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31B-310 Appleton CORPORATION Asset & Property lianagenient Services December 6, 2012 Mr. Louis Hasbrouck 57 Suffolk Street Building Commissioner Suite 200 City of Northampton Holyoke, MA 01040 212 Main Street (413) 536-8048 Northampton, MA olo6o FAX (413) 534.8344 Re: Michael's House, replacement of acoustic ceiling tiles in public area Dear Mr. Hasbrouck, I request that you grant a modification to waive the requirement for control construction for the acoustical ceiling replacement project at Michael's House, 71 State Street in Northampton, because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. I have provided a stamped letter from Tom Douglas of Thomas Douglas Architects in support of this request. Thank you for your consideration. Best Regar Flink Regional Facilities Manager € CIF. . , A NI holly-onned subsidiary of ME O'CONNELL wmappletoncorp.net COMPANIES fi THOMAS D II OUGLAS - Architects, inc. Louis Hasbrouck Building Commissioner City of Northampton . ' 212 Main Street Northampton, MA 01060 12/05/12 RE: Michael's House, replacement of acoustic ceiling tiles in public areas Dear Mr. Hasbrouck . I am writing to kindly request that you grant a modification to waive the requirement for control construction' for the above referenced project at Michael's House, 71 State Street in Northampton for Appleton Corporation who has prepared the project scope of work. I have toured the project with the project manager and believe the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work Please except this stamped letter as consent that we allow for Appleton Corporation of Holyoke MA to oversee the construction and implementation of this project. Thank you for your consideration. Respectfully ( 47 44 " DO v)lkS f. ....44N f 1;4 O q eN * TV : , it:' " *s l . '' i t # 1 ;e§: C \\ 1 Tom Douglas • n .; t : t c :, A1 4.1 1 r i Thomas Douglas Architects 2 . ' `' ' ,, { 196 Pleasant Street ' ;-��`'� � � "' r ,t Northampton, MA 01060 4.:,, 4 ' 1 4 ,f. f. .`;. ti a' ,•• y.:;7 ;„ py • 1$6 Pleasant Sum, Northampton. MA 01060 1 413.S8S.OS412 1 tdouglaurchilecu.cam PROPERTY SERVICES AGREEMENT This Agreement is made this 19th day of December , 2012 by Rocky's Acoustics Company , (the "Contractor ") with an address of 70 Martone Place Springfield, MA 01109 and Appleton Corporation (the "Agent "), with an address of 57 Suffolk Street Suite 200 Holyoke, MA 01040. • WITNESSETH: WHEREAS, Appleton Corporation is duly authorized by The O'Connell Companies (the "Owner ") to enter into on the Owner's behalf various agreements with outside contractors for the purposes of servicing, repairing and/or maintaining the development known as Michael's House Apartments , located at 71 State Street Northampton, MA (the "Property"). WHEREAS, Appleton Corporation seeks to engage the services of Contractor for the purposes hereinafter described. NOW, THEREFORE, in consideration of the promises contained herein and the exchange of other good and valuable consideration, receipt of which is hereby acknowledged, the parties hereby agree as follows: 1. SCOPE OF WORK The Contractor shall provide services generally described as acoustical ceiling replacement , but defined more specifically and completely in the Rocky's proposal dated March 15, 2012, a copy of which is attached hereto as Exhibit "A 2. COMPENSATION The cost of the work shall be as described in the proposal as $13,945.00 Subject to Agent's and Owner's acceptance of the work, said payment shall be due within thirty (30) days upon receipt of invoice. The Contractor /Vendor /Service Provider agrees, in the performance of this agreement, to comply with all federal, state, municipal, and local laws, ordinances, codes, and governing regulations, including obtaining the proper permits to perform the work; to pay all costs and expenses thereby; to pay all fees and taxes, including sales and use taxes, (unless the work is exempt by Law from Sales Tax), and all payroll taxes and any other taxes imposed by any federal, state, or Local law for employment insurance; pensions; old age benefits; union benefits; or for such comparable purpose. NON- RESIDENT CONTRACTORS /VENDORS /SERVICE PROVIDERS shall obtain a certificate in duplicate from the Massachusetts Commissioner of Corporations and Taxation indicating that the requirements of M.G.L.A. Chapter 64h, Section 30A, and Chapter 641, Section 31A have been met. The Owner /Agent shall determine the appropriate retainage for the total amount of the work and payment shall not be made to said contractor /vendor /service provider who is Non- resident until said certificate is obtained and a copy furnished to the Owner /Agent, or the tax imposed by these chapters has been paid. 5. INSURANCE AND INDEMNIFICATION The Contractor shall provide insurance coverage and indemnification under the terms and conditions and in the amounts set forth on Exhibit "B" attached hereto and incorporated herein. 6. DAMAGES The Contractor shall be responsible for the cost of repairing or if necessary, replacing, any improvements on or equipment servicing the Property that are damaged or destroyed by the Contractor or its subcontractors, agents or employees. Agent shall have the right to offset against any compensation due to Contractor the cost of such repair or replacement. • • 7. TERMINATION Either party may terminate this Agreement by giving not less than 30 days prior written notice to the other party. Said written notice shall state the effective date of the termination. Agent may terminate this Agreement effective upon receipt of notice by the Contractor provided such termination is made due to the failure of the Contractor to perform its obligations under the terms and conditions of this Agreement. 8. NOTICES All notices under this Agreement shall be in writing and shall be sent by: (i) recognized overnight mail service (e.g., Federal Express, United Parcel Service, Tiger or DHL), (ii) facsimile, or (iii) prepaid registered or certified mail, return receipt requested, addressed as follows: If to Contractor: Rocky's Acoustics Company 70 Marione Place Springfield, MA 01109 Attention: Keith LaFlamme Phone: 413- 732 -8656 Email: Roekysacousties@aol.com If to Agent: Appleton Corporation 57 Suffolk Street, STE 200 Holyoke, MA 01040 -5015 Attention: Matt Flink Phone: (413) 536 - 8048 Email: mflink @oconnells.com All invoices to Agent and all payments to Contractor shall be sent the aforementioned addresses, unless otherwise provided for in writing. Notices shall be deemed effective if delivered by: (1) recognized overnight mail courier service, when deposited with such service, (ii) facsimile, when the sender thereof has received electronic confirmation of delivery of such facsimile, or (iii) prepaid registered or certified mail, when deposited with the U.S. Postal Service. Any party hereto may change its address for purposes of receipt of notices under this Agreement by written notice given to the other party hereto. 9. ASSIGNMENT The Agent on behalf of the Owner may assign this Agreement without restriction, provided Agent notifies the Contractor of such assignment within ten (10) days following such assignment and the assignee agrees to accept assignor's obligations thereunder. The Contractor may not assign this Agreement without the prior written approval of the Owner, which approval shall be at Owner's sole discretion. Subject to the foregoing, this Agreement shall inure to the benefit of, and be binding upon, the parties and their respective Iegal representatives, successors and permitted assigns. 10. MISCELLANEOUS PROVISIONS A. Integration. This Agreement embodies and constitutes the entire understanding between the parties with respect to the transaction contemplated herein, and all prior agreements, understandings, representations and statements, oral or written, are merged into this Agreement. Neither this Agreement nor any provision hereof may be waived, modified or amended, except by an instrument signed by the party against whom the enforcement of such waiver, modification or amendment is sought, and then only to the extent set forth in such instrument. B. Governing Law. This Agreement shall be governed by, and construed in accordance with the laws of the Commonwealth of Massachusetts. C. Captions. The captions in this Agreement are inserted for convenience of reference only and in no way define, describe or limit the scope or intent of this Agreement or any of the provisions hereof. D. Drafts. This Agreement shall not be binding or effective until properly executed and delivered by both Contractor and Agent. E. Litigation Costs. In the event that either Agent or Contractor shall commence any litigation against the other party in connection with any dispute under or related to this Agreement, the party which prevails in such litigation (including any appeals thereof), as determined by a court of competent jurisdiction, shall be reimbursed by the other party for its reasonable attorney's fees and expenses and court costs. F. Counterparts. This Agreement may be executed in counterparts, all of which executed counterparts shall be considered the same agreement, and the signature of any party to any counterpart shall be deemed a signature to, and may be appended to, any other counterpart. G. Facsimile Signatures, In order to expedite the transaction contemplated herein, telecopied signatures may be used in place of original signatures on this Agreement. Agent and Contractor intend to be bound by the signatures on the telecopied document, are aware that the other party will rely on the telecopied signatures and hereby waive any defenses to the enforcement of the terms of this Agreement based on the form of signature. IN WITNESS WHEREOF, the parties hereto have affixed or caused to be affixed their respective signatures, under seal, as of the date first written above. Witness: CONT • CT: By: Its: [`„-,a Witness: AGENT: APPLE 00 j • ON By: ' r r . ti ► Its: 'Regional Facilities Manager 19 App et Fax ( s 5/ Er et A- pi I RIT Pobt/0 R ocky's Acoustics Co., Inc. 70 Martone Place Springfield, MA 01109 Mhout 413»7324656 Fear: w-731.1310 FAX BID FORM Date: 3/25/2012 • • To: Scott Morin • From: Keith LaFlamme Sob NameKkfichaels House Job Looatioai 71 State Si Northampton, M Seotion Number: Acoustical Ceilings OS Addendum: NIA Ceiling mod: Ceiling Tile; Tile type 2: • Bid Amount: itZ,S$0.00 Safes Tax : 'Yes.: xx rx No: Inc1uior : .Price includes all the labor to rernoPe the Ming grad and tale, from the spaces to reeve the new OcoI icat.ce tgs: Exct z kan: t ' e wi supply a thanpster to dispose of f ti a ok' grad and Vie~ A.()c- • (if-) Acoustic al Coning Contractors T Installers & Sup ' .�3- 1;- '2;ii;i6 t; Appleton Fax ; 3/ 3 qvoisrr c - Rocky s Acoustics Co , Inc. 70 Marton Place Springfield, MA 01109 Phone: 413 - 732 -$656 Fes;; 4134314310 FAX BID FOE Date: 3/19/2012 ~ ?. f, e IC' To Scott Moquhrt f r ' ,Freya: Keith LaFlarnone Sob lame lifi fteli ou- Sob Location: 71 State 34 Northampton, M 4 ec�t Number: Acoustical Ceilings 095 • Addendum;. N/A Ceiling Odd: Chicago Metallic 250 Fire Rated 15 /16th grid Ceiling Tiler VSG # 2115 Radar Fire Rated 2x2 square edge tire Tile type 2: Bid Amount: $11,865.00 Sales Tax: Yes: ,tax No: inclusions: Price includes all rnaterlal and labor to Install alb' new oconstical ceilings in the lobby, East & West hallways, moll roam and Community room all on tke fist floor only with a commercial fire rated grid and tile, sintk`ar to existing,. Exclusion: We will remove all our trash related to the installation front the site Acoustical Ceffisig Contractors — Installers & Suppliers t$m d SAX 0$ETtELETr L97% LQ► /s t /se EXHIBIT 13 INSURANCE AND INDEMNIFICATION Insurance: The Contractor shall purchase and maintain in a company or companies licensed to do business in the state in which the contract services are to be performed, insurance as set forth below which will protect the Contractor, Owner, and the Agent, and their respective employees, agents, successors and assigns, from claims which may arise out of or resulting from Contractor's operations under the Agreement, whether such operations be performed by the Contractor, its subcontractors, or by anyone directly or indirectly employed by any of them for whose acts they may be liable. 1. Worker's Comnensation and Employer's Liability Insurance Policy Limits: Coverage A = Statutory Coverage 13 = minimum $100,000 per accident/per disease/aggregate 2. Comprehensive Genera( Liability Policy Limits: Bodily Injury $1,000,000 per occurrence/$2,000,000 aggregate Property Damage $1,000,000 per occurrence/$2,000,000 aggregate Coverage Requirements: Premises/Operations Liability Broad Corm Contractual Liability Broad Form Property Damage Liability Independent Contractor's Liability Completed Operations/Products Liability 3. Automobile Liability Policy Limits: Bodily Injury/Property Damage $1,000,000 Combined Single Limit Coverage Requirements: Owned, non - owned, and hired vehicles. An excess liability or umbrella policy may be used to attain the $2,000,000 aggregate limit. All policies of insurance, except worker's compensation will be endorsed to name the Owner and the Agent as additional insured as their interest may appear. The Contractor and its insurer(s) agree to waive all rights of subrogation against the Owner and the Agent. Certificates) of Insurance must be provided to the Agent upon the execution of the Agreement and, subsequently, upon expiration of any insurance policies therein. lithe contractor shall fail to obtain or maintain the required insurance coverage as set forth in this Exhibit D, the Agent may terminate this Agreement. Indemnification: To the fullest extent permitted by law, the Contractor shall indemnify, defend (with defense counsel mutually acceptable to both parties) and hold harmless the Owner and the Agent, and their respective partners, directors, officers, agents, employees, successors and assigns from and against all liability, claims, damages, losses and expenses, including but not limited to attomey's fees, arising out of or resulting from performance of the Contractor's operations under this Agreement, provided that any such liability, claim, damage, loss or expense is attributable to bodily injury, sickness, disease, or death, or to injury to or destruction of tangible property, including the Loss of use resulting therefrom, to the extent caused in whole or in part by any act, negligence or omission of the Contractor or anyone directly or indirectly employed by him or anyone for whose acts he may be liable, regardless of whether it is caused in part by a party indemnified thereunder. Such obligation shall not be construed to negate, or abridge, or otherwise reduce any other right or obligation of indemnity which would not otherwise exist as to any party or person described in this paragraph. In any and all claims against the Owner, or the Agent, or any of their respective agents or employees, by any employee of the Contractor, anyone directly or indirectly employed by him or anyone for whose acts he may be liable, the indemnification obligation under this Exhibit D shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor under worker's compensation acts, disability benefit acts or other employee benefit acts. The aforementioned indemnification provisions shall survive the expiration or termination attic Agreement. Certificate of Insurance: EXACT WORDING FOR "DESCRIPTION OF OPERATIONS" Appleton Corporation and all of its interests are included as additional insureds with respects to General Liability. CERTIFICATE HOLDER: Appleton Corporation 57 Suffolk Street, Suite 200 Holyoke, MA 01040 4_` , The Commonwealth of Massachusetts „-- - Department of Industrial Accidents -- - � '' ` Office of Investigations t , • , 600 Washing Street r -" Boston, MA 02111 �t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): — Address: City /State /Zip: Phone #: 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 have hired the sub - contractors 6. ❑ New construction employees (full and/or part- time). Remodeling 2. E1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ ship and have no employees These sub - contractors have 8. Remodeling 2. working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.0 Other employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. { Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City /State /Zip: At ach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Fa lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fi e 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 o up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigation of :e DIA for insur• 'ce co erage verification. I do hereby c4, tify under he pa' , nd , 4, alties of perjury that the information provided above is true and correct. Si• nature: (► _ ‘• <J A . ..-�� Date: 4 t i-,;\-- Phone #: L ki,4 ')'5) -- 6 176 Official use only. Do not write in this area, to be completed by city or town official __ 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 #: Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) , Independent Structural Engineering Structural Peer Review Required ' Yes 0 w No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, __ m ... _ .... _ .. _ __... , as Owner of the subject property hereby authorize . _.___ act on my behalf, in all matters relative to work authorized by this building permit application. ._ f nature of Owner_ ____ __ _ _ Date __ . , 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 perjures! . a . Print Name ignature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 19:1 Licensed Construction Su ervisor: Not Applicable ❑ `L� C (Name of License Holder . ' 1 ,, a License Number Address Expiration Date Signature Telephone SECTION 13 - WORKERS' COMP NSATION INSURANCE AFFID (M 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 enial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No . Version1.7 Commercial Building Permit May 15, 2000 J SECTION 9- PROFESSIONAL DESIGN' AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF'EISLOSED SPACE) 9.1 Registered Architect: . ._ . ._ _ Not Applicable ❑ Name (Registrant): Registration Number Address - -- ---- — Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number__ _ , _ __._._. 1 Signature Telephone Expiration Date . Name..__. _ r. Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility . Address , ...___ ..___.__...___.___.__.__ ___.___....__._..___........... .__.__.. ._ __ ..._...- .._.__...._....._.._ Registration Number ignature Telephone ..m Expiration Date W 3 General Contractor .__ .. _w ...__.:_.__._m Not Applicable ❑ Company Name: _.... ,��..._.._._..._._.. Responsible In Charge of Construction 'Z d �t - ._..... { yC ._ ... _, _..._. _.... _ _.._._. _.__ _. Address _r J� .x_ _.. ,, ,,44-1A-------- .....: ..„, Signature Telephone • Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Toning This column tore 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 parking) ._w..,....�.. �,,.�»,....� n�.....,...b ,...�.. t # of Parking Spaces F111: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 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 0 , 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 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .. Version 1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 , CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other vg. Brief Description Enter a brief description here. f 1. Of Proposed Work: v`S t �m Ov\ ©P V\-e "v ( O v � \ --I' CX l t " SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F -1 ❑ F -2 II 2C ❑ H High Hazard ❑ - 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 - ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: , M Mixed Use ❑ Specify: __ S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: .___., ___ _ _._.. ,____ _ . ____, < Proposed Use Group: _____.......__________.__.., ___.___ _. Existing Hazard Index 780 CMR 34): _~ w _ __- ,,.mm,..__ ___ Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 ____ . . ..,_..,,..- ..- ..- ,M -... nd 2 nd rd 4in _..,.__ _..._.___....._....,... ___ 4 th 4 m i Total Area (sf) Total Proposed New Construction Total Height (ft) ._. ______ ..._ _____ Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone _ ___, __ Outside Flood Zone❑ Municipal ❑ On site disposal system Versionl.7 Commercial Building Permit May 15, 2000 ' 5- J `fD usae ,11 . . - _ City of Northampton . _ Sta #1� r� �� Building Department CrrrlCut/D1lvevtr� Pet r DEC 2 2012 212 Main Street SewerlSeptte atafitlrty Room 100 5 at fi e e atfabilif � k ' DE 1 ILD,s Northampton, MA 01060 1 `'� t r tt Ap, a is � � NORTHAMPTON PTO" M" J 06 p hone 413- 587 -1240 Fax 413- 587 -1272 Plod t Fla , OtherSp APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: • CjAO� -A -S v ..) ro Map V Lot ( �?) v Unit / 4-/ �. �Dt� ` - Zone Overlay District EIm St. District CB Di � ----- -a District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED-AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: . _ L _ . Telephone _ . ___� ._________ -_-_�_ ..._-.-_-___,__ .. Signature p �.2 Authorized Agent e, _ .y._ . -- (, ,'G wv -.., __M ______ , _ Name (Print) Current Mailing Address .. ., _ Signature s j `" ' ........ _ Telephone ��. ._ __..__._._._ _.�._ __- ...._- _. _,.�. -__.__ ._ SECTION 3 ESTIMATED-CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building i ; i , 6 5 . c>0 (a) Building "Permit F ee 2. Electrical ., , (b) Estimated Total Cost of Construction from (6) _...______ _ .-._._ r_ - -._ , .... 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) _-_: ______ _______ _-,_._M-__-_ 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) Check Number / Th i s,Section For Official Use Only I ` [ d Building Permit Number 'Z, z /p- / � / �D Date:: (✓ CCCJJJ Issued 1 Sgnatur / 773.______ ,,,....,..,„,, :uildi . -. s ioner/Inspec • -Sf 1 din! Date Bk "627//t/ - 71 STATE ST BP- 2013 -0680 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 310 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2013 -0680 Project # JS- 2013- 001128 Est. Cost: $14450.00 Fee: $85.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH A LAFLAMME 53353 Lot Size(sq. ft.): 90735.48 Owner: MICHAEL'S HOUSE LLC Zoning: URC(100)/ Applicant: KEITH A LAFLAMME AT: 71 STATE ST Applicant Address: Phone: Insurance: 141 GRANBY RD (413) 323 -7163 BELCHERTOWNMA01007 ISSUED ON:1/9/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW ACOUSTICAL CEILINGS 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 1/9/2013 0:00:00 $85.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner