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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