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42-048 BP-2024-0596 625 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 42-048-001 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-2024-0596 PERMISSION IS HEREBY GRANTED TO: Project# s season porch 2024 Contractor: License: Est. Cost: 60000 ERIC PAYNE 086442 Const.Class: Exp.Date:01/22/2025 SIMPSON RACHEL SHELBY&KENNETH Use Group: Owner: CHRISTOPHER HELLMAN TRUSTEES Lot Size (sq.ft.) Zoning: WSP Applicant: ERIC PAYNE Applicant Address Phone: Insurance: 32 BURTS PIT RD (413)218-4276 NORTHAMPTON, MA 01060 • ISSUED ON: 05/22/2024 TO PERFORM THE FOLLOWING WORK: ADD 3 SEASON PORCH 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 Driveway 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: /72_ Fees Paid: $390.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Z- 0,1 File #BP-2024-0596 APPLICANT/CONTACT PERSON:ERIC PAYNE 32 BURTS PIT RD NORTHAMPTON, MA 01060(413)218-4276 PROPERTY LOCATION 625 WESTHAMPTON RD MAP:LOT 42-048-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $390.00 Type of Construction: ADD 3 SEASON PORCH New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: V Approved Additional permits required(see below) For all projects that need additional reviews 0 :. Y O as checked below,please see the Office of Planning& Susta inability Permit nage or scan here - r'` PLANNING BOARD PERMIT REQUIRED UNDER:§ - ta. A% .. 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 Demolition Delay 5-1 7-24Z(y 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. [ 9cEiv �. 7pon t- peirrnN t �f AY T e Co onwealth of Massachusetts 1 4 2Qoar of ilding Regulations and Standards FOR fil. Massdchus tts State Building Code, 780 CMR MUNICIPALITY • USE DEFT. a kt;; ,i• ,-�, cT1�,,:_icatii�n To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 ._.__ ��o__ RT m.•r”,,r4 MA 01060 One-or Two-Family Dwelling � Thiction For Official Use Only �,� � Buildin Permit Number: 6V(/ Date Applied: ev1N x //%' 5.22-zozy Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Add ss: 1.2 Assessors Map&Parcel Numbers 2 1.1 a Is this an accepted street?yes no Map Number 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 El _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1ithyperli of.Recopbri Name(Print) City,State,ZIP (od C- U„of t.ha to ptz n /1 at c1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction El Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 3 S C.wS.o.... of o J G�-/IL&. a f'Ob/M ', OK:ce e©VSJLA s '* • - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ SO I'C 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 5- 0 Standard City/Town Application Fee /�../2 0 Total Project Cost3(Item 6)x multiplier x 5" 3.Plumbing S r }G 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S r Suppression) Total All F Check No. Check Amount: Cash Amount: 6.Total Project Cost: S 6 b k 0 Paid in Fu 0 Outstanding Balance Due: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License. HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW / private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ^^ f L(. t� el' , c % License Number irati n Date Name of CSL Holder �� A.,54 List CSL Type(see below) No.and S e ` Type Description 1'�� n U Unrestricted(Buildings up to 35,000 cu.ft.) Cit own, fate,ZIP "" �"+ R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 1 14 g4 � f r SF J Solid Fuel Burning Appliances (�,1� es C O I Insulation Te one ail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) !2- HIC RRegistration Number Exp rati n 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 * 0 .No .0 . SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize lJ n G . 4 G�n e to act on my behalf,in all matters relative to w rk authorized by this building permit application. f a t✓h 4d Si fn ?sell 67/ $/ °-`f Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this applica 'on is true and accurate to the best of my knowledge and understanding. C ��/ 9 Print Owner's or Authori Agent's Name(Electronic Signature) to NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks'/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON ' SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: f re tN'C 'REAR YARD ! �� r pi-Milli'pa io a SIDE YARD I ) SIDE YARD I j 0 0 XI 1Le-0-1 0 D e•F tUP''SETBACK FRONTAGE City of Northampton •.ii��+ar�r:. s� r •�'" Massachusetts !�t DEPARTMENT OF BUILDING INSPECTIONS :jA \1 212 Main Street • Municipal Building C� Northampton, MA 01060 "jti. .;,.p‘'$ 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: 11 Location of Facility: V The debris will be transported by: -PCA1 Name of Hauler: G Signature of Applicant: Date: Z! The Commonwealth of Massachusetts Department of industrial Accidents 1 Congress Street,Suite 100 1 x44.■u►► Boston, MA 02114-2017 =,. ,vi4', www.mass.gov/dia 11 orkers'Compensation Insurance Affidavit: Buiidcr 'Contractorsi ElectriciansfPlutnbers. 'I'O 11k t 1'4:I)11I1't! I tit-i't.tott I um;A. I'IHOltl l 1. Annlicant Information Please Print Let*ihh Name IBusinessC rganization indtvidua!1 c. a L to Address: �2 J U � City/State/Zip! 7 V I '(4 \d OJ V b 0 Phone 13 2_1 V' 1- C :'t. 2 Are you an employer h,v k the appropriate tut: ( SS hype of project(required). I.a I am a employer with employees trail wain part.time)..• s �y �. Q New construction 2.t /fit ant a sole pruprietui ur partnership and have no employees working for me in 8. (� Remodeling any aapaeaty [No wieners'comp.inane unee moaned] Li 9. ❑Demolition 30 t am a homeowner doing all work myself.(No workers'comp.malmsey required.)' 10 Q Building addition 4.O I am a h urneowno and will be hums ountradurs to conduct all work on my property. I will ensure that all rontmeturs either have workers'camper:atium insurance or are sole 1 1 E3 Electrical repairs or additions pntiprident with no employees.. 12.0 Plumbing repairs or additions 5C3 1 am a general contractor mull base bind the sub-contractors listed on the attached sheet. 110 Roof repairs These sub-cuntractors have tYnplutcc%and base workers'comp.insurance. p 6.Q We um a corporation and its.officers have exercised then ne_ht of exemption pet Wit_c. 14.0 Other Is!. h(4i.and we has no employees.[No waiters'comp-insurance r%yuiivd j *Any applicant that checks boa el must also till out the section below showing then worker,'compensation policy ud irntataon s Ituaneuwurrs who submit this allidavit indicating they are doing all work and then hire outside emit/actors must submit a new att'rdav it indicating such. :C untracturs that check this bus must attached an additional sheet showing the name of the sub-contractors and stale whether or not those entities have employee, If the sith-euntrsetors have employees.they must provide their workers'comp vohey number. I ant 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.Lie.#: Expiration Date: Job Site Address: CityiStateJZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MMGL c. 152, §2SA is a criminal violation punishable by a fine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a tine 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 verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 11 Date: Phone#: 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.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS S-��• 212 Main Street • Municipal Building low Northampton, MA 01060 ��`A`� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (insert full legal name), born _ (insert month, dam, i/ear), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20 . (Signature) m4":G ----- ) r111 j 3 $1 --N100Icy -. 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