38B-092 (4) 10MUNROEST BP-2019-0049
GIS#, COMMONWEALTH OF MASSACHUSETTS
MaQ:Block:38B-092 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:ADDITION BUILDING PERMIT
Permit# BP-2019-0049
Project# JS-2019-000066
Est Cost$50000.00
Fee: $325.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN YOSHEN 88490
Lot Siae(sp.R.), 4965.84 OWner: HALPER SARAH
Zoning:URB(100)/ Applicant. STEPHEN YOSHEN
AT: 10 MUNROE ST
ApplicantAddress: Phone., Insurance:
P O BOX 41 (413) 695-78010
CUMMINGTONMA01026 ISSUED ON.717612018 0:00.00
TO PERFORM THE FOLLOWING WORK:DEMO EXISTING &ADD NEW MUDROOM
&RENO KITCHEN
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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/16/20180:00:00 $325.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0049
APPLICANT/CONTACT PERSON STEPH:N YOSHEN
ADDRESS/PHONE P O BOX 41 CUMI,INGTON (41')695-7801 .;
PROPERTY LOCATION 10 MUNROE ST
MAP 38B PARCEL 092 001 ZONE URBE001
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 1. ..
Building Permit Filled out
Fee Paid
Tvoeof C nstmcC : DEMO EXISTING&ADD NEW MUDROOM&RENO KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included: _
Owner/Statement or License 88490
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved_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
volition Delay
Signature of Bmidin 'tial Da[
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
rrncr�,� City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
tM1 s 212 Main Street Sewer/Septic Availability
ROOM 100 Water/Well Availability
L= t Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413587-1272 PloVStie Plans
S h
APPLICATION TO CONSTRUCT,ALTEF,RE R,RENOVATE OR D LISI I A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION JUL - 9 2018
1.1 Property Address.
NAdd1d�rePs}sIC.h, This motion to be completed by office
DEPT ONC INSPECTIONS
NOnTHAMPT06 Lot 0VL Unit
IV Munroe ^R
MA
0� 06o Zone Overlay District
Elm SL DisMct CB Dlwrict
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
gacah Ha�per 0 Mjnroe Slnrt N61411Rw .pi, 0060
Name(Print) Cunera Mating Address:
413- 69S -3776
Telephone
Signaw
2 2 Authorized Acent:
�3 Btva�t ►Zit Cpm
Nam ng rens:
695- 7!o
Signature U Telepi ore
SECTION 3-E�TIMATIEO CON5RiU ON C SFS
Item Estimated Cost(Dollars)to be Official Use Only
completedby rintapplicant
1. Building O 0 a (a)Building Permit Fee
2. Electrical 5o (b)Estimated Total Cost of
Construction from 6
3. Plumbing 0 O Q Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) 00 CID Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissiunerlinspeclor of Buildings Data
dp-P keyouS �f11 @ onga l , coo
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Itis[Be Completed.Permit Can Be Denied Due m
To Incomplete Infora[lon
Exisdng Proposed Required by Zoning
ibis edumn to M filled in by
Building Depmrmrnt
I.ot Size qSN, q
Frontage
Setbacks Front
Side L-. R.R. L�R:
Rear as 2s
Building Height 33VA. 33
Bldg.Square Footage I�e� "b /
Footage
/7
Open Space Foge > �j
(Ion atw minus bldg&paved
Intdo-it)
#of Parking Spaces
Fill:
vdumc&L ion
A. Has a S al Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O 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 Q� 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 Issued:
C. Do any signs exist on the property? YES O NO V
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 V
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, ex ation, or filling)over 1 acre or is it part of a common plan
that vAll disturb over 1 acre? YES ( NO
IF YES,men a Northampton Stan Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aodM.ablel
New House ❑ Atltlltion Replacement Windows I AleeranoMs) Q Raofl g Ef
Dr Doors L3
Accessory Bldg. ❑ DemolHbn New Signs [0] Decks [M Siding[o] Other[El
Brief Desgg��ption of Pro oossyy r .1
Work: Ily.,m r ca^F DO fC } ckL
Alteration of existing bedroom_Yes No Adding new bedroom Yes --'�No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
ea. If New house and or addition toexistin housin complete the followIpM.
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unu_�._ Numberof Babnooms
c. Is there a garage attached? 00 � ./g��'
d. Proposed Square footage of new constmction. l .'7-/Y W Dimensions Q X J
e. Number stories? �"� �
I. Method of heating? Fireplaces WOb T[• ,_Number of each
g. Energy Conservation Complian/ce. Masscheck Energy Compliance form attached? IQ,CA
h. Type of construction n, 00 d -F-sk—Z.
i. Is construction within 100 ft.of wetlands?_Yes V/No. Is construction within 100 yr. floodplain_Yes ✓ No
i
j. Depth of basemen[or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No
I. Septic Tank CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ( 'C' 0.�OP/ as Ownerofthe subject
proper,
hereby authorize
to act on my b in; ma relative to work authorized by this building permit application.
Sig MOwner Date
I, —_ PM , as Owner/Aud o ed
Agent hereby d are M statements and inform 'on n the fo 'ng application are true and accurate,to the best of my knowledge
and belief.
Signed under the pairfs and penalties of perjury.
Print
Signa ure of Ager- �7 Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sue
oviwr: �(/� / Not Applicable
Name of Licenw Holder: <+9�( p0yyrhlev� (fS- 059M
M
—t Licecee NumEer
Id �dl hd)°�
Addre Egpualion Date
Signature Telephone
9.Reafstered Home Improvement Contractor: Not Applicable ❑
149yoy
Company Ham Registration Number
O I /d 9 AZO 2y
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.15Z§2SC(8))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide Pais alfidavR will result
in the denial of the issuance of the buildi g permit.
Signed Affidavit Attached Yes...... Id No...... ❑
City of Northampton
n r r Massachusetts
Irk DOWS
212 Min T ee BGI Ici IftnSld mq
zlz Main stxeec on, M.i 01 m.ilai+q �•
NoiTLaq,Wn, Mw 01060
Debris 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.
The debris from construction work being performed at:
/0 MunroE
(Please print house number and street name)
Is to be disposed of at:
JQ l ace-x C-
(Pleaqe print name r
d location Or facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
llbJ
Signature of Pe it App Kant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
--- The Commotrwealth ofMassachusens
Department oflndustrlalAccidenis
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass gov/dia
Aorkers'Compensation Insurance Affidavit:BuildeNContmetors/Elmtriciaos/Plumbem
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Letaflily
Name(Business/Organvetion/Individual): Q,— Y-
05"-Address: �� 9fY�n-�'F �•
City/State/Zip: "0, 0 (Phone#: i(f 3 05- 720\
Are you an emptorer'Caeca ae ap p^ Y boa:
Type of project(required):
I.�Iam a employe wiN employees(full and/or pen-time).* 7. []New construction2.[�Iam soot*propncmr«paVarship asd leave roanPloyees working f«mein 8. sfRemodeling
any capacity.[No works'comp.insurance material 1 ff
3[] be
I am a meowrer doing all work myself[No warters'comp manancc rentsoils q. I_l D¢m011lion
4.[]famahomeow�a�Mwill be M1evg c«�harwrsm ronduct ell wad an my pmp«ty Iwdl 10 EfI adding addition
em«e dot all conuact«seeder have Workers'compem«ion ins«mce«are axle
1 1.[3Elmtrical repmrs or additions
peaMetors wrath no employees' 12.❑Plumbing repairs or additions
5.❑I am agencral mtNacturaM l leave hired the subconnacmrs listed on the amelval shoot 13.[ repo
Roof ins
These subcontrax«s have employees and have wohers'comp.noontime:
6W are a c«Pm«i«,oral its officers have moused then right ofaventmin per hall, 14.[–]Other
152.§](4),and we have no employees.[No wwkers'romp.na«erre required]
*Airy applicant(hist checks be.91 most also fill out the section below showing Nan workers compensation policy information.
t Homoowners who submit this affidavit indicating they are doing all wok and tlan him outside eentmctora mutt submit a new affidavit sidearms suet,
iConaacmts that check this box most smched m additional sheat showing the name ofthe subcawactors and slate whether or net thou entities have
employees. If the subcontmMrs have employs,they must Provide that, wmrkes'amp.policy number.
l am m employer that iv providing workers'compensation iuurancefor my employees. Below u the policy andjob 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 the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a
day against the violator A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do herebyce the nahtes of perjury that the information provided above is fire andcorred.
Simature: Date:
Phone#:
Official use only. Do noal write in this area,as be completed by city or town ofjretai
City or Town: Permit/License#
Issuing Authority,(circle one):
I.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
1n i` Massachusetts
1 / �Fy T>$PBRnffiaT OP =WZHG rnaPSCTZOna y
212 Win Sheet a l impal Guild , ;
e--' Nortl,eepton, Na 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, attention, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing ownerb upied building containing
at least one but not more than four dwelling units....or to structures which an adjacent to such residence or building"be
done by registered contractors.
Note:/fthe homeowner has contracted with a corporation or LLC that entity mast be registered
Type of Work: Q A1;-N� Fs r M A roc Y K:61� R242a&t.Cost: 0 O
,ems
Addressof Work: ID A)nroe Sl�Cr7 /vdr"��7gw, N) �} Cll � rci�
Date of Permit Application: 76 /1 a _
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
til,7lr9 i�� ��
Date Contractor Name i4ll Regtstrntion No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
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