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e�...n+4+....�,..n.-.••w,+•;i«n,:s+T„r,.F..,.p,.•wov,m.►x•;,=..n,+;.TS;R�"T'•�P:•..-H.r•-rarn7.;� -.......•v.-,-•-...-e.-..,r.
OVA [E C� PET V
Y INSULATION ,
.. , .
SIOTNG`CO., INC.
56 FRANKLIN STREET EASTHAMPTON, MASSACHUSETTS 01027,
EASTHAMPTON OFFICE: 527-0044 WESTFIELD OFFICE: 568-0411
Contractors license #101858
Proposal Submiitfsad to Phone pats
Jud aril John Lak � "Purchoser" 5%-09-9q— i � t�r 2� �1
Street Job Name
81 High Street
Cit Stag and Zip Code Job Location Job Phone
FYf orertce MA 01062
Cont►ac►or INreby wbmib to Purchaser specifications and estimates for: INSIAI_I.ATION OF A NEW ROOF
aMNMNSww..
WC.ATION: Sf-_COW UOR"ROOF -
1. We will re mve all~layers of"exlsting shingles and dispose of in a Bur r supplied' by us.
2. We will install 15# felt paper over entire roof surface. "
3. We will install new AT,Atect Shingles.' They will have a "25-Year 1"'Mlfactl-rer' Gu(+rrantee". 'FkTPowner
will have choice of color.
4. Al I. shingles will be nailed with at least (3) nails iJer shingle.
5. We will install a new drip eb-:�e arnrid outside perirrnter' or nx)f.
!�snhalt ice and wafter barn all
6. 1l,e,will i nstal.l 132' of-3611 barrier on r�,ve 1 i ties artd va l I i(-�.
7. *,'id 1-1 install 40' of tic je vent an peak of roof to increase <)ttic v«nt.ila�,ion. _
8. We will ralnve and reinstall cutters if and thre need ! _
** IF ANY SUB SrEATkiING IS NEEDEll, THERE WIIl BE AN ADDITI(NA1 CH -8 CO PPR SI FT TO REPS, DISPOSE
OF AND INSTN ! NEW 1/2 EXTERIOR p YWOOD .,
PRICE: $ 6,983.00
** FIRST F.00R 400E IS NOT INC_UDM.
O ** A CERT I F I CATS OF INSI RANG, FnR WDRKMAN 1 S- GM)ENSAT-10N AND I T AR T I-TTY Wm+ 1F F _
(fin I tan"1,ACp ES7
T.P. DA-EY INS11RMCE AGOCY OF WEST SPRIN H n, MA N n IR Arf rT
De 12
WE PROPOSE to furnish material and labor, complete in accordance with above specifications, for the sum of:
$ 6.3.00 dollars (s 5A dM, hr3lflnCe dt1P Lmn ), payment due upon receipt of invoice.
If payment late, interest it 1 1/2%may be added, ompletion of job,
NOTE: This proposal may be withdrawn by us if not at;cepted within THIRTY
days.
>t �_ 77 �d l_asacaro, !?vim^
Contractor Salesman
`) Judy' arx-i l+ �,, � Acceptance by Purchaser, and Title
"You may, cel�FN agreement if it has been consummated by a party thereto at a place other than an address of the
seller, whic ' ay;�'e 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 th@ third usiness d ay
following the signing of this agreement. In DI � rn a4 CL)
See the attached notice of cancellation form for an explanation of this right.' 4 V
$ TO TERMS AND CONMTIONcz PrIINTPn r?N qF:vcacF cinr
' i O�K1�lp�0
of 'Wort alilvturt
$ 6 A as$achnoetts
` r
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 ,
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, ED LOSACANO, OWNER OF ALL STAR INSULATION & SIDING CO., INC.
-- {license/permiti.ee)
with a principal place of business/residence at:
56 FRANKLIN STREET, EASTKWTON, MA (phone#) 413-527-0044
• (strecticity/stair/zip)
do hereby certify, under the pains and penalties of perjury, that:
(X) I am an.employer providing the following worker's compensation coverage for my
employees working on this job.
h. I '(q' ot'x,Y17��1 a�C.
(Iaranee Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Comlpazy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Pollcy Number) (Expiration Date)
(Name of Contractor) insurance Company[Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shed ifneoessary to 6cluda 4dormatioa pertaining to all ooauactors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo bomoowam who ec aploy person,to do maiateaaxe,caostr=oa or repair worst on a dwelling of
not toner than throe units is wWch the bmeowrcr r=dcs a on t5e voun app jamant thereto acs not ecaraily ooasWeced to be
employers under the woricerls ccmQcuatian Act(0L152,ss l(5)} application by a homeowner for s license or Pernik may evida—tbo
legal status of an employer under the Woriroes Compaoaatioa Ace.
I understand drat a copy of this mtcmem may be fwww dad to tbo DVwtracnt of 1n&utri al Aoci&a&Ofsoe of Lnuranoo for the
ooverw verificst oa and that failure to scatrc covtrngo unda-a oa 2 5 A of MoL 152 can lead to the ia>pasitioa of aimintl penalties
oomiaiag of a fine'of up to S 1,500.00 and/or ix;riso of up to one year and civil penalties is the form of a Stop Work Order and a
find of 4100.00*,day against or-
For dcpaoam use only
Permit Number
•
Map
dt Lot�
Signature of LixnseelPermittce Date
SECTION>8-CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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....... ❑ No...... ❑
--m-
6,.J1
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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
%TION'5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ • Sheet❑
6.a, if ew i�ouse..and or.a+ddition 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. Mascheck Energy Compliance form attached?
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
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
I, �;J- C.1 as Owner/Authorized Agent
hereby declare that the staterrIents 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.
P'ri
Print Name ,
Ed YoXmiZ lo Aq lag,)(
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW V/ YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES_
No
IF YES, describe size, type and location:
orthampton f
86.1 n Department
2 2 in Street
OCT 2 5 2001 m 100
North mpt n, MA 01060s
S -12 0 Fax 413.587.1272
rr, r I
�lrrlyN MPTQNYA 01060 P
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1'SITE INFORMATION
1.1 ProRerty Address: This section tai be.completgd by,office
Map hot Uttit___�__
Zone Overlay District
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
Ow
UrIQ I t ner of Record:
i
I t14TEEi
Name(Pri t) Curce aili ss:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 -''ESTIMATED CONSTRUCTION CQ,5-
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building �Q�f (a) Building Permit Fee
2. Electrical VV (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
O cw-
4. Mechanical (HVAC) dg--40146 10
5. Fire Protection
6. Total =(I + 2 + 3 +4 + 5) Check Number "
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
. � B P 2002 0453
CIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Cate orv: roofin g BUILDING PERMIT
Permit# BP-2002-0453
Project# JS-2002-0683
Est. Cost: $6983.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: All Star Insulation & Siding Cc Inc 101858
Lot Size(sq. ft.): 10497.96 Owner: LAK JUDITH
Zoning: URB Applicant: All Star Insulation & Siding Cc Inc
AT. 81 HIGH ST
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers
Compensation
EASTHAMPTONMA01027 ISSUED ON:10125101 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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/25/01 0:00:00 26275 $100.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo