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HomeMy WebLinkAboutBuilding Permit # 12/9/2015 �ORTN BUILDING PERMIT '-V 6 4_ 6 1 TOWN OF NORTH ANDOVER 10 7 0 APPLICATION FOR PLAN EXAMINATION Perini Date Received 01i*rcD t No#: S, C14u Date Issued: IMPORTANTmust complete all items on thi r ul, rill Maw _nwI MW g-" 'wa P. ON 9 Tv,j ERR'!�YR99J L 4 WAR TYPE OF IMPROVEMENT PROPOSED USE 7— Residential Non- Residential ❑ New Building [I One family [I Industrial 0 Addition El Two or more family El Commercial El Alteration No. of units: [I Repair, replacement El Assessory Bldg @/"bthers: El Demolition El Other "�/......... RK TO 131� PERFORMED: r DESS IPTI®N ®F 66 C­ Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: p .0,n.Q: ............ A P0'a wi Ar E w, x ,,,Datei. _j ......... ...... ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F- Total Project Dost: $ FEE: Check No.: 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ace to the uar , and signature qf c0hfr�W_ - -' :' • - Town of Andover to 2 Mar s 4. r-.?� ;,t'J: , zt\ a ver Mass 4t"S Lj PE RMI r.. OAR OF HEALTH i ... Septic System BUILDING INSPECTOR bujildt gs on .....C.wr.........U.111101W .0.4......$r00.0 Foundation .. . to be occupied as .......... ...... .........U.I. . ..... .. ........................ Chimney Construction &00* to Iii e0e . ........... ery respectlqo�n...rm'...to' 't, terms ofithe application provided that the person accepting this permi�s �in me v Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and of • .•.sin theTown !• North Andover. '.•' VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR tUNLESS CONSTRUCaNS S Rough Service BUILDING •- INSPECTORGAS Occupancy Permit Required to Occupy Bu Ro u*gh Display Do Not Remove f Fully Licensed and Insured-Member of MA Better Business Bureau Member of NH Better Business Bureau GAF Cert.ME If 20212 V HIO Reg#166661 EIN#'26-1081508 C M MA GSL It 014728 33B33 00120rai COiTtFaCtingy LLC iffm FIR i F�in 4WENEWIMEM 51 S.Broadway#2214 e Salem,NH 03079 (603)090.0084 1 10 Stevens Street#141 Andover,MA 01810 (978)475.0095 PROPOSAL SUBIArEDTO PHOUE DATE 'I 7V STREET E-M L"'JCCA'J SV j��aej I./Z.Z CD CITY,STATE,Alto ZIP CODE Jce Strip off existing siding material down to the bare side wall.Inspect the sidewall for structural defects. Determine the condition of underlying plywo 7d or boards,repair and replace as necessary*. ,/e, ,�r ��_ ,Vtp I,Cz C, Install "C"P YZ11--J-toiJ vapor barrier to entire house.Tape all seams with proper vapor barrier tape. Install corner boards to the comers of the house. Install AA(;,A,c starter strip to bottom perimeter of house. Instal W T_ Z f fv\, channel to all designated areas(i.e.windows,doors). Install light blocls and split blocks to all lights and penetrations. anneal) 0 9V �" siding.Color choice: 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: c—,f Install shutters of desired style,color,number: A,to �h,,AAO'_S it Thoroughly clean up,dispose of all debris generated on property.Magnetically sweep property for hails. Notes: S'h�-i4z C54 C'1k C'y'JfyA1% Alefk<, LvAL' _41IeCJWLO' e>"C) ,,5 Llv, M'11r-1 _o 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 and described work will be completed in about 6'16'days. Product Upgrade 1: S4-C"NA b.CA- CCO AMt KNcd 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 lion in (lability I lability Insurance, connection herewith. Upon let completionof the above work,all undersigned agree to execute and It is further agreed that this contract may be assigned by the contractor,aqfd 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, '?-S years.All materials installed are guaranteed per manufacturer's and expenses,In addition to the amount due and unpaid,that shall be Incurred warranty. 'Edmunds General""tTacthng LLC TAB proAdo the oullarials'labor and,disposal to placeupto(54sq. it of roof decking and 20 It of fascia at no additional cost Arty arldithored materials including labor and disposal will W replaced at, -per sheet or�Z��Qb linear fool . Edmunds General Contracting,LLC agrees to furnish the material and am. prectice.A.y.heralion or dairiabon e*3 coetavAl N executed 0*upon Written laborginplete in accordance wit he above specifications,for the sum nda.,and ug become.elba charge wer and above the stated conbacti,6'e.Con drodaria rt,.V..FA.ler a. of but due to the I—of the m*9 am lone Nm=do and ogur dolle M-174 0Q e— —oentraft 4 cnaiderate of mrranr tardecaping and kkulaiJon some damage mor occur We attempt W mindrute,my damage,end YAI not be Mid reWorutre If arry Payment"narms: damage oecus. corbacter 9 net resperwe for any dernane to IN kilero,of property,Including lao-edStIng A deposit of not to exceed f the total Contract)is due upon —0c.O.., W.W.,crurrblig pl.ater,cpaod car=).,.,dfi——AN.9 fir—pplic.15.of maderfale as specified able.N=In IN One many Mad to be conned by IN"er.Contractor Is net responabo for damage due when work is completed to the jwd bykm dern buld-up.Ni agreements etpw ouden%a debw beyord cer_NL start of work.The balance of- (V� satisfaction of all parties. • For your convenience we offer financing and accept all major credit cards. Authorized Signature: If you elect one of these options we will add an additional 5%to the contract Edmunds General contracting LLC 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 Note: This proposal may be withdrawn by us If not accepted within days. I over 30 days accounts 0 accountsover3 days day-. 91CLIPtallre of Vropo5af -The above prices,specifications,and 00 NOT SIGN THIS CONT�ACT IF HERE ARE ANY BLANK SPACES. 11 o conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined abo Authorized Signature: Date of acceptance: V Authorized Signature: dy.w worn. J—.1—Tie h.U,,ffe(3)Nr1r.5 tuya te—1 dfae,t aM�,,ne p-4j.C edpende­9Wl le d,.dld b 66­1"fce�C.Ukv LIX.M.W.addaea. IN 1n1 I.&e a�ljavd M of thi� bel.,.,k'i 6161 P_X yhe commonwealth of Massa.chusefis Department ofIndustrialAceldents I Congress Street,Suite 100 Boston,MA 02114-2017 wwwmass.gov1dia Workers'Compensation insurance Affidavit:13uilders/Coutractors/FIqetrlcians/Ttumbers- TO BE FILL'P WITH THE PEPMTTING AUTHOBJTY' Please Print LegLbh Applicant Information I A Name(Business/Organization/Individual): V U Address: 2_1 C) City/State/Zip: Phone 6-'3 Ase you an employer?chlc*kthe appropriate box; Type of project-(Tq4uired): 1F1 lamaemployerwith ,�arnployecs(full and/or part-time).* 7. New construction I am.a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3Q 1 am ahomeowner doing all work myself[No workers,comp.insurancerequired.]f 10 Building addition 4.FJI 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 11.Q Electrical repairs or additions proilietors with no employees. 12.Q Plumbing repairs or additions 5.FJ I am a general contractor andl hayehiredtho sub-contractors listed on the attached sheet. 13. " airs R ofiep These sub-contractors employees and have workers'comp.insurance,$ 14. 70thbr 6.F1 We area corporation and its offlqqrs have exercised their right o£exemptionper MGL 0. 152,§44),andwo have nue,M 9s.[No workers'comp,insurance required.] %%Any applicant that checks box41 must also fill out the section below showing theirworkers'compensation policy information i Homeowners who nformationf1foracownerswho siibiMf this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. tContrators that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have emplo�ees,je�mustpravide their workeis'corap.policy number. employees. I-C-the sub-cbfi� 'avo ' policy andjoh site lam an eniployel,tliatispidvidiizg-worllrePs'compensation insurance for my employees'Below isthe PO information. Insurance Company Name: 2- Ex drat On Da* Policy#or Self-ins,Lie. C e fob Site Address: .9�� Lri City/State/Zip: A and expiration date).(4 I wing the policy number Attach a copy of the workeis'compensation policy celaration page(showing Failure to secure coverage as requited under MOL o. 152,§25A is a criminal violation punishable by a fine up to$1,500-00 as well as civil penalties intho form of a STOP WORK ORDER and aflue of up to$250.00 a and/or one-year imprisonment, be forwarded to the Office of Investigations of DIA for insurance day against the violator.A COPY Of this statement may Coverage verb patiof, 1 do hereby c tl epa ns andpenaldes ofpeiyuly that the informationprOpided above is true ndcorrect Si natur . Date: /Z'_ Phone 015 1 2 Official use only Do OtIppite in this area,to be completed by MY OF town Official. City or Town: Permit/License V 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 -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 INSURANCE DATE(MMIDDIYYYY) CERTIFICAT F LIA ILITY 12/09/2015 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 pollcy(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 CONTACT NAME: James A Santo PlanrightInsurance-Salem PHONE 603-890-6439 Afc No: 603-890-6521 224 Main Street Suite 3C AIC No Ext Salem,NH 03079 A DRESS:jam ie santoinsurance.com James A Santo INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:St Paul Surplus Lines Ins Co INSURED Edmunds General INSURER B:Liberty Mutual Insurance CO Contracting, LLC INSURER C: PO Box 2214 Salem,NH 03079 INSURER D: INSURER E: 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLIO EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIWYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR WS264625 11/11/2015 11/11/2096 D ERENTED 50 000 PREMISES ( R occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&_ADV_INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY Ea(Ea SINGLE LIMIT t $ ANY AUTO BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS ANO-OWNED PROPERTY DAMAGE $ Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER H AND EMPLOYERS'LIABILITY YIN 500 000 B ANY PROPRIETOR/PARTNER/EXECUTIVE WC5-31 S-602821-015 04/03/2015 04/03/2016 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? NIA 3A NH 500 000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Dave Edmunds is excluded from work comp coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of North Andover, MA 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©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 CERTIFICATEC LIABILITY INSURANCE79/18/2015 (MMIDD/YYYY) 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 NCO AMEACT 224 MAIN STREET STE 3CPHONE FAX SALEM, NH 03079 E-MAIL o Ext: AC No ADDRESS: INSURER($)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: EDMUNDS GENERAL CONTRACTING LLC P O BOX 2214 INSURERC: SALEM NH 03079 INSURERD: INSURERE: INSURERF: 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑PRO ❑LOC PRODUCTS-COMP/OP AGO $ JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acddent ANY AUTO BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ ''..... A WORKERS COMPENSATION WC5-31S-369752-025 1/26/2015 1!26/2016STATUTE ORH _ AND EMPLOYERS'LIABILITY ANY PRO PRI ETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500000 OFFICER/M EMBER EXCLUDED? ❑Y N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 500000 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. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ! t7 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD !6473324 11-369752 1 15-16 WC I Aahieh eoxgaonkar 19/18/2015 10:41:30 AM (EDT) I ?age 1 of 1 Massachusetts Department of Public Safety Beard of Building Regulations and Standards License: CS-104728 Construction Supervisor DAVID C EDMUNDS P.O.BOX 2214 SALEM NH 0307 -� CIA— Expiration: Commissioner 10/03/2017 ���ze�o'��o'rataecvC�v o�C1v��ac�u�eG�i. Office of C.onsuiner Affairs,&Business Regulation OME IMPROVEMENT CONTRACTOR Type: egistration 166661 Corporation 6/2112016 ! ` :.Expiration' LLC EDMUNDS GENERAL CONTRACTING, DAVID EDMUNDS g= ole_ 18 ASHFORD RD Undersecretary HAMPSTEAD,NH 03841