The URL can be used to link to this page

Home My WebLink Aboutbld-20-004488 ` AWE ® OfficeOfficeIlse Only ' t'cO` - Aa'o6jS�� t Q1 � �- Nil (.r!� ' 5' -- Amount • ,S�, Permit expires 180 days from • -.5*� r DaTM issue date ENT EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 flu (508)398-2231 Ext. 1261 CONSTRUCITON-ADDRESS: v a7 0A-Ks ci - ' ASSESSOR'S INFORMATION: Map: / r7 Parcel: 3 ' tDCL -f 1.yn nr: OWNER: />Q P.l(ct!'.(2._ 8-(flan y id s 0►tt- Varna i 01A (-- )zz/-If -d0 NAME L- r,� (t ,OP�Perri✓?9 E ^cl O?-6/7155, # EmaitAddres CONTRACTOR: A 11Prn N.g W tiro D S�MAII n1G ADDRESS f f z,'7 ``oli ZZT--to° �v Email Add Residential Commercial Est.Cost of Constmction$ Liiii Home Improvement Contractor Lic.# 17 3 Z'IS Construction Supervisor Lic.# 0 7670 7 Worl man's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: riREI1LAJS 1 PS- Cjjx?? 13f Worker's Comp.Policy# CA aI6r72,Z-2.— WOKS TO BE PERFORMED Tent Duration (Fire Retardant Certifi ed?) Wood Stove Siding: #of Squares Replacement windows: 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 Wh de //1s- a tPlh @ /_ i' f-:e(I ^ Z astiun of Facflit't' 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 caesura denial or papocari a of.1 - and for prosecution under M.G L Ch.?A Section 1. Applicant's� �111�i.'�.... Date: Owners Signature(or attachment) aC SW- Atteathet Date: _ Approved By: — / Dade: � /_ 3 ZO Building designee) e? • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Frotectinn District Within 100 ft.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms br'An Ie fin. dba:Renewal ByAndersen of Southern New and Frank&Lynne Mellace •40- Legal Name:Southern New England Windows,LLC 8 Many Oaks Circle RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Yarmouthport,MA 02675 WINDOW RE 'ACEYERT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)394-3067 Phone:401-349-1384 I Fax:401-633-6602 I saleserenewalsne.com C:(508)776-4829 Buyer(s)Name: Frank& Lynne Mellace Contract Date: 02/01/20 Buyer(s)Street Address: 8 Many Oaks Circle, Yarmouthport, MA 02675 Primary Telephone Number: (508)394-3067 Secondary Telephone Number: (508)776-4829 Primary Email: fanl@comcast.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: $34,717 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: $17,358 Balance Due: $17,359 Estimated Start: Estimated Completion: Amount Financed: 10-12 WEEKS 10-12 WEEKS $34,717 Method of Payment: Financing 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: 17358.00 deposit-GREEN SKY; 17359.00 balance due upon completion-GREEN SKY 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 02/05/2020 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 By Andersen of Southern New England Buyers) Signature of Sales Person Signature Signature Chris Hutson Frank Mellace Lynne Mellace Print Name of Sales Person Print Name Print Name UPDATED: 02/01/20 Page 2 / 16 ..)e-/29.-/22e-vme-Lea /2- (127,-/ea:).*. ..a_4.4e/4 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 20ne-05i17 Update Address and Return Card. 61,77~il,c eaCt/ re -ie efclt; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card before the expiration date. If found return to: Reaistrafioq_ 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 RESERVVOIRRROAD ROAD SMITHFIELD,RI 02917 Undersecretary N` without signature r _ Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construct on`Supervisor CS-095707 _ Ea, p i res: 09/08/2020 BRIAN D DENNISON !, 8 BLACKWELI DRIVE , — s " CHARLTON MA%01507 Commissioner CAL _ e -. The Comtnorcwealtli of Massachusetts =74 _' cart teeth of tsitdush idAcrtdertts -E= 1 Congress Stree4Suite 104 =_e1.7-7;1 _ Boston,MA 02114-2017 �,,.-' iYWItK gott/�1Q Workers'Compensation insurance Affidavit BuIIders/Coatractors/Eleciricians/Pinmbers. TO BE FLED WITH THE PER.MLTFING AUTHORITY. Anolicsat Information ! 1 Please Print Leoibiv_ Name(Busine$/o �c�dividuat): S ocu f`h a r A. ,V a u, tnq/G4 W l ll tilOLDS Address: 10 ter nor Lr t �.1 . City/StatelZip:S F,r ►-a el eE,Pi 42,9 1 67 Phone#: 5/ol-2.Z�- 9' � Are yea as employer?Cheek the appropriate box t2. t eta a�tpttryer with �-h� l Type of project(required): amp ogees(tiro and/or part-nine). 7. 0 New construction am a salt proprietor par>:tmsdip and have no employees rwrldng forme in 8. 0 Remodeling am capacky.[No wicks'comp.insurance required.] • sat am a homeowner doing all wodc myaeif[No workers'camp.hrauran=requited.]'' 9. Q Demolition 4.0 lam a homeowner and will be hiring 0000ractors to conduct ail waticoa my patty. t will 10 D Building addition enure*mail contactors either have wars'compensation irotaaace or are sole I L.Q Electrical repairs or addition., - prop with no employees. l2.0 Plumbing repairs or additions 51:3`am general T6esesub.cmhomment sad haveI have kited the�rs listed an the attached sheet 13. Roof employees mud have worms'comp.irucaance,r n 6.0 We are corporadoa and its officers have exercised their right of exemption per MGL a 14 Other IIN�t)c0 4. I.12,¢t).and we have no employees.[No wrultea'rump.inseam required.] e n I11 Pi ' 'MY applicant that checks butt mast also li l out the section below showing trek waitaa'omopeasaliou policy ill03171111d011. • t Hamer who submit' affidavit Meeting they are defog ell work and dmarr lag outside comet=most submit a new affidavit indicating such. tContractots that check this box mast attachedanaddidonel heetthowing the Rome of the sulKontrectors and state whether or not those entities have employees. Mat have employees.they must provide their'workers'comp.policy=bar. I amWor an employer that Is prodding workers'comae •oa lnsarancefermy employe= Below is the policy and fob stir on r Company Name: arelaie a . of r W b_C . F� � s p Poway#or Self-ins.Lic.b:�WCA3/s8�/a!c2 E:pit on Date: 1- /-2.D 2.l Job Site Address: zr-/11t!Uy oilies 61,re, . C lip• Or('LO4 '+'1 f Pill Attach a copy of the workers'cotipensadoa policy declaration (showing the amber and -4 I don page { �S tam dote}. Failure to secure coverage as required tinder MGL c. It,125A is a criminal violation ptmishable by a fine up to S L,500.00 and/or one-year imprisonment;as well as civaa penalties in the form of a STOP WORK ORDER and a Ohre of up to S250.00 a ' day against the violator A copy of this statement may be forwarded to the Office ofInve stigauons of the DIA for insurance: coverage vim, - f do hereby aasderdfre , i - patel.des of perfr+ty that the Lefinraiaaprer i _ and at rreet Signature: _ _ ,t_ • Date: A-- 2.6 Phone#: In1 .-LW— 70 Official use ealy, Do oat write be thk area,to be completed by city or town q ietol City or Town: Permit/License# fuming Authority(circle one): I.Board of Health Z.Building Department 3.City/Towa Clerk 4 Electrical Inspector 5.Plumbing Inspector #.Other Contact Person: Phone/A: S A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 POUCIES 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 1600 Broadway, 9th Floor A/c.No,Ext):303-988-0446 (A/C,No):303-988-0804 L Denver CO 80202 ADDRESS: insure@bokf.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Acadia Insurance Company 31325 INSURED E$1.ERCO.01 INSURER B:Firemen's Insurance Company of WA,D.C. 21784 Soudba e Na AEngndedrsen Windows, LLC INSURER C:Homeland Insurance Company of New York 34452 dba Renewal by Andersen of Souther New England 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURERS: _ • 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 CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSIBR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSD yyyD POUCY NUMBER (MM(DOIYYYY) (MMIDDIYYYY) UNITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2020 1/12021 EACH OCCURRENCE S 1,000,000 , CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S 300,000 MED EXP(My one person) S 10,000 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: I GENERAL AGGREGATE S 2.000,000 X POLICY TNT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: S A AUTOMOBILE LIABILITY CPA3158728 1/1/2020 1/12021 (Ea Mc iden SINGLE LIMIT Snt) 1.000.000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) S A X UMBRELLA LIAB X OCCUR CPA3158728 1/1/2020 1/12021 EACH OCCURRENCE S 15,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTIONS n S B WORKERS COMPENSATION WCA315872922 1/1/2020 1/1/2021 X STATUTE EOTH- R AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) I EL DISEASE-EA EMPLOYEE S 1,000,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 1,000,000 C Pollution Liability 7930073340002 I 1/1/2020 1/I2021 Each Occurrence S2,000,000 Claims-Made Policy I Agg ate 52,000,000 Retroactive Date 06r202013 Dr a S25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom 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 POUCY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE SalfrWaiss, 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD