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HomeMy WebLinkAboutBuilding Permit #980-16 - 71 REGENCY PLACE 5/1/2018 TOWN OF NORTH ANDOVER ° Ani . APPLICATION FOR PLAN EXAMINATION Permit NO: O ' Date Received 74�°AwT[O['pP` Date Issued: 9SSgcHus�� IMPORTANT: Applicant must com Tete all items on this a e 077, LOCATION " #, Print PROPERTY bWNEI MAP NO: ,PARCEL ZONING DIS41 TRICT Historic pistrict yes. no 6 a'i " w Machin #fop 1lillage; yes nti 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 Pr 0 Septic ❑Well b Floodpta n Wetlands V1latershed District z o Water/Sewer, t 00 esrPol Identification Please Type or Print Clearly) OWNER: Name: Phone: q7%- 771 -5601 Address: CONTRACTOR Name: C ~� 3y :. G : k Address: rbc ' Supervisor's Construction License `" Exp Bate: . w v t,— Home Improvement'License' , . Ex-p. Date. m ARCHITECT/EN (NEER P•�+ P�, Phone: Address: I2. S�e( Reg. No. 12.5-38 , FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST,BASED ON$125.00 PER S.F. gr Total Project Cost: $ `�1 FEE: $ Check No.: Receipt No.: O NOTE: Persons contracts it unregistered contract s do not have access to the guaranty fund 6ignature of Agent%Owne` "vSigraature 4fi cotrac€crr A 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 PLANNING & DEVELOPMENT Reviewed On 3-Z,"�lP Signature_ 4M �qk COMMENTS W.DEQ PJ()W v,S rvri- -- M-r 7 - /lbws s Q,CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 6onservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPAR�TMENT�4' TemptDumpster,'onisite ,yes�},��� no}'' F Located^et 12AjMinESt�eet .r S�teY.ry, j,..,a r-....r ?♦ tt:' 4 ;( * , N: ' + `� r ,r FirejDepartt ent�signatupq date. :t F,. •�r.�uti_ L � ,*'- � t �q ,Si �;•, ..........� COMMENTS. I 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 s approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department ease) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 4. Copy of Contract 4� Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products ire sign off from Fire prior to issuance of Bldg Permit Department OTE: All dumpster permits requ g p 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Location i No. lL. / Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# // 17 J Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 57/590,G.00 m $ - $ 684.00 Plumbing Fee $ 85.50 Gas Fee 100 comm. .$, 100100;, Electrical Fee $ 85.50 Total fees collected $ 955.00 71 Regency Place 980-2016 on 3/17/2016 Inground Pool and Spa t10RTIy Town of O - 0 No. 261 C h ver, Mass, ` 1114 Coc"ICM!-Wl[.f x.95 RAn0 U BOARD Of HEALTH Food/Kitchen PERMff T LD Septic System THIS CERTIFIES THAT ern ...... .... BUILDING INSPECTOR Ic has permission to erect .......................... buildings on ...2Z.1 .�!y� , .�G....................................... Foundation Rough to be occupied as ..............f�`.��..1.4. ::Y ..... .� Y.�..F... ....... ....................................................... Chimney provided that the person acceptirfg this permit st all 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 CONSTRUCTIO S ARTS 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. TOWN OF NORTH ANDOVER OFFICE OF s BUILDING DEPARTMENT 1600 Osgood Street,Building 20, Suite 2035 +1 North Andover, Massachusetts 01845 Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUDINO PERMIT APPLICATION Please print DATE: JOB LOCATION: Number treet A r s Map/Lot HOMEOWNERL_jAJPj) -ZC �-- 7!/ S ICJ Name 116ine Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner occupied dwellings of one or two family dwellings and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one-or two-family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.(780 CMR Section I IO.R5.1.2) The undersigned"homeowner"assumes responsibility for compliance with State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she un efstands the Town of North Andover Building Department minimum inspection procedures and require ents n t at he/she will comply with said procedures an requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 8.2015 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Gn q I eon YM.� ?4Q`% Address: Rmynte L City/State/Zip:( k,4 In1eQ; )1d 01 pz l Phone #: C17 Y- ZZ 0 Are ou an employer?Check thea propriate box: Type of project(required): SA 4. ❑ I am a general contractor and I I I am a employer with R6. New construction 0 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 required.] officers have exercised their 10.❑Electrical repairs or additions 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.n Roof repairs insurance required.] t employees. [No workers' 13. Other �I KA comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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. �A i Insurance Company Name: �r /�lS /All U(=AV L9 Policy#or Self-ins.Lic.#: S�U3&D-T2.I V'Z_.- Expiration Date: Job Site Address: City/State/Zip: ?'s" 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 pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 7_&,#h& Phone#: - ( Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: C 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 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 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 have been 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 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 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 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 5-26-OS w,mass.gov/dia DATE(MMIDDlYYYY) ACCO CERTIFICATE OF LIABILITY INSURANCE 1 10/1/2015 RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)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). CONTACT PRODUCER NAME: Service Team PHONE (602)635-4848 FAX .(480)991-0634 AIMS Insurance Program Managers, Inc. AIL EMAIL s 1418 N Scottsdale Rd ADDRESS: erviceteam@simsinsurance.com Suite 100 INSURER(,AFFORDING COVERAGE NAIC B Scottsdale AZ 85257 INSURER A:Hart ford Accident and Indemnity 22357 INSURED INSURER B•Twin City Fire Insurance Company29459 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. ITR A L S POLICY EFF POLICY EXP LIMBS TYPE OF INSURANCE POLICY NUMBER M IYY /D Y X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A GE O RENTE6-- 300,000 A CLAIMS-MADE Xj OCCUR PREMISES_(Ea occurrence) S 5/14/2015 5/14/2016 MED EXP(Anyone person) $ 5,000 59tTENOJ2180 - -" PERSONAL&ADV INJURY $ 1,000"000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OPAGO $ 2.000,000 IN X POLICY❑ PRO - Loo $ I OTHER: COMBINED SIN LE LIMIT $ AUTOMOBILE LIABILITY Ea age;ident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS I PROPERTY DAMAGE $ NON-OWNED Per accident HIRED AUTOS _I AUTOS $ UMBRELLA UAB 1I OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE $ $ DED RETENTION WORKERS COMPENSATION X PER ERH AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 11000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE L J NIA OFFICERIMEMBER EXCLUDED? 59NEOJ2282 S 5/14/2015 5/14/2016 E,L.DISEASE-EA EMPLOYEE $ 1 000 000 B (Mandatory in NH) I "— �- If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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 (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Kimberly Birk/KAT �� - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ® DATE(MMIDD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 5/12/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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 NAME; Service Team AIMS Insurance Program Managers, Inc. PHONE (602)635-4848 1 FAX NC.No;(460)991-0634 1418 N Scottsdale Rd EMAIL serviceteam@aimsinsurance.com ADDRESS: Shite 100 INSURERS AFFORDING COVERAGE NAIC# Scottsdale AZ 85257 INSURERA:Hartford Accident and Indemnity 22357 INSURED INSURERS:Twin City Fire Insurance Company 29459 Environmental Pools, Inc. INSURERO: 184R Riverneck Road INSURER D: INSURER E: Chelmsford MA 01824 1 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. ILTR TYPE OF INADOL SURANCE B POLICY EFF POLICY EXP POLICY NUMBER M MM/DD LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR PREM SES Ea occu ence $ 300,000 59UENOJ2180 5/14/2015 5/14/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY[::]PRO- JECT RaJECT LOC PRODUCTS-COMP/0P AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION , X I STATUTE I I ERH AND EMPLOYERS'LIABILITY Y ANY PROPRIETORIPARTNERIEXECUTIVE ❑NIA A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MB (Mandatory In ER H)EXCLUDED? 59WEOJ2182 5/14/2015 5/14/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEO$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It 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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 6 Kimberly Birk/KAT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25_(20141/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Vhe�po�rnmanrvercl�o�G?�er�ccaelli ' - SMSMEM Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: .< 107083 Type: Expiration: Private Corporati; ENVIRONMENTAL POOL$INC. Andrew Everleigh 184R Riverneck Road g -y � Chelmsford,MA 01824 Undersecret ry r i _Aga— 6,31•E / __� 196 ` \ \"0�\ X92\ 340.01''—,g4 ---- --- td (190 Fence to have self-closing,self4atching gates to 188 / meet all state and local building codes. / Proposed Spa / / a,/ \\ \\ Proposed Pool t �\ 28' 23'x40' �C, BARN F r 0 186--------- I .y T.F.-187.0 K SFy (177.0) 23' j Fir �s, LOT ' x(186.3) \ \ 5 06 S.F. 6 Acres �`� ------ ----- BENCH MARK �\ _ (CBA=1009) PROPOSED _,e2 MAG NAIL IN 24" MAPLE DRIVE ELEV.=179.93 (NAVD 88) Qa— \ 05�0�1�1� \ /-176 y _ PROP. RET. WALL / TOP_WALL=184.0 .JGyp� •! // coo ;14 EROSION CONTROL BARRIER 174 7!Y (178) / / / LEGEND: EXISTING CONTOUR PROPOSED CONTOUR \� '72 \ \ U�2 — / x \ — � / (177.0) PROPOSED SPOT GRADE •.•......... PROPOSED HAY BALES 100' WETLAND BUFFER \� 76g) SITE PLAN \ REGENCY PLACE NORTH ANDOVER, MASS. PREPARED FOR: CHERRY PROPERTIES, LLC DATE: APRIL 2, 2015 SCALE: 1"=20' consultants inc. Dennis A. Gnecci 1 East River Place Peter D. Goodwin \� Reg. Prof. Engineer Methuen, Mass. 01844 Reg. Prof. Land Surveyor 0 20 40 60 80 Ft. \\TSCUENT\P\14\14-12\DWG\LOT 7.DWG 1 0 5 10 20 Meter Environmental Environmental Pools Inc. °`` _, "`�houzz} j!�houzz} Pools,Inc. 184 R Riverneck Road,Chelmsford MA 01824 an Aquatech builder Phone: (978)256-0200 Fax: (978)256-6620 www.envirorLmentalpools.com info@environmentalpools.com ®Top 50 Builder Name(Buyer): ---,e�r Mail Address:_ 1 Q Job Address: City:-)ILL State: 16 Zip Code: 019115" Residence Phone: r� Cit. State: , , Zip Code: Cell Phone: c�7 g -7•% 1 _ 8� Email: 4 Wt,_ •1nI n a"/J a�rx n:l �,..;� Environmental Pools,Inc(hereinafter"E.P.I"agrees with the buyer or buyers above(hereinafter"Buyer")to construct a swimming ✓a good and workmanlike manner in accordance with the following terms and specifications g pool/or spa in Width: Z 3 Length: 40 Shape: + Depth: 3-•01 Pre Excavation and Excavation 1. Generic structural engineered plans for pool structure Hydro Therauv Sna Incl. 49. Attached: 7�- Separate: 2+t 2. As built plan and additional engineered plans if required BuyerLight: p A Beam Size: 3. Pool layout plan Y 50. Light. :r^Jr k),,^t t Wµ ��, Blower: 4 K Incl. 51. Hydrotherapy jets: (y1 Mircossage jets: 4. Layout pool and set elevation for buyer's approval Incl. 5. Perform normal excavation(See line 5 on back of contract) Incl 52. Raised height. ltqN Spillway Size: IroO 6. Access wall or fence:Removed b 53. Veneer material. (37 o Aiq s - /1Q- Y By << Replaced by: ;r 54. Additional specifications: 7. Trees in access and working area to be cut down so that stumps do not exceed 2'in height Design Features Buyer 55. Custom W 8. Remove from site loads of trees,shrubs,stumps, Size: asphalt,concrete and other debris 56. Water Fea::�: n Dumpsters 9. Hand form and shape pool 12" 1811 --.. 10. Removal or relocation of cesspool,drainage systems,septic tanks, Incl 57. Raised Beam: 6" Tile/Stone Veneer: leach fields,sewers,pipes,utilities(overhead or underground) Buyer 58. Start u Start Un/Accessories 11. Water Condition: $ p pool system after interior finish Incl. (Cr 75 20 tons of 1.5" Stone NGL 59. Follow up instructions 12. Additional Stone: $ „7� per IN-U. Buyer 60. 8 gallons of acid,50 lbs.calcium,50 lbs.of total"a", Steel and Gunite Incl 13. Steel reinforcin 1 gallon of stain and scale,6 lbs of shock, g per engineered plans Incl. 30-3"chlorine pucks 14. Engineered gunite structure to meet local or state codes Incl. Additional Suecs 15. Watercure gunite shell twice daily for seven days Buyer 16. Install continuos bond beam around skimmer Y 61. �'f!`/S t� F x CAV pert ewe iM r i.,,Q+� o 17. Shallow end steps with: bench Incl 62.- O de W DR.L �'+ Incl. 63.-C, i3 OTN-- AS 18. Tanning shelf n l w 6K' BY O1•r„/F�� 19. Deep end swlliiout or loveseat: �' f rJ length Incl. 65.y r lJp �P - �iydraulicsandCrculationS - 1, Im.TU LA11 20. Provide ( 5�. wall returns with directional eyeballs Incl. IN o ` O 0 a 21. Provide 3) eyeballs-Inc- 22. _ 67. lower returns with directional eyeballs Incl 22. Floor system.Type. Gradin,E 23 r1 Leaf Vac: 68. Eight(8)hours of backfilling . Stub plumbing for future robotic cleaner Incl. 24. Skimmer(s)with weir gate and basket incl. 69. Sub base material Buyer -TWO Z Incl. 25. Mara drain. aSales Tax.Insurance and Permission Type: ��^„Nht-c- g Quantity: C2 Incl 70. Payment of all sales tax on 26. Vaccumpool components and accessories Incl. m fitting m skmuner 27. Up to 50'of plumbing between filter and skimmer Incl. 71. Motor vehicle,workers'comp and general liabili Incl. h'insurance Incl. 72. Buyer agrees to allow Environmental Pool Inc. Additional pipe @$7.00 linear ft. to take photographs of project to be used for marketing28. Backwash/Dump Line 29. Pre cast slab for equipment Incl. Mechanical Eauioment Incl. Pa went 30. Pump: Type: XyMX"VL& X c Size. Vpt tq�uS Incl The Buyer agrees to pay E.P.I the following contract amount for E.P.I's 31...Pump: Type: Z�•fta�'t�P 0 y t Size: U p. t� performance of its obligations under this agreement 32. >~ilter. Type: Cc.�13 CU4(L_ Size: Contract:!5� 33. Heater. Type: j�{g51,E� ,��P Size: ZO Incl , Op0.00 30%Day of Excavation: 34. Nat/Pro. Y00 boo Deposit: $ _���O.e m 40%Day of Gunite: •y0 n o; In/Out: oR'S% Oz Fuel Connections,heater venting,fuel storage tanks,permit Buyer Bance s SZ. �•�� 25%Day of Tile: 0 13 oo 0 35. Heater: Type: Y 5%Day of Interior Finish: s 6OA, ✓\1 Os Size: n �� « 36. Automatic Cleaner. ?ti`A, q 1, 5.14M S P a ZT TOS' S 2 o oa 37. Cleaner Pump: Type: Pe1q,Oi Size: 38. Sanitation: Type: C H Terms and Conditions 39. Incl. The buyer understands that Sanitation II: Type: ^�AIn'signing this agreement,he or she enters into a contract with E.P.I and the Incl buyer concerning EP-rs construction of a swimming pool.Meeting the specifications contained in this Electrical agreement,any changes in any of the terms or specifications of the agreement must be made in writing and signed by both E.P.1 and the Buyer,and no verbal changes in these terms and specficifications are 40. Electrical bonding and wiring up to 75'from service panelpermitted. Pool over 75'@$15 per foot GL As part of it's obligations under this contract E.P.I is providing the buyer written guarantees regarding Buyer the swimming pool which it will construct pursuant to this agreeement,these guarentees are contained Heat pump over 75'@$18 per foot Buyer in a sperarate document which is provided to the buyer. 41. Install underwater pool light:Type= L ,W( Quantity: 2 The buyer has the right to cancel this agreement greement at any time before midnight of the third business day 42. Tlmeclock: after the date on which either the buyer or E.P.I has signed this form by giving written notice of n'a cancellation to E.P.I 43. Automation system. P �rsyt1 a 4/L iN � �'U#3![-m*tO The back of i tra contains important terms and conditions.The re part of this agreement s�STG'll1•l 44. Handheld controller: I ac ledge that agreement is a legally binding ct,subject to the above cancellation Cr�y�,` Screen logic: in pro isions and I cc t ha read and a all terms and conditions of this agreement 45. Intellichem system: Q Tile and Interior Finish S r, / 46. Install 6"band of frost proof tile: 0�7 47. Pool interior f6 inish: �cl uy r a e Date W h i� �A ra Incl. 48. Filling of pool promptly after interior finish Z7 OOo w Z L y 0 4jW Environmental Poo Dat Environmental Etivu'onmenlal P ��; 7anools,Inc. �� ��• �q houzz I I f1 houzz j Aquaj builder 184 R Riverneck Road,Chelmsford MA 01824 ~f Phone: (978)256-0200 Fax: (978)256-6620 www.environmentalpools.com info@environmentalpools.com Top 50 Builder Name(Buyer): --�� ®NM- --- Mail Address: Job Address: >\ Cit': State: City: ti A Zip Code: 019 Residence Phone: Cell Phone: State: J. Zip Code: �, -�7$_ �.� 1_ 5.8 / Email: q - Environmental Pools,Inc(hereinafter"E.P.I"agrees with the buyer or buyers Y yers above(hereinafter"Buyer")to construct a swimming pool/or spa in a good and workmanlike manner in accordance with the following terms and specifications Width: 2 31 e Len th ' g y 0 Shape: Depth: �j^ �I to �• �: Pre Excavation and Excavation 1. Generic structural engineered plans for pool structure Hydro Therapy Spa 2. As built plan and additional engineered plans if required Buyer 49. Attached: ']�� " Separate: Z,t Light: � Beam Size: 3. Pool layout plan Y 50. Li t: XAi-4 `l Blower: 4 NP 4. Layout pool andset elevation for buyer's approval Incl. 51. Hydrotherapylets. Incl. (y) Mlrcossage bets: (2,� 5. Perforin normal excavation(See line 5 on back of contract) Incl 52' Kais�height. l,ay Sptllway Size: 6. Access wall or fence:Removed b 53. Veneer material, tad Y gv << Replaced by: &y4c- 54. Additional 7. Trees in access and working area to be cut down so that stumps specifications: do not exceed 2'in height D � estQn Features 8. Remove from site Buyer 55. Custom W=- , : loads of trees,shrubs,stumps, h Size: asphalt,concrete and other debris 56. Water Fea 9. Hand form and shapeDurnpsters: 57. Raised Beam: 6" 12" Pool Incl. -' 18" _.• 10. Removal or relocation of cesspool,drainage systems,septic tanks, Tile/Stone Veneer: leach fields,sewers,pipes,utilities(overhead or underground) Buyer Start Un/Accessories 11. Water Condition: $ Y 58. Start u of s �� P Po stem �0 75 20 tons of 1.5 St system after interior finish Stone 12. NinstructionsIncl. Additional Stone: � 59. Follow u $ S' per load Buyer 60. 8 allots o50 lbs.calcium,SO lbs.of total"a", Incl. Steel and Gun_ite g Incl 13. Steel reinforcing per engineered plans I gallon of stain and scale,6 lbs of shock, 14. EngineeredIncl• 30-3"chlorine pucks gunite structure to meet local or state codes 15. Watercure gunite shell twice daily for seven days Incl. Additional Specs 16. Install continuos bond beam around skimmer Buyer 61._�aa0 S 17. Shallow end steps with: Incl. bench 62. ;M03 Lg W0 R� 18. Tanning shelf: Incl. 63+n �A . M 14� 19. Deep end swnnout or loveseat. 64. ~FA� 5' length Incl. HYdr lies an 65' 1►1 ATO.! ani A G7 t`i.+. a� d Clrc�.lA*t.. a t�� ..�LLld N►�ols'1' C3 to 0�1 29. Provide wall returns with directional eyeballs �� IrT 21. Provide Incl. 67. u ` V a lower returns with directional eyeballs Incl. 22. Floor system:Type: e% Leaf Vac: Grading 23. Stub plumbing for future robotic cleaner 68. Eight(8)hours of backfilling 24. Skimmer(s)with weir gate and basket Hyl' 69. Sub base material Incl. 25. Main drain: Type; C X01 Buyer PIM�S Quant Sales Tax-,rnsnr nce and Permission26. Vaccumm fitting m samer Incl. 70. Payment of all sales tax on pool components and accessories Incl. 27. Up to 50'of plumbing between filter and skimmer Incl. 71. Motor vehicle,workers'comp and general liability Incl. 72. Buyer insurance Incl. Additional pipe @$7.00 linear ft. Y agrees to allow Environmental Pool Inc. 28. Backwash/Dump Line Incl. to take photographs of project to be used for marketing 29. Pre cast slab for equipment Incl. Pa went Mechanical Eauinment 30. Pump: Type: �11�tCFi&.�� X F Size:31. Pump TypeZA1 Tta, t.. y •lPrlS S Incl The Buyer agrees to pay E.P.I the following contract amount for E.P.1's 32. Filter Type 1= Size' V PtC performance of its obligations under this agreement L � v y C���,,,, Size• 33. Heater Type: HA2 yo Incl. Contract: 57,Oto.Oo 30%Day of Excavation: "'Elt-[�.;P Slze• Ya dy > Deposit: ffi I5. pC o 0 34. Nat/Pro In/Out: {',inn••0 40%Day of Gunite: •2, Fuel Connections,heater venting, off, Balance • Z ��'°� .23%Day of Tile: I;S .00 fuel storage tanks,permit Buyer 35. Heater: Type: 5%Day of Interior Finish: O� Size: h 36. Automatic Cleaner: Total: 37. Cleaner P "�'' Type. Ps�Ar»�s Slze: 38. Sanitation; Type: Terms and Conditions 39. Sanitation II: Incl. "rhe buyer understands that Type: by signing this agreement he or she enters into a contact with E.P.1 and the ~ Incl. buyer concerning E.P.rs construction of a swimming pool.Meetingthe specifications Elea cal agreement,any changes in any of the terms ors nmutb made in ri this aW signed by both E.P.1 and the Buyer,and no verbal coons of the agreement must a made in writing 40. Electrical bonding and wiring up to 75'from service panel changes m these terms and speclicifications are N c e... Permitted. Pool over 75'@$15 per foot As pan of its obligations under this contract EP-1 is Buyer the swimming providing the buyer written guarantees regarding Heat pump over 75' 8 Pool which it will construct pursuant to this agreement,these guarantees are contained @$18 per foot Buyer in a speramte document which is provided to the buyer. 41. Install underwater pool light:Types 1 t L •43 Quantity; Z The buyer hes the right to cancel this agreement at a�time before midnight of the third business day 42. Timeeloek: n l after the date on which either the buyer or E.P.I has signed this form b vin written notice of 43. Automation system. cancellation to E.P.I y 8 Sks� iJ UL The back of tre contains important terms and=S�bject part of this agreement 44. Handheld controller: I as ledge that agreement is a legally bindinge above cancellation Lti Screen logic: h P ions and I ee t ha read and a all temrs and conditions of this a 45. Intellichem system: agreement Tile and InteriorFinish 46. Install 6"band of frost proof tile: 47. Pool interior finish: h Incl' u e �At'aIncl. Date 48. Filling of pool promptly after interior finish V 00 d w C' Z L y O Ow En ental Poo Da ALL StMACE WATER SHALL F8t STATE COM CODE DRNN AWAY FROM FOOL f d-AS 1111RS W BC>l11D BEAM BEV 0'0 LKRIT NICE TGPOFBOND BEAM P� BEY f 0' 2 &r Oft WAM FR(W • MAX VERT.PVALL r , RAM EFORE POOL A Twely oN pcW1 MN 6 ED BARS®t•O.G BOTM WAYS BiY Y 0' SAf LEDGE Ilc �` DIMK'(CARD NATMAL M. BEV 3'0• REQ ON 'L GO!!� g RGPAXJND M OIFALT 4'Vi�E S'ANGLE MRS BEV�1'0• q . � OI ASNOT® BEVS'O' MAIN DRAW NYDRMADC: CONNECT DMU=Tn RR! RELY VALVE 311 ALTERNATE RBIDevrw.a C MEILC AL �, B>EV T d' P� CLM VVITM KOM BLY T!• Bblfr 0"' y.a-�t 6•f►ft�t rrn . .F1+OORR� wtse . fr*C WM WAUTW STANDARD WAU SEC nM sIR dIRS @'ECS P -- WX • d •; n vironme, „ SL S 4fAt�3awrtdaos d✓ler:srt tarts a�lora/ •s t •re :,0 • :e: 'o . • 8•f'lfl+f ,,�'"' "210Mda+er SNet Uuit2�W�tar�,1SA 01ED POOLS, • Q i ' ''' an Aquatech builder • •6 f f '• .•': CONSTRUCTION NOTES •o' •: • • •r a• aGENERAL REINFORgNG STEEL, e mour CONRUXI '' ' •.4 • • .eut MR ATOAraCrrYDewiTMrroF WARM s1�+oRaNcstm.s�ttaa�aw rowsTMats�cnnn A.ls S1WiWAM MMaTMWDVJ*7 RSfA �• 1!'1Ni�lES111CB000<At • /BOO coNa1WC110N9lllftl�TAl idlMlsTMIDMOi OOA°M�ORiY t AN M fOltll�6, M•tSSRO{SHbb9Y!lAM�OOlf d' GROOM CRAMP :•. � MEIIL7M Off:A1�1lOYAt�{A!N FOA ALL COMEStC7AL T1�E "�'OM M SUMAM a ?am GUNITE COMSTRt,mTom R•11RQARS(E1N) D_ • SMNSiMLWAK4CW*mmAPOAM=NMMTr_#LLV • 'tf�'iOMMUCONDWTOWMCOVELMDUPONA M MNLEOI�EMRrm �l�f�Of=AWAMWFARTi&A UNDER WATEIR LOGH'P •••0,A p, a�U' 1EAlD1f1WrM a b{L42 urs !RAOMMalMS0Sa DAYS 2/W0FT0PCFldMK4X ANVOW97 MWILLAIMRWA6Cff*WAATW92MNorVoCWI 1*2eNSFM VWXCFCDIW RATE& UNRealrARYMALANDagum • CLMGLW BrAU MrWATMSMAYTMMnMaADAypM o • FUME •,. SEWN DAYI " c ?OL FENCE To ILO, caosTtwv&o o IN /F�tiDJtN�t. U),T*' OR BARS s•O.C. o ewA<or�rrAtroaA acsEaues � A Ap P •.� of.. ° o, o, BOTH WAV5 a OEMCwc IN COQ ware LCM Crrr CR TCVM oADA�rANce A%• F : •e . o• .•� RRO VALVE ♦ ;too �i PREPARED By �• AFAM" COLLECTION •01 FAM A Raj tH OF TUBE(P REQD) SMUMPAL 00 Is 3LBOf AD PAUL A •tom ti h � r r � 0 o CFBI'lMOdt4!!A 01#24lL H.I 0STRWRM Nm 425M C RL.$POUT. Ii:APPLICI9®LE DAAVVM SCAIS:NTS i � l N812 31»E -_x 340.01' x x pROPOSED ENC o 0 J + \ LOT 7 82' \ PROPOSED 3 POOL \ \ + 549506 S.F. 23•X40 BARN \ \ �0.o UNDER \ \ Osteo ONSTRUC-np v' + �F,y 23.2. � F h CP ti \ \ \0 \ R�3 \ R,60.0 0' - \ � c F F PLAN SH❑WING PROPOSED POOL 71 REGENCY PLACE 1H OFMgss'�y wi ANDOVER, MASS, ;,w� SA MacLEODv, Prepared for +andover pgo82964429644 Q CHERRY PROPERTIES, LLC consultants inc. P.\'4\14-12\DwG\P00L7.DwG SCALE: 1"=40' DATE: 2-29-16 1 .East River Place, Methuen, Mass. Ng12 31"E -_x 340.01' x \ ENCE o PROPOSEDoJ \ LOT 7 82, x \ PROPOSED 3 POOL \ \ + 10 54,506 S.F. Ok 23'x40' BARN \ \ 00 UNDER \ SFO ONS7RUC710 v0� \ + �Fti 1 23.2. \ O4)"R F \ \ 9sF Vis- \ \ R�60.0 0' — \ \ O F F PLAN SHOWING PROPOSED POOL 71 REGENCY PLACE o����,�tt�OFMgs��ry WILLIAM G. ANDOVER, MASS, S. MacLEOD H Prepared for A\andover829644 p929644CHERRY PROPERTIES, LLC consultants 'ND SURN1 inc. P:\,4\,4-,2\Dwc\1P00L7.Dwc SCALE: 1"=40' DATE: 2-29-16 1 .East River Place, Methuen, Mass. Ng1.2 31„E x�— x 340.01' xFENCE) CD PROPOSED o 0 \ \ LOT 7 82' x \ PROPOSED 3 POOL r. \ \ 14� 549506 S.F. � 23'X40' BARN \ \ 0000 UNDER 0)\ SFO ONSIRUC770 �O \ � F •��. 23.2. CO9 5 co N \ 9s� 00 tiA \ 'o \ \ \ Rog0.00' - \ �O v PLAN SH❑WING PROPOSED P❑❑L `�N OF�;�ss 71 REGENCY PLACE o�y' icy ANDOVER, MASS, ;o� wl SIAM MacLEOD v N29644 Prepared for /J�.andover p�ofESS,oNP� CHERRY PR❑PERTIES, LLC consultants �qND suaV�vOQ in c. P:\1+\14-12\PWG\1PDOL7.Dwc SCALE: 1”=40' DATE: 2-29-16 1 ,East River Place, Methuen, Mass. it i N81.2 31»E ix 340.01' x \ x x PRC FENC� C 0 J \ \ LOT 7 82. S PROPOSED x 3 \ P POOL :— \ \ + $ 54,506 S.F. 23'X40' BARN \ \ 00Ao UNDER \ d) CNSIRUCTjO Vp) \ + \ �� pF 0�. 23.2. + 9 \ \ + 5 co N F 03 9S tiA \ 'o \ \ \ �1400.00' - \ �O \ gyp• v C' PLAN SH❑WING PROPOSED POOL � _jN oFMgs • 71 REGENCY PLACE ANDOVER, MASS, ;c� WILLIAM MacLEOD v Prepared for +andover jOq�82964429644 Q CHERRY PROPERTIES, LLC consultants `qNB SUTN 'O inc. P:\14\14-12\0Wr3\1P00L7•DWr3 SCALE: 1"=40' DATE: 2-29-16 1 East River Place, Methuen, Mass. N81.2 31"E i 340.01' x rn r-x-- ' PROPOSED FENCE o 0 J + \ LOT 7 82' " \ PROPOSED 3 POOL \ \ + 10 543,506 S.F. 23'x40' BARN \ \ 00 UNDER 't \ \ Os1O ONSTRUC-no + 23.2 \ \ 1ry6 zix 5 co clq Vis- \ \ \ R,,g0.O0' — \ h0 v PLAN SH❑WING PROPOSED POOL 71 REGENCY PLACE �,L�H OF o� 'cy WILLIAM ANDOVER, MASS, o S. ca MacLEOD v #29644 Prepared for andover ESSION�� CHERRY PROPERTIES, LLC con su I tants "qNo SUR\j in c. P:\14\,4-,2\DWG\P00L7.DWG SCALE: 1"=40' DATE: 2-29-16 1 East River Place, Methuen, Mass.