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35-242 (3) JUL-26-2006 12 :02 PM P. 01 1 F' 'goon A 3L b ( R. 'C a 4 i ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 78`0 CMR Appendix J / / Applicant Name: /U(//!c� /G�� Site Address: �3 j' L,7dI j/<�W Applicant Address: City/Town: ,/� 7L ,/j'j A Use Group: _ O Date of Application: 7-/ Applicant Phone: )!,/ ') Applicant Signature: v Compliance Path(check one): ❑ Prescriptive Package(Limited to I-or 2-family wood frame buildings heated with fossil fuels only) Package(A through KKfrom Table J5.2.1b): Heating Degree Days(HDD65)from Table J5.2.1a: (For items d. through i.,fill in all values that apply from Table J5.2.lb:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- e. Glazing%(100 x b-a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE ❑ Component Performance: "Manual 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 Worksheet from Appendix J, [and HVAC Trade-Off Worksheet,if applicable] ❑ AVIAScheck 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 Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area 5_3 V sq.ft. b. Glazing Area' sq.ft. c. Glazing%(100 x b-a) —,L210 ❑ ADDITION with Glazing% (c.)up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration'. Ceiling' Wall Floor I Basement Wall Slab Perimeter,Depth 0.392 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 maybe used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings) ❑ "SUNROOM"addition (greater than 40% glazing-to-wall and ceiling gross area) Attach"Consumer Information Form"from 780 CMR Appendix B. Official's Name: ,/7, Official's Signatur � Application Approved 5� Denied ❑ Date of Approval/Denial: 1cY� Reason(s)for Denial: (provide additional details as needed on back side) ..�. - ��-tee. �• xi A Al OL R ir r ¢�,�'•m •'=�Rr �.. r'' �`fir � ,.� -=�'"r r���nr r � y `�`7 4 'i ivy r• '"�� ivo '1.-'rte. ��.', �� ifse a •"� •a-', s} x � � ` A t L __- W _, .�A Aar A AW1I , %,ivyi - 11 1 rvK V ULUMARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address: 39 Ladvslipper Lane ►caner: Sagalyn ate of Inspection: October 5, 2005 KETCH OF SEWAGE DISPOSAL SYSTEM -ovide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. [so See attached 3, / J x � I � 39 10 TITLE 5 OFFICIAL INSPECTION FOR- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 39 Ladvslioper Lane Florence MA 01062 Owner's Name: James Sa2alvn Owner's Address: 17 Woodlawn Ave. Tel 586-3770 Northampton. MA 01060 Date of Inspection: October 6, 2005 Name of Inspector:Alan E. Weiss. R.S# 933 Company Name: Cold Spring Environmental Inc Mailing Address: 350 Old Enfield Road Belchertown, Massachusetts 01007 Telephone Number: (413)323-5957 fax: 413-323-4916 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and Complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper fitnction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CNR 15.000). The system. W Passes Conditionally Passes �- Needs Further Evaluation by the Local Approving Authority Fails n Inspector's Signature: Date: October 5 2005 V The system inspector shall submi a cope of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design Dow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments Septic System was in good condition, There is no sign of current or past failing coindlfi`on. S. Tank(1500 gallon) was in good shape. Baffles were inplApe and septic tank was pumped. One 1000 gal. L. tank was found & opened. L. Tank stowed no sign of hi staining or Failure. Est. G.water 101+ in sand. System is 20+/-years old. 0-3 pL I S kt* T— QP Ca.1•e w C9p A ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same difrerent conditions of use. 1 \tx I t 1 J d� O BOOK 4199, PAGE 177 PLAN BK. 129, PG. 60 LOTS # 33 & 33A X12 o 't i SHED 1 � x � �N 0 �,pec,c Rc r�0 rc0 �S a)��aLX& ex ls pawls � #39 N 1 i - SEE' SEPJ'eC P�q+►� H7iAct} G' L=134 . 99 't �pZ- ff 4 0,0 i/D�/ OAT P�� Crzfv of1�zI��1il �rt r $ & �$SSRtlTitsrtr3 DFPARTMci'NT OF BUILDP\TG INSPECTIONS 212 Main Street Municipal Building '\ ` Northampton, Mass. 01060 WORKER'S COMTENSATION 26URAINSCE AFFMAYTT i Nelson Shifflett - Valley Home Improvement Inc . (li�nses:ipc:mit'�} with a principal place of business/resldenc_- at: 340 Riverside Drive, Northampton, MA 01060 (puoner) 584-7522 do hereby cer-d=y, under the pains and penalties of pe'u1, ILA_: (X) I am an employe- providing the following, worker's comp nsa*oa cove age for ;ny employees working ca this ec: • Acadia Insurance Co . 0109302-12 2/1/07 J_ swans✓COMT—'-7) (--xpir ion D=', ( ) i am a sole proprietor, geaerai con=cror or homeowner ;c cle one} and have h red the contractors listed below who have the follo7ginit workers c-omoensadon oolicies: (Ni amI! of Cont<=) (nairaLG Corn^3r:YhoLi7,, 10C ; (_`i_ma0a Da"c" (Name 0 C0aL CiOi) (lIlSilr"dllc: Co=ain/Polic:v Numc?:; cumaoa late; (iali:e of Co==,C.-) (Lnsuraac� Cau-, am yiPoEc \. :Irrh,_--) ;�:�il�acn Dale; (Name of Coanc-,cr) (Inszlcancc Comps" /Policy Neu.x) (Expi:--aion Da!°) (atlas's additioasl s cd ifceccury to inclui irforrnuioa pertmi=ir_&'o ail xza:rac r3) ( ) I am a sole proprie.or and have no one wor4dng for me. ( ) I am a home owner performing all the work myself. NOTE:prose be aware tfut while homeov4vera who cnplay pecan to do=�-a M = =on or hair weric on a dwelling of not ruse then three units is Which the homoowner reside or oa the g v-Ln6 appu',rsat thereto are opt gma%dy co=Aacd to be e:=ploY=under the worktr`s e=pc_satica Act(GL152,z 1(5)),application by a hcmeow=far a Gccase cc permu:.av cvidcace the legal ctatu o£an asployer under the Workces Compewation Act I undrstaad that a oopy of this z7n1e d may bo for-% n t.o tho Dcpartasm2 of In&L-,t,al A=&.&Offioe of Inairaaca for the cover age verificuioa and that failure to seuue ooverago tinder socdoa 25A cf MGL 152 can[cad to tee imposition of mmi W peaakies comir.ing of a fine of up to S1,500.00 and/or impriso of up to one year and civil penalties in the form of a Step Work Ord-and a Lac of S 100.00 a day against me 0 Signed this�"'-___day Of /ri aG L/, For dcq�massl uac mhy Permit Number , —"7 SECTION 8 - CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Nct =:�plicac!e i Name of License Holder : Nelson Shifflett 060300 Valley Home Improvement, Inc . L:ce^se Numcer i 340 Riverside Drive. Northam on,_1 ", 9/22/% Address I Expiration Date I 584-7522 Signature Telephone s 9. Re6ster ed Hom 'orovernent Contractor: I `Jct =ppiicacie Valley Home Improvement, Inc . j 105543 j Company Name Reg-s raticT,, ceY i 340 Riverside Drive 7/17/09 Address Northampton, MA 01060 `ee-phor, 584-7522 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFi_ AVIT (M.G.L. c. 152. § 25C(6)) i `Ncrkers Compensation !nsurarce arridavit rr„st "e ccmpletec -,Cl suom:ttec with this acciica: ,n. .. -vic-e arida,rt i resuit in the cen ai ;,r the issuarce or the :�uiidirg permit. Signed Affidavit A.t�ac^ed Yes....... ...... G 11. - Home Owner Exemption "fhe current exemption for"homeowncrs" was extende` o include Owner-occupied Dweilinzs of one(J i or two(2) families and to allow such homeowner to en aLe an individual hire who does not possess a license, provided that the owner acts as supervisor. CMR'180. Sixth Edition Section 10, =.5.1. Definition of Homeowner: Person (s)who own a pare., of land on which he,%she resides cr intends to reside,on which there is, or is intended to be, a one or two family dwelling,at ached or detached structures accessory to such use andi or farm structures. 4 person who constructs more than one It me in a two-Fear period shall not be considered a homeowner. Such"homeowmer"shall submit to the Building Officia on a form acceptable to the Building Official,that he/she shall he responsible for all such work performed under the h iildini! permit. As acting Construction Supervisor your presence on t: 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 (We-leers' Compensation) and Chapter 153 (Liabilit% of Empio%ers 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 undersi_ned"homeowner'certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laves and State of Massachusetts General Laws Annotated. Homeowner Signature I 'FCTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition I Replacement Windows Alteration(s) ❑ ( Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Sig. s [ ] Decks Siding j Other L 1 E4 Desc}-ctiolof Proposed Work*field Sa'.,26 heo-1 �1tc,�ycidlC 40OUC C1lc� -- g tT "Y s Vo Adc;ng ne•w "ecroem 'es ' c Alteration existing bedroom ° Attached Narrative _ Renovating unfinished basement es No Plans Attached Roll _ Sheet ✓ p�C /'S �,� — S412.4 ,nom c 6a. If New house and or addition to existing housing, complete the following: L + 7' J�r:;,Jllt cr j a. Use of building : One Family —,vo Family Other ✓ ©7v �J b. Number of rooms in each family unit: Number of Bathrcoms c. Is there a garage attached? c. Proposec Square footage of new oorst uc:icn. dof Cir7ersicrs i I F .� i vlet'c- of real ng� © ! irep!aces cr `,Vccls oves rl-e.' earn g. Energy Conservation Compliance Pilascneck ^ergy Ccm.pGance cr r. a :ac:, rr,� y ype of construction aiy IS nS: :C cn within _CO it. c".ve;lands? i4, yes :%c. 'S GrS .' c:ICn ,VI: _ V �. f a! e5 N,c Depth c' zasement or cellar flcer bei„,,•r 'ir!shec grade 7 / 'Jill buiicirg conform to the Buiicing and Ecning regulations? c - 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 I ��Q ��t l��C' ►� as C,vne the suclect prccerty hereby authorize Nelson Shifflett, Valley Home Improvement Inc. to act or' my ehalf. in all matters r tive to work authorized by this building perms; application. t Signature of Owner Date - -(� I i 1, Nelson Shifflett, Valley Home IMPrnyPmPnt- _ Inc as Owner'Authorizec Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best cf my knowledge and belief. Signed under the pains and penalties of perjury. I Nelson Shifflett Print Name 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:filed in o Building Department Lot Size > Frontaae Setbacks Front Side L: ),5 R: L: Rear d Building Height G C� �0 Bldg. Square Footage d�l�yy / ' 4 s do IV �e( Open Space Footage %'o (Lot area minus bldg&paved 6,0 parking) 9 of Parking Soaces Fill: �✓ (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO LX 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 y 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: } i Department use only City of Northampton iStatus of Permit: - Building Department )Curb Cut/DrivewayP.ermit i 212 Main Street Sewer/SepticAvailablity ;E Room 100 Water/Well Availabiiity _ F Northampton, MA 01060 Two'Sets of Structural Plans phone 413-587-1240 Fax 413-5-87-1272 Plot/Site Pihss I f Other Spect€y - APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATIONCv6 1.1 Property Address: This section to be completed,by office ! C 24 ZV_ z—,. x, L,J Map Lot Unit Zone Overlay District Elm St. District C8 District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT i i 2.1 Owner of Record: T�iec-c^e gig"ature 2.2 Authorized Agent: Nelson Shifflett Valley Home Improvement, Inc P .O . Box 60627, Florence, ?g 01062 Pdame(Print) QQ cur.er.t Vailinz.=adress: �/L• 41,z,Di° C, 584-7522 Signature SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Off iciai Use C-:v cornoleted by cerr c nit aclican, J _. Ewidino !a) Building Permit Fee 2. Electrical (5) Estimated Total Cost of i O OO Construction from o 3. Plumbing Building Permit Fee l 4. Mechanical (HVAC) �00a , 5. Fire Protection j o. Total = (I + 2 + 3 + 4 + 5) 23 00-7 Check Number ; Q This Section For Official Use Only Building Permit Number: Date Issued: t Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0067 APPLICANT/CONTACT PERSON Valley Home Improvement,Inc ADDRESS/PHONE P O Box 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 39 LADYSLIPPER LANE MAP 35 PARCEL 242 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out QQ Fee Paid T_vueof Construction: CONSTRUCT 8 X 26 ADDITION(ENLARGE BEDROOM) RELOCATE BULKHEAD& REMOVE DECK New Construction Non Structural interior renovations Addition to Existing AccessoTy Structure Building Plans Included: Owner/Statement or License 060300 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF LOWING 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 Co sion 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. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. BP-2007-0067 CIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0067 Project# JS-2007-0107 Est. Cost: $73000.00 Fee: $290.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Valley Home Improvement, Inc 060300 Lot Size(sq.ft.): 60984.00 Owner: SCHROEDER ROBERT&CAROL Zoning_SR Applicant: Valley Home Improvement, Inc AT. 39 LADYSLIPPER LANE Applicant Address: Phone: Insurance: P O Box 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON.81112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 8 X 26 ADDITION(ENLARGE BEDROOM), RELOCATE BULKHEAD & REMOVE DECK 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 8/1/2006 0:00:00 $290.0021280 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo