11 INTERVALE RD - BUILDING INSPECTION Irk - 10,4 q __)O q z to
�- The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
EM
Massachusetts State Building Code, 780 CMR SALRevised Mar 201/
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use-Only,
Building Permit Number: Date Appl' d:
,r builumg Official(Print Name) e Signature ; Date
r. SECTION 1:SITE INFORMATION
1.1 Property Address- p(� 1.2-�) Assessors Ma &Parcel Numbersho 11tGLdL6 LL. L� — � 'i21-1__
Ma is this au accepted street?yes no r"'p number Pa cel fur ber
-3 Zoning)aformition: 1.4 Prot.ertvDimensions:
Zoning District y r t Proposed Use Lot Area(sq ft) Frontage(ft) o CA
1.5 Building Setbacks(ft) n
Front Yard Side Yards Rear Yard ~=
Required Provided Required �rovided Required Pmvidetty Drii n
rc
rn
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❑ Check if yes❑ Municipal❑ On site mspo:;al syste�l]
SECTION 2: PROPERTY OWNERSHIP[
.1. Ownerlof ord: .-
Name(Print) City,State,ZIP
_J i ���s`✓ale-�-------
No.uid Sue;er -Telephone Er :z'Address
FECTION 3:"DESCRIPTION OF PROPOSED WORK'. (check all that apply)"
f New Construction❑" Existing Building❑ Owner-Occupied ❑ I Repairs(s4 Alteration(s) 0 Addition ❑ -
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:�Tosilw I I n 4
SECTION 4:ESTIMATED ICONSTRUCTIONCOSTS et.-
Estimated Costs:
Item n
Labor and Materials OlLctal Use O
,-` . .'"- .. ..-.�- •�ly
1. Building $ 10 t7�] <Ie Building Permit Fee:$ Indicate how fee is determined::
13 Standard,City/Town Application Fee
2.Electrical $ Total Project Cost'-(Item 6)x multiplier x
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: $ �Ui35'{,Oa p Paid in Full ❑Outstanding Balance Due:
P.t L '_O COn3t-(Z
SECTION 5 CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) -
7hd ria S Y'. rdxny License Number Expiration Date
Name of CSL Holder I
List CSL Type(see below) �J -
. . a6 T - Description .
No.and Street`
W Unrestricted(Buildings u to 35,000 cu. ft.)
obU(()t m A d( g Q( U
Restricted 1&2 Family Dwelling '
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding - - -
SF Solid Fuel Burning Appliances
I Insulation --
Telephone Email address D Demolition -
5.2 Registered Home Improvement Cu.itractor(HIC)
' ' _ _)y am _ b �-14
—_.. - HI Registration Number Expiration Pate
HIC�Ca a/ Na�m�e rH[C.Regisn tName III
TlCl�c]
No qnd Street mail ad ss -
t � 1fY)ia >>�a► ��l � q�� �4��
City/Town,State,ZIP Tele h
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 ......... XJ No...........❑
SECTION 7a:OWNER'AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR
�1OR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject rroperty,hereby a:thorize. ( LG
to act on my behalf,in all matters relative to work authorized this bull ng permit a lication.
) t
`I� u- .nJS�J- a).19C -----
Pnnt O ner's Name(Electronic Signature) Date
a . SECTION 7b: OWNER'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.
Print Owner's or Authorized Agent's Name(Electronic Signamue) I Dale -
-- 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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dl)s
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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"
MA Reg#146589 INFrom0rr Homet,Yomn
CT Reg#0605216 Contract#
RI Rey#26463 Energy 5aving Horne lmproventenn Federal ID#20-2625129
Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211 (F)781-933-9626,www.newpro.coom 65899
THIS CONTRACT MADE THE L day of �„ : 2.0 �
� between `c. _
( -er1t.P + / 1 F't-7fC �,( r�c3 N4 '�01 5-7rU}' 7/o— �y_
(Home Owners) (Home Phone) (Bus/Cell Phone)
Of I ,' L4ii,V ( tt �` �1} tii b6 10
(Address) (City) (State) (Zip)
the"Owner"and NEWPRO Operating, LLC, "NEWPRO". (E-Mail) for proprietary use only
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:
",itrz 1 i. Q ❑ The job address is a condominium.
(Job Address)
TOTAL#; a e, NEWPRO y/' WINDOW OPTIONS• rY '" «" V •z 4' ""` y:
WINDOWS,:,"ia-- ; /v SERIES# (- 1)/) ! Grids:LJ YES V NO LJCONTOUR LJSDL LJEUROLJDIAMOND
Window Color CITY I Window Color CITY DES I TMP: (Location) ❑T P ❑BOTTOM
Int: I I-�'T- Int: Screens: (Exterior color Full Screen Standard) ,. HALF []FULL
Ext i HT Ext: Vent Latches: -0S [} YES ❑NO
Capping Color: (�Gjli DOORS rs. V, tv 1''.'; MODEL'°CITY Please Initial:
PVC LU,,Smooth NoMar No Capping Sliding Glass Door '
MODEL NAME,. s s. 4 o .x, ri.MODELil Or Lt.QTYJ4 Color In: Out: Customer understands that NEWPROO
Double Hung (-/`/(r 755 t) Active: Left Center ht does not do any painting or staining.
2 Lite Slider 757 HDWR: SN BB WH BGE (ie:when removing or replacing interior
3 Lite Slider (1/4,v2,114) 753 Entry Door Style stops rtrim). NEWPROOis not respon-
3 Lite Slider (1/3,1/3,113) 756 Color In: O ( sible for conditions or circumstances be-
Casement(Hinged Right) _851 Fiberglass Steel yond its control including condensation result-
Casement(Hinged Left) 85 HDWR: SN BB AGB AB ORB ing from or due to pre-existing conditions.
Twin Casement Z 853 3idelite t le",'"`'" u" ; I (circle one):
Stationary Casement � 856 color In: out. CASH
Triple Casement (1/4,1/2.1/4) 859 Storm Door$ le '''d Balance paid to installer at completion
Triple Casement (113,v3,vs) 860 Color
Picture Window _751 HDWR: SN BB AGB AB FINANCE
Sash Only 752 ft Hinge Right Hinge Bank completion form signed at installation
Hopper 491 Entry 06or Style i"
Awning 351 color In: out: -`TOTAL'
Garden yvilinclow 798 Fiberglass steel y C_ASH "J�)
Bay n
dow(Roof/Soffit) H WR: SN BB AGB AB ORB "`.PRICE' /`�' i f
Bo Indow,(Roof/Soffit) Dither Door "r '` '" s. DEPOSIT. � .
Other Color In: Out: Tilt'
7H r
Pther HDWR: ORDER`:
DESCRIBE WORK&PROMOTIONS APPLIED: T a,)14. -( C.d tr C strr J /_; a,.TOTAL
f .I A4 r I DUE AT
'. n. A.,. . Y-' F f .I.'l .)- f f..ii r� is 11' ( .^"1 /flyfr ya 4. 1 INSTALL
Est. Start Date: -j-if Est. Comp.Date: `�- - l Customer understands this is an"estimated date" T'�t
Owner has read and agrees to the terms and conditions on the front 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 promises made by NEWPRO. Owner has been
orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the
date of this transaction and Owner was provided with two(2) copies of a cancellation form explaining this right.
DO NOT SIGN 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 entitled to a copy of this•'
Agreement at the time you sign it. (3)You may at6y time pay off the full unpaid'b'alance 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 seller
has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased
under this Agreement. (5)You may cancel this Agreement if it has not been at the main office or branch office of
the seller in the Agreement by registered or certified mail,which shall 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. See the accompanying notice of cancellation form for an explanation of
buyer's rights.
(Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing
Boardt I.consumer education materials. � Owner's initials
lt/
By: 1�( l/��} 1 7 /C. 4-?oy- EIN# Signed:
Product Specialist(Printed Name) owner
NEIN O Operating,IIC(Signature) Owner
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
us-is
Rm1z
ADDITIONAL TERMS AND CONDITIONS
LL i �
yVar§'anties:'rkny product warranties are provided by the manufacturers of the products that Owner is purchasing. NEWPRO is also
providing Owner with a labor warranty, which covers NEWPRO's labor. Owner understands that Owner should read all the written
warranties for complete details of warranty coverage and that warranties are available for complete review before signing this Agreement.
Late Cancellation: Owner understands that Owner has three (3) business days to cancel this Agreement. Owner understands that if
Owner wants to cancel this Agreement after those three (3) days, NEWPRO does not have to allow that. Owner understands that if
NEWPRO does let Owner cancel, however, that Owner will have to pay to NEWPRO a late cancellation fee equal to 33.3% of the
purchase price in order to cover NEWPRO's labor,administrative,and material costs, so tong as that is legally allowed.
Delay/Unknown Conditions/Damages: Owner understands that ifNEWPRO determines within thirty(30)days of the date of this
Agreement that it cannot perform the work according to NEWPRO's professional standards,NEWPRO can cancel this Agreement,notify
Owner of cancellation,and promptly return Owner's money.Owner understands that issues that may cause NEWPRO to cancel this
Agreement include incorrect pricing or unknown pre-existing conditions to the property.Owner understands that NEWPRO is not
responsible for structural or other defects in the property,and that NEWPRO's products do not cure these problems. Owner understands
that the work could be delayed by events that NEWPRO does not control. Owner understands that NEWPRO is not responsible for(a)
damages due to causes beyond NEWPRO's control,(b)damages arising from a delay in NEWPRO performing under this Agreement or
(c)unintentional damage to Owner's personal property,it being understood that it is Owner's responsibility to remove/secure his personal
property prior to commencement of work.
When Money Is Due: Owner agrees that when the work is"substantially complete",Owner will pay the balance due on this Agreement.
Owner understands that "substantially complete" means the work has been materially finished, functional as intended, and a final
inspection,permit,or occupancy certificate,if required, has been obtained. Owner agrees that once Owner has paid the purchase price, if
Owner believes any of the work performed by NEWPRO is defective or incomplete, NEWPRO will inspect the work and perform any
service Owner is entitled to under this Agreement and/or any warranty. Owner agrees that if Owner does not pay any of the money when
it is due,Owner can be charged a late fee of'1.5%on the arnount owed for each month the money is not paid. Owner agrees that if Owner
defaults on any promises under this Agreement,and NEWPRO hires an attorney to enforce this Agreement, Owner will pay NEWPRO its
reasonable legal fees and related costs or expenses,as long as it is legal for Owner to do that.
Other Understandings: Owner agrees that Owner will assert a dispute,claim,or controversy(hereafter referred to as a "Claim")
arising under or relating to this Agreement only on behalf of Owner's own self and that Owner will not assert a Claim on behalf
of,or as a member of,a class or group in either an arbitration proceeding,a private attorney general action or in any other forum
or action. If a court determines that this specific paragraph is not fully enforceable, the court's determination shall be subject to appeal.
This paragraph does not apply to any lawsuit or administrative proceeding filed against NEWPRO by a state or federal government
agency even when such agency is seeking relief on behalf of a class of buyers. Owner agrees and understand that if Owner finances the
work, Owner's separately provided financing documents will include the number of monthly payments and the amount of each payment,
including any finance charge. Owner promises that he will provide NEWPRO with access to the work area, including access to electrical
outlets. Owner understands that this Agreement and any attachments make up the entire understanding between the parties. Owner agrees
that any change to this Agreement must be in writing and signed by both parries.
(Massachusetts Sales Only): All contractors and subcontractors must be registered by the administrator of the Board of Building
Regulations and Standards and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of
Consumer Affairs and Business Regulation,Ten Park Plaza, Suite 5170. Boston,Massachusetts 02116 Telephone: (617)973-8700.
It shall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement,as the Owner's Agent.NEWPRO
shall advise Owner of any necessary permits. 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.
Any deposit required under this Agreement to be paid in advance of the commencement of work shall not exceed the greater of one-third of
the total contract price or the actual cost of any materials or equipment of a special order or custom-made nature,which must be ordered in
advance of the commencement of work,in order to assure that the project will proceed on schedule.No final payment shall be demanded
until the contract is completed to the satisfaction of the parties.
(Rhode Island Sales Only): THIS IS A NON-NEGOTIABLE CONSUMER NOTE. During the term of this Agreement,NEWPRO shall
maintain public liability and property damage insurance covering the work of not less than $500,000 combined single limit, bodily injury
and property damage and workers' compensation insurance as required under chapter 29 of title 28. NEWPRO and/or subcontractors or
material persons may file a lien in accordance with Rhode Island Mechanics Lien Act,chapter 28 of title 34.
(]Maine Sales Only): Consumers are strongly advised to visit the Attorney General's publicly accessible website
(www.maine.gov/ag) to gather current information on how to enforce their rights when constructing or repairing their homes.
The Attorney General can be contacted by telephone at 207-626-8800.
Any alteration or deviation from the above contractual specifications that results in a revision of the contract price will be executed only
upon the parties entering into a written change order.
In addition to any additional warranties agreed to by the parties, NEWPRO warrants that the work will be free from faulty materials,
constructed according to the standards of the building code applicable for this location, constructed in a skillful manmer, and fit for
habitation or appropriate use.The warranty rights and set forth in the Maine Uniform Commercial Code apply to this Agreement.
If a dispute arises concerning the provisions of this contract or the performance by the parties that may not be resolved through a small
claims action, then the parties agree to settle this dispute by jointly paying for one of the following: O Binding arbitration as regulated by
the Maine Uniform Arbitration Act, with the parties agreeing to accept as final the arbitrator's decision; O Nonbinding arbitration,with
the parties free to not accept the arbitrator's decision and to seek satisfaction through other means, including a lawsuit; or O Mediation,
with the parties agreeing to enter into good faith negotiations through a neutral mediator in order to attempt to resolve their differences.
(Connecticut Sales Only): THIS INSTRUMENT IS BASED UPON A HOME SOLICITATION SALE, WHICH SALE 1S SUBJECT
TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT. THIS INSTRUMENT IS NOT NEGOTIABLE.
The owner(s) of NEWPRO is or has been a shareholder, member, partner, or owner of the following corporations, limited liability
companies, partnerships, sole proprietorships or other legal entities that have been a home improvement contractor during the previous
five years:NONE
' 5/2/201d 11:16 AM FROM: Fax Mackintire Ins Agcy Inc TO: 17919320960 PAGE: 002 OF 002
'NCO G RTIFI _ATF OF LI__ABILI DATE LIABILITY
(c '
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. If 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 endorsements.
PROWLER NAME: Melissa Pflug
Mackintire Insurance Agency Inc NAME: (508)366-6161 FAX
WC Net: (SOB)344-5202
11 West Main Street IL .melissa 8mackintire.com
INSUtl S AFFORDING COVERAGE NAIC9
Westborough MA 01581-1931 INSURERA.Liberty Mutual/Peerless 24198
INSURED INSURERBACadla Insurance Co.
Newpro Operating LLC INSURER
26 Cedar St. INSURER D:
NSURER E
Woburn MA 01801 INSURERF:
COVERAGES CERTIFICATE NUMBER:13 - 14 Master 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
M ADM
-LTR TYPE OF INSURANCE POLICY NIAMBER MMI POLICY FF M I I 'LIMIT6
CYEXF
GENERAL LIABILITY In
EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwnence $ 100,000
A CLAW"ADE ®OCCUR BP 8589577 2/31/2013 2/32/2014 MEDEFP An one Orson 5,000
PERSONAL6ADVIN,URY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,00
X POLICY PRO- LOC g
POMOBILELIABIUTY OMBINent ED L LM 1 000 000
AANY AUTO BODILY INJURY(Per person) $ALL OYMED X SCHEDULED 8584174 2/31/2013 2/31/2019BO
AUTOS AUTOGDILY INJURYHIREDAUTOS X AUT08MED PROPERTY DAMAGE
Perecddent $
Uninsured motorist Elsplit limit $ 250.0001
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,0001
A EXCESS IAB CLIOMSMADE
AGGREGATE $ 5,000,000
'DED I X I RETENTION 10,000 1 0582578 2/31/2013 2/31/2014
B WORKERS COMPENSATION 173
IC STATU- OTH-
ANDEMPLOYER5LMIBILITY T RY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT
CFFICER/MEn BERNHI EXCLUDED? NIA(MI e7C-20-20-003506-01 /1/2034 /1/2015 $ 500 000
EL DISEASE-EA EMPLOYE $ SOO OOO
If yes,de 1 under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACOM 101,ACditipnW Remarks Schedule,Ir more apace le re4u1nd)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TO WhOM It May Concern ACCORDANCE WITH THE POLICY PROVISIONS.
A$ITIXIR12ED REPRESENTATIVE
T Moynagh MARIAN
ACORD 25(2010105) ®1988.2010 ACORD CORPORATION. All rights reserved.
INS025(201005).01 The ACORD name and logo are registered marks of ACORD
r The Commonwealth of Massachusetts
Department of Industrial Accidents
tee o nvestlgations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organization/Individual): AI e.LA_-,r--, (54.a Ll_L
J.
Address: a� �'� 7�f SST. -
City/State/Zip: Lia6L,Cn i P] ) q C) C3, Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
I I am a employer with So 4. ❑ I am a general contractor and 1 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. t y U Remodeling
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 ME]Electrical repairs or additions
3.❑ I 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 new affidavit indicating such.
=Contractors 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
inforuration. -
i
Insurance Company Name: {mac J�In - 1 n Stm r-rnce_ J9�OCY
Policy#or Self-ins.Lie.#: Expiration Dater
Job Site Address:_ Na I �� City/State/Zip: �5akrn, M19 61 9°7o
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 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 certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature• 12"11~ aif Date � ��
Phone#:
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/Liceuse#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other T ._r. _
Contact Person: Phone#:
I
5 -
_ ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date.If found return to:
-r Registration: 146589 Office of Consumer Affairs and Business Regulation
";"' -- Type: 10 Park Plaza-Suite 5170
Expiration: 5/5/2015 Supplement bard
NEWPRO OPERATING-, LLC. Boston,MA 02116
THOMAS FOXON - -
26 CEDAR MA
WOBURN, MA 01801
Undersecretary Not valid without sigry tore
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Cnnstruction Supcn'isur - - - -
_icense: CS-029090
THOMAS PFOXQN
230 WALNUT STs
READINGMA 01H6T
t�
=k.pfratlOn
Commissioner 11/19/2015
im now
WMEEM
® - quelllled In an zones
NEWPRO MANUFACTURING
C1NFRc SERIES G NEWPRO 2000130001
LORC
4000 DOUBLE HUNG
:,llli Cellular PVC frame,Triple glazed,
Nallonal Fenealred®n Low E coating(e=0.027, S2&5),
Rating Caundl
a Argon/air filled
DEV•K•27.00034.00001
ENERGY PERFORMANCE RATINGS
U-Factor(U.SJI-P) Solar Heat Gain Coefficient
®w'� ®c24
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage (U.S./I-P)
0.40 0. 1
Condensation Resistance
67
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