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30C-056 (11) BP-2024-0622 113 CLEMENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30C-056-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) • BUILDING PERMIT Permit# ' BP-2024-0622 PERMISSION IS HEREBY GRANTED TO: Project# POOL/DECK 2024 Contractor: License: Est.Cost: 15730 Const.Class: Exp.Date: Use Group: Owner: A GREENE ROBERT A&PATTY Lot Size(sq.ft.) Zoning: SR Applicant: A GREENE ROBERT A& PATTY Applicant Address Phone: Insurance: 113 CLEMENT ST FLORENCE, MA 01062 ISSUED ON: 06/06/2024 TO PERFORM THE FOLLOWING WORK: POOL WITH DECK 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( ' .."P Fees Paid: $132.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Z-0.K. ✓ File #BP-2024-0622 APPLICANT/CONTACT PERSON:GREENE ROBERT A&PATTY A 1,.i41-1 2v14 4 113 CLEMENT ST FLORENCE, MA 01062 PROPERTY LOCATION 113 CLEMENT ST MAP:LOT 30C-056-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out _ Fee Paid $102.00 3J/1./2o2-I #&- 5/2ekm Type of Construction: POOL WITH DECK New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: proved Additional permits required(see below) For all projects that need additional reviews sk;p as checked below,please see the Office of Planning& Sustainability Permit nage or scan here PLANNING BOARD PERMIT REQUIRED UNDER:§ T 1 'OZIA• 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 ///../7.2 5- 17 Zoz' 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 Ivorks 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. _ le Ana st.. The Commonwealth of Massachusetts B rd ooBuilding Regulations and Standards FOR MAY MUNICIPALITY 1 6 2024 M ssac)tusetts State Building Code, 780 CMR USE qt.). 3 Building Permit tppliation To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 .7`i'.',c~ ''_ ;-r �T�_o_NJg j"One-or Two-Family Dwelling MA °6 ,C, /T'his Section For Official Use Only Building Permit Number: d3PeA 7^lam)y Date Applied: e:EVi 0 ([45 ''Z' 4-4ZZLI Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 113 C(z tu.....4- St Flotria.,erA eltt.A 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: flcbtr.► A • srl.,rez t Sr 143 CI.6„4J 54-- Fm.4.w-c-, M.st. o i ) .L Name(Print) City,State,ZIP ft' 60)144 $+r 9 t S8N-BogS nivrse.1 ,5C iej4116e. Cem No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Existing Building 0 . Owner-Occupied\Fe Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': follei A 2'1 Fro- b0,,� Ccv r✓61 ec4L 1,.) 4,C Of A.1Ac44,,.,.il . Asa h;rioi C44.e.4,+e: 4 t LJ ,,K .ce s4:J ( ,i-. SECTION 4: ESTIMATED CONSTRUCTION COSTS • Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building I a c L. $,„ t jpo Io,130 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical ���. $',� YAK Z�a��, 0 Standard City/Town Application Fee 0 Total Project Cost3 (Item 6)x multiplier x 6 3. t�ec r<• $ 3•o u. 2. Other Fees: $(02 423 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire - ck 0"2--7 D 430(:� 01 Vi Suppression) $ Total All Fees:'$� f' Check No. i tl Check Amount:'D Cash Amount: 6.Total Project Cost: $k 'lad 15 i 030 ❑ Paid in Full 0 Outstanding Balance Due: q e'covciact KAA-d 111- Ch'id i n5 ( -F. �.eidid $c a� 53-7 - 501,3 pa SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6: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 0 No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. V. tfi k• GC S ? 52. Sl1y1241 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.govidps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton 4Jr..�AMi. Massachusetts �?-' !<<G rf � yt 'qL � � ?'' DEPARTMENT OF BUILDING INSPECTICNS S. ` 212 Main Street • Municipal Building J�}. Northampton, MA 01060 -3'7•:k0 n HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, t`" �"' A " ,)'t- (insert full legal name), born 1 I Zg I6 Z (insert month,day, year), hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualifij under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns 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-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this I4 day of ►►"A , 2024 . 44 A. � ' (signature) . The Commonwealth of Massachusetts Pr fir/ Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,114 02114-201" trti/r.mass.gov din %Viitkars'Compensation Insurance Affidavit:Builders'Contractor Electricians Plumber:, TO BE FILED RTIH THE PER%u I'IZVG AL'IHORITY. Applicant Information Please Print Legibly Nam(Business Orr„ dot.Indirit�ral): Address: City State.Zip: Phone#: Are yes e■eaaplerer?Chock the appreprien bex Type of project(required): I ant a ecap:o}vr with eroplern (full and es part-tiaoe)-e 7. D New construction DI ac a sc:o propane:c:prowl-hip and have no employees working for me m 8. ❑ o,cie rig any apace•.[Nc waken'ccap thsurance raq-_irsdj 3.01 a=r a hcta. a-ner door al:work tr.,.lr s[Nc weaken'camp insurance required.)s 9- ❑Demolition 10 O Budding addition 4A I as a he .owner and wi:1 be hiring centacton to contract a:l wake on ney property. I will ensure that a 1 coaaactcss saber have workers'compaasatiea insurance a are sole 11.D Electrical repair:or additions proprietor:with nc saplccees. 12.Q Plumbing repair_or additions I ac a!mare:contra:for and I have hued the sub-coazactors hired cm the attached:test 13.E Roof repairs These sub ccasactors have employeesa and have works:1'co, Insurance ' Owe are a cerpoatiaa mad its offu srs have satirised their rian cf saemphoa per 1MGL c 14.a Other 152.11(4).and we have so employees.(No workers'comp =mane rsgtmsd.] *Any applicant that checks box e1 mast also 511 oat the section below showing their waken'cattapeasarim policy information. Hcmeowaars who submit this affidavit sndicatng they are tieing all work and then hire outside connecters mmst ssbnut a sew affidavit indicating such :Ccanac ors that check this be'must mashed an additional thew showing the name of the tub•ccntractars and tans whether a net those ant is%lave soy lc?vas If the sub-ccnaxters have employees.they must provide their wcr ors'coo•, policy=mbar. I am an employer that is providing workers'compensation insurance for in employees_ Belch is the policy and job sits information. Ins-Laance C otia.-} Policy t=or Self-ms.Lie.*: Expiration Date: Job Site Address: C[ty'State/Zip: Attach a copy of die workers' compensation policy declaration page(showing the policy number and expiration date). Faihre to secure coverage as required under tiIGL c 152. 25A is a minimal violation ptmichable by a fine up to S 1,500.00 ardor one-year impnsonm tit.as well as civil penalties is the form of a STOP WORK ORDER and a fine of up to S250.00 a day agarmt the violator.A copy of this statement may be forwarded to the Office of Inve;tigatioas of the DIA for m-urance coverage verification I do hereby ccerfj ti�-under the pains and penalties of perjury that the information provided above is mue and correct. Si nature: F ` 1 &tt;r rt- , Date: 1 Phone 4 u1 S Ji4 $C 5 Official use only. Do not write in this area, to be completed by city or tower official City or Town: • Permit license>_ ' Issuing Authority(circle one): 1.Board of Health Z.Building Department 3, City Town Clerk 4.Electrical Inspector F.Plumbing Inspector 6.Other Contact Per:on: Phone P: fAy CITY OF NORTHAMPTON cl St' E Corgi r,A, V t D 6 7- SETBACK PLAN 413 S 84- Se b MAP: LOT: — `-113 10 1115 0,0 LOT SIZE: REAR LOT DIMENSION: I CU REAR YARD SIDE YARD 1:‘(� o SIDE Y U" aVk \\s poi, VA'Xi„TL ` "Da k 11- )1 II' I\ ' C r Q - I� ((,> le) trch coo j.e-5 FRONT SETBACK FRONTAGE r -) Above Ground Pool • • Plot Plan A. elk 4E.11, ,i...1411. i.t,tt_. 0. if 7 •l TEDDY BEAR POOLS C SPAS li:10 The plot plan below is approximate measurements for the pool placement at the home of: Customer Info: 120b.,0 -1 CAt'ft) (;-c-R- 'f`)4-- 113 Cl-Pi e/J-1— In the City/Town of: -V LZ(' i ✓') R, 0 1 C (,, at .r 0 Fk Fk Nr'q- Ij I4 Above ground pool set backs are: __ of House 2 Side Zi Rear S tir Le Field . i4 6- 1 5e— . _____. , , , r � � dr.. � �...--_,A..,,, . , . , . , . , . . . 1 , ,, 0 . 'V. . , . , ,i_ ' —, . . . , . 1 f1/4....j_.,. . . , . . . , , . .. , . "t 1................ .. t...)1,64 iik"-: . ' ' ' ' ---i , ir , , t. , n„,4 ,,,, ,,, . , . , . . . , \\,....., IL . , 4 " \\.....:: . , , , , , cluPe \ . , Draw out you backyard including the back of your home and lot lines. Show measurements from tot lines, both sides and rear as well as from the back of the house. (See example on back of page). This plan was completed by: fiPt 6 v. - k — Date: C I I Kt 2 c1-1 41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpools.com City of Northampton ;? � O�[H�M ,o. S M. S T.tir S ,C '� •�' Massachusetts �? L_ !<<; 1 DEPARTMENT OF BUILDING INSPECTIONS \^,v 4. -r 212 Main Street • Municipal Building p- .C;" \ Northampton, MA 01060 syj�; 'jN'�0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: c.-C CAA) OYJ Prq.cr4 The debris will be transported by: Name of Hauler: Ite-cyclk4 I repurt`J' Signature of Applicant: an- A � Date: 44, ILL( The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR 1 / Massachusetts State Building Code,780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 113 Clement Street 1.1 a Is this an accepted street?yes MI no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' R1 Owner'of Record: obert Greene Florence, MA 01062 Name(Print) City,State,ZIP 113 Clement Street 4135848085 pattvana(d vahoo.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units �,) or' Mops Pool Brief Description of Proposed Work2: Above Ground Pool SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fcc 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees:$ 10730.19 Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(sec below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP - M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele hone Email address D Demolition 111889 02/07/2025 Teddy Bear Pools & Spas HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 41 East Street Conoroateddybearpools.com No.and Street Email address Chicopee, MA 01020 413-594-2666 City/Town,State,ZIP Telephone SECTION 6: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 9 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Teddy Bear Pools & Spas to act on my behalf,in all matters relative to work authorized by this building permit application. ChClitt wner's. (Electronic Signature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Conor Otto 5-13-24 •f�i!�iy (Electronic Signature) D`:°.1 , • NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will Ed have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system_ Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" _ The Commonwealth Masstteliithefit 1*—*4a� / Department of IndustrialAccitlfeitt _ ��elAi 1 Congress Street,Suite 100 watt°,►3_01 � Boston,MA 02114 2017 www.muss.gov/dia Workers'Compensation Insurance Affidavit.:Builders/Contractors/EIectricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Teddy Bear Pools & Spas Address:41 East Street City/State/Zip:Chicopee, MA 01020 Phone#:(413)594-2666 Areyou an employer?Chiilatite'appropriate box: Type of project(required): 1.Q✓ I am a employer with 100 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. [3 Remodeling any capacity.[No workers'comp.insurance required.] 3.1fj l am a homeowner doing all work myself[No workers'comp.7iptsai.]t 9. ❑Demolition 10 []Building addition 4,0 I am a homeowner and will be hiring contractors to conduct all work on.my property. I will ensure that all contractors either have workers'compensation insurance or arc sole 11.O Electrical repairs or additions proprietors with no employees. 12.['Plumbing repairs or additions 5.171 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.n Roof repairs These sub-contractors have employees and have workers'comp,insurance,; 6.[3 We are a corporation and its officers have exercised their right of exemption per Ma c. t4. ✓l Other Pool 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box HI 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. tContractors 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... lam an employer that is providing workers'compensation insurance for my employees. . elow is the policy and job i1te information. Insurance Company Name:HUB International New England Pbj`Ii;y# it Self-ins.Lic.#:WC 8665063 Expiration Date:04/01/2025 Job Site Address: 113 Clement Street City/State/zip:Florence, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy nnapber and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A:041#'Of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature:Conor Otto Date: 5-13-24 Phone#: (413)594-2666 Official use only. Do not write in this area,to be completed by city or town official 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 6.Other Contact Person: Phone#: _ - �....41 TEDDBEA-04 JTALLARIT• ACORD' CERTIFICATE OF LIABILITY INSURANCE DAT00/YYIY) �� 3/27/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER iVigiACT HUB International New England CNN,EA:(833)462-2554 (A�c,No):(413)731 9539 East96Lon Shaker Road 1OnSE: Longmeadow,MA 01028 — INSURERS)AFFORPJ// COVERAGE NAIL H ----- INSURERA:All America Insurance Company _ 20222 INSURED INSURER e_Central Mutual Insurance Company _ 20230 Teddy Bear Pools Inc. INSURER C:_ _ 41 East St INSURER 0: Chicopee,MA 01020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSF IADDL SUBRI POLICY EFF POLICY EXP j,TR TYPE OF INSURANCE 1NSO MIL POLICY NUMBER OM/00/YYYY) IMMIDD/YYYYI LIMITS A )( COMMERCIAL GENERAL LIABILITY 1,000,000 �_ EACHQCCSIRRENCE 3 CLAIMS-MADE X l OCCUR CLP 8665062 4/1/2024 4/1/2025 _per ISESGE OREEB- E ao 8 300,000 _^ MED EXP(My one Person) S 5,000 PERSONAL a ADV INJURY $ 1,000,000 GEHL AGGREGATE LIMIT AP ES PER: GENERAL A�.REGATE S 2,000,000 POLICY(—i�a 11 Loc PROpup s-c0MP/OP AGG $ - 2,000,000 OTHER:General Aggregate POLLUTION $ 50,000 A AUTOMOBILE UABIUTY CO BIBI tlED SINGLE LIMIT $ 1,000,000 X ANY AUTO BAP 8669261 7/1/2023 7/1/2024 BODILY INJURY(Per camel 8 OWNED — SCHEDULED AUTOSAU�Ep ONLY AUTOS BODILY tE INJJUQRYYI(Per E'Cd nQ S AUTOS ONLY OATS ` eri: 'aJ I S B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CXS 8669257 411/2024 4/1/2025 AGGREGATE $ 1'000,000 0E0 X RETENTIONS 0 Aggregate S 1,000,000 B WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY STATUTE 1 ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 8665063 4/1/2024 4/1/2025 500,000 FICER/MEMTO /PARTNDED7 N/A j.l EACH ACCIDENT ( andatory in NI EL DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) CERTIFICATE HOLDER CANCELLATI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Verification of Insurance Purposes OnlyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEJE 4. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. Thn A(nRrl name anri Innn aro ranictororl marks of ACORD Teddy Bear Pools, Inc. �•r,'Tj. 1 r �� 41 East Street • Chicopee, MA 01020 a . • (413) 594-2666 • (800) 554-BEARilk till ��� �5 FAX (413) 598-8823 1 ���T� Ap Home Im�rm�e onals 8`9�/C�TM#520951TEDD ,a:�D�.da TEDDY BEAR POOLS C SPAS THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affat 'and Business Regulation 1000 Washing treed Suite 710 Bosto assachusetts-02118 Home Im ro a len µG a rac oe•isJtration ;n i. s +" « : ,IF--... 0 Type: Corporation TEDDY BEAR POOLS,INC. � ""== �"".�.....� et is anon: 111889 ='= =" E 6 ation: 02/07/2025 41 EAST ST _"'it="it +� CHICOPEE,MA 01020 . Was r N 4rr.17 .w '."' 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I-VA/ r .,A / (/oLi.�n hz�h�l S)k-' !d" S-1-1 l 6 00 n-7 r (� -Dr, Q 90 0 • 6j.r -,.re>r" 641{Hd f 11 s' 'm,4cl , w-) aiivut- \- 5\' C-Lik(i4(9- , rA A . o 00, PO- Fe.4-) 02-- tz NI.,-i_ Sc. F� �� II 4 -- ► ( V•i ( -- Qr'''''j I rGIAAA e`- -OP kl- ,---r--- � � ' /LS 1'':-- , \X 1 Glasshouse Construction, LLC 1119 Dicksinson Street Springfield.MA 01108 US (/ +1 7815000537 _ co josh@giasshouserenovations.com GLASSHOUSE "a$R.} s6r-� o 1:=3 OD nnri Q . estimate 1DDREi F, ESTIMATE 1065 kitty Green DATE 05/27/2024 13 Clement Street Jorthampton,Ma DESCRIPTION QTY RATE r MOUNT Deck Build •Install and dig 8 sonotube concrete 1 8,284.00 8,284.00T supports for new pool deck •All new deck framing will be constructed of 2x8x12 pressure treated lumber.Deck size will be 12'x12'with 4 foot pad coming off right side of deck between pool and neighbors yard. Stairs will come off pad towards house/hot tub •Composite decking will be installed coastal gray will be color)with hidden fasteners to not show any screw holes. •Deck will be picture frames with square edge coastal gray decking around entire deck and stairs to give nice clean finish look. •Deck railings will be white vinyl with black spindles. •Deck gate to match railings will be installed on top of stairs platform. •Deck boards will be Installed proper distance away from pool frame to insure for pool cover and space to get in between frame and decking. - 8,284.00 'Se apprecrate your business.Please tiad your estimate details here• it you SUBTOTAL rould like to pay any portion of an invoice via CC.please let US know. All CC 517.75 harges will has a 4%lee of the total added to the invoice.Feel free to contact TAX s d you h8ve any 9uestiorrs. TOTAL $8,801.75 lccepted By lccepted Date • Page of 1 HOME i-:I,i rNIw`N LIFE SEARCH SHOPPING i it:, 'US Upgrade Now Find messages,documents,photos or people Advanced ••• O patty Home E ,,,,,,<,, , F Back « <« • Y Archive 5 Move m Delete © Spam 28 �attyang@ya... (No Subject) Yahoo/Inbox * gt Ia bob greene 6Tue,May 28 at 5:30 AM ♦' A 1 From:nursebobsr@yahoo.com 360 CHECKING ' To:pattyang@yahoo.com I ` Keep more of your 1' A "¢ money-no fees or minimums Get started I O C CaPnaje r00 !' 1, 360 CHECKING �'6� \\. ij Bank 24/7 with N our top-rated '' N ,\11//' mobile app !til .-,'I, �� /f 14446, -'� View details 45 Yahoo Mail:Search,Organize, Congo" HOME Mi I , -,fOIZT`', ENT`P,AAINMEFFT LEE SEARCH SHOPPINF, I F i: 'US Upgrade Now Find messages,documents,photos or people Advanced s/ (;) patty Home f- Back 411k < . m Archive n Move M Delete 0 Spam 28 Pool deck Yahoo/Inbox * CD )attyang@ya... JCPenney p bob greene rEq Tue,May 28 at 5:31 AM * A 1 From:nursebobsr@yahoo.com To:pattyang@yahoo.com 1 8 if...Li:W.9m telbertfocn com II 8h3p law , • e I C> 6I e . .`...• 111111,11\\\\\\\\\\\\\\\ 111111111/111F:4.::.. ,111, 'I- ti a I I I I t Yahoo Mail:Search.Organize.Congor 41 <4% * ••• . , i __ _