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•
TEDDY BEAR POOLS, INC.
41 East O Ur MA Home Improvement Cont. #111889
Chiccopopeee, , M MA 01020 VI R e " CT Home Improvement Cont. #520951
Chicopee,
(413) 594 -2666 �� Fed. I.D. No. 04-2583701
MA/CT: (800) 554 -BEAR O
Fax: (413) 598 -8823 �'
www.teddybearpools.com a
C N tit
TEDDY BEAR POOLSQSpAS
• R #-T 1 ; CO
`� RK COST ESTIMATE
TO: 6 ., a g PHONE: H V, DATE: M / �`, 1 111('''1'4 8
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JOB NAME / LOCATION:
JOB DESCRIPTION: f ,*
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Quick Open Space Calculations Coverages
34 Sylvan Lane Porch existing
Lot area existing proposed Garage existing 0
1 540001 3887 4687 House existing 2567
Accessory existing 120
Open Space 50113 49313 Driveway ; existing 1200
total 3887
Open % 92.8% 91.3%
Zone New Drive new 0'
Req'd ISR-WP-VVSPII
60 %1 pool new 800
Garage new 0
total 4687
ACORDThi CERTIFICATE OF LIABILITY INSURANCE DATE (MM/D T)
PRODUCER Phone: (413)781 Fax 413731 - 9536 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P O BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
WEST SPRINGFIELD MA 01090 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A Arbella Insurance Company
TEDDY BEAR POOLS, INC INSURER B:
41 EAST ST - INSURER C:
CHICOPEE MA 01020
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONOTTION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NSR ADO: TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS
LTR WSRC DATE IMM DO/Yr DATE (KMIDDAM
GENERAL LIABILITY 8500036498 04/01/09 04/01/10 EACH OCCURRENCE 9 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE 7oREH71 D 3 100,000
PR av
PREMISES (Ea eNnce
CLAIMS MADE I-1 OCCUR MED. EXP (My one person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE 3 2,000,000
GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS - COMP /OP AGG. S 2,000,000
7 POLICY n LOC
AUTOMOBILE LIABILITY 32176400003 07/01/08 07/01/09 COMBINED SINGLE LIMIT 3 1,000,000
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
(Per person) S
X SCHEDULED AUTOS
A X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE 3
(Per accident)
GARAGE UABIU TY AUTO ONLY - EA ACCIDENT ,S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY: AGG S
EXCESS! UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE I 3
RETENTION$ t
WORKERS COMPENSATION AND 9104140407 04/01 /09 04/01/10 X TTOORY OTHER
EMPLOYERS' LABILITY
EL EACH ACCIDENT S 500,000
A ANY PROP(DETORIPARTI,ERIEXLWTNE 500,000
EXCLUDED? E.L DISEASE -EA EMPLOYEE S
NAL daaa1M Laded
Seem'. PROVISIONS D.I.w E.L DISEASE-POUCY LIMIT 3 500,000
OTHER:
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO WHOM IT MAY CONCERN TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,
ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Attendon: _ 4rfitirm fu '
ACORD 25 (2001 /08) Certificate S 41052 ® ACORD CORPORATION 1988
Teddy Bear Pools, Inc. Known By Our Reputation
41 East Street r (413) 594 -2666 • 1- 800 - 554 -BEAR
Chicopee, MA 01020 -3562 • NIP . FAX (413) 598 -8823
Home Improvement Cont. MA #11889/CT #520951 www.teddybearpools.com
P &SPAS TEDDYIEAR
,.. tik ' ,, - , A I, , 4 ' 1 4
'P = .�t - f Boar. o : ui • Ing ' egul ions an • tan • ards
a 11—
tE One Ashburton Place - Room 1301
==
.. Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 111889
Type: Private Corporation
Expiration: 2/8/2011 Tr# 279922
TEDDY BEAR POOLS & SPAS INC
THEODORE HEBERT
41 EAST ST
CHICOPEE, MA 01020
Update Address and return card. Mark reason for change.
_, Address _ Renewal Employment Lost Card
DPS -CA1 0 50M -07/07- PC8490
t
r"- " 11'11` Z-P Z-� 1A11%. w
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L !i �fr lit '11. +��
— — !, - " — �-� fi `+ a'
STATE OF C • DE OF CONSUMER PROTECTION !
1
- ! B e i kn that � _'� + ;I:-
. - _'
TEDDY BEAR POOLS INC_
41 FAST ST
,y t-
CHICOPEE, A 01020
1
is certified by the Departm 6,C444striaer E4tection as a registered . -?
zip -
HOME IMPROVE N' ,CONTRACTOR �-
_
Re 1 : .
J
a; 1 TEDDY BEAR POOLS INC ` �"rR `�� 7 -
Effective: l2 /01/2008 ,
• • 1 . : Expiration: 11 /30/2009 I ,
,. x, i
t • + , i . Jerry Farrell, Jr., Commissioner '
L , - f. .... g' 41 ••■• 4, Ii . 1. 4 ' I, 41 ' III. q . I 0 ' 0. ir ',1 4 * 0 4 . 1.• 4 4f 4 ' 1.• 4 i ' I. 4 ''• 4 .. 11' ••■ 41/ - 1.• 4 -
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS
THE MASSACHUSETTS STATE BUILDING CODE
. SECTION 4 - WORKERS' <:COMPENSATIOM INSURANCE AFPSDAZ7IT..(M G.L c. 252.' § 25C(6)); I
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 0
SECTION 5 DESCRIPTION OF PROPOSED WORS'(Check a1I appllicabie) I
New Construction o Existing Building ❑ Repair(s) ❑ I Alteration(s) ❑ 1 Addition o
Accessory Bldg. o Demolition o Other o Specify:
Brief Description of Proposed Work:
0 X VO //1 1 u1 j � 0
SECTION 6 ESTIMATED? CONSTRUCTION COSTS ,1
Item Estimated Cost (Dollars) to be Official TTse Only
completed by permit applicant
1. Building (a� B 1` n _ i - l ' dtrrg PenzrttFee . t
2. Electrical .Estimat+ocl TotaiC.OS Of
::Construetlon.frour (6)
3. Plumbing
4. Mechanical (HVAC) BniLdiag Pemii Fee:
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) check Number
3SECTIONla OWNERAITT$ORIZ&TION :T08ECO111PLE ED w nr4:.
OWMER SAGENT:OR.CONTRACTOR.APPLIES FOR:. BVIIDINGPERMTT` :i
I 1 _ -41 . as Owner of the subject property
hereby au . rize 'C- a ,:6' Ro O SP4" S to act on
my be all rr k authorized by this bullring permit applicatio
�. .—�►�- . / 7 !'? 7a7
Sign li of • • Date
SECTION 7b OWNER /AUTHORIZED AGENT DECLARATION
I. %awry &ar )►is SP4 • as Owner /Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate. to the best of my
knowledge and belief.
Sign - de the pains and penalties of perjury.
AV„ '< / . 11 (Y•
Print llffirmi y 3 4
Signature •( • - / _ - t _ Date
•
672 780 CMR - Sixth Edition 2/7/97 (Effective 2/28/97)
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS
APPENDIX B
The Commonwealth of Massachusetts
,, tr . , State Board of Building Regulations and
Standards FOR MUNICIPALITY USE
' Massachusetts State Building Code
780 CMR .
APPLICATION TO CONSTRUCT. REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
,: This. Section ForOffcial:Use`Onlyi .
Bu lding Permit Nwnber . :Data Issiu i
$4idtn& /fnspectorofBuildings _ :... Dat ;:
SECTION 1 SITETNFORMATtON
1.1 Property Addre 1.2 Assessors Map & Parcel Number.
3 `f 5-11 s fl- - wr.._ WSPIL
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
1 - LA 5
Zoning District Proposed Use Lot Area (st) Frontage (ft)
1.6 Building Setbacks (ft)
Front Yard Side Yards Rear Yard St e
Required Provided Required Provided Required Provided h
i S 15'0 10 / 10 Its /1 1 5b R ;
1.7 Water Supply Supply (M.G.L. c. 40. § 54) 1.5 Flood Zone Information: 1.8 Sewage Disposal System: (x
Public Private ❑ Zone: Outside Flood Zone c Municipal ❑ On site disposal system
SECTION 2 PROPERTY OWNERSHIPIAAUTHORIZED AGENT."
2.1 Owner of Record:
S8y - 7mi
gr 11 E Pe-ki"�r, 3 4 5 'v l u r, 1.-ti h c
Name (Print) Address for Service:
Signature Telephone
2.2 Authorized Agent:
Name (Print) Address for Service:
Signature Telephone
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3.1 Licensed Construction Supervisor: 1i Not Applicable ❑
Licensed Construction Supervisor. License Number
Address Expiration Date
Signature Telephone
3.2 Hom oven t tractor. Not Applicable ❑
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2/7/97 (Effective 2/28/97) 780 CMR - Sixth Edition �/� ` 671
•
File # BP- 2010 -0033
APPLICANT /CONTACT PERSON TEDDY BEAR POOLS & SPA
ADDRESS/PHONE 41 EAST ST CHICOPEE (413) 594 -2666 Q
PROPERTY LOCATION 34 SYLVAN LN
MAP 35 PARCEL 286 001 ZONE SR(100) //WP /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
F''e Paid
(Atli dins Permit Filled out
ePaid "' ; " •1110:
Typeof Construction: Inground Pool
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
T F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
A pproved 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
11"-. /.
Signature of Building Official 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.
y �r.
BP- 2010 -0033
GIS #: COMMONWEALTH OF MASSACHUSETTS
Mai r _
t shi CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0033
Project # JS- 2010 - 000044
Est. Cost: $7400.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TEDDY BEAR POOLS & SPA
Lot Size(sq. ft.): 52576.92 Owner: PETERSON BILL E & LAUREN E DUNCAN
Zoning: SR(100) //WP/WSP II Applicant: TEDDY BEAR POOLS & SPA
AT: 34 SYLVAN LN
Applicant Address: Phone: Insurance:
41 EAST ST (413) 594 -2666 ()
CHICOPEEMA01020 ISSUED ON :7/9/2009 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:
FeeType: Date Paid: Amount:
Building 7/9/2009 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo