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37-065 (4) ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RgSIDENTIA1 NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix .3 // Applicant Name: Poo' )A S C�c ,O(A -1 Site Address: /13 /Back 15;2( +rc Applicant Address: o):S- old (,(es er 2p City/Tow-n: Nor ()I lc, tliwn.$b�^ !vi. o)&q Use Group: A-3 Date of Application: ( `S/ o.' Applicant Phone: `]t-L1.3g7 Applicant Signature: ! (- Compliance Path(check one): ❑ Prescriptive Package(Limited to 1- or 2-family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.lb): Heating Degree Days (IWD„)from Table 15.2.1a: (For items d. through i. fill in all values that apply from Table J5.2.1b:) a. Gross Wail Area 76 sq.ft f. Wall R-value R- b. G1a7ing Area' /3 0 sq.ft. g. Floor R-value R c. Glazing %(100 x b a) h. Basement wall R- d. Glazing U-value U- i_ Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE U Component Performance: "Manual Trade-Off" (Limited to wood or metal framed buildings only) Climate Zone (from Figure J6.2.2) Zone 12 Li Zone 13 _j Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HLAC Trade-Off Worksheet,if applicable] MAScheck Software Attach Compliance Report and Inspection Checklist printouts Home Energy Rating System Evaluation Attach Home Fnergy Rating Certificate (HERS rating score must be 83 or higher) Systems Analysis OR P Renewable Energy Sources Attach Mass Registered Architect or Fngineer Analysis ALTERNA"1`1VE FOR ADDITIONS ONLY: a. Gross Wall +Ceiling Area 7 6 Li sq.ft. b. Glazing Area' sq/ sq_ft. c. Glazing °,/o(10O s b L�EDITION with Glazing% (c.) up to 40% may use 780 CMVR Table J1.1.2.3.1 below: MAXIMUM U-value I MINIMUM R-Values Fenestration' Ceilinzs I Wall I Floor I Basement wall 1 Slab Perimeter.Depth 039" _ I R-37 I R-13 I R-19 I R-10 I R-10.4 ft t Gla7inu Area may be either Roush Opening or Unit dimensions. 2 Based on N RC lisunJ Applies either to every unit, or to area-weighted average of all units. R-30 ceiiina insulation may be used in place of R-37 if the insulation achieves the full R-vaiue over the entire ceiling.area (i.e.-not compressed over exterior walls,and including any access openings.) "SL? OOiN1'_additioo._(greatrr th;ia 4tl%glazing-to-wall and ceiling gross area) . i Attach"Consumer Information Form"from 780 CMR Appendix B. Official's Name: Official's Signature: Application Approved i Denied J Date of Approval/Denial: Reasons) for Denial: (provide additional details as needed on back side) .. ?° " "rz fi Northampton �z Y —_ t v.y`= i 1 "GI assactlusetts A —_ eire `.'�� may DEPARTMENT OF BUILDING INSPECTIONS , ='e=�_/- INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 e" HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction super ,ssor. 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 tegulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfiIl). 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 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 r i �Q¢ZtLV-t P)�y i.. :-� + 'ie Cris >�f {Rrflla111}zfoli = � � �' � �t c7ar<r'�nsrlla' _ • _ DEPARTMENT OP nuILDr c INSPECTIONS , _ es 212 Main Street " Municipal Building Northampton, Mass. 01060 7,- WOR1tER'S COM ENSATIO.N GYSURANCE AFFTT)A.\'"IT QduGI � S 6oQc 4 ) • (liccnsxJper ittcc) =rith 2 principal place of business/residence at: V' D$ t)(d C�est-er- Pe14 RQ . (Aillitia,i �°ic(phone) YI3- .) 14.136- 7 (sn-=.t/city/aairJ p) do hereby certify, under the pains and penalties of perjury, _h:l . ( ) I am an employer providing the folio.vine.lworkcl✓s cornocnsa ion covemgc for my , employees worng on this job: • • (I sur-a c Cocipaay) (r ctic:Nu_•nbcr) (r';-piritior.Da,L.) . (VI am a sole proprietor, general contractor or homeowner(circle one) and have hired • the cone ctorslisted below who have the foilo �ne worker's moen_ation p bicies: X/Amt-s ,- IF— �v ca G��rr-,' So-fence .. s.& 6:).-6p-3:)&sb ,S go? 1 Cttr'r► tr P� m� bir O3SJGa(,) I6 (Nam: of Co_,-1clor) (Insuranc:. Cornpanyi?oiic 'turn=c:) :per-1 o tDn� - s-le r 1Ae.0 /rj6 — /V t..fl ti,,S' C©.,np Mr IS 07 e/ ° ? - (Name of Cont nclor) (Lnsuranc Company/Policy Nunc_r) (E aii n Date) _S 40.' 017(A p 1 i Al.;-T rils. (mMy. pi pal 70.7 07 b 7 (Name of Cocuracia) (Insur-anew Com-un--/poi; - Number (E� imcio D lc r� i � � ) D ) &A A I S.-1-T,- PC )I n111:\ 1'6/h ri 1.�',�,h�p I'l p�'Do a 6 7 ,/ J//0(Name of Conuacior (Lnsufan= Company/Policy Nttrnty;.r) t>:A-pisauon Date). (aa3th '.vocal stir .lrnCCC.sr to me irtforoa pctairca6 ban ooC'LOrs) _-. ( ) I am a sole proprietor and have no one wodng for me. ( ) I am..a home owner performing all We work myself. NOTE_plr-..be eoeyc rfi••v.+-iio bcmeuwven v.'yo czaplay pc-taoa to do r-s"r'..,-,,•,-r, -.ciao c rexu work oar d..c t1:n;,of not lace th.n t -c. =its in w the bomoowoc raids or oo the E:ouacS zppurt ct==tba-ao r_z oat Cry° y Decd.-od to be civic:es unc.=the\.,ai: ems-_-*on Aa(0LI4 52...a1(5)). ptia6,o by a botno2a o fc=ti .-z.:or pewit rm.),e\ideoer tho 1cp.1 at-a.•of..a•o loy.r uodcr thn Wocir-0!r Coaspo .t oa Aa_ l undcn+=d tha a Dopy of this mtcmecd rainy b.foco.i.rded to ch.Dryanm-x¢of J.+A.,r.id Ao.sjorg'Offiw of Ir'' '''' .rrx th. o3vc-lo^C vcif euoo and tit_t L-.iltac to iecvrc tovcrase t,r,A.,-,.cLVOa 25,A of MOL 152 Qa lod to the i 2ioa of ei aia3l p-n,Irio ear-airs of a rux of up to.11_,S00.00 andfor icupriyoamc o of up to ooc y-r Lod civil praatia in 6c form or.Slop Work Ordc sod a fig of S100.00 a ty Litt nx For dog+rtm=J u.c only :Ai .:4'4'(''i e / �V / 1\'1.J lbw -- l e i>••+ tzrt of Li 'ciucc to I l E • „e SECTION 8-CONSTRUCTION SERVICES t 8.1 Licensed Construction Supervisor: C / Not Applicable Q❑' Name of License Holder: Wc���Ir~s E. 6t-1od/1° vs (-18 License Number ,) c a)dCk e ter Atck R ( lCl6a-oval Address Expiration Dat Uvvf1( Sb-r ) 0114 O)v4 Signature Telephone 0E14/ 1_ /P44 V. Li/3 - a16- f3 7 ,n..R r.,.......r Ka_zit:, , .-.{�..zwa�. a:a5- ..w.o-¢ . ✓m° '° '.'1"77.5,17 -4 SwRe•ISterec'pxio>Frie:°im a cavemer�E'ontrac�crrb.,�„� `�.�m .” ,�'. Not Applicable ❑ G'OCI Cke ©O C 0fl 3fruC .c■ S— if Company Name n Registratio Numbe .g_ 01,AcA4,3ier&elk Address Expiration Date tik i�(IaAIS j.,r`l /1,4 6 O 'L Telephone 41/3-.) SECTION 10 WORKERS'COMPENSATION INSURANCEAFFIDAVET"(M.G.L..c.'I52,S 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 ❑ a ' ne 7, L,-:.em 3 3 31/ 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 r Iwo • I i SECTION 5-DESCRIPTION OF PROPOSED WORK.(check all applicable) New House El Addition Replacement Windows Alteration(s) n Roofing n Or Doors El Accessory Bldg. El Demoliti n ❑ New Signs [El] Decks [Zi/- Siding[O] Other[0] Brief Desc.iption of Proposed e , ozck Bn 5 c at tai /n bct cA of Pro/)ar (PJA* I) Work: /�� /� a 0Plf`► rt w�h 9')(J� Alteration of existing bedroom Yes �o Adding new bedroom Yes "------No f Attached Narrative Renovating unfinished basement Yes No -Pta t�s-Kttached Roll Sheet sa:i-yNeWii' .tse- r*i crdrt a —ife iii i6Vs itiaAt k a ion iii: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: D Number of Bathrooms c. Is there a garage attached? ,VO d. Proposed Square footage of new construction. 2 di' Sf fT Dimensions A I/ i`1, e. Number of stories? / f. Method of heating? .iat rr�^kr)) &t,-S yr;f 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? NC Yes No. Is construction within 100 yr. floodplain Yes t/ 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 APPLIEST FOR BUILDING PERMIT e' _ S I, C�A-ikr'\,is& .- OA SY\st.�y -b e 1 Tk() ,as Own9,of the subject property hery thorize k.,r\(( cn�t„S,r%.J to a my be Ifilt all matters relative to w :,- orized by this building permit application. �I� ut\ i 6( idb Signature of Owner Date 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 t Section 4. ZONING All Informatihii 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 ` 3 Frontage --- — I ` Setbacks Front 30 Side L:° R: L: R:= !- /S-- Rear ' 30 Building Height ,--- Bldg.Square Footage , I % I l Open Space Footage (Lot area minus bldg 8c paved j 1 I '�a(7 parking) . #of Parking Spaces Fill: / E (volume-84 Location) A. Has a Speci Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO eDONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? • Needs to be obtained Q Obtained 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 Q NOS IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavatio ,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q r NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. a► . 5 r N fie• "g 4 *1;i Z + ' 'City of Northamptont" —Building Department via ' r ,---, *,1 v 212 Main Street ''� e -gig E, 2(1 Room 100 . el ° 0 '. ' 3\� 1 0 Northampt n MA 01060 ,ms tri: er �%� a,r phone 413-58t�7-12 Fax 413-587-1272 peat/site-lane ,�j"� i Qttie& meaty"- _ W 3 adz 1 I' APPL9 T1ON Td tCONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completedby office 1.1 Property Address: /3 8la C� 6/t-cA "tra-/ I . Map _ Lot- ,' - /o r4_%?G e_ 014 Zone „ +` •veday•Drstnct. 4 e4n7 S.District C@.Dtrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ow pp�of Record: j, 1) C A' i1n1j t, Oe Jt416 'Icf , CT- aP^,,�o 11 I (c.c.tt. „rea„ Tc-'µ I �-ll c 't.z MIi Oi4G'Z Name(Print)''' (,/� CUirent Mpiling Address: c— Telephone Signatu 2.2 Authorized Agent: Qou 6 IUS F. 6QL,44IJ 2�S" C�1ckCies- rFtto rd . MA- wog . Name(Print) Current Mailing Address: -. C 4ialy-A AA-v---- y/3 _ 16 —Li 317/C2J 6 lc-L/4/i° i ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 5-0, ©tQ (a)Building Permit Fee 2. Electrical 1.'6 0 0 (b}Estimated Total Cost of Construction.from(6) 3. Plumbingb L� Building Permit Fee 4. Mechanical(HVAC) )-D 5. Fire Protection --6. Total=(1 +2+3+4+5) 57700 Check Number r1 )d /4d This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2008-1106 APPLICANT/CONTACT PERSON DOUGLAS GOODNOW ADDRESS/PHONE 225 OLD CHESTERFIELD RD WILLIAMSBURG (413)296-4387 PROPERTY LOCATION 113 BLACK BIRCH TRAIL MAP 37 PARCEL 065 013 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � � Fee Paid dat 4/�,, yCJ (p Typeof Construction: CONSTRUCT 16 X 18 Ti �'/ ILY ROOM ADDITION&9 X 10 DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082188 3 sets of Plans/Plot Plan THE F 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 Signature of Buildi 'rficial Dat- 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. T } 113 BLACK BIRCH TRAIL, BP-2008-1106 GIS#: COMMONWEALTH OF MASSACHUSETTS -115 CITY OF NORTHAMPTON Lot: -013 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-1106 Project# JS-2008-001632 Est. Cost: $51700.00 Fee: $1 62.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DOUGLAS GOODNOW 082188 Lot Size(sq. ft.): Owner: DEMEO RAYMOND T&SHELLY G Zoning: SR Applicant: DOUGLAS GOODNOW AT: 113 BLACK BIRCH TRAIL Applicant Address: Phone: Insurance: 225 OLD CHESTERFIELD RD (413) 296-4387 WILLIAMSBURGMAO1096-9318 ISSUED ON:6/17/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 16 X 18 FMAILY ROOM ADDITION & 9X 10 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 6/17/2008 0:00:00 $162.00229 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo