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Home My WebLink AboutBLD-19-2584 i ' ! .(Moto Only .04:474%.3 a\ Permit* • *Amu' monm 50—' O :-n.. vg, ti �c� j� Permit expires 180 days from c issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED. Yarmouth Building Department 1.146 Route 28 • South Yarmouth,MA 02664 OCT 2 4 2018 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: f6 Ruh nel.:n K /a e_ ASSESSOR'S INFORMATION: .• Map: Pucci: • OWNER:SanJia t i /6, 43,4 (J 1.1•M inti r✓�rarS,tim 1 t 1` 4 021.7 5 0107- S22- N Z N pk s 1Sges,, TEL. # EmaltAdtire 10 of xz 8-v800 CONTRACTORL Au1 4rrn FI (idrn0oms SmnwivaancRI- a47 • 3ti) r-1 TV Email Ad' Residential Commercial Est Cost of Consuocdon$ ' Home Improvement Contractor Lie.# 17 azq,C constructionSupervisorLic.# 0T6707 Workman's Compensation Insurance (check one) . I am the homeowner I am the sole proprietor have Worker's Compensation Insurancee i Insurance Company Name: f REth7LAuS IPS. I eta'�PTAt Worker's Comp.Policy# M'a16r72 7-2 A WORK TO BE PERFORMED • Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Z Replacement doors: # Roofing: to!Squares__ ( )Remove existing*(max.2 layers) Insulation Old Kings]3lghwayff istorricDiist. ( ).Replacing like for Re / . •The debris wal be disposed of at 1h h e/tet t een e l—_// S aM' (�9r Dation of Faelttt), Ideclare under mettle;.ofperjmytbattbe herein conmlavd ate sine and connctto the best of my boWledgeandbelItt I1mderstnnd that any false answetC will be just cense for denial grsagocadonofn 11 se and forprosecudonunder MLCb.268.Secdon1. Applicant's Signaaua. Vt LYj1^..� (.�,,��,, Dan /M Z'/-/k Owners Signature(or attacbmen 'eC c� At4 o• s.. Q,oi 4c Data /./ • Date /G .2 L/'rn Approved By: +�/ . ..Hier• (, designee) / . ZoningDistri deal. Di Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 ft.of Wetland Yes No Renewal Agreement Document and Payment Terms Andersen. dbm Renewal By Andersen of Southern New England Sandra Young �joasa. �:_ Legal Name:Southern New England Windows,LLC 16 Bob 0 Link Lane 110.919, � •.4RI#36079,MA#173245,CT#0634555,Lead Firm#1237 West Yarmouth,MA 02673 WINDOW LACIMINT 10 Reservoir Rd I Smithfield,RI 02917 H:(207)522-9813 Phone:866-563-2235!fax:401-633-66021 salesOrenewalsne.com Buyer(s)Name: Sandra Young Contract Date. 10/12/18 Buyer(s)Street Address: 16 Bob 0 Link Lane,West Yarmouth, MA 02673 PrimaryTelephoneNumber: (207)522-9813 Secondary Telephone Number. Primary Email: exterrachick@yahoo.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 arc 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: $4,606 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: $1,535 Balance Due. $3,071 Estimated Start. Estimated Completion: Amount Financed: $0 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,induding 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 10/16/2018 ORTHE 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 C dba:Renal By n ofthern New England Buyer(s/ An Signature of Sales Person Signature Signature Paul Sandrey Sandra Young Print Name of Sales Person Print Name Print Name UPDATED: 10/12/18 Page 2 / 10 i e- eveadIc�.AaiJezdebi . - Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LLc- Registration: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 Update Address and Return Card. 3CA 1 Q 20M-05/17 aivnen wee4Jar r rno,...;acii<Je<C' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Suoolement Card before the expiration date. If found return to: Registration.. Fxolration Office of Consumer Affairs and Business Regulation 173245 _-- 09118/2020 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211: BRIAN DENNISON 10 RESERVOIR ROAD U _eer. SMITHFIELD,RI 02917 Undersecretary N -_1 • without signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations ulations and Standards Construction Supervisor CS-095707 ' E-pires 09/08/2020 Mkt t- • ... / ft, r }t - BRIAN D DENNISON , �j _ 8 BLACKWELt'DRIVE , SX7 ' . ' i CHARLTON MA;01607 ' � �. . '1 Y Cele ilarmsae Commissioner L - J • The Commonwealth of Massachusetts TOW t Department oflndustrialAccidents i 1 Congress Street,Suite 100 Boston,MA 02114-2017 be, www mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. • Applicant Information / n nPlease Print Legibly Name(Business/Organrzaf $j oniindividual): , ,(rei ,&i vIa✓7rr l� r/ou/( Address: /n Re sr('int'(' Rd- J . • City/State/Zip: St)-j%4e/c (�r 0ze3 t 7 Phone#: O l-Z2 g-98.00 Are you an employer?Cheek the appropriate bon Type of project(required): I.�I am a employer with o O+,employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] • 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required) 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. r will ]0 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: �� pp 6.0 We are a corporation and its officers have exercised their richt of exemption per MGL C. 14.l Cher cu,% ✓ 152,61(4),and we have no employees.No workers'comp.insurance required] 1'eof4(-(irt(4/5 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 sub-contractors 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 is providing workers'compensation insurance for my employees. Below Is the policy and job site information. r Insurance Company Name: 1�,Fe/nen '3 (OS. (Dm Pan s1 Policy#or Self-ins.Lie.#: ry e A S/ S-R 72-R / Expiration Date: /— I i j • Job Site Address: /6 3o 0 /;_ IC Lan 6— City/State/Zip: Ae. tits,.,e„4-4 At Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). 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 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 cerci under the pal and penalties of perjury that the information provided above is true and correct Sienatur Date: /o— 2 .1— t 1- Phone 0- - Phone#: • 401 -2.2.Ff-gs'nt) Official use only. Do not write in this area,to be completed by city or town oPciaL 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#: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 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. H 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 CONTACT CoBIz Insurance,Inc.-CO NAME' 1401 Lawrence St,Ste. 1200 i&c.Nri.Far 303-988-0448 FAX .Not:303-988-0804 Denver CO 80202 ADD"R'ESS. COMaii@cobizinsurance.com INSURERS)AFFORDING COVERAGE NAIC II INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER a:Firemen Insurance Company of WA,D.C. 21784 Soudba Ren New England Windows,here INSURER e:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southam New England 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. NOTWITHSTANDING 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 CLAIMS. � WSR TYPE OF INSURANCE AUX SUM ' POLICY EFF POLICY EXP INAD WVD POLICY NUMBER (MM/DDM'Vt) INM00Mry1T LIMITS A X COMMERCIAL GENERALLIABIUTY CPA315BT28 1112018 1112019 EACH OCCURRENCE $1.000,000 AIAAE TO RENTED CILAIMS-MADE IJ OCCUR PREMISES JED=unreel 5300.000 — MED EXP(My me person) $10000 _ — ` PERSONAL$ADV INJURY $1,000,000 — GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2000,000 — POLICY❑irCT Ei LOCPRODUCTS-COMP/OP AM $2,000,000 - OTHER $ A AUTOMOBILE LABILITY N CPA3158728 1112018 1/12019 COMBINED$TNGL.E LIMIT Ms adent) $ ;cadent) 1000000 X ANY AUTO BODILY INJURY(Per parson) $ — ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURYaccident)accident) $ X HIRED AUTOS X AUTOS NON-OWNED (�PerOemdenenll DAMAGE S $ A X UMBRELLA LAB H aCIlR CPA315B728 1112018 1/12019 EACH OCCURRENCE _ $10,000.000 EXCESS LAB CLAIMS-MADE AGGREGATE 510.000.000 DED X RETENTION$0 $ a WORKERS COMPENSATION yCA3158729-20 1/12018 1M2019 AND EMPLOYERS LABILITY YIN X BTA UTE Ep Rµ ANY PROPRIETORIPARTNEEXECUTIVE ' R/ OFFICER:Ma/ER EXCLUDED? Ei N/A EL EACH ACCIDENT $1,000,000 (Mandatory In NH) EL DISEASE•EA EMPLOYEE $1,000,000 If D OF OPERATIONS below EL DISEASE POLICY LN1rt $7.Om,000 _ DESCRIPTION OF O C Polluban Liability 7930073340000 1/112018 1/12019 Each Oca ,oe • $1,000,000 Clams-Made POLY Raeoactiw Date 08202013 Dec :WM $1.000000 eduscetae $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Addidenal Remarks Schedule,may be attached If more 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 _ 01986-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD