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44-129 (2) 3 tNCE ROAD gag K AD El • o � oZ �o / j �t 57.0•• / / :Y•/ t , C■ 0 p� �I ��Yo \ i v : Ea I 0 1 .. / Y� I �t�70'f-E / `gg• Yi+��6en 04/15}2008 12: 11 FAX 1 6-506318367 CHRISTENSEN INSURANCE 19002/002 CERTIFICATE OF LIABILITY INSURANCE °A04/15M9 PRODUCER Chri tenser Insurance LLC THIS CERTIFICATE 12 ISSUED AS A MATTER OF INFORMATION P.O-81w 956 ONLY AND CONFERS NO RIGHTS UPON THE CE"FtCATE HOLDER THIS CERTIFICATE DOES NOT AMEND.txTENo OR West Simsbury,CT 06092 _Amt TE&Tktl~COVERAGE AFFO-RDED Bjj E POR. FS 9ELQW,-. Phone (864)851.8236 Fax (860}651-8367 INSL)�AFFORI)ING COVERAGE tiAlC# w5uRED Barber Pool Construcdon wsuRER A: SCOTTSDALE INSURANCE CO. 4 Thompson Hill Road M ., PROGRESSIVE NORTHERN INS.CO. w 'INSURER D: GRAN STATE INSURANCE CO. CollinaVille,CT 08019- - (860)$98.0539 INSURER I=- COVERAGES _ ry YNE POLICIES OF INGURANC5 LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECULREMENC,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCtIMENi-YVITH RESPECT TO VVHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSLIR44M A1FF0AnEPJ WTK AMLCM DESCkMW HEREIN IS SUBJECT TO ALL THE TERAAS,EXCLUSIONS AND 0OUDITIONS OF SUCH POLUES.AGGREGATE U mn S SHOWN MAY HAVE BEEN RMUCED BY PAID CLAIMS. Ngll AOD`L TYPE OF INSURANCE POLICYNUM9Wt I► CY PDtACYEJIP9IATIDN LIMITS GENERAL,WABILFFY - EACH OCCURRENCE $1,000,000. CONIAERt kL Gl:nIF_RAL LIABILITY CLS1573705 12la2MOM 121222009 PREMISES fEw oalurnDectoe $100,000. CIE] cLAw MADE ® oCCuR MUD IV Oft an I:Wgan} $5,000. A ❑ (] PERSONAL$ADV INJURY $1,000,01a M — oEN�iALAGGREt;ATE $2.00-rah GEMAGWiEGATE LIAR APPUES PER: ( I C PRODLI=-COMPIOP AGG .52.000,ODO.j ® POm► ❑PRMCT Q LOG l ALE car Q1 S224$7 229 0929201 SIGLE UAT ANY AUTa 6 a1. .OpO. ALL OWNED AUTOS B ❑ SCHEDULED AUTOS (Pff ee INJURY ® HIRED AUTOS BODILY N)URY Q NON OWNED wror. uN a ❑ �... _.. PROPER!Y DAMAM - _ (ten e LIABILITY AUTO ONLY-EA ACCIQEN'r ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGO EXCESS I U01MIRM.LA LIABILITY EACH OCCURREUM ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ••— DEDUmeLE RETanM — ' YM IIVC=46-$�6_.1 _ 12ROMOOS 12/1 n009 A ❑ o7w EMPLAYERS`LIAaltJTY - C OFFICER AAA PEX�D?� Y EL EACH AoCID6lC1 $1x.000. lypip y EL DISFAW-EA EWLCPYEE $100,000. 5 4#L PRGVtS1ON3�OYt E i DISEASE-POLICY UM1rr L-M,000. OTHER DESC�TTON OF OPERATiLNiS f LOCATLONS!V�:I.E$t E>t�Ct.IfS10MS ADS 8Y ENaORSEMENT19P6C1At PRONLtt� Nate:Cove Is olftwl far the co nperry ow w Edwwd Barber and he Is press exuded tt+ m workas 00m;m-wabon coverage CERTIFICATE HOLDER C.ANCELt ATION SHOULD ANY OF THE ABOVE DE$CR POLICIES BE CANCELLED SORE THE AYION DATE THUMOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL TOWN OF NORTHAMPTON 10 WAY$WFAT EI+CNOTWE TO THE CERTrtICATH HOLDER NAMED TO ATTM:Lads H86bI+Dtidt THE LEFT,BUT FAILURE TO DO SO SHALL IINPOSE NO OBLIGATION OR LW KM OF ANY BIND UPON THE INSURER,ITS AGENTS OR RBP IREMENTATWEL 2"12 Main Sl"-- AU7HQRM0 RYRESENTA ThWL _ f Northampton, MA 01080 1 q� r � ACORD Z6(2001MI)OF V 19884DtI9 ACORID CORPORATION.All rights nssl ". The ACORD name and logo are tsg domed marks of ACORD ]HOME OWNER EXEMTTIO N ACICliO LEDGEMENT 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 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 IhS �.. -� S��tlro> understand the above. 1 N.(Home owner/resident's signature req-ti-eistin exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date AP4 13 Zoo Address of work location X9 2 6S,k C AJ, Fto-'e&Jt Mrs. ,© (0Z The Commonwealth of Massachusetts Department of Industrial Accidents fOffice bf Investigations 600 Washington Street Boston, MA 02111 wwwarnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeeibIv Name(Business/Organization/Individual): ,,g-/&>rz= sF Address: City/State/Zip: Phone#: F2.0 re you an employer?Check the appropriate ox: Type of project(required): ❑ I ant a employer with 4• NJ am a general contractor and I * ave hired the sub-contractors 6. ❑New construction employees (full and/or part-time). _ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, E Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. t required.] 5. F-1 We are a corporation and its 10..0 Electrical repairs or additions 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.F-1 Roof repairs . insurance required.j t c. 152, §1(4),and we have no employees. [No workers' 13. Other y/ 2� 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 subrnit 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: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address:_-c21.2 (j'6 W 1 (Sep k) K ("�i 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 5250.00 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 er the pains an en a ies of perjury that the information provided above is true and correct. Signature: gg Date: — f � 0 Phone#: 3`—�� 73J 7 Eonly. Do not write in this area,to be completed by city or town offciaL n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9:'Re stiSedNoii' lth �Sie Not Applicable ❑ Companv Name Registration Number Address r I Expiration Date l�C'1��5(f Tele hone 46'75 y �o a�f� SECTION 10-WORKERS'COMPENSATION fNSURANCE AFFIDAVIT(M.G L c.452;§25C(fij� 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...... ❑ � _om 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,Z6ningLLaws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1 Addition Replacement Windows Alteration(s) Q Roofing Or Doors E3 Accessory Bldg. Demolition 01 New Signs [O] Decks (M Siding[0] Other[n] Brief Description of Proposed I Work: N(Re%AN D Pd0 d' d Alteration of existing bedroom Yes_ `No Adding new bedroom Yes a No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet sa. If-N4w_hau e46d, or.acCcilirt tc� n" 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 stones? 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 I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent he eby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. ISigned under the pains and pen ties of perjury. r ,-'X Print Name 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 Setbacks Front � ,`�$" L240 Side L R:`^ . . r L.£J�' R.i_ Rear 30 Building Height Bldg.Square Footage z-- _........ % __ r__ --- Open Space Footage % (Lot area minus bldg&paved (sila ._. 5i% parking) #of Parking Spaces i Fill: ��...Mq....x..�._._ ;I a (volume&Location) -A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book = Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 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:_ 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 0 NO 9 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Buildin Department Room 100 Nooamp€ori AMA 0'1060 p phPne413-587-1210 Fax_13-587-1272 t w> APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Prooe tv Address:. T his section to be Completed by office<o`v.Sry9 4vVl� ►- JU vI i q Sze/��'�S Mqp' :Lot %Z Unit do i 9-Z 0 IP 15 �D zone Z Overlay District Elie-5L District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGE[fT 2.1 Owner of Record: Name(Print) Curre a in Address: Telephone elep one 2.22 Authorized A ent: Name(P S� 7 &dy �`�Q f/ C/urrre�ntt Mailing Address- Signature Telephone — SECTION 3-ESTIMATED CONSTRUCT COSTS :: Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building rya (a).Building Permit Fee 2. Electrical (bj Estimated Tota[Gost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 6 5. Fire Protection 6. Total=(1 +2+3+4+5) -Check Number This Section For Ofricial'Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0834 APPLICANT/CONTACT PERSON BARBER POOL CONSTRUCTION ADDRESS/PHONE 4 THOMPSON HILL RD COLLINSVILLE (860)693-0538 PROPERT 2 OLD WILSON RI) —AM . �r l §90IIU� THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out H AA Fee Paid Ty_peof Construction: CONSTRUCT 20 X 50 INGROUND POOL New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure BuildinizPlans Included• Owner/Statement or License 162740 3 sets of Plans/Plot Plan THE F' IOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON Il` `dATION W SENTED: ,pproved ditional 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 �;,.;� „�s Signature of Building ffi al 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. Jun 05 2009 9:01 ' City of Northampton DPW (413) 587-1576 p. 3 PENDING APPROVAL 242 OLD WILSON ROAD,FLORENCE BY SIG. THIS FORM,THE APPLICANT,OWNER.AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH,OR,BEFORE COMMENCEMENT OF THE WORK,WILL BECOME FAMILIAR WITH,ALL LA,%,S AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.a 82A,520 CM R 7.00 et,seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER,AND ALSO,FOR THEDURAMON OF C043STRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHEDNERETO AND DIE LAWS AND REGULATIONS GOVERNING SUCH WORN THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY TM MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEMNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OV4tNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AAV ALL LIABILITY,CAL:SES OR ACTION COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH,LOSS,OR DAMAGE TIO ANY PERSON ORPROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT, APPLl NATURE DATEa EXCAVATOR SIGNATURE(IF D REN 17 DATE OR'NER`S SIGNATURE(IF DIFFERENT) DATE y. mot'=% '• i- _ ".xj�',•.�64i«+v�W.ji +:.�.3'.s:: — r` ne� ,.. Via::..._ N _'�'�t,�'2;r, •r._� .:a � - vF: Jun 05 2009 9:01 ' City of Northampton DPW (413) 587-1576 p. 2 �7it�d u� �•3�-0� PENDOC;APPROVAL 292 OLD WILSON ROAD,FLORENCE CITY OF NORTHAMPTON Permit No. 5409 DEPARTMENT OF PUBLIC WORKS DISAPPROVED 123 Locust Shmet Date Isstncd 411312009 Nortbampbma,MA 01060 By Phone 413-587-1570 (Deparunaat of Public Works) FAX 413-587-1571 No work to sent until W' TRENCH PERMIT Pursuant to G.L.c. 82A§ 1 and 520 CUR 7.00 et seq. (as amended) THIS PERM3T MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION This permit(Lumse for excavating on any public way and private property)is issued under the promloos of MAU.c.82A# 1 and 520 CMR 14.00 and Section 283-21 of the Revised Ordinance of Ow City Of Northampton subject to the'Specifications for Caro of Sued Cuts"approved end adopted by the Deparenant of Public Walks as JaNsda 21.1941.The applicant hereby ap=to protect all cuts with barricades and lights,and to save the City of Northampton bwmkss from all claims for damages whatsoever arising from the occupadoa of all pcepaties affected by ft permit, until such time as the work bag been approved and accepted by the Department of Public Works as provided far blow,sod in the case of private udny,to pay all cbargas for reswtbeing. Fee:$250.01) Check# 4122 Valid for 30 days from date of approval.Expiration Date 5123!200'9 Name of Applicant Phone Call BARBER POOL CONSTRUCTION 860.693-0538 Strut Address 4 TNOMPSON MLL ROAD Cityfl'own STATE ZIP COLMNSVILLE CT 06019 Name of Faccamtwr(ifdif bent fh nt applicant) Phone Cell WALTER CHAMPAGNE,JA 860-633-9310 Street Address PO BOX 6696 City/Town STATE ZIP GR4NRY CT 06035 Name of Owners)of Property Phone Celli KOWSTANTINESIERROS 5tree:t Address 292 OLD WILSON ROAD City/Town STATE ZIP FLORENCE MA 01062 Location of proposed trench: 292 OLD w►LSON BURR FLONVWE Description and purpose of proposed trench:please describe the cacao!location of the proposed uwcb and its purpose.include a description of what is(or is intended)to be laid in proposed trench(eE pipes/cable lines etc...) INSTALLING NGROUND POOL 2OX 50 Estimated daw of occupation of street: PENDING APPROV.4L Insurance Certificate#: CLS 1573705 Name and Contact infonuation of Insurer: CHRISTENSEN INSURANCE LX PO BOX 3546 WEST S,IAL48URYCT. 06092 Policy iration Date: 1212212009 Dig Safe#: 200440-2929 Name of Cotrrpetent Person(as defined by 920 CMR 7.02): EDWARD BARBER& WALTER CHAMPAGNE J% Massachusetts Hoisting License#: License Grade: ExEkalion Data: Note-Contractors will be eMrged for Inspections requested outside of regular working boon(7:90 a.m.-3:00 p.m.M-F) Contractor to notify DPW wbera job is in programs. NOTE: Engineers need ties to this service for our records. TEMPORARY INFRA-RED SMALL BE REQUIRED AFTER TRENCH CUT IS MADE PATCH WQUIRKD File#BP-2009-0834 APPLICANT/CONTACT PERSON BARBER POOL CONSTRUCTION ADDRESS/PHONE 4 THOMPSON HILL RD COLLINSVILLE (860)693-0538 PROPERTY LOCATION 292 OLD WILSON RD MAP 44 PARCEL 129 001 ZONE SR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out alcfLd --4-4 Fee Paid Typeof Construction: CONSTRUCT 20 X 50 INGROUND POOL New Construction Non Structural interior renovations Addition to Existiniz Accessory Structure Building Plans Included: Owner/Statement or License 162740 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Commission Permit DPW Storm Water Management Demolition Delay l 0410's-, 0 9 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. BP-2009-0834 GIs#: COMMONWEALTH OF MASSACHUSETTS 016ck-44-1, 9 `�" CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0834 Project# JS-2009-001234 Est. Cost: $100000.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BARBER POOL CONSTRUCTION 162740 Lot Size(sc. ft.): 290066.04 Owner: SIERROS KONSTANTINOS N&SUNITA B SIERROS Zoning: SR(100)/ Applicant: BARBER POOL CONSTRUCTION AT. 292 OLD WILSON RD Applicant Address: Phone: Insurance: 4 THOMPSON HILL RD (860) 693-0538 COLLINSVILLECT06019 ISSUED ON.61512009 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 50 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 6/5/2009 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo