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Home My WebLink AboutBuilding Permit #739 - 281 BLUE RIDGE ROAD 6/26/2009BUILDING PERMITO� OO oTFI qti TOWN OF NORTH ANDOVER o? '.`�' -hb*° APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: V I IMPORTANT: Applicant must complete all items on this ease PROPERTY OWNER ( -,r4/,.5 -�CJW fQ 12e—V, Print MAP NO:�PARCELi4 ZONING DISTRICT: Historic District yes Machine Shop Village es t p g Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repai , cem Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer i OWNER: Name: Address: CONTRACTOR Name: - Address: r( gl cy Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER .✓ Type ori?rint Clearly) ne: � o�l 3e /- U <� A Exp. Date: Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $dv FEE: $ q7 Check No.: / Receipt No.: ;a [(!� , NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner Signature of contractor Location �� 4111'e— No. 111'e—No. --) Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Z Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t!_ 22 I 61 -0�� Building Inspector k Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed DATE REJECTED DATE APPROVED IF) re Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signaturefdate 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) ❑ Notified for pickup - Date _._..._ . ........................... __.......... _.............. __...................................... __....................... _........ _.............................. __.............................. _................................ __..................... _..... _.......................... _............................. __......................... __... _........................................ __................................. Doc.Building Permit Revised 2008 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 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 ❑ 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) ❑ 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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 VI m m m x m CO) EP m CO) 10 CD a Z CD O Cr d a� O o p CL cto CCD O a p o Co CD y CD O CO) d CO O CO) O CO) d CD O CD y CD O CCD O CD cn n O V C O 0 I rerun rn cia d= O MW O Q M So ROW -0 y •♦ .= a m n m C) C y C7 d2 � mZ • m gr h O .r .di m N T C9 —40 m H p N O ? O O = GCD 3 C co O 0 oZAC.C.2 n• a CA air. URC -12 =r =rco 7 Ab• � m O m G• CL 1 .dr• N O w CO) H O. d C C O d N m mO IPA W y CD X or H oo: CD y -CD ? sm co'.cn CD CD '. =r oC: mm: a -o C7 C, O .•r O C O s m cn o � w z rn -moi 7d tTj 15 wCD z G1 w a- rfjb w oG�a "� w n ew 7a � C1. O cn."n d F 0 a nC tv i r 0 c 04 gORTq TOWN OF NORTH ANDOVER ,•1,V� • : o� OFFICE OF BUILDING DEPARTMENT + 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please mint DATE: JOB LOCATION: `.--( Number HOMEOWNER Name PRESENT MAILING ADDRESS City Town Street Address Map/Lot_ Home 3c. Work Phone State CYC Zip Code The current exemption for"homeow=r was extended to in In& owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she ver the Town of North AndoBuilding Department minimum inspection procedures and requirements and that he/she will cmpiy with said procedures and requftments. HOMEOWNERS SIGNATURE A APPROVAL OF BUILDING OFFICIAL xevind io.ioos Form Homeowners E=mptk, ROARDOF %PPFAIS FRR 9511 C0NSERV.11'I0N 6gg_9530 HEAU11i 689-9540 PLANINING 698-9535 CJl ("— �r ItWWI r The Colnln Mwealth ofMassachusetts Department of Industrial Accidents Dice of Investigations 600 1frashington Street Boston, MA 02111 www -mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Coafracfors ip cant Informa/Eiecfrici ans/pitunbers ttinn Name City/state/zip: Are yon sa employer? Chet:k.the appropriate box: 1.❑ I°am a employer with 4. 111 am a genu contractor and I employees (full and/orpart-time).* 2. ❑ have hired the stab -contractors I am .a.sole proprietor or partner. ship and have no employees' listed on the attached sheet. ? These sui}.contractors have working for me in any opacity. [No workers' comp. iasw=ce workers' comp. insurance. 5. El We are a corporation and its 3. required.] I am a homeowner doing all work officers have exercised their right of exemption per MGL myself, [No•work=' ' comp. c, 152, § 1(4),'and we have no nsurance required.] .t employees. [No workers' comp. insurance u"A I Type of Prelim (requires: 6. Now construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition I0.❑ $leetric:al repairs oradditions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs I3.❑.Other •Any applicant that chreks bot:ltust t malso Ml out the section below showing their workers' bompontion policy information. t tiomeownara who submit this affidavit indicating h doing sill work and th they ars en ire outside connectors must submit a new Affidavit indicating such ;Contractors that check this box must, anad d an addhioasi shar showing. the numof the sub-cormractma and their workers' eernc. aol:=v ns,,, ., j WF an emproyer that is providutg:workers' Compensation insurance for int' enrploYees: Below is �e n , _..._ ... informafion. p k andie, site . Insurance Company Name: Policy 4 or Self -ins. Lie, 9: Expiration Dare: Job Site Address: City/State/Zip. Attach = a copy a the workers' compeQsaiion policy declaration page (showing the policy number and expiration dale Failure m secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500.00 and/or one -yew imprisonment, penalties of a- y pri eM; as well $s 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. I do hereby cer*under the pains and peno/ties o pcdury mate information provided above is true and correct Sienature- r . . official use only. Do not write in this area, to he completed by mY or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health Z Building Department 3. City/Town Cierk 4. Electrical inspector 5. Platubiog Inspector N Contact Person: Phone #- r Information a nd In'structions- Massachusetts General Laws chapter I S2 requires all emp 3 oyers 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, assodiation, corporation or other legal entity, or any two or more of thelbregoing engaged in a joint enterprise, and includirag the legal representatives of a deceased employer, or the receiver ort ustee of an individual, partnership, associatioin or other legal entity, employing employees. 'However the owncrof a dwelling house having not more than three apa rtmerft and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, consiruction 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 shag withhold the issuance or renewal of license or permit to operate a business or ito construct buildings in the commonwealth for any Applicant wino 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 arty contract for the perfiornrsrtee of public workuntil-acceptablo evidence of compliancx with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit compbmtely, 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 certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members orpariners, 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 can the Department at the nurriber listed below, Self-insured ooimpanim should enierdmir self insurance'lieense number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed Iegibly. no Department lois 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 v►-iI1 be used as a reference number. In addition, an applicant that must submit multiple pmmit/licwm 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 f tum permits or licenses. A new affidavit must be filled out each year. When: a home owner or citizen is obtaining a license or permit not related to any business or commercial va tiae (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Invesiipations 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 E Depart meat of 1mdustial Accidents Office of Lnwcstli rations 600 Washington Stied Boston, MA 02111 TeL # 617-727-4900 e= 406 or 1-977-MASSAFE Fax # 617-727-7748 Revised 5-26-45 WWWmass.gov/dia Charles C Hugo Landscape Design LLC Estimate PO Box 263 South Berwick, ME 03908 6/25/2009 Estimate # 443 Chris 5kowronek 281 Blue Ridge Road North Andover, MA 01845 Project #402 Deck Installation 2009 Description Qty Ulm Total Skowronek Deck Installation - Preliminary Estimate for Permit - Based on Plan Dated 9/10/08 Approximately 400 sq ft of new deck to consist of 1"x6" Ipe decking and 14,312.00 approximately 50 linear ft of Trademark Composite railing system and Azek trim. Cost includes removal and disposal of existing deck, and new footings. Terms: $10% ($1,431) deposit for scheduling and deck removal, $5,700.00 due prior to construction of new deck. Balance due upon completion. ADDITIONAL WORK not included in this proposal involving extra costs will be executed upon written change order. Payment for additional work is due upon completion of change order work. Contractor shall have right to stop work and keep project idle if payments are not made in accordance with this proposal. The prevailing party in any legal proceedings related to this agreement shall be entitled to payment of reasonable attorney fees, costs and expenses. 1.5% finance charge on all accounts past 30 days. STANDARD EXCLUSIONS: State or local permits required for any work, repairs for 0.00 concealed underground utilities not located on prints, not located by DIG SAFE or not marked out by owner, additional work to rectify concealed underground conditions, repairing/locating existing irrigation system, surveying to establish property lines, moving owner's property around site, clean-up of other contractor's work Wice 603.742.1174 Website www.charieshugo.com Total 'ax 6n -A, 747 1174 Finail mtrnvnnlianrnmrnct mat Page 1 Charles C Hugo Landscape Design LLC P4 Box 263 South .Berwick, ME 03908 Chris Skowronek 281 Blue Ridge Road North Andover, MA 01845 Project #402 Deck Installation 2009 Estimate 6/25/2009 Estimate # 443 Description Qty U/M Total Customer Acceptance and Date: 0.00 Thank you for the opportunity to present this pricing. Wice 603.742.1174 Website www.charieshugo.com Total $14,312.00 .ax 603.742.1174 Email mtravnn1ia(5')rnmract not Page 2 0 CONSERVATION DEPARTMENT Community Development Division June 18, 2009 Chris Skowronek 281 Blue Ridge Road North Andover, MA 01845 281 Blue Ridge Road, North Andover Replacement of an Existing Deck Conservation Conditions of Approval, NACC #53 Pursuant to section 4.4.2 B of the North Andover Wetlands Protection Regulations, Chris Skowronek, applicant/ homeowner, filed for a small project for work proposed at 281 Blue Ridge Road, North Andover. The work consists of replacement of an existing deck, decreasing the deck from 625 s.f. to 382 s.f. Existing and new footings will be used to support the new deck configuration. Portions of the proposed deck are within the 100 -foot buffer zone to a Bordering Vegetated Wetland (BVW) which is located to the south and east of the site. Additional work includes the installation of a rain barrel and the piping of gutter downspouts on the rear of the house into adjacent planting beds. Construction of this stormwater control system will include the installation of 4" perforated pipe surrounded by 3/4' crushed stone wrapped in filter fabric as shown on the herein referenced plan. Work will be conducted outside of the 50 -foot No Construction zone from the edge of a Bordering Vegetated Wetland (BVW). This small project is issued in addition to an Order of Conditions issued for the property under DEP File #242-1423 and does not replace any of the conditions or requirements referenced therein. During the June 10, 2009 public meeting, the North Andover Conservation Commission (NACC) voted unanimously to approve this project as described above. The following conditions were hereby mandated for the proposed work: RECORD DOCUMENTS: Proposed Pool Plan, 281 Blue Ridge Road, North Andover, MA Prepared by: New England Engineering Services, Inc. Dated: February 26, 2008 Revised: 3/17/08 Proposed Deck Added by: Charles Hugo Landscape Design LLC Scaled Sketch prepared by Charles Hugo, Landscape Design LLC PO Box 263, South Berwick, ME, 03908; Project Description email from Charles Hugo Dated May 30, 2009. 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://Nvnv'w.townofnorthandover.com/conservel.htm 0 A CONDITIONS: 1. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 2. Excess material and construction debris shall be properly disposed of off site and all stockpile areas shall be located in accordance with the Order of Conditions issued to the site under DEP File # 242-2423. 3. The applicant shall include the deck in as -built plans to be prepared as part of a request for a certificate of compliance under DEP File # 242-1493 (when that project is complete). 4. This permit shall expire concurrent with the Order of Conditions issued under DEP File # 242- 1423. Please do not hesitate to contact me should you have any further questions or concerns in this regard. Thank you in advance for your anticipated cooperation. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Jennifer A. Hughes Conservation Administrator 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www. http://www.townofnorthandover.com/conservel.httn 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 Doc -Building Permit Revised 2008 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 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 ❑ 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) ❑ 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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Permit N Date Issued: 6-1S/ 0 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION f� Date Received 3 �d I I ` IMPORTANT: Applicant must complete all items on this pate I LOCATION Zg1 Ql-u 6 Rv AdB t'2_MD PROPERTY OWNER C+Q�S%N,i2. SlCaw?r�, K �, Print MAP NO: b PARCEL: k99 ZONING DISTRICT: Historic District yes no Machine Shop Villaae yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: ,� �%(Zb""'< t �0��` S�sk "�' Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: gkow Rot�ig-'K Phone:SW-"21�- 1,911 Address: Z � 2� 0 f-�,Ndly 5j2 W\ o� CONTRACTOR Name:yt rtwr,� thVN-Cx%L is —Aw Phone: Address: I t2 R402�%zWjLk CtltLMSR�r 1'1A Supervisor's Construction 'License: U 2 3 150 Exp. Date: (012 �t v Home Improvement License: 09 3) c U 1070K3 Exp. Date: ? `/ C ARCHITECT/ENGINEER \C-\.)1, 14 RNAL�9ry Phone: S-18-zs'?- -0 mc -10 Address: Nr2 C/ELtsFu2d Y44 of jrz�J Reg. No. !r3&' FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ sc?I a3 FEE: $Z 0 Check No.: Receipt No.0 NOTE: Persons contractin' h of rstered contractors do not have access to the guaranty fund i- - ignature of Agent/Own _ 1 .- Si-gnature of contractor �J Location�a 1 � lac ,�- ICA No. 41 Date S o l TOWN OF NORTH ANDOVER A Y Certificate of Occupancy $ 10 'SSACHusEt Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I O 21 1 30 Building Inspector Plans Submitted Pla TYPE OF SEWERAGE DISPOSAL ` Public Sewer I Well Private (septic tank, etc. Environmental POOLS mm Design Excellence 76 IDe¢sonaf (3ouc4 184R Riverneck Road Chelmsford, MA 01824 jwatson@environmentalpools.com Tobacco Sales Jack Watson 978-256-0200 aped Plans 1-800-696-6976 Fax 978-256-6620 Cell 978-569-6871 Food Packaging/Sales Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U Fnpm PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION Reviewed on—q / so /v� COMMENTS Cmc %v1 r V1'�'e k HEALTH Reviewed on Si nature COMMENTS Lak. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connections.girin,4.— e DPW Town Engineer: Signature: FIRE DEPARTMENT Ternp Dumpster-on site yeS Located 384 os ood street Located at 124 Main Street no Fire Department signature/date Environmental POOLS 1, 1", o�./��aa6a�r�lld - Board of Bulldlag Reguiations and Standards HOME IMPROVEMENT COWRACTOR iftagistia-n: '07083 `__ "PI /2008 to Corpora0on :dretiv Evarleig! f; < raywz 81IR .Riverneck moi\# Cha!rsford, MA 05824 Deputy Adagalstrator Design Excellence (With ,�:74 -rjDEL1ona 7ouC/Z 184R Riverneck Road - Chelmsford, MA 01824 License or registration valid for individul use oala before the expiration date. If found rctur2 to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 093190 Birthdate: 06/28/1964 Expires: 06/28/2009 Tr. no: 93190 Restricted: 00 DAVID BRABANT ROAD WILMINGTON, G– MA Commissioner 800-696-6976 MEMBER 978-256-0200 � 184R Riverneck Road 978-256-6620 Fax NSTO SPA & POOL TOTE Chelmsford, MA 01824 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Le:tibiy Name (Business/Organization/Individual):1Lt�e� M�NZAL zLS`tl� Address: City/State/Zip: s44rt% i MA. 00Z-4 Phone.#: C`�& Are you an employer? Check the apps 1. EK I am a employer with 'c�o ' employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp, insurance required.] . 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t riate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 5. ❑ 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.] Type of project (required):., 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building. addition 10.❑ Electrical repairs or additions 11. [1 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other -Z& Upl L *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ' t Homeow—ners 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 subcontractors and state whether or not those entities have employees. If the sub-contractorshave 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:AQ_c11uS:.`taauC F f nvnOf" Policy # or Self -ins. Lic. #:' -Z . q U U Expiration Date:_ Job Site Address: ZE51 UWf_ \1i�ag zL City/State/Zip:. 1y ER, MA cst��s 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 T--4-: :.._- -1 L _ 7 -IT I I do hereby certify unde,z the not write in this area, to City or Town: of perjury that the information provided above is true and correct or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 7.51 A 4. Electrical Inspector 5. Plumbing Inspector ct Person• Phone #: Information and 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 not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera°te>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, §25CO) 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 maybe 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 callthe 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 permittlicense 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 pemaits 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: The Commonwealth of Massachusetts Department of Industrial Accidents Ufee of Investigations. 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext.406 or 1-877-MASSAFE ` Revised 11.22-06 Fax # 617-727-7749 www.mass..gov/`dia K , I" ACORD CERTIFICATE OF LIABILITY PRODUCER (602) 635-4848 FAX: (866) 696-4918 AIMS Insurance Program Managers A' �+ C DATE (MMIDD/2 0/YYYY IiNSUIS TIRANCE FICATE IS SUED AS A MATTER OF SNFORMATOION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 15230 N. 75th Street, Ste 1002 Scottsdale AZ 85260 SURERS AFFORDING COVERAGE NAIC # URERA:Arch Insurance Company INSURED Environmental pools, Inc. j URER B: 184R Riverneck Road URERC: URER D: URER E: Chelmsford MA 01824 THE REQUIREMENT, THE AG rA POLICIES INSURANCE RE ATE ADD'L OF INSURANCE LISTED BELOW TERM OR CONDITION OF ANY AFFORDED BY THE POLICIES LIMIT WN MAY HAVER TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR HAVE BEEN ISSUED TO THE INSURED CONTRACT OR OTHER DOCUMENT DESCRIBED HEREIN IS SUBJECT Y P D CLAIMS, POLICY NUMBER NAMED ABOVE WITH RESPECT TO ALL THE POLICY EFFECTIVE DATE MM/DD/YY 5/14/2007 FOR THE POLICY TO WHICH THIS CERTIFICATE TERMS, EXCLUSIONS POLICY EXPIRATION DATE MMlDD/YY 5/14/2008 PERIOD INDICATED. NOTWITHSTANDING A MAY BE ISSUED OR MAY PERTH AND CONDITIONS OF SUCH POLICI LIMITS EACH CCURRENCE $ 1,000'O DAMAGE TO RENTED 100,0 REMI Ea occurrence $ZAGLB9044500 MED EXP An one erson $ 5,0 PERSONAL &ADV INJURY $ 1,000 ,0 GENERAL AGGREGATE $ 2 , 000 , 0 PRODUCTS - COMP/OP AGG $ 2,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY[771 JECT LOC AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN A S AUTO ONLY: qGG $ EXCESSIUMBRELLA LIABILITY EACH REN $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE A RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X WRYTA IT- OTH- FIR E.L. EACH ACCIDENT $ 1 ' 000 , C E.L. DISEASE - EA EMPLOYE $ 1,000,( ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ZAWCI9086000 5/14/2007 5/14/2008 E.L. DISEASE - POLICY LIMIT $ 1,000, OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *Except for ten (10) days cancellation notice applies for non payment of premium. CERTIFICATE EVIDENCE OF INSURANCE ACORD 25 (2001108) wcn,)A ,n, , „o_ GANGCLLA I IUIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ? IT I EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO M IL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, E IT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON . IE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Peter Godfrey 0 ACORD CORPORATION 988 Oon, I of 9 'eJ V 1 05':16/2007 WED 1425 FAX 'L5 "l-5 re ul. DATE (MpVOD'YYY1' 07 A(;ORD,� CERTIFICATE OF LIABILITY INS�IFIRAN �E gD�AMATt�R4FiNFORMA710N — WOOL :tR OfLDE NIBNCfiRRT )N1CATE NOT AhNEND, Ip(I END OR Thi] �r,t =asurax►Ce Agency. IAC • ALT'ER7HE COVERAGE AFFORDED BY THE POLICIES GELOVI(- 221 C.'helmsford 1824®E NAIL 0 Che' snsford Xh 0 INSURERS AFFORDING COVERAGE _ pho lE: 97$256-3367 Fait=978-256-8215 IMSUFMA• Merchants„ Insurance Groff_ INSIX D INSURER B: — INSURER C: Env;L ro= w:ltal Pooleiac. wsURERD: 1848 hive:�neck Rd chalmsford �► 01024 INSURER E: COVI RAGES _ MSUED TV THE THE paLjr-iES OF ANE RFAuIREME INiW AM OR COS. E LELOWON OF; RAVANY CONTRACT OR OYHER DOCU ECTURED NAMED ABOVE OTO � Tm ok F�� MAY BE ISSUED OR DING MA) PERTAIN, THE INSURANCE AFFORDED liY THE FOLiCIES OEBCRBFD HEREIN IS SUBJECT TO ALL THE TERMS• QCCLUS10N5 AMD CONDITION$ OF SUCH - POL C1E8. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 6Y PAID CLAIMS � M � LIMITS )D• POLICY NuMOGR DSA T MiD S — TYPE of INSURANC9C EACH OCCURRENCE A GENERAL LIABILITY COMMERCIAL GENERAL LM1117Y CLAIMS MADE a OCOUR GENL AGGREGATE LIMIT APPLIES PER 7 POLICY JECT 7 LOC AUTOMOBILE LIABILITY ANY AuTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON-OWNEDAUTOS GARAGE LIABILITY —I ANY AUTO EXCES51UMBRULLA LIABILITY 7 OCCUR :7 CLAIMS MADE OwuCT18LE R[-•eN'MN i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY iCEERRIPMEMBEREXCLUDED4 CUTIYE 5M( RLPTION OF OPERATIUNa r L------- Ev-dence of Insurance. 7AN027-7014363 GEF .TIFICATE HQLDlrK Evidenae of Insurance ACORD 35 (2001108) PREMISES Ea --w4e) b — MED 9XP (Any one Person) S — PERSONAL & AVV INJURY i — GEINERALAGGREGATE i PRODUCTS.COMPIOPAGG 5 COMBINED $I NGLE LIMIT I S1,000,00 05/14/07 05/14/08 (EanodaenQ BODILY INJURY j g I (Per Pavan) ` BODILY INJURY I i (Pet acadcnt) PROPERTY DAMAGE i (P4r amdmAL) AUTO ONLY • EA ACCIDENT i OTHER THAN EA ACC f AUTO ONLY: AGG i EACH OCCURRENCE i AGGREGATE i S E.L. EACH ACCIDENT 5 E•L DISEASE - EA EMPLOYE 5 E.LDMEASE- POLICY LIMIT 5 CANCELLATION 1111111 SHDULG ANY OF THE ABOVE DE50RIBED POLICIES BE CANCELLED IO Days WRE THE CC' UTP_ EDFISS DATE THER, M UING INSURER WILL EKDEAVOR TO MAR MN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO St IKAU )MPOSE NO OBLIGATION OR LMLITY OF ANY KIND UPON THE INSURER ITS AGENT OR REIIYRTIV6S cdRPORATK V 9958 V �l3 184R Riverneck Road • Chelmsford, MA 01824 0 d U i ' OL 978.256.0200 / 800.696.6976 / Fax 978.256.6620 E-mail: info@env!ronmentalpools.com • Website: www.Environmentalpools.com NATIONALO An Aquatech Builder SPA & POOL INSTITUTE Design Excellence: With A Persona[ pouch The General Terms, Representations, and Conditions on reverse side are part of this Agreement. NAME (Buyer)-t� t t o 4. t a" a iti.:,1\) A. S e, iA)y,,, K €= MAIL ADDRESS Zell CITY h)c" C I . STATE 01 Pe ZIP tJ % k 4-r JOB ADDRESS CITY St4Y'vr!` STATE SR vvxC: ZIP RESIDENCE PHONE OFFICE PHONES=` ! �• 1 "I P Environmental Pools, Inc. (hereinafter "E.Rl.") agrees with the buyer or buyers above (hereinafter the "Buyer") to construct a swimming pool and/or spa in a good and workmanlike manner in accordance with the following terms and specifications. DIMENSIONAL SPECIFICATION -S 5 Width Length : s�iy Shape Depth 3 z,- to GENERAL CONSTRUCTION SPECIFICATIONS 1. Structural engineered plans........................................................................INCL. 2. Pool layout plans........................................................................................INCL. 23. 3. Layout pool for Buyer's approval................................................................INCL. 4. Set pool elevation for Buyer's approval ......................................................INCL. 24. 5. Perform normal excavation and remove soil on day of excavation only...... INCL. 6. Access wall or fence: removed by: Pressure test all pool piping........................................................................INCL. replaced by: 26. 7. Trees in access and working area to be cut down to that the stumps do not exceed 2' in height................................� ...................................BUYER Non -corrosive PVC plumbing throughout ....................................................INCL. 8. Remove from site I loads of: trees,(shrub' ,sstumps, asphalt, 28. concrete and other debris 9. Hand form and shape pool..........................................................................INCL. 10. Removal or relocation of cesspool, septic tanks, leaching fields, sewers, pipes and utilities (overhead/underground) ................................BUYER Main drain suction line with grate................................................................INCL. 11. Steel reinforcing per engineered plans ........................................................INCL. 31. 12. Engineered gunite structure to meet or exceed local or state codes .......... INCL. 13. Watercure gunite shell twice daily for seven days....................................BUYER Vacuum fitting outlet in skimmer..................................................................INCL. 14. Install continuous bond beam around skimmer ..........................................INCL. 15. One set of shallow end steps with 4' bench................................................INCL. 16.,Swimout or loveseat Irtr a, G 4a= ,%<s,.s3 ate.► ToiAa. C'x) 17. Install 6" band of frostproof tile..............a�f Cid/ ..........................................INCL. 18. Pavers, Bullnose Brick, or Bluestone -t,:.• 19. Cantilever form for deck A2114 20. 2 hrs. backfilling and grading -deck area only..............................................INCL. .21. Pool interior finish,.:..>.w3.L!:?.....a ..:........ � .............INCL. 22. Filling of pool promptly after interior finish ..............................................BUYER HYDRAULIC & FILTERING SPECIFICATIONS IP 23. Approved deluxe filter: Type �:aAr/ Size 24. Pump and motor: Type ¢jc+ t,, .+ `.�Jz; (A ffo Size - a j 25. Pressure test all pool piping........................................................................INCL. 26. Hook up all water lines from filter to pool....................................................INCL. 27. Non -corrosive PVC plumbing throughout ....................................................INCL. 28. Hydrostatic valve........................................................................................INCL. 29. Provide return inlets for filtered water to pool ............................................INCL. 30. Main drain suction line with grate................................................................INCL. 31. Deluxe Skimmer Including Weir Gate and Large Basket............................INCL. 32. Vacuum fitting outlet in skimmer..................................................................INCL. 33. Up to 30' of plumbing between filter and skimmer......................................INCL. 34. Pre -cast pad for pool equipment................................................................INCL. 35. Backwash line..............................................................................................INCL. AUTOMATIC EQUIPMENT 36. Automatic pool cleaner: Type 37. Stub plumbing for future pool cleaner .................f:E :€:......... .....INCL. ............... 38. Floor recirculation system A o f =,°..� a l s. w.+x� II' 7ivoiQ 39. Automatic chemical feeder...................................INCL. 40. Automated Pool Controls POOL HEATER & UTILITIES 41. Deluxe pool Heater: Size �41i, or t" Make IIA v36, i eti, g.s. Indoor/fib too r_1s. r::. 1r,a� (N ,/Pro min i, ° Fuel connections, heater venting, fuel storage tanks, permit ..............BUYER 42. Install underwater light(s), each with 10' conduit ............... f.VM.................... INCL. 43. Electrical bonding of pool as required by city or town code _ �%A - 44. Electrical wiring and connection up to 75' from service panel A 0 Pool over 75' at $15.00 per foot BUYER Heat Pump at $18.00 per foot BUYER HYDRO THERAPY SPA -4 45. Attached a's Separate Raised` z -'x 'z. r Light 7A,e.: loo aok) Blower IIT ( # Hydrotherapy jets G, er, Additiona(Specs. <.Q �7aA. _,irh-t'c �,vv. r', i_�_ i!)fr._i. :a ,:...,,a ia9:l S:•'li .:" .�.{� '�C. M.:: O S?n ACCESSORIES 46. Deluxe cleaning tools (18" nylon brush, hand leaf skimmer, thermometer, pole, test kit, deluxe vacuum) ..............................................INCL. 47. Diving board: Size % j r Color %01 A 48. 3 -tread S.S. ladder/handrail r..; w,,4.. 49. Pool slide: Size Ir -I. Color ¢i A 50. All jigs installed by decking contractor or buyer *-,1 ) A 1 f MISCELLANEOUS 51. Raised Bond Beam: Tile 131 +ft- Stone +; N 1 A 6' 12" X11 18" t�� 52. Start-up chemicals: Initial start-up and follow-up instructions ....................INCL. 53. Water Condition - $675.00 - 20 tons of 1.5" stone Additional stone at $400.00 per load ..................................................BUYER 54. Clay soil - $450.00,X15!!s.:Zr?!.1..�....�u4t.:k8�►.�...�..�! i.a.s�.r.�►.S.BUYER SALES TAX & INSURANCE 55. Payment of all sales tax on pool components and accessories ..................INCL. 56. Motor vehicle insurance, workers' compensation insurance and general liability insurance....................................................................INCL. ADDITIONAL SPECIFICATIONS 1 57. fi A 1-1. U.a %t> -V Si* nc_k e;t. L ral= a A, c r.S 610% AfA1_L. VP 58. .a a_� xC�rsa�a�,�� r t� ar �/caYA � waC4 59. t l da\a4_ihas G.vJOki of At L°*cvAvoAeAt,_4t At. JJ 60..Ir 61. 62 11 63. sa: 65. 9MA.Juk_ oy lub-baiF V,4. Ac►;, POOL DECK PRICES SUB -BASE MATERIAL IS NOT INCLUDED. Decking square footage:Type lijA"t urLAL. _Q01JE Other -—01 Reg, SW VJr_ PAYMENT The Buyer agrees to pay E.P.I. the following Contract Amount for E.P.I'svp q performance of its obligations under this Agreement. u° Contract Amount $ .� Deposit $ BALANCE $ Sn 311. "a PAYMENT SCHEDULE 30% Day of Excavation 40% Day of Gunite 25% Day of Tile 5% Day of Interior Finish �S TOTAL TERMS AND CONDITIONS THE BUYER UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, HE OR SHE ENTERS INTO A CONTRACT WITH E.P.I. AND THE BUYER CONCERNING E.P.I:S CONSTRUCTION OF A SWIMMING POOL, MEETING THE SPECIFICATIONS CONTAINED IN THIS.AGREEMENT. ANY CHANGES IN ANY OFTHETERMS OR SPECIFICATIONS OFTHE AGREEMENT MUST BE MADE IN WRITING SIGNED BY E.P.I. AND THE BUYER, AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE PERMITTED. AS PART OF ITS OBLIGATIONS UNDER THIS AGREEMENT E.P.I. IS PROVIDING THE BUYER WRITTEN GUARANTEES REGARDING THE SWIMMING POOL WHICH IT WILL CONSTRUCT PUR- SUANT TO THIS AGREEMENT. THESE GUARANTEES ARE CONTAINED IN A SEPARATE DOCUMENT WHICH IS PROVIDED TO THE BUYER. THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANYTIME BEFORE MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE ON WHICH EITHER THE BUYER OR E.P.I. HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO E.P.I. THE BACK OFTHIS CONTRACT CONTAINS IMPORTANTTERMS AND CONDITIONS.THEY ARE PART OF THIS AGREEMENT. READ THEM. I ACKNOWLEDGE THAT THIS AGREEMENT IS A LEGALLY BINDING CONTRACT, SUBJECT ONLYTO THE ABOVE CANCELLATION PROVISIONS, AND 1 CERTIFY THAT I HAVE READ AND AGREE TO ALL TER S AND CONDITIONS OF THIS AGREEMENT. �- U & ENVIRONMENTAL POOLS, INC. 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