22B-011 (9) BP-2022-0600
140 MEADOW ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-011-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0600 PERMISSION IS HEREBY GRANTED TO:
Project# DECK Contractor: License:
Est. Cost: 10000 JAMES MAILLOUX 081694
Const.Class: Exp.Date: 10/16/2023
Use Group: Owner: GROW FOOD NORTHAMPTON INC
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: JAMES MAILLOUX
Applicant Address Phone: Insurance:
221 PINE ST SUITE 160 (413)585-1592 WCT0721Q
FLORENCE, MA 01062
ISSUED ON:05/27/2022
TO PERFORM THE FOLLOWING WORK:
4X4 FREE STANDING DECK
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: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
e, V • .>2 •
Fees Paid: $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
a*
he Commonwealth of Massachusetts
MAY 2Office of Public Safety and Inspections
6 20Qz Massachusetts State Building Code(780 CMR)
Buildig P mit pplication for any Building other than a One-or Two-Family Dwelling
'( crPr oFgU� (This Section For Official Use Only)
N�"rr i loin C IN
Building Perms q H 1 mate Applied: Building Official:
J4/0 MEAO0 w S SECTION 1:f7741/10tiC C d/06 Z
No.and Street City Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration ❑ Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy,,} CIOther 0 Specify:FREE 51hvPI rVG' PlAt rni Rower
we r
rrte
Are building plans and/or construction docunts being supplied as part of this permit application? Yes IBA No yIs an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work:
sl.� 9' 4" bee S te+-o,N� Deck I,/S��rf
!Z-� k// 3 it 61,A-1 POoo p/4/h
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
•
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 Cl Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB 0 IIA 0 IIB ❑ IIIA 0 IIIB 0 IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site 0
A required 0 or trench or specify:
/7 Private 0 or indentify Zone: 7 or on site system 0 permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
�a�i✓ zai A/t/Ito V Ui Prot Ft rent; d/vi '�
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
- q7( 9 s &3 ,mot,c 02-4-
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
4. -Afer ,nd4i1
Company Name
• GS 8/‘9 4'
Name of Person Responsible for C9nstruction License No. and Type if Applicable
ZZ2t You, $r S�-it /go Tor 4,6e ^4 v/ptZ
Street Address City/Town State Zip
2; -s?3- wry fri ,/c/od te)ovfn.,J . cols
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee TI W (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 0 Qfp (contact municipality)and write check number here I 3 ytS"
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurat bes of my knowledge and understanding.
y/7 slit 5/24/,?
Please print and sign name Title Telephone No. Date
71 . Fxic,etL4 "4 01 chi i
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: iiI' `'� " �� a-•
aa.
Name 0 e
'�— The Commonwealth of Massachusetts
. =7, � r� Department of industrial Accidents
='.' =-�n / Congress Street,Suite 100
Boston. MA 02114-2017
vows
:,111 14-- w►titn nitlss.goil/dia
14ukers' ( uttiI eIlti:ttiuli Iii,uranceAffidasit: 13uilticr•ti.1('ontractorsfEtectriciansll'lumbers.
I(► III. I I I L I)%%I 1II 1 111: I'I.f('tl l l I'1N( Al 1•t1ORfl•Y.
Applicant information PleAst' Print 1.t ihl%
Name(Rosiness,'OrganlzatiorL'individual): /101 /✓/A/
Address: - - e f kto $ 1 5-tr. IGd
City/State/Zip: �-�7-rn, aidt Zone sT's �sf
Are to an emphncr'(lurk the appropriate rwrt: Type o roject(required):
I.'1ant a employer with 2/ect$r3owes(full and or part-time)-" 7. Nc\y construction
20 I ant a auk pcupnetur or purtnenhip and have no employers working for nx m S. i, Remodeling
any eapanty.[Nu workers'comp.insurance required]
t.-..7a
9. p Demolition
31:j 1 am a ho is sa ner doing all work myself.iNo workaxs'comp.Insurance n.sit aired]
10❑ Building addition
4.0 I ant a homeowner and will be berm&aurora•tors to conduct all work un my property. I will
ensure that all oYmtrra fun either have workers'compensation insurance or are sole. I 1.a Electrical repairs or additions
proprietors with no employees.
I2.®Plumbing repairs or additions
50 I ant a general contractor and I have hired the sub-conuactors listed on the attached Arec'1.
These sub-contractors base employers and hate u urkers'comp.insurance.' I a'❑RWt repairs
14.0 Othet
6.0 We are a evaporation and its officers have exercised then nght of exemption per?JUL e. —
I §1(4).and we have nu employees.[No workers'comp.insurance required.]
*Any applicant that checks boa ttt mast also till out the sectitnt below showing,their workers'compensation policy information.
i Homeowners who submit this affithivu indacatine they arc doing all work and then hire outside contractors must submit a new affidavit indicting suck
lContracturs that check thin bus must attached an additional sheet showing the name of the ante-earnr-a tors and state whether or not those entities have
employees. If the sub-contractors bro.:employees.they must pnwide their .t orkers'arrnp policy nuanber.
I am an employer that is providing►vurAer%'compensation insurance,fr r my employees. Be'lint'is the policy and job site
Information. ,� /�
Insurance Company Name: frrl tOJJA' u 4 IVGC Nit
Policy#or Self-ins. Lie.#: 1n/C r 0 (. Expiration Date: 10%/72'
Job Site Address: i 40 /41-E1'Wit) "r` City/StateJZip: FPt a/0117-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under A1GL c. 152. M25A is a criminal violation punishable by a fine up to S1.500.00
andior one-year impnsonment,as%sell as civil penalties in the fora ofa STOP WORK ORDER and a fine of up to S250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance
crag vertfieatit.an.
do hereby cert. •at cry tins and penalties of perjury that the information provided aba►'e is true and correct.
Sitnature: 14 Date: C121/2 Z-
Ill.uriC a' '71jj SyS /S�1
Official use only. Do not rtvire in this area. to be completer)by city or toxin officiaL
t'ity or Town: I'ermitlLicentte#
Issuing authority (circle one):
I. Board of Health 2. Buildint;Department 3.('ih/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
In.Other
t (intact Person: Phone#:
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U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2) insurance agent/company, and (3) building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Grow Food Northampton, Inc.
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
140 Meadow Street
City State ZIP Code
Florence(Northampton) Massachusetts 01062
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Assessors' Map 22B Lot 11 Hampshire Registry of Deeds Book 10488 Page 108
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) Vacant,Agricultural Use
A5. Latitude/Longitude: Lat. 42.333489° Long.072.679898° Horizontal Datum: ❑ NAD 1927 0 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2. County Name B3. State
Northampton, MA 205167 Hampshire Massachusetts
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
0001 A 04-03-1978 04-03-1978 A7 242.8'
B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in Item B9:
FIS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 89: 0 NGVD 1929 ❑ NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes 0 No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6
OMB No. 1660-0008 •
ELEVATION CERTIFICATE Expiration Date: November 30,2022
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:
140 Meadow Street
City State ZIP Code Company NAIC Number
Florence(Northampton) Massachusetts 01062
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑x Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: City of Northampton see comments Vertical Datum: NGVD 1929
Indicate elevation datum used for the elevations in items a)through h) below.
Q 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) — ❑ feet ❑ meters
b) Top of the next higher floor ❑ feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑ meters
d) Attached garage(top of slab) ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building ❑ feet meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building (LAG) 237.9 ❑ feet ❑ meters
g) Highest adjacent(finished)grade next to building (HAG) ❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including
structural support ❑ 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. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? Yes ❑No ❑Check here if attachments.
Certifiers Name License Number
Emily B. Holmberg, PLS 34308
Title r ,ti,�"" "
President
Company Name C
r`:S F�t3
Holmberg&Howe, Inc.
Address — ` A����
hf"
PO Box 945
City State ZIP Code "���
Easthampton Massachusetts 01027
Signature Date Telephone Ext.
((�G Oct (OS(Zpz( (413) 529-1700
Copy all pages of this ElevatL Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
A4:The property is currently used for agricultural(food production). The intent is to install an electrical panel and meter above the base
flood elevation.
A5: Latitude and longitude was determined using Google Earth Pro.
C2: Benchmark was supplied by the City of Northampton Engineer and identified as TBM 13 Spring St. reconstruction, 242.90'NGVD
1929
C2f: Elevation was taken at a set stake where the electrical equipment is proposed to be set.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
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:
140 Meadow Street
City State ZIP Code Company NAIC Number
Florence(Northampton) Massachusetts 01062
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 El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—E4, use natural grade,if available. Check the measurement used. In Puerto Rico only,
enter meters.
El. 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 El 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 1-2 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: If 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 are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
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:
140 Meadow Street
City State ZIP Code Company NAIC Number
Florence(Northampton) Massachusetts 01062
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(including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022
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:
140 Meadow Street
City State ZIP Code Company NAIC Number
Florence(Northampton) Massachusetts 01062
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.
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Photo One
Photo One Caption Proposed location looking south September 1,2021 Clear Photo One
gia '
4
. t
', ; ,:- 4
7ti.
Photo Two _.
Photo Two Caption Vicinity photo of proposed site looking south August 31, 2021 Clear Photo Two
Form Page 5 of 6
FEMA Form 086-0-33(12/19) Replaces all previous editions.
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30,2022
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:
140 Meadow Street
City State ZIP Code Company NAIC Number
Florence(Northampton) Massachusetts 01062
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.
Photo Three
Photo Three
Photo Three Caption Clear Photo Three
Photo Four
Photo Four
Photo Four Caption Clear Photo Four
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6
City of Northampton
P
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS tff
212 Main Street • Municipal Building
Northampton, MA 01060 rI.,y .A,.��`�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: / `/a ri
The debris will be transported by:
Name of Hauler: J EL- F ir,//ev
Signature of Applicant: Date: