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HomeMy WebLinkAboutBld-20-000890 I.Office Ilse Only . Si. % Permit# �^� ,. . `i c1. Amount ' Qf Ca �''e Permit expires ISO days from • �� ;- �" j\ ��(��(��+�/ issue date EXPRESS BUILDING PERMIT AP L PIED TOWN OF YARMOUTH Yarmouth Building Department AUG 15 2019 1146 Route 28 South Yarmouth,MA 02664 Bu, , ..�.W..r7 N. (508)398-2231 Ext. 1261 By. J CONSTRUCTION ADDRESS: 2 Silo-re 'Ref ASSESSOR'S INFORMATION: { Map: . Parcel: i1r-f4tor ,.fit, r"1rA O.zCo7� J��'��5=�6�'j6 OWNER: .Tc y c.Jarrt�/l .z ,c1ore t2 O . ,r�[ y�r,�� , / TEL # EmailAddre NAME t•., `` . /OP.M.esPRA -Ad• 22 CONTRACTOR&U±(A lV g i )ifW1:404 4...C" h-Cr kJ,-N l'? /7 CPS) Ste"%147Q NAME MAILING ADDRESS TEL.# Email Ad Est.Cost of Construction$ l A, i a 6 Residential � Commercial 76-70 7 Home Improvement Contractor Lic.# 113 2.45- Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) worker's Compensation Insurance I am the homeowner I am the sole proprietor A 2.4 Insurance Company Name: 6 L S� IDS. C A Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove 2 Replacement doors: # Siding: #of Squares - Replacement windows:# Roofing: #of Squares ( ) Remove existing*(max.2 layers) Insulation Old Kings Highway! istoric Dist. ( )Replacing like for like *The debris will be disposed of an A C. flue of Multi ues of that the s ants herein contained are true and correct to the best of my knowledge and belief. Iundetstand that any false anew I declare just cause perjury e and for prosecution M.G.L.Cb.26S,Section 1. will be just causefor denial r ovation ofPro Date: —� — ( Applicant's Signature: �i r� 1 I., .te: Owners Signature(or attachment) to j'� ` $ �(�^/] — Date Approved By: Building Official(or designee) OP Zoning District: No Historical District Yes No Flood Plain Zone: Yes Water Resource Protection District: Within 100 it.of Wetlands: Yes No Yes Renewal Agreement Document and Payment Terms byAndersen. Judy&Arthur Warren dba:Renewal By Andersen of Southern New England 2 Shore Rd. ` Legal Name:Southern New England Windows,LLC West Yarmouth,MA 02673 00. � i ., RI#36079,MA#173245,CT#0634555, Lead Firm#1237 H:(508)775-3696 WINDOW RE'LAOEMENT 10 Reservoir Rd I Smithfield,RI 02917 C:(508)775-3429 Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsne.com Buyer(s)Name: Judy &Arthur Warren Contract Date: 07/30/19 Buyer(s)Street Address: 2 Shore Rd.,West Yarmouth, MA 02673 Primary Telephone Number: (508)775-3696 Secondary Telephone Number: (508)954-3429 Primary Email: judithannwarren@aoi.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: $19,656 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: $6,551 Balance Due: $13,105 Estimated Start: Estimated Completion: 6-8 weeks 6-8 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: 6551.00 deposit-CHECK; 13105.00 balance due upon completion-CHECK 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, attached eNoticess the terms of this of Cancellation,on the date firstreement, written above and 2)wa has received a s orally signed, informed of Bated uyer's right f this tttorcanceltthiscluding 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 OINESS DAY AFTER THE DATE OF THIS TRANSACTION, W 00O2 WHICHEVER OR DATE THE SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPWHICHEVER LANATTION OFgl THIS dRIGHT. Legal Name:Southern New Enand Winows,LLC dba:Renewal By Andersen of Southern New England Buyer(s)^ Li � ¢� nature Signature of Sales Person Signature Signature Chris Hutson Judy Warren Arthur Warren Print Name of Sales Person Print Name Print Name Page 2 / 14 UPDATED: 07/30/19 e __9- -/2.2y/2262-/-epee0d-A 6>4_,/gcblis)-C(70 .4c,4-6/./), 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: Regipiration: -093242 10 RESERVOIR ROAD Expiration: 9/18l2020 SMITHFIELD,RI 02917 - Update Address and Return Card. SCA 1 Cr 20M-05/17 ./r.'� Fev,m7ewit azei of //z:-i aielG. 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 1/3245__._.,:' 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 f s I BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD,RI 02917 a without signature Undersecretary { = Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consti ct on Supervisor CS-095707 5 , IAN D DENNISON = L C ELL D -W E Commissioner h. .\ The Commonwealth•of Massachusetts Department oflndustrialAccidents , 1 Congress Stree4 Suite 100 # _-" Boston,MA 02114-2017 ; :s,, www.mass.gov/dia -N.1 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTLNG AUTHORITY. Anolicant Information (,, Please Print Lgiblv Name(Business/Organization/Individual): SC3(�i t e f A-- /Je to tc /Cl4 v. f 4r]�• Address: /0 Se.r UD/r -gel • J City/State/Zip:S el t t-4-1cl , t O 9 /7 Phone#: 40/-2�2-i'- `� 6 Are you en employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with ZO•�employees(full and/or part-time).* 7. ❑New construction 2 am a sole proprietor or partnership and have no employees working for me in S: 0 Remodeling arty capacity.[No workers'comp.insurance required.]• g. CIDemolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. t 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 P[umbing repairs or additions ; 5.0 lam a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑goof repairs These sub-contractors 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. L 14.Er/Other it)i✓1 etol"/ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ref.214 reed e-r 7 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 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 nmy employee!Wig is`the policyand job site information. KJ - Yt/f�� 4J.�/ Insurance Company Name: �re hen s ,5aut'ai __ oc • Policy#or Self-ins.Lic.#: Wc�ri�/.5 c ?O?( • Expiration Date: /" /"2 2-0 Job Site Address: 2- S -<- J 1 • • City/State/Zip: ktl/ i-wv /4 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$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 cezunder the p ' penalties of perjary that the information provided above is true and correct: Signature: _ Date: F -/�/4 ....._ Phone#: q(QI '-22 -... 9 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MMIDDNYYY) R CERTIFICATE OF LIABILITY INSURANCE 12/28/zo18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C F ALTER IIGHHE SC UPON N T HE CERTI CERTIFICATE THE POLICIES T EIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 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). CONTACT PRODUCER NAME: I FAX CoBiz Insurance, Inc. CO PHONE ,No):303-988-0804 (Am,No.Exo:303-988-0446 140 Lawrence St.,Ste. 1200 ADDRE Denver SS: COMail@cobizinsurance.com CO 80202 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 £SLERCO-01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 INSURED ' Southern New England Windows, LLC. INSURER C:Homeland Insurance Company of NewYork 344 2 dba Renewal by Andersen of Southern New England INSURER D: 10 Reservior Rd Smithfield RI 02917 INSURERE: 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.CERTIFICATE MAY/1BESISSUED OR MAY PERTAIN, THEANY REQUIREMENT,T INSURANCE AFFORDED BY THE POLIERM OR CONDITION OF ANY CIES DESCRIBED HERE N IS SUB ECTCT OR OTHER DOCUMENT WITHPTO ALL HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDU E E BYF PAID CLAIM LIMITS ` I NSRY EXP LA ADDL SUBR . POLPOLICY NUMBER (MMIDD/Y`YY) (MM/DD/YYYY) TYPE OF INSURANCE INSD NND 1111201g 1/1/2020 EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPA3158728 DAMAGE TO RENTED X I OCCUR PREMISES(Ea occurrence) $300,000 CLAIMS-MADE MED EXP(Any one person) $10,000 - PERSONALS ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 ' X POLICY I I JEC LOC $ 1/1/2019 1/t/2020 COMBINED $ OTHER: denSINGLE LIMIT 1.000.000 A AUTOMOBILE LIABILITY CPA3158728CO(Ea aBINED) BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED AUTOSNON-O N SCHEDULED PROPERTY DAMAGE AUTOS NON OWNED (Per accident) $ X HIRED AUTOS X AUTOS $ CPA3158728 1/1/2019 1(112020 EACH OCCURRENCE $15,000,000 A X UMBRELLA LIAR X OCCUR AGGREGATE $15,000,000 I EXCESS LIAB CLAIMS-MADE $ DED X I RETENTION$n 111l2Q19 1!1l2020 X I STATUTE I I ER B WORKERS COMPENSATION WCA315872924 AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $i,000,OOQ ANY PROPRIETOR/PARTNER/EXECUTIVE NH) Fin I N/A (Mandatoryin OFFICER/MEMBER EXCLUDED? I "' ( E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $1,000,000 If yyes,describe under DESCRIPTION OF OPERATIONS below 7930073340000 1/1/2019 1/1/2020 `Each Occurrence $2,000,000 C PollutionClaims-MadeiPy Aggregate $2,000,000 RetroactivePolicy Deductible $25,000 Retroactive Date 0 8120/2 0 1 3 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space 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 ONLY AUTHORIZED REPRESEENTTA�TIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD