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HomeMy WebLinkAbout0032 LAFAYETTE AVENUE A �ggr7 fS3 Application number.......... o� .. ...................................... Date Issued..........BAMNSTABM Y�� 1 ..................... MASS. 039. `0�' Building Inspectors Initials...... COW 0� bAHNS IABL Map/ParceL.......Z p.�.................... ........................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY MORMATION Address of Project: 3.2, �, ye��e A IC NUMBER STREET VILLAGE Owner's Name: `3e Phone Number s oY-7 7 S 7e u Email Address: E(� I ud�-(ce ✓�,,-ao.�,net Cell Phone Number Project cost$ 3 7 8yp — 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: Sep -F(Q �Q ��,,-{cc,c-� Date: TYPE OF WORD ❑ Siding U Windows (no header change)# 12- Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to W 4s4e-I,,2,w e-n Pn ,!�4 C0/•, /� L CONTRACTOR'S FORMATION Contractor's name I�r un `7R n.�,'so✓� - .SoA-e cn d P,J & ,CV4 1,11'n Aw S Home Improvement Contractors Registration(if applicable)# 17 3 2_q 5 (attach copy) Construction Supervisor's License# M S 7 07 (attach copy) Email of Contractor CrSgee- 9q5- e C bm Phone number q0l z 2 R -9 X00 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. 4� APPLICATION NUMBER........................ . ............................... *For Tents Only* 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/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION 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,speck inspections and documentation required by 780 CMR and the Town of Barnstabie. Signature Date PLICAN T'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Renewal Agreement Document.and Payment Terms' byAndersen. dba:Renewal B Andersen of Southern New England� _ Y g Betty Ludtke Legal Name:Southern New England Windows,LLC 32 Lafayette Ave RI#36079, MA#173245,CT#0634555, Lead Firm#1237 Hyannis Port,MA 02647 WINDOW NE LACEMENT 10 Reservoir Rd I Smithfield,RI 02917 H:(508)775-7845 " Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: Betty Ludtke Contract Date: 04/03/19 • 32 Lafayette a ette Ave,Av Buyer(s) Street Address. y . e Hyannis"Port, MA 02647 . . . Primary Telephone Number: (508)775-7845 Secondary Telephone Number: Primary Email: bettyludtkeCyerizon.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.ihis Agreement Document,the terms of which are all agreed to by the parties and incorporated herein byy 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: $37,820 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: $12,605 Balance Due: $25,215 Estimated Start: Estimated Completion: Amount Financed: $O 6-8 Weeks . - 6-8.Weeks 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: $1.2,605 check dep, 1/3 at start, 1/3 at comp, permit/taxes PD in Barnstable 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(0 hereby acknowledges that Buyer(s) ]).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: y • 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 04/06/2019 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 ByAaOersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature' Seth Grizey _ Betty Ludtke Print Name of Sales Person Print Name Print Name UPDATED: 04/03/19 Page 2 / 16 ��/!� �'j C'�fi'":/"i' r'/`7//�C�rr�%%/(. t!'-d,� _..'�(/T/=•.'i-l/�%/�/���IJ r 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: 73245 0 Expiration: - 9118/2020 10 RESERVOIR ROAD SMITHFIELD, RI 02917 . Update,`Address and Return Card. 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: Registration Expiration Office of Consumer Affairs and Business Regulation M245 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 vva van Witt®ut signature Commonwealth of IiM assal.i :usett-S Division af Professional Liceinsure Board of Building Regulations and Standards �4 1-1S t r U!CtiO n S u ps)°v 1-or S-095'70 _ i res : 09/08/2020 qt�p C��p� p®gyp gg�p�p_ f� BRIAN D DENNISO p 8 i � 8 LACK ELL!DRIVE , CHARLTON A..-01607 The Coer monwealdi of Alassacltusetts . Department oflndustrialAccidents I Con;ress Street, Suite 100 a Boston,MA 07114--2017 www mass.go v1dia NV orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER-1I1ITIING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Qrsea tiration/Individual): G► her lieu) Address: w � Se_r Vol r City/State/Zip:&I-Hi 1 ele ,/?• t OLq 17 Phone#:_ 40 —2,Z g-- Arryan employer'Check the appropriate box:1L�: yType of project(required): a employer with 20T employees(full and/or part-time).* 7. New construction 2.M I am a sole proprietor or partnership and have no employers working for me in $: Remodeling any capacity.[No workers'comp.insurance required.] 3.[]I am a homeowner doing all work myself.[No workers'camp.insurance required.]* 9. ❑Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. [will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 3M I am a general contractor and I have hired the sub-contractors listed on the attached sheet . R of re airs These sub-contractors have employees and have workers'comp.insurance.* 13 ❑ p n 6Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[50ther (,'t r Gt6 W \ 152.§1(4),and we have no employees.(No workers'comp.insurance required.] rcola c.e fs *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information r 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 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 prodding workers'compensation insurance for my employees Below is the policy and job site information.. Insurance Company Name: _' C" /7cSW0/ °_ (.O • Off- ��, (�. Ci . Policy#or Self-ins.Lic.#: fin/C3 l S g 7 2G Z Expiration Date: Job Site Address: 3= Lna F4 -Y e— City/State/Zip: uV4 ✓t'(/-�: Attach a copy of the workers'compens tion policy declaration page(showing the policy number and expiratio 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 certi under the p ' d penalties of perjury that the information provided above is true and correct ' Sinature- Date: " 17-1`I Phone#: Official use only: Do not write in this arert,to be completed by city or town official City or Town: PermitMcense# Issuing Authority(circle one): r 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical-Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC>Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/28/2018 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 PHCON o Ext: 303-988-0446 ac No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 Southern New England Windows, LLC. INSURER B: Firemens Insurance Company of WA,D.C. 21784 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 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 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 EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 111/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,00D PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT LOC I PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 l/l/2019 1/1/2020 COMBINED SINGLE LIMIT $ Ea accident 1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS dent BODILY INJURY( )Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per acc dent $ $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/l/2019 1/1/2020 EACH OCCURRENCE $15.000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DIED X RETENTIONS $ B WORKERS COMPENSATION WCA315872924 1/112019 111/2020 X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/112020 Each Occurrence $2,000,0D0 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25.000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION s 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 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) r The ACORD name and logo are registered marks of ACORD