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31A-124 (8) BP-2023-0907 14 JEWETT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-124-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0907 PERMISSION IS HEREBY GRANTED TO: Project# SHED 2023 Contractor: License: Est. Cost: 15000 RICHARD WEST Const.Class: Exp.Date: Use Group: Owner: G COPE JAMES P& SUSAN Lot Size (sq.ft.) Zoning: URB Applicant: RICHARD WEST Applicant Address Phone: Insurance: 10 BARSTOW LN 413-519-7692 HADLEY, MA 01035 ISSUED ON: 07/24/2023 TO PERFORM THE FOLLOWING WORK: 10X14 GARDEN SHED 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: /\ � Fees Paid: $30.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner File #BP-2023-0907 APPLICANT/CONTACT PERSON:RICHARD WEST 10 BARSTOW LN HADLEY, MA 01035 413-519-7692 PROPERTY LOCATION 14 JEWETT ST MAP:LOT 31A-124-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $30.00 Type of Construction: 10X14 GARDEN SHED 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 2 1 IN RMATION PRESENTED: OPCQ� I��S V Approved Additional permits required(see below) Co Nl \Ur b 7 PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Specia Permit With Site Plan Major Project: Site Plan AND/OR Specia Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Varia ce* Received&Recorded at Registry of Deeds Proof Enclose. Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water P.tability Board of Health Permit from Conservation Commission Permit fro CB Architecture Committee Permit from Elm Street Commission Permit DP Storm Water Management Demolition Delay lit ft • 1/P ii723 Sig Iture of Building Official l s d g O cia ate Note: Issuance of a Zoning permit does not relieve a applicant's burden o comply with all zoning requirements and obtain all required permits from Board of Health,Co servation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standa s of MGL 40A.Contact Office of Planning&Development for more information. ' SEC CGeSSo 5�y2cc PCs re.... /40 S ��" �'IV�Cp he Commonwealth of Massachusetts 1 J Bo d of Building Regulations and Standards FOR M sachusetts State Building Code, 780 CMR MUNICIPALITY �Fa USE Np 8Ul(p/ • P mit pplication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 rv'PRTHq TON Mq gezoNS One-or Two-Family Dwelling Qsp _ This Section For Official Use Only Building Permit Number: bfi ' 3 — Q07 Date Applied: Building Official(Print Name) Signature I+ -.7/__Da e SECTION 1:SITE INFORMATION 1.1 Prop.374 Address: l 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes o 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 r 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recor �, / �� D/ , Name(Pant Ci ,State,ZIP Ay Lk- vir# 57 � L (. ; ,/ No.and Street Telephone ail A ress SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Constructiong Existing Building 11 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief p3scription of Pro sed W rk2: /Yew' 7or,�f--te e( 74Y' � i."'c✓r•-) ..:-e✓_ or `7i�r��, SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only . (Labor and Materials) 1. Building $ tJ��'1'I 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ l ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: aGe:eSSrsril Siikat 30 5. Mechanical (Fire $ ((_ Suppression) Total All Fees: $ , (� , Check Noi.VP Check Amountt, _Cash Amount: 6. Total Project Cost: $ 15-O06 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) GS r { G 9? / �; 'j /' T R/,,' ..— / CND,/ License Number E it on Date Name of CSL Holder List CSL Type(see below) 14_ /0 gOi-,,SAI/ kG ht No.and Street Type Description 1-4i/ /VA) D/ 0. — U Unrestricted(Buildings up to 35,000 cu.ft.) [`1/� R Restricted I&2 Family Dwelling City/Town,Stdte,ZIP M Masonry �� RC Roofing Covering WS Window and Siding / ` SF Solid Fuel Burning Appliances /)'- C"&/ // C n'Gn4,-,14/10/ I Insulation Telephone �'— Email address D Demolition 5.2 Re iste ed Home Improve ent Contractor(HIC) / �� iGa t:% l�P`tu HIC Registration Number xpir on Date HI o Nam or HIC a strant Name // 421;.>>*4A ,�4�e.._ /1 4,,J /33 a /1,r -7, pe I- No.rd Street /V �/ 95 96<�f5 — �9.< Email address City/Tow,tate,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 f2( 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 '�G / 4 r, C /, 1:4 to act on my behalf,in all matters relative to work authorized by this building permit application. Vices I`. 6 ii@_-- 7(7 2 3 Print Owner's Name Electro c Signature) 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. / i1U,^r `///a5/ — 7 //z3 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/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 pt Mr,� ..m. S'5 .. SiC •" Massachusetts � 1 DEPARTMENT OF BUILDING INSPECTIONS �. * • "' 'r fkt 212 Main Street • Municipal Building Northampton, MA 01060 syW• ‘ 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: c�Y 1 g--1/„.."J The debris will be transported by: .i Name of Hauler: / Xc' A it le57— Signature of Applicant: 2.4�G ,(/ r/1/t Date: 0�� The Commonwealth of Massachusetts - - f',i Department of Industrial Act idents 1 Congress Street,Suite ii,00 Boston, ,AMA 02114-201 � J www.mass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 1'O BE FILED WITH THE PERMITTING 1tlJTHOR1TY. Applicant Information Please Print Leeibly Name(Business;0rganrzationtIndividual): /gik.,k • C� _ s" 7� Address: �k/'9)ca 16Ne City/State/Zip: t9i Phone#:J/3-� j` 1 Are you an employee?Check the a prorriate bon: Type of project(required): 1.0 I am a employer with employees!full anrl'or part-tinsel.* 7. laNew construction 2 I am a sok proprietor or partnership and have no cn Iu'ei working for me In g. Q Remodeling any capacity.[No workers'comp.insurance mquiraLj 9. ❑ Dernati. 1 am a homeowner doing all work myself.No w'orloas'curry.rmuram:c rc urrah.) 0 Q Building addition 1.0 1 ant a homeowner and will be hiring contractors to conduct all work on my property_ I w t enure that all contractors either hake atorkcrs:corapu-n:katrcm insurance ur arc sulr 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions SC)1 am a grru-ral contractor and I have hired the sob-contractors listed rrrt the atunireel sheet- 13❑Roof repairs These sob-contractors.haws employees and have workers'comp.insurance. 6.0 We arc a corporation and its officers have enemised their nght of exemption per hie L r 14.a OthC1 152,flit,.and we lime no employees.[No workers'ccenp.insurance required.] •Airy applicant that checks bus al roust also till out the section below showing their workers'compensation policy information. homeowner,who submit this atlidaait indicating they arc doing all work and then hire outside contractors must submit a ncu atfufavit irtthieating Much. :Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether rn nut those enirtirs have ctnpluyeca If the sub-contractors have employees.they must provide their workers-comp.policy number I am an employer that Ls providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy 4 or Self-ins.Lie. 4: Expiration Date: Job Site Address: CityiState/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 v Oiation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOPII 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 verification. I do hereby certify un r the tins and penalties a the information provided above is true and correct. Si'nature: ` � Date: *0/473 /Phone 4: 7 � IOfficial use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermitiLicense Issuing Authority (circle one): 1. 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