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HomeMy WebLinkAboutBuilding Permit #484-2017 - 425 GREAT POND ROAD 11/8/2016�/ ►� (ZZII, cQ-�Q [�' BUILDING PERMIT rr%Xfif 1 nc A1/Yr3TLI AAIr1P1V1=0 N TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ qpKmercial [IRepair, replacement ❑ Assessory Bldg Others: ❑ Demolition ❑ Other Septic o Well Floodpl Wetlands n Watershed Dis�tct 4 , IHM^!A•.Ar .t}wf. a HYi•w .....- .r. .1 OWNER: Name: DESCKIPIIUN Ui- VVUKM I U or rr-mrvruvlcu. ification - `Ple4se Type or Print Clearly U� I Phone: vl-��� gd�c) I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �_��C� FEE: $ V l Check No.: Receipt No,- NOTE: Persons contracting with unregistered contractors do not have: access to the ica ncii S`ignatu�e of Agent/Owner --Si ature of coiitract� =< N V/0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building _n_nnn..fPmflxt 0 Addition 90 0 Industrial 0 Alteration 60P El 9pKmercial Others: ❑2`1 Repair, replacement El Demolition fliAr, El Septic El - Well' - 1A w. OWNER: Name: Address: Contractor Namef i '§i 6� --onslifu Ue Rhbhp: ? onLicense,nn.zEx Phone:q tk6 5 ARCHITECT/ENGINEER Phone: Address: Reg. No., FEE SCHEDULE: BULDING PERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. '----,,Total Project Cost: $_I (e-2 2 FEE: $ Z-1 Check No.: Receipt No.: �/ — the a �1 nd NOTE: Persons contracting with unregistered contractors do not have. access to the r of ont�� -I -tu re ofr� Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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) o 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit N 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 ■ Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ T- PB'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature A COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Locatea M4 usgood Street no limension 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 . DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min:$100-$1000 fine Doc.Building Permit Revised 2014 Location % ,, No. 404t,, "206�7— +/ Date // Check t TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ , ZJ— Foundation Permit Fee $� Other Permit Fee $ y TOl U) 10 CID 0 Z CIDO Cr C D cc C .Z 00 CL cr m O W CL C C. CD CD0 rF O A 'a 0 O ai CD CD CD CD U) v Z a C CD P- 07. 0. 0 " 0 03 i -a FA c _O CD 0 CD C7 0O = 0 3 m o �: 3.0 v in a;, -n h=CL 0 N 3 W n O N 0 O 0 D CD = -s 0 CD p C� � co = O r+ _N, O D) '+CCD C D CD -0 _ O O 0 < to O 0in N O -h a C CD U) - 0 O CL D) Cn CDN su CD < M �D N rt 0 rt C � O CD C CD U) 0 CD � OOw O r.. n CD 91)O C O O O �q y 4 N ° VI m OZ co 3 �+ m v M T °-' Z7 O m N HrD- 70 T j' °-' O O w rO m A 0 T j °-' T7 O o C 00 +n 0 T j' °-' (� S 3 m O 0 T O = v O 0 W C F v z 0 Vf N N N O 3 T O a n S N Cn O O = .a Fully Licensed and Insured Member of MA Better Business Bureau '�• Member of NH Better Business Bureau GAF Cert. ME # 20212 HIC Reg # 166661 s `¢z :T e OSHA 30 Hour Construction Safety Training EPA Lead Safe Certified _ General Contracting, Hca 51 S. Broadway #2214 Salem, NH 03079 • (603) 890.0084 10 Stevens Street #141 • Andover, MA 01810 (978) 475.0095 PRO ,O Al_ SUBMITTED TQ„� (N ••+�' C ' PHONE ?81 �S � DATE�D bg, STREET E-MAIAYILLil CITY, STATE, AND ZIP CODE A (is41S� JOB LOCATION Com'plet;ely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds. Slayers of roofing material down to the bare roof deck. Inspect the roof deck for structural defects. D'eter<m"lt)eAhe condition of the underlying plywood or boards, and repair and replace as necessary*. Inspg'ct'rrroof ridge for proper 11/2" spacing on either side of ridge for maximum exhaust ventilation. Cut in if necessary. Install;new. heavy gauge 6.r.2 -{G (color) A 1ur%4;tJuM drip edge at roof eaves. Instaice and water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valley`s, around all skylights, chimney bases, roof penetrations and at all sidewall transitions). Install''' ';.pe Ct-, Asmpx' breathable roof deck protection to remainder of the roof deck. \ Install new heavy gauge GVM roe- (color) A ),,nn r^.L.wt drip edge at roof rakes. \ Install 09M S+starter strip at roof eaves and rakes. C�14 &l kS 4p Install F T,4bec 1, .,P- 1-ll� l desired color. �.�' LA- — (color) Install new flashings to meet manufacturer's specifications. (i.e. sidewalls, chimneys, skylights androof' ene�a�ons). Install (feet) of (t>1 i%Ck 5_ j 6�y ridge vent at roof ridge to allow maxUU\—,ntilation. Hand nail to ensure proper fastening. Install 1 `?0 (feet) of —4 r0 bid +tA distinctive hip and ridge cap. Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on property. Magnetically sweep property for nails. Notes: i u CtJ �ox +S if -4� GcrnJ ous-C AlfoISe ofh - rv1 i7eC ).o 11 All material is guaranteed as specified. All work to be completed in a workmanlike manner according to standard 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 /-3//6 and described work will be completed in about 2 days. I%�PU / Payment Terms: Product Upgrade 1: Product Upgrade 2: 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. 01/13 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 that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. Finsurance. letion of the above work, all undersigned agree to execute and deliver to tor, their joint note in accordance with his (their) above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for y contractor. Upon refusal to do so, contractor may at its option declare � years. ontract price or so much as then remains unpaid, immediately due and Q/ payable. It is agreed that, if permitted by law, contractor shall be paid by the We will registers m f/ /VS factory enhanced warranty owner(s) all reasonable costs, attorney fees, and expenses, in addition to the providing'years of material defect coverage and _> years of amount due and unpaid, that shall be incurred in enforcing the terms and conditions workmanship defect coverage through for: of the contract and/or any lien in connection herewith. _X no charge the additional cost of "Edmunds General Contracting LLC will provide the materials, labor and disposal to replace up to 64 sq. ft. of roof decking and 20 ft of fascia at no additional cost. alto Any additional materials including labor and disposal will be replaced at / O per sheet orZ S. 00 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 cQQQm lete in accordance with the above specifications, for the sum orders, and will become an extra charge over and above the stated contract price, contractor is pot responsible for Cry`_ _ of a 111 �'7Uc.A eW,0, `��� x dollars ($' damage due to high winds, tornadoes, hurricanes, fire or other hazards. Owner(s) agree to Garry fire tomeand other necessary insurance. Contractor is considerate of owner's landscaping and but due to the nature of the roofing / \ �t C O / f� r� 1 "�" �� %6Q -�•�� installation some damage may occur. We attempt to minimize any damage, and will not be held responsible if any damage Contractor is for damage to the interior including I%�PU / Payment Terms: occurs. not responsible any of property, pre-existing conditions (i.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 • A deposit of (not to exceed 1/3 of the total contract) is T caused by ice dam build-up All agreements are m tingent upon strikes, accidents, or delays beyond our control. due upon start of work. The balance of 15, ('k-57—due when work Authorized Signature: A.� is completed completed to the satisfaction of all parties. Edd funds General Contracting LLC • A finance charge of 1.5% per month (18% per year) will be charged on Note: This propostay be withdrawn by us if not accepted within ccounts over 30 days days. ce Of J)TO)pogaf - The DO NOT SIGN THIS CONTRACT IF THERE ARErANY BLANK SPACES. above prices, specifications, and rDate e satisfactory and are hereby accepted. You are authorized to do pecified. Payment will be made as outlined above. Authorized Signature: eptance: Authorized Signatur : 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. 01/13 51.S. Broadway #2214 Salem, NH 03079 (603)-890-0084 10 Stevens St. #141 Andover, MA 01810 (978)-475-0095 About Us For nearly a decade Edmunds General Contracting, LLC has been providing professional contracting services to residential and commercial customers throughout Southern New Hampshire and Northeastern Massachusetts. Our goal is to provide our customers with professional service and installation of the highest quality materials at a fair price. You can count on the experience, organization, and knowledge of our team to understand your needs and guide you from the initial estimate to the flawless completion of your next project. Edmunds General Contracting, LLC specializes in the installation, replacement, repair, and maintenance of all types of roofing systems. nth our vast experience and knowledge of roofing materials you can be confident in our ability to guide you in choosing the right roofing system to fit your particular property and budget. Through our certifications and continued educational training with some of the nation's largest roofing manufacturers we guarantee the very best installations, materials and warranties. Our Mission Our mission is simple, to continue to be the very best choice in roofing -and contracting services for both residential and commercial property owners. We will continue to meet and exceed this goal through our professional management and organization, continued educational training, flawless efficient installations of top quality materials, and our superior customer service. Our Credentials We have met the strict criteria and have earned the following manufacturer certifications: o GAF Master Elite Weather Stopper Roofing Contractor ME #20212 o ®oven Corning Roofing Preferred Contractor o Mastic Vinyl Siding Preferred Contractor o Vinyl Siding Institute (VSI) Certified Installer o GAF Certified Green Roofer We are proud members in good standing with the following professional business organizations: o The Better Business Bureau of New Hampshire o The Better Business Bureau of Massachusetts o The North/East Roofing Contractors Association o The Greater Salem Chamber of Commerce o The Salem Contractors Association We have participated in the following educational trainings sponsored by manufacturers: o GAF Steep Slope Pro Field Guide Training o GAF Everguard Single Ply Pro Field Guide Training o GAF TruSlate Installation Training o CertainTeed Shingle Applicator Best Practices o James Hardie Siding Products Installation Best Practices We have completed the following construction safety trainings: o ®SHA 30 Hour Construction Safety Training o ®HSA 10 Hour Construction Safety Training o EPA Lead Safe Renovators Training Licensing and Insurance Edmunds General Contracting, LLC is a fully licensed and fully insured contracting company. We hold the following state licenses: o Construction Supervisors License CS #104726 o Home Improvement Contractors Registration HIC #166661 We are fully insured for your protection with workers compensation insurance and a two million dollar general liability policy. Insurance certificates are gladly provided upon request. ....... ..... BBB recognizes Edmunds General Contracting, LLC. for 5 years of commitment to * honesty, integrity, ethics and trust. Kevin I Sanders President & CEO 8/1/2013 H ME, M) WIN s � b m < o m LD. s rD CD O Q u� p O O 3 r " 0 n n O O co 3 5 r m @ T� , rna O n n 3 v 3 N O _O O' m � D Q CDp 3 CD m M Q � M. o m. s m m cra v �n_ s < o �. rD CL W C y CD C Z rf i N (a rt � O O O 3 < M n N 3 � H O 0 I d ET ct O O ED rD O 3 in rD M n v 7 < v r+ CL O UQ rD rD rt O m © n O O O O U�d r+ O O o O i G) n LD cr m n rt C) w JIM Nm C7 a ,O .o, Z, MtF tea- Q _ M, . 1. n C 0 Z 3 a SINSMILOW w fD w rn O ,, 3 N ' N Q — U �T QZ C N N n CU @ rri f� D L o Z5 - oa Pi P4'! (D Ln n I Ln Ln O N (D r+ -0 O C� N Q Q LA r (D 2 w (D n (D fl cin n 'R1 J N n G PTq Ln r�i- Ln In V' M Ma ®4 Z 3 a SINSMILOW w fD O ,, 3 Ili al W-1 P= . gpo CD i5 - en eD -1 fb W-1 The Commonwealth of Massachusetts Department of IndustrialAceidents X Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia Compensation Insurance Affidavit: Buil.ders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMH"Ne- ,A-UTHORrl''Y. Name (Business/orgabization&divi6A:. Address: City/State/Zip: - "1 Phone #:� Are yo employer? Checktheappropriafebox: 1. I am a employer with employees (full and/or part-time).* 2. C] I am a sole proprietor or partnership and have no employees working for me m any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself• [No workers' comp. insurance required] t 4.❑I am ahomeowner and will be, hiring contractors to conduct all work on my property. 'will ensure that all, contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.1-11 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. ❑We are a corporatiori and its, of$cers have exercised their right of'exemption per MGL c. 152 No workers' comp. insurance required.] 1(4) and we have no empldyees. [ Type of project (required): 7. [] NdVdonstraction 8. [] RemodeliiA 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additi9ps 12. []:Plumbing repairs or additions 13•. 0 Rb6f repairs 14.n Other *Any applicant that checks box#1 must alsd fill out the section showing workers' compensationpolicy infozsnation:' t Homeowners who submit this a d Bch Ira adihonal aheet sing howing theye of the sub coniractorork audth--hire outside os and. statrs se whether hmit�n or j otot chose entitr',esAha such tContractors that check thrs b employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. orng employees Below is the policy aridro�i site jam an employer tltat is providing -workers' compensation insurance f information. `1 Insurance Company Name: k 4 NCS\ Expiration Date, l 1 Policy # or Self -ms. Lie- #: W C --- City/State/Zip: e Job Site Address: 1 C-� the otic number and expiraizon )- Attach a copy of the workers' compensation policy declaration page (showing p y Failure to secure coverage as required under it ena1�es2in the f rm criminal faS OP WORK ORDERIe by a ftb and fine onfpup to $250.00 a and/or one-year imprisonment, as well as iv p day against the violator. A copy of this statement may be forwarded to the Office of Invesitgaiions of the DIA. for insurance coverage verification. X do Itereliy and'vmalties ofperjury that the information provideedd above is true arra cufre:',�- 7--4.�. / ®' -/'? / illi official use only. Do notwrite in t1jis area, to he completed by city or town official. Permit/Liceuse # City or Town" Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Towu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. other Phone #- Contact Person: 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 enierpri'se, and including the legal representatives of a deceased employer, or the receivbfor 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 o£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 b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or Iocal 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 xequilred." 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=contractors) name(s), address(es) and phone number(s) along with their cerdficate(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 IndustrialAccidenis. 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 (ifnecessary) 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. Anew 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-MASSAFE Fax # 617.727-7749 Revised 02-23-15 wwwmass.gov/dia M N O O 3 0 m v 3: 0 w En w 0 c cn 0 Nn[(D ao 3 7 T p rN -Ur o(D0cn�0 (DA. C(p0�(DNZ) "OM N 0o 0 � � � cn 5' z CDv�•� ....o �0o—c mEnCD Dcn (n CD cn 10CD 0 D0o n ml 0 0c• cn CD =a� 3(D m< 04 c0 o00 L CD 0CD m (n —Impr- O xy n v ;. (D M `<_ w o cn to =� -% (D (rtD (D O (D N 000 NNNN r -r 0002 O-,jcnG' O 7 cn C (D N• O (D `D.WX> 0 0 (DC � Q ' • fD r (D =W U) �D CD Z 3 CD 3 .. ME (DO 'COCD p 0m � v �cn 0" ID 0 0 0 prMIL 0 K v 0 0 am0 3 0 i7 0 CD T. U) Convenient. Methods of Payment Along with traditional methods of payment such as cash or check, Edmunds General Contracting, LLC has joined with EnerBank, USA Express Loans to offer a 12 month, 0% interest free loan program. To take advantage of this program, call the toll free number 1-866-405-7600 today to complete the pre -approval process. To complete the over -the -phone application please follow the simple steps outlined using the following information: o DIAL toll free: 1-866-405-7600 o Our Company Name: Edmunds General Contracting, LLC o Project Type: roof replacement, addition, siding replacement, bathroom remodeling, etc o Dealer ID Number: 80671 o Total Cost of Project: see our proposal for the total cost of your project o Promotional Code: 821177 For your convenience Edmunds General Contracting, LLC also accepts all major credit cards including: o VISA o MASTER CARD o AMERICAN EXPRESS o DISCOVER •'' !: -MI 7rM hUlMUN_1 UP IU: Mt: 06101120/4 1 rtes cEIZTIFICATE 13 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 TETE 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 i certificate holder in lieu of such endorsement(s). PRODUCER Planrightinsuranc"alem 224 Main Street Suite 3C Salem, NH 03879 James A Santo WNIAVr James A Santo PHONE Fax ArC N Ext • 603-890-6439 ktC No ; 603-890-6521 AEDp Imo: Jamie antoinsurance.com INSURER($) AFFORDING COVERAGE NAiC'4 INSURERA:St Paul Surplus Unes Ins Co INSURED Edmunds General Contracting, LLC PO Box 2214 Salem, NH 03079 INSURERS: Liberty Mutual Insurance Co INSURER C: Essex insurance Company INSURER D: 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 LTR k LISUB POLICY EFF POLICY NUMBER I MPWD POLICY EXP (MMIDD LIMITS I A jX COMMERCIAL GENERAL LIABILITY ( ; EACH OCCURRENCE is 11000.00( j J Ct AtMS MADE X j OCCUR S797699 11/11/201$ 1 1 (I1$/Zi�14 I PREMISES 60300E (Ea occurrence) is f � MED EXP (Any one person) ,!! S 6,00( PERSONAL & ADV INJURY 1 S 9,t1E10,00( p GENERAL AGGREGATE IS 2,000,00( GEN'LAGGREGATE LIMIT APPLIES PER: ! j POLICY i JEr° "LOC S j® PRODUCTS-COMPIOP AGO is 2,000,00( !OTHER: y� $ S� f -• t COMBINED SINGLE LIMIT I Ea accident){ § AUTOMOBILE LIABILITY (—� I ANY RUTOy RLL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per person) is i BODILY INJURY (Per accident) i S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE j S Per accident I i X UMBRELLA LIAB X - i OCCUR I ! EACH OCCURRENCE S 1,(100,001 C I EXCESS LIAR � }, CLAIMS -MADE CUBW4880813 ; 121021201311210212014 AGGREGHTE i S 1,000,001 X 10,000 is t DED i l RETENTION$ 1WORKERSCOMPENSATION ' II ! (:R AND EMPLOYERS' LIABILITY B !ANY PROPRIETORIPARTNER(EXECUTIVE YIN� IWCS-31S-602821-014 10410312014 04103120196 STER ATUTE E I E.L. EACH ACCIDENT Is 500,00( I OFFICERIMEMBER EXCLUDED? L'� (Mandatory in NH) NIA �3A: NH j — 1 E.L. DISEASE - EA EMPLOYEE{ S 800,001. 1 Byes, describe under i DESCRIPTION OF OPERATIONS below ; , , E.L. DISEASE - POLICY LIMIT is E(I0,004 i DESCRIPTION OF!OPERATIONS I LOCATIONS /VEHICLES (ACORD 1011, Additional Remarks Schedule, maybe attached if more space Is required) _ -snp ec �2rage . CERTIFICATES OF INSURANCE ARE PRODUCED UPON REQUEST ,i AND DELIVERED DIRECTLY TO THE CUSTOMER T €GATE HOLDER CANCELLATION YOUR NAME AND ADDRESS PRINTED MERE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE tMLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marls of ACORD EDMUN-1 OP ID: NB CERTIFICATE OF LIABILITY INSURANCE r04106/2016 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 2A NAME: James A Santo PHONE Alc No Ext :603-890-6439 AIc No : 603-890-6521 Salem, NH 03079 A Santo A DRE SS: anile Sant0111SUranCe.COm James INSURER(S) AFFORDING COVERAGE NAIC A INSURER A:St Paul Surplus Lines Ins Co INSURED Edmunds General Contracting, LLC PO Box 2214 INSURER B: Liberty Mutual Insurance Co INSURER C INSURER D: Salem, NH 03079 INSURER E: 11/11/2015 INSURER F DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY FF MM/DDfYYYY -POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR WS264625 11/11/2015 11/11/2016 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: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PJECTRO- ❑ LOC PRODUCTS- COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS r PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIF�CUTIVE YIN OFFICER/MEMBER EXCLUDED'? Y❑ (Mandatory in NH) N I A C5-31 S-602821-015 3A NH 04/03/2016 04/03/2017 PER OTH- 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 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Dave Edmunds is excluded from work comp coverage fax# 978-688-9542 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) ©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, N0110E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover, MA 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. 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