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HomeMy WebLinkAboutBLD-19-002593 � „ ¢ u ° ° • rixk .OtTicct'sOnly Petrel/ : CO— Amount Permitexpires 180 days from` ""u"ut issue dam • . BUS-1Q-ala 593 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth,MA 02664 OCT 24 201 B (508)398-2231 Ext. 1261 }� CONSTRUCTION ADDRESS: /HO 42111./7 'rro"7 Fat B Util n ASSESSOR'S INFORMATION: Map: Parcel: ' r OWNER: K. Sur/Z-7 F_ /'s %/ i>) 01 cr,-, S•?d wti 4-/- M/k o tat / Stfl-ao&-946 3 NAME / TEL # EmaTlAddress CONTRACrORSAatilt n fag. Oraolotas Sev /rP1e/c i?X rug f 7 Cleo0 n a--98ao NAME MAIUNOAD_bbRESS TEL.# EtnaH Add 40210 Commercial Est Cost of Constntcdon S et', 6 S S— Home Improvement Contractor LW.# 17.3 2.4s Construction Supervisor Lte.# os670 7 Workman's Compensation Insurance: (check one) . I am the homeowner I am the sole proprietor s have Worker's Compensation Insurance Insurance Company Name: $RENE1S.)S EAS. 6/D1r)\ ,1 Worker's Comp.Policy# 10 WI 3172 9-.2O WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# rji Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_ • Old Slings Hiighway/Historic Dist. ( ).Replacing like for Re / //� ' *The debris will be dised of at fuhi a .✓ttei t(49"e —// 51dolt 'eil 9r West ua ofradiity i I declare under penalties of perjury that the eats bemin contained are true and comet to the best of my knowledge and belief. 'understand that any false answer(s) will be just cause for denial o5,agoc:en of m' se and for prisecudon under M.O.L Ch.268.Section 1. Applicant's Sigsatme �1Yf"��"`�. Dam: /D—/7—/g Cg- i t�,•i� OnarP- (ter Date: Owners Signature(or Maslen ) �7 .,./ Approved Ey v Dare /' GY/g 1. ': • 'cls(or designee) / Zoning Distrirr Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 R of Wetlands: Yes No Yes No If • Renewal Agreement Document and Payment Terms Anrdrersen. dbar Renewal By Andenen of Southern New England Kathryn Surette .iL't,:,4;41 Legal Name:Southern New England Windows,LLC 140 Captain Bacon ;INK - RI#36079,MA#173245,Ci#0634555, Lead Firm#1237 South Yarmouth,MA 02664 w,ueow in LAG,w,ar 10 Reservoir Rd I Smithfield,RI 02917 H:(509)208-9663 Phone:866-563-2235 I Fax:401-633-6602 I salesorenewalsne.com Buyer(s)Name: Kathryn Surette Contract Date: 10/03/18 Buyer(s)Street Address: 140 Captain Bacon, South Yarmouth, MA 02664 Primary Telephone Number: (509)208-9663 Secondary Telephone Number: Primary Email: delmarva52@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: $6,655 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: 62,218 Balance Due: $4,437 Estimated Starr. Estimated Completion: Amount Financed: $0 7-9 weeks 7-9 weeks Method of Payment: Cash/Check 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 ANYTIME NOT LATER THAN MIDNIGHT OF 10/06/2018 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 I B An n of S kern New England Buyer" Signature of Sales Person Signature Signature Paul Sandrey Kathryn Surette Print Name of Sales Person Print Name Print Name UPDATED: 10/03/18 Page 2 /9 _ _75.. " 'i `•v k. . £� carnrno-neaea a-..i�acoaz%zset4 • 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 LLC Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Update Address and Return Card. ICA 1 O 20M-05117 (/ Office of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE Supplement Card before the expiration date. If found return to: Registration. expiration Office of Consumer Affairs and Business Regulation 17320.5_ , 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 C-3—Undersecretary i"• a r' without signature I Y '1 Commonwealth of Massachusetts 4 Division of Professional Licensure Board of Building Regulations ulations and Standards Construction-`Supervisor CS-095707 :i. EA" pires : 09/08/2020 y F ,-. ti. / ,,sg, y"asxtai,,'C xxri ',t1tc: l+ • BRIAN D DENNISON A 8 BLACKWELL DRIV 7 , ; � 4s x 4 iF -. CHARLTON MA,0150 u Y Of ya Lis- 0 -_,, T • Commissioner CAL iag----- The Commonwealth of Massachusetts e= t Department of Industrial Accidents • = 1- .1 Congress Street,Suite 100 • • .'� - Boston,MA 02119-2017 www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. • Applicant Information / s Please Print Legibly Name(Business/Organization/Individual): 3 /A ,rern 4. land /�i)a/ou/�1 Address: Jr') Reservnir Rd, J • City/State/Zip: SothIA e/„l 02.g l 7 Phone#: 1-/O I–Z28–q(gDO Are you an employer?Check the appropriate box: Type of project(required): I.'Cam a employer with €204.,employees(full and/orpart-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] C9.am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. ❑Demolition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 O 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.❑Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. R repaiiS These sub-connactocs have employees and have workers'comp.insurance.: 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14. then ,,,L✓!!!1 r1,(6�/ 15{§1(4),and we have no employees.[No workers'comp.insurance required.] ruse rea?en 7 S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information 1 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 Insurance Company Name: ere in C/1 5 I/1 S. Com OM pln v/ Policy#or Self-ins.Lie.#: W�eael .3/ T'R 72-'1 / Expiration Date: /— /—/q • Job Site Address: lq O Lagt n Pon City/State/Zip: Sl.k.-10,41, /4.4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiiLtion 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 certi under the pai and penalties of perjury that the information provided above is true and correct Signatur a Date: /0—/l/ phone#: 40I –2.2.Ff–gl'n0 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#: i''1 • ® ACME) M/ CERTIFICATE OF LIABILITY INSURANCE DATE 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: N 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 endorsemeM(s). PRODUCER CONTACT CoBiz Insurance,Inc.-CO NAME.: 1401 Lawrence St.,Ste. 1200 uuc'No,Ext.303-988.0448 FAX Not 303-988-0804 Denver CO 80202 ADD HAG COMaiI@cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC e INSURER A:Acadia Insurance Company 31325 INSURED ESLF.RCO-01 INSURER B,Flremens 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 E: 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTTYPE OF INSURANCE AODL WEIR • POLICY EFF POLICY EXP INm WVO POLICY NUMBER (MM/DDWY)Y) (MwoDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1112018 111)2019 EACH OCCURRENCE $1,000000 I dWMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Es occurrence) $300000 _ MED EXP(Any one cereal) $10,000 _ 1 PERSONAL&ADV INJURY _ $1,000,000 _ GEM.AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE $200,00 .�POLICY EST El LOC - PRODUCTS-C01APVPA( $2.000.000 OTHER $ A AUTOMOBILE LIABILITY N CPA3158728 1/12019 7)12019 CO� tSINGLE LIMIT I7 00000° X ANY AUTO BODILY INJURY(Per person) S — ALL OWNED —SCHEDULED _ AUTOS _ AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per scddeM) $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/12018 7112019 EACH OCCURRENCE _ $10,000,000 _ EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ 9 WORKERS COMPENSATION wCA3158729-20 1/1/2018 1/12019 XPER AND EMPLOYERS LIABILITY V I N STATUTE ERµ ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $1,0 ,000 OFPICER/MEMBER EXCLUDED? N/A 0 (Mandatory In NH) EL DISEASE•EA EMPLOYEE $1,00,000 y descrha Under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $7,00,000 C Polulion Uabtty 7930073340000 1)12018 1112019 Each Occurrence $1,000,00 Clrms•Made Policy Retroactive Date 06202013 Ded�blle $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks SMedula,may be attached rimae pace H 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 ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD