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HomeMy WebLinkAboutBld-20-003238 ,R F. .Office Ilse Only : ,ti(I `r Permit# Oy` Amount 50 J._�� Permit expires 180 days from • issue daze . 3 -ZD 3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH • Yarmouth Building Department ;=•, ) , r, 1146 Route 28 South Yarmouth,MA 02664 CaRDI(508)398-2231 Ext. 1261I a CONSTRUCTION-ADDRESS: Z 1 Calira i 11 Lri k ref c j ASSESSOR'S INFORMATION: 1 Map: Parcel: ' .AiiOWNER: 'n`i rI P/-t rhS QZ i�aeiav,L `&(o p la, S.Atinert• -el4 OL66./ (o l 7-5'17-2/2 I NAMEio e Drkd• ` Ow) TEL # EmaitAddres CONTRACTOR: dt tfA N o. ( rn0vvs �Sr►Maaara A kf, R1 r7 4 9:x..� Email Add Residential Commercial Est.Cost of Construction$ 6/2'L— Home Improvement Contractor Lic.# 17 3 v./5- Construction Supervisor Lie.# 0 4670 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietoret A have Worker's Compensation Insurance , Insurance Company Name: .6L t,S IPS. Worker's Comp.Policy* (A)CA,13168 2 8,24 WQix TO BE PERFQRMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# 4 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation_ Old Sings Hgghway/Historic Dist. ( ),Seplac ing like for like *The debris will be disposed of at 1/4.life Aran it ((Ff t 0�� /_ Sei;`' ''•e( (2r k6bcation of FacilltS, f 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 any false answers: will be just cause for dental . ,.-,.:. of and for proseption under M A L Ch.268.Section I.Applicant's Si V.gnature: Date: 12 —4/— q/ f Owners Signature(or attachment) Ste= i ''s' Date Approved By. loy 1-11111X2/ . i 1 —5---/7 Building Official , <t"R-'-) Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District~ Within 100 itof Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms bAtxrsen' dba:Renewal ByAndersen of Southern New EnglandDavid Fleming Legal Name:Southern New England Windows,LLC 21 Captain Lothrop Rd .411N16...{ __ RI #36079, MA#173245,CT#0634555, Lead Firm#1237 South Yarmouth,MA 02664 WINDOW RE LACOIEMT 10 Reservoir Rd I Smithfield,RI 02917 H:(617)347-2121 Phone:401-349-1384 I Fax:401-633-6602 I salesorenewalsne.com C:(617)653-8112 Buyer(s)Name: David Fleming Contract Date: 11/21/19 Buyer(s)Street Address: 21 Captain Lothrop Rd, South Yarmouth, MA 02664 - Primary Telephone Number: (617)347-2121 Secondary Telephone Number: (617)653-8112 Primary Email: trmtrtenOcomcast.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: 56,292 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: $2,097 Balance Due: $4,195 Estimated Start: Estimated Completion: Amount Financed: SO Spring 2020 Spring 2020 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 11/25/2019 OR THE THIRD BUSINESS DAY Ak 1'i R 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 B de n of Southern New England Buyer(s) N Signature of Sales Person Signature Signature Paul Sandrey David Fleming Print Name of Sales Person Print Name Print Name UPDATED: 11/21/19 Page 2 / 10 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 i 2onn-oein Update Address and Return Card. :Re Ftww nn z,ecni41 cyf„//a..-i"..f.C./ eCG. 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 Exoiration Office of Consumer Affairs and Business Regulation 173245 _ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211,8--- BRIAN DENNISON !,Q„C ,� ' —10 RESERVOIR ROAD Y ''� U SMITHFIELD,RI 02917 Undersecretary Nv-t i without signature r Commonwealth of Massachusetts IFDivision of Professional Licensure Board of Building Regulations and Standards Construction- Supervisor CS-095707 - p i res : 09108/2020 y -, I BRIAN D DENNISON -. `, .- - 8 BLACKWELI DRIVE ; i= 1; CHARLTON MA-01507 }1, -.4 Commissioner • ue The Commonwealth of Massachusetts _ '- Department of lmfusfr al Accidents -_� - 1 Congress Stree4 Suite 100 =� �" Boston,MA 02114-2017 J• >!vlvw massgov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER EITIYG AUTHORITY. Aoolic.nt Information t � Please Print Legibly Name(Business/Or_eaniration/Individual): s 00-f'11 e r r. 'Veto top 1 G� W j iI CI I LLIS Address: /O set-UDt r i .0..1 . J City/State/Zip:.S m rti-i-a d cl,RI O2 9 / 67 Phone#: �/O/—ZZ�— z. Are you an employer?Cheek the appropriate bac: Type of project(required): t. 1 am a employer with 20�empioyees(full and/or part-time).* 7. New construction am a sole proprietor or partnership and have no employees working for me in S: Remodeling any capacity.[No workers'comp.insurance required]• ❑ moa 3.D I am a homeowner doing all work mysel£[No workers'comp.insurance required]* 9. ❑Demolition 4.0I am a homeowner and will be hiringcontractors to conduct all work on my property. I will ICI❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 l.❑Electrical repairs or additions - proprietors with no employees. general [2.QP[umbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contactors listed on the attached sheet These sub-conttacears have employees and have workers'comp.insurance.: 13.0 of repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other G✓/4 152,g 114),and we have no employees.[No workers'comp_insurance required] 1'(j4r 0e/ti e rf e5 'Any applicant that checks box#1 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 die sub-contractors and gate whether or not those entities have employees. Mho sub-coatracpats have employees,they must provide their workers'coop.policy number. I am an employer that is providing workers'compensation insurance for my employeeL Below is the policy and job site information ' 1;16 Insurance Company Name: remefl Ufa a - orWf4rn i b. ai . Policy#or Self-ins.Lic.#: ())CA34.5.75 / !a • Expiration Date: /- /-2.0 Z.O Job Site Address: 2- I (sip/cr,-\ 4 o-1h co p R. City/State/Zip: S4+>e4AI i 114 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation date). Failure to secure coverage as required under MGL c. 152,§2SA 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 I do hereby - under the p ' penalties of perjury that the informadionprovided above iv true and correct • ! Si Date: - L/'/ Phone#: lb? -7�2- — 9 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 f#: AC ID CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYVY) 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 i 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 NHS` 1401 Lawrence St., Ste. 1200 (NC.No.Extl 303-988-0446 FAX NM:303-988-0804 Denver CO 80202 E MAIL ADDRESS: COMail@cobizinsurance.com INSURER(S)AFFORDING COVERAGE NAIC 6 INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO Dt INSURER B:Firemens Insurance Company of WA,D.C. 21754 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 ADDL SUBR . POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MD WVD POLICY NUMBER IMMIDD/YYYY) (MWDD/YYYY) LIMITS A X COMMERCIAL GENERAL UABILI Y CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 GE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $300,000 MED EXP(Any one person) 810.000 PERSONAL A ADV INJURY 5 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 (Ea accident) UMIT $1,000000 X ANY AUTO BODILY INJURY(Per person) $ — AUTOS OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE - HIRED AUTOS AUTOS (Per aeeident) $ $ A X UMBRELLA UAB X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE 515,000,000 EXCESS LA48 CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTIONS 0 $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 )( PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N/A E.L.EACH ACCIDENT 5 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-POLICY LIMIT $1.000.000 C Pollution Liability 7930073340000. 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims-Made Policy Deductible $2,000 00 Retroactive Date 06/20/2013 00 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 AU``T''HORIZEDREPRESENTATIVE N4 I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD