HomeMy WebLinkAboutBLD-19-002764 ^('.' `9R,r -0ffrceUseOnly
c Amount 60—
‘e6V‘lennot$ e34/ Fermi[expires 180 days from
'issuedate
EXPRESS BUILDING PERMIT APPLIC I; 'o E I V E D
•
TOWN OF YARMOUTH
Yarmouth Building Department OCT 31 2018
1146 Route 28 -
South Yarmouth,MA 02664i P
- (508) 398-2231 Ext. 1261 02664BUJ r k •. J $
CONSTRUCTION ADDRESS: I I 1 SWttn Le Ace C)
ASSESSOR'S INFORMATION:
Map: Parcel:
T"..a s //
OWNER: ..rt-e ran i" 114 caHit La/Ce /ZcV [tL•Yarewn..4-t, ML! 0-1 .1'3 77l - 16-//S k
NAME PRESENT ADDRESS f - TEL. # Email Address:
CONTRACTOR:hnfeo/Voxffof`Bo?3an,LLM ofiklebrlr„i S & ISA IAA burn r/3• Cm) 432-440S
NAME MARANOADDRESS 01701 TEL it Email Addre
esi andel • Commercial Est Cost of Consimction$ 76 2 S
Rome Improvement Contractor Lie.# / 4. 02C Construction Supervisor Lie.# 072-774
Workman's Compensation Insurance: (check one)
I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance
' Insurance Company Name: Haritele+ Fire_ Thc. C n. Worker's Comp.Policy# 2-7— WE-CI-524 3C
WORK TO BE PERFORMED ! •
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
tI
Siding: #of Squares Replacement windows:# 9 Replacement doors: #
Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation
Old Kings Highway/fiisttoric/Dist. ( )Replacing like'for like /1
*The debris will be disposed of at: 44;4 �/14 Tem ea7 ct/p.6vnn . #1A
'' Location of Facility
I declare under penaldes of perjury at the s%. . e. . mill.ed are tau and correct to the best of my knowledge and belief. I understand that any false answer(s)
will baps'cause for denial or revo;d.. •4,1-..4—•ra � T:-, .. •- MOY Ch.26g,Secdon 1.
Applicant's Signature: j r_t/���r\.... .• Date: /l7- 3/--/Cr
Owners Signature(or at ♦ ��See 6.41:41.- r Gna c. — late: .ry
Approved Sy. , 11 r/�C.� _/ Date: /U- 3/ - i
•pal(or designee)
Zoning District
Historical District Yes No Flood Plain Zone: Yes No
•
Water Resource Protection District Within 100 ft.of Wetlands
Yes No Yes No
I
♦. ..._'A
1 .
Vinciviil. Window World of Boston MA HIC RegistrationOffices & Showrooms Number.
O 15A Cummings Park 0 295 Old Oak Street 166025
Wobum,MA 01801 Pembroke, MA 02359 Federal IDS
OW (781) 932-4805 (781) 826-6281 82-4898432
www.WindowWorldofBoston.com
Customer. Thom a g S+t.r-r4.Qvelt44 Phone(h) 1!774- lc- 115-R
Install Address: (ilQ Sfa>c.n( La(L.e '2J . Phone(w) fIf
City:(,SeS4 7armnt..41. State:MA Zip 024:73 E-mail I
WINDOW WORLD GLASS OPTIONS
_1000 Series Single-hung All-Weld $199 SolarZone Elite•Dual Pane $119
_2000 Series DH All-Weld • $215 of Triple Pane/Krypton f $c69 332!
4000 Series DH All-Weld $240 (*Series 6000 04)
86000 Series DH All-Weld $260 23"C WINDOW OPTIONS
2 Lite Slider
3 Lite Slider _Glass Breakage Warranty(4000/6000) $15 INCLUDED
On.+a 1nl (IM,in,vq $575
Picture/Fixed Lite (0-83 UI) $365 1/2 Screens l$9 INCLUDED
_Picture/Fixed Lite (84-130 UI) $445 _Foam Insulation on Jambs and Head Si 1 INCLUDED
Awning $310 _____Double Strength Glass(4000/6000) 15 INCLUDED
_Casement Plus$49(DH Sash Rail)$330 Double Locks(>261 ( 155 INCLUDED
_2 Lite Casement $595 _Full Screens $25
_3Lite Casement maim m 014,12.1/41 $910 Colonial Grids(Contoured/Flat $65
_Basement Hopper $434 Prairie Grfds I $75
_Bay Window-Soffit Mount/INS Seat $2660 _
_Simulated Divided Lite i $182
_Bow Window-Soffit Mount/INS Seat$2785 _Tempered DH Sash(BSO) (TSO) $75
_Garden Window $2040 _Obscure Glass(BSO)(TSO) $75
_Bay,Bow,Garden Oversize (+109 UI) $975 _Oriel Style(40/60 or 60/40) f $75
_Beige/Almond $40 Foam Enhanced Frame i $35
_Wood Grain Interior(Selves 40001 6000 only)$100
(Light Oak/Dark Oak/Cherry/ Fox Wood PRE 1978 BUILT HOMES(EPA LEAD SAFE RENOVATION)
Rich Maple) _____Lead Safe Practices Required I $30
_Brown Exterior(Arch.Bronze/American Tena)$100 MY HOME WAS BUILT IN THE YEAR I initial
____Designer Color Exterior $175 MISCELLANEOUS
_Speciality Window $ `Custom Exterior Aluminum Cladding(1WI Bend)
Window Color Wh i-b / LOIN;-1.4, ❑Textured$90 0 G-8 Smooth$90 $
Inside Outside Facing Color 1
NON CUSTOM DOORS _Metal Window Removal $ 5
Vinyl Rolling Patio Door 5ft.or Oft. $1096 Newq Construction Vinyl Removal $1 5 /S7 S
Vinyl Rolling Patio Door WI81195 _Multi-Bend Cladding $20
Add to base price for Custom Rolling Patio Door$1250 _Mull to.Form Multi Unit $30
_French Rail Sliding Patio Door 5ft or 6R $1395 _Install Interior/Exterior Stops 1 $50
_French Rail Sliding Patio Door aft $1495 _Install Interior Casing Starts At $95
_French Rail Sliding Patio Door 9ft. $1595 _Insulate Weight Boxes $20
I
Windows_Custom Exterior Cladding $300 _Roof for Bay/Bow $560
_SolarZone Elite or ETC Glass $305 _Existing New Const.Ext.Retro Fd $150
Grids Patio Door $210 _Removal of Existing Bay/Bow ( $250
Woodgrain Interiors $395 _Repair Sill,Jamb or replace sill nosing $75
_Exterior Designer Colors $595
_interior Casing 21n 31n $275 —Full Sub-Sill(Single)replacement $175
Mull'wn Removal I $60
_Handless(Options714,
$
1 $ _BayBow Conversion Ext.Retro lit $450
(New Siding Will Not Match) if
Door Color W al, ROUND-UP FOR WINDOW,WORLD CARES
Inside Outside
St.Jude Children's Research Hospital s "1
4 [.. i
`I Customer declines grids on /�C.t windows/doors Initlal r I
IDISCLAIMER;Customer is responsible for the fonowing In connection with this contract Painting,Staining,Alarm System disconnect/reconnect Blinding Permit lees in
excess o1$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sldewalk Permit tea in connecdo5 wit Msahation.
NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows:
C,Zm64, Ca-S: II II eModc Extra tabor&Materials $ I
Mi+-e Cr' S-It .ps ap 1 Site Set Up, Permit,Disposal&Delivery Fees$ I $389:00
�4 5 e EX r C{ i0 ice, ty)i Nj-,`.�) ` Total Amount $ i 4 2S' --
0 e ,c4.e (WS-{d.1( l..)e J,tJ Custom Order
artPayDeposit 33% $ 257(., 9k#
au tee aa�� tJq Project Start Payment 33% $,fl I
Ss- ere°r I a !�p Balance Due Day of Installation $ ,� q,3, —
Window World of Boston anticipates starting hs work on //(p//9 and being substantially completed fnnt F ys. $ I G Z S
Any deposit required b advance of the start of the work SHA NO exceed 331/3%of the total contract price or the of interest Yes No
special order or custom made nature,which must be ordered in advance of the start of the work to assure that the any mhterfaeoNoamain e t
shag be demanded until the contract is completed to the satisfaction of bath parties. project will proceed On schedule;No final payment
An home improvement contractors and subcontractors shall be registered and that any Inquires about a contract or subcontractor retasng to a registration should be
directed to:(Mice of Consumer Affairs and BusMesa Regulation,Ten Park Plaza,Suite 6170 Boston,MA 02116.Phone:(617)9734700
No work shag begin prior to the signing of the contract and transmiitter to The owner of a copy of such contract.
BostoWindow
shag not be deemed rWorld 01 Boston esponsible for delaysion of s Chapter the work 142A of the
scrribed in Nis a agreement causeduired to byrfor egulatory,
all it g granting
agencies,
,permits. widow World of
Notice:x the PURCHASER(S)obtains his own construction related permits for the work describeunder this agreement orordeals with ung red contractors,
the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or
collection from the guaranty fund established by chapter 142A,M.6.L
You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.
Notice of cancellation must be In writing postmarked no later than midnight of the following third business day.
THIS ISA CUSTOM ORDER NOT FOR RESALE! I 1
This Window World*Franchise is Independently owned and operated by L&P Boston Operatir In under license from widow World,Inc tel I
Owner.Do not sign if are there aany blank spaces. Date
/7 ���
Sal n:Do not sign If there are any blank spaces. Datei
(Tuner.Do not sign if there aro any blank spaces. Data
seem este _
White Copy•Original Yellow Ca
9q not 1n41 Mea a Copy:File Pink Copy.Customer ` 1
inn it etre A M ma(etc j0 uongdwoo eql m nueteq amour/mina mu r+•+n••u w. '•••••..r--,--.--w_„H. .em ,Printing assasr-m tie
n I ep sI weirs se Buoi se scam Amu am eseo'ppm ul'qof Asp-£toy a eq nM p sselun'euop sl qof eqs iln Aets Ajle1eue6 em•noA
trim step uonetletsul eqi do las em town mg ltt Men mo lot awn lawn papodxo mgt to non emnpa Bum am-seam empedeq putt tenaup•g
'BUM pedI spuet so rouge'stupid
01 aBewap Rue moi elgtsuodsak lou am eM•Apedwd noA uo 6unpom angM Arejes mo pun smopuIM mnot'lom mo uo snot ap am semuoud
mno lnq'uogele6en punom Suppont uagM Intern eq of ens em*mem eueseid of meta not pus uo peddals 6uieq anptms louueo Amp
a pompoms Almewdwq eq pireogs Moperm a moieq mem seem u1 egniys pue wield ew3Ileo•smopulm mot til sseooe sn BNB of Moeq
peumd eq o1 peau segsnq enooBµpun saw;ewes•swelgomd legualod 101 4001 pus Bu1n!mma sn os load plait m ac Sums eseaid troop pun
smopuua can of emote em um ewoq mnl 20 seem pedeospuel mango pun sietueld ul 3210M of peau am Ageuo!seao0•seysng pue meld't
man tletsutem os patina!EMI Amu 1e41 suoneiele
Bumenoo Mopuga Rue moi algteuodsa lou em 0sle am'Uogegelsutai pue Ie*owa aql in Suptnear peewee ioi eiglsuodsa tau am pue
sweq asaiil W uogegelsulas to Bulnowes sol esq!suodses lou am aM uopelpelsul mo 02 oud penowa Mm8A00 mopu!m'm1110 Rue pun
sadism'smarms'sepegs dMpi'spugq!eogmon'spw q iuw tie peau em'sMopuIM eta pa mamWI 04101 mom aleft oy•s&gseAoq empaIM'C
tel missy AMMO Ps SM Agee snow M RAeSq oa am siren sinip ini AM
II'Mom sno p Rem erg uI tee seal seutgsnunt Rue ep!se snow eseald•Agieiodwet palesolem mo pelane eq pines luewdmbe aluompele natio
pue s:alndwoO'wem eseoolem pun puma alp Aq pegmn sip eq ins mat swell Items iegto putt'tuned lueuoduq setpe6o1 setpee of egasv pe in
n town mot gBnonp mop Rgeo!dL*puha p stsn6'penowa am sMopuIM pp exp uagq mom mo wroped of Nesseoeu stool pug sloop dap
ma soeld ues am os'ewoy snot eplsu!'Mopuim apse jo;cap u!mei 3 Alelewptosdde peau g!M aM'a000 pus ea lopumM eta 01 neon•y
'skeet*masa rmag WOW si isenbem nOR temp eat II uo!W1192sua emoleq mums'Chipman 9111 pampa 01 peen IIIM
em•noR cam 3210M 01 Rddeg eq Ism ani sapmo mot galeal os Apea em am leg(uogeoggou saps salaam p asdnoo 9 ueat sow moi uoge!!elsul mot
temp of peau noR uosees euos mol 21 temp uonellelsul IN las 01 noR Ii°ism em lulod lent 1V slava 9 019 Ageo!dAt in peetuemn6lou a0nora
Mamma eq o1 Apeem em sMoputm els uegm pue paaeid at sepso snot mum ueemleq awn egy•suogeool ppoM MopuiM coy Jeno mo io Rue 01
peddigs pue Agunos eta punom Damao'shield Buunpelnuew ma to euo le spew wolsno em sMoputm m0 to hiv-amp.Rsanpep impede]1.
I
' Apie ssaffelslg mo uegM asedxe 01l0yM tam noR
lulenbae m mommy sun paleaso any GM'efgfssod se Rryloows se eaeld 03fel of uopef(elsul syn ejgeue pue luewlsenui
mol azlwlxew N.•ewoy moR jo esueseedde pus onion'tonal laojwoo eyl eseaoul of uoispep mol uo euojlelnlaiOuo0
1
Sa00a aNd SMOUNIM M3N tit1OA HOd ONIabdJad
I
•
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-072772 Expires: 04/07/2020
kr, wti
a
JEFF C STEELE
24 SHERWOOD AVE
DANVERS MA 01923 ! ,.„
Commissioner
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:LLC
Registration Expiration
166025 04/112020
WINDOW WORLD OF BOSTON,LLC.
JEFF C.STEELS \2 ISa.�-
15A CUMMINGS PARK U
W OBURN,MA 01801 Undersecretary
The Commonwealth of Massachusetts
l _.ql=At Department of Industrial Accidents
_mi c1111= 1 Congress Street, Suite 100
-7.---4:1:17— Boston,MA 02114-2017
�, www.mass.gov/dia •
\Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information / Please Print Legibly
Name (Business/Organization/Individual): �jnda i/ k r/e/n-P & L1r LI e
Address: Pi11Cu/in t•-,:n5 S r K
City:lState/Zip: a iA ; o Phone #: 7g 1 -q 3 Z - i{R o S
Are you au employer?Check the appropriate box: Type of project(required):
1.EgI am a employer with CO employees(full and/or part-time).* 7. ❑New construction
2. I em a sole proprietor or partnership and have no employees working for me in
❑ B. ❑Remodeling
any=toothy.?le 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
4,01 an,a homeowner and wnl be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
•proprietors with no employees.
12.0Plumbing repairs or additions
5.01 area general contractor and I have hired the sub-contactors listed on the attached sheet
These sub-contractors have employees and have worker comp.insurance.: 13.QRoof repairs
&❑we are a corporation and its officers have exercised their right of exemption perMGL c. 14.� er W I O
152,{1(4),and we have no employees. [No workers'comp.insurance required.; I pe I c'fr1,g^--f—y
*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'camp.policy number.
I am an employer that is providing workers'compensation insurance for ors employees. Below is the policy and job site
information. .
Insurance Company Name: 14"att.-Corti FF re TJ'ts3R.f1Nd Cc .
Policy#or Self-ins.Lie.#: Z Z W r C LT.2(, c Expiration Date:/ /- 2 7- /q
Job Site Address: /19 -Swat en La/fe, 'Rd CitvState'Zip:t,/, atewa✓J4 f-(A
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 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 :temem may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifi•`„(on.
I do hereby der 1 under ' e pax 7....--- . • •erjury that.the information provided above is true and correct
Signature: Pi r Date: /0- 31-/t
Phone#: ,r 'a 3L- 9S05-
a _. a use only. Do not write in this area,to be completed by city or town official
City or Town: Permit'Licease#
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#:
•
•
•
•
•
Ac 2n CERTIFICATE OF LIABILITY INSURANCE
DATES✓aVOWLYyy)
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 CERIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS AUITt
REPRESENTATIVE OR PRODUCER,AND THECE RTIFICATE HOLDER. ( �: Oti12EO
IMPORTANT; If the certificate holder is an ADDITIONAL INSURED,the Polig(tes)must have
If SUBROGATION IS WAIVED,subject to U terms end cm ditlorls.OfTa ADDITy require INSUREDenn endorsement
orA se tement on
this certMarte does not confer rights to the certificate holder in lieu of such midmorning*
CIE!Ilfay 9Rdat6em9l{t, A statement OR
PRODUCER
3625 N McLenen Agency LW .. NF m Cars Vachon CIC,CISR.CBIA
MDTSGreensboro NC 27455irre �B �� iwcNor.212 soA6516
ADORES% CarL.VMtcheemershmne.Cpm
INSURERS)AFFORDING COVERAGE J NAIC0
INSURERA,Allmerice Financial Benefit 31534
INSURED tiwaDa2
Wndow World of Boston.LLC GSM e:Hartford Fire Insurance COMpany
118 Shaver Street • INsoRER o:Massadnrlm8s 19882
North Wilkesboro NC 28659 Bay Insurance Company 22306
INSURER 515
.
INCOME:• '
•
COVERAGES CERTIFICATE INSIoIERF: .
THIS IS TO CERTIFY THAT lit POLICIES OF INSURANCENUt��10gQOyy HAVE BEEN ISSUED 70 THE INSURED NAMEDABOVE FOR THE POLICY PERIOD .
INDICATED. NOTWITHSTANDING AM,REQUIP.EMENT,TERM OR CONDRION OF ANY CONTRACT OR OTHER.DDCUMENT YINTH RESPECT TO WIICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, .
(CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PNU CLAIMS.
X I OMt WEE tNWRaHCE '1NSDsiW
/ PdIMPRI IRER —POLICYEPPPOUC/m) TE%P
�at.WlannY .(M YYYYI (MU Dp LAWSC omNeRlanL
COME=
i'� I CLAI�7SMADE Q OCCUR 41,20111 MAOI FACHOCCURRENCE ;1tla,000
PREMISES fb AiPNmml ammo
MEOFXP(my ono paanLn 95500
Gr3fLAGORBGATEISDTypt!£g PER;
�PERSONALi WIREGY Et 000.040
POLICY ID JJECo-T 1_I 1_1 LOC
GEM:RALABGRLGRfE E20pD.000
OTHER -
PRODUCTS-COMPOPAGe 132000.S10
11A AUTOMOBO..YAa1LRY f
X ANY AUTO ; M687S�a I EtleC 17 Mere Ream N SINCLEUNiT Tit OOaWO
A DNLY '-1N.E0 BODILY INJURY(Per pm-
gabnq 5 '
_M AS
NN 6 .!
BODILY ZUURY ee
rPr A:yy NAGASEE a
ONLAUTOS ONLY '
C I X UMaRELLAUAa I X OCCUR 001790220I
I EXCB99LWB r CLAIMSYALLe 412C17 aroma EACHOCCURRENCE SAM=
CpED I 1 RETEAMONE I AGGREGATE ..f
jEOGLOCa
1.a WOR E SCOMPENSATION
AND EMPLDYERs'LIABILOY rtYIEl.Ge95 p 3
CA ppicesesayansROPRIETORNARTNERID(ECInNE YrN trllGaib V27320111 X l8TAT11rEi IERS
IMyLOoAAMAly In NNt ENCLULFA7 �;AlA •
ELPAm1AOCIDENT ;8a0.la0
DESCRIPf10ND WERATI',N,ISORbr ( EL.DISEASE-EA EMPLOYEE ;500.000
I •
•
I EL DISEASE-POLICY MET MEM
I
� '
NESLSmRTO.Y OF CP!RATIDRSILOCAUWISPIEmCLSS WCORD UPIcASOlflarlitervarls SefiIWR!,ANs Mcnaa Baan cpm brngWNO)
•
•
•
CERTIFICATE HOLDER
CANCELLATION
e,ION
SHOULD ANY CF THEABOVE.DESCR®ED POLICIES BE CANCELLED BEFORE
•
THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN
•
ACCORDANOENRHTHE POLICY PROVISIONS.
. 0r®®sEPRFSENYATIVA .
•
•
01589-2015ACORD CORPORATION. All rights reserved.
MORD 25(2015/13) The ACORD name and logo are registered marks of ACORD