44-107 .
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R , oy E (1 iI- of Northampton . !
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:� DEPARTMENT OP BUIWD -C INSPECTIONS •
212 Main Street ' Municipal Building_
Northampton, Mass. 01060 No
I WORiCEI'S COMTENSA'iiO fiSURAN'CE AITU)I \lT
i
I, All Star Insulation &Siding Co.. Inc. ____ -_._ -- _ __ ___ _... _ _ -
(li ccascxdpermi ttcc)
v.riLb a principal place of businessfresidence at: -- --
I
56 Franklin Street - Easthanpton, MA 01027 (phone-0 413 -527 -0044
(so lsZairia
do hereby certify, under the pains and penalties of perjury., that
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(x) I am an employer providing the following kvorker's cotnocnszoon coverage for my
I employees wor iog on this job:
. � C- 0 (-.C) 1, I \ C (- t LS
(insure rn Co v) (Peke: Nt -abcr) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circ:e one) zed have hired
the conuactors listed below wbo have the following worker's con pens2don policies:
—
Marne of Co„_r cior) (InSuranc::, Company /Policy NumOC) (Explyduon Datc)
(Name. of Con or) (insurance CompanviPo!ic - y Nuslc-er) (E;apimtion Date)
(Name of Conaaeto:) (Lasuranc: Co mpany/Policy N:1mt s) (Expiration Date)
(Name of (Lasutan Comp y/Poticy Numb`.r) (Expiration Date) .
(.cL th •tioc7.t rScct to c ctr& inforcii pc to alt ooc=--- r..o: .
( ) I am a sole proprietor and have no one worid.ng for me.
( ) I am..a home owner performing all the - work myself.
NOTE: pl,-,. be .v-2rt au! ..-t Je 6emeov.vcn u =play pc to do -. esoo c rc*r work ao a dwdlinc o f
(tot maz th n '470_ =it" is u3ieb the bola oveocr raids or oo the frouacks x, purteo_ri. tab,--en .-r we ca..--1.1y cc :d_TOd to be
ei:ploy= „ -tbc wok kel: oocap - . An GL!152, -a! 5
t � )). : ppliczcion by n homcoovc7 for c licz __ a p,-.,r,it rr_y evid acct the
lc-1331 rt~'uc of as exployec under the Wohcl. CompomaLioa Act -
I uodeztaad ttia a copy of this mt ®eat easy b. for -r.urd.ct to the Dcpa tma4 of 1..4 .eri c1 Acc Offoo of lemur +vee for Lila
eovcxsc vtrireaioo And th t (=In= to socum' '-c1- se rm.-1,-; soctioa 25A of MOL 152 an led to the imposaioo of cimioal p^r+•iticn
comiti:z of a riff of tp to 51.00.00 .ndfor iompriyoc. o=t oCup to ooe year e.nd affil peaattio in tb form of. Slop Wort; Ordc and .
f i t r r of S 100.00 t d_y .ptiatt me
. For dcpartroar:- ase only
-- 1 Permit Number
)1(i dat i _ eSi . e it of Lis nsrxlPcrmiucc •
SECTION 8 - CONSTRUCTION SERVICES I-
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Edwin LosaCa110 CS SL 99739
License Number
128 Glendale Road - Southampton, MA 01073 '1 L1 -t
Address Expiration Date
(413) 527 -0044
Signature Telephone
:lte • is ere kTome m ®rovement �atrat e� S ,_;„ �ir &R; ,, . ,_ ii.ta . r Not Applicable ❑
All Star Insulation & Siding Co., Inc. ID\
Company Name Registration um er `-
56 Franklin Street (..S/ ' 7
Address Expiration Date
Easthampton, MA 01027 Telephone 413 -527 -0044
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 t) No ❑
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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 more than one home in a two -vear 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
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SECTION 5- DESCRIPTION OF-PROPOSED WORK (check all applicable)
New House [] Addition ni . Replacement Windows Alteration(s) n Roofing 1
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Ea Sid& g. J.) Other [0]
Brief Description — \PP<\\ �1 `` C J����
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll - Sheet
�a; 1f�N�`"w lio�as�anor,�acldi�io��a eXSt>ni�°C�o�sinq; coriplet�fhe.�o[1QaraRlnq:
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
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
All Star Insulation & Siding Co., Inc, , 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. r
i
Ed Losacann, fwn r /President
Print Name
Signature of Owner /Agent Date
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Section 4. ZONING All Informatibf Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning ili
This column to be filled in by
Building Deparniient
1 { i t ._ ,,__. ,
Lot Size .—
Frontage '
Setbacks Front 1 I i
I ; i ; j V... i i I
Side L: R:_ L:' R:
r i I 3
Rear L
Building Height
I I 4
Bldg. Square Footage I I r ----- 1 % 1 !
Open Space Footage %
(Lot area minus bldg & paved I I I I i i 1 I L -1
parking) .
# of Parking Spaces I
Fill: 7-- -- , - - -- - - -___
, i
(volume & Location) -- - I
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES 0
IF YES: enter Book j Page; ; and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: I
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 Q r NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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' RECEIVED r Y ,D6-6 o n sX :k
Cit of Northampton ; � � �^ , � � °` r E k
NOV , ! Bu ding Department " a ' P ` 1:: IN Oxi n..
12 Main Street w x ® ° x
Room 100 r = t R
DEPT OF LD INSPECTION am ton; MA 01060 e ;® :r:: u �' ,
NORTHAM BUI , MA 01060 IV p:. m o �?
phone 41 - 87 -1240 Fax 413 - 587 -1272 Pt it n
a - < 74
� e l � I •
O he pe M : , F -)r,..
, �. - a
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION .1. - SITE IN
This section to be eted by office
1.1 Property Address: E F qs 3- complt x
3 ^ 1 . C-C - t"Li ,--\.1- \ \ 1?--L- Map $ Lot 4 Unit
{/ f (/"'�� �f /{ {/�/'� �j //��]�,.. ZoneO District z !:1--.'--,..
1 1 EImiSt District :k •CB .
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r int C` unC\ c C \-k � �`� � S i C j 1 it — o ,
N e (Pr Current Mailing dress:
Telephone
Signature
2.2 Authorized Agent:
All Star Insulation & Siding Co.. Inc. 56 Franklin Street - Easthampton, MA 01027
Name (Pri ) Current Mailing Address:
413 -527 -0044
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item • Estimated Cost (Dollars) to be Official' Use Only
completed by permit applicant
1. Building \5 ._' _ (a) B uilding Permit Fee
2. Electrical (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) l 5, , --- 1 , Check Number �(q � '`• j l S
Thi Section For"Official "Use;
Date
Building Permit Number Issued:
Signature:
1
Building Commissioner /Inspector of Buildings Date
y :
375 ROCKY HILL RD BP- 2012 -0519
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 44 - 107 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: vinyl siding BUILDING PERMIT
Permit # BP- 2012 -0519
Project # JS- 2012- 000869
Est. Cost: $15371.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sq. ft.): 40946.40 Owner: DUNN WILLIAM J & RITA J C/O BARBARA C DUNN
Zoning: SR(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 375 ROCKY HILL RD
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527 - 0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:11/29/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SIDING & 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 11/29/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner