16 HOWARD ST - BUILDING INSPECTION i
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7a'edition Ois SALEM
1/�. Revised January
Building Permit Application To Construct,Repair,Renovate r Demolish a 1, 2008
One- or Two-Family Dwelling
This Secti ' or Offi 'al U
Building Permit Number: Da p,
Signature: Id ,
Building Commissioner/Insp or o Building's Date
SECTION 1: 1 EIINVORMATION
1.1 Property Address: r 1 Assessors Map&Parcel Numbers
1Lo i-10LUOrd eJ
L 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(Il)
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:
Zone: Outside Flood Zone?
Public❑ Private❑ — Municipal❑ On site disposal system ❑
Check if yes[]
SECTION 2:-PROPERTY OWNERSHIP[
2.1 Owner of Record:
Linda FfCc-hr, I Lo Howard S .
Name(Print) Address for Service: S Gt-�£t"Yl
Atz (1 CM S -n (4 1-z Q Z cq
" Signature Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
in' t,+-ri i I 4 1eQ1� ( �rYln1 wlld6IA_2
kn � KIS�t� (e) r)9S Ni
0
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item
Estimated Costs: - "Labor and Materials Official Use Only
1. Building $ 7 q(do.Kb I. Building permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost',(Item 6)x.multiplier
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: "
5.Mechanical (Fire $
Suppression) Total All Fees:$ `
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 3a(o(o C-"6 13 Paid in Full 13 Outstanding Balance Due: '
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 2' q D 9 O 1 1-(q- (Al
I' r O X on License Number Expiration Date
Name of CSL-Holder
2 O C e of-CQ List CSL Type(see below)
Address i t/\/D b U f Yl o 5,000Cu. t
�`� U Unrestricted u to 35,0 Description
.
R Restricted 1&2 FamilyDwelling
Signat� �� M Masonry Only
-7 S 1 C-I 3 Z $300 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) 1 (.J (P S g G
1P(.Up(C)
HIC Company N e r HIC Registrant Name Registration Number
(� Ceaar S+ WobLtvn 5-5-Zoo
Ad
1 .etiata rl —7 �- 14 3 z 9 5 W Expiration Date
Sigfiatufe 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 FOR BUILDING PERMIT
I, L 1 nd Q F--Y CL hr-\ as Owner of the subject property hereby
authorize N F'( ()P✓O to act on my behalf,"in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
I, Th OTY\0 S P FOK. (fin 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.
T"Or�Qs Q FOxor\
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.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"maybe substituted for"Total Project Cost"
FMM
T Reg 2 6 53351c1 oa`"° .- `- .RI Reg#26463 Reg#06060563 1 Federal ID#20-2625129
RI C A
CorporateWindows,Siring and More J J Corporate Headquarters,26 Cedar St,Wobum, A,(P)g.p-3g2-2211 (F)781-933-9626,www.newpro.mm
THIS CONTRACT MADE THE day of ('µ,)�glt
� ) 20 d between
(Home Own rs 2 7�g g? 2 SS
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(Home Phone) � 33� FJ
// (8 Cell hone)
of (Address
the"Owner"and NEWPRO Operating, LLC, "NEWPRO". (Cih') (state) (Zlp) �
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,furnish
l The abor job
address
necessary to install the following
described work at the premises located atg
Job Address �.
TOTAL ( Additional Model Email) for proprietary use only
I J
Windows Purchased: TOTAL
NEWPRO Work
Window Color In: Number Q CASH, / J
Out: Sliding Glass Door7
Capping Color Steel Security-Door PRICE l6i
Model Name Door Color In: Out: DEPOSIT
Double Hung Mo I er s) Qty Sidelites WITH
Picture Window New Construction Unit ORDER
Casement Storm Door BALANCE
2 Lite/3 Lite Slider Obscure Glass BOTTOM DUE AT
Be /Bow Frame Screens FULL INSTALL
Please Initial.
Roof.' ❑ Soffit: ❑ Customer understands that E PRO®tloes not
Garden Window do any painting r staining. CASH
o
Awning g. (le:when removing " Balance paid to installer at installation
or replacing interior stops or trim)
Hopper haped NEWPRO®is not responsible for conditions or
S
Other circumstances beyond its control including con- FINANCE
G D densation resulting from or due to pre-existing Bank completion tone signed at installation'%
Colonial SDL Euro conditions.
D SCRIB W RK: m6/.P_ S
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Est.Start Date: Customer understands this is an"estimated date"
Est. Comp. Date:
m
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, is the Owners 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 applicaton referencing
a time schedule of payment,to be made under this tract,and the amount of each payment stated in dollars,including all finance charges,shall be
con i
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
for/Yfor explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
has seen"sample"warranties that will be provided by NEWPRO upon installation. Sample w ranties provided to Owner.
IN WITNESS WHEREOF,the parties have hereunto signed their names this
GJ �� n _day,�' L 20DS
/� EIN# Signed )
Marketing Representative Printed Nam
Accepted: NEW OOperefing, C
By
Signed
CORPO TE OFFICE Owner
26 Cedar St WARWICK BRANCH OFFICE
Woburn,MA 01801 24 Minnesota Ave
(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 py PINK: File Copy GOLD: Finance Copy
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rOMER
MAIL ADDRESS HOME PHONE �y ��' �' !
DATE S/ID�v`� WORK/CELLPHONE
(Circle one) F6x a. 'f 7f- 2-7$—
ADDRESS �� r/��� " ' � BEST DAY TO INSTALL: M T W TH F.
CITY,STATE � /` Y N'
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PRODUCT SPECIALIST c116V�- j k4y'?aQ_, BRANCH: kI� ESTIMATED START DATE.
TOTAL#OF #OF DOORS WINDOW COLOR
WINDOWS #OF BOW/BAY/GARDEN swan,Steel,Petlo
wside/0ulside CAP COLOR
OPENING SIZE STOPS
NO. STYLE W x H U.I. LOCATION GRID SCR IN OUT ADDITIONS OPENING CUT
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Measureman: -
Initials D e - Crew Size Needed Time Frame to Complete Job. Capping T e
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Special Installation Instruct s �N l p GI�"�
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5/7/2009 3:59 PH Man: nacUcure Insurance«acUntire, Insurance A9en TO: 8.17819320060 PAGE: 002 OP 003
ACORD CERTIFICATE OF LIABILITY INSURANCE os/0"7/20 0
°nooucFa (508)366-6161 FAX (508)366-5202 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Nackintire.Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
11 West Main Street HOLDER.THIS CERTIFICATE DROFOESA.BVNOT AMEND EXTEND OR
Westborough, MA 01581-1931
ALTER THE COVERAGE AFFO THE POLICIES BELOW.
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INSURERS AFFORDING COVERAGE - NAICB
Hansen Newpro Operating LLC IFauma Peerless Insurance Co. 24199 -
26 Cedar St. INSURER a:
Woburn, MA 01801 INswwn - -
INSURER E:
bOVERACPS
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 WE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUNMS.
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DW-K-27.00016-0001
NERGY PERFORMANCE RATINGS
Gain Coefficient
U-Factor N.S.A-P) Solar Heat Ga
O a i V 0.27
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Ali Leakage(U.S./I-P)
0.40 0,01
Condensation Resistance
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The Commonwealth of Massachusetts
Department of Industrial Accidents
(� Office of Investigations
600 Washington Street
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Boston, MA 02111
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Workers' Compensation Insurance Affidavit: Builders/Contractors;'Electricians/Plumbers
Applicant Information Please Print Legibly
Name Gusiness/Organizationflndividuall: N�WP�O
Address: 22 CEDAk. ST
City/State.Zip: WOl3U,_A1 MR 01801 Phone ,=: `7S l - 93,A-d'36b EXT a5i
Are you an employer' Check the appropriate box: Type of project (required):
i. I am a employer with 50 f 4. ❑ I am a general contractor and 1 6 ❑ New construction
employees (full and/or part-time).' have hired the sub-contractors
7,❑ am a ooie p:opRiwr or partri
listed rn the attached sheet : 7. Remodeling
1
These sub-contractors have S. ❑ Demolition
ship and have no employees
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
J.ElI am a homeowner doing all work right of exemption per MGL 11.❑ 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' 13.❑ Other
comp. 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 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 attached an additional sheet showing the name of the sub-contractors and their workers'comp.polic% inforrrtation.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.Insurance Company Name: HQCkir)4ire Tnsuronce Aginoc!j _
Policy r or Self-ins. Lic. =: IN G S to y 5 q'1 L Expiration Date: 5- I - 2 O 10
Job Site Address: I CO 1 1 oWard Cq Cirv/State/Zip: So I-ern
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 S 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 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 terrify under the pains andpenalties ofperjury that the information provided above is truce and correct
Signature! F M' Date /o /.S/o 9
i
Phone" r1 q 5 3- 8114tp —
Official use only. Do not write in this area,to he completed by city or town official.
Citv 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#: