35-241 .... . ........ / N /i A iu t %/..Y'Y Yf 'r JAY Y/FNiY•Y/YYfJ;y i�nJC•'.•% :;M'. /:J,GjY�4 Y T' :.. .. .
' l
DATE
03 28 03 <:
PaoouceN
......... " f` Ia IsSUED As A MATTER OF INFORMATION
-1 ONLY INSURANCE CENTER OF N ENGLAND HOLD AND CLv AT RIGHTS UPON MEND EXTEND OR
HOLDDa 'THIS CERTIFCCATE GODS NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O BOX 1175 COMPANIES AFFORDING COVERAGE
W SPRINGFIELD MA 01090 COMPANY
A HARTFORD INSURANCE COMPANY
INSUaED ! COMPANY
TEDDY BEAR POOLS INC I B COMMERCE INS CO
ATTN: TED HEBERT COMPANY
41 EAST ST C A. I . M. MUTUAL INS CO .
CHICOPEE FALLS MA 01020 COMPANY
D
cc�ERaGE __ _ _ _ _
.. . . ...... .....
.....
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LWITS
LTR DATE(MM/DWYY) DATE(MM/DOlYY)
GENERAL LIABILITY . 0 8 UUNQS 9 3 8 7 04/01/03 7 0 4/01/0 4 GENERAL AGGREGATE s2, 000, 000
�{ COMMERCIAL GENERAL LIABILITY. PRODUCTS-COMP.IOP AGG s2 , 000, 0 0 0
CLAIMS MADE X OCCUR PERSONAL&AOV INJURY 31, 000, 0 0 0
OWNER'S 3 CONTRACTOR'S PROT EACH OCCURRENCE -S.1, 000 , 0 0 0
FIRE DAMAGE(Any orw 6n) 3 300, 0 0 0
MED EXP(Any one peon) S 10 , 000
AUTONOBIL.E LUBILITY 0 3 MMVN14 6 6 3 04/01/03 0 4/O i/0 4 -- -- ——` 1, 000 , 000
COMBINED SINGLE LIMIT 3
ANY AUTO
_ALL OWNED AUTOS BODILY INJURY 3
X SCHEDULED AUTOS (Par rrwn) ---
X HIRED AUTOS BODILY INJURY 3
X NCN-OWNED AUTOS IPM
accident)
.- — P90PERTY DAMAGE 3
i
i
GARAGE LIABILITY AUTO ONLY.EA ACCIDENT S
AN At.;70 _OTHER THAN AUTO ONLY:
EACH ACCIDENT S
AGGREGATE 3
i
EXCESS LIABILITY EACH QCCURRENCE —a„ – —
UMBRELLA ECQM AGGPEGA°E i
C-1-Ea -}--AN UMBRELLA=CAM
a
C W ORKEA3 COMPENSATION AND WNIZ 8 0 0 2 9 9 4 0 1 - 04/Cl/03 C 4/01/0 4 X R'-;M[73__ -ER
—`--.
EMPLOYERS' LIABILITY EL EACH�CCIOENT 3_...500 , 000
THE P9CPRIETOR, INCL EL DISEA_SE-PCLICY LIMIT___3 50c , 000
PARTNERS EXECUTIVE
CFFICERS ARE, EXCL EL DISEASE EA EMPLOYEE S S00 , 000
OTHER
OESCRIPTION OF OPERATIONS,LOCATION&VEHICLESiSPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
O WHOM IT NtAY CONCERN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
20 DAYS WRfTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LIFT,
BUY FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KBO ItON THE_ T. ITS AGENTS on aEPaE3ENTATME3.
AUTHOR a !
X JY-F .
ACORD ZS-S /ASj aACORO -CORPORATION 1l3a
Teddy ear Pools, Inc.
y Known, By Our Reputation
41 East Street ( (413 594-2666 1-800-554-BEAR
Chicopee, MA 01020-3562 FAX (413) 598-8823
Homm Improvement Cont.MA#11889/CT#520951 dp Alb w ww teddybearpools.com
TEDDY BEAR POOLS 9 SPAS
STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTIOi`,'
Be it known that r
TEDDY BEAR POOLS MC
Y° 41.EAST ST
C MCOPEE,K 4 01020
has been certified by the Departs" tit of Qbr stoner Protection as a registered
s
HOME IMPROVEMEINT"CONTRACTOR y
Contractor of Record:-TkM0D0RE G. HEBERT
Registration #• 520951
E ffec ti%e: 12/01/2003
Expires: 11 '330 .•
2004
Ja T. Fleming.Comm sioner
jyl (Aea 14 1 a c/e, effj,
Board of Building Rec-ula ions and Standards
One Ashburton Place - Room 1301
Boston. itilassachusetts 02108
Home Improvement Contractor Registration
Reqistrat]on. 111889
Type: Pnvate Corporation
Exoiration. 2i8i2005
TEDDY BEAR POOLS 8i SPAS INC
THEODORE HEBERT
'41 EAST'ST
CHICOPEE. ti!r. 01020
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e ?e Gif-r of 'Nort4aillptan
Z =
�ItIl ASSA[}�1i8[tt5 I
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal 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 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 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
C�i,zf�J of Nal-ilJzimpf[III
6 �fl�i35 AC{11SSCII�
z lll:Pl�t2TNID,,'T OI' £UILDI?�G INSPECTIONS
212 ATnin Strcet ' Municipal Building j
Northampton, Mass. 01060
WORICE<'R'S COMTENSATION INSURANCE AFFMAVIT
principal place of businessJresidenc�2
��p110 f1 LFr;
do 11 C1Cby CCrill} 1::7:1 1" Lhe pai17S a lid pcn ltle.. 01 pe.I�111�J, ?11aI
I am an employer providing the follow.,_ v,ork-cl=s eornncasacion cove;-awe -or my
eltlployces working un t}lis job:
(Lassl czn Cony) l c c,Number) — (rarir,:ioa Datc)
j I am a sole proprietor, general conij-2c`or o- honleo,.,�-ne: (circle one) and 1:ave hired
the con—L,ac7tors listed beio -.010 ii th? `Olt 2 `�;OFke"S comoeII--�Z;iorl
(-N1=c of COnIS 1ClGr) (Ins -nc Cor1��-:;v�PolicJ Nunn r) i� '• :�.�c^ Date)
(Nacrtc of Conumclor) Nlmir_r) (Fx .anon D2tc)
(N2mc Of Coatmclor) (lr]J �I)Cv t_O ]F,?_ .i%�OII�:TvillIlf��r) '_Aj,ii�i 0� Dal,-,)
- (Name of Contl-ilclor) — (Ins Inc Com- y.}'�olic� Nu.m);�) (I,;n:-:lio Datc)
l 1 Lull it „olC 1?rUl?CIf.0i i!:1:1 1?ijv' 110 0111, ..'it? ii` for ill
?ill a home
cl
not utcce th_o thrrce um,5 in t i ic't Lhc b;tip..zr r:::.�Zo Gi oc—` v:-wit z cc_ni Lhce o t2 n t wally c.:r.:::::r, :o h
cIployc3 U:: tiv,tvo:i'.'a cc^- '.at;cc Prt(G 7.1 S2�s t(S);•'-:acme.,b,n hnt-icot,-xs`•cr a L c c ct p-r^i::: ...'ter c L._
Icgal rtatua of an c=pIoy undo i n Wa 1 c,. oz;xar.tion!.ct
1 unde.xl.nd thL a copy of tlii ct euy bo fo nrcio-1 to 0 f rtw LZrsL of 1.dxl tri.J Cil for the
covera&c vaifi=ioa and that C It re tot c coy r ut 3 sc`.iec:S A n(1.GL.1 S2 cxn ir:i to t!x im}azT tics oC cr i:l pawl:cs
comirti-tg of a fur-of up to S 1.500.00 n:t14x ir:pri �z !of:;p to un-}u e:-.l dvil pCmItia in d�Conn of+S!cp' `ni: t:A
firm of',1 OG.Do a day igtin:l rns.
Foe dq:utzxrrLzl u�c Wly
t ,
`r r _
StcAaCllrC Ot, 1.iCC:1:;C�1 CCllliilr'°
SECTION 8 :CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
� Regisfered�t�o'�me�lm'droirementnGontra°cto �,; � ,�� �� �, „_ _�� Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 1NORKERS'COMPENSATION INSl1RANCE°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...... ❑
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-year period shall not be considered a homeowner.
Such"homeoNvner" 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 P� ts I�}�j�l�tN J
SEGTlONSDFStPTtON OF�PROPOSED WORK(check ll a hcale
i
e . pp c 'sue
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks
[ ] Siding[ ] Other�
Brief Description of Proposed Work: A6auc`-ro;,,J� Sw1M,,nrn�fi ���;1
Alteration of existing bedroom Yes_4 No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes _ No
Plans Attached Roll ❑ • Sheet❑
6a I°f�.ew`°. oudor� 8dition°Ito.existing:fousiiig �cariphe�e fhefollowin� /~f�'��
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. Mascheck 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 7a OWNRUTHORIZATION TO.BE COMPLETED WHEN:
`OWNEFSAGENTOtCONTRACTOR APPLIES FOR BUhLDING 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.
�wvs, r
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
6
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage 121
Setbacks Front
Side L: R: L: R: Zd
Rear `f
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved �d�o
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON T KNOW YES
IF YES, date issued: AT!J fA-
IF YES: Was the permit recorded at the Registry of Deeds?r
NO �I VC� DONT KNOW YES
IF YES: enter Book fJ 1`N Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? N�l
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: /9j
D. Are there any proposed changes to or additions of signs intended for the property?YES
No N
IF YES, describe size, type and location:
S
111
City of Northampton >�
Building Department . tea.
212 Main Street `
Room 100 a
Northampton, MA 01060 `
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This section to be completed by office
1.1 ProuertyAddress:
43 b' -i SL.; fPc4 ANC= Map : 1 Unit
c
/V,)✓Ld'l( w �t f G 2 done O�rerley D
C5 �stlnct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
%�-/, Y^7,-a.'A N , 14c /j rw& j( -f3 z f-oYsLr4eeet Lam-, �fap ,� 0racz
Name(Pri nt) f(� {I �q N � �( w�ff Current Mailing Address:
Telephone
Signature �°j �(3 ,76c
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 (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 =(I +2 + 3 +4 + 5) 1"7 JCS Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2004-0991
APPLICANT/CONTACT PERSON HELLIWELL PETER B&SANDRA N
ADDRESS/PHONE 43 LADYSLIPPER LN FLORENCE
PROPERTY LOCATION 43 LADYSLIPPER LANE
MAP 35 PARCEL 241 001 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
T_ypeof Construction: INSTALL 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 F LLOWING 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
Z ``
Signature of Building Official Dat
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.
43 LADYSLIPPER LANE BP-2004-0991
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-241 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-2004-0991
Project# )S-2004-1465
Est. Cost: $17000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 45302.40 Owner: HELLIWELL PETER B &SANDRA N
Zoning: SR Applicant: HELLIWELL PETER B & SANDRA N
AT. 43 LADYSLIPPER LANE
Applicant Address: Phone: Insurance:
43 LADYSLIPPER LN O 586-1708 O
FLORENCEMA01062 ISSUED ON:4126104 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ABOVE GROUND POOL
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occ panty Shmature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 4/26/04 0:00:00 mo0257 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo