Loading...
HomeMy WebLinkAbout0075 MOCO ROAD '7S i�o c0 S M E A D No.53LOR UPC 125U smsadcom • Mach In USA A IN SUStiIINABLE . crd�aFe.rfourefno WWWJ VGMM IMF Application number................................................ ' ate RIO BARVSTABLE ® i Issued....................qz.A.�. MASS. t a39c 61 APR 30 2019 Building Inspectors Initials....... ..... 0 MA _ TOk0llj� EARNS1t1 ap/Parcel.......... .. ........ 1.n�........................... TOWN OF BA STABLE �35. OD EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 73' 1"larr, IJ cy Rpan-,St NUMBER STREET VILLAGE Owner's Name: Phone Number So& 25 4 2--2 H 7 Z Email Address: Cell Phone Number Project cost $ ( . 3 7 — Check one Residential V1 Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: le e A- 2 cLa C'� �-� Date: TYPE OF WORK ❑ Siding 2rWindows (no header change)# ❑ Insulation/Weatheriza g ) �_ tton ❑ Doors (no header change)# Commercial boors require an inspector's review Ell Roof(not applying more than 1 layer of shingles) rr n Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name I�t�an ��n�t,'so✓� - -!,Ae rr\ Weld ccf,� (t,4 rf'n chow S Home Improvement Contractors Registration(if applicable)# 17 3 LLt-. (attach copy) Construction Supervisor's License# DJ 5`7 07 (attach copy) Email of Contractor StJee�9 q56 6iyV; • C M Phone number 1101— Z 2. R -�goo ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents OnIY* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/C®AL/PELLlET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXErv2TION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICAN 9 S SIGNATURE Signature 4v�—� Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal By Andersen of Southern New England Russel Moulaison Legal Name:Southe New England Windows,LLC 00 � ,, RI #36079, MAr#173245,CT#0634555, Lead Firm#1237 7 SW Maco Rd West Barnstable,MA 02668 .1"00. ae .CEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:5083622472 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: Russel Moulaison Contract Date: 04/16/19 76 Buyer(s)Street Address: *Maco Rd, West Barnstable , MA 02668 Primary Telephone Number: 5083622472 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: $6,837 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: $2,278 Balance Due: $4,559 Estimated Start: Estimated Completion: Amount Financed: $o 6 to 8 weeks 6 to 8 weeks I 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: Depo paid by Check/ Bal check. Barnstable (pending son in-law 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 04/19/2019 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,LL.0 dba:Renewal By Andersen of Southern New England Buyer(s) -Q�S5-1r jJ�vrt.�Soil Signature of Sales Person Signature Signature Cory Scanlon Russel Moulaison Print Name of Sales Person Print Name Print Name i UPDATED: 04/16/19 Page 2 / 11 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 1 -05/17 Update Address and Return Card. a� 20"M�� 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: Repisfafibn. Expiration Office of Consumer Affairs and Business Regulation 1°7_5245,- 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW-.ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON, 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary M.O without signature Commonwealth of Massachusetts Division of Professional Licensure 4 Board of Building Regulations and Standards Constr _ct n supervisor CS-095707 ,p i res . 09/08/202.0 BRIAN D DENNISON 8 BLACKWELL�DRIVE CHARLTON MA-01507 ;vCL :Ql COMMIssioner i The Comunonwealth,of Dlassacltusetts Department of Industrial Accidents 1 Congress Streely Suite 100 Boston,M,9 02114-2017 www mass goV1 a Workers'Compensation Insurance Affidavit Builders/Contractors0ectricianslPiumbers. TO BE FILED WITH THE PERNIITTLYG AUTHORUY. Anoliant Information e Please Print Legibly Name(Business/Organizationtlndividua(): c her Q o Address: City/State/Zip:Sin l-H1 e��t 1�1 0z9 17 Phone#: Are you an employer'Check the appropriate box: Type of project(required): 1. 1 am a employer with �4'employees(fidl and/or part-time).* 7. New construction 2 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurm=required] 8: Remodeling 3.[J 1 am a homeowner doing all work myself[No workers'comp.insurance require.]t 9. ❑Demolition 4.❑[am a homeowner and will be hiring contractors to conduct all work on my property. [will 10 D Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L:Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions S.O[am a general contractor and 1 have hired the subcontractors listed an the attached sheet. `- These sub-contractors have employees and have workers'comp.insurance.t 13. Ro f repairs /f 6.0 We are a corporation and its officers have c mmised their right of exemption per MGL c. 14.[ e[_tt,i r`GC'��c� 152,§1(4).and we have no employees.(No workers'comp.insurance tequited.1 !`�ll'r t'i►t B� 'Arty applicant that checks box p I must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such t6atracmcs that check this box trout attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the strb-Contractors have emplo yas,they must provide their workers'comp.policy Mader. I inn an employer that is providing workers'compensation insurance for my employees: Below it the policy andlob site Information. Insurance Company Name: 7FMeWA5Q/lM,-_ .WA Policy#or Self-ins.Lic.#: WCA,3l,5el,2 ?ay Expiration Date: — 2-0 Job Site Address: 7 5 :QGU �� City/State/Zip: -,'n- �AA'�,4 Attach a copy of the workers'compensation policy declaration page(showing the policy number 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby ce under the p ' Apdpenaffa ofpedaty that the infornmtion provided above is true and correct t Date: — I — / Phone#: !!!IQ) 9" Official use only: Do not write in dds arcs,to be completed by city or town o,oWaL 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#: Acl�>REY CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) `� 1 12128/2018 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 CoBiz Insurance, Inc.-CO NAME` 1401 Lawrence St., Ste. 1200 PHONE t 303-988-0446 FAX Not:303-988-0804 IL Denver CO 80202 ADDRESS: COMaiI cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER s:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC.dba Renewal by Andersen of Southern New England INsuRERc:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:787175890 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 NTH 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. TYPE OF INSURANCE POLICY EFF POLICY EXP ILNSRR ADDL SU POLICY NUMBER ►yIMIODIYYYy MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS MADE OCCUR PREMISES occurrence $300.000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,00o.0o0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY 0 jE T LOC PRODUCTS-COMP/OP AGG $2,000,0D0 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT a aoddent $ 000 0 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS AU BODILY INJURY(Per accident) $ X HIRED AUTOS M NON-OWNED PROPERTY DAMAGE AUTOS (Per accident $ A X UMBRELLA LIAR X OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 �EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DE D I X RETENTION$ $ B WORKERS COMPENSATION WCA315872924 1/1/2019 1/1/2020 X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEM8ER EXCLUDED? � N/A E.L.EACH ACCIDENT $1,000.0W (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 0W.000 C Pollution Llabllily 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Claims Mada Policy A98re9ate $2,000,000 Retroactive Date 08/20/2013 Deductible $25,000 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES-ONLY AU``TjjHORIZEDREPRESENTATIVE /vR ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD