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HomeMy WebLinkAboutBld-20-4721 i Office Use Only •YARQS Permit# ' 3' - o Amount AA « V }.:Permit expires 180 days from 4. _'issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVEDI 1146 Route 28 I 1 South Yarmouth,MA 02664 CEO . 2f.11 U—:it (508) 398-2231 Ext. 1261 1 n et�irty u CONSTRUCTION ADDRESS: /7 .gir�QG/i° Y"�Y ASSESSOR'S INFORMATION: � // Map: /� Parcel: OWNER:_/'1e/Dd�f��►t f /C!/ �.�12c�P �lci'. f r r-fiei ax 4,7 S 7 7'P/O-070O NAME PRESENT ADDRESS ' TEL # Email Address: CONTRACTOR: co O�r�K /L P e26 �eaar Sf.u/ ,�,,.NA oief o _ /-_800-342-2 2/l NAME / -S MAILING ADDRESS / TEL.# Email Addres esidential Commercial/ Est.Cost of Construction$ /0 Sys Home Improvement Contractor Lic.# /1/6 5/' Construction Supervisor Lic.# //O 7 6,_5 Workman's Compensation Insurance: (check one) V I am the homeowner I am the sole proprietor �I have Worker's Compensation Insurance Insurance Company Name: (aetr d-1 S Worker's Comp.Policy# /lI EJ✓e` 2? -7 7 C� WORK TO BE PERFORMED Tent Duration (Fire Retardant Ce ' toattttach,.. Wood Stove Siding: #of Squares Replacement wind. s:# l Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation b Vd l Sings Highway/Historic Dist. (- lacing like for like *The debris will be disposed of at eP.rlai.a .o�,/ 1g 4,i r./t ✓ t Location of Facility I declare under penalties of perjury i,. the N>: �1 ,is herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or rev er!'o . t e and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signatue: ` TV Date: i `g/Z.- Owners Signature(or attachm- f Se 2 ct,-f' e�Q C-.1. a L4' Date: Approved By: � �.. Date: Building Official(or designee) Zoning District: Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No Page 1of13 MA Reg#146589 CT Reg#0605216 Federal ID#20-2625129 Window / Door Contract Customer Information - Harold Jr !sham (774)810-0700 Date: 02/06/2020 19 Barnacle Rd Smilewithhank@hotmail.com Rep: Kurt Raggio Yarmouth Port MA 02675 Office# 800-242-9974 Location Agreement NEWPRO hereby agrees that it will,for the consideration hereinafter mentioned,furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this"Agreement") at the premises located at: 19 Barnacle Rd Yarmouth Port MA 02675 Windows Being Installed: 7 Doors Being Installed: 0 Window Details I Location: Bedroom 1 Series: Ecomax Double Hung r -� Interior Color: White Screen Type: 1/2 I ! Exterior Color: White Grid Pattern: 6/6 - Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Bedroom 2 Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 - Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Bedroom 1 Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 I Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None ,{ Location: Bath 1 Series: Ecomax Double Hung ! " Interior Color: White Screen Type: 1/2 I Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Kitchen Series: Ecomax Double Hung 1 Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: cx, None ttqari--7 � LJ ry • Page 2 of 13 Location: Hallway Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Hallway Series: Ecomax Twin Casement Interior Color: White Screen Type: Full Exterior Color: White Grid Pattern: 0/0 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Window Capping Type Standard Capping Capping Texture PVC Capping Color Aspen White 27243 Additional Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Payment Total Price: $10,945 Deposit $0 Due Upon Completion $10,945 Payment Method Finance Estimated Start&Completion Dates Estimated Start Date 03/30/2020 Estimated Completion Date 03/31/2020 Customer understands that these are estimated dates and will be contacted to schedule actual date. r,r;foD.cia;.corn .5-6 Page 12 of 13 Terms and Conditions Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION. SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. The undersigned gives NEWPRO permission to debit their checking/savings account, or process a credit card transaction, for the deposit amount indicated on or after the contract date. Subsequent payments, such as start payments, or completion payments will remain in effect until I cancel it in writing, and agree to notify NEWPRO of alternate payment intentions. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that NEWPRO may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. gol..(044/9/. atm OA Harold Jr(sham 02/06/2020 Date Kurt Raggio 02/06/2020 Date Uris s ac€ {?t'r"x! t' 1 iel Ia"k e;spfc gia .r.c>rr .r.6 , DocuSign Envelope ID:07CDD2B3-3FFF-427E-A23D-52FDE397130B Page 1 of 2 MA Reg#146589 CT Reg#0605216 'Wm Federal ID # 20-2625129 Change Order Customer Information Harold Jr Isham (774)810-0700 Date: 02/07/2020 19 Barnacle Rd Smilewithhank@hotmail.com Rep: Peter DiGiano Yarmouth Port MA 02675 Rep# 800-242-9974 Description of Change: Hank did not receive the add on customer discount, we are including the discount of $500 with an additional $100 for the confusion and multiple. We will also wrap and cap a garage window, the window is facing the house on the right side. Payment Previous Contract Amount: $10,945 Revised Contract Amount: $10,345 Original Deposit: $0 Additional Deposit: $0 Due Upon Completion $10,345 Additional Deposit Payment Method None Estimated Start Date 03/30/2020 --DocuSIgned by: hra it `--E25A23F43649453... Harold Jr (sham 02/07/2020 Date Accepted: The above prices and specifications of this Change Order are satisfactory and are hereby accepted. All work to be performed under same terms and conditions as specified in original contract unless otherwise stipulated. Peter DiGiano 02/07/2020 Date This space intentionally `ett t)!Ank Leap 1 cOlg:ti:d con-, 3.ti • DocuSign Envelope ID:07CDD2B3-3FFF-427E-A23D-52FDE397130B Page 2 of 2 Customer Information Harold Jr (sham (774)810-0700 Date: 02/07/2020 19 Barnacle Rd Smilewithhank@hotmail.com Rep: Peter DiGiano Yarmouth Port MA 02675 Total Price: $10,345 Deposit $0 Balance Financed $10,345 Amount Financed $10,345 Stage 1 to be processed at order r$6,172 Stage 2 to be processed upon completion ,173 Financing terms are subject to change based upon review of customer credit history. Customer Info Last 4 Digits of Social 2034 Disclaimers By signing below, I/we,the Borrower(s): 1.Acknowledge submitting an application for a loan with a participating financial institution in the GreenSky Program; 2.Acknowledge receipt of the GreenSky loan agreement ("Agreement")with the lender specified on the Agreement ("Lender")and agree to be bound by the Terms and Conditions of the Agreement. 3.Authorize the payments in the schedule above subject to mutually agreed upon completion of the project stage; 4. Instruct our Lender to disburse the proceeds of the GreenSky loan to the Merchant identified above in the Amount(s) specified in the Payment Authorization Schedule. The Signature of a Borrower(s) below or the subsequent use of the GreenSky loan to make a purchase will constitute acceptance by all Borrower(s) of the Agreement and the authorization of Borrowers to process the transaction as identified in the Payment Authorization Schedule above. c—Doeusipnad by: Ranl,L ,�� (stall, �—E25A23F43849453... Peter DiGiano Harold Jr Isham 02/07/2020 02/07/2020 Date Date ThIS space intentionally left ;lank Leaploagga'.cc 5.6 77 / / / /i / �� .,� `iir l.f:.i;,%," C)flce of Co� sLirner Affairs and Su.iness Regulation 1000 Washington Street - Suite 71C, Boston, Massachusetts 0.2.118 Home !irpro•✓ement_Contractor Rejistratio,-7 Tyco: SuccIernsnt Cart Registration: 116589 iE'i'/PRO OPERATING LLC. E; iration: 05/04;2021 25 CEDAR 3T. WOBURN, MA 0'1 301 Update Address and Return Card. sc's t c. 20Ml15/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SuCalement Card before the expiration date. if found return to: Registration Expiration Office of onsumer Affairs and Business Regulation 148588 05,0,42.021 1000 ington Street -Suite 710 NEW PRO OPERATING.i__C. Bbstpn„ A 02118 JE=FR'c''{CONNORS I / 26 CEDAR ST. 1,,,.a(7/-t.G.4i►"• / rrCeURr;.MA oiaal ' of valid without signature Undersscrstar/ i Massachuse.tts Department of ruoihc Safet 2oard o` Building Regulations_and Standards License.: CS-110763 = ' JEFFREY CONNORS 64 OLD FIELDS ROAD SOUTH BERWICK ME 03908 =zp!r3ton i n r to 3 u ii r 05/05/2020 - . . .... . .. _ _ .. _ .... . .. . . . . .. . . , . , . • . . - • - . _. _- . . .. . . . . . . . • . . . . . . ..... . - „ ... . . . . .. — . . . • - :- . .. . . • - • .: . , . . . . . . . - . 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'.. --._,.:'-:-.;:.-.,.,.. .-.-,:-,-:-, •,,-,..=;-•••,-;.,-,=•-,-i., ,,:,-;: • .._ - • •-._.,• - ,r :'::;..'''. ' 7‘:'j 4 7: .. .._....I, '. ..7.-..": 7,-... '...',: . ‘,..,:„.4.,;f: - ._ ; t .4.'7,-=-':2-.:-:;i2-:.=:ic.cv-, :-.-::i=.,-•-,.:.'..'1•:-,,..--,.-,-.-— - — - 1--...'':1-. ! • '--' • _ The Commonwealth of Massachusetts w_ = Department of Industrial Accidents =fir' I Congress Street,Suite 100 t Boston,MA 02114-2017 4 www.mass gov/dla Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): JAW pro tr�erov�h ll.3 L_L.C Address: 2.6, Cto Aa r S'1 , ` City/State/Zip: Wo 6 0 cyl Nt A 0 t g 0 1 Phone#: /—goo - 3 Z - 2_ z I Are you Type of project(required):n employer?Check the appropriate box: 1. I am a employer with 2.a 'employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. ❑Remodeling 3.�1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9 ❑Demolition 4.ElY Property. I will I am a homeowner and will be hiring contractors to conduct all work on m 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 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. 13•0 of repairs 6.El Weare a corporation and its officers have exercised their right of exemption per MGL c. 14. Other /,t/r it 4. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] /'„�l�tit e- et i7L_C*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 1'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-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'con_ nsation insurance for my employees Below is the policy and job site information. g„ ,� A Ii, y� Q...,f3 Insurance Company Name: 1.� Policy#or Self-ins.Lic.#: N0.13i©.''7 71S p� Expiration Date: //Za Job Site Address: / /37/%/4 c. 4_ (rc City/State/Zip:*i,vi.co,r'f rtA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi/atiot date). Failure to secure coverage as required wider MGL%_ 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year impriso ent,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 viol r.A y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . I do hereby certify nd t flpains and penalties ofperjury that the Information provided above is true and correct. Sienature:'-• Date: ,2-2/ —.Zt:' Phone#• —8 y l-(W L t( 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#: .=�_C'' LD t v ER 71 u"JC.=.A i } , i _, - oar_(,atuDDrrrrrl 1;" 1�J b J3 J'-1 i f :3as� . , .�=��'l!,. ! 04/30/201 i ..._.; THIS CERTIFICATE.IS ISSUED AS A MATTER O;IPIFORNIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE'HOLDER.THIS CERTIFICATE DOES NOT.aFFIR3JATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 3Y THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 3ET'JVEE')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 have ADDITIONAL INSURED provisions or 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 NAMTACt Melissa Pliug Mackintire Insurance Agency Inc PHONE No.ExU: i508)366-6161 FAX No): (508)368-5202 11 West Main Street E-MAIL melissap@mackintire.com ADDRESS: Westborough MA 0'1581-1931 SentryiInsuranlce AFFORDINGS) COVERAGE NAIL II INSURER A: INSURED Middlesex Insurance Co INSURER B: Newpro Operating LLC INSURER c: Guard Insurance Group 26 Cedar St. ColonyInsurance Co INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR HUOLSUBR POUCY eFF POLICY EXP LTR TYPE OF INSURANCE INSQW I D POUCY NUMBER JMMIDD/YYYYL,JMMIDOIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY It EACH OCCURRENCE S 1,000.000 I CLAIMS-MADE 1-1OCCUR PREMISES(Ea occurrence) 3 500,000 — MED EXP(Any one parson) S 15,000 A A0092403003 12/31/2018 12/31/2019 PERSCNAL&ACV INJURY S 1,000,000 GEN'LAGGREGATE UMITAPPUES PER: I GENERALAGGREGATE g 3.000.000 POLICY I I jECa n LOC I PRODUCTS-COMP/OP AGG �' 2,000,000 OTHER: AUTOMOBILE UASIUTY COMBINED SINGLE OMIT g 1,000,000 J (Ea accident) -^ANY AUTO BODILY INJURY(Per person) S g —7 OWNED SCHEDULED A00512403004 12/31/2018 12/31/2019 3O0ILY AUTOS ONLY © INJURY(Peraeddent) S AUTOS s.... HIRED B NON•OWNED -PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY (Per accident) S Uninsured motorist SI s 250,000 X UMBRELLA UAB I OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS UAB CLAIMS-MADE A0092403006 12/31/2018 12/31/2019 AGGREGATE S 5,000,000 DED X RETENTIONS 0 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS.UABIUTY - STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? n N(A NEWCO28778 05/01/2019 05/01/2020 500.000 (Mandatory in NH) E.L DISEASE-EAEMPLOYEE S H If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S Limit 51,000,000 Pollution Liability D CSP304242 12/31/2018 12/31/2019 Aggregate $2,000,000 DED S5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddIUonal Remarks Schedule.may be attached B more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01504 ,a„//% I @ 1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD