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38B-099 (10) BP-2022-0970 42 MUNROE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-099-001 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-2022-0970 PERMISSION IS HEREBY GRANTED TO: Project# DECK Contractor: License: Est. Cost: 5500 Const.Class: Exp.Date: Use Group: Owner: ANDERSON MILGRIM DAVID J &KYRA Lot Size (sq.ft.) Zoning: URB Applicant: ANDERSON MILGRIM DAVID J&KYRA Applicant Address Phone: Insurance: 42 MUNROE ST NORTHAMPTON, MA 01060 ISSUED ON:08/12/2022 TO PERFORM THE FOLLOWING WORK: REPLACE DECK 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I • V • - 3195, Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner A. �``The Commonwealth of Massac sett �-- ,. Board of Building Regulations and tan rds�� I t/t, FOR Massachusetts State Building Cod , 780 MR 'PALITY _ CC USE Building Permit Application To Construct,Rep ,Re ovate U tor Iiein h a Revi ed Mar 2011 One- or Two-Family Dw llin e2 This Section For Offici e la v suit Building Permit Number: (j P�d 1 - 170 Date Applied: �AMp oN q OF�o,y4 VE.U1 o &a5s f72 ; 6-I Z-202Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1 1.2 Assessors Map&Parcel Numbers y vril��e �T, 3e� Ogg 1.la Is this an accepted street?yes no Map umber 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' MIIPOwner'of Reco Name(Print) City,State,ZIP r/ 61 0-0 1 (.4 2- M V r r b � 1-/13 713 Q'.�J a-0 d Mill!t M .(Am 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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Pr osed Work /`T Mon,V oe vn, ',j; 7 'A-7 ' ,� 1G. /r�-i -A L� A'A iV P• 7/Y.7, OfG.E, ,hee")40/rat- 1 pit A'1W r. 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 Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. �� heck Amount:4,m6 �i otal Project CAM �� .._- c�) `✓ 0 Paid in Full 0 Outstanding Balance Due: City of Northampton sr•, Massachusetts *ifDEPARTMENT OF BUILDING INSPECTIONS o .w. 1 212 Main Street • Municipal Building t �� Northampton, MA 01060 4'4,11 .1`"• PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. A SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling n' M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiation 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 ❑ No . 0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date OWaR' D 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. t)A V) i'vt 6 iv— timmiummummionlimmaimut Print Owner's or Authorized Agent's Name(Electronic Signature)' 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.govidps 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" k The Contmonwealth of Massachusetts Department of Industrial Accidents = ,.111101111 =11.1112.14 I Congress Street,Suite 100 • .„ Boston.MA 02114-2017 WWW.mass.gorldia %%Others' Compensation Insurance Affidavit: Builders. ontnictorsiElectriciansfPlumbers. RI BF. FILED WITH 1 IIL P}:RMI II t' Al'11101t1IN. Applicant Information Please Print Legibly Name Busincs...c,Organization,Individual): Address: City/State/Zip: Phone#: Air yen en employer?Cheek the appropriate bitt: Ty pe of project (required). 1.01 am a employer rti emproy ries k fall arad'or part-time t_' 7.. Ncw construction 201sma,ule.prupnctor or pustriership and have nu etriployi=s working fur me in gc3 Remodeling an capacity f.No workers'comp.mauninix required.] 9. ED Demolition moiin Ileum:tow ner dome all wort myself.[N workers'comp,insurance required]' 10 Building addition 41110I ant a homeowner and will be hum astUradutri to etledbet ail Nark On my proceny... I Will ensure dila all contractors either have workers°compensatiun insurance 4.1r are sole 1113 Electrical repairs or additions proprietors with no employees_ 12.E]Plumbing repairs or additions 50 I am a general contractor and 1 has-e hired the Ans-cuntraeturs listed on the attadled aheet 13 Rout repairs These sub-contractors hue ellaplu±..ers and ha%e workers;comp.insurance.: 14_ Other 6.0 We are a...-orporatiun and ira officers have exercised their right of exemption per 152.*1.441.and we have no employees.[No workers'comp.insurance ream/ed.! An. NA 41 mita also till uLl I showing their v, policy information Homeowners*Eau 1.1briatt this atrit6Vit 131161:34112g they are:10111IF ail work and then hue ctitside contractors must subiaut a now affidiev it indicating such. ICulatactors that cheek this but must attached an additional sheet show ing the name of the auh-contrachrra and gait:witeituT or not thuse entities have employees. lithe mb-contracturs have emphiyees.lix.y must profile their iurkxna exrip. ke number I am an employer that is providing ovorAers compe&tation insurance far my employees. Below is the polity and lob.alte informality& Insurance Company Name: Policy#or Self-ins.Lic. #1 Expiration Date: Job Site Address: City/State-7in: Attach a copy of the workers" compensation policy declaration page(showing the policy ounibcr And Ckpirlition date). Failure to secure coverage as required under NIGL c. 152. §25A is a criminal violation punishable by a tine up to$1.500.00 andior 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 DR for insurance coverage verification. I do hereby cerriti•under rhe pains and penalties of perjury that the information provided above is trut,and correct. tee .1 rhoilc Official we only. Do not write in this area.to he completed hI'city-or town it/Tula City or Tow n: Permitilicense Issuing Authority (circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other ('ontact Person: Phony City of Northampton „.„.,:„,,,,,,,,,,.. Massachusetts ,... i * , r DEPARTMENT OF BUILDING INSPECTIONS 4 x` y 212 Main Street • Municipal Building Northampton, MA 01060 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: / /`��r1 Vii.-1 J 47 'E ec IIANil^ The debris will be transported by: Name of Hauler: J IA, L/ill hi , -1tk Signature of Applicant: • ` 1/1t04►A't..C.''��1 --, Date: r//1 /42, City of Northampton Massachusetts ;+ *.' DEPARTMENT OF BUILDING INSPECTIONS � '� ` 212 Main Street • Municipal Building Northampton, MA 0106011yL HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, L7 A V 140 l L& )1/1 (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. , 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. /( Signed under the pains and penalties of perjury on this day of A✓f vs"'1 , 20 • (Signature) pit rpoSp ,pie 3 6/ Prilikv tsfa- P01 t ' 2 %d1' 6/sr11 /'vc • 1-A f 7 � � „ �f ��o w G�ST� t1�s (3) 2- /2 I7 /3 Q✓►7 ci4Gr4t7 0 bc.z.11P1 wird 8d.f6geri tJ=0 oLT. 4.4' /?_// G' q' trip y, n/ G N Si JuM,EN4406 1/13flse3cr 5evA 4k si �12 /1l WPrig sr. Mil