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36-297 (2) ~YL[ASB REAL) CA0F[FLLT^ AS[11`-B.)-STITCHECK1,1S] OF YOUR NFW P001 INS-IA1,1-ATION CUST00ENRESy0NSlBlI [TlES ApnIcAnox FOR FINANCING-Please MAC di/n I mm^""/`p`v,xo ilk ;"'"k`p,".,^`/l-(Io% x,x,'`^x""/o`,no,*"m"/po, p",//xis mo assure m,urlo.and nm,u'for ovnrm"`n.moou TREE xcmuval.mu:canmm-,emmu°,mx tree specialist.n the p,o'trees m""//va/m.u^'^u^`make"*m^"Your pool.up",nnoc,',"""Ill u,ig/uuw refer you m local companies. REGARDING STUMPS:x", lump that u"m,m"mxa'rx`-1'III diameter°.m/nu pool uieu°ill^ox/uu/vre"""u|»rr,uu/um,Po(./. /n ill.�.,mx mum,m°^mnonuu,^nominal fee°Ill/euu'ss' ,/,.mam/=om'"mov ,uomu^`" ,needed v+xvmxnmvv u"mr'iunm the ja,siu�x .m"an,have the stumps ground r ^a"°ground/o«/ scrnc*rs/EImy/LEACH FIELDS mnxrn/uL Ili the,,m,r`",p~,e"'vp."./,tell,(it"^cnu//'^'h held/.n."are:"."g,^,.oco","till pool uxam*^m,*mnpnuou should/vm"d,:mvk,opm,11xvn.,:mo/cux^mmm,^.m``uwom r*I|�uu,uwi,.^mxmpn*a.^om"C"^II*xrm^,he cc u, an//a,/omu*.`' ,oil III'|u/`^nu.nx.,ou^matter It',our tank."womov"mu/.n/m`,m:k,'Life.,..r"mro / mck Ili i(|um' xrr/ISs The fit n«`,*own,.." nnu�omk'mr.h,.' ,I,ww(lvp*/`./"vmw /mu`.~m./plc�,,° h^lic"a. m"v.x/e greatly appreciated retu/xcu Pool,mmxu/xuspw"u,for`i^nox,n| ovm, "o Olt,"/"", /)clapumu"uw. this hit, riot^uxukmc" " ill w|."mx� x:u.xi�s uo"°am.�_,hh"'`vnpuv .' "m»,�w,`�" ".w.,Nm.h^ ".h,.nCm"_.w",u..^.x^,om/ov.va'o* pw,mv�"o rm^,r"o.".xu�um,m""`p.,�w.nov the noi^uy�u�m You n"��, "."u. xm/Locv GnoRmn* nua.`ux.op`m/w.m.nup=/*,v'ck,Ili.u.um,^/oc nmm Viluo/mauxu,amx�I mx'these^^m`"it!/,m,./uh* �o~r^=n/"r~Upon request Our x"""Imvm"w",m Contractor License#s are;NIA# n/m and rrwszov /. //xcTxx./r`'x/mu/e/V, xArsponsxscrnxxc\uV' m"xhe^upvo`ym(lie ua,m.^oau,.Azom`n outlet nm`vmu.o most Cases. xAnEx nm"make.(Ile'o* vm,installation cu"has o*./ow"/x`xp«,00IWv nv'x^oomzn/nxu' ', Ile Ile tiju»|,m^/ux:n'"|.".rm`,I0'x,^. enter»°mh,,m,. AT TIME Of'CONSTRIL4,"I'llON: on/VcnAY/s:nxw`L^S the point v/,mn lot trucks m equipment ~mx,x^x^"m,xmwiku.po".'xa/ "znp` m��.'~u.x'"°no"^"� u^uwc|uvm,*x wkovx.n:how^m`^uo.,u°"/"ao"n"or°.o|v��c.°xu�c,"r/pucm=.,x��*m'^v�m'"w»mm.cufrij,e,wm".m.u.mv nmucm that mu m,sc�/xo,up"o.°«cmomit,o:'n^o\ l"w.,»vamu:p"/^o'kind, SITE WORK-"THINGS YOU Sit()-( LD KNOW' SHALE/ROCK'sxr'oscmuu,ap./xomcoo,v,prou."u(III till'"rcmo,u"cc..henmu!his umv ill|eu.vu`°a oil xo.mo"oou/hm.` *AnoR/xxLxw/Gux,cnouxn"x/CLAY/ucurAw aod.� Bear Pool ch,nm till!C"^"mc fill-o."^"~".w/� uwax,"mw`~,/.""/."/cu^ma store".n`"mu[or muvnw,xmu,v*|'m.n=^m*z load.``umm` �amm`.�x,ocu�,s^/m'`um/"m ^v,m^°m�mu^m,~m^,mx'ov.. o/:�* NON'Anxncxrt_nnrx/;xxxm`oxs/a,./Es o..�r�_,n~ili/dc+l is(I C,smillp'.mxx locks,u,,"um","om'o../ "m//voCc'°.o^`Use m"m.a "tic hm-,I nxy.concrete and/or mm.'"^p,.^x.t% m'..":`o,ilte(I/r'h��"m. /.och ./u�*for till,'\p'.^ummill ".x»'mowu|x.m»m/ excavation pi*mm'. EXTRA FILL oou\ hvnuoun:,u,^,huu|o."uxo/*`my"vrpuw'nu'cm.`vxh°"m,pac'. mx.^.^/h'o.c,"*in|vpo,nxr*o~w^x^,m/v additional fill brought III lot uuo.v�_',o"uc,n' xww»u,ca:x~.|..'"Ill lie no,uon^vpm*ha, the m"Ehuux top(tressed.its'ux cannot xrvvox|m/neuiva/ m other types wLiwunumaterial a'uv Bear xm|`wx leave lvu"./h omu"n,"mxcwmo:�/"rw,|unu�no,�u|io�°.x/vx"vru,pm,.ux� uxA/wAcs'()z»"wx/k^site o",nnu",aonuoiule -xrm title^..m�vmr landscape xnu'oil conditions, /)I-"^ Lc""vu it)pnvox Arid- [till )it allot upper seepage m°um the pool xa'r.`directed v*xv from the pool*x lower point"o[Ile site Gutter downspout should u|~/xanz',|x°u/front m,p",/ xslAIxnw' WALL'xxm*n.,*vmo.^mzc"an'nuo":nxn�covu`o.vou^`ouu�uknoiox,"oni`^,^,om.�n�c un',mrp^.|"^xmu^^o p|cxm °`m*^~cmwuuu/»mo`w|'^,u=o sort m^.v" LAwos«AmwG lctuxxo"Pools a"p riot,^...^,(his*p.u,w11Co he ,life^,nn."'aiou pitch uvw onmm,pool uu^vlc,u.cw,IIu "vo, ^xoxm/h*.cxov effective wx wpm".e proper m.oa:'. x^Tcxn.FILL POOL x.x.m"al/'vti,pool .`mux through rm,*uco how. ow*ou^``Ill»'Mickel]Ill.J)]m'C.nxm^its ii1ldwonw 'll'000*"� armng,m'm", xuT:*c | chn.. m:.o|�mvn the p^ku:.n`"/mo.pmmI.w Ill^,puko|uroC�iorxoo left for'».o/mn~"/rm,11mx'u"m. AFTER INS'lIALLATION OF POOLISTRUCTILTRE: CONCRETE DECKING aakn^vx"o"vox^`the^.gliotvvo|k'nuxn |.iflvo:mill file most qualified cun`mu mmmm that'nckin,"/o"mco.` �p mami"imum� co^won�'|x;i"n the x"uxon '|.m*,oxmo»"|w"o,oi"uumphxhommx �e v"."uo xm/umox,uuk*mou� /n~`/m.m*-- u/u min.uun^din and*hxo�",that mu Come in"`m"u".'xnw/azkpmmu.v^kxumco,ovki*/ n/^rku*,m,o«k�'�m�rw�m'u, ^,,.Lo --- xotuothe ommmmwo«kmm,/u"m/|u ground*.nxx'um""m|.' // v.n/vpo'u`,wuwi'//"o:c"ux`muo'� h�Wx. --' FLOATING LINERS'Excessive m.nw/ma mu'Cnmxx*/^mmupm,pp|mwh like o.Joe,^, nux`v|/."'u`ou'|eon"*i,:o~i,which u omanur leave=""uc..n the xmi.xacn*rcroilt it,nm^u01C�Cv"nu"/r^~ " The a°/"oh...n/o°Ill/"o,,ov|/p most h,mumo',"msllmu,policies. SnASrwxLs|a,/cs Pool"pmioL and u.~.,«v".oc, Ile n^"a«'»vmWh"mScn.u/�p�un^w x,rm"u,*,o rill vn ices w Cater o,ou»."*moui 111(fividual nee(k, ncu'uvnmmomge,pw,°:m'mr/ro."Im,.oxpmrp*/n`veo,"oow|"m/a^vu /*,su,"znrpmmo/i.vmau|rpmte"°a./ Set`ice Toc,hni/iumxx"tire mu.,pz|"III,»c^.p�Iu/h`"'u|pmm.|min.or,n.co,.u-, xu,/+^,/s',,.t o' Iom".x",,o.muu.,,cp:,px,|nx.lc`"vom|' ,nsv/cx1,rnEArMuwr'l'cu,xoxx^Ill Ill ` ILL cm*m'"to)o°.w/, '/uu,u/uu,o"`/`xn,mnuodc./'licm.o|^Ili_%oil ski,imm.o:poi dnuu ch,miu|^/u,'�mvm u|,mm`,uo/wo^vu/^'o�|..*vm/.^ "/".,,"duu".'hm/oun�"/^u.o;wv"nu.o��"x^|�'."uvmxmo ,/um"'`/`.. Lxunio| ""�/^�,.x"ao"*uoocm^u"a`000.�,�'m,~^om� A:u^/a"wo�,"u�."ku"o",/,cx,a.v, ".ox,p°"../'u°`.pvp".umrl` .vn"/�."/rn,x swimming Pool. Please read(his h"kmcma"xvo^riot uuun*zpm,xunxw'/r.^/,,.n»,"vuum.'a`. ' |Nc/xmpx -- |clmy Bear*w/, i.fr,,wmy»y umoomu,xnor Ill a. mix;"mon our pm',mkc, that trust.^`vimmm:pool is it |.`ou u,"/ Imcstincilt. Fimo|��""v.x/vn,o/wm�o'.nu"m."".mx,,x�.xxn^="|v,"/o'"/^�//xm,n"`|"»'ov",pool �~�o i^xvuu and v�mx�woI^,"ca ov�nmmu l humxv h*a,ovh� u Thank, *m Once again from all (Pfm at TvNy lko,Pm)ls & Spas rxmmrsrxu*xGNu)Am.uxn/xNE'oxEx`xLxzcAv`noxIt AN /*xxmPOOL urxno/wm;mw'su EA; /uoo�* roA\sNo'` Owner Date nea.w sign w.ropjfmapaL�e Itr/Mdv Bear Pools and keep the otherfiwYmmrecords. /7 • TEDDY BEAR POOLS, INC. MA Home Improvement Cont. # 111889 CT Home Improvement Cont. # 520951 A 41 East Street O��,Re Chicopee, MA 01020 Fed. I.D. No. 04-2583701 (413) 594-2666 MA/CT: (800) 554-BEAR Fax (413) 598-8823 0 www.teddybearpools-com C TEDDY BEAR POOLS fe SPAS EXTRA WORK COST ESTIMATE TO: PHONE: H DATE: W JOB NAME LOCATION: JOB DESCRIPTION: ........... ......... .......... .................. .......... .......... ---------- .......... ....... ..........- ........... ----------- ....... j- 3�7 j! ............. ............ ........... .......... ................ ........... /* ........ --4 . ............ r rfi, ------------- S, 4tj Not Included: Loam .............................. ........... ........ J, Fencing Dry: D Yes ❑ No 3/4"Stone ............. J,cqhemicals Water Tanker: ❑Yes LJ'No Clean Fill ................ ................ ...... �.I'Bld. Permit Trucking: Yes ❑ No Pump.......I .............................. C, Labor............ .....4/ Ll"Water Stumps: ❑Yes :1 No ......... ................... BackHoe.. ............................................... Job Description: Excavator ............................................... 14 Stump Removal.................ifv " ........................ Other 21 See wording contract for signing back. ESTIMATED JOB COST THIS ESTIMATE IS FOR COMPLETING THE JOB AS DESCRIBED ABOVE.IT IS BASED ON OUR EVALUATION AND DOES NOT ESTIMATED J INCLUDE MATERIAL PRICE INCREASES OR ADDITIONAL LABOR BY a W0 0 d AND MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORSEEN CUSTOMER PROBLEMS OR ADVERSE WEATHER CONDITIONS ARISE SIGNATURE AFTER THE WORK HAS STARTED. WHITE COPY:OFFICE YELLOW COPY:OFFICE in Commonwealth of Massachusetts Department of Industrial Accidents • 0J/Icool/o�yslloas 600 Washington Street Boston;Mass 02111 Workers' Compensation Insurance Affidavit name: location: city phone a ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer provi ' workers' compensation y employees working on this job. COMP n3�� -� Gl6�i�tf insa ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name address: city phone# insurance eo, noh�y#! comoany naive: address: € ... ... • city' .insuranee co policy'# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to St,$00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify nder th pain nd p alti /perjury that the information provided above is true an come Signature Date h Print name V , i CC% hop #z official use only do not write in this area to be completed by city or town official city or town: permit/license ii OBuilding Department OLicensing Board 0 check if immediate response is required []Selectmen's Office OHealth Department contact person: phone t1; 00ther (revised»s Pig) Complete Pool 8 Spa Specialists _ Known By Our Reputation 41 East Street �' "1 (413) 594-2666 • 1-800-554-BEAR Chicopee, MA 01020 FAX (413) 598-8823 /S TEDDY BEAR POOLS 9 SPAS STATE OF CONNECTICUT 10/07/99 E DEPARTMENT OF CO:VSUIVER PROTECTIOrV 165 CAPITOL AVE - HARTFORD CT 06106-16'0 Be it known that TEDDY BEAR POOLS INC 41 EAST ST ' CFUCOPEE :VIA 101c2c ' Is hereby certified by the Depa:-,rnent of Consun-er Protection as a registered HOME ENIPROVEy1ENT CONTRACTOR REGISTR,kTION `t;FIBER: =52:93 i EFFECTIVE DATE: 12/C1/1999 EXPIRATION DATE: 11/_C/2= DBA: TEDDY BE-3R POOLS IBC CONTRACTOR OF RECORL!TH—rODCR..G. rE3F—R-1 fames T. FIeming _ A HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 111889 Expiration 02/08/01 Type - PRIVATE CORPORATION TEDDY BEAR POOLS b SPAS INC THEODORE G . HEBERT 41 EAST ST CH :C,:PEE M:• 01020 I►�/R�.^ #r 04/04/00 Paocum AS Of RIMMATM INSURANCE CENTER OF N $NGLAND MOT L uvoN TAR MI$ CElMCATE DM NOT ANOM EXTIM oR D/B/A SU'LLIVAN INSURANCE COVERAGE AMR= BY THE POMM uLow. P 0 BOX 118 0 COYOANI3 AFFORDMG COVMGE W SPEW MA 01090 COMPANY A CNA/CONTINENTAL (SURPLUS SVC) E�suN6D COMPANY TEDDY BEAR POOLS INC B ATTN: TED HEBERT COMPANY 41 EAST ST c CHICOPEE FALLS MA 01020 COMPANY �p �.+y".y xz;, "'• .r r.. f .�1*a.ra$ `•• +"`-Mx'•r�`.''a+~uR iu+ssu'�3a•r^i!`a.'di#w``^.: ''..:ifr'u�'I<:NkS.t.af t•.,bit:,`'`�'it.'. .:,FG.'.wii:"+'..+YSf, .'t:+�r:e'iyva.".:f T cll A��tl> a`ti•:°...:<d.�y�y�G..'rr 'S>2.�+rf;':•"�hLw$* k:: ,. :. ,,...r x THIS 4=TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY MUIREMENT.TERM OR CONDITION OF ANY CONTRACT 001 OTHER DOCUMENT WITH RESPWCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PIRTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREW IS SUBJECT TO ALL THE TERMS. IXCLUSIONS AND CONOITIONS OF SUCH poWIlS. UNITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF NiYNCE POLICY Mijumm �� r M Wtrs LTN IounpAL LIAEUTT TO BE ADVISED 04/01/00 0 4 01/01 Ga TAL AGG"GATE s2, 000, 000 X CQMMV0A`GmEneIAL ULry PnooucTs•coMPioP AGG *2, 000, 000 i18 MAIMS MADE [X OCCUA i PG0NA1;ACV INJURY $1,000,000 CWNUtS•CONTRACTORS PFIOT [AGH OCCURRENCE S1, 000,000 FIRE DAMAGE WV WW M•1 S 50,000 MEW eXP OM WO WW) i 51000 7A4W 06"UASLM TO B E ADVISED 0 4/01/0 0 0 4/01/01 caAEam swGU u�uT s l, 0 0 0, 0 0 0 AuTo OWNED AvTOB (BOOLY �{J"'' i X &OWN LID.urns Hi1l0 AUTot � i X mxros i l PROPERTY DAMAGE i GARAGE UAEUTY i AUTO O Y-E/1 ACCp i ' AUTO OTMER 14M AUTO ONLY. I UCH ACCiOENT i i AccnECA�s atCM UAMILM TO BE ADVISED Q 4/01/0 0 0 4/01/0 I 0CCNNRENC6 s3, 0 0 0, 0 0 0 X,u�aElu Ac NM ( I AGGnFOATE i3 0001 0.0 d IoTME"h�AN uMSaEw►PcNM ' TO BE ADVISED 04/01/001 04/01 O1 ; X i �;,�s' I ems''"'''" WO=X^S COYPO/{AT1ON AM V i EMPLO'RNE'UAEEUrY a ut„AC=ViT s 500,000 ' I �__ me P"QPacTOnr «a ( a 0�6 r uMR s_ 5 0 0,0 0 0 �� oL ojsEASE•u**%OYU s 1500, 0 0 0 IQTmX i I 0[tCrnOM OF OPiRATIOPOLOCA n �•r!`-� fir' *�•'�•`f•I�Y•.N..•.1. 'Vin• �. . ~r G.-i.%..•N.. • .� H :M .. M. .�.n..�+u•.M1!'..n..i.. .44... ..... •NOULO ANY Of THE Awvt ocscm O Poucm K TO WHOM IT MAY CONCERN ZWWAMN an THRKOF. TM GSUM %'OW W" 09KAVON'TO MAIL 6Q_OATS WOWTM My"TO THE CCXTvWATE HOLD"NANO TO THE LEFT. NIT VALUM TO MAL tYCN NOTICE*%M&E/O"NO ORIOATION ON UAIUTT OP ANT ILaND UPON Trs r.01IA1fT, n3 AQiMa 0" REMEENTATMEE. 700 - M� riNwJ�wrF�i�w�� :1st ,w n.�.I• ..G 1, 10110 S S 07'026 '30#f E 07426 r 3 O.r 44.39' s L OP 125.05 �t y Jc Cp �` V o cr) 00 CV C� C14 � � � � Jd CV,L w © ��jwm wWSW � > v �Qv to CIO to co 4 > � � -k o w CO o ° w CO q � q 4q� 3 � � CO M ° cod II II II � Cl) � day V ^ c > , Ar N 05.44 '54" 44.< N 05°.4454" �' 125.00' 110.63 S 05'44 194': Cl) o . SOVEREIGN WAY o , Orr f ;, oo to S 05 044 '54" E S 05044 5 li li it �- lTO 2 r .c y (yif�) Of In�tl1aul}�fc>>i - _ DEPARTMENT OF OUIIDR\'G INSPECTIONS 212 Main Strcct ' Municipal Building Nor thampLoll, Mars. 01060 0RICT-IZ'S COivLI'T ATION INSURANCE AFFIDAVIT (]i ccascJpcl�>;tree) ith a pli�cipal place of businesslresidencc at (Sl rc:Uci t y;n:=ic-'v P) do hereby certify, undei the P2M)S <Dd penalties o.pc;jwy, th:�l ( ) I stn an ernpioyer providirn: the covcra_,c {(.)r ur, c lllpIOVCCS wwl-11114 oil lillS iUl) 1 2171 2 SOIe i?rOUi1CtC)i :CilCr'i! CIOMY-cC'Oi 0- ")On-teownce (c"'cle opc) <__lU llcve hjl(Ld the colltyactols hste-0 b-10O v have 01e i011G`,vli;Q ',vort:C-r'S tOGlDellS?i101-1 i)okl:':S '' ;�.r�t.on I�atc )amt o� Con.- (1 ,i..�. c� t ompan-,u out, :.um.��;) ) (Name of Contractor) (Insuranc Comv2av"110licv N`umc•=r) CE»irluon Date) (Name of Conn cloy) (1riuranc: Compacy Poke Number) (E�pir.�uon Date) (Name of Contractor) (lasivancz- Comrz,y/Policy Number) (Expiration Datc) (truth acidrtioczl c'xci irncxxzid,:to irx-}wl-iafav�itioo pcl""' ,to n11 ( ) I am a Sole propnetoi and have no one working for me ( ) I am a home oNvtier performing all the ,vork myself. NOTE:plc- be awwc diu u,tnio homco�wbo cruploy p,w w do r,Ty---1ra,ru'coax- oo a rcpa worx on i d.,cili_g of oo(more than thmo unity in which llie bomoown T Idea oa the E7oucx i' appurte thcctn trx oo(CCncr,i1ly WC-dacd to be errn;lloym tinder the wo i cs� s=dim Au(GL152,s l(5)�:.ppt a-0oo by a homcow=fore bc=x a permit m:y c`16m the legal ct m"of m :Mployo<under d-Wod cOet Coaipom—t-ion Aec 1 undcru d thxt a ooPy of this vw—cm maybe focv—dod tv tbo Dcpartma�¢of ln�>-trial A�dc�'01Tioo of Itz u'�nro for Iba oovQ-Xg vet-ifit:tioo aad that f_iJtse to aoauc eovcTn under Sccu0o 25A of idOL 152.Ic d io tba inxpoiiiioa of eriminsl pcnaliiet oomi-.a g of a f nc of up to S 1.500.00 and/or¢izpruoa»,=4 of up W Ot year and avil peashia io d� form of a Stop W oric Ordcr and a rim of S 100.00 a day a inA ax- For dcp-rt r,l uic only c Pc-=t Number 0 _ Mop', DEC(' gnahirc of Li ccriscrJPcrnuucc SERVICES ECTION 8-CONSTRUCTION LSERVICES J111 , I or. Not Applicable 1:1 ­1 Licensed Construction SuperviAor: Not Applicable 0 Name of License Holder 6 License Number Address Al Expiration Date Signature Telephone IN Not Applicable ❑ 111k k 9" Company Na nA Registration Number Z/ C/ T - A 77 41 C #- 0102 0 12-012001 Address Expiratiofi Dat�( '2000 0(,,W -Telephone SECTION 10-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;Jhe building permit. igned Affidavit Attached Yes....... No...... ❑ ft, ,--iiit The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.,that he/she shall be responsible for all such work performed under the buildinp,permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature__J1iA-dtu �Mw.CT1914 DESC TIQN OF PRQ,PQSE(�WQRK(cheek all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other,' lli� - GAG Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ pleteA1*40INWIne a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby autho e to act on my behalf, in all matters elative to ork authorized by this building permit application. 5---_ '� Sign-at ur caner Date ` as Owner/Authorized Agent hereby eclare'that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signe under the pain and enalt. s of perjury. P n Name Signature of Owner/Agent Date r � Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by / Building Department Lot Size G 5 /�� -S61 F '� v Frontage Setbacks Front e Side L: � R: 35- R:3�� /O t Rear 30 ,l D Building Height V U Bldg. Square Footage % D Open Space Footage % (Lot area minus bldg&paved D parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ✓ DON'T KNOW V"'f YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO V DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: City of Northampton Building Department vp 212 Main Street Room 100 �s orthampton, MA 01060 =° 413-587-1240 Fax 413-587.1272 3 3 5/ yi lv R P. ,ye APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION(1-SITE INFORMATION 1.1 Property Address: This sectil.9p�e com,>pleted }f Mice" Se V I.e2 Wa Map 1.ot Unit Q Zone rlay Dfstr vx_ ha Eire St;l� ct Co Dfts rlct„--;' SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �1�u 4 C en -t ame(Print) Current Mailing TAddress: -5—L1 I161 Lf Telephone Signa e 2.2 Author' A ent: i f e c / S Name int Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only ,�V11AfW-j,'N 4/6 completed by ermit applicant 1. Building V vQ� OU (a) Building Permit Fee 2. Electrical O qM Q (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) Check Number Q' This Section For Official Use Only Building Permit Number: y n%! Date Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2000-0933 APPLICANT/CONTACT PERSON JACOBS JUDITH ADDRESS/PHONE 41 SOVEREIGN WAY (413)584-1104 Q PROPERTY LOCATION 41 SOVEREIGN WAY MAP 36 PARCEL 297 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled ou Fee Paid Yyo Typeof Construction: CONSTRUCT 20 X 40 INGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THELOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: !//Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § _w/ZONING BOARD OF APPEALS 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 C sion Permit from CB Architectur Co ittee 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. t 41 SOVEREIGN WAY BP-2000-0933 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-297 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: Inground Pool BUILDING PERMIT Permit# BP-2000-0933 Project# JS-2000-1720 Est.Cog 3 AA , Xa� Fee: $50.00 / ! PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq.1): 32539.32 Owner., JACOBS JUDITH Zoning: SR Applicant: JACOBS JUDITH AT. 41 SOVEREIGN WAY Applicant Address: Phone: Insurance: 41 SOVEREIGN WAY (413) 584-1104 () FLORENCEMA01062-9622 ISSUED ON:4128100 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 40 INGROUND POOL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 4/28/00 0:00:00 840 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo �o ,o� � � �asssclpisrtts �^ 5" v DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street * Municipal Building N Norftunplon, MA 01060 June 21, 2000 William Kuta 89 Pond View Dr. Chicopee, MA 01020 RE: Pool Inspection 41 Sovereign Way Dear Mr. Kuta: On June 19, 2000 you called for an inspection of the wire mesh at 41 Sovereign Way. On June 20, 2000 I made the above inspection. The inspection was disapproved. Reason for disapproval is Rule 10 of 527 CMR 12:00 Massachusetts Electrical Code. Electrical installations shall not be concealed or covered from view until inspected by the Inspector of Wires. As per Section 143 Section 3L 1 AM giving you written notice of disapproval. The inspection could not be done because the wire mesh was covered with concrete. Respectfully, l George A. Fournier Inspector of Wires cc: Judith Jacobson, Owner Anthony Patillo, Building Commissioner Stanley Sze\vczyk, Building Inspector