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ENERGY CONSERVATION APPLICATJ(3AI FORM FOR
•RISE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS
it 780 QMR Appeodix J{-e f tive 3/1/98)
�� � �r AAp� /K4te_Zj, • Ifi
Applicant Add ess: 491 City/Town:
T!t tS rf Use Croup:
A,te-J,C lC Date of Application:
Annli_nt Phr' _: ��/3),.� 07 3 a�..i:.._.:_..
.��... �, n{lFl4/�.P 11 VII JI�IId LUG. L'
CempUanm Path(check one):
ll Prescriptive Package(Limitea to 1- or 2- family wood Frame buildings heated with fossil fuels only)
Package (A through KK from Table J5.2. lb): ____ Heating Degree Days (HDD.)from Table J5.2 la:
(For items d. through i., fill in all values that apply from Table J5.2)
a. Grow Wall Area sq. ft f. Walt R-Vattw R /3
b. Glazing Areal S-q. f! g- Floor R-Value
c. Glazing%(100 x b4-a) ?i�� h. Basement wail 8-�r,
.d• Glazing II-yX11r J` . 1.2<Slab Pni
e. Ceiling Rt-value i- Heating AFUE
❑ Performance: "Manual Trade-01'r (Limited to wood or metal framed buildings only)
Climate Zone("m Figure J6.2.2) ❑ Zone 12 ( l Zone 13 !] Zone 14
Attach Trade-Off f4brlcsheet from Appendix J,Viand HVAs irade-Off Worksheet,it applicable]
❑ tAAAScheck Software
Attach Compliance Report and Inspection Checklist printouts.
❑ Symtrns Amlysis OR Q Renewable Energy Sources
Attach Mau Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall +Ceiling Arefyf sq ft_ b. Glazing Area sq.ft. c_ Glazing%(100 x b*a) g(,
ADDITION vrith Glazing% (c.)up to 407�may use 780 CMR ''able J1.1.2.3.1 getow:
MAXIMUM U-yalua Minimum R•values
Fenostration Ceiling Wait I R t Wall j Siab Perimeter, Dept
L0_ R-37 12-53 R 19 ' R-1Q
❑ -SUNROOM'addition(greater than 40%glazing-to-wall and ceiling gross area)
Attach `Consumer Information Form"from 780 CMR Appendix 8.
Official's tame: Official's Signature:
kpplicgttan Approved L) Denied ❑ Date of Apprmal/cDenjal:
Plo ason(s)fvr ucniai: (pramidC addiiionai details as needed on back side)
Area=wy be ektAer Roq&t Opmmg or Unix TXm rmons
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-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
2 2H
PT^ '
0
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a
Y
I
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TO: CITIMORTGAGE, INC. &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
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
l2eb -NO TE-
SURVEYOR: �• THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
of u+s
-MORTGAGE LOAN INSPECTION PLAT-
boy NORTHAMPTON, MASSACHUSETTS
RANDA.L `,1� PREPARED FOR
�.
H SANDRA HYATT GRAHAM
#35032 SCALE: 1 "=30 ' MAY 24 , 2000
HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
=O¢(ll/.J•f p2,0 .
A E Cri of 'Nod11amploll = —_
�taxaarhncttfa '•� —
c� DEPARTME14T OP BUILDING INSPECTIOI.'S
212 Alain Street ' Municipal Building
Northampton, Mass. 01060
«VORICCR'S COMTENSATION INSURA-NCE AFTCMAVIT
(Iia ScrJpermittcc)
%with a principal place- of business/residence at:
do hereby certify, under the pains and penalties of perjury, har
( ) I un an employer providing the following worker's co171DCnSc1102 cove 2gc for Inv
eluployces worming on tills job.
(lbs=nc' CoopzLy) (Poh ?:u--,ib--r) ------ (rrpir-,tion Dztc)
O I am a sole proprietor, general contractor or homeowner (ci:cie one) and have hired
the contractors listed below who have the following workers coDnensanon policies:
(N rvc o-Co t actor) (InRrant Comma-flyPouc-, Nurnh--r) C=_xpirauon Date-)
,f
(Name of Con(ractor) (La5-a ancr. Company/Policy Nuncrr) (ExpLMiion Date)
(Name of Coturacto,) (Insuranc Compan}•/PoOcy MuDbu) (E-xpiraoo Date)
(Name of Contractor) (Insurance Company/Policy Number) (E�piration Datc)
(aaiCll:.d{i:ioc>,1 ciicci if neac:si:y to ax!u infoctni:i oo pertaiaing to ajj
O I am a sole proprietor and have no one wor4dDg for me.
(>I I am,a home owner performing all the work myself.
NOTE:plc:-&c be tw-arr&tj HQ,r lioar_oKOCn ubo cazploy pct- a w r- =—,U--00 c rcau woric oo.d--U og of
orit mat tL'A Lb OC L--Lc to%-bS ch Lt'b0fDOOK'UCf rc-dc,IX co tb-c p-oup IrpullCnl-t1 aC-o LT WC C=xr.Uy oCCS:d.'mL to he
cctployc-s unr c the t.--km;oCZ [Lioa Arx(GL152=I(5)�spplicttioo try a bomeowva far a Ilea-,or permit r=y nidmcc the
Ic1PJ nnau of aA c=ziloyec under dui WOrkOel Coaapo¢saLioa Ad_
I undaTLi d d»a copy of ttva eimlemml may bo foew„tded to tbo pcp„t of lo6,r id Amde.&Offioo of(triit+ooe for tho
eovmsc`a-iLCIIioo am a"f_iJmc to toauc wvcnkgc trader soU oa 25A of MGL 152 an lud to the i , ioa ofmmiarl pea&Wc,
000siautg of a rsnc of up to S 1 500.00 and/or ialpriioamcoi of up to coc yv tnd Cj D pcOj do io 6,fo m of n Stop Wort Ordcr and a
fim 0(5100.00 a day tpinss m--
For dwi�u.c only
Permit Numbes --
Map;:_ Lot
St atom of Li�iscc/Pcrl7tiUcc ���
W -PONSTRUCT1016111 WCES
.r Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
sum Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
sECl IQ1�110»'.:iNtlRKEiS CON(P ENSATIQN 1NSURAldCE Af FIDAYI7 2SC(r }
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.
ned 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 Qoqral L ws Annotated.
Homeowner Signature
a
New House ❑ Addition C9 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: JjLe� '2 Intkii4 cur WV hen bxw bi �itlyc±k,i�'1G =V91 lceldd on / r
Alteration of existing bedroom Yes K No Adding new bedroom Yes _X No ! AAk cart
Attached Narrative❑ Renovating unfinished basement Yes XNo
Plans Attached Roll ❑ - Sheet 1&
X
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? 6k -
d. Proposed Square footage of new construction. L98�5g'I Dimensions � ��/� Ll J/
e. Number of stories? 0r12-
f. Method of heating? QC(g' Fireplaces or Woodstoves A16 Number of each 0
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
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_ C Private well City water Supply
SECT!gN 7a t ffl A1JTHpl li a lQN-TO COMPLET q 'WHEN
OWNERS,AG ",OR COPI7RAC OR AP',P "I FQR BUILDING PERMIT
as Owner of the subject property
hereby authorize /"C2L� 7—A,-A to act on
my behalf, in all matters relative to work authorized by this building permit application.
�2r —
Signature o er Date
6&f o Z 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.
lm&gned under the pains and penalties of perjury.
r ,n Q /Vat!
Print Na
• / cy U
Signat a of Owner/Agent Date
4
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
2 !�
Building Department
Lot Size q 173 1 72 3 V 0T j 6U
Frontage
Setbacks Front � d
Side L: R: L:O�R R:� 0
Rear D
Building Height
Bldg. Square Footage T� % g 3 \ C
Open Space Footage % d�
(Lot area minus bldg&paved v
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 9 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 N>('— 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. Are there any proposed changes to or additions of signs intended for the property ?YES_
No
IF YES, describe size, type and location:
Northampton
i� I g Department
j Main Street
_ oom 100
N t pton, MA 01060
$58 -1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE;INFORMATION
, This se+rltl
1.1 Property Address: a
r' n,
SECTION 2=PROPERTY OWN ERSHIP/AUTHORIZIrD AGENT
2.1 Owner of Record:
me(Pri t) Current Mailing dress:
v �/o
Telephone f�,
Signature % J <1 7A3
2.2 Authorized Agent: ,(
,4�2,e, ,d, -din j a(_1 o Z M C,
Name rint) Current Mailing Address:
&7a..�
Si ture Telephone
SECTI °N S-ESTIMATEI?!CONSTRUCTlOh1 COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 0 e, (a),Building Permfffee
2. Electrical 60e. v a (b)Estlrnated Total Cost of
Construction from 6
3. Plumbing U C/0 C". C/C; Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 +3 +4+ 5) J Cheo&K,N(4m[ber
.'� �Section'For Official Us�'On#
uildingPermit Numbor.' Date Issued:
—
signature:
ate
Building Commissioner/l,nspeetor of Buildings D
File#BP-2001-0127
APPLICANT/CONTACT PERSON MARTIN PAUL&KAREN
ADDRESS/PHONE 491 BRIDGE RD#2724 (413)582-0723 Q
PROPERTY LOCATION 1195 BURTS PIT RD
MAP 35 PARCEL 089 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled ou
Fee Paid Y20 <
TVeof Construction: CONSTRUCT 16 X 12 KITCHEN ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accesso 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.
enied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
ee
ariance Required under: § w7ZONTNG 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 Commissiou. Permit from CB Architecture Committee
Signature of Building Official 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.
File#BP-2001-0127
APPLICANT/CONTACT PERSON MARTIN PAUL&KAREN
ADDRESS/PHONE 491 BRIDGE RD#2724 (413)582-0723 Q
PROPERTY LOCATION 1195 BURTS PIT RD
MAP 35 PARCEL 089 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled o
Fee Paid
Typeof Construction:_ ONSTRUCT 16 X 12 KITCHEN ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE LOWING 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
Finding Required under: § w/ZONING BOARD OF APPEALS
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 Commission Permit from CB Architecture Committee
—A �5''-4 , '<
Signature of Build' Official 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.
MI
:,` BP-2001-0127
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:ADDITION BUILDING PERMIT
Permit# BP-2001-0127
Project# JS-2001-0187
Est.Cost:$7500.00
Fee:$76.80 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:
Lot Size(sq.ft.): 9713.88 Owner: MARTIN PAUL&KAREN
zoning: SR Applicant. MARTIN PAUL & KAREN
AT. 1 195 BURTS PIT RD
Applicant Address: Phone: Insurance:
491 BRIDGE RD #2724 (413) 582-0723 O
FLORENCEMA01062-1076 ISSUED ON:813100 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 12 KITCHEN ADDITION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/3/00 0:00:00 920 $76.80
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
c: e
��f
..__a_____�-----�.�-.—�.
�w _.��.
.��r.�-_ _-� _�_
v__ — __ ,__ � _ 4.._�.____ _ _ .___
_ __ _
.:.�..... v,. ..�. .�:�.�..�.,w__—
1195 BURTS PIT RD BP-2001-0127
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM Block:35-089 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cate o :ADDITION BUILDING PERMIT
Permit# BP-2001-0127
Project# JS-2001-0187
Est.Cost:$7500.00
Fee:$76.80 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group:
Lot S' sg.ft.): 9713.88 Owner: MARTIN PAUL&KAREN
Zoning: SR Applicants MARTIN PAUL & KAREN
AT. 1195 BURTS PIT RD
Applicant Address: Phone: Insurance:
491 BRIDGE RD #2724 (413) 582-0723 O
'FLORENCEMA01062-1076 ISSUED ON:813100 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 k 12 KITCHEN ADDITION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:( �f�/ •p e ;xJ
Final: Final: // Rough Frame: -7 c,-,el,
a . .
E t�
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: Q
THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/3/00 0:00:00 920 $76.80
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo