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15081911 B T01 �UEENPOST
--- _ -- _-- _ L --
Universal ___ Job Reference(optima Forest Products -- -. y _ Aug 015 Page 1'
ID:VTmIEEaBbMX8L_005TMo0T ni7Y-szclQZ2fPLRcWztd9Yx5hA6NH8F L87HNb4hCGyni6>
29 2015 MiTek Industries,Inc. Sat Au 1508:2818 2
1-0-0
5-8-7 10 0 0 14-3-9 20-0-0 21-0-0
1-0-0 5-8-7 4-3-10 4-3-9 5-8-7 1-0-0
S. =1:35.4
4.4
f I I
1'lty,
'B.00r2 156
/ T1 V2
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-- -- - 10-0-0
10-0-0 — -
Plate oflsefs fx Y} Iz:o-2 9 a 4LL6 az s 0 1=6)<L 0=4-0_a3-off
- - -
-
TCLL (ps40 0 SPACING 2-0-0 CSI DEFL. in (loc) Udefl L/d r PLATES GRIP -
(Roof Snow--40.6) Plate Grip DOL 1.15 TC 0.46 Vert(LL) -0.12 8-11 >999 240 MT20 1971144
TCDL 10.0 Lumber DOL 1.15 I BC 0.69 Vert(TL) -0.33 8-11 >717 180
BCLL 0.0'
Rep Stress Ina YES WB 0.37 Hea(TL) 0.06 6 n!a nla
BCDL 10 0 Code IRC2009/fP12007 1 (Matrix-M) Wlnd(LL) 0.03 8 >999 360 Weight:68 lb FT=4%
LUMBER- BRACING_
TOP CHORD 2x4 SPF No.2 TOP CHORD Structural wood sheathing directly applied or 3-1014 or purfins.
BOT CHORD 2x4 SPF No.2 BOT CHORD Rigid ceiling direly applied or 10-0-0 oc bracing.
WEBS 2x4 SPF No.2 or 2x4 SPF Stud MTek recommends that Stabilizers and -
required cross bracing be installed
during truss erection,in accordance with Stabilizer Installation guide.
REACTIONS. (lb/size) 2=1300/05-8 (min.02-1),6=1300/0-" (min.02-1) - - -- - -
Max Horz2=64(LC 9)
Max Uplifl2=-68(LC 8),6=68([_C 9)
FORCES. (Ib)-Max.CompJMax Ten.-All forces 250(lb)or less except when shown.
TOP CHORD 2-3=-1898/398,3-4=1402/305,4-5=1402/305,5-6=-1898/398
BOT CHORD 2-8=247/1815,6-8=247/1815
WEBS 3-8=-633/218,4-8=137/7(30,5-8=-633/218
NOTES
1)Wind:ASCE 7-05;100mph;TCDL=5.Opsf;BCDL=5.Opsf;h=24ft;Cat.II;Exp B;enclosed;MWFRS(low-rise)and C-C Exdenor(2)zone;cantilever left and
right exposed;C-C for members and forces&MWFRS for reactions shown;Lumber DOL=1.60 plate grip DOL=1.33
2)TCLL•ASCE 7-05;Pf--40.0 psf(flat roof snow);Category II;Exp B;Partially Fes.;Ct=1.1
3)Unbalanced snow bads have been considered for this design.
4)This truss has been designed for greater of min roof live bad of 16.0 psf or 2.00 times flat roof load of 40.0 psf on overhangs non-concurrent with other live
loads.
5)This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other live loads.
6)'This truss has been designed for a live load of 20.0p9 on the bottom chord in all areas where a rectangle 3-6-0 tan by 2-0-0 wide will fit between the bottom
chord and any other members.
7)Provide mechanical connection(by others)of truss to bearing plate capable of withstanding 100 lb uplift atjoint(s)2,6.
8)This truss is designed in accordance with the 2009 Intemational Residential Code sections R502.11.1 and R802.10.2 and referenced standard ANSI/TPI 1. i
9)"Semi rigid pitchbreaks including heels"Member end fixity model was used in the analysis and design of this truss.
LOAD CASE(S) Standard
Job Truss I Truss Type Qty Ply Northampton,MA
150819116 iT01GE (GABLE 12 --1 -- -1
-.---- _ --f--- _ 1 Job Referenced -all I Forest Products - 7.610 s Jan 29 2015 MTek Industries,Inc. Sat Aug 15 06:28 15 2015 Page 1
I D:VTml EEaBbMX8L_005TMoOTyni7Y-ROxvnXOm6Q31 f W87C0?ET3Yga4H P8rLghdsocxyni7
1-0-0 10-0-0 20-0-0 2.1-0-0
1-0-0 10-0-0 10-0-0 1-0-0 1
Soak=1:%.4
44 a
9
17y
I i>00 X12 5 / 8
23
24
4 10
3
2
S,0 Z2 21 20 19 18 15 14 30
- -- 20-0-0
--
2a-o-o --- - 1
Plate OfTse[s_LX�Y) 118:0-3-0 3-0� - —_ ---
(P f1 _ - -
LOADING s SPACING 2-0-0
CSI. DEFL in loc Vdefl Ud PLATES GRIP
TCLL 40.0 ( )
(Roof Snow--40.0) Plate Grip DOL 1.15 TC 0.17 Vert(LL) -0.01 13 n/r 180 MT20 197/144
TCDL }0.0 Lumber DOL 1.15 BC 0.06 Vert(TL) -0.01 13 n/r 80
BCLL 0.0` Rep Stress Ina YES WB 0.11 Horz(TL) 0.00 12 n/a We
BC_DL 10.0 Code IRC2009/fPI2007 (Matrix) I.- Weight:78 lb FT=4% -
LUMBER- BRACING-
TOP CHORD 2x4 SPF No.2 TOP CHORD Structural wood sheathing directly applied or 6-0-0 oc purtins.
BOT CHORD 2x4 SPF No.2 BOT CHORD Rigid ceiling direly applied or 10-0-0 oc bracing. �!
WEBS 2x4 SPF No.2 or 2x4 SPF Stud --- —-- ---- --
OTHERS 2x4 SPF No.2 or 2x4 SPF Stud MiTek recommends that Stabilizers and required cross bracing be installed
during truss erection in accordance with Stabilizer Installation guide
REACTIONS. All bearings 20-0-0 except Qt length)2=0-0-1(input 20-0-0),12=-0-0-1(input:20-0-0),18=-0-0-1(input:20-0-0),19-0-0-1
1x6=0-0 (input: 0-0-0),15p=-0-0-1 20-0-0),21=0-0-1 iput:20-0-0),14=-0-0-1 rP -(input 20-0-0).(�p�215-0-0),17=-40-0-1(input:20-0-0), j
(lb)- Max 14=2=63(LC 9)
Max Uplift All uplift 100 lb or less at joint(s)2,12,19,20,21,22,17,16,15,14
Max Grav All reactions 250 lb or less at joint(s)18,21,22,15,14 except 2=270(LC 12),12=270(LC 12),19=333(LC 2),20=286(LC
2),17=333(LC 3),16=286(LC 3)
FORCES. (lb)-Max.CompJMax Ten.-All forces 250(lb)or less except when shown.
WEBS 6-19=293/85,8-17=293185
NOTES-
; 1)Wind:ASCE 7-05;100mph;TCDL=5.Opsf;BCDL=5.0psf;h=248;Cat.II;Exp B;enclosed;MWFRS(low-rise)and C-C Exterior(2)zone,cantilever left and
right exposed;C-C for members and forces 8 MWFRS for reactions shown;Lumber DOL=1.60 plate grip DOL=1.33
2)Truss designed for wind loads in the plane of the truss only. For studs exposed to wind(normal to the face),see Standard Industry Gable End Details as
applicable,or consult qualified building designer as per ANSVTPI 1.
3)TCLL ASCE 7-05;Pf--40.0 psf(flat roof snow);Category II;Exp B;Partially Exp.;Ct=1.1
4)Unbalanced snow bads have been considered for this design.
5)This toms has been designed for greater of min roof live bad of 16.0 psf or 2.00 times flat roof load of 40.0 list on overhangs non-concurrent with other live
bads.
I
6)All plates are 1.5x3 W20 unless otherwise indicated.
7)Gable requires continuous bottom chord bearing.
8)Gable studs spaced at 2-0-0 oc.
9)This truss has been designed for a 10.0 psf bottom chord live load nonooncurrent with any other live loads.
10)*This truss has been designed for a live bad of 20.0psf on the bottom chord in all areas where a rectangle 3-6-0 tall by 2-0-0 wide will fit between the bottom
chord and any other members.
11)WARNING:Required bearing size at joints)2,12,18,19,20,21,22,17,16,15,14 greater than input bearing size.
12)Provide mechanical connection(by others)of truss to bearing plate capable of withstanding 100 lb uplift at joint(s)2,12,19,20,21,22,17,16,15,14.
13)This truss is designed in accordance with the 2009 International Residential Code sections R502.11.1 and 8802.10.2 and referenced standard ANSIfTPI 1.
14)"Semi-rigid pitchbreaks including heels"Member end fixity model was used in the analysis and design of this truss.
LOAD CASE(S) Standard
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City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 19SLc-f �'Gr
— z
The debris will be transported by: D-A v
The debris will be received by: tc[ y !`stiC1Lc1
Building permit number:
Name of Permit Applicant 64U LJ
ial
Date Signature of Permit Applicant
08/24/2015 MON 13:30 FAX lL7.J001/001
AC40 V CERTIFICATE OF LIABILITY INSURANCE Da/24� 2o1sY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE -ERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
Certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT House
NAME:
King & Cushman Inc, PHO H Ext: (413)584-5610 rAAIC No) (a131sea-9322
P.O. BOX 447 EMAIL
ADDRESS:
176 King Street INSURERS AFFORDING COVERAGE _ NAIC#
Northampton MA 01061 INSURER A:Liberty Mutual Group_
INSURED IN SURER B:Ohio Security Insurance Co. 24082
David Fortier Builders INSURE_RC:___
32 Laurel Street INSURER D: _
INSURER E:
Northampton MA 01060 INSURER F
COVERAGES CERTIFICATE NUMBER:CL1582401086 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFF POLICY EXP
ILTR TYPE OF INSURANCE BR POLICY NUMBER YY lmmfoorff"I LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE a OCCUR UAMAGE TO RENTED 50,000
PREMISES Ea occurrence $
BKS55722835 12/2/2014 12/2/2015 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY M PRO-
JECT 2,000,000
JECT LOC PRODUCTS-COMPI_OP AGG $
OTHER' 'I. - $
AUTOMOBILE LIA!?!:in >i ,. (v7,..
.acud�•r".
ANY AUTO BODILY INJURY(Per person) $
ALL
AUTOSED AUTOS BODILY BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE I$
AUTOS Per accident !
$
UMBRELLA UAB OCCUR EACH OCCURRENCE _ $
EXCESS UAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER
AND EMPLOYERS'LIABILITY YIN ISTATUTE I ER _
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT 11$
OFFICERIMEMBER EXCLUDED? F]NIA 100 000—
B (Mandatory in NH) XWS55722835 9/4/2015 9/4/2016 E.L.DISEASE_EA EMPLOYEE$ 100,.000
If yes,describe under ----
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Northampton, MA 01060 ACCORDANCE WITH THE POLICY P IONS.
11 NUAN
AUTHORIZED REPRESENTATIVE
1
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025(201401)
City of Northampton
Massachusetts
I r DEPARTI�MNT OF BUILDING INSPECTIONS ,
m
212 Main Street • Municipal Building
.y Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 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 building inspection
(before work is concealed), insulation inspection (if required) 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 occupancv 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
I, 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
The Commonwealth of Massachusetts
.Department of Industrial A ccidents
Office of Investigations
600 Washington Street
i Boston,M4 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 4-62'[t A_ ty«X)if.p
Address: r✓A life Fg, ('
City/State/Zip: o Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with -_ 1— 4. ❑ I am a general contractor and I
employees (full and/or part-time),* have hired the sub-contractors 6. New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• ®Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance. 9 E]Building addition
required.] 5. ❑ We are:a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 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.
fHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 0110 _ ficu r, ►-1'Y 3_,,V_5y I'Le .
Policy#or Self-ins. Lic. #: (xl$"" f r,`O g{3 Expiration Date:
V FL 2N*4 Q
Job Site Address: —wity/State/Zip: 0a® a
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 of MGL 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 be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cer, ' under he pains and penalties ofperjury that the information provided above is true and correct.
� l
Signature: I 1vl U Date: g ►�
Phone#:
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1_Licensed Construction Supervisor: J/ Not Applicable £
Name of License Holder: opu l:7 r"t �6 2<1r,2 CS " W g o3(e _
License Number
3a
Ad Expirati n D e
C(&
Signature Telephone
_..
9 Registered HomeamprovementControctor _ , y , . w _ _. _ _, Not Applicable £
/0 T4 l
Company Name Registration Number
�AU 10 �—o/ i (Lngt�(, r)
Address p') J� Expir ion D to
31Lf k\�L Ct. Opgo p-miu, ' l�• ��rr�I�� Telephone`��_��_7t FJ
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.
NX
Signed Affidavit Attached Yes.. £ No...... £
11 .Home Owner Egempt>lon
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,
I
I
i
i
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition [] Replacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition New Signs [0] Decks [❑ Siding [0] Other[0]
Brief Description of Proposed , /� i U
Work: 0 E M s B[STin/t. r`lokib t AN-6 ( ViACE W I rH P NtFW �&,s- °I1 CAQA
Alteration of existing bedroom Yes No Adding new bedroom Yes No &-IS l I
Attached Narrative Renovating unfinished basement Yes No 4-6 d-i /djc, JV
Plans Attached Roll -Sheet
6a . Newhouse and..-or addition".to extstinq houslng, complete the followmc�:
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? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 900 yr. floodplain Yes No
j. 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
I, d i ��>)/�'� as Owner of the subject
property
hereby authorizeR
to a n my behalf, in all matters rel tive to ork authorized by this building permit application.
S' nature of Owner Dale
I, 'w.1 f1, t t�1 d T I�,'f ae-Ove ;/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 underthe pains and penalties of perjury.
Print e —
r? S�
Signature of Owner/Agent D to
i t
eon � t
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To IncompteWiFformation "ll
F
Existing Proposed Required by Zoning 31 4W L
This column'to be filled in by
Building Dep rtment
i
Lot Size
Frontage
Setbacks Front
Side L:' f R: I R=
Rear
Building Height F— (-
Bldg.Square Footage 1
Open Space Footage __ }} %
(Lot area minus bldg&paved I --
arkin )
#of Parking Spaces i--- r -- --
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q
IF YES: enter Book Pagel ~--1 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO
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 0
IF YES, describe size, type and location: j
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 Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
I
i
MEE-1 Aepartment use only
k �'
ity of Northampton Status ofPermtt �'' �1' ' y�'
2 uilding Department Curb CutlDrirce�ay Perrrtt# �'x '
Jr 2015 r
212 Main Street SewerlSepticAvaifa6l(ity k
+lc F
Room 100 Auaila6dity a
{
;"S ins rthampton, MA 01060 Twa Se#s o1 Stti otr�ral PIaBs
0
r:A 7
-587-1240 Fax 413-587-1272 PIot/Site Plans " F, z
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
This secfiorr to be complefed by office
1.1 Property Address:
TJ
mm
Zone Overlay District
_Elm St,District - C8 District -..
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT .
2.1 Owner of Record:
Nam (Print) coq ® Current Mailing Address:
Tele one
ignature
2.2 Authorized Agent:
Name t) ,,-- Current Mailing Address:
73
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 (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) (t $[y`a . b Check Number
This Section For OfficW Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings: Date
File#BP-2016-0245 Ok/T-o 579-rR-r
APPLICANT/CONTACT PERSON DAVID FORTIER J
ADDRESS/PHONE 32 Laurel St NORTHAMPTON01060(413)586-8965 j
PROPERTY LOCATION 187 NORTH MAPLE ST
MAP 17A PARCEL 182 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 0 -q19'@ A119
Building Permit Filled out
Fee Paid
Typeof Construction: DEMO&REPLACE 20 X 20 DET GARAGE ON EXISTING FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 008026
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO$AIATION 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 Permit DPW Storm Water Management
m i . n Del
Sig ature 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.
187 NORTH MAPLE ST BP-2016-0245
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 182 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: GARAGE BUILDING PERMIT
Permit# BP-2016-0245
Project# JS-2016-000401
Est.Cost: $26850.00
Fee: $110.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID FORTIER 008026
Lot Size(sg. ft.): 7187.40 Owner: TOWLES SUSAN E&ANDREA M ADAMOWICZ
Zoning:URB(100)/ Applicant: DAVID FORTIER
AT: 187 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
32 Laurel St (413) 586-8965 WC
NORTHAMPTONMA01060 ISSUED ON:91812015 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO & REPLACE 20 X 20 DET GARAGE ON
EXISTING FOOTPRINT
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 9/8/2015 0:00:00 $110.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner