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HomeMy WebLinkAboutBuilding Permit #413-13 - 127 HIGH STREET 11/21/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I Date Received Date Issued: -- IMPORTANT:Applicant must complete all items on this page r LOCATION I2-7 Print PROPERTY OWNER �U� i� _ �� _,e Print 1D0 Year Old.Structure yes no MAP NO` PRRCEL: ZONING DISTRICT: Historic District yes no. Machine Shop Village yes no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ On fly ❑Additio wo or more family ❑ Industrial ❑AI ation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: d Demolition ❑ Other n Septic ❑Well ❑ Floodplain ❑-Wetlands ❑ WatershediDistrict C7 Water/Sewer, , rDESCRIPTION OF WORK TO BE PERFORMED: i P r� �' Id ntification Please Type or Print Clearly) OWNER: Name: 2 Phone: Address: {,r�eIk - ICONTRACTOR Name: Ec)+A Phone: r Address: �z d� PO LA �J� _ _- � co . 1 Sbpervisor's Construction License: j.0 t1 2,'J6 .Exp. !Date: . /D -3 A2 Home Improvement License: IC,CC G / .. Exp. Date: Co Z e- aa//Y. . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.SULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. r Total Project Cost: $ 'q"1 IS FEE: $ �" y Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o the a f nd Signature ofAgent/Ownery~ _ ,Sign t re of contrac r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Sam PI s❑ Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work 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/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 subm:?ted with the building application Doc: Doc.Building Permit Revised 2012 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS f i CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS I I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments c.• Conservation Decision: Comments � Water & Sewer Connection/Signature& Date Driveway Permit ,r DPW'Tow,]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124,Main Street- rtmen si' �natu"re/date Fire Depa g COMMENTS i 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 q pp 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 F Doe.Building Permit Revised 2010 Location �- No. Date l_dl • - TOWN OF NORTH ANDOVER � �UTy.1;IbUjr`lq�. 1 O Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ xj TOTAL Check# 25971 v Building Inspector t tko H Town of OA. - .�.. , No. o `AN, h ver, Mass, QUO �• COC NIC Nl WIC.{ y1. S V BOARD OF HEALTH PERMI: T T LD Food/Kitchen Septic System t THIS CERTIFIES THAT �,� . . 4�' ............................................... BUILDING INSPECTOR has permission to erect .......................... buildings on ....later...... .. . �./!�...... ............... Foundation Rough to be occupied as ...................... .. ........... ..... .................................................... Chimney provided that the person accepting this rmit shall in every respect c orm 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6ON HS ELECTRICAL INSPECTOR UNLESS CONSTRU, 10 T TS Rough Service, ........... ...... ........................................................ Final i BUILDING INSPECTOR I GAS INSPECTOR Occupancv Permit Required to 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-Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE `Fully Licensed and Insured Member of MA Better Business Bureau Vropo! y T Member of NH Better Business Bureau 't GAF Cert.ME#20212 al HIC Reg#166661 z`4 1 EIN#26-1081508 MA CSL#104728 OSHA 30 Hour Construction Safety Training EPA Lead Safe Certified I oit� l Genera/ Contracting, LLC 51 S. Broadway #2214 Salem, NH 03079 (603) 890-0084 1 10 Stevens Street#141 Andover, MA 01810 (978)475-0095 PROPOSAL SUBMITTED T ( '1 P(((.--T --G�/ PHONE /�s p, GATE Z tc s 11„ Cd i C d r1 ZO. /t'S SCC-14�10� 8 iG�I7 1 ; f �G. STREETE-MAIL X7 140-tk S+ CITY,STAT AND ZIP CODE 4 JOB LOCATION 1 \ AAA Completely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds. Strip off layers of roofing material down to the bare roof deck. Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards, and repair and replace as necessary*. Inspect roof ridge for proper 11/2" spacing on either side ofridgefor maximum exhaust ventilation. Cut in if necessary. Install new heavy gauge 6. 41%. (color) ,A)u v% AkWVI dri. _edge at roof eaves.. Installer IWC-t&- ice-and-water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valleys around I kylights, chimney bases, roof penetrations and at all sidewall transitions). install 1 P_ breathable roof deck Protection to remainder of the roof deck. �- color d,;MiNOM drip edge at roof rakes. Install new heavy auge (a_�/1, (color) � p 9 SCS Install starter strip at roof eaves and rakes. , K..Z. �F"1 51a+e- &vxl Install desired color. ilor) Install new flashings tc meet manufacture s specifications. (i.e. sidewalls, chimneys, skylights and roof penetrations). Install-64 (feet) ofo;rG� `-a/ � ridge vent at roof ridge to allow maximum ventilation. _- Hand nail to ensure pr per fastening. "_ cc .-Hand-nail to proper fastening. Install / ✓Q(feet) of distinctive hip and ridge cap p p g Thoroughly clean up and dispose of all roofing debris on property. Magnetically sweep property for nails. Notes: Y Edmunds General Contracting will: • Obtain all necessary construction-related permits to complete this project. • Perform work as efficiently as possible without sacrificing quality. • Furnish and install all necessary materials to complete the project. • Provide a thorough clean-up and disposal of all debris generated during project. Edmunds General Contracting LLC agrees to commence work on/or about and described work will be completed in-about J_days. Product Upgrade 1: Product Upgrade 2: s F//�Cor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,and also e. that the obligations hereof shall bind and apply to their heirs,successors Dr estates of the parties. mpletion of the above work,all undersigned agree to execute and deliver to ractor,their joint note in accordance with his(their)above obligations as ds General Contracting LLC guarantees all workmanship performed for d by contractor.Upon refusal to do so,contractor may at its option declare years.e contract price or so much as then remains unpaid,immediately due andIt is agreed that,if permitted by law,contractor shall be paid by the We will re 1 erfac ory enhanced warranty )all reasonable costs,attorney fees,and expenses,in addition to the providing g years of material defect coverage an�years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defect coverage through GAF Materials Corporation for: of the contract and/or any lien in connection herewith. no charge. —the additional cost of r Edmunds General Contracting LLC will provide the materials,labor and lisp al to re ace up to 64 sq.ft.of r of d ckin bpd 20 tt of fascia at no additional cost. Any additional materials including labor and disposal will be replaced at per sheet or linear foot. Edmunds General Contracting, LLC agrees to furnish the material and All material is guaranteed as specified.All work to be completed in a workmanlike manner according to standard practice.Any alteration or deviation from above specifications involving extra costs will be executed only upon written labor complete i accordance with the above specifications,for the sum orders,and will become an extra charge over and above the stated contract price.Contractor is not responsible for yr�.�//ar,^ damage due to high winds,tornadoes,hurricanes,fire or other hazards.Owners)agree to carry fire tornado and other of _t dollars($ )®d necessary insurance.Contractor is considerate of owner's landscaping and but due to the nature of the roofing I installation some damage may occur.We attempt to minimize any damage,and will not he held responsible if any ! damage occurs. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials as Payment Terms: specified above.Items in the attic may need to 11 covered by the owner.Contractor is not responsible for damage caused by ice dam build-up.All agreements re ntingent upon strikes,accidents,or delays beyond our control. • A deposit of_�_(not to excee 1 3 of the total contract) is due upon start of work.The balance of is due when work Authorized Signature: V t is completed to the satisfaction of all parties. Edmunds General Contracting LLC a J' A finance charge of 1.5% pec-month (18% per year)will be charged on Note: This pro po I ma be withdrawn by us if not accepted within tC7 e accounts over 30 days days. ". DO NOT SIGN THIS ONTRICT�F THE E A .E AN /BLANI(SPACES. {, of 3PrOtl05a1 The above prices,specifications,and /� atisfactory and are hereby accepted.You are authorized to do �.cified.Payment will be made as outlined above. Authorized Signature:tance: �� �/ Authorized Signature: All home Improvement contractors shall be registered.Any inquiries about a contractor or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,10 Park Plaza,Suite 5170,Boston,MA 02116(Phone:617-973-8700). Owners who secure their own construction—related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund provisions of MGL.c.142A The owner will receive a signed copy of this contract before work will commence.The owner has three(3)business days to cancel this contract and incur no penalty.Correspondence should be directed to Edmunds General contracting LLC at the above address. Rev.04/11 I I 672e rOoarv�rzaracueccN, Office of Consumer Affairs&Busihess Regulation 1, License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR " before the expiration date. If found return to: egistration: 166661 Type: 1 Office of Consumer Affairs and Business Regulation xpiration:.=6/2:V201.4, Corporation 10 Park Plaza-Suite 5170 - _ Boston,MA 02116 EDMUNDS GENE RAL`CONTRACTING, LLC. DAVID EDMUNDS ti I .18 ASHFORD RD HAMPSTEAD, NH 03841' =- Undersecretary of v lid thout 'gnature i a From:Julie Dortona FaxID: Page 2 of 2 Date:11/21/2012 09:17 AM Page:2 of 2 EDMUNA OP ID: JD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 11/20/12 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(iss) 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 Phone:603-890-6439 INTACT Planright Insurance-Salem NAME: 224 Main Street Suite 3C Fax:603-890-6521 PH NNo Ext: FA Salem,NH 03079 E-MAIL AIC No: James A Santo ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURE RA:St Paul Surplus Lines Ins CO INSURED Edmunds General Contractor LLC INSURER B:Riverport Insurance Company 36684 � PO Box 2214 INSURER C: Salem,NH 03079 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 PO IC FF LIC EXP LTR TYPE OF INSURANCE INS WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY WS091261 11/11/12 11/11/13 DAMAGE PREMISES(Ea a occurrence $ 50,000 CLAIMS-MADEa OCCUR 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 AG $ 2,000,000 X POLICY PRO- JECT LOC $ 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 LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION TATIT- OTRH_ AND EMPLOYERS'LIABILITY X OCR YS B OFFICER/MEMBER/EXCLUD /EXECUTIVE Y7 NIA WC288300042504 04/03/12 04/03/13 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) 3A NH and If s,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 ye DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) - David Edmunds is excluded from workers compensation coverage job: 127 High Street, No Andover MA CERTIFICATE HOLDER CANCELLATION TOWNNOA 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. 1600 OSGOOD STREET NO ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE .A � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ^ COo,�� ,,KG, } L. -C . Address: �tl City/State/Zip: 0 j ( Phone#: "D�- �,��` 7 7 3Z Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 2 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y p n'• 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3-El I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] 1 employees. [No workers' 1311 Other comp.insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t 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: C_A�lc Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: LZ 7City/State/Zip: ©��5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against-the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif inn to sins and penalties of perjury that the information provided above is true and correct. Sign re: Date: 21 t`Z Phone#: "3 ^•77 -z— Official Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"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 be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1.877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia tv s�achusetts- Detrtrtmi°(�,, . t1 St i dar(fs 1'1 - �.._ iVl.► Board of Bur ilain. License erviso cons i- Sup ; License: CS 104728 4 DAVID EDMUNDS P.O. BOX 2214 SALEM, NH 03079 xpiration: 101312013 E ! 104728 Cun'missiunce. _ 1 \., :N V f