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HomeMy WebLinkAboutBld-20-002996 _ .Office Use Only Ot Amount s t3 Permit expires 180 days frog issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH f W 19 0. O0?) Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: .31 jJl, bleek.ci D1. ASSESSOR'S INFORMATION: Map: 3D Parcel: /5 • owNER.q;(ip Mackay ,3i d,In ►C.c . J.4 Arr a r-t;-A DLG 7 3 5ec art 7— 14 7 S- NAME I • io e D+ TEL TII # Emait Addre. TR CONACTOR: mi't rn M.A. R.A. W �iPs �SM:4A7-Ce%/ R-C(929/7 • CPS, 228 9td AME MAILING AD> S TEI.# Email Adc Residential Commercial Est.Cost of Construction$ //8/7 Home Improvement Contractor Lie.* 17 3 2.4-15" Construction Supervisor Lie.# 0 47678 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor )'have Worker's Compensation Insurance Insurance Company Name: rORtigEAA INS. /W��'� Worker's Comp.PoliCY# L)CA �/ 72 Q Z L. / WO1 TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# 9 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( ),Replacing like for like ' *The debris will be disposed of at: 6/it die ,441,n 6 (.P..10^�— Sfili44'' 'iCJ•'2_r i�Catiun of Fad* I declare under penalties.of perjury that the,•, r•,- herein contained are true and correct to the best of my knowledge and belief. Iunderstand that any false answers; will be just cause for denial apocation of,, and for prosecution under M.G.L.C h.268,Section 1. C�' Applicant's Signatue: {y�'''� •�•' /f v -1 I Owners Signature(or attachment) 4k�- ' r' - Date: Approved By: 4 '�,9 Date: //-2 f Building Official(, •' • • 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 New England 81 Philip Mackay +/ j , Legal Name:Southern New England Windows,LLC 31 Wimbledon Dr _ RI#36079,MA#173245,CT#0634555, Lead Firm#1237 West Yarmouth,MA 02673 WINDOW NE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)487-1475 Phone:401-349-1384 I Fax:401-633-6602 I salesOrenewalsne.com C:(781)724-0515 Buyer(s)Name: Philip Mackay Contract Date: 11/08/18 Buyer(s)Street Address: 31 Wimbledon Dr, West Yarmouth, MA 02673 Primary Telephone Number: (508)487-1475 Secondary Telephone Number: (781)724-0515 Primary Email: pmack914@yahoo.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: S19,817 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: $9,908 Balance Due: 59,909 Estimated Start: Estimated Completion: Amount Financed: 6-8 weeks 6-8 weeks 519,817 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: 50% paid now by GS, 50% paid at completion by GS.Taxes paid 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 11/12/2019 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 n o uthern New England Buyers) Q7'h,, - Signature of Sales Person Signature Signature Kevin Desmarais Philip Mackay Print Name of Sales Person Print Name Print Name UPDATED: 1 1/08/1 9 Page 2 / 14 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: 173245 10 RESERVOIR ROAD Expiration: 09/18/2020 SMITHFIELD,RI 02917 SCA 1 0 20M-05/17 Update Address and Return Card. .'Ti.P Kvnin seveaeC cy/I 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: Registration 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 C ' 10 RESERVOIR ROAD u v SMITHFIELD,RI 02917 Undersecretary N-v without signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructtn Supervisor CS-095707 = Expires: 09/08/2020 BRIAN D DENNISON / ts_ 8 BLACKWELL-DRIVE ; e CHARLTON MA�01507 -1 14" ' Commissioner i • The Commonwealth"of Massachusetts ..r'- Department ofIndsrstrial Accidents - 1 Congress Street;Suite 100 — Boston,MA 02114-2017 %4, i� � www./1laS.l;.aov/dla Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER'ttTTLNO AUTHORITY. Attalla nt Information Please Print Leeibly Name(Business/Oranization/Individua(): S c#h e d r. ke IL) t,,3 1 G,y/ IL)/ii ti„DLLs Address: /0 ese.r up!r 4 . City/State/Zip:3n1 j*Ii4 el I!RI DL9 ! C) 7 Phone#: MIDI-2.?��— are you an employer?Check the appropriate box: -7� Type of project(required): 1. I am a employer with 2 V�employees(full and/or part-time).* g 7. New construction am a sole proprietor or partnership and have no employees working for me in any capacity.[No waiters' 8: Remodeling comp-insurance required] 3.0I am a homeowner doing all work myself[No workers'comp.insurance required]* 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all wodkon my property. I will 10:1 Blinding addition ensure that all contractor either have woricers'compensation insurance or are sole 11.❑Electrical repairs or additions - proprietors with no employees. 12.( Plumbing repairs or additions 5-D 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.insu ance.t I3.0 Roof repairs 6.12 We are a corporation and its officers have exercised their right of exemption per MGL C. 14.[ the: 1.-)n 152,§l(4),and we have no employees.[No workers'comp.insurance required.] r ep/4 C Oin C-t'IS 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information ��'1l� • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside canhactnts must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-conuacmrs and state whether or not those entities have employees. Ift a 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 infornmiioic -� Insurance Company Name: '7"l rester Li 7;ksu 'aMe Ltp - or Wt ti b. C . Policy#or Self-ins.Lic.#: LOCA3fsR /2!c2 . Expiration Date: 1" /—2.D LO Job Site Address: 3 l tA.);✓►-,b ie or\ r. City/Statie/Zip:I.J•/arsw�.1 ,tom t Ft Attach a copy of the workers'compensation policy declaration page(showing the polity nal6ber 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 verbcation. I do hereby c - under the p ' penalties of pe7ary that the information provided above is true and correct Si : = Date: //-- Phone#: 101 7.7- ? 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#: 9 DATE(MMIDDIVYYY) ACGRD CERTIFICATE OF LIABILITY INSURANCE '- 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: 1401 Lawrence St., Ste. 1200 tAic.No.Exd: 303-988-0446 FAX Not;303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCD411 INSURER B:Firemens Insurance Company of WA,D.C. 21764 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 r Smithfield RI 02017 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER. LTR TYPE OF INSURANCE 1N3D YWD POLICY NUMBER POLICY EFF POLICY EXP {MM/DD/YYYY1 (MM(DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 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) 510.000 PERSONAL A ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2.000,000 O- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1N/2020 COMBINED SINGLE UMIT $1,OOQ000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) g _ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ A X UMBRELLA LtAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000.000 DED X RETENTIONS 0 $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N❑ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NM) E.L.DISEASE-EA EMPLOYEE 51,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $1.000,000 C Pollution Liability 7930073340000. 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD 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 /0(t ' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD