HomeMy WebLinkAboutBld-20-001394 _ .Office Ose Only
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_�� Permit expires 180 days from
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EXPRESS BUILDING PERMIT APPLICAT] __1 V !.'
TOWN OF YARMOUTH
Yarmouth Building Department i SEP 11 2019
1146 Route 28 V�,
South Yarmouth,MA 02664 ' P'
(508)398-2231 Ex1261 �t.
CONSTRUCTION-ADDRESS: .?g (n)e 'r Rok
ASSESSOR'S INFORMATION:
IMap: Parcel; •
R. ^ /r J S I
OWNER: trcn1 upa .M kJpic ?et., / e� MA- Z1- ,7� >aef-57c— a 0 e 0
NAME • /O fle��C �. # Email Addre
CONTR.ACTOR:S.444Frn W.A. {�raCvtos SiTh J'(--e/CJ/�_R--10 f7 . CPO a28'-98�
NAME MAILING ADDRESS Tom..# Email Ad(
Residential Commercial Est.Cost of Constriction$ S L/ —
Home Improvement Contractor Lac.# (7 3 2.43 CfodfonSn or Liu.# 0467$7
Workman's Compensation Insurance: (check one)
I am the homeowner I am the sole proprietor have Worker's Compensation Insurance
(1
lit)CA 4t68'72 8 Zs/
Insurance Company Name: ��r'�En.�s 1a5. C�� � Worker's Comp.Policy*
WQ)K_TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares - Replacement windows:# Z Replacement doors: #
Roofing: #of Squares ( )Remove existing°(max.2 layers) Insulation
Old Kings H'ighway/Historic Dist. ( )Itepla lid for like
ith..)Le ,✓lam„ t.p.�►DrS 3(-Ce.fa��r
isbothe debris will be disposed of erettlon of Far 1
I declare under penalties of perjury that the, s•.- herein contained arenas and correct to the best of my knowledge and belief. Iunderstand that any false answer(
will be just cause denial oc. attitm of,i . and for prosecution under M.O.L.Cb.268,Section 1.
Applicant's Signature: _ Date: 7- r i - 11
4i Date;
Owners Signature(or attachment) -
Approved By:
. G Date: —//'�
Buil or designee)
Zoning District
Historical District Yes No Flood Plain Zone: Yes No
Water Resource Protection District Within 100 it.of Wetlands:
Yes No Yes No
The Commonwealth-of Massachusetts
,�,L- Department oflndustrialAe dents
> = 1 Congress Stree4 Suite 100
__',=.1=_ =' Boston,MA 02114-2017
.'J.�,s-o' www.mass.gov/dra
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Letibly
Name(Business/Organization/Individual): S V t.tlh e/'Ae k)e IA) tn,..1/COE/ Wind r]i
Address: I Ser UDt r g.c1 •
ry p Sn►t -4dei,i'i Oz l 9 v Ci /State/Zi : 9 7 Phone#: y0/—ZZ�-
Are yea an employer?Checkk thhee appropriate box Type of project(required):
1. l am a employer with 20 'employees(full and/or part-time).*
g 7. New construction `
am a solo proprietor orpartnership and have no employees working forme in S: 0 Remodeling
any capacity.[No workers'comp.insurance required]
3.ID I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my PRY- [will I0 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions •
proprietors with no employees.
l2.['Plumbing repairs or additions
5.O I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑ p
Roof 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 a 14.[Other (-li()c r(?tn/
152,I l(4),and we have no employees.[No workers'cony insurance required] re / i/t
js
'Any applicant that checks box 51 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 slate whether or riot those entities have
employees. Ifthe sub-contactors have employees,they must provide their workers' , 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: r . ..,,,, a _ o f W(T, b. C .
Policy#or Self-ins.Lic.#: telk,q /,SB7a Pp? • Expiration Date: /- /—2.0 LO
Job Sire Address: . 8 !,J e it CO( City/Stet/Zip: rir o.ri �t 1A--14-
Attach a copy of the workers'compensation policy declaration page(showing the policy bar and ea ppiradon 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 verifitation.
I do hereby c under the p penalties ofperjury that the Information provided above is true and correct
Signature: Date: 7—3 I—/ 1
Phone#: 101 2 0
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Lkense#
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#:
AC RLf CERTIFICATE OF LIABILITY INSURANCE �;2 z8,o;8rn
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
1401 Lawrence St., Ste. 1200 INC No.Ext1: 303-988-0446 FAX Nol:303-988-0804
Denver CO 80202 E-MAILD SS: COMail@cobizinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC I/
INSURER A:Acadia Insurance Company 31325
INSURED ESLERCO-01 INSURER B:Firemens 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 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 ADDL SUER . POLICY EFF POUCY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MMIDO/YYYY) (MMIDDIYYYY}
A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/112020 EACH OCCURRENCE $1,000,000
DAMAGE TO CLAIMS-MADE n OCCUR PREMISES Ea occurrence) $300,000
MED EXP(Any one person) S 10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY ECT 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) $
AUTOSAUTOS
X HIRED AUTBS X �-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 RETENTIONS a $
B WORKERS C TION WCA315872924 1/1/2019 1/1/2020 X PERTUTE E• R
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below •
E.L.DISEASE-POLICY LIMIT $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 06/2012013 Deductible $25,000
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 POUCY PROVISIONS.
FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE
NR&
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
•J�e Jociw2-ze�/�C Je-C/G ��
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Card
Registration: 173245
SOUTHERN NEW ENGLAND WINDOWS,LLC Expiration: 09/18/2020
10 RESERVOIR ROAD
SMITHFIELD, RI 02917
Update Address and Return Card.
SCA 1 0 20M-05/17 `
LOTe �O/Jm,,vLCCP „?c G�2i-i LC/LI,GJc%�J
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:
Renistr-atioq Expiration Office of Consumer Affairs and Business Regulation
173248_.__ 09/18/2020 1000 Washington Street-Suite 710
SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211
BRIAN DENNISON ALe ---
0 RESERVOIR ROAD lJ
SMITHFIELD,RI 02917 Undersecretary without signature
Commonwealth of Massachusetts
IF7,i Division of Professional Licensure
Board of Building Regulations and Standards
Construction `Supervisor
CS-095707 Expires : 09/08/2020
: .
BRIAN D DENNISON .--r `
8 BLACKWELLDR1VE ; /
CHARLTON MA-01507 ter. 41"
( 1i;'
Commissioner
•
Renewal Agreement Document and Payment Terms
byAndersen. dba:Renewal By Andersen of Southern New England Richard Erenius&Joanne Ereniuw
�j Legal Name:Southern New England Windows,LLC 38 Weir Road
OP .,,4i RI #36079, MA#173245,CT#0634555, Lead Firm #1237 Yarmouth Port,MA 02675
WINDOW E LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)375-0080
Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsne.com
Buyer(s)Name: Richard Erenius & Joanne Ereniuw Contract Date: 07/19/19
Buyer(s)Street Address: 38 Weir Road,Yarmouth Port, MA 02675
Primary Telephone Number: (508)375-0080 Secondary Telephone Number:
Primary Email: rerenius29@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: $4,321 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: $1,440
Balance Due: $2,881 Estimated Start: Estimated Completion:
Amount Financed: 8-10 weeks 8-10 weeks
SO
Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on
Cash/Check 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 DEP 1/3 ON START 1/3 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 07/23/2019 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 By AAndersen of Southern New England Buyer(s) m
Signature of Sales Person Signatures Signature
Eric Woods Richard Erenius Joanne Ereniuw
Print Name of Sales Person Print Name Print Name
UPDATED: 07/19/19 Page 2 / 11
e
°` `4-No TOWN OF YARMOUTH RECEIVE !
,:; 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 AIJC 2 12019
RE NG'S HIGHWAY HISTORIC DISTRICT CO MITT,. UUT
COLD K►NG'S HIGHWAY
SEN 11 'CU 19 APPLICATION FOR
TOWN CLERK CERTIFICATE OF APPROPRIATENESS
ApOIJb1 WI 11divlAr issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended,for proposed work as described below&on plans, drawings, photographs, &other supplemental info accompanying this
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S), ELEVATIONS, PHOTOS, &SUPPLEMEyTAL INFORMATION.
Check All Categories That Apply: Indicate type of Building: Commercial ✓ Residential
1) Exterior Building Construction: New Building Addition /Alterations Reroof Garage
Shed Solar Panels Other:
2) Exterior Painting: Siding Shutters Doors Trim Other:
3)Signs/Billboards: New Sign Change to Existing Sign
4)Miscellaneous Structures: Fence Wall Flagpole Pool Other:
Please type or print legibly: Q' ���p /
Address of proposed work: u t0`—t r pci.. Map/Lot# 121 1� r
Owner(s): Fi abed 4 J *nne_ t n/L[S Phone#:..9e 3 73 G0e9C)
All applications must be submitted b owner or accompanied by letter from owner approving submittal of application.
Mailing address: c39-LUe.Ir Rd , arP Dttt f rtf MA 0›-67 c Year built: / 97/
Email: (� Preferred notification method: ✓ Phone Email
Agent/contractor:A(lc�(el) JI e.{. v& r AIE • ID(Rd0 wS Phone#: 101-7 ig/ "4 3 97
Mailing Address:
.}-/0 � e 4 vo i r- / ja (-RI d2J 7
Email: QSWQe4 9'9c a1 1 mod • 4-17M Preferred notification method: Phone ✓ Email
Description of Proposes Work:
be)-Jb�e JrX — r 0 3 c':c3-S
Signed(Owner or agent): Date: 8" 41
1/y
> Owner/contractor/agent is aware that a permit is required from the Building Department.(Check other departments,also.)
> If application is approved,approval is subject to a 10-day appeal period required by the Act.
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
> All new construction will be subject to inspection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections.
For Committee use only: ! Approved Approved wit: Modifications Denied
Rcvd Date: o.o9%, \°► Reason for Denial:
Amount 4 110
,
Cas :j� Signed:
Rcvd by: /p�
45 Days: IO— /o
/f41. !i
J _ .
Date Signed: q ct (zOl9
1 APPLICATION#:) 9 - A 0 7 0
0'tw"'"
-,
GENERAL SPECIFICATION SHEET
Project Address: i'ir W f , RI .
FOUNDATION: Material: Exposure(Not to exceed 18"):
CHIMNEY: Material/Color: GUTTERS: Material/Color:
ROOF: Material: Pitch (7/12 min) Height to Ridge: Color:
SIDING: Material/Style: Front: Sides/Rear: COLOR CHIPS
Color: Front: Sides/Rear:
TRIM: All windows &doors to be trimmed with: 1x 4 1x5 (Circle one.)
Material: Color:
DOORS: Qty: Material: Color:
Style/Size(if not listed/shown on elevations):
STORM DOORS: Qty: Material: Color:
GARAGE DOORS: Qty: Mat'l: Style: Color:
WINDOWS: Qtv/side:: Front::� 2 Left: Right: Rear: Color: WiT�
Manufacturer/Series: A QB Material: rl,brl')C v ; L ,—,,;,,Is I I
Grilles(Required): Pattern(6/6,2/1,etc.) Grille Type:True Divided Lite:
Snap-In: Between Glass: Permanently Applied: Exterior Interior
STORM WINDOWS: Qty: Material: Color: RECEIVED
SHUTTERS: Mat'l: Style: Paneled Louvered Color: SLY 1 2019
SKYLIGHTS: Qty: Fixed Vented Size Color: TOWN CLERK
SOUTH YARMOUTH, MA DECK: Size: Decking Mat]: Color:
Railing Mat'l: Style: Color:
WALLS/FENCES*(Max 6'height): Height: Mat'l:
Style: Color:
(Show running footage &location on plot plan.) *Finished side of fence must face out from fenced in area.
UTILITY METERS/HVAC UNITS: Location: Screening:
LIGHTS: Qty: Style: Color:
Location(s):
LIGHT POSTS: Qty: Material: Color:
Location(s):
Additional information: rictileR1 Ni q 3-k v uJou) boo r,J . 4 '05!/4Jf q A
miL1(94 dou6 h uO41-5% ! — / 47c.( Y� l• `r e ko F1 —s - w�lki�Skll tA i N 41(2) Mt— 411011g.
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