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29-321 (2) *•1 • -& Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street �4 (413) 594-2666 • 1-800-554-BEAR Chicopee, MA 01020-3562 FAX (413) 598-8823 Home Improvement Cont.MA#11889/CT#520951 www•teddybearpools.com TEDDY BEAR POOLS G SPAS ��e d 9i p Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 111889 Type: Private Corporation Expiration: 2/8/2009 Tr# 126084 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST — --- -- — —_— -- CHICOPEE, MA 01020 ----- - -- ---- -- Update Address and return card. dark reason for change. Address Renewal - Employment Lost Card pc-CAt i� SOM-vv^a,05-PC8698 — --- -- .? _ .times;, \:'.• " � 1':`•;� 'f.'_ ��",Jfja �. c�ti ,p\i/ ''TFl °/ f+ •'' r` r /= Fi �+r STATE OF CONNECTICUT + DEPARTNIENiT OF COSUi�1ER PROTECTION Be it known that - TEDDY BEAR POOLS INC 41 EAST ST CHICOPEE, MA 01020 i< certitied b the Depanmenr'ofConsumer Protection as a registered HOME IMPROVEMENT CONTRACTOR ,, T Registration # 520951 TEDDY BEAR POOLS INC EffectP.e: L/O1/2006 Expiration: 11/30/2007 Edwin R Rodriguez.Cmnmi—innef '�'' ACORD TM Ct2TIFICATE OF LIABILITY INSURANCE 07116/2007 PRODUCER Phone, (413)781-2410 Fax 413-731-9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATICN 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 NA1C# INSURED INSURERA. ARBELLA PROTECTION INS CO TE DY BE POOLS,INC INSURER B: ST ST INSURER C: C ICOPEE 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 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 AWL POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS LTR INSfiO DATE DATE M GENERAL LIABILITY 8500036498 04/01/07 04/01/08 EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILITY PDAMAGE g(Es 00=xe) $ 100,000 CLAIMS MADE FX OCCUR MED.EXP(fury one perm) g 6,000 A PERSONAL SAOVINJURY S 1,000,000 GENERAL AGGREGATE 3 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG. $ 2,000,000 POLICY PERCOT LOC AUTOMOBILE LIABILITY 32176400003 07/01/07 07/01/08 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) 3 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per Person) 3 X SCHEDULED AUTOS A X HIRED AUTOS BODILY INJURY (Per accident) 3 X NON-OWNED Al1T0S PROPERTY DAMAGE $ (Per accident) GARA03E LIABILITY AUTO ONLY-EA ACCIDENT ; H ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO S EXCESS/UMBRELLA LJABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE f i j j ElDEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND 'TORY u u °TM� 5104140407 04/01/07 04/01/08 X Torrruwrrs EMPLOYERS UAWLrrY EL EACH ACCIDENT S 500,000 A ANY m0PRlET0RNARTNER1EXkcuTIVE OFFICEIVAEMBER EXCLUDED? i E.L DISEASE-EA EMPLOYEE $ 500,000 If m'desafts WWI" I E.L DISEASE•POLICY LIMIT f 500,000 SPECIAL PROVIStom bak- OTHER: DESCRIPTION OF OPERATIONSIi_OCATIONSIVEHICLESIEXCLUSIONS 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER R'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /Attention: iam O.Tru ACORD 25(2001108) Certificate S 28744 C ACORD CORPORATION 1988 III, I r**Mm O � L6 CO CO 0) qqrmm I N O m O N r- qqrmm cyi � co N Y, 2� c co 00 LO O � N CY) i i o �O O� Lzty of X ort4allipta t Z �.. � �833ACh1I8tif3 DEPARTMENT OF BUILDDAIG INSPECTIONS 212 Main Street • Municipal Building INSPECTOR / Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as l.is/her construction sup!:: ..`,Sor. 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 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 buildine inspection (before work is _con_cealed) insulation inspection (if required) anda_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 occupanev 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 77 ,/,, z rZ .C w✓' 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 of Massachusetts Department of Industrial Accidents W� Office of Investigations �l 600 Washington Street Boston,MA 02111 �M = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers ADDlicant Information Pigase Print Legibly c Name(Business/Organization/Individual): Address: City/State/Zip: Phone.#: Are you an employer?Check the appropriate boa: 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 proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no enoployees These sub-contractors have g. ❑Denoliuon working or me in an capacity. employees and have workers' g Y P tY- $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ 1 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.] 'ttriy app icant-mat caecks box 41 must also Hu out ttie sectors 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 workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:- �!'t/ ���Zdq 7 Expiration Date: Q 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$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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Siznature: Date: Phone#: vffcciai use only. uo 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 S.PIumbing 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 ;.,.. Not Applicable ❑ 9 ,Registered Norrie_linprovement 6IA6ctor:; Company Name Registration Number 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...... ❑ 11.:--Home Ow>ner.Egemption 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. �tfomeowner Signature I * -* ! 9 . SECTION 5—DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other 0 Brief Description of Proposed Work: //'2-/Cc L ✓i be r P sI rot (/'l l Alteratiori of existing bedroom Yes No Adding newbedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.'1f New house and.-or-add Lion to existing fiousmd;-complete the fo(lowiina: 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. Mouplall, �—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 1 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 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. Print Name S' gnature of Owner/Agent Date 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 Sizej� Frontage Setbacks Front Side L:_ R L: R. Rear Building Height III Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved i0 1 parking) #of Parking Spaces Fill: -- I (volume&Location) A. Has arS`Spp�ecial Perm it/Variance/Finrdiinn`g ever been issued/f/orr/on the site? _— NA __LPL E)ONT 14PIA—W , 1 YES { 1 IF YES, date issued:' CJ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page- and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO G DONT KNOW 0 YES 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 ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 NO f� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. «..wilr•� tax••- S Oeparf€ en f€tse aniy City of Northampton Statusoi Permt F R Building Department Curb Cu1LDnuewa !?ermtt _ 312 Main Street Sewerz SepttcAva�labrJrtynRR , I• �� Room 100 � eUe1 Ava�labE[ ity- Northampton, MA 01060 - Setsof8tructLf1tFPan ne,t 3-587-1240 Fax 413-587-1272 PloflSEfe Pfarl ' L�tl� AU APPLICATION TO CONSTR�ItCT,A4TER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING fSE CTIO N:f=SITEINFORMATION Property Address: This section to-be completed byo�ce• 11105 Lot . nit' ✓ � Zone. /f Overlay District EbrifSt.,DIstri SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: jH-F,ll 1, Name(Print) (j /Jf i/ T Current Mailing Address: i �i4 Telephone SignatuA 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3.-ESTIMATED`CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building /DID j (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 O#kfa!`Use Only _..,- Building Permit Number. Date issued: Signature: v Building Commissionedlnspector of Buildings- Date File#BP-2008-0177 APPLICANT/CONTACT PERSON CHARTIER MAURICE J JR&SHEILA ADDRESS/PHONE 405 ACREBROOK DR FLORENCE PROPERTY LOCATION 405 ACREBROOK DR MAP 29 PARCEL 321 001 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 T_ypeof Construction:_INSTALL 15 X 30 ABOVE GROUND 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO�tMATION PRESENTED: 1-,'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 d0 -Z ! J Signature of Building fficial 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. 405 ACREBROOK DR BP-2008-0177 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-321 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit:' Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0177 Project# JS-2008-000259 Est. Cost: $10000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 14026.32 Owner: CHARTIER MAURICE J JR&SHEILA Zoning. URA Applicant: CHARTIER MAURICE J JR & SHEILA AT 4.05 ACREBROO_K.,DR Applicant Address: Phone: Insurance: 405 ACREBROOK DR (413) 586-8973 O FLORENCEMA01062 ISSUED ON:812412007 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 15 X 30 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: Smoke: Final: Final: 0 - )_[b• d g THIS PERMIT MAY BE REVOKED BY T ITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL TIO Certificate of Occu anc Si nature: FeeType• Date Paid: Amount: Building 8/24/2007 0:00:00 $25.003893 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo