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I REPORT THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY CO p SCALE: 11.10' JULY 20, 2001
W1M THE 1976 RULES AND REGULARON5 OF THE REGISTERS 0B
3 HAROLD L EATON AND ASSOCIATES INC.
OF DEEDS OF THE COMMONWEALTH OF MASSACHUSETTS. RRUSIEREO PROFESSIONAL HAOL IMO SURVEYORS
233 RUSSELL STREET - HADLEY - MASSACHUSETTS
RANUAU.FEC ILLH /35O3R .— - n. 4 iR Z.
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46 MUNROE ST BP-2017-0689
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B- 101 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Pennit BP-2017-0689
Project# JS-2017-001132
Est.Cost: $37400.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo: ROBERT WALKER 034783
Lot Size(sq.ft.): Owner: Susan Rogers
zoning: URB(I00)/ Applicant: ROBERT WALKER
AT: 46 MUNROE ST
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Liability
NORTHAMPTONMA01060 ISSUED ON:11/18/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BUILD 2 STORY REAR PORCH
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 N 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 11/18/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File#BP-2017-0689
APPLICANT/CONTACT PERSON ROBERT WALKER J� /"� 0
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 AQ
��� �—�
PROPERTY LOCATION 46 MUNROE ST D Q j)Vvv l""
MAP 38B PARCEL IOt 000 ZONE URB(100)/ f
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 4:}1.1
Fee Paid
Typeof Construction: BUILD 2 STOR A
New Construction -
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 034783
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
Demolit. n la
Signature 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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Seth of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 property Address: This section to be completed by office
4 g Muw stet ST. Map Lot Unit
C y2'fl to 1/✓1Oic Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.� usaoCar l S '}'x ell LOA roc= ST .
Name(Print) Current Mailing Address:
Te-714 f drlephone
Signature
2.2 Authorized Aaent:
V0%23t'tr- `A 4a,.XYt(1 r3b S&2vlCv (o-oScti, Naei2-o-..,y2
Name(Print) Current Mailing Address.
<7.1 3-‘4— 171.1-4
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building .6 (a)Building Permit Fee
2. Electrical (COO. (b) C imatedion fromoof
(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /J
{ +//
6. Total=(1 +2+3+4 +5) Z7, 4-00. Check Number 10 7 7 �J
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
/C
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column m be filled in by
Building Dcpanmcm
Lot Size b -7Gs .we
Frontage 75.1 -7 c I
Setbacks Front IZ ti
Side L: (b R: (Ic L: (6 R: ( (0
Rear 34- r 2-ez a
Building Height 30, 30'
Bldg.Square Footage ,ctSQ 2°1 ° Z.c 7)01
Open Space Footage %
(Dot aa minus bldg&paved 3S 40 S`foy 76 3790 Seo c(2'
parking)
#of Parking Spaces 3
Fill: V S
illume&Lo Location) (�
A. Has a Spec ermit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the it recorded at the Registry of Deeds?
NO DONT KNOW O YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Iss d:
C. Do any signs exist on the property? YES O NO !2"
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exca ion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition I✓ j Replacement Windows Alteration(s) n Roofing n
Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs [Cl] Decks [CI Siding[CI) Other(C)
Brief Descriptio9r�,of Proposed
Work: l7 u•r-() ' WL' SSC %Zf1✓1¢_ PO4ZZ4I-
Alteration of existing bedroom Yes IZNo Adding new bedroom Yes 4/ No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -SaseL_
ea.It New house and or addition tp existing housing, complete the following:
a Use of building : One Family ✓/ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? NO
d. Proposed Square footage of new construction. Z to 9/ft Dimensions at l 13 e /L. 5-Toiz y
e. Number of stories? 2 STUtwi
f. Method of heating? t--.501.-3-C_ Fireplaces or Woodstoves Number of each-----
g.
achg. Energy Conservation Compliance. /"/A- Masscheck Energy Compliance form attached?
h. Type of construction t•-.)Go 1? /..
i. Is construction within 100 ft.of wetlands? Yes Vo. Is construction within 100 yr. floodplain Yes • No
j. Depth of basement or cellar floor below finished grade NON4r__
k. Will building conform to the Building and Zoning regulations? Yes No
I. Septic Tank_ City Sewer ✓ Private well City water Supply
SECTION 7a•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Sa St-tn. C - Zt)6_Lp ,as Owner of the subject
property I_ -- ,
hereby authorize bent c(11 ie
to act on my behalf, in all matters lative to work authorized by this building permit application.
�� P 0 HA 51//(-)
SignatureofOwner / Date
I, [v t2t4ct w,Act ,as Owner/Authorized
Agent hereby declare that the statements at-Vol-nation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
c2„„),,.. .--v,- RI -(tt,
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �n � Not Applicable I
Name of License Holder Fr, rpfcAbC \A/rKLtw� •,C CS — U , 4.7 6 3
License Number
34 S E. (2- c12-M44,1PTD1-/) .&I&- f o ( t L 2t l7
Add Expiration Dale
cF3 - -
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 1
Wu I; 71- W A-L..van_ 1 7 7--o L b
Company Name Registration Number
")y cu.C2Ul6C.- Gid-1`-A'evtt�ULM4 wrdr, /µA- Sll sl. / Zo 17
Address / Expiration Date
Telephone p4 - 12z4-
SECTION 10-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 b ' ing permit.
Signed Affidavit Attached Yes t No .
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occuoied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 108.33.1
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
_t-r- 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation I ns ranceAffidavit: Buil der WContractor sIEIectricians'Rumbas
Applicant information Please Print Legibly
Name (Business/Organizatio&individual): Roy,Pz-cz - tkJ ,(t_ 7 rt-t, cy--tu a- 4 c ce
Address: 9-j Co S&2 V tL% ( gam c'C / G
oto " 4t2 c84- - I2-Ci ty/State/Zip hone #: &
Are y an employer? Check the appropriate box:
I am a general contractor and I Type of project(required):
4.
1. I am a employer with 1 ❑ g
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ ition
working for me in any capacity. errpl ogees and have workers 9. anruilding addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
officers have exercised their 11.❑ Plumbing repairs or additions
3.El I am a homeowner doing all work
mysdt. [No workers cornp. right of exemption per MGL
12.n Roof repairs
insurance required.] ' c. 152, §I(4),and we have no
employees [No workers 13.0 Other
comp. insurance required.]
'Any applicant that checksbox#1 mud al9J fill out thessction blow showing their workers'compelsdionpolicy informdian.
Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-eontralors haieemployers,they mud providethd r workers'comp.policy number.
I am an employe that is providing corkers' 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: City/State/Zip:
Attach a copy of the workers compensation policy declaration page(showing t hepol icy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#:
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):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 46 6Lvo.-5 run cc Cr t c cora-H it
The debris will be transported by:
1 ,(Dr,-<srnua- liC.t
V
The debris will be received by: kLicti '`C---1 C.II i!.(
Building permit number:
Name of Permit Applicant f7d-t2-51—
t ,L tt, I
Date Signature of Permit Applicant