92 TREMONT ST - BUILDING INSPECTION (2) 78 C i= l C7Li 30
The Commonwealth of Massachusetts RECEIVED
W
Board of Building Regulations and Standard9SPECTIOMAL SERVICRTE°i
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,RenovatAll&Rolfi aA 01
l� One-or Two-Family Dwelling
N This Section For Official Use Only
t Building Permit Number: .. " Date Applied• `'
J0
I Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:CIQ ` 1.2 Assessors Map&Parcel Numbers
1.1 a 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(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 Zone1 Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owne Io�Record: 'I�� � t• � f
Name(Print) City,s6te,ZIP
No.and Streetpytofie Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORle(check all at apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work :
SECTION 4:ESTIMATED CONSTRUCTION COSTS
item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 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: -- - E
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 1 ❑paid in Full ❑ Outstanding Balance Due:
mntt.�r� 1-D Pevv • 2t 3I t L
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
I Licens Exp# tw ate
Name of CSL Holdir
List CSL Type(see below)—41
No.an treet Type Description
U Unrestricted(Buildingsg up to 35,000 cu.ft.
L,dJ/{_�.} - R
wn, tatd Restricted 1&2 FamilyDwelling
City/To ,ZI M Masonry
RC Roofing Covering
WS Window and Siding
�, SF Solid Fuel Burning Appliances
d g �X L� ���� I Insulation
Tele hon'e '- Email address D Demolition
5.2 Registered Home pro rent Contractor(HIC) A
HIC R gistration Number pir wn Date
HIC pa an or eg tmor Name
No.an Email address
L
Ci /Town, State,Z 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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FO ILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) - ate
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under ins and penalties of perjury that all of the information
contained in ��afi s true and ace e to b my knowledge and understanding.
Pri er Au o '2 g s- ctr ignature) Date
NOTES:,
l. 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 can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns
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 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 SM E.M. TAksS.AICHUSETTS
Bl:1LDLNG DEPIRT%MNT
• P• 130 WASHNGTON STREET, 3"0 FLOOR
T EL (978) 745-9595
FAx(978) 740-9846
1 IN fBERi FY DRISCOLL
MAYOR T Ho&w ST.PIFm
DIRECTOR OF PLBLIC PROPERTY/BU DING CO\L%assIONER
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 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 by:
(name of aul r)
The debris will be disposed of in
(name of facility)
I-Ali,-; t
(address of facility)
signature of permit applica
O
--;�date
debrivlLdm
The ConremaiI of hf asstacrirrase&s
Departs nett of Inelff5frial'1cc€desets
i Congress Street,Suite 100
%i
B052@FE. MA 02114-2017
DVM'V.epuas.govIdi a
Workers'ers' Compensation Insurance Affidavit:BuildcrS/Contractors/Eleetricians/Plumbers.
TO BE FILES)WITH T91F PERMITTING AUTHORITY.
Applicant Information, Please Print LenillaIv
Na)ne(Business!Oreanirationllndividual): I > -s lI
1
Address: r
City/Siate(Zip. Phone:
Are Not an emnIDyer"C'h:ek:bt nropriate box-
Type of project(required)_
am x empla)'cr with employees(fill!andfor part-rime)*
T [] New COnSLNCIIpn
2.�1 am¢sole proprietor or partnership and have no untplm•ccs reorkine fnr mr in
an-capacip'_(NO worker comp. insurance required] S. Remodeling
3 1 am a homeowner dome all work myself(\o walkeri comp insurance required.] 9. ❑Demolition
nI am a homeowner and will be Ii"InY conlreetors to conduct all work on mg propertq I will I(l.❑ Building addition 4
ensure that all contractors either have workers'compensation insurance or are sole I LQ Electrical repairs or additions
pmanelors with no emplol ees
=.®
I2.Q1 am a general<INnractvr and i have hired the sub-cortracors listed on fire attached sheet Ill u bing repairs or additions
These sub-conractors have employees and have workers'comp.insurance. 73. oof repairs
6�\Pe are a cnrpnmtion and its officers have exercised their right of exemption per M1t(il.-c. 1+ ther J �_
I?_-§t/''.I-and we have no employees (hto workers comp insurance required.]
applicam"rat checks has#I"lost also fill out the section belua'shou'ine then workers'comp ensatfnh policy infianitatinn.
.Iloww wrers rdm submit this affidavit indicatine they are doing all work and then hire outside contractors must submit a new aliidavit indicinur such
:Comraaors dial check this box mus;notched an additional sheet showing the name of the sub-contractors and slate whether or no)those entities have
cmplovecs if the soh-camracrors have employecs,tbev must provide their workers'comp.policy number
1 lrilF(Z%) fJ3110}PY PIraP lS pr011dir,�sport of:r'c•an eosrdiaiJ!➢tSl4/'a]tCB fnr ney eorplar•ees, Below is ehe policcy arzd job site
F.
Insurance Company Name:
Policy 4'or Self-ins. Lic-4. Doi°e---`/ "-�N-s_.. Expiration Date*
Job �—t _ _Attach
Site Address:- {�Q,w City/Stale/Zip: _- �� —
$ttac2s acopy of Ilse:sorlscrs' compensation policy t-eetaration page(shotving the pokey numb and expt-'ation date)"
Failure to set ore coverage as required under MGL c. 152,j15A is a criminal violation punishable by a tine 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.A 1701 of this statement may he forwarded to the Office of Investigations of the DIA for insurance
coverage verification-
1 do herebt�-i lr'pnifis Mid penal Soperjrir}:that the injorMalionprovi(led above is true and correctSignature: A Dale L -
Of":vial use onin Do not write in ffty area, to be completed by city-or town afftcinl.
C?et•or Town: Permit/Lice-Use#
issnin-Autsority (circle one): -
d. sward cflicaltf. 2.6. (Brier Building Department 3.0 N'/-r wa Clerk 3-Electrical Inspector 5. Plumbing Inspector
Contact Person: Phone#_ f
page 3 of 4
Office RConsumer Affairs end Business Regulation
Suite 5170 _--
Boston;-M achusetts 02116
Home Improve ntractor Registration =
Reglatra8on: f48500
e Type: Supplement Card
M W Expliatlon: 5/5/2017
NEWPRO OPERATING, LLC. —
THOMAS FOXON M
26 CEDAR ST. w
WOBURN, MA 01801 b �<
t
ve Update Address and return card Mark reason for change.
' scat A zarausrrr Address Rene"l Ej Employment n Lost Card
C92evrrmeovv�aall�a�Br�¢`ermatttA
Q, into ofCorsumer Affairs&liseloeea Rogetetiod License or registration valid fortndividal use only
ME IMPROVE EMIT CONTRACTOR before the expiration date. If€ound retari to:
lmratlo .._ _ Office of Consumer Affairs and Ruslness Regulation -
Expiret = S Tyw 16 Park Plus-Suite 5170
upplemordCard Boston,MA02116
NE69PRDOPERAT _-
T a i
THOMAS FOXOPf --�
26 CEDAR T.
WOBU1iN,MA 01909 Uaderaeerelary Not veld withoaf signature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-029090 -
Construction Supervisor
THOMAS PAUL FOXON
230 WALNUT ST
READING MA 01867
Expiration:
Commissioner 11/19/2017
I
is
�LSIf s @ Eg'@�i.4 t t UTr LIANILITY fW3URA qCE DATE'(14 ..r)
THIS CERTIFICATE IS ISSUED AS A IVfA 1/11/2016
TIER OF INFORMATION ONLY AND CONFERS ND RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR DOSS NO ELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 15ETWEFZN THE ISSUING INSURER(S), AUTHORIZED
REPRESENtATIVE DR PRODUCER,AND THE CERTIFICATE HOLDER,_
raPDttTANT: It he CErtifieate holder is an ADDITIONAL INSURED,the p0licy(ies@ must be endorsed. If SUBROGATION IS WAIVED,subject
:o
the terms and conditions ofihe DDI'fay,Certain Policies may require an endorsement A statement on Orin CUEJROG HM not confer rights to tilE
cerTiflcate holder in Iitt Ot SYctr endomement(s)_ does
PRODUCER - CONTACT
ME.Ci[1nt1Se InsLTr NA 11ssa PFiug
alCE ageD� jDC PHONE
NP.air eSDB)366-6161 FAX it writ Dfai:T s`-eat ESL IN Np1-(fi0el'-fis-520z
AnoRFss: lassanCmacklntire_com
We=�orou h — INSURHINNAFFOROINGCDVERAGE
__ g MA 01581-1931 NAM
IILSugt3tA lierla - 243 '
a
INSURER B-liberty Mutual/peerless —I a
26 Cod ooeraci.ng LLC i 2198
25 CaCa= B�_ !nc•_+_sec Acadia xnn.a=anco_Co. .—�—
IR6URRD•
1'� D18D1
COVERAGES F IN50RER F: -
C_RTIRCATE NUMBER!Master 15-16 REVISION NUMBER:
i HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 1 USIA I I NAMED ABDUE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT TERM oR coNarTloul OF ANY CONTRACT OR OTHER DOCUMENT Vmli RESPECT TO WHICH THIS
r¢-rrPleaT WRY BE ISSUED OR MAY PERTAIN TiiE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE ALL IS SUBJECT EC ALL THE TEfTHIS
EXCLUSIONS AND CCPMrtIONS OF SUCH POLICIES.LIMITS SHOMI MAY HAVE BEEN REDUCED BY PAID CWMS.
1 �L NN POUCYNUroBB,
LTi iYJE CP1115URANCE PoLICY 6'F i PG!ICV qP
1NSV00 + VwN` ry CGfArAERCUIL GENEPALLUU?ILITY I _ LIIIATS - ---
--ci1NlSrngDE FilO=R—i FA:.IIOCCURRENCE 5_1,000,000
A.fA,RE;II J
' 1 t�E8589577 PRENLSc6tPs eceuL ,_ _ 700,000
I12/3I/20S 12/31f2016=1y.MEXPIAllootp,.(SPnf 5,000
GI7JI:.GGR_ 1 I PERb'ONn_6A0 ItlJUP.Y �g 1,000,000
-GAT<LC.i1T:PFLfcSP'cR;
DUCT❑P JLOC 1 OIIiERnL.AGGREG:SE ;$ 2,OOD,000
} l PRODUCTS-C@APtOPAEG S 2.000,000
AIITD1I05ILE UAI I 3
LO!A61VED 6fN6LE UNr'
ANY AUTO I e (Ea omaat JS 1,000,e00
r II BO.7ILYIN:URY(Pet(L'Fell)
rYL OI:NEp ((((((�:�����''7JJ��CX�DVCED
x "'RED AVTOS - Jd 65BE175 !12/31/2a15112131/20 FFF-[�---OILY VLURY[Yir accy?�lt)I5~ NHtp,.lSiGS X NON-RN1E0 - ..--
AUTOS PROPHiY p,;!e
racerevl_ 5
`'uarssLUAUgs X OCCUR. { uninvaePtmtntEls ftlinB S 250,000
B IEXCES$LlAB GI:.IvsASGOc I EACH OCCURBHaGE tS 5 OpO,OCG
@ R RETENTIONS 10,0oo Cu 61
W 0 BNPLOYEW HSATAN _ s/31/201E(IZ/31/2016 _S
AND EN.pLOYERS LViDILRY I p�
-VAT PROPRIErC)z rAltriEPIEXa'.UnVc YrR: X STATUTE EftN. _
DFFICERANE111I PJ(Q.UDED3 �N/AI EL EACH ACCIOErrr S
C (raa�at�1.NX) R,c_20- 500 000
XS: Mp o.% Tt 20-003506-02 S/i/2e+e 5/1/2016 ELD6EASc_1p EtA 3
D_SCRIPDOti O-OPHtcTp,YS Eebm I - SOO oOOC
1.0GEASE-POUC'umn' S 500,000
CESCRO�nDN OFOPE,ATIONSI LDCATIDrI$r VEHICLES rA1DtIRD 101.Aeenhnnr neema-t sa,�eu,t,my e_va=nee irmo2 apa,s.cq.wu)
CERTIFICATE HOLDER
CANCELLATION
To W-nom it May ConcSI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B£CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE RILLL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHO[lREO NEPa6F21TATNE
T 1'7C,jl agh!TP,3^3Y
ACORD 25(20141011 Tna ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved.
INBv25 r::r,en„
CT Reg#D605216 Federal ID#20-2625128
RI Reg#2e463 yumeldprPK+tianSama;a ,
. Corparete HeadNuanere,28 Cadarai, MA,(P)80a3a�@ti IF111/at./p933A6Tewvw.nawprnmm nawprnmm -
THIS CONTTR^CT MADE THE�6 day of 2 0- bat v an
lya7T q7�-7 �g9 6/7
fffoma ,ai /thmepnnao) rvtrvc>w�,a�
of
(AnAPA) Xv tJff 7-7—k� '�qo I-
the'Owner'and NEWPROOperating,LLC,"NEWPRO". ffl4 #lbrprwwarry use only
NEWPRO hereby agrees that R will for the coreslderaton hereinafter menuoned.termsh all labor and material necessary to insist file following
described work at the premises located at
The Job address Is a condominium. �.
Zt
M- I
Orida; Y S O CONTOUR +EURO WMOND
CTY Wlt OPBoInc: Screens:(EaNdor vier Fan Screen SfaMaN) NALF FULL
Exb Vent latcbae: YES [NMO�+7 1+' ... -" eb I�eth yNobler NO Cap "(gg; ,, o"Yg,""? �
Y 1 ♦ {, Lh 1 i uyT color Ir Out
Double Hungaam AcUm Leh Canter silted five NEWPRM
2 Lite Slider Owl . SN Be SGE WH rat Poets Palaergm ueWre.
3LIte Slidar I+N.et;tm Iltkv � . •aw- a:when mmaNry urtepama Wener
:'
3LItesadef (W 1R>nl 4.1i
W. Out: ,aps mHm)NE PROebrerearlo-
Casement(Hinged Right) Maroons Steel Isimmndfimnmtlmumalameaoar-
Casemanl011nitadLefl) N BB AGO AS ORB Ibamnml auhdtre oxdam6Von,as-
vAnCasemenl "'„�, saefora arm mPramfietlnq wHlfiwrc
Station Casement Ire out:TdoaCasement ON,ra•w) CASH
Tripe Ceaemml (>n,,n w) bPictureWindowN BB AGS AS
Been Only Lea Hinge Right H12E FINANCE
HDAPar f _ Dart ravels ,narefiaUon
Awning Color he W. '
Garden Window Frerlitass Shet -
Say Window inwot&onal HDWRx 9N BB ABB AD ORB / 1)
Bowwwalow(Rmsom fft) ( ( C
Other Color• , h: am
Other HDWFe
DES C R/HE WORK B AROA10770N$APPUEZ v
If 4—
Est.S&rtOwe: a1 (+ Est Corn DW. 1- ( Comamer understands rats is an"ealmoted data•
Owner has read and agrees to the terms arm conditions on the font and the reverse of this Agreement. Owner
specifically agrees to the'(1)Total Cash Price;(2)work being performed;and(3)work not being performed. Owner
understands that this Agreement and any attachments contain all of the promisee made by NEWPRO. Owner has been
rarely advised of his right to cancel title transaction at any dnre prier to midnight of the third business day after the
date of this transaction and Owner was provided with two(2)coples of a cancellation form explaining this right.
gO NOT SIeN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
(Rhode Island Sales Only): Notice to buyer. (1)Do not sign this Agreement If any of the spaces Intended for the -
agreed terms to the extent of then available information are left blank. (2)You are eniided to a copy of this
Agreement at the time you sign It. (3)You may st arty time payoff the full unpaid balance due under this Agreement,
and In so doing you may be entitled to receive a partial rebate of the finance and Insurance charges. (4)The roller has no right to unlawfully enter your premises or commit any breach of the peace to.reposserss goods purchased
under this Agreement. (5)You may cancel this Agreement If It has.n of been signed at the main office or branch office of
the seller,provided you notify the seler at his or her main office or branch office shown In the Agreement by
registered or certified mall,which shell be posted not later than midnight of the third calendar day after the day on
which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.
Sea the accompanying notlrae of cancellation farm for an explanation of buyers rights.
(Rhode Island Sales Only): Owner acknowledges morelpt of required Contractors Registration and Liberasing
Board consumer education materials, (Overrates Initlala)
... BY• HNB Signed:
Pre'fdduuctt Special llaallyrIAfivedN*MV Q Owner
Br1"_4T' giglmd:
NEVJPRO OperffiIng,LLQSLeaaaV dwmr �—