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Home My WebLink AboutBLD-19-1648 .Office Lisa Only O` Permit# cta T "efri�> -1 Amount `�`� ,, .. :A Permit expires 180 days from• issue dam • 15 L A-.Pi --to t(0,q EXPRESS BUILDING PERMIT APPLI 4 I i. TOWN OP YARMOUTH RECEIVED Yarmouth Building Department , 1146 Route 28 SEP 13 2013 South Yarmouth,MA 02664 (508) 398-2231 Ext 1261 BU • 7 �fiT.s r/ n By -- / lb CONSTRUCTION ADDRESS: 6 1 sive A P—.— -4410-9-- RA • • ASSESSOR'S INFORMATION: Lb(n Act 4 1 Map: Parcel: • OWNER:?4t at I 1�r 0/4 61 Ski Ker 1 se2J. 'ar.-. rM jV4�1.4 02.6o75' 978- c /si L qqp Email Addres 2— NAME PRES it Rod IJ. CONTRACTOR' ZZ II'-9�a nu Orn .+ W1n4DtPs S,n, I,Pe Rso29r� C�1) AME MARINO ADDRESS TEI.# Email Adc 0 cormnetdal Est.Cost of Co»sanction$ a r 1 I(p Home Improvement Contractor Lie.# 173 2.43 Construction Supervisor Lia# 076707 Workman's Compensation Insurance: (chrrk one) I am the homeowner I am the sole proprietor A have Worker's Compensation Insurance l PPS. (nc_rcfr r/ WOrkes's Comp.Policy', G)CA s161,2 7-2 D Insurance Company Name: �PZLJI']��1.)S 1 WORK TO BE PERFORMED Tent _ Duration (hire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# /1 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation eq,rne fi.:4s 46,09/ /011d Kings Highway/I storicDist. ( • • ,epladng like for like 64/*/,wae../3l a ss *The debris will be disposed of ac W.f��2 /�•tnt ``Pi•l �/ �rt,`¢I ' `Y(9_C lbartiun of Faci'.rt)• !declare under penaltesofperjury thatthertaz. eatsbereincontainedatenneandcorrecttothebestofmyknowledgeandbelief. I understand that any false answerft will be just cause for denial fm+Ii se and for prosecution underM.O•LCh.26 ,Sectlon1. Date: q-12- --/2 Applicant's signature: Owners Signature(or attachment) $e42 "r s- /,_ - a 'atm Approved By: 4/1,4 A I Dam: q-15-4- Building Official(or designer Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 it.of Wetlands: Yes No • r Renewal, � Agreement Document and Payment Terms JAl del$en. dbar Renewal ByAndersen of Southern New England �� 6l Micchael Pouliot&Wanda Poilot I �� -_ Legal Name:Southern New England Windows,LLC 61 Shaker House Rd 4. 1 IL\�!i RI#36079,MA#173245,a#0634555,Lead Firm#1237 Yarmouth Port,MA 02675 •iaaaw as uesatas 10 Reservoir Rd I Smithfield,RI 02917 H:(978)514-1312 Phone:866-563-2235 I Fax:401-633-66021 saleserenewalsne.com C:(978)895-7142 Buyer(s)Name: Micchael Pouliot &Wanda Poilot Contract Date: 08/28/18 Buyer(s)Street Address: 61 Shaker House Rd, Yarmouth Port, MA 02675 Primary Telephone Number: (978)514-1312 Secondary Telephone Number: (978)895-7142 Primary Email: pouliot.wanda@gmail.com Secondary Email: Buyer(s)herebyjointly 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 thearties and incorporated herein byreference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $28,916 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: $9,637 Balance Due: 619,279 Estimated Start: Estimated Completion: Amount Financed: 60 7-9 weeks 7-9 weeks Method of Payment: Credit Card 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: 1/3 deposit,1/3 at start,1/3 at completion 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 08/31/2018 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 al B dersen of Southern New England Buyer(s) - ^ - ater Signature of Sales Person Signature Availug Paul Sandrey Micchael Pouliot Wanda Poilot • Print Name of Sales Person Print Name Print Name UPDATED: 08/28/18 Page 2 / 16 /12f77one t add.r°S/ / / 4 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration "' Type: Supplement Card ' "" Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,LCC=^?1.. .,:c-7f= Expiration: 09/18/2020 10 RESERVOIR ROAD __'-� rn SMITHFIELD,RI 02917 -='r Update Address and Return Card. SCA 1 0 200M�M-05/17 dd/l qq 66a..''i reerinvneveez Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: JiealsttatIon -. Expiration Office of Consumer Affairs and Business Regulation 173248: i 09/18/2020 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON cote--- _ate 10 RESERVOIR ROAD U _ E,/ SMITHFIELD,RI 02917 Undersecretary �' • ' without signature Commonweh ®j Division of ProfessionalaltofMassachusetts Licensure �.. Board of Building Regulations and Standards Constru._Ct n IS�upervisor CS-095707 '-`;°4x"("1 Expires: 09/08/2020 ' tl,rs r 1,M leii dr < BRIAN D DENNISONC D . = '> `.' ^3 8 BLACKWELRIVE ; > ; `�j' :y " ir` CHARLTON Mk:0_1507 ,-- V ONSer110cot • Commissioner L The Commonwealth of Massachusetts • g=,=lei=i • Department oflnclustrialAct deals k- _ S 1 Conp,ress Street,Suite 100 . • `i Boston,MA 02114-2017 . • ww w mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. • TO BE RILED WITH 7BE PERT J TIA'G AUTHORITY. • Applicant Information [ , Please Print Le¢iblt • Name (Business/Organization/Individual): -�O[i7'H-,Aj kJ e to eyed £ �( cloth. . Address: /D *set yew' _Pc/ City/State/Zip: rc eI • _ / Phone r: 1,01 -2 Zg'— Q get) Are you an employer?Cbeck the appropriate bar Type of project(required): I. I em a employe with .ZO remployem.(full and/or part time 2 I ern asole proprietor 7. 0 RNemodeling uction ❑ pmpd parmership and Leve no emplw,see working for me in any capacity.[Noworlare comp..insmance required.] E. Q Remodeling 3.0 I am a bomeovmer doing all work myself[Noworkers'comp.instance required]t S. 0 Demolition 4.❑I am a homeowner and will be hiving contractor.to conduct all work on her;Inver.... I will 10❑Building adtii5on . ensure that all coaoactorseither have%wrlcacompensation ILEI Elect*icalI°Nateor additions proprietors with no employees 22.0Plutmbing repairs or additions 50I em a general con= I Lave hied the subcontractors vaed on the attached she= Toast sub-connaaors have employees end have wadcers'romp.insurance? ! I3.0Roefrepairs //�� e.❑we m a corporation end in°Meer!inane exercised their right o;exemption pct Ida c. III 14.[J✓rOther U lA goy) )x Il(C),and we]°vena employees.[No written'comp.instance required] Ce?Odle e.a,e e't fit 'Am applicant that cher.=box t l must also tin our the section below showing tbennectars'comperszioc policy ir+oma9oz 1 Homeowners who submit this affidavit indicating they ere doing an work and then hire outride common must submit a new davit indicarina such. ' ZCwtractos that check this box must samba an additional sheet showing the name of foe sub•co uactortand sere whether tont those entties have employees Lythe sub-contarmrsInt emplows;they must pmvidetheo workers'come.policy number. I am on employer that is providing workers'compensation insurance for my employees. Below it the policy dud fob silt Tformaaon. Insurance Company Name: f t re men s I u s. Lo , -q f / Policy ForSelfins.Lie.#4: WCIA31-r2.9 - 2.C) on.Date: / j/ li Job Site Address: Al 5/ /(ef ' - nJ S2. cm-a City/Stare Zip:l a.i P ,Q Attach a copy of the workers*compensation policy declaration page(showing the policy umber and eapira on date). Failure to secure coverage as required under MGL c.152,E25A is a criminal violation pudisbable by a fine up to 51,500.00 and/or one-year imprisonmem,as we]]as civil penalties in the form of a STOP W ORR ORDER and a$ng atm to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations ofthe MA for insurance coverage verifastion. J do hereby certify under th ens mrd penalties((papa".ram the informaffon provided above S Me and correct Sienature: `_ "�J/' — _. Date: 9 - /Z /g phoney go I-ZZ tet-T coD • - Official use puha Do notwrae in this area,to be completed by city or town Cidat . City or Town: Permitticense le Issuing Authority(circle one): • 1.Board of Health 2.Badding Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector . 6.Other Contact Person: Phone*: • ACO CERTIFICATE OF LIABILITY INSURANCE DATE(M DD"YYY) `..----- 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,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 CONTACT CoBiz Insurance, Inc.-CO PHON: PHONE 1401 Lawrence St,Ste. 1200 A/C No.Fen.303-988-0446 IAAiCC.No).303.988-0804 Denver CO 80202 EMAIL CO Mailecobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIL 4 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER a:Tremens Insurance Company of WA,D.C. 21784 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!: INSURER F: COVERAGES . 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. NOTNiTHSTANDING ANY REQUIREMENT,TERM OR CONDRION 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 CWMS. INSR TYPE OF INSURANCE AODL SUER ' POLICY EFF POLICY EXP LTR p451) YND POLICY NUMBER IMM/DDM'YYI (MM/DDM'YYI UNITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/12018 1/12019 EACH OCCURRENCE $1000000 EWMSMADE OCCUR DAMAGE TO RENTED - • PREMISES(Es rr,nce) $300.000 — — MED EXP(My one person) 510,000 _ PERSONALS ADV INJURY 51.000000 ''�'G�ENL AGGREGATE LIMIT APPLIES PER GENFAAL AGGREGATE 52.000.000 - 1 POLICY f EPR- n LOC - PRODUCTS-COMP/OP AGG $2.000,000 — . OTHER: $ A AUTOMOBILELABILT• N CPA31511728 1/12019 1/12019 COMBINED SINGLE LIMIT (Ea amdenn 51000000 X ANY AUTO I BODILY ML/URY(Per person) 5 — ALL OWNED —SCHEDULED — _ AUTOS _ AUTOS BODILY WORT(Peroccident) S IX X NONOWNED PROPERTY DAAMAGE — HIRED AUTOS ' AUTOS I (Per acodenll 5 S A X UMBRELLA LIAB X OCCUR CPA315a728 • I ( 1112018 1/12019 EACH OCCURRENCE_ 410.000.000 EXCESS LAB CLAIMS-MADE AGGREGATE 5 10 000000 DED X RETENTION GO 4 9 AND EMPLOYERS LABILITY YIN 00403158729-20 1/12015 1n2019 X SATUTE ERµ ANY PROPETOWPARTNER/EXECUnVE WEL EACH ACCIDENT 51.000.0X0 OFFICER%IEICER EXCLUDED? El NIA • (Mandatory In NH) EL DISEASE-EA EMPLOYEE 51.000.000 V yes.describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT $1,000,000 C Pollution Tabaly, 7930073340000 1/12018 1/12019 Earn Oconnce $1.000,000 Ralroataae Debt 06170/2013 Deducu to $10,0000° DeOuwae 410000 DESCRIPTOR OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If man space Is required) CERTIFICATE 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. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD