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24D-310 r Montpelier Mediunz Insert // i 2. Determine the R -value of the proposed alternate floor protector: -- - i. Use the formula in Step 1 to convert values not i expressed as R. ii. For multiple layers, add R- values of each layer to i_ determine overall R- value. % 3. If the overall R -value of the system is greater than • the R -value of the specified floor protector, the alter- / • Hate is acceptable. `-- — EXAMPLE: The specified floor protector should be 11- B I I v� inch thick material with k- factor of 0.84. The proposed ' alternate is 4" brick with an r- factor of 0.2 over 1/4" A mineral board with a k- factor of 0.29 1 Step a: Use formula above to convert specification to R- value: R =kxT 084 x1.25 =1.49 c >1 Step b: Calculate R of proposed system. United States Canada 4" brick of r = 0.2, therefore: A, 18 "* (460 mm) 18" (460 mm) B. 8" (203 mm) 8" (203 mm) R brick = 0 . 2 x 4 = 0.8 C. 44 (1137 mm) 44 (1137 mm) 1/8" mineral board of k = 0.29, therefore Typically, thermal protection with the above dimensions will be R = 1 required. The equivalent of 1.25" (32 mm) of a material with a k- mineraiboara 0.29 x 0.25 = 0.431 value 0.84 (or a total R -value of 1.49) is necessary. R = R + R = 0.8 + 0.431 = 1.66 If the insert is elevated 8 (216 mm) or more above a combus- Rtotal brick mineralbnard tibie hearth, thermal protection is not needed. However, spark and Step c: Compare proposed system Rtotal of 1.66 to ember protection is still necessary. specified R of 1.49. Since proposed system Rtotal is *If the insert is elevated 3" (76 mm) or more, this dimension may greater than required, the system is acceptable. be reduced to 16" (406 mm) (US only) beyond which no thermal protection is necessary. FF1095 Definitions Fig. 5 Unless your fireplace and hearth are constructed over = (Btu)(in) a dirt floor (or unpainted concrete over dirt), you must use a R — Btu k (ft2)(hr)( °F) K x 12 floor protector that satisfies the above requirements. K = (Btu)(ft) r _ (ft °F)_ 1 How to Determine if Alternate Floor (ft °F) - (Btu)(in) k Protection Materials are Acceptable All floor protection must be noncombustible (i.e. met Optional Surround Packages als, brick, stone, mineral fiber boards, etc.). Any organic Custom -made surround panels may be made from any materials (i.e. plastics, wood paper products, etc.) are noncombustible material. combustible and must not be used. The floor protection MHSC offers both steel and cast iron Surround panel specified includes some form of thermal designation kits, each in two sizes. such as R -value (thermal resistance) or k- factor (ther- Enclosure Area mal conductivity). Georgian Cast Surround: Procedure: 30DVSGTKCB, 30DVSGTKB 1. Convert specifications to R- value: 30 x 41 (768 x 1041 mm) i. R -value given - no conversion needed. Mead Cast Surround: ii. k- factor is given with a required thickness (T) in MEAD3CB, MEAD3EB, MEAD3BS inches: R = 1 x T 281/4" x 41 (718 x 1059 mm) k Caprice Cast Adjustable Profile Surround: iii. K- factor is given with a required thickness (T) in CAPCB, CAPEB 25" x 35" (635 x 889 mm ) inches: R = 1 x T K x 12 Bevel Cast Trim Surround: iv. r- factor is given with a required thickness (T) in LHEABSL 271/4" x 40 (708 x 1035 mm) inches: R = r x T Steel Surround: LHE3OSSB 27" X 381/4" (686 X 972 mm) LHE3OSLB, LHE3OSLGA 281/4"x41 "(718x 1041 mm) 30004403 7 f38 -qg SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 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. Signed Affidavit Attached Yes ❑ 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 Zonin! Laws and S . Massachusetts General Laws Annotated. � Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I l Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [D Siding [D] Other [I ( Brief Description of Proposed x it ! �t Work: - f /4` l (,✓Qs pr Mr .71 f (oUe � 5<ff l4 T �i� � hiL e Y �l 0.144.0,4 (...`sS puel S Alteration of existing bedroom Yes No Adding new bedroom Yes No !Y l �p Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or additio existing housing, complete the following: 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? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. 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 Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 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 declare 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. ft tlelfie -1 A Print Name ,� � ( -4/Ze• If 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 .1 • 17 Frontage 'ff " sr' Setbacks Front v' 20' Side L: L t R: Z.' L: Zr R: ZD Rear 715- 3e' Building Height ›zrs fyr Bldg. Square Footage ) ,, • % pa Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces 3 3 Fill: (volume & Location) A. Has a Special Permit /Variance /Findin ever been issued for /on the site? NO 0 DONT KNOW 0' YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 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 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 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO e IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc vation, 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: 1 2 ' Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability I 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 This section to be completed by office 1.1 Property Address: 8?-- LP- el ed. 16,140.00-..1 SAS fy I mil vl -..1) it Odd Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I ic 4 419 ( fle' t..,/ pr t vie eil, /k ( 4. y f.t, /074 Name (Print) Current Mailing Address: i13- io4 -0373 Telephone Signature 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 permit applicant 1. Building -i ,- ,�'L qx�.o° (a) Building Permit Fee 3 S 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 y This Section For Official Use Only Building Permit Number: Issued: (/// 'r / r— / / Si nature / /'�i�F /'- // / l 9 Building Commissioner /Inspector of Buildings Date S ;k . , BP-2011-0632 GIS #: COMMONWEALTH OF MASSACHUSETTS 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-2011-0632 Project # JS-2011-001020 Est. Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784 Lot Size(sq. ft.): 8319.96 Owner: HEMPSTEAD MICHAEL Zoning: URA(100)/ Applicant: HEMPSTEAD MICHAEL AT: 84 BANCROFT RD Applicant Address: Phone: Insurance: 84 BANCROFT RD (413) 204 -0393 () WC NORTHAMPTONMA01060 ISSUED ON:1/13/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL WOODSTOVE 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 1/13/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner