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17C-006 (2) 130901369 ly", I,10' ',jr-iarokind Tirne. Groen faro lf.,cl, hifj Sena Remill" ki, Projt,ct Na,))L,: inyclice to: ,,arTq Email to, Re F.jject N ,e umt) r lri7jli,( rlescript:()n ((-.'o,nmfnts/cwm--jaj hone. II lvyt,uct lolls `-4k IC 21Lriple Number Sample L Sample Description A Attn: Adam Lesko Customer ID: GECL78 Green Environmental Consulting, LLC Customer PO: 296 Sylvester Road Received: 04/14/09 9:55 AM Florence, MA 01062 EMSL Order: 130901369 Fax: (413)341-3419 Phone: (413)341-3418 EMSL Proj: Project: 00126/24 Lake Street;Florence,MA Analysis Date: 4/21/2009 Report Date: 4/21/2009 Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Location Appearance % Fibrous % Non-Fibrous %Type 00126-01A East Window; White 100% Non-fibrous(other) None Detected 130901369-0001 Window Glaze Non-Fibrous Homogeneous 00126-01B South Window: White 100% Non-fibrous(other) None Detected 130901369-0002 Window Glaze Non-Fibrous Homogeneous 00126-02A Roof;Roffng Black 30% Cellulose 70% Non-fibrous(other) None Detected 130901369.0043 Shingle Fibrous Heterogeneous 00126-02B Roof;Roffing Black 30% Cellulose 70% Non-fibrous(other) None Detested 130901369-0004 Shingle Fibrous Heterogeneous 00126-03A Roof;Roofing Black 30% Cellulose 70% Non-fibrous(other) None Detected 130901369-0005 Paper Fibrous Homogeneous 00126-03B Roof;Roofing Black 30% Cellulose 70% Non-fibrous(other) None Detected 130901369-0006 Paper Fibrous Homogeneous Analyst(s) Kevin Pine(6) Renaldo Drakes or other approved signatory Due to magnification limitations inherent in PLM,asbestos fibers in dimensions below the resolution capability of PLM may riot be detected. Samples reported as<1%or none detected may require additional testing by TEM to confirm asbestos quantities.The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical,Inc. EMSL's liability is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client Samples received in good condition unless otherwise noted. NVLAP Lab Code 101147-0,AIHA IHLAP 180179,MA AA000188 PLM-1 THIS IS THE LAST PAGE OF THE REPORT. 1 Asbestos Survey 24 Lake Street(Garage),Florence, MA Page 2 of 2 Limitations This report is intended for the sole use of Alexandra Wagman. This report is not intended to serve as a bidding document nor as a project specification and actual site conditions and quantities should be field- verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users,and use or re-use of this document,the findings,conclusions,or recommendations is at the risk of said user. Although a reasonable attempt has been made to locate suspect asbestos- containing materials(ACM's) in the areas identified,the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and, therefore,all areas of potential ACM. Estimated quantities of ACM are based on professional judgment and practicality. Other unidentified ACM's may be located within walls,ceiling cavities,below flooring or grade,and other non-accessible areas. Caution should be used during any demolition activities. GEC's asbestos inspection was limited to accessible areas of the building and select concealed or inaccessible areas made accessible by demolition using non-powered hand tools. Although limited demolition was performed at select locations to access potential hidden asbestos located behind walls, ceilings and other solid enclosures,it was not within the scope of this survey to fully inspect areas requiring extensive demolition or areas deemed unsafe by GEC's inspector. In addition,electrical systems and/or components were not included in GEC's survey due to the safety issues inherent with sampling such systems. Conclusions/Recommendations No asbestos-containing materials(ACM's)were identified during GEC's inspection. Any suspect asbestos-containing material that is discovered)during building demolition that was not sampled as a part of this inspection should be assumed to contain asbestos until further bulk sample analysis is performed. GEC has been pleased to assist you with this important project. If you have any questions on this survey, the sampling,or the analytical methods employed,please contact us at(413) 341-3418. Sincerely, Green Environmental Consulting,LLC 9UVI Adam Lesko President MA Inspector Uc#A1073071 ,y Ct Green Environmental Consulting, LLC 296 Sylvester Road - Florence,MA,01052 -Tel/Fax(413) 341-3418 April 24,2009 Alexandra Wagman 24 Lake Street Florence,MA 01062 Re: Pre-demolition Asbestos Survey 24 Lake Street-Garage Florence,MA Dear Mrs.Wagman: At your request,Green Environmental Consulting,LLC(GEC) performed an asbestos inspection of the garage building located at 24 Lake Street in Florence,Massachusetts(hereafter referenced as"building"). Fieldwork associated with the inspection was performed on April 13,2009. Background GEC understands that above-referenced building is scheduled for demolition. In accordance with state and federal asbestos regulations,asbestos-containing materials(ACM's)in the building are required to be identified and removed prior to any activity that would disturb the material. Sampling/Results Six(6) samples of suspect asbestos-containing materials (ACM's)were collected and submitted to a properly accredited laboratory for analysis by Polarized Light Microscopy with Dispersion Staining(PLM/DS). Materials found to contain greater than one-percent asbestos by weight are considered to be asbestos- containing materials(ACM's). Refer to Attachment No.l for laboratory results,including detailed description of sample locations,as well as chain of custody records for samples collected during GEC's inspection. No asbestos-containing materials(AGM's)were Identified during GEC's Inspection. The following materials were sampled and determined not to be asbestos-containina materials(less than one-percent asbestos by weight): GreenEnvironmentalCc>nsulting.com Page.J.,� .. A true copy, BUSINESS CERTIFICATE Attest; G,Louise Slysz U, „ OOMMONWEALTH OF MASSACHUSETTS Q, Town Clerk TOWN OF HATFIELD Date c�' -nJ In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare (s) that a business under the title ; ?..................................... is conducted at r � Address: t� .....� 5 L ....1...�`.. .. ' �1. ..Hatfield by the following named persons. j FULL`NAME RESIDENCE lay. ........ .x.4. ............5' .� .....� �:.P., "...�S::z::.... �F� ........................................................... . ............................................................ ........................................................... ............................................................ .......... ....................................................... (SIGNATURE) SIGNATURE ........................................................... (SIGNATURE) THE COMMONWEALTH OF MASSACHUSETTS ...., -......... ...........ss. Personally appeared before me the above named............................................... ... .............. .. ... ..... . .. .. and made oath that the foregoing statement is true. Notary Public, Comm Expires ,�7-/F-// Received and entered, in the office of the Town Clerk of Hatfield, MA Filed.... Business Certificate Book... 1.... Page../6,Z:... G. Louise Slysz, Town Clerk --------------------------------------------------------------------------------------------------------------- A certificate issued in accordance with,this section shall be in force and effect for four years from the date of issue and shall be renewed each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. Certificate Expires.... 4 DEL" i tie; DAVE WICKLES TRUCKING ROLL-OFF RUBBISH REMOVAL AND RECYCLING SERVICE P.O. BOX 382 HATFIELD, MA 01038 TEL:413-247-9231 Jay Rathaus 24 Lake Street Florence, MA 01062 April 23, 2009 Re: Price Quote for Demolition and Removal of Garage Demolish and remove garage at 24 Lake Street, Florence, MA--------------- $2,400.00 All Demolition waste will be hauled and dumped at F&G Recycling in East Windsor, CT. Estimated time to complete job will be 1 to 1 %2 days. The Asbestos Survey Report is the responsibility of the land owner Jay RathausA Alta WO'JMd-1 Payment of$2,400.00 will be paid to Dave Wickles Trucking upon completion of Job. Thank you, David E. Wickles Owner, Dave Wickles Trucking 1, CJuality is the foundation on which we build. it 7 '� t�z . t j S tii `y :- -�'.n Ai,PA Road fpt. ":I;, hsi�_t.',tl�I'. (,�i7I1IlE'Ci_�CL'f'060,19 ;h�i-��^1 i�;�h �_f�';.Ii)-��'•, i.�{.j N/A Fit 1 E -- —:- — AtZGHrM RAIL o.�i. DOIrmMµP �izON'T J% t to W)ve-2 x.4-0 (2 1k1cG111,z 'IVCAL_- ( t6uo.o. " a St-1� 12'ywA t4'WIDE•2°x.4" �A¢.'Vr_ )tIoc r tL`itnfoov 16 yc�sL"°O' I�aa+r stt�FttctG tJ»'tft 9tvr✓s WOob FA561A WOOV or_%AN`(L ftFF-T OY 5 WALl.4-A1-L Ajt2a5 2aY.4t #'T. �1ux q"is CO'MVE - 2",,4° 12`and 1L}`W117fc-22 )'0 &'b" t'� VIN`(LytblaG ovE(� e l2xo.c. a6WOO� CoGP1>MLOm sw_"Cri-tt I 4"x 4' u a - . �rL .z ELI"TE SERIES, , Bu1WIng Code-Confonnsto 20031ntcmadonal Residential Code (portion of the 2009 State building Code•State of Connecticut) •Designed to resist wind gM of 120 MPH for 3 seconds •Design wind force-34 pat •Design snow load-40 psi •Dcoign floor load•100 pff Cx,eltty Is the foundation on which we build: p,tttttuu 216 west Rd Ellington,CT Mom aRU 83.29a) DWG.M°. , ���o ....D C��• 1-8048W FINE 860.871..048 `,`. FAX 860.871.1117 Z 0� www.kloterfarms.com CE. I .m Email:salos@idaterferms.ccm NA 2238 Q f �? S 4( 5233 o4.31q��� SO107 i 07 NEW OUTBUILDING AT 24 LAKE ST. SETBACK 87.8' i 1 S ' SETBACK uj ui ro w <t 771 LAKE STREET EXISTING GARAGE AT 24 LAKE ST. 14 ' SE'l BACK 87.8' ;1APAr 1 - ' SETBACK I f•_ern ir�.�ir nr.,;� �,�,,, W r 1 cc W z' Of ix M Y 77 LAKE STREET HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants person(s)who seek to use the home-owner-exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings(before backfill), sonotube holes (before your). a rough building inspection (before work is concealed), insulation inspection(if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these insuections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing&gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections.Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, lexarJM 5 VA 5 M understand the above. .(Home owner/resident's-sig ature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date IAn 6, lo b°� Address of work location �`� LA kf 51 R-W-t N c5 , MA O M 2., Information ana instructions Massachusetts General Laws chapter I52 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, expi`eSs or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the e.commonwealth for any applicant who.has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152;§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall -enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this.chapter have been presented to the contracting authority." Applicants - Pleas`e 3 ill girt the worl ers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s).name(s),addresses)and phone nurnber(s)aloes with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LL wi -7!e- members or partners, are not required to carry workers'_compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents.-Shoui&you-liav e-any-questions regarding the law-or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured.companies:should enter their Self-insurance-license.number on the appropriate line: City or Town Officials Please be sure that the affidavit is complete and printed Iegibly. The Department has provided a space at the bottom . of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be.sure to fill in the permit/license'himiber.which will be used as a reference number. In addition,an applicant that must submit multiple permiv/ cease applications in any given year,need only submit one affidavit indicating current policy;nR= t;or.,(if necessary)and_under'"Job Site Address"the applicant should write"all locations in (city.or town)."A-copy oftlieaffli3avit that-has-been officially stamped or marked by the city or town may be provided to the , appEcant s �afid affidaidt_Jis filo.far-Tuture.permits or licenses:-A new affidavit must be'f lIedout each _:. _ . . year. Mere-a home Owner r citizen is"obtairiizzg a license or permit not related to;any business or oomnercial venture. i.e. a do license'or' rr it to burn.leaves etc.- said rson is NOT required to co fete this affidavit. (.. . g. pe ). pe eq ?np .. The,Office of investigations,would Irke_to thank you in_advance:for your cooperation and should you Have any questions; please do not hesitate to give us a cal-L The Depart neint's address,telephone and fax number. The Commonwealth ofMassachusetts epmtment-af 16'diis*trraf Accidents Office Gf Investigatians 600 Washington Street Boston,NIA 02111 Tel. # 617-727-4900 ext 406 or 1-877- ; -SSAFE www.tiass.gov, to A The Commonwealth of Massachusetts Department oflndustrial Accidents � = Office of Investigations 600 Washington Street Boston, MA 02111 �,�-- wwrv.massgov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/EIeetriciaus/Plumbers Aonlicant Information Please Print Legibly Name (Business/Orgariizatfon/Individual): Almadna VV 0� nil Address: City/State/Zip: l o re n U M 00'62- Phone#: 913 586 0,5[) l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am.a employer with 4. [] I am a general contractor and I * have hired the sub zontractors 6. New construction employees (full and/or part-time): . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship and have no employees These subcontractors have g, ®"Demolition worlentr for me iii an ca aci. . employees and have workers' Y p ty t S. ❑ Building addition [No.workers comp. insurance comp.insurance. ---._-_ -.--_ - - - 1.0. Electrical re required.) � 5. [] We�-are a corporatton and its pars or additions officers have exercised their 11. Plumbing r 3.❑ I am a homeowner doing all work (� g epau-s or additions myself. [No workers'comp. right of exemption per IvIGL 12.[]Roafrepaizs insurance required l# c' 152;§1(4),and we_have no employees. [No workers' 13.❑ other . comp.insurance required:] *Any applicant that checks box#1 must aiso.fill out the section below showing their woi-k='compensation policy information. tHo meowners who siifiiiit ihis'aflidavit inticat ug"tlueyire doing all work-and-then-hireroats de contractors must-submit anew aSidavit indicating such. =Contractors 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-contractors have employees,they must provide their workers'comp:policy number. 2. Lam an employer that is providing"workers'compensation insurance for my employees. Below is thi pb acy rind job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job.Site Address: City/State/ ip: . Attach a copy of the workers'compensation policy declaration page{showing Me--policy nuImber and expiration date). Failure"to secure coverage as requued under Section 252`oMCM c 152 cau lead a the"impos tt� of � es of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil-p­n- ties m the form of a STOP WORK(JIZDER`arid.a fine of-up to$250.00 a day against the viola tor.'Be.adyised 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 ofperjury that theihformadon provided above is true and correct, Sisnature: Date: - bff eial.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#: -" SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable/ID Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Hone.imptouemenf C©ntractor ._„ , ,.. .; Not Applicable ❑ KUTtR f-A\2,9 S F t�►C HIC- 06t816 Company Name Registration Number 2k(0 1t/ 3-0J 2-0�q Address i ^� g Expiration Date &-TO IN � t o���rl Telephone 3ltg 3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.c. 162,§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...... ❑ •� 1 L HonYe Owner== gem 4.1 The current exemption for"homeowners"was extended to include Owner-occupied 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 108.3.5.1. 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) D Roofing E Or Doors E-1 Accessory Bldg. ® Demolition New Signs [O] Decks [E:] Siding[0] Other[p] Brief Description of Proposed Work: 1)P_'MLoIt5� Aoim, Ruku wAlYle w 61n lotn�cL�►�t��pie Alteration of existing bedroom Yes No Adding new bedroom Yes No C�t15� c Attached Narrative Renovating unfinished basement Yes No ShQf�) Plans Attached Roll -Sheet sa If New house and, addition to existing h'ousinq, 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? d. Proposed Square footage of new construction. Dimensions '•t\' e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 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 1 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. Signature of9wmer__ _____ ____-- __-- _- _ ----_ ___.Date- 1 as Owner/Authorized Agent hereby declare that the statements and information 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 0111r� 5 •S M nature of Owne4Nent Dat Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning is column to be filled in by &A R A3 C O U 16 U I L 0 1 Building Department Lot Size Frontage __..__.. .._. ......,...: Setbacks Front 1 �' 1 Side L:,__ _.__ R L.�.2_ R:"�... Rear . ' Ar' Building Height Bldg.Square Footage 3.02 % o j Open Space Footage % (Lot area minus bldg&paved 4!' r, .73' 0 W= parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued:,. IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 IF YES: enter Book Page' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan Ah that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water.Management Permit from the DPW is required. Oepar eht use only City of Northampton Sta*ot Perrrnt � � ^l �i �� 11 ilding Department Cv D e"ayEPermr -- 212 Main Street Searer/Sep a abty � Room 100 Water=eH Iva a iltty MAY _ $ 20Qg NENiampton, MA 01060 Twoets of Stntctural Puns phone 413-58�i 1240 Fax 413-587-1272 Ploff He Plans -' f i APPLICAT{ON1 ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: /1 q LAKE- J r Map_ Lot Unit LO R 6)'�C E I M A V i O/l,4 l Zone_ Overlay District Elm'St-District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: \AIA(YM A f1 2-al LAKt� ST, fL6'12XN(,C, tA A 01066 Name(Print) 5 Current Mailing Address: 1 1 3J 5' I p - o 8 C J 3 U, Telephone J I l� Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building a a , 0 V D (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 - 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection f1 6. Total=(1 +2+3+4+5) 000 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0939 APPLICANT/CONTACT PERSON WAGMAN ALEXANDRA S&LYNN L WAGMAN ADDRESS/PHONE 24 LAKE ST FLORENCE (413)548-0853 Q PROPERTY LOCATION 24 LAKE ST MAP 17C PARCEL 006 001 ZONE URBO991/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out IL Fee Paid ' YLol Typeof Construction: DEMOLISH&REMOVE GARAGE FOUNDATION&REPLACE W/16 X 24 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOXMATION 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 Demolition Delay 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. } A . q.x.24: ._ B P-2009-0939 GIS#: COMMONWEALTH OF MASSACHUSETTS 7 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0939 Project# JS-2009-001364 Est. Cost: $22000.00 Fee: $96.80 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 9539.64 Owner: WAGMAN ALEXANDRA S&LYNN L WAGMAN Zoning:URB(100)/ Applicant. WAGMAN ALEXANDRA S & LYNN L WAGMAN AT. 24 LAKE ST Applicant Address: P_hone: Insurance: 24 LAKE ST (413) 548-0853 FLORENCEMA01062 ISSUED ON.511812009 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMOLISH & REMOVE GARAGE FOUNDATION & REPLACE W/16 X 24 SHED 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 5/18/2009 0:00:00 $96.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo