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30a-035 (4) 327 RIVERSIDE DR BP-2017-0708 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-035 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-2017-0708 Project# JS-2017-001167 Est.Cost: $8321.00 Fee:$80.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALL STAR INSULATION & SIDING CO INC 99739 Lot Size(sq. ft.): 2787.84 Owner: DAVOLOS STEPHANIE Zoning:URB(100)! Applicant: ALL STAR INSULATION & SIDING CO INC AT: 327 RIVERSIDE DR Applicant Address: Phone: Insurance: 56 Franklin Street (413) 527-0044 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:11/22/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE 1 LAYER OF ASPHALT SHINGLES & INSTALL NEW ROOF, REMOVE EXISTING SKYLIGHTS & INSTALL NEW SKYLIGHTS 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 11/22/2016 0:00:00 $80.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 6,3s i i cy, The Commonwealth of Massachusetts ,i::rto Board of Building Regulations and Standards FOR MUNICIPALITY> Massachusetts State Building Code,780 CMR USE Lii N ?: Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 0 I; One-or Two-Family Dwelling Lij CC Z e This Section For Official Use Only Failcil 'ng Permit Number:V—/7• _ a to ' ., .-I: i pz. //—a Building Official(Print Name) /ee--/ �/ Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 327 Riverside Drive, Florence, MA I.la 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 0 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: Stephanie Davolos Florence, MA 01062 Name(Print) City,State,ZIP 327 Riverside Drive 978-866-2392 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units _ Other 0 Specify: Brief Description of Proposed Work': REMOVE 1 LAYER OF ASPHALT SHINGLES AND INSTALL NEW ROOF, REMOVE 2 EXISTING SKYLIGHTS INSTALL 2 NFW SKYLIGHTS SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ - ❑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 $ Suppression Total All Fees:S CO") Check No.`'jL/ heck Amount: U Cash Amount: 6.Total Project Cost: S 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('SI I(older List CSL Type(see below) 128 Glendale Road No.and Street T}'pe Description Southampton, MA 01073 U Unrestricted(Buildings up to 35.000 cu.ft.) R Restricted I&2 Family Dwelling City/Town.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SI Solid Fuel Burning Appliances 413-527-0044 allstar5270044@gmail.com Insulation Telephone t:mail address l) Demolition 5.2 Registered Home Improvement Contractor(HIC) 101858 6-29-18 All Star Insulation & Siding Co., INC. 1110 Registration Number Expiration Date WC?aatr.Name or l J('Registrant Name allstar5270044@gmail.com N and Street Email address Easthampton, MA 01027 413-527-0044 City/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 13 No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BL:ILDING PERMIT I,as Owner of the subject property,hereby authorize Ed Losacano to act on my behalf,in all nta;,rs r 1. ive to work thoriz' by this building permit application. Stephanie Davol• � � r� l�/ to Oo Print nes s Name(Electronic aturel " ' A AL Date SECTION 7b:OWNER' S R AUTHORIZED AGENT DECLARATION By entering my name below.I hereby attest uncle', he pains and penalties of perjury that all of the information contained in this application i to •nd accurat ; the best of my knowledge and understanding. Ed Losacano 1 /•-- /g—/ t Print O r1er's or Authorized Agent's Nan - •h, tmnie 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. I42A.Other important information on the HIC Program can be found at ww‘v.ntass.gov'oca Information on the Construction Supervisor License can be found at wv .mass.gov 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" • INSULATION SIDING CO., NC. EASTHAMPTON OFFICE 413-527-0044 CSL License #CS SL 99739 WESTFIELD OFFICE 413-568-6411 56 FRANKLIN STREET • EASTHAMPTON, MASSACHUSETTS 01027 • FAX: 413-527-1222 Proposal Submitted to Phone Date Stephanie Davolos "Purchaser" 978-866-2392-C November 4, 2016 Street Job Name 327 Riverside Drive MA HIC REG#101858 City,State and Zip Code Job Location Job Phone Florence, MA 01062 Contractor hereby submits to Purchaser specifications and estimates for: INSTALLATION OF A NEW ROOF AND NEW SKYLIGHTS 1. We will remove (1) layer of existing asphalt shingles and dispose of in a dumpster supplied by us. l - *1 . .§. 11 :1 1• 9- . • -•1-1 . 1 1•- - u-1 • - -1 - '••-• •• U . - 3. We will install new Gaf/Elk Timberline Architect shingles. They will have a"Manufacturer's Lifetime Limited Warranty". Color will be black. 4.All shingles will be nailed with at least(5) nails per shingle 1 A •I • 1 a • 11 1 11 • • •• •I •. - - -1• 1- , • 11.1 .11 -.- -••- •1 -- ► - install pipe boots and metal step flashing where needed. 6 We will install approximately (22)'of roll vent on peak of roof for additional ventilation. 7. We will install a 36"wide asphalt ice and water barrier on eave lines/valleys of heated areas. 8 We will remove(2)existing skylights and dispose of. 9. We will install (2) new thermal VELUX Model-08 operational skylights with new flashing kits. PRICF$8 321.00 ** IF ANY SUB SHFATHING IS NFFDFD THFRF Wit I BF AN ADDITIONAL CHARGF OF $38 PFR SHFFT TO RFMOVF DISPOSE OF AND INSTAI L NFW 7/16 STRAND BOARD SUB SHEATHING **APPROXIMATE START DATE WILLDEDECEMBER/JANUARY ONCE WE RECEIVE DEPOSIT AND SIGNFD CONTRACT LFSS ANY INCLFMFNT WFATHFR **ALL STAR W111 SFCURF BUIL DING PFRMIT IF NFFDFD HOMFOWNFR WII I BF RFSPONSIBLF FOR ANY &ALL FFFS RFQUIRFD. ** HOMFQWNFR WILL BF RFSPONSIBI F FOR ANY &All FLFCTRICAL OR Pt UMBING WORK ** NO PRODUCT&LABOR WARRANTIES WILL BE ISSUED UNTIL WF RECEIVE FINAL PAYMENT. ** HOMFOWNF.g WtI I.BF RFSPONSIBLE FOR COVFRING ANY STORED ITEMS AND FOR ANY Cl EANUP WORK IN THE ATTIC NFFDFD FROM DUST&DFBRIS FROM ROOF RFMOVAL **A CFRTIFICATF OF INSURANCE FOR WORKMAN'S COMPFNSATION AND LIABII ITY WILL BF FORWARDED UPON REQUEST T P DALFY INSURANCE AGFNCY OF WFST SPRINGFIFLD. MA IS OUR AGENT 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. Address of the work: 327 Riverside Drive, Florence, MA 01062 The debris will be transported by: Complete Disposal The debris will be received by: Holyoke Transfer Station Building permit number: Name of Permit Applicant Ed Losacano Date Signature of Permit Applicant Client#: 13250 ALLST ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/27/2016 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 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 CONTACT Jane Eitel T.P.Daley Insurance Agency, Inc PHO N, Ext):413 788-0971 FAX No),413 739-2.645 1381 Westfield St. E-MAIL laneeiteli@tpdaleyinsurance.com P.O.Box 1150 INSURER(S)AFFORDING COVERAGE NAIC# West Springfield, MA 01090 INSURER A:Peerless Insurance INSURED INSURER B:Star Insurance Company All Star Insulation &Siding Co.,Inc. INSURER C: 56 Franklin Street INSURER D: Easthampton, MA 01027 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 CONTRACT OR 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 ADDL SUB R� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD I POLICY NUMBER (MMIDD/YYYY) (MMIDOIYYYY) [NITS A GENERAL LIABILITY CBP8052996 08/13/2015 08/13/2017 EEAACCMHHp�OO,C7COURRRENCE $1,000,000 X CCMMERCI.AL GENERAL LIABILITY PREMISES(Ee occurrrrence) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY Tcof LOC $ A AUTOMOBILE UABILITY BA8054496 08/1312016 08113120171 CEaOMacdBINEDdent)SINGLE LIMIT ( — ANY AUTO BODILY INJURY(Per person) $100,000 ALL AUTOS OWNED X SCHEDULED BODILY INJURY(Per accident) $300,000 _ X HIRED AUTOS X AANOTNaNNED PPRerOPPEentDAMAGE) $100,000 _ $ UMBRELLA UAB i OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC0681114 08/13/2016 08/13/2017 X IT STATU- I 0TH- AND EMPLOYERS'UABILnY YIN TORY I IMITS 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $100,000 OFFICERlMEMBER EXCLUDED" N N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S100,000 If yes. Oe under E.L.DISEASE-POUCY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) GENERAL CERTIFICATE CERTIFICATE HOLDER CANCELLATION All Star Insulation &Siding CO. 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 POUCY PROVISIONS. Easthampton, MA 01027 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #5131574/M123220 JXE Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CSSL-099739 Construction Supervisor Specialty EDWIN W.LOSAcANO • 128 GLENDALE ROAD N SOUTHAMPTON MA 01073 0 pa N txprration: V).a Commissioner 02/14/2018 • GTr ti • C-'l e Wommtoznweala o a/ealdad ' . 't'fiei + . 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: 6/29/2018 Tr# 419291 ALL STAR INSULATION & SIDING CO. Edwin Losacano 56 Franklin Street Easthampton, MA 01027 Update Address and return card.Mark reason for change. 0 Address Il Renewal ❑ Employment ❑ Lost Card SCA 1 C) 20M-0'i/11 rrk. / r111 mom/Pea/1i r/(7'/(r,JJar t,,jcr/J Office of Consumer Affairs&Business Regulation License or registration valid for individual use only r-r— before the ex iration date. If found return to: CO_:74ME:P HOME IMPROVEMENT CONTRACTOR P '�'terr= Registration: 101858 Type: Office of Consumer Affairs and Business Regulation ""��" 10 Park Plaza-Suite 5170 `.';; Expiration: 1/29/2018 Private Corporation Boston,MA 02116 ALL STAR INSULATION&SIDING CO. Edwin Losacano 56 Franklin Street _2/..4tALN, M / Easthampton, MA 01027 Undersecretary Not valid with s ature The Commonwealth of Massachusetts Department of Industrial Accidents lr--it Office of Investigations :;- ,,j= 600 Washington Street • WI / Boston, MA 02111 "44 %NI 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): 1.1 I am a employer with 10 4- 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 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 working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition 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 11.111 Plumbing repairs or additions myself. [No workers' right of exemption per MGL Ycomp. 12.0 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#I must also fill out the section below showing their workers'compensation policy information. I.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. lithe 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. Lic.#: WC0681114 Expiration Date: 08/13/17 327 Riverside Drive Florence, MA 01062 Job Site Address: 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 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. Signature: C%`„-door ' s Date: Phone#: 413-527-0044 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#: