33 BELLEAU RD - BPA-10-312 WINDOWS The Commonwealth of Massachusetts Town of
Board of Building Regulations and Standards
Massachusetts State Building Code. 780 CMR. 7'"edition Building p
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One.or Tuo-Fumdp Duelling
This Sectio Official Use Only
Building Permit Num c�1 to A ied:
Signature: A)
Budding Commissioner/1 sPector of gutldings ale
SECTION I: SI E 1 ATION
1.1 Property addr as: Assessors Map 6 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 La Area(sq(1) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rest Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private O Zone: _ Outside Flood Zone? Municipal O On site disposal system O
Check if s0
SECTION 2: PROPERTY OWNERSHIP'
2.1�1 Owner'of Recoil
Name(Print) Address for Service:
617 79 '7_�6 I ?
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction O Existing Building O Owner-Occupied Repaira(s) Alterations) O Addition O
Demolition O Accessory Bldg.O Number of Units_ Other O Specify:
Brief Descriptio of P posed Work':
.4 G
SECTION 4: ESTIMATED CON RUCTION CbSTS
Item Estimated Costs: OAlelal Use Only
Labor and Materials
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical S O Total Project Cost'(Item 6)x multiplier x
3 Plumbing S 2. Other Fees: f 22
4. Mechanical (HVAC) S List ,mil l 64
s Mechanical (Fire S Total All Fees. S
Su ression
Check No. _Check Amount: Cash Amount:_
6 Total Project Cost S L
/b��, 0 Paid inFull 0 Outstanding Balance Due
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supersisor(CSL)
7,
L.mn,e Number Evprntion to
N4rae of CSL Hyldet List CSL Type thce heluwl
T Description
Address
U I Unrestricted I up to 73,000 Cu. Ft.
R Restricted 1&2 Family Dstellints
Signature M Masonry One
RC Residential Roofing Covering
Telephone W S Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 ReglmeredAHornst mprovemmt Contractor(HIC)
HIC Company Name o HIC Registrant Name egistration Nu ber
Address
Signanue elephone
SECTION 6: WORKERS'COMPINSATION INSURANCE AFFIDAVIT(M.G.L.e. 132.1 2SC(6))
Work Compensation Imurance andavit must be completed and submitted with this application. Failure to provide
thin andavit will ,!ion
in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........k No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/ten as Owner of the subject property hereby
authorize11A/ to act on my behalf,in a)1 matters
relative to work authorized by this building permit application.
lrct�� C��iliz�
signature of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
%�6 XOIl/ , aster 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.
l %e) 6 S o-,0
Print N _ p
Signature of Owner or uth tzed Agent Due
Owed under the sins and penalties of r u
NOTES:
1. 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 rg have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 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
,~'umber of fireplaces Number of bedrooms
Number o(bathrooms - Number of haifbaths
Type o(heaung vystem Number o(deckst porches
Type ofcoolmgsystem Enclosed Open
3 "Total Project Square Footage'may he .uh,filuied for 'Total Project Cost"
MA Reg#146589 rromoarxorsetorosrs...CT Reg#0605216 Federal ID#20-2625129
/�RI Reg#26463 Windom Siding and mor, 59064
Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211 (F)781-933-9626,www.newpro.com
i
THIS CONTRACT MADE THE day of 20 0 P between
Cwc�ir�✓r,� �., �,,�
(Home Owners) I (Home
Phone) (Bus/Cell Phone)
Of 3� �P �IPUu 9d StyGGM M19 toil
(Addres (City) (state) (LP)
the"Owner"and NEWPRO Operating, LLC,"NEWPRO". The job address is a condominium.
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
�7nnti0
(Job Address E-Mail for proprietary use only
TOTAL Additional Model TOTAL
Windows Purchased NEWPR��0 Work Number O CASH
Window Color In: Out: Sliding Glass Door PRICE / v
Capping Color W ) Steel Secun "Door
Door olor In: Out., DEPOSIT
Model Name Model Number s Qty Sidelites WITH /7 00
Double Hung 19 New Construction Unit ORDER
Picture Window Storm Door BALANCE
Casement - Obscure Glass TOP M DUE AT
2 Lite/3 Lite Slider Screens ALF FULL 2�v
/'�
INSTALL
Bay/Bow Frame Please Initial:
Zeffs
Roof. ❑ � soffit: ❑ Customer understands thatQwov does not CASH
Garden Window do any painting or staining. (ie:when removing Balance paid to installer at installation
Awning or replacing interior stops or trim)
Hopper NEWPRO®is not responsible for conditions or
Shaped circumstances beyond its control including con- FINANCE
Other densation resulting from or due to pre-existing Bank completion form signed at installation
GRIDS 0-1 nial SDL Euro conditions.
DESCRIBE WORK:
45 ✓�
t v rM4 lil/zt—l�. ze7elew InZe
Est.S Date: / Customer understands this is an"estimated date" Est.Comp. Date:
as
Initials Customer Lunderstands 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 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 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
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.
XThe owner has seen"sample"warranties that will be provided by NEWPRO upon installation. Sample warranties provided to Owner.
IN WITNESS WHEREOF,the parties have hereunto signed their names this _day b �, q
- A/L C-0,0 jtW 17 EIN# Signed
Marketing Representativ Printed Name Owner
Accepted: NEWPRO Operatin ,LLC
e
By Signed
Owner
CORPORATE ICE - WARWICK BRANCH OFFICE
26 Cedar t 24 Minnesota Ave
Woburn,MA 01801
(P)800-242-9974(From NE) Warwick,RI 02888
(F)781-933-0717 (P)800-356-3312(From NE)
(F)401.732-1371
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
us-is
R0508
JOB# 4�� Windows,Sling and More - _ r - Page °f
r� �:. / Jy
I K3
CUSTOMER
@•MAIL ADORES& HOME PHONE
DATE AIe9 WORK/CELL PHONE
(Circle one)
ADDRESS 313 ge lle d R6�
�i BEST DAY TO INSTALL: M T W TH F
CITY,STATE [) r'Yj - M (Please circle one)
PRODUCT SPECIALIST as-4D Yf NCH: _j4jVbj2Y ij ESTIMATED START DATE TOTAL#OF --
#OF DOORS WINDOW COLOR
WINDOWS #OF BOWlBAY/G ARDEN Sio(m,Steel,Patio
Inside/Outs ide CAP COLOR
F�� F7w :E�t]
OPENING SIZE STOPS
NO. . STYLE W x H U.I. LOCATION GRID SCR IN OUT ADDITIONS OPENING CUT
a6r3t 02 6,9A x z
too doss A61 �7 g,'d �� 'a x x
I®, a957 06Y-5 wt� Ga � x x
99575- dG Y 6 /aa' gkc-IthK b x x
x x
x x
x x
x x
x x
x x
x x
xx
x Exx
Measureman: 1_ lAyr J'
Initials. Data - Crew Size Needed Time Freme to Complete job Capping T�ee'� - -
Special Installation Instructions: - '
Directions to site:
Reviled i/01
5/7/2009 3:51 PM P : Ndc"nt re Inaucance xackinUre InauranCe Agenw 70, 9.17019320960 PA6a: 002 Oi 009
ACORD CERTIFICATE OF LIABILITY INSURANCE 05/07/2 o
vA*XWER (508)366-6161 FA%.(508)366-5202 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Mackintire Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATE
11 West Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND EXTEND OR
Westborough, MA 01581-1931 ALTER THE COVERAGE AFFORDED-BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIL# -
meweo Nexpro Operating LLC nmem. Peerless Insurance Co. 24199
26 Cedar St. IN9LPBRa.
Woburn, MA 01801 InsLPmc .
muR o:
' IUPs�Re -
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATED.NOlW11NSTAN0ING - -
ANY REOOIREMENT,TERM OR CONDNION OF ANY CONTMCT OR OTHER DOCUMENT WITH RESPECT TO 9VIIICII THM CERTIFICATE MAY BE ISSUED OR -
MAYPERTAIN,THEINSURN E AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDmONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIM9.
Ix90. D' }ypE6F W9UMNCF ppLlCyxy,mER EFFECME PPLILYn,nPAn N L,�E
oExewLUFaam P 8588370 - MA POLICY 12/31/2008 12/31/2009 EHYl occuuFxce 9 1.000.00(
p _Q �ttYde�d 1;, j
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uAIMS MFpE 0X ocan Lm 6m IA�Y Fn6weml t 15.00 �—\ Board of Building Regulations and Standards
A PERSo A/OYmWRY s 1,000.00
oE94],.LIEFRe6Are 9 2,000.00 HOME IMPROVEMENT CONTRACTOR
GENLPffAEwIE LIWlPP0.1ES PFA: PIropUCI9.COLNKP A00 a'
ooLkY s 2 000,0 RegistrBV,06 146589
-AVrPMoaRE LIFaLLm Ba BS24174 12/31/2008 12/31/2009 w1.Gnz:o slxoLELWD19 E'itpiTatl(Sa 5%5/2011
MIY PUIO (6 eetleenl) 9 _
_ 1,000.00 t Type SOpplement Card -
NlovmEo%Uros S.LY IILIUtY r f • t 1 r s
% suedAEoAuros IPx PNranl t 11 i"'~ E ' ,r
A X HIPFDAVl09 eoonvwAnv NEWPRO OPEW1�tiCs IL -7.
x P` THOMAS FOXON'd F %-,-teat+
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Ie'Y„oE ' 26 CEDAR ST.
wRAoeLuelLm AurooBLY-EAAmoaa s WOBURN,MA 01801
Administrator i
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rWfOON.y: p06 I
EkceswxeRJaaALueem CU 8582578 12/31/2008 12/31/2009 eeHoccumSYce t 5,000,00C
X .=R 9 S 000 00 - -
A t
DEDucnelE $ - -
% AEIEMION t 10.00Ct
WORIn'AB COMPENwT10N9xC '�N' -
p wnvR IR erawv oeamrE VC8645974 OS/01/2009 05/01/2010 e.�FxH,¢cmExr 9 :500 00 --
_ CFFICEWMFMBER EA0.1AED9 EL Oa'FASE-EAENPIG f $DD D _
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sPEcvR Nmvlsloxs eao,. E1.msrisE-P6LIn LmR t $00,00 I `ybF 07 , -
o,wER Board Of 116118ing Regulations and Stag ds
' ? Construction SUPervisor License
OEIICWPTIONOF OPERAnON91L0UTON9IV@IICLEYIFICLD910NP10DE(IBY6NpOR96M6MlEPECaIPRON9NN9 ' '
Lic se.: CS 29090
s 7 ja4 � 1 /2009 Tr# 8131 '
I
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CERTHFICATE HOLDER CANCELLATION
' axomourvaFnM seovF OE90uem roucies es euttELLEo stsOwlHs ! -- 1�'*�y}� �k 31 '�
t
THOMAS P FOXQ
' EWPunON wTETN6REOF.TxE IeWIxO P19WERNYL FxoF,NORTO1Ma
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eur F9aLmEro MUL such xorcEawuRPosc xooelrcsTMm wLueam i - /`— t f
Tom OF Saugus y READING, IAOt867
298 Central Street PF Axr NNRwoxrNtmeuRER na AOErm ORRFPAF9ENrAlI9EA C6mI1dBill er
Saugus, MA YRXONSOPFMEt6MAlNF - - 1.
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ACORD 26(2001Ma) ®ACORO CORPORATION 19B8
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NEWPRO MANUFACTURING
A0. NEWPRO 2000 DOUBLE HUNG
Cellular PVC frame,Triple glazed,
Low E coating(e=0.034, S2&5),
f1a0nO0dundl® KryptonlArgo0lair filled
now DW-K•27-00016.00001
ENERGY PERFORMANCE RATINGS
U-Fa dor(U.S.A•P) Solar Heat GainCoeffident
0.19 0.27
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage(U.S./I-P)
0v40 0A
Condensation Resistance
70
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-The-Commonwealth of Massachusetts--- ------- --- -- - - ---_-
Department of Industrial Accidents
?I MS. Office of Investigations
(y � 600 Washing-ton Street
Boston, MA 02111
" wwx1.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/oreanizationgndividual): NEWPAQ
Address: 2& CEb1QP_ ST
City/State-Zip: W013U2J�/ MR 01901Phone 78/ - 93(�;-8300 EXT .05/
Are you an employer' Check the appropriate box: Type of project (required):
rn t 4. ❑ I am a general contractor and I
I.�l I am a employer with 50 6. ❑ '.New conswcrion
employees (full and/or part-time).' have hired the sub-contractors
=.❑ I urii a Sole prop—Ietor Or partner- listed rn the zttached-beet % Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions .
u officers have exercised their
required.]
iticns
i 3.El am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or add
myself [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance t employees. [No workers'
anee required.] 13.❑ Other
comp. insurance required.]
'Any applicant that checks box g I must 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 must submit a new affidavit indicating such.
'Contractors that check this box must anached 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: HOCkin+ire 1:nsuronce AginncV _
Policy=or Self-ins. Lic. #: V\J C 9 to y S G`)4 Expiration Date: 5- 1 - 2 O 1 0
Job Site Address:-3 3 �Q VXILCL/ C_ City/State/Zip:A,��w -
Attach a cope 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 DI.A for insurance coverage verification.
I do hereby certify nder the pains a ahies of perjuq that the information provided above is truue/�An9d correct
Siztattre�1 /��t ,�y FOR NEyyPPn Date
Phoney � $ 1-g53 $It/Lp
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#:
y" r L)EV K l .vtc1-4 r
�. . Its t'vv, ,, ,: � lr� •;�rv_ ":�,
,4 y.
Construction Debris Disposal Affidavit
(required Iur all demolition :md rcnovaliolt work)
In accordance all the sixth edition of the State Building Code, 7SO CNIR section 1 1 1.5
Dcbris, and the provisions of MGL a 40, S 54;
Building Permit a 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
t 11. S 150A.
The debris Nvill he transported by:
L Ho-,( vey
t name(it hauler)
I he debris will be disposed of in
- tuaine.,1 Lnthly)
t3 WhecILi v ✓
taddrea. ur t�cililvlw0 uIrri—
,
ipnalu,t nt piton! app cant -
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ate