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36-330 (6) e 10. Do any signs exist on the property? YES NO V es c i a s . Are there any proposed changes to or additions of signs intended for the property? YES NO'` IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) over acre or is it part of a common plan of development that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED .!_:" - Lot Size h l Frontage X84 Setbacks Front .j Side L R L9 R: 1 14 . /0 R: / 0 -- - Rear / 11 ` ' / 0 Building Height Building Square Footage % Open Space: (lot area minus building & paved parking i # of Parking Spaces - i # of Loading Docks 1 Fill: (volume & location) –'----- 13. Certification: I hereby certify that the information contained her in is true and accurate to the best of my knowledge. : /1 f 1 ,7N— Date: < AO 4(; Applicant's Signature 1G NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards, Department of Public Works and other applicable permit granting authorities. W:1 DocumenttTOPtii. S' 1o; ieina1\3ui1dine- InspectorZoning Permit- Application- passive.doc 8/4!2004 I • LI / S 1 File No. /#7/Pt4://fy _ ,,___ __.. Please type or print all information and return this form to the Building Inspector's Office with the $15 filing fee (check or money order) payable to the City ofNorthampton l � ) 1. Name of Applicant: (,i (ei i 1 i ) 1 v oy i 1 • - Address: I)-- 06 Oat.( ] Oftl /Oi l t Telephone: .. D. I 7� , I c g 2. Owner of Property: r1�1I S (A rid Ka:i1 ll� ✓(�/� Address: I b ((di& 1 00 F/ C_ l./ 4 106 Telephone: �7 - 7I7 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) 4. Job Location: (c� �,U(d WG I�Or 1 ( (( _M ._ - -e- eS:0 -., - €et i ctr�c3 . , -.. ..--- - --- -� - 7- „ 5. Existing Use of Structure /Property: 3e1inU l5 IinU , h ih C lr 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 0 e • m C t P � 0 , or'c., d) I).•)1 1'1 1 1 bon p70 111C , e,- 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans WA 101 pre, e i7i Su.rc r 501e_ x Z ,' � X(,.' il24. - e - (.3,11 --gtf &Ad_ Joo t'i c�"It 8. Has a Special Permit/Variance /Finding ever been issued for /on the site? ,l1 }--1 i NO DONT KNOW ✓ YES IF YES, date issued: MIIIII j / iv. 1 I IF YES: Was the permit recorded at the Registry of Deeds? Shec NO DONT KNOW ` YES 90 a I IF YES: enter Book Page and /or Document if 9.Does the site contain a brook, body of water or wetlands? NO ✓ 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: (Form Continues On Other Side) WADocumen*s\ ORMS\ orioinanl auiidins- lnspeczorZoning- Permit - Application- pnsive_doc 8/42004 ' a I ,n 4 12#31-114 "1 �/ 3l+", , � .� f �' % fir'" • 1 L7 /'�4 `. -; .-. ‘; - ort : .6-,4_,--. \ \ .... ., --"-- C4 '' .L:e*,/ i ''''. -4 ...6e-‘ ... os .,,,., ,, , „..-, _ / ,,,, t, _ . A _...--.2.-.- / , ,, ..... ...iga ., ' fi s'a .\ ‘ ..,;\ - -- A.93 0 . ki . - /...., / (.' .1., \ 4 - - / I . .0 / ca oy& z ca.* - 1. ] .,. \ , ` - /nit -3 ( � 1 # 4,43 % it • ,.. j ii-' ii I, 1 .,.. 4 ...., , ,,, , ., ..--,,-;„.. k 1 - -- mpg t ! ( �\ •\ S te * = . ,!* f ....it Z ! M * • ! J s - `, .� . : I i 1 3.05 - -- 1 \ "% Sit --' „t 1 ../(._ ' ". ..' # - _ CD t i1/4i . e : 1 1 l i 5: 1 ... _ E h f sot ... A - e ,' ".v • . - A *. ' _. j ' R l ig ..—--- --I - . . 4 . V . a # = r r - tirrriii • *I vesitz p .cosr x iii t4 ...ge - St# 0 :" ir ) T ' - 1.3 ?.-- f 1 / 1 , : 7 sLTOS —7 . \' a / » j *01.13'' 4 Sit 141' •"•/ / / Val 11141 1 '`` / , ; ----. F. t • T / / f..1 I 1 W. 9 ‘•■ • \ 411. • A* (r * - -4- 17, G r r .4%'- \ -.*j .-- - 1 1. I I s' 7 *' l I -'.. ''*.> . • 5£:0" 31 : 11 ', .. ` � . J� � .�- ,' � t 4' ♦ /J "'" ` �Q fi r ' t rat, s� 1.1:'" A 0 a .s �,�+•"-' j � .- .C' a r► • J '.. "•‘.1. • 4- \ .1-- 7 1 -9 syS3P4 tI 4 .,, . \ Cc V/ Uki" • 4,\,,,,>// t -7. • 4,A -,,, T N .-- a .44 w.t..... t: o s.tii. : 0 : 03 , :I 30, ).1.. 124_94,2 ...., 4.4.....44.4 ::: ‘'‘,\‘` - : zi.: 1 l i 0 - tri.x- p ittA \ v ., .., t W ) ca : (11,8 - - " .•*.... Pt 1 ' , I a N el Om Lt'�`, ; y 1 f tom 101: s • er# \; a � , i _ - » . .' _ t y `" .. . ' std '' £4i"la0t - • r 8 in 9 v 3.0* l Lu ,. . trdt SOU- - Z •"` i 0 . t41# File # MP- 2006 -0119 APPLICANT /CONTACT PERSON SULLIVAN DENNIS A & KAREN D ADDRESS/PHONE 182 CARDINAL WAY (413) 584 -7819 O s THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ON1N; FORM LLED OUT 5 / �� Building Permit Filled out Fee Paid Typeof Construction: ZPA - SHED 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 PRE�S NTED: 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: § l • 3 s $b/ r< 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 Penniit from CB Architecture Committee Permit from Elm Street 'ssion 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 the Office of Planning & Development for more information. ACORD DATE (MM /DD /YY) TM CERTIFICATE OF LIABILITY INSURANCE APR 204 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR W SPRINGFIELD MA 01090 - 1175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. • PHONE: 413- 781 -2410 FAX: 413 - 731 -9539 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A HARTFORD INSURANCE COMPANY TEDDY BEAR POOLS, INC INSURER B COMMERC INSURANCE COMPANY 41 EAST ST CHICOPEE MA 01020 INSURER C A. I. M. MUTUAL INS CO INSURER D INSURER E COVERAGES (TUE POLCIES OF I,■.-••_ - • - -- - ' _ - ° ISSUED TO TNE - NS:JAED NzmEE a❑n,Jr ^4 -mac o^ ..._n - - -- 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 INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM /DD/YY) DATE (MM /DD/YY) GENERAL LIABILITY 08UUNQS9387 APR 1 04 APR 1 05 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PREMISES (Ea occurence) CLAIMS MADE X OCCUR MED EX? Or.a Person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRP IFrT I OC AUTOMOBILE LIABILITY 04MMVM4663 APR 1 04 APR 1 05 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ B X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS / UMBERELLA LIABILITY EACH OCCURRENCE $ OCCUR ':.AIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION 3 WORKERS COMPENSATION AND WMZ800299401 APR 1 04 APR 1 05 EMPLOYERS' LIABILITY E L EACH ACCIDENT $ 500,000 C ANY PROPRIETOR,PARTNER OFFICERIMeMBER EXCLUDED E L DISEASE EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS /LOCATION/VEHICLES /EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR to MAIL 2C DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT TO WHOM IT MAY CONCERN FAILURE TO DO SO SHALL IMPOSE NO OBLIGA OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE Attention: / ACORD 25 (2001/08) Certificate # 4515 William 0 Trudeau. VP Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street (413 594 -2666 • 1- 800 - 554 -BEAR Chicopee, MA 01020 -3562 . OP . FAX (413) 598 -8823 Home Improvement Cont. MA #11889/CT #520951 www.teddybearpools.com Aiso sk No, TEDDY BEAR POOLS B SPAS ,,„,.,,:,...,,::„..,:.„,...:.:::„.:,,,,,,,,,„;:„.,,, F ' ' ',; .: :. : P:,..: . r i' i' i':: STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION , Be it known that TEDDY BEAR POOLS INC ,41 EASI ST C H ICOP E 'E, 1O102Q, �'� has been certified by the DepartnT pt of C'grisumer Protection as a registered HOME IMPROVE ; ENT' ONTRACTOR ' `- Contractor o f Record: ODORE G. HEBERT At, Registration # 520 1 : — : 1..1 Effective: 12/01/2003 `` ' Expires: 11;'30 2004 -' _Jo T. Fleming. Co stoner _ n ai ,\ . � ' P ,..3'''',. l * .0 .'1:' stye• tiS' r :\ r \Vr '40' ti t t; `` 1'? * 3i: . ti , ` + , \ r ` \ n t a Y ,'� ti � tc 4 , 1. .5.. : .... .i. .. .t- ... .i. ,... .I. r.. , I• ,r. .t. .•y- ,1. :. J. ,... .I. t�. .l- { µms ,3. .. .L , t• ... ... %e Cammiinevea1( o- � l - /a;11ac` u e tJ '" / - Board of Building Regula and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 111889 Type Private Corporation Expiration: 2/8/2005 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST CHICOPEE, MA 01020 00ssv xaer0 xod Qdaad 1 . 1 iDvssviAr ` gyp �1 '`Lv �t OLL,V, T,AarZd ,Ln p SMICiens am d Q ..ZC- ,ZC -.L 1_-:..1 l� .OWN =P40 ` =1 .1,0'0 1 ..!$ - ,52- ,60N =P40 \ ..81-�F , , �1� '00'SOC =d , d �ZZ- 8 1.--L1--..-1 �‘_ „SZ.•Z.OSI ,LC '009=- .O 0bl X3 .� S©OOM ,.SZ,C' .05' l ,80'' 179=- 3 00 s�Z /9 j � . ■ \ " w C1i / \ y S W A Y .171191. A ' O t����a. �� � i co - �S- ,9SS =P40 d ��...� �, � /�'�,.Ob- . i�� - , `8! ,61'1791 =1 v'. 1 / v .00• O� z--- ao _i___, _o . S6Z = d o .0n 2U� ��ht�1� �d.? . '1 � •bs 86 2`6 ) l * i 3 •Z► ,, ,;T_ ` ` , • / \ ` \, 1 , O m • 6 ''-... 0 01 431 N00 : 01 41 / , 69 . .. -.- th I T g . leo ,...„,_,. \ 4 � �: I . c.,. Li ,. \ I 89 3f7.0) \ - M A'El TO: • 1-;'." .)11H , PHONE: H `5,...,5 - / A' ; 13ATE: r-71 i f. /; ''''' L ? 82 ( 1 A rc I v " 1 h4 './ W 4 (. ' Cil l ' h -.E ' - ' l' — JOB NAME / LOCATION: /-'—' 1 { f i ,, i , • _ 1 .,-, '. ' 4 .- . " „k 2 , ,i ,/ -.- 'I JOB DESCRIPTION: .c....,- 4 I v , u v . 4 . 0 ty; c d, ,-) I r... t? )• :4FD vv / L 6 -1-- ,,, f v / , ./.. i i / IP dil , ‘, 1/4, -, lei 11 - ; , -, , 4,„ 4 1 [ E ,?.:..............,_,_,____ *-.-- ' \ -,.. - - ---- ! -1111 PIN r..-,. _ . _ r ,..., ,...,....- -...,.„--7 , (- ,... : ,-.,,- - Immigmli.... t t / /- ,-, , / 44 / i f ■ 0 0 Not Included: Dry: 0 Yes 173 No L oam ...,\ e- ... .. ., .„..) 0 Fencing i q /A „ -/. Water Tanker: 0 Yes 71 No '-"-- St°ne ,71 Chemicals (") , Clean Fill . ..-:- .... ........ ..-..Z1.0- .-...-(:-<— ° -/ Trucking: 0 '?es. 0 No _,---lf 0 Bid. Permit , Pump .. ..... ..4....::.....:7..J ,.., Ai Water Stumps: 0 Yes CI / No Labor ........44/...... . ... . . . . .. . .. . ... . . ....... ..... . ......... ....... Back Hoe ,-,g7 , Job Description: i' Excavator .., LI i-i- , Stump Removal Other N I ‘ See wording contract for signing back. ESTIMATED ,''''. ---- 7 (.., " c/ 4 / THIS ESTIMATE IS FOR COMPLETING THE JOB AS JOB COST: ',- DESCRIBED ABOVE. IT IS BASED ON OUR / 1 7 1 / - /..= EVALUATION AND DOES NOT INCLUDE MATERIAL ESTIMATED ' ,,,, ,,,,---..,/ ,„;,,' PRICE INCREASES OR ADDITIONAL LABOR AND BY: '' ' / l, MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORSEEN PROBLEMS OR ADVERSE WEATHER CUSTOMER 7 CONDITIONS ARISE AFTER THE WORK HAS STARTED. SIGNATURE: --` ''' ' / WHITE COPY: OFFICE YELLOW COPY: OFFICE PINK COPY: CUSTOMER „K it � ' _` (Lzfp of Xor#I�ampten i, = #_� _ ��y /��i I [I BSSA c1�liSetto ^ — , 5 -' 'W 2 DEPARTMENT OF BUILDING INSPECTIONS 4 _'= _�= INSPECTOR 212 Main Street • Municipal Building '�, Northampton, MA 01060 `s e . r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction sups. : :isor. 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) s who seek to g p y P yP () 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 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 .. 4p,... . o . -- = Qi,itir of 1,.. _,....,,..g...1" ,. ti 4 ,,, c 4 ,., . • 4,„ - . -- ' DEPARTMENT OF BUILDING INSPEUI IONS - • ..„.. : .----=------ - . ,c7 212 Main Street ' Municipal Building Northampton, Mass. 01060 iris' WORKER'S COMPENSATION INSUIZANCE,' AFFIDAVIT ------- (iicctis,!!:-../r..ornuttcf:.) with a pan cipal place of business./residence at: (-- I /1 i 4/ i ) /,,,- to A oj 0 q• q/ 3' 3 v2C; 1 L 4_ _ (st tylf;atfily_ip) do hereby certify, under the pains and penalties or that _.. ( I am an employer providing the fo 1 1 ovv nc. worl- coinpensanon covera‘...te for lily employees wording on this job: A:1,41 A 11 1 / 6 Woo Y/ AIR . I 05 - (lasur anc... Cornpany) (Poi.icy Nu:Tiber) ( Date) ( ) I am a sole proprietor, 2.elleral C-Orltr2C 'Dr homeowner (circle one) and have hired the contractors listed beiow who have the t. Workers COMPe..11S.a 7 , - .)01.1CleS: (Name of Contractor) (Insurance Conip2m,71)ol1'c-f Nu_inbcr) CE. Date) (Name of Contracloc) (Tas Co rzi. Number) (i Date) (Name of Contractor) (Insuratice Co 133 pal rt 0 I i C N tunixir) 6F....x;.: Tabor: Date) (Name of Contractor) (Ina:ranee Cou=ay/Policy Ntiml (fixpimticn Date) ( :..-.....-}_...,,, •- 7-..-.: • • — ' - 7 • • - U ,,,--- -' • - , ) ( ) 1 Zun a sole propne01 and have 00 onc , for me. 1 am a hone oviiic: on all th;T: -, ii'ISC.11 NOTE: pk_ms.c be riw2.,- air. v. bc..71-ic:,) ,,,-,-. c. p--7 to , A) : c-,-,..rr..:c......ci cr irc , .‘":).1 , 2-7: ,. i.:‘,.c.111.-.:, 0: not more 1.1-L thrco Linzti ; :Ix 1 r:c cc oci L1,..ii i-.,: :i.:: • at thc-cto..1.: r c-cr_rally c hr. cz unz_tc.; the . tvcr-'... , •-e:. c-, Art (G1_1521_11(5)), r.r.T...1..:ation by 5. b,c,...n 0 1. for a Lc-c or legal rtatur of r otaployer under tho Woricoet i_,-'0,-1iori..A..ci._ 1 and.c....--ztuad the a coy of thi, ct,..tort--.,-rt raxy bo forwardo.ti to thn 1),: o f Loho-drieJ Arcid.mt..s' 0113 of ',.._-..0 for the coverage vorsia_tipo oral that friluro to ......:,_ �tt uri.d.cir : 251 of ).;01., 152 can 1=d to the imposttim of or,..-mir-o...1 pettz.11iot . Coon.i.ltg of a , f of u p t 21,200,00 ,,n... ixi.... of up to cr..-. civil pc.n.Otic.1 in t1•4 form of .t Ste? W Ord ?r-d fir of S100.00 I thy 1.g:•..i0.-.1try:.. Fur dr4.-..twere,1 ttoe only i Pcrmit Nainlyzr 1 ... 4,...... :3! gim Cu rc or I .iccn;ef.11 it t cc Tj. i.7 i r- / SECTION 8 = y CONSTRUCTION S ERVICES _ AK 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature � / �il Telephone 4 % i> 5rY2_64 7:1117:17676.1: b T e4, m ,•vemen: Ce ntr`'ctor �, „73-r Not Applicable ❑ , i firilffillr, Company Name Registration Number %' £ 57 cr s- o 5 Address Expiration h ti at : e 41 /414 O �� T e ephone l ` Al 6, SECTIONIO;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 ❑. r� 1. -ome® 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 • N. SECTION �D S AN OF PROPO WORK (check a1I apaltcable) :' „ >>�..,..y F?+.+e{±' fib. eta..."b"fidpllYt�+'.5?.W.K:Pra -% !'A::J+`ai n3i:, ,• i f r '... ^f.:.va,>,biP5.8+.+M, s u' .. .. 3a r .:: itegge .aa. u -.,- -. 49.g n 'a N ".f „, ,, , :, - '..a.. %P `. Me r 5 rte” 5 - ' .M?e.:. ,.. 'S .s .... 3 + ='^� n x: 5 i :: .i.., a.. ,P New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks / [ ] Siding [ ] Other r,•<] Brief Description of Proposed Work: i ' L ye a fu 9 j ' GC L /O x 3 ` . Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6a I.f NewThouse and 6 atlditfon bre'zisfm 1hougi i comple heffolil.owl'ng: 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 13- x 3 b - v Noro,,., Po e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck 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 SE:41A *. ORIZAT ION = TO, BE.COMPLETED: : WHEN OWNEFtSAGENT CONTRACT APPLIES, FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, i III matters rel;p. 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 a p- altiesbf perjury. J vio R. t ucct Print ril ' f 01./ Signature of Owner /Agent Dat Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size / / l l j Frontage 1 6 f 55 Setbacks Front / v / d Side L: r R:�✓ L: R: I Rear / Building Height 3 Bldg. Square Footage /7 a 4 04 i O Space Footage % (Lot area minus bldg & paved Sd parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO 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: A City of Northampton 0i ' 2 Building Department 1 +a 212 Main Street ,, H � � ,� ` Room 100 + -4-47-, - �„ � �- Northampton, MA 01060 f1 _ . a _ � ar , phone 413 - 587 -1240 Fax 413 - 587 -1272 �� . = , . ,.` p ', APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION 1.1 Property Address: Thissectio be . , . „ office Mall ., tat ` Unit iia9 a t - 41( Al (Jai t 6 r i c 0/06.a Zo - t' Overlay Distri , Elm St. D istrict CB Di t SECTION '2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: i•pri-75ae- ( nfr)-o-ik)1116,-, 1 ,13 Cdunti ( Et J Name (Print) Current Mailing Address: J (/ �..,".r/ _AI. Telephone Signature 2.2 A�ut rized A ent:z_i ? !rr([ (u r) � /3 G�5 ill ECi,5t Sf edipcorAt 1 16- d 16, ° ;/ 4 / Name (Pri / , � may d Current Mailing Ad ress: �)}/r � / l / /, ,..( r e-ii,7 �y l 'v�YW Signa e Telephone 9 SECTION, 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Of del Use Only completed by permit applicant 1. Building 2 :? j 000 0 C (a) Building Permit Fee 2. Electrical / d (b) ial �U v d Construction Tot from Cost (6) of 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) (1, 5O() Check Number This Section For Official. Use Only Building Permit Number: Date Issued: Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2004 -1003 APPLICANT /CONTACT PERSON TEDDY BEAR POOLS & SPA ADDRESS/PHONE 41 EAST ST CHICOPEE (800) 554 -2327 PROPERTY LOCATION 182 CARDINAL WAY - LOT #26 MAP 36 PARCEL 330 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: CONSTRUCT 18 X 36 1NGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 111889 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 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 Co ssion Signature of Building Official Dat- 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. 182 CARDINAL WAY - LOT #26 BP- 2004 -1003 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 330 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- 2004 -1003 Project # JS- 2004 -0780 Est. Cost: Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq. ft.): Owner: LEPINE DAVID M WILLIAM P WZOREK SR Zoning: SR Applicant: TEDDY BEAR POOLS & SPA AT: 182 CARDINAL WAY - LOT #26 Applicant Address: Phone: Insurance: 41 EAST ST (800) 554 -2327 CHICOPEEMA01020 ISSUED ON:4/26/04 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 18 X 36 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: Receipt No: Date Paid: Check No: Amount: Building 4/26/04 0:00 :00 2655 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo