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HomeMy WebLinkAboutBuilding Permit #674 - 105 LEANNE DRIVE 5/5/2008 NOR TF1 BUILDING PERMIT 0 -fuvD 16 TOWN OF NORTH ANDOVER O� yt APPLICATION FOR PLAN EXAMINATION '" I Permit NO: 6 N, Date Received Je, 9 p0"ArE0 PPP`•�� 9SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATI D .. N �lk �'� � � r Yk PITYel_17 ,OWN WNEI x MAP NO ""5 PRoEC���= ©IdIN,G ISTItT HISTORt� l1T tT yeses: ro : Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential X New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement A Assessory Bldg ❑ Others: ❑ Demolition We -Septic °I 1 , I Fl oda etland Dsrict � ; Water/5 _ g DESCRIPTION OF WORK TO BE PREFORMED: �►.S"h`2c..c��ir�N ��'' 'Ar.� �x'v�ir��� C�tu�i�� �rr irw���w► ��L �xl� ��=c Identification Please Type or Print Clearly) OWNER: Name: S:c6�C-1c VZva 4 131;.5 LArav-, Phone:181-2_* 3 i Address: '%os �-F�t,.J NS CONTI:2ACT03 ePhor ` h � � . ;Address: ,fix i i SuperVispei Gonstr ° o,: ;cense Exp.; Cate Al Name Irnproveri# Leri e v . . F.. Exp. �atea4 ARCHITECT/ENGINEER iAV(. to 14t:LAN 1'2. Phone: - tib ..(,c `l,L Address: k�44 2 ?,vuGavlcck eZr ,,,�u„c � wkzti 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: $ .,.s FEE: $ �i�0 Check No.: 7 Receipt No.: �l NOTE: Persons contrractin with unregi tered contractors do not have access to the guaranty fund Signature of Agent/Own r Signature of contract tom" Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED , DAATE P OVED CONSERVATION ❑ I� 7 COMMENTS No W e V-,4S (/Vt k t I LA (C)© � pG Vb 0W& VU1V Z DCS I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL "Public Sewer P--**' Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ 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 Permit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Durrlpster on"site yes no Located at 124,Man Street ` Fire Department signaturefdate c• - . COMMENTS .6 Dimension Number of Stories: ,* Total square feet of floor area, based on Exterior dimensions. r_t Total land area, sq. ft.: 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 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. 7y Date MORT1y TOWN OF NORTH ANDOVER WNW 9 ' Certificate of Occupancy $ ;SSS "us<� Building/Frame Permit Fee $ 6 U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 , = 57 Building Inspector XAORTH TO" Of No. ` 74 '-_ 0 dover, Mass., I� COCMICMEWICK 7,9 ORATED PS C2 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �GO1. �..Q. 'L.f..................................... Foundation E �' has permission to erect........................................ buildings on ...0.D. r..�E�.�i.. .N..!U......�........................................... Rough to be occupied as............. A..... ' 'r`6 ate.c� o o�. '..`�Id��-....... . ........................................ Chimney provided that the person accepting this permit shaltin every respect conform to the terms of the application on file in Final 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 6 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION �'S ELECTRICAL INSPECTOR Rough 4....... .......... ... ...... ....... Service B DING INSPEC Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. PLR ?I)IJF L7J/nA1.ftaQE O D,tAIN ~qr fmi+ A004 r' � s- Aa RA.CS /N 60N0 SEAM ' r 2ZPAELEYOO' FG.'/r /FSOEC/FIED TOPOFdeNO afAM 7 antzffirTrr - r ECEvi=a• JPU AMir• IVA'rM ntoef wl J• ,y Ir1Az VE,Cr wACL 3 *,r �c,osrz°� f/yr/rF mat ,r• � G�" _ _ ELEY2'D' • rRa�vrlTian�Pa/nrr �,� R 3 e.oAs m/r oc Born wA?3 �- r.�D/ViAiC Baa,w / . �` C.acuwo � ELEY 3'D' -WerrLet'/ -� eaern -rte�- R cur oqcr WD &WY ( ES'ANGLE b N3 01!X3 SG'OL. _C'LlTOff AS NOTED ELEY S=0' Gh• S'RADIUS Ir IC _ _ ELEY 1.=0' MA/N D,cA/N - iCK;c F YoLvE CO�S�NECTD/RECr TO LUMPUrQfFRlTERNRTF RES/OENrIAL COrnntguAL G"M/A'fLoGK S' IA/. _BA.CS - L�LE!/'7 D' Z-CLfAX / al1r;v OLOcts El EY 7t 9." EL EK 8=0' �aFf•Tr LFo�E � ---f'�' \ f b fL OOR RE/MA -0:3 GARS _ [p/Z-a C. 50TH ways rPP. STANDARD aWALL SECT/ON Z,. �r3�a�ts/z• ba s . CONSTR UC TION NOTES B'mmf , ° , ; , .+ e°o .• GENERAL RE//VFOAC/NG STEEL •01NSTRUC7I,I1V SHALL COiYrORIH TD CITY DEPT t F>'E/NAORC/NG STEEL 5H,9LL CO,,Vr T7 OF BLDG .iAFETY CODE 4e STANDA�POS. T!J A.S.T.M. DES/C/tilAT/DNS A -/S er A 3v- RD e' V . ° • D/!//NG L3dF,RD NOT PcxmITfD ON POQLS LAPS 'S1�'ALL BE "q M//V!.'�U/�1 OFTN/RTY� • a c / ! (' LASS THAN EIGHT FEET /N Dfpry AT BDFI,PD. o�UR TERS ox I8"lUXEJP.= SPL/CES o'.° ` •r ovovIr •HEALTH D[PT. APPRDYAL RED U/RED FDR . G uN I rE cows r.4v c r1o/v �: d• ALL CDMME"�4C/qL TYPE POOLS. a GUN/T1- VldZI BE/YIACH/.'t/E IVI rf0 AND a e Pune r — ;�� DESIGN APDL/ED PNE U/VAT/CALL Y. M/X JNRLt BE _ • THIS DESIGN CONFORMS TO LOCAL COLE AND ONE PART CEMF/Vr• TO FDU.e R/YD A h'l91F 1�ASED UPO.�V ?, REASONAL3LY LEVEL SITE P.9RT.S Sf3/YD /.' 4/z ULT. CD/9�P ST,PE/1IGTX EOUAL/IF1t L/NE o 3GbD PS/ 3S DAYS Comm orvLr . , • CAWA10 CLAMPAND APPRD��ED NATURAL G�POUNO 1�//ThIIN-2 FEET e u,ATf?-ne—lveNr z1grzD SlYALL wT z rcet'D RUTO!'1ATIC SURFACE SX/MIlER ° OF TDP OF •30ND l Fq.,Ij, i9NY FYCEPT7ONS 3 /z GAL 3 !.�/RTER PER SACK OFCE',�fENT s ti W/LL REOVIXF SUPPLEMEN TRARY DeTA/L /DES-161e rFN C E GUN/TE BY A L/GHT GVRTER SP.PRr 2-.3 0.1RC r, 7.lXeC r1M.F5 A DRY FO.P ,SEVEN I7ArS • 1LVNER 5/47 L PROVIDE FENCING //Y COMIZ //91vCf LI-VOEA WATEX L/GHT l II-11 LOCAL'_ C/TY of rO cuN DRDINANee 0, o. GATES TD z! SELF LLDS/NG [�9TCN/NG- U ' J p o• • ELECTR/rR SHgLL Cdv,,:bx N TO STATE PLR rgAND LOCAL R_FOU/REMENTS QLSN OF M,% •s I O PAUL A. KGs da�f5 G-OC PHELAN JR. mVP - b" O sores rtiAYG c� STRUCTURAL ; • " O. „ No. 42538 YO"S7;777C Environmental N , t 0� JPEL iEF ✓.°L of • POOL f� C` m 4 - b. - a . O. (iFRf71L� • a:` �I 1 ry 'n• ,6,���csS�STE��OF� a fS ONL�� COGL���N •�.;a '�,, -�,.�:s."`� �►i_' � 7U 8E(f"F,RE O Design Excellence _zu,0S aws 'Z'7 Qvit4 C14 Saturn P e i 'Deuonal gouc�Z Andrew Everleigh President r - 978-256-0200 0 1848 Riverneck Road 1-800-696-6976 MAIN our�Fr Chelmsford,MA 01824 Fax 978-256-6620 _ Fisc SPOUT A el- SbR,-Ace &.,Acre swAzL PLAT srArr Cro101.CME O DR,t/N AYi/gr F•mM SCOL s- WS SAXT M QeNo 6Z#Ar EZfYO'D- AcSREG/FlED TOP OFdaNd IIE.9M . r"srT- ELfY/=0' NIS A111% wArF,t RWNdff A7AZ VE,CL Wi4LL MASI Ar _ ELEY2'O• • TRANS/r/GN Pa/NMAr R,3 M 0 pr De a0rm xW7A ��- a,r,�nc tsoarto , " �vvu�ac _ _ ELEf/3•a• S C17LE11GE/ L ._• •L CDPIM �rIR CrfDUNO Cl/rciFF&1Lr 1PE00 COAW — — — [snit �^ /DES•AN6CE A +►3 dll�lS SG"OL. ' \ cur 00'A AS NDTED EL EY S=0' G•h, S'RAD/L/S •c,esTariC •- � _ _ ELfY Lr0' MA/N DAAfN RK;Ef YACYE Cn,vvECT DI,?fCT TO rytnPs-_ Ur QFF RL rFir/YATE RES/DENr1At COrnrlElCGflt '•�` - G'M/X FLaK � S• /~ BA.cs D EL '7 ' 2"CLfAd AFETY LFDC;1r • nDDR RE/N,K A3 A91 011 LxG 601N,WAY^S EYP. 5TR1VD19RD 'WALL SEC T/ON 17'� �3wrts/Z.,oc enr CONSTR UC TI LIN NOTES •'° e ; ,•.. ° °°• GENERAL RE/NFOAC/NG STEEL _ ° •CGNSTRUC770/V SHALL CONTOR/11 727 C/7Y DEPT RE/NFMC/NG 57FEL St/RLL CONFO/P/" o °. ...� •' OF BLDG V 5AFE7'Y Coof� STANDARDS. TD .9.S.T.M. DES/GNAT/ONS A/S c.9-3v-j- 675- oS _ '' • • '' o `- L I9 PS 'S!•+AL L BEAM//V/:�U/'! C7F TJy/R-rr 2G. • D/f//NG ff'o RD NOT PERM/TED ON PDQCs • c r, ' (' ' • LESS 711RN ErGHT FEET /N DfPTl1 AT BDA,PD. QD �ETERS OR /8 LUHER,= SPL/CES OVowr •HEAL r!/ DEPT. APPROYAL RE011/RED FOR •�a a ° A[L COMME,QUHC TY?F POOLS. GUN%TE CL)NS TRUC T/ON_ GUN/lz� T111fL L BE'W oell"t/E/yl/.t'ED ANO touni r ;_-__j „i� DES/GN HPPL/ED P/VeLINS T/CAL L Y. /V/,r JHRLL BE • TH/S DE.S%GN CONFOR1 5 M LOC,94 CODE AND pghTS X.5.91vq /.-f/z ULT. D/7fiP S E/YGTX EOuAC/lFR CIMF e BASED 0,001V P, RF,9SONA3ZY LEVEL S/TE 3AOO PS/ dc 3S DAYS Comm ory r ANO.9PPRO t'ED NATURAL aPOUNO It//TNIN-Z fFET /yATF/T-CEMENT .SAT/D SHELL /t�T EXCEL D a' • GMA/D CLAMP OF TDP OF r30ND 64,917, ANY FYCEP77o1vS AUTOMATIC SURFACE SWIMMER s ti W/LL REOU//�E SL/PPLEMEN TR Rcr DfTA/L /DE31GN 3'/� GAL3 6tJRTEiP PER SACK OFC .ofENT rFN C E CURE GUN/T,r .6Y A L/GHT l!/RTfie SP.P/PY 2-•3 89X5 rELv] TNXeZ TirnES A DRY FO.P .SEvEM DAYS 1f� • OIUNFP .S/Ih'LL PRO/D6 fENC/NG Hy COnIPL //I NCE L-WOEA WATEx u&Hr //,//,r'y LOCAL C/TY o,e rD GUN ORDNANCE 0 •' O 6A775 TO GE SELF OLDS/NG [A1'CN/NG V o °' • ELECTR/CAL SHRLL CdN,-7 r,f ' TO .17?ATF - PLATE � •' ANO LOCAL REOU/REjyEry75 �� P`SH OF 44,gs09cy PAUL A. GtP V L?�5 G'OL 1 p PHELAN aJR. R'+ orw w.9YC c) STRUCTURAL I '• ''O. „ - H1sYA7"57W"C • Environmental O 0 If EL,`F rocVF • • :•;:•••� �o o� 3 �Q��� LISTER •.� ,,. �530 CTu�FrF,�EOcI r,, Design Excellence' /6•/8•zv CM9� jDz%sonaf Douag Andrew Everleigh -- .� President 978-256-0200 0 184R Rivemeck Road 1-800-696-6976 M A r N O U TL ETChelmsford,MA 01824 Fax 978-256-6620 F/!Z SPOUT 0 LS Design Excellence �' �c::--4 JntzgonaL :Lia,a 184R Riverneck Road - Chelmsford, MA )1824 f ;sd of 63s:e3d:�g xeguts#ions and Standards License or registration valid for individul use owdy fiC is s t1t ROv fiREt1T�OrikTRACTOR before the expiration date. If found return to: �r Board of Building Regulations and Standards Re;,Estt:c.�, a 07083 One Ashburton Place Rm 1301 - N12008 OWN Boston,Ma.02108 Tate Co. �ora�on Cha lens ford,M;09824 Deputy Adminhtrator Not valid without dgMare ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 093190 Birthdate: 06/28/1964 Expires: 06/28/2009 Tr. no: 93190 Restricted: 00 DAVID BRABANT 54 MCDONALD ROAD WILMINGTON, MA Commissioner 806-696-6976 MEMBER Q 978-256-0200 1848 Rivorneck I load _A LL MA 0 82978-256-6623 FAx ST— , t a � DATE(MMlODM'YY ACOR T. CERTIFICATE OF LIABILITY INSURANCE 5/16/2007 (602) 635-4848 FAX: (866)6964918 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AIMS Insurance Program Managers HOLD R.HE THIS CERTIFICATE AFFORDEDOE BY NOT AMPOE ODES BELOW.EXTEND OR 15230 N. 75th Street, Ste 1002 Scottsdale AZ 85260 INSURERS AFFORDING COVERAGENAIC# INSURER A:Arch Insurance Company INSURED Environmental Pools, Inc. INSURERS: 184R Riverneck Road INSURER C: INSURER D: Chelmsford MA 01824 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING F REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTF 1, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICI _La'R E LIM T N MAY HAVE R E Y P POLICY EFFECTIVE POLICY EXPIRATION LIMITS INS R ADD'L TYPE of INSURANCE POLICY NUMBER DATE MM/DDIYY DATE MM/ODIYY EACH OCCURRENCE $ 1,000,0 O GENERAL LIABILITY DAMAGE TO RENTED 100,0 0 P EMISES Ea occurrence) $ X COMMERCIAL GENERAL LIABILITY 5 0 0 A CLAIMS MADE X�OCCUR ZAGLE9044500 5/14/2007 5/14/2008 MED EXP An one person) $ PERSONAL ADV INJURY $ 1,000,() 0 GENERAL AGGREGATE $ 2,000,0 O PRODUCTS-COMPIOP AGG $ 2,000,0 0 i GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO - ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HBODILY INJURY HIRED AUTOS $ (Per accident) NON-OWNED AUTOS ' PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY OTHER THAN A $ ANY AUTO AUTO ONLY; AGG $ EXCESSIUMBRELLA LIABILITY EACH RREN $- OCCUR CLAIMS MADE GGREGATE $ $ DEDUCTIBLE RETENTION $ X WCV L�EACHACCIOENT MT O R A WORKERS COMPENSATION AND 1 QQQ,C )0 EMPLOYERS'LIABILITY E.L. $ANY PROPRIETORlPARTNER/EXECUTIVE 1r000 ( )0OFFICER(MEMBER EXCLUDED? ZAWCI9086000 5/14/2007 5/14/2006 E.L. EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000 r( )0 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *Except for ten (10) days cancellation notice applies for non payment of premium. J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IE N ' EVIDENCE OF INSURANCE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO M IL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,E IT FAILURE TO DO$O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON' 1E INSURER,ITS AGENTS OR REPRESENTATIVES. — AUTHORIZED REPRESENTATIVE Peter Godfrey _ ACORD 25(2001108) O ACORD CORPORATION 988 Oon 1 of) I AICA9r.,n,nono_ a +. AlAbU'l 05 ,16/2007 WED 14:28 YAX 25tfl1215 l DATE(MVMDmm ACD DCERTIFICATE OF LIABILITY INSURANCE EDASAMATTiwRQFiNFORMATION �' _ Tyi$CERTIFIC PROOL:ER QNLY AND CONFERS NO RIGHT$UPON THE CERTIFICATE BOLDER-THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Tall lot Insurance Agsncyl ItiC. ALTER THE COVERAGE AFFORDED BY THE POLlC1ES BELOW. 221 Chelmsford Street NAiC# Che: w Ord KA 01824 INSURERS AFFORDING COVERAGE _ . Pha ie-. 978-256-3367 Fa7Gz978-256-8$15 INsuRExA. Merchants I sn urance Grou INSUR D INSURER 9: INSURER C: Envirp=ental Poole, Inc. 1848 hive neck R wsuRER D: _. Chelalsford Imo► 01 24 INsuRERE: COVI:RAGES _T ��c.es of jwQUCtANCE LISTED BELOW HAVE BEEN L9SUED TO THE INSURED NAM@ ABOVE FOR THE POLICY PERIOD KATE ED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY(,.ONTPKL'T on OTHER Docurav+* ^+txE&PECT TO tAAJICM TFn5 CERTIFICATE MAY BE IBSIJED OR MAA PERTAIN,THE 1N8,WCE AFFORDED BY THE POLICIES DESCRIBED MEFM"IS SUBJECT TO ALL THE TERMS.OCCLUstoNs Arima GOMDmOr+s or suc�+ _ PON PERCIFSAGGREGATE LIAUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS D M R L1NAT8 )17 TYPE OF INSURANCE POLICY NUMBER D L MIA EACH OCCURRENCE — LTR 5 GENERAL LIABILITY PREMISES Ea o¢utenoe) — NIMERCIAL GENERAL LIABILITY NIA 6)fp(Army one persm) S _. GLAI�S MADE OCCUR PERSONAL 8 ADV INJURY i — GENSRALAGGREGATE S PRODUCTS.COMPIOP AGG §.-.. GEN1 AGGREGATE LIMIT APPLIES PER POLICY71 PRO-- LOC COMBINED SINGLE UMIT $1,000,40 AUTOMOBILEL"LITY 05/14/07 05/14/08 (Eesocment) A , ANY AUTO 7.m027-•7014363 . BODILY INJURY 9 ALL OWNED AUTOS (Per Perron)) — X SCHEDULF�AIJTOS BODILY INJURY y X HIRED AUTOS (Per aoadc^t) X ,NON-OWNED AUTOS PROPERTY DAMAGE S (Per amaenq .. ...._ AUTO ONLY.EA ACCIDENT S GARAGE LIABILITY EA ACC E OTHER THAN AUTO ONLY: AW S ANY AUTO �- EACN OCCURRENCE s _ - i EXCEswum RELLA NJABILRY AGGREGATE OCCUR L CLAIMS MADE S .S oEDUCT1aLE - �$ RETENTION S TORY LIMITS ER W0rRKTj4 COMPENSATION AND E.L.EACH ACCIDENT S EMPLOYERS'LIABILITY ANY PR0PRIETORIPARTNERjm0UTIVE EL DISEASE.EA EMPLOYEE S t oFFICERiMEMQEREXCLUDm° ELDISEASF-POLICY LIMIT 5 — t(ya;S drxc�e ander SYE(:IAL PROVL410NS below OTHER DES(PJPTION OF OPERATIONS I LOCATI 51 VCHICL6S 7 p(CLUSIONs ADDED sY ENDORSEMENT!SPECIAL PROW&ONS Ev:.dence of Iasurance- CNF TIFICATE HOLDERtATION CANCELLATION 1111111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE AYSHE IX� I-FEN DATE THEREOF,YNE muNG IN3UREA VYILL ENDEAVOR TO MAIL NOTICE TO THE CF-R'FlFrATE HOLDER NAMED TO THE LEFT'BUT FAILURE TO DOW r1w-L Svidenee Of Insurance IMPOSE ND OwGATION OR LIMIRM OF ANY OND 17PON THE INSURER ITS AGSM OR PEPROMTATIVEL ® ORD CCRPCRATK 4 408 ACORD 25(2001106) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ` Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): jJ V ���MFyvyZrpL ���� ��C_ Address:l$G City/State/Zip: apiA, 14 01 K 2A Phone#: `i`a$ Q K b - Ole Are you an employer?Check the appropriate box: 1. general contractor.and I Type of project(required): ( I am a employer with �� 4. ❑ I am a employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' comp.insurance.t 9. ❑Building addition [No workers'comp.insurance P• required.] 5. F-1We are a corporation and its 10.EJ Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 1LE]Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 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. 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 thepolicy andjob site information. Insurance Company Name: -_,VQwzVVYgk_z Co Policy#or Self-ins.Lic.#: *ZPtW Cu,Zt S CZSlb „Wo Expiration Date:Ali Job Site Address: WT tZIN IUS �l� 'City/State/Zip:h6tl1 AT-A ULq IMA- 01� 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 tine 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 cerci zd a pa nd penalti of perju the information provided above is true and correct Signature: Date: /0—V U Phone#: 1 27 L 0 2-0C> 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#: ENVIRONMENTAL POOLS , INC. I�,�� "`�'�-''• MEMBER (46 184R Riverneck Road a Chelmsford MA 01824 `3 0 978.256.0200 / 800.696.6976 / Fax 978.256.6620 E-mail: info@environmentalpools.com • Website: www.EnvironmentaIpools.com �® An Aquatech Builder p NATIONAL , SPA 8, POOL Design Excellence: With A Persona(Touch INSTITUTE The General Terms, Representations, and Conditions on reverse side are part of this Agreement. NAME (Buyer) <'_ �.� Z :L `�'�= a�•a"�z 1�'s�11� MAIL ADDRESS J6j�; CITY ��60,0A :;fJ > 3<.i�" STATE �N�c ZIP ("'s't.'4 JOB ADDRESS CITY to STATE iAYVk t= zip RESIDENCE PHONE S' �;�: `43'i A OFFICE PHONE Environmental Pools, Inc. (hereinafter "E.Rl.") agrees with the buyer or buyers above (hereinafter the "Buyer") to construct a swimming pool and/or spa in a good and workmanlike manner in accordance with the following terms and specifications. L C•`V i ���11 ��c i 1_< DIMENSIONAL SPECIFICATIONS Width li Lengthy:. Shape :�t:��A Depth to GENERAL CONSTRUCTION SPECIFICATIONS MISCELLANEOUS 1. Structural engineered plans........................................................................INCL. 51. Raised Bond Beam: Tile el Stone ` IN 2. Pool layout plans ........................ INCL. 6" e1� 12" tLd i# 18" ................................................................ flL 9�� 3. Layout pool for Buyer's approval INCL. 52. Start-up chemicals: Initial start-up and follow-up instructions ....................INCL. 4. Set pool elevation for Buyer's approval ......................................................INCL. 53. Water Condition -$675.00-20 tons of 1.5"stone 5. Perform normal excavation and remove soil on day of excavation only......INCL. Additional stone at$400.00 per load ..................................................B UYER 6. Access wall or fence: removed by: k 54. Clay soil $450.00 ..................................................................................BUYER replaced by: r�F �A 7. Trees in access and working area to be cut down so that the stumps SALES TAX & INSURANCE donot exceed 2'in height.......................................... .............................BUYER 8. Remove from site 55. Payment of all sales tax on pool components and accessories..................INCL. '+. ' loads of:trees, shrubs stumps, asphalt, concrete and other debris e>;i�7 'ay, s �; t C�;� 56. Motor vehicle insurance, workers'compensation insurance and general liability insurance ....................................................................INCL. 9. Hand form and shape pool..........................................................................INCL. 10. Removal or relocation of cesspool, septic tanks, leaching fields, ADDITIONAL SPECIFICATIONS sewers, pipes and utilities (overhead/underground) ................................BUYER 11. Steel reinforcing per engineered plans........................................................INCL. 57. 1�. �i� r �Ca.�> O,ati ,� ��CR1�- S c3�('Li►`��_� �'t t�ci IS'I�� 12. Engineered gunite structure to meet or exceed local or state codes..........INCL. 58 �- {Ri=' Ti V) 13. Watercure gunite shell twice daily for seven days....................................BUYER 14. Install continuous bond beam around skimmer..........................................INCL. 59.+ ( :_s .e oxi=R •'k. Ft a 0cti��- . � - ��C:Itii_ C�F'S��iv �:zye•�'(':¢"t� 1 �'et�S't,�T.4sCT:Dt� 15. One set of shallow end steps with 4'bench.............. ..... .. . .. .... ID e� ...............INCL. 60.+ �ec:,� A S R (.u:vs-Uluc4 a6 `-t'a, ILS.; , 16. Swimout or loveseat "�ti.�� ._;.v.� .z 1rsaZ'Ii-�t_ . y( v:•c ire 17. Install 6"band of frostproof tile....................................................................INCL. 61. oradIgit � �UCTisc1r jN c- iS 4r 18. Pavers, Bullnose Brick, or Bluestone rat r}. it E u 19. Cantilever form for deck 't>>c:h-,�k i:: 62. t 20. Z hrs. backfilling and grading-deck area only... ............INCL. 63. ',�cc tc �1 it's r Ny CYrd� CR wnt T;,is S"var I•i�f��c�" 21. Pool interior finish..................i RL.,),, .►t......... .......................................INCL. 22. Filling of pool promptly after interior finish BUYER 64. "u�'`' ' dd � ` r ......................................... .� S . �s� - 22.1j 65. 4 '�s>)��-2�4c tui '��F1� , ,�1.���;2 r•C�I'v,4L �IPCYdI Nag's HYDRAULIC & FILTERING SPECIFICATIONS >c r ,dc+'! �'� n a-f'i'POOL DECK PRICES*0,JU'"a`LR' ��;'t9 y 23. Approved deluxe filter: Type I{p.,i a,>': ,.. •;:,, Size ? SUB-BASE MATERIAL IS NOT INCLUDED. 24. Pump and motor: Type ti).,)s[ j3 Size '?tilc� Decking square footage: E - Type I, �$i a �� �tial tT 0 Sg > 25. Pressure test all pool piping........................................................................INCL. Cuir�,i2c% �� in�a_u t Vt4 (;eac �u Zi'>>. � 26. Hook up all water lines from filter to pool....................................................INCL. Other: "S .��,a � �'i�l�1E��y `► i r�� `�t ��t i� `;.��;Totf>i 6 27. Non-corrosive PVC plumbing throughout....................................................INCL. C:i,:r�SESI; 1n�1E t1 .,r1c i �1 '1 ��{ �i C< L tI �, 28. Hydrostatic valve ........................................................................................INCL. 29. Provide return inlets for filtered water to pool ............................................INCL. PAYMENT r rl 30. Main drain suction line with grate.................. .. . INCL. t` f } '« 31. Deluxe Skimmer Including Weir Gate and Large Basket............................INCL. The Buyer agrees to pay E.P.I.the following Contract Amount for .I's 1 jl 32. Vacuum fitting outlet in skimmer..................................................................INCL. performance of its obligations under this Agreement. Qe_d.5 Ll 33. Up to 30'of plumbing between filter and skimmer......................................INCL. 34. Pre-cast pad for pool equipment ................................................................INCL. PAYMENT SCHEDULE 35. Backwash line........................... .........................................INCL. Contract Amount $ ,eft'is 30%Day of Excavation $ '.7I��:c:� ` AUTOMATIC EQUIPMENT Deposit 40%Day ofGanite $ ze, 36. Automatic pool cleaner: Type i-t. 71k,v t-g-i4i BALANCE $ i ' 25%Day of Tile $ l�S C-,".,) 37. Stub plumbing for future pool cleaner ..............................:. .......................INCL. ° - 0 5%Day of Interior Finis •\ $ : cv 38. Floor recirculation system 39. Automatic chemical feeder.... �.R.k: "F. t'� =:4'.?.:.-s;• INCL. "� � '''' "``� TOTAL 40. Automated Pool Controls _`�:�c u--� c. -J-s I�</ � i •,, �zza\ �w TERMS AND CONDITION THE BUYER UNDERSTANDS THAT BY SIGNING THIS GREEME HE OR SHE ENTERS INTO A POOL HEATER & UTILITIES CONTRACT WITH E.P.I.AND THE BUYER CONCERNING E.P.I:S CONSTRUCTION OF A SWIMMING i POOL,MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT.ANY CHANGES IN ANY 41. Deluxe pool Heater: Size 4_�: ,k-.�,_,_, Make Vkkr'a �a�at` Salm OFTHETERMS OR SPECIFICATIONS OFTHE AGREEMENT MUST BE MADE IN WRITING SIGNED BY t� Y E.P.I.AND THE BUYER,AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE Indoo Outdo C.yk -r ---..," Nat/Pro t i1Cts�1s PERMITTED. Fuel connections, heater venting, fuel storage tanks_, permit...............BUYER AS PART OF ITS OBLIGATIONS UNDER THIS AGREEMENT E.P.I. IS PROVIDING THE BUYER 42. Install underwater light(s), each with 10'conduit .�' ti*�...h{�:��^i �r 6.ti��j.l .INCL. WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- 43. Electrical bonding of pool as required by city or town code ( 4�: % ^` NIL: SUANTTOTHIS AGREEMENT.THESE GUARANTEES ARE CONTAINED IN A SEPARATE DOCUMENT 44. Electrical wiring and connection up to 75'from service panel WHICH IS PROVIDED TO THE BUYER. a Pool over 75'at 15.00 per foot ' .�- a='t_ i y r�. ��� $ p 1 � tii� a�T<_ -T,s��t,r. BUYER THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANY TIME BEFORE MIDNIGHT OF Heat Pum s p at$18.00 per foot �� �t�,. BUYER THE THIRD BUSINESS DAY AFTER THE DATE ON WHICH EITHER THE BUYER OR E.P.I.HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO E.P.I. HYDRO THERAPY SPA '7;'? THE BACK OFTHIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.THEY ARE PART td OF THIS AGREEMENT.READ THEM. 45. Attached _- Separate vvI LL Raised \5 C> Light }E-7 1 ACKNOWLEDGE THAT THIS AGREEMENT IS A LEGALLY BINDING CONTRACT,SUBJECT ONLY TO Blower y #H drothera ets `; Y pY 1 � }!, ` THE ABOVE CANCELLATION PROVISIONS,AND I CERTIFY THAT I HAVE READ AND AGREE TO ALL Additional S ecs. 'i q 1,� f EtE t' Y� '� i h c:\_ 67 .c_k= \ +164,i: TERMS q C N ITIONS OF THIS AGREEMENT. ENVIRONMENTAL POOLS, INC. ACCESSORIES BUYS BY, ' l 46. Deluxe cleaning tools (18"nylon brush, hand leaf skimmer, ,, �-"�...� �aXJr�jl`�.�L,�-- thermometer, pole, test kit, deluxe vacuum) ..............................................INCL. BUYE 47. Diving board: Size Color I Y i1 A 48. 3-tread S.S. ladder/handrail ;� i- DATE vi:�- �' DATE 49. Pool slide: Size Color 1\1�b 50. All jigs installed by decking contractor or buyer