28 LYNDE ST - BUILDING INSPECTION ;'IcAJI The Commonwealth of Massachusetts
A I Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR RevisedLEM2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
Otte-or Two-Family DwepVg
This Section For Offic' I Ilse Only _
Building Permit Number: Date d:
ac . L° �l
Building Official(Print Name) _ Spalure _ Date
SECTION 1: SITE I F RMATION
1.1 Pr r
erty A dress: 1.4 ssessors Map&Parcel Numbers
12
1.1 a Is tan accepted street?yes no Map Number Parcel Number
1.3 Zoning InformationN 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,gw7er'pf Record:
Name(Print) I City,State,ZIP
�� L-4ytc e.
No.and Str et Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction ❑ Existing Building er-Occupied Repairs(s)'6 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ I Other Specify: e . e
Brief Description of Proposed Work : L 10 LW t"L �
c c.
SECTION 4: ESTIMATED CONSTRUCTION COSTS,
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 006- u 1. Building Permit Fee`$ Indicate how fee is determined:
❑Standard City/Town Application Fee -
2.Electrical $
❑ Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $Su ssion Total All Fees:$
re
6. Total Project Cost: $ (a,A�il .u Check No Check Amount: Cash Amount:
❑Paid in Full 0 Outstanding,Balance Due:
w SECTION 5: CONSTRUCTION'SERVICES y„
5.1 Construction Supervisor License(CSL)
2')S r_ 0� �2 iA License Number Expiration Datg
Name
of C1 LL Holder I /
ID 6 K r.(�,e � a lJ � List CSL Type(see below) V
No.and Street I Type ; Description -
'{, U Unrestricted(Buildings up to 35,000 cu.ft.
+"t t'fT't2 0 fJ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP z I M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
n `
5W9-SS_I-r�Ull .X 55�4 I I Insulation
Telephone Email address D Demolition
5 Registered Home Improvement Contractor(HIC)
efvPW&� �.a Q-A A—e(—S� lam 81 d la a3�t
HIC Registratt ber ion Ni Expiration Date
V.�
IC Cob�mpan Nam
t se or HIC Registrant Name
S-t�
�trtree Email address
�d,�S�-�.l,a" r� � I �3a �ss)-ads
City/Town,State,ZIP Telephone $S
SECTION&WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1-52.§ 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 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
I,as Owner of the subject property,hereby authorize �t Se A\ tl e-- � G
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: OWNER' OR AUTHORIZED AGENT DECLARATION m
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this ap 'c do 's true and accurate to the best of my knowledge and understanding.
loft 17
Print Owne s or, ho ed Agent's Name(Electronic Signature) Date
NOTES:
1. 9xfher who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
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
inn .mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
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"
i CITY OF SM .M. INWSACHUSETTS
<� BumDwG DEPART%wNT
120 WAsms:GTON STREET,3;°FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KIJfBERLEY DRISCOLL
MAYOR THOMAS ST.PIERRR
DIRECTOR OF PIBuc PROPERTY/BunDING Cow%awIONER
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 At 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 IIby:
�u I���}n c`CrSert
(name bf hauler)
,(The debris will be disposed of in
Y�C�V)cu-i& \ �).4 14A dLV Sc/�
(name df facility)
Nbr'—WLe's, vtrcA,
(address of facility)
gnatu of permit applicant
1/1'1
(o %i �/ 3
date
dcbrisulydoc
Renewal
al ' 1 MA Home Improvement Contractor
I.E ILYY(A :O 'r� _ �--�. License#170810(Expires 12/23/2013)
byAndersen. Rett¢Wal by Andersen Corporation Federal Tax ro#41-1s18413
WINDOW REPLACEMENT as Mdneen Compay -
104 Otis St.,Northborough,MA 01532
(508)351-2200•Fax:(651)351-4810
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyers)Name - Dale of Agreement '
CaN TfJNe� L. �/OL
Buyers)Street Address,City,Slate,and Zip Code
�28LyN�� �% lJNA7� .1r�LfH, 7/A Ul970
EMoil Addres, Home Tale hone Number i Work Telephone Number
0T--51g14,0Ve1417-,n1,0t/PT 97P 7111 7976
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.
�� �T�,r� Estimated Starting Date: Method of Payment:
Amount Financed ,., C 3 OCheck OCash
Total Jab Am..rd) I A-.VVV
Deposit Received(33%): � O LiDisco,ner
Balance at Start of Job(33%): 0 d OAMEX
Estimated Completion Date: If credit card is selected,please
Balance on Substantial see Credit Cord Payment Form.
Completion of Job(33%1
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 Buyer(s) and Contractor. Buyer(s) hereby
acknowledges that Buyers) 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)
l
By: u i
Signature of Product Manager Signature Signature
' r
�< t �J l(�;y�ol a 6A/JTAA1K �9ay
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.
NOTICE OF CANCELLATION �' - - ee K 1 4 NOTICE OF CANCELLATION '
Date of Transaction You may cancel Date of Transaction You may cancel
this transaction,without any penal orte obligation,within this transaction,without any peaut w obligation,within
da three business days from the above .If you cancel,any three business days from the above date.Ifyou 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 returned within 10 days following receipt f 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; orou may, if you wish, comply Contract or Sole;oryou may,if you wish,comply with the
with the instructions of Xe 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 date pick them up within 20 days of the date of your Notice
of your Notice of Cancellation,you may retain or dispose of Cancellahon,you may reain or dispose of the goods
of the ggoods without any further obligation. If you fail to without an further obligation. If you fail to make the
make the Dods available to the Seller, w if you agree 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 Dods 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. notice,or send a telegram to Contractor.
Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Street,
Street, Northborough, MA 01532, BY NOT LATER THAN Northborough,MAL01532,BY.NOT LATER THAN MIDNIGHT
MIDNIGHT OF .(Date) OF .(Date)
I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
Buyer's Signotum Print Nome out. Buyei,signature Prim Name Dale
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink CJBILP2009.kBAAPn MANH
Renewal (—Renewal by Andersen CorporaL_ MA Home Improvement Contractor
{,,,,��7 �� 104 Otis St.,Northborough,MA 0153 License#170810(Expires 12/23/2013)
"J" '••dersen• (508)351-2200•Faz:(508)956-707 Federal Tax ID#41-19I8413
WINDOW REPLACEMENT an MduxnCon any
WINDOW SPECIFICATION SHEET
Buyer(s)Name Date of Agreement
In 10 L IS 13
The Buyers)listed above herebyjolntly and severally agree to purchase the goods and/or servi s listed below,in accordance with the prices and terms
described an the Specification Sheet and the front and the reverse of the accompanying CUSfOA i WINDOW AND DOOR REMODELING AGREEMENT,
of which this Specification Sheet is a part.
WINDOW DETAIL
1. Can tot will Install a total o windows in Owners home,using the following individ al quantities:
Oriel sash)(2/3 to 1/3 bottom)_Phil sill nova o tom«.r is of
Dou a Hugg(DB) Equal sash_Cottage such U/3 top,2/3 bottom)_ R re f amo bet
+.lu:¢e Check Rail_Curve Check Rail
Casement(CS)_Hinge right_Hinge left(as viewed from exterior)
Doublc Casement(CD)
2 Gte Gliding Window(GW)
Casement/Picture/Casement(CD—1:1:1 or_1:29
Glider/Picture/Glider(GPM_1:1:1 or—1:2:1
Picture Window Bay or Bow
Awmir4 Window _#Liles Soffit/Roof Shingle/Copper
Specialty Window Patio Doors(su servrale door spec'hre Seat to be Primed/Oak/Pine
2. Q(r o t Windows to be Custom Fit Replacement:
3. QIy of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR&EXTER OR CASINGS)
Exterior asiegs:_Pine_Maintenance-free material_Factory applied 908 film T brickmold
4.Glazing to be:_HP Ir-E4®SmarlsunTn _Tempered —Other If other,please spec'
B.Exterior color to be: �/ ile_Sand_Canvas_Terralone_Cocoa Bean_Dark Be raw_Forest Green_Black_Red Rock
6.Interior color t While_Canvas_Pine_Maple_Oak_Same as Exterior N te:Wood interiors need to finished by Owner.
7.Hardware:Z White_Slone_Canvas_Estate Hardware: Style:
8.�Install lifts with Double Hung Wigd'ows )'D)s+' )"
9. Screens:windows to have:—Half Or P)r screens Screens to be:_Fiberglass_Aluminum_TruS:ene
C.RILU DETAIL
10 ows have grilles: Grille Between Glass(GBG)_Removable Interior Woad(INTW) Full Divided Light(FDL)
/ wrier approved(initials) Draw grille patterns below •Use additional sheet if needed
Q Qtr Qtr Q7' Qty: QH: Q7
LD'i
ADDITIONAL WORK DETAILS
11. 2lY 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_Exte m casngs in—Pine Maintenance-free material
14. or will install new_paint-ready or—slain-ready_Interim—Exterior stops in—Pine_Maintenance-free material
1 ( tls-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 fA�lov
Note:Wrapping may be required with stern window removal;removal of storm M idown will leave screw holes in casing.
17.Contractor will insulate,caulk and seal windows with 3-Point system to prevent water and air Titillation. Removal and disposal of all job related debris,
windows,storm windows and vacuum nightly included Upon completion of the job and payment in full,a limited womanly shall be issued. Customer is
aware m e roses there will be glass Iocs If there is glass loss,the amount will be dependent on t e type of existing window,type of installation,insert or
full fro and the window style. We make no guarantee as to the amount of glass loss Customer' also aware and understands that any and all unseen nv is
noI eluded in this contract.Should ally rot be found there will be an additional charge for time ant I materials unless so stated in this contract.
18. Yes No Building Permit—Contractor will secure any and all necessary permits.The fee for the pennit(O is not
included in the Contract Price and s separate check is required at the time of sale forthis fee. Ck# C_ 0! 67 S�_
19 Yes❑No All discounts have been applied to this agreement price.
20.Additionaljob details:
21.Fz Yes❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/firtance f nna(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(si and Contractor.Buyer(s)hereby acknowledge that Buyerts)has read this Specification Sheet.
Renewal by a ndersen Corporation Buyer(s) Buyer(s)
gnature of P ea-roduct Ma ager Si si re - - Signature
✓l-1(-- -w.�� ril�J�G` �_ �,.yLhTAnPrint a
Print Name of Product Manager Print Name Print Name
Renewal
byAndersen.
WINDOW REPLACEMENT :�n,Aa.lcrsen C :+ruh.,iu
CONDOMINIUM PERMISSION FORM FOR SUILPINC PERMIT
28`�Ly Sfr"f Urwf F SaLeM, MA o].970
W& Ja ve -AKdrewv be ng fI^z d wl.y av4j,&rt zevf represewfafwey of
Jaw�ey Andrews G�cwu�otu�
Have.re vizwed t{.t.e��,e, y dot' i,�rY�t'ovew,zewty to-
28 LywdeSfree( Ulf F Sa tow, MA 01970
Owwad,by C-owytaalce SaAL
-rP,&Condo-AySooi,afi.ow or Ma-"e.w,ewf-Covwpawy 0-9ree3,11tia4 ff+z,above ownerY t,aw perwwy6i.ow
fo-se perww49 and fa-carry owf-f{ti proposed work,
SigwMewe of CoKAv As,ou.afio++.Rwese1+.lvfi.ve V- d&
Pvi.„M tJwt+t
V w Uzv-of flop Forw•, a u4fer sfwti.Kg fi,z W-*V.2 pt wpo7",ay above-: o w f kz.C ,dew i,�.i,��
Mcwagemewf-CmnpiwuJ yfafwnary wray be.ywbyFvtwfed.)
104 Otis Street
Northborough,MA,01532
Phone.(508)351-2200
Fax(508)986-7072
Website: www.renewalbvandersen.com
The Comnronwea t/e 001mrswAmeft
Depw*new oflndpsl W-4eetdex&
Q,(SM ofinveiage&M
600 washingion&rest
Boston,AL4 02111
www n/ass:gov/dle
Workers' Compensation Insuritnee Affidavit: Builders/Contr:Mors/Eleetrici&uw lmnbers Applicant Information PPesiae print b
Name(Bus aessaorgsoicadury adi idaaQ: R p
r /1
Address: 10 s ST
City/Sfate/Zip: 1 S a Phone#:
Are you an employer?Check the appropriate box:
1. I am a employer with 3� a 4• I am a general contractor and I of pro]ect(required):
employees(hill and/or Part-time).* have hired the sub-contractors 6. ❑New construction
2. 1 am a sole'propridor or partner- listed on the attached sheet. 7. (a'Rempde�
ship and have no employees These sub-coohactors have
working for me io any capacity. employces and have workers' 8' ❑Demolition
(No workers'comp.instuance COIDP.insurance S 9• Buildmg addition
required] 5. We are a corporation and its 10.❑Electrical repay or additions
3. 1 am a homeowner doing all work officers have exercised their 11.[]Plumb• ' n
my �oo wow]t comp. right of excmption per MGL m8 1>sua or additions
c. 152, 91(41 and we have no 12.❑Roof repairs
employees.[No workers' 13.❑Other
�.insurance regahed.]
•Aur INHoud that 4bedo4 boa#1 must also°a out Poe sOCt10L below f Homeowms who submit Poi,atBdavva huliatiog they ere. dwwmg amso,lo~n•com�sanoa policy;oPosmaPom, .
'Coss that&wk this box muststtaehed se Wditiond� work and Posen oft outside onmsiae0oss OWN submit a new a1BMwit mdicaft seek
mployees. lrthesub•e�hsMtsMe �Dws w enureatPoesubPoonausmsandsatewbcdmorsotPoosesmassbase
amployeet,Pory must provide Poet wmken'Comp,pol;eynambm.Iffn .
an ./o';/dint 6 prpvldbrg worktr#'contlperaoJ►oa bwanrtee for rs8'oWPlOYOM Below is Ore po/Iry arm ornwOon. /ob rlre
Insurance Company Name:
Policy#or Self-in.Lie.#:�_(A� C ( t 1 4 Ci LJ 5?0 b HViration Daft.-
Job Site Address: dy ✓1 r� \� n City/Stff11M&p: S4.caA
Attach a copy of the workers'tour
secure ptxaation policy o atlom page(showing the polity number and expiration date).
fine up to$1 00 00 and/or onoov�rsgc as e tender Section 25A of f MGL a 152 can to the.imposition of taimind Pace of a
Y a°�omnce�as well as civil penalties in the frnm Of STOP WORK
Of up to$250.00 a day against the violator. Be advised flint a copy of this statement be f ORDER and a tine
Investigations of the D1A for insurance coverage verification. >�Y °TM�nd to the Offiee of
I do lieieby ill dpe pobrs and pmaNn ofperjm*dgOt t/re infonnadon provlded ebattr
and torrent
Phone
Ohkiel use only. Do not wr&e to this area,to be co►rkled by City or town 0J/rcioL
City or Town: Permit/ldaense#
Issuing Authority(drele one):
L Board of illealth 2.Building Department 3.City/Pown Clerk 4.Electrical Inspecto 6.Other r S.Plumbing Inspector
.
Contud Person:
Phone#:
CERTIFICATE OF LIABILITY INSURANCE o 25/" 20 2
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UpON THE CERTIFICATE HOLDER,TItlB
CERTIFICATE GOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTmATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSIRNG INSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: N Um coatlleats holdor Is an ADDITIONAL INSURED,fhb polk7(bs)must be eldomed. N SUBROGATNNI E WANED,suhjaci b the teens and eondllons of the policy.Cerlaln policies mry mqulre an endonam nL A stsi ment on this eaFUlicats does not WAIVED,
subje the
cerdeata holder In Bou of auch a domeme s
PRODUCER 1-612-333-3323 Jamaile 3argrove or Eric Johnsen
Faye Companies PHONE
. 612-333-3329 1y:612-373-7270
0o Sough eth Street
Suits 700 PROOIIGER
Ninneapolis, NN SS402 -
INSURED HAR:eaAn1ERA: !TM
Renaval By Andersen Cotpor:tie¢ 24147MSURERS: p pITTS 19445
10{ Otis street ISUIUMC:
Northhorough, NA OIS32 ISUREND:
I SUIER E:
MIURE/lF:
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,
Lm TYPE OF NEURIINCE PODGY MURRFR -ar
A I GENERAL.LIABILITY NRZX 59026 10/01/1 10/01/13 EACH OCCURRENCE Leah
Z t 11000,000
COMMERCULL6ENERALUIIBILRV S 6 500,000
CUJMS#NDE IKI OCCUR NED OD' one omen 6 10.000
PERSONAL A ADV INJURY 8 1,000,000
GENERAL AGGREGATE 6 4.000,000
0���P APPLES PRODUCTS-COMPJOP AOG f 3.000,000
T
A AVIDYO LE LIABILITY MINT9 21700 10 Ol 1 10 Ol 13 CONE"WSWGLE LIMIT t
Z ANYAUT0 me momed) 63,000,000
ALLOWNEDAUTOO BODILY INJURY(Pw Pe ) 6
SCHEDULED AUTOS BOMLYBuuRY(P.,"Wwd) 6
E HIRED AUTOS PRPROPERTYDAMAGE 6
= NONOAMMAUIOS t
t
E Z WIBIB1A lU1B Z OCCUR 19273355 30/Ol/1 10/01/19
CIAA164MDE
EMOSIS UAB EACH ODURRENM 6 25,000.000
AGGREGATE 6 25,000,000
DEDUCTIBLE
HxRETmNTmN 125.000
s
A WORKEPECOMPENSATION AND 13 LIAeANYPROPMETORIPARTllfY YIN NNC 117940 00 10/01/1 10/01/13 Z WC STA7IL OTN- t
OFFICERa1 Wh NIA El EACH ACCOUNT t2,000,000
Ooelak,Y ti MR)
If deaeeewidw El DISEASE-EA Ba t 1,000,000
D 1P7ON OF OPERA71ONS below EL DISEAOE-POLICYUMIT S 1.000.000
oEFCRoTnONOFOPERA7Rme/LouT IVEWCEa0ul.acow 101.A"MOMIK.non.awede,R,naegeaenuo ,
Evidence Of Insurance.
CERTIFICATE HOLDER CANCELLATION
Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EZPIRATTON DATE THEREOF, NOTICE WLL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEOIEPREAENTATNE
V
.=lei
®1956,2005 ACORD CORPORATION. All rlahta na...�r
ACORD 2512g09/09M The cceRn¢a.,....,.e Lww...,,.�.��_�--,-- -.._---
C-�,�ie�Oarnmw-nwe¢!!/e o�p�aaaad,.re�eda
ffice of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
egislratlOn:.170810 Type
Expiratlofc 12Q 2013 Supplement
RENEWAL BY ANDERSON CORPORATION
JOSEPH REZZA - r
104 OTIS STREET g L--
NORTHBOROUGH,MA 01532 Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen isor _
License: CS-065272
JOSEPHPREZZer --- '%
168 KELLEY BLVD �
N ATTLEBORO MA
Expiration
Commissioner 04/25/2014
i
i
Renewal
�G byAndersen.
WIND0IT• REPUICEMENT �nAndclxn('.nnm117
?#aCIXsS WoodMr84 Composite IF
Ca.Ed1c Rov
Dual Argon Low E4 SmenSun
Double Hung
100-00473618-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)I-P Solar Heat Gain Coefficient
0x29 0m19 `
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
O E 42.
I
YMmm�mwFYurlu ll.Wm(gylcMbMmypfa4Y NfRC PAMnne brMYmiiByla�pwO�o1 i
� pMmwM�.Mflq milpp wwM,lYa b�6ne rt Y�wiesrYYrsMbM W♦NMNe pmnuY N�. I
NIDC MMrn wcmmm MYp^e�rin Ceupp wMY1NwbCiYYwppmnw:IbinY4r�n s. I
. GMMN�ermY NmmiNYG�lplmwnW�iJelaalien. I
YAYW.AIIEMP
�� SERC YA*PwwY m..l.awM �
YMhiMiMOM111Y �1 y
w OeWM WwmiNiMN/ 1 �i'i.<...� `Y'��'iL• ,
�YYOiry.Mw'Ymmv0
Iti hmrMfYU I
IQprmrµ p�cbpfipnm I
DESIGN PRESSURE(PSF)
$ �y f,
�LfiS RbA DB Sloped Sill DH IN
untlC11N8Qf�NM+YO.lY1:MtNavAW ac WWWY n41/GIIYIW DYw YMO<.
nW raxMGa N.EG.Cll,f 4EDG.AY YJfIWse npY�mwYlMAIMvkGnFmiM Repnw.
I
j
I '
I
• I
i
I
I
Renewal
Andersen.
WINDOW REPLACEMENT anMdaamCwl�onq
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 0&stt
NoHhbo=Xk MA,01532
Phone(508)351-2200
Fax(651)-351-"07
Website:www.rwewaihvaadasen.com
Renewal
byAndefsen.
WINDOW REPLACEMENT ttnAnderaatCos�orty
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 Sftd
Notthboroogh,MA,01532
Phone(509)351-2200
Fax(651)-351-4807
Website:g ,r®ewalbvandeesm oom