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HomeMy WebLinkAboutBLD-23-005860 .Og+YA ce se Only O .44"1! V H' Amount *44.0* � E� Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 APR 2 0 South Yarmouth,MA 02664 ;231 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT CONSTRUCTION ADDRESS: 3 ei Dana s pain-. E,Y ASSESSOR'S INFORMATION: Map: Parcel: f OWNER: Ho)ik Ilia. Git 9 + tam'Peal, �vYctOwvLNAME f ll ��,, n rr PRESENT ADDRESS�,Q ,//+., u, TEL. # /,, r� • CONTRACTOR:L D 4- M'o(113 '2 J„ i€c 54, Il/1 1314 1 i(, i, fi s L(Q 1 .L(�UI {L/ () NAM ING ADDRESS TEL.# 04Residential 0 Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# I f / S I O Construction Supervisor Lic.# 0 OS "i f/g Workman's Compensation Insurance: (check one) 0 I am the homeowner �❑ I the sole pro �rietor(f have Worker's Compensation Insurance )r 7 Insurance Company Name: LA ✓ Y 1 Vw�WC� Worker's Comp.Poll (e r 3 J S* • 1 4 �1�13 0 3 WORK TO BE PERFORMED Tent .LJ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# I 1 Replacement doors: # Roofing: El o I I Old Kings Highway/Historic Dist. Replacing like for like Pool fencing n *The debris will be disposed of at: i • L' 1 \,?' 6 SaZ .(S 1- J Location of Facility I declare under penalties of perjury that the statements 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 deni r revocation license and for prosecution under M.G.L.Ch.268,Section 1. V a Applicant's Signature: ,,(� Q �p Date: q. l a ,v 3 Owners Signature(or attachment) /(C `"' li Date: (/ /U .n Approved By: L ' Date: i'--- -/' -! - Building Official(or designee) EMAIL ADDRES c ) Zoning District: Historical District: ❑ Yes No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 0 No 0 Yes 0 No • Page 2 of 21 MA HIC#187510 Lang Roofing, LLC •300 Myles Standish Blvd Taunton MA, LONG HOME 02780 (800)470-LONG • (240)473-1400 • LongRoofing.com PRODUCTS By Long Roofing, LLC Kathleen Mahoney 5086558768 Date:04/08/2023 39 Dana's Path mahoney.kathleen@gmail.com Product Specialist: Gary Jean West Yarmouth MA 02673 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Windows Being Replaced: Partial Total Windows Being Replaced: 0 Entry Link Number NA Window Job Specifications I/ 1. Obtain all necessary insurance i/ 2.Arrange for pre-installation measure V/ 3. Prep individual work areas. (Homeowner is responsible to remove blinds, drapes,furniture, security systems and any special items.) V 4. Carefully extract existing window(s)/door(s)and prepare opening for new vinyl window(s)/door(s). ✓ 5. Install new vinyl window(s)/door(s) into existing opening. ,/ 6. Square up/adjust new vinyl windows)/door(s). ✓ 7. Insulate perimeter of window(s)/door(s)with fiberglass, if necessary. %/ 8. Custom wrap wood exterior with PVC coated aluminum coil stock. %/ 9. Caulk with OSI lifetime caulk. OSI can produce a strong odor that can last up to 10 days. %/ 10. Clean up and remove old windows)/door(s)and debris and dispose. ✓ 11. WARRANTY- LIFETIME TRANSFERABLE WARRANTY Initials Window Item 84-103 UI Window Style Double Hung Room Location Living Room Glass Package Low E Argon Size 32 x 64 Quantity 1 Capping Color Black(PVC) •n, White White d Window Project Notes White on white no grids black trim around ext. Of window only Window Item 84-103 to Window Style Double Hung Room Location Bedroom 3 Glass Package Low E Argon Size 32 x 64 Quantity 1 ' Capping Color Black(PVC) White White Window Item 84-103 UI Window Style Double Hung Room Location Bedroom 2 Glass Package Low E Argon Size 32 x 64 Quantity 1 Capping Color PP 9 Black(PVC) d White White Page 3 of 21 Wl dow Item 84-103 UI Window Style Double Hung Room Location Bedroom 1 Glass Package, Low E Argon Size 32 x 64 Quantity 3 Capping Color Black(PVC) i 4 White - White Window Item 84-103 UI 'ri Window Style Double Hung Room Location Family Room Glass Package Low E Argon Size 32 x 64 Quantity 3 Capping Color Black(PVC) White White F i Window Project Notes No grids white on white black trim on ext. Window Item 38-83 UI Window Style Double Hung Room Location Bathroom 1 Glass Package Low E Argon Size 28 x 35 Quantity 1 Capping.Color Black(PVC) r: White White Window Item 38-83 UI riWindow Style Double Hung Room Location Kitchen Glass Package Low E Argon Size 28 x 35 Quantity 1 Capping Color Black(PVC) 111 White White Additional Details ORDER NEW CONSTRUCTION WINDOWS WITH J CHANNEL This space intenfionally left blank MA HIC#187510 Page 4 of 21 Long Roofing, LLC •300 Myles Standish Blvd Taunton MA, LONG HOME 02780 (800)470-LONG • (240)473-1400 • LongRoofing.com PRODUCTS By Long Roofing, LLC Kathleen Mahoney 5086558768 Date:04/08/2023 39 Dana's Path mahoney.kathleen@gmail.com Product Specialist: Gary Jean West Yarmouth MA 02673 The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Homeowner's Association Approval Required NO I do not belong to an HOA.I accept FULL responsibility for this project and authorize installation I confirm that the above information is accurate // Dumpster Required NO I confirm that the above information is accurate Are there electric lines within 3 feet of where LHP will be performing work? NO Preferred Method of Contact Phone Phone/Text/Email 5089602035 Total Purchase Price $21,070 Deposit with Order $8,300 Amount Due on Substantial Completion $12,770 Amount Financed $0 Form of Deposit Check The Estimated Date of Commencement of the Work Is 5-7 Weeks The Estimated Completion Date Is 5-7 Weeks I am aware that the above dates are an ESTIMATE Aix The Project Is Contingent Upon Obtaining Permits ria THERE ARE NO ORAL AGREEMENTS Promotion Selected(Cannot be combined with other offers) Cash Discount Customer Promotion Acknowledgment '' This stake intentionally left blank r It is agreed and understood by and between the parties that this Agreement, constitutes the entire understanding beihILIO of 21 the parties, and there are no verbal understandings, changing or modifying any of the terms of this Agreement. Buyer(s) hereby acknowledge that Buyer(s) has read Agreement and has received a completed, signed and dated copy of this Agreement, including the two accompanying Notice of Cancellation forms, on the date first written above. Buyer(s) acknowledge that they were orally informed of their right to cancel this transaction. 0211- ‘441€14:714eadX71 Gary Jean Kathleen Mahoney 04/08/2023 04/08/2023 Date Date You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the accompanying notice of cancellation form for an explanation of this right. Pus space intentionally left blank. • Commonwealth ot Massachusetts * L=, Division n of Prnfessjona1 Licensure Board of But1dil g; Regulations and Standards o615 Peg ATHO AMA '3 CommissionerY.6ncit,12, Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card LONG ROOF.ING LLC Registration: 187510 Expiration: 04/20/2023 8530 CORRIDOR RD,SUITE 200 SUITE 200 SAVAGE,MD 20763 Update Address and Return Card. 1• Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE;Supplement Card before the expiration date. tf found rearm to: Registration Expiration Office of Consumer Affairs and Buotiness Regulation 187510 04/20/2023 1000 Washington Street -Suite 710 LONG ROOFING LLC Boston,MA 02118 GERRY PRTRIQUIN 8530 CORRIDOR RD,SUITE 200 i':rl4s98i" SUITE 200 Undersecreta valid witho signature SAVAGE,MD 20763 ry LONGFEN-04 DHARRIS '4`C,.�.= CERTIFICATE OF LIABILITY INSURANCE MEY DATE(MM/DD/YYYY) 1/3/2023 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 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 License#0C36861 CNE cr Danielle Harris Lanham-Alliant Ins Svc Inc PHONE FAX 16901 Melford Blvd Ste 123 (A/C,No,Ext): (A/C,No): Bowie,MD 20715 Mass;ss:danielle.harris@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED INSURER B:Commerce Insurance Company 34754 Long Roofing LLC dba Long Home Products INSURER C:Burlington Insurance Company 23620 300 Myles Standish Boulvard INSURER D: Taunton,MA 02780 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INBD WVDIMMIDDIYYY1() IMMIDDIYYYY), A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CF4GL01198-221 12/31/2022 12/31/2023 DAAMAGET El:ENTErence) $ 100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BCDX02 12/31/2022 12/31/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AURT�OS ONLY X AUIT�OpS D RR AUTOS ONLY AUTOS ONLY (Per aceidentDAMAGE $ $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE 600BE00525-03 12/31/2022 12/31/2023 AGGREGATE $ DED RETENTION$ Aggregate $ 5,000,000 WORKERS COMPENSATION PER 1OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ RFFlC�E oryEMB NFL EXCLUDED? N/A � N E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /41-45 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • WORKERS COMPENSATION AND EMPLOYERS UASLITY INSURANCE POLICY W(� Liberty Mutual. INSURANCE Ate INFORMATION PAGE 175 Ebrkeley street Boston,MA 02116 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-626143-013 Issuing Office 016C RENEWAL OF: WC5-31S-626143-012 Issue Date 12-20-22 Account Number 1-626143 Sub Account 0000 1. Insured and Mailing Address LONG ROOFING LLC DIM LONG HOME PRODUCES RISK ID 001090057 8530 CORRIDOR RD SAVAGE, MD 20763 Status 46 - LIMITED LIABILITY CO Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE 2 Poky Period: The policy period is from 01-01-2023 to 01-01-2024 12:01 A.M. standard time at the Insured's mailing address. a Coverage A Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the poly applies to work in each state fisted m Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000, 000 each employee C. Other States Insurance: Part'Three of the policy applies to the states, It any, listed here SEE END WC 2003 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. AI information required below is subject to verification and change by audit. Code Premium Basis Toth Rate per $100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ Premium will be billed ANNUAL Producer 0004010026 ALLIANT INSURANCE SERVICES INC 16901 MELFORD BLVD STE 123 BOWIE MD 20715 W C o o 000 1 A ©1987 National Council on Compensation Insurance,Inc. WC 00 00 01 B(CA) Ed.07/0112011 Al Rights Reserved Page 1 of 1 Department of Industrial Accidents 4. Office of Investigations l,�� Lafayette -, '� City Center It = ,. 2 Avenue de Lafayette, Boston,MA 02111-1750 i n ' www.mass govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): LONG ROOFING LLC dba LONG HOME PRODUCTS Address:8530 CORRIDOR RD, City/State/Zip:SAVAGE, MD 20763 Phone#:844-317-5664 Are you an employer? Check the appropriate box: 1.m I am a employer with Type of project(required): 15 4. [] I am a general contractor and I employees (full and/or part-tine).* have hired the sub-contractors- 6• —New construction 2.[] I am a sole proprietor orpartner- listed on the attached sheet. 7. ,®j/ emodeling ship and have no employees These sub-contractors have 8. a Demolition working for me in any capacity. employees and have workers' [No workers'' comp.insurance comp. insurancet 9. [(Building addition required.] 5. [] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof re insurance required.]t c. 152, §1(4),and we have no pairs s employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are,doing all work and then hire outside contractors must submit a new affidavit indicatingsuch. :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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE CORPORATION Policy#or Self-ins. Lie.#:WC5-31 S-626143-013 Expiration Date:01-01-2024 Job Site Address: aS Ci !State iZlp ,\fa taNi Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert�under the ins and penalfies ofperjury that the information provided above is true and correct. Signature: --) {/ ,, Date: 4 3 Phone one#: Official use only. Do not write in this area,to be completed by city or town o ciaL fh City or Town: Permit/License;# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 41:-.1 Electrical Inspector 5Elumb' Inspector 6.1:3Othertug Contact Person: Phone# . _ ...,, a IRestorations Restorations Window (PI—RESTORE) N3200K — itlplePane—Krypton Filled—Qum Low—E NetionM Fenestration Standard Fixed Window Hating Cannon® CERTIFIED Vinyl insulated Frame sUW-K-7-00626-000o1 ENERGY PERFORMANCE RATINGS U—Factor (t1.S. 1-P) Solar Heat Gain Coefficient 0 . 16 0 . 23 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage (IM.S./1—P) 0 .44 1 < -0 3 imeme, in Manufacturer stipulates that these ratings waterer to appitcabfe NFRC procedures for determining whole product performance. NFRC ratings are determined for a fixed set of environmental conditions and specific product site. NFRC does not recommend any product and does not warrant the suitability of any product far any specific use. Consult Manufacturers literature for other product performance information. www.ifrc.org ENERGY STAR"' Certified EitlRcrsTnn in All 50 States