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HomeMy WebLinkAboutbld-23-002543 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department , ...'Y. ._ 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 1' �' Massachusetts State Building Code,780 CMR "` Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only _� Building Permit Number: B ch-a 3., ()to 3 Date Applied: . ti r-_.. SeAc S \l- 11- j Building Official(Print Name) Signa re Date U 3 20ZL SECTION 1:SITE INFORMATION , ; iII ; in,, r)FpgRTMENT P,p i� , 1.2 Assessors Map&Parcel Numbers z — 1-4 Lt 1.1 Pr er j �ss:O , 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 21 OwtRer'of Record: � 1 LAW° M „_ -1(� (A,T1114 J�OO YadYrykibUk iV�'� (�U�ame(Printt1 ,State,ZIP GLe,if) 4-1/3•')-fq• 30'46 i96t a ntivat hi.e4r.i/Nv--- No.and Street Telephone Email Addtess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building Owner-Occupied 0 ..tRepairs(s) 00.Iteration(s) 0 I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: tf(1)Detriptliar of ProposrWor ArtA,10Sti � �)vlfkr- 5ufrGvna. (a/(Id S i w GEC_ 04) -� SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (1,0 terials I.Building $ / I. Building Permit Fee:$ 1 so Indicate how fee is determined: 2.Electrical $ > ll1 Standard City/Town Application Fee 0 Total Project Cost3(Item 6 x multiplier x 3.Plumbing $ 2. Other Fees: $ : S', 4.Mechanical (HVAC) $ List: &V4 Li 7 5 fJ 5.Mechanical (Fire $ . Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount 6.Total Project Cost: $ G� -/ ❑Paid in Full ®Outstanding Balance Due: Ili v SECTION 5: CONSTRUCTION SERVICES 5.1 Cos uct' n Supervisor License(CSL) I 1 J�-k. cohnoYS f� �' �� License Numberr Expiration Date Name of S 11 �(a List CSL Type(see below) No. d Street / Type Description Sit w ICI. M,I, RCI,0 U Unrestricted(Buildings up to 35,000 cu.ft.) City/To ,State,ZIP R Restricted 18c2 Family Dwelling exijM Masonry St r V I.CS fl'P. G c ivA, RC Roofing Covering 4 ) i WS Window and Siding 61 . (a! O 1 SF Solid Fuel Burning Appliances Telephone ` Insulation Email address D I Demolition 5.2 Cieered Home Improvement Contractor(HIC) , !16�q-� A -1 S.y' 9J3 HIC�om e o gistrant Name HIC Registration Number Expiration Date Yweti 0 aatb 1 th, I ,`W t/( ] ‘) / . CI S.P P V Email ddress City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes CQ No U . SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORIl , APPLIES FOR BUILDING PERMITI,as Owner of the subject property,hereby authorize ..!`� , (°6 Yl n OY °to act on my behalf,in all matters relative to work authorized by this building permit application. (,1/`41"^()\ 11"h CI U I.� Print Owner's Name(Eomc Signature)l (� " Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION • By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding. hnoY5 jo..;?. )-1 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3, "Total Project Square Footage"may be substituted for"Total Project Cost" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at y(e oat G I`Q n Work Address Is to be disposed of oat the following location: 9 I &N 1 3-' pat,,,,,,‘44, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. (6 ii-a --- ffiature of Application Date Permit No. NLL Page 1 of 12 CT Reg O(S05216 MA Reg#146589 RI Reg#26463 t HOME SOLUTIONS 26 Cedar St Woburn, MA 01801 800-242-9974 Federal ID# 20-2625129 Luxury Contract Customer Information Daniel McDonough (Cell): 413-218-3046 Date: 09/03/2022 46 Oak Glen (Email): pdanmcd@gmail.com Rep: Ryan Gaucher Yarmouth Port MA 02675 Office#401-829-5983 Location Agreement NEWPRO hereby agrees that it will, for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 46 Oak Glen Yarmouth Port MA 02675 Custom Shower Details Package: Tub to Shower(Custom Acrylic/Spray Foam) Wall Color: Arctic Ice Size - Drain: 541 x 30"W -• Left Wall Style: Smooth Base Color: VVhite Walls To Ceiling: Yes Threshold: Single Fixtures Gibson 8" Shower Trim&Valve QTY 1 Chrome Moen Single Tier Metal Shelf QTY 2 Chrome Liquid Accents Labor Wall Repair(As Needed) QTY 3 Extensive Plumbing OTY 1 New Toilet-Customer Supplied OTY 1 New Vanity-Customer Supplied QTY 1 Vanity to Pedestal Sink is Not Allowed, Like for Like Only Customer Supplied Toilet Disclaimer Customer Acknowledges: NEWPRO must be provided confirmation the customer supplied toilet is on site and free of damage before an installation date will be set. DV/ This space intentionally left blank leaptodigital.corn 2.10.0 Page 2 of 12 Customer Acknowledges: Upon arrival for install, if the customer supplied toilet is NOT on site, damaged or incorrect size, preventing NEWPRO from installing on original install date, NEWPRO will forgo installation of the toilet and credit the customer $250. DVV Customer Acknowledges: If toilet flange is discovered to be broken upon removal of existing toilet, there will be an additional charge of$150 for replacement, due at install. D '1J. Customer Acknowledges: NEWPRO will not offer customer supplied toilet installation at a later date to accommodate a floor replacement. Customer agrees to hold Newpro harmless of any damage caused by installation of new customer supplied toilet (flooring, walls, etc.). ,DVV Customer Su. •lied Vani Disclaimer Customer Acknowledges: Newpro must be provided confirmation the customer supplied vanity is on site and free of damage before an installation date will be set. 3v) Customer Acknowledges: Customer supplied vanity musi be a one-piece unit and same configurations as original vanity(same drawer configuration, same number of sinks, dimensions, etc.) DVJ, Customer Acknowledges: NEWPRO is not responsible for installing custom vanity counter tops, back splash or baseboards. DVJ\ Customer Acknowledges: On day of installation, if customer supplied vanity is NOT on site, damaged, or incorrect size, preventing NEWPRO from installing these items on the original install date, NEWPRO will waive installation of vanity and credit the customer in the amount of$600 for a single vanity or$1,200 for double vanity. DV1it Customer Acknowledges: NEWPRO will not offer customer supplied vanity installation at a later date to accommodate a floor replacement. DVV\ Customer agrees to hold NEWPRO harmless of any damage caused by installation of new customer supplied vanity(flooring, walls, etc.) Sliding Glass Door Details S'Platinum Riviera Euro Series (Semi-Frameless) This space intentionally left blank leaptodigital.com 2.10.0 Page 3 of 12 Door Height: 75 3/4" Finish: Chrome Glass: 5/16" Clear w/C-10 EZ-Clean Coating Handles: Towel Bar with Pull Knob Installation & Promotion Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Payment Total Price: $17,481 Deposit: $0 Due Upon Completion: $17,481 Payment Method: Finance Estimated Start&Completion Estimated Start: 14 to 16 weeks Estimated Completion: 1 to 3 days Customer understands they will be contacted to set a firm installation date once all product is received. 3W\ State MA Year Home was Built 1975 LSWP NO This space intentionally left blank q (t, 0 6,\(, G .R, Page 11 of 11 Ima•e: 1.9 s- s .F 'n , \ .,......„,,,...., .,'t t h is s k kd 1 . r i x+;w - __ ca tz '.• , -- .,,;.--7, .7 .';',----•,,.. ,. 415 a tit`, ,4 1' 4 k 1 . a 1/.. � i` :ti'''' ..,... ' " / `N 1 . I leaptodigital.corn 2.10.0 0 4y gyp, �' }gy` a 4 - - t q may},' [ _ µ ' NA -R Y2 f- _ # f 0 r� R ''T. r''''''*-f ,,-- ,„.,_-_,-,pe. 4 `.''et.:- '...4'4 r t''} t'�.,, ""`' 'say f - S t3f .K? g' i4 S f if• w Wr Y .x - r .rS '.Y' • %, ..,:'.' V.,•,...4'' "Z YY '' ''' ' 3 A p a l: ', ASa i :K-r " Z. � "Itty, - - .r 3 Y. x..y,, .: 3 s :� -' i w °" r ,` ,".7,,,,,-..; '.!;,..,.. '-`,',' :,,,-,k; -...;:-.,.,":,.,-.-.,,,, , j 4 . : # o".. )t, 4 ti � is - - - »tsq t t"Y } �,'{T�' 3&. i r. 3; .. �a r" z ''r' 9/28/22,9:04 AM Mail-Katherine Searle-Outlook Fwd: Daniel McDonough - Shower Installation *Approved* Ryan Gaucher <rgaucher@newpro.com> Wed 9/28/2022 8:19 AM To:Katherine Searle <ksearle@newpro.com> BANG'!" All set! Ryan Gaucher NEWPRO Project Advisor 475 Washington St Wrentham, MA 02093 Toll Free:800.342.2211 Cell:401.829.5983 Fax: 781.933.9626 Ryan Gaucher Design Consultant Toll Free:800.342.2211 Mobile:401.829.5983 NEWPRO Home Solutions 475 Washington Street Wrentham, Massachusetts 02093 Visit us online:www.newpro.com I We're Hiring: Apply Here! I Facebook I Instagram I LinkedIn I Youtube I Twitter << � w� i c o�e ctuc it3o8tOnelobt Ir El IVY_ Best .4 ®oa TOP PLACES WE'RE Honoree TO WORK 2021 HIRING HOME SOLUTIONS MASSACHUSETS v.[ +nc rrrc Lsr< We want to be your home improvement partner for life I WINDOWS • DOORS • SIDING • ROOFING • BATH REMODEL MA REG#146589,RI REG#26463,CT REG#0605216 The information contained in this transmission may contain privileged and confidential information,including information protected by federal and state privacy laws.It is intended only for the use of the person(s)named above.If you are not the intended recipient,you are hereby notified that any review,dissemination,distribution,or duplication of this communication is strictly prohibited.If you are not the intended recipient,please contact the sender by reply email and destroy all copies of the original message. Begin forwarded message: https://outlook.office.com/mail/inbox/id/AAMkAGUxMTg2OTM1 LTNIMmEtNDhmNy1 hN2MyLWQzZDc1ZTFjMmQ4MABGAAAAAAC149D%2BFHByS4... 1/2 9/28/22,9:04 AM - Mail-Katherine Searle-Outlook From: Kevin Howard <Manager.kwc@barkanmanagement.com> Date: September 28, 2022 at 07:54:33 AM EDT Subject: RE: Daniel McDonough - Shower Installation Hi Ryan, Thank you for contacting us.You can move forward with the installation. Please let me know if you have any questions. Kevin <8F7F9560101B4A76A485E018E0597EAA[104919801],png> Kevin M Howard Property Manager Barkan Management Company, Inc.AMO® Kings Way Condo 64 Kings Circuit Yarmouth Port,MA 02675 t:508.362.3535 e: manager.kwc@barkanmanagement.com https://outlook.office.com/mail/inbox/id/AAMkAGUxMTg2OTM1 LTNNmEtNDhmNy1 hN2MyLWQzZDc1ZTFjMmQ4MABGAAAAAAC149D%2BFHByS4... 2/2 Page 1 of 11 CREATE A 5 STAR EXPERIENCE FOR EVERY CUSTOMER ASK FOR A REVIEWlllll wi'i HOME SOLUTIONS Luxury Work Order Customer Information Daniel McDonough (Cell;: 413-218-3046 Date: 09/06/2022 46 Oak Glen (Email): pdanmcd@gmail.com Rep: Ryan Gaucher Yarmouth Port MA 02675 Rep#401-829-5983 Bathroom 1 Details *crawl space under shower* Package Includes Selected Base, 3 Walls, 1 Corner Trim, Floor Repair if needed Shower Measurements Package Tub to Shower(Custom Acrylic/Spray Foam) Wall Color Arctic Ice Size- Drain 54"L x 30"W - Left Wall Style Smooth Threshold Single Walls to Ceiling - Room Height Yes - 96 Base Color VVhite Left Side Wall Width 30 Opening Length x Existing Base Width 54" x 30" Left Surround Width 30 Trim Skirt YES Right Side Wall Width 30 Right Surround Width 30 Fixtures Gibson 8" Shower Trim&Valve QTY 1 Chrome Moen TRM-M-3002-C Single Tier Metal Shelf QTY 2 Chrome Liquid Accents LA-ST-C Labor Wall Repair(As Needed) QTY 3 Extensive Plumbing QTY 1 New Toilet-Customer Supplied QTY 1 New Vanity-Customer Supplied QTY 1 Vanity to Pedestal Sink is Not Allowed, Like for Like Only Sliding Glass Door Details S'Platinum Riviera Euro Series (Semi-Frameless) This space intentionally left blank leaptodigital.com 2.10.0 Page 2 of 11 Door Heiv_ ht: 75 3/4" Finish: Chrome Gl ss: 5/16" Clear w/C-10 EZ-Clean Coating Handles: Towel Bar with Pull Knob Additions: %PullKnob2.name% Installation Instructions Left Wall Valve - Shower Fixture - Wall Repair- 1 Corner Shelf Back Wall Wall Repair Right Wall Wall Repair- 1 Corner Shelf Pre-install Checklist Variance Required NO Property Type Condo/Townhouse WITH Own Shutoff Parking Options Visitor Parking (Condo) Fixture Install Shower Head Only Curtain Rod or Glass Doors to be Installed Glass Door Bath Location 1st Floor Existing Base Type Fiberglass Existing Walls Fiberglass Is there access behind wet wall or below base? YES Below Base Ceiling Panel /Soffit NO Window Within Wet Area NO Wainscoting/Accessories NO Second Full Bath NO Additional Items to be Installed Install New Vanity(customer supplied) - Install New Toilet (customer supplied) Are there any existing problems with the plumbing? NO This space intentionally left blank Page 3 of 11 Image: 1.1 ,1?,1 d'1,44,16j ` tt .=ot ter , S f 9i w y r ? Y A Page4of11 image: 1.2 ..v\\ v\v v\ \\ v1\ v1i v1 i\ 01 iy1 11i i\1 1Ii IIi11Ir � tEOC .6? 8L9S1 ,• • , „ . _„ . . . •-:-• • ..• -• kkkk a _ eaptodigital.carn 2.10.0 Page 5 of 11 , .. ..:...•:-_-,.?-4,,:,-;.:.-J,-,-i4-x-,-,, Image: 1.3 . . . -, ,---__,.i..:04xg.•:i. .-,2,-- :::::,'--w::' ''.A.4*-e.L'•-it.,,,,,,IN •::, .„t-g-ki,..:,, .w.--•,:..,-,,_,,:•-4-.*:-.:0A...‘,;',4r,---4-1--,-,'3, .-- , .. ' '• . . . 4. cr.::;','•t;i.'.':'5.'-:', l' ''',.'-W.'4VO4,,k-f5:41"i!,'A:'.;:;.'''. .--..-.-;-.1',T.,-, •.. 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Detached -- 20' front property 1i-ne 4' side & rear property 1-i-ne - 6' house or a-ny other bldg. Carport— Sxrne as detached (unless attached to house). Pools Above Ground—Locked gate around ladder. Minim„7r, height of pool has to be at least 48 (any pool lower than 48" needs a fence around back yard). In-ground Pool—Fence with self-closing & self-latching gate, at least 4' in height_ • 6' from side&rear propertyli-ne & 10' from the front properly line (for both above and in-ground pools) Fence • 1.. No permit needed as long as it doesn't exceed 6' -.rn height • 2. The finished. side can face either property. 3. The fence can.go up to pi operty lire , but stay on your property. 4. If fence is parallel to a driveway, the last section near the front property line has to be cut down to 2 %2 - 3 feet Also, if the property - is-on a bl-i-nd corner, the fence must not exceed 3' in height 5. Any fence over 6' in height they need to speak to a building inspector. - , . Shed • � ,. 4,v 6' off any structure , 4' side and re&property line 1J 20' from front of property line ATTN: Building Dept. To Whom it May Concern, I have attached a pre-paid return envelope with this building application. Once this permit has been issued, please send the permit back to me in the enclosed self-return envelope. I appreciate your help with getting these permits back. In case you can not send the original permit back, would you be kind enough to send me a copy of the issued permit, as it is very important to me to obtain a copy of the issued permit? If you prefer to scan a copy of the permit and email it back, that would be fine also. Whichever is the easiest process for you. If you have any questions or concerns with the above request, please do not hesitate to reach out to me directly to discuss. Best Regards, Cathy Bedard Permit Services LLC 224 Broad St. # 2-L Cumberland, RI. 02864 cathy@permitservicesne.com Office: 401-601-7400 An®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) 12/30/2021 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 have ADDITIONAL INSURED provisions or 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: Melissa Pflug The Hilb Group of New England PHONE (508)366-6161 FAx (A1C,Na,E#I: LAIC,Na), 120 Turnpike Rd.Ste 300 E-MAIL Melissap©mackintire.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC Southborough MA 01772 Employers INSURER A: Mutual Casualty Co 21415 INSURED — — INSURER S: Newpro Operating LLC INSURER C: 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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 AUUL SUSHIPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wvo POLICY NUMBER IMMIDorr'YYYI I IMMfDOMlYYI LIMITS XI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 lCLAIMS-MADE l XI OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) S MED EXP(Any one person) $ 10,000 A 6015090 12/31/2021 12/31/2022 PERSONAL BADVINJURY $ 1,000,000 GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PECOT- LOC 2,000,000 PRODUCTS-COMP/OPAGG S OTHER. EMPLOYEE BENEFITS s 1,000,000 AUTOMOBILE LIABILITY GOMBcident)INEE SINGNC LIMm" $ 1,000,000 (Ea ac ANY AUTO BODILY INJURY(Per person) S A OWNED v SCHEDULED 6Z15090 12/31/2021 12/31/2022 BODILY INJURY(Per accident) $ AUTOS ONLY /s. AUTOS X HIRED v NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per acddent) Uninsured motorist BI $ 250,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 0,000,000 A EXCESS LIAB CLAIMS-MADE 6J15C90 12/3112021 12/31/2022 AGGREGATE $ 5,000,000 DED XI RETENTION$ 0 S WORKERS COMPENSATION — RERv AND EMPLOYERS'LIABILITY Y/N STATU-E OTRH- ANY PROPRIETOR/PARTNERIEXECUTIVE 500,000 A OFFICER/MEMBER EXCLUDED? N NIA E.L.EACH ACCIDENT S (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 DESCRIPTION OF OPERATIONS/LOCATIONS J VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contractor/Carpentry/Siding Install 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 IfrC = ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Aco D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/30/2022 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 have ADDITIONAL INSURED provisions or 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: Marsh Affinity Marsh AffinityPHONE 866-2374079 C (NC,No,Ext): (A/(NC,No): a division of Marsh USA Inc. EAIL ADDRESS: ADPTotatSource@marsh.com PO Box 14404 Des Moines,IA 50306-9686 INSURER(S)AFFORDING COVERAGE NAIC rt INSURER A: New Hampshire Insurance Co. 23841 INSURED INSURER B: ADP TotalSource CO XXII,Inc. INSURER C: 5800 Windward Parkway INSURER 0 Alpharetta.GA 30005 Alternate Employer: INSURER E: Newpro Operating LLC INSURER F: 26 CEDAR ST Woburn,MA 018010000 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, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS I INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYW) (MM/DD/VYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE OCCUR DAMPREMISES occurrence)T MEDENccurrence) S _ MED EXP(Any one person) S PERSONAL8,ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY JPECT LOC PRODUCTS-COMP/OP AGG S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ HIRED ^NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEL) RETENTIONS $ WORKERS COMPENSATION [PER STATUTE ERH- AND EMPLOYERS'LIABILITY YIN ti' ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 2,000,000 OFFICER/MEMBER EXCLUDED? NIA WC 024509800 MA 07/01/2022 07/01/2023 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 2.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 2 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) All workslte employees working for NEWPRO OPERATING LLC,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy.NEWPRO OPERATING LLC is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Newpro Operating LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26 Cedar St Woburn,MA 01801 AUTHORIZED REPRESENTATIVE • Lid ACORD 25(2016/03) ©1988-2015 ACORD CORPO ION. All rights reserved. The ACORD name and logo are registered marks of ACORD 5 v p, - Office of Consumer Affairs and Business Regulation - 1000 4Washingtrxi Street-Suite 710 Boston,Massachusetts 02118 Home[mu,tu,uvement Contractor Regisfat on Tjpe Suppleme Cerd NE WRO OPERATC 0.LLC. Regis rtimcation: 146589 26 CEDAR Sr- E pira OSiUC!''..02 WOBURN.,MA G1001 i 11ggyAddross arm ern,can, :Alm p1ConmmprAE,irs A Rueeton reomda`ien 'HOME I6PROlt87i60CCONIRACTOP, RegtsiaUon valid for indi,dwi use say TrPeetomunalc Card bearoltrse expimton date.*found retum to: .ReoWeadon s iretton Opte or MmoomerAftSirs and aunMurs Wguiat;on 146539 SSrt1oan 1124105Nania ton Saaat-Soite71O !PRO OPOIATING.LLC. Soston,RA 8 Rtr-'Y fANNORS ' , ,elf/ - EilARSi. } -'G':'t&"d� . df �Out9Tjnatun. 3liPN.MA analtkniersecretay / �N �j( �j CommonwealthO Me R Division of Occupational ...;:lift i • Board of Building Regulations and Standards Con�tectidtS ,rvisor 0r1.. -r fi CS-110753 e<pires:05/05/2024 .�: JEFFREY CO�NORS rit,..,;., : _, ,,.. 64 OLD FIELD.RD •r SOUTH BERItECK ME D3s0S :P , - -- '1 mill . Comrntssioner 0.4, f:, :3Ci»„la_, r. J1. r, '''� The Commonwealth of Massachusetts • Department of Industrial Accidents t�c. � y1,t1 Office of Investigations t, - a Lafayette City Center 4i-7', '✓�,.___ 2 Avenue de Lafayette,Boston,MA 02111-1750 `.- www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): NEWPRO OPERATING INC Address:26 CEDAR ST City/State/Zip:WOBURN MA 01801 phone#:401-475-2849 Are 4. ❑ I am a ou an employer?Check the appropriate box: �� general contractor and I Type of project(required): I. I am a employer with 36 �, 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. remodeling ship and have no employees These sub-contractors have 8. 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 11.E1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]r c.152,§1(4),and we have no 13.Q Other employees.[No workers' comp.insurance required.] 'Any applicant that checks box 41 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: NEW HAMPSHIRE INSURANCE CO Policy#or Self-ins.Lic.#:WCO24509800 Expiration Date:07/01/2023 Job Site Address: 6' O :61srI ` CityrStateiZip. (IC- (iti L -J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify 1 rde2 e ins and penalties of perjury that the information provided above is true and correct Signature: I , ;✓. - Date: t t i ) " Phone#: 401-47g12 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(check one): 11:3Board of Health 2I Building Department 3DCity/Town Clerk 4.1:Electrical Inspector 5ElPiumbing Inspector 6.QOther Contact Person: Phone#: