18C-089 (3) _, -.. 1
ACORD CERTIFICATE OF LIABILITY INSURANCE DAT OS 2s�2o , W '
TM
__
PRODUCER Phone: (413) 781 - 2410 Fax: 413 - 731 - 9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P O 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 8 TGH Leasing, Inc INSURER s:
41 East St INSURER C:
Chicopee MA 01020 ',
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 AIL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
+NSRADDl POLICY EFFECTNE : POLICY EXPIRATION '.
L7R _tNSRti TYPE OF INSURANCE i POLICY NUMBER ry�yy tstu+rmmt '. In4r¢ LNMIDDmn LIMITS
GENERAL LIABILITY CPA 03 621 8 8 - 1 0 ' 04101/11 04/01/12 'EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY: ', DAMAGE TO RENTED $ 100,000
PREMISES (Ea xwrence)
'. CLAIMS MADE X OCCUR j ', � MED. EXP (Any one person) $ 5,000
A �. ' PERSONAL & ADV INJURY $ 1,000,000
_ , GENERAL AGGREGATE $ 2,000,000
', GEN'L AGGREGATE LtM1T APPLIES PER:' i PRODUCTS- COMPIOP AGG $ 2�000�000
PRO-
' POLICY t ' LOC
AuroMOBILE LJABIUTY MAA0382191 -10 07/01/11 07/01/12 COMBINED SINGLE LIMIT $ 1,000,000
ANY AUTO (Ea accident)
�'. � ALL OWNEDAUTOS BODILY INJURY
X '. SCHEDULED AUTOS ', (Per parson) ', $
A X HIRED AUTOS
BODILY INJURY ' $
' X NON -OWNED AUTOS '. (Per accident)
'. - - -- ', '. PROPERTY DAMAGE ',$
'. '. ', (Per accident) ',
GARAGE LIABILITY � � �AUTOONLY -EA ACCIDENT $ �� ,
ANY AUTO OTHER THAN EA ACC $
', : AUTO ONLY: AGG $
EXCESS! UMBRELLA LIABWTY ', EACH OCCURRENCE $
' OCCUR CLAIMS MADE ', '. AGGREGATE $
'. $
'DEDUCTIBLE $
'. RETENTION $ '. $
WCA 0382194 -10 04/01111 04/01/12 roaYLlMlrs
WORKERS COMPENSATION AND we srnru- orneR
EMPLOYERS' LIABILITY E L EACH ACCIDENT $ 500,000
A ANY PROPRIETORIPARTNER/EXECUTIVE '. -- - - - -- -
DFFICER /MEMBER EXCLUDED? E. L DISEASE-EA EMPLOYEE $ SQQ,000
If yes, tlescribe antler
SPECIAL PROVISIONS below E L DISEASE•POLICY LIMIT $ 50Q,000
OTHER:. _ -__ _ ._ _ _.. _ ,
DESCRIPTION OF OPERATIONSlLOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
_ ,
CERTIFICATE HOLDER CANCELLATION
_.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCElLEO 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 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,
IT'S AGENTS OR REPRESENTATIVES
.. _ .
AUTHORIZED REPRESENTATIVE
Attention: iam 0. Tru�
__
__ ,.
ACORD 25 (2001108) Certificate # 56769 O ACORD CORPORATION 1988
780 CMR: STATE BOARD OF BUII.DING REGULATIONS AND STANDARDS
THE MASSACHUSETTS STATE BUII.DING CODE
secrion a = �o.co�swztotratsvaeat►�msvri� orc.�.�e. az:! �cgl) i
woskea Ca®pensattoa Iasuiance a must be compktad aad submitted wtth this appltcatbn. Failure w provyde ttas
aIDdavft wW result hs the denml of bsuaace o[ the bu0ding permit
stgacd Affidavit Attached Yes p No...... p
SECFIOR . S DESCRSTiON OF PiLOP06�WOftS {'c[teeiCaII appIicab�le� ' I
,;.
......
Nea' CoastruCtlon O Eklsttag Bufldtrlg O Repa�r(s1 O i Alte:atton(s) D , Addttbn p
accessory Bldg. o Demolltlon O oti,er o spedfy:
srlet Desccip tloa of proposed woria .
sscriox a s.4ancsrffi cor�r�.vc�no� cbsrs°°`+
....
[tem - F.stbmated Cost ®orla:s) to be � .� '' ' � List On�r' �` ,�,,
oompkted by permit applicant ; �K ' `� ... � . _ .° z ��,„ �'��%� ` ' �'
s .
1. Btutding w � y ,�.•r � ,z. � �
_`
... `�Y"�!' � *'L LAS'"`°" . � i ... �.: ...., � ,�`�.:.
2. F•IeCttiCal x`Sst<� `��
aYiRr'W\A�iM1F k� <§��2 ... � � - � •
.. .. ..w:x.eL +3W ... ... � ....
4. !r[echanlcal (HVAC) �,Ye®o1c';� �.� n ��� � � ��� `��
6. Total : 1 + 2 + 3 + 4 + 5) �'�lecl� _ � '
SECtI01'�Ti"��aW1�L"E[ EITrli0�7ATIOP�'��8U COl
OW!'f �BS� '[lTORCX�!'tT'O7tdPPL'tES!'Ojt HQ
..:: a v..:�. .v. "4. � R
I, . as Owner of the subJect property
kureby uthorfu to act on
mY be � � . 1a �� to work wthorized by this btiliding ptrmlt appLrtgoa
�� ��.�� ��III
s�n,r< or o.+e,a n.c�
�� sECrtox a� : owr�x /wio�rsoa�.n ar�r�r naccsASrtox;a
[. . as Owtxr /Attthocized Agrnt
hereby declass that the statements sad Informatfoa a► the 6aegotag applfcattoa ate true sad accurate. m the bat of mY
Imoakdge and beLeL
Sign �nnder the pains and penalties of pecJ�uy.
Pr1nt Name /��
H of Owner /Anent Date
672 780 CMR -Sixth Edition ?!7/97 (Effective ?J28/97)
780 CMR: STATE BOARD OF BUII.DING REGULATIONS AND S'''ANDARDS
APPENDIX B
The Commo�aWealth of Massachusetts .
,. tr ,, State Bond of Buildia� Re�alatioas aad
•. FK Stiadasds FOR b[iJNICIPAI�TY USE
� 1 1j W r � Massachusetts State Bnildiag Code
_ 780 CMR
llppl,ICATiOIf ?O OOMSTgIICT, jt8PAD1. REl'fOVATE OR DEI[OI.13H A OMB OR'1'AO Fe3QLT DWF•Id II�IG
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;; � >�
�BF. GtIOYR "i ' v
1.1 ��Addrpe�� �� 1.2 Aseeswa 1[ap Ac parcel Piamber.
v Map Number Parcel Number
1.S ZonlII� IIIfo:mttlon: 1.4 psope[t� Dlmeafionx
yonh� pbt�t propwed Use Lot Mn (sA Frontage lRl
1.6 Basdinj Setbacks (!t)
ihoat Yard Side Yards Rear Yard
Requftod Prwlded R°4ul:ed P:wlded Rcquh+ed Provided
/ /
1.? Water Sapper pLG.I.. a. 40. � 54) 1.5 Ffaod Zoae Iaformation: 1.8 Sews�e Dbpwel 9�stam:
P�sbbc o Prtrace o Zones. Outside Food Tie o lduntdpal a oa site dbposal system o
e Z:ECTtON' � PilOP6S� GIPIOSRSBS�AITrHO1tiZ15D� '`AGEltT
a �:;� . ..
Z.1 O�aer of Record:
Name (Pr1nU Add�as for Srsvloc
s�c,an,�e T�kpt�one
2.2 Aut1►orised A�eat•
_ �
N y wddr+ess for savue:
"7��
Telephone
8�t"l101'IS lA1t61RIIC?IOlf�4ICdS >;�'>
S.1 Llcea�ed Coast�netioa 9apes�i�oz: Not AppUcabk O
r
Loenaed Con�tructlon SupeMwr. [mme Number '
�� Explratlon Date
S�n� Telephone
3.2��� Hom�prv►em� �+ntraccor. Not Applicable o
Registry n tuber
a � X0 /3
tX / Expires cn to
Signature Telephone /�
2/7/97 (Effective ?J28/97) 780 CMR -Sixth Edirion 67 �
City of Northampton � _�_ f
��
� . �� �.��,
''� y �"� Massachusetts '� �;� ��`t� =.,
��.
�` � .
�a �;
��,� � �� ; �, � DEPARTMENT OF BUILDING INSPECTIONS , � �`��
� � � r �� 212 Main Street •Municipal Building �y� �� '
� � Northampton, MA 01060 `�!'tr� �'t`�'
-'- "
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 familydwelling, 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 persons) 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 backfill), 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 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 i � . pections are : de
y�,.�_ - - tp-- -- understand the above.
H • e o � er /r sident's signatu a requesting exemption)
I will c. I to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
' �- � The Commonwealth of Massachusetts
W--�� Department of Industrial Accidents
':` "�
Office of Investigations
�; --� -�� _� 600 Washington Street ,,
'� "�� '� Boston, MA 02111 J
,� ..�.
` www mass gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
e Business /Or anization/Individual ' r I C� S
Address:
City /State /Zip: Phone #:
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- time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.- 7. ❑Remodeling
- These sub - contractors have
ship and have no employees 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. n We are a corporation and its 10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs 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
comp. insurance required.]
*Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they aze 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- conhactors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site 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 MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature:.. _ _ _ _ Date:
Phone #:
-- — -- - Official use only. Do not write in this - area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of f.Tealth 2. Building Bepartmen t 3. Ci �-/Ta::�n Clerk �. Electrical Inspector �. Plu;..brng Inspcctar
6.Other
Contact Person: Phone #:
w .,
SECTION 8 - CONSTRUCTION SERVIGESI
� ,
.�
8.1 Licensed Construction Supervisor: Not Applicable ❑
'Name of License Holder
License Number
Address Expiration Date
Signature Telephone
„ "_, . °� '�-. .. � "" Not A licable ❑
9' �KRegis #eretl:hfom�lmproyement�G tractor � -�..�� �,:�°
Company Name � Registration Number
Address Expiration Date
Telephone
.:,� Y ._:
SECTION 10- WORKERS' }COMPENSATION 1NSURANCE i4FF1DAtl'IT (M G L c 'f52, § 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 ❑
�,
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 maybe liable for persons)
you hire to perform work for you under this permit.
The undersigned "homeowne 'certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, S : � - and L. cal Zoning .: w .,, � State o assachusetts General Laws Annotated.
�,
Homeowner Signature � �� � �' ��
..
SECTION 5= DESCRIPTIgN OF PROPOSED WORK (check.all applicable) � ', �.
�r
New House ❑ Addition ❑ Replacement Windows Alterations) n Roofing n
Or Doors D
Accessory Bldg. � Demolition ❑ New Signs [O] Decks [Q Siding [O] Other [p]
Brief Description of Proposed /� /' ��� j j ��(� (f
Work: �1'1 C� (�'� v1 �c�.. t / /'" Q
Alteration of existing bedroom Yes �No Adding new bedroom Yes !/ No
Attached Narrative Renovating unfinished basement Yes �No
Plans Attached Roll -Sheet
sa; �J# I�te" �.. taous��and =ocaaddifiion'to:�ezistirq housing ,;complefe�he < > #oll`ownq;
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each '
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
. � :,
SEC ?IC�!N 7a OWNERAUTHORiZATION TO,BE �QMPLEl'ED.',WMEN� ,, ;� ,,, ��.
OWNERS AGENT OFt C+DNTRAGTORAPPLIES FOR BL]ILDiNG PERNIIT� , r ,:
r
1 A`n � ; �' (�,, ( � (1 l Ci�Gi f � , as Owner of the subject
property
her: by authorize ��EX.�, ! �Pi. � ��`� � S
to .ton m� behalf, ' I all m e�- = -tive to work authorized by this building permit application.
ign• ure of �) er Date
1, C T , 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.
���. � � � (�K/
Signat re of O� erlAg nt Date �
.�
SeCt10n 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Inco . e e n + � ��+ ` ,. � ��'� .
Existing Proposed Required �y'Z�ng'`� "� r ' ��- <
This col �� to bcfilled in by
Building D .artmcnt � i.,
r. �,.:.+ Q,�i
Lot Size 3 ; ° ....,.
t+raa.; <.� � td t =t
Frontage
Setbacks Front ; � 4 t
Side L:' f R: L:�� R: I r
i
Rear � � `
Building Height � � �i
B1dg.Square Footage � � % �
- --
...Open Space Footage % - -- _ __
(Lotazea minus bldg &paved ' I l ! I �
Parking)
3 i � � � I
# of Parking Spaces
Fill: _._._.._. �.�___..� ___ � ... _ _ , � ._.r._._._. _v. _ _ .. _ _ r ', ; ._._..� � _____.� . _._.,
(volume &Location)
�, £ F
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO ��,� DONT KNOW ® YES
IF YES, date issued: I
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW ® YES
IE YES: enter Book � � Page; � and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO ��a DONT KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® ,Date Issued: a
C. Do any signs exist on the property? YES � NO `j
b �"'"
IF YES, describe size, type and location:
- - - - --
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO ��;
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES � NO ��S
�,�,
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
� !
�`� - -�� � �� � "� �- pe�art�iel�t use�cir�4� ' F`�x � ��
�. City of Northampton Sta us�`�ecm` ,�
REC �_ � = uilding Department "�� ��ttP.raVe�r�a�,�` � �y �`�'�,�
212 Main Street Senn e•�� atlal�it`� � � �
�.
Room 100 1Na e � e ��Iafxll � � � �. _ � >� �r�
A 3 rthampton, MA 01060 - • t r�' a�,as`
Y
. • • - � 41 587 -1240 Fax 413- 587 -1272 ��� �'� �[a � �� ,_
,�,. .�• Qther fa� �� � �� � � .,c����� � � � ;
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - 51TE� MFORMATION
" � n� ,�, This�ect�on10 b� completetl byoffice��� `� �
1.1 Property Address: � � `'r� �� , , . � ��� � � � ,� ;�� � ,�t� � >�k :�
Q I ��' 1 / 1 � � � p a�f�' -.r� �'s„'� � a;�.�`k.> `� �""v"* '�`.`" 'k s y��°'�`' � '''- �x �. �
V t ��i� �- ^, ^��. u�x � � ' LOt '� +' �-�„ t'^r� ^,s;m � �Rlt"s�`I� �"`.. � "� ^�:
,,,j o ' O r � 3 �ZOlne � � �` �� ���l O �rla�► DISt1`ICt � '�� �` � � � � �
�d ���+ ► i � � lfl �3 .; ;� n q�,' s. T .e�x� t t z^ ��u � rr, z�''�*' n �3 s� i 3 �'� �` a x "
=Elm St.�t7,�strict �� ,, � ..., �,.; , e CB U�s��ct.. "� ,v_ ' -; ;° ,°
,SECTION ? - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
{� r e� r�e � � , � C,�' v� � � �'►� c, /� � r" �°'� � L.e�,s art �Z � -
Vam Print) Current Mailing Address:
° �� (�C�•�..- Telephone[ p �(
Sig at re / �-� � - �O � � / ���
2.2 Authorized Aqent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 = ESTIMATED CONSTRUCTION�COSTS � " -�
Item Estimated Cost (Dollars) to be Official Use Onty -�-
completed by permit applicant � ,
1. Building �,[' s� �, ���, �� (a) Bualdrng Permit"Fee
2. Electrical p{ '(li} Esfimated Total Cost of =.=
Coristruction #rom (6) ." _
3. Plumbing Building Permrt Pee
4. Mechanical (HVAC) ,
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Cheek Number " � _ ,����
- This Section For Official Use Only
'Building Permit Number " Date " "
Issued:
Signature - , -
Building Commissioner /Inspector of Buildings " Date
3 �
File # BP- 2012 -0127
APPLICANT /CONTACT PERSON MCNAIR THOMAS P
ADDRESS /PHONE NORTHAMPTON (413) 586 -8926 Q
PROPERTY LOCATION 58 GLEASON RD
MAP 18C PARCEL 089 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out .y�
Fee Paid � ✓�7 4r
Tvpeof Construction: CONSTRUCT 14 X 28 INGROUND POOL
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��OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Pernut 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
�i D''ela
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.
58 GLEASON RD BP- 2012 -0127
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C - 089 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: Inground Pool BUILDING PERMIT
Permit # BP- 2012 -0127
Proaect # JS- 2012- 000185
Est. Cost: $28000.00
Fee: $60.00 PERMISSIONIS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 12763.08 Owner: MCNAIR THOMAS P
Zoning: URB(100)/ Applicant: MCNAIR THOMAS P
AT: 58 GLEASON RD
Applicant Address: Phone: Insurance:
(413) 586 -8926 ()
NORTHAMPTONMA01060 ISSUED ON:8/4/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 14 X 28 INGROUND POOL
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 8/4/20110:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner