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HomeMy WebLinkAboutBLD-19-001110 _ Use Only : g�' ` , 79'xV0 **4'1.* ,, 01 oI,. 2 C.^ " $ Amonot Permit expires 1SOdays from• .0 aw• ` issue date I EXPRESS BUILDING PERMIT APPL : $ • i. TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 AUG 22 2018 South Yarmouth, MA 02664 (508)398-2231 Ext1261 EA , :ATM1 CONSTRUCTION-ADDRESS: 'al cl( 1S/e4-trXPro I/4 • ASSESSOR'S INFORMATION: . Map: Parcel: tioviS-C- OWNER: ✓r '. a /Li.05, " s✓. :rn i A • . - .. IS` _ Flue DRsES$ ^ TEL # Email'Address: CONIRACTOR•tnutf1'!n MA. (Otn�ows (,f N, R/ otaer CYOI) zZ8-4 evo AME MAILING ADDRESS TEL# EmailAddrr Residential Commercial Est Cost of Construction$ Lf 7 S7 Home Improvement Contractor Lie.# /732.4s Construction Supervisor Lie.# 0W707 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: Fr/RE/tit/US /u5. �)�` ,", / Worker's Comp.Policy# U)CA 3/er72 I-2 0 WORK f TO BE PERFORMED Tent — Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( .).Replacing like for like • *The debris will be disposed of at Wn S-IP.'ur4 of e m eAr - /n co/n fC Locution of Facility I declare under penalties of perjury that the herein contained am true and correct to the bat of my knowledge and belief. I understand that any false answer(s) will be just cause for denial cyayccation of m se and for prosecution under M.O.L.tb.268.Section 1. Applicant's Sigma= �(Yf-"/1" •..• -_I-'' Date: rrl-2 2 12 Owners Signature(or attachment) t Sett AL 1 ' r Dam• Approved By (!/— c Date: $- 0 "rp/h Building Official(or designee) • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 it.of Wetlands: Yes No Yes No P\ SCA 1 CVI C 9.0aai I .um Renewal Agreement Document and Payment Terms • brAfldersen. dba,Renewal By Andersen of Southern New England Louise Vitagliano / as � Legal Name:Southern New England Windows,LLC 481 Buck Island Rd Apt#168 .� 0, 4111/4*,,t� RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Yarmouth,MA 02673 WINDOW u IC Reservoir Rd I Smithfield,RI 02917 H:7747781542 Phone:866-563-22351 Fax:401-633-66021 salesarenewalsne.com Buyer(s)Name: Louise Vitagliano Contract Date: 08/10/18 Buyer(s)Street Address: 481 Buck Island Rd Apt#16B,West Yarmouth , MA 02673 Primary Telephone Number: 7747781542 Secondary Telephone Number: Primary Email: louise.camelioagmail.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 theparties and incorporated herein byreference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate fter Contractor has completed all work under this Agreement. Total Job Amount: $4,737 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: $1,578 Balance Due: $3,159 Estimated Start: Estimated Completion: Amount Financed: $0 8-10 weeks 8-10 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Cash/Check 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: 1/3 dep; 1/3 due at start; 1/3 due at finish 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 Buyet(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 08/14/2018 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,LIC dba:Renew •. of Southern New England Buyer(%) Signature of Sales Person Signature Signature Kevin Desmarais Louise Vitagliano Print Name of Sales Person Print Name Print Name UPDATED: 08/10/18 Page 2 / 11 t 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 + =-0f ' ce of Consumer Affairs&Business Regulation Registration valid for individual use only before the .-.w HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 1732,15 Type: 16 Park Plan-Suite 5170 Expiration: 9119/20.18 Supplement Card Boston,MA 02116 'LITHERN NEW ENGLAND WINDOWS LLC. E BYANDERSON .IANIAN DENNISON ISON `-i ALI3ION RD JCOLN, RI 02865 Cz;ndersecreiary Not valid without signature „ 4 _ - `,y` -'e "en r . n. ^, . .• Safr„y z.',Cari: cf Buntline Reg atbbns and Siar:taras ril CS-095707 - Y}3PY ' ",� r. _ , . ' a._. , rx. t - ".-..-:.- ,:,1474-€-E-%' eS'�€e�5 i BRIAN D DENNISON �..” ��' 7 LAMBS POND CIRCLE s . «;,, . CHARLTON MA 01507 - ` — 1 "4a � M CA__ _ ^i f :.C Commissioner 09=08.2018 The Commonwealth of Massachusetts l5_;_,its 6i Department of Industrial Accidents ='t'= 3 I Congress Street,Suite 100 • weir- a� Boston,MA 02119-2017 ayes. 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 (Businessiorgani7ntion/individual): ,� uni-E_R,j �e aO "E !A4 Go,I(7 4dws Address: 260 4[...]sjoAD -.P.,4 1 City/State/Zip: ., , t, P # . • Phone#: '*)J - 2>.21-- ?ea) - Are you an employer?Check the appropriate bocci Type of project(required): 1 I am a employer with 20 temployealfull and/orpart-time),• 7..0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in arty capacity.[No workers'comp.4nsutance required.] 8. 0 Remodeling 3.01 am a homeowner doing all work myself[No workers comp.insurance required]t 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct an work on my property. I will 10 Building addition • ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.01 am a generalwtr tabt etar and I ban hired the sub-contractors listed on the attached sheet. 12"Q Plumbing repairs or additions These subcontractors have employees and have workers'comp.insurance? 13.DRR000f repairs // 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.(} tber t✓o.f/o cl OU.r 152,§1(4),and we have no employees.[No workers'comp.Laurance required) *Any applicant that chem¢box in must also fill out the section below showing their workers'compensation policy irdmmation. t Homemvners who submit this affidavit indicating they are doing all work and then hire outside contactors must submits new affidavit indicating such :Contactors that check this box must attacked 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 acrd job site information n Insurance Company Name:Fire men s gI�N s. ap p'i .1 Policy#orSelf-ins.Lic.#: Li)(14aic ]2.9 — 2-0 Expiration Date: iJi 7,� ' Job Site Address: y// Zs/( lrla n/ ?r� "e/6r3 City/State/Zip:A/.yrnan'4, f�f/.�. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c.152,§25A is a criminal violation piriichable 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 ring of up to$250.00 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 cern),under and penalties ofperjury that the information provided above is true and correct. Signature: Date: g-.02Z -/7 Phone#: 401-22.t T 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.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ' A OROa CERTIFICATE OF LIABILITY INSURANCE DATE 0DIYYYY) 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 ADDmONAL 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 lieu of such endorsement(s). 'RODUCER CONTACT CDB¢Insurance, Inc.-CO NAME: 1401 Lawrence St.,Ste. 1200 PHONE n ser 303-988-0446 PAX ( .Nob 303-988-0804 Denver CO 80202 ADDREss. COMaila8cobizinsurance.com POURER/SI AFFORDING COVERAGE RAR e INSURER A:Acadia Insurance Company 31325 ' VSURED ES(ERCO.01 INSURER e:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows,LLC. iba 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AODL SUER ITR TYPE OF INSURANCE INSO WVD POLICY NUMBER INMJDO YEYYFYI IMMNDMEXP 'YYI UNITS ` A X COMMERCIAL GENERAL LLABIL£TY CPA315S728 1/02011 111201a EACH OCCURRENCE E1.000,000 G`WMS-MAGE OCCUR DAMAGE TO RENTaD PREMISES(Ea occurrence` 5300000 MED EXP(My one person) £10.000 PERSONAL S ADV INJURY _ £1,000,000 _ GENT AGGREGATE LWR APPLIES PER GENERAL AGGREGATE _ S 2.000.000 _ © POLICY 111P`•'Q0 LOC - PRODUCTS•COMP/OP AGG £2.000.000 OTHER s A AUTOMOBILE WBILRY N CPA315S72B 11112011 vN2OlS COMBINED SINGLE LIMIT CO BIKED51 OIV!000 © ANY AUTO BODILY INJURY(Per person) S . Al.!-OWNED —SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per emp Eq, S © HIREDAUTOS X NON-OWNED PROPERTY DMIAGE S (Per todeMI S A 11 UMBRELLA LIAR X OCCUR CPA315872E 11112015 11112015 EACH OCCURRENCE _ S 10.000.000 EXCESS LAB CLAIMS-MADE AGGREGATE 510.000000 DED X RETENTION St a WORKERS COMPENSATION WCA315S72620 1/12011 1/1/2015 X PER AND EMPLOYERS'LILITY OTK STATUTE EA ANY PROPRIETOR/PARTNER/MEM-FINE EL.EACH ACCIDENT 31,000,000 OFFICEM.EL@ER EXCLUDED? ❑ NIA ( fib ) EL DISEASE-EA EMKO 51,000,000 IAB Bdescribe under DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY UNIT £1,000,000 C Pollution 000 Clams-MadePolicyTI7930 73340000 1112018 1112015 Each Omenn* $1.000,000 ReboeryW Dune 05/202013 D umMe 110.000 • IESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached If more space N required) • :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 AUTHOR=REPRESENTATIVE T ' @ 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD