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HomeMy WebLinkAboutBuilding Permit # 11/23/2015 .......................................................... OORTH BUILDING PERMIT TOWN OF NORTHA VE 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page r r, r 1fffff R p� � /, / / e I)yav TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building A'One family P"Addition [I Two or more family Li Industrial 0 Alteration No. of units: 0 Commercial 11 Repair, replacement RAssessory Bldg 'pcof Li Others: 11 Demolition 0 Other DESCRIPTION OF WORK TO BE PERFORMED: S; x 40 �Iikg (dme4 ell J Identification- Please Type or Print Clearly OWNER: Name: j:4-iA,1 Phone: 112, Address: -I fr, �,�/ f //1����/ ref l � �' ,���/�„ � //lr � �/ I,/// ,�/ / � �/��/ r/ ��/. OWN= li Ilii III II la e r ror e r e tc L ce se� r��� �����f����J,/„f: J' Da�� ',r ����nJ�/ ARCHITECT/ENGINEER Phone: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund igna ure b contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. Pennanent Dumpster on Site ❑ THE FOLLOWINGSECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF ® U FORM '/PLANNING EV L PM T Reviewed On Signature_ COMMENTS /CONSERVATION Reviewed on Signature COMMENTS d" � - .ter ,. 0t I. " HEALTH Reviewed n ( > ( ,, Si nature COMMENTS ' od()L,P-,(, osL--e'e'A r7 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 i,.if I rRE ,a ,. H�` „,,. .?f l ,, ,,,. a , r, ,r,.., f/ „ „ i r/,,,,,/i r ✓, //�/. //„,//!,// „/v//1 i:.,/„ / /r�' /Irfl�o l �� �� ,/ 1 ,�f /r�, /r,/ /r / / r /n r r ✓/ / r Y � r � �/ a , �� r1,r�, r, �;�D ��`' r //. �/, ✓ �/r / ,/ /r�,/r// ///- ii, /r! „ � f � l�r/ � 1�„�, 1,.„ t�!/I/, �/rr�� r. ,,,:/ i,/„ i J////,, /�/l/ �//% // ,//✓r ,, �// � ,l�/Irr; I / /,//1, 1l ,,,�, //� IlaLu e r / r r' COMMENTSS /%„ .l/i//%✓c, ,%//,,i,, ,,s a, .,1 , / tri/i // //!/// //// j/// %%j r%// / /i , Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) t) ej U Notified for pickup Call Email Date Time Contact Name ....................._.............__..................._._........... .__.__._._...___..._._.____-----. --- Doe.Building Permit Revised 2014 t%ORTH"W nclover 0% Ion sm N ® W44 •� ® - �# h ver, ass i� 0 LAK1 cocniE cnewIcK � DRATED S U BOARD OF HEALTH IT T� Food/Kitchen Septic System THIS CERTIFIES THAT FBUILDING INSPECTOR has permission to erect ......... ..,buildings on Foundation III Awk • , Rough to be occupied as ............... .. ... ���ty. ....1�. ......... .`, ... . . .... ��. ......... Chimney provided that the arson accepting this permit shall in eve respect conform to" o the terms�f tN'e application p p g p rY P pp 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 PERMITEMONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service ................. ...............................:. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. '0 south Broadway 45 Route 125 ,awrence,MA 0184:' Kingstoo,NH 03848 ,'el:978-688-8307 Tel:603-642-9909 rax:978-688-.1949 Vax:603-642-9906 IlV pffitnv�rvi(fing o.10 line qfseiwices andsul3f)lies co) fii.11y heensedand insured "',tvW.61 fit ilypoollsinfli necoinj 2�) Jame Data 2:71 Lddress ...................__...... ---------------------- ----------- city ':A State_v.tAx___.__ Zip come Phone Work Phone 6.1-- Cot Add'l 'ro, , ss Street/Dractions :.stimated Start Date ------------- ------- Uslimated Completion Date___................. We propose to furnish and install one Unite swirrinning pool for the ;urriof$-. Z '?­0 ------- 'HIS PRICE INCLUDES: Normal Excavation up to hours on day of dig Manual vacuum cleaner kit Waterline rile(W) k/A Backfill and Sub-Grace,LIP to 3 hours 3-SeLip Stainless:ladder Liner Choice 1:i underwater White Light 120 Volt Rope and floats Test Kit Steel Reinforcing per Engineered Plans for gunite lariat balancing chemicals -Surface skimmer(s)_ Steel Structure per Engineered Plans for vitro 8 to 12 Wk supply of maintenance chemicals Dust Main Drains Over-Flo Line for added protection Supply depends on pool size) Coning, Pressure testing of plumbing during construction Leaf net Ion Year Plumbing Guarantee(see Specifications) Wall brush Handrails Z Transferable Lifetime Structural Warranty Extension pole Filter, (plumbed no more than 25ft it pool) lc t Pump&motor 'HIS PRICE DOES NOT INCLUDE: ttrA r (( Any plumbing over 25ft train pod-Additional runs an,not recommended but would be at a cost of per foot per line. Machine time in excess of that specified above.Additional machine time to be billed at including machine,operator,and laborv,due with Second pool payment. All hours of trucking will be charged at$ per hour per truck due with second pool payment Any dumping costs incurred for disposal of ledge,large rocks,garbage,stumps buried or othetwise,building materials,unsuitable or nonstructural sdls,i�x any unforeseen material that must be removed. Removal of ledge or large rocks by way of a Start bit,chipper,or blasting. Additional fill,if necessary,for proper backfill or reshaping of here,supply or spreading of learn,reseeding of grass. Patio,fence,retaining wall,or any accessory items other than noted an contract. Electrical wiring,fuel connections,heater venting,fuel storage tanks or permits. Repair or replacement of sprinkler systems or any burled Items such as well lines,drywells,leach fields,electrical lines,cables,etc.that-,#a damaged during migeriction Coluo to water or soil conditions lax,day,peat,live Send,excessive rock,etc,)recruiting a stone pack of the note The stone pack will be at an a minimum to maximum and at the dlecreflon of the job supervisor,Additional machine time and/or materials necessary to rectify Such a condition will be al a cost over and above file Slone pack and will be quoted by the jot)supervisor. Water to fill pool, Initals 'USTOMERS MUST SUPPLY: Access for all bricks and equipment -Building and Electrical Permits or assume the costs necessary to obtain such permits. Water and electric necessary for construction of pool Customer must water cuts Gunite shell for 7 to 10 days if applicable. Water to fill pool immediately upon interior finish IOTES: 0 L 110 ,L )PTIONS: J TOTALS: Wing Board Basic Pool Price Val(.over ---------—1 &itional Pool Lighlinq /k �P_p 1,A;L Options :nvuonpool Plus,8 W�2 surface SUBTOTAL x1ditional Lloor Hcmds 'Plans vau-swecir, '115%Sales Tax s 'olaris retrofit only TOTAL $ 2-47, Bench iternor Finish Less 10%,Deposit A"' -------- utornated Centel Systein Balance of Contract to S ;all Chlorine Geneialol A-C nhot PAYMEN'rs:1/3 EXCAVATION 1/3 BACKFILL+EXTRAS 113 SYSTEM START-UP 'he buyer hereby agrees to pay,in full,the total amount of this transaction upon start-up of the installed pool.Your salesman or job supervisor will meet with ou prior to excavation at which time all decisions including pool size,shape,elevation,liner pint,and all options must be final.Changes after this date will be ubject to extra charges,where applicable,and will result in unavoidable delays.You,the Buyer,may cancel this transaction at any time prior to midnight of the ilrd business clay after the date of this transaction.Credit card payments not accepted on contract amount. BUYER data CO -BUYER-BUYER date 6i8Ei i�i�-al`�7ANYL7J1� -'roe ,.� At 49 1 �'"'t°e�oma`,`"".mow.� ����• ,w,y�.N - - L�+t/�c:�•.•C ,P'°°7 htPrt'174MsYwP'v"wY"pa0tiAd9M5i°'�WiW 'llr,tlrl M�rpmd�^�%wN�^�j 6Ac^mn""a4 �f �Y '�P+rry�K+9�iisO kSl�•ECOkW7G1 a Pm:wy',v�u.uu.wWlHP�°ePQ'�mKwMT°e°'�'f`F'PTM�9 2 71Y 'c iAd[C[e!^M7a1 P' qn t§itiCa'��yyNk�xcsua �S5 4�•nrae•w�-r�ar�r+wrww .r.p,.ve�,nr*n g !9VF?WWkIDPBd4 t'°aP'�^+3Paaw^r4r•N���r4�¢�m•a�/.yy,gF�r•N !t WPB@4• °G!"°o7P'^"'MO�t-�4w••A'PT"'Y!'�'�►•� 7�Iii1IlOiiplY4k}�dd - _ ._ _ ... w.rr^q...... �,..,rw.a /w+ w.dr .....y 10SdAlWSt�t 'uasaoo�W! >.QG4ue. 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' . 6901190 1 S5 Fes"'---Y'�"! � 6=------•-� I o fTl LLI T 1 i The Commonwealth of Massachusetts z Department of IndustrialAecidents w. d 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwwanass.gov/dia fA Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERNHT IPTG AUTHORITY. _Applicant Information Please Print Legibly Name(Business/Organization/Individual): , It Address: ,. c 66A06JA14 City/State/Zip: 1 i L (&V,3 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. New construction 2. J I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I haye hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14. Other -V 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. [ 152,§1(4),and weTI) have no.employees.[No workers'comp.insurance required.] t. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submif•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for•my employees.'Below is'the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: til C d ` Expiration Date: (2-3t B Job Site Address: City/State/Zip: r Gt r"r AA Attach a copy of the wor vers' com epsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.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 andpenaltl'es ofpe)jury that the it formation provided above is true and correct. Si nature: 1 Date: 1 Phone# Official use only. Do not rprdte 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#: Client#: 53642 FAMILYPOOL1 /� DATE(MMIDDIYYYY) ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE 19/30/2015 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(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: HUB International New England 070-0642 -475-7959 (A/C,PHONE :80 (FA/C, 299 Ballardvale St ADDRIEss: nee.certificates@hubinternational.com Wilmington, MA 01887 INSURER(S)AFFORDING COVERAGE NAIC4 978 657-5100 INSURER A:Valley Forge 20508 INSURED INSURER B:Technology Insurance Co 42376 Family Pools&Patios Inc. INSURER C:Safety Insurance Co 39454 Family Pools North LLC INSURERD: 70 S.Broadway -INSURERE: Lawrence, MA 01843 INSURERF: 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 CONTRACTOR 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. ADDLSUBR INS TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DDY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY 6015920803 09/19/2015 09/1912016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oNc E�nce $100,000 CLAIMS-MADE EIOCCUR MED EXP(Any one person) $5,000 Blanket Addl Ins X as contractually required PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JECT LOC $ C AUTOMOBILE LIABILITY 3947232 12/3112014 12131/201 EO aBI d n SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DE I I RETENTION$ $ B WORKERS COMPENSATION WWC3112837 12/31/201412/31/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Property 6015920803 09/1912015 09/1912016 vrs limits Spec Form Repl Cost $1000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation has Blanket Waiver of Subrogation,as required by executed contract.Work in NY is excluded; new construction of 10+units is excluded. Re: Ellen&Fran Murphy, 169 Gray Street CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1466778/M 1453341 CW001 F lQ ,r Office of Consumer Affairs ani Business Regulation 10 Park Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration , Registration: 118204 FAMILY POOLS&PATIOS INC Type: Supplement Card GLEN WIGGIh! Expiration: 2/13/2017 70 S. BROADWAY --— - LAWRENCE, MA 01843 - ---- - ---_ _. - --- sca i 2or5-os,± Update Address and return card.' 1ark reason for change, - .address Renewal ' '% Em to yment iv`(-..y;n+cvrrr'rq/�G r�r•./� rr„r __ �_` _ P } _�.. Lost Card N;—= f{ce of Consumer Affairs&Business[iegulation License or registration valid for individul use only 7. nE IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: 4 egistration: 118204 Office of Consumer Affairs an Expiration: d Business Reaulation y13/2017 Type. 10 Park Ptara-Suite 5170 - FAMILY POOLS&PATIOS INC $0pplement Card Boston,NIA 02116 GLEN WIGGIN r.13 70 S.BROADWAY r /� LAWRENCE,MA 01843 ` f Lndelsecrc -- ---- --� Not valid without signature r CS-0103.30 70 S BROADWA j )I 1}I C niss;iona, 0711-/2017 i