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24D-091 (11) 76 NORTH ST BP-2022-0160 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-091 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-2022-0160 Protect# JS-2022-000282 Est.Cost: $9617.65 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: 21ST CENTURY POOLS & SPAS 116579 Lot Size(so. ft.): 8145.72 Owner: PAR SHALL TIMOTHY&PAUL MATYLAS Zoning:URC(100)/ Applicant: 21ST CENTURY POOLS & SPAS AT: 76 NORTH ST Applicant Address: Phone: Insurance: 1801 MEMORIAL DR (413) 532-0100 WC CHICOPEEMA01020 ISSUED ON:8/12/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 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. e ' A • z Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 8/12/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner • The Commonwealth of Massachusetts rt ! Board of Building Regulations and Standards FOR i ' -' Massachusetts State Building Code, 780 CMR MUNICIPALITY I USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 1c. One-or Two-Family Dwelling IL This Section For Official Use Only Building P_ertalNumb 3 —2.4)22 ft(00 Date Applied: 03(2(20L &WIN)a3 ; 8- 12-20zt Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers '1C� !Jack S 2t17—nq 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning In ormation: 1.4 Property Dimensions: URcLtov Zoning District Proposed Use Lot Area(sq 11) Frontage(I1) 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 if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: 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 Specify: \(g' Brief Description of Proposed Work': k( ` G'c ,..A . , SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ I. 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 (IIVAC) $ List: 5. Mechanical (Fire i No Suppression) $ Total All Fees: $ u Check No?15r(1 Check Amount:4 O,— Cash Amount: 6.Total Project Cost: $O1r „`1. (S ❑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 M Masonry RC , _ Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2Registered( Ho a Improvgment Contract IC� 0 27 ZOZZ O `S fIIC Registration Number Expiry ion Date Company ame or HIC gistrant liame 1 n at S‘ToO`S Q-c)4t - ot.andttreet � Lj j —a tos0 Email address City/Town, tate,ZIPY\A 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 ®' No ❑ 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 7b:OWNER1 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 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 I-IIC 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" A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/12/2021 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 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 The Dowd Agencies, LLC PHONE Mary Beth Russell FAX 14 Bobala Road (Atc.No.ExtI:413-437-1050 (A/C,No):413-437-1450 Holyoke MA 01040 EADOReSS: mrussell@dowd.com PRODUCER 21STCEN-01 CUSTOMER ID#: 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:522359896 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 INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) UMITS A GENERAL LIABILITY 8500068379 4/1/2021 4/1/2022 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY C JECT LOC $ A AUTOMOBILE UABILITY 1020071994 4/1/2021 4/1/2022 COMBINED SINGLE LIMIT $1,000,000 (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 LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ B WORKERS COMPENSATION 014005032389120 1/1/2021 1/1/2022 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (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 I 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. City of Northampton Building Dept. 212 Main Street, STE 100 AUTHORIZED REPRESENTATIVE Northampton MA 01060 \ �[ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD City of Northampton ‹',, Massachusetts A ° i ,jSk DEPARTI�NT OF BUILDING INSPECTIONS b 40 # •, . 212 Main Street • Municipal Building / Or Northampton, MA 01060 '/4 4. ' HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day, year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of ,20 . (Signature) 8/11/2021 76 North St-Google Maps Google maps 76 North St i z •7eNO Nonh SI,Nhan�pron,MA 01060 - C I I' BSI la° k . i 1 ,I ae`Ft I! N9" IGoogle Map data©2021 20 ft► I A Iii on e E2 _ °"`^i" n n w 76 North St Building O Q to- CO Directions Save Nearby Send to your Share phone 0 76 North St, Northampton, MA 01060 Photos https://www.google.com/maps/place/76+North+St,+Northampton,+MA+01060/@42.3257536,-72.6314832,21 z/data=!4m5!3m4!1 s0x89e6d7391 f3a5a9... 1/2 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: Li REAR YARD , SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts ,c y DEPARTMENT OF BUILDING INSPECTIONS �. - » 212 Main Street • Municipal Building �, ,` --7•� Northampton, MA 01060 ``4v i .'\�" 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: ViCA 'C\SL C‘e9,,` & '� CV1% tCsnS2Q orkG,- The debris will be transported by: Name of Hauler: DN\ \'' C9-NA, 3`_S Q^-.3 Signature of Applicant: Date: Er-- \ - - t ----- The Commonwealth of.ilassachusetts "61.41- . vra:44uks_ c ' , .„ 's.:....L.....- ..4.. Department of Industrial Accidents 1 Congress Street,Suite' 100 Boston, MA 02114-2017 ---,,..-;..:. •- www.maNS.gor/dia 4»kers'( ompensation Insurance.1flidits it: BuilderylContrai tors I lectricians/Plumhers. 11 i HE 11111)11111i I Ili.NAIAD I I 1St; St 1114 itt111. .1oolicant Information Please Print Lettilds ..-t..,, Name 4 atpor.,:-.•:,,..,.„.,..,11 ,:. I.,: ,,,,,,,, D.‘ .\-- C.9.....,--\\Q-0...., N-c.:z\s -.9- - Address: VSCA NI--VNISC% OA ----,. N ' , City:State ti p cz,9.16L, (-...c....... C.:)\0')13 Phone '-'- ..‘\ 6`- D- G‘oc, ' Art"ma 1111 rutplms r!4 Ms k the A pplurtalt•hut: I,pi:of project i required i 11:1trani a employ:a'with 1 emplo.sces t Wit 4;1•! •t.t•' : .' i 7 1 \e COTV.I1UL:0011 ,.„.. .....D I 4111 A Wit plOctUtrttOr 1.*r palintrAhap and hats no cult-, .,.. -. ,, .,. - I me Its 8. a Remodeling .1112.4...4.84:11) /NO At orkers'...4.,rop.nniouney rs-quit:; 9. fp Demolition IF]i Jrn 4 horneoWnel doing all work myself.INo Noti.,..1, ,ttrtait trrwrinet....:!....;into&i I 0 3 Building addition 4.0 t ant a Ito:meow twr and will be hying contractors to conduct att work on!: :••!;:...t ti. 1 ..!I. ..-rbutv ilia aft tontr4aors*Athol basm.workers'compensation tiburun.o...: i. I I 0 Eleetneal repairs or additions N.:Tn.:Joh..r.Oh no employes% 12.E)Plurnbing repa::• ,q Aditions in I ant a gensnal euntractot anti I hessc harsi the soh,:ontractors Wee or its:,t•.n_ ,,I sins 1 i 3[3 Root repairs I lie.:suisseontrutors tuna etriplotesss And workers'comp onwannec, 14.EaOthet WIZICNJI..6-4 Q3CA 4s L]VCc arc a corporation and its ofttects ha sc etc-tenet!then right ot excropinv.is.t Vita,t. 152.l.+14 4 i.and nt limy no employees.l ISM workers'comp insurance rettuired I l 'At appitcard that chn.its hot.A t must also fill out the stenots below showing then workers.'compensation pot:c."!,tittormation .%:.nets who-,J-inti dux daridad tstehcatuit the!,atc&sing ail work and awn hire outside contractors must submit a nest affklas it usd.cci,r.: Mai ch.. , -ns hot moo anaelsint an a:1:11tIonal hes howing the rustic of the sutserntractors and state*a hether or not 64.1%7 otl.stic..haws; . :!. .. !' : . .• ,:.!. . - : . -!..!.,.... '..,.tro.'rt:,...u.kitrcir wolk::-. ..-,:ni, rot's:::T.unifs.1 /am an t'Inp101 CI-litla t‘prOVillint:Is'errher‘.c ompensation insurance fOr my employees. Below is the policy and job site intornailirai .-- ,.., .. lasL.7,.ah., , • ;1:1'..:.'. '', ,;1 .„.....,.... . ,s, ..,. c\s,.._‘ _ Pulley z or Seit-III i ::. 0 --I q6c) ()_r-Sc) 3geo DOD— ..sptration Dan:_ Job Site Address --1(-9 1( :)eteer‘C . Ntxk-VoArvk-ey,_,_ ,..it, ,tatc zip. WO' G t 6 Ca() Attach a cum of the workers'compensation milk% declaration page(showing the polic, number And espiration data t.aiture to secure coverage as required under Nil,I L i•-••1. ,.2 is A J.-a crunittal s tolanon punishable b,s a fine tip to S1.5140 no and.or one-year imprisonment.as ss ell as cis il penalties in ills t.,:!1 t of a STOP WORK ORDER and a tine of up to S:250.4LK)a das against the sittkttor A cops of this statement Ina) be forwarded to the Office of Ins estigat ions of the DIA for twarratwe cos crags' '.4.:iiti,:ation. I do hereby certilv under the pains and pettalti.• eriury I the inlormation provided above is true and correct. **.11:11.outc- e-----') Date'. Phonc :: tAl 3 `3 a c)\ co 1 Official use onlc. Do nor write in this area,to he completed by city or town official ('its or I own: Permit/license a Issuing.‘uthorit (circle onei: I. Board of Health 2. Building Department 3.Citylown Clerk 4. Electrical Inspector 5. Plumbiou lo.pct tor 6.Other Contact Person: Phone#: 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: ABG Pool Install Web: 21 stpools.com Revenue Center: Pool sales Created: 3/19/2021 11:33:42 AM Completed: 3/19/2021 1:26:08 PM Customer Id: 7390 Invoice 476 Register: SalesOffice � n7-3nn* *nnnnA tea* TIM PARSHALL H: (413) 588-8712 76 NORTH ST Email: timparshall@yahoo.com NORTHAMPTON, MA 01060 Qty Part Number Descriptio Price Amount 1 16METRIC 16 ROUND METRIC KIT 6,843.33 6,843.33 1 MISC MISC 850.00 850.00 16 R Metric above ground install 1 SRCF2019DE1260 191N CRISTALFLO II SAND W/ 1 HP DYNAMO 560.26 560.26 PUMP FILT 1 K-PM16-2-G 16FT ROUND COPING KIT 557.78 557.78 upgrade liner and coping 1 145164 A-FRAME LADDER MODEL 400200 224.21 224.21 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 FRAMt 1 145145 STANDARD LEAF RAKE ALUMINUM 1 23060610 ALGAE ALL 60 1QT 1 22947B10 SMART SHOCK 1 LB 1 22947B10 SMART SHOCK 1 LB * Non-Taxable Items Sub Total $9,101.91 State Tax $515.74 City/County Tax $0.00 Total $9,617.65 Amount Paid $1,368.66 Balance $8,248.99 Payments Type Approval Code Id Numbers Amount Date of Trans Type Reference# Date Received Employee Name Visa 00144C $1,368.66 3/19/2021 P 107817074986 3/19/2021 Dominic Santos Special Comments: This Quote was created on 3/11/2021 4:25:15 PM Pool not expected in until August AGREEMENT OF SALE: Invoice:476 TIM PARSHALL Friday,March 19,2021 Page 1 of 2