Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit #167-15 - 54 LONG PASTURE ROAD 8/14/2014
i � I NORT{♦ BUILDING PERMIT O* tLeo q TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATIONso I' 1 I Permit No#: � ��� Date Received � f�, �gSSgcHus���� ArED Date Issued: f -1 IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER jL43,4LE•rc- ��SI_LVE�.RR m -= - Print 100 Year Structure yes no MAP It' PARCEL O _. ZONING.DISTRICT: Histone Distract yes no, Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetland's ❑ Watershed District ❑Water/.Sewer.,, _ DESCRIPTION OF WORK TO BE PERFORMEDSe-r-- : 10,71-0util ll7 �&2,u r'TE ,S w i�„v,„�1c, �po( AV Z© x 3 9 J e-r- ' 7 Identification- Please or Print Clearly OWNER: Name: ��5,4LErE j ,,5 Phone: Address: 5,1 L6ty g —uzr P,,o o Afoc-rr( NDovep- Contractor. Name.tNa14014Me141ai Poon Phone:_ �1�8, Z5 - Z-5 C) Address; Ig��- �v� ecK. r? �,uEL►nSw2o r~1Y1 __�i8z (. _ _ Supervisor's Constru,ctionLicense ( � _� _ Exp.. Date: Home Improvement License:. _ 1076 _ . Exp. Date: 7 z ARCHITECT/ENGINEER SoLoyir-ts L&4,„ue&e., Gc,.,,f,LLL Phone: 778-35z- ' 71 Address: 22 M6unrr oc4aaAJ g�An ;?oxyoeo Mff 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: $ Z89 . V7 FEE: $ Check No.: 13� `C® Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner -,0 Signature of contractor I 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/Cross Section/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 I 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 i ❑ 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:Building Permit Revised 2014 Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer i ❑ Tanning/Massage/Body Art ❑ Swumning Pools Lel 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 PLANNING & DEVELOPMENT Reviewed OnfEG Signature_ COMMENTS ' I CONSERVATION Reviewed on - Signature% 41u, i z � COMMENTS 2 l HEALTH Reviewed on 7/,7/jSi nature COMMENTS / Gyv 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 FIRE' DEPARTMENT TempBumpster. on site yes no. _ L-ocatedtat 124 MainStreet Fire Department signature/date____ 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) t 4� r A-CA CL UN- t? i ❑ Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit Revised 2014 Location fo , a-- No. ,lY "� .J Date . • TOWN OF NORTH ANDOVER '77 ik Certificate of Occupancy $ Building/Frame Permit FeeTwO Foundation Permit Fee Other Permit Fee $ TOTAL $ Check#L 27901 - Building Inspector i Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 69,289.00 m $ - $ 831.47 Plumbing Fee $ 103.93 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 103.93 Total fees collected $ 1,139.34 54 Long Pasture Road 167-15 on 8/14/14 20x39 Inground Pool with Spa NORTH Town of n 0 . , No. Z o h ver, Mass, Q cocHicnewic" 4,1' 0 / A04ATED S U BOARD OF HEALTH PERMIT LD . Food/Kitchen Septic System f THIS CERTIFIES THAT . S. �• . BUILDING INSPECTOR ® Foundation has permission to erect .......................... buildings on ... ... ON ••`•• `• ?!�4.•••••••••• Rough to be occupied as ... ... 1.! , ...^"A.�... .. .o,...�.�5. .�31�.... ...... . i .......... Chimney provided that the person acting 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTFWCTIO T Rough -- Service .!.:. ....... .... ............ Final BUILDI 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. North Andover MIMAP July 31, 2014 ,alis-_::. 106.A-0028 m.:ulu.:: .._:,tl„.>;<. ,Ju:: ,._.. 106A-0131 #445 -' 106.A=.:0189 ,,,--•.. 105.0-0017 106.A-0216 106.A-0268 #453 0 m�. #57 ;AKW0017 106.B-0222 :_.,: ::: 'fur•:: #51 Ir , #00 �a 106.B-0221 1�¢0 106.B-0053 -�T #485 106.8-0054 ` #26 ` - 106_B-0218 ultr..:••:. - -.-106.B-0219 106.B-0055 106 B-0220 _ `•`: R \� #54 1 � .:. #50 106.B-0099'. #26 106.B-0244 106.B-0056 106.B-0 80 100 #15$0 -= 106.B-0025 .,i. - �C ..... I .I; 106.B.' 7.•_: :: 106.B-0101 #1592 _._•:„G #45 A 106.B-0102 "•i;• "�'-1116'B=0217• #9 #25 ' 106.B-0104 106_B-0103 1066 003,4 .4"..'N" #1620 . :•,�,..: .:.... -. :•.:btu ":::: 1 . 106.B- 026 10 —Rail Line +w Wetlands Zoning Interstates 0 Exempt Lands 13 Busine s 1 DisMcl _ sine s 2 District Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83, SR a Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack ®Busine s 4 District '11110111I - Valley Planning Commission(MVPC)using data provided by the Town of - Roads 0 Genem Business District Of tea o q� North Andover.Additional data provided by the Executive Office of t r Easements O Planne Commercial Dev 'IN °`� r++s OQ Environmental Affairs/MassGIS.The information depicted on this map is ❑MVPC Boundary G Corrido Development Dist L for planning purposes only.It may not be adequate for legal boundary 0 Corrido Development Dist .- .—. fn definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Zo Municipal Boundary �Corrido Development Dist �• p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Ca Industri 1 District Zoning Overlay # >< THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY �Industri 12 District 0 Adult Entertainment # i ,�, ; OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT b Industri 3 District Downtown Overlay District * o Kti ��+ ; ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF �Historic District O Industri I S District �+ ®water Protection Reside ce 1 District �l °++ya° y� THIS INFORMATION O Reside ce 2 Dlslrict ,'SSACNUset ❑Parcels n anside ce 3 District LI Hydrographic Features de ce4 District —Streams 1"=178 ft de ce 5 Disldct - ede be fi District a e esidential District ALL SURFACE WATER SHALL PER STATE COMM.CODE DRAIN AWAY FROM POOL 3-#3 BARS IN BOND BEAM ELEV O'0" 72" LDETERMINED BY POO GTH ON LIGHT NICHE IF SPECIFIED TOP OF BOND BEAM 21 " ELEV 1'.0" 3/8"MIN.WATER PROOF 6" MAX VERT. ALL ELEV T 0• PLASTER ENTIRE POOL 12 3 MIN #3 BARS 6"O.C.BOTH WAYS 4 " A TRANSITION POINT 12" NATURAL ELEV 3'0" SAFETY LEDGE IF 'RES. DIVING BOARD 12" 6a R GROUND REQ'D ON COMM. '6"COMM- CUT OFF ALT BARS ELEV 4 0 POOL #3 @ 6"O.C. 4"WIDE 5°ANGLE C OFF AS NOTED ELEV You ELEV 6'0" HYDROSTATIC MAIN DRAIN RELIEF VALVE . Il CUT FF ALTERNATE CONNECT DIRECT TO PUMP 80° 0 6"MIX FLO 3' MIN. 3 BARS ELEV T 0" RESIDENTIAL&COMMERCIAL A 2rCl Ep`R ELEV T 9" WITH BLOCKS ELEV 8'0" SAFETY LEDGE y,S-j 2 6"MIN.TYP. FLOOR RE-INF.#3 BARS @ 12"O.C.BOTH WAYS TYP. STANDARD WALL SECTION 27" JUNCTION 7 #3 BARS 12"O.C. Box Environmental Design Excellence With A Personal Touch Pools, 184R Riverneck Road-Chelmsford,MA,01824 ° 8..MIN Pools,Inc. Y-:t '-e '" °d � 978.256.0200/800.696.6976/Fax 978.256.6620 O ° eft Aquatech builder Info@EnvironmentalPools.com-www.EnvironmentalPools.com o .,`0 O..o . : Q Q CONSTRUCTION NOTES 2 Q " CONDUIT GENERAL R REINFORCING STEEL O• °• ° ° ' o .0 ° • CONSTRUCTION SHALL CONFORM TO ALL CITY DEPARTMENT OF • REINFORCING STEEL SHALL CONFORM TO ASTM DESIGNATIONS A-15 PUMP BUILDING AND SAFETY STANDARDS &A-30S. LAPS SHALL BE A MINIMUM OF THIRTY DIAMETERS OR IS"WHERE SPLICES OCCUR. ° • POOL CONSTRUCTION SHALL MEET ANSI/NSPI-5 2003 STANDARDS EQUALIZER LINE FOR RESIDENTIAL INGROUND SWIMMING POOLS COMM ONLY cl'o GROUND CLAMP • HEALTH DEPT APPROVAL REQUIRED FOR ALL COMMERCIAL TYPE AUTOMATIC sulacE SKIMMERPOOLS GUNITE CONSTRUCTION 2-#3 BARS(EW) DESIGN i • GUNITE SHALL BE A MACHINE MIXED AND APPLIED PNEUMATICALLY. i MIX SHALL BE ONE PART CEMENT TO FOUR AND A HALF PARTS SAND UNDER WATER LIGHT • THIS DESIGN CONFORMS TO LOCAL CODE BASED UPON A 1:4 1/2 UTL COMP.STRENGTH IS 3000 PSI @ 3S DAYS REASONABLY LEVEL SITE AND APPROVED NATURAL GROUND WITHIN • WATER/CEMENT RATIO SHALL SHALL NOT EXCEED 3 1/2 GALS PER O .2 FEET OF TOP OF BOND BEAM. ANY EXCEPTION WILL REQUIRE SACK OF CEMENT • .O O SUPPLEMENTARY DETAIL AND DESIGN • CURE GUNITE BY A LIGHT WATER SPRAY THREE TIMES A DAY FOR PLATE& SEVEN DAYS. �p FRAME OOL TQ grr- G0r1ST ftWQT&,0 FENCE IN A-cc-orL-Phoc,t . #3 BARS 6"O.C. • ENVIRONMENTAL POOLS,INC.SHALL BE RESPONSIBLE FOR PROVIDING of e s sly M is G ArP P Cr Q s FENCING IN COMPLIANCE WITH LOCAL CITY OR TOWN ORDINANCES o; BOTH WAYS 0 HYDROSTATIC PREPARED BY C2' ° .ate: RELIEF VALVE a V• . e-.o o : ° (IF REQ D) V PAULA PHELAN.IR �.',v ��N OF IWq COLLECTION V. vp STRUCTURAL ENGINEER,. �y�tiP qC�G TUBE(IF REQ D) _ I Sx 18xD 24 Y°o / CHELMSFORD,MA 01824 �� PAUL A. ... GRAVEL SUMP o- ( g PHELAN JR. STRUCTURAL cn Na 42538 O r FILL SPOUT, f ��FFSSIO ���'\ IF APPLICABLE DRAWING SCALE.-NTS NA i i i D.H. FND. S66'28'30"W 139.82' S64-24' 5"W D.H. 44.23' FND. CONSERVA TION EASEMENT D.H. i� \ FND. z m 185.18 � w 9.05' - o z nl y N D � LA N N/F CONSERVATIONZROBERT MARGARET E. JM RT/N EASEMENT S ,00'� � EASEMENT 'i Nae a� \w\ NATION t 79 p9 183.18, CONSER 4.09' $50.53,11 VUY3 DRA CNA GE � � Z � �. s48•06'27"w P� EASE ENT �y 20.00' v tJ,Ucl ' LOT 3 A\ Nva I � AREA = 2.00 ACRES �w� �� D.H. / \ 0 \ I FND. _ . � C.B.A.=70,132 S.F. D �w CONS£RVA TION ;, 1 � 7- EASEMENT EASEMENT I i w \ N�\ >, o NsF 1 o,,o\ �;, CARL & KATHLEEN DRA INA GE m\ z SCHOEN£ EASEMENT le.N \ 9IC- i� 25WIDE may/ /ya k DRIVE WAY 8.70' EASEMENTuo 9 ? 868 9y? , D.H. 7s . /0 6,9 SAY //ti FND. S06.49'05"W ♦ / \ / IS07'18'50"W Q p " "- --33-3�' \ �25.00� � 2 t /YJ�N �=45.23' Sa%a 98 o i , E� Z Qt � STONE BOUND ^, ���3,- TO BE SET 46 ..� 0, (TYPICAL) 90 Z 00 a = 34.14' (b L = 20.56' � . N O ,Q N ♦ W ♦�js L = 25.92' O 25' WIDE / 2o — w w DRIVE WA Y A EASEMENT J ENVIRONMENTAL P004SINC. MEMBER 184R Riverneck Road • Chelmsford, MA 01824 LJ 'u ` 978.256.0200 / 800.696.6976 / Fax 978.256.6620 E-mail: info@environmentalpools.com • Website: www.EnvironmentalpooIs.com An Aquatech Builder NATIONAL SPA& POOL INSTITUTE Design Excellence: With A Personal Touch The General Terms, Representations,and Conditions on reverse side are part of this Agreement. � pp NAME (Buyer) P A'A d A '1 C, I V 0 r_ MAIL ADDRESS °�`" x : f . . CITY -A �. faas , . STATEZIP " , r- JOB ADDRESS . � ,¢} . A � , = -(� .. CITY ,& � STATE A4 ZIP _ RESIDENCE PHONE OFFICE PHONE Environmental Pools, Inc. (hereinafter EPI:') 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. DI ME NSIONA`L SPECIFICATIONS Width Length 3 Shape e q, Depth to 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 .:.......... ...................................................... Y P Y ppINCL. 52. Start-up chemicals: Initial start-up and follow-up instructions ....................INCL. . 4. Set pool elevation for Buyer's approval ........................ ...........................INCL. 53. Water Condition-$ -20 tons of 1.5"stone 5. Perform normal excavation and remove soil on day of excavation.only......INCL: Additional stone at$ per load................................................BUYER 6. Access wall or fence: removed by: ,X� /rk 54. Clay soil-$ ..............................................................................BUYER replaced SALES TAX & INSURANCE 7. Trees in access and working area to be cut down so that the stumps do not exceed 2'in height................... $ .... ........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. . 513 a s �' / l nte 13. Watercure gunite shell twice dally for seven days......... ..BUYER - 14. Install continuous bond beam around skimmer............ ...... ..............INCL. 59 �t� .f �,,� . 15. One set of shallow end steps with 4'�,,Oench.................. INCL. 16. Swimout or loveseatc s �' "6 •` 17. Install 6"band of Frostproof tile.......... : . . ......: ...... INCL. 61. A : .,o t 18. Pavers, Bullnose Brick, or Bluestone $ I � 19. Cantilever form for deck 62. rl ,.. .r`) iQ 20. 2 hrs.backfilling and grading d ck are only .. r .INCL. 63. t A fs 21. Pool interior finish..�./. .4.41.1 .. t, .. �° . ?. I�1CL. le r a .. _ �- flllrng~of pool promptly after lrrteylor finish` ...".b t . 22 64. - HYDRAULIC.& FILTERING,SPECIFICATIONS POOL DECK PRICES ��}} t' i` SUB-BASE MATERIAL IS NOT INCLUDED. 23. Approved deluxe filter: Type C�r-s• �,r-1. Size Z a7 24. Pump and motor: Type go_L „'tom; I Size' 44- Decking square footage: Type 25. Pressure test all pool piping.......................................... ...INCL.' 26. Hook up all water lines from filter to pool...................... ......... ....INCL. Other: 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................................................................INCL: 31. Deluxe Skimmer Including Weir Gate and Large Basket............................INCL. The Buyer agrees to pay E.P.I.the following Contract Amount for E.P.I: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 $ `r.i 30%Day of Excavation $ ' I ` AUTOMATIC EQUIPMENT Deposit $ , �12 ;,q4ao�io Day of cunite $ 36. Automatic pool cleaner: Type BALANCE $ ,7 S . SZ 25%Day of Tile $� � . 13 . 37. Stub plumbing for future pool cleaner .................:........ ..........................INCL 5%Day of Interior Finish $ �� -2- 38. floor recirculation system 39: Automatic chemical feeder....l,: .:::�'��x :}.1. ...� e�?� t. .................INCL. TOTAL $ ? �a 40.. AutoLnated Pool Controls £T �c � a: - -tell- ,r E - ° a-`"t-� s�A `�'� C'4"� 'w�� � 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 y POOL,MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT.ANY CHANGES IN ANY e � OFTHE TERMS OR SPECIFICATIONS OF THE AGREEMENT MUST BE MADE IN WRITING SIGNED BY 41. Deluxe pool Heater: Size rj t C� Make E.P.I.AND THE BUYER,AND N0,VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS C FICATIONS ARE Indoor/Outdoor Nat/Pro r r � P- .i PERMITTED. . Fuel connections, heater venting, fuel storage tanks, permit..............BUYERf AS PART OF ITS OBLIGATIONS UNDER THIS AGREEMENT E.P.I. IS PROVIDING THE BUYER 42. Install underwater light(s), each with 10'Conduit.�: �. ....... ........INCL WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- 43. Electrical bonding Of pool as required by City Or town code SUANTTO THIS 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 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 THE BACK OFTHIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.THEY ARE PART OF THIS AGREEMENT.READ THEM. 45. Attached Separate Raised Light r, :(f. I ACKNOWLEDGE THATTHIS AGREEMENT IS A LEGALLY BINDING CONTRACT,SUBJECT ONLY TO Blower #Hydrotherapy jets THE ABOVE CANCELLATION PROVISIONS,AND I CERTIFY THAT I HAVE READ AND AGREE TO ALL Additional Specs. TERMS AMD CONDITIONS OF THIS AGREEMENT. f ~� ENVIRONMENTAL POOLS, INC. ACCESSORIES BUYS w..- BY: 46. Deluxe cleaning tools (18"nylon brush, hand leaf skimmer, , thermometer, pole, test kit, deluxe vacuum) ..............................................INCL. BUYER 47. Diving board: Size Color 48.' 3-tread S.S. ladder/handrail DATE ! f / f DATE-;4,,a 49. Pool slide: Size Color 50. All jigs installed by decking contractor,or buyer a Office of Consumer Affairs&Business Regulation _. � TOME IMPROVEMENT CONTRACTOR != egistration' 107083 Type: Expiration 7129/2016 Private Cor poratir ENVIRONMENTAL POOLS INC, Andrew Everleigh 184R Riverneck Road Chelmsford, MA 01824 Undersecretary v t�7•--�..�--�O fit.� .� +Ca� : •.4r�°�, r� I Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File 1!:242.1622 WPA Foran 5-Order of CoMition8 cDEPTransaction0:653792 l Massachusetts Wetlands Protection Act M.G.L.c. 131,§4t1 City/PownNORTH ANDOVER A.General Information I.Conservation Commission NORTH ANDOVER 2.Issuance a. F OOC b.r Amended OOC 3.ApplicantDetails a.First Nano ELVINO&LA-SALE?E b.Last Name DA SILVEIRA G Orgd dmtion d.Mailing Address 54 LONG PASTURE ROAD e.City/l'own NORTH ANDOVER f.State MA g Zip Code 01845 4.Property Owner a.Fust Name ELVINO&LA-SALFM b.Last Name DA SILVEIRA Q Organization d.it4aifit>g Address 54 LONG PASTURE ROAD e.City/fown NORTH ANDOVER f.State MA g.Zip Code 01845 5.Project Location a.Stt M Address 54 LONG PASTURE ROAD b.Cityfrown NORTH ANDOVER c.Zip Code 01845 d.Assess rs Map/PhO 106E e.Parcemot# 220 f.Latitude 42.65038N 8.Lawtude 71.OS864W 6.Property recorded at the Registry of Deed for: a.County b.Certificate c.Book d.Page NORTHERN ESSEX 13636 39 7.Dates a.Date NOI Filed:515/2014 b.Date Public Heving0ased:5!14/2014 c.Date Of Issumoe;6/4/2414 8.Final Approved Plans and Other Documents a.Plan Title: b.Plan Prepared by: e.Plan SignedlStamped by: d.Revised.Final Date: e.Scale: 54 LONG PASTURE SULLIVAN JOHN D.SULLIVAN M.P.E. ROAD ENGINEERING &SCOTT L.GU ES,PLS 518114 t"=2V GROUP,LLC B.Findings l.Findings pwmtant to the Massachusetts Wetlands Protection Act Page I of 10"ELECTRONIC COPY Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-031367 TIMOTHY JRIVgkS le�ir. 25-HOWARD ST s FITCHBURG Mk 014 `4 Expiration Commissioner 11112!2013 �aaY .. . . PEND - , i, CSU✓lUa DfF s:/L /k( on oaf do hef�byosd$oto :. (auth►r d agent appI scant andj�or cc�rrenf�r�sirie4 . O%M$t CKATLAST @111E BLpCIQ f 1 atri.the of.. . }�arn#aic►�tvr#h app 4A.... (appUran#z e o�r:�eornfran nca t c) tate appluan#itpo tnThom prder,ofonthoxs `` -`� [ ?t - have"beerb p�T�ced upon ► �.fDP t►rh1 'G.rrttmb ) the. *# A ado vert,C e rat az.C m asston: 87ox A. 1 am die �l I le_� o� � . :G. p�� (posf oxt with owx er) (owner, . :axvner tpon w Bose,laird L?xder of ci cis#ons Z f Z (},:z�"L.-i have; pla�l.up by . .'air 1VA�C number) #be itoir#h:Ai�do r Cons aho {.© :. s oTL. 3 T how bar-affirm and aek. a ..cige a1.-1 1.have rerelv€d said 4rxle- of Gcmc itxons_� and hav+e.re . die sante and enders nai acct (f?EP Axle azul every cttztditrCm uv 'ICh has`been s #for#li: m so:c 00 of.Ccaric Ztlons f;lI.i r, _ Y_affiirm and ackYtawXedge#ha#.x�n this p Qf ` v J mspeted saicT proprt tcge#her yt#h any anc aft izrip .wer.xbents have 1. t►.. . 'A do o: a sameI.and hexebS► rtcfy tha#each andI.every rdndihon se# vrdi fn;C?r%d d Cenci; ruts Ly- . z_:t�Z,m prese t#i 71 +> azrtpl anc ..... D. Fi a ) . 8z 1 hereby affirm and aknawledge#lia#this_ioctiznert#wt11 be relied upon by fhe II 'r�,r h 4ztdover Conservtthon eon► :as vve i as a n ofent- ljttyers of .. p . az4.pxoperty vhieh is stzN. 0 std CXrd �of Ci�ndittgi s y.Z. 1 .�Z (DE 'Ftl ) Signed �(nder#ate1.pains and penalties penury this 0 da ofg 2O1 #horae2ed (Signature au ageztt of applicant er oswn } 24 iG 2 34 Long f asiui'e mad 666 Sp�ciat Coziditmasl�.: NACU fi/4J2�14 � �._ � r �..� , «`. i 1 l ® DATE(MMIDDfYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 5/14/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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). CONTAPRODUCER - NAME:CT Service Team AIMS Insurance Program Managers, Inc. PHONE (602)635-4848 FAX (480)991-0634 ac No EM 4110 N Scottsdale Road ADDRESS:serviceteam@aimsinsurance.com Suite 140 INSURER(S) AFFORDING COVERAGE NAIC# Scottsdale AZ 85251 INSURER A-Rartf ord Casualty Insurance 29424 INSURED INSURER B: Environmental Pools, Inc. INSURER C: 184R Riverneck Road INsuRER D INSURER E: Chelmsford MA 01824 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE L U POLICY EFF POLICY EXP INSR LTR IN WVD POLICY NUMBER MMIDDNYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTFU_ X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 300,000 A CLAIMS-MADE Xa OCCUR 59UENOT2180 /14/2014 /14/2015 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 MX POLICY JECTPRO LOC S ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT _ S 11000,000 OFFICER/MEMBER EXCLUDED? N/A gWEOJ2182 /14/2014 /14/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) This certificate is only a representation of coverage afforded by the insurance companies noted on it. Terms of coverage are defined in the policies[ies] shown and those terms may or may not comply with the requirements of any contract entered into by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Peter Godfrey/iszumi ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9mno.)m The.&r()Rr)name and Innn arc rcnictcrcrl mnrirc of A(OPn I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV 600 Washington Street Boston,MA 02111 . www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiorvindividual): X�V/05,'q —twe:- . Address: •tel✓t=,i �l 'C r �J '' Gity/State/Zip(2k46A 49. ®lr Phone#: Zff'--S. Are yo n employer?Check the appropriate_bos:- Type ofpr ' squired): 1. I am a employer with Z 4. ❑ I am a general 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• Q Remodeling ship-and-have no--employees These-sub-contractors-have 8, C]-Demolition working for me in any capacity. ' workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13,0 Others fir•, 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. . Insurance Company.Name: 1 aW ,'r Policy#or Self-ins.Lic.#:,7 Ldeo Expiration Date:_ '�;_/YT Job Site Address: Z9447?4l,'� City/State/Zip: > > G 74 ' Z' X 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 hereby certify under the pre' enahiT of perjury that the information provided above is true-and-correct Si afore Date: Phone#: I?7�' � - G z--� Official use only. Do not write in this area,to be completed by city or town offieiaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service 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 toconstructbuildings 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 commonwealth 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-pr-esented-to-the-contracting=authority." AnMcants- 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 permit 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 Department 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current 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 (i.e.a dog license or permit to bum 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 Investtgatlons 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia