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SEP-04-2008 03: 14 AM f .'
P. 01
2008
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL N9W CONSTRUCTION. tzd ADDITIONS
�Ul/I cr . ,,fez 780 CMR Appendix J
Applicant Name: �R,/hY _Z; 1w T, Site Address:
Applicant Address: ,lac cir:s,. i Cityrrown: 1 f5!ha4Anc -
�� .r Use Group:
Date of Application: ?-3. 04
Applicant Phone: 7 1112 T Applicant Signature:
Compliance Path(check one):
❑ Prescriptive Package(Limited to t-or 2-family wood frame buildings heated with fossil fuels only)
Package(A through KK from Table J5.2.1b): Heating Degree Days(HDDds)from Table J5.2.1a:
(For items d.through i_,fill in all values that apply from Table J5.2.i b:)
a. Gross Wall Area _ . _- sq.f1 f. Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value R-
c. Glazing%(100 x b a) °1° h, Basement wall R-
d. Glazing U-value U- i. Slab Perimeter R-
e. Ceiling R-value R- j. Heating AFUE
❑ Component Performance: "Manunl Trade-Off'(Limited to wood or metal framed buildings only)
Climate Zone(from Figure J6,2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade-Off Norksheer from Appendix 1, (and HVAC Trade-Off Worksheet,if applicable]
❑ MAScheck Software
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Rating System Evaluation
Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher)
❑ Systems Analysis OR [] Renewable Energy Sources
Attach Mass R 'sterW Architect or En ineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall+Ceiling Area_sq.ft._ _ sq.ft. b.Glazing Area' sq.ft. c.Glazing%(loo x b t a)
❑ ADDITION with Glazing%(c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below:
MAXIMUM U-value M.WMMUM R-Values
Fenestration' Ceilin ' I Wall Floor I Basentmt Wall Slab Perimeter tb
0.39' R-37 R-13 R-19 I R-10 R-10 4 ft
i Glazing Area may be either Rough Opening or Unit dimensions.
2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units.
3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area
A not compressed over exterior walls,and including any access openings_)
UNROOM"addition(greater than 40%glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form"from 780 CUR Appendix B.
Official's Name: Official's Signature:
Application Approved ❑ Denied ❑ Date of Approval/Denial:
Reason(s)for Denial- (provide additional details as needed on back side)
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co .DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION RISURANCE AFFIDAVIT
I, Nelson Shifflett - Valley. Home Improvement Inc .
Ncenseelpermittee}
with a principal place of business/residence at:
340 Riverside Drive, Northampton,MA 01060 (phonell) 584-7522
do hereby certify, under the pains and penalties of perjury, drat:
()) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
A.I .M. Mutual Ins . Co. WMZ8005610 01 2008 2/1/09
(ln_surance Company) (Policy Number) -- (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hued
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Cortlparry/Policy Numbcr) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance. Comp"My/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Conipany/Policy Number) (Expiration Date)
(attach additional sheet if ri—nary to iachtidc information pertainic:g to oll cc':actors)
( ) 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 aware that whilo homcov,n=who employ peaaas to do.,,++inicaan.e,con=viction or repair work on a dwela—of
not atom then thrw unfits in which the hoawown<r resides or on the grounds appueeraut therr+,n ere not gcoetally ooasidard to be
employers under the worker's coat{--rsatioa Art(GL152,=s 1(5)},application by a homeowna for a licc=or permit may the
legal status of an employer under the Woricfx'g Comjxination Act.
I and trY d that a copy of this uatemcat may ba forwcudod to tho Deparunced of I -1'rial Accidc QlPioa of Insuranca fcr the
00veragc vcrif cation and that fail=to$nout coverago under—don 25A of MGL 152 can lead to the impoatioa of criminsl PCOalties
cOmixin of a find of up to S 1,500.00 and/or i rinso—rf of up to om year and civil pcnalticS in the form of a Stop Word order and a
fiun of 5100.00 a day&piast mc.
Signed this ? day of yr ��G F�d� _l use only
,✓J Permit Number
Lot 9
Y�.
i
9EI CTION 8 -COrdsTRUCTION SERVICES _ ---.- -
.1 Licensed Construction Supervisor: Not Applicable ❑
Narim of License Holder :_Nels.on Shif flet --_._.__ 060300
Valley Home Improvement, Inc. License Nunik;er
9/22/08
_340 Riverside Dri_v_e-, Northampton, MA-0-106.0 --
Address I Expiration Date —
i
_ 584-7522
Signature Telephone
Ilk
i
9, Re`istere _ome Improvement Contractor: Not Applicabie ❑
105543 _-
Valley,_ Home ImprQV�m�s��. .zr_c_.T ---------
Com�any_Narrte
--�--�------ Registration Number
_340 Riverside Drive --,-- X17/10
P.ddress --- Expiration Date
Northampton, MA 01060 Telephone 584-7522
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.O.L. c. 152, §25C(6))
vworkers Compensation Insurance affidavit must be completed and submitted ^rich this application. failure to provide this affidavit �
,rill result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... 1 Flo...... 0
'['tie current exemption for"hoineo,wvncrs"was extended to iiaclude Owner-occupied Dww•ellini,,s of one(1) or two(2) Families
and to allow such honaeowvner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor.CMt R 780. Sixth Edition Section 108.3.5,1.
Definition of Homeowner:Person (s)wwho own a parcel of land oil which he./shc 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 wr•ho constructs rtlorc than one home in n trio-veer t)eriod shall not be considered a homeowner.
Such"homcowvner" shall submit to the Building Official,on a form acceptable to the Building Official that by/she shall be
respor4iulL for nil sucii work pet-forined under the building permii.
As actin,Constr•ncuoat Supervisor voter[7"I-esunce vaa the job site will be,required from tilt,.,t- t:nne, durir �lndl:gip^n
completion of the work for which this perinit is issued.
Mso be advised that with reference to Chapter 152(Workers' C;ornpensation) and Chanter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may liable for person(s)
;roll hire to perform work for you under this permit.
The undersii-ned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
-Northampton Ordinances,State and Local Zoning Lawvs quad State of Massachusetts General Lawvs .Annotated.
klooneoww°nLr Sion attire
t �
;� f � • DESCRIPTI ON OF PROPOSED WORK(check all A
New Flouse ? Addition _._..,m... Replacement Windows Alteration(s)0 RoutinC n
�._�...�........�...._��_. Or boors f:I '
o Accessory Bldg. 0 f DernolitionO New Signs f ] Decks ] Siding i j Other
on c! I'rcl.if°;= �`�'{ /�i /►tom
-)riy°,tr p,, ?1P..".,^;:t:m
-tRachu "lytrrat!'<°; I:c t r;sts.4 .:€!t !!:l J l..;�ta rtt c.t Yr Nu
6a. If New house and or addition to existing housing. complete the foilowin
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SECTION 7a -OWNER AUTIiORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Ownct ct r— L P„131�;I�rty
Nelson Shifflett, , Valley, Horne Improvement, Inc.
Al
€r a �I �;�t, t1°�> �."' ! •� vv ate .!a€iC:'!:'.C�t :�`r.1I1i.� 17,.s��;F!!� ��tt�`!w �.FlI3Il, .tlr'°'r.
// f •fo '/1
�lr�,.�..ir�"�1f1 t,J 65��,�r u•L"!t('v
t
. .Nelss�r�Y�.i.�.flexx.�Y.al.�ey Hie.�Z3ztg.�cL�rernen..t...�Inc�. -t�,:;�,',';�f-rer;€,r ���•,a�a �,���r�a !
m i'l!v 0 Ctd i9l.wt.r:Flts, io '.Ive ff t.:! Ilwy
kr c•edcc ge, G.nr_.' bel ief,
r;�,�� .! •��. CI' �7 t',_ �s°�i �'{, e.!'k€�._ U� Gr�,t{1 .t.
r
.Nelson Shifflett_..- -_ _.-
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 00
Frontage ffO
Setbacks Front
Side L: R: Vd L: U /s
Rear
Building Height f ��-
Bldg. Square Footage 11.7G % l 3
Open Space Footage V % l
(Lot area minus bldg&paved 1 f3
parking) s//
#of Parking Spaces
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: f
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 t site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or neen'eod 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:
w
Department use only
Cit y of Northampton p Status of J?eHtt:
Building Department Curb Cut/br!veway Permit, '
I` -�12 Main Street
3 2 �$ Seuver/Septic Availability
Boom 100 Watea`/Vdel(Availability . ^.
G�$othamoton, MA 01060 Two Sets of Sictural Plans
phone' - = -Z40 Fax 413-587-1272 PlotlSite Pi
Other Specly
r
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Pro erty Address:
This section to be completed by office
2 /
L �Y / 464 L N Map Lot Unit _.._.
Zone Overlay District
Elm St.District_ C8 District _
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZER AGENT
2.1 Owner of Record:
Na, P &} Current Mailing Address
Telephone G
gnature
2.2,Authorized Agent: Nelson Shif f lett
Valley Home Improvement+, Inc . , P.O. Box 60627 Florence, MA 01062
Name(Prin Current Mailing Address:
584-7522
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 o a a (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (FiVAC)
5. Fire Protection
6. Total =(1 + 2 + 3.74 4 + 5) J Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/inspector of Buildings Date
I
File#BP-2009-0232
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522
PROPERTY LOCATION 68 BLACKBERRY LANE
MAP 18C PARCEL 136 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out *01tX111 .9 ,31
Fee Paid
Typeof Construction: CONSTRUCT 14 X 16 SUNROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 060300
3 sets of Plans/Plot Plan
THFpproved OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INTION PRESENTED:
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
Signature of ruilding Official ate
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.
,a BP-2009-0232
GIs#. COMMONWEALTH OF MASSACHUSETTS
5 rF 3 77 3 '.
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-2009-0232
Project# JS-2009-000304
Est. Cost: $35.00
Fee: $210.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 060300
Lot Size(sq. ft.): 10846.44 Owner: CALLANDER ROBERT A&JEANNETTE
Zoning: URB Applicant: Valley Home Improvement, Inc
AT: 68 BLACKBERRY LANE
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON:91912008 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 16 SUNROOM
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 9/9/2008 0:00:00 $210.0024649
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
CA�� CA�C.6
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