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31A-071 (3) Simpson 4 -16 -12 KeyB a , Northampton 11:03am f' 1 of 1 KeyBeam® 4.507f PC4, kmBeamEngine 4.509x Materials Database 1353 Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: None Standard Load: Moisture Condition: Dry Building Code: IBC / IRC Dead Load: 10 PLF Deflection Criteria: L/360 live, L/240 total Live Load: 40 PLF Deck Connection: Nailed Member Weight: 7.1 PLF Filename: KYB1 Other Loads Type Trib. Dead Other (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PSF) Top 0' 0.00" 8' 0.00" 7' 6.00" 10 30 Live Additional Uniform (PLF) Top 0' 0.00" 8' 0.00" 80 0 Live Additional Uniform (PSF) Top 0' 0.00" 8' 0.00" 11' 6.00" 17 35 Snow - 8 0 0 / / 8 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall Spruce- Pine -Fir 3.500" 2.105" 3132# -- 2 7' 6.750" Wall Spruce- Pine -Fir 3.500" 2.105" 3132# -- Maximum Load Case Reactions Used for applying point loads (or line loads) to carrying members Dead Live Snow 1 1352# 851# 1522# 2 1352# 851# 1522# Design spans 7' 6.750" Product: 1 -3 /4x7 -1/4 VERSA -LAM 2.0 3100 SP 2 ply Component Member Design has Passed Design Checks.** Connect members with 2 rows of 16d common nails at 12.0" oc Design assumes continuous lateral bracing along the top chord. Design assumes no lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 5921.'# 9634.'# 61 % 3.78' Total load D +0.75(L +S) Shear 2631.# 5544.# 47% 7.18' Total load D +0.75(L +S) Max. Reaction 3132.# 5206.# 60% 7.56' Total load D +0.75(L +S) TL Deflection 0.2742" 0.3781" L/330 3.78' Total load D +0.75(L +S) LL Deflection 0.1558" 0.2521" U582 3.78' Total load 0.75(L +S) Control: TL Deflection DOLs. Live =100% Snow =115% Roof =125% Wind =160% All product names are trademarks of their respective owners �$ a i . F o "- 4'. Copyright (C)1987 -2011 by Keymark Enterprses, LLC. ALL RIGHTS RESERVED. "Passing is defined as when the member, floor joist, beam or girder, shown on this drawing meets applicable design criteria for Loads, Loading Conditions, and Spans listed on this sheet. The design must be reviewed by a qualified designer or design professional as required for approval. This design assumes product installation according to the manufacturer's specifications. '----""41) OP ID: AC AC-012C) `.... -- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YIYY) 03/15/12 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 Charles G. Marcus Agency, Inc. 860- 563 9353 NAME: FAX 842 Silas Deane Highway 860 - 257 -8404 i P i C , No. Extl: (A/C, No): P.O. Box 290756 E -MAIL Wethersfield, CT 06129 -0756 ADDRESS: PRODUCER CUSTOMER ID # INSURER(S) AFFORDING COVERAGE NAIC # INSURED TAYLOR BRYAN ASSOCIATES, LLC INSURER A :National Grange Mutual 14788 DBA TAYLOR BRYAN COMPANY INSURER B :TRAVELERS 25615 768 SOUTH STREET SUFFIELD, CT 06078 INSURER C INSURER D : INSURER E : 1 INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR wvn POLICY NUMBER I (MM /DO/YYYY) 1 IMM /YYYYI LIMITS GENERAL LIABILITY j I EACH OCCURRENCE $ 1,000,000 • DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY I MPJO449M 03/05/12 ! 03/05/13 PREMISES (Ea occurrence) $ 500,000 CLAIMS -MADE X OCCUR I I MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: ! PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- LOC ! $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ i (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS i BODILY INJURY Per accident) $ SCHEDULED AUTOS ! PROPERTY DAMAGE $ , HIRED AUTOS (Per accident) NON -OWNED AUTOS ! _ $ $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE 1 AGGREGATE $ DEDUCTIBLE $ ' RETENTION $ ' $ WORKERS COMPENSATION W C STATU- OTH- y AND EMPLOYERS' LIABILITY y / N TORY LIMITS ER • h B ANY PROPRIETOR /PARTNER/EXECUTIVE � N ,NIA IE-UB-2B94772-A-12 03/05/12 03/05/13 �', E. L. EACH ACCIDENT $ 100,000 OFFICER /MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 I If yes, describe under ! j _ DESCRIPTION OF OPERATIONS below c.L DISEASE - POLICY LIMIT $ 500,000 A 1 I MPJ0449M 03/05/12 03/05/13 content 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I( II CERTIFICATE HOLDER CANCELLATION ` I Li SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN r ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ;I )vtiro(Pl uS ( © 1988 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD At The Commonwealth of Massachusetts Pr Form rry Department of Industrial Accidents ,. � •�.. � Office of Investigations ; ja 1 Congress Street, Suite 100 . - . 'ow ." r Boston, MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): I A`jI.c,IL 14 (-C t«11 `-J Address: '/(Lb - r- sr. City /State /Zip: 3 ,9- t 1E1,0 1 Cr 6‘0 Phone #: £' C • 7 -( 5'7 Are you an employer? Check the appropriate box: Type of project (required): 1. NI I am 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. 14 Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ® Building addition [No workers' comp. insurance p required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ 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. -t- Insurance Company Name: 1 tR-LIE k' Policy # or Self -ins. Lic. #: E. 11; - 2f 9` �" 13 " A- 1 Expiration Date: 31 J 113 Job Site Address: ,21 E& %A ST City /State /Zip: 1\6Lili/k rti %, it lA Olt o0 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 pains and penalties of perjury that the information provided above is true and correct. Signature: I - Q- ,... Date: ' IS ' 12 Phone #: 4i2) -3 b7 - 4 - 2 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: Not Applicable i liicable ❑ Name of License Holder : 141' L`'( /J rC E C5 1 o t 4 t License Number 7� f 3 L'it St » I ftiu -o Cr a rc "7 5 It s t Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number (QC S C �1., 'r. �m -r-tki.17 ) {MA- oic35 (i41 Address Expiration Date Telephone 41 .3 ° 1 ' 41 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 Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing n Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I] Siding [d] Other [O] Brief Description of Proposed ` L ' �..������ �/ Work: 1ltLt J F IL f e-t- Ir ictzv( , Move- f /.f14Glt Alteration of existing bedroom Yes )( No Adding new bedroom Yes h' No Attached Narrative Renovating unfinished basement Yes )C 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: Number of Bathrooms c. Is there a garage attached? 40 d. Proposed Square footage of new construction. ` (0 JF Dimensions 47 © h' 17 - D /Shi4 e. Number of stories? Up d l�� `' f. Method of heating? rj e.0/hr -t7 r I,arrq.. Fireplaces or Woodstoves Number of each V g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction ()ov() tef-PWAe. i. Is construction within 100 ft. of wetlands? Yes )U No. Is construction within 100 yr. floodplain Yes jX 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 X SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1ZkGtt -. SI W't Px. , as Owner of the subject property -{-,'- hereby authorize 1 4 . 0M 7 AMA r.Ll'j g1`'Yi C to act o my behalf, in all matters relative to work authorized by this building permit application Signature of Owner Date 1-14 MA PM) n4tJ J , 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. I tfv DM) Atilt) Print Nam 4 L-_ w /1 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 Open Space Footage (Lot area minus bldg & paved parking) # 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 0 YES IF YES, date issued: 3 J 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book (0 %0 Page ;Z and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® 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 f Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q 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 ® IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. L_ _ _. - -- `^ Department use only ._ City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 1.112471AZ 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability pE N p F BUILDINGI TIONS Northampton, MA 01060 Two Sets of Structural Plans 3- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans t ..-- 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 2.1 ' -1-Wl 5( Map Lot Unit 0c :Ttt-AvArt - MA oto6o Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: KtNNe =1l1 4.w4lt 1 Si 1 2.1 o E.I~wt 51' . i p h wt P rot liAA o ic60 Name (Print) Current Mailing Address: 413 N y (0424 f Telephone Signatu 2.2 Authorized Agent: IAA A DA1)►A) ‘O `c •:.,V1 a', • (' 1 1 11n 4 010 (eo Name (Pr n) Current Mailing Address: "..,\ 04(",---- 413.36'7 42.5 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building '° 6( I 9:b0, 4.c (a) Building Permit Fee 2. Electrical 4 4 I 1 :.-,, (b) Estimated Total Cost of I Construction from (6) 3. Plumbing 4 1 13c>o, cc, Building Permit Fee 4. Mechanical (HVAC) t 2., 0 40, o" 5. Fire Protection G r s� /_ 6. Total = (1 + 2 + 3 + 4 + 5) 4 6 & >`'" Check Number 5q 1, Yi / /lo Section For Official Use Only This S O y Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0913 APPLICANT /CONTACT PERSON TAYLOR & BRYAN ASSOCIATES 61<— ADDRESS/PHONE 60 SCHOOL ST HATFIELD (413) 387 -4252 N( PROPERTY LOCATION 218 ELM ST r ►.. CE MAP 31A PARCEL 071 001 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 £�j L� Fee Paid J / 49 / / /' Typeof Construction: REMODEL KITCHEN, ENCLOSE PORCH, MOVE & REPLACE WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 101410 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOATION PRESENTED: t/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 - molition Delay S : re o : uil e mg 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. 218 ELM ST BP-2012-0913 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 071 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Zoning Permit BUILDING PERMIT Permit # BP- 2012 -0913 Project # JS- 2012- 001257 Est. Cost: $69170.00 Fee: $414.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TAYLOR & BRYAN ASSOCIATES 101410 Lot Size(sq. ft.): 8450.64 Owner: HELLMAN KENNETH C & RACHEL S SIMPSON Zoning: URB(100)/ Applicant: TAYLOR & BRYAN ASSOCIATES AT: 218 ELM ST Applicant Address: Phone: Insurance: 60 SCHOOL ST (413) 387 -4252 WC HATFIELDMA01038 ISSUED ON:4/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN, ENCLOSE PORCH, MOVE & REPLACE WINDOWS 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 4/30/2012 0:00:00 $414.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner