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HomeMy WebLinkAboutBuilding Permit #667 - 145 COLONIAL AVENUE 6/4/2009 BUILDING PERMIT O� ftAORTH -'"D 6,q�0 TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION h T Permit NO: Date Received �SSACHU`��� Date Issued: (l" IMPORTANT Applicant must complete all items on this page "„ '4 - LOCAT, N r 'N; ..... 443 f 4 PROERTYOItII-R w. �MA��NO: �, � PARvCEI �,. `�� ZDI�ING�DiSTRICT TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑ Two or more family 11 Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ ssessory Bldg [IOthers: [I Demolition Ev Other C /D eptr1�1fe11 �Fdpf etlar��s gtersd his rd lfltafertewerVC DESCRIPTION OF WORK TO BE PREFORMED: I Identification Please Type or Print Clea rly) if OWNER: Name:���S Q 616 Com. Phone: 19 Address: 0 . ,&/ vge YA- ow a<µ. C@I�ITR "TTORIae� �one° Ad ress yhib , S ervr ti�-'s O©r str�c i rn Lr t se , Ewo 47 We me lmprav8fr-er L16 &e U . ARCHITECT/ENGINEER Phone: ' Address: ��,� �� 6\�Mag. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CAST BASED ON$125.00 PER S.F. lJ� -� Total Project Cost: $ �� '�Ll G) FEE: $ 300 Receipt No.:�J"` Check No.: p NOTE: Persons contr cting with nregistered contractors do not have a to the guarantyfund Signature of Agent/Owner_ 4ignature of contractor r Location /!/ i No. 6 Date OORTol TOWN OF NORTH ANDOVER 3? � N,t`•O •,hOOL F 9 Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ --� Other Permit Fee $ TOTAL $ Check # ��a 22Uu4 Building Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan i Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATEA PRO)/ED CONSERVATION ❑ �_� �f V�# COMMENTS , 'Z. (� b m DATE REJEC ED DATE A,,P VED CO LTH MMENTS TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well 17, ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(§eptic tank,etc. ❑ Permanent Dumpster on Site ❑ �i 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 #1=1RE QEPARTMEN -,Temp Dnumpmer on siteyes rtnoAz Loeated at 124, ain Street � �� R Ftre Cfepartment Mgnatuireld � ae Y k , 14 4 CCIUIIIIIENTS ,. .wj /icy Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. 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 ..................................................................... ....................... .................................... ................................................ ...................................................................................................................................... ...... --H: 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 NORT1q ® of : 4Andover . o o L dover, Mass., LA COC MI C ME WICK ORATE D IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........e .0 .......0 ... .. . . .1"o................... ....... ...... ............................. Foundation has permission to erect........................................ buildings on ........1q ...... a. 0!�.!.y` � .�................ Rough .......................... o �d hobo L t0 b8 OCCUpled as........ Chimney ..k.....�.. ............x,1!1.�.(. .V............... ...... .............................................................................. provided that the person accepting this permit shall in 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 PERMIT EXPIRES IN 6 MONTHS � ELECTRICAL INSPECTOR UNLESS CONSTRVLSTa&RTS Rough Service BUILDING INSPECTOR 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. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature am COMMENTS ✓� (� HEALTH Reviewed on �1 `�� Signature OMMENTS 1 �- �-�— >! 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 DPW Town Engineer:Signature: _ Located 384 Osgood Street TM-Midge. �DEPAA ' g ►ps_er�oi�e� yes - 'f ter` �� < '"` � z r,, e z "Itsy� FORM - U - LOT RELEASE FORM- 3 � INSTRUCTIONS: This form is used to verify that all-necessary approval)permits€ronf"` '" �` Boards and Departments,having jurisdiction have been obtained. This does not relieve the applicant and'or landowner from compliance with any applicable requirements. Asa-sasaasasasasaasasa•asar.Now a*asaasssasass■ APPLICANT CO ��'l Cl � i�'��I Q PRONE " 7 S (vt Y I 6 Q&-.A 3 ASSESSORS MAP NUMBER O 1 PJ LOT NUMBER SUBDIVISION LOT NUMBER STREET ��`�►r"\i � �• STREET NUMBER �tJ. �aaasss0r-a-0aa-sassarra0.0.0rrrrsrssa.0 a a a asassasaaaaaasa.si.5a*.a aafa-Eaaaaaaasaa-s■ OFFICIAL USE ONLY IND sarsea.as.rs.aa:arras**sass News.ssarsssswas assaaasee a-owe R'asasa,*•aaWE11anow-man RECO ATIONS OF TOWN AGENTS t*R*-a ■a ■a *a.sa*s*s:*aa**aa*.aasa Na 7 a.a.■a a ON DATE APPROVED .,/ CONSERVATION ADMINIS TOR DATE REJECTED COMMENT'S s DATE APPROVED TOWN PLANNER � DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTO HEALTH DATE REJECTED DATE APPROVED x Li S OR- TH DATE REJECTED COMMENTS /� f ` PUBLIC WORKS—SEWER!WATER CONNECTIONS DRIVEWAY PERMIT i DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andover Page I of I Base�M-p Zoning 2005 Aerials Watershed Zone]FUtilities [] SizeDE][] Selection FLegend TLocation FMarkup R Help Scale 1"=F-1�58 ft F-I Select = FFw,7els (show all)_______I 1Owner lAddress Lot Size T. DESTEFANO,COSMO PI 145 COLONIAL AVENUE 1 222161 14 ......---- ----- 1 selected To Mailing Labels To SpreadSheet Property� Print Ownerl DESTEFANO,COSMO P Owner2 TINA M DESTEFANO Address 145 COLONIAL AVENUE Map/Lot 107.13-0135-0000.0 Lot Size 22216 sq.ft. Uld C,IrFiscal Year 2007 t - -7 a Land Use 101 Code Last Sale 10/30/1998 12:00:00 AM 1_Get Pi;ctoSave Ma- 10 �-etrY Irn-g�rl Go �2.5[beta 2] AppGeo PFLEF� http://maps.mvpc.orgNorffiAndovermimapNiewer.aspx 5/20/2009 The Commonwealth of Massachusetts Depai7ment of.Industrial Accidents F Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect ricians/Plumbers Applicant Information Please Print Leilibly Name (Business/Organization/Individual): A/'1/ Address: City/State/Zip: / //. A Ci Phone #: ���,�5��- LSo,160 Ar you an employer? Check the ropriate box: Type f project(required): 1. I am a employer with 4. ElI am a genera] contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs of additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. 00frepairs insurance required.] t employees. [No workers' 13. Other/&C4e, Al T.Y,j 6 7, comp. insurance required.] �T— *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: I Homeowners wbo 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information- Insurance Company Name: Policy#or Self-ins. Lic. #:_ ],tIC� ;23 7-141_2 2,_,0 Expiration Date: _ 110 Sob Site Address: Af C���i/���.�Sl� Cit;/State/Zi� ,����.l�)/ 7, Attach a copy of the.workers' compensation policy declaration page (shwAring 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 covera.g verification. I do hereby ce► ' u rder7)'is a penal 'es ofperjury that the information provided above is true and correctSi attire: Date: Phone#: z? o Official use only. Do not write in this area, to be completed by city or town official. City or Town: T icense# 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#: t J Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. PLrrSllaIlt i0 CMS statute, an er,�ployee is defined aS "...ever,'person in the Senn�P of another under any Contract Of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter havebeen presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s) of,:, . insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees..other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pernut or license is being.requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Depamnent at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernudlicense number which will be used as a reference number. Iu addition, an applicant that crust sul;..it multi iP Prmit/lirenSe _ plications in any ven year, need only submit one affidavit indicating curreni P. F g'- policy information(if necessary)and under "Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or pemut to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 4066r 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia "4 �Rr.+[C.tuwJT,P S.vA[G n-x SrxrE,cv/00-EDGE O VAA1*V Ak/,or eIIII POOL ,r3 SAAB iN JOND 6EwR ELEYO'O 22' rER,`IJN POOH Cl/v6 1 • S" S !'• ELEvl=O` S�EL/f7E0 TOP OF ddNp of'" vFCf'wa[L ELEY2•�• �tosrfr fnrr/zf �ersc, rr ' O 3 UA3 m Pr04C6Orx lIrA7S � 3 -,•.r rrra�r5/r�aJv PaJn/r /v,�rvut _ ECf6�3'Q' rJ� aea,ca '/�� ,.J�JJ GIbU/Y0 •L COKM % '�-�rR cur nFF�c r ; — — Grist REao av ca+w d• �-�OL +r3 GeR3 S (,;-�/pES'AaGtE _carOfF AS NdrED EL EY S=0' `� �h �, S RAO/!!S ELEY Gro" ,c.cST.oriC 2 a•� , UrGfFR[rE.Pi1'A7f MR/N DAAII1r - .CK%e`F YALYE 0CG � BA.CS - ELEi+'•7'CD' ,'A'6rTD,RfCr TO lump /N. l — RES/DEN r1AL# COrantxC/AL �'M/X FLS 3• CL EAR . - uirrf/ eLacrs EL El�7``7"- i EL F1C 16=0' i T— • lo"M//v rro �aF�Tr cfocf -r-- -�-�/ N • - �/ � i // b fZ DO S RE/NIC r 3 6RR5 ' QG 60TN'WR75 r7'P_ STANDARD '{�I/ALL_ T/ON Z7_ R361iR5 n' cc - CONSTR UC T1O-N NOTES g ��~ FTFINF�f7L`/NG STEEL GENERAL o J •� • ° 6 - � � •C4NSTRUCi7u;V 5,M1,1 CON rORl1! TU L:/7?' DEPT or J�E/NFORC/NG S7FEL StI.9LL CONFJt?� OF IILDG f ". AfETY CODL=� ?D AS•T.M. DES/GNAT/ONS A -/SFA �� L R PS SJ'fAL L BEA /s'1/N/:'SUM OF T•5�/.�TY� e •. 4' /' a • D/Y/NG L4iiR0, .NOT PERM/TED oN RvaS j]/A/YJETERS OX /8"!U/`1Ek.' SPG/CES G- • . r - o L ESS Th'A/Y Er'GHT FEET /N Dfr:t/ AT BOAPO Q CCUR 2 ° ', ( : .' '_ e a+,ou/r •KEAL rN DF'T. /dPPROYAL REAL//RE=D FDR /;[J/V/TE CONST�tJCT/Q/�/ ALL TY?F P000• 0 GUNJTP Sfi/BLL BL`/nACf//.IJf/�7/.rED AND a /PPL/ED PNEU�IAT/CAL L Y. M/,r JHALf ze ' ,__•_ = DESrGN QivE P/�RT cE=rlL=/vT• Ta FaU•Q ,91VD R N�9Lf —� I • TX/S DES/CN COJVF01?11S TO LDCAt CODE ANO • PRRT.S �,9/YO !: 9'�z ULT. CD/",7 S71. /GTX 13.4S6-10 V106A, ?, .REASIONABLY LEVEL SITE 3Gb0 PS/ 4:9 3S DAYS EOURUIEX LINE ANO APPRD i FD NATURAL G�?OL/NO 1(J/17�IN Z FFE7- • W.frn7-CEME=NT .E'AT/O Sfi`fi'LL /t'�r C��O COMA•ONLY s ��• GRrr/ND CLRMP OF TDP GF ,30N0 l3EAP9, ANY FYCEP770NS ,�,/� GAL.3 �c%q7 PER SACK OF CE,ofFi1/T w/ AUTO f'1 R T 1C SCI R FACS SX/MI•l ER [L REOU/'E SE/PPLE MEN TARRY DETA/L --DES/G/1f s >. • CZ1,?, 6UN/777 BY A L/Gh'T 6u.9TEX • rf/V C E T,',%CfC rIM,5:S A DRY Fa.P SEVEN DRYS 2-�3 bR1tS fEW] • z7vNE7 _rf/A�L PROY/DE FENCING //Y C01VIOL IR NLf DAT ER WATER Ll GNr .4(11711L OCR C/Ty a,Q TO GUN ORDNANCE GATES Ta _ - SELF CLAS/NG � LATCH/NG- I c. • ELfcrR/CA SH,91-L cam-cx,a; TO STATE ANO LOCAL RCOU/RE/`lENIS PLA M TH OF47 PA L A. ti d; SPHELAN�R. R, I U pac-5 G"OC 1 A10.42,v Bonv �uar+" 38 ci Environmenful O. Nr-ORd 57=77C f"h 0- o" AELv�F racvE at-� �� POOH SS/ d - , - 4 • (iF '`T�`�h) DNAL ET1GtN COL1LrT�OA/ I-� o o� 7uaF�r,REob) r Design Excellence �O /6Y/8 Z4 �.. Andrew Everleigh` � 1 G�/a/B �rn a �euonar�ouc�Z President - 978-256-0200 '\ - 184R Rivemeck Road 1-800-696-6976 0 Chelmsford, MA 01824 Fax 978-256-6620 MA1IV 0U71Er F/ic sPor�r -- 64. ... 22. Filling of pool promptly after interior finish ...........................................BUYER ---' 65. HYDRAULIC & FILTERING SPECIFICATIONS 23. Approved deluxe filter: Type QQ �,�- Size SIDD-BASE MA ERIAL IS NOT INCL D. 24. Pump and motor: Type Size Decking square footage: Type 25. Pressure test all pool piping........................................................................INCL. 26. Hook up all water lines from filter to pool....................................................INCL. Other: /Q� �+� of 27. Non-corrosive PVC plumbing throughout....................................................INCL. X77 ' 28. Hydrostatic valve ............................. ................... ..........INCL. 29. Provide return inlets for filtered water to pool .... . ,�... CM ................INCL. PAYMENT 30. Main drain suction line with grate... ) . �/4tl� INCL t , T�• - .- • "�"T The Buyer agrees to a E.P.I.the following Contract Amount foi E 31. Deluxe Skimmer IncludingWeir Gate and Lar e Basket Z .�7sJ0.. ... ..INCL. Y 9 pay 9 32. Vacuum fitting outlet in skimmer............. INCL. performance of Its obligations under this Agreement. �z � / I 33. Up to 30'of plumbing between filter and skimmer......................................INCL. t` - 34. Pre-cast pad for pool equipment ................................................................INCL. PAYMENT SCHEDULE 35. Backwash line..............................................................................................INCL. /�� Contract Amount $ _ _ 30% Day of Excavation $ VL ^O EQUIPMENT Deposit Gl®� 40% Day of Gunite $ 36. Automatic pool cleaner: Type T1� Y18�� ta�� BALANCE $ (' � 25°o Day of Tile $ 37. Stub plumbing for future po I cleaner ......... ..............................................INCL. 51% Day of Interior Finish 38. Floor recirculation system 39. Automatic chemical feeder.. .. (,(�CIAIrE�.£a$�.T........... ...... ................INCL. TOTAL $� 40. Aut mated Pool Controls TERMS AND CONDITIONS r THE BUYER UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, HE OR SHE ENTERS,INTO A POOL HEATER & UTILITIES CONTRACT WITH E.P.I.AND THE BUYER CONCERNING E.P.1-S CONSTRUCTION OF A SWIMMING `��yy / POOL,MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT.ANY CHANGES IN ANY 41. Deluxe pool Heater: Size Sal /SS" MakeAd?74, OFTHETERMS OR SPECIFICATIONS OFTHE AGREEMENT MUST BE MADE IN WRITING SIGNED BY E.P.I.AND THE BUYER,AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE Indoor/Outdoor Oc..- 2>awC Nat/Pro �"7S 0?ftp 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 .t1_2F .7 .....INCL WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- 43. Electrical bonding of pool as required by city or town code .L" SUANTTOTHIS AGREEMENT.THESE GUARANTEES ARE CONTAINED IN A SEPARATE DOCUMENT 44. Electrical wiring and connection up to 75'from service panels , WHICH IS PROVIDED TO THE BUYER. Pool over 75'at$15.00 per foot THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANYTIME BEFORE MIDNIGHT OF Heat Pump at $18.00 per foot UYER THETHIRD BUSINESS DAY AFTERTHE DATE ON WHICH EITHERTHE BUYER OR E.P.I.HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO E.P.I. HYD'O THERAPY SPA THE BACK OFTHIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.THEY ARE PART OF THIS AGREEMENT.READ THEM. 45. Attached 4Kyd at R sed I ht I ACKNOWLEDGE THAT THIS AGREEMENT IS A LEGALLY BINDING CONTRACT,SUBJECT ONLY TO Blower rot apy jets THE ABOVE CANCELLATION PROVISIONS,AND I CERTIFYTHAT I HAVE READ AND AGREE TO ALL Addition Specs. TEND CONDITIONS OF THIS AGREEMENT. ENVIRONMENTAL POOLS, IN ACCESSORIES BUYER •�-"'',� B 46. Deluxe cleaning tools (18"nylon brush, hand leaf skimmer, r/•d c,R` thermometer, pole, test kit, deluxe vacuum) .........................'....:.--..............INCL. BUYER 1 47. Diving board: Size Color ,•; 48. 3-tread S.S. ladder/handrail DATE_ 1..�./ ;•f-• _ DATE 49. Pool slide: Size Color �- 50. All jigs installed by decking contractor or buyer �. ENVIRONMENTAL POOLS , INC. ��r1��11��i��j�r!c�� MEMBER 1848 Riverneck Road • Chelmsford, MA 01824 ��'��' 978.256.0200 / 800.696.6976 / Fax 978.256.6620 C�j An Aquatcch Builder E-mail: info@environmentalpools.com . Website: www.Environmentalpools.com NATIONAL - SPA 8 POOL Design Excellence: -With A Fersvnaf Touch INSTITUTE The General Terms, Representations, and Conditions on reverse side are part of this Agreement. NAME (Buyer) �/ , 157 MAIL ADDRESS % CITY V40, / _ STATE q ZIP JOB ADDRESS (� / CITY STATE ZIP RESIDENCE PHONE 2c� 6 - _qz OFFICE PHONE Environmental Pools, Inc. (hereinafter "E.P.I") 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. DIMENSIONAL SPECIFICATIONS v u G'�S7ir�f' i a N Width 1� Length Shape S/WV Depth �� to � C� GENERAL CONSTRUCTION SPECIFICATIONS MISCELLANEOUS 1. Structural engineered plans ........................................................................INCL. 51. Raised Bond Beam: Tile Stone 2. Pool layout plans ........................................................................................INCL. 6" - 12" 18" �'- 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 - $-67S- - 20 tons of 1.5"stone TgAhnim Litz- 5. Perform normal excavation and remove soil on day of excavation only......INCL. Additional stone at$ (o 7S__ per load ................................................BUY 6. Access wall or fence: removed by: fL 54. Clay soil - $ .........................................................................BUYER replaced by: C3 vIj SALES TAX & INSURANCE 7. Trees in access and working area to be cut down so that the stumps do not exceed 2'in heigh ........................................................................BUYER 55. Payment of all sales tax on pool components and accessories..................INCL. 8. Remove from site loads of:trees, shrubs, stumps, asphalt, 56. Motor vehicle insurance, workers'compensation insurance concrete and other de ris �? 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 . 77 Ar 11. Steel reinforcing per engineered plans........................................................INCL. 57• Z ! 0 12. Engineered gunite structure to meet or exceed local or state codes..........INCL. 58. C---w774,)0 .S 13. Watercure gunite shell twice daily for seven days....................................BUYER 14. Install continuous bond beam around skimme ........... ............................INCL. 59• 15. One set of shallow end steps with bench..��' .... .................INCL. 60. 16. Swimout or loveseat Ane 8WI , 17. Install 6"band of frostproof ..........................INCL. 61. V1 t/VWX , Me _ 18. Pavers, Bullnose Brick, or Bluestone _4*6__ 19. Cantilever form for deck 62. 20. 2�rS'.backfilling and rading-d . .. eck area only... ,09.Vj.... t....................INCL. 63. 01 Pnnli.�Mrinrfinioh LO'C//�i.'T�/Qii0.4./ Xie BoaTroffullrinegi#egula/ons an Man �ars� One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 107083 Type: Private Corporation - Expiration: 7/29/2010 Tr# 271559 ENVIRONMENTAL POOLS INC. = _ Andrew Everleigh 184R Riverneck Road Chelmsford, MA 01824 -- Update Address and return card.Mark reason for change. J Address J Renewal . Employment i- Lost Card DPS-CA1 5OM-07/07-PC8490 ✓!,z -�omvnwouveal�i o�✓l�aaaacleuaee7� Board of Building Regulations and Standards License or registration valid for individul use only =_ HOME IMPROVEMENT CONTRACTOR before the expiration.date. If found return to: Board of Building Regulations and Standards Registration: 107083 - - One Ashburton Place Rm 1301 - Expiration: 7/29/2010 Tr# 271559 Boston,Ma.02108 Type Private Corporation ENVIRONMENTAL POOLS INC. Andrew Everleigh 184R Riverneck RoadeQ-a ..� Chelmsford,MA 01824 Administrator Not valid without sign re BOARD OF BUILDING REGULATIONS +' License iNSTRUCTION SUPERv'iS1E ,r Number. s i Birthdate: 06128,",9�,! Expires: J6!2812005 Tr. no: Restricted: 0C DA\IID BRABANT 1;4 MCDONALD ROAD vb'ILMINGTON MA fy_ f Commissioner / !I ti i, ��F r=�.r-;rrCynrrsrrCC�z ,.fit._ //.r,_:uc%rtr<W�.;IJ 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 i Commissioner DATE (MMlDD/YYYY) ACQ89. CERTIFICATE OF LIABILITY INSURANCE 5%6/2009 PRODUCER (602)635-4848 Fax: (480) 991-0634 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AIMS Insurance Program Managers, Inc. j HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 15230 North 75th Street #1002 ! ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i 1 Scottsdale AZ 85260 INSURERS AFFORDING COVERAGE MAIC# iINSURED 1 INSURERA:Great American Assurance 26344 Environmental Pools, Inc. INSURERBGreat American Alliance ; 26832 iiBGR Riverneck Road INSURER C I 1 I INSURER D: Chelmsford MA 01824 i INSURERSCOVERAGES ' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO i 1NITHST.ANDiNG A ` REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE D MAY ITIISSUED OR MAY OLICIcc.1 THE INSURAhC= AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PO ? f _A. r RE ATF L;M!T9`44QWN MAY HAVE BE N RED D BY PAI !AIM POLICY EFFECTIVEIPOLICY EXPIRATION I INS^n AO L! POLICY NUMBER DATE MMIDD/YY I DATE MM/DD/YY LIMITS 1 1 TYPE OF INSURANCE 1,0 u��.0�•_!nr; I GENERAL LIABILITY i I EACH OCCURRENCE S PREMI ETGRENTED IS lOO,C^v Q's j X I COMMERCIAL GENERAL LIABILITYI I PR°MISES(Ea occurrencel 5.00015/14/2010 MD EXPIAnvoneoeen? S OCCUR G37141000r00t A I CLAIMS MS MADE LP2 - ADV NjURY IS PERSONAL i 2,000,0001 GENERAL AGGREGATE '= 1 ICE,ti'LAGGREGATELIMITAPPL!ESPER: PRODUCTS-COMP/OPAGG IS 2rUOD'OvC i �'; f� oRC- I � I X I POLICY"! (JECT 17 LOC ! ! VTOMOBiLE LIABILITY I I i COMBINED SINGLE LIMIT ! I (Ea accident) 5 € I I ! ANY AUTO s j 1 I AU_ I E eINJURY O';NSD AUTOS (Per person) ii S i _! • I SCHEDULED AUTOS 1 s BODILY INJURY 1 HIRED AUTOS I I t) c i i I i (Peracdden NON-CWNED AUTOS J I— i I i PROPER--DAMAGE I i—� I !(Per acciden!1 1 I I AUTO ONLY-EA ACCIDENT S _{ GARAGE LIABILITY i I I j OTHER THAN EA A" I a —i j ANY AUTO I AUTO ONLY: AGG b I I ! s iS e XCESSIUMBRELLA LIABILITY I EACH OCCURRENCE , OCCUR CLAIMS MADE i AGGREGATE j 6 i IC i I ^!DEOUC70_E I I I is RETENTION $ iL7" ! X I WC S T ATU- 3 I WORKERS COMPENSATION AND T^RY IMIT r I EMPLOYERS'LIABILITY ,000 E.L.EAC HACCIDENT 000 IS ( ANY PROPRIETOP'PARTNER(EXECUTIVE IOFFICEPhiEPABER EXCLUDED? iVC2371422-01 15%14/2009 15�14�2010 E.L.DISEASE-EA 6�•1PLCYEES 1:0%0`n':CO'J if yes.descr,be under E.L.DISEASE-POLICY LIMIT I c 1 r OC'0 C0 I SPECIAL PROVISIONS below OTHER. I # I I ! FSCR!PTION OF OPERATIONS/LOCATIONSNEHICLESIEXCWSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS =Except for ten (10) days cancellation for non-pay. All policy forms apply. This certificate is ony a representation and may or may not comply with any written contract. i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t EVIDENCE OF INSURANCE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I XXXXXXXXXX *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT i XXXXXX FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1 INSURER,ITS AGENTS OR REPRESENTATIVES. ; E AUTHORIZED REPRESENTATIVE i � Peter Godfrey ; ! ©ACORD CORPORATION 488 ACORD 25(2001108) Iucn)c