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35-233 -NOTE - THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED c30, 4-c.c, , -t 17 (h iit L 1 � U' -------A . 7 Jvc� �`+c2 `�A fir. s�al�• �-v r� G Tl - V a , � � c- , Cb . SS T� `,�� ZS \ \' b ^� ' \3c:' . Z-\'- \�■ \ G Gr 'J r \ C ICI ( -- _ I'C., f' .. N,,,, N . 2 .\:\ 1 r \k TO: FIRST MASSACHUSETTS BANK, N.A. & �� \ FIRST AMERICAN TITLE INSURANCE COMPANY OF • NrCrM eT1 ON !/NOW EDCE AND 3E1 IEF TO THE BEST Vi MY IIYI tii vVlrli:vlt, .:te ._ .� .. ,_�. I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY # 250167 - -NOTE— SURVEYOR c: L — -� THIS PLAT FOR MORTGAGE LOAN PURPOSES ON AND DOES NOT CONSTITUTE A PROPERTY SUF V of — MORTGAGE LOAN INSPECTION PLAT — � c N Ss 4 NORTHAMPTON, MASSACHUSETTS 1 RANDAL - s ` PREPARED FOR E. a KATHY L. TEECE 0 IZER y , #35032 j , SCALE: 1"=60' JUNE 30, 2( \ , `14 s _to HAROLD L. EATON AND ASSOCIATES, INC. - . REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET — - HADLEY MASSACHUSE L . - Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to t th- 2009 IECC requirements in REScheck Version 4.3.1 and to comply with the mandatory requirements listed in the R oh: -c •n2hecklist. V Name - Title Signature / Date Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieg \My Documents \REScheck \TEECE.rck Page 2 of 6 200 I E En Efficiency y ate Insulation Rating R -Value Ceiling / Roof 55.00 Wall 33.00 Floor / Foundation 5.00 Ductwork (unconditioned spaces): Glass & Door Rating U- Factor SHGC Window 0.30 Skylight 0.30 Door 0.30 NA Heating & Cooling Equipment Efficiency Heating System: Cooling System: Water Heater: Name: Date: Comments: • • Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieg \My Documents \REScheck \TEECE.rck Page 6 of 6 Where a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). ❑ Duct tightness test has been performed and meets one of the following test criteria: ( Postconstruction leakage to outdoors test: Less than or equal to 8 cfm per 100 ft2 of conditioned floor area. (2) Postconstruction total leakage test (including air handler enclosure): Less than or equal to 12 cfm per 100 ft2 pressure differential of 0.1 inches w.g. (3) Rough -in total leakage test with air handler installed: Less than or equal to 6 cfm per 100 ft2 of conditioned floor area when tested at a pressure differential of 0.1 inches w.g. ( Rough -in total leakage test without air handler installed: Less than or equal to 4 cfm per 100 ft2 of conditioned floor area. Heating and Cooling Equipment Sizing: u Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. Li For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and /or Service Water Heating (Sections 503 and 504). Circulating Service Hot Water Systems: u Circulating service hot water pipes are insulated to R -2. u Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: u HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R - 3. Swimming Pools: LI Heated swimming pools have an on /off heater switch. u Pool heaters operating on natural gas or LPG have an electronic pilot light. Li Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar- and /or waste - heat - recovery systems. u Heated swimming pools have a cover on or at the water surface. For pools heated over 90 degrees F (32 degrees C) the cover has a minimum insulation value of R -12. Exceptions: Covers are not required when 60% of the heating energy is from site recovered energy or solar energy source. Lighting Requirements: • A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a) Compact fluorescent (b) T -8 or smaller diameter linear fluorescent (c) 40 lumens per watt for lamp wattage <= 15 (d) 50 lumens per watt for lamp wattage > 15 and <= 40 (e) 60 lumens per watt for lamp wattage > 40 Other Requirements: D Snow- and ice - melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement 'c'). Certificate: u A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R- values; window U- factors; type and efficiency of space- conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, service disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieg \My Documents \REScheck \TEECE.rck Page 5 of 6 Comments: Slab insulation extends down from the top of the slab to at least 6.0 ft. OR down to at least the bottom of the slab then horizontally for a total distance of 6.0 ft. Air Leakage: u Joints (including rim joist junctions), attic access openings, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed with caulk, gasketed, weatherstripped or otherwise sealed with an air barrier material, suitable film or solid material. Li Air barrier and sealing exists on common walls between dwelling units, on exterior walls behind tubs /showers, and in openings between window /door jambs and framing. • Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. • Access doors separating conditioned from unconditioned space are weather - stripped and insulated (without insulation compression or damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed to maintain insulation application D Wood - burning fireplaces have gasketed doors and outdoor combustion air Air Sealing and Insulation: • Building envelope air tightness and insulation installation complies by either 1) a post rough -in blower door test result of less than 7 ACH at 33.5 psf OR 2) the following items have been satisfied: (a) Air barriers and thermal barrier: Installed on outside of air - permeable insulation and breaks or joints in the air barrier are filled or repaired (b) Ceiling /attic: Air barrier in any dropped ceiling /soffit is substantially aligned with insulation and any gaps are sealed. (c) Above -grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d) Floors: Air barrier is installed at any exposed edge of insulation. (e) Plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to fit around wiring and plumbing, or sprayed /blown insulation extends behind piping and wiring. (f) Corners, headers, narrow framing cavities, and rim joists are insulated. (9) Shower /tub on exterior wall: Insulation exists between showers /tubs and exterior wall. Sunrooms: j Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U- factor of 0.50 and the maximum skylight U- factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: u Vapor retarder is installed on the warm -in- winter side of all non - vented framed ceilings, walls, and floors; or it has been determined that moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided. Comments: Materials Identification and Installation: u Materials and equipment are installed in accordance with the manufacturer's installation instructions. Li Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R- value. ❑ Materials and equipment are identified so that compliance can be determined. D Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R- values and glazing U- factors are clearly marked on the building plans or specifications. Duct Insulation: ❑ Supply ducts in attics are insulated to a minimum of R -8. All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R -6. Duct Construction and Testing: u Building framing cavities are not used as supply ducts. Li All joints and seams of air ducts, air handlers, filter boxes, and building cavities used as return ducts are substantially airtight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Tapes, mastics, and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and /or fittings are mechanically fastened. Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet -metal screws. Exceptions: Joint and seams covered with spray polyurethane foam Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieq \My Documents \REScheck \TEECE.rck Page 4 of 6 R, ci REScheck Software Version 4.3.1 Inspe Checkl Ceilings: ❑ Ceiling 1: Cathedral Ceiling (no attic), R -55.0 cavity insulation Comments: Above - Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R -33.0 cavity insulation Comments: ❑ Wall 2: Wood Frame, 16" o.c., R -33.0 cavity insulation Comments: ❑ Wall 3: Wood Frame, 16" o.c., R -33.0 cavity insulation Comments: ❑ Wall 4: Wood Frame, 16" ac., R -33.0 cavity insulation Comments: Windows: ❑ Window 1: Vinyl Frame:Double Pane with Low -E, U- factor: 0.300 For windows without labeled U- factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 2: Vinyl Frame:Double Pane with Low -E, U- factor: 0.300 For windows without labeled U- factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 3: Vinyl Frame:Double Pane with Low -E, U- factor: 0.300 For windows without labeled U- factors, describe features: #Panes Frame Type _ Thermal Break? Yes No Comments: ❑ Window 4: Vinyl Frame:Double Pane with Low -E, U- factor: 0.300 For windows without labeled U- factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Skylights: ❑ Skylight 1: Vinyl Frame:Double Pane with Low -E, U- factor: 0.300 #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Glass, U- factor: 0.300 Comments: ❑ Door 2: Glass, U- factor: 0.300 Comments: Floors: ❑ Floor 1: Slab -On- Grade:Heated, 6.0' insulation depth, R - continuous insulation Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieg \My Documents \REScheck \TEECE.rck Page 3 of 6 REScheck Software Version 4.3.1 Compliance Certificate Project Title: TEECE ADDITION Energy Code: 2009 IECC Location: Northampton, Massachusetts Construction Type: Single Family Project Type: Addition /Alteration Building Orientation: Bldg. orientation unspecified Heating Degree Days: 6404 Climate Zone. 5 Construction Site: Owner /Agent: Designer /Contractor: 25 BAYBERRY LANE DAVID TEECE SIEGFRIED PORTH NORTHAMPTON, MA 01060 OWNER ARCHITECT 25 BAYBERRY LANE 116 PLEASANT ST. NORTHAMPTON, MA 01060 SUITE 331 EASTHAMPTON, MA 01027 529 9434 Compliance: Passes Compliance: 16.0% Better Than Code Maximum UA: 319 Your UA: 268 The % Better or Worse Than Code index reflects how close to compliance the house is based on code trade -off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Gross Cavity Cont. Glazing UA Assembly Area or R -Value R -Value or Door Perimeter U- Factor Wall 1: Wood Frame, 16" o.c. 158 33.0 0.0 5 Orientation: Front Window 1: Vinyl Frame:Double Pane with Low -E 48 0.300 14 SHGC: 0.00 Orientation: Unspecified Wall 2: Wood Frame, 16" o.c. 355 33.0 0.0 13 Orientation: Right Side Window 2: Vinyl Frame:Double Pane with Low -E 80 0.300 24 SHGC: 0.00 Orientation: Unspecified Wall 3: Wood Frame, 16" o.c. 384 33.0 0 0 13 Orientation: Back Window 3: Vinyl Frame:Double Pane with Low -E 64 0.300 19 SHGC 0.00 Orientation: Unspecified Door 1: Glass 42 0.300 13 SHGC: 0.00 Orientation: Unspecified Wall 4: Wood Frame, 16" o.c. 327 33.0 0.0 9 Orientation: Left Side Window 4: Vinyl Frame:Double Pane with Low -E 72 0.300 22 SHGC: 0.00 Orientation: Unspecified Door 2: Glass 63 0.300 19 SHGC: 0.00 Orientation: Unspecified Ceiling 1: Cathedral Ceiling (no attic) 1050 55.0 0.0 19 Skylight 1. Vinyl Frame:Double Pane with Low -E 28 0.300 8 SHGC: 0.00 Floor 1: Slab -On- Grade:Heated 121 5.0 90 Insulation depth: 6.0' Project Title: TEECE ADDITION Report date: 09/23/10 Data filename: C: \Documents and Settings \Sieg \My Documents \REScheck \TEECE.rck Page 1 of 6 Toot, YtL1D 336 700 I n- / 704, oo tD Ectc 16 c. OsCto (6d.010 S P-5 Q G 6 7.d 2c: 6 ?s s 33 2 13 1 IERy 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 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 jermits 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 opfassachusetts Department of Industrial Accidents Office of Investigations . Si ril i IL■r• .i 600 Washington Street Boston, MA 02111 mass ' _.. • -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name pusineseorganizationadivirin.D: 6e, kkt A i„..0i- Address: th 3 fi s p .5+' City/State/Zip: etca,Abfi - Aci,.. ° 1.° 7 ° Phone.#: 33 Are you an employer? Check the appropriate box: S Type of project (required): / 1.0 lama employer with >(.... 4. 0 I am a general contractor and I 6. 0 New construction have hired the sub-contractors employees (full and/or part-time).* listed on the attached sheet 7. 0 R.emodeling 2. 0 I am a sole proprietor or partner- These sub-contractors have ship and have no employees These 0 Demolition and have workars' .. working for me in any capacity. employee 9 0 Buildifig addition [No workers comp. insurance- 10.0 Electrical repairs or additions required.] • - 5. 0 We are a corporation and its 3. 0 I am a homeowner doing all work officers havet xercised their . 11.0 Plumbing repairs or at myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs . • insurance required.] t c. 152, §1(4), and we have no c: r rec icers ed-' I , 11E3 0ther •Any applicant-that checks box #1 must also fill out the section below showing their workers' compensation policy infomntion_ t Homeowners who submit this afficlaVit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. 1 -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. l am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. • A Insurance Company Name: 4 l k v 1 Policy # or Self-ins. Lic. #: V (Ai C 400s 6octo Expiration Date: - t — // . 4.. 1 Job Site Address: ( 9 , 5 30. tri-1, .. 11 , City/State/Zip: Aldri464. gc. 01060 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 iinpOsition of Ciiminil penalties of a fine up to S1,500.00 and/or one imprisonment as well as civil penalties in the form of a STOP WORICORDER 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 EiViiiikations �f the DIA for insurance cdveiii4iifiCiiiiiii: Ida hereby certi under the pains and penalties o perjury that the information provididabove_iS _true_tirid_correa Signature: 4,,,,Qnk 1 Da.te: , • Phone #: i l I 3 -.3 ' 74' / 0 - • 1 ....,_ ,,.. ....,—.__ Official use only. Do not write in this area, to be canirlet.ed by city townofficiaL . City or Town: Issuing Authority (circle one): .- Permit/I.Acense # .1. Board of Health 2. Building Department 3. City/Town Clerk 4. ElectricalInspector 5. Plumbing Inspector 6. Other Contact Person: ' Phone #: , SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 Not Applicable ❑ Name of License Holder : ( e ` ' , pw f / 07 8 8 (� License Number f ra S J}' `f Ye rU t; u r 107 a 1 t Address Expiration Date jj-Gt4i ateLik '3 _ - 7 /c Signature Telephone 9 f eatsteiedrlfatrielntti Xretti#en l aintriataii.. `.. � ; . ' Not Applicable ❑ 6-e■roAk r3 Company Name Registration Number 943 el-as ke.x.1* 1' Fin 0 167 0 11- .2 ,13/0 Address Expiration Date Telephone 33 7 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 ❑ 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 S , ` SECTION 5- DESCRIPTION! OF PROPOSED WORK (check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition 1E3 New Signs [D] Decks [M Siding [D] Other [D] Brief Work :� MO1r�e dee.k & soh. Ford, Q►� w-� CLGOratn - b fIUMS, Po *oo AeCt Alteration of existing bedroom Yes No Adding new bedroom _ Yes No �ai. g);.2; Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll - Sheet sad f3fiirr :aii�iatt,'e�rsiirFa�np�i. #k�e °:'�lair>«t: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: r Number of Bathrooms c. Is there a garage attached? ye S - ' rc C I ` ' c: d. Proposed Square footage of new construction. / c Dimenswns '--t' lc'LI'1 e. Number of stories? 1 '' �,.L� f. Method of heating? (a� �' / W0744 .. Fireplaces or Woodstoves Number of each � g. Energy Conservation Compliance. T .e5 Masscheck Energy Compliance form attached? - Y-e5 h. Type of construction i 114 e) a_ i. Is construction within 100 ft. of wetlands? Yes X. No. Is construction within 100 yr. floodplain Yes x No j. Depth of basement or cellar floor below finished grade ilA+01 I..Sla v 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 , as Own oft subject property hereby authorize 6-Q vcAl. 0.., Lew if my beha II matters relative to work authorized by this building permit ap . licatio zy Signature of Owner Date I af,YA_p 6t4j , 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. cefrelsu Print Name _ .. .L Lam: ... --lily Signature of Owner /Agent Date . i . . 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 —1 — __ I _—_— Lot Size i 1 t. , , _. , 1 Frontage t H i Setbacks Front Side L:1--.1 R:I,10--; L: i R:[ ..._! . Rear 1900 1 1 ; . , Building Height Bldg. Square Footage 1 I I " f ----- 1 F-----1 17 Open Space Footage % c I (Lot area minus bldg & paved L._.1 i....__J ThRe 1 parking) ! , # of Parking Spaces _ c ,---- — Fill: (volume & Location) 1 I t A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ta DONT KNOW 0 YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 -- i I 1 .._ IF YES: enter Book Pagel I and/or Document # L , 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 . •,4 4 ,.. I ; 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 :Pip 46. i 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 s IF YES, then a Northampton Storm Water Management Permit from the DPW is required. . City of Northampton Building Department p t i 212 Main Street ' ; M 1 6:- -41;41.‘,,4;,...7.4. ;144,7:15E;IMM1,74i-ii.:q1linl Room 100 Northampton, MA 01060 ; s ..� -r phone 413 - 587 -1240 Fax 413 - 587 -1272 i Y APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A • ' • • TWO FAMILY -= SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by offi t 5— r (�Y4 e, :Map Lot ce Unit k)0 i ow,�lf1 Zone . Overlay D 1 Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: av Te 7-s 13 O-Q Na Print) Current Mailing Adore Telephone Signature 4 2.2 Authorized Agent: 46" 6 �*(.�, .A, , �,,,� -h-- >r.3 fro 5pec• ' a L o'70 Na (rint) ' Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ! (a) Building Permit Fee (Qo 000d oU 2. Electrical ,...-- (b) Estimated Total Cost of O + d O Construction from (6) 3. Plumbing Z -60° l°13 Building Permit Fee 4. Mechanical (HVAC) O 5. Fire Protection L ro O O i x 6. Total = (1 + 2 + 3 + 4 + 5) - t j` ©OD) Q Check Number af°/ f $"3 3 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date , File # BP- 2011 -0307 APPLICANT /CONTACT PERSON GERALD ARCHAMBAULT t!' J ADDRESS /PHONE 263 PROSPECT ST PLAINFIELD (413) 522 -7410 0 n �, PROPERTY LOCATION 25 BAYBERRY LN 1' ' 1' )1 MAP 35 PARCEL 233 001 ZONE SR(100) //WSP II SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 2- ZONING FORM FILLED OUT Fee Paid „1 C Building Permit Filled out Q (0,5 f v Fee Paid o)0 /' Typeof Construction:_CONSTRUCT 1440 SQ FT ADDITION W /800 SQ FT DECK & 16 X21 SHED 9 Q " New Construction cc J Non Structural interior renovations _ G Addition to Existing Accessory Structure Building Plans Included: ‘\. Owner/ Statement or License 010788 3 sets of Plans / Plot Plan THE FOLLOWING 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 „hem elay AO " 1.1 ture of Building * 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. 25 BAEY LIB BP- 2011 -0307 GIS #: COMMONWEALTH OF MASSACHUSETTS map: ock: 35`- 233 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 -0307 Project # JS- 2011- 000505 Est. Cost: $75000.00 Fee: $933.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GERALD ARCHAMBAULT 010788 Lot Size(sq. ft.): 123710.40 Owner: TEECE KATHY L & DAVID F Zoning: SR(100) //WSP II Applicant: GERALD ARCHAMBAULT AT: 25 BAYBERRY LN Applicant Address: Phone: y Insurance: 263 PROSPECT ST (413) 5 -7410 0 Workers Compensation PLAINFIELDMA01070 ISSUED ON:11/16/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 1440 SQ FT ADDITION W /800 SQ FT DECK & 16 X21 SHED -NEED FASTENING DET FOR SEGMENTED SECTION BEFORE RGH 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 11/16/2010 0:00:00 $933.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner