The URL can be used to link to this page

16C-013 (8) BP-2022-0923 272 SPRING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16C-013-001 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-2022-0923 PERMISSIONIS HEREBY GRANTED TO: Project# ABOVE GROUND POOL Contractor: License: Est. Cost: 13161 Const.Class: Exp.Date: Use Group: Owner: ANN LOVELAND-PANDORA BETH Lot Size (sq.ft.) Zoning: WSP Applicant: TEDDY BEAR POOLS & SPAS Applicant Address Phone: Insurance: 41 EAST ST (413)594-2666 0 WC8665063 CHICOPEE, MA 01020 ISSUED ON:08/04/2022 TO PERFORM THE FOLLO WING 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: 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: a � y •TO Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner sly 41)-1/Le ^ ' % ! `"6' The Commonwealth of Massach Department of Public Safety o,90 u. sachusetts State Building Code(780 CMR) gyp/ :ui ing Permit Application for any Building of er an a •ne- i s4„. q (This Section For Official Use Only) y F ) o,c� Building Permit Number: Z2-"q 23 Date Applied: Building Official: SECTION 1:LOCATION 272 Spring Street Florence, MA 01062 No.pnd Street,' City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 13 or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other B Specify:Above Ground Pool 24'x 52" _ Are building plans and/or construction documents being supplied as part of this permit application? Yes B No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No B Brief Description of Proposed Work:Above Ground Pool 24'x 52" SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ❑ A-4 0 A-5 0 B: Business 0 I E: Educational ❑ F: Factory F-1 0 F2 0 I: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5❑ I: Institutional I-1 0 1-2 0 1-3 0 1-4 0 M: Mercantile 0 I R: Residential R-1❑ R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use El and please describe below: Special Use Description: Above Ground Pool 24'x 52" SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IBC) IIA 0 IIB 0 ILIA ❑ IIIB ❑ IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site 0 Public B Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be I Private 0 or indentif Zone: required 0 or trench or specify:r ✓ ) y or on site system❑ permit is enclosed 0 USA Hauling Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable B Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No El Yes 0 No El SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Beth&Mike Loveland-Pan 272 Spring Street Florence, MA MA 01062 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: - - 413.205-6646 demilovamsn.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Beth&Mike Loveland-Pandora 272 Spring Street Florence, MA MA 01062 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here CI. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Teddy Bear Pools&Spas Company Name Scott Alexander HIC 111889 Name of Person Responsible for Construction License No. and Type if Applicable 41 East Street Chicopee, MA 01020 MA 01020 Street Address City/Town State Zip 413:594 2666 scotta@teddybearpools.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 13 161.44 and Materials) Total Construction Cost(from Item 6)_$ _ 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ . 3.Plumbing $ (_�V 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 13,161.44 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name .•low,I hereby att• . i • • f •an ••nalties of perjury that all of the information contained in is applica'on is true a curate to the best o eV I• •a d understanding. / i,i 't ` ate. 'lam 1 i % , 94' . _' .f 413 205 6646 Please print and sign name Title Telephone No. Da e 272 Spring Street Florence, MA MA 01062 demilov(D_msn.com 1 Street Address City/Town State Zip Email Address aaMunicipal Inspector to fill out this section upon application approval: 1. � 'I � 1bj ^' D'ate 1 Name r --) Above Ground Pool • • ., 6 AD Plot Plan , ,,,,,,,,zr. „„ TEDDY BEAR POOLS C SPASi le) i) 4. .,,i The plot plan below is approximate measurements for the pool placement at the home of: Customer Info: Beth & Mike Loveland-Pandora, 272 Spring Street In the City/Town of: Florence, MA 01062 Above ground pool set backs are: of House Side Rear Septic Leach Field \. ' r —---.--- VA4‘ .). :71 I r it 4" i/t, ___-. /in (.19,/ (le k-t"1-- _i_........____ _ _____ _ifiiL ,./..jt- - --, -,- Draw out you backyard including the back of your home a lot lines.Show measurements from lot lines, oth saes and rear as well as f m the back of th ouse. e example on back of page). This plan was completed by: / Date: k S Z-----/ 41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpools.com City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit 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. Address of the work: 02 7, S72iA/� The debris will be transported by: 0-c/ 2 The debris will be received by: /tou-n‘z/,o t 4I/vti o-r/4 ``; Building permit number: Name of Permit Applican , 4..• pr .. g Date i ature o Permit Applicant • The Commonwealth of Massachusetts .Department of Industrial Accidents _� 1 Congress Street,Suite 100 _� B Boston,MA 02114-2017 ar www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM1t LING AUTHORITY. Applicant Information Please Print LeR-ibly Name(Bisiaess/Orgenizatiorilndividual):Teddy Bear Pools & Spas Address:41 East Street City/State/Zip:Chicopee, MA 01020 phone#:413-594-2666 Arc you au employer?Cheekthe appropriate box: 3Type of project(required): in I am a employer with 100 employees(full and/or part-time).' 7. New construction 2.01 am a sole proprietor or partnership and have no employees working for me[.^. 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself(No workers'comp.insurance required.)' f 10[]Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on toy property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions with co mployees. proprietors e 12.OPlumbing repairs or additions 50 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 e. 14.0Other POOl 152,§1(4),and we have no employees.[No workers'comp.insurance required.) 4Any 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 ell 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 ronst 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:HUB International New England Policy T or self ins.Lie.#:WC 8665063 Expiration Date:04/01/2023 Job Site Address: vZ 7C.?3."-.7'Ai�1G-Q12 T City/State/Zip:__ f� .✓ A a/O - 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 andpenalties of perjury that� tthe information provided above is true and correct Signature:-5 a%:% x-4/x��:�Z�_L7r7� '�_3'�_-_� Date: 7A S/4 Z.Z 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 R 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_ --'~1 TEDDBEA-04 MPROULX A — s27/2 R� CERTIFICATE OF LIABILITY INSURANCE OAT/E 22YY) 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME__...-_—____.._._- •-- HUB International New England PHONE _ FAX 96 Shaker Road lac,No,Est):(833)462-2554 (An No):(413)73119539 East Longmeadow,MA 01028 miss:9DDBESS:__— INSURER(S)AFFORDING COVERAGE__ ._— NAIC N -......_ I INSURERA AII America Insurance Company jj 20222 INSURED i INSURER B:Central Mutual Insurance Company_______ 20230_ Teddy Bear Pools Inc. II�INSURERC: — ( _ 41EastSt IMSURERD: - _. . - . .. .-..---..._—_. 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 POUCY 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. NSR !AODL SUBR POLICY EFF POUCY EXP I Ljg_ TYPE OF INSURANCE IINSD riNQ POLICY NUMBER 1MWOD/YYYYLIMM/DO/YYYYL: LIMITS A X LIABILITY1,000,000 I COMMERCIAL GENERAL i EACH OCCURRENCE S CLAIMS-MADE X OCCURI DAMAGE TO RENTED 300,000 -._ CLP 8665062 4/1/2022 4/1/2023 pREM)SES(Eaoccurm�)_. i _- — -- MED EXP(Any one person) ,„S5,000 —I•__ PERSONAL E ADV INJURY f 1,000,000 I GENL AGGREGATE LMI1APP ,S PER: 1 GENERAL AGGREGATE 5 2,000,000 I Pqp I 2,000,000 ! �POLICY JECT �LOC I PROOtlCTS-COMPJOPAGG ; I OTHER.General Aggregate I I f A AUTOMOBILE LIABILITY ? I (E1�86eD�SINGLE LIMIT (f 1,000,000 EX ANY AUTO — ( BAP 8669261 7/1/2022 7/1/2023 BODILY INJURY_IPeryerson) I; I AUTOS ONLY ! AUUTNOSSyU�L�EDp I 'BODILY(tt INJURY(Per accident) $ _ I - AUTOS ONLY AUTOS ONLY I I i AMAGE L(Pw y c eITYSL f S B ! X UMBRELLAUAB rX OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CXS 8669257 4/1/2022 4/1/2023 1,000,000 I AGGREGATE i DED X RETENTIONS 0 S B ;WORKERS COMPENSATION X S ATUTE 0TH FR I AND EMPLOYERS'UABILITY Y IN WC 8665063 4/1/2022 4/1/2023 500,000 :ANY PROPRIETOR/PARTNER!EXECUTIVE I El.EACH ACCIDENT _._-__-I.S 'OFFICER/MEMBER EXCLUDED? 'NIA A ---- I(Mandatory in NH) I ElDISEASE-EA EMPLOYEE; 500,000 II yes,describe under i I I 500,000 DESCRIPTION OF OPERATIONS belay I .E.L.DISEASE-POLICY LIMIT!S I I ESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached it more space Is required) ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED:.EFORE For Verification of Insurance Purposes OnlyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELVE•ED IN p ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE G?N� dw - CORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights :served. The ACORD name and logo are registered marks of ACORD Teddy Bear Pools, Inc. ;N11,'1'►• r �") 41 East Street • Chicopee, MA 01020 o a i 49�� is (413) 594-2666 • (800) 554-BEAR 11) FAX (413) 598-8823 ';. A. Home im rovement Cont. MA#11889/CT #520951 c, f; . Ilk '�,/' 1PEDOYBEAAPOOLS.C�M • TEDDY BEAR POOLS e spas Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 111889 TEDDY BEAR POOLS, INC. Expiration 02/07/2023 41 EAST ST CHICOPEE, MA 01020 Malre%a` ;,' `.f' ltet, 4Y.'>7 :4Y?�. Fi wl- t10. h"l•� LA. Y."';'•;�V :\ n .'.Y $'� h�� ph p .V'•,�'�::. I ��y�l� i% �4 , , �'� ��a�� ti, ,. J w r K �' q tt /AI A�, .'� `Cr �3 t� v3v"N" a'�� `Y'�� trs �' r �N'K� 1�. �1 ,4�y!yd : , �,d •�,t_�./y r i' ' a{y�.' Jq,' a` i Ei {yA 1; ell vy:s _ a.... g , 1,..„ ,: _.,. S` ,� ~ ..„, j ��b'a'3�^ trt it v li A'II E (1`r' CON NECMUT 1)E:PARTMEN'I OF CONSUMER PROVEC'II ION z,lii it known !hat t.: .,. 'TEDDY BEAR POOLS INC =' . :iir 41 EAST ST lsj�'' 4''s CIIICOP] L MA 01020-2605 k i i. 1 has satisftcd the qualifical.ious required b}.law and is hereby rri;istcred as a r. , 4 HOME IMPROVEMENT CONTRACTOR. -' 1 Registration # IIIC.0520951 ' ',:•'' r : „/ R 1 5. f Ac j1w''t Effective: 12/01/2021 r'rr! Lid; Expiration: 03/31/2023 .� ?�� -, I :°zee, -- - Michelle Seagull,Commissioner y3+07 '> — .. d6•�..,.0 _ •:J ti. .C!-,,• .':TY 41` y �1`� q J q'�.•. ^rJ�;.•..,, ;R.• 'f`Ti,` - - �_.xt A-.�..ST �. L •..?„,, dY fb8::1 r•^ i1. .:..{y. d!.i„y\\_J w:%•-SL :..+• I