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Home My WebLink AboutBld-20-004473 3_ .Office"(Ise Only f 4 , C' Amount • c .,, Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department ".._ .._.._._.._. _ — 1146Route28 ` E C EDI u South Yarmouth,MA 02664 T� 1 I (508 398-2231 Ext. 1261 cc' ;j' z / - CONSTRUCTION ADDRESS: 1 "" �I �� ‘� -TM E rv� ASSESSOR'S INFORMATION: Map: 6 y Parcel'.y OWNER: Weisii3a /Z FAN j2,01. LO.Yorta cutit, MA C77YJK70- '/lQ L NAME /OPRESENTv,DDr d 10 'S/ 027 TEL # Email'Addres CONTRACTOR:~e 1 rn N (A')rn oyu Sr�.:K)�`�e%/ /?s chi 7�11) ZZ f-IVO AME MAILING ADD S TEL# Email Add Residential Commercial Est.Cost of Cons action$ ' I b 37-0 Home Improvement Contractor Lie.# /7 3 2.4s Construction Supervisor Lic.# 0Q670 7 Workmen's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor ! 'have Worker's Compensation Insurance Insurance Company Name: riptilLAA 1tuS. CD 2s} t Worker's Comp.Policy# 10 CA aI6r72 2.1 WO$B TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares - Replacement windows:# 7 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) motion Old Kings Highway/Historic Dist. ( ),Replacing like for like *The debris will be disposed of at Wh de pals.►t ((Pi•► "` &haulUfl of FacIlit I declare under penalties of perjury that the,, A:,-.. :herein contained are true and correct to the best of my knowledge and belief. understand that any false answers; will be just cause for denial ar,�pocation of •-.• and for prosecution under M.G.I.C h.268,Section 1. Applicant's Signature �(yr`r..�'-_ Dam: Z t L 2.0 Owners Signature(or attachment) / r;r - Date: � Date: �/� -y � Ar Approved By: Buil. .. •'. ;r designee) • Zoning District Ilistortcal District: Yes No Flood Plain Zone: Yes No `Water Resource Protection District: Within 100 it.of Wetlands: 1 Yes No Yes No Renewal Agreement Document and Payment Terms byAndeisen. dba:Renewal By Andersen of Southern New England Paul&Joanne Wedge ' Legal Name:Southern New England Windows,LLC 12 Lu Ellen Rd RI#36079,MA#173245,CT#0634555,Lead Firm#1237 West Yarmouth,MA 02673 miming RE LACENENT 10 Reservoir Rd I Smithfield,RI 02917 H:(774)470-4199 Phone:401-349-1384 I Fax:401-633-6602 I salesOrenewalsne.com C:(413)351-6362 Buyer(s)Name: Paul &Joanne Wedge Contract Date: 01/23/20 Buyer(s)Street Address: 12 Lu Ellen Rd,West Yarmouth, MA 02673 Primary Telephone Number: (774)470-4199 Secondary Telephone Number: (413)351-6362 Primary Email: sail57_1@msn.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: $26,370 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: 58,789 Balance Due: $17,581 Estimated Start: Estimated Completion: Amount6-8 weeks 6-8 weeks Financed: $0 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: 1/3 paid now, 1/3 paid at start, 1/3 paid at compl.Taxes W 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 ANYTIME NOT LATER THAN MIDNIGHT OF 01/27/2020 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 f Southern New England Bayer(s) WeZer— Signature of Sales Person Signature Signature Kevin Desmarais Paul Wedge Joanne Wedge Print Name of Sales Person Print Name Print Name UPDATED: 01/23/20 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 > '+ 20M-05n7 Update Address and Return Card. ,Re Femm w-eceez&ey412:i oJclGi 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: Reaistratiort Expiration Office of Consumer Affairs and Business Regulation 17824E . 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 \ BRIAN DENNISON AZ- i 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary tv without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-095107 EXp i res : 09/08/2020 :i. " BRIAN D DENNISON 8 BLACKWELL DRIVE ; CHARLTON MA:01507 ' .; ~' • �yh ^a Clair Commissioner The Commonwealth of Massachusetts �,`^- Department of industrial Aecidentr ' —=_�- 1 Congress Stree4 Suite 100 !: =1=_ Boston,M.4 02114-2017 .�.,. . www marssgov/dia Barkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anolicsat Information + Woo Please Print Legibly Name(Busir s/Organizationandividual): S ot�`f h e r y Nett) t1)Q!ef� 1 A 4tJLU S Address: /O SPA•UDI r i 4 - J City/State/Zip:S pi t#-4 e.1cI/7! aZ917 Phone#: 40/-22,Fr- ? eo 6 A o yea as employer?Check the appropriate box: Type of project(required): 1. I am a employer with 20 'employees(full and/or part-time).* 7. 0 New construction am a sole proprietor or partnership and have no employees working forme in 8: Remodeling any capacity.[No workers'comp.iaurrance required]• 9. ❑Demolition 3.01 am a homeowner doing all work mysel£[No workers'comp.insurance required] 4.0 I am a haneown er and will be hiring contractors to conduct allwork on my property. I will 10 D Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LC)Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and!have hired the sub-contractors listed on the attached sheet 12.Q RoofPlum repairsissg repairs or additions These sub-contractors have employees and have workers'comp.insurance? 13.❑Roof ,,f'_ 4-0 6.0W e are a corporation and its officers have exercised their right of exemption per MGL c. 14 Other t!l� 152,11(4).and we have no employees.[No workers'comp-insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy mtbtroati • t Homeowners who submit this affidavit indicating they are doing all work and then hire outride contractors must submit a new affidavit indicating such. CContractors that check this box must attached an additional sheet showing the name of the sub actors and state whether or not those entities have employees. Mho sub-contractors have employees,they must provide their workers'- ,,, policy number. I am an employer that is providing workers'compensation insurance for my employeess. Below is the policy and jab site Wormation. +,t Insurance Company Name: T"l r�= 5 15c.512lraMe-- 0 - OF W fo T, b.C . Policy#or Self-ins.Lic.#: tdeA 3L5.-8 c2 ? Expiration Date: 1' J"2.0 L L Job Site Address: /Zl si t - City/State/Zip: w� a/IAio&(, y ed Attach a copy of the workers' ompensadon policy declaration page(showing the policy nuns r 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 iinprisontnent,as weU as civil penalties in the form of a 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 verifit attion. I do hereby wader the p penalties of perjury that the information provided abo is true correct` 2 1 Signature- �� Date: L ? Phone#: 101 - ?0 Official use only. Do not write in this area,to be completed by city or town ofclat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City!I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Otber Contact Person: Phone#: ® '`�`.�o CERTIFICATE OF LIABILITY INSURANCE DATE(PAPA/OD/MY) 12/30/2019 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 BOKF Insurance CO Risk Management PHONE FAX,,,);303 988 0804X 1600 Broadway, 9th Floor tamNo,Exit303-988-044s Denver CO 80202 ADDRESS: insure@bokf.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:Firemen's Insurance Company of WA,D.C. 21784 Soudba e Na AEngndndersen Windows, LheC INSURER C:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Southern New England 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER:1098883046 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MSD WVD POUCY NUMBER (MMIDD!YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1112020 1M2021 EACH OCCURRENCE S 1,000,000 , CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 I MED EXP(Any one person) 510,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X I POLICY JEIT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE UABIUTY CPA3158728 1/12020 1/1/2021 COMBINED SINGLE LIMIT $1 .000.000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS (Per accident) $ A X UMBRELLA LiAB X OCCUR CPA3158728 1/1/2020 1/12021 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION WCA315872922 1/12020 1/12021 X STATUTE FOR AND EMPLOYERS'LIABILITY Y/N OFFANYICRERIM OPRIE ER EXCLUDED?ECUTIVE IN N/A EL EACH ACCIDENT $1,000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $1,000,000 If yyees desaibe under DESGrRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340002 1/12020 1/1/2021 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 08l20/2013 Deducible 525,000 I I . DESCRIPTION OF OPERATIONS!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 AUTHORMED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD