HomeMy WebLinkAboutBuilding Permit #804-14 - 72 SUGARCANE LANE 5/8/2014L
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Ji Date Received 3 �2-0
Date Issued:
PORTANT: plicant must com 1
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EMAP NOU��FARCEL� = ZONING D SsTRICT
ete all items on this page
100 Year OlddStructure yesF
HistoricDastrict yes,
�._Wachine Shop Village
TYPE OF IMPROVEMENT
PROPOSED USE
Non- Residential
Residential
❑ New Building
❑ One family-
❑Industrial
❑ Addition
[i Two or more family
❑Commercial
E! Alteration
No. of units:
11 Others:
El Repair, replacement
ElAssessory Bldg
❑ Demolition
`Well
❑ Other
❑�Floodplaii �>:1Netlands
=
❑ 1N_atershedcJ istnct>
e tick r s
VtVate Sewers
_
nG WnRK TO RE PERFORMED.
Please Type or Print Clearly)
OWNER: Naq),e:
ARCHITECT/ENGINEER
77/ 72-�
Address: 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: $ 2-t� � r ! FEE: $`5/ 15 2„
Check No.: i 7 t 7 Receipt No.: 2-1 59A -
NOTE: Persons contracting with unregistered contractors do not have accessp the guaranty fund
Plans Submitted Plans Waived ❑ Certified Plot Plan N Stamped Plans ❑
- Plans Submitted' PlansWaived-E]
.-Certified Plot Plan Stamped Plans f�
TWE '
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`
COMMENTS
CONSERVATION Reviewed
COMMENTS
HEALTH
Reviewed
_ ,DATE REJECTED
.❑
DATE: APPROVED
P 4? Cz
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COMMENTS P, 901 2/O fl
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comme
Conservation Decision: Comments
Water & Sewer ConnectionlSignature Date Driveway Permit
eDPW Tovvas Engineer: Signature:
Located 384 Oso treet
FIRE DEPAhtM,r . Temp Dumpster on site yes no
Located at 6124Mair'Street n 4 `� ,.;
Ftre Departme►rt,signatureldate ,
.-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.Z®NE LITERATURE: Yes No
MGL -Chapter -166 Section 21A -F and G min.$100-$1000 fine
NOTES and DATA — (For deaartment use) 0.0 P
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4 if'
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112
El Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The fol'wang is'a list of the required.forms to be filled out for the appropriate. permit to' be obtained.
Roofir?g, Siding, Interior Rehabilitation Permits
❑ Btailding Permit Application
Li 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 w
❑ 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) _
o Building Permit Application _v "
o ,_"Certified Proposed Plot Plan _
L3 Photo of H.I.C. And- C:S.L. Licenses
❑. Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of'Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc -Buil, -ling Permit Revised 2012 .
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Location t t`+�I�N•
No. CSL 1 Date
1
Check #
i
27554
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ c553 • (�
Foundation Permit Fee $
Other Permit Fee $
TOTAL4,17$
1
t Building Inspector
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 42,000.00
m
$ -
$
504.00
Plumbing Fee
$
63.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
63.00
Total fees collected
$
730.00
72 Sugarcane Drive
804-14 on 5/8/2014
Inground Pool
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ASSESSOR INFORMATION:
MAP 106A LOT 239
OWNER INFORMATION:
JOHN & JODI CURTIN
72 SUGARCANE LANE
NORTH ANDOVER, MA 01845
DEED REFERENCE.
BOOK: 8406 PAGE: 317
ZONING INFORMATION:
ZONING DISTRICT. R1
S65 °15'09„
15 97, f
S28
18'1
35
N265 50 „ f
192 41,
100' BVW BUFFER ZONE LINE —�
TAKEN FROM PLAN BY
NEW ENGLAND ENGINEERING SERVICES, INC
DATED JUNE 7, 2004.
ELECTRIC
EASEMENT
W
O
C)
1�O
0
Existing
Leaching
Chambers
LULUS MAF':
SCALE. 1"=120'+I— VJGA AiNE LANE
PROP. 4' HIGH FENCING
TO SECURE POOL AREA
;S,
8 5
s '5
8.04 ,
Note: No Work to take
place within the 100
foot BVW Buffer Zone. /
0
LOT AREA
43,957 S.F.t
N 17°09'42"E
150.00'
SUGARCANE
I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED BY AN
INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN.
LANE
PROP. INGROUND POOL
�9
4
PLOT PLAN OF LAND
#72 SUGARCANE LANE
NORTH ANDOVER, MA
PREPARED BY:
SULLIVAN ENGINEERING GROUP, LLC
22 MOUNT VERNON ROAD
BOXFORD, MA 01921
(978) 352- 7871
DATE: 3/25114 SCALE: 1 "-30'
TIT' Comm*onwea-lth of Ma'sachusetts
Department. of Indusirial ccidents
Office of investigations'
. ---
Congress-S4reet, Suite 100
�-2X 7
�3oston, .lid D2Z:�4� 0.. - -
September 5, 2012 .
Creative Edge Pools and Spa, Inc. .
54 McDonald Road
Wilmington, MA 01887
Notice of Decision Regarding
Affidavit of Exemption for Certain Corporate O Tiicers or Directors
Pursuant to the provisions of MGL 152, Sect ion- .1 as the amended by Ch..169 of the
Acts of 2002 your affidavit has been reviewed and the Office of Investigations has
determined the following:
NOTE: It is. your obligation to submit an approved affidavit to your insurance carrier in
order to complete this process.
X The affidavit was approved on 9/05/2012, Attached.please find your approved
affidavit:
The affidavit was rejected on. .
Your affidavit was rejected for the following.reason(s):
Related SWO Case ID#:
Affidayit ID #: 165608
T .ORM 153 The Commonwealth of Massachusetts DIA Use Only
Department of Industrial Accidents
Office of of investigations - Dept. 153
i 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
h //www.mass. ov/dia '
HP� g InvestiSWOiIID #:
r AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE . A
OFFICERS OR DIRECTORS
Chapter 169 of the Acts of 2002 amended M. G.L. c. 152, §1(4) by adding the following paragraph: _
"This chapter shall be eledtive for an officer or director of a corporation who owns at least 25 percent of
the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall
apply only if the corporate officer provides the commissioner of industrial accidents with a written
waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the
purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set
forth in section 25C."
Pursuant to M.G.L. c. 152, §1(4) as amended, I/We the undersigned officers of-
,reaj�v
Ed o fl .nd ,�� c 5qme8QnddRd
(Name of Corporation and Address) VV r'r-1r�-
each holding at least 25% of the issued and outstanding stock in said corporation, do hereby invoke the
right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a
workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the
undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 fol
any injuries that may be sustained while in the employ of the above-named corporation.
Further, Uwe the undersigned do understand that, should the above-named corporation hire or have in
its employ any employee(s) in addition to the undersigned corporate officer(s) or director(s), said
corporation is required to obtain workers' compensation coverage for the employee(s) as prescribed by
M.G.L. c. 152, §25A.
I/We the undersigned have read and understand the statements and obligations as delineated above and
Uwe have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or
not to be exempt from the provisions of M.G.L. c. 152.
Signed under the pains and penalties of perjury:
I ),� . Dc v{ -J 6ralb"�
Signa re Print Name & Title
I wish exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Print Name & Title
❑ I wish NOT to exercise my right of exemption
c-ipp
oRb'g- Z�1_..
Date ( dd/yyy )
Date (mm/d yyyy)'`
Signature Print Name & Title Date (mm/dd/yyyy)
❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name & Title
❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Date (mm/dd/yyyy)
Note: ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Insiructfons
on back. Form 153 - 7/2010
1. NATURE OF SWIMMING POOL' CONSTRUCTION AGREEMENT
This Swimming Pool Construction agreement is an agreement for construction of a pool and/or spa in accordance with the terms and specifications set forth herein. It does not
provide for certain items necessary for a complete pool project. The Buyer is responsible to make any and all provisions for FENCING AND ALARMS (as required per town
code), retaining walls, landscaping and drainage. The Buyer is responsible for providing all necessary acceptable water to fill the pool beyond what is included on contract.
2. COMPLIANCE WITH ZONING, PERMITS, VARIANCES AND ORDERS OF CONDITIONS
The Buyer has the responsibility to pay for all permits, variances, and orders of conditions necessary for pool construction and is solely responsible for ensuring that the on-site
location of the pool complies with the local zoning and any applicable deed restrictions, variances, or orders of conditions. C.E.P.S. shall have no responsibility in the event of
any non-compliance with municipal permit granting authorities rules, regulations, and conditions.
PREPARATION OF ACCESS, WORKING, AREA, AND POOL SITE
C.E.P.S. requires access to the pool site and a working area at the pool site. Unless otherwise agreed, the Buyer shall be responsible for providing and adequate access, an
adequate working area, and a pool site clear of all trees, stumps, planting, fences, walls and other obstructions and structures. The access and working area must be capable of
supporting the operation of heavy equipment during the construction of the pool, and in the event the access and working area will not allow heavy equipment to operate, the
Buyer shall be responsible for the corrective work necessary to permit construction to proceed. C.E.P.S. shall not be responsible for any damage to property (such as curbs,
sidewalks, driveways, sewers, cesspools, septic tanks, pipes, utility lines, patios, lawns, trees, fences or shrubs) within the access, working area, and pool site during
construction.
4. DIMENSIONS ARE APPROXIMATE, LIQUIDATED DAMAGES FOR DEVIATION
The length, width, and depth dimensions of a pool or spa are approximate with up to six inch tolerances either way and within such tolerances shall be deemed to meet the
specifications contained in this Agreement. If any deviation in length or width of a pool is greater than six inches but will not substantially affect the normal use and enjoyment of
- the pool, C.E.P.S., as the remedy, shall credit the Buyer $3 per square foot for a water surface area in excess of the area specified on the reverse side and $9 per square foot
for a water surface area less than the area specified on the reverse side. If any such deviation in depth of a pool is greater than six inches but will not substantially affect the
normal use and enjoyment of the pool, C.E.P.S., as the remedy, shall credit the Buyer $20 per inch for a depth in excess of six inches over the depth specified and $20 per inch
for depths less than six inches under the depth specified (the depth of the pool is the distance between the finished floor of the pool and the middle of the water line tile).
5. ON-SITE LAYOUT OF POOL LOCATION, SHAPE AND ELEVATION
Prior to excavation, the pool location and elevation of its rim shall be laid -out on site by C.E.P.S. with notice to the Buyer, and the Buyer or a representative authorized in writing
shall be present and shall approve in writing the on-site pool location, shape, and rim elevation. After excavation is completed, C.E.P.S. shall have no responsibility to change
the approved pool location shape or the approved elevation of the pool rim.
6. EXCAVATION AND SITE CONDITIONS
The contract price is based on a "normal excavation" (1) one hour per 100 Square Feet) which is defined as being an excavation on a pool site which meets the following
conditions. The pool site is not filled ground (soil not compacted to 90% and a compaction ratio less than 1,000 lbs, per sq. ft.) and does not contain any peat or other organic
material, stumps, expansive material (such as wet clay) or buried trees. There is no ledge, rock formation, boulders, underground tanks, leaching fields, sewers, pipes,
underground utility lines or other man-made obstructions to excavations. The existing earth material around and below the pool shell is capable of bearing the weight of the
pool.
7. ROCK PACKING WHEN WATER IS ENCOUNTERED
If, during the course -of excavation, any groundwater is encountered, or soil conditions with low percolation rates, the completed excavation will rock -packed (20 ton of 1.5
crushed stone will be spread in the deep -end bowl of the pool) to stabilize the excavation and to provide a footing. If removal of 50 gallons of water per minute over the course
of a one-hour period is exceeded by groundwater infiltration into the excavation, and C.E.P.S. determines that the pool is unbuildable on account of the water condition, it shall
notify the Buyer, and its obligations under this Agreement shall thereafter be limited to filling the excavation with suitable fill, and the Buyer shall only be responsible for C.E.P.S.
actual costs of site preparation, excavation, hauling, dumping, filing, and materials plus 20% for overhead.
8. ADDITIONAL WORK ON ACCOUNT OF SITE CONDITIONS
(a.) When C.E.P.S. discovers one or more of the site conditions listed in Paragraph 5 during the course of its excavation for a pool, it will, as fully as possible, disclose
to the Buyer the nature of the site condition and give its best estimate about the extent of the condition. C.E.P.S. will specify to the Buyer the construction work and
materials necessary to deal with each such site condition. C.E.P.S. will make a good faith estimate of the amount of work and materials involved, if C.E.P.S. has
discovered enough about the site condition to be able to give such an estimate. In some cases, additional excavation is required before the extent of the condition
can be determined and, if this is the case, C.E.P.S. will so advise the Buyer.
(b.) The Buyer within (5) five days of receiving notice from C.E.P.S. that site conditions have been discovered requiring additional cost, shall have the option to reject
the addition work and cost and require C.E.P.S. to fill the excavation with suitable fill. If the Buyer elects this option, the Buyer shall be responsible to pay C.E.P.S.
for its actual costs of site preparation, excavation, hauling, dumping, filling and materials plus 20% for overhead and administration costs,
(c.) If site conditions require work at additional cost, C.E.P.S. will submit a written offer to do the work except that C.E.P.S. need not submit an offer to do blasting,
jackhammer work, and removal of cesspools, septic tanks, leaching fields, sewers, pipes or utilities. The Buyer may make his/her own arrangements at his/her own
.expense to have any such additional work, required by site conditions, to be performed to C.E.P.S's specification, as are reasonably necessary for completion of
the pool
9. WORKING DAYS
Working days are to be defined as any weekday Monday through Friday, (weekend, legal holidays, days with precipitation exceeding .02 inch in any 24-hour period or days with
temperatures below 38 degrees Fahrenheit in any24-hour period are not considered working days). Delays caused by municipal and/or local regulations (such as electrical
inspections, re -certification of pool location, surveys, etc.) or outside contractors such as electricians, decking contractors, landscapers, etc., are not to be considered working
days. The pool will be deemed complete upon application of plaster finish.
10. COMPLETION OF THE POOL
C.E.P.S. shall use reasonable good faith efforts to ensure completion of pool construction within a reasonable time. Allowance shall be made for delays due to inclement
weather, frozen or water saturated site conditions, lack of necessary permits or inspections, delays by outside contractors, labor unrest, acts of God or other circumstances
beyond C.E.P.S.'s control. The Buyer shall use good faith reasonable efforts to ensure timely performance of the work by outside contractors, and give C.E.P.S. (1) one week
notice prior to completion of any outside work. The pool will be deemed complete upon application of plaster finish. Following completion of the pool, C.E.P.S. will not be
responsible for the removal of gunite rebound material, which is a gunite by-product produced during the gunite application and is buried during backfilling. C.E.P.S. reserves
the right to cancel this Agreement if the start of the construction is for any reason delayed (100) one hundred days from the date of this Agreement.
11. PAYMENT BY BUYER
Due to administration, scheduling and structural design cost prior to applying for permits, deposit is non-refundable after the three day rescission is reached. Upon C.E.P.S.'s
arrival at the pool site on each such date, ready, willing and able to perform, the Buyer obligated to make a payment specified on the first page of this Agreement. Non-payment
by the Buyer at or prior to such time shall be a breach of this Agreement and shall relieve C.E.P.S. of further obligation to perform under this Agreement, provided that no
payment shall be due from the Buyer until C.E.P.S. has completed all the work necessary to permit commencement of the work scheduled on the giving date. In the event a
Buyer makes payment within (14) fourteen days of the due date of a missed payment, the breach of contract shall be cured, and C.E.P.S. shall resume work within a reasonable
time, but the Buyer shall be liable to C.E.P.S. for the value of the labor and equipment plus 20% for any corrective work required as a result of the work not having proceeded as
scheduled (this amount shall be added to the amount due at the next stage of construction). Any outstanding payment due prior to the date scheduled for application of plaster
finish is to be paid by Buyer, prior to application of plaster finish. If Buyer does not cure the breach and C.E.P.S. institutes' legal action against Buyer on account of non-payment
of the amount due, the Buyer shall be responsible for and shall oav all costs and expenses incurred by C.E.P.S. including reasonable attorney's fees in the collection
of and charge under this agreement. If the Buyer Shall wrongfully breach the Buyer's payment obligations for pools -related work performed by an outside contractor (such as
an electrician or decking contractor), and such contractor shall assert a lien pursuant to G.L. c. 254 s.l., C.E.P.S.'s obligations under this Agreement at C.E. P. S.'s election, be
suspended until such time as the Buyer cured such breach.
12. CARE OF THE POOL AND SAFETY OF ITS USERS
Upon application of the gunite, in order to permit proper curing, the Buyer shall wet down the gunite twice daily for a period of (7) seven days. Upon completion of the pool, the
Buyer should be responsible for its proper care and maintenance and to ensure that the pool. water is kept in proper chemical balance. The Buyer understands that misuse of a
swimming pool, diving board, slide, ladder, or spa can result in personal injury, and that the users of the pool, and C.E.P.S. shall have no responsibility for any injury, loss or
damage resulting from the Buyer's failure to maintain the pool and its equipment and a safe condition or from any misuse of the pool.
13. GUARANTEES AND WARRANTY
C.E.P.S. provides a written Limited Warranty which specifies certain guarantees and warranties on the pool, the plumbing, and the equipment, providing all payments are made
according to schedule. Except as may be otherwise required by law C.E.P.S.'s Limited Warranty contains all the guarantees and warranties given by C.E.P.S.
.14. C.E.P.S NOT LIABLE FOR WORK OF OUTSIDE CONTRACTORS
C.E.P.S. will not be responsible legally or otherwise for work perform by outside contractors such as electricians, landscape contractors, decking contractors, fencing
contractors, blasting contractors, etc., or for any personal injury or property damage, including damage to the pool caused by such outside contractors. The Buyer shall be
responsible to ensure timely, work -manlike performance from such outside contractors and adequate insurance coverage for the work performed by them. If C.E.P.S. shall refer
the Buyer to an outside contractor, it does so as a gratuitous customer service and does not undertake any responsibility, legal or otherwise, on account of such, reference.
15. ARBITRATION AND GOVERNING LAW
Any disagreement arising with regard to this Agreement or its interpretation or application shall be resolved by binding arbitration in the City of Boston, Massachusetts,
conducted by the American Arbitration Association before a single arbitrator appointed by the American Arbitration Association. The arbitrator's decision will be final and binding
and may be enforced in a court. The Buyer and C.E.P.S. each waive their right to trial by jury or a court and agree that such arbitration shall be the exclusive method of resolving
disagreements between the parties. The laws and regulations of the Commonwealth of Massachusetts shall control without giving effect to its conflicts.of laws principles.
16. THE AGREEMENT AND WARRANTY ARE THE ENTIRE CONTRACT
This Agreement and C.E.P.S.'s Limited Warranty constitute the entire contract between the Buyer and C.E.P.S. with respect to construction of the pool. There can be no
modifications or amendment of any of the terms of this Agreement except by writing signed by both C.E.P.S. and the Buyer. This Agreement binds all signing as the Buyerjointly
and severally and shall insure to the benefit of C.E.P.S.'s assigns. If any provision of this contract.is for any reason declared void or enforceable, this shall not affect the validity
of the remaining provisions.
X
CREATIVE EDGE
POOLS AND SPA INC.
"Where your outdoor dreams come alive"
P.O. Box 84
Wilmington, MA 01887
Job Name:141 j
��, - Mailing Address , I- ,
Street: a� _ � ± ,,r' , ; "�%,.�s C� f_! City: �l%{i�s/+�.A� State : ���+ zi
Email: el: Cell:
POOL DIMENSIONS
Width, r i`'i. Length % Shape <"TDepth To '
A
GENERAL CONTRUCTION SPECIFICATIONS ACCESSORIES
1. Structural engineering plans INCL.
42. Clay soil - $600.00 per load of 1.5" stone I
2. Pool layout plans INCL.
43. Additional stone at $600.00 per load iA
3. Layout pool -Per buyers approval INCL.
44. Owner grants permission to photograph pool for use in advertising INCL.
4. Set pool elevation - Per buyers approval INCL.
SALES TAX & INSURANCE
5. Perform normal excavation and remove soil (Exc. Day only) INCL.
45. Payment of all sales tax on pool components and accessories INCL.
6. Access wall or fence: Removed by: 1,, -*7��1
46. Motor vehicle insurance, workers' compensation insurance and general
Replaced by: +` f
Liability insurance INCL.
7. Hand form and shape pool INCL
Additional Specifications
8. Steel reinforcing per engineered plans INCL
9. Engineered quality controlled gunite structure INCL
10. Watercure gunite shell twice daily for seven days Buyer
11. Install continuous bond beam around skimmer INCL
�,�., �i,', ^,�,�• ,�
12. One set of shallow end steps INCL
13. Swimout or loveseat in deep end INCL „'71
14. Install 6" band of frostproof tile INCL
15. Backfill materials .
16. Up to 4 hrs. of backfilling 1 - INCL
17. Interior finish / ! INCL
18. Water to fill pool r`t r ;7
HYDRAULIC & FILTERING. SPECIFICATIONS
-
PAYMENT
The Buyer agrees to pay C. E. P.S. the following Contract Amount for
C.E.P.S's performance of its obligations under this Agreement.
Contract Amount $ l
Deposit 15% $ t�fk'1
PAYMENT SCHEDULE
30% Day of Excavation $��:i,
40% Day of Gunite $ / (y ~�
12% Day of Tile $
3% Day of Start up
���� � y
TERMS AND CONDITIONS
19. Approved deluxe filter: Type: !j� t 'Jam; (�'r Size���
20. Pump and motor:: Type: ,i ; r;/ Size' `WJ1� s 0j A
21. Pressure test all pool plumbing - INCL.
22. Hook up all water lines from pool to filter INCL.
23. Non -corrosive PVC plumbing throughout INCL.
24. Hydrostatic valve INCL.
25. Provide return inlets for filtered water to pool INCL.
26. Main drain suction line with grate ;"�3�y f,/Af4NCL.
27. Deluxe Skimmer including Weir Gate and Large Basket INCL.
28. Pre -cast pad for pool equipment INCL.
29. Backwash line INCL.
30. Pool cleaner
't'"r !`rr= f � � r�t•..,..� .� ..i.�Jrf r' �u.S� �i(�''1:��.��
31. Sanitizert, ,1 n x . 1r c � ^ J L/ A
t POOL HEATER & UTILlfiES
32. Deluxe pool heater: Size 7, d/p-//) Make 2224
'
Indoor�0utdoor . ) _ Nat/Pro f ��"""""""
'
THE BUYER UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, HE OR SHE ENTERS
INTO A CONTRACT WITH C.E.P.S. AND THE BUYER CONCERNING C.E.P.S.
CONSTRUCTION OF A SWIMMING POOL MEETING THE SPECIFICATIONS CONTAINED IN
THIS AGREEMENT, ANY CHANGES IN ANY OF THE TERMS OR SPECIFICATIONS OF THE
AGREEMENT MUST.BE MADE IN WRITING SIGNED BY C.E.P.S. AND THE BUYER, AND NO
VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE PERMITTED. AS PART
OF ITS OBLIGATIONS UNDER THIS AGREEMENT C.E.P.S. IS PROVIDING THE BUYER
WRITTEN GUARANTEES ARE CONTAINED ON A SEPARATE DOCUMENT WHICH IS
PROVIDED TO THE BUYER.
THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANY TIME BEFORE
MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE ON WHICH EITHER THE
BUYER OR C.E.P.S. HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF
CANCELLATION TO C.E.P.S.
THE BACK OF THIS CONTRACT CONTAINS IMPORTANT TERMS AND CONDITIONS AND
THEY ARE PART OF THIS AGREEMENT, PLEASE BE SURE TO READ THEM. I CERTIFY
THAT I HAVE READ AND AGREE TO ALL TERMS AND CONDITIONS OF THIS
AGREEMENT.
r CREATIVE EDGE POOLS AND
w
BUYER - i SPAS INC
By" - �r
BUYER
DATE j! �?" DATEf
HIC# 166034 CSL# 93190
Fuel connection, heater venting, permit BY BID ONLY
33 .(#) of underwater light(s) �� INCL.
34. Electrical bonding of pool as required by city or town codes INCL.
35. Electrical wiring and connection from service panel ,'!C_
Pool over 75' at $15.00 per foot" "'' BY BID ONLY
Heat pump at $18.00 per foot ,BY BID ONLY
36. Electric panel upgrade if required BY BID ONLY
HYDRO THERAPY SPA
""'
37. Attached__ Separate Raised---'--
aised_---
Light `Blower _ '' #t Hydrotherapy Jets
Veneer
Spillway size
38. Deluxe cleaning tool (18" nylon brush, hand leaf skimmer, vac. Heal#,,_,
pole; test kit) INCL..
39. Initial start-up and 1 hour of follow-up instructions INCL.-�`,.�.
40. Raised Bond Beam: Tile Stone
Of 6" of 12" of 18" of 24""
41. Water Condition - 1 load (18 tons) of 1.5" stone ($600.00)
} ) f f
� �� '( /P i'�"� �f,%'Q f:� 1 (+ •f *6`X4 N � =...3
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7
The Commonwealth of Massachusetts
- Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
t www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
z
Address:��
City/State/Zip: � � �--r� . �r Phone #: :7w c 79 c,
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
listed on the attached sheet. I
ship and'have no employees/ork
sub -contractors have
working for me in any. capacity.
rs' comp. insurance.
[No workers' comp: insurance
5.e a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors thatcheck 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.
f
Insurance Company Name:,
Policy # or Self -ins. Lie. #: Expiration Date:
Job Site Address: City/State/Zip:
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.
` f
I do hereby ceW05Y-Vnder the pal nd penalties ofperjury that the information provided above is true and correct.
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 #:
Information and Instructions r r
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 ofhire,
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."
ti
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." r
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. , ti
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottoms
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 infonnation (if necessary) and under -"Job Site Address" tine 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 maybe 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:
Revised 5-26-05
i
The Commonwealth of Massachmetts
Department of Industrial ,Accidents
Office of Investigations
600 Washington Street
Boston, IIIA, 02111
`1'el, # 617-727-4900 oxt 406 or 1-87TMASS.AFE
Fax # 617-727-7749
wWw naass,govfdia
Corrinonwealth of Massachusetts-
=Department of Pudic Safety
Ho istinu Engineer-
? icense: HE400925
DAVID BRABAIV+T
9 54 MCDON'AwD`ROA-,`
wommgton MA 01887
COmmissiionn'err �-Xpisatior
06/28%2015.
Cfo9�tnta>ttt�cal��OfC�I'Cl7JJac�a�c//r
Office of Consumer Affairs & Business Regulation
q---.-x'xPirStr-2tlon-
m ME IMPROVEMENTCONTRACTOR
eg166032 Type:
atio_ 4/13/2016= Private Corporatia
CREATIVE EDGE POOLS AND SPA INC.
DAVID BRABANT
210 ANDOVER ST
WILMINGTON, MA 01887 Undersecretary
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PRODUCER (918) 664-2000 FAX: (978)664-0160 3/10/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA-nai
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ANY' REQUIREMENT TERM OR CONDITION OF ANY CONTRACT DR 07HEH DOCUMENT%V,T}i RESPECT TO WHEN THIS CERTIFiCATE MAYBE :$SUED OR..
MAY PERTAIN, THE INSURANCE AFFORDED By THE POLICIES CESCRIBFDHEREIN IS SUB ECi TO ALL THE TERMS, EXCLUSIONS
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