17C-219 (6) i
PIPE SIZES (in. )
NON-CIRCULATING CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1 .5-2. 0" 2 . 0+"
I 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
----NOTES TO FIELD (Building Department Use Only) -------------------------
VAPOR RETARDER:
Required on the warm-in-winter side of all non vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
] Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
j and cooling equipment and service water heating equipment must be
provided. Insulation R-values, glazing U-values, and heating
equipment efficiency must be clearly marked on the building plans
or specifications.
DUCT INSULATION:
Ducts shall be 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, shall be 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 must provide a means for balancing
air and water systems.
TEMPERATURE CONTROLS:
[ ] Thermostats are required 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 shall be provided.
HVAC EQUIPMENT SIZING:
[ ] Rated output capacity of the heating/cooling system is
not greater than 1250 of the design load as specified
in Sections 780CMR 1310 and J4 .4 .
[ ] SWIMMING POOLS:
All heated swimming pools must have an on/off heater switch and
require a cover unless over 200 of the heating energy is from
I
non-depletable sources. Pool pumps require a time clock.
[ ] HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F must be insulated to the following levels (in. ) :
PIPE SIZES (in. )
HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1 .25-2" 2 . 5-4"
Low pressure/temp. 201-250 1.0 1 . 5 1.5 2 .0
Low temperature 120-200 0. 5 1 . 0 1 . 0 1 . 5
Steam condensate any 1.0 1 . 0 1. 5 2 . 0
COOLING SYSTEMS:
Chilled water or 40-55 0.5 0. 5 0 .75 1.0
refrigerant below 40 1.0 1 . 0 1 .5 1. 5
I
i
[ ] CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in. ) :
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2. 01
DATE: 2-27-2003
Bldg.
Dept .
Use j
j CEILINGS:
I. R-38
Comments/Location
WALLS:
[ ] 1. Wood Frame, 16" O.C. , R-19
Comments/Location
BASEMENT WALLS:
_ . Conc. 9. 0' ht/5 . 0' bg/9 .0' insul, R-19 interior cavity
Comments/Location
WINDOWS AND GLASS DOORS:
_. U-value: 0.32
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
I
DOORS:
1 . U-value: 0.28
j Comments/Location
I
SLAB-ON-GRADE FLOORS:
[ ] j 1. Unheated, 2 .0" insul. , R-7.2
Comments/Location
Slab insulation to extend down from the top of the slab to at
least 2" OR down to at least the bottom of the slab then
horizontally for a total distance of 211 .
I
HVAC EQUIPMENT:
[ ) j 1 . Furnace, 80. 0 AFUE or higher
i Make and Model Number
I
AIR LEAKAGE:
[ ; Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
j 1. Type IC rated, manufactured with no penetrations between the
j inside of the recessed fixture and ceiling cavity and sealed or
j 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 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
MAScheck COMPLIANCE REPORT —— --
Massachusetts Energy Code i Permit #
MAScheck Software Version 2 .01
Checked by/Date
CITY: Northampton
STATE: Massachusetts
HDD: 6404
CONSTRUCTION TYPE: 1 or 2 Family, Detached
�IEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 2-27-2003
COMPLIANCE: PASSES
:required UA - 198
Your Home = 195
Area or Cavity Cont . Glazing/Door
Perimeter R-Value R-Value U-Value UA
----- ---------------------------------------------------------------
CEILINGS 400 38 .0 0 .0 12
WALLS : Wood Frame, 16" O.C. 684 19 . 0 0 . 0 41
BSMT: C=c. ° . " ht/5 .0' b9/9.0' insul 285 19. 0 0. 0 15
GLAZING: Windows or Doors 120 0 .320 38
DOORS 21 0 .280 6
SLAB FLOORS: Unheated, 2 .0" insul. 82 7 .2 83
IIVAC EQUIPMENT: Furnace, 80.0 AFUE
---------------------------------------------------------------------- -
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 Lhe requirements of the Massachusetts Energy Code.
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 cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer L. Date / —�y
1
r3 �
y
may.
1
91i ;
r1
-C ttA�11'T
g��� o°e of �17� �Ij�111�7�II1i
�i3ERCE�ttSt{{E
c
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
W0RICER'S COMPENSATION INSURANCE AFMAVFT
(licenscrlpermittee)
with a principal place of busi1CS-'J1 sidence at:
(phone#) y/ 70
(sti�{lci ty/stat.elzi p)
do hereby certify, under the pains and penalties of peguly, that.
O I am an employer providing the following worker's compensation coverage for my
employees worcing on this)ob:
(Insurance Company) (Policy Number) (Expiration Dale)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Nome of Contractor
) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Poticy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additiooil abort if neaauy to inc}ude information pertaining to all ooatx er )
(✓) i am a sole proprietor and have no one working for me.
( ) T am a home owner performing all the work myself.
NOTE:please be aware that wfrile hancowncra who cmpfay pawns to do rnai tca ^n omsb 00 or repair work on a dwelling of
not mom than tbroo units in whicfr the homeowner r=dcs or oo the grounds vvarteaani therd arc Dot genaady Ww6crrd to be
etnployera under the worker`s comp==tim Act(GL152,m 1(5)),application by a homeowoa for a Haase a P=Mif=Y cvidc=the
ItsA ctatua of an employer under the Workoea Compamation Ad
-
I uadastsnd the z ocpy of thia rtatcmcd may bo forwarded to tho Departax:at of Industrial A=dea&Ofoo of Inxuwoa for 0-
covmge verMostioa and that failure to secure ooverago uudcr section 25 A of MGL 152 can lead to tba"impost -of cumin penalties
oomisting of a fine of up to S 1,500.00 aadlor hnpcisoamart of up to o=year end civil penatlia in the form of a Stop Work Ord--and a
fim o(5100.00 a day ag&hA me
For dgMtmd--'uao ooty
Permit Number
Q`�/7 0 3 Lot#
Late
Signature of LicenseelPertnitlee
R Version 1.7 Commercial Building Permit May 15,2000
SECTION10 STRUCTURAL PEER REVIEW(780 CMR 11011)
.... ., ,
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......(Z
-SECTION,11 OWNER AUTHORIZATION ,:TO,B....-E COMPLETED WHEN
,01NNERS'AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
:.
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
as Owner/
hereby declare t at 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
Signature of Ow er Date
•°SECTION 12 CONSTRUCTION SERVICES
: .,.. .
10.1 Licensed Construction Supervisor: k Not Applicable ❑
Name of License Holder: �—1Gi I` D ZA) '3/ 0
License Number
Lees 0`/-�) 3— :?-ooy
Address Expiration Date
L113 51 Y
Sign Telephone
SECTION 13�1NORER
S' COIyIPENSATlON1NSURANCEA�FIDAVIT(MG L c X52
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...... ❑
Version 1.7 Commercial Building Permit May 15,2000
'SECTION 9 "R&ESSIONALA ESIGN AND CONSTRUCTION;SERVICES - FOR BUILDINGS AND STRUCT,URES,SUBJECT TOM g
CONSTR"UCTION'CONTROL"PURSUANT TO"780 CMR 116`(CONTAINING "MORE THAN 35,000 C F ,OF.,,ENCLOSED`SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public EO Private ❑ Zone: Outside Flood Zone 12 Municipal 0 On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ��a�• ? -� Cir. ✓
Frontage Sa rK �-
Setbacks Front
Side L: ,�3G"R: 30 , L: R:_ e_
Rear
Building Height
D Saws �_
Bldg. Square Footage % r
Open Space Footage %
(Lot area minus bldg&paved 79, a7
parking)_
#of Parkin S aces ) S-
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 +-"' 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:
Version 1.7 Commercial Building Permit May 15,2000
SECT "' 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC`FEETOFENCL0�5EbSPACE � 3 '
,k
Interior Alterations Existing Wall Signs Existing Ground Signs Additions fib Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]l
✓►—�1 F��'1`�r 1J i �Cf'V t o L f' f jC'i S t•n C 4,c IN 4 c tOU S ti r Pc m
S,ECTION'$ USE`GROUPAgND CONSTRUCTIONgTYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 113 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 513 G3
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION (F EXiSTING'BUILDING UNDERGOING RENOVATIONS,ADD1Ti0NSiNDIOR CHANGE IN.USE
Existing Use Group: Proposed Use Group: eA e
Existing Hazard Index 780 CMR 34): `� Proposed Hazard Index 780 CMR 34): �4✓n F'
SECTION 6$U1t.DIIG�HEIGHTANDAREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf) 15t �4 ?�
1 St CZ ,4��� 2nd �/c •��_
-
�+
2nd s D s4 0
3rd
3 rd 4th 141e,r1 e2
4th �a n
E
Total Area (sf) 3 �5� � Total Proposed New Construction (sf)
�...
Total Height(ft) j f ,
H.e
Total Height ft - `' —
'�
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413.587-1272
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SEC?ION`1 SITE INFORMA710N, ,
1.1 Property Address: h1s " irton{to`'be completed b�dffiee''
P Y TM
��Zone "' � ."� Overday D1strlct�� � f
EIm�S �lstrict_ CB Distr►ct °air z
3
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t
Name( int) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION.3.''E3STIlVIATE[)`CONSTRUGTI0 COSTS;
Item Estimated Cost(Dollars)to be ;Official�UseOn =�mr � �
com
pleted _
1. Building (a)BUlldirig v' Permit f ee A 3 . �� �
3 v 0 o
2. Electrical (b)�1~stama#ed�fit {:oStiof '
��` .Constiuctlonrom 6 '" ".,,, ER,
3. Plumbing Bul1#41 Per mit F
4
„h
4. Mechanical (HVAC)
PE
/00°
�w
5. Fire Protection
s a' d's. . - �,.
6. Total =(1 + 2 +3 +4 +5)
3 '?00I�ecklumb„e,; 33 d ,
”'p Mi.;'
a
�.
Seet1'0wF6KO,(f1G111 5e 1]nl
i
d)r1gPei'{I11M Um ber
4
� y
i .�
InIT
S1 atllr2 f3UIldIQ t✓ORlrY115SI0fler✓In$peCtOCO �
..,- 8 :Buildipgs
File#BP-2003-0903
APPLICANT/CONTACT PERSON Roger Clark
ADDRESS/PHONE P O Box 34 (413) 584-1170
PROPERTY LOCATION.2A,,,,ORT9*b T
MAP 17C R Rte CEL 21 I ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid O —'
Typeof Construction: REMOVE ATT/GARAGE, CONSTRUCT 25X 16 ADDITION (1ST- 1NGROUND POOL
2ND ADD(2)BEDROOMS)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 02 13 10
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION DRFSENTED:
Approved__y 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: § Z
Finding Special Permit Variance* ''
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from Di'\%J _ 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 Stree mission
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.