29-238 ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
O E- AND TWO - FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00)
Applicant Name: - J 8 lv Site Address: l /9' 5 e, I}) )
ynMr Town: 10 fLe_ e) `ei 61 . !)-
Applicant Phone: cl)Z 5.4*
.* 4 -t 7? ?
Applicant Signature: (14,04a-- Date of Application: ? /
NEW CONSTRUCTION: (choose ONE of the following two options)
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE - AND TWO - FAMILY BUILDINGS
MAXIlvrtrn1 MINIMUM
Ceiling or Slab
Option I. Basement
Fenestration exposed Wall Floor Wall Perimeter gSPF SEER
U- factor floors R -Value R -Value R -Value R -Value
R -Value and Depth E ,
National Appliance Energy
R- 10, Conservation Act (NAICA) of
.35 R-38 R -19 R -19 R -10 O ft 1987 as amended, minimums or
greater as applicable
Note: This form is not required if you choose either afth versions oT c zeck as listed�e�ow.
❑ Option 2: ' REScheck Version 4.1.2 or later variant software analysis must be completed
(780 CMR 6107.3.2)
REScheck —Web which can be accessed at http : / /www_enercwcodes_zov /rescheck/
;, DIT I OR,ALT EXISTING,BII
*Buildings under 5 years old must use option 41 or #2 in New Construction section above.
Complete the following formula to determine the % of glazing_
(a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a)
‘00 SF
100 x COO = ` % of glazing
(b) Glazing area equals S, g SF b a
az g sk4ii use. the'.ch 0OM" ection avalto
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTLNG
LOW -RISE RESIDENTIAL BUILDINGS
MAXJMUM MINIMUM
Ceiling and Slab Perimeter
Fenestration Wall Floor Basement Wall
Exposed floors R -Value
U- factor R -Value R -value R -Value
R -Value and Depth
.39 - R -37 a R-13 R-19 R -10 R-10, 4 -feet
a R -30 ceiling insulation may be 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).
I SUNROOM — An addition or alteration to an existing building/dwelling r7nit where the total
glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the
addition.
Note: Owner to fill out Consumer Information Form (found in Appendix 120.P)
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HIMSELF THE ELF CONSTRUCTION
P.O. BOX 121
Chesterfield Ma. 01012
413- 296 -4710
There will be three suna tubes poured with anchor bolts. The floor joist 2x10 pt will be
16" oc with a sill plate. The walls will be 2x4 with 2x8 headers above window and doors,
but the sliding door will have 2x10 header. The rafters will be 2x8 16" oc with hurricane
clips. Ceiling joist will be 2x4. Insulation in floor it will be iceaneen blow in and walls
r13 and ceiling r30.
E '
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)500 1
rY oLf! pry r p
)67-?fis
— INU I t
:% THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
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P
t3' SPRUCE HILL AVENUE
: ` r ; , CK MORTGAGE COMPANY, INC.
� � ' �: T1CUT ATTORNEYS TITLE INSURANCE COMPANY
L 5
P BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
' '. i ,: REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
i v , ' i * ,. 2 '`ATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
ND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
se,,,,,, t , 7. a T AS NOTED. 1 FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
' 1 PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
' TY #250167
�—' —NOTE—
° THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
Y G
• � AND DOES NOT CONSTITUTE A PROPERTY SURVEY
'u ;' — MORTGAGE LOAN INSPECTION PLAT —
NORTHAMPTON, MASSACHUSETTS
Y. ,, ; 5 4* DONALD SHARON A. DUMAS
' '1,4 '' S �.Y 14, 2009
�, � �. • . ` A.SS�,TES, INC.
i REP-k.., , is . ;3.,or 4 . , LAND SURVEYORS
x � HAIXEY — UASSACHUSETTS
l'� k l a ,, ; rd adi
¢SK PT •
3 . ,. 13a7C�125ttSS '' t , \.;)
DEPARTMENT OF BUILDING INSPECTIONS r =m /
INSPECTOR 212 Main Street • Municipal B uilding
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction sups:_ .-:sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he /she resides or intends 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
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation /footings (before backfill).
sonotube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if required) and alinaLbuiid.ina inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the wnrk ran he inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
. `
' The Commonwealth of Massachusetts
L-- ,, Department of Industrial Accidents
„-� - 6_ Office of Investigations •
.� 1- e
600 Washin Street
.T Boston, MA 02111
•/ www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
/
Name ( Business /Organization/Individual): / y1, (kj` J i � a C » /
Address: f C.) , d . i'
City /State /Zip - c i if r., ' 4/ j i t f fi ‹ j bi i Phone #: <-)/ ,5 5 6 '
Are you an employer? Check the appropriate box: Type of project (required):
1. j I am a employer with
employees (full and/or part-time).*
4. Q I am a general contractor and I
have hired the sub- contractors 6. ❑New construction
2.'i�A I am a sole proprietor or partner listed on the attached sheet. 7. Q Remodeling
ship and have no a levees These sub - contractors have 8. Q Demolition
working for me in any capacity. employees and have workers'
Y 9. � Building addition
[No workers' comp. insurance
required.]
comp. insurance.:
5. Q We are a corporation and its 10.❑ Electrical repairs or additions
3. Q 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. Q Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13.Q Other
comp. insurance required.]
- - - - -- *luny applicant mat checks oox #1 must also till out the section below showmg then 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 - contactors 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:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
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 51,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 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 certi under the pains and penalties of perjury that the information provided above is true and correct.
- S ilatnte: - - �� Date:
a r1
Phone #: 7 r a �7 '°l /
/
a
II
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permii'License
Issuing Authorit (circ one):
1. Board of Health 2. Bu 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 ❑
Name of License Holder : J /} y� I e' S � f31sJ e� V
f � 3 �? / License Number
ca !j IZ> /G1165- / hl/ 010/-2-- ' 7
Address j 1 Expiration Date
/. . a _ �� r C 1/ ! — 7
2 . ate-- C/ / / L !
-Anature Telephone
X12—/2 t°
9. Registered -H{amel veicient.Contr'acfor°"_ "' '- y t u ' Not Applicable ❑
Company Name Registration Number
P/ 0. Erb"— r 2 a C l o,� r e / J "'. i / S
Address Expiration Date
r ., : JL1. Telephone '/
_ / o! 0
SECTION 10- WORKERS' COMPENSATION INSURANCEAFFIDAVIT (M GL 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 ❑
14fe.
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 fl Addition S] Replacement Windows Alteration(s) n Roofing n
Or Doors CD
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0]
Brief Descri. ior. of Proposed e ' • I Work: " _ • � _ 0 1 Ci A 1 2 • . ') 4 .4a /I
Alteration of existing bedroom Yes ✓ ---" Ne Adding new bedroom Yes . ‘,/" ..--- No
Attached Narrative Renovating unfinished basement Yes m�No
Plans Attached RoII Sheet
Sa if -Nevi- house. ailfl oraddition- o4ki§t nit - hOUSma,= cOmpletithilo loWinct:
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? I'v �,
nn
d. Proposed Square footage of new construction. O'O 5 t ,( Dimensions 1 6 � A
e. Number of stories? l
f. Method of heating? F6P-(; '1. Q D c1 /7 ) (L Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction 0-) 000 f rA m'r
i. Is construction within 100 ft. of wetlands? Yes ,' `o. s cons ruc ion wi i • e • . -•i••• - ' Yes - �...No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? V 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
COW/Ur , d ii* (,( /g , as Owner of the subject
property
hereby authorize jirl s t dG i /
to act on behalf, in all / ma relative to work authorized by this building permit application.
�
Signature of Owner Date
1 '31 r"'i (g1 ■VC)_,4J , 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.
T1 KY D� N
Print Name, J
c- 7
a ture of Owne /Agent Date
, r r
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 Iv', 5 Ya -- 71 • 3 q 1 04-1_, S -l- ( n - 03 4 /
Frontage
XS A3 Z X7.2
Setbacks Front 50 ' TO - �.-Z)
Side I L: �..QL:: R: L: -1�%> - R:TF-
I s$' I
Rear
Building Height `a /-7'
Bldg. Square Footage ' F % H o
Open Space Footage % /�,
(Lot area parking) minus bldg &paved I Zia/
# of Parking Spaces 2 2._
Fill:
(volume & Location) r
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
. A111 01 AI
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW e 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 Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , 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 Q
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.
,
•
� D - 4 only
�� Cit�t of Northampton StatusofPer
, c_:,,,--:, �` - [1di Dep artment Cu nrrewaj P-e t }
--- \ 212` IVj ain Street SevuerllSept<c°�4ua �
In
i \ ,., `� X09 Room'100 ateFtWel spa ahtGf
` � 3 Northampton, �1(IA 01060 `� sets of Pt -
} �Fphone 413 40�'ax 413- 587 -1272 t?loSiteP tans-�
c Ottrer5pec}
i APPLICAx1 {+1 tO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
1
SECTION - 1. - S)TINFORMATION
1.1 Property Address: r r r• This sechon-ta 6e compietea oyat ::;
�Ll : : : ,--72n„ U c� Ii P /
�, - • _rot tr�tlt
Zane Over -
E i4:r*ncf - _ _ ..._ ..y _CBD sfrrct :_
SECTION - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
u Sif�z/ l rl� /�9 c%C t �Lr
N e (Print) 1 C::Z T
Signature iii-,
2.2 Authorized Agent: f ---)0 0 ,N I -2 , f ,. amormisitrillnr -71" (
Name (Print) Current Mailing Address: 7,---,‘- /)?" g nature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
comp leted by permit applicant
1. Building j/ 5,000, c4) (a).- Building Permit Fee
2. Electrical Je .S 00, cC7 (b�EstimatedTotat_Cost-of
C onstruction..from (6)
3. Plumbing �Y Building_ Permit Fee
4. Mechanical (HVAC) 1 /S 4, a)
5. Fire Protection
Check Number 1/6/if /a 2,
6. Total = (1 +2+ 3 + 4+ 5) � 5 5c2
This Section For OffitieTUse-Only
_ Dame
Building Permit Number.. Issued '
Signature:
Building Commissioner /Inspector of Buildings Date
1
File # BP- 2010 -0318
APPLICANT /CONTACT PERSON JAMES DAWSON
ADDRESS /PHONE P 0 BOX 121 CHESTERFIELD (413) 296 -4710 Q
PROPERTY LOCATION 149 SPRUCE HILL AVE
MAP 29 PARCEL 238 001 ZONE URA(100) / /WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ��� / Fee Paid
Typeof Construction: REMOVE DECK & CONSTRUCT 10 X 20 ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 002701
3 sets of Plans / Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
Demolition Delay
O 07
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.
ff „ LAVE' BP- 2010 -0318
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Enocki:250.138 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- 2010 -0318
Project # JS- 2010- 000424
Est. Cost: $6950.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES DAWSON 002701
Lot Size(sq. ft.): 10062.36 Owner: DUMAS DONALD & SHARON A
Zoning: URA(100) //WSP Applicant: JAMES DAWSON
AT: 149 SPRUCE HILL AVE
Applicant Address: Phone: Insurance:
P 0 BOX 121 (413) 296 -4710 0
CHESTERFIELDMA01012 ISSUED ON:9/28/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REMOVE DECK & CONSTRUCT 10 X 20
ADDITION
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 9/28/2009 0:00:00 $100.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo