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EXIEBDR DM UPTS, REFER TO ELM i • \ ' • PLATS.F0F 0410 SIZE 111 EXTERIOR AWIDOW 1N0: 5/4 1 P•, HEAD I ��r�� �`• .6 SIT, 5//• 6 I JAMB. 51001X. w.� HARDI -6VIIC PAN1E0 68060E PREFWI1IFD Irl,l r IffTA OAP FUSNG AS PEOPRED. {. --- 1;t1.1 ' 11. EKIFAIOR DM 12641.5/4 0 40, 40AD. i .II I / SJ4 .MA N, 51001 NAAd- PLANK, -11 I / PANTED. MANX 400111 1 META 2. � Nil FLANK AS REWPEMIRED. MJ MOM I lE .�•IE /� 1 w 12. 5/4• % 12". SNOOK HARP -PUNK VERTICAL, il�h�l "Il I CORNER DOE, PANTED. s /4• % IlKt:a L" 1a f'. 51 HAIHVERTICAL n i• J (� I /VI�•:1 III--_ 4. WIOOI ,NIB 11116 -REICH L 15, 4" CUr sT Ot ONE FU cAPYS1LL ON s L SCREEN L 1 I�O 5 v aaE bu, ax wHFAa APREO ,11.1■..' SOME YE IEER, RA00/ PATTERN AMMAN . P p P p P A ��� P / , p - ^5 CAP FLASHING, AS REQUIRED. $ +m m 15. BROOM FINISHED AND sum. CONC@IE StAB AT ® �® ®A ®� � ���® m 17. DIMON 6F0400 SEAM, CONCRETE + - {' {t " j - SLAB 0161 1 8. PREFRASED. IEIA. FOEPLACE 0RAU51 YQFE. It GRADE, 306E AWAY FROE RUINING - . 20. DASHED LINE5 IDICA111 FOOTINGS AAO FOUNDA0ONS, B • _ 0• 0 -0• y_4 BELD1r DUDE. VET1EY 4' -0• WWI DEPTH BELOW • 111401t X061. MNDN. KRT. Mt HRIT. MAX Pm P4 P $ $ 4 21. 12 X 12 MIK 5/4 K 12 51001X, O 4 p A � HAPITARP-PLA A N 5/4 0 2 0*0 s/E 5 X P X 004 2 r � RASE PAWED, �1- -- -r1- -- LL ID. i a 1 --------' ) .1, 1- - -- a s i r7 I / . ar Vi . / 1 2 -�I o 5 g , @ y 4 S g. pNIYOLil 7° _ G . �J 7 r . lo • L J -- - 1 . TIP P 11 / . 4 ■ Ts x a spy N r 0 _ ° �I I ''I J y URBAN CarrACE9Ems I I11ij J A S O, 1 ?' ' ...• p C z -4 AY lilt • SzAwLoW5KI 3/ i-ioyq & °too 2007 IECC Energy Efficiency Certificate Insulation Rating R -Value Ceiling / Roof 40.00 Wall 25.00 Floor / Foundation 19.00 Ductwork (unconditioned spaces): Glass & Door Rating U- Factor SHGC Window Door 0.38 NA Heating & Cooling Equipment Efficiency Water Heater: Name: Date: Comments: ❑ Materials and equipment are identified so that compliance can be determined. D Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. u Insulation R- values and glazing U- factors are clearly marked on the building plans or specifications. Duct Insulation: • Supply ducts in attics are insulated to a minimum of R -8. All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R -6. Duct Construction: ❑ Airchandena, _ filter boxes, and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and nevaaTically fastened. • Il. = ti connections are made substantially airtight with tapes, gasketing, mastics (adhesives) or other approved closure mss. Tapes and mastics are rated UL 181A or UL 181 B. 13 Building framing cavities are not used as supply ducts. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. ❑ ` . at fiiW r ents for tape sealing and metal duct crimping are included by an inspection for compliance with the International Mechanical Code/ Temperature Controls: u Thermostats exist for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and /or cooling input to each zone or floor is provided. Heating and Cooling Equipment Sizing: D Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. D For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2006 IECC Commercial Building Mechanical and /or Service Water Heating (Sections 503 and 504). Circulating Service Hot Water Systems: O Circulating service hot water pipes are insulated to R -2. D Circulating service hot water systems include an automatic or accessible manual switch to tum off the circulating pump when the system is not in use. Certificate: ,Apennanerd certificate is provided on or in the electrical distribution panel listing the predominant insulation R- values; window U- factors; i ttfe ncy of space-conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, service disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) { Project Title: new construction Report date: 11/29/09 Data filename: Page 3 of 3 CI Generated by REScheck -Web Software Inspection Checklist Ceilings: ❑ Ceiling: Flat or Scissor Truss, R-40.0 cavity insulation Comments: ❑ Ceiling: Flat or Scissor Truss, R-40.0 cavity insulation Comments: ❑ Ceiling: Flat or Scissor Truss, R-40.0 cavity insulation Comments: Above - Grade Walls: ° ' I: Wood Frame, 16in. o.c.E [..0 cavity insulation <____:____ �" Comments: Basement Walls: �.` } CI Basement: Solid Concrete or Masonry, 8.0' ht 17.0' bg / 2.0' insul, R- 30.E#' t insulation 1 - 1 0 v" Comments: Doors: ❑ Door: Solid, U- factor: 0.380 Comments: Up to 40 sq.ft. of this door is exempt from the U- factor requirement. Floors: ❑ Floor: All -Wood Joist/Truss Over Uncond. Space, R -19.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Air Leakage: ❑ Joints, attic access openings, and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housftt Alnd interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather - stripped and insulated (without insulation compression or damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed to maintain insulation application. ❑ Wood - burning fireplaces have gasketed doors and outdoor combustion air. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U- factor of 0.50 and the maximum skylight U- factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: ❑ A minimum of Class II (1.0 perm) vapor retarder is installed on the interior side of above -grade framed walls or it has been determined that moisture or its freezing will not damage the materials. Exceptions: Class III (10 perm or less) vapor retarder is permitted for vented cladding over OSB, plywood, fiberboard, gypsum, or for sheathing over 2x4 framing having insulation of R -5 or better, or for sheathing over 2x6 framing having insulation of R -7.5 or better. Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R- value. Project Title: new construction Report date: 11/29/09 Data filename: Page 2 of 3 _CN 0) LW) )j)ler -v pj c 11/14- j 01 V 91\1‘ 4 4 . ( cir \191/ M i hdOd ij 6 S 4: c , )991/1/) (I/ N , s 9 a) Cr s110 -- a) 00 1 d V cfl Joc)?1 , . R6.5c-ticttc ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR OE- AND TWO-FAMILY DETACIIED RESIDENTIAL CONSTRUCTION (780 cmit 61.00) Applicant NPme: „ a ,, A , • Site Address: 3/ print Town: X Applicant Phone: -,e/2 ___6• 3 243 Applicant Signature; of Application: / 1.:NEW CONS'IRUCITO options) 780 CIVLR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MA_XIIVIUIVI MINIMUM Ceiling or Slab 21 Option 1: Fenestration exposed Wall Floor Basement Perimeter Wall AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Enerry, R-1 0, Conservaticm Act (ACA) of .35 R-38 R.-19 R-19 R-10 4 ft 1987 as amended, minimums or greater as applicable Note: This form is not required if you choose either ofthe two versions oTKESeffeera s e D Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR. 6107.3.2) 4 REScheck—Web which can be accessed at http://www.eneravcodess.ov/rescheck/ .1:9:47*7Arglittiorox4tot7 *Bnildines 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) SF 100 x = % of glazirtg (b) Glazing area equals SF b a ,t4Tiiie7W. diart.helow Itt proceedto rZTIMOONMav 780 CYR/. TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Fenes 'on Wall Floor Basement Wall Slab Perimeter Exposed floors R-Value U-factor 1 R-Value R-value R-Value R-Value 1 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 (Le_ not compressed over exterior walls, and including an access o eninas). SUNROOM — An addition or alteration to • existing buildin2/dwellirm unit where the total 0 glazing area of said addition exceeds 40% of the combined gross wail and ceilin2 area of the addition. Note: Owner to fill out Consumer Information FOrili (found in Appendix 120.P) p c M k, C Generated biy REScheck li C -Web Software Comp Project Title: new construction Energy Code: 2007 IECC Location: Northampton, Massachusetts Construction Type: Single Family Conditioned Floor Area: 2262 ft2 Glazing Area Percentage: 0% Heating Degree Days: 6404 Climate Zone: 5 Construction Site: Owner /Agent: Designer /Contractor: 31 henry st. Alabama Alabama Northampton, Massachusetts 01060 Compliance: Passes on U . trade - off Compliance: Maximum UA: 389 Your UA: 370 Gross Cavity Cont. Glazing UA Assembly Area or R -Value R -Value or Door Perimeter U- Factor Ceiling: Flat or Scissor Truss 965 40.0 0.0 28 Ceiling: Flat or Scissor Truss 965 40.0 0.0 28 Ceiling: Flat or Scissor Truss 965 40.0 0.0 28 Wall: Wood Frame, 16in. o.c. 4050 25.0 0.0 211 Door: Solid 66 0.380 25 Basement: Solid Concrete or Masonry 10 30.0 0.0 1 Wall height: 8.0' Depth below grade: 7.0' Insulation depth: 2.0' Floor: All -Wood Joist/Truss Over Uncond. Space 1040 19.0 0.0 49 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2007 IECC requirements in REScheck -Web and to comply with the mandatory requirements listed in th REScheck Inspection Checklist. lie , , '4 /� ./ ' / / Name - Titi 7 ��� Signature Date c8 GI 7LjOO Proiect Title: new construction Reoort date: 11/29/09 4 - 1 SKAMp l , ,'7 .44' 0 Q 'IITcai3tyitaII Z �" ----, f Vrif l fi DEPARTMENT OF BUILDING 'I.NSPECTIONS i L = INSPECTOR 212 Main Street ®Municipal Building e , - y Northampton, MA 01060 LOCATION , �1 / V SQUARE FOOTAGE AMOUNT 1. BASEMENT @ . 20 7/.7_4 / t/-1 b 0 1 FLOOR @ .50 D - c j� � j 0 2 FLR @ 30 //11 --, FLOORS, FINISH ATTIC, GARAGE @ .20 DECKIPORCHES @ :20 TOTAL. `�' 1 • Nov 20 2009 12:20 :Cit� Northampton DPW (4131 587 - 1576 p.2 MUNICIPAL SEWER/ AVAILABILITY APPLICATION Northampton Streets Department 125 Locust Street Northampton, MA 01060 587 -1570 A Department of Public Works Trench Permit and Sewer Entry Permit shalt be required prior to any construction or connection activity associated with this application. Location: 31 Henry Street, Northampton, MA 01060 Inquiry Made By: Jerome Szawlowskl 686 -3286 Date of Inquiry: 1113(09 Reason for Building New Home Request: Municipal Sewer Main in Front of Location: Yes 5 No Municipal Storm Drain Available: 5 %a deep Yes No Size of Sewer Main: /0 r ` Material: C iii. y Age: 147r6 Depth of Sewer Main: 6 K} Size of Service Connection: Type of Service Connection: Tie-in to Sanitary Main Tie-in to Sanitary Stub Comments: ,TUB ,i n/ A/ ? a I -f AT /c li J. (-, 1c T Note: if this availability is for new construction. this form must be hand delivered to Building Inspector. A corresponding "sewer entrance fee" shall be paid prior to making any connection tothe municipal sewer system. Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. NJo Hal Sewer Department cc: Ned Huntley, Director DPW Anthony Patitlo, Building Inspector MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton, MA 01060 587 -1097 A Department of Public Works Trench Permit shall be required prior to any construction or -- connection activity associated with this application. Location: 31 Henry Street, Northampton, MA 01060 Inquiry Made By: Jerome Szawlowski 586 -3286 Date of Inquiry: 11/3/09 Number of Type of Single Family X Type of Private X Units: New Unit(s): Accessory Apart. Ownership: Condo Multi- family Rental (Annlicant to fill out the above) Municipal Water Main in Existing service to Front of Location? Yes: X No: site? Yes: No X Size of Water Main: 6" Material: CI Age: 1938 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 125 If done attach results Size of Service Connection 1" Suggested Meter Size: 5/8" Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department with a minimum of 5 working days notification. • / All work s . nform to Northampton Water Department specifications. David W. Sparks, Superintendent of Water Water Entry $ 200 Meter $ 100 Radio $ 100 cc: Ned Huntley, Director cc: Tony Patillo, Building Inspector Note: If this availability is for a new construction, it must be hand delivered to the Building Inspector. R €_SCtier-ic — ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR O'1 E- AND TWO - FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: + Site Address: print Town: Applicant Phone: ' %S'.�3,‘, 3743 Applicant Signature: < �✓ `' /ice J e 1ofApp1ication: NEW CONNSTRUCTIO (choose ONE of a e following two options) 780 C_1VID TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE - AND TWO - FAMILY BUILDINGS mAXImu- MINIMUM Ceiling or SIab El Option 1: Basement Fenestration exposed Wall Floor Wall Perimeter AFIJE HSPF SRRR U- factor floors R -Value R -Value R -Value R -Value R -Value and Depth National Appliance Energy R-10, Conservation Act (NAECA) of 35 R -38 R -19 R -19 R -10 4 ft 1987 as amended, minimums or greater as applicable Note: This form is not required if you choose either of `the two versions o c rev as is ed ❑ Option 2: V 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.ener vcodes.aov /rescheck/ DDITION M TE fl1 S , f..... Il ; L DIN �GS O R.5 YEARS OLD* , o *Buildings under 5 years old must use option #1 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) SF 100 x – _ % of glazing (b) Glazing area equals SF b a ; Iaz n g < 40%,use othe : art,below` ° . ,I l az g sr,> 0 : :proceed to "STJNROOM" sectio ., * 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW -RISE RESIDENTIAL BUILDINGS MAXIh1U142 MINIMUM Ceilin and Slab Perimeter ❑' Fenestration Wall Floor Basement Wall Exposed floors R- Value t7- 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 ofR -37 if the insulation achieves the full R -value over the entire ceiling area (i.e. not compressed over exterior walls, and includin4 any access openings). SUNROOM – An addition or alteration to an existing buildingfdwelling rinit 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) lE n,1 c G{ , ,� , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 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 .regulation NI - • • • - • • • • • - 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 a final building 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 work can be 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 - conjunction_to the_huilding_permitissued,_ 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 (--' cl I, �k - r/2 t' ) . \_.) 770, i/ a)S / 0 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- --- c 7 47.,. / ___ _ Address of work location 3/ �/ ��- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6 00 Washington Street yff Boston, MA 02111 www.mass.gov /dia hers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers nt Information Please Print Legibly 3usiness /Organization/fndividual): f'.. )yrit')/ /l5Gl/ S. 4 gate /Zip: 4'4c-7 oc? 0/O60 Phone . #: 32" an employer? Check the appropriate box: . Type project (required): am a employer with 0 4•. ❑ I am a general contractor and I 6. [ New construction nployees (full and/or part - time).* have hired the sub- contractors am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling These sub - contractors have l bup nztel have. Din loyees S. ❑ D emolition i orJcin¢ for me in any capacity. employees and have workers' Y P ty 9. 0 Building addition LNo workers' comp. insurance comp..bnsnrtnce. required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I am a -home oficer,s ve lxercisediz —_ 1-1—.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.] .ny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this afda%it: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 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 $1 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. to advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA. for insurance coverage verification - 6 I do hereby certify under the pains and penalties of perjury that the information provided _above is_true atcd_correct._._ __ Signature: , Date: — Phone #: Official use only. Do not write in this areato be completed by city or town offu:iaL City or Town: Permit/License #` Issuing Authority (circle one): k: Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector Plumbing Inspector_ 6. Other Phone #: Contact Person: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder ///777— / /j -;Z/9 '7 License Number Addres 1 s 7 %� Expiration Date Signature ✓ / Telephone 9. Registered. Home ImprovementContractor „ 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 Vf i -L; Hen., Owner.Ext ©lai The_current_exemption for "homeowners" 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. Alco be advired that iirith refer- nrr'tn Chapter 157 (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$iie ro perform work foryau - — — The undersigned "homeowner" c ertifies and assumes responsibility for compliance with the State Building Code, City of , • - s-General - •ws- Annotated. ort amp on e r. finances, • ' e n o Y2.. � _ • ,� . - Homeowner Signature % ;,t% / n • r ■ SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Er Addition Replacement Windows Alteration(s) Roofing I I El Or Doors ❑ Accessory Bldg. ❑ l Demolition El I New Signs [Co] Decks [[7 Siding [O] Other [0] Brief DescripAon of Propo d Work: `, .i �} /r' >n,ra� f he rne- 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` addition to existi q housitfct; complete the follouuina: a. Use of building : One Family / Two Family Other b. Number of rooms in each family unit:., ) Number of Bathrooms 2- .5 c. Is there a garage attached?/' / d. Proposed Square footage of new construction. /ICI - 30(10 / G Dimensions 30 X CI 4 ' e. Number of stories? .2— , '27 i 7 f. Method of heating? K..;4r Fireplaces or Woodstoves / Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Xe - it/ 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 k. Will building conform to the Building and Zoning 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 I, LA : 719/ 1 - c' ._>,= 'iy'Lig(9,. ?/) /j , as Owner of the subject property hereby authorize /1//1 44 / 7 to act on m alf, in all matters re19tive to •rk auth•nzed b this building permit application. Signature • Owner Date Algr Q ca I, , 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. Print Name 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'/ Frontage _..__ ._ _.:,.. _, ...__. , Setbacks Front - Side L._.. . _ R:______ L _i 5 ,, R: .. /,_)....., ,....../`? Rear Building Height 0 )�) � Bldg. Square Footage r _ % 2� to > Open Space Footage % .. _ ,. (Lot area minus bldg & paved j parking) # of Parking Spaces " - Fill: (volume & Location) _. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued:) 8 /� (,a i 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 ec DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: ec C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D:hereany proposed changes to or additions of signs intended for tie property ? YES I NO 6 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, ex vation, 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. NDepartmentPse -only City of Northampton St ' a - v, Building Department 0 Cr~it/ilt wa ,„,...c,,,, rnsit 212 Main Street � ; e att Availabrlhty Room 100 y p. , te a r a j r -A Northampton, MA 01060 - meet ot � 5trb � c � trt al l Ps phone 413- 587 -1240 Fax 413 - 587 -1272 Plalhrte Il`ens M V e Other Spea" ,s APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION , - -- - 1.1 Property Address: a �,,,�, e This section to be completed by office 3/ Ilea/ Map Lot Unit i S Zor♦;e Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: • `/ta`v7-7T Name (Pr_ n f Current Mailing Address: ei;�1�.' /.(" �l�,/l/ �/ Telephone Signature / -/ J`` 6:� z c3J- 2.2 A tG horized 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 , /30,00(9 (a)'Building Permit Fee 2. Electrical , j ) (b) ! Estimated Total Cost of Y � <✓ Construction from (6) 3. Plumbing "j /� ) Building Permit Fee 4. Mechanical(HVAC) ���� 5. Fire Protection ' �j —y - .4),, tic �c , ' 6. Total = (1 + 2 + 3 + 4 + 5) x 7 ) c Check Number 1 • b /t This Section Fnr °official Use Only Building Permit Number: Date r: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP -2010 -0499 APPLICANT /CONTACT PERSON SZAWLOWSKI JEROME ADDRESS /PHONE 25 Henry St. NORTHAMPTON PROPERTY LOCATION 31 HENRY ST MAP 32C PARCEL 354 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ifi( 41,404 Fee Paid Typeof Construction: CONSTRUCT 2 STORY SINGLE FAMILY HOME W /ATT GARAGE /PORCH /DECK Ncvv Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: i Owner/ Statement or License / /,� 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 /Z cs 4» 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. • 31 HINRY S'R BP- 2010 -0499 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:giodcltt =- 5 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 -0499 Project # JS- 2010 - 000688 Est. Cost: $160000.00 Fee: $1065.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: 5B Contractor: License: Use Group: R4 Homeowner as Contractor Lot Size(sq. ft.): Owner: SZAWLOWSKI JEROME Zoning: URC Applicant: SZAWLOWSKI JEROME AT: 31 HENRY ST Applicant Address: Phone: Insurance: 25 Henry St. NORTHAM PTONMAO1060 ISSUED ON:12/16/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 2 STORY SINGLE FAMILY HOME W /ATT GARAGE /PORCH /DECK 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 12/16/2009 0:00:00 $1065.40 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo