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30C-084 Job Truss Truss Type Qty Ply NORTHAMPTON, MA QB1110001 T1GE GABLE 2 1 Job Reference (optional) Truss Engineering Corp., Indian Orchard. MA 01151 - 7.250 s Nov 19 2010 MiTek Industries, Inc. Wed Oct 05 14:52:52 2011 Page 1 ID:NOXjwB ILLeDyAVcPtGEGMOyWRt_-rfCoPn7d5rvgy6OgQGzRfZCL9uykCzfBemrlKl y WRry 1 -0 _ 12 -0-0 24 -0 -0 - -- 5 ' 1 -04 12 -0- f 12 -0-0 1 -0-0 4x4 = Scale = 1:35.1 25 5.00 12 • / • 1 \ 9 1A 1� . - 10 7 Ty -� ' T. } T1 11 T- T % r - . a T a T• 1 ST 26 T TI 12 M y]Q ► i ' i B , 8 �� }] �� __ B2 - El 13 1 3x4 = 22 21 20 19 18 17 16 15 14 3x4 = 5x6 = 24-0-0 -- - -- — -- -----.-__..---- 24-0-0 Plate Offsets (X,Y): 116:0-3-0,0 -3-01 - _ - - _ -- - - -- - LOADING (psf) SPACING 2-0-0 CSI DEFL in (loc) Wen Lid PLATES GRIP — - TCLL 50.0 Plates Increase 1.15 TC 0.21 Vert(LL) - 0.01 13 n/r 120 MT20 197/144 (Roof Snow =50.0) Lumber Increase 1.15 BC 0.12 Vert(LL) 0.00 12 Nr 90 TCDL 10.0 Rep Stress Ina' YES WB 0.14 Horz(TL) 0.00 12 n/a Na BCLL 0.0 " Code IRC2009/TP12007 (Matrix) Weight: 90 b FT = 10% BCDL 10.0 LUMBER TOP CHORD 2 X 4 SPF 1650F 1.5E 10) • This truss has been designed for a live load of 20.Opsf on the bottom chord in all BOT CHORD 2 X 4 SPF No.2 WEBS areas where a recta OTHERS 2 X 4 SPF Stud 6-19= 345 /134, 5-20= 344/95, 3- 22= -430/157, 8-17= -345/134, rectangle 3-6-0 tap by 1-0 0 wide wilt between the bottom chord and any other members, BRACING 9-16= 344/95, 11- 14= -430/157 w th BCDL = 10.Opst, TOP CHORD 11) All bearings are assumed lobe SPF No.2 . Structural wood sheathing directly applied or 6-0-0 oc pudins. NOTES (15) 12) Provide mechanical connection (by others) of Truss to bearing plate capable of BOT CHORD 1) Wind: ASCE 7 -05; 100mph; TCDL= 4.2psf; BCDL= 5.Opsf; h =25ft; Cal. 11; Exp B; withstanding 100 b uplift at joint(s) 2, 12, 19, 20, 21, 22, 17, 16, 15, 14. 13) This truss is designed in accordance with the 2009 International Residential Code Rigid ceiling directly applied or 10 oc bracing. enclosed; MWFRS (low -rise) gable end zone and C -C Comer(3) - to 2-0-0, Exterior(2) 2-0-0 to 9-0-0, Comer(3) 9-0-0 10 12 -0-0, Exterior(2) 15-0-010 22-0-0 zone; sections R502.11.1 and R802_70,2 and referenced standard ANSI/TPI 1. REACTIONS All bearings 24 -0-0. cantilever left and right exposed ;C -C for members and forces & MWFRS for reactions 14)'Senr -rgrd pitchbreaks war fixed " Member end fixity model was used in the (Ib) - Max Ho(z shown; Lumber DOL =1.33 plate grip DOL =1.33 analysis and des gn of this lruss. um 2= 42(LC 8) 2) Truss designed for wind loads in the plane of the truss only. For studs exposed to 15),41 Plates 20 Gauge Unless Noted Max Uplift wind (normal to the face), see MiTek "Standard Gable End Detail' LOAD CASE(S) All uplift 100 Ib or less at joints) 2,12, 19, 20, 21, 22, 3) TCLL: ASCE 7 -05; Pf =50.0 psf (fiat roof snow); Category 11; Exp B; Partially Exp.; Standard 17, 16, 15, 14 Ct =1.1 Max Gray 4) Unbalanced snow bads have been considered for this design. All reactions 250 Ib or less at joint(s) 21, 15 except 5) This truss has been designed for greater of min roof live bad of 16.0 psf or 1.00 limes 2= 376(LC 1), 12= 376(LC 1), 18= 336(LC 1), 19= 421(LC 2), flat roof bad of 50.0 psf on overhangs non - concurrent with other live loads. 20= 387(LC 2), 22= 536(LC 1), 17= 421(LC 3), 16= 387(LC 3), 6) All plates are 1.5x4 MT20 unless otherwise indicated. 14= 538(LC 1) . 7) Gable requires continuous bottom chord bearing. 8) Gable studs spaced at 2-0-0 oc. FORCES (lb) - Max. Comp./Max. Ten. - All forces 250 (Ib) or less except when shown. 9) This buss has been designed for a 10.0 psf bottom chord live load nonconcurrent with WEBS any other Eve loads. 6-19= 345/134, 5- 20=- 344 /95, 3-22=-430/157, 8-17- 345/134, Job _ - Truss ---- - - - -_ - Truss Type Ply NORTHAMPTON, MA QB1110001 T1 FINK 15 1 Truss Engineering Corp, - - -- Job Reference Optional) ___ ng ng orp., Indian Orchard. MA 01151 7.250 s Nov 19 - ED Industries, Inc. Wed Oct 05 14 52:32 he Page 1 gg ID:NOXjwf3ILLeDyAVcP1GEG EGM0yWRt_ Rp Rp? EDy u4pi0 7Y1sgF3clrLNoFgzaWrlF2f?hel3yWRs ' 1-0-0 i 6-3-12 3 12 I - 5-8-4 5-8-4 - G 2 -0 Scale: 3/8 " =1 5x6 = • .' - 5.00 12 j 1.5x4 \\ - 1.5x4 // 1 q AO `- 5 16 • , 17 - a- - - �� B2 \ 7 : a 9 10 11 8 5x6 = 4x6 = 5x8 = 5x6 = 8 -0-0 16 -0-0 _ 24 -0-0 8 -0-0 H 8 -0-0 I -- 8 -0-0 Plate Offsets X,Y : 2:0 -2-0 E. a ej ls:ai o,Eapel, (8:0-4-0,0-3-0i LOADING (psf) SPACING 2 -0-0 CSI DEFL in (loci Merl L/d PLATES GRIP TCLL 50.0 Plates Increase 1.15 TC 0.79 V ert( LL -0.27 8-9 >999 240 MT20 197/144 (Roof Snow=50.0) TCDL 10.0 Lumber Increase 1.15 BC 0.73 Vert(T1) -0.44 8-9 >652 180 BCLL 0.0 • Rep Stress Inc/ YES WB 0.51 Horz(TL) 0.11 6 n/a Ma BCDL 10.0 Code IRC2009/1 (Matrix) Weight: 81 lb FT = 10% LUMBER ------ -- -- - - -- - -...- TOP CHORD 2 X 4 SPF 1650F 1.5E BOT CHORD 2 X 4 SPF 1650F 1.5E TOP CHORD 6)' This truss has been designed for a live load of t on the bottom chord in all WEBS 2 X 4 SPF Stud 2 -12= 3448/368, 12 -13= 3318/385. 3- 13=3158/386, areas where a rectangle 3-6-0 tall by 1-0-0 wide will l 51 fit between the bottom chord and BRACING 3- 14=3027/364, 414 =- 2878/374, 4- 15=- 2878/374, any other members, with BCDL = 10.Opsf. TOP CHORD 5-15=3027/364, 5.16= 3158/386, 16-17=3318/385, 7) AI bearings are assumed to be SPF No.2 . Structural wood sheathing directly applied or 2 -4-4 oc purflns. 6-17 =3448/368 8) Provide mechanical connection (by others) of truss to bearing plate capable of BOT CHORD BOT CHORD withstanding 206 lb uplift at joint 2 and 206 lb uplift at joint 6. Rigid ceiing directly applied or 10-0-0 oc bracing. 2 -9 =273/3044.9 -10= 135/2022, 10.11 =135/2022, 9) This truss is designed in accordance with the 2009 standard International Residential Code 8-11= 135/2022, 6- 8= 273/3044 sections R502.11.1 and R802.10.2 and referenced standard ANSI/TPI 1. REACTIONS (ib/size) 1/VE88 10) "Semirigid iaks with fixed heels" Member end fixity model was used in the 2 = 1831/0 -3-8 (min. 0-2-14) 3-9 859/168, 4- 9= 81/1192, 4.8=- 81/1192, 5-8=-859/169 analysis and dessign gn 01 of this truss. 6 = 1831/0 -3-8 (min. 0 -2 -14) 11) AN Plates 20 Gauge Unless Noted Max Horz NOTES (11) 2 = 41(LC 8) 1 Wind: ASCE 7 -05: 1 LOAD CASE(S) Max Uplift ) Orise) gable end and C-C Exterior(2) h=2) -1-0-0 Cal. o ; - 0 - B; Standard enclosed; MWFRS (low-rise) gable end zone and C-C Exterior(2) -1 -0-0 l0 2 -0 -0, 2 = - 206(LC 8) Interior(1) 2-0-0 to 9-0-0, Exterior(2) 9-0-0 to 12.0.0, Interior(1) 15-0-0 to 22-0 -0 zone; 6 = - 206(LC 9) cantilever left and right exposed :C-C for members and forces 8 MWFRS for reactions shown; Lumber DOL =1.33 plate grip DOL =1.33 FORCES (lb) - Max. Comp /Max. Ten. - All forces 250 (lb) or less except when shown. 2) TCLL: ASCE 7-05; Pf=50.0 psf (flat roof snow); Category 11; Exp B; Partially Exp.; TOP CHORD Ct =1.1 2- 12= 3448/368, 12-13=-3318/385, 3-13=-3158/386, 3) Unbalanced snow loads have been considered for this design. 3-14'- 3027/364, 414 =2878/374, 4-15= 2878/374, 4) This truss has been designed for greater of min roof live load of 16.0 psf or 1.00 times 5-15=3027/364, 5.16=3158 /366, 16-17=-3318/385, flat roof load of 50.0 psf on overhangs non - concurrent with other Iva loads. 6-17=3448/368 5) This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other live loads. \l 6 (L 1 1 r /LS Cardnal 11- 7 -11 LE ,E/ �r KeyBeam 134 Clement St. 131 C 1 S-1, 8 :11am Northampton, Ma. 1 of 1 KeyBeam® 4.507f kmBeamEngine 4.509s G ��.. - / � , t 74 p R Materials Database 1314 + O l G/ Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: IBC / IRC Dead Load: 10 PLF Deflection Criteria: L/360 live, L/240 total Live Load: 40 PLF Deck Connection: Nailed Member Weight: 9.4 PLF Filename: KYB1 Other Loads Type Trib. Dead Other (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PSF) Top 0' 0.00" 9' 6.00" 13' 0.00" 10 50 Live al y tb rqy 41.4 , f' 5 t° "yx 'S"'17 x . x'y;.7�^ 'Z' ri r 9 ' " e' �t� x � € µ, ms a y 2rr'�_� H�� r � " ��R ��}t �`.. -� i? iSt tt G ' a�s ] "5g �`3 hM�4i�..��5't '1•,,5'c,��l�i, 1'� 4 '.* f . :Litt " `-.rig:41;.k+, - f ai--._.�.M,�+r.V t' i n n „' $ aigg k ., wk`s 5 tw A 9 6 0 9 6 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall Steel 3.500" 1.500" 3577# -- 2 9' 0.750" Wall Steel 3.500" 1.500" 3577# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live 1 632# 2945# 2 632# 2945# Design spans 9' 0.750" Product: 1- 3/4x9 -1/2 VERSA -LAM 2.0 3100 SP 2 ply Component Member Design has Passed Design Checks.** Design assumes continuous lateral bracing along the top chord. Design assumes no lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 8104.'# 13958.'# 58% 4.53' Total Toad D +L Shear 2952.# 6317.# 46% 0.01' Total load D +L Max. Reaction 3577.# 9187.# 38% 0' Total load D +L TL Deflection 0.2395" 0.4531" L/453 4.53' Total load D +L LL Deflection 0.1972" 0.3021" L/551 4.53' Total load L Control: LL Deflection DOLs: Live = 100% Snow = 115% Roof = 125% Wind =160% Manufacturers installation guide MUST be consulted for multi -ply connection details and altematives l . All product names are trademarks of their respective owners t* �,' . _- Copyright (C)1987 -2011 by Keymark Enterprises. LLC. ALL RIGHTS RESERVED. iesrruse�.t t �' "Passing is defined 05 when the member, floor joist, beam or girder, shown on this drawing meets applicable design criteria for Loads, Loading Conditions, and Spans listed on this sheet. The design must be reviewed by a qualified designer or design professional as required for approval. This design assumes product installation according to the manufacturer's specifications. :71 '7`' „9,1 X„a( 11bM 51 ) h � s r a , )xz - -vox, c� tia S N. N. .a5 • , sis5n1)L. 5-7.7nvq -s f f/ <71 - 77 � ih ca S wF c-,dd1 , ") c s( 4-4 id S 0111\ 11) r ('L/' 37 3 +L? a!V ,4 -) iv inr M q h i � ��fZ cc S rvc - 7})cv Q., G s c2 x9 „ii? - QI h b - - - - , .0 L. X[9 . <l . tk . a Lxb r ,� I FYot__t„-yn3 -5g C4 _s irysWA ?, h 1 c v 0 r__L---V 313 .! 2 i - (_-- - -- , 5 I I__________ 5 1 I - ,1 - 1 I O •c, • 1-1 o 1-- 1 1 „ 2 I .--- _s t I , • ci frO 1_ 6 -- 5hAlf JTJ •0 g s - , c->d <70o - 9 c1 taao-- ,, 17 'se QQQ17 DJbg i3u - s C.-Y " CI- hFayL CA,2e.Si,,,4L 1-6* Size ii i 673 .5 P1 EX )s 6 Coy EA.A-GE - 3 7/O SQ ET i)(LpPDS6 CO V'£QA6: -0 — 51 SS S6? Pr •7 -0 9 t A)E,0 C. .&L)ief+C - 3` 5 S. sC < S l °7 .- -----, /Vo P174 a ti ic 2� Uz,1- '6e p — 9 r �v 13 u C l6-7Yv J, t) • L > 2 y 1, a N 0 i il I i24 A 7 0 9� t N t� , �, 4e, r r � r ,� v i7lLovrti,�r t ( /x ti > 4'v { Z -io — 1n.5 A PI" i I N I us - , Db 6= (co ,J i 6. 4 ,o Clem c,v 7 - s Workers' Compensation and Employer's Liability Policy OUP NorGUARD Insurance Company - A Stock Company NSURANCE Policy Number JAWC224435 R Renewal of NEW NCCI No.[25844] Policy Information Page [1] Named Insured and Mailing Address Agency James D Ross FINCK & PERRAS INS AGENCY PO Box 66 6 CAMPUS LANE Whately, MA 01093 Easthampton, MA 01027 Agency Code: MAFINC10 Federal Employer's ID 061 - 55 - 9981 Insured is Individual Additional Names of Insured (N2) JDR Builders Locations on Policy (L2) 177 State Road , South Deerfield, MA 01373 (01/29/2011 - 01/29/2012) [2] Policy Period From January 29, 2011 to January 29, 2012, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $100,000 Bodily Injury by Disease - each employee $100,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 3,126 Total Surcharges /Assessments $ 189 Total Estimated Cost $ 3,315 INTERNAL USE GT Page - 1 - I formation P -•e MGA : JAWC224435 i(tc •!06014 Date : 01/28/2011 / �` �- MANOTE 16 South River Street • P.O. Box A -H • Wilkes- Barre, PA 18703 -0020 • www.guard.com Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance — — requirements of this chapter have been presented to the contracting` authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub- contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self - insured companies should enter their self- insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations -- --- 600 - Washington - Street Boston, MA 02111 Tel. # 617- 727 -4900 ext 406 or 1- 877 - MASSAFE Revised 4-24-07 Fax # 617 - 727 -.7749 www.mass.gov /dia SI \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t. – , 1... ss.....L 8 600 Washington Street - ...L.,-.4 ........ .t Boston, MA 02111 ..... — ....,- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 31) Address: Co 2G.7-te-Cf City/State/Zip: CliV\14-1 -. C. i /VU Phone #: . 3 Are you an employer? Check the appropriate box: Type of project (required): 1. 0 I am a employer with 4. El I am a general contractor and I 6 0 New construction employees (full and/or part-time).* have hired the sub-contractors 2. D J-ain a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.: - - required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions 3. 0 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 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no 1 employees. [No workers' 13.1: Other . comp. insurance required.] *My applicant that checks box #1 must also fill out the section below showing their workeii" 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. Contractors 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: _ CAi-- Policy # or Self-ins. Lic. #: n C.- ..a4 3--S Expiration Date: i - 2-2- 0 ! 2_ , Job Site Address: 1 C*PeC-t-fr 31 • 44 \ Oil 1 4: 40 City/State/Zip:Co" OC:7-- I 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 thy DIA for insurance coverage verification. I do hereby certi u e i te pains and penalties of perjury that the information provided above is true and correct Signature: Phone #: Lt( Lo (4,S ?Se 7 - Official use only. Do not write in this area, to be completed by city or town official _ - - City or To _ vvn: 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. T Not Applicable ❑ Name of License Holder : � .% ° 8 T /9 5U; - )o/ 0 ! OS License Nu er pe) 61 9 b/0 Address Expiration Date \-0 (// 3 3 7� �3 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ t _ �� Company Name Registration Numb r -37212- Booas Address Expiration C7ate PD w /114_ O/ 3 Telephone L fi3 - 3 Y -1 it 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 121 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) I I Roofing I Or Doors E] Accessory Bldg. 54 Demolition ❑ New Signs [El] Decks [E] Siding [O] Other [i]] Brief Descriptio e P / Work: iJ CW (� = COK- ) a I k 3? bfQ c 4 ed 6tet-, m-G 6 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family V 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 stones? 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 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, C�il / �� . C ....`} /2 e/ ri/4 (_, , as Owner of the subject property n hereby authorize ---- '> • 2 . 2)5/ 4 - 371)r 3o1 i_b to act on my behalf, in all matters relative to work authorized by this building permit application. S ignature of Z r C Date U55 , 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 Signature of ner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by � `_ o� Building Department Lot Size Z. 13, 13� ( / l 3 1/3, (G 6 Frontage Setbacks Front (DI Side L: 0 R:.211 : c l 12,2D /DP R: 21 Rear 2 ` ao Building Height Bldg. Square Footage 1)0[1 % Open Space Footage Q y� A (Lot area minus bldg & paved 31� �(p3 q j J 38, SS- parking) # of Parking Spaces 3 Fill: Cr t/ 4 � f. ✓PUuc ek �w e s (volume & Location) J A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW co YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (3 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 4 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO „Ye) 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, -xcavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO ' IF YES, then a Northampton Storm Water Management Permit from the DPW is required. link 40. NI ;EivrD "' ° ""`"`— Departm use only City of Northampton Status of Permit: KIN . t Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify L APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 39 CL.6Mt-nf S'T . Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: CAA /G-- 612.0/A/4 c � � Name (Print) Current Mailing Address - /12 C •jet: Telephone Signature 2.2 Authorized Agent: n -Tam 5 `1D. 2 l I j Die EZi)il�c ,9'c) I50x y, A/c), 1 41"7" -- )E - c-13/4,4 - C)/o 6 4 Name (Pri Current Mailing Address: /‘-'°' l� 4/ 3 — 3/7y-792 3 Signatu Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 3 g l) (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) 3� Check Number / �$r_ This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0454 to N t 6v APPLICANT /CONTACT PERSON JDR BUILDERS ADDRESS/PHONE P 0 BOX 4 NORTH HATFIELD (413) 665 -7587 PROPERTY LOCATION 134 CLEMENT ST MAP 30C PARCEL 084 001 ZONE SR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / H 1/53 6,o Fee Paid 5� � _ Typeof Construction: CONSTRUCT 24 X 32 DET GARAGE ((Est t)WN T I A L (1E ON cq New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 074105 3 sets of Plans / Plot Plan THE F LLOWING 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 Demolition Delay (2Z-- Signature of Building Of icial 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. 134 CLEMENT ST BP- 2012 -0454 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 084 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit # BP- 2012 -0454 Project # JS- 2012- 000740 Est. Cost: $38000.00 Fee: $153.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JDR BUILDERS 074105 Lot Size(sq. ft.): 43342.20 Owner: CARDINAL CRAIG S & CHERYL L Zoning: SR(100)/ Applicant: JDR BUILDERS AT: 134 CLEMENT ST Applicant Address: Phone: Insurance: P O BOX 4 (413) 665 -7587 WC NORTH HATFI ELDMA01066 ISSUED ON:11 /15/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 24 X 32 DET GARAGE - RESIDENTIAL USE ONLY 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 11/15/2011 0:00:00 $153.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner I1 ��