28-066 (12) CONSUMER INFORMATION FORM -"SUNROOMS"
Massachusetts State Building Code (780 CMR,Appendix J,Section J1.1.231)
The Massachusetts State Building Code(780 CMR)includes provisions to ensure that houses and
house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION
FORM is to be filed as part of the building permit application when a builder/contractor or homeowner,
constructing/installing a house addition with very large percentage of glass to opaque wall,seeks to utilize a
special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR,
Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a
"sunroom"of any size,configuration,orientation,form of construction or percent glazing,but rather is only
intended to assist homeowners in becoming aware of some of the important energy conservation and year-
round comfort considerations involved in selecting and utilizing a"sunroom"addition.
The connection of "sunroom" structures to residential buildings may create comfort and energy
consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In
the selection and construction/installation of"sunrooms",included below is a non-required,open-ended list
of product and design considerations that a homeowner may wish to consider before actually
constructing/installing a"sunroom". It is recommended that consumers carefully review these options with
their designer, builder, or contractor, in order to minimize potential energy consumption and/or house
discomfort issues. In addition,the qualifications and reputation of the company or individuals to be hired
are important considerations.
PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS"
• Solar Orientation and Natural Shading
• Type of Glazing
• Insulating value
• Solar heat gain
• Frame materials
• Glazing to frame sealing and gasketing materials/seal durability and/or
weather tightness of the sunroom
• Adequate ventilation-Operable windows and fans
• Applied Shading Systems
• Insulation level in floors,walls,and ceilings
• Possible Sunroom isolation from the main house via a wall and/or door or slider
• Heating and Cooling Methods:Efficiency,Zoning and Controls
Homeowner Acknowledgment
The Massachusetts State Building Code,Section J1.1.2.3.1,requires that the actual property owner(not the
owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to
issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential
building. In accordance with this requirement,the undersigned hereby acknowledges that she/he has read
the information in this document concerning sunroom comfort and energy conservation.
aroC� 1 / 9/ 019/3
Signature of Actual Building Owner Dat
E. 6/101)T-640 CE l0/AJ ie 02 v Lvts,-/re ? Xlb277{,47n-P%
Print Name Address of Permitted Project
a R 14,3 JD'S 7),,F 7 9,17 01860
Owner Address(if different than project location) Owner's telephone number
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6 tp, o f Northampton --u-------__---- -.
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'V___,. Tat alt. •
*11,, DEPARTMENT OP BUILDNG INSPECTIONS
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212 Main Street ' Municipal Building
2,------
Northampton, Mass. 01060
N'Y 0 RICE,R'S CO Ki)EN S A TI 0 N IN S IIRA,N CE A 171.713)A\fn.
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Ola:usedperrnittec)
. with a principal place of businessiresiclenc-e at:
v- "F&( , (phoncJo 913 -Ixt-/-)22,-/
A7. r-n—ot_LA.,,,4–, 14-A- . VIO(Szo:=Ucity/slaid73p)
do hereby certA, under the pains and penalties of perjury, that
(..>(.1 am an employer providing the followincz worker's compensaior: coverage for my
employees working on this job.
Aro(t"aleit 4.^064-1) , 0,144 <Nu'Ci ot ix 1-z- :} -01 -/4-/
(nsus ,,,= Cornpr-nY) (Wt. tekoz.I (PoLic-; Numbcr) (Tixatrtior, Data)
( ) I am a sole proprietor, general contractor or homeow-ner (ctroie one) and have hued
the contractors li sted below who hive the foUowng worker's ear.t. nmon pchcles:
(Name of Cont7,1aor) (Insnranc-c CompanyiPot1c,. Nn (:) (F... icat:on Date)
(Name of Coucrac-lor) (in_surapcc ComnanwPoLic-y Nunbcr) (EpiratIon Date)
. .
. .
(Name of C01111-2C100 (Instirancc GozopanyiPoLcy Nzunbe.r) (ExpLracion Date)
. •
(Name of Coutractor) (insuranoz Corniny/PoLicy Numly:_r) (1:1.vp1raLioa Date)
(ocuth..6..-...4.:t;c3..i,t.,.,:t it nenc-lcy to anc.2u.eie infoczu.^i oc c.,..--1,Laln.g to all carc.r...n,aa)
( ) I am a sole proprietor and have no one wor .,n,Q, for me
( ) I arn.a home owner performing all the work mys(-lf.
NOTE:plc,,be twarc 0-2,..n,-tnie baccacowncra SN tY3 CIIIP I Cry P.C.-:Oa/LO'o M.-,L1:71..7,.'V-r =-!...f......,C_I 00,..--'re;YLar woCe no I.d,,I.Enz of
do,moos-ft'-'-'C 11-7-C.,1..--rd,r1 Wd:ch Lb,:borne>awucr rmicka or cc La- p-rytn.,43 zvperinmer,Lber-d.a no na crnarreffy ea:a:dal-red to a
r-..-12loyr.rs Imr'..--thc WZgi."..Ce 7.c------ -in.aticxi Act(G1_152_,Iz 1(5)), moon try a bannor,xr ICI a 1: ..rlarz or pc—ma m_ay a-rd.x.to(ho
I esx/ctenu of ea eoap I o yec under(ho W orient'.Canp.oacial An._
1 i Luaderrtend eraet o coy of tbio etIteennat anLy bo forwatrei.d to Liao Dep.,-taueal of LorSierid neradexa"001 no of lra,urenc.for the
4 . covcr,„-c vcn„Gc=tioo and thai fziitz-c to accxtra novcra,gc Irodca-section 25A of MCIL.152 an Iasi to Lb.:1.- 00,61:1<xl of rz-Lanacl pc-nein cs
car/ISA:n.8 of IL fine of up to S 1}00 f)0 Lancifor iarr4Iriacxxox---J:t or up to one ycox end ci Yll pcnetaca a 6c form of e Stop Work Onicr and a
(inn o(S i 00.00 idly IF,./ia_ mc_
(7.7 Pcanit Nwnbor __ _.._
Signature of Lic:cliscciPcrmit.tcc De I
SECTION 8 ON fiRUct"iON SERVICES
1 Licensed Construction Supervisor: � f Not Applicable ❑ I
Name of License Holder
0),vc-/- / SP( ,,.. Sri .�
License Number
Address Expiration Date
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Signature /] - Telephone
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e - � �.g�i:� � � L._�1ia�x �,1l ;F�. ��f�d� ;,,:g ,„ r°or,,z, ffsi:ittval Not Applicable
Pie. /- J_Z
Company Name Registration Number
4> - Ot/ / y
Address Expiration Date
Telephone
SECTION E10 WARPS'COMPENSATI ON;INSURANCE AFFIDAVIT(M G,L A152,.§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 f the building permit.
Signed Affidavit Attached Yes I No ❑
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
—ECTION4~FITTIOM 9PIMOPQ ttEiVKIIiK(check all"applicable)
New House 0 Addition 0 Replacement Windows Alteration(s) Roofing 0
Or Doors ❑
Accessory Bldg, ❑ DemolltionD New Signs ( ) Decks [ ] Siding[ j Other( )
Brief Description of Proposed Work:. J-4.0-4)t nGJ lo timoboS Mid( dos r fi. 'r i J+ t ,v rdt-
No Adding J I
Alteration of existing bedroom Yes g new bedroom Yes ✓ No
Attached Narrative 0 Renovating unfinished basement Yes _✓ No
Plans Attached Roll n-Sheet 0
• .. -il- .'� .: . ...�:" iiii a' ..Ili r. tl .. 'J . ...`iir..
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?
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. Mascheck Energy Compliance form attached?,.
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.
1. Septic Tank City Sewer Private well City water Supply
S... . Zs-•_ �Q .iiiiit�COMPL WHEN
OWN - Eft' • �• [ FC'TOR A "1 ES POPSUI DING PERMIT••
1, e Ho O rEi4v L` ✓/N� .,as Owner of the subject property
hereby authorize 0'0 6/ /S/E,L-/w' to act on
my ball,in all atters relative o wo authorized by this building permit application.
Signature of Owner Date
1, �-=^t Q 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 and t e pains and,penalt'es of perjury.
. 2,;re
Print Name 7f
?A 7)1.7
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
4 This column to be filled in by
f!✓0✓1� /✓� �J< )—._. `j„ l Ip�,,,,,` Building Department
Lot Size J J
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:
Jvolume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW _
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: _
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
, RECEIVED
zJUL 1 8 2u13 �. .. r
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City of Northampton - ., z. iv.,..--,:,.,.
Building Department w r
DEPT.OF BUILDING INSPECTIONS � -%,k� .� �'�° '" �.
NORTHAMPTON MAO7O60 212 Main Street ' "
Room 100 t.J .
Northampton, MA 01060
phone 413.557.1240 Fax 413.587.1272 , ' , „ '„.
, , .t
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SE r '1.-SITE INFORMATION
1.1 Property Address: , ae z.
SECTION 2_PRO flfWi ERsmmpfAUTHOR AGENT
- +rte
2.1 Owner of Record:
13..11 d Ct�-0- - .. e Li ,el ; if 2,ic' .'oG. Dr. D 'i ,k.... '114 aziz i
Na ie P• . Current Mailing A�dress:
CO 1 „/ �L 1 -.L,A.4 / a Telephone
.ignature
2.2 A
7;c1
rized Agent:
ed i41 J.. Se /f.; J6 -.;_rf, •a- � fw Iet. )4/0/4-Alt
Name(Print) Current Mailing Address:
(./1
„. X113- �'"� _ ,2Zy
Signature Telephone
SECtiOn E1DCONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official UseOnly
_ completed by permit applicant ..: . '
1. Building 24 °IQ (a)Building Permit F
2. Electrical j 00 (b)Estimated'Total Ctit2 of
Z Construction from(6)
3. Plumbing ,r Buildiiiig.Permitfee
4. Mechanical(HVAC) 0 '',..‘t, ..5. Fire Protection 3/ 0-0 }
6. Total=(1+2+3+4+5) 31�Z O o Check Number dl(CI>..
„ . ` TfikSoction For Official Use Only
BuildflMillilit Number Date issued:_
Signature:
Building:Commissioner/inspector of Buildings Date
File#BP-2014-0049
APPLICANT/CONTACT PERSON OLIVER ISELIN 0/00i-- CO 1 —•
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 242 SYLVESTER RD
MAP 28 PARCEL 066 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
�ao ,ys�
Fee Paid )CF
Typeof Construction: INSTALL REPLACEMENT WINDOWS&INSTALL SLIDER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 039073 riei gpsis'
3 sets of Plans/Plot Plan ' ed' G
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ON 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
40,00• s Delay
//
7/9—/5
Signa - 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.
242 SYLVESTER RD B P-2014-0049
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 28-066 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2014-0049
Project# JS-2014-000118
Est. Cost: $31200.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: OLIVER ISELIN 039073
Lot Size(sq. ft.): 935668.80 Owner: LEVINE WILLIAM M&E CHOUTEAU LEVINE
Zoning: Applicant: OLIVER ISELIN
AT: 242 SYLVESTER RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers Compensation
NORTHAMPTONMAO1060 ISSUED ON:7/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & INSTALL
SLIDER
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 7/19/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner