11 MAJESTIC WAY - BUILDING INSPECTION l�� y � 9 (0� a �R �k3�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Requred Alar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For OfficiajUse Only
Building Permit Number: Daft lied:
Building official(Print Name) l q
Signature Date
SECTION 1:SITE INFORMATION
1.2 AfTmors Map B Parcel Numbers
12-0003-832
1.1a is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
CONDO
Zoning District Proposed Use Lot Area(sq fl) Frontage(R)
1.5 Building Setbacks($)
Front Yard Side Yards Rear Yard
Required Provided Requited Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Fhiod Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public O Private 0 — Check if es0 Municipal O On site disposal system 0
SECTION2: PROPERTY OWNERSHEPI
2.1 Owner'of Record:
LINDA TREMBLAY SALEM,MA 01970
Name(Print) City,State,ZIP
11 MAJESTIC WAY 978-2104913
No.and Street Telephone Email Address
;SE4 TION 3:DESCRIPTION OF PROPOSED WORW(check all tbat apply) _
New Construction O Existing Building It! Owner-Occupied 14 I Repairs(s) ]D I Ahesation(s) 0 Addition ❑
Demolition O Accessory Bldg.O Number of Units I Other 6 Specify: REPLACEMENT
Brief Description of ProposedWorle. REPLACE 4WIND -NOSTRUCU
SECTION 4:ESTIMATED CONSTRUCTION COSTS `
Item Estimated Costs: =a.. r - Official Use Only -
aAbor and Materials
1.Building $5,394.00 1 ,Building Permit Foe:$ . Indicate how fee isdatermined:`
2.Electrical $ 0 S'tenderd..City/Town Application Fee t
0 Total Projad Costa(Item 6)x multiplier x
3.Plumbing $ 2- Other Fees; $ `
4.Mechanical (HVAC) $ List.
5.Mechanical (Fire Sion) $ Total All Fees:$
6.Total Project Cost: $ 5,394.00 Check No. Check Amount: Cash Amount:
0 Paid in Full O Outstanding Balance Due: `
�--
SECTION S: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-14
JAIME MORIN License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
86 GARDINER ST
No.and Street Type Description
LYNN,MA 01905 U Unrestricted(Builditurs up to 35,000 cu.ft
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2200 X 55285 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-15
RENEWAL BY ANDERSEN HIC Reig-
HI04 m any Name or HIC Registrant Name ne Number Expiration Dace
1 O�IS ST
No.and Street 508-351-2200 X 55285 Email address
NORTHBORO, MA 01532
City/Town. State.ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(hLG.L c.15L$ 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fa m to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........b No...........❑
SECTION 7a:OWNER AUTHORIZATION TOM COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR IIURMING PERMIT "'
I,as Owner of the subject JAIME MORIN
property,hereby authorire
to act on my behalf,in all matters relative to work authorized by this building permit application
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION
By entering my name belo by under the pains and penalties of perjury that all of the information
contained in this sppliailon is true accurate to the boat of my knowledge and understanding.
06-17-14
Print Owner's or s Now(Electronic Signature) Dace
;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 ao1 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 rues-.Mora Information on the Construction Supervisor License can be found at www rut ov/dos
2. When substantial work is plumed,provide the information below:
Total floor area(sq.fL) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.fQ Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halflbaths
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" $5,394.00
CI1"Y OF SALE14 UkSSACHUSEM
11LIM24G DEPUTUIENT
120 W.1SHWGTON STREU,r FLOOR
TEL (978)745-9595
PAX(978)740-9M
KIInERLEY DRISCOLL
MAYOR THOMU Si.PMUI&
n;mwrOR OP PI;Buc PxoPEm/st:uimG commmsK*m
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 insulting from
this work shalt be disposed of in a property licensed waste disposal facility as defined by MGL c
111,S 150A.
The debris will be transported by:
RENEWAL BY ANDERSEN
(name of hauler)
The debris will be disposed of in :
RENEWAL BY ANDERSEN
(name of facility)
104 OTIS ST NORTHBORO, MA 01532
(address of facility)
si of t applicant
06-17-14
date
Jdmaafidoe
I
Renewal- -------------- -------------
Home Improvemenractor
License#170810(Expires 12/23/2015)
bYAf1dE2I5ef1. Renewal by Andersen Corporation MA t ContFederal Tax ID#41-1 91841 3
tYlNoon plrltClNINT w,ANa,m,"Cuw:n
104 Otis St. Nodhborouqh,MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
IBu es,s Name Date:
LINDA TREMBLAY - APRIL 30, 2014
IBu era Street Address City State Zip Code
11 MAJESTIC WAY SALEM IV 01970
!Email Address Home Telephone Number Work/Cell Telephone Number
978-210-4913 617-643-9428
iBuyer(s)hereby jointly and severally agrees to purchase the goods 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.
Est,Start Date Method Of Payment
Total Job Amount $ 7,986.00 sum Flnented$ 0.00
Deposit Received(33%)$ 2,662.00 „- Check/Cash i
10-12 weeks
Balance Stan of Job(33%)$ 2,662.00 Deposit at signing$ 0.00 Check#
Balance on Substantial Al Substantial Est,Install Time Credit Card
Completion of Job(33%)$ 2,662.00 umplenon$ 0.00
T.B.D. If credit card is selected,please
see Credit Card Pe mend fort"
I
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
lot both Buyers)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 Buye's right to cancel this Agreement DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation.
,�yyy I // Buyer(s)
nC� Buyers)
Signature of Project Manager - Signature Signature
ROLAND PELLETIER LINDA TREMBLAY
Printed Name of Project Manager Printed Name Printed Name
YOU,THE SUYER(S),MAY CANCEL THIS TRANSACTION ATANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACRON.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT "
_____---_______________________,----_-_-------------------------------
NoTT"OFCANCELIATTON NOTICE OF CANC 110N I
1
Del.of Teenaentim 4/30/14 You navy rental this Dale of Trussertim 4/30/14 .You omy raacel this
uanaaction,without any penalty or obligation,within three business days from the I tranaesel without soy penalty or obliaetim,wiW;v dare burins drys an.the
.boor date.If yon onset my property trotted in,any p rymen.made lr you under I abort date.if y e cevicel,my property traded in,any payment made by e.
rise Contents a gale,end any rego l imtremmt restored byyna oral be i the Covtrart of Sale,and eery vegotiable imtroment erecvtd by n odU beer
ntvm<d withiv 10 drys foMow:vg receipt by the Cottactur I"Seger')of yew I entrusted within 10 days following receipt by the Coarseness,("Seger") a yow
coseellession notice,mend my recerity interest arising out ache traosaction cant be I emeegadon notice,and any areerity in.reen arising ow a the tTnoseetion corm be
resorted. Hyo�overt you must mahe ovagable mthe Seger a[yow m:dence,iv I nmcrled. .the Sellerwyourresidence,in
substantially.good coadidon as when received,very goads delivered to you under 1 sebs.odagy as goad envd:dun .whey received,any goods delfvurd to you under
this Conteacs w Sdq -e you may,H you wisb,mmpty with the hemmed.of the I the Contort or Sao; or you ma,Nyon wish,c®ply with the iosvortinaeof Use
Seger regarding doe seism shipment of the goods nt the Seller's erpenee and r6i6. I Seller regaudtng the.morn shipment of the gods at the Seger'.uprose and risk.
.H Too do make rise geode available on the Seger end the SeMer does not pick th®upi H you do make the Bonds.vegeble.the grant,need the Seller done rat pick them op
ledthin 20 days a the date of your Nods.of cameramen,you may retain or dispose within 20 days of the date of your Notice a Cancellation,fee may tensile or dispose
of the geode without any fmtheu obtigatioo. If yra fag to m b the goods svageNe o£U.e geode wiWow any Crashes obligation. If yoo fail to make the gods aeagahle
.the seller,or ffy ru agree no.the goods.the Seger an d fog to do so,then .the Seger,tuff you ease-.return the goods to the Seller and fat to do so,then
you retrain Eabie for performance of d obggntioso order the Contents. To caeecel I Tooreood,Ratio,for perfeeamauce of all obggatioes sorter the Contents. To covert 1
this teastsantion,rang or degorr a sigod end dated copy of this restceilation notice I this tuwadm,mat or deliver a signed and dated copy a this cants on ondce
Ion 06St. Northb nodcq orxn1532,B NOT TgRTre Renewalby Anderee4 I as, OtisSt.writtennatice,d ee532,Bar NOT
THAN
NmewGbyAdeeam,�
1109 Otis S[. Nwehbotorgh,MA 01532,MY NOT HATER THAN MmNIG2Tf OF i ]04 0m St.Nonhborongh,MA 01532, BY NOT HATER TEIAN MIDNIGBT OF
5/3/14 .moss) 11Dm8EY CANCEL TIOS TRANSACTION. 5/3/14 .(Dare) i1MmEeY CANCELTTDSTAANSACTTON.
I 1
. i �e,psr 5s o_,. fine xmm pm N,Prssm. ram - _I
� r
Renewal Renewal by Andersen Corporation MA Home Improvement Contractor
Andersen. 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015)
woowr ars.ucrrewa ,..n.,k..,.cM.y.�. (508)351-2200 Fax:(508)-986-7072 Federal 10#41-1918413
w Window Specification Sheet
Buyer(s)Name Date of Agreement
LINDA TREMBLAY WED, APR 30, 2014
1The buyer(s)listed 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 front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING
(AGREEMENT,of which the Specification Sheet is pan.
WINDOW DETAILS
Approx. EMedar/1Merior Color Hardware Hardware tuwEA1 Grille Grille Glass
Rwm M U.I. Window/Door Style Derail Carin s Et-im Color leve screens smarisun Grilles Sashl/3 Sears URs Options
Famil 2 87 DB sq rail equal insert sloped sill No WUYWF White Standard FFG SmartSur None ---- ----- ----- No
Kitchen 1 96 New GW insert lafo No wtVWF White Standard FFG SmariSru None ---- ----- --- No
Bed 1 2 78 DS so rail actual insert sloped sill No WKWF White Standard FFG SneartSur None ----- ----- ---- No
Bed 1 1 90 New GW insert lafo No WFVWF White Standard FFG SmsnSur None No
Tow 6 1 BAY&BOW DETAILS *See Bay/Bow Measure Sheet
Style Detail/ Approx. Approx. Number Fmme Wintlow Entl Center LowE/ Roof/ Hardware
Room Count a Flankers U.I. Cazl a M le Lttes Interior EMnt Color Grilles sashes sashes Some Smamsun Solfit Color
SPECIALTY WINDOW DETAILS
FalI Approx. tnwE/ Specialty RAY/BOW ADDITIONAL WORK NOTES
Room Coum S e Insert U.I. Smmisun Grille9 Grille a Ex at Color
ADDI770NAL WORK DETAILS:
choose I w and I<..,otn in me tad bedroom window
I No Contractor will wrap exterior Casings with coil stock color of
Owner is aware that Contractor does not do any painting/staining or removallinsfallation of alarm system or window treatments/hardwans.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
i 2 whethera/amrs or window treatments/hardware will fit after replacement. Customeris also aware in some cases there will be glass loss. N them 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 nighty 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 tee for the permit(s)is not included in the Contract Price and a separate
check is required at the time of sale for this fee. Check# 2999 $ 56
3 Yes All discounts have been applied to this agreement.
. 6 ✓ 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 arty way a iese such change are in writing and signed by bath the Buyer(s)and Convector. Buyer(s)hereby acknowledge that Buycris)has read this Speafication
Sheet
Renewal by Anderesea Corporation Buyer(s) Burris)
�zn Ll
Signature of Project Manager _. _ _ Signature Signature
ROLAND PELLETIER ,LINDA TR EMBLAY
Print Name of Project Manager Print Name Print Name
Renewal Renewal by Andersen Corporation
���� 104 Otis Street•Northborough,Massachusetts 01532 MA Home Improvement Contractor
byAndersen. Phone(508)351-2200•Fax(508)986-7072 MA License#170810(expires
WINDOW REPLACEMENT .nn"dem�cAmwm 12/23/2015)- Federal 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 Linda Tremblay("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:
The customer wanted to remove the 2 gliding windows from the order.
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: $5,394.00 Payment Method:
New Deposit Received:$2662.00 Received Credit Card
New Balance at Start of job:
New Balance on Check/Credit Card
Substantial Completion of job:,$2732.00 .
'Please Note—Your job will be delayed until amendment is
signed and received.
It is agreed and understood by and between the parties that this Amendment and the original 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 Buyers)hereby aclmowl-
edges that Buyer(s)has read this Amendment and has received a completed,s>,geted,and dated copy of this Amendment on the date written below.
Renewal by Andersen Corporation Buyer(s)
By.
Signature of Product Manager . Signature Date
- - • Roland Pelletier - - 5/9/2014 --- ---
=IP:132.183.13.73
51041201412:13 PM CST
Print Name of Product Manageemblay Date.
m
Doe Id.--fr 6509073644359- - ,':poimeseiao5090" 4435 '—
Sertill Electronic Signature
R.eevwa
byAndersenm
.132 .
WINDOW REPLACEMENT an Andersen Company
CONDOMINIUM PERMISSION FORM FOR OUILDING PERMIT
11 Ma4e0i&Way Salzw, MA 01970 We,, T4�e,Hat�b," f4w du.l,y aw&,o-ri ze& re.prvw4t fvvey of
ciro4VwA.Ny4U.e(aL Ma-.aguvz. (-Corp:,
Have r&o-ew titre,31�4� for w"yirovew e"fy fa
I.J. Ma4eyfi&Way SaLevw, MA 01470
ow-uk Iyy L. a -fr6wa>ka .
Tl w Caved Asyoci.adiaw or Ma."ewzo--Compa agrees ff a, fig above'owwzrk ka r&perwv ' aw
fo-SzzIvperwwf awdf carry avf fiterworyos workF
Pvi..vh Na.vw
(!w uue of t4-vr a U-fff 5.fafi.Kg tow w by e,pu.rpoye,aP above', ow fig co-do-WzKiAA.
Mavu�ge.w.ewtCampawy vfafi.ohary wta.y be.yubyfvfwfecL.)
104 Otis Street
Northborough,MA,01532
Phone(508)351-2200
Far(508)986-7072
Website:www.renewalbyandersen.com
The Commonwealth ofMassaehuseus
Department of Industrial Accidents
Off we of Investigations
600 Washington Street.
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information (� Please Print I eatbly
Name (Business/Organizatio1n/Individual): �M eW c `
Address:_
City/State/Zip: A p �D G m>hone#: d�p�}
Are you an employer?Check the appropriate box:
1,�I am a employerwith 3 J 4• ElI am a general contractor and I Type of project(required):
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling
ship and have no employees These sub-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.❑ I am a homeowner doing allmork officers have exercised their 11.❑Plumbing repairs or additions
Myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees, [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomration.
t Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicating such.
jContmetors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
!am an employer that is providing workers'compensation insurance for my employees. Below a thepolicy and job site
Information. n
Insurance Company Name:
Policy#or Self-ins.Lic.M M—W:306 G[ 00 Expiration Date; [ 0—
�{ nn t
Job Site Address: 1 `aC 0-Ake- A ,T_City/State/Zip: s4 t,M
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 S 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 t50.00 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 herebi7erd under the pains and penaltles of perjury that the information provjded above is true and correct
Si nature: Date
Phone#• CU`g -` CN— >
F[6. .
only. Do not write in this area,to be completed by city or town official
n: Permit/License#
hority.(circle one):
I. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector --
rson: Phone#'
CERTIFICATE OF LIABILITY INSURANCE OlU0/ 1/°'/213
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: fi the certificate holler Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certmcate holder in Ileu of such endoreemen Ir.
PRODUCER 1-612-333-3323 C
Bays CO➢wanles
PNoxE
. 612-333-3323 F,A"ID Me: 612-373-7270
BO South Bth Street DRE65
Butte 700
Nimeapolle, MN 55402 NSURERS AFFORDING COVERAGE Nwe
Irm
RRPDeLIC =6 CO _ 24147RSuewO IONAL ONIOM FIRE IN8 CO OP PITTS 19445
Raneaal ey MdeiaeD Corporetim104 Otte StreetMOrtbborougb, PM 01532
COVERAGES CERTIFICATE NUMBER: 36122490 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI RESPECT TO WHICH IS
TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRBED HEREIN IS SUB S,
SUBJECT TO ALL THE TERM INVIREXCLUSIONS AND CONDITIONS OF SUCH PD CLAIMS.TYPEOFRSURAMCE POUCY I" POLICY IXP
POLICY NUMBER Laois
A GENERAL LIABILITY NNBY 300361 Is/02/1 20/02/14 EACH OCCURRENCE $1,000,000
E COMMERML GENERAL WUJILRY
EBEMSES ft e500,000
CWM9-MADE OCCUR MED EIP OM I10,000
PERSONALSADVINJURY 4 1,000,000
GENERAL- G REGATE 34,000.000
GENT AGGREGATE MR APPLIES PER PRODUCTS-CON PIOP AO $4,000,000
Z PDUCY mg LOC 4
A AurcecelLE Luuou Y RW1 300076 1
E..ma:�I61N "n s,0oo,000
E ANYAUtO emsy RIuRY(ve.PMLLD) 4
AU DA7rED sCNEDULED
AUTOS AUTOS BORLYINRIRYOWeaomq :
Z HIRED AUTOS Z AUMS E0 PROPERLY DAMAGE
i
4
B E UMBRELLALYIB E OCCU0. 70561235
IXCEs8 L1AB 30/01/1 30/Ol/34 EACH OCCURRENCE 425,000,000
CLAm6#IADE AGGREGATE i 25,000
5,000,000
DED Z RETENigN 25,000
A WO"NeRa COMPE/18AlION MC 300359 00 YJC STATLL DTN 4
AMD EMPLOYERS-LWLLnY YIN 10/Ol/1 10/01/14 E
ER
OfTICE PRRTERPARINERAJIECUTNE 6 1,000,000
OFFICERMFMNN)IXCLUOED7 O MIA E1.EACH AC om
ryYYMnn onry�"fir EL RSEASE-FA EMm 61.000,000
OESCRIPRON Of OPERATIONSW. E.LM&EASE-POUCYUMn 41,0D0,000
OESCRRTgM OF OPERADDN81 LOCATIONS/VEHICLES(ANeCA ACORO IOI,AddRmW Rrm"Me BMMAub,M men spa Y Ip„InA) I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
To Whoa, IC May Cmeern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Insurance Purposes only ACCORDANCE WITH THE POLICY PROVISIONS.
AUMORQED REPRE6ENTAlIVE � ..
01988.2010 ACORD CORPORATION. All rlgMs reserved.
ACORD 25(2010/05) The ACORD name and logo ere registered marks of ACORD
jMrgrova
361224 00
�„ Massacnusetts Departritent of Public Safety t
' 'Board of Building Regulations and Stanttard5' i
Construction Sypenisnr .'"
License CS-090125
JAEM L MORIN r
86 GARDINER S'1' i
LYNN MA 01905
a
J..L... Expiration
Commissioner 10f0012014...
i
SCA 1 o 2oM-05,11
� cT,��'�uealr/c gec�lla� ,�r i
free of Consumer Affairs&Business Regulation
OME IMPROVEMENT CONTRACTOR
RegfstraBoh 1y081{j
Expiration ,12l23i2U15. Type:
RENEWAL BY AND'ERSON"C.ORPO SuPPlement r:
RATION
JAIME MORIN = '
104 OTIS STREET -
NORTHBOROUGH, MA 01532 �—
Underse��_
i
enewal
byAndersen.
WINDOW REPIACEMCNT smAndegeRQ"oy
? t: zy(� st�[a• WoodMnyl Composite lF
•,;. C�axdta Dual Argon Low E4 SmartSun
Double Hung
1 00-00473 610-01 0
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
Woul.tlenrgb.mlMtMllnw nliypmAem•b.PPfe4m NiRCP�.w lq Numdnig MMmp•elucl
"Flbimiv+.NflW WNpItw JCMglillOb t!Eas1A.nVetnb•MNCMNeMtMt.W�m PKd.q M..
NFRC Aa•F Ml nmma.M•%pwEuvltMlm MttmglMpul.mRyWtnYPleEuq krt%.p.�w
Camas mtn�ganly 4glon bgM•papw glMgooa bWqubn .
Y�
WlnNlllemry
ok 'E41 TI�b PmOvq nMPgQMn .
PMM1te•ienm.q.l pnlr _ 'y.. 'gyp
' ai. OME.d40mamP.Mgf • "tr �~! SA
f,8: Nalnq'.AMryn.umb • t /'•V
'I`Nx m.q.teptM
. QmgK�l P.gtPMbq
7pP COMomgtlnegbvY
e mgg0h Y.FRR �{�
DESIGN PRESSURE(PSG
Fr
c5 HbA DB Sl peed S 11 DH IN
TtlYEmIWSmtAM1I1IMM11RSA1RA4'MIPpS E1NINn1fN nammlNAdbmm• gmCtmt
MMugN¢MU•tl.ES..GES.IIELL.NWY•aiM N.Y.m.m W4.U1Y4MIkplliatM Ayytm
��4..V V�� ♦ RECEIVED
bYA►1'1�eCS�CI�
♦ JNSPECTIONAL SERVICES
RWINDOW REPLACEMENT an AndersenCompai%y Iia'a JUN 18 AD Uq '
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.renewalbvandersenxom