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15B-051 132 CHESTERFIELD RD BP-2021-1563 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 15B-051 CITY OF NORTHAMPTON Lot: - PERSONS CONTRACTING WITH UNREGISTERED CONTRA(`I ORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Inground Pool BUILDING PERMIT Permit# BP-2021-1563 Project# JS-2021-002593 Est. Cost: $50000.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PEACEFUL POOLS 194683 Lot Size(sq.ft.): Owner: SAUDEL CAROL Zoning: Applicant: PEACEFUL POOLS AT: 132 CHESTERFIELD RD Applicant Address: Phone: Insurance: ISSUED ON:7/1/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INGROUND POOL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: .+ : • r • (LIT FeeType: Date Paid: Amount: Building 7/1/2021 0:00:00 $75.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2021-1563 APPLICANT/CONTACT PERSON PEACEFUL POOLS ADDRESS/PHONE PROPERTY LOCATION 132 CHESTERFIELD RD MAP 15B PARCEL 051 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 194683 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 Managenient Demolition Delay � s i J1 �t 7 ) a 4 Si: ature of Building Official I I Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoni g 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. 10 _~�= ice,. �9 <702 T - Co onwealth of Massachusetts FOR )'''' Hoar: of ilding Regulations and Standards \ �n,,,, Ma ..ch efts State Building Code, 780 CMR MUNICIPALITY � can USE '. n, A IQp Builditxi .P ;ppli htion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 f One-or Two-Family Dwelling This Sec 'on For Official Use Only Building Permit Number: 6 A. "4'I SQ. Date Applied: ., , ;iv, A t 4 ... - _743&__ Building Official(Print Name) Sign ature + ate SECTION 1:SITE INFORMATION 1.1 Property A r ss• 1.2 Assessors Map&Parcel Numbers 1 3cA L� f5fer ie/C,(,k • ism a ‘ I 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP1 1 Owner'o Re o i4 (o rcy fr( ( 1 c J QM firrtrv►np — f-ed S itit.a U t 0 5=.? Name(Flint) 4 City,State,ZIP 13 ( h f iv / . .' rJ lot (17 z 1{r3 CS-and-elol Z 23C� itutl.CO� No.ands treet Telephone Email Address' SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other IRI Specify: xt.4 PCC'i Brief Description of Proposed Work': 'p c Sly 1/ l K 14-c' - 'G/ rco e.g., /1 e tt 7LJ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: 6 ,\� Check No.3g O3Check Amount: Cash Amount: 6.Total Project Cost: $ c0100V 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration[)ate Name of CSL Holder List CSL Type(see below) No.and Street Type Description - U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition / A.2 Re 's r d ome Improvement Contractor(HIC) C cr q6 S? 3 j2 7l 3 Fe.(ecQVc1 d 'J et C (G� � Q�.5 HIC Registration Number Expiration Date '' HIC Company Name or HI Registrant Name ,2,( CU * V 0tslWa Ca wte►e,"Sow-I(oc.0wr 3T.,trer- No. d Street Email address c1 kLe 6 o 0(C,43 if[3 s�-1- t3 q laity/ own,State,ZIP Telephone SECTION 6: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 0 No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACT R APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize f( tcdLE per/ c. cV TA C Gu4 ia.i S+r 7 to act on my behalf,in all matters relative to work authorized by this building permitrapplication. Saw( e ro q Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information c a ed in this application' e and accurate to the best of my knowledge and understanding. /t/z., Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" •AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/28/2021 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT Lea-Rose Fiega NAME: FSC Insurance Agency,Inc. PHONE (413)569-2928 FAX (413)569-2949 (A/C,No,Ext): (A/C,No): 603 College Highway E-MAIL lea@fscinsuranceagency.com ADDRESS: P.O.Box 259 INSURER(S)AFFORDING COVERAGE NAIC# Southwick MA 01077 INSURERA: Harleysville Ins.Co. INSURED INSURER B: Aim Mutual Ins.Co. Peaceful Pools and Spa Inc INSURER C: do Cameron Sours INSURER D: 964 North West St INSURER E: Feeding Hills MA 01030 INSURER F COVERAGES CERTIFICATE NUMBER: CL2151103175 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE /� OCCUR DAMAGE 10 REN t ED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A MPA0000004317BP 04/25/2021 04/25/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,l)00,000 POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED ^ SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ` AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y!N 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A AWC-400-7038073-2021A 05/03/2021 05/03/2022 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 5001000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) POOL SALES,INSTALLATION,SERVICE Installation of an inground pool. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Carolyn Sande)Jennifer Harmon ACCORDANCE WITH THE POLICY PROVISIONS. 132 Chesterfield Rd AUTHORIZED REPRESENTATIVE Leeds MA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ia The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 —'• --` Boston,MA 02114-2017 wwii mass.govldia 11 urkers'Compensation Insurance Affidavit:BuildersiContractorJ Ekctririans/I'Itimbera. U)BE FILED WITH'.HE PERMITTING Al ritIORIT1. Aoalirant Information ` Please Print Legibly Name(Business+Ortanincion lndividurl): jea c 4 .I C,r,1 S�c �.(t( l a t iAQ t<,,V 1 Address: ac col te.3.e fk 5 044-7 City/State/Zip: cc c c. 7Y`O O 3 Phone#:, 'fC3 c-2 Ar'eyew as fir"Cheek theapprepriste : T pe of project(required): am a employer with SI. ca>lrloy.(full sad in part-tango 1.' 7. ❑New construction _ofl I am a sole proprietor or partnership and have no employees wanking for tot in $. ©Remodeling any capacity.[No workers"camp.insurance ntluirisL 9. ❑Demolition 3. 1 am a homeowner doing all work myself[No winters`comp.nnwinane ngdurtil..l" 4.0 I am a homeowner and will be hiring contractors to conduct all s ink on any property. I w ill 1()❑Building addition cosine that all euetGa<tora either have workers'compensation rnsoarnnce or are sole 11.0 Electrical repairs or additions proprietors with nu inriployees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hind the sub-ccaetractors listed on the attached sheet. 130 Roof repairs These subcontractors have et an d d have workers"cairn.insurance.• it �� 6.0 We are a corporation and its officer%have esaseiscd then right of:xemptiun per IA [. MGL r_ 14. Other 152.§1t4).and we have rrao enipknees.[No wooers"carman_norm araee required.) 'Ayny applicant that chocks box t:�I nowt also fall out they w sectiir�f�_below Ave.. their winters'compensation policy information. homeowners who submit this attsalayit indicating they are doing ale weak and then hire outside cant act r%runs submit a new affcdavat naheating such. 'Contractors that check this bras must attached an additiunai share show MI:the name of the sect-eda*actersatd One whether or not those entities love employees_ If the sub-contractors has employees.they must prow&arca winters"Lump.policy atettaer. I ant an employer that is providing winters'compensation insurance for oar employees. Below is the policy and job site information. Insurance Company Name: See rc.C.i € Policy#or Self ins.Lice.U: Expiration Date: — Job Site Address: City/State/Zip: Attach a copy of the workers'cwapea.naI.n pity declaradaa 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 fine up to$1,500.00 iind'or one-year imprisonment,as well as civil penalties in the form ofa 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 at the pole allies efperjury that the information provided abate' and camel Signature: �l Date: b JV / Phone L l c, Official use unit'. Du not write in this area.to be completed by city or town official ' ('ith or Town: Permit/License# Issuing tuthoritt(circle one): I. Board of Health 2.Building Department 3.City/Fawn Clerk 4.Electrical Inspector S.Plumbing Inspei Inc 6.Other Contact Person: Phone#: City of Northampton f?°i'�MP °l 50,.a'— SIC Massachusetts �4t - `'<< �':G ' N. r S DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building v bd c • Northampton, MA 01060 �� ", 1�4 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: S CCl((ere 1 hm, -C /1Icw 0 1'0�J The debris will be transported by: Name of Hauler: PJ %j1cd( S -Dt Signature of Applicant: (),(14( Date: 6 6.6/1/ CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD k liciE et 0)6 ts-p- (��� v pits SIDE YARD q" v Se SIDE YARD S ILOktr (C1 ilq FRONT SETBACK FRONTAGE