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F1W STAR REMODELING
& CONSTRUCTION
1 Loomis Way / P.O. Box 778
Easthampton, MA 01027
Toll Free 1-800-767-6355
Telephone (413) 527-6355
Fax (413) 527-8255
DATE:
ATTENTION: t
FROM:
NUMBER OF PAGES INCLUDING COVER SI-IFFY:
REGARDING: 6"V 4
d 59ZSLZ9£67 Jauaad UTA8)i dLtr:£0 90 £Z JBW
Mar 2,3 06 03:47p Kevin Perrier
4135278255 p.z
FIVE STAR
REWDEMG
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C4NSSTRV MN
P.O.Box 778
EaWa MW%MA 01027
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MAR-06-2006 02 :00 PM COUCH, K�t't—KUN' a
P OPOSAL
11 V11 5 1 AK
REMODELING ;'
CONSTRUCTION >*ET f
P.O.BOX 778 93ATE
Eulwqft,MA 0102? •a�
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT
NrAME -
ADDRESSZ ,
AAmNAMPT-W 14A 100660
DATE OF PLANS
PHONE NO, ARCHITECT p
r3-b95- 3SLS
We hereby propose to furnish the materials ar-perfarrr`the lafior tiede'ssary#or...fie 00171pietion of
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Y....
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All material Is guaranteed to be as specified, and the above work to be performed In accordance with the drawings and specifications
submitted for above work, and completed in a substantial workmanlike manner for the sum of` W& A`'V �1M fits
EA"T.H fdar� �'� Tt'Ipex'Tetii�d — Dollars (S 107, 123.0 0 r_}
with payments to be made as follows: jO% Clem cum"er
Respectfully submitted
Any altarat Idon shova sper0h-suifnp Involving 0mra ows .Lr.,a� }� ����y��.y �.`L will he a cuteen order, and wlfl beoome an extra charge Per �f{/�.nF��CI'{C.�L�.ir AJ,6 over abovll asgreemems contingent upon strikea, ac-
cldo r d Note - This proposal may be withdrawn
by us if not accepted within -50 days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are sattsfectory and are hereby a ted, ou are authorized to.do the work
as specified. Payments will be made as outlined above.
Signature y`
pate ✓ ,3"j�-z Signature
(PA' �
S t
ee.nv MADE IN USA � 4�� � � tie/
The Commonwealth of Massachusetts
Dep6 rtment of Industrial Accidents
600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit:Bluildin umb.;
WSh', in/rElectrical Contractors
name: e JVZ'160—
address:
city zip: 0,10,)7 -phone# 7- ea�
work site location(M address):
❑ I am a homeowner performing all work mysc If. Project Type: ❑New Construction MRemodcl
❑ lamasole proprietor and have no one worki%m' an ca acity. EL-❑J1 Building Addition
n
P
r/m/s/0
I am an employer providing workers' compei sation for my employees working on this job.
Company name: /eLle
address-
city: /star
— phone M S1 -7
insurance co. R01JcV#
O/ /W//,
❑ I am a sole proprietor, general contractor, oi homeowner(circle one) and have hired the contractors listed below who
have the following workers' compensation polices-
companv name:
address:
city• phone H:
insurance co. F/5 oliex
company name:
address:
city: phone#•
insurance co.
Failure to secure coverage as required under Section 25A of D 1GL 152 can lead to the imposition of criminal penalties or a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penpoics In the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be fe rded e Office of InvV tigations of the DIA for coverage verification.
I do hereby certify unde pa' ndpenalties of per Fury that the information provided above is true and correct
Signature Date
Print name Phone 9
official use only do not write in this area to be complet W by city or town official
ffic
tfh..-.# ❑B-Ming Department
r— license# CIBuilding Department
�i y r
city or town._ permitP --00 using�o
OLicensing Board
❑ le.
check if immediate response is required ❑Selectmen's Office
c
❑Health Department
contact person,: phone#; _OOZer
—E]Other_
contact
S�cpI720903)
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Apppliicabl�e�❑G
Name of License Holder:- eU1 d/1 �r�l�� 6 ( /
License Number
�t9C>'1/S
Address �~) f Expiration Date
1 Signatu
re i Telephone
9 Registered Home Improvement Contractor: Not Applicable ❑
z�%��
Company Name / Registration Number
Address / Expiration Date
l Li , `. p �rf
Jt -Telephone
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.......J�r— No...... ❑
11. - Home Owner 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 pen-nit.
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) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[o]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes (--,-<—No Adding new bedroom Yes 0< No
Attached Narrative Renovating unfinished basement Yes 6,-" No
Plans Attached Roll -Sheet
6a. If New house and 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. 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
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
as Owner/Authorized
Agent hereb 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 a;dnalties of perjury.
4 e611 0
Print Name
/f
Signature of Owner/Age Date
Section 4. ZONING All 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
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 �-- DONT KNOW Q YES 0
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 1,,j . DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 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:
E. Will the construction activity disturb(clearing, grading, a avation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
101 Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone,413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
S7- Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1416/l/ `
Name(Print) o Current Mailing Address:
Telephone
Signature �
2.2 Authorized Agent:
Name(Print) / Current Mailing Address:
v 7"�JJ��
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building / '"7 �� (a) Building Permit Fee
2. Electrical / (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 17 Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0968
APPLICANT/CONTACT PERSON FIVE STAR REMODELING
ADDRESS/PHONE P O BOX 778 EASTHAMPTON (413)527-6355 Q
PROPERTY LOCATION 59 NORTH ST
MAP 25C PARCEL 198 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPAIR PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 085319
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 S Commission
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.
NORTH ST BP-2006-0968
GIs#: COMMONWEALTH OF MASSACHUSETTS
Nx. .
z. CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-0968
Project# JS-2006-1444
Est.Cost: $17873.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: FIVE STAR REMODELING 085319
Lot Size(sq. ft.): 5967.72 Owner: DOLLARD ANDY
Zoning URC Applicant: FIVE STAR REMODELING
AT. 59 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 778 (413) 527-6355 ( WC
EASTHAMPTONMA01027 ISSUED ON:312812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR PORCH
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 3/28/2006 0:00:00 $50.003567
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo