38B-101 (6) BP- 022-0840
48 MUNROE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-101-002 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-0840 PERMISSIONIS HEREBY GRANTE TO:
Project# BATH RENO Contractor: License:
Est. Cost: 29320 ROBERT J WALKER 034783
Const.Class: Exp.Date: 10/18/2023
Use Group: Owner: ROGERS SUSAN CAROL
Lot Size (sq.ft.)
ROGERS SUSAN CAROL
Zoning: URB Applicant: JUST WALKER
Applicant Address Phone: Insurance:
48 MUNROE ST•
NORTHAMPTON, MA �-tOG8
36 Service Center (413)584-1224.0 WMZ-800-8006540
NORTHAMPTON; MA 01060
ISSUED ON:07/19/2022
TO PERFORM THE FOLLOWING WORK:
RENO 2ND FLOOR BATH
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 VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
II; • al 11 >2 T •L
Fees Paid: $190.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I 1 '._____QE7 V---
The Commonwealth of Massachusetts
1Wit Board of Building Regulations and Standar sFO
Massachusetts State Building Code, 7S0 C R ` la 1 822
ZQ IUI AE
I LITY
Building Permit Application To Construct,Repair, enov emolish a R ised Mar 2011
One- or Two-Family Dwellings Nounn,Nr
TN4e4P,�N Pr1SPrCTr
This Section For Official Use Only -'`1---;_ q orn�Drug
Building Permit Number: ap- .3- g i o Date Applied: ` . '
• '/'uU, .2 i 1 r
Building Official(Print Name) Signature I e
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
41? klA ui I2-0 a S-rr 3d 3 161
1.1 a 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) 1.�U—, pro 1)t.-t C Lc I —1- ' rct t-tpt%-- (7-2V'V L ^ ?le LL
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 EK-- Private❑ Zone: _ Outside Flood Zone? ,�
Check if yes': Municipal g vn site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
5 U` AN V--()(0 E(LS tuv cam►F Nr f/? r 0 r u C o
Name(Print) City,State,ZIP
413 ur..1 2i1 . S-i .g-E,4.— ci , A-3 sc=ir1 � iiyv . €3.0
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) /Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
? 'too - cFA:..v - et&'i i 4?-47,rN►A
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2 p c, 4_0 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
i r Z C' 0 Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $
-]'r l f3 u. 2. Other Fees: $
4. Mechanical (HVAC) $ _ List:
5. Mechanical (Fire $
Suppression) Total All Fees: 0 AP
Check No.` heck Amount: Cash Amount:
6. Total Project Cost: $ 2 61 r 3 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-0 34 7 71 tO t 61 23
ed. �Qv't w i�i eV'? License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) V
3f� eD EA2AACVCV N rt
No.and Street Type Description
'I 10 h Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
ST4-►Z24 t-i—r\W—e ie0.5-"S+r"vt'-C\55Cuta4-E5.(Cit`• I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) .7 ZcD i 2a.
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street
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 1'JA _Ac 4�
to act on my behalf, in all matters relative to work authorized by this building permit application.
SL) 6if 7/ ►s42
Print Owner's Name(Electronic 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.
� - w I �� I
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
' Massachusetts �j]f5�` �f<<41
7 �`
{ l 1KK DEPARTMENT OF BUILDING INSPECTIONS
,t
�` ' " 11 212 Main Street • Municipal Building J' s
Northampton, MA 01060arD‘1�C
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: \ At
The debris will be transported by:
Name of Hauler: C
Signature of Applicant: c L« z „/(� Date: 1( it
Lid
The Commonwealth of Massachusetts
L _—_ i= t Department of Industrial Accidents
it y
=11Ii= tit I Congress Street,Suite 100
a ,iF= � Boston, MA 02114-2017
"I
www.mass.gov/dia
%%pikers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO RE:FLED 11 I'III I lIE_PE:RMI7TiNG Airniot1i'I'1.
Applicant Information Please Print L.el!ihiv
Name(BusinessOrgttnization lndividuall:�
Address:
City./Stater'Zip _._. Phone#:
Art'nuns einpkrytr'('heck the appropriate but: Type of project(required).
yiamactrq:loyo1wide ,(1 crrgrluycrs(Nil arid orpart-umc1.• 7- New construction
20 1 am a wk proprietor or purtncnhrp and!laic no employee:working for me to R. Q Remodeling
any capacity.[flu winter:.comp.in:unmet nyturul.(
30!am a humcttwner doing all work myself.jNo workers'curry n=in ce reyurred.)
9. ❑ Demolition
4.0 1 am a Itoorrsuwtr r and will 6e hirut},t:snit:actors to conduct all work on my property. I will
10 a Building addition
crsure that all contractors tuts tither hake workers'corriperhauar insurance or are sole 11.a Electrical repairs or additions
proprwtors with no employees.
12.0 Plumbing repairs or additions
50 i am a general contractor and I have hued the sob-contractors listed on the attacheet sheet l 3_0 Roof repairs
Thin subcontractors have employees and base wwkets'swap.insurance)
o5.o Wen a u corporation and its officers have acre:red owed their nglu of etcmptrun per At(iL e 14. Other
152.S 1(41.and w e have no onpluyees.(No winters'comp-insurance required.j
'Any applicant that chocks bus a 1 must also till out the section below show ins their workers'compensation policy information
+Hantm'uwncrs who submit this affidavit indicating they art doing all work and then her outside contra tors mint submit a new affidavit uadicating such
:Contractor*that check the box must attached an additional sheet showing the nanie of the sub-contractors and state whether or not those entities host
employee:. lithe sub-contractors ha,.:employee:.they mustus tde their workers'comp.puticy 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: , , , IAA,. ►v"W"CV,.c CO •
Policy#or Self-ins. Lie.#: t}J Yy' )z_ - �(LU 'R00 6)516— 2�2! ri Expiration Date: '7 i t 1 7 eZ 5
Job Site Address: 4-c, `1?-0 City Susie Zip: N G iZT x 17 Zy- Mr\
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to state coverage as required under MGL c. 152. §25A is a criminal violation punishable by a line 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 tine of up to$250.00 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.
do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: 7/ 1
2. '
Phone 4: 4 I - `4 — l Z1 2 c1
Official use only. Do not write in this area,to be completed b1'city or town official
(Tits or Town: Permit/license fl
issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
s►40-J 12 Gee. . �� Q OWt
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