35-230 (8) 24 BAYBERRY LN BP-2018-1030
GIs d: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 35 -230 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Ineround Pool BUILDING PERMIT
Permit# BP-2018-1030
Project# JS-2018-001870
Est.Cost: $48497.00
Fee: $75.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grm10: TEDDY BEAR POOLS & SPA 111869
Lot Size(sa. ft]: 74487.60 Owner: CURRIE MELANIE
zo> n� Applicant: TEDDY BEAR POOLS & SPA
AT.- 24 BAYBERRY LN
Applicant Address: Phone: Insurance:
41 EAST ST (413) 594-2666 O Workers ComDensatiop
CHICOPEEMA01020 ISSUED ON.-411712018 0:00:00
TO PERFORM THE FOLLOWING WORK 18X36 IN 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 4/17/20180:00:00 $75.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1030 f)
APPLICANT/CONTACT PERSON TEDDY BEAR POOLS& SPA I"
ADDRESS/PHONE 41 EAST ST CHICOPEE (413)594-2666 Q
PROPERTY LOCATION 24 BAYBERRY LN
MAP 35 PARCEL 230 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Lr I
Fee Paid
Typeof Construction: 18X36 IN GROUND P
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 F,OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN gRMATION 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 Commission Permit DPW Storm Water Management
Demolition Delay p
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.
The Commonwealth of Massachusetts
lBoard of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
F"�r✓� Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mnr 2011
One-orTwo-Family Dwelling
This Section For Official Use Only
Building Permit Number: 819-1 -rO-Ja J41te Applied:
A'fJ Grila LLg_
Burl mg O ma ( n ame ave
SECTION 1:SITE I14MORMATION
1.1 Property Address: 1.2 Assessssor�s 11}ap&Parcel Numb
24 BAYBERRY LN. I��II bb F/
310
Llals this an accepted street?yesyL no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(R)
1.5 Building Setbacks(11)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
10 80 10 175
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check ifyes❑ Municipal❑ On site disposal system [I
SEMON2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
MELANIE CURRIE FLORENCE, MA. 01062
Name(Print) City,Santa,ZIP
24 BAYBERRY LN. 781-864-6389
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alutation(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other F✓ Specify: P00I
Brief Description of Proposed Work': 1BX36 IN Ground PODI
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ElStandard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
6.Total Project Cost: $ 48,497 Check No3O(1 Check Amount: Cash Amount:_
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.
R Restricted 1&2 Family Dwellin
City/Town,State,ZIP M Mason
ry—
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(HTC) 111889 02/08/2019
Teddv Bear Pools & Spas HIC Registration Number Expiration Date
HIC Cmrn a Name or HIC Registrant Name
41 East Street TEDATEDDYBEARPOOLS.001
No.and Street Email address
Chicopee, MA 01020 413-594-2666
Ci /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 ..........t] No...........❑
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 Teddv Bear Pools & Boas
to act on my behalf,in all matters relative to work authorized by this building permit application.
M8L_RJie C(JfI- lP " 11 4X
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW 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.
TED HEBERT 3/25/2016
Not 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.a 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/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 ofMassaehasetts
Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
WVv.skers'Compeasation Insurance Affidavit:Builders/Contracton/Electricians/Plumbers.
TO BE FILED WITH THE PERhDTPING AOTHORMY.
A Ii
Information Please Print Legibly
NameTeddy Bear Pools & Spas
Address:41 East Street
City/State/Z.ip:Chicopee, MA 01020 phone#:413-594-2666
Are you au employer?Cheek the nppropraft hox: Tyke of project(required):
t0✓ iamaemployar Witt 100 employcea(tWl arworP -tie)" T ❑New construction
z.❑IemasolepropriemrmparmeNupand haveno employees working for P.e in 8. ❑Remodeling
any.'.it,INowodrma'comp.insumoce 'NuhN.]
3.❑l amahomeovmer doing ell wwkrn elf Mo woke'comp.irvsumaceraryuN.]i 9. Demolition
4.❑1 am ahomeownv avd will to M1irivg conuactom to mvduv all wed on my Property. 1 will 10❑Building addition
ensure waz au covnecmrs eitherhavewmken'compmration vuwavice mare sole 1LE]Electrical repairs or additions
pmyriesors wth m wPloyees.
12.[]Plumbing repairs or additions
5.❑]aura geveral oosasuor and i have hued Use sao,oahactors listed an Ne ettacsM,hee[ ]3.❑Roof repairs
Thus salrcoabactom have employees and baveworkas'tamp.insurartcc.t
5.❑Waueacmpomtionsod its of .have ezemisW the¢right ofexemptiw pvMGL c. I4.Er Other POOi
152,§1(4),and we have m employee:.INoworkem'comp hnurmcerequ"ved.J
'AnyapPlicars, toheriubox#1 mustalaofliIautlhe sectionbelow aboxmgtheuworkas'compevsationpoliry ivfonaatioa
t Homeownvswhosubmnthis et5davitindicazwg tbeY medoingaa workeaditma eoulaidecotIDaWmrs twbmitarmwatfsdavitindicanogsach.
TConhacmn cwcbeekdvs box must amalod an additiovl sleet showing tlw vmoe ofthe submatacmm andsm¢whdhvm ret thasecntitiu have
employers' ]fdesubeMectombaveemployeea,theymartprovidetheir coo 'romp polity vmobv.
I am an employer that is providmgworkers'compensation insurance for my employees. Below is the porry andjoh site
information-
Insurance
nformationInsurance Company Name:Acadia insurance Company
Policy#or Se)€ins.Lie.#:WPA0382194-16 Expiration Date:04/01/2018
Job SiteAddress: 24 BAYBERRY LN. City/Stalelzip_FLORENCE, MA. 01062
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dateL
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a foe 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 line of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
Ida hereby certify under thepains and penalties ofpujury that the information provided above is true and correct
Sienature:TED HEBERT Date. 3/25/2018
Phone#: 413-594-2666
Offrciat use only. Do noswrhe in this area,to be completed by city err town offrciaC
City or Town: Parmitfl.icense#
Issuing Authority(circle one):
1.Board ofHealth2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
TEDDBEA-01 ULX
,4`ORD CERTIFICATE OF LIABILITY INSURANCE °A03/232018 ,
03/23/2016
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),AUTHORMED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the polig(Ies)must have ADDITIONAL INSURED provisions or be endoreea.
If SUBROGATION IS WAIVED, Subject to the terms and conditions of the polity,certain policies may require an endorsement. Astatoment on
this certificate does not confer rights to the canlOcate holder in lieu of such endorsements.
PRODUCER , cT-_
Insurance Center of New England,Inc - - _ --
1070 Sumeld Street PHONE.M Exr:(800)243-8134 I,ING.K04413)731-9539
Agawam,MA 01001 1 AAILADDRESS: _. _
INSURENS)AFFORDING COVERAGE _ MARC 0
_. .. INSURER A:ACacHa Insurance_Company
INSURED INSURER e:ALL AMERICA 20222
Teddy Bear Pools Inc. INSURER C.
41 East Sl
INSURER D: - _ •_. -_-
Chicopee,MA 01020 - -- - --
INSURER E:
INSURERF: --
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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.
INSR pODL SUBR - --POLICY EFF - POLJCY EpP -- -
TYPE OF INSURANCE POLICY NUMBER LIMB$
A X GO MMERCIAL GENES LLIABILITY EACH OCCURRENCE '.S 1,000,000
CLAIMS MAGE X OCCUR CPA0382188-i6 0410112018 04/01/2019DAMAGE TO RENTED - 300,000
PgEMISE5(ESIxA, ercej S -- _
MED EYE(Any onO prawn) ".S 51000
PERSONALaADVINJURY_ _'$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _$ 2,000,00D
POucv IM Loc '' ', PRODucTs.comwoP ADD s2.000,000
OTHER
B
NUMMI LIABILITY COMewEO SINGLE LIMIT 1,OD0,000
IEA.acu_mm) -_a_. _ _.
ANY AUTO BAP 9655061 1, 0710112017 07/01/2018 GUSLY INJURY(Per Senn) $__-_- _
OVMED SCHEDULED -
AUTOS ONLY X AUUpTT�OpSSµµNN pp g001LY INJURY(ParaCtiOeMj $
X TLTVS ONLY X gIROSO�Y _PP,0,.RZI MAGE $ ---
UMBRELLA LIAB OCCUR EACH OCCURRENCE_ _ $ _
EXCESS WB C(AIMS.MADE AGGREGATE_
DED RETENTION$
A WORKERS AND EMPLOYERSE CUei°m X STATUTE PER EER"
ANY PROPRETORIPARTNERIEXECU71VE YIN WPA0382194-16 OW0112018 ON0112019 - - 500,000
ITGENMEMPER EXCLUDED? NIA EL EACH ACCIDENT $
(M_XI In NN1 EL DISEASEEAEMPLOYEE $ 500,000
n ee as:enoe Ano",
---
DES ZTICN OF OPERATIONS oelow EL DISEASE-PouCY UMrt s 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS IvEHICLES (ACERD 1D1,AGERIonalft l 6*UNEuN,mry Ee FWCMY ttrmn eWm b nqulmdI
To Show evidence of covenage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
For Verification of Insurance Purposes Only THE EXPIRATION OATS THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CA
ACORD 25(2016/03) 911988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Teddy Bear Pools, Inc. Known By Our Reputation
41 East Street �' 1 (413)594.2666 • 1-Bb0-554.8EAR
Chicopee,MA 01020.3562 FAX(413)598-8823
Hems lmprwarnaof Cont./M+x11889/0 M0951 ® www.teddybearpools. com
10w
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massa usetts 02116
Home Improvemeltractor Registration
F�m Type Corporation
ff —' Z Registratm: 111889
TEDDY BEAR POOLS &SPAS I ^� E) iration: 02/07/2019
41 East St
Chicopee, MA 01020 "
q�
N SV/
Update Atltlress and return card. Mark reason for Mage.
QF CQNN)6t'y16hr t+ R P iTM N'�' Cl i I1l1ER PROTEG',ON
R y
13Y_1t)4nOWn thaE .
TEDDY BRAR POQLS INC
Al
CHICOOE, 4A 09,029-2605
is certified by the Depar=ent'of Consumer Protection m a registered
HOME IMPROVEMENT CONTRAC`T'OR
Registration #.HIC.0520951
Effective: 12/01/2016
Expiration- 11/30/2b17
-.to aaw n.xwda,'Cammraswa:.
TEDDY BEAR POOLS & SPAS
41 East Street Sales Order
Chicopee, MA 01020 Sales Order ID: 566468
Customer ID: 52174
Employee ID: ScottA
Ordered: 10/31/2017
Invoiced:
Ship To: Distribution: In House
C0005413 C0005413
Melanie& Karen Currie Melanie& Karen Currie
24 Bayberry Lane 24 Bayberry Lane
Florence, MA 01062 Florence, MA 01062
Cell (508) 736-3529 Karen
Cell (781) 864-6389 Melanie
Oty Item Unit Price Total
1 18x36 GRECIAN W/8'4 STEP WHITE END STEPS $15,000.00 $15,000.00
1 CONSTRUCTION $33,497.00 $33,497.00
1 ALL CREEKSTONE LINER-NO BORDER $0.00 $0.00
1 ACT 1250 HEAT PUMPNVIRED $0.00 $0.00
1 8'DIVING BOARD $0.00 $0.00
1 HAYWARD EC 75 VARIABLE SPEED FILTER&PUMP $0.00 $0.00
1 900 SO FT CONCRETE $0.00 $0.00
1 ECOSMARTE $0.00 $0.00
1 S-200 DOLPHIN AUTO CLEANER $0.00 $0.00
1 5000M Standard 95 Blue Mesh Safety Cover, 5x5 Panels $0.00 $0.00
Sub Total $48,497.00
Deposits/Invoices Terms: Cash On Delivery
Taxes $937.50
10/31/2017 Applied Credit $1,937.50
03/19/2018 Deposit- Check-548 $20,000.00 Total $49,434.50
Deposits $21,937.50
Invoices $0.00
Order Balance Eji7,497.00
41 East Street, Ch,a pee, MA 01020, (413)594-2666 152, Fax (413)59&8823
IIII IIII I II'I I'I Accepted Date
Monday, March 19, 2018, 11:23:17 AM Received By Date
Printed By johns Preferred Customer No. C0005413 Page 1 of 1
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8' x 36' RE C—F. (2' RAE). ACCORDANCE WITH THE
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'IRE24S 1836 SURFACEAREA,'.U,2): 645 IPERIMETER'104'-7' aEASE CONTACT THE DJING�SUDING
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DATE: 01101113 LINER AREA(h'): 648 VOLUME SUS Gap: 23.586 THEIR SPECIFICATIONS.
SCALE. 1/8"=1'-0' SEW COVER AREA(ft°):760 VOLUME(1: 89,283 MEETS DEPTH AND SHAPE MINIMUM STANDARD ANI-52011 GXRE24S1836-13
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