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42-027 (2) 795 WESTHAMPTON RD BP-2017-0418 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42-027 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2017-0418 Project# JS-2017-000692 Est.Cost: $20000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo: DANIEL HEWINS 049714 Lot Size(sq.ft.): 28662.48 Owner: BLAIS RAYMOND&ROSEANNE RISER Zoe Applicant: DANIEL HEWINS AT: 795 WESTHAMPTON RD Applicant Address: Phone: Insurance: P O BOX 186 (413) 582-9929 CHESTERFI ELDMA01012 ISSUED ON:9/28/20I6 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE 15 WINDOWS -WHOLE HOUSE EXCLUDING SUNROOMS * MUST BE ENERGY STAR WINDOWS 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: Driveway Final: 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: FeeType: Date Paid: Amount: Building 9/28/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0418 APPLICANT/CONTACT PERSON DANIEL HEWINS ADDRESS/PHONE P O BOX 186 CHESTERFIELD (413)582-9929 PROPERTY LOCATION 795 WESTHAMPTON RD MAP 42 PARCEL 027 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid , / C) Building Permit Filled out ✓� Fee Paid L. rel(eLIC TypecfConstmction: REPLACE 15 WINDOWS-WHOLE HOUSE EXCLUDING SUNROO S New Construction Non � Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 049714 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR TION PRESENTED: pproved 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 Commission Permit DPW Storm Water Management Sign • - o :ui . ng b cial 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. \ N , Department Cue only - - a E try ofNorthampton statusnfaermu E. / r'\ Lidding Department Curt CuUDv newayP rmit 4 Z tit Main Sireet S xer/345h Availability =cy '� Room 100 WeterNVell Avallabdiq� - _ Northampton, MA 01060 Two Sets of structural Flans ead = phone 413-587-1240 Fax 4113-587-1272 Waterta plane OtherM peciiy _ __- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address'V Y,�/ i ht•s^section to be completed by office 715 eytkAa -o1 ItoZ-, a LOveflay District , Elm t District - Re District_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1Owner of Record: ��yy T� _.... ft4V r Rose0.nne gia,5 Sa• nft Nene(Pont) Cunont Mailing Address: i IS 444 44 a Teiepbone Signature 2.2 Authorized A ent: 1> an, i, l Hfe,tse, •15 _ f•o - BQ- ( p6 CIna s-rc---C, 1.1d Name(Pont) Current Mates;Address: Signature ' Telephone I SECTION 3-ESTIMATED CONISTRUCTION COSTS stern Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1- 5uilding . (a) Building Permit Fee s'L0, 0O — 2 Electrical (b)'cslimnatd Tctal Cost of ConstructtomTom tEl 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) • ft yyl A Pine Protection 6 O / 6. Total=(1 +2+3 +4 +5) `z_• p BOOP -- ,CheckNumber / ) —1 This Section For Official Use Only _ Date Badding Permit Numbers Issued: Signature: auildlnnC mmissianedinspector of Buildings Date Etna, • Oil ke.+Win5 ce eQ 'PlarI • CDM Section 4. ZONING AR Information Must Be Completed_Permit Can Be Denied Duo To Incomplete Informatior. Existing Proposed Required by Zoning This column to be Had in by Building Ceparhnent Lot Size _.. _ .._ S. Frontage Setbacks Front Side L R L ____ R__ Rear -___ ... • Building Height _ Bldg. Square Footage -- "". -'-'_` Open Space Footage ra _ (Lot area minus bldg paved parking) #of Parking Spaces(v Folume&Location) l: A. Has a Spe I Permit/Variance/Finding ever been issued for/on the site? • NO DONT KNOW 0 - YES 0 • IF YES, date issued:__.._ I • • ,, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page L. and/or Document#, B. Does the site contain a brook, body of water or wetlands? NO erii DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Cate Issued C. Do any signs exist on the property? YES . NO l IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property ? YES 0._ NO IF YES, describe size, type and Location: E. Will theoover a construction tcttiYES � tydisturb ring grading, excavation or filling)over 1 acre or is it part of a common plan that will disturb NO IF YES,then a Northampton Storm Water Management Permit from the DEW is required eq, 4 r. e . SECTION G-DESCRIPTION OF PROPOSED WORK(check all spoilable) Plew House I 1 Addition I Rapiacemsnt Yll{thdows _ Aiteration(s) 1-1 Roofing Or Doors I3 Accessow Bldg ❑ Demolition ❑ New Signs IO] Decks trl Siding l0) . Other ID) grief Description of Proposed ,_ cur Work. R'z Ince, 1 $ Win �o`r s' 7O L, lin-telt - PAL1Lto(l iv//< _SW7 r"'G'Ifii7_5 Alteration of existing bedroom Yes V No Adding new bedroom Yes No � Attached Narrative Renovating unhnitadbasaRteF t Yes No, Plans Attached Rall -Sheet Ga.If New house and or addition to existing hou=sing, complete the following: a. Use of building One Family Two Family Other fff b. Number of roosts in each.famify unitNumber of Bathrooms .] { c. Is there a garage attached? /V I A d. Proposed Square footage of new construction_ Dimensions a. Number of stories? f. Method of heating? Fireplaces cr Woodstoves Number of each g. Energy Conservation Compliance- Pdasscheck Energy Compliance form attached? h. Type of construction— ' i. Is construction within 100 it. 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 I. Q£pttifie . jekSL)-sQ/I ,as Owner of the subject property hereby authorize 5-1),/ tj I 6.4— 4-4 EWI14 to act on my behalf, in all matters relative to work authorized by this building permit application. 9 Peja 12 iej„ w 9'11( 16 Signature of Owner Dais IMMINIMSSEMIMMEffiliffEIC I, 1 �1 pit E G. E W I d - as Owner/Authorized As�an hereby declare that the statements and information on the foregoing application are true and accurate,to{he best of my RnowTedge and-belief. Signed under the pss and penalties of perjury. `yKdi( L Hew/ A9 Print Name r /� / Date 1 2 7 cf .7 I 1 Signature of Owner/Agent1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Noma e+License Holdo 0.tJ I L W I J S _ 0 49 7 I y License Number f)eRas. I1?• 6 CMf5M2FIEc.D Slid / tq AddressExpiration Date- Signature 1Telephone - IA —7 -2-5.09. I46I 19. Registered Home Improvement Contractor: __ Not Applicable E SAme 17769 ? Company Name Registration Number Adcress 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 theyuilding permit Signed Affidavit Attached Yes £ No £ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 a.5 ¢pervisor.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 oermiL , As acting Construction Supervisor your presence on the job site will be required from tune to tiinc,'dming and upon completion of the work for which this permit is issued. Also be advised that withmeference 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 Gable 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 I - - '40" The Commonwealth of!ip"hs5rac,?ytse?ts �_u a*. De�pazn sit a o; f-ie?:n 331 " a^ddeasts r'-7d '^t" OObflne ©fInv s$ng 1 ons v t 1j 600 Wa5h10gire Siren Boston,MA 02171 z" _%re Pi'ww.66.e:s:s.g ov"/Loin Workers' Compensation 1111Huutrance Fefndokt lknti1dess/ ontreetorsIEiectridtams/Fbn1Gvers AlpWlicant Imformattsiom �} / .. . Plemse 'Mat Lejfkke Name(Bu.s iess'Organv%gmum3ividuiai): I C 4 (I p W I Address:_ P_ O D o y. J fp=i6 City/State/Zip: C t;1k S T E R t E Li) 4 A Phone#: co - ! hi 6 ! .� Axe you an employer? Check the appropriate box: Type of project(required): I.._ I am a employer with 4. fl I am a general contractor and I f employees (full and/or part-time).* have hired the sub-contractors 6 r: New construction2.[� l am a sole proprietor or partner- listed on the attached sheet, 7. s+ Renodel ng ship and have no employees These sub-contractors have g, fl Demolition working for me in any capacity. employees and have workers' comp. insurance- 9. �W Building addition [No workers' comp. insurance required.) 5. We area Corporation and its 10.(_Electrical repairs or additions 3.11 I am a homeowner doing all work officers have exercised their I I.E Plumbing repairs or additions myself [No workers' right of exemption per MGL, Y comp. 12.r Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.1— Other WI pii79-if comp. insurance required.) R E P t R‘i m rf *Any applicant that checks box#1 must also fill an the section below showing their workers'compensation policy information. tFtlu memvners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If thesubcontractors have employees,they mustprovidetheir workers'comp.policy number- 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 Selifins. Lie. i#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as feqused under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be tbnvarded to the Office of Investigations of the.DIA for insurance coverage verification. y . I do hereby certify the pains and pa nal6es ofpe{jnry that the information provided alcove is true and correct. Signature: I Date: q I17 l I .p� Phone k: 2 4-0 ' / '4 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License a Issuing Authority(circle orae): • 1.Board of Health 2. Building Department 3. City/'Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other _ Contact Person: Phone a: City c f No a-t3-21 amp to , s"rar-B b• r Iu ssachu z - i I f c JB,t/ DrP? ^'RN OF7P J LD JG ECTTONs 0 � 1 • If y, 212 M Street o municipal Building p���°°° _Si 4 rthamnton, ?m 01060 ` 1 ,f INSPECTOR Louis Hasbrouck _ Chuck Miller Building Commissioner e Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNMP. 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made N I, I A understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 9 7 y e5 h k ` f>to , k The debris will be transported by: T i a n ak , v kmc,yc I o The debris will be received by: V dJ1 cy R e c,/c I e Building permit number: Name of Permit Applicant t) a n ' '1 / 117 L. <3 -7 \-71 Date Signature of Permit Applicant