Loading...
35-272 (3) 34 WOODLAND DR y BP-2016-1344 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-272 1CITY 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-2016-1344 Project# JS-2016-002310 Est. Cost: $20000.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FLORENCE SWIMMING POOLS INC 002719 Lot Size(sq. ft.): 106896.24 Owner: RIVERA-BERIOS DAMARIS&JORGE L BERRIOS-TORRES Zonin : Applicant: FLORENgE SWIMMING POOLS INC AT. 34 WOODLAND DR Applicant Address: Phone: Insurance: P O BOX 385 (413) 268-3635 WC HAYDENVILLEMA01039 ISSUED ON.-511912016 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 18 X 36 INGROUND POOL - Note: Barrier must be in place before pool is filled 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 5/19/2016 0:00:00 $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1344 APPLICANT/CONTACT PERSON FLORENCE SWIMMING POOLS INC ADDRESS/PHONE P O BOX 385 HAYDENVILLE01039(413)268-3635 PROPERTY LOCATION 34 WOODLAND DR MAP 35 PARCEL 272 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE Fee Paid Building Permit Filled out Fee Paid Tyneof Construction: INSTALL 18 X 36 INGROUND POOL ToTF 4 pA2 E I N PL R G-f- New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 002719 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: i/ 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 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. w 4 Departmerif use only R���y��� ty Northampton Status of Permit B ildi g Department Curb Cut/DriveWay Permit ' G �Q'� 12 aln Street Sewer/Septic Availability V R Om 100 WaterM/ell Availability rn On, MA 01060 Two Sets.of Structural Plans h 0 Fax 413-587-1272 Plot/Site Plans Other Specify. r APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit- e"� J Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1-41Name(Print) Curr Mailing Address: C>> W - 7 ' T41ephone { J Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature T$lephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Oftlicial Use Only BuildingPermit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Requir by r-oning This col n to e filled in by # Buildin ep t Lot Size ' Frontage Setbacks Front Side L.'., .< R L.. ��.. R:' . Rear Building Height Bldg.Square Footage % __..... Open Space Footage % .......,, (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:; i IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0YES 0 ............. ............ IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 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 0 , Date Issued: F C. Do any signs exist on the property? YES 0 NO 0 ......... __. _._.... 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 0 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I + S SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aomlicIgble) New House 7 Addition F-1 Replacement Windows Alteration(s) El Roofing Or Doors ❑] Accessory Bldg. ❑ Demolition ❑ New Signs [q] Decks [Q Siding [Oj Other[Q Brief Description of Propose Work: \�(i 1r 1 ["� 1r1C�c�N n C\- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. if New house and or addition to existing housing, cgmplete 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 I, 1' A Al� _l �►��& as Owner of the subject property hereby authorize �/2Q C,4' to act on my behalf, in all m elat eRi 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 and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �,(� Not Applicable £ Nance of License Holder: I'!4/414� f/ M VNIy L-= -..�K License Number 93(4 fIQkA1N P(fr(.0 ROD 13514 Ftty(YJ 44 01330 C-a 0(s4• 2 49 Address Expiration Date Signature Telephone / --3 el' P7 .9.Registered Home Improvement Contractor: Not Applicable £ ��C� L Nfa}°`i �:,.r►tnr lu4 I9Vz>L S l/VL- 1( b Company Name Registratic umber Address / Expiration Cate J4fJy1),W"Vt444?t Telephonellb111A-3kl�i 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....... £ No...... £ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 I I The Commonwealth of Massachusetts Department of Industrial Accidents ®fJ7ce of 1h vestigations S t is 600 TVashington Street r' Boston, MA 02111 b -� :--•- wVyw.➢DDeaassyg®v1dia Workers' Compensation Insurance Affidavit: Builders/Contr,%cto rs/1Eleetricians/Plulraalbers Applicant Informationn © Please Print Legibly Name (Business/Organization/Individual): Ft-qn(fN6 WG/`llttiWL PSL" LNc, Address: (71f, HAiri s1� PCs. 130 City/State/Zip: P 4 A3wJvq_Lrr /Yves oote; Phone #: 1113 - '48-�L3g Are you an employer? Check the appropriate box: Type of project(required): 1.W I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-coritractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. EJ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.F-1 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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:AsoC w,T an F_npl we& NSV AA#w-IFf Policy#or Self-ins. Lie. #: wG t'soo 10570 m o 13 Expiration Date: 1- :31 3 o l!2 Job Site Address: WV&6l•H DR City/State/Zip: rLuR(gNz_.� 14A 0(o to 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, enalties 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 trate and correct. Signature: � i, U` Date: y_1q' I& Phone#: q11- '�LB- ::16:1 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#: City of Northampton Massachusetts DEPARTMENT OF BUILDIXG INSPECTIONS t r 212 Main Street o Municipal Building Northampton, MA 01060 sPt yy u:j11' 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 1, understand the above. (Homeowner/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 I �I f City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: The debris will be transported by: The debris will be received by: Building permit number.- Name umber:Name of Permit Applicant Date Signature of Permit Applicant Massachusetts Department of Public Safety ®' Board of Building Regulations and Standards License: CS-002719 Construction Supervisor THOMAS P O-DONNEILL,JR 836 PLAINFIELD RD. 1W ASHFIELD MA 01330 I Expiration: Commissioner 12/30/2017 .I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 106886 Type: Private Corporation Expiration: 7/28/2016 Tr# 253096 FLORENCE SWIMMING POOLS, INC. Thomas O'Donnell 196 Main SUPO Box 385 ---- __ Haydenville, MA 01039 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 i5 20M-0511 Office of Consumer Affairs& Business Regulation License or registration valid for individul use only ,HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 106886 Type: Office of Consumer Affairs and Business Regulation �Aan, Expiration: 7/28/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 FLORENCE SWIMMING POOLS, INC. Thomas O'Donnell 196 Main St/PO Box 385 Ha denville, MA 01039 y Undersecretary Not valid without signature ACORDM CERTIFICATE OF LIABILITY INSURANCEDATE 04/29/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION K.S.K.INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 203 Northampton St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0. Box 597 Easthampton MA 01027 INSURERS AFFORDING COVERAGE INSURED FLORENCE SWIMMING POOLS, INC. INSURERA. 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: COVERAGES THE POLICIES OF INSURANCE LISTED BELOWHAVEBEEN ISSUEDTOTHEINSURED NAMEDABOVEFORTHEPOLICYPERIODINDICATED.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 BYTHE 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 POLICY EFFECTIVE POLICY EXPIRATION:. LTR TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY --- EACH OCCURRENCE $1,000,000. _ RAL LIABILITY CPP0713150 12/17/2015 12/17/2016 FIRE DAMAGE Arnr one fire $50,000. A X CO _ -_ -COMMERCIAL GENE CLAIMS MADE OCCUR ! MED EXP(Any oneperson) $5,000. PERSONAL&ADV INJURY $1,000,000. GENERAL AGGREGATE $2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS_COMP/OP AGG $2,000,000. X POLICY PRO- ^I', LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 3950090 08/20/2015 08/20/2016 (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $250,000. SCHEDULED AUTOS (Per person) HIRED AUTOS NON-OWNED AUTOS 1 (P DI cci e^URY $500,000. i I —1I ----- ! PROPERTY DAMAGE $100,000. (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTOOTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- O O FR-I TnRY I IMITS C EMPLOYERS'LIABILITY WCC 5001057012013 01/03/2016 01/03/2017 E.L.EACH ACCIDENT $100,000. E.L.DISEASE-EA EMPLOYEEI $100,000_ E.L.DISEASE-POLICY LIMIT $500,000. OTHER f II DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS SWIMMING POOL INSTALLATION 8,SERVICE CERTIFICATE 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <DA> M ACORD 25-S(7/97) c CFORATION 1988 i ? l N"K'"9t� ; i