23D-194 01111111111317 BP-2008-0459
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CON IRACT1NG WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0459
Project# JS-2008-000670
Est. Cost:$21680.00
Fee: $108.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: FIVE STAR REMODELING 085319
Lot Size(sq.ft.): 156816.00 Owner: BIRCH HILL LLC
Zoning:URB Applicant: FIVE STAR REMODELING
AT: 70 RIVERSIDE DR
Applicant Address: Phone: Insurance:
P O BOX 778 (413) 527-6355 () WC
EASTHAMPTONMA01027 ISSUED ON:10/29/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:SHINGLE ROOF & CREATE NEW SLOPE
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 10/29/2007 0:00:00 $108.005233/5216
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
•
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well 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 iJ l5 S ''
1.1 Property Address: r j� r -�"? This section to be completed by office
70 Riverside Drive OCT 5 2007; MaPi- Lot Unit
Northampton, MA 01062 z ne Overlay District
DEPT Of fi0llDik 1P/SP
NO f,;; • ECTION
70f4,Am 01060 Elm St. istrict CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Birch Hill LLC. 2036 Roaring Brook Road Conway, MA 01341
Name(Print) Current Mailing Address:
413-369-4972
Telephone
Signature
2.2 Authorized Agent:
Five Star Remodeling & Co truction 17 East St. Easthampton, MA 01027
Name(Print) Current Mailing Address:
413-527-6355
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee -
$21,680.00
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 3.
6. Total=(1 +2+3+4+5) $21,680.00 Check Number 5o7) &,
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 F
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 Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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 0
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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑✓
Or Doors El
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [El Siding[O] Other[0]
.gBr „
Work:Description of Proposed New roof, over existing. Create new slope to redirect run-off.
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
sa. 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
, 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
1, Kevin Perrier DBA Five Stare Remodeling & Construction ,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
10/11/07
Signature of Owner/,rent/ Date
SECTION'8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Kevin Perrier 85319
License Number
17 East St asthampton, MA 01027 1/13/09
Address Expiration Date
413-527-6355
Signature Telephone
[Registered Home Improvement Contractor: ___^___ Not Applicable 0
134511
Company Name Registration Number
Five Star Remodeling& Construction 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 Q No 0
I11.. — Home Owner Exemption1
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
17 East Street 413-527-6355
Easthampton, MA 01027 ti v e V g 7....., 1-800-767-6355
Ili,‘,)it,c,*,4r, A4„.
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 a Company Name
l 1 I M, H (.� !- Five Star Remodeling
Street Address do not use a Post Office Box address) Contractor I Salesperson/Owner Name
0 fey RO R f f,_3 to i°; s t:,. h7(3 A i) Kevin Perrier
City I Town State Z Code Business Address(must include a street address)
COO1,tJA V t�`iPi • v?lig 17 East Street
Daytime Phone Evening Phone City/Town State Tip Code
j - ,::).. - 3 93 illG-• 6?—44 9172. Easthampton Mass. 01027
Mailing Address(if different from above) Business Phone - Federal_Employer ID or S.S.Number
65 5)j E 1-413-527-6355 ` 7513034389
C,>/=j j ( 7 1 O f} -P RI() taw requires that contractors home
improvement cont Home Improvement Contractor Reg.Number - Expiration Date
f
NIP `(,' {. _,1_1I A'. C?.r 0(f)P have a valid regisuauon 134511 12 3 07
The Contractor agrees to do the following work for the Homeowner: 17-',0oF ovER a -isT I OG As f-taLTt I A-) v AfAT
(Describe in detail the work to be completed,specifying the type,brand,and grade of materials to be used.) /= ,3 uE .TQ. 5/7E sc{/eL Pt,L,.U) I OST ALi O /
A C,.t-1 IT CTLfizt pi'tkjf.T:1-1,t.OGLE• FR • I1E- O+.)E.:? e..c.t Tfp.l(, FIAT-ROOFS CT/.)6(\R 'i : 191()fia RE-d'f .l-5ter
L PE To E•D i ze T wirNise Pt;1 it) O t-i-. . A tJ 4,,I ST i kk q'�'14i 1=.-3 i).1 PLACE,E,• M t^1t-?C)(-0 f ": 'K.',C1 a1.:.2 LIP
t 2:l 0/J 1D'( .)y t..LS . i'RiC TO (i) t-t..t. +E t "t'E (1^l I. ac3, 12. -owe NOCE. LICapjf.0- ?Ept)itT'`acts etasS(7i~
CL A0.--tit P.
❑Check this box if additional pages are used for this section
Required Permits-The following permits are required and will 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 contractors control arise.These dates are approximate start and finish dates.
Guaranty Fund provisions of MGL chapter 142A.
/r i.F;C-L AC'c:/-3 "07 Date when contractor will begin contracted work.„.," ,.)71Iti .6,1.17 l"f pq-,-.)
But I Nm-, TE 2 t-i IT p cc�t:.�;7ff
PI), ,'., O.7/'� tO".its- Date when contracted work will be substantially completed ,, ej/tj f •/-N„fa
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:$ i./.6 FO.(D C
Payments will be made according to the following schedule:
cc"'• /:(.. - upon signing contract(not to exceed 1/3 of the total contract price D[the cost of special order items,whichever is greater').
S '- i"1P7c9 . 00 by I / or upon completion of /CAT 4 "TART r it j/ / )f` /t 7 1 T ti/14,E, Arc Olt-
s #a0Q •°C) by / / or upon completion of HAM:WA Y THFOZ i W S TE T
S 4/600 • a 0 upon completion of the contract.(Law forbids demanding final payment until contract is completed to both party's satisfaction).
The following material/equipment must be special $ '' to be paid for c'
ordered before the contracted work begins in order to
meet the completion schedule': ..S _ . _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?CI No Oy4'es (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 iniwriting 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 SPACES!!!
Two identical copies of the contract must be signed.The white copy goes to the homeowner.The yellow copy should be kept by the contractor.
{''J�j)` N g} �ps.� Fes, �+p /j}p' {/y pt/��' J `('�f j( //��/''J'�
tt (�3iA t✓ it IJ ^@. — �./i ...0 ,/ l/S'IIt FnL/ I ~ f -1! I
tYita +
H�rnleowner g Signature Date Contractor's Signature Dale
PART 1 OF 2
17 East Street 413-527-6355
Easthampton, MA 01027 'v e V 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 Rat 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.
Hojneowner's Signature Contractor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.
The,homeowner may:initiate alterj1ativg dispute_resotutio4 evert,Vlwlere this section is riot separatellysigneCl 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 crpy of-"A-Consumer Gwue'tto Horie-iriiproverrcen#:,entraeto`r 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
PART2OF2
The Commonwealth of Massachusetts
; Department of Industrial Accidents
Nth Office of Investigations_ 600 Washington Street
v.-1.6=r ji Boston,MA 02111
www.nuassgov/d1a
...._..Woxkexs'CoxupenslltionInsu rl�.cise dawit(xin tt l.CSlt taaetors/Electracians/Plt tubers __... ..Applicant Information .. - PIease Print Legibly
Name(BusinesslOrganizationllndividual): Five Star Remodeling
Address: 17 East St
City/State/Zip: Easthampton,MA.01027 . Phone#: 413-527-6355 •
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑I am a general contractor and I 6. []New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its 10_0Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.O-Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.[]✓ Roof repairs
insurance required.]t employees.[No workers' 13.0 ether
comp.insurance required.]
sAny applicant that chectcs box tEl must also fill out the section below showing dick wasters'compensation policy information
t Homeowners who submit this affidavit indicating they am doing all work and then him outside contractors must submitanew affidavit indicating such.
*Contractors that check this box mustattarhed au additional sheet showing the name ofthe sub-contractoss and their wodions'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Associated Employers Insurance Company
Policy#or Self ins.Lic.#: WCC500626401200 Expiration Date: 5-9-08
Job Site Address: 70 Riverside Drive City/State/Zip:Northampton,MA 01062
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required 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 fine
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 verage verification:
I do hereby certify under e p penalties ofperjury that the information provided above is true and correct
Signature: Date: 10/11/07
phone#: 413-527-6355
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ,
6.Other
Contact Person: Phone#:
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Board of Su�c�ing�eg'°�'n�n''nn tan ar��
( g` construction Supervisor License
License CS 85319
�' Birthdate 1/13/1982
Expiration 1/13/2009`• Tr#''9125:
Restriction 00
Ai t7
KEVIN A"PERRIERF _ >
FO BOX;778
EASTHAMPTON MA 01027 Commi•ssioner.
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Bo 4i�o uut in egII an ti ini xS 1�iW :fi:
*_— o,. HOME IMPROVEMENT CONTRACTOR
7Eriie� Registration 134511.
E Expiration 12/3/2007
Type DMA .
{
FIVE S7AR REMODELING i �.:
KEVIN"PERRIER
1LomisWay -n,
EASTHAMPTON,MA 01027'` �i0ninisfrat�r
•