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29-273 (4) i R, M c E � v E NERDY CONSERVATION APPLICAM4 F&RM FOR D SE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS 780 PMR Appendix -]{-effective 3/1/98) MAR 2 0 2001 Applicant.Name: t,< Site Address: e Jr City/Town: DEN RTRAMPTON,MAPO 060 0 Use Group: Date of Application: Annlirrr2t ICni,l Sidi otiiir: ContpHattce Path(check o")z 0 Prescriptive Package (Limit-ea to 1- or 2- family wood framebuiidings heated with fossil fuels only) Package (A through KK from Table J5.2. lb): _ Heating Degree Days (HDD6s)from Table J5.2 la: (For items d, through i., fill in all values that apply from Table J5.2) a. �B.tross Well urea sq. ft 1'. Walt R-Vstvc R- b. GtBSIRA/`,7'bd' FIc.;r R-a� Cie C. GIazing (1 00 x b+z) _ '' h. Basement wall d, GlazinR, I1-yxi_a Slab PtSrtrrle4c3 1{' c. Geyifing ft-value - j. Heating AFUE ❑ w„Fxnnm Fe vrri�2rcc `PA.anual Trade-Crif' (1_imited to wood or metal framed buildings only) Gim6tt Zone(from Figure 15.2.2) P Zone 12. 1-1 Zone ?? 01 7n,^,r 14 Attach Trade-Off}.” ts1 c;frorI Appendix J, [end HVAC 7rac+e-uhFi%oriaheet, if applicz.b!e) Cl MASCheck SOslvl�n' Attach Cornphance Pfrp-- and Inspeclion Checklist printouts. Q Sy�tterns Anaiysis OR D Renewable Energy Sources Attach Mass Registered Architect or EnL7irj.--r Ana!ysi1 ALTERNATIVE FOR ADDITIONS ON?Y: a. Gross OSS Wail + i)inv ArP� J , cp. ft, b- Glazing firEa J sq. c, �fazing `X,(ICX7 x b ra) �:S ADDITION with GIVing% (c.)up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-f6t.x- hfinimum R-Values Fbr*strabon i;eilirg Wall Floor 8ascment Wall Siab Perimeter, Dept 039 R-37 R-13 R-19 R-lo R•10, 4 tt, ❑ 'SUNROOM" addition(grE,,!ter than 40% gia2ing-to wall and ccilinF gross area) Attach `Consumer Form" from 780 CMP Appendix B, vfficiai's t�kam2: — O`ficial's Sign ature: Appficzt an Approved Denied (,_l Date of fiN ,•o1;D�isi: (Prvviae additional details 2s needed on back side) Glazes hna may be okher kourfi opoon,g or unit Dimersjms O��itAMP�0 w $ B �:sartcElnsctta' � t _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT l-, (licensee/permittec) with a principal place of business/residence at: (phone#) (st=Ucity/sta&21iP) do hereby certify, under the pains and penalties of perjury, that. ( ) I am an employer providing the following workers compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Corupary/Policy Number) (Expi atioa Date) r. (Name of Contractor) (Insurance Company/policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addition,shod ifn6oc=lry to inchsde information pataiuiag to all oor¢tadora) ( ) I am a sole proprietor and have no one working for me. Y am a home owner performing all the work myself. NOTE:please be aware that wbilo homeow=a wbo emplay priors to do mairdZaance,wastru on or repair work on a dwelling of not more tban three traits in wbch the homoowacr raider or on the p-ounds appttttenaat thaYto arc no(gcoaally ooa-krcd to be employ=under the worker z oompensatioa Act(GL152,m 1(5)�application by a homcowns for a 6o asc or permit may evidmoe the legal etahrs of an employer under the Workee,compomatioo A,-,L I un8era nd that a copy of this ctatcmeni may be forwarded to tbo Deper mxnt of Inju'tri d Aui Onion of Im+r for the covaa.ge verification and that failure to aecute co%Crago under soctioa 25A of MCIL 152 can lead to tba m ion of a-B d pcaaUies ooasist'ag of a fine of up to S 1,500.00 andlof of tip to one year and civil peaniti es in the form of a Stop Work(hda and a firm of:S 100.00 a day against mw !� For dcp:rtu�use caly ' permit Number map# Lot# Si of Licensee/permittee e SECTON 8 �C©NSUGTION SERV -.1 Licensed Construction Supervisor: Not Applicable )1' Name of License Holder License Number Address Expiration Date Signature Telephone r::fs x it3a+ �...f' emen ntract r � ..,'. E 'g "04_...... Not Applicable I 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. `�igned 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 a Local ning La s an tate of Massachusetts General Laws Annotated. Homeowner Signature t ♦ EC'f1ON 5 'DESCRiP�ION OF PROPOSED.WORK`(ch�ck a"II a�lica6le) New House ❑ Addition X Replacement Windows Alteration(s) ' Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Ps i c��� 'o i auto re'..4- Alteration of existing bedroom Yes X No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes _ No Plans Attached Roll X- Sheet 0 e nd 6 004 Ith 01e:, sii`°W6 us-r' ....ee efolMY ...... a. Use of building : One Family X. Two Familjt Other b. Number of rooms in each family unit:.4 Nurpber of Bathrooms c. Is there a garage attached? J10 _ *c'vt�� d. Proposed Square footage of new construction. X57 Dimensions 7 e. Number of stories? o- T / f. Method of heating? �7 4-f-wJet' Fireplaces or Woodstoves_� o _Number of each g. Energy Conservation Compliance. Ve S Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes--Y,—No r j. Depth of basement or cellar floor below finished grade 7 k. Will building conform to the Building and Zoning regulations? _Yes No . I. Septic Tank City Sewer . Private well City water Supply SECTI60a OWNER AUTHORIZATION -TO SE COMPLETED WHEN OW..NERS AGENT OR CONTRACTOR APPLIES FOR BUILDING;PERMIT 1, 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 as Owner/Authorized Agent hereby deG1 re 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. YJIDVC- Pri Name Signs ur Owner/Agent Date 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 1,S o ,s� ►' S� .n o?o o-a�-a r l� Frontage Setbacks Front / Q Side L:—(�/' R: "'Y L: R: )Js Rear i .' x Building Height Bldg. Square Footage Open Space Footage t*. S�l % (Lot area minus bldg&paved S S� parking) C #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO _ 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. No,�re there any proposed changes to or additions of signs intended for the property?YES_ IF YES, describe size, type and location: E c n mpton f 1 E !1 d g 3rtment u 212 N1 S treet MAR 2� 201 Ro 0 ort amp A 01060 phnne 41 40 ax 413-587-1272 D PT OF BUILDING INSPECTIONS NORTHAMPTON MA 01060 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION,--ZITE�INFORMATION 1.1 Property Address: Y �npletey offfce u his sec ion tube co / ,a U r`eW' ,�dam, rylakpLot Urlit -- - !g Leh Lev NI. 01 0 6 Zone; Ou F1ay Des riet r 5 Eim St Distri ct O District SECTION 2- PROPERTY'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / / ` oG / VDJmac. .t�re,,�,S -t /L� 'CG ✓✓h � �l c5 7 l-'0hr , &I xar F1,9fe Na ( in ✓ Current Mailing A ress: Telephone �•�� Signat / 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature 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 `1SJa, g 4. Mechanical (HVAC) 5. Fire Protection �hc lv 1 ( ;n 6. Total =(1 +2 + 3 +4+ 51 om Number This Section For Official USe.Onl Building Permit Wmber. 17,31 Date Issued: 'Signature: Building Commissioner/Inspector of Buildings Date File#BP-2001-0731 APPLICANT/CONTACT PERSON ANDREWS DOUGLAS&MICHELE BUMBAUGH ADDRESS/PHONE 89 LONGVIEW DR (413)584-1370 Q PROPERTY LOCATION 89 LONGVIEW DR MAP 29 PARCEL 273 ZONE URA 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 PARTIAL 2ND FLR ADDITION&CHANGE ROFF PITCH OVER REMAINING AREA(NEW BATHROOM) New Construction Non Structural interior renovations Addition to Existing Accessoa Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD / Received&Recorded at Registry of Deeds Proof Enclosed n y Finding Required under: § _w/ZONING BOARD OF APPEALS pR6X/ST��� Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Co ission Permit from CB Architecture Committee o Signature of Building O al 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.