HomeMy WebLinkAboutBuilding Permit #958-15 - 35 JOHNNY CAKE STREET 6/9/2015t%ORTH
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BUILDING PERMIT
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received o;?ATED 9
ACHUE
Date Issued: IWORTANT: Applicant must complete all items on this page
— — (
LOCATION Vvn� ,
rint
PROPERTY OWNER- 6 V -n
Print 100 Year Structure yes no
MAP.1_'6'_2,A PARCEL:/�7? ZONING DISTRICT: Historic District yes no
Machine Shop Village yes. no
TYPE OF IMPROVEMffN__T
PROPOSED USE
Residential
Non- Residential
0 New Building
[] One family
0 Addition
0 Two or more family
El Industrial
El Alteration
No. of units:
El CoWmercial
0 Repair, replacement
0 Assessory Bldg
thers:
0 Demolition
0 Other
OTT.&
*11 0001N , W", tj h�
'T" e,
DESCRIPTION OF WORK TO bt FtK1-UK1V1tU-.
M
— Identification -,Please Type or Print Clearly
OWNER: Name:
Phone: ��c6 ZL
Address:
J k\
T
Contractor Name: F_4)&vJrA Phone: -z–
Lm'ail:
ress:
Supervisor's Construction License: to�:A� Z_% —Exp.. Date: �C�b>bs
Home Improvement License: # t U I ExAp. D ate:
ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT.'$1200 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: nd
NOTE: Persons contracting with unregistered contractors do not have access to th(T&An3ftNfu
N
Plans Submitted El Plans Waived Certified Plot Plan El Stamped Plans F1
TYPE OF SEWERAGE DISPOSAL
Public Sewer El
TauningfMas s age/B o dy Art El
Sw'mming Pools
well F1
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank, etc. El
Pennanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature'.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Variance, Petition No: Zoning Decisionfreceipt submitted yes
Zoning Board of Appeals,
t
Planning Board Decision:
Comments -
'\,&nservation Decision: Comments
Water & Sewer Connection
]DPW Town Engineer: Signature:
384 Osgood Street
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PqA ff-N�Tj
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:,
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G rnin.$100-$1000 fine
NOTES and DATA — (For department use
No
I L) Notified for pickup Call Email I
1 a
Date Time Contact Name
Doc.Building Peniait Revised 2014
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
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
,4-.- 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
OTE: 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 BeReturned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: 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
Doe: Building Permit Revised 2014
Location
140. Date �-12 2
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
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Fully Licensed and Insured Member of MA Better Business Bureau
Propoat
GAF Cert. ME # 20212
F�er= 2a
Member of NH Better Business Bureau
HIC Reg # 166661
KAA rqf A I n,179A
OSHA 30 Hour Construction SafJ-,.� EPA Lead Safe Certified.
General Contracting, LLC
ilea
51 S. Broadway #2214 - Salem, NH 03079 (603) 890-0084 1 _1 0 Stevens Street #141 - Andover, MA 01810 (978) 475-0095
PROPLO §A� SUBM17TED TO
_3�oe 56'Je, IfEr�'ell
"047-d &2rcY 2.4 -30
DATE
STREET
35 C14KC Sf I
E-MAIL
CITY, STATE, AND ZIP CODE
/ -4 3�*r A
Uw
JOB LOCATION
Completel protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds.
Y,
Strip off layers of roofing material down to the barb roof deck. Inspect the roof deck for structural defects.
Determine the condition of the underlying plywood or �oards, and repair and replace as necessary*.
Inspect roof ridge for proper 11/2" spacing on either side of ridge for maximum exhaust Ventilation. Cut in if necessary.
Install new heavy gauge W�%, '� C, — (color) AQ1MINUM drip edge at roof eaves.
Install ice and water shield to me�t manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in
va 66, aroun 1 11 skylights, chimn6y balses, r6bf -plVetrations'and at all sidewall -transitio'ns).
ovil
Install tc,6 breathable roof deck protection to remainder of the roof deck.
Install new heavy gauge (color) drip edge at roof rakes.
I'nstall —starter strip at roof eaves and rakes,
7(30
Install—OA F- Hll� t1l"ll" . desired color. (color)
Install new flashings to meet manufacturer's specifications. (i.e. sidewalls, chimneys, skylights and roof penetrations).
Install __6_6 (feet) of COSC"-� ridge vent at roof ridge to allow maximum ventilation.
Hand nail to ensure p roper fastening.
ri T It t +C A Hand fastenih.9"
Install (feet)'of -� distinctive hip and ridge cap. nail to ensure proper
Thoroughly clean up and dispose of all roofing debris on property. 'Maginetically sweep property for nails.
Notes: 604,K c T�A)C 5 0 spe C
P c-,5 b 0 -Ir" LI\
_C
. Edinunds General Contracting will:
e 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.
Authorized Sig nature:
Edmunds General Contracting LLC agrees to commence work on/or about
I
and described work will be completed in about days.
Product Upgrade 1:
A finance charge of 1.5% per month (18% per year) will be charged on
Product Upgrade - 01!
_J _j5CC^—i-y — 4 SOO, 0L.," (7P 45 0�
.7016cr P �J (
Contractor'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
insurance. that the obligations hereof shall bind and apply to their heirs, successors or estates
of the narties
Upon completion of the above work, all undersigned agree to execute and deliver to
the contractor, their joint note in accordance with his (their) above obligations as
ds General Contracting LLC guarantees all workmanship performed for
Wyears.
requested by contractor. Upon refusal to do si�, contractor may at its option declare
the entire contract price or so much as then remains unpaid, immediately due and
payable. It is agreed that, if permitted by law, contractor shall be paid by the
we will r6gis factory enhanced warranty
9-1
owner(s) all reasonable Costs, attorney fees,,and expenses, in addition to the
providing ears of material defect cov and ')t- years of
-'amoufiftWe and -unpaid,,that shal Ir be inc�jrreO in prif orci ng --the- term s.,a nd conditions -
-�_,workmanftlp de coverage through fo r:
of the contfact:and/or any lien in' Connection' 66rewith.
V no _16h_a��e the�additidnal-cbst of
*E dmunds General Contracting LLC will provide the materials, labor and dis Sal e lace up to 64 sq. ft.
of f dS,qking and 20 ft of fascia at no additional cost.
Any additional mater ials including labor and disposal ivill be per sheet or
3 00 linear foot.
! --------------- ,,
4
Edmunds General Contracting, LLC agrees to f`1,Imish the'material and
All material is guaranteed as specified. All workto be completed in a workmanlike manner accordin g to standard
)abor complete in accordance with the above sp�ecific'ations, for the sum
practice. Any alteration or deviation from abo�e specifications involving extra costs will be executed only upon written
orders, and will become an extra charge over and above the stated contract price, Contractor is not responsible for
-Se "T_^
_)of e.
damage due to high winds, tornadoes, hurricanes. fire or other hazards. Owner(s) agree to carry fire tomado and other
insurance. Contractor is landscaping and but due to the nature of the roofing
dollars ($ necessary considerate of owner's
k_0 Installation some damage may occur. We attempt to minimize any damage, and will not be held responsible, If any
damage to the interior in lud,
0%mage occurs. Contractor is not responsible for any of property, gkisting
conditions (i,e. water stains, crumbling plaster, exposed nails) or conditions resulting fro applj ation - rhalterials as
PaymentTerms:
specified above. Items in the attic may need tobe covered by the owner. Contractor is not responsible for damage
caused by Ice dam build-up. All greements a 11 gent upon strikes, accidents, or delays beyond our control.
A deposit of (not to exceed 11� of the total contract) is
X
due upon start of work. The balance of 5 li� is due when work
Authorized Sig nature:
is completed to the satisfaction of all parties. 'P, ��600,
Edmunds General Contracting LLC
A finance charge of 1.5% per month (18% per year) will be charged on
Note: This proposclL[Qay be withdrawn by us if not accepted within
past due accounts over 30 days
days.
!.c�eptance of V ropogiff -The above prices, specifications, and DO NOT SIGN THIS C 01 YT?ACT IF T,H Ir- R�; Rj_ANX.,BLA N K SPA C DES.
.nd,tions are satisfactory and are hereby accepted. You are authorized to do
be made as outlined above. _Nz�� f i)
Authorized Sighatufe.
the wbrk as specified. Payment vi
'acc,
LDate odf!Acceptance: 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 Affalis and Business Regulation, 10 Park Plaia, Suite 5170, Boston, MIA 02 6 JPhione. 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 win 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. 01113
"I I
Cl\ , The Commonwealth of Massachusetts
0 Department ofIndustrialAceidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass-gov1dia
rkers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/pi4mbers.
we Wrr V" V"TU TBE PERTMTT . ING AUTHORITY.
I I 1 11
*Any applicant that checks box 41 must also fill out the section below showing t eir 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 and state whether or not those entities have
fContractors that check this box must attached an additional sheet showing the name of the sub
provide their workers' comp. policy number.
employees. If the sub -contractors have employees, they must...
ensation insurancefor my employees. Below is thepolicy andjob site
I am an employer that is providing workers' cOMP
information.
�U
Insurance Company Name: Expiration Date:
Policy # or Self -ins. Lie. 9:
.—City/State/zi-p:
Job Site Address.
n page (showing the policy number and expiration date).
Attach a copy of the workers comPensa on policy declaratio
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500-00
well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
and/or one-year imprisonment, as nt may be forwarded to the office of Investigations of the DIA for insurance
day against the violator. A copy of this stateme
coverage verl
I :: d : o :::: h ::: e : r : e :: b : y :: p/0 ins andpenalties ofperjury that the information provided above is true and correct.
,prnd
,er thepa
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): i
1. Board of Health 2. Building Department 3. city/Town Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Other
Contact Person: — Phone
Please RKjnLLtgihh
Appli ant Information
Name (Business/Organization/individual):—EL)AA�A
Address:
City/State/Zip: Phone#:
-77: . �'Z-
A n employer? Check the approp riate box:
Type of project (required):.
7you
I air ull and/or part-time).*
1 I am a employer with __��PmPlOyees (f
7. [:]New construction
.
2.F1 I am a sole proprietor or partnership and have no employees working for me in
8. El Remodeling
any capacity. [No workers' comP. insurance required.]
9. 0 Demolition
3. F1 I am a homeowner doing all work myself. [No workers' comp. insurance required.) t
10 E] Building addition
4. F1 I am a homeown . er and will be hiring contractors to conduct all work on my property. I will
compensation insurance or are sole
11. [:] Electrical repairs or additions
ensure that all contractors either have workers'
with no employees.
12.' airs or additions
.F1 Plumbing rep
proprietors
5. F1 I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
comp. insurance.t
13. E] Roof repairs
These sub -contractors have employees and have workers'
14. F1 Other—.
6;. n We are a corporation and its. officers have exercised their right of 'exemption per MGL c.
152 81(4) and we have no employees. [No workers' comp. insurance required.]
I I 1 11
*Any applicant that checks box 41 must also fill out the section below showing t eir 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 and state whether or not those entities have
fContractors that check this box must attached an additional sheet showing the name of the sub
provide their workers' comp. policy number.
employees. If the sub -contractors have employees, they must...
ensation insurancefor my employees. Below is thepolicy andjob site
I am an employer that is providing workers' cOMP
information.
�U
Insurance Company Name: Expiration Date:
Policy # or Self -ins. Lie. 9:
.—City/State/zi-p:
Job Site Address.
n page (showing the policy number and expiration date).
Attach a copy of the workers comPensa on policy declaratio
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500-00
well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
and/or one-year imprisonment, as nt may be forwarded to the office of Investigations of the DIA for insurance
day against the violator. A copy of this stateme
coverage verl
I :: d : o :::: h ::: e : r : e :: b : y :: p/0 ins andpenalties ofperjury that the information provided above is true and correct.
,prnd
,er thepa
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): i
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 covera I ge required."
Additionally, MGL chapter 152, §25C(l) 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 (LLQ 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 "fob 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 now 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
EDMUN-1 OP ID: NB;
AC�CIIIHLX
164.� CERTIFICATE OF LIABILITY INSURANCE
_�ATE (MM/DD/YYYY)
F 05/22/2015
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
Planright Insurance -Salem
224 Main Street Suite 3C
Salem, NH 03079
James A Santo
CONTACT
NAME: James A Santo
H FAX, -890-6521
CA Ex* 603-890-6439
P /M. (A/C No): 603
E-MAIL
ADDRESS: jamie@santoinsurance.com
INSURER(S) AFFORDING COVERAGE NAIC #
I
INSURER A: St Paul Surplus Lines Ins Co
WS236058
INSURED Edmunds General
Contracting, LLC
PO Box 2214
-INSURER B: Liberty Mutual Insurance Co
INSURER C:
INSURER D
Salem, NH 03079
-INSURER E:
-INSURER F :
6VVtKAUt5 CIFIRTIFICATIF NII IMRFP- 0I=%1IQ1nki MI IRADUD-
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.
INSIR I
LTR
TYPE OF INSURANCE
ADOL
INSD
SUBIR
WVD
POLICY NUMBER
PMOLICY EFF
(M DDIYYYY)
POLICY EXP
(MMIDD/YYYY)
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FxIOCCUR
I
WS236058
11111/2014
11/11/2015
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 50,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- F
POLICYEI JECT LOC
R
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
$
OTHER
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea a _cd.nt) $
BODILY INJURY (Per person) $
ANY AUTO
—
ALL OWNED CHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident) $
—
NON -OWNED
HIRED AUTO AUTOS
S FS
PROPERTY DAMAGE
(per accident) $
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
__fDED
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
RETENTION$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
,DESCRIPTION OF OPERATIONS below
N/A
WC5-31S-602821-014
3A: NH
04/0312015
04/03/2016
OTH-
X SPTEATUTE ER
E.L. EACH ACCIDENT $ 500,000
E. L. DISEASE - EA EMPLOYEEI $ 500,000
E.L. DISEASE -POLICY LIMIT 1 $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Dave Edmunds is excluded from work comp coverage
CERTIFICATE HOLDER r.ANrFl I ATInN
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of North Andover, MA
ACCORDANCE WITH THE POLICY PROVISIONS.
120 Main Street
AUTHORIZED REPRESENTATIVE
North Andover, MA 01845
I
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Massachusetts - Department of Public Safety
Board of gulld,ing Regulations and Standards
Constructi6n Supen,isor
License: CS404728
DAVID C EDMUNDS
P.O. BOX 2214
SALEM NH 03079
WOL10 Expiration
Coffirnissioner 10/0312011
4C�\ Office of ConsurnerAffairsA Business Regulation
'WOME IMPROVEMENT tONTRACTOR
egistration: �1�6p6l Type:
'Expirati . on: 61i'll'461 6 Corporation
LLC.
EDMUNDS GENERAL--'CONTRACTIN
DAVID EDMUNDS
18 ASHFORD RD
HAMPSTEAD, NH 03841
Undersecretary