HomeMy WebLinkAboutBuilding Permit #340-2016 - 75 MILL ROAD 9/17/2015 G NORTH BUILDING PERMIT O`gTLED �6�4' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 3 ! 6 Date Received �qs AATEO "�c5 SgCHUS� Date Issued: o IMPO TANT: Applicant must complete all items on this page LOCATION Punt ] PROPERTY OWNER. U - -. Pant k " �" ,x100 YeartStructure yes MAP 04.59;PARCEL: n/ �'ZONINGDISTRICT Histone District yes Machine Shop Village yes n 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 D Other E Septic O.W.ell . "D Floodplain E15,1Netlands. �....0 Wa- tershed Districf- .. a - E1-Water/Sewer-'_- DESCRIPTION OF WORK TO BE PERFO MED: C v�v� Identification- Please Type or Print Clearly OWNER: Name: �.►e,i��,, Z l,,e,� Phone: °17�1-��-?351 Address: s Contractor Name: F.p IA ,�� z Phone.._ __... . Email: i i , -w. Address:: c7. - _2 1 H' S!Fn L '` C� Supervisor's Construction License /C ]Z Exp Date: 4 -- } Home Improvement,Licerise _ :� C'.� _�. w Exp J ARCHITECT/ENGINEER Phone: Address: 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: $ FEE: $ go Check No.: . Receipt No.: �j NOTE: Persons contracting with unregistered contractors do not have access t e ar my fund Signature of Agent/0wner ignature of contractor I 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 pp 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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 v U FORM PLANNING &.DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature A COMIC-ENTS 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: FIREa Located 384 Osgood Street DEPARTMENT Te_ rnpDum ster�onxs es :� 124!M a ,Located at ain�SCreet l I? si e: Miet _ 7rt COMMENTS. �' 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 r Location(, 'o 2-) 4�P" 2c)I Date t + I • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee �.$ Other Permit Fee $ TOTAL. $ Check# "J r� Building Inspector r3u $ r 7 NORTPI - 1� fA. ic . _" ver O ..�. TA No. * t i 000 ' " �` C, h ver, Mass, O ���e 1. COCNIC"Ewer K 0 C2 S u BOARD OF HEALTH Food/Kitchen PER MIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ................................................................ .:......................................................... has permission to erect ... buildings on .... .� .. ...... �...�. A.A. Foundation Siv ` Rough tobe occupied as . ....... ... ..... . .. ........................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION MR Rough �� vw--� Service .....................A...... .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Why Licensed and Insured I Member of IAA Better Business Bureau Member of NH Beller Business Bureau GAF Cert ME$20212 7l Y HIC Fleg#166661 Owens Corning Preferred Contractor#212828 MA CSL If 104726 -°t OSHA 30 Hour Construction SafetyTraining _ EPA Lead Safe Certified LSF General Con-tracting, «a , M - R91MW 51 S,Broadway#2214 • Salem,NH 03079 (603)890.0084 10 Stevens Street#141 Andover,MA 01810 • (978)475-0095 -MOPOSALfi! ,TIFF.n T9 1110M -- CAR t �3' )'l IV?1? a73S /�� /,3 J!S� A,i 2t, CITY Jnr F NinrA+P,o1)e AaIGGiW4 Completely protect the home with tarps to catch falling debris.Respect and protect shrubbery and flower beds, Strip off?-_layers of roofing material down to the bare roof deck,Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards,and repair and replace as necessary". Inspect roof ridge for proper 11,12"spacing on either side of ridge for maximum exhaust ventilation.Cut in if necessary, Install new heSw gain,._ 1.46 (color) A&Qli,Uvfn drip edge at roof eaves. Install � J&tAWZIt ice and water shield to meet manufacturer's specifications(i.e.6 feet from roof edge,3 feet centered in valleys,around all skylights,chimney bases,roof penetrations and at all sidewall transitions). Install�0,&, breathable roof deck protection to remainder of the roof deck. Install new heavy gauge 1,L) ;tG' (color) A1utvtlt\&?m drip edge at roof rakes. Install Rlz� ice c starter strip at roof eaves and rakes, I)at _ t;;r1,.kdesired color. 7;S b (color) Lt"U"( Install new flashings to rpeetlm�a`nufacturer's Sp ci iAns.(i,e.sidewalls,chimneys,skylights and roof penetrations), � Install�(feet)of ,:AUrn3�t t`rdge vent at roof ridge to allow maximum ventilation. Hand nail to ensure proper fastenin .. Install 7 V0 (feet)of %tY)tnr 6, 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: eatl AJQ,,�) le41> " T 3e. 1'r nh' „t. ''If G wiS b� �.115`.ii GO '}'G PC •-R+ Gt 3 si DLS o -7Ae ID-_-e, 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 materiais to complete the project. •Provide a thorough clean-up and disposal of all debris generated during project. Edmunds General Contracting LLC agrees to commence avork on/or about �//JIS and described work will be completed in about Li2_days. Product Upgrade 1,. Product Upgrade 2:.-- Contractor's : 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 parties, 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 �1mDnds General Contracting LLC guarantees all workmanship performed for requested by contractor.Upon refusal to do so,contractor may at its option declare L 7 years. the entire contract price or so much as then remains unpaid,immediately due and j /i payable.it is agreed that,d permitted by law•contractor shall be paid by the We will repQj �/_ _�/yS�factory enhanced warranty owner(s)all reasonable costs,attorney fees,and expenses,in addition to the providing_ years of material 41 a and X years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defe-t coverage through_ toe of the contract andtor any lien In connection herewith. no charge _the additional cost of 'Edmunds General Coalneting LLC 11'll provide the materials,I,*and dis asal la replace up to o4 sq. a roe!decking and 20 it of fascia at no addiffanal coxl Any aftrianal materials ir.clutnag Uonrand disposal will be replaced at L � par sheet pr +�'� lineartool. .: .. Edmunds General Contracting,LLC agrees to furnish the material andsamnuuaanand�tw•nmoemaYe•enawrlr�cn,dr>yffiff em. '. t'rec:ce.tle9 sNnR7ndrdsriri"rrr"remehanadedraWeebrSAw czaact�w9tps •rims �. lalscar CAy1�ple� ncc9 with the aUfJva spe�ifjGatiai 1,WAhe sufYc ,eed rn4 terome w rr�c r o w Baa tab"I"p.nbxd mafxa arx..tba sxpf /� dothlrs iS� f�°iCx1nn r�iows a.ew Wi &-d a�mio n a Wokdb FOA I7 t}/v t rf s� d� --- kavW#t frma uw►tt eyg oca&GZ tyve+n ntt na!vJA, x�r oe! t rrwceiLt a N cG-1p meta. Rte" r b asl t 1e I bill b W!14 No 0 FenatR A' mm taassler's Payment Terms: '►s e !g,W.• A deposit of�(not to exceed 1/3 of the total contract)is due upon start of work.The balance oft(lam is due when work Authorized re: is completed to the satisfaction of all parties. runih General contrac7ing LLC • A finance charge of 1,5%per month(18%per year)will be charged on Note: This prop6-al' ba withdrawn by us if not accepted within tDateof counts over 30 days _ � days.. CQ 01tJI0p0gtlY -The above prices,specifications,and 04 NOT SIGN THIS CONTRACT IF THERE 7ANY :SPACES. satisfactory and are hereby accepted.You are authorized to dopecified.Payment will be made'as outrinadtrtipve; Authorized Signature: ptance: lkjo IAuthorized Signature: til as-x unpprcma';cM'laCNSEh:t Ce misl:rA.AH'hiEG aaae;a mnintcrasutv_:d'aslp:rtCrq le a reysln.a'i s-�"Id Ce dxrc:ed le:e;!he p.'wnsuaer mfxi,s x:a evsr.zss a39UhUen.to PaIX Pia+.a,.Nk 517C,Paslw RIA p"<t!6IP:iu-6'617.e]ac7i.11. cox,xh iaace;h.a wm<onslrvtrCn-.'eh2E pe:mi5 0Jett w:.n uar:g'Sb;edcmertlors s°:p 5e cIUJCM n:[:n xCXsi 1C Itn GudxN9!Fu'?pms3im�or 4niCc n4?A Themne:u'a1A a.xeeeq'i6tIRs-rd tit-erw't n91wnrsr E.The Ml tca-1.131-Ym oya b.s iitisWnhavaw;_,A'su.1,Lbrraspor,Eeres s1M::d'x C6et'zd IDEE�'.u.tG.nei91 hn•2:;i;;�LLGal1`e x6eto�E^ss ea.77r,3 The Commonwealth ofMassc ehusetts z. Department of IndustrialAceldents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www Mass.gov/dia iy Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FMED WITH TEE PERMUTING AUTHORITY. Applicant Information \ Please Print Ledb Name(Business/organization/Individual): FC)U"W o1s C"'r, C, .Address1)rA. City/State/Zip: ' � '�c5l Phone#: (Z. 2,L 77 2 Areyou an employer?Checktbe appropriate box: Type of project(required): 1. KM.aemployer-with__,_�. - employees(full and/or part-time,).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in &. 0 Remodelirig any capacity.poworkers'comp.insurance required.] 9. ❑Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner andwill be hiring contractors to conduct all work on my property. Twill ensure that all contractors either have workers'compensation insurance or are sole 11.F1 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roofrepairs These sub-contractors have employees and have workers'comp.instrance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *.Any applicant that checks box 4l must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . employees. if the sub-contractors fiave employees,they must provide their workeis'comp.policy number. X am an employer that ispr'oviding workers'compensation insurance for my employees'Below is thepolicy and job site information. Insurance Company Name: �-!' ✓ `�� Z Ex iration Date: 2 G Z / Policy#or Self-ins,Lic.#: WL 23 �S � C �1 S P Job Site Address: 1� J"VA City/State/Zip:��T�l �J-�� I � Attach a copy of the workers'comp nsation-policy declaration page(showing the policy number and expiration date). Off$ - 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 o tor.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage ve ` catio X do hereb' ce ify thepars andpenallies ofperjury that the info rm a tion p ro vide d above is true and correct. Si a e: Date: 9/d/ /5 Phone#: Official use only. o no write in this area,to be completed by city or town official.. City or Town: Pei mit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empoyees. 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,partnexshap,association,corpogation 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 comm onwealth 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=contractors)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 Iirdustrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the aflidavit. 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' compensatioil policy,please call the Departmentt,at the number listed below. Self-iii'ured companies should'enter-their• self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 hadustrialAccidents 1 Congress Street, Suite 100 Boston,MA.02114-201.7 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia • I ACOR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `6.� 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(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& FINANCIAL LLC NCONTACT AME: 224 MAIN STREET STE 3C PHONE FAX SALEM NH 03079 C AIC No + E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: EDMUNDS GENERAL CONTRACTING LLC P 0 BOX 2214 INSURER C: SALEM NH 03079 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 26473324 _ 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ I l DAMAGE TO RENTED CLAIMS-MADE I I OCCUR PREMISES Ea occurrence) ccurrence $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY D PRO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC5-31S-369752-025 1/26/2015 1/26/2016 ; STATUTE OH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/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. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE 120 MAIN STREET ACCORDANCEW TH THE POL CY PROVIS PROVISIONS. WILL BE DELIVERED IN NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation lJ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 26473324 1 1-369752 1 15-16 WC I Ashish Borgaonkar 1 9/18/2015 10:41:30 AM (EDT) I Page 1 of 1 Massachusetts -Department of Public Safety Board Of Building Regulations and Standards Construction Supervisor 1 License: CS-104728 ° ' DAVID C EDMUNfiS P.O.BOX 2214 t SALEM NH 030; Expiration Commissioner 10/03/2015 ,. ��ie�pom�norursecr,��o�C/�aQoacfu�aeLt Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: -,,d%6661 Type: Expiration 6/2;1%20,16; Corporation (T\ ! EDMUNDS GEN ERAL=CONTRACTING LLC. DAVID EDMUNDS , 18 ASHFORD RD �t ' HAMPSTEAD,NH 03841 Undersecretary License or registration valid for individul use only j before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 r Not id at signature ( '1