24A-095 27 DICKINSON ST BP-2019-0750
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-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:ROOF BUILDING PERMIT
Permit# BP-2019-0750
Project# JS-2019-001233
Est.Cost:$6153.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 101858
Lot Size(sq. ft.): 15594.48 Owner: SILVERMAN ALEX&MARJORIE ROSS
Zoning:URA(100)/ Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 27 DICKINSON ST
Applicant Address: Phone: Insurance:
56 Franklin Street (413)527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:12/26/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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:
FeeTyne: Date Paid: Amount:
Building 12/26/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
__-70
v The Commonwealth of Massachusetts
o Board of Building Regulations and Standards MUNICIPALITY
ALITY
D c Massachusetts State Building Code,780 CMR USE
�o
M Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
0 — One-or Two-Family Dwelling
oa This Section For Official Use Only
o
a Buildi it Number: fJ �� ' 7 Date Applied:
0
z
CU)"� O55 lZ•ZG-lg
ficial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Ass ss rs Map&Parcel Number
27 Dickinson Street
Lla Is this an accepted street?yes no Map Numbef Parcel Number
13 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:
Alex Silverman&Jori Ross Northampton,MA 01060
Name(Print) City,State,ZIP
27 Dickinson Street 413-586-9964 Home alex.silvermanOsit.edu
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORI O(check all that apply)
New Construction❑ Existing Building Pd Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) M Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units I Other ❑ Specify:
Brief Description of Proposed Work2: We will strip all layers of detached garage roof and install new 7/16"subsheathing
where needed and new architectural shingles on entire roof surface with underlayment. Shingles will match main house
as close as passubleRoof area approx.5 sq_
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 $ 0 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 $ Total All Fees:$
Suppression)
Check No.41heck Amount: qO Cash Amount:
6.Total Project Cost: $ 6,153.00 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL-099739 2-14-20
Ed Losacano License Number Expiration Datc
Name of CSL Holder
List CSL Type(see below) R
128 Glendale Road
No.and Street Type Description
U Unrestricted(Buildings ue to 35,000 cu.ft.
Southampton,MA 01073 R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-527-0044 allstar52700440gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
101858 6-28-20
All Star Insulation&Siding Co.,Inc. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
56 Franklin Street allstar5270044@gmail.00m
No.and Street Email address
Easthampton,MA 01027 413-527-0044
Ci /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..........M 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 authori d Losacano
to act on my behalf,in all matters relative o ork a thori by this building permit application. )
Alex Silverman&Jori Ross Owner /
Print Owner's Name(Electronic Signature) bate
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,OwnerL-E_' ( 4mn
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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
w« v.mass.R'Cl�Inca Information on the Construction Supervisor License can be found at w"-w.mass.govrdps
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"
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.
Cr
Address of the work: o) '') D)C I Y)S0 V-) sht-e N l)
18
The debris will be transported by:
an n c —
The debris will be received by: otos
Building permit number:
Name of Permit Applicant E Lasa
ccznn X11ruS.o.-h"on� ic�i��q
EA
Date Signature of Permit Applicant
The Commonwealth of Massackuseas
Department of Industrial Accidents
Office of Investigations
kvi 600 Washington Street
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 boa: 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. E]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 8. ❑ Demolition
workingfor me in an capacity. employees and have workers'
y � �'• 9. E] Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.El 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,§1(4),and we have no
employees. [No workers' 13.0 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 employeeL Below is the policy and job site
information.
Insurance Company Name: THE TRAVELERS INSURANCE COMPANIES
Policy#or Self-ins.Lic.#: 6HUB-8H2630c2-8�-18 Expiration Date: 0'8/13/19
Job Site Address: ��Ckl Y1 C1� t`,11�2-Il; ` City/State/Zip: �p�'V�Q"Qu w X11
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.
er
Signature: C d Date:
o-
Phone#: 413-527-0044
Official use only. Do not write in this area,to be completed by city or town offwiaL
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#:
.•- V� -�C��i7/yl Q�C����u'.u�d�C1ZC'C'd�
_ ---.Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
_ .. Boston, Massachusetts 02118
• - Home Improvement Contractor Registration
.. Type: Corporadon
Regisd atton: 101858
"= ALL STAR-.iNSULATION.4 SIDING.CO. ExplrsVon: 08/2812020
56 FRANKLIN STREET
__.... ... EASTHAMPTON,MA 01027
Update Address and Return Card.
SCA t 4 2CM 4WIT
- HOME tAAPRONEMENT CONTRACTOR RegialraEonwad for Individual use only
TYPE:C looratlon before the expMbn date. It found return to:
OMlos of Com mw Afhirs and duaimss Rspulation
OtilM020 1000 Washbvton Street-Sulte 710
ALL STAR INSULATION d SIDING CO. Boston,AAA 02111
EDWIN W.LOSACANO �,C�u�►-- Gt k
58 FRANKLIN STREET U
- - EASTRAMPTON,KRIC'tTiO'17' Undemserstory Not out signature