HomeMy WebLinkAboutBuilding Permit # 2/16/2017 BUILDING PERMIT OF Noy,-H
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION a
"
Permit No#:_ Date Received
..._ S yh
—_ pr gssvcaus�S
Date Issued^
IM OR
T'A v tl Apphc uit must complete all iterns on this urge
LOCATION
Print
PROPERTY OWNER 61t` �r �r� ar°
t r
PARCEL Z t- --
� 100 Year Structure yes (,no„)
MAP �.'. . ( µ ZONING DISTRICT;,,,„ Historic District yes
Machine Shop Village yes c"noi
--
TYPE OF IMPROVEMENT PROPOSa
ED USE
l Non-Residential
I:I New Bu_ Residentiilding *'One family
Addition (I Two or more family ❑Industrial
n AlterationNo.of units: ❑Commercial
I Repair,replacement i i Assessory Bldg 1 Others:
I Demolition I Other r t
�fl Septra Well i�i� ��l Flottidpla E Wetlands„ �„ Watershed Dtnc
UuateT/Sealer /G/ / 7i�//% //�U//�rr��%��%
'o ,,,i i,,,,iE,,,, ! /i�� ;/i i:.::.;_ .. i iii/—_..,«. ,. %C._- .... ,,,s......_ ..•_...
DESCRIPTION OF WORK 70 BE PERFORMED:
— — —
8��e W PI dig a r r fi z,,,'7
[�alp-
cleaililrc siruu- Please Type or-Print Clearly
OWNER: Name: �f�,r� 2 S00""'6, I”e t e"�t,. Phone: ...
Address Vt ` 4lgC� d ,s r A�t L a , rI:,w �� r p l/��W s. r�,I"�� w
Email
N ,aJui .��mtia� �rec,c Phone ",�"�... ;q) .c�.:, g'a
Address: t) >c,
pontractor Name:.,, ,, . a... �.,.� �rra7
f f✓n frv6 _
° �.. J
Supervisor's .Construction License: ?Wr —Exp. Date:_L2-edI t
p
omIm Improvement License
..........
,.,,....,.:r.,
ARCH ITECT(ENGINEER Phone:__--,-
Address: Reg.No. _
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:$_ l,,I'b FEE:$ 5
�VVr z
Check No Receipt Nor:
"� 9 �
NOTE: Persons can Ing avith�ana�rc ristered contractors do not have access to the guurgnty faand
Signatures of Agent/Owner
Signature of.confracto
i
Plans Submitted! Plans Waived Certified Plot Plan n Stamped Plans C�
TYPE OF SEV/ERt)GE DISPOSAL
PnblicSewer Tanning/Massage/Body Art ❑ Swimming Pools R.—
well ❑ Tobacco Sales ❑ Food Packagiug/Sales ❑
Private(septic tank,etc. ❑ Permanent Dmnpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
/PLANNING&DEVELOPMENT Reviewed On�„�,.,,, S 7 na
ignature
COMMENTS �rU�'W� J l '` r 'I-CA k6,
CONSERVATION Reviewed on � Signature' i5. u _
i7o
COM NTSk > leo
7E
EALTH Reviewed on Signature
Zoning Board of Appeals:Variance,Petition No: __._Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer Connection/Signature&Date Driveway Perm t
DPW Town Engineer:Signature:
Located 384 Osgood Street
FIRE DEPARTMENT =i emp Dumpster bmsite yes. now:,
Located at 124 Mein SfreeC ”t �; �? '�.w
Fir
Departrri`enlsignatureldaYe
COMMNTS
Dimension
Number of Stories: Total square feet of floor area,based on Exterior dimensions._
Total land area,sq.
ELECTRICAL:Movement of Meter location,mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21n-F and G min,$100-$1000 fine
NOTES and DATA
-62
Pr,
Ock-1
0 Notified for pickup Call Email
Date Time Contact Name
L
Doc.Building Permit Revised 2014
NaRTk �
Town0 2 6 Over
0
No. Z -
�. Ver, Mass,
X1,9 ASR^TeoNow
3 U 4
BOARD OF HEALTH
FhRM11 I ILD Food/Kitchen
1 C _( ,,1 Septic System
THIS CERTIFIES THAT..G -. L ti,�?.N!!.!....M`"y , .. m�� .. Y„y3�,/� BUILDING INSPECTOR
' iC1Q PA Foundation
has permission to erect:.........................buildings on....,..,. V ...�.f'............... !
/^Q� AA�� ,/]� Rough
to be occupied as.,.22.X..3%....... r.�.1<./.:N....,,. .. .., �............................. chimney
provided that the person accepting this permit shall in every respect conform tot a terms of the application Final
on file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS GONSTRUCTITRT
W Rough
Service
..
:. ................ . .. ..
Final
BUILDING INSPECTOR
GAS INSPECTOR
OceupaneV Permit Rertuired to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No,
Smoke Det.
70 South Broadway r" lz45 Route 125
Lawrence,MA 01843 Kingston,NH 03848
Tel:978-688-8307 Tel:603-642-9909
Fax:978-688-1949 Fax:603-642-9906
providing afull line of services and supplies
fully licensed and insured
www.familypoolsonline.com
Name Date _Z " ' L
Addresszip '4
—City ttate s.
Home Phone Work Phone Cell_2 Add'l#—
Cross Street/Directions
Estimated Start Date Estimated Completion Date
We propose to furnish and install on"inylgunite 1, swimming pool for the
sum of$
THIS PRICE INCLUDES:
•Normal Excavafion up to 8 hours on day of dig •Manual vacuum slower kit -Watedma Tile l6)
•Backfill and Sub-Grade up to 3 hours •3-Step stainless ladder •liner Choice
-nirdraValerWhite Lightl20V61t •Rope and floats •Test Kit
•steel Reinforcing per Engineered Plans for gunite •Initial balancing chemicals •Surface skimmer(a)
•Steel Structure per Engineered Plans for vinyl •8 to 12 Wk supply of maintenance chemicals •Dual Main Drains
•Wer-Flo Line for added protection (supply depends on pod size) •coping
•Pressure trading of plumbing during construction Leaf net :•Steps
•Ten Year Plumbing Guarantee(see specifications) -Wall brush Handratls
•Trahaferaflbelfeffme Structural Warranty -Extension pole •Filter
fliflumbed no more than'26ft from pod)
•Pump A motor__,(_"':_
otor_�L'
THIS PRICE DOES NOT INCLUDE:
•Any plumbing over 25ft from pool,Additional runs are not recommended but would be at a war of$ perloct per line.
Machine time in excess of that specified runs machine time to be billed at$ i including machine,operator,and laborer,due with second pool payment.
•All hours of trucking will be charged at ll per hour per Duck due with second pool payment
•Any dumping costs incurred for disposal of led ge,large rocks,garbage,slumps boded or otherwise,building materials,unsuitable or nonstructural sells,or any unforeseen material that must
be removed.
•Removal of ledge or large rocks by way of a Start or,chipper,or blasting.
•Additional fill,if necessary,for groper backfill or reshaping of hole,supply or spreading of loam,reseeding of gram.
•Patio,fence,roaming wall,a any accessory items other than noted on contract.
•Eledricalvaring,fuel connections,heater venfing,fire)storage tanks or permits.
•Repair or replacement of sprinkler systems or any buried items such as well lines,drywells,leach fields,electrical lines,cables,etc.that are damaged during construction.
•Costs due to water or sol conditions(ex,day,peat,live sand,excessive rock,etc.)requiring a stone pack of the hole.The stone pack will be at an extra charge of$ "•1 6!.; minhurn to
$ " maximum and at the discretion of thelob supervisor.Additional machine time and/cur materials necessary to rectify such a condition will be at a coal over and above the stone
pack,rund will be quoted by the job supervisor.
•Water to fill pod,
CUSTOMERS MUST SUPPLY:
Access for all trucks and equipment •Building and Electrical Permits or mum the cents necessary to obtain such permits.
•Water and electric necessary for construction of pod •customer mustivater cure cattle shell for 7 to 10 days if applicable.
Water to fill pool immediately upon interior finish
NOTES:
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OPTIONS: TOTALS:
Diving Board Basic Pool Price, $
Solar Cover
Additional Pod Lighting
Options
Heater
Enviranipool Plus,8 hd+2 surface SUBTOTAL $ f '7
Additional Floor Heads "I';'� -
Polaris Vac-Sweep A"d'd/� 5%Sales To
Polaris retrofit only TOTAL $ f,
sAdinbun2ench rr 1,,, 4 0
Less 10%Deposit $ 3
Spa
Balance of Contract
Automated Control System
Salt Chlorine Generator
Other
PAYMENTS:113 EXCAVATION 1/3 BACKFILL+EXTRAS 113 SYSTEM START-UP
The buyer hereby agrees to pay,in full,the total amount of this transaction upon start-up of the installed pool.Your salesman or job supervisorwill meet with
you prior to excavation at which time all decisions including pool size,shape,elevation,liner print and all options must be final.Changes afterthis date will be
subject to extra charges,where applicable,and Will result in unavoidable delays,You,the Buyer,may cancel this transaction at any time ptior to midnight of the
third business/day after the date of this transaction.Credit card payments not accepted on contract amount
BUYER
—date
SELLER date CO-BUYER date
CER77FIED PLOT PLAN
PROPOSED POOL
IN
NORTH ANDOVER, MASS.
MIDDLESEX SURVEY INC. LAND SURVEYORS
131 PARK STREET NORTH READING, MA. 01864
SCALE: 1"--- 60' DATE DEC. 24, 2016
ol 60' 120' 180'
%ommmmmi
QRk
.4 7- polV
q
4 '08';5- 1?0AD
150.00,
% -75
REFERENCE- t
3K. 14014 PG. 233 (DEED) i i
PL. NO. 7646 (PLAN) 'x\
EL EV. (ASSUMED) k LOT 6 100
A
LOT 7 1 A)* 44,417.*sf
LOT 5
ZONE RI
MIN SETBACKS PROPOSED POOL
FRONT 7 JO' LOCATION
SIDE JO' ry
REAR 30'
POOL
FRONT4-
SIDE 0�0
REAR 10,
OVER 1400' TO LAKE -+
-- -----
C�CHI,;�EWC�K
DETAIL
SCALE' 1" JO'
Iso
\'\�A OF
LOT 21 ALPHO SE
D.
LOT 22 HALEY
CERNY THAT THE EXIS77NG DWELUNG IS NO 31312
LOWED AS SHOWN. If
DAM 12124116 L LAMS
Regi Atered La" Surveyor
NO. 7840
................................ - 11
North Andover MIMAP January 23,2017
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The Commonwealth of Massachusetts
-Department of IndustrialAceidents
I Congress Street,Suite 100
Boston,AM 02114-2017
www mass.gov1dia
• Workers'Compensation Insurance Affidavit-Builders/Contractors/E,Iectricians/Plumbers.
TO BE FILED WITH THE PER31ITTING AUTHORITY.
ApplicantInformation Please Print ibl
Name(J3usiness/Orga3iization/Individual)'
A d d r es s
City/State/lip: b�Wf"QvLU, AASS� Phone#:__ t37
Are you an employer?Check tKa.ppropriate box: Type of project(required):
I.Alarraeroployerwith4D—oreployess,(fall and/or part-time).* 7. New construction
2.E]Iam a sole proprietor or partnership and have no employees working formein 8. Remodeling
any capacity.[No workers'comp.hemmoca required.] 9. E!Demolition
3. I am a homeowner doing all work myself,[No workers'corividnarmanae,requirod.1 1 .10 E I]Building addition
4.n I am a harecovoier and will be hiring contractors to canduct all work on my property.livili
—that all contractors either have workers'compensation insurance or mea sole 11.0 Electrical repairs or additions
proprietors with no employees.
I Plumbing repairs or additions
5.F-1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet
13.E]Roof repairs
These sub-contractors have eniplayeas and have workers'comp.msucarceJ
6.Q we me a corporation and its qffice.in have exercised their right of exemption per MGL a. 14.� .Othbr .....
mo
152,§1(4), dlwshavenopm
p,
*Any appliseenthat,checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners whosubmit this affidavit indicating they are doing all work and than hire outside contractors=at submit a new affidavit indicating such,
tContmatnrx that check this box mustattaq ad an additional sheet showing the ofZ sub
.in not
those
7ttbom.aad state whether oryto those entities have
employees.If the sub-conbacione have employees,they must provide their wiskers'c P,p
Iain an employer that isproviding workers'compensation insuranceformy employees. Below is thepolicy andjob site
information.
Insurance.Company Name
Policy#or Self-ins.Lic. Expiration Date:_,d Z-3 7
Job Site Address: ( 0 City/State/Zip. 1%
_AL..........
Attach a copy of the workers'compenption 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 imprisonorent,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 no hereby certify,under the pains and penalties ofpaujury that the information provided above is trite and correct.
I
Signature- Date: f-- 7
Phone 9: d`7 4�2 .1..Z2
Official use only.Do not write in this area,to be completed by city or town official,
City or Town; Permit/License 9
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#:
FAMIPOO-02ICK
CERTIFICATE OF LIABILITY INSURANCE OAT1 612017 17 )
1/6/2
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(les)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 License#1780862 C NTACT
HUB international New England PHONE � AID, -
299 Ballarelvale Street (A/C,No,Ext):(978)657-5100 x;(978)988-0038
Wilmington,MA 01887
INSURERISN AFFORDING COVERAGE __ NAIC#
WSURERA_Valle Forge Insurance Company 20508
INSURED NSURERB:Safety Insurance Company_ 39464
Family Pools&Patios Inc, wsuREa c:Wesco Insurance Company X25011
Bill&Cindi Gianopoulos --
70 S.Broadway INSURER D:
Lawrence,MA 01843 INSURER E:
WSURERF: — _—_—
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 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 TYPE OF INSURANCE ADDLISUBRI POLICY NUMBER POLICY EFF POLICY EXP UNITS
A X COMMERCIALGENERAL LIABILITY 1,000,000
..,_ EACH OCCURRENCE.___._..$__._..,_______—___
CLAIMS-MADE OCCUR 6015920803 09119/2016 09/1912017 DAMAGE TO RENTED $ 100,000
..........._ X SF.S.LEA.PrereNRIB4dJ.
X Blanket Add'I Ins.
PERSONAL aAOV INJURY. $ 1+000+000
GEN'L AGGREGATE pLRIMIT APPLIES PER: GEN-RAL AGGREGATE $ 2+000+066
POLICY T& E2,000,000 PRODUOTB-COMPIOP AGG S 2+000+000
OTHER'.
B AUTOMOBILE LIABLLIfY COMBINED SINGLE LIMIT 1,000,000
ANY AUTO 3947232 12/31/2016 12/3112017 BODILY IN JURY(Pee(son
OWNED X SCHEDULED
AUTOS ONLY AVTOS GODLY INJURY_(Per,9cuGenJ1_$_,,,,,,_,,,,,,__�_-_„-
X HIRC-D )( NON-0WNED PROPERTY !MAGE'
.._.._.AUTOS ONLY �AUTOS ONLY Per 1GE&Zt,__- $
UMBRELLA LNB OCCUR EACH OCCURRENCE $
EXCEGS LIAR CLAIMS-MADE AGGRE�..._._GATE
..___ _.. _ ..__....._. $
OED _ RETii' ..ENTIONS $
C WORI(ERS COMPENSATION X PER OTH-
AND EMPLOYERS LIABILITY YIN STATUTE..
ANY PROPRIETORJPARTNERIEXECUTNE C3246415 12/3112016 12/3112017 500,000
pFFlCEWMEM REXCLUDEDI NIA E.L.EACH ACCIDENT
(MaMatory In NSI)
1( d®scribe antler EI.DISEASE-EA EMPLOY.-$ 500,000
._._
DESCRIPTION OF OPERATIONS W- E.L.DISEASE-POLICY LIMIT $ 500+000
A Property 16015920803 09119/2016 09/1912017 vrs limits
A Rept Cost X6015920803 09/19/2016 09/1912017$1000 ded
f
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Addhionai Remark.Schedu)e,ma b®—d ff...apace Ia required)
Workers Compensation has Blanket Waiver of Subrogation,as required by execute contract.
Workers Compensation has Blanket Waiver of Subrogation,as required by executed contract.Work in NY is excluded;new construction of 10+units is
excluded.
Re:Gabe&Sondali Mater,1490 Great Pond Rd
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN
1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover,MA 01845
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) ®1988-2015 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD
X6
..
Office of Consumer Affairs and Business Regulation
10 Park Plaza Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Type: Supplement Card
Registration: 118204
FAMILY POOLS&PATIOS INC Expiration: 02/12/2019
70 S.Broadway
Lawrence,MA 01843
Update Address and return card.Mark reason for change.
..... ......__ _._.. ....... .._ _O_Address 0...ec'.=rQwal ❑Ernv_plcayrnen4.0_Los4:.Card
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Supplement Cud before the expiration date.If found return to:
r� Re gi tratin¢nEx it ion Office of Consumer Affairs and Business Regulation
118204 02/12/2019 10 Park Plaza-Suite 5170
F-- Boston,MA 02116
AMILY POOLS&PATIOS INC �Nl
GLEN WIGGIN
roadwa70S.BroadwayLawrence,MA 01843Undersecretary lid wl ho nattcre
�.a:,J p✓�,.l.r l���%`��1�':.3::��,r'f^sir'f✓r�t'f.
a) Office of Consumer Affairs and Busaness}Zeguiation.
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Registration: 1162O4
FAMILY POOLS&PATIOS INC TVPe: SuPPI—m M Card
GLEN VVIGG(N Exp"ra on 2/13/2017
70 S.BROADWAY - _......_...
LAWRENCE,MA 01843
roFs.oe:., OpdateAddr andretur - ..
d:Mark re ( h
--.Address Etenewai 'i'mpipyme t '.L tCard
..�.O;fce Cf 417 .tRain g ftusiness Aeg 4 uon
dh,1M?v1EtMPROVEMENTCONTRACI'OR Lrcense Pr use
registrakrtlu valid for iadwidal Doty
before the czprranon da@.d£found rehan tn:
.,N gistrafran:11H7.04 OrFae of C;ocsumer Affairs acid BAsiAess Regutatiotl
ExPiraYiort:2"'201T TYPe:Gaal 10 park Pla>a_guise'5170
"ANILY POOLS&PATIOS INC SupP�emenl guston,MA 02116
G UGfN .a.
P ACWAY
1VAc,,,
IVlssuctscfseiYs_Denrir;�enE oY;3ualic,Satt;'t,J
Sazarw of#?t;ilciln9��egui2iicns antF S:arca�;ds
License:CS•010330 t
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WILLIAM C 6°OpIuS, j
70 S BROADWAY
LAWRENCE MR 0.1&4 $-
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CO M ISSiOner 7/19/2'17
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