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08-007 (9) 906 NORTH KING ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1932 Map:Block:Lot:08-007-001 Permit: Swimming Pool CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-1932 PERMISSION IS HEREBY GRANTED TO: Project# ABOVE GROUND POOL Contractor: License: Est. Cost: 15235 TEDDY BEAR POOLS & SPAS Const.Class: Exp.Date: Use Group: Owner: JENKINS MARY ANN Lot Size (sq.ft.) Zoning: HB/RI Applicant: TEDDY BEAR POOLS & SPAS Applicant Address Phone: Insurance: 41 EAST ST (413)594-2666() WC8665063 CHICOPEE,MA 01020 ISSUED ON:09/27/2021 TO PERFORM THE FOLLOWING WORK: 24X52 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. Signature: 10 I s • y2 7- 1 • I ' I Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner Z "-o►2 File #BP-2021-1932 APPLICANT/CONTACT PERSON:TEDDY BEAR POOLS & SPAS 41 EAST ST CHICOPEE,MA 01020(413)594-2666() PROPERTY LOCATION 906 NORTH KING ST MAP:LOT 08-007-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $40.00 Type of Construction: 24X52 ABOVE GROUND POOL iLA-01 New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 SpecialPermit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Perm its Required: Curb Cut from DPW WaterAvailability 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 Vara,' Srg�ature 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. RFc The Commonwealth of Massac usett•. SEP Board of Building Regulations an'• Stat lards 2� • F�eoa UNI PALITY Massachusetts State Building Co',e,7:► A SE Building Permit Application To Construct, Repair, • t,14i7, h a Revis=d Mar 2011 One-or Two-Family Dwelling nTON�MgPs.c, __._.._._....._......._.... orasoOas is Section For Official Use Only Building Permit Number: r -I Date Applied: BuildingOfficial(Print Name) Signature Date g SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 906 North King Street 1.1 a is this an accepted street?yes Q no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(II) 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 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check ifyes❑ _ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ^ Mary Ann Jenkins Northampton, MA 01060 Name(Print) City.State,ZIP 906 North King Street 348-8919 littalbignosegmail.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other []✓ Specify: Pool Brief Description of Proposed Work': Above Ground Pool (24' x 52") 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'(Item 6)x multiplier 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fe O 6.Total Project Cost: $ 15,235.38 Check No.\ heck 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 Dwelling City/Town,State.LIP M Masonry RC Roofing Covering — WS Window and Siding SF Solid Fuel Burning Appliances t insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 111889 02/08/2023 Teddy Bear Pools & Spas HiC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 41 East Street scottata7.teddybearpools.com 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 io act on my behalf,in all matters relative to work authorized by this building permit application. • �►- n 3 la Print wner's rent(Electron6 ignature) 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. Scott Alexander t 7/20/2021 A Print Owner's or Authorized Agent's Name(Electronic Signatufe) 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 trot 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.gov/dps 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" ---,,,—,—_,7---- „ c --) A bl,:,)ves„. (7/ rc)t A i id ' c.)()I tvo l' 1 i'' )t r's)I el 1 -,-) ,,,, „ .- ,CA i '''' \iv"' ' ' c`ktel--, f 043) itp)i„ ( ,c, yo . i 7 . t'-'," . 0. ': ( :') („) r D 'i- '., -A-1, „..„,ii ir.,, el. ir The plot plan below is approximate measurements for the pool placement at the home of: Customer Info: Mary Ann Jenkins, 906 North King Street In the City/Town of: Northampton, MA 01060 Above ground pool set backs are: of House Side Rear Septic Leach Field \ I 0 (-A- t\ \\\1 1 , t 7 1,-//q , 1 J//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: c,./. Ih Date: C1 130a" I _ 41 East Street * Chicopee, MA 01.020 * (4:13) 1)94 2666 * (800) 554•BEA}t 4 www.teddybearpools.com The Commonwealth of Massachusetts g.�. Department of Industrial Accidents 1 .I Congress Street,Suite 100 z.. = Boston,MA 02114-2017 www.rtaass.gov/dia Workers'Compensation Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers. TO BE FILED WITH THE PERMITTING AC11 HORITY. Applicant Information Please Print Letribly Name(Business/Organization/Individual):Teddy Bear Pools & Spas 41 East Street City/State/'Lip:Chicopee, MA 01020 Phone i:413-594-2666 Arc you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with 100 __employees(full and/or part-time).* 7. E)New construction 2.0 I am a sole proprietor or partnership and have no employees working for n;e in 8. E Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 l am a homeowner doing all work myself.[No workers'comp.insurance required.)t 10 El Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.[]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the subcontractors listed on the attached sheet 13,DRoof repairs These sub-contractors have employees and have workers'comp.insurance.' I4. ✓DOther Pool 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. --- 152,§1(4),and we have no employees.[No workers'comp.insurance required.) *Any applicant that checks box:1 must also fill out the section below showing their workers'compensation policy infonnation. t Homeowners who submit ibis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractor s that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lithe sub-contractors have employees,they must provide their workers'comp.policy numb_r. I art:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:HUB International New England WC 8665063 04/01/2022 Policy/F or Self ins.Lic.if: Expiration Dec__.._ 906 North King Street cit /statel7i Northampton, MA 01060 Job Site Address: y 'p:.-.Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.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 ofperju y that the information provided above is true and correct Signarnre;_.Scott Alexander c`.�- '"" r-' 7/20/2021 eGY� �`� :...-...Utc_.. . Phone :: 413_594-2666 Official use only. Do no{write in this urea,to be completed by city or town official City or Town: Pertnit/l.,icense it Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.1 Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _•-._._._.. ____ Phone#: The Commonwealth of Massachusetts /. Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Teddy Bear Pools & Spas Address;41 East Street City/State/Zip:Chicopee, MA 01020 Phone#:413-594-2666 X 145 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 1 00 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. n Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 30 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hirng contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.ID Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c 14. ✓❑Other POOI 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 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 contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I asp an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:HUB International New England Policy#or Self-ins.Lic.#:WC 8665063 Expiration Date:04/01/2022 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 MGL c.152,§25A is a criminal violation punishable by 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.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' true and correct. SiKnature:JOHN SHEA vim/ C j Date: 9(11 ) .. Phone#: 413-594-2666 X 1 A. 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#: _. _. _____'—.41 TEDDBEA-04 MPROULX ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(M �' 6/25/20210 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),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: HUB International New England PHONE FAx 1070 Suffield St (A/C,No,Ext):(800)243-8134 (A/c,No):(413)731-9539 Agawam,MA 01001 E-MAILSS: INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:All America Insurance Company 20222 INSURED INSURER B_Central Mutual Insurance Company _ 20.230 Teddy Bear Pools Inc. INSURER C 41 East St INSURER D: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER M/POLICY EFF ; POLICY EXP LIMITS LTR WSD WVD IMDD/YYYYI (MM/DD/YYYYI. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X I OCCUR CLP 8665062 4/1/2021 4/1/2022 ' DAMAGE TO RENTED 300,000 i PREMISES(Ea occurrence) S __ I MED EXP(Any one person) - $ 5,000 I PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I spa [ J LOC PRODUCTS-COMP/OP AGG $ 2,000,000 — OTHER:General Aggregate $ A AUTOMOBILE LIABILITY (ECOMBINED sod &NGLE LIMIT $ - 1,000,000 X ANY AUTO — BAP 8669261 7/1/2021 7/1/2022 BODILY INJURY(Perperson) $ OWNED SCHEDULED __AUTOS ONLY _ AUTOS _BODILY_BOO�DILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS ONLY (PeOr acdt Y AMAGE $ $ B X , UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB __111 CLAIMS-MADE CXS 8669257 4/1/2021 4/1/2022 AGGREGATE $ 1,000,000 DED X [RETENTION$ 0 S B WORKERS COMPENSATION X STATUTE TRH- _ AND EMPLOYERS'LIABILITY Y/N WC 8665063 4/1/2021 4/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER FICE/MEn B ER EXCLUDED? N N/A500,000 EL DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Verification of Insurance Purposes OnlyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDgik--?REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation TEDDY BEAR POOLS,INC. Registration: 111889 41 EAST ST Expiration: 02/07/2023 CHICOPEE,MA 01020 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Eygl;trajLgn Expkai!4tt Office of Consumer Affairs and Business Regulation 111889 02/07/2023 1000 Washington Street -Suite 710 TEDDY BEAR POOLS,INC. Boston,MA 02118 r �r. zrti.: y; 4 cy- t '«,. s,7 .V4 t 4 .� y £': �`+}' �i" 0\`Z\. ,. � '�\ s� t��lv. �1P',;a. '+"4r '}" r. �ry" +� tr� t �� � �..^. Y /iy �a �- �' t�#� 1 n4'u. A t rh '. I ,y ♦ VO4 • 7 F t �z^� 'y r z; f t V:l ati S I'/4�'I ��, OF( NNEC`I'8('U I DE ,��RTIVII�i ; E` .DC� �'ONSUMLR PRO I F CJ IOI ��4: 4 Hc• dknown that ' TEDDY BEAR POOLS INC 14E, • 41 EAT' S" ` 1f.1 Pe . CHICOPEE, MA 01020-2605 -4 h., - C Y ` c� , z Y t .,r,.s',t� Jam~FIJ.� ',Y . . H... „: K .: �. �{ has satisfied the qualifications required bylaw and is hereby registered as a r' HOME IMPROVEMENT CONTRACTOR f 01Reis gtration # IIIC.0520951 �r •4 r ; Effective: 12/01/2020 � � � � 2 �-�- ) , E )ixatiox�. 11/30/202"1 �, v k• ,-„ MicLclie Seagull,Commisaloner I S . r >Yt �r } • S { • �i � t A ! , �` k'rx.r� t. r uf�nv,r i. rl" . : � t, - � :� t... ��;, a;e .:: r�;Mo� al�+e,;, .eeiit,,a,,,,, . i6. D-41.. . ,:z: ie.' . ....n-.,% G tA..,•. . +... . Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation TEDDY BEAR POOLS,INC. Registration: 111889 41 EAST ST Expiration: 02/07/2023 CHICOPEE,MA 01020 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: 89g)sj0ton Expiration Offico of Consumer Affairs and Business Regulation 111889 02/0712023 1000 Washington Street •Suite 710 TCDOY BEAR POOLS.INC. Boston,MA 02118 ,''a) i .9Y1.v�'{r 4or '7t* ty` fY z `, P - 4, Y ,y//-- -....p _ -tk,zs . "7v`�e; 'v�� 'Y ayj!''C4.•.; ,u yL,"'�€+n. t.� ':% .4' v"A: � '1+ "�° "4}; ',e' ikkyt 4 z' ',k`{'i. '• 0.' . '�''. ti 4. - ,{�..... ___ ._{�i .,�{ ._t.�1.r/� ii��. A EPA �(._ j( j�`r (� (� fl (�..(r. F (@,�(_ p_ lilt?, �j(ice ij tf(� (y). _ i ,� 'STATE' OLD ,CONNIELTIlClti l' DEPARTMENT 'L.)F 0..`l�`�S�)M 1.4t R or� I ie,i ib V �,. , ' � 13e It known that• �+' r 4 TEDDY BEAR POOLS INC ,tatuu ' • ,,'< 4.. EAAST Srii /. 2-4 Lzg CJHCOPP Er MA 01020-2605 fr i . r ': has c ttisf ed the qualtficatuins tegttirr d by law anti Is hereby registered as a ',, HOME TiVCI- IZC)V MEN C-ONIR�1( (3,ft . ,{ Rc(;istiation ## 1111;.0520951 I, . ' 1) .10A '01 Effective: 12/U1/2U20 /// r( °i 'I a z: .11/30/2021. { ' �, ,, t Ai fa,tte Seagull,CUM rnissfotilr 1 ., �'+�,1t ;��. � i}�,'4���.%j/+ }`�<)`+��,�+i a'�:r� "p. r "r z�//,.��,,;���'1 y� r�; a�rr:� a --� ^�, - ;j I ,• .t Y+ .a:•;%1� �V1 r lT,i;; 3;Yv"'ab his �' i`r3'r <vv )., �1. "~41 ih4 ! �d... ---• .4> "• '? #\''''-i'plii �:3 i t ,, by 4,,�,.s� 10, f` e' 'kF:N p.! 1 Ft{ vei l;rL aS� .f f.-. C v�d s ',�we,,„R. A' , 1. iff sf i'14'A�`k7, t, ,rA,, %-cep t 1.iki 1 1,t1,3. ,ete� r `� . � f ..w v. '. . � �''' ., , � ..r-Y ... .. � SfA� Sr\-; tra.�.... .y�o•.^/f ;Z,-,el. fY..� r. ) , ,x�-f dZ-'kyl�tl'I.r:vY��+�\•'• � r+�t '��"ar\.i�S y. %-.--"", TEDDBEA-04 ____in• LX ACORO CERTIFICATE OF LIABILITY INSURANCE OATE(MMlDDlYYYY) �„ 6/2512021 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),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 lieu of such endorsement(s). _ _______ PRODUCER NQATACT HUB International New England PHONE -FAX 731-9539 1070 Suffield St (NC,No,Est):(800)243-8134 (A/C,No)a(413) Agawam,MA 01001 E-MAIL DRIESS: INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:All America Insurance Company .20222 INSURED INSURER B:Central Mutual Insurance Company 20230 Teddy Bear Pools Inc. INSURER C: ....._......... 41 East St INSURER o ......................................................... 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUBR: POLICY EFF POLICY EXP I TYPE OF INSURANCE POLICY NUMBER LIMITS &RS(!LYt2,:—.�__---� aMldiRRLYYYYL.iMMIRA. � A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X I OCCUR CLP 8665062 4/1/2021 41112022 pREM SEa a occurrence) .•5 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&AOV INJURY S 1,000,000 GENL.AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE ;$ 2,000,000 • POLICY PRO. 2000000 JECT LOC ; , , PRODUCTS-COMP/OP AGG;S OTHER:General Aggregate $ _ ....... COMBINED SINGLE LIMIT 1 000,000 A AUTOMOBILE LIABILITY (Ea accidont) $ X ANY AUTO l ,BAP 8669261 7/1/2021 7/112022 BODILY INJURY(Per person) . $ OWNED SCHEDULED, AUTOS��p ONLY AUTOS WNF . pBODILY RINJURY(Per accident) $ AUTOS ONLY UTOS ONLY: (PefoRconl�AMAGE $ $ B X UMBRELLAUAB X OCCUR EACHOCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE CXS 8669257 • 4/1/2021 4/112022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 , ... B WORKERS COMPENSATION X PER STATUTE OER TH AND EMPLOYERS'LIABILITY 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 8.665063 . 4/1I2021 4/1/2022 E L EACH ACCIDENT $ FICER?MEMLER EXCLUDED? N N/A 500,000 andatory In NH) E L.DISEASE-EA EMPLOYEE S It yes,describe under • 500,000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required( CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Verification of Insurance Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -j ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts �;: .A.- 1 DEPARTMENT OF BUILDING INSPECTIONS 2 ! o �� 212 Main Street • Municipal Building f ., r i Northampton, MA 01060 J'l ,4�ji"\� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: ALocation of Facility: C ( o e lM The debris will be transported by: 1 Name of Hauler: Tddu l Oa h (- i')A4 ,� �3 lYi Signature of Applicant: Date: l