Loading...
HomeMy WebLinkAboutBLD-19-003728 .Office Use Only 1 Permit* e60Amount fir,EI �.o�� Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R E C E Q V' C) Yarmouth Building Department 1146 Route 28 L G EC 19 2018 South Yarmouth,MA 02664 • (508)398-2231 Ext. 1261 a u n . —. r CONSTRUCTION ADDRESS: 6 U Her,+ASP 7)r-we- alSO ASSESSOR'S INFORMATION: J. 5 `'1 Map: Parent • OWNER: /e+kiSKtt.{ Y60fkr;fajei)-. t,/sr14�`agr�novlt. to cu 6,11 SQrr—;n-144 L NAME /pPKE,$arfel�C TEL * Email'Addre CONTRACFOR•`SAuthern W.l; Gdrnolo os Sm,-•F:e%1 f2.04 7 . (p') 22r-91C0 NAME MAILING ADDItESS TEL* Email Ad Residential Cot Est.Cost of Consaacdoa$ ?-111 I S 6 Home Improvement Contractor1k.* 1732.4.5 Construction Supervisor tic.# 0r967D7 Workman's Compensation Insureneet (check one) . I am the homeowner I am the f Rsolepmprieetor ` A have Worker's Compensation Insurance Insurance Company Name: Ef'IEAn is Ws. ( 13iskf Worker'sCA Comp.Policy* Le '3/dr72 ?—2 0 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# 1 Replacement doors: # 2— Rooting: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Sings Hjghway/Historic Dist. ( )$eplachig like forlike • *The debris will be disposed of at it le /4n4 t Waitron of Facial* M e( f 9� Idc Sat penaMS of pcjury That the ents herein contained ate true and coneato the best of my knowledge and belief. lunderstand that any false answer( wUl be just cans tot Gordal of and for proseendonunderM U.Ch.268.Sectlon1. Applicant's Signa int a Dere: /2 —/9 —/F Owners Signature(or attachment) of e- `v"" ire' Det 7.#2 *-77t--- 91Approved By: 4 Mit B (or designee) • Zoning Distri Historical District: Yes Noce Flood Plain Zones Yes No Water Resource Protection District: Within 100 R of Wetlands Yes No Yes No Renewal Agreement Document and Payment Terms \1 Idersen. dbu Renewal By Andersen of Southern New England Nancy Vileniskis los �4# Legal Name:Southern New England Windows,LLC 60 Heritage Drive I % RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Yarmouth,MA 02673 �:e. .,Near as 10 Reservoir Rd I Smithfield,RI 02917 H:(508)358-7492 Phone:866.563-2235 I Fax:401-633-6602 I salesarenewalsne.com Buyer(s)Name: Nancy Vileniskis Contract Date: 12/08/18 Buyer(s)Street Address: 60 Heritage Drive, West Yarmouth, MA 02673 Primary Telephone Number: (508)358-7492 Secondary Telephone Number: Primary Email: seaducttwo@aol.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: $24,156 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: $12,078 Balance Due: $12,078 Estimated Start: Estimated Completion: Amount[inanced: $24,156 7-9 weeks 7-9 weeks Method o 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: 50% deposit by bank,balance on completion by bank 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 12/12/2018 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,LLC dba:Ren By erscn of So horn New England Buyer(s) frau t ThnutAkii. Signature of Sales Person Signature Signature Paul Sandrey Nancy Vileniskis Print Name of Sales Person Print Name Print Name UPDATED: 12/08/18 Page 2 /9 ;Se %onvne-ruuiea j c am-/eaz)-.iac%. -ie4i • 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: 93245 0 Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 45 20M-05/17 ..//r 'rtvnnreweervv4 rye...4,arroehe&e/' 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- 09/18/2020 - 1000 Washington Street•Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211: BRIAN DENNISON ?Pr—Cat- 10 �R_C 10 RESERVOIR ROAD C, SMITHFIELD,RI 02917 Undersecretary N . 'reit: without signature = Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor • CS-095707 Expires : 09/08/2020 BRIAN D DENNISON • ,' rt"bft «j v 8 BLACKWELL DRIVE , :.` i ' Ail CHARLTONy. Vq9 , F MAf01507 fi kci,LA "1 ' ; Commissioner CAL e The Commonwealth of Massachusetts fMOat)ri Department of Industrial Accidents a i .'1s - 1 Congress Street,Suite 100 la Boston, MA 02119-2017 y. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMUTING AUTHORITY. Applicant Information /&d f/! /] Please Print Legibly Name(Business/Organization/Individual): Sid-tier J ern G 1a/a I�17r�Ok/L( Address: Ito Reservoir R0 - J City/State/Zip: Soidi- ;e,J 2r oz'i 17 Phone#: 4/0 I—Z21—')POO Are you an employer?Check the appropriate box: Type of project(required): 1.i1 am a employer with eA O+•employees(full and/or part-time)." 7. ❑New construction 2.0 lam a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.(No workers'cramp.insurance required.) 3.9 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 10❑Building addition 4.❑I 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.❑Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ ]3.QRo f repairs These sub-contract=have employees and have workers'comp.insurance.; 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other bJr:,e(,sv A( Jo. r 15?,11(4).and we have no employees.[No workers'comp.insurance required.] reicIa ten a vt'f *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'comp.policy number. I am an employer that is providing workers'compensation insurance for trip employees. Below is the policy and job site information. Insurance Company Name: ere r'te.11 3 leis. Com eaeny/ Policy 0 or Self-ins.Lie.#: Gt/GA 3I 5"& 7Z''I• r Expiration Date: // — '/— / Job Site Address: i(� -4-e4-(4-4 r7r. City/State/Zip:L,,�?Sf firn,,,.1kr RA Attach a copy of the workers'compensation policy declaration page(showing the policy numbe 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. I do hereby certi y under the pal and penalties of perjury that the it formation provided above is true and correct Signator Date: /2— /Q— t7 • Phone#: 401 -2.Z.k-5-8.00 • 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#: `ORS® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOMYY) 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: It 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 NAME: 1401 Lawrence St.,Ste. 1200 ,Ale NoEste 303-988-0448 Denver CO 80202 E-MAIL FAX Not 303988 0804 AooREss: CO Mail@cobizinsurance.com UNSCREW)AFFORDING COVERAGE NAIL E INSURER A:Acadia Insurance Company 31325 INSURED ESLERCD-01 INSURER B: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 ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTTYPE OF INSURANCE AUOLISUBR ' POLICY EFF POLICY EXP INSD W'YO POLICY NUMBER IMMMONTYYl IMMIDDIWYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3156728 1,1/2018 1/12019 EACH OCCURRENCE 1 1.000.00D _ DAD CLAIMS-MADE [J OCCUR PREMISES EB occurrence)TO E 300.000 •— MED EXP(Any one mown) _ 510.000 _ PERSONAL 6 ADV INJURY_ $1,000,000 _ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000000 POLICY jTeiI^ LOC - PRODUCTS•COMP/OP AGG $2.000,1100 — OTHER: S A AUTOMOBILE LIABILITY N CPA315B728 1,12018 1/12019 COMBINED SINGLE LIMB X ANY AUTO IEe amdentl Derain) $1 000 000 _ BODILY INJURY(Per pen) S ALL OWNED SCHEDULED _ AUTOS AUTOS BODILYINJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ (Per accident) _ $ A X UMBRELLALIAB X OCCUR CPA315872E 1/12016 1/12019 EACH OCCURRENCE 110.00.000 EXCESS LIAB CLAIMS.MADE AGGREGATE 510.000.000 DED X RETENTIONS II 5 B WORKERS COMPENSATION V.CA3158729-20 1h201B 1n2019 AND EMPLOYERS LIABILITY YIN X StATUTE OTH- ER ANY PROPRIETORPARTNER'EXECLMVE E.L EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) EL DISEASE•EA EMPLOYEE 11000,000 II yes.describe under DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY LMR 51.000.000 C Polu8dn LladTty 7930073340000 1/12018 1/1/2019 Each Occurrence 11.000.000 Clams-Made Policy Aggregate 11,000.000 Retroactive Date 062012013 Deductible $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES (ACORD 101.Additional Remarks Schedule.may be stunned N men space 4 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