10 WOODSIDE ST - BUILDING INSPECTION (4) The (lnnnionwealth of Massachusetts
and Standards H)R
Board of Building Regulations a
. ' l
1 Massachusetts Seale Building ('ode, 730 C'NIR, 7"'edition \II Vh'll'.\I I'l
I'�E
[;wilding Permit Application To Construct. Repair. RJnUt'ate Or Demolish a Re i i)/ ,ittt1,
(hie- or Tit o-Foindv Dn effili ;
This Section For Official Use Only --- -
Building Permit Number Date Applied:
\ u g Commis+omen/ apeaor of BudJntgs D:ue
SECTION I: SITE INF'ORMA FION
1.1 Pro rty Ad ess: 1.2 Assessors NIap & Parcel Numbers
I.la Is this an accepted street'.' ycs ✓ no_ Mup Number P:uret Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Dtstrict Pro)wscd Use Lot Arca hU fit Frontage o1i
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yurd
! Required Provided Rcquwed Provided Required Pros lded
i
1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone:' Municipal ❑ On site disrytsal system ❑
Public ❑ Private O Check if yes❑
e� F SECTION 2: PROPERTY OWNERSHIP'
2.Dwn.Y1 Pf 'Y(�� Z�v� '3rY_T 5` a 5�i S�Qst rl t Vy .
Name tPrinir Address for Service:
-It -1 - ly S- Lj o
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building 9 Owner-Occupied M Repairs(s) ❑ Alteratiun(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ,�-Specify:
Brief Description of proposed Work'':
SECTION J: ESTIM TED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials) —
I. Building 5 I. Building Permit Fee: $ Indicate how tee is determined:
❑ Standard Cily/Tuwn Application Fee
2. Electrical S ❑Total Project Cost' (Item 6) x multiplier x
n t
3. Plumbing S 2. Other Fees: $ � i— i
4. Mechanical N AC) $ 1 List: _
5. Mechanical (Fire S Total All Fees: S. —T -
Su t ressionl
r�r Check No. CheckAmount: ('ash .\muunC
2 ` 515
b fatal Project Cost: Sa " 0 Paid m Full ❑ Outstanding Balance Due:_—- ,-
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (C'SL)
.. License Number Expoatiou Date
Namc ol'CSL- Ifolder
List C'SL I)pe t see hclott)
\ddress Tv thscn pion _
L t'nresormed iut to 5.IXK)('it F1
i R Reslncted 1&_' Fannb Dttclhue
Signature NI %lasonn Only ..r
RC- RevJcmial Rooting(wincing I
rcicphone l\'S ItrstJcnnal R'mJo�t .utd Sn6ue _ _�.
j SF RcstJcini.d Solid Fuel Humrn_c \pph.ntcc lu.t.dlamm
D Residonied Demolition
Re istered Ilo to Impr em nt C'u t actgr(1 1 I
g HI 'C)[npa tstran N nc or HIC Re tNutrte Registration Number
rn
Ad
S—C>
i W tit oiy� Expiration Date
Signature 'releptione
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 it) pros ide
• this affidavit will result in the denial of the Issuance of the building permit.
.. Signed Affidavit Attached? Yes ..........Pl�- - No........... ❑
' SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I• 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.
i Signature of Owner - Date
l SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1. oar-r- -- - ,as Owner or uthorized —g )hereby declare -
P
I that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
"Print . aG WO ,{
1,'2Z-
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own woo k,or an owner who hires an um"eg)stered 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 he found in 780 CMR Regulations I IO.R6 and 110.115. respectitcly.
2. When substantial work is planned,provide the information belbwi
Total floors area lSq. Ft.) (including garage, finished base ment/athcs, decks or porcht
Gross living area tSq. Ft.) Habitable nNtm Count
Ntunber of fireplaces Number of bedrooms
Nunther of h:uhrooms Number of halt/baths
Tvpe of heating system Number of decks/ porches
"type of cooling system - Enclosed Open.
3. 'Total Project Square Footage" may be substituted fitr "Total Pntject Cost"
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)
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Ulf www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information (� Please Print LeeiblY
Name (Business/Orgmizatiion/Individual):
Address: 12G CV_&C1A 5'F
City/State/Zip: (ADr,b rvn\, YY CG to1)t Phone #:
Are yo -an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 1__ — 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. $ ❑ Remodel ng
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I I.El Plumbing repairs or additions
myself o workers' coat c. 152, §1(4),and we have no
y [N p. 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other V ,zQ n
comp. insurance required.]
*Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the time 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:
Policy#or Self-ins.Lic.#: 1:� 0`) cn1 OC3 Expiration Date: \__
Job Site Address: 0 1�Ol�Q S ie �Qx City/State/Zip: 5c)G¢ yY (Y-)4
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 vio ator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for ins ur age verification.
I do hereby certify and he pai d u that the information provided above is tru and correct
Sienature: Date: �2
Phone#:
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 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
I
r
� �lte �iom..narwieall/i o�./�aaaac�umetla ,_ _ ___ _
- Board of Building Regulations and Standards License or registration valid for individul use only ,
HOME IMPROVEMENT CONTRACTOR beforetheexpiration date. If found return to:
j Board of Building Regulations and Standards
Reglatratiod 1.46589 iII One Ashburton Place Rm 1301
Ex piration 5%5/2009 :i Boston,Ma.02108
Type Supplement Card
NEWPROOPERATING LLC v
MARK HOLLETT� \� a t -
26 CEDAR ST.
WOBURN,MA 01801 _ Administrator Not valid without signature „
- --- -- --•.,, rm iDl_/rYu9D8s AMERICAN FIRST INSURANCE [A 002
I
acORD- CERTIFICATE OF LIABILITY INSURANCE OPID DC DATE(MrynDYYYY)
NEWPR-1 02%28/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
American First Ins Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
122 Quincy Shore Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Quincy NA 02171
Phone: 617-770-9000 INSURERS AFFORDING COVERAGE NAIC k
INSURED INSURERA: Arballa Protection Ins. Co
INSURER B:
" Bro Operating LLC INSUREfl C:
PO OX 2b96 INSURER D:
Woburn NA 01801
INSURER E: I
COVERAGES
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
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 POLICY EFFEUTIVh DATE OATS Me WDNY LIMITS
GENERAL LIABILITY EACH OCCURRENCE 51,000,000 .
A X COMMERCIAL GENERAL LIABILITY 850000010649 01/01/08 01/01/09 PREMISES(Ea=c mnce $ 50,000
CLAIMS MADE a] OCCUR MEO EXP(Any one person) S 5,000
PERSONAL B ADV INJURY S 1,000,000
GENERAL AGGREGATE $2,000,000
GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000
POLICY JEOT LOG
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A ANY AUTO 8103740DO01 12/31/07 12/31/08 (En ecciEenl) $1,000,000
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Parperson) S
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per=cloen $
t)
PROPERTY DAMAGE $
(Pareecitlent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN FA ACC $
AUTO ONLY: AGO S
EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $5,000,000
A X OCCUR � CLAIMSMADE 4600010709 01/01/08 01/01/09 AGGREGATE $ 5,000,000
S
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X TWrlTA 0- ER
A 'EMPLOYERS'
IETOWPRY 90967005 05/01/07 05/01/08 EL EACH ACCIDENT S500,000
ANV PROPRIETOR/EXCLUDED?
OFFICER/MEMBER EXCLUOEOP EL DISEASE-EA EMPLOYEE S SOO,OOD
If yyrs,tlaunbe Un
'SPEC IALPROVISIONSbetc. E.L DISEASE-POLICY LIMIT $ 500,000
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OP$RATIONS OF INSURED
CERTIFICATE HOLDER CANCELLATION
S•PECO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOP
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
SPECIMEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO;SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES
AUTHORU:ED REPRESENTATIVE
James J. Farren, CID
ACORD 25(2001/08) ® -O D CORP RATION 198
=� CITY OF SALEM
PUBLIC PROPRERTY
' ' l •I DEPARTMENT
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wl .•.. K l_': `X'�in:SG'J`�:acFT � �.\;. \t. )1.\,iu :�, .'�:. ., _.'/':.
Construction Debris Disposal affidavit
(required for all demolition alid renovation work)
In accordwice with the sixth edition of the State Building Code, 'SO C\IR section 111.5
Dcbris, and the provisions of NIGL c 40, S 54.
Building Permit p _ is issued with the condition that the debris resulting from
;his work shall be disposed of in a property licensed waste disposal facility as defined by '.VIGL c
, 11. S 150A.
The debris will be transported by:
(name of haurm)
I'he . ,�brs ww ill be disposed of in
,
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d .aA D- 9
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MA Reg.#146589 Siding Contract
CT Reg.#0605216 � �
RI Reg.#26463 American Classio wau systems Federal ID #20-2625129
Corporate Headquarters:26 Ceda fit.,P.O.Box 2696 Woburn,MA 01888 (781)933-0100 1-800-342-2211
THIS CONTRACT MADE THE day of 0� between
Home Own s) (Ho�e Phone) (Bus./Cell Phone) (Mr./ M.)
of
(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 w at the premises located a
av
(Job address) (E-Mail Address)
S eCIfICatIOnS AP OVED MATERIALS WILL BE FURNISHED AND INSTALLED TOTHESE SPECIFICATIONS.
P PLEASE READ CAREFULLY:ONLY ITEMS CHECKED r'YES"ARE INCLUDED IN YOUR ORDER.
YES YES NO /
1. �SOLID VINYL SIDING cover only flatwall are s designated for 5lding, 15. O QI�EAMS/COLUMNS wrap with approved VINYL CLAD ALUMINUM.
excep tq ose areas des_ iy1/1 below l I 5Tv �-> circular or round columns) Color
Size Colo NgfEpatter KPackage 16. O L GUTTERS/LEADERS remove existing and replace with new custom
Custom corner posts color seamless gutters and leaders. O White O Brown
1A. O SIDING will be applied to the following areas only: 17. 0 O SHUTTERS provide&install yL pair a rove p styrene
O Front Elevation O Rear Elevation O Other shutters. Color
O Left Elevation O Right Elevation O Other 181 MASTER MOUNTS��U���ppprovide&install for exterior li ht fixtures only.
Partial O Details: 18A.)Lights# 18B.)Water/Elect Outlet#_Z^
ntire O Details: }8C.)Dryer Vent If Color
2. i�INSUI.A_710 covemy flatwall areas designated for siding with 19. O ET GABLE VENTS provide and install vents.
�(/ /TN�P.� / inch insulation. Color No circular or triangle vents.
3. O Use proved STARTER STRIP where contractor deems necessary. 20. 9�0 CLEAN UP property at completion of work.
t available with Nailite) 21. INSURANCE All Workman's Compensation and Liability to be maintained.
4. O iEing to be applied over EXISTING FOUNDATION. 22 0 WARRANTY Mail to customer after completion&full payment is received.
S. O se approved PERMA TABS AND FINISH STRIP where contractor
deems ne�cessary in same color as siding.(Not available with Nailite) • O PAYMENTS on NON-FINANCED orders installer is authorized to collect
6. O wII W OPENINGS progressive payments.
gusto wrap with approved vinyl clad aluminum 24. 0"0 TI NA RK(not specified above)
# Color W/ 7,9-
O Jump over casings with siding and"J"channel 'S
It Color
O Channel existing window only(eg.Andersen type or previously 25. O or Nott to Be Done
wrapped)# Color �OS
�� Other details
7. Ldx7 CAULK all sills with rubberized color coordinated caulking. �- 0
8. �' O DOORS custom wrap with approved VINYL CLAD ALUMINUM. 26. W O epair or Replage the ollowing wood
#of Doors— Color /.0l"/7V— /I/�e/1P�(/)lAl1J�Lr/ S//LS
9. O O GARAGE DOOR FRAMES custom wrap with approved
VINYL CLAD ALUMINUM. Color
O Single O Double with Mull O Double No Mull
�41
10. O FASCIA custom wrap with approved 1,[ / T4!W11aI6 pH¢e '
J VINYL CLAD ALUMINUM. Color�.✓/T�45 INDICATE F/Oj�M OF PgVMENT
11.,2 O SOFFIT(eaves/overhangs)cover with approved SO I�FIT : /7 NT / �� oa
�� SYSTEM.Except area noted below.1/3 Vented. Colo
12.13 O ROTTEN WOOD Will only be repaired or replaced where specified on line Deposit With Order $
item#26listed below.Any additional areas needing a repair will be Payment on
estimated upon their discovery and priced accordingly. Measure or Start 33% $
Ross not include wood studs,or exterior sheathing,)
13.O RREMOVE EXISTING MATERIAL exterior of house. O Other Balance Due On
;WInyl O Aluminum O Wood Shingle O Wood Siding Substantial Completion 34% $
14.0 C'PORCH CEILINGS cover with approved SOLID VINYL CEILING MATERIAL of
l A O tamoun
in the following areas: To
Balance to be Financed $ /5�27
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 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 pa 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.
❑ Sample warranties provided to Owner. 2J
I WITNESS WHEREOF,the parties have hereunto signed their names th' day of �� 2006
M EIN# Signeal
Marko ing Representative Printed Name Owner
Accep d:NE�fj}Op r ling, L
y Signed
M <etin Representative ignature Owner
wall Systems Branch Office,151-153 Memorial Drive Business Park,Suite B-C,Shrewsbury,MA 01545,Phone 800-456-0555,Fax 508-842-9248