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46-053
79 ISLAND RD BP-2019-0504 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:46-053 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADD BATH BUILDING PERMIT Permit# BP-2019-0504 Proiect# JS-2019-000823 Est.Cost: $14500.00 Fee: $94.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 23609.52 Owner: DEMETRIUS ROBERT D tonin Applicant: DEMETRIUS ROBERT D AT: 79 ISLAND RD Applicant Address: Phone: Insurance: 79 ISLAND RD NORTHAMPTONMA01060 ISSUED ON.-10/25/201$0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE EXISTING PORCH TO BATH ROOM--2 ,MEANS OF EGRESS, WIRING ABOVE 1ST FLOOR ONLY 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 10/25/2018 0:00:00 $94.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0504 APPLICANT/CONTACT PERSON DEMETRIUS ROBERT D ADDRESS/PHONE 79 ISLAND RD NORTHAMPTON PROPERTY LOCATION 79 ISLAND RD MAP 46 PARCEL 053 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC REQUIRED DATE ZONG FORM FILLED OUT F e Paid guilding Permit Filled out F e Paid I�Teof Construction: RENOVATE EXISTING PORCH T HROOM coop"k o N New C n tructi n 6f ft aks S W 1 R I N J Non Structur 1 int r' r rgnovations 0 r, f1 N(,y 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 INFORMATION 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 Permit DPW Storm Water Management Demolition Delay J /_�� 10 /Z41 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. RECEIVED City of NorthE rn ptc n OCT 2 4 2U A Building DepE rtme it � 212 Main S treetFPT.OF E3UILDING Room 1 do NORTHAMPTON,MA F Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Q p—tq-45oK 1.1 Property Address: This section to be completed by office '.79 j�LAhlb �tD Map q' (' Lot Unit 1�9Q�-^�E,AcNVt p�}1v, MA 000 j a() Zone Overlay District Elm St.District GB District- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 7Q l� ry�, � �j C)VtrP^AA P-Oa J 1A Na a(P nt) Current Mailing Address: Telephone Sig lure 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 7 t �� (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of J 115 Construction from 6 3. Plumbing t�� Building Permit Fee #qV 4. Mechanical(HVAC)5. Fire Protection 6. Total=0 +2+3+4+5) �� / Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date b t GI-errn&, LA S @ C 0 Vn co't ►--I- EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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.,,, Frontage 3 Setbacks Front _. r . Side L:L---~.` R.l.... „~...i L:L", _' R..__...._..: Rear . 1 ........... Building Height C Bldg. Square Footage i` % ................., Open Space Footage _- % - -. (Lot area minus bldg&paved E I parking) #of Parking Spaces -- - �- Fill: volume&Location) P A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:€ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page]7fj and/or Document# ` B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES WA-Tsq— it., AYDL)Ac'-='NT - D 'i>a0PUVr- VJ IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued W~ 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: vJ� E. Will the construction activity disturb(clearing,gradingye�avation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ,❑ New Signs [[3] Decks [Q Siding[O] Other[p] Brief Description of Proposed Work: ' Alteration of existing bedroom Yes—4 No Adding new bedroom Yes N Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If Now �tf 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 of new 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 I, as Owner of the subject properl�— hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, �dri �Ini ' j( j 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 p 'ns and penalties of perjury. Print Name Signature of wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone RepieLes'+AdiW[nrsat l'bve>t '!todrih fir: 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...... ❑ City of Northampton Massachusetts 's c DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Est.Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit e o er of the bove property: )uZtK Date Owner Name and Signature City of Northampton �� ss Massachusetts MIF DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton _ Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Northampton, MA 01060 9 `1 Debris 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. The debris from construction work being performed at: 71 16r.�b bzpq) (Please print house number and street name) Is to be disposed of at: VAIUCtJ1 I¢.%-;;6=l1DQNL, QIE�K4 4-rUANrJF;e%L r^(-(IJF' (Plel4se print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) a-(Y&, 16 Si ature of FF-errbit Applican r Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 ` www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): WW07T PP;AAV'T W 0rj Address: -74 14--zN O 124)PV, p City/State/Zip: �DI�c}� M� 0t0bPhone#: A113 2" ?S(o$ Are you an employer?Check the appropriate box: Type of project(required): 1.[:]I am a employer with employees(full and/or part-time).* 7. E]New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.EJ Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#I 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. $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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veriftcati n. 1 do herebycer 'y nder t e pains idpenalties of perjury that the information provided above is true and correct. Si nature: Date: 0 Phone#• ,@ 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#: 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 Liability Partnerships(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 Department 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia 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: `77 1G►�4�(p t2(PPry, The debris will be transported by: VIF4- IGL O The debris will be received by: V2t1,V 'R 6ACU nrSPM e' . Building permit number: Name of Permit Applica k0y2c- 'T tx Nw 6-T-W UY--' lC) Date Signature of Permit Applicant City of Northampton 'l I Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 7` 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings(before backfill), sonotube holes(before pour), a rough building inspection (before work is concealed), insulation inspection (jf require and a final buildingins ecp tion. The building department requires these inspections before the work is concealed, failure to secure these inspections can result In failure to obtain a certificate of occul2ancy until the work can be ins ep cted. If the homeowner hires other trades to perform work(electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issu d, and that they get their required inspections. Failure of the individual trades to secure the permil ndins ctio as required can DELAY the project until such time as the proper permits and ins cions are made I, understand the above. ( ome owner/resident's s' nature requesting exemption) I w/ I call to schedule all required building inspections necessary for the building permit issued to me. Date i Address of work location Q IeZL I tyb V-6Ao 00 I Hl 0 PROPOSED RENOVATED WEST ELEVATION ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 79 Island Rd 9 City Northampton State MA ZIP Code 01060 Company NAIC Number. If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. pQ— FEMA Form 086-0-33(7/12) Replaces all previous editions. �f • X. kI Ple f:•r�.' t Form 086-0-33 Replaces a • -• ELEVATION CERTIFICATE,page 3 Building Photographs See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number. 79 Island Rd City Northampton State MA ZIP Code 01060 Company NAIC Number. If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken;"Front View"and"Rear View"; and, if required,"Right Side View"and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.If submitting more photographs than will fit on this page,use the Continuation Page. ...� r Wi, y . t FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE,page 2 IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 79 Island Rd City Northampton State MA ZIP Code 01060 Company NAIC Number: SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenf/company,and(3)building owner. Comments Signature Date SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B. and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is _. ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is �._ ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ,.` ❑feet ❑meters ❑above or❑below the HAG. E5, Zone AO only: It no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E correct to theftipst of my knowledge. �j Property Owners or Owner's Authorized Representative's Name 4De-,C-IZT CPEM f�;-T12J Addressrs�N Clty State ZIP Cot e Signature Date r _ _ /I Telephone 4) 2� y; 7 SPP Comments ❑Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: __ ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum _ Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions. U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No.1660-0008 Nationall7ood brsurmree Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name RobertDemetrius Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number. 79 Island Road City Northampton State MA ZIP Code 01060 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Assessor's parcel 46-053,Deed Book 5627,Page 251 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)_ A5. Latitude/Longitude:Lat.42.2939 Long.-72.6226 Horizontal Datum: ❑ NAD 1927 ® 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: a) Square footage of crawlspace or enclosure(s) 700 sq If a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 3 within 1.0 foot above adjacent grade c) Total net area of flood openings in AB.b 864 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes (D No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number 82.County Name 133.State 250167 Hampshire MA 84.MaplPanel Number B5.Suffix B6.FIRM index Date 87.FIRM Panel B8.Flood B9.Base Flood Elevations)(Zone 0002 A April 3,1978 EffectivelRevised Date Zones} AO,use base flood depth) A13 123 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: 811. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 812. 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. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction' © Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARAE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:RM 11 Vertical Datum: 121.10 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 115.74 ®feet ❑meters b)Top of the next higher floor 123.15 ®feet ❑meters c)Bottom of the lowest horizontal structural member(V Zones only) 122.32 ®feet ❑meters d)Attached garage(top of slab) NA. E feet ❑meters e)Lowest elevation of machinery or equipment servicing the building 115.72 ®feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 119.3 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 120.5 ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 119.0 ®feet ❑meters SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I certify that the information on this Certificate represents my best efforts to interpret the data available. �tN OF I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. Elo UCheck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �.ic BR/1 �A ❑ Check here if attachments. licensed land surveyor? E] Yes ® No CE m COOMBS Certifier's Name Bruce A.Coombs License Number 27814 No.27814 Title President Company Name Heritage Surveys,Inc. STERE Address PO Box 1,Clark St City Southampton State MA ZIP Code 01073At gps Signatur Date 3 0,// Telephone 413-527-3600 FEMA Form 086-0-33(7112) See reverse side for continuation. Replaces all previous editions. } PROPOSED RENOVATED SOUTH ELEVATION Re-flash chimney with new roof '_ Double 2"X 10"Header --.� Flashing(new roof into existing south exterior wall) 25 YR asphalt shingles Architect _ 30"rubber ice dam sheathing 1/2"plywood sheathing -- 2"X 12"Rafters 16"OC 2"X 8"ceiling joist 16"OC Remove existing window,close Triple 2"X10"header - --- -- in and install new cla boards. Cedar clapboard siding Remove existing porch roof - - - - - and exterior walls. 1/2"plywood sheathing - ^---- — — Vaporbarriersheathing Vapor barrier sheathing 6"fiberglass insulation R19 - - -- -- 2"X 10"joists 16"OC -- ------ - 2"X 6"sill plate -- -- Sill insulation PROPOSED RENOVATED SOUTH ELEVATION Z 10 0 KITCHEN 7!1 6"Cast Iron Sewer Pipe • � : Tie new bathroom into • Existing sewer stack C ■ M DINING ROOM i • i • i)v2'-6„` K "'-CLO. • • Q ••`--� pR T • a CLO. 5'o' LIVING ROOM HALF_- BATH °t • 11'-1' C+J Of Louis Hasbrouck<Iasbrouck@northamptonma.gov> Forthu rwttm .................................................... ......................................... ..... ......... ......... ......... .. ........................... 79 Island Road Louis Hasbrouck<Iasbrouck@northamptonma.gov> Wed, Oct 24, 2018 at 7:00 PM Draft To: bob demetrius<b.demetrius@comcast.net> Robert, I've approved the permit for your bathroom at 79 Island Road with 2 stipulations; The bathroom will eliminate the door on the southwest corner of the house.The house still needs to have 2 doors to the outside. I can see the door onto the porch on the east side;where is the other exit door? All electrical work must be done above the 1st floor level because of the base flood elevation. You could have your electrician contact the wiring inspector to discuss it. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax