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Home My WebLink AboutBLD-19-3086 .Office L'saOnly ' 1.0'' `4 ? '1Ve .i so • t 4 C Amount V -' o�-.4c4"+. •RCd Permit expires 180 days from• issue date B03— l9—LD3v&G EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth,MA 02664 NOV 14 2018 (508)398-2231 Ext. 1261 t 1 CONSTRUCITON ADDRESS: S S 1"arfir1 of S e. ✓'ct le/ RV. B UCP—P-` [ f 1- ASSESSOR'S INFORMATION: J. Map: Parcel: • OWNER: '/Annalef gn,ir Bi s c /rtnijeVJe%V. 499-vat /IA a.2473 ,a�_se,-9/9Y NAME • /OPRESENLADDRFSS. / TEL # Email Addres CONTRACTO • tt I4 n N.A. Omocoms Sr,,Kret'%ef yr aa,7 . Ow)x28-9gv0 AME MAILING ADAMS T .* �qEmail Add Residential Commercial Est Cost of constructions 10134S � •w ) Home Improvement ContreaorLie.# 1732hl.S Construction Super/Igor Ile.# 076707 Wotnan's Compensation Insurance (check one) . I am the homeowner I am the sole proprietor ` ,iG have Worker's Compensation Insurance t Insurance Company Name: f n1 (wt./It IPS. 6�7s)�xrt wo> s Comp.Policy# te OA aiern 7-2 0 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows.# 7 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway(Historic Dist ( )Repladng like:for Rer- . *The debris will be disposed of at ',hie A'..^�_ astlun of Rattly{ SnaA Q Id 9L Idecla eunderpenaldesofpetjurythatthe hernia contained are true and correct to the best of my knowledge and belief. lunderstand that any false answer(s) will bejust cause for denial or{,m�yet�tieaof m for pmsepudonunderM.O.L.Ch.268.Section 1. Applicant's Signatures �li�,,�•� YDate: //—/t/r Owners Stgnatare(o ent) ate. M ,_''S Paw Approved By. 41 nate: //..-/ r—/- Adding Official(or designee) Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 tt.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms yA_Idersen. dbar Renewal By Andersen of Southern New England Ma)orie&Ronald Bourgeois / Legal Name:Southern New England Windows,LLC 55 Partridge Valley Road I IP # wia, \,. RIR 36079,MASmithfield,#1 4 025 7#0634555, Lead Firm#1237 West Yarmouth,MA 02673 10 Rd I RIH:(508)367-9198 Phone:866-563-22351 Fax:401-633-6602 I salesarenewalsne.com C:5084004567 Buyer(s)Name: Majorie &Ronald Bourgeois Contract Date: 10/30/18 Buyer(s)Street Address: 55 Partridge Valley Road,West Yarmouth, MA 02673 Primary Telephone Number: (508)367-9198 Secondary Telephone Number: 5084004567 Primary Email: marjorieb@bassriverproperties.com Secondary Email: Buyer(s)herebyjointly 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: 510,255 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: 510,255 Estimated Start: Estimated Completion: Amount Financed: $10,255 8-10 weeks 8-10 weeks 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: Taxes Paid 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 11/02/2018 OR THE THIRD BUSINESS DAY Al 1-RR 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 By Andersen of Southern Ncw England Buyer(s) _ Signature of Sales Person Signature Signature Eric Woods Majorie Bourgeois Ronald Bourgeois Print Name of Sales Person Print Name Print Name UPDATED: 10/30/18 Page 2 / 11 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- 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 .. . Update Address and Return Card. SCA 1 0 20M-05/17 T4; ✓<Mwn.waea44 v(a" ¢r tail Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration.. pa oiration 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 \R_CGQ.I�a-- a - 10 RESERVOIR ROAD U _,� SMITHFIELD,RI 02917. Undersecretary N r a. ' without signature r + Commonwealth of Massachusetts il I Division of Professional Licensure Board of Building Regulations and Standards Construction" Supervisor CS-095707 ,. E- pires : 09/08/2020 ,/ - 7 J a t BRIAN D DENNISON r ' %� — : 3 8 BLACKWELC1 DRIVE , k' "� Ii ' CHARLTON MAf01507 -" `�,�'1 11 ceL. alau,...e Commissioner J • The Commonwealth of Massachusetts 1, Department of Industrial Accidents 111 %. 1 Congress Street,Suite 100 sal"="21r. {=� Boston,MA 02114-2017 --,;7449 www mass.gov/dia Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMUTING AUTHORITY. Applicant Information / n Please Print Legibly Name(Business/Organizatlonfndividuai): Stagiern a/{��rt/fCA5 lard /4nr/vk/( Address: /n Reservoir Rd- J City/State/Zip: ,541). .f;e/d 2.1 o.z i l 7 Phone#: NO t-2_28-9 00 Are you g employer?Check the appropriate box: Type of project(required): i.Ef am a employer with ai O+,employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. Demolition 4.0 t am a homeowner and will be hiring contractors to conduct all work on my property. I will 30 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These subcontractors have employees and have workers'comp.insurance.; 13.0 B. repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Cher 152,#1(4),and we have no employees.[No workers'comp.insurance required.] i< art--r?n S *Arty 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. lel Insurance Company Name: FI re r't e./1 5 c. l/+DM Past y Polity#or Self-ins.Lic.#: weA 3/ T R 7Lel Expiration Date: f— / /g • Job Site Address: tic larfne IIle/ /�eK City/State/Zip: AX Zrnoul PIA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 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 cern under the pas• and penalties of perjury that the information provided above is true and correct. Si- atur •�,S _ l _ Date: /-/ Phone#: • 40I2.2-g-q8"100 Official use only. Do not write in this area,to be completed by city or town offieiaL 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#: • • A o CERTIFICATE OF LIABILITY INSURANCE DATE"""JDDITYYY) 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 terns 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 COBI2 Insurance,Inc.-CO PHONY FAX 1401 Lawrence St.,Ste. 1200 IA/CNNo Eri.303988-0446 incNek 303-988-0804 Denver CO 80202 ADDRESS: co MailicobizInsurence.com INSURER(S)AFFORDING COVERAGE NAIL/ INSURER A:Acadia Insurance Company 31325 INSURED ESLERC0•01 INSURER a:Firemen Insurance Company of WA,D.C. 21784 SouthernNew England Windows, LLC. dbaRenewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 dba 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 ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER ' POLICY EFF POLICY EXP LTR MSD wan POLICY NUMBER (MWDDNYVYI INM/DDIYYWI LIMITS A X COMMERCIAL GENERAL LIABILITY CP/13158728 1/12018 1/1)2019 EACH OCCURRENCE 31.000000 dWMSMADE O OCCUR PREMISES(Ea occurrence) S 900.000 MED EXP(My ere pMsen) S 10.000 - PERSONAL a ADV IKNRY _ $1,000.000 _ GENL AGGREGATE LOM APPLIES PER GENERAL.AGGREGATE _ S2.000.030 _ POLICY❑ref 0 LOC - PRODUCTS•COMP/OP AGG S 2000,000 _ • OTHER: S A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/1/2019 CPOOMBINeesclED SINGLE UMIT 51000000 X ANY AUTO BODILY INJURY(Pr penes) S — ALL OWNED —SCHEDULED _ AUTOS — AUTOS BODILY INJURY(Per s • X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Pot ecdden0 S 3 A X UMBRELLA LIAB H OCCUR CPA3153728 1)112015 1/12019 EACH OCCURRENCE S 10.000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10000,000 DED X RETENTIONS° S a WORKERS AND ESC ,WBILED OMPENSATION wCp3158729-20 1/1/2019 1/12019 X S.UME X14 ANY PROPRIETORIPARiT1ERIE]D:LVnVE YIN OFFICER/MEAGER EXCLUDED? N 1 A EL EACH ACCIDENT 51,000,000 (MVtdaRn'b NH) EL DISEASE•EA EMPLOYEE 31000,000 It yet deserts under O DESCRIPTION OF OPERATIONS below - w POLICY LIMIT $1000,000 C Pollulion Lice Bty 7930073310000 1/1)2018 1/12Each Manna01Manna51.000.000, Oaims-MReepeae Date 08202013 Decket le 51Policy Aggregat000'0 000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 191.AdMBenal Remarks Schedule.soy be fleas/M mere spa S seers) • 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(2014101) The ACORD name and logo are registered marks of ACORD