37-111 (4) 4 • r
O�tKA,Xf�0
riti7 of Nart4 amptan F
�Tassacf�ttsefta
DEPARTMENT OF BUILDDtG INSPECTIONS a
212 Main Street •-Municipal Building
INSPECTOR p
Northampton,NL4 01060
LOCATION 1p'2
SQUARE FOOTAGE AMOUNT
BASEMENT@ =20 6oO -5
lsT FLOOR @.50
2ND FLR @ 30
FLOORS, FINISH ATTIC,GARAGE @.20
DECK/PORCHES @ .20 SS _ Ile)
TOTAL. dw
CITY OF NORTHAMPTON, MASSACHUSETTS
,► ` ` ,_T d DEPARTMENT OF PUBLIC WORKS
125 Locust Street
Northampton, MA 01060
413-587-1570
Samuel B. Brindis, P.E. Fax 413-587-1576
Director, City Engineer
Guilford B. Mooring, P.E.
Assistant Director of Public Works
BOARD OF PUBLIC WORKS
DRIVEWAY PERMIT
GENERAL INSTRUCTIONS AND REGULATIONS
1. A "Driveway Permit" is required in all cases where a new curb cut or an alteration to an
existing curb cut is proposed on a City public way.
2. Driveway permits issued by the Board of Public Works (BPW) shall be attached to and
become part of the 'Building Permit" issued by the Building Inspector.
3. Prior to the issuance of a "Building Permit" the owner of any lot to be serviced by a new
driveway shall apply to the BPW for a "Driveway Permit" by completing the pertinent
portions of the permit (see attached). Once the location of the driveway is approved by the
BPW, a building permit may be issued.
4. The Building Inspector shall not issue an "Occupancy Permit" unless the driveway to the lot
has been approved by the BPW.
5. By the issuance of a driveway permit for the stated location, neither the City of Northampton
nor the Department of Public Works imply that no drainage problems will result with the
driveway when constructed. Properties situated or driveways installed in low lying areas in
the path of the natural drainage will be subject to water problems. These problems may
include water sheeting across roadways adjacent to the driveway. The City and the DPW
assume no responsibility for any such drainage problems. The owner of the property is
responsible for constructing and maintaining the driveway with adequate provision for natural
water runoff situations.
q'amuel B Brindis, P.E.
Director of Public Works
C:AN4yFi1es\L,yn\Driveway Permit General Instnictions
(SUBJECT TO ATTACHED CONDITION 1 & 2)
Permit No. i^/- C^v
Conditions: Driveway Permit
In lieu of plan approved by City Engineer
I agree to the following added conditions:
1. I will contact the Department of Public Works and have an inspector
check and approve the graded gravel base prior to paving to insure
compliance with slope and location;
2. I further agree that if in the inspections any of the permit conditions are
not met that I will at no expense to the City remove and replace the
driveway as directed by the City Engineer.
By: U n: 1 *�
Petiti her
Note: The Public Works Department recommends that you provide a plan showing the
proposed driveway with grades and location in the future to avoid possible
expense which you will incur by not getting approval of actual plans in advance.
cc: Building Inspector
Permit No. D 14-05
CITY OF NORTHAMPTON, MA
DRIVEWAY PERMIT
Date: 9/9-8/2004
FEE: $25.00 CHECK#: q�0
p=
THE BOARD OF PUBLIC WORKS
The undersigned respectfully petitions your honorable body for:
Permission to install a riri eway at 26 ire Pond Drive, Lot 21
Fiftet-n (15) fbot waximjim width at the street fine Giater
draiDage shall be direfl-ted off the driveway surface tu adjacept laud and not on ihe existiag
roadway Driveway surface to be paved as s- 'ble if the grade of the pwposed
driveway t, ceeds 3% ur more Hameuwncrs will be beld respunsible fur any rust to tbe City
of Northampton in the event of a washwit of this driveway
By: �—x-
Tom FQey
80 Blackberry Lane Northampton, Ma
Telephone #: (413) 584-1986
Proposed Location v� :f w�•�-t_ d-,,�^
Inspected By: 1lrSa� ��' y a K /P,� ,r- e�i0
Gravel Base Grade /
Inspected By:
Final Approval
THE BOARD OF PUBLIC WORKS voted that petition be granted.
George Andrikidis
Director of Public Works
MUNICIPAL WATER AVAILABILITY APPLICATION
Northampton Water Department
237 Prospect St.
Northampton,MA 01060
587-1097
A Department of Public Works Trench Permit shall be required prior to any construction or
connection activity associated with this application.
Location: 26 Ice Pond Drive
Inquiry Made By: Tom Foley,584-8417,x267
Date of Inquiry: 12/2/05
Number of Type of _x_Single Family Type of x Private
Units: 1_ Unit(s): _Accessory Apart. Ownership: Condo
_Multi-family Rental
(Applicant to fill out the above)
Municipal Water Main in Existing service to
Front of Location? Yes: X No: El site? Yes: X No�
Size of Water Main: 8" Material: D.I. Age: 2003
Approximate Static Street Flow Test Conducted:Yes: ❑ No: X
Pressure: 65-75 If done attach results
1"
Size of Service Connection:
Suggested Meter Size: 1"
Comments: The Water Department cannot guarantee adequate water pressure during peak demand
times at elevations above 320 feet.Meter fee and entry fee to be paid prior to construction.
• A corresponding water entrance fee shall be paid prior to making any connection to the municipal water
system.
• ents of such' tion shall be made with the Northampton Water Department with a minimum of
5w ' g days cation.
• work to Noqtu
#pton Water Department specifications.
David W. Sparks,Superintendent of Water
cc: Ned Huntley,City Engineer
\\a111) Applicntion\Wntcr AN ailabilitYAoc.
4F
Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes
Insulation Thickness in Inches by Pipe Sizes
Non-Circulating Runouts Circulating Mains and Runouts
Heated Water Up to 1" Up to 1.25" 1.5"to 2.0" Over 2"
Temperature(°F)
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2:Minimum Insulation Thickness for HVAC Pipes
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4"
Heating Systems
Low Pressurerremperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0
Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD:(Building Department Use Only)
Foley Page 4 of 4
Floors:
❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation
Comments:
Heating and Cooling Equipment:
❑ Furnace 1:Forced Hot Air.78 AFUE or higher
Make and Model Number:
❑ Air Conditioner 1:Electric Central Air:13 SEER or higher
Make and Model Number:
Air Leakage:
❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed.
❑ When installed in the building envelope,recessed lighting fixtures#meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the
conditioned space to the ceiling cavity.The lighting fixture has been tested at 75 PA or 1.57 lbs/ft2 pressure difference and
shall be labeled.
Vapor Retarder:
❑ Installed on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
Materials Identification:
❑ Materials and equipment are identified so that compliance can be determined.
❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications.
❑ Insulation is installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a
manner that achieves the rated R-value without compressing the insulation.
Duct Insulation:
❑ Ducts are insulated per Table J4.4.7.1.
Duct Construction:
❑ All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud
bays or joist cavities/spaces used to transport air,are sealed using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 1/8 inch.Duct tape is not permitted.
❑ The HVAC system provides a means for balancing air and water systems.
Temperature Controls:
❑ Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or
cooling input to each zone or floor is provided.
Heating and Cooling Equipment Sizing:
❑ Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR
1310 and J4.4.
Circulating Hot Water Systems:
❑ Circulating hot water pipes are insulated to the levels in Table 1.
Swimming Pools:
❑ All heated swimming pools have an on/off heater switch and a cover unless over 20%of the heating energy is from non-depletable
sources.Pool pumps have a time clock.
Heating and Cooling Piping Insulation:
❑ HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F are insulated to the levels in Table 2.
Foley Page 3 of 4
REScheck Software Version 4.1.0
Inspection Checklist
Date:06/21/07
Ceilings:
❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-19.0 cavity+R-19.0 continuous insulation
Comments:
Above-Grade Walls:
❑ Wall Front:Wood Frame,24"o.c.,R-19.0 cavity insulation
Comments:
❑ Wall Left:Wood Frame,24"o.a,R-19.0 cavity insulation
Comments:
❑ Wall Right:Wood Frame,24"o.c.,R-19.0 cavity insulation
Comments:
❑ Wall Rear.Wood Frame,24"o.c.,R-19.0 cavity insulation
Comments:
❑ Walls all Shorts:Wood Frame,24"o.c.,R-19.0 cavity insulation
Comments:
Windows:
❑ All Front Windows:Wood Frame:Double Pane with Low-E,U-factor:0.310
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Windows All Left:Wood Frame:Double Pane with Low-E,U-factor:0.310
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window all right:Wood Frame:Double Pane with Low-E,U-factor:0.310
For windows without labeled U-factors,describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window all rear:Wood Frame:Double Pane with Low-E,U-factor:0.310
For windows without labeled U-factors,describe features:
Vanes Frame Type Thermal Break? Yes No
Comments:
Doors:
❑ Door 1:Solid,U-factor:0.400
Comments:
❑ Door 2:Solid,U-factor:0.400
Comments:
❑ Door 3:Glass,U-factor:0.500
Comments:
Foley Page 2 of 4
CNJ( REScheck Software Version 4.1.0
Compliance Certificate
Project Title: Foley
Report Date:06/21107
Data filename:C:\Program Files\ChecMREScheck\Foley Northampton.rck
Energy Code: Massachusetts Energy Code
Location: Hadley,Massachusetts
Construction Type: 1 or 2 Family,Detached
Heating Type: Other(Non-Electric Resistance)
Glazing Area Percentage: 14%
Heating Degree Days: 6404
Construction Site: Owner/Agent: Designer/Contractor:
80 Blackberry Lane Thomas Foley Timothy Neyhart
Northboro,MA 01060 Northampton,MA 01060 TNT Consulting
413-584-1986 16 Kosior Drive
Hadley,MA 01035
413-584-7594
tim_neyhart@hotmail.com
,Compfiance:Passes
Maximum UA:451 Your Home UA:419=7.1%Better Than Code
Gross Cavity Cont. Glazing UA
Assembly Area or R-Value R-Value or D..
Perimeter U-Factor
Ceiling 1:Flat Ceiling or Scissor Truss 2600 19.0 19.0 68
Wall Front:Wood Frame,24"o.c. 635 19.0 0.0 29
All Front Windows:Wood Frame:Double Pane with Low-E 108 0.310 33
Door 1:Solid 40 0.400 16
Wall Left:Wood Frame,24"o.c. 383 19.0 0.0 21
Windows All Left:Wood Frame:Double Pane with Low-E 27 0.310 8
Wall Right:Wood Frame,24"o.c. 450 19.0 0.0 22
Window all right:Wood Frame:Double Pane with Low-E 47 0.310 15
Door 2:Solid 34 0.400 14
Wall Rear.Wood Frame,24"o.c. 635 19.0 0.0 31
Window all rear:Wood Frame:Double Pane with Low-E 90 0.310 28
Door 3:Glass 20 0.500 10
Walls all Shorts:Wood Frame,24"o.c. 26 19.0 0.0 2
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 2600 19.0 0.0 122
Furnace 1:Forced Hot Air78 AFUE
Air Conditioner 1:Electric Central Air13 SEER
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code
requirements in REScheck Version 4.1.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design
Conditions found in the Code.The HVAC equipment selected to heat or codthe ild ing hall be no greater than 125%of the design
load as specified in Sections 780CMR 1310 and J4.4.
�!S vL /�1 C 2/
Name-Title ignature Da
Foley Page 1 of 4
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J
Applicant Name: �a rJASL Site Address:
Applicant Address: City/Town: NoR P/L4✓1 7D
Use Group:
Date of Application:
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 J5.2.1b): Heating Degree Days(HDD6,)from Table J5.2.1a:
(For items d. through i.,fill in all values that apply from Table J5.2.1b:)
a. Gross Wall Area sq.ft f. Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value R-
c. 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 J6.2.2) ❑ 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 sq.ft. b.Glazing Area' 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 MINIMUM R-Values
Fenestration' Ceilin ' Wall Floor Basement Wall Slab Perimeter,Depth
0.39' R-37 I R-13 R-19 R-10 R-10 4 ft
i 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)
Information anct Instructions .
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
ex pte s or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any
applicant who.has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractors)name(s), address(es)and phone number(a)a19gg with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLPywith no e -odrei=than the
members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of.insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have-any questions regarding-the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be.sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information-(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ,x
applicant as proof-that-a-valid affidavit is-on file for future permits or licenses. -A new affidavit..-must be filled out each
year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture.
(1.6. a dog,license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
DeparEment cif Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 446 or 1-877--NIASSAFE
2evised-4 24-07
wv.rnass.gav is
,4 The Commonwealth of Massachusetts
Department of Industrial Accidents
� � _ Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Auglicant Information Please Print Le_gibly
Narr10 (Business/Organization/Individual):
Address:
City/State/Zip:
AA
Phone#: -541
Are you an employer? Check the appropriate box: y Ty;Zew roject(required):
1.El am a employer with 4. [] I am a general contractor and I
. 6. construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. Demolition
wonting for me in any capacity. employees and have workers' S ❑ Building addition
comp.insurance.1
[No workers comp. insurance - 10. Electrical repairs or additions
�,�quired.] 5. � We are a corporation and its P
3.L�•'I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions
of exemption MGL �
myself. [No workers comp. right. p lion p er 12.❑ Roof repairs
insurance required.] T c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
}Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
'Ho meowners who submit this affidavit indicating-they are doing all work-and-then-hire--outside contractors must submit anew affidavit indicating such.
Contractors 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 ofMGL 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 he forwarded to the Office of
Investigations of the DIA for insurance coverage verification:
I do hereby certify under the pains and penalties perjury that the information provided above is true and correct.. ..
C . Date: :e �'
Sienature:
Phone# /-3 -���� ?e6
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#:
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. 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 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 an
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 reguired)-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
e d 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 o2 �-�r
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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...... ❑
11. - Home Owner Exemption
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"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 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 o assachusetts General Laws Annotated.
Homeowner Signature G;-�, r",
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aamlicablel
New House ❑✓ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 17-1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[[3] Other[O]
Brief Description of Proposed
Work: CONSTRUCTION OF RESIDENTIAL HOME
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building: One Family X Two Family Other
b. Number of rooms in each family unit: 6 Number of Bathrooms 2
c. Is there a garage attached? Yes
d. Proposed Square footage of new construction. 2600 Dimensions 42.6 x 70.6
e. Number of stories? 1
f. Method of heating? Forced Hot Air Fireplaces or Woodstoves Yes Number of each 1
g. Energy Conservation Compliance. Yes Masscheck Energy Compliance form attached? Yes
h. Type of construction Wood Frame
i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes x No
j. Depth of basement or cellar floor below finished grade G F 'r
k. Will building conform to the Building and Zoning regulations? X Yes No.
I. Septic Tank City Sewer C Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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.
Signature of Owner Date
a OOwwnerr uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the b'�C'of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name-_,
v 2
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 62632 62632
Frontage 50' 50'
Setbacks Front 185 U
Side L: R: L:40 R:40
Rear 65
Building Height 256
Bldg.Square Footage % 2600
Open Space Footage %
(Lot area minus bldg&paved 9333
parking)
#of Parking Spaces 2
Fill:
(volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
ti
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
er1S ec
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE-OR-DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION NA,AR 1 6 2009
1.1 Property Address: - --
his s It on to be completed by office
(p CL Jor o Oct Map ' Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Thomas/Nancy Foley 80 Blackberry Lane Northampton Ma
Name(Print) Current Mailing Address:
413-584-1986
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant s
1. Building 200,000 (a)Building Permit Fee
2. Electrical 17,000 (b)Estimated Total Cost of
Construction from 6
3. Plumbing 15,000 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 15,000
6. Total=(1 +2+3+4+5) 247,000 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
ti
File#BP-2009-0766
APPLICANT/CONTACT PERSON FOLEY THOMAS C&NANCY A
ADDRESS/PHONE 80 BLACKBERRY LN NORTHAMPTON (413)584-1986 O
PROPERTY LOCATION 26 ICE POND DR
MAP 37 PARCEL 111 001 ZONE SR(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid J If I
Typeof Construction: CONSTRUCT SFH W/ATT GARAGE/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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
L//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: §
0
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed p 6-AAL
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 Permit DPW Storm Water Management
Demolition Delay
Signatur 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.
2614CETO DR BP-2009-0766
GIs#: COMMONWEALTH OF MASSACHUSETTS
"' ern CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:New Single Family House BUILDING PERMIT
Permit# BP-2009-0766
Project# JS-2009-001081
Est. Cost: $247000.00
Fee: $2119.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: 5B Contractor: License:
Use Group: R4 Homeowner as Contractor
Lot Size(sq. ft.): 62726.40 Owner: FOLEY THOMAS C&NANCY A
Zoning: SR(100)/ Applicant: FOLEY THOMAS C & NANCY A
AT: 26 ICE POND DR
Applicant Address: Phone: Insurance:
80 BLACKBERRY LN (413) 584-1986 (�
NORTHAMPTONMA01060 ISSUED ON:411312009 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT SFH W/ATT GARAGE/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 Signature:
FeeType: Date Paid: Amount:
Building 4/13/2009 0:00:00 $2119.001260
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo