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HomeMy WebLinkAboutBuilding Permit #357-16 - Exception 9/18/2015 %'/�lws Flo t ScA1►1U&:b TOWN OF NORTH ANDOVER. APPLICATION FOR PLAN EX Z�ATION ���R7h"' vv�av 4aa 4.� Permit NO: Date Received == •' a � StRCNUS'� Date Issued:_ r EMPORTANT:Applicant mustcompleteall items on this page /Vrjr4L e-0 AA Chi LOCA.TION__ ��� �R�A`I— N� �_�_ A)VL 4J- A�D 8 u L-2_ /"t Print PROPERTY OWNER !J Cc-..e..- C L9 Print MAP NO.: 6 1 PARCEL: ZONING DISTRICT:--:;: l TYPE AND USE OF BUILDING _ HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE _ Residential _ Non-Residential ❑New Building — ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Movin relocation `�Qther ❑ Others: ❑Foundation only DESCRIPTION OF WORKTO BE PREFORMED Identification Please Type or Print Clearly) lay f /01 3 pve s� OWNER: Name: No,-cc A N b oo ck Phone: (T 7 -0) 7 n n Address: Q0 _6 &,q A- lYc��-0` �cs�c�. �l ' g tI e J+S �r C CONTRACTOR Name: S�P A I �5RQPti "TeNAS 56'AC0,4 S'T Phone: b8 3 S-70 Yg 7 Address:_ 5 NA -(TU CK VYA-y /J eUJ L N 6 /114 0 p Supervisor's Construction License:_ _ Exp. Date: _ Home Improvement License: Exp. Date: St µ 5w G'01%%peRt2- AR.CHITECT/EN.GINEER Name: Phone: '7 � � `�� -7 '? C Address: t )J 5 f.�A t(�{�4u N� Reg.No. -I ti ( `I 'Mt C�(AV.( J`� -�rc .1 O �3 FEE SCHEDULE.BULDING PERMIT:,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$_ `3 O 000. O J x12.00=FEE:$_ Check No.:� Receipt No.: 2 Page]of 4 s � Location 5w C Ty No. ' 6 Date .•-� : . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,; Building/Frame Permit Fee $� Foundation Permit Fee $ x � Other Permit Fee $ TOTAL $ Check# . .; " Building Inspector .-- j NORTH BUILDING PERMIT o. TOWN OF NORTH ANDOVER io- APPLICATION FOR PLAN EXAMINATION T ZT� h Y Permit No#: Date Received AC US Date Issued: IMPORTANT: Applicant must complete all items on this page i LOCATION. - Print PROPERTY OWNER' � . Print 100 Yea kStructure yes. _ no7. u MAP PARCEL : ; ZONING DISTRICT: Historic Distncty yes no _ Machiiie,Shop illage yes ,. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic b V11ell ❑ Floodplain1Netlands ❑ Watershed Distract; Water/Sewer ` DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Gontractor'Name _ �Phone Email: Address: t -_ p y ExDate.` Supervisor's Construction License p Home drmprovement.Lice nse a :Date: r 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: $ FEE: $ Check No.: Receipt No.: 740TE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor . 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 o Floor Plan Or Proposed Interior Work o 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 2014 3 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS mooning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes `Manning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Towr,Engineer: Signature: FIRE}DEPARTMENT, , Ternp ®umpster gnsite eyes -•� o cat ed Osgood Street ,LocatedatMainzStreet gFire Department s,ignafure/date , _ , t 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 approval requires a Electrical Inspector Yes No q pp al of DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i LJ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Final Construction Control Document N W To be submitted at completion of construction by a A ' d Registered Design Professional h for work per the 8t"edition of the O,,M 5y0 Massachusetts State Building Code, 780 CMR, Section 107 Project Title: North Andover Pool Deck Date: 09.29.15 Permit No. Property Address:500 Great Pond Road, Andover, Massachusetts 01810 Project: Check one or both as applicable: X New construction ❑ Existing Construction Project description: Pre-engineered floor deck above pool. I Jeffrey M. Reder MA Registration Number: 48535 Expiration date: 06.30.16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural N Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. OF Nothing in this document relieves the contractor of its responsibility regarding th s G 107. JEFFREY M. ` a REDER CAP Enter in the space to the right a"wet"or S electronic signature and seal: 9.15 NAI EAG Phone number: 513-851-1223 Email:ireder=clarkreder.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 F_ , NORTH 44 W. - A­. d , ve . 0 No. ;01 In h ," ver, Mass, COC NIC«l WICK S R^TED IJ BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System rN THIS CERTIFIES THAT A. //`` BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .p. � . ....... ...................., f=/ to be occupied as .:...� ....... .... .. .. .... '.".�..�... . ......... Chimney Rough provided that the person accepting this permit shall in every respect conform to the terms of the ap lication Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR © UNLESS CON TR TI S UC 0 ST TS Rough Service ................... .... ... ..... ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildink 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. Initial Construction Control Document a To be submitted with the building permit application by a > Registered Design Professional for work per the 8`l`edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:North Andover Pool Deck Date:09.17.15 Property Address: 500 Great Pond Road,North Andover,Massachusetts 01845 Project: Check(x)one or both as applicable:x New construction Existing Construction Project description:Pre-Engineered Pool Deck Structure for wedding. I Jeff Reder,MA Registration Number: 48535, Expiration date:06.30.16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural x Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee-SGH)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'. OFA Enter in the space to the right a"wet"or JEFFREY electronic signature and seal: NI. A .15 Phone number: 513-851-1223 Email:jreder@clarkreder.comjONgIE�G Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 R 11:0, 0+ 7 .. F'. 6133- TCf- 557 436 Shattuck WAY Unit A 1a3 para eff,i ttsau sort ctss assiaa�a7r� Newington, NH 03807 < this eortmla is rye . ■ij./�.- ��, i 1'L\`+�( 9YT19 T lkY �q � Yh •• �� i ,, „P r.5 > i. S bV''Y✓ !}��. S E A' .C:: © A: S T. � � ,., ., �.... z Customer ID=== -=-= --==- == - ___--======_ ====_== Contract ,Number 97847583`95 RESERVATION 0001-0°01863-10 ------ ------- ---- - --- --- --- ---------- ----------------- ----- 09/16/15 Reed JoAnne North Andover Country ,Club Nort{ An Country Club - a Reed,., JoAnne500 Great Pond Road 500 Great• Pond Road North Andover, MA 01.845 North. And over,, ;MA.: 101845. , Sales Elizabeth Simays Rsrvd: MON 06/23/14 Primary Contact JoAnne, (MOB) P:.. 975-475-8395 X Delivr: WED 09/30•/15 Primary. Emai1:mjmlreed@verizon.net Out' SAT 10/03/15 Alt . Contact:Lauren :(Bride.) P: - X ' Pickup: SUN 10/04/15 Event Stara Time pm . End Time Lauren' s Email Reed.Laurenl@gmail.com Steve is the GM of the club ._ Jim Titos is ..the Superintendant Monique Johnson is the planner 978 7`71. 1061 Deposit refundable. is North :Andover. denies permit $7500 of $9000 initial deposit moved as cash deposit on =8/14 . Remainder on the reservation topay for engineer -- - - a ---- --- ---- -- --- -- -- - -------- .-- -- -- -- - ------ =Item y., =Item No.=--=Qty=Description -.__ - =Rate Info==----=-__ Unit.. EXtended` 9997-0006 1 ;Dig Safe- Discount: Your prices «_ 0:=:000 0. 00 Client is -responsible for all underground utilities Anchori-rig .stakes go, 42" into gqr.ound.� You. are required to con act Dig Safe At least 14 days xrior to installs www,.dig_safe.com - or 1:-888-34q-7.233 _ _. I w,Vi n4 itit nwis e ON n IAT THCMA"MM 'i0 RS:F At?litTi;iS+3@OVA MS S4Lx','G?4�iFRG THfRC'a`ir7f t�CS?IIA.Lmli'6TWEf6 gE?Td:'�cT4Ta'i'97IICY tiit"s`INu U€'s��iLft�#h.LYtila�.r-;6E}�h1YCt1,�gstis p 7 - h doraa�a w mcc rhatge a�>ptestfied,subjhct�'tfrr 1-�t,tar�3 add tXr ErxEi:nsr,iu�agrFe?�rtriss#€fq tre�+rrs rrf tn�s sr,rf^art aril to;r2tis^re ' Vou w is_E tY anter$1,5DD of ascii er>}aE damage to t1t?items ren ed,o'tder tAts contr; and far taws doe to fii% o Us,ntr w:�sd^torm,uasat ani "� n be e5cdd f m. the vniv izoweier,an.'d 3os or dara�e dt to E , nt t..e,tr ahiKe tinyy ronrersen fsvain >harges,$nfet fltna3• fi u darna�r,.riy32�riav5�tiis€�fhr.�uxa7iY>�of s'h`orfaq�diicio3ed ot?riteMbiv .ri,r�seht"n�4r,4r4n�ewri„3`d#nr,.c�.'�REa a,ng t.>re.r�+L�c#:cap�irtY cts•(�ntaYS" � ,..� .�` `� itet?rs.Ltisscaused+iSY inYYY nt y"eix,ycs�?�?npidpe�s�r^�eraons i'o'ad#trsiii:�c�i�2ust�m�ifena,;c§sct.7v tts 6rr*ae?,raf UeEerm o£ffriz r#ernac�t3 t.res,rims caux.5�Y hla vc ts,8ruiees c"&,,rrrad a66 th e,dwoaga to i uan ouettreside.or i4r,ince,dr OtW t*s5 due to Yod'r favute to tate for thi rented#temas a Prtiatent man wold.h s ow4orope tv.tt"rs wrapped i)ij dstic wM cam nv=;rtesv,candle svac on)rens.eQ iiAitxept and fineA:;:?p nitw`r d oe eml.med tvsn.pnifd6wtid,or .Syf i5 4f t N t!fi„a;CE. Ezra+ burred eynnd cies i'rn�av1i46e c4 at od2hss:tEjiiaa$m f vatue"n ads rit.Ts cne<d%a4 t a ge,if ar= such io s h�}e3tea acrvnereaay e`tie: cs i r tit,-a e rdiY an gf the waiver hAist Vou mom.,r ax 99m qis�taz of .in h'.c.a pon,to the.p, •er taw Brit-rremeht auiftcmtas s5d f finish vs�r�th a- r.rst;du jFdee%y�,ura:�a c.asc rr:5 Ytst r loss,you at nxerci O r gh's avaaWe,ta.Vo,�y�C��nderg uS'itisura+�ce,.te};e eit i"'3e-'cur3E5 wqX tiwa3wwata rs� fonsuet,ir 3� cB�S=fi l>u -0 5 v5a 1r seas1a laid van ie: garflsutal ff+�K s Y 3 `e V m"I&W0 01- 018 6 3 �0 _*-mo-r-e'd *_j R 11. 0 . 0+ v P. 603-570-4857 438 Shattuck" �y U, !tz A: ltt s � ni;ta ar c rt stcrrr al zlrt� _.. Newigton, NH-05,801 is"gri 14q'p wr , .wrrMI1MIM�1 3SP ��' a� tom€ •a - .„ 2 »� 2 n „ t M UTRRY TTS 5 E A C 0 :,A S T' K:. Customer ID-------- - -- _ =_-__ - --- ====Contract Number --- -------- -- 9784758395 RESERVATION 0001-001863-10 --Receipts Summar - -- ----- -- -- -- ---- Summary Date Seg Method Ref/P� Amount RENTAL 27251 16= 08/14/15 07 Cash 7500.. 00 09/14/15 09 AX Credit Card 17000 .0'0 Pickup/Delivery. 300...00'. MASS. TATE . ` 1703:2' Total 29254,.36 Deposit 24500. 00 I €HAVi ALAU S€€Od'OrTHIS'AGREM-47 ANO C'W'If* R'A4T 3i�'aC OftiW iA'yk OfI#teY S@DE ,TOIbSiF PRiwI`A AdC3vE frlY SiGTdtTE1RC fiWtRiA9i;P1t709h>:-trR VY�WCRC*E3E5-111TMMW�Ew6Yai€+O,3DE6 t-C;itElh b+3tv7A.'GE xVA(f".?f NAY / »,„.,a€,,,z,.g• k .• ENel37enagP WRiV£f Gb@fie ac rtk6`i'•i�4 sui3}L£L`tbitts4��,`.m€'_3t=i3?'.5 khil PrrciUfiibrt§3hrcz'Y'a.� Qr,"''�:S+sS�iiy'�f c&rn's¢7f�tIS cG`'t^act a'3�sta Ielreve yw pi E7�'a�C€t�uneer$i SDO a�aitit3entef dan°5ge to h&Rems r€rted unser Chf-�O rtsoct xrx�far lrsys dse � °€.-, rstax,rart va;rids err:,uFset�r�i s:dc LVe exc'uEe f•�{?Y;'th�'t�atv�*x,fukWevEr,andio>er'dama�dUz Yn t��e�t.°as 34.x",'sr ab�s�;ibif-bs o53vi<r�i�rfr h3wi':�fi��Fax�es irtaht;cnai <��. d�rnagr;,r?tV3tevitrtts'�s`saFP�r�Yi�"��t�4sgedi�7a3ed o�ki��t�nrr',�.ti resuhsir�£tors c�v�rlva�ltl�or€xin�t£-xsd czpatity:x�rrkhrm(4 :,_4 ^ra �'' - €tems.lrJASY&USltl bti?s�4C:�i#at ptiki Y9urro�ttp9CYafF%�'la�r+3ta'fr+?tolai'gmu efott#3t�rr{ikeas;.3s3adu�.n 0r��c�at the tern3s sli'Yfiix a�heCnR��stf ... .,, .,',�. .�" ,-� ' damage r:�rtes,rims caure��}e Gi3iynat4,bruises cert,r0.rd tiaX.ttds anis.tfie?ke,:ien;aga Eo c�R is•r25u;t€nR frsstn�r5 Mien±z�ue ts..c•J,side�r rear:*fearanee..t}r oth�Sass Sue to Yov�{ai'Etre 20 careier the rented stern as a pn;degz man vruuitS his�vn Fsc�,erty C srsi'r�rap€sed it Ftas caw'.=asss��r.`dev�,z�rrdie aaax cF�,lir�rls,eq.itpmelt.9ixn€stern,nqz re°uan2ti u�[e#p€ried ssrn,m93dew�+i oe w .��r r i€u:rttA�uef.nc'rre burnzd�eyana clee:rtir�wviQDe d�ar�e�2ng•c�,�taz�z�nt valx::nad83nTrn�fa}��s�;ata..le;�at��:i(ary's;yi�i�s'n�:§e�tes a�.r?me:n��rf�+�'he�a��,ri"tiY;der6,aatm'CidAc�€s^,v�.tfewaYet isthat i*oudr� �nr .mrst�S txtF.ta.;ewr he a •.i thr;F'��h=r.sacv ent+Lrceni�M authcxR.s rs�jur^ash u�uritis n v.€'I`C+E�-?vrr y,carnrcc+�-pYer�a�r'4ur€osS,(�r'aaii ezer4�se n3;rRMz xuai€ab3e?a gD under nur ln5urence>Cake aft D:G'il.R�S """"';�...A.�._ P Y 1$ F @ iPrti§Say 8ry attc€ ...........zo n'su.ti 041— l( itry �i eedc iron u ch nS rn v io us," ushe 91t/eY� �sn is Sl�tsrat.i a ve Y ordes v ar su ayt@ 0 01—0 018_6 3 €— _ R 11 . 0.0+ s 0 Pi 603470-485 �•. _ �, 436 Sha'ttu&Way Unit i� ".lit rerr��tlrt tasarp�rrsrt rzr�ter rpabili& Newington,l�k-63;80 this'ronarr a{a'rsa't�t&'0' 1m avledj,taper S E E Y\R Y i. E1 7 i W Customer 'ID ___ __ __ -_ _ __ ___ ________ __ -===Contract Number, 978475'8395 RESERVATION 0001-001863-10 9997-0025: 1 4ermi, ing�- Discount. Your pricer 0.000 fl 00 Client is .:res onsible for, checking their: gown laws regarding ten /;temp structure permits. If required Sperryy: cTents offers . the. service of. Pullin , permits for .$5'0/hr -fora minimum of 6. hours + cos of permit. 9997-0003 1 -Delivery 'and Pickup- Discount: ickupDiscount: Your price 0:000 . 0.:.00 ''Delivery of tents is scheduled 1-5 days before your. event. Pick-u is scheduled 1-3 days after. You will. be notified of actual dates the week prior. Specie . arrangement.s`.can be" a'de at additional Costs . 9997-0007 1 **DAY-OF ONSITE ATTENDANT** Discount: Your price: 0.000 0 0.0 For rentals over $10, 000, an. on-site attendant will be provided for up to 4hrs. If the client requests the attendant sta longer, the client will be billed at the rate of $7 /hr, for each additional hour. 50000160 1=;, y46x105 Sperr Sailcloth Tent 371875 3718 75• 5020-0010 14 Clear Sides (7 . 51X20' ) 3000 420.-D 5020-0015 1 Clear Side's (7 . 51X10 ) 15.,-0.0 15 00 5030-0630 1 :Perimeter Li hts for 46X105 =,288; 20 288'-.20- 5530-0130 2 Dimmer Swi ch 60 . 00 12.0 00. 5080-0050 1 1,2x24 Band' Sta,ge , 72-,0.,0-0,:_: .b_72,,,0, 00, 5070-034.0 1-A.81 X112' , Leveled Floor (<41 Grade) 28066. 50 Discount: Your price: 20769.,210 2 076 9` 21: ,Includes,Finished wood floor cover -PRICING FOR EMPTY 'POOL -Club is pulling required permitting :. 5560-0120, 40 B of Handrail for Engineered Floor, 40. 00, Discount: Your pricer F' 30:000' ` 1200` 00 ' 9997-0004 1 .,--CONFIRMATION=- Thank you for your non-refundable deposit ! Your order is reserved. Please remember that: tfina-1 payment is duea minimum of two weeks prior to;.your - event E° itiR`Ji:fiEA4TplCTLtdNiS�COPdA€llgt��4f5fd3C8'yNS1iSE�'i3ETeflStplaE;�tt€tfJ� '�JC£k3�r €�aYT=J?krnit:�i�bGty•ftiLf3TakpS€UEAnE'�fsSicE�t •� � ToA5uWNT'MMOVE MYN€3WAAGL WANER.ifiu. t?ie damage wgint rAwge as Wsif_ed,subf�d foo lis imfi0tas 5"ta wbis€br beir~,�.',ti fir €ei.:riRhrlifY=i=e rrn s of n s w*&Kt an,.,;..D:r.j•.ve c of la i€y trace Si,SD 3e tzi larvae to the ferns Bred under thi co»itrac and nr'dss due inte> r rs an.wands orm,unset e f k eol" e tit UtlC`f(t?t tl:e'tva1V' ;hodrever,�5hC7 10 d or L�asr a 'disc tc-thile m C c"or`abwi-ff?I by•;or"rsloo, oL`r(",p�ciuii6s,'+ehfitultl ' `�,t -n„,�.<: --'"� .,.x as:sane,'rts�'ste2t`utn- "i5apk+"a*ani ci'snzte disa5se8 ar?nventarry ':tsssnsuit+trm aJerlad€!tq,or axc€•edin xhe:tt�led:.canae�Y: •rah ais: _ ":: itt� s.4x+sg ra'.istd b*inf tQN oT-y'Su,your ode to bmael,a#ehe,tarms of tNs agreement darnage to,`res,rims caused by bioivatar3,brtilses cufs,roa§howds and the£1ke,dmage to sehitse rL�Vng f.'urn Fci rave het 1;side ar re t>Se rarsce>ar n$ toss w! t0 Yr r jai dFe to care ey the rented lYen as a.yn:dent man svouiu t<s arosn ptopettp l er s wrop3 ed in Blast c wii eauw in,d vu„andle wax ors l rims.etfluii#)oeot wiui[nep not rewme r acture ed issrn>mildewed or w:t s nt,r,a atn WNkA €aureedt�yo rd clef ti g tall!be cWtiedittrs fe{iiatr:.ttem vAre n add'z t r to t€o+e°itai c a ge>it 6ny'tuzh ic%�?h vAo a cr^rze:r day ceavt be-_6 coYtbnirttK, a co titrori of tf e w s cmt b"hat vou,nitro?, a�v 6.tom arcs�G`N€nwC to P t�i tqAie ?h�^e('Rp iadfirrmCtri,offrpah's'na�a3hs r€n3tsccryfau�ren_isfih vus�uszu�hi nign y0�3a�.1 e%y=e hS .f� kS 9}Ul.l, »YI gab s ae da &1111111-6111 a er r u Oe b6 Pu andtr V6uincori tf 01-001l �`e1gBee ; A863-IIE13EC0t.0 irzE: ( _.' Certifitate Of ,'lame Rem'!gtante Issued by: "T', Manufacturer Number: woAt o Sperry Sails, Inc. 842 11 Marconi Lane +d Marion, MA 02738 Date of Manufacture: �gt 508.748.2581 20-Jul-11 f p E. ' F-X112{#1 This is to certify that the materials described have been flame- retardant treated or are inherently non-flamable and were supplied to: Sperry Tents Seacoast 195 New Hampshire Ave Suite 110 Portsmouth NH 03801 Certification is hereby made that: The articles described on this certificate have been treated with a flame retardant approved chemical and that the application of said chemical was done in conformance California Fire Marshal Code equal to or exceeding NFPA 701, CPAI 84 Method of Application: Coated Lot Number: 0 Fabric Color, Type and Weight: Oyster Polyester 7.2 oz. Description of Item Certified: 46x105 ft. Pole Tent Flame-Retardant process used will not be removed by washing and is effective for the life of the fabric. Name of Applicator of FR Finish: Signed: Kolon � �P ' ace group WORKERS COMPENSATION. AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 t A) POLICY NUMBER: (6S62UB-6BOO721-2'-1':5) RENEWAL OF (6562UB-6600721-2-14) INSURER: ACE AMERICAN INSURANCE COMPANY NCCI CO CODE:.80500 INSURED: PRODUCER: PORT CITY EVENTS INC DBA D S WARLICK AND CO SPERRY TENTS SEACOAST PO BOX 1260 436 SHATTUCK WAY NORTH HAMPTON NH 43862-1260 NEWINGTON NH 03801 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s)attached. 2. The policy period is from 05-21-15 to 05-21-16 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the,state(s) listed here: NH d.� B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE EXCLUDED - REFER TO RESIDUAL MARKET LIMITED OTHER STATES INSURANCE ENDORSEMENT WC 00 03 26 a� nr-- D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE a� 4. The premium for this policy will be determined by our Manuals of Rules,.Ciassffications, Rates and Rat.ing Plans. All required information is subject to verification and change by audit to be made ANNUALLY'.. DATE OF ISSUE: 05-11-15 WC ST ASSIGN: NH OFFICE: ORLANDO DA ACE 24M PRODUCER: D B WARLI.CK AND Co 76KKP 018145 PORTC-1 OP ID:JDP ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE 0512 1/2 01 5 Y) 05121/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS 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 CONTANAME:CT Joe Potthast Foundation Insurance Group Inc PHONE 703-527-8780 (FAX No):703-532-8300 PO Box 6326 A/c No Ext Falls Church,VA 22040 E-MAIL Joe Potthast ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Axis Insurance Company 37273 INSURED Port City Events,Inc. INSURER B: Mike Parkin 436A Shattuck Way INSURER C: Newington,NH 03801 INSURER D: 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR DD1348AO5 05/20/2015 05/20/2016 DAMAGES( RENTED 100,000 PREMISES Ea occurrence $ � MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO- F—]LOC PRO- JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB CLAIMS-MADE DD1348AO5UM 05/20/2015 05/20/2016 AGGREGATE $ 1,000,000 DED T RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? D N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A DD1348A05 05120/2015 05/20/2016 Equipment ALS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION FORIN-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATION PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PORTC-1 OP ID: EB ACORO" F DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/17/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS 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 endorsements). NACT PRODUCER NAMTE: Joe Potthast Foundation Insurance Group Inc PHONE FAx PO Box 6326 r IC Ne Ell:7O3-527-8780 A/C No:703-532-8300 Falls Church,VA 22040 E-MAIL Joe Potthast ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:AXis Insurance Company 37273 INSURED Port City Events,Inc. INSURER B: Mike Parkin INSURERC: 436A Shattuck Way Newington,NH 03801 INSURER D: 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 TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE ToREITIED CLAIMS-MADE ❑X OCCUR X AlPONHO03-008495-01 05/20/2015 05120/2016 PREMISES Ea occurrence $ 1,000,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 JECT X POLICYPRO LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 100000 Ea accident) > > A ANY AUTO A2PONH003-008496-01 05/2012015 05/20/2016 BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident x Trailers $ UMBRELLA L X OCCUR EACH OCCURRENCE $ 1,000,00 A X EXCESS UAB CLAIMS-MADE A5PONH003-008497-01 05/20/2015 05/20/2016 AGGREGATE $ 1,000,00 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ A Blanket Equipment AlPONHO03-008495-01 05/20/2015 05/20/2016 Inventory Included DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Event: 9/24-10/07, The North Andover Country Club, 500 Great Pond Road, North Andover, MA 01845. Town of North Andover is added as an Additional Insured with regards to the General Liability Policy when required by written contract. CERTIFICATE HOLDER CANCELLATION TOWNON1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE N$4k-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD