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25C-050 (6) 227 NORTH ST BP-2017-0032 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-050 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-2017-0032 Project# JS-2017-000056 Est. Cost: $3852.00 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.): 9583.20 Owner: WILLIAMS STEPHEN E(I:KATHLEEN M O'NEILL Zoning:URBINO)/ Applicant: ALL STAR INSULATION & SIDING CO INC AT: 227 NORTH ST Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:7/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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: FeeType: Date Paid: Amount: Building 7112/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts Board of Building Regulationsand Standards FOR ( ! Massachusetts Stale Building Code,780 CMR MUNICIPALITY USF: Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Afar 2011 One-or Two-Family Dwelling Ti This Section For Official Use Only Building Permit Number. Date Applied: g h T —.. Building Official(Prior Name) Signature Date ` SECTION 1;SITE INFORMATION :u i 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 227 North Street, Northampton, MA 01060 I la Is this an accepted street?yes no Map Number Parcel Number Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area tsq h) Frontage(H) 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 0 Private 0 Zone: _ Outside Flood Loney Municipal 0 On site disposal system 0 Check ieyes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: KasSeen O'Neill 8 Stephen Williams Northampton.MA 01060 Name(Print) City.State,ZIP 227 North Street 718-930-9672 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction O Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alterations) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other O Specify: _ Brief Description of Proposed Work':_ REMOVE i LAYER OF SHINGLES FROM FIRST FLOOR REAR SCREEN PORCH ROOF AND KITCHEN AREA ROOF INSTALL NEW ROOF OVER THESE AREAS SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materialsl_ I. Building $ I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical S 0 Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanic& (HVAC) $ List: 5.Mechanical (Fire $ -- - Suppression) Total All Fees: Cheek No$0. heck Amoun 14° Cash Amount: 6.Total Project Cost: S 3,852 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CST) • CSSL-099739 2-14-18 seine Ed Losacano -..... Licenpe Number t,xptmnon Date i( Name of CSI.IIuIJcr R 128 Glendale Road i List CAI. FHA;(,ca Mow) No.and Sum, T)pe Description UnroWlctad(BUlidrtisu ro3.000 cu.IGS Southemptan, MA p1 q73 __ _-.. _ R Restricted 1B Famdr Dwelling Lny(fown.Slaw,LU' M Masons R(' Roofing Covering WS Windom.mMSiding __ sf- Soli Fuel nurning App)an..ces 413-527.0044allstar56 —venallstar56@verizon.net �I Insulation lckphune Email address D acmolillan 5.2 Registered Home Improvement Contractor(HIC) 6-29-18 All Star Insulation & SidingCo.. INC. 10185$,..,.-- DIU Recismarion\ mint Expiration Date rs} C Rugwt aM Name� `i nain"�� ee� allstar561@verizon.net k and Stant — -- Irma address Easthampton, MA 01027 413-527-0044 City/Tenon,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 L'd No........._❑ SECTION 7a;OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I.as Owner of the subject propene.hereby authorize Losacano g z. Owner's Williams & Khln O'Neill lateeto work authorize by this building permitappiicanou StephenPrim to act on my behalf,in all matters relative7 �J",�� - ' dote SECTION 7b:OWNER'OR AUTHORIZED.AGENT DECLARATION By entering my name below. I herehy attest uncle, the pains and penalties of perjury that all of the information contained in this application i� e and ascor to the best of mw knowledge and understandme. Ed Losacano _ �,�.�.� ..: j6--> iMm(hvnvr',or Authorized Agent's N...int . mnir 5bm' .-_....._ ,... tnrel Date NOTES: I. 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 prouram or guaranty fund under M G.L.c. 142X.Other important information on the MC Program can be found at wwwmass komaca Information on the Construction Supervisor License can be found at wrnv.mass.erw ins 2. When substantial work is planned.provide the information below: Total floor area(sq. IL) (including garage. finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number ofi;mplaa...s — Number of bedrooms Number ofbathrooms Number of half/baths c_ Type of heating system_ , Number of decks/porches Type of cooling system Enclosed Open_ 3. "Total Project Square Foliage'may be substituted for"Total Project Cost' Client#.13250 ALLST ACORD.. CERTIFICATE OF LIABILITY INSURANCE °ATEIML4DY) 09/04/2015 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 poi lcylies)must be endorsed.It 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 CON!ACT NAME: Jane Eitel T.P.Daley Insurance Agency,Inc P HCen}413 788-0971 N.„1 413 739-2645 1381 Westfield St. ADDRESS: janeeitel@tpdaleyinsurance.com P.O.Box 1150 _- ---- - - - — -- West Springfield,MA 01090 _ slAFFORDING COVERAGE NAIC INSURERA Peerless Insurance nce INSURED iNsuRER B,Star Insurance Company AR Star Insulation&Siding Co„Ina INSURER c 66 Franklin Street INSURER D: Easthampton, MA 01027 INSURERE. INSURER 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 ADOLSUBR POLICY EFF POLICY EXP LTa TYPE OF INSURANCE NSR WVD__ POLICY NUMBER IMMNDLYYYYI (MWDOIYYYYY_ LIMITS A FERAL LAWN CBP8052996 08/13/2015108/13/2016EACH OCCURRErce s1000POD OAMF OPEN 4¢O X COMMERCIAL GENERAL LIABILITY PREMIEg gcmneonel S1,fJtl,TODD I CLAIMS-MADE X.OCCUR MED EXP(Any une Person: s600 PERSONAL cADV INJURY 151,000,000 GENERAL GGREGATE s2,0P0,000 GENT AGGREGATE LIMIT POLICY X APPLIES PER PRODUCTS•COMPI AGG s2,000,000 IECT LOC cOMBINFDSINGP 10 S AYA LE LIMIT A ■ ` BA8054496 08/13/2015 08/13/2016 LE 1 s BODILYINJURY:Pe, . s 0,000 • iNJuRr AXI HIREDMnu*o-s LIABILITY ENTS X NON-tMswED -:. --PROPE PROPERTY O MAGEM d 15 00,000 ..... iPer '� UMBRELLA LIAR OCCUR EACH OCCURRENCE5 EXCESS LIAB LAIMRNADE AGGREGATE lE •DEO RETENTIONS B WORKERS COMPENSATION08113/201510811312016 WC0681114 08tt N2015 08773f2pi6 X WSMANO FMPLOYSR 'LIABY oxTORMARLCER/DxaryurrvE EL EACHAI PRGPRI 100- 000 F IGERNEMNHR EXCLUDED” N N/A — (Mandatory in NH) EL DISEASE-EAs100,000 oX,NnBNOeOPERA-IOas Wow EL DISEASE suucr LIMIT s600000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IMMO ACORD 1St Aadl[mnxl Remat Schedule.R more space is require/II GENERAL CERTIFICATE CERTIFICATE HOLDER CANCELLATION All Star Insulation&SidingCO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 56 Franklin Street ACCORDANCE WITH THE POLICY PROVISIONS. Easthampton,MA 01027 AUTHORIZEDREPRESENTATIVE £k/ 1 --- (g 1988-201e -©1988-201e ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD $S1232211M123220 JXE Massachusetts Department of public Sslety Board et Building Regulations and Standards Ucenac'.OS Supervisor SS b Construction Supervisor Specially EDWIN W.LOSACAND 130OtENDALE ROAD 1111311H. SOOTNAMPTON MA 11073 ( tmn1 M{^^� Expiration: Commissioner Ovl4tlo0 • G5 hru Ny In t • • • - 297%e ` 'd � �e,Cth ( a irrr -1, , " Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101858 Type: Private Corporation _ Eviration: 629/2018 Trp 419291 - ALL STAR INSULATION & SIDING CO. Edwin Losacano 56 Franklin Street • Easthampton, MA 01027 • Update Address and return cord.Mark reason for change. SCA 1 0 20M-05/II0 Address f] Renewal 1] Employment O Lost Card n 4r VrYNmrnwore 44 iin//NlnrArurhi S Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: Registration: 101808 Type; Office of Consumer Affairs and Business Regulation Expiration: 6/29/2018 PrIvale Corporatlon 10 Park Plaza-Suite 5170 Boston,MA 02116 ALL STAR INSULATION 8 SIDING CO. Edwin Losacano - A 56 Franklin Street \ ._,_�....__ y Easthampton,MA01027 Undersecretary Not valid w , , 1 .. alum The Commonwealth of Massachusetts n a"Y—= Department of Industrial Accidents §= = t Office of Investigations ti c„m=F 600 Washington Street Boston,MA 02111 ""•�e'C 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: Easthamiton, MA 01027 Phone #:..... 413-527-0044 Are you an employer?Check the appropriate box: Type of project(required): 1.121 1 am a employer with 10 4. 0 I am a general contractor and 1 employees(full and/or part time).* have hired the sub-contractors 6. ❑New construction 2.0 tam a sole proprietor or partner- listed on the attached sheet. 7. 9 Remodeling ship and have no employees These sub-contractors have S. 9 Demolition working for me in any capacity. employees and have workers' insurance.] 9- 9 Building addition cora [No workers' comp.insurance p- nquired] 5. 9 We are a corporation and its 1091 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MCL 12.0 Roof repairs insurance required.] c. 152,§1(4),and we have no employees. [No workers' 13,9 Other comp. insurance required.] *Any applicant that checks box 41 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-comractors have employees,trey must provide thG1 workers'comp_policy number. [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. d: WC0661114 Expiration Date: 08/13(16 Job Site Address: 227 North Street City/State/Zip: Northampton, MA 01060 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 M(PL 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. t do hereby cer&f under rhej alas and penalties of perjury that the information provided above is true and correct Signature: — .1001.0 At 4/0 Date: 7 -6' ',S-� Phone N: 41 -527-0044 Official use only. Do not write in this area,to be completed by city or official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone H: