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Bld-20-000456 ' It. .Office Ilse Only . Permit , '' C Amount �%, ,fr'� Permit expires 180 days from issue date • gut—20-1,5� EXPRESS RIMMING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department J . L , r 1146 Route 28 South Yarmouth,MA 02664 COI RTF=7 (508)398-2231 Ext. 1261 CONSTRUCTION-ADDRESS: 5 HarAn rJr -/—f%l/ iRv/1 ' ASSESSOR'S INFORMATION: Map: Parcel . OWNER: /�er�p Can. ' 9 iier6o it//'//,‘,/^ S. .ezi lash. (A 7 2-64a Gil.26 4`cf9 42_ NAME iO Ke TEL TEL # Erne Addre: CONTRACTOR, rn /J . " tRotkO;44 in; i-Ce// Nr DAi )22r--Syo ANE MAILING AD S TEL.# Email Ad( Residential Commercial Eat,Cost of Consauction$ 1410 R 0 Home Improvement Contractor Lic.# Il i 2.5/5- Construction Supervisor Lie.# 07678 7 Workman's Compensation Insurance: (check one) I am the homeowner I amens sole proprietor have Worker's Compensation Insurance Insurance Company Name: p ttA..4 1 ?S. ( Worker's Comp.Policy# 140'3/ 72 5' 2-4 WQJ TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Z Replacement dodrs: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( ),Replacing like for like *The debris will be of at lac)Ie Ater ((.P.r►o~�— S41i4-t�:e c �� ��� fibettion once* 1 I declare under penalties.of perjury thatthe,,., <,,-, herein conadned are true and correct to the best rimy knowledge and belief. Iunderstsnd that my false answer( will be just cause for deeial' . ,.:.,,,of, -and for prosecution under M.G.L.C h. ,Section 1. tax . Date: 7—i 7— l i' Applicant's Signaoue: ` '� Date: Owners 3�natare(or a ,.w,„�„) � ��� 46. 4 Date: 2 — 4 '`, Approved By* Btfldkng 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 bAndersen. dba:Renewal By Andersen of Southern New England Benard Caniff Legal Name:Southern New England Windows,LLC 9 Harbour Hill Runn �� • RI#36079, MA#173245,CT#0634555, Lead Firm#1237 South Yarmouth,MA 02664 WINDOW\LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(781)334-5442 Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsne.com C:5083988998 Buyer(s) Name: Benard Caniff Contract Date: 07/02/19 Buyer(s)Street Address: 9 Harbour Hill Runn, South Yarmouth, MA 02664 Primary Telephone Number: (781)334-5442 Secondary Telephone Number: 5083988998 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: $4,090 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: $1,363 Balance Due: $2,727 Estimated Start: Estimated Completion: Amount Financed: $O 6-9 weeks 6-9 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: 1/3 DEP 1/3 ON START 1/3 ON COMP TXS PD IN SOUTH YARMOUTH MA 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 07/06/2019 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 nderse, Southern New England Buyers) Signature of Sales Person Signature Signature Eric Woods Benard Caniff Print Name of Sales Person Print Name Print Name UPDATED: 07/02/19 Page 2 / 9 ,) e !iCt�/22 eGEC/G i 071, G'/JC/ J G ;e(4e/44 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 as 20M-05/177r�17/- // ,.%/LP F/v7a n./'n"a'4� L Ra..i-i2C/GCG)Cvi 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: Reaistratton 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 A'- C --_ 10 RESERVOIR ROAD u SMITHFIELD,RI 02917 Undersecretary it t,i v without signature Y Commonwealth of Massachusetts igDivision of Professional Licensure Board of Building Regulations and Standards Construction 'Supervisor CS-095707 N Epp i res: 09/08/2020 = .1:" " BRIAN D DENNISON _ 8 BLACKWELL DRIVE CHARLTON MA=01507 41. Commissioner CL ali----- - The Commonwealth of Massachusetts )'(.. V,�,'- Department aflndusltrialAccidents = 1 CongressStree�Suite100 .T=- "' Boston,MA 0311 2017 < ir www.massgov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERK LTFING AUTHORITY. Applicant Information Please Print Let ibly Name(Business/Organization/Individual): S 06.th e/',.. ke U..) till/6.„7,1 O i A 4,111.6 Address: /O 4er tJDt r ?4 • el/ 7 Phone#: 5/4/—ZZ -- `� S t City/State/Zip:S nt r del J�'! 4Z4 l Are you as employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with ZO'remployees(full and/or part-time).g7. New Construction ant a sole proprietor or partnership and have no employees working forma in 8: Remodeling any capacity.[No workers'comp.insurance required] ❑ 3. I am a homeowner do all work myself * 9. ❑Demolition ❑ doing y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on mY PtopenY- [will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors wish no employees. 12.[ Plumbing repairs or additions .- 5.0 Ian a general contractor and I have hired the sub-contractors listed on the attached sheet D These sub-contractors have employees and have workers'comp.insurance.: 13. 5pof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MG[.c. 14. Other 4v/i1 K.Bi./ 152.¢1(4).and we have no employees.[No workers'comp.insurance required.] reply(/••h 1ih-tS 'Airy applicant that checks box el must also MI 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 contractots 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 subcontract or have employees,they must provide their wodeers'camp.policy number. I am an employer that is providing workers'compensation insurance jor my employees. Below is the policy andJob site injormation. Insurance Company Name: cl red eft 5 7;ksurame_ a . of Wig, U. C . Policy#or Self-ins.Lic.#: FICA 3/58 7n ?p?X • Expiration Date: I' /—21)LO Job Site Address: 9 -/Gcaour a'( ( R.,,,,j,,c i City/State/Zip: S G7"d,f1- "i4 Attach a copy of the workers'compensation policy declaration page(showingthe policynum r and expiration p n 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 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifihation. I do hereby wider the p pe.cennalties ojperjury that the Information provided above is true and correct Signature: Date: 7-/7 -/9 Official use onlyy. Do not write in this area,to be completed by city or town o fficiaL 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 IContact Person: Phone#: ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 PHOE 1401 Lawrence St., Ste. 1200 rcN: i No.Egli 303-988-0446 A FAX Not:303-988-0804 IL Denver CO 80202 ADDRESS: COMail©cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC 4 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. I POLICY EXP N SR TYPE OF INSURANCE pINSD DM INVD POLICY NUMBER (�LIM9NIDWYYYY) nismooryrm LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1HI2019 1/1/2020 EACH OCCURRENCE 5 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 5 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: $ 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 X NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $15.000,000 DED X RETENTION$0 $ g WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X PER ' O H- AND EMPLOYERS'LIABILITY Y/N STATUTE 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 $1,003,000 If yes,describe under DESCRIPTION OF OPERATIONS below El.DISEASE-POUCY UMIT $1,000,000 C Pollution Liability 7930073340000. 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate 52,000,000 Retroactive Date 06/202013 Deductible 525,000 DESCRIPTION OF OPERATIONS I 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 puTHORIZEDREPRESENTATIVE 5 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD