32C-115 (5) 41 CONZ ST BP-2020-1186
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 115 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Above ground pool BUILDING P E RM I T
Permit# BP-2020-1186
Project# JS-2020-001990
Est.Cost: $500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 15507.36 Owner: BOUCHER GERARD
Zoning: URC(100)/ Applicant: BOUCHER GERARD
AT: 41 CONZ ST
Applicant Address: Phone: Insurance:
164 CRESTVIEW CIR
LONGMEADOWMA01106 ISSUED ON.6/1/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-ABOVE GROUND 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:
FeeTvne: Date Paid: Amount:
Building 6/1/2020 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIV�1� --
MAY
Department use only
;., ty of orthampton Status of Permit:
'14 nv .>' INC;INSPEcTI ildin Department Curb CutfDriveway Permit
Etc? ON.MA 01060 212 ain Street Sewer/Septic Availability
? Room 100 waterfwell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
- Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map�� Lot / 1 i.7 Unit
41 Conz Street,
Northampton,MA, 010603 Zone Overlay District
Elm St.District CB District
---7SECTION 2-PROPERTY OWMERSHiP1AUTHORIZED AGENT
2.1 Owner of Record: 164 Crestview Circle,
Gerard Boucher Longmeadow, MA,01106
Name(Print) Current Mailing Address: 413-567-9+9'3- g t
Telephone
Signature
2.2 Authorized Agent:
Christopher Boucher 41 Conz St.,Apt.2,Northampton, MA,01060
Name(print) Current Mailing Address:
2''' 413-335-9263
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(dollars)to be Oficial Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical $500.00 (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
lu
4. Mechanical(HVAC) !
5.Fire Protection
6. Total=(1 +2+3+4+5) $500.00 Check Number
This Section For Official Use Onl
�►—�0 -�� ! bate
Building Permit Number. Issued:
Signature: 4)0
Building ComrnissionerHttspe:for of Buildings Date
heychrisboucher @ yahoo.com
|
}
Section 4. ZONING AIL Information Must Be Compteted. Permit Can Be Denied Due To Incomplete Information
Existin.- Proposed Required by Zoning
This columm to be filled in by
Building Dcpartment
Lot Size 141'
Frontage
Setbacks Front 20'
Rear
Building Hcight
Bldg.Square Footage %
Open Space Footape %
(Lot area minus bldg&paved 7050'
4 of Parking Spaces
/
A. Has Finding ever been issued for/on the site?
��
NO Y���/ DONT KNOW \�� YES
IF YES, date issued:
IF YES: Was the permit recorded atthe Registry ofDeeds?
NO �_�/-� DONTKNOW y=\ YES
�~� 0
IF YES: enter Book Pageand/or Document#'
�� ��
��
B. Does the site contain a brook, body ofwater orwetlands? NU v�� DONT KNOW \~� YES \_�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained \-�/~� Obtained /—� Date '
C. Doany signs exist onthe ppnpert �� ��y7 YES \�� NO ��/
|FYES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
|FYES, describe size, type and Location: `
�
E mflfthe construction activity disturb .grading .or filling)over 1acre mis it part ofecommon plan
that will disturb over Iame? )ES [ > NO ��
�� ��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) 0 Roofing ❑
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks i[] Siding[pj Other[tglj
Brief Description of Proposed I'd like to install an above-ground swimming pool.
Work:
Alteration of existing bedroom Yes x No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing, complete the following:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions The pool I'd like to add is 18' in diameter.
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain.___Yes----No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
1. 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
! Gerard Boucher as Owner of the subject
property
hereby authorize Christopher„Boucher.
to act on ray behalf,in all m/att¢ri relativeAo work
authorized by this building permit application.
Signa ''b caner Date
1, Christopher Boucher as OwnerfAuthonzed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
k0SMPM '& s-�g
Print Name
</6"
Signature ofO
D e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor; 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...... ❑
I
i
City of Northampton
'
Massachusetts � �� s '*.
ff �
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
s_. Northampton, MA 01060 Xh• S a;
AFFIDAVIT
Home Improvement Contractor Lan
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("HIC").
M.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.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Addition of above-ground swimming pool Est.Cost: $500.00
Address of Work: 41 Conz Street,Northampton, MA,01060
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
x Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
_Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IM.PROVEMEN'T 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 RESPONSIBILI ES 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,46—tick I hereby apply fo a b,Ading perr#as the owner of the above property:
Dat caner Name ignature
City of Northampton
6 . . 5
Massachusetts
6
DEPARTN= OF BUILDING INSPECTIONS
212 Main Street a Municipal Building
Northampton, TSA 01060
Debris Disposal Af f idavi'c
In accordance of the previsions of MGL c 40, S54, l 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:
41 Conz St., Northampton, MA
(Please print house number and street name)
Is to be disposed of at:
Since there will be very little debris, all of it will be disposed at the Locust Street Recycling Center.
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
��Zpp� !�
U
Signator of Permit Applicant or Ownq D to
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.
Dear Mr. Hasbrouck, so'
Please forgive the rudimentary 10' Electrical line,
sketch. This drawing is to scale, --- Installed by
-------------------- licensed
though, and it indicates where I'd electrical
place the pool on lot 32C-355. I've contractor
also indicated where the electrical 1s'
line for the filter pump would run,
and I've noted that the pool ladder
would be removed when the pool's
not in use.
18'pool,which will
Please let me know if I can provide have a removeable
ladder that will only
you with additional information or be attached when
answer any questions about this the pool's in use
application.I'm available by email
at heychrisboucher@yahoo.com,
or by phone at 413-335-9263.
Thanks very much for your time.
Sincerely,
Christopher Boucher
N
Lot 32C-355
so'
Conz Street
The Commonwealth of Massachusetts
Department of Industrial Accidents
`t I Congress Street,Suite 100
t
Boston,MA 02114-2017
w�o www mass gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED ArITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lezibh
turtle(Business/Organization/individual.): Christopher Boucher
Address:— 41 Conz Street
City/State/Zip: Northampton,MA,01060 Phone#: 413-335-9263
Are you an employer'Check the appropriate box: 'Type of project(required):
l.❑I am a employer with employees(full amd orpart-time).` 7. F1 New construction
❑I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling
any capacity.ilio workers'comp.insurance required.]
9. F1 Demolition
3.[3I am a homeow-ncr doing all work myself.(.No workers'comp.insurance required.]
10 Q Building addition
4.X�T am a homeowner and will be hiring contractors to conduct all work on my property. Twill
ensure that all contractors either have workers'compensation.insurance or are sole I l.Q Electrical repairs or additions
proprietors with no employees_ 12.❑Plumbing repairs or additions
5.0 1 am a general contactor and i have hired the sub-contractors listed on the attached sheet-
These
repairs sub-contractors have employees and have workers'comp.insurance.
74.MOther Installation of above-
6.r_1 We are a corporation and'ars officers have exercised their right of exemption per MGL c, ground Pfl01
152,v 1(4),and we have no employees.[No workers'comp.insurance required J
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
}Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new arTidnit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-comuactors 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic_#: Expiration Date:
Joh 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 MGL c. 152,§25A is a criminal violation punishable by a f ne 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 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
I do hereby certify under the s and penalties of perjury that the information provided above is true and correct
Signature: Date: 5/6/20
Phone#: 413-335-9263
Oficial use only. Do not write in this area,to be completed by city or town oj*iaL
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
b.Other
Contact Person. Phone#-
RIECEIVED
Christopher Boucher
MAY 2 g 2020 41 Conz St.
Northampton, MA 01060
DEPT.OF BUILDING INSPECTIONS heychrisboucher@yahoo.com
NORTHAMPTON.MA 01060 (413) 33'55-9263
May 29, 2020
Louis Hasbrouck, Building Commissioner
Department Of Building Inspections
212 Main Street
Municipal Building
Northampton, MA 01060
Dear Mr. Hasbrouck,
Thanks for taking the time to speak with me by phone earlier today about my application to
install an above-ground pool at 41 Conz Street in Northampton.As I mentioned when we
spoke, I submitted a building permit application, a drawing, and my electrician's
application for an electrical permit by email on Thursday, May 21.You told me that I didn't
need to submit a printed copy of those documents, but that I should drop off checks for the
electrical permit fee ($55) and the permit fee for the above-ground pool ($40). I've
included both checks here. Please let me know if I can provide you with any additional
documents or information.
Thanks very much for your time.
Sincerely,
C ris Boucher