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22B-058 (6) U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Policy Number Frances C Wi lk' A2. Building Street Address(.including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. Company NAIC Number 45 Spring City State ZIP Cade Florence MA 01062 A3. Property Description(Lot and Block Numbers, Tax Parcel Number,Legal Description,etc.) Tax map 22B, Block 058 Lot 001 A4. Building Use(e.g.,Residential, Non-Residential, Addition,Accessory,etc.) Residential A5. Latitude/Longitude: Lat. 4 2. 3 31 9 Long. 72. 6810 Horizontal Datum: ❑NAD 1927 X❑ NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 2 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: N/A a) Square footage of crawlspace or enclosures) 493 sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawlspace or 0 b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b �— sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes f,]No d) Engineered flood openings? ❑Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Commun Name&Community Number B2.County Name B3.State Ham shire MA B4.Map/Panel Number B5.Suff ix B6. FIRM Index B7. FIRM Panel B8.Flood 39.Base Flood Elevation(s)(Zone Date EffectiveiRevised Date Zone(s) AO,use base flood depth) 2501670001 A i 4/3/1978 4/3/1978 A7 242 ' to 243 ' 310. indipate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑FIS Profile Kj FIRM Community Determined ❑Other(Describe) Bl 1. Indicate elevation datum used for BFE in item B9: R] NGVD 1929 ❑NAVD 1988 ❑Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑ No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Budding elevations are based on: ❑Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the budding is complete. C2. Elevations—Zones Al-A30,AE,AH,A(with BFE),VE,V1430,V(with BFE),AR.AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.3-h below according to the building diagram specified in Item AT Use the same datum as the BFE. Benchmark Utilized Ma S s Geodetic Survey #1 1 6 0 2Jenical Datum NGVD 19 2 9 Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 236 8 2 feet ico on y) b) Top of the next higher floor 243 7 feet t--I meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) n a. !❑feet i l meters(Puerto Rico only) d) Attached garage(top of slab) n a _❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 237 5 ®feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 240 7 ®feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 241 6 r❑X feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at !owest elevation of deck or stairs.including feet I❑meters(Puerto Rico only) structural support SECTION 0- SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION ^.is enification s to ce signed and s ealed by a and surveyor erq veer or architect authorized by aw to certify eie,,atien -formation. 1 errtFl rhat;he nformaticn on his Ced,,ficate epresent.9 my best afforts ro,nterpret the :ata 3varlacie. LP4(H MASS. _,nderstard'hat any alse aatement may ,e purishable by 5re or,morsormernt nder 18 U.S. Code, Sert.on '001 Sty C^erk Here if-cmmerts are grovtded;;n;ack cf form, ,'Mere�aUtLde and`crgrtude in Sect,on A crov ded by a WILLIAM cersed'and surveyor? _j Yes L__, No o� F. a U J :,rtif,er s Name _.tense Number N g^ William Dr 1d , Jr MA Reg # 32893 �Ie ^.omoanv Name p� Professional Land Surveyor Huntley Associates, P.C. .doress �ty State "P Code 30 Industrial Drive East, Northampton, MA 01060 i t _grature Jate '=iephcne L a /?1 171711 n ( d1 584-7444 1 FEMA Form 81-31 Mar 09 See reverse side for continuation. Replaces all previous editions i ukt00 CO ate( r Re bolt PC c-, vad e I ��t4 � a I �}lR>�4rrtj � u i Nopsed I - �CT f 4 ?r 7DNS`RTa '- Epp g a a i1 I t I �� 4 el C-1 �� t 7 � 4 r I x, F t t ti I v"_ E f y , i F i A l! well gx GYaOle X33 f w r i •\ F I i y iN fi i. -vA U Q ? `� , r H e o is s- S 10 'bc �-�, �.`� Tr �9�„ ''� �' s .� C�� �� � �� �� �; .._.... ..,;�ti. �, D i i yy 4- � z= -.�, k t°-~• fi ' �j `. S i ..�Y� � A 'p �fi �i6 � � 1j 6 � :_ r �.� -.......... .....�r..m- .._.._. � � ,,. Y 1 .... 1 u r' a br � ., Y {!''{ '� .,- rte.._.._�...._._., � 'l _:...,.. y. �y✓,p i s -� a ,. 3Po .. r \ � �. _ oiltt Vol A September 13, 2015 45 Spring Street Porch alteration. The scope of the proposed work is as follows.. • Remove existing porch roof • Remove existing porch, • Remove existing cast concrete foundation and steps • Dig new footings and place new concrete piers • Enclose area previously occupied by porch • Construction of new wood steps Owners: Douglas Thayer/ Jain Lattes 45 Spring Street Florence MA Parcel 22B-058-001 N s a4VI v 6 v � • 4-S City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: S S eP f The debris will be transported by: 0 S n a P The debris will be received by: Qer� c U J-Building permit number: Name of Permit Applicant DC)Ck(4 l u V Date Signature of Permit Applicant ]he Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): T)n(,t(4)(t �_ C((4 P V_ 13 Address: Po OON G©3 El kc P City/State/Zip: Phone#: ' S Y Are you an employer?Check the appropriate box: Type of project(required): C.[I I am a employer with 4. F] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction ��I am a sole proprietor or partner- listed on the attached sheet. 7. F-1 Remodeling r ship and have no employees These sub-contractors have g. F-1 Demolition working or me in an capacity. employees and have workers' g Y P tY• $ 9. �Building addition [No workers' comp. insurance comp. insurance. required.] 5. F-1 We are a corporation and its 10.0 Electrical repairs or additions S.❑ 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 13.0 Other employees. [No workers' comp. insurance required.] any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. isurance Company Name: _ olicy#or Self-ins. Lic. #: Expiration Date: )b Site Address: City/State/Zip: .ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify under the pains enaldes of perjury that the information provided above is true and correct. i ature: (� (� Date: hone#: 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)r❑ Name of License Holder: li `y G 5 7 61 License Number a7 l % Address Expiration DA Signature Telephone 9. Reaistered Home Imorovement Contractor: Not Applicable ❑ D04h1(,S � 1 -790 5S Company Name Registr tion Number 6117116 Address Expi ation Cate Telephone _j""s1��f 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 10835.1. 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 buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon compietion of the work for which this permit is issued. Also he 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-DESCRIPTION OF PROPOSED WORK(check all aaglicable) New House ❑ Addition ❑ Replacement windows Alterations) Roofing Or Doors ❑ �4 i Accessory Bldg. ❑ Demolition ❑ New Signs Decks [❑ Siding Other[q Brief Description of Proposed Work: J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Ye 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 Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage ew construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 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 Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT_f�I 0-(A Q 0 F as Owner of the subject property \ hereby authorize 1 U to act on my behalf, in all matters relative to thorized by this buildin ermit 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 perju O ct t t h QC Print Name 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 A Building Department Lot Size Frontage p o 6 ` d bG ' Setbacks Front god o Side L: l' 1'R:� L: _R:7_ Rear d t (I C), Building Height 90t �t Bldg.Square Footage j 1'7 I % 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 0 DON'T KNOW o YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 10 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 W 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: 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ,cv Department use only lI�F JCity of Northampton Status of Permit: $Ep , Building Department Curb Cut/Driveway Permit `� 212 Main Street Sewer/Septic Availability nc p•v,� k. Room 100 Water/Well Availability NDnnG� " j Northampton, MA 01060 Two Sets of Structural Plans # 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: `T J 4' This section to be completed by office _ Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 90 Sox 60 ,UO2 Name(Print) Current Mailing Address: Fld �j ,�uCP ./ / CAS:2(j Telephone(,J_S 3 �7 d s V�q/0 62 Signature Y d 2.2 Authorized Aaent: 06U3140 ?o 12x do 142 FCoqi,« /7, Name(Print) Current Mailing Address: ,,910 G,7 / W3 - 53o- MS C� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building _ ( 1 ®� © (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= 0 +2+3+4+5) y S (J G Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Comm issioneNlnspector of Buildings Date C"[ O(,b File#BP-2016-0317 APPLICANT/CONTACT PERSON DOUGLAS THAYER 073�� 115 114 ADDRESS/PHONE P O BOX 60322 FLORENCE011062(413)530-4785 Q r~ PROPERTY LOCATION 45 SPRING ST 100 MAP 22B PARCEL 058 001 ZONE URA(100)/WP(100)/WSP(100,) t THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE !� ZONING FORM FILLED OUT Fee Paid C7 ((A Building Permit Filled out Fee Paid Typeof Construction: ENLARGE&ENCLOSE PORCH TO MUDROOM(12 X 5) 0, New Construction , L �c I„qF Non Structural interior renovations E Addition to Existing 70 0� 57,47-AA Accessory Structure Building Plans Included: q C. Owner/Statement or License 5 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO NATION 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 o fc. ;s Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay � / «IL s 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. 45 SPRING ST BP-2016-0317 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22B-058 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-2016-0317 Project# JS-2016-000508 Est.Cost: $4500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DOUGLAS THAYER Lot Size(sq. ft.): 20124.72 Owner: THAYER DOUGLAS&JAIN LATTES Zoning: URA(100)/WP(100)/WSP(100)/Applicant. DOUGLAS THAYER AT. 45 SPRING ST Applicant Address: Phone: Insurance: P O BOX 60322 (413) 530-4785 (� FLORENCEMA011062 ISSUED ON.10/15/2015 0:00:00 TO PERFORM THE FOLLOWING WORK.-ENLARGE & ENCLOSE PORCH TO MUDROOM (12X5) 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 10/15/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner