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Home My WebLink AboutBLD-19-003085 .Officct''sa Only .01-772:1• tel, ! 0 Permit* , S/.u4== O O -- i 0 .,,�'y€, y Amount -i c. @ w....;,.tri Permit expires 180 days from issue date Bu -fq--tea&s EXPRESS BUILDING PERMIT APPLICATION TOWN OP YARMOUTH • Yarmouth Building Department RECEIVED . 1146 Route 28 . South Yarmouth,MA 02664 NOV 14 2018 (508)398-2231 Ext. 1261 8ttIL �` CONSTRUCTION ADDRESS: 020 y r;c.5e_`7r. ar: � � Jima ASSESSOR'S INFORMATION: 1 Map: Parcel: . P;sn4t- e1 OWNER: . . d . ' ' oto rOa :r. a T/� 'ar't lL h .z. C. 7 -4? ; 7y' N. /54041149k0(. TEL # EmailAddres cONTRACTORL5Au-I4rn W.A. tdrnotcvws „5",n,-447.4/c/ RI-0fi7 . Cil) ZZs-9too __� AME MAuavoADz s TEL.# Email Add Residential Commercial Est Costal Constmcdon$ 0 7200 - Home 200Home Improvement Contractor Lie.# 17 a 2.45 Construction Supervisor Lie.# 075707 Workman's Compensation Insurance: (rherlr one) . I am the homeowner I am the sole proprietor have Worker's Compensation Insurance A Insurance Company Name: $RrJt'IEA�S 1 uS. l n'�P1M1 Worker's.Comp.Policy* to M 43857-12 9—2 0 WORK TO BE PERFORMED Tent _ Duration` (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# 9 Replacement doors: It Roo • #of Squares ( )Remove existing*(max.2 layers) Insulation►DId Sings Highway/Historic Dist. ( ),Replacing like for like ' *The debris w10 be disposed of at Wide /Lei `9,e er Sia-CA-67m. Jrcetlun of Factittry i I declare under peualtlds.ofperjury that the et pants herein contained axe true and conedm the best of my knowledge and belief. 'linden-end that any false answers) vdabejastonusefadealar tlonofm1i]ihenuand for pmaWvdonunder MO.L(x.268.SeNanL Applicant's Signature: �'�'�--- ` \ • Dam: //-P//S- Owners Signature(, , ., I .:• s_ OntnagAer palet , Date ,tuApproved DY ilding. - (or designee) ng District• Historical District YesZoniNo • Flood Plain Zoite Yes No • Water Resource Protection District Within 100 ft.of Wetlands: Yes No Yes No • r • ,,JN Renewal Agreement Document and Payment Terms bIdersen' dbu Renewal By Andersen of Southern New England John&Dianne AdellzzI(Phase2) /1- ari Legal Name:Southern New England Windows,LLC 20 Bayridge Drive WINDOW\uou.. RI#36079,r MASmithfield,# 4 , 740634555, Lead Firm#1237 Yarmouth Port,MA 02675 RIH:(774)994-2879 Phone:866-563-22351 Fax:401-633-6602 I saleserenewalsne.com C:(508)362-6957 Buyer(s)Name: John &Dianne Adelizzi (Phase2) Contract Date: 11/01/18 Buyer(s)Street Address: 20 Bayridge Drive,Yarmouth Port, MA 02675 Primary Telephone Number: (774)994-2879 Secondary Telephone Number: (508)362-6957 Primary Email: adelizzi0716@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: $9,200 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: SO Balance Due: $9,200 Estimated Start: Estimated Completion: Amount Financed: $9,200 5/20/19 5/23/19 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: Financed via greensky;(Plan 2541); ;Please Install after May 20 2019; 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 11/05/2018 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,LIE alba:Renews denen of So rn New England Buyers) /1 l/2-n, A k-Y3c- • Signature of Sales Person Signature EY// Signature Josh Ocharsky John Adelizzi (Phase2) Dianne Adelizzi (Phase2) Print Name of Sales Person Print Name Print Name UPDATED: 11/01/18 Page 2 / 11 ,97ie S,n ozoneoaade ItAaciciaciebieleii- , 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. SCA 1 0 20M-05/17 b� �JJ 6 B arLVnin"41e,sze e ( a...ac4z•JAdt 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. Expiration Office of Consumer Affairs and Business Regulation 173245-:. . 09118/2020 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON R nate__ a� 10 RESERVOIR ROAD U SMITHFIELD,RI 02917 Undersecretary N op Without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-095707r < E- pires 09/08/2020 fr. BRIAN D DENNISON "jt r a' `'i a 8 BLACKWELL`DRIVE , ' ' x • CHARLTON MA;01507 /, ;s . 1 ,6 c#04 laic Commissioner The Commonwealth of Massachusetts —= a Department of Industrial Accidents 1Congress 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 de.„4A/ Please Print Legibly Name(Business/Organization/Individual): 5,r{�ern de„4A/t&13 land �rl dolva Address: /0 ReSer✓nr'r' Rd J City/State/Zip: .S*1411 (/ /J 2.Z 0.z 1 7 Phone#: "10 1-2-2 s>-9100 Are you an employer?Check the appropriate box: Type of project(required): 1.EI am a employer with oZ O' employees(HI and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or parmership and have no employees working for me in $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 10 0 Building addition 4.0 lam 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 These sub-cantracm¢have employees and have workers'camp.insurance. 13.0 Roof repairs 10142 6.0We are a corporation and its officers have exercised their right of exemption per MGI.C. 14. Other ey/et ce-n rr aK-r,!-t�5 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 fob site information. r r+ Insurance Company Name: erC/''tell 5 lnc. t Dm pang Policy#or Self-ins.Lie.#: WGA 31 CR 72-4 Expiration Date:/ / Job Site Address: -z 0 y raid(e 1)r. City/State/Zip:`,Euro vi t0,fl fl4 Attach a copy of the workers'colnpensa'fion 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 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 pai, and penalties of perjury that the information provided above is true and correct • ‘. ,/ Si' aturmow _ nate. '7—/• � Phone#: • 401 —LZFs"—�l'S'DD Official use only. Do not write in this area,to be completed hy dry or town officfaL 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(MMDD"YYY) 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 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 CDB[Insurance, Inc.-CO NAME: 1401 Lawrence St., Ste. 1200 (AC E ELM-303-988-0446 FAX Noe 303-988-0804 Denver CO 80202 ADDRESS• CO Mallecobizinsurance.com POURERS)AFFORDING COVERAGE NAIL e INSURER A:Acadia Insurance Company 31325 POURED ESLERCO.01 INSURER a:Tremens 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DOR um. TYPE OF INSURANCE ADOL S ' POLICY EFF POLICY EXP LTR PVD WW POLICY NUMBER (MMIDPAYY11 IMMIDDIWYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CPA315872e 1/1!2018 112019 EACH OCCURRENCE 51,000000 _ CLAIMS-MADE E OCCUR PREMISESA (TOu RENTED cel $300,000 — MED EXP(My one person) $10.000 _ PERSONAL B ADV INJURY _ 51,000,000 GEM.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52.000.000 POLICY❑JJEDr ❑LOC - PRODUCTS-COMP/OP AGG $2E00.000 OTHER S A AUTOMOBILE LIABILITY N CPA3158728 112018 1112019 COMBINED SINGLE LIMIT (Ea adenll 5 m 1 000 000 X ANY AUTO BODILY INJURY(Per person) S — ALL OWNED —SCHEDULED AUTOS — AUTOS BODILY INJURY(Per•cadan0 5. X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Pr accident) 5 _ $ A X UMBRELLA LW! -X occuR CPA3158728 112018 11/2019 EACH OCCURRENCE 510.000.000 EXCESS WB CLAIMS-MADE AGGREGATE _ 510000,000 DED I X RETENTiONS0 $ 9 WORKERS COMPENSATION 1ACA3158729-20 112015 11(2019 AND EMPLOYERSIA LIABILITY YIN x SEAME I ERIC ANY PROPRIETORPARTNEW � DCUTIVE OFFICERAEMBER OCCLUDED? MIA EL EACH ACCIDENT $1.000,000 Mandatary M NH) EL DISEASE•EA EMPLOYEE $1000,000 OESCRI OF OPERATIONS below EL DISEASE-POLICY LIMIT $1000000 C � Dably 7930079390000 112018 112019 Each Occurrence 11.000,000 ade Party Aggregate $1.000.000 Reboarnle Dat. 202013 Deducbbl 510000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltonal Remarks Schedule,may be attached R more apace Is required) • CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE el 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD