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SYLVESTER ROAD
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE
rM 0211312006
IODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
S.K.INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
)3 Northampton St. ALTER THE COVERAGE AFFORDED_BY THE POLICIES BELOW.
.0.Box 597
astham ton MA 01027 INSURERS AFFORDING COVERAGE
ISURED FLORENCE SWIMMING POOLS, INC. INSURER A: PHENIX MUTUAL INSURANCE COMPANY _
196 MAIN STREET INSURER B: SAFETY INSURANCE _
ROUTE 9,P.O.BOX 385 INSURER c: ASSOCIATED EMPLOYERS INSURANCE _
HAYDENVILLE MA 01039 INSURER D:
INSURER E:
'OVERAGES
THEPOLICIESOFINSURANCELISTEDBELOW HAVE BEEN ISSUEDTOTHE INSUREDNAMEDABOVE FORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN,THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000.
COMMERCIAL GENERAL LIABILITY CPP0703530 1211712005 1211712006 FIRE DAMAGE(Any one fire $50,000•
CLAIMS MADE F-1 OCCUR MED EXP(Any one rson $5,000•_
PERSONAL&ADV INJURY $1,000,000•
GENERAL AGGREGATE $2,000,000• _
GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000•
POLICY PRO LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO 3950090 COM 00 0812012005 0812012006 (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
$250,000.
X SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $500,000.
NON-OWNED AUTOS (Per accident)
-- PROPERTY DAMAGE $100,000.
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $ _-
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE __— $
DEDUCTIBLE $
RETENTION $ $
WC STATU- OTH-
WORKERS COMPENSATION AND I7
EMPLOYERS'LIABILITY WCC 5001057012002 0110312006 0110312007 E.L.EACH ACCIDENT $100,000•
E.L.DISEASE-EA EMPLOYEE $100,000•
E.L.DISEASE-POLICY LIMIT $500,000•
OTHER
IESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
iWIMMING POOL INSTALLATION&SERVICE
:ERTIFIGATE HOLDER ADDITIONAL INSURED;INSURER LETTER: _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
N%nCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
a
IMPOSE NO OBLIGATI OR LIABILITY OF ANY KIN[ UPON THE INSURER,ITS AGENTS OR
REPRESENT_AT
AUTHORIZE
Buard of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 106886
Type: Private Corporation
Expiration: 7/28/2006
FLORENCE SWIMMING POOLS, INC.
Thomas O'Donnell
196 Main St/PO Box 385
Haydenvilie, MA 01039 ---- .---- ----.-
Update Address and return card.Mark reason for chang
Address ❑ Renewal Employment —7 Lost Card
DPS-CA1 0 50M-04/04-G101216
- Board of Building Regulations
One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/10/1933
Number: CS 002720 Expires:05/10/2006 Restricted To: 00
THOMAS P ODONNELL
18 LEENO TER
FLORENCE, MA 01060
Tr. no: 21740
Keep top for receipt and change of address notification.
—�\ ✓ 7G� � t��Ifs li(�/
Board of Building egulations
One Ashburton Pace, Fpm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 12/30/1958
Number: CS 002719 Expires: 12/30/2007 Restricted To: 00
THOMAS P ODONNELL JR
836 PLAINFIELD RD
ASHFIELD, MA 01330 -
Tr. no: 12359
Keep top for receipt and change of address notification.
DPS-CA1 Cj 50M-04'05-PC8698
�834Htjjit8[tt3
s
DEPARTMENT OF BUILDDIG INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as h.is/her construction sups:zx o.r. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be,a one or"tvoamz --_
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 bbil ing department f r the Ciry of Northampton w_ants--any persorl(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/footines (before backfiIl),
sonotube holes (before pour). a rough building inspection (before work is
concealed), insulation inspection (if required) and a final buildin'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
`ti (yif f �.Tcrrfl}aII133 011 _
g�isaAc4rrtrlle' _
DEPARTMENrT OP I3UILDT)\'G INSPPCTIol's
212 Train Strcct Municipal Budd;n�
Northampton, Mass. 010GO
WORCCR'S CON=NSATIO.N G`�SUR.AI CCA , �iVIT
,%riLh a principal place of business/residencc at: -
(phone:')
I (sum-ticl i`J/szatLTa p)
do hereby cerdi under thc.pa_ins and pen2llties of penury, that
{ ( ) I am an employer providing the following'%vorkcr's comocasa:Joo coverage for lily
etnplovecs %vor�3ng on ijiis job:
I
1 (I�sur-mac Conn) (Polio:N_ter) — pir�rior Du-)
I
( ) I am a sole proprietor, general contractor or homeowner (ccie one) and have hired
the cone actors lisiwd below vvbo llzve the following worlter`s coi oen_sadon poiicies:
i
("';=C OT CO:tMCiOr) (Ir1Rr3ricc COrrlD3S])'/l�GUCi Drum=Ct} �tiJtiJ�Q Dntc)
I -
(Name of Conc-3eror) (irsa=c_- C.omoaavipol.in \unc_r) (Eipira6on Dace)
I
(Name of Coturaaor) (Insuranc_- Comp=)-/Po�-cy N=b_.r) (Expilaaoo D3tc)
I
(Name of Coatmcior) (Lasllranc_- Company/Policy Numbs) (Exp-,6oa DaE>).
(nrad zddtro�^alca.irn +- v to mdud iafor�ion pctn is ag to.II cat-_.curs)
i
{ ) I am-a sole proprietor and have l�
e no one wong for me.
I ( ) I a-t..a home owner performing all the work myself.
NOTE:pies:lx aarlrc t... -�jc bcm vcra Sabo e=;) p�-zom to d� as e m c rc a-a _ca of
nrx most:th=U=r =tci•13 in Wa ch the bomoo vac rcxida oc oa the pmua6 zppamc ==tb,==r.:we C=�-.11v Decd.-ni to L-
-=;,I the -i; _az --•,:ca Aa(GI-452 =;*in.600 by w bona f=-_Gc.oc pcmr:r=-y cvid�tl;c
legal e.^•,of ea c.,coyer wader dso Workelc Compom�lion Ad "
I uad---d tha>Dopy of tbic mr emmx osay b.f r-rded to the Dcpartmmt of la&s:.si d OT,-or I+r w+°°°for tho
j eov 4,s vcr6c=ion=d that L-itta•e to secure bovcrad-c tmdc==oa 25 A of)%101-152 can Irk to the imp..i6m or eimiazl P-16-
or a fiat or up to s 1.�oo.00.ndtoc 6apr600,c r up to one y-_r rsd =;,i3 p..Itio is tc form or.Slop Work Ord--'nd°
fir=0(S 100.00 a dzy cp.iast ED,--
onty
perD311 Number
i
Si�natiutofi icy—/Pcrr iu= ce
' Zf
SECTION 8-CONSTRUCTION SERVICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
i License Number
Addre / Expiration Date
Signature Telephone
9: 2e isfered Lorne. roverrierontractor - Not Applicable ❑
Company Name Registration Num er -- -
Address Expiration Date
Telephone
SECTION 10-WORKERS'"COMPENSATION INSURANCE'AFFIDAVIT(M;G.L.c.152,§2X(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-vear 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
r
i
,A
i..
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑;. Replacement Windows Alteration(s) ❑ Roofing
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [[p Siding[0] Other[�
Brief Description of Proposed / (�
Work: LA & S t;L-E ZAD K
Alteration of existing bedroom Yes Ot No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes 0C No
Plans Attached Roll -Sheet
sa� IVewc�he=,a'n� diti >Gr to eiastn�-,ho>�s ni g cor��lete#I�e�fof��in in
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 Ta-'OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT;OR`CONTRA,CTOR APPLIES.FOR BUILDING PERMIT
I, �4J�b �� � as Owner of the subject
property
hereby authorize �l or4�G6 �o� 10M 0 lJ.1 el
to act on m M ll matters relative to work authorized by this building permit pplication.
0
Signature of Owner Date
I, Av 113 ,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.
i
Print N
eR\
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage I15 I ` l�l
Setbacks Front
Side L:' R: L: R: _ — ,
1.10 , ,n,
Rear `7—
Building Height
Bldg.Square Footage -- % —�
Open Space Footage %
(Lot area minus bldg&paved i
parking)
r--
#of Parking Spaces
Fill: r
�E
(volume,&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page: and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YE� �Yoo�
IF YES, has a permit been or need to be obtained from the Conservation Commission? ?ro f er
Needs to be obtained Obtained Date Issued: F _ ' I N .,a,
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 0 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 r NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
l
�, � '°DepartrrrenLuSe only
City of Nortf ampton State ail f?ermt ?K ,e
Building Department CtGuv� Perx»t `
212 Main Street
Room 100
x
Northampton MA 01060 ��uans
phone 413-587-1240 Fax 413-587-1272 tw
WINE
A
PeM � FIF w
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Z8 �or �S j This section to be cotnpleted by office
1.1 Property Address:
veSTT�' /C�
�MaP` mot unit
Zone Overlay Dtstnct-
p1Ob L
..-
Eliit St D�stau CB District_. „_
SECTION 2-PROPERTY OWN ERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: ✓
Name(Print) /! Current Mailing Add ess:
J- t; C(ft�v-L o F l o re^ 4— /✓(Nt D 1 O b'L-
Teleplao e�v --7��1 -7 d J-31-l3SU
Signature U
2.2 Authorized Agent:
�q<!i Ij �1re vet O Z S25 J,�Wo Q F �`vtr.c ►4 e, t a CS L
Name(Print) Current Mailing Address.
V8 q --7
Signature Telephone
SECTION 3-ESTIMATED"CONSTRUCTION COSTS
Item ✓ Estimated Cost(Dollars)to be Official Use Only
completed by ermit appli cant
1. Building �otir�b�- S�r� 100a (a)Building Permit Fee
2. Electrical P ea L— Estimated Total Cost"of
! Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(H'vAC)
5. Fire Protection
6. Total=(1 +2+3+4+5)
Check Number
This Section For Official Use Only
Date',
Building Permit Number. Issued':
Signature: '
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0880
APPLICANT/CONTACT PERSON PREMO DAVID A&CLAIRE A
ADDRESS/PHONE 79 COUNTRY WAY FLORENCE
PROPERTY LOCATION 255 SYLVESTER RD
MAP 28 PARCEL 075 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APP_LICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
T_ypeof Construction: CONSTRUCT 20 X 40 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 YOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 lion
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.
255 SYLVTER RD , BP-2006-0880
GIS#: COMMONWEALTH OF MASSACHUSETTS
28-075 CITY OF NORTHAMPTON
Lot: -001 1
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0880
Project# JS-2006-1353
Est. Cost: $12500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: PREMO DAVID A&CLAIRE A
Zoniniz:RR Applicant: PREMO DAVID A & CLAIRE A
AT. 255 SYLVESTER RD
Applicant Address: Phone: Insurance:
255 SYLVESTOR RD (413) 584-7797 O
FLORENCEMA01062 ISSUED ON:311012006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 40 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 3/10/2006 0:00:00 $50.003383
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo