28-069 (2) ENERGY CONSERVATION APPLICATION FORM FOR
s LdW-RISE RESIDENTIAL NEW CONSTRliCTION and ADDITIONS
780 CMR Appendix J
Applicant Name:' I A IVI 14(l r, �n�� Site Address: e S �' J�(��'��'
Applicant Address._ �,'(0 (C,v: r r �fl- City/Towm:
Use Group: S,1wc _�
Date of Application: v 7 3
Applicant Phone: S '.• `� �1 �� Applicant Signature: 2Z
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 J5.2.1b): Heating Degree Days (HDD65)from Table J5.2.1a:
(For items d. through i.,fill in all values that apply from Table J5.2.Ib:)
a. Gross Wall Area sq.ft f. Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value R-
e. 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
❑ Component Performance: "Manual Trade-Off' (Limited to wood or metal framed buildings only)
Climate Zone (from Figure J6.21.21) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade-Off Worksheet from Appendix J, [and N_V,4C Trade-Off Worksheet, if applicable'
❑ AL4Scheck Software
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Rating System Evaluation
Attach Home Energy Rating Certificate (HERS ratio,score must be 83 or higher)
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall+Ceiling Area 3a 0 sq.ft. b. Glazing Area' 13 r1 sq.ft. c. Glazing%(100 x b_a) 43 %
❑ ADDITION with Glazing % (c.)up to 40%may use 780 CIMR Table J1.1.2.3.1 below:
MAXEMUM U-value MLNIMUM R-Values
Fenestration' Ceiling' Wall Floor Basement Wall Slab Perimeter,Depth
0.39' R-37 R-13 R-19 R-10 R-10,4 ft
1 Glazing Area may be either Rough Opening or Unit dimensions.
2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units.
3 R-30 ceiling insulation maybe 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.)
19 "SUNROOM"addition (greater than 40%glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form"from 780 CMR Appendix B.
Official's Name: Official's Signature:
Application Approved r-" Denied ❑ Date of Approval/Denial: Q
Reason(s) for Denial: (provide additional details as needed on back side)
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A
Board of Building Regulations and Standards
'
-, One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 131945
Type:
Expiration: 10/13/2008
STEVEN A. SILVERMAN
STEVEN SILVERMAN - - - ---- -- - ---
268 FOMER RD. - --- ----------- --- -
SOUTHAMPTON, MA 01073 ---- - - - ---- ------------- -
update Address and return card..Nlark reason for change.
address -- Renewal - Employment — Lost Card
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 131945 Board of Building Regulations and Standards
Expiration: 10/13/2008 One Ashburton Place Rm 1301
Type:
Boston,Ma. 02108
STEVEN A. SILVERMAN
STEVEN SILVERMAN
268 FOMER RD. ,,
SOUTHAMPTON, MA 01073 Deputy.administrator Not valid without signature
.%/;� '��nr.rec.�z.�.��cr'f✓r c�.- lli;;nclu.;r:'!
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 07,7279
Birthdate: 06/21!1964
Expires: 06/2112008 Tr. no: 24270
Restricted: 00
STEVEN A SILVERMAN
268 FOMER RD
SOUTHAMPTON. MA 01073
Commissioner
a
�O e O,y
�dSa NCItttSCt15
cwr.
DEPARTMENT OF BUILDThG INSPECTIONS
212 Main Street ' Municipal Building
N'ortlhampton, Mass. 01060 '
WORCER'S COMPENSATION rYSURANCE AFFIDAVIT
I, Nelson Shifflett - Valley Home Improvement Inc .
(Ii ccnserlpermi ttee)
with a principal place of business/residence at:
340 Riverside Drive, Northampton,MA 01060 (phonc, ) 584-7522
do hereby certify, under the pains and penalties of pe. ury, tl1a:
( I am an employe: providing the following workers compensation coverage for my
employees working on this job:
A.I .M. Mutual Ins. Co. WMZ8005610 01 2007_ 2/1/08
(LCIrTMRce Cornpanv) (Pcf icy Nu..Tber) (aTirat on Daze)
( ) I am a sole proprietor, general contractor or homeowner (cif cie one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Nam^of Contractor) (Insuran(--Company/Policy Numer) (Expiratica Date)
(frame of Contractor) (Ins.iranc: Compazy/Policy Number) (E\oimtioa Date)
(Name of Contractor) (Imuraac; Compaay,Policy Namb,-) (Eapir ucn Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioenl sboe if noceauy to ind infUrmatioo pc tmiu to ail cca'raclors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homeowners who aapioy pc-scat to do oo isuLcion or repaw work on a dwelling of
not more than three unite in which the homeowner resides or on the groua&appurtenant thereto arc not gcaraily ooandered to be
employers under the workrta o=p=uticn Act(GL152.s 1(5)�application by a homeowner for a doe=or permit may ev.,dcnce the
legal stahra of an employer under the Workeet Compomation Act
I undesc d that a oopy of this uat=ca may be forwarded to tbo Depnrtm of In&Lsni al A=dcn&Offroe of Unumooe for the
coverage verification and that failure to secure coverago under section 25A of MGL 152 can lead to tha imposition of criainsl peaallies
ooasis ing of a fine of up to S1,500.00 and/or imprison of up to one yew and civil pemlties in the form of a Step Work Order and a
firm of S 100.00 a day against ma
Signed this _day of_ For dcprctmmtal use only
Permit Number
1t/F�So/�/
SECTION 8 - CONSTRUCTION SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Steven Silverman 077279
License Number
268 Fome 6/21/08
Address � Expiration Date
584-7522
Signature Telephone i
9 Registered Home Improvement Contractor: Not Applicable ❑
Steven Silverman 131945
Company Name Registration Number
268 Fomer Road 10/13/08
Address Expiration Date
Southampton, MA 01073 Telephone 584-7522
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....... X No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners" was extended to include Owner-occupied Dwelling,s 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-vear 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/site 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
Ncw House E34 Addl#on 0 Replacement Windows I Afteration(s) C Roofing 0
Or Doors -1
Accessory Bldg. 0. Dernolition❑ New Signs Decks Siding[ Other
Brief Desc-io-on of Proposed '.1ook. G**4,Af4
tj r,
><
Iteration of existing beCrcom-Yes Acd;ng new IFdfcorr Yes
Attached Narrative
'- yc, No
Plar s Attached Rol!
- Sh
6a. If New house and or addition to existing housing, complete the following:
;i. Use of bullring : Cne Family Two --amily Ot-e r
U,. (Lumber o I rcolr s in each far-fly U ni t: Nu^lne, or satt",cc-`5
c, Is tnere a garage attached?
ti. PfcPz)tied SQuare fcotalpe of new construct:01)
'Acthod of heating? or Wcc<jctc;vri,, (mi-tv of cocti
g Energy Cc!,.serva!icn 'Cor-;ip iat-ce.
Type of cc-sifuctic"I
vo lh,:t 1 W :n(57 00
Dtvth of oa,.ement or cellar Vo,or'below linicShe(! ;rode
','Jill oujldir-.F -cr.tor-n to :he Builcinp, and 'Y No
i Septic T,,)nk C.,y Se• •�,r Pr Va"a �%eI �J'ky Vater Soo[" Y
SECTION 7a • OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as 3,.%,ner cf t-e sul:,ject p-opef tv
lierel,y autnnr17P Steven--Silverman,_Vaj1ey_Home_ Improyement, Inc a:,t oil
my Lc`1alf, in all M I
%v)0% aulnenzed by this
:;ate.
i. Impromement. Inc, as Cwnpr/Aulrionzerl Agent
Stamen Silverman$ Malley Hme
hereby declare that the statcrnerits and infofmation cri the forcpowy, copliciticii ,Aro lrw; orid occurate, to he t>t5, of Ivy
krc-Nlodgc and belief.
Signed under the pains and penalties of pert, Y-
S teven�
Prirt Name
Signatur Mile
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 Departme11-1'
F:
Lot Size 1-2-0) ODD 3�. ±
I
Frontage 25
Setbacks Front I50
Side L: 50 R: U) L: R: /
;f
Rear —75 /fir
Building Height
Bldg. Square Footage 1 -3,000-L
Open Space Footage
(Lot area minus bldg&paved
oarkina)
T of Parking Spaces
Fill: — I
(volume&- Location)
A. Has a Special Pe it/Variance/Finding ever been issued for/on the site?
�-XNO DON'T KNOW YES
IF YES, date ued:
IF YES: Wis the permit recorded at the Registry of Deeds?
NO 4 DON'T KNOW YES
IF YES: enter Book Page and/or Document Y
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 N0�
IF YES, describe size, type and location:
D. Arere any proposed changes to or additions of signs intended for the property ?YES —
No
' IF YES, describe size, type and location:
wDepartment use only
of Northampton Status of Pew it
1 I-Bbiilding Department Curb Cut/Dnveway;Re—
ELI
�t
;�
-- �12 Main Street Sewer/Septic Avaifa ty . �. .
Room 100 W er/Well Availability
JUL 2 4 2007 Na h;ampton, MA 01060 Tw Sets of cturai Plans
phone
413-517-1240 Fax 413-587-1272 Plof/Ste P[ ter "
_,xb Other Specify 3
TI,A°# PL1CA$f(bl8 CIIRSTUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING l
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
Zone Overlay District
Elm St. District CB District _
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone Cie-
2.2 u j
Signatu L I
— I
Authorized Agent: Steven Silverman
Vallev Home Im rov nt P.O. Box 60627, Florence, MA 01062
Name(Pri Current Mailing Address:
584-7522
Signa re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
. Building e (a) Building Permit Fee
2. Electrical r (b) Estimated Total Cost of I
000 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
:.,,, ♦
File#BP-2008-0085
APPLICANT/CONTACT PERSON Valley Home Improvement,Inc
ADDRESS/PHONE P O Box 60627 FLORENCE (413) 584-7522
PROPERTY LOCATION 138 SYLVESTER RD
MAP 28 PARCEL 069 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 4 God
Fee Paid
Typeof Construction: CONVERT 3 SEASON ROOM TO LIVING SPACE(HEAT&INSUL WINDOWS)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 077279
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOOORATION 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 Co ssion
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.
13$.& 'L k;, ' BP-2008-0085
GIs#: COMMONWEALTH OF MASSACHUSETTS
M �'- CITY OF NORTHAMPTON
alz:$�k;28 n.6t�i9�`
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-2008-0085
Project# JS-2008-000126
Est. Cost: $22600.00
Fee: $88.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Valley Home Improvement, Inc 077279
Lot Size(sq. ft.): 131725.44 Owner: SCHAFFERASHLEY&JAMES GRINNIS
Zoning:RR Applicant: Valley Home Improvement Inc
AT: 138 SYLVESTER RD
Applicant Address: Phone: Insurance:
P O Box 60627 (413) 584-7522 Workers
Compensation
FLORENCEMA01062 ISSUED ON.81212007 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT 3 SEASON ROOM TO LIVING
SPACE (HEAT & INSUL WINDOWS)
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 8/2/2007 0:00:00 $88.0022828
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo