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HomeMy WebLinkAboutBuilding Permit # 6/12/2015 t%O R T#1 BUILDING PERMIT o&�tLED /bgtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ' Date Received Sys R—tr. SgcHUSE Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION � � �l r��1 V (�C. Leao a— Print PROPERTY OWNER M�ke n t I i e)s Print 100 Year Structure yes no MAP PARCELID�0 ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building K One family W,Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t ,5'e. icy ❑�Well,�.���,� � ,�, _ CF'[ood lata � ❑,Wetlands, „ �,� ,.�� Watersh dw i trr t a� , r�r ,. „< q�. ...�.. :� .u! �r~-. �'.t-..,r ✓xr�.:�t�r ,: :� rr. ,7a-.,. ,,.�.,.,,.. r;,_c.ylF� .;�r.�`,'t; x r .,.: -rrr�:� ..- ,.. s'.2'; �-. ,_�,. ^r r'S, rr,.r �<"„r r .r�rr� r.,.,�,�>r� r .,„�.clr` .a"�,"/,dr2..r�� ..�r�.;!,r,.� r•..rYf.3 ,f�, r ."�,�"fes. ..,��f5r jf";s r,:?.-'s"«'�p' .F r ^a'".::a.,,r,t .-f"�'w�lt fir.. ...r�°Crsr=..J amu. .': �,W�er/Sewers'�sr�r;rrt J�r�u��fF�,��� ��i'�t���rtv ,ar�����w�fr�F?`J��� ;�" ,rC p da��' s:!` r s` � %�✓v`i,�rd x�ir"1*Fas fr ra �`�� , � ss^ � . DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: PUP— Cot(;-is Phone: Address: 5!; � �v+ le L,,oe-- AaJdvt &, 0(84� Contractor Name: tvt► Pcd.S 11PG 0S) Phone: Email: t', n _! neo AoL—e lm Addres . W Cf �tU tt 0t 's,ES Supervisor's Construction License: 010,1SO Exp. Date: Home Improvement License: 2-a Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7S® � FEE: $ Li Check No.: Receipt No.: NOTE: Persons contractingf with unregistered contractors do not have ac ess to the guaranty fund26 %I r Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools p Well ❑ Tobacco Sales ❑ Food Packaging/Sales/ ❑ Private(septic tank,etc. Pennanent Dumpster on Site ❑ �'-& r A T A-YLA) THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF ® U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ �`;Z" -se—.— COMMENTS .._ CONSERVATION Reviewed on Cc �°" �w Si nature MWe" COMMENTS `M HEALTH Reviewed on 1 Si nature ( ° COMMENTS,,_,_ 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 DEPARTNIENTr Te D ' / r r! r r / �, ii fr l/ nl Un1 Ster-On>51te orf' J/7� �l(r/,�!/LIyJ(rl �/ Ii 0 /rr/IO p"' r;r p �//Grd��r �,! ��� Located�at�124/Mamr„°°Street „ ,.�/ ,„ /%/� /,, ,,, r� %i/, f„ r :,�o,�,��il l�/loyi,/✓���` ✓,.,, �, rj rr l¢�r �n�tUre�Clate 1 „-,1. r i.,/Gi,":n r rf,,,X/F 1 !:� /r / / //rG/rr% //fll/�/// /(��ryhrl/i/Gri�/�� fir' /r��/�, "� x r r r r/ %AORTH _ t E v&AN' dover Town o • y ,T - _VW _ 9cil, 16 o LAN. h ver, Mass, A� COC NIC Nl WICK 04 A'riE c) IJ BOARD OF HEALTH Food/Kitchen PEK..M11 T D Septic System • THIS CERTIFIES THAT ...................fh1.. ....... .. : .1........... ......... . ....................... BUILDING INSPECTOR ... 5 ......&.QW4 . . Foundation has permission to erect .......................... buildings on ... 1�......... .................. Rough to be occupied as .......&0..Y.... .. ....... . ..... . I ..... ....�:I6. .......��................... Chimney provided that the person accepting this permit shall in a respect conform to the terms of the application p p p g p ry p pp Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT E I E 6 MONTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUCTIO TA S Rough Service ................. .... ........... ::................................ BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. 70 South Broadway45 Route 12 M i; Lawrence, A 01843 e Tel:978-688-8307 1Cingsfon,NH 0384, aJ 1 V Tel 60, F1990; Fax:978-688-7949 u� "srncei�x� Fax:603-642-990, providing e7full line of'set,vices•and supplies , idly licensed and insured z✓av�v.�at ass lyo�folsorllan:�.t�oen Name Li v l t�)S Date - ----- Address ( _-- �-- -- - ---- - -- — 1 City (�: ��Lc�rly_t State 6i�G�__. Zip U(Sc/-y Home Phone ._ ------------ -------- Work Phone / ------_ -- Cell-1, �)(-Add'I#------------ -- Cross StreetiDirections C' / SCJCoL� ----------------------------------------------- Estimated Start Date - Estimated Completion Date__ _ We propose to furnish and install onemy gurlite_ v k` _ L t z<<J Zc<_=l• F swimming pool for th sum of$ 2, t Dau THIS PRICE INCLUDES: Normal Excavation up to 8 hours on day of dig Manual vacuum cleaner kit Waterline Tile(G) W Backrill and Sub-Grade up to 3 hours 3-Step stainless ladder Liner Choice Underwater White Light 120 Volt Rope and floats Test Kit •Steel Reinforcing per Engineered Plans for gunite •Initial balancing chemicals °Surface skimmer(s) � _ Steel Structure per Engineered Plans to vinyl8 to 12 Wk supply of maintenance chemicals Dual Main Drains Over-Flo Line for added protection (supply depends on pool size) Coping-, �-� t 'L" Pressure testing of plumbing during constructionLeaf net •Steps_ �c 7J - __i-_-e— Ten Year Plumbing Guarantee(see specifications) Wall brush •Handrails Extension pole °Transferable Lifetime Structural Warranty • •Filter—_ �� Vii✓/tc:.w (plumbed no more than 25ft rom pool) • Pump um &motor—i--I {� THIS PRICE DOES NOT INCLUDE: t: w/k'l j{ 6r •Any plumbing over 25ft from pool.Additional runs are not recommended but would be at a cost,of5_ _� per foot per line. Machine time in excess of that specified above.Additions machine time to be billed at$ fes) including machine,operator,and laborer,due with second pool payment. All hours of trucking will be charged at$. !�Q per hour per truck due with second pool payment. Any dumping costs incurred for disposal of ledge,large rocks,garbage,stumps buried or otherrdse,building materials,unsuitable or nonstructural soils,or any unforeseen material that must be removed. Removal of ledge or large rocks by way of a Starr bit,chipper,or blasting. Additional fill,if necessary,for proper backfill or reshaping of hole,supply or spreading of loam,reseeding of grass. Patio,fence,retaining wall,or any accessory items other than noted on contract. Electrical wiring,fuel connections,heater venting,fuel storage tanks or permits. Repair or replacement of sprinkler systems or any buried items such as well lines,drywells,leach fields,electrical lives,cables,etc.that are damaged during construction. Co d e to water or soil conditions(ex.clay,peat,live sand,excessive rock,etc.)requiring a stone pack of the hole.The stone pack will he at air extra charge of$ `_ _minimum tc $ maximum and at Hie discretion of Hie job supervisor.Additional machine time and/or materials necessary to rectify such a condition will be at a cost over and above the stone pack and will be quoted by Ore job supervisor. Water to fill pod. CUSTOMERS MUST SUPPLY: --- Initial: Access for all trucks and equipment Building and Electrical Permits or assume the costs necessary to obtain such permits. Water and electric necessary for construction of pod Customer must water cure Guaira shelf for 7 to 10 days if applicable. Water to fill pool immediately upon interior finish NOTES:_ -Ck 1 t 'I - I.vr%t `�" i�'t i1-✓N_ z• }-Zr e4L,3 _f OPTIONS: TOTALS: Diving Board Solar Cover (�,7�d d1 �� lLr t-�) —__t`il�7__._. --_ Basic Pod Price $ — Additional Pool Lighfiny Options Heater t ) Environpool Plus,8 hd+2 surface ( ) __—f_ tl U SUBTOTAL Additional Floor Heads _ _ 5/u oSales Tax rj S Polaris Vac-Sweep Polaris retrofit only ( _ .- - rr.. TOTAL Interior Finish (l ( ) _- _,--___--- Less 10%Deposit Spa ( ) - ------ Balance of Contract Automated Control System — Salt Chlorine Generator Otter GVo PAYMENTS:113 EXCAVATION 113BACKFILL+EXTRAS 113 SYSTEM START.-UP The buyer hereby agrees to pay,in full,the total amount of this transaction upon start-up of the installed pool.Your salesman or job supervisor will meet with you prior to excavation at which time all decisions including pool size,shape,elevation,liner print,and all options must be final.Changes after this date will be subject to extra charges,where applicable,and will result in unavoidable delays.You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Credit card payments not accepted on contract amount. BUYER date G.�.�.:, r i 2-k �lis•�`.�, SELLER date—'date— GO-BUYER _ -date _---- � L � � rt - ii�'PkdnPoads tt8f1•°a9- c ._ .. . �0'—D' 4.4'Rndrs{m�1s OBOl-U16 i4-&aas U8ti1-1�l 2'RAL, 9` Er 8' 8' 4' F4•�euilknflan DwI.21tWl0 2'RA]R 1.51ed lterde ltir 4800 Qi6 t^—E F "'a'�"l a J k •-� d�- 2•l�' 4' 1•TAedhest fngGrrtwSit 1001-138 "3oxhk �'' iD rrdr xA tt rve� >° tr f-Y�yi t>ma 411-2 9' ,a,f�. td a1. rt° x�F.. ar�� rs'n• r �;. ..� . - �..- �� 20,u°t 8' / andl�uie�ra2.9'paltrlsltmarll•6`�p,!•s�ot�ls � �--tw^ 44`-4` $' d`S P�o-re 24'paint.liar l-d`stap,24'pWk 1 AD 4' 8' 4' 2`RRA. 1 sIhler2$ M142 77iE'RAD 41'— 2RAA2 L > 4' 5` . . o DIVING 2'RRD. ae*afoaocmwmc+(axsscew �y 8` 4 T...ea+'rt�.+bb.�..a.aaerosa.�i.byfS.Ld.N�fY�I �.� 17bpodea<rtyd hh!Q1P[Xn1V`bn �nQ myredddf poboefSePA9'maWibit66Mihedr{,fcl6r�k! ..,.dam-nC k �1w c.dfnafht6mlmtuaad5w .F �.avwr4,kib.l�.cv+ceior..6a,.l�mbttffrn*ad6rntriv�d.e d,.vmt��Fe�w..f a°°0s-�7',;folie F.- .- Vii. y -'L we+oo>•on�isfr m arH�.�a.s,s�tvan.�fr�o�m�PndrHufm>d `Qf n}S b)V pokt of=Mrs. Nspt rfps ol t•'ar � a••�eab•�r�M•.�..a��.aeo..n.n.y�..ea+.a poml�...dJ��a.a .r.,p•r+.r�II�,:fk..ew+i d6eIm Rm"aS.`t :. t. .�.� nm d•�,frt.�r�Yew.a...ae.s,e,rf��r�hg rfm.[seamaba fgao6it FFFn �. �_✓�OeLFc4L �f0ee1riN/g6QV'MSV'Ya9f'.b7G�(gDj Pd.P_ �7.fr� f.$FYllowdn'i'6f L�tlI('RaUm.wd. 6.a.�,r.aty,r@i'^lMtlzwdk.m�ib1.1s�{��4a6xflAemdih'enCevO�ra.dLIammn�oaf�c,4anY�wlt�hsr1,'�ffi'.dptl.�lNfR�ak.JSffinemkOf�I�ICfl,eydeppA�.S��1M.lNapnerty�liOacteTWf r}+akaGunld STERLINGYZ11Llppf;P- w .. f(`1FLS8{:-0t:Z�•�tHSsi ' 2x816.7 Mata S The Commonwealth of Massachusetts f Department of Industrial Accidents a 1 Congress Street,Suite 100 Boston,MA 021142017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMCTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): � 4G` ISVfLL Address: City/State/Zip: '2 ✓+ A, 3, Phone#: 017 S-9 93&7 Are you an employer?Check the appropriate box: 'Type of project(requiI•ed): 1.4 I am a employer with ?�employees(full and/or part-time).* 7. EgNew construction In I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9• ❑Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10F]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[�Other4pa �- 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I arrr ara employer that is providing worlrers'compensation insurance for rrty employees. Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins.Lie.#:__bJ111,2117 Expiration Date: 12--34 -i s 8 Ci /State/Zi l�r�Ulf n Oy e,f. 1W Job Site Address: isa � 1'e7 hVi l Ie (0 � City/State/Zip:p�_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a S'T'OP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is tate and correct. Si nature: Date: Phone# LLthe only. Do not write in this area,to be completed by city or town official. n Permit/I.icense# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector son: Phone#: North Andover MIMAP May 27, 2015 u Y, tl i r rr. �r>"��'�*Jai �✓ � �rr��w11!��� 1, �kh'h. �lru i u i ei i l l} I 4f f I b�; 3 f. I rF, Interstates —I —SR HodmnlaI Datum:MA Stateplane Coordinate System,Datum NAD83, - Roads Meters Data Sources:The data for this map Was produced by Merrimack NORTN Valley Planning Commission(MVPC)using data provided by the Town of Cr Easements �f tt4�p rb p�4 North Andover.Additional data provided by the Executive Office of MVPC Boundary r qt '6 p Environmental AffairslMassGIS.The Information depicted on this map is Parcels for planning purposes only.It may not be adequate for legal boundary �6 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY VL OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ��sSACHUs�t 1"=68ft � ° North Andover MIMAP May 27, 2015 • ' tl ao 41.F,r 0, :"if Y.tf.'.•:... `o'�t.CF ., I ;J�,lc{ 4I, kJ.F{ If ."atle:.: , .. -tI,-• ''•.:.s3,lC{. �lJc:•: I, `�).�^.:. tIJ S"�J.!." tli -••'�:=„ Ffi., tlr •� ;'� •'al, ••'`��F{•:::•_ I - F{ tr ^�J,tr ^>�J.e{ 4I, Fi ~r�lu ,rf �4flf{ .„ F �,• '�alv ��~**,IF{ �,s�{ ^r3J'`4+,5�, '�sl✓.,r.:.�::: ��I.F.{,.,._, -{ :� � � I ;4'�.F,r' tl, �,� .• 'T'},U,f:tlr.•''�I,{RZ ....,•,� 'x'�.�, til ,•': { to ;��' ,�.tr ... �J.t{:•`-:, f;,r.'`:” ,,ire: ,'" •:r:3alr. =:_... . .�„,::.~ t �- t{ J,..;:.. aL<: ''�"�" ti `x3lf,,!; I�.l,c{ :_:_+•:�;+A '•axir'.•'�_:=tl'`J: - xl ..J's).� 4 f ,�F{ 1 .'V�.{ 4L '" .:•"s'Sa.&" IA ''e-e'tIf "; • „ Af�...... •t ,. . .,•'.'y( ::-�,..*'`.tlx' `tl _.. •' .� SIJ..... _ .�.J:3f.�F.,{.••trl . 07, ::-S`,at{. •"••'„a,r,{ o-`tat{. .:_.::•,',`.• tl,_- r'- ''4 "!! tl, Y'kt,!{ _., • AV 7. f _, 4 " xl lu �•f ttF,P ..�IFc Rail Line Wellands Zoning Interstates Exempt Lands Bus lne s 7 District I ( Buslne s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR M Buslne s 3 District Meters Data Sources:The data for this map was produced by Merrimack WW Buslne s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Tovm of Roads M Genera Business District f J 'q North Andover.Additional data provided by the Executive Office of III Plan— Commercial Dev O b4 {,s o �•6ti0 Environmental Affairs/MassGIS.The information depicted on this map is Co Easements Corrido Devote ment Dist ? 4 O p � L for planning purposes only.It may not be adequate for legal boundary MVPC Boundary 1,',Corrido Development Dist O -- m definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER [3 Municipal Boundary X Corrido Development Dist (" 'A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overlay Indusln]1 District * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Indusln il2 District ^y w' ,y OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Adult Entertainment Li Indusln 13 District .K no M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Downtown Overlay District „„,w +,'� M Industri I S District 'a THIS INFORMATION Historic District o44" 'p�` ej Reside ce t District �1 0 Water Protection qs i Reside ce3Disldcl SACHUS� El Parcels '=' Reside ce 3 District ' '#Hydrographic Features ,.l de ce4 District 1"=382 ft �(�de ce 5 District Streams Y Ede ce6Dislricl mage esidential DisUict '.. Client#:53642 FAMILYPOOL1 ACORD. CERTIFICATE OF LIABILITY INSURANCE5/11/2015 DATE(MMIDDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT HUB International New England PHONE 299 Ballardvale St Arc,No,Ext:978 657.5100 Alc,No): 866-475-7959 Wilmington, MA 01887 aopR ss: nee.certificates@hubinternational.com 978 657-5100 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:Valley Forge 20508 Family Pools&Patios Inc. INSURER 8:Technology Insurance Co Family Pools North LLC INSURER C:Safety Insurance Co 39454 70 S.Broadway INSURER D: Lawrence, MA 01843 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD[SUB LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY 6015920803 9/19/2014 09/19/201 EpACMHpOC7CURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea NToccuE encs $100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $51000 X Blanket Addi Insured as contractually squired PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- JECT LOC $ C AUTOMOBILE LIABILITY 3947232 12/31/2014 12/31/201 'OM a BI NE SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WWC3112837 12131/2014:12/311201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YN E.L.EACH ACCIDENT $500 000 QIRYLIM[IS ER OFFICER/MEMBER EXCLUDED? ❑ N/A I Mandatory In NH)and E.L.DISEASE-EA EMPLOYEE $500.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Property 6015920803 9119/2014 09/19/201 vrs limits Spec Form Repl Cost $1,000 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation has Blanket Waiver of Subrogation,as required by executed contract.Work in NY is excluded; new construction of 10+u its is excluded. Re: Mike Collins,155 Granville LaneYAncNover,MA CERTIFICATE HOLDER CANCELLATION Town of Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St.,Building 20 ACCORDANCE WITH THE POLICY PROVISIONS. Ste 2035 �•Andover,MA 01810 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S1378479/M1283395 DKO04 A j, Office Of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 118204 Type: Supplement Card FAMILY POOLS& PATIOS INC Expiration: 2113/2017 GLEN WIGGIN 70 S. BROADWAY LAWRENCE, MA 01843 Update Address and return card.blanc reason for change, Address Renewal Employment Lost Card Ree of Consumer Affairs&Business Regulation License or registration valid for in dividul use only E IMPROVEMENT CONTRACTOR before the expiration date. Iffound return to: egistration: 118204Office Of Consumer Affairs and 611sinessRegulation Type: 10 Park P1212-Suite 5170 Expiration: 2/13/2017 Supplement Card Boston,MA 02116 FAMILY POOLS&PATIOS INC GLEN WIGGIN '7 70 S.BROADWAY LAWRENCE,MA 01843 Unden5ccretan Not valid without signature f construction -supervisor CS-010330 WH,LL4,M C POU LOS- 70 S70 S BROADWAY-- LAWRENCE Mk 01843 92. 07/1912015