36-253 1 Loomis Way, P.O. Box 778 413-527-6355
Easthampton, MA 01027 'v l p. J 1-800-767-6355
REMODELING
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they
have a dispute with a contractor.The same right is not automatically afforded to the contractor,however.The contractor would have to resolve any
dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor
the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the
contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs
and Business Regulation and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws,chapter 12A.
Homeowner's Signature Contractor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to altemative dispute resolution initiated by the contractor.
The homeowner may'initiate alternative dispute'resolution even where this section is not separately signed by the parties
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e. MGL chapter 93A)
may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not
properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund
provisions or the Home Improvement Contract Law. The contractor is responsible for completing the work as described in a timely and workmanlike
manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or
materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantabil-
ity and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the
terms of the contract as long as they do not restrict a homeowners basic consumer rights.If you have questions about your consumer/homeowner rights,
contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties
are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. Any
modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a
fully executed copy of the contract.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself
to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the
balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said
account would require the signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to
obtain a free copy of"A Consumer Guide to Home improvement Contractor Law,"contact
Consumer Information Hotline
Executive Office of Consumer Affairs
One Ashburton Place,Room 1411,Boston,MA 02108
(617)727-7780
If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration
component of the Home Improvement Contractor Law,contact
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Standards
One Ashburton Place,Room 1301,Boston,MA 02108
(617)727-8598 or(617)727-3200
For assistance with informal mediation or disputes or to register formal complaints against a business,call
Consumer Complaint Division
Office of Attorney General
(617)727-8400
PART 2OF2
I Loomis Way, P.O. Box 778 413-527-6355
Easthampton, MA 01027 V e �'` 1-800-767-6355
ti
REMODELING
This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A).Any person planning home improvements should first obtain
a copy of°A Consumer Guide to the Home Improvement Contractor Law"before agreeing to any work on your residence.The guide will inform you of your rights and respon-
sibilities as well as provide you with important information about what to do if a dispute arises.You may obtain a free copy by calling the Executive Office of Consumer
Affairs'Consumer Information Hotline at 617-727-7780
Homeowner Information Contractor Information
Name Company Name
Five Star Remodeling
Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name
Kevin Perrier
City/Town State Zip Code Business Address(must include a street address)
1 Loomis Way, P.O.Box 778
Daytime Phone Evening Phone City/Town State Zip Code
-Easthampton Mass. 01027
Mailing Address(if different from above) Business Phone Federal Employer ID or S.S.Number
1-413-527-6355 75-3034389
Law regavm that as home Home improvement Contractor Reg.Number Expiration Date
rwt
h ive a v"Ord registration 134511 12-3-05
rxrve
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to be completed,specifying the type,brand,and grade of materials to be used.) ,..
Q Check this box if additional pages are used for this section
Required Permits-The following permits are required and vmll be secured by the contractor as Proposed Start and Completion Schedule-The following schedule will be adhered to unless circumstances beyond
the homeowner's agent.Owners who secure their own permits will be excluded from the the contractor's control arise.These dates are approximate start and finish dates.
Guaranty Fund provisions of MGL chapter 142A_
—Date when contractor will begin contracted work
—Date when contracted work will be substantially completed
Total Contract Price and Payment Schedule
The contractor agrees to perform the work,furnished the material and labor specified above for the total sum'of:$
Payments will be made according to the following schedule:
$ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater).;-
$ by / / or upon completion of
$ by—�—J or upon completion of
$ upon completion of the contract.(Law forbids demanding final payment until contract is completed to both party's satisfaction).
The fallowing material/equipment must be special $ to be paid for
ordered before the contracted work begins in order to
meet the completion schedule: $ to be paid for
Homeowner is responsible for all collection and reasonable attorney fees if payment is not received at time of completion.
Express Warranty-Is an express warranty being provided by the contractor? O No Q Yes (all terms of the warranty must be attached to the contract)
Sub contractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the
contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement.
Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or
other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract.
• Don't be pressured into signing the contract.Take time to read and fully understand it,Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires all home improvement contractors and sub contractors to be registered with
the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the director at One Ashburton Place,Room 1301,Boston,
MA 02108 or by calling 617-727-8598 or 617-727-3200.
• Does the contractor have Insurance?While it is not required by law,it is a good idea and an additional protection.
• Know your rights and responsibilities.Read the important information on the reverse side of this form and get a copy of the Consumer Guide
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office
or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached
notice of cancellation form for an explanation of this right_
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
Two identical copies of he contract must be signed.The white copy goes to the homeowner.The yellow copy should be kept by the contractor.
Homeowner's Signature Date Contractor's Signature Date
PART 1 OF 2
The Commonwealth of Massachusetts
r2i Dept:Hment of Industrial Accidents
600 Washington Street
Boston,Mass. 02111
Workers Com ensation Insurance Affidavit:Buildin umbin Electrical Contractors
V
g
name: Kevin Perrier I DBA Five Star Remodeling
address:1 Loomis Way
city St8:e: MA Zip: 01027 phone# 413-527-6355
work site location(full address)
❑ I am a homeowner performing all work mysc If. Project Type: ❑New Construction❑Remodel
❑ I am a sole etor and have no one worki in a,%capacity,/
11 :1,10 -1 E,/1,&U`dd",/M
//%//%%/%/%%%%/I 1p,
I am an employer providing workers'compel cation for my employees working on this job.
company name: Five Star Remodeling
address: 1 Loomis Way
citv: Easthampton,MA.01027 phone#• 413527-6355
insurance co. AIM policy# AWC7012947012005
❑ 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;
company name:
address:
city phone#•
insurance co. lie #
company name:
address:
city: phone#:
insurance co. --Policy#
ORDER and
IT
I
T
Failure to secure coverage as required under Section 25A of DI one years'imprisonment as well as civil penalties In the form of.Slop WO K
lk tote of$100.00 a day against me I understand that n
t. ti
.o
copy of this statement may be forwar,4ed to the Office of Inve: ga f ZDIA for coverage veriflcarioa
117
1 do hereby certify yrth e ns and penalties ofper,uyy that the information provided above is true and correct.
signature -Date
n
Print name Phone# 413-527-6355
official tot only do not write in this area to be cgmplel ed by city or town official
city or town:
permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response Is required
❑Selectinen's Office
T []Health Department
F phone#,
, contact person: Other
(reViscd Sept 2003)
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Namg o(_License Holder:---Kevin Perrier na5,41Q
License Number
1-13-07
1 Loomis Way.Easthamptnn Ma 01!)97 -----
Address Expiration Date
413-527-0355
Signature Telephone
9Re friStere�'Nomeir'rtnrovement Contractor•,,,,{1a . �u. �_,,, ,. ,_,., , w. . ., ,.,, Not Applicable ❑
434T
Company Name Registration Number
Five Star Remodeling 12-3-07
Address Expiration Date
1 Loomis Way Easthampton,MA 01027
Telephone 413527-0355
i
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....... 1�✓ No_.._ ❑
11. Nome Owner Exemption
"1 he 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 persons)
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 11 Replacement Windows Alteration(s) ❑ Roofing Fe/
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Deck ] Siding[ ] Other [ ]
Brief Description of Proposed Work: Strip existing roof.install year roof.
Alteration of existing bedroom Yes E2:1 No Adding new bedroom Yes _r-V� No
Attached Narrative J Renovating unfinished basement Yes 0 No
Plans Attached Roll -.7• Sheet D
6a. lf'New house aril or addition to existing housing complete the following:
1
a. Use of building:One Family _ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
i 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
I
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 .
L 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
l �-:ereby authorize _
___ _ to act or
^ly 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_
f Signed under the pains and p alties of perjury.
Kevin Perrier /
Print Name f
-/a
Signature of Own /Agen 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
arkine)
#of Parkins;Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Ei DON'T KNOW YES
IF YES, date issued:
s
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
I
B. Does the site contain a brook, body of water or wetlands? NO 0✓ 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: _
City of Northampton Sta'tfts of'Perm n �` !'
Building Department Gur�b Cuff DDr ve`
212 Main Street Se -er, epti'cAVaia t
Room 100 Water/WeiiAi r[. . �
Northampton, MA 01060 Twa sets o#St c r
hone 413-587-1240 Fax 413-587-1272 plot/ t_- Plans
OtherSpecify
----. .
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
Lot Unit
43 Maple Ride Rd. p
iFlorence,MA.01062 Zone Overlay District
Elm St.District__ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
12.1 Owner of Record:
I
Micheal Posner 43 Ma le Ri a Rd.Florene Ma 01069 __
"Jame(Print) Current Mailing Address:
586-7224
— ----------_ --------__-- Telephone
Signature
2.2 Authorized Agent:
1
_FIY9.Staf-RemodLing.___ _.—__ __— PORor.778 Fac}hamptf n'_ryan1n97
Name(Print) Current Maiiing Address:
413527-6355
Signature— Telephone '
SECTION -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
I__ com leted b permit applicant
1. Building (a) Building Permit Fee
$8,800.00
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Ph:mbing Building Permit Fee
4. Mechanical (HVAC)
} 15. Fire Protection
I 6. Total =(1 + 2 + 3+4 + 5) $s,aoo.00 Check Number
f This Section For Official Use Only
Building'Permit Number: Date Issued: _ _
Signature:
Building Commissioner/Inspector of Buildings Date
43 MAPLE RIDGE RD BP-2007-0404
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-253 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-2007-0404
Project# JS-2007-000592
Est. Cost: $8800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: FIVE STAR REMODELING 134511
Lot Size(sq. ft.): 128502.00 Owner: OWEN CAROL L&MICHAEL K POSNE
Zoning: SR Applicant: FIVE STAR REMODELING
AT: 43 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
P O BOX 778 (413) 527-6355 () WC
EASTHAMPTONMA01027 ISSUED ON.1011012006 0:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & S I N G L E 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 10/10/2006 0:00:00 $25.004223
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo