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HomeMy WebLinkAboutBld-20-004486 �.� • Only Amount .5-0 CO Permit expires 180 days from • o1 J date 1.1.UIIVG DEPARTMENT EXPRESS BUILDINGTERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 6 3 Pi f rt Q.h L.(' U 1,47 ASSESSOR'S INFORMATION: Map: Parcel: • OWNER: Z 1 /Yl ‘- 7 A kki c k A Ciri.est;roai arf� n ,1 (3D&- q/y'070c NAME Do 2v7,, `TA. # Email Addres ,'"� io ese v 7 C } 229-9-- CONTRACTOR: �tu-I"�rA !J� Uv�n�vt�s �Sa►.���e/c/ i`�� i '�1 AME MAILING ADDRESS T # Email Add Residential Commercial Est.Cost of Construction$ 22 '7 ZZ Home Improvement Contractor Lie.# 17 a 2.5/S Construction Supervisor Lie.# O 4767e 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor )4 have Worker's Compensation Insurancenn ,�� Insurance Company Name: i'11 f 7EAJS 1 L S•. �i Wor::es's Comp.Policy# 0A 8I6Y1 z 9 2- WOyjc TO BE PERFORMED Tent Duration (Fire Retardant - . ,,ed?) Wood Stove Siding: #of Squares - Replacement windo, - /, Replacement doors: # Roo : #of Squares ( )Remove existing*(max.2 layers) Insulation a''13 Old Kings Highway/Historic Dist. --to cc e '.5-11 cc`' ah U. o -p e�e-, *The debris will be disposed of at ith de �tn a (,Pat 0" // O 'e cnttun of Facklitk I declare under penalties of perjury that the:,.. A:,-. herein contained ate true and correct to the best of my knowledge and belief. 'understand that any false answers; will be just cause for denial _ ocadon of. ,,., and for on under M.G.L.Ch.268.Section 1. . i /Z.X-/2-0 Applicant's Signature: Date: Owners Signature(or attachment) at See- *tartlet r- Date: Approved By: Dace: 2— Bail (or designee) • Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 it.of Wetlands: Yes No Yes No Renewal Agreement Document and Payment Terms �' ersen. dba:Renewal By Andersen of Southern New England Judy Tyler ►� Legal Name:Southern New England Windows,LLC 59 Miriah Dr. war 4 - RI#36079,MA#173245,CT#0634555, Lead Firm#1237 Yarmouthport,MA 02675 WINDOW\:ACENEar 10 Reservoir Rd I Smithfield,RI 02917 H:(508)414-0705 Phone:401-349-1384 I Fax:401-633-6602 I saleserenewalsne.com Buyer(s)Name: Judy Tyler Contract Date: 12/03/19 Buyer(s)Street Address: 59 Miriah Dr.,Yarmouthport, MA 02675 Primary Telephone Number: (508)414-0705 Secondary Telephone Number: Primary Email: tylerja.aol.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: S22,927 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: S11,463 Balance Due: S11,464 Estimated Start: Estimated Completion: Amount Financed: **3/16-3/31 2020** **3/16-3/31 2020** 522,927 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: **ORDER CONTINGENT UPON SECONDARY FINANCE APPROVAL** 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 12/06/2019 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 Buyer(s) Signature of Sales Person Signature Signature Chris Hutson Judy Tyler Print Name of Sales Person Print Name Print Name UPDATED: 12/03/19 Page 2 / 16 r— JFiL/92/22 li Aje • 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 Update Address and Return Card. SCA I G 20M-05/17 fe Fcvninnn,!uea,& 77.2i-ie e-J?4 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: Reaistratio_n Expiration Office of Consumer Affairs and Business Regulation 17a245._ 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON s 10 RESERVOIR ROAD �� SMITHFIELD,RI 02917 Undersecretary ft without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construct on Supervisor CS-095707 = r E- p i res: 09/08/2020 1 BRIAN D DENNISON - 8 BLACKWELI DRIVE :� _ ' CHARLTON MA /01507 .. ^� 31 • cAL Commissioner "� - The Commonwealth'of Massachusetts - -�' Department oflndustrialAceidents - fir! " 1 Congress Stree4 Suite 190 *_=_� _ ' Boston,MA 0211�2017 .,. .0.-- www.mass.gov/dia Workers'Compeosatioa Insurance Affidavit:BullderslCoatractors/Electrfciaas/Plumbers. TO BE FLED WITH THE PERMITTING AUTHORITY. ,stng1Jcant Information Please Print Leaibfv Name(Business/Organization/Individual): S OG`I'h t'/',1. &)e IL) tn,4 1 et*/ 1/0 l l i(fat)S Address: I ?e.serUQjr �J City/State/Zip:Sp)rn-6I elcit h`'- 1 ©Z9 /7 Phone#: 44/-2.?i r- ? go° Are you as employer?Check the appropriate box: Type of project(required): 1. l am a employer with 20 employees(full and/or part time),° 7, New construction ` am a solo proprietor or partnership and have no employees working for ate in 8: 0 Remodeling any capacity.[No workers'comp.insurance required.]• 9. ❑Demolition 3.01 am a homeowner doing all work myself[No workers'comp.insw•nce required.] 4.0I am a homeowner and will be hiring contractors to conduct all wadcon my property. [will 10 0 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 5. [am a general contractor and[have hired the sub-connectors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other r,(� n O 6.�We are a corporation and its officers have exercised their right of exemption per MCI.a -�n,� 152,g[(4),and we have no employees.[No workers'comp.insurance required.] t /1l *Any applicant that checks box el must also fill out the section below showing their workers'compensation policy n.o 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 rams of the orb-cmCacoms and sties whether or not those entities have --,toys a. Mtn sub.cmuractWs have employees.they must.ravine their wodars'- ,,. policy number. I am an employer that Iv prodding workers'compensation insurance for my employees Below it the policy and job site information � lawaMe ,,rInsurance Company*Vatic: '7"t t' 111e1IZ . - of �NfiI Cb. C Polle?#or Self-ins.Lic.#: W'CA3ls8 2 7 0? . Expiration Date: `' — L lob Site Address:t 7 /'l 1 r i e k bi. City/State1Zip: r 7 Al Attack a copy of the workers'compensation policy declaration page(showing the policy nu bar and expi Lion date). Failure to secure coverage as required under MGL c. 152,625A is a criminal violation punishable by a fine up to S 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 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 venon. f do hereby under the p pendties of pedal that the information protddef7 _J2 / bove true and correct 2,0 Signature: A Date: l Phone#: 1n f 4—7;24 --2 100 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/Iowa Clerk 4.Electrical Inspector 3.Plumbing Inspector 6.Other Contact Person: Phone!i: t DATE(MMIDD/YYYY) A�o® CERTIFICATE OF LIABILITY INSURANCE 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 1600 Broadway,9th Floor A/c,No,Extl:303-988-0446 (sic,No:303-988-0804 Denver CO 80202 ADD TRESS: insure@bokf.com INSURERS)AFFORDING COVERAGE NAIC 0 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 D: 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. INN ADDL SUER POUCY EFF POUCY EXP UNITSLTR TYPE OF INSURANCE *MD WVD POLICY NUMBER (MIIIDD/YYYY) (MWDDIYYYYt A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/12020 1/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300.E MED EXP(Any one person) $10,000 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2020 1/1/2021 COMBINED SINGLE LIMIT $ (Ea accident) 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OSMED SCHEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS x AUTOS (Per accident) $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2020 1/1/2021 EACH OCCURRENCE $15,000,000 EXCESS IJAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION `WCA315872922 1/1/2020 1/1/2021 X PER ER OTH- AND EMPLOYERS'UABIUTtt STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICER/MEMBER EXCLUDED? N N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Dyes,describe under ESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340002 1/1/2020 1/1/2021 Each Occurrence 2000 R pd ae $2,000,000 Retroactive Dato05013 $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/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 POUCY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE Ai ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Renewal bYAndersen. WINDOW REPLACEMENT an AndctsenCompany To whom it may concern: The Association, or its' Management Company,grants permission to Renewal by Andersen to install custom-made replacement windows in the following facility: Name of Development Deb's Hill Customer Name Judy Tyler Address 59 Miriah Dr. , #)mouth Port Unit# State MA Number of windows I1 doors 1 0 I Style(i.e.double hung/casement,etc.) (10)double-hung,(1)picture, (1)casement double White "PROPOSING TO CHANGE GRILLE Exterior window color P CONFIGURATION FROM 12112 TO 6/6, I�FrN1 Gi'b�f �! 4/4(BAY WINDOW SIDE UNITS), Exterior window trim finish Yes 0 No Color Choose One: CHANGE PICTURE WINDOW IN BAY FROM 6 WIDE/4 HIGH TO 5 WIDE/4 HIGH,AND CHANGE(2)REAR Grids Yes a( No Q FACING DOUBLE HUNG WINDOWS (NEAR PATIO DOOR)FROM 12/12 TO White SHORT FRACTIONAL-TOP SASH Grids between the panes Yes Gal No Q Color ONLY(TO MIMIC EXISTING PATIO DOOR GRILLES)" Grid pattern matches existing Yes C No 123 To pAATC N ,TttNc kteb �►In t'C�- S i i�i 1 I t{ . TO BE COMPLETED BY HOA MEMBER: Signing below indicates approval of window color,grid pattern and color as well as trim color/finish on exterior for the above unit 141 , "meowner.Nil Signature Ir '4r Print name PAULA.BARON Title PR#PFD tY P4AwA&EA Phone# 508-360-1557 Date 1/27/2020 Product Specialist Chris Hutson Offices: Rhode Island/Cape Cod/CT 10 Reservoir Rd Smithfield,RI 02917 Fax 401-633-6602