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17A-234 761j 7D Manual Trade-Off Worksheet Permit Builder game �/Q' ry- -�� -- >/ S��l' Date ' Builder Address /.1J � - Checked By Site Address 7 C.-�s►�� Sl" ,�'i�.�c�`�+ ` Zone[]12 013 _14 Submitted By Phone c­q `113 ;•/`VJ"10 Mite yis �-Y'7' 90'e-Y Ceilincs. Skylichts. and Floors Over Outside Air Required Insulation x Net U-Value Desc.-iotion R-Value U-Value . Area = UA (Table 622h) x Area = UA Ceiling d S6 y (cable J6.2.2a) Floor Over Outside Air I ftz (fable J622a) ft2 f 1 I I fe Total Area SG y rte Walls. Windows, and Doors Insulation x Net Required Desc r)tion R-Value U-Value Area = UA U-Value x Area = UA Walls I /'7 I ' 0 7 7, 2Z (fable J52.2b.c.d) Windows (NFRC crTable J1.5.3a) I '33 I g ft� --► -28,7/ Doors I --- I I f (NFRC crTable J1.5.3b) -` Sliding Glass Doors (NFRC or Table J1.5.3a) I f ft2 . - Total Area Floors and Foundations Insulation insulation x Area or Required DesGiotion Deoth R-Value U-Value Perimeter =UA U-Value xArea =UA Floor Over Unconditioned 3 (i able 3v I ,�3.3 J' �G Lr 22 Space J6e) 3asernent Wall (rable ( I ft2 w J6.221) Jnheated Slab I I tt ._ .�:-::. I :-• Table J6-22g) in. seated Slao Table j6.2-2g) in. - • I I ft2 ftZ. Total Proposed UA must be less Total Total han of equal to Total(orAdjusted)Required UA Proposed UA QR Required UA ' Statement of Compliance:The proposed building design represented in Adjusted hese dc=ments is consistent with the building plans,specifications, Required UA ind other calculations submitted with the permit aoolication. 6" iuilcer,O'esigner Company Nai: c Date OVER FTT.T. nT" nii= ST-wp. /� � ,. __ � � - . , - `-�i , � � j __ f ---_- _ _._-Vii_-------------___._-_-------------__--._._l._._�., _- ---- -- -.-- __ ----__---- _- -__ _ -___ ----__ _ -- ___._._. _ _^�- � ��� ���� ? ti i ' tt � i !i � 1 i f � ___i �--� � � SG/h� %� " � � � r i !O s 1 - N 1 i � � �-' t�-✓�);.IC. .� [.Srt! �._• r'•(':�5 'Jr< t.(_.!';'� .� ;,t .,�:� � ,.-�r t C�b , . ..y 21,j 2& rttl),W-7 *y, T 5�11-yclwll_ t ti ------------- Fj li i Z>E �\ I � r � N N � 1 i II I i 1 f i 1 --9 d 7 el r�tl;"W-7 ly, moo„ -941 ------------- 12 PV 4-1 71' IT i3 y I � I I m; I 28 Sot 7L>J Tkio�ta- I � 8,9-W SiivG c c i tT GO i I 'A-AU- 5 Ii i A Q ' zz QJ � {I 1" y Q 2 r Ld & i 2 (J) II �-T� - N 11,96 Roos ± I Brr 173* 197 RsS�s con. _ ORIV`e � a0 +� \� 6 ly) � a 3 47 t9 _ z LLI _1_J Imp` —p5 <Ia , CS P's I1J HEV., 5�) Z C Lo-r 3 To TI✓LEPMflNE Ljc)Rkp_t CR-M[T VW16N HERE r—kST T A'T�I HA EITPERFORMEDATHIS INSP?CTION o�� 1KOF,�s 1N ACCORDANCE WITH THE TECHNICAL STANDARDS FOR �� �osEPH s MORTGAGE . LOAN INSPECTIONS AS ADOPTED BY THE RAUCHL N MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND o ':CIVIL ENGINEERS, INC. 1 REPORT THAT ALL EASEME NTSo ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE o 'STEPSJ�� GROUND' AS SHOWN. I FURTHER REPORT THAT THIS t LANo 'PROPERTY IS NOT SHOWN TO BE IN THE ESTABLISHED FLOOD HAZARD AREA ON THE REFERENCED FEDERAL FLOOD "THIS SKETCH FOR INSURANCE -RATE. MAP. (CO vurrY PAUL- -� 2,50167 �1 A,� MORTGAGE PURPOSES ;ONLY" DATE: 2 . L �4 OWNER: 15F�,RRv M. 1?GH SKETCH OF LAND AT 137 L0-KF— 5TREET C I OP ADDRESS: 87 LAKE 5TR E L-T ►-lOtzTf+p V PP-MN COUVTN of 4FAM?5, 1RE NoR'TU f)-mr- o H. OM M ON WEA L TH OF MASSACHUSETTS 1 f,K\PSNIRt COUNTY REGISTRY OF DEEDS: DATE: MR'fRGN Z7 1997 SCALE: I 1. i{Ol BK.PLS: "" PAGE: 110 - 171 LOT: 15 DRWG.NO RA UCHL E ASSOCIATES 83 ' Loy NtuCU� 1 - Q� W v1 v � { s Hem e'7 Le"C }0 ��3i�,0 //�r F r� GTf-�) of �'Torf jallipJ 011 A E 31c anchnccIIa — Q o DEPARTMENT OP DUILDrNG INSPECTIONS 212 Main Strcet . Municipal Building Northampton, Mass. 01060 NW)PICCR'S COMTENSA'ION MSU ZANCF AFFMAVIT 1, Jolt ! . 2(&.''1 ) (li ccusxJpermi ttcc) NvIth a pancipal place of businesslresidencc at: i>2 / D DE- C (phone 7- r7®� (Sa-c:-.t/ci ty/statcID P) do hereby ccrdi ;, under the puns and penalties of pcfjury, ?hzl } I am an employer providing the following worker's comnens ion cove age for Inv eluplovecs wor-�Dirlg on this job. C10-1 Of 3 -2-6 F13le (Casa—= Coo r,V) (PoUc-, Nu_-nir_r) ---- (� :-pir;acion Dan) { ) I am a sole propretor, general contractor or homeow-Der (ci:cie one) and hwe hired the coat;actors listed below vybo have the ioDo%vu3P- worker's coc nen"anon policies: (iiamc 0; C0 n.. c-,0r) (1rtRr3ncr tlmc) (Name of Contractor) (Ins rrancc ComoaDv/Polic-v Nua)crr) (-DTiFa Lion Date) (Name of Coa>racto,) (LnsuraDcz CompanyfPoUcy Numbu) (Expirtion Date) (Namc of Contractor) aDsuranc-- Comozay/Policy Numbs) Zxpu-a6on Date) (.Hach:dii:i oeil t_'urt ircc—.i to mcud`iaform._:ioo petunias to.L oOc=r-L;O,�) ( ) I am a sole proprietor and have no one working for me. ( ) I am,a home owner performing all the work myself. NOTE:plc-'c be.watt Lha:µ•talc hca'cc A- ,ubo employ petont w w M.rt-+�cz=^.:ems c r.pau work oo.d..ciLS of aot moct th_o d:ro:t-afa;n which the bornoov ocr raid,a oa the Uvj-c A�ap�thee".L "Sec-1 Y trct:dat j to be miploy—U--' trhe t.vci ch O=i*�tim Aa(G L 152 n 1(5)�t ppttnt)cra by.bommama fer c Iiezr-c oc permit try--rd—tt c Icsu rtatvt of.a crPtoyx undo dtn W.+k e.Coax�oan.tioa/at I undest..ad d%4 x copy of tbii ctst�m.y bo forxi rd.d to tbo D,a ,t_c of Ind�i.l A,n&.!Oleo.or Irru�for the covczz�c vaifierr�li�m.rid au,L-it m w coauc tcovcrnse uodct soet;oa 2 SA of MGM-152 etc Ind to the Lm position of c imiail pcnatties 000si.11 g of a GDC oC tP to S l 500.00 RnNOr imprupaaY of up to ooc ytnr r-od civil pcaal'..d'tc form of.Stop Work Otdcr.ad. fim of S 100.00 a day aFpiust me / 3/,O For dcp.ruzv�r u.c onfy — ------- ✓ / I P(.rmJl 1�Itunbcr Lot �>e ,tun;of Li�scrlpermiUcc Signature of Owner/Agent Date g SECTION 8-CONSTRUCT N SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder l®/e:�3 License Number c L,JCQ D✓z-t E-1�0 11W 0 C ? Address Expiration Date Sig a re Telephone 9:Registered lfiom+ inro`ventient Contactor:' Not Applicable ❑ Company Name I Registration Number V t,.s0C>D41a6E r !� � r-r ra- I p© 13 3 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........0 No...... ❑ ..................................................... ..................................................... rr:r++rrr.'rrr�r�r��rrrr err 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 of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Alterations) ❑ Roofing X Windows Or Doors Accessory Bldg. ❑ Demolitionjh New Signs [ ] Decks [ J Siding,W Other[ ] V+-+aU514 f Brief Description of Proposed Work: �PhT�zt�cs't`) eDD /O x/ tJ 2ti rJ S/Di � /,/�,J LJ��✓DOW3 FDe Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll❑-Sheet X- �a.:���IZni�:Ei�i�lse-aii�E:- a. Use of building : One Family Two Family Other ,5iz>S77"4 T / b. Number of rooms in each family unit: 1"p Number of Bathrooms A-�,D I c. Is there a garage attached? yt-3 d. Proposed Square footage of new construction. `�` Dimensions 1 V x f2 e. Number of stories? ''// f. Method of heating? hf t- A),�-yz f?gc >a• Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction AWC10 IWOm C i. 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 `{Cq if k. Will building conform to the Building and Zoning regulations? k Yes No . 1. Septic Tank City Sewer�_ Private well City water Supply_X_ SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L--'F(-- �"1� �� , as Owner of the subject Property hereby authorize J t�r�r t �� i i ^�K-► to act on my be4alf, in all matters relative to work authorized by this building permit application. Signature o9Wer 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 Name a 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 13 `7,L sz fr. 13, sa r-r: � Frontage 73 p 3 Setbacks Front Side L: R: / L: Z V R: 7 ,0 Rear 99 20 Building Height / -7 1 -7 34 Bldg.Square Footage 7 G 4,1./ ✓Z 0 v J � Open Space Footage % (Lot area minus bldg&paved )-07.7 7 parking) /V #of Parking Spaces Fill: volume-&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO X DONT 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 X IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No 2 IF YES, describe size, type and location: {S � ww City of Northampton ng Department `� � � 4 t5 Main Street oom 100 N pton, MA 01060 � r Ahon 441 1240 Fax 413-587-1272 h n AP�I.XCA'(>OIV1•p( iTRUCT ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Properly Address: This section ti be completed by office Lot Unit Zoirie Overlay District E!*$t DisiTict CB District SECTION'2-PROPERTY-OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) ` Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: y�3 Signature Telephone SECTION 3-.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical cve (b) Estimated Total Cost of Construction from 6 3. Plumbing --/a v a Building Permit Fee_ 4. Mechanical (HVAC) -2 :S-4`' 5. Fire Protection TZ 6. Total = (1 + 2 + 3 +4+ 5) 9D o00 "'— Check Number D This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2005-0225 APPLICANT/CONTACT PERSON John Zieminski ADDRESS/PHONE 8 WOODRIDGE CIRC HATFIELD (413)247-9014 PROPERTY LOCATION 87 LAKE ST MAP 17A PARCEL 234 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out A4 i Fee Paid Typeof Construction: DEMO PORCH&REBUILD 12 X 12 SUNROOM&CONSTRUCT 14 X 22 ADDITION (BEDRM/BATH) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 017889 3 sets of Plans/Plot Plan THE F IL OWING 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 Street Co ion p� Sj 2 /Zoy 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. 87 LAKE ST BP-2005-0225 GIs#: COMMONWEALTH OF MASSACHUSETTS _MW91mk 17A.234 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0225 Project# JS-2005-0278 Est.Cost: $90000.00 Fee: $450.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: John Zieminski 017889 Lot Size(sq. ft.): 13721.40 Owner: THOMAS JEFFREY J& Zonin :URB Applicant: John Zieminski AT. 87 LAKE ST Applicant Address: Phone: Insurance: 8 WOODRIDGE CIRC (413) 247-9014 Workers Compensation HATFIELDMA01038 ISSUED ON:8130104 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO PORCH & REBUILD 12 X 12 SUNROOM & CONSTRUCT 14 X 22 ADDITION (BEDRM/BATH) 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: Feel e: Receipt No: Date Paid: Check No: Amount: Building 8/30/04 0:00:00 1706 $450.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo '` / 01 87 _E ST BP-2005-0225 COMMONWEALTH OF MASSACHUSETTS M D:Block: 17A-234 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate BUILDING PERMIT Permit# BP-2005-0225 Project# JS-2005-0278 Est. Cost: $90000.00 Fee: $450.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: John Zieminski 017889 Lot Size(sq. ft.): 13721.40 Owner: THOMAS JEFFREY J& �:�nlna iTAR fti�nJirni!*. lf�l?!� 7inn4in�l�i AT. 87 LAKE ST Applicant Address: Phone: Insurance: 8 WOODRIDGE CIRC —(413 2) 47-9014 Workers Compensation HATFIELDMA01038 ISSUED ON:8130104 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO PORCH & REBUILD 12 X 12 SUNROOM & CONSTRUCT 14 X '22 ADDITION (BEDRM/BATH) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: rvice: Meter: `� �y FDUt1C.g8: Rough:f!� ^ (���1 r Rough:t,�, �- House# Foundation:e)tK �� Driveway Final: Final: ( ,"` �-Vwinal:r K� � 3�0 4/,J�% G � `( ,& /ll�s fvn j, Rough Frame: 'A" Gas: Fire Department Fireplace/Chimney: Insulation: C7 K ( / Rough: Oil: Final: Smoke: Final: 0 i( `a. 3_0 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. \ Certificate of Occupanc v — ;f '+ _ — iatw;e: FeeType: Receipt Nn.,--,– Date Paid: Check No: Amount: Building 8/30/04 0:00:00 1706 $450.00 212 Main Street,Phwx.(113)587-1240,Fax: (413) 587-1272 Building Conn issioner-Anthony Patillo