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17A-306 (2) F t' i Vol ro a u a w r x C 5� 1 N y� »� r ••••rii lil •1ii♦ ♦IIiI ♦11 ♦x111111 i11 1/1111111111 1 ♦11x11 111111♦ 1111♦ ♦11111111 � ,�. - � �-�. �� ':Y rv. "may° �"�'r"�..,is "M"€ •.€.-. s � CONSIIOM0-M0WRT1IONI FORM ,SUNROO W Appen MS". Ma'ssac asetts State Bdmg Cod80 CMRii J;Section JI:1.2'31) The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix J, Section J 1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selectng and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a "sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation -Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual property owner(not the owner's agent or representative) acknowledge receipt of this CONSUMER INFOKMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in th' d t concerning sunroom comfort and energy conservation. I L�4 Signature of Actual Building Owner Date Print Name Address of Permitted Project �-Dr -0rsr Owner Address(if different than project location) Owner's telephone number 7 x 1 � - � � �' u -r ✓'�'�' C � ,� , 7 X I i- w � � � � � � � � i � �� / C �1^� � � o ��- © ��� eat � ��'� �'°�.� �" . /�, 06 3- � do . �� / � 7 � ( • =r 4134431053 P010`1 06-20 00r 14 '0616 EPT�FPUSLI'CiSAEETY .,, , ENERGY CONSERVATION,APPLICAT"•FO.14M FOR LOW-RISE-RESIDEUTIAL-NF—W CONSTRUCTION AND ADDITIONS, { 780 PMR Appendix J-(effective 3/1/98) App1i cant Name: A,p n4y;J rrs/t'te Address: Applicant Address: +t U(RNS`T ,_jZL i t_ 0ty/Tnwn: E rdeE Fl b&rIC E I'1 o9 ®[o 0- Use Group: Date of Application: 2 Applicant Pho.t►- Jf" �-C,i5-I Appfication Signature: CempHanoe Pads(check one): ❑ Proscriptive Package(L.imitea to l--or 2- family wood frame buildings heated with fossil fuels only) Package(A through KK from Table J5.2. lb):_ Heating Degree Days(HDDgs)from Table J5.2 la: (For items d, through i.,fill in au values that apply from Table J5.2) a. Gross Waif Area sq.ft f. -WallftYah - 13- b. Glazing Area? sq.ft g.- Floor R•Vafue R C. Glazing-x.(100 x bra} h: Basement wall R_ d_. Glazing U-Yat,,- Li_ i. Slab Forimeter R. e. Ceiling R-value 8 1. Heating-AFUE C.,,mponWi Performance: 'Manual Trade Off` (Limited to wood or metal framed buildings only) ClirmaWZore(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach trade-Off Wb(ksheet from Appendix J,[and HVAC Trade-OtfWorksheet, if applicable) ❑ MAScheck Software Attach.Compliance Repod.and Inspection Checklist printouts. ❑ .Systems_Anatysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engiromr Analysis -ALTERNATIVE FOR ADDITIONS ONLY: a. Gloss Wall +Ceiling Area sq. ft. b. Glazing Areal sq.ft. L_-Glazing_%(100 x b+a) AAA .❑ ADDITION witb Glazing%(c.)up to 4.0%may use 780 CMR Yable J1.1.2.3.1 below: MAXIMUM U-value Minimum R•Values Fenestration Ceiling Wolf Floor Basement Wali I Slab Perimeter, Dept 033 R-37 k--13 K19 ' R-10 R-10,4 It- k`SUNROOM'addition (greater than 40%glazing-to-wall and ceiling gross area) A ch 'Consumer Information Form'from 78G CMR-Appondir8, Official's Name: Official's Signature: Appticah n- Approved [] Denied ❑ Date of Appro al/Denial: Reason(s)or uUmd : (prvride additional details as needed on back side) a,x„� t Asea=my be or Unh Tkmmuons, 06-26-00 14:01 TO:DEPT OF PUBLIC SAFETY FROH:413 4999444 P61 i . 4�1�PTO goo `g �x tllf wart 4aill hall 9 Blxsaxchnsctfa' b _ m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 y WORICER'S COMPENSAITON INSURANCE AFIMAVIT _ C ft L Cj V/'+1-f—sJ cIx- (licenseeJpermittee) with a principal place of business/residence at: ?r 4- P a /30,,X, TZ,S -C14e5 �qi" (phone#) (V(VX4W--kd (streeticity/statrJrip)do hereby hereby certify, under the pains and penalties of perjury, that: O I am an employer providing the folloltving worker's compensation coverage for my employees worldng on this job: (InSumuce Company) (Policy Number) (Expiration Date) ( ) 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: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compaay/Pokcy Number) (Hxpuation Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional t+stet ifntoc=xzy to include infonn+hofl pertaining to ell 000tradon) O I am a sole proprietor and have no one worldng for me. ( ) I am a home owner performing all the work myself. NOTE:please be n vart that wtri]e homcowixra wtso employ pawns to do maintcaancr 000str=c'cl ar rcpair work on a dwelling of not more than theca units in which the hombor%mcr resides or oa the grounds appurtcmant thr;cto arc not gcaavily comidcrcd to be employers under the wort s coarp=sation Act(GL152,sa 1(5)),application by a homcowar for a lactase oc permit may cvidcaoc the legal etxtua of an employer under thn Workeet Compoo:Lei AeL I underhand that a copy of this ctatcmcai may be fo:wwr iad to tbo Departmcol of lo&zu l Aoodm&Offioo of Lurie*ao°for tho oovaage vaificatioa and that fail=to scatre coverngo under sodion 25A of MGL 152 can lead to the in>posdion of criminal penall:es oornixtii of a fine of up to S 1,500.00 and/or imPrisorrma#of tip to ow-year and civil pcnaltits in the form of it Stop Work Ord and a fmo of S100.00 i day tgLiwl me- FCC mortal uac only Permit Number Lot tt Signature of LiccnseclPermittee Date SECT�jO�N�8 aCONST=�2l1CfTION,>5�ERYICE� � ' 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone t MMM e r ff e,: r �. me n Not Applicable ❑ ie 4 JC ( 3aio3 Company Name Registration Number Fla . �n� Address Expiration Date OOLY Telephone 41 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 affid� 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)famili( 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( 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 ECTION ` D�ES IP It �0'FPROPOSEDaWO gala 1ic'abte ,3 = �".A�..;!fi_31d!rs syr,y� ...�A ysi,._, ak3tk!1?f3kM �,4,'• .,x�,z.,d�_m�v.i3 aM,..3,LsXa R „hN,,., s N v9 ..!i+fiS f�1,331.� �R -: .... .:T , New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: � � "�i �l'"� � SCP-F-64ap FOKC 1+ 1Z Alteration of existing bedroom Yes_�_ No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes -"r No Plans Attached Roll ❑- Sheet* sa Ifi New house ari"d or addition''to'yezlsthl"I lying comple a the=f611, in : a. Use of building : One Family Two Family Other WA 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. 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 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 OW ,R S CONTRACTOR ARP.LIES,-'FOR:I3UILbING'PERMIT as Owner of the subject proper hereby authorize 'Lce- ' to ac. my behalf, in all tter, relative to work authorized by this building permit application. JZ ( 0 Signature of Ow er Date ri IT ei V'4 LC-r C [x as Owner uthorized Age hereby declare that the statements and information on the foregoing application are true and accurate, to y knowledge and belief. Signed under the pains and penalties of perjury. WUL ES ALC--d C 1 K- Print 1 ' Signature of Owner Agent Date d f 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 Building Department 17I1v 5 Lot Size Frontage P4! "� Setbacks Front Side L: R: •- L: Rear Building Height , Bldg. Square Footage G p % Open Space Footage / % T`f (Lot area minus bldg&paved p j parking) 4 a #of Parking Spaces 4 + Fill: � A 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 kf 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: f . 1 Northampton EB it i g Department Main Street ?�C� oom 100 i DEC - 7 No n1pton, MA 01060 phone 4 87-1240 Fax 413-587-1272 0 / a e L 1;, �� ; ,crG �lr.NS DEPT nF B l „f, .t . C. ( e _ ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This sectio o becompl'' teed by',Aff�ce f 1.1 Property Address: g- l LL CAS f L��'l✓F Ma P Lot nit Ft-o tzErj c Zone= 4uve la}r District f Elm St. District GCB D strict ''L' SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 41114117t6wi, -, 77 kllete-4c- s--7 It. Name(Print Curre Mailing Address: Telephone Signatu e 2.2 Authorized Agent: / � " S V�i��C�c l K P k 5Z s" �h -✓ i , ,Nt �ja1� N p P rint) .� � Current Mailing Address: Signature T lee phone SECTION`3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building ) (a) Building Permit Fee I �roo 2. Electrical (b) Estimated Total Cost of If CIV v " Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 + 3 + 4 + 5) d d Check Number This Section For Official Use Only Building Permit Number: - '2� Date Issued: Signature: Building CommissionerAnspector of Buildings Date r File#BP-2002-0573 APPLICANT/CONTACT PERSON CHARLES VALENCIK ADDRESS/PHONE P O BOX 565 (413)296-0226 PROPERTY LOCATION 77 HILLCREST DR MAP 17A PARCEL 306 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildine Permit Filled out Fee Paid Typeof Construction: CONVERT 3 SEASON PORCH TO LIVING SPACE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 063354 3 sets of Plans/Plot Plan THE F9LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFMATION 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 19 -13-01 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. I HILLCREST DR BP-2002-0573 GIs#: COMMONWEALTH OF MASSACHUSETTS = 8ocki 17A-306 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002.0573 Project# JS-2002-0890 Est. Cost: $19000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHARLES VALENCIK 063354 Lot Size(sq. ft.): 21823.56 Owner: KESIN HOLLY B&ANDREW M Zoning URA Applicant: CHARLES VALENCI K AT. 77 H I LLCREST DR Applicant Address: Phone: Insurance: P O BOX 565 (413) 296-0226 CHESTERFIELDMA01012-0565 ISSUED ON.121141010:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT 3 SEASON PORCH TO LIVING SPACE 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 12/14/010:00:00 2625 $90.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo at T� Plumbing ❑ Building ❑ Electricals � a City of Northampton ; BUILDING INSPECTION LABEL APPROVE 2��6 nspector fewc l/ ) Date_ 77 HILLCREST DR BP-2002-0573 CIS#: COMMONWEALTH OF MASSACHUSETTS Ma:Block: 17A-306 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0573 Project# JS-2002-0890 Est. Cost: $19000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CHARLES VALENCIK 063354 Lot Size(sg ft.): 21823.56 Owne,-: KESIN HOLLY B &ANDREW M Zoning:URA Applicant: CHARLES VALENCIK AT. 77 HII_LCREST DR Applicant Address: Phone: Insurance: P O BOX 565 (413) 296-0226 CHESTERFIELDMA01012-0565 ISSUED ON:12114101 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT 3 SEASON PORCH TO LIVING SPACE 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: /�Q/d� Rough Frame:0t Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:ok- a-L/—(q o THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON V>'N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/14/010:00:00 2625 $90.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo