36-228 e S
INS-1LATION
SIDING CO., INC.
EASTRAMPTON OFFICE 413.527-0044 CSL License #CS SL 99739 WESTFIELD OFFICE 413-568.641 1
56 FRANKLIN STREET • EASTHAMPTON, MASSACHUSETTS 01027 • FAX: 413-527-1222
Proposal Submitted to Phone Date
Amy Mitrani "Purchaser" Home:413-727-8087 January 31,2014
Street Job Name
48 Winterberry Lane Cell:413-210-5119
City,State and Zip Code Job Location Job Phone
Florence,MA 01062
Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF NEW ROOF:1ST FLOOR BREEZEWAY FLAT
ROOF
OPTION 1- INSTALLATION OF NEW FIRESTONE TPO ROOF
1 We • n.^^^•^ 'Ming deck flooring wood sle�a en we will Sava them for relnctallatinn
2 We well remove a Iay and di oo �f in i��E I _A
tf
a -
**IF ANY SI IR SHFAlIN( S NFD.TFiE_RF wLLi RE AV nDmoiV FAR_,L,F, nF$38 FTO REMOVE..-
DISPOSE OF AND INSTALL NEW 7/16 STRAND BOARD SUB SHEATHING
**HOMEOWNER WILL BE RESPONSIBLE FOR COVERING ANY STORED ITEMS AND FOR ANY CLEAN FAN UP WORK IN THE
RRFF7EWAY NEEDED FROM nI IcT n DEBRIS FROM ROOF REMOVAL
ALL STAR IS NOT RESPONSIRI r FOR ANY LEAKS THAT OGGI IR IN EXISTING.SKYLIGHTS(IF APPLICABLE)-
-r-�NO oonnl ITT L LABOR WARRANTIES WILL RE ISSI IED LINTIL WE RECEIVE FINAL PAYMENT
*' ALL STAR WII L SECURE BUILDING PERMIT IF NEEDED HOMEOWNER WILL RE RESPONSIBLE FOR ANY&ALL FEES
RFQtIIRED
**A CFRTIFICATE OF INSURANCE FOR WORKMAN'S COMPFNSATION AND LIABILITY WILL BE FORWARDFD UPON REQUEST
**T P DAI FY INSURANCE AGENCY OF WEST SPRINGFIELD,MA IS OI IR AGENT
-- V+E PROPOSE to furnish rnatenal and iabul,cunmlete In eccuruance witll above specifications,foi-tile twin of: -
dollars($ _501/.Down,Balance Due Upon C_ompletiog,payment due upon receipt of invoice.
If payment late,interest at 11/2%may be added. of Job
NOTE:This prpppsal,may be withdrawn by us if not accepted within _ THIRTY ........... days.
ED LOSACANO,OWNER
•---- Contractor Salesman
AI71y Mitran—, Acceptance by Purchaser,and Title
"You may cancel this agreement 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
Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information .. _ .. ...,.... ..._.. _ ....Please Print_Ueibly
Name (Business/OrganizatiorOndividual): 56 Franklin Street
Easthampton, MA 01027
Address: 1413)527-0044 (413)568-6411
City/State/Zip: Phone #:
AVI u an employer? Check the appropriate box: Type of project(required):
1. am a employer with C) 4. ❑ 1 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 sub-contractors have 8. ❑ Demolition
working far 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 10.0 Electrical repairs or additions
officers have exercised their 11. Plutrrbin repairs or additions
3.❑ [ am a homeowner doing all work g p
myself. [No workers' comp. right ofexemption per MGL 12.�Roofrepairs
insurance required.] t c. 152, §1(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 ofthe sub-contractors and state whether or not those entities have
employees. Ifthe 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: LCSS �k hilt"LLC�r lC
Policy#or Self ins. Lic. #: L-' C�03 l t ] Expiration Dater 13 �I
Job Site Address: L 'It A If I I i r C— City/State/Zip:
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 ofMGL c. 152 can lead to the imposition ofcriminal penalties ofa
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine
ofup to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations ofthe DIA far insurance coverage verification.
I do hereby certify under t pains andpenalties ofperjury that the information provided above is true and correct.
J
S' ature: l �'_ �c - �, Date:
Phone#: qk?>` Sal 400L1 Ll
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 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor: Not Applicable ❑
c} cc_C c
Name of License Holder: C,c�.wj rA L ;
cc License Number �++
L � �=1 LC' � t� i >�CL �L; r� 7 �i11 `�1� 73 G l `T ' a i
Address Expiration Date
--Lie
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
ALL STAR INSULATION& SIDING CO.,11M 1 0 18 s`es`
Company Name 56 Franklin Street Registration Number
Easthampton.MA 01027 C' /' ci b,
Address Expiration Date
Telephone
SECTION 10-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....... No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings ofone(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or firm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion ofthe work far which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility far compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofMassachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Er
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (p Siding [[:I] Other[O]
Brief Description of Proposed b
Work: 4y\-� M)_� /n r\ &tA
Alteration of existing bedroom Yes No Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes _No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
ISi,L OLA 1 ayu? C} i C as Owner/Authorized
Agent hereby declare that the statements and information on tj foregoi g application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
GrLuu k"U 'C'C2;Zi� i OOtle C jpvec JC:'-t
Print Name
L at,I f
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#ofParking Spaces
F ill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW U YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
r° Department use only
of Northampton Status of Permit:
ilding Department Curb Cut/Driveway Permit
d Q 2014 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
N hampton, MA 01060 Two Sets of Structural Plans
�f8�fric,Pium,k�ino�G_
Norfr&rr,ptor,, ki/P"0 587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address. This section to be completed by office
L tlk� Y L) U hC— Map Lot Unit
Zone Overlay District
t-'l ct i�,c"_��_ � ����� �}r C Cc`s.—.
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Pl"Yl tai (h i b"6 VIA
Name(Print) Current Mailing Address:
__ -" ' ) t U&'2_
Telephone
Signature
2.2 Authorized Agent:
P�I I S t c r i�3 h j' '_i Cr:J. I � l ty lkL'r, S ,I uS ut ,,r?tCn . YY119
Name(Print) C Current Mailing Address: C"`Z-1
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �. (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) , G« Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
48 WINTERBERRY LN BP-2014-0973
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-228 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-2014-0973
Project# JS-2014-001694
Est.Cost: $5632.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sq. ft.): 75358.80 Owner: MITRANI AMY JO
Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC
AT. 48 WINTERBERRY LN
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:312412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW TPO ROOF SYS
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 3/24/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner