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29-583
121 WOODS RD BP-2017-0053 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-583 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Above ground pool BUILDING PERMIT Permit# BP-2017-0053 Project# JS-2017-000097 Est. Cost: $8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq. ft.): 20168.28 Owner: PARENT RYAN M&KIMBERLY L Zoning: Applicant: PARENT RYAN M & KIMBERLY L AT: 121 WOODS RD Applicant Address: Phone: Insurance: 37 GREGORY LN ( ) 584-8480 0 Workers Compensation F L O R E N C E M A 010 6 2 ISSUED ON:7/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 24' 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 7/21/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0053 APPLICANT/CONTACT PERSON PARENT RYAN M Be.KIMBERLY L VI ADDRESS/PHONE 37 GREGORY LN FLORENCE01062( )584-8480 Q PROPERTY LOCATION 121 WOODS RD MAP 29 PARCEL 583 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT FeePaidM0 Me Building Permit Filled out „/ j�V Fee Paid Tweet Construction: INSTALL 24'ABOVE GROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 111889 3 sets of Plans/Plot Plan THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN MATION 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 Pennit 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 ds-- / i 7 of I 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. REC ga F e Commonwealth of Massachusetts 1.v oar. of Building Regulations and Standards FOR mitD « asschusetts State Building Code, 780 CMR MUNICIPALITY USE nu„ . q` i1 Ap I lication 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 I:SITE INFORMATION 1.1 Prope�rrryty' Ad ss: 4 1.2 Assessors Map& Parcel Numbers 14 W ;0O aS 1.1a Is this an accepted street?yes 0 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❑ Private 0 Zone:OOutside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ecord: {'.,t3{nn4-- dr\ivy)heArti • j anent 3bray' P 1 FAA GIn(„ z Namet(Print) City,State,ZIP IZ1 ' ion as gi3 - C41-(Pie3ci kpaxentem`i-inet(OIQt. eck& 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑✓ Specify: Pool Brief Description of Proposed work': Above Ground Pool SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ I. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees:$ Suppression) ��/�y Check No. Check Amount: /" Cash Amount: 6.Total Project Cost: $ g.00 0 0 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(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 111889 02/08/2017 Teddy Bear Pools & Spas HIC Registration Number Expiration Date HIC CompanyName or HIC Registrant Name 41 East Street 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 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 Teddy Bear Pools & Spas to act on my beh. �.•• .II matters relative to work authorized by this building permit application. Print Owner s Name(S ectronic 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. Stephen Otto Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.eov/dos 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 of Massachusetts Department of Industrial Accidents — _ Office of Investigations 5 77:41,121 600 Washington Street Boston, MA 02111 tirsat� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatioNlndividual):Teddy Bear Pools & Spas Address:41 East Street City/State/Zip: Chicopee, MA 01020 Phone #:413-594-2666 Are you an employer?Check the appropriate box: Type of project(required): l.[✓] I am a employer with 100 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 proprietor or partner- listed on the attached sheet. 7. 5 Remodeling ship and have no employees These sub-contractors have 8. ❑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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL Y 12.0 Roof repairs insurance required.] c. 152, (4),and we have no employees. [No workers' 132 Other Pool comp.insurance required.] 'Any applicant that checks box H I must also fill out the section below showing their workers'compensation policy information. 'Ilmneowners 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 slate 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:ACadi Insurance Compay Policy#or Self-ins. Lic.#:WPA0382194-14 Expiration Date:04/01/2017 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Stephen Otto Dale: Phone#: (413) 594-2666 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Teddy Sear Pias, Mt / �I Known By Our Reputation 41 ®sz Street �. r� ©� J (493)594-2666 0 1-SOO-554-B EAR Chicopee, MA 09020-3562 \1 \I ,,FAX 093):593-3323 Home Improvement Cont.MA#11889/CT#520951 QI0) r) www.teddybeclrpooes.cofel SPAS 1 0i-e1 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massach efts 02116 Home Improvement Cor Registration • Registration: 111889 — mei Type: Private Corporation / i [/ Expiration: 2/8/2017 Trk 260956 iiii TEDDY BEAR POOLS & SPAS INC ----Tr 14 M .w THEODORE HEBERT III 41 EAST ST CHICOPEE, MA 01020 i �1c . 7 m1 ^M 0,0`.• Update Address and return rd.Mark reason for change. Address Renewal caEmployment Lost Card Al: 0 2DML5/11 ;rC' yw v.t K.w KY`.:1„r ..Y =• Yr' .4k-k- :Ii'e !, ♦ r.a'. yy,Y "�' y i'_ y . ,i �`'ri ct: , a°6i, „,- s.. ,-n r ?4•�$a6 4� e° k,:R£i -t , 112w�k i • C,. s c Y *NI 6 � ;3'1411 +hnf 3t' 8#4C + 7' 14 t��s s.{.,''' '_.,.,4G t 7'.-eq* - ° err -8141 ,ry'T'x"��'-��' + �^�`' s Ile 1. a? Si y Dpi r - 4$4. . Bae of w 34 7:,:?,,--s e .. lre z y > 'a' , p@ i.yw s ii : . �• c, 7 ,r �yA'1" : , 142 4 +aft,+ . �,k8 1 . e . py'k41 � yfs ' }ys b e : er'r ,�`' "'}' �$ z� a xx-.r �`� 'et esa,-,A4 '-e, Ti.,, ..,q n; -fir sr' f < a x '" x g it- r'3.�I"x ,s 'as a ir. ,++„v r,4- % e „a k ,;r 4 Y,,," Sa&a�`Yei' itw rS,,�„s.r3i d4:94.C. 'k "K; ..d� s '' a: -14, r _ ,4k AI --t �e�ke _ 11,4t-,‘-.-rF. h•2y{ '.,1 --74..-.......A.,..4 x..�+� A a.. .k �av�� .� �l.t4.fly - As ie ▪k'st' Rte' E'�X t! `, t'LL( -`a ` b 1--t" 3 f` ,,Cs1y e _ 'er �,• r t' 1 i)E µp-. '-i oar - v-17.7 .-`eLtP . y $r` 411. 11S`T �_ • v'd`al+r'i9 4 , `+ gx 5sv,Enid' "'[ �:.o. v.. - z x ars %a d� , • • .a.* i~k 5Fa, gi. j .. _ 1, 4 Anw M,W. '�'m R, --""..., TEDDBEA-01 MPROULX a� CERTIFICATE OF LIABILITY INSURANCE DATE M 6/28/2016/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TME 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 policypes)must 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 Ileu of such endorsement(s). PRODUCER CONTACT Insurance Center of New England,Inc -PHOt@ "'"_'-"' FAX -- 1070 Suffield Street LAIC um em:(800)243-8134 g�p,qor(413)7315539 Agawam,MA 01001 CESS: __._.__. INsUREWS)AFFORm3a COVERAGE NAICB Inseam A:ACadia Insurance Company INSURED _INSURER a:ALL AMERICA • 20222 Teddy Bear Pools Inc INSURERC: 41 East St INSURERD: t _ 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.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR iYae OEINSURANCE "i,. ,•:: •ar•_ ]. +:a,.• yp LTR INSD WVD POLICY NUMBER n . MessivrYI (MMNGTYYYI LIMITS A X COMMERCW&GENERAL LIABILITY EACH OCCURRENCE 1,000,000 ' CLAMS-MADE [X I OCCUR CPA0382188-15 D4/012016 04/01/2017 PRELIISES(FeEN 1 Eamtu 1 —250,000 NED DP ,yu y are poral 5,000 PERSONAL&MVSJJURY 1,000,000_ GEN&AGGREGATE LIMIT APPUES PER I GENERAL AGGREGATE 2,000,000 mJEm0. POLICY�� L_J LOC p2ppIC15-CPIP.OPAGO 2,000,000 i OTHER' AUTOMOBILE IJAe'LLW Ise e tIBINE1)SINGE UNIT1,000,000 accide B ' ANY AUTO BAP 9655061 07/01/2016 07/01/2017 BODILY INJURY(Prprml) PLL OWNED 1 -[1 SCHEDULED BODILY INJURY(Pet accident AU iubAlti Die X HIRED AUTOS X- NONOVMED PROPERTY DAMAGE _AUTOS (Pr aYGrM UNRRA IALIAR COLLAR FACHO"/'a RRENCE — ra.ebs WB CLAIMS-MADE AGGREGATE DED I RETENTIONS WORKERS COMPENSATORPER lar* ER EMPLOYERS'LIABILITYX STATUTE 1E? A ANY PROPRIETDanPRTNa ECUTNE YIN WPA0382194-15 041012016 04101/2017 EL PANPLLDEN( 500,000 OFFlCeuMEMaER DTI USED N 1 N/A (MYmµSC*tory N NH) EL DISEASE-EABAROVES 500,000 DERRIPIION OF OPERATIONS Wow EL DISEASE-POICYLMW 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/V I1ICLES(ACORD 101,AddItomi RemarksSCMJWe,may be MOmed II more space b required) To show evidence of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Verification of Insurance Purposes Only THE CPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r �-) Above Ground Pool Plot Plan �. a a `''r i TEDDY BEAR POOLS C SPAS 1470 The plot plan below is approximate measurements for the pool placement at- the home of: Customer Info: an-- ak t inn crit 2i (1 E-in 1. In the City/Town of: 51,0)(`-P.yj U j Alt-4- Above ground pool set backs are: of House Side Rear Septic Leach Field y 11; ; el •1111111 L. , 111111111111101111111111111111111111111111111I ; ; ; 1111 MINI --T- 11111111111111111111111111111111111111111111■� iiiUtiIn f 111.110111111 EN : te r ; 1111 nlhuiiiiuiiii 1 i1 11111 fi1 MIMI I.■ ; ; ; 1 a ; MEN um ; ; 1111111 EMS 1111 �I r more. cams , T- _� + + I ■■u 7_ t 4- 'Iititi ; ...au !�nu■n■ _ II ■■uInn ■ m ■■■■■. 1I1111111lu11IM111111111 I I I , I ? ( •Draw out you backyard including the back of your home and lot lines.Show measurements from lot 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: Date: 41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpools.com