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HomeMy WebLinkAboutBld-20-000889 i-Office Use Only -•� G�. 0 °r Permit,'1 Orl'E h` Amount �J O— "a" P u Permit expires 180 days from • -JJ issue date '\ G EXPRESS BUILDING PERMIT APPLI TDIO 1 TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 "AUG 15 2019 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 IttW___Til By: CONSTRUCTION-ADDRESS: F 0 i✓1 6-a` , ASSESSOR'S INFORMATION: IMap: Parcel: • OWNER a✓l Gll1JDn ne Rd• 5•Y4lrwv4,t,414 A n.46� 5ti8- 341� �i s-erk NAME t S TEL # Email Addres • (t • /OglleS�Dk� Zc�• _ _ . CONTRACTOR:`1��! en N • uuatotPs Sfrn. -C•e/d RI- C ') ZZ$r-98na AME MAILING AD S TEL•# Email Add • Residential \ Commercial Est.Cost of Construction$/©10 6 7 Rome Improvement Contractor Lie.# 173 2.413— Construction Supervisor Lie.# O7 -740 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: •ri,RE16,6h.>>S 1 DS. CADTalif, f Worker's Comp.Policy# 4I6Y 2 0,2-7 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares - Replacement windows:# 6 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( ),Replacing eplacing like for like *The debris will be disposed of at tIAC de Atet tiara of 1~acllit r I declare under penalties of perjury that the. , :herein contained are true and correct to the best of my knowledge and belief. Iunderstand that any false answer( will be just cause for denial: seyoc atio'a o f rag it. se and for prosecution under M.G.L.Ch.268,Section 1. (��-�'�"'_,,,"-' Dam 8'—/� /�'i Applicant's Signature: -at Hate: Owners Signature(or attachment) see- Q — Date: O - I S Approved Tiy: 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 byAndersen. dba:Renewal By Andersen of Southern New England Joan Hanson �/.0 - Legal Name:Southern New England Windows,LLC 8 Paine Rd j South Yarmouth,MA 02664 ����j�!F RI#36079,MA#173245,CT#0634555, Lead.Firm#1237 H:(508)394-9588 WINDOW RE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 Phone:866-563-2235 I Fax:401-633-6602 I saleserenewalsne.com Buyer(s)Name: Joan Hanson Contract Date: 07/29/19 Buyer(s) Street Address: 8 Paine Rd , South Yarmouth , MA 02664 Primary Telephone Number: (508)394-9588 Secondary Telephone Number: Primary Email: 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: $10,067 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: $3,355 Balance Due: $6,712 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: 1/3 paid now, 1/3 paid at start, 1/3 paid at compl.Taxes paid in Yarmouth 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 08/01/2019 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:Renewal n of Southern New England Buyer(s) Signature of Sales Person Signature Signature Kevin Desmarais Joan Hanson Print Name of Sales Person Print Name Print Name Page t / 12 UPDATED: 07/29/19 Pi JC,fnfnif?Cpe d 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: 93242 0 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 Update Address and Return Card. SCA 1 Ca 20M-05/17 .%fi.'e wcvwr✓rcwrtwix i4cf-flz.)-i aJeGG1 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 73245 ': 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 - i BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary row t cu without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction ' upervisor CS-095707E , i r es: 09/0 /2020 E NISON 3 r 8 LACK ELL DRIVE CHARLTONA- 1 7 • t \ - ra • 1 • Commissioner The Commonwealth of Massachusetts . 1,,,_,.,___= e Department of Industrial Accidents __i 4 1 Congress Stree4 Suite 100 - Boston,M4 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): Scm.-..therA. N, `e& tc 1 G4 )/' 4 r-)Los Address: JU 1 Sec UQIf 'gel City/State/Zip:S rl t t-4 e-ic i l7- l d Z9 /7 Phone#: 40/—2,2,4f 4, 6 z. Are you an employer?Check the appropriate box: Type of project(required): I. 1 am a employer with �'1�'employees(full and/or part-time).* 7. ❑New construction 2 am a sole proprietor or partnership and have no employees working for me in 8: 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition CI am a homeowner doing all work myself[No workers'comp.insurance required] 4.3 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 Q Q Building addition ensure that alt contractors either have workers'compensation insurance or are sole 111Q Electrical repairs or additions • proprietors with no employees. 12.Q Plumbing repairs or additions 5.Ej I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q R of repairs These sub-contractors have employees and have workers''comp.insurance; 6.Q We are a corporation and its officers have exercised their right of exemption per MOL e. 14. Other !�/I h IT�. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] repbt^,"'evr 13 '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 and job site informatiax '..; Q Insurance Company Name: Ti reinesis In6UfaMe..... - OF W t e l U. Policy#or Self-ins.Lic.#: t41CA 3f 7 7c2 • Expiration Date: I' /`2-0 LD Job Site Address: ' 91in € tom' City/State/Zip: S.yarr1.),.4'- 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 violatof.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby c . under the p ' penalties of peditry that the information provided above is true and correct Signature: . -_.J • Date: P -/ 3 - /' Phone#: 101 '-2 2-J - - ?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#: DATE(MMIDWYYYY) Ac CERTIFICATE OF LIABILITY INSURANCE DATE 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 CONTACTNAME: CoBiz Insurance, Inc.-CO PHONE 303-988-0446 FAX c,No):303-985-0804 1401 Lawrence St.,Ste. 1200 E-MAIL No,Est): Denver CO 80202 AooREss: COMail@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. ADDL SUER . POLICY EFF POLICY EXP LIMITS ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYY► (MMIDD/YYYY) 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 POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X PROPERTY DAMAGE $ AUTOS ED (Per accident) HIRED AUTOS x AUTOS $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$n $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X PE TUTE OT AND EMPLOYERS'LIABILITY Y I N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 08/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 REPRESENTATIVE Oak `a ,— ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD