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X cw Sol ?Sir. �, q r ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CNIR Appendix J Applicant Name: Site Address: l2 45 &u 5 24 RZ Applicant Address: \&,F� (LILn RI_Z City/Town: F\UM^lf U W Z ��Ozf,c,_ KV, wu(,e, Use Group: 2 F5 i Df,-q,A L- Date of Application: —\-U-I Applicant Phone: 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 (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- c. Glazing%(loo 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 J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet,if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate (HERS rating 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 22-S' sq.ft. b. Glazing Area 33 sq.ft. c. Glazing%(100 x b=a) l�lbb [� ADDITION with Glazing% (c.) up to 40%may use 780 CMR Table J1.12.3.1 below: NLAMMUM U-value MINIMUM R-Values Fenestration' Ceilini Wall Floor Basement Wall Slab Perimeter,Depth 0.392 R-37 R-13 R-19 R-10 R-10,4 ft 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 frill R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings.) ❑ "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 ❑ Denied ❑ Date of Approval/Denial: Reason(s)for Denial.- (provide additional details as needed on back side) a 3 �o N � z i 0 3 � I /0 Z O i ?° N b 7 BURTS PIT ,PD Zb �� April 16, 2007 To whom it may concern, The work to be done at our house on 1245 Burts Pit Road in Florence will not be used as an accessory apartment. Sincerely, 4Na-Q P- &,z- our e-, (�'&" Michael P. O'Brien Celeste E. O'Brien ( t 6 7- MARION D.WALSH Notary Pudic T(IfI L'!th of Massachusetts ;•E Commission Expires March 6,2009 • Estimate ■ Date Estimate# HOME IMPROVEMENT 2/8/2007 621 128 Ryan Road Florence Village Northampton;MA 01062 MA reg#137097 CT reg#0722787 Name/Address Celeste and Mike O'Brien 11-45 13u11s Pit Rd Florence. MA Terms Project Oil receipt O'Brien addition Description subtotal \1a1crial. per job I ubor. par job Subcontract. per job Project Suhtoial "Project rotal i Total `611,065 57 14c propose to hereby furnish material& labor complete in accordance with the above specifications, for the sum total. Payments to be made as Gtlluws 1.3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to he as specified. All work to be completed in a manner according to standard practices. Anv alterations or deviations from above specifications n\ol\ing esna costs will be executed only upon written orders.and will become an extra charge over and above the estimate. All agreements contingent upon strikes.. accidents or delays beyond our control. Owner to carry tire, tornado,and other necessary insurance. Acceptance of Proposal kill commence with the home owners signature. Prices, specifications and conditions are satisfactol.v and are hereby accepted upon signature. Rainbow I lone Improvement is authorized to do the work as specified and to be paid as specified. this estimate is good for 30 day s. Phone# E-mail Signature 113 885-9038 petenii�rainhome.net Page 6 • Estimate Date Estimate# HOME IMPROVEMENT 2/8/2007 621 128 Ryan Road Florence Village Northampton, MA 01062 MA reg#137097 CT reg#0722787 Name/Address Celeste and Mike O'Brien 124 Burin Pit Rd Ilorence. MA Terms Project On receipt O'Brien addition i Description subtotal Rectangular mouldings. pine 1141.E Painting. Primer coat and one finish coat light color 1 532 SI Franc and replace tub surround in existing bathroom I I.a Interior closet door and dryer area door and hardware. Rcuse existing interior door at entrance. I Ea l'arpeting. Subcontract Meditnn quality. $20.00 SY allowance 19 SY Shect aim l flooring$3.00 SF allowance in kitchenette area 12S1' Cabinets Base and Upper cabinets. Oak Classic style cabinets 60 in wide, upper and lower. Space will be configured for client provided apartment sized refrigerator unit 61 3/4 height,29 1/8 depth,28 in. wide. LF Laminated plastic countertops ; II Installation oftile in thin-set mortar, floors. 8 in. x 8 in. to 12 in. x 12 in.glazed field tile 40 SF Screen doors 80 in. high I Ea Project material_ Tabor, subcontract Total \\c pioposc to hereby furnish material& labor complete in accordance with the above specifications, for the sum total- Payments to be made as follows l,3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be a,,specilied. All work to be completed in a manner according to standard practices. Any alterations or deviations front above specifications imol\ing extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agiecnunts contingent upon strikes, accidents or delays beyond our control.Owner to carry tine,tornado,and other necessary insurance. Acceptance of Proposal \+ill commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone# E-mail Signature — - 413 885-9038 peter((ivrainhomc.net Page 5 Estimate &Iht2 Date Estimate# HOME IMPROVEMENT 2/8/2007 621 128 Ryan Road Florence Village Northampton,MA 01062 MA reg#137097 CT reg#0722787 Name/Address Celeste and Mike O'Brien 1245,Bm-ts Pit Rd Florence, MA Terms Project On receipt O'Brien addition 5 Description subtotal Rader bay vent channel Rafters 16 in. on center, 14 in. wide, 15 in net-free vent area 24 Ea Unfaced fiberglass insulation, 16 in. OC framing members walls 6-1/4 in. (R-19) 72 S1= Vinyl siding Color re-use existing I SQ Vinyl siding Starter strip re-use existing 10 LF Vinyl siding J channel trim at wall openings re-use existing 61 LF Vint I siding Outside or inside corner re-use existing f0 LF Building permit fees I I'S fhnnp ties 3 Ea Aluminum rain gutter Fascia gutter, 5 in. Dropouts,elbows, for either of above downspouts 24 LF Gypsum wallboard screwed 1/2 in. on walls 1532 SF Gypsum wallboard nailed or screwed. Add for taping and finishing ceiling joints 1532 SF Total V c propose to hereby furnish material& labor complete in accordance with the above specifications, for the stun total. Payments to be made as follcm,,: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations trom above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry tire,tornado,and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow I1ome Improvement is authorized to do the work as specified and to be paid as specified.This estimate is good for 30 days. Phone# E-mail Signature 413 885-9038 petercrrainhome.net Page 4 • Estimate Date Estimate# HOME IMPROVEMENT 2/8/2007 621 128 Ryan Road Florence Village Northampton,MA 01062 MA reg#137097 CT reg#0722787 Name/Address Celeste and Mike O'Brien 1245 Burts Pit Rd Florence. MA Terms Project On receipt O'Brien addition 5 Description subtotal Insulation board,4'x 8'panels. l in.thick(R-5.0) 153 SF Removal of siding 376 SF Window removal 15 SF Stud wall removal 2 in.x 4 in. for openings 240 SF 2 in x 6 in. wall stud framing 16 in,centers exterior wall 72 SF Wall plates 2 in.x 6 in. 27 LF 2 in. x 6 in. door framing To 3'wide(4 in. x 4 in. header) 1 Ea 2 in. x 6 in. window opening fi-aming 2 Ea 2 in. x 8 in. rafters. 16 in. centers(1.34 BF per SF) 231 SF Stud walls 2 in.x 4 in., interior walls 256 SF Fascias 30 LF Total We propose to hereby furnish material& labor complete in accordance with the above specifications, for the sum total. Payments to be made as hollows: Ii3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry tire,tornado,and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified.This estimate is good for 30 daNs. Phone# E-mail Signature 413 885-9038 peterrJrainhome.net Page 2 R in ab'* tv I I Estimate HOME IMPROVEMENT Date Estim,te# 128 Ryan Road 2/812007 621 Florence Village Northampton, MA 01062 MA reg#137097 CT reg#0722787 Name/Address Celeste and Mike O'Brien 1245 Burrs Pit Rd Florence- MA Terms Project On receipt O'Brien addition 5 Description subtotal Light wood frame demolition 144 SF Removal of suspended panels. (250 SF per CY and.25 lbs. per SF) 364 SF Plumbing in new bathroom and kitchenette.Gas heating unit to be installed in new room and venting trom existing unit to bathroom. Waste water and vent pipping for one toilet, one shower,one lavatory sink and one.kitchen sink. Waste to tie into desisting drain under existing slab. Water pipping to start at existing loafer pipping in mechanical room. Supplied with new shut offs. In includes all labor and materials to complete and all necessary permits. Also includes relocating gas main trom outlet o1'gas meter. lfgas line before meter has to be moved that would need to be done by gas company at additional cost to home owner. I f lertrical to code. Move existing service to accommodate overhead new addition. includes microwave circuit.dr\cr circuit,correct service cable to shed(overhead). New service cable to sub panel.Bath fan- li2ht. paddle fan wiring, openings for switches,outlets, lights cable TV and telephone. One temporary set ice and electrical permit fee. Heating system wiring. Install seven smoke detectors and two CO dcWors per code. All lighting fixtures to be supplied by owner. I Excavation and site work. i Unfaced fiberglass insulation. 16 in. OC framing members 10 in.(R-30).ceiling 517 SF Total 1 r propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as foho\�s: 1,13 of full total upon acceptance, 1/3 of full total upon the start ofpro,{ect and the balance ,poll completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations fi,om above specifications imAX ing Czt'a costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. 0wuer to carry tire,tornado,and other necessary insurance. Acceptance of Proposal will continence with the home owners signature. Prices,speciticatiorts and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good tier 30 days. Phone# E-mail D E 4 Signature Ell, L5- 38 peterl_rainhome.net Page 1 3; 2X S RAFt�� �r—vEut �— FN�StI FASGA VA- 2 X$ C,CI1.1 n►G 1 otSt < SiDtN(s SµEAT1FiN6 Z.X (p S'tvD W�u. d 'e a ♦ q ' VAOOR eaA%MF-K iII, �_ �IIII ° ,ul v ill i v lit 48 A II 0 Ni'-Souk) F-lotus I VILA PfLV tiT- IC.„ �-o 12-q S By i2TS `p i T- SIN Pv 95.05 !:� �',� ' �►' sir f T Lore 10 „ Ira ft; ILI7 r o *v , . s Y h o Q j V vi Q W � T � v e I I i i I o cn `o O 2 q p w all I • Estimate ■ Date Estimate# HOME IMPROVEMENT 2/8/2007 621 128 Ryan Road Florence Village Northampton,MA 01062 MA reg#137097 CT reg#0722787 Name 1 Address Celeste and Mike O'Brien 1245 BUM Pit Rd Florence. MA Terms Project On receipt O'Brien addition Description subtotal CDX plywood roof sheathing I/2 in., 5-ply 250 SF Plywood wall sheathing 1/2 in. 72 SF Cased openings Opening to 4'wide 3 Ea Fxterior door Lockset installation Mor ise type lockset,using hand tools I Fa Weatherproof underlay Roll covers 250 SF Tyvek house wrap 72 SF Labor to install building papers Self-adhesive,typical 250 SF Architectural shingles, 3 SQ Re-Install window I Ea Fxtcrior door. 9 light I Ea Soffit vents 2-5/8 in. wide, white finish I Fa Total \N e propose to hereby furnish material& labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1i3 of full total upon acceptance, 1/3 of full total upon the start of'project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Atty alterations or deviations from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes.accidents or delays beyond our control. Owner to carry tire,tornado,and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices,specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone# E-mail Signature 413 885-9038 peter @rainhome.net Page 3 O¢�t1AMp�0 r � � �iGlassacl�usrtfs _- " DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building 'co Northampton, MA 01060 5 ' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1083.4 to act as its/leer construction sup,::-,-,,sor. 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 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 location 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name(Business/OrganizationlIndividual): Address: City/State/Zip: =�c ^, �. C�.0 f :� Phone#: sA L Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. f�'I am a general contractor and I .employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, F-1 Demoliiion working for me in any capacity. employees and have workers' insurance.$ 9. (Building addition [No workers comp.insurance comp. required.] 5. f__J We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L Plumbing repairs or additions myself. [No workers'comp. right of exemption'per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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 the 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$1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: :� - Date- Phone Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person• Phone#: SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: � r`� `� ,1 "�\4��(. 'i-" �� U Ss Z3(!j License Number Address Expiration Date Signature Telephone 9.R'e'sistered Ifiorrile`frrroraa1Vem\ent t ontractor Not Applicabllee�'❑1 Company Name ° Registration Number 3 y Address Expiration Date Telephone`~\'a .IC . SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT MG-.L.c..1.52,;§2SC(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....... E!( No...... ❑ 1.1. 0m .Owner zetll01 11 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-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/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 Gable 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 Y SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing F7 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks Siding[O] Other[0] Brief Description of gProposed 5G� Work Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.IfNew iiociseand or�acl ditiarr�to`=ezrstir�cr'Cio�isna�Ycoiinp�efe�#�iesfotCouiriig: a. Use of building:One Family V" Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? o i, 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. Masscheck Energy Compliance form attached? h. Type of construction L 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. I. Septic Tank City Sewer 4 Private well City water Supply 4' SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED,WHEN OWNERS AGENT OR;CONTRACTOR APPLIES FOR'BUILDING PERMIT I Y I (�lj ' 001 ���p,d�-� � ,� ` ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. t ' a 11.x., t � Date Signature of Owner as Owner/Authorized Agent hereby declare that the statements and information on the foregoi g 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 Frontage Setbacks Front Rear 36 Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved (volume&Location) A. Has a Special Perm it/Vohance/Fndi ng ever been issued for/on the site? NO �~�� VV� DON7KNO �� YES ���� � IF YES, date icsued: IF YES: Was the permit recorded at the Registry of Deeds? NO K ) DONlKNOVV YES�� IF YES: enter Book Page and/or Document# B. Does the site contain o brook, body of water orwetlands? NO x_��� D0N7KNOVV YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs tobmobtained /~� �b�a�nmd � ^�� Oatm |ssuad'. �~� �~� . C. Du any signs exist on the proporty �� ��� 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 0 � NO �') IF YES, describe size, type and location: ' E. Will the construction activity disturb .grading or filling)over 1 acre nris it part ofo common plan that will disturb over 1acre? YES � ) NO �� �� �� IF YES,then a Northampton Storm Water Management,Permit from the DPW is required. ' Department;�us�one ��� ^� City of Northampton Status of Perrnit x r . Building Department urr GrflDrrveuva �e rm► �� € g_ � 212 Main Street SewerSept<eAalab�r►t � Room 100 vAlater/INellAva116l7rlrtj � ' r Northampton, MA 01060 Ians � � * ` phone 413-587=1240 Fax 413-587-1272 PloSrte Plans k = ., Other Speejr " APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE,INFORMATION 1.1 Property Address: Thus section to IJ6 completed#3(,offfce Qverlav Drstril Elmer Sf.Drstnct .� CE#Drstnct SECTION 2-PROPERTY OWNERSHIPfAUTHORIZED AGENT R 2.1 Owner of Record: 1� ,- ir?; ? ( _a, i' � Name(Print) {� Current Mailing Address: Telephone Signature 2.2 Authorized Agent: vi-jr,'+� �•-..... Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be ffi� I __:_r-. completed by ermit applicant 1. Building (a)Building;Permit 3 200 2. Electrical (bT Estimated'Total Cost of` ' � -Construction fro 6 3. Plumbing Building Permit Fe ; 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 _9 ..Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0966 APPLICANT/CONTACT PERSON THOMAS MALONE ADDRESS/PHONE 128 RYAN RD FLORENCE (413) 885-9038 PROPERTY LOCATION 1245 BURTS PIT RD MAP 35 PARCEL 083 001 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 V U Cl"6 y i Typeof Construction:_Kitchenette addition New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FO OWING TION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION ELATED: Approve itional 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 Commissio 100 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. - i , �* r ; � 11,y� �`s`; ,, i a f. � ,,,� ; � 55 z fim i"TL' * �S' _ it .� _ 5 2 t y N f �' 3.2.°`3 , ✓ '.., y 4 `� ' R # ){ .. { 3 t I I I I r ik i - , d $ 1 ,, 4 k, + f _ ay x ,c y _ �°Fes" r ` }�' z 11 1 y y d P - Y - fC } N.54 3.t F�Y t I t. Q a ✓s , y } " �-� q 'ay'F p § s�"' ) > : .,--,1,, �, - .gyp ' �_ 'yam+c - ..a.*.,was .....-. !•+w.a c,+xm.�w^'n• d b4" �', `��F _ . 9 it I � 4 3 w a I'll,111 11 c ,cam r t a I �,*.a 'e& 3 t .c. ql-� , 1 �t r u t to t�C�.wk k,..14-{ 6 '" x� ti x " ;`e� a �{ ,' , ;am,. a.. ?I r ro,.,.,.' d al 1245 BURTS Prr RI3 c � � � � �► WZW2&35= ORS DO �T HAVE� � TO T RN FW0 TRMFU ------------ . . "s,p� �; '_ Bst.Caist:�41fl414.4i� " VCR:114(1.41(? PAW,- S 1 r WERE Jr-,GRANTED ro £'©nectar: License: THOMAS MALONE I,A&kYVKN1Q , 1 T STkutt 0 X 17 KITGH NETTE ADDITION eetnlr 1Iuiha� ter LT1k"itt�li: Servl�e:,j,Q. C�ex: Flea Gas:` - `' :gam Ftre �acefCtm�ney: Rough: ;r womil: - ` Insutaticua: /"�:l�► �? THUS PERMIT MAY BE REVOKED BY THE OF NORTHAMPTON UPON VIOLATI N OF ANY OF TS RMES^A"' w NS �. er_t Ca#E {? S3 e• Feel e: Hate d: rnuun# Building Y. M007 0.00:OQ $146 QA17t001 lit, m 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 . Building Commissioner Anthony Patillo