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31B-234 (2)
u. 7 U1, INSULATION r & r SIDING CO � I ., INC. EAST13AMPTON OFFICE 413-527-0044 CSL License #CS SL 99739 ;WESTFIELD OFF�-1�413-568-641 1 56 FRANKLIN STREET EASTHAMPTON, MASSACHUSETTS 01027 • FAX: 413-527-1222 Proposal Submitted to Phone Date Phyllis Wilhelm "Purchaser'"413-586-3480-Office July 21, 2015 Street Job Name 74 King Street City,State and Zip Code Job Location Job Phone t Northampton, MA 01060 Contractor hereby submits to Purchaserspecificationsandestimatesfor: INSTALLATION OF VINYL REPLACEMENT WINDOWS A/ . r d di {wood and or aluminum windows if existing, " 1 � e will remote any�,^pr^^^^ 2. We will install(3) Double hung Simonton Asure Energy Star Rated Vinyl Replacement Window units in designated areas 3. They will have double l2ane insulated glass with Half creens. Color will be Tan-wi style grid work, 4 We Will install foam insulation around window units installed arid seat with �jilicone CaulIK-7 ntebarxi;;g p P7 --1 and exterior- I We will blow Class One Cellulose in weight cavities around window units installed whe Jed- 6- Vinyl Replacement WindQw Unit has a"Manufacturer's Lifetime Wa nti'and the a D"r� 7 : M C 9 " h[OTE Approximate start date will be a-5 weeks from depos't date less any inclemen wepther L . ** HOMEOWNER WILL BE RESPONSIBLE FOR ANY FEES REQUIRED FOR RI ill DING PERMITS ** HOMEOWNER WILL BE RESPONSIBLE FOR REMOVAL OF CURTAINS, MINI BLINDS-AND SHELVES. ** " omEQ,n,NER \NI L BE RESPONSIBLE FOR ANY &ALL ELECT RICAI OR PLUMBING IMBING FEES THAT MAY BE nvlv�wvviti r< vvi�� oc ��c NEEDED ** HOMEOWNER WILL BE RESPQNSIB E FOR ANY SECURITY SYSTEM INSTALLED FD IN WINDOWS ** PRODUCT & LABOR WARRANTIES WILL BE ISSUED UNTIL WE RECEIVE FINAL PAYMENT �*A QERJIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION AND 11 l IARIL ITY WILL BE FORWARDED UPON REQUEST WE PROPOSE to fumish material and labor,complete in accordance with above specifications,for the sum of- $ 1,382.00 - -_- - _-._.-.- - dollars($ 50% DOWN, BALANCE DUE----------. ),payment due upon receipt of invoice. -- If payment late,interest at 1 1/2%may be added. COMPLETION OF JOB. NOTE;his oposal may be withdrawn by us if not accepted within THIRTY --------------- --- ----- ----- --------------------- - -- - - - days -- --`-- __ __ED-LOSACANO 0--------_---. ---Contractor Salesman OWNER - ----- LC ylelm Acceptance by Purchaser,and Title "Ycancel this agreement if it has bee consummated by a party theret 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 I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): ALL STAR INSULATION&SIDING CO.,INC. Address:56 FRANKLIN STREET City/State/Zip:EASHAM PTO N, 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.❑ 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 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.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ 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. fi 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.#:WC 068114 Expiration Date:8-13/14 Job Site Address:74 KING STREET City/State/Zip:NORTHAMPTON, MA kj1 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: Phone#:413-527-0044 Official use only. Do not write in this area,to be completed by city or town officiaL Project: Project Address: 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 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.Reallstered 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 6-29-14 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....... EX 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 WiRdows Alteration(s) Roofing ❑ Or Doors 14 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[fnl� Brief Description of Proposed ----' Work: ` C_ S Alteration of existing bedroom Yes ✓ dding new bedroom Yes -----N o Attached Narrative Renovating unfinished basement Yes ___LLNo 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 I, 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 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. ED LOSACANO Print Name Q h 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 C) DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DONT KNOW Q YES 0 IF YES: enter Book Page and/or Document#; B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW *' YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © , 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 ity of Northampton Status of Per lk: uilding Department Curb Cut(Driveway Permit U —3 2015 i` 212 Main Street Sewer/septic Availabilit�+ Room 100 Watsr;NVOK Avallability tric, Plumuing&Gas Inspecll� hampton, MA 01060 Two Sets of Stf'u Elec ctural Plans Northampton, M otoeo - 87-1240 Fax 413-587-1272 Plottsite Plans Other rSpecify 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 74 KING STREET, NORTHAMPTON Map Lot Unit Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: PHYLLIS WILHELM 74 KING STREET,NORTHAMPTON,MA 01060 Name(Print) Current Mailin Address: 413-586-3480-OFFICE Telephone Signature 2.2 Authorized Agent: Nam (Print) _> Current MailingAddressF-eJ�ho AA �7-\ !7 Id Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 1,382 (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) 1,382 Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date 74 KING ST BP-2016-0139 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B-234 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeoa: windows replaced BUILDING PERMIT Permit# BP-2016-0139 Project# JS-2016-000234 Est. Cost: $1382.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group ALL STAR INSULATION & SIDING CO INC Lot Size(sq. ft.): Owner: WILHELM JOSEPH A III&PHYLLIS zoning: CB(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC AT. 74 KING ST Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 EASTHAMPTON MAO 1027 ISSUED ON.81312015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS 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 8/3/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner