24A-156 (3) Ilt
INSULATION -----
&
SIDING CO., INC.
EASTHAMPTON OFFICE 413-527-0044 CSL License #CS SL 99739 WESTFIELD OFFICE 413-568,64.1 1
56 FRANKLIN STREET • EASTHAMPTON, MASSACHUSETTS O 1027 • FAX: 413-527-1222
Proposal Submitted to Phone Date
Devlin Farmer "Purchaser"413-320-2899 (C) June 16, 2015
Street Job Name
19 Norfolk Avenue
City,State and Zip Code Job Location Job Phone
Northampton, MA 01060
Contractor hereby%ubmits to PUrchaser specifications and estimates for: INSTALLATION OF ATTIC !NSU LATION, VINYL
REPLACEMENT WINDOWS, GUTTERS & DOWNSPOUTS
1- We will install (1) insulated Fiberglass basement door.
PRICE $832 00
**APPROXIMATE START DATE WILL RE 3-6 WEEKS FROM THE DATE WE RECEIVE THE REQUIRED
DEPOSIT AND SIGNED CONTRACTS LESS ANY INCLEMENT WEATHER
r
ALL STAR WILL SECURE BUILDING DING PERMIT IF NEEDED HOMEOWNER WILL-B.E-R,ESPONSIBLE FOR ANY
&ALL FEES REQUIRED
NO PRODUCT & LABOR WARRANTIES WILL BE ISSUED UNTIL WE RECEIVE FINAL PAYMENT.
HOMEOWNER WILL BE RESPONSIBLE FOR ANY&ALL. ELEQTRICAL OR PLUMBING WORK,
} HOMEOWNER WII-L BE QESPONSIBI F FOR REMOVAL OF CURTAINS MINI BLINDS AND SHELVES
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WARRANTY". LABOR IS GUARANTEED FOR 1-YEAR". ICE DAMAGE IS NOT COVERED UNDER MATERIAL
OR LABOR WARRANTY
s ALL STAR SEAMLESS GUTTERS IS NOT RESPONSIBLE FOR WATER LEAKING BETWEEN FASCIA BOARD
AND GUTTER DUE TO IMPROPFRI v INSTALLED ED DRIP EDGE=
ALL STAR SEAMLESS GUTTERS IS NOT RESPONSIBLE FOR BIRDS GETTING INTO GUTTERS AND
MAKING NESTS
ALL STAR SEAMLESS GUTTERS WILL NOT RE RESPONSIBLE FOR REMOVING OR REINSTALLING
INS;
HEATING CABLES IF EXISTING
'S LEAF SHELTER GUTTER GUARD HAS A "MANUFACTURER'S AC.TI IRER'S 20 YEAR WARRANTY" LABOR IS
GUARANTEED FOR "1 YEAR" ICE DAMAGE IS NOT COVERED UNDER MATERIAL OR LABOR WARRANTY
*'A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION AND LIABILITY ITY WII I BE FORWARDED
UPON REQUEST
} T P LEY INSURANCE AGENCY OF WEST SPRINGFIELD MA IS OUR AGENT
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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
Type Description
No.and Street
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(a-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 Corrivany Name or HIC Re tstrant 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
Prifi J 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 7-8--/s
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.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"
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.[3 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 or me in an capacity. employees and have workers'
g y P Y 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 11.0 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' l3.❑ 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: 19 Norfolk 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
under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: ' / �S
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-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[E3] Othe [ ]
Brief Description of Proposed d
Work:
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 x 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.
Signature of Owner Date
1 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.
Edwin Losacano
Print Name
s 7/8/2015
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 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO () DON'T KNOW YES C)
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 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
LElect Depa rtment use only
ity of Northampton Status of Permit:
A132015 ii uilding Department Curb Cut/Driveway Permit
J 212 Main Street Sewer/Septic Availability Plumping&Gas Inspections Room 100 Water/Well Availability
rthampton,MA 01060 hampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plott$ite Plans
Other Specify
APPLICATION 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:
Map Lot Unit
19 Norfolk Avenue, Northampton, Ma 01060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Devlin Farmer 19 Norfolk Avenue, Northampton, Ma 01060
Name(Print) Current Mailing Address:
Telephone 413-320-2899-C
Signature
2.2 Authorized AgentAll tar Insulation 9 5idin3 Co., Inc.
56 Franklin Street
Name(Print) mp n/ ?VtA Current Mailing Address:
(413) Si7-0044
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 4,068 (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) 4,068 Check Number
This Section For Official Use Only
Date �p
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
19 NORFOLK AVE BP-2016-0075
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A- 156 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2016-0075
Project# JS-2016-000137
Est. Cost: $4068.00
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(ssq. ft.): 13764.96 Owner. FARMER DEVLIN&TAMSIN
Zoning: URA(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC
AT. 19 NORFOLK AVE
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTON MAO 1027 ISSUED ON.712012015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION, REPLACEMENT
WINDOWS & BASEMENT 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 7/20/2015 0:00:00 $70.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner