32C-210 (5) Board of Building Regulations and Standards
HOME II4JPR, EMENT CONTRACTOR
R is51-111 rtfi 2559
rma
sn�— �6/�011 Tr# 281697
`j'' date Corporation
FIVE STAR SUIL I - /a
KEVIN PERRIER° 1%
17 EAST STREET —'s
EASTHAMPTON.MA 01027 Administrator
•-3,-" Massachusetts-Department of Public Wily
Board of Building Rcgulationti And Stand:_trds ,
Construction Supervisor-License [
i
[JCense: CS 85319
t Restricted to: 00 'f
r,; y
s' KEVIN A PERRIER.
• 17 EAST ST }
'zt EASTKAMPTON,•MA 01027
Expiration: 1l13r2ml
i.. Cyn!misduner Tr#: 8377
21e Comnwnweafth of M=sachrisetfs
Deparottent of Industrid A ccidentv
' Office of Investigations
600 Washington aRreer
Bostot4 MA 02111
www.mass.goPMa
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Anplicant Information Please Print 1A U.
Name(Business/Orgus zationthAividual): Five Star Building Corp.
Addregs. 17 East St
City/$tatelZip: Easthampton,MA.01027 phone#. 413-587-4060
Are you an employer?Check the appropriate lox: Type of protect(reguired):
1. I am a employer with 4. El I am a general contractor and 1 6. New co mstztmcdon
employees(full and(or part-time).* bave ha-od the sub-contractors 7. ❑Remodeling
2.® 1 am a sole pmprietor or partac-r- listed on the attached sbeet
ship and halve no employees T11ese sub-contractors have 8. []Demolition
working for me in any capacity. workers'comp.in===. 9. Building addition
[No workers'comp.insu auce 5. Q We are a corporation and its 10n Electrical repairs or additions
requir l officers have exercised.their
3.❑ 1 am a homeowner doing all worms right of exempWo.per MGL 11.E Plumbing repairs or additions
myself.(No workers'comp. c. 152,§1(4),and we have no 12.(]Roof rep�iirs
insurance required.]t employees [No workers' enovations to the
tamp.insurance me 13. Other Gardner Senior centerequired.] E✓
`Any applicaat that ct=ft twat#1 must also fill out d=%m6aa betow showing tb*wockem'compensation policy inforn>mion
T 1lomeowuem who submit this WF*&*indicating they ace doing all wo&and ties bim outside wnVadon must submit a newafFtAwd indicating suck
tContncxors tined check this bas auustaatad wd,as additional.A*d sbowing the ammo oftha sub-canrrxaares acct their wakes'comp.policy inforroa dom
I am an employer 44 at isprovidoig wwrkersI compensddion iarsaraffm for my emplo'em Below it tttepotiry and job site
informatiom
Insurance Company Name: Associated Employers Insurance Company
policy.#or Self-ins.Lit #; WCC500626401200 Eacitiration Dale: 5/9109
Job Site Address: 47 Holyoke Street CitylStatelZip. Northampton,MA 01060
Attach a copy of the workers'compeassoon policy declaration page(srhawing the policy mmber and expiration date).
Failure to secure coverage as inquired under Section 25A.of MGL c.152 can lead to the imposition of crlmiarW perolties of a
fine up to$1,500:00 antllor one-year iinprisaumedt,as well as civil penalties in the form of a STOP WORK ORDER and a fmnc
of up to$250.00 a day against lire violator. Be advised that a copy of this stadem ut may be forwarded to the Office of
Investigations of the DIA for' coverage venfica#ion.
I do hereby cero arras•the dpenabies of perjury that lire information provided above is tMe and correct
Signature: Dom: May 5,2009
pbG,w#: 413-5874060
QJ)Wal axe only. Do not smite in this area,to he complaed by city or tower official
City or Town: Permwucense h
Ruing Authority(, irje one):
1.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M.
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Kevin Perrier 85319
License Number
17 East Street Eas ham on, MA 01027 01/13/2011
Address Expiration Date
413.587.4060
Signature Telephone
9. Registered-Home Improvement Contractor; Not Applicable ❑
Five Star Building Corp. 162559
Company Name Registration Number
17 East Street sth m ton, MA 01027 03/16/2011
Address Expiration Date
Telephone 413.587.4060
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 affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... El No...... 0
1. -,`flame t)wner,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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) E] Roofing ❑✓
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[E7
Brief Description of Proposed
Work: Roof alteration/improvements Qrl /
j2 ('All j` % ficV,
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
6a. If Newhouse and or addition to existing housina, complete the fallowing:
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. Masscheck 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
1, Sandy Milo as Owner of the subject
property
hereby authorize Five Star Building Corp.
to act o y be alf, in all matters relative to work authorized by this building permit application.
May 2009
Signature of Ov
Or Date
1, 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 d�the pains and penalties of perjury.
Ke i err
7 N �jj
May 5,2009
Sign re Owner/Agent Date
Section 4. ZONING ALI Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
LotSize _._,,... _.......... ..... __..._..........
Frontage _.. _._..: _,..: __.,..... .
Setbacks Front
Side L..,... ....,... R.b._... L _.. R.'....
Rear _. ._.
Building Height
Bldg. Square Footage i
Open Space Footage ..o
° ...........�
(Lot area minus bldg&paved teT____J i
..mr......
arkin )
#of Parking Spaces ... j
Fill:
(volume&Location) 1
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:��
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW Q ' YES . .
IF YES: enter Book i Page ! and/or Document#!
B. Does the site contain a brook, body of water or wetlands? NO 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:w
...._
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 0 NO
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 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
F
Department use only,
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street ewe antic Avaliabilify
Room 100 1Vater/U1Ie0Avalaburty ..
Northampton, MA 01060 Two Sets ofi Strtacfitral Plans
phone 413-587-1240 Fax 413-587-1272 Ptot/Site Plans ,.
ether
APPLICATION TO CONSTRUCT,ALTER, REPAIR,..RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: M AY — In�i�It_!I This section to be completed by office
47 Holyoke Street j Map Lot Unit
Northampton, MA 01060 r S
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sandy Milo 47 Holyoke Street Northampton, MA 01060
Name(Print) Current Mailing Address:
;Lz 413.587.4060
Telephone
Signature rz
2.2 Authorized A t:
Five Star B 'di Corp. 17 East Street Easthampton, MA 01027
Name(Prjnt /1 Current Mailing Address:
President 413.587.4060
Signature Telephone
SECTI 3'-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
$8,000.00
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2+3+4+5) $8,000.00 Check Number J~"
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2009-0938
GIs#: COMMONWEALTH OF MASSACHUSETTS
_ � � f�, Y CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0938
Project# JS-2009-001363
Est. Cost: $8000.00
Fee: $35.00 PE"ISSIONIS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Group: FIVE STAR REMODELING 134511
Lot Size(sq. ft.): 3179.88 Owner: MILO SANDRA J
Zoning.URC(100)/ Applicant: FIVE STAR REMODELING
AT. 47 HOLYOKE ST
Applicant Address: Phone: Insurance:
17 EAST ST (413) 587-4060 () WC
EASTHAMPTONMA01027 ISSUED ON.511112009 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 5/11/2009 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo