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32C-125 (3) Council on Aging -Home Repair Program INVOICE To City of Northampton I am requesting payment for work performed under contract to this Repair Program at (property address) s-/ /^l�_L{i f' :/ belonging to the homeowner fi rf/_r�' (2.; !6/9' My Total Labor Charge is $ 70°0. 00 . My Total Material Charge is $4,11 200.4.© My Total Invoice to the City of Northampton is $ /1j 02540 • OD I warranty all materials and labor to be free from defects for a one-year period upon completion of the wprk;"'unless an extended warranty is called for in the bid specifications. _ 9/ Signed: 1' " Date: e, L'' ( Contractor Homeowner's Approval I have inspected the completed work and give my approval for payment. Signed: Date: Client Approval of Payment I have inspected the completed repair work at the above address and approve payment to the contractor. Signed: Date: Inspector/Home Repair Program Authorization of Payment I have reviewed the request for payment and authorize payment for both materials and labor. Signed: Date: Executive Director/Council on Aging BID SPECIFICATION Residence: Bruce Gibbs May 10, 2006 34 Fruit Street Northampton, MA 01060 Inspector: Bill LaBombard Office #413-587-1230 Home #413-498-5856 Cell #413-687-7946 REPAIRS //,250.oo Remove existing roofs Furnish &install 1/2 plywood over existing decking Furnish &install alumimum drip edge, pipe flashings and chimney flashings Furnish &installnew lead counter flashings Furnish &install ice &water barrier along eaves and valleys Furnish and install 15 lb. felt Furnish and install 30 year Shingle Furnish and install Cor-A-Vent ridge vent All roofing related debris to be removed All work performed according to manufacturers'specifications All related permits will be obtained Please respond by: /1 J )1-' Authorized Signature: f Company Name: FLOE 2 ci-A� Er-4.ob 1.1 I • `_','- The Commonwealth of Massachusetts u:1 _=' ____ ,6 Depc rtm ent of Industrial Accidents a! _- is sfi sUiaU as 600 Washington Street* Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Buitdin: 'lumbin lectricai Contractors / name: Kevin Perrier/DBA Five Star Remodeling address:1 Loomis Way city Facthamphm sta:e: MA zip: 01027 phone# 413-5271355 work site location(full address): ❑ I am a homeowner performing all work mysc If. Project Type: ❑New Construction['Remodel ❑ I am a sole proprietor and have no one workiig in any capacity. ❑Building Addition VI ani an employer providing workers'compel sation for my employees working on this job. company name: Five Star Remodeling address: 1 Loomis Way city: Easthampton,MA.01027 phone#: 413-527-6355 AIM AWC7012947012005 insurance co. policy# //ai/%/ii//////i/////i// / /%//ii%%////%///////%/iii//%/% i/////i/ % ❑ I am a sole proprietor,general contractor,of homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices' comp_anv name: address: city: Phone#: insurance co. yolic # company name: , address: city: phone#: insurance co. /olic # Failure to secure coverage as required under Section 25A of it IGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties In the form I,f a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of hive tigations of the DIA for coverage verification. I do hereby certify under ins i penalties ofper.Fury that the information provided above is true and correct. Signature Date 9 -� C'l� Print name Kevin Perrier Phone# 413-527-6355 official use only do not write in this area to be complet r,d by city or town official Y: city or town: permit/license# DBullding Department ". ❑Licensing Board ` D check if immediate response Is required ❑Selectmen's Office •1 • DHeaith Department .1 I contact person: phone#; ❑Other f` K-. (revF,ed Sept 2003) wrnees�•Y�m - 1. '�t�.r�. ..�-- .... :sr-k.. "_.. ...y is".. - _i;:, 4 :"y P: ,1,....+-^< '- t.-4---'�;�t� • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Kevin Perrier nttg319 License Number 1-13-07 1 Loomis_Way Fasthamoton,_Ma 01027 Address Expiration Date 413-527-6355 Signature Telephone �,. ,..... _ Applica e Not bl ❑ o 134511 Company Name Registration Number Five Star Remodeling 12-3-07 Address Expiration Date 1 Loomis Way Easthampton,MA 01027 Telephone 413-5276355 SECTION 10-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 artidavr: will result in the denial of the issuance of the building permit. 4 Signed Affidavit Attached Yes D✓ No ❑ 11. =f HOme rOwner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature_ _ 1 ` SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing IS Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Strip existing roof.install new 30 vear roof, —.__,-- Alteration of existing bedroom Yes Ca No Adding new bedroom Yes I ✓I No Attached Narrative i7 Renovating unfinished basement Yes 12 No Plans Attached Roll i• Sheet f? 6a. lf'New.houseand or addition to existing housing,complete the following: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves_ Number of each g. Energy Conservation Compliance. _ Mascheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank _ City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , as Owner of the subject property hereby authorize _ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Kevin Perrier /Five Star Remodeling , 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 penalties of perjury. Kevin Perrier Print Name ti e ��} Signat of R, per/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: 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 I ✓ I DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book _ Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 12 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued:_ C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: _ . . C Northampton | - i � / Building- Dapadrnent | 212 Main Street ewer �y~� RoornlO0 _= Norti mpton, MA 01060 phone 4I3`587'I240 Fax 413'587'1272 • Other �`~=~` ^~, APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to b 'r 1.lProoe,�Addrvvx: mnmm Map �Lot '�. � �� /Vnit ^ ' Northampton, Zone District omst. oimncL_- nem,tri^t SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Bruce w�u�u�aua"m"�wmn,mm mamo(r,m�� Current Mailing Address: 413-584-6809 Telephone Signature 2.2 Authorized/Agent: 778 Pagrharnprnn,ma 01027 Name(Print), Current Mating Address: �,�xrwn� --' — ---- -- -- Signatur Telephone SECT ON -ESTIMATED CONSTRUCTION COSTS Item EsmaLodCost(DoUam)�o�� Official U completed by permit applicant l Building (a) Building Permit Fee $11,250.00 2. Electrical (b) Estimated Total Cos of Construction from (6) 3. Plumbing Building Permit Fee 4. Weohanica| (HVAC) 5. Fire Protec ion Check Number =i/ ~31 Q_'1-5 5 Total =(1 + z + 3 + 4+ 5) p11,250.00 This Section For Official Use Only Building Permit Number: } Date Issued: Signature: �a BuUdnmCommio�on*�|n,»emo of Buildings a BP-2007-0293 GIS#: COMMONWEALTH OF MASSACHUSETTS x ,Md t-Tk 3 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0293 Project# JS-2007-000444 Est. Cost: $11250.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FIVE STAR REMODELING 134511 Lot Size(sq. ft.): 5488.56 Owner: GIBBS BRUCE A&MARGARET L Zoning: URC Applicant: FIVE STAR REMODELING AT: 34 FRUIT ST Applicant Address: Phone: Insurance: P O BOX 778 (413) 527-6355 0 WC EASTHAMPTONMAO1027 ISSUED ON:9/15/2006 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 9/15/2006 0:00:00 $25.004170 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo