15B-046 (2) r�l
NOTE
YEe T�oundary lines shown hereon
are based upon found survey stakes
and occupation lines. An update of
the legal description is recommend-
ed in order to more closely reflect
the lines shown,
/•.
I]?F DENOTES: Iron pin found.
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� BUpNTCK H
�33178 Mortgage Loan Inspection Plan
GMU SURVEr°A C A B C 0 I'll LOAN 1,161GT114 M lYlcE.
CONSULT L ANO&--*WEYr Q AND MAPPr4'G
t G1A._F,ynnit64 cXJ1Fkn.rwv3OE&C3NseaVCee
A REGISTERED LAND SURVEYOR,DO p'D'mox 14 TgL- earl
HEREBY CERTIFY THAT THE ABOVE CLRVTOn6MA01I510 FAX b08-36e-7416
P �EpG triONW DATE SE T• 2S, Lg9S RECORUEDAT COUNTY REGISTRYCfDEEDS
P n aA � �� CLIENT _ BOOK lAGF C Carl
IN'CONNECTION WITH A NEW CLIEN.REF.i _ PLANREPERENCt, �:tt r Q}�(_PA �1�-
M011iGAGE ANO LS NOT INTENDED J•O•R DRAWN PER TOWN OF ASSESSOR'S
OR REPRESENTED TO BE A LAND OR MAP! PARCE4 DATED
PROPERTY LINE SURVEY. NO COR• THE LOCATION OF THE ORIGINAL ADDRESS, rr'�
NERS WERE SET,IT CANNOT BE USED DWELLING SHOWN HEREON EITHER
FCR ESTABLISHING FENCE, NEDGE WAS IN COMPLIANCE WITH THE LOCAL BORROWER, _
OR BUILDING'LINES.THE LAND AS APPLICABLE ZONING BYLAWS IN EffECT SUBJECT DWELLING LIES IN FLOOD ZONE oY t
CLENT FURNISHED IS BASED ON WHEN CONSTRUCTED WITH RESPECT AS SHOWN ON NATIONAL f1000 INSURANC PROGRAM EL
CLIENT MAY INFORMATION Q HORIZONTAL ). OR ZONAL RE. INSURANCE RATE MAP DATED s� tl_ ?" Iy�A
AND MAY BE SUBJECT TO FURTHER fRROM OLA ONLY), OR M EkEJvLP. COMMUNITY--PB NEL,1,
O117.5�41.E5,-TAXINGSr, EASEMENTS f�YJJvk�70LATK3N ENFOKZ;,EMcNT AC.
AND RIGHTS Of WAY.NO RESPCNV- TLON UNDER MASS.GS.TITLE VII,CHAP.
SIBIULYIS EXTENDED HEREIN 1 THE "OA, SEC. 7, UNLESS OTHERWISE FIELDED D AFTEO CHECKED HAm 2iH.*
LAND OWNER OR OCCUPANT,IT IS NOTED OR SHOWN HEREON. BY c 5
NOT)I,MNDED TO BE RECORDED. DATE z r• f,d. :Ti;r PGC.
?FJ'd T4TT89E F1
ACORD I DATE(MM/DD/YYyY}
TM. CERTIFICATE OF LIABILITY INSURANCE 03127/2008
PRODUCER Phone: (413)781.2410 Fax 413-731-9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P O BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
WEST SPRINGFIELD MA 01090-1175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
INSURERS AFFORDING COVERAGE NAIC III
INSURED INSURER X- Arbella Insurance Company
TEDDY BEAR POOLS,INC INSURER B:
41 EAST ST
CHICOPEE MA 01020 INSURER C:
INSURER D:
INSURER E:
COVERAGES •.
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR A sR, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMITS
LTR INSRq I DATE MMIDO DATE MMID
GENERAL LIABILITY 8500036498 04/01/08 04101/09 1 EACH OCCURRENCE is 1,000,000
X COMMERCIAL GENERAL LIABILITY PR�EM{sES Me�°�)_ s _ 100,000
`I CLAIMS MADE� OCCUR MED.EXP(Any one person) s 5,000
A PERSONAL 8 ADV INJURY Is 1,000,000
GENERAL AGGREGATE I3 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. S 2,000,000
POLICY PRO- —)
JECT 1 ILOC
AUTOMOBILE LIABILITY 32176400003 07/01/08 1 07/01/09 COMBINED SINGLE LIMIT
ANY AUTO 1 (Ea accident) s 1,000,000
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Per person) S
A
X i HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) 3
PROPERTY DAMAGE IS
——�
(Per accidaccident)GARAGE LIABILITY ` AUTO ONLY-EA ACCIDENT S
f I
ANY AUTO { I I AUTO ONLY: EA ACC s
AGG •S
LEXCESS I UMBRELLA LIABILITY I EACH OCCURRENCE Is
OCCUR I CLAIMS MADE I I AGGREGATE is
DEDUCTIBLE S
i
RETENTION S 3
WORKERS COMPENSATION AND 9104140407 04/01/08 04/01/09 X CRY.IMIT.3 { CTI+EP
EMPLOYERS'LIABILITY SOO,000
A ANY PROPRIETORlPARTNER/EXECUTIVE i
E.L EACH ACCIDENT 3
OFFICERIMEMaER EXCLUDED? E L.DISEASE-'A EMPLOYEE 13 500,000
■».,a.cna unWr
SPECIAL PROVISIONS Wlaw I E L OtSEASE-POLICY LIMIT j 3 500,000
OTHER:
1
DESCRIPTION OF'OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE
TO WHOM IT MAY CONCERN TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER
rrS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
Attention: 44 iam 0.TrU ,
ACORD 2S 12001108) Certificate 8 34065 0 ACORD CORPORATION 1988
Teddy Bear Pools, Inc. Known By Our Reputation
41 East Street r� �1 (413) 594-2666 • 1-800-554-BEAR
Chicopee, MA 01020-3562 FAX (413) 598-8823
Home Improvement Cont.MA#11889/CT#520951 � AID www.teddybearpools.com
A.Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
. Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 111889
Type: Private Corporation
Expiration: 2/8/2009 Trx 12608:
TEDDY BEAR POOLS & SPA'.> INC
THEODORE HEBERT
41 EAST ST
CHICOPEE, MA 01020 '
Update address and return card. dark reason for change.
- Address Renewal Employment Lost Card
STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTIO`
I
Be it know that
i
TEDDY BEAR POOLS INC
41 EAST ST
C1.11COP-EE1- 01020
I I�rl- T r
` is cer-tied by ffic Dep e$*. Coastlr�'ers�Protectior. as a re2tstered
HOME IMPRi I V' .J�NT'CONTRACTOR
. 20951 f
\�Ti?ANST �SV
TEDDY BEAR POOLS INC �V�ir
l 'r
Effective: 12/01/2007
i
Expiration: 11/30/2008
Jerry FfirMk jr,CAN n0dsioaer f
HOME OWNED EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants person(s)who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before sour) a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing& gas)the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections.Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
:�hw
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
Tire Commonwealth of Massachusetts
y
- Department of Industrial Accidents
=7� T Office bf Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le6ibly
Name (Business/Organization/IndMdual):_
Address: 46EA< 00 O �
City/State/Zip: Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole propri etor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have I S. ❑Demolition
working for me in an aci employees and have workers'
J y capacity.�'- 9. ❑Building addition
[No workers' comp.insurance comp.insurance.:
required.] 5. F-1 We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
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.
Contractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 perjatry that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town offcciaL
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone#:
P�6L e fps b.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Hone lmpoweme> t Contraor
ctti� r„. .. ;,. ,. ,a . .,, Not Applicable 13
Company Name Registration Number
Address Expiration Date
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 the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
I1. - Home Owner�Exemptlan.
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 building 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 Signatures q d,(Sr.
CA
►;
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 171
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [ Siding P] Other[r♦]
Brief D ri f n of Pr d &Vc
Work: �� 1 i L a�� pot)
Alteration of existing bedroom es Adding new bedroom es _ Qo DELVC
Attached Narrative Renovating unfinished basement Yes L000!�_Ql
Plans Attached Roll -Sheet
6a. If New house and or addition.to.existi g housing;:complete the following:
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. Masscheck Energy Compliance form attached?
h. 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
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name /
nA� Q (9�)-I.tr✓1 71 f g toff
Signature of wner/Agent Dat
` a
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Depa=ent
Lot Size _... _...., .._.,_..,
Frontage
Setbacks Front
Side L: __...,..
-- "
..., . ,.., R. . .. _.✓ L ,". ._._. R: 01f
Rear _
Building Height
Bldg. Square Footage _.. %
Open Space Footage _,.. %
(Lot area minus bldg&paved
parking)
#of Parking Spaces _.
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW • YES
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES 0_ .
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO • DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location: j��� U ti 11' -3 ? �(� re-ET ram Pec.� l
Li ll.lC
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
.- .
.{ � Department use or�l�
�It sj aY
o610 npton Status of Permit
+ding Die*ipent Curb. utf3rwewaYE?et t
212 Njain $,tbiet SewerfSeptt Avail brl�ty
`k r, 100 Water/Well Availability
J��10)' hamptonyNPA 01 0 fwo,Sets of Structural Plans
� hone 413-58 - ? ��' x587-1272 Plo
Q tfSite Plans
Other Sp,
APPLICAT N TOy @NSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
(e(0 S PKINij 5"["A T Map Lot Unit
LtcdSt IVA• Zone _Overlay District
d 1 O 53
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Cyrrl nt I�vailing® s � �
Telephone •-
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building U '4 Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing — Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Totai=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0052
APPLICANT/CONTACT PERSON O'BRIEN LESLEY J
ADDRESS/PHONE LEEDS
PROPERTY LOCATION 610 SPRING ST
MAP 15B PARCEL 046 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: REPLACE ABOVE GROUND 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
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
Signature uilding 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.
CI Sfi BP-2009-0052
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE: ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0052
Project# JS-2009-000063
Est. Cost: $6500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOmeOINner as Contractor
Lot Size(sq. ft.): 29664.36 Owner: O'BRIEN LESLEY J
Zoning.URA Applicant: O'BRIEN LESLEY J
AT. 610 SPRING ST
Applicant Address: Phone: Insurance:
LEEDSMA01053 ISSUED ON:712112008 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE 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 Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/21/2008 0:00:00 $25.004996
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo