Loading...
HomeMy WebLinkAboutBld-20-000983 ' .of cc L'sa�Only O ' is y �-i� Amman, ta ti`" AT to Permit expires 180 days from '< -O issue date tiPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department d� 4+0°, 1146 Route 28 E` S©uth Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION-ADDRESS: 3 7 a.• ✓ ((a e . ASSESSOR'S INFORMATION: • Map: Parcel: ),9/' • OWNBR:Aka Al Wild' 3 7 SeQ,_(//kegeg� S•A o G• NA f22ALW Sop- 760/2-6, NAME 10 P D 1 TEL # EmailAddre: CONTRACTOR:± rn 0.A. (them �SM7,-0,, e" r 7 C /) c30 22'—• t Email Adc �`C s1 Est.Cost of Con acdon$ I Li(4 3 Ho Improvement Contractor Lic.# 17 3 2.45" CoastrmcdonSupervisor Lk.* 0g67D 7 Workman's Compensation Insurance` (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: r1�T. IJt$ INS. Co js) I Worker's Comp.Policy# 1A)CA.(6T q.21-4 WOK.TO lip itERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: it of Squares Replacement windows:# I Replacement doors: # I Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Sings H'ighwaylHistoric Dist. ( )replacing like for like *The debris will be disposed of at: ty R,ie e4 cn s ``,P O S;''e!47r irbtx�►a of Fac43tc I declare ender penalties.of perjury that the }: „ . :herein contained are true and correct to the bast of my knowledge and belief. Iunderstand that any false answer° will be jest cruse for denial as uryocaian of,.% se and for under Iv1.G.l-Ch.268.Section 1. Applicant's Sigma= �tYl� " Date: //- /S -/`1' Owners Signature(or attachment) 'IlC See- ,- ►t...; Date: Approved By: Building ) .01 • • 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' dbaz Renewal By Andersen of Southern New England William Hart Legal Name:Southern New England Windows,LLC 37 Seai Vitae Rd � RI #36079,MA#173245,CT#0634555, Lead Firm#1237 South Yaouth,MA 02664 WINDOW NE uccreNn 10 Reservoir Rd I Smithfield,RI 02917 H:(508)760-1266 Phone:401-349-1384 I Fax:401-633-6602 I salesOrenewalsne.com Buyer(s)Name: William Hart Contract Date: 11/01/19 Buyer(s)Street Address: 37 Seal Villae Rd, South Yaouth, MA 02664 Primary Telephone Number: (508)760-1266 Secondary Telephone Number: Primary Email: vgreenmotel@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 theparties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate fter Contractor has completed all work under this Agreement. Total Job Amount: $14,938 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: $4,978 Balance Due: 59,960 Estimated Start: Estimated Completion: Amount Financed: S0 7-9 weeks 7-9 weeks 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,1/3at 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 1.1/05/2019 OR THE THIRD BUSINESS DAY AH 1'ER 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:Re al y of Southern New England Buyer(s) Signature of Sales Person Signature Signature Paul Sandrey William Hart Print Name of Sales Person Print Name Print Name UPDATED: 11/01/19 Paget / 10 --)%f:2'7'7.? `'_ r, J f� 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 f C� 20M-05/17 Te ivninanrc q.z of //2:��u ioiclGi 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 ALCC-Qx --- 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construtfon Supervisor CS-095707 E--p i res: 09/08/2020 BRIAN D DENNISON --- - 8 BLACKWELL DRIVE ; :' -� CHARLTON MA 0150T _1 Commissioner The Commonwealth of blassacirusetts te r:..L- Department of Irsdust iad Accidents ' t I Congress Street,Suite 190 -.t..**--7" ^y Boston,MA 02114--2017 -,..,,. .7'url� www.mass_gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMI rING AUTHORITY. Applies at Information Please Print Legibly Name(Business/Organiration/lndividual): S U(, her 1ft..- N}e bl:} tnq I G� 111('tYws Address: /O Ser UD/t J tY P S -6 de Pt OZ Ci /State/Zi : ni 17 Phone#: 4O l—ZZ g'-- v Are you as employer?Check the appropriate box: Type of project(required): L, l am a employer with 2 +-employees(full and/or part-time).' 7. New construction ` am a sale 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 m selE 9. ❑Demolition ❑ y [No workers'comp.insurance required]'' 4.❑1 am a homeowner aridmy PRY-will be hiring contractors to conduct all wortcoa L will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.C7 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed an the attached sheet These sub-contractors have employees and have workers'camp.insurance.t 13. Rpof repairs ��Jo 6.0 We ace a corporation and its officers have exercised their right of exemption per MGL c. 14.,T�,Outer NJri1(,f/%/8 152.§L(4).and we have ao employees.[No workers'comp.insurance required.] r �if("en ie•'t `Any applicant that checks box MI 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 coat acmrs must submit a new affidavit indicating such. ;font actors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. IPthe sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that is providing workers'compensation insurance for my employee.. Below is the policy andJob site informadioic Insurance Company Name: Tl re:Will Lf$ (1/1 d:2 - Or UM, B. C . Policy#or Self-ins.Lic. #: ( )CA 3I5 ]a ?p2 y • Expiration Date: `- /"2.0 LO Job Site Address: .3 7 ; i 1 J/a e RoC - . City/State/Zip: Sl. ' vi ail H,4 date). a copy of the workers'compensation policy declaration page(showing the policy number and ex iration d . Failure to secure coverage as required under MGL c_ 152,§25A is a criminal violation puniahrble 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 DiA for insurance coverage veri tt�atiion. I do hereby ce under the p ' penalties of pe ury that the information provided above is bug and correct t S ignatltre: Date: //-/?-/el Phone#: 101 2:24----- 9 0 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License ii Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrfown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone!i: AC RE) CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY, • -' 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:O 1401 Lawrence St., Ste. 1200 INC.No,Ext): 303-988-0445 .1,vE No):303-98B-0804 Denver CO S0202 E-MAILDRESS: COMail@cobizinsurance.com INSURERS)AFFORDING COVERAGE NAIL M _ 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 INSURERD: 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 SUER . POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER ,IMMIDD/YYYY1 IMMIDDNYYY) LIMITS A )( COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/112020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE -X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) S 10.000 PERSONAL&ADV INJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT LOC PRODUCTS.COMP/OP AGG S 2,000,000 • OTHER: A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT S Me accident) , I.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) S A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000 DEC) X RETENTIONS 0 g B WOAND EMPLOYERS LIABILITYTION YIN WCA315872924 1/1/2019 1/1/2020 ` X S TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Ej E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1.000,000 I/yes,describe under DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT S 1.000,000 C Pollution Liability 7930073340000. 1/1/2019 1/1/2020 Each Occurrence S2,000,000 Claims-Made Policy Aggregate $2,000.000 Retroactive Date 06/20/2013 Deductible 825,000 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD