17A-173 (13) BP-2022-0437
40 HOWES ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-173-001 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-2022-0437 PERMISSION IS HEREBY GRANTED TO:
Project# ABOVE GROUND POOL Contractor: License:
Est. Cost: 7399
Const.Class: Exp.Date:
Use Group: Owner: S BASSETT THOMAS A& BEVERLY A
Lot Size (sq.ft.)
Zoning: URB Applicant: TEDDY BEAR POOLS & SPAS
Applicant Address Phone: Insurance:
41 EAST ST (413)594-2666() WC8665063
CHICOPEE, MA 01020
ISSUED ON:04/28/2022
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:
O
Fees Paid: $40.00
2l2 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
•
File #BP-2022-0437 Z—a'V.
APPLICANT/CONTACT PERSON:TEDDY BEAR POOLS & SPAS
41 EAST ST CHICOPEE, MA 01020(413)594-2666()
PROPERTY LOCATION 40 HOWES ST
MAP:LOT 17A-173-001 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
Al
Type of Construction: ABOVE GROUND POOL
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 Perm it With Site Plan
Maj or 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
///g Li"Z8-ZO2Z
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.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Offi9e of
Planning&Development for more information.
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNICIPALITY o; n• 1,1 t Massachusetts State Building Code,780 CMR USE
EF,�I 0 Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
4 One-or Two-Family Dwelling
ZZ c—) 1 a This Section For Official Use Only
Building Permit Number: 3 P• Lf3 r7 Date Applied:
a m f V ,P'(
8o
Building Qfficial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
40 Howes Street l'7 A -(7 1) -O 0 1
1.Ia Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
- t4$ (-> Z ti (o,
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
2,o FT 4 FT 4 r-
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public Private❑ Check if ye Municipal On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Bev Shaw Florence, MA 01062
Name(Print) City,State,ZIP
40 Howes Street (41373351836 t3Ev SNAvv 40 e GoAtL. corn
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other ❑✓ Specify: Pool
Brief Description of Proposed Work2: Above Ground Pool
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 x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $ [
7399 Check No.705R Check Amo t'1Y Cash Amount:
6.Total Project Cost: $ ❑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 Expiration Date
HIC Company Name or HIC Registrant Name
41 East Street
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
to act o my behalf,in all ma ers relative to work authorized by this building permit application.
Print Owners Name(E ctronic Signature) D
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 Alaxander 4/3/22
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"
r -) Above Ground Pool
• • Plot Plan
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TEDDY BEAR POOLS C SPAS I .M 3
The plot plan below is approximate measurements for the pool placement at the home of: "arc)
Customer Info: -9 C2 //Otv6S 6 — Q GYFRLy SN-9W M Ti A SSE7In the City/Town of: ./0 2 7f/A , P?O�
1-07 LiNe 20 -r cacgsrc 4vT 5,0g 4FT Soot
Above ground pool set backs are: of House Side Rear Nfr"Septic N/A— Leach Field
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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: A4SS677— Date: 2 EA PR 1L 2oZa
41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpools.com
r Above Ground Pool
0 0 Plot Plan
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TEDDY SEAR POOLS SPAS 1 :Si -71:1
The plot plan below is approximate measurenwrts for the pool placement at the home of:
Customer Info:
In the City/Town of:
Above ground pool set backs are: of Fouse Side Hear Septic teach field
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Draw out you backyard including the back of your home ant eat Imes.Show measurements from lot litter,both sides and
rear as well as from the hack of t he house.(See example on back of page).
This plan was completed by: Date:
41 East Street • Chicopee, MA 01010 • (413) 594-2666 • (800} 554-BEAR • www.teddybeuepools.corn
The Commonwealth of Massachusetts
t ''`,Li I, Department of Industrial Accidents
_1'...raw 1 Congress Street,Suite 100
eye, / Boston,MA 021l9-2017
` — ` www.mass.gov/dia
'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH rHL 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#:41 3-594-2666
Are you an employer?Check the appropriate box: Type of project(required):
I.E1 I am a employer with 1 00 employees(full and/or part-time).* 7. El New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. D 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.]t
10 0 Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on ray property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. p
n Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
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 fi11 out the section below showing their workers'compensation policy information.
I 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 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#or Self-ins.Lie.#:WC 8665063 _ Expiration Date:04/01/2023
Job Site Address: 40 Howes Street City/State/Zip:Florence, MA 01062
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Stephen Otto Date: 4/3/22
Phone#: 413-594-2666
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�—.4,1 TEDDBEA-04 MPROULX
,acoRo CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDD
`.------ 3/24/202222
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER NONjACT —
HUB International New England PHONE __- --- --- FAX
Eat): I NC,No);(413)731-9539
A R``SS: -------__. _..---------
INSURER(S)AFFORDING COVERAGE NAIC
1N$URERA:All America Insurance Company 20222
INSURED INSURER B:Central Mutual Insurance Company 20230
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 CONTRACTOR 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 ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD,4WD POLICY NUMBER UNITS
A X COMMERCIAL GENERAL LIABILITY ------ -UdhVODlYYYYI IMM(DDIYYYY) 1,000,000
EACH OCCURRENCE _�
CLAIMS-MADE I__X l OCCUR CLP 8665062 4/1/2022 4/1/2023 DAMAGE TO RENTED 300,000
PREMISES/Fa occurrence) $
--_--- -- MED EXP(Aneperson) $ 5'ODO
n�o
PERSONAL BADVINJURY $ 1,000,000
GEN1-AGGREGATE LIMITqp.�APPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY 1 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER General Aggregate
A 'AUTOMOBILE LIABILITY COMBIACTS1NEDt SINGLE LIMIT 1,000,000
X ANY AUTO BAP 8669261 7/112021 7/1/2022 BODILY INJURY(Per hereon) $
OWNED SCHEDULED
AUTOS ONLY _ AUTOS BODILY p B�ODILY INJURY(Per accident) S
AUTOS ONLY ___ AUTOS ONLY (Per acc rl DAMAGE J_--_—(Per S
B . X UMBRELLA UAB X OCCUR1,000,000
LEACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE ICXS8669257 4/1/2022 4/1/2023 AGGREGATE $ 1,000,000
DED I X RENTIONS 0
B WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y!N X STATUTE ERH
WC 8665063 4/1/2022 4/1/2023 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT _l_
j (MFICER/M MgER EXCLUDED? N N/A
andatory In NH) 500,000
I1 yea,deacnbe under E.L.DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SOO,000
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace 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.y/4 -
1
ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Teddy Bear Pools, Inc.
r 41 East Street • Chicopee, MA 01020 . ' ; r
• 0 (413) 594-2666 • (800) 554-BEAR A 7 .)
FAX (413) 598-8823
Home Im rovement Cont. MA#11889/CT#520951 e•es
ak '��' T'IDDYBIUPOOI S.CWM
TEDDY BEAR POOLS C 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
? STATE OF CONNECTICUT 0 DEPARTMENT OF CONSUMER PROTECTION ,`
Beit luiown that ��
::__ * TEDDY BEAR POOLS INC
41 EAST Si.'
a CIIICOPEE, MA 01020-2605 s:
,, "f has satisfied the qualifications required by law and is hereby registered as a
HOME IMPROVEMENT'CONTRACTOR 't
Registration # 1-1IC.0520951 1
Effective: 1.2/01/2021
{ Expiration: 03/31/2023 R.
Michelle Seagull,Commissioner
ti )
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