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HomeMy WebLinkAboutBuilding Permit #703-2016 - 55 LINCOLN STREET 11/9/2015YdAw NF1 f':9 -.16 - /,S Permit N®: -703 YJ A BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ C mercial ❑ Repair, replacement ❑ Assessory Bldg GKOthers: ❑ Demolition El Other -< R t ., © Septic , 0 Well v�+�'..�-N ®Flo„od�plyain® S'� f �5„-ieR 1 ®`Watershed ®`sect i ® Water/ewer . �� Yea`` Dhbi: 11' 1 Iur4 ul- vvurv' I u is ranrumwirzu. tAlOft iN.,oAr 025V%111- ' Identification - Please Type or Print Clearly OWNER: Name: ionone: -1(-6- b-75`1 ARCH ITECT/ENGI NEE Phone: Address: Reg. N 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 1 FEE: $ 7ia� Check No.: _ 0 Z) Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accfss to the guai iti,r�`nf AaF nt/Owi'ier Siariature of,contractor:: . Plans Submitted ❑ Flans Waived.❑ _Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming fools ❑ W011 ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature*. 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: Comme Waters & Sewer ConnectioY1/Signature &Date Driveway Permit DPW Town Engineer: Signature: COMMENTS. Located 384 ester onsite yes. enc' Y ,..f � � Y'., .s � :�Cl�.i.wli, •.:r, la,rS .•.+s� w..�. _sem Street qj a25<�.+ �Xi., �J+e�Ls � • Dimension Number of Stories: Total land area, sq. ft.: 2 Total square feet of floor area, based on Exterior dimensions. ELECTRICAL Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 C 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 DTE: 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 )TE: 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 )TE: 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 Clerics office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording dust be submitted with the building application Doc: Building Permit ]Revised 2014 1 / Location /'j No. r a Date TOWN OF NORTH ANDOVER Certificate, of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL .$ jj . - Check # 1�� r 2 i 7 9 3 Building Inspector Location 5�- 4 N! 0 0�j J;4 e No. / W -3 — ,zo �b Date r Z l 5 • - TOWN OF NORTH ANDOVER TLED Certificate of Occupancy $ Building/Frame Permit Fee $fid s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # N N ` U 29793 Building Inspector = Q 2 LL O O 0 m D \ p O LL E T Ln U a U0 0 Ix W Waif Z Z G J C a+ "O 7 LLL t : w ? C E U — LL 0 0 W tail z Vr Z J a t 0�0 d' LL W of Z J V � W t 7 �' U ` N LL oc O V W Vf Z Q O L -7 ll z W d W LU oc LL � N i CO O Z N (U N N Y O In ULJ r.7 O M 0 •� L CL m ' OO ) , E c. d N as �, y. O � � E a� o = c c O 0 L ■ T vj N " 3 m � U J U), L > M = d y d O O > fA — - O.a — = V Q N (nz �r� y O O t mp = 3 wL ) V � is w 'N c = Q L L 4 Q 4) 's N d m W = -0-- O O L1i ON = — •� w :r W .L V W .- L U Q. 0-0 O N N •= O = F=— t Q.ot0 r O W :a z Z .C3 w4 2 Z z WNN w CL LLI WA CL li co O C) J M 0 (ie L.: CL vE al u Y \ O LL E a) V) U N Ln p w Z z m C O m -O O LL �d aa) C L U <u W Z r � u °� " O .. �Q � �NOQ �Q N o** v U N C LL O w CL Z Ln O LL W LL o o m al u Y \ O LL E a) V) U N Ln p w Z z m C O m -O O LL L O W aa) C L U C LL O u a Z Z m J O. L p_ cc C LL O a Z J V J NJ _C v U N C LL O w CL Z Ln t .� LL z W a p o_ 6L L m z N +' a) O O Ln v O C Q 0 R _ �s00 .y •C O O •E O� :r � c -a 0 0 0.0L '� O N O t �O CL 00 2 0- O O d Z N I � _ N •E m m a0� O WOO O CL CL C. 0) Q OM _ �CL O 4) ��. Z 0 CL V U) - s Fully Licensed and Insured • Member of MA Better Business Bureau ,��y+}�Yi. Member of NH Better Business Bureau GAF Cert. ME # 20212 rapog`'•` HIC Reg # 166661 CIAI ak'Ja_,DAtGDA .. _- ..'...`..'.' U yr . S ofm rvin uJcn vlwl cV General Contracting, Lcc &M" 51 S. Broadway #2214 • Salem, NH 03079 a (803) 890.0084 1 10 Stevens Street #141 • Andover, MA 01810 • (978) 475-0095 PROpos uski 1TEa TO 1 ! t l vl�li PHON/NEJ}7/!t(� } DATE C I V V 0 1 / SIRE f•3 c�1.� S "o.2C E-MAIL j Zy Z -2 �� ves"2c� a (4, ' CITY, STATE,AND ZIP CO DE JOB LOCATION I Strip off existing siding material down to the bare side wall. Inspect the sidewall for structural defects. Determine the condition of underlying plywood or boards, repair and replace as necessary*. Install a CtJ Jf(� l r� vapor barrier to entire house. Tape all seams with proper vapor barrier tape. Install c4,`(CA.N A+1'Eti$ q `y corner boards to the corners of the house. gC Install���I`c. fufVt i NUt1� starter strip to bottom perimeter of house. Install 'r�lfT!ii ll Tkifyi channel to all designated areas (i.e. windows, doors). Install ligh blocs and split blocks to all lights and penetrations. �^ Install ca5' iC 6CA-N- G-30c�c3 !W q t/ v siding. Color choice: - J�0.5C.• + J CV -t � Install vented soffits to all soffits and overhangs. Drill holes in soffits for proper attic ventilation if needed. Install aluminum trim coil to all fascia and rake trim. Color choice: Install shutters of desired style, color, number: /Up Thoroughly cleanup, dispose of all debris generated on property. Magnetically sweep property for nails. t t 1 Notes: Sit r J7 c�1'Y" CaYcr� (k e`,'o/k a Si �`• C�tf illi .`�i�1PC 7T 4tii0 .�, GvL�i �t„jr,,w 1 LJt11'na t rLti C o�`S `tib MCA 1 Edmunds General Contracting will: i • 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. at 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 willbe completed in about �_�iays. } ��(/ Product Upgrade 1: SL\ �9� `j ti �c Cr1 `o�0 Product Upgrade 2: Contractor's employees are fully covered by workmen's compensation and in enforcing the terms and conditions of the contract and/or any lien in liability insurance. connection herewith. Upon completion of the above work, all undersigned agree to execute and It is further agreed that this contract may be assigned by the contractor, arjd deliver to the contractor, their joint note in accordance with his (their) above also that the obligations hereof shall bind and apply to their heirs, successors obligations as requested by contractor. Upon refusal to do so, contractor may or estates of the parties: 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, Edmunds General Contracting LLC guarantees all workmanship performed for contractor shall be paid by the owner(s) all reasonable costs, attorney fees, Z 5 years. All materials installed are guaranteed per manufacturer's and expenses, in addition to the amount due and unpaid, that shall be incurred warranty. •rn,�„�H�r„e�,c,,.,ria,,,,.nr.,4n._.,..:a-..__.,..:_,_,_._.__. ,._____.._ __.. _. .. '_. .. ___ ....... ....,o ”' ayvaa, w llw up 11104 b4. It. of Four ae^qng ano Lu a m rascla at no aaamonal cost Any additional materials including labor and disposal will be replaced at ® per sheet ors S,(36linear fooL Edmunds General Contracting, LLC agrees to furnish the material and labor Cc�,Q�m'pplet'e� in accordance wit the above specifications, for the sum of doll�arsr($L7t1Q PaymentTemts: ("7�. ttt_%,JQV'C0 CxAD ILC m- A deposit of y' not to of the total contract) is due upon o ex start of work. The balance of$ ;, due when work is completed to the satisfaction of all parties. • For your convenience we offer financing and accept all major credit cards. If you elect one of these options we will add an additional 5% to the contract price stated above to cover dealer/merchant fees. • A finance charge of 1.5% per month (18% per year) will be charged on past due accounts over 30 days Rcceptance of Prop05af - The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined abov& [ Date of acceptance: f / // `J sxo % C`/ All material is guaranteed as spedbed,hi surds lobe completed Ina workmanlike marea raccording to Standard pmc0ce, Any alteration Or deviation from above specmcations I -Mag a= costs w10 be executed ony upon written orders, and Wit become an arms charge over and above the stated contact price. contractor is not responsible for damage due to high %Ands, tornadoes, hurricanes, fire a otter locards. Ower(s) agree to cavy the tornado and other necesszry insurance. contractor is considerate of owners handacepingand of due to the nate 0 the cooling installation some damage may occur. We attempt to minimta any damage, and wit net be held responsfee B any damage occurs. Contractor s net responsible V arty damage to me Interim of property, mclo ling pro -a isting conditions iii.e. water spirs, crumbling plaster, rup sed uric) or conditions resulting frwn application of marries as specified abore. Items In the attic may reed to be Ousted by the Omer. contactor is not responsible for damage caused by Ice dem buad9p. All agreements a%cbr#gem upon stokes, aaidar s, or delays beyond our amua. Authorized Signature:(lam Edmunds General Contracting LLC Note: This proposal may be withdrawn by us if not accepted within ^�+�`1 'bays. f DO NOT SIGN THISCONTRACT s I nRE ARE ANY BLANK SPACES. Authorized Signature: .' . t Authorized Signature: AD home improvement Cgmmloa shat be registered Any inquldes Drrars aft secure their onn about a conbazar or subcommctor raNfta to a regalmilon should be dontm to: Oma of Consumer Mobs, and BoReg t""to, 10 Park naz, asupe 5170. Bost., MA 02116 (Phone: 617-973-870D), eorsW ctlolrre!ated permits or deal y.$h unregL^tzr¢tl sontralms�tyli bo_gxcleded from access to 1'na Guxransa fund pravlslaris W MGLc.147A Th, —dill r -W a signed espy of this control Went .,E cdn cammeaes, Tl,a -has three (3) business days to sante! /his mntraai aIW Inas no pwig.. CD,r,spandovw stanld da d!reartl fa Edmn:fis Ganewl tantaling LLC a! ai aaove xddus. B-04111 The Commonwealth of Massachusetts Department of Industrial Accidents X Congress Street, Suite 100 ttl Boston, MA. 02114--2017 www.mass.gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPMTTING AUTHORITY. Name (Business/Organizatiton&dividual): LylVy>,k—AC) 17r v\1 L 0 W -v' .A _X r- v Address: p k,�C)A 6 9Ann, S.207 City/State/ZiD: Are you an employer? Check the appropriate box: Phone #: G d -J 1.F] I am a employerwith employees (full and/or part-time).* 2. Q I am a sole proprietor or partnership and have no employees Working for me in any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.FJ 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_J 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.: 6.F1 We are a corporation and ifs officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no, err�ployees. [No workers' comp. insurance required.] n Type of project (1•equired): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 [] Building addition 11.❑ Electrical repairs or additions 12. Q Plumbing repairs or additions 13. erepairs 14. :';Any applicant that checks box#1 must also tui out the section oeiow snowing i ucu wvia ­=.r—u,..,=t 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. tContractors 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 -contractors fiave employees, ley must provide their workers' comp. policy number. dam an employer that is providing workers' compensation insurance for my employees.' .Below is the policy and job site information. ,{ Insurance Company Name: Policy # or Self -ins, Lie. #: W �- Z '�5 1 360775-2— Ex irai on Dat : Z Za Gi-� 4tc/Zip: / Ci /SC9lob Site Address. �-�/ � � Attach a copy of the workers' compensation policy eclaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 fine 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 DIA for insurance do lI eby c t epa ns andpenalties ofpeijury that the informationprovidedabove is true�znd correct. Official use City or Town: in this area, to be completed by city or town official. 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 #: Massachusetts General Laws chapter 1.52 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 l`iire, 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-'contractox(s) name(s), address(es) and•phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cavy 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 foi- coeumation 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 -insuran'c'e 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 "rob 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, AIA 02114-2017 Tel. # 617•-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia -rom: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 ACORL?" CERTIFICATE OF LIABILITY INSURANCE ATE (MMIODNYYY) r12/09/2015 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 Planrightlnsurance-SalemPHONE 224 Main Street Suite 3C CONTANAME: C James A Santo Arc No Ext 603-890-6439 AIC No; 603-890-6521 I oRlEss: jamie santoinsurance.com a Salem, NH 03079 James A Santo INSURER(S) AFFORDING COVERAGE NAIC 11 INSURER A: St Paul Surplus Lines Ins Co INSURED Edmunds General B: Liberty Mutual Insurance Co Contracting, LLC PO Box 2214 -INSURER INSURER C Salem, NH 03079 INSURER D: INSURER E DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER PO ICY FF MMIDDIYYYY POL CY EXP MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE aOCCUR 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 ❑ JjRO- ECT F—]LOC PRODUCTS- COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per acciden[ $ UMBRELLA LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION Y AND EMPLOYERS'LIABILITY OANY FFICEOPRIETER EARTNER EXECUTIVE � (Mandatory in NH) NIA C5-31 S-602821-015 3A NH 04/03/2015 04/03/2016 X 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) Dave Edmunds is excluded from work comp coverage %.QFN r 1n% -1A 1 r- nyLLJr-M UANI.tLLA I WN 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 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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 ACORI70 CERTIFICATE OF LIABILITY INSURANCE TE (MMIDDIYYYY) 79/18/2015 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 CONTACT NAME: PHONE FAY Arc Ext:(AIC' AIC No: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA : LM Insurance Corporation 33600 INSURED EDMUNDS GENERAL CONTRACTING LLC INSURER B : EACH OCCURRENCE $ P O BOX 2214 INSURERC: INSURERD: SALEM NH 03079 INSURER E : INSURER F : DAA 0 RENTED PREMISES Ea occurrence $ COVEKAGE5 CERTIFICATE NUMBER' 9AA74g9A RFVISInN NIIMRFR- 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. IL1R TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR 1-1 DAA 0 RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL I£ADVINJURY $ GEN'LAGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ PRO - POLICY JECT LOC PRODUCTS - COMPlOP AGG $ $ OTHER: AUTOMOBILE LIABILITY Co MBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per $ ( ) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED RETENTION $ $ A WO REMERS PLO COMSEL ABIILI N Y / N OANY FFICER/PROME BER EXCLUD D7 ERIENECUTIVE El N / A WC5-31 S-369752-025 1/2612015 1/26/2016 sEnruTE ETH E.L.EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 500000 (Mandatory In NH) fns describe under E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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. TOWN OF NORTH ANDOVER, MA 120 MAIN STREET NORTH ANDOVER MA 01845 ACORD 25 (2014/01) 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 LM Insurance Corporation fJ 0 1aus--LU74ACVRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD !6973329 1 1-369752 1 15-16 WC I Ashish Borgaonkar 19/18/2015 10:91:30 AM (EDT) I Page 1 of 1 cl u1:3 - �a§ . \ c emit cg ■i E] `©e. 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