36-003 ENERGY CONSERVATION APPLICATION F0RM FOR
LOW-RUSE RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS
780 QMR Appefidix J{zffective 3/1/98)
Applicant Name: �� �rl� _ Site Address:
Applicant Address: viz .✓ City/Town:
r7nIL�.� L Use Group:
Date of Application:
n• Phorn. NF+ucu♦Ivin JignoiUre:
C mpUartce Path(chock o"),-
❑ Prescriptive P:>:kage (Limited to 1- or 2- family wood frame buildings treated with ,"ossil fuels only)
Pac+,a." (A through KK from Table J52. lb): _____ Healing Degree Days (HDD s) from Table J5.2 la:
(For items d. through i., fill in all values that apply from Table J5.2)
a. Gross Wait Area sq. ft f. Walf R-Vatac R
b. Glazing Area' sq. ft g- Floor ° ."alive $-
c. Glazing x,(100 x b+a) ` h. F3asement wall 6
d, Glazing 11-varlir i Sifib Perimeter tL
e. Ceiling R-value R j- Heating AFUE
❑ C--npone-r i Performance- 'Manual Trade W (Limited to wood or metal framed buildings only)
t!�
Gimate Zone(from cxn Figure J6:2.2) ❑ Zone 12 D Zone 13 ( . Zgie r.
q
Attach rrade•O!f f'f'orksheef from Appendix J, [and f-i VAC Trade-Off Worksheet, if apO14 I'C•`--
❑ tvtAScneck Softwart DEC i -. ?
Attach Compliance Reporf and Inspeclion Checklist printouts.
❑ Systems Analysts OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Engin--,r Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wail + Coiling Area 4 sq. ft. b. Glazing Area' �Q sq.tt. c_ Glazing ,(100 x b-+-a)
❑ ADDITION with Glazing% (c.)up to 4C% may use 780 CMR Table J1.1.2.3.1 below:
MAXIMUM U-value Minimum R,Values
Fertesfration ilitg atl Floor Basement Wall Slab Perimeter, Dept
t):39 R 37 R I3 R-19 ' R-10 R•10,A tt.
❑ `SUNR'OOM`addition (greater than 40% glazing-to-wall and ce;ling gross area)
Attach Consumer Information Form'from 78G CM-P-Appendix 6.
Of iCi tl'S Name: Official's Signature:
Appficatan Approved ❑ Denied ❑ Date of ApprovaIlDenial:
°GaS;,n(s)yr Dcniai:
(pr Wide additional details as needed on back side)
i Glazes=Ma SMY be okher hXgE%Opening of Unh DUWItsiv
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Web Guide es
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Mom
Minimum distance hom face of support to the center of hole.See chart below. See Note 5.
3'4x L
� t11aITi£LCY
�` r +ur � r u ,) pe4+urk'� nr� ✓"�""��ti��'r,l r,�v^rrr.. ,�„,.,r ,�”,ru +i'ri„a,r%rn,�d�,."'y ,��t"(ra,�' •." F „t',
l
2x diameter I
oflarger hole
IB 1-joist top and bottom flanges must never be cut,notched,or other"isemodified.
EN
1
Minimum Distance from Inside Face of Any Support to(enter of Hole Of-in.)
Round Hole Diameter(in.)
)uist Joist �T..� T___ --�
Depth Designation 2 3 4 5 6 6;4 7 8 SIN 9 10 10", 11 12 12',
IB-400 1'0" 2'0" NO" 4'0" 5'0" 5'6"
.
1B 600 2'0" 3'U" 4'0" 5'0" 6'6" 70"
I1;-400 0'6"_JW 6" 1'6' 2'6" 3'6" 4'0" 4'6" 6'0" 7'0"
117/x" IB-600 0'6" 16" 3'0 4'0" 5'0" 5'6' � 6'6' 8'11" � 9'0"
I B boo 2 0" 3 6"__
T-6" 6'0' F 7 0" 7'6" 8'6" 10'0 11'0 �
—� - ----111---
IB-400 0'6" 1 0' 2 11' 'l 4 0 4'6" � 5'6 6'0" � 6'6" 8'0" 9'6
14" IB-600 0'6" 1101, 1101, 1'6" 3'0" 3'6" 766' " T 0" 7'6" V W' 10'6"
t�18-800 06 20 30 46 � 56 60 ) 6 lU0 116 � 130
IB-9110 0'6" 0'6" 1'0" 1 0" TO 2'0" 3 0" 0" 4'6" 5'0" 6'Ol' 7'0" 7'0" 9 0" 10'6"
16" IB-fillo 0'6" 0'6" 0" 1'Il" 1'0 1'6" 2'0" 3 6„ T 6" 5'0" 6'6" 8'0" 4,6" 10'6" 12'0.,
— -
[8-80(1 �� 0'6" CI'6„ 1 0 2'0" 3 6„ 910- 51 0" 6,6„ 7 6 8,0" 1l'6" 1J'6" 15 0"
Notes.
I. Above tables mar be used for IB 1-joist spacing of 24 inches on center or less.
2. Hole location distance is measured from inside face of supports to center of hole.
3. Distances in this chart are based on uniformly loaded joists that meet the span requirements.
4. For continuous joists with more than one span,use the longest span to determine hole location in either span.
5. A group of round holes at approximately the same location shall he permitted if thev meet the requirements
for a single round hole circumscribed around them.
N
International Beams Inc.
Sales and Marketing Office
565 Priestman Street,Suite I01,
Fredericton,Ncw Brunswick Canada L3B 5X8 1
Te1:506-457-4043 Fax:506-457-0879 J
c
�.., Poll Free Customer Service 1-866-457-4043 v
' Website:www.internationalbeamscom L___ G
y
Floor ,
FranungDetails
All nails shown in the details below are assumed to be common nails unless otherwise noted.10d box nails may be substituted for 8d common shown in details.
Individual components not shown to scale for clarity.
1 Rim Blocking Rim Board
A r Blocking panel vertical load �B F— Rim hoard vcrueal load
R transfer=2000 plf maximum, transfer=2750 plf maximum for
Rim board blocking vertical load "thickness and 3000 plfmaximum
transfer=2750 plf maximum for for l is"thickness
F thickness and 3000 plf maximum _ 7
for I Y thickness One8d nail at top and
y
"T7 7 bottom flange
8d nails((V 6"o.c.
(when used for lateral shear Attach rim hoard to
transfer,nail to bearing One 8d face top plate using Sd box
z plate No,ith same nailing as nail at each toenails(&6"o.c.
Attach IB I-joist required for decking) side at bearing
to top plate per IB
To as oid splitting flange,start nails at least
I'ri"from end of lB l-joist.Nails may he driven
at an angle to avoid splitting of hearing plate.
IB Rim Joist
ivm joist Squash Block
1Cvertical load transfer
2000 plf maximum Run board
Attach rim joist to ! bloekmgpanel per lt for lumber
1
floor oast w ith one nail squash
r
at top and bottom.Nail � blocks
must pro,idc I inch r
t
minimum pencti'ation T
�n a
' into floor joist.I oe nails -
mav he used.
Attach IB 1-joist
per 113 —� � � �
F <\ Vertical load transfer capacny per
Attach rim joist to - Minimum I V, Squash block - pair of squash blocks as shown:
top plate per IA hearing required f—�
Pair of Sgaash Blocks (Ib)
Provide lateral bracing 2 x 4 4000
Pei I N,1 B,of K'
p RvnBoard 3000
1„R, Board 2700
Solid Blocking Parallel Rim Blocking Panel
E. Load hearing wall above shall align verticalh'
I Ise single IB I-joist for loads up to with the wall below other conditions such as
2000 ph,double I-joists for loads up offset walls are not covered by this detail.
to 4000 ph(filler block not required).
Joist attachment Blocking
(F per detail lli m required over
� all interior
o,
,�, I r• a' supports
Transfer load
from above /,° _Provide backer j
to bearing below for siding 8d nails
install squash blocks Wall attachment at 6"o.c
per 1D.Match bearing sheathin unless nailahte
area of blocks below e _ Blocking panel
as required sheathing is used.
l vertical load transfer=2000 pit maximum,
to post above.
Rim board mae
Rim board blocking vertical load
he used m lieu otlB I-joists.
transfer=3000 plf maximum for Vs"thickness
Backer is not required when rite hoard is used.
Cantilever
Franung
r wt e w � �� $ � '�"w � M� '�s�e��k���✓��r�✓.lr��u �,� i�,�� �m',M �"�� �;"�,�+ r r� rM,��d�, �a�w�.
Alternate Method 2
Double IB 1-joist
Kim board,or wood structural
panel closure(o32"minimum
thickness),attach per Detail IB
— ];locking panel or ring board
blocking,attach per Detail Ili
See double IB l-joist construction
y
detail-pigure A
Blo-k IB I-joists together wish
2 U " filler blocks for the full
maumurn � wt`�i��„u 4'� � �,, length of the reinti�rcement.
x
For IB I-joist flange widths
\ r greater than 3inches
Attach IB I-joisu to top plate N 'wwa�C place an additional row
at all supports per Detail I B of IOd nails along the
3Y'min,bearing required minimum
\ centerline of the reinforcing
j, panel from each side.
y Clinch when possible,
' "y r ✓ a w�"��, r�r '��r>~"r w � r� w.. .�r" '',w'tJ a;� ,u a:.yP ,�,� th -
a s4 w2 �+$ �a x���r d'wr�?��u,"�'��r" r�'Y�w" a✓w�^.a"kk,""nw�� c`s" r w w� .. ,war t' �, a yp 9 y s "� "",w AC Vr,.
� NY r,5 r �i _rMr �r °r': r Pb��� ����'Nt��wr l"y�,r„��Y u f r�^�n,z a a^ G�� M �4 rw �' "✓�� � � dp h�k-r���'�"rw��"r
Figure A Table A
I iller blocking per
Table A - Flame Joist Filler
Width Designation Depth Block Size
gap X 2'/i IB 400/600 9Y2.' 2X"X 6"
hetwcentop \
"
flange and r IB 400600 11"it 2Ya'X 8"
filler block —
I$4001600 14" 2'/8"X t0"
Oftset nails 111400/600 t6" 2'/s"X 12"
from opposite --
face by 6" 3i4" IB 800 11'%" 3's"X 8"
— — _--
IB 800 14" 37K"X 10"
111800 16 3% X 12"
Note, — — — —.
I. Support back of 111-joistweh during nailing topm cut damage
to wehlflange conrnection.
2. 1_cas'e a Y'gap between top offil]er block and bottom of tot)
iB I-joist llangc.
3. Filler blcxk is required between joists for full length of span.
4. Nail joists together with m o rows of I0d nails at 12"o_c.
(clinched when possible on each.side of the double IB I-joist.
`Iota]of 4 nails per tootrequircd.If nails can be clinched,onto,
2 nails per foot are required
Construction details reprinted with permission of APA-The Engineered Wood Association
r�
Maximum oor SP ans
< :�. :" ,1: r,;rrr k,�.F. ,rM1,r '� ,✓:�;s",�4� �'"��Ci.�;t� � ,� < . �+.. ,r r <'". ,ra,c ..,'.a r.�.;,
Working Stress Design 100%Load Duration 40/10 Loading Glued and Nailed
Simple Span 1.480(Live Load) Multiple Span L(480(Live Load)
Series Depth 12" 16" 19.2" 24" 12" 16" 19.2" 24"
9',2" 18'0" 16'6" 15'7" 14' 1 19,7„ 17'2" 15'8" 14,0
113 400 11'/R" 21'6" 19'7" 18'2" 16'3" 23'0" 19'11" IS'2" 16'2"
(2 x 3)
14" 24'4" 22'1" 20'2" 18,01' 25'6" 22'1" 20'l" 18'6"
16" 27'0" 24'0" 21' 11" 19'7" 27'8" 23'11" 21'10" 19'6"
9%z" 19'0" 17'4" 16'4" 15'4" 20'8" 18'10" 17'9" 16'5"
IB 600 11%s" 22'8" 20'8" 19'6" 18'3" 24'8" 22'6" 21'2" 19'1"
(2x3)
14" 25'9 23'6" 22'2" 20'9" 28'1" 25'7
23'8'" 19'9"
16" 28'7" 26,1" 24'7" 23'0" 31'2" 28'1" 24'9" 19,9"
11%11 24'11" 22'8" 21'4" 19'111' 27'1" 24'8" 23'3" 21'8"
IB 80fl 14" 28'3" 25'9" 24'3" 22'8" 30' 10" 28'0" 26'5" 23'11"
(2 x 4)
16" 31'4" 1 28'6" 26'11'" 2=Ir' 34' 31'1"' 29'Y 23'11"
Notes:
1. Spans are based on a composite floor with glued-nailed sheathing meeting the requirements for APA Rated sheathing
and conforming to PRP-108,1 S1 or PS2 with a minimum thickness of1932"for joist spacing of 19.2"or less and 2%32"
for a joist spacing of 24".Adhesives shall meet APA specification AF(;-01 or ASTM 1)3498.Spans shall be reduced by one foot
when the sheathing is nailed only.
2. Minimum bearing length shall be 1%"for end bearing and 3 Y'for immediate bearing.
3. Bearing stiffeners are not required when I-joists are used with the spans and spacings given in this table.
4. The span chart is based on uniform loads.
5. Spans are centerline to centerline of hearing.
Our uarantee
International Beams Inc.manufactures and tests its products to very high quality control standards.We are confident that our products
wvill provide our customers with consistent high performance when handled and installed in accordance with our installation Guide.
We guarantee that our products are defect-free and capable of supporting loads as specified in our product literature for the life of the
structure.In the unlikely event that on receive a product that has a manufacturer's defect,please contact us to have the problem
remedied immediately.
International
Product Line
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� "rY. '" r�r,,n „,":i,:.;7. ..„'�r✓ „�,�+�E.;��,��",l z�^t1n�>�' ,a�v�i w �k� �"�zx'.ryM',� �, �,�N �z,.,- ��. �f'""^,r� ,.�,,,,., .d,„!' '„�,;
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s. ✓:- - :r`� ss '^ f tf °gym ,wrfauvn' x'xb a,rr''c 1f e„M"" 3 w +"'"
'
," '
Depth Designation Bending Stiffness Allowable Moment Allowable Shear End Reaction Interior Reaction K Weight
El M V FR IR 10° lbs/lin
10111)f in' Ibf-ft lbf lbf Ibf lbf ft
IB 400 193 2355 1080 2160 2.6
9%" 1120 4.94
IB 600 231 3245 1080 2160 2.6
111400 330 3145 1200 2500 2.9
11 7K" M 600 396 4335 1420 1200 2500 6.18 2.9
1B 800 547 6130 1280 2760 3.7
IB 400 482 3860 1200 2500 3.1
14" 111600 584 5320 1710 1200 2500 7.28 3.1
IB 800 802 7525 1280 3020 3.9
IB 400 657 4535 1200 2,500 3.3
16" 1B 600 799 6250 1970 1200 2500 8.32 3.3
IB 800 1092 8845 1280 3020 4.1
Votes: 4. The tabulated intermediate reactions lR are for aminimurnhearing
L The tabulated values are design values for normal duration of load. length of 3 Yz'without web stiffeners.
.All s,flues,except FI and[t,are permitted to he adjusted for other load 5. The tabulated end reactions IA are for a minimum bearing length of
durations by code. I tl""ithout web stitfenen.Higher end reactions are permitted.For a
2. The tabulated values for bending stiffness H,moment capacity M and hearing length of 4"the end reaction may be set equal to the shear
shear rapauts V are for a single I-joist. value.For end reactions over 1550lbsf,web stiffeners are required.
3. The tabulated moment capacty,is for a single 1-joist.For repetitive
member calculations,the tabulated values are permitted to be increased
he a repetitive memher factor of 1.07 as stated in AS TM D5055.
Listed
Listed ����
s NEW YORK CITY For information relating t0 the
IBOCA �`� �"
use oflnternutional Beam Products
�Q �� in Canada, lease refer to our
N �`iii,2 127688 253-98-M p
VOLUME 3 Canadian literature
No,9724 TM
No.5317
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9 6 ��asnachncrtta'
m DEPARTMENT OF BUILDI?\IG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSUIZANCE A F MAVIT
(li rlscrJpermittcc)--- ----
with a principal place of business/residence at:
} e s
(str Ucity/statc/zip)
do hereby certify, under the pains and penalties of penury, that.
( ) I am an employer providing the following v;orke�s compensation coverage for my
emplovees working on this job:
(InSIiT Ice Company) (Policy Number)--_--__ (Expiration Dace)
( ) I nail a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the fbUo.0g workers compensation policies:
(Name of Contractor) (Insuranoc Cornpaiy/Poticy Number) (Expiration Date)
(Name of Contractor) Compariy/Poky Number) (Expiration Date)
(Name of Contractor) (Insnanc:, Comr--mylPolicy Nrunber) (Expiration Date)
(Name of Contractor) (Insurance Comt),—ny/Policy Number) (Expiration Date)
(atiuh�.iticnil zlxc(if ne�uzsry to irtc}ude inforrttati on putaiuir_g to ell c_cy'rn�u�:.)
( ) I inn a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:ptease be await that whilo hoa=oti ixn who eruplay pc:zo;.s to 63 miiutcasnce,coa!�t-c ion or tcpau work m a dNst ing of
not mete than thrco units in which the homoowDC resides or oa tho p-,U,,ds pp utcc ai thcad arc not Gcncr111y ooasidcrcd to be
cutploym under the woticct's ceatyx=aticct Act(GL152,i 1(5)�app at on by a home oATncr for a lic-uuvc a pcfajit»Y cv�,�Lh,:
legal ctntuo of an employee under tho work",&Compensation Ad-
I understand that a copy of this rixtcmmt may ba forwwr to tho DtVwu ,i of h dur t6 al Ac idm&Offioo of Ir-ursnoe for tba
eovctage vaifieadoe and that failure to s,==eovctngo utid:s soctioa 25A of MGL 152 can Icmd to the imposition of criminal pc 96cs
oousisdm of a fine of up to S 1,500.00 and/or iaqu iwssn»tt of up to one year and civil paultics iu the form of a Stop Work Order and a
fitm of S 100.00 a day agtinsl me.
For dcpartrz�—""y
permit Number
Lot
e
Si ab=of Liccnst/Pe
— i e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: f/ Not Applicable ❑
Name of License Holder :____''��_�ce S _l� _ C5 pypr7�
n License Number
/ � /��
Address Expiration Date
Signature Cl Telephone
• � _, -�_.,, a
z9R''eeisteredNomeIm�rovement Contractor ,� r4„ � ; �„
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...... ❑
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 fey 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
a w
SECTION 5 .DESCRIPT1MOF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Otherpp[ ]
Brief Description of Proposed Work: »i �' 1;'6%k JCvAk
Alteration of existing bedroom Yes No Adding new bedroom---ZYes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a Jf&N'd h"duse antl£or',atlditi0n'to existing housing, complete the-:following_
a. Use of building : One Family__ _ T,;;o 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. _3 96 Dimensions r�� 17th
e. Number of stories? —�
f. Method of heating? L✓1r7at- C _ Fireplaces or Woodstoves P"' Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction _
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
k. Will building conform to the Building and Zoning regulations? _ 1r Yes No .
I. Septic Tank City Sewer `✓ Private well City water Supply
SECTION 7a-�OWNERAUTHORIZATION -TO BE COMPLETED WHEN
0{NNERS AGENT"O'R;'CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 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, 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
Signature of Owner gent Date
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
j Building Department
Lot Size �� ��? � 5� 1,�,
Frontage 1516 -j
Setbacks Front 6 r—' �}
7 T
Side L: R:-f� L:.__,JQ__R: 6 4
Rear ; } 1 /
Building Height
Bldg. Square Footage �% /� % � �*� /
Open Space Foota&e %
(Lot area minus bldg&paved
parking)���
#of Parking Spaces
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
IFrYES, describe size, type and location:
ae
City of Northampton S atus
Building Department Curb- u Jp�:
212 Main Street Se rlSe
Room 100 Wa er e
Northampton, MA 01060 7 aSets e a -
phone 413-587-1240 Fax 413-587-1272 Pot�/StePa
O ctfy;
APPLICATION TO CONSTRUCT, ALTER, REP'A1R, �E^ VAfEEILt A ONE OR TWO FAMILY DWELLING
_ l
I
SECTION 1 - SITE INFORMATION
NOV 2 2 2002
1.1 Property Address: ' r °� ,; This sec#lion to be completed by office
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Lot Unit
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Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current MailinS Address:
Telephone
Signature
2.2 Authorized Anent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building C 00, (a) Building Permit Fee
2. Ele(arical �� (b) Estimated Total Cost of
6G Construction from 6
3. Plumbing Building Permit Fee CN
4. Mechanical (HVAC)
5. Fire Protection p/D
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 �X5 1740
This Section For Official Use Only
Building Permit Number: 5 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
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File#BP-2003-0534
APPLICANT/CONTACT PERSON FOLEY JAMES V&COLLEEN B
ADDRESS/PHONE 10 FOREST GLEN DR (413)584-6370 Q
PROPERTY LOCATION 10 FOREST GLEN DR
MAP 36 PARCEL 003 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 23 X 17 ADDITION(BEDRM BATH&FIREPLACE)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory_Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,�IMATION PRESENTED:
_IZApproved 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 ssion
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.
BP-2003-0534
G1S#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0534
Project# JS-2003-0888
Est.Cost: $36000.00
Fee: $158.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(sg. ft.): 15333.12 Owner: FOLEY JAMES V&COLLEEN B
Zoning:URA Applicant: FOLEY JAMES V & COLLEEN B
AT. 10 FOREST GLEN DR
Applicant Address: Phone: Insurance:
10 FOREST GLEN DR (413) 584-6370 0
FLORENCEMA01062 ISSUED ON.12111102 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 23 X 17 ADDITION (BEDRM,
BATH & FIREPLACE)
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 12/11/02 0:00:00 139 $158.40
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo