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Home My WebLink AboutBLD-19-002594 .umco use unry Perth# _ ' tra#124\144. 3 1 :�i�' e Amount 50 O :,moi .. . $ E' =do, Permit expires 180 days from�� issue date 13Lb-19-(xils9y. EXPRESS BUILDING PERMIT APPLIa-WeiI V E D TOWN OF YARMOUTH Yarmouth Building Department OCT 2 4 2018 1146 Route 28 South Yarmouth,MA 02664 Bu,�� N} (508)/n398-2231 Ext. 1261 Br: 5415B1 of CONSTRUCTION ADDRESS: g' WAA/t no IR(9. ' ASSESSOR'S INFORMATION: • Map: Parcel: ' 0' i — ' a IC-in : -, .. .e?! ., ..... 0" 4 A 0 , — 4-4'1 t -Pa 1 NAME �. _ TEL # Emelt Addre t es 'i . • DI- CONTRACTOR �u'f'{�rn lag tdinolvos SA MI> /r/ .R.Z... 1 Cybl�ZZ S�r/81?0 AME MAILING ADDIS TII-# Email Ad Commercial Est Cost of Conmoctlon S Home Improvement ContractorLh .# 17.3 2.45- Construction SupervisorLlc# o76707 Workman's Compensation Inman= (check one) . I am the homeowner I an the sole proprietor A have Worker's Compensation Insurance Insurance Company Name: $afirttkks IPS. Cop ` ,ig Iwor'.mr's Comp.Poky# U)OA a/ 72 7-2 0 WORK TO BE PERFORMED Tent _ Duration (Fsre Retardant Certificate attached?) \ Wood Stove Siding: #of Squares • Replacement windows:#___a_4151.0) Replacement doors: # ��R``oofing. #of Squares ( )Removeveexisting*(max.2 layers) / Insulation I7V ICIa�6ld Sings Highwayy/HistoricDist. ( /eplacinglke for like *The debris will be disposed of at le de "'Ws reek 0 ofFernley/ S l IAfieIC 9r I declare under penalties of perjury that tbe ants herein contain are are ueand correc tothebestofmyimowledgeand belief. Iunderstnndthatany false answer will he Just cause mrdenial orwyocaooaof se and forproseendonunderM.O.LCh.268,Section1. t f/1"-`-".,� Date: /0-17-12 Applicant's Signature: OwneriSignatnre(or attachment) al Ste- 1t• 6 Ade _��/ Data: /D ✓/ J' Approved By Snit ( designee) Zoning District:_ Historical District Yes No Flood Plain Zona Yes No Water Resource Protection Mulct: Within 100 es of Wetlands: Yes No L. Renewal Agreement Document and Payment Terms byAndersen. dbas Renewal By Andersen of Southern New England Larry Jenkins ¢ I�' Leal Name:Southern New England Windows,LLC 8 Wianno Road t � %� . RI#36079, MA#173245,CT#0634555,Lead Firm#1237 Yarmouth Port,MA 02675 WINDOW RE 10 Reservoir Rd I Smithfield,RI 02917 H:(774)994-8489 Phone:866-563-22351 Fax:401-633-6602 I salesOrenewalsne.com C:(860)614-3605 • Buyer(s) Name: Larry Jenkins Contract Date: 10/05/18 Buyer(s)Street Address: 8 Wianno Road,Yarmouth Port, MA 02675 Primary Telephone Number: (774)994-8489 Secondary Telephone Number: (860)614-3605 Primary Email: )enkinsburns@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LW 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: $7,443 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: $2,480 Balance Due: $4,963 Estimated Start: Estimated Completion: Amount Financed: Su 8 weeks 8 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: Taxes PD 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 10/10/2018 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 din:Renewal By Andersen of Southern New England Buyer(s) 21 AZ Signature of Sales Person Signature Signature Eric Woods Larry Jenkins Print Name of Sales Person Print Name Print Name UPDATED: 10/05/18, Page 2 / 8 • fm oneae a/.Aa�-sao44 ehh� 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. 3CA 1 4 20M-05117 rm„rnWee6 reaaciadelli Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: Realstration. Expiration 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 u SMITHFIELD,RI 02917 Undersecretary N. a°' without signature 7 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations ulations and Standards Constructon'Supervisor CS-095707Ej pires: 09/08/2020 v a 6,9 saw h`#"a #4 •*2.r tl t : 'az Ry rti • i1 a� BRIAN D DENNISON - "• ` y, k 8 BLACKWELI DRIVE ; ,(1/ . -," 44: CHARLTON MA#01507 �;„ ' r= I4 • Commissioner CAr. L _ J The Commonwealth of Massachusetts ntnij' ` Ci Department of Industrial Accidents - • 1 Congress Street,Suite 100 Boston,MA 02114-2017 • 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/Organization/Individual): $, l-iperei dent/4;25 Ian ) 1.47,;:),-/o144.1.Address: /(> &e Seor'(/nt'n J • City/State/Zip: . it fel/ ez r 0. g 17 Phone#: 1/0 I-Lz 8'-91'OO Are you an employer?Check the appropriate box: Type of project(required): I.15cam a employer with e204-'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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. 1 am a homeowner doingan work myself. 9. Demolition ❑ y [No workers'comp.insurance required.] 4. I am a homeowner and will be hiring contractors to conduct all work on ]0❑Building addition ❑ B my 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. R is airs These sub-contractors have employees and have workers'comp.insurance: q 6.0 We area corporation and its officers have exercised their right of exemption per MGL a 14. Other Ls);r•r(�D i✓ 152,§1(4),and we have no employees.[No workers'comp.insurance required.) r 1,14 cal t•il _S 'Any applicant that checks box al 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�1reine 'i 5 Lel S. COM eanw/ Policy#or Self-ins.Lie.#: W(_f] 31 TR 72-g / Expiration Date: /— /—p9 Job Site Address: g hiin"lel orte' �Y• City/5tate/Zip: anti ri /rf 114 Attach a copy of the workers'compensation policy declaration page(showing the policy dumber and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a Erie up to$1,500.00 and/or one-year imprisonment,as well as civil penaltiesin 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. Si• am G _ Date: ♦ - / / $ • Phone#. • 401 —LZR*—g8e0O Official use only. .Do not write in this area,to be completed by dty or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department I City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e ^`�RiATE(M CERTIFICATE OF LIABILITY INSURANCE DMNDIYYYY) 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 CONTACT CoBiz Insurance,Inc.-CO PHOS 1401 Lawrence St.,Ste. 1200 IA/C N Far 303-988-0446 I FAX Not 303-988-0804 Denver CO 80202 Enou IRFsse: COMailkcoblzinsurance.com INSURERS)AFFORDING COVERAGE NAIL S INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER e:Tremens Insurance Company of WA,D.C. 21784 Southern New England Windows,LLC. dba Renewal by Andersen of Southern New England muse'e: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 AU.THE TERMS, ' EXCLUSIONS AND CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE I'13D WVD POLICY NUMBER (MMIDDY� (MOMJDDD)EXP LIMITS ` A X COMMERCIAL GENERAL UABILITY CPA3158728 1/12018 1/12019 EACH OCCURRENCE (1.000.000 CIl/UMSMADE O OCCUR DAMAGE TO RENTED PREMISES(Ea ottllrrenxl f 300,000 - — MED ID(P(Ary w perms)_ 510.000 _ PERSONAL B ADV INJURY _ 51000,000 GENL AGGREGATE DMR APi�PLIES PER GENERAL AGGREGATE S 2,000.000 �0OLICY 7 I ILS PRODUCTS•COMP/OP AGO $2,000 0Q0 I OTHER: 5 A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 OECtaNc DSINGLE LIMIT 51000000 X ANY AUTO BODILY INJURY(Per parson) S — ALL OWNED SCHEDULED - AUTOS AUTOS BODILY RUIRY( accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE - AUTOS (Per accident) S _ S A X UMBRELLA LIMB )( OCCUR CPA3158725 1/12018 1/12019 EACH OCCURRENCE _ 110.000.000 _ EXCESS LMB CLAIMS-MADE AGGREGATE 310,000.000 DED X RETENTIONS0 s B WORKERS COMPENSATION - VYCA315E729-20 1/12018 1/12019 p µ AND EMPLOYERS LIABILITY Y 1 N X STATUTE ER ANY PROPRI RIETOPARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 OFFICEFU EMBER EXCLUDED? R I A Mandatary Si NH) EL DISEASE-EA EMPLOYEE S1,000.000 Eyu�deaed0a seer DESCRIP? OF OPERATIONS below EL DISEASE•POLICY UNIT f 1.000,000 C Psubn180ability e 7930073340000 1112018 1/12019 Each Occurrence 51.000,000 ClamRaboaaive Date 05202013 DeAggregatductible 51051,000,000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more same Ie required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD •