38B-096 BP-2022-0267
30 MUNROE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-096-001 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-2022-0267 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO Contractor: License:
Est. Cost: 38000 ROBERT J WALKER 034783
Const.Class: Exp.Date: 10/18/2023
Use Group: Owner: J KUROSE JAMES F&JULE
Lot Size (sq.ft.)
Zoning: URB Applicant: JUST WALKER
Applicant Address Phone: Insurance:
36 Service Center (413)5 84-1 224 0 WMZ-800-8006540
NORTHAMPTON, MA 01060
ISSUED ON:03/21/2022
TO PERFORM THE FOLLOWING WORK:
2ND FLOOR BATH RENO
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
1
a •
' I
Fees Paid: $285.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
I'il L. F
The Commonwealth of Massachusetts
AAR 1 8 20�2 3oard of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
,�-r.of ru
")� ��li 'g ,App)icati To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
, ron
NORTHAMPTON.MA 01060 _ _1 One- or Two-Family Dwelling
1 This Section For Official Use Only
Building Permit Number: 6P' .2a—�(,p 7 Date A plied:
l4viNJ '' v-55 I/4Z
'3.2,-Zbzz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Asses �L�- r `7(�>Yylap& Parcel Numbexs �,0
Q Yf u NZof_ ST
1.la Is this an accepted street?yes V 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) I- c r A-W L t cA-st.nE / pA. . . -h-r- c t2 l c,a. zwiwk.o Prc.L.
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M 1.. c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public[y3Private Zone:. Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1l'v1fS A Ns) -r -►c V.v f2-0 S-_ KL)c,al-- HA-w, vrt — AA A-
Name(Print) City,State,ZIP
7)0 ON L.;N3 2- i. A15 Sib 1075.-'
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) Ell Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: -vvt,u(G-L_. SG,CuND c&c01/... IS rtH--tt oolt,
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Z7 to J V 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ Z- Co' ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ "\,1 OCR • 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ _
Suppression) Total All Fees: $./
6. Total Project Cost: $ Check No. ell Check Amoung - Cash Amount:
"3e, UUC1• 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
�-S4 783 loftel '1 Zo23
Vt4i T License Number Expiration ate
Name of CSL Holder
List CSL Type(see below)
34 �Cre-Afl:Og (trt-vic I+;-na
No.and Street Type Description
(VVbN 1 0 U 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
w 0A‘aa"r SF Solid Fuel Burning Appliances
Q 13_ ¶'4--122 4 Cavys ructclSSoctbAeS •CUw‘
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) , 2t.)1 b S_ 1t3 I 24,Zz 12..Ov3 vr�¢--f w A- HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
cs
SPYIMP� n,v�-Q
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 Issuanc f 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 o c.i — ln�Jk��c
to act on my behalf,in all matters relative to work authorized by this building permit application.
�1►�►� 1C v-ittvj SC 5�t pl ZaZZ
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.
b-esr-� 12J�m-{1 Yam—_ r I,�' I.1'- 2"-\
Print Owner's or Authorized Agent's Name(Electron?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"
The Commonwealth of:Massachusetts
t`•=== — • Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gor/dia
terkers'Compensation Insurance Affidavit:RuildersiC:ontractorsIEkctricians/Plumbers.
ft)BE FILED WI t11 11IE PERMUTING Atri'IIORITY.
Applicant Information Please Print Leeihh
Name(13ustnesa Organtzntion`individual1:
Address:
City/State/Zip: Phone#:
Are yew an employer'?(leek the appropriate tat: Type of project(required):
am a employes with 11 _,_employees(full andl'm part-time?-* 7. O N construction
?In 1 am n sole proprietor or partnership and have no a tployet worinig for nu:in g. Remodeling
any capacity.[Nu workers'comp.insurance required.]
9. Demolition
30 I ant a hutrntnwncr doing all work myself.[Nu workers'cott{t.inutance regutrte)"
4.0 I am a lionseowmx and will be honing,ontn.►ctun to cundixt all work on my property. I will
10[3 Building addition
ensure that all emit aciurs either hate workers'eonpcn a1s tt insurance or are wie i 1.0 Electrical repairs or additions
prupnetots wuh nu empluyt:c% 7
1 2.❑Plumbing repairs or additions
5/0 I am a getx-r i contractor and 1 lute hired the sub-contractors fisted on the attached sheet_ 130 Roof repairs
These sub-contractors have employes and lute workers'comp.utsumnce.l
(1.0 We are u corporation and its utrteehi have exen rued they night of exemption par 1ttt3L C 1 4. Other
152.61(4).and w e lute nu employees.[No wider.'coop.insurance required.)
*Any applicant that cheeks tax Pt must alw an out the section below slowing tbetir trotters'compensation policy inform:a ten
+liornuuwia:n who submit this drain it indtcatinp they are doing all work and then hire outside ronuactun mmt submit a new aftidat it ysdicating such.
IConuaeiuru that check this box must attached an additional sheet showing the name of the tub-cuntracturs and state wlucther or not those entities hate
employees if the sub-contractors hate employees.tito mull pro+idr their workers'comp.policy nuinber.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sue
information.
Insurance Company Name: .(2i 1'i 114, ( ' 't h/S C u. .--
Policy#or Self-ins.Lie.#: %.t) St'vo7 ro?— 207-c 165 Expiration Date: '` / i , Zct Zz
Job Site Address: -)u iNNyt.fltkP- City/State.2ip: +
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 e. 152. §25A is a criminal violation punishable by a tine up to S1,500.00
ardor 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 verification.
I do hereby certify under the pains and penalties ofperjury that the Information provided above is true and correct
Signature: Date. i 1,0 2.Z
Phone><: 4 (2, c 4- — IZ Z 4--
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 S. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
,1,M r,Z �S . S,
Massachusetts �2Sf�,.- cr
A.
(�N., t ' ,f DEPARTMENT OF BUILDING INSPECTIONS ' j,
212 Main Street • Municipal Building °I: ,'b.
Northampton, MA 01060 ds. ,,, ,10C�
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: V `� `� �y �cL��(-- ` I�v�C1S-A-war-1 sT.
The debris will be transported by:
Name of Hauler: (AY '\,S C
Signature of Applicant: Date: C—I it' Vozz__