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24D-287 (4) 172 CRESCENT ST BP-2021-1082 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-287 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2021-1082 Project# JS-2021-001826 Est.Cost:$15000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DANIEL HEWINS 049714 Lot Size(so.ft.): 6141.96 Owner: PATER JOSEPH V Zoning:URB(75)/URA(25)/ Applicant: DANIEL HEWINS AT: 172 CRESCENT ST Applicant Address: Phone: Insurance: P O BOX 186 (413) 582-9929 CHESTERFIELDMA01012 ISSUED ON:3/30/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE FRONT PORCH AND REPLACE WITH WOOD PORCH IN SAME FOOTPRINT 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 jI. Cr • Certificate of Occupancy signature: 1 FeeType: Date Paid: Amount: Building 3/30/2021 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ff Z (: The Commonwealth of Massachusetts ��„e Board of Building Regulations and Standards Iya MiJNI c Y c�0 V, Massachusetts State Building Code, 780 CMR t�J USF- ^,, Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised MaK72#1 One-or Two-Family Dwelling \,� .'oti is Section For Official Use Only s Building Permit Number:/j0 a7/464' ate Applied: i/0I►J (2055 3 3d Z6Z 1 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property j AddCresbs:�5 C EriT S T. 1.2 AssessorsMap&Parcel Numbg12 �er,S, Li 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 Ei Private❑ Zone: Outside Flood pone? Municipal l"On site disposal system 0 Check if yesPRI SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,jo( PAT FR Nok-r14•A► .PTIHJ , ' A o ) 060 Name(Print) City,State,ZIP 172. C “ C�,jT sT, ('f-/3) '9 P7- S ►73 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building a Owner-Occupied L( Repairs(s) Er Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_ Brief Description of Proposed Work': R F'r 0v F E x 14'r,N G ON R S o N R.y 5 R 0 rf T pozcp . RFPLA (4 wl11-1 wooD PoRCH , b' ), iv l 5FTDf4CK,5 RfmAi,J ✓NCHAtIGEp. 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: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check N heck Amoun : ap Cash Amount: 6.Total Project Cost: $ ) 5 0 p 0 . 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) OtiLQ71 s za/zZ DL I S License Number Expiration Date Name of CSL Holder p.o , D Do I List CSL Type(see below) R. No.and Street Type Description r/S LT �h ,. m O I 0 I z, U Unrestricted(Buildings up to 35,000 Cu.ft.) Cr I R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 1 3 (Q 16 l SF Solid Fuel Burning Appliances J7 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �ArlIE� �} Fwl >JS 1776639 l z"7 �zz HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street /A 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 Issye of the building permit. Signed Affidavit Attached? Yes 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 b ,j l L 1 w 0 N S to act on my behalf;in all matters relative to work authorized by this building permit application. .2 Print er's Name(Electronic Sign �ef-� 104 / ( 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. �)AIJI (4, 1-q`^/1 /45 3ZLZ Print Owner's o uthorized Agent' ame(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 `?? � Massachusetts �÷' .c A. $ DEPARTMENT OF BUILDING INSPECTIONS '212 Main Street • Municipal Building ti lD, •e 'i. a� Northampton, MA 01060 Jspw 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: ° k,T `"` PT0, / VALL � y [Z, CYG E The debris will be transported by: Name of Hauler: 1) Pc � Ewl � S • Signature of Applicant: \ 3 1 /I) t NN 7 Date: The Commonwealth of Massachusetts Department of Industrial Accidents _ /1=t b 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia 11 orders'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE FERMI—ITC%AUTHORITY. Applicant Information Please Print Legibly Name Bohn((hpanmation.lndtcidu:rl►: D ' F L H E '( t S Address: f• 0, D 0 X 1 9 6 City/State/Zip: C C S R F► C t_ D_L R CPhfdhi,#: L 13) Z S o ' I `f b I Are yet ow employe?Check the oppropr1aie box: Type of project(required): 1. 1 am a enpkuycr with eriviloyec+(fill aedror part-time)• 7. New construction 2.211-anu a sod proprietor or purtncrship and have no employees narking for me m g, O Remodeling any capacity.(No workers'comp.in urancc required" 9. ❑Demolition 30 1 am a homeowner doing all work myself.(No workers'comp_insurance required.)' 4.0 I am a homeowner and will he hiring contractors to conduct all wink on my pruputy_ I will 10 0 Building addition ensure that all contractors either have workers'compensation unurance or an:sole I ICI Electrical repairs or additions proprietors with no employers. 12.0 Plumbing repairs or additions 5o I am a general contractor and I have hired the sub-contractors lt.tcd un thr attached sheet 13. OOI repairs These sob t o tractun have employees and have workers'camp.insuraner: D b.a We arc a corporation and its offices hav a rxcrcisedl their right of exemption per MGL C. Othtx r 0 Q 152.41(4).and we have no employees.[No wor►ers•camp.insurance required.) *Any applicant that chocks box al must also fill out the section below showing their woe—Lori compensation policy inhumation. liurncownwn who submit this affidavit indicating they arc doing all surd and then hire outside contractors must suhnut a new affidavit indicating such. :Contractors that check this box must attached an additional duct shining the nave of the sub-curtrxtun and state whether or not those entities have emuployees lithe sub-ctmtracturs have c'trploy'ces.they must pnuvidr their workers'romp.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 Nana::_ Policy#or Self-ins.Lie.#: 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 violation punishable by a tine up to S I.500.(N) 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 veriticat' I do hereh)•certi der the pains and/penalties of perjury that the information provided above is true and correct Sittnature: \ T" Date: 3 11''1- 12) Phone-: (`) ► )) 25D• I `/ 6( 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1)\'') P PE-TA ` Lc ' PPNP`t-f s4-+ ► NGLtS bVE/Z Li / Cg & 5C /-1T 5T, s) ,?. ,, 5wtrx-r irio 014 P (, )4 �? t- pLAc,E eriT 2I6" RPETERS IV o. c, ° � S-PArir' ING b ' I _ — — L -- --- ---.1 \', k A. --14 ! Dov; L ; --) ki._ -4. 4 ? TX .0G I LI IJG (11 E1\ �� ffTT 4" k'f. ( 1 l'i \ /I' muoil -- -1:::::1--car=m=a=z- 1 PT z*. 76::: -7c- . T - A Spy►., 6 ' 6 .i. 6PTPo5T /7 1 - — *-- 0" .(DNo T 4D (1-f) ---IS - , la' 0 . C .