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11-007 (4) A 114 4 f) n vi, INSULATION Nov 2 8 2014 SIDING CO., INC. qa EASTHAMPTON OFFICE 413-327-0044 CSL, License #CS SL, 99739 64 9 9 56 FRANKLIN STREET EASTHAMPTON, MASSACHUSETTS O 1 027 • FAX: 413-527-1222 Proposal Submitted to Phone Date Eleanor Rothman "Purchaser"413-584-3438 (H) November 10, 2014 Street Job Name _ _ 67 Country Way F} 7 eel City,State and Zip Code Job Location Job Phone Florence, MA 01062 Contractor hereby submits to Purd asei specifications and estimates tor: NE/\ ROOF ON MAIN HOUSE, SIDF EXI ENSIGN, 2-CAR GARAGE, REAR SCREEN PORCH, AND KITCHEN AREA 1. We will remove (2) layers of existing shingles and dispose of in a dumpster supplied ied by us 2. We will install Titanium Rhino Deck over entire stripped roof surface. 3. We will install new CertainTeed Landmark or Gaf/Elk Timberline Architect shingles over existing roof. 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. ,. 6. We will install pipe boots and metal step flashing where needed. -> 7. We will install approximately(86)' of roll vent on teak of roof for additional ventilation. 8. We will install a 36"wide asphalt ice and water barrier on evelines and valleys of heated areas. 9. Rear shed dormer roof surface will have ice and water barrier installed over entire roof surface. PRICE: $13,852.00 * APPROXIMATE START DATE WILLBE DECEMBER/JANUAR)'.LESS ANY INCLEMENT WEATHER- " IF ANY SUB SHEATHING IS NEEDED, THERE WILL BEAN ADDITIONAL CHARGE OF $38 PER SHEET TO _REMOVE. DISPOSE OF AND INSTALL NEW 7/16 STRAND BOARD SUB SHEATHING *Y A I STAR WILL SECURE BUILDING PERMIT IF NEEDED, HOMEOWNER WILL BE RESPONSIBLE FOR ANY &ALL FEES REQUIRED. HOMEOWNER WILL BE RESPONSIBLE FOR ANY &ALL ELECTRICAL OR PLUMBING IMBING WORK NO PRODUCT & LABOR WARRANTIES WILL BE ISSUED UNTIL WE RECEIVE FINAL PAYMENT. HOMEOWNER WILL BE RESPONSIBLE FOR COVERING ANY STORED ITEMS AND FOR ANY CLEANUP WORK IN THE ATTIC NEEDED FROM DUST& DEBRIS FROM ROOF REMOVAL *A CERTIFICATE OF INSUSeMULFOR WORKMAN'S COMPENSATIQhLAND LIABILITY UPON REQUEST. % LP. DAL EY_INSURANCE AGENCY OF WEST SPRINGFIFI_D MA IS Qt IR AG;FNT 45/3, 02.( The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Ulf 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.[ I am a employer with 10 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 or me in an capacity. employees and have workers' g y P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ 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, §1(4),and we have no employees. [No workers' 13T] 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. 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#or Self-ins. Lic.#: WC0681114 Expiration Date. 8/13115 Job Site Address: 67 C o tntW Wav City/State/Zip:Flnr -n .e, 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature A�� Date � p I Ll 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 List CSL Type(see below) R 128 GLENDALE ROAD No.and Street Type Description SOUTHAMPTON, MA 01073 U Unrestricted(Buildings u 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(E verizon.net I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 101858 6-29-16 ALL STAR INSULATION & SIDING CO., INC. HIC Registration Number Expiration Date HIC Com an Name or HIC Re istrant Name 56 FI KIKLIN STREfT 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..........[R 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. d4NcR- ;z 'Z 01H tii"i A-2 Prdnt Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By ettering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true d accZratet he bes t of my knowledge and understanding. Ed Losacano //-��o " Print Owner's or Authorized Agent s Na. a tronic 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.niass.gov/oca Information on the Construction Supervisor License can be found at www.mass.';ov/dns 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"maybe 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 � 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....... 1% 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 faun 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 �s I�TION OF PROPOSED WORK(check all applicable) e Addition ❑ Replacement Windows Alterations) Roofing 0 Or Doors 171 =Qs So,::] Demolition ❑ New Signs [oJ Decks [p Siding[01 Other[[3] OeScof Proposed �pof on main house side extension 2-car garage, rear screen torch & kitchen area o12 oAsting bedroom Yes No Adding new bedroom Yes No aNi ive Renovating unfinished basement Yes No t�hd Roll -Sheet souse and or addition to existing housing complete the followin �.<.uilding :One Family Two Family Other nber of rooms in each family unit: Number of Bathrooms there a garage attached? roposed Square footage of new construction. Dimensions lumber of stories? Method of heating? Fireplaces or Woodstoves Number of each Energy Conservation Compliance. Masscheck Energy Compliance form attached? Type of construction Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No 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, Joan Barrett _ as Owner of the subject property hereby authorize All Star Insulation & Siding CO, Inc to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Ed Losacano 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. �Jd SCE Ct�r10 --- Print Name Dat Signature of Owner/Agent Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterlWeli Availabilit lqo'ithampton, MA 01060 Two Sets of Structural Plans ring 87-1240 Fax 413-587-1272 Plot/Site Plans ,pton,r�lA of oso Other Specify .ICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SITE INFORMATION y Address: This section to be completed by office ntry Way Map Lot Unit 3e, MA 01062 Zone Overlay District Elm St.District CB District N 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 'ner of Record: aor Rothman 67 Country Way Florence,MA 01062 (Print) Current Mailing Address: 413-584-3438 Telephone ature Authorized Agent: G C1 Cc�rti o S( �;r 04-\ ;n S t -C.St k*-rn ton o ro� i��me(Print) urrent Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b y.permit applicant 1. Building $13,852.00 (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) Check Number This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissioner/inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑✓ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [p Siding[❑) Other[❑] Brief Description of Proposed work: New roof on main house, side extension. 2-car garage, rear screen porch & kitchen area Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet sa. 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 I, Joan Barrett as Owner of the subject property hereby authorize All Star Insulation & Siding CO, Inc to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Ed Losacano 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. Print Name Signature of Owner/Agent Datel Section 4. ZONING Atl 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 Rear L: R: L: R: 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 O DON'T KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ) YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , 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 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 1 -SITE INFORMATION Department use only .:- Ir L _ City of Northampton Building Department Status of Permit: Curb Cut/Driveway Permit Map Lot Unit 212 Main Street Sewer/Septic Availability DEC 5 Electric. Plumbing& Northampton, MA 01060 Room 100 eo hampton, MA 01060 87-1 240 Fax 413-587-1272 Water/Well Availability Two Sets of Structural Plans 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 67 Country Way 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: Eleanor Rothman 67 Country Way Florence,MA 01062 Name(Print) Current Mailing Address: 413-584-3438 Telephone Signature 2.2 Authorized Aaent: 1E& ��c�C @�O S� Ft &-re k ►n j t fast kar,12ton 0 b� Name(Print) urrent Mailing Address: p Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $13,852.00 (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) Check Number `l'j This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 67 COUNTRY WAY BP-2015-0644 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11 -007 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-2015-0644 Project# JS-2015-001236 Est. Cost: $13852.00 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.): 43690.68 Owner: ROTHMAN STANLEY zoning: Applicant: ALL STAR INSULATION & SIDING CO INC AT. 67 COUNTRY WAY Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON.•121812014 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. Underground: Service: Rough: Rough: Final: Final: Gas: Fire Department Rough: Oil: Final: Smoke: Meter: House# Driveway Final: Building Inspector Footings: Foundation: Rough Frame: Fireplace/Chimney: Insulation: 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 12/8/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner