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17A-050 (3) Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulatiniz Runouts Circulating-Mains and Runouts Temperature(F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 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 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) 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. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120°F or chilled fluids below 55 OF must be insulated to the levels in Table 2. MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release 1 a DATE:09/24/02 TITLE: Harder Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] I. Wall 1: Wood Frame, 16"o.c., R-19.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Vinyl Frame, Double Pane with Low-E, U-factor: 0.370 For windows without labeled U-factors,describe features: # Panes Frame Type Thermal Break? [ ]Yes[ ]No Comments: Heating and Cooling Equipment: [ ] I. Furnace 1: Forced Hot Air,90 AFUE or higher Make and Model Number 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: I. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or 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 cfin(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/112 pressure difference and shall be labeled. 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 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. I � f I I ?I �� ' i :1141 .� � f, _ ;��. ��.��� Dui ,. �i Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release la Checked By/Date TITLE: Harder CITY:Northampton STATE: Massachusetts HDD:6404 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE: 09/24/02 DATE OF PLANS: 8-22-02 PROJECT INFORMATION: Dormer and Garage Addition COMPANY INFORMATION: Diversified Const.And Services COMPLIANCE: Passes Maximum UA= 141 Your Home=94 33.3%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 717 30.0 0.0 25 Wall 1: Wood Frame, 16" o.c. 850 19.0 0.0 47 Window l:Vinyl Frame,Double Pane with Low-E 60 0.370 22 Furnace 1: Forced Hot Air,90 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifiF�ktions,and other calculations submitted with the permit application. The proposed building has been desigt qcG w uwet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release 1 a. 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/1),IVsigner Date ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE-RESIDENTIAL NEW CONSTRUCTION AND ADDITIONS //780 PMR Appendix J{-e�tive 3/1/98) Applicant Name: �! °is' °j� Site Address: ApplitairttAddress: Cityf Town: Use Group: �"! Date of Application: Ar�nlir� t 7� iCdiSvi Signature:ANN i Cen pUanm Path(aleck a"): ❑ Prescriptive P< kage(Limitecl to 1- or 2- family wood frame buildings heated with €ossil fuels only) Package (A through KK from Table J5.2. 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 Wail Area sq. tt f. waif f-yatuc R b. Grazing Meal sq. ft g. Floor R-`value R c. Glazing%,(10D x b+ h. Basement wall !3 d, Glozing Lf-vaWe Ll- Slab Perimeter r e. Ceiling R-value Heating AFUE ❑ C,-rnponefit Performance: *Manual Trade-Oft` (Limited to wood or metal framed buildings only) Gimate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Ktrksheet from Appendix J, [2nd HVAC Trade-Off Worksheet, if applicable) [,J N#AScheck Software Attach Compliance Report and Inspection Checklist printouts. ❑ Systems Analysis OR Q Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wail+Ceiling Area sq ft. b. Glazing Areal sq.ft. L_ Glazing%(.ICU x b*a) y{, Q ADDITION with GWing%(c.)up to 4Cg6 may use 780 CMR 'fable J1.1.2.3.1 below: MAXIMUM U-yaluv Minimum R•values Fenestration Ceiling kratt Floor Basement Wall Slab Perimeter, Dept 0:39- R-37 R-13 11=19 R-10 R-10,A ft, ❑ "SUNPOOM-addition(greater than 40%glazing-to-wall and ceiling gross area) Attach ^Consumer Information Form"from 78D CmR Appendira. Official's Name: Official's Signature: Appticatran Approved ❑ Denied ❑ Date of Appmva 11 Denial.- F'meson�^'-'(s);vi nisi: (provide additional details as needed on back side) Glazaz Am mxy be dtlher-ihpuilltk Opening at Unh nimermons. y" r A ' i yi 1 4 � k \ i 3 1 ; Isla.-e nc,4 y- n r"i"—Orl IL r r �vv t' �o y"L°rn at I „I nl e w o(a r,��r- n�a,� •� � 6 S+ o o C I_ Ye. en��neere I 7 acs S Cc ro I � � q 2x � I S���s i '� 5 f,,t�ua IJs• oSi „ � q oo r i FI, ro,CD --� L z o cn z z z � o o� O oe W r 0 4.�1t/JlPTt7 +�O O B [3SACll I[S[lrb e DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATTON INSURANCE A F11DA.VIT with a principal place of business/residence at: DIVERSIFIED CONSTRUCTION (phone#) do hereby certify, underB u s 8� ury, that ( an employer providing the following worker's compensation coverage for my employees working on this job: /1R ,6r12 Z 3vS75_�x fYe,070 J Gt1 GT (Insurance Company) (Polity Number) �— (Expiation ate) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worke's compen-sation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance CorrpaU/Policy Number) (Expiration Date) (attach additioml shoe(if neccu to incrude infoemiaon pertaining to all coatn, ors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that wbilo hcmcowo=wbo cmplay persom to do w jajc a� or repair"uric on a dwdliag of not mote than droa units m trhich the houtoowocr midcs oc on the Erarar3 appurtcusnt t1b�o arc Dx 11y to be cmploytirs under tl-e%cork&::com ration Act(GL152,-.s 1(5)),application by a homcon is for a x cc permit racy cvidaxx the legit swuv of an employer under the Workoes Compem&tkm Act_ I uadere-And that a copy of thin rtatcmcai may bo forwarded to tho DcVcut of indw trial Acadc Offs o of 1=--nco for tho coverage vaificatioa and that failure to secure covcmr under scetioa 25A of MGL 152 can lead to tho imposition of criminal penalties oonustiag of a fine'of up to S 1,500.00 wdlot imprisonara of up to one year and civil p..,l6.in the form of a Stop Work Ordtr and a fimo of s 100.00 a day against mc. For 1—only Permit Number WP;;----Lot# Im of Licensce/Pe e CONSTRt1CTtON SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ o Name of License Holder : ;0 � T•A�_r,u- License Number 420 Allen Rd, +BOX 168 o o Address Beekhgt0tor4 MA 01007 Exp' atio ate Signptu Telephone i 29 a YINB itngr vement'Cont actof F.. " _ N.wz " � ..` Not Applicable ❑ C Company a SERVICES, LLC Registration Number P.O. BOX 168 Address BELCHCRTOWN, Expir do to Telephone y/-?-2S-?Z-;� ,$ACTION '47-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...... ❑ � I'll 0 �11� i, me _OwnerEempt><, n 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.Aperson who constructs more than one home in a two-,ear 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 SECTI N�S DBE R Tt NOF4PROPOSED�V RK check all a liable New House ❑ Addition 9;,� Replacement Windows Alteration(s) ID— Roofing ®-- Or Doors ❑ Accessory Bldg. ❑ .Remolitionjp New Signs [ ] Deck# [pl-' Siding[Z_}--- Other [ ] Brief Description of Proposed Work: 15 �' 62 �h �crcl5e` �� Oa ,P �r2�ft cLLLvt�F4 Alteration of existing bedroom L--'Y'e's No Adding new bedroom__tow�Yes No Attached Narrative❑ Renovating unfinished basement Yes Plans Attached Roll sheet B 6a if New house a�n l 2 ddW6tVEt65d'Xi'stin ho sih °'com IditRh'e.fo11-win W-: a. Use of building : One Family L/ TWO Family Other b. Number of rooms in each family unit: Number of Bathrooms Z c. Is there a garage attached? YES- d. Proposed Square footage of new construction. Dimensions_lam, /�c Z /Z'r79 r e. Number of stories? 21 f. Method of heating? /=� V-IV, hva ene s Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction Q',�- i. Is construction within 100 ft. of wetlands? Yes o. 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 4,-' Private well City water Supply �- 3 SEC7ION �d�lE 01iIZATlON T.q BE CQMPLETED WHEN QWNERS ACS �Q&�. 0 TRACTOR APPLIESJOR BUILDING PERMIT I, r950.� S ^e �P 2CiZ as Owner of the subject property hereby authorize 1 lee to act on my be a, in all mattes relativ t work i )ize this building permit application. Z_S' ture of Owner Da e 1 c �,00�&�I as Owner u horized Agent hereby declare that the statements an nformation on the foregoing application are true and accurate, t the be knowledge and belief. Signed under the ains and penalties of perjury. l 11 Av P Print Name Dat Sign u of Owner/Agent 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 Lot Size Frontage / Setbacks Front /7Y �) i < Side L:&R:_, L: Rear 7L Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parkin ) #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? // NO L 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 i ' # 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 ther any proposed changes to or additions of signs intended for the property ?YES — No j_ IF YES, describe size, type and location: t f Northampton i ng Department Main Street 5E, oom 100 e r t ha ton, MAO 1060 gu► ©VIVA 6587-1240 Fax 413-587.1272 rl� NOaSHAV`�10N,MA � gip, t APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This sec ion obecompletedwby office 1.1 Property Address: WU ,,Zone Pk Elm St"District"' Clist�rict a SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT_ / 2.1 Owner of Record: J Narne(Print) Current Mailing Addre (- � � 0/0(0 Z, Telephone n ure _ 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMA`TD 605NSTRUCTION:COSTS Item Estimated Cost(Dollars) to be Official Use,O n(y completed by ermit applicant _ 1. Building G'. �._ (a) Building Permit Fee 2. Electrical (b).Estimated Total Cost of Construction from- 6' 3. Plumbing y 000 , _ Building Permit Fee i 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(I + 2 + 3 +4 + 5) 49 occ Check Number 1 This Section For Official-USe,Onl 1. Building"Permit,-Number: Date Issued: i `nature ! Iss�oerllnspecfo� ofI# I (riBs i . te4� f D" File#BP-2003-0329 APPLICANT/CONTACT PERSON Diversified CoN struction Services ADDRESS/PHONE PO Box 168 (413)253-2798 PROPERTY LOCATION 144 BRIDGE RD MAP 17A PARCEL 050 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: RAISE ROOF ON REAR,ADD 2ND LEVEL TO BREEZEWAY/GARAGE(2 BEDROOMS) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 030787 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 Commiss' 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. CE g,�` _ BP-2003-0329 i4% B GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building; Category: BUILDING PERMIT Permit# BP-2003-0329 Project# JS-2003-0552 Est. Cost: $38000.00 Fee: $81.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Diversified Construction Services 030787 Lot Size(sy.ft.): 11935.44 Owner: HARDER JASON C&STEPHANIE Zoning:URA Applicant: Diversified Construction Services AT: 144 BRIDGE RD Applicant Address: Phone: Insurance: PO Box 168 (413) 253-2798 BELCH ERTOWN MAO 10070168 ISSUED ON.1019102 0.00.00 TO PERFORM THE FOLLOWING WORK.-RAISE ROOF ON REAR, ADD 2ND LEVEL TO BREEZEWAY /GARAGE (2 BEDROOMS) 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: Final: Final: ie: Gas: Fire Department J himney: Rough: Oil: Final: Smoke: THIS PERMIT MAY BE REVOKED 'ON VIOLATION OF ANY OF ITS RULES AND REGULA' Certificate of Occupancy Jlj*ndiwc. Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/9/02 0:00:00 2015 $81.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Conunissioner-Anthony Patillo 0 4.�ti/rJ•lpy0 � e - Blassttc[insctta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AF MAVIT 1, (lieensee/permittee} with a principal place of business/residence at: t� e� C44 �Q ok. (�.vcity/statd2ip) do hereby certify, under the pains and penalties of penury, that: ( } I am an employer providing the follotiving tivor'kers c0inpensat10n coverage for my employees working on this job: (Insurance Company) (Policy Number) J (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors fisted below who have the following workers compensation policies: (Nome of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Lnstlrana Compmy/Po?.icy Number) (Expiration Date) (attach additiocil shed if noccss to inchuk inforavII oa paYaining to all crest;od ores) I am a sole proprietor and have no one wring for me. ( ) I am a home owner perfornsing all the work myself. NOTE:please be aware that W1nlo hoar_owixm who cmplay persoM to do n a nicaatxcc cons.•-udioa or repair Work oo a d ATIlmg of not mote than thrco units is wbid+t the lcn�trzidcs cc oa the g c' is F,,L t nAct tha-cto arc cot�cncral2y oonsidcnd to be cmployr:s undo the woricct's ccQ�ca Act(GL152,n 1(5)),application by a homeowner far a Gccsnc cc pernri2 may cvidcace the legal etahrs of an amployoc under tho W orkAves covpematio'a Act_ I underhand d"t x copy of this crntcmoa may bo forwarcW to tbo Dcvart of Ind=±,id Aocidm 015o0 of Iu-nr—for the coverage verification and that failure to secure coverage ua44�r steien 25A of MGL 152 can lead to tho imposition of CCi n sl pcualtics oomisting of a fine of up to S 1,500.00 W-00C i-pris(� of up to one ycar and civil penalties in the form of a Stop Wort;ordc and a f=o(:S 100.00 a day agatnsl mG For cicpartma>t,l use only permit Number 0� Mapf Lot Signature of Llcensee/PermiUm e P $ _ S, C`T ON 8 =CON kUdTICiN SERVICES 8.1 Licensed Construction Supervisor: C� Not Applicable ❑ Name of License Holder; Ala'r�A0 � ��—��� License Number td <c� 3�N� � �� Address Expiration Date Signature Telephone Red bme."munvemnonra� or:� „ ,,.,' � ,� Not Applicable ❑ Company Name Registration Number - 33 "old b D-U C��S Address �TrT Expiration Date Telephone 5 SECTION J0-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 buildinw 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 SECTION°5 DESCRIPTIONtOFI�ROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacen1g;Windows Alteration(s) ❑ Roofing ❑ Or Doors��`��\\'' Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Descr' tion of Proposed Work:_ 0 � C-"& Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll❑- Sheet 0 6a��lf�Neiti�h�ouse�a� �dditionto_ezisting�'hou"sing,:com':pleteth�e'��followiri�: 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? �C S 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 No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1. Septic Tank City Sewer Private well _ City water Supply SECTION 7a 7r,,OWNEWAUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING''PERMIT ) S6 N' Af&JZ ST&640 as Owner of the subject property hereby a orize /5 �0 �° '� to act on my beha , in 11 tte s rela ive o work authorized y this building permit application. Si ature of wn ` Date /� ��,�✓1 - �� � 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/Agent 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 Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (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 IF YES, describe size, type and location: _ it orthampton FS 1�1 i Department I� Q ain Street m 100 North m p on, MA 01060 e a IAA 7.12 0 Fax 413.587-1272 o St pEF'1 of BI111.Dhlt !NSPEC t t N ph 01060 Ode D ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION -This section babe completed by�`o#f��ce �� �" 1.1 Property Address: 1q(-4 istr ci t y 44 r .l p Elm`St. District :CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT ' 2.1 Owner of Record: _ f 7 £_;l Lt cf Qc7 N me(Print) C rent ai ng Ad ress: Telephone gnature - 2.2 Authorized Ascent: /, vQ AA--1 Name(Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted I— a licant 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) Check Number This Section For Official Use Only Building Permit Number:; Date Issued: Signature: Building Commissioner/Inspector of Buildings E � F `.`. BP-2003-0262 COMMONWEALTH OF MASSACHUSETTS x s' 'flso CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003.0262 Proiect# JS-2003-0460 Est. Cost: $8000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NORMAN ZALESKY 128482 Lot Size(ssq. ft,): 11935.44 Owner: HARDER JASON C&STEPHANIE Zoning URA Applicant: NORMAN ZALESKY AT: 144 BRIDGE RD Applicant Address: Phone: Insurance: P O BOX 53 (413) 268-3553 WILLIAMSBURGMA01096-0535 ISSUED ON:9113102 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACEMENT WINDOWS & ONE BOW WINDOW 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 9/13/02 0:00:00 783 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo