22B-008 (9) hi
BP-2007-0959
COMMONWEALTH OF MASSACHUSETTS
Map:Bloc CITY OF NORTHAMPTON
'
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0959
Proiect# JS-2007-001560
Est. Cost: $35000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: 21ST CENTURY POOLS & SPAS 050056
Lot Size(sq. ft.): 65775.60 Owner: PEASE THOMAS R&PEGGY-ELLEN
Zoning: GI Applicant: 21ST CENTURY POOLS & SPAS
AT: 130 SPRING ST
Applicant Address: Phone: Insurance:
1801 MEMORIAL DR (413) 532-0100
CHICOPEEMA01020 ISSUED ON:4/18/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 18 X44 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 4/18/2007 0:00:00 $50.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2007-0959
APPLICANT/CONTACT PERSON 21ST CENTURY POOLS&SPAS
ADDRESS/PHONE 1801 MEMORIAL DR CHICOPEE (413) 532-0100
PROPERTY LOCATION 130 SPRING ST
MAP 22B PARCEL 008 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 0S7Z 45D —
Typeof Construction: CONSTRUCT 18 X 14 INGROUND POOL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 050056
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO.Approved
Ad
TION PRESENTED:D:
THE
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 Str t Commission
—
. 2409
Signature of Building Of icial 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.
I
Qeartmertt user-only
City of Northampton 1?taa of- ►t. gt, �,� `;
� x .do- ^Y�,«,• ', LLr�hc� o
•
Building Department urb:04#1t lra � . !ss k
212 Main Street ,,56,1174';a.,te' ` g� tV:7':'.4.,::: :
Sekve �e® �c vat bitity � ,. � ��
Room 100 W.a �fl A it h lit 7,a Z... � ,, e• :v-
Northampton, MA 01060 Twsoitrrc�ira Plans
-ia k b ,,
phone 418-587=1240 Fax 413-587-1272 PJotYte Plans ;
Ofher�pe ,- ,F z
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: 1 This section-to becompleted byoffice
.-
13o 6eT t�c� �TI'e N[ap ,�f of Unit
(/0 r--r'1 G 6)04-
(i.e._ Zone overlay District
n
Elm St Distract .= CB"Distract
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
homAS t L. " eqs f.�6�.5 r,nG r f ,gee. ao 0/0
Name(Print ,7�
4076
Current M�iling Ad ss:
-Signature ' Telephone
Signature
2.2 Authorized, ent:
/hrr!4S QS - e� y eUsz /'tea r�„!, g/tern 04
NIS 76
a (Print) Current Mailint�Addre 0 O(avL1
Signa ure /� '
Telephone
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,frolm.(6) j�'
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
4
•
6. Total=(1 +2+3+4+5) Check Number po ,50.........,
Thi_ Official Use Only
Building Permit Number. Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
., .
Section 4. ZONING
1
Lot Size 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
Frontage Z-7:17-S- ---
Setbacks Front
-- - 4:-
Side L: R:. L: WR: 22
---1 - -IS--
Building Height '
' /
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved , ; , -2o2
parking)
I
#of Parking Spaces
Fill:
(volume&Location) '
Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO :it DONT KNOW 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 31 DON'T 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
---,
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 fi)
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 pl)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors E
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[El] Other pt
Brief Work:Description of Propos d � /fy'7 t
Alteration of existing bedroom Yes N Adding new bedroom Yes N
Attached Narrative enovating unfinished basement Yes o
Plans Attached Roll -Sheet
... --h.. '� '«a,;,-r, a,:-o=+ :yet-� moi^ ".'..r^.ro','r�e""�",,i ;a"""v .rsr .�-'�e ,�„�.-."s„�, _.
6a 1f Newhouse and'of;additionto=existtnq fio�tsmq,=com 1etee�the#o1(owmq:
a. . - of building:One Family Two Family Other
b. Number of r..• as in each family unit: Number of Bathrooms
c. Is there a garage attac-• ,?
d. Proposed Square footage of new =.struction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woo.: .ves Number of each
g. Energy Conservation Compliance. t ch-- Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? 'es No. Is construction within :: floodplain Yes No
j. Depth of basement or cellar floor bel. • mished grade
k. Will building conform to the :. ding and Zoning regulations? Yes No.
I. Septic Tank ity Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO'BE COMPLETED WHEN
OWNERS A ENT OR'C TRACTOR APPLIES FOR'BUILDING PERMIT
J ,as Owner of the subject
Prop rty
i ///������ " . Iii i`,
hereby authorize �! . _/I (Te�s.D !' �,
to act oo y behalf, i- all matters relative to wo/authorized by this iuild'g permit application. '
—r ....S.,I� ' 'd —(17
Signature 407 er Date
4'1( �--- ,as Owner/Authorized
A t h eclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under tpains and penalties of perjury.
Print Na
17 -67
Signature ofr/Agent Date
lj \�
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:// ) Not Applicable 0
Name of License Holder: J D �t II (/A/ l/4 H "j G coo"sl�L
(j License Number
/ Ol , / mom,cdi 10r, Chi ce e t /dlr d%ozo 6512 /
Address Expiration Date
Signatur- Telephone
W3 —cr i C12a
9i;'Register`ed`Homeirnp ovemeiit:Conit c#ar '`-w a SSS a W` Not Applicable 0
275 * C'e -iU,,y s ya-5 IiiS7
Company Name ,� Registration Number
J66/0-6
Address q/3 Expiration Date
C Cr.i7"2 /m, - °'d Zc' Telephone TY Z —6 / 61"
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL.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 0
Y 1.,-.:Rome Owners E tnjztion
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
The Commonwealth of Massachusetts
• Department of Industrial Accidents
sto! gi
6— � Office of Investigations
Ms off)
600 Washington Street
Boston, MA 02111
%rem www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 2 / 5 t C ' , , 7' Pop l'.5 es t� �a
Address: /e v l /M 7ari q
City/State/Zip: C6(.6 c p e /Mf 0/6 ZU Phone#: `//3 573 2 -G/ Q U
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 13,I am a general contractor and I
employees (full and/or part-time).* have hired the sub contractors 6. 0 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
- ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp.insurance comp. insurance.:
required.] 5. D We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
m self. [No workers' cou right of exemption per MGL
y c. 152, and we have no 12.0 Roof repairs
insurance required] t 13.0 Other SA-' aro/
employees. [No workers'
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:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investieations of the DIA for insurance coveraee verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: � Pf Date: 0
Phone#: G"((3 ' 3 Z- . —O/ a Q
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
KAMp
eZeica(41, _*(rzty of Nnrtl &mptnn ,
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$ kijt: RSOAClusrtte _` _
Ilair DEPARTMENT OF BUILDING INSPECTIONS "4 S-11 4===L
INSPECTOR 212 Main Street • Municipal Building 7c
Northampton, MA 01060 ,~ 5
e
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as Lis/her construction sup,: .' :or. 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
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SITE PLAN
Spring St.
Meadow St.
__. 535 ft.
320. 15 ft.
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ta.
430.26'
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21ST CENTURY
POOLS & SPAS
Subcontractor List
Name W.C. Policy#
Brian Sullivan d/b/a Sullivan's Pool Service 76WEGRL4098