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#:
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