15 Woodside Building permits 2014-2022.pdf

Inspectional Services Department, Department of Public Works · from the Town's request portal · released Aug 15, 2022 · 32 pages · 2.0 MB
open the file ↗ · original at the source ↗

8/15/22, 10:44 AM

@ Town of Winthrop, MA

BC-21-4

Building Permit - Commercial

Status: Active

Applicant

David Borges

david. borges@chaffeeroofing.com
193 amaral street

RIVERSIDE, Rhode Island 02915
401-601-8223

Project Info

Type of Proposed Work
Other

Is the owner doing the work?
No

Brief Description of Proposed Work

OpenGov

08/15/2022

Date Created: Feb 19, 2021

Primary Location

15 WOODSIDE AVE
Winthrop, MA 02152

If Other, please specify
Re- roof

Remove existing epdm and iso. Furnish and install new double layer 2.6" iso and install new Carlisle fully adhered 60 mil

epdm to manufacture 20 year specs.

Owner Information

Owner Name

Site & Construction Information
Current Use

Lot Area (sq ft)

Construction Type

Fiood Zone

0

License Construction Supervisor

hitps:/Avinthropma.viewpointcloud.io/#/explore/records/526/printable?act=true&app=true&att=true&emp=true&int=true&loc=true&sec=1011023%2C10...

Owner Phone Number

Proposed Use

Frontage (sq ft)

Zoning District

Flood Zone Details

V5

8/15/22, 10:44 AM

| understand that Workers' Compensation affidavit must be completed and submitted with this application. Failure to provide this

OpenGov

affidavit will result in the denial of the issuance of the building permit.

wv

Registered Home Improvement Contractor
Contractor's Name

STEVEN H. CHAFFEE CHAFFEE INDUSTRIAL ROOFING

License #
196942

License Type
Home Improvement Contractor

Corporation/Partnership/LLC License #

Zip Code

Email
David.Borges@chaffeeroofing.com

Policy and Job Site Information
Insurance Company Name

Beacon mutual ins.

Expiration Date
05/01/2021

Registered Achitect

Architect Name

Telephone

Expiration Date

General Contractor
Company Name

chaffee industrial roofing

Address
193 amaral st. riverside r.i 02915

https://winthropma.viewpointcloud.io/#/explore/records/526/printable?act=true&app=true&att=true&emp=true&int=true&loc=true&sec=1011023%2C10...

Business Name

License Expiration Date
10/09/2021

Type of Business

Mailing Address
193 AMARAL STREET EAST PROVIDENCE RI 02915,

State

Preferred Telephone #

Policy # or Seif-Ins License #
85314

Architect Address

Registration Number

Responsible in Charge of Construction
David Borges

Telephone
401-438-1160

3/5

Completed

Mar 8, 2021 at 9:51 am

Assignee

Kathy Rappa

Due Date

8/15/22, 10:44 AM OpenGov

Label Status Activated —_ ;
wf Tax Review Complete Mar 8, 2021 at 8:44 am
af DPW Approval Complete Mar 8, 2021 at 9:51am
fe} Permit Fee Paid Mar 8, 2021 at 1012 am

“Berit issuance Issued Mar 8, 2021 at 12:58 pm
a] Inspection Active Mar 8, 2021 at 12:58 om
iS Certificate of Occupancy {ssuance Inactive -
ia Final Inspection Inactive

Mar 8, 2021 at 10:12 am

Steven Calia

Mar 8, 2021 at 12:58 pm

Mar 8, 2021 at 12:58 pm

https://winthropma.viewpointcloud io/#/explore/records/526/printable ?act=true&app=true&att=true&emp=trued&int=true&lac=true&sec=1011023%2C10... 5/5

: ‘Comnionwealth of Massachusetts ‘
Division of Professional Licensure. © x
Board ‘of Building Requlations and Standards

pk en, ee f a : :

cs. 113728

Commissioner bi yon —

The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations

Lafayette City Center
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):_ C Ha F FFE R oo Fry
Address: 47 3 Ada ta ote
City/State/Zip: Quvacide VA il ab / O2UL Phone #: Lol _ S3F- Mh 6¢

Are you an employer? Check the appropriate. box: T: ; i .
u ‘ype of project (required):
1. {Lam aemployer with ) O 4. (] Lam a general contractor and I 6. [New construction
employees (full and/or part-time).* have hired the sub-contractors ’ .
2.C0 1am a sole proprietor or partner- listed on the attached sheet, 7. C Remodeling
ship and have no employees These sub-contractors have , 8. [[] Demolition
working for me in any capacity. employees and have workers 9. [1] Building addition
[No workers’ comp. insurance comp, Insurance.* . . : ws
required.) 5. [] We are a corporation and its 10.(] Electrical repairs or additions
3.1] 1 am a homeowner doing all work officers have exercised their 11,([] Plumbing repairs or additions
myself. [No workers’ comp. right of exemption per MGL 12.(] Roof repairs
insurance required.] t c, 152, §1(4), and we have no 13 Wor Qe- D 08 F
employees. [No workers’ : ther,
comp. insurance required.]

*Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information.

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.

Tam an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site
information.

Insurance Company Name: Bre tw ft, (3) tua | | Ags.
Policy # or Self-ins. Lic. #: SE. ~~ 3/ 4 Expiration. Date: S> [ ~a |

Job Site Address: 1S aad sie Aue. how vive wu ov City/Staterzip: 4 Mya MA 8 a ie

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.

ido hereby AA pains,and penalties of perjury that the information provided above is true and correct.
Signature: i Lp Date: 2 : / 9 ‘od [
Phone #: WAY A —66f -~GdA 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 (check one):
iLIBoard of Health 2] Building Department 3 cityrrown Clerk 4.0] Electrical Inspector s{_iumbing
Inspector 6.[_]Other

Contact Person: Phone #:

Private and Confidential

CHAFFEE

INDUSTRIAL ROOFING February 10,2021

INVESTMENT SUMMARY

Apply for permit to the City of Winthrop MA

Conduct safety briefing / Install necessary safety equipment

Remove and properly dispose of EPDM and polyisocyanurate insulation to expose tar surface
Remove and properly dispose of flashings and terminations as necessary

The existing perimeter metal edge will remain in place

Furnish and install a double layer of new CaRLIsLe 2.6" POLYISOCYANURATE INSULATION

* ‘Ma Building Code 780:CMR 13,00-- Section: 1300. E+ JECC 2015 Climate Zone'S

* The new insulation will have a total thickness:of 5.2 "and a total R-value of 30:0:

Furnish and install new CARLISLE FULLY ADHERED 60 MIL BLACK EPDM Roor System

Flash and terminate the HVAC unit, walls and projections per CARLISLE SPECIFICATIONS

Furnish and install two (2) new 30"x30" heavy-duty walkway pads at each of the two (2) HVAC units
Furnish and install new 2" plywood over the parapet wall

Furnish and install new pressure treated lumber dunnage beneath the free standing HVAC unit
Fumish and install new wood nailer at outside edge to match height of new insulation as necessary
Furnish and install new .040 ALUMINUM CUSTOM METAL EDGE with a cleat

Clean up and remove all job related debris

Standard Chaffee Industrial Roofing Terms and Conditions apply

Roof +Permit Totat
$45,227 +$602 $45,829 Oo

20 YEARS TOTAL SYSTEM LABOR AND MATERIAL WARRANTY BY CARLISLE, WITH 2 YEAR WORKMANSHIP
WARRANTY BY CHAFFEE ROOFING

One-half (4) of contract price is due upon loading of job site, balance due upon job completion, unless

otherwise agreed to in writing. Please read the enclosed terms and conditions as the additional terms
and conditions thereon are part of this contract.

Col Rp

Colm P Rogers - Project Manager
colm.rogers@chafieeroofing.com PRICE FIRM UNTIL:
(603) 520 3311 - cell March 10, 2021

Acceptance of Proposal:

[here by authorize Steven H. Chaffee Company to proceed with and complete the roofing
work as outlined in this proposal at the prices and terms described above.

Date of Acceptance;_02/12/2021 Company Name: _ Webster First Federal CU
Signature: fol) Kirn b Title: —Chief Operations Officer
Print Signature: _Robert J KeithJr.

193 Amaral Street + East Providence, RI 02915
800-ROOF-1908 ¢ 401-438-1160 # Fax 401-431-0628
www.chaffeercofing.com 35

8/15/22, 10:46 AM

@ Town of Winthrop, MA

E-21-291

Electrical Permit

Status: Active

Applicant

Anthony Callahan
anthonyc@servelectricalsystems.com
131 CHESTNUT ST

MARLBOROUGH, MA 01752
17742498982

Project Info
Total Estimated Cost
4,500

Location
Bank office area

Brief Description of Proposed Work
Install (20) cat 6 data jacks

Occupancy Type
Commercial

Permit is in conjunction with a building permit

O

OpenGov

08/15/2022

Date Created: Oct 25, 2021

Primary Location

15 WOODSIDE AVE
Winthrop, MA 02152

Owner:

Webster First Federal Credit Union
15 Woodside AVE Winthrop, MA 02152

Utility Authorization #

Work to Start:
10/25/2021

Estimated Cost of Work Associated with Building Permit (Do not include the dollar symbol [$].)

Owner Information

Owner Name
Anthony Callahan

Primary Contractor

Owner Phone Number
7742498982

hitps://winthropma.viewpointcloud.io/#/explore/records/2982/printable?act=true&app=true&att=true&emp=truesint=true&loc=true&sec=10480%2C101... 1/6

8/15/22, 10:46 AM

No.

No.

No.

No.

No.

No.

No.

No.

No.

of Luminaires

of Switches

of Ranges

of Dishwashers

of Water Heaters

of Hydromassage Bathtubs

of Hot Tubs

of In-Ground Swimming Pools

of Gas Burners

AC Total Tons

Heat Pump Tons

Space/Area Heating KW

No.

of Ballasts

Motors Total HP

Transformers Total KVA

Generators KVA

No. of Security Systems Devices or Equivalent

No. of Data Wiring Devices or Equivatent

https://winthropma.viewpointcloud.io/#/explore/records/2982/printable?act=true&app=true&att=true&emp=trued&int=true&loc=true&sec= 10480%2C101...

OpenGov
No. of Receptacle Outlets

No. of Ranges

No. of Waste Disposers

No. of Dryers

Water Heater KW

No. of Ceil.-Susp. (Paddle) Fans

No. Above Ground Swimming Pools

No. of Oil Burners

No. of Air Conditioners

No. of Heat Pumps

Heat Pump KW

No. of Signs

No. of Motors

No. of Transformers

No. of Generators

No. of Emergency Lighting Battery Units

36

8/15/22, 10:46 AM OpenGov
I have current liability insurance / workers' compensation policy or its substantial equivalent
Yes

Insurance is not required

O

Workers' Compensation Insurance Affidavit

Are you an employer? Select from the options below.
lam an employer with full and/or part time employees.

Policy and Job Site Information

Insurance Company Name Policy # or Self-ins License #
The Hartford (Bright Agency inc) O8UE0Z3526

Expiration Date Type of Insurance Coverage
06/22/2022 Liability Policy

Workers’ Compensation Affidavit Signature

I do hereby certify that under the pains and penalties of perjury that the information provided above is true and
correct.

4

Attachments

Gee 22.pdf
Uploaded by Anthony Callahan on Oct 25, 2021 at 11:06 am

(Pé" Electrical lic 2022. pdf
Uploaded by Anthony Callahan on Oct 25, 2021 at 11:03 am

History

Date Activity
Oct 25, 2021 at 10:49 am Anthony Callahan started a draft of Record E-21-291
Oct 25, 2021 at 11:08 am Anthony Callahan submitted Record
Oct 25, 2021 at Ih: 08 am , approval step Inspector Reviewwas as

nny Gray on Record E 21- 201 —

Oct 25, 2021 at 1: 26 pm Danny Gray approved approval step Inspector Review on Record E- 21- 291

Oct 25, 2021 at 1:50 pm completed payment step Permit Fee on Record E- 21- 291

Oct 25, 2021 at 1:50pm inspection step Inspectionwas assigned to Danny Gray on Record E- 21-291
Timeline

hitps:/Awinthropma.viewpointcloud.io/#/explore/records/2982/printable?act=true&app=truesatt=true&emp=trued&int=true&lac=true&sec=10480%2C101... 5/6

Fae Ce Wd be . .
VENT IVAPD UP LiAnvilii rr davon. | oe/29/2021

THIS CERTIFICATE [S 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 cartificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION 18 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 GQNIACT Kourtney Welch
Bright Agency, Inc PHONE, (608) 473-0566 [ERE Noy: (008) 478-6709
6 Congress St. EMAIL .g. _kwelch@brightinsurance.com
P.O. Box 424 INSURER(S) AFFORDING COVERAGE NAIC @
Milford MA 01757 insuRERA: [he Hartford
INSURED Insurers; Afbella Protection ins 41360
Serv Electrical Systems LLC INSURER C:
131 Chestnut St INSURER D:
INSURER E :
Marboro MA 01752 INSURER F:
COVERAGES CERTIFICATE NUMBER: _ CL2162113689 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 JADDL[SUBR) POLICY EFF POLICY EXP

LTR TYPE OF INSURANCE INSD | Wyo POLICY NUMBER (MM/DDYYYY) | (MMIDO/YYYY) LIMITS
><} COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ¢ 1,000,000
JAMAGE. TO RENTED
| cuams.maoe [3] occur PREMISES (Ea occurrence) | §_ 900,000
= MED EXP (Any one person) _| $_ 5-000
at] OBUENOZ3526 06/16/2021 | 05/16/2022 | pergonar eanv injury | s 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ¢_2,000,000
|__| Poucy 5S [| Loc propucts -compror ace _| g 2,000,000
OTHER: s
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY (Per person) | $
[| owneo SCHEDULED
B |__| autos onty [><] AUTOS 1020082909 03 06/30/2021 | 06/30/2022 | BODILY INJURY (Per accident) | $
$<] HIRED NON-OWNED PROPERTY DAMAGE ry
| 2S) autos onty AUTOS ONLY | {Per accident)
$
[><] UMBRELLALIAa — |X] occur EACH OCCURRENCE s_5,000,000
A EXCESS LIAB CLAIMS-MADE O8HHUOZ3576 06/16/2021 | 06/16/2022 | sacrecate ¢ 5:000,000
op |_| netention s 8
WORKERS COMPENSATION PER OT
AND EMPLOYERS’ LIABILITY YIN ><[Siiure | [Es 7000000
Pr eae el ts lle NIA O8WECCQ5257 05/16/2021 | 05/16/2022 | EL EACHACCIDENT $n
(Mandatory In NH) E.L, DISEASE - EAempLovee | g 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below EL. DISEASE -Pouicy mit | s_1.900,

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached 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

Johnson Control's Security Solutions LLC ACCORDANCE WITH THE POLICY PROVISIONS.

80 Capita! Dr
AUTHORIZED REPRESENTATIVE

West Springfield MA 01089 KOE

© 1988-2015 ACORD CORPORATION. Ail rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

\GHUSETTS
ESSIONAL LICENSURE

pw.

Pinal

vo

ESN Commonwealth of Whassachusots Official _
Permit No._i2 Jo~-
Department of Fare Senices ome

Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS _ [Rev. 1/07] (leave blank)

APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK

All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1-21-2020

City or Town of: Winthrop To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.

Location (Street & Number) Woodside Avenue 15
Owner or Tenant Webster First Credit Union Telephone No.

Owner’s Address
Is this permit in conjunction with a building permit? Yes Cc No | (Check Appropriate Box)

Purpose of Building Bank Utility Authorization No.
Existing Service Amps / Volts Overhead im Undgrd Cr] No. of Meters
New Service Amps ! Volts Overhead C] Undgrd im No. of Meters

‘Number of Feeders and Ampacity

Location and Nature of Proposed Electrical Work: Retrofit (83) existing lighting fixtures to LED.

Completion of the following table may be waived by the Inspector of Wires.

‘No. of Recessed Luminaires No. of Ceil.-Susp, (Paddle) Fans No. of rmers Poial
No. of Luminaire Outlets No. of Hot Tubs Generators KVA
ar . = . oF Emergency Light
No. of Luminaires 83 Swimming Pool Above O ond. O Battery Units vee
No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones
No. of Switches No. of Gas Burners No. Coenen Bass
No. of Ranges No. of Air Cond, Jotal No. of Alerting Devices
. Heat Pump | Number [Tons [KW No. of Self-Contained
No. of Waste Disposers Totals: Detection/Alerting Devices
No. of Dishwashers Space/Area Heating KW Local [] Municipal C) Other
No. of Dryers Heating Appliances KW maa: vices or Equivalent
No. of Water No. of No. of Data Wiring:
Heaters KW Signs Ballasts No. of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP ‘Telecommunicattons Bouin ‘att
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $15,126.00 (When required by municipal policy.)
Work to Start: ASAP Inspections to be requested in accordance with MEC Rule 10, and upon completion.

INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including “completed operation” coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.

CHECK ONE: INSURANCE [lf] BOND [] OTHER [J (Specify:)

I certify, under the pains and penalties of perjury, that the as WA this application is true and complete,

FIRM NAME: Commonwealth Electrical Technologies LIC. NO.:
Licensee: John P. Duquette Signature 4/ (44% LIC. NO.: 113014
(f applicable, enter “exempt” in the license number line.) fT Bus. Tel. No.:.508-421-6600
Address: 125 Blackstone River Road Worcester, MA 01607 Alt. Tel. No.:

*Per M.G.L. c. 147, s. 57-61, security work requires Departme Public Safety “S” License: Lic. No.
OWNER’S INSURANCE WAIVER: I am aware that the Licgisee does not have the liability insurance coverage normally

required by law. By my signature below, I hereby waive this requirement. I am the (check one) [_] owner [7] owner’s agent.

Sigeature Telephone No. PERMIT FEE: $242.00

Email Address: _mhunt@comelectrical.com

4 COMMONWEALTH OF MASSACHUSETTS

DIVISION OF PROFESSIONAL LICENSURE
""- BOARD OF

ELECTRICIANS - 700"
ISSUES THE FOLLOWING LICENSE
REGISTERED MASTER ELECTRICIAN

JOHN P DUQUETTE ©
: COMMONWEALTH ELECTRICAL TECHNOLOG!
125 BLACKSTONE RIVER RD:

WORCESTER, MA 01607-1491 _ SE
A ‘Shias12022. . 638957

"EXPIRATION DATE. SERIAL NUMBER

NSEQSIGNATURE™

The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100

Boston, MA 02114-2017
www.mass.gov/dia
Workers? Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly

Name (Business/Organization/Individual): Commonwealth Electrical Technologies, Inc.

Address: 125 Blackstone River Road
City/State/Zip: Worcester, MA 01607 Phone #: 508-421-6600
Are you an employer? Check the appropriate box: Type of project (required):
1.X] 1 am a employer with 140 4. [] Lam a general contractor and I 6. [1] New construction
employees (full and/or part-time). * have hired the sub-contractors ‘ :
2.) 1 ama 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.* . re
required.] 5. [1] We are a corporation and its 10.[-] Electrical repairs or additions
3.1] 1am a homeowner doing all work officers have exercised their 11.) Plumbing repairs or additions
myself, [No workers’ comp. right of exemption per MGL 12.) Roof repairs
insurance required.] * c. 152, §1(4), and we have no 13.%] OtherLighting Retrofit
employees. [No workers’ 3. ther Dightang Retro
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,
tContractors 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.

Iam an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site
information.

Insurance Company Name: Traveler's Indemnity Co. of Connecticut
Policy # or Self-ins. Lic. #: UB9J589765 Expiration Date: 01/01/2021
Job Site Address;15 Woodside Avenue City/State/Zip: Winthrop, MA 02152

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 aSTOP 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 OL” ‘perjury that the information provided above is true and correct.

Signature: Date: 1-21-2020

Phone #: 908-421-6600 Vi

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 #:

2 : 7 DATE (MMJDDIYYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE

4/16/2020

THIS CERTIFICATE 1S 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: ff the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf 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).

CONTACT
‘Marsh & McLennan Agency, LLC ORE Susan R. Pace FAX
100 Front St, Ste 800 ae {AlG, No):
Worcester MA 01608 ADDREss: Susan.pace@marshmma.com
INSURER(S) AFFORDING COVERAGE NAIC#
INSURERA: Phoenix Insurance Company 25623
‘Sommonwealth Electrical Technologies Inc COMMOELECT1) isurere: Travelers Indemnity Co of America 25666
425 Blackstone River Road 8 ° INSURER CG: Travelers Indemnity Company of CT 25682
Worcester MA 01607 INSURER D: Travelers Property Casualty Co of Amer 25674
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 846966812 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 [ADDLISUBR POLICY EFF | POLICY Exe
{MNIDDIVYYY) |

LTR TYPE OF INSURANCE INSD | wp | POLICY NUMBER (MNIDDIYYYY) LIMITS
A | X | COMMERCIAL GENERAL LIABILITY DTCO3F370507 41/2020 4/4/2021 | EACH OCCURRENCE $2,000,000
DAMAGE TO RENTED
| CLAIMS-MADE OCCUR PREMISES (Ea occurrence) _| $300,000
X | xcu included MED EXP (Any one person) _| $5,000
X | LmtContract Liab PERSONAL & ADV INJURY _ | $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY Sect [_] Loc PRODUCTS - COMP/OP AGG | § 4,000,000
OTHER: s
B | AUTOMOBILE LIABILITY DTA08103F343073, wii2020 | 4/1/2021 | FEMBIED SINGLE LIMIT | § 1,000,000
X | ANY AUTO. BODILY INJURY (Per person) | $
OWNED SCHEDULED
HE OMy [| Sogo BODILY INJURY (Per accident)| §
X | HIRED X | NON-OWNED PROPERTY DAMAGE 3
|“ | AUTOS ONLY AUTOS ONLY | (Per accident)
$
D | X | UMBRELLALIAB =| X | occur CUP9J559908 11112020 4/1/2021 | EACH OCCURRENCE $10,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
oe |X [retentions 10 cnn $.
C |WORKERS COMPENSATION 1589765 PER OTH
AND EMPLOYERS’ LIABILITY VIN uBe wira020 treozt X_| Stature |__| Be
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBEREXCLUDED? NIA
(Mandatory in NH) E.L, DISEASE - EA EMPLOYEE] § 1,000,000
if yes, describe under
DESGRIPTION OF OPERATIONS betow E.L. DISEASE - POLICY LIMIT | $ 1,000,000
D | Inland Marine QT6604F117215 41412020 11112021 | Leased/Rented $1,000,000
; Installation Fioater $1,000,000
ard Party Crime

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Scheuiuie, may be attached if more space is required)
RE: Webster First Credit Union / 15 Woodside Avenue, Winthrop MA 02152

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

Town of Winthrop ACCORDANCE WITH THE POLICY PROVISIONS.
Public Works Facilities Building

100 Kennedy Drive AUTHORIZED REPRESENTATIVE

Winthrop MA 02152 <7

i

© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

Fi val iv

Wo

ESN : Commonwealth of Wrassachusetts Official Use ny
Permit No._f2 2O— -
Department of Fire Services ermit No B 2 5. F

i Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS _ [[Rev. 1/07]

{leave blank)

APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK

All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2-18-2020

City or Town of: Winthrop To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below,

Location (Street & Number) Woodside Ave 15

Owner or Tenant Webster First Federal Credit Union Telephone No.

Owner’s Address

Is this permit in conjunction with a building permit? Yes im No (Check Appropriate Box)
Purpose of Building Utility Authorization No.

Existing Service Amps / Volts Overhead oO Undgrd C] No. of Meters
New Service Amps / Volts Overhead C Undgrd O No, of Meters

Number of Feeders and Ampacity

Location and Nature of Proposed Electrical Work: Retrofit (83) existing lighting fixtures to LED.

Completion of the following table may be waived by the Inspector of Wires.

No. of Recessed Luminaires No. of Ceil,-Susp. (Paddle) Fans No. Ot armers Fetal
No. of Luminaire Outlets No. of Hot Tubs Generators KVA
No. of Luminaires Swimming Pool apove O an | Battery Unie Fighting

No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones

No. of Detection and

No. of Switches No. of Gas Burners Initiating Devices
No. of Ranges No. of Air Cond. poral No. of Alerting Devices
. Heat Pump [Number [Tons  /KW No. of Self-Contained
No. of Waste Disposers Totals: Detection/Alerting Devices
No, of Dishwashers Space/Area Heating KW Locat (] Municipal LJ Other
: + oT oe
No. of Dryers Heating Appliances KW Security ines or Equivatent
No. of Water No. of No. of Data Wiring:
Heaters KW Signs Ballasts No. of Devices or Equivalent
No, Hydromassage Bathtubs No, of Motors Total HP ‘Telecommunications Equivtient
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $15,126.00 (When required by municipal policy.)
Work to Start: ASAP Inspections to be requested in accordance with MEC Rule 10, and upon completion.

INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including “completed operation” coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.

CHECK ONE: INSURANCE —] BOND [] OTHER [J (Specify:)

I certify, under the painsand penalties of perjury, that the information on this application is trae and complete.

FIRM NAME: ran je ube Z ? LIC. NO.:

Licensee: Ej Cu 1H < J Lye yt He Signature LIC. NO.: 10 >} 1A

(f applicable oper “exer, 1” in the license manber line, Bus. Tel. No.:
Address: 24 1 Wes Thom spn! fea homes OC C627) an Tel. Now SEO UTE 4242.

*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety “S” License: Lic, No.
OWNER’S INSURANCE WAIVER: | am aware that the Licensee does not have the liability insurance coverage normally
required by law, By my signature below, | hereby waive this requirement. I am the (check one) [_] owner _[_] owner's agent.

Owner/Agent
Signature Telephone No. PERMIT FEE; $ 242.90 Pad
Email Address: mnuntecomelectrical.com Commonweal

1 Electrical

D by
th

) @
ACORD
—

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DDIYYYY)
02/18/2020

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: !f 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 GOMIACT Karissa Verrette
Gerardi Insurance Services, Inc. PHONE ext, (890) 928-7771 FAX Noy: (860) 928-7144
16 Pomfret St EMAL 45. kverretie@gerardiinsurance.com
INSURER(S) AFFORDING COVERAGE NAIC #
Putnam CT 06260 insureRa: Main Street America Assurance 29939
INSURED INSURER B; NGM Insurance Company 14788
HOULE ELECTRIC LLC INSURER C :
341 W THOMPSON RD INSURER D:
INSURER E:
THOMPSON CT 06277-2606 | wourERF:
COVERAGES CERTIFICATE NUMBER: _ 19-20 BOP, 20-21 Auto 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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ABOLISUB
ey TYPE OF INSURANCE Insp | wwD POLICY NUMBER (GRIDDIYYY) | (MODI) LIMITS
><] COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
DAMAGE TO RENTED
| cuams. wane OccUR PREMISES (Ea ocourrence) ___| ¢_ 500,000
MED EXP (Any one person) $10,000
A MPP1782E 10/06/2019 | 10/06/2020 | personaLaapvinsuRY | $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s_2,000,000
|__| pouicy SBS Loc probucTs -compiopace_| § 2,000,000
OTHER: CRIS $ 25,000
COMBINED SINGLE LMT
AUTOMOBILE LIABILITY ra $ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
B SNE ONLY SCHED B1P1782E 01/28/2020 | 01/28/2021 | BODILY INJURY (Per accident) | $
HIRED NON-OWNED PROPERTY DAMAGE rs
Loe] AUTOS ONLY AUTOS ONLY | (Per accident)
Uninsured motorist $ 1,000,000
uwereciauins | ~ | occur concours
EXCESS LIAB CLAIMS-MADE AGGREGATE $
pep |__| retention s $
WORKERS COMPENSATION [EER LIS
AND EMPLOYERS’ LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L, DISEASE - EAEMPLOYEE | $
if yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LimiT | s

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space Is required)

Work Being Done at:Webster First Credit Union 15 Woodside Ave Winthrop, {"* 02152

Work Description: Retrofit (83) existing lighting fixtures fo LED.

CERTIFICATE HOLDER

CANCELLATION

Town of Winthrop Public Works Facilities Building
400 Kennedy Drive

Winthrop
!

MA 02152

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

Cou Le

AGORD 26 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www, mass. gov/dia

Workers’ Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.

Applicant Information Please Print Legibly
Business/Organization Name: Fran x Hoole
Address: SH Wes + hempsen nd

City/State/Zip: Thomepsan/ CT OCA7Brone#: GGI-VSO -FGaya

Are you an employer? Check the appropriate box: Business Type (required):
LEP tama employer with employees (full and/ 5. [Retail
or part-time),* . O Restaurant/Bar/Eating Establishment

6
2.L4 Tam a sole proprietor or partnership and have no 7. [[] Office and/or Sales (incl. real estate, auto, etc.)
employees working for me in any capacity. ;
[No workers’ comp. insurance required] 8. [] Non-profit
3.0] Weare a corporation and its officers have exercised 9. oO Entertainment
their right of exemption per c. 152, §1(4), and we have ' 10.(] Manufacturing
no employees, [No workers’ comp. insurance required]* 7 oO Health Care
4, We are a non-profit organization, staffed by volunteers, . : : . .
with no employees. [No workers’ comp. insurance req.] || 12.2] Other Lighting retrofit

“Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation poticy information.

*“IF the corporate officers have exempted themselves, but the corporation has other employees, a workers’ compensation policy is required and such an
organization should check box #1,

—

Zam an employer that is providing workers’ compensation insurance for my employees. Below is the policy information.
Insurance Company Name: t < Har + vy,

Insurer's Address:? +0. Box 14170

City/State/Zip: Lexington, KY 40512

: . . 4 LOF tgs 01-01-2021
Policy # or Self-ins, Lic. ¢_’° "8 AB4 10 Expiration Date:

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.

Ido hereby certify funder the ne penalties of perjury that the information provided above is true and correct,
Signature: Deo. t
Phone #: Ebe ~ 450 44.

Date; 2718-2020

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. Licensing Board 5. Selectmen’s Office
6. Other

Contact Person: Phone #:

. } wiww.mass.gov/dint

OMMONWEALTH OF MASSACHUSETTS
VISION: OF:P;

ROFESSIONAL: LICENSUR
BOARD OF

ELECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN
FRANK J HOULE

341 W THOMPSON RD

rae,

SIGRATURE

THOMPSON, CT 06277-2606

10317 8

vate

07/31/2022 630513

TOWN OF WINTHROP BUILDING DEPARTMENT
100 KENNEDY DRIVE

WINTHROP, MA 02152

—

ae [——1 ELECTRICAL PERMIT £4 1KG
— PLUMBING PERMIT = Amount:_2. 2.
Permit No: J220~30) col ;

{[ 1 GASFITTING PERMIT Check #:094/ 472
PERMISSION IS HEREBY GIVEN To: COA MCW UsALTIT BLL, TROR,
susiness aporess: (5 GLI SRR PilVBe ff.
To PERFORM WorK at: /9 Wood Sik Avis
ownep ay: 4 PSTBR F-RS7 CREDIT Om on
trpeorwork: Z£/ ear (ve IPR Tho AIT LEO

In accordance with an application on file in the Building Department.

dani AAR Inspectors Signature

NOTICE: Only registered licensed electricians, plumbers aiid gas fitters can perform work in
this town. All others will be prosecuted according to law.

Ob* 9044

BUILDING DEPARTMENT

Céldlle

APPLICATION FOR SIGN PERMIT BI 4-37 L v sh 1

The en respectfully petitions

Huminated

~ 0
for permission to erect(1) WALL. SiON,.ON. ROE. Evevanion Now ilonnated sign at

TOWN OF WINTHROP

Location: vt aud SODOSIDE.. AVE io

from an story of building, and of the following description and dimensions:

Material of which composed nn Sth THM hen MCtninnisertivseeeecc

Height of lowest part above street...V. eesceeenesesecusnecceecsssesssintstsscssseneesunvecees .. nn Te
SION iS WWENTED FLUSH. TS Wale,

Projection of farthest part over sidewalk not to exceed MATEIRTL.1S..3/¢. THICK... feet,

Length... 1. 42/ 6." sestetteteteesnce

NI

onteneanenh@Ok,

tennessee fQOk,

Description to be placed on sign as follows:

7
Sketch of sign must accompany this petition.

WEBSTER FiRsr CREDIT ONION
PROPERTY OWNER..... PREM... WINTHROP. Ceenir Uniw

EST. COST $.. ZQOO .©© OWNER’S ADDRESS. SOS..AQENIN. St. SMUALS,,.A 0140 &
TEL: ACE..G2I S002

he SIGN company. MIEUROIMS... Sen... AW se

ADDRESS 35..LyMAN. Sc. NORTHBURO. .MA.O153 2

TOWN OF WINTHROP BUILDING DEPARTMENT

OFFICE OF THE BUILDING COMMISSIONER/INSPECTOR

JAMES SOPER’ COMMISSIONER
Town Hall, 1 Metcalf Square, Winthrop, MA 02152

Tel (617) 8464344, Fax (617} 539-$826, Email jsoper@ town. winthrop.ma.us

DEBRIS REMOVAL FORM

“As a condition of issuing a permit for the

ion of a building or Structure, M.G.L. c, 40
, Tequires that the debris resulting therefrom shall be disposed of ina properly

G.L.111, subsection 150A.”

Job Location: 15 Wonnsine Ave

Mewroir Sian « Annie -
Location of Facility or Dumpster Co

35 Lumen! So Maen, mA GiS32
mpany’s Name and Address '

on. CC, LM AM LipReEn! Ceonyin) ~ Poem it Mer.
Signature of Applicant Print Name

VIEWPOINT Signy ©
Date: aot fia

AWNING.

ViewPoint

SIGN ano AWNING

35 lyman Sireet
Northboro, MA 01532

508 393-8200
* 508 393-4244 Fax
signs@ViewPointSign.com
www, ViewPoiniSign,com

INTERIOR/EXTERIOR
SIGNAGE

Electric
Archilecturat
Dimensional
Wayfinding

Channel Letters
LED/Neon
Elecironic Message Centers
Digital Graphics

AWNINGS
Commercial
Bocklit
Canvas
Retractable

SIGN SERVICE

ARCHITECTURAL
METAL FABRICATION

VEHICLE GRAPHICS

MEMBERS
Mosrachusetis Sign Association
Rhode Islond Sign Association
Inlernational Sign Association
Northeast States Sign Association

North East Canvas Products
Association

Industrial Fabrics Association
tnlornational

UL LISTED FABRICATORS

Landlord Authorization

Date: thy us Ze

To whom It may concern:

’ ~ . .

\ Alps Tet tehaval Gaby dio

Owner of the property located at _ <7 Waddie PVE
Lythine , LHA_LYEZ.

Do hereby consent to allow Jeff Kwass of ViewPoint Sign and Awning to act on my

behalf pertaining to permitting and installation of signs and/or awnings for the property
named above.

Sincerely,

Arad. AD

Wei FRESE Preach, dawislia Tron

address 329 MayalsT Saugus MA_219 ob
Telephone (SB 5} bF/ -SO4 2

Email: ANfestn 0 LQWVEESTCR. Lest. Came

(Please print carefully)

Deeded name of property:

licesTen Ens debe Be Uihot
? 7

Srcce saa Sty J besa Arn

“L ¢ Y g . .

‘SOmy HOF Plaga Sty Fase

cauany -aoHoy slow nay “ef

ain | | | Prcr'E6E°20S"t XV4 SININANY ONY NSIS ga cusses neosouara econ enim | | } SoC oategncg MnP + MASE SL
SUGHETE WHISIRO SHAVING) SéLAEREG TySDdONd SHE

ooze'ese'g0s1 FUIOGIMAI/, ‘SER oe ow Ee mo ENED ie 4

JPasuddy wonpany peeuddysafoony pay stanly nui

sposodouy

(won| sa4yoay) |AUIA ay)O}9y) OO LEL-0ZZ WE-
e2uowiopad yBiy aya 20 uoLy -
2 2nfg xB YoY SWa YPrOLU O4 payuioy -

1$10)0)

“agopowor2o of paysnipo Bupods sisya] pun sieyya) punoio pappo auiying
“ej Uo 080]
rofoy

“andy Uo [AUwA Adquy payiddn edoying -
‘Yong pojunow prys says] puo 080) Ag ,P/E -

(Auta Apu

AIA 490} JOPUID GL X .8 PIEPUEIS

“bs 02 = .8/2 LLL .8/¢ BZ 2604004 a1onbs (0,
91095 0] 409)

nla ma APIS \

NOINM
ALIGskslD)

cow wie TYEE SEILSEELMOF |
|

(842 6-6) fe LUE |

solydels feucisuaWiGg

Vision Government Solutions

http://gis.vgsi.com/winthropma/Parcel.aspx?Pid=3470

15 WOODSIDE AVE
Location 15 WOODSIDE AVE Mblu 36/ 26///
Acct# Owner WINTHROP FEDERAL
PBN Assessment $710,500
Appraisal $710,500 PID 3470
Building Count 1
Current Value
Appraisal

Valuation Year Improvements Land Total

2017 $509,500 $201,000 $710,500
Assessment

Valuation Year Improvements Land Total
2017 $509,500 $201,000 $710,500
Owner of Record
Owner WINTHROP FEDERAL Sale Price $260,000
Co-Owner CREDIT Certificate
Address 15 WOODSIDE AVE Book & Page 19680- 081

WINTHROP, MA 02152 Sale Date 04/04/1995

Instrument 00
Ownership History
Ownership History
Owner Sale Price Certificate Book & Page Instrument Sale Date

WINTHROP FEDERAL $260,000 19680- 081 00 04/04/1995
WOODSIDE REALTY TRUST $0 01/01/1988

Building Information

Ll of 3

8/24/2017, 11:59 AM

Vision Government Solutions

2 of 3

Building 1 : Section 1

Year Built:

Living Area:
Replacement Cost:
Building Percent
Good:
Replacement Cost
Less Depreciation:

1967
4,622
$611,447
83

$507,500

Building Attributes

http://gis.vgsi.com/winthropma/Parcel.aspx?Pid=3470

Building Photo

Building Photo.

(http://images. vgsi.com/photos/WinthropMAPhotos//\00\00
\72/66.jpg)

Building Layout

Field Description
STYLE Branch Bank
MODEL Apts/Comm
Grade Average +10
Stories: 1
Occupancy 1
Exterior Wall 1 Brick Veneer
Exterlor Wall 2
Roof Structure Flat
Roof Cover Asph/F Gis/Cmp
Interior Wall 1 Drywall
Interior Wall 2
Interior Floor 1 Carpet
Interlor Floor 2
Heating Fuel Gas
Heating Type Forced Air-Duc
AC Type Central
Bldg Use BANK
Total Rooms
Total Bedrms 0
Total Baths 00
Int vs Ext 31
Foundation
1st Floor Use: 3410

Building Sub-Areas (sq ft) Legend

Code Description one Nee
BAS. First Floor 4,622 4,622
FOP Porch, Open 40 0
QBM Bsmnt, 1/4 Finished 4,622 0
9,284 4,622

Heat/AC Heat/Ac Pkg
Frame Type Masonary
Baths/Plumbing Average
Ceiling/Wall Acoustic Tile
Rooms/Prtns Average
Wall Height 10

% Comn Wail 0

8/24/2017, 11:59 AM

Vision Government Solutions http://gis. vgsi.com/winthropma/Parcel.aspx?Pid=3470

Extra Features

Extra Features Legend

No Data for Extra Features

Land
Land Use Land Line Valuation
Use Code 3410 Size (Acres) 0.14
Description BANK Frontage 0
Zone Depth 0
Neighborhood C2 Assessed Value $201,000
Alt Land Appr No Appraised Value $201,000
Category
Outbuildings
Outbuildings Legend
Code Description Sub Code Sub Description Size Value Bidg #
PAVL PAVING-ASPHALT 2000 S.F. $2,000 1
Valuation History
Appraisal
Valuation Year Improvements Land Total
2016 $509,500 $201,000 $710,500
2015 $509,500 $196,800 $706,300
2014 $509,500 $185,700 $695,200
Assessment
Valuation Year Improvements Land Total
2016 $509,500 $201,000 $710,500
2015 $509,500 $196,800 $706,300
2014 $509,500 $185,700 $695,200

(c) 2016 Vision Government Solutions, Inc. All rights reserved.

3 of 3 8/24/2017, 11:59 AM

es. Massachusetts Department of Public Safety
| Board of Building Regulations and Standards

License: CS-076718
Construction Supervisor

DAVID J RANDA
8 CIDER HILL LANE
SHERBORN MA 01770

[=x CAL Expiration:

Commissioner 03/15/2018

Construction Supervisor

Restricted to:

Unrestricted - Buildings of any use group which contain
less than 35,000 cubic feet (991 cubic meters) of
enclosed space. :

Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.

DPS Licensing information visit: WWW.MASS.GOV/DPS

2 Yo
ATORD
We

CERTIFICATE OF LIABILITY INSURANCE

DATE (MMIDDIVYYY)
9/7/2016

THIS CERTIFICATE !S 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 hoider 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 Neu of such endorsement(s).

PRODUCER
FM Walley Insurance Agency Inc

MANE Elizabeth Bortone

fale No, een: (781) 326-8383 FAR i), (701) 326-0387

475 High Street OA og: ebortone@walleyinsurance.com

P. 0. Box 469 INSURER(S) AFFORDING COVERAGE NAIC #
Dedham MA 02026 iSURERA ‘Travelers Indemnity Co of CT 25682
INSURED INSURERB ‘Charter Oak Fire Insurance Co 25615
Expansion Opportunities Inc INSURERC ‘The American Insurance Company 21857
DBA ViewPoint Sign & Awning INSURER D ‘Travelers Casualty & Surety Co 19038
35 Lyman Street, Suite 1 INSURER E :

Northborough MA 01532 INSURER F:

COVERAGES CERTIFICATE NUMBER:2016 REVISION NUMBER:

THIS (S 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,

Gr TYPE OF INSURANCE insoles POLICY NUMBER (GMIDO NY) UDO) LIMITS
X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A ] cuAIMS MADE ce PREMISES (es eummance) | § 100,000
| 630-5609C939 9/14/2016 | 9/14/2017 | Men Exp (Any one person) $ 5,000
|__| PERSONAL & ADV INURY | § 1,000,000
| GENL AGGREGATE LivliT APPLIES PER GENERAL AGGREGATE § 2,000,000
| X | poucy BS Loc PRODUCTS - COMP/OP AGG | § 2,000,000
OTHER: §
AUTOMOBILE LIABILITY ONES PNSLE TIT “Tg 1,000,000
B Ea Any aro BODILY INJURY (Per person) | §
{| auros [ | ScHEQULED BA-01231'720-16 9/14/2016 | 9/14/2017 | BODILY INJURY (Per accident)| $
| X | wire autos AuTos ee (Peresuaeay PE $
$
|; UMBRELLA LIAB 1 X | occur EACH OCCURRENCE, $ 5,000,000
c LX [excess uiaa CLAIMS-MADE AGGREGATE $ 5,000,000
ceo |__| retewrions SSE 00015244213 9/14/2016 | 9/14/2017 $
Ro SAT, «Five Ta
ANY PROPRIETORPARTNEREXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
D {Mandatory in Ni} OLMDED? wa UB-4A698605~-16 9/44/2016 | 9/14/2017 | EL. DISEASE - EA EMPLOYEE) $ 1,000,000
BESET TION OF OPERATIONS below E.L DISEASE - POLICY LIMIT | $ 1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more space Is required}

CERTIFICATE HOLDER

CANCELLATION

(508) 393-4244

Expansion Opportunities, Inc.
DBA Viewpoint Sign & Awning
35 Lyman Street, Suite 1
Northboro, MA 01532

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

Frank Walley 111/BETH ea ee

ACORD 25 (2014/01)
INS025 ,201401)

@ 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

& The Commonwealth of Massachusetts
: Department of Industrial Accidents
J Congress Street, Suite 100
Boston, MA 02114-2017

www. mass. gov/dia
Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.

Applicant Information Please Print Legibly

Name (Business/Organization/Individualy; EXPansion Opportunities dba ViewPoint Sign and Awning

Address; 35 Lyman Street

City/State/Zip: Northborough, MA 01532 Phone #: 508.393.8200
Are you an employer? Check the appropriate box: Type of project (required):
4 Tam a employer with 48 employees (full and/or part-time).* 7, {J New construction
2) flama sole proprietor or partnership and have no employees working forme in 8. CT] Remodeling
any capacity. (No workers* comp. insurance required.} .
3C] Tam a homeowner doing all work myself. [No workers’ comp. insurance required.) t 9. 0 Demalition :
4.f ]1am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 O Building addition
ensure that all contractors either have workers’ compensation insurance or are sole ] | Electrical repairs or additions
Proprietors with no employees. 12.[] Plumbing repairs or additions
5 1am a general contractor and | have hired the sub-contractors listed on the attached sheet. 13 O Roof repairs

‘These sub-contractors have employees and have workers” comp. insurance.’
14. FAother Bla KS

6] We are a corporation and its officers have exercised their right of exemption per MGL c.
152, §1(4), and we have no employees. [No workers’ comp. insurance required.}

*Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information.
* 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.

Zam an employer that is providing workers’ compensation insurance Sor my employees, Below is the policy and job site

information.
Insurance Company Name: Travelers Casualty & Surety Co NAIC#19038

Policy # ot Self-ins, Lic. #; UB-44698605-16 Expiration Date; 99-14-2017

Job Site Address: 15 \Wlepdaise AEA City/State/Zip: Wine? , MA

Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date).

Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to $250,00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance

coverage verification.

Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct.

Signature: a ae Date: gfast 7

Phone #; 908-393-8200

Official use only, Do not write in this area, to be completed by city or town official.

Permit/License #

City or Town:

Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector

6. Other

5. Plumbing Inspector

Phone #:

Contact Person:

ViewPoint

SIGN ano AWNING

35 Lyman Street
Northboro, MA 01532

508 393-8200
508 393-4244 Fax
signs@ViewPointSign.com
www. ViewPointSign.com

INTERIOR/EXTERIOR
SIGNAGE

Electric
Architectural
Dimensional
Wayfinding
Channel Letters
LED/Neon
Electronic Message Centers
Digital Graphics

AWNINGS
Commercial
Backlit
Canvas
Retractable

SIGN SERVICE

ARCHITECTURAL
METAL FABRICATION

VEHICLE GRAPHICS

MEMBERS
Massachusetts Sign Association
Rhode Island Sign Association
International Sign Association

Northeast States Sign Association

North East Canvas Products
Association

Industrial Fabrics Association
International

UL LISTED FABRICATORS

August 24, 2017

Town of Winthrop

Building Department

Public Works Facilities Building
100 Kennedy Dr.

Winthrop, MA 02152

Re: Webster First Federal Credit Union - 15 Woodside Ave.

Hello,

Enclosed please find an application and associated
documents for a permit for a new wall sign at the above
location.

Please give me a call once the fee is determined and I will
mail you a check as quickly as possible. AGo attached is a

pre-stamped, self-addressed envelope for the permit once it
is issued.

Please feel free to call me with any questions or if you need
more information. I appreciate your help with this project -
J look forward to hearing from you!

Best Regards,

Lauren Cronin

Permit Manager

Viewpoint Sign and Awning
35 Lyman St

Northboro, Ma. 01532
508-393-8200 X21
L£Cronin@viewpointsign.com