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Home My WebLink AboutBLD-19-003479 Offico Use Only '• 'utg Pamlt# G1/ u= ,P• ti A�ont L i R ,;�� 7v knw,�,t.-rca Permibsus aete i expires 180 days from BU6- 1-CO3y-7 9 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH ! RECEIVE D Yarmouth Building Department [ DECO 6 1146 Route28 uth,MA 02664 ___2018 J (508)398-2231 Ext. 1261 Eilhe HY las-. , CONSTRUCTION ADDRESS: �/S T l ( �t tie s --4--.)1% r —=— ASSESSOR'S INFORMATION: Map: Parcel: • --S.:1-e' 3 OWNER: els•fMey VC 12i Rnes 17r 4--.0-4. eg�t,1 M4 °se/s SW 77(0—s730 NAME • /0 K % ct n. # EmailAddres CONTRACTOR* _ - t A .. ' ra• •tPs rr,.c-/ r r .0, ') nS 4817d AMB MAILING ADD• "S TEL.# Email Add Residendal Commercial Est.Cost of Conslnucdon S 6,51-6, Home Improvement Contractor Limit /7 aL43- 03119truucdonSnpet7isor Ian.* 076-7D 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor A have Worker's Compensation Insurance Insurance Company Name: PIRf/i'14A,t5 IlvS. l/�rD7h` ,�'P, Worker's Comp.Policy* til CA•x/68'72 ?-2 0 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: 0 of Squares Replacement windows:0 Replacement dodrs: # 1 Roo ,g: 0 of Squares ( )Remove existing*(max.2layers) Insulation ltiDI�OldSings HighwayllistoricDist ( )Repladnglike for Bite d:pb shit seterie cLA--0'* flhedthtin4flbctusposed of at WA!'(e 4z.t£ mt.,eriun of aeflity 3 4 (19.. Idpeosldesofpejmy that the herein contained are true and correct to the the best of my knowledge and belle!. lunderstand that any false answer(s) will be just cause for deaal oLwyocaeon of and for prosepadon under Mat.Cl'.268.Section 1. Applicant's Signature tele " ' ' Out /2 - S- — / V Owners Signature(or attachment) :11S- _ • -i ' �? Approved By -ezJI Date /2- -"Z 'MVV Bug. • ord6sigaee) Alf Zoning District Historical District Yes No Rood Plain Zone: Yes No WaterResonrceProtection District Within 100 ft.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms ',Andersen. dbat Renewal By Andersen of Southern New England James Gaffney ra e4—I Legal Name:Southern New England Windows,LLC 45 Tall Pines Dr 1111. 40. - RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Yarmouth Port,MA 02675 neat is LAeawaer 10 Reservoir Rd I Smithfield,RI 02917 It(508)776-5730 Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsne.com Buyer(s)Name: James Gaffney Contract Date: 11/24/18 • Buyer(s)Street Address: 45 Tall Pines Dr,Yarmouth Port, MA 02675 Primary Telephone Number: (508)776-5730 SecondaryTelephone Number: Primary Email: jimgaf450gmail.com 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: $6,586 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: S0 Balance Due: $6,586 Estimated Start: Estimated Completion: Amount Financed: $6,586 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: Permit is in Yarmouth.; 25 % discount islocked in for any future purchases. 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 ANYTIME NOT LATER THAN MIDNIGHT OF 11/28/2018 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 Namet Southern New England Windows,LLC dba: I By Andersen of Southern New England Buyer(s) /VL Signature of Sales Person Signature Signature jim passanisi James Gaffney Print Name of Sales Person Print Name Print Name UPDATED: 11/24/18 Page 2 /9 c9Z %,nmonea l,Aa a zo&ielf4 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. KA 1 O 20M-05/xr117�7 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: Reaistration expiration Office of Consumer Affairs and Business Regulation 173245___ 09/18/2020 1000 Washington Street-Suits 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 6e-cc-at- 10 RESERVOIR ROAD U- ""�P SMITHFIELD,RI 02917 Undersecretary N 41 Without signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations ulations and Standards ConstriU_ction'Supervisor CS-095707 ' „ Easpires: 09/08/2020 '".144 01.40-#444ThSitn, BRIAN D DENNISON C Y ' t 8 BLACKWELL-DRIVE , i4 i CHARLTON MA,01507 = ; :: 4 4 f =. �J� r< f•"�1y3 3Y' 171 Commissioner L The Commonwealth of Massachusetts —''= Department of Industrial Accidents • 1 Congress Street,Suite 100 l Boston,MA 02114-2017 a .' 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): ...& er/i deif/ljfav-, c—t/ doi/S Address: /0 Reservoir Rd - City/State/Zip: so,A.ce.tJ 'RE 0,2.M 17 Phone 0: yp I—y2 8-91'OO Are you an employer?Cheek the appropriate box: Type of project(required): I. I am a employer with a C!'r'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 g. 0 Remodeling any capacity.(No workers camp.insurance required.) 9. 0 Demolition 3.01 am a homeowner doing all work myself.(No workers'comp.insurance required.)' 10❑Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I"ill 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 13 f repairs These subcontractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 1<Jo d a a 152,tt 1(4),and we have no employees.[No workers'comp.insurance required.] 1J rel eaten e t" •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 sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comppolicy 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 CA 5 leis. Com 07 n y Policy It or Self-ins.Lie.#: li/CA S//��fl 7Z 4 Expiration Date: /-- / /e3 Job Site Address: V C TI/ F ei e c .------ •-'. City/State/Zip: 10r.^'ar P.z f/1-[A Attach a copy of the workers'compensation policy declaration page(showing the policy nt5mber and expirdtion 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 pal• and penalties of perjury that the information provided above is true and correct. r Signatures.* _. _ — Date. L — —' /? Phone*: yol •-LZFf- 1!170 • 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 C�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD""'"' A 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: 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 COBiz Insurance,Inc.-CO PHMN: 1401 Lawrence St,Ste. 1200 uK No.syn.303-988-0448 FAX NPC 303-988-0804 Denver CO 80202 E-MAIL ADDRESS- COMail@coblzinsurance.com INSURER(S)AFFORDING COVERAGE NAIL S 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 D:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER 0: Smithfield RI 02917 INSURER!: 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 COND(ON 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER (MM)pDIYICY VYIT IMFF MNOIYYYVI LIMITS A X COMMERCIAL GENERAL LIABILITY CPA31513728 1/1)2018 1/12019 EACH OCCURRENCE S 1,00M 000 CINMS-MADE OCCUR ••v, • -1 --Yr PREMISES(Ea ocounencel S 300,000 MED EXP(My one person) _ S 10,000 _ PERSONAL&ADV INJURY $1,000,000 GEN-AGGREGATE LMR APPLIES PER: GENERAL AGGREGATE _ $2,0011,000 — POLICY O J T ❑LOC - PRODUCTS-COMP/OP AGG $2.000,000 °THEW . S A AUTOMOBILE LIABILITY N CPA3158728 1112018 1)12019 (CaM�BI FNINGLE LIMIT 5 1000 000 X— ANY AUTO BODILY INJURY per person) S ALL OWNED SCHEDULED , AUTOS _ AUTOS BODILY INJURY(Per EWderd) S X AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per a<ddentl S X HIRED AUTOS _ S A X UMBRELLA LIAB X OCCUR CPA3158728 1/12018 1112019 EACH OCCURRENCE 110.000.000 EXCESS'JAB CLAIMS-MADE AGGREGATE 510.000.000 DED I X I RETENTIONS o S B WORKERS COMPENSATION WCA315e729-20 1112018 11120190TH. AND EMPLOYERS'LIABILITY YIN X SiTAER TUTE ER ANY PROPRIETOR/PARTNER/EXECUINEEL EACH ACCIDENT OFFICERMEMBER EXCLUDED? El N/A 51,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE St.000.000 V yes describe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY MIT $1,000,000 C �oU y 7930073340000 1/12018 1112019 Each Ommenee 11.00,000 Retroactive Date 0820/2013 cy Aggregate 11.000.000 .00 -DESCRIPTOR OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addldana Remarks Schedule,may be ruched If mare space Is required) • • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED P4 ACCORDANCE WITH THE POUCY PROVISIONS. For informational Purposes AUTHORIZED REPRESENTATIVE ®1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD