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29-334 123 " 24" - - 36" 28" --31 ' .r 16.r 12 ' 9'�" � 59 is" 154#1 n t,rr 2 3 1T' 0" W2430 W2830 WAC3D� to O p BEPO SB3 DB1734:BAC n - N, W - rn � N N _ W W B183418R DB243418 B183418L s CO W1848R W243212 WI 848L 18" 24" 18" 63f' 81 J-11 T 271 14 11 18"-, 24" 55 24.. rr 18"; 24" 18" 634" 123 ' All dimensions size designations given are Copyright Helen Zapka This is an original design and must not be Designed:1/5/2007 subject to verification on job site and Century Kitchens released or copied unless applicable fee has Printed:119/2007 adjustment to fit job conditions. 3 West Street been paid or job order placed. West Hatfield,MA 01088 (413) 247-5072 new coleman All Drawing Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership, association,corporation or other legal entity,or,,aaytm, or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,emplo�%g employees: Plorever the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhiold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. , .w, The Department's-address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office Of Invadvatiens 600 Washington Street Boston,_Ma. 02111 fax#:(617)727-7749 phone : (617; 7274900 ext. 406, 409 or 375 SWINK + --- ---� The Commonwealth of Massachusetts Department of Industrial Accidents exce01I Mes99-7deas 600 Washington Street Boston,Mass 02111 Workers'Compensation Insurance davit name: J6 -0r,4A&1 F.�n_nk,� location: /y.? M Cc� city phone 3 Z`f 7 U Z I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity (] I am an employer providing workers'compensation for my employees working on this job. comnanv- :.:.. nama-. :- - .:.. - - address:' phone#•- - - - insurance co. Aotcr#= gI am. sole proprieto general contractor,or homeowner(circle one)and have hired the contractors listed below who have the fo o en'compensation polices: b company name: 5e%? ` (���•� address: city: ... .. . .: ` phone#• insurance-co. .. ... ... :. .. PAX - comoanv name: address. .. . city phone#- insurance co. Failure to secure coverage as required under Section 23A of MGL 132 can lead to the imposition of criminal penalties of a fine rap to S1—�;H.00 and/or one rears'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Bme of S100.00 a day against roe. I understand that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verifxatim 1 do hereby crrtiJv under the pains end penuhies of perjury that the information provided above is true and correct Signature t� Print name Ph one# L ci 7 0 L :`7 Orr cial use only do not write in this area to be completed by city or towns official city or town: permiNitense# nBuilding Dtpartment 1]Licensing Board L.check if immediate response is required c1Sclectmen's Office ❑Hcaltb Department contact person: phone M; nOthcr i:cvncd-IM PJA) Bardwell Woodworking & Remodeling 49 Main ST. Hatfield Ma.01038 413-247-0226 CONTRACTORS INSURANCE POLICIES: Company Name: Phone# Insurance Company Policy# Jonathan,Bardwell 413-247-0226 Farm Family Casuality Ins Comp 49 Main St 2008x0043 Hatfield Ma 01038 Korpita Masonry 413-256-8541 Blair,Cutting & WC59747007 P.O. Box 263 Smith Inc. Deerfield Ma. 01342 Mistarka Home Improvement 413-575-1271 Brooks-Neylon Ins Inc CTR0002122 P.O. Box 205 80 West State St. Northampton Ma. 02061 Granby, Ma. 01033 AM/PM P&Heating Inc. 413-256-8541 Blair, Cutting& XHUB2841-1910801 P.O.Box 527 Smith Inc. Hatfield Ma.01038 Thomas G. Sullivan Dream Tile 413-863-9994 A.H. Rist Insurance Agency, INC. 13 H St Box 391 Turners falls,Ma 01376 Turners Falls Ma. 01376 SCP 35693283 Harris&Gray 413-781-0416 IRM Insura Bresnahan WC7488266 P.O. Box 300 Insurance Agency Ashfield Ma. 01330 Dion &Son Floor Contractor 413-538-7862 Webber&Grinnell SWC1'70074900 74 Russell St. Insurance Agency Hadley Ma. 01035 James Crowell Carpenter 413-247-5467 Whalen Ins Agency ART0360451 84 Elm ST. Hatfield Ma. 01038 M&S Electric Inc. 413-247-5330 Webber&Grinnell 1608357L3746TCT02 119 Elm Street Insurance Agency Hatfield Ma. 01038 All Seasons Heating &Air 413-247-9842 Webber&Grinnell MPP45108 Elm Street Insurance Agency Hatfield Ma. 01038 Great Trails Council rage/- or a Great Trails Council Boy Scouts Of America 2/28/2007 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder: d1y,+7 AW -9011-AW& `1 C 6le�/ / 0 '! License Number -/fie o 8 _ Address Expiration Date /v 2-y OLZb S atur Telephone 9.Registered Home improvement Contractor: Not Applicable ❑ Company Name Registration Number Mo- "M cS� • i �dip be rX • 6l�L Address Expirati n Da Telephone 'Y! Z y 7 0 ZZG 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....... No...... ❑ 11. - Home Owner Exemntion 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 _ Great Trails Council Great Trails Council WjMv Boy Scouts Of America 2/28/2007 ti SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑ Or Doors I& Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding Pj Other[ED] Brief De ription of Proposed � �� ` t os-I �l 1 iq" W�:� tp Work: �tp;� +¢,� !! ii �uniu W ji r�c�0u�. i yf Alteration of existing bedroom Yes��No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 a,rr�5 C6/Lp rYkx� as Owner of the subject property LLL��1 hereby authorizeR-�w to act on alf ' all s re k authorized by this building permit application. 3 - -G Signatur of Owner Date � as Owner/ uthonzed �the st atements and information on the foregoing application are true and accurate,to the best of m wledge glief. Signed under the pains and penalties of perjury. �- Prin me Signature er gent 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 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 ® DON'T KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO tg DONT KNOW O YES 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 ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212;Main Street Sewer/Septic Availability Room 100 WaterNVell 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 1.1 Property Address: This section to be completed by office ,2,52• rfC,2f- brook Map Lot Unit rla�la � t Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C 1+A'?-L ES COL e t-^+4 Fldreivgv NO,, d 1d 6 Name(Pri ty `� Current Mailing Apdre s Telephone Si ature 22..2—Abutth—orizzeed Agent: _ `►d`A)AT- Name(Print) Current Mailing Address: AaL 'I/3 zy7 (IZz6 Signature Telephone SECTIO - STIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Q ��7 4V (a)Building Permit Fee 2. Electrical (b)(b)Estimated Total Cost of 7o0' "' Construction from 6 3. Plumbing tom© pQ� Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) p Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 1ft File#BP-2007-0831 APPLICANT/CONTACT PERSON JONATHAN BARDWELL ADDRESS/PHONE 49 MAIN ST HATFIELD (413)247-0226 PROPERTY LOCATION 252 ACREBROOK DR MAP 29 PARCEL 334 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction' REMODEL KITCHEN REPLACE 1 WINDOW&INSTALL NEW WINDOW New Construction _ Non Structural interior renovations Addition to Existing Accessory Structure - Building Plans Included: Owner/Statement or License 055910 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Co ssion 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. 252 ACREBROOK DR BP-2007-0831 GIs #: COMMONWEALTH OF MASSACHUSETTS Map_Block: 29-334 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pernut: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: BUILDING PERMIT Pernut# BP-2007-0831 Project# JS-2007-001370 Est. Cost: $15602.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Coast. Class: Contractor: License: tlse Group: JONATHAN BARDWELL 055910 Lot Size(sq. ft.): 10497.96 Owner: COLEMAN CHARLES L Zoning URA Applicant: JONATHAN BARDWELL Applicant Address: Phone: Insm-mice: 49 MAIN' ST 413 247-0226 HA.TFIELDMA01038 ISSUF_D ON.3 1712007 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN, REPLACE 1 WINDOW & INSTALL NEW WINDOW POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of'"siring D.P.W. Building inspector Underoroand: Service: Meter: Footings: Ik dic1 „- Rough: iR Q '- House.# Foundation: Driveway Final: Final: Final: /�� / �f��17('�lJj Rough Frarne-6W Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Finai: Oi< 06�lt� 1 L,-'L,413 THIS PERMIT MAY BE REVOKED BY THE CITY F NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. ,— Certificate of Occupancy si<_nature: r _ — FeeTvpe: Date Paid: Amount: Building 3/7/2007 0:00:00 $50.001378 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo