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HomeMy WebLinkAboutBLD-19-000736 o }�C� cct''Psa-Onl/i =0007 kik: . ` pf ;LW 0 eC 0 i • c;i .r• ► c . 1 /" ` T'': ."I Permit expires 180 days from• issue dam EXPRESS BUILDING PERMIT APPLIG&TIQN- ' r1 TOWN OF YARMOUTH e Yarmouth Building Department - I 1146 Route 28 AUG 1 2018 t South Yarmouth, MA 02664 J 1 (508) 398-2231 Ext. 1261 BUILDING DEFARTMEfli aY CONSTRUCTION-ADDRESS; 4 3 -171-P4 Rd ASSESSOR'S INFORMATION: • . Map: Parcel: • "Ztvr ei Pi OWNER:��/ �iiz/,if' 6 ; Ta' i 1,74-,,,,44-. ,i-tAo.un 3 Sog--1A0-64180 NAMEPRL` D,t , Tom. # EmaiAddress: coN1RACTOR:SAu11Pfn IU A. 00404 /,/ N, 72i o28uf CP1� 228=vivo SAME MAuD4OADDRESS TEL# EmailAddri Residential Commercial Eat Cost of Construction S -2-1/7--(0 0 — Home Improvement Contractor Lie.# 173 2.4- Construction Supervisor Lic.# 07670 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor A have Worker's Compensation Insurance 1 QA .a/68'72 9-20 Insurance Company Name: SAE/de-AA IPS• l s�ln�!-� Worker's Comp.Policy# 10 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove • Siding: #of Squares Replacement windows:# 8 Replacement doors: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/HistoricDist. ( )replacing like for like *The debris will be disposed of at Un-fe slant } Grp.'- Ln /� - . c Din 3 Locution of Facility I declare under penalties of perjury that the stat. eats herein contained are tine and correct to the best of my knowledge and belief. 'understand that any false answer(s) will be Just camelot denial oçocatlon of in a and for prosecution under MIL Ch.268.Sectlon1. Applicant's SignDate: R- I - I S Owners Signature(or attachment) 'tf See �K/f� Date. p Approved By . Dam: B'p.' 0 Building Official(or designee) • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resolute Protection District Within 100 ft.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms • byAndersen. dba Renewal By Andersen of Southern New England Maureen &Paul Ritchie iii Legal Name:Southern New England Windows,LLC 63 Taft Rd 411,r4/ RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Yarmouth,MA 02673 mangy\Laguna, 10 Reservoir Rd I Smithfield,RI 02917• H:5062806980 Phone:866-563-2235 I Fax:401-633-6602 I saleserenewalsne.com • Buyer(s)Name: Maureen & Paul Ritchie Contract Date: 07/16/18 Buyer(s)Street Address: 63 Taft Rd,West Yarmouth , MA 02673 Primary Telephone Number: 5082806980 Secondary Telephone Number: Primary Email: kangamhrayahoo.eom Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: 521,260 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash, Deposit Received: $10,000 Balance Due: $11,260 Estimated Start: Estimated Completion: Amount Financed: $10,000 8 to 10 weeks 8 to 10 weeks Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Depo paid by gsky, bal gsky. IFD will be looking into bal.tx yarm Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 07/19/2018 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Nama Southern New England Window,,LLC alba:Renewal vAndersen of Southern New England Buyer(,) Signature of Sales Person Signature Signature Cory Scanlon Maureen Ritchie Paul Ritchie Print Name of Sales Person Print Name Print Name UPDATED: 07/1 6/1 8 Page 2 / 12 • Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS LL BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Update Address and return©rd.Mark reason for change. _ Address _ Renewal _ Employment _ Lost Card =-0t5ce of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 173245 Type: 10 Park Plaza-Suite 5170 Expiration: 9/19/201 B Supplement Card Boston.MA 021I6 IUTHERN NEW ENGLAND WINDOWS LLC. IE Y ANDERSON f,IAN DENNISON / ALBION RD JCOLN.RI 02865 Lxndersecreiarc Not valid without signature • ,,n:J.:.Gl.-11:JC.tS i.epart.,"t.i. o - .i L:iv Sa-fi r Scar: of Building Regulations and Standards :5 r se.: CS-095707 T., 05,- t" - - fix.: 1 4- BRIAN D DENNISON , , LAMBS POND CIRCLE a-1,--4li CHARLTON MA 01507 r `"r` ` vo1^�rn ssic 09.08-•-• 9c rat iS �.. . The Convnonwealth o ._�.— of Massachusetts t _-y �'t • Department of lndustrialAccidents 7= 1 Congress Street,_n`'__ gr Suite 1 DD • — p Boston,MA 02114-2017 • �ta` www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BEETLED WITH THE PERMITTING AUTHORITY. Applicant Information � Please Print Leah • Name (Business/Organization/Individual): ISta-*E AJ /(V e to f4/ , it clot s Address: -24n 1Jiog3 Ciry/5tate/Zip: : ..t. . . - Phone#: ID,-2 .r— ?gee - Are you an employer?Check the appropriate box: 1Imnaemployer with 20 tType of project(required): �Pl%Kes(full andlorpart-timer r 7..0 New construction 2.0 I em a sole proprietor or partnership and ban no employees worlong for me in any capacity.ND workers'comp.insurance required.) T. D Remodeling 3.0I am a homeowner doing all work myself fNo workers'comp.insurance required)t 9. El Demolition 4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I win 10 0 Building addition ensure that all contract=either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or addition contractor These sub-contractors have employees and have workers'comp.insurances 13.❑Roofrzpsub-contractors 11'' / 6.0 We are a corporation and its()Mears have exercised their right of exemptior,per MGL c. 14. ther Win- cL s g dao 152,§1(4),and we have no employers No workers'comp.insurance required) 'fury applicant that checks box yI must also fill out the section below showing their workers'compensation policy information Hmnmwners who submit this affidavit indicating they we doing all work and then hire outside contactors 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 employers. If the sub contract=have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancejor my employees. Below is the policy tthd)ob site information. Insurance Company Name: fire mer s I Ns. 045,(TIM � � Policy*or Self-ins.Lic.*: to CA 3 46-8,7 2.9 _ a0- / Expiration Date: 1/i if Job Site Address: ('O I q 2, f-/ ZJ• Ciry/StmeSip./1/. fink,AIN) ti A- Attach a copy of the worker compensation policy declaration page(showing the policy annSber 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 of a STOP WORE ORDER and a fine of up to$250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cern:),under and penalties ofperjury that the information provided above is true and correct. Sienature: Date: ?_ /--I£" phone'±: l0 t-22.t—T r->e • 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*: a`oRn CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM'W) 12 (THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.I7 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. IIMe POnTANT: ondidIf the certificate r tifics of teeeholder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to 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). 'RODUCER CONI ACT COBiz Insurance,Inc.-CO NAME: 1401 Lawrence St,Ste, 1200 PHONE IMC Ne Fal-303988.0446 IM,NPL.303-985-D804 Denver CO 80202 E-MAIL COMBII(Thcobizlnsurance.com INSURERS)AFFORDING COVERAGE NAIC I INSURER A:Acadia Insurance Company 31325 CURED ESLERC0-01 INSURER a:Firemen Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURER e:Homeland Insurance Company of New Yolk 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F: :OVERAGES ' CERTIFICATE NUMBER:1252551165 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 CONDrnONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -•1RR TYPE OF INSURANCEADDLSUbR ' POLICY EFF POLICY EXP S M50 WW1 POLICY NUMBER (MM/DD/YYYYI INM/DDP/YYYI LIMITS A X COMMERCIAL GENERAL UABILITT CPA3158728 1/12018 1/172016 EACH OCCURRENCE E1.00DOfp°I-AIMS-MADEADE OCCUR DNSEEOTE PREmIESft.omeencel 11111 3300.000 MED EXP(My one parson) 510,000 PERSONAL a am PU URr _ 51,000.000 _ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _ $2000,000 © POLICY O J�EL4T ❑LDC - PRODUCTS•COMP/OP AGG 52,000,000 OTHER 5 A AUTOMOBILE LIABILITY N CPA313B72B I inR018 1/12016 COMBINED SINGLE LIMIT CO BBINED 51000000 X ANY AUTO BODILY INJURY(Pr Penwn) S ALL OWNED �—SCHEDULED BODILY INJURY(Per acodent) I rrr-��- AUTOS AUTOS '� HIRED AUTOS X ANON-0NMED RO r modest 3 _ I 5 A X UMBRELLA LIAB X pccuR CPA315B728 I 1/12016 10201E — EXCESS WB EACH OCCURRENCE .510000 OOD DLAIMSNMDE AGGREGATES 10,000000 DED X RETENTIONSD - B WORKERS COMPENSATION WCA315S120.20RIE: EfFL 5 AND EMPLOYERS LIABILITY YIN 471/2013 1nR018 x I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERR.I1EIER EICLUDED7 NIA EL EACH ACCIDENT 51,000,000 (Mandan M NH) EL DISEASE•EA EMPLOYEE 51,000,000 If ym�describe under Dyes.d PION OF OPERATIONS below EL DISEASE•POLICY LIMIT $1,000 000 C ��IIy6Ly 7930073340000 1/12018 11172019 Each Occurrence 11.000.000 Retmaa,wDa 06262013 Aggregate CIrLble St00�00� IESCPoPfION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached N men nee N requ,red) • ;ERTIFICATE 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. For Informational Puryoses AUTHORED REPRESENTATIVE I ®1988-2014 ACORD CORPORATION. All rights reserved. CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD