36 -348 147 Dunphy bp-17-954File # BP-20 17-0954
APPLI.<:ANT/CONTACT PERSON JULIANO'S POOLS
ADD~SS/PHONE 321 TALCOTTVILLE RD VERNON (860) 870-1085
"
PROPERTY LOCATION 147 DUNPHY DR
MAP 36 PARCEL 348 00 I ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLQSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ~A~
Typeof Construction: 24'x40' in ground swimming poolwith high safety fence with self closing & self latching gates
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Ownerl Statement or License 139826
3 sets ofPlans I Plot Plan
THE FOLLOWIN~CTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ' No'T£: Pt<.lJ e(J 'S€j)
INFORMATION P. SENTED: ,
__Approved __ Additional permits required (see below) . ibOL LOCA."rl4)3 tN-
PLANNING BOARD PERMIT REQUIRED UNDER:§ _________ ~ACtt"S 0 ,N wSrUn.)
L(M,ftS nf wotU:.Intermediate Project: ___Site Plan AND/OR ____S,pecial Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
(-'ZONING BOARD PERMIT REQUIRED UNDER: ~_________ f.!f13 PBO'I< U2J ~~
Finding_____ Special ____________ Variance*____
___Received & Recorded at Registry ofDeeds ProofEnclosed,_____
___Other Permits Required:
___Curb Cut from DPW Availability ___Sewer Availability
___Septic Approval Board of Health ____Well Water Potability Board of Health
_JV>:..-permit from Conservation Commission ___Permit from CB Architecture Committee
Permit from Elm Street Commission ___Permit DPW Storm Water Management ----'
___Demolition Delay
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 ofMGL 40A. Contact Office of
Planning & Development for more information.
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413·587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR lWO FAMILY DWELLING
j~E#r,q~:i;,X .
1.1 Property Address:
If7/)v/Jpl7y ~(ld
FIt1renrel' MPJ tJ/lJltJ:<
". 'o:f~Q~I~~D:;*~$NXi
." "(.~ ';",' "J'J' , , \'»::'."i-",'
2.1 Owner of Record:
Did tJOI/ Leah SfC/hklf
Name (Print)
/0/7 /.) tlnphy ROdcl2...
Current Maili~:1:essi l:J1/: 'I. -~-..:J8tJ9
Telephone
Signature
Current Mailing Address:
Item
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
---
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
w~
L:[2~ R:r;7~1
~
Fronta e
Setbacks Front
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
arki
# ofParkin S aces
Fill:
volume & Location
A. Has a Special PermitlVariance/Finding ever been issued forlon the site?
NO 0 DON'T KNOW ~ YES 0
IF YES, date issued:[=~~-=~~_J
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW ~ YES 0
IF YES: enter Book [ _---. --] page[. -==---1 and/or Document # '-___...___________1
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'TKNOW 0 YES f9
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ef Obtained 0 'Date Issued: ,...-.----.------,
C. Do any signs exist on the property? YES o NO C5?J
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO0 0
IF YES, describe size, type and location:
E. Will the construction activity disturb (~ring. grading•. excavation. or filling) Qver 1 acre or is it part of a common plan
that will disturb over 1 acre? YES U NO ~
IF YES. then a NorthamptQn Storm Water Management Permit from the DPW is required.
Accessory Bldg. D Demolition New Signs [0] Decks [CJ
£!
no~ ~. Uc.. . as Owner/Authorized
d information on the foregoing application are true and accurate, to the best of my knoWledge
Brief De5criPtiow~posep , .
Work:K¥O fO [INN JWirnm::y· porL wi tt'h"Jh~.~ u/f(:t{~'~~f"
Alteration of existing bedroom __Yes ~No Adding new bedroom Yes./ No SdP t 'hiJ
Attached Narrative Renovating unfinished basement Yes ,/ No
Plans Attached Roll -Sheet
i~~j'f~Nlailluli1allw'iilitllilh\i~QJI.ilIMltlIQin!ijfi.itiillffifirillitl:
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. 7W: 11J4.ft Dimensions -~J~v..:J---::1J(:...-'1..L.=.O_'________
e. Number of stories? _____________
f. Method of heating? _____________ Fireplaces or Wood stoves ____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 1 City Sewer Private weJl ___ City water Supply ___
1.-_··_·""_-,..........·_·__·,,·_·,______________________________, as Owner of the subject
property
hereby authorize U-.
to act on my behalf. in all atters relative to work authorized by this building permit application.
Date
8.1 Licensed Construction Supervisor:
Name of License Holder: BncmJUrlOY7D J "'J"ulian6.ifhols
Telephone
Company Name
Address
.'3{JI 7?Ucc-HM"f.e fC}. VtWl.PI1/ cr allOu (,
______________Telephone &WJ,87~-I/)1.5
Not Applicable 0
Ucense Number
Expiration Date
Not Applicable 0
/.3't,f,;l " Registration Number
8/:;;7/,£0/7
Expiration Date
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....... a" No...... 0
The current exemption for "homeowners" was extended to include Owner-occupied Dwellings ofone (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.
Defmition of Homeowner: Person (s) who own a parcel ofland on which helshe 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
reseonsible 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 ofthe work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofEmployers to
Employees for injuries not resulting in Death) ofthe 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 ofMassachusetts General Laws Annotated.
Homeowner Signature ________________________
feB \ 12.0\1
Department yse only '"
City of Northampton StatU$ of Permit:
Building Department Curb CUllOriveway Permit
212 Main Street SewerlSepticAliaiiabinty
Room '100 WatertWell Availability'
Northampton, MA 01060 Two Sets of SlructurBI Plans
phone 413-587-1240 Fax413-587-1:!72 Plot/Sile Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR lWO FAMILY OWeLLING-
,Signature
ll.g &,Itl.!oriM<! Arum!;
~~b1i~~l___________ ~1?/t't>l-ly///.c; tf'or:;rA ,
Name (f'rtl1l) /, Cutroflt Mailing Add""",:
SECTIOl'l1 • SITE INFORMATION
1.1 Erol!~mAddres$: This saelion to be OClll1pletlltl by Offl~'"
/f70Vl7p/lY;(dad' Map Lot ._Unlt___
pIM!l7re~ MI9 ~/t1ft:,;? Zone Overlay District
SEC110N 2 _ PROPERTY OWNERSIiIP/AU,_TH_O_R_IZ_E_D_A_G_E_NT__l_E-llm_S_tDlstrIG~________C~OISUiot =~=~,--
sgcnON 3 -EStIMATEO gQ!)!S~UbTION c~~=r=-~4P!:L";;!.7...L.___-::-::~-:-:-__-;-________,
: Ilam Estimated Cost {Dollars) to be Official Usa
COOl leled II ermit a lean\
. 1. Building ij,,?c gq,5 Ie) Building Perm'! Fee
2, Electrical .'1 All (b) Estimated Tolal Cost of ~________________+-___~~/._~_v_6____________t-_Co~'~~~t~ru~onrrom~____-+______--------4
3. Plumbing Building Pi....nlt Fee
SECTION f!.. DESCRIPTION OF PROPOSED WORK (check all appUcable)
NewHoIIIKI Addition Replaeement Windows
Or Doors Cl
Accessoty Bldg. 0
o o
Demolillon o New Signs rClI
BrtefOescrlp~on)/f P),!posed /1 '
Work: ;,Ilf'X/fO' lafPuad JI.;J;II1.rn!) f!H1.1t. u.;f 0/' hi;Jh sffldy ImG!? wj.wtf-e{{)J~1r ._.
Alleralion of exl~tln9 bedroom __Yes ~No Adding new bedroom ___Yes ~No Self't hi]"
Attached NarraHve Renovating unfinisheo basement Yes......L No
Plans Attached Roll Sheet ----
&•• 11 New house and or addition to eximing hoysing. complete the following:
a. Use of building: One Family ~Two Family ___Other ____
b. Number of rooms In each family uoil:_____ Number of Bathmoms,_____
c. Is there a garage attached? ___
d. Proposed Square footage of !lew construcUon. 7'tg: if~Dimensions -.,,';?rt'lf.!(..,.!.',,;..:'i:u!():...'________
a. Number of slodes?
f. Method Of heating? ____________ Fireplaces or Woodstoves ____!'umber of each __
g. Energy Conservlltion Complian"". _________ Masscheck Energy Compliance form altachad? ______
h. Type of construction ______
1" coostruG!ion wilhin 100 fl. of wellen"s? __Yes __No. Is construction within 100 yr. Roodplain __Yes _..-No
j. Depth of basement or cellar floor below finished grade ________
k. Will building conform to the Building end Zoning regulations? ___Yes ___No
Septic Tank..L City Sewer___ Private well ___ City watAr Supply ___
SECTtON 1a -OWNER AU1HOII:lZAliON -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPL.IES FOR BUILDING PERMIT
._-'-_"':"'_~-'-'--'-__. ~as Owner 01 the subject
, _j () . Uc. . _._ ,as Owner/Authorized
d information on the foregoing appllcalion are true and accurate. to the best ormy f<nowiedge
Signed under Ihe pains and penallies of ""rjury.
L~OGI9~/Z
City ofNorthampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40,854, 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: /"17 /)vOf?o/ IIt¥1ct....
The debris will be transported by: --I("""AJQJ'(,{/'u.Ji4_n=f/..~J-L8.......:(:.'::::...(;)=I..4:..:l_______
The debris will be received by: 6>tLflaqir boIs" ,,::2/ 7ilkcIM'/l.o Jf). V~mcn,. cr-
Building permit number: _____________
Name of Permit Applicant Ui{(!/tzl-lt;,,~
Date Signature of Permit Applicant
The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office ofInvestigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers
Applicant Information Please Print Legibly
Name (BusinesslOrganizationlIndividual):~"",:ru'-""'-LL/j..... ... _ol.,J.n.q,O,p.~r.l--..!11~OO~/sr...L..--!.LLIWC=--___________
Address: .lal ~/cottvi Il.t t.oo.d
City/State/Zi Phone #:
Are you au employer? Check the appropriate box:
1. IX! I am a employer with ¥ 'it 4. 0 I am a ~eneral contractor and I
employees (full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner-listed on the attached sheet.
ship and have no employees These sub-contractors have
working for me in any capacity. employees and have workers'
[No workers' compo insurance compo insurance.:!:
required.] 5. 0 We are a corporation and its
3.0 I am a homeowner doing all work officers have exercised their
myself. [No workers' compo right of exemption per MGL
insurance required.] t C. 152, §1(4), and we have no
employees. [No workers'
compo insurance required.]
Type of project (required):
6. ~New construction
7. 0 Remodeling
8. 0 Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roofrepairs
13.[2(Other /.6=. ,padZ..
*Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing alI 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' compo 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: bans/ Pica (inti LeonarL
Policy # or Self-ins. Lic. #: eWe 1/9'180 Crt Expiration Date: (}WO/At)!?
Job Site Address: / ¥7l2UD"hy ~oad City/State/Zip: F/tJt121(12,. All /tl 11!/J';;l
Attach a copy of the workers' compensation policy declaration page (showing the policy nnmber and expiration date).
Failure to secure coverage as required under Section 25A ofMGL 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 ofa STOP WORK ORDER and a fine
ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
I do hereby certifY under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: ~K'~ Date: 021'/1'/'20/7
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: _______________PermitlLicense #______________
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.0ther ______________
Contact Person: _________________ Phone #:
~ .. " ..
JULlA·1 OP 10: ME
OATe(MMIPD/vVYYjCERTIFICATE OF LIABILITY INSURANCE 12/2912016
THIS CERTIFICATE IS ISSUED AS A 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 HOLD.ER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement s •
.....•..-----.--...."'-,.--"-''"""".....--.,,,"",,,,.,,,,,,,,··"""""""""""",,--,1
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDIOATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF !W( 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. l.1MITS SHOWN MAY HAVE SeEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE IGENERAL LIABILITY
A r-j(,"! COMMERCIAL GENERAL LIABILITYCD CLAIMS-MADE [K] OCCUR
WORKERSCOMPENSATION
OCCUR
5~fd.\I~~:fy1.A.g§:
10000
IAND EMPl.OVERS· LIABILITY YIN A ANY PROPRIETORIPAR:fNERlI;XECUTIVE r7.]OFFlCERlMeMBER exCl!!DEO? ~!(Mandatoty In NH)
NS
POLICY NUMBER
!
ICOl1220708
I
CBA1220708
CU 1220708
WC1194806
01[01/2017
01/01[2017 01/0112018
01101/2017 01101/2018
oesCR!PTION OF OPERATIONS I LOC.ATlONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is requjl1)d)
PRODUCER
Evans, Pires & Leonard
121 Roberts Street East Hartford, CT 06108
Timothy J Evans
INSURED Juliano's Pools, LLC
321 Talcottville Road
Vernon, CT 06066
COVERAGES CERTIFICATE NUMBER:
CERTIFICATE HOLDER CANCELLATION
EVIOENC
Evidence of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELWEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS.
!
AUTHORIZEOREPReseNTATIVE
.p~~ge~
® 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
-t-
LOT 2
141,184+ SQ. FT.
3.2411 ±ACRES
Eroliicn Omtrol Notes f__~___"'~hd>i"-,-",__
to--,~""""'*,-....... a..ob,_............--._lIIu""'tr:br"*""".,..
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........... ~~ttI'*' ("l~IIt12-''''''''''' f'AX(4f~n2-'I~----
White Oak Woods
Subdivision
NonIwopIoD, m
F...,_~~u.c
Proposed Site
Pian
1