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17C-061 (2) FROM : MJ PHONE NO. : 4135671233 Jan. 22 2007 02:17PM P2 Council on Aging Home Repair Program Bid Specification Residence: Theresa Collins 181 Chestnut Suet 584-6326 Inspector: Bill LaBombard Office(413)587-1230 Home(413)498-5856 Cell(413)687-7946 Fax(413)587-1233 Demo/Construction REVISED BID Remove roof rafters,sheathing,windows,framing and concrete blocks. Dispose at appropriate facility Remove paneling on house common wall and replace with vinyl siding of similar house color Install flashings as necessary Install transition trim board between new siding and old siding Concrete pad to remain Fireplace to remain Seal firebox with masonry blocks mr Total Labor Total Materials s LUG. uNtit''sClri� Please respond by ASAP Thank you! Authorized Signature LA n d�� Company Name F1 &S-DOFFS POT►NCLUM CLC- CMtCtA•L WORK May 02� 07 10:54a Town Of Petersham 9787243501 p. 4 The Commonwealth of Massachusetts Department of rm&sfri&Accidents Office of In Vesligations 600 Washington Street Boston,MA 02111 lip www.massgovItfia . .. -Workers' Compensation Applicant Information Please Print Legibly Name(Business/OrganizatioiVliOividtw), Five Star Remodeling Address.- 17 East St City/State/Zip: Easthampton,MA.01027 Phone 413-527-6355 Are you an employee Check the appropriate box: Type of project(re(primd): 1 1 am a employer with_ 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full arid/or pari-time), have hired the sub-cowmaofs 2_0 I am a sole proprietor or partner- listed on the attached sheet# 7, [-]Remodeling ship and have no employees These sub-contractors have 9. ❑Demolition working for me,in any capacity. workers'comp.iasurance- t 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporution and its required_] Electrical repairs or additions quired-1 offiom have exercised their 3-El I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp- c- 152,§I(4),and we have no 12-❑Roof repairs insurance required-] t employees.[No workers' 13,E]Other---- comp.insurance required_]'Any applicant that drclni box 41 must also ED out the stxlian betow showing tbcir workers'compensation policy iaratuixiou. 1'1 lonneowners WIN submit this affidavit indicating they me doing all work and then him outside contractors must wbonitanew affi4avit indicating such. tContnctors that check this box most attached an additio"shed showing the came ofthe sut>cantradan and their workus'comp.policy information. I am an employer that is providing-*wrkffs1 emnpensation insurance for my ewployeex Belgiv is the policy and job site information. Insurance Company Name: AIM Policy#or Sctf-ins.Lic-#1- AIM200771809 Expiration Date: 7-01-07 Job Site Address: S� ej, e— city/statc/zip. E ,MA.01027 Attach a copy of the workers'compensation policy declaration page(showing the policy mimber and expiration date). Failure to secure coverage as roquired 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 fuze 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 COV77crification- 1 do hereby certify under the and ofpe4my that the information provided above is true and correVt sig"aturg.. ___ 7 t� Date. 5-02-07 Phone#: 413-527-6355 - offlaoluse only. W., of wrw;4 this area,to he vompleWdby city or lawn qKwial City or Town: Permit/License 14 Issuing Authority(circle one). 1.Board of Health I Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 4: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Kevin Perrier 85-A1 A License Number 17 East St Easthampton MA 01027 1/13/09 Address Expiration Date 413-527-6355 Signature Telephone 9.Registered Hoge Improvement Contractor: Not Applicable ❑ 134 11 Company Name Registration Number Five Star Remodeling 12/3/07 Address Expiration Date 17 East St Easthampton MA 01027 Telephone 413-527-6355 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....... d 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 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) ❑ Roofing ❑ Or Doors F-1 I i Accessory Bldg. ❑ Demolition 0 New Signs [0] Decks [0 Siding [0] Other[0] Brief Description of Proposed Work: Demo rear porch. Alteration of existing bedroom Yes No No Adding new bedroom Yes No No Attached Narrative Renovating unfinished basement Yes No 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 1 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 I, Kevin Perrier DBA Five Stare 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 Z11 'ALA 5-02-07 Signature of O*ffAgeJf 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 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 0 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 Q DON'T KNOW ® YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES Q 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,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only " pity of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability r� Room 100 WaterMell Availability c W'-'" Northampton, MA 01060 Two Sets of Structural Plans phone 413-.587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APOLICATION 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 181 Chestnut St Map Lot Unit Florence, MA 01062 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Theresa Collins 181 Chestnut St Florence, MA 01062 Name(Print) Current Mailing Address: Signature Telephone 413-584-6326 2.2 Authorized Agent: Five -qtar Re rn n- 17 East St. Easthampton, MA 01027 Name(Print) Current Mailing Address: 413-527-6355 Signature Telephone SECTION 3-ES IMATED IONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $5318.00 (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) 5318.00 Check Number i This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-1117 APPLICANT/CONTACT PERSON FIVE STAR REMODELING ADDRESS/PHONE P O BOX 778 EASTHAMPTON (413)527-6355 Q PROPERTY LOCATION 181 CHESTNUT ST MAP 17C PARCEL 061 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: DEMO REAR PORCH New Construction Non Structural interior renovations Addition to Existing 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 INF90F,9.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 Commis ' n zoo• Signature of uilding 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. 181 CHESTNUT ST BP-2007-1117 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-061 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: BUILDING PERMIT Permit# BP-2007-1117 Project# JS-2007-001781 Est. Cost: $5318.00 Fee: $15.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FIVE STAR REMODELING 085319 Lot Size(sq. ft.): 27704.16 Owner: COLLINS THERESA ELLEN Zoning:URA A_pplicant: FIVE STAR REMODELING Applicant Address: Phone: Insurance: P O BOX 778 (413)527-6355 O WC EASTHAMPTONMA01027 ISSUED ON.511712007 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO REAR 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: R°rbh: Oil: Insulation: Final: Smoke: a final: O j C'7-3 f1-D 7,'�', v THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION t ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy FeeType: Date Aid: Amount: Building 5/17/2007 0:00:00 $15.004711 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo