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HomeMy WebLinkAbout0022 TOWNHOUSE COURT �c� Tbcv r1 a�S� C® c�•r-�- . _ tHE r, Town of Barnstable *Permit# �7 + Expires 6 man m' e dat Regulatory Services Fee > r,�i,E 1659. 1m� Thomas.F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-403 8 Fax 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint. Map/parcel Number Property,Address Z Z I oc_j H k t o S L ��`9 a ,��< < S iAI- J.L ❑Residential . Value of Work L 7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address R ✓) -� f H �'l c hC l-..k, Z 2 C� Contractor's Name C�(� 'p�� I-.-t t. PC..a C b Lf Telephone Number ��l ell-5 Home Improvement Contractor License#(if applicable)' 7Construc 'on Supervisor's License#(if applicable) orlanan's Compensation Insurance PRESS. PERMIT Check one: ❑ I am a sole proprietor ❑ Lem the Homeowner JUL 2 I have Worker's Compensation Insurance 6 2012 Insurance Company Name P t `1 C K f N 1 Workman's Comp.Policy# C', G `/ S g 7 `/ TABLE .Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors .� CO"Repla Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S.and inspections required. . Separate Electrical&Fire Permits.required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Propez�Owner must sign Property Owner Letter of Permission. . A � of the Ho prove ent Contractors License&'Construction Supervisors License is r ired. SIGNATURE: Q:IWPFILES\F0RMSlbuilding permit formslEXPRESS.doc Revised 053012 i 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): It\/ -r-C-_� p 2 b Address: 2- 6 --z: -1 A 2 S / City/State/Zip: l-)O 2 �' jM A- G Phone#: ` Z ZZ t AW* I u an employer?Check the appropriate box: Type of project(required): 1. am a employer with T 4. ❑ I am a general contractor and I employees(full and/or part-time).*. have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. modeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition ' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Q]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t a 152, §1(4),and we have no 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Nam '' ll eAc&�'� �l ✓1- Policy#or Self-ins.Lic.#:W C� G U j �l L� Expiration Dater / /3 Job Site Address:.0� 0� I U``) SL City/State/Zip: plata S �4 �016U 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 covera verifi tion. I do hereby certi nde a pains an en es o perjury that the information provided ab ve/is t ue and correct. Signatur LG` �� Date: C� Phone#`. / l)LtJ 2 2 Official use only. Do not write in this area,to be completed by city or town official 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#: .f A CO1 1 � E MM/DD Y fit,+ DAT /Y Y I Y) CERTIFICATE OF LIABILITY INSURANCE 05/02/2012 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 CONTACT - NAME: Mackintire Insurance Agency, Inc. a"c°NN Ext: 508.366.6161 AC No:508.366.5202 11 West Main Street E-MAIL ADDRESS: Westborough, MA 01581-1931 PRODUCER 00013793 _ CUSTOMERID . INSURER(S)AFFORDING COVERAGE NAIC# INSURED - INSURER A: Peerless Insurance Co. - 24198 Newpro Operating LLC INSURERS: ' 26 Cedar St. INSURER c: ' Woburn, MA 01801 INSURERD: INSURER E: •- INSURER F: COVERAGES CERTIFICATE NUMBER: 11-12 Revised 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY CBP 858957 12/31/2011 12/31/2012 EACH OCCURRENCE $ 11000,000 PCOM MERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:. PRODUCTS-COMP/OP AGG $ 2,0009000 POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY BA 858417 12/31/2011 12/31/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) _ $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR CU 858257 .12/31/2011 12/31/2012 EACHOCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE A AGGREGATE $ 5,000,000 _ DEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION WCH645O7O5/O1/2012 O5/O1/2013 0 TH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) * E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ S00,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION 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 To Whom It May Concern 11"imothy Mo na h ©1988-2009 ACORD CORPORATION. All.rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD . Federal ID#20-2625129 CT Reg#0605216 RI Reg#26463 Windows,Siding and More Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211 (F)781-933-9626,www.newpro.com '--tHIS CONTRACT MADE THE _day of / t,! 20 /c4— between �il �-r l✓ i� i n./1 , \'` r�f%'L�( �1 � l �7�� t � ( r c) ! � (Home Owners) (Home Phone) (Bus/Cell Phone) Of Cr!. (3•.r.rjF :a ) l "� T -.rC• vt I/1/l (Address) (Clty)I (State) (zip) the"OAer"and NEWPRO Operating, LLC, "NEWPRO". ® e job address is a condominium. 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 Job Address) ` I J:� c r (E-Mail) for proprietary use only TOTAL l ` Additional Model TOTAL Windows Purchased NEWPRO r��'-� Work Number Qt _ CASH ? =' Window Color In: ti•3 ry i Out: j? �,-Sliding Glass Door PRICE Capping Color f fr Y Steel Security Door � Door Color In: Out: DEPOSIT Model Name Model Number(s) Qty Sidelites WITH 1 (_; j Double Hung New Construction Unit --77-1 ORDER Picture Window Storm Door - BALANCE Obscure Glass H OPF_: B Casement.__ -•—`'"" BOTTOM DUE AT ` Lite,/3 Lite'Slider P..7 J 1` { Screens - FU_L.L..--T INSTALL Bay/Bow Frame Please Initial: :%C Roof: ❑ Soffit: ❑ Customer understands that NEWPRO®does not (CASH Garden Window do any painting or staining. (ie:when removing Balance paid to installer at installation Awning :. "- or replacing interior stops or trim) Hopper NEWPRO®is not responsible for conditions or Shaped circumstances beyond its control including con- FINANCE - Other densation resulting from or due to pre-existing Bank completion form signed at installation GRIDS Colonial _SDL Euro conditions. DESCRIBE WORK: A )r �;sa, is rn �/i �� ��rr•: /`'��� i % �1V'1 C! 1 P r �.0_ !c P 71. ta,:•\- �c v r c t. Gwc:. ✓s% Est. Start Date: d-.-. Customer understands this is an"estimated date",.)'�C'Uniti,55;ls Est.Comp. Date:� 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,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 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 application referencing a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars,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$100,600-$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 th4 signingkokhe-af8.resaid 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 delive-ry, 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 i form for an explanation of this right. DO NOT SIGN THIS:CONTRACT IF THERE ARE ANY BLANK SPACES. ,T F he owner has seen"sample"warranties that will be provided by NEWPRO upon installation. Sample warranties provided to Owner.. IN WITNESS WHEREOF,the parties have hereunto signed their names this• t day of J•_f��, 20 (r — t f..•t; V ( 1 s•° EIN# Signed Marketing Representative Printed Name Owner i, Accepted: NEWPRO Operating iLLC By :J Signed ; �. Owner I CORPORATE OFFICE WARWICK BRANCH OFFICE 26 Cedar St 24 Minnesota Ave Woburn,MA 01801 Warwick,RI 02888 (P)800-242-9974(From NE) (F)781-933-0717 (P)800-356-3312(From NE) (F)401-732-1371, I WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy US-15 R0508 . .... -..... _.._._. .. ... :......._.___ _.__ -. ........ _. . .. ... _.. - - _..----- ----.-------� C Massachusetts - Department of Public Safety Board of Building Regulations anti Standards . C'()nstruction Superi isor , u'`' - License: CS-096093 �� n y� `'*! THOMAS E PL�-ACOGKMJR 38 OAIQ.ANO A SEEKONK#A0� i J. �'7�l•4g�`�"� Expiration Commissioner 04/08/2014 671-2 0 f ce of Consumer Affa' and Business Regulation 10 Park Plaza ' Suite 5170 " Boston, M. _ssachusetts 02116 Home Improve ` ontractor Registration Registration: 146589 Type: Supplement Card Expiration: 5/5/2013 NEWPRO OPERATING, LLC. Jh = - � TOM PEACOCK 26 CEDAR ST. WOBURN MA 01801' F i Update Address and return card.Mark reason for change. Address -Renewal r Employment Lost Card DPS-CAI 0 50M-04104•G101216 • w. A " = ✓fce�oalvnrb-nuk.�tlt�z o�,��aaedc/zic�e� . Office of Consumer Affairs&Business Regulation License or.registration valid for individul use only ` ' OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration-'mg89. .. Type: 10 Park Plaza-Suite 5170 r� Expiratrot� Supplement Card Boston,MA 02116 , NEWPRO OPERATI�I6'L�Lti ; TOM PEACOCK 26 CEDAR ST. WOBURN, MA 01801 - ilndrrsv�re to ry Not Valid nut cianahira ■ ® Qualifled In all zones Ic NEWPRO MANUFACTURING GINFR%— SERIES G NEWPRO 2000 DOUBLE HUNG Cellular PVC frame,Triple glazed, NatlonalFenestratlon Low E coating(e-0.027,S2&5), Rating Coundle Krypton/air filled ® DEV-K-27-00030.00001 ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient 0, 17 0,241 } ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage(U.SA-P) 0040 0.1 Condensation Resistance 70 Manutaoturerdpuletes that thus ratingscadormtoapplfc a HIM procedures for determining whole product performance,NFAC ratings eta determined for a find set of aWroamenli.1 conditions and a epecirtc pteduct size.NFflC does not recommend any vvrodud xW does not Wrard the euifebft of any product for any eDoctilc uea Caneutt manufechtrer'a Aterature tar other Droduct perfortnence 1Marmation. www,nkorg.