25A-151 (3) 38 WOODBINE AVE BP-2017-1478
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A- 151 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-2017-1478
Project# JS-2017-002462
Est.Cost:$/3656.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sq.ft.): 4007.52 Owner: SHAHAR HAIM
Zoning: URB(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 38 WOODBINE AVE
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:6/20/201 70:00:00
TO PERFORM THE FOLLOWING WORK:STRIP 2 LAYERS OF EXISTING SHINGLES AND
REPLACE WITH NEW ARCHITECTURAL SHINGLES IN DESIGNATED AREAS
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 6/20/2017 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
05 The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
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
j p /� This Section For Official Use Only 1W
----Building Permit Number: frit 19- 1408 D
6-/y/?
Building Official(Prim Name) Date r
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Ass's_Map& Parcel Numbgye/7•
38 Woodbine Avenue /7
I.1a 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(sy H) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.!.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0
Zone: Outside Flood Zone? Municipal❑ On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Haan Shahar Oak PartCA 91377
Name(Print) City,State,ZIP
478 Savona Way ____ 630-902-1627-_,Igno Ionoroschaemalltom
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 1 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: We will strip(2)Layers of existing shingles and replace with new architedural shingles
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building S I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $ — - --
Suppression) Total All Fees:An �/(/
6.Total Project Cost: $ 13,656.00Check No.'4 Cfheck Amount: 4 tfilash Amount:
0 Paid in Full 0 Outstanding Balance Due:
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128 Glendale Road - - - -----
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Southampton, MA 01073 •
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The Commonwealth of Massachusetts
Department of Industrial Accidents
�fl
"9G'_•; Office of Investigations
€fl2 _ 600 Washington Street
= tc 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
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. ❑ Remodeling
2.El I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp, insurance comp. insurance. 9. ❑ Building addition
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 ILL Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGI.
12.11I Roof repairs
insurance required.] c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that cheeks box b I must also fill out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
IContrsctors 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 subcontractors have employees they must provide their workers'comp.policy number.
tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she
information.
Insurance Company Name: Star Insurance
Policy#or Self-ins. Lie.. #: WC068f11114 / k0 Expiration Date: 08/13/17 •
_ bo
•
lob Site Address: 3X I/0ncri 4'J/J au-en ice City/State/Zip: 1ai4q rmfOio60
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration1date).
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
)f 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.
f do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
3i•nature: 4 •.ts%/ / . .- Date: • •.
Thone#: 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
ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE( TYYT)
07/27/2016
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). T
PRODUCER CXUREAET Jane Eitel
T.P.Daley Insurance Agency,Inc PNCME .413 7884971 rut .413 739-2645
1381 Westfield St. {A4,X>.E+}} t+DC Nnt _
EMAIL aneeitei dal insumnce.com _
P.O.Box 1150 ADCREss. j INSO S)A
IXSURW(SI AFFORDING COVERAGE NNOX
West Springfield,MA 01090 L INsuRERA:Peerless Insurance
INSURED INSURERSStar Insurance Company
All Star Insutation&Siding Co.,Inc.
INSURER C:
56 Franklin Street
Easthampton, MA 01027 INSURER D,
INSURERS:
IXSURE0.F;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 15 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 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.
IRSM - ADDLSVBR _— POLICY EFF r POLICY EXP - —.
LTA TYPE OF INSURANCE INSR
WV POLICY NUMBER (MMMDMTY}I{MMOOYYYY1 LIMOS
A opNEPALi IARC ITV CBP8052996 68113/201508/13/2017 EACH�,� OO(CCTpURRENCE $1,000,000 _
COMMERCIAL GENERAL LIABILITY Eee Irrsnul s100,000
El19nat-E(
CLAIMS-MADE OCCUR MED EXP(My one Person) $5,000
PERSONAL&ADV INJURY 61,000,000
GENERAL.AGGREGATE $2,000,000
GENL AGGREGATE LIMIT APPLIES PE'. ( PRODUCTS-COMPtOP AGO $2,0000OO
I POLICY X JECI� LOC $
AUTOMOBILE LIABILITY BA8054496 08/13/201608/13/201 cO RED SINGLE LIMIT
A I(Eaa249Pn $
BODILY INJURY(Per persalt $100,000
ALL
ALAUTO
OAUTOS SCHEDULED - BODILY WJURY(PoraztlJ ly $3OOy000
LXAUTOS
NON-0WNEP ^LO CRTYPAMAGE $100,000
X HIRED AUTOS
X._ AUTOS SPsL I4 O+H _ _...
UMBRELLA LIAR OCCUR IEACN OCCURRENCE E_
EXCESS LIAR CLAIMS-PLACE AGGREGATE $
f
i ER I RETENTIONS
_ _ $
WORKERSCOMPENSATION UATMN W(%tiTAMu7 Otrv-
B WC0661114 08/13MOt6 08/13f207Dyt P PR
AND EMPLOYERS'WBINER
ANY PROPRIETOR/PARTNERIEXECUTIVE Y IN ELfhf„N ACCIDENT $100,000
Of FICERIMEMBER EXCLUDED? NI NIA'
(MeMatory In Nxl EL.DISEASE.EA EMPLOYEE $100,000
IfDEsCRIunce Under
OEb'CRIPTIONO OPFP't>TNrv6eaw . � _ A5E POLICY LAII? $500,000
_.. ... EL.OIBri
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,If more apace Is lumuIr d)
GENERAL CERTIFICATE
CERTIFICATE HOLDER CANCELLATION
All Star Insulation& CO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS,
Easthampton,MA 01027
AUMOInT31 REPRESENTATIVE
19884010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) t of 1 The AGGRO name and logo are registered marks of ACORD
#5131574/M123220 JXE
Massachusetts Department of public Safety
Board of Building Regulations and Standards
License;CSSL4U730
Construction Supervisor Specialty
SOWN W,LOSACANO
S &EROAD
SOUTHAMPTON
MA 01079 is
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Co missIoner 02/14/2018
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.� lie (po4;re�nvnweer i o/G� UGa4aa(Aaoet '
nOffice of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
ROMMAIltiom 101858
Type: Private Corporation
Expiration: 829/2018 Trp 419291
ALL STAR INSULATION & SIDING CO.
Edwin Losacano
50 Franklin Street
Easthampton, MA 01027
Update Address and return card.Mark reason for change.
arnI os+n p Address 0 Rtaewat 0Employment 0 Lost Cud
1 (rmnu•a„,rera.In/6w r/,airmi
Office of Consumer Affdss&Bminu ke2nladon License or registration valid for Individual ase only
ROME IMPROVEMENT CONTRACTOR before the expiration dab. If found return to:
Regbdudon 101858 Type: Wilts of Consumer AMEN,and Bwbess aeguindon
Expiration: 82812018 PrNate Corporate License
Park Plaza-Suite SPS
Boston.MA 02116
ALL STAR INSULATION 8 SIDING CO.
Edwin Louden 410,
58 FmNvin Street ' ,.w.._-- —
Easthampton,MA01027 Undersecretary Not valid wit Mare
ft n . f- : i ".4- ,. i,
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