7 TAFT RD - BUILDING INSPECTION (2) Z, The Commonwealth of Massachusetts
Board of Building Regulations and Standards n of
Massachusetts State Building Code, 780 CMR, 7'"edition l .
Building Permit Application To Construct, Repair, Renovate Or Demolish a 13 0
One-or Two-Family Dwellin
This Section For ctal Use Only
Building Permit Number: Date ppli d:
Signature:
Building Commissioner/Inspector o Buildi'gs
SECTIO 1: SITE I ATION
1.1 Property Address: Assessors Map& Parcel Numbers
l TaF Qd Sa1�m 3� lad
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Ronald aid Eta,ne Rlanchel+ -7 -F0 Rc( Salem , V 1
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ i Repairs(s)jV1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': IV1Sfal1 2 f Calta rncof Loto uJS into
t0 0 r N F P-c- •19
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ L4-13 Z o6 1. 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: 'n&edr _
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: ❑Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
2aogo II- IG -oG
ThOMQS P P 0 X On License Number Expiration Date
Name of CSL-Holder
2 b C e d cz r S+ Woburn List CSL Type(see below)
T
Address e DescriptionU Unrestricted(up to 35,000 . t
R Restricted 1&2 Family Dwelling
Signature
$ 0l 3a- 830(J M Mason Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) I U(o S
NewpfD 8 9
HIC Company Name or HIC Registrant Namc Registration Number
Z(o (edGr St V\/obuna
Address 5 '5-ZDI I
y s o�ff- --1$1 -q 3a-93o0 I Expiration Date
Signature Telephone
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 Issuanf 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
1,QOr)Ol C_j__G7rld cw C(G't n , btor�elrl as Owner of the subject property hereby
authorize N e Loprn to act on my behalf,in all matters
relative to work authorized by this building pennii application.
Signature of Owner Date
SECTION 7b: OWNER[ OR AUTHORIZED AGENT DECLARATION
I, -rh oii n OS P (70�C7`) ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
_ Thomas P Fo Kan
Print Name
Signature of Owner or Authorized Agent - Date J
(Signed under the pains and Penalties of perjury
NOTES:
I. 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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I I0.R5, respectively.
2. When substantial work is planned,provide the information below:
Total Floors 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 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"
CITY OF SALEM
PUBLIC PROPRERTY
'= DEPART MENT
Nt
V;.
construction Debi---is Disposal .-Affidavit
( I
rcw aired liir all demolition :'I'd 1e10v36u1 \pork)
In accordance ill' Ilse sixth edition of the State Building Colt, 780 ChIR scctiun I I I.5
Debris, and the provisions of MGL c 40, S 54:
Building Permit r! is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL'c
! l 1, S 150A.
The debris will be transported by:
I name of hauler) U .-
The debris will be disposed of in
durnps+r
tnamr ut la�tltty)
B Wh-eeltnq Qve Wobur
luddrci� u(1]cihlvl
. olutmc of penntt .y,phrmu
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5/7/2009 3:59 PM FROM: HacsIntlre insurance HacklnT re Insurance A9en TO! 0,17819320860 PAGE: 002 OF 003
ACORD CERTIFICATE OF LIABILITY INSURANCE 5i 7/2°9'
PAMUMR (508)366-6161 FAX (508)366-5202 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MackintireAnsurance, Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
11 West Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED-BY THE POLICIES BELOW.
Westborough, RA 01541-1931
INSURERS AFFORDING COVERAGE NAICa
INSURED Newpro Operating LLC smxeRA Peerless Insurance Co. 24193
26 Cedar St. INSURERS:
Woburn, M11 01801 IuaaEac:
-
COVERAGES
INStf�RE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM ORCONDITIONOFAMYCONTRACTOR OTHER DOCUME INIT11RESPECTTO VMICHTHIS CERTIFICATE MAY BE ISSUEDOR -
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SH MAY HAVE BEEN REDUCED BY PAID CLAIMS.
w8R TWEOF WBYMNCE PRIG NWBEq "LICYEFPERNE POLILYEVIRATWN puns Isunssurn LPRE
oENEMLLNBINIYCIP 9588370 - MA POLICY 12/31/2008 12/31/2009 PAMOC<WwEXCE s 1,000,
% c«x m4Y+cENERYL Lvaa P 9599577 - RI POLICY f 300.0 ,per
CVJNEMPnE %❑orxw NmOwl^r�.P.r�l L 15 �\ Board of Building Regulafious and Standards
A PEgsaPlerovlNwv s 1,000,001
HOME IMP,tOVEMENT CONTRACTOR
DemlKroaREwre f 2,000,00
R-
POLIRELATE UNrt PPttIES PER: PRIXMKTS-couPioP PSD f 2.000.O
Poucr ,°E°caT LOc Regl9tratAi;.;146689
Aufa ow am aA 8584174 12/31/2003 12/31/2009 rye s,q L,wT f Expirat;ort-,%52011
1 000 oD , ,'� e SDPPlement Card
x R@0.LEDNtIW 90DILYIn) f I 3-3 1� ,�1 SOOsvmnl
A x wREOPuros NEWPRO OPERA7IN4+',LLG
X NONowNmPuros °D:°CtlONo L THOMAS FOXON ,., zzz
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PROPERTY D4M4E f � �c--=-•' %.:
IP..°uaml 26 CEDAR ST.
anRAoeLuelLm - Amoalar-FnroaoD+r s - WOBURN,MA Ul801 -` i
Administrator
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EXCEaanwwRELULuaum CU 8582578 12/31/2009 12/31/20DD eAa acURRwce f S.000.00
X OCCUR a,wusN Pow+EGAm s 5,000.00
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x RETENTION s 10.00C s
waRXERe<oNPExeanoxAHD �A
ENPLorERruAssm WC8645974 OS/01/2009 05/01/2010 et EALHACCIOFM s 500.00
p Pm PROPRRTOPRPRMEWUELUOVE.
ELOISFASE-EAEAPLOY i 500 0 per- .,
OFFICERT1FAeERB(f1LGE0i 4 3 w •_ _
s�Ecau PgovlslaW:INbn BL DISEroE-PcucLMrt f 500 00
oTIER Aapogc%Uaella
Board'of Building Regulations and Standards I
Construction SUPervisor License- I -
OEBCWPTIONDiOPEMTONSIlOC1T10NY1VFWCLESIEECLYSIONSPDOFOBYENDORSFMEMIBPECMLPROV151648
LIC ns C$ 29090
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7/2009 T4 81310ERTIFICATE HOLDER
CANCELLATION
I
sNDuw ANYOPTHWssons DEswMED Pouuesas CANCELLED BEFORETNe , /F����Lty...}```
ElPOU,TIDN WTETI@AEOF,T¢Ie6YWDweuREgW6L ENDF.LWRTO NALL THOMASP FOX
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10_DAnwmrsExgoncemme eERlwcare NOLDEaNANeoTOTTa:rEsr, 230 WALNUT ST Cl\�, 5X�1'flll,,,�_ �. fj
OYTGA61➢F TD I46 WCNNOTK6 aIMLL e1P09E NO0elIGAlIR10RLMBILwY �.. .y
Town ofSaugus
Cenentral Street READING,MA01867
Saugus.
of ANvwxowoNT,MweugERmAoswrs oagEmeeENrAmEe Cbmiidssiouer
Saugus. MA - AvnwwseoRaRREaegamE I k
Tlnothy 2. Maynagh
ACOR023(2001/08) MACORD CORPORATION 198E
The Commonwealth of Massachusetts
Department of Industrial Accidents
—(� Office of Investigations
I 600 Washington Street
;, Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance AffidaNit: Builders/Contractors/'Elect ricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Oreanization'Individual): /V E W P A
Address: 2b C&-DAR- ST
City/State.,Zip: Wol3uen( W DISO) Phoney: 78! • 43o}-B36p EXT �5 /
Are you an employer" Check the appropriate box: Type of project(required):
t 4. ❑ I am a general contractor and I
1. I am a employer with 50 6 ❑ New construction
* have hired the sub-contractors
employees (full and/or part-time). 7. Remodeling
_ _ _ listed an the attached sheet. 4.
'.❑ 1 an aWoreF':opictor OF partner-
v S. Demolition
ship and have no employees These sub-contractors have ❑
working for me in any capacity. workers' comp. insurance. 9. ❑ Buildine addition
[No workers' comp. insurance 5. ❑ We are a corporation and its ME] Electrical repairs or additions
required.] officers have exercised their
i right of exemption per MGL .__. _ 11.❑ Plumbing repairs or additions
3.❑ I am a homeov.�ner doing-all work � p
myself (No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. c workers' 13.❑ Other
camp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
t Homeowners who submit this sffida%it 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the polio-and job site
information.
Insurance Company Name: HacKintire ZnswanCC AQe_r)CUT_ _
Policy=or Self-ins. Lic. #: W C R- to 4 S cl 9 L4 Expiration Date: (�5 2 O 10
Job Site Address: G + R_d City/State/Zip:
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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 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 the pains andpenalties of er'ury that the information provided above is true and correct
Simare: N _ Date:
tu
Phone#: 9 twtp
FFOfficial only. Do not write in this area, to be completed by city or town official.
wn: PermitlLicense#
thority (circle one):f Health 2.Building Department 3.City/I'own Clerk 4.Electrical Inspector 5. Plumbing Inspector
Contact Person: Phone#:
R
in Highlighted Regions
Fpw "- e
0 -Quallfled In all zones
NEWPRO MANUFACTURING
L"NIM1 NEWPRO 2000 DOUBLE HUNG
Cellular PVC frame,Triple glazed,
Na nal Fends epan Low E coating(e-0.034, S2&5),
Raft Coundl0 Krypton/Argon/air filled _
DEV•K.27.00015d0001
ENERGY PERFORMANCE RATINGS
U Fa_to, (U.S.A-P) Solar Heat Gain Coieffident
0.19 0.27
ADDITIONAL PERFORMANCE RATINGS
Visible Transmltta nce Air Leakage(U.S./I-P)
0.4 0
0 A
condensation Resistance
70 _
�panl`a fiaH 0deeusnnA�w Mn MnnYMQ I- a eAe°enele HMO We�rcailNeeiu�Ihb�NM oFerry
'OleduGl OnC edeolAe eee.CGCSaaMMefdCNRw.nH'C mong� eCaCUdnC1D MWa InNCIIIiUaR
i
MA Reg#146589 53lt53`'f hFmmomHomeMYoms.. aviiiiiih Federal ID#20-2625129
CT Reg#0605216smmu
C c c n
RI Reg#26463 vrndowssieingandblme J O v G
` Corporate Headquarters,2 edar St,Woburn,MA,(P)800-342-2211 (F)781-933-9 6,www.newpro.co
THIS CONTRACT MADE THEM—Jyb^'/ day of 20 between
MAU) ` 2 A 8 f
(H a Owners) p (Home Phone (BusrCell Phone)
of ��� l�� �eM , i% " lA � 0/970
(A dress) (City) (state) 'I— (Zip) J n
the"Owner"and NEWPRO Operating, LLC, "NEWPRO". ❑ The job address is a condominium.
NEWPRO hereby agrees that[twill for the consideration hereinafter mentioned,fumish all labor and material necessary to install the following
described work at the premises to ated at cft/�A9
Job dress (E-Maill rproprietary use only
TOTAL Additional Model TOTAL
Windows Purchased I NEWPRO Work Number City CASH
Window Color In Out: Sliding Glass Door PRICE
Capping Color 06 Steel SecurityDoor
Door Color In Out: EPOSIT �}
Model Name Model Numbers City Sidelites WITH �f�] 9F7;
Double Hun New Construction Unit ORDER v r V v
Picture Window Storm Door BALANCE .�
Casement Obscure Glass DUE AT C/J1��(
2 Lite/3 Lite Slider Screens INSTALL
Bay/Bow Frame 1171ease Initial:
Roof.' ❑ soffit ❑ - Customer understands that NEWPRO®does not CASH
Garden Window do any painting or staining. (is:when removing Balance paid to installer at installation
Awning or replacing interior stops or trim)
Hopper ,/ NEWPRO®is not responsible for conditions or
Shaped c. circumstances beyond its control including con- FINANCE
Other densation resulting from or due to pre-existing. Bank comp) 'on form sign at installation
GRIDS C01061 conditions. _
DESCRIBE WO o
K O O a
,
—7 ® ° v %
Est.Start Date: ✓ Customer understands this is an"estimated date" We Est.Comp. Date:
�/.
Initials Customer understands all steel security doors will have a 3/4"aluminum threshold installed over existing threshold.It shall 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 PI,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 caries 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 the entire agreement between Owner and NEWPRO and cannot be changed except in 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
sailer,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.
1 The owner has seen"sample"warranties that will be provided by NEW O upon' tallation. Sam Is wart nties provided to O er.
` IN WITNESS WHEREOF,the parties have hereunto signed their na s thi day o 20
EINd7 Signed
Marketing Representative Printed llame Owner
Accepted: W RO Operating,LLC
By t'1i�1 Signed / ✓
Owner
/ORPORATE OFFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE
26 Cedar St - 151-153 Memorial Drive Business Pk 24 Minnesota Ave
Woburn,MA 01801 Suite B-C Warwick,RI 02888
(P)800-242-9974(From NE) Shrewsbury,MA 01545 (P)800-356-3312(From NE)
(F)781-933-0717 (P)800-456-0555(From NE) (F)401-732-1371
(F)508-842-9248
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
Us-15 Re508
Page of
JOB# (��j����/� �y� a,7ndowt,Sfding an�dMon
CUSTOMER
E-MAIL ADDRESS HOME PHONE 7O
DATE WOR CELL PHONE f
e ADDRESS one
` l oy
F
BEST DAY TO I AL
CITY, STATE v/ v/ \ 1'
fe s We circleTH one
PRODUCT SPECIALIST_ BRANCH:` ESTIMATED START DATE
TOTAL#OF #OF DOORS WINDOW COLOR
WINDOWS #OF BOW/BAYIGARDEN stm'steel.Patio Inslderooblde CAP COLOR
OPENING SIZE STOPS
NO. STYLE WxH U.I. LOCATION RID SCR IN OUT ADDITIONS PENING CUT
pC L - 1 a x
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x y� x
et ' � S3� T o x� L �xS
x x
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