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HomeMy WebLinkAboutBuilding Permit #727-2017 - 19 BOXFORD STREET 1/19/2017A71111 4J BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: W-? _ fe17 Date Received [ I o t Date Issued: LM]PORTANT: Applicant must complete all items on this page (11%IAP� TYPE OF IMPROVEMENT PROPOSED USE ,,A g sLi _ .4 1Jc� X __..- _ J .�C�C Residential Non- Residential ❑ New Building ❑ One family � f ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'Septic 1Nell! . r r ❑YFloodplain . ' � 1Netlands ~ �. i ' ; cWatershed!.District JQ _ _ 1 RIPTION OF WORK TO BE PERFORMED: Identificatii OWNER: Name: eP n-2 Address: �o X F4C_C_( - � I� Q✓� �cr ifs Pleas Type or Print Clearly ARCHITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE; BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASTED ON $125.00 PER S.F. _ notal Project Cost: $ 4 FEE: $ 10(� •� Check No.: Receipt No,. 31q S� NOTE: Persons contracting with unregistered contractors do not have: access to the ara fu Signature of Agent/Owhe" Signature of contractor; ,,A g sLi _ .4 1Jc� X __..- _ J .�C�C /"" . `��� Supervisors�C_onstructiom � f . 7 �HMOmej1rn(0roverpent1License ,..t: t).�6 3 .3_� .- __ _ _ �_ _ ARCHITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE; BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASTED ON $125.00 PER S.F. _ notal Project Cost: $ 4 FEE: $ 10(� •� Check No.: Receipt No,. 31q S� NOTE: Persons contracting with unregistered contractors do not have: access to the ara fu Signature of Agent/Owhe" Signature of contractor; Location 19 9 wi G a I), �t No. 79L"7' 9Q/'7 Check # ),1+ -Cf a �,, 14.55 Date ti i5 ab►7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee _ $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ hoff ly Ll Building Inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ -TyPF-6F SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Siqnature I � caning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ r lj Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Si-qnature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT -.Temp Dumpster on site yes Located;at-124,Main Street , Fire.Departrrient-signature/date. COMMENT; 3 Located 384 Osgood treet no -Nmension 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 1. I re'! quires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$10041000 fine 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 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 VOTE: 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 Enter construction cost for fee cal - North Andover Fee Caku/ation Construction Cost $ 85840.00 m $ - $ 106.08 Plumbing Fee $ 13.26 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 13.26 Total fees collected $ 232.60 19 Boxford Street one bedroom from two 727-2017 on 1/19/17 0 !: id E9—* 0 J Q LLI ZN LL O Q [G V N Y \ O O LL a) vY n U a N V) w Z Z J m O O Y f9 -O C: M O LL -C MD O d' N C L U (a LL 0 U a N Z Z m J d t bn_ O K co LL 0 v aLLI N Z V F- w J W L O C U i (n ro L. u LLJ C Z Q t O d' m LL z Q W LV a. LL 7 m z N y {n Q1 O E Ln •: LL W O iv O Rv U W .Q i CL O N d Q Z O � D � V J 2 N lo: 0 0 0 to LU O 0' •� o i— rn O 0 a (n �z .2 LLJ o V sE o o U (D Cl) �, �v) vLon oo c W _! c0i_ G.Z CL Jv- c r_ � 0 v, 0) 0 ; o -0 CD _ Q �- 0 _ a Q m 'S N F- O N 2 m N W O •a — O O ui Iz LL O m = O Q� O aM W i V o U m o N Qo "- = O H t $ a o U > ��: s w N N O 0 O C� Z o N Q as � - a v O O cuCL CL �a Cc M v -J 'O .Q O }) (n Z0 CL v V � >b cc i c Con3'fr udion Co, Kt:mc»»a.urc: srrctnt.ts-rs x@78—E"s'y►`1—a2O-i KeenConstructionCo.com i Gene & Teddie Hunt 19 Boxford St. N. Andover, MA 01845 Contract #16050; Appendix A Remodel bedrooms: January 12, 2017 • Remove and dispose of existing closet walls and carpeting in front two bedrooms • Frame closet in first room (closest to front door), including removing and framing door to hallway • Relocate wiring as needed. Wire for light in new closet and two ceiling lights ($1500 allowance) • Patch walls as needed, plaster new closet walls • Supply & install 6' x 6'8" unit pair (two, hinged doors) closet doors and trim to match existing • Supply & install scuttle hatch into attic, in closet ceiling • Supply & install heat enclosure to connect existing heat on front wall • Paint walls, ceiling and trim • Supply & install carpet in new room ($30/sq yd installed allowance) Total Price: $8840 (eight thousand eight hundred forty dollars) Price does not include cost of permits or repairs to any unusual, unsafe or non -code compliant existing conditions not addressed in this quote. oa Payment Schedule: $1000 due upon signing contract) $2000 due the first day of work $2000 due when plaster is complete $2000 due when painting is complete $1840 due at completion of contracted work mer Robert A Keen � 13 h zz Z/� Date Date PO Box 935 Page 1 of 1 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL #076691 Sales@ KeenConstructionCo.c m HIC #108383 6050 KEEN CONSTRUCTION CO. PO BOX 935 PROPOSAL NORTH ANDOVER, MA 01845 Tel: (978) 691-5201 AI home improvement contractors. and subcontractors engaged Fax: (978) 682-3231 in home improvement contracting, unless specifically /// Chapter exempt from registration by Provisions of 142A of the general laws, must be registered Submitted to: with I about the Commonwealth of Massachusetts. Inquiries registration and status should be r, _ 1 /}(1 J D 19 Q-1 made to the rector, Home Improvement Contract Registration, Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 1 �— (J5 iJ Owners o who secure their own construction related permits deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE AT 1 REGISTRATION /! NO. EIN N0. / (?' 7 MA. H.I.C. 108383 46 — 3783401 1 See Attached Appendix A > C/S = Customer Supplied S +'I = Supply + Install We hereby submit specifications and estimates for work to be performed and materials to be used: i y The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract, the contractor may submittheldi 'ute to a private arbitration firm which has been approved by the Secretary of the Executiyy Office of Consumer Affairs and Business Reg and the be ;'Yio�i consumer shall required to submit to such arbitration as provided in ssachGsetts General Laws, chapter 142A. Krr,�' IiomeowGr's, Signature Contractor's Signature NOTICE: The Signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Construction Related Permits: WORK SCHEDULE Contractor will not begin g o 0 order the materials before the third day following the signing of this Agreement, unless specified here in writi o �r�acIpr will begin the work on or about date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by Z ( te). The Owner hereby acknowle ges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor hall not be considered 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--"(".a-r 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 Contractor, his sub- contractors, employees or agents is discovered within 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 hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: -1 I— � ,._1 y l I I C-' V .) x k1 L l L i �) 1", + i �>Y i 1' i� Cl `22/' _ _._ dollars Payment to be made as follows V/ i, ($ %($ ) upon signing Contract; ROBERT A. KEEN Name of Contractor / Designated Registrant ($ ) upon co�ryplkt1pn t PO BOX 935 —(> \l Q �i Street Address �% IS)upon completion of N. ANDOVER, MA 01845 City / State Ji alp ($ )shall be made forthwith upon (978) 691-5201 (978)682-3231 completion of work under this contract. Phone I Fax Notice: No agreement for home improvement contracting work shall require a '"'�-i' >down payment (advance deposit) of more than one-third of the total contract Name of Salesman %price or the total amount of all deposits or payments which the contractor must J make, in advance, to order and/or otherwise obtain delivery of special order Auth ri,edilgn'a materials and equipment, whichever amount is greater. Note: This proposal may be withdrawn by us if 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 outline 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. ..D_O-NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature.._-v,�-ri..--;.Y� Date Signature Date IMPORTANT INFORMATION ON BACK ► The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information Please Print Legihl, Name (Business/Organization/Individual): 1 e Address: P O 06 X /Sta 6/P"hone #: 9 -2a- (O 9/ - 922 l Are you an employer? Check the appropriate box: 1. [� I am a employer with 2— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ 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.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 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 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 Name: I rr, V'E.IL' i5 S Policy # or Self -ins. Lic. #: 4, H 999 M 5"Z Expiration Date: -LG /f Job Site Address: 7 BO City/State/Zip: 1clC ev Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u der he p i s and enalties of perjury that the information provideX;, s true and correct. Si ature: q-7 Q Date: I/ Phone #: / 1 D - _ � 91 � � 2� IIOfficial use only. Do not write in this area, to be completed by city or town offcciat I 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 #: ACOR 1 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) 10/17!2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Barbara McDonough GILBERT INSURANCE AGENCY INC. PHONE . (781) 942-2225 AAic N„ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR E-MAILbmodonou h Ilbertinsurance.com ADDRESS: g Gg INSURER(S) AFFORDING COVERAGE NAIC# 137 MAIN ST. INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 READING MA 01867 INSURED INSURER 8: KEEN CONSTRUCTION CO INSURER C: INSURER D: INSURER E: PO BOX 935 INSURER F: NORTH ANDOVER MA 01845 COVERAGES CERTIFICATE NUMI3ER: A49RR RIPVISIAN NIIMRFR- THIS IS TOCERTIFY 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. I TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MWDDfYYYY MWDD/Y Yl LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $ PREMISES Ea =no,)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ N/A GEN'LAGGREGATE DMITAPPLIESPER: PRO POLICY JECT LOC GENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO SCHEDULEDTOOJc ALL OS AUTOS O N/A BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE N/A DED RETENTION $ $ WORKERS COMPENSATION STATUTE ER A AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 WA (Mandatory In NH) If yes, describe under NIA N/A 6HUB9991M58216 10/06/2016 10/08/2017 X E.L. EACH ACCIDENT $ 100,000 - E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires; or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.mass.gov/twdtworkers-compensation/investigations/. IV1a C41 11;1 IM_1lla:U17117: ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Le Daniel M. Croy, CPCU, Vice President — Residual Market — WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACOR 70 COO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 2017 1i9iD 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 Gilbert Insurance Agency, Inc.PH� 137 Main Street Reading MA 01867-3922 CONTACT Barbara McDonough N (781) 942-2225 A No: (781)942-2226 AIL ADDRESS:bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Norfolk & Dedham Insurance 23965 INSURED Keen Construction Company PO BOX 935 North Andover MA 01545 INSURERB:Safety Insurance CompanV 39454 INSURERC:Travelers Ins. Co. 0031 INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 MASTER 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF iMMIDDIYYYYI POLICY EXP (MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [i]OCCURDAMAGE ND -P-010078/000 3/13/2016 3/13/2017 EACH OCCURRENCE $ 1,000,000 TO RENTED 100,000 PREMISES(E occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: %t POLICY ❑ JEa D LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 6228807 COM 02 5/23/2016 5/23/2017 COMBINED SINGLE LIMIT $ 1,000,000 accidem BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident Underinsured motorist $ 100,000 UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A To be issued directly by the company. 10/8/2015 10/8/2016 PER 7OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER rANrFI I ATInNI ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MA ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /yam N Gilbert, CIC/LINDSE ACORD 25 (2014/01) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts - Department of. Public Safety Board of Bbilding Regulations and Standards LI/ILLI UlLl 11 11 Jll 11Cl V 1\1'11 License: CS -076691 �� ' ROBERT A KEEfV 12 E WATER ST < IMF North Andover ba 0 y � J.�• �. ��'��` Expiration Commissioner 08/161201=7 dgzoa���nrnurrP, o�C%UGadactc>lu�aeC Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Reg istration:�1;08383 Type: Expiration .°8/812x1,8 DBA 71 KEEN CONSTRUCtIN Kenneth Keen 2 r` 1175 TURNPIKE ST sem= NO. ANDOVER, MA 0184 =r Undersecretary