17A-285 (4) i
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Rear view 64-66 Lake St. North Hampton
Laged 2" x 8" Wall Support
5/4" PT Decking
2" x81) x12' PT16" 0C
TPL 2" x 1 OTT Front Carrier
4" x 4,' PT
28' ! ---
4,
8" Concrete with 22"Bell
12' Dick
8, 27.5'
I! li
17.5'
24'
T -
$6'
50'
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p4'�t1Aa1P�� t
$ � �Glassacltasetts
DEPARTMENT OF BUILDINTG INSPECTIONS
INSPECTOR '212 Main Street • Municipal Buildinly 5
Northampton, MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sups:-.'sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two-ami y
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 bull mg department f6-f-he City of Northampton wants any 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 iegulations. 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 pour) 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 inspections can result in failure to obtain a certificate of occuvancv
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
understand the above.
( m owner/r ' ignature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
- - issued-to me.
Date �'�/'/ A
Address of work
location -f 66 q -
-
9
o DEPARTMENT OP BUILDr>,IC INSPECTION'S -
212 Blain Strcct - Municipal Building
Northampton, Mass. 010G0
WORJ:CE- R'S CONUENSA71O.N MSURA.NCE AFFMA.VIT
%VILh a principal place of business/residence at: --
(phone:')
(s[r�t/ci rj isZa.tcla p)
do hereby ccrdi ;, under thc.paim and pen2l6es of pc
ri
-ur-y, -Ial
O I am an employer providing die followin-,%vori;es comocns2don coverage Lor Iny
emplovccs Nvoridng on tills job:
(Inszu--n=Conrad) (Polio:Nt= r) — (r:pirtior, Da_l^-)
(') 1 am a sole propretor general contractor homeow-oer(c c;e one) aid have hired
Vine Con tors listed below v�rbc 1iavc the follotv�n` is c, :)en_�don policies:
`L;=,- Oi Contmaor) (Inn�ranc;. COTIlDa�I)./PGUC-i NIUMLC) wuo—
(N=c of CoaTzcIor) (LIS-d ncr- CompaavfPOUM, `umc_r) (Ex-oimtion Date)
(N me of Connaeldr) (Lnsuran= Comnanylpoli(:y tv nor) (Expirdou Daic)
(Namc of Conaactor) aasurancc Company/Policy Numbs) -Expi ztion Daic).
(aa1L!1:ddi�ocilc�.ifacca+_�•to¢tc?vc�iaform,�oa petasain�to all ec�-_.eo�) - _
O I.am a sore proprietor and have no one wort ng for me.
;K) I am,a home owacr performing a1! the work myself.
NOTE:plese be aware tfi,,w Jo bC@A tae 1_bp ploy PC=-.4=[O fSJ -• cs-riao a rcRa_ore on of
oat taocc tb_a t lee�itr is t-imeb the bomoo+wc r=de a oa the pwars jq �tba• r_z oo(C=>rlly oci=d.-cd to he
caV4` ca une-the -�-,=_,:oc A, G L't S 2-1 1(5)).( )).=pplirstioo by n 6amcoQaa fc a 1i�_oc pc^ait rr_y c+-idmrx tf:c
1c�1 n-^••of ea a—�loyx undertSio WorScda Co¢xPooa+lioa net
[uadesx.a.od tha a oopy of this to t!w peya.rtmeoi of In•duxr;,j OT,—or 6 =r+oo=for Lb.
covef-b'e vctiretioa and a"L-iliac to s.==`eovcr,, a tmdc soe oa 25A orhldL 152 m.Ir-d to the itxxpalII On o(eimiasl peasl7ia
eoosrF.rn of a fine of Up to S 1}OO.oO artdfOr i=,y of up to ooc yt-_r e.od affil pmahia in t5e form o(a Slop Work Ord--and s
f=0(S 1 OO.QO a�y a�a,ia:!�• -
Forfir � 1 v,c only
PcrmII t NLLmbc.
Si£OZturr of Lic�IPc miri -TJ3CE I F
SECTION 8-CONSTRUCTION SERVICES J
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9--Re isteEe ,lfai a ni' aventent Gaht�act�ar '` "' -''' m Not Applicable p l
,� .,_
Company Name Registration um er
Address Expiration Date
Telephone
SECTION 1'0-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GeL- 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.....,. 0 No...... O
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 Massachusetts General Laws Annotated.
Homeowner Signature f 'r
f
a
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SECTION 5-:DESCRIPTION OF PROPOSED,WORK(check all applicable)
New House ❑ Addition [].: Replacement Windows Alteration(s) T ofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [[J] Decks U2 Siding JM] Other[p]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new b oom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
"New'] 3.rw �u :�' �, . �"ax3`�-1.'an:+eaar. t•ti„�,.r� :�,±e�w sx
sa �t Neva] Ouse-arvOr r�lO to exxstitT mrisl cr co t��e e46e�
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 attache
d. Proposed Square footage of new struction._ Dimensions
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 wetlandsl, Yes No. Is construction within 100 yr. floodplain Yes No
r
j. Depth of basement or cellar floor bJel6w finished grade
i
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well C water Supply
SECTION Ta OWNER AUTHORIZATION,-TO BE COMPLETED? WHEN
OWNERS AGENT OR'CONTRACTORAPPLIES FOR BUILD ING.PERM T
1, as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authori d t i ding permit application.
Signature of Owner Date
1, as Owner/Authorized
Agent he"9 Oclare that theefate en s and inform n on the foregoing application are true and accurate,to the best of my knowledge
and belief-
Signed under the pains and penalties of perjury..'
c� C
Print Name
Signature of Owner/Agent Date
»
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Section 4. ZONING All Informati6h Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height 777=
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volurne&Location)
A. Has a Special Perm it/Varia nce/Fi nd i ever been issued for/on the site?
'
NO 0 DON'T KNOW 6 YES 0 �
>F YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ����
� DON-r mvuw ,c^
IF YES: enter Book Page: and/or Document#
�� ��
B. Does the site contain o brook, body of water urm/ec|unds? NO ��/�� VV v��DON7K0O YES ���
IF YES, has a permit been or need to be obtained from the Conservation Commission?
'
Needs tobeobtained «��x�� Obtained v~v~.�� OateXssued'
' '
C. Du any signs exist on the property �� ��� YES x�� NO ��/
IF YES, describe size, type and location: i '
D. Are there any proposed changes to or additions of signs intended for the property? YES �~� NO �"`
'
IF YES, describe size, type and location:
E YYUtheonnstmcUnnoctivdydistoMb grading,excavation,nr filling)over 1 acre orisd part oVo common plan
that will disturb over 1acre? YEGK._,] NO E)
r ,�^
}F YES,then a Northampton Storm Water Management Permit from the DPW is required.
� �� ,• - .:a °' man `�. ���.
City of Northampton tP
Building Department
212 Main Street Sewe t
Room 100 . erne �tt�a � �~
Northampton; MA 01060 e s o 5 ctu' ra Mar
phone 413-587-1240 Fax 413-587-1272 tafStte (an � T
®theOpectfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1,-SITE INFORMATION
Thrs sectron to be comfeteci by office
1.1 Property Address:
(v e> �l"�Q, ,j`t MaP "" Lot 14 unit
—�
Zane ti��) _O�erlayDistnct
�ElrttSf.Distrrct "_`` CB Distr�cti .
SECTION,2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
j 1 11 M
Name(Print) ��/� Current Mailing Address'. 3 7 3 Z—
Telephone
Si atgr
2.2 Authorized Agent: -
Name(Print) Current Mailing Address:
Signature Telephone " —
SECTION 3-ESTIMATED,CONSTRUCTION COSTS --
Item y Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 7 (a)Building Permit Fees,oU / Qa0
%'S�cU
2. Electrical (b)Estimated Total Cost of 500.old
Construction.from 6' 7
3. Plumbing Building Permit Fee
�►S�, vv
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number 106 Y f
This Section Fir Official"Use Only
Date
Building Permit Number.' " Issued:
Signature:
r
Building Commissioner/inspector of Buildings Date
File#BP-2006-0576
APPLICANT/CONTACT PERSON Joseph Dumont
ADDRESS/PHONE 3 Hemlock Street Douglas
PROPERTY LOCATION 64 LAKE ST
MAP 17A PARCEL 285 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid VP 5-0, 06 l06
Typeof Construction: ReRoof, Siding,Add a 12x28 Deckdeck
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THEYOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 Co ssion
12�/1'/?—e, 7�_
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.
64 LAKE ST BP-2006-0576
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-285 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category: BUILDING PERMIT
Permit# BP-2006-0576
Proiect# JS-2006-0846
Est. Cost: $7500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13372.92 Owner: Dumont Realtv
Zoning:UR13 Applicant: DUMONT JOSEPH
r. y
Applicant Address: Phone: Insurance:
3 Hemlock Street (50804.76-3732
DouglasMA01516 ISSUED ON:1211312005 0:00:00
TO PERFORM THE FOLLOWING WORK:ReRoof, Siding, Add a 12x28 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: d t� 1`���05 to�(S
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: N'.►::w Qt '�-
THIS PERMIT MAY BE REVOKED BY THE CI OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc si nature:
FeeType: Date Paid:_ Amount:
Building 12/13/2005 0:00:00 $50.00
21.2 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Cormnissioner-Anthony Patillo