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19-004 • c. Landing at each door 36" out and the width of the door minimum 36 ", maximum step 7 3/4" from the top of the threshold and only in- swinging doors. 780 CMR R311.3 13. Stairs have critical standards, make sure you know the floor finishes when planning. Minimum tread 9 ", maximum riser 8 % ", maximum overall variance for the run is 3/8 ", 4" sphere rule on risers, 4 3/8" on balustrade, 6" in the triangle. Graspable rail 1 %" minimum and 2" maximum rail, height minimum 34" maximum 38 ", required for 4 or more risers. Landing to landing constitutes a new run. Minimum 6'8" ceiling height from nosing. 780 CMR R311.7. 14. Guards 36" minimum height above walking surface, a bench is a walking surface, required for more than 30" above floor or grade within 36 ", 4" sphere rule. See 780 CMR R312.1. 15. Educate the plumber and electrician about maximum notch and hole sizes, and placement. See 780 CMR R502.8 and R602.6. In bearing studs holes not larger than 40% of a stud no closer than 5/8 to the edge, In interior non - bearing studs holes not larger than 60% of a stud no closer than 5/8 to the edge, in bearing walls if more than 50% of a plate is cut or notched a 1 %" 16ga. strap must extend a minimum of 6" past the cut both directions and be nailed with 8 -10d per side, or holes in joist are a maximum 1/3 the depth not closer than 2" from the top or bottom. Notches are different. 16. Fire and draft stopping shall be completed before rough inspection. See 780 CMR R302. 17. Ignition barriers in place before final. See 780 CMR R316. 18. Energy aspects shall comply with energy code. See 780 CMR and 2009 IECC. a. Energy information including mechanical equipment posted on the electric panel. 19. Deck ledgers and post must be appropriately attached. Note: ThruLoks are engineered for post attachment supporting a railing. See 780 CMR R502.2.2.1 20. Smoke and CO detectors as required. See 780 CMR R314 and R315. Relevant items must be submitted to the building department for approvals before inspections and or CO can be signed. Other items are intended to avoid costly issues at inspections. Feel free to call if you have any questions. My telephone number is 587 -1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting we close for walk -ins at 12:00 noon on Wednesdays. My email address is: cmiller Thank you for your cooperation on these matters. Chuck Miller ;010 1." 0 01111.F O L____ ity of Northampton Assistant Commissioner and Zoning Enforcement cmiller(7a northamptonma.gov city or N ortnampton Massachusetts t r y r � * DEPARTMENT OF BUILDING INSPECTIONS a 212 Main Street • Municipal Building Northampton, MA 01060 ssbW i INSPECTOR Peter Ciszewski Sr. 230 Damon Road Northampton, MA 01060 October 14, 2011 Subject Location: 230 Damon Road Map Block: 19 - 4 Mr. Cizewski, Your plans dated 10 -14 -11 have been approved as noted. As of August 4 2011 the 8 Addition MA code is the 2009 IRC with MA amendments. In the following are some generic requirements which seem to be problematic. This is not a substitute for purchasing and reading the MA codes. 1. Structures shall conform to 780 CMR 8 addition 1 and 2 family building codes with MA amendments. 2. Grading plan for structures being constructed required. See 780 CMR R401.3 for drainage requirements. 3. Where ceiling joist are not directly connected to the rafters, rafter ties are required. See 780 CMR R802.3.1. Minimum 2x4 16" OC nailed per 780 CMR Table R802.5.1(9) 4" slope 8 -16nd common at each connection. 4. Steel straps over the ridge or 1x4 minimum collar ties are required 4' OC in the upper 1/3` 780 CMR R802.3.1 5. Ridge boards must be the full depth of the cut 780 CMR R802.3. 6. A complete window and header schedule is required. See 780 CMR Table R502.5 for header sizing and number of jack studs required. 7. All framing materials which are not code prescriptive must have stamped engineering. a. LVLs b. I -joist and or Floor Truss c. Roof truss 8. A braced wall plan identifying appropriate braced wall areas and braced wall method being used. See 780 CMR 602.10. a. Garage corners and large corner window /door layout may require special solutions. b. All corners must be appropriately attached to the foundation. 9. Ceiling heights minimum 7' for habitable spaces, 6'8" for bathrooms includes tub /shower area if a shower head is used, 6'8" for basement without habitable space, 6'4" at beams /ducts. 780 CMR R305.1. 10. Hazardous glazing locations, within 24" of a door, or within 60" of a stair, or across from hot tubs, spas, bathtubs within 60" if not 60" above the walking surface, and other locations. See 780 CMR R308.4 11. Windows over 72" above grade with the opening less than 24 above the finished floor shall meet the 4" sphere rule. See 780 CMR R612.2 12. Egress and emergency escape requirements shall be strictly met. a. Windows within 44" of floor, DH 3.3 sqft min window size, Casement 20 "x41" exception 5 sqft at 1 floor. Minimum clear opening 20 "x24" or 24 "x20 ". 780 CMR R310.1.1 b. Two doors remote as possible at the normal level of travel, opening measured from the face of the slab to the stop with door at 90 degrees, one 32" and one 28" minimum 78" high. 780 CMR R311.2 4 X Se 0 a/ r709 ,has, 6 9 11 4 N- b9 4434-c° , a/ 0 r . . Y . . l L 1 ,e 1"°Z, gt),CV e 4 1 /// ,,c, _ _ _ _ ... _ ..i .- - - — . 9 - - - i , )7 6 °I , ir 0414 r l rra/d A / ‹......- _..... ?I ------ / / 1 A . pa l vwi cEe J , , ,I .1,cra-2s t,7 _sa► - tv 5- 'f;')Q)Q1? • 10, Do any signs exist on the property? YES NO X 4. iii AO IF YES, describe size, type and location: n 4 Are there any proposed changes to or additions of signs intended for the property? YES NO x IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES NO X IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED) :A Lot Size } ; 3 0 ( Q.Cr2_ . ,_ Frontage 1 i Setbacks Front 3 v / 30 Side L: q 9 R: ID L: l 1 R: /v ;R Rear (25 / A5 I Building Height / - 1 3 _ I6) Building Square Footage % Open Space: (lot area Iv k . ;, minus building & paved �� �7 t ' - * parking ` _ # of Parking Spaces c # of Loading Docks Fill: (volume & location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. _— Date: y //3 Applicant's Signature r NOTE: Issuan of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards, Department of Public Works and other applicable permit granting authorities. W :\Documents\ FORMS \original \Building - Inspector\Zoning - Permit- Application - passive.doc 8/4/2004 I . RECEIVED N 420(1 _ File No. .- f - ^°r �"^ tQ`.,.' +^ `""'*, "�'. `-- .'' =' ". y a�a 1 � s"°. .. ✓ r' `v T , F # ' i^ Y,,_ r � f� — -. , t ,77 -7„ '€ Y � x © L� H ? r a (' ,,, 4r `� r } J t -- m �. � g � ... . , m.c�,. -��;� s ��__�"� '`fin Ple type or print all information and return th form to the Bu Inspector's Office with the $15 fr fee (check mon order) payable to the City ling ofNorthampton or 1. Name of Applicant: Pe try-f- ? c, Sz e_ A r Address: 3V 0: 1444 r:� 7i. c Telephone: y� �5 7 2. Owner of Property: S a vN €_-- Address: Telephone: 3. Status of Applicant: Owner .___,2„_ Contract Purchaser Lessee Other (explain) 4. Job Location: 0232 u.aw — g r-Q "T r-�- �rre.,- ^rs� -+sv .a^,rz '*'+^% °�^^ a ^�..^�-* »"ra-t ' rev urn'° x �+y .' " i } j r 4 y"7 4 - d s � .-iF" .�w 'Y '� � .' "� s ,, a,. ,,;' r s 4s L s 7 w 3 r r.4 , {, ,,i. u �+ : ';f' J y -:- i f I t x l:- z� i 3. ''""t ' '. 1: - - , .s' rN k lif i K .� ;� m'"� �'r J sx S , � i � A a t� y " .." i 7T'�ro -� r � V=1 r r p a"'c J -��.7 '� . , t ic,_:. r o.;qk- - _ t ' 1 q ., t .. } r 4 t ° � -7 . - -, m F ' "f • d �t g � l i 1 i 9 �V g g i f 6� 4'� r t$ F`r e' � i' ^— x',j•C," x �R. ` 1 5. Existing Use of Structure /Property: rt'IZ I A VI ��— 6. Description of Proposed Use /Work/Project/Occupation: (Use additional sheets if necessary): � t .ri ,I —1-- y c a , 0F41 i Lo d -ooe43 . (... - 'I t r '11 beir,r-plecl ieulo ci ,,,_,,, j 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans 8. 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 DONT KNOW YES IF YES: enter Book Page and /or Document # 9.Does the site contain a brook, body of water or wetlands? NO K DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained date issued: (Form Continues On Other Side) W:\Documentsk.FORMS \o:ig aairl'aildiind ii1sspecto:LGfing_ Peer mi - : : P pi:C3 i :C^ . - Permit, 8/4/2004 • e • File # MP- 2011 -0100 APPLICANT /CONTACT PERSON CISZEWSKI PETER P SR aK ADDRESS/PHONE 230 DAMON RD (413) 695 -7700 0 °4€ PROPERTY LOCATION 230 DAMON RD MAP 19 PARCEL 004 001 ZONE SC(4) /URA(96)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ONING FORM • LLED OUT Building Permit Filled out Fee Paid `� Tvpeof Construction:_ZPA - 12 X 26 ADDITION 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 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 6 1 6/1, Signature of Building 0 ficial 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 the Office of Planning & Development for more information. • Residential Stretch Energy Code Regnirementsl for: E x�e fi� , e t30 e e 'PAM, �� " ® a CIS 3 � a a 11S ear e airs � � �*,� � €: c � � ✓; %5s ' w ' b Y �t � � � �, .. 8 12r °t ..pnhaa Or4o kin 4 °, , or - e 1 3 �a� .,.., o ions4 Prescriptive Performance Prescriptive Performance Conformance to IECC HERS Rating2 w /same If accessing the HERS Rating* 2009, Chapter 4, and area requirements as building envelope, • 85 (o —1 ,999 s.f.) fenestration U- factor new home performance follow prescriptive requirements of path requirements for • 8o (z 2,000 s.f.) ENERGY STAR. Homes additions, plus... ENERGY STAR ENERGY STAR ...meet or exceed 2009 ENERGY STAR Thermal Bypass Thermal Bypass IECC insulation levels Thermal Bypass Checklist3 Checklist 402.1.1, or fully insulate Checklist cavities z R =3.5 /inch Duct tightness Duct tightness requirements, see note requirements, see note below below NOTE on Ducts: EXAMPLES of Renovations /Alterations See code wording on back. If ducts are part of a new • If you are replacing windows and opening part of heating system in an addition or renovation, then the a wall cavity when remodeling a kitchen or stretch code duct standards would apply; if ducts are bathroom, the windows and wall insulation must added to an existing heating /cooling system, then meet the Stretch Code as the envelope is opened; ducts would not need to be tested. appliance choices are exempt; other energy EXAMPLES of Additions features of the existing home could be left as is. • If replacing a heating system, efficiency • Stretch Code applies to additions of any size. specifications would be exempt from the Stretch • Using the prescriptive option, only the addition Code and other efficiency upgrades like windows, has to meet the Stretch Code and the Thermal insulation, water heater, etc. would not be Bypass Checklist; energy upgrades are not triggered. required for the existing home (e.g., new heating • Adding wall insulation must be at least an R -value system, new windows, more insulation, etc.). of 3.5 per inch, but will not trigger window or • If the builder chooses the performance option for heating equipment upgrades, for example. compliance, a HERS rating on the whole house, including the addition, would be required at the EXCLUSIONS same HERS Index as a new home (65/70). • Storm windows installed over existing windows; EXCLUSIONS repairs to existing windows • Re- roofing or re- siding over uninsulated roofs or • Heating /cooling and water heating equipment walls (when sheathing is not exposed) located in the addition, because they are regulated by the Federal Government, not the • Existing ceiling, wall or floor cavities of the State. building envelope, exposed during construction, • Appliance choices for a kitchen located in a new provided empty cavities are filled with insulation addition are exempted by the Stretch Code. at least R3.5 '•.. ' kitchen appliances This handout was compiled on 4.12.10 and 7 -26 -10 by the Center for Ecological Technology (CET) using materials from BBRS, DOER and statewide Energy Code Training materials. www.cetonline.org 2 HERS ratings can only be done on a whole house 3 Unless one is seeking true ENERGY STAR certification, (the Stretch Code is not ENERGY STAR), then a HERS Rater is not required to fill out the Checklist and only the Builder has to verify Checklist items. ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO- FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: 4 print Town: /t» *lii 0-47177Z‘.." , Applicant Phone: 5 6 95 er7 Applicant Signature: /' ;_. r Date of Application __ � Z . /( , NEW CONSTRUCTION (choose °O • .of the following. twooptionsY. .r TartijaidiMBIZairgja gOO I '7^L(Oa,L PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO - FAMILY BUILDINGS MAXCMUM - MINIMUM Ceiling or - Slab Option 1: Basement Fenestation exposed Wall Floor Perimeter Wall. AFUE HSPF SFRR U- factor floors R -Value R -Value R -Value R -Value R -Value and Depth < S R —3 0 National Appliance Encrgy (�/ R -10, Conservation Act (NAECA) of ft_ R -3 8 R . o R -10 * 1987 as amended minimums or M N R -I �l r r p � greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed ('f SO CMR6iiiffied4 6/ 01 „ 1 I 1 v 1 REScheck—Web which can be accessed at http: % /www.eneravcodes.gov /rescheck/ `.ADDITIO ORR.ALT 'ION4i z TO,E X TING Bf DI OVER- VELARS OLT * A *Buildings under 5 years old must use option #1 or #2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b = a) SF s - 70Z o = 5 g g 100 x C� % of lazin (b) Glazing area equals SO SF b a I` g sr�40 A,u chart elnw , ,`£lazing . 40 ► pioceed to r SUNROOW sectiohU 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE.COMPONENT CRITERIA ADDITIONS TO EXISTING LOW -RISE RESIDENTIAL BUILDINGS MAxIMUM MINIMUM ❑ Fenestration U- factor Ceiling and Wall Floor Basement. Wall Slab Perimeter Exposed floors Value ,K v lue ��nn R -Value R -Value R -Value is PP.t III , ;V h e and Depth .9 ,3U R -31 a 1 M:dR -19 R -10 R -10, l�feet a R -30 ceiling insulation may be used in place of R -311 if the insulation achieves the full R -value over the entire ceiling area (i.e. not compressed over exterior walls, and including any access openings). SUNROOM — An addition or alteration to an existing building/dwelling unit where the total 0 glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P) v t_p cle 1 --- , . — - . . t e 13 APR- 15- 2019((THU) 00:14 1 P. 001!001 ci a ® . Precast Concrete Pier* �� P ` • 3 • Vimt Qc) 4 .. ,,.. -lag 11 o • • . +fir .{ q M • bol ' _ 1L. ' • Y . • b • . Y. • • • • a it • • • 5 • 6 • • • • ' • i 4 ' 2 • • • • • ;,, . • G • 2' iv II ... • • • • • • '' '� - - - - • ... �- _. *4_Rebar_.. _- • • • •. • Concrete-4000 P - - -- -- -, Poured With Rebar • e ,.- -`., 4" and Industrial Fiber Overall f is 60" . 24" This 17�awing is . — - :-t" - - - -- __.t_D.OA -- ---- - - -6 -P 5 11--2 9 208- (X Eli ) - -- --- Ja4an-t- u1- -so t-i-m- - =J -- LO O1— ("03m)0 1 0=8di - - tD:d Q- --- J a0 tun t —a_aW 5 attm ')I =j -- f El 6 P1 01 =�VI amilld4 u— Kg — — - - - ! ..fit 13 7 --Q3 , 11 , ! • 1.111111111111111111111116 - _, „act Arli Ills WI el "I) , t ca -Vi n c e J. r11L—. - /7J a/ v j,'"R1:›11. ` E:4 s i✓10 , 50-%. A 1 . ni,,,,,c) l -21-33r -- I 1---;1 � � -a-AA � a `�� � E� 0 1X a . ® vf 109- 3 -' 1 ' ; ,_:„7.0. P ---sr-A— 4- y 0/ 0 --v -ai a 0 v - 0 0 9 I f)r "tar 51. ti. jti/5 ' gy , ,,,,,,,, ---)C7 ..(Ylv 1, troVP117 � 0 h , ti ' i 4 1 1 f'd ),/c(9' . 1r ' ' 1 -a t_a 1 96 vo9 � - 1 G '' c , 0 4 p P 14#-S Qm t ,I a Mo �.r►� �� J *'r` ! ?Ga t p M 1_,-,t0d01 l ot a+ - •N' 'y O ► N e 14" as b h Qe17 1/ Q d 'S c7 la rdrai. l s b • cidfr` i he ad, 9,n/ 1IV ° -z O Q / Q tiw rvi_filwiel4 efi )' O k4 J Q Er 1 i >I s / _ l 1.0 ct,j, City of Northampton 41 t Massachusetts ;` ='! r { ic ° DEPARTMENT OF BUILDING INSPECTIONS r a , 212 Main Street • Municipal Building Northampton, MA 01060 4 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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 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 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 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 ��c'✓�'� - , Ur c' , 7 7 e c e r'" P, (, �'" zeu, a understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date /0/, / Address of work location .1 ct, ke j • • The Commonwealth of Massachusetts Department of Industrial Accidents --. Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): Pie GI Ae-'et.c, 7.34. `f Address: (3 City /State /Zip: att, 7ovim;/, E r9040 Phone #: t . 6 1 ( 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 employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [I Remodeling These sub - contractors have ship and have no employees 8. ❑ Demolition for me in any capacity. employees and have workers' working Y P h'• 9. S. Building addition [No workers' comp. insurance comp. insurance.$ required.] ui 5. (l We are a corporation and its 10.❑ Electrical repairs or additions � 3. IR I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152- can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certcfy under the pains and penalties of perjury that the information provided above is true and correct. oe Sit ature: Date: 0 _ /t Phone #: 5 7 6 / 5 Official 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 ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone e %i s'ere • airs: m:'cover C 'antra • - , - , . 9 ' Ttl., Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSU RANCE AFFICIAVIT (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 etif No ❑ onataiowli -3 011 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 /,r `.r ............... • .1 .Y SECTION 5-'DESCRIPTION O 'PROPOSED WORK .fcheckalt'applicable) r , w New House ❑ Addition 4ki Replacement Windows Alteration(s) n Roofing n Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [0] Other [D] Brief Description of Proposed ,� (� ' t I Work: � 1 fie 4UD L irlit4't( -5 Paz) E. / of t.44 e'rq d Alteration of existing bedroom ' \ Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa" lf:lli tanus arrr! „or a dditiornito `ezis'ting lull siD94+66iiip .e e' hei olloUttiif g: a. Use of building : One Family Two o Family Other b. Number of rooms in each family unit: 5 Number of Bathrooms c. Is there a garage attached? , 4 0 d. Proposed Square footage of new construction. 3 / Dimensions / X s,IQ e. Number of stories? 41 r f. Method of heating? ek iX i o f / ,/ 4 . - ee F=ireplaces or Woodstoves Number of each Energy Conservation Compliance. Ye 75 Masscheck Energy Compliance form attached? h. Type of construction 40 it pQwt e_ i. Is construction within 100 ft. of wetlands? Yes iNo. Is construction within 100 yr. floodpiain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? 4 %. Yes No . I. Septic Tank City Sewer Private well City water Supply . SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN a : , bWNERS'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. Signature of Owner Date I, a art'. p /,w -r ' , 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 eN / /0 /,3/t Signature of Owner /Agent Date = f Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inc Information Existing Proposed Requirod by'Loning This colfmn to be filled in by Buildinit Deportment Z r Lot Size 1 igL'��► 3 00 't! l 4 i _.. . . . 1 Frontage r / 70 i' 17 0 ii Setbacks Front 5 Side L::/ 9 G 1 R: ``= ii' g L:' /0 r 1 R:+ / i i___i ___. Rear Building Height WJ ITT F1 Bldg. Square Footage 7/q = % /+0254' Open Space Footage 11 (Lot area minus bldg & paved 3 E_! parking) # of Parking Spaces :7-2-7-1 i 1 --- ...., „ _ ... ....�,._...., .w...., Fill: - 1 (volume & Location) a A. Has a Se eclat Permit /Variance /Finding ever been issued for /on the site? NO 1 1 „ 2, DON'T KNOW 0 YES CD IF YES, date issued: 3 IF YES: Was the permit recorded at the Registry of Deeds? NO • DONT KNOW 0 YES 0 I i IF YES: enter Book i Page I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ∎'� • DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: { C. Do any signs exist on the property? YES 0 NO t 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. WiII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO ie . IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ED V - '; "1 . • ry y g RECEIV , ity of Northampto s #anus 4f � ,er ►,it' x a � :uilding Department c el , ,' . � �� Qc 1 22et� 21 Main Street Sew r im e ,, t : d Room 100 t r, . " pEcnowNo i ampton, MA 01060 e � °E , atw N".'"'i' 0 - 587 -1240 Fax 413- 587 -1272 Pl � s fa } ` APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S ECTION 1= SITE INFORMATION .. 1.1 Property Address: s fhis section t o be c o m p leted by A . 3 0 7. ReR t fl)MAP';','"::::„:.'....,1,1,'-‘44.: 44.09 '' ,on d r xs Ov Distri a t , ":Y 4 k,+� ; A z! ^ emu q� 't EY.o'i l in 'A 5 , I Sf.. DIstr ct H G ,. DIStr s , SECTION 2 .PROPERTY OW NERSHIPIAUTHORIZED A NT GE m 2.1 Owner of Record: ' Z. t/a 0, 7 3 e#( Name (Print) Current Mailing Address: 5 ,4 eit 5 l .. z,,e;,)____ip..... r Telephone Signature • 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS ".6 Item Estimated Cost (Dollars) to be Official' Use Only • completed by permit applicant (a) Building Permit "Fee 1. Building 2. Electrical (b) Estimated Total n frorrl Cost (6) of _ 3. Plumbing Building PermitFee"" , 4. Mechanical (HVAC) K 5. Fire Protection I ) 6. Total= (1 +2 +3 +4 +5) Check Number`" f This Section For Official Use Only Date uilding Permit Number: issued. B ' Signature. Building Commissioner /inspector of Buildings Date • File # BP- 2012 -0366 fat/(1 '6 kdk) APPLICANT /CONTACT PERSON CISZEWSKI PETER P SR ftA) ADDRESS/PHONE 230 DAMON RD NORTHAMPTON (413) 695 -7700 0 PROPERTY LOCATION 230 DAMON RD MAP 19 PARCEL 004 001 ZONE SC(4)/URA(96)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid �J � I Typeof Construction: CONSTRUCT 12 X 26 BEDROOM ADDITION & CONVERT 2 BEDRMS INTO ONE 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 FOLLO ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I FO TION 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 "4°11111.:1/ 2 -/ iggnature of : uilding 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. 230 DAMON RD BP- 2012 -0366 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 19 - 004 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2012 -0366 Project # JS- 2011- 001693 Est. Cost: $22000.00 Fee: $156.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 13372.92 Owner: CISZEWSKI PETER P SR Zoning: SC(4)/URA(96)/ Applicant: CISZEWSKI PETER P SR AT: 230 DAMON RD Applicant Address: Phone: Insurance: 230 DAMON RD (413) 695 -7700 0 NORTHAMPTONMA01060 ISSUED ON:10/17/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 12 X 26 BEDROOM ADDITION & CONVERT 2 BEDRMS INTO ONE 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 10/17/2011 0:00:00 $156.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner