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ENERGY CONSE,RVATIOti APPLICAT>444 FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS
780 �MP Appendix 14-e�tive 3/1/98)
,ppi,c2nt f4sme: _-- S;te rddress:
P,ppltc_knt A.ddrwss: Ctty/T;run. �.e,. >°-
Use Group: "3
Anrni_ir_rnt phw,•�-
�.pt'71#13t4GC �8tf'S(C�Or`C-iC OrtCX _
U Proscriptive Pa:e—_ (1-imiiec ro 1- or 2- family wood fr_--ie t)uiidings t-eatea -11,1-i fossil fuels only)
Pa.e�.are (A throuzi KK from Table J5-2. Ib)• ` Heating Degree Days (t1DD ) fTOn Table J5.2 la:
(For tiioms 6. tnroun, ;., Eiji in ali vaiues.t iv, apply from Taole J5.2)
a. Gross vraii iuea sq. ft f. Vr'a;i R vatc-c R
b.
c. GiFZing (l x b+a) h. P.asement wall
r�
e- %o+ling Ft-valve Pi- I. 11EZt;ng :,FUC
u r--- , Perrbrm2nce- 'Mzrivaf Trade Crfi` (j_;mtted to wood or metal freme"d buildin?s only)
Ctimate Zap(tarn Figvrt X52.2) El Zone 12 ❑ 2-one ?3 ❑ Zor:G
Attach irad -( f-ri--`e c, `rom t"-:Gp=r„ix J,[2nd nVRC Trde-C) Reut, if app Iiublej
ED MASch&---k So,t ,arc
A:ach Colrpifance Pert and.irsps'7ia) CheCklisi printou'.s.
L1 Sysiem,s Anal)-sis OR L_t Renewable "Energy Sources
Attach Mass Registered Architect or Engin--r Anatys;s
ALTERNATNE FOR ADD)T1D1gS ONLY:
a: Gross Wail Gciiin.g p,r�� .T . ` . b. Glazing Frea'� '-`- . , )
- 33%t
AD�ITIDN wiTh G,12zing % (c.)up to 4-r-%, may use 780 CMR Table J1 1.2.3.1 below:
U MAXIMUM U-vakm Minimurn R-VaSucs
i a rattdn Coilirg wall I Floor Bastm--"rt Waft '; Siam Perimeicr. Dep
0.39 R-37 R-13 R 19 P-10 i ?•10. 4 ri.
❑ 'SUNF?'JON- addition (gre.eter than 4C7% eia2ing-to wail and cc+i-np gross area)
Attach 'Cansumer lnfarrnation Form' from 7b'C- CM-P, App—_nchr B.
Gfnciai's time: Crficial's Signature:
Applicgtron Approved Q Denied Date of ppxo.al;Denial:
nRvasv�(S)vi (pr 'd-- aaQlilOndl tlefatlS as ne6C@d On tack, SttlA)t
-'.Qa-sxs Arta.suy-bc.vitd�-Rzm k C--,,nmE or Una D v—,= n:
r. '. .
�(t1AMP�,
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C-ifV of Northampton z =
� � j�Iassacl�i�sctfs e -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/her construction sups;:.,:sor. T he 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 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
Iocation
N
fry y
� 6 fi�ISSxcflnbrlls
1
of al-111alliptoll
,tp i>I:PARTMEi.T OP EUILDD? G INSPECTIONS
212 Main Street ' Municipal Building j
Northampton, Mass. 01060 '
WORKER'S COMTENSAIION INSURANCE A MAVIT
whh a principal place of buslesdreidence at
(SLTCeuCitvi:;t:. _:r?p)
do hemby cent, mOer the NO -and
O I m an empioyer providing the follownt worr:cr's comnens lion coves e for Iny
calployces workiiig on this)ob:
( pi ,:don Date)
( j I �1 a sole propnctor, yenerz can c cr , - on eo.' ne: (curcle one) and tlz,e tlirec
the, con-uactors Red bdovi v' o haw the `Oily .;� '';OCke�s GJu DeIl�?'�Orl ;�0!1C'.cS:
�`:IIIIIC Of ConL`1CtGr) (�P._`�i?_nCC l GIr^?.:i'{r�l'GI]C'j T�urTl�i) i�?:`:"IliiC' DiaC)
(Name of Contractor) (j Ls-,;r,_nc z (Ex7)iimuon Date)
(Name of Contractor) (Ins._ 3icti Ct zi—pao-y Po)iC.' i,'\;,:":i.G,a Dal',)
- Name of Cant-actor) — -- r n t r. -- (Exni::atioll Date;
( ) (Insurance Co_i.: -��}°-1 olio hump_)
( i ILTl c. ,;01(; jAnprowi mid have no one .,'irAg Or 111c.
home owlle�
5
*JOTI::plcsc L<aw:Lrc thst"vLllc cr:-pair" ,.-_..
not uncc ih_n throe uni+li in v.i c+7 I L F.:ti�,.tiz,�T=i': 7 c-a;'` �:_r.:i ur cr t t_hcGo c nXt Gc-rr ally r:: Lti
cntploycs uz!c llr wcr:ci_cc --::i:c Pr:(GL.1 S2 _!(St?,n+: -a;ic., y e hnc ICOt n-,I.,
IC&I Ratur of an o aployx un er the WCrkcrt Ca -.6n!.CL
I uz Nand thi 3 copy of th.elate:s_r_iy Fn fo ,v o-1 to tt»[Ytxi LZxs� of Iz�L�ric1 M�r�:f Ciroo or l: irur o for tlx
covcra,c vu-ificalioo and th_t f:.ilurc to urd-r cC.iM 25'k d l.;GL,151 can lc_ci to the in'T-situ of
comisti g of a ftrr_of up to S I.SWoo an'or i-r;Ir: r.zti:!of:_p to cr.:}- r.-.j Civil xsultia in do Ii-,rin
firs of S 100.00 I d_y tz:.in:.t m:.
_ Foe atrj;.W=e11 uie Udy i
Pcrrnit i�Iumtr.:r ____--
1✓
•
SECTION 8 :;CONSTRUCTION SERVICES
8.1 Licensed Construction Su erviso : Not Applicable ❑
Name of License Holder
License umber
Addres Expirati D to
' / 7 �
Signat e Telephone
R g'St�e ec] 'ome"1+trTproVernentCnniracnr_____ __�_ � � ,n s Not Applicable ❑
fl - r
Company Name Regi tration Nuiber
Address Expiration Date
P Telephone
SEGTIO'hI10-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...... ❑
The current exe ion for"homeown s"was extended to include Owner-occupied Dwellings of one(1) or two(2)fami:ies
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 far 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=D�S.�CR P�T�:OtJOF�PROPOSED WORK(checkafl applicable)
New House ❑ Addition Replacement Windows Aoofing 1l
Or Doors ❑
Accessory Bldg. ❑ Demolition( New Sign ] Decks
[ ) Siding[A Other[ )
Brief Description of Proposed Work: Inc, f� F- AM V61
Alteration of existing bedroom_, Yes No Adding new bedroom_ Yes No
Attached Narrative 0 Renovating unfinished basement Yes _ No
Plans Attached Roll 0- SheetX
X52, ifN;e io1,90, afi"d o atld.Ition to.ex is tang,housirJ1NR lee hef,6-J n7
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. J 7oZ, Dimensions c 71( a�2
e. Number of stories? 1)
f. Method of heating? /'cL itof Fireplaces or Woodstoves 4h o Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction S /
i. Is construction within 100 ft. of wetlands? Yes L1 No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade (a
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer_>4- Private well City water Supply
X
SECTIOPE7a�OlNNERgAUTHORIZATION TO BE COMPLETED WHEN
OWNERSAG�ENO�tCONTRACTOR�APPL1ES FOR BUILDING PERMIT
.:Q ,
/, ✓� as Owner of the subject property
hereby authorize 2�C� /�ur1C �� c , e to ac;. on
my behalf, in all matters relative to work authorized by this building permit applic tion.
Signature of Owner Date
I' as Owner/.Authorized Agent
herebWeare h t e ZstatemeZnts and i the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and pen (ties of perjury.
Pri 6A,V4
Signature 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
This column to be filled in by
Building Department
r
Lot Size o s 2 � ��►"
Frontage qo
Setbacks Front
Side L: R: L: R.
3if s�'-� ai'
Rear 77 71,r p�O
Building Height 1 y CZ 19
Bldg.Square Footage D io V %
Open Space Footage D %
(Lot area minus bldg&paved
parkin ) /
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO �_ DONT 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—k
IF YES, describe size, type and location:
y rya
City of Northampton e °
Building Department
212 Main Street 's
Room 100
Northampton, MA 01060 = ,
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, , A O",,EMOLISH A ONE OR TWO FAMILY DWELLING
i J U N 1 5 2005 ;
i ;
SECTION 1-SITE INFORMATION
1.1 Property Address: DEPT(�� 90!DIN; 'Ih&sSectiio �e o�npleted bgOffroe
r7r1 Q1/l
s
/ nL�c, Zone Ouerla/D�stnct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nam (Print) Current Mailing A ess:
— / /J—f /n �^n r y
Telephone
Signature
2.2 Authorized Accent:
E /c, C.- 9✓tC, f/f'f7 Gs� /V� C-�7{CA4 e
Name rin Current Mailing Address:
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 7 ,, (a)Building Pemiit.Fee'
2. Electrical (b)Esti,rnated Total Cost of
o Construction from' 6
3. Plumbing Buitding,Permit Fee
w JJ 0,
4. Mechanical (HVAC)
5. Fire Protection l `� �' y 4
0
6. Total = (1 + 2+ 3 +4+ 5) J Check Number.
This Section For Offcciat Use Onf
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
• ,0 • •
File#BP-2005-1270
APPLICANT/CONTACT PERSON DOUGLAS ANDREWS
ADDRESS/PHONE 89 LONGVIEW DR FLORENCE (413)584-1370
PROPERTY LOCATION 79 LONGVIEW DR
MAP 29 PARCEL 272 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 171/M 56 C-32TO
T_ypeof Construction•_CONSTRUCT 2ND STORY 27 X 36 ADDITION Q BEDRMS/BATH)& 10 X 12
MUDROOM&RENO 1ST FLR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin¢Plans Included:
Owner/Statement or License 078947
3 sets of Plans/Plot Plan
j FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ATION PRESENTED:
pproved 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 C ssion
�f CIS
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.
79 LONGVIEW DR BP-2005-1270
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-272 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2005-1270
Project# IS-2005-1690
Est. Cost: $92000.00
Fee: $380.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group DOUGLAS ANDREWS 078947
Lot Size(sq.ft.): 15246.00 Owner: WANAR KEN
Zoning.URA Applicant: DOUGLAS ANDREWS
AT. 79 LONGVIEW DR
Applicant Address: Phone: Insurance:
89 LONGVIEW DR (413) 584-1370
FLORENCEMA01062 ISSUED ON.6/27/05 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2ND STORY 27 X 36 ADDITION (3
BEDRMS/BATH) & 10 X 12 MUDROOM & RENO 1ST FLR
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 Occupangy Signature:
FeeType: Date Paid: Amount:
Building 6/27/05 0:00:00 $380.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo