43-010 � P1D70E0v[E
Y INSULATION j, OCT 1 5 -901.4
& Lk
SIDING CO., INC. { t
EASTHAMPTON OFFICE 413-527.0044 CSL License #CS SL 99739 WESTFIP OFFICE► !413-,568-,64. 11
56 FRANKLIN STREET • EASTHAMPTON, MASSACHUSETTS 01027 • FAX: 4Y3-527--12212
Proposal Submitted to Phone Date
Patrick Sullivan "Purchaser"413-585-5898 (H) October 3, 2014
Street Job Name
115 Westhampton Road
City,State and Zip Code Job Location Job Phone
Florence, MA 01062 1413-579-4004 (C)
Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF VINYL REPLACEMENT WINDOWS,
STORM DOOR & PRIME STEEL ENTRY DOOR
W '"iii remu've and d:s;j e of wood and or aium`njrn w;ndows if exisiina
2 We will install (2) Do Ibl e Hung and (1) Picture Simonton Asure or Harvey Slimline Energy Star Rated Vinyl
Replacement Window Units in designated areas --
3 (2) Double Hung will have double pane insulated glass with Half Screens Color wall he White without grid work
4 We will install fiberglass insulation around window (snits installed and seal with Silicone Caulking on interior
and exterior
5- NG will blow Class One Cellulose in weight cavities around window units installed where needed
6-Window Units will have ProSclar Low E glass with Argon Gas
We will tall 1 cool stock material around outside perimeter of window
V111 install aluminum 1. I
8. vinyl Replacement Window Unit has a "Manufacturer's Lifetime Warranty" and the glass has a"20-Year
0 Ord
We will remove and dispose of existing front door unit. -
2 We will install (1) White Harvey's Fstate //S((��eries Self storing model H801 Unit in the front moor.
We will remove and dispose of existing rear kitchen door unit
We w' Lr) tall t11 Therm.a-Tr I Steel Prime Door Unit yjmth AcItustable Threshold in rear of kitchen
s We will install fibergl'ss insulation around door nit installed and seal with Silicone Caulking on interior and
4 We will reinstall existing wood door casing around interior of door unit installed
5. Homeowner will be responsible for any painting or staining
6. We will install bright brass lock set
PRICE- $2.983.00
APPROXIMATE START DATE WILL RF 3-6 WEEKS I FSS ANY INCLEMENT WEATHER-
ALL SI I qF IRE I]I III nli IG PERMIT IF NEEQED HOMEOWNER WILL RF RESPONSIBLE FOR ANY
** HOMEOWNER WILL BE RESPONSIBLE FOR ANY R ALL ELECTRICAL OR PLUMBING IMBING WORK
** NO PRODUCT ° LABOR WARRANTIES \AJII I RG IQCI IGD I INTII WF RFQEIVF FINAL PAYMENT
**A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION AND LIABILITY ITY WII I RF FORWARDED
UPON REQUEST,
**T.P. DALE IRIS(IRANCF Af;FNr Y OF WEST SPRIN FIELD MA IS QUE LaENT. _
1' WE PROPOSE to furnish material and labor, complete in accordance with a.bove specifications,for the sum or:
$2,983.00 dollars($ 50% DOWN, BALANCE DUE UPON--__ � payment due upon receipt of invoice.
"-- -- COMPLETION OF JOB
If payment late, interest at 1 1/2% may be added.
NOTE: This proposal may be withdrawn by us if not accepted within __- THIRTY ..._ days.
ED LOSACANO, OWNER
--- ;.�-f. °-°- ------.1 =- - --- ---. ..�:- - . - -;_ - Contractor Salesman
r. .
-"- ---_—-- _—--- Acceptance by Purchaser,and Title
Pa nc Su�ivan-- -
"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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, 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.[f 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. ❑ Remodeling
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.❑ Roof repairs
insurance required.] c. 152,§l(4),and we have no
employees. [No workers' 13.❑ 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 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.
1 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#or Self-ins. Lic.#: WC0681114 Expiration Date: 8/13/15
Job Site Address: 115 Westhampton Road 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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
rt
Signature: Wes- �L.�l-n�'�'1rn1� Date: �1)' � aI ILi
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#:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL-099739 2-14-16
EDWIN W LOSACANO License Number Expiration Date
Name of CSL Holder
128 GLENDALE ROAD List CSL Type(see below) R
No.and Street Type Description
SOUTHAMPTON, MA 01073 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-527-0044 allstar561(cD-verizon.net I I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 101858 6-29-16
ALL STAR INSULATION & SIDING CO., INC. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
56 FRANKLIN STREET allstar561 @verizon.net
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..........IR 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,hereby authorize Ed Losacano
to act on my behalf,in all matters relative to work authorized by this building permit application.
Homeowner
Print Owner'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 Losacano (�, �� l� Z 1L
Print Owner's or Authorized Agent's Name(Electronic Signature) Da e
NOTES:
I. 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. og v/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"
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Ed LOsacano CSSL 099739
License Number
128 Glendale Road, Southampton, Ma 01073 2-14-16
Address Expiration Date
�&'Jw 413-527-0044
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
All Star Insulation & Siding Co. Inc.
Company Name Registration Number
56 Franklin Street, Easthampton, MA 01027 101858
Address Expiration Date
Telephone 413-527-0044 6-29-16
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....... ESC No...... ❑
11. - Home Owner Exemption
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-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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors IZI
Accessory Bldg. ❑ Demolition ❑ New Signs [[3],,, Decks Siding[0] Other[ ]
Brief Description of Proposed
Work: vinyl replacement windows,storm door and steel entry door
Alteration of existing bedroom Yes R No Adding new bedroom Yes X
Attached Narrative Renovating unfinished basement Yes x _No
Plans Attached Roll -Sheet
6a. 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
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Patrick Sullivan
I , as Owner of the subject
property
hereby authorize All Star Insulation & Siding Co, INC Ed Losacano, Owner
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date 10-22-14
All Star Insulation &Siding Co, INC Ed Losacano, Owner 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.
Signet] uryder the pains and penalties of perjury.
Cf LOS CACQ0 0
Print Name J=JM Sig nature of Owner/Agent / Date 10-22-1
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW (�) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
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 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
I - i
l ;� 'City of Northampton Status of Permit:
1 building Department Curb Cut/Driveway Permit
8 ii(j(i 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Electric. Plumbing&Gas Insp ;or„ orthampton, MA 01060 Two Sets of Structural Plans
Northampton, MA e 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
115 Westhampton Road Map Lot Unit
Florence, MA 01062
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Patrick Sullivan 115 Westhampton Road
Name(Print) Current Mailing Address: 413-585-5898
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building $2,963.uu (a) Building 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=0 +2+3+4+5) 2,983.00 Check Number C5
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
115 WESTHAMPTON RD BP-2015-0495
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43-010 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2015-0495
Project# JS-2015-000927
Est.Cost: $2983.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 069281
Lot Size(sq. ft.): 14505.48 Owner: SULLIVAN PATRICK
Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC
AT. 115 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON.1012812014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS & ENTRY
DOOR
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 10/28/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner