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17C-168 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 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ..E,��.G„A � GVy- I, as Owner of the subject property hereby au rize _ _ _._ _ to act on my eh. ' - '-rs rel. . e to work authorized by this building permit application:_ Signatur of Owner Date --- •-•-- ,as Owner/Authorized Agent hereby declare that the statements and information on e foregoing -■•lication are t urate,to the best of my knowledge and belief. --- Signed under the pains and penalties of pert r _ • Print Name Signature of Owner/Agent Date c3Cy\J i 2.1 2c2-1 SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder �? ._ s License Number Address 6 � _._.. .._.. Expiration•.__ _ ._,_ _ _. ._, ._, .. µ� s-� Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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 0 No 0 The Commonwealth of Massachusetts --� M Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): `^ �-� C(34u.kjx, L C_ Address: V r"?. 0, &� to o (GQ 6 City/State/Zip: ∎\\Y 4.3vL-U) Phone#: y 3 3 7 G Are yo n employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Ei Building addition [No workers'comp.insurance comp. insurance.t 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r 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: -- Sci .\,pl'. - �t�,.(�\at ` Policy#or Self-ins.Lic.#: �?�_�—��C� �Cj "7e��I 2Dt ? Expiration Date:(6 /Oil C Job Site Address: '3 I City/State/Zip: �( �,, {�lQ 6 D 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 o i. ance coverage verification. I do hereby ins nd pen,lties of perjury that the information provided above is true and correct. Si• � �. Date: CJ.i ( 2, 5 Phone#: Li i'j 3 7 6 `F 6 e 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#: 1 , .., ..,". . -f- --71-- "" i .. , /„. .. 11 i 1 0 +I ., II ..3 1. I. .- „ow, -3 1 , I 1 , .e„ ' —4- 4., L 4 , ,, , E....4 , .....,. r..) i- 3 1 . ....._ i , V— i i • 1 I 0) ■ _ 3 : — 1 ----..--.... ..-----iNf-!—r.-- , N , ,- I 1 1 i\-) 1 , e, : a t I I ' 1 I i I , I ' I- , I / t I , CID i r.---/ 1 z ' iliC 1 1 1 , t I I I I .1•••• 1 I CI) ... I ! I 1 1 i ••• I 0) i I 1 ! CNJ I LW i 1 i - 0 E N NO i N N , kr II I I c.i (N , ... i CL 1 c.., 1 (N i i (NJ I i 41•0 I I i ' 1 1 i 1 i 0 ., i , I i I : ILL 1 :.... i , , 1 , --1,- 1 - 3 [11 it 1 1 t I I N 1 I 1 I 1 I i 1 ; i 1 1 c 1.- ; r- , , I I i, ■ 1 hl 1 1 i I 1 N--- (NJ 1 1 1 •izr I ■ ! -----'-- ._ ,.. .. ..d .--, - 4 +- 1-----1- CA) ...., I 1 ••••• ).; 3 3 (1) CI i ! -- --4.--------- ------------------4,:------ --- ,,-Z 0 6 1„ r‘ tIl. 8 L, C") Cf) tai _":‘ IC. •1 ;,..■ 1 1 0.4 0 i I , 4.4 w., ........... 119-19 i r-4 (1) r..4 Alik, 1....1 I Cip 4.1 ro4 i "I° Acheson Company LLC Time & Expense Invoice / r 6 North Main Street PO Box 1052 Invoice#: 13193 •� Williamsburg, MA 01096 Invoice Date: 9/11/2013 4,,, Phone:413.374.6468 Due Date: 9/11/2013 E-Mail: dean @achesoncompany.com Project: Move in repairs for Massoit, NH P.O. Number: Bill To: Dr.Tor Krogius 107 Massasoit Northampton, MA 01060 Description Hours/Qty Rate Amount Work Description Sept 4-11, 2013 Paint work on bathrooms, kitchen and rear bedrooms. Floor board replacement of holes for the old radiator system. Labor Costs Adam Leach 15 37.50 562.50 Adam Leach 24 37.50 900.00 Ethan Jones 15.25 30.00 457.50 Ethan Jones 24 30.00 720.00 Juno Orion 40 37.50 1,500.00 Galen Wood 8 37.50 300.00 Material Costs olok Florence Hardware 13875 joint compound 19.11 19.11 Florence Paint S2147452 finish paint 132.57 132.57 Fleury Lumber 174571 3.77 3.77 Fleury Lumber 174577 refund -3.25 -3.25 Williamsburg Transfer Station dry wall &trim debris 8.00 8.00 caulk&sanding 43.63 43.63 Florence Paint S21103304 paint 44.19 44.19 Fleury Lumber 175191 wood trim 102.64 102.64 Florence Hardware 13651 dry wall mud 1 19.11 19.11 paint 132.58 132.58 Fleury Lumber 175256 wood trim 93.00 93.00 Fleury Lumber 175340 picture molding 218.66 218.66 Total Material/Other Expenses 814.01 Total $5,254.01 Payments/Credits $0.00 Balance Due $5,254.01 A** 413.374.6468 dean @achesoncompany.com N d O R a 00000000000000000000000000000000000 ! y 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O U ao ao f0 (O ui�i ui ui tti tri of ri ao aD ao aD ao ri ati ao ai oo ao O .= co f0 aJ(O m C (NCDN 0)tntn(0 aON M(0(0U 0)t'M 1-N (00000(0(0�)-('4t- aDNOtn0) 0) �p � OOOONNNNMMMM��tn to(0n na0 QO O)O)mOO�e-NNM��� ; � ja �(V NNNNNNNN(N N i r+ 01 C 10000000000000000000000000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O o tnO Mtn to tn�00000aOOtnO000tn to Otn tf)ON OOOtn000 to o MR Ntn N V `? 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A message has been left at Marney to call me. 6 From: Mike Sola [mailto:mikesola©gmail.com] Sent: Monday, November 04, 2013 9:48 AM To: Dean Acheson G , Subject: Marvin Windows and Doors Photo Gallery - Dean, �'v.'-)--"- c; What do these Marvin windows cost? They are in the Ultimate Casement series . "Z1� 4 � ,+ , :to �T,3' :� 1—a n 7 px , a V , 4:::70-41 , ; -':.f JM ..., E 1111 � Ell III IR v °��r rr r �, � ,. 1111 :rr rr r rr rr r r lr r r�. 11 Nil 1111 r mill / . �. i ♦ .�, is I +, r , "�` fiv '.l mac` . `. 1 ' ` ` ' yr s. wwlraKT' t i" L' 1 , 7 ti. � y .i" 54'+ . ' . i .�.a t. ..,.,v. ... .+r tl�` w i: L4 } aa[Y+"t` .,.._.z 1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: � Not Applicable ❑ Name of License Holder: ��/��C�`N\tPTL.1 License Number 4ddress - �\r Expiration Date .mot 3 , • signature Telephone I.Registered Home Improvement Contractor Not Applicable ❑ :omoanv Name Registration Number .ddress Expiration Date Telephone ECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,_§25C(6)) 'crkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result the denial of the issuance of the building permit. gned Affidavit Attached Yes 'Z" No ❑ 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 _ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement ows Alteration(s) Roofing C Or Doors I Accessory Bldg. ❑ Demolition 3 New Signs [inj Decks I Siding[Di Other[D] n 3 i .tii/Ir, --"Norj• 4.,/,i—:- ' r"%i✓i Brief Description of Proposed - ' Work: 5k,r ,it?.a.,%,-No vJ 41.■ • \?. tiw.,>t�:\ 4.. (‘-1 °"A k's l �cA k"--'')C 6 Alteration of existing bedroom Yes UJ No Adding new bedroom Yes i Attached Narrative Renovating unfinished basement Yes t No Plans Attached Roll -Sheet 6a. if Neiki,'house and or addition;to extstinc housinCl,carnpFete€he fc[ a cing: 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 ����� �-c> _(. - , as Owner of the subject property hereby authorize ' ` o'v� �- -.. -4 to act on my behalf, in all matters relative to work authorize• by this ouil.ing permit application. 'ICY a 2Q I3 Signature of Owner Date I , as Owner/Authorized Agent hereby declare that the statements and information cn the foregoing application are true and accurate. to the best of my knowledge and belief. Signed under the pains and penalties of perjury. t -4"1/e Heitc6—k" r7.)7.-,*7 i � Print N. ,: I' 21,/ an:re ;r Cwner ant uate t. Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due Tc Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department I Lot Size _. . .... ... _....._ __.. Frontage _.._._..._ ��_._.____. ... _. _I . _m., .., ,w_ - ., Setbacks Front �� 1 SideL: .._....._ R. ._.__,.. L R .. ._.._., .__.._ _ Rear ___ ....,__. Building Height Bldg. Square Footage I % _..:___ __, Open Space Footage _ I % __ _ (Lot area minus bldg&paved . — naricine) #of Parkin Spaces _ __: .. — .--- . Fill: (volume&Location) ._.._....—... —L...____ ,.. .. . - --_. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW ® YES 0 IF YES, date issued:- IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES _V V IF YES: enter Book -�_... Page M.. 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 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 40 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 ptan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm WaterManagemerifPeimit from the DPW is required. - Department use only �`".1.-177-7:: City of Northampton Status of Permit: -;- uilding Department Curb Cut/Driveway Perm i, ' 12 Main Street Sewer/Septic Availability I r A/0 1 Room 100 �/tfaterNt(e[I Availab lity L 1 z 4.0/3 Northampton, MA 01060 Two Sets of Structural Plans I phone 413-�:87-1240 Fax 413-587-1272 Plot/Site Plans /EIecric F° � , w --) Other Specify APPLICATION i''''23 e UC T,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 I 35 rT`)1_ 5, -- Map Lot Unit �� cam_, t 1. 'T^ o k Q 4 e Zone Overlay District 1 '� Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP!AUTHORIZED AGENT 2.1 Owner of Record: ` C1 1 0 Ca_ M i-��- SC.J -- — 38 k y s / Flovt04,02I Name(Print) Current Mailing Address' q1 5 I .�/��,— 7 73 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone I SECTION 3-'ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ` ci ®O (a)Building Permit Fee 2. Electrical U (b)Estimated Total Cost of 0 Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) I xoci 5. Fire Protection /) - 6. Total=(1 +2+3+4+5) Check Number 3� 0 065- This Section For Official Use Only Date Building Permit Number Issued: Signature: Building Commissioner/Inspector_oi uuaings Date File#BP-2014-0611 APPLICANT/CONTACT PERSON R DEAN ACHESON ADDRESS/PHONE 6 NORTH MAIN ST WILLIAMSBURG (413)268-0246 PROPERTY LOCATION 38 HIGH ST MAP 17C PARCEL 168 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 373 i 443 Fee Paid Typeof Construction: CONVERT 3 SEASON TO LIVING SPACE 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 OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION PRESENTED: Approved 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 Demolif.n Delay Li 7 //'/ / 3 Signature of Building Offici.4 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. 38 HIGH ST BP-2014-0611 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 168 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-2014-0611 Project# JS-2014-000987 Est.Cost: $7500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: R DEAN ACHESON 83968 Lot Size(sq. ft.): 8189.28 Owner: BRODEUR GEORGE J&THERESA R Zoning:URB(100)/ Applicant: R DEAN ACHESON AT: 38 HIGH ST Applicant Address: Phone: Insurance: 6 NORTH MAIN ST (413) 268-0246 WILLIAMSBURGMAO1096 ISSUED ON:11/18/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONVERT 3 SEASON TO LIVING SPACE 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 11/18/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner