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Home My WebLink AboutBLD-19-3385 � � .Offle°UmOnly • 41/4 $; i7•• - - Pemiat vak Amount Ore�,\° • w"® .•%�r'� Permit expires 180 days from issue date ,3CA—ICI-DD 33 5,S' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department jRECEIVED 1146 Route 28 1 r South Yarmouth,MA 02664 ' i i ( NOV 28 2018 (508)398-2231 Ext. 1261 -� F11 CO/FP, f CONSTRUCTION ADDRESS: / 7Z Rtin e L✓Gt y 1-!'Y CA._- , ASSESSOR'S INFORMATION: Map: Parcel: ' OWNER: ZaiS /Owe / 7 Uc41nPhA/ Stu v-Pcet A /2244I/ NAME • io c TEL # EmaktAddres CONTRACTOR' _ . . i . Jl) ' to•otos nl.Fh-C /c/ r r ire/ %) 22 t 9S6 A� MAILING AD'• S TE-# Email Add Commercial . Cost of Consuucdon$ 2(i it. , --- 4 < Home Improvement Contractor lie.# /73 2.g/s Constructlonsupervisor uc.# 076707 Workman's Compensation Insurance: (check one) . I am the homeowner I am the sole proprietor ` ,A have Worker's Compensation Insurance�, t Insurance Company Name: RE/fit/US /RS. ` a'�A)i y Worker's Comp.Policy# it)CA a/er72 ?-2o WORK TO BE PERFORMED Tent _ Duration (The Retardant Certificate attached?) Wood Stove Siding: 4 of Squares • Replacement windows:# Replacement doors: # N Roofing: #.1::I Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Blghway/HistoricDist. ( ).Replacing US for like '/ *The debris will WL be disposed of at J/E �sn' t rivaor k SaA-Ce.lcl9r Ideclare under penalties ofperjury tbatthe.i emsherein contained attune and corrw the best of my bowledge and belief. lunderstand that any false answer(s) will bejust causefeedenial ormpocadoaof . so and for prose;udonunder MO.LQ 268.Section l. Applicant's Signature VI{f�1'`--' late /1-• 2 /- / V Ownerstore(or attachment) L'‘ iop ii.'i(.&2 —' —, Date. A Br > l/�Q Building*, -71.9 -• pee) Zoning District Historical Dlstdct 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 brAndersen. dba:Renewal By Andersen of Southern New England Lois Lowe %. .....917-1 Legal Name:Southern New England Windows,LLC 1 Touraine Way ,��f� '. RI#36079,MA#173245,CT#0634555, Lead Firm#1237 South Yarmouth,MA 02664 WINDOW PE 10 Reservoir Rd I Smithfield,RI 02917 H:(508)760-3828 Phone:866-563-2235 I Fax:401-633-6602 I saleserenewalsne.com Buyer(s)Name: Lois Lowe Contract Date: 11/07/18 Buyer(s)Street Address: 1 Touraine Way, South Yarmouth, MA 02664 Primary Telephone Number: (508)760-3828 Secondary Telephone Number: Primary Email: loislo@tomcast.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 panics 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: S21,116 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: $7,037 Balance Due: 514,079 Estimated Start: Estimated Completion: Amount Financed: SO 6-10 weeks 6-10 weeks Method of Payment: Cash/Check 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: 7037.00 deposit-CHECK; 7039.00 due at start; ;7040.00 due at completion-CHK 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 11/10/2018 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 Noma Southern New England Windows,LLC dba:RenI By Andersen offSSouthern New England Buyer(s) Signature of Sales Person Signature Signature Chris Hutson Lois Lowe Print Name of Sales Person Print Name Print Name UPDATED: 1 1/0 7/1 8 Page 2 / 17 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,US Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Update Address and Return Card. SCA 1 0 20MMy'OsIl7 LG/ yy,,�� ,{6 ..7 e 2 ovnMawads v r�i2iiaa a& Office of Consumer Affairs E 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 end Business Regulation 173245- 09/18/2020 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON \R.!-C12'er—� 10 RESERVOIR ROAD U SMITHFIELD,RI 02917Undersecretary Nt •a' without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction`Supervisor CS-095707 EXpires 09/08/2020 4 ss BRIAN D DENr NISON " " j ' 8 BLACKWELL DRIVE , . b '� • If CHARLTON MA;01507 iUT cc:CI-SC 1y ,I ar. Sae Commissioner L The Commonwealth of Massachusetts Mi= I Department oflndustrialAccidents • - 1e 1 Congress Street,Suite 100 l� 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 / n Please Print Legibly Name(Business/OrganvatimJlndividual): $,,tern ,/eft/7-45land /c�r/olt/r1 Address: /n Reservoir Rd - 7-45 City/State/Zip: ._Yr,I•rt'l4l re.lJ ?/- ozM 17 Phone#: L/O I-Z2 8'-9,'DO Are you an employer?Check the appropriate box: Type of project(required): LIEr am a employer with e2 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. ❑Remodeling any capacity.[No workers'comp.insurance required3 9. Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]` 10 Building addition 4.0 1 am a homeowner and will be hiring comraclms to conduct all work on my property. I will Q ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 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. 13.ERoof repairs These sub-ccantracto6 have employees and have workers'comp.insurance.: / r 6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14.QOther k Y OU 152,§1(4).and we have no employees.[No workers'comp.insurance required.] reeks rein e'-'171-5 *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 job site Information. Insurance Company Name: ere cma l 3I/1S. " "p.nc/ Policy le or Self-ins.Lic.#: Gtir(_ R A 3/ ¶' 72..'? / Expiration Date: /— /—/e3 Job Site Address: / Torai n e GJa y City/State/Zip: S.yai,+.o.. .4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and efpiration 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. I do hereby certi under the pat and penalties of perjury that the information provided above is true and correct. r Sienatur • Phone#: • 401 —LZFr—r1gen D 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#: A O CERTIFICATE OF LIABILITY INSURANCE DATE(MMADNYYY) 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(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 Deli of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME:PHONE 1401 Lawrence St., Ste. 1200 IA/C.No.Etch 303-988-0446 .Not 303-988-0804 Denver CO 80202 EMAIL ADDRESS. COMalkecobizInsurance.com INSURERS)AFFORDING COVERAGE NAIC a INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER a: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 D: 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. NOTWATHSTANDING 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MLTR TYPE OF INSURANCE J)N5D MIT POLICY NUMBER POLICY YV POLICY YYV IMOLIC/YEFF I POLICY XP LIMOS A X COMMERCIAL GENERAL Leasure CPA315e728 1/112018 1/12019 EACH OCCURRENCE $1,000,000 f:WMSNADE D OCCUR DAMAGE f0 REMtD PREMISES(Es ommeneel S 300,000 MED EXP(Arty one permed S 10,000 - ` PERSONAL a ADV INJURY _ $1, 00,000 _ GENT.AGGREGATE LMITAPPLIES PER GENERAL AGGREGATE $2,000,00 _ POLICY D jE� C LOC - PRODUCTS••COMP/OP AGO E 2,000,00 STI OTHER: S A AUTOMOBILE LIABILITY N CPA3158728 1/12018 1/12019 COMBINED SINGLE LIMIT IES modMn 510000 X ANY AUTO BODILY IUIIRY(Per Person) S — ALL OWNED —SCHEDULED —, AUTOS _ AUTOS BODILY NAXiY(Per eLodanq s X HIRED AUTOS X NON-0WNED PROPERTY DAMAGE AUTOS (Per ecddent) $ S A X UMBRELLALIAB X OCCUR CPA3158728 1/12018 1112019 EACH OCCURRENCE $10,00,00 _ EXCESS LIA! CLAIMS-MADE AGGREGATE $10,00,00 DED_X RETENTIONS 0 $ a WORKERS COMPENSATION A315arN30 1/12 01 018 1/129 x AND EMPLOYERS LIABILITY YIN ISTATUTE ERµ V1r, ANY PtOPRIETORIPARTNEREXECUnVE EL EACH ACCIDENT S1,00,00 OFFICER/REAMER EXCLUDED? NIA pass 5IPry N NH) EL DISEASE•EA EMPLOYEE $1,00,00 I've. SCRdeentaIPTION OF F OO DEOPERATIONS below EL DISEASE-POLICY LIMIT $1,00,00 C ClalPolkdon ms-MLIMPIgy�y 7930073340000 1/12018 1/1/2019 Each 0 Ocunnence 51.0 ,00 000.000 Retroactive Date 08/102013 Aggregate dibe Si,0Retroactive DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Add/Bons Retorts Schedule,may be smelted If mon mace le repulred) • 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 • ®1985-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD