212 LORING AVE - BUILDING INSPECTION Application for Permit to:
Location
Permit Granted
/S/a
App ' v
/ L
Inspector of Buildings
//1\/\ / I %
CITY OF S.ULENI, TNLxSSACHUSETTS
• BUELDLNG DEP ART.%MNT
` 120 WASHINGTON STREET,Yo FLooR
T FL. (978) 745-9595
PA.x(978) 740-98"
KIN[BERLEY DRISCOLL
MAYOR T HoMAs ST.PtERRs
DIRECTOR OF PIBLic PROPERTY/BUILDING CONDMIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
r 111, S 150A.
i
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
rn
(name of facili y T
(address of facility)
signature of permit applicant
V
dace
dcbriwiF.doc
CITY OF S UETNI, NULSSACHUSETTS
• BL MnLNG DEP AR'n [INT
' 120 WASHINGTON STREET,3ra FLOOR
s' TEL (978)745-9595
FAX(978) 740-9846
KEMBERLEY DRISCOLL
MAYOR THOMAS ST.P�RRB
DIRECTOR OF PUBLIC PROPERTY/BVILDING CONMUSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibly
Name(BusnxssiOrganization/individmi): w)Qyo LU .
Address: �� ORALs4 -34. 6iobr_ n _ i�G
city/state/zip: MC. Phone #: O
Are you an employer?Check the appropriate box: Type or project(required):
I.❑ 1 am a employer with 4. ❑ I am a general contractor and I
+ have hired the sub-contractors 6. ❑New construction
employees(full and/or part-tune).2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7, ❑ Remodeling
ship and have no employees These sub-contractona 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 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions
myself. No workers' comp, C. 152, 1(4),and we have no
Y- [ P § 12.0 Roof repairs
insurance required.)t employees. [No workers' 13.0 Other
comp, insurance required.]
'n^Y^ppacont That checks box#1 nowl also fill out the section below showing their worlds'compensation policy inromtatien.
*Ilonxowneo who submit this affidavit indicating they are doing all work and then him outside ommosers must submit a new affidavit indicating such,
=Cdrtioctats that cheek this lox must onachod an additiontal shod showing the name of the atb.tomractots mud their worlano'comp,policy mlers atim.
I am an employer that Is providing workers'compensadon insurance for my employees. Below is the pelicy and Job site
injormarion.
Insurance Company Name: AL beI "
Policy#or Self-ins.Lie.#: S_,0(1 (.0,,OO Expiration Date: 5
Job Site Atkimss:a i a LUr Mr, 0,L- City/Statwzip:V�QbIY\ a 1► 1 G.
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 wall as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 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.
/do hereby certify trader the pains and penal-ties ojperfury that the information provided above Is true and correct INS
Signarttre: " '(`t�= Date• 01 La 1 1�1J 1
Phone#: ::) ` -7 �(q - 7-�:i_ I0 C3 i
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permidldeense#
Issuing Authority (circle one):
1. Board of tiealtb 2.Building Department 3.Ci(ylfown Clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person:— Phone#•
S
i - CITY OF SALE,% iNLAsSACHUSET B
130 W.{sttnvG'rou STnEsr. Yo Rooa
�-, TEL (978) 745-9595
PAX(978) 740.9846
KIaffiERLEY DRISCOI L (�
MAYOR THOarAs ST.PtERaB "�1��
DIRECTOR OF PUBLIC PROPERTY/KnING CO%M - _f�
APPEWATM FOR THE CONSIRUCMW REAAlk$WMAMN. CHANGE IN USE OR ,- ,
OCCUPANCY.OR DEMOLITION OF ANY SWLDINO OR STRUCTURE
r".86c on.for OMkm Use 0W -
itTo
1 i
4
.001W
Start End:
Da/os: . .
d
O Conwnenbr
1.0 SITE INFORMATION
r Logtlon Nance BuddkW
Propti Address: (�//�//
V i / / c,
till Assessors Map�IBiodc Lot/Parcak
2.� ORIYATION
Y 2.1 Owner at LAW
�l� ^ Name: pi
Address:
Telephone.
2.2 Owner or lessee of buffs ft or abuahm
Nemec.
Address:
�d Telephone:
V
3.0 AGENCY OR AUTHORITY AUTHORIZING CONSTRUCTION
Agency Name:
Address:
Agency Project Number:
Projed Manager Name: L.�_
4.0 PROFESSIONAL DESIGN SERVICES:: r^
4.1 Reglstered TArch"iAi'` 7
r
Name: Seal and Signaiuro ''
Address:
Fak w
42 llti ;ed prokss&, " gtitei se"tue:` u tl i.carsoiy ane alNd+b waM 4l
Nmw Seal and, °
f1
Telepho w. Fax:
Nemx :�
Address:
Telephone:.. Fax ,.
Ares a Responsibility
Name: Seal and Signature
Address:
t
Fax:
responsibility:
i
5.0 DESIGN AND CONSTRUCTION UTILiZ1�14 MGL C 112 SECTION 81 R EXEMPTlON3
(See note below)
Contractor
Name:
Address: &C.
b
5
Area of responsibility
Elodhdd NUmber3_ Date of,Expiratiom
Telephone: $� �'( * ,. : ;:Fa�c
a�-
s QMtredor
w
'i Address
f
Area of responsibility-
License Number. Date of Expiration:
-Telephone: Fax
Contractor
Name:
f
Address.
I'f Area of responsibility:
License Number. Date of Expiration:
Telephone: Fax:
Note: For portions of work utl buV exemptions Of Munk.112 e.8111 complete thq,sectlon above..
Use additional sheets if necessary and attach to application.
8.O PROFESSIONAL CONSTRUCTION SERVICES:
8.1 General.Contractor
Address.
jTelephone: Fax:
Responsible In Charge of Construction:
7.0 CONSTRUCTION DOCUMENTS -to be prepared by applieant re n
Item° d as Appal iabil 74
7.1 Plans(Note 1 this page) Submitted Incomplete Not Reeuired
7.1.1 Architectural
7.1.2 Foundation
i
7.1.3 Structural
7.1.4 Fire Suppression ,, x
7.1.5 Fire Alarm
a
7.1.6 HVAC
7.1.7 Electrical
7.2 Specifications
7.3 Structurat Peer Review
7.4 Structural Tests & Inspections '
Program
7.5 Fire Protection Narrative Report
7.6 Existing Building Survey
7.7 Workers Compensation Insurance
7.8 Other Documents (Specify)
(Energy Narratives, etc.)
Note 1 Areas of Design or Construction for which Plans are not complete at the time of
this application must be identified herein.' Work so identified must not be commenced until this
application has been amended and proposed construction has been approved by the
Department of Public Safety Distrid Building'Inspector having Jurisdiction.
8.0 COMPUTE THIS SECTION FOR NEU "CONSTRUCTION ONLY
_For 6k Build procead,to Section 9.0
Number of Stories above " 'Number of stories Behr Grade Gras
Story Height Area Per Floor
Total Building Height Tot ,Building,Area Above
above Grade Grape } ,
"
Total Building depth below - To' tel Building Arei Below"
Gam.... r_
Brief Description of Proposed Work
a9
t 82' USE GROUP ANDZONSTRUC IONGLA 311FICATION.(NowConsbuctlon;Only),
U34:O* U :.r ' G Ups TEGO_ 'CONBRtJCTION
�fak' 1 �r x«, , CLASSIFICATION
1 7 sp
ai s ' �Y u /� " Artl ' ' A�4
Pea 7 .i.. .-�i�r 't s..n. n,_.
13 "nose 1 B
E Educatiana 2A
F Factpry F-1 F-2 2B
H ' Higi Hazard H-1 H-2 H-3 H-4 2C
i Inst�tutlona 1-1 1-2 1-3 3A
M; Mercanttle ` Y 38
R Residential; R-1 R-2 R-3 4
S Storage 3-1 S-2 5A,
U Utility 5B
Mx Mixed Use Specify.
Specify.
Sp' Special Use
fAdd
COMPLETE THIS SECTION FOR WORK IN EXIarlNG BUILDINGS ONLY
For new s ctio 0
�/�/� covation Number of Stories Renovated
Change in Use New
Demolition Existing-
a 5
f a pe
r
(so Renovated
Approximate year o
construdiai or renovation. �.
of existing building
add Description of Proposed ta
vin
„{
�YIC� r
f,
v
GQuP AND C,O.N$iRUCTI ?M'CLJ18S1ITION( zisYnpirIjiQnlj�
E)uSTI W-7 t ""PROPOSED Chanps� JCr
t0
USE Group(sy" zr ,. ;CLASSIFICA
U Hazard Usea H . Hazard
TIC 4
x
v(imtesubcateeo+» Group Index: `Oroulp .. Irk- ..Indek" ('J
A Assembly `1'A
8 Business
E Educational ?J►
F Factory 2E > I
H High Hazard 2C l
I InSffiubonak, 3A- Y
M Mercantile 38
v
R Residential. _ 4
S Storaga SA
U Utility SR.
Mx Mixed Use Hazard Index
Modifier
Sp Special Use
Note: Include Hazard Index Modifier for Construction Type as applicable
MA Reg. #146589 Siding Contract
CT Reg.#0605216 Owwwmq
RI Reg. #26465 American Classic Wall Sys Federal ID #20-2625129
r Corporate Headquarters:26 Ceitar St.,P.O.Box 2696 Woburn,MA011188 (781)9334100 1-800-342-22/1
THIS CONTRACT MADE THE day of 200 between
/� (Home Own ) Home Phone) /��f deW
(Bus✓Cell Phone) (Mr./Mrs.)Z�f
(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 folloyng described work at the pr raises located at
�uc� g� �i
(Job address)--" (E-Mail Address)
Specifications APPROVED MATERIALS WILL BE FURNISHED AND INSTALLED TO THESE SPECIFICATIONS.
P PLEASE READ CAREFULLY:ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER.
YES 0Wy l�FPrlJI�' C YES NO
1. O SOLID VINYL SIDING cover only Malwa-irarea designated fo�-r s,ildi� 15. O NO
wrap with approved VINYL CLAD ALUMINUM.
except t q�e areas desi hated below. + FJ�l (No circular or round columns) Color
Ize Color Pattern Package./G 16. 00, D GUTTERS/LEADERS remove existing and replace}}'v+ith new custom
Custom corner posts color / seamless gutters and leaders. O White E1Brown
1A. O SIDI will be applied to the followin areas only: 17• f� SHUTTERS provide&install .5 pair a roved olystyrene
row-Elevation ear levati1 OOther shutters. Color
p•C�ft Elevation t Elevation O Other 18. O MASTER MOUNTSIprovide&install for exterior light fixtures only.
Partial ails: % '� V 18A.)Lights# e7t _ 18B.)Water/Elect O et#,�_
O Entire ails: �18C.)Dryer Vent# Color FIRE13 Pr
2. O IN$ULpTION Qoverpnly�iatwal!areas designated for siding with 1g• (tJ'173 GABLE VENTS r vide and install r+2- vents.
,�([/ {"1-Y-2cI 'Zh(rJ1C. inch insulation. y,
.e1'✓- y� Color F%QE�i=ICee No circular or triangle vents.
3. O U�seapproved STARTER STRIP where contractor deems necessary. 20. -/�Ir��' CLEAN UP property at completion of work.
4. O _1S1 ing available
lo be applih over EXISTING(STING FOUNDATION. 21. L7� INSURANCE All Workman's Compensation and Liability to be maintained.
5. O se approved PERMA TABS AND FINISH STRIP where contractor 22. V/0 WARRANTY Mail to customer after completion&full payment is received.
deems necessary in same color as siding.(Not available with Nailrte) PAYMENTS on NON-FINANCED orders installer is authorized to collect
6. • O WIN40W OPENINGS / progressive payments.
ustom ra with approved vinyl clad alu hum 24. 111 O ADDITIONAL WORK(not specified above)
# rV color i uc!OC/,L/D F13v✓vey/lrJtAril�C'D s M r92r
O Jump over casings with siding and"J"channels F
# Color F r-
O Channel existing window only leg.Andersen type or previously 25. O
rapped)# -�.- ColorS!+-
J/wO+ther details
7. f,rT,rr�/CAULK all sills with rubberized color coordinated caulking.
8. IOr" OORS custoy�wra with approved VINYL C UMI U 26. epair or Re pi Cep followingwoods
/,#p of Doors PD Color l p ///S /`c /I/G�L��fi/•
9. Vd' D GARAGE DOOR FRAMES custom wrap wit�pproj���v
VIN CLAD ALUMINUM. Color
ingle O Double with Mull O Double No Mull
10. O FASCIA custom wrap with approved ` ,ra���
V LCLAD ALUMINUM. Color NK -- --
INDICATE F RM F PAYMENT
11.0 OFTET,(eaves/overhangs)Exptarea noted cover with approved SOLID VINYL SOFFIT
/SYSTEM.Except area noted below.1/3 Vented. Color �y �.✓C/��'
12. O ROTTEN WOOD Will only be repaired or replaced where specified on line Deposit With Order a 33% $ /
Item#26listed below.Any additional areas needing a repair will be
Payment on %
estimated upon their o discovery and priced accordingly. Measure or S rt � 33% $
(Does not include wood stustuds,or exterior sheathing.)
13. O RFJwIOVE EXISTING MAT exterior of house. O Other Balance Due on
'Vinyl 0Alummurll• ood Shingle OWood ng Substantial Completion 34% $ ------- .
14.O PORCH CEILINGS cover with approved SOLID VINYL CEILING MATERIAL Total Amount of
in the following areas:
Balance to be Financed $
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 unregisteretl Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and
Subcontractors shall be regis[eretl 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 credh 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 port'on of the credit application referencing a time schedule of payment,to be made under this contract,and the
amount of each payment statetl in tlollars,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 ppermit 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
sap n ItY withouif a proof of loss or damage.
NEWPRO shall not be heltl liable in damages far 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
pasted, by telegram sent or by delivery, not later that: 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.dclw zz' f' /( ?� -
❑ Sample warranties provided to Owner. Y` rcl
IN WITNESS WHEREOF,the parties have hereunto signed their names this day of ApBTU 200 �
EIN# Signed
Marketing Representative Printed Name Ti hlctla5 Owner
Accepted:NEWPRO Operating, LLC
By Signed.
Marketing Representative Signature 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
WHITE:Branch Copy YELLOW:Customer's Copy PINK:File Copy GOLD:Finance Copy
US-21(Rev 1/07)
!� Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration 146589 - Board of Building Regulations and Standards
Expiration: 515/2009 One Ashburton Place Rm 1301
Type: Supplement Cab Boston,Ma.02108
NEWPRO OPERATING LLC 't
MARK HOLLETT t,...r. �"-7
26 CEDAR ST. w`
WOBURN,MA 01801 Administrator Not valid without signature
'A
• •05/01/2007 12:50 FAX 1781933SG26 NEWPRO a SHRE4IS8URY [A 001/001
vov'v rr liI 1Z:94 NAA 16177709683 AMERICAN FIRST INSURANCE -z001
�coRo 1=VR CERTIFICATE OF LIABILITY INSURANCE DATB(MMDGrvYvrt
la 05/01/07
PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OP IN FORMATION
•ONLY AND CONFERS NO RIGHTS UPON THE CERITFICATE
American rirat Ina Agency Inc 'HOLDER.THIS CERnFICAYE DOES NOT AMEND,E XTEND OR
122 Quincy shore Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Quincy MA 02171
Phone 617-770-9000 INSURERS AFFORDING COVERAGE HAIC0
INsuREo INSURER A, Arballa Protection Mo. Co
INSURER&
WOWN prorating LLC INSURER C: _
PO HOR 2b96 INSURER o.
Woburn NA 01901 --
' _ INSURER E;
i COVERAGE3 __
THE POUCHES OF INSURANCE LISTED BELOW'WAVE BEEN IDSUED TO Tt E 0 WARD NNAEO ABOVE FOR THE POUOY PERIOD INDICATED.NOTW ITHSTµDINO
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHE 1 DI IOUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE WSURANCE AFFORDED BY THE POLICIES DESCRIBE I HEREIN IS BJBJECT YO ALL THE TERMS.GXCLUIRON5 MO CONDITIONS Or SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY P JD )UIMB- POLICY 5FMUTIVE (p�RA7�p
LTR rMMLWERCJALOE:NEHALLlMlL[TY
I+SUPANCPOLICYN MEER DOT DATE EM1M10!'/'f L Ts
Y EACH O�CURRENDE 11,000,000
ALOENEHALLIABILRY 85000001061E 01/01/07 01/01/08 _ s50,000
MADE Q OCCUR PERSONAL S ACV INJURY 11 000,0000EHFRAL AOGAEOAIT $2,000,000
E IIgqMppR.APPLIES PER: PRODUCTS•COMPIOP AOD 12,000,000
JDCT LOC _
AUTOMOBILE LIAMLRV wMaiN�PIBLE LIMIT` 11,000,000
AMY AUTO R1037400001 12/31/06 12/31/07
ALLOWNEOAUJ is BODILY INJURY y
(Pw mfy )
X SCHEDULEDAUTOS
X MIRED AVTOB BODILY HAIRY 1
x NDN•OWNED ALTOS (per eeelOPMI
PROPERTY DAMAGE 1
(Psrwleen0
GARAGE LJASIUTY - j AUTO ONLY•EAAWIDEN" 1
(~�_. FA ACG 1
ANY AUTO - OTHER THAN
AUTO ONLY:
EXCES"MRELLALWeLITT EACH OCCURRUNCE t$ 000,000 -
A X' OCCUR ❑CuIMSMADE 4600010701 01/01/07 01/01/06 AGGREGATE s5,000,000
s
DEDUCTIBLE IL S
RETENTION s _ s 1
YLIMRB ER 1
WORItFJL4 COMPENSATION AND - X YD
A BMpLOYERe'UAMLITY• 90967003 05/01/07 -05/01/08 ELEAOHACCIDENT 1500,000
OPyPIeEC�EWEMB RPCC AXD9 EClfi'HVE
E.L.DISEASE-eA EMPI-ME 3500,000
I'm{AL PROVISIONS OEIow _ 0lti IBE•POUCY LIMIT $500,000
OTHER j
I
DE,gMpTION OFOPERATIONSI LOCATIONS I VEHICLES I TJ(OLUSIONBJ NM—➢�BV E—NDORSEMENT I QAL PR°YIBid18
OPERATIONS Or INSO"D -
fyj
R 1 li
CERTIFICATE HOLDER
CANCELLATION
p 9P81.SE0! SHOULD ANY OP THE AeOVEDmCReee pOUPIa aE CANCNJlO OePORETNe 11(PI TION
DATETMERSOF,THEIBSUMGINSURBRWILLFNOEIIVORTOMAL SO DAYBWRRTFN
MOTI°a To THE OBIOIPIOATC MOLDER NAMED To THE LEFT.BL r FAAUIIA TO BID SO BI)ALl
SYECINBN MPOSE NO OBLIGATION OR LIABILITY OP AN Y KIND UPON THE'I"U"M A9 AGEMTe Oh i
REPREBENTATNBA
AUTHORHM NEFRESIVMATIVE
Jemae J. P6L'.YSD CrCV ! 07 ORPORAnON'116BB
ACORD 26(2001106)