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HomeMy WebLinkAbout0022 TOWNHOUSE TERRACE eIdB, s ARBE LLA® INSURANCE GROUP qq r Elaine Dupuis-Lane,thin Manager August 28,2017 —� EX) HYANNIS BUILDING COMMISSIONER I NO 200 MAIN STREET co M HYANNIS,MA 02601 Claim Number: 033856239 Policy Number: 57162400002 Company Name: Arbella Mutual Insurance Company Date of Loss: 08/01/2017 Insured: CHARLES BEZANSON Property Location: 22 TOWNHOUSE TERRACE, HYANNIS,MA To Whom It May Concern: Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer.Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, Melissa Ross Claim Service Specialist Property Claim Office 800-272-3552 ext. 2489 Fax 617-773-4760 CC: HYANNIS HEALTH DEPARTMENT 200 MAIN STREET HYANNIS,MA 02601 HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD HYANNIS, MA 02601 iioo Crown Colony Drive P.O.Box 699195 Quincy,MA o2269-9i95 telephone(800)ARBELLA www.arbelia.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Y4,/ Mapql) Parcel �_ d>� application Health Division Date Issued �' Y toye Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address v2A 7_D1JM'1*" M?44Gf Village PYXY vis Owner R1A1 B0eo6P_ &Ajoo fiSgy t Address SOME Telephone �aB° � 9499 tlmg l- Permit Request �� //✓6r�E= Gl� �✓� fooF Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o Project Valuation ''��✓� Construction Type J - Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s� porting Amu ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highway.,,❑Ye�� ❑ No Basement Type: ❑ Full . ❑ Crawl ❑Walkout ❑ Other rT1 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) '+ Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Cul,06 rlaue/Ro q Telephone Number SO-9:237 Y59.Y Address .21) C41 P-,-nnJ AJ6ycS R6 License # /b11 J 07 S. yAft mo v 7w , OIR 6®q Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YAeMovy 7'tafisrim 6-rX7 ohl SIGNATURE DATE l 6 Id-f %y FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t The Ctan=a mm**of Massachu dft �e�r ��rf��t�sh earl�lu�e�r 600 Washbigton Street $osfwj,.MA 02M "W.7nasmgoVdxa W,arke& CaampensafianInsuranceAffidavit:B•mgders/Cmtmctors�Electricians/Nwnbers xplicant Inrfarmafion Please Print LegiW Address- A W r7 I�l 1I®V&,C Gtyf5tate/Zip: SQ y u ®,SOD Phonate so8�a3 T r9s'�,Z Are you an employer?Checkthe appropriate bow; r T ' et and L 3'Pe of�'oIe. {���- I ama contractor L I am a employer wift ❑ 6- ❑New oanstrwfioa employees{fill andtorput4time}* have the I am a sole proprietar orpartner- listed on thr attached sheet 7_ ❑Remodeling' C ship and have no employees Throe sib-contrwtors have 8- ❑Demolitiao_ working for me is any capacity. emplo ees and have workers'' p El Build-mg addition [No.Warkers' camp.insarance comp-insmwme, rtxLaire�J 5. ❑ We are a corporation aad its 10-❑Electrical repairs sir additions 3_❑ I am a homeowner doing aU word officers have ex=sed their 11-0 Plumbing repairs or additions Myself [No Workers,comp- ft•of esmption per MGL: 12_❑RDof repairs insurance required.]F c-152,§1(4),and we hnm no employe es-INC;workers' 13. Otlret��� 11D F comp-insurance required-1 *Any aDpUxxat that chedLs box ll-ms#slso fll antth�secfroabcTowsLnceing iheatvo3c�'campeassfiau palit3 fn ts� �ffnmeowness aha sffbmPi this a�ci.-�i�.�csti��e3`a'e doing.II r.*�-_*�thy*hTMe o-ntsir�contracrors mist snbolit a new a�darit ink snrl� ZCwtracros that check this box mist attached an addiarmal sheet showing the mmme of die srd}cofradan ands tP whether txnot 11mse MM1j1,s hTM employees. Ifthe sib{oatactas have employees,the3r must pmuide their warps'tamp.policy 1LUmber_ lam an emyLr fhrr#isgr�t urg tr�orkets'r-otttperrsrrliun amsurrutce far rut}�et Inyecu. �e�arr is fttegoFic}rcnd job sits i�rforxrrrtci�n_Issuance Company Name_ //J�/' 4*0 i4 /N.S'u a,Sl CE PaFicy arSelfius_Li� 9�lic�oaD �4do�' ExpisationDate: Job Sii,-Ate:IU VWOi f T& -A � CifylState/2 tp: Attach a copy of the workers'compensation policy-dedarstion page(showing the policy number and exgu-atiDn date). Failure to secure-cay er age as reg6redunder Section 25A of MGL c. 152 can lead to the imposition of rriminal Penalties of a fine up to 3I;5MOD ziWor me-year impm=merd,as well as c iiil pertallies in the form of a STOP WORK ORDMZ-anda fine of up to V-50.00 a day against the violator. Be advised that a copy of this stxtem maybe forwarded to the Office of Investigations of the DIA for insurance coverage verffic atiozL I can Irsrebj under tfce pains widponaeas of uq fhatthe truce and carrect S Date 0Jtdol use and . Da not wiftff in fins area,to be cam pieted by cry or tirwn afficiaL City or Town Pt r dyucense# Firs-�A.ufhQritg{dicic one : ' L BwArd of Health 2.BuWng Department 3.Utyfl`awn Qcrk 4.Elw--trical Inspector 155.Pf mdag Inspector 6.Other contact Person: Phone ff-. 6 Wormation and.Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for illeit ftloyees. pmm atto this staff,an employee is defined as"---every person in the service of another tinder any contract ofhire, express or implied, oral or written.°' An employer is defned as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal mpresentati..ves of a deceased employer,-or the receiver or trustee of an individual,part=bip,association or other legal entity,employing employees. However the owner of a dwelling house having not more than.tbree apartments and who resides therein,or the occupant of the: dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MCrL chapter 152, §25C(6)also status that every state or local licensing agency shall withhold the issuance of renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who-has not produced acceptable evidence of compliance with the insurance.coverage required.'' Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractDr(s)name(s), a.ddmss(es)and phone nurnnber(s)along with their certficatc�s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LL.P)Wkhno employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees;a policy is requ ire . Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation ofins,r ance Coverage. Also be sure to sign and date the affidavit The afada)*2t shouuld be returned to the en city or town that the application for the peEMit or license is being requested,not the Department of Industrial Accidents. Should you have any questions;regarding the law or i f you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-i-asurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to£II in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense applications in any given year,need only submif one affidavit indicating cur mt policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fiiivre permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to burn leaves etc.)said person is NOT reguired to complete this affidavit The Office of Investigations wound hlse to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's ad&css,telephone and fax number: y The Commonwealth of Massachu&,2tts Depai�mcmt of hiclustial Aoc ldeat Off ice of kve, Oiimi 6W Washzngtan Strom Ras m.,MA 02111 TeL f4 617-727-4,90a W±4.06 Q.T.l 477-MkSSAFt Revised 4-24-07 Fa# 617-` 27- 49 wwwx�gov/dia � E rti Town of Barnstable Regulatory Services 9EA STABM MASS. g! Richard V.Scali,Director 16gq. �0 ,erfo .t� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder TRu5T('e I, MPP'fI BAKE, ,ash of the subject property . hereby authorize C 4 14' j�VA151—koc i i o0 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) " "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Sig a of RVS TEE Signature of Applicant Print ame Print Name Dae Q:FORMS:O WNERP ERMISSIONPOOLS Town of Barnstable Regulatory Services ' V' P�oFV4 roryk Richard V.Scali,Director Building Division HARNSTABrt~ ' Tom Perry,Building Commissioner MASS. v$ 1639- ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner' shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s) for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &ReguIations for Licensing Construction Supervisors,Section 2.1S) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a Iicensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formleertification for use in ,your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Rzvised 061313 Bk 27672 r7r2 35 17 f PINERR0OK CONDOMINIUM TR UST j 25 TOWNHOUSE TERRACE HYANNIS, MASSACHUSETTS 02601 NOTICE OF ELECTION OF TRUSTEES In accordance with Article II, of the by-laws of Pinebrook Condominium Trust recorded in the Barnstable County Registry of Deeds, dated September 16,1971,Book 1530,Page 132, Instrument#39989,Notice is hereby given of Election of Trustees. The undersigned hereby certifies that,pursuant to the vote held at the annual meeting of unit owners on July 20,2013 at the Community Building,the following unit owners were elected to be the duly constituted Trustees of the Pinebrook Condominium.Trust of Hyannis: Names&Addresses Term Expires 4th Saturday of July of the year: Ruth Ouellette, 76 Townhouse Terrace 2014 Linda Bezanson, 22 Townhouse Terrace 2014 _ .Don McArdle, 62 Townhouse Terrace 2014 Marti Baker, 76 Townhouse Terrace 2015 Phil Kelly, 10 Townhouse Terrace 2015 Executed as a seal instrument this -4� day of 2013. Linda Bezanson, Secre COMMONWEALTH OF MASSACHUSETTS Barnstable, ss 12013 Then personally appeared the above-named Linda Bezanson,and acknowledge the foregoing. instrument to be of her free act and deed, before me. -ARAM.@UBTIN Not ublic �co-cu� � My Commission expires: aoo2 7/0 My a€ion Eo(es SARNSTAM REGJSMOF DEED aarl;eu�i§;n0g1!M.p![UA;obi f Publi c c Sa fety Massachusetts Departryento +I Sta ndards d s Board of Building Regulations and.and i i'onstructivii Supervisor i rt License: CS-104107 9IIZU YL1[ uq;sog' o, ULIS 01inS,77 rzuld�1a�d OI � uogelnDa�ssamsng p€ s��e33d aawnsao zo a,� CARLOS H FIGUI-MOA~ J:. J30 20 CAPTAIN NOY.W R o;urn;aa puno33Z a;ep u01;eaidxa ai0 sn ;aro3aq SOUTH YARM( CJTH;IVLA 02 64 a lnp!A►pm'jo3 p!l".uogea • ae'�s Expiration 08/25/2015 Office of"Co J�^, 1f ,t�s�,• P � � ��e�o���zaazcueizL�o'�C��aafa�cr�eC63: . nsumer'A &_rfairs Business Ft Ex irationeUulatioa", Commissioner ME ] ' _ M..IMPROVE NT CONTRACTOR _ egistration F� Y� 792 TYpe• j - xpira, n 1/8/2C)15 DEA i C&F REMODF_LINC + - F ➢=1 . l ARLOS FfiUEIROA 20 CAPTAIN NOYES'RD �F g'•vv� - `S YARMOUTH; Undersecretary:. . ;l DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE F 8/26/2014 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 - Leonard Insurance Agency Inc NAME: Berkley Assigned Risk Services PHONE683 Main St B ,C,No.E,, (800)634-4589 FAX No.): 866 215-8118 Osterville, MA 02655' E-MAIL ADDRESS: Policyservices@berkieyrisk.com- INSURER S-AFFORDING COVERAGE NAIC# INSURER A: Acadia Insurance Co. 31325 . INSURED - INSURER B: - Carlos Figueiroa INSURER C: - dba: C N F Remodeling INSURER D: 20 Captain Noyes Rd INSURER E: South Yarmouth, MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONSAN CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR PE OF INSURANCE ADDL SUBR - POLICY NUMBER POLICY.EFF POLICY EXP - LIMITS - LTR INSR WVD MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence ❑ CLAIMS-MADE ❑ OCCUR ❑ ❑ MED EXP(Any one.person) $ - PERSONAL&ADV INJURY $ - GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: - - PRODUCTS—COMP/OP AGG $ PRO- $ POLICY ❑ JECT ❑ LOC' - AUTOMOBILE LIABILITY ❑ ❑ - - COMBINED SINGLE LIMIT - $ Ea accident ANY AUTO - BODILY INJURY Perperson) $ ALL OWNED ❑SCHEDULED AUTOS - - - $ ..AUTOS - BODILY INJURY Per accident NON-OWNED - - PROPERTY DAMAGE HIRED AUTOS ❑AUTOS Per accident $ ❑ - - - UMBRELLA LIAB ❑OCCUR' _ ❑ ❑ - - - EACH OCCURRENCE $ EXCESS LIAB ❑'CLAIMS-MADE - AGGREGATE $' DED ❑ RETENTION$ WORKERS COMPENSATION - - X WC STATU OTH- "AND EMPLOYERS'LIABILITY Y/N - TORY LIMITS ❑ ER ANY A OFFICE/MEMBERREXCLUDED?EX,ECUTIVE N/A ❑ WC-20-20-000092-07 05/01/2014 05/01/2015 E.L EACH ACCIDENT $ 500A00 (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $ 500,000 0 El DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional.Remarks Schedule,if more space is required) , Election Category Election Status Name All Entities/Insureds: Sole Proprietor Include -Carlos Figueiroa Rgueiroa Y . y CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Andrew OV13rien THE EXPIRATION DATE THEREOF, NOTICE WILL BE:DELIVERED IN 91 Pleasant Pine Ave. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - Hyannis, MA 02601 Signature: ACORD 25 (2010/05). BRAC 3.139. Town of Barnstable *Permit# pf/off 3 * Regulatory ►Services FFee6monthsfrom issue date • * snaxsresi.E, : r 9� sb q ��� Thomas F. Geiler,Director. p�D MA'1 A - Building Division. y� Tom Perry,CEO,' BuildingCommissioner mmissioner 200 Main t1reet,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 EXPRESS PERFax: 508-790-6230 MIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �0 y-�MY Property Address oZ j���e.l I ti u o s 'T i Q✓t / T y A n n ,,sEg-R sidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&AddressC AR l r15 4-• Z_1­L.)P4 Contractor's Name lr1loand r ccx r� Telephone Number :-5Z Home Improvement Contractor License#(if applicable) L�G•Sc�S� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor X PRESS PERMIT' ElI the Homeowner PERMIT 1M� Q111 have Worker's Compensation Insurance JUL 02 2012 . Insurance Company Name l A 141,,41,2 C Workman's Comp,Policy•# WC 4-,13-6'241 TOWN OF BARNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. C Permit Request(check box) y ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be to ❑Re-roof(hurricane nailed).(not stripping. Going over existing layers of roof) ❑ Re-side - #of doo rs Replacement Windows/doors/sliders.U-Value d�p�3 m( axtmum.35)#of windows_ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is red. SIGNATURE: QAWPFILESTORWbuildingpermitformslEXPRESS.doc. Revised 051811 lie � iai d Business Re elation v O ice of Consumer l�.<t, an g n Pkk �' a-Z'a � Suite 5170 Bostonssachusetts 0211 E Home Impraveontractor Registration _yam Registration: 146589 Type: Supplement Card i Expiration: 5/5/2013 NEWPRO OPERATING, LLC. t =�; - TOM PEACOCK i � 26 CEDAR ST. � - ,� WOBURN..IAA 61 801 �i�� 1� -- kF' card.Mark reason for.change. e. Update Address and return g - Address ❑ Renewal Employment Lost Card 1PS-GA1 .0 50M-04/04-G101216 ,per .J ILG -C/J6'I➢7/YIt0921(I�2Gl� a�✓I�GQ.ddQ�tlC6C�6 .. _. - .. Office of Consumer Ai;airs&Business Regulation T ice;s:sir i egistration valid for individul use only OME._IMPROV EMEFIT CO:yTRr-'70i� t efo L exiiii ation date. If found re.=ar!?to Off of Consumer Affairs and Business Regulation Registration�14tb8a �YhE. 10I '::P'-:'a-Suite 5170 Ex� f� / 2E1�3 - Supplements d Bos '�,Nir�02116 NEWPRO OPER1TIP(f_, C TOA,1 PEACOCK'&,c 26 CEDAR ST. - VJOBURN,MA 01801 Not valid, out signature Undersecretary The Commonwealth ofMassachaseas Dipartment o, Industrial Acriderrts Ogee o,f Investigations . 600 Washington Street Boston,AM 02121 tRvry Latrirs�gov►ldia Workers' Compensation Insurance Affidavit:Baders/ContractorsfFlectricians/Plumbers AppFicant Information Please Print I.e�hlY Name(B on/lndividuau_ �c�S 1�J /LG Address: ��r7✓t + ity/ tate�'C p_.t4-)O3 .4#1 y 3 q 2-z z I Are you an employer?Check the appropriate box: Type of project(requ ired): I_ memployerwib,3—bT 4. I am a general contractor and I 6_ Newconsttruction employees(full and/or part-dme).* have hired the snh-CDUftactM 2.❑ I am a sole proprietor orparbxT- Iisted on the attached sheet T Pll�'=dehng These:sub-con ractars have skip and have no employees8_ ❑Demolition working fear nee in any capacity. employees and have workers' [No wodoers' comp-ins ante . comp_insur�l 9- ❑Building addition required] 5. ❑ We are a ccaiporation and its. 101-1 Electrical repairs,or additions 3-❑ I am a homeowner doing all wo& officers have-exercised disk l I.❑Plumbing repairs or additions myself [No worbus'comp: right of exemption per MGL 12.❑Roof repairs insurance &]t C.152,§1(4X and we have no employees- o workers'. 13..0 Other comp.insurance required_] 'A ay appllc�t#bat checks has#1 must also fill cut the section below showing their wodie a compensatimpoNcyiufty Hameoovnars who subunit this affidavit iD&catiag dey are doing all wmt and d m him outside contractors must wbinit anew amdavit indicating MdL ICantrHctow that check thus Imo.must xrmd]ted an additional sheet showing the name of the sub-conftww s aod:MU whether ornot those entities ham emphl . If the mb-mutnicton have employees,trey must provide their workers'comp.policy number. IamarlempzLlg,wthtitisprovMYngworkers'congwasabianinmraircaformyamplpjwa& Bdow is the p,vUry aced job site. information Insurance Company Name: 8"r 7C�r Policy#or Self ins-I.ic.# �- �y S 9`� `� Expiration Date: �� L Job Site Address. cityl5tar: f`r�J bt u a �s 2 C 6 c Attach a copy of the workers'compensation.policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under Secticm 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 ofup 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 ce co I do hereby cactiii e pains an pasta 'ury that the inforrnathm,prove>rd ab vus.is hue and c arrect Date: Phone O;(jacied use ortd}.. Do not write in this area,to be iwiripdeted by cis}'or town.cffkiat City or Town.: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Ong Department 3.Gityir wn aerk d..Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 .t s ' Massachusetts - Department of Public Safety Board of Building Regulations a_nd Standards Consiructioll Superviscir " License: CS-096093 .3 ' THOMAS E PLACOC`I JR v,, 38 OAIC.ANO , SEEKONK r0Arxpiration 0 " Commissioner .. 04/08/2014 off ce of Consumer Affa'ff and Business Regulation 10 Park Plaza * Suite 5170 Boston ssachusetts 02116 Home Improver Contractor Registration Registration: 146589 , Type: Supplement Card NEINPRO OPERATING LLC. 1. ' I p �—`Y`� . Expiration: 5/5/2013 TOM PEACOCK 26 CEDAR ST. WOBURN, MA 01801 ?' r rP Update Address and return card.Mark reason for change. (�DPSCAi iv SOM-04/64G101216 Address Renewal Employment Lost Card 0p ' `�� ✓�ce loaawn:arw�ll/r. `�".�r!alaac�ucse�.a - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVE M.E T CONTRACTOR before the expiration date. If found return to: Registration.' Type: Office of Consumer Affairs and Business Regulation - .6�89 a 10 Park Plaza-Suite 5170 Expirat^ Supplement Card Boston,MA 02116 NEVVPRO OPERAT11N r TOM PEACOCK:...-..,� Y ACORL , CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) 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 NTA T ---- NAME: Mackintire Insurance Agency, Inc. PHONE 508.366.6161 FAX'A/C No, o Ext: A/C 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 INSURERB: 26 Cedar St. INSURER C: Woburn, MA 01801 ° INSURERD: INSURER E., INSURERF: - 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 MM/DD/YYYY MM/DD/YYXYP LIMITS LTR INSR WVD POLICY NUMBER GENERALLIABILITY CBP 858957 12/31/2011 12/31/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE -PREMISES Efl occurrence) $ 100,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,0010,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,OOO POLICY JECT LOC AUTOMOBILE LIABILITY BA 858417 12/31/2011 12/31/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 11000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ A X SCHEDULED AUTOS BODILY INJURY(Per accident) $ ' PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB_J�OCCUR CU SS8257 12/31/2011 12/31/2012 EACHOCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE A $ 51000,000 DEDUCTIBLE X RETENTION $ 10,00 $ WORKERS COMPENSATION WC864507 05/01/20 2 05/01/2013 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A OFFICER/ME BEER EXCLUD D?ECUTIVEr—] N/A L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ S00,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - r a 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 iTimothy Mo na h ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD MA Reg#146589 nmroarl"torours.... Federal ID#20-2625129 CT Reg#0605216 C rSL21 RI Reg#26463 trodows,S;*V W tJ Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211(F)781-933-9626,www.newpro.corn - THIS CONTRACT MADE THE day Pf 20 (L between' (Home Owners) _ (Home Phone) (BusJCeff Phone) of '�,"Z- �.�d fv�il 0 f S j'� cej,Is p— O Z Go 1 (Address) k (City) ( late) (zip) ' the"Owner'and NEWPRO Operating,LLC,"NEWPRO". The 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 describe/lAwork at the premises located at " () 'fV�L, LUK CAI 04J0 MI ,vlyiMS Job Address E-Mall)nor proprietary use only TOTAL ') Additional Model TOTAL Windows Purchased / NEWPRO Work Number Q 4CASH f/ Z�" Window Color In Out: t SlidingGlass Door. PRICE ( l• Capping Color Steel Security Door. yta c.�.v Door or. in., out: DEPOSIT Model Name Model Number(s) Oty Sidelites WITH 2 a Double Hung New Construction Unit ORDER Picture Window Storm Door BALANCE C ement 9r Obscure Glass TOP BOTTOM DUE AT it 13 Lite Slider V757 Screens HALF INSTALL y l Bow Frame Please Initial., Roof.' ❑ Sofnt:❑ - Customer understands that NEWPROS does not - CASH' - Garden Window /� do any painting or staining. (e:when removing Balance paid to installer at installation Awning or replacing Interior stops or tdm) Hopper NEWPRO®is not responsible for conditions or - Sha ed circumstances beyond its control Including con- INANC Other S`6 densatien resulting from or due to pre-existing Bank completion form signed at installation GRIDS Colonial I SDL 5uro, conditions. DESCRIBEWORK- k1k jiV-ea,,jora w a.s CLr.— wStd-, _1W a,at— t" -A. �w r_ co r (I s:ca Co^. .+=t Lit r .3•1 oel 1 l - r i n. .t`K S5 Q A jw,.w EstAtIrt te: (t�. Customer un erstands this is an"estimated dateMnrba 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 dearly 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$100,000-$300,000. _ If the Owner refuses to permit NEWPRO to proceed with the work herein,or In the event of any breach of the Owner of-this agreement,for any reason whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed, liquidated and ascertained damages,and not as a penalty,without further proof of loss or damage. ' NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond Its reasonable control. Owner warrants that he Is the owner of the property on which the work Is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. -This contract represents the entire agreement between Owner and NEWPRO and cannot be changed except In writing signed by both the Owner and NEWPRO. You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We,the aforesaid owners,certify that immediately after the signing of the aforesaid agreement,a copy was-furnished to us. You may cancel this agreement If it has been signed by a party thereto at 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'mall posted,by telegram sent or by delivery,not later than midnight of the third business day , following the signing of this agreement. (Saturday is a legal business day). See the attached notice of cancellation form for an explanation of this right n r n DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. - .I PIThe owner has seen"sample"warranties that will.be provided by NEWPRO upon.Installation. Sample warranties provided to Owner. i f .IN WITNESS WHEREOF,the parties have hereunto signed their names this I ( .. day 0 ' to EINtF Signed Marketing Representafi r'' ted Name e Accepted: NEWPRO Operating,LLC By Signed ' ner CORPORATE FICE Office ofConswner Affairs and BusinessRegulation WARWICK BRANCH OFFICE 26 Cedar St Ten Pads Plazs,Slate 5170 24 Minnesota Ave Woburn,MA 01801 Boston,MA 02116 Warwick,RI 02888 }' (P)800-242-9974(From NE) Phtme:(617)973.8700 (P)800-356-3312(From NE) (F)781-933-0717 (F)401-732-1371 WHITE: Branch Copy YELLOW: Customer's copy PINK: File Copy GOLD: Finance Copy `' [� a NOW NEWPRO MANUFACTURING Nr�zt SUPERMAX DOUBLE HUNG Cellular PVC frame,Double glazed, Low E coating(e=0.027,S2; 0.149,S4) NaWnalFenaetfdon Krypton/air filled,Grids petlnp CaunPU'a DEV-►c-27-00046-00002 ENERGY PERFORMANCE RATINGS U-Factor(U.SA-P) Solar Heat Gain Coeffident 0s23 - 0,24 ADDITIONAL, PERFORMANCE RATINGS Visible Transmittance Air Leakage(U.S,A-P) y On42 01 Condensation Resistance 47-- - 11 rryPAW dutthere Mllnpe caftan to eppftwe RRO proeedurer for delmminhpWhole p ucfperfamtnoe.NFAOntlrtyerrdahrtahKdhrrtl6radurtofen�lronmandloandltlmeande rpe0 productelte,Nftdonnot aMdeeanatwormtfheaull bidydany Product r arry epeclfk uee,Ibneuft manufegnnr a lRertlun for olherproduol perfarrwroa lrrlormetlon, • vnvw.Nrc.orp