25 -012 25-012 (2)File #BP-2017-043(�}Vli��
APPLICANT/CONTACT PERSON YELL SANDRA L
ADDRESS/PHONE 214 RIVERBANK RD NORTHAMPTON () 584-0504 Q Iv
r1/h A� to
PROPERTY LOCATIONS RIVERBANK RD �� U n
MAP 25 PARCEL 012 001 ZONE p �`
THIS SECTION FOR OFFICIAL USE ONLY: r—
i 1V�
PERMIT APPLICATION CHECKLIST MV
ENCLOSED REQUIRED DATE
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATIONPRESENTED: CoNDt'LIuMk<—MPfan�M
Approved _ Additional permits required (see below) port. ');fjs MAtWV O NGIf
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project Site Plan AND/OR Special Permit With Site Plan
Major Project_Site PlanAND/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 front CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demulifpn Delay
CoilI)
Si a
d
fFicial Date
06
66
jo(W
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain alt 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
Mam.Block: 25 - 012 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ADDITION
BUILDING PERMIT
Perm¢# BP -2017-0431
Proiect# 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.): 44666.80 Owner: YELL SANDRA L
zoning Applicant: YELL SANDRA L
AT: 214 RIVERBANK RD
Applicant Address: Phone: Insurance:
214 RIVERBANK RD 0 584-0504 fl
NORTHAMPTONMA01060 ISSUED ONaI114/2016 0:00:00
TO PERFORM THE FOLLOWING WORK. •BUILD 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:
Smoke:
Final:
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 11/14/20160:00:00 $65.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck — Building Commissioner
SECTION 1 -SITE INFORMATION
- Departmen4useonly
1.1 Property Address:
City of Northampton
Status of Perin ft
Lot Unit
Building Department
CuuUDrrvewey—Permit
�I /, p
/ �)� I' �' I / ('� / C
212 Main Street
Se"dSepti Yeilablllty
District
Room 100
Northampton, MA 01060
Wale ANe10aifiiiiii
Twig Seteof$tructursl Plans -
p
hGH-t.lC.
y� r !K�
yr
Name( nnt)
one_ -587-1240 Fax 413-587-1272
Ploti$te:Plane
Telephone
Signature
Other Specdy
0
AP TION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Name (Print)
Current Mailing Address:
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
��Map
Lot Unit
Zone Overlay District
�I /, p
/ �)� I' �' I / ('� / C
Elm St. District CB
District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
p
hGH-t.lC.
y� r !K�
yr
Name( nnt)
�✓2t
Current Melling�U -0
06-0
'Y 11 �7 T
Telephone
Signature
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 b permit applicant
1. Building � / d dy O r4�
(a) Building Permit Fee
2. Electrical v -e , od
(b) Estimated Total Cost of
Construction from 6
3. Plumbing
Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1+2+3+4+5)
Check Number
i o1O ` d This Section For Official Use Only
Building Permit Number'.
Date
Issued'
Signature:
Building Commissienerllnspector of Buildings
Date
SECTION 7 -SITE INFORMATION
Thts section to be completad'by office
i.i Property Address:
G
Map Lot Unit
Zone Overlay District
tt
,,1 n -f �1 j' �} t c
Elm St. District - _ CB Distr lot
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(/(\ riot)—
Current Mailing Addfys�_ c,6 (0 </'
Zj l/J i
Signature
F-"' ml�,`
2.2 Authorized Agent:
Nzme (Print}
Current Mailing Address:
Siynature
Telephone
SECTION S ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollars) to be
com leted b ermit a licanl
Official Use Only
i. Building
(a) Building Permit Fee
2. Etectc al gg $ . aCl
filn Estimated Total Cost of
Construction from LD
3. Plumbing
Building Permit Fee
4. Mechanical
wrr MES�^�...�—' 1
Check Number 5
r .....-
P.M -
For ~ Time
aav��
NI �yrvLr �-
f"i
W icial Use Only _
2e
ued:
Date
TeteptrNtad- p(aase call g�ler onit��
t yae ori a9an' !�" .
°' Waataros�'1a'
--
Me�
uNV4El12'3� r'7 '
SECTION S. DESCRIPTION OF PROPOSED WORK (check all applicable) j
New House ❑
Addition ❑
Replacement Windows Alterations) Q Roofing ❑
Or Doors ❑
Accessory Bldg. ❑
Dimolition ❑
New Signs (01 Decks (Ea Siding [101 Other IQ
_.._.. _
f ropgsed p
Brief DescriQtlnn 0701's-%y-T,
tNbrk: �S hoAGm
-%
��
Alteration of existing bedroom _Yes _,.... No Adding new be ccm Yes No
_
Attached Narrative Renovating unfinished basementYes No
Plans Attached Roll - Sheet __
6a: if New house and or addition to existing housinet: complete the foiiowira
a. Use of buildingOne Family Two Family Other_„__
b. Numberof roams in each family unit: Number of Bathreams
c. Is there a garage aftache,17
it Proposed Square footage of new construction.___ Dimensions
e. Number f stories?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Massrheck Energy Compliance form attached?_
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yea No. Is construction within 100 yr, tloodplam __Yes —_No
j. Depth of basement or cellar Floor below finished grade _
k, Wit building conform to the Building and Zoning regulations? Yes No .
I. SepticTank._ 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
1, , as OwnertAvthorized
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
P /
, fie. �M [ C /b `711nldkA L,
Signature (5wnerlAgent Date
SECTION S. DESCRIPTION OF PROPOSED WORK (check all applicable) ----
- -_ -- _
New House ❑
Addition ❑
Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors O
Accessory Bldg. ❑
Demolition ❑
New Signs [O] Decks [Q Siding l0) Other[❑J
Brief Description ofrop sed
Work:
Alteration of existing bedroom No Adding new beoom Yes No
_Yes
Attached Narrative Renovating unfinished basement Yes No
Pl ons 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 roams 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?
I. Method of heating? Fireplaces or Wocdstoves 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 COI WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I 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 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- ')'1
Signaturebf Owner/Agent Data
Section d_ ZONING
Ali lniormatem Must Be Completed, Permit Can Be Cooled Due To Incomplete Information
Existing
Proposed
Required by Zoning
This column to be filled In by
Building Department
Lot Size
Frontage
Setbacks Fired...
x.....___11
Side
IJ Ra
LJ (RI
Rear
Building Height
L __j
Bldg. Square Footage
Open Space Footage
(Loo arc. minus bldg&neved
(_.
ar6in I
I J
Fill:
ydame&I. Aim)
- -.
A. Has a Special Permit/Variance/Finding ever been issued /for/on the site?
NO 0 DONT KNOW O YES 1.1
IF YES, date issued:
IF YES; Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES Q
IF YES: enter Book _1 Pagel __ J and/or Document #)
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued: {
C. Do any signs exist on the property? YES i./ 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 we or is it pan of a comrrwn plan
that will disturb over 1 acre? YES O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8 - CONSTRUCTION SERVICES
8A Licensed Construction Supervisor r --- - _. __.
Name of License Holder.
Not Applicable _El -
License Number
Address
Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: _,.
Not Applicable ID
Company Name
Registration Number
Address
Telephone
Expiration Date
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(8j)
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 buildina Dermit.
Affidavit Attached
11. - Home Owner Exem flon
The current exemption for "homeowners" was extended to include Owner -occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 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-vear 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 persons)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with fit Stale Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature6ej—t 4 C ,
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: a) [f �l iie 2�✓ �P �2�fJog }ti a n
The debris will be transported by:
The debris will be received by: W,6,40 A&& `/�
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Commonwealth ofBlassaehusetts
Department of Industrial Accidents
Qfce of Investigations
I Congress Street, Suite 100
Boston, AM 02114-2017
kIFF-1
www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors(Electricians/Plumbers
Applicant Information Please Print Legibly
iQ3Rtfl i0tnines/Or¢uniutionRndir-idual):
Address:
CitylState/ZSp:
Phone 4:
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
6. New construction
employees (full and/or part
have hired the sub-contractor
sub -contractors,
2. ❑ I all a safe proprietor or partner-
listed on the attached sheet.
7_ ❑ Remodeling
ship and have no employees
These sub -contractors have
g, ❑ Demolition
working for me in any capacity,
employees and have workers'
9 ❑ Building addition
[No workers' cmep. insurance
required.]
comp. insurance.!
5. ❑ We are a corporation and Its
10.❑ Electrical repairs or additions
3. tam a homeowner doing all wort¢
officers have exercised their
I LL] Plumbing repairs or additions
'} myself [No workers' comp-
right of exemption per MGL
12,E] Roof repairs
introduce required.] t
c. 152, §1(4), and we have no
13.❑ Other
employees. [No workers'
come. insurance reavired.l
'Any appliuot that checks her €1 most also till out do oration below shmviag anew workers' co n,awafioapolioy amemario s
t tiomeowmars who sobminh(s affidavit indicating they are doing all work and then hire outside cuntrachas most submit anew affda✓t indicating such.
iContmctnre that eheckthis box must suachad an add it, I mel sheet showing the mate of the oh -contractors and stale whether or not how entities have
amp laPass, . If the sub-earturcurs have aa,d eo, they must provide their robe, cutu, policy number
I Qm NF enlpldifer that is providing workers' contpanSature, insurancefor bar employees. Below is Qte pOlicyr and Jett site
information.
Insurance Carol Name:
Policy X or Self ins, Lie.
Expiration
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 MGt, c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 andfor 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 eerlijv under nationals and penalties it/ perines that the information provided above is true and correct
U
Official rise outs. Do not write to this area, to be cosepiesedby city or town official.
City artistic
Permit(License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3, CitytTown 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 fat 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 writs
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or imstee 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, §25Ck6) also states that `every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required,"
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of Compliance with the insurance
requirements of this chapter have been presented to the contracting autharhy"
Applicants
Please till not the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) courts), address(es) and phone number(s) along with their certiftcabits) 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 docs have
employees, a policy Is required. Be advised that this affidavit they 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 he 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 to (city or
town)" A copy of the affidavit that has been officially stamped or marked by the city of town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit mast be tilted out each
year Where a home investor 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 els.) 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 Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. 'k 617-727-4900 ext 7406 or 1-877-MASSAFF
Fax 4 617.727-7749
Revised 7-2013
W W W.ma91.gOV/ilia
INSPECTOR
Louis Hasbrouck
Building Commissioner
City of Northampton
Massachusetts
-DEPAR2WRW"OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton_, MA 01060
Chuck Miller
Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLFDOEMFNT
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
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failyre to obtain a certificate of occuFancy 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 n
�aW Ae, , C; 6W 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 10 - JL /1 p /�
Address of work location
JL.
sr�y
��om
Chuck Miller
Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLFDOEMFNT
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
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failyre to obtain a certificate of occuFancy 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 n
�aW Ae, , C; 6W 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 10 - JL /1 p /�
Address of work location
U.S. bEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency ; Wevambar 30, 2098
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions an pages 1-9. IN, r_
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance igen ny, and (3) building owner.
SECTION A — PROPERTY INFORMATION
SURANCE COMPANY USE
Al. Building Owner's Name
Policy Number:
Christina Marie Wilkinson, Owner; Sandra L. Yell, Life Estate
A2. Building Street Address (including Apt., Unk, 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, Acwessorv, etc.)
A5. Latitude/Longitude: Lat. 42 19 48.5245 _ Long. 72 36 44.8452 Horizontal Datum: [] NAD 1927 x❑ NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain food insurance.
AT Building Diagram Number 2A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) sq ft
b) Number of permanent food openings in the crawlspace or enclosures) within 1.0 root above adjacent grade
c) Total net area of Flood openings in A8.b sq in
d) Engineered flood openings? ❑ Yes Z No
Ag. For a building with an attached garage:
a) Square footage of attached garage sq it
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of Hood openings in A9b sq in
d) Engineered Flood openings? [J Yes Z No
SECTION IS — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number B2. County Name B3. Slate
City Of Northampton, Massachusetts 250187 Hampshire Massachusetts
B4. Map/Panel B5. Suffix B6. FIRM Index 87, FIRM Panel B8. Flood Zone(s) Fig. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
2 A 04/0311978 04103/1978 A13 125
B10. Indicate the source of the Base Flood Elevation (BFE) data or base Hood depth entered in Item B9 -
E] FIS Profile 0 FIRM [-] Community Determined [ Other/Source;
811. indicate elevation datum used for BFE in Item 39: fE NGVD 1929 E] NAVD 1988 [] Other/Source:
812. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (DPA)? Q Yes [XJ No
Designation Date: _ [] CBRS [] OPA
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
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
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based cm F] 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 AI -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with SFE), AR, ARIA, ARIAS, AR/Al-A30, ARIAH, AR/AO,
Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: onsite GPS position Vertical Datum: NAVD 1988 _
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 Z NAVD 1988 7 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, crawispace, or mi me floor) i 18.86 Q feet meters
b) Top of the next higher floor 126. 03 feet meters
c) Bottom of the lowest horizontal structural member (V Zones only) feet E] meters
d) Attached garage (tap of slab) ❑ feet C] meters
e) Lowest elevation of machinery or equipment servicing the building 116 . V8„„_ feet meters
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LAG) _, 19 . V feet meters
g) Highest adjacent(finished) grade next to- building (HAG) 81 feet meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including _.._. [J feet E] meters
structural support
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Ibis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
1 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 i] No ❑ Check here if attachments.
Certifier's Name License Number
David R Enberg #47142 1t1 OF yta_
Ttie
yy DAVIDo
Survey Manager 3 R R,
Company Name t"EPWffRG
Berkshire Design Group N604VI42
..--.....--..... - t r
A Here
Address -Here
4 Allen Place II4Q Simi
City State ZIP Code
Northampton Massachusetts 01060
Signature Date Telephone
11/21/2016 (413)582-7000
Copy ai ages of this Elevation rtificate and all ahachments far (1) wmmunity official, (2) insurance agentmompany, 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 riot allow entry of leading zeros)
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
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, andJor 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 Et—E5. If the Certificate s intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items Et—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 bell= floor (including basement,
crawlspace, or enclosure) is ❑ 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 �_. ❑ feet ❑ meters ❑ above or [❑ below the HAG.
E3. Attached garage (top of stab) is . [:]feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery andfor 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. 'f he 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 w
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 Owners 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
OMB No. 1660-0008
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
NAIC
Company 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 items) 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-iss(;ed 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*ccupancy issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement)
❑ feet ❑ meters
of the building: 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 hem if attachments.
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item AS. Expiration pate: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Skuldir Street Address (including Apt., Unit, Suite, andfor Bldg, No.) or P.Q. Route and Box No. Policy Number.
City State ZIP Code Company NAIL Number
If using the Elevation Certificate to obtain NAP 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 ft on this page, use the Continuation Page.
_ r.Uw
Photo One Caption 11-17-16 Right side -facing West
v'au r x
Polo iWr
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, shelter 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.
j<
P
I
r
Pmm o.A
Photo One Caption 71-1 f-16 Left side facing Fast
ifitY
�i
k,Myx
PM1om Twn
Photo Two Caption 11-17-16 Rear Side facing South
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6
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Pier Detail 3b•=1
214 RIVERBANK RD
BP -2017-0431
GIS#:
Contractor: License:
COMMONWEALTH OF MASSACHUSETTS
Mim:Block: 25 - 012
CITY OF NORTHAMPTON
Lot: -001
Zoning:
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit
Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateerv,
ADDITION
BUILDING PERMIT
Permitil
BP -2017-0431
ISSUED ON.-II/1412016 0:00.00
Protect #
JS -2017-000725
Final:
Est. Cost $6200.00
Fee: $65.00
PERMISSIONIS 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
0 584-0504 0
NORTHAMPTONMA01060
ISSUED ON.-II/1412016 0:00.00
TOPERFORM 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:
Smoke:
Final:
Footings:
Rough:
Rough:
House#
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 OccuoancV signature:
FeeTvoe: 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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MARK B.
DARNOLD
CIVIL
No. 32458
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