35-020 (6) 120 WEST FARMS RD BP-2017-0172
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-020 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPLACEMENT DOOR BUILDING PERMIT
Permit# BP-2017-0172
Project# JS-2017-000282
Est. Cost: $892.00
Fee_$49.0 3 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALL STAR INSULATION & SIDING CO INC 99739
Lot Size(sq./I.): 67082.40 Owner: MARTINEZ DANIEL R&ELIZABETH.'
Zoning: Applicant: ALL STAR INSULATION & SIDING CO INC
AT: 120 WEST FARMS RD
Applicant Address: Phone: Insurance:
56 Franklin Street (413)527-0044 Workers Compensation
EASTHAMPTONMA01027 ISSUED ON:8/9/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT ENTRY DOOR
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 et 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 8/9/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
R �-
AUG 9 2016 The ommonwealth of Massachusetts
B.: d .f Building Regulations and Standards FOR
-..1 , .•='°'.ocauao,,Ncw LAA..sae usetts State Building Code,780 CMR
MUNICIPALITY
Bui •m: ' '= ation To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
120 West Farms Road, Florence,MA
1.1a 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Daniel Martinez Florence, MA 01062
Name(Print) City.State.ZIP
120 West Farms Road 413-341-3163
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units l Other ❑ Specify:
Brief Description of Proposed Work'-:
INSTALL NEW FRONT ENTRY DOOR
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I.Building $ I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical 5 ❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ --
Suppression) Total All Fees:
Check No. Check Amount Cash Amount:
6.Total Project Cost: $892.00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CSSL -099739 2-14-18
Ed Losacano License Number Expiration Date
Name of CSI I[older
List CSL Fype see below) R
128 Glendale Road _---
No.mid Street — Ta pc Description
Unrestricted(Buildings upin35,lmocu.B.)
Southampton, MA 01073
( pi Fmua Slate.ZIP -- - - - R Restricted 18(2 Family Dwelling
M Mamnre
RC Roofing Covering
WS Windmv and Siding
SP Solid Fuel Burning Appliances
413-527-0044 allstar561@verizon.net 1 Insulation
I elephant; Ii mail address D Demolition
5.2 Registered Home Improvement Contractor CHIC)
All Star Insulation & Sidin9 Co INC 101858 _ 6-29-18
_— IBC Registration Number Expiration Date
k7�o
iiklinu�'lree�Nor I l C Regisimm Name
allstar561@verizon.net
Ns andvreet -- Emailaddress ----
Easthampton, MA 01027 413-527-0044
_—.—
City fawn State.LIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152.§ 25C(6))
Workers Compensation Insurance affidavit must he completed and submined with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes CX No ❑
SECTION 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I.as Owner of the subject property.hereby authorize Ed Losacano _
to act on my behalf irialj move rd\ atie to worka zedbvtiis building permit application.
Daniel Martinez `t—
_..
Print OstnerName(F er ixtTumfimu
k Si
rel nate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering nit name below. I hereby attest under the pains and penalties of perjury, that all of the infonnation
contained in this application is true and accurate to the best of my knowledge and understanding.
Ed Losacano
Print Owner's or Authorized Agent's Na rte(Electronic Signature) 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 Iimnc Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. I422A.Other important information on the HIC Program can be found at
tris w.nrns.gowoca Information on the Construction Supervisor License can he found at ww'w.nnm!aovdps
2. When substantial work is planned,pros ide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross I Wing area(sq.ft.) Habitable room count
Number offireplaces _ _ Number of bedrooms
Number of bathrooms Number of halObaths
Type of heating system Number f 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
=,yam ft Office of Investigations
_'it_ 600 Washington Street
Sill= 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 box: Type of project(required):
I I am a employer with 10 4. ❑ I am a general contractor and I
employees(full and/or part-time).' have hired fie sub-contractors6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P 9. ❑ Building addition
[No workers'comp,insurance comp. insurance
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself, [No workers' comp. right of exemption per MGL 12.5 Roof repairs
insurance required.] c. 152, §1(4),and we have no
employees, [No workers' 13-5 Other
comp. insurance required.]
`Any applicant that checks box G 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 shoving 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.
1 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: 08/13/17
Job Site Address: 120 West Farms Road City/State/Zip: Florence. NA 01062
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 ofa
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
Signature: � � r1A,P6tile.�'J Date: .H 1(0
Phone#: 413-527- 4
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#:
/ ic.„
cs,u
INSULATION •
G - 16 J
SIDING CO., INC. ( b'cn b""e +‘,50 G-Ist)S
EASTHAMPTON OFFICE 413-527-0044 CSL License #CS SL 99739 - • , . .- 1
56 FRANKLIN STREET • EASTHAMPTON, MASSACHUSETTS 01027 • FAX: 413-527-1222
Proposal Submitted to Phone Date
Daniel Martinez "Purchaser"413-341-3163-H July 25,2016 -
Street Job Name
120 West Farms Road MA HIC REG# 101858
City.State and Zip Code Job Location Job Phone
Florence, MA 01062 503-758-9015-C
Contractor hereby submits to Purchaser specifications and estimates for INSTALLATION OF A NEW FRONT ENTRY DOOR
1 We will remoyE..and dispose of existing door unit in designated area
7 We will install (1)Therma-Tru Fiberclassic Smooth Star Door I'nit Model#S256 or#5296 with Adjustable
Threshold in designated aresA homeowner will be responsible for painting or staining the new orime door
3 We will install foam insulation arouncLdoor units installed and seal with Silicone Caulking on interior and
exterior
4 We will reinstall existing wood door casing around interior of door units installed
5 Homeowner will be resnnnsible for any painting or staining of door casing
6 We will install bright brass lock set with dead bolt on new door
7 We will reinstall existing storm door
PRICE$897 00
APPROXIMATE START DATE WILL BE 3-6 WFEKS ONCE WF RECEIVE DEPOSIT AND SIGNED CONTRACT
I ESS ANY INCLEMENT WEATHFR
HOMFOWNER WII I BE RESPONSIBLE FOR ANY SECURITY SYSTEM INSTAL'FD IN DOORS
" HOMEOWNER WII LBE RFSPONSIBI F FOR ANY & Al L FI FCTRICAI OR PLUMBING WORK THAT MAY BE
NEEDED
.. 1 . . P :11 I • e .•11 • 1 L . 1 : : Yt •: dL
R At I FFFS RFC'IIRFD _
• n 1
"A CI PJIFICATE OF iNStIRANCE FOR WORKMAN'S COMPENSATION AND 1 'ABILITY WII L BE FORWARDED
UPON REQUEST
T P DALEY INSURANCE AGFNCY OF WEST SPRINGFIELD MA IS OUR AGENT
WE PROPOSE to furnish material and labor, complete in accordance with above specifications,for the sum of:
$892.00 dollars($ 50% DOWN, BALANCE DUE ), payment due upon receipt of invoice.
If payment late, interest at 11/2% may be added. COMPLETION OF JOB
NOTE:This proposal may be withdrawn by us if not accepted within __— THIRTY _ days.
ED LOSACANO
'- --- -- - - __-- -Contractor Salesman
Daniel.Martinez 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