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17A-245 (21)
BP-2024-0364 86 LAKE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-245-001 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-2024-0364 PERMISSION IS HEREBY GRANTED TO: Project# CLOSET 2024 Contractor: License: Est. Cost: 1500 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: 04/04/2024 TO PERFORM THE FOLLOWING WORK: 6X6 UTILITY CLOSET 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(r? Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner I The Commonwealth of Massach 4 c APR eft1s I i Board of Building Regulations and Standaids — - FOR W Massachusetts State Building Code, 7180 CMR MUNICIPALITY LITY , USE Building Permit Application To Construct,Repair, enovcati � leEwised Mar 2011 r , A01Cso One-or Two-Family Dwelling.-----— •- -- - -- This Section For Official Use Only Building Permit Number: 1611- `-I-30 y Date Applied: lieu i^.1< Koss / y-3-z621/ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 11111rtoperty Addre#s: -A/„ Lakes 1.2 Assessors Map&Parcel Numbers rclicumel--,.1 r4 OI OCP Z 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 0 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:' Si--eAke i Le_meS livwJ 610✓1,1"..el-.1 M ik o1 Do 2— Name(Print) City,State,ZIP 6.0 ewe.n. c0114-01-4 Vat Sk ,_W,ej 6,� 'I,c, 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: (Brief Description of Proposed lb'ork2: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) tir:Building y $ /SOO 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: ! Check No.0411 Check Amount: ' t,Total Project Cost: $ / 0 Paid in Full 0 Outstanding Balance Due: I) City of Northampton R HA ^g4, '• Massachusetts , d {: *` it DEPARTMENT OF BUILDING INSPECTIONS „ 212 Main Street • Municipal Building Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC. s 1. 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. 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.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D i 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 ❑ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. Sl.eQ�el Le wte s hoJ � 3Z 344F !wilt-Owner's or Authorized Agent's Na ( lectron c ignature) 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.govloca 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" 4 3..:.,, The Commonwealth of Massachusetts =34201111= Deportment of Industrial Accidents ... se....... ...= 1 Congress Street,Suite 100 ;ay : Boston, M-102114-2017 www.ntass.gothlia 11,iir kers" t'ompensation Insurance A flida v it:Builders/Con tractorstElectricia its/Plu Hikers. III HE PILED ii8 fill 1 HE PERMI fltsiC ALTHOROA. Auntie nu I it for ma thin Please Print Legibls ame OfustIvesavOrsjanization;hubs nitwit: kaieoui 1.4,,,,e_jk v,..4 Address: City/State/Zip,: Phone g: Are yral Oa VIII*,tr?t'heck the appropriate hosi Ty pe of project(required): .ID I am a employer with mamboyees thin imam parssimel... 7. 0 New cotistruction 20 lam a tole proproctor or pannerMip and have ito employees winking for orse in R. 0 Rerriodehng inly ea/win /No workers"cram.EttNLIVALICY requirilil 9.. 0 Demolition S'..0 I ain a lionmowiter Mang all work myself.IN*workers'comp,nustrance revisit-ILI' am a hoineownor and ottl be histrig emaramort to ettadoet all omit ort my property„ 1 will 02( mature ntr ll coactors ithr ee hate maker s'compensation ran ee IN art Nal' 1 0 ID Building addition that a II a Electrical repairs or additions primnetess with no csitiployees, 1 2„Ej Plumbing repairs or additions 50 I MU a mmealsontot and 1 have lmtd the substormactors listed on the anached ahem 130 Roof repairs These tobworaraclon have employees and Lust workers'comp.stimorancm; 14.LI Otte: n.E:1 We are a corporation and in offkors base exorcised their right of exemption per NICOL e. 151.§114),and we loom too entployeen.No awaken'canon.insurance stationed./ *Ay applicant that cheeks box al must alto fill oat the section below show in then*stokers'eomporisation whey Liman* ' olanneownert win,submit dm affidavit intlaratav they am ammo all work and then hoe outside ciminctors man submit a new affair,a otitis-ming stock crattratitay.that chat.*dna box Mika SITAtheil an 1)&12 tiunal stmts.alum into tiro name of the stift-contractors and'nate valetas or not those monies 11.264e vinploy cm if the solso:untiseturs have employees,thev lautl provide their workers'comp.pt.they raandm 1 om an employer that is providing worAers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: — Policy#or Self-ins.Lie.O: Expiration Date: LcAKe S V- Kb A-Lt---e,---1 'I IV CityiStatuZip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expinttion date). Failure to secure coverage a required under NAGE c. 152.§25A ia a criminal violation punishable by a fine up to Si,9)0.00 and/or one-year imprisonment,as well as civil penalties in the form°fa STOP WORK ORDER and a line of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance eoverage verification. I do hereby certify ander the Piiiti.'4 and pentildeS of perjury that the information provided above is true and correct 010.41 ".1 (-1-/47(32%(/1- ...--- -...._ 4 jititima.: Phone;:: Official use only. Do not write in this area,to be completed by thy or town official ' City or Town: PermitiLicense# Issuing Authority (circle one): I. Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: Mimic el: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS rzj 212 Main Street • Municipal Building _ Northampton, MA 01060 ,'h CQNST,RUCTI©N 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: The debris will be transported by: Name of Hauler: S `-"'` Signature of Applicant: Date: 3J2-5/1-y_ City of Northampton �tJ dy y . st .. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 4 ""� ' 212 Main Street • Municipal Building Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT w, itt I, S -% l.c �k 8S (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 at day of Ilierth , 202'{ . (Signs re)