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35-266 (6):9B,EAR P ��INC.6( MA Home Improvement Cont.#111889 East Street — y Our R p CT Home Improvement Cont.#520951 Iicopee,MAO 02b' � _ Fed.I.D.No.04-2583701 13)594-2666 6,/CT:(800)554-BEAR 0 ( �x� 0285 ix(413)598-8823 ORDER 99- Nw.teddybearpools.com Ae Ilk �NQVOA SALES RE /V TEDDY BEAR I INGROUND POOL PURCHASE AGREEMENT DY BEAR POOLS, INC.(DEALER) HEREBY AGREES TO BASE S'rRUCTURE L AND INSTALL THE FOLLOWING PRODUCTS,MATERIALS MODEL EQUIPMENT, AT THE BUYER'S ADDRESS AS SHOWN POOLS X _ Concrete Collar LINER PATTERN 13CWF tefTYSIOLUC OW, FOR THE CONSIDERATION AND PRICES SHOWN FILTER SYSTEM —k / IEIN.THE ABOVE-NAMED BUYER HEREBY AGREES TO S.S.LADDER Safety Line (CHASE SAID PRODUCTS,MATERIALS AND EQUIPMENT MAINTENANCE KIT POLE,HOSE FOR VAC,HEAD,TEST KIT TO MAKE THE PAYMENTS LISTED IN THIS AGREEMENT. THERM,SKIMMER&BRUSH a'DIVING BOARD With Stainless Steel U-Stands (ER \ © Walk-in Stairs S.S.Handrail Size nd/Side / SPA ACTION Hydro Therapy Jet - '.EET rV ELECTRICAL ALLOWANCE- Y Permit Ground Pool Wire Pump&Motor A/� LIGHT 300 WATT 12 Volt Wired and Installed /� (y ZIP CONCRETE sq.ft. $ 4"Thick 6'Wire K- ( V 7a STAMPED CRETE sq.ft. $ Fiber Mesh VERMICULITE BOTTOM;(IF NEEDED)Approx. INC, I OPTIONS TIMER FOR FITTER OSTS TOTAL $ AUTO POOL CLEANING SYSTEM PTIONS TOTAL $ 70 + i0a SOLAR COVER OTAL $ SOLAR REEL OWN PAYMENT (20 t� ' HEATER Z ��T 'L E ON EXCAVATION (30 CLOSE POOL 1 st YEAR IUE ON DELIVERY (20 SAFETY COVER XTRA COSTS WINTER COVER BE PAID UPON SERVICES RENDERED WATER TANKER UE ON INSTALLATION (2IF LINER `: OTHER WE ON COMPLETION (5 SUB TOTAL �Q hi s agreement includes any installation by Teddy Bear Pools,Inc.,installation shall begin SALES TAX(MA 5%,CT 6%) , p yg V CONSTRUCTION ov roximatel 1_ d is scheduled to be substantially completed by_1_1_ ^� TOTAL 13q �r TERMS AND CONDITIONS THE DEALER WARRANTS THAT ALL LABOR AND WORK PERFORMED UNDER THIS AGREEMENT SHALL BE PERFORMED IN A GOOD AND IORKMANLIKE MANNER ANDTHATTHE DEALER SHALL REPLACE OR CORRECT ANY DEFECTS IN WORKMANSHIP WHICH APPEAR WITHIN FIVE 'I)YEARS FROM DATE OF INSTALLATION.NO IMPLIED OR EXPRESSED WARRANTY ON CONCRETE PATIOS. I ACKNOWLEDGE RECEIPT OF TWO COMPLETED COPIES OF THIS NOTICE OF CANCELLATION AND CONFIRM THAT I HAVE BEEN ORALLY (FORMED OF MY RIGHTS. MASSACHUSETTS BUYERS ONLY:THE REQUIRED PERMITS FOR THIS CONTRACT ARE AS FOLLOWS:IT SHALL BE THE OBLIGATION OFTHE OME IMPROVEMENT CONTRACTOR TO OBTAIN SUCH PERMITS AS THE OWNER'S AGENTS. OWNERS WHO SECURE THEIR OWN ONSTRUCTION-RELATD MGL C. 42A.OWNERS SHALL L BE WITH FOR THE CO TCAND EXPIENSE OF PERMITS OBTA NED BY DEALER. FUND THE DEALER AND THE BUYER MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE DEALER HAS A DISPUTE CONCERNING THIS :ONTRACT,THE DEALER MAY SUB T SUCH DISPUTE TO THE AMERICAN ARBITRATION ASSOCIATION AND THE BUYER SHALL BE REQUIRED '0 SUBMIT TO SUCH ARBITRATION BUYER: � DATE: DEALER: dy Bear Pools,Inc. IS aturel DATE: /ff /� ` uthonzed Signawrel ev n chic IOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute settlement initialed be the contractor.The Buyer may Initial alternative dispute resolution ev n where This section is lot separately signed by the parties. CONN.BUYERS ONLY:THIS INSTRUMENT IS BASED UPON A HOME SOLICITATION SALE,WHICH SALE IS SUBJECT TO THE PROVISIONS OF rHE CONNECTICUT HOME SOLICITATION SALES ACT.THIS INSTRUMENT IS NOT NEGOTIABLE. MASS.AND CONN.BUYERS:You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation for an explanation of this right. THE BUYER AND DEALER AGREE THAT THE TERMS AND CONDITIONS SET FORTH THE REVERSE SIDE OF THIS DOCUMENT ARE A PART OF THIS AGREEMENT AND ARE HEREBY INCORPORATED BY REFERENCE INTO THIS AGREEMENT,AND TOGETHER WITH THE PROVISIONS ON THE FACE OF THIS DOCUMENT,AND TOGETHER WITH ANY OTHER DOCUMENT THAT IS EXPRESSLY IDENTIFIED IN THIS DOCUMENT,SUCH TERMS AND CONDITIONS AND PROVISIONS CONSTITUTETHE ENTIRE AGREEMENT BETWEEN BUYER AND DEALER.THIS AGREEMENT COVERS AND SUPERSEDES ALL CONVERSATIONSaAgeni STATEMENTS OR AGREEMENTS BETWEEN THE BUYER AND DEALER, THEIR AGENTS OR REPRESENTATIVES. D N NTRACT IF THERE ARE ANY/BLANK SPACES BUYER: DATE: II _ 'f EDDY BEAR POOLS,INC g aturel tS�gneture Teddy Bear Pools,Inc 41 East Street,Chicopee,MA 01020 Mass.Home Impc Contr.#111889;Conn.Home imps Conti.#520951 Buyer's Add re4' - ---------- ------------------ -- CANCELLATION -_------- NOTICE YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OF SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OF SALE:OR YOU MAY,IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IFYOU DO MAKETHE GOODS AVAILABLE ANDTHE SELLER DOES NOT PICKTHEM UPWITHINTWENTY DAYS OFTHE DATE OFYOUR NOTICE OF CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OF IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THIS CONTRACT, TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE OR SEND A TELEGRAM,TO TEDDY BEAR POOLS,INC.41 EAST STREET,CHICOPEE FALLS,MA 01020 NOT LATER THAN MIDNIGHT OF (DATE). DEALER:TEDDY REAR POOLS,INC. DATE:_ RUYER:_. _DATE: (Authorized Signature) fSlgneture) 41 East St.,Chicopee,MA 01020 Mass.Home Impc Conti,a 111889;Conn Home Impc Conti.#52C951 *PLEASE READ CAREFULLY* A STEP-BY S"CEP CHECKLIST OF YOUR NEW POOL INSTALLNHON CUSTOMER RESPONSIBILITIES THREE WEEKS FROM CONSTRUCTION: APPLICATION FOR FINANCING-Please make all final arrangements with your hank 3 weeks prior to Teddy Bear's arrival for excavation of your pool.This will assure no delay.and provrole for completion on time. TREE REMOVAL-Make arrangements with a tree specialist in the event trees must he eliminated to make room for your pool.At your request,we will be glad to refer you to local companies. REGARDING STUMPS:Any sunup that is approximately 3"to T"in diameter within a pool area will he gladly removed by Teddy Bear Pools.In the event a stump must he excavated.a nominal fee will he assessed,i.e machine time and/or extra materials needed.We do not remove stumps from the job site.If you can,have the stumps ground I'below ground level. SEPTIC SYSTEMS/LEACH FIELDS&DRYWEILL- In the event your present,septic system or arterial leach field lines are going to interfere with pool construction.arrangements should be made now.through a optic contractor,to address thi,concern.Teddy Bear Pools is not equipped to remove such systems,be we are available to assist you in the handling of this matter.If your tank i,nonfunctional.Please make sure it is pumped I week in advance. ACCESS-The first step,ot course.is excavation. Please make sure that enu, to the card is clear from fences,wood pit".swingsets,bushes,ctc.This will he greatly appreciated.Teddy Bcar Pooh cannot he responsible for the removal for any of the above.Delays could occur if this has not been taken care of in advance. If access is across a neighhor's property it will he your responsihilu to obtain their permission and it\y ill he under,tood that you,not Teddy Bear Pools,will assume the responsibility for the finished grade of your neighbor',sard TWO WEEKS FROM CONSTRUCTION: BUILDING PERMITS-Plca,c obtain your'huilding permit two weeks in advance of excavation-where local codes apply.Usually these firms will he mailed h_v your town to you upon request Our Hume Improvement Contractor License#'s are:NIA#11189 and CT#520951. ELECTRICITY--AVOID DELAY-HAVE POWER SUPPLY READY."Power must he supplied to the excavation area.A20 amp outlet will suffice in most cases. wt1TF.R-Plea,c nmkc sure that_tour installation crew has availahi[ity to water and hose.For insurance purposes.we are unable to allow any of our employees to enter your home. AT TIME OF CONSTRUCTION: DRIVEWAY/SIDEWALKS- If the point of entry for trucks or equipment i,Over Your concrete or blacktop driyewar,we regret to say.it is at the owner,risk since we have no tray of knowing how hrrn each indiv idual driveway will he We will take e�cr_v precaution.or listen to any sugge,tion coo might have,to minimize arty problem that may arise.Once again,we cannot❑ccept any liahility for damages of any kind SITE WORK-"THINGS YOU SHOULD KNOW" SHALE/ROCK-Expeme could van significantly depending on the circurn,tancc,:thcrctorc,this cost will he discussed on an individual hasis. WATER TABLES/GROUND 1'1:ATER/CLAY/REDPAN-Teddy Bear Pool charges the customer fix direct costs only. Usually one or two loads(it crushed none will suffice for an average water pnrhlem I'hc co,t per load is 5200.00-5300.00(felivered.(Extra excavation for this work and stone will he hilted with labor) NON-.APP.ARENT UNDERGROUND OBSTACLES-If underground dchris(i.e.stumps,large rocks.etc.)arc encountered.it may he necessary to use material such its gravel,concrete and/or Sono tubes ur rectify arry coils created by the removal of such obstacles.Am-charges for this type of extra material will be collected with your excavation payment. EXTRA FILL-It may he neccssary tit us to haul dirt away from your varef to create enough work space.It this iv the case,it will he your responsibility to have additional fill brought in for grading.it necessary. It you have clay Soil,it will he necessary lot you to have the rough grade top dressed,as clay cannot he spread as effectively as other types of ground material.'Teddy Bear Pools will leave you with a rough machine grade around the pool area.Fine grading will he your responsibility. DRAINAGE-Occasional[v a site may require a drainage system due to irregular landscape and soil conditions.Drainage is used to prevent surface run off and upper seepage toward the pool.Water is directed away from the pool to a lower point on the site.Gutter downspout should also be directed away from the pool. RETAINING WALL-It a retaining wall is necessary,please arrange for construction and back fill if the wall is to he constructed after the pool installation. Please see that it is constructed promptly to avoid,oil erosion. LANDSCAPING-Teddy Bear Pock does not provide this service.When landscaping,he sure to maintain a pitch away from the pool and concrete.Crashed stone is an aesthetically effective way to provide proper drainage. WATER TO FILL.11001,-Normally\,our pool is tilled through your garden hose. If water need,to be trucked in,please inform as and we can make the nccessan arrangements. REFUSE-Dchris,maims front the packaging of equipment,will he packed up neatly and Lett for your curhmdc trash collection. AFTER INSTALLATION OF POOL STRUCTURE: CONCRETE DECKING-Teddv Bear Pools utilires the highest quality materials along with the most qualified crahsmen to ensure that cracking of concrete is kept to a minimum. Unfortunately,given the Northeast climate cracking of concrete is a fact which cannot he:nuided.Your concrete deck WILL crack.In some instances.acid rain,leaves,dirt and other debris that mac conic in contact with your deck could discolor concrete decking. Please keep your fleck as clean as possible from foreign debris. Within the first month of deck completion the ground will settle around it.It will he your responsihility to regrade to mid-deck height. FLOATING LINERS-Exces,ice rainfall may cause flooding around your pool much like it doe,to a basement. The result of this may be a floating liner.which at times may leave wrinkles in the liner.We can attempt to remove these wrinkles by resetting it The cost of this scn ice will he coverer)by most homeowner's insurance policies. SEASONAL SERVICE,-Pool opening and closing services are provided through our Senice Department We provide several services to cater to each customers individual needs. Please(to not endanger your warrant by not having your pool properly opened and closed.Our Service Department is statfed by professional Service Technicians who arc equipped with tacton authorized part,and training 'The Todd} Bear Pool Service Team will open and close your pool professionally. CHEMICAL-TREATMENT-Teddy Bear Pool,urge,our costumer,to use only the Tcddy Bear Pool,recommended chemicals in you swimming pool.These chemicals have been specially formulated to ensure the life lung quality Of our product,without the risk of fading or wrinkling caused by interior grade chemicals or chemical imbalance.Such disorders are nut covered under your warranty.A detailed outline and booklet on water chcmistn wilt he provided to you upon completion of your new swimming pool. Please read this booklet carefully_TO not endanger your warranty by using inferior chemicals. IN CLOSING....... Teddy Bear Pools is honored by your conI dcncc,and will do everything within Our power to keep that trust.A swimming pool is a long term investment. Finally,you will be given completc instructions as to the operation of your new Teddy Bear Pool when your pool has been inspected and passed your electrical requirement,.Thi,must he dune he a licensed electrician. Thank you once again from all of us at Teddy Bear Pools& Spas THIS MIDST BE SIGNED AND RETURNED BEFORE,EXCAVATION CAN BEGIN ON YOUR POOL DUE TO INSURANCE REGULATIONS. THANK YOU. Owner Date Please sign tone copy of this page for Teddy Bear Pools and keep the other for your records. • fee 0 TEDDY BEAR P SPAS - . •• ....................... �......................■■■ ................................................... ................................................... !■■■.■■■■■■■■■!!■■■ ! ! !f!!' il ■■.■■■■■■■■■■■■■■■■■■!■ Included:Not ■ No Loam �! Fencing • Water Tanker: ne ■ E • Trucking: GI ■ • • • Stumps:Water 71 Yes No •• Back Hoe_.�—� Job Description: • Stump Removal Other Northampton. MA Property Detail Page 2 of 2 Vacant/Dwell/Oby Status: Dwelling Open Frame Porch Additional Features: lWood Deck Brick Trim: 0 X 214 Frame Garage Stone Trim: 0 X 0 Frame Overhang Remodeling Data: jEnclosed Frame Porch Year Remodeled: 0 IFrame Overhang Kitchen Remodeled (Y/N): IFrame Overhang Bath Remodeled (Y/N): Land Data F Outbuilding Info Square Foot Type Utilities Type F Qt Value no Prime information Site 39,993 112,750 Type Qty Year Size 1 Size2 Grd Coi RS1 0 2004 0 96 ©C Acreage Type Street/Road Type Acres Value no no information information Sales Info Permit Info Date Type Price Validity" Date Permit # Price Purpose, yp ���--� 10/05/2004 353 2,300 8 X 12 SHF 06/01/1990 Land+Bldg 51,600 L� 06/22/1996 538 10,000 CONV DK 2 http://www.northamptonassessor.us/noho/propertydetail.php?map_no=35 -266-001&pagec... 9/11/2008 Northampton, MA Property Detail Page 1 of 2 City of Northampton, M.A: Residential Property Record Ca New Search Property Type_ Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block- 35 -266-001 Lot: Zoning: Assessmen Location: 21 WEST PARSONS Neigborhood: 19 Land: LN Deed Book: 3646 Building: #Living Units: 1 Deed Page: 112 Total: Class: R-101 Dwelling Information Building Sketch Style: Col/Gam Year Built: 1990 Story Height: 2 Attic: None Basement: Full 16 Total Rooms: 8 12 EFP Bedrooms: 4 1 sz Full Baths: 2 114 s `i, 2 H Half Baths: 1 32 21 24 12 1 Fr/B Exterior Walls: Frame zss Unfinished Area: 0 27 2FrlB 24 Ground Floor Area: 864 Bs4 Total Living Area: 2160 22 FG Finished Basement Living 0 X 0 5zs Area: F 1 Basement Recreation Area: 0 X 0 c 5 Woodburning Fireplace 2 /2 Stacks/Openings: Metal Fireplace 0/0 Stacks/Openings: Heat/Central A/C: Basic Heating System: Hot Addition Information: Water Fuel Type: Oil Quality Grade: B Physical Condition: Good Lower 1st Story 2nd Story E Interior/Exterior: Same Basement One Story Frame One Story Frame Condition/Desirability/Utility: GD Basement One Story Frame http://www.northamptonassessor.us/noho/propertydetail.php?map_no=35 -266-001&pagec... 9/11/2008 ACORD �- DATE(M WDD/YYYY) TM.` CERTIFICATE OF LIABILITY INSURANCE 03/27/2008 PRODUCER Phone: (413)781-2410 Fax 413-731-9539 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 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 REOUIREMENT, 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. INSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR DATE MM/DDfYY DATE MM/DD GENERAL LIABILITY 8500036498 04/01/08 04/01/09 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 PREMISES(Ea occurence) CLAIMS MADE 7 OCCUR MED.EXP(Any one person) $ 5,000 A 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 - POLICY JECPRO T LOC AUTOMOBILE LIABILITY 32176400003 07/01/08 07/01/09 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ X SCHEDULED AUTOS A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC is AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ TATU WORKERS COMPENSATION AND 9104140407 04101/08 04101109 X TORY LM, S OTHER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF'60ERATIONS/LOCATIONS/VEHICLES/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 / Attention: iam 0.Truce , ACORD 26(2001/08) Certificate# 34065 0 ACORD CORPORATION 1988 Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street r 1 (413) 594-2666 - 1-800-554-BEAR Chicopee, MA 01020-3562 FAX (413) 598-8823 Home Improvement Cont.MA#11889/CT#520951 A* www.teddybearpools.com 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: 2/8/2009 Trit 126084 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST CHICOPEE, MA 01020 Update Address and return card.Mark reason for change. DIPS-CAA ., 50M-04i05-PC8698 I Address a Renewal f— Employment 7 Lost Card �Y STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it knot that i TEDDY BEAR POOLS INC 41 EAST ST CHICC VER,� A--01020 j ;r T i is certified by the Dep i ek Cons¢ Protection as a registered HOME IMPR .,I WNTRACTOR gt i 20951 ov', TEDDY BEAR POOLS INC TRnsrv�Th' I Effective: 12/01/2007 Expiration: 11/30/2008, + Jerry Farrd4 Jr.,Commissioner 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 your) 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 permits 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, 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 Address of work location The Commonwealth of3fassachusetts < Department of Industrial Accidents r Office of Investigations _ »s 600 Washington Street T — Boston, 31A 02111 www.Inass.gOv/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A J Please Print LeQibiv IV kName(Business/Organization/Individual): t° - loo _ Address: 1C 0164 City/State/Zip: Phone #: Are y an employer? Check the appropriate bob: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propri etor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors 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 is providing work 'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 1111011146;6e.... Policy#or Self-ins. Lic. #: T J Expiration Date: l Job Site Address: /� Q 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cov rage verification. 1 do hereby certi under h ain an alties of perjury that the information provided above i true and correct. SiEnature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL Citv 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 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Reclistered Horne Ini r vement Co rac r: >,"` Not Applicable ❑ Comp ny Name Registration Nu ber Address Expiratio D e Telephone7�-�� 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...... ❑ 11 Home Owner Egeinption 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, Sixth Edition Section 108.3.5.1. 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 Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors EJ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[71] Other[O] Pt-ief Descripti )P�clpgsed �1/Vprk: YY G(��' J Alteration of existing bedroom Yes No Adding new b room Yes No Attached Narrative Renovating unfinished basement Yes 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 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. I. Septic Tank City Sewer Private well City water Supply i✓ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED-WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereb uthorize i to act o my be If all tter lative to work authorized by this building pt ion. Signature of Oiinef Date( I, 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. Siggled unde the ains d alties,of perjury. 7 rint Name /Z'A tip- '7111 h Signature of Owner Agent Dat Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ._.. Frontage Setbacks Front Side L: 5. R: L: ..., R Rear Building Height Bldg.Square Footage % _.. Open Space Footage % ~_,° (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES IF YES, date issued:;; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 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 Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Statusbf Permit: Utimel Department Curb Cut/Driveway Permit '0 L`a i �21 in Street Sewer/Septic'Availability k6onri 100 Water/Well Availability 1 hampton, MA 01060 Two Sets Qf Structural Plali SEPphIJ 4 #8 7-587-1 0; Fax 413-587-1272 Plot/Site Plans __.. Other Specify APPLIej, ,i&;t To Cr4N$S ~rT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: /// This section to be completed by office Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Slcklmqcker- Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Acient: / .414 �4 ! Na a(Pent) Current Mailing Address: N / Signature Telep`kpne SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5 0() Check Number 6 This Section For Official Use Only Building Permit Number: IIsssued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0274 APPLICANT/CONTACT PERSON TEDDY BEAR POOLS&SPA ADDRESS/PHONE 41 EAST ST CHICOPEE (413)594-2666 Q PROPERTY LOCATION 21 WEST PARSONS LANE MAP 35 PARCEL 266 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT A_PPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid T_ypeof Construction: CONSTRUCT 20 X 40 INGROUND 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 FgLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,XMATION PRESENTED: L/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 Of icial 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' BP-2009-0274 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2009-0274 Project# JS-2009-000363 Est. Cost: $39850.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq.ft.): 39988.08 Owner: SCHUMACHER JAMES zoning: SR Applicant: TEDDY BEAR POOLS & SPA AT. 21 WEST PARSONS LANE Applicant Address: Phone: Insurance: 41 EAST ST (413) 594-2666 () Workers Compensation CHICOPEEMA01020 ISSUED ON.911912008 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 40 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 9/19/2008 0:00:00 $60.0026089 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo