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P � � *PLEASE READ CAREFULLY* A STEP-BY-STEP CHECKLIST OF YOUR NEW POOL INSTALLATION 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 provide 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 stump that is approximately 3"to 4"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 be 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 F below ground level. SEPTIC SYSTEMS/LEACH FIELDS&DRYWELL-In the event your present septic system or arterial leach field lines arc going to interfere with pool construction,arrangements should he made now,through a septic contractor.to address this concern.Teddy Bear Pools is not equipped to remove such systems,he we are available to assist you in the handling of this matter. If your tank is nonfunctional.please make sure it is pumped I week in advance. ACCESS-The first step,of course,is excavation.Please make sure that entry to the card is clear from lences,wood piles,swingsets.bushes,etc.This will he greatly appreciated.Teddy Bear Pooh cannot he responsible for the removal for any of the above.Dclays could occur if this has not been taken care of in advance.If access is across a neighhor's property it will he your responsibility to obtain their permission and it will he understood that you,not Teddy Bear Pools,will assume the responsibility for the finished grade of your neighbor's yard. TWO WEEKS FROM CONSTRUCTION: BUILDING PERMITS-Please obtain vour building permit two weeks in advance of excavation-where local codes apple. Usually these tbrms will he mailed by tour town to you upon request.Our Home Improvement Contractor License#'s are:MA#11189 and CT#520951. ELECTRICITY-"AVOID DELAY- HAVE POWER Sl-.!PPLY READY"Power must he supplied to the excavation area.A 20 amp outlet will suffice in most cases. "A'TE:R-Please make sure that_your installation crew has availability to water and hose.For insurance purposes,we are unable to allow any of our employees to enter your home. A'1'TIME OF CONSTRUCTION: DRIVEWAY/SIDEWALKS- If the point of entry for trucks or equipment is over your concrete or blacktop(it Iv cway,we regret to say,it is at the owner's risk since we have no way of knowing how firm each individual driveway will be.We will take esery precaution,or listen to any suggestion you might have,to minimize any problem that may arise.Once again,we cannot accept any hahility for damages of any kind SITE WORK-"THINGS YOU SHOULD KNOW" SHALE/ROCK-Expense could\ary significantly depending on the circumstances,therefore,this cost will be discussed on an individual hasis. WATER TABLES/GROUND N1'ATER/CLAY/REDPAN-Teddy Bear Pool charges the customer for direct costs only. Usually one or two loa(k of crushed stone will suffice for an average water prohlem.The cost per load is 5200.00-5300.00(Iclivcred.(Extra excavation for this work and stone will he hilled with labor.) NON-APPARENT UNDERGROUND OBSTACLIES-If underground dehris(i c.stumps,large rocks.etc.)are encountered.it may he necessary to use material such as gravel,concrete and/or sono tubes to rectify any voids created by the removal of such obstacles_Any charges for this type of extra material will be collected with your excavation payment. EXTRA FILL-It may he necessary for us to haul dirt away from your yard to create enough work space. If this is the case,it will he vour responsibility to have additional fill brought in for grading,if necessary.It you have clay soil,it will he necessary for you to have the rough grade top dressed,as clay cannot be 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 responsihility. DRAINAGE-Occasionally 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 he directed away from the pool. RETAINING WALL.-It it retaining wall is necessary,please arrange for construction and hack fill if the wall is to he constructed after the pool installation. Please see that it is constructed promptly to avoid soil erosion. LANDSCAPING-Te(Idy Bear Pools does not provide this service.When landscaping,he sure to maintain a pitch away from the pool and concrete.Crushed stone is an aesthetically effective way to provide proper drainage. WATER TO FILL POOL-Normally your pool is filled through your garden hose.If water needs to he trucked in,please inform us and we can make the necessary arrangements. REFUSE-Dcbris, mainly from the packaging of equipment,will he packed up neatly and left tor your curhmde trash collection. AFTER INSTALLATION OF POOL STRUCTURE: CONCRETE DECKING-Teddy Bear Pools utilizes the highest quality materials along with the most qualified craftsmen 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 avoided.Your concrete deck WILL crack.In some instances,acid rain,leaves,dirt and other debris that may come in contact with your deck could discolor concrete decking.Please keep your deck as clean as possible from foreign debris. Within the first month of deck completion the ground will settle around it. It will be your responsihility to regrade to mid-deck height. FLOATING LINERS-Excessive rainfall may cause flooding around your pool much like it does to a basement.The result of this may he 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 sen ice will he covered by most homeowner's insurance policies. SEASONAL SERVICE,-Pool opening and closing services are provided through our Service Department.We provide several services to cater to each customer's individual needs. Please do not endanger your warrantv by not having your pool properly opened and closed.Our Service Department is staffed by professional Service Technicians who are equipped with factory authorized parts and training.The Teddy Bear Pool Service Team will open and close our pool professionally. CHEMICAL TREATMENT-Teddy Bear Pools urges our customers to use only the Tedd% Bear Pools recommended chemicals in you swimming pool.These chemicals have been specialty formulated to ensure the life long quality of our products without the risk of fading or wrinkling caused by inferior grade chemicals or chemical imbalance.Such disorders are not covered under your warranty.A detailed outline and booklet on water chemistry will he provided to you upon completion of your new swimming pool.Please read this booklet carefully.Do not endanger your warranty by using inferior chemicals. IN CLOSING......- Teddy Bear Pools is honored by vour confidence,and will do cverylhinL,within our power to keep that trust.A swimmin<*pool is a long term investment. Finally,you will be giycn complete instructions as to the operation of vour new-teddy Bear Pool when your pool has been inspected and passed your electrical requirements.This must he(tone by a licensed electrician. Thank you once again from all of us at Teddy Bear Pools & Spas THIS MUST BE SIGNED AND RETURNED BEFORE EXCAVATION CAN BEGIN ON YOUR POOL DUE TO INSURANCE REGULA'T'IONS. THANK YOU. Owner Date Please.sign one copy of this page for Teddv Rear Pools and keep the other for your records. • • TEDDY BEAR POOLS & SPAS ................................................... ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■!■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ mom C ■■■■■■■■■■■N■■K■MINM■ ■ ■■C■■■Ems■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Not « m ■ No •. • Fencing Stone Water Tanker: ■ Yes ■ No J71 Chemicals • '- Trucking: ■ ■ • - • Excavator Stump Removal Other Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street r (413 594-2666 ° 1-800-554-BEAR Chicopee, MA 01020-3562 ® FAX (413) 598-8823 Home lmproverMent Cont.MA#11889/CT#520951 A. www.teddybearpools.com TEDDY BEAR POOLS 9 SPAS 91t e -60 Wiln Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108s Home Improvement Contractor Registration �X-' Registration: 111889 } -_ Type: Private Corporation Expiration: 2/8/2007 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST CHICOPEE, MA 01020 Update Address and return card.Mark reason for change. �] DPS-CA1 0 50M-"04,-G101216 Address [:] Renewal D Employment ❑ Lost Card I STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it Known TEDDY BEAR POOLS INC 41 EST ST CHICQ�W '01020 i is certified by the Department tf' onsunO Protection as a registered HOME IMPIeOVEI1Lt*T c0-NTRACTOR Regisratt g, 52(I TEDDY BEAR POOLS INC TRaivsrU `'� i Effective: 12/01/2004 } Expiration: 11/30/2005 p , Edwin R Rodriguez,Comn-dasioner i ACORD DATE(MMlODlYYYY) TM. 'CERTIFICATE OF LIABILITY INSURANCE 04/05/2005 PRODUCER 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: HARTFORD INSURANCE CO TEDDY BEAR POOLS,INC INSURER B: COMMERCE INSURANCE CO 41 EAST ST INSURER C: A.I.M.MUTUAL INS CO 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 CONOI"TON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS wSR AOOL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EX►IRATON LIMITS LTR INSRD DATE MM/00/VY DATE MM/D0,YY GENERALUABILITY 08UUNQS9387 04/01/05 04101/06 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TG RENTED S 300,000 PREMISES Ea ocmrence CLAIMS MADE 7X OCCUR MED EXP(Arty one person) ; 10,000 A PERSONAL&ADV INJURY 4 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE OMIT APPLIES PER PRODUCTSCOMPlOPACG. S 2,000,000 POLICY T-- LOC AUTOMOBILE LIABILITY 04MMZP4572 07/01/04 07101/05 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 ANY AUTO ALL OWNED AUTOS I BCDILY i (Per person) S X SCHEDULED AUTOS B X HIRED AUTOS BCDILY INJURY $ X NON-OWNED AUTOS (Per accident) �CIIIERT Y DAMAGE S Per acc ident) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT S _ ANY AUTO I OTHER THAN EA ACC AUTO ONLY-. AGO IS EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CI CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTGN S S WORKERS COMPENSATION AND we srArc- prHER WMZ800299401 04!01/05 04!01!06 X n7ReuMirs EMPLOYERS'LIABILITY I E L EACH ACCIDENT S 500,000 ANY PRO►RIE-CPJPARTHEWEXECUTIVE I--- C OFFICERIMEMBER EXCLUOEO? '_ GII SE.4:E-E.A EMPLOYEE 500,000 Ryes,d*SCnbf under I E L DISEASE-POUC'r UNIT $ 500,000 SPECIAL PROVISIONS below OTHER: i DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS EASTERN STATES EXPOSITION IS NAMED AS ADDITIONAL INSURED AS RESPECTS THE SHOW PERIOD OF SEPTEMBER 1 TO OCTOBER 5TH AS PER WRITTEN CONTRACT ONLY F#787-0127 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION CATE THEREOF,THE ISSUING NSUP.ER WLL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE "ERTIFICATE -iCLOER NAMED TO THE LEFT,BU"FAILURE TO DO SO SHALL IMPOSE NO C8LIGATICN OR LIABILITY OF ANY KIND iJP DN THE INSURER.TS 4GENTS OR REPRESENTATIVES AUTriCRILED REPRESENTATIVE Attention: liam O.Tru; U, ACORD 25(2001108) Certificate# 11255 ©ACORD CORPORATION 1988 _Lity of Warthttntpton z �A44 AC}�IlStttB _ DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR '212 Main Street • Munici1W Building ' Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc:-,'isor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two fariftTy_-_ 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 any 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 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 ¢Z tw•r pT f _ 0ti� $ �• E 3�+7+nchnsrlla' W v DEPARTMEI-I- OP BUILDrl'G INSPECTIONS 212 Train Street Municipal Budding Northampton, Mass. 01060 WO RICE IZ'S CO NIT EN S A'X`IO N MS URA-N CF- A I (li txusaJpermJ ttcc) %vich a principaJ place of businessfresidence at: -- — (phone-') (sat/c�tr/stalLra p) do hereby cervfy, under the.palnS and penalties of pcgu-ry, :hat ( ) I arm an employer providing dic followine''workcr's comocnsado, cove age for Inv etnplove(:s wortang on tliis job. (Iasun-n=Coar, clr) (relic:Numbcr) -- (E:-pin or,Date) O I act a sole proprietor, general coon-actor or homeowner(ci cie one) and have hired the coauaCprs listed below wbo have the folio%vino worker's cacpen.Sadon policies: (i+ttMc Oi C0 n. c ") (IIIRirancc C01110anyi-Pobc NtufII=`-r) D.Itc) - (Name of Coamaor) OiL7W-ancz Comom".1?oUc-' Numcst) (Lx�iz6on Daie) II I (Name of Con=dor) (Lasu=cz Company Pcbq- Number) (Expirrdoa Date) I (Name of Conaacior) (Insuraa(--Comrzay/PoUcy Numbs) (Expin6oa Dair) . (aa.ac3 wool dtC,if acocaa ti•to¢icrv[L iafocma-Zoo pcta.iaing to'U { ) I am a sole proprietor and have no one work-iog for me. i ( ) I am..a home owner performing all the work myself. NOTE:plea be axarC rt,,.w't Je 6cmeo.�vera M-bo a=ploy pccooa eo de r-+• cs.•rr�a a rc,-nir w-orie oa of W man th.m twee LniCr is utuch the bomeowarr raid.cc ea the pouo6 tbc-,I oo(C=:.-UY oec d.-cd to be cavlor-untie the Dui ds c=p ---,.m Aa(GLI52=1(5)l =ppU=Ldon by a bomraa-o=fcr:be=--a pc=R rr=y--i'd—tL- leggy!CLz-=of an e-gloyet wader dto W*Ck. -a C.ompomitioa AeL I' [aaadezaa.ad the a Dopy o(thi.mtcmr�may bo foe-v.nrd.ed to tbo Dopertmraa of InrS+.s+i al nccdr>zt�Olt+oo oC la�+r•a�C��' covrrase vciresioa and the t L-ilmc to so�uc'eovczasc undo soeiioa 25 A of hi4L 152 eaa icd to the i�rpOSmoa of aimia+l p�� ooaii:r ora fine.Cup to S1X00.00 andfoc ix� oCup to ooe yr=r end avU p=Al-j=is d-form of a Stop W-+Order and+ C=0(:S 100.00 a day apiasl tnc For dcq+^a'='-'1 u.e only p CTIII7I l`LLmbcr h�P° Lot ° . SigpatLrc of Lia-succ/Pccrrtittcc -- SECTIONS-CONSTRUCTION SERVICES ,:f 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone J°Re4istere�Honieinnrnve [eCa Y Not Applicable ❑ - — Company Name Registration Num a r -- --- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE"AEFIDAWT 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...... ❑ 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"certi a Au5nes responsibility for compliance with—the State Building Code,City of Northampton Ordinances,St d Loca o ' g Law of Massach eral Laws Annotated. Homeowner Signatur r i SECTION 5--DESCRIPTION OIF PROPOSED WORK(checkallapOicablel New House Addition ❑: Replacement Windows Alteration(s) [� Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [p Siding[C]] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet .rC,mwe .?ir,'' '" , t�M..,� t fz" `.xt. sawIf' 4 Rio'usera�tc s cidr ion t�f08•exts r> a s n carp of :the a farlr�ln 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? Yes 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 SECTION Ta-OWNER AUTHORIZATION-TO E.COMPLETED WHEN ' GPES FOR BUICDINERMIT OWNERS AOENTARCONTACTOR.APPLI 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. Signature of Owner Date as Owner/Authorized I, 6dfA4, 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. Prin a ®/G Sig o caner/Agent at 4 Section 4. ZONING All Informati6h 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 F77" Side L:'` R: L: R: �_ Rear �Q Building Height - — Bldg.Square Footage { Open Space Footage % (Lot area minus bldg&paved EWO parking) #of Parking Spaces 1 Fill: volume'&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO Q 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 Q Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: i D. Are there any proposed changes to or additions of signs intended for the property? YES NO Q 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. J Y rth ampton i �� r �� ii n �epartmen# 6 , r 2 ' pin Streete a tli ' Q 1m 100 etab� "C��rtha` t n; MA 01060 s t r ari phone 413-58:7-12 0 Fax 413-587-1272 '� t J' tllP.t.1f}ti � �a» m _-.,APPLICATION TO CONSTRUCT;ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-SITE1NFORMi4T10N 1.1 Property Address: This sectran to be compCeted byoffice Ocl DLA Arl"O 7)1 IVIL1 COt � [ �, ` k �.ElttkSt Distract GB-D�sfict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: IS Ste_ Name Current Mailing Address: 5�=47-3 '4��Z2 Telephon6- Si re 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3--ESTIMATED CONSTRUCTION COSTS 7 Item - Estimated Cost(Dollars)to be Official Use Only co feted by ermit applicant 1. Building ©0 (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) Check Number This Section For Official"Use Only Date Building Permit Number. Issued: Signature: j Building Comm issionedinspector of Buildings- Date File#BP-2005-1281 APPLICANT/CONTACT PERSON DRABEK EDWARD ADDRESS/PHONE 69 WOODLAND DR FLORENCE (413)584-9307 Q PROPERTY LOCATION 69 WOODLAND DR MAP 35 PARCEL 296 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Ty_peof Construction: CONSTRUCT 16 X 50 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 THE F LOWING 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 C ssion 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. 69 WOODLAND DR BP-2005-1281 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-296 CITY OF NORTHAMPTON Lot:-001 Permit: Building Cate ory: BUILDING PERMIT Permit# BP-2005-1281 Project# JS-2005-1710 Est.Cost: $29900.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. £t.): 33628.32 Owner: DRABEK EDWARD Zoning: SR Applicant: DRABEK EDWARD AT. 69 WOODLAND DR Applicant Address: Phone: Insurance: 69 WOODLAND DR (413) 584-9307 () FLORENCEMA01062 ISSUED ON.6/27/05 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 50 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 6/27/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo