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HomeMy WebLinkAboutBld-20-000459 IJTUGG u5 only 4 _,l g ` • CAmmunt 6 v*� ill ' `` 2.01(i Permit expires 180 days from s issue date - Ci --in2e./Sr7 -2V 57 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION-ADDRESS: 6 1 G vn c,./dr-!.e..-- ,,a/ >r ASSESSOR'S INFORMATION: •' Map: Parcel: • i?.../I G•a5 - 77�/-Z7Z-3 if re �t/gt".el I GonWn.(C_ �ay y.,,.�ou ��� MA 0 7S� NAME iO �l TEL # EmaltAddre CONTRACTOR 14hern 0.0% �I itiogPU S�►.:7-F,'�e%/ Ni-0,29i7 CP1)1a g'-98ao AME MAAILLINGADD 'IEL.# Email Ad, Residential Commercial Est.Cost of Consaacdon$ 9 7 c.c.----- Home Improvement Contractor Lie.* 173 2.'I5 Construction Supervisor Lie.* 076 78 7 Workmen's Compensation Insurance: (check one) . I am the homeowner I amtbe soled )4 have Worker's Compensation Insurance Insurance Company Name: R ,?1 1JS 1 PS. p) .+A d Worker's Camp.Policy# (A)CA 43I6r72 g LW WORZ0O BE PFfFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares - Replacement windows:# (3 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation NJ 1J14d Sings Highway/Sistoric Dist. (vilacinglike for like (o,ck`\a5 , ,.. /fir *The debris will be of at l✓�t de /l`n t tt•Pf►o^��---/ S/1T.i4'' 7e.Li 9X ijmtien of Fad t I declare under penalties ofperjury ttnttbe . .•.-.., herein contained are true and conga to the best of my lmowledge and belief: Iundestand that any false answer( wilbe just cause for denial,:T.,.-:•,,;,of,• 1 and for prose�on under l.G.L.Ch.268,Section 1.Date 6 -Zoo -l l Applicant's � � �aMVI' -r- Date: Owners SWAMI Or atsA.,kmo++r) $ ,' � Approved By: — Date Building°Metal` (or, __) Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 it.of Wetlands: Yes No Yes No • Renewal Agreement Document and Payment Terms l'Andersen. dba:Renewal By Andersen of Southern New England Paul&Cindy Guerin > Legal Name:Southern New England Windows,LLC 61 Gunwale Way RI 136079,MA#173245,CT 10634555, Lead Firm 11237 Yarmouth Port,MA 02675 272-3338 WINDOW\uoEYENT 10 Reservoir Rd I Smithfield,RI 02917 H:(774) Phone:866-563-2235 I Fax:401-633-6602 I salesOrenewalsne.com C:(508)981-4548 Buyer(s)Name: Paul &Cindy Guerin Contract Date: 06/11/19 Buyer(s)Street Address: 61 Gunwale Way , Yarmouth Port, MA 02675 Primary Telephone Number: (774)272-3338 Secondary Telephone Number: (508)9814548 Primary Email: paguerin48Ohotmail.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: $9,755 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: $3,251 Balance Due: $6,504 Estimated Start: Amount Financed: SO 8 to weeks 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 included; S3251. Pd ck; Permit $50 paid ck 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 06/14/2019 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:Reneyra�By jdlersen of Southern New England Buyers) 14 __ _ ,qc,,,,,0 iliviA.— Signature of Sales Person Signature Signature Paul McLean Paul Guerin Cindy Guerin Print Name of Sales Person Print Name Print Name UPDATED: 06/11/19 Page 2 / 13 . -17ie Fo--/-12/27-61LiwPeagn 074_,A.a.34-acAK(.4-e/-4 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: 0 09/118/28/2 020 SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 is 20M-05/17 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: Reaistraf1oq 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 Ak CCre_5 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary it without signature r �-- Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction-Supervisor CS-095707 y Epp i res: 09/08/2020 BRIAN D DENNISON ,-�• , - 8 BLACKWEL1 DRIVE ,;/ -0` , °� - 1 CHARLTON MA-01507 -` 4_ Commissioner C•14 .4* -- The Commonwealth'of Massachusetts Department of IndustrialAtddents 'c,, ie; 1 Congress Stree4 Suite 100 1 _ '' Boston,M.4021142017 ir; wwtv.irassgov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT DIG AUTHORITY. Aaolicant Information , ! Please Print Legibly Name(Business/OrganizationfIndividual): S btu th e t'11. Ne btu t 1/G4 V3 i/1 ci)1iis Address: /0 Ser UDl r IZ41 . City/State/Zip:Spt ►-ee1citRt am /7 Phone#: 40/-22,ir- ? v Ara you an employer?Check die appropriate box: �n Type of project(required): 1. 1 am a employer with �/f employees(full and/or part-time).* g 7. New construction ` am a sole proprietor or partnership and have no employees working for me in any capacity comp•irntaance n:4uired) [No wodcers, 8: 0 Remodeling 3.0lam a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.0lam a homeowner and will be hiring contractors to conduct all work on my property. [will 10 D Budding addition ensure that ell contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 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'camp.insurance.t 13.❑R f repairs /J 6.0 We are a corporation and its officers have exercised their rightof14. Other Gdi/�(� 152,g 1(4),and we have no employees. exemption per MGL c. �[+ Y [No workers'comp-insurance required.] t ePt4C e,.,t..'Tf-5 'Any apleicare that checks box#1 must also NI 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 have employees.they must provide their workers'camp.policy number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy andJob site infortnatiort. Insurance Company Name: cl re/Mill -6121/0/I _ LO - oF WiT, U. C . Policy#or Self-ins.Lic.#: LOC,4 3/587eR pup? • Expiration Date: /- 1-2.D ZO Job Site Address: 6 I G u/1 tt/a iti coal City/State/Zip: A�Yr�a G,�1,--f /' 1 A Attach a copy of the workers'compensa don policy declaration page(showing the policy number and expit'ationtdate). 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$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 vtri tf t 'on. I do hereby c ' under the p,' penalties of perjury that dte information provided above is true and correct Signature: — Date: 2 G - /6) Phone#: 1°! .--7. ?N Official use only: Do not write in this area,to be completed by city or town ofciaL City or Town: • Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/1'own Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: DATE IMM/DD/YYYY) Alm RLF CERTIFICATE OF LIABILITY INSURANCE 12r28r2018 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 tA/C.No.Exit 303-988-0446 INC.NO 303-988-0804 _ Denver CO 80202 EA SS: COMail©cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCOO1 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. INSR TYPE OF INSURANCE ADDI SUER . POUCY NUMBER POLICY EFF YFJtP LIMITS ` LTR JNSD,4WD- JNMNDOIYYYYIJ YYY). A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 DAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEM.AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY Mg LOC PRODUCTS-COMP/OP AGG $2,000,000 ^ -- OTHER: _ $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE UMIT $ (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X t) HIRED AUTOS X NON-OWNEDA PPReOPE TY DAMAGE $ UTOS (Pr $ A X UMBRELLA UAB X occuR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$o $ B WORICERS COMPENSATION WCA315872924 1/1/2019 111/2020 X STATUTE OTH- ER AND EMPLOYERS'UABILITY Y/N 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 I yes und er DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY OMIT_$1,000,000 C PoNulon Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 08/202013 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 POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE Na>k- 501/4444*/ ) ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD