29-119 (4) 76 FOREST GLEN DR BP-2017-1430
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 119 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-1430
Project# JS-2017-002374
Est. Cost: $6982.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sq. ft.): 12893.76 Owner: MARTIN JEAN M
Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 76 FOREST GLEN DR
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:6/7/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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:
FeeType: Date Paid: Amount:
Building 6/72017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
"-) Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
%JUN – s
, ., � Northampton, MA 01060 Two Sets of Structural Plans
-. J phpne 413-587-1240 Fax 413-587-1272 Plat/Site Plans
`._ Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH�A ONE OR
TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION B0 17'/r'/,all
1.1 Property Address: This section to be completed by office
�, Map
(1.°11/4 Lot �`�{ Unit
7� Thrks-^' n`,`� Qf��I Zone Overlay District
for r Q, )jf es" a Elm St District CB District _
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
JEAN MARTIN, HOMEOWNER 76 FOREST GLEN DRIVE FLORENCE,MA 01062
Name(Print) ,r ,, ,,_' /\ Current Mailing Address: 413-588-8532
iatt' t- -171-1 "� Telephone
Sig ure
2.2 Authorized Agent:
Fri InS3fanC ,n(uner 5G, FranklinSf Eaoflhauf mn m14
Name(Print) Current Mailing Address: 10fv3-7
14/3 507-00gg
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Penult Fee
4. Mechanical(HVAC)
5. Fire Protection ''//'' JO
6. Total=(1 +2+3+4+ 5) 6,982 Check Number esla%V l/ Pi
t0
Section For Official Use Only
Building Permit Number -. Date
Issued:
- at_ D
// ^7 //may
Signature'. //�/ / L �/
Building Commissionerllnspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Q
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [El Siding[CI Other[Cl]
Brief Description of Proposed
Work: wp WIII.STRIP II EXISTING LAYER OE ASPHALT SHINGLES ANT)INSIALL NEW ARCHITECTURAL SHINGLES.
Alteration of existing bedroom _ Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
w.If New house and or addition to existing housing. complete the following:
a. Use of building : One Family 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. Masscheck Energy Compliance form attached?
h. 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
'Mar AGENT� OR CONTRACTOR APPLIES FOR BUILDING PERMIT
jI, t \ n ,as Owner of the subject
property on n� ✓1 c� (�� /� Co In-
tohereby authorize �d Loaacano - A-uu$� ,Thcu(dm 6-Sid/I/ If
to act on my behalf, in all matters relative to work authorized by this building permit application. J
4za.ta 11 t&Zt i i - 7
Signatg/e of Owner /� /! v�canDate
I, Fa k,c(,t.cc ,asOwne _ tAt�i hod�e
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.
Edwin k.OSQI'Af n
Print Nam
S:3!-I�l
Signature of Owner/Agent Date
Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled In by
Budd mg Department
Lot Size
Frontage
Setbacks Front
Side L: R: L:_ R:
Rear
Building Height
Bldg. Square Footage I I
Open Space Footage
(Iail area minus bldg&paved
parking)
P of Parking Spaces
Fill:
molume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document It
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained o , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and Location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: /'1 NotApplicable 0
Name of License Holder: `C)�0,r )0 l SSt -0,191'39
� ' 1 License Number
�
Ia? 5levie. cad STUAt'Yll 1 NR a ,y
Address I Expiration Date
4 PC3 o - -- P--- 413-537-DOW
Signature Telephone
9.
R�eniffstered Home 1m•rovoment Contractor: I Co. �'^ Not Applicable (❑
S-164 JTI1 l ) ��f 'S7�I r o � 5lohh� o . 7r . /oiX5
Company Name r Registration Number
6 Frank!,n iS+rnP4 Li W{-haAxfbr, rnA 69-/k
Aressr Expiration Date
1-11.3--(5)9
ry'l3( 2)9 It#]
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 of the building permit.
Signed Affidavit Attached Yes 6Y No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 more 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
n d Office of Investigations
,= $ 600 Washington Street
• '1'i=slaiBoston, MA 02111
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 #: 413-527-0044
Are you an employer? Check the appropriate box: Type of project(required):
1.[) I 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
•
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Di Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance. 9. ❑ Building addition
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 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] c. 152, §I(4),and we have no
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.
t Homeowners who submit this affidavit indicating they arc 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 site
information.
Insurance Company Name: Star Insurance
Policy ft or Self-ins. Lic. #: WC0681114 Expiration Date: 08/13/17
Job Site Address: j��-�PYI IJ171/�: City/State/Zip: FioYene Q_I m f}(?j '1
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 under the pains and penalties of perjury that the information provided above is true and correct
Signature: Ed QDate: 1/45P/49
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#:
Client#:13250 ALLST
ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MwODRYYY)
07/27/2016
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 CERTIF/CATE HOLDER.
IMPORTANT(If the certificate holder is an ADDITIONAL INSURED,ihe 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 I 1NAD2IEACT Jane Eitel
T.P.Daley Insurance Agency.Inc PILLRLE,E�L1.413 788.0971 — PRx 413 739-2645-_--
1381 Westfield St. IAm,Nw.
ADDRESS'janeeitel@tpdaleylnsurance.eom
P.O.Box 1150
INSURERS.)Ai-FORMA COVERAGE ;
West Springfield,MA 01090
INSURER A:Fearless Insurance
INSURED I INSURER a:Star Insurance Company
All Star Insulation&Siding Co.,Inc.
MSURERC_
56 Franklin Street INSURER D:
Easthampton,MA 01027
INSURER E:
INSURER F: I
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 I
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OE ANY CONTRACTOR 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.
MR - , W I
IADOLSUBRI """' r POLICY
LTR TYPE OE INSURANCE INSR MHO' POLICY NUMBER Mum M LIMNS
A GENERAL LIABILITY CBP8052996 Y: 1312015 08(1312017 EACCyHp(MQPiUUpRReeNCE 31,000,000
X COMMERCIAL GENERAL LIABILITY PEpREMII+txlEeam-.oTEnnenWl 5100 Doo
CLAIMS-MADEox ponce. 55,0,00
_ X OCCUR =� PiJ
,
I
I
I PERSONAL&ADV INJURYE11000,000
GENERAL AGGREGATE s2,000,000
GENt AGGREGATE LIMITAPT,IES PER. PRODUCTS-COMP)OPAGO s [2000,000
POLICY X' P a 1 I LOCS
A AUTOMOGE PLIABlua BA8054496 18/13/201608113/2017 OMBINEDSINLE
' LIMIT
ANY AUTO BODILY INJURY(Par Peron/ x100,000
'ALL OWNED Ar I GOigULED ' i BODILY INJURY(Per aWaent) 6300,000
_I AUTOS iAu'r pay„ arorE ldenil CE xiD0,000
XI HIRED AUTOS X 1AUroe iLPmA deft _
CLAIMS-MADE s
I.
UMBRELLA UAB I OCCUR 1 EACH OCCURRENCE s
EXCESS LIAB AGGREGATE s
OED ( RETENTIONS S
B WORKERS COMPENSATION I WC0681114 18/13/2016 08/13/201 'X WCSIATu OrH
AND EMPLOYERS'LIABILITY RTIIMt6 FR
ANY PROPIMOWPARTNEWEXECUT YIMI .F L EACLIACCOENT 6100)000
M
OFFICER/WARIER EXCLUDED'
�N:INIR -
IMBnGNaryInNHI _L DISEASE•FA EMPLOYEE 5100000
If me describe under ELDISE SE-POLICY LIMIT ,500,000
DESCRIPTION OF OPERATIONS below _
I I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,II more mercy es required)
GENERAL CERTIFICATE
CERTIFICATE HOLDER CANCELLATION
All Star lnsula0on8Sidin Co. HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
9O. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS.
Easthampton,MA 01027
AUTHORIZED itREPRESENTATIVE ,r/le///h,. J .. 2aZe*j
191988.2010 ACORD CORPORATION,All rights reserved.
ACORD 2512010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#5131574/M123220 JXE
O. Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:u88L-0orSp
Construction Supervisor Specialty
EDWIN R
121011140ALE m)
SW7BRMPTONMA
UU,
11073
0
ari
Mr.(' EXpvation: a
Commissioner 02/1412011
•
7a
m
N
m
a
m - t Office of Consumer Affairs and Business Regulation
-!1--' 10 Park Plaza - Suite 5170 1
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Registration: 101858
Type: Private Corporation
Expiration: 6292018 Tr* 419291
ALL STAR INSULATION & SIDING CO.
Edwin Losacano
56 Franklin Street
Easthampton, MA 01027
Update Address and return card.Mark reason for change.
wnI o 0 Address 0 Renewal 0 Employment 0 Lost Card
n-l- r 1",,,,,r.n,,rw/fAre's//,ac4,,,rm
Office of Consumer Albite&Buttress Regulation License or regbtratlon valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
i Registration: 101858 Type: Office of Consumer Affairs and Business Regulation
%' Expiration: 8/211/2018 Private Corporation 10 Park Plara-Suite 5170
Boston,MA 02116
ALL STAR INSULATION&SIDING CO.
Edwin Losacano - A
58 Franklin Street _,.`....— •
_
Easthampton,MA 01027 Uoderaeerelary Not valid with. ahrc
-
r\_ �CI- Q V 1is�
N Chk t
SL L A7"10 MAY 3 0 2011
SIDING CO., INC. ,{ miffc "'n 1 r
Easthampton Office West I
4I3.321-0044- 56 Franklin Street • Easthampton, MA.01027 413;i6&-6411
CSL License, NCS SLO9739/MA RWCN 101858/CT IIIC4063(0805
fax 413-527-1222 • emailtallslatS27OO4.4@gmail-COm • www.allstarinsulatiOnsiding.COti1
Proposal Submitted to Phone Date
Jean Martin "Purchaser 413-588-8532 Home May 24,2017
Street Job Name
76 Forest Glen Drive
City.State and Zip Code Job Location Job Phone
Florence, MA 01062
Contractor hereby submits to Purchaser specifications and estimates for INSTALLATION OF NEW ROOF ON MAIN HOUSE
S 1 We will remove(11 layer of existing asphalt shingles and dispose of in a dumpster supplied by us
3 2 We wilt install Titanium Rhino Deck or Fleohant Skin underlayment over entire stripped roof surface
-. 3 k - , • . I -., • - • .•r••. . • , '• . f•. • , ln- 1- A I. c ."1. -
4 All shingles wlll be nailed with at least(5)nails per shingle
2 &We will install new aluminum drip .ge on all eves - . .-, - . • .a -..-. a..- •• -
We will install nioe honts and metal St-.. - •••. • - u--•-•
e We will install approximately(501' of roll vent on peak of roof for additional ventilation
Z We will install a 36"wide .•. ' - ,.• ,• - ., ''r ,. -, .•. •- _ . -- -• ...,.
" IF ANY G11B SHEATHING IS NEEDFD THFRE WII1 RF AN ADDITIONAI ,DHARGF OF $98 PFR RHFFT TO .,.....,,—
RFMOVF DISPOSE OF AND INSTALL NEW 7/16 STRAND BOARD SUB SHEATHING
PRICE $6 982 00 - ......
SIGN D CONTRACT -S S ANY INCLEMENT WEATHER ,_ .,,,
• t, . :u e • e • L.'Li •1 t : 1. ; . ""SPONSIRi F FOR ANY
t • C •.......
"`ALL STAR IS NOT RFSPUN518 FOR ANY LEAKS THAT OCCI IR IN EXISTING SKS{ IGHT __
(IF APPLICARLEI
HO if • 1.I -a A [ 'R •. •: Ai :. A t 1 A " : • /l: tk :.
" NO PRODUCT& AROR WARRANTIES WILL BE ISSUED UNTIE WE RECEIVE FINAL PAYMENT �^
H•tl • 1 . [ 1 . . •S I ' LE FOR COVERIN , ANY STOR DIT .MS AND FOR ANY . EANUP
WORK IN THE ATTIC NEEDED FROM DUST&DEBRIS FROM ROOF REMOVAL
d . • - . ::L •R WORKMAN'S COMPENSATION AND IABI ITY WI B FORWARDED
_UPON RFOUFST
" T P IIA' FY INSURANCE AGENCY OF WEST SPRINCFIEI p.--MA IS OI IR AGENT
WE PROPOSE to Ruttish material and tabor,complete in accordance with above specifications,for the sum of.
$6,982.04 dollars(a 1/3 DOWN, 1/3 AT START OF JOB, ),payment due upon receipt of invoice.
If paymentlate, interest at 1 112% may be added, RA! Ap!CF DLG I7 E7I01-: I`JCB
NOTE:This proposal may be withdrawn by us if not accepted within THIRTY days.
ED LOSACANO, OWNER
� )
flr Contractor Salesman
i..... ...` -
Jean Ma— n t _ . w i � Acceptance by Purchaser,and Title
"You may cancel this agreement it it has been consummated by a patty 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