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HomeMy WebLinkAboutBLD-19-001112 •fficctise Only Amount �� :Nce Permit expires 180 days from'@a, issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH ' Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508)398-2231 Ext. 1261 • CONSTRUCTION-ADDRESS: I 'A Vent) S CRS • ASSESSOR'S INFORMATION: . Map: 6i Parcel: $nJQKa.ni/1 t OWNER yyla t✓PtI i9✓kis g. SS )(Irmo„ yl✓k 0.2A44 771-.2/2- 3110 NAME �}�nn TET- Email Address: CONTRACTOR:Scutt urn IJ., 011101 cls ti P, in 0286( (1l) xas-,aro NAME MAILING ADDRESS TII-# EmailAddrt 0 Cgnmmetcial Est.Cost of constructions 15:-34 3 Home Improvement Contractor Lk.# 173i4-C Construction Supervisor Lie.# 096707 Workman's Compensation Insurance: (check one) . I am the homeowner I am the sole proprietor� A have Worker's Compensation Insurance Insurance Company Name: SR in-AAS 1 PS. ` tilts 1ts Worker's Comp.Policy# 10 M 3J63.--72 7-2 Cs WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# /D Replacement doors: It I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_____ • Old Rings Highway/Historic Dist// ( )I;epladng like for like 'The debris will be disposed of at vU/C'r in t ^ --- `/ ^k6`'�•, PIC Nun of Fatdllty I declare under penalties of perjury that the ems herein contained are true and correct to the best of my knowledge and belief. I understand that any false aaswens) will be just cause for denial orfayocadon of m iii se and for prosecution under MO.L Ch.268,Section 1. Applicant's S -WI Yf1'�.... Date: i? —.2 2 —I e Owners Signature(or attachment) ofght Dap:�[__. // Approved By Z !!GG Date: Se'a.3 - !F Building cial(or designee) RECEIVED Zoning District trtY }classicistDistrict Yes No Flood Plain Zone: Yes No AUG 22018 Water Resource Protection District Within 100 ft.of Wetlands: Yes No Yes No BUILDING DEPARTMENT By: z Renewal Agreement Document and Payment Terms JN tdel$en' dbar Renewal By Andersen of Southern New England Benjamin d Kayla West Viiia � Legal Name:Southern New England Windows,LLC 19 Venus Rd -�V►%!2 RI#36079,MA#173245,CT#0634555,Lead Firm#1237 South Yarmouth,MA 02664 w,soow\u 10 Reservoir Rd I Smithfield,RI 02917 H:(774)212-3840 Phone:866-563-2235 I Fax:401-633-66021 saleserenewalsne.com C:(774)268-2417 Buyer(s)Name: Benjamin &Kayla West Contract Date: 07/31/18 Buyer(s)Street Address: 19 Venus Rd, South Yarmouth, MA 02664 Primary Telephone Number: (774)212-3840 Secondary Telephone Number: (774)268-2417 Primary Email: kayla.karpicus@gmail.com Secondary Email: Iittlewesty2Ogmail.com 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: 525,343 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: $6,000 Balance Due: $19,343 Estimated Start Estimated Completion: Amount Financed: $19,343 8 to 10 weeks 8 to 10 weeks Method of PaymentCash/Check We schedule installations based on the date of the signed contract and secondarily on Financing 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: Dep. paid via check#257; ; Balance via Greensky;;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 ANY TIME NOT LATER THAN MIDNIGHT OF 08/03/2018 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,LLC dba:Ren# Andersen of than New England Buyer(s) jej^- ' Gift/12) - - /t Signature of Sales Person Signature Signature rG,'Illlr//av- Josh Ocharsky Benjamin West Kayla West Print Name of Sales Person Print Name Print Name UPDATED: 07/31/18 Page 2 / 13 • Renewal Itemized Order Receipt brAndersen &at Renewal By Andersen of Southern New England Benjamin a4 Kayla West 441 Legal Name:Southern New England Windows,LLC 19 Venus Rd � � -J RI #36079,MA#173245,CT#0634555,Lead Firm#1237 South Yarmouth,MA 02664 WINDOW NE u 10 Reservoir Rd I Smithfield,RI 02917 H:(774)212-3840 Phone:866-563-2235 I Fax:401-633-6602 I sales®renewalsne.com C:(774)268-2417 # Room Field Misc: Misc-THANK YOUI, We appreciate your business and look forward to exceeding your expectations. # Room Field - Misc: Misc- PERMIT, Customer has paid $50 for Renewal by Andersen to secure a building permit for their project. 1 Front Window: Double-Hung, Equal, Full-Frame, Contemporary Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance, No Pattern, Hardware: Black, Standard Color Hand Lift, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: NEW Ext. Casing Azek(White Only), Picture Frame or Traditional, Includes sill nose., NEW Int. Casing - Pine, Picture frame or Traditional, stool and apron. 10 Bay Window: Double-Hung, Equal, Full-Frame, Contemporary Checkrail, Exterior White, Interior White, Glass: All Sash: High Performance, No Pattern, Hardware: Black, Standard Color Hand Lift, Screen: TruScene with Exterior Color Match, Full Screen, Grille Style: No Grilles, Misc: NEW Ext. Casing -Azek (White Only), Picture Frame or Traditional, Includes sill nose., NEW Int. Casing- Pine, Picture frame or Traditional, stool and • apron. • • • • UPDATED: 07/31/18 Page 3 / 13 • Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2018 BRIAN DENNISON 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.Mark reason for change. _ Address _ Renewal _ Employment _ Lost Card 7 t-ptfice 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 Plan•Suite 5170 Expiration: 9(19/2019 Supplement Card Boston,MA 02116 IUTHERN NEW ENGLAND WINDOWS LLC. ;NEWAL BY ANDERSON IDENNISON AL ALBION RD COW,RI 02865 LVudersecreiary Not valid without signature •: =.° ssaC`,Lse':s Department Saaje_y Board of Bt;ildir;a ReeJla.ior:.s and Standards ._=. CS-095707 „'t ;i Le'.k;k =e r+1 BRIAN D DENNISON ` *' i t 7 LAMBS POND CIRCLE :< ` r , CHARLTON MA 01507 Oornmissioner 09.08,2018 The Commonwealth of Massachusetts it_ t=at Department of Industrial Accidents a =E 1 Congress Street,Suite 100 T.S.:1- y Boston,MA 02119-2017 %_y, w wwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BEETLED WITH THE PERMITTING AUTHORITY. Applicant Information Print Legibly • Name (Business/organization/individual): r,�rjtAr* Rij kJ e t.t) 'E)QI JO.L.)4Ows Address: 2 C 4u5100 _ .1 City/State/Zip: tilWieb.7 f R ( 022fb(' Phone#: 1.01 -2 Z8'— j ftp) - Are you an employer?Check he appropriate box: Type of project(required): 1I1 am a employer with 20)employees(full and/or pastime)• • 7. 0 New construction 2.01 am a sole proprietor orpartnership and have no employees working for me in any capacity.[No workers'comp.ansurance required.) S. ❑Remodeling 3.01 am a homeowner doing all work myself[No workers'comp.insurance required)t 9. D Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ]0 D Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contracmrs listed on the attached sheet These sub-contractors have employees and have workers'comp.insurances 13.0Roof repa�ir�s / 6.9 We are a corporation and its officers have exercised their right of exemption per MGL a 14• Ler t✓, F �Qq e r 152,§l(41 and we haven employees[No workers'comp.insurance required) re P/n t fi r en-1—S. *Any applicant that checks box#I must also fill out compensation section below showingtheir workers'compeon policy information. Homeowners who submit this affidavit indicating they are doing all work and then hive outside contactors must submit a new affidavit indicating such tContractors 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy artdjob site information. Insurance Company Name:Fi rg Men S QIps. Oj f1l - /.[ Polity 4 or Self-ins.Lit.4: CA 31-�pn 72.9 — Z _0Expiration Date: I// /f r Job Site Address: /9 (/G'/1(/S `32fr,Y City/Stare/Zip: S r4r,.,ev44%/ n A Attach a copy of the workers'compensation policy declaration page(showing the policy nuMber and capitation date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation pt fishable by a fine up to$1,500.00 and/or one-year imprisonment,as 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.A copy of This statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepphiS and penalties of perjury that the information provided above is true and correct Signature: JJS. _ — Date: tI 2 2 —/ V phone*: 401-22.e- (APs? 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*: • 4 0RCP CERTIFICATE OF LIABILITY INSURANCE I D"s"MMIDD"`"^ TH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO1�R.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 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polies/ties)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 toBiz Insurance, Inc.-CO NAME: 1401 Lawrence St,Ste. 1200 urc No Mel-303-988-0446 Denver CO 80202 EMAILI( .Nok 303-988-0804 ADDRESS. COMailtcobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC e INSURER A:Acadia Insurance Company 31325 VSIRED ESLERCO-01 INSURER B:Firemens Insurance Company of WA, 21780 Southern New England Windows, LLC. dba 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 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 AU.THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR ADOL SUER TR TYPE OF INSURANCE NT/ WVD POLICY NUMBER (MMIDDnYY1'1 IMMU�O/EXP WYy1 LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3159728 1nf201B 1n1201e DACH MAGE 0RENTE 51.000,000 CLNMSMADE X OCCUR DAMAGE IRENTED PREMISES Me vac tercel S MEMO MED EXP(Any one person) S 10.00D PERSONAL S ADV INJURY _ S 1.00°.000 MR GEN.AGGREGATE LAPPLIES PER GENERAL AGGREGATE 52.000.000 © POLICY 0 def 0 LOC PRODUCTS-COMP/OP AGG 42000.000 OTHER' 1 A AUTOMOBILE UABILI Y N CP021557211 1 1/1)2018 1 1/12019 COMBINED SINGLE OMR (Ea rodent) 51000000 ©ANY AUTO BODILY INJURY(PM person) I NM AUTOSAUTALL OWNED —ED D accident)X AUTOS ED BODILY INJURY(Peraccident) S © HIRED AUTOS _ AUTOS (Per aDAMAGE s _ cadenllI S A X UMBRELLA LIA6 IX pccuR CPA315672E 1/1)2016 1/1/2011 EACH OCCURRENCE S 10.000.000 EXCESS LIAR CLAIMS.MADE - AGGREGATE $10.000.0DD - DED X RETENTIONS° B WORKERS COMPENSATION S CA5872a,2D 1/1/201B1/1201 pt! 9 X $TgTUTE EDTR AND EMPLOYERS LABI.nY YIN µ W91 ANY PROPRIETOR/PARTNER/EXECUTIVE .00° OFFICEAMFAeER EXCLUDED? N I A EL EACHSE.LA ACCIDENT $1.000 ISIWIIdimrf SI NH) EL DISEASE-EA EMPLOYEE 11.00E000 Byes MVO*under DESCRIPTION OF OPERATIONS below E L d5FASE-POLICY LIMIT S1.000.000 C Poll/ran ray 7930073940000 1/1101E 1/1/2019 Each Occurrence 11.000.000 ROMEICOVe Date°620.2013 Aggregate a 110.000'00°'000 IESCRIPTON OF OPERATORS I LOCATIONS I VEHICLES (ACORD 101.Addlbonal Remarks Schedule.may be Winched If more space Is 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 AUTHORIZED REPRESENTATIVE I ®1988-2014 ACORD CORPORATION. All rights reserved. LCORD 25(2014/01) The ACORD name and logo are registered marks of ACORD