Loading...
HomeMy WebLinkAboutBuilding Permit #705-2016 - 405 GREAT POND ROAD 12/9/2015YeR'yNFt) /-, -/d - /S - BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Not#: -(015 'Lc) Date Issued: � Z h I 15? LOCATIONI Date Received IMPORTANT: Applicant must complete all items ort this page PROPERTY OWNER`_ 1 1 1 i l ..fid/_\_ P 100 Year sf6.6iurE MAP 4'____PARCELE r_ ZONING DISTRICT:_.__ Historic District yes no: yes n0=. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ❑ Demolition ❑ Other 0 Septic p UVelll 0 Floodplain4 ❑Wetlands. 0 1/Vatershed District ESCRIPTION OF WORK TO BE PERFORMED: Type or Print Clearly OWNER: Name: Address: Phone: Contractor Nam0' Phone Address] Supervisor's Construction Lic,erse �C2_Z �6 _ _._.Exp: 'Date:10 ,b7 Home fmprovemenf Licenser l L G_� _- e.. _.. , Exp. Date= ?_ �.. ARCHITECT/ENGINEER Address: Phone: 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: $ 1 0\ . FEE: $ Z� ` Check No.: 1 ` '�o Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;SigFEK e7df Agent/Owne_r.. nature of contractor OL 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 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 VOTE: 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 VOTE: 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 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 lies No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NU I Lb and IJA 1 A — ([-or department use ❑ Notified for pickup Call Emai Date Time Contact Name Doe.Building Pennit Revised 2014 No Plans Submitted ❑ Plans Waived.❑ GartififA, Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS ' CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DrivewaV Permit DPW Town Engineer: Signature: Located 384 Usgood Street IFIREtpEPARTMENT - Temp .Dumpster onsite ,yes _ _ ono ;Locat0 at 124<,Main?.Street Firfure/date C®MENTiS.. Location -1165- / lllh 111 No. —7 65- Date Check # uilding Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ A Building/Frame Permit Fee $2 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ % '' 4 RAI Location -Z/j 5- Pgg,;?4 ",U, No. IDate Check # 14 r6- i Building Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 29794 41, rA J uai LL O QO m O v t = ]G O LL Y Y Q Ln p a Z (DZ Z 0 O i 7 LL on 7 1' N E U C LL O a z Z m J d bo 7 d' to LL O a z -1 Q U U W J YJ -CO w O d' (.lto i {n tO li 0Ln a H H Q (, .3 d' (0 LL Z LLJ � Q NJ D W 5 LL i m O Z aJ (% a N O (A FlMbo �* 4mo 0 O F�� 0 1=0 O H uu am _ _ O O _ Ccv .Q Q 4) CcQ O O IUL w H V E Q. L N 0 _ d d � t .r E a_, O - ev 0 i (nCD" 3 CD C CL Cc 40 J L m a�� � Cc L _ °' cn a� _0 0 CD V _ U a •E ■.- C CD o z CL r_ wn mp 3 = oo L Q. Q. CD w O rO+ Vi • ♦+ _ CM F— O E- 12 L iC CD Q. _ (D- o ~ o O .v m co W = M O O .2 u) �' y _ R N •� w w+ w Eu__� V Q O N O o %- C N � O F t ,� ssoU cn 2 Z W Z W w CLx LUW a- r almof col J r iff C-i i M ti 5 O x Fj w LL OC7 CZ cr O m u 2 LIELO Ln U ❑. (DO p z mJ c O Y 'O 3 LL L to. T c U LL O a in ? Q Z m d o: LL O F - a Z U 2QW u W C K U N t0O L.L. O a Z . O O' LL Z W cr CL w z LL c0 O z N N v Na O0 N W am O LU CL Z Z m y O L /A a._ Z 5 �_y a W LL N a Z O W O a V CCO W c ce W J . CLz m O .O N d t O z �s O Q O Fully Licensed and Insured • Member of MA Better Business Bureau j GAF Cert. ME # 20212 Owens Corning Preferred Contractor #212828 ' �6'° OSHA 30 Hour Construction Safety Training 51 S. Broadway #2214 • Salem, NH 03079 PROPOSA SUBMITTED TO 165 - v rulioat General Contracting, ccc - s (603) 890=0084 1 10 Stevens Street #141 Member of NH Better Business Bureau HIC Reg # 166661 --� MA CSL # 104728 EPA Lead Safe Certified ROM • Andover, MA 01810 • (978) 475.0095 0746 Cule Completely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds. Strip off 1 layers of roofing material down to tlSe 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/j2" spacing on either side of ^/ridge for maximum exhaust ventilation. Cut in if necessary. Install new heavy gauge(color) IT10M Wu!v% Install C,1 C��t�i�.lct�t drip edge at roof eaves. ice and water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valleys, aroundII skylights, chimney bases, roof penetrations and at all sidewall transitions). Install �chr A(breathable roof deck protection to remainder of the roof deck. Install new heavy gauge r (color) —Aum Ju lCh drip edge at roof rakes. Install —cS"f starter strip at roof eaves �and Install — esired �%�h (color p,,y,� 6�1 Install new flashings to meet manufacturer's speci (cations. (i.e. sidewalls, chimneys, skylights and roof penetrations) Install (feet) of � � 6- , ridge vent at roof ridge to allow maximum ventilation. 4, Hand nail to ensure proper fastening. Install !/ (feet) of 77--"v16C Thoroughly clean up and dispose of all roofing —distinctive Maaneti and lly s ee and nail to ensure proper fastening. g p p Y g Y p property for nails. Edmunds General Contracting will: • Obtain all necessary construction -related permits to complete this project. ZAA• 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 1 and described work will be completed in about _&I days. Product Upgrade 1: Product Upgrade 2: Contractor's employees are fully covered by workmen's compensation and liability insurance. 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 requested by contractor. Upon refusal to do so, 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 owner(s) all reasonable costs, attorney fees, and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. 'Edmunds General C t Cscc. At lar.,:, 1) c3n nab 11Y1s)a�l 23-.""� It is further agreed that this contract may be assigned by the contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. Edmunds General Contracting LLC guarantees all workmanship performed for Z-1—years. c We will regi ter ✓ C° �S factory enhanced warranty providing �c� years of material defect c ve age and _ years of workmanship defect coverage through —&ems ---Xno charge for: 9 _the additional cost of on red ng LLC will provide the materials, labor and disposal to replace up to 64 sq ft ft. of -r of decking and 20 ft of fascia at no additional cost. Any additional materials including labor and disposal will be replaced aQ � at per sheetoii linear foot. Edmunds �ener �I C,ontract,n' .V grees,to fur�h tPfa3`fffafe'r1�1 labor c�OU145 pile. with the above specifications, for the sum dollars ($" F��.-, Payment Terms: �GG ! q 1 DSO t • A deposit of (not to exceed 1/3 of the total contract) is due upon start of work. The balance of ZSG due when work is completed to the satisfaction of all parties. • A finance charge of 1.5% per month (18% per year) will be charged on past due accounts over 30 days RecePta11CC Of VTDt70gBI - The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will bemade as outlin Bove. Date of acceptance:_ _ / I/ • `_-'/� r .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 orders, and will become an extra charge over and above the stated contract price. Contractor is not responsible for damage due to high winds, tornadoes, hurricanes, fire or other hazards. Owner(s) agree to carry fire tornado and other necessary insurance. Contractor is considerate of owner's landscaping and but due to the nature of the roofing installation some damage may occur. We attempt to minimize any damage, and will not be held responsible If any damage occurs. Contractor is not responsible for any damage to the interior of property, including pre-existing conditions (.e. water stains, crumbling plaster, exposed nails) or conditions resulting from application of materials as specified above. Items in the attic may need to be covered by the owner. Contractor is not responsible for damage caused by ice dam build-up. All agreements are ti ent upon strikes, acrid nts, or delays beyond our control. Authorized Signature: Edmunds General Contracting LLC/ Note: This propo y b withdrawn by us if not accepted within days. , 00 NOT SIGN THIS CONTRACT IF THER RE ANY BLANK SPACES. Authorized Signature: Authorized Signature: Owners who secure their own construction—related permits ordeal with unregisteAll 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). red 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 cancal this contract and incur no penal*.;. Corre^pondence should be directed to Edmunds General Contracting LLC at.the above address. Rev. 01/13 The Commonwealth of,Mass�chusetts _ Department ofindustrialAccidents e 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: )Builders/Contractors/Eketric!an s/Plumlbexs. TO BE PILED WITH THE ]PERMITTING AUTHORITY. _ Name (Business/Organizatio'Audividual): Fb6V1 Address: -7--L UA (�yi cr/Ci afP/7.in' Phone #: Ce C)—�) Are you an employer? Check the appropriate box: l.❑ I am.a. employer with empIoyees (full and/or part-time).*- . 20 art tune).* - 2,Q I am a sole proprietor or par[nership and have no employees working for me in any capacity. [No workers' comp. insurance required,] 3.C] I am a homeowner doing all work myself- [No workers' comp. insurance required,] t 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 proprietors with no employees. 5. F] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and ifs officers have exercised their right o£ exemption per MGL c. 152, § 1(4), and we have no, employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition I L ] Electrical repairs or additions 12.E] Plumbing repairs or additions 13.eOer pairs14. b --_-_-- _ ipolicyinformation, *Any applicant that checks bOXM must also nn. uuL elm ��� — U,,, v �-- W Homeowners who ;ubmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContrabtors 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-con#.ractors have employees, ley must provide their workers' comp. policy number. I am an employer that is pidvidijtg workers' compensation insurance for my employees.' below is the policy and jolt site information. C Name V Tnsuxance ompany _ I - / Policy # or Self -ins, Lie. #: �1% �- Z- J� ��' c7 S� E irat onDat (S Oki Ci /S ate/Zi rob Site Address: �-�� p Aiiach a copy of the woxltexs' compensation policy eclaxation page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 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 STOP WORK ORDER and a line 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 DTA. for insurance I do Aereby c tl ep ns andpenaldes ofpe1 jury that the information provided above is true nd correct. Official use on City or Town: M write in this area, to be completed by city or town official. Pelmit/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 Iustruction.s Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation fox their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofire, express or implied, oral or written." ' An employes is defined as "an individual, partnership, association, corporation or ocher legal entity, ox 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-contractoz(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'affiidavifshould 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 areference 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. ## 617•-727-4900 ext. 7406 or 1-877-NUSSAFE Fax ## 617-727-7749 Revised 02-23-15 www.mass.gov/dia From:Nicole Boudreau FaxID:Santo Insruance Page 2 of 3 Date: 12/9/2015 09:03 AM Page:2 of 3 EDMUN-1 OP ID: NB CERTIFICATE OF LIABILITY INSURANCE ATE(M12/09/209120 5 r15 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 Planright Insurance -Salem 224 Main Street Suite 3C(Alc Salem, NH 03079 James A Santo CONTACT NAME: James A Santo PHONE 603-890-6439 FAX No): 603-890-6521 No Ext A oREss:jam ie santoinsurance.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A:St Paul Surplus Lines Ins CO INSURED Edmunds General Contracting, LLC PO Box 2214 INSURERB: Liberty Mutual Insurance Co INSURER C INSURER D: Salem, NH 03079 INSURER E INSURER F : 11/11/2015 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY -POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMSMADE OCCUR WS264625 11/11/2015 11/11/2016 AMAG TO RENTED PREM SES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F—] PRO- ❑ JECT LOC PRODUCTS- COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Perperson) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ LJ DED i RETENTION $ $ B WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y! N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A WC5-31S-602821-015 3A N H 04/03/2015 04/03/2016 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Dave Edmunds is excluded from work comp coverage CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From:Nicole Boudreau FaxID:Santo Insruance Page 3 of 3 Date: 12/9/2015 09:03 AM Page:3 of 3 ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/18/2015 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(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 PLANRIGHT INSURANCE & FINANCIAL LLC 224 MAIN STREET STE 3C SALEM, NH 03079 NCON AME CT PHONE FAY AIC Ext: AIC, IC No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA : LM Insurance Corporation 33600 EACH OCCURRENCE $ INSURED EDMUNDS GENERAL CONTRACTING LLC INSURER B P O BOX 2214 INSURER C : SALEM NH 03079 INSURERD: INSURERE: INSURER F : LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS GUVtKAGtJ CFK III-It=A I F Nt1MFt I -K' 9Rd71Z')A RFVISIr]N N1111AF2FF7• 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. INSINSIR LTR TYPE OF INSURANCEADDLISUBR INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY PO P MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR EACH OCCURRENCE $ AMAGE TO REN PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENT AGGREGATE UMIT APPLIES PER- POLICY❑ JECT PRO ❑LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Perperson) $ BODILY INJURY (Peraccdent) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB tEXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PRO OFFICER/MEI BER EXCLUDED? ET ORIPARTN ER/EXECUTIVE F (Mandatory in NH) If yyes desaibe under DESCRIPTION OF OPERATIONS below NIA WC5-31S-369752-025 1/26/2015 1/26/2016 /STATUTE �RH E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 500000 E.L. DISEASE - POUCY LIMIT 1 $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates, only as they relate to workers compensation coverage. I.CK IIrit AIt MULLILK CANCELLATION TOWN OF NORTH ANDOVER, MA 120 MAIN STREET NORTH ANDOVER MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4. LM Insurance Corporation [f 6 CEJ lUBS-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 26473324 1 1-369752 1 15-16 WC I Ashish Sorgaonkar 1 9/18/2015 10:41:30 AM (EDT) I ?age 1 of 1 a r -.<2r n oI o �00 { mak. I§m 0 0 2� i ��\ k { 7 � �(n k§� )d ®2 \ r y/ c 3 kJ . . 3 , J o CLC §§ $0 . CL 0I \} gm