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ENERGY CONSERVATION _4PPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE- AND TWO - FAMILY DETACHED RESIDENTIAL CONSTRUCTION (Igo cMR 6i.00>
Applicant Name: ��' Site Address: �✓ -�–
Print
Applicant Phone: �/
Applicant Signature: Date of Application: 1 ®g
NEW CONSTRUCTION: (choose ONE of the folloNvi t!8 op io !>
I
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE CO'MPONEN'T CRITERIA FOR
NEW O NE- AND TWO - FA MILY BUILDINGS
MAXIMUM MI N MU"M
j Ceiling or Slab
71 Basement
Option 1: Fenestration exposed I Nall Floor Nall Perimeter
AFUE HSPF SEER
U- factor floors R -Value R -Value R -Value R -Value
R -Value and Depth
- National -\ppliance Energy
R - 1 0, Conservation Act (N.AECA) of
R -3 �' �� !, R-1 1957 as amended, minimums or
greater as applicable
i
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
Op ? ti' I REScheck Version 4. 1.2 or later variant softv�vare analysis must be completed
– 1 (780 CMR 61073.2) —.�
A/ I REScheck–NVeb Which can be accessed at hftp•/ /N Nvw.eneravcodes.go�r /rescheeIc/ �
ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS OVER S YEARS OLD*
*Buildings under d years old must use option` I or - -,'2 in New Construction section above.
Complete the following formula to determine the % of glazing:
I
(a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a)
Sr 100 X �. ®d= – �' _ °'o of glazing
(b) Glazing area equals /27 SF b -
rf 01'a7 ;?1 ,� � �.lt 0/- �r1�T�n�h
ff ctla?tno tc G �.���.. ttc� tha Wharf halncz - - --- - -- —4
• - - --
- :• �o� l t� 4
� —_ -__. - -- - - -- - 780 C>t MR TABLE 61 01.3
RE SCRIPT YVi✓' ���'EE G'PE CO �1Pt�'EN1T CRi T T. rililt siv5 Ttr rIST1.IwTr�
LOW-RISE RESIDFtiT7 R f BUII A INGS —
M T ITT 1M M T� t -
Ceiling and Slab Perimeter
Fenestration �Va11 } °loor Basement \fall I R Value
r Exposed floors p
i-,- v aluc -
and Depth
R- Value
39 R -37 a R -13 R - i9 —1 R -IG R -10, 4 feet
--
- -
a R -30 ceiling insulation may be used in place ofK -_ ; if the insulation achieves the tali f � -value o r he e.�tn•e ceiling I
area (i.e. not c ompressed over exterior N� ails, a nd Including any_' access openin
-- -- 1 iNl;0l P �'icttnCr h,t,l ltnT!'�,,,allir,` ttn t < -v r
1 vi — .fin wMitinn nr aitPrajinn to an a
glazing area of said addition exceeds -10 ° r / of the combined gloss «a'I and c,eilin area of the
addition.
Note: OF'ne Co >11 Dell CoF�sE�axea � (found 1 n Appendix 120 .1')
d
DECK
I
i
I
I I
ar -o° X 291-1 ,
I�
1085 sq. ft.
1
E
I �
r _
i
T -10" X 64 I 13' -9" X 8.4
50 sq.ft. 87 sq.ft.
I i li
�l PM�a le
t
0
�I
�✓�� �� 6' -11 "x 12 -0" 10' -3 "x 12' -0" i 13' -10 "x 12
83 sq.ft. 123 sq.ff. 166 sq.ft.
32 -2 " x 24' -0"
518 sq. ft.
i i
/ T -10" x 12 -0"
1ZM 118 sq. ft,
i
; I
11-0 "x4.10" 31 . ft.
� 53 sq. ft. 150 sq. ft.
Y N
C�k
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction F� Supervisor Not Applicab ❑
Name of License Holder c 1 440
License Number
C> s 6�.2 d /O.2
Address Expiration Date
Signature Telephone
0. Registered Nome Not Applicable ❑
12-0 $ 0-6
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- 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...... ❑
11. - Home Owner Exemption
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
�t TtAJ t P�
�=O o f G2t� of & --
$ 8 �asaachnsrtta _ —
Q DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building
N Mass. 01060
WORKER'S COMPENSATION INSURA -NCE AFTTDAVIT
- - -- - -- --
(h�permitz�)
with a principal place of busmess/residence at:
QIIsGZ.
(st=t /city /stalrizi P )
do hereby certify, under the pains and penalties of perjury, that
() I am an employer providing the following ��orkcr s compensation cove age for my
employees working on this job:
(Insurance Company) (Polio Number) (E-- piration Dom) -
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the folloxving workers compensation policies:
(Name of Contractor) (Insurance Compw y/Poticy Number) (Expiration Date)
(Name of Contractor) (insurance Companv /Policy Number) (Expiration Date)
(Name of Contractor) (Laau Compauy/PoUcy Numbu) (Expiration Date)
(Name of Contractor) an_stlrance Company/PoLicy Number) (Expiration Date)
(attach addition! shoe[ ifn«xuuy w inehrde infvcrosrion pauiaing us all ooa'rnGn:a)
f I am a sole proprietor and have no one working for me.
() I am a home owner performing all the work myself.
NOTE: please be awam tbat whilo homcowncn wbo employ peso s to do u==manor , cons:rucuoo or rtpao work on a dwelling of
not more thaw thsoo units is which the bomoowvtr rcadcn or on L b.- ground, appurtcnsn. tbm-do arc cot gcxrstly oocmdcrcd to be
cmployen under the work - s ooc pessatioa Act (GLI52 -z 1(5)), application by a homcownrr for a Geenx or pctnil may evid— the
legal statue of an oaxployor under dw Workoet Coo4xmation Act
I uadesstand that a copy of this sratcmmQ may be fm vmrded to tbo Dopartmm2 of Iodated Aoad—! Offio° of trnun-ooe for tlk�
covcage vcnGc = oa and that failure to scauc covet Lp under section 25A of MOL 152 can lead to tba impon ion of c n=wl pmahics
consisting of a rme of up to S1.300.00 andfor meanest of up to one year and civil pcaa•a io fist form of a Stop Work Ordrr and a
fine of S 100.00 a day agninA mc.
For dq -- ce-1 use poly
Pcrulit Number
MapR Lot
Signab= of LiccnscclPcrmittcc -- - -- fie
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: OL1 rA qh C4 S'¢ 4
Alteration of existing bedroom Yes No Adding new Yes No
Attached Narrative 0 Renovating unfirnshed basement Yes No
Plans Attached Roll 0 - Sheet ❑
6a. I New Q S t31 or addition, #o : #. s1 CO t to the f0f 0W'tf :
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
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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
I , �/l ��L,�r►✓ as Owner of the subject property
hereby authorize :22& ,* ,6 to act on
my behalf, in all
9au ers relati o k orized by this building permit application.
Signature of Owner Date
as O"Mr /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
Signature of Owner /Agent Date
100
135.42
145
150
100
32.6
100
80 150
114.23 100 W .i 100
100
a
150.17
z
LLI 150
100 100
J
150
38.5 251. _ , a
171.14 175
I
{
�o
1 9.6
� 13F 7
2.7 52. --
7,
� 165.99 50.3 0
165.99 50.0
329.04
82.63
138.0
125
200
100 328.53
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontag
Setbacks Front / / 0
Side L: c96" R: -59-/ L: R: _J;�(_
Rear 17
Building Height e e
Bldg. Square Footage //0 g p %
Open Space Footage 02 pqo % r99?9 3
(Lot area minus bldg & paved
p arkin g)
# of Parking Spaces 3
Fill:
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO V DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO �' DON'T KNOW
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 _
No
IF YES, describe size, type and location:
RECE1�/�i� Department use only
CV Ci y of Northampton Status of Permit:
B ilding Department Curb Cut /Driveway Permit
OCT 1 8 2011 212 Main Street Sewer/Septic'AvailabilitIy
Room 100 Water /Well Availability
Feu NQ INS o hampton, MA 01062 Two Sets of Structural Plans
- 87 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
1.1 PropertxAddress This section to be completed by office
5P2— �.0 �e h�Aa Map Lot Unit
Zone Overlay District
Elm St. District CS District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Own of Record
Name (Pri ) Current Mailing Address:
- - -2630
Telephone
Signature
2.2 Authorized Agent:
� � - -°? yid
Name (Print) Current Mailing Address:
Ci �� 7
Signs ure Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) 1 T��o
5. Fire Protection
6. Total =(1 +2+3+4+5) �S Lf 0 ® ® • cc Check Number
This Section For.Official Use Onl
Building Permit Number: Date Issued:
Signature:
Building Commissioner /inspector of Buildings Date
File # BP- 2012 -0407
J �
APPLICANT /CONTACT PERSON RICHARD DENNO � �, l / /.f�V^P,�/ /•h
ADDRESS /PHONE 551 FLORENCE RD FLORENCE (413) 584 -0852
PROPERTY LOCATION 92 GLENDALE RD
MAP 42 PARCEL 078 001 ZONE SR(100 )/ /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out -,
Fee Paid
Typeof Construction: CONSTRUCT 1 ST & 2ND FLR ADDITION & DECK
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/ Statement or License 066189
3 sets of Plans / Plot Plan
THE WLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
olition la
0 -� -��
Sign " of i di g fficial 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.
92 GLENDALE RD BP- 2012 -0407
GIS #: COMMONWEALTH OF MASSACHUSETTS
Ma :Bloc 42 - 078 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 -0407
Project # JS- 2012- 000649
Est. Cost: $50000.00
Fee: $300.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD DENNO 066189
Lot Size(sq. ft.): 25918.20 Owner: POWERS DAVID S
Zoning: SR(100) //WSP II Applicant. RICHARD DENNO
AT. 92 GLENDALE RD
Applicant Address: Phone: Insurance:
551 FLORENCE RD (413) 584 -0852
FLORENCEMA01062 ISSUED ON :1012512011 0:00:00
TO PERFORM THE FOLLOWING WORK.- CONSTRUCT 1 ST & 2ND FLR ADDITION & 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:
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 10/25/20110:00:00 $300.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
i I .LIP