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Home My WebLink AboutBLD-19-3478 Office Ua Only -Amnuot. . '3 .%} Permit atphes 180 days from lame dam _ t3(.btici hD 34 : i: 4�� EXPRESS BUILDING PERMIT APPLICATION TOWN OP YARMOUTH Yarmouth Building Department RECEIVE () 1146 Route 28 South Yarmouth,MA 02664 DEC 0 6 2018 (508)398-2231 Ext. 1261 CONSTRICTION ADDRESS: 4 ( 7cce ei lea ( Jay S/_ A!S-(W� ASSESSOR'S INFORMATION: • / Map: Parcel' . OWNER:_✓ i S r er /l Qo.enTR(J' Grrou'orer rt1Q 024/5 9 -- F62-c305- NAME p�ESEN�/ trnait Addres NAME /O fCeSE/'✓OD / a # CONTRACTOR:Cs 1J COMoip(os 5n,m-F;e%/ Rs e Ar7 . CYO Z2 S-9too NAME MAILING ADDitF.SS Tom.* Email Add Residential Commercial Est Cost of Construction$ 1 SI C,,00 Home Improvement Contractor Lie.if n a 2.45— Construction Supervisor uc.* o467t 7 Workman's Compensation Insurances (check one) . I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: SR Uv1tA)5 WS {/t taltet .k,f aWorWs Comp.PolicyPolicy* U)I24s,5fl27-20 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding. 0 of Squares Replacement windows:# 5 Replacement dodrs: # Roofing: Vii#of Squares ( )Remove pldsting*(max.2 layers) Insulation H i 1 al�0/bId Sings Mghway/EistoricDist. ( ) eptacing lik for bite *The debris win be tuapos of at 4h3h P'I''t. i.e ofFadmy S;4A-Ce. e(�( (71 Ideclare under penult/ofperjurythat the euc ems betelscontainedfararetrueandconeexmthebestofmyknowledge and belief. 'understand that say false answers) will be just tausefor dedal orwyc ation of mf Eapase and for prosecutionunder M. Cb.26g.Section 1. Applicant's Sigmmrm �114f"J1''`' Il ., Thum /2 --5 — I k af Owners Signatory(or at.: i.,-, `' / Ay si,. i- ;r Date: Approved 4/ i Darr: /2 [� 78 •, g Official(or designee Zoning District HismdcalDistrict Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 S.of Wetlands. Yes No Yes No Renewal Agreement Document and Payment Terms rAndelnen' dbar Renewal By Andersen of Southern New England Ted&Ruth Welssberger ti LI ��.. Legal Name:Southern New England Windows,LLC 16 Green Teal Way • ' RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Yarmouthport,MA 02675 wino" aiuoswsar 10 Reservoir Rd I Smithfield,RI 02917 H:(508)362-5308 Phone:866-563-2235 I Fax:401-633-6602 I salesOrenewalsne.com _--- Buyer(s) Name: Ted & Ruth Weissberger Contract Date: 11/20/18 Buyer(s)Street Address: 16 Green Teal Way, Yarmouthport, MA 02675 Primary Telephone Number: (508)362-5308 SecondaryTelephone Number: Primary Email: eweissbergerl@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: $15,600 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: $5,200 Balance Due: $10,400 Estimated Start: Estimated Completion: Amount Financed: $0 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: 5200.00 deposit-CHK; 5200.00 due 0 start; 5200.00 duet, completion-CHECKS 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 11/24/2018 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 Names Southern New England Windows,LW dba:Ren el By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Chris Hutson Ted Weissberger Ruth Weissberger Print Name of Sales Person Print Name Print Name UPDATED: 1 1/2 0/1 8 Page 2 / 13 AC ilmogo6(7, 1C/t iejadeerjehl • 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: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 Update Address and Return Card. 3CA 1 0 20MM-05117 �Y ..rr J/Ht FevsvnnneewmtXe/.(42.-iadaJea. 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: Reaistation Fxoiration 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 \2_CGQ�a-- 10 RESERVOIR ROAD U SMITHFIELD,RI 02917 Undersecretary ------ -Til T:1'without signature 1 r in Commonwealth of Massachusetts Division of Professional Licensure r Board of Building Regulations ulations and Standards Constru.ton'Supervisor CS-095707 ' E- pires 09/08/2020 — a. l yy�, F Yt et •°- 4g x?[ BRIAN D DENNISON r 1,r--:.g." , ,a x 1 ` 2 8 BLACKWELE DRIVE , ?' . � t �, ;F• ,Ip CHARLTON MA/01507 -f t' 2r)i`+.L�Sj'� t` p..p nriv I MIV, hC Commissioner atie it--e „ The Commonwealth of Massachusetts Department of Industrial Accidents == t: a 1 Congress Street,Suite 100 ;); _. __Boston,MA 02114-2017 y ; www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. • Applicant Information Please Print Legibly Name(Business/Organization/Individual): £,4herei JP�,t/e0151a,-716.1/;;,n1014,41. Address: /n Reser'�✓oir • J City/State/Zip: ,mill-ie a 21 o.zM 1 7 Phone#l: 410 l—22 r1-9?OD Are you an employer?Check the appropriate box. Type of project(required): I.EI am a employer with sg 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. ❑Remodeling any capacity.[No workers'cramp.insurance required] - - 9. ❑Demolition 301 am a homeowner doing all work myself[No workers'comp.insurance required.]' 10 Building addition 4.❑1 am 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insluance.4 13.0 Roof repairs 6.Q We are a corporation and its officers have exercised their right of exemption per MGL e, 14. Other Ivr ri 152,f 1(4),and we have no employees.[No workers'comp.insurance required.] r.e pie cent 941—S *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 subcontractors and state whether or not those entities have employees. If the subcontractors 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 infonnation. Insurance Company Name: et C M C 'i L/1 S. (Din DM(la-r y Policy#or Self-ins.Lie.#: we_A S/ CR 7Lei Expiration Date: /— /—j9 Job Site Address: (e en 7e_G City/State/Zip: �rn.e✓}( dr/l NA �G C j� Attach a copy of the workers'compensation policy deccllt[ration page(showing the policynumber and expitation date). Failure to secure coveraue as required trader 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 cart! 'under the pat and penalties of perjury that the Information provided above is true and correct. .. r Sienatur� Date- Phone tr atc•Phone# 401 —LZ.k—gf'DO Official use only. Do not write in this area',to be completed by city or town officlaL 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#: r'� e ACORD CERTIFICATE OF LIABILITY INSURANCE DA'E"""°DNY'"' 12/2912017 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 lieu of such endorsement(s). --- - -_ --- -- ----_ - PRODUCER CONTACT COBiz Insurance,Inc.-CO NAME: 1401 Lawrence St., Ste. 1200 ''WC WC Path 303-988.0446 FAX Noy 303-988-0804 Denver CO 80202 1 ADORRLMS: COMaiI(tcobizinsurance.com PISURER(S)AFFORDING COVERAGE NAIC e INSURER A:Acadia Insurance Company 31325 INSURED 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 D: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1252851165 REVISION NUMBER: *NIS 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL SUeR ' LTR TYPE OF INSURANCE INSR wVD POLICY NUMBER (MN/DD/YVYFY) (MMND7EYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1112018 1/1/7019 EACHOCCURRENCE S1.00,000 I&&MS-MADE OCCUR REMISESl aaC1p1E TO 1 ) 3300.000 •— MED EXP(My one person) 510.000 _ — PERSONAL 8 ADV INJURY _ S1,000,000 _ GEN.AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE 52.000.00 — POLICY O JE8T 11:1LCC PRODUCTS•COMP/OP AGG 32,00,00 - I OTHER: $ A AUTOMOBILE LIABILITY N CPA3158728 1112018 1/12019 COMBINED SINGLE LIMIT (Ea ecadenD 31 OM 000 X— ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED — SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NONNED PROPERTY DAMAGE _ AUTOS (Per accident) 5 $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2018 1/1/2019 EACH OCCURRENCE _ $10,00,00 EXCESS IJAB CLAIMS-MADE AGGREGATE S 10,00000 DED X RETENTION 5a S B AND WORKERS YETIS'COMPENSATION - WCA315B]2B-2p 1H2O1B 1/1/2019 X AND EMPLOYERS'LIABILITY YIN STAME OTH- ER ANY PROPRIETORIPARTNEWDOECU1IVE EL EACH ACCIDENT $1000,000 OFFICER/MEMBER EXCLUDED? NIA' I A (Mandatory M M„) EL DISEASE•EA EMPLOYEE 51,00,00 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY LIMIT $1.00,00 C Petition Uab8Ity 7930073310000 1/12018 1/12019 Each Occurrence 11.000,000 Re oactive D tek082020 DeAed Ma 110,00051.000.000 0 Retroactive eeh O8B 13 DESCRIPTOR OF OPERATIONS/LOCATIONS/VEHICLES(ACOR)101.Additional Remarks Schedule.may be attached if mere epee 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