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HomeMy WebLinkAboutBLD-19-000996 �n� - •umca use limy . O'g eYi�"� - Permit# - �1 k. :. �` � _ 4 °1\:7±1!: 'Amount wr± 41 u 'tx„w-�9 r ±Permit expires 180 days from • 'issue date @LD-Iq-vtxl% EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH -- • Yarmouth Building Department R r C E I V F [; i 1146 Route 28 [------1 I South Yarmouth,MA 02664 AUG 15 2018 i . (508)398-2231 Ext. 1261 BUIL .. CONSTRUCTION ADDRESS: Z9 SK�/It ii e �r BY li951� ASSESSOR'S INFORMATION: Map: Parcel: ^ OWNE•• A Al g •L' .g 1 .S(/inea W. it v „ 0.4ro73 .1792. -ic1.0 NAME PRESENT "DRESS TEL # Email Addres CONTRACTOR: A/& gear 64.5C GLC .2 0 Celefr Si: ',Allure! M4 olio! 800-342-2-a r I NAM J MAILING ADDRESS 1 TEL# Email Add esidenti Commercial Est.Cost of Construction$ at (t51 .00 Borne Improvement Contractor Lie.# 796 5-89 Construction Supervisor Lie.it /os/crer Workman's Compensation Insurance: (check one) I am the homeowner I am The sole proprietor I have Worker's Compensation Insurance Insurance Company Name•. q'UCtraC to S. (=Troy p Worker's Comp.Policy# RI EW✓r 2 7e/0 6 6 WORK TO BE PERFORMED Tent _ Duration (Lire Retardant Certificate attached?) Wood Stove Siding:.#of Squares Replacement windows:# 2— Replacement doors: * Roofing: #of Squares ( )Remove existing*(max.2 layers) I Insulation Old Sings Highway/Historic Dist. 1 )Replacing like for like ^ "(hedebris will bedisposed ofae 410s-fe (-44Astsert. e- = &Leder" MA Location of Facility / I declare under penalties ofdi statements herein contained are true and correct to the best of my knowledge and belief. 'understand that any false answer(s) will be fust cause for denial of my license and for prosecution under MO.LCh.268.Section 1. Applicant's Signantre: / Date: e-/5-'1, Owners Signature(or amain .. e •D.;4 _Si_-/ .s.ae1 -CL r Approved By .0 Date: B ' g. •rid(ordealSnec) Zoning District ITistorlcalDistrlct Yrs No Flood Plain Zone: Yes No • Water Resource Protection District Within 100 ft.of Wetlands: Yes No Yes No • // to K A Rag#146589 Page 1 of 11 CT Reg#0605216 �ii__. ./1J(T: Federal ID #20-2625129 Window/ Door Contract • c( Customer Information Ann Hablanian (617) 923-1590 () Date: 05/30/2018 29 Skyline Drive chodor@rcn.com Rep: Michael Castiglioni West Yarmouth MA 02673 Rep# 508-294-3218 Location Agreement NEWPRO hereby agrees that it will,for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 29 Skyline Drive West Yarmouth MA 02673 Windows Being Installed: 2 Doors Being Installed: p Window Details I Location: Living Room Window Series: Ecomax Double Hung 1_11 Interior Color: White Screen Type: 1/2 "'- ' Exterior Color: White Grid Pattern/Type: 8/8 Grids Between Glass Hardware Finish: Antique Brass Included Glass Options: Additional Details: Additional Labor: Location: Living Room Window Series: Ecomax Double Hung „II_ Interior Color: White Screen Type: . ' 1/2 Exterior Color: White Grid Pattern/Type: 8/8 Grids Between Glass Hardware Finish: Antique Brass Included Glass Options: Additional Details: Additional Labor: Capping Please Go Back To Estimates In WINDOWS And'Add Capping Option Capping Type YOU NEED TO ADD CAPPING Additional Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Discounts Senior Discount Applied r Payment Total Price: $2,651 Deposit ' $884 Due Upon Completion $1,767 Payment Method Cash le arr."o'•i,t' 1413 • Terms and Conditions Page 11 of 11 Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION. SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. Ann Hablanian 05/30/2018 Date fl" Michael Castiglioni 05/30/2018 Date This space intentionally left blank _t]PTc•O Jr':ai a••:' 4 13 Division of Professional Licensure Board of Building Regulations and Standards C o n st r.Vcflan''S d pe ryi s o r CS-105168 E,Lpires: 11/01/2019 VLADIMIR KRUC •,�M _ HYNSltYYrfi 1 PAVILLION ROAD :;,, AMHERST NH 08031 -/ft p •rirw?-•ot- r Commissioner• • e\ w 1=00e111n)rrp0?/r/n/'Q-1 aa,r4.vde.f Office egulation : Consumer AM &�jHOMEIMPROVEMENT CONTRACTOR I k, - TYPE:LLC keefstratian Expiration _ — -3®55 03/23/2019• ALL WORK CONST 1 thi itVC • VLADIMIR KRUC i PAVILLION RD. :• (�" "'�""� AMHERST,NH 03031 Undersecretary The Commonwealth of Massachusetts t�w a i a5'----947----- Department ofIndustrial Accidents 1F3,41=-7." I Congress Street,Suite 100 - • ' _"�i- Boston,MA 02119-2017 . .' *v. www mass gov/dia W'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A. .Iicant Information Please Print Le ibl Name (Business/Organization/Individual): dew 0<o 0r ; At nn .� na Address: - , City/State/Zip: ay t,net M A of Pn t phone#: /- ?00 - Are you an employer?Check the appropriate boa: 3 512- Z z 1 ' Type of project(required): 1.10/I am a employer with SQ'['employees(Ml and/or part-rime).* 2.01 am a sole proprietor or partnership and have no employees working forme in 7. 0 New construction g• El any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself(No workers'comp.insurance required.)t 9. 0 Demolition 10❑Building addition 4-01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole • 11.0 Electrical repairs or additions proprietors with no employees. 5.0I am a general contractor and!have hired the sub-contractors listed on the attached sheet 12.0 P I um b ing repairs or additions These sub-contractors have employees and have workers'comp.insurance? 13.❑,/Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14,L Ether tat 152,f 1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Gtinrel a)• GroQp Policy#or Self-ins.Lie.#: AAtve P 7 OAF, 7 Expiration Date: 5--- /-/9 Job Site Address: 29 SKy/t.,.e C.. r. CiTy f'1.4 Attach a copy of the workers'compensation policy declaration page(showing the policy number ind expiration tdate). 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 imprisonmen 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 cop , r. statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . Ido hereby derti un er a pa and penalties ofperjury that , • ormation provided above is true and correct Signature: • Date: IF'75--1, Phone#: /-7nO- 3W2 -1 2 11 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#: - • `�-/ L , y24G antfle-ati "i'j Q.'L' ��fi/ 9,f3'ii atiat. Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration NEWPRO OPERATING,LLC. Type: Supplement Card Registration: 146589 26 CEDAR ST. Expiration: 05/04/2019 WOBURN,MA 01801 %1 =_er.:.e5;» Update Address and Return Card. l../ant!n.rn.%.. 7 hid.:f.r hi:..//, Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Suooiement Card before the expiration date. If found return to: e istre i Ir ti 146589 05/04/2019 Office of Consumer Affairs and Business Regulation NEWPRO OPERATING,LLC. M -' 10 Park Plaza- ,'T,O Boston,MA 021118,.18,� VLADIMIR KRUCHYNSKW4 28 CEDAR ST. y�, f r ; WOBURN,MA 01801 Not valid without signature Undersecretary • 4O CERTIFICATE OF LIABILITY INSURANCE I DATE01/05/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS OS/2018 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEA 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(les)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 pCOMEACT Melissa Pflug Mackintire Insurance Agency Inc 1acNNo.Patk (508)388$781 FAX (508)368-5202 11 West Main Street I fee,No); IL melissap@macldntire.com Ag-MgAP� cklntimcom We3iborough INSURER(S)AFFORDING COVERAGE NAIC 5 INSURED MA 01581-1931 INSURER A: Sentry Insurance INSURER Si Guard Insurance Group Newpro Operating LLC 2e Ceder St INSURER C: Colony Insurance Co INSURER D: , WDODm INSURER E: MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master 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 RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS. EXCLUSIONS AND COMMONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OP INSURANCE IN911 IFIND POLICY NUMBER PODGY LFF POLICY EXP X COMMERCIAL GENERAL UABIUTY IMMIDDIYYYr) (MMIDDNYTTI LIMITS EACH OCCURRENCE S 1,000,000 ICWMS MADE OCCUR DAMAGE TO HEN I ED 500,000 PREMISES(Ea ocamence) 8 A �.— A0082403003 PERSONAL tAMED EXP(Airy one person) g 15,000 12/31/2017 12/31/2018 DV INJURY _ s 1,000,000 GENT.AGGREGATE UMRAPPUES PER GENERAL AGGREGATE g 3,000,000 X PODGY O jEGo- ❑LOC OTHER: PRODUCTS-COMP/OP AGG S 2.0 0.000 — s AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT ANYAUID (Ea acodeM) S 1,000,000 — OVAJED BODILY INJURY(Per person) 9 A AUTOS ONLY _X UTIOESULEO A0092403004 12/31/2017 12/31/2018 BODILY INJURY(Per accident) S J X HIRED NONOWNEO AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE S - (PeremdeM) X UMBRELLA LIAR FACHOUninsured motorist BI S 25Q000 A EXCESSUAB OCCUR CCURRENCE — S 5,000,000 CWMBMADE A0092403008 12/31/2017 12/31/2018 AGGREGATE S 5,000,000 DED I X RETENTIONS 0 • WORKERS COMPENSATION s AND EMPLOYERS'LIABILITY YIN 16T TUTS II ERS B OPRCEWE OERR uc UDEED ECUrNE O N/A NEWC874060 E.L EACH ACCIDENT S 500,000 (Mandatory In NH) 05101nD18 05/012019 IT yea,deeWhs under E.L DISEASE-EA EMPLOYEE 9 500,000 DESCRIPTION OF OPERATIONS e EL DISFASE•POLICY LIMB $ 500,000 babe C Pollution Limit $1,000,000 CSP304242 12/31/2017 12/312018 DED $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddWonal Remarks Schedule,may be attached It mom space Is mulled) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN eoxtwmugh Item Hall ACCORDANCE WITH THE POLICY PROVISIONS. 29 Middle Road AUTHOR2ED REPRESENTATIVE Boxborough MA 01719 i44th- I - ©1988-2015 ACORD CORPORATION. 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