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22D-008 BP 2022-0838 91 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22D-008-001 CITY OF NORTHAMPTON Permit: Swimming Pool PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0838 PERMISSIONISHEREBYGRANT I TO: Project# swimming pool Contractor: License: Est. Cost: 13066 Const.Class: Exp.Date: Use Group: Owner: MCCLENAHEN VICTORIA S Lot Size (sq.ft.) Zoning: WP/WSP Applicant: TEDDY BEAR POOLS & SPAS Applicant Address Phone: Insurance: 41 EAST ST (413)594-2666 O WC8665063 CHICOPEE, MA 01020 ISSUED ON:07/19/2022 TO PERFORM THE FOLLOWING WORK: SWIMMING POOL REPLACEMENT 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: el • V .›.2 1 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED JUL 1 5 2.022 The Commonwealth of Massachusetts FOZ °>, Board of Building Regulations and Stakdards 1 % Massachusetts State Building Code,7UIIDING INSPECTIONC ALITY �AMPTON.MA 04060 f USA Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling T i ction For Official Use Only Building Permit Number: ,,g P.- �1' 1f Date Applied: r •Building Official(Print Name) SignaturTe D e SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Number 91 Ryan Road ,a a. 0 W 1.1 a 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Victoria McClenahen Florence, Ma, 01062 Name(Print) City,State,ZIP 91 Ryan Road 541-62-3031 vmcclenahen4620( centurvb 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 Work2: Swimming Pool Replacement, above ground SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is det'rmined: 2.Electrical $ ❑Standard City/Town Application Fee 1 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ 1A.00 13066.99 Check No. ) Check Amount: Cash Amount 6.Total Project Cost: $ la(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 1&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 02/07/2023 Teddy Bear Pools & Spas HIC Registration Number Expira(ion Date HIC CompanyName or HIC Registrant Name 41 East Street JOHNSHEA(a�TEDDYBEARPOA 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 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 Teddy Bear Pools & Spas to act on my behalf,in all matters relative to work authorized by this building permit application. V;Pc...-/LOhe 0—.A1 eitti_k_t..44.. 7A.5/7-0 2j2-- Print Owner's Name(Electronic Signature) /2i4 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. JOHN SHEA X145 .T//.-/Ze.2 Print 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.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" The Commonwealth of Massachusetts —__"*, ;,�1— 1, Department of Industrial Accidents (rE_ij�j1 1 Congress Street,Suite 100 *=a: Boston,MA 02114�-2017 t. www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH 1'tlh,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 EXT 145 Are you an employer?Check the appropriate box: Type of project(required): LID I am aemployerwith 100 employees(full and/or part-time).* 7. 0 New construction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ['Demolition 10 Q 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 11.[]Electrical repairs or a ditions proprietors with no employees. 12.Q Plumbing repairs or a ditions 5.❑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.t 6.11 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ✓❑Other Pool 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 atn an employer that is providing workers'compensation insurance for my employees'. Below is the policy and job.Fite information. Insurance company Name:HUB International New England Policy#or Self-ins.Lic.#:WC 8665063 — Expiration Date: 04/01/2023 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$1,50 .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$25 .00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insur ce coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature:JOHN SHEA Date: Phone#: 413-594-2666 EXT 145 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.ElectricaI Inspector 5.Plumbing Inspectok 6.Other Contact Person: Phone#: �� Teddy Bear Pools, Inc. a%., 41 East Street • Chicopee, MA 01020 ° ail 0 0 (413) 594-2666 • (800) 554-BEAR y ofr V FAX (413) 598-8823 Q �� �� Home improvement Cont. MA #11889/CT #520951 • , ca�L��,r* 'I�EDDYBEARPOOLS.CIUM • TEDDY BEAD PCOLS SPAS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ,Type: Corporation Registration: 11;1889 TEDDY BEAR POOLS, INC. Expiration: 02I07/2023 41 EAST ST CHICOPEE, MA 01020 �Y" - eK '§,4 r"' ''' T F5 A 'r yN�'1(I P .t e �,Iy d ,., ,_._v tiAr J ' 'i , � o iit „ y - '�,;0 ORAAxtig. i f w ... -, I `'y .L a_ SU=Ln im .., , a . ... a3 .4-,.„f 57V4. a z 2_� t _ . __ _ _ S ATE OF°.CONNEC`TICUT .4 ,DEPARTMfli,NT OFCONSUMER P1 O'TEC"Il'IK)N I ` .N A Be it known that TEDDY BEAR POOLS INC ."" 41'EAST ST I ` CI3ICOPEE; IVIA 01020-2605 1 %-- (' has satisfied the qualifications required by law and is hereby registered as a Ped r�,. . HOME IMPROVEMENT CONTRACTOR kch : kit.° ` Registration # HIC.0520951 f Effective: 12/01/2021 /Lid 1 Expiration: 03/31/2023 . r, Michelle Seagull,Commissioner '. •iw ' i• gb .! '11•... - _. I -�...4) TEDDBEA-04 _,....____J PROM X ACORD DATE(MM/DDNYYY) - CERTIFICATE OF LIABILITY INSURANCE 9/27/2022 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAMF:__...__._.._.�._.___. I HUB International New England PHONE fJo,Eat 833 462-2554 FAX (413 731-9539 96 Shaker Road _�� ):( � (arc,No): 1-__ East Longmeadow,MA 01028 ADDBm: INSURER(s)AFFORDING SQVERAGE _ NAIC N-,-. 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 0: . 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 ROLICY 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_........_..- ADDLSUBRI...-_-- —.-_.._ __..... ..._. - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° VWD POLICY NUMBER (MM/DDNYYY1 (MM!DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE _S._ 1,000,000 CLAIMS-MADE [X I OCCUR CLP 8665062 4/1/2022 4/1/2023 DAMAGE TO RENTED 300,000 . P.REMISES.(Eaoscuttence) $ .------.---_.. _ MED EXP(Any one person) $ 5'000 _ PERSONAL d ADV INJURY $ 1,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ POLICY I J jEeT [ 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER:General Aggregate $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 _(Ea accident) $ — 1 X ANY AUTO BAP 8669261 7/1/2022 7/1/2023 I BODILY INJU„RYSPerJerson)_- S I OWNED SCHEDULED AUTOS ONLY 1 AUTOS _LCIDILY INJURY(Per accident) $ AURED oµ/� p PROPERTY(DAMAGE AUTOS ONLY L .AUTOS ON�Y I _,(.Per accident) $ $ B X UMBRELLA LIAB ' X OCCUR EACH OCCURRENCE $ 1,000,000 L,EXCESS LIAB CLAIMS-MADE CXS 8669257 4/1/2022 4/1/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ B WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y l N WC 8665063 4/1/2022 4/1/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ .—._...- OFFICER/MEMBER EXCLUDED? I N NIA 500000 (Mandatory n NH) E.L DISEASE-EA EMPLOYE $ If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I r 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. AUTHORIZED REPRESENTATIVE ?,.9.-7/,..,—.1,-- ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r - Above Ground Pool Plot Plan ak, 0 --m 00 ,,-7'1*-,,,,.-1- 49 1 i TEDDY REAR POOLS C SPAS 11,,,,. 'a:fo?" The plot plan below is approximate measurements for the pool placement at the home of: Customer Info: Vic' 79'' w a ( AC 0 142403\e'M► In the City/Town of: 6 or--e-A z7 A'1 P Above ground pool set backs are: of House Side Rear Septic Leach Field ,i. { ass aaaaaa ■■ ■ , Ima11111111 mi. i iii m0 NI srihr/16111111104 i PVT .., r'► arrairra t a� R a.�■au.■■ui ism .g -=... �l . --L!!!!!!!!I!! U!ai1aIM!1uIIHIIIIIII ,•, ■■wtm■ s, II il iii—rililliiiii * allisammuuml on min IN NMI INN 1111.111 NIONIMMININIMININ sr., .... ,............._ __ria.................. a a ONIUMME IMMO 111111111.1111111111111 11111.111.110Milli11111 III IIIMININ II NB INIANNINNallIMINER a■NIN IMMIIIIIINIMINNINNIii 1111111.111/111 11 UUN ■Ur ■ 1 IIIIIIIIIIflIflhIIIIIUIIIIIIHhIIHIlIIIII .... irum a ■ , ■a ans III IAN a Cuaa '!'•"'.__as' mMINm __ _ . _. a a. . , .. a iu"' a 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: rr'e.Gl r $1.1 OVIA611. Date: 0 Z'2- 14 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybe rpools.com