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22D-067 (2) ,--- .0-'- 1 . r-\ 10,26.1/1Q _C . ,/ O k --q ‘t*-- - 1 1,4:., ------ t \ \-' 0 . 0 <6) 1 Ci(CLI CD.2 SCCC \t/11 Morin 8- 3 -10 K eVE e Florence, Ma 9:41am l 01 KeyBeam® 4.506a kmBeanEngine 4.508h Materials Database 1140 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: SBC Dead Load: 10 PLF Deflection Criteria: 0360 live, L/240 total Live Load: 40 PLF Deck Connection: Nailed Member Weight: 9.4 PLF Filename: KYB3 Other Loads Type Trib. Dead Other (Description) Begin End Width Start End Start End Category Replacement Uniform (PSF) 0' 0.00" 12' 7.00" 11' 0.00" 10 30 Live 12 7 0 / 0 12 7 0 Bearings and Reactions Location Type Input Length Min Required Gravity Reaction Gravity Uplift 1 0' 0.000" Wall 3.500" 1.500" 2729# -- 2 12' 1.750" Wall 3.500" 1.500" 2729# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live 1 725# 2004# 2 725# 2004# Design spans 12' 1.750" 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 8287.'# 13958.'# 59% 6.07' Total load D +L Shear 2373.# 6318.# 37% 0.01' Total load D +L Max. Reaction 2729.# 9188.# 29% 0' Total load D +L TL Deflection 0.4400" 0.6073" L/331 6.07' Total load D +L LL Deflection 0.3231" 0.4049" L/451 6.07' Total load L Control: LL Deflection DOLs: Live = 100% Snow= 115% Roof= 125% Wind= 160% Manufacturer's installation guide MUST be consulted for multi -ply connection details and alternatives Ad product names are trademarks of their respective owners O', Y.'}"F`''' 'R `+ ?; (C)1989 -2005 by Keymark Enterprises, LLC. ALL RIGHTS RESERVED. r -xr "Passing is defined as 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. 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 person(s) who seek to use the home owner exemption, to act as their own 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 i:14ermits 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 I, 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 Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents — ( Office of Investigations lismezu_= 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): if Pi Yr c_i_f Or4'•-• ro"..) Address: 9.. ct 1?).0Y IQ- City/StateiZip:c I . i 0/ 1 - Phone.#: 1 -1/j --- o Are you an employer? Check the appropriate box: Type of project (required): . • 1.0 I am a employer vvith 4. 0 I am a general contractor and I 6. 11 New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet 7. 0 Remodeling 2.. T. I am a sole proprietor or partner- These sub-contractors have ship and have no em These 0 Demolition • erciployees and have workers' working for me in any capacity. 9. 0 Building addiftifin # - [No workers' comp. insurance - - - - -- required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. LI I am a homeowner doing all work officers have4xercisecl 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 employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box #1 must also fill out the section helot showing their workers' compensation policy infonnation. 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 rherk 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. • am an employer that is providing workers' compensation insurance for my employees. Below is the policy am! 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 ofMGL c 152 can lead to the imposition of crimirt41 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 ErViltizitions &the DIA for insurance coverane verification. do' herebycertfbr under the pains and penalties ofperjray that the information provididabove_istrue_azuLcorrect. I 7 Signature: 9, Dath: ih Phone #: (-it - . • • Offic.kr.1 use only. Do not write in this area, to be completed by y or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. ElectricalInspector 5. Plumbing Inspector 6. Other f- • • Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �^ j� Not Applicable ❑ Name of License Holder : J ei J D/ ' J ��+� ` `✓ License Number Address Expiration Date el /3 X- e/7/ o ignature Telephone 9 Reatstere ` "d- f+oriaelrrlpi'oemrgrrl #tibraitbrg Not Applicable ❑ C m an Name Registration Number r, ( i)° , Y L r 2.1 A4 0/0/ 5h. r/ Address (� Expiration Date 4 q /3 � C ""� % / 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 ❑ futpUon 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 Bu 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 ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition El New Signs [O] Decks [C7 Siding [DI Other [o] Wor k : eDescription of Proposed ( U r PcXi/ d j1 t M- �1m OW} ,i' Work: �W!d �'Z.. � ��Lii+ Poor! AA ' 11- � � l�r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Qt; No Plans Attached Roll - Sheet 04. eW T'ous + anc di iie n�tcexistinq.J atilt cri omptete tie:foilowifp: 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. 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 Ta'- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T !eViek e igr , as Owner of the subject property (�,3, hereby authorize v a `"s to act onn my behalf in all matters elative to work authorized by this building pgrmit application. Signature of *ler Date I J Ary t ( .-) J C' , 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. Ate" Qi . 1) P w S'dJ Print Name Sit6Ature of Owner /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 Building Department ' Lot Size ; i ... _.. Frontage __ Setbacks Front Side L:` R:L L: R: Rear 1___ Building Height r 1 __.. Bldg. Square Footage I % E" I i 1 r Open Space Footage % -- (Lot area minus bldg & paved s ,a,_, 1 F parking) # of Parking Spaces 1 Fill: ... . _m,. , . _ ._ �_ _� ,.�.�,.. ____ . _ .. —._ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO e DONT KNOW 0 YES 0 IF YES, date issued:I IF YES: Was the permit recorded at the Registry of Deeds? X/ " NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # _ B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q k /, 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 Q NO 0 w //1 IF YES, describe size, type and location: ! _ mm D. Are there any proposed changes to or additions of signs intended for the property ? YES i0 NO Q IF YES, describe size, type and location: E. Will 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 it IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - .. . a e* ,, w , iii as t ,x a City of Northampton ( 14 Building Department et- a r� �r � . i , 212 Main Street �' - 1� 1 ' Room 100 .. lt, 11, , n7 ' — £ N orthampton, MA 01060 � . �" phone 413 - 587 -1240 Fax 413 - 587 -1272 e APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: DNA This section to be completed by office I( (1ra'f_. ��'� Map ' ' Lot Unit r - Zone Overlay District 1C)r e " "Q Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner rd: e of co Mort f ' /k' k C `: Nfirfie` - - :, ) ee M 'I Ad dress: �� to .— . - . 2.2 Authorized Agent: f V AInv5 'i7/ J .d j? c) 'd�� / ?�I (� r,�S 0►, 1"i.+ M(4 of I z Name (Print) Current Mailing Address: 6 � r j a-_,:-.---.,------ 1 / 3 y b -- C/ i / nature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 13 do, (a) Building Permit Fee e 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) n(0, ( t_) Check Number IP r27 This Sect For Offic Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 121 FLORENCE RD BP- 2011 -0100 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22D - 067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0100 Project # JS- 2011- 000181 Est. Cost: $5000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES DAWSON Lot Size(sq. ft.): 302742.00 Owner: MORIN MARLENE A Zoning: URA(100) //WSP Applicant: JAMES DAWSON AT: . 121 FLORET E RD Applicant Address: Phone: Insurance: P 0 BOX 121 (413) 296 -4710 0 CH ESTERFIELDMA01012 ISSUED ON:8/1 0/201 0 0:00:00 TO PERFORM THE FOLLOWING WORK: Replace Door and Header 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: p 3113/10 Rough Frame: 1 Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK ei,3 i v0 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA IONS. Certificate of Occupan c Signature: (7f I FeeType: Date Paid: Amount: Building 8/10/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner