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Home My WebLink AboutBuilding Permit #120-11 - 99 OGUNQUIT ROAD 8/11/2010 NORTH BUILDING PERMIT °�tt-`° 1616 TOWN OF NORTH ANDOVER L p APPLICATION FOR PLAN EXAMINATION * ,� 04 C Permit N0: ( Date Received S RATE° SACHUS Date Issued: ',— d I IMPORTANT: Applicant must complete all items on this page j LOCATION ��- Pnnt PROPERTY OWNER , g.)14 L i J Lk ` Print MAP 210 QR PARCEL: ZONING DISTRICT:IHistoric District yes no I Machine Shop Village yes no I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I 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 Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: v Identification Please Type or Print Clearly) OWNER: Name: /,?Lr- 43JJ1J1J1f19gW M&A J& Phone:4i7 T -?W. M4 Address: St W00%0 I-I,i44- F,r,XA*-t-r- POOL5 .. CONTRACTOR Name; Phone,- Address: 4`q� I OC,70 P TUM P1 (,�uny vilk OI 'SN Ex Supervisor's Construction License: �1 %� p. Date: Horne Improvement License: CJ Exp. Date: _3— G�1> ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. F- q Total Project Cost: $ FEE: $ Check No.: Receipt No.: 27 3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ent/OwneSi nature of contractor Signature of Agr 9 __. i i I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans I 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 e�S DATE APPROVED v DATE REJECTED rV S��O ✓is1l PLANNING & DEVELOPMENT lQ COMMENTS CONSERVATION Reviewed on a Signature COMMENTS' - c��l — 1 y') N r HEALTH Reviewed on Signature COMMENTS 7 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 - Temp Dumpster on site yes no Located at 124 Main Street 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) i ❑ Notified for pickup - Date Doc.Building.Permit Revised 2010 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o 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) Li Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 o 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 2008 Location v �� No. 12 � Date ^T� TOWN OF NORTWANbOVER ' 16. 9 ' + ; ; Certificate of Occupancy $ �►�S',.•°'E��' Building/Frame Permit Fee $ sAcHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 3 3 building Inspector The Commonwealth of Afassachuseus Department o f Industrial Accidents Office of rnvestigations 600 glashineton Street Boston, 112A 02111 N'ww•massgav/iia Workers' Compensation Insurance Affidavit: Bee /C rsontractors/Eler-tricians/P A Leant Information lumbers Please N=e (Business/orpnization/Individual); 56A 4A, Print Legibly Address: �l City/State/Zip: � ` Mone#: y= �"e u an employer?Check the appropriate boa: 1 u 1 am a employer with 4. ❑ I am a oeneral7shcet. Type of project(required): employees(full and/or p * have hired cont the sub- 6. ED construction 2•❑ I am a sole proprietor or partner_ listed on ship and have no employees the attache7• ❑Remodeling These subcontractors have working for me in any capacity. workers com . ' 8• ❑Demolition [No workers' camp. ' P insurance. required.] insurance 5. ❑ We are a corporation and its 9• ❑Building addition Officers have exercised their 10.❑Electrical repairs[].1 or additions Myself, [No workers'comp. exemption Per MGL I l.❑Plumbing r c g airs or P . 152,§I(4),and we have no � additi°ns insurance required.] t 12 R em to Roof r P Yees. o work=, epaus � kers comp.insurance required.] 13•0 Other A-Y HPPhcant that che^xa bog. 7 n US £1a0 rT ont the Ee_ t Homeowners who s "tia b=ow ahoy Wbeir wori:Ws'comp�...s_moc. r: ., c submit this affidavit indicating the;,are doing at',work and then r-il iz c•baa *Contractors that check this box must attached an additional sheet showing hire outside contract=m„s+sn , :t. e the name of the sub con ` a new afnoavn mdicating such. I am an e/n tractors and their workers'comp.pobcy information. Peyer that is providing workers'compensation ins information. urance for my employees Below is the policy and job site Insurance CompanyName: p �' tl►L CO rPlc Policy#or Self-ins,Lie.#:- (e/l�-f �� r�`c Expiration Date: Job Site Address:(' j r, !� 2,n Attach a copy of the workers'compensation policy declaration Pa. sho C� /State/Zip Failure to secure coverage as required underSection 25A ofM p tr ( �the policy number and expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as Glc. 152 can lead to the imposition of c Of up to$250.00 a da a Pities in the form of a STOP WORKcriminal Penalties of a Y against the violator. Be advised that a coER and a fine Investigations of the DIA for insurance coverage verification PY of this statement may be forwarded to the Office of I do hereby certify under the pains and penalties o er u fP Signature: J r7 that the information provided above is true and correct 12- Phone#: Official use only. Do not write in this area, to be completed by citj,or town official City or Towu• Issuing,AuthorityPermit/License# (circle one): I.Board of Health 2.Building,Department 3.Ci /Town p 6. Other ' Clerk 4.Electrical Inspector' 5.PIumbin� d Inspector Contact Person: Phone#: Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employcrrs 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 t3he legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association ox-other legal entity,employing employees. However fire 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 maintemiance,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'canstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of Wimprmce 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 ung 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-cmtractor(s)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liabib'ty Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers' comp enation 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 'tee.return,d to the city or town that the applicaiioa for the pert t or license is being:egoes*ed,not the.Depast~z:ent of Industrial Accidents. Should you have any questions regardirag the law or if you are.required to obtain a worl.—s' compensation policy,please call the Department at the numbe=r listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. Cite or Town Officials Please be sure that the affidavit is complete and printed legrbly. 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/licewe 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 officiiMY 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 per? its 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 ofInvestigations would Ince to than 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.f m numb=-.... The Commonwealth of M&Ssachusetts Department of lrtdustrial Accidents Office of Investigations 600 Washington Street Boston,MA 0?111 Tel. # 617-72.7-4900 cxt 406 or 1-977-MASSAFE Revised 5-26-05 Fay:4 617-72.7-7749 urvrw.mass..aov/dia. I FROM NEVE—MORIN GROUP (WED) JUN 16 2010 10 :54,"ST, 10 :'54,'No, 6802445191 P 1 CL op �v zi ?d v 'I Z o \ �� ✓ ) _510 0,op p 6 . y r ab �bui?spx3 \ l l �. Q 1 f , t� f Mme^ �.,�. OOLS 8R PATIO' 895 Bosto Turnpike Road L Shrewsbury, N Tel. 08-719-5202 Fax 508-719-52 construction @ ferraripools.com DIRECTIONS - . Bo""ffogegula ions an. tan. ar s One Ashburton Place Room 1301 Boston, Massachusetts. 02108 Home improvement Contractor Registration Registration:. 123408 Type: Private Corporation Expiration: 2/13/2011 Tr#' 279570 FERRARI POOLS & PATIOS, INC. JASON WARD 19 BRIGHAM ST UNIT4 MARBOROUGH, MA 01752 Update Address'tmd return card.Mark reason for change. Address i_ Renewal Employment Lost Card IS-CAI is SOM-07/07•PC8490 ✓12C ZpO�yh//7ZO/tc�e�UL O�✓//L[tdf?��Ld�C� . Board of Building Regulations and Standards License or registration valid for,individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date.. If found;return to: Registration: 123408 Board of Building Regulations and Standards Expiration: 2/13/2011 Tr# 279570 One Ashburton Place Rm 1301 Boston,Ma.02108 Type::Private Corporation . FERRARI POOLS 8 PATIOS,INC. JASON WARD 19 BRIGHAM ST UNIT 4 _.. MARBOROUGH,MA 01752 Administrator Not valid without signature . i i �• Massachusetts- Department of public Safet% Board of Building Regulations and Stand,�u•ds Construction Supervisor License License: CS 69397 JASON E WARD 10 ISAAC MILLER RD WESTBOROUGH, MA 01581 c— Expiration: 6/5/2012 ('ummisiuncr Tr#: 29852 a i CERTIFICATE OF LIABILITI( INSURANCEli,o212o PR R (800)572-4538 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 1129 HOLDER:THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northborougho MA•OIS32. INSURERS AFFORDING COVERAGE .NAIC . INSURED Ferrari Poo7s-And Patios, 'Inc. INSURERA: /a[adia Insurance Company Ferrari F477. Circ7e Service Company . INSURER B: Ferrari Spas ,& Leisure, Inc. INSURER C: 895 Boston Turnpike INSURER o: . Shrewsbury, MA 01545 INSURER E: VERA E . . 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS:CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIESC-U .DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXdSIONS.AND CONDITIONS'OF SUCH POLICIES.-AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR ADD' TYPE.OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPA01.3615714 02/01/2010 02/01/2011 EACH OCCURRENCE $ IOOOOO X .COMMERCIAL GENERAL LIABILITY D �.$0 RENTED r $ 30000 CLAIMS MADE A OCCUR 7. An EXF:(Ariy one person) i ' 500 A PERSONAL$ADV INJURY i..' 100000, GENEAA1 i4 G`REGATE ': i 200000 GEN'LAGGREGATE LIMIT APPLIES PER:- PROD>jCTS==i;OMP/OP AGG $ 200000P6LICY X JPE LOC AUTOMOBILE LIABILITY 1MA0I36I58I4 0210112010 0210112011 COMBINEQSINGLE LIMR . i ANY AUTO (Ea accident) 100000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS. . (Per person) i A X HIRED AUTOS BODILY INJURY NOWOWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accid9nt) GARAGE LIABILITY' AUTO ONS!,,EA ACCIDENT. $ ANY AUTO EA ACC = OTHE12:)FLAN;:'.. _ AUTO'ONY:::, AGG i EXCESSIUMBRELLA LIABIUTY CUA0136160140210112610 '-0210112011 .EACH^n'y RRENCE.. s 5 •000,004 X• OCCUR F CLAIMS MADE AGGFFt} "?.; .:• i S OLIO,004 A i DEDUCTIBLE RETENTION WORKERS COMPENSATION AND WC4013615914 02/01/2010 02/01/2011 X'.:.GI - aTN• ;. EMPLOYERS'LIABIL'ITY y l"Y A ANY PROPRIETORIPARTRER/DCECUTIVE ' E•L:.n„` 6E .,• $ 1000001 OFFICER/MEMBER EXCLUDED? E,L •EMPLOYE $ 1000001 Ifyes,describe under SPECIAL.PROVISIONSbelow EL rfGl'UMIT $ . 1000001 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT ISPECIAL PROVISIONS FICATE HOLDER CAN CELLATION SHOULD ANY OF THE ABOVE DES CRIB CELLEO BEFORE THE EXPIRATION DATE THEREOF,THE ISSUIKI>}• KIWI=AVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE-1R'NAMED TO THE LEFT,' Ferrara P0o7s. BUTPAILURE TO MAIL SUCH NOTICE SHAD li1GATION4R LIABILITY -895 Boston,Turnpike Rd. p OF ANY UP NTHE.I U ER,fTS/CG E�JTATIVES:. * . Shrewsbury, MA 01545. J.AUTHiDRIZAI��E!It A Franc e :. �';...::... ACORD 25(2001108) T CORPORATION 1981 895 Boston Turnpike Rd. FERRARI 66 Portsmouth Ave. Shrewsbury,MA 01545 Exeter,N.H.03833 F1-888-283-9993 x 5GB 229 3304 POOLS & PATI OS ait� 1-800-506-3101 Fax:603-778-9258 35 Mill Street Central•Marlborough,MA 01752 800-448-6483 •Fax:508-229-3304 www.ferraripools.com•sales@ferraripools.com SWIMMING POOL CONSTRUCTION AGREEMENT (BETWEEN"CONTRACTOR"AND"BUYER") NAME(Buyer) 61LI t1)�i�( /►�iA-A)t)RLi�EMAIL HOME PHONE MAIL ADDRESS 5 t 1 iboti Aw Kh. CITY d�oaI/tit STATE )�A ZIP WORK PHONE rr JOB ADDRESS 47'f QGLCAi&(1Irj��bCITY Aj,A1jb0VF/� STATE"ZIP /y ZIP CELLPHONE '710b—?6q�gk6*7 POOL SIZE x y a DEPTH 3 t TO_ SURFACE AREA '77S Sq.FT-1-1-q PERIMETER_SHAPE GENERAL CONSTRUCTION SPECIFICATIONS 40)AGA ApproveSYHeater Mod9l SYrI_Qiff BTU 460 Heat Pump❑ 0 Indoor outdoor QLP O Natural ❑Oil:.. ........................::......' 1) Engineered Structural Plans,Working Drawings and Permits.................._11X5 _ 41) Fuel Connections,Heater Venting(through Roof or Wall), 2) Access Well,Fence or Shrubs.Removed and Replaced..........................By Others Fuel Storage Tanks,Permits........................................................................By Buyer 3) Remove from Site Loads of:Trees,Stumps,Asphalt, Concrete,other Debris ON DAY of EXCAVATION ONLY..........._......... MISCELLANEOUS SPECIFICATIONS 4) Establish Shape,Elevation and Location Prior to Excavation.....................Included 5) Perform Normal Excavation and Remove Soil 42) National Electrical Code U.L.Listed time Clock................. .........: ON DAY OF EXCAVATION 0 LY(UP To 8 HOURS)...............................incI d 43) Electronic Control System........Type ::.......... 6 Additional Excavation....... /2,Day=$850.......0 Full Day=$1300.....: 44) Electrical Bonding,Wiring Connections,and Permits................ 7) Hand Form and Shape Pool..............:.. By Buyer {.........................oad.......................Included. 45) U.L.Light-TYPa Srn #—�—Watts Sao Volts o 8) .Water or ReinfoExparcing P Soil Condition$ s and .od Per Load:,............ :�F 46) Flush Mounted Anchors,Safety Rope,Floats....................��.........� inc 9) Steel Rsinforoing Per Engineered Piens and Codes..........:.....................: lpdad Includede •..^.. • •• 10) Electrical Bonding of Reinforcing Steel,Jigs.and Equipment....................By Buyer 47) Pool Cover•Type S p <Y L t? L o,„ ,,,,,,,,,,,;,,,;,,,,•;11 C, 11) Gunite Structure(to meet or exceed local or state codes).........................Included 48) Stainless Steel Ladder..................................................:........................... 12) Install Bond Beam Around Perimeter of Pool and Skimmer(s). 49) Stainless Steel Rail............................................�1...........:......................... ...:Included :. 13) Elevated Bond Beam 8'. 12° 18" 24°.... •^ 50) Diving Board Size Color a Dive Rock.............. ••••• C' 14) One Set of Conigined ShallowEEpp ...................d Steps with Bench :........Included 51) Slide Size—Color—Curve ......................:...... (Jigs for Item #48,49, %51 Install d by Deck Cont!ct r 15) ❑Swimout ove Seat Vbeep End Bench..................................... ii A1C. . - e )I) 52)Therapy Sp Size�— Shape fl4� Depth 3-1, Ft. (Buyers Responsibility to water cure Gunl4e Shell twice a day for one week) O Sep. IfAft. ❑Sep.Spa Pak ❑Raised.................... ( 16) Additional Gravel for Grading.:...................................................................By Buyer //J y 53) Hydrotherapy Fittings....rf),Type S 7D Watts Number lts ►uc. 17 Deluxe Sate Grip Coping ••••••�� Safety P P g....................................................................... r 54) U.L.Spa Light•Type #_L_Watts o2S0 Voile t18) Coping Type ryPe Ft............... 55) Re-Routing Sanitation,Water Supply Systems and Utilities.........:..........,By Others 19) Natural Stone.Coping...Type 41e Ft...:.1r�c� 56) Payment of All State and Local Taxes During Construction........................Included 20) One 8"Band of Water Line Tile Color ...................Included 57) Negligent Property Damage,Public Llablllty,and Workers 21) Finish Pool Interior With Marble Plaster.;...Color .............:.... Compensation Insurance During Construction..................................:.........Included 22 Finish Pool Interior with Aggregate Plaster.....,.ColorR.t Y...�i► C, 58 Transferable Structural Warren 23) Filling of Pool Promptly after Interior Finish Application....................... .By Buyer ) Warranty"""""""""'""""""' ^^ •••Included ""' (Deck,Electrical,Fuel Hookup and Fence are not art of this Contract (euyer's_Gea�otrr�(ty,-�o bruati plea er s cestter fill np ot_p�g1),_;-;•-,.._._ P ) PLUMBING,HEATING&FILTRATION SPECIFICATION TT STARTUP AND INSTRUCTIONS 24) Install Non-Corrosive Plumbing and Fittings Throughout............ ........ . Included 59) Deluxe Maintenance Tools(nylon brush,leaf skimmer 25) Self-Adjusting Surface Skimmer(s)with Weir(s) Number Included telescoping pole,test kit,vacuum head&hose,manual...........................Included 26) Leaf and Halt Strainer Basket for Skimmers) Included 60) Start-upService and Maintenance Instructions..........................................Included 27) Return Inlets and Directional Fittings Number _......................Included 61) Start-up Balance Chemicals................ ....................Included ...........................:........ 28) Main Dreln,Cover and Hydrostatic Valve...................................................Included 29) Install.'Piping and Fittings for Future Poo(Cleaner................................... ,/Ale,; ADDITIONAL SPECIFICATIONS 30) Flexible Hose for Pressure Backwash of Filter up to .......................Included 31) Up to 25'Plumbing Run Between Deep-end Skimmer and Fllter...............Included Extra Pipe to be Charged at$6.00/ft Per Llne.:.............................I.......... -- 32) Pressure Testing of Plumbing Lines during Construction...........................Included 33) N.S.F.Approved Filter Type 1ob 11 Size 0•••.,,,,, Included 34) N.S.F.and UL Approved Pump and Motor;Size ......................Included 35) Hair and Lint Stainer for Pump Pot......................... 36) Automatic Chemical Dispenser .....:.................:........:...Included .....Type - 37) Alternative Sanitizec....:..Type l .fA? .$.............. 1 f r 38)Automatic Pool Cleaner............Type_I�LAlL t c a ...........:. t . 39)Automatic Floor Circulation Type .............. rAjC- ContraaaContractor a Buyer PAYMENT SCHEDULE sJ B Buyer(s)agrees to pay the Contractor the sum of $ J 50.4(7 Down Payment,receipt of which Is hereby Buyer acknowledged. $ 3Ood,oo Balance: $Contrac The balance will be paid as follows; Contractor reserves the right of.Mal acceptance or refusal of this contract,If said contractor feels 0 STANDARD he has not been fairy represented by any or all of his representatives.NO VERBAL AGREEMENT WILL BE ACCEPTED.The General terms and oondNlons on reverse aide are part of this agreement. 40% prior to Excavation ....... Buyers)acknowledges that he(they)has read.this agreement In Its entirety and has received a 55% prior to Gunite ........... completed,signed, legible copy thereof.Buyer(s).also realizes that any amounts Indicated on - - other contracts and addendums with this company are In addition to this contract amount. 5% . prior to Plaster O FALUSPRING Accepted this .b 30% prior to Excavation ....... Day of M r7—f 20 l4 40% prior to Gunite 15% prior to Tile ............... 10% prior to Equipment ....... You may cancel this agreement If It has-been consummated by party thereto at a place,other 5% prior to Plaster than an address of the seller,which may be his main office or branch thereof,provided .''''•'''' the seller In w P you or y writing at his main office or branch by mall posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of lhls agreement. � NORTIy ToVM of Andover 0 No. V"'I ,. t o A K E o " dover, Mass, sy COCMICMEWICK Ne ADRATED � `sS ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT L I. r ......%A A. `0.1 .J........................................ .... .................. Foundation has permission to erect.................. .... buildings on ...... ....... �/�.. .............. Rough to be occupied as. . ... ►........ 1!IIV'y► ..R ........ ................. I.......................... Chimney provided that the p rson acceptor this permit shall in eve ct conform to the term thea licationonfileing P rY PP Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations-Voids this Permit. Rough / Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU 2NS TS Rough ..... ................ Service LDING INSPE C Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Date. .} �/�G. .. . .... . I ORTk 14, 3? '` TOWN OF NORTH ANDOVER " PERMIT FOR GAS INSTALLATION ,SgACHUSEt This certifies that . . . I.Pr. B.S! has permission for gas installation . . . . !e t { c ,, <, . . . , in the buildings of . . .Pc, � .!1, . ,6, Ac ` . . . . . . . . . . . . . . . . . . . . at .G,1�y. . .�. :"�T <<. J ., North Andover; Mass. Fee. /.4G? . . . Lic. No.. ... . . . . . . .. . . . . . . . . . . . . . . GAS INSPECTOR Check# 2 1 1 k 7263 f i MASSACHUSETTS UNIFORM APPLICATON FOR PERM TO DO GAS FUTI NG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations (�—�l✓�d V' Permit# Lv 3 Amount Owner's Name �'�,� � �rrtr v^• New Renovation ❑ Replacement ❑ Plans Submitted ❑ U a y U W a U cw7 a a w o m x a 0 � xz v w x z �" a O x > w w w � ., a x x w w H a �d w > w z Q a ¢ o °o z o x a SUB -BASEMEN T v > B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR .8-T H . FLOOR Ej I (Print or type) \ \,(� Check one: Certificate Installing Company Name l 1 - .1 ):tf js'Cl t moi^.b L. L fi N 1 t Y` ❑ Corp. Address 1i C.46 6-1�y-c w Ja- G ❑ Partner. L—V! �U�rc1 usm ss Telephone Firm/Co. Name of Licensed Plumber or Gas Fitter c,w �� 3 G INSURANCE COVERAGE Check.one: I have a current liability Insurance policy or it's substantial equivalent. Yes No� If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 0 J hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S Gas Co and Chapter 142 of the General Laws. By. Signatureo icensed Plumber Or Gas Fitter Title Plumber L City/Town 1122 0 Gas Fitter icense umber Master APPROVED(OFFICE USE ONLY) Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informatioa Please Prl<nt Legibly Name(Business/Organization/Individual): ( 1 Pt f (} �� l. � �_` Address: -aQ) C �A( City/State/Zip: —J1t_�s)-,r,r cl tTA C, V5 Phone#: G17� Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6' E]New construction 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. [No workers' comp. insurance 5. 9 El Building addition � p ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I`Eg-Pinmbing repairs or additions myself [No workers' comp, c. 152, §1(4),and we have no insurance required.] t 12.0 Roof repairs q ] employees. [No workers' comp.insurance required.] 13.[] Other `Rny applicant that checks box#I must also fill'out the section below-N." work='_Omp=sation policy informatiorn. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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'comp information. ensation insurance for my employees Below is the polio,and job site 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 . Y expiration date). Failure to secure coverage as required p e)' g q ed under Section 2 SA of MGL c. 152 can Iead to the imposition fine up to$1,500.00 and/or one-year imprisonment as well P of criminal penalties of i • as civil penalties in of up to$250.00 a da against P the form of a STOP WORK ORDER and a fine y g 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 unde ins andpenalties ofperjury that the information provided above is true and correct Si ature: Phone#: Official use only. Do not write in this area, to be completed by city or town off,-ciaL Cita 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 an d 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 notbecause 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 sig and date the affidav t. The affidavit should be.refined to the city or town that the application for the perp itoi 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 Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 www.mass..gov/dia