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.
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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.
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City of Northampton 'st ef
Building Department r3 , F J�ewaF �
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orthampton, MA 01060 T ez �- a �� -- � �t° az E ,
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----- � 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