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43-044 (3)
41 AUTUMN DR BP-2016-1489 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block:43 -044 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2016-1489 Project# JS-2016-002550 Est. Cost: $832.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALL STAR INSULATION & SIDING CO INC 99739 Lot Size(sci. ft.): 12109.68 Owner: LADOUCEUR FRANCIS J JR R. MARGA Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC AT: 41 AUTUMN DR Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 EASTHAM PTO N MA01027 ISSUED ON:6/14/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 1 REPLACEMENT WINDOW POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: 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 Signature: FeeTvpe: Date Paid: Amount: Building 6/14/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR 0 CD '"s = ! MUNICIPALITY ui 0 4: • Massachusetts State Building Code. 780 CMR USE cs Z Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 LU C 4 One-or Two-Family Dwelling W i This Section For Official Use Only cc B 1dmg Permit Number: Date Applied: ho" Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 41 Autumn Drive. Florence,MA 01062 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Check if ves❑7.one? Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Frances&Margaret Ladouceur Florence,MA 01062 Name(Print) City.State.ZIP 41 Autumn Drive 413-586-2956 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work`: INSTALL 1 NEW VINYL REPLACEMENT WINDOW SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building S 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All eeee�:$�i �v Suppression) 7 Check N51 Check Amount:- Cash Amount: 6.Total Project Cost: $ 832.00 0 Paid in Full 0 Outstanding Balance Due: H I Lt . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSL-099739 2-14-18 Ed Losacano License Number Expiration Date Name of CSL Holder R List CSL Type(see below) 128 Glendale Road No.and Street Type Description Southam ton, MA 01073 U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town.State,ZlP - R Restricted 1&2 Family Dwelling M Masonn RC Roofing Covering — -- WS Window and Sidin. 413-527-0044 SE Solid Fuel Burning Appliances allstar561@verizon.net _ I Insulation Telephone Email address 1 D _ Demolition 5.2 Registered Home Improvement Contractor(IIIc) All Star Insulation & Siding Co., INC. 101858 6-29-18 tiic Registration Number Expiration 1):u, i IIIC Con .Nawe or MC Registrant Name allstar561@verizon.net N and Street Email address Easthampton, MA 01027 413-527-0044 City/Town,State,ZIP Telephone SECTION 6: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 of the b ilding permit. Signed Affidavit Attached? Yes Li No. 0 SECTION 7a:OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Ed Losacano _ o act on y b al in all matters re tine toLew,or oriz by this building permit application. /l/t'0 " G -� j1� C21d�� Fr is J C✓ad u Jr.. & garet Ladouceur _ _ P . _ Print wner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Ed Losacanok _67460 ' -(o -/Print Owner's or Authnt's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) _(including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms - Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system __ Enclosed Open _ 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Client#: 13250 ALLST ACORD-. CERTIFICATE OF LIABILITY INSURANCE DATE IMM,DDiYYYYI 09/04/2015 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 Jane Eitel T.P. Daley Insurance Agency, Inc rHONE !FAX (euc,No.Ext):413 788-0971 aC.Nal: 413 739-2645 1381 Westfield St. !E-MAIL laneeitel@tpdaleyinsurance.com P.O. Box 1150 West Springfield, MA 01090 INSURER(S)AFFORDINGCOVERAGE NAICA INSURERA:Peerless Insurance INSURED INSURERB:Star Insurance Company All Star Insulation &Siding Co.,Inc. —INSURER C: 56 Franklin Street • Easthampton, MA 01027 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY `-IAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSJREC NAMED ABOVE FCR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT -0 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SJBJECT TO AL.. THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMl00lYYYY) LIMITS A GENERAL LIABILITY CBP8052996 08/13/2015 08/13/2016/EACH OCCURRENCE _ 41,000,000 X COMMERCIAL GENERAL UABILITY pAM A�E TQ RENrEO PREMISES hEa ocrurencel 4100,000 ICLAIMS-MADE [OCCUR MEO EXP(Any are person) S5,000 I PERSONAL&ADV INJURY S1,000,000 !GENERAL AGGREGATE s2,000,000 GEN.AGGREGATE LIMIT APPLIES PER: 'PRODUCTS-COMP/OP AGG S2,000,000 POUCY X JECI PROT- in LOC 5 _ A AUTOMOBILE UABILITY BA8054496 08/13/2015'08/13/2016 (aM en SINGLE LIMIT $ ' ANY AUTO BODILY INJURY(Per person) $100,000 ALL AUTO OWNED x SCHEDULED I BODILY INJURY(Per acodent) $300,000 X HIRED AUTOS X AUTOS ED (PROP tlTMnti AAMAGE $100,000 $UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE __ S DEC I RETENTION 5 • $ B WORKERS COMPENSATION WC0681114 08/13/2015 08/13/2016 XhACS'O OTH- ANDEMPLOYERS'LIABILITY TORY LIMITS ER Y N ANY PRCPRIETORIPA.RTNER:EXECJTIVE I E.L.EACH ACCIDENT sI 00,000 OFFICERiMEMBER EXCLUDED? N N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5100,000 I1 yes,describe under DESCRIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space Is required) GENERAL CERTIFICATE CERTIFICATE HOLDER CANCELLATION All Star InsulationSiding CO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS. Easthampton, MA 01027 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S123221/M123220 JXE ® Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099739 Construction Supervisor Specialty iii EDWIN W.LOSACANO 128 GLENDALE ROAD N SOUTHAMPTON MA 01073 o• CA , Po NI--M l/-- hxpiration: chi Commissioner 02114!2010 w rn U • • 9L �pa4;VMo o/CiG4aoo,adutoe Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101858 • Type: Private Corporation Expiration: 6/29/2018 Tr# 419291 ALL STAR INSULATION & SIDING CO. Edwin Losacano --— -. 56 Franklin Street Easthampton, MA 01027 Update Address and return card.Mark reason for change. SCA a zoMr� 0 Address 0 Renewal 0 Employment 0 Lost Card fime /fI(/n ((wad hve/6 '-' Office of Consumer Affairs&Business Regulation License or registration valid for individual use only before the expiration date. If found return to: �, ; HOME IMPROVEMENT CONTRACTOR p " Registration: 101858 Type• Office of Consumer Affairs and Business Regulation Expiration: 6/29/2018 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ALL STAR INSULATION&.SIDING CO. Edwin Losacano 56 Franklin Street Easthampton,MA 01027 - Undersecretary Not valid with s : ature The Commonwealth of Massachusetts Department of Industrial Accidents M=.L'li•i�•••••=1M 't Office of Investigations t_t f 600 Washington Street Boston,MA 02111 "4,,� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): All Star Insulation & Siding Co., Inc. Address: 56 Franklin Street City/State/Zip: Easthampton, MA 01027 Phone 4: 413-527-0044 Are you an employer?Check the appropriate box: Type of project(required): 1.2 1 am a employer with 10 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ElRemodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]+ c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box ail 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 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 providing workers'compensation insurance for my employees. Below is the policy and job sue information. Insurance Company Name: Star Insurance Policy#or Self-ins.Lic.#: WC0681114 Expiration Date: 08/13/16 Job Site Address: 41 Autumn Drive City/State/Zip: Florence, MA 01062 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 certify ndef the pains and penalties of perjwy that the information provided above is true and correct. Signature: -e,e1Q.,4I/2 Date: G ' -76, Phone#: 413-527-0044 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/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: A.- : Sr.• LNSL.JLATION :' eg �/ a Easthampton Office & k tfi: I five • 413-527-0044 SIDING CO., INC. 413-5 `y%• 11 CSL License /CS SL99739 44' -al , 00 www.sidingandroofingwestern a.com 56 Franklin Street • Easthampton, MA 01027 • fax 413-527-1222 • emaihallstar561@verizon.net Proposal Submitted toJ'� ,� Phone Date Jim Ladouceur -f- MAelea L �urcTiaser"413-586-2956-H May 2, 2016 Street Q Job Name • 41 Autumn Drive City,State and Zip Code Job Location Job Phone Florence, MA 01062 Contractor hereby submits to Purchaser specifications and estimates for: INSTALL NEW KITCHEN VINYL REPLACEMENT WINDOW 1. We will remove and dispose of existing kitchen window. - , .1 e• • - ■ I• •11.1 •1 -i1-i Ails i• •i designated area 11- , "1.121 I. i- S• .• •-1- '1 . • .. I• . --1 • • I. .- ,' i• •1• , • ► 4. We will install foam insulation around window unit installed and seal with Silicone Caulking on interior - and exterior i• • • 1 •1- - • - •I , -••1 - - - • .i. I.1.9 i 1. .1 -. I i- . 1"0".41 6. Window Unit will have ProSolar Low E glass with_Arson Gas. 7. We will install aluminum coil stocklmaterial around outside perimeter of window where wood exists. 8. Vinyl Replacement Window Unit_has a"Manufaoturerslifetime Warranty" and the glass has a"20-Year Warranty". PRICE:S832 00 NOTE: APPROXIMATE STARTDATE WII I BE 3-5 WEEKS FROM DEPOSIT DATE LESS ANY INCLEMENT WFATHER _i - - ** HOMEOWNER WILL BE RESPONSIBLE FOR ANY FEES-REQUIRED FOR BUILDING PERMITS.: **HOMEOWNER WILL BE RESPONSIBLE FOR REMOVAL OF CURTAINS. MINI BLINDS.AND SHELVES. **HOMEOWNER WILL BE RESPONSIBLE FOR ANY&ALL ELECTRICAL OR PLUMBING FEES THAT MAY BE NFFDFD ** HOMF.QWNFR_W1LL BFBFSPONSIBLF FOR ANY SFCURITY SYSTFM INSTALLED IN WINDOWS ** PRODUCT& LABOR WARRANTIES WILL NOT BE ISSUED UNTIL WE RECEIVE FINAL PAYMENT. **A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION AND LIABILITY WILL BE FORWARDED UPON REQUEST. • **T.P. DALEY INSURANCE AGENCY OF WEST SPRINGFIELD. MA IS OUR AGENT. WE PROPOSE to furnish material and labor;complete in accordance with-above specifications,for the sum of: $832.00 dollars ($ 50% DOWN, BALANCE DUE ), payment due upon receipt of invoice. If payment late,interest at 1 112% may be added. COMPLETION OF JOB NOTE: This proposal may be withdrawn by us if not accepted within THIRTY __ __ _ days. / .- ED LOSACA O, OWNER Contractor Salesman 64L lm a ouceur 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