29-076 (5) INSULATION
SIDING CO., INC.
56 FRANKLIN STREET EASTHAMPTON, MASSACHUSETTS 01027
EASTHAMPTON OFFICE: WESTFIELD OFFICE: 568 O.1-:
('r)t�lt�1( IUrS IiE , fist tr 10 IW-):i
Proposal Submitted to Phone pot*
KoIeU "Pvrchoser•' %�-3129 }) , cxx
Street Job Name ()ct 10 2
"-
62 Aar ebr ook Drive
Cit�yy, State and
� Tip Code Job Location Job Phone
/
Contractor hereby submits to Pvrchoser specifications and estimates for; Ii`61PLI_VION OF VIN t REPI ACEMWI WI
1. We will install 1.9) DoLble �tff,� (,ertainTead 59uc)r, Vii,yl RePI --r'ertt W,11-MW Units in 00signated yeas.
2. They, wii; have crxt)le parx� insul,�tk!4� glass w'j",i; hal .i;` Galcr ;ili be wMite wit-a.rt r, .
5. We wi:). inst911 i`irk?f' glass lrls,latici arcunc. 'r'l.l k Alir� iRstal1e iirv, so t with SI1iaM r;c7lt:Cit1C}. -
4. All wirx y units will have Therrrtaflect glass_ _
5. We will blart ClaSr aim t llulosr irl '+might ct.�sties wrtr r dl wi;Y:ywi amts installe 1 (W'Pr~e
�. Vinyl Re�lat f ;* `:,'irxkw 'Lhit rlas a arx,fa;: ��t�r's i f,� a f e
—_ t ,;rt ,�.3r•ra,rty ,rr:. th.. glass has a ?0-r�r
Warranty". -------- ._
I i PRIG lX: t ,1�T �1 u IRIS( _LING ALUw1IPlt ,11'RIY EXTERIOR GF ',t,11 )w 1JNI15.
7. �O will r,,i� vtiA arr.` i:islose of r-Cr� ar)d,'or altrriruTl Y,,j x Ns if existing.
PR I CF: S2,412-00-
* R OR CIONiiACTORL
BE . OAN q-- BUI!..-l'C tr PERf�IT ;IF IV Gff!�.
A . �iS „ _ FACD UPON
12FiT.
T.P.
�i12. WE PROPOSE to furnish material andr� c e•tP r}_..�c�pr {ce with above spec fications, for the sum of
' —dollars ($
1
),
If payment late, interest at 1 1/2°h may be added. -• •�- G - i ..' l� �-�� payment due upon receipt of invoice
NOTE: This proposal may be withdrawn by us it not accepted wtthrn .!_ �'Ilir days.
r
~Contractor Salesman
Judy K0 etl __ Acceptance by Purchaser, and Title
"You may cancel this agreement if it has been consummated by a party thereto at a place other than an address of the
seller, which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or
branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day
following the signing of this agreement.
See the attached notice of cancellation form for an explanation of this right•"
SUBJECT TO TERMS AND CONDITIONS PRINTED ON REVERSE SIDE.
a �
OQ"�tlAblp�O
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DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building; '
Northampton, Mass. 01060 Ib
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, ED LOSACANO, OWNER OF ALL STAR INSULATION & SIDING CO., INC.
(1i censer/permi ttee)
with a principal place of business/residence at:
56 FRANKLIN STREET, EASTHAMPTON, MA (phone#) 413-527-0044
(strt:eUcity/s=d2ip)
do hereby certify, under the pains and penalties of per3ury, that
(X) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Comfy) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) insurancc Company/Policy Number) (Expiration Date)
(Name of Conlractor) insurance Company/PoGcy Number) (Expiration Date)
(Name of Contractor) insurance Company/Policy Number) (E)Tiration Date)
(attach additional shod ifnooeauy to inc}ude iafortnatioa pertaining w all ooatradon)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOIE:please be aware ttx whilo bomco-nets wbo employ pctsoas to do maixztenaace,masmxuoo or tepee work oo a dwelling of
W morn than throe tarts in which the hoeteowna resides or oa t5e Uourn b appurtenant thm-cto art oot grnor 4 ooastciered to be
employers uOdcr the wort %ration Act(GL152,ss 1(5)),application by a boa=woer for a license or permit may evict'=the
legal statue of an amployer under the Wockoes Compomation AcL
i
I understand d at a copy of thin r&L—It may be forwarded to tho Depart of Irr&tstnal Atxaderj&Offioe of Inwrwoe for the
ooverage verificatioa mad ante f iltrre to&eclat covcrab-o unda union 25A of MGL 152 can lad to the i oa of airmail pcaallies
ooasb:tbag of a fine of up to S 1,500.00 and/or impri3o�of up to om year and civil pmattia in the form of a Stop Work order aid a
fund of 3100.00 a day tpicst me
For&Pvttmaw uao oaty
Permit Number
1c) 31100 Map#►---Lot 4
Si of Lioansee/Permi
SECTION'8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
r a �w ad 9&rk*EP
N t A
�t� a E it
WW, :°', opplicable ❑
r C 101 bs$
Company Name Registration Number
54D P-MnyjIn s�-r-Pie-}- lol 0a
Address , I Expiration Date
Telephone^ `f
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c'. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance f the building permit.
Signed Affidavit Attached Yes....... No...... ❑
ti
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures. A person who constructs rro:a than one home in a two-year period shall not be considered a homeowner.
Such"homeowner" shall submit to the Building Official, on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
c'CTION 5. DESCRIPTION OF PROPOSED WORK(check all applicable)
1.
New House ❑ Addition ❑ Replacement endows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: 9,e%1D0C 0W WIt1dUw5 .�OW 10'nJ f6P10a)1k n+- "Ows
Alteration of existing bedroom Yes No Adding new bedroom _Yes No
Attached Narrative o Renovating unfinished basement Yes No
Plans Attached Roll o - Sheet o
6a�f�New�ou a nd or atltlition to existing housing, complete the following:
a. Use of building : One Farnil, _ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions.
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves_ Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade _
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
-, as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
L=A1 O-j<A CG n 0, V�_eSl d O n+
Print Na e
03doo
Signature ner/Agent 10 Date
t
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES _
IF YES, date issued:
IF YES: Was the permit recorded at the Registr of Deeds?
NO DON'T KNOW _ YES
IF YES: enter Book Page and/or Document #
B. Do the site contain a brook body of water or wetlands? NO DON'T KNOW Z
Does y
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
! 0 of Northampton
ing Department `
3 2 Main Street
Room 100
th mpton, MA 01060 ]j
3 yf:
tfP—T OF 8UILD,MG a e � <
•1240 Fax 413.587.1272 IY
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-'SITE INFORMATION
1.1 Property Address:
This section to53�e completed=by off e
�a Fac,�eb�rool< "Asp Lot unif
Flren
Zone Overlay District
o
Elm St. District CIS District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e \ud 9 Y-ile m (na reb OK Dc' Elor a Ce
Name(Pr' ) Sit Addddr ss:
S l(P
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTIQN 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building A 00 6Tl (a) Building Permit Fee
2. Electrical Ql 1 V V (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
x-.62 ACREBROOK DR BP-2001-0469
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-076 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:windows replaced BUILDING PERMIT
Permit# BP-2001-0469
Project# JS-2001-0800
Est.Cost: $2400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: All Star Insulation & Siding Co Inc 101858
Lot Size(sq.ft.): 20821 .68 Owner: KOLEMBA EMMANUEL J&JUDITH L
zonin, .URA Applicant: All Star Insulation & Siding Co Inc
AT: 62 ACREBROOK DR
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers
Compensation
EASTHAMPTONMA01027 ISSUED ON:11 13100 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si¢nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/3/00 0:00:00 24844 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo