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HomeMy WebLinkAboutBld-20-002483 s s,�_ Office lira Only • ,�°,�,1��a Permit • OC° Amount.' / D { /y � ,,,,�.>;_t3� Permit expires ISO days from BC-D- °---.zy�3 issue date • EXPRESS BUILDING PERMIT APPLI a ' ~'II:Au; Ei V E TOWN OF YARMOUTH Yarmouth Building Department OCT 2 3 2019 1146 Route 28 South Yarmouth,MA 02664 B u 1t. `r �-'�,� T-' n 1 (508)398-2231 Ex1261 CONSTRUCTION ADDRESS: 1/ r'O r Zf ✓ f i ASSESSOR'S INFORMATION: Map: Parcel: • OWNER: ito %.a c //S it is/smo ai, 7;r4rfiloviliPort�14 A c0I.&rc 5 6E-S62- /2G 5' NAME 10 D � TEL # Email Addres CONTRACTOR: estst6A rJ.A C /u 4 SM. -pc-efdf graz9/7 &') 22 B=98" AME MSG ADDRESS TEL.# Email Add Residential___). Commercial Eat.Cost of Construction$ C; 1 6 R Home Improvement contractor Lie.# (7 3 2.'15 Construction Supervisor Lie.# 076-76 7 Worltman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: R 6A) ' liaS Worker's Comp.Policy# bi.)CA•aI6r72 8,2L/ WORK TO BE PERFORMED Tent Duration (lire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# 3 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_____ k)`°I 6 d Kings Highway/Historic Dist. ( • ),Replacing k�er e �S\ b' '0 I, 4'o� 11/s klec.r-ob‘.o0S.r.-- a ccu4..ieo.)'s Az l'.a sess noJ r•s•tke s *The debris will be disposed of at: Wh de /✓lam.►a (�..•o ff_ it /'"•e(I 9_r iLation of Facility I declare under penalties of perjury that the r,,. herein contained are tine and correct to the best of my knowledge and belief. Iundetstand that any false answers; will be just cause for denial of my V and for prosecutfionunder M.G.L.ch.268,Section 1. Applicant's Sigma= Date: /D c1 " /9 Owners Signature(or attachment) aC See-*tadr iI °l ve r Date: Approved By: ./�ri -% za. 3-7 Buil-.• •1Tr 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 "i Andersen. dba:Renewal By Andersen of Southern New England Nancy Deshaies Legal Name:Southern New England Windows,LLC 11 Portsmouth Terr 0.117 it RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Yarmouth Port,MA 02675 WINDOW NE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)362-1265 Phone:401-349-13841 Fax:401-633-6602 I saleserenewalsne.com Buyer(s) Name: Nancy Deshaies Contract Date: 09/19/19 Buyer(s)Street Address: 11 Portsmouth Terr, Yarmouth Port, MA 02675 Primary Telephone Number: (508)362-1265 Secondary Telephone Number: Primary Email: ndeshaies@comcast.net 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: $5,968 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: $1,989 _ Balance Due: $3,979 Estimated Start: Estimated Completion: Amount Financed: November 20,2019 November 20,2019 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 credit card, 1/3 cash and 1/3 cash 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 09/23/2019 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:Ren wal By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature John Harrington Nancy Deshaies Print Name of Sales Person Print Name Print Name UPDATED. 09/19/19 Page 2 / 12 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 scA i c, 20M-05i17 / Update Address and Return Card. Te Fivn/17tWaVe¢C!C 6,1 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: Reaistratio_q 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 !Q 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary NJ without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-09 70 Epp i res: 09/08/2020 BRIAN D DENNISON -. / 8 BLACKWELL DRlVE , -= CHARLTON MA 01507 • t T,a„'( 1 Commissioner CAL h. • The e Commonwealth of Massachusetts : Department oflndustrial Accidents -ieF= - 1 Congress Stree4 Suite 100 • -:, '.;4 Boston,MA 02114-2017 ':. '� www.mass.nov/din orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER_ILIITINC AUTHORITY. Annfic.ent Information Please Print Leaib[v Name(Business/Organization/tndividual): S b(x`Ij'h e rj. A.)e LL,) ti) / 10/A 4 i](,v.$ Address: /O et-UDl,- J pS -( elel Ill OM l�City/State/Zi : n�t 7 Phone#: 5/O/—ZZ�— Are you an employer?Check the appropriate box: Type of project(required): t. I am a employer with 20f employees(full and/or part-time).* g 7. 0 New construction am a solo proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.[No workers'comp.insurance required] ❑ 3.1=1 I am a homeowner doing alt work myself[No workers'comp.insurance required.]: 9. ❑Demolition 4.❑tam a homeowner and will be hiring contractors to conduct all woricon my PropenY- t will ](]❑Building addition ensure that aR contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions • proprietors with no employees. 12.0P[umbing repairs or additions 5.0 Lain a general contractor and I have hired the sub.conaractors listed an the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: /J 6. We are a corporation and its officers have exercised their rightI4• Other led Yr/may y/ of exemption per MGL a 152,f l(4).and we have no employees.[No workers'comp.insurance required] rese4r-t neTie 'Arty applicant that checks box pi must also till out the section below showing their workers'compensation policy intbnnation. • t Homeowners who submit this affidavit indicating they are doing all work and then hire outride contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contactor end state whether or eaten entities have employees. Hrha sub-wttotactom have employees.they must provide their workers'- ..policy number. I am an employer that Is proadding workers'compensation insurance for my employees Below Zr the policy andjob job site information. Insurance Company Name: '7"Il' • aA a _ pr Wf[l b. C . Polies k or Self-ins.Lic. it: L1CA345?72?a • Expiration Date: /- /-2 D LO Job Site Address: 1/ �n r74S/P1D(/4l"1 Tr'r` City/State/Zip:/Qi>•+a.,r/ f-1/4• Attach a copy of the workers'compensation policy declaration page(showing the polity bomber and expiration 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 imprisbnment,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 vton. f do hereby ce - under the p penalties of perjury that the inform adoul provided above is true and correct Signature: J Date: /0 - 1—/9 Phone#: I Q/ *-2..24— 9 .00 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/: ACGR CERTIFICATE OF LIABILITY INSURANCE OATSIMM/CO/YYYY1 i 12/28/201 3 1 j 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: 1401 Lawrence St., Ste. 1200 PHONE No.Est): 303-988-0446 FAX Nol:303-988-0804 IL Denver CO 80202 ADDRESS: COMail©cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER 3: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 ADM SUBR . POLICY EFF POLICY EXP LTR INBD I WD POLICY NUMBER IMMIDD/YYYY► (MM/OD/YYYY) UMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE I 1,003000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED - PREMISES(Ea occurrence) S 300,000 - MED EXP(Any one person) 5 t0,000 _ PERSONAL A ADV INJURY $1,000,000 GEN'L AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE 3 2,000,000 X POLICY JEa LOC PRODUCTS-COMP/OP AGG $2,000,000 • OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 I 1/1/2020 COMBINED SINGLE UMIT e (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ANON-OWNED PROPERTY DAMAGE X 1 HIRED AUTOS X AUTOS (Per accident) $ S A X UMBRELLA LIAB X OCCUR CP/1315872B 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTIONS o $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/t/2020 X INTUIT I ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N❑NI A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY UMIT $1,000.000 C Pollution Uabilly 7930073340000. 1/1/2019 1/1/2020 Each Occurrence S2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/2012013 Deductible 125,000 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 !A)) 54/fir yl9i . I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD