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HomeMy WebLinkAboutBld-20-002733 .vsuw u ocS,u,J . � : y_ 1.51 Amount SD-- 0 Permit expires 180 days from . issue date ).3) EXPRESS BUILDING PERMIT APPLICATIONg -: ... TOWN OF YARMOUTH Yarmouth Building Department 1146Route28 i?'+ ti 7 nil South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 , 'co 1. 2 _ __LAY- L. CONSTRUCITON-ADDRESS: 9g 4}cre s .A✓e.- ASSESSOR'S INFORMATION Map: Parcel: . /vt 144*_/ _ _2�( ' I OWNER: h ) s kbg$gg I,-nt, NAME /O 11e,85 ' antic • TEL # Email Addre! CONTRACTOR:400 1 &LA Otte 8Sin; -:-e/c6L RI' 9i 7 O' ')a2 A'—cit o MmuNGADnliFss T 3 G�q _ Email Adc Residential.) �Coa ial Est.Cost of Cons!notion S Home Improvement Coro raetnrLie.# 173 2 & Co on Supervisor 1k.# 0'78 7 Workman's Compensation Insurances: (check one) I am the homeowner I am the sole proprietor have Worker's Cron Insurance a �q� Insurance Company Name: �t2I L PS. i * 1' Wos crimp.Policy* 60 nCt'�tOQ ,2. ,ZL. WQ pi,TO BE PEBFOIAMED Tent Duration (Fire Rat Certificate attached?) Wood Stove Sidings #of Squares Replacement windows:# ( Replacement dodrs: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation__._._ Old Kings Bighway/Historic Dist. ( ),Itepladug like for like ' will of at . . e �sn.c ��►�^�' -�ig�� � 'Me debris spored 'Y n of ladnii r I declare underpe of perjury Mattis:;, hada contained ate trmand comecxto the beat of my Imoaladge and belief. I -F: ttrat any false eusw&0 will be jestcausefor denial - •..,...,aim? ..:, and forprowsintion under M.G.L.Ch.268.Section I. VIP - - Dam it/ ‘ i 1 Applicant's Sigma= 4r Owners Sigimture(or attactmteat) Jc - '" 0'r )?ate; Approved By; ,,,�+ Building Official(or, • Zoning District;. ElstoricaIDistrict Yes No Flood Plain Zone Yes No Water Resource Protection District Within 100 R.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms byAi5et1' dbai Renewal ByAndersen of Southern New England$l Michael Needham Legal Name:Southern New England Windows,LLC 98 Acres Ave �� RI#36079,MA#173245,CT#0634555, Lead Firm #1237 West Yarmouth,MA 02673 WINDOW NE LACENENT 10 Reservoir Rd I Smithfield,RI 02917 H:(301)758-2451 Phone:401-349-1384 I Fax:401-633-6602 I sales©renewalsne.com Buyer(s)Name: Michael Needham Contract Date: 10/14/19 Buyer(s)Street Address: 98 Acres Ave,West Yarmouth, MA 02673 Primary Telephone Number: (301)758-2451 Secondary Telephone Number: Primary Email: mvneedham@icloud.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: 53,899 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: $1,299 Balance Due: $2,600 Estimated Start: Estimated Completion: Amount Financed: ;p 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,1/3 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 AF l'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:Ren 71 of Southern New England Buyers)7_,____ Signature of Sales Person Signature Signature Paul Sandrey Michael Needham Print Name of Sales Person Print Name Print Name UPDATED: 10/14/19 Page 4 / 9 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: 10 RESERVOIR ROAD piration:Expiration: 09l13245 8/28/2020 SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 C+ 20M-05/17 TP Fivn,99/WeVeadi/ /to 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_p 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 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary without signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constru_ tfon Supervisor CS-09 707 E p i res: 09/08/2020 = L. BRIAN D DENNISON `• r' 8 BLACKWELL=DRIVE -' CHARLTON MA;01507 Commissioner C2'"" .,". The Commonwealth'of Massachusetts ��'- Department ofindustriat Accidents ' -itt r 1 Congress Street,Suite 100 • =' Boston,MA 02114 2017 1 www.mass gov/din J• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERK 1 TING AIJTHORLTY. Auollcant Information Please Print Legibly Name(Business/Organitation/Individual): S U(,i.`th e,f Aka) tn�/G0/ W i n 4XIIS . Address: /0 ?eSer UOI r i4 . City/State/Zi : ol t p 5 fh-a elel 1 7?! O ZQ 1 7 Phone#: AID l—ZZ r- ? to 6 Are yea an employer?Check the appropriate box: Type of project(required): t. l am a employer with 20+.employees(full and/or part-time).* 7. 0 New construction ` 1 am a sole proprietor or partnership and have no employees working for me in 8: 0 Remodeling any capacity.[No workers'comp.insurance required] 3. tam a homeowner doingall work myself 9. CI Demolition ❑ y [No workers'comp.insurance required] 4.0[am a homeowner and will he hiring contractors to conduct all wodcon my property. [will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions s0[sin a general contractor and I have hired the sub•cont actors listed on the attached sheet 13. of repairs These sub-contractors have employees and have workers'comp.insurance.: ❑ p 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. er /,✓f.:l�j-t.� 152,¢t(4).and we have no employees.[No workers'camp.insurance requited] r`ep4 r��f- •My applicant that checks box el 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 sub-contractms and state whether or not those entities have employees. If tin sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee.. Below is the policy and job site information. Insurance Company Name: Tl rerien1 1;1vr wa ii °e_ t-o - OF ill. 14 j b. c. . Policy#or Self-ins.Lic. #: L iC.A3ILcc'7a PO?I • Expiration Date: I" /—2 D LO Job Site Address: 9 S Acre s A.re_ / - City/State/Zip: Iv./ na 1iA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirdtion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation pnoiehable 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 DR for insurance coverage ver1fi1 ation. I do hereby ce -) under the p--' , ,penalties of pedury that the information provided ab' a brie and correct : t L ' • �+ �_t : _ t+: 61 6 at Phone it: 4 o! .. 9 Of) Official use only. Do not write in this area.to be completed by city or town official City or Town: Permit/License b 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#: g�� C .P� LIABILITY /VYYY) ��. 3t"s L71 INSURANCEDATE IMMIOD12/28/201 3 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 (A/C No.Ext1. 303-988-0446 FAX Nol:303-988-0804 Denver CO 80202 ADDRESS: COMaiI@cobizinsurance.com iNSURER(S)AFFORDING COVERAGE NAIC M _ INSURERA: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 0: 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 SUER . POLICY EFF POLICY EXP LTR 1NSD,WVD POLICY NUMBER IMMIDDIYYYY) (MMIDDIYYYY► LIMITS A )( 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) $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 POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000.000 • - OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT $ (Ea accident) 1,000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED — SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) 5 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE 515,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,00D,000 DED X RETENTIONS 0 ER $ B WORKERS COMPENSATION WCA315672924 -' 1/1/2019 1/1/2020 X STATUTE ER , AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE IN E.L.EACH ACCIDENT $1,000,000 OFFICERMIEMBER EXCLUDED/ N I 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 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 $25,000 DESCRIPTION OF OPERATIONS I 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 AUTIdOR12E0REPRESENTATIVE N I ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD