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32A-091 Contract: Prepare & Skim Coat East living & dining room Sign and return one of these two documents along with a deposit of 1/3 th he cost of labor and materials for the work which you wish Acheson Company to complete.($600.00) Final balance is due upon completion of the specified work. • Material expenses are at cost. All invoices for materials will be given to the homeowner. Invoices will be provided showing all purchases of materials used. Unused materials will be returned or left on the job site. • Any change of work description will be accompanied by a written work order delivered t f-J 1. .n .r..,......:. -within twenty-four 4'.. 1. 44.1. 4i�v.atcd change ' i ld bdd [ rd \i .i l J the tt J owner aY LJItId IVY 6% 1L �d JU hours j �d !A!{+ O.iJ bd �.dd 6l Lt ��: of costs. • The work will be completed within a time determined by mutual agreement between the homeowner and contractor. The project could begin as soon as Monday, August 13, 2012 and be finished within the week. • Acheson Company is fully insured (Worker's Compensation and Liability) and licensed (CS, HIC, and Lead). A copy of our insurances can be sent to the homeowner by the insurance agency. Copies of Acheson Company's HIC, CS, and Lead license can also be provided. Reference phone numbers and home owner's names with pictures from similar projects can also be provided to you upon request. • By signing this you are stating that you understand the estimate you received is just that, an estimation in our professional opinion of what it might cost to complete the work. However it is impossible to know, until we begin, exactly what will be required to complete said job. Acheson Company will endeavor to keep you apprised of any situations that arise that will effect the estimate given. ‘ 31k(11■ n, er : Kysa ygreen & Arin - Dube Date 411111 _ 4/16/12 v C ! i Ache�: I T"a i r an Acheson Date c c li srntki\. \ \N C r-96(c \i\kl ( . 7 ' c f CG) "CF 117 ) 14' cr'9ht R SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : x N ' ENC -) License Number -c Addre Expiration Date Signs - 1110wa _ \, .9:.Registered,Hame lmproddment Co itratthei k 1.z . A ,� . ,. .:4„ % „_.u. Not Applicable ❑ Company Name Registration Number Address Expiration Date 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 buildin rmit. Signed Affidavit Attached Yes No ❑ tt E etnp 1 The_current_exemption for "homeowners” 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 NbtTiampton Ordmances, Sfafe and 1✓ocal= rg awns and State- of-Masssachusetts Laws - Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n I I Or Doors Accessory Bldg. El Demolition ❑ I New Signs [El] Decks [E Siding [O] Other [Oj Brief Description of Proposed A...4 Work: 7 � (2_ 'De . � �- n Alteration of existing bedroom Yes 1 . No Adding new bedroom Yes V No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll - Sheet 6 a ith e* h userarrd_or`addit r n to kistinct housinel,.comaTetethe' fotFointirfq: 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 0ej3 *-, ,VtC L C'k. v 1' as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and curate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. - Print Na Signature of 0 = I - 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 s Lot Size.__ .,. ,. __._,_ _._ _ _ Frontage .„. . _.,,. Setbacks Front f .. Side L R. ,_., ._ ...? L :.__.__j R '..._...._.. _...,., Rear _., ._. .... .._ Building Height _... Bldg. Square Footage % €, Open Space Footage (Lot area minus bldg & paved parking) �aa_ # 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 IF YES, date issued:;; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 '• DONT KNOW 0 YES 0 g IF YES: enter Book ` Page : and /or Document # B. Does the site contain a brook, body of water or wetlands? NO : DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ,Date Issued: C. Do any signs exist on the property? YES 0 NO a IF YES, describe size, type and location: ':? D. are there any proposed changes tto of additions of signs intended - for tfie property ? YES 0 NO t IF YES, describe size, type and location: E. WiII 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 a IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 ~ 5, ' 1 c m'df idr[SC .-r 411f 1 % ,, � � F . rt� City of Northampton 'st ef Building Department r3 , F J�ewaF � s � i . 2 12 Main Street 5 � �fE - ' rte r y .i ` Room 100 A � ¢ - ' � AUG orthampton, MA 01060 T ez �- a �� -- � �t° az E , piiu 41 -587-1240 � 13 587 272 - y "rah i ` Fax 4 1 3 -58 - 1 2 7 2 I�t / Are t �',- t — .L , ,AA 0106G �� .. s.._ N i FfA.o ' . ----- � CATION TO CONSTRUCT. ALTER. REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: 3 3 G(t(�y1 S M ap d Lot ( Uni `00r`.peu 0% 0 60.> Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: 5 t 1 ...-. 5 2 _ C 141 5.1 'N-s'-/ Q��J Telephone Signature 2.2 Authorized Agent: /" 1 ' S. Name (P '. Current Mail Address: -2A9 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 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) / o C) Check Number • / ' This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0183 APPLICANT /CONTACT PERSON R DEAN ACHESON ADDRESS/PHONE 6 NORTH MAIN ST WILLIAMSBURG (413) 268 -0246 PROPERTY LOCATION 3 GRAVES AVE MAP 32A PARCEL 091 003 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out r — —r Fee Paid / ' O 7/ h Typeof Construction: REPLACE 8 X 12 W/ 7 X 12 DECK New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/ Statement or License 83968 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIjMATION PRESENTED: p zApproved 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 Commission _ Permit DPW Storm Water Management Demolition Delay JC Y:7, / �- 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. 3 GRAVES AVE BP- 2013 -0183 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 091 CITY OF NORTHAMPTON Lot: -003 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit # BP- 2013 -0183 Project # JS- 2013- 000301 Est. Cost: $1800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: R DEAN ACHESON 83968 Lot Size(sq. ft.): Owner: NYGREEN KYSA Zoning: URC Applicant: R DEAN ACHESON AT: 3 GRAVES AVE Applicant Address: Phone: Insurance: 6 NORTH MAIN ST (413) 268 -0246 W ILLIAMSBU RGMA01096 ISSUED ON:8/24/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE 8 X 12 W/ 7 X 12 DECK 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 8/24/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner