32C-210 (10)Board of Building Regulations and Standards
HOME II4JpFZOVEMENT CONTRACTOR
R L1-!t1_4t16Md_ 2559
ra 0— 1& 011 TrN 281697
, 311, 101100 Mail; -
M to Corporation
FIVESTARPUIC V_zW___.r1;1
KEVIN PERRIER
A
17EAST STREET
EASTHAMPTON. MA 01027 Adminisirator
I
_&?h. Massachusetts- Department of Public Safety
•Board of Building P
tegulationsAnd Standards
Construction Supervisor- License
Cleanse: CS 85319
Restricted to: 00
ix,
• KEVIN A PERRIER.
17 MT ST
EASTFJWKON,44A.01027
Expiration: 1AU"I
Tr#: 8377
Departitrent of IndustridC
Office CtInvestigations f f
1' f.'f y..
'r
Bostoi4
www.massgopl&a
Name (Business/OrganiaationthAividual): Five Star Building Corp.
Addregs. 17 East St
C11y/$tatelZip: Easthampton, MA. 01027 Phone #. 413-587-4060
Are you an employer? "Check the appropriate lox:
Type of project (reguired):
1. ❑ I am a employer with
4. El I am a general contractor and 1
6. New construction
employees (full and(or part-time).*
bave hu-od the sub -contractors
7. ❑Remodeling
2. ® 1 am a sole proprietor or partzrcr-
listed on the attached sheet
ship and halve no employees
These sub -contractors have
8. [] Demolition
working for me in any capacity.
workers' camp, in===*
9. Building addition
[No workers' comp. insu auce
are
5. Q We aa corporation and its
10n Electrical repairs or additions
requiroJ
officers have cxencisod their
3. ❑ 1 am a horneowner doing all work
right of exemption 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
13.Other Gardner Senior center
tamp. insurance required.]E✓
`Any appticaat atoll ctwodm box lit mud also fill out the %m6aa below showing tb* wockem' comwpeasa6m policy infoun3 ion
T Homeowuem who submil this WY*&* indicating they ace doing all work and thea bice outside wntradon must submit a vewafFtAw d indicating suck
LCotiftlAors that check this bas anustattad wd. yea adthiiooW A*d sbowing the neuro oftha sub-cantrxaares acd their wakes' comp. policy inforroa dom
f am an employer that isprovidorg wwrkersI compmsdion iarsaraffm for my emplo'em Below it Ae potiry and job site
informatiom
Insurance Company Name: Associated Employers Insurance Company
policy. # or Self-jnS Lie #; WCC500626401200
Expiration Date: 5/9/09
Job Site Address: 47 Holyoke Street City/Statd Zip. Northampton, MA 01060
Attach a copy of the workers' compeass0on policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requited under Section 25A.of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500:00 andlor one-year iinprisaumed, as well as civil penalties in the form of a STOP WORK ORDER and a fire
of up to $250.00 a day against the violator. Be advised 8iat a copy of this stadem ut may be forwarded to the Office of
Investigations of the DIA for insurancf coverage verification.
I do hereby certify arida• theyq# fedpmaftn ofperjz y that ilre information provided above is t'rrre and owed
413-587-4060
QJ)Wal use only. Do not write in this ares to he completed by ratty or tow o,,(Jrcial
City or Town:
PearntwUcense h
5, 2009
Luing Authority (Circle orae):
I. Board of Health 2. Building Department 3. CUyiTown ckxk 4. Eieetrical 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
Expiration Date
Address
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
Expiration Date
Address
A 1� 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.
Sioned Affidavit Attached Yes....... El No...... ❑
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
Roof Qrl' %
('All ficV,
Work: alteration/improvements j2 jL %
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 housing, 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 in all matters relative to work authorized by this building permit application.
2beealf,
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
�M_May 5, 2009
SOwner/Agent Date
Section 4. ZONING Al Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
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.
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
Open Space Footage
° o
............. �
(Lot area minus bldg & paved
teT____J
arkin)
# of Parkin Spaces
". .
"`
Fill:
i
(volume & Location)
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.
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR,..RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: M AY— ��(;� This section to be completed by office
47 Holyoke Street j Map Lot Unit
Northampton, MA 01060 1 S
Zone Overlay District
Elm St. District CB District
I SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sandy Milo 47 Holyoke Street Northampton, MA 01060
Name (Print) Current Mailing Address:
413.587.4060
;Lz Telephone
Siqnature
Five Star &4diCorp. 17 East Street Easthampton, MA 01027
Name (Prjnt /� 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 permit 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: I Issued:
Signature
Building Commissioner/Inspector of Buildings Date
GIS #:
Lot: -001
Permit: Building
Category:
BP -2009-0938
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Permit # BP -2009-0938
Project # JS -2009-001363
Est. Cost: $8000.00
Fee: $35.00
Const. Class:
Use Group:
Lot Size(sq. ft.): 3179.88
Zoning. URC(100)/
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
FIVE STAR REMODELING 134511
Owner: MILO SANDRA J
Annlicant: 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.
Underground: Service:
Rough: Rough:
Final: Final:
Gas: Fire Department
Rough: Oil•
Final: Smoke:
Meter:
House #
Driveway Final:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
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