Loading...
24A-138 II 1 li II ki -6 V N NA WI. - - - n t ,•g �33rn ac�gDm _ � o w�o.A A N r \ { 6w °S a d2�"�'jm ' � ..'48- c°'imc z z m AN_ IIl I -off r'o �m m mm °» ,D3:5-..-2 H. f ° - ). -{nm _ E -" 8 8 ° c v Q ^. m =. o ° 0 F m 9° 0 . m m m C • (n. y O N A rn u m x ET It - 8_. o < p n � o a - o o r mco rn yNmo - +1C -o� -0 A x ~ 1 f ',- • i n- y <<S o ) om n� A O m D m› to -, K 'D W Q �* a i y ill Z ; Q . j f , N D D n A A m A z z z g D z m ' i ,. 3 8 r '" K m x m Z rm- �� r m - m� y O 9 It Ir d tia4> >HO 5e3 ° mc� o I 1 2 £3 1^ _-min 2 C „' n .�yo...ym 30 -§' O -, Z Z . A" m N �.N m a m \ X J ? -• A-. A A A A A A AA A n ' N N I PZv c 11 9.M0.1, nm' Fa %p CI 2 0 A O N Z-• CO w KJ 0 V 0) m A O� W N� A O C R A q `� — & 2• w N ou A p N Cr NO STAIRS , Fir n m 4 3 c m 3 , N P N w 0 6' STEEL STAIR 8 3 a o m 8.� ° rs a m - O N m w N -s -• -• m 8' STEEL STAIR (3 CORNER LEFT) .4 co - P a 0 3 N 0 D w ^ f a) 6' STEEL STAIR (3 CORNER RIGHT) ^., m ° ^, w N -• A 8' PLASTIC STEP . b• it N j v i fr 'or -D n ryy .t 4 r 1 m m r t w,a, . Ili A r y r A .. . O "ti Ii iI O 0 0 � 7 I II I O 7 =— T_ �� r D n r w ... I1 I .,m,..... I r. III; fD o �.� _ 7 14, V 'I I ' I 02 g 3 m ar F ic A r 70 2 0 � " { 1 y o m A cl � A tO iO .. "u ,l il v ls'8 A AA .. 1 1 111 3d 444 , r # V I I I r 8 • ... .. Cy z , ' fa N co ' - O A N . j ... rTi p l 11 v ` m N �li ■ a oo 0, m D I^ A m r m 1 1 J f ' ii 1i �� AIL-12 P � 11 1 I to _ _ u � N l x00 3 M. -f cn V �£ rn t .... . , a ,m ° vro ('� N r OJ m A A �1 sl) 0 A .._..., � Iii O 4-/w. 4 (.,' I F a �� li1 .. .11131 4.,!, -"I ' !! m ° ::;: �= A � 01 _ Z ` $ v O LIII 1 1 1 , — zi m II ri p . I I I, N N? S." I " I , P, O 9.. N / H / / W CD Y !Id o N �� co �/ N I , g A N" " N A Oy y Q N R 0 ° y r rLi ` 11 Ills r z �� II 1 -I 1 71 ■ i 4S . • ... \ . , � Lm , ��v 0 v; I A J I +II ° °ptW m? <m O N mm cl � p N ^ # I O U: �p ¢ v _ O o O ® e O a A °z" U ° oo � �R � r Vm T ... ( r _ m x i� I ! 1 A ■ N I E I • • • P 4 -6 O 1/(ae cJ� t lo y,. --jn `•6 P C 6 OP ID: LL A� °R CERTIFICATE OF LIABILITY INSURANCE I DAT /11 D/YYYY) 12/11/12 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 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 860 - 289 - 6816 NAME: Marnie Evans Evans, Pires & Leonard 121 Roberts Street 860- 291 -8848 (ac No. East): 860 289 - 6816 ac , N 860 291 - 8848 East Hartford, CT 06108 E -MAIL mevans@levans Timothy J Evans � ADDRESS: R (� ans- insurance.com ClIJSTOIMER ID #k. JULIA-1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Juliano's Pools, LLC FEfi 4 2013 INSURE A : CNA Insurance Companies 321 Talcottville Road INSURE B: Vernon, CT 06066 Risune C: 0" fJ t 0.6C INSURE D: INSURER E : INSIIRFR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR !NAP wvn POLICY NUMBER fMM/Dr1/YYYY1 (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 4026526238 01/01/12 01/01/13 DAMAGS TO RENTED 300 PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) _ $ 10,000 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 X WT LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANY AUTO 4026526224 01/01/12 01/01/13 (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 2,000,00C EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000,00C A 4026526241 01/01/12 01/01/13 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION X 1 ORY IMTS X Ica AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER /EXECUTIVE YIN 4028798172 04/10/12 04/10/13 E.L. EACH ACCIDENT $ 500,00C OFFICER /MEMBER EXCLUDED? n N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00C If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER _ CANCELLATION INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Timothy J Evans © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD tl [[[ FEB 4 2013 Ct 1 .;.,, c3lbe / Office of Consumer Affairs and Bu iness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 139826 Type: DBA Expiration: 8/27!2013 Tr# 215648 JULIANO'S POOLS BRIAN JULIANO _ 321 TALCOTTVILLE RD. VERNON, CT 06066 _ Update Address and return card. Mark reason for change. Address E Renewal El Employment CI Lost Card 321 . 1'akoll v ille Road f - Vernon, CT 116(166 I1lIIuIp1 (: 1 1 iu? • 612 77 Plume (8611) 8711 IO1083 , ` yr l.ii . 13982(1 Ph R r ? -17 ('hone (113) 5 -7665 .- 0 L 1 i n Fax (860) 872 6639 ��rr sulcsH�]uliano_cl o _ oiu NAME 'u C- `✓t d 't \'SSA 1-1/4-)e -r,L_ DATE c 'l / 1 L / 31 ) ADDRESS L ip Rne- Ave HOME PHON `il cFS'S - ''' 3 CELL PHONE C 7]P _ " 1;1T ST r i �� ''�' Y � A T (' pi's �t kcr- h,,,,, -h�. ,, PHONE ( L A 1 7 -.) 'S ` ;�'C"" i : FE.a c — -I i : L ADD • I „ SS CELL Pl10NE Est. Start Date `'1 / 1 0 a.,.,1"5. POOL DRAWING e faint bru - ed concrete deck is / 4 / t cluded C ot lnclu r d - $1,500 credit to be taken Est. completion Duce / / - I. (a of pool base price ,,.1 POO : SPIfrIFICATlONS _ __ r, l ( y 5 •1 } :5 Pool Description /Depth \ k r [C L F1�1r - CO i tar n,;t Constructed With y + r,, <, Liner M II. Pattern 5 Liner Covered Stair Come. is L,L „Yt' a_ Bench 5 Spa fyl NO 1 1 YES Type Color Air Blower 11.."o 1 1 Yes Coping 1 I White [ Gray___ ___ -_ 1 ]Extrusion - Concrete 1 ]Extrusion - paver /stone � O V AL. u ^ ...4.-^ ,. C f.10 C Isr --t�> $ � /L. Sanitizer f 1 AU'1'QMA'1IC CHLVRNATOR (included) 1L3'MINERAL SYSTEM 1 ] SALT SYSTEM f ] OTHER $ L I, I, s O Heater _[ [NO [ ” S 'TYPE Pv - I. Z'° $ t0" LIGHT W / LENS KIT [ 1 NO 1 1 YES I I ADDITIONAL 10" W / LENS KIT QTY I I LED QTY - -- -- $ Diving Board [41 3 [ ] YES COLOR * Standard Features * • 2" Sta -Rite Pump $ Slide ['O [ ] YES TYPE / COLOR • Sta -Rite System 3 D.E. Filter • Vermiculite H.B. $ Deck Jets [ t..i0 [ 1 YES QTY • 10" Light w/ lens kit I • • rr o Skimmers $ Safety Vacuum Release System (SVRS) [t.,{' NO [ ] YES • # of Returns ,.C. [ ] • Plumbing: FLEX or POLY [. $ Automatic Vacuum O YES TYPE • 8' Gray Step $ Solar Cover / Solar Rings [1,10 [ ] YES • Automatic Chlorinator • Rope & Float $ Solar Reel [„ O [ ] YES TYPE • Maintenance Kit _ -- - - - • Commercial Grade Pool Alarm 5 Tree Work [t.]IO [ ] YES Bucket Truck/Climber Required [ ] NO [ 1 YES • Vacuum Kit • Start-up Chemical Kit $ Shed Site [ 1�1O [ ] YES Size • 2 Main Drains Dumpsite Required [ 0 [ ] yES • 3 Step ladder - Gray 5 7 , ` ) t . . . ) 5 3 Electrician provided by Julianos 1 ] NO 14 HIGHLY RECOMMENDED ' martdrsil.- nay._ Po $ t _ S SAFE- 7.`•�1 ("c1"/64 • Standard Winter Cover $ * SPECIAL NOTES * 5 t,'i_. Ta ,17.:11 TtMa11 "a-h,,n -{ cn;at. SCHEDULE OF PROGRESS PAYMENTS l y S, k.t.,x f t<- v�.<e. ( i 1 � Swimming pool and equipment to be at a total cost of ($ _ ,`) .`), plus any extras Cu( lOx'f -- C `.\"'- 1.r>;. Ck# 443 �,- -- -- (See Reverse) C I. J ,. „.. > ' , -'C Deposit 00 signing contract 500 a co t , c.c.. ` When pool is delivered and work begins l � • ri; . A When pool hole is dug and walls are erected 1 a , -.4 S0 • 00 A.c_ce 15,441 t nt:_9 vcl -.ar l P « . -- '(NJ c_ln,Ar t-. Whin liner is set in pool and water begins to fill the pool , SO C.) - C)J _ _ N tk 1 .wr, - 1 s, 4 c Balance, including all extras, when pool filter is operating (-Ls , 00 - 1 w4(.0 (. e.vsa,,..4 .. t . 'co ',It/ I1 be -10,J.--, 3` t'/“..e . When concrete patio is poured and forms are removed l , cU () , G0 t e y(1z•,w k „i - 352: 41 dea - Sit.._ i. 5,t,..),,,..1 1 $ t , a,.C. '12, .. - Toes°. (".•. t2 Ai -' l`ful; S. k1'-1 Pool / 4- 1c:..- ,td i 9 44. (---',-.^.- / / / / / / / / Tax / = Total ''i.s -00 H(, ivc(. 3,c)00. Occ I, 207 3‘ '1-1 Acceptance of Proposal: the above prices, specifications, and conditions are satisfactory and Date of ransaction q l ■ -.1-. are hereby accepted. You are authorized to do the work as specified. Payment will he made as outlined above. Signature (Juliano's Rep) Air j �' r In the event of default by the Buyer, the Buyer agrees to pay all costs of collection including Signature (Curraner) •'"' reasonable attorney's fees in addition to other damages incurred by the Contractor. Signed at 1Z 1 l ra 1 e,ru-, • 11 <- j2, If this instrument is based upon a Home Solicitation Sale, it is subject to the provisions of the Flume Solicitation Act, and you, the Buyer, may cancel this transaction al any time prior to in the town of , / r C ∎ o---6,... C. 7 Midnight of the third business day after the date of this transaction. See rear of contract for Notice of cancellation for an explanation of this right (Saturday is a legal business day.) www.JulianosPools.com City of Northampton - . i 1{ ,..a f7 a�" 7, ` ,. a s „ w. g w °. Massachusetts f o lr :._ rr' 1 d . DEPARTMENT OF BUILDING INSPECTIONS a S x " ' 212 Main Street • • Municipal Building y +' Northampton, M 01060 t'ti A 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 family dwelling, attached or detached structures accessory to such use and /or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include 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 • . The Commonwealth of Massachusetts �-- Department of Industrial Accidents k , - Office of Investigations W ' It INIIMIM OW IMMO �. o --- 600 Washington Street , r LL Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): J . sa 5 (?4.03 Address: �x\ Tom\ z� rv` z' �. s City /State /Zip: Vz.c , ( Phone #: ` t.0 -- - '1 c Are you an employer? Check the appropriate box: Type of project (required): 1. IA I am a employer with J`; 4. n 1 am a general contractor and I 6. El New construction employees (full and/or part- time).* have hired the sub - contractors listed on the attached sheet. 7. ❑ Remodeling 2. Ell I am a sole proprietor or partner- ship and have no employees These sub - contractors have 8. E Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions q ] 3. ❑ 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.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.[ Other` ^^ r^j e, 0\ 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 information. Insurance Company Name: C U i'n `''Y" Policy # or Self -ins. Lic. #: y abl y 1 . Expiration Date: 41 t o 1' Job Site Address: Ho Ko `.- 14.x-... City /State /Zip: 4141^-r al\ i PA A 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 may be 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: J -7. ---� Date: D /y/IS Phone #: d'C - --1 b 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9, R ed Home Improvement 'Contractor '" ..,.r. � W _ "' , , Not Applicable El �J v\%0-- r S yam` 1 75 ta‘ Company Name Registration Number 3 :∎ ; <..\ < o'T . t( c.),,i 13 Address Expiration Date \ftfIN‘Q./N, Telephone (2‘4-)-8 -7o-16 t.1 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 B No ❑ 114 w Home Owner;:Exemption 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 • A SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ] Roofing ❑ Or Doors E Accessory Bldg. n Demolition ❑ New Signs [O] Decks [0 Siding [17.11 Other R Brief Description of Proposed Work: ►y Jt3l`>s 11.+r``� j.�.a:r�.v�.'v Pte\ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll - Sheet sa New house and or addition to existinq housing xcomplete the following: 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 SECTION 7a - OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, c■L‘/ K.ACN , as Owner of the subject property hereby authorize 30 \ to act on my behalf, in all matters relative to work authorized by this building permit application. 3Aitt13 Signature of Owner Date 1 -"' 1 P4)N , 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 _✓ •MI5 Signature of Owne /AP gent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information • • Existing Proposed Required by 'Zoning This column to be filled in by Building Department Lot Size _ — L. Y ___ .._____ _ Frontage — — • Setbacks Front Side L: ......_. _ R: _ L: R. �__ �_ Rear Building Height Bldg. Square Footage Open Space Footage % - ---- -- (Lot area minus bldg & paved parking) i # of Parking Spaces Fill: . _ .._ _.. (volume & Location) - A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW G YES 0 IF YES, date issued: IF YES: Was the permit recorded at the R istry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book ` Page.: I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO d DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO (g IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO d IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, a avation, 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. Department use only � � r7 7 �- "CI of Northampton Status' of Pertni# - - --� e Bu (ding Department Curb Cutipnv 12 Main Street Swe r /SepticA�va liablllty ' � , �x FEB 4 2013 Room 100 W Availability ' , ort mpton, M 01060 Two e #s`of S # ru o tuta l Plans 4 h 1 - phone-4146-5 7 -1240 Fax 413- 587 -1272 P1oflSite 3�lans� ,U -_ -- Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by offi 1.1 Property Address: t ; 0 (�, a., 11v'2:+ Map L ot Unit 0,„,,2,,,,,,,.,,,,, Ya rn, I ��''�' Zone Overlay Disfrict Elm St. District CB District SECT 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: C.> n.ti` . d1r� i .s 5-. \( .) a.,.�.. s `(� 4 :,t A,�.) N�r'tr),., ar 1 ^l t Name (Print) Current Mailing Address: 413 - -H6 3 Telephone Signature . 2.2 Authorized Agent: ��, Ccr rv�:y � �J \: �.. � r'cc,NS 3.11 T�.)<<;t� -:�1j� � ,. Ur�J' (-1.- 1 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 Building e 1. Building 3C 85 5O '(a)` Prmit Fee 2. Electrical 1 �a (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire P rotection 6. Total = (1 + 2 + 3 + 4 + 5) j`9,15 c3 Check Number ©g (! ,,1p T h is Section For Official Use Only Building Permit Number: Date . _ Issued; Signature: Building Commissioner /Inspector of Buildings ` . Date • File # BP- 2013 -0747 APPLICANT /CONTACT PERSON JULIANO'S POOLS ADDRESS /PHONE 321 TALCOTTVILLE RD VERNON (860) 870 -1085 PROPERTY LOCATION 40 ROE AVE MAP 24A PARCEL 138 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid f � lv g�D Typ of Construction: CONSTRUC 8 INGROUND POOL PJSFEC-T1O J AN t V P(2 1 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 139826 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 N— 74- 217 /13 Sig re 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. 40 ROE AVE BP- 2013 -0747 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 138 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- 2013 -0747 Project # JS- 2013- 001283 Est. Cost: $39750.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JULIANO'S POOLS 139826 Lot Size(sq. ft.): 7710.12 Owner: KUENY TUCKER & MELISSA Zoning: URA(100)/ Applicant: JULIANO'S POOLS AT: 40 ROE AVE Applicant Address: Phone: Insurance: 321 TALCOTTVILLE RD (860) 870 -1085 WC VERNONCT06066 ISSUED ON:2/7/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 14 X 28 INGROUND POOL - INSPECTIONS & ELEC PERMIT REQUIRED 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 2/7/2013 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner