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HomeMy WebLinkAboutBuilding Permit #165-14 - 45 WINDKIST FARM ROAD 7/30/2013 BUILDING PERMIT tpOR%ORTh#t TOWN OF NORTH ANDOVER o2 APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received '044TED♦�`.�5 \ �SSAGHUS�� Date Issued: V IMPORTANT:Applicant must complete all items on this page LOCATION C,3 -tA Zzz. Print PROPERTY OWNER Print MAP NO: _PARCEL: ZONING DISTRICT: 2- Historic District yes Machine Shop Shop Village yes o I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial i Repair, replacement Assessory Bldg Others: Demolition Other Q4w&U Sf Septic Well Floodplain Wetlands Watershed District Water/Sewer ---� DESCRIPTION OF WORK TOJ3E PREFORMED: °X46 ' Identification Please Type or Print Clearly) OWNER: Name: Phone: 'Q�•/ Address: Iu k.�sT o "� O .► 1 CONTRACTOR Name:&f19&J#1eW1Z1-7-leW Phone: 2Z-.Z1O Address: �>Ia460C-t, r Supervisor's Construction License: S-(%-Zk) Exp. Date: Home Improvement License: 0 Exp. Date: ARCHITECT/ENGINEER rAcAJ— P Phone: n Address: t. F!5�I �, ( -/�4SWx0 ,x-'74- Reg. No. � '� b� FEE SCHEDULE.-BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.. Total Project Cost: $ 40�';OZSQ FEE: $ Check No.: [-�l 22, Receipt No.: 1P NOTE: Persons contracting with unregistered con)ractors do not have access to the gua nd Signature of Agent/Owner_ ign�of contractor 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 on7 C� / Si nature d. COMMENTS 1 c L //MI ol"navi-e-d HEALTH Reviewed on 7 c2l, Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes n Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signaturefdate COMMENTS 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 Doc.Building Permit Revised 2008 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 �?a,---Ip- Copy Of H.I.C. And/Or C.S.L. Licenses Cpyof 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 Li 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 2.2008 �•� L � LocationJ� No. y, 7 Date • - TOWN OF NORTH ANDOVER LED Certificate of Occupancy $ Building/Frame Permit Fee $ ��u•raj Foundation Permit Fee. $ Other Permit Fee $ TOTAL $ Check# �' u �: Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 453000.00 m $ - $ 540.00 -Plumbing Fee $ 67.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 67.50 Total fees collected $ 775.00 45 Windkist Farm Road 105-14 on 8/1/2013 Inground Pool NORTFt own of ? E ndover 0 *.1 'S4J (A w 30 h ver Mass T O LAN■ � COC NICNl WICK y1. �i9 ADR�tTED rPa��S S 11 BOARD OF HEALTH TT LD Food/Kitchen PER Septic System THIS CERTIFIES THAT ....!f1 ...... 640phl ....... BUILDING INSPECTOR ............... .... .......... .....A. 04A .............�........ � �h Foundation has permission to erect .......................... buildings on ..... ... .... .......... ....7I.�!�..... • Rough to be occupied as ...........� .. J. Z....... K*......................................... Chimney provided that the person accepiiA this permit shall In every respect conform to the 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 CONSTRUCTI N STARTS Rough Service ........ ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. SEE REVERSE SIDE ENVIRONMENTAL POOLS , INC. MEMBER 184R Riverneck Road • Chelmsford, MA 01824 M 978.256.0200 / 800.696.6976 / Fax 978.256.6620 i= E-mail: info@environmentalpools.com • Website: www.Environmentalpools.com NATIONAL An Aquatech Builder SPA& POOL INSTITUTE Design Excellence: With A Persond Touch The General Terms, Representations, and Conditions on reverse side are part of this Agreement. NAME (Buyer) C7�i MAIL ADDRESS ltiL1kAir � . CITY +J lI�'�=- STATE ��' ZIP © T JOB ADDRESS Q CITY STATE .-- ZIP RESIDENCE PHONC � 7� 9'UZ-��J 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. DIMENSIONAL SPECIFICATIONS ,�3 . , I 3 Width Length Shape 7&0"7 Depth to GENERAL CONSTRUCTION SPECIFICATIONS MISCELLANEOUS 1. Structural engineered plans........................................................................INCL. 51. Raised Bond Beam: Tile �^ Stone 2. Pool layout plans ........................................................................................INCL. 6" 2` 18" �- 3. Layout pool for Buyer's approval ................................................................INCL. 52. Start-up chemicals: Initial sWt-up and follow-up instructions ....................INCL. 4. Set pool elevation for Buyer's approval ......................................................INCL. 53. Water Condition -$ 67� -20 tons of 1.5"stoneir C115 4-- 5. Perform normal excavation and remove soil on day of excavation only......INCL. Additional sto eat 4 per load................................................BU R 6. Access wall or fence: removed by: 54. Clay soil -$ ..............................................................................BUYER replaced by: 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 debris 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. 12. Engineered gunite structure to meet or exceed local or state codes..........INCL. 58 13. Watercure gunite shell twice daily for seven days....................................BUYER 14. Install continuous bond beam around skimmer..........................................INCL. 59. 15. One set of shallow end steps with 4'bench... .�?�:�..................INCL. 60. 16. Swimout or loveseat 914N.±A 17. Install 6"band of frostproof tile..%................................................................. CL. 61. 18. Pavers, Bullnose Brick, or Bluestone 62 19. Cantilever form for deck 20. 2 hrs.backfilling and gradi g- ck area only........,,..............................INCL. 63. 21. Pool interior finish....... ....%.- 1.. 1K%...................................INCL. 22. Filling of pool promptly after interior finish ..............................................BUYER 64. 65. HYDRAULIC& FILTERING SPECIFICATIONS POOL DECK PRICES SUB-BASE MATERIAL IS NOT INCLUDED. 23. Approved deluxe filter: Type Size 24. Pump and motor: Type Size Decking square footage: Type 25. Pressure test all pool piping............................................................... IN LC Ir -/; &i 26. Hook up all water lines from filter to pool....................................................INCL. Other: U 27. Non-corrosive PVC plumbing throughout....................................................INCL. 28. Hydrostatic valve ..................................... ................ .................................INCL. 29. Provide return inlets for filtered water to pool ...... ./ INCL. PAYMENT 30. Main drain suction line with grate...-b(. 4r...4v:....'W................INCL. 31. Deluxe Skimmer Including Weir Gate and Large Basket.......".L^ ..............INCL. The Buyer agrees to pay E.P.I.the following Contract Amount for E.P.l.s 32. Vacuum fitting outlet in skimmer..................................................................INCL. performance of its obligations under this Agreement. 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 $ Jow- 30%Day of Excavation $ AUTOMATI OUIPMENT Deposit $ 40%Day of Gunite $ (.� 0 36. Automatic pool cleaner: Type Z 7)14L. BALANCE $ 25%Day of Tile $ 37. Stub plumbing for future pool cleaner ........................................................INCL. 5%Day of Interior Finish $ '� 38. Floor recirculation system 39. Automatic chemical feeder.. .................................INCL. TOTAL $'W 40. Automated Pool Controls .i Tdte�f �d TERMS AND CONDITIONS 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.I:S CONSTRUCTION OF A SWIMMING POOL,MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT.ANY CHANGES IN ANY OFTHETERMS OR SPECIFICATIONS OFTHE AGREEMENT MUST BE MADE IN WRITING SIGNED BY 41. Deluxe pool Heater: Size 000 Make E.P.I.AND THE BUYER,AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE Indoor/Outdoor 011_ Nat/Pro 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..U.3.0!Y ............ ..INCL. WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- 43. Electrical bonding of pool as required by city or town code I364,*�X. 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. Pool over 75'at$15.00 per foot BUYER THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANYTIME BEFORE MIDNIGHT OF Heat Pump at$18.00 per foot BUYER THETHIRD BUSINESS DAY AFTERTHE DATE ON WHICH EITHERTHE BUYER OR E.P.I.HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO E.P.I. HYDROTHERAPY SPA THE BACK OF THIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.T;IEY ARE PART _/ OF THIS AGREEMENT.READ THEM. 45. Attached ill$Separate Raised Light I ACKNOWLEDGE THAT THIS AGREEMENT IS A LEGALLY BINDING CONTRACT,SUBJECT ONLY TO Blower� F;i� l.z4L-- #Hydrotherapy jets ��S t.,e THE ABOVE CANCELLATION PROVISIONS,AND I CERTIFY THAT I HAVE READ AND AGREE TO ALL Additional Specs. S .7 ,&C TERMS AND CONDITIONS OF THIS AGREEMENT. ENVIRONMENTAL POOLS, INC. ACCESSORIES BUYER BY: 46. Deluxe cleaning tools (18"nylon brush, hand leaf skimmer, thermometer, pole, test kit, deluxe vacuum) ..............................................INCL. BUYER 47. Diving board: Size ColorZ1_ //� 48. 3-tread S.S.ladder/handrail .�� DATE (( �/ DATE 49. Pool slide: Size Color 50. All jigs installed by decking contractor or buyer ►�I��N� TEs . cot20EIZ A 12, Lal•--11--��E�•`� • o� Z�►J�E�i � F 3-7 �e hY-C l tJ 5 bj�� . TEZ. �'✓ - Z�0.2.E Q 4cvT%_e, 4 yz;rE M R.A,tij � Lc"( 4.11 j r2 jet`s PWn•,-" C�IJb. �� b 2�iD• DZ gY 2. Aei- P3 Lai L'-r t�P-r!-c (�I,,k,.S� Lea ElJ41 EE ria e4 D%Tenn g•2`1 -��, 3�3/• PAj ! T-( �Vla eve I,J 1 IJ i -fi rA e►-i IZO�D uILT OF SLWURWE DISPWAL, SYSTEM LOG n- D IN IJ D12 1 I AQ POV:12 J �4.5�,/ iZ� I ►`I DLI Fs� iZ ,40 AS PREPARED FOR DATE: T I--I iN of 90 SCALE: 1 40� '�� % %`� �� DANIEL tiN o KORAVOS // v CIVIL CAP D L '- No.37752 qF �O MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURMORS • PLANNERS 66 PARK STREET * ANDOVER. MASSACMURM 019_10 0 TEL (617)473-3553. 373=l 1 t h�"f' I v F 2 i ASSESSORS.• NOTES, MAP 109, LOT 49 I. THIS PLAN IS NOT TO BE CONSIDERED AN ZOO. AL TA/ACSM LAND TI TLE SURVEY, NOR IS IT TO BE RESIDENT/AL 2 USED FOR RETRACEMENT OF PROPERTY LINES REFERENCES: 2. 'AS-BUIL SYSTEM TAKEN FROM PLAN EN77TLED AS-BUIL T SUBSURFACE DISPOSAL SYSTEM" PREPARED DEED BOOK 13159, PAGE 288 BY MERRIMACK ENGINEERING SERVICES INC. DA rED PLAN #12957 NO VEMBER 3, 2000, PRO VIDED B Y BOARD OF HEAL 7H.. 3. UTILITIES SHOWN HEREON FROM FIELD LOCATION OF SURFACE STRUCTURES NO UNDERGROUND U17LIT/ES WERE INCLUDED AS PART OF THIS SURVEY. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO CALL Q '9 tel/ DIG-SAFE A T 811 A T LEAST 72 HOURS PRIOR r0 O,/mss 4. EXCAVATION OR CONSTRUCTION BOR . DERING VEGETATED WETLANDS SHOWN HEREON Q off Cy / WERE DELINEA TED BY HANCOCK ASSOCIA TES AND WERE > 1 the r�S / FIELD LOCATED BY INSTRUMENT SURVEY. (� ,�., 9�� moo• Proposed 0 Silt Fence Q k 0 �h W ryryELECTRIc O /01 Q Propose TELEPHONE o I Patio \ ICABLE h CoQou 18 t a Q W \ / I r tA w LAWN �I \ O I lRRIGAAON1} y,1 V ' �I � 52 4' SAL If O 58 k .,A c w \ 30 > I ---� G1� [ir Z ` O 1 STY SEPTIC Q\ % 'In V7� 1 V TANK M Z V DECK �,, i i K I m N Q I I t Op I I , 13 + ZI I PEA �S TONE DEC II �i i \ -v PA O + 1 I Q 1 1 1 I I \54.9' + 1 I _ COR. W (Trn> J i i ± ;I 1 it O i I I 1 1 I + X11 1 I 1 ;{; II ;Fill '\ j� • I I II I Z t I =1 I ZI 1\ 11 1 1 nl 1 1 =1 I I1 1 =1 1 I I + OZI 1 0 I I I ' i 1 A Q LOT 3 J AREA Jol 461 369 _i- S.F. c T !!! PAID COS JCET TT ER �, Coo 230•x, �EXAN�RINE 6' A KATIE r PLOT PLAN CHK. BY- OF YOF OF LAND /CW so45 WINDKIST FARM ROAD, NORTH ANDOVER, MA Ft PROPERTY OF STEPHEN COSTA DA TF• HIL 48M �IANCO CK 7/24/13 SurveyAssociates, Inc. JOB SCALE- 1" = 30' 23 /3 185 CENTRE STREET, DANVERS, MA. 01923 NO. PROFESSIONA LAND SURVEYOR VOICE (978) 777-3050, FAX (978) 774-7816 0 15 30 6o 17568 X.•117568-C0sto-North AndvKrk17588fdwgj 17568cpp.dwg Ad 2.> 2013- 1:28 pm I be cowntonweault of Massachusetts Department of lndushW Accidents Office of Invesfigadons IF ],Congress Street, Suite 100 Boston,MA 02114-2017 www.mass govldiia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AMMut Information Please Print Legibly Name(Business orgar&Ationandividuai): FA)//Aw7M&VJV4_ P �-e— city/State/Zip: � 2 Phone Are you mployer?Check the appropriate box: Type of project(required): 1.ET I am a employer with 2-0 4. ❑ 1 am a general contractor and I employees(full and/or pait-time). * have hired the sub-contractors 6. 0 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. [] Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' insurance.t 9 ❑ Building addition coinP- _ [No workers'comp. insurance required.] 5. 0 We are a corporation and its 10•❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercis their 11, g repairs or additions Q plumbing myself. [No workers'comp. right of exemption per MGL 12,0 Roof repairs insurance required.] # c. 152, §1(4),and we have no 3 Other employees.yees. [No workers' 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 showingthe name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must vide their workers'co policy num �P Pm mp p cY her. I on an employer that is providing workers'compensation insurance for my employees Below is the.pokey and job site information. �. Insurance Company Name: Policy#or Self-ins. Lie.#: �� � &`Z,.� 2-- Expiration Date:. Job Site Address: X41h�kls'� ?_0 City/State/Zip: FAh"�ac dV� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance_coverage verification. I do here Gerd u r e o 'u that the in ormation provided above issue and correct Si Lure: Date . Phone#: F only. Do not write in this area,to be completed by city or town officialwn: Pernnit/License# thority(circle one): ...____. T1 11 A` RO CERTIFICATE OF "- ILFrY INSURANCE DAT(M oi )40iis THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Oi4LY 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 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 CONTACT NAME: Service Team AIMS Insurance Program Managers, Inc. PHONE (6O2)635-4848 IAIFAAxX No:(460)991-0634 4110 N Scottsdale Road E-MAIL . ADORE service@aimsinsurance.com Suite 140 INSURERS AFFORDING COVERAGE NAIC# Scottsdale AZ 85251 INsuRERA:Hartford Underwriters Insurance 30104 INSURED :NSURERB:Hartford Casualty Insurance 29424 Environmental Pools, Inc. INSURER C: 184R Riverneck Road INSURER D: INSURER E: Chelmsford MA 01824 INSURERF: COVERAGES CERTIFICATE NUMBER:13-14 All lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO4, -4V= BEEN ISSUED TO THE INSURED NAMEC ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND 71--1% Df ANY CONTRACT OR OTHER DOCUMENT '1 TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFZ'?7E: BY THE POLICIES DESCRIBED HERE'N iS S:;BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HA VE SEEN REDUCED BY PAID CLAIMS. (NSR TYPE OF INSURANCEADDLISUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDO A MM/DD/YYYY LIMITS GENERAL LIABILITY EACH ecc'RRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY�dPREMISES:E2r- ?nce $ 300,000 A CLAlMSADE ®OCCUR 9DENOJ2180-2 ?/=4/2013 /14/2014 MED EXP.Ar:ore-erson) $ 51000 PERSCNAL&A0V INJURY $ 1,000,000 GENERAL AGGR=-GATE $ 2,000,000 GEN'LA GGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY. PRT 17 O LOC !$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddeM ANY A=,. BODILY INJURY(Per person) $ ALL \ = SCHEDULED AUTC0-v'^'=-- AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED?.: AUTOS Per acc dent $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS L A3 CLAIMS MADE DEO =E-NTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N ANY PRG='R'c a RTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 000 000 OFFICE?t'VE.V'x= EXZ UDED9 7 N!A (- (Mandatory;r,10i 9WEOJ2182-2 }5/14/2x:3 5/14/2014 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes,des,-se ce DESCRIP`-c* C:==_RATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OP'EFA:rONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Pet-arm Schedule,if more space is required) This cer—_ica_e is only a representation of coverage afforded by the insurance companies noted on it. Terms of ;.:erage are defined in the policies[ies shown and those terms may or may not comply with the requirements o: any contract entered into by the na=ed insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EVIs MT,r r OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I (Peter Godfrey/TEAM ACORD 25{20.001 ©1988-2010 ACORD CORPORATION. All rights reserved. INS025tx,--i,_. Tho annpn n2ma nnrl 4.— gra ranie4arori mnore of Ar-non Environmental POOLS Design Excellence ova wq-(PEzto,=fgo19 184R Rivemeck Road -Chelmsford, MA 01824 Office of Consumer Affairs&Busifess Regulation IMPROVEMENT CONTRACTOR egistration: 107083 Type: xpiration: 7/29/2014 Private Corporatic ENVIRONMENTAL POOLS INC. Andrew Evedeigh 184R Rivemeck Road Chelmsford,MA 01824 Undersecretary Massachusetts - Dcpurtmcnt of Puhlic Safety Board of Building Regulations and Standards Construction Supervisor License 'to: 00 Massachusetts -Department of Public Safety Board of Building Regulations and Standards 00- U>areslziclted Construction Su fwr%i.or :s-." ->; 1G-12 Fan*Homes i License:CS483208 DEAN 29CRESCEI t S 6� FaRm to possess a current edition of the TEwxseu>w�t M4�Ive, - Miasaehnsetts&me'Bnldit Code is case for revocation of this Geease. r.�.• "��� Expiration Refer to: WWW.Mass-Cav/DPS Commissioner 02/14/2014 800-696-6976 - Q7f2_7r%R_n,)nn - 1 PAP Riucmcrk Rnari 0#44 S&R�,KE WarrR SNa[C R star£cvnrm.caoE O D'4'44' Aa/Ar rAom POOL �-• S,- �_' rF,9H1Ai �3 aA.tS /N QeND &Z-AN_neELEYO'O' ucNr ,vitNc - hcSoEV/27t TOPCFQaNO ZeAM 2 rxsrT— • ff rAz vE,rc w,ocL fLEv2'D' 3 *, XaSrec f/ nrr pbw /Z1 — • 77ta.vS/riaN Pa/�vT J . �,,�� •3 aAA5 W rr OC AWN wars '�- ��/r/� aaA�o / . � • cr.�uNo ELek,3'a' .s+flfrrczocE•/ ca�rrr R curaFF wcr REDD dw lDHt�•l — . — -- — — aAR t — _ ELEY�=O' /OES'ANGLE or-3 aAX3 b' a _CL/rU+cf AS IWED EL EY 5 � S'RADIUS ,[.GSTAT/C MA/N D CA/N AIR;EF rACYE ,'I/ � UrQfFAI rAF PrW 7TE 0'. vECT D/;QEC r TO IUMP S• /N S B.9�s FLEIi'• D' RESIDENr/AL COrawitUgt G"MiA'FLaK � 3 _ -3"CL EAt &I/IH acnes �� FL EY 7`q i - }tAFtTr cfocE • t 0C -11 WRVS STA/VDfAAD 'WIY I- S'ECRON R36AAS/z• oZ a CONS Fl?LIC TION %VOTES • e�� • - � e'o � .' GENERAL AE/NFOAC/NG STEEL •CONS TR UC777viV SHALL C0/Y17,0R/N TD C/TY DEPT REINFORCING STEEL SHqLL CONFOiP/a7 a 1 �. .•,� OF BLDG ,' SAFETY CODE ST.9N.L�A.fOn TD A.S.T.M. DES/C/VAT/ONS A -1-1 A3DS • '. /' aL APS 'S/YAL L BE A M//V/.'�U/�! C7F TH/RTY� • D/!//N G 13rj/%R -NOT PERM/TED ON POQL S 2G� a •0 •_ / ' f ' ('o LESS Th%,Y E/GY7"FEET /N Dfr'i H AT 9,0,geD -CLLR. O DIAMeTERS OR J8"LUHEl�,= SPL/CES o;vouir •HEAL rH Df DT. APPROVAL REo U/RED FOR eg t1/V i re CONS rRL/C T/O/V_ a o: d. a ALL COMMEXC/gC TYPE POOLS. 0 GUN/Tt= SN�fLL BEANO Pune � �— —�— • �1I DES/GN /PPL/ED PNE UMAT/CALL Y. M/X JH�9Lf BE �•— �� Iave RaRT CL=MF/VT- TD FDU.e h9/VD ,,7 • TRIS DES/G.N CONFOR%fS TO LOCAL CODE .9�/O FwRTS =,9/YD /.'9'/z ULT: CD/J9P STiPENGTH IfASED aaav P, .TEASO1vAL3LY LEVEL S/TE 3AOQ pS/ 3S DAYS EOUACItE;t L/NE a AND APPRO J„ED NATURAL G,POUNO 1!//TI//N-Z FEET Comm•orvtr' Gaxao [L,vMv r • I1ArFJT-CEMENT' .VAT/D Sh'ALL /1. r EXCEED OF TDP DF ;SONO t3Ef/l'�, ANY FY CEP T70NS 3 � GAL 3 L[/RTFR SACK OF CEAyE/YT SURFACE URFACE SX/MtIER a ` G!//LL REOL11KIF SUPPLEMEN TRARY DfTR/L /DFS/GJVPER • CURE GUN/Tf BYAL/GHTGvh7TER SP•PR)' 7--•3 DARS/EcvlTh'XeZ Ti/r1ES A DAY Fo.� SEvE'N DArS • O/uNER rh';�r�L PROVIDE £ENC/NG //Y CO/J1PL /ANCE L,NDEr( WArE;C t- GHr u//Th' LOCAL' C/Ty p,{ jOGUN CRL1/NANCE GATES TD 'M SELF C•LDS/NG e [ATCN/NG o :� -° • ELEC'TR/CA;: YRQzz CdNF6.P�7; ro -STATE PLRrF fINO LOCAL RFpU/RE/`lENTS OF M4 SS9cti v L?af5 G-OC �� PAUL A. G� aorw ".0119 YC -V PHELAN JR. o •'o. - STRUCTURAL -' ,vYOW5-ranC ° , Environmenta h `� No.42538 N - �- REL/EF Y•QtvE . t w"t b' • Poo .. Tu aE(.•Fo SIONAL RE o'I `� Design Excellence iat�a �Zv •.' �1Ntt� 2 r C tAiB sz/,”y ' Andrew Everleigff J 0,0,07�, J E-uonaf�:7oucPresident 978-256-0200 0 184R Riverneck Road 1-800-696-6976 MAIN OU r�FT Chelmsford, MA 01824 Fax 978-256-6620 _._ _ F��r_ SPOUT 6-1 as ,1d ca ,--IL- �s Docket#3 5 7 THE COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Notice of Correction Secratary of the Commonwealth Regulation Filing To be completed by filing agency CHAPTER NUMBER: 780 CMR 51 .00, CHAPTER TITLE: Administration AGENCY: State Board of Building Regulations and Standards ORIGINAL PUBLICATION REFERENCE: S 1074 Date: SUMMARY OF CORRECTION: Insert"construction of swimming pools"in exemption 1. as shown below... 5108.3.5.2 Exemptions from Construction Supervisor License Requirement. A construction supervisor's license is not required for: 1. Erection of rooftop solar collectors,the erection of signs,the erection of tents,construction of swimming 2.Projects which are subject to"construction control'(see 780 CMR 2.00 for definition of `.` "Construction control,); AGENCY CONTACT: Mike Guicili PHONE: 697-727-3200x25215 ADDRESS.- One Ashburton Place 13th Floor,Boston MA,02108 ATTESTATION- The regulation described hereir,and attached hereto is a true copy of the regulation adopted by this agency. ATTEST: SIGNATURE: DATE: � Publication To be completed by the Regulations Division MASSACHUSETTS REGISTER NUMBER: 1103 EFFECTIVE DATE: _ 4/1/07 DATE. 5/2/08 CODE OF MASSACHUSETTS REGULATIONS Remove these a es: Copy ATTEST Insert these a es; yo AM 505 , 5 0 6SECR AIA OF TRANCIS E COMMONWEALT H ly 505, 506 Xl' o CLERK .5) 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE which he or she resides or intends to reside, 5108.3.6 Registration of Home Improvement (� j on which there is, or is intended to be, a Contractors. In accordance with the provisions one- or two-family dwelling, attached or of M.G.L. c. 142A, no home improvement detached structures accessory to such use contractor, or organization or firm shall be and/or farm structures. A person who involved in the improvement of any existing constructs more than one home in a owner-occupied one- to four-family residential two-year period shall not be considered a building unless said home improvement homeowner. contractor has registered with the BBRS in Note:Any licensed construction supervisor accordance with the rules and regulations for the who contracts to do work for a homeowner registration of home improvement contractors as shall be responsible for performing said set forth in Special Regulation 780 CMR 110.R6. work in accordance with 780 CMR 51.00 5108.3.7 Certificatigp of Inspectors of Buildings, through 99.00,Special Regulation 780 CMR Building Commissioners and Local Inspectors. 110.R5 and all referenced standards and/or Except as allowed for conditional appointees, no manufacturer's recommendations,whether individual shall perform the duties of municipal or not the licensed contractor secured the inspectors of buildings,building commissioners or permit for said work, local inspectors unless certified by the BBRS as set 5108.3.5.2 Exemptions from Construction forth in Special Regulation 780 CMR 110.R7. Supervisor Lice utrem A 5108.4 Enforcement. Whoever violates the cons eta supefvisor's Iicen is not provisions of 780 CMR 5108 or any rules and aired for-:" regulations promulgated hereunder,or who falsifies 1. Erection of rooftop solar collectors, or counterfeits a license,registration or certification erection of signs, the erection of ten issued by the BBRS,or who fraudulently issues or construction of swimming pools; accepts such a license,registration or certification - 2. Projects which are subject to shall be punished as provided in 780 CMR 5118 or "construction control"(see 780 .00 shall be subject to any other penalty provided for by for definition of"Construction co of"); law. 3. Agricultural buildin s ch are not 0 or otherwise made 7S0 CMR 5109 APPROVAL available for public use; 4. Massachusetts-registered engineers and 5109.1 Approved Materials and Equipment. All Massachusetts-registered architects materials,equipment and devices subject to approval (collectively referred to herein as"registered by the building official shall be constructed and design professionals"), provided such installed in accordance with such approval. engineers and/or architects comply with the 5109.2 Used.Materials and Equipment. Used Construction Supervisor oversight materials, equipment and devices which meet the requirements set forth in Special Regulation minimum requirements of 780 CMR 51.00 through 780 CMR 110.R5 generally and 780 CMR 99.00 for new materials, equipment and devices 5116.0,as applicable;and shall be permitted; however, the building official 5. The practice of any trade licensed by may require satisfactory proof that such materials, agencies of the Commonwealth, provided equipment and devices have been reconditioned, that any such work is within the scope of tested,and/or placed in good and proper working saidlicense,including,but not limited to, condition prior to approval. wiring,plumbing,gas fitting,fire protection systems, pipefitting, HVAC and 5109.3Modifications.Wherever there am practical refrigeration equipment, difficulties involved in carrying out the provisions of 5108.3.5.3 Municipal Construction 780 CMR 51.00 through 99.00,the building official Licensing. No municipality shall be shall have the authority to grant modifications for prohibited from requiring a license for those individual cases,provided the building official shall individuals engaged in directly supervising first find that special individual reason makes the persons engaged in construction, strict letter of 780 CMR 51.00 through 99.00 reconstruction, alteration, repair, removal or impractical and the modification is in compliance demolition in those categories of buildings and with the intent and purpose of 780 CMR 51.00 structures for which the BBRS does not require through 99.00 and that such modification does not a license, provided that those municipalities lessen health, life, fire safety or structural which have established licensing requirements requirements. The details of actions granting forconstruetions�pervisors prior to January i, modifications shall be recorded and entered in the 1975, may maintain their existing licensing files of the building department. A building official requirements. may seek assistance from the District State Building Inspector for action under 780 CMR 5109. The 506 780 CMR-Seventh Edition 5/2/08 (Effective 4/1/07)-corrected I • SMMM), � North Andover Health Department (ommunity Development Division July 26, 2013 Paul F. Driscoll, Revocable Trust Patricia Driscoll, Trustee 90 Nashoba Rd. Littleton, MA 01460 RE. Re: Subsurface Sewage Disposal System Plan for Lot 3 Boxford Street(Map 105C,Lot 52) Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Andover Consultants Inc. dated June 24, 2013,revised July 23, 2013 and received on July 25, 2013. The design has been approved for use in the construction of a 4- bedroom (9—room maximum)home, on-site septic system. This plan is good for 3-years from the date of approval. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. 1. Prior to the issuance of the building permit the potable well test reports must be submitted indicating sufficient and safe potable water is accessible on site. 2. Prior to the issuance of the Disposal Works Installers Permit,the applicant must submit a foundation as-built at the same scale as the approved plan. 3. Prior to the issuance of the Disposal Works Installer's Permit, the applicant must submit the floor plans of the home showing no greater than four bedrooms or a total of nine rooms. 4. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Page e 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Lot 3 Boxford Street July 26, 2013 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 5. Prior to issuance of Certificate of Compliance a confirmatory well water test shall be submitted indicating potable water post construction of the site. 6. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director cc: James Fairweather 11, PE file encl: Installers list Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 � yegTtED��s . North Andover Health Department Community Development Division June 24, 2013 To whom it may concern: Please be advised that Kyle Corkery, Health Department Summer Intern, is an authorized representative of the North Andover Health Department as of June 17, 2013 for the summer of 2013. Kyle will be independently conducting inspections and surveillance of a variety of permitted sites including, but not limited to; sanitary surveys of trash dumpsters, inspection of septic trucks, food survey questionnaires for establishments etc. as directed by the North Andover Health Department. If you have any questions regarding Mr. Corkery please feel free to contact me at the Health Office. Th you, san Sa er, /RS Public ealth erector 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com North Andover Health Department (ommunity Development Division June 24, 2013 To whom it may concern: Please be advised that Kyle Corkery, Health Department Summer Intern, is an authorized representative of the North Andover Health Department as of June 17, 2013 for the summer of 2013. Kyle will be independently conducting inspections and surveillance of a variety of permitted sites including, but not limited to; sanitary surveys of trash dumpsters, inspection of septic trucks, food survey questionnaires for establishments etc. as directed by the North Andover Health Department. If you have any questions regarding Mr. Corkery please feel free to contact me at the Health Office. Th you, san Sia er, /RS Public ealth erector 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com . y�{'CLED North Andover Health Department Community Development Division June 24, 2013 To whom it may concern: Please be advised that Kyle Corkery, Health Department Summer Intern, is an authorized representative of the North Andover Health Department as of June 17, 2013 for the summer of 2013. Kyle will be independently conducting inspections and surveillance of a variety of permitted sites including, but not limited to; sanitary surveys of trash dumpsters, inspection of septic trucks, food survey questionnaires for establishments etc. as directed by the North Andover Health Department. If you have any questions regarding Mr. Corkery please feel free to contact me at the Health Office. Th you, san Sa er, /RS Public ealth erector 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i S�g1'LEDJ North Andover Health Department fommunity Development Division June 24, 2013 To whom it may concern: Please be advised that Kyle Corkery, Health Department Summer Intern, is an authorized representative of the North Andover Health Department as of June 17, 2013 for the summer of 2013. Kyle will be independently conducting inspections and surveillance of a variety of permitted sites including, but not limited to; sanitary surveys of trash dumpsters, inspection of septic trucks, food survey questionnaires for establishments etc. as directed by the North Andover Health Department. If you have any questions regarding Mr. Corkery please feel free to contact me at the Health Office. Th you, san Sa er, /RS Public ealth erector 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com y�.{g1ED North Andover Health Department (ommunity Development Division June 24, 2013 To whom it may concern: Please be advised that Kyle Corkery, Health Department Summer Intern, is an authorized representative of the North Andover Health Department as of June 17, 2013 for the summer of 2013. Kyle will be independently conducting inspections and surveillance of a variety of permitted sites including, but not limited to; sanitary surveys of trash dumpsters, inspection of septic trucks, food survey questionnaires for establishments etc. as directed by the North Andover Health Department. If you have any questions regarding Mr. Corkery please feel free to contact me at the Health Office. ?sZan you, 7aeRS Publicr 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i