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0 CLARK AVE - BUILDING INSPECTION (4) C4,-901l. The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only. Building Permit Number: Daf Applie • 12- Buiidmg;Ofiicial(Print Name) '.!. ignatura Date ... SECTION'I:SITE INFOR TION 1.1 Propertt Address: 1.2 Assessors Map &Parcel Numbers L la Is this an accepted streets;es no k1ap tJuwber Parcel Nr ober fa omnpTnt; ,,, ..SS Y: Lv Dimensious: ---� Zoning District Proposed Use Lot Area(sq it) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided .� Required Provided Required rrovuied 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone" Public El Private O - Check if yes❑ Municipal 13 .,i u On site disposal syste SECTION 2: PROPERTY OWNERSHIP'.. 2.1 Owne r of Record: Name(Print) City,State,ZIP No.and I elephone Errnil,Address SECTION 3:DESCRIPTION OF PROPOSED WORK. (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alterations) El Addition LJ Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': , -- — � lr.,,- ' - --- ---- ----- "_'" SECTION 4:ESTIMATED'.CONSTRUCTION COSTS; Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ Otr 1 Buildmg Permit Fee:_$ Indicate how�fee is determined: 2.Electrical g O Standard_City/Town.AppheahonFee' P Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ h /( 4.Mechanical (HVAC) $ List: V v 5.Mechanical (Fire $ - Suppression) -Total All Fees.$ " Oa ;CheckNo.'..� Check Amount: = Cash Amount: 6.Total Project Cost: $'i} DSO. 0' Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ' 5.1 Construction Supervisor License(CSL) — 0-1e6n License umb rr — Expiration Date E Name of CSL Holder / �_ , List CSL Type(see below) 9 " L9 and Street Type Description - No. — OL J�n In�� U Unrestricted(Buildings u to 35,000 cu.ft.) X R _ Resuictsd 1&2 FamilyDwelling City/Town,State,ZIP M Masonry `-- RC Roofing Covering WS Window and Sidingt�Tele SF Solid Fuel Burning AppliancesI Insulationhone EmailaddressrD Demolitionegistered Home Improvement Cw,,tractor(III--) cnl* _.__. -- - ItIC Registration Number Expiration Date HIC Cd±�-anvN eor'-IiC.Regi tName dbuMMn 06�0 aoQncL�n leabM No.and Street Email add fs -- Ci /Town,State,ZIP 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 m`,E.COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APP��-LIES/S FOR B'''UILDING PERIMT 1,as Owr:er of the subject rroperty,hereby authorize. to act on my behalf,in all matters relative to work authorized b this building permit ap cation. Print Owner's Name(Electronic Signature) te SECTION 7b:O`R'NEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. �— I � t id _ ! -- Print Owner's or Authorized Agcnt's Name(Eleclmnic Signature) Date 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 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.niass.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dos 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" . llll����Fwn nurxomebhwr... CT Reg#146589 601t WOWHOM® Federal lD#20-2625129 r CT Reg#0605216 ��ff���� RI Reg#26463 E.WiFaxbgxumefmprnvwrena 1L7 — _ Corporate Headquarters,26 Cedar St.Woburn,MA,(P)810-342-2211(D 781-933-9626,arms newpro.com N? _2 0.3.1. 9 THIS CONTRACT MADE THE-ALO ifd day of M NIA l be r 2013 between mr. Ai Q5 z¢„a1 9)g- ?zifi � sill 7.5-8- 2g&3 (Home Owners) ��11 (Home Phone) / //(Bus/Cell Phone) of lJ C l ✓v 4yt S9/PM 11W 0/ 970 (Address)- (Cdy) (State) (Ip) 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 tabor and material necessary to install the following described work at the premis located at q rl-,4 (Job Address) (E-Mail)/orpmpartary use only - Buyer(s)hereby jointly and severally agree to purchase the goods and/or services listed below in accordance with the price and terms described on the front and reverse of this Remodeling Sale and Installation Agreement. Style Tear Off Tear Off Color Style Roof Size 2 Layer 1 Layer rfetime Dimensional ❑ X- SHS V<...00c,Q H D t1 SR ❑12 year low pitch(modified) ❑ 0 ❑ ❑ — 11 ❑ ❑ ❑ 'I ❑ ❑ ❑ ADDITIONAL REMARKS id i e o S ¢ o� tt-tst f S t.a r c'n r c } }• SYStItIANHANCEMENTS .¢e. S O t.go Ave Qae' 01-Tarp from roof to ground to keep clean.. ❑Install rubber roofing system on entire low pitch root area. ❑Remove layers of eyx��ssting roof&haul away debris. ❑F 4 1/2 Metal Edging(Flat Roof). C3'Replace bad sheathing fle�u6.k./sheet additional to this estimate. f911istall ice&watershields.Location: ti<aaf * $cc k L`i`Nail down premium roof deck protection. (6'up from edge) CI-Starter course at all roof edges. 8-tis-tall premium ridge venting system on roof peaks Y 9' ft. Mall 7"drip edge at roof edges. 13-Glean up&haul away of job related debris. ❑Install heavy duty aluminum flashing in all valleys. II roofing materials guaranteed as specified by manufacturer ❑Replace all chimney flashing with new lead as needed. @fetching Hip and Ridge shingles used in all roof peaks. ®'rTeplace all pipe collars with new heavy duty aluminum. p uslomer to remove breakables from walls. glace all wall flashings with new heavy duty aluminum as needed. [915iustomer asked to cover items in attic. ❑Skylight flashing# ❑Remove existing fan,replace with sheathing. Since it is not possible to determine if there are more layers of existing roofing when estimating the cast of your roof,there will be an additional charge for removing any additional layers and disposal fees. Per extra layer per square ❑Cathedral ceiling waiver Customer Initials—Q,) Q V— QUALITY ASSURANCE PROMISES LBNewpro's Platinum Protection 5 yrs OffFully Licensed&Insured *100%coverage material,labor&workmanship - *See back for details 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 he a registration should be directed to: Director,Home Improvement Contractor Registration,One Ashburton PI.,Room 1301,Boston,MA 02108, (617)727.8698. 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 ad`::ince cdergec.'he Retail Installment Sales Agreement shall be incorporated herein by reference. If the Owner is obtaining a revolving credit line!�pay,in who o min part,!n;the contract amount name,the terms of the revtW'ng line of credit including interest rate and payment terms,shall be clearly set out on the credit application.-rile 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 dopers,including all finance charges,shall be incorporated herein by reference. NEWPRO represents,that it carries Workmads commission and Public Liability Insurance in the amount of$100,000-$300,000. It 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 the money coup]a hirty-iinee and one-third content of the once 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 erformance of this contract due to uses beyond its reasonable control. Owner warrants that he is the owner of the property on which IRca e work is to be performed or Nat he is otherwise authorized on behalf of the owners to enter into this agreement. . . This centred represents the entire agreement between Owner and NEWPRO and cannot be changed except in writing signed by both he Owner and NEWPRO. You are entitled to a copy of the Contract at the timeyou 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 ithas 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 exp Bastion of this right. D,P NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. l7P tZ t`g.•rhn� f)<P jgns rgegS•re hill kv Vr: qq c, t.vpy The owner has seen"sample warranties that will be provided by NEW F RO upon install(altion.Sample warranties provided to Owner IN WITNESS WHEREOF,the parties have hereunto signed their names this�(Y day of OOJQ M6 el 20 1, INVESTMENT AGREEMENT It is agreed and understood by and between the parties that his contract constitutes the entire Finance Job ❑ understanding between the parties,and here are no verbal understanding,changing or modifying any of the terms. This contract may not be changed or its forms modified or varied in any way unless such changes are in writing and signed by both the Buyegsl and the Contractor.Buyers)hereby atlmowledget Brands)has is contract. �^1 Approval j� "-�" Dale 01 Total Cash Price $ �y4 dam_ Cast at 5 Approval Date I I Less Deposit $ stome� S000,co Approval Date.' (� / cU / al Amount Due at Install $ g`f000.� Home Improvement Consultant WHITE:Branch Copy YELLOW:Customer Copy , eco_ ,PINK:, ile Copy GOLD'Finance Copy "� CERTIFICATE OF LIABILITY INSURANCE 5/1/203"" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Melissa Pflug g Mackintire Insurance Agency Inc PHONE (508)366-6161 FAX N :150B)3fifi-5202 ll West Main Street E-MAILars,melissap@mckintire.com INSURER(Si AFFORDING COVERAGE NAIC9 Westborough MA 01581-1931 INSURER A:Peerless Insurance Co. 24198 INSURED INSURER B-.Acadia Insurance Co. Newpro Operating LLC INSURER C: 26 Cedar St. INSURER D: _ INSURER E: Woburn MA 101801 1 INSURER F: ' COVERAGES CERTIFICATE NUMBER:12 - 13 Master w/13 WC REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONTRACT OR 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.UNITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. INSR TYPE OF ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBEfl MM/DDNYYY- MM/DDIYYri GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 OMAGE TO IED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 A CLAIMS WOE OCCUR 2BP 8589577 12/31/201212/31J2013 MED EXP(Any one person) 8 5,000 _ - PERSONAL&ADV INJURY_ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:. PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COBINEDI SINGLE LIMIT 2,000,000 A ANY AUTO BODILY INJURY(Per person) .. ALL OWNEDSCDULED 8584174 2 31/2012 2/31/2013 AUTOS X AUTOSHE / BODILY INJURY(Per accitlen0 $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Pern dent)$ Uninsured ru tarist Els lk limit $ _ 250,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CIAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTIONS 10,00 0 8582578 2/31/2012 2/31/2013 It $ WORKERS COMPENSATION _ WC STALIMTU- DTH- -- AND EMPLOYERS'LIABILITY — ANY PROP RIETORIPARTNERIEXECUHtiSn N - _:: !'ADH ACCIDENT $ 500,000 OFFICERMIEMBER EXCLUDED? u NIA -'- -'- - -- (MandelorylnNH) C-20-20-073506-01 15/1/201.3 /1/2014 EL DISEASE-I A EMPLOYEE $ 500,000 Il yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space isrequired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN d TO Whom It May Concern ACCORDANCE WITH THE POLICY PROVISIONS. j AUTHORIZED REPRESENTATIVE T Moynagh/MARIAN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The Commonwealth of Massachusetts Department oflndustrial Accidents UlfOffice of Investigations 600 Washington Street Boston,MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N3R18(Business/Organization/Individual): Afel(,­�,nr - x„ 11 D., LLC 7 r Address: g2r City/State/Zip: ( LOburn , njjg C)/ Fol Phone#: Are you an employer?Check the appropriate box: Type of project(required): ,.� I am a employer with SO 4. ❑ 1 am a general contractor and I 6. E]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. t 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition 'working for.me in any capacity. workers' comp.insurance. 9. I❑Building addition [No workers' camp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I ant a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required., 13.0 Other Any applicant drat checks box#1 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. JContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ' I hnt'an employer tliat is providing workers'conpeasatiori irnsurance for nny employees. Below is the policy and jab site information. Insurance Company Name: Aa;�nC _ Policy#or Self-ins.Lic.#: ( IC �q f. --.�o- Expiration Date: ^—I Job Site Address: U C I A t kC —Ay City/State/Zip: � , d 14M O Attach a copy of the workers'compensation policy declaration page(showing the policy number am' 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$1.5010.00 and/or one-year finprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fide 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 hrvestigations of the DIA for insurance coverage verification. I do hereby certify under thepains and penalties ofpeljury that the information provided above is true and co F -act Signalure: Date: l Z- 5 Phone#: Official use only. Do not write in this area,to be completed by city or town offnciat .' 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#: ,,... _ Ir 'nurmrnrn,"n�//r�%:•/(ru.;rrriirurJG lFice of Consumer Affairs d.Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: MrIR-agistration: 146589 _ Office of Consumer Affairs and Business Re ulation Type: 10 Park Plaza-Suite 5170 g Expiration: 5/5/2015 Supplement ;:ard NEWPRO OPERATING, LLC. Boston,MA 02116 THOMAS FOXON - 26 CEDAR ST. WOBURN, MA 01801 Undersecretary Not valid without sigture Massachusetts -Department of Public Safety Board of Building Regulations and Standards C umstructlun Supen'isur r License: CS-029090 `. THOMAS P FOJION READING 1 0 r }S`*• x Commissioner Expiration 11/19/2013 Massachusetts -Department of Public Safely Board of Building Regulations and Standards - Construction Supen-isur icense CS-029090 THOMAS PFOXQN 230 WALNUT ST.--- READING TREADING MA 01867', _„p�ration Commissioner 11/19/2015 s v