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17C-203 (2) ' INSULATION w„ SIDING CO., INC. r. r2 ILA , 56 FRANKLIN STREET EASTHAMf''1-ON, MSSA(:HCJSETTS 01027 EASTHAMPTON OFFICE: 527-00-1-4 WEST!"'IELD OFFICE: .568-641 1 Proposal Submitted to Phone %'.'•~,.K. - - 1 Cowan "Purchoier" t ^11� 1?1 `-A. Stmt Job Nome IM Smth Str1 t 2001 City, State and Zip Code Job locotion n .1r 4'�i'l l ams I'iCf U 1 V 9,6 t`l xence,, K �.' I 05�.: Contractor f»..by wbiq p urcbaOpaKifications and estimates for: IN-7.Nt I.ATI( J C`r" V1\M_ STDING � 1. 1b will inSt:all rew Virr"l S di rr on all exteriur vol Is. )brecvrnc-r 4•ji11 'love choice of colas, style, brand d rem. 4. Y r � c - �• w. a1. �". '. -�..�. 2. We will nail all sidim ac)orox. 16-2411 on cent-, , usiqg_a1uirdn m. r�,i's- .'o Uhey wi11 not rust Lnoerneatli t * si ding. _- .i. We wi 11. iris f., A_�811 ins r I ara _ y^,stow barj; e-'-- II�.K'.L s�7i ctrl 1 1'' , 'wi[X; S. ICIrWgsi.l.1s 'oiiil --7e trjm-?-" cut wi n `bite' alugi! i , !!j, avr. r!.il , 'Ale will rlfl It under the interior wiD(jy,. Ci. We wiiI r't-1'1 Ic'"' v 1) 1 Slrr: 1� 'ft t ih� a11lTttrtttil StC`NtTI !�r"t'rJV1 Br..C1�` c'J`fC? tJvti?r NK1C)d dear tt^tiTi. --/, �iF' williYlrKk' �:E_3.i I��'�.&'Ai,.`,_l�k :_'ii !_ 1 �__ }' 1Ci1�1C}� Y le(2 arrCj 1 (1!?2�EC�. B, 'W'f i !P of �zf�antt,�n � e + j lass arhnsetts DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street a Municipal Building ' Northampton, Mass. 01060 " WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, ED LOSACANO, OWNER OF ALL STAR INSULATION & SIDING CO., INC (li censer/permi ttee} with a principal place of business/residence at: 56 FRANKLIN STREET, EASTHAWTON, MA (phone#) 413-527-0044 (strcei/ci ty/staie/�p) 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: -Im�ge� Tot�%15 Hq(:,7 ©( (Insurance Cody) (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 Company/Poli7y Number) (Expiradon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiocal:hoer if nooena y to inchide infortna2i oa pestaio erg to all o0wraoton) ( ) I am a sole proprietor and have no one worbdng for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homeowners who e rnplcy pcnow to do=�im S oonsmucdoa or rc*r work oo a dwelling of not moe»thaw throe units in wretch the homeowner r=da or oo O e grounds appurtcoarrt thereto arc not generally oowi&e to be employers under the worker's ooa=sx4cn Act(GL152,ss 1(5)},application by a homeowner for a Ucc=or permit may evidenoe the legs!ctatua of an employer under the Workees Componeution Act. I undenuad that a OOYY of this rw=ncm may be forwarded to tbo D of Indz ,d A=&c&Oflioe of&swuranoe for the coverage verific:�oa and that failure to sex=covcr undct=U 25 A of N1 GL 152 can lead to the i ion of crtmixa penalties oonsistatg of a fine of up to S 1,500.00 mr'Nor imprisc�of up to one year and Civil Pcmriics in the form of it Stop Work Order sad a Lm 0(3100.00 a day agniw me. For departavxiW use oaly Permit Number a Map# Lot# Si of Licensee/Pe rice i SECTION$-CONSTRUCTION SERVICES 1 Licensed Construction Suter: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone N � In'Mfie'Jlmq. 4J�emelrifiCc'ntira ( � `f' ;;f „ " +�' of Applicable Company Name Registration Number ,� Fop ri I ri aC&fi Address Expiration Dat v Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.131. 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...... ❑ 4 UbJULA M,�er. X olion 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 UTION 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: d--�I � cn Q i nq f ()q Alteration of existing bedroom Yes No Adding new bedroom —Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D - Sheet D 6bi If New i6use 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. 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 I 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 l as Owner of the subject property i hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 Date r Section 4. Y 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 Lex Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved akin #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 ✓ry 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: • w 1 r City of Northampton �i � EC E I artment Street R 00r/vw% f , MAY 1 QIoQp�m MA 01060 Q SetSs` T phone 413.587.1 40 Fax 413-587-1272 %Site' • F U r Sp " i A T , REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION L.;;SITE INFORMATION o This section to 1.1 Property Address: _, a� c m le, nP ;td, , y� I �r�:�"f[Jf 1 ( ,a�rT y Map-• Lot,, �j��.,_,_�_.,. Zone Ovorlay`District Elm St. District CB District,, SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: e 07(v Name(Print) Current rr`� (5f 'Current M ilin dr 1 Telephone elephone 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 leted by ermit applicant 1. Building cc (a) Building Permit Fee I 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) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date r BP-2001-0950 G1S#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate orv:vinyl sidin BUILDING PERMIT Permit# BP-2001-0950 Project# JS-2001-1709 Est.Cost: $5432.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: All Star Insulation & Siding Co Inc 101858 Lot Size(ssq. ft.): 1960.20 Owner: COWAN DONNA Zoning: GB Applicant.• All Star Insulation & Siding Co Inc AT. 1 BRATTON CT Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:5122101 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 5/22/010:00:00 25613 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo