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2" x 6" Walls
16" 0. C.
w/6" Fiberglass
112" Sheetrock
1/2" x 6" pine
clapboard
2" x 8" Floor Joists
16" O.C.
PT 2" x 10" Triple
Girder
10" Poured
Concrete
Sonotubes
Daniel Hewins
1504 Westhampton Rd.
Florence, MA 01062
Typical Wall Section
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..�. � Daniel Hewins
1504 Westhampton Rd.
Florence, Ma 01062
ApR - 5 2
. ds Scale 1/8" = 1 '
expanded workshop
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woodshed
deck
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24'
Dan Hewins
1504 Westhampton Rd.
South Elevation
1/411 = 1 1
CAMP TON N 11 0 79 HAMPSHIRE
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m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE + + AVIT
(liccnscx/pctmiUcc)
with a principal place of business/residenu at: � �3
VV
(str�t/c i ty/sta iriz�p)
do hereby certify, under the pains and penalties of that
O I am an employer providing the foilowinc; vrorkcl''s compensation coverage for my
employees wor�ng on this job'.
------- -- ------------------------
(Insunslce Company) (Policy Nu Ilrr) -(L�pirauon Date)
( ) I am a sole proprietor, general contz ac,or or homeo«,-ner (circle one) and have hired
the contractors listed below who Dave the following v,rorker's compensation policies:
(Name of Contractor) (Insurance (Expiration Date)
(Name of Contractor) Onsuranc-- Comi)Ew/Pohcr Num'trr) (E-xpimtion Date)
(Name of Contractor) (Insurance Comp.nl /Pork; Nninb(,-I) (Expiration Dale)
(Name of Contractor) -- -- (Insurance Comlk.ny/Pcli--,,- NuInlYu) (Expiration Date)
(rnac�aciditi«ul r_+)cct if naccisrr}'to ix}uc}<infornurioo pctz:nin�t�ell mC7at..n:3j
( I asn a sole proprietor and have no one "-orkin2 for me.
(v�I am a home owner performing all the ,vor}, myself.
NOTE:ntcaFC bC awY-rc Ithat Ni) IC homco"-,Kf3'AikQ cIS):Oy�^S to MXLt �CO:I�SULLoa or rq)-a Work oO S dHCt1 g C!
riot more than throe units in which the homno-Ancr n=ldcs or oa the g ou ris zpjx rtcn. thcez arc oo(gencrslly ooandered to be
emptoyas under the Nvori ct's com9casation Act(GL152,s3I(5)�r{)plicabon by a hoauow=for a bcrase or permit may cvr6—the
ltpl ctabu of an ennployor uoder the Workeet Cocnpenzat Ad
-
I uadcrsttad dirt a oopy of thiz ztai cmcai may bo f«waded to the Dq,xi meat of Indrstrial AaidoQt!Offioo of Insxurnco for the
oovaagc vaificatioc and that ftdurc to aoatrc coverage undo suction 25A of MIL 152 can lead to the imposition of criminal pcnaltics
coosistaig of a fine of up to S 1,500.00 and/or impruounicni of up to orx ycw and civil pcnxitia in the form of a Slop Wort;Order and a
fino of S 100.0 t day igaiust tz�--
.. For dcputnrrLnl urc oa7y --—^--
Permit Nmnber
---- - --- -- Mud—
W4
Sigu;iturc of Liccriser/I'crruittcc � '
)IIIIIiIllkCTION 8-CONSTRUCTION SERVICES
..1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder License Number
Address Expiration Date
Signature Telephone
Not A p p I i c a b I e ❑
Company Name Registration Number
Address Expiration Date
Telephone
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.
fined Affidavit Attached Yes....... ❑ No...... ❑
WIN
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�thhji permit.
The undersigned"homeowner"ce rti I _ a , assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State an ate o ning Laws vd S f Massachusetts General Laws Annotated.
,--
7
Homeowner Signature Loca
t
TIM 5- SCRIPTIO O -P OPO E c ec cable
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition[>il" New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Descriptionof Proposed Work: �G � ++u�}odg�rd 2xP �r} �� od° 2- wo•^ks�,� ����a
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes "` No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
a. Use of building : One Family ✓f Two Family Other
b. Number of rooms in each family unit: S 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?'�!I L r '[o I wA'r L R Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
Type of construction � �u p
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 tJ J A
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
I , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
igned under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
3 ,
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building}Department
Lot Size �' A r 7V/
Frontage 3 , ` 75�
Setbacks Front 3 ' 3 �C
Side 1 S®� L: S R: ► O L: i R: ►S
D
Rear 5 01 I J Sd
Building Height ! ��
Bldg. Square Footage 1,67 4 % �� �7/
Open Space Footage % `J /
(Lot area minus bldg&paved
parking)
#of Parking Spaces Z
' Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO V DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 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:
� t 1
IS T
Ci ,° Northampton
Ok L-:I---,_ 5 2MU Department
UU 12 ain Street
. D °n pT QF gik INS,Erf��tis R om 100
ton, MA 01060 _ .
phone 413.587.1240 Fax 413.587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION ].-SITE INFORMATION
/ This Sectyan't�r be completed by office
1.1 Property Address:
'
I Vk/e 5 r►, f� r� 4 . Map Loi a it""
P o-e.n e 1/1 A i C Zone Overlay District
Elm St District CB DfstrIct
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ame(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �CC)C) — (a) Building Permit Fee
2. Electrical -7 , L (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 + 3 +4 + 5) `J -700 `� Check Number q753
This Section For Official Use Only
Building Permit Number: �E p/S� t Date Issued;
Signature:
Building Comm issioperlfnspector of Buildings Date
File#BP-2000-0846 VVVV
APPLICANT/CONTACT PERSON HEWINS DANIEL E
ADDRESS/PHONE 1504 WESTHAMPTON RD (413)582-9929 Q
PROPERTY LOCATION 1504 WESTHAMPTON RD
MAP 41 PARCEL 007 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid ZZ13 d
Typeof Construction: DEMO EXISTING SHED&REBUILD 20 X 32 ATTACHED SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE F(�I LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
pproved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § _w/ZONING BOARD OF APPEALS
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
Signature of BuildinK 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.
1504 WESTHAMPTON RD BP-2000-0846
GAS#: ' COMMONWEALTH OF MASSACHUSETTS
'Map-Block:41 -007 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category she BUILDING PERMIT
Permit# BP-2000-0846
Project# JS-2000-1590
Est.Cost: $7700.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin
Lot Size(sq. ft.): 43560.00 Owner: HEWINS DANIEL E
Zoning:RR Applicant: HEWINS DANIEL E
AT. 1504 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
1504 WESTHAMPTON RD (413) 582-9929 O
FLORENCEMA01062 ISSUED ON:417100 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO EXISTING SHED & REBUILD 20 X 32
ATTACHED SHED
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
000" Building 4/7/00 0:00:00 4753 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo