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#: