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HomeMy WebLinkAboutBld-20-001764 P-Z1 - - .Of cc Ilse Only : Permit# tit �!+ � • ti Amount cs�,� A° �-' 7 fr�' f' Permit expires 180 days from ,�,/�/,i� issue date ' ifr ri/Ti —1 , . EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH . Yarmouth Building Department —w—/-7(0ki 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: q2 9A///,'s . )I • ASSESSOR'S INFORMATION: Map: Parcel: ' ?.6e 1 i'i;4 If,• OWNER:(Surat) Frio �'i L ?Adis Dr, S Gn•,. 'f-, 'IA0 266,1 s D k-2F3� i'S 6 7 NAME is rkcf TEL # i maitAddres CONTRACTOR: Au Pro N A. Otnouws S.n. l-e/c/L�/?���rx?9,7 Cal) ZZI1'-981?a 3�tAME MAILING ADDRESS TEL# Email Add Residential Commercial Est.Cost of Consauctton$ Hi 3 4 2 Home Improvement Contractor Lic.# 173 2.45- Construction Supervisor Lis.# 0Q67B 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor ]4 have Worker's Compensation Insurance Insurance Company Name: �iP LASS 1 a�S. j7s) `t Worker's Comp.Policy# 10 CA '3I6r72 az-/ WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# I Replacement doors: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_____ Old Kings Rlghway/Historic Dist. ( ),Replacing like for� like e(l2.r The debris will be disposed of at �t/���� �s �.Qr..k S4�►a .P � � ration of 1~acilif I declare under penaides of perjury that the ; •,,-„,:herein contained are tine and correct to the best of my knowledge and belief. I understand that any false answer(s', will be just cause for denial or wya adon of m?li•a.4-,and for prosecution under M L.Ch.268,Section 1. Q q Applicant's Striatum �(y�J�'�-.�`�_ Date: (—"S-/ r i Owners Signature(or attachment) s� Date: Approved By: // l Date7.4V.Z7 Building Official(or,i • • Zoning District Iristoricai District: Yes No Hood Plain Zone: Yes No Water Resource protection District Within 100 it.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms E'Andersen. dba:Renewal By Andersen of Southern New England Bob Michetti&Susan Franco 3. �j Legal Name:Southern New England Windows,LLC 92 Phyllis Drive �� ��_ RI #36079, MA#173245,CT#0634555, Lead Firm#1237 South Yarmouth,MA 02664 WINDOW RE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)394-8567 Phone:401-349-1384 I Fax:401-633-6602 I sales@renewalsne.com C:5082411382 Buyer(s)Name: Bob Michetti & Susan Franco Contract Date: 08/12/19 Buyer(s)Street Address: 92 Phyllis Drive, South Yarmouth , MA 02664 Primary Telephone Number: (508)394-8567 Secondary Telephone Number: 5082411382 Primary Email: rhmichetti@hotmail.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: $11,362 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: $0 Balance Due: $11,362 Estimated Start: Estimated Completion: Amount Financed: 8-10 weeks 8-10 weeks $11,362 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: 50% DEP 50% ON COMP 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 08/15/2019 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 Names Southern New England Windows,LLC dba:Rene By Ande of Southern New England Buyer(s) Signature of Sales Person Signature Signature Eric Woods Bob Michetti Susan Franco Print Name of Sales Person Print Name Print Name UPDATED: 08/12/19 Page 2 / 8 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: 9 3245 10 RESERVOIR ROAD Expiration: 09/18/28l2020 SMITHFIELD, RI 02917 SCA 20M-05/17 Update Address and Return Card. •_�//P 9:5evimmYJ.CvF,'Q.Gl1l '.,��2v//LC�;co elG.• Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Reaistratiorl 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 ALCC 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary without signature Commonwealth of Massachusetts Division of Professional Licensure • Board of Building Regulations and Standards ConstruCti'on Supervisor CS-095707 • Expires : 09/08/2020 BRIAN D DENNISON Y•,; 8 BLACKWELLDRIVE ; CHARLTON MA -01507 -� Commissioner CAL _ _ The Commonwealth of Massachusetts Department of Industrial Accidents ' ."= 1 Congress Stree4 Suite 100 =: :.„4- ) Boston,MA 02114-2017 �'... ruww mass gov/tiro Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMtITI:YG AUTHORITY. Applicant Information Please Print Letibly Name(Business/Organization/Individual): Se)a.sth e r h,. Ille Id,) to p/G Wind r�1�1s Address: /O ?e.Se_r UDt r i4 • J /'' City/State/Zip:S 07 t f-4 del t R! OZg /7 Phone#: 4 Ol-2.2,4- , to 6 z. Are you an employer?Check the appropriate box: Type of project(required): 1. lam a employer with 20'e-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.] 3-0 I am a homeowner doingall work myself 9. ❑Demolition y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be contractors to conduct all work on m10 Q Building addition huutg Y property. [will ensure that all contractors either have workers'compensation insurance or are sole 11 0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.CI I am a general contractor and I have hired the subcontractors listed on the attached sheet. [3.o repairs arts These sub-contractors have employees and have workers'comp.insurance.: / / 6.a We ace a corporation and its officers have exercised their right of exemption per MGL c. 14. Other win/frg.d 1t co of 152,144),and we have no employees.[No workers'comp.insurance required.] ref /!'C'PAPI P-i 'Any applicant that checks box el 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. Ifthe 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 information. /� Insurance Company Name: TTI repnel'1s J j(,..,,t/(( a . of W A' b. C' A�/,57 I Policy#or Self-ins.Lic. If: LOCri! PC? . Expiration Date: I' /—2-02-0D O Job Site Address: 9 2- f h yg c r City/State/Zip:,5 .�,..o„ , //A Attach a copy of the workers'compensation policy declaration page(showing the policy nu ber 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 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance coverage verifation. I do hereby ce ' under the p . penalties of perjury that the information provided above is true and correct i : Da —/ Phone If: '1'01 Zz— 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): 1.Board of Health 2.Building Department 3.City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other I Contact Person: Phone#: I ^AC RD CERTIFICATE OF LIABIL I DATE(MMIDDIYYYY) I `. IIWS I Iy�C I 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 FAX 1401 Lawrence St., Ste. 1200 ac No.Ext):303-988-0446 INC.Nol:303-988-0804 AAIL Denver CO 80202 ADDRESS: COMaiI©cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIL# INSURERA:Acadia Insurance Company 31325 INSURED ESLERCO 01 INSURER a:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. INSURERC:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New EnglandP Y 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. INSR TYPE OF INSURANCE AINSD DDL SWVD POLICY NUMBER I MIOOY EFP) ( MIOO/n,POUCY� LTR ) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY 11.000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JPERC LOC PRODUCTS-COMP/OP AGG $2,000,000 - OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT (Ea accident) '1.000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $_ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE — AUTOS (Per accident) $ $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$1L _ $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X PER TUTS OT AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,003,000 OFFICER/MEMBER EXCLUDED? Na N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 DEH yes, SCRIPTION O describe d below _E.L.DISEASE-POLICY UMIT $1,000,000 OF OPERATIONS 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/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD