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24C-092 December 29, 2010 Kent Hicks P.O. Box 57 West Chesterfield, MA 01084 Subject Property: 59 Massasoit Street Northampton, MA 01060 Mr. Hicks 1. Corrected and stamped engineering for 15t and 2 floor I -joist submitted electronically before rough inspection. 2. Corrected and stamped engineering for roof system /beams submitted electronically before rough inspection. 3. Room by room heat loss calculations submitted electronically before rough inspection. 4. Revised foundation drawing or SK. 5. The HRV manufacture requires 6' separation between intake and exhaust. 6. Plan set submitted electronically before rough inspection. 7. Structure conforms to 780 CMR 7 addition 1 and 2 family with 2009 IECC prescriptive requirements or RES Check 4.4.1 and mandatory requirements. 8. Smoke and CO detectors per code, plan and as noted. SD /CO outside the guest bedroom. ./ es M er Assistant Commissioner of Buildings , . REScheck Software Version 4.3.0 Compliance Certificate Frerciy 2003 IECC ocimior Northampton. Massachusetts Coi0rctior Type Single Family Glazing Area Percentage 11% Heating Degree Days 6404 ;ors'iructinn Sit o Owrtei/Agert Uen.gne Covience: Passes - Compliance Maximum lift 906 Your UA: 536 Gross Cavity Cont. Glazing UA Assembly Area or R-Value R-Vaiue or Door Perimeter ti-Factor xmting ;ioot (.;athF.tdral Ceiling no attic) '345 20 0 25 0 30 New Roof Cathedral Cering attic) 'OS 47 1) 25 0 ACM Wood Frame '6" o c 3287 10 0 25 0 New V.dindows Other 277 0 200 Windows. Wood l-rarti)) Fano. wth Low-E 94 0 330 31 rrpnt 'Wall I Soto Concrete o Maser 538 0 0 330 16 Wall heignt 8 C Derita oelow grade I 0' Insulation depth: How 1 S ab-an-G 220 - 0 0 218 Insulation depth. 0.3 Graw Solid Concrete oi Masonry 1350 0 0 20 0 Vial height 5.0' noNr below grade 3 0' I r suation depth 5.0' lrs ne below-grade depth 0 0' I feat hurt) 1 P.r F, S tISPF 14 1 SFF7751 Comphance Staterrwinr ThP. prr..,r,,osed buldiiq des or desc,1155al1sre IS CON hit liddy pals, calculations subni fled with the plitql I application 'he crorlosed teas e. e dos:firer: to meet 1e 2003 lECC "'AU! urnc,n,,, in HFShws Ver.sior 4.3.0 are cotrioly with the rnaidatcpy Scksii... Chacld 1°' 4 v ' Ninu - I Ak1 Signalirtt :3;ire . lie ciccsd Cat: 1 0:22,1 : i leoarrie• 101C21-qESChec' W ckte.k aqc ' 0 4 ,, The Commonwealth of Massachusetts Department of Industrial Accidents 3t ' Office of Investigations 600 Washington Street -- • Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): C .1 7 / - c`-/ 1` Address: f _ f/'. h a X 2 �1 , � / �f �g City /State /Z l, 5 � i s�c: r � �, �I�Ph � one #: '7 - 29Z - 2 3 Are you an employer? Check the appropriate box: Type of project (required): 1. ©'I am a employer with -- 4. 0 I am a general contractor and I employees (full and/or part - time).* have hired the sub - contractors 6. 0 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Q"'IFemodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' g Y P h 9. uilding addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 6 i "7C.., •' le 1 %e: 4- c Z Policy # or Self -ins. Lic. #: ti/ ') 92, / / 7 Expiration Date: /._ / j — - %/ Job Site Address: " r, 'S 'r. ... ..e , „ 7 City /State /Zip: /C f ;. -x /f „` r 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 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. Signature: / /Date: L .. . , — �� > Phone #: 1 //3 - 2, C / Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): - I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector - 6.Other Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supe isor: Not Applicable ❑ Name of License Holder : I <, }`� / /P License Number 1 6 <✓ s/1/ (- / n/c i( l" / 26/2 - Address Expiration Date Si attire Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ /f 4<15.- k f " 47). l ICJ 9 5 Com an Name Registration Number Is 4'. e X 6" L z‘- Address Expiration Date j / � 3 �r N/ S C S i<c- ��� . �i ' Telephone / 2 VL 0:23 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 f=i No ❑ 11. - Home Owner Exemption 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [J Addition Replacement Windows Alteration(s) E " Roofing Or Doors ❑ Accessory Bldg. El Demolition ❑ New Signs [D] Decks [D Siding [D] Other [d] . e66' jrat ' c2‘td 0 Brief Des 'ption of Proposed // D � WOrk: .rvdn't! 4 ��. f c.3 F is . ' i, t *.) 1)6r / Si & . e, e . — r.� /y' ∎ 3 4' ∎ 4 , s �; 4 R •"", e e ' 6 le , i �e,. /VII,/ G.+ -`f Alteration of existing bedroom Yes No Adding new bedroom ------ - Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing. complete the following: a. Use of building : One Family --''--- Two Family Other b. Number of rooms in each family unit: ,3 Number of Bathrooms 2 - c. Is there a garage attached? A.)i,, G, t1(; 7e.- i - , / / / rr q d. Proposed Square footage of new construction. / 3 t 57, (I- - 4', >' Dimensions /9.)(1 2 d .5 e. Number of stories? /� /9 :., . s- / f. Method of heating? /!,:., ,5 , z it ; / Z. ---. 6 Fireplaces or Woodstoves / Number of each Energy Conservation Compliance. g. gy p ' „5 3 L Ma sscheck Energy Compliance form attached? k , h. Type of construction Li).- t I i. Is construction within 100 ft. of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes ° / No j. Depth of basement or cellar floor below finished grade '7 k. Will building conform to the Building and Zoning regulations? Yes No . r 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 I, V 4 / l tcIv_ie KA (1-(, , as Owner of the subject property hereby authorize kf/4" i1-11 - - ii-_s to act on my behalf, in all matters relative to work authorized by this building permit application. ' 7)11 alit (A-4 vL id -10 Signature of Owner Date I, /Li) / All 61/5 , 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 e pains and p nalties,of perjury. ell l / `; G f ` f Print Name ;,� i i Signature of Owner /Agent Date 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 Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage iJ a P % 0 Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Specia ermit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q 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 (3 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO e---- IF YES, describe size, type and location: E. Will the construction activity disturb (Gearing, grading, ex ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit j Zone Overlay District ,r "A Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailin Address: // A- hi /4 Telephone Signature 2.2 Authorized Anent: f?�, - `" 0 r, J Z/ 3 f �. ' (Print) re 3 ` -77i' -ac eff.ty, - `s`� j 'L 4— Name ( Current Mailing Address: 6106 l� . ::.rte- �.r..•�•:` �s y/ - - 6/.1 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 2/©, 30.0 - 2. Electrical (b) Estimated Total Cost of /1. Construction from (6) 3. Plumbing / . C � _ Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 3 6 y D 6. Total = (1 + 2 + 3 + 4 + 5) 6 A / Check Number foi' ,, ;i' '" This Section For Official Use Only laps i Permit Number: Date Building Idmg erm b Issued: Signature: Building Commissioner /Inspector of Buildings Date ' File # BP- 2011 -0569 2aN(tJ aK - FLAB fU t €� APPLICANT /CONTACT PERSON KENT HICKS ADDRESS/PHONE P 0 BOX 57 WEST CHESTERFIELD (413) 329 -4788 0 PROPERTY LOCATION 59 MASSASOIT ST MAP 24C PARCEL 092 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out (�� Fee Paid d Typeof Construction: REBUILD 2 STORY ADDITION CKITCH,BEDRM,BATH & UNFINISHED 2ND FLR) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 66104 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ION PRESENTED: pproved 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 Demo ire, Delay Signature of Buil ing Of cial 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. '' ` Sr $ BP- 2011 -0569 GIS #: COMMONWEALTH OF MASSACHUSETTS ~gook: 24c -092 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP- 2011 -0569 Project # JS- 2011 - 000647 (. Est. Cost: $262000.00 RA \� Fee: $420.00 PERMISSION IS HEREBY GRANTED TO: 5 f - Const. Class: Contractor: License: pp Use Group: KENT HICKS 66104 Lot Size(sq. ft.): 15855.84 Owner: WICK DAVID B & MICHELE T Zoning: URB(100)/ Applicant: KENT HICKS AT: 59 MASSASOIT ST Applicant Address: Phone: Insurance: P 0 BOX 57 (413) 329 -4788 O WC WEST CHESTERFIELDMA01084 ISSUED ON :1/6/2011 0 :00 :00 TO PERFORM THE FOLLOWING WORK :REBUILD 2 STORY ADDITION (KITCH,BEDRM,BATH & UNFINISHED 2ND FLR) 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 1/6/2011 0:00:00 $420.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner