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HomeMy WebLinkAboutBuilding Permit #997-15 - 155 GRANVILLE LANE 6/12/2015 NORTH BUILDING PERMIT JI (Jri� L� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . `• � ( I � nO 1 M OH Permit No#: Date Received I nn �gSSgcHus���y Date Issued: 1� IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER M t ke Cr l I ins Print- 100 Year Structure yes no MAP PARCEL: b�o ZONING DISTRICT: Historic District yes qD Machine Shop Village yes r7o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building K One family i kAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 0 Well ❑ Floodplain� El Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Zo x n�.� SLJ t mow• LJ U ?. Identification- Please Type or Print Clearly OWNER: Name: Kitt G((i✓iS , p Phone: Address: �v� (.C� Lapt�. IV AgcldvtfLk, OtS4s— Contractor Name: M� Qr,��S y��Pl? oS Phone: Email: Addrese—,flohCi�.,) r�tut Otr 3 Supervisor's Construction License: 01031D Exp. Date: 0�-1 Home Improvement License: Exp. Date: 02- - t3- 1 ? 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. t� Total Project Cost: $ Sq 7S-0 FEE: $ ��)71*0 '" Check No.: Receipt No.: NOTE: Persons contractin with unregistered contractors do not have ac ess to the guaranty fund Location No. Date 2 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit FeePP $ f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#�� LBuilding Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan K Stamped Plans ❑ t' TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools Well ❑ Z©K qc �i Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.- Permanent Dumpster on Site ❑ �V--&Ot1T THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM X ANNING & DEVELOPMENT Reviewed On Signature_ v-_ COMMENTSig- CONSERVATION Reviewed on C-0 / Si nature , COMMENTS W e_�-- lG �� l0 HEALTH Reviewed on Si nature 4j 2Q�t COMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: -- }--- � z Located 384 Osgood Street 0 FIRE DEPARTIMENT� ;Temp Dump,�steron site' yeasa {no Located at2,4Mamtreetf: Fr� Departmentgn atur�e%date �-r -.rte � a. r• Vie. i i 4 Dimension i 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) 01 jALj ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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 Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Caku/at%011 Construction Cost $ 28,750.00 m $ - $ 345.00 Plumbing Fee $ 43.13 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 43.13 Total fees collected $ 531.25 155 Granville Lane 997-15 on 6/12/2015 Inground Pool ttORTH Town of 2 t 7.,. Andover o�h ver, Mass, A_ COCMIC..l WIC.c 7�p0RAT E 0 Okp�,`'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT fh k o C0.1..� ...... BUILDING INSPECTOR has permission to erect buildings on �� ......&.2110 .. � .................. Foundation .......................... ...... ...... .......... Rough p Q....... .linery.f ..... ....�:�1. to be occupied as ....... ..Y.... .. ...... ..................... Chimney provided that the person accepting this permit shallres ect conform to the terms of thea licationp p p g p 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 031�. UNLESS CONSTRUCTIO TA S Rough Service ................. .... ........... ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. NORTH own o E ndover . 0 A_ai� � Z h 9GO.- h , ver, Mass, COCNIGMl WICK S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • t THIS CERTIFIES THAT fhl.t�...... .�. ...� ..!+�. BUILDING INSPECTOR tt .................... Foundation has permission to erect .......................... buildings on ......1� ....... .. .. !!....... .................. Rough to be occupied as ....... Q..�l.. .L?...... . ..... .� !��..... .�.. :, ......��...................... Chimney provided that the person accepting this permit shall in a res ect conform to the terms of the application p 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 03111C' UNLESS CONSTRUCTIOf TA S Rough Service ................. .. ............ ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 70 South Broadway 45 Route 12. Lawrence,MAO 1843 Kingston,NH 0384: 'rel:978-688-8307 "I Me �A TeL 603-642-990, Fax:978-688-1949 F[rU dT Fax:603-642-990, providing afidl lint-,of services and supplies fully licensed and insured WW%failifflypoollsonfine.colin Name 4,V_Q ca 'qs Date Address City ov­e_' State_JY. ..... Zip Home Phone Work Phone Cell # Cross Street/Directions 41 Estimated Start Date Estimated Completion Date We propose to furnish and install oneCi4ngunite 2,0 X 40 - 2—' 3f-Iswininning pool for thf. sum of$ > it tn-zu THIS PRICE INCLUDES: Normal Excavation Up to 8 hours on day of dig Manual vacuum cleaner kit -Waterline Tile(6') — Backfill and Sub-Grade up to 3 hours 3-Step stainless ladder -Liner Choice �71_ Underwater White Light 120 Volt Rope and floats lost Kit •Steel Reinforcing per Engineered Plans for gunite •Initial balancing chemicals •Surface skimmer(s) •Steel Structureper Engineered Plans for vinyl •8 to 12 Wk supply of maintenance chemicals •Dual Main Drains Over-Flo Line for added protection (supply depends on pool size) Coping Pressure testing of plumbing dudng construction _Gj Leaf net Steps_ -Ten Year Plumbing Guarantee(see specifications) Wall brush Handrails cAZ_ZA'._ -Transferable Lifetime Structural warranty Extension pole Filter (plumbed no more than 25ft rom pool) -Pump&motor THIS PRICE DOES NOT INCLUDE: -Any plumbing over 25ft from pool.Additional runs are not recommended but would be ata costof per foot per line. -Machine time in excess of that specified above.Additional machine time tobe billed at$ I V� including machine,operator,and laborer,due with second pool payment. All hours of trucking will be charged at$__So per hour per truck due with second pool payment. Any dumping costs incurred for disposal of ledge,large rocks,garbage,stumps buried or otherwise,building materials,unsuitable or nonstructural soils,or any unforeseen material that must be removed. Removal of ledge or large rocks by way of a Starr bit,chipper,or blasting. Additional fill,if necessary,for proper backfill or reshaping of hole,supply or spreading of loam,reseeding of grass. Patio,fence,retaining wall,or any accessory items other than noted on contract. Electrical wiring,fuel connections,heater venting,fuel storage tanks or permits. Repair or replacement of spfinldor systems or any buried items such as well lines,drywells,leach fields,electrical lines,cables,etc.that are damaged during construction Go d $=to water or soil conditions(ex.clay,peat,live sand,excessive rock,etc.)requiring a stone pack of the hole.The stone pack will be at an extra charge of 111111hrium tc maximum and at the discretion of the job supervisor.Additional machine time and/or materials necessary to rectify such a condition will be at a cost over and above the stone pack and will be quoted by the job supervisor. Water to fill pool. CUSTOMERS MUST SUPPLY: Initial! Access for all trucks 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 wafer cure Gunite shell for 7 to 10 days if applicable. Water to fill pool immediately upon interior finish NOTES: td� 5;,evvta +U OPTIONS: TOTALS: Diving Board 'r--t.-�, Basic Pool Price Solar Cover 'J Additional Pool Lighting Options $Heater Environpool Plus,8 hd-.2 surface ( SUBTOTAL $ Additional Floor Heads 5%Sales Tax Polarislac-Sweep Polaris retrofit only TOTAL Bench Interior Finish Less 10%Deposit Spa Automated Control System Balance of Contract ON Z,. $ Salt Chlorine Generator Other PAYMENTS:113 EXCAVATION 113 BACKFILL+EXTRAS '113 SYSTEM START-UP The 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 you prior to excavation at which time all decisions including pool size,shape,elevation,liner print,and all options must be final.Changes after this date will be subject 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 third business day after the date of this transaction.Credit card payments not accepted on contract amount. 2-k lip BUYER date G. SELLER date CO-BUYER date 1 • 11-9 Pk n Pasds pgi1,014 t •- i 14`Piainfhnds OBIIUI6 — C MINN � 40'�' l4-ErocsF�Garas. Q811-1�1 6' 4' i4•"bko Pldn 4DU1.911W1E { J t 2'RAD 2'RAD. OEIO Qf6 i�"E R r I•Aed brfiw9 ft M-moi 217 5taibht Gpi�(9I w 1011.411 A 8 C p a F 0 H � 4' t•7 As+dhc tap(ng aer Sal 1001.198 37 x W Se'' 16 t�6 xaF" F33"" TYb 0- ..K- i-9try111nat '�`,�' to xa+' re" Yi". 3ri' SYe" 41�2 gp'�a r 8' i b'Step•Mmore?•B'pmFek 111•b`�!•S panels .. f 44'-91andl bras eepp•• :. $ e Sl 4' lim�raae?-8'puaele lesar!=I s ?4'pmlah tawFrela4 4 ?aa4rmas rrrRee t 2 RAD. (�� 8' ekGnaer�p�mab+th epaweccwa j 2 RAA, i 441_ ah or- 41 1Q 44'-4• t 'O1eSpaals `on Q eaY'Q�y..FP�..6tr.a.oe.+0a.a.brC�.O�W.•.a.�ka@f&fln'+�Mimeh3EhmS•aR,�rf.`.a,cA�agpp4u.QArwtU�IXS.�m«IrtPaf«PARoaT..+�aievy.[Na>,.7..•,1sdt,dC.,s1.,er[[�y�%Krw.✓f81amfr97.Cmh+.a�dlIlrAxmea:hM.2RAD, Mgt" `pB1°40" id o1 aers. T „tYrls.awSeat.Ai6paaUp�b.dMnhtlFmrq�dM+.r�eaBi'aWaa.y.amba:.MsbB'."de.a/ •sra.1.,4v�et„l.y f�.�a��aa.�s#*ReYt•�)+.wLpM1dd�..1MWh.:�v��'r�.teviW`�an... ..F ea„wd6. i9 IN(lQtl"ar UK deeShcadGk-fcue.xa4.s.d,d.e.aia®e¢jWhio Mtfo-d Sp.and hw �t.Tp��t�I�7� IMUDM 14, 9�1 �+ InNw.tag•adet.5n,.7vdeel ler.seie�mle�F.dteehawdueYd•hn � •STERLING F4A igN�u(A 1. .saowdd ..Fm a.iv.lhne 4a0°P.e.p 7. I.e Yy��ydveye�I aewd• 6.rMat.9eih wmb 9l+nN a+raAdoWtirct,ad nwn�fw.til-hemmd °f OlT• (31 p.ecn+fenmalladc Y���ialfMatboNN �dpmd�t�d�q�.dl, ekFh�.�,tW'+fF+d�.esn.t��n.dadpan•a �,,,� . "�°'+ 9— i.�mg�l�e mNat�°d^ dtl" 71Bi.iaoA6sdIa+N 27➢u�. 'j�{> rF,e.i.Heft w,.nr KWlS.1�V66�-1611rlV.1 .iF'4?� The Commonwealth of Massachusetts Department of Industrial Accidents a i d I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia '1 SV•v1 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): I-Am L4 Address: A o City/State/Zip: e+ ,. 3 Phone#: 017 - b ` r3 7 Are you an employer?Check the appropriate box: Type of project(required): 1.-I am a employer with �'S employees(full and/or part-time).* 7. [ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]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 pairs or additions ire Electrca ❑ ensure that all contractors either have workers'compensation insurance or are sole 11. proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[j'Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] `r *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit 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. 1 Insurance Company Name: ���1 'r? e" Expiration Date: Policy#or Self-ins.Lic.#:Jin Z 12—R17 p Job Site Address: ��� til 1,fA 11V1 j (L P,46) City/State/Zip: �t"i 4 (t�le'�_ MA Attach a copy of the workers' compensation policy declaration pages owing the policy number and expiration ate). 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 and penalties of perjury that the information provided above is true and correct. D Date: Si nature: Nom` '` Phone#: �y ' LLthe only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: May 27, 201 North Andover MIMAP s ��� s � r •f �' t.�: s" ,P� •'1"a "S; r:x•r�.0� 1 /,!�r ,.�. �r•��. � w � e � 25ir pad' � !3 •r �3`� ,a �€.,;: � "�'�tra �i�l�t g, �, r �i.. h{ 1 �tilt �� ''��` � iE y,," �J"P"�• k ✓..- .. 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P�kt r0. w74-A..¢r �` r •� � �}a.F T"t3"d � M _ IS �1 �`1 _, e `�. _ a �. f �.�'` "tib` I`.: a,� Y r c�;�e+slew• V,Vyr t�� .4f, �'# t�x. t'.J+ ,,,',,CRs&- art It H.k { K'• '�i''+�.. v�'t;? a17•? ,. fi °' �,v J 'rte ° „ rc ik �L �e 1+ 1r3 �Al l. ��{ �i ?t,PIN �� Swl^x�+�' � �,� �� r ti �".y ., + x i� .e 1 � �3' � � 1,�•t ti >c t �! r.. } ? Int rstates, SIR Roads Easements ORTh yy �. •.. ■ ■Parcels0fe - - - •• •� •• �• • •- North Andover MIMAP May 27, 2015 e Gia ;00 v ... ... Aw. ------- ....... Aw. N)j . .. ....... 7 ..... .....W . A�. .. ....... 7. N)w .. .... Ac- -Ak. R2 . ..... .... ...... . Al d J; ... ....... ....... Ate ....... .... . ............ ......... \_ .�� a& 10' )J& Rail Line Wetlands Zoning B in!: Interstates 0 Exempt Lands t' 2simeI District ! 2 District Horizontal Datum MA Staleplare Coordinate System,Datum NAD83, —I ".B.aina�:3 District Meters Data Sources:The data for this map was produced by Merrimack —SR 0 Busi ne! 4 District V40RT#t Valley Planning Commission(MVPC)using data provided by the Town of Roads M Gene" Business District Of North Andover.Additional data provided by the Executive Office of ,Easements 13 Planne, Commercial Dev 6.1 0 Environmental Affaim/MassGIS.The information depicted on this map is C C nrido Development Dist for planning purposes only.It may not be adequate for legal boundary E3 MVPC Boundary ]a Corrido DevelopmentD�:'l 0 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER C1 Municipal Boundary 0 Comdo Development D It MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overlay I rcustri il 1 District THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY K! ndu 1ri 2 District OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT (3 Adult Entertainment Indus 3Overlay District 13 In ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Industri 3 District v t (3 Downtown 0 Indu ri IS District THIS INFORMATION 13 Historic District Reside ce I District lo.. 0 Water Protection Residec 2 District a 0 Parcels Is Reside ce 3 District C MUS 13 Hydrographic Features de ce,t District —Streams 1 382 ft 15 District Ede ce 6 District ge isidential District Client#:53642 FAMILYPOOLI ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYY1() 5/11/2015 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 WANED,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 C NTANAMET HUB International New England PHONE 299 Ballardvale St Alc,Nc Ext:978 657-5100 A/C,N9J: 866.475.7959 Wilmington,MA 01887 nDDRESS: nee.certificates@hubinternational.com 978 657.5100 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Valley Forge 20508 INSURED Family Pools&Patios Inc. INSURER B:Technology Insurance Co Family Pools North LLC INSURER C:Safety Insurance Co 39454 70 S.Broadway INSURER D: Lawrence,MA 01843 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LTR TYPE OF INSU7CEADD SUER POLICY EFF POLICY EXP WVD POLICY NUMBER MM/DD MM/DD *.1.3,dent) LIMITS A GENERAL LIABILITY6015920803 9/19/2014 09/191201CURRENCE7 $1,000 000 X COMMERCIAL GENERo"caED nce $100 000 CLAIMS MADE (Any one person) $5000 X Blanket Addl Inas contractually required L s ADV INJURY $1,000,00() AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: S-COMP/OP AGG $2,000,000 POLICY SCOT LOC $ C AUTOMOBILE LIABILITY 3947232 12/31/2014 12/31/201D SINGLE LIMIT nt $1,000,000 ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ X AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAR ROCCUg EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ B AND EMPLOYERS'LIABILITY WWC3112837 12/31/2014 12/31/201 X WC STATU- OTH- ANY PROPRIETOCERIMEMBERIEXCLUDR/EXECUTIVE YIN IORY LIMES ER E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? ❑ N/A I Mandatory in NH)nd E.L.DISEASE-EA EMPLOYEE s500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Property 6015920803 9/19/2014 09119/2015 vrs limits Spec Form Repl Cost $1,000 ded DESCRIPTION OF OPERATIONS/LOCATIONS/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:Mike Collins,155 Granville Lanepko'nTover,MA CERTIFICATE HOLDER CANCELLATION Town of Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St.,Building 20 ACCORDANCE WITH THE POLICY PROVISIONS. Ste 2035 fJ•Andover, MA 01810 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 #S1378479/M1283395 DKO04 C A F k� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 0211.6 Home Improvement Contractor Registration Registration: 118204 Type: Supplement Card FAMILY POOLS&PATIOS INC Expiration: 2/13/2017 GLEN WIGGIN 70 S. BROADWAY - LAWRENCE, MA 01843 -- scH; t: Update Address and return card.iVlark reason for change. zorn-os-a; Address Renewal Employment - Lost Card —� -: 8 a of Consumer Affairs 3 Business Regulation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to F, g e istration: 118204. Type: Office of Consumer Affairs and Business Regulation' Expiration: 21131201710 Park Plaza-Suite 5170 Supplement Card Boston,IIA 02116 FAMILY POOLS&PATIOS INC GLEN WIGGIN A 70 S.BROADWAY LAWRENCE,MA 01843 Undersecretary Not valid without signature Construction Suped vimlr - - CS-010330 WELLIAM C POULOS 70 S BROADWAY- LAWRENCE ROADWAYLAWRENCE Mk 01843 . .: . _ ... 07/19/2015 150' o I co O � O M PROP POOL j 25' DECK P,IX//�ii�1 EXIST HSE %% �%11Ifrf11L� � N EXIST SEPTIC SYSTEM ' / I 150' j I GRANVILLE LANE PROPOSED POOL �N OF MASLOCA TION PLAN of�r up G. FOR yG155 GRANVILLE LANE °CHRISTIANSEN � M H CIVIL —'ti /N H � No.28895 � NORTH ANDOVER, MASS. N 3 9y 1 A9 9FGIS �` ��``� DATE.•MAY 4,2015 p CFFSSIONAt��G SCALE 1"=20' CHRIS T/ANSEN u SERGI PROFESS SURVEYORS ERS 160 SUMMER ST. HAVERHILL, MA 01850 TEL. 978-373-0310 ©2015 BYCHRIST14NSEN&SERGI,INC. DRAWING NO. 15025005