31B-234 (3) 74 KING ST BP-2016-1109
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B-234 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2016-1109
Project# JS-2016-001892
Est. Cost: $2983.00
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.): Owner: WILHELM JOSEPH A III&PHYLLIS
Zoning_CB(1002/ Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 74 KING ST
Applicant Address: Phone: Insurance:
56 Franklin Street (413) 527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:3/16/201¢0:00:00
TO PERFORM THE FOLLOWING WORK.•INSTALL6 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:
FeeType: Date Paid: Amount:
Building 3/16/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
FW The Commonwealth o Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Buildini g Code,780 CMR MUNICIPALITY
USE
LL
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITt INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
74 King Street, Northampton, MA
L l a 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(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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Phyllis Wilhelm Northampton, MA 01060
Name(Print) City,State,ZIP
74 King Street 413-586-3480
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work 2: INSTALL 6 NEW VINYL REPLACEMENT WINDOWS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials Y
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fe s:Check No. heck Amount:040 Cash Amount:
6. Total Project Cost: $ 2,983.00 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONS17RUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL -099739 2-14-18
Ed Losacano License Number Expiration Date
Name of CSL Holder
128 Glendale Road List CSL Type(see below) R
No.and Street Type Description
Southampton, MA 01073 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 FamilyDwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-527-0044 allstar561 @verizon.net I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 101858 6-29-16
All Star Insulation & Siding Co., INC.
a g HHIC Registration Number Expiration Date
T MWn�ln JIre_JC Registrant Name
N
allstar561 @verizon.net
Eand Street asthampton, MA 01027 413-527-0044 Email address
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 .......... (9 No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTQR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject pro erty,hereby authorize Ed Losacano
to act on my behalf,in all a rs relative to wor uthorized by this building permit application.
Phyllis Wilhelm Z 2 9 Zo
Print Owner's Name( lectronic ignature) ate
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 tru and accurate to the best of my knowledge and understanding.
Ed Losacano
Print Owner's or Aut oriz d ent'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
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.<(ov/dps
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of rpvestigations
ig UV, 600 Washington Street
Boston, MA 02111
www.mrss.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
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y9. F1 Building addition
[No workers' comp. insurance camp. insurance.+'
required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers ha*e exercised their 11.❑ Plumbing repairs or additions
myself o workers' eom right of exemption per MGL
Y [N P• 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees.',[No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#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 is the policy and job site
information.
Insurance Company Name: Star Insurance
Policy#or Self-ins. Lie.#: WC0681114 Expiration Date:_ 0,8//13/16
Job Site Address: 7`/ xity& s racor City/State/Zip:--I0/2,771 t^1zwiy,, /T7/q
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dateff 066)
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 1v true and correct.
Signature: ,{y Date: slaL,;z0/(p
Phone 4: 413 7-0044
Official use only. Do not write in this area,to be completed by city or town of)iciai
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#:
R 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: 6/29/2016 Tr# 252104
ALL STAR INSULATION & SIDING C0:
Edwin Losacano
56 Franklin Street
Easthampton, MA 01027
Update Address and return card.Mark reason for change.
-
OPS-CAI 0 50M-04104-G101216 Address [:) Renewal 0 Employment F7Lost Card
,,,,//�� �,,�
Office of Con ey Atixa s mess egu ate io"n� License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: :-101858 Type: Office of Consumer Affairs and Business Regulation
Expiration: .6/2912,016 Private Corporation 10 Park Plaza-Suite 5170
AL TAR INSULATIOht&SIDIt�1G CO. Boston,MA 02116
Edwin Losacano
56 Franklin Street
Easthampton, MA 01027
Undersecretary Not val' hou signature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License:CSSL499739
Construction Supervisor Specialty D
(n
EDWIN W.LOSACANO
128 GLENDALE ROAD
SOUTHAMPTON MA 01073
o•
Expiration: co
Commissioner 09/14/2019 °
. 1a
Cn
N
4J
(J1
V
tIt
Client#: 13250 ALLST
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
r 0910412015
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,qXTEND 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).
PRODUCER NOMT
EACT Jane Eitel
T.P.Daley Insurance Agency, Inc PHONE - - VAX
(AIC,-No,E,):413 788-0971 JAIC,No, 413 739-2645
1381 Westfield St. E-MAIL
ADOREss, janeeitel@tpdaleyinsurance.com
_,
P.O.Box 1160
West Springfield,MA 01090 INSURERS)AFFORDING COVERAGE MAIC#
INSURERA:Peerless Insurance
INSURED INSURER B:Star Insurance Co-mpany T__
All Star Insulation&Siding Co.,Inc.
56 Franklin Street INSURERC.
Easthampton,MA 01027 .1NSUREFtD.
INSURER E
INSURER F:
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 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� ADDLSUBR, POLICY EFF POLICY EXP
L t TYPE OF INSURANCE I LIMITS
TR POLICY NUMBER I LIUD YYYYJ__I[MM1/DDNYYYJ
1MM
A GENERAL LIABILITY CBP8052996
08/13/2015 08/13/2016,EACH OCCURRENCE
X COMMERCIAL GENERAL LIABILITY DE T RENTED
PREMISES -
ilaoccurrencei 00,000
CLAIMS-MADE
XOCCUR MED EXP(Any one person) $5,000
F
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG s2,000,000
PRO-
POLICY ril JECT I LOC
A AUTOMOBILE LIABILITY BA8054496 8/1312015 08/13/2016 COMBINED SINGLE LIMIT
ANY AUTO _ BODILY INJURY(Per person) $100,000
ALL OWNEDSCHEDULED
AUTOS BODILY INJURY(Per accident)AUTOS $300,000
NON-OWNED 'PRoptRfYbAME AG
X HIRED AUTOS AUTOS (Per accident) $100,000
UMBRELLA LIAR __. _. .. .__.- __. ___.___
OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS-MADE AGGREGATE
......... DED_i__J_f ETENIION ------- $
B WORKERS COMPENSATION WC0681114 WC STATU- 'OTH-
AND EMPLOYERS'LIABILITY 08/13/2015 08113/2016 X LORy_UMtT,5_ LER
Y/N
ANY PROPRIETORIPARTNER/EXECUTIVEE�j 11,EACH ACCIDENT $100000
OFFICER/MEMBER EXCLUDED? !NIA -1
(Mandatory in NH) E.L.DfSEASE-EA EMPLOYEE $100 000
'I UIU"�
If yes,describe under
DESCRIPTION-OF OPERATIONS below DISEASE-POLICY LIMIT 600000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required)
GENERAL CERTIFICATE
CERTIFICATE HOLDER 'CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
All Star Insulation&Siding Co. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS.
Easthampton,MA 01027
AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/06) 1 of I The ACORD name and logo are registered marks of ACORD
#S123221/111111123220 JXE
IS
Easthampton Office INSULATION& Westfield Office
413-527-0044 S1�SING CO., INC. a 413-568-6411
CSL License#CS SL99739
www.sidingandroofingwesternma.com
56 Franklin Street • Easthampton, MA 01027• fax 413-527-1222 • email:allstar561 @verizon.net
Proposal Submitted to Phone Date
Phyllis Wilhelm/Wilhelm,Shimel&King "Purchaser"413-586-3480-office February 18,2016
Street Job Name
74 King Street
City,State and Zip Code Job Location Job Phone
Northampton, MA 01060
Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF NEW VINYL REPLACEMENT
WINDOWS
1.We will remove and di=se of existing wiadows in second floor back left office and center left office
2 We will install(6)Double Hung Simonton Asur Fn rgy Star Rated�ZinylReplacement Window Units in
designated
3 They will have double pane in ulat d glass with Half Screens Color will be T with tipper Prairie grid)Mork
4 We will install foam insulation around window unitq installed ands ^I with Silicone Caulking on interior
and exterior
5_We will blow Class On _ceiiijiose in weight cavities around window tinits installed whe[Q needed
6 Vinyl Replacement Window Unit has a"Man ifa t rr r'G Lifetime Warranty" nd theegl ss has;;"20-Year
Warranty"
PRIG 98 00
NOTE APPROXIMATE START DATE nm I BE 3-5 WEEKS FROM DEPOSIT AT S ANY IN MFNT
WEATHER
*HOMEOWNER WILI BE R PONSIB F FOR AM'F S R OIIIR D FOR gjjII DING P RMITS
HOM=�oVVNE Vl.LJaPq3� SNFILMINI BI,.It�n.�ANn. FaF NLEa
*"HOMEOWNER WILL BE RESPONSIRI F FOR ANY&Ai I ELECTRICAL OR ELUIVIRING PLUMBINGFFFS THAT MAY RIF
N D D
HOM Oln N R WILL RF RFSPONSIBLF FOR ANY SF(`I RITY SYSTEM INqjALLFD IN WINDOWS
PRODUCT&LABOR WARRANTIES VVII L NOT RF ISSI IED UNTIL WE RF,:QVE FINAL PAYMENT
*`A CERTIFICATE OF INSURANCE FOR WORKMAN'S COMPENSATION i open LIABILITY Wil I BF
FORWARDED UPON REQUEST
"T P DALEY INSURANCE AGENCY OF hVEST SPRIN(-,FIELD, MA IS O R AGENT.
Vn!c_PROPOSE a lab--',CC ^t^ ah ti �
_ furnish r^ a ^d pl. � an .vi. spe tlo ns,; the cf:
$2,953.00 dollars($ 50%DOWN,BALANCE DUE y ),payment due upon receipt of invoice.
If payment late,interest at 1 1/2%may be added. COMPLETION OF JOB
NOT THis proposal may be/ythdrawn by us if not accepted within THIRTY days.
,r 1
n ED LOSACANO, OWNER
Contractor Salesman
CidLE?
y IS ! I e m I e m, Ime Ing 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,providedyounotify 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