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24A-122 (3) Northampton, MA 01060 Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF NEW VINYL SIDING ON l C GARAGE/WORK SHOP TO MATCH HOUSE �l exterior walls Homeowner Wall have choice of color style-. and brand 1 We will install new Vin�CLSiding on all x. III style, - - name 2 will nail all siding approximately 16-24" on center using aluminum nails so they will not rust underneath the siding.- We will onstall a 3/8" insulated Styrofoam backer behind the siding. 4 Wood trim around (15)windows, (3) doors R (2) gage doors will he covered w0th White aluminum cool stock '— material F Windowsills will he trimmed out with White aluminum Im coil stock material FFi+ d fascia will he covered wwth White all Iminum coil stork and perforated White vinyl Soffit I �, Wood trim Svini and laa�ia l"vnl �c v vinyl We will drill out wood soffit areas to increase attic ventilation, k:-°(r a r c J,✓",,?-SpPy +�..ut.CG:?` �!.Wood I fascia will he covered weth White aluminum roil stock material 8. Any caulking tha+ I^ Caulking,eds to he Anne will he done with Silicone � , 9 Any existing wood that is loose will be renait d 10. We will install (2)� hlte gable end louvers in designated areas.1 4) White vinyl lite blocks behind light fixtures, and (1)White dryer vent in designated areas We ill install White Traditional corner posts on all corners. 12 We will remove and reinstall existing_gutters and downspouts on left side of garage, 13, wall remove love al d reinstall stall existing gutters and downspouts with new hidden hangers on right side of _garage, We will install approximately{33)'of heavy duty WHITE aluminum Leaf Shelter Gutter Guard onkl4ft:r( r.•; I'll k; re side of garage ONLY,w - .ri-a,> VIII remove and Ielllstall_(1.) rear door canopy,�..��•�t^.c� ,1,5 Job site will be cleaned upon completion of job,{ 16, Vinyl Siding has a "Manufacturer's Lifetime Warranty" r_ , PRI E' $87100 **APPROXIMATE START DATE WILL RE�n JULY/AUGUST ONCE WE RECEIVE DEPOSIT AND SIGNED ' _ CONTRACT LESS ANY INCLEMENT WEATHER--`_ **ALL STAR WILL SECURE BUILDING PERMIT IF NEEDED HOMEOWNER WILL BE RESPONSIBLE FOR & ALL FEES REQUIRED- NO PRODUCT & LABOR WARRANTIES WIL RE ISSUED UNTIL WE RECEIVE FINAL PAYMENT. ** HOMEOWNER WILL BE RESPONSIBLE FOR ANY&ALL ELECTRICAL OR PLUMBING WORK THAT MAY BF I NEEDED. **A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION NATION AND I IARIL ITY WILL BE FORWARDED UPON REQUEST, T P DALEY INSURANCE AGENCY OF WEST SPRINGFIELD MA IS OUR AGENT. <, ;E PROPOSE_to furnish material and labor, complete in accordance with above specifications,f.)r the sum of: p4 ��� f ' `• :�� � r�C...�y� dollars ($ 50% DOWN, BALANCE CUE UPON �, payment due upon receipt of invoice. If payment la_te, interest at 1 1/2°% may be added. COMPLETION OF JOB. NOTE- TT is proposal may be withdrawn by us if not accepted within _ THIRTY_ days. ED LOSACANO, OWNED° Contractor Salesman ;r arty & Edmund o as Acceptance by Purchaser,and Title "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.[ I am a employer with 10 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ 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 10.17 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.] t c. 152, §1(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. 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: 8/13/15 Job Site Address: 9 Hooker Avenue City/State/Zip:Northampton, MA 01060 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 f under the pains and penalties of perjury that the information provided above is true and correct. Ol Date: ��� 1 S Signature• 1 .-, 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#: Client#: 13250 ALLST ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE/08/2DIY 08 10812014 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Jane Eitel PRODUCER NAME: T.P.Daley Insurance Agency, Inc PHONE 413 788-0971 p/C No: 413 739-2645 AIC,No,Ext: .._. 1381 Westfield St. E-MAIL ADDRESS: I aneeitel t dale insurance.com — P.O.Box 1150 INSURERS)AFFORDING COVERAGE NAIC# West Springfield,MA 01090 INSURER A:Peerless Insurance INSURED INSURER B:Star Insurance Company All Star Insulation&Siding Co.,lnc. INSURER C 56 Franklin Street INSURER D Easthampton, MA 01027 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY/DIYYYY POLICY D //YYYY LIMITS A GENERAL LIABILITY CBP8052996 8/13/2014 08/13/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESOE.RENTED ence $100,000 CLAIMS-MADE 4 OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X E LOC COMBINED SINGLE LIMIT $ A AUTOMOBILE LIABILITY BA8054496 8/13/2014 08/13/201 Ea accident $ BODILY INJURY(Per person) $100,000 ANY AUTO ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $300,000 AUTOS X HIRED T SAUTOS X NON OWNED PROPERTY DAMAGE $100,000 AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC0681114 8/1312014 08/13/201 X TORY LIMIT OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? FN� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) General Certificate CERTIFICATE HOLDER CANCELLATION Allstar Insulation& SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Siding Co.,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S113421/M101619 JXE 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) 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@verizon.net I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 6-29-16 ALL STAR INSULATION & SIDING CO., INC. 101858 HIC Registration Number Expiration Date HIC Comvany 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.......... Q No...........❑ 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 Prigt 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 applicati nis true and accurate to the best of my knowledge and understanding. Ed Losacano 1"--'[( � 7 Print Owner's or Authorized Agent's Name(Electronic 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. 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" —�e -62omwwnaieaa Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101858 Type: Private Corporation Expiration: 6/29/2016 Tr# 252104 ALL STAR INSULATION & SIDINGi-CO- Edwin Losacano 56 Franklin Street Easthampton, MA 01027 Update Address and return card.Mark reason for change. Address 7 Renewal 7 Employment ❑ Lost Card DPS-CAI is 50M-04104-G101216 Office of on�su°nme'�r Af s&BiCines` R g a, License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: .,:101858 Type: Office of Consumer Affairs and Business Regulation Expiration: ,6/29M16 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 _, VAL AR INSULATION:;&S 004 CO. Edwin Losacano 56 Franklin Street g � o Easthampton, MA 01027= Undersecretary Not val'd�y hou signature D v 5 m 0 U n: Massachusetts-Department of Public Safety 1 Sward of Building Regulations and Standards Olnti[.ru,aiwi Supon isor Sheeinlit License:CSSL.M739 ; EDWR4 W.IASA_ ANa 128'GIMALE Southampton MA 02073 w Expiration ~ Collmssioner 02/1412018 c� cn v cn v 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 Reaistered 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....... Ly, 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 D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0] Brief De crip 4n of Proposed Work: � t i I �nC��.� y��luI <1'I CLt n c (gin C. ��� c Alteration of existing bedroom Yes _No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 1 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. ignature of Owner Date a-0 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. Sri (OSCL CC-V')0 Print Name S! 'Zo 1 (5 Signature of Owner/Agent Date 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 Jq) DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES 0 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 0 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only L1 o City of Northampton Status of Permit: ` Building Department Curb Cut/Driveway Permit_ << a a Cyr 212 Main Street Sewer/Septic Availability 1 0 Room 100 WaterANell Availability Q Northampton, MA 01060 Two Sets of Structural Plans o 0 phone 413-587-1240 Fax 413-587-1272 PlottSite Plans 2 Other Specify LI ATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 9 Hooker Avenue Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Barry&Edmund Golash 9 Hooker Avenue Northampton,MA 01060 Name(Print) Current Mailing Address: 413-727-8252 Telephone Signature 2.2 Authorized Agent: F', (� o aC Ct o O l m l M,r Name(Print) Current Mailing Address: LA I ) SAD Lby-A`-A Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $8,703.00 (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) $8,703.00 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 9 HOOKER AVE BP-2015-1194 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 122 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-2015-1194 Project# JS-2015-002264 Est.Cost: $8703.00 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.): 7753.68 Owner: GOLASH EDMUND Zoning: URC(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC AT: 9 HOOKER AVE Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON.61212015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL GARAGE VINYL SIDING 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 6/2/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner