Loading...
HomeMy WebLinkAboutBLD-19-000735 -�, Office Use Only s o� �` •• Argiy vdb73S • ;‘' o o •44111y Amount 5D� Permit expires 180 days from • Issue date EXPRESS BUILDING PERMIT APPLICA=TION TOWN OF YARMOUTH Yarmouth Building Department - 1146 Route 28 I AUG 1 2018 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT ay CONSTRUCTION-ADDRESS: X1'0 3 W fr,07e ASSESSOR'S INFORMATION: . Map: 8f. Parcel: '} lye./ amP ^c OWNER: - anGenn*. SIO 3 t✓Yet rel.,..4' . I. ttlest/cnova •7'dfl ntb73 SO2- I(z(3 NAME f FRLSG�',lggDDRFSS� TEL # Email'Address: cONTRACTOR: Autile!n R1.):. (timed cos Gr�tJe�p, 1e/tt!llCCo28‘f CPO AME MAILING ADDRESS TEL.* Email Addn Commercial ESL Cost of Construction$ 7, 3 7/ -- Home Improvement Contractor Lia# /73 2.5/.S Construction Supervisor Lice# OQ67O 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: $RFnr1EA -S 10S. ' J Worker's Comp.Policy# U)CA 3/682 7-Z O WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_____ Old Kings Highway/Historic/Did. ( )I;eplacfng like for like *The debris will be disposed of an WA S+t "lc n 4.5 em r^.it - /-..n tJ-t ? Location of Facility I declare under penalties of perjury that the eats herein contained ate true and comet to the best of my knowledge and belief. Iunderstand that any false enswet(s) will be just muse for denialofm se and for prosecution under MO.LCt268,Section1. p Applicant's Signauuc Date: O - /^ I er i' Date: Owners Skeeter.(or attachment) See �1r p Approved By /i Date 0 Building Official(or designee • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 ft.of Wetlands: Yes No Yes No • • Renewal Agreement Document and Payment Terms ',Andersen. dba,Renewal By Andersen of Southern New England Lynne Carey ���[ Legal Name:Southern New England Windows,LLC 563 W Yarmouth Rd 1Er 4" RI#36079,MA#173245,a#0634555, Lead Firm#1237 West Yarmouth,MA 02673 WINDOW\u 10 Reservoir Rd I Smithfield,RI 02917 H:(508)394-1613 Phone:866-563-22351 Fax:401-633-6602 I sales®renewalsne.com C:7742123108 Buyer(s)Name: Lynne Carey Contract Date: 07/19/18 Buyer(s)Street Address: 563 W Yarmouth Rd,West Yarmouth, MA 02673 Primary Telephone Number: (508)394-1613 Secondary Telephone Number: 7742123108 Primary Email: jeanneg57@comcast.net 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: 57,379 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: $3,690 Balance Due: 53,689 Estimated Start: Estimated Completion: Amount Financed: $7,379 8-10 weeks 8-10 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: 50% dep paid by GS; 50% dep paid at comp;Taxes to be paid in Yarmouth 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,inducting 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 07/23/2018 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 Name,Southern New England Windows,1W dba:Reonva n. of Southern New England Buyer(a) -`(oaL5# Signature of Sales Person Signature Signature Kevin Desmarais Lynne Carey Print Name of Sales Person Print Name Print Name UPDATED: 0 7/1 9/1 8 Page 2 / 11 I 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 card.Mark reason for change. Address _ Renewal _ Employment _ Lost Card -781Lce 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 plait-Suite 5170 Expiration: 9/19/2018 Supplement Card Boston.MA 02116 ILITHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON IIAN DENNISON `// ALBION RD N.{_�N•-- rJ�— JCOLN,RI 02865 LZndefsecreiar,• Not valid without signature %n C?"- rt_M r'..tnt ., .:.. - tom_ tiil ;\arY Buildi�ifiRf=o;:Iati1a�ls-at�iv: Standards .._ r.t. CS-095707 . i'>y'�'�' e. YCT BRIAN D DENNISON ]-£u , ' LAMBS POND CIRCLE Wim' '..yam;*' ,., , CHARLTON MA 01507 .. t- :::-.7d:" • NV!6....A.,\ C/ —Le ": C T-0 al^'1:ssioner 09:0$/2C1S The Commonwealth of Massachusetts —el Department of Ind Pustrial Accidents De 8��=� * =t'A 5 1 Congress Street,Suite 100 __ 55 Boston,MA 02114-2017 • _., www mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERM:MONO AUTHORITY. Applicant Information ( � Please Print Letbly • Name (Business/Organ'vationnndividual): Sov.nq-' A� tV e uJ EU2/14,wJL e( f 1,b�f lows Address: 2ln u City/State/Zip: L. a.a e p r . . - Phone#: Ip/ -2>4?--- 7gto - Are you an employer?Chat the appropriate box Type of project(required): '^ ' IX am a employer with 20 temployees(ful)and/orpart-time).• 7..Q New construction • "U I am a sole proprietor or partnership and have no employees worldna for me in any capacity.[No workers'comp.Insurance required.] 8• 0 Remodeling 3.01 am a homeowner doing all work myself[No workers'comp.insurance requi ed)t 9. 0 Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition • ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors wiffi no employees 12.0 Plumbing repairs or additions 5.01 am a general mrmacmr and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance 13.0Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption pet MGL c. 14.CJ Otber�ct"/io c10o 152,f l(4),and we have no employees.[No workers'comp.insurance required.] reeke ei'i e4� •Any applicant that cheda box*1 must also 511 out the section below showing their workers'compensation policy information, 1 Homeowners who submit this affidavit indicating they are doing ail 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-contactors and an whether or nor 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 ad-job site information. • /� Insurance Company Name: Fire me fl s 1p$• (ort Policy*or Self-its.Lie.*: U)C84 3I�t/ Z q�1- Z.C Expiration Date: 1// li V Job Site Address: 5-6 3 f4/. Xt r e,o u-k1- r eR„v. City/State/Zip:bip rruu 4-1-‘, et A- Attach a copy of the workers'compensation policy declaration page(showing the polity num er and expiraon date). Failure to secure coverage as required under MOL c.152,§25A is a criminal violation pt3iishable by a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORE ORDER and a tine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certifycer4fy under and penalties of perjury that the information provided above is true and correct Sienature: Date: P- i- /9 Phone*: '101-22.g T PO 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*: ' ORO® q CERTIFICATE OF LIABILITY INSURANCE DATE ISIMMOTYYYY) 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: et conditions cate holder 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). 'RDDUCER CONTACT COB¢Insurance,Inc.-CO RANEE_ 1401 Lawrence St.Ste. 1200 IAKD Na Ear 303-98&0446 I mit,Not 3D3.988A504 Denver CO 80202 NDOARILESS• COMaII@cobhlnsurance.wm INSURER(S)AFFORDING COVERAGE NAIC e INSURER A:Acadia Insurance Company 31325 NSURFD ESLFRCD-01 INSURER a:Tremens Insurance Company of WA,D.C. 21784 Southern New England Windows,LLC. lba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D Smithfield RI 02917 INSURER E: INSURER F: :OVERAGES • CERTIFICATE NUMBER:1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ER TYPE OP INSURANCE ADM.UDR ' POLICY EFF POLICY EIV PIM wYD POLICY NUMBER (MWDONYVY) IMM(DDWYYYI UNITS A X COMMERCIAL GENERAL LIABILITY CPA315B72fi 102018 111)201➢ DNMOCCURRENCE E1.000,000 MS-MADE OCCUR DAMAGE(0 RENTED GIWX PREMISES IFS o0.menee) 5300,000 MED EXP(My we person) S 10.000 PERSONAL ADV INJURY _ 51,000,000 GEM.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2000,000 _ POL/CY LOC I PRODUCTS•COMP/OP AGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY N CPI/315872B 1n120113 102015 earyciiI,DitSINGLE umn S 000 000 ANY AUTO BODILY INJURY per person) S ■ L1 AOWNED SCHEDULED BODILY INJURY(Per accident)accident) $ AUTOS AUTOS © HIRED AUTOS X AUTOS ED PROPERTY DAMAGE • (Per apedeMl $ A X UMBRELLA LIA1 X OCCUR CPA3158T2E I 102016 111201E EACH OCCURRENCE _310 000.000 EXCESS UAB CLAIMS-MADE AGGREGATE $10.07)DOD DED X RETENTIONS C E WORRIERS COMPENSATION5 AND EMPLOYERS•WBOJTV WCA3158T2F20 10/2018 10201E X PER R. AND YIN Mum I FR OFFICER/MEMBER EXCLUDED? ❑N/A EL EACH ACCIDENT $1.000,000 (Mandatary M MM EL DISEASE EA EMKO 51,00°,000 P rya.dascrbe wear DESCRIPTION OF OPERATIONS below EJ-DISEASE•POLICY LIMIT 31,000,000 C � 7tYNade NRy 7930073310000 111201E 1112019 Er Ocamrrz 11.008000 ARetroactive Dale 06202013 Deduces* 11,000.0001000 IESCROTON OF OPERATORS I LOCATIONS I VEHICLES (ACORD 101,Addieonpl Remarks SNledula,nay be attached R more apace Is requlnd) • :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 Purposes AUTHORIZED REPRESENTATIVE I ®1988.2014 ACORD CORPORATION. All rights reserved. ',CORD 25(2014101) The ACORD name and logo are registered marks of ACORD