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22B-058 (5) BP- 2011 -0350 GIS #: COMMONWEALTH OF MASSACHUSETTS Its .s CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0350 Project# JS- 2011 - 000584 Est. Cost: $45000.00 Fee: $270.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. Al 20124.72 Owner: THAYER DOUGLAS Zoning: URA(100) //WP/WSP Applicant: THAYER DOUGLAS AT. 45 SPRING ST Applicant Address: Phone: Insurance: 212 NORTHWEST RD (413) 527-4491 WESTHAMPTONMA01027 ISSUED ON :1012712010 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT BEDRM TO FULL BATH,REMODEL BATH, KITCHEN & INSTALL REPLACEMENT WINDOWS 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 10/27/2010 0:00:00 $270.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck - Building Commissioner File # BP- 2011 -0350 APPLICANT /CONTACT PERSON THAYER DOUGLAS ADDRESS /PHONE 212 NORTHWEST RD WESTHAMPTON (413) 527 -4491 Q i,J i i�l. - (C+ � Ib PROPERTY LOCATION 45 SPRING ST MAP 22B PARCEL 058 001 ZONE URA(100) //WP/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: CONVERT BEDRM TO FULL BATH,REMODEL BATH, KITCHEN & INSTALL REPLACEMENT WINDOWS New Construction Non Structural interior renovations 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 INF ATION 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 /d Zj 1 110 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton MA 01060 Two Sets of Structural Plans phone 413 -507 -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 (! 7 1.1 Property Address 5 .Spv C This section to be completed by office vt S I'lo+ iI Apl oh 11A o i U � 2 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record D r21AalaS T�ak r 12 )y 0r t,,t5� �o( Name (Print) Q Current Mailing Address: Vos4kaN!!*dw 1`1,4 O i 0 ; 2 7 z Telephone Signature 9 / 3 5.2 7 - y q l 2.2 Authorized Accent: 1 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 1 - 7 1 0 0 6 (a) Building Permit Fee 2. Electrical G (b) Estimated Total Cost of O 000 Construction from 6 3. Plumbing 006 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 600 6. Total= 0 +2+3 + 4 + 5 ) Soon Check Number This Section For Official Use Onl Date Building Permit Number_ Issued: Signature: Building Commissioner /Inspector of Buildings 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 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 paric ing) 4 of Parking Spaces Fill: (volmne & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW XX YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO jV DONT KNOW Q YES a IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 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 O NO Q5 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable} El New House ❑ Addition ❑ Replacement endows Alteration(s) ❑ Roofing Or Doors Accessory Bldg, ❑ Demolition ❑ New Signs g [C7] Decks [Q Siding [p] Other [[J Brief : Kp ' n of Proposed Work ac n 1 . 1 c 1 C �l � '� Now : D! n t �..ivr�owS ►to Pva e � �r ?h acrd flu Q ne.v «P DJ« .�. Alt bedroom Yes No Adding new bedroom Yes _ No ttached Narrative ' Renovating unfinished basement Yes _ No Sheet 6a. If ew house and or addition to existing housing, comp lete 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 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 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I ° ( u c! - T as Owner /Authorized Agent hereby declare that thek4tatements and infornihtion 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 ~l gnature er /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor. 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.__... ❑ C; Home Uwner Exem tion The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one(]) 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 1083.5.1. 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 tvo 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 aQ 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 of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Orga=tion/Individual): AtIr C, Address: VA., 0)d City /State /Zip: l AleyA et v>r /4 Phone.#: y(� S o2 7 - � ycf Are you an employer? Check the appropriate box: Type of project (required): / 1. ❑ I am a employer with 4. � I am a general contractor and I employees (full and/or part- time). * have hired the sub- contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no enTloyees These sub - contractors have g. Demolition working for me in any capacity employees and have workers' 9. -EJ - -J Building [No workers' comp. insurance - comp. insurance.$ _ required.] 5. We are a corporation and its I( t4 Electrical repairs or additions _ I am a homeowner doing all work officers have ,,exercised their 1&iPlumbing repairs or additions myself. No workers' comp. right of exemption per MGL 12. Fl Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insuran required] Any applicant that checks box 91 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. =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 Addr 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 requited under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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' fire of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi¢ations of the DIA for insurance coverage verification - I do hereby certi u pat penalties of perjury that the information provided above istrue arid_corrert Si tore: 2 ate: - (� - l - U _ Phone.* 1 2 7 Official use only. Do not write in this area, to be completed by city or town official Cii ' or To'rcu5 - . r r ermittUcense # _ 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 house use 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 reauirements of this chapter have been presented to the contracting authority." Applicants Please fill out the w orkers' comnen. affidavi c oirpletel3;b3� ck g hebex s} {gin- if _ - necessary, supply sub- contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insuran 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 anybusiness or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required.to complete this affidavit.. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate Tfie ISepirtment's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 640 Washington Street Boston, CIA 02111 Tel. # 617- 727 -4904 ext 406 or 1- 877- MASSAFE Fax # 617- 727 -7749 Revised 11 -22 -06 x wv v.mass_gov /dia HOME OWNER EXEMPTION ACKNOWLEDGEMENT r [ 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 persons) who, seek to use the 'honre 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/footinsa (before backrdl), sonotube holes (before your), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these i can result in failure to obtain a certificate O occupancy until the work can be inspected. 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 �ermits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, D4 e r understand the above. .(Home own resident's signs re requesting exemption) I will call to schedule all required building inspections necessary for the building permit i ssued to `i me. Date 1 1 Address of work location �h s October 19, 2010 City of Northampton Building department Building Permit for 45 Spring St, Northampton, MA Douglas Thayer 212 Northwest Rd, Westhampton, 01027 Scope of renovations First Floor • Install replacement windows (7) and exterior doors(3) • Remodel existing bathroom • Remodel existing kitchen • Drywall and paint as needed • Relocate boiler room to utility closet on first floor • Install wall hung boiler and add 2 heating zones Second floor • Install replacement windows (4) • add (8) receptacles and 3 switches • convert Bedroom (c) to a full bath • Drywall and paint as needed. U S DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE I OMB NO. 1660 -0008 Fr -deral Emergency Management Agency Expires March 31, 2012 Rational Flood Irsurance Program Important: Read the instructions on pages 1 -9. SECTION A - PROPERTY INFORMATION For Insurance Company Use: .Al. Budding Owners Name Policy Number Frances C 1 ,2. Bwid ng Street Address (ncludmg Apt., init, Suite, and,or Bldg. No.; or P O. Route and Box No. Company NAIC Number 45 Sprin - ity State 7 1P Code Florence MA 01062 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Tax man 22R, Block 058 Lot 001 44. Building Use e.g., Resident +al, Non - Residential, Addition, Accessory, etc.) Residential A5. LabtuderLongitude: Lat. 4 2 . 3 3 19 Long. 72 . 6810 Horizontal Datum: 0 NAD 1927 NAD 1 A6. Attach at !east 2 photographs of the budding if the Certificate is being used to obtain flood nsuronce. A7. Budding Diagram Number 2 48. For a building with a crawlspace or encicsure(s): 19. Fora building N+th an attached garage: N /A i i Square footage of crawlspace or enclosure(s) 4 9 3 :q it a) Square footage of attached garage ,q ft o) 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 Nithtn 1.0 foot above ad)acent grade cl T )tal net area of flood openings in A8.b � �q in C) Total net area of flood openings in A9.b �,q in d; Ergineered flood openings? 0 Yes &] No d) Engineered flood openings? f Yes [] No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION f 131 NFIP Community Name & Community Number I B2. County Name 83. State CitT of N nrthAmpt nn 290167 1 Hampshire MA 34 Mao,P3nei Number 35. Surfix 36. FIRM !rdex 37 FIRM Panel 38. Food 39 Base F'000 E!evaucrts, , Zone I ate ffective,Revised Date Zones) AO. use base flood Jepth) 250167 0001 A 4/3/1978 4/3/1978 A7 242' to 243' 310- - dtcate , ne source of •he Base Food Elevation BFE) Jata or case flood depth entered ,n Lem B9. 1_ FIS Profile FIRM Community Determined ❑ other, Describe) 311 ,rdicate elevation datum _sed for BFE .n .tem B9: Er NGVD 1329 ❑ NAVD 1?88 ❑ Other Describe) AO*" 512. 's the buuding located in a Ccastai Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes No Designation Date [] CBRS F� OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C 1 Budding elevations are based on: i Construction Drawings" C Building Under (Construction' 12 Finished Construction 'A new Elevation Certificate will be required when construction of the budding ,s complete. ;2. Elevations - Zones Al -A30, AE, AH. A (with BFE), VE, `11 -V30, V -,vith BFE), AR. ARA, ARAE, ARAt -A30, ARAN, ARAO. Complete Items C2.a -h telow according to he building diagram pectfied n Item AT Use the came datum as the BFE. Benchmark Utilized Mass Geodetic Survey #11 60 2ertical Datum NGVD 1929 Conversion Comments Check the measurement used. a) Top of bottom floor (including basem ent, crawlspace, or enclosure floor) 2 3 6 8 `eet meters . Puerto Rico only) -:p J the oext higher `!oar 243 7 —1 feet meters ( Puerto Rico only) 3cttom of the lowest horizontal structural member ;V Zones crly) n a _J feet meters .Puerto Rico only) J) attached garage iteo of slab) n a _71 feet L�I meters (Puerto Rico Cnly) �> :west elevation of machinery cr equipment servicing the budding 237 5 ® `eet 17 meters ( Puerto Rico only) Deschbe type of equipment and 'ocation in Comments) f) Lo est adjacent ifinished) grade next to building ( LAG) 240 7 feet ❑meters (Puerto Rico only) 4) '4ighest adjacent rfirnshed) grade next to budding HAG) 1 ! 6 eet •-teters , P Rico crlvi Nest 3d,acent ,rode at chest - �fevaoon ;f :erk :r ; +airs - c /- / /,4 - 'et _ - e,ers P._erto re v� '31 _�Vn 3ECT?ON D - 3URVEY(DR, ENGINEER, +3R ARCHITECT .ERTIFICATION -.3r ;,­an . ^a . -. ,, :4 _ :r0 .r - ;r ri r? r _ r , -ea - n : ,_ =a,a + Cn c r r cie yr' /L' N 'Nq t ,� _P .•H r^r -r'l e .! :.� .f cr'� g. r ./ ? J 3 _ :)P. s :- _K _ . e � :, :ea : _�_n :r ,r•n _ �t _..e - d ; e_:e__ .ct :r a - .ed �v a �lx >ti`1L`_. �, 3rd ..r,e or' J 'S '40 1 c e atf .e.. William F_ Drude, Jr_ CIA Reg. ^ # 32893 e� Professional Land Surveyor Huntley Associates, 30 Industrial Drive East, Northampton, MA 01060 ��� = _re =ate - -- ephcre /D1 / ?f11f1 (d1'i1 n,Rd 7ddd rc 1 MA r 31 - .filar ')9 '�&e - everse i de or ccr,Iirs,atlon. ?Pplaces ,;II rev ous ea(tlors IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Budding Street Address iincludinq Apt., Unit, Suite, und;or Bldg. No.i or P.O. Route and Box No. Policy Number — 45 Spring Street - ,ty State ZIP Ccde Company NAIC Number Florence MA 01062 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) ,.py both sides cf this tlevahcn Certifie�te fort 1 ; rommurnty , ,tflaal, i 2) insurance agent company, and 13) building owner. -cmments Latit longitude per Google Earth M agh.in ery in C'2 - F. is a heating _system Sgnature Date ❑ Check here if attachmerts SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Fcr Zones AO and A (without BFE) , complete Items E' -E5 If the Certificate is intended to support a LOMA cr LOMR -F raquest, complete Sections A, 8, ,nd C. Fcr ;terns EI -E4. ase .aturaj grade, ,f 3oailable. ��heck the measurement used. in Puerto Rico only, enter meters. E1. Provide elevation information for the fallowing and check the appropriate boxes to show whether the elevation isabove or below the highest adjacent Trade (HAG) and the Lowest adjacent grade ItAG). 3) Top of bottom floor i including basement, crawlspace, cr enclosure) is ❑Feet ❑meters ❑above or ❑telow the HAG. b) Top of bottom floor (including basement, craw(space, or enclosure) is ` Deet ❑meters ❑above or ❑below the LAG. E2. For Building Diagrams 6 - with permarent flood openings provided in Section A Items 8 and/or 9 (see a es 8 -9 of Instructions), the next higher floor ­ievation C2. b in the diagrams) of the building is _ ❑ feet ❑ meters ❑above or below the HAG. E3. Attached garage (top of ;lab) is ❑ feet ❑ meters F� above or ❑ below the HAG. E -1 T ;o cf platform of machinery and /or ?quioment ;ervicinq the building is _ ❑ `eet ❑meters ❑ above or ❑ below 'ne HAG. --5 -ore AO only: If no f!nod Depth numter �s avajlab!e, s'he'Dp of the bottom rbor - levated �n 3eccrdance with she ccmmur_itys 9oedpiam Tanagerrent inarce F: 'as No 71 'rkrow ^ n ' e ;coal o final post cerify this , rfrrm as aticn .n Seon G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION —e eroperty owner or owner's authorized representative .vho completes Sections A. B. and E for Zone A without a FEMA -ssued or community- ssued BFEI ,r Zone AO must ign here. The tatemanfs ,n Sections A. B. and E . ,r e r to th best cf my knowledge. Property Owner s or Owners Authorized Represent aUVe s Name etlM� Address City State ZIP Code Sgnature Date Telephone Comments ❑ Check here .f attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) 'he !opal official who is authorized by aw or ordinance to administer the community's Poodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable ;tem(s) and sign below. Check the measurement used in Items G8 and G9. G1 ❑ The information in Section C was taken from other documentation that has teen signed and sealed by a licensed surveyor, engireer, or architect who s authorized by jaw "o certify elevation nforrratuon. Irdicate the source :and date of the elevation data in the Comments area telcw.) D2. ❑ A community official completed Secnon E for a building located .n Zor.e A ('without a FEMA - Issued or community- , ssued BFEI or Zone AC. , 33. ❑ The `cilowirq ,nforrrmat;on !'ems G4-G9) is cmv ded for community floodplain management purposes. G4. Permit Number 35. Date Permit Issued i 06. Date Certificate Of ComphancerOccupancy Issued i ! r37. This permit has Geer issued for: ❑ New Construction ❑ Substantial improvement - �d - 'evahor )f as -oudt cwest ;f the - oiiding � 'met �rq an,m _ _._.ter? ..C)[. _ ,] �. :ary _ a ne -R,. ... Set Fars A"i :,c r eras >ef -ere 'f - ;tt cnments =EMA Form 81 -31 N.1ar 09 ?eoiaces all previous editions Building Photographs See Instructions for Item ,A6. 3uiiding Street Address indudin a t., 'snit, Sint ,and /or Bldg. ; or P O. Rouie and 'Box No. 1Y 7— '��icy v� tier Qa 9 P g ;, lo. Ity Mate Florence = IPCode cmoanyNAicNumber MA � f ,sing the Elevation Certificate to obtain NFIP rleod affix at least t wo building photographs below according to 'he , nstructions `or item A6. Idell all Photographs Nith: date taken: 'Front View' and 'Rear View d aide View' and "Left Side View.' if submitting more Photographs than Mll fit on thi reverse. s page, use the Continuation g � ge on e Front View QfZO �ZOtQ i k� I a r' 1, r 4 n ,� s Building Photographs Continuation Page For Insurance Company Use. 8ullding Street Address i including Apt.. Unit, Suite, and/or Bldg. No.; or P O. Route and Box No. , Policy Number i 45 SIDri ng St - r t j City State ZIP Code Company NAIL Number Florence MA 01062 If submitting more photographs than will `t 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." Rear View Auk i 6Y � f . , Oct 25 10 09:39a Douglas Thayer 413 527 4491 p.1 Northampton Building Commision �✓ti Y �� r 4 Loins Hasbrouck Or-tuber, 25, 2010 45 Spring Street OCT 2. 2010 Douglas Thayer, (413) 5274491 Scope of mechanical reuovatie!!5- i n regards to th-e ; 2sot Vlved elevation. Base flood elevation is determined to be the top of the Joists supporting first floor. Eletrical: • New service panel, 48" oft first floor • All electrical fixtures are to be fed from this new service panel location. • All feeds are not to be below the top of the first floor ioists, a -- - * A single feed is to supply the existing basemen± Y -nA, t3aat Wit] be-Momassubpanel to feed existing basement light and existing basement outlet (for sump tvamp) • Any feeds that are rotted below the first floor levee) MY. be & W?Aer Akft c onda,it HVAC * New wall hang boiler is to be places in new location off first floor bathroom. (48" off floor) 0 Circulators for new hydronic system are to be placed 30" off' floor. Oct 25 10 09:40a Douglas Thayer 413 527 4491 p.2 � 4 1 4 l w f k � s � s x s �J A J s f t oai i V - T e AD ." C � � 4 A s kp d �, ` Ll ! CIO �LL '1 L r O o _ .R Ck -