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Home My WebLink AboutBLD-19-2590 •ro-cep 1:13er;81_.-- Of'ticeUseOnly . O •Y`'h t qi O , e i C' O4'w.l�.-, Hunt J�c�" ,`o $ it expires 180 days from•8L6—Iet-GSSG date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 • OCT 24 2018 /(508)398-2231 Exert 1261 B lJlygill4�EP�g i CONSTRUCTION ADDRESS: ,2-Z- /+err a.re. _Ince ink e-Q-.4 � (�.�Jl(C�'�[i f \ G1� ASSESSOR'S INFORMATION: 1 Map: Parcel' ' -de-AS OWNER: N ?L, int 2I Mac re-(' 7 c, (-, &t f/4• o.2L7s� 020 S_C �25U 1 AIuffi eSE or > qD c TEL # EmaitAddres J /O CONTRAcro • aul4rn Ug, td/hoot'.s Srr.it-c•e/r// __E-tuA7 CS/) 228-98x0 MARINO ADDRESS Tom•# Email Add 0 Commercial Fat Cost of Consuucaon$ y�a GI 3 --- HomeImprovement ContractorLie.# !732.4." Construction supervisorLie.# 096707 Workman's Compensation Insurance (check one) . I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name; SRLMaLS IPS. Cjfi ty worker's Comp.Policy# id)CA af6fl2 7-2 0 WORK TO BE PERFORMED Tent — Duration (Fire Retardant Certificate attached?) Wood Stove o Siding: #of Squares • Replacement windows:# Replacement doors: # I gap Rooing: #of Squares ( )Remove existing*(max.2 layers) Insulation 60 1016 Old Kings H'ighway/Historic Dist. ( Repiadng like for like ' *The debris will he disposed of at Ali_ie ,✓lAwl a `Q efteiCkSni4 Iel .r of I declare under penaldés of perjury that the eats herednfcowainedate true anMOcoafe.ttoheBbestofmykaowledgeandb eltet Iunderstandthatanyfalseanswet(s) wllbejust cause for denial wa yV'ad�not or pinsepudonCh.26 .Son1. Applicant's Signature: Oats /(D -/ 7—/t af Ownersture(or ,., + ' .iislr_._,-".•:: ..1G: Date: s� -.• Dam ,6�'/ - Approved By* ..a n I._ r.. (or designee) • > • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 S.of Wetlands: Yes No Yes No Renewal, L Agreement Document and Payment Terms rA^IdeFSen' dbas Renewal By Andersen of Southern New England Betsy&Ralph Grant 1.4•0 - Legal Name:Southern New England Windows,LLC 22 Margaret Joseph Rd �. RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Yarmouth Port,MA 02675 o411/4....i% Meso. u 10 Reservoir Rd I Smithfield,RI 02917 H:(203)231-0627 Phone:866-563-2235 I Fax:401-633-6602 I salesarenewalsne.com C:2035560230 Buyer(s)Name: Betsy& Ralph Grant Contract Date: 10/02/18 Buyer(s)Street Address: 22 Margaret Joseph Rd,Yarmouth Port, MA 02675 Primary Telephone Number: (203)231-0627 Secondary Telephone Number: 2035560230 Primary Email: betsygrant63@gmail.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 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: $4,693 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: $1,564 Balance Due: $3,129 Estimated Start: Estimated Completion: Amount Financed: $0 8 to 10 weeks 8 to 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: Depo paid CC Bal paid by check tax Yarmouth 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 10/05/2018 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,LIZ &ba:Renewal rBy Andersen of Southern New England Buyer(s) Cacti CY- Signature of Sales Person Signature Signature Cory Scanlon Betsy Grant Ralph Grant Print Name of Sales Person Print Name Print Name UPDATED: 10/02/18 Page 2 / 11 ✓m rain moneveaII a�✓Saci-/./S rae i.� 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- - 0 Registration: 93245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 - Update Address and Return Card. iCA 1 0 20M-05117 :no Kwinievaiewynieyeel,grea.,,,ezel,.;. 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: 12eaistration Jxoiration Office of Consumer Affairs and Business Regulation .173245-_. 09/18/2020 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211: BRIAN DENNISON \\ 10 RESERVOIR ROAD U _��, SMITHFIELD,RI 02917 Undersecretary N -a • without signature r � Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr,u_ctron'Supervisor CS-095707 E- pires : 09/08/2020 BRIAN D DENNISON �/ y ` ' 8 BLACKWELL DRIVE , Via= • p' f ' CHARLTON MA4:1507 1507 " t, i #€.fir. cot Commissioner L - - J The Commonwealth of Massachusetts ,zirrna.s t, Department oflndustrialAccidents • $ 1 Congress Street,Suite 100 -tti= Boston,MA 02114-2017 ttu:= 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(Business/OrganiTation/Individual): 5 Aern ,fo�,t/tit land nelort/c Address: /p Re seen/nit- Rd J City/State/Zip: S i;4In 4ele< 2,r 02 3 17 Phone#: 2/O I-2_2 t1-9?DO Are you an employer?Check the appropriate box: Type of project(required): I. lam a employer with e20+,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 g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required]' 9. 0 Demolition 4.0 1 am a homeowner and will be hiringcontractors to conduct all work on my10 Building addition 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. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.D Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0We are a corporation and its officers have exercised thein right of exemption per MGL c. 14. Other Pat;0 100 152,11(4),and we have no employees.[No workers'comp.insurance required] 1 f 9014 rl-h e *Any applicant that checks box NI 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. 7 am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: I'mfieriej s I/IS. (DM Pant/ Policy#or Self-ins.Lic.#: leve.A Si// 5-"R 72- — CRS / Expiration Date: /— / Job Site Address: -2,2 /e t- eel CGept- CRdl. City/StatelZip�� r/ //4 Attach a copy of the workers'compensation policy declaration page(showing the policy umber an 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. 1 do hereby certi under the poi and penalties of perjury that the information provided above is true and correct � t Signatur Date: 10 - /7-18 • Phone#: • 1-101 —LZ.S"-gS'DD Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License it • 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#: • A O O CERTIFICATE OF LIABILITY INSURANCE DATEIMM'DD"'YYV) 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 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 CONTACr CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St.,Ste. 1200 /A//CC N F &1.303-988-0446 Denver CO 80202 EMAIL uuc.NA:303-988-0804 Amen. COMail@cobizinsurdnce,com INSURER(S)AFFORDING COVERAGE NAIL 5 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER a:Firemen Insurance Company of WA,D.C. 21784 Southern NewEngland Windows, LLC. dba Renewal byy 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. 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 CONomoN5 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '. ILTR TYPE OF INSURANCE Wm ylw POLICY NUMBER (MRVDDYIYYWI( M W Dl? ?) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2018 1/1019 EACH OCCURRENCE 51,000.000 DAmAGE CIAIMSMADE E OCCUR P MISESO(EaErrenw) $300000 — MED EXP(My one pereen) $10.000 PERSONAL 5 ADV INJURY _ S 1.000,000 GENT.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.000,000 ) .POLICY❑ C II]LOC - PRODUCTS•COMP/OP AGG $2.000.000 OTHER S A AUTOMOBILE LIABRITY N CPA315111725 111/2018 1/1/2019 COMBINED SINGLE LIMIT (Ea ecodenll f 1 000 000 X— ANY AUTO BODILY INJURY(Per Pelson) S ALLOWNED SCHEDULED - AUTOS AUTOS BODILY 811U2Y(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE — AUTOS (Per accident) f S A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2018 1/1/2019 EACH OCCURRENCE $10000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE 510.000,000 DED IX RETENTION S0 S 9 WORKERS COMPENSATION - WC-83158729.20 1112018 tD2019 X PER I EETRH. AND EMPLOYERS LIABILITY YIN STATUTE PROPRIETORNARTNERIEXECLMVE EL.EACH ACCIDENT 51.000,000 OFFICER/MEMBER EXCLUDED? N I A (Yandaipytn NH) EL DISEASE•EA EMPLOYEE $1000.000 S deco ,.under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY UMR S 1.000000 C Parkin L Pry 7930073340000 1/12018 1/1019 . Each Occunnrce $1000000 Clams-MAggregate $1,00.000 Retroactive On 0520/2013 Degowble $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddISoml Remoras Schedule,may W attached If mea Waw M 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 7` 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD