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HomeMy WebLinkAboutBuilding Permit #846-2016 - 111 CAMPBELL ROAD 1/29/2016 L �aoRTy BUILDING PERMIT O� t`eo 6,gti0 TOWN OF NORTH ANDOVER _ ' A APPLICATION FOR PLAN EXAMINATION , - I K. ,. Permit No#: Date Received �RA�RA7ED,P¢ �C SSAGHUS� Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION P` L t1r; 1 Print �U Cil�� PROPERTY OWNER M��� 'I' ��1/i� Print 100 Year Structure yes to MAP�PARCEL:�ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other ❑ Septic ❑Well ❑floodplain ❑Wetlands ❑ Watershed District ❑_Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly `I OWNER: Name: jjgaT�l, 6 Kotiy- Be)cLL+,!� Phone: Address: I i�a �M t - I J , kc6ren o f Contractor Name: &0 64 �© - Phone: y7`13 X91-�aZd Email: 5 C n Address: 0 c' � All 0/$ r Supervisor's Construction License: 6:� 0 (a �o _Exp. Date: 1 CCo l p _ Home Improvement License: / 0� �J� � Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDION$125.00 PER S.F. Total Project Cost: $ 7- 2� (o d� FEE: $ l Check No.: �� �3 Receipt No.: kol NOTE: Persons contracting with unregistered contractors do not have access to i Ira fund � - P of —. - -n ( O� NORTF/ q A)AY BUILDING PERMIT TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION b pq<x.c.c.. . . Permit No#: - Date Received �19SS4rED Date Issued: 71A Ii I PORTANT: Applicant must complete all items on this page LOCATION 1 LA G�/J U nnnn Print PROPERTY OWNER IYI err '� C� �t` Print 100 Year Structure yes too MAP f � PARCEL:� ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer OF WORK TO BE PERFORMED: TESCRIPTION 1� V Identification- Please Type or Print Clearly OWNER: Name:����rk +�r��nn'� ���1' �JG��'`'� Phone: Address: �1 1 C sM { K� i J , Contractor Name: FSA-o ��r-5 (Ud t rA 1 o - Phone: Email CD , ' vv� Address: P 0 60)< A-Acktp—(- 01 r Supervisor's Construction License: GJ`r 0 7�to I Exp. Date: Supery / Home Improvement License: 1 0:9 .353 Exp. Date: 0 //�,:,2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBAS D'N$125.00 PER S.F. Total Project Cost: $ 2- Z 1 (e)0 FEE: $ Check No.: in Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to ra fund Location No. ��_Z L) Date 24 . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit:Fee $a� Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# /J F ,� Building Inspector J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i a i Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ;FIRE RR-9 NtT -`Ti_emptDumpster, or tsiter �y�es�_ Ino Y6` "- ` ' I gafed at0'.4i11/lnl~SDepartment�syignature/date j ' G.®MMEN�T,,S: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP"A` — - - M --r . u�a..__ FL RT�M_ENT TemDumpAster��ons to ,yes .� iio Located x`61'24 Mai StreetE -- Fire Department si1 nature/date ) G.®MMENTS �_ 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: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit Revised 2014 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector 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) r r i 'i ill ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I _- r fl Building Department The followingis a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4. 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 01 : All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application Certified Surveyed Plot Plan 4. Workers Comp Affidavit 4, 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 HydraulicCalculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products IS 01 �: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I t New Construction (Single and Two Family) 16 Building Permit Application Certified Proposed Plot Plan I 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 2012 IECC Energy code Engineering Affidavits for Engineered products OT All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In l cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals tha he appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording mu be submitted with the building application Doc:Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4� Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit 4; 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 IS OTE: 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 Include Sprinklerrinkler Plan And Two Sets of Building Plans (One To Be Returned) to Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 v Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 22,600.00 m $ - $ 271.20 Plumbing Fee $ 33.90 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 33.90 Total fees collected $ 439.00 111 Campbell Road 846-2016 on 1/29/16 Kitchen Remodel i �I i. �� I �,i �' kI ,� �I �� ;I i! �� i r7 NORTH . - - . wnA-. ,. . ve . No. ' j� NAh ver Mass, In 001 � o coc"Icnewicoc 7,95°RArEo '-P����S U BOARD OF HEALTH Food/Kitchen PER T T LD Septic System THIS CERTIFIES THAT3L BUILDING INSPECTOR . . Uns-lic6c.11 ..... ...... (�—� .............. Foundation has permission.to erect .......................... buildings on ...1 1.'....... . . " .� Rou 1�c.1M Jz I........ gto be 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 CONSTRUCT TTARTS Rough Service ......... :.... .. .. .... !: -:......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Find No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. I �� �� l i� i 7 => Canstruclran. .6, ItEMOUFLINC:.SPEC:IAI_Iti7"5 9'7AE39—Fs9-1—.52"-6 KeenConstructiooCo.com Buchta, Mark&Caroline 111 Campbell Rd N. Andover, MA 01845 Contract#5757;Appendix A November 24, 2015 Remodel kitchen: • Remove and dispose of existing cabinets,wallboard on both cabinet walls and ceiling • Frame rear wall; supply& install Andersen CN235 double wide casement window. Approx. size 40 W x 40 W,with flat casing Upgrade electrical as needed. Install seven recessed lights& under-cabinet lighting ($3000 electrical allowance) • Remove and install new plumbing fixtures supplied by customer, including new water box for refrigerator($1500 plumbing allowance) • Insulate to code • Supply& install %2" blueboard on walls and ceiling and skimcoat plaster to smooth finish ® Paint walls, ceiling and trim in kitchen and living room(including corner built-in unit) Y Install customer supplied cabinets and related trim • Supply& install tile backs lash standard installation 300 tile allow p ( ,$ ante) Total Price:$22,600(twenty two thousand six hundred dollars) Price does not include cost of permits, cabinets,counters or repairs to unusual, unsafe or non-code compliant existing conditions not addressed in this quote. Payment Schedule:$5000 due the first day of work(plus permit fee) $4000 due when rough plumbing and electrical is complete $4000 due when plaster is complete $5000 due when cabinets are installed ) $4600 due at completion of contracted work f: � Customer Robert A. Keen Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N.Andover, MA 01845 F: 978-682-32.31 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 i I�� i 57 KEEN CONSTRUCTION CO. ���X�+ qA L 1175 TURNPIKE STREET NORTH ANDOVER, MA 01845 All home improvement contractors and subcontractors Tel: (978)691-5201 engaged in home improvement contracting, unless Fax:(978)682-3231 specifically exempt from registration by Provisions of p Chapter 142A of the general laws, must be registered Submitteod rl/'Ctr�( CG r6�I y Q ��t)� Cn with the Commonwealth of Massachusetts. Inquiries V h about registration and status should be made to the I I �``( e 't �� Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- J� 8787 Owners who secure their own construction I /t c�GU�C/ / ��T��{5 related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision Of MGL c.142A. PHONE DATE REGISTRATION NO. EIN N0. )t Z2-9 ! 1 j MA. H.1 C. 108383 46—3783401 C/S=Customer Supplied St+I=Supply+Install 10 See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: - SP 2 h o P�ewi cfk, x > Construction related permits: ._...._...,.___......._._.-_..-..-..._______._._...............__....... I `- W_.,......_,_„.,_.........__,.._..,.._..........._...___._..............._.....__..___.__........_.___.__._.__.__. WORKSCHEDULE __..........._..._.............._.__..._........_........._........._............._.................._ Contrat<<or ill n t gin the work or order the materials before the third day following the signing of this Agreement,unless specified her i iti C ntractor will begin the work on or about L (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall n t be con dered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of I— following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contracto his subcontractors,employees or agents,is discovered withi ,n one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose herr' ' hereby to furnish/material and labor-complete in accordance with above specifications,for the sum of — I ,'`C VJ �/ 1�J, -1L c)u:),_4d ollars($ 2 2, O 0 ). Payment to be madb as follows: _% ($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant /o ($ ) upon co le} n of 1175 TURNPIKE ST. ,\ I4� t ` Street Address %(�J/,$ upon,completion of.. N. ANDOVER, MA 01845 C _ City/Stale ($ ) shall be made forthwith upon (978)691-5201 (978).682-3231 completion of work under this contract. Phe Fax Notice: No agreement for home improvement contracting work shall require a _ Ole -? > - >down payment(advance deposit)of more than one-third of the total contract price Name nl sal or the total amount of all deposits or payments which the contractor must make,in _/ z advance,to order and/or otherwise obtain delivery of special order materials and Autho.zea Signatu e equipment,whichever amount is greater. Note:This proposal may be withdrawn by us it not accepted within days. Acceptance of Proposal-I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signatut@.�L/ 6 �'^-- pat �— /'Signature Date IMPORTANT INFORMATION ON BACK ► i The Commonwealth of Massachusetts Department of Industrial Accidents a d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1,11)eV., C— 0:i ro 1 cy) Address: 5 City/State/Zip: N,) `�`n c�)'`�e�-M G $PoneP4 `572,C) Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 2 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 8. �Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑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.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑Other 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Nae: �f��i/� ISS / d�J m -5 — Policy#or Self-ins.Lic.#:6 140 1J —92,9 1 J?-Z ' �� Expiration Date: Ve 11 City/State/Zip: Job Site Address: 1��c,7 d�_�___ Attach a copy of the workers' compensation policy declaration 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 coverage verification. 1 I do hereby certify/ a die p i s and penalties of perjury that the information provided a ove is true and correct. Si ature: ° Date: Z i Phone# Q 7 0 1 5-Z-o Official use only. Do not write in this area,to be completed by city or town official. City or Town: 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#• I '� '�� ��4 ��1 ACC>R& CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `� 10/23/2015 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 TAC Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAAXX c:(761)942-2226 137 Main Street ADDRIESS:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURERA Norfolk S Dedham Insurance 23965 INSURED !NSURERB:Safety Insurance Company 39454 Keen Construction Company INSURER C:'Travelers Ins. Co. 0031 483 Chickering Road INSURERD: INSURER E: North Andover MA 01845 INSURER F. COVERAGES CERTIFICATE NUMBER-CL1552101779 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 INSURANCEADDL SUBR POLICY EFF POLICY EXP LTR A52POLICY NUMBER M LIMITS X COMMERCIAL GENERAL LIABILITY1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE PREMISES aoccurrence $ 100,000 ND-P-010078/000 3/13/2015 3/13/2016 MED EXP(Any onePerson) $ 5,000 PERSONAL b ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 2,000,000 X POLICY F—I jE 6 F-�LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYa BBINBED SINGLE I $ 1,000,000 BANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AIITO,S 6228807 COM 01 5/23/2015 5/23/2016 BODILY INJURY(Per aloe-) $ X HIRED AUTOS X NON-OWNED AUTOS ra PROPERTY DAMAGE E Underinsured motorist $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 `, OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory in NH) 68135-9991M58-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYE E 100,000 H 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 B more space Is required) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert CIC BARBAR @ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 no14o11 i i Massachusetts -Department of Public Safety Board of Building Regufations and Standards 1.11111L1 tilllllll JUIICI V 11111 �. License: CS-076691 -1:VIS ` ROBERT A KEEN- 12 E WATER ST..; North Andover WA, 0 r y � s N:� " Expiration Commissioner 08/16/2017 Office of Consumer Affairs&Business Regulation W'ME IMPROVEMENT CONTRACTOR gistration: ;;08383 Type: piration: _1811 /Q=1&= DBA KEEN CONSTRUC7Ct�� Q $rfy r ,J Kenneth Keen 1175 TURNPIKE ST NO.ANDOVER, MA 01845` -` Undersecretary I II w