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17C-092 (12) City,State and Zip Code Florence, MA 01062 q P P 9 R °t"`4'' Contractor hereby.submits to Purchaser specifications and estimates for: INSTALLATION OF NEW N RIGHT SIDE OF HOUSE 1 We will remove all layers of existing asphalt shiogles and dispose of On a dumpster Su P ed by us, 2. �r �a We will install Titanium Rhino Deck or Elephant Skin underiaym -nt over entire stripped roof surface. 3. We will install new C.ertainTeed Landmark, Owens Corning or Gaf/Elk Timberline Architect shingles. They will have a "Manufacturer's Lifetime Limited Warrant. Shingles will match the left side of roof. } A. All shingles will he nailed with at least (5) nails per s hingle 5 We will install new aluminum drip edge on all eyes and new aluminum rake edge on rake areas. We will install pipe boots and metal step lashing where needed 6 We will install a 36"wide asphalt ice and water barrier on eye lines/valleys of heated areas. PRICE $3.982.00 — IF ANY SUB SHEATHING IS NEEDED,THERE WILL BE AN ADDITIONAL CHARGE OF $38 PER SHEET TO REMOVE DISPOSE OF AND INSTALL NEW 7116 STRAND BOARD SUB SHEATHING *'APPROXIMATE START DATE WILL BE NOVEMBER/DECEMBER ONCE WE RECEIVE DEPOSIT AND _SIQ ED CONTRACT LESS ANY INCLEMENT WEATHER. .r a STAR VVII I SECURE BUILDING DING PERMIT IF NEEDED HOMEOWNER WILL BE RESPONSIBLE FOR ANY & ALL FEES REQUIRED, ALL STAR IS NOT RESPONSIBLE FOR ANY LEAKS THAT OCCUR IN EXISTING SKYLIGHT (IF APPLICABLE) * HOMEOWNER WILL BE RESPONSIBLE FOR ANY &ALL ELECTRICAL OR PLUMBING WORK NO PRODUCT& LABOR WARRANTIES WILL BE ISSUED UNTIL WE NO PRODUCT& LABOR WARRANTIES WILL BE ISSUED UNTIL WE RECEIVEFINAL PAYMENT, HOMEOWNER WILL BE RESPONSIBLE FOR COVERING ANY STORED ITEMS AND FOR ANY CLEANUP WORK IN THE ATTIC NEEDED FROM DUST & DEBRIS FROM ROOF REMOVAL. *A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION AND LIABILITY WILL BE FORWARDED UPON REQUEST I.E. DALEY INSURANCE AGENCY OF VAIEST SPRINGFIELD MA IS OUR AGENT. WE PROPOSE to furnish material and labor, complete in accordance with above specifications, for the sum of: $3,982.00 dollars ($ 50% DOWN, BALANCE DUE ) payment due upon receipt of invoice. _.. ----- ... ...... If payment late, interest at 1 112% may be added. COMPLETION OF JOB. NOTE: This proposal may be withdrawn by us if not accepted within _._----_..---______--------------_-.__..-_.THIRTY - ------------- days. ED LOSACANO OWNER ---... ------------------------- .. - - - ----- - ------- - Salesman--..-. Contractor TOfJlil Rftf i ,��, Acceptance by Purchaser,and Title r "You may cancel this agreerent 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 x Office of Investigations 600 Washington Street , rr 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): 1121 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 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.❑ 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, §](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: 08/13/16 Job Site Address: 122 Chestnut Street City/State/Zip: Florence, MA 01062 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. Si nature: f 1 Date: '✓5 Phone#: 41 -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: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSL -099739 2-14-16 Ed Losacano License Number Expiration Date Name of CSL Holder R 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 idin 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 C� px g� HIC Registration Number Expiration Date �� Fran paM.NaJjree�C Registrant Name allstar561 @verizon.net Ntand treet Email address astnampton, 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 .......... L'6 No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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. Tobin Rift 9-30-15 Print 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 applicatiop is true and accurate to the best of my knowledge and understanding. Ed Losacano r ,%i ,` 9-30-15 Print Owner's or Authorize gent's Name(Electronic Signature) Date NOTES: I. 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.cov/oca Information on the Construction Supervisor License can be found at www.mass. ov/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" 0 " J The monwealth of Massachusetts { Moardb� lding Regulations and Standards FOR MUNICIPALITY Ulf assachO State Building Code,780 CMR USE uil ng Pen-nit A�pplic To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 ne- r Two-Family Dwelling n MA 01060 T is Section For Official Use Only Building ermtt Number. Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 122 Chestnut Street, Florence, MA 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Tobin Rift Florence MA 01062 Name(Print) City,State,ZIP 122 Chestnut Street 413-586-5664 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work 2: INSTALL NEW ROOF SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: i Check? heck Amoun : -/U Cash Amount: 6.Total Project Cost: $3,982.00 ❑Paid in Full ❑Outstanding Balance Due: 122 CHESTNUT ST BP-2016-0464 GlS#: COMMONWEALTH OF MASSACHUSETTS MU-Block: 17C-092 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0464 Project# JS-2016-000765 Est. Cost: $3982.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALL STAR INSULATION & SIDING CO INC 99739 Lot Size(sg. ft.): 7013.16 Owner: RITT TOBIN C&LAURA A ST PIERRE Zoning. URB(100)/ Applicant. ALL STAR INSULATION & SIDING CO INC AT: 122 CHESTNUT ST Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:101612015 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: FeeType: Date Paid: Amount: Building 10/6/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner