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Home My WebLink AboutBLD-19-002767 :lit_ .(Wilco Use Only �c°1 %o Perini+# i.i... Si ` Er/� c' nmoaae 50 p1 iT ti �,,�,,. � Permit expires 180 days from c issue date Nsb—P -1-t0760 EXPRESS BUILDING PERMIT APPLIC 4ii* E I.V D TOWN OP YARMOUTH Yarmouth Building Department 1146 Route 28 OCT 31 2018 South Yarmouth,MA 02664 B i P ��y (508)398-2231 Ext. 1n261 ey. — —d1 CONSTRUCTION ADDRESS: 3 2- aaene ra. 1 -F-10I%ay R.i! ASSESSOR'S INFORMATION: Map: Parcel . t own -re.--, Oil(ia..-. tnv-n 32 ewe*(ilolwtyc/ •,:A3^ov-11--y4A- a264N r1h1-9S/-Se/71 NAMED ) - £maRAddre /oeic(. �ZS�-98t7o coNTRAcroR:,Samiler n iJ 1^ Otn4oto- .s,n;m—Cefd fir ae37 . CSI) NAME MAXIUN0 ADDRESS TEL# Email Ad 0 Cormnercisi Est Cost of Contraction$ /2,0 7 6 — Home Improvement Contractor Uc.# 173 2.45" Construction Supervisor tic.# 076707 Workman's Compensation!nsurance: (check one) . I am the homeowner I am the sole pruprietor 74;lave Worker's Compensation Insurance Insurance Company Name: Rt i4EA�S IRS. t inp)44I Worker's Comp.Policy# 10CA'r316r72 7—2 0 WORK TO BE PERFORMED • Tent _ Duration __ (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# & Replacement doors: # Roofing #of Squares ( )Remove existing*(max.2 layers) Insulation L1) qit Nr' j0/31I2 �r+ y19ties Old Rings ffighway/Histo/ricDiist. ( )Replacing like for bike '`43./�,t�r. air ibedebriswillbedisposedofat Ah le /WI ``e ",ch�/ "'e/�9� f bmtlun of Earn* r Ideclare underpeaaldEs.ofperjury einem:.1 +.,ants hit .ereincontainedaretrueandcorrecttothebestofmyknowledge and belief. Iunderstandthat any false answer( "- vat bejust cense fordwlaloragocedonof andforpmsecadonuadenMO.LCb.268,SectionL Applicant's wl f-'/1 `-�, Date /D �/-it at Owners§1grmtan(or attachment) S7 /t <�� Data ,.� Dace /U ' 3/ ' li Approved Dy /��+•� Building Official(or designee) Zoning Dbtaier• Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 ft.of Wetlands: Yes No Yes No • Renewal Agreement Document and Payment Terms bvAndersen. dbu Renewal By Andersen of Southern New England Tom i Margie Williamson /'i '/ 'i� Legal Name:Southern New England Windows,LLC 32 General Holway Rd `PPP p!' mason OrYrXT 1RI o Reservoir360RdMSmithfield,A a 0291745, #0634555, Lead Firm#1237 South Yarmouth,MA 02664 H:(508)951-5471 Phone:866-563-22351 fax:401-633.66021 saleserenewalsne.com Buyer(s)Name: Tom &Margie Williamson Contract Date: 10/15/18 Buyer(s)Street Address: 32 General Holway Rd, South Yarmouth, MA 02664 _ Primary Telephone Number: (508)951-5471 Secondary Telephone Number: Primary Email: aeforms@comcast.net 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 documcnts 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: $12,076 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: $4,024 Balance Due: $8,052 Estimated Starr. Estimated Completion: Amount Financed: 50 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: 113 deposit,1/3 at start,1/3 at completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the panics 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 10/18/2018 OR THE THIRD BUSINESS DAY Al 1 ER 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 y d en of urhern New England Buyer(s)_giros 'TX Can—a04_ Signature of Sales Person Signature Signature Paul Sandrey Tom Williamson Margie Williamson Print Name of Sales Person Print Name Print Name UPDATED: 1 0/1 5/1 8 Page 2 / 11 f� . am noneveadi o/✓gacmac .lea • • 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: 093245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 Update Address and Return Card. KA I 0 20M-05/17 66 I. leas. Fewmnikeut Uas.JP.r/e`uJea 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: Realstfattorn 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 _F;� SMITHFIELD,RI 02917 Undersecretary N To, • without signature r Commonwealth of Massachusetts Division of Professional Licensure . Board of Building Regulations and Standards ConstrUcton'Supervisor CS-095707 E- pires: 09/08/2020 • E4 yg -n- ♦ES4r A 1r�E5. z !zrl yah '. BRIAN D DENNISON r ` ; .- 8 BLACK WELL'-DRIVE , . ,i'- A CHARLTON MA;01507 ' a • 17 r• p • w-: tr#0 • Commissioner ale L The Commonwealth of Massachusetts g ,uv_ t Department oflndustrialAccidents =tel_ A 1 Congress Street,Suite 100 • 4:J=5 Boston,MA 02114-2017 �*` www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoalicant Information / Please Print Legibly Name(Business/Organization/Individual): Sal-In��el de.4 /f�5land i7J0u/( Address: /p Re ser'I/nr'r' Ref- J City/State/Zip: . Ya'ii41-1-]ie/21 % 0zcl 17 Phone II: 1/0 1-22?-9(POO Are you an employer?Check the appropriate box: Type of project(required)' 1.Elam a employer with el 0*,employees(full and/or part-time). 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]' 9. 0 Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑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.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: �[ 6.0 We area corporation and its officers have exercised their right of exemption per MGL a 14.[t]Other t�/t n�¢h/ 152,11(4),and we have no employees.[No workers'comp.insurance required.] re4rt.n./+t '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. Insurance Company Name: I',r e/''t en 5 tel c. IAM pa n Policy#or Self-ins.Lie.#: WCA 3/ Sr� 72.q / Expiration Date: / f—/9 • Job Site Address: .� 2- Ge,ert l -Pp lair y (R-L) City/State/Zip: nyi£/M.r,d�. /1-4 Attach a copy of the workers'compensation policy declaration page(showing the policy nu er and exciration date). Failure to secure coverage as required under MOL 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 pat and penalties of perjury that the information provided above is true and correct e Sienatu ® �,�� Date; l0 ' 31 —fr� Phone#: • 401 —LZ,R'—q '60 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#: • e A DCERTIFICATE OF LIABILITY INSURANCE DATE IMMIDONYYY) 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(les)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 (Arc x Eat•303-988-0448 FAX No):303-988-0804 Denver CO 80202 • ADDA"REESS: coMail@cobizinsumnce.com NSIIRER(S)AFFORDING COVERAGE NAIL e INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemen 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 0: 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -, ILTR TYPE OF INSURANCE ADOLSUBR ' POLICY EFF POLICY EXP tomb WVO POLICY NUMBER (MMIDDIYYYY) LMM/DDIYYVY) LIMITS A X COMMERCALGENERALLABILT' CPA3158728 1/1/2018 1/12019 EACH OCCURRENCE $1,000,000 I dUUMS.MADE O OCCUR DAMAGE '0 RCM ED — PREMISES(Ea occurrence) $300,000 - MEDEXP(Any om Person) $10000 _ PERSONAL B ADV NARY $t eces00 GEENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000.000 — POLICY O Ta, O LOC - PRODUCTS•COMP/OP AGG $2,000,000 �7I OTHER: S A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 COMBINED SINGLE LIMIT 5(Ea occident) 1000000 X ANY AUTO BODILY INJURY(Per person) $ — ALLOWNED SCHEDULED — AUTOS AUTOS GODLY MARY(Per accident) $ X HIRED AUTOS X NONOWNED - (Pr PROPERTY DAMAGE ' AUTOS accden0 $ _ S ' A X UMBRELLA LAB X occuR CPA3158728 1/1/2018 1/12019 EACH OCCURRENCE 510,000,000 EXCESS LAB CLAMS-MADE AGGREGATE _ $10,000,000 DED X I RETENTIONS 0 S B WORKERS COMPENSATION VVCA3158729-20 1/1/2018 1/12019 X MID EMPLOYERS LABILITY YIN STATUTE OTH- ER ANY PROPRIETORPROPRIETOR/PARTNER/EXECUTIVEEL EACH ACCIDENT 51,000,000 OFFICER/MEMBER EXCLUDED? 0 N I A (Mandatory In NH) EL DISEASE.EA EMPLOYEE $1,000,000 N descrmeundr DESCRIPTION OF OPERATIONS bSow EL DISEASE•POLICY LIAR $1,000,000 C Liraty 7930073340000 1/12018 1K2019 Esdi Occurrence $1.000,000 p ma-MedeY Renoadiw Date 06202Dadud 013 educ Me 51.000,000 ible $10000 DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(ACORD 101.AddiaonM Rrnarb Schedule.may be enacted It more epees N 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(2014/01) The ACORD name and logo are registered marks of ACORD