41-050 1388 WESTHAMPTON RD BP-2019-0253
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:41 -050 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categorv: Door Replacement BUILDING PERMIT
Permit# BP-2019-0253
Protect# JS-2019-000406
Est.Cost: $1982.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sa.R.): 91693.80 Owner: COTTER GERALD S&DIANE P
Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC
AT. 1388 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:8/3012018 0.00:00
TO PERFORM THE FOLLOWING WORK REMOVE &DISPOSE OF REAR GLIDER DOOR&
INSTALL VINYL REPLACEMENT
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 8/30/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
4VL Uplaco"l-ci
RECEIVE
ga The Commonwealth of Massachusetts
r5�, Board of Building Regulations and Standards FOR
A `q;� Massachusetts State Building Code,780 CMR MUNICIPALITY
A10 USE
g P mnit Application To Construct, Repair,Renovate Or Demolish a Revised:Nar 2011
DFPT OF BUILDING Mea6CTIdtY One-or Two-Family Dwelling
CCr
This Section For Official Use Only
Building Permit Numbed — — Dare Applied:
8 Z7 l8
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1388 Westhampton Road
I.l a is this an accepted street?yes no Map Num r Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq In Frontage(R)
1.5 Building Setbacks(R)
Front Yard Side Yards Rcar Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone Information: IA Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Checkif es❑
SECTION 2: PROPERTY-OWNERSHIP'
2.1 Owner of Record:
Gerald and Diane Cotter Florence MA 01062
Name(Print) City,State,ZIP
1388 Westhampton Road 413384-7275 Home
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 13 Existing Building M Owner-Occupied 13Repain s) ClAlterations) ® Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': We will re ncom and dispose of(1)rear patio glider door unit and install(1)new
vinyl replacement patio glider door unit
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building S 1. Building Permit Fee:S Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing S 2. Other Fees: S
4.Mechanical (HVAC) $ List
5.Mechanical (Fire $ Total All Fees:$ �p
Suppression)
Check No.Wj Check Amount: Cash Amount:
6.Total Project Cost: S 1,982.00 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CSSL-099739 2-1420
Ed Losaearm License Number Expiration Date
—__
Name of CSL Holder
List CSL Type(sec below)
128 Glendale Road ----
No.and Stmet -- Type Descer'non
U Unrestricted(Buildings up to 35,000 cu.h.)
Southampton,MA 01073 R Rnsvieed I&2 Family Dwclling
Cityffown,5a¢,ZIP M mason _
RC R.r..•Covmui
--- - WS Wi d wand Siding
SF Solid Fuel Bunting Appliances
413-527-0044 allsGr52700449kgma11.wm I Insulation
_—
Telephone Email address D Dcmolant.
5.2 Registered Home Improvement Contractor(HIC)
101858 6-28-20 _
All StarInsulation HIC Go. Inc. HIC Registration Number piation Date
o
HIC Company Name or HIC Regisrram Namc
56 Franklin Street allstar5270044Q9it
No.and Sweet Emaul il address
Easthampton pM 01027 413527-0044
Cit /Town,State,ZIP Telephone
SECTION 6:WORMERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavi(most 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..........® No ..._....❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as(honer of the subject property,hereby authorime Ed Loseoanct
to act on my behalf,in all matters relative to wpd�autlamixeQ{ty this wild' emit application. —
Dane and Gerald Cotler Homeowner i.BIA.0
Print Owner's Name(Elecuonic Signawal �� Dura
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 hereby attest under the pat and penalties of perjury that all of the information
contained in this application is me and accurate to the I of my knowledge and understanding.
Ed Loss cavo,Owner I —/ ca
Prior Owocr'snr Amh...ed Agent am rgnamm) Dam
NOTES:
I. An Owner who obtains a building permit io do is/hero"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
e tt p.m t )%,pea Information on the Construction Supervisor License can be found at ru st t m t _u, ",
2. When substantial work is planned,provide the information below:
Total Door area pq. B.) (including garage,finished basementlalues,decks or purch)
Gross living area(sq.R.) Habitable room count
Number of 5rcplaces Numberofbedrooms
Number of bathrooms Number of halfib iths
Type of heating system_ Number of decks/porches
Type ofcooling system Enclosed _Open
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: I $R k - n VA F16re=, mA w6zx-
The debris will be transported by: �S� - ��rtu�ir)4t 'itC5111U
—�I ac , d cmct
The debris will be received by: `I ;J pkv �t( 4 t 0 l,llilbw&, rr»,11tt) caw3
Building permit number:
Name of Permit Applicant Cd LfKuonn- hllSiam_CxsuRa4iorlii�'Ai �cGc.Tvx!.
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 01111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name IBusiness/orgmimtionandividuap: 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.Q 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These subcontractors have 8, [j Demolition
workingfor me in an capacity. employees and have workers'
Y P tY 9. ❑ Building addition
[No workers' comp. insufance comp. insurance.•
required.] 5. ❑ Weare a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.] c. 152, §I(4),and we have no
employees. [No workers' 13.0 Other
wrap. insurance required.]
*Any applicant thatch""box#1 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 anew affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they most provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance jar my employees. Below is the policy and job she
information.
Insurance Company Name: THE TRAVELERS INSURANCE COMPANIES
Policy #or Self-ins.Lie.#: 6HUB-8H2633002-8-18 Expiration Date: 08/13/19
Job Site Address: I' � w MU k)n City/State/Zip: fore m_c wft G)aA a
t
Attach a copy of the workers' compensation Iicy 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$250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature, 0-d— &W Cn(_A �— Date,
Phone#: 413-527-0044
Oficial use only. Do not write in this area,to be completed by city or town official
City or Town: PermitiLicelaw#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Client#:13250 ALLST
ACORD- CERTIFICATE OF LIABILITY INSURANCE -=
Wzzrzole
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:IfMY cer116eats holder Is an ADDITIONAL INSURED,Me polky(les)must be endorsed.H SUBROGATION IS WAIVED,sub)act W
the terms and mndMons of the policy,certain Policies may require on andonNnem.A stawmam on this certificate does not confer rights to Me
ceNgcab holder in Itsu of such andomemenl(s).
PRODOe. Ryan Daley
T.P.Daley Insurance Agey,Inc ^ Bu,413788-0971 x„413739.2645
1381 Westfield St. EaMIL : ryandaley@tpdaleyinsumnce.com
P.O.Boz 1150
wewEBIsI AFFORDNGcavEEAGE NAc•
West Springfield,IAA 01090
NBMED NBUPm a:oxuulb YSG.
All Star Insulation 83itlin9 Co.,lnc.
56 Franklin Street NSMaR o:
Easthampton,MA 01027
N9Ua'A E'
waI11ERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT r0 WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCHES DESCRIBED HEREIN IS SUBJECT r0 ALL THE TERMS.
a1gEXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS BROWN MAY HAVE BEEN REDUCED BY PAD CLAIMS.
LTR TYFEOFNBMANCE POIKr NVYBBI 6F PoLKY EMP UMRS
p GEJBML MABIDTY BKS1957957626 1312018081131201 EACHOCCCURgREENCE 87000000
X C.OMMERCIA- £NEWLL I MHUTY 6W&aZM+nD,la S100000
CIUU. M E ❑X OCCUR MPOExv m.') s15000
'PE0.50NA saavlwMNr $1,000000
GENERA ADORE". 52,0100,000
GERLAGGIOZIEUMn AFT1E5 FE R. PROpICTS-w.AoPAuA 52000,000
GCUCY X PRO LOC 5
B AUTOMOBILE LABIDTY BA01957957628 1312018081131201 i„�;°IN” uMIT
.WYAUTo eomLV lwuvv lPw P.+�t $100,000
Au owxED uHEOULEO WDILr INNURVIemNnD $300,000 _
AOTOS X AUTOS PROPERLY YZE $100,000
% wRED AOT_ % ^mDDS EO Pw�MI
s
MYBRNI/,LIIb OCCUR EACHCCCMRENCE $ -,
"ORM'. CWNSIMDE AGGREGATE _ $
DED REIENTGNs s
C �RN�ccYPEX9ATOM 6HUB8H26302818 811312018 08/13/207 X `YD srATu- oTw
/JID ENPLOYEae'IIABILmYIN
HCEEQIET EDD'RPE%�CLVCEOi ECUTW IA
E.L EACH ACCIDENT $100,000
m,MLbyN Nm E L.MSEASE EA EMPLOYEE $10D 000
Xyes JmvM inOa000
OESCRIPTIONOF OPEMTpIS GAAv E L.MSFASE ICYLIMIT $800
DE$OR1M)MOFCPFMl10Ms/LOCATMIXB/VBKLH MRVI,ACD1O l01.MltlwW RwLMAeWr,N.Mlmnrl�Y,apX,alll
General Certificate
CERTIFICATE HOLDER CANCELLATION
All Star Insulation IS Siding SHOTHE TLD ANY OF WE EXPIRATION DATABE TEYTHEREOF.ED F. NOTICEIES BE WILL CANBE CpDELIVEED BEFORE IN
Co.,Inc. ACCORDANCE WITH WE POLICY PROVISIONS.
56 Franklin Street
Easthampton,MA 01027 A°T"°�I°/am"E+IMaeNTATrvE /' '
01988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) 1 oil The ACORD time and logo are registered marks of ACORD
BS1NN6451M748605 RTD
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Wave,of PMOIW ILICOWla
�. OWfgas in Probaabml and Stare
Bpanl OI Ou0d4q Regulations and 6lpndards
ConelrueNon Supervisor Specialty
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r - Office of Consumer Affairs and Business Regulation
- - - - 1000 Washington Street-Suite 710
Boston, Massachusetts 02118
Homel
- mprovementContractorReglstraUon
Type cDIDaa6DR
._ .. ... . . R4911IM n: 101855
. ... - . ALL STAR INSULATION.&SIDING CO. EAp mdw: 052812020
- 56 FRANKLIN STREET
--- - EASTHAMPTON.MA 01027
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.. ALL STAR INSA.ATKRN B SIDING CO. �,MA 02115
EDWIN W.LGSAcwo '
56 FRANI JN STREET- __
EASTNMP
AION;M1'Df027 - .. .-. Undelaeoeldly Not VM Wil out MgnmM
V�SULATION AUG
&SIDING CO., A1C.Easthampton Office - � C4ata-5270044 56 Franklin StreetEasthampton, MA 0102CSL License MCS SL99139/MA HICa1018581C1'HICa0630805
fax 413.527-1222 - emaH:allstar527OO441@gmalLcom • www.allstarinsulationsiding.com
Proposal Submitted to Phone care
Gerald Cotter "Purchaser"413-584-7275 Home July 30, 2018
Street Job Name
1388 Westhampton Road
city state and Zip Code Job Location Job Phone
Florence, MA 01082
Contractor hereby submits to Purchaser specifications and estimates for INSTALLATION OF NEW REAR PATIO GLIDER DOOR UNIT
1 We will remove and r!sunrise of Ax%t no rest netin Glider Door Unit
9 We w'II 'n (1) New Rear Pat rn GIlder Door Unit-Simontdn Asuirr TgyStarStar Retain area.
9 It will haves do hle pane insulated glass with a Full Snreen Color will ha White without and work
4 We will install foam 'naulation around rear pat'n glider in t ri and seal with S'I'cons,Caulking on nterior
And exterior
5 We will remove and reinstall exiatinot nterlor wood frim amnntl (,i�pew rear natio glider unit. Homeowner will
he rA%pnn%hip for any pa'nfng or sta'n'Ing that may he needed
PRICE Si 989 00
—APPROXIMATE START DATE WI BE 3-5 WEEKS FROM DEPOSIT DATELESS ANY INCLEMENT
WFATHFR I ABOR IS GUARANTEED FOR"1-YEAR"
"HOMEOWNER WII U RF RFSPONSUR F FOR ANY FEES REQIRFD FOR BUILDING PERMITS.
" HOMEOWNER WILL BE RESPONSIBLE FOR REMOVAL OF CURTAINS MINI BLINDS.AND SHEI VES
- HOMEOWNER WII I RF RESPONSIBLF FOR ANY 8 AI L ELECTRICAL OR PLUMBING FEES THAT MAY BE _
NEEDED
" HOMEOWNER WIL( BE RgSPONSIByPFOR ANY URITY SYSTEM INSTAI t FD IN WINDOWS
" PRODUCT& 16DUR WARRANTIES WILL NOT BF ISSI IED IINTii WE RFCFIVE FINAL PAYMENT
"A CERTIFICATE OF INSI TRANCE FOR WORKMAN'S COMPPNSATION AND I ARII ITY WILI BE
FORWARDED UPON REQUEST
P...RBLEY..INBiIRNd.CEASiELV�Y..Sl1=YYF�Z.SPlililGE;IELR..36A.LS-S�JJ6..AGF.CIL_—.�------..--.—
WE PROPOSE to furnish material and labor,complete In accordance with above specifications,for the sum of:
$1.862.00 dollars($ 50% DOWN BALANCE DUE _ ), payment due upon receipt of invoice.
If payment late, Interest at 1 112%may be added. COMPLrTION OF JOB --
NOTE, This proposal may be withdrawn by us If not accepted within _ _ TH17Y _ _ _. days.
ED LOSACANO OWN
�� contractorealeamen
Gerald Colter ' " (Acceptance by Purchaser,and Tkle
"You may cancel this agreement if it has been consummated by a parry the r6{o at ai1pplace other than an address of the
seller,which may be his main office or a branch thereof,provided you notify the sellerYn 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