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HomeMy WebLinkAboutBuilding Permit #807-15 - 72 FARRWOOD AVENUE 4/15/2015BUILDING PERMIT TOWN OF NORTH ANDOVER w APPLICATION FOR PLAN EXAMINATION Permit NO: 7Y S Date Received � 5 Date Issued: 1 11_�� L °t 9- ORTANT: Applicant must complete all items on this page LOCATION - �� �G r->^t,� aooiyc, Un F y Pint PROPERTYOWNER D) +Vi',L, -vt'an rint MAP NOPARCEL:��ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic - Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO B,E PKtr-UKMtU: 'C'.x t S i-, n 6 LI) Identification Please Type or Print Clearly) OWNER: Name: 61 �y Phone: 3a-�.5� 8 _ Address: 72 - CON TRACTOR 2CONTRACTOR Name: k-cwp,r 0•DY rcAh' Address: �� CeduT woboen Mfl b1,2 a Supervisor's Construction License. da,Oi 0 1 LJ Exp. Date: fi - N - ► � Home Improvement License: )y t06S9 Exp. Date: S - S - )S ARCHITEC /ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: ULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No. 7 NOTE: Persons contras :ing with unregistered contractors do not have acces�o thI guaranty fund Sianature of Apent/Owner Signature of contractor^ Permit No#: Date Issued: LOCATION BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page Print PROPERTY OWNER Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT` Historic District yes Machine Shop Villaqe ves no no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFURMtL): Identification - Please Type or Print Clearly OWNER: Name: Phone: Ar4rircee- Contractor Name: Phone: Email Address: Supervisor's Construction License: Home Improvement License: Exp. Date: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 1_" t Signature of Agent/Own-er Signature of contractor, Location Fpe zin,t 4 U, A 1 No. o- 6 Date4 I TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $$� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�s Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street _ Fire Department signatureldate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU Its and UA I A — (For department use ❑ Notified for pickup Call Ema I Date Time Contact Name Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application a Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report D Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 CA 10 � Z CD O CLr CL D cam' O 00 CDQ cr CD O CD CL O CO CD LW.J y O O� 0 0 r* cD CD Cl)• CD v z CD O CD W v C) z� n O ;. z m Cf) O cn 0 1 m X cn z m ti O 0 0 0 0 O = —DI fD CO 0 O 0 v. 0CD 0 3 ,h O O n v m s c1n) m W vi 0 (D -0 O = (D ; O CL O " NCD n O O• O C O ...� (O' N Q rt _ - pO O O' W �CCD (D XPL -0— CD o s' Z 0 CD pi.�: =C > CD �, CL • cn � 0 v-' Q C O (v - 5 O < CL — v, Q N o N 7 C v CD CL up CD O 'v U) n O O O .� aO;a c ipt y a cv O 0 rr r CD ID U) C-) N O 0. - Dv m-0 O C o v v N 7c m � Ln mrD Z O co C N m T ;a 5 T 2 N M 77 OG 3 T Z7 Oq 7" T al n 3 7 ro d Z7 O- S T 7 Q m M N �. A T Q \ r M m m D m z H m n O m m n Z �n A O M M C z G) Z (n A O � C v z Z LA fl A 0 3 s ' o0 v O 'n x m rD- s 441 h .Vl^ rxCy * 1•+o0oa Contract # CT Reg #0605216 Federal ID # 20-2625129 RI Reg #26463 lipitiejfriptpvpnienf 5t�liti"ons . ` Corporate Headquarters, 26 Cedar St, Woburn, MA, (P1) 800-342-2211 (F) 781-933-9626, www.newpm.com ` " THIS CONTRACT MADE THE day of 20—t! between (Home Owners) r( i� 11 nn ,,(Home Phone) ^^ (Bus e,. iPhoneJ of �. �f�.f f \�/n r(iIA..1JY1'14 I��4l A1R1t'1'T�v�r n 1 wA t-, (Address) (City) (M (Z%P) L% A0,30 MQ S q Mal . com the "Owner" and NEWPRO Operating, LLC, "NEWPRO". (E-M,01#Jh roprietayo a only NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, fumish all labor and material necessary to install the following described work at lo. premises located at: M qt� The job address is a condominium. t✓ob Address) t07�# YmN.pOIA�(1e FIO ' _.__.. ND'©Yl% • ONS' ..m_�,,..�.�� ::..,.x...�z,.. -r�o,...,u»a:,..v,�.F.,.�,w .c;? $Citi_ r GrldS: YES NO CONTOI)R SDL EURO DIAMOND 111 Window color QTY Window color QTY ;([ocatron) N►Nt IaTOP AEJBOTTOM Int: Int: [� Screens: (Exterior color Full Screen Standard) &ALF ❑ FULL Ext: Ext Vent latches: YES NO Capping Color. Ff6�'a /ease PVC Smooth I Il oMar LJ No Cap Ind ass: _ R Col In Out: Double Hung/Q b Active Left Center Riylit customer understands that NEWPROO 2 Lite Slider HDWR. SN BB BGE W H does not do any painting or staining. 3 Lite Slider (1/4,112,1/4) lie: when removing or replacing Interior 3 Lite Slider (1/3,113, 113) Color In: Out: stops or him). NEWPROS is not respo- Casement (Hinged Right) kergiass Stdel rlsibie for conditions or circumstances bey - Casement (Hinged Left) HDWR: SN BB AGB AB ORB and Its control including condensation resu- Twin Casement e; _ Itirg from or due to pre-existing conditions Stationary Casement Color In: ut (e%r/aone)•- Triple Casement (114,1/2,114) �Wrrrr► QpC as ASH Tr pie Casement (1/3.1ro,1r�) ^ Color In: Out: `F Balance paid to inat completion Picture Window ^ HDWR: SN AB AGB AB Sash Only Left ingeigM Hinge FINANCE Hopper �� ? ---Bank / completion form signed at installation Awning Color In: Out Garden Window Fiberglass Steel 5 235 J Bay Window (Roof/8ofnt) HD SN BB AGB AB ORB BOW Wlndow(Roof/Sofia —^ - Or;1;�:.� Other for In: Out 11111 ��1�� }� ( t_ J S � 51 / j ,,(JJ `l Other HDWR: DESCRIBE WORK& PROMOT/ONSAPPL/ED.• v 'I-A&rch e womb,:e i G Est" Start Date. 55 SEt. Comp. Date.. 5. 15 I "estimated Customer understands this is an date" Owner has read and agrees to the terns 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 at any time pay off the full unpaid balance 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 signed at the main office or branch office of the seller, provided you notify the seller at his or her°ntaln office or branch office shown in the Agreement by registered or certified mall, which shall be posted not;7aterilli"rTldnight of the third calendar day after the day on which the buyer signs the , lain y g Agreement, excluding Sunday'and any holiday on which regular mail deliveries are not made. See the accompanying notice of cancellation form for an explanatlon of buyer's rights. (Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing ."""o,Y vv.wumor ovY..auVn ulaaarrara. tVWmer-s Initials) BY g rad 16m ,b my�u �0 EIN# Signed: Product SpeciallaWdatedName) Owner By: Signed: NEWPRO Op"n6, LLQ'S/gnadvm) Owner u�-ia WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy R0714 ADDITIONAL TERMS AND CONDITIONS Warranties: Any 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: Ownek understands that Owner has,•three (3),business days to caneei-,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 havp to pay to NEWPRO'a late cancellation• fee equal to 33.3% of the purchase price in order to cover NEWPRO's tabor, administrative, and material costs. Delay/Unknown Conditibns/Damagesi Owner understands that if NEWPRO 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 inbomplete, NEWPRO will inspect tl'ie 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 amount owed foi 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 isnot fully enforceable, the court's determination shall be subject to appeal. This paragrapj=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 parties. (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 Agreeinedt to be paid le advance of the commenpement of work shall .not exceed the 'greater -of one-third bf the total. contract price or the actual cosfvf.anymateriils or equipment of a special order on- 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;contracrprice Twill 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'locatien; constructed in a skillful manner and fit for habitation or appropriate use. The warranty rights and remedies-sefforth in the Maine Uniform Commercial Code apply to this Agreement. :. . If a dispute arises concerning the provisions of this contract or ihe'performan_ ce by the parties that may not be resolved .through•a small claims action, then the parties agree to settle this dispute by jointly. paytrtg . one of the following: 0. Binding arbitration, as regulated by the Maine Uniform Arbitration Act, with the parties agreeing to accept as final the arbitrator's decision; 0 Nonbinding. arbitration, with the parties free to not accept the arbitrator's decision and to seek satisfaction through other means, including a lawsuit; or LO Mediation, with the parties agreeing to enter into good faith negotiations through a neutral mediator in order to attempt to resolye4heir differences. (Connecticut Sales Only): THIS INSTRUMENT IS BASED UPON A HOME SOLICITATION SALE, WHICH SALE IS 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 bf-the,following.corporations; :liinited liability companies, partnerships, sole proprietorships or other legal entities that have been a home improvement contractor during the.previous five years: NONE Product Specialist Date Homeowner Name(s) '�) �Wlubtllbbd Address City Phone Other/Cell hi 19LWPjV0 Home Improvement Solutions 26 Cedar St • Woburn, MA • 01801 781.933.4100 • newpro.com 4u State G1 Z�1 Email TOTAL # OF # OF BOW/BAY/ *EXTERIOR U.I. I LOCATION WINDOWS GARDEN Bay' Bow•_ CLADDING White # OF DOORS Storm J{ OPENING , Garden_ Shelf_ Roof or Soffit Painted Steel Patio Locks & Keepers (circle one):hite Almond Bronze Brass Satin Nickel candles & Night Latches (circle all that apply): kite Almond nside Color:kite Natural Oak ColonialCherry Barrister Oak )utside Color: hie Basic Brown CT Beige Forest Green Nindow Model: Zip Job #: Page of Lead int Status Yr Built LSWPg Must Exempt Be Selected 1 �1 Uq 1'I j 1, r M T W TH F �S✓/b ;I Best Day To Install Est. Sta Date GRID COLOR (circle one) (inside/Outside) CAP COLOR ^z� ray MFG: NAPCO / Norandex / �1 ontour C' Other y Prairie (circle one) Diamond PVC / Smooth (circle one) (circle one) Bronze Satin Nickel Brass No Bottom Handles Night Latches Tuxedo Gray Claystone Terra Brown Bronze Winterbeny Wedgewood Blue NO. MODEL OPENING SIZE W x H U.I. I LOCATION GRIDS SCR STOPS CONV ADDITIONS OPENING , CUT IN OUT e XyL f��, �/ Y ✓ �� ,;�, 1 xti x 1s !a ` 5 /0 5" /o �s 36,012- 12 l3' ' �� kyLrZ , .K6i�� - ) �- �) y �l i�. l y ✓ I% ��w i i ���� ;4101 Mt��l;or, x 4j P7 L x 11 x $a M x VX x Lt 2- �� s x S x �-4 x�� 2 i1 1c) ti' 3f xvt r: 3'c% P YL ILI1-1 /x t `! x - } /0 <� 5, 3 Y'yZ jG �-�. �) % �. %� � i l -' x Y� x x x x x x x x x x x x x x x x x easureman: -, r Ini^ ti�als ate Cre—w SizeNeededTime Frame to completelob Capping Type )ecial Installation Instructions: r ' r s WD -0178 CUSTOMER NAME ADDRESS PRE -INSTALLATION INSPECTION MATERIAL CHECK LIST C 4 - PHONE: DATE: Please Circle TYPE OF HOUSE 2 Story 3 Story Camponelli's Cape Raised Ranch Ranch Split Entry CONSTRUCTION Barn Sash Bay Removal Bow -Removal Enlarge Opening Garden Removal Metal Fin Mullion Removal Reduce Opening Vinyl Fin EXTERIOR Aluminum Siding Asbestos Brick Clap Board Stucco T1-11 Vinyl Siding Wood Shingles TYPE OF INSTALL = _Aluminum Trac Anders Outside Install Plastic Track Replacement Steel Frame Thumb Latch Weight Pockets Wood Conversion OUTSIDE CASING 908 Brick Mold 4 Bend Blind Stop Crown Headers Flat row Meta in �`—rrm�-ieid STOOL 2 1/2 3 1/2 __...----4 1/4 5 6 Clear Silicone Latex White Silicone H N 6)3 List all other information and Stock Needed All �[�L� �Y CASINGS 2 1/2 Clam 2 1/2 Colonial 3 1/2 Clam 3 1/2 Colonial Belly Flat STOPS 15/8 Colonial 2 1/2 Colonial 15/8 Ranch 7/8 Colonial Bull Nose Scotia � k V \ k� k 2 C4 / v 3 iks \ j 0 2 2 LL cc o f°« kcr.�i 4co Z Uj IU�/ �� Q co# 2 ca � v k 4 0 < 22�2x 0 | 0 _ a � ] 0 � k CL 3 � 0) LL C9 a Gj u & w Z Q ®ALO )arl § \ )q � Lj 2 us z -fo frig § sa ^ az p Q > E -$$g � 2I� r ftvn (lflr HOW -to 1tMaS... Ulm W=bK- .dN-AW2 Authorization to Perform Work For Management Company/Association This authorization to replace windows/doors serves as an official do cument providing NEWPRO Operating, LLC (hereafter called NEWPRO) thl; approval now and in the future. to install windows/doors in any unit at: Name i i Company QUI C4 Y%A() Lll!r I" State This approval is in effect providing the homeowner, Management C )mpany and NEWPRO understand the style of window replaced will remain the Name (I.E. double hung to double hung, slider to slider, etc.). When replacing an existing metal window with our non-metal windoN, the exterior appearance will be different due to the difference in frame s ize. When replacing existing wood windows, the exterior trim will remain the same and be covered with vinyl coated aluminum to seal the window and frame from the elements. The interior and exterior of the windows will be whiite frarne and sash. Homeowners contracting with NEWPRO will verify styles, colors and exterior appearance, as described below, by seeing a window sample as wall as before and after pictures.c�f�'�Jv�1 NEWPRO will perform in a workman like manner according to state building codes. NEWPRO will keep worksite in a clean and safe manner anj remove all debris from the property. Attached you will find a copy of NEWPRO's Workman's Compensation and liability insurance certificates. /727) d1" - R0308 26 Cedar St, Woburn MA 01801 ♦ (P) 800-342-2211 ♦ (P) 781-993-0717 -► www.n Bwpro.com l From Our Home to Yours... i Windows, Siding and More Authorization to Perform Work For Homeowner(s) 1I11 I d 1�N) lA V but , have seen a working sample of the NEWPRO Homeowner(s) Window and have reviewed before and after photographs. I understand the style of my windows to be replaced will remain the same (I.E. double hung to double hung, slider to slider, etc.). The interior and exterior sash and master frame will be white in color. • When replacing a wood window the exterior trim will remain the same however, will be covered with vinyl coated aluminum to seal the exterior trim from the elements. • 1 understand when replacing a metal window the exterior appearance will be different due to the difference in frame size between a non-metal window and the existing metal window. The exterior trim will be covered with vinyl coated aluminum to seal exterior trim from the elements. Homeowner -12 F�nvptA Nx '9 M dW eve,114 CMMS S Address �fj City " State zip Homeowner Signature' ° Homeowner Signature 7�� S, 2- I Salesprese ignature Date 2bs"A �X ` _052I 26 Cedar St, Woburn, MA 01801 ♦ (P) 800-342-2211 ♦ (F) 781-933-0717 ♦ www.newpro.com R0308 The Commonwealth of Massachusetts -- Department of Industrial Accidents Office 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 Name (Business/Organization/Individual): A I e- C ]ll���,-. f � 1 LLC PC Address: 9L (2f del r City/State/Zip: _ A )n b u rn , 0i A 1 a o i Phone #: Are you an employer? Check the appropriate box: 1.0 I am a employer with SO 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. K Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. El Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -i-my appucanc mar cnecKs oox 8t 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. policy information. I au: an employer that isproviding workers' conspensatioii insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:----(AJC - o -moo dd3SyE � k, Expiration Date: �� — ' , PT Job Site Address:.22 2 82 r r 0 01)J A Aq City/State/Zip: (V . An�(Ove ( MIA 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 car% 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 o perjury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # W, 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 #: ACS o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/WYYI 1/6/2015 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 endorsement(s). PRODUCER Mackintire Insurance Agency Inc 11 West Main Street Westborough MA 01581-1931 CONTACT Melissa Pflug g PAIC,HONE . (508)366-6161 A/C No: (508)366-5202 ADDRIESS:melissap@mackintire.com INSURERS AFFORDING COVERAGE NAIC # INSURERANetherlands 24171 INSURED Newpro Operating LLC 26 Cedar St. Woburn MA 01801 INSURERB.Llbert Mutual/Peerless 4198 INSURERCAcadia Insurance Co. INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBERMas ter 14-15 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. INSR I LTR TYPE OF INSURANCElull ADDL UBR ima POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR CEIP 8589577 12/31/2014 2/31/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Eaoccurcence$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS NON -OWNED X HIRED AUTOSAUTOS 8584174 2/31/2014 12/31/2015 BIND EO a.,denISINGLE LIMIT 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Uninsured motorist BI split limit $ 250,000 B X FIEXCESS UMBRELLA LIAB LIAB X OCCUR CLAIMS -MADE CU 8582578 12/31/2014 2/31/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,00C $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA -20-20-003506-02 05/01/2014 05/01/2015 WC STATU- I OTH- TORY LIMITS FIR E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) rE HOLDER To Whom It May Concern ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moynagh/KRISTI CEJ 1SUB-2010 ACORD GORPORATION. All rights reserved. Tl... 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