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03-018 *['LEASE READ CAREFULLY* SI 1,1'-iiY-STEP CHECKLIST OF YOUR NEW POOL INSTALLATION CUSTOMER RESPONSIBILITIES THREE.WEEKS FROM CONS RU(_ITON APPLICATION FOR FINANCING-Please make all final arrangements with your bank 3 weeks prior to Teddy Rear's arrival fir excavation of your pool.This will assure no delay,and provide Im completion on tinrc. TREE REMOVAL-Make arrangements with a tree specialist in the c\cm tree>must he eliminated to make room for your pool.At your request,we will he glad to refer you to local companies. REGARDING STAMPS:Any stump that is approximately 3"to d"in diameter within a pool area will be gladly removed by Teddy Bear Pools. In the event a stump must he excavated,a nominal fee will he asses'ed,i.e machine time and/or extra materials needed.We do not remove stumps from the joh site.If you can,have the stumps ground I' below ground level_ SLIIHC SYSTEMS/LEACH FIELDS&DRYWELL-In the event your present septic system or arterial leach ticld lines are going to interfere with pool construction.arrangements should he made now,through a;optic contractor to address([it,concern 'feddy 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 is nonfunctional.please make are it is pumped I week in advance. ACCESS-The tiro,top.of crane.is excavation_Please make sure that cnuy to the yard is clear from Icmccn,wood piles.swingsets.bushes,etc This will he greatly appreciated Tcddy Bear Pools cannot he responsihle lir the renunal for any of the❑hove belays could occur if this has not heen taken care of in advance. It access is across a neighbor's property it will he your nrsponsihilnN to obtain their permission and it w ill be understood that you,not Teddy Bear Pools,will assume the responsihilny tot- the finished grade of vour neighhors yard. TWO WEEKS FROM CONSTRUCTION: BUILDING PERMITS-Plato oh!ain sour huildtng permit two weeks in advance of excavation-where local codes apply Usually these forms will he mailed h_v your town to you upon request Our Home Improvement Contractor License#'s are:NIA# 11189 and CT#520951. ELECTRICITY-"AVOID DELA1"-HAVE P()"E-R SL'PPLY READY."Power must he supplied to the excavation area.A 20 amp outlet will suffice in most cases. W'ATF:R-Please snake sure that vour installation crew has availahility to water and hose For insurance purpose,.we arc unable to allow any of-our employees to enter your home. AT TIME OF CONSTRUCTION: DRIVEWAY/SIDEWALKS- 11 the point of onto for trucks or equipment is over vour concrete or blacktop driveway we regret to say,it is at the owners risk since we have no way of knowing how firm each individual driveway will he We will take even precaution,or listen to any suggestion you might have.to minimize any problem that may arise-Unce again.we cannot accept tnty liability for damages of any kind SITE WORK-"THINGS YOU SHOCLD KtiO NV- SHALE/ROCK-Fxpensc could v acv significantly depending on the circumstance,;therefore,this cost will he discussed on an individual hasis. WATER TABLES/GRO( ND WATER/CLAY/REDPAN-Teddy Bear Pool charges the customer tit direct costs only.Usually one or two loads of crushed ,tune will sutlice for an average water pr'oblcm The cost per load is`y200.00 5300.00 delivered Lvtra excavation for this work and stone will he billed with lahor.) NON-APPARENT t'NDER(,R0( ND OBSTACLES-If underground ctehris or stumps,large rocks.etc.)arc encountered,it ntav he neccssary to use material wch e,grtcel.concrete andior'ono whes Io rcctity any void,created by the removal of 'uch ohstacles_Anv charges for this type of extra material will be collected with your excavation payment. EXTRA FILL-It may he neccssary for us to haul dirt away from your yard to create enough work,pace It this is the case,it will he your responsihility to have additional till brought in for grading,it neccssarv. If you have clay soil,it will he necessary for 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(cave you with a rough machine grade around the pool area Fine grading will he your re,sponsihility. DRAINAGE-Occasionally a site mazy require a drainage sysicm due to irregular lanckcape and soil conditions.Drainage is used to prevent surface run otf and upper seepage toward the pool Water is directed aiway from the pool to a lower point on the site_Guttcr downspout should also he directed away from the pool. RETAINING WALL-It a retaining wall is necessary,please arrange for comtruction and hack till it the wall is to he constructed after the pool installation. Please see that it is constructed promptly to avoid soil erosion- LAN'DSCAPING-"Fedd,y Bcar Pools doc,not provide this service-%b lien landscaping,he sure to maintain a pitch away from the pool and concrete.Crushed gone is an aesthetically effective wav to prov idc proper drainage. WATER TO FILL,POOL-Nor'ntttlly our pool is filled through vour garden hose It water needs to he trucked in.please inform us and we can make the necessary arangements. REFUSE:-Dehris,mainly from the packaging of equipment,will be packed up neatly and Icti tic your curhside trash collection AFTER INSTALLATION OF POOL STRUCTURE: CONCRETE DECKING-Teddy Bcar Pools utilise,the highest duality materials along with the most qualified crattsmcn to ensure that cracking of concrete is kept to a minimum.Unfortunately.given the Norlhcast climate.crackin',of concrete is a fact which cannot he avoided Your concrete deck WILL crack. In some instances,acid rain,leaves,din and other dehni that mac come to contact with yom deck could discolor concrete decking_ Please keep your deck as clean as possible from foreign debris. Within the first month(it deck completion The'-'form(]will scale around it. It will he vour responsihiliry to regrade to mid-deck height. FLOATING LINLRS-Excessive ratint Ill may cause flooding around your pool much like it doe,to a basement.The result of this may be a floating liner,which at tunes may Ica vc wrinkles in the liner wkc can uincntpt to rcnn,ve these wrinkles by resxtting it.The cost of this scraicc will he covered by most homeowner's insurance policies. SEASONAL SERVICE:-Pool opening and closing services arc provided Through our Service Dcpartmcnl,We provide several services to cater to each customer's individual needs-Please do not endanger vour warranty by not haying your pool properly opened and closed.Our Service Department is staffed by professional Service Technicians who are equipped w-ith lacU,n authorr/cd parts'Ind training.The Teddy Bcar Pool Scryice Team will open and close your pool professionally. CHEMICALTRLATNIENT-"Fcdct Bear Pools urge,our customers to use only the Teddy Bear Pools rcconnnended chemicals in you swimming pool.These chemicals have heen specially formulated to ensure the liti`long quality of,fur pnutucts w nhout the risk or fading or wrinkling caused by interior grade chemicals or chemical imbalance.Such disorders arc not covered under your warranty.A detailed outline and hooklet on water chemistry will he provided to you upon completion of your new swimming pool. Please read thi,hooklet aretully Do not endanger vour warrants by using interior chemicals. IN CLOSING....... Teddy Bear Pools is honored by y our confidence,and\k ill do even thin.z vv ithin our power to keep that trust.A swimming pool is it long term investment. Finally.you will he encn complctr instruction,as to the operation of your new Teddy Bear Pool when your pool has been inspected and passed your electrical requirements.This must he done by a[seemed electrician. Thank you once again from all of us at Teddy Bear Pools& Spas THIS NLt ST Bt:SIGNT:D AND RETURNED BEFORE EXCAVATION CAN BEGIN ON YOUR POOL DUE TO INSURANCE REGULA'T'IONS. THANK YOU. Owner Date Please sign one copy o/this page Jbr leddv Hear Pools and keep the other jor-vour records. • • • TEDDY BEAR POOLS & SPAS Not................................................... ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ate■■■.■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■iii■�'1■f�■ ■�"I■■�'i�i■®■■i■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ • ■ 71 No •. Tf Fl.pncing • 71 Yes elNo 0 7T Rid. Permit 7T Water Stumps: I Yes 71 No • • • • Description • • •• • • •• • •• • Teddy Bear Pools, Inc. Known By Our Reputation 41 East Street 1 (413) 594-2666 - 1-800-554-BEAR Chicopee, MA 01020-3562 FAX (413) 598-8823 Home Improvement Cont.MA#11889/CT#520951 AD www.teddybearpools.com -61 Boar fo ui in e ul ion�an tan g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 111889 Type: Private Corporation Expiration: 2/8/2011 Tr# 279922 TEDDY BEAR POOLS & SPAS INC THEODORE HEBERT 41 EAST ST ---- - - -- - ____ CHICOPEE, MA 01020 --- - -- --- - - Update Address and return card.Mark reason for change. - Address -- Renewal Employment Lost Card OPS-CAI O SOM-07107-PC8490 STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it known that TEDDY BEAR POOLS INC 41 EAST ST CHIC4PkC'�'A`•01020 :z is certified by the Depa.rtmetir a$opsiii�er Pptection as a registered HOME IMPRQYNFN' ONTRACTOR 012095 it _ S3 TEDDY BEAR POOLS INC �c�RANSTUI r� V Effective: 12/01/2008 r fk Expiration: 11/30/2009 a. � Jerry Farrell,Jr.,Comms�ioaer ACORD TM CERTIFICATE OF LIABILITY INSURANCE DATE(MM2 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 NAIL III 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 POLICYPERIOD 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. INSA ADO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICYEXPtRA'MM UNITS LTR MR OATE IMMO CATE GENERAL LIABILITY 8500036498 04101109 04/01/10 EACH OCCURRENCE $ 1,()00,0()0 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(EC OCatwm $ 100,000 CLAIMS MADE a OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,()00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG. is 2,000,000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY 32176400003 07/01108 07101/09 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) S 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS I UMBRELLA LL481U Y EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION$ - $ WC Y UMr WORKERS COMPENSATION AND 9104140407 04/01/09 04/01H0 X ToavulEtTS DTM� EMPLOYERS'LIABILITY A EL EACH ACCIDENT $ 500,00t1 ANY Pw)PRIEm"AmvvE=uTNE OFFICBRNMMeER EXCLIJOW? E.L.DISEASE-EA EMPLOYEE $ 50()'ow SPEC, « PR E.L. AS Eune 500,000 SPECIAL PROVISIONe OElow E. DISEASE-POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONSiLOCATIONSNEHICLES/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 MAL 2D 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: I 4iam 0.%Tru ACORD 25(2001108) Cer ifrate 0 41052 ®ACORD CORPORATION 1988 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 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 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 pennits and ins ns are made erstand 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 r ., The Commonwealth of Massachusetts Department of Industrial Accidents Office bf Investigations 600 KashinaQton Street Boston, MA 02111 ` 71 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Name (Business/Organization/Individual): /i7/ Address: Lw� s; 5 — City/State/Zip: Phone#: Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 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 g. ❑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 officers have exercised their 3.❑ I am a homeowner doing all work 11. Plumbing repairs or additions myself. [_No workers'comp. right of exemption per MGL 12.❑Roof repairs . insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. ?r6t er comp.insurance required.] *Any applicant that checks box ml 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 contactors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contactors 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. fipeiot"A Insurance Company Name: Policy#or Self-ins.Lic.#: TJ 000 3ID q 9 Expiration Date: a Job Site Address:9/ h ► ,,,$'&' A 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 verifica�n. I do hereby cer ' er p! and p�Z hies pe ry that the information provided above is true and correct. Si Ynature: /}' Date: Phone#: L( 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered HbjJne-,Iimbrbv6 nibbit Contractor: Not Applicable ❑ Company Name Registration Number J, � Y/ 9 � a/ / - Address Expiration Da et Telephone 64y'2Ga SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c 152,§356 0))" 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 Owrier EzO" on 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 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[] Siding[❑] Other[❑] rief Description of Proposed Work: &< '3tn sjg��� 4Q� 14 V Alteration of existing bedroom Yes No Adding new bedroom 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 fol(owing: 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 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 p alties of perjury. Print Nam ignature wner/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 Size _. .... Frontage _... . _. _ _ _,.. _. ...,,,..__ .._.__.... . .. . ...... .. Setbacks Front Side L: __ ... R. .._.._. L: _ R06-1--- Z Rear _..._ ` — G7�-•s✓ 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 0 IF YES, date issued:'. 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 0 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Department use,tinly ;City of Northampton Statusuf Permit Building Department Cui Gtit/Draye�vay Perrrr ' _- s 212 Main Street Sewertsept<cAvatabitity= Zddg � Doom 100 Ullateff Vell Aara�tabif, a Northampton, MA 01060 Tvuo Sets ofStructuraf Pfans phone 4137187-1 40 Fax 413-587-1272 plt�tStte Mans APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be co leted by office L NS Eli? Map v Lot /7 Unit o� 1 pp )VO It � 0� Zonel- erlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Nam ( r' t) Current Mailin Addres Telephone Sign re 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 com leted by ermit applicant Building �1 �'�' --7 © ° (a)Building Permit Fee 2. Electrical p( / jb)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) fJ Check Number This Section For Official Use Only Building Permit Number: Date Issued: - Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-1034 APPLICANT/CONTACT PERSON GAUGHAN STEPHEN P&LENORE M ADDRESS/PHONE 21 LINSEED RD HATFIELD (413)247-6994 Q PROPERTY LOCATION 21 LINSEED RD MAP 03 PARCEL 018 001 ZONE RR(100 //RI/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction:_CONSTRUCT 16 X 36 INGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 111889 3 sets of Plans/Plot Plan THE�FOOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: Aed 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 - y 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. i A BP-2009-1034 GIs#: COMMONWEALTH OF MASSACHUSETTS 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-2009-1034 Project# JS-2009-001492 Est. Cost: $28067.00 Fee:$60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq. ft.): 100623.60 Owner: GAUGHAN STEPHEN P&LENORE M Zoning: RR(100)//RI/WSP Applicant: GAUGHAN STEPHEN P & LENORE M AT: 21 LINSEED RD Applicant Address: Phone: Insurance: 21 LINSEED RD (413) 247-6994 O Workers Compensation HATFIELDMA01038 ISSUED ON.611512009 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 16 X 36 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 6/15/2009 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo