Loading...
HomeMy WebLinkAboutBld-20-000964 .Office Ilse Only • Permit# • oti- Amount gO ASy�"w ep: Permit expires 180 days from • eC.1 -R4q issue date EXPRESS BUILDING PERMIT APPLICATION�� ���� TOWN OF YARMOUTH f a° - ----.�p t Yarmouth Building Department E I V 1146 Route 28 South Yarmouth,MA 02664 R (iG 1 20 jy (508)398-2231 Ext. 1261 g „,a,,LJ 1 C571.1 U D R T `--1 CONSTRUCTION ADDRESS: y/ Del) tr/�// i�er \,) — ��E Nr ASSESSOR'S INFORMATION: Map: Parcel: . OWNER: '72t.ctilr♦ y/ •1/> 'Grrw 1 -f M4 d267s ..S' dZS-'.-SYR 3 NAME D ' TEL. # EmaitAddres CONTRACTOR:curthifn l f+ WiAWpWs si/. 7 2/c/ /`�-r D /7 CP1) 22r-lit" NAME MAILING ADDS TEL•# Email Add Residential Commercial Est.Cost of Construction$ 2Gi ton Hoare Improvement Contractor Lie.# /7 3 2.'/5- construction Supervisor Lic.# 0 767D 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: f�2ex.6R)S 1VS- Cpj1nJ•- Worker's Comp.Policy# /A)CA 316r 72 0.-zq WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# /G1 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation D) JaY )Id Sings H'i�ghway/Hlstoric Dist (v1 eplac ing like for like cia\.5c-;X\e S rr wed-Ec eg & 4- i 0 *The debris will be disposed of at ith JIe /sn.c ((.P,.+o... ---, ` 'e- 22-_—_ f iacetion of Facility I declare under penalties of perjury that the scat -,i.herein contained are true and correct to the best of my knowledge and belief. I understand that any false answers; will be just cause,for denial ocrA aLon nr •a,-.and for prosecution under M.G.L Ch.268,Section 1. Applicant's Signature: Date: g --21-J- Q U r Date: Owners Signature(or attachment) 41' - ' i'- G '�� Dare: -�l i ) Approved By: / ;4 I� Building Official(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 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 :, 20M-05/17 .f//B /Y77/7�/YI.CL'Pq.zef' ��Zi-//LC�.IGICCGi 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: Reaistration Expiration Office of Consumer Affairs and Business Regulation 17324& _„ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretaryv without signature :om ci Ms Division of ProfessionalmonWeaithfas Licensurachusettse Board of Building Regulations and Standards Construct on S pervisor CS-095707 f i res: 09/08i 0 0 BRIAN D DENNISON -- 8 BLACKWELL DRIVE CHARLTON MA=01507 Commissioner L Renewalw�A Agreement Document and Payment Terms ~ rn' dba:Renewal ByAndersen of Southern New England$I Barbara Buchner Legal Name:Southern New England Windows,LLC 41 Debs Hill Rd. �� �._ 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)259-8493 Phone:401-349-1384 1 Fax:401-633-6602 I sales@renewalsne.com C:(508)259-8527 Buyer(s) Name: Barbara Buchner Contract Date: 08/09/19 Buyer(s)Street Address: 41 Debs Hill Rd., Yarmouth Port, MA 02675 Primary Telephone Number: (508)259-8493 Secondary Telephone Number: (508)259-8527 Primary Email: briarcliff17@gmail.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: $26,606 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: 513,303 Balance Due: $13,303 Estimated Start: Estimated Completion: Amount Financed: 526,606 8 to 10 weeks 8 to 10 weeks 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: Taxes paid in 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 08/13/2019 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 I By Andersen of Southern New England Buyer(s) ,4 / Signature of Sales Person Signature Signature Gino Montesi Barbara Buchner Print Name of Sales Person Print Name Print Name UPDATED: 08/09/19 Page 2 / 15 _ The Commonwealth of Massachusetts y —'' Department of lndustrialAccidents z1�ri- L. �"=ier_= 1 Congress Stree4 Suite 100 • -� Boston,MA 02114-2017 �..,r,,.r� www.neassgov/din Workers'Compensation Insurance Affidavit"Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMLTFLYG AUTHORITY. Aaoliant Information Please Print Letibly Name(Business/Organization/Individual): S bet,j,`et w Aka) t/lQ/b4 110i n 4r:� Address: /6 e Se.r UOl r 74 . J tY pS ►-6del t OZ l v Ci /State/Zi : �tj � 7 Phone#: y0/—2.Z�— `� Are you as employer?Check the appropriate box: Type of project(required): 1. lama employer with 74" 'employees(full and/or part time).• 7. 0 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. I am a homeowner doingall work myself 9. 0 Demolition ❑ y [No workers'comp.insurance required.]'' 4.❑ my property. [will I am a homeowner and will be hiring contractors to conduct all work on 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11 0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 tam a general contractor and I have hired the sub-contractors listed an the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'camp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. tllef / i n�,f ✓ 152,1((4),and we have no employees.[No workers'comp.insurance required.] rep kfce--,C.k.IS 'Any applicant that checks box#I 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 otetside eantract=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 infornratioic Twa,ue /� 'I fInsurance Company Name: rc�e 1 . of Wt�- b. C C . I polies-,#or Self-ins.Lic.#: (A)C4Mat o 90?/ • Expiration Date: /- /—2.0 L.O Job Site Address: 14 I D toS 1-1;1 l / City/StatelZip:)�f ,.-ki ii I Attach a copy of the workers'compensation policy declaration page(showing the policyiumber and expiration ion 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance coverage veriffcation. I do hereby ce ' under the p ' penalties of perjury that the information provided above is true and correct f I• D ef- Phone#: 1.01 —7.7 9 ee 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#: I ACCAR EA CERTIFICATE OF LIABILITY INSURANCEt �TE(MMIDD/YYYY{ `"f 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 NAME:PHONE 1401 Lawrence St., Ste. 1200 (Am.No.Ext): 303-988-0446 FAX No):303-988-0804 Denver CO 80202 E-MAIL COMaiI@cobizinsurance.cam _ INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURERS: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. ILTR TYPE OF INSURANCE ANO,D�L SIMVD POLICY NUMBER 1 POLICY EFFY1 ( cCYY 1 UMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 MAGE TO REND CLAIMS-MADE X OCCUR PREMISES(Ea occururrrence) $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 JE 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.D00.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE — AUTOS (Per acciden0_ $ _ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$d $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X AND EMPLOYERS'LIABILITY Y/N ST TUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a N I A E.L.EACH ACCIDENT $1,000,000 _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate 00 Retroactive Date 06/20/2013 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 I Ai ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD