HomeMy WebLinkAboutBuilding Permit #16-13 - 72 PATTON LANE 7/10/2012 BUILDING PERMIT 0 tAORTH
TOWN OF NORTH ANDOVER 6 6
oL
0
APPLICATION FOR PLAN EXAMINATIO
41
Permit NO: Date Received AreD
_4zACHU
Date Issued:
IMPORTANT:Applicant must complete all items on this page
N -`L
-6
_477—7— 7.
R,
� &4:�* �' - [A.:, - -
�,AbPEAT�
I OWNR
!PHht-i
0-
C.
,l#,-AR EP1&90 " QNLN TRICOT M A,e,�I N 0 y
9
M-hl' ' �fila k ,�
j qq nq� 9
TYPE OF IMPROVEMENT PROPOSED USE
_Residential Non- Residential
New Building One family Industrial
Addition Two or more family Commercial
Alteration No. of units:
Repair, replacement Assessory Bldg Others:
Demolition Others�'Jl
s :Di
tj' - S
7,
Se tic. :7; A41:1
t
"Wate68*6- e-
w
DESCRIPTION OF WORK TO BE~ REFORMED
YZ))AAn X 34
V
Identification Please Type or Print Clearly)
OWNER: Name: 4,,-sh add--- IA44� Phone:
Address: L.JA
P h 6 n ei
C�
0
Add
-7777
't§40"isops CQhttQ. ti
Home '..
-tb*
EkOr-Da
Improvement12fic6iise-.
ARCHITECT/ENGINEER4""&�L Phone: 3
Address: DAnQy,3 Aiq- O(qL3 Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATEST BASED ON$125.00 S.F.
Total Project Cost: $ FEE: , 2z_iK 70-0-0
Check No.: Receipt No.
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Si h e
r i "E Signature of contractor/, A 04L.4"l-
_j�Ptqre q
ZIO/
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
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
o 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
on
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
Li 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
I
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
y
CONSERVATION Reviewed on r ,3 -
Si nature �
COMMENTS `
HEALTH Reviewed on �— :Sjinatur;e4
COMMENTS ` �v
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
Comments
Water & Sewer Connection/signature&Date
Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE 6EPARTMENT
V Temp Dumpsteron site yes:,. > r
;L!; c etl%ta-d24,Maifi S,treet '
'`Fire 7Department nature/tl
r M§ �� ate
h
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
i
Total land area, sq. ft.:
i
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.s100-s1000 fine
I
NOTES and DATA- (For department use)
mo so
i 1
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
Location n Gi
No. Date a���
e TOWN OF NORTH ANDOVER
5�r 'J 1 1:
Certificate of Occupancy $
Building/Frame Permit Fee $l
� Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#�
25490 Building Inspector
F_ , , NORTH
At c . " ve" '*
0
No. rp
L0,040h ver, Mass, •
C0[M1[N9WIC« 1•
�•9 R^Te o
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
THIS CERTIFIES THAT ..................... BUILDING INSPECTOR
................ . . ...:s. .......................... .. '`wn
has permission to erect .......................... buildings on ... . ........ ..........(^.o.... Foundation
Rough
tobe occupied as ....... .. .. ...... .. ... ............................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application 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
b PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
-UNLESS CONSTRUCT T Rough
Service•
............... ............................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
SEE REVERSE SIDE
Steps Position
9R-6'
24R-6' Return
Skimmer 24R-6' 24R-6'
24R-6' ,,- ,
24R-6' 9R-6'
24R-1' 9R-1'10°
4' 9R-4' ,,, ; 9R-6'
T i 9R 2'
Return 9R_6' S�6sa q
i
9R-6' T MIN. 9R-6'
18' 10' 1� i —� SAFETY ROPE 21 Return
AND FLOAT
o 9R-6'
o 9R-6'
9R-6'
4'
7RR-6' \� 9R-6' .
9R-2'2° 9R 5'6"
9R_6' 7RR-2' 9R-4'
9R-6 9R-6'
Return 9R-6'
Return
---------------------- -----------------
3'-4 - 6"Waterline -T ---- 3'-411 9R-6'
-----------------------------
9R-4'
9R-6'
4' 6' 14' 12' Step O
36' 9R-6'
Return
DIVING/SLIDING EQUIPMENT SHALL BE
CRESCENT/KIDNEY 1.8-0 X 21-0 X 36-0 LEFT °E AND SHA°BEINSMALLEDIINNING 9R-6'
' ACCORDANCE WITH THE
42"STEEL PANELS PERIMETER: 95' VOLUMEUS Gal): 20 900 DNING/SUDING EQUIPMENT
( ) T.. MANUFACTURERS SPECIFICATIONS.
DWG#: AREA(SgFt): 603 VOLUME(Litres): 79 100 • PLEASE CONTACT THE DIVING/SLIDING
�j l 1C� EQUIPMENT MANUFACTURER FOR
CROOS 1836L08 LINER AREA(SgFt): 648 DATE: 01/Jan/2008 t14T LI tl�f ��.7 THEIR SPECIFICATIONS. 9R-2" ,any
PART#: CROOS1836 SAFETY COVER(SgFt): 936 SCALE: 1/8"= 1'-0" MEETS DEPTH AND SHAPE MINIMUM STANDARD ANSVNSPIS2003 9R-6'
CRESCENT/KIDNEY SHEET: 1 OF 2
The Commonwealth of Massachusetts
Department of Industrial,accidents
Office ofInvestigations
..600 Washington Street
Boston, AM 02.711
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information
PIease Print Legibly
Name(Business/Organization/Individual).. 0VA.,
- - Address: (}
City/State/Zip: �&wW_kc_ M.-91K b 1 �J Phone#:
F3.01
n employer?Check the appropriate bozo a employer with Z'� 4. Type of project(required):� ❑ I am a general contractor and Ioyees(full and/or part-time).v have hired the sub-contractors6 New constructiona sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodelingnd have no employees These sub_contractors have 8. ❑Demolition
ng for me in any capacity. workers' comp.insurance.
orkers com .insurance 5. 9. []Building addition
p ❑ We are a corporation and its
ed.] officers have exercised their 10.❑Electrical repairs or additions
homeowner doing all work right of exemption per MGL ' 11.❑Plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no
insurance required.]t emPtoYees. [No workers' 12-El Roof repairs
comp.insurance required.] 13.L.Other SLr t wk,nn,
*Any E ulleent that cheeks boximl must also fill out thesection below_ .b ,woi:;,s
eoWY-srL poLcy i*ifozmatioa
f 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 their workers'comp,policy information.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: AVvn VL 1
Policy#or Self-ins.Lic.#:-
I Expiration Date:
Job Site Address: Z. k?1-b"►.0 1_ 1 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 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as wellas 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 certify under the pains and penalties of perjure that the information provided above is true and correct
Sienature: n
Date.: ! 2,
Phone#: —F
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.PIumbing,Inspector
son;
• 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 apartraents 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"every state or local licensing'agency shall withhold the issuance or
renewal of a license or permit to operate 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,§25C(7)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 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
tit �� f�^ i'3r rr toCn t h=t tha F'vvlsc&uRii for the}G 0 ' fl2 eni f
�[DS the l,� —t[!T'P—f of
Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' -
compensation policy,please call the 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 permit/license 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 permits 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would1ke to thank you in advance f6r 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
Office of Investigations
600 Washington Street
Boston,MA.02111
Tel. #617-72.7-4900 ext 4-06 or 1-8.77MAS.SARE
Revised 5-26-05
Fax#6.17-727-7749
70 South Broadway 45 Route 125
Lawrence,MA 01843n Ch Kingston,NH 03848
Tel:978-688-8307 q%W\Vf
FU
1el:603-642-9909
Fax:978-688-1949 s,Nce rme Fax:603-642-9906
providing a full line of services and supplies
fully licensed and insured
www.familypoolsonline.com Z c{ F>✓5
Name ,�` u" c, Date Z l°J.rl12-
Address 72 Poor �-✓� City 14• A,.11(State Y-tCdJ Zip Ot
Home Phone� �t�S- `� Tr`f` Work Phone r / Cell Add'I#
Cross Street/Directions & q m-V T Ra ,-PJ.
Estimated Start Date Estimated Completion Date
We propose to furnish and install on via unite I fir X 3 6 k.At,, (C refs L#' swimming pool for the
sum of$ 1 dl gSy
THIS PRICE INCLUDES:
Normal Excavation up to 8 hours on day of dig Manual vacuum cleaner Idt Waterline Tile(6-)
Backfill and Sub-Grade up to 3 hours 3-Step stainless ladder •Lina Choice_7-v
Underwater White Lighr*@04elb Rape and floats Test Kit
Steel Reinforcing per Engineered Plans for gunite Initial balancing chemicals Surface skimmer(s)
Steel Structure per Engineered Plans for vinyl 8 to 12 Wk supply of maintenance chemicals Dual Main Drains
Ova-Flo Line for added protection (supply depends on pool size) •Coping__Cc �r
Pressure testing of plumbing during construction Leaf net Steps 6e—Lo
•Tei Year Plumbing Guarantee(see specifications) Wall brush Handrails T y}yU 11 C 4l E
•Transferable Lifetime Structural Warranty Extension pole •Filter-
(plumbee nom oathan25ftfrompool) /Jo/J �i7cf1A+�
•Pump&motor
THIS PRICE DOES NOT INCLUDE:
Any plumbing aver 25ft from pool.Additional runs are not recommended but would be at a test of$�1_r..per foot per line.
Machine time in excess of that specified above.Additional machine time to be billed at$1 to including machine,operator,and laborer,due with second pool payment
All hours of trucking will be charged at$ J 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 Stan bit,chipper,or blasting.
Additional fill,f 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 replacementof sprinkler systems or any buried items such as well lines,drywelks,leach fields,electrical lines,cables,etc.that are damaged during construction.
•Cos�due to water or soil conditions(ex.day,peat,live sand,excessive rock,etc.)requiring a stone pack of the hole.The stone pack will beat an extra charge of S W minimum to
$ V3O 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 aid above the stone
pack and will be quoted by the job supervisor.
•Water to fill pool.
_Initials
CUSTOMERS MUST SUPPLY:
Access for all trucks and equipment Building and Electrical Permits or assume the costs necessary to obtain such permits.
Water and efedric necessary for construction of pool Customer must water cure Gunite shell for 1 to 10 days if applicable.
Water to fill pool immediately upon interior finish�
NOTES:
47,1(
v� S
C
OPTIONS: � � -- �' _ J OTALS:
Diving Board ( )
( ) Basic Pool price
Solar Cover $
Additional Pool Lighting t v\,44 tja-p Options
Heater -a2 3 S
EnvironpoollPlus,8 d+2 surface ( ) — SUBTOTAL $ Z 3 w
Additional Floor Heads &%-Sales Tax
( ) D �f t
�PolarisVacSweep
Polaris gfitonly TOTAL � $$�s� 5ma �n
Interior Finish Less 10%Deposit
Spa Balance of Contract
l�4
�
Automated Control System
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 atter 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.
oG� BUYER date
V `
SELL cat CO-BUYER date
�� i
t"%61114,-.I IJ I(v'N I %jv)I-JO I-g ur-uts
ClIentg,5:642 FAMILYPOOLI
A C VOR D CERTIFICATE OF LIABILITY INSURANCE
MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
THIS GERTIFICATE 13 ISSUE13 AS A 1 110312012
CERTIF!CATE DOES NOT AFFiRMAT!VELYOR NEGATRIELY AMEND,EXTEND ORAt.TEIRIHECOVERAGE AFFORDED BY THE,FOLiCIES
BELOW.THIS CERTIFICAT E OF W SURANCE DOES NOT CONSTITUTE A CONTIRACT BETVUEENT;iElSSU!tNGir4SURERi.S),AU-THC)RIZED
REPRESENTATIVE OR PRODUCER,AMD THE CERTIFICATE HOLDER.
IMFO—RUM—A_the_cenITica1a,`io!dor is all ADDITIONAL INSURED,the poiji;y(jes)must be endorsed,If SUBROGATION!_1S VVAWED,subject to
the terms and conditions of the po1icy,certain roticies may require a en
In lieu Of such erldorsement(s). n d o rs01 nent,A statement on this cert�lficate does not confer fight
I)RCOMP
PHONE IVIE:
HUB International Now England PHONE
299 Ballardvale St (AIC.No.Ext):978 657-51100 856.475-793S
�4"IL
Wilmington, MA 01887 ADDRESS:
978 657-51100 INSURER($)AFFC)FONr-COVERAGE I NXC 9
INSURERA:Nautilus Ins Co
Family PoolsNsuRFs&Patios Inc, R a:Ttchn V Insurance Co
.NISURER C:Acadia Insurancv Company
70 S.Broadway N5UREIRD:Safety II11SLIMCQ CO
Lawrence,MA 01843 -INSURER E:
INSURER r:
COVERAGES CERTIFICATE NUMBER: REVIVON NUMBER:
THIS IS TO CERTIFY THAT THE HE POLCIFS 0'-: INSURANCE LIS7EI: PELOW HX,/ BEEN ISSUED TO THE NSUR_�D INIAMED ABOVE FORTHE POLICY PERIOD
INDICATED, NOTINITHSTANDING ANY PEOUIREMENT TERM OR CONDIT ION OF ANY CONTRAC7 C.Ir� OTHER D.)�LJV.Er,7 �,',!ITH RESPECT 70'WHICH THIS
CERTIFICATE [AAY RE ISSUED, OR IMAY PE7� ]Ajfj, 71JE JI,jSURA1\'G-F AFF'
RY THE POLICIES DESCRIBED 141EjREJI4 !S _q*,jFjp-T TED ALL THF7ERIAS.
EXCLUSIONS AND CONDITIONS OF St,'GH POLICIES. LIMITS 8,11,OvvtI 1W,' HAVE SEEN REDUCED 8Y PAID CL41NIS,
TYPE OF INSMANCE POLIC)
R A111T_;_1_Ir_Y NUMBER M
IYYYY� JNI�.!!DD.`YYYY! UIVI17S
A GF-011AL LIABILITY
N N 13 9379 M119011 EPCHOCCUPF;�ENCE
X
7
CLkMS-MADE x
DC-CUR
NicD*
ed: 2500
PERSONAL&ADVINJURY_ $1.000,000
GEN'L A70REGIIJ-E LTJ:!'APPUEe PER: GENERAL!4GREGATF. s2,000,000
PRO. [—I F1A0I1UC7C- ooprP.;optCc $2,000,0.00
DOLICYF,JEC7
AU70MOSILE LIABILITY
1,447232
ANYAUTO $0 0 1 L V I,*J U PY r_pe-s z,r,-)— $
ALL UANEDFY7&CHEDULED
AIJTa-
NOrj&N[z-L) 50DPLY!NJURY Pe,, S
x Ec"WTOS X I
AUT0b
UMBRELLA LIAS
'UP.
EACH Or URRENCE
EXCESS LIAB1418 CLAMAS-WADE
Jz_[) RETtEENTIDNI
WORKERS cDmpENsAr*t,, YVC STATIJ. $
_tl I TORY LIV ITE; IEP
AND EL1!2L0YER$'UAeIUre T C329762r. 12W12011 121311201�, 07H.
YIN r—
'ANY PRCIF>R'eTOfPP,RTNEkIFXECUTI4'EF-�-,7, ,
OFPCMMEMBER Exc;_UDED? LN J NIA1 E,..EACH ACCIDENT 5600 000
(Mand atorn in NHI I
1 L�1 DISEASE EA=_V.P�OYEE!$500,000
D NON GF OPERAIPOINS boov I
it 6PT. :E=D;SEMF-POLIC',.'LOJ;2T j$500,000
C 1Property i CrFA01 8008415
910912011 09/19,1201Z vrs limits
DESCRIPTION OF OPERA71ONS!LOCA7IONS!VEMC'_E6;At Bch ACDRD 101,Addit rnnl Remarks Schedule.if more r;paca Is requirtcf)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCR;BED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE 9,OUCy PROVISIONS.
ALITHORM0 K-;)KSEIITA7;VE
E � C4-*%—
@ 1988-2010 ACORD CORPORA',[ON.All rights reserved.
ACORD 25(20110105) 1 of The ACORD name and logo are registered marks of ACORD
*M62041MG24304 EH002
j�a^ii3d tY 3i sii `�a
Win-
L!C2F75�:
WILLIAM C POU"-OS
70 S BROADW AY
LAWREC�' p,X1.843 -
�xR 711g12013
20968
4 „apaat;;..i,raaar
��ie ??artt�narunev�� o � (�scr��fca�✓,.si
Office of Consumer Affairs&Business Regulation
NOME IMPROVEMEAIT CONTRACTOR
j
Registration,— 118204 Type:
- � Expiration; 2/1312013 Private Corporatio
FAMILY POOLS&PATIOS INC.
WILLIAM GIANOPOUI_US
70 S_BROADWAY
LAWRENCE,MA 01.843 Undersecretary