Loading...
35-037 (15) 198 WEST FARMS RD BP-2018-1153 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 35-037 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catecom Above around pool BUILDING PERMIT Permit# BP-2018-1153 Project# JS-2018-002067 Est.Cost: $2900.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PEACEFUL POOLS Lot Size(sa.ft.): 118918.80 Owner: WERNIK JOSEPH M&SUSAN Zoning. Applicant: PEACEFUL POOLS AT: 198 WEST FARMS RD Applicant Address: Phone: Insurance: ISSUED ON:5/11/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO OLD POOL AND REPLACE WITH NEW***SEE ATTACHED POOL REGULATIONS**** 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 5/11/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fat:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2018-1153 APPLICANT/CONTACT PERSON PEACEFUL POOLS ADDRESSIPHONE PROPERTY LOCATION 198 WEST FARMS RD MAP 35 PARCEL 037 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICAT CKLIST ENCLOS REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid p��µ1gT)dNS TvueofConstruction: DEMO OLD POOL AND REPLACE WITH NEW 365 AilAthcO New Construction Non Structural interior renovations Addition to Ezistinp Accessory Structure Buildin Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN 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 Sim Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit _ Variance-- Received& ariance*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 Building S to !g Signature of O [tial 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 we granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. �' 6 Department use only City of Northampton Status of Permit ' ,✓ Building Department Curb CutlDnveway Permit 212 Main Street Sewor/Septic Availability Room 100 Water/Well AWflatlility Northampton, MA 01060 Taro Sets of StrucWrab.Plans ,y.\s phone 413-587-1240 Fax 413-587-1272 Plovsibe Plans Other specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION Pni 5 1.1 Pro a Address'. oo ThLs section to be/c�om1pleted by office � //✓�$ /(,af� Map 3S Lot �J7 Unit `/Dre nC� r rn/r ole6ca? Zone Overlay District Elm St.District Ce District SECTION 2•PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1Owner of Record: 0 J s cr 09 W firms Named) < Current Mailing Address, 4 J b�/J>/ ] _ 3 D-'5' Telephone T ( Signature 2.2�Authorized Agent: 5..,7- �'IM Str LY3 PtALQ4y1 P°cls bib henna Current Mailing Morass: 4/zo�r-� W3 S-2-7 Issf nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by peonnitapplicant 1. Building irowp 0� /, Ud (a)Building Permit Fee �00I GV 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee gyU OD 4. Mechanical(HVAC) 6. Fire Protection 6, Total=(1 +2+3+4+ 5) Check Number b This Section For Official Use Only Date Building Pernit Number: Issued: Signature' Building Commissioner/Inspector of Buildings Date � 1J ) OW o�cS' @ _q C( I � COIy1 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) C,ial-erwtSvv- e Cow-ct r- ""' t Section 4. ZONING All Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column in be filled in by Building Deco mem Lot Size Frontage .. .... _. Setbacks Front Side U R ._.. L R ._- Rear Building Height -- Bldg.Square Footage Open Space Footage % -- (Lor area minus bldg&paved adtin ) _.. _.. #ofParking Spaces -- Fill. .. vomme&Iocanonl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 t acre? YES O NO O IF YES, then a Northampton Stonn Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteratlonle) ❑ Rooting ❑ Or Doo Rep=.., Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks i0 Siding i01 Other 117) Brief Description of Propose 1 ('' 1Rpj ,LOU( S�.. I I•�Cyl � (e,�,4r_2 Workc�w-�5(G^J %+✓ �-I CV V4'Gle rt• Y`D VV``ww I' 1 olcQpl' Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet Sa, If New house and or addition to eAsting'housina, complete the following. a. Use of building '. OneFamill 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 Is construction within 100 ff.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 A h 1 e r I'D ( IC- as Owner of the subject property p//'�� (� p herebyauthimize (kixen6 Sa-VS 1e2.CRT(l� IOL' G,- p 5-,4c to=n my behalf, in all matters r lative to work authorized by this builtling ermit she ication. i /O Signature of Owner Date —1 116 I (( Ke rfm S-",T Pea.ee']�( I"OU"f �'�r� SP 4 as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are Nue and accurate, id the best of my knowledge and belief. Signed under the pains and penalties of perjury. C� tuerri Gov-, Print Name 711 caner/ Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Noma of License Nclder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contactor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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...... ❑ City of Northampton „s Massachusetts IJEPAitTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Huiltling �. C Northampton, MA 01060 4.: AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("IBC"). NI.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Nate:Lf the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: r / Est.Cost: Address of Work: /-qg a), YL!//YI 3 Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 11 Owner obtaining own permit(explain): wilding not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a build g permit as the owner of the above property: �j�/rte Date Owner Name and Signature City of Northampton MassachusettsCNT 212 Hain S OF BpZL nI i INSPECTIONS n 212 Main Street • M,v 010 Building F .� Northampton, MA 01060 Massachusetts Residential Building Code Section I I O R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton Massachusetts G DEPARTMENT OF BUILDING INSPECTIONS 212 Na.. Stzeet •Municipal Building `> C „ Northampton, NA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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. The debris from construction work being performed at: 7 0 MI Lyy( r—rkV M 2. (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 4PV6 tf- SWvv-�is (Company Name and Address) kp Signature of Permit Applicant or Owner DateO — If, for any reason,the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department oflndustrialAceidents 1 Congress Street,Suite 700 02H Boston,MA 02714-20-2077 www.mass.gov/dia Workers'Compensation Insurance AmdaviC General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: �C'Q nL(-- 1 E 5A Address. `3-5 Uqe (At h 01CL 1 City/State/Zip: S—vim^ k,i n'tii OGe73 Phone#: q(3 3SF OYS7 Are you an employer?Check the appropriate box: Business Type(required): L09 I am a employer with employees(full and/ 5. [Retail or part-time).* 6. ❑Re6tamam1Bar/Eating Establishment 2.El I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] & ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, $1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]* 4.❑ We are a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees. [No workers' comp. insurance req.] 12.JgOther � 'My applicant that checks box#I mull also fill can die section below showing their workers'cnmpeusetion Polity infomution. ""If the cotryrmN officers have exempml themselves,but the corpomtlon has otheremployces,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy information. Insurance Company Name: Insurer's Address:- City/State/Zip: Policy#or Self-ins.Lie.# Expiration Date: 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of 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. 1 do hereby c rt f,, der the p ilandpenalties ofperjuty that the information provided ab ve is n e and correct $�a> t�/ DtZ1C� Phone#: 40 JCL -? (3 �-d Official use only. Do not write in this area,to be completed by city or town official. City orTown: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: w—craoss.goodia 6-(^ Ewa � Ne�-r Po, . Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,out the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit license number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense applications in any given year,need only submit one affidavit Indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a and affidavit is on file for future permits or licenses. A new affidavit most be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Deparhnent of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 TeL # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Pomt Ravued 02-23-15 ,vew- a s � >s„Id 4� -z 4 r � A�C' —yJ DATEpS/2Oi6 ) VK[J CERTIFICATE OF LIABILITY INSURANCE o4msrzol6 IBI THIS CERTIFICATE IS ISSUED ASA 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 cerUNcale holder is an ADDITIONAL INSURED,the pollcy(Ies)..at have ADDITIONAL INSURED proNslons or he endorsed. M SUBROGATION IS WAIVED,suhfect to IF.terms and conditions of Me policy,certain all1ples may require an endorsement. A statement on this mrdFlCale does not confer rights to the Certificate holder In lieu of such endomement(B). PRODUCERC el Lea-Ross Flags FSC Insurance Age., IC PCNEa. (413)569@928 Mc xa: (413)5692949 603 College Hlgi "OgIEL ISPUSISCUPeorarcea9encYcom P.O.B.259 INWflERS)AFFORDING COVERAGE Banca SDulhwick MA 01077 ..URE RA: Hata ville Preal ins Co. INSURED IXSUPER. Ammo He Co. Pea00WI Pw15 and Spa Inc INSURe, CIo Cameron SOUR INBVRE0.0 91N MIND Wal St INSURER E'. _ Feeding Hills MA 01030xsu ERI, COVERAGES CERTIFICATE NUMBER: CLIM1002890 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..a,ID-1 Per -yrzygOLITE. LTR ffiE Of INSURANCE son VNa POLICY NUMBER MMNOWLY' MMNDRYYY OMITS )( COMMERCHLGENERALLIABM1Iry EACMOCCURNENCE s 1000000 —TICIAIMADAOE OOOLUN -rGE.sMEDlIE"—PIr`e—P S 100000 MEN EXP A s 5,000 q SPP000000606010 0412512017 04052018 PERGONAISAYJINURY $ 1000,000 GENT AGGNEGTELIMIT APPLIES PER GENERAL AGGREGATE S 2000.000 POLICY�JKOT ELOL PRODUCTS- WW COMPMP AGG S2, O,O OTHER AUTOMOBILEILBILITY 'PeeapEECOMBINE�DBINGLE LIMIT S Nr AUTO BOOILYI NJURY IP¢r poiml I OWHED SCHEDUPG BODILYlluunv leer acotlenll s AUTOS OxIr AUTOSPROPERTY DAULRE E AUTOS ONLY AUTOS ONLY Per bcou s UMaflELA LPS H OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMSMADE AGGREGATE 1 _ OLD I I BETENRON S S WORKERS COMPENSATION siaiVi EONH AND EMPLOYERS UABILrTY FNYPROPRIETOWPA 'D.1E%ECVTIVE YIN L EACHACCCENI 3 500.000 B OFF ICERMEMBFR EKUVDEO'I NIA MPARP302744 05IOW2017 05/032016 E IMelerteryinxx) Ei.DISEAGEEA EMPLavEE s 500.000 1 1 mcneso m.I 500.000 OE SC RIPTION OF OPERATIONS aeW IOISFASF POLICYIIMIi s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES HCORO 101,AEaxleml Pamaha SABi may be alni If mom spec,le u,,Y) Not a spa sales and service it CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Tie Town M N011hamplon ACCORDANCE WITH THE POLICY PROVISIONS, Ciry Ha11210 Mein street AUTHORIZED REPRESENTATIVE l q Npphempton AM 01060 ©1980-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018103) Tho ADDED name and logo are registered marks of ADDED