm nt(Min policies IrBir raauln an endomnwnL A s4bmmd on this cori fi�o does not coder rights to the
fATfNECate holder N Seu d such endorseme s
PaOOMICBr 3-612-339-3923WUNTACTJoaelle iargrove or Erie Johaeoo
Bare CeNpeaiee ~ . 622-333-3323
n
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Suite 700
Yianoayolie, MR 55402
N$Lgm AFF R001000VERM ums
Renewal BY Andareeu WNNBMA: OLD REPUBLIC SEE CO Corporation 24147
104 Otie street RARN Ms: EATIGNAL UBIOR PIKE IEB Co OP PIrn 19443
Nauafee:
Eorthhorough, IB 01532 INSURERS:
WINNERS: .
WBU�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 SUBAECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
"Lalle TYPE OF INSURANCE POLICY NUMBER PONCY POIICYEA
A I GEImm LIABILITYLie
NNEY 5992E 10/01/1 10/02/13
E CMHIOHrERALUAB6T, EACHOCCURRENCEf 1,000,000
CLA9A6 LAAOE ❑OCCUR f 500,000M®EXP ane f 10.000
PERSONAL SAW HAIRY i 1,000.000
OENIR&AGGREGATE f 4,000,000
OBrI �
PRO. LOC PROOUCTS-COMPIOPAGG f 3,000,000
A i
AYMEOaeF LIAaa11Y IBIrS 21700 10 Ol 1 10 Ol 13 Op®OEpgIGIAQT
E µy�O IEA ee1I0N) i 3,000,000
ALLOWNEDAUIOS eOwLrNA1RYIPa pop,) i
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E HIREOAUTDS PRo�DAM AM .
t
E NONOWNWAUMS
t
UMBREL
s
E E AlW i OCCUR 1]373355 10/02/1
EXCESS 10/01/13
EXCESS � uAIM15{tADE w EACH OCCURRENCE i 25,000,000
DEDUCTIBLEAGGREGATE S 25,000.000
E RETENTION S 25,000 S
WOMOMCONPBMATM A AM BllOY6rPUA/5RY r/N INSIC 1179{e 00 10/O1/1 20/02/13 X *Wmc OTF S
ANr ❑obaditA�bwQ E7ICLU0EpT E NIA FI FACHACCDENT f ],000,000
�N ds wKIK EA-beFwSE•EAEMP $ 2.000,000
�OF OPERATIONS bdaw E.L.DUiEAEE•POLICYLIWT f 1.000,000
t&yKm LOCATNINS/VEacm WYd,ACOI1D 101, RppJle ,epp.,p.a h,NyMyl
Evidence of Iaeurauce.
CERTIFICATE HOLDER CANCELLATION
Evidence of Iaeurance SHOULD ANY OF THE ABOVE DESCrygED POLICIES BE CANCELLED BEFORE
THE EKPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TIME POLICY PROVISIONS.
AUTHORIZED R9RE9BrtAl1VE
":I
Af•.flOn 9e Mwwewe, —- ---__
(lice of Consumer Affairs&Business Regulation
! ME IMPROVEMENT CONTRACTOR
egistration 170&10: TyPe'(
Expiration 12tf23/2013: Supplement l�
RENEWAL BY ANDERSgO�N CORPORATION
v' 1
JOSEPH REZZA ''':y>'_`�
104 OTIS STREET
NORTHBOROUGH,MA 01532 Undersecretary j
j
I
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisur
License: CS-M272 z
JOSEPHPREZW
1611 IIELLEY BLVD 'Q
N ATTLEBORO FAA b
Expiration
Commissioner 04/25/2014
,
ours
aMon
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