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38B-066 (7) 249 SOUTH ST BP-2019-1473 GIs#, COMMONWEALTH OF MASSACHUSETTS MayBlock:38B-066 CITY 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-2019-1473 Proiect# JS-2019-002387 Est.Cost:$29900.00 Fee:$75.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor. License: Use Groun: CLARENCE KAYE 064314 Lot Size(sa.R.): 9583.20 Owner: CAMPBELL ALYSIA Zoning:URB(100 Applicant. CLARENCE KAYE AT: 249 SOUTH ST Applicant Address: Phone: Insurance: 3 WESTERNVIEW RD (413) 221-8358 WC HOLYOKEMA01040 ISSUED ON.62 712019 0:00:00 TO PERFORM THE FOLLOWING WORK:IN GROUND POOL"Pool fence 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: 001: 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 OccuoancY signature: FeeTYpe: Date Paid: Amount: Building 627/2019 0:00:00 $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File 9 BP-2019-1473 APPLICANT/CONTACT PERSON CLARENCE KAYE ADDRESS/PHONE3 WESTERNVIEW RD HOLYOKE (413)221-8358 PROPERTY LOCATION 249 SOUTH ST MAP 38B PARCEL 066001 ZONE URB000U THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid tek9f�iE—fly PLACE Typeof Construction: IN GROUND POOL Pad(.- �a New Construction 4i Ef-oflE Pool, IS FLtLED Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 064314 3 sets of Plans/Plot Plan THE6LLOWING 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 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 nZ,- 1 � � z SignaturKof Building Official Data r ' ' 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. City CEI Building pa 212 Ma St et Roo 1 y p 4 2019 North aInpto , M 0101 phone 413-587-1240 F 413-587-127 DEPT.O%D6��I,DINC�NnAO 060 i APPLICATION TO CONSTRUCT,ALT PAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE WFORAMTION 1.1 PmoeM Address: This section to be complelW by afli 249 suulh street um2 5 _. ..� Loi Ji�tiler Nenhempmn,MA 01060 Zerie .Overlay Distdct EeeM OI141o1 CB WYiat_,__-__- SECTION 2-PROPERTY OWNERSHIPIAUTHORUED AGENT 2.1 Owner of Record: Adysie Campbell 129 Hill"Avenue Hatyoke MA �q N.(PA 1 Curentnt_ yJ,�ail�gp-pgppes l /� Teleptore l0 22 Authorized AAerd: Ciamnce E Kaye 3 Western View Rd Hdynke,MA N Pon ^ / Cu ant MwFg Addesa. 413221.8358 &gwtue Telephone SECTION 3-ESTOAATED CONSTRUCTION MM kom Estimated Cost(Dollars)to be ONcial Use Only comp4eted by t applicant 1_ Building 299DO (a)Building Permit Fee 2. Ekoctical (b)Estimated Total Cost of Cmsvucvon tram 8 3. Plumbing Building Permit Fee 4. Wchanical(HVAC) 5.Fire Protection 8, Totes= 1 +2+3+4+5) Check Number This Seckm For Official Use Only Dais Bustling Pernik Ni Issued: [S�natum: Building Caem®sionedirep mr ofBuldrga Dale EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �/� Fo �; PVF f)ocls . ceM Section 4. ZONING an Inrornffiion last Be Completed. PeMt Can Be Dented Doe To loc oplete Intornecion Existing Proposed Required by Zoning This mhvn t to be fLlWm by 6uildina Ocperfmmt Lot Sin Fratuage SNbaeks Fmot LOAD O Side L:Ir�1 R-NID L:O R:= Rpt n 0 Building Height O Q Bldg. Square Footage % ® O 1Open Spat�bldyate O O % M of Parkin 5 aces Fin: wlmnealmtinv _ __t A. Hasa Special Permit/Variance/Findin ever been issued for/on the site? NO O DONT KNOW YES Q IF YES, date issued:j IF YES: Was the permit recorded at the R istry of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page ���/yyy� and/or Document#� B, Does the site contain a brook, body of water or wetiands? NO -V DONT 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 © , Date Issued: C. Do any signs exist on the property? YES O NO IF YES,describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended far the property? YES O NO 10 IF YES, describe size, type and location: E. Wit the eonstntct[on activity disturb(clearing,gmdng,e��-m§§§vetlon,or fl/ing)mer 1 acre or is It ped of a common plan that wll disturb over 1 Bore? YES O NO tP[ y IF YES,Men a Northampton Storm Water Management Permft from the DPW Is required. SECTION S DESCRIPTION OF PROPOSED WORN(check all 8WHc 1e1 Naw House ❑ Addition p Replacamand Windows Alteration(s) ❑ Roofing ❑ a Dorn o Accessory BN94 Demolition ❑ New Signa IDI Decks Ip Siding 101 Other IIS Brief Description of Proposed In 9-cund tbergass pod in backyard Work' Alteration of e)isting bedroom_Yes®No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Atfacbed Roll -Sheet e- Use o/building!One Family_ _ Two Family Other b. Number of roams In each family unit. Number d Bathroorm c. Is there a garage attached? 12Y24' d. Proposed Square footage of new,construction. 288 Dimensions e. Number of stories? I Method of heaping? Fireplaces a Woodstoves Number of each_ g. Energy Conervation Compliance. Masscheck Energy Compliance brm attached? h. Type of construction 1. Is construction within 1008 of wetlands?_Yes - No. is construction within 100 yr. Acodplaln_Yes */No I. Depth of basement or cellar fox below finished grade k_ Will building conform to the Building and Zoning regulations? Yes_No I. Septa Tank_ Gy SewerPrivate HCMI City water Supply it - SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Aiysa Cank i ,as Owrer of the subject Property hereby authorize Clarence Kaye to act on my behalf,in all matters relative to wok authorized by this building permit application. 824.19 5 caved Qwrer Dela I, Clarence Kaye .as Owner/Authadzed Agent hereby declare that the statement and lnfamration on the to egdng applicator are true end accurate,to the best of my knowledge and bete(. S er The pariatnd penalties of perjury. r l�li 824.19 LShim mn,nt OwrerlAgent Data SECTION 8•CONSTRUCTION SERVICES 8.1 Lkeneod Construeean Sr Icor. Not Applicable ❑ Marro of Lkmw Clan rco E Kaye PI~Vaisy Fiberglass Pools 084314 -- —_ linrwe Number 3 Wesbm Vivo Rd HdyoM MA 01040 1 VSS2020 Expiation Oat, 413221.8358 ue TWphmw 6 Roolswod Home Ynproverow CoofflO : Not Applicable ❑ Clarence E Kaye Pioneer Valey Fiberglass Pods _ 143233 ComNnv Nam, Registration Number 3 WesLml Vlew Rd Holyoke MA 01040 7WO20 Address ExOmbon Dale Telephwe 413221,8358 SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT JBLO.L C. 152,;=" Workers Compensation Insurance a8idavft must oe completed and submitted M4N this application. Felureto provide Ids affidavit YAI result In Ire cartel of the issuance of the building perm A. S ned Affidavit Attached Yes....... No.. ❑ City of Northampton _ Massachusetts aSPAllA OF as WMG MVMZCnWS ` 212 In aee«c 0s .ipal Hailer tb tM1a, .' . 01040 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 284 South Street (Please print house number and street name) Is to be disposed of at: 65 Canal Street,Holyoke,MA Holyoke Ring Center (Please print name and location of facility) Or will be disposed of in a dumpater omfle rented or leased from: (Company Name and Address) oLd'4 6 , 24- 12 Signature ofPe&It Applicant or Owner Date 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. 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: '�?iy So U�-il The debris will be transported by: 9 I o n e',a V h,,, The debris will be received by: lo lfLecyCl%vesz Building permit number: n 1 / n Name of Permit Applicant PIG VG lin `rlie c 650 Date Signature o ermit Applicant The Commonwealth of Massachusetts I Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-20177 www mass goF/dia Barkers'Compensation Insurance Affidavit:Builders/Contractors/Eleatricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITI'. AaaBcaut tufo xuwdou Please Print Legibly Name musineadOtganimlionnndividua0:Clarence E Kaye Pioneer Valley Fiberglass Pools Address:3 Western View Rd City/State/Zip:Holyoke MA 01040 Phone#:413.221.8358 Are you m employer?Check the appropriate boa: Type of project(required): LQ lama employerwnh 4 employees]full andlor pan-rimeh• 7. ❑New construction 2.❑l am u sole promeser or monership and have no employees working formula 8. ❑Remodeling any capacity.Mo assurance Mutual] IMIamahomeowner doingall work myself[No workers'comp.insumtme require.]' 9. Demolition 4.❑1 am a hommwrar and will be hiring contractors to conduct all work on my property. I will 10❑Building addition eirme usual]son ..either have wmkers-c in suremias imumme or are mle 11.❑Electrical repairs or additions gran as with m employees. 12.❑Plumbing repairs or additions 5.C]l am.general comeornrmd I have hired the mi,om memrs listed on the attached sheet. 13.❑Roof repairs These subcontractors have employees /.romo mance.:have workermp. mme.: b.❑Wc arc a c.awl we n and its emcee have o worked their m ur ofcambium per MGL c. 14.Qr Otherin ground pool 152.41(4),and we have no employeca.[No wohers'comp.insurance requved.] •Any applicant that checks box#I mon also fill aur the section below showing their workers'comacamtion policy information. f Homeowners who sohnul MIs amdavit indicating they are doing all work and then hire muide connactom must submit arm affidavit indicming loch. :Contmetons that check this box must attached an additional sheer showing the name of the sub-conawme and stare whether or not those entities have employees. It the znbmntractors have employees,they must provide their workem'comp,policy number. I am an employer that is providing workers'compensadon insurance for my employees. Below is the policy and job site information. Inwrance Company Name:ACE AMERICAN Policy#or Self-ins.Lia#:U13414340061 Expiration Date.5.1.2020 Job Site Address:284 SOUTH STREET City/State/Zip:NORTHAMPTON MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,425A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yew imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penahies ofperjuty that the information provided above is true and eorreet. signature Date' phone 4:413.221.8358 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permtt(License# Issuing Authority(circle one): I.Hoard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector h.Other Contact Person: Phones: /-NN PIONVAL-06 CHRISTINE A�KO CERTIFICATE OF LIABILITY INSURANCE DA61'2M019 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N Ne cermlcate holtler is an ADDITIONAL INSURED,the policy(")must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain Policies may require an endorsement A statement on this certificate do"not confer rights to the certificate holder in Ileo M sash endorseme e. PRODUCER WNVCT Christine Sullivan Phillips Insurance Agency,Inc. PJx,EMI,(873)594-5984P xo x473 b82-0498 97 Canter Street Chicopee,MA 01013 .chriginefthlifiloslinsurance.comi INSUREPINNARPORDINGOOPWAGE NNCe _ INSURER A:Philadelphia Insurance Company wtur. INSURER B:Selective Insurance 12572 Pioneer Valley FlIe rglass Facts and Spa,LLC INSURER c:ACE American Insurance 3 Western View Road INSURER D: Holyoke,MA 01060 M.E: INMER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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, EXCLUSION$AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. .SRTYPEOFw91MRNC4 ADM MR PoEOYNUMBER IMAM POCKY EXP HANTS A X I COMMERCMLGENERALLMat1TY EACH OCCURRENCE f 1.000.000 cLAIM521ADE �X OCCUR PHPK1978312 &1@019 5/1YL020 DAMAIM (RENTED a 300,00p MEDIEXP(Aryw5,00 PERSONALRAWINJURY s 1,000.000 GENL AGGRE ATE UMn APPLIES FE R'. ENFRALA GRE TE 2'000'000 X Pa1CY�X JP[8r LDL PRODUCTS-COMPOP AGG s 2,000,000 OTHER' B AMTIM1MBlE LIABILITY COMaINEDSINGLE LIMIT E 600,000 ANYAUTo A9,1071911 6/1/2019 0/112020 BODILYINJURY VI OWNED X SCHEDULED Al�-prr��$ONLY At�r1rJO�SJµµTNJ��pp BODILY INJURY ar soadene X RUTAONLY X MUTOSCNLY PROPEgR MAGE UName--B a eJAWB -c- PPEACCCHOCCURRENCE $ E.E.. CWMSNPIIE AGGREGATE DED I I RETENTIONS C YpMERanway 9Al10N X PER TN AXDEMPLOYEA9'Las NY PROPRIEigRRAmNERffXELVTIVE YIN 562UMN34996-1 $11/2019 $/112929 E. .EACHIDEM 600,0 OF.1=1RBER—LUDEDi ❑N N/A �UMM .X.0 EL.g5E0.5E-EA EMPLOYE f 600'000 N YBe INTIONIKON 6000QQ OEBCRIPTICN OF CfEPATIONB ONex ELgSEASE POLICY LIMIT 3 OESCRVngJOFOPEAATONS/LOCATIDIMIVEICLES IACORD 161,AEJItlolul Re�Ie�M XMEUM,may MaW[MOXmon epwls�epulMl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of Northampton THE EXPIRATION DAIS THEREOF, NOTICE WILL BE DELIVERED IN City P ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspector 212 Main St Northampton,MA 01060 AM..REPRESEN.. N ACORD 25(2016103) ®1986-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD Clarence Kaye, Owner ��' Pioneer Valley 3 Western View Road Holyoke, MA 01040 Fiberglass Pools and Spas pvfpools@comcast.net 413.221.8358 License information for Pioneer Valley Fiberglass Pools I Clarence E. Kaye, Owner CSL-064314: Exp 11/5120 d"M graphic Information Full Ni CLARENCE E MYE C Add SS information t HOLYONE h. MA E ' pm0e: mwa u lea /ales atlon _. ll No: c5L6ilta T.0 Type CgebWmSi4avlq � rlaeaewn: ealai.g L�umes namaLaF Renews: x2o1s J LI ma Ey,atlq,oae. It v2mo F 8blus: AWue TWaYs Gale NRJ18 6ttmNlY LFsiee Type: y euvren As _ F o ea WmN C 3011 CwnmonxealM M MaaEW,usaM $ICi fylGYy_I HIC: 143233—exp 7/10120Jryy J/!F (>(A9YlfIYKINYI//�1�./6'('iq«61?M!ldl�Ir3 00w MClawFner Afleirs ana& imss RWJ tlon 1000 WaMimlwl Street-SuAe 710 SZN'Malapl,ue s 02118 Ibnq IlrymwmalyQsnvaaor Repialm0.n a.weWeE Wve � � { Fm.sm. I'll. NtNeIVFW IIO Mq.RRE.W plp0 mae �� laa.wle.nl.ul.yl,.w� Pioneer Valley Fiberglass Pools— 3 Western View Rd— Holyoke, MA 01040 pvfpoolsC&comcast.net—www.PVFPools.com MA HIC: 1432333— MA CSL: 64314—CT HIC: 0605046—CT SPB: 0000065— RI GC: 37997 Most I . Accepted I Trusted ESICC EVALUATIONSERVICE Report Reissued 0711712018 ICC-ES 1 :aa s 05/2019 EVALUATION SUBJECT: FIBERGLASS ONE-PIECE SWIMMING POOL SHELLS DIVISION: 13 00 00--SPECIAL CONSTRUCTION SECTION: 131113—BELOW-GRADE SWIMMING POOLS Report Hc1der: LEISURE POOLS AND SPAS MANUFACTURING NORTH AMERICA Look for the ICC-ES marks of Confarmity! ��_ IM ICCGES Ewluat ml Repwfs me n0 to ce ca trued as repre Minga< 1111"0 any other arlrioutes nd specdicatty�ereaaea,nor are they to be construed as an endorsement of the suhrea of tirc � PflEfERREO �� report or a re<ommerWalron fw its use.mere is rro warranty M Icc Evawarian Smdse,LLc,ezprex �„ EOOCATION ��` wimalrt4asro any finding or other maser in this repos,w as to am prodsct cometl by me low, �' ��� PROVIDER MOa Copn�anr 0 2018 IM Ewluaeon$ervire.LLC.An rights reserved. coo[[10.11. ii i ESLVALUATION . IVICE Most Widely Accepted and Trusted ICC-ES Evaluation Report ESR-1732 Effective Date:May 2018 Revision Date:July 17, 2018 This report is subject to re-examination in one year www.icc-es.ora 1 (800)423-6587 1 (562)699-0543 A Subsidiary of the International Code Council® DIVISION:130000—SPECIAL CONSTRUCTION circulated through a filter in a closed system. The pools Section: 1311 13 Bolow-Grade Swimming Pools comply with APSP/ANSI-5 as Type O or I pools. REPORT HOLDER: 3.0 DESCRIPTION The fiberglass pool shells consist of one-piece fiberglass LEISURE POOLS AND SPAS MANUFACTURING construction shop-fomled over a mold. The material is NORTH AMERICA minimum '/Is-inch-thick (7.9 mm), fiberglass-reinforced www.leisurepoolsusaxonn plastic(FRP), composed of vinylester resin and fiberglass roving. The surface finish is a vinylester resin-rased gel EVALUATION SUBJECT: coat. FIBERGLASS ONE-PIECE SWIMMING POOL SHELLS The overall dimensions, depths and capacities of recognized models are shown in Table 1. 1.0 EVALUATION SCOPE Notice: The pool shells are designed to remain full of Compliance with the following codes: water at all times. The shell may be damaged if the water level is allowed to drop below the skimmer. When ■ 2018, 2015, 2012, 2009 and 2006 International Building appreciable drew-down is noticed or If it becomes Code(IBC) necessary to drain the pool, Leisure Pools or its dealers ■ 2018, 2015, 2012, 2009 and 2006 Intemational should be contacted for instructions. Residential Code®(IRC) 4.0 INSTALLATION ■ 2018 and 2015 International Swimming Pool and Spa The pool shells must be permanently installed in-ground in Code(ISPSC) accordance with this report and the manufacturer's ■ 2016,2013 and 2010 California Building Code(CBC) Published installation instructions. All plumbing and elecuical installations must comply with the applicable ■ 2016, 2013 and 2010 California Residential Codes codes in effect at the construction site. (CRC) Subject to the code official's approval,the pool shell may ■ 2017 Florida Building Code(FBC) be installed without a soil investigation by a registered ■ 2017 Flonda Residential Code(FRC) design professional, unless any of the following conditions is encountered at the site: ■ 2013 Abu Dhabi lntemah'ona/Building Code(ADIBC)I 1. The existence of groundwater within the excavation, For evaluation for compliance with Los where the pool floor will contact the soil at the time of Anaeles Dedertment of Building and Safety(LADBSI, see installation. ESR-1732 LABC and LARC Supplement 2. The existence of an uncompacted fill in contact with Compliance with the following standards: any portion of the pool or spa shell. ■ APSP/ANSI 5-2011, Standard for Residential Inground 3. The existence of any expansive-type soils, unless the Swimming Pools pool manufacturer has provided specific instmctions ■ fence Criteria for In round, regarding expansive soils within their installation AC274, ICC-ES Acce P g instructions. Residential, Fiber4einforced Plastic Swimming Pools and Permanently Installed Plasfic Spas, dated 4. The existence of any soil types with an angle of repose December 2006(editorially revised July 2017) that will not support the walls of the excavation at 2.0 USES desired slopes. The fiberglass pool shells are permanently installed 5. Danger to adjacent structures posed by the proposed in-ground and are intended for recreational use as pool location. swimming pools in residential applications with water If any of the above conditions is encountered,excavation / F M1e 'rueJ pre. X A y h M1 peafi llyw d. a M1el' M1e a'onvrnda+on rm.Weemem.....eYe �� ,Ina,uniael a,Phe lr,rixarorve,.eme l � reeo, --it,bill zlnlraram4 �ne.nr. yr e.. -mdlee a:meeyfrvrmx er mM1ermmrrrnnlhaJl.rorgo a.,rn ,prd-1rmeredhy,h kI x "rM. —_ CopyIpM02p181CC E alustm Serviro.LLC.Al rgfib reserve]. Page 1 of 4 i ESR-17321 Most Widely Accepted and Trusted Page 2of4 must cease immediately. The site conditions must then be APSPIANSI-5 must be submitted for approval by the reviewed, and recommendations made, by a registered code official. design professional. The code official must approve the 5.6 The registered design professional's report before work is pools are classified as either: resumed. Tyne 0 pools.not intended for use with diving boards Details specifically for installations in expansive, clay, or or other diving equipment;or adobe soils apply only when supported by the registered Tyne I pools: maximum height of stationary diving design professional's recommendations and approved by platform or diving rock above the waterline shall be 42 the code official. inches The pool excavation profile must coincide with the 5.7 Pools located in flood hazard areas established in contours of the pool. The overexcevation is approximately accordance with Table R301.2(1) of the IRC must 6 to 12 inches (152 to 305 mm) on the sides and ends. comply with Sections AGIO1 2 and AG103.3 of the The ow rexcavabon at the pool bottom is approximately IRC, Section AG101.2 of the CRC or Section 304 of 4 inches (102 mm). The backfill for the pool is a layer of the ISPSC. minimum 3-inch-thick (76 mm) bedding sand matching the 5.8 Suction outlets must be designed and installed in pool or spa profile. This sand layer is compacted using a accordance with IBC Section 3109.5, CBC Section manual tamper and water. The pool shell must sit firmly on 31378, CRC Section AG106, ISPSC Section 310 and the sand and be within 1 inch (25.4 mm) of level. IRC Section AG106.1. Simultaneous waterfill and sand backfill operations then 6.0 IDENTIFICATION commence. The sand is compacted with a tamper and water. The installer must ensure that the backfill level and 8.1 The pool shells are identified adjacent to the skimmer water level are approximately the same throughout the with an imprint that includes the words"Leisure Pools filling procedure. USA," the model designation, a coded serial number After Completion of the backfill, the bond beam and and the ICC-ES evaluation report number (ESR- decking must be installed in accordance with the 1732) manufacturers published installation instructions, and as A permanent sign, bearing the following statement, approved by the code official. must be attached to the pumping equipment: 5.0 CONDITIONS OF USE Notice: The pool shell is designed to remain full of The fiberglass pool shells described in this report comply water at all times. The shell may be damaged if the with, or are suitable altematives to what is specified in, water level is allowed to drop below the skimmer those codes listed in Section 1.0 of this report, subject to When appreciable draw-down is noticed or if it the following conditions: becomes necessary to drain the pool, contact Leisure Pools USA or its dealers for instructions. 5.1 The pool shells must be Constructed and installed in accordance with this report and the manufacturers A permanent label must be attached adjacent to the published installation instructions. In the event of above sign indicating the Leisure Pools USA conflict,this report governs. distributers name,address and telephone number. 5.2 Electrical and plumbing installations must comply with 62 The report holders contact information is the the applicable Codes in effect at the construction site following: at the time of construction. LEISURE POOLS AND SPAS MANUFACTURING 5.3 Clearances of the pools from slopes set forth in IBC NORTH AMERICA Section 1808.7, CBC Section 1808.7, CRC Section 2901 LEISURE ISLAND WAY R403.1.7 or IRC Section R403.1.7 must be observed. KNOXVILLE,TENNESSEE 37914 5.4 A banter must be installed in accordance with IBC (865) 80 www.loisumeisure000kusa.com Section 3109, ISPSC Section 305, CRC Section AG105 or IRC Section AG105,as applicable. 5.5 Slip resistance is outside the scope of this evaluation report. Reports of slip resistance tests that demonstrate compliance with Section 8.1 of TABLE 1 MODEL Sim MODEL LENGTH WIDTH MAIL DEPTH CAPACITY POOL TWE ABBREYIATIM (fletrinches) Peeeinches) (feasinches) (gallons) Allure 30 AU-30 30'0' 14'T 6 V 8,247 O Allure W ALL35 3510' 14'9" e'4- 11,174 O Allure b AL140 40'0' 15'T 68- 14,637 0 Caribbean 40 C 1140 40'0' 1601, 6'4" 16,535 0 Cube wl Cover Box 23 CUBC23 23 1 112' 11'91, 4-11- 81400 0 Cube W Cover Box 26 CUB026 26'5 1119. 4'11" 9,700 0 Cube wl Cover Box 30 CUB30 29'6" 13'9" 5'3" 8,850 0 Cube wl Cover Box 34 CUB3d 34'5112' 13'9' 5'7' 11,000 0 Cube wl Cover Box 39 2UB39 39'4112" 13'1 5'10" 16,000 O Eclipse 30 ECL30 30'0' 14'9" 6'1- 8,62d 6 ESR-1732 I Most Widely Ax pted and Trusted Page 3 of 4 EdiW 35 ECL35 35'0' 14'9' 8'4' 11,593 O Eclipse 40 ECL40 40 0' 158' N 8- 15,045 O Elegance 20 E20 19'8' 11'6' 516' 5,361 0 Elegance 23 M 23'P 12'6' 67' 7,113 O Elegance 26 E26 263' 14'6' 519' 10,012 0 Elegance 30 00 29'T 14'T S'0 11,282 O Elegance 33 133 3310' 14'6' 6'0' 12,837 O Elegance 39 09 394' 14'8' 6'2' 15,301 O Esprit 19 ESP19 168' TS' 4'S' 4,727 0 Fiji Runge 10 FU10 VT 8'11' 4'5' 2,236 O Harmony 16 HAR16 16'5 916' 5'T 3,573 0 Harmary 20 HAR20 19'8' 916. 6'4' 4,559 O Harmony 23 RAR23 23'0° W6" FT 5,397 0 Horn., 26 HAR26 26'3' 916' 619' 5,906 O Horizon 23 HOR23 15'9' 23'0' 4'0' 3,761 O Iron 40 IC040 40'0 16.6. 8'0 20,113 1 Infinity 40 INF40 40'0' 166' 810' 28,000 1 Limitless 26 LIMM 26 P' 1Y 6" 67- 12,000 0 Liminess m LIMM 300" 1Y6" 6'1/8" 14,500 O Meciderrenea i 40 MENS 40'0" 16W 8'0' 20,826 1 Moroccan 27 M9 26 11' 13'6' 5'5' 8,972 O Moroccan 31 Min 30'10' 14'6' 5'8' 11,854 O Moroccan u mu MT 14'F 5 11' 13,658 O Mora con 38 M38 38'S 14'N V2- 15,n7 O Opel WA TL 1015" 7'10 12' 425 0 Palladian Runge 16 PA16 16'0' 8'0' NW 2,742 0 Palladivn Plunge 20 PA20 20'0' 8'0' 510' 3,889 0 Pinnacle 30 PIN30 30'0' 15'S 610' 11,267 0 Pinnacle 35 PIN35 360' 15'5' 6'6' 14,356 0 Pinnacle 40 PIN40 40'0' 1515' 7'0' 17,890 O Predsim 23 PRE23 23'312 10 10" 4'11" 9.300 0 Proclaim 27 PRED 26'T' 1910" 4'11" 10,600 0 Reflection 23 REF23 23'0' 12'6° 511' 7,418 O Reflectim 26 REF26 26'3' 12'6' 118' 8,744 O Reflect. 30 REF30 29'T 12'6' 5'10' 10.114 0 Reflxtim 33 REF33 32'11' 12-6- 6-1- 11,589 O Reflectim will 23 REFC2326'0 13'4' 515' 8,068 0 Cover Box Reflectim Win 26 REFC26 29'3' 13'4' S'e' 9,410 0 Cover Box Reflection v4th 30 REFC30 3T T 13-4- 5'10' 10,793 0 Cover Box Reflection wl Deck 28 REFD28 2T 101'2" 17 512' N 512' 9,9u 0 Reflection wl Deck 31 REFD31 3TT 125 V2" 5'71f2" 11,700 0 Rivem 27 RN 26 T 12-4- 5'5' 6,665 O Rivera 30 RN 30'3' 13'11' 5'T 9,255 0 Rvera 34 RN36 34'1' 14'6' 5'f0 11,363 O Courtyard Ronan 20 RM 19'9' 11'W. 61, 5,122 0 Roman 23 R23 23'1' 11'6' Nil 5,586 0 Ronan 28 R28 26 T 1116, S'S 7,332 0 scrsmrepa SOS T5" T5' ST 567 0 Sonenlo Spa SSG 7'5' 7'S' 3'2' 567 0 (Sauce-Spilbva) So(RmrSpa SSR 8'0' 8'0 Y10 583 0 (RoundS.-Spill a1 SSS 810' 8'0' Y 10 583 0 Supreme 30 SUP30 30'0' 1651, 5.11. 17,000 0 Supreme 35 SUP35 369' INN, 613, 21,000 0 Supreme 40 SUP40 40'0' 155, 67' 25,u0 0 TaPax WA RR 195' 6110" 12" 456 0 ESR-1732 Most Widely Accepted and Trusted Pape 4 of 4 Tusany 23 T23 23'3" 12'1' 5'0' 5,408 O Tuarany 29 T29 28'6' 14'1' 1 S8' 9.157 O Ultima!! 30 ULM 30'0' U.S. 6'0' 11,318 0 Ultima!i, 35 am 35 0' 1 195. 8'8' 14,438 O Ultimate 40 OLT40 490- IST T 0' 17,890 0 Far 51: 1 fool-304.8 mm,1 irch=25.1 mm.1 pallor=3.]851iten. ES Most Widely Accepted and Trusted ICC-ES Evaluation Report ESR-1732 LABC and LARC Supplement Reissued:May 2018 This report is subject to renewal May 2019 www.icc-es.ond 1 (800)423-6567 1 (562) 699-0543 A Subsidiary of the International Code Council® DIVISION: 13 00 OO--SPECIAL CONSTRUCTION - Section: 1311 16—Below-Grade Swimming Pools REPORT HOLDER: LEISURE POOLS AND SPAS MANUFACTURING NORTH AMERICA 2901 LEISURE ISLAND WAV KNOXVILLE,TENNESSEE 37914 (865)219-2880 www.leisumpoolsusa.com EVALUATION SUBJECT: LEISURE FIBERGLASS ONE-PIECE SWIMMING POOL AND SPA SHELLS 1.0 REPORT PURPOSE AND SCOPE Purpose: The purpose of this evaluation report supplement is to indicate that Leisure Fiberglass One-Piece Swimming Pool and Spa Shells, described in ICC-ES master evaluation report ESR-1732, have also been evaluated for compliance with the codes noted below as adopted by the Los Angeles Department of Building and Safety(LADBS). Applicable code editions: • 2017 City of Los Angeles Building Code(LABC) • 2017 City of Los Angeles Residential Code(LARC) 2.0 CONCLUSIONS The Leisure Fiberglass One-Piece Swimming Pool and Spa Shells, described in Sections 2.0 through 6.0 of the master evaluation report ESR-1732, comply with the LABC Chapter 318, and the LARC Section R326 and Appendix V, and is subjected to the conditions of use described in this supplement. 3.0 CONDITIONS OF USE The Leisure Fiberglass One-Piece Swimming Pool and Spa Shells described in this evaluation report must comply with all of the following conditions: • All applicable sections in the master evaluation report ESR-1732. • The design, installation and inspection are in accordance with additional requirements of the 2017 LABC, as applicable and the Information Bulletin P/BC 2014-014. • The pool must remain full of water at all times.A permanent sign shall be attached to the plumbing equipment to read as follows: Notice:The Pool and Spa shells are designed to remain full of water at all limes.The shell may be damaged if the water level is allowed to drop below the skimmer.When appreciable drawdown is noticed or if it becomes necessary to drain the pool,contact Leisure Pools or its dealers for instructions. • Pools shall not be installed in a"Grading Area"if the direction of the bedding planes is such that the water used to puddle the sand fill may lubricate the bedding planes and cause earth movement.A pre-inspection of every pool located in a "Grading Area"shall be made by the grading inspector to verity this condition as well as other potential geologic hazards. 1"-1x ! Rory Ee a.repesen6^R^ 1' 1 Y M1r 11 6 /nryC1.111•JJ :M.--dwy � naeJ «l I M' /ti of 6e ro wa reeanunervbllan! ....o' ry4 rt'!'l,nl Ve 'e,LLC u0 plled,a.. nYhJ/�XmnOmr In IMrreWr(ma,morryynrlun om ercJ M1Y IM rcOorl. s'^"j' ,� Cepyrs1A020181CC Evelutlion Service,LLC. NI rghb mserved Page 1 or 2 ESR-1772 LABC and LARC Supplement I Most Widely Accepted and Trusted Page 2 of 2 • The pool shall not be located where it may be surcharged by an existing building footing or other superimposed load on the same property or possible future surcharge from an adjacent property. • The structural capacity of the pool wall has been verified by test and shall be assumed capable of supporting either expansive or non-expansive earth banks with the pool empty. • The reinforced concrete pool deck,which shall have a minimum width of four feet,shall be designed by a California licensed civil or structural engineer to take the reaction from the pool wall assuming a triangular load distribution on the wall.The reaction will be dependent on whether the soil is expansive or non-expansive.Where the soil is expansive,the minimum assumed equivalent fluid pressure shall be 45 pounds per cubic foot. Proper consideration shall be provided at construction joints, if any,in the pool deck to assure that reinforcing steel is continuous and that shear reactions are provided for. Proper coverage shall be provided for the reinforcing steel. • Pool lighting fixtures shall be specifically"listed"for use in plastic pools and shall be supplied by a circuit protected by a ground fault interrupter. • Diving equipment may only be installed on Type I pools and must meet the minimum requirements of,and be installed in accordance with,Section 5.8 of APSP/ANSI-. • During installation,pool protection fences and gales shall be in place and operable when the depth of water exceeds 18". • The main drain line and its connection to the pool shell are assembled during the fabrication process and no on-site inspection of that line is required other than the pressure test required by the Plumbing Code. • Pools will be supported by at least 8"of puddled sand placed over the excavated area and between the pool wall and the earth bank. • Public swimming pools(i.e.accessory to multi-family dwellings)require approval from County of Los Angeles Department of Health Services prior to issuance of permit for the swimming pool or spa. This supplement expires concurrently with the master report, issued May 2019 i I - I � 1 , aMr- .� t rn'.i. tE__.CT , tea. .✓`- e °�'! ✓�'i uOGE .=ll WUi _ U P1F M X L£PiN �E EiEFE 1-eLi xUTh�G.VIH UEp'N F RxMe ERYLENGIX COVER !y+EM MDUE_ LENG iGTh UEPiH -- UEPh P PIMEiE3 32 ---- 1 -J MDJL LE,G Y :rIGIH D VI I —."I VENIMLIL+ I M9CEL LHG'H W'UI- MIY D"PM MAY GEFIX FERIMEIER MiUEL 1Y'riH N N CE'X Mf% U:.VIN VLHILI-1 PRELIMINARY - FIBERGuSS SHE t Muc Ee ieE ..[xeu se irorz p - T.—v gym[p • . .. I ,7=1 e'w Y � e�w 'Y' n ewrtry n wem a u[wurt pae) uuurTwn nw+s a armu m xort p- u[wMa a rm[p °�' � DIES _ TI i TYPICAL WALL SECTION OPTIONAL WALL SECTION EXPANSIVE SOIL x.,T „s �uE xTs s<r� "Ts I ITT TYPICAL COPING DETAIL OPTIONAL COPING DETAIL mue xTs scuE xTs PREYMINMY �tviii�'i-Tw..�.'.wH�i .�rnTMAr r x Um+omanc: -NOTE- THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. Ro,s Y� t c 1 , v \ u l P izae- ro D � TO: FLEET REAL ESTATE FUNDING CORP. & FIRST AMERICAN TITLE INSURANCE COMPANY I HEREBY REPORT THAT 1 HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. 1 FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY $ 910167 1 pe —NOTE— SURVEYOR: � � THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A. PROPERTY SURVEY —MORTGAGE LOAN INSPECTION PLAT— NORTHAMPTON, MASSACHUSETTS E PREPARED FOR em PEOPLES SAVINGS BANK own SCALE: 1 "=20 ' JULY 24 , 199, HAROLD L EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LAND SURVEYORS 235 RUSSELL STREET — HADLEY — MASSACHUSETT' DECLARATION OF HOMESTEAD KNOW ALL MEN BY THESE PRESENTS that I, Catherine Campbell, of 284 South Street, Northampton, Massachusetts, as the owner of real estate by deed of Peoples Savings Bank to Catherine Campbell dated July 25, 1994 and recorded in the Hampshire County Registry of Deeds in Book 4522, Page 89, as an owner thereof and having a family and being entitled to an estate of Homestead in the land and buildings hereinafter described do hereby declare that I own and possess and occupy said premises as a residence and homestead under Massachusetts General Laws, Chapter 188 as amended, to wit: SEE EXHIBIT "A" ATTACHED HERETO AND INCORPORATED BY REFERENCE Witness my hand and seal this 13th day of February, 1998. o t% � C Witness / Catherine Campbell COMMONWEALTH OF MASSACHUSETTS HAMPSHIRE, as. February 13, 1998 Then personally appeared the above-named Catherine Campbell and acknowledged the foregoing to be her free act and deed, before me. Cheryl A.4kjor Notary Public My commission expires: 11/05/04 EXBIBIT "A" The land in Northampton, Hampshire County, Massachusetts with the buildings thereon bounded and described as follows: Two certain tracts or parcels of land, situated in Northampton, County of Hampshire, Massachusetts, bounded and described as follows: PARCEL ONE: That tract situated on South Street in said Northampton and being the westerly portion of lot number one on the Plan of Lots marked "Plan of a proposed new street and building lots belonging to Ralph E. Barlow, dated August 1922, E.E. Davis, C.E. " recorded with Hampshire county Registry of Deeds, Plan Book 6, Page 48, and more particularly bounded and described as follows: Beginning at a stone bound on the southerly side of South Street at the westerly corner of the tract to be conveyed, thence running SOUTHERLY one hundred three and 5/10 (103.5) feet to the westerly corner of Lot number 3 on said plan; thence NORTHEASTERLY along said Lot number 3 forty (40) feet to land of Margaret Brown; thence NORTHWESTERLY along land of said Margaret Brown ninety-three and 5/10 (93.5) feet to said South Street; thence SOUTHWESTERLY along said South Street forty-two (42) feet to the place of beginning. Granting also a right of way both by vehicle and afoot over the southerly portion of land of said Margaret Brown to Harlow Avenue, the northerly line being parallel with division line of lots number one and number three on said plan, and seven (7) feet distant therefrom. EXCEPTING from the above tract that triangular portion conveyed by Quitclaim Deed by Margaret E. LaFreniere to Franz Lifka and Mildred L. Lifka, under date of See,tember 18, 1928 and recorded with the Hampshire County Registry of Deeds, Book 849, Page 375. PARCEL TWO: A certain tract or parcel of land situated on the Southerly side of South Street in said Northampton, bounded and described as follows: BEGINNING at an iron pin at the westerly corner of the tract herein conveyed, the same being the northerly corner of the land of these grantors, being Parcel No. 1 above; thence SOUTHERLY along land of these grantors, Parcel No. i above, seventeen (17) feet to an iron pin; thence NORTHERLY on land now or formerly of Franz Lifka at ux sixteen and 58/100 (16.58) feet to an iron pin on said South Street; thence WESTERLY on said South Street for and one tenth (4 . 1) feet to the point of beginning. That being the same triangular piece of land and a portion of the tract conveyed to Franz Lifka at ux by deed of Perry F. Brown, dated May 1925, recorded in Hampshire county Registry of Deeds, Book 814, Page 103 . See also map recorded in Hampshire County Registry of Deeds, Plan Book 12, Page 40. Subject to sewer easement to the City of Northampton dated ' September 22 , 1909 and recorded in said Registry, Book 667, Page 612. h'lildino law 6, yPage 48, and more particularly boumYma : — Beginning at a stone bound on the s therly slie at Smuts Stxvet at the westerly corner of the tract to be come" . tiscz rmming SOUTHERLY one hundred three and 5/10 (103.5) feet to the Westerly corner of Lot number 3 on said plan; thence NORTHEASTERLY along said Lot number 3 forty (40) feet to land of Margaret Brown; thence NORTHWESTERLY along land of said Margaret Brown ninety-three and 5/10 (93.5) feet to said South Street; thence SOUTHWESTERLY along said South Street forty-two (42) feet to the place of beginning. Granting also a right of way both by vehicle and afoot over the southerly portion of land of said Margaret Brown to Harlow Avenue, the northerly line being parallel with division line of lots number one and number three on said plan, and seven (7) feet distant therefrom. EXCEPTING from the above tract that triangular - -- conveyed by Quitclai- Deed ry Margaret E. LaFreniere - =r=-z ___ _ and Mildred L. Lifka, under aate cf b_:�tember i_ - =-H and rer_:e_ with the Hampshire County Registry of Deeds, Boot 949, Page ::5_ PARCEL TWO: A certain tract or parcel of land situated on the Southerly side of South Street in said Northampton, bounded and described as follows: BEGINNING at an iron pin at the westerly corner of the tract herein conveyed, the same being the northerly corner of the land of these grantors, being Parcel No. 1 above; thence SOUTHERLY along land of these grantors, Parcel No. 1 above, seventeen (17) feet to an iron pin; thence NORTHERLY on land now or formerly of Franz Lifka at, ux sixteen and 58/100 (16.58) feet to an iron pin on said South Street; thence WESTERLY on said South Street for and one tenth (4 - 1) feet to the point of beginning. That being the same triangular piece of land and a portion of the tract conveyed to Franz Lifka et ux by deed of Perry F. Brown, dated May 1925, recorded in Hampshire County Registry of Deeds, Book 814, Page 103. See also map recorded in Hampshire County Registry of Deeds, Plan Book 12, Page 40. Subject to sewer easement to the City of Northampton dated ' September 22, 1909 and recorded in said Registry, Book, 667, Page 612. Said premises are hereby conveyed subject to any building law and zoning law requirements which may be in force and applicable; also subject to restrictions, easements and conditions of record, if any, so far as the same are now in force and applicable, to assessments (special or otherwise) and betterments, if any. City of Northampton Massachusetts 4 DiPAA2rmP9' or R=ZDZ= SASPE Offs 212 oar.. atm runiairul mildim Ibzrx�yCm, nx 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontraaecs performing improvements or renovations on detached ane to four family homes. Print to performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC"). M.G.L Chapter 142A requires that the"roomsfrudion, affemtlon,rerovaaUon,repair,modanvzation, conversion, Impmvameniremoval,damnation, orcansaucaon gran addlron b any pre-exafing owner cupled building oonfafNng at Isasf one butnot more gran?"ifivaging unas....or fo sfinetuma which are atlacent io such mstdence orbrdagng"be done by registered contractors. Note.If the hwneowner has contracted wtth a corpomdan or LLC,that erdlty most he registered Type of Work: nstaa9aon of N gourd swlmmng pool Est.Cost: $29,900 Address of Work: 284 South Stre64 NaMamptm,MA 01060 Date of permit Application: 824.19 l hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _ Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(Specify): OWNERS OBTAINING THEN!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 RESPONSIBILTTES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION Signed under the pernalties of perjury 1 hereby apply for a building permit as the agent of the owner: 824.19 Amew Valley Rbarglass Pool and Spas LLC Date ContractorName HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property. Date Owner Name and Signature