25-012 (2) File if BP-2017-0431 700 l N 5 4"/ 4OL0
APPLICANT/CONTACT PERSON YELL SANDRA L `` 11 r ec P
ADDRESS/PHONE 214 RIVERBANK RD NORTHAMPTON 0 584-0504 Q Iv
r / hAcl
PROPERTY LOCATIONS RIVERBANK RD U n
MAP 25 PARCEL 012001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY: `y�v e ft-
PERMIT
APPLICATION CHECKLIST *.IUVY
ENCLOSED REQUIRED DATE
ZONIN FORM FILLED OUT ,,,rte 0 L��VPt
Fee Paid S
Building Permit Filled out saarrallEr
Fee Pai MEMOTAMMIr
_
T neof onstmction: B ILD''r-`rx_?"c • ' 'OM IN EXISTING FOUND.. ON CjE
New Construction
Ln 5/I NCJ
Non Structural interior renovations L v
Addition to Existing
Acceasory Structure
Building Plans Included;
Owned Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON /C pd KE �c(
INFORMATION PRESENTED: CON DtTIpMM-- MPfan�R'L^ t,..J '' (^t gi"'p
Approved Additional permits required(see below) FOB- ' tin/ OML)( Cd taw
PLANNING BOARD PERMIT REQUIRED UNDER:* tUj
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
Demoliton Delay/ 2n
rip y'it
Siy +. a`'frrd afficial 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.
214 RIVERBANK RD BP-2017-0431
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25-012 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-2017-0431
Project# JS-2017-000725
Est.Cost: $6200.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 44866.80 Owner: YELL SANDRA L
Zoning: Applicant: YELL SANDRA L
AT: 214 RIVERBANK RD
Applicant Address: Phone: Insurance:
214 RIVERBANK RD O 584-0504 O
N O RT HA M PT O N MA 01060 ISSUED ON:II/14/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BUI LD 3 SEASON ROOM ON EXISTING
FOUNDATION "CONDITIONAL APPROVAL FOR DEMOLITION 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 11/14/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Departmentusepnty .
City of Northampton Statue of Perhift
Building Department Cu ut/Drrvewey Permit �"
212 Main Street SeA�et/se ifs�hila6fli
k ty
3` Room 100 Wa2e(ANelvelfabihty „r' '3x
��'� Norylampton, MA 01060 Twla SeIS of$Wctural Plans
on8. -587-1240 Fax 413-587-1272 PIoUSItePlane
O'A':' otherSpecify° - -a- ^•
AP o TION�TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address.
This section to be completed by office
di HI K L' A M IC 6� Map Unit
k /, p q nn L\ Zone Overlay District
Orkr friV IFILI M� �l C `' � Elm St.District CB Distrid
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sitd) d,C.�"� [(, dl yq✓2,v� r hGH K J
Name(Print)
Current Mailing 6 d 4 /T F-Q c (
Telephone 'Y 11�7 T
Signature �IYtun
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 16 . 0 a' O )fie)
(a)Building Permit Fee
2. Electrical 4 '}2r , COI (b)Et
Construction stimatedTofromalCost(6)of
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection ////// p/� //
6. Total =(1 +2 + 3+4+5) Check Number 6ib7 '/ LC
6;i"I ' d/ This Section For Official Use Only
Date
Building Permit Number'.
Issued:
Signature'
Date
Building Commissioner/Inspector of Buildings
SECTION 1 -SITE INFORMATION
This section to be completedby office
1,1 Property Address:
Q Map Lot Unit
- KLu 4% 'J/c Pep
cc jjjj �)( p 0i c Zone Overlay District
A. 0T. ( }i f�" t Elm St District - _ CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1,
SA-u d r,i"�.�/ 1(.,. ,)/y J2,vc r f£Gt-etc Z•
Name(Print) ' Current Mailing4 s _ ac0 c!
Au... ,�U- l.t.^ �1 Telephone t {{�O lJ0 7
Signature nerte N <-1
2.2 Authorized Agent:
Name(Pring 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 4 6e(y O ,e0 (a)Building Permit Fee
2, Electrical Qi232f . ad (b)Estimated Total Cost of
Construction from(8)
3. Plumbing Building Permit Fee
i
4. Mechanical(HVpr' tr / /
G . iorr MESSAGE w Check Number (5-1'If '/ l( 5
oMpORTA aM 7fficial Use Only
()i P.M-
___21J------
.M- 2e
For
it Time ued:
Dayy-----11IN - /g/6. 4 -
IA i ver Date
phone a+acege
wmto 00011111
ode
M 41601111160. S
c
oma
" lory 0 a/ y ,
StMessage
e h 000,01. r.
f'/NR /r7U
pw r
.rv^^�� ^/� aausA
maned ' r � 'f/ H3
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition fl Replacement Windows Alteration(s) Roofing n
Or Doors 0 !I
Accessory Bldg. U Demolition [ [ New Signs (DI Decks [ia Siding 101 Other[CAI
Brief Description of roc sed •
Werk: Avgr; Aw u�'r erl
Alteration of existing bedroom Yes No Adding new be corn Yes No
Attached Narrative Renovating unfinished basement Yes 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
h. 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 f 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
lc 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
,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
,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name 141,714..t. cpp
i /b ' "CINdL.
Signaturewner/Agent
Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)..
New House n Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [I] Siding [0] Other[17]
Brief Description opropgse
Work: 7i a1� il12011-1_,Y404-
Alteration
/IWYAAlteration
of existing bedroom Yes No Adding new behicoom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ba: If New house and or addition to existing housing, complete thefollowing:
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 ftof 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
, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit applicationmilli .
Signature of Owner Date
,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name t„djtlyv1') ' w,tn—� (�}�gaSlnr 111. -1dGnSun
���. ' (4i/ /d -�-,� oicNd4 L. `/
Signaturener/Agent /� Date
Section 4- ZONING Alt Information Must Be Completed,Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size i E
Frontage
Setbacks Fron6... �.....___H L.�
Side Lf � R:I I L: IRI _ _.F 1 I
Rear .. L 1
Building Height I - I l
Bldg. Square Footage 1 L 1 % L. I _-.-_.-1
Open Space Footage
(Lot arca minus bldg&paved t (_.�
parking)
#of Parking Spaces L—
(volume&I.ocahen)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES Q
IF YES, date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Pagel j and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained Q , Date Issued:
C. Do any signs exist on the property? YES l./ NO O
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and Location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris it part of a common plan
that will disturb over 1 acre? YES O NO O
IE YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor-- --- - _—_. _ __. NotApplicable_O_. _. . .
Name of License Holder.
License Number
Address Expiration Date
Signature Telephone
('roll,
.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 ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,duringand 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 tie State Building Code,City of
Northampton Ordinances,State and Local Zoning Lawspand State of Massachusetts General Laws Annotated.
Homeowner Signature /€f tq„ '{I„ c ��Z�
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: el vt,J4 P P /L )Joki-4.4 n
The debris will be transported by: ad,,Eodki, o j
The debris will be received by: 3/L /AI, 6
Building permit number: v
Name of Permit Applicant
t
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
A410...' Department of Industrial Accidents
k',.,„' '✓_
(Nice of Investigations
>• I Congress Street, Suite 100
Boston,M9 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone _ _
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ 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.El lam a sole proprietor or partner- luted on the attached sheet. 7. nRemodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity, employees and have workers' 9 E Building addition
[No workers' comp. insurance comp. insurance.(
required.] 5. ❑ We are a corporation and its 10,❑Electrical repairs or additions
3. I am a homeowner doing all work
PIofficers have exercised their 1;.(_”] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12,0 Roof repairs
insurance required] 1 c, 152, §1(4),and we have no
employees. [No workers' l3.❑ Other
comp.insurance required.]
ny apptieant that checks box€I must also fill out the section belowtheir workers'comp po y
'A showing ensaaon Iio information.
t Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tuontractors that check this box must attached en additional sheet showing the name of the subcontractors and state whether or not those entities have
employees If the sub-contractors have employees,they must provide their workers'camp,policy number.
I am an employer thin i5 providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie.It: 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 Section 25A of Wil,c. 152 can lead to the imposition of criminal penalties of a
fine up to SI,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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certift under) the pains and penalties of perjury that the information provided above is true and correct
Signature:JTIrY G I7mo/ C O� Date: /(1'-',? — /9
( /a
Phone#: 'I ) 3 i]....0 U 4j 'f _
Official use only. Do not write to this area,to be completed by city or town official,
City or Town:i Permit/License#,
Issuing Authority(circle one):
I.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 arty two or more
of the foregoing engaged in ajoint 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, §250(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 tilt nut 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 he 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
Mum)," 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 furore 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Ltdustrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. 'k 617-7274900 ext 7406 or 1-$77-MASSAFE
Fax 4 617.727-7749
Revised 7-2013
www.mass.gov/dia
City of Northampton
,..%P��'Ib N OPPASi3O\T'
Massachusetts j, -DEPARTMENT-OF BUILDING INSPECTIONS -212 Main Street • Municipal BuildingINorthampton, 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/footingt(before backfill). sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The budding department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of 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 permits 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 �,nn
1, �Ii? . Or, (v�Y understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date in - 3- 11�
Address of work location " ,p.O' °,„h°"1
Net tirp7*3 _
U.S.'DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency a
National Flood Insurance Program aQgfe:We++ember 30,2018
ELEVATION CERTIFICATE
Important:Follow the instructions an pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance tgenry ny,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Christina Marie Wilkinson,Owner;Sandra L.Yell,Life Estate
A2. Building Street Address(including Apt.,Unit, Suite,and/or Bldg.No.)or P.O. Route and Company NAIC Number:
Box No.
214 Riverbank Road
City State ZIP Code
Northampton Massachusetts 01060
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. Latitude/Longitude: Lot, 42 19 48.5245 Long. 72 36 44.8452 Horizontal Datum: [] NAD 1927 0 NAD 1983
M. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
Al. Building Diagram Number 2A
A8. Fora building with a crawlspace or enclosure(s):
a) Square footage of crawispace or enclosures) 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 NI 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? 0 Yes 0 No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP Community Name&Community Number 32. County Name B3. State
City Of Northampton,Massachusetts 250167 Hampshire Massachusetts
B4. Map/Panel 85. Suffix B6. FIRM Index 87. FIRM Panel Ba. Flood Zone(s) 09.Base Flood Elevation(s)
Number Date Effective/ (Zone AO,use Base
Revised Date Flood Depth)
2 A 04/03/1978 04/03/1978 A13 125
B10. Indicate the source of the Base Flood Elevation(BFE)data or base Hood depth entered in dem 89:
[� FIS Profile 0 FIRM 0 Community Determined [] Other/Source:
811. Indicate elevation datum used for BFE.in Item B9: NGVD 1929 0 NAVD 1988 Other/Source:
812. Is the building located Ina Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Q Yes 0 No
Designation Date: U CBRS ❑ OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6
660-000
ELEVATION CERTIFICATE E piration Date:November 30,2018
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
City State ZIP Code Company NAC Number
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: U Construction Drawings' 0 Building Under Construction' Q 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,AR/A,APJAE,AR/A1-A30,ARIAH,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: on site GPS position Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
NOVO 1929 j NAVD 1988 n 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) 118 . 86 Q feet J meters
b) Top of the next higher floor 126 . Q 3 0 feet n meters
c) Bottom of the lowest horizontal structural member(V Zones only) U feet n meters
d) Attached garage(top of slab) _ n feet 0 meters
e) Lowest elevation of machinery or equipment servicing the building 116. 18..,,_ Er feet n meters
(Describe type of equipment and location in Comments)
0 Lowest adjacent(finished)grade next to building (LAG) _, 1 19 . 04 feet 0 meters
g) Highest adjacent(finished)grade next to-building(HAG) 121,,. 81 N feet D meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including _.. ❑ feet n meters
structural support
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 maybe 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
David R Enberg 647142 06 .-
Title �\
yy DAVIDc�
Survey Manager ,3 R. r„1
Company Name u FleSPRG `Tni I
Berkshire Design Group ,c N6044t42
Address ..—.....—..... mere �r
Esso
4 Allen Place .tp
��o SUBVtiT�P
City State ZIP Code
Northampton Massachusetts 01060
Signature Date Telephone
I / 11/21/2016 (413)582-7000
_ 33�
Copy of rages of this Elevation rtificate 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)
Elevation established on NAVD 1988 with a Leica Viva GPS RTK Rover
Lowest machinery=Well Pump In Foundation Hole External To House
Kitchen In Walk-in Basement Where Current Furnace Is Located At Elevation 118.86'
Section C Elevation C2(b)=126.03
Section C Elevation C2(f)= 119.06 (form would not allow entry of leading zeros)
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date:November 30,2418
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:
City State ZIP Code Company NAIC Number
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—ES. If the Certificates intended to support a LOMA or LOMR-F request,
complete Sections A, Band C.For Items El—E4, use natural grade,if available. Check the measurement used. In Puerto Rico only,
enter meters.
Et. 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 El feet ❑meters ❑above or ❑below the HAG.
b) Tap 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 _. El feet 0 meters ❑above or 0 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 El 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 Slate ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE ExpiirationlDae:Novvember 30,2018
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.
City State ZIP Code Company NAIC Number
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 08-010. 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 BEE)
or Zone AO.
G3. ❑ The following information(Items G4-G10)is provided for community floodplain management purposes.
04. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy issued
07. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: _ 0 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 9 meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments(including type of equipment and location,per C2(e),if applicable)
9 Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions, Form Page 4 of 6
• - BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item AS. Expiration Date:November 30,2018
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.Q.Route and Box No. Policy Number
City State ZIP Code Company NAtC 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 dale 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.
err * ..SY •
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Photo One Caption 11-17-16 Right side-facing West
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Photo two
Photo Two Caption 11-17-16 Front side-facing North
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date:November 30,2018
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:
City State ZIP Code 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.
v twir4 I.- 31).‘''1,17:45414911r-ta'7 11:1:41r1r6:47:: :
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Photo One Caption 11-17-16 Left side facing Fast
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Photo Two
Photo Two Caption 11-1746 Rear Side facing South
FEMA Form 086-0-33(7/15) Replaces all previous editions, Form Page 6 of 6
�" .�..e e
:flit:.
rte'- 4 - �j� - r. ' �- R_ 4� 3
? �s v Mm. �/ W j y Kola of finishfloor to ! >mvste qyJ. €
ooagn .orert..r. ^ a''(b / `�` cDre I be 9uSh with toper 9J
o re
floor. Bracket may a p z ; ill
skewed to achieve el, I-
/o],_X Cd" /I c... w / concrete cover "
`E.aa��..� t. — _ — roar 2
ed
iralm
/// Iwiara.. _ pa. anthers. t p
0,,k,,,,by ± Beam Designed by others
/ See notes For beam supped.
sa
ho bb.een--.m . ! �tf +o fV I install per manus.
B2 k pa ._ e,a
o Ig m bore / ' w a f #3 Ye bars,8"dia.or 6"
.-_ iV _ qq square,located as shown.typ
-. . i _ ti+ 4)#4 bars � r� ¢
J/ / r. I_^^ 12°da Form Tube mI� z. cS_
.m aaa=are evoyeyl U I oo 3r-' o :�
Oa rannmvez to yore. online or porch above, O / Finish Grade ' a k -ro
eo
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Foundation Plan 1rE I ' /{0/12'
na
II 2 �
CM \
caneare to be 3X,4 p31 26days.S& esied y maxa re?ae site,vAvme into Fier I i - Rev Pole / By / C¢1
3consolidation.
steal to be as 4„min. 1'-10" 02/23/20l6 JW j
J.Beam suppon brackets to be Simpson Ce a,,LCp shimmed m hi.a ac4M type bracket,Dribeamem
to be tT Into concrete,2"from edge of tiler.
F bears support InDel twisting bracket
t
k have i1 clia bolts. a ma 3'from bottom f b ,and min td/12 Foot'Tube, 22"die base
m. . a- 2' COVE( `j ..< alta Form tube
AZ aa. nice e ren sustains w arra:y. -:saa.urs h=oe a. aremr� As Shown
ACI 318 standards. /� 'jy—M3 tie bars 8"tlla Ponee
ot, end hest dpl4 M1 abovefoundation,and poen IgvA by `+x pa No
others,propeay:reebeams ned joists may bcantilevered cpm ewnnpw affecting footinga ego f""—own.
equal spaced barssg°
equal spaced
S. sumer soli bearing.sand/gravel,2000 psi capacity. or
6.All banisters m have nevem tkind for use and lonatlnn
Pier Detail 3rW"=, \ J
214 RIVERBANK RD BP-2017-0431
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25 -012 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-2017-0431
Project# JS-2017-000725
Est.Cost: $6200.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: Homeowner as Contractor
Lot Size(sq. ft.): 44866.80 Owner YELL SANDRA L
Zoninc: Applicant: YELL SANDRA L
AT: 214 RIVERBANK RD
Applicant Address: Phone: Insurance:
214 RIVERBANK RD 0 584-0504 0
NORTHAMPTONMA01060 ISSUED ON:11/14/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BUILD 3 SEASON ROOM ON NEW PIERS
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 it Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 001: 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 11/14/20160:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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