42-052 (5) BP-2022-0612
587 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
42-052-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0612 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO Contractor: License:
Est. Cost: 40000 DANIEL HEWINS 049714
Const.Class: Exp.Date:05/20/2024
Use Group: Owner: RAWLINGS FRANK V& ELIZABETH WITTE
Lot Size (sq.ft.)
Zoning: WSP Applicant: DANIEL HEWINS
Applicant Address Phone: Insurance:
P O BOX 186 (413)250-1461
CHESTERFIELD, MA 01012
ISSUED ON:06/01/2022
TO PERFORM THE FOLLOWING WORK:
KITCHEN RENO
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Drh in,ay Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: LeilviA ., .5.9 7-,
•
Fees Paid: $260.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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UA y 3 1 �022
L ''T F QUlL
The Commonwealth of aM ssacltrA DiNri��Sp
Board of Building Regulations and Stands SON MAo,O60oNs M FOR
UNICIPALITY
Massachusetts State Building Code, 780 CMR
-
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two Family Dwelling
22,,�,, This Section For Official Use Only
Build,in Permit Numbers -v al)"
&CP:3 Iv- Zo2
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7 s7-11 RmPT°r/ RP.
�,1, d6�
1.1a Is this an accepted street?yes 1.7 no Map her Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: — Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O er'of Record:
Fa ASK V fcivi2 iNivi /•6-5 coo,e icE /IA of 062
Name(Print) City,State,ZIP
s$7 wEsTK/}rPTPv 57. C 17 5-°1 rt37 6-c"oM•
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work' K i l [.l- Fri jt E To D FL . R r avov F o e.D C A g(Pi ETS/
COvf1/4/1ER_1op i r- vIIJyL FLoog • App woof FcOoR 1''( A
A B 1rf4T5 , (vvi4 2"ropS i L,GH-Ic
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3 000 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 5 p (:).0/ 0 Total Project Costs(Item 6)x multiplier x
3.Plumbing $ i C o O 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ /'�
u Check No.d��l8' Check Amount: O�UDCash Amount:
6.Total Project Cost: $ / 0 o D O ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) )4/ 5 'z O IL, .
DA 1" l C L I rjs License Number Expiration Date
Name of CSL Holder
ID p . b D p X I 6, List CSL Type(see below) J<
No.and Street Type Description
C l- S Ek F i F L�/11 m A Q 1 0 f Z U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
n' M Masonry
RC Roofing Covering
WS Window and Siding
Fuel Burn
c6113) 1"-C°‘ I`16I DNFwrt�S 5 ® 6n�AIL . iF Solid
Ltsuation `ng Appltances
elephone Email address 4 0"1 D Demolition
5.2 Registered Home Improvement Contractor(HIC) I-7 7 6 9 9 1 f /Lit
S A to t HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6: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 I No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTORj APPLIES FOR BUILDING PERMIT U
I,as Owner of the subject property,hereby authorize A r l E L Ff E w l iI S
to act on my behalf,in all matters relative to work authorized by this building permit application.
FRANKV Ic�R �PAwc.ti c-5 �,.,� a,. j f��lJ M1gY 3� 2c�Z),
Print Owner's Name(Electronic Signature) DAte
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,T hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
tqkPIE , f-��wl /�s S1311.z1
Print Owner's or(uthorized Agent's Name Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
11,v w.maSS.D)vOoca Information on the Construction Supervisor License can be found at ww-ww..maa.<a()v �1pS
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
Jar
Massachusetts
�,5 } DEPARTMENT OF BUILDING INSPECTIONS 6®,;
212 Main Street • Municipal Building + ,,
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: v r �y L
The debris will be transported by:
Name of Hauler:
DPcIJI EL liFvvI�s
Signature of Applicant: 7 Date:
..' The Commonwealth of Massachusetts
►* 1— Department ofIndustrial Accidents
r =_ �,= n
ct . 1 Congress Street.Suite 100
m Boston.MA 02114-2017
�, ,,�' w w mress.goi/dia
11 orkers'(•onyrensation Insurance Affidavit:Builders/('ontractors/ElectriciansiPlumber..
TO 11E FILED%%fill THE PERMUTING At'•1'110Rf11.
1ttfilit:tilt liil°rin:tlion Please Priol I_ryihl+
Name I14ustncs.lhyanvatton twig%uivaii: . D A r i F L j C w p 4 S
Address: p•0 . Boy- I fed / , 00 oL O C4-1�STEIZF, EL P CZD
city.`statc/Zip: C-0 Et-TX X F I k-L p r>1 A non,. )I o[ 2. ( ►- ) -1- p .. I..'� 6 I
.%rc sou an employer?(lnsi the appropriate but: Ty pe of project(required):
i.0 I.nt a.vgd.n.wdll employees'lull under part-tulrl 7. jJ New construction
2 I am a sole p opn.ior or purtncrmhip and hate rue ci kryees w°rimy beer me in $. O Remodeling
• an capacity_[No workers'comp.insurance requited"
9_ El Demolition
tt
1 ant a honwnrwrer doing all work myself.(No workas-comp.,t.ur-ait.x rcgwi. d_I'
10 0 Builduut addition
4.0 I am a homeownes and will he know contractors to.Yxtdud all work on my prop.?ry. I will
enswc that all coutraetor either lute warier'conttwrosatrom nil°ranee..ate sole 11.0 Electrical repairs or additions
p op:w om with no cntpluyc...
12.0 Plumbing repairs or additions
5.cn I ant a°sacral contractor and I hate hued the sub-contractor listed on,the attached shed_ 130 Roof repairs
the.:sub-conhtrutor lute employees and hate winksis'comp.ur utance.:
b.Q We arc a corporation and its orticrn hate cxcrciscJ their right otexemption per kK it 1:. 14.p.0t11ei K) 1'L.H Frf
I5_'. 11.11.and we 114%c tw employees.[do worker'comp.insurance rtgutr:J.] R (N 0 t/A ft o r/
'Any applicant that chicks box 41 must also till out the teetunt below show mg their wotriers'compensationparltcy mWernalwa /_
'lknu.:°%ter.who+subrettt thus altidat it ntJicattng they ate doing all work and then lute uuts*Jc contractors must subunit a new atftalat it indicting stub.
:Contractors that cheek this host must attach-A an additional sheet showtntr the name of the sub-contractors and state V.further or not those entities hate
employees. if the sub-contractors lute employees.they must pu st&c their workers"comp.ponce member.
I am an employer that is providing worAer►'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City:State Zip:____ ___ __
Attach a copy of the Norker's'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NICE c. 152.§25A is a criminal violation punishable by a tine up to SI.500.(0
and`or one-year imprisonment.as well as cis il penalties in the firm ofa STOP WORK ORDER and a tine of up to S250.00 a
day against the s iolator. copy of this statement pray be funsarded to the Ottice of investigations of the DIA t.tr insurance
cotera_'c scntic-anon.
I do hereby certify uiul I •!Milts and penalties of p rjur r that the information provided above is true andcorrect.
5ht:htatwe. / \--7/ 7 Date: '-f 13 I J Z Z
Phone-'. (4 I) ) DSO . t 9" 6 I
Official use only. Do not write in this area.to be completed hr city or torn official
('its or Town: I'ermit'l.icensc>e
Issuing.suthority (circle one):
I.Board of Health 2.Building Department 3.('ityFl-ossn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone*: