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29-614 (2) 55 STONE RIDGE DR BP-2022-0043 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-614 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 PERMIT Permit# BP-2022-0043 Project# JS-2022-000070 Est. Cost: $13055.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: 21ST CENTURY POOLS & SPAS 116579 Lot Size(sq.ft.): 83765.88 Owner: KROSCOZKA JARRETT J Zoning: Applicant: 21ST CENTURY POOLS & SPAS AT: 55 STONE RIDGE DR Applicant Address: Phone: Insurance: 1801 MEMORIAL DR (413) 532-0100 CH ICOPEEMA01020 ISSUED ON:7/1 5/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:SEMI 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 signatu • , r ., .)2 . 5 FeeType: Date Paid: Amount: Building 7/15/2021 0:00:00 $75.00 212 Main Street, Phone(413)587-1240,Fax: (413)587 11272 Louis Hasbrouck—Building Commissioner I z—OR File#BP-2022-0043 APPLICANT/CONTACT PERSON 21ST CENTURY POOLS&SPAS • ADDRESS/PHONE 1801 MEMORIAL DR CHICOPEE (413)532-0100 PROPERTY LOCATION 55 STONE RIDGE DR MAP 29 PARCEL 614 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E L SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ' 416 Fee Paid , $ Typeof Construction:_ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 116579 3 sets of Plans/Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ORMATION PRESENTED: j 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 1 I Q NV/ _ Via-PI Si,:,ature of Building Official le, 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 of MGL 40A.Contact Office of Planning&Development for more-information. Jo The Commonwealth of Ma acs .- ,� Board of Building Regulations an • ��, FOR .t.': Massachusetts State Building Code,,78 o GIPALITY iv USE •Building Permit Application To Construct,Repair,Renovate a Revised Mar 2011 One-or Two-Family Dwelling so s This Section For Official Use Only '-', Building Permit Number: Date Applied: •` Building Official(Print Name). Signature Date SECTION 1:SITE INFORMATION 1.1 PropertyAddress: 1.2 Assessors Map&Parcel Num hers 65 SQL ; � - '-a- 1.la 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 Own of cord: �� Sac zCCc,s_. 5S V‘.. Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other l Sped • ,, PO Brief Description of Proposed Work'-: D CI (k c .SL GN- •edk• 'iea vt j SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building 1. Building Permit Fee: $. . Indicate how fee is determined: 2.Electrical $ ❑ Standard. City/Town Application Fee Total Project Cost'('Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (IIVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fe 0 L�ld Check No. � Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration.Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft,) R. Restricted 1&2 Family Dwelling City/Town,State,ZIP IVI. Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2`Registered;Home Imp ovem pit•Co e r a (HI " C \-C ' HIC Registration Number Expiration Date RIC Company Name or HIC RegistrantNa ,N .and Street Email.address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 lss apce of the building permit. Signed Affidavit Attached? Yes El No::.........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7Ir:OWNE;':'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(;Electronic Signature) Date NOTES: 1. An Owner who obtains abuilding permit to do his/her own work;or an owner who hires an unregistered contractor ' (not registered in the Home Improvement Contractor(HIC)Program),op not have access to the arbitration program or guaranty fund under M.G.L.c.I42A.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.govidps 2. When substantial work is planned;provide the information below: Total floor arca(sq.ft.) (including garage,finished basementlatties,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 he substituted for"Total Project Cost" ,, City of Northampton f fi sf y � ti� Massachusetts J,��2s! w,. ��,c�� ... -.) ., �,i11 ; r DEPARTMENT OF BUILDING INSPECTIONS n "r 212 Main Street • Municipal Building 0, "b, \ Northampton, MA 01060 J. ,- �1�1^�' 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: ----a Location of Facility: 1 :GA•G t\N- L Q 4P' -Q-1 - The debris will be transported by: S� 1 ?5 �\ 52_ Sc-x-- Name of Hauler: D. .��; S Signature of Applicant:` �, Date: - —"` CITY OF NORTHAMPTON SETBACK PLAN MAP DA LOT: 62\'I LOT SIZE: REAR LOT DIMENSION: REAR YARD 1 /6° r SIDE YARD 6"r---CP SIDE YARD 1/ 4d- ivS-e_ /1-0(6-€__ � -I FRONT SETBACK 10V"/-I4 FRONTAGE b_ ` The Conunotrttteult/t of:$lassuclruseus �, 'K De'partrnenl of llydustrial.4(villeins 1 Congress Street,Suite 100 ii:i 't* l Boston, MAt??ll�t-201 � ' ' t►rifi►t:mnsc.goItidirt wtt, 1Vatke s'Compensation Insurance Affidavit:Builders'C:untractor!ElectricianstPluuthers. 1T BE FCt.EI)11"I`t"Ii"t'III.PER5NIrrt!NG ALrrFIC)121'l"l'. Applicant Information `�% (��/�A �V�y ` Please Print Legit& Name.(13u,in or aniratIt n Iu li�•i:lual}� C"� _\tea U\�.I25:, �"�1 _ —_ ., . ddr :SS: V ` ` `✓C \V — City,1stateiZip C9p.:§ . �__' 6_t( �(.1 Piton �'11-^ .] 3D--C k G 0 Are,;rou an employer?Check dhca print II!r[In cINA ` 'Type ofpri ject(required): 1_ 1 to a:ntl+lt';'u with_.)5 cinpluyce>(full nsndforpari-tine I.' ]. 0 Nev construction 2.01 ant a suite proprietor or 1x.i.irrc-rs$ti1:anti have no snnptoyces'w'ruking.for tisi.,in a i3. Reir'rctcl5rti, any czpacny INu m'orkeri comp ii uru t.x.required.] 9. Q Deinolition 30 1 ant a hutncov-rszr'doing all node s v s„It:l,''°H'urketa'curs:itsaasr..m 1.r•.luite:l.)r 10 0 Building addition .2.0 I in a Ietut, wnerard'tcili ty.Ftitutg Gantt utu:>to conduct.nil work on my l rurei't':. 1 gilt i:r'.3ure.that sll ccsntractorn eit yr ko a uilrici ec-rnle.ustnou itburanee or are-ole 110 Electrical repairs or additions. ruuplieroM with no cmployet . ,,', 1_, 1 lutnb nru repairs or additions SO I nor:a utteral contractor.tnd I have hard ttr ub-Gantt to om holed on tl attached.tatcet_ 1 30 Roof rein irs l.seu 503-. unir turn hste ei tpl,nw,. ails e.t airkt. + comp.nt,uranee _ rr.CJ we am a corporlitsun and sis utticetx kite:exCo.-n:e l then right P.t e.:.t.tt..pnon p:t h.tit'r c:, % ' `�`•=Q-""C=. ....... '`''"'=. I`2 'It;:h and we ltavir no e:rslrloM'tez:.!NO Win kaS.comp_insi ante te^dt.ritcdj "Any tspptii i t lira-checks boX tit ratn4.altn till Can ithe cicina belcr stioti.inktheir C..'CJI :a,'oo:p i:matic n poli...'y ntfitn na*, . f .. F{i�sticew:+�s3ets�v6[r subtnti dux affidavit is::itc•ti:ng[hc4''art:disirsg a:t wink;fail tlr:n tttrr u+stule etxrst:ec•tvra tong,sdbtntt a new"ati;:law tt itxlknting uc:ii. Cormactsars that,cdstrek hi':b 'x must at. :t:S Art s klitiurta15ltcct shot;ing the mote of tlii.s:nirconera•_lrsr;and state whether thew or not the ne-nts`tles luii ysiple0:ci 11'tlx asrb•ciantrt;r tOra I>a c employeaz4.tltcy]alas pro,ilk heir won:it !t rusp.Folivynumbir, I am an employer r thin is providing workers'compensation insurance for nzy employees. Beloit'is the policy and job site itifrrmttliun. Insurance Company Nance:\'•&_ \.h..A sksc .S _ Polity•;_or Self-ins.Lie,fir`:V \LAD 4 56'3 2.3 61 0 Expiration Date: i. \ 4 _ Job Site.Address:./S S -� •^v i&cet..— CDC CityiStzttJJL_ip\ 1(\A--¢"-- Attach a ropy of the workers'compesisation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MMOL i:. 152, §25A is a i..riunutal violation punishable by a fine up to$1,500I_0() and/or one-rear imprisorinle1It,as well as civil penalties in the form ofa STOP WORK ORDER,and a lisle of up to S250,00 a thy against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance nce eoverat.Ie verification. I do hereby c t'under the pains and,enables c 't jury that the information provided abate is true and correct. Sienature: Date': 2 / I Phone 4: tit I J. _ . 5 3) V/o.0 Official use duly. Do not write in this area,to be completed In city.or town r ficial City or 1'own: . Permit/License A 1 Issuing Authority(circle one): . I.Board of llealtlt 2. Building Department 3.C:ity/1'4mo Clerk 4.Electrical Inspector S. Mouthing Inspector 6,Other Contact Person #:_ 'Phone- _ A CERTIFICATE OF LIABILITY INSURANCE DATE 7/12/2021rr� 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 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 CONNAME CT Mary Beth Russell The Dowd Agencies, LLC PHONE FAX 14 Bobala Road (A/C.No.Exfl:413-437-1050 (A/C,No):413-437-1450 Holyoke MA 01040 ADMDRESS: mrussell@dowd.com PRODUCER CUSTOMER ID#: 21 STCEN-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Arbella Indemnity Insurance Company 10017 21st Century Solar Pools, Inc.Brian Sullivan 1801 Memorial Dr INSURER B:Massachusetts Retail Merchants Workers' Chicopee MA 01020 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:647842418 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. INSRCY EXP L TYPE OF INSURANCE j R IADDL SWVD POLICY NUMBER (MM/UBR DD/YYYY) (MM/DD//YYYY) LIMITS A GENERAL LIABILITY 8500068379 *4/1/2021 4/1/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PR T l RENTED PREMISES M E (Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY j GT n LOC $ A AUTOMOBILE LIABILITY 1020071994 4/1/2021 4/1/2022 COMBINED SINGLE LIMIT $1,000,OOD (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ B WORKERS COMPENSATION 014005032389120 1/1/2021 1/1/2022 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Granby MA 215 W State St AUTHORIZED REPRESENTATIVE Granby MA 01033 • ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 21st Century Pools & Spas Sales Order 1801 Memorial Drive Chicopee, MA 01020 Salesperson 1: DJ Phone: 413-532-0100 Fax: 413-532-1009 Email: brian@21stpools.com Sales Type: Asc Pool Install Web: 21 stpools.com Revenue Center: Pool sales Created: 6/18/2021 9:38:48 AM Completed: 7/12/2021 11:02:45 AM Customer Id: 3558 Invoice 3300 Register: SalesOffice *1"1(14)==0* *nnn ),)nn* JARRETT KROSOCZKA C: (617) 230-4198 55 STONE RIDGE DR Email: jarrett@studiojjk.com FLORENCE, MA 01062 Qty Part Number Description Price Amount 1 28ULTIMATE 28 R ULTIMATE POOL KIT 8,908.65 8,908.65 I have been advised and am fully aware that diving or jumping into the swimming pool is dangerous and can result in serious injury and I will warn those using the swimming pool of this danger. 1 28RINST 28 ROUND ABOVE GROUND INSTALL 1,900.00 1,900.00 1 PNCC01000E1160 100 SF CLEAN CLEAR CARTR W/ 1 HP OPTIFLu 703.33 703.33 PUM 1 C710OX EVO AFRAME LADDER WITH BARRIER48-54IN 256.24 256.24 POOLSGRAYCON 1 MAINTENANCE KIT MAINTENANCE KIT 66.33 66.33 1 JED171B PREMIUM VINYL LINER VAC BULK 1 25291 JUMBO THERMOMETER 1 JED5056016 PRO 8FT-16FT TEL POLE 1 JED364 SKIMMER HEAD HEAVY DUTY PLASTIC FRAM= 1 145145 STANDARD LEAF RAKE ALUMINUM 1 23060610 ALGAE ALL 60 1 QT 1 22947B10 SMART SHOCK 1 LB 1 22947B10 SMART SHOCK 1LB 1 25918610 DELUXE VAC HOSE 1-1/2IN 30FT 3 0.00 .00 1 JOB/LABOR JOB/LABOR * 600.00 600.00 charge for mini excavator to remove rock and stump * Non-Taxable Items Sub Total $12,434.55 State Tax $620.91 City/County Tax $0.00 Total $13,055.46 Amount Paid $2,611.00 Balance $10,444.46 Payments Type Approval Code Id Numbers Amount Date of Trans Type Reference# Date Received Employee Name Visa 02505d $2,611.00 6/18/2021 P 33 6/18/2021 Dominic Santos Invoice: 3300 JARRETT KROSOCZKA Monday,July 12,2021 Page 1 of 2 AGREEMENT OF SALE: All items are covered under a manufacturer's warranty.These are the only warranties that apply.Homeowner is responsible for the location of pool and must secure any necessary permits. All changes to a pool package must be made before 4pm the day prior to installation. A 20%deposit is required for any in-stock pools.The balance must be paid off 10 days prior to pick up,delivery or installation if paying with a personal check. We must allow proper time for a personal check to clear. Payment must be made 3 days prior if paying with a credit card,cashier's check or cash so we have ample time to prepare for installation,delivery or pick up.In the event of a cancellation a 5%restocking fee will apply. In the event of a cancellation by the homeowner,after the on-site inspection was completed,a fee of$85.00 will be non-refundable to cover the cost of the on-site inspection,and a 5%of merchandise restocking fee will apply. If an on-site inspection appointment,or on-site orientation/skimmer cut appointment or an excavation appointment is missed by the homeowner at no fault of:There will be an additional charge of$85.00 for a new appointment and a possible delay of the installation. EXCAVATION includes 12 inches of digging to level ground.Any additional digging to level ground will be charged according to the individual job and will be quoted by the inspector at the on-site inspection. Installers do not haul dirt away or do landscaping. Installation does not include: Water-Wiring-Back Filling Approximate Installation Date is weather Permitting Important: Please Note 1.Pool must be installed on solid level surface per factory instructions. 2.Water fill or water loss responsibility of homeowner. 3.Check your town or borough ordinances regarding obtaining a permit 4.Filter and pool should be properly grounded. 5.Read filter manual for safe operation. 6.Correct chemical content is important for health and proper filter operation. 7.WARNING-DO NOT DIVE IN POOLS LESS THAN 8 FEET DEEP-HORSEPLAY,RUNNING IS DANGEROUS 8.When your pool is not in use,remove ladder. 9.All chemicals must be handled in accordance with manufacturer's instructions. • • Invoice: 3300 JARRETT KROSOCZKA Monday,July 12,2021 Page 2 of 2