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17D-040 (3) '' LOW -E WINDOW UNIT V` i EXPANDING FOAM �� of'? ./ SEALANT — 7_, Iti 112 "x2" BACK DAM I I � CONTINUOUS BEAD OF Mr SEALANT 4 .... SELF- ADHERED MEMBRANE • 1 IIII FLASHING t i _� WOOD LAP SIDING /�G�.et :: :: i VENTED AIRSPACE Maid _ .. 1 " RIGID INSULATION ....� 2x6 WOOD FRAME 1••• 1/2" GYPSUM BOARD ... WINDOW SILL 11 NAILING FLANGE II WOOD LAP SIDING 111" RIGID INSULATION 3.00i pi; GreenBuildingAdvisor.com 9 Scale: 3" =1 © BuildingGreen LLC 2008 1x3 WOOD FURRING 24" OC WOOD LAP SIDING VENTED AIRSPACE 1112" RIGID INSULATION Il c i 2x6 24" OC WOOD FRAME 2' a CAVITY INSULATION 112" GYPSUM BOARD T♦ r T T T '' '' T T T T T INTERIOR CONDITIONED SPACE PLAN DETAIL 11 WOOD LAP SIDING/11112" RIGID INSULATION GreenBuildingAdvisor.com Scale: 1112 " =1' -0" 2.01002 p BuildingGreen LLC 2008 • • . . WOOD LAP SIDING VENTED AIRSPACE j '! C'1 Ili WOOD FRAME ,� HE - 112" GYPSUM BOARD . , .. .......... ■ ■ii 11111:1::: 1112" RIGID INSULATION ... _ __ _.. 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I ' Addition I Existing House - 9' 2 1/2" ' . ► II Lt1 I i N E ■ E ' ri 1 Division of Dbu (ex p E � ■ Existing E i �I - I 7: iii Kozuch Addition Roof Plan 8 High St Florence, MA 01062 • • 10Fr 8' 9 Kozuch Addition North Section 8 High St Florence, MA 01062 MOOT %..av!Cy v an.. 1/2" Gypsum Board on 1x3 Furring Strips on 1 #5" Polylso Foam Interior to Studs. i Blown In Cellulose,; 5/8" Plywood Sheathing, Fabral SSR16 Standing �i� 5 Seam Metal Roof. Continuously VentEld Beneath _ Sheathing with Insulation Baffles, Soffit and Ridge Vents L1 • 11 __ 3 Interior Post Lag Screwed to 6 "x7.5 "x2' atilt up PT Beams Bearing Directlfr on existing Tied to Found tion w/ 2x '6x1'6x12" Fo •r Under Center Post Foundation 24" Nailed Straps, Posts Rest on Copper Sheet as Capillary Break Kozuch Addition East Section 8 High St Florence, MA 01062 I . Wall Frami g 2x6 KD SPF 24" OC Window Head: rs: Two 2x4s with 2.5" Foa , A - -..1 -. '. • A .. Metal Hang ng . ardwar- II II i i Iv ...., .., -1, ...,, ming 1 As , . . , ri I, 1 I FA. 2' 4" 2' 11 1/2" c ti New Window Same width M E and postion as� - -� PT Sill w/ Anchor Bolts 6' OC Existing Windo , !(r I Sill Raised 20" 1 742Polhoo Kozuch Addition East Framing Elevation 8 High St Florence, MA 01062 , , i . 1 g 1 1 1 1 2 "6 4 o ld 1 + 1 Transom Windows Ili MIN ■ ■ ■!■ 111111 ■ ■ 1 ■ ■ ■ ■ Ffeoei F ramed m Space ® Between Gables I I I. ■.� � w� \ t y q 7 ^11 0 11 ,, L .4 , li . , ,„1 :41 , ':', '' . ' 1 11'''':; xR "si. 1 ‘.;?; / 1 y A 4 14 Flat 2x6 Headers, Nori Bearing Wall, Hun on A Hangers pP roved kg r 1 11 M etal 9 A ,1,1r-- 4 . 1 1 ! 4 e "orilAN:1114. i } I % , _ r i 0 tr ' 4 1 1 i ° r 4, n .w a. mss. - a. - . t „� e., •' y xx., -,k m it; , ''' . . Y ... ., ,. << 4 y ,;. -7", ` . v . s ", z' '»..' t#. § rya, > —4 0' .`< PPIIIMI - - , — - - PT Sill w/ Anchor Bolts 6' oC / c.) Kozuch Addition South Framing Elevation 8 High St Florence, MA 01062 • • 1 } i 1I a<< 1f 11' <ar al r' h I.. 11 n U 11 D 11 P ii 1 i _. i k Exposed Slab Floor in Addition - New Interior Walls i - 2x4 24" OC w/ Batt Insulation around existing Foundation Jotul F100 Nordic QT Existing Hou - Woodstove Installed, * I' 0 to Manufacturers Specifications _r III 11•11 6x6 Column . 1 L .x6 Column _ A 1 I I New Interior Walls, ` .� ° I o, E i I 1'I 'ill l�l�I Ii t • _ ko Wal! Cavity Details: 1/2" Gypsum Board, 5.5'i Blown In Cellulose, 1.5" Polylso Foam! rn Neighboring Duplex I N on xterior of Studs, 1x3 strapping 24 "OC,I - m y Fibre Cement Siding I, it 5k ,, 'trh y - Kozuch Addition Floor Plan 8 High St Florence, MA 01062 Wall Framing 2x6 KD SPF 24" OC I Door and Window Headers: III Two 2x4s w th 2.5" Foam • ttached Usi ig Approved -tal Hangirg Hardware 3 I i 1 istii ii c V I Franl 2' 10" i ." r 2 0" FlP 71 All III 1 111 ! 1 _ / etal L annel :racing ;. j Landing Supported on Ledger at house and 2x6 PT Joists 13" OC two 8" piers set below frost line on 20" footers Supporting Outdo•r Landing PT Sill w/ Anchor Bolts 6" OC i Kozuch Addition West Framing Elevation 8 High St Florence, MA 01062 • t 2x10 KD SPF, 24" OC 2 ' 0 ., t I 1' 3 1/2" i it h 'I . 11 11 I , = 6 "Stove Pipe _ Installed as 'I per manufacturers instriuctions, •Super Pro insulated I �` ;� T stainless systeni I r.._ Rafters Supported on — Timber Frame Ridge Beam,• 0 \ - See Section � link 1 = II ... . ....aw , , ..,.._ low I i 1 , El.limi t ,___. , ,________, --4r-- il 1 l iL, I _ u l II II 1 _ _,_= Bat room Vent Installed as per Manufacturers Instructions 4 - f I Kozuch Addition Roof Framing Plan 8 High St Florence, MA 01062 • ildrefic/4) S IT ,, 6 7i6 -9'It AP/ 10' 93/16 is _ 9'10" Kozuch Addition East Elevation 8 High St Florence, MA 01062 a • r; ‘3\ 17` Qco t e5 12 \V/ 15' . . r 0 �V Odk- 1 ) Gr‘ di3 proposed addition �r — garage t r i 11 ' 4 E i existing house 161' 4 a Ccrnel b.u:)e driveway 100 6 -8 High St. Information and 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, express 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 - contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Lia'CilityPartnerships (LLP) with no employees other 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 Deparhnent 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 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 home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 Department of Industrial Accidents Office of Investigations 600 Washington Street - - Boston, M.A. 02111 Tel. # 617- 727 -4900 ext 406 or 1 - 877- MASSAFE Revised 11 -22 -06 Fax # 617-727-7749 www.mass.gov /dia. The Commonwealth of Massachusetts Department of Industrial Accidents _►mo Office of Investigations _FEE= § 600 Washington Street Boston, MA 02111 www.massgov /dia -Workers' Compensation Insurance Affidavit Builders / Contractors /Electricians/Plumbers Applicant Information i Please Print Legibly Name ( Business /Organization/Individual): /�' l ,�� -} �' K r . r Address: City /State/Zip: � o f ()Ace_ /A 4 /, /D6 Phone. #: '/J Z % / /!9 /p Are you an employer? Check the appropriate box: Type of project (required): " 1. ❑ I am a emplo with 4. 0 I am a general contractor and I 6. ❑ New 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 ro. employees These sub - contractors have g. 0 Demolition working for me in any employees and have workers' Y ca P aci t3' 9. �u�lding addition [No workers' comp. insurance comp. insurance.* ,equired:] 5. El We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have .exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1 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 of MGL c. 152 can lead to the imposition of crimin9l 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 certify under the pains and 'amities of perjury that the information provided above is true and correct. Si .s .ture: Y I I tir Date: Phone #: � � l • 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: 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, § 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 ❑ 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 ning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ' ,q.A. . , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition 151 Replacement Windows Alteration(s) n Roofing ri Or Doors 0 Accessory Bldg. ❑ Demolition Er New Signs [0] Decks [Q Siding [IZ7] Other [0] ' &Z *4. ` Brief Description of Proposed Q i � ^ z w /hi' Work: building addition off the southern side of property. G- (J V � 0 kit e 5 ( i W z rii �i e i ) ,r 7 ( Ls() Alteration of existing bedroom Yes X No /// Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family x Other b. Number of rooms in each family unit: # Number of Bathrooms 1 �� ` , ` p Z$ �„ c. Is there a garage attached? no / d. Proposed Square footage of new construction. 288 Dimensions 19 x 18 vif e. Number of stories? 1 f. Method of heating? wood stove and existing furnace Fireplaces or Woodstoves 1 Number of each 1 g. Energy Conservation Compliance. S 6 Ic 1,15 Masscheck Energy Compliance form attached? h. Type of construction stick frame i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 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 �1/ Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS 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 I, 4 Z u r.. , 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. 1∎ 114 ikke f,t: K) z. (' IA. Print Name /1/) 7 Atie 6 yell 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 i l& 5 S y P) Frontage /00 - - k Setbacks Front _15 55 ! Side L: ij R: L: R: I0 Rear V3 f Building Height ti 3 Bldg. Square Footage L2_43" f t�. % 1 ' 16, Open Space Footage tg01)4.7 V ` % t ,3 $ t (Lot area minus bldg & paved '6f parking) # of Parking Spaces Z Fill: (volume & Location) 7 ? A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES Q IF YES, date issued: 07/t20D5 IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO CI 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: 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. ii so* Department use only ,ReC City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit Q 0 212 Main Street Sewer /Septic Availability Room 100 Water /Well Availability • hampton, MA 01060 Two Sets of Structural Plans • one 413 - 587 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 14° I S1 Map Lot Unit Fl d `- e- ANA Zone Overlay District 010(02- EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner � of Record: MA Name (Print) Current Mailing Addre �f l 3 — s -10 32_1 y 5 M Telephone Signature C.e, / L113-91-3-1 1 0 ( 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 permit applicant 1. Building (a) Building Permit Fee 2. Electrical c (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) 30 000 Check Number / " This Section For Official Use Only Building Permit Number: Issued: s g I Signature: Building Commissioner /Inspector of Buildings Date ■ - r UJ 'LOt CIA ` { :JmIl'fQ ";►-)i,'9 File # BP- 2011 -0923 c i 1 01 ti , N a D APPLICANT /CONTACT PERSON KOZUCH MATTHEW t --16A-.4. ' c ° ADDRESS/PHONE 6 HIGH ST FLORENCE (413 570 -3279 0 r II) ►, R� PROPERTY LOCATION 6 HIGH ST MAP 17D PARCEL 040 001 ZONE URB(100)/ 12 ' ''kf �U ,fgs' l/\ THIS SECTION FO OFFICIAL USE ONLY: - • e \ w C . PERMIT APPLICATION CHECKLIST �Q� A N ' c 4 ENCLOSED REQUIRED DATE t- c\ (1 ZONING FORM FILLED OUT G� sW �� Fee Paid '5,1IA ��� Building Permit Filled out P� Q .6 / Fee Paid o Typeof Construction: CONSTRUCT 288 SQ FT LIVING RM ADDIT ON, RENOVATE KITCHEN ( t -S t, New Construction 4 - 0 k' Non Structural interior renovations - �,�, b r - ` M a r U �' - , - Addition to Existing �F. • l tR'� 11' e Accessory Structure C 6: '4 t Building Plans Included: 0 ,C � ` `,a K Owner/ Statement or License ,1 E ° .SS 3- sets of Plans / Plot Plan 3 Q �1,� THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 5 \ ice ` \\ INFO ATION PRESENTED: pjaA) MI (°,' 0 �(�, (} Approved Additional permits required (see below) k y J 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 Demolition Delay / - Signa 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. l t 4 6 HIGH ST BP-2011-0923 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 040 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP- 2011 -0923 Project # JS- 2011- 001505 Est. Cost: $30000.00 Fee: $180.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 16509.24 Owner: KOZUCH MATTHEW Zoning: URB(100)/ Applicant: KOZUCH MATTHEW AT: 6 HIGH ST Applicant Address: Phone: Insurance: 6 HIGH ST (413) 570 -3279 () FLORENCEMA01062 ISSUED ON: 6/9/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 288 SQ FT LIVING RM ADDITION, RENOVATE KITCHEN 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 6/9/2011 0:00:00 $180.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner