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36-261 (3) ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS 78O AMR Appendix J{-ethective 3/1/98) Appl,cznt Name: Site Address. , ApplLcxnt Addross: GtylTown _ Use Group: Date of e,po(ica lion : JZ•ua,iilu- Co�np-!?ar4Cr �YCi!Y (d�eek OeM'k ❑ Prsscriptitire Package ('_imitec to 1 or 2- family wood frame Uuildmgs Heated with fossil (ueis only) Package (A throu ti KK from Table 35.2. Ib) Heating Degree D2ys (I1DD,,) from Table J5.2 la: CFcr items d. through i., fill in 211 values ttiat apply from Table J5.2) a. Gross W&H ivy sq, fi t. Waii R-Vafuc R b. Glazine Areal =q• h Flc o; R :'a1L,- n C. Giezing%(100 x bi-a) h. Eiasement wall d GEazinv 11-self✓+ i ";au Fcrimeier e. Go Jing R-value {Z- i Heaving AF U- ❑ C,,;, m�� PeFform;iirice: 'Manual Trade tiff` (Limited to wood or metal framed building-S only) Clirnat�-Zone(from Figure J6.2.2) ❑ Zone 12 L] -'one : ❑ Zone Attach Trade•Off ttwl;tect`rom Appendix 3, [2nd %l VAC 7-raCe-01"l oiishee1, if applicable) ❑ (wtC,Scnc+ck Softwarr Attach Compliance Peport and Inspet7ion Checklist printouts. ❑ Sy3tcrns krnaiysis OR ❑ Renewable Ener�y 50-.,tces Attach Mass Registered Architect or Engirf--r Analysis ALTERNATIVE FOR ADDITIONS ONLY_ y a. Gross Wall + Cciiing Are-A� 5q f•!. b Glazing Area N® sq.tt c, Glazing% (100 z b� a)jTXj- Q ADD!T t(DN witti Glazmg % (c.)up to 4-0% may use 780 CMR Table J1 1.2.3.1 below: MAXIM,I.",.", U- Minim. urn R values Fenestration Ceiling Wall Floor Basen,ent Wall i Slab Perimeter, Dept O3s R-37 P-13 R 19 y R-10 I R-10,4 It ❑ -SUNP'O<JM' addition (greeter than 40?, glazing-to wail and cc+l ng gross area) attach 'Consumer Jnfvrmation Form' from 7K CMft Appendix B. cil icial`s Name: WA-l�a� k.� Official's Signature. Appticatton Approved � Denied ❑ Date of App oval:De i&l: r;oa�vii(�) tvi icnial: (prOV1c34t adCdiiional de-wis as needed on back side) Claziaz Area axwY be vkhtir Pixigh Opwmg or Unit Dtmcncirmc � � .. .._.. � _. - 1 r '- ���, � __ • � _ __ _� � i� _. _ i�:� _ f ,� �� ,e ,` � � '�1 i �J _ _ .__._. _ ., �- tt _ _ _._ , , � ,� �"� Ri1�� i .. tt,.� f a Y V d j\ �� y � .� a __ 3 t � .A - � � �:i � .7 _ `, a ��� � �� - ^,� �' � 1j��� , . �__` i �.�: _. __ ,�� :� 1----� �� `� � � f- f �, ._. � � �� �� .� _- __..._ _4 r / A }� / j r' r' lR q's z�_. ...} � � / _, _ ,pg 7' �. _`:.:� .. f" OOOF b � t 7 P _ a a 3n ?3 t a �P�Y lr o--� �� � ���� ��c,��r� � � � , � , � � �.• i{ rta CV°�`''� I It i� i, ' r , i r � � r 22 3` o Xta`%,, an S rnc"f�L �59"X 43M 25'-4" (�wN^JS C6 �t�tt 3r,5 t1 zz CD r�- S 25'-4" PF FT- M RIDGE- CBS TK& W RAFTERS Y? SQNKES I'E AND WATER BARRH-R 3P N SJ, T SErhil VFNT HLADERS ?�XIM I R K ------------ 2X6 WALLS 16, MY I&B, R q 9 IN K--d AT WRAP W- VA-OR BA-R u R 30 -2'x 4' EXIS--ING ,WALL-S ------------------ 16, Uc, GARAGE AN,,' FL JN F-1--- --l' UNIVERSHL FOREI,T rROL: ji1?3 ----------- ..-1_ ;'`-_f_.. __- _ _ _ --- - T) Universal Fleury Umber ury r Forest Cavanaugh Products' Quote sheet : 03"10212 COntaCt: David Laurin 55 Bay load,PO Box 945,Belchertowt;Ma 0100-7 Designer:1Mke Finch phone;413-323-7241 Fax:413-323-5257 Sku ------ ......_.,....._..... Total door beck � � 7 Floor Girder 15371 L04 13/4" G-L..QVI, 1b 2950 x 4 Floor Girder 15571 L26 13/4" G-L•A1v116" 29:0 x 26 Floor Joist 41669 L14 'Lpi 36A 16"x 1.4 Floor Joist 41669 L26 Lpi 36.E 16"x'26 Hanger 13817 �Z1?3516 1-T ngff 16734 1\1IT'416 Interior Blocki.ing 41669 L02 Lpi 36A 16'x 2 Rim Joist 40313 L12 1-Ii8"x 16"Rimboard x 12 Gri aw x. ;9 I'd-Y, j-, 1 4. 02 REQ.QUOTE DATE ORUER# Universal ORDER DATE 01.10TE# 131021213 DELIVERY DATE I I CUSTOMER ACCT ft Forest oATE OF iNvc)wE CUSTOMER PO oRosftar)sy Products' David Laurin INVOICE TERMS 165 Bay Rozkd,PO SOX 245,80chertown,MA.01007 SUPFRINTENDANT David Laurin SALES REP Phone:413-323-7247 FU.413423-526? JOB$ITIE PHONE# SALES AREA Fleury Lumber JOB NAME,Cavanaugh LOT 9 SUBDIV: 231 Main Street PO Box 282 MODEL: TAG: JOB CATEGORY, Residential t4sthampton,MA 011027 DEUvriLRY INSTIkUCTIONS-, (413) 527.2693 Cavanaugh SPECIAL INSTRUCTIONS: Florence, MA 0(-- AT- 4.DING DEPART-10-2-4TIOVERHAN'S IN�FHEEL HF.IG.NT 00,04-03 RI,LAYOUT'S RR W2 OUOTE IIVJF 1 1W �101ANSISS ENO cur!--itriTURN NONE I NONE PLtJM6 NO I GABLE STUDS 24 IN.04 1. CUTTING OOF TRUSSES LIA1111 Tc"-Tcni..ecL~scoc srrsss kaR. ROOF TRUSS SPACING:24,0 IN, O.C.(TYP,) INFORMATION 40.0,10,04 0.10.0 i 1-15 ROFILE OTY -P17CI-1– TYPE BASE 01A I LUMBER I OVERtIANG CANYILEV>=R s-rus ID SPAN I Top FB—o-TA�T Kw- LWfFT RIQT LIFT R1 Ey 'rop I 80'r I SPAN ATTIC T01 28.00-00 2".00 2X6 2X81 I GABLE 6.00 0Z TOIGG 28.M.00 2800-00 2 X 4 2X41 I• ROOF E ousted price will a*nored fo 30 as of 10/23103 _ Y CCEPPURCHASER:P TED TLE: PURCHASE ORDER# *$IRF-D DELIVERY DATE: REQUIRED JOBSITE INFORMATION DRESS: SITE CONTACT: N JOSSiTE PHONE- 3S sTX i�'A_F-7,R 30 YR 'K;INLLLS AN P. \d A T R 9 A R R" R 3F, FNG, VG—N, Du RS N 2X6 WN-; ILI- R 30 X EXTSFINU WA; El 1-1 - - I V �, (LA6 s a' NOV — E j a, w Nc") wee—��-�--- ��V c l JC IV' [� r it 1 yn Og'Ct1AA1P�0 Grit r of Norf4outp#on z z � � �lassacl�nsctf4 - DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building 'o Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:,,i ,or. 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 requesti xemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 1 � - O le - C Address of work location t fY1(4 P 1_cL (Z< 6 (=t F JZ S] �j tt/aN/>TO d rlK5$acflttsrtts' � 1 s cfl 1?'11,1 1-MENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, lfftss. 01060 T 'WORKER'S CONITENSAUON INSURANCE APMA IT (lic�n4°��c�-mittcs) �lrith a principal place of businesslr sideucc t. do llcrcby ccrlizy, u.1("i d1C p Ills lilQ 1)Cil ttt1CS o rpe['tl[�', tI12i O I am an employer providing the ollo`,,inc .:orr_ci's comnensat;on cove.a e or lay emplovce's worEng on 11115 job: (LtLrISanG Co�lpvm) ('c c,Number) (E7pirt]^h Date) l ) I am a sole proprietor, y=enerai conla-2c`er o- homCONVOer (circle Oct) and leave hirt i the contractors listed beio`v -_,to h - the OLr : is worker s compensa on ;o! c es: (Name of r..ontmcCor) (1nSLt .1C ( v^I^^.:::i'r:�Gll f NllSTl r) (E x rz-,c-, Datc) (Name of Connacto-) (Znsarmcc Coa pa.nvPo!ic; Nt rn r r; (Eyn mtion Date) (Name of Coa'tnctor) — (In;•sr�nee Coa; Polic, Nusnt�s} "_ -�; r,:doe Late) - (Name of Cont nctcr) — (Insumnc:. Come,=)'Policy Numli=r) (E:pi-:tie- Dare) (r.IL>dl=.d'!itieril z:.'rt i1!:<ce-•.r::::ir.-cl's::...�cr:':a:ie.:-:--.... � ell.�r< :_.-.-..•.) ( 1 iUll a Qle 1?("UpiletCli i'.:Ill h vc 110 one ••'J?"ti ii for ill". ` 1 ?ill A 1101?1e OWi1C� iiCi:O`I111I1 all NOTE: ptczsc Lc a%,wc L's:.vt-i7C m or,cpatr\\ ...... ' li cc :not utcee thna tiu-o unis in c'aU zn*_t:cr_r1 C-lC1zl - cm to z u_ur the tvc,}_cr'z ca:x^_.erica,r: GL15��a 511, "ic vy s hn- ,a for z liccu a p:rn:i: Icgal etaluc of an o�ployvr under t.`:n Woriccla iav-;>orr..iion!.ci - [undc-itaad dl!x copy of t4v uatcis:rn-y bo fawnrc!S to tbo D-jxi t.,cs>:of Ir>dzr.;!rizl of is for ti- coverage va-Matiioa and that failure to s c rn�-rte ur-d,d., zet.ion 25A of::GL,152 can Ic:d to the impositia�o;c e!pa�L:es comutiag of a Cur of up to S 1-5 w1.00 n:tn i-:i:riv�z :;of up to cr.:} !:.i civil}xmltin tm of S 1011W a diy main:t tn.. . For tja;u111f1j 11l G lly • 111I11T::S ---_-__-- Ycrmlt ----- �!,°,D1Llli'C()f 1,1CCII':C[aYC[il] S,ECiON 8 CONSTRUCTION:SERVICES VP 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :_ '`t 1'-- 69 ':1 J N�v10 C._.otS 015( 11� 3 S License Number 1 b 3 Mw P I--q. Y? t nG o. 4Nt14 01 t4k 7-T 9 s Expiration Date Signature Teleph ne ; Reg s Meg .�.-orn: �mpro .-em^ent_.°ont`=a:cto:- Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS''COMPEN,SATION 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 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"homeoNvner" 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"homeow er"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinanc s, Sta and Local m, aw d State of Massachusetts Gen ral Laws Annotated. Homeowner Si natu e A_J g SECT10� DES R TiIUNW.F PROP�OSEDiW0RK= checl fl=a I�ca61e New House ❑ Addition , Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New n ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: A `R0o X\J* le G1grV+6►`Z, w (nX(L @li C Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll PC- Sheet❑ 6a. Mew .ou ar aWittonto exisfing h uo sin- co te. a £het=low-rn a. Use of building : One Family Two Family Other r� 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 o7`J ' X 4@L e. Number of stories? f. Method of heating? U)�C Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction luau' k _ i. Is construction within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes X No r 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 Private well City water Supply SECTIO 1ffINER� y©RIZATION TO BE COMPLETED WHEN OWNEk GO CONTRACTOR"APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize CL- L- CA iJ&4(\J vi-V(n, t-r to ac: on my beh , II matters r ative t work authorized by this building pe it application. U)—)L�—'Signature of Owner Date 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 N7 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 This column to be filled in by Building Department Lot Size t tics. 01 Frontage Setbacks Front Al?S Side L: R: A10 L: R: PO Rear 160 r j Building Height Bldg. Square Footage a3© % ��g Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&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 K 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: � y `,l) City off, Northampton Bu,ildrig Department 2121Main Street R' om 100 Northam ton, MA 01060 phone 413-58 240 Fax 413-587-1272 u er APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION "`�� -� 'This sectnon to�be`comp(ete�dbx'" o fvice� �� 1.1 Property Address: �' r (VA L S� i t k 6? rY1 V3, d k©leaZont� O�erla listr�ct '�� SECTION 2 - PROPERT"Y OWNERSHIP/,AUTHORIZED AGENT 2.1 Owner Record:� �� �� Cl��I ryN WU(r l-{ LOAM ( 6 3 4►'1y9 P i- +2 10 ro f Qo►9 O Na Print) Current Mailing Address: — -7 5-7S ate. Telephone Signature - 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECT10N.3.- ESTIMATED CONST.RUCTI"ON COSTS" _ Item Estimated Cost(Dollars) to be Official Use:'Ohl Y completed by ermit applicant 1. Building (a) Building Permit Fee 0 ci,C)(3 2. Electrical t �d�Q© (b) Estimated Total Cost of Construction from:' 6 3. Plumbing i C©Q��� Building Permit Fee 4. Mechanical (HVAC) J 5. Fire Protection ^ 6. Total =(I + 2 + 3 + 4 + 5) t CW6.0 Check Number This Section For Official Use Onl wilding Perm "Number: Date:lssued: Signature: Date Building Commissioner%Inspector of Buildings File#BP-2004-0561 APPLICANT/CONTACT PERSON CAVANAUGH PAMELA&DANIEL P ADDRESS/PHONE 163 MAPLE RIDGE RD (413)586-7575 Q PROPERTY LOCATION 163 MAPLE RIDGE RD MAP 36 PARCEL 261 001 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 /o Typeof Construction: CONSTRUC T 2N15 FLR ABOVE GARAGE 25 X22(BEDRM,FAMILY RM,BATH),&6 X 16 DECK 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 F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Stre ommission Signature of Building(Iiffici4V 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. 446WAPa,RIDG RA BP-2004-0561 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Perrnit: Building Category: BUILDING PERMIT Permit# BP-2004-0561 Project# JS-2004-0789 Est. Cost: $14000.00 Fee: $182.10 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): 55756.80 Owner: CAVANAUGH PAMELA&DANIEL P Zoning: SR Applicant: CAVANAUGH PAMELA & DANIEL P AT. 163 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 163 MAPLE RIDGE RD (413) 586-7575-0 FLORENCEMA01062 ISSUED ON:11114103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2ND FLR ABOVE GARAGE 25 X22 (BEDRM, FAMILY RM, BATH), & 6 X 16 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 SiLinature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 11/14/03 0:00:00 102 $182.10 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo