06-004 (5) RECEIVED JUN 2 2 1998
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J (effective 3/1/98)
Applicant Name: M -1blK. Site Address: r�_0'2_ .} ypr;Tll/71 i
Applicant Address: - ; S 7" City/Town: F MA-
15�'13�7'�1y`�'S�N , 1✓t� Use Group: S106-L/1 f7W I VY
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.i b): Heating Degree Days (HDD6S) from Table J5.2.la:
(For items d. through i., fill in all values that apply from Table J5.2.1 b:)
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. Stab 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 F� Zone 13 F� Zone 14
Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable]
F� MAScheck Software
Attach Compliance Report and Inspection Checklist printouts.
F� Systems Analysis OR [] Renewable Energy Sources
Attach Nlass_Registered Architect or Engineer.Anal�rsis__________________
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall +Ceiling Area (6q sq.ft. b. Glazing Area' 'o'3 sq.ft. c. Glazing,% (100.K b=a) %
F-1 ADDITION with Glazing % (c.) up to 40% may use 780 CNIR Table J1.1.2.3.1 below:
MAXIMUM U-value MPJINItiM R-values
Fenestration Ceiling Wall Floor I Basement Wall Slab Perimeter,Depth
0.39 R-37 R-13 R-19 I R-10 R-10,O ft
F� "SUNROOM"addition (greater than 40% glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form" from 780 CNIR 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)
' Glazing Area may be either Rough Opening or Unit dimensions. MRS 06A2193
--. WRIGHT BUILDERS, INC. LUE lUM W U ° ° GJ MU LT LL,
48 Bates Street
NORTHAMPTON, MA 01060
DATE � JOB NO
22 D
(413) 586-8287 ATTENTIO .
FAX (413) 587-9276
TO k1 lP00 IF;AAiGDl(J lS -D�� RE. 432 NVl LU -1Rb
WE ARE SENDING YOU 7 Attached CI Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
Shaw
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
As requested ❑ Returned for corrections ❑ Return--corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
w�A
1 o VACtrr'h aS ed is Ise 0_*-a e {�
ofrem 4:-�
Ina,ve mn o c e a(
COPY TOI
SIGNED:
If enclosures are not as noted,kindly notify u at once.
t �
Pitt
I/
Affidavit of Gordon P. Shaw
1. My name is Gordon P. Shaw. I reside at 582 Haydenville Road, Leeds,Massachusetts. I live
there with my wife Arlene Con-ea, my 19 year old nephew, and my five year old son.
2. This past year we contracted with Wright Builders to perform a home renovation which
included the addition of two small rooms off of the master bedroom.
3. It is our intention to use these rooms for storage (closet) and as a small study/library. Neither
room will be used for sleeping purposes. Our house already has four bedrooms and there would
be no need for such usage.
Dated: September 21, 2004
Gordon P. Shaw
Subs ibed to and sworn eatore me
I! �� �, this y of cj
i'
1 `
�' Vivienne Wai ht,Notary Pu tic
��� My commission expires Sept 5,2009
I
. a
f
SECTION 8-CONSTRUCTION SERVICES
1 Licensed Constructions Supervisor: Not Applicable ❑
Name of License Holder: 0 5 04 Cj 0-75
License Number
Address Expiration Date
Signature Telephone
-J7 egis ere ame, mpro ernes o a or 2 E Not Applicable ❑
iN p o I-rT E1m*,�s INC '1 D ( ED-3 (,,
Company Name Registration Number
5 STS t �(���rbN l MA ((,- 1?4 104
Address (' Expiration Date
Telephone 4Q—r�%-182b7
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...... ❑
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 Emplovers 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
r
CTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition 11- Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ J Other [ ]
Brief Description of Proposed Work: Yl Cet(�fNCi�1iJn r%wcooim remo wI 1(ievi �incli ►S `i MudrCairY►
Or :ef C OSet �c
Alteration of existing bedroom Yes _No Adding new bedroom Yes �=No
Attached Narrative❑ Renovating unfinished basement —Yes No
Plans Attached Roll ❑ . Sheet❑
Al I V C' ov�e a 1-
6a I V ouse an or d'dition a existing ho'�i sfing -comet fe"the foilow�ng:
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?
d. Proposed Square footage of new construction.— Dimensions'
e. Number of stories?
f. Method of heating? FirWgces or Woodstoves Number of each
g. Energy Conservation Compliance. l Mascheck Energy Compliance form attached?
Type of construction
i. Is construction within 100 . f wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of baseme r cellar floor below finished grade
k. Will buil conform to the Building and Zoning regulations? Yes No .
I. tic Tank City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION-TO BE COMPLETED,WHEN
OWNERS AGENT OR.CONTRACTOR APPLIES,FOR BUILDING PERMIT ;
I,
as Owner of the subject property
hereby authorize ()T M kf-!;N w f– ANT -t3U m g- to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, 1,L1 a-rt �n+ st+ I Wye t 1 l,t)E12S as Owner ed 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. .
tit i+
Print Name
Signature wnerA nt Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION,
ant lam► e i5 �� - � n✓�� ,
Existing Proposed kequired by Zoning
This column to be fine n by
Building Dep
Lot Size
Frontase
Setbacks Frynt
Side R: L: R:
ZZ
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parkin aces
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 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:
{ �1
City of Northampton t
Building Department "t,H
212 Main Street n ,e ,�
Room ].00
Northampton, MA 01060 e
phone 413-587.1240 Fax 413-587-1272 0 1 t
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR`QEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION �l�dljGligtci 04 MOO
p eted by office
1.1 Property Address;
� �
_`Mak�ot
11)1� M ZoneOverlay District` '
a
=Elm St.'`Djistrk't CB DIstri t
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
6162 Ht LADS, M16,
Name(Print) Current Mailing Address:
Telephone
Xgnature 1 tt
[22.2 Authorized Agent:
Name(Print) Current Mailing Address:
+2
Signa a Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS D ,k I V5 ; (a
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ' 3�3 (a) Building Permit Fee
2. Electrical (b)Estimated Total Cosf_of .
Construction frari 6
3. Plumbing 0 Building Permit Fee',; t
fi ..
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(I +2 +3 +4+5) �D� ( IC%J Check Number '
_ his Section For°Official Use OnN
BuildingPerl`nit Number (2 ���� "�������'` Date lssue�a�f�'
ar w r m c m a r sa a z .
.. x
:�.w.ro chi."..y '�w..�,u ..::it C`::T�.�4'."'��n�i- -�.�`.�.0 �i. ��,,, 1 �` .z��?:�i c�}S-,j ��,.cti�iiK•r�lr �", nqr,°'`�:.�`!1�^.��,.
.dam r
T}l''
yw ...
�Sy [.wyJ. ?
Signa ure
~Y�� "Building Commissioner/Inspector of Buildings `�� 36 t Nw^ + 'mate ..;t;
File#BP-2004-1059
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION 582 HAYDENVILLE RD
MAP 06 PARCEL 004 001 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
Typeof Construction: KITCHEN&SUNROOM RENOVATION,MUDROOM DORMER,CLOSET ADDITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 045075
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS 13EEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Commission
��.
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.
582 HAYDENVILLE RD BP-2004-1059
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mag:Block:06-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: UI:LDING PERMIT
Permit# BP-2004-1059
Project# JS-2004-1583
Est.Cost: $66183.00
Fee: $300.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Wright Builders
Lot Size(sq ft.): 32800.68 Owner: CORREA ARLENE&GORDON SHAW
y •cr L •'1.r'I;J •�
Zoning:S'.
AT: 582 HAEDENVILLE RD
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:514104 0:00:00
TO PERFORM THE FOLLOWING WORK.-KITCHEN & SUNROOM RENOVATION, MUDROOM
DORMER, CLOSET ADDITION
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: -/J'0 Rough: G�/�� �, House# Foundation:
Driveway Final:
'F inal:, Rough Frame:0V( 'I( .O 41
>k x •93 DO �l
Ga,;: Fire Department Fireplace/Chimney:
hough: Oil: Insulation:
Smoke: 3/ Y Final: 6 ''S �—3 1- (�q ✓4Aw
Final• -� � �� u
THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATI OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si nature:
Feel e: _ Receipt No: Date ;raid: Check No: Amomit:
Building 5/4/04 0:00:00 18357 $300.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo