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Home My WebLink AboutBLD-19-003087 iThYtte ,, ��®\+ O • Otr� C .Office Use se Only Permiu AmoDer5 Permit expires 1 80daysfrom issue date BCD-t�-W3b87 • EXPRESS BUILDING PERMIT APPLICATION TOWN OP YARMOUTH }� E C E I �/ Yarmouth Building Department E 1146 Route 28 South Yarmouth,MA 02664 NOV 14 2018 (508)398-2231 Ext. 1261. Ll. n T dY. CONSTRUCTION ADDRESS: i c h•• to al I Gr"rtJAy ASSESSOR'S INFORMATION: Map: Parcel: ' Gveo-r�y a if (j SoE-m s'10 I OWNER Cifbert .1-nukes i5-�,n Oil, &St✓a A/igfii>-E4 on 1S' a FRES � iEmattAddre NAME • /O Ke,SB on (in Frac CONTRACrOR5nu-I- rn N % (,f�rn4m04 S,n a,-F;•e/rl//�__R�t-fl'7 • C`of) NAME MAILINGADDRESS TEL.# Email Ad 0 Commer sl Est Cost of Consnnctioa$ WM/ Home Improvement ContractorLia# 17 aig.S construction supervisoritc.# o76707 Workman's Compensation Insurance: (check one) . I amthebomeowner I am the sole proprietor� A have Worker's Compensation Insurance Insurance Company Name: f RE 11LAis l P.S. t tn' it4PWorker's Comp.Policy# 1&)04 a'af 1-2 D WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Cerlificate attached?) Wood Stove Siding: #of Squares • Replacement windows# 2- Replacement doors: # I Rooi:gi#9f Squares_,.,_ ( )Remove existing*(max.2layers) InsulationJIt d Kings H'ighwaylfistorfc Dist. ( )Repladng like for lt'ke .. he debris Ma be disposed of an liii a "tans (Q �fh S liZI j (7_ tion Ideclare under penaMS.ofperjuryEtas the eats herein cantainedfhatatetmeanldedcconectY mmebest ofmyboy/ledge end belief. Fundentand that any false anaweic wMbejust cause for denial � do�nand for proswution under M.GL as.268,Section 1. Applicant's'Signet= n ati: a— / / / Fr at Owners Signature(ora eat) C - : S:�I- A Cr , to Data ii—ter . AppmvedDy �gOfficial . designee) • Z s D N isicty Hismrtcat District Yes No Flood Plain Zona Yes No Water Resource protection District Within 100 ft.of Wet)ands: Yes No Yes No RenewalLAgreement Document and Payment Terms ['Andersen.Idersen. dba:Renewal By Andersen of Southern New England Robert&Georgia Lonkart r� ��e1 Legal Name:Southern New England Windows,LLC 15 John Hall Cartway •�� Yarmouthport,MA 02675 �i, RI#36079,MA#173245,CT#0634555, Lead Firm#1237 w,aoew\40[Mler 10 Reservoir Rd I Smithfield,RI 02917 H:(508)789-8401 Phone:866-563-2235 I Fax:401-633-6602 I salestrenewalsne.com C:5087287128 Buyer(s)Name: Robert & Georgia Lonkart Contract Date: 10/29/18 Buyer(s)Street Address: 15 John Hall Cartway, Yarmouthport, MA 02675 Primary Telephone Number: (508)789-8401 Secondary Telephone Number: 5087287128 Primary Email: rslonkart@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 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: $14,399 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: $0 Balance Due: $14,399 Estimated Start: Estimated Completion: Amount Financed: 8 to 10 weeks 8 to 10 weeks $14,399 Method of Payment: Financing 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: Plan 2736 6.99% at 10 yrs fixed 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) I)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 11/01/2018 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:Renewal�y of Southern New England Buyer(s) Signature of Sales Person Signature Signature Paul Conboy Robert Lonkart Georgia Lonkart Print Name of Sales Person Print Name Print Name UPDATED: 10/29/18 Page 2 / 12 �� . now,uoecJI a 245arijaaad4 • 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. SCA 1 0 20M-05/17 .y� s .7.2; artimm/vuessezeG!I,9!'i2YJa fade/' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Realsttatlort 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 mom: . SMITHFIELD,RI 02917 Undersecretary N. "a• • without signature • 13, Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr Lcti-on`Supervisor CS-095707 • E- Aires 09/08/2020 f K: BRIAN D DENNISON / •,,, ;< 8 BLACKWELI:-DRIVE , -I . . It CHARLTON MA;01507 l 'g . •. ale 44...........e. Commissioner The Commonwealth of Massachusetts 1 Department oflndustrialAccidents__u® 1 Congress Street,Suite 100 ' =` d , Boston MA 02114-2017 a,,. www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTLNG AUTHORITY. . Applicant Information q Please Print Legibly Name(Business/Or ganization/Individual): nx des C,.i e&15lane! f�i7riou/c Address: Jo Reset-I/Of? Rd- J City/State/Zip: , i41t-Ce.a, (21 02M 17 Phone#: WO I-L2 l-9/'DO Are you an employer?Check the appropriate box: Type of project(required): 1.121.1ath a employer with 42i O*,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. 0 Remodeling any capacity.[No workers'camp.insurance required.] 9. 0 Demolition 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. t will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contract=have employees and have workers'comp.insurance. 13.0 R of repairs ,/ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14.QOther tonetch) �r d0 d r 152,61(4 and we have no employees[No workers'comp.insurance required] rer&Arun a'•1-415•Any applicara that checks box#1 must also fill out the section below showing their workers'compensation policy information VV 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-contmctens have employees,they must provide their workers'comp.policy number. 1 am an employer that Is providing workers'compensation insurance for my employees. Below Is the policy and job site Information. Insurance Company Name: rZre/'•tejl5 LI S. COM(bpi Policy#or Self-ins.Lic.#: we A 3l 4'R 7ZQ Expiration Date: /— f—f9 Job Site Address: /5 et fit I C air'K141 City/State/Ziphrnevftfor F14 Attach a copy of the workers'compensation policy decla{ation page(showing the policy umber and exp 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 cent under the pal• and penalties of perjury that the it formation provided above is true and correct t• Sienatur-....._� Date: phone#: • L[OI —LLFf—qeDD 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#: • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MrwDYWY) 4......--- 1229/2017 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 tens 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 NAME' 1401 Lawrence St,Ste. 1200 HONE .Far 303-988-0446 jA c.Nur.303-988-0804 Denver CO 80202 EM ESS• COMailttacobizinsurence.com NsuesarS)AFFORDING COVERAGE NAIL e INSURER A:Acadia Insurance Company 91325 NSURED 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 o: 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 CONDfTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. visit ADD].Slime ' POLICY EFF POLICY EXP LTR TIE OF INSURANCE PASO MD POLICY NUMBER IMMNDIYYYY) IMMNDIYYYY) LIMITS A X COMMERCIAL GENERAL LUIBILAY CPA3158728 1/12018 1112019 EACH OCCURRENCE $1.000,000 I dWMS-MADE 0 OCCUR X PREMISES peytrnente) 3300.000 _ MED EXP IAV'One penal) 510,000 _ PERSONAL 8 ADV INJURY _ S 1.000,000 _ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52.000.000 _ POLICY 0 jE f O LOC - PRODUCTS•COMP/OP AGG 52000,000 OTHER S A AUTOMOBILE LIABILITY N CPA3158728 1112018 1112019 COMBINED SINGLE LIMIT (E,emOenD 51000000 X ANY AUTO BODILY INJURY(Per penal) S — ALL AUT 003 WNED —SCHEDULEDBODILY INJURY(Per accident) 5 AUTOS X HIRED AUTOS X A�NNED PROPERPer YDAMAGE IS S A X UMBRELLA UAB -X OCCUR CPA3158728 1/12018 1/12019 EACH OCCURRENCE _ $10.000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE 310.000.000 DED X RETENTIONS 0o S e WORKERS COMPENSATION INCA315972120 1/12018 1/12019 X Or • AND EMPLOYERS'LIABILITY YIN STA UTE fN ANY PROPRIETORPARTNER'EXECUIVE EL EACH ACCIDENT $1. 0o0 oFFICERR,EMeER E(CLUDED7 C N I A Oo0, Mandatory hi NH) EL DISEASE•EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LINT $1.000.000 C Paueon DabMly 7930073340000 1/12018 1112019 ETT Occurrence 11,000000 DaDdimme 5100 °° Redo�n 06202013 Deduced. 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addibenet Remodel Schedule,May S attend N more space Is 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