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Home My WebLink AboutBLD-19-000873 .. - OfficeUseOnly °Y.Y • •ks ; • 4 Permit# i O w..,...sVP Permit expires 180 days from • Issue date • BLD- 19873 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R E C El 1 V E ) Yarmouth Building Department 1146 Route 28 i South Yarmouth,MA 02664 AUG 0 8 2018(308)398-2231 Ext. 1261ELM i CONSTRUCTION ADDRESS: c 2 6 S-Le. CR-CQ.• V V • 1 ASSESSOR'S INFORMATION: • 1 . Map: Parcel: ' Colo ZarSY OWNER: Ayrnda rl tDaySj .?G dra.,s .r REQ. t✓. arsnn M4 O.7G73 Cat-s7q-870& NAME i PRES D TEL a EmaitAddress: t(° II La rl0,022r-flan coNTRAcmaL5Au rA UP. G)IngDUxs c, N, W ota6s- 0, NAME MAILING ADDRESS TEL# Email Addri 0 Commercial Est Cost of Construction$ IS'21 3 — Home Improvement Contractor Lin# x73 Z it Construction Supervisor Lie.# 0767O 7 Workman's Compensation Insurance: (check one) Tam the homeowner I am the sole proprie ettor /4 have Worker's Compensation Insurance Insurance Company Name: $REI4e.JS 1125. `13m1Nt Worker's Comp.Poicy# l()M.d16r72 7-2 0 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding. #of Squares Replacement windows:# s Replacement doors: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like J • tie•The debris will be disposed of ac ALL Ma Ira t e i't C.., . Ls)i C.., Cc-+^,CZ J Locution of Facility I declare under penalties of perjury that the eats herein contained are min and correct to the best of my knowledge and belief. I understand that any false answer(s) will be Just estee let dental rLof " se and for prosecution under M.G.L Cli.268.Section 1. Applicant's Signature: Date $- $ -I k Owners Signature(or attachment) 4-- . • r,.�:. Date: -Z. 453P�/ Approved By �, !�/ �- Date: /d Buil.. • Offs••., (or deal:' ) 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 bYAndersen. dhu Renewal By Andersen of Southern New England Aytan&Guluzar Daysal Legal Name:Southern New England Windows,LLC 26 Brewster Rd OM �i West Yarmouth,MA 02673 *Ail—, RI#36079,MA#173245,CT#0634555, Lead Firm#1237 snrs"w as ucsrur 10 Reservoir Rd I Smithfield,RI 02917 H:(508)579-8708 Phone:866-563-2235 I Fax:401-633-66021 sales®renewalsne.com Buyer(s)Name: Aycan & Guluzar Daysal Contract Date: 07/29/18 Buyer(s)Street Address: 26 Brewster Rd,West Yarmouth, MA 02673 Primary Telephone Number: (508)579-8708 Secondary Telephone Number: Primary Email: aycanday@gmail.com 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: 51 5,293 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: $5,097 Balance Due: 510,196 Estimated Start: Estimated Completion: Amount Financed: $0 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: Deposit paid via check ii; 106;;Taxes paid in Yarmouth MA 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 ANYTIME NOT LATER THAN MIDNIGHT OF 08/01/2018 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, New Eng LLC A O Del)dha;Renew y dersen of So ern New England Buyer(s) (�(1I`"�'-��'{-`JJ(�t'U�`J Signature of Sales Person Signature Signature Josh Ocharsky Aycan Daysal Guluzar Daysal Print Name of Sales Person Print Name Print Name UPDATED: 07/29/18 Page 2 / 10 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 :Rffice 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: 1732s5 Type: 10 Park Plaza•Suite 5170 Expiration: 9/19/2018 Supplement Card Boston.MA 02116 IUTHERN NEW ENGLAND WINDOWS LLC. :NEWAL BY ANDERSON �, IIAN DENNISON --- ALBI ON RD `�{��, J�—�' CCOLN, RI 02865 LL:ndefsecreiary Not valid without signature . • e �aac.. Lsee s Lm::artTen: d : ..0:.0 Sect/ TI =card .^` cUili 1C RG :18:IGfib 2^'l. Standards _•.,r. CS-09 57 07 . µ,1 " Vit„ K i BRIAN D DENNISON 5*; 3 ' ; 7 LAMBS POND CIRCLE 1 its CHARLTON MA 01507 Let. d^^^1,ssioner 09 08/2018 . • • • The Commonwealth of Massachusetts ClDepartment of Industrial Accidents =5►d= I Congress Street,Suite 100 . �;= I= a Boston,MA 02114-2017 • www.mass.gov/ilia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. • TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibh • NameessfOrganization/lndividnal): , jEa}F cj RAJ AJ e t f- L ^" IN j f 11' 40ws Address: .to AtAle C )• I In City/State/Zip: _ 4,.4., s . . • Phone#: '1,pi_ 2k8'— Q eft - Are you as employer?Check ibe appropriate box: f 1 l am a employer with 20 temployees(full and/or part-time). Type New cont const(reqruction red): 7. New construction 2.01 am a sole proprietor orpartnership and have no employees working forme in any capacity.[No workers'comp.insurance required.] &. ❑Remodeling 3.01 am a homeowner doing all work myself[No workers'comp.insurance required]t 9. El Demolition ]0 Building addition • 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or me sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contactors have employees and have workers'comp.insurance? 13.❑D�/RR,00f repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 74'LI"•beT/..1 r tc repairs X (40 r 152,t)(4),and we havetm employees.[No workers'comp.insurance required] ratter ere.t 13 'Any applicant that checks box t/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 contactors must submit a new affidavit indicating such. =Contractors that check this box must attached m,additional sheet showing the name of the sub-contractorsand state whether ornot 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 did job she information. n/7 Insurance Company Name: tire ;nen S (NS, ` 7t tA71, Policy triorSelf-itss.Lie.*: eAz1_&t 7x9 — ZC / Expiration Date: /// 7/ V Job Site Address: 16 re 4A s4 r 20(. City/State/Zip:Aj.%'moo -, HA- 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 pttiichable 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 fin;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 verifi(cation.under •��pppp I do hereby certify mans and penalties of perjury that the information provided above is true and correct. Signature: Date: 2- 2- /2 Phone#: "{D I-n e-c['irk' 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 O CERTIFICATE OF LIABILITY INSURANCE I DATE(MWDOWW1) 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,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). 'RODUCER CONTACT CoBiz Insurance,Inc.-CO NAME: 1401 Lawrence St, Ste. 1200 uK re,Fail-303488.0446 Denver CO 80202 E-MAIL i c Not 303-988-0804 /Omen- COMeB(Mcobhinsurance.Lnm INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:ALadla Insurance Company NSURED ESLERCO-01 31925 INSURER e:Flm rems Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. !ba 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR ADDL SUER TR TYPE OF INSURANCE INSD WVD POLICY NUMBER NAM/DDIWYV) NMI0EFF OIYExII ri11 LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3155726 1/1/201I 1/1/201a EACH OCTORENCE 61,000000 MADE OCCUR PREMISES oRENTED eV/SAS-MADE ccorrence! $100.000 MED E3(P(My one person) 610.000 L S PERSONAADV INJURY 510,00000 _ GENL AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE _ $2.000.000 POLICY c UPERa LOC - PRODUCTS-COMP/OPAGG $2000000 OTHER $ A AUTOMOBILE LUIBILITt' N CRAMP/SZE 1/1/2016 imams COO eBBIINdEDiSINGLE LIMIT $ we 000 X— ANY ALIO BODILY INJURY(Pr person) S ALL OWNED SCHEDULED _ AUTOS AUTOS BODILY INJURY(Pr Mocked) $ X HIRED AVrOS X NO NON-WNED PROPERTY DAMAGE (Per accident S AX UMBRELLA LTA! X main CP1)3156725 1/1/2015 1112015 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10000000 DED X RESENTIONID $ E WORKERS COOmPEEWeT� WCA31513726-20 1/1/2015 1/12015 X PER OTK ANY PROPRIETORIPARTNER/DC=CUTIVE YIN STATUTE I ER OFFICERA.6EER EXCLUDED? U N/A EL EACH ACCIDENT $1.000,000 (rraratamry In NH) EL DISEASE-EA EMPLOYEE$1,000.000 Dyynsaa RRoln antler DESCRIP)ltN OF OPERATIONS below EL.DISEASE-POLICY OMIT $1,000.000 C Ribbon LMbet, 7930073340000 1/1)2015 111201E Each Oconce $1.000,000 Aegate Clams-Made Pok y Retroactive Date 06202013 peCumble S10.030 Clams-MClams-Made IESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Renuris Sehedult may be attached I mac apace Is rpWred) • .tERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. For Informational Purposes AUTHORIZED REPPRESENTATIVE I ®1988.2014 ACORD CORPORATION. All rights reserved. tCORD 25(2014/01) The ACORD name and logo are registered marks of ACORD