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HomeMy WebLinkAboutBuilding Permit #655 - 605 OSGOOD STREET 4/28/2010-,BUILDING PERMIT TOWN 0 -F -NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: TYPE OF. IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Rep6ir, replacement Assessory Bldg Others: Demolition Other flbod!01 ain s; Wetlan Watershed Distract -_-!Wbter/Sewer,. UtbUK11' I 1UN Ur VVUKK I U BE PREFORMED: 1 13 - I M r- L�> U r- C Tl!—. U VOL- alvu r. Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: � o Plans Submitted Plans Waived Certified Plot -Plan F!e ---_. Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art =Swimming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMEN ,B CF' Reviewed on s HEALTH Reviewed on_ r�. _ COMMENTS Sianature `l-Lj-' o ��-�C�s �,� I i N (GUS ld Si nature A4 )0 -Ic J�z Azo c 5 a �z 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: t 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 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Apphication ❑ 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: Building Permit Revised 2008 Location ��,o-r a-!� No. 4; Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Mu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # //3 2 2 9Y 3 Building Inspector THE 1'RUSr Fp �F 78.82' R PUBLIC LAND - N8104 N 79 °59'4 ,\ r PROPOSED N80*22'14„E 116.66',, 2 ,8„E 83.72, FIELDSTONE N 7.93 - N82°25'0 N8 -11,19),E WALL7„E 236 �, n 00 00 PROPOSED 4' HIGH CHAIN LINK FENCE z nLn Q N 96.12' 00 PROPOSED c , SPA LOT A N j PROPOSED co 36 .'� AREA -95,843 S.F. o SWIMMING m a 411ci POOL =2.2003 AC. o Q (L al 2 X12 STORY N W. F. D.00 #605 'N I � 1 STORY ^ WOOD 3 V 1� PLAYHOUSE w o � O O ati •o�^ o 398.07zz S75°14'45"W � -- o �o NOTES a I. SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS N MAP #35 LOT #32 AND E.N.D.R.D. BOOK #5764 PAGE #265 Z�, AND PLAN #12491 FOR SITE DEED. OWNER OF SITE IS "tDOUGLAS KEITH 605 OSGOOD STREET, NORTH ANDOVER, MA. 3'I 2. ZONE DISTRICT IS R2 WHICH REQUIRES 30' FRONT, 30' 7 SIDE, & 30' REAR YARD SETBACKS. Q 00 PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR CREATIVE EDGE POOLS & SPA 210 ANDOVER STREET WILMINGTON, MA SCALE: 1"=50' DATE: APRIL 12, 2010 0 M M M - m . �■5 MERRIMACK ENGINEERING SERVICES 4112110 66 PARK STREET STEPHEN E. S L. S. DATE ANDOVER, MASSACHUSETTS 01810 E 6 z rA w x w O O GQ u; O w° v cin OU U z GQ s '� w° O a4 ,j E -C U cis C w aa O w t7 04 w to O w C w O w W O a: v 4)C cn tw � O H. a c7 O w C LL W a d w x W C w o b t cn q o E cn H. Cf) M E f T 2 O O • Q s Z co a O y � C co Gm I pCA� y0CD O .O m m .00 to � 3� O O C i c O d m cma CO2 s c O Cp v J •a .y Z v V CO)CDCL Q C C C Q. cm o CD c • c C�7 O � C ti c V V 'd•0 Q. c O O �= O aCD 4m Ea D o •� n " o c. D • Q'0, o 0 o� :.0 c m c �mo a H o 3 y +- c 3 :yc o y N m 7: m o C.c.s I.: � m y m m L = O CI C CID m �' C m v•yZ O ()Om co y.: cL O c = O H06 m c O p c C2 r=, H OCD IV m L W •y +' O O C.Z C CD Z ac E m 0= , y C) m c O C.3 A ` H O _ CL M. H. Cf) M E f T 2 O O • Q s Z co a O y � C co Gm I pCA� y0CD O .O m m .00 to � 3� O O C i c O d m cma CO2 s c O Cp v J •a .y Z v V CO)CDCL Q C C C Q. cm I A CREATIVE EDGE POOLS AND SPA INC. "Where your outdoor dreams come alive 210 Andover St. Unit #21 `� Wilmington, MA 01887 Job Name: , i � j, 'j Phone (1) (, t -1 _ _. Lj j q C-- Phone (2) Mailing Address Street: -2,(D .�- S - City: Ci ao State : A )A. ZIP: 01-7q(2 INCL. v 2. Pool layout plans INCL. Job Address (same as mailing yesl o j c= INCL. S S 0 1-qg s - POOL DIMENSIONS Width Q> Length -3 (Q Shape Q��, �� Depth To 1 GENERAL CONTRUCTION SPECIFICATIONS ACCESSORIES 1. Structural engineering plans INCL. 41. Deluxe cleaning tool (18" nylon brush, hand leaf skimmer, thermometer, 2. Pool layout plans INCL. pole, test kit, deluxe vacuum) INCL. 3. Layout pool INCL. 42. Start-up chemicals: Initial start-up and follow-up instructions INCL. 4. Set pool elevation INCL. 43. Raised Bond Beam: Tile Stone 1(,11,4- 5. Perform normal excavation and remove soil INCL. of 6" of 12" of 18" of 24" 6. Access wall or fence: Removed by: 44. Water Condition - Up to 1 load (18 tons) of 1.5" stone INCL. Replaced by: 45. Additional stone at $575 per load (includes delivery) 7. Hand form and shape pool INCL 46. Clay soil - Up to 1 load (18 tons) INCL. 8. Steel reinforcing per engineered plans INCL 47. Upto two Door Alarms INCL. 9. Engineered quality controlled gunite structure INCL 48. Owner grants permission to photograph pool for use in advertising INCL. 10. Watercure gunite shell twice daily for seven days Buyer SALES TAX & INSURANCE 11. Install continuous bond beam around skimmer INCL 49. Payment of all sales tax on pool components and accessories INCL. 12. One set of shallow end steps INCL 50.Motor vehicle insurance, workers' compensation insurance and general 13. Swimout or loveseat in deep end INCL liability insurance INCL. 14. Install 6" band of frostproof the INCL PAYMENT The Buyer agrees to pay C. E. P.S. the following Contract Amount for C.E.P.S's performance of its obligations under this Agreement. Contract Amount $ o� Deposit ',15% $ PAYMENT SCHEDULE 25% Day of Excavation 25% Day of Gunite $ �b 25% Day of Tile 10% Day of Start up $ (� TOTAL $ _53, /Z-!;-- 15. Upto 3 loads of backfill material INCL 16. Upto 2 hrs. of backfilling and grading per load INCL 17. Pool Plaster interior finish INCL 18. Upto 3 loads of water to fill pool INCL HYDRAULIC & FILTERING SPECIFICATIONS 19. Approved deluxe filter: Type:-4AQt,)A C L Size L4,R 20. Pump and motor:: Type: Size -7 If f' 21. Pressure test all pool plumbing INCL. 22. Hook''up all water lines from pool to filter INCL. 23. Non -corrosive PVC plumbing throughout INCL. 24. Hydrostatic valve INCL. 25. Provide return inlets for filtered water to pool INCL. 26. Main drain suction line with grate INCL. 27. Deluxe Skimmer including Weir Gate and Large Basket INCL. .\ TERMS AND CONDITIONS THE BUYER UNDERSTANDS THAT BY SIGNING THIS AGREEMENT, HE OR SHE ENTERS INTO A CONTRACT WITH C.E.P.S. AND THE BUYER CONCERNING C.E.P.S. CONSTRUCTION OF A SWIMMING POOL MEETING THE SPECIFICATIONS CONTAINED IN THIS AGREEMENT, ANY CHANGES IN ANY OF THE TERMS OR SPECIFICATIONS OF THE AGREEMENT MUST BE MADE IN WRITING SIGNED BY C.E.P.S. AND THE BUYER, AND NO VERBAL CHANGES IN THESE TERMS AND SPECIFICATIONS ARE PERMITTED. AS PART OF ITS OBLIGATIONS UNDER THIS AGREEMENT C.E.P.S. IS PROVIDING THE BUYER WRITTEN GUARANTEES ARE CONTAINED ON A SEPARATE DOCUMENT WHICH IS PROVIDED TO THE BUYER. THE BUYER HAS THE RIGHT TO CANCEL THIS AGREEMENT AT ANY TIME BEFORE MIDNIGHT OF THE THIRD BUSINESS'DAY AFTER THE DATE ON WHICH EITHER THE BUYER OR C.E.P.S. HAS SIGNED THIS FORM BY GIVING WRITTEN NOTICE OF CANCELLATION TO C.E.P.S. THE BACK OF THIS CONTRACT CONTAINS IMPORTANT TERMS AND CONDITIONS AND THEY ARE PART OF THIS AGREEMENT, PLEASE BE SURE TO READ THEM. I CERTIFY THAT I HAVE READ AND AGREE TO ALL TERMS AND CONDITIONS OF THIS AGREEMENT. CREATIVE EDGE POOLS, AND BUYER SPAS, INC BY: BUYER DATE DATE HIC# 0 CSL# 93190 28. Vacuum fitting outlet in skimmer INCL. 29. Pre -cast pad for pool equipment INCL. 30. Backwash line INCL. 31. Pre -cast pad for pool equipment INCL. 32. Backwash line INCL. 33. Stub plumbing for future pool cleaner INCL. 34. Automatic chemical feeder S _ IN INCL. POOL HEATER &UTILITIES 35. Deluxe pool heater: Size =4 0001; � Make 1-1iAu W�42 (i Indoor/ utdoor Qu �r)onCZ (Nero A"i1)�_ Fuel conn tice on, heater venting, permit BY BID ONLY 36.- of underwater light(s) INCL. 37. Electrical bonding of pool as required by city or town codes INCL. 38. Electrical wiring and connection up to 75' from service panel � Pool over 75' at $15.00 per foot BY BID ONLY Heat pump at $18.00 per foot BY BID ONLY 39. Electric panel change if required BY BID ONLY HYDRO THERAPY SPA 40. Attached Separate a_1, Raised 1 r Light --- ABlower Z HP # Hydrotherapy Jets Veneer& Tile Spillway size I`.i 1.A j 7 15 -� 1 `I E �o bDG A -i 1. NATURE OF SWIMMING POOL CONSTRUCTION AGREEMENT This Swimming Pool Construction agreement is an agreement for construction of a pool and/or spa in accordance with the terms and specifications set forth herein. It does not provide for certain items necessary for a complete pool project. The Buyer is responsible to make any and all provisions for FENCING AND ALARMS (as required per town code), retaining walls, landscaping and drainage. The Buyer is responsible for providing all necessary acceptable water to fill the pool beyond what is included on contract. 2. COMPLIANCE WITH ZONING, PERMITS, VARIANCES AND ORDERS OF CONDITIONS The Buyer has the responsibility to pay for all permits, variances,, and orders of conditions necessary for pool construction and is solely responsible for ensuring that the on-site location of the pool complies with the local zoning and any applicable deed restrictions, variances, or orders of conditions. C.E.P.S. shall have no responsibility in the event of any non-compliance with municipal permit granting authorities rules, regulations, and conditions. 3. PREPARATION OF ACCESS, WORKING, AREA, AND POOL SITE C.E.P.S. requires access to the pool site and a working area at the pool site. Unless otherwise agreed, the Buyer shall be responsible for providing and adequate access, an adequate working area, and a pool site clear of all trees, stumps, planting, fences, walls and other obstructions and structures. The access and working area must be capable of supporting the operation of heavy equipment during the construction of the pool, and in the event the access and working area will not allow heavy equipment to operate, the Buyer shall be responsible for the corrective work necessary to permit construction to proceed. C.E.P.S. shall not be responsible for any damage to property (such as curbs, sidewalks, driveways, sewers, cesspools, septic tanks, pipes, utility lines, patios, lawns, trees, or shrubs) within the access, working area, and pool site during construction. 4. DIMENSIONS ARE APPROXIMATE; LIQUIDATED DAMAGES FOR DEVIATION The length, width, and depth dimensions of a pool or spa are approximate with up to six inch tolerances either way and within such tolerances shall be deemed to meet the specifications contained in this Agreement. If any deviation in length or width of a pool is greater than six inches but will not substantially affect the normal use and enjoyment of the pool, C.E.P.S., as the remedy, shall credit the Buyer $3 per square foot for a water surface area in excess of the area specified on the reverse side and $9 per square foot for a water surface area less than the area specified on the reverse side. If any such deviation in depth of a pool is greater than six inches but will not substantially affect the normal use and enjoyment of the pool, C.E.P.S., as the remedy, shall credit the Buyer $20 per inch for a depth in excess of six inches over the depth specified and $20 per inch for depths less than six inches under the depth specified (the depth of the pool is the distance between the finished floor of the pool and the middle of the water line tile). 5. ON-SITE LAYOUT OF POOL LOCATION, SHAPE AND ELEVATION Prior to excavation, the pool location and elevation of its rim shall be laid -out on site by C.E.P.S. with notice to the Buyer, and the Buyer or a representative authorized in writing shall be present and shall approve in writing the on-site pool location, shape, and rim elevation. After excavation is completed, C.E.P.S. shall have no responsibility to change the approved pool location shape or the approved elevation of the pool rim. 6. EXCAVATION AND SITE CONDITIONS The contract price is based on a "normal excavation" (1) one hour per 100 Square Feet) which is defined as being an excavation on a pool site which meets the following conditions. The pool site is not filled ground (soil not compacted to 90% and a compaction ratio less than 1,000 lbs, per sq. ft.) and does not contain any peat or other organic material, stumps, expansive material (such as wet clay) or buried trees. There is no ledge, rock formation, boulders, underground tanks, leaching fields, sewers, pipes, underground utility lines or other man-made obstructions to excavations. The existing earth material around and below the pool shell is capable of bearing the weight of the pool. 7. ROCK PACKING WHEN WATER IS ENCOUNTERED If, during the course -of excavation, any groundwater is encountered, or soil conditions with low percolation rates, the completed excavation will rock -packed (20 ton of 1.5 crushed stone will be spread in the deep -end bowl of the pool) to stabilize the excavation and to provide a footing. If removal of 50 gallons of water per minute over the course of a one-hour period is exceeded by groundwater infiltration into the excavation, and C.E.P.S. determines that the pool is unbuildable on account of the water condition, it shall notify the Buyer, and its obligations under this Agreement shall thereafter be limited to filling the excavation with suitable fill, and the Buyer shall only be responsible for C.E.P.S. actual costs of site preparation, excavation, hauling, dumping, filing, and materials plus 20% for overhead. 8. ADDITIONAL WORK ON ACCOUNT OF SITE CONDITIONS (a.) When C.E.P.S. discovers one or more of the site conditions listed in Paragraph 5 during the course of its excavation for a pool, it will, as fully as possible, disclose to the Buyer the nature of the site condition and give its best estimate about the extent of the condition. C.E.P.S. will specify to the Buyer the construction work and materials necessary to deal with each such site condition. C.E.P.S. will make a good faith estimate of the amount of work and materials involved, if C.E.P.S. has discovered enough about the site condition to be able to give such an estimate. In some cases, additional excavation is required before the extent of the condition can be determined and, if this is the case, C.E.P.S. will so advise the Buyer. (b.) The Buyer within (5) five days of receiving notice from C.E.P.S. that site conditions have been discovered requiring additional cost, shall have the option to reject the addition work and cost and require C.E.P.S. to fill the excavation with suitable fill. If the Buyer elects this option, the Buyer shall be responsible to pay C.E.P.S. for its actual costs of site preparation, excavation, hauling, dumping, filling and materials plus 20% for overhead and administration costs, (c.) If site conditions require work at additional cost, C.E.P.S. will submit a written offer to do the work except that C.E.P.S. need not submit an offer to do blasting, jackhammer work, and removal of cesspools, septic tanks, leaching fields, sewers, pipes or utilities. The Buyer may make his/her own arrangements at his/her own expense to have any such additional work,.required by site conditions, to be performed to_C.E.P.S's specification,.as are reasonably necessary for completion of the pool. 9. WORKING DAYS Working days are to be defined as any weekday Monday through Friday, (weekend, legal holidays, days with precipitation exceeding .02 inch in any 24-hour period or days with temperatures below 38 degrees Fahrenheit in any24-hour period are not considered working days). Delays caused by municipal and/or local regulations (such as electrical inspections, re -certification of pool location, surveys, etc.) or outside contractors such as electricians, decking contractors, landscapers, etc., are not to be considered working days. The pool will be deemed complete upon application of plaster finish. 10. COMPLETION OF THE POOL C.E.P.S. shall use reasonable good faith efforts to ensure completion of pool construction within a reasonable time. Allowance shall be made for delays due to inclement weather, frozen or water saturated site conditions, lack of necessary permits or inspections, delays by outside contractors, labor unrest, acts of God or other circumstances beyond C.E.P.S.'s control. The Buyer shall use good faith reasonable efforts to ensure timely performance of the work by outside contractors, and give C.E.P.S. (1) one week notice prior to completion of any outside work. The pool will be deemed complete upon application of plaster finish. Following completion of the pool, C.E.P.S. will not be responsible for the removal of gunite rebound material, which is a gunite by-product produced during the gunite application and is buried during backfilling. C.E.P.S. reserves the right to cancel this Agreement if the start of the construction is for any reason delayed (100) one hundred days from the date of this Agreement. 11. PAYMENT BY BUYER Upon C.E.P.S.'s arrival at the pool site on each such date, ready, willing and able to perform, the Buyer obligated to make a payment specified on the first page of this Agreement. Non-payment by the Buyer at or prior to such time shall be a breach of this Agreement and shall relieve C.E.P.S. of further obligation to perform under this Agreement, provided that no payment shall be due from the Buyer until C.E.P.S. has completed all the work necessary to permit commencement of the work scheduled on the giving date. In the event a Buyer makes payment within (14) fourteen days of, the due date of a missed payment, the breach of contract shall be cured, and C.E.P.S. shall resume work within a reasonable time, but the Buyer shall be liable to C.E.P.S. for the value of the labor and equipment plus 20% for any corrective work required as a result of the work not having proceeded as scheduled (this amount shall be added to the amount due at the next stage of construction). Any outstanding payment due prior to the date scheduled for application of plaster finish is to be paid by Buyer, prior to application of plaster finish. If Buyer does not cure the breach and C.E.P.S. institutes' legal action against Buyer on account of non-payment of the amount due, the Buyer shall be responsible for and shall pay all costs and expenses incurred by C.E.P.S. including reasonable attorney's fees, in the collection of and charge under this agreement. If the Buyer shall wrongfully breach the Buyer's payment obligations for pools -related work performed by an outside contractor (such as an electrician or decking contractor), and such contractor shall assert a lien pursuant to G.L. c. 254 s.l., C.E.P.S.'s obligations under this Agreement at C.E. P. S.'s election, be suspended until such time as the Buyer cured such breach. 12. CARE OF THE POOL AND SAFETY OF ITS USERS Upon application of the gunite, in order to permit proper curing, the Buyer shall wet down the gunite twice daily for a period of (7) seven days. Upon completion of the pool, the Buyer should be responsible for its proper care and maintenance and to ensure that the pool water is kept in proper chemical balance. The Buyer understands that misuse of a swimming pool, diving board, slide, ladder, or spa can result in personal injury, and that the users of the pool, and C.E.P.S. shall have no responsibility for any injury, loss or damage resulting from the Buyer's failure to maintain the pool and its equipment and a safe condition or from any misuse of the pool. 13. GUARANTEES AND WARRANTY C.E.P.S. provides a written Limited Warranty which specifies certain guarantees and warranties on the pool, the plumbing, and the equipment, providing all payments are made according to schedule. Except as may be otherwise required by law C.E.P.S.'s Limited Warranty contains all the guarantees and warranties given by C.E.P.S. 14. C.E.P.S NOT LIABLE FOR WORK OF OUTSIDE CONTRACTORS C.E.P.S. will not be responsible legally or otherwise for work perform by outside contractors such as electricians, landscape contractors, decking contractors, fencing contractors, blasting contractors, etc., or for any personal injury or property damage, including damage to the pool caused by such outside contractors. The Buyer shall be responsible to ensure timely, work -manlike performance from such outside contractors and adequate insurance coverage for the work performed by them. If C.E.P.S. shall refer the Buyer to an outside contractor, it does so as a gratuitous customer service and does not undertake any responsibility, legal or otherwise, on account of such reference. 15. ARBITRATION AND GOVERNING LAW Any disagreement arising with regard to this Agreement or its interpretation or application shall be resolved by binding arbitration in the City of Boston, Massachusetts, conducted by the American Arbitration Association before a single arbitrator appointed by the American Arbitration Association. The arbitrator's decision will be final and binding and may be enforced in a court. The Buyer and C.E.P.S. each waive their right to trial by jury or a court and agree that such arbitration shall be the exclusive method of resolving disagreements between the parties. The laws and regulations of the Commonwealth of Massachusetts shall control without giving effect to its conflicts of laws principles. 16. THE AGREEMENT AND WARRANTY ARE THE ENTIRE CONTRACT This Agreement and C.E.P.S.'s Limited Warranty constitute the entire contract between the Buyer and C.E.P.S. with respect to construction of the pool. There can be no modifications or amendment of any of the terms of this Agreement except by writing signed by both C.E.P.S. and the Buyer. This Agreement binds all signing as the Buyer jointly and severally and shall insure to the benefit of C.E.P.S.'s assigns. If any provision of this contract is for any reason declared void or enforceable, this shall not affect the validity of the remaining provisions. - — - - u U ° ft� v� Cl 7 O J `; i C J i w rd u U F J ` -� 5 b Yl • O , , u! ti 1 1 Ilia y tf7 Qm cd id n �vs O 4� 41. yl �kyK Otz y� bJO 'd In rv�r� by Uy14 p v tJ�J�j Q q U 4e V In "�" •V7 N J V' bn P' p` O U C7, •fin C ti LL,- i y_IL In da oG' u LL . l ---- -...- -- i . '6 - Ait , o ° R i __ - V�R�c�r� Cu h m W r' O p " 00 n J. •:ly� ii.'.' , �`�` ^d *d..-pvp I!j Q`c�l. F�,.O I (10 — • r y r., u] 0 Ud! QI ° rdt lIl Li ! v, ° O N w r� FLl +J rr j I • —1 WA I Q 1 R � • tt (j m 9 Iq 1 tj IL 4 a�'aa �� V�l PC � Uh r "1 +• t —L b J r p 1 I l 1 + wee , .' �•� ' .I I. ,q ;, , `� ilk 0. ja lk - t-A t , :,'+;}r:. 5 , i :.' ,r✓� tC iui •bY. �r � 1_. , U Chi � 1, l � � 1 9 .31; 4r u�1 � ly�'.tU u � • y, O m•'•' _' , , r � tl d U i •I 1 � 1 4 •f' e - ,`( 1 Y N9assachbsetts - Dep:u-tmcut of Public Safeth Board of Builclino�. Re„ulatiuns and Standards Construction Supervisor_ License. License: cs 93190 Restricted to: 00 DAVID BRABANT u 54 MCDONALD ROAD WILMINGTON, MA `t Expiration: 6/28/2011 ('��minisinncr Tr#: 20531 '4� V� CERTIFICATE OF LIABILITY INSURANCE DATE 4/15/20 0' PRODUCER (978) 664-2000 FAX: (978) 664-0180 Linnane Insurance Agency Inc. 280 Main St. #101 N. Reading MA 01864 DD'LPOLICY INSRD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED BRABANT, DAVID dba, DBA: CREATIVE EDGE POOLS & 210 Andover St. Wilmington MA 01887 INSURER A: Scottsdale Insurance INSURER B:MWC ARP INSURER C: INSURER D: INSURER E: COVERAGES 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 CONTRACT OR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'LPOLICY INSRD TYPE OF INSURANCE NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE ToRENTED PREMISES Ea occurrence) $ 100,000 A CLAIMS MADE F-1 OCCUR TBA 04/14/2010 04/14/2011 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F� CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � BA 04/16/2010 04/16/2011 WCSTATT- ST 7RH- E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ 500,000 (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500.000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS t;tK I II-R;A I t MULUtK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 384 Osgood St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL No Andover, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE M Ellen Stanton/LINMS ACORD 25 (2009101) INS025 (200901) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD of I ; N +i fpj�l�-o'�f IN fnfC6 U (D :(1) 0) otu) ' J 1 I � ' J- ..�oi Ii W IF- l0 coo oro4�ico m O Oft i O !co 0 i0 TI pi {z. 0, .0 i IO 10)1 1 m I ca W i o,MW , -a p m a U fa l `op' OI Q w IS 'IS'oi I, iF% Wo to N, CL W o oo im 014 '> c ., -p o f (V (V4)J (2) ffS fa f0'Fa f6;i �����P. N IT F !nN I o o 'g C41 I C) c O 14il•i Ea m o'c° c C! o t00 M!O! o' i M F -Hi , CL Q 0 m 7 C S m E E 0 U 0 o Z o0 rn o 0 O o o � Q ,o z� U T 00o V) M M M Goo o Z �a W O J N W w � c V �LU y> Do O -! Q a O~ oZ p1 0a w =_ vi0� L: a t= cWW bpd Q 3. Fl CL t O Q o0 rn U) t �. z� U T 00o V) M M M N N ,U a t ..or_ c C) ;o fLo J J e• .,;�F, N i fC N >NOi OI- OO F W app z Qin ' d M M i}. � , Z N N fel 0 O:0'fo O ~ cl LL W!c 2Z C) Q,Ooo �`o' �JJ w ON IQory pfUQ Zoo ; wLo Zti p L 0o ZOo0 f : W:O.Q co Lo t.. p..!LLo� .m == w J ! p •w co J 0) 0) W U o x .?' `° V W Q >mm s' p=I x m Q f f }� ' p O rQ Iz. 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City/State/Zip: 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 ZSA of MGL e. 152 can Lead to the imposition. of criminal fine up to $1,500,00 and/or one- ear impenapenalties of a of to $250.00 a da against the violator. Beadvised that a copyofthiesm s statement may be forthe fbrm of a warded dedOta the ffic o8� a fine up Y gni Investigations of the DIA for insurance coverage verification. 7i1do hereby ertify u der the pains andation proved above is true and corned ture: (7/-)` � Dai• Phone #: �% g — ip J Lf - 7 T Ofj`icial ase only. 13o not. write in this area, m be completed by city or town oft iaL City or Tota; Permit/License # Issuing Aathorify (circle ooe); 1. Board of Health L Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Piumbing Inspector 6.Other Contact Person: Phone #: AM The Commonwealth of Massachusetts I 1 Department of Industrial Accidents Office Investigations of 600 Washington Street Boston, MA 02111 c ` www.nzass.govldia . Workers, Compensation 1witrance Affidavit: B�nilders/Contra.etors/Eiectricians�Piumbers A licant Information Please Print Leaibl Alan a (Business/Orgeniration/Individual): CiR i��'lvr ,fir �L Address: 1©Q"-1,gP c.L City/State/Zip. &94,07 Phone Are you an eatployer4 Check.the appropriate box: LO ❑ I am a employer with 4. Type of project (required): ❑ i am a general contractor and I employees (full and/orpart-time).* 2. El I am .a.sole proprietor or have hired the sub -contractors 6. ❑New construction Iisted partner- ship and have no employees on the attached sheet. = 7• [� Remodeling These stLb-contractors have 8• Q Demolition working for mein an ty. y caped [No workers' comp. insurance workers' .comp. insurance. 9 Building 5. We are a corporation and its ❑ addition required } 3 - El i am a homeowner doing officers have exercised their l0.❑Electrical repairs oradditions all work myself. [No•worken, comp. right of exemption per MGG I I.[] Plumbing repairs or additions c, 152, § 1(4), and we have no insurance -required.) 't 12.�] Roof repairs .ernplpoyees. [No workers? 13. Odaet COMP. insurance -required.]_ "�Y appl216T that checks bo>L # 1 must else fill out the section below showing their workers' bumpensetimi policy information. t Homeowaera who submit this atii'davit indicating they doing are all work end then hire outside contractors must submit anew affidavit indi �Contractora that check this box mustiutached an additional sheet showing the nems• of therb-i.::� ' such cam.p. w.a+p. puri• inmrmatioa. I am an employer that is providing:workers' compensation insurance for my enrp[oyeesc Below is the policy ,red job site . information. Insurance Company Na me: L �� Policy 4 or Self -iris. Lic. #: Expiration Date: -r- fd 1 Job Site AddressC6 0 �C±. City/State/Zip: 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 ZSA of MGL e. 152 can Lead to the imposition. of criminal fine up to $1,500,00 and/or one- ear impenapenalties of a of to $250.00 a da against the violator. Beadvised that a copyofthiesm s statement may be forthe fbrm of a warded dedOta the ffic o8� a fine up Y gni Investigations of the DIA for insurance coverage verification. 7i1do hereby ertify u der the pains andation proved above is true and corned ture: (7/-)` � Dai• Phone #: �% g — ip J Lf - 7 T Ofj`icial ase only. 13o not. write in this area, m be completed by city or town oft iaL City or Tota; Permit/License # Issuing Aathorify (circle ooe); 1. Board of Health L Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Piumbing Inspector 6.Other Contact Person: Phone #: