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HomeMy WebLinkAboutBld-20-003864 • r"' �a .Office Use Only .4—;', r 7 Perinit' Q( y �� Amount • sy� .� to Permit expires 180 days from • issue date .3U.).a D--3R coq EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: !5 l\j their" L r 82. ' ASSESSOR'S INFORMATION: Map: Parcel: • owNER:6 erteJLLe— $runes /6 v*- r I32. l Qrienit I fin (77J7iv`ZoSy NAME Dt�, 02673 TEL # Email-Address i01�fR a?ct/ CONTRACTOR:,Aa1"+'lern Il1.i. Olhottws Ste. 3 e%/ Xi"029i7 CPO 228.=9tOO AME MAILING ADDRESS TEL.* Email Addr Residential Commercial Est.Cost of Construction$ ' Home Improvement Contractor Lic.# 173 2.45- Construction Supervisor Lic.# O?67 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor A have Worker's Compensation Insurancen Insurance Company Name: riR E-I'JS 1,US. 33/11 4•t)'f Worker's Comp.Policy# t) �►�a168,2 S-2'4 WOOtKTO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares • Replacement windows:# S 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 Wit. /e /44.- e fr o'4"— Sn;-hU ie l i•bnition of Fad it f I declare under penalties of perjury that the stet <,-, herein contained are true and correct to the best of my knowledge and ef. I derstand that any false answer(s) will be jest cause for denial ar rsgocaaon of m+ •- ,and for prosecution under M(I.L Cb 268,Section 1. �iy.'"/-� � � � Date: Signature: Date: lid 4c scs:„...:10i aorver Owners Signature(or attachment) Date: Approved By: Date: 1 ' $ - ,L o Building Official(or designee) Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resolute Protection District Within 100 ft.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms bY1i1. dba:Renewal ByAndersen of Southern New EnglandGenevive Bruneau ( Legal Name:Southern New England Windows,LLC 15 Denver Dr B2 RI#36079,MA#173245,CT#0634555,Lead Firm#1237 West Yarmouth,MA 02673 WINDOW E LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(774)740-2059 Phone:401-349-1384 I Fax:401-633-6602 I salesOrenewalsne.com Buyer(s)Name: Genevive Bruneau Contract Date: 12/17/19 Buyer(s)Street Address: 15 Denver Dr B2 , West Yarmouth , MA 02673 Primary Telephone Number: (774)740-2059 Secondary Telephone Number: Primary Email: 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: $36,961 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: $15,000 Balance Due: $21,961 Estimated Start: Amount Financed: 8 to 10 weeks • $21,961 Method of Payment: Cash/Check 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: Taxes included; $15000. Dep ck; $50. Permit pd by ck; $21961.GS 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 12/20/2019 OR THE THIRD BUSINESS DAY AT TER 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:Royal By of Southern New England Buyer(s) Signature of Sales Person Signature Signature Paul McLean Genevive Bruneau Print Name of Sales Person Print Name Print Name UPDATED: 12/17/19 Page 2 / 14 i fir: 2/=7 7Wi/L /,/ 'f.Le f 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 SC.1 0 20M-05/17 Update Address and Return Card. ,Te FecvninoncLW /f e/.. -j c/ )ch Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suonlement 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 2* �?l"--- +++ 10 RESERVOIR ROAD !� — oo it I. , without signature SMITHFIELD,RI 02917 Undersecretary r Commonwealth of Massachusetts illDivision of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-095707 = E-Xp i res: 09/08/2020 BRIAN D DENNISON �._- • 8 BLACKWELL�DRIVE . ;' - .: ;; A= CHARLTON M01507 Commissioner CI' 441- '" . '.\ .. The Commonwealth'of Massachusetts � ��:- Department of laaddudustriadAcridents -ielL= 1 Congress Stree4 Suite 100 . "� Boston, 02114-2017 ' i71i;,..r" l+vww.massgos/dia J Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PLED WITH THE PEltMll'C[YG AUTHORITY. Aooljcaut Information ` Please P 'at Leeib(v Name($usiness/Organization/Individual): S bti."th et A., Ne L1) d.s/) 1 ref i I L)LJJ.S Address: I Q ?seSer UDi r F.ci • City/State/Zi : /R t -6 e..i '1 OZ9 I p S t 7 Phone#: 401—2.2,r— 9` E-6 6 Are you as employer'Check the appropriate box: Type of project(required): g am a employer with 2-remployees(full and/or pert time).* 7. 0 New construction am a solo proprietor or partnership and have ao employees working for me in S: 0 Remodeling any capacity.[No workers'comp.insurance required?• 9. ❑Demolition 3.E1 I am a homeowner doing all work myself[No workers'comp.insurance required.] 4.:I am a homeowner and will be hiring contractors to conduct all work.on my property. 1 will 10 0 Building addition ensure that all contactors either have workers'compensation insurance or are sole 111E3 Electrical repairs or additions • proprietors with no employees. l2.C7 Plumbing repairs or additions 5a t am a general contractor and I have hired the sub-contractors fisted on the attached sheet 13. p Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.: I. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�Otlter wash�v 4 I GOM 152,ILO),and we have ao employees.[No worked'comp.insurance a nce required.] t?erfr1 *Any applicant that checks boxal must also MI out the section below showing their workers'compansaton policy' v�'� • t Homeowners who submit this affidavit indicating they are doing all work and then biro outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached as additional sheetabowing the name of the sub•contractors and state whether or not prose entities have employees. Ifthe subs ontmetam 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 she information Insurance Company Name: -f re ien, . 1;Lsorat a . o b.W(1, . C C . Policy ft or Self-ins.Lic.#: WC ��s /r2 8 ?O? Expiration Date: !" L/ Job Site Address: 1 'Per' i'r---. a j 2, City/StatelZip: d� Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration date). Failure to secure coverage as required under MOL c. 152.§25A is a criminal violation punishable by a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form de STOP WORK ORDER and a fine of up to S250.00 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 es ,, anderthe ,„ ,penalties of pointy that the Information provided a it egad correct . Signature: _ Date: / 7 2 0 Phone#: Iclili •-z — Of 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#: 5 TE(MM/DD/YYYY) A o® CERTIFICATE OF LIABILITY INSURANCE DA2/3o/2os 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 NAME: BOKF Insurance CO Risk Management PHONE FAX 1600 Broadway,9th Floor • Kac.No.p.m303-988-0446 (AIR,No):303-988-0804 Denver CO 80202 ADDRESS: insure@bokf.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemen's 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 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1098683046 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. iLTR TYPE OF INSURANCE INSD WI/D POLICY NUMBER (M SUBR MIMIDDIYYYYYYI (MMID�DIYYYYYY) LIMITS A X COMMERCIAL GENERAL UABIUTY CPA3158728 1/1/2020 1/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(Ea occu RENTED trencel $300.000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY TECOT- LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: $ A AUTOMOBILE UABIUTY CPA3158728 1/12020 1/12021 COMBINED SINGLE LIMIT $ (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ A X UMBRELLA UAB X OCCUR CPA3158728 1/12020 1/12021 EACH OCCURRENCE $15,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$0 $ g WORKERS COMPENSATION VVCA315872922 1/12020 1/12021 X PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANYIPROPRIETOR EXCLUDERCUTNE Y , j N/A EL EACH ACCIDENT $1,000,000 EMBER(Mandatory In NH) IF Ti ( E.L.DISEASE-EA EMPLOYEE $1,000,000 If es desaibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340002 1/1/2020 1112021 Each Occurrence $$2,000,000 2 000,000 Re oscMad 06 :• bee $25,000 Retroactive Date to OBJ202013 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Subject to all policy terms and conditions. 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 AUTHORIZED REPRESENTATIVE Alt SA ritWaitek/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD