Loading...
23B-035 (12) I • • glee eo g dea Board of Building Regulations and Standards - ; HOME IMP.R CONTRACTOR ° ° " °t L Re, !182559 ;LEI: iXf 1' �6 /2011 Tr# 281697 T pew ate Corporation FIVE STAR BUILIJi 'G P,1 t 1 KEVIN PERRIER' ` ==fir- 17 EAST STREET EASTHAMPTON, MA 01027 Administrator Massachusetts - Department of Public Safety • Board of Building Regulations And Standards +.. Construction Supervisor- License license: cense: CS 853t9 ` R estricted to: 00 #:, ' KEVIN A PERRIER . 17 EAST ST EASTHAMPTON, MA 01027 Expiration: 1/13!2011 • C'anmiuduner . Tr#: 8377 • The Commonwealth of Massachusetts :7= Department of Industrial Accidents LL eia t Office of Investigations r a =° °+ a 600 Washington Street 1;4 Winililawm • :A Boston, MA 02111 www. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization /Individual): Five Star Building Corp. Address: 17 East Street City /State /Zip: Easthampton.MA 01027 Phone #: 413.587.4060 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. I am a general contractor and I 6. ❑ New construction employees (full and /or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7 ❑ Remodeling ship and have no employees These sub - contractors have 8. © Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.12 Other Rot Repair comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: General Caualty Policy # or Self -ins. Lic. #: CWC082037310 Expiration Date: 5/9/2011 Job Site Address: 61 Locust 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 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 agains the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fo insurance coverage verification. I do hereby certify ' • r he pains and penalties of perjury that the information provided above is true and correct Signature: Kevin Perrier, President Date: of IS 1 I D Phone #: 413. :87 4060 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 #: Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No C) SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT William Trusswell I __ as Owner of the subject property Five Star Building Corp. hereby authorize .. to act on my be . f, in % atters elative to w. .uthorized by this building permit application. Signature ' F ner ' Date Five Star Building Corp. , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and of perjury. Kevin Perrier, P si• - nt Print Name iii, 06/15/2010 Signature of Owner/ • fent Date SECTION 12 - Co ST UCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :. Kevin Perrier CS 85319 License Number 17 East Street, ' asthampton, MA 01027 01/13/2011 Address �� Expiration Date (413) 587 4060 Signature Telephone SECTION 1 - 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 No 0 Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: N/A Not Applicable CI Name (Registrant): N/A Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): N/A Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Five Star Building Corp. Not Applicable ❑ Company Name: Kevin Perrier Responsible In Charge of Construction 17 East Str ;i t, asthampton, MA 01027 Address (413) 587 -4060 Signature 1 Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book Page and /or Document # Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained lj Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: 3x3 sign in front of building D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO C) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations GI Existing Wall Signs ❑ Demolition GI Repairs al Additions ❑ Accessory Building ❑ Exterior Alteration 0 Existing Ground Sign ❑ New Signs El Roofing ❑ Change of Use ❑ Other ❑ Brief Description Rot repair on exterior of building. Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly CI A-1 CI A -2 CI A -3 ❑ 1A ( ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business 0 2A Cl E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ _ Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 El S -2 ❑ 5B L ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Business Proposed Use Group. Business Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 st 1st ' 2 nd 2 nd 3 rd I 3 rd ..... 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system Versionl.7 Commercial Building,Permit May 15, 2000 Department use only '' -- City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 2.010 -...- 212 Main Street SewerlSepticAvailability SUN 3 Room 100 Waler!Well Availability � Northampton, MA 01060 Two Sets of Structural Plans : ' ; phone 413 -5>87 -1240 Fax 413 - 587 -1272 Plot/Site plans Uther Sectfy APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 61 Locust Street, Ste 2 Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Hampshire Associates 61 Locust Street, Northampton, MA Name (Print) 4 Current Mailing Address: (413) 587 -0600 Signature i / Te 2.2 Authorized Agent: Five Star Build; g Corp. 17 East Street, Easthampton, MA Name (Print) ' ' Current Mailing Address: ; G (413) 587 -4060 Signature 1 Telephone SECTION 3 - E' IM • / ED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $23,500.00 (a) Building Permit Fee 2. Electrical $0.00 (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00' Building Permit Fee 4. Mechanical (HVAC) $0.00 5. Fire Protection 6. Total = (1 + 2 + 3 +4+5) $23,500.00 Check Number 1 !� This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -1159 APPLICANT /CONTACT PERSON FIVE STAR BUILDING CORP ADDRESS/PHONE 17 EAST ST EASTHAMPTON (413) 587 -4060 0 PROPERTY LOCATION 61 LOCUST ST MAP 23B PARCEL 035 001 ZONE NB(100)/URB/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �,� /3 �f Fee Paid /T Typeof Construction:_REPAIR EXTERIOR ROT New Construction Non Structural interior renovations Addition to Existin Accessory Structure Building Plans Included: Owner/ Statement or License 085319 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW _Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay V 6 1 2 ; 2 1 o Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. VittVCIAT ST t' BP- 2010 -1159 GIS #: COMMONWEALTH OF MASSACHUSETTS .23B - 035 CITY OF NORTHAMPTON Lot: -001 PERSONS CON IRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1159 Project # JS- 2010- 001694 Est. Cost: $23500.00 Fee: $138.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FIVE STAR BUILDING CORP 085319 Lot Size(sq. ft.): 27007.20 Owner: SPRONG JAY W & WILLIAM TRUSWELL & SAMUEL TOPAL & LORRAINE BELLO Zoning: NB(100)/URB/ Applicant: FIVE STAR BUILDING CORP AT: 61 LOCUST ST Applicant Address: Phone: Insurance: 17 EAST ST (413) 587 -4060 0 WC EASTHAMPTONMAO1027 ISSUED ON:6/23/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR EXTERIOR ROT 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 6/23/2010 0:00:00 $138.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo