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29-075 ` Teddy Bear pools, Inc. Known By Our Reputation 41 East Street 1 (413) 594-2666 - 1-800-554-BEAR Chicopee, MA 01020-3562 ��� FAX (413) 598-8823 Home Improvement Cont.MA#11889/CT#520951 AID www.teddybearpools.com r Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 111889 Type: Private Corporation Expiration: 2/8 12009 Tr# 126084 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST CHICOPEE, MA 01020 Update Address and return card.Mark reason for change. OPS-CAI u 5OM-04;05-PC8698 7-1 Address i Renewal 7 Employment Lost Card i STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it known that i i TEDDY BEAR POOLS INC 41 EAST ST CHZCOO= E'T _U1020 i is certified by the Depart ue$t x€Coastfn ei Protection as a registered HOME IMPRO -Nt CONTRACTOR # 20951 i TEDDY BEAR POOLS INC IEffective: 12/01/2007 Expiration: 11/30/2008 i Jerry Firma,jr,commiacioner s A CORD ' , DATE(MWDDIM—n TM. CERTIFICATE OF LIABILITY INSURANCE I 03127/2008 PRODUCER Phone: (411 3)781-241C Fax 413-7311-9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR WEST SPRINGFIELD MA 01090-1175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I NAIC# INSURED INSURER A. Arbella Insurance Company I TEDDY BEAR POOLS,INC INSURER B: 41 EAST ST CHICOPEE MA 01020 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'N-R ADD'4 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR�INSRq I DATE MMrDD DATE MM/DD LIMIT$ GENERAL LIABILITY 8500036498 04101/08 04/01/09 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea ocaurence) $ 100,000 CLAIMS MADE F v-1 OCCUR MED.EXP(Any one person) - $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG. $ 2,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY 32176400003 07101/08 07101/09 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ P .ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 71 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ Is WC STATI WORKERS COMPENSATION AND 9104140407 04/01108 04/01/09 X TORY LIMITS OTHER EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 9 yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ $00,000 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 2D 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 / Attention: V#Miam 0.Trull'e4, l ACORD 25(2001/08) Certificate# 34065 ©ACORD CORPORATION 1988 ate' lot VIP M 9 } a C I ,� V . � HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNM 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour) a rough building inspection (before work is concealed) insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper perrr,its in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, Q a� J,a-!:!, J understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date t'/— .:�? C?— O c " Address of work location %th a� se Cofnmonwe, � ctts Department of�ndrestrial_�ecidents of h:vestig anions 600 RT ashin-ron Srreet — _ Boston, 414 02111 Ylww.in ass.oov1d a Workers' Compensation Insurance -Affidavit: Builders/Contractors/Electricians/Plumbers A,colicant Information Please Print Leaibl, N3n1e iBus,,n ess/Organizatiorr<'Individual): P 4 Address: City'Statz,"Zip: Phone rr: Are you an employer' Check the appropriate box: Type of project(required): 4. W I am a general contractor and I ❑New construction 1.❑ I am a employer with 6 � employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have. S. ❑ Demolition working for me in an capacity. employees and have workers' g addition Y 9. ❑Building [,io workers' comp. insurance comp. insurance.* required.] D5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1,?.❑Roof repairs insurance required.] ' c. 152, §1(4), and we have no employees. [No workers' 13•❑ Other comp.insurance required.] *Any applicant that checks box=1 must also:ill 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 affidavit indicatne such. Contractors that check this box must attached an additional sheet showing the naTne of the sub-contractors and state whether or not those entities have emplovees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: — Policy#or Self-ins. Lic.;'': Expiration Date: Job 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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. Be advised that 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 thepains andpenalries of perjury that the information provided above is tree and correct. Signature GL c��^ .tea �+ C� �� Date: - �-6 Phone=: Jffcial use onll-. Do not write in this area, to be completed by city or town offtciaL Citv or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. CityiTown Clerk 4.Electrical Inspector :. Plumbing Inspector 6. Other j Contact Person: Phone i=: SECTION 8 -CONSTRUCTION SERVICES 8.1 LlcerI d Construction Suoer/isor: Not Applicable ❑ I Name of License Holder License Number Address Expiration Date Signature Telephone I 9.Registered Home Improvement,Contr'a'ctor Not Applicable ❑ POOL'S Comoanv Name Registration Number G��aglo y 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...... ❑ Fl6& Owner Egemphon The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor.CMR 780. SLZth Edition Section 10835.1. Definition of Homeowner: Person(s)who own 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-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and L a g Laws and State of Massachusetts General Laws Annotated. —� Homeowner Si;nature I S=C-710N F-DESCRIPTION OF PROPOSED WORK(check all anolicablep New House Addition 71 Replacement Windows Alteration(s) Roofing Or Doors r Accessory Bldg. C Demolition ❑ New Signs [0] Decks [jam Siding[I=11 Otherj< Brief Description of Proposed /� © Work: 660''x cxr_-O lNN 4 4C i.r Alteration of existing bedroom Yes k No Adding new bedroom Yes y No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet 6a.-If New house and or addition to existing housina complete the following: a_ Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms Ic. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Wocdstoves Number of each c. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 1 GO 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 . I. 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, l as Owner of the subject property hereby authorize to act on my behalf, in all matters rel e rk aut zed by this building pe it applic on. Signature of Owner Da 1 En Uk-(A R e ej,A/ as Owner/Authorized Agen ereby deciare 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. -- - -- -- -- - --------- Print Name cn,ature cf Ownen'Aaent �a*.e i Section ^. =CNING I All Information Must Be Completed. Permit Can Be Denied Due Te Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department LotSize ._......... ,__ ._ __._.... .. .. ... .. _ ._ ._.,.._.. Setbacks Front � �� Side L. _...,_.._. L R _ . Rear Building Height Bldg. Square Footage % Open Space Footage _ % (Lot area minus bldg&paved caridn2) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DO NT KNOW YES 0 IF YES: enter Book Page _ and/or Document# B. Does the site contain a brook, body of water or wetlands? NO is DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: ; D. Are there any proposed changes to or additions of signs intended for the property? MYES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing;grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management-Permit from the DPW is required. Department use only City of Northampton Status of Permit: Pl tilHinn Department Curb Cut'DrneewayPermit 212 Main Street Sewer/Septic Availability I Room 100 WaterfWeltAvailability Northampton, Mr. 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-537-1272 Plof/Site Plans- Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 pro De Address: - fis-section to be completed by office 31 w ��L�� Map °t Unit o�•��Yc �� AP Ov_gt1aAi Dist�ct 41in St Distrlc�t SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owne ecord: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: c� 49 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit aoolicant 1- Building I (a)Building'Pemtitfee to 0 ®C 2. Electrical I (b) Estimated Total Cost of I Construction from(6) 3- Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Totai=(1 +2 +3+4+5) I Check Number This Section For Official Use Only Building ermit Number Date ss e- g ...Issued: Signature: --- -- — Building,Commissioner/lnspe�to or ui mngs "" - Cate t File#BP-2008-0956 APPLICANT/CONTACT PERSON SHEEHAN FRANCIS K&DORIS M ADDRESS/PHONE FLORENCE (413)586-0496() PROPERTY LOCATION 54 ACREBROOK DR MAP 29 PARCEL 075 001 ZONE URA 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: INSTALL ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 111889 3 sets of Plans/Plot Plan THE F91kLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 Management Demolition Delay 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. REBROOK DR BP-2008-0956 GIs#: COMMONWEALTH OF MASSACHUSETTS 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-2008-0956 Project# JS-2008-000095 Est.Cost: $6000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq. ft.): 20386.08 Owner: SHEEHAN FRANCIS K&DORIS M Zoning. URA Applicant: SHEEHAN FRANCIS K & DORIS M AT: 54 ACREBROOK DR Applicant Address: Phone: Insurance: (413) 586-0496 O Workers Compensation FLORENCEMA01062 ISSUED ON.51212008 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. Certificate of Occupancy Signature: FeeType• Date Paid: Amount: Building 5/2/2008 0:00:00 $25.00644 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo