42-052 (6) BP-2022-1031
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-2022-1031 PERMISSIONIS HEREBY GRANTED TO:
Project# ADD PORCH Contractor: , License:
Est. Cost: 31500 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:08/25/2022
TO PERFORM THE FOLLOWING WORK:
11X16 SCREENED PORCH ADDITION
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 Drivena), 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:
t9'11tih. 5 -
Fees Paid: $204.75
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
Z—a1�
File #BP-2022-1031
APPLICANT/CONTACT PERSON:DANIEL HEWINS
P O BOX 186 CHESTERFIELD, MA 01012(413)250-1461
PROPERTY LOCATION 587 WESTHAMPTON RD
MAP:LOT 42-052-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $204.75
Type of Construction: 11 X16 SCREENED PORCH ADDITION
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
4 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 SpecialPennit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its 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
I '' g
r(1 LVid)N Sign./ure 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.
F•-,�
RECEIVED
AUG
e C mmonwealth of Massachusetts
.,i d of 13uilding Regulations and Standards FOR
• T AF eul�rnrvr tSPE t MUNICIPALITY
r1 'achuetts State Building Code, 780 CMR
r �'^�iTH4Mt? lh.�,1A01060 USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two Family Dwelling
This Section For Official Use Only
Building Permit Number: 64:1" a I U 31 Date Applied:
ii-mdieVL
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
$ 517 wFS-rNA►r\PTaN RD Z 5'-'.
Li Is this an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: I O
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
6o' 2.0' ► co-
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Hood Zone Information: 1.8 Sewage Disposal System: —/
Public lEr Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system LK
Check if yeslir
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
LIB wr-rrE 0- VIC RPA"LIrrGS NoR.T14a►\PrOti II\ A olo6O
Name(Print) City,State,ZIP
497 `^i�STNAhtPTorf p.,D. (734) 395- 3906
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': S C R.FErt Po R c 1+ o rJ P.E k k a F 1.1 0 5 E 11 16.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 3 0 o fl o 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical /5-00. 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ /'
Suppression) Total All Fees: �19
Check No.a'�7 I I!Check Amount: (V Cash Amount:
6.Total Project Cost: $ 3 $ A p Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
b‘t 97 I 'f
Pc friI c L F -✓l r/ S License Number Expiration Date
Name of CSL Holder
100 OLD C.N F3 T C R F 1 L p k p List CSL Type(see below)
No.and Street Type Description
r O Q 0 1 U Unrestricted(Buildings up to 35,000 cu.ft.)
R City/Town,State,ZIP M Masonry
1&2 Family Dwelling
ry
C E ST E R F ► E L D A o 1 012. RC Roofing Covering
/ WS Window and Siding
� )3 'L r 0 16 1 SF Solid Fuel Burning Appliances
J I Insulation
Telephone Email address D Demolition
5.2 Registered Horne Improvement Contractor(HIC) 17 7 6 9 5
�A � IFL HE vINS I Z�
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street $ A — 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 E{ No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize A r� I tt L- H E kn/I I' s
to act on my behalf,in all matters relative to work authorized by this building permit application.
\ 2,-Li
Print wner's Name
(Electronic Signature) e
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I 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.
b H 2Z
Print Owner's or Authorized 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
www.mass.gov/oczi Information on the Construction Supervisor License can be found at www.mass.gov/dps
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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD / SP '
•
0 .� r
SIDE YARD SIDE YARD l/ J /
PORc,H
.FISTING
1
FRONT SETBACK 6 O
FRONTAGE I I d
City of Northampton
` F 1 Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 'CS
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: 0 izt ?A M� � T 014 VALLEY jz -cy,... LE
The debris will be transported by:
Name of Hauler: D A IJ I E L,, µ w I PIS N Ti A Lt01Z
Signature of Applicant: ) -� � 7 -7 Date: A I 271 Z�
The Commonwealth of Massachusetts
Department of Industrial Accidents
•_ ��= s 1 Congress Street,Suite 100
-> i{ Boston.MA 02114-2017
1�F www mass.gom/dia
II utters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
'10 BE FILED'Sf,fill'111E PE1t111'rl IM;AUTHORITY.
Applicant Information Please Print Le>_ibls
Name(Husrnc s aki antmtion•India idual1: D A E L N lC t'✓it-I s
Address: I o 0 0 L.D C H F S i 'p. F, E 1- D R L P. o. Bob' 1 S 6
City/StateiZip: (,'N(` S I F P- F I E L D d I o 1 Z Phone#: ('/ 3 ) 1-5 6- 1516.1
Are you an employer?check the appropriate boa: Type of project(required):
1.Q 1 an a employer with employees(lull antl'ut part-dint).. 7. New construction
2.171,am a sok prujmoor or partnership and hate no employees working fix me in g �Remodeling
any capacity.No workers'comp.usuran a requited_]
301 am a hom work myself.doing all wo myself.[No workrn'comp.insurance ro d_]yuin " 9. Demolition
10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property- I will
ensure that all contractor.either have workers'compensation inwranee o an:!sole 1 i.0 Electrical i epatrs or additions
pmpne[un with no employees.
12.0 Plumbing repairs or addition.
Sin I am a general contractor and I have hired the sub-contractors Toted on the attached sheet_
These sub x cm p+-cuntrtun hate pluyecs and hate workers'comp.insurance.' 13.0 Roof repairs
14-aPthei 6.0 We acorporationa corporation and its officers hat c exercised their right of exemptions per ARIL c.
S C R F F,-J F o .
132..510).and we have no employees.I%o workers'coop.m.urancc reutnd.)
'Any applicant that checks box al must also till out tic section below show mg their workers'conprcmattun policy inhumation.
Homeowners who submit this affidas it indicating they an:doing all wink and then hue outside ecaatr.tclura must submit a new at$idat it indicating such.
:('ontractars that check this box must attached an additional shed show ins the name of tin:sub-contractors and state whether ow not those unities hate
employees. II the sub-cumracios king cntih.yccs.they must ptusodethew workers"comp.policy ntunher_
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'Statc.?Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to SI.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 S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage teriticatiom.
I do hereby cern *under the pains a_ndd penalties of perjury that the information provided above is true and correct.
Signature: 7 \ 7 Date: I 1-
Phone n: (`�l3) 150- i`f 6 1
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):
I.Board of Health 2.Building Department 3.City/own Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
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