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HomeMy WebLinkAboutBld-20-002951 : .. .C cc Ilse Only . ,ice' • ,, y�,xrr,., OS d� . Amount ♦ • .9 �� �� Permit expires 180 days from• issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH • ,` `, Yarmouth Building Department , *4k A419 kOe0 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 2 2- Tir.n�U i I Ti11; • ASSESSOR'S INFORMATION: Map: /2 Parcel: /p - OWNER .Su-San 3erl i,n ,.,2,2. Z ; I T '/-vw c r( 11.A D.2-H 7 S i o£- 37;-17 99 / NAME /0 ,SEP✓vD�c('•t TEL. # Emalt Addres CONTRACTOR:„, Aai J n W.A. ( f/to PU>s Sini:I/-1-# e/cf /'L o29i7 - ( ) 2 �-98eX AME MAILINGADDRESS Tom-# Email Add =..)-ResidentialCommercial Est.Cost of Construction$ 2-Cj Zoo Home Improvement Contractor Lie.# 17 c3 lair Construction Supervisor Lie.# °767D 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor1� A have Worker's Compensation Insurance Insurance Company Name: r1'�f LA).S 1 PS• l..0T1 '! Worker's Comp.Policy# )C .3t68'72 S .i4 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares - Replacement windows:# Replacement doors: 3 Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like ' - // off._ Si;-l�i4 (4�Lr *The debris will be disposed of an W�de �icn.c ((•Pi"► o Upen ion of Facial i declare under penalties of perjury that the ,. -,,:herein contained are true and correct to the best of my knowledge and belief. I understand that my false answers; will be just cause for denial or,�wpa ation of mi ,.. se and for prosecution ender ML Ch.1b8.Section 1. 2 Applicant's Signature` Date: Date: ', /t—(Gl Owners Signature(or attachment) 41 See- Af47 Date: Approved By: Date: 4 '.g-2-'7 1>------ Building Official(or ) Zoning District Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No • k° -: TOWN OF YARMOUTH 0. i 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 _, Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 i C I sh "'D 1 OLD KING'S HIGHWAY HISTORIC DISTRICT COMM NOV - 7c-, J APPLICATION FOR YAKIVIUU I h CERTIFICATE OF EXEMPTION OLD KING'S HIGHWAY Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work: a - 1 RA-J 1, .� 1 L. Map/Lot# Owner(s): SUS an E3e-r'\ln Phone#:3'08'.57.5 VT q I All applications must be submitted by ow er or accompanied/ by letter from owner approving submittal of application. Mailing address:2Z Tfbnpk fl rt, Qrfnoi ?rfit Al 02.(7� Year built: / Tel 1- Email: Preferred notification method: Phone Email Agent/Contractor: Andy S W Sou;-+l'IErn N_e, W to c10 W S Phone#: 1OI-7rg 4391 Mailing Address: /0 1�eservol r Ind smr1hP,ild RI 0.2117 Email: t1 Su t ¶q5 kyna II . COfi Preferred notification method: Phone ✓ Email Description of Proposed Work(Additional pages may be attached if necessary): In sT)w Ci R'pIaeemetri front cry .laoor„4s per ,v�ritei.eIj1/uTrc frw . actor : 1-dresr G irer� , dR(6 'color is l ietc�) , i cte_en &t c A� A- eite� f litis7reel7rA, t u.�r,�-� �� l�e�acem�eK� �f r � 0 totr ; f"f.1rect c7 ree,A..:(pr13(net--t c oiotr 1.5 1 I p. C' ' i'1t +�1pI e f cer W,..,° forl� t°`� .P 5 ' Nn cc n Ps— s Signed(Owner or agent): . �e;i fii,V Date: !r/4//q Mil > Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.) This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: Date: II— 7-1 q /Approved Approved with changes Denied Amount Reason for denial i a� 1 f ___ D ) Cash/CK#:19 0 7` Rcvd by: L OLD KiIRt;'�HIGHWAY Date Signed: /1 4 2 2,O/9 Signed: 67 APPLICATION#: i 7^L-/t, 'y V5.2017 c-' r - Renewal Agreement Document and Payment Terms ''Andersen. dba:Renewal By Andersen of Southern New England Susan Berlin � � � Legal Name:Southern New England Windows,LLC 22 Tranquil Trail _ RI #36079,MA#173245,CT#0634555, Lead Firm #1237 Yarmouth Port,MA 02675 WINDOW NE LACENENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)375-9991 Phone:401-349-1384 I Fax:401-633-6602 I sales®renewalsne.corn C:(973)477-0235 Buyer(s)Name: Susan Berlin Contract Date: 08/29/19 Buyer(s)Street Address: 22 Tranquil Trail, Yarmouth Port, MA 02675 Primary Telephone Number: (508)375-9991 Secondary Telephone Number: (973)477-0235 Primary Email: susanberlinlgmail.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 ter of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agr es G.�/ Z- 'D to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amou Wait 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: $27770 Balance Due: 457542 Estimated Start: Estimated Completion: Amount Financed: SO 6-8 weeks 6-8 weeks Method of Payment: Cash/Check We schedule installations based on the date of the signed contract and secondarily on CV J1I Tr the date in which we complete the technical measurements.The installation date that 'T I 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 m delay. Notes: Deposit on check # 1830, permit on check as well, in Yarmouth. 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 09/03/2019 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 B/yAndersen of Southern New England Buyer(s) lBL Q l� 04.5�t7"lt- -_, Signature of Sales Person Signature Signature Allan Langer Susan Berlin Print Name of Sales Person Print Name Print Name UPDATED. 08/29/19 Page 2 / 12 9/30839 lR,'e��newa l -4 HIC 05627255MA HI#119535 • byA idersen - Lead Hazard Control Firm W INDDW eEPL�CENEMT :i•a.�-..nv-.+I.nv License#LHCF-0059 Renewal by Andersen of Southern New England Federal Tax ID#46-0566630 10 Reservoir Road,Smithfield,RI 02917 Contract Amendment This Amendment("Amendment")is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT("Agreement")by and between Southern New England Windows,LLC.dba Renewal by Andersen of Southern New England and Susan Berlin (buyers).Contractor and Buyer(s)hereby agree to amend and modify the Agreement as indicated below.Other than as specifically indicated below,all the terms and conditions of the Agreement will remain in full force and effect.This Amendment is subject to the terms and conditions of the Agreement. The following is an addgQdwm tashe Ageement dated: 08-29-19, Customer is adding one perms shield 3-panel patio door on the back of the house,as well as as another entry door and storm door.Customer is also changing the colors of I each door to Forest Green.Hinge sides are attached and confirmed by customer. New 1/3rd deposit will be S6,732,which means customer will mail in a check for$3,962 to be added to original deposit of$2,770. 0.4 Loy-} ✓ Wr'r 4"Ci. cker 5 )9-72 0 -y- Original Contract Price: $8,312 New Contract Price: S20,200 Financing Approval Amount NA Method of Payment(if other than finance): Check .._..__._....... It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment.Buyer(s)hereby acknowledges that they have read and agree to this Amendment on the date written below Disclaimer for customers with obtained Greenskv financing. Buyer acknowledges that if original contract amount has increased due this Amendment,that within 24 hours of this Amendment,Southern New England Windows LLC,dba Renewal by Andersen of Southern New England will contact Greensky to increase loan amount.The buyer(s)are responsible for contacting Greensky to confirm any change to funding. Greensky Financing Customer Service Phone Number(866)936-0602 You are hereby agreeing to all changes listed above and further certify that Greensky has been made aware of any financing changes as a result of this amendment. Title Name Date Renewal by Andersen Project Consultant Allan Langer 08-20-19 Buyer(s) Susan Berlin 09-08-19 Buyer(s) �'/`i'G' /i '.7i% " %7i/ 'Y /i 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-05/17 :T6 iCY77/19197.1G'P.2C!/, 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: Reaistratiorl gxairation Office of Consumer Affairs and Business Regulation 17324S 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON A°Q,-C - 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constru f'onSupervisor CS-095707 E p i res: 09/08/2020 BRIAN D DENNISON F._^3 8 BLACKWEL!DRIVE ; -' - ,r CHARLTON MA =01507 tea ,. ,. 1 Commissioner CA" • L _ The Commonwealth of Massachusetts �` � ;�'- Department of IndustrialAccidents 7.' j = 1 Congress Street,Suite 100 ' Boston,MA 02114--2017 ., www ntassgov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plambers. TO BE FILED WITH THE PERMLTTI NG AUTHORITY. Aaoliant Information ,, ll Please Print Legibly Name(Business/Organization/Individual): S oc,.-t'h e f y Net~) ti)p!G //)4t]it].S Address: 10j ,4e r UDt r i 4 • J City/State/Zip:Sp,liii-a7e1e/tl?! DLq /7 Phone#: 40/-2.Z4- 4, to° Are you an employer?Check the appropriate box: �n Type of project(required): i. lam a employer with 20'-employers(firtl andtor part-time).* 7. 0 New construction 2 am a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.[No workers'comp.insurance required] 0 3. I am a homeowner doingall work m selL 9. ❑Demolition ❑ y [No workers'comp.insurance required.] 4.0 1 am a homeowner and will be hiring contractors to conduct all work on mY property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions Proprietors with no employees. 12.0Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per Ma.c. 14. Other Cr+-I cy[(Do C 152,¢1(4),and we have no employees.[No workers'comp_insurance required.] 1,pp/at C._ 'Any applicant that checks box O l 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. :Contractors that check this box must attached an additional sheet showing the name of the n and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that is providing workers'compensation insurance for ny employees: Below is the policy and job site tn,jornmhion. /� Insurance Company Name: 'Tl r� �e Q a . - wA b. a . Policy#or Self-ins.Lic. #: (A1CA N.31,S8"7a ?p?y • Expiration Date: /' /—2 0 L.O Job Site Address: 2- 2 -un u; IC ) City/State/Zip:Kfreiorriqr-f r- A Attach a copy of the workers'compensation Orley declaration page(showing the policy number 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 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 verification. t do hereby c under the p ' 'penalties of petjury that the information provided above is true and correct Signature: — � Date: q—//— /1 Phone#: q01 -LZ 9aw Official use only: Do not write in dais 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#: D• ;AWR CERTIFICATE OF LIABILITY INSURANCEI 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 ^Ij°'" 1401 Lawrence St., Ste. 1200 a NNo.Exti: 303-988-0446 FAX No):303-988-0804 _ Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC#1 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. INSR TYPE OF INSURANCE ADDL SUM' POLICY NUMBER (M II3O/YYYYUCY Y) ( /YYY POLICY Y) UMITS ` A X COMMERCIAL GENERAL LABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $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 $1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY PERC LOC PRODUCTS-COMP/OP AGG $2,000,000 • - OTHER: _ _ I A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE UMIT (Ea accident) $1.000.000 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 accident) $ $ A X UMBRELLA LAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,030,000 DED X RETENTIONS 0 $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 AND EMPLOYERS'LIABILITY Y/N X S ATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? all N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY UMIT $1,000,000 _ C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy AggregatRetroactive Date 08/20/2013 Deduct bite $2,000,000 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD