Loading...
HomeMy WebLinkAboutBld-20-000891 I.Office Ilse Only • ZC) ` \ Permit# /-� �s; E S amount 5v— • 1 l j ri ti` i !'�. 1SArrAeN t c(� Permit expires 180 days from • ,�,a_�� f� --.2(�--�5-1 issue date EXPRESS BUILDING PERMIT APPL , I el t V E D TOWN OF YARMOUTTH Yarmouth Building Department 1 2D�9 • 1146 Route 28 . By A South Yarmouth,MA 02664 B 11 I (508)398.2231 Ext. 1261 CONSTRUCTION ADDRESS: 7 5t')ord 4i,cc-. r• . ASSESSOR'S INFORMATION: IMap: _.. j Parcel: OWNER:` iCt Sbe4 2(41a. 7 Swat-cgs 1, 'Dr SAr. kiAA-`� M A .0-2464 cog- 2L 7 S 3 C NAME TEL # Emait Addres CONTRACTOR: A*1f' rA iJ A. tAat"tPs SMOG-e ss r 7 001) TEj # Email Add NAME Residential Commercial Est.Cost of Construction ) Home Improvement Contractor Lie.# 17.3 2fri Construction Supervisor Lir.# 0`76-7a 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: r Worker's Comp.Policy# CA aI6r 72 0,24 WORN TO BE jERFORMED Tent Duration (Fire Retardant Certificate attached?) 'Wood Stove Siding: #of Squares Replacement windows:# Replacement dodrs: # 2-, roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( ),Replacing like for like The debris will be disposed of ate 3�e de6astioa of Faeili r I declare under penalties of perjury that the•,, ao ants herein contained are d and er MG tC o the best of on imowiedge and belief. Iunderstand that any false answers will be just causefor denial oo` of .s,se and for prosecution un iii Date: — /1/—! Applicant's Signature: .— Owners Signature(or attachment) Ge ate: APPro` Y �.�G•- ed B . Building Official(or designee) • • Zoning District: Historical District 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 b'Andersen. dba:Renewal By Andersen of Southern New England Robert Palma 04 Legal Name:Southern New England Windows,LLC 7 Swordfish Dr 4 South Yarmouth,MA 02664 4#4P . RI#36079,MA#173245,CT#0634555, Lead Firm#1237 H:(508)922-7536 WINDOW REPLACEMENT 10 Reservoir Rd I Smithfield,RI 02917 C:(617)309-94H4 Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsne.com Buyer(s)Name: Robert Palma Contract Date: 08/02/19 Buyer(s)Street Address: 7 Swordfish Dr, South Yarmouth, MA 02664 Primary Telephone Number: (508)922-7536 Secondary Telephone Number: (617)309-9484 Primary Email: bpalma22@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: $9,335 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: $3,111 Balance Due: $6,224 Estimated Start: Estimated Completion: 8 to 10 weeks 8 to 10 weeks Amount Financed: $0 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: Taxes paid in Yarmouth, Ma 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 08/06/2019 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:Renew B Andersen-o out hern New England Buyer(s) I 64112c/ Signature of Sales Person Signature Signature Gino Montesi Robert Palma Print Name of Sales Person Print Name Print Name Page 2J11 UPDATED: 08/02/19 � JC�f7'I�f �f7iCoe° l�/� 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 sca i a 20nn-05i17 Update Address and Return Card. 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 1Z3245' 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN I 10 RESERVOERVOIRR ROAD SMITHFIELD,RI 02917 Undersecretary tot �4 without signature f f Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr ' n Supprvisor CS-095707E p i res: 09/08/2020 BRIAN D DENNISON { LAKWELL� Rl { CHARLTON A =O 0 7 7 Commissioner The Commonwealth ofMassachusetts . � ,`- Department of Industrial Accidents ' :,� 1 Congress Stree4 Suite 100 ...'. .. Boston,MA 02114-2017 ' .'—, ;r' www nrass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apollo nt Information Please Print Lexibly Name(Business/Organization/Individualy S occth e r A, 'Veto tnl CGtfj/l /II /, IiS Address: 10 Se r UDt r 'gel - City/state/zip:S r!t�-4 de,RI DZQ /7 Phone#: 40/-2.-2-,Fr— Are you an employer?Check the appropriate box: ••�� Type of project(required): 1. 1 am a employer with �/'remployees(full andtor part-time).* 7. New construction 2 am a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.[No workers'comp.insurance required.] ❑ 3. I ant a homeowner doingall work m self 9. 0 Demolition ❑ y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on mY P�nY• [will 10 CI Building addition 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 Q I 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.insurance.* 13.Q Roof repairs r 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[Other -Fi t7 d o Q 152,§1(4),and we have no employees.[No workers'camp.insurance inquired.] r? /'1 q c n e n"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 my employees Below is the policy acid fob site information. `,r/) Insurance Company Name: -fl reime� Inve' 1 a rtee_ - a - ©!'- W/1, b.Ci . Policy#or Self-ins.Lic.#: Litt /c&7 ?p?7 • Expiration Date: 1' /—2D Zo Job Site Address: two rcl - i si-, )I• City/State/Zip: S. ,n..,,n,-44.-N M A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 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 S250.00 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 ce ' under the p penalties of peduty that the information provided above is true and correct Signature: -J Date: k— /4—/�t Phone#: 101 `-2Zg*-- 9 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): i.Board of Health 2.Building Department 3.Cityli'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC CERTIFICATE OF LIABILITY INSURANCE DATE'MANDD"YYY' L...► 12/28/2018 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 PHONE FAX 1401 Lawrence St.,Ste. 1200 (A/C.No.Ext):303-988-0446 (A/c,No):303-988-0804 Denver CO 80202 ADDRESS: COMaiI@cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company _ 31325 INSURED ESLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. INSURER c:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New England 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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. NSR TYPE OF INSURANCE INSD ADDL SWVD POLICY NUMBER (UBR MMIDO�) (MM�IYYYYPY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY JJEE a LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/112020 COMBINED SINGLE LIMIT $ (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED RETENTION$0 $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X PERTUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE � E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? I J N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY UMIT $1,000,000 C Pollution liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 IESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) :ERTIFICATE 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 ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD