35-235 (8) 17 BAYBERRY LN BP-2018-1135
GIS#: COMMONWEALTH OF MASSACHUSETTS
MatxBlock: 35-235 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catesorv: Above ground pool BUILDING PERMIT
Permit# BP-2018-1135
Project# JS-2018-002040
Est.cost: $2700.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group, TEDDY BEAR POOLS & SPA 111889
Lot Size(sa. ft.): 36241.92 Owner: PARZIALE MICHAEL J&LAURA I
Zoning: Applicant: TEDDY BEAR POOLS & SPA
AT. 17 BAYBERRY LN
ApplicantAddress: Phone. Insurance:
41 EAST ST (413) 594-2666 0 Workers Compensation
CHICOPEEMA01020 ISSUED ON:5/3/2018 0:00:00
TO PERFORM THE FOLLOWING WORK: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 Occuoancv signature:
FeeTvpe: Date Paid: Amount:
Building 5/3/2018 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2018-1135
APPLICANT/CONTACT PERSON TEDDY BEAR POOLS&SPA
ADDRESS/PHONE 41 EAST ST CHICOPEE (413)594-2666 Q
PROPERTY LOCATION 17 BAYBERRY LN
MAP 35 PARCEL 235 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT z �.
Fee Paid I , (/-1
Building.Permit Filled out
Fee Paid
Tvpeof Construction: ABOVE GROUND POOL
New Construction
Non Structural interior renovations
Addition to Exlstine
Accessory Structure
Building Plans Included:
Owner/Statement or License 111889
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 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
�/1
,:4r /h—� i "-max SI7' i a
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.
;oMmsa7chusetts
:� The Common ealtBoard of Buildin RegFOR
Massachusetts Sw a BMUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mm 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: — 8 • Date Applied:
Building Oficial(Print Name) Signature Data
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 3/
17 Bayberry Ln 1,1 C
I.la Is this an accepted street?yes,_n no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(ft)
1.5 Building Setbacks III)
Front Yard Side Yards Be.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❑ Zone: Outside Flood Zone?
Check ifyes❑ Municipal13On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record: ��
Michael Parziale r7 --/ 52'Aliorthhampton MA 01060
Name(Print) City,State,ZIP
17BavberryLn 5862608 m!pttzi .hors ual7n(�< Irl
Na,and Street Telephone Email Ad mss
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Ownc,Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other Q Specify: Pool
Brief Description of Proposed Work2: Above Ground Pool
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $
❑Total Project Cost'([tem 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.1olechanical (HVAC) $ List:
5.Meehanical (Fire $
Suppression) Total All
6.Total ProjeM Cost: $ 2700 Check NofCheek Amount: Cash Amount:_
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: COM3TRUCTION 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,OOD cu.ft.
R Restricted 1&2 Family Dwelling
City/To.,State,ZIP M Masonry
RC Roofing Coverall
— WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Nome Improvement Contractor(HIC) 111889 02/08/2019
Teddv Bear Pools & Spas _ _ HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
Chicopee, MA 01020 413-594-2666
Ci /Town,State ZIP Tflephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT Hill e.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 ofhe building permit.
Signed Affidavit Attached? Yes .._......i] No _....--❑
SECTION 79: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 behalf,in all matters relative to work authorized by this building permit application.
Pod/L'y4 � _ s�/h
er'sN (Elecwoic Si store) 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.
Stephen Otto 4/27/18
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 ovg /oca Information on the Constructien Supervisor License can be found at www.mass.eov/das
2. When substantial work is planned,provide the infamtalic n 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
Namber of bathrooms Number ofhalf/baths
Type of beating system Number of decks/porches
Type of cooling system Enclosed Open
3. `Total Project Square Footage"may be substituted for"Total Project Cost"
The CommonweaHh ofMosnaehusetts
Deparentent oflndustrta(Accidients
I Congress Street,Suite 100
Banton,MA 02114-2017
www.mnssgov/dia
WWorkers'Compensation Insurance Affidavit:Builders/Contactors/ElectriciaosMiumber&
TO BE FILED WITH THE PERMf11TNG AUTHORITY.
Apoacsu"Mormadon Please Print Leeibly
Narne(Braiaemor8a.;sado,.ana:vided):Teddy Bear Pools &Spas
Address:41 East Street
City/State/,ip:Chicopee, MA 01020 Phane#:413-594-2666
wwyou an<mgown m«tthe app<dPrian cox: Type of project(required):
I.OlwaemPioy«with 100 mryloy«a cmu ew/wpmr-mn<)<
7. El New wnstruction
2.❑Mamie propdrtmmPermuship mdhevemempioym vwidog farmew g, E]Remodeling
eoyoc,ciq.Mowmtea'mimp manna.requbed.] 9. [1 Demolition
3.❑1 am alnmmmm doing all wwkmw<If[No wmkvs'�.humance mquved]t
a.❑ram.lnmeow�a mdw;uhhiitmaig cmuacmam<®d«tau eah onmy PraPmy. r.„u 10❑Building addition
come sent ell comenmaeiWahav<wor4ma•r.�p®vetian iruume<u<rt ml< 11.❑Electrical repairs or additions
mapd<tmswim m uuplo'«a. 12.Q Plumbing repairs or additions
5❑1 an a gmrsd mnaactd and i hew huedthe cm�4vtuslistedwrMetprhdsheet
'Pveea�b-comncmn leve mplay«a mf eve vor4as•mmp Inovmce.t 13.E]Roofrepairs
6.❑Weazcauaporauonmd its officashave e�nacimd Worngta ofmampri®pmMGLc ME10ther Pool
152,41(a),eM xehava vo emprayeec lt8a xwYen'mraR msuanoer<gahed]
'AmgplvmtroatcheeYa bmr81 rrmaelm GII math satiwbdawaMwmg thcvrwrkma'mmtea9timpotiey informmaooa
t Bomeomima who mbmrt tivs etfidrvit iodioatotB rhey me dame sU nmk wd iLea him on�do mmhmtma rmat arbmit a ton Mflderit hW inadvg mcb.
ea ohxtorafhtchcckihuhmtmP#atbchW maldiYovel aa<l ahowmgth®e ofth<ubsomsWn md<mte wMha«mtWweevikics haw
®daY«+. Bthnmbcmaemm have wp1aY«r,[try rmmprnvideaxh wmims'nmiP.polity mmhv.
Iamanemployerdratuprootdurgworkers'comgyiorsoaonberwmceformy&vooym. Blow is Wepoacy andjob site
information.
humeroce Company Name:Acad is Insurance Company
Polity#or self-ins.Lin.#:WPA0382194-16, Expiration Date-04/01/2019
Job Site Address: 17 p
Bayberry Ln Northham ton MA 01060
city/StatcMix ---
Attach a copy of the workers'compensation policy dedsration page(showing the policy number and expiration date).
Failure to secure coverage at required ander MGL c.152,§25A is a criminal violation punishable by a fine up to 31,500.00
and/or one-year i rgmacnuem;as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office oflnvestigaticus ofthe DIA for resonance
coverage verification.
I do hereby on*under the pain,andpensifia ofperjury that Ike leformadon provided above is tae andeoraee.
sienat_ Stephen Otto Data: 4/27/18
Phone#: 413-594-2666
Offidal meanly. Do notwMe in tkiv area,W be completed by dry or town ojyidal
City or Town: Permit/Licenee#
Issuing Authority(circle one):
1.Board of Health 2.RandingDepar'tment 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.other
Contact Person: Phone#:
Information and Instructions
Massachusetts Ground Laws chapter 152 requires all amp oyer to provide workers'compensation fortheir employees.
Pussumt to this stature,an employee is defined in"...every person in the service of another under airy contact ofhim,
express or implied,oral in written."
An employer is defined as"an individual,partnership,ammicistlon,corporation or other legal unity,or my two or more
ofthe foregoing engaged in ajomt enterprise,and including tbe,legal representatives of a deceased employer,or the
receiver or trustee oft individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three spirmrenis and who resides therein,or the occupant ofthe
dwelling house of mother who employs persons In do maimmance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§250(6)elm states that"every state or local licensing agency shall withhold the issuance or
renewal of a litems,or permit to operate a business or to construct buildings to the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§250(7)states"Neither the commonwealth am my ofits political subdivisions shall
enter into my contract for the performance ofpubhe work until acceptable evidence ofoomplism a with the insurance
requirements of this chapter have been,presented in the correcting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply m your situation and,if
necessary,supply sub-contactor(s)unreels),address(es)and phone number(s)along with flair certificates)of
Insurance. Limited Liability Companies(LLC)orLimited Liability Partnerships(LLP)with no employees Omer than the
members or parmeM aro not required to carry workers'compensation insurance. ]fm LLC or LLP does have
employees,a policy is required. Be advised that this affidavit nay be submitted m the Department of Industrial
Accidmts for confirmation of insurance coverage. Also be more m sign and date the affidavit The affidavit should
be rammed to the city or town thatthe application for the Fennelt or license is being requested,not the Department of
Indnatrial Accidents. Shouldyou have my questions regarding the law or ifyou are required to obtain aworkers'
compensation policy,please call the Department a the number listed below. Self-insured companies should anter their
self-insurance license mrmber on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
ofthe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permittlicense numbs which w11 be used as a reference number. In addition,an applicaut
that must submit muhiple permitniouse applications in any given year,need only submit one affidavit indicating current
policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy ofine affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proofthat a valid affidavit is on file for fuhue permits or licenses. A new affidavit must be filled out each
year.Where a home owner or old=is obtaining a licetue or permit act related to my business or commercial vunne
(i.e.a dog license or permit in bum leaves etc.)said person is NOT required to complete this affidavit
Ile Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of lndustrial Accidents
1 Congress Simi, Suite 100
Boston,MA 02114-2017
Tel.Al 617-7274900 ext. 7406 or 1-877-MASSAFE
Fax If 617-727-7749
Revised 02-23-15 WwWMMs.gov/dia
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s,
Office of Consumer Affairs and Business Regulation
10 Park Plaza -Suite 5170
Boston, Me".saGfiusetts 02116
Home Improvemehh krac[or Registration
Type Corporaw
Regswadwo 111889
TEDDY BEAR POOLS 8,SPAS Ij ,i _ =—s ` E,grauon: 02107/2019
41 East St
Chicopee, MA 01020
�� WM�MIMsbW nern wE. Yarkrwsan for .
sCAt G �.., o.
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TEDDY Ep INC
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CHICOPEE, MA 01020-2605
is cemGey3 liy-the Depulment q€(„oospme5-P;ote don w a teVterO
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Above Ground Pool
Plot Plan
oru..
The plot plan below is approximate measurements for the pool placement at the home of:
Customer Info: I C� i C-- f A Lj 0. F. I;_;,
In the City/fown of: Lltoy/.e z 6/O6 2
Above ground pool set backs are:_X!j!—of House_�_Side 1CW Rear Septic hYY Leach field
r t- -T )
i-
- + # 7
_f- 1 '
I
it
i
i - i fi i I
Draw out you backyard AcludingthL 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: I 'e1 �n2,��'� Date: / 3U //d'
41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpools.com
Above Ground Pool
Plot Pian ,ry
The pilot plan below is a ap � IJctproximate,,((measurements for the pool placement at the Mme of:
Customer Info: )01` e JvIysrt I ee fe 5-�-
Inthe City/Town
Above ground pool set backs are. `�-' of House_ 6 Side_6 gear_Septic Leach Field
. . . . . . . . .
1 60 ' -+
i
- I ,
Draw out you backyard including the back of your Mme and dot fines Show measurements from lot lines,both sides and
rear as well as from the hack of the house.(See example on back of page).
This plan was completed by: Date:
41 East Street •Chicopee,MA 01020• (413)534-2666- )800)554-BEAR•w Aeddybearpoots.com
City of Northampton
CA'
Massachusetts
DERARTM6NT OF BUILDING INSPECTIONSs=`" ..M 212 Hain street 'Municipal Building
Northampton, NA 01060 Yy,
abr i s Di sposal Mfi davi t
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
��a&Z
(Please print house number and street name)
Is to be disposed of at:
(Please print name and locatio of fade )
Or will be disposed of in a dumpster onsite rented or leased from:
/ (Company Name and Address)
Si naure of Permit pp nt or caner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.