17A-245 (15) BP-2023-0398
86 LAKE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-245-001 CITY OF NORTHAMPTON
Permit: Demo
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0398 PERMISSION IS HEREBY GRANTED TO:
Project# DEMO SHED Contractor: License:
Est. Cost: 5000
Const.Class: Exp.Date:
Use Group: Owner: LEMESHOW, STEVEN & ENGEL, HANNA
Lot Size (sq.ft.)
Zoning: URB Applicant: LEMESHOW, STEVEN & ENGEL, HANNA
Applicant Address Phone: Insurance:
86 LAKE ST
FLORENCE, MA 01062
ISSUED ON: 04/06/2023
TO PERFORM THE FOLLOWING WORK:
DEMO 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:
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:
iy i
Fees Paid: $30.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2023-0398 -
APPLICANT/CONTACT PERSON:LEMESHOW, STEVEN &ENGEL, HANNA
86 LAKE ST FLORENCE, MA 01062
PROPERTY LOCATION 86 LAKE ST
MAP:LOT 17A-245-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $30.00
Type of Construction: DEMO SHED
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING 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
Demolition Delay
Sign ture 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.
ce 8;41 g ✓7
The Commonwealth of Massachusetts 1...F. ,- ,
W
_Board of Building Regulations and Standards-- --- 9 _,a,.,1 FOR
,. ..MUNICIPALITY
Massachusetts State Building Code, 780 CMR USE
Building Permit Application To Construct,,Repair,Renovate Or,iio1igf a2Revised Mar 2011
one-or Two-Family Dwelling
This Se .on For Official Use Only
Building Permit Number: 6,- A 3 - Date Applied: 1
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
tilliiMilk6(0 L&L S\- 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes 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)
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 Cl Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Soh 1—tv. s haA Fl y +^'� o ►�v z
Name(Print) City,State,ZIP
L�� irk!-GS 1�Zy S �.erl.ev.tsL���@��,.,,1.c
��„�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
! Accesso Bld . Number of Units Other 0 Specify:
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:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fee .` ‘t I,
Check NiL h. reek Amount: V Amount:
t Cost: 5 J:::; 0 Paid in Full 0 Ou .ndin ance Due:
lae'r
��� � 04111
ASBESTOS REMOVAL
All residential, commercial and institutional buildings are subject to Massachusetts Department of
Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners
and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and heating
contractors, flooring contractors, etc.) need to determine al asbestos containing materials (ACMs),
both friable and non-friable, that are present at the site, and whether or not those materials will be
impacted by the proposed work, prior to conducting any renovation or demolition activity.
Examples of commonly found ACMs include, but are not limited to, heating system insulation, floor
tile and vinyl sheet flooring, mastics, wallboard, joint compound, decorative plasters, window glazing,
asbestos containing siding and roofing materials and fireproofing materials.
Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition
activities, can result in significant penalty exposure, and higher clean-up, decontamination, disposal
and monitoring costs.
A DOS certified asbestos consultant must be contracted to determine if asbestos is present and
whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and DOS.
DOS provides a list of licensed asbestos abatement contractors and consultants. You may wish to
inquire if a contractor has any history of violations. Only DoS licensed and DOS certified asbestos
abatement contractors and consultants may be hired to perform asbestos related work in
Massachusetts.
Received by:
Print Name Title
Signature Date
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
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 Expiration 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 0 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
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.
on
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"
City of• Northampton
Massachusetts 4, cf
r4? am , ti w
DEPARTMENT OF BUILDING INSPECTIONS
+r ^ 212 Main Street fa Municipal Building 1 ..:A.
I r.' Northampton, MA 01060 vs ,‘-"
.. . ,Y i - T
(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:
The debris will be transported by:
Name of Hauler: K.H. AA04r 4 CD-pi,-
Signature of Applicant: Date: 1113/2
BUILDING DEPARTMENT
DEMOLITION PERMIT SIGN-OFF SHEET
Date: s3) 1 12..i
Address: Building Use:
Owner: S LIAneS}1;,J Phone: 41 -Say- 1404
Owner's Address: &Q LAt S}.
UTILITY CUT OFF
(Signature of Authorized Representative of Utility Department required)
As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not
be issued until a release from the utilities is obtained, stating that their respective service
connections and appurtenant equipment have been removed or sealed and plugged in a safe
manner.
Eversource (Gas)
Signature Title
National Grid (Electric)
Signature Title
DPW (Water)
Signature Title
DPW (Sewer)
Signature Title
DPW (Storm water)
Signature Title
DPW (Tree Warden)
Signature Title
DPW Director
Signature Title
Historic Comm. Review
Signature Title
NaoaLtment oo I t ,,,lb,N
Signat e Lt 1 Title
17(N,E 4,1 rt �1 . 0- yG�S 3aJ�rlri 1,1 AA-"i" �14,..iY �trtFtC< . C
W 17t `,J .�1 .'10,A(C a r.._f, q cocci t v�aS lycji. � ,c A V^C., �`(44.,,j.
Ktuih � ,7 . L//3 - 335 UooS----
City of Northampton
's Massachusetts o', - °°cc
41i 1,
41
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �
APPLICATION FOR DEMOLITION PERMIT
Attached are the forms required for a Demolition permit. Please fill out all of the attached forms and
submit them to the Building Department with the appropriate fee. Please make checks out to the City
of Northampton. (Cash not accepted)
Please be advised that disconnect signatures from the following departments must be submitted with
the application:
1. Eversource (Gas division)
2. National Grid (Electric division)
3. Northampton Department of Public Works - Water
4. Northampton Department of Public Works — Sewer
5. Northampton Department of Public Works — Storm water Management
6. Northampton Department of Public Works —Tree Warden
7. Northampton Historical Commission Review (if built prior to 1945)
*Proof of extermination is required to be submitted to the Health Department for all Commercial
demolitions and all abandoned residential properties. (Extermination may be required at the Health
Inspector's discretion if evidence of rodents exists).
Other required documents:
• Massachusetts Construction Supervisors License
• Copy of Workers Comp Affidavit
• Asbestos abatement report
A Demolition Permit will not be issued, and no demolition is to commence until ALL required
documents are submitted to the Building Department.
For further questions or information, please contact this department @ (413) 587-1240
'Pr '..
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston. ,VIA 02114-2017
www.mass.goWdia
Woriters'Compensation Insurance Affidavit:Builders/ContractorsiElectridans/Plumbers.
TO BE FILED WITH I IIE PERMFTTINC At'THORIT .
Applicant Information Please Print Legibly
Name(Buwl.c..,.,i)1-4,Jilliditon InkiLl.Awl p:
Address:
City/StateiZip: Phone z•-•': !
, - —
.kre y au an eniphry cf.t:heek the appropriate Ws: Ts pc of project(required):
1.E3 I am a employer with employees thin*akar part 7. 0 New COndIrt/CliOn
din a sole propnetor or pannershrp and have no employees.working for me in B. 0 Remodeling
.iii)capacity.[No workers'comp.insuninix required]
9. 0 Demolition
Aterr,a homeowner duing all work myself.[No workers`comp.inhtisunue milli:red]°
4 41:24...homeowner and will he hiring oormactors to conduct Jl wink on raty property. 1 will
ensure that all contractors either&ore'minters-ii,Warenzialion in3lsmilLie air aere vOlt 10 in Building addition
i..._,
11.10 Electrical repairs or Ailtlitions
proprietem with no employers
12.0 Plumbing repairs or;uldttions
50 I ant a general L'untrJelor and I base hired the sub-contra:ans.listed on the au:ailed sheet
13.Ej Roof repairs
These aits-f:untraeturs have employee%and have workers'comp.insurance;
Other
6..0 We art a oospormion and im officers have eternised theft right of eXemniplitro per hitiL L . 14.0
152.§if 4).and we have no employees.[No workers'comp.iniumice regain:ft]
l
'Any applicant that chocks KA al nubs Abu till oLl 11,:.,:cti,'it:,,..to.. ,:u .§,ing then A uria-.......ontpensalurt Fnitt,.....y Enformabon_
f.lixneowhers who submit Out.affulairat Ladle:ate[thy arc doang all vkutk and then hue outside contractors mutt.libtfut a new aft-wt.:if it lirflivaline such.
',Contractors that check this box.must attached an addition:a sheet howing the name of the mth-,:ontractor%and stare whether or rur liurNe .it title*h.:3-,
,-inpl,L,.•o.• It',13,.:.‘1.1h,^1:Ctillracturx hate einplt*',..44..s.die!,Musl rriv.ide their stinkers'oornp.puhey number
1 am an employer that is providing woriers*compensation insurance for any employees. Below is the policy and job site
information.
insurance Company Narne: ____
Policy#or Self-ms.Lie.#: Expiration Date:
lob Site Addres': City/State/Zip:
Attach a copy oldie workers'compensation polics declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MOE L.. 152, §25A is a criminal violation punishable by a fine up to S1.500.00
andlor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the vtoidtor. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
critic:ration.
1 do hereby certify under tire pains and pen o/lit nf perjury that the Information provided above is true and correct.
OEM l'‘.--(- --- UMW 41/3/2-7
Phone#:
, .
Official use only. Do nor write in ari. area. to be completed by city or town official
City or Town: Perntit/License#
Issuing Authority(circle unel:
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:
Phone#:
•
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
-- '� Northampton, MA 01060 's ,.>
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
ee 1 -KA-e-?ktZ, / 141,9S
I, J (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 'r rA day of /\ , 2013.
( ignature)
•
City of Northampton
. „ ,,r
Massachusetts -'
Iffi /� DEPARTMENT OF BUILDING INSPECTIONS j ti
212 Main Street • Municipal Building ,7,;.'
Northampton, MA 01060 1y�yv -„:�
CONSTRUCTION DEBRIS AFFID • T
(FOR ALL DEMOLITION AND RENOVATIO 'ROJECTS)
In accordance of the provisions of MGL c 40, S54, a co :ition of Building Permit
Number is that all debris resulti,g from this work shall be disposed of
in a properly licensed waste disposal facility, as d fined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility:
The debris will be tr. sported by:
Name of Hauler:
Signature of Applicant: Date:
oatHAMPT CITY of NORTHAMPTON
DEPARTMENT of HEALTH& HUMAN SERVICES
•ri
• ,, Commissioner--Merridith O'Leary, RS
"4 1.�_,I� Municipal Building-212 Main Street- Northampton, MA 01060
C� P
Phone(413)587-1214—Fax(413)587-1221
V7=4 http://www.northamptonma.gov/245/Health Public Health
Prevent.Promote.Protect.
WITNESS OF EXTERMINATION
Date �' Time f ) `3 0
Property Owner: e\1614 l e1M Q-S'1n.J•J L e m E 6 h d vim"
Property Address: cf"? frek 0 o f Q
Exterminator: r
Company: )7 rYKGG /0to3 Jd% 1L(d4-J
Company Address: ,-10 Sf rr Pt,f l/l e&9L- MOi/C 11C e O4't-�'C- C7/Q&J
Rodenticide/Chemicals Applied /T
Reason for Extermination: Av/A--
Comments: -7 S.f V e S dry Cfcor ti, s a fe'f/i✓.t etf- -40' ) `-sce
I hereby certify, under the pains and penalties of perjury, that Ito the best of my knowledge
and belief, have applied the above noted pesticide in accordance with M.G.L. Chapter 132B
and any other applicable law or regulation.
54 City Water ❑ Well ❑ Septic System
If applicable ❑Yes ❑ No
(sWdLeW 0,15 60/1
Board of Health epresentative ignature of Exterminator
*Demolition best practices relating to fugitive dust and debris must be adhered to in accordance
with MGL Chapter 111, Section 122.