3D SPRUANCE WAY - BUILDING INSPECTION (2) What is the current use of the Building? 71
Material of Building? If dwelling,how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name 771H GOXUN — i�/t�cJPi2 D
Address and Phone;��
Mechanic's Name
_s, tJbBr�2N�1 -� "
Address and Phone o26 C�IJA'2 si
Construction Supervisors License# D�99O HIC Registration# l igO6 �9
Estimated C.o _o9fAP�rojegct�$"J8 3y Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An-Additional$5.00 is added as an `
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply fora Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date
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' Department of Industrial Accidents
Office of Investigations
A//XAUfj 600 Washington Street
✓✓ Boston, MA 02111
ulr� www.mass.gov1dia
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 1 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2, ❑ 1 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
[No workers' comp. insurance 5. ❑ We are a corporation and its ❑ Building addition
10.❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ 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.]
*My 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 we doing all work and then hive outside contractors must submit a new 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.
I 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: JD cSQ,eyhlx� AJ41V v t T 3/7 City/State/Zip: (3A,EN1 r/?9
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 D1A for insurance coverage verification.
I do hereby certify underr/thepains and penalties of perjury that the information provided above is true and correct
Signature: �✓ N�LGG/ FOR NEWPRO Date: s/�/D7
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 Depart 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
CrIY OF SAmm
PUBLIC PROPERTY
DEPARTMENT
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OS/91/07 07:16 FAR 16177709683 AMERICAN FIRST INSURANCE IM 002
' DATE(MWDDNYVY)
ACORD CERTIFICATE OF LIABILITY INSURANCE NEWPR-16 05/01/07
S THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
American First Ins Agency Inc ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
122 Quincy Shore Drive NAIC#
North Quincy MA 02171 INSURERS AFFORDING COVERAGE
phone: 617-770-9000
INSURER A: Arballa Protection Ins. Co
INSURED
INSURER B:
NSURER C:
ro Operating LLC
N msuRER D:
p0 ewp 8ox ZE96
Woburn MA 01801 INSURERS
COVERAGES
THE POLICIES OF INSURANCE ANY REQUIREMENT TERM OR NG
OONORION OF ANV CONTRACTOR OOTHER DOHE)NS UMENUIRED T WITH RESPECTT TTO WHIOHITHIS CERTIFICATE CATS MAY BE ISSUED OR
DI
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. mc LIMITS
LTR NSR
TYPE OF INSURANCE POLICY NUMBER DATE MIDD DATE MM/DD/YY EACH OCCURRENCE $1,000.000
GENERAL LIABILITY O1/O1/O7 O1/01/OB PREMISES Ea occufance S50e O0O
A X COMMERCIAL GENERAL LIABILITY 850000010649 MED EXP(my.ne Person) $ 5,000
CLAIMS MADE IKOCCUR PERSONAL 6 ADV INJURY S1i000i O00
GENERAL AGGREGATE $ 2e 000.000
PRODUCTS-COMP/OP AGG $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
PRO-
POLICY JECT LOG COMBINEOSWGLELIMIT $ 1,000,000
AUTOMOBILE LIABILITY 12/31/06 12/31/07 (E"wdant)
A ANY AUTO 81037400001
BODILY INJURY $
ALL OWNED AUTOS (Per person)
X SCHEDULED AUTOS BODILY INJURY $
X HIRED AUTOS (Per accident)
X NON-OWNEDAUTOS PROPERTY DAMAGE $
(Per accident)
AUTO ONLY-EA ACCCENT $
GARAGE LIABILITY EA ACC S
OTHER THAN {
ANY AUTO AUTO ONLY: AGG $
EACH OCCURRENCE $5,000.000
EXCESS'UMBRELLA LIABILITY $5/0 00.0 0 0
A X occuR
❑ CLAIMSMADE 4600010709 01/Ol/07 OS/01/08 AGGREGATE $ 1
$
DEDUCTIBLE - $
RETENTION $ X TORY LIMITS ER
WORKERS COMPENSATION AND 90967005 OS/01/07 05/01/06 E.L.EACH ACCIDENT $ 000,000 }
A EMPLOYERS'LIABILITY
ANY PROPRIETOFLPARTNEWEXECUTIVE E.L.DISEASE-EA EMPLOYEE $ 500.000
OFFICERNEMBER EXCLUDED? E.L.DISEASE-POLICY LIMIT $ 5013r000
It yes,descdbe under
SPECIAL PROVISIONS below
OTHER
OVISIONS
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/5PECUIL PR
OpEpILTIONS OF INSURED
CANCELLATION
CERTIFICATE HOLDER SPECIME SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE E%PIRA
DATE THEREOF,THE ISSUING INSURER WILL EOEAVOfl TO MAIL 1O DAYS WRITTI
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SH.
E(2001108)
IMPOS Io ATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OF
REP SENT IVES
AUTH RI2ED PRESS A E
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! BOARD OF-BUILDING REGULATIONS
Board of Building Regulations end Standmels x Lidense CONSTRUCTION SUPERVISOR
HOME IMPROVEMENT CONTRACTOR
Number: CS 028090
If
Reglstratwn 146589 �` k Blrthdate.4, 911953
? j ExplrGOofi-: _6/5/20,07. .
( �PType S�pplemenl Card r j . ttE,xpires s11f19/2007 , Tr.no 98790 ..
n¢r W914:JPG
Restrict d �00'� "COMMJS�Sjor
NEWPRO OPERTHOMAS.P•THOMAS FOXO � ? ( 230 WAL
2¢CEDAR ST. �"` '':^t'`'/ �.G-.�' � ' READING MA 01b667 �^ts
WOBURN,MA 01801 Administrator � �
4. _ mwvwah,v..r..�.L'I�.,'�s.«ew..a..s....a...,..,.V�•
MA Reg. # 60 5 1 FOHERWIMPEPOPLE]
J26CT Reg. #0605216RI Reg. #26463 Federal ID #20-2625129
Corporate Headquarters:266 Cedar St.,P.O.Box 2696 Wobum,MA 01888 (781)9w4loo 1.800-362-2211
THIS CONTRACT MADE THE . . . . . .4 . . . . . day of.4a . . . . . 200 between . . . . . . . . . . . .
W"L . . . . . . .6l.7 3-. .5$ 1
� (Home Owners) /, ) (Home Pho ) (Bus. e11 Phone) (Mr./Mrs.)
(Address) (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 premises located at
(Job address') . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(E-Mail Address) .
TOTAL NEWPRO Additional Style q TOTAL CASH ��
Windows Purchased G duv Work PRICE
Window Color S eci wht = Sliding Glass Door DEPOSIT
Capping Color S eci L ?h( f% Oty Steel Security Door WITH ORDER
Double Hun
Picture Window Obscure Glass BOTTOM BALANCE
Stationary Casement Screens FULL DUE AT
Casement - Model# INSTALLATION
2 Lite / 3 Lite Slider NEWPRW 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 taller at Installation
Awning condensation resulting from or due to p
Other existing conditions. FINANCE Bank Completion
Diamond
GRIDS Colonial Signed at Installation
CRIBE WORK: k Q W10v Q, t C S (' S OL4✓
i 61 uk l uln t I t C-C �cJl to
r
All steel security doors will have a 3/4"aluminum threshold installed over existing threshold.0 Customer initials
Est. Start Date: p Est. Comp. Date: p,
It shall be the obligation of N RO to obtain any and all permits necessary un this agreement,as the Owners Agent. The Owners who secure
their own construction-related rmits, 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 line 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$100,000-$300,000.
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 a sum 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 held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control.
Owner warrants 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 be his main office, or branch thereof, 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 notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
The)owner has seen 'sample" warranties that will be provided by NEWPRO upon installation.
r�`J�' Sample warranties provided to Owner.
I ITNESS WHEREOF e a ies have hereunto signed their names this
' day of 200
EIN# Signed -�
Marketi Rep entative Pr' ad Na a Owner
Accept I PRO ati C
By Signed
Marketing Re sentative Signa ure Owner
WOBURN BRANCH OFFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE
26 Cedar Street 151-153 Memorial Drive Business Park 45 Gilbane Street
Woburn,MA 01801 Suite B-C Warwick,RI 02986
TEL:781-932-8300/EXT:330 Shrewsbury,MA 01545 TEL:401-732-2407
800-242-9974(FROM NE) TEL 508-842-6876 800358-3312(FROM NE)
FAX:781-933-0717 800456-0555(FROM NE) FAX:401-732-1371
FAX:508-M-9248
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
US-15 100/PKG. 11/05
ENERGYSTAR QURiltled
in Highlighted
'. MM03 .,
DEVCO PRODUCTS, INC.
._O� Newpro/DenaU 2000 Double Hung
Lim Vinyl Itame,.Trlpla Otued,
. " .. - low E eao'tiny 1e-0.07d,s1 a al. _ -
pi°° ItryptonlArponfalr filled,Divides
esaD 010.
ENERGY PERFORMANCE RATINGS
U-Factor(U.S./I-P) Solar Heat Gain Coefficient
0.19 0.25
ADDITIONAL PERFORMANCE RATINGS `
Visible Transmittance Air Leakage(U.SJI-P)
0.36 :0.1
Condensation Resistance
73
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. www.nirc.com
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CIS-
OF-PUBLIC PROPERTY
DEPARTMENT
KISRIERLEY DRISCULL
MAYOR M WASHINGTON STREET•SAL kK MASSACHLSLrM 01970
741 97 8-7 4 5-9S95 6 FAx 978-740-9U6
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
3D 5A&MA42E P-)d uN I T 3D
Property is located in a; Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: f 1A2/� HA2TiNEA��CJ99 Address:
Telephone: S-93 "S 8iz
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
&/e ( lCE7 /b Gk)INDat -)5 9 / SUD /NTU
C-X/ST71,,J6 6,vEklN6S.
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- G� cvrr
Mail to: �Permit 31� KOAA 2'