25C-048 (9) 224 NORTH ST BP-2021-1081
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-048 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2021-1081
Project# JS-2021-001824
Est. Cost:$10000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL HEWINS 049714
Lot Size(sq. ft.): 7579.44 Owner: BRODWYN JANE
Zoning: URB(102)/ Applicant: DANIEL HEWINS
AT: 224 NORTH ST
Applicant Address: Phone: Insurance:
P 0 BOX 186 (413) 582-9929
CHESTERFIELDMA01012 ISSUED ON:4/13/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:ADDITION OF SCREEN PORCH TO EXISTING
DECK IN REAR OF HOUSE
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.
I I' •
r
.>2
Certificate of Occupancy Signature:l
FeeType: Date Paid: Amount:
Building 4/13/2021 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
S �
File#BP-2021-1081 L Q
APPLICANT/CONTACT PERSON DANIEL HEWINS
ADDRESS/PHONE P O BOX 186 CHESTERFIELD (413)582-9929
PROPERTY LOCATION 224 NORTH ST
MAP 25C PARCEL 048 001 ZONE URB(102)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid vtp
Building Permit Filled out
Fee Paid
Typeof Construction: ADDITION OF SCREEN PORCH TO EXISTING DECK IN REAR OF HOUSE
New Construction
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
INFORMATION PRESENTED:
X 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 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
(adia,„,
Sig3ature 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.
`I
The Commonwealth of Massachusetts /
Board of Building Regulations and Standards F 1 'A
i.
WMassachusetts State Building Code, 780 CMR IUSE L`
/
Building Permit Application To Construct,Repair,Renovate Or Demolish a Rev{' 2011 `�<'t
One-or Two Family Dwelling ���q t»o�N�
,`,"n iHsN
�J This Section For Official Use Only �N°\q„4p /1 '
Building Permit Number: 64 ' ,1191 Date Applied \��NS ;
cs/I\0%A,, A, ":. 'b 4*: 1
aa
Building Official(Print Name) Signature t a /Da fe
SECTION 1:SITE INFORMATION
1.1 Property Address: f 1.2 Assessors Map&Parcel Numbers sL` IVoRTHST• orga
l.la Is this an accepted street?yes V 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 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 1E( Private 0 Zone: _ Outside Flood�ne? Municipal l 'On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
JA,I4 91LODwyI4 No ICI NAw\PTo14I MA 0I 060
Name(Print) City,State,ZIP
ZZ N0RTH ST . 0-13) 17,4 - 5,0;13
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Ef Owner-Occupied lEf Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other d Specify: S c R+r ►`A P 0 R C I
Brief Description of Proposed Work': ADD I T I 014 O F 5 C R.F C pJ P o R.C N TP
E4- 15TorIG De-GI( IN “AR or H °Of E / " 11')L 12.'
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:
Check No "Check Amount.$'- Cash Amount:
6.Total Project Cost: $ 1 0 I (J 0 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) o o 7 I ,'- S 1 o/z 2
NC I 5 License Number Expiration Date
Name of CSL Holder List CSL Type(see below) /
p. o. goy I6It'
No.and Street Type Description
C n F S-6 r'F I 6L D w\A O( D i 2. U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
3) Z S O- I`{6. I I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 17 7 9 1 11,3 / 1 z
VA pl I E L f' E W I r S HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street 7/.p M t 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 ❑
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
to act on my beh in all matters relative to work authorized by this building permit application.
.1 11-1 /2,
Print er's Name(Electronic ) Date
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.
tA/JIL NFwIrl$ II-2I2.1
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. 142k 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"
ter, City of Northampton
eg4%. -,,,
Massachusetts ky:
` ti [/" DEPARTMENTOFBUILDING INSPECTIONS212 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: VL t i R t. CY ( ` - N oxTy-A NNP LOp
The debris will be transported by:
Name of Hauler:
Signature of Applicant: \ Y2 / Date: 7/ 1 1
The Commonwealth of Massachusetts
Department of Industrial Accidents
irn,i/l= a 1 Congress Street,Suite 100
ad:4.101 Boston,MA 02114-2017
www mass.gov/dia
U urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumber.
TO BE FILED WITH THE PERMIT11NC AI THORITY.
Applicant Information t Please Print Legibly
Name(Business organvalwa individual): p At I F t` W E'''"I)J 5
Address: P. 0 . L3 o X ) P 6
City/State/Zip: C H E S T E P F I E L P , r'\1\ Phone: O r o 12 (`1 )3 ) SSA ��61
Arc you an employer?Cheek the appropriate boa:
Type of project(required):
I.Q lam a employer with enytloyccs(full•and of part-tuna* 7. Ei New construction
2.24 am a soh:proprietor or partnership and have no employees working Cur nw in 8. O Remodeling
any capacity.[No worker;comp.insurance miliaria!'
9. ❑Demolition
i ant a homeowner doing all work myself.[No workers'can{'_I. Ir.nwc nywnrl.l'
10 Q Building addition
4.0 I am a homeowner and will be hiring contractors to madam all work on my property. I will
ensure that all contractors intlwr have workers'compensation insurance u an:sole I IC Electrical repairs or additions
pruptietun with no employees.
12.0 Plumbing repairs or additions
5 I am a tterteral contractor and I have hind the subaYnttrectors listed on the attached sheet
These sub-euntracton have employees and have worker, n comp.insurance.: 13. I.Wf repairs
6.0 We area corporation and its officers have exercised their rieht of exemption per Mt:l_c.
14.fL�L7other .5" R.FE�
re
152.§1(4),and we'have no ei1r/tloyees.[No workers'comp_Insuranee required.] P oQ('N
'Any applicant that checks hue n1 must also fill out the section below Auxins their workers'compensation policy information.
*homeowners who submit this atlidas it indicating they are doing all work and then hire outside contractors must submit a new affrdav it indicating such.
:Contractor that cheek this box must attached an additional sheet showing lie name of the sub-contractors and state whether tx not those entities have
employees. If the sub-contractors haver employes.they must provide their worker,'curnp.policy nurnbcr_
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: ('ttx State Zip:
Attach a copy of the workers'compensation Miley declaration page(showing the polio number and expiration date).
Failure to secure coverage as requimd under MGL c. 152,§25A is a criminal violation punishable by a tine up to S 1,500.00
and/or one-year imprisonment,as well as civil penalties in the form 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 verity 1 .
I do hereby r•erti der the pains and penalties of perjury that the information provided above is true and correct.
SatnaEwe:
---� Date: 3 I Z / 1)
[tlt.,tt� (4) 3 ) Z S ► 4- 6 I
Official use only. Do not write in this area.to be completed by city or town ofcial
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.('ityffown Clerk 4.Electrical Inspector 5.Plumbing 1nvpretrrr
6.Other
Contact Person: Phone#:
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