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04-018 (7) ---- PROPERTY OF CHARLES R. & ELIZABETH GREG 'OSED INDIVIDUAL SUBSURFACE SEWAGE DISPOSAL SYSTEM AU 17,ra QN_ R Q AIL - _ 14 OR T tIAMP T ON _ _ _ (4.'7 j -....... , . ..() .........." 4.- N \ ,... -s, \ , , , ri .„.... \ \ \ 4. , \ \ EXISTING CURTAIN DRA'.4(see-nos) ----1 \ , \ 1 , \ \ , ,., , . \ . , 1 PLAN VIEW \ . „. - 4 Li ) 1 , N ) N. \ . ARPA = + /. c 72 0 \ 1 = P R \. . '9- . \ ',PRO' ,. • N I \ ' ' 1 i Nrb \ \ \ S I L T tE 11 ( SEE IPPROVED I Ras] \ '1, \ i ----___________ . I —,...._ ___L---- \ , .1•NONIMPONNIONIMPINIIMMIlaw RY . -------- ---- \ SEC.:N OF CURTAIN DRAIN TO BE RFMnVE ---,....„....,,_ -----......--fig• s ROPERTY LINES (see nn. ..... : . __..- ,_ __ ___ 1 OW .. • - <7' ' RA ' 'IP VII - L.L.L , fr. , ..• ' ti's . . , \ a 4 MIk - •_ ' \ , - ----------- ______ . • - -- 4 --J- ' li i n, \ _ , 41 , .: v -- k-fir c....... L• _______,..----------- ti l 0 i CLEAT FILL MATERIAT - 1 1 `)% 0 TONE WALL ----Nit* 7 \ 2,, \ . , , ,, 0/ ., . - t 1 0 I \ .„--- --- 4. . . 4 ---- . \ - r itt,7' -"..4- ......... -----. ---- _, \ -r\ 1"-- r......... 44 . ( 4 4 .4 .44 4 i ' , \ 1 ,, \ • .:-,.:;',.:.. \ ______ „ ,, $: 1 4 1 \ I \ \ 4, \ i \ 4 " kt,„ s s- - \ N' c ) 4 1 # 15 ' \ ' \ \ , \ ...4 ,...... . ____ I ; I 1 1 1 ti, i 41 3 / l' 1 ■ ' E ; , 1 1 - . , 1 \ 1 1- ' 1 ,''' , , 50 0 2 D 'r 1 7-'1 1 \ I I 1 I ! ......,..Aw. ■........ .......i i i 1 1 i ' * *......4 . ' 4 ;a • I ' i --- i , -;,ir ; , , ,,, , 4 4' ; 4 ' . r." '• 11 i , 1 e"- i --IA , 1 ,i \ , I \' FPCkiSED , i 1 I l i , , „ ____ , „ 1 \ I 1 ( I t I /‘ :: \ 1 1 1 i 1 1 / .;••• ' ' ' - ' ' ' ---- , ! s : . 1 1 ? 1 T ‘ - ' 7 ' c , 1 . ! ; — - - - " , " 4 " P',H P T \ 1 k i % _ ! r_;:;\: -43,,e- --•—•• ! , i . ,E,. ''..,..,. {7*„......_ 2 - - - ----- — ... ! . . - 1 30 1 I f i I ; . i ,.../ , L . : ____---- 1 , 1 - , i POED SPTIC i TANK , \ V---- -- / D V Rr i :; 7, tz 7 ea..._ ,-, • ..... :, .1, )....1 , ‘..., ; AR EA — •.. , 1 ! : :, • 44 , ZOPOSED pump iCHAMER ' ,i , / _..c.A. , 1 i • , .,.... in i )S ED DIStRiBt 1 TIO1 F3 (IV' , / . . . / I = ''' , - i -,.. / y7 IN -e- ,--, i •-----.--- i i /7; : /1 i / i fit 1. p fii, ti p i .- 1--):- , (,,,,,, i / , N cb j 17 7 7\ i-T 7, tI'l 7 77--f; .' ''. .-' ("st 4 ) - _. / I / P.Pr TY i i ,' ! ■ 1 / i 1 . - i 1 , ! _.,....----- , :, -,-----"r"-------1"------'-'7"-- " $ ,--------- ,.." -------„,_ \• 1 i /1 OF 7 ,7 7 V I' i 1 I _. ,‘ / , .i....) Li ‘k s.3 La ACORD DATE (MM /DDlYYYY) TM.. CERTIFICATE OF . . LIABILITY INSURANCE 03/27/2012 PRODUCER Phone: (413) 781 -2410 Fax: 413 -731 -9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER OF NEW ENGLAND INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 BOX 1230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AGAWAM MA 01001 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Acadia Ins Co Teddy Bear Pools, Inc & TGH Leasing, Inc INSURER s: 41 East St Chicopee MA 01020 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ' ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NCR A001 P OLICY EFFECTIVE O POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS LTR I'•rF,l " " +(1 DATE IMM /DDM') DATE {MM /DDlYY) GENERAL LIABILITY CPA 0382188 -10 04101/12 04/01/13 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 I PREMISES (Ea occurence) CLAIMS MADE X ! OCCUR ? MED. EXP (Any one person) $ - 5,000 A : PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE "$ 2,000,000 , GENAGGREGATELIMITAPPLIESPER . PRODUCTS- COMP /OP AGG ; 'L $ 2,000,000 • POLICY PRO- r LOC AUTOMOBILE LIABILITY MAA0382191 -10 07/01/11 07/01/12 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ,$ 1,000,000 ■ ALL OWNED AUTOS ' ! ' BODILY INJURY X SCHEDULED AUTOS \ (Per person) I $ A X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ - -- - - -- -- - ! PROPERTY DAMAGE ;$ (Per accident) GARAGE LIABILITY •:AL/ I O ONLY - CA AL C:DE N r ' $ ANY AUTO OTHER THAN EA ACC $ _.. _.... • AUTO ONLY AGG $.._. EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 1 ■ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ . _.. ._.. WORKERS COMPENSATION AND WCA 0382194 -10 04/01/12 04/01/13 ORY OTHER EMPLOYERS' LIABILITY A ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.. L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under ! - -- SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE • EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE To Whom it May Concern TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES • AUTHORIZED REPRESENTATIVE l ,, d� Attention: iru ACORD 25 (2001/08) Certificate # 61547 © ACORD CORPORATION 1988 Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street (4.°.4(:;"."'4P 1 (413) 594 -2666 • 1- 800 - 554 -BEAR Chicopee, MA 01020 -3562 ® FAX (413) 598 -8823 Home Improvement Cont. MA #11889/CT #520951 aik I www.teddybearpools.com 0 sE TEDDY A RPOOLS SPAS _ - f , f I. to../ - - -, ii, e Office of Consumer Affairs and usiness Regulation 1 , 10 Park Plaza - Suite 5170 . Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 111889 . Type: Private Corporation Expiration: 2/8/2013 Tr# 207240 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT - 41 EAST ST CHICOPEE, MA 01020 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal 0 Employment ril Lost Card DPS -CA1 it 50M- 04/04- G101216 S Nr t 4�. i•••M t v 1 t' S i''ri Y��t 14M1 t •V.• tt— ' , t f .':::— , _; - rs.., . rt ..,F.s.,r. •,tr.. .••i.. .. ?r. 9 s. , .r • }r. a b Y l s,n r s{ X' / b i t•!•r' •.. r fr 1, ra•:. s t .t•.• 4 �, rs .r r S• •try :•SR ssi ... {•r SI ri s /i •• f s .•A •:r' it •r R i , t , sigh •R' r,% "• ..av 'M1 �i i. •vvi .nw. „a'k•.. tai,•. w+r 1 s. r, r. .° .! .•r•r; r - %r y ?' \ ,. {�.. s• sa�. L- .,+, F\.+ � r r \..{ • {,.r,,r , }. :0% \'• ix t � S 6 £ R „.., s ss ,. ? 1 �- ii \ fitii6 t•�,} '4 4 ; , I J�c. r }, ft,. \ afJi i, \ iM1 1 i f s .\ ' ;�s \ /�, i�` a . a \,..,� �` S s » c«.• STATE Off' CO1� N U ECTIC T + DEPARTMENT OF CONSUM PROTECTIOI�1 ;,;', 'F ' Be it known th at •' �z i I' : TEDD BEAR POOLS IN � • cct -If � d EAST :',S.11„., f :` CHICOPEE,`MA 010 ;0 *?13 "l ' { s' \'( :. a ° + ; i - to .� "i � r �;J } 1 is certified by the Departrrxent €8 currier PCQtection as a registered . &. �v Ng 7: t 4 , ” H OME IMPRO ? M GO1®TTRACTOR ��.: a 2 . _s r 2 y -- N . } i Registrttinli # T ... is _ U95I �,i; r —; ¥ 4 ,) N» x t . TEDDY BEAR POOLS INC r Irv' `' Eff ective: 12 /01/2011 N{ �''� `. � � i `� k `fi Expiration: prat on, II/30/2012 "�`, ;i � ; � SUi im M Rubenstein Commissioner 1 ' ` ` \ ,t• .Y'r i`J it t f k. A '% r• S ; , . t ` r, r t ! ,r ` Z ` .) y - �. t a't L ,/: v t \ \ ., ' .i 6r y L' r . 2. f t i •a 'i. / '.\ 'h �' — .Tr ..••F' s m 6' c r / �' .•.t. .:� r � � r � •.v�. 4 N, . •�1� , v 1; ••< . , }� � „ •im � , s , ! !. +. n: �. . /n.. - .J,,, � �,a, / .•�l.r .,aa.••7r,,v,•�, r:',� -:: ..,i \�t {r „J 'N;' >. (/ :r{ ti k.',.Y" f, \'t ,` •4r •l.Ye. „ \. {,:,7.� y;�.c fk t� . . i L %. .b .. .7 . {c S .rf :� \." �( 'L .Y • \Y o3. , r<b /. . rJ., „ {r. .7 .•N. dX:��' 5 M r e "t ':•'r'' . r r ) r r � r '• rr rr,.. ;. �ri�.., f •S•. d 'Y t P t . •r•:l yS.• {.. y . F � \ t .S• y • r. r > �„n, . Pi`s. :• �• {•tiv)•'n,•• r k „ tfr r ' (• .. •' .i:..r3' ;i .. s 4• J t. tii ts ... . }. ...A. ;,.• .• f r ..,r,. q t 8 tirr t. ¢,�St•. ,.,}.•::% . • :•• si.. .iX t rs...vi- r: a.i: , .,r,� iy.. • S: :'S ' y, :.argue ,.rgsM1.tj " :te�"'� • - :ti�.�� _lia.' .e..•%[�. • /ti\- S. s ?•,� � % +: . t ts i• '� i ! e yt .:s, t eS {s .•: }• s o. •t, } k • , { • ''• .r ' t � Y •.,+' '' {�vs�• _rGw _Aw ,rid: > • � e�+. 2 }�9rs�s� L. �U u ?5"•+Y'� �.. 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 person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfdl), sonotube holes (before pour), 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 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 iermits 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, 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 Address of work location The Commonwealth of Massachusetts , Department of Industrial Accidents I - =,.. E Office of Investigations • =, — t.i 1��= 600 Washington Street 'mile— Z _.._._ Boston, MA 02111 � „ ' www.mass gov /dia -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Indiviii �-e t1 / f!).e'4'/ C= 5 7 5/‘.-.1 Address: yl E f S 7 1 . • City /State/Zip: Cii x rov ,,, e, /'i c.2/0dO Phone. #: S - 0 6 Are ou an employer? Check the appropriate box: I Type of project (required): / 1. 3' am a ��� I Io. er with /441 4. D I am a general contractor and I 6. ❑ New construction t time).* have hired the sub-contractors employees (full and/or par 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling These sub - contractors have ship and have no loyees 8. Demolition working for - em�lo - yees and have workers' me in may capacity. 9 13 Building addition [No workers'' comp. insurance c0mP incniranrP # .. required.] 5. 0 We are a corporation and its 10.E:f Electrical repairs or additions i 3.0 I am a homeowner doing all work officers have xercsed their 11. - Plumbing r ❑ g epairs or additions myself. [No workers' comp. right of exemption per MGL 12.(].Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13 Other /4be v e) to ,/, e / • comp. insurance required. }. / au I *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit .indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. / Insurance Company Name: /\ cuf�1l C e (e T � a r e G✓ L %, o� /G,, • Policy # or Self-ins. Lic. #: IN 0 9 - 0 ?6C) f . .f - 1 U Expiation Date ✓ - 7 - / L 3 Job Site Address: S7 3 /4 a. ba- . 1 2 t`' , City /State/Zip L .� 5 4 - 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 'of MGL c. 152 can lead to the imposition of cr unmal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to $250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the O.fce:of Investieations of the DIA for insurance crime vetfication ,. , . _, :.:.- I do hereby ,certi under the , , ' , z - - -- -- fy d , enalties ofperjuiy:thafthe information provided�bavE tsur asiLrorrerf Signature: ..• / / " 1 0 1 o1 .. , Phone #: fi y _ ._ 6 a - Official use only. Do not write ill this area, to be completed by city or town official City or Town: Permit/License # _ _ .._ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk . 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: 4 .. SECTION 8 - -- CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone N ot Applicable ❑ av�� ;��� � .: : _��'� PP 54 / s t cez /It f S I Company Nme Registration Number E5-1" 57 / '� c ee AC Q ti rjd a c? _ .$ " 1J Address �y Expiration Date Telephone 0 " V � 6 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 ❑ eirt Wit 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 -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, 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 and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. El Demolition El New Signs [O] Decks [Q Siding [IM] Other Brief Description of Proposed L / / _ /(� / Work: /P1 ° j7u -�l a-e._ alt yap- I��G SZ t Alteration of existing bedroom Yes ""`No Adding new bedroom Yes " ----- N T3' Attached Narrative Renovating unfinished basement Yes --- Plans Attached Roll - Sheet 6a. If .Ne ous ride i tl [otr ha Istin houses mDfe a the fc l owing: a. Use of building : One-Fimily Two Family Other b. Numbetr.orrooms in each family unit: Number of Bathrooms r> c. ,. there a garage attached? r' 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 l , 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 Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning i' ` ! . This column to be filled in by Building Department Lot Size ! Frontage �1 ,-s r Setbacks Front '"` I — A S ,. "1 -.." Side L:[ R:1 I L:EB R:i i s3� a / Rear d Building Height Bldg. Square Footage I I t I% L 1 1 i Open Space Footage , __ % i (Lot area minus bldg & paved I ? I L m i parking) # of Parking Spaces Fill: _ 1 ._, ..w. . _. ... _ . 1 (volume & Location) i A. Has a Special ermit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES i IF YES: enter Book Page ? and /or Document # ` _ _ N B. Does the site contain a brook, body of water or wetlands? NOONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q ,Date Issued C. Do any signs exist on the property? YES Q NO' IF YES, describe size, type and location: t D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO (e IF YES, describe size, type and location: 1 E. Will the construction activity disturb (clearing, grading, excavati , or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. n • t' ''r , ___v Cit of Northampton P � �� ° Building Department -� �x r .Ml 2 0 2012 212 Main Street a ° : - 3 Room 100 oE� oFaur "�:P�criov I Northampton MA 01060�� iii` * F ORTHAMP c. 1 MA 01060 _pkibne 41 587 - 1240 F a x 413- 587 -1272 s � � k4,~•: ,, �. °, . ^,:,.. a d °t $a . z APPLICATION 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 33 `'ii.4_, g--. Map : dot 11 Unit Le es -5 /0.4g_ - f)/ t'S3 orwe Overlay Dis trict Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ill rn e-1ps , Ph Ip3 3 33 4-I b /�v L�t� / Name ( 'nt) Current Maili Address: Telephone Si 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 (a) Building Permit Fee 2. Electrical (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 This Section For Official Use Only Date Building Permit Numbed '�/C.r./ - ssued: r Signature: ® b " � C�;1 Building Commissioner/Inspector of Buildings - Date File # BP- 2012 -1148 APPLICANT /CONTACT PERSON TEDDY BEAR POOLS & SPA ADDRESS /PHONE 41 EAST ST CHICOPEE (413) 594 -2666 () PROPERTY LOCATION 533 AUDUBON RD MAP 04 PARCEL 018 001 ZONE RR(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid i 't2'5 / "o Building Permit Filled out Fee Paid Typeof Construction: install above ground pool 18' round 52' 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 INFORMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay 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. 533 AUDUBON RD BP- 2012 -1148 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 04 - 018 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- 2012 -1148 Project # JS- 2012- 001964 Est. Cost: Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA Lot Size(sq. ft.): 47916.00 Owner: PHELPS HENRY & JILL M Zoning: RR(100) /WSP(100)/ Applicant: TEDDY BEAR POOLS & SPA AT: 533 AUDUBON RD Applicant Address: Phone: Insurance: 41 EAST ST (413) 594 -2666 () CHICOPEEMA01020 ISSUED ON:6/21/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: install above ground pool 18' round 52' 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 6/21/2012 0:00:00 $30.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner