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HomeMy WebLinkAboutBuilding Permit # 8/14/2015 BUILDING PERMIT a eµoorH q o TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION Permit No#: /9v- 61 Date Received yq .e'.ry Date Issued:3' b-i' 15 IMPORTANT:Applicant must completeall items on this page LOCATION 1 -5U'"' - '' C`;¢ Print PROPERTY OWNER t-_1v6P_ C. -4,i 7 _ Print 100 Year Structure yes o MAP PARCEL: `r' ZONING DISTRICT: Historic District yes nno ` Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition L Two or more family ❑Industrial Alteration No.of units: L Commercial ❑Repair,replacement ❑PAssessory Bldg ❑ Others: Demolition Other elate ��� DESCRIPTION OF WORK TO BE PERFORMED: Identification-Please Type or Print Clearly OWNER: Name: Phone Address._ r 1.I. �? vl Contractor Name: r ' a%s _a Phone. f t= `�r- Email: gLft�,! - - i ' Address:' Q�f Az? - .s,c ,1,j Supervisor's Construction License Ar�'t'= Exp. Date: ` Home Improvement License: Exp. Date: `r' ARCHITECT/ENGINEER -'% Phone: mhA Address: Reg.No. FEE SCHEDULE:BULDING PERMIT'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$_-LL - � FEE:$ b6 f Check No.: 3d'a-3� Receipt No.: 7 NOTE. Persons contracting with unregistered contractors do not have access to the guaranty fund ,. Plans Submitted Plans Waived❑ Certified Plot Plan❑ Stamped Plans❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taumug/Massage/Eody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Aivate(septic tank,etc. 0 Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM /�'�J PLANNING&DEVELOPMENT Reviewed On 1.5 Signature, 1�� Z COMMENTS N f' •,,f CONSERVATION Reviewed on �t I 1 r� Signature COMMENTS`'.. ,� i,=fir,. --f� -;�:1. ict. ��c'i:..t,� t HEALTH Reviewed on/amu- V V COMMENTS �u��� v1,. ,��.- �/oll!i \, t k Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes_ Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer ConnectionlSignature&Date Driveway Permit DPW Town Engineer:Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpstet onsite yes no � Located at 124 Maln Streets FireDFne epartngsignatui'e COMMENTS Town of Andover 0 No. % '�Mlh ver,Mass, 30.1101 HEALTH Food/Kitchen PERMIT TO I L D —Septic System THIS CERTIFIES THAT 110.40W................................................................... BUILDING INSPECTOR has permission to erect..........................buildings on to be occupied asconey provided that the person accepting this pelit shall in every1respect conform,tio"'the terms o'f"the"application al 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 H.1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTII0 ARTS R-gh lek . ................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 0ccyL!E BuiidinQ Rough Display in a Conspicuous Place on the Premises—Do Not Remove H-I No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner For Marketing Dept.Use Only Gibraltar Pools&Spas J Where Buyer Heard About Gibraltar. POOLS•HOT TUBS•SAUNAS Buyer initials: 2. I.S.Aire-435 Bosun Street-Tapsfield MA 01983•(978)887-31]A•wwwyxexwimsom 3. 2. Date -Ur ill+ Buyer's E 1 ro '" s v. Buyer Nama antl Phone Number Buyer 2s Name M ding Add—(StrualTF—State and Zip Code) Physical Addngreen,Tour,State antl2ip Code) We hereby agree to sell,and Buyer and any Co-Buyer shown above agree to buy in good faith subject to the terms and conditions at forth below and upon the reverse aide hereof,the following: Your pool has the features and accessories checked below: SWIM AREA OUTSIDE DIMENSIONS WG-90 Steel Buttresses and Supports UPREMIUM Filtration System: a--Vacuum Equipment With Baked Acrylic Finish aDeluxe High Rate :a`Dual Bottom Drains ajinterlocking G-90 Steel Side Panels J Standard 3Tlummum Coping :Aluminum Fence eL irgin Vinyl Printed Liner a0urep 3 In Pool Laddeau fill __ f,"J €+Flush In-Wall Skimmer O'Deluxe e3"beck(Patio and Full Promenades) J Standard a55s"Bottom Leveling Channel UrStarter Chemicals '.. 33kim Net 5 Aluminum Outside Ladder eeriest Kit aApproximate 4'Wall Your pool includes only those features and accessories specifically stated herein and those included by the manufacturer unless otherwise indicated in writing in this agreement. ASSEMBLY:Your pool will be assembled by J you 13 us LOCATION OF YOUR POOL:Your pool will be assembled at Buyer 1's address stated above or,if not,at 1.Price of pool 2.Trade-in description,if applicable $ r t -"c "= f r- t->' 3.Net price of pool S2 4.Salestax t-',-__-, $ f.- r= S ' 5.Total price(3plus 4) $'_ - ) F-�+ 6.Initial deposit J 4,00002,000 J other $ - Am.sores""o'=ro•e 7.Total Balance due(S less 6) $ cau,Fcn�s ane,-X y - 8.Amount due on or before delivery $ 9.Amount due on completion and/or financed $ By signing this agreement,you acknowledge receipt of a completely filled in copy of this agreement,two completed copies of the attached notice of Cancellation and confirm that you have been orally informed of your right to cancel;and that you have read and understood completely the f pt a back of this gemennt SIg i fBuyar l I depa d tSalespeh," l A Signatwe'f Buyer2 Bacot—'fan Oficer of Gat ltar Pools Corp. NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OF SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 BUSINESS DAYS FOLLOWING RECEIPT BY US OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED.IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO US AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION ASWHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OF SALE,OR YOU MAY,IF YOU WISH,COMPLY WITH OUR INSTRUCTIONS REGARDING THE RETURN SHIPMENT OF THE GOODS AT OUR EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO US AND WE DO NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETURN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO US,OR IF YOU AGREE TO RETURN THE GOODS TO US AND FAIL TO DO$0,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THIS CONTRACT.TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM,TO GIBRALTAR POOLS CORPORATION,435 BOSTON STREET,TOPSFIELD,MA 01983 NOT LATER THAN MIDNIGHT OFG-J"_:`- (Wt) I HEREBY CANCEL THIS TRANSACTION (Date) (Buyer's signature) -6 - Zlv,la _ W n.A.PSENAULT �� AREA h� 3 x 1' W^z A�sENAI/Lr '� Ni.v ARSFNF LLT o� S MMER S BEET-- re r��.� PLAN OF LAND /N NORTH ANDOVER I v 530 G a sus uFv // //% oa The C.—tunvealth cfMassachusetts Department oflndustrfalAccidents Office oflnvestigations I Congress Stree4 Suite 100 Boston,MA 02114-2017 wanv mass gorldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers App&cant Information Please Print Legibly Name Bnsmess/ocgmvizaziorlrtnaiviauaq: GIBRALTAR POOLS CORP. Address-e—.STREET City/State/Zi:TOPsrIELO M✓.a,— Phoner:978asTzaza Are you on employer?Check the appropriate box: Type of project(reqitued): 1.❑®I am a employer with a 4.❑1 am a^eneal contactor and 1 6.❑New nor—co- employees(full and/or part-time).' have hired the sub-contractors 2.❑loan,ole proprietor or p rmer- listed on the attached sheet. 7.❑Remodeling ship and have no employees These sub-contractors have S.❑Demolition orking for me in any capacity an loycees�d he, workers' 9 ❑Building addition [No workers'comp.i c p" 10. Electrical re mus r additions equired] 5.❑We are a corporation and its ❑ P 3.❑1 am a homeowner doing all work officers have exercised their 11.0 plumbing repairs or additions itself.[No workers'comp. right of--ptmn per MGL 12❑Roof repairs mstuance requrzed.]' emplys. —,kc.'152, o o rkc.' 13.❑®Other ABOVEGROUNDPOOL comp.insurance relemod.] y applicmtfat Werks box l mutt also aU not fe—e.below shouw&fcuwohers comp®sanw policy ie[otmsaon. t H.aaa rswhosubmit Wis affidavit mdicatiwtefey amdoivgall work mussubmita new a--it indicating such. '—ma..nol--,— l saaac owing Ne aam otfesubco ante whefcror no[fose eonaa have employees.If[he sub-convattorsbave emplo}re¢,fey mos[pmvid—wohers comp.pni,ammbsr.�d I am as employer that is providing workes'compensation insurancefor my employees.Belowathepaaryandjabsire information. Insurance Company Name:TECHNOLOGV INSURANCE COMPANY Polity#m Self-ins.Li,#:TC33]B]20 Expiation Data ml—loll Job Site Addre I"d- City/Srate/Zip i� Attach. be porkers'compensation penson policy declaration page(showing the policy number and expiration date). Failure[o secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties ale 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 drat a copy of this statement maybe forwarded to the Office of Investigations ofihe DIA for instuance coverage verification. Ido hereby cera yxde(r U e pave and penalties ofperjmy that the injormaffon provided above is flue and rorrect S"enatme 1 Date , phone#:978 887 2424 Official ase only.Do not write f this area an be completed by city or town ficial. City or Town: Permit/License# Issuing Authority(circle 1.Board of Health 2.Badding Department 3.City/To—Clerk 4.Electrical lnspeetar 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC CERTIFICATE OF LIABILITY INSURANCE ��`mms zo is THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIMANVELY 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: Rihe certificaetholder is an ADDITIONAL INSURED,the policy(es)must be eldorsed.If SUBROGATION IS D,WNVEsubject to rm the tes and conditionsofthe policy,certain policies may require an endorsement.A statement on ttus certificate does not Confer rights to the certificate holder in lieu of such endareeTaa St. APE Kilgore Insurance Agency 5 Centennial Drive Peabody, MA 01960 xsuvaE�J-arEoao�covExacE xnctt a:Nautilus Insurance Co. 17370 uam s:SaM Indemnit Insurance Co. Gibraltar Pools Corporation c:Technolo Insurance Com a 435 Boston Street TopsEield, MA 01983 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERMOR 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 DESDBIBED HEREIN IS SUBJECT TO ALL THE TERMB, EXCLUSIONS AND CONDTIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CU MS. LR ^L LnT NN347534m 10/12/14.1 A /x/15 2.000,000 XN� u 100 000 IMsmAoe LX GaExpµ e,ml 5 000 s s wuxr 8 2 000 000 s 4 000 000 c�R!Are Lm T=lR 111 Dms-o3M= s_z,000,D_D_o__ A oelLeuneuTr 11023481 5/18/15.. s,a/j,,! 1,000.000 sl liver arson) $ o X a o m(ver arieeml S X HIRED AUTO X REUA LLUt uR 1 `E4CH occ S IXc6s DAB CLAIMSMnDE AGGREcwTE CTNC3932600 1G/13/14 1G/13/15 X w�No�v,ovEEa Aw-1WP _�1,0_00,000 -P DIERED#runvE�N QAa lm�auy ln�lp __ _ E_ - 000,000 lo�cal`x rt S 1,000 000 A Coumercial EPackageW NN347534 10/12/14 10/12/15 Bus seers SProp. 500,000 --N—E r Latanoxs rvpueLss larxn Aee¢D tm,Ammaul aemms smmwa,lemoresrew�zrequreol CERTIFICATE HOLDER CANCELLATION THE EXR-01 DATE THEEPOEaED NOTICECIES W—BE I EDVERED IN ACCORDANCE WITH INE POLICY PROVISIONS. AU—ma.REEEE— Cy'rnS A. Kilgore ©1968-2010 ACORD CORPORATION.All rights reserved. AC0RD 25(2010105) The AGORD re me and logo are registered marks of ACORD Phone: Far: E-Mail: �� _ �11tP €.'Gt1J ff7f=11f4'{'fti�l f��CifF:ijtFf'f!fF.if��.i Office of Consumer Affairs and Business Regulation _ 10 Park Plaza-Suite 5 170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 129931 Type: Private Cprpp idw Expiration'. 111232015 TY'216258 GIBRALTAR POOLS CORP PETER DE BERNARDO _ 435 BOSTON ST TOPSFIELD,MA 01983 update Address and return card.Mark reason 1.1 change. Address Renewal Employment '.. Loss Card or6e�a c -m,;rs �s Ramat oa Licerd r -dh did asa omv dOME IMPROVEMENT CONTRACTOR before the-pi-i—d—!ff dtarnto. . Regisin 129931 Type. Orfice of Consuveer tfiatrs and Bus�nessRegulatton "IExPitat 11=015 Private Corporation B tonk.lfi .51'0 A02116 GIBRALTAR POOLS CORP PETER CE SERNARDO 435 BOSTON ST TOPSFIELD.MA01983 L.nderserr< 1 dot valid..ithoot lig.—I HAYWARD Xto WNitration Iti Above Ground Full-Flo Cartridge \\ Element Filter Systems 111&411 I\J ieoky~ es aspect call1 o t edg r above ground filtration #m large filter body ensuresa 01 eaualtlstr;Gutsonof dirt and doors throughout the filtering elemert nsuring a longer more ef•iciem fiftenog life. Engineered for n.xvith flsiele or rigid plumbing Glass-reinforced,noncorrosive filter tank for long life Easy-Lok-ring design gives you single turn access to all irtemal components ZE Dower-FDower-Fto Matrix '-' THE SUPERIOR CHOICE IN ABOVE-GROUND POOL PUMPS. low Features an industrial-size strainer basket to collect a lot of debris without a lot of maintenance Converts from horizontal to vertical orientation at the press of a button Quick connecUdisconnect intake and discharge connection �� v ;