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36-274 (2) Y\1�1•�1 00015 :2 V a Date Filed- _ File No , ZONING PERMIT APPLICATION (§10 . 2 ) I . Name of Applicant : Address : Telephone: 2 . Owner of Property; Address : Telephone: 3 . Status of Applicant: -,-,,Owner Contract Purchaser Lessee Other (explain : ) 4 . Parcel Identification: Zoning Map Sheet# 3(o Parcel# a , Zoning District (s) (include overlays) S Street Address bU Required 5 . Existing Pro osed by Zoning Use of Structure/Property (if project is only interior work, skip to #6) Building height %B1dg. Coverage (Footprint) Setbacks - front - side - rear Lot size Frontage Floor Area Ratio %Open Space (Lot area minus building and parking) Parking Spaces Loading Signs Fill (volume & location) 6 . Narrative Description of Proposed 4�ork/Project : (Use addit$onal sheets o if necessary)�h�, / �, ,�. �� /��>7 ,•�, LA 7 . Attached Plans : Sketch Plan Site Plan 8 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowled�e , Date : Fth/� ~ Applicant ' s Signature:C---W'` f THIS SECTION FOR OFFICIAL USE ONLY: '-proved as presented/based on information presented ,/'Denied as presented ason f nial : '�-- ignatu e of Bui Inspector ate NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from dw Board of Health, Conservation Commission, Department of Public Works and otlior applicable permit granting authorities, I DEC ENERGY CONSERVATION APPLICATION FO-RM FOR -- LOW-RISE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS 780 PMR Appendix J{-(_ffective 3/1/98) Applicant Name: `� Phc D(Ro►cY�. Site Address: 160 R,19 �t:Q Apphtacit Addrnss: E1_Q ve 4 Gty/Town: Poez.,nSC vti.a 55 Use Group: v(C0 & a- _ Date of Application: c l7 O ApNirrAnt P1v_x,±: JC �OC�y • pp!icatiori Silinaiiir: c ntpUartc± Patti(chieck ane)r M Prescriptive Po7*.age (Limited to 1- or 2- family wood frzme-buildings treated with ossil fuelS only) Package (A through KK from Table J5.2. tb): _____ Treating Degree Days (HDDBS) from Table J5.2 la: _ (For items d. througn i., fill in all values ttiat apply from Table J5.2) G a. Gross Waif Area 5D sq. h f. Walt R=Yatvc R f b. Glazing Areal Ici 4 cn K 'Floo; R Val:,e R_ d C. Glazing x,(100 z b+a) ( � 6 ' h. Basement wall t 9 d, Glazing If-Vaf_v_. i i. Slab Roriinri / e. Ceiling R-value i Heating AFUE [� Co,;,poner; Peeforrniance: 'Manual Trade Oft (Limited to wood or metal framed buildings only) GimateZor►e(f-am Fi"J6:2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off K'orksheet Yom Apperidix J,[and HVAC Trade-Off Worksheet, if applicable) ❑ �4AScheck Software Attach Compliance Deport and Inspection Checklist printouts. ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engin—_,r Analysis ALTERNATIVE FOR ADDITIONS ONLY. a. Gross Wall + Ceiling Arm sq ft, b. Glazing Areal Sq.ft. C_ Glazing%(100 x b+a) ❑ ADDITION with Glazing % (c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value Mmimurn R•Valucs Fenestration Ceiling wall Floor Basement Wall + Slag Perimeter, Dept 0:39- R-37 R-13 R-19 ' R-10 R-10,4 tt, ❑ "SUNROOM` addition (greater than 40°x,glazing•to-wall and ceiling gross area) Attach -Consumer Information Form- from 780 CMR-AppendixB. OffiCial'S N4Me: Official's Signature: Appficatian Approved ❑ Denied (] Date of Apps all Denial. waso n.(j)Nr Denial: y(prWide additional details as needed on back side) 1 Gla2�.Alts wxy be O�br Wuj' 'OpmIlg oar Unit Nme=ons, ENERGY CONSERVATION APPLICATION FORM FOR LOW-I I ,�JZESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J / %Applicant Name: f t1 U Q Applicant Address: 0-V City/Town: l oco Use Group: 0106e- Date of Application: 0 Applicant Phone: 0 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 J5.2.1b): Heating Degree Days(HDD6,)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%(too 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 /I CIS sq.ft. b. Glazing Area' c2/ I sq.ft. c. Glazing%(loo x b-a)ff c 1K ADDITION with Glazing% (c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration' Ceiling' Wall Floor I Basement Wall Slab Perimeter,Depth 0.392 R-37 R-13 R-19 I 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 may be 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.) ❑ "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) Calculations: Cellar: Glazing Wall/Ceiling Wall: 50 linear ft. x 7.75 feet high = 387.50 sq.ft Slider Door: (1) x Eft wide x 6.5 ft high= 39.00 sq.ft Casements: (2) x 1.5ft wide x 5.75 ft high= 17.25 sq.ft Double Hung: (3) x 2.5 ft wide x 3 ft high= 15.00 sq.ft Dining Room: Wall: 50 linear ft x 9 ft high= 450.00 sq.ft Ceiling: 22 ft x 14 ft= 308.00 sq.ft French Door: (1) x 6 ft wide x 8 ft high= 48.00 sq.ft Casements: (6) x 2 ft wide x 7 ft high= 84.00 sq.ft End wall windows: (2) x 2 ft wide x 2 ft high= 8.00 sq.ft Totals: 211.25 sq.ft 1145.50 sq.ft Glazing % = 100 x 211.25/1145.50 = 18.44% MORTGAGE LOAN. ..INSPECTION TIIIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES t10'C CONSTITUTE A PROPERTY SURVEY G 2 u3 r � ? '' ✓' Z STOGY vi P HOUSE Po RCN I tiR1VE I `4 1-721.34+ I Z I I,'' E } od magic- QUA Eck � t 0 ►2e-,x ce wA 11rs .5 0 10� � . O�.KHAMP�O Gz#p of Worflamp#ou z I � � � �Llassaclp�setle �� q _ DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street & Municipal Building NorUiamptom, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sulr: : ,isor. T he state defines "Homeowner" as, " Person(s) who owns a parcel on which lie/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 buildinp, inspection (before work is concealed), insulation inspection (if required) and a final buildinz 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 1, 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 u\— clHip of ortijamp!till R1 r 5 1 ACII lit 5 T -,- '')EPARTMIENT 01; 1 NS PEC I'l C)�,�s ME/, M 212 Main sti-ect I'dilillcipal Pulldini, Northampton, Mass. 01060 'WORKE'R'S COM-PENSATION INSURANCY, AFFIDAVIT C %vith a principal plack, of'bi IsinessJ1 enld enc-, it R 0 Ve 4E V-t C- %-4t C) C.) do hcicl)y v, �ii)S pcil:lltl:-, 01 111 V, i ai-n 211 employer the o' ly —7— Company) ( I -m a Sole prou'Ticol, "Ilred the Contractors 11sted, bc:ov,' -,vho lhzave th,, 1 S. of('mit,-actor) cy N'Ilin'rcr) Date) (Nam'-- of Colm�,o)-) u D<I,C) (Nallic of Con"Incto') Pat,-) (Nal-.1c Of C-011*Lractof) Datc) �1111 a sole 1 l I I Il 1 I o 11,c 1 7 1-1111 v" NOTE:plc.'s ffia: Ic h, [!C4 11Kcc ill-❑three units ir:ui,:dl Oyc:3 u r r tlr\wz 161 1 2,-n lcl n 1, ICS11 Etatu;ofrn acwloyx under tl-,o 1 and..tend that.copy ofth;, -1!:`--"1"t-i` -C,R&C vcnficali0o and tlu f-.ilur,to!< rc covcl rr- �rc"ir�2 1A f M(11,15 2 c--Ln Iced to thc U-POs f ic"I czu I c,xiii-iting of A fin,of up to S I,SCKJ.00 a:`�Yc of up to C;vil p nzttio mfr,c;nn of a S!,',"Vc;i'Op":and a ft of 7;IN-N&cily C) of SECTION'8 -.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder r o E License Number /"] Address Expiration Date Signature Telephone 6 92egistete Homelrinrovettierit°ICo'ntra�ctor �� E Not Applicable ❑ PP Company Name T Registration Number Address Expiration Date Telephone 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....... ❑ No...... ❑ HIM,- . tome ®wnEenap.�io- - The current exemption for"homeowners"was extended to include Owner-occupied Dwellings-of one(1) or two(2) farlilies 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 f rom time to timC during and upon cornpletion of the work fer which this permit is issued. Also be advised that with ;efeience to Chapter 1�2 (\Vorkers Compensation) and Chapter 153 ,Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, v ou 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 5 'DESCR'1{RTION D:OF PROPOSE WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Sidi [ ] Other [ ] Brief Description of Proposed Work: Q :510 kJ- l Li X a ve Alteration of existing bedroom Yes__-X No Adding new bedroom Yes /` No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet ❑ 6a. 1UNd Nci seTand or'adtlitibn'to"existing housing ?complet6,,the`followin ; 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? 5 5, FT d. Proposed Square footage of new construction. --- Dimensions l X e�- e. Number of stories? j)J Q f. Method of heating?�o2�ec� A��'� A Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance.. Mascheck Energy Compliance form attached? h. Type of construction u,200cI i. Is construction within 100 ft. of wetlands? _Yes _)�_ No. Is construction within 100 yr. floodplain _ _Yes __✓\ No I. 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 SECTION 7a-'OWNER-AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR'CONTRACTOR APPLIES FOR BUILDING PERMIT l o r '�'� , as Owner of the subject property hereby au rize �� `— �©�`�G _ to ac; o�. my beh , in all ma s relati to or _ thorized by tiv, c)uilding permit appli ation. — 3 ure of Owner Date �he ,� ��C�1 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. S�e \< 4' p --- -- - - - --- -- - Print Npw;� Signature of Ow er/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 LJ` 0©o �� 3co Frontage / -?J , 317 'A >� f— Setbacks Front q0 r f — L10 f Fr fT Fz Fr , Side L: _r R:� t L:�S r R: — Rear I r r-r Building Height (� 6 7` Bldg. Square Footage % 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 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. Yhere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: , NU City,of Northampton S atus of�Pe ft `` Building Department Cy�rb�Cut� D' ve y a j 212 Main Street Se er/Sep Room 100 WaterlWet va au t " ',g,', �lorthampton, MA 01060 Twos is f Str, ct aI� phone 413-587-1240 Fax 413-587-1272 PIo /SltePlns. _ OtherSpectfy � + APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by;office 1.1 Property Address: .- �. loo mi " P1 < \�Gx Map Lot Unit rte'e Zone Overlay-; File#BP-2003-0582 APPLICANT/CONTACT PERSON STEPHEN BROIDE ADDRESS/PHONE 820 FLORENCE RD (413)585-8000 PROPERTY LOCATION 100 MAPLE RIDGE RD MAP 36 PARCEL 274 001 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 T e f. ction: CONSTRUCT 14 X 22 2 STORY ADDITION NEW KITCHE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 039880 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO�Y�TION PRESENTED: r 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 Signature of ui din facial 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. � . . BP-2003-0582 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0582 Project# JS-2003-0958 Est. Cost: $85000.00 Fee: $187.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin STEPHEN BROIDE 039880 Lot Size(sg. ft.): 41382.00 Owner: KOBYLARZ EMIL J&SANDRA L Zoning: SR Applicant: STEPHEN BROIDE AT. 100 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 820 FLORENCE RD (413) 585-8000 FLORENCEMA01062 ISSUED ON:4124103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT- 14 X 22 (2) STORY ADDITION (NEW KITCHEN)4/24/03 - ADD 7 X 12 ENTRY 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• Receipt No: Date Paid: Check No: Amount: Building 4/24/03 0:00:00 762 $187.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo t£'S tea. '* "��i �," x o �' �@ ', ��- ta,�§.�•&F �r�` •��°�2a'"� f as a.,r��+� ��z5� �� - � - ! IN prio � � s Or. t "' fr z f � 4 o- i k� '. 3 X k Y fi x 100 MAPLE RIDGE RD 4 BP-2003-0582 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block:36-274 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2003-0582 Project# JS-2003-0958 Est.Cost:$85000.00 Fee: $187.60 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Gropp: STEPHEN BROIDE 039880 Lot Size(sg. ft.): 41382.00 Owner: KOBYLARZ EMIL J&SANDRA L Zoning SR Applicant. STEPHEN BROIDE AT: 100 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 820 FLORENCE RD (413) 585-8000 FLORENCEMA01062 ISSUED ON:4124103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 14 X 22 (2) STORY ADDITION (NEW KITCHEN)4/24/03 - ADD 7 X 12 ENTRY 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: _)S4,2 tough: 712.5.103 l'�7 house# Foundation: (�� Driveway Final: (j b Y) ,O s�, O Final: / 404 f Final Rough Frame: Gas: / 1314, Fire Department Fireplace/Chimney: Rough71, 41 Final: Smake: Fi"ls .711'0�s THIS PERMIT MAY BE REVOKED BY THE CITY O NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certiflote Of Occugan i nat re: FeeTytae: Receiut No: Date Paid: Check NZ Amount: i Building 4/24/03 0:00:00 762 $187.60 212 Mai Street,Phone(413)587-1240,Fax:(413)587-1272 Buildina Commissioner-Anthony Patillo r � E k _ s