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17C-263
niatenais uataonse l' , _ __ ____ . 1 of 2 Member Data Description: CaIcB5 Member Type: Beam Application: Floor Comments: Top Lateral Bracing: Continuous Bottom Lateral Bracing: (See Below) Standard Load: Moisture Condition: Dry Building Code: IBC / IRC Dead Load: 0 PLF Deflection Criteria: L/360 live, L/240 total 1.500" max. LL Live Load: 0 PLF Deck Connection: Nailed Member Weight: 10.8 PLF Filename: Q: \KeiterSco Other Loads Type Trib. Dead Other (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PLF) Top 0' 0.00" 6' 11.50" 61 246 Live Replacement Uniform (PLF) Top 6' 11.50" 21' 8.50" 60 240 Live Point (LBS) Top 0' 7.00" 71 0 Live Point (LBS) Top 7' 7.00" 292 1 Live Point (LBS) Top 7' 7.00" 0 362 Snow Point (LBS) Top 10' 10.88" 347 3 Live Point (LBS) Top 10' 10.88" 0 971 Snow Point (LBS) Top 14' 4.25" 282 2 Live Point (LBS) Top 14' 4.25" 0 789 Snow Point (LBS) Top 17' 9.63" 347 3 Live Point (LBS) Top 17' 9.63" 0 971 Snow Point (LBS) Top 21' 1.50" 292 1 Live Point (LBS) Top 21' 1.50" 0 362 Snow ' . 7 re n �k")r,�"w �+, rt � -`'� ia44: ' � t tf # , ,1 to " 7 i fit Q 7 5 8 610 5 © 7 411 21 8 8 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall N/A N/A 1.500" 1038# -- 2 7' 0.875" Wall N/A N/A 1.500" 3199# -- 3 13' 11.188" Wall NIA N/A 1.711" 4349# -- 4 20' 11.250" Wall N/A N/A 1.500" 1713# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live Snow 1 259# 779# -68# 985# 2039# 914# 3 1286# 2007# 2077# 4 593# 759# 734# Design spans 7' 0.875" 6' 10.312" 7' 0.063" Product: SP PT #1 2 x 10 3 ply Component Member Design has Passed Design Checks.* * ** Design assumes continuous lateral bracing along the top chord. No lateral bracing required along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 2603.'# 9194.'# 28% 17.42' Odd Spans D +0.75(L +S) Negative Moment 2696.'# 9194.'# 29% 13.93' Adjacent 2 D +0.75(L +S) Negative Unbrcd 2696.'# 9194.'# 29% 13.93' Adjacent 2 D +0.75(L +S) Shear 1628.# 5585.# 29% 13.94' Adjacent 2 D +0.75(L +S) LL Deflection 0.0276" 0.2335" L/999+ 17.43' Odd Spans 0.75(L +S) TL Deflection 0.0363" 0.3503" L/999+ 17.79' Odd Spans D +0.75(L +S) tt Ae product names are trademarks of their respective owners _.. -1 A / La 14... Copyright (C)1987 -2011 by Keymark Enterprises, LLC. ALL RIGHTS RESERVED 7 t ft te i r 41""") , A T. .: , / / ,,,. 9xy e I 'f 1 j i 1 Yte- 2k10 i� P r t x �, , ,. ., ,— 7*.i6C°''ry • ! ....... 711" 36 ._..._ M ROOF FRAMING PLAN 2X10 ROOF RAFTERS 16" O/C , 2x12 LEDGER ATTACHED WITH TWO 3-1/2" LEDGERLOKS 16" 0/C swpsox lawn RAFTER HANGERS , lid i! I , 6 A ■■ ! 'I !' P l! fq LPC4 POST CAPS ON ALL POSTS !! L " SIMPSON H2 . 5A HURRICANE TIES ON EA. RAFTER 72. ,Z4 r.k. Miles incorporated AIN* Hodgi DECK FRAMING PLAN I TRIPLE JOIST HANGERS h i � < r .._ 2X10 PT LEDGER ATTACHED WITH + TWO 3 -1/2" LEDGER LOCKS 16" O/C I I \\ T d II -� _ $ , G ERS I III ' I hi ii l a LU 210 JO ZST HAN h i ii ,I I �! il II 11 11111 11 II i 1 if it 1 ATTATCH 6X6 POST TO BEAM WITH ilh 1� � ! SIMPSON LPC6 POST CAPS II }0 -12 FOOTING TUBES TUBS I,I I �� h 'WITF SIMPSON ABE66 PO$T BASES - r.k. Miles incorporated Amok .. .. . Designer:Doug Hodgins / 12' -O" ----- Footing Tubes set 4' • beneath grade 2 x 10 PT Floor Joists 16" 0,C. nr m All All R AO h _ � i S An in in m III I Existing Home on 9 5 on on S m r • O 5 III If- on on a - � ' MI.' r 3• - ye °" I I Mail III 6 III 11.1 Olk im Triple PT 2 x 12 Beams Ill r 1.11 g ED MI 111 Ill 1 lli 1111 A _ o0 rn Mg HI I ll gill iti . IA 1111 M. , te a, MI ' -- rte. .. 10' -6%" , 6'-b" I' -0" 1' -0" I' -0 20' -4" .;;,5 - 7 / /4" 1 ‘ \ \ r 7 ks '4 ■.< ;/ g apx. de IX' ts To ( 14 QV (r IsNos.v.4, 4 - 6 11- /Ad 4 / 3 IC/ i 1. .' i L 1 I f 4-1 t" 2 C I-Jci,z if re 14 AK 1 )6c) t‘ .2x 0 L-1 il,, 11 ee, / ' / _________. - . , f 1 _______„—___ .. f Lcie., 4- il err Cki a S. . i ! , , I • I ; 1 ,t... „,,-- u ‘1 : Vz,vt,..7 ; .,..,1 s. ev cr /..1 ck - ..cr-J11 , ; , ;` k / 1 1 , . I , — : r i 1 - 1 --1 .---- , fa , I: ' "1 1 1, : 1 — -1 1 1 1 ‘,'- ci r n f, - • '; c --(--- ,i; t:• t'r - f i ', 1 ' 1 f , 1 ) I ; I 1 • C ', 4 .`, . i ■ ' r, ■ , I ; ' ; 1 V ' ,; I , 1 , ■ ' 4 i ■ A ,I ' F ' i . 1 1 f } , r 4 '[.• i 1 H. I . ! , i t i I , 4 _.,.., t, r, ii, iii 1,1,, ,1,1 l t !: ' l i , 1 II i : 1 11 1 ;1 1 11 11' — 111,1 1 H t — - 4 1 1,4 it ! 4 i . 1 4 1 t , t ...' I. f ) 1 1 , : l: : :, ; t ,...2., 14.,-..t....1.4_ , 1,.., , ,.. i ,J, „, , ! , , ..„ --i-,,, -°If ----' 7 f t , ' t t,'` 4 „/ Ini ■ 1 4 ('-‘; I . - ,, , ,_, , 1 1 " 1 i j " ntg dise .2 Y /0 .d6 - ; 41-c: 7 1 I to' ti t .1' ■ ,-, -..--- / izu ers." S , ' es* '',.4. 11111 \_, I / , t . iz- ,/ \ , i , 1 \ CERTIFICATE OF LIABILITY INSURANCE V ""tmM'UV "Tr'+ 06/06/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Webber & Grinnell Ins. Agency, Inc. HONo,Exq: 413. 586 i FAX 413. 586.6481 i (A/C, No): 8 North King Street E -MAIL ADDRESS: Northampton, MA 01060 PRODUCER 00021099 CUSTOMER ID ii: INSURER(S) AFFORDING COVERAGE NAIL C -- -- ' — - -' -- - INSURED Casualty ofAmerica Keiter Builders, Inc. Companies, INSURER Travelers CInc. 51A Hatfield Street INSURER C : Northampton, MA 01060 INSURER D: INSURER E : I INSURER F : 1 COVERAGES CERTIFICATE NUMBER: Master Exp 06/12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I L LTR ___ - - - - -- ------ -- - - -- ----- - - - - -- - 1ADDITSUBRj POLICY EFF - i POLICY EXP TYPE OF INSURANCE ; (MMUDDIYYYY) I (MMIDD YWY) LIMITS INSR WVD POLICY NUMBER , GENERAL LIABILITY [ I6 806319N661ACJlli 06/01/2011106/01/2012 c ! PREr E $ 1,000,000 D..,lk F` RENTED i X 1 E n,L L AEIL:T v -MN $ 300, 000 .IM - 1�1.�.CE Ea > ur r n pj hL1� N �:I I X ∎ `;;r.,IR nL'i_' E �P (Any n r rs m' i $ 5,000 A J E i< _r:IAL y!L ,r -.J. u I $ 1,000,000 - =FN. F v , r__NEC �TE 1$ 2,000,000 ' (7NL „ -FE ELIMT T APG'tI RC F`REP , = M r :∎P A 1 $ 2,000 000 I - AUTOMOBILE LIABILITY COMBINE.' .;IP. LE -MIT ' ,( '1----, I I to a i its ■ ANT ,AI ITV 1 ALL OV VED AUTOS S 1-- POC It Y [(MOP! Ft r a rid r Q $ 1 �(.HEUI ILEL. AiLTC . I l Fr EP T r L,� ;E $ H TED AUTO'S e'er a 1 nt? I (-1(7.11- . , o' LG a),JTUS $ 1 $ I t UMBRELLA LIAB i 0 _r1_IP EA(.(' 'TLE(TI PREPicE I $ I I EXCESS LIAR wIMS- tW1AC I A - -PE -ATE If 1 - ETETh: -N $ $' AND EMPLOYERS' LIABILITY Y l N 0 6/11/2011 06/1112012 X i T P l Ih T F 1� 1 _ WORKERS COMPENSATION j UB 2A 565 782 cFFi-: t oryir BF E LI _G'� (N � - L EA EH - "ICE F 100,000 tip.. lscra., under - ELL EA E -EK EMI- b- 100, 000 t -.. 1 4 __. _ AN PP OPPIEi P/PAPT EpE ((-. llT ME B R �F DETYTPI TION (,F Ur ErATI'��d,.• b?Ine+t I . C E.- - F �t i,_ r :IfY��T ' $ S00,000 I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /!_.,,_, fj _ i.. - _ :,:. For Information Only :r Cynthia Henderson, CISR /CINDY ©1988 -2009 ACORD CORPORATION. All rights reserved. Agreement, as well as receiving payment for Contractor's attorney's and legal fees and all lost anticipated gross rofits on the work not performed as of the date of the termination. a , NOTICE Notice will be deemed if delivered in hand or if sent by certified mail, return receipt requested, to the address listed on the front page of this Agreement. ARBITRATION THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISUPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVIED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN MASS. GENERAL LAWS, C.142A. KEITER BUILDERS, INC. (CONTRACTOR) HOMEOWNER Dpi -�S -rL ( - 2q`- / By S t Keiter, President Date Date ! t 5 Alai //Li ki -?... -1, , F 1 Date 1 f E NOTICE 1 THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY !i THE PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS ■ ii AFTER THE DATE OF THIS AGREEMENT. 'l DISPUTE RESOLUTION AND ATTORNEY'S FEES ' f Any controversy or claim arising out of or related to this Agreement involving an amount less than $5,000 (or the ; 1 maximum limit of the Small Claims court) must be heard in the Small Claims Division of the Municipal Court in I the county where the Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct a binding arbitration in accordance with the arbitration laws of the state where the project is located. The arbitrator shall be either a licensed attorney or retired judge who is familiar with construction law. If the parties can not mutually agree on an arbitrator within 30 days of written demand for arbitration, then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration li Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attorney's fees, costs, and post judgment interest at the legal rate. 10 A P; J -0 6 r o C �Cv� -L51X� 4 a. r I ham I � R) s, c 0"colo �Y1d -3)1\/-11 `" \ The Commonwealth of Massachusetts 1 Print Form Department of Industrial Accidents Office of Investigations IA :-- t = 1 Congress Street, Suite 100 'rte w Y Boston, MA 02114 -2017 . " -7.,:-,;-, E -' www. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information //, Please Print Legibly Name (Business/Organization/Individual ): /�Cll rti &ra tl , INC • Address: 51 4 144-rfiet--, ST. City /State /Zip: )1/43,, To,V Mai ofac.a Phone #: 9/3 - 3La -go 3S' Are you an employer? Check the appropriate box: Type of project (required): 1.m a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodelin These sub - contractors have ship and have no employees 8. 11/Demolition working for me in any capacity. employees and have workers' g ca p 9. [ilding addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ I 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. tContractors 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: 'T2A veLert.S . \isc, alcmce. Policy # or Self -ins. Lic. #: 03 .2A5A,$7 f Z. Expiration Date: 6-H- a o/L Job Site Address: $g No t1,Tt} MPti Sr- City /State /Zip: r1-on CE j M A o 1 ato %— 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 ce • ' under th pain and penalties of perjury that the information provided above is true and correct. Signature: / f T£ e� ' — ■ Date: D y :Z6 - L Phone #: y /3 . 3 Lo - ,oi 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): 1. 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 Supervisor: Il Not Applicable ❑ Name of License Holder : a c. o rr K '. e r vt_ /al 'S' 7 License Number C A 1-x+4- FlE,LI, S't . , nl� ThN MA ©IOc,a 06 -dO�L Ad ess Expiration Date 9/3 - 3 Zc) — 5o 2 S ignature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ j(( trbt. Byic -bel s c . 1423z9S_ Company Name Registration Number S/A ff ST. Ala ti,77-M-fr rb,) MR Q 06- of - =WI 3 Address ' Expiration Date Telephone 4 47 32-0 FO-1\ 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 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 stnictures 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 ❑ Addition IN Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[ Siding [0] Other [0] Work: Description of Proposed SGT► -Eck' Pb � � 1 + C&NG Work: � � ��C..�. t2 .$LA3 /I'U aPsse•Mb1rr - . Alteration of existing bedroom Yes X No Adding new bedroom Yes 1C No (phtirtAL) Attached Narrative Renovating unfinished basement K 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 v.. 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 1, , 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. PLC—# Sc.G A; c'kc E, S l il nfel CAN', 2.. •L`7 - " Signature of Owner Date I, ti:1iT k &rt. ke T6-A. ' 8 . v % L 'O�A.S , 1'1'V C. , as Owner /Authorized Agent hereby declare that th 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. S : a 67 T6-es-- P rint t i e...,,LT D`t --26 - iZ nature 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 6 o c Frontage 95 Setbacks Front .A d Side I,: R: I_,: R: f 5 ( 5 Rear 6 Building Height Bldg. Square Footage c Open Space Footage °io rd, (Lot area minus bldg & paved , parking) _ ii of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 10 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 14) YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO %V DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO q W YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 6 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, ex avation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO I 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 r- 212 Main Street Sewer /Septic Availability APR I Room 100 WaterNVell Availability j Northampton, MA 01060 Two Sets of Structural Plans o 413 - 587 -1240 Fax 413 - 587 -1272 Piot/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: g This section to be completed by office No27) AtiNve,s . f 0 eLeN Ga s M■ Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: D �,SriAJ TErvSEN 4- `0 AmiAC `it YVoti•T 4 MA Al r ) pn - JVCE. M1%. 01 o(cL_ Name (Print) Current Mailin Address: V /7- /LZI btk4kse SEE ATD4Gt1E) cT Telephone Signature 2.2 Authorized Agent: KEl Ten A., u, iAeNc.s , c - S i A I -* rf .<. Lb s � Notirn4Pop 'anl � � / Name (Print) Current Mailing Address: r 913 3z-o- S41.5" S e a ure Telephone it SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee X83.76 2. Electrical / / ,.,7,S: 00 (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection d n / � ✓ 6. Total = (1 + 2 + 3 + 4 + 5) 4, 2 Q 351f. ? (4. Check Number dt This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0941 rP APPLICANT /CONTACT PERSON SCOTT KEITER J ADDRESS/PHONE 51B HATFIELD ST NORTHAMPTON (413) 320 -9035 9J11%.' PROPERTY LOCATION 88 NORTH MAIN ST MAP 17C PARCEL 263 001 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 , / (O 1' fz /s Fee Paid p� Tvpeof Construction: CONSTRUCT SCREEN PORCH, DECK & SLAB IN BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 102457 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Commission Permit DPW Storm Water Management (,: yiD/cti n Del. , Signature of Bui . ing 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. 88 NORTH MAIN ST BP- 2012 -0941 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 263 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit # BP- 2012 -0941 Project # JS- 2012 - 001640 Est. Cost: $28359.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): 10890.00 Owner: KIMMELL ROB & KRISTIN JENSEN Zoning: URB(100)/ Applicant: SCOTT KEITER AT: 88 NORTH MAIN ST Applicant Address: Phone: Insurance: 51B HATFIELD ST (413) 320 -9035 WC NORTHAMPTONMAO1060 ISSUED ON :5/3/2012 0 :00 :00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT SCREEN PORCH, DECK & SLAB IN BASEMENT 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 5/3/2012 0:00:00 $150.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner