Loading...
29-086 (14) BP-2023-0696 410 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-086-001 CITY OF NORTHAMPTON Permit: Swimming Pool PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0696 PERMISSION IS HEREBY GRANTED TO: Project# POOL 2023 Contractor: License: Est. Cost: 11000 MR.POOL &SPA LLC Const.Class: Exp.Date: Use Group: Owner: L KRAUSE, KAREN Lot Size (sq.ft.) Zoning: WSP Applicant: MR.POOL &SPA LLC Applicant Address Phone: Insurance: 1353 RIVERDALE ST WEST SPRINGFIELD, MA 01089 ISSUED ON: 06/02/2023 TO PERFORM THE FOLLOWING WORK: ABOVE GROUND POOL -24'ROUND POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: }3"1\giA\k,/'all Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner File #BP-2023-0696 APPLICANT/CONTACT PERSON:MR. POOL & SPA LLC 1353 RIVERDALE ST WEST SPRINGFIELD, MA 01089 PROPERTY LOCATION 410 RYAN RD MAP:LOT 29-086-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $40.00 Type of Construction: ABOVE GROUND POOL 24'ROUND New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 01-/e14--' INFORMATION PRESENTED: X 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 Specia Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit_ Varia ce* Received&Recorded at Registry of Deeds Proof Enclose Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water P tability Board of Health Permit from Conservation Commission Permit fror�r CB Architecture Committee Permit from Elm Street Commission Permit DPWI Storm Water Management Demolition Delay „yak 3 I i eW ,3 Sigeature of Building Official i ate Note: Issuance of a Zoning permit does not relieve a applicant's burden o comply with all zoning requirements and obtain all required permits from Board of Health,Co servation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standa s of MGL 40A.Contact Office of Planning&Development for more information. RECE \. The Commonwealth of Massa uses MAY 3 0 2023 FOR W Board of Building Regulations an Stan Nod: MUNICIPALITY Massachusetts State Building Cod , 78a -INSPE. USE BUILDING INSPEC Building Permit Application To Construct,Repair,Renovat defel_bt4tifgv. Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:IS// 3 3- (/ 9�/ Date Applied:f Building Official(Print Name) Signature I i to SECTION 1:SITE INFORMATION ,1.1 Pr erty Address: 1.2 Assessors Map& Parcel Numbers boolt&&Qs 3.S, P5 ob 1.1 a Is th. an accepted street?yes X' no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1)3c fat(o5a Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: .8 Sewage Disposal System: Public Private 0 Zone: _ Outside Flood Zone?Check if yes❑ unicipalk On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2. caner'of Rec r : e\ `-' K(C � �� ) C`t 010(e a_- Name(Print) C State,4lo (.s A 3-431 - (t.l`t6 , iblie,1-irj II mai t-&kr' No.and et Telephone J Email Adam, SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs( ) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units I Othe 111 Specify:IC2ba.te errouncl.'eccil Brief Description of Proposed Work2: ()LyY1CQ.- AC) it Ck. a4I about of r0J1XY,1 eta l i P1sk.U,ea by H(.-0z5l&SKS J SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1 O,650.CD 1. Building Permit Fee: $ . Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ I, a>o. bl, 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Q= VA Suppression) Check No. Check.Amount: Cash Amount: 6.Total Project Cost: $ t 1 t C)OO. OE> ❑Paid in Full G''Outstanding Balance Due: HSC‘TA OA cc. '4%aoaa Iva m.t C,I 045A, io < ern L. Hei,r'ue,& SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( Oi Oy 0 License Number Expilation Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U L nrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1�� M((' � '�" m L�-C- HIC Ro'sttrr�ation Number Expiration Date HIC or HIC Registrant Name vperactle, t No.and Street Email address kisjeS4 Sgf►\1 MA• C*o9 P City/Town,Slate, Telephone SECTION 6: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 . 0 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize M r.�GokS & to act on my behalf,in all matters relative to work authorized by this building p1rmit application. " L. Vrc L,H-I,ec6e0 ,50s►a3 • t Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pe ury that all of the information contained in this application is true and accurate to the best of my knowledge d understanding. Vr-krer(-1 , (CA)t.) Me, c4 e,�2-� 5 Ia c IcR > Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ` . I rte l..U/Rrrtli t►VGUttrt (IILrsuaSUG/tu.etta I\ Department of Industrial Accidents 17) ;j jOfce of Investigations } Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractprs/Electricians/Plumbers Applicant Information Please Print Legibly r_Name (Business/Organization/Individual): M r- Pool f Sp Address: 135-3 ZVG'dJe- cr • City/State/Zip: Gil�stSrtn - 1AA, /vlr� C/C Phone#: 4t3-26,"-2-77 11- Are ou an employer? Check the appropriate box: Type of project(required): 1. I am a employer with g 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.; required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.03.00f repairs insurance required.] t c. 152, §1(4),and we have noI employees. [No workers' 13. Other Pop comp. insurance required.] *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 inf rmation. i C Insurance Company Name: A(tlMe-O 1 -NJ tV1�St/ra.�c e_ O ' Policy#or Self-ins. Lic. #:W C-C-500 ,$'026 1452 2022.A Expiration Date: Ozlo+17.o2T Job Site Address: LfI 0 PV/1-nJ 2� AOrc� City/State/Zip: MA OlO(pZ Attach a copy of the workers'/compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to th$imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the fo ti 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 mat a be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der t • enalties of perjury that the information provided above is true and correct Signature: C `/..'" Date: 5/24/ .3 Phone#: 413 - 2-6 -217 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3ElCity/Town Clerk 4.0Electrical Inspector 51:Plumbing Inspector 6.0Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such 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,§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 authority." Applicants Please fill out 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 TolA n Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to 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 Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Revised 7-2019 Fax (617) 727-7749 www.mass.gov/dia '4`��® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)5/17/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LONIALT NAME: Andrea Hills Koverage Insurance Group (JCNNo,Ext): (860)7454222 FAX No): 657 Enfield Street E-MAILDDE andreah akovera a ou .com ADDRESS: C g � P INSURER(S)AFFORDING COVERAGE NAIC# Enfield CT 06082 INSURER A: PHILADELPHIA IND INS CO 18058 INSURED INSURER B: AIMCO MUT INS CO 11545 Mr Pool&Spa,LLC INSURER C: 1353 RIVERDALE ST INSURER D: INSURER E: WEST SPRINGFIELD MA 01089-4916 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD b1NVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MM/DDIYYYI) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A PHPK2515839 02/04/2023 02/04/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 'C n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY GOMBIND SINGLE LIMI I $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 A —OWNED y SCHEDULED PHPK2515841 02/04/2023 02/04/2024 BODILY INJURY(Per accident) $ 1,000,000 AUTOS ONLY A AUTOS X-HIRED NON- WNED PROPER I Y UAMA(E $ AUTOS ONLY X AUTOOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A -EXCESS LIAB CLAIMS-MADE PHUB850534 02/04/2023 02/04/2024 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OrH- AND EMPLOYERS'LIABILITY X STATUTE ER B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEANY YIN N I A WCC-500-5026452-2022A 02/04/2023 02/04/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 24'AG Pool CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Karen Mercier ACCORDANCE WITH THE POLICY PROVISIONS. 410 Ryan Road AUTHORIZED REPRESENTATIVE A,,.dru.FlWs Florence MA 01062 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairseand Business Regulation 1000 Washingt. z .r `'t - Suite 710 Boston,wMassachusetts--O?118 Home Improve ntm —tractore li istration ' , . - ' 4.,: " Type. LLC `ei- aticny 194010 MR. POOL&SPA LLC `" E 6 atio,1: 05/04/2025 1353 RIVERDALE STREET .....0.0,00._ a — WEST SPRINGFIELD, MA 01089 "' lk :"014 116.' '4'. ...or Awoolowate; r Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVENI, TCONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation Re.is t .Ir.tion 1000 Washington Street -Suite 710 44 o ;,,,i Boston, MA 02118 v1R.POOL&SPA LL ri r-Ma ,ii i �.,.� ' --=a . ,„ ,,, ..„ ...„ . = . 3RIAN R.JULIANO r 1353 RIVERDALE STR �"' ``Ya NEST SPRINGFIELD, MAC, + � * Undersecretary Not valid without signature - --- �` v ee 10U 12U 10U final I 12U final CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD AGvnd SIDE YARD { �U • I 66 SIDE YARD 14,15 / FRONT SETBACK a V' FRONTAGE rCity of Northampton a.� ,�� Massachusetts `' DEPARTMENT OF BUILDING INSPECTIONS }• l;, ,, 212 Main Street • Municipal Building l' G4'" *'— Northampton, MA 01060 aryo.' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: (10 / 7 .-n /24) ' ! V /-d/1 ' ` 07czd-- The debris will be transported by: /I/AName of Hauler: Signature of Applicant: 7,,- i Date: ,3 �6=`v13 City of Northampton Massachusetts tf ( DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 l ✓ HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on. my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of ,20_. (Signature)