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46-058 (20) BP-2021-1985 503 MOUNT TOM RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 46-058-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1985 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: ALL STAR INSULATION & SIDING Est. Cost: 16532 CO INC 099739 Const.Class: Exp.Date:02/14/2022 Use Group: Owner: GLAZEWSKI HELEN S & MARY Lot Size (sq.ft.) Zoning: SC Applicant: ALL STAR INSULATION & SIDING CO INC Applicant Address Phone: Insurance: 56 Franklin Street (413)527-0044 6HUB-5N0691 1-1-2 1 EASTHAMPTON, MA 01027 ISSUED ON:10/07/2021 TO PERFORM THE FOLLOWING WORK: STRIP AND SHINGLE 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. Signature: I i O Ti • Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner f t 0oCT The ommonwealth of Massachusetts '° ` 4 j B and Building Regulations and Standards FOR assa usetts State Building Code,780 CMR MUNICIPALITY =fPt,u USE ,•!'.+) ng , �o ' App ication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 `'0�060 IONS One-or Two-Family Dwelling This S n For Official Use Only Buildin Permit Number: 6 P— r I /Date Applied: /I�UIIJ D�� /C& 1O-7-Zoz, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 503 MT. Tarn P.ad 1.1 a 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 Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: �Q Mar GiaZ•o1,LDsf•-1J\)°'`144a 1m - O{O6O Name(Printity,State,ZIP 503 IN- .-Torn 4i3 LSzi-4-1bq H or a 9-"$c No.and Street Telephone rf365'a700t{ .(�yi SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) �`L'J New Construction 0 Existing Building IN Owner-Occupied 0 Repairs(s) 0 Alteration(s) El Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description ofProposed Work2: 1,14. 1 St f (I ) ' �)CI Sh IAA/' 1 lAli (kph r>, `Sh I i✓ 0 P .y•. cs 0 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /L,53a.cp 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ s ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) rin Check No4G aeck Amount: Cash Amount: 6.Total Project Cost: $ /6 ,53 a 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSL-099739 2-14-22 Ed Losacano License Number Expiration Date Name of CSL Holder List CSL Type(see below) R 128 Glendale Road No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Southampton, MA 01073 R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-527-0044 allstar5270044@gmail.com ► Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 101858 6-28-22 All Star Insulation &Siding Co., Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 56 Franklin Street al�star5�,C0-.�27 ,� �ymail.com No.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 building permit. Signed Affidavit Attached? Yes El No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,here thorize Ed,Losacano to act on my behalf,in all matters rclat ork autho iz tr_ this building permit applicatio Mary Glazewski, Homeowner lV ia,.,�� Print Owner's Name(Electronic Signatu c) Dat SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest unde pains and penalties of perjury that all of the information contained in this applicatio true• Id aidztu to the best of my knowledge and understanding. Ed Losacano,Owner L4 Print Owner's or Authori. g t' ectronic 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. I42A.Other important information on the HIC Program can be found at w‘‘ oea Information on the Construction Supervisor License can be found at N‘w w.masti. wcips 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" City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit in accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 5O 3 CYO- . To -Vend The debris will be transported by: U.`5n - maul i t1 c `4-R�i C 11'1C t aced f3 C oVe The debris will be received by: \1jQ.*vt\ 1 clut;"-3 Building permit number: r Name of Permit Applicant Cc1 Lc;< ern on 11 Sf r I�`�SuQo k on-r s ic'is Cc, 3-DC. �►la7/ / Fri Lug CCt L10 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations =Y�_ Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: 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: Business Type(required): 1.❑■ I am a employer with 10 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. [' Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. El Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, CONSTRUCT/ HOME IMPROV with no employees. [No workers' comp. insurance req.] 12.❑■ Other *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: THE TRAVELERS INSURANCE COMPANIES Insurer's Address: 97 CENTER STREET City/State/Zip: CHICOPEE, MA 01013 Policy#or Self-ins. Lic. # 6HUB-5N06911-1-21 Expiration Date: 8/13/22 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under § 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- (4,. Date: 9 --off 7—09 Phone#: 413-527-01944 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1.0Board of Health 2.1=1 Building Department 3.1=I City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia �.1 ALLSTAR-05 LAURA ACORO DATE(MMIDDIYYYY) �, CERTIFICATE OF LIABILITY INSURANCE 8/20/2021 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 have ADDITIONAL INSURED provisions or 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 Laura Misseri Phillips Insurance Agency,Inc. PHONEFAX 97 Center Street (NC,No,Est):(413)594-5984 (NC,No):(413)592$499 Chicopee,MA 01013o RIESS:laura@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:State Auto Property&Casualty All Star Insulation&Siding Co.,Inc. INSURER C:Travelers Insurance Company 36161 56 Franklin St INSURER D: Easthampton,MA 01027 INSURER E: INSURER F: 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 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYYYI IMMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2903632 8/13/2021 8/13/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JE& X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY _(Ea accNED Sident)INGLE LIMIT $ 1,000,000 X ANY AUTO BAP2482222 8/13/2021 8/13/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYO INJURYp (Per accident) $ AUTOS ONLY AUTO ONLY (Per acEcRident)AMAGE $ $ A X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE PBP2903632 8/13/2021 8/13/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ C AND EMPLOYERS'COMPENSATION X STATUTE OTH- ER 6H U B-5N06911-1-21 8/13/2021 8/13/2022 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N NIA 100,000 andatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts t Division of Professional Licensure Board of Building Regulations and Standards ConstructionSupevvisor Specialty CSSL-099739 Expires:02/14/2022 EDWIN W.LOSACANO 11 128 GLENDALE RD. SOUTHAMPTON MA 01073 �` 't Commissioner u,t)1f•,+,-'*'4 — e omno,?wwteoW o /),./ cr,),)f.rr• 11:T4P17) Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 101858 ALL STAR INSULATION & SIDING CO. Expiration: 06/28/2022 56 FRANKLIN STREET EASTHAMPTON, MA 01027 Update Address and Return Card. SCA 1 Ce 20M-05i17 .17ir (iiv,,,,,,i,,,', r/// i . �tii.;.;,,,4,i.;i//i Office of Consumer Affal s& Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 101858 06/28/2022 1000 Washington Street - Suite 710 ALL STAR INSULATION & SIDING CO. Boston, MA 02118 EDWIN W. LOSACANO - '�'��- ^mot 56 FRANKLIN STREET EASTHAMPTON, MA 01027 Not valid without signature Undersecretary c w‘h 01.1c, •• S •• • q "., � a ��!`\�` �. SAP 2 4 2021 f�� t \ INSULATION • SIDING CO., INC. `-SS66 Easthampton Office Westfield Office 413-527-0044 56 Franklin Street • Easthampton, MA 01027 413-568-6411 CSSL License # CSSL-099739/MA HIC# 101858/CT HIC# 0630805 fax 413-527-1222 • email:allstar5270044@gmail.com • www.allstarinsulationsiding.com Proposal Submitted to Phone Date Mary Glazewski "Purchaser"413-584-4109 Home September 7, 2021 Street Job Name 503 Mt. Tom goaci, 413-593-3978 Cell City,State and Zip Code Job Location Job Phone Northampton, MA 01060 Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF NEW ROOF ON MAIN HOUSE (METAL ROOF NOT INCLUDED) AND GUTTER REPAIR INSTALL NEW ROOF ON MAIN HOUSE (DOES NOT INCLUDE MFTAI ROOF AREA) 1. We will remove (1) layer of existing asphalt shingles_ansLdispose of in a dumpster supplied by us 2. We will install Titanium Rhino Deck or Elephant Skin underlayment over entire stripped roof surface. 3. We will install new CertainTeed Landmark, Owens Corning. or Gaf Timberline Architect shingles. They will have a "Manufacturer's Lifetime Limited Warranty". Owner will have choice of color. 4 All shingles will be nailed with at least(5) nails per shingle. 5 We will install new aluminum drip edge on all eves and new aluminum rake edge on rake areas We will install pipe boots and metal step flashing where_needed. We will install new steaflashing around base of chimney underneath new shingles 6. We will install approximately(60)'of roll vent on peak of roof for additional ventilation. 7. We will install a 36"wide asphalt ice and water barrier on eave lines/valleys_of heated areas **IF ANY SUB SHEATHING IS NEEDED THERE WILL BF AN ADDITIONAL CHARGE OF $88 PER SHEET OR CURRENT MARKET VAI OF OF OSA TO REMOVE DISPOSE OF AND INSTAL L NEW 7/16 OSB SUB SHEATHING. WINDOW TRIM REPAIR 1. We will repair/repiace white vinyl window trim arounr&pxterior of window units where_needed