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HomeMy WebLinkAboutBld-20-002482 O* `` CTffcot''saOnly 4 _j am C Permi* g. 4 C -a)— C,W 2- Amount 5 v I� J il a vo. Permit expires 180 days from 3 115 I--\-eCk� 1fit"(,w0� issueda� EXPRESS BUILDING PERMIT APPLIC. w 1 TOWN OF YARMOUTH - VED—._._____..—_ __ Yarmouth Building Department O C T 2 2019 1146 Route 28 South Yarmouth,MA 02664w__. (508)398-2231 Ext. 1261 B` `y 7 t4Y CONSTRUCTION'ADDRESS: rd�P_ 1.e.rid er Inn 4-ea-lhertobaci 1)6 re, • - ASSESSOR'S INFORMATION: toll f tl y 1.cJ Ci Map: Parcel: • OWNER: qf.A 7(dc/er /Gb{4>fler ir.D�r:131/S /,t/'inv..-4/Zfi r`19 01.(0 7 5 -5 -3 ,Z- 0 37 NAME ff-- t.-, ff /OH Fd ( Ta. * �maitAddre: CONTRACTOR::n�IPtA N r OutothiP' `�iMAII�NG D�tES3 243/7 `P) 2 ta0 ��TT Email Adc Residential.) Commercial Est.Cost of Completion$ --7,2.€1 7 -- Home Improvement contractor Lic.# 17'3 2.45" Construction Supervisor Lic.# oq 7D 7 Workman's Compensation Insures (check one) I am the homeowner I am the sole proprietor )4 have Worker's Compensation Insurance Insurance Company Name: rP 4 1 uS. 1.07x)1 Worker's Comp.Policy* CA 43I6872 azi-i WQ11K'O BE PJ.FORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# 2— Replacement dodrs: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation rYV OId Kings Blighway/Hlstoric Dist. ( ) leplaang like for like The debris wtU be disposed of at £h de /44,,a (Pam.v^�_ -1 e.("' (P_r cstiun of Facllltc f I declare under peaaides.ofpeojury the , , herein contained are true and connect to the best dray knowledge and belief. Iunderstand that any false answer(1 will be just cause for denial ,.:,, of,, and for under MILL.Ch.US,Section 1. Applicant's Sigma= lex - Dt /0-.23 - /9_ Owners Signature(or attachment) 4C / �G� r Approved By. " ' � Date: /c '_�• —/l (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 Andersen' dba:Renewal ByAndersen of Southern NewEngland Page Kidder Legal Name:Southern New England Windows,LLC 100 Heatherwood Drive apt 3115 11 \ y RI#36079,MA#173245,CT#0634555, Lead Firm#1237 YarmouthPort,MA 02675 WINDOW aE uCEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)362-0379 Phone:401-349-1384 I Fax:401-633-6602 I sales®renewalsne.com Buyer(s) Name: Page Kidder Contract Date: 10/12/19 Buyer(s)Street Address: 100 Heatherwood Drive apt 3115, YarmouthPort, MA 02675 Primary Telephone Number: (508)362-0379 Secondary Telephone Number: 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: 57,297 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: $2,432 Balance Due: $4,865 Estimated Start: Estimated Completion: Amount Financed: 7-9 weeks 7-9 weeks S0 Method of Payment: Credit Card 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 deposit,1/3 at start,1/3 at completion 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 10/17/2019 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.Ren d n of them New England Buyer(s) t45� �� A30._r Signature of Sales Person Signature Signature Paul Sandrey Page Kidder Print Name of Sales Person Print Name Print Name UPDATED: 10/12/19 Page 2 / 10 z7-7 '/,)9 2,71z- it-L /? / 77 •z/- / > 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�-05/117/7�� //"s 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 173245. 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS, LLC Boston,MA 0211 r:.......2:.......,..- 1 \ BRIAN DENNISON 2„ 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary M., . without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards - - Constructs'onfSupervisor CS-09 70 -4 • E p i res: 09/08/2020 -- ' BRIAN D DENNISON I 8 BLACKWELL DRIVE _; CHARLTON MA:-01507 ''•- Commissioner CAL gatis- - . The Commonwealth"of btilassachusetts � � - .Department of lndustiriaiAccidents -��--.+ 1 Congress Street,Suite 100 .= Boston,M.4 02114-2017 ^_ _ www.nrassgov/die Walters' Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT['L•YG AUTHORITY. Antilles at Information ! Please Print Legibly Name(Business/Organization/Individuai): S U(s..f'h e,f r Ne tf.) till/C &O i A dt)//j3 Address: /C} 4e.�'U it O/ 1`ei . �J p S ►-ai etc/r!?t 049 l City/State/Zi : �( 7 Phone#: 4/0/—ZZ g--- ? E.-06 Ara yen an employer?Check the appropriate box: Type of project(required): t. t am a employer with 20'femployees(full and/or part-time).*2 7. New construction ` am a sale proprietor or partnership and have no employees working forme in 8: 0 Remodeling any capacity.[No workers'comp.insurance required] ID I am a homeowner doing ail work mysel£[No workers'comp.insurance required.]* 9 ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all wodcon my10 p Building addition g property. C will ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions proprietors with no employees. [2.0 Plumbing repairs or additions 5.0 tarn a general contractor and[have hired the sub-contractors listed art the attached sheet [3.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 [Other c. -' 152,f 44).and we have no employees.[No workers'comp.insurance required] re DT,r re-'G--t`f-- 'Arty applicant that checks box S t 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. :Contactors that cheek this box must attached an additional sheet showing the came of the sub-contractors and state whether or not those entities have employees. Iftha 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: T-t refire,, l;vr LIca i _ a - or W,4i b. C C . Policy#or Self-ins.Lic. #: (A e•A�.3 "pr ]a 90?y • Expiration Date: /" /"2D LO Job Site Address: /r v f ' r•,-.,,.,o0/ Dr. 13/i S City/State/Zip: `�'r Lam` rf/- '-t A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data). 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 verih'hation. I do hereby ce ' under the p penalties of perjury that the information provided above is true and correct Signature: J Date: /0 —oZ 3-/ Prone#: 10 f '-ZIT.-t-- 9 d w 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#• /11. ' l � „� OIY re'', i MMlD ACo. : CERTIFICATE OF LIABILITY INSURANCE DATE 12(MAIDola 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 NAME: COBiz Insurance, Inc.-CO PHONE FAX 1401 Lawrence St., Ste. 1200 INC.No.Extl: 303-988-0446 JAJC,Nol:303-988-0804 Denver CO 80202 ADDRESS: COMail©cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIL INSURER A:Acadia Insurance Company 31325 INSURED ESLERC0.01 INSURER B:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC. dba Renewal by Andersen of Southern New England INSURERc:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURERS: 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.SUBR . POLICY EFF POLICY EXP LIMITS LTR /NSD MD POLICY NUMBER IMMIDDIYYYY),/MMIDDIYYYY} A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S 300,000 - MED EXP(Any one person) $10.000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY JEc LOC PRODUCTS-COMP/OP AGG $2.000.000 • . OTHER: _ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE UMIT S (Ee accident) 1.000400 X ANY AUTO BODILY INJURY(Per person) $ - ALL OWNED - SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE gXH HIRED AUTOS X UTOS (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 RETENTIONS a - S B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X s nTUTE • ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Uabllity 7930073340000• 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000.000 Retroactive Date 06/20/2013 Deducible $25,000 DESCRIPTION OF OPERATIONS f 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 A) I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD