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25A-095 (8)
354 BRIDGE ST BP-2016-1490 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A-095 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2016-1490 Proiect# JS-2016-002551 Est. Cost:$1253.00 Fee: S40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALL STAR INSULATION & SIDING CO INC 99739 Lot Size(sq. ft.): 14810.40 Owner: KIBE DANIEL E&CAROLYN Y Zoning: URB(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC AT: 354 BRIDGE ST Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:6/14/2016 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL 3 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: FeeTene: Date Paid: Amount: Building 6/14/20160:00:00 $40.00 212 Main Street.Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner • ga The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR �l" Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 354 Bridge Street, Northampton, MA 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Int Arca(sq It) 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.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: Carolyn Kibe Northampton,MA 01060 Name(Print) City.State.ZIP 354 Bridge Street 413-586-2581 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work: REMOVE 3 OLD WINDOWS AND INSTALL 3 NEW VINYL REPLACEMENT WINDOWS SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ I. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ -- Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ $1,253.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSSL-099739 2-14-18 Ed Losacano license Number Expimlinn Date Name of CSI. Iloldcr 128 Glendale Road List CSI.Type(see below) R --- _ No.and StreetItpe Description Southam ton, MA 01073 (I Unrestricted(Buildings up to 35.000u.It) --_ P Restricted I&2 Family Dwelling C /Fobs.State ZIP M Masonry RC Roofing Covering WS Window and Siding Sr Solid Fuel Miming Appliances 413-527-0044 allstar561@verizon.net I Insulation lephunc Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIc) 101656 6-29-18 All Star Insulation & Siding Co_, INC. Reuist�.,n Na ,n�. enpir- l)atc IUC` �on 'ra- NNaJ9rrTicRg trant Name allstar561@verizon.net nd Street _ --- Email address Eastham ton, 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 fel Nc. 0 SECTION la: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. Carolyn Kibe C-211[30_(4/1(7 {4 �dJ (eL3 f/ Print Uwncr Name(Electronic Sign once 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 ablpFJp/rdzeso 6/3 /(p_ I 'm Owner - Authorized A Name(Electronic Signature) Dale NOTES: I. An Owner who obtains a building permit to do histber own work.or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(MC)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.nov/oca Information on the Construction Supervisor License can be found at wtaw.mascgomdps 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.ff.) 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' Client#: 13250 ALLST ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDOTYYYI 09/04/2015 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 certificateof holder y.is an ADDITIONAL ayURED,the endorsement must Ast endorsed.mnton ISUBROGATION IS WAIVED,subjecttto the terms and conditions thespolicy,certain policies may require an entlorsement statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER :CON Jane Eitel T.P.Daley Insurance Agency,IncI wcNE 1 413 788-0971 ;,AVS Nog 413 739-2645 uc 1381 Westfield St. EMAIL Eil P.O.Box 1150 ADDRESS: laneeitel@tpdaleyinsurance.eom West Springfield,MA 01090 _ INInsurance AFFORDING COVERAGE HAICM INSURER A Peerless Insurance INSURED INSURER H:Star Insurance Company All Star Insulation&Siding Co.,lnc. - -- I— 56 Franklin Street INSURER c: Easthampton,MA 01027 msuaeao: _,- INSURERS: INSURER F-. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR 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. INSR - - ADM_ POLICY EFF •- POLICY EXP - LTR TYPE OF INSURANCE BIER MND POLICY NUMBER (MMIDDIYYYY) IMMIDDMIYY1, LIMITS A GENERALLIABILITY CBP8052996 08/13/201508/13/2016 EACH OCCURRENCE IIs1,0000� 00 _ X COMMERCIAL GENERAL LIABILITY AG TO RENrEO $100,000 �R` MISEEs Ea NTED �I CLAIMS-MADE X OCCUR MED EXP/Any one Pereom s5,000 PERSONAL&ACV INJURY $1,000000 • GENERAL AGGREGATE I s2,000,000 GENE AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP ASS s2,000,000 POLICY X jRO- 1 LDC oLMJw $ A AUTOMOBILE LIABILITY BA8054496 08/13/201508/13/2016 EOMBIrmnllSINGIF rtT- ANY AUTO BODILY INJURY,Per Pelson $ 100,000 rX_T SCHEDULED BODILY INJURY/Per a¢deml $300,000u Os Tss - % HIRED AUTOS % TON DINNED P OPEAUTOS i i Per dT DAMAGEenb $100.000 ! 11 _ __.. UMBRELLA LIAR _ OGLER EACH OCCURRENCE 5 I EXCESS LIAB CLAIMS-MADE AGGREGATE S • /DED RETENTIONS B WORKERS COMPENSAnON WCOBS1114 08/13/2015 08/13/2016 X wC ST'TU- I DTH. AND EMPLOYERS'LIABILITY 1,IN TDRYIIMITG f_ FR ANY PROPRIETOR/PARTNER/EXECUTIVE! J E.L.EACH ACCIDENT 5100,000 OFFICERMEMEER EXCLUDED' I NT I.N I A I IMandatoryInNH) EL.DISEASE-EA EMPLOYEE $100,000 U yes descnbe under DESCRIPTION OF OPERATIONS below i EL DISEASE-POLICY LIMIT x500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) GENERAL CERTIFICATE CERTIFICATE HOLDER CANCELLATION All Star Insulation&Siding CO. SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS. Easthampton,MA 01027 AUTHORIZED REPRESENTAnVE I --H<<fx-fc 61, ii-_C- lGy ---- ®1988-2010 ---©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD 85123221/M123220 JXE Massachusetts Depadmenl01 PublicSurety Board of 0uilding Regulations and Slantlelds License'.CSSL-0997 Constructipn Supervisor Specialty EDWIN LOSADANO 128 NALE ROAD m SOUTHAMPTON MA 01075 5.fri..xn w Expiration'. Commissioner 0IIMO010 cn N 01 J !P D Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101858 Type: Private Corporation Expiration: 629/2018 TM 119291 ALL STAR INSULATION & SIDING CO. Edwin Losacano 56 Franklin Street Easthampton, MA 01027 Update Address and return card.Mark reason for change. SCA I 0 2014-05111D Address 0 Renewal D Employment 0 Lost Card /Anne-knelt) IN Office of Consumer Affairs&Business Regnladon License or registration valid for individual use only '? HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Regintradon: 101Bs6 Type: Office of Consumer Allaire and Business Regulation Expiration: 629/2018 Private Corporation 10 Park Plaza•Sidle 51/0 Boston,MA 02116 ALL STAR INSULATION&SIDING CO. Edwin Losacano 56 Franklin Street Easthampton,MA 01027 Undersecretary Not valid with• stun The Commonwealth of Massachusetts Department of Industrial Accidents N!= l Office of Investigations 5_a_3 600 Washington Street til Boston, MA 02111 r "%md, 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: Easthampton, MA 01027 Phone#: 413-527-0044 Are you an employer?Check the appropriate box: Type of project(required): I.12f I am a employer with 10 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P ry 9. ❑ Building addition [No workers' comp. insurance comp. insurance.• required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions q ] officers have exercised their 3.❑ 1 am a homeowner doing all work 11.10 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 2 ❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box a I must also fill out the section below showing their workers'compensation policy information. '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 Ls the policy and job site information. Insurance Company Name: Star Insurance Policy#or Self-ins.Lic.#: WC0681114 Expiration Date: 08/13/16 lob Site Address: 354 Bridge Street 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 ofa 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 certi under th pains and penalties of perjury that the information provided above is true and correct Signature: .#1/Z ,0 Date: 6 3/1 c Phone/1: 413- 7-0044 Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: