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27 PLANTERS ST - BUILDING INSPECTION (3) Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers, Applicant Information Please Print Legibly Name (Business/Organization/Individual): NEWPRO Address: 26 CEDAR STREET City/State/Zip: WOBURN,MA 01801 Phone#: 781-932-8300 Ext.251 Are you an employer? Check the appropriate box: - Type of project(required): 1.X I am a employer with 50+ 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # 7. X Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation and its re P ]0.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL I1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.❑ Roof repairs insurance required.] + employees. [No workers' 13.❑ Other comp. insurance required.] -Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ARBELLA PROTECTION INSURANCE Policy#or Self-ins. Lic.#- 90967005 Expiration Date: 05/01/2008 Job Site Address: 7 �1EL ? — City/State/Zip: ®mow 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 under thepains and penalties ofperjury that the information provided above is true and correct. Signature: FOR NEWPRO Date: Phone#: 781-953-8146 Official use only.Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health .—Building De artmci 3. City/Town Clerk 4.Electrical Inspector.5.Plumbing Inspector 6.Other Contact Person: Phone#: CITY OF SALEMt MASSACHUSKTTS PUBLIC PROPERTY DEPARTMENT 120 WAS14INGTO14 STREET. 3R0 FL"* SALEM. MASSACNURETTR 01970 STANL=V J. UROVICE, JR. TELEPHONE: 478-745-9895 EXT. 300 MAroR FAX: 070-740•9446 Salem Building Department Debrls Disposal F rm In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: (Location of Facility) I.3 W hrel nq Ave. Woburn Y�i4 Signature of Applicant Date 664427-5 MA Reg. #146589 r 54322 CT Reg. #0605216 RI Reg. #26463 Al EPUICEMENrWINDI PEOPLE Federal ID #20-2625129 Corporate Headquarters:26 Ceder St.,P.O.Box 2696 Woburn,�M.,A 01888 (781)933-4100 1-800-342-2211 THIS CONTRACT MADE THE . . . . . . . ! . . . . . day of . F`�?r � 200.9. between . . . . . . . . . . . . i N1avT-iron��e� �(� - l Li .-.'a�'114.11 . q.] . me Owners) ( ome Phone) Bus.Cell Pone r.Mrs.( ) ) of `e` . . `. . . . . . . . . . . . . �� i�1 . . . .� . . . . .0 M`? . . . . . . . (Address) I (State) (Zip Code) the "Owner" and NEWPRO Operating, LLC, "NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the premise located at vDn� (Job address) . \ ' (E-Mail Address) TOTAL Cr NEWPR02C Additional St le 0 TOTAL CASH Windows Purchased Work Y PRICE �) Window Color Specify W A.tiv Sliding Glass Door DEPOSIT Capping Color S eci Qty Steel Securit Door SS 6 WITH ORDER Double Hung Ci Picture Window / Obscure Glass BALANCE Stationary Casement Screens AL DUE AT ? Casement - Model # INSTALLATION G J 2 Lite / 3 Lite Slider J NEWPRO° does not do any painting or Bay/ Bow Frame �� staining. CASH Garden Window NEW PRO° is not responsible for conditions Balance Paid to or circumstances beyond Its control Including _ Installer at Installation Awning condensation resulting from or due to pre- , Other �� existing conditions. FINANCE Bank Completion GRIDS,— �6eieRiai A mond Form Signed at Installation DESCRIBE WORK: N ; 19 k 1 , t , All§Lteel security doors will have a 3/4"aluminum threshold installed over existing threshold.-EEEEEE5--Eastomer INtias Est. tart Date: Ll Est. Comp. Date: ` ,, 17 "hlall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement, as the Owner's Agent, The Owners who secure their own construction-related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration should be.directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108, (617)727-8598. If the Owner is obtaining financing by way of a Retail Installment Sales Agreement, such Agreement shall include a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges. The Retail installment Sales Agreement shall be incorporated herein by reference. If the Owner is obtaining a revolving credit Ilne to pay, in whole or in part, for the contract amount herein, the terms of the revolving line of credit including interest rate and payment terms, shall be clearly set out on the credit application. The portion of the credit application referencing a time schedule of payment,to be made under this contract, and the amount of each payment stated in dollars, including all finance charges, shall be incorporated herein by reference. NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,0004300,000. If the Owner refuses to permit NEWPRO to proceed with the work herein, or in the event of any breach of the Owner of,this agreement,for any reason whatsoever shall cause the owner to pay NEWPRO asum of money equal to thirty-three and one-third percent of the price agreed to be paid, as fixed, liquidated and ascertained damages, and not as a penalty,without further proof of loss or damage. NEWPRO shall not be herd liable in damages for delays in the performance of this contract due to causes beyond its reasonable control. Owner war.ants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. This contract,represents that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner and NEWPRO. You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We,.the aforesaid owners, certify that immediately after the signing of the aforesaid agreement, a copy was furnished to us. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may a be his main office or branch thereof h r f Y e eo , provided you notify seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day:following the signing of this agreement- (Saturday is a legal business day). See the attached noticgo of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. The�O—tw,ner has seen "sample" warranties that will be provided by NEWPRO upon installation. L2f Sample warranties provided to Owner. . IN WITNESS WHEREOF, the parties have hereunto signed their names this day,of 200 EIN# Signed Marketing RepresentatiA Printed Name Owner Accept E Ope g, LLC By — Signed Marketing Representative Signature Owner CEL N BRANCH FFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE Cedar Stre 151-153 Memorial Drive Business Park. - 45 GIIbane Street burn,MA 01 01 Suite B-C Warwick,RI 02886 .932-83 xT:330 Shrewsbury,MA 01545 TEL 401-732-2407 2-9974 ROM NE) TEL:508-842-6876 800356-3312(FROM NE) 7 -pea-n7r7 10014 V. •��..� ��� � Imp /�l��DlOy�l W+ndws In House NL07 1010SPLACCII44HT WiM00W EOPL6 � 1,,� � �� page^_Of JOB u" .:r CUSTOMER I10ME PHONE E•MAILADORESS .n WORK/ ELL HONE " J ' DATE �".�" (Circle ADDRESS Jl I T._U,Li.I-1=�-� �..� p �� OEST DAY TO INSTALL: T W TH F /`� Wr�O'•�n� =r 1- �jG,leU (Please Circle one) CITY,STATE PRODUCT SPECIALIST 1 V1�.••Uy --- ORANCH: W D� ESTI DATE. �— _O 1 #OF DOORS WINDOW COLOR TOTAL#OF- �neldeiOui51du CAP COLOR WINDOWS #OF SOWIBAYIGAROEN Stom+, W .Patio -r� OPENING SIZE CUT STOPS NO. STYLE W x H U.I. LOCATION GRID SCR IN OUT ADDITIONS OPENING I/1 x x �. .kb '� x "� �-`� z x x v 1Ow 5 x 2 L 'V x 3 x N1 x3� ��1x3�� ✓ l 3 i 1/Z 3 x373 3/ x 3 �� SC 2 x63' 3 S/ x S � 51 2xa5 f NudA1.. x x x. x x Measure man . i G c, ndials al o Crew Sze Needed Time Frame to co �Plete job Capping Type Special Insl4112uon lnstruolions, Dhections to site? ' Revlaad ll01 GA ACOf Q.-::=CERTIFICATE OF LIABILITY INSURANCE NEWER-J 12/31�07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATEDOES NOT AMEND,EXTEND OR ATnerican First Ins Agency Inc ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 Quincy Shore priVO 02171 NAIC# North Quincy NA INSURERS AFFORDING COVERAGE Phone: 617-770-9000 INSURER AL Arbella Protection Ins. Cc INSURED INSURER B: INSURER G. Newppro Oppperating LLC INSURER D: Woburn MA 01801 -'' � INSURERE: COVERAGES ABOVE THE POLICIES OF INSURANCE ORCONDITIONLISTED BELOW OF HAVE V CONTREN IAGT OR OTHER INSUREDSSUED TO THE NAMED WITH RESPECT TO WHICH THISCERTIFICATE MAYBE ISSUED OF DING MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER OATE(MNVDDIYY) DATE(MMl00 LIMITS PlY EACH OCCURRENCE S1,000,000 - GENERAL LIABILITY 0],/01/O9 O1/O1/O9 PREMISES(Eeaccurence - S5O!000 A X COMMERCIALGENERALLIABILITY 850000010649 MEDEXP(Anyonepamon) $ 5,000 CLAIMS MADED�l OCCUR PERSONAL&ADV INJURY s1,000,.000 GENERAL AGGREGATE - $ 2r000,OOO PRODUCTS-COMP/OP AGG $ 2i000o 000 GEN'LA REBATE LIMIT APPLIES PER: PRO- OC POLICY JECT COMUINEOSINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY 12/31/07 12/31/08 (Es accident)A ANY AUTO 81037400001 BODILY INJURY $ ALLOWNEDAUTOS (Per person) X SCHEDULED AUTOS - BODILY INJURY S - X HIREDAUTOS - Fumcldent) X NON-OWNED AUTOS PROPERTY DAMAGE S _ (Per accidw) - - AU'10 ONLY-EA ACCIDENT 5 GARAGE LIABILITY EA ACC S OTHER THAN ANY AUTO - AUTO ONLY. AGG $ - EACHOCCVRRENCE - $ S�OODr OOO E%CESSIUMORELLA LIABILITY $ S OOO OOO Ol/OL/OB 03/01/09 AGGREGATE A X OCCUR OLAIMSMAOE 4600010709 - $ $ DEDUCTIBLE - - - _ S RETENTION $ X TORY LIMIT" WORKERS COMPENSATION AND - 05/O1/07' 05/01/08 EI EACH ACCIDENT $ SOO�000 EMPLOYERS'LIABILITY 90967005 E.I".DISEASE"EAEMPLOYEE $ S0U�000 J\ APIVPROPRIETOWPARTNCR/EXECUTIVE OFFICERIMENBER EXCLUDED? - [,L.DISEASE"POLICYLimir 5500r 0001 II yes,describe under SPECIAL PROVISIONS below OTHER NS DESCRIPTI NOF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED DV ENDORSEM ENT!SPECIAL PAOVISIO OPIpRATIONS OF INSURED CANCELLATION - CERTIFICATE HOLDER SHOVED ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORE THE E%PIRATIC SPECINE DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURETOGO SHALL SPECIMEN P ENO BLIGATION OR L ITV OF ANY KIND UPON THE INSURER,ITS AGENTT S OR REPRESENT TIVES. Illnnn r A IZE EPFIES NTA IVE �/ //��•v J Farre CP ©ACORD/COR_PORATION 191 DEVCO PRODUCTS, INC. Newpm1DenzY 2006 Double HungLA Vinyl ftame,.Toipla gIi¢ed, _ . N.MuWi.nnnmi . Low Ecoallnfl(•�9.0.7/.,S7,65j, .. P+i%scenra Krypton/Argonlair oiled,01v1dw., ENERGY PERFORMANCE RATINGS U-Factor(U.p6SQ�/I-P) Solar Heat Gain Coefficient ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air leakage(U.SA-P) 0.36 Oaf . Condensation Resistance 73 . MamnxnensGWUim ttaimepn,gry rnnq wmp=e bTanmrHnpntW. . . .prodalpedumirci.NFP.Cnt'n1Rx�de�imi,dbrakd W NmdmmienNmditlnsaMa speafcpoduc mCamdlnw�R+cO+#ii4rmutratlirpM�d pxpanw.elpmufim. . .. www.nfrc.cam 4 + ; Board of Building,Regulatlons and Standards :Construction Super .1spr License Li qs CS 29090. _ ,.! - _ -9/2009. Tr# 8131 1. ro THOMAS P FOXQ � 230 WALNUTST READING, MA.01867 Commissioner - I Jrze Y�anvrseozcwecz�Gz .r�:/�ia�`zrro7euJeCet6 .. — Board of Building Regulations and Standards. - HOME IMPROVEMENT CONTRACTOR ' Registration 146589 Expirafipn 5/5/2009 _ Type Supplement Card �i NEWPRO OPERATING,LLC THOMAS FOX ON 26 CEDAR STD WOBURN, MA 01801 Administrator t FEP FPPARTMENT 'Q o� Wraa 130 WAsawrom*rww•sALjokasAmLu3&scns019M U1 k f'fa.7464916 EAS M74&f W AlPi.ICATION FOR THZ REFA11L Rw10VA'1'iOI�L Cn1VQ7'QIIi('TinN_ DEIOLPT M OR CHANGZ O/USZ OR OCCUWjM FOR A111V Valwa NG 1.0 UM INFORMATION Location NNM 2ri P1ckr)+r-f-c, St 2'l PiC,� , St SOI m , NA F%wwlv Y loealad in a;Conservation Ama YM HWoft omw YM E HIP INFORMATION Land Kern • FlCit �rrc✓� Surlcs Addroosco LOCOMPLETE THIS SECTION FOR WORK IN E7f;1>MKO BU LD"s ONLY Addition EAWN Renovation Number of Stories Renovated Change in Use Now DemoO ton Ex,ykV (of) construction oYr renovation 'fie nOOrRenovated of existing building New Brut Description of Proposed Work: 10 rcplacem-ern+ Windows or--% d one door r�Frzc 19 --- - ---Mail Permit to ���i,���L - What is 00 Cuffmt uae of the 8uildinpl► t+Aatariai at fsutidk+p� Itdweltrq.Aow marry urrils9 /labaatos9 wa the mAdinfi Codas t0 LW? Ma Naito /ldreaa and Phan ( 1 madrndds Now Addr§U and Phone 8 a 2 0 a 0 HIC RepisfiaMon 0l ' I(0 5 d q Eaumabd Coat d Project t 1315 Perri F«Calardaeo Per"Fee i Es*rAod Coat X$71:1000 Rssklw" --- - - - Es*nefnd Coat X f11/f1009 Conn Wtk' --- - - An Addwonai S&OO is added as an Admirri WWw eAarpa. Make cure that as flelds are Properly and wow w men to avoid delays In prooualna 7}N vndarslpnad do"herby apply for a SuW"Permit to build to the above ststad spedlkatlom Signed under v«Oft of P«jury Dateso s3 Z 3 lLll� A ,a