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HomeMy WebLinkAboutBuilding Permit #650 - 19 HOLLY RIDGE ROAD 3/13/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: l(/ " Date Issued: EwoRTA.NT: Applicant must T nr+n'TTn_NT 1 J �0' I `_11 Date Received all items on this — - - --�� "Print PROPERTY OWNER Print MAP NO: �PARCEL01;Sq ZONING DISTRICT: Historic District yes Machine 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 ❑Others: Repair, replacement ❑ Assessory Bldg ❑ Demolition pSe tic ❑ well T, 1 ❑ Other `O�loodplain" ®Wetlands LtjY> r8 -_2`t ' 0 'WaterShediDistr'ict� �e s'^; 3,Fa4� • ❑iWater/Sewer��� � v LM1 F�.M _ _'L vY —��rr —1+.-'p^_..-+�.�»r� DESCRIPTI- YN k- WIJK& i U rsr, rrsr-Lr luvlcL: mmco de) OWNER: N Address: CONTRACTOR Name: Address: Z \ Please Type or J? int CIearly) c� Pn,� t �5 GTl can Co P5on9 691 -52a 1 Supervisor's Construction License: _7 4o G / I Exp. Date: �� (� /Zy /,3 Home Improvement License: $ 3 �� Exp. Date: /ZU Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ 3 `� , 99 3 , g J FEE: $ �O O Check No.: 6 2- Receipt o.:� NOTE: Persons contracting with unregistered contractors rqt!!ottve cess to the guaranty fund - - e o �co'�t acfor -nafiar f. n r - - t ,G.-,rim+i�ro �f/Snanf/C�wnP1'.:;,;;: Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Well ❑ Tobacco Sales ❑ Private (septic tank, etc. ❑` ' Fl,' Permanent Dumpster on Site Swimming Pools' • I]-. Food Packaging/Sales ❑ t THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMM CONSERVATION Reviewed on Signature COMMENTS ' r '': r� r •1 a HEALTH Reviewed on ' ' cnature COMMENTS' Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments - Y --4,, Conservation Decision: Comments Water & Sewer ConnectioCl/Signature &Date Driveway Permit - DPW Town Engineer: Signature: ` " Located 384 Osgood Street, FIRE DEPARTMENT - Temp Dumpster on site yes _ no Located at 124 Main Street- _ Fere Department signature/date J 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 - Date Doc:.Building Permit Revised 2008 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/Crossection/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 priorto 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 - JOTE: 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 Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording - lust be submitted with the building application — Doc. Doc.Building permit Revised 2008mi Location No. Date'l � - / Check # 25091 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $- Building Inspector 49 h Cd w -n °o w c v cn 0ZW0. W GO � w a � o w o w' U C w o W � on o ;2 C w x a U W I. o r2 a, cn C w" O a o r�4 Id w" w cq cn Q o cn 1 co .m c o 4Q CD 0 = H l a G v C3 -a-0 ea � I O r0.. C atE= z • c :Q CD cm CD c E ~r3 IS 02 IS CID s Go O O EcD v m cm C V m •�:=L oC.Im a �! ._ i m m v =� D o ea .� .:. AS o. o c Q C ca m = •O = m mw cCOO N F— yO y m o m Y W C �y...mo•_ .w •ty O.t= z coa � C .y o C.3 O LU p = c H CL O' O.O = W Ca y '& O z 0 w w P-4 s 0 U 0 z O U Cf) •„a 2 O O O E O O v z co d O y C Icm 0.— An y m m L O � co 0 � o m o a a �a co c cc o cc O C Z CD V y O C C C is U) U) W W , W,ww Y/ The Commonwealth gfMassachusetts Department oflndustrial.Acciderfs %ke oflnvestigations 600 l;Yashingtpn fteet Boston, 5, MA 02111 l�vww fflassgovldia Worker' COMP ensationInsurance Affidavit: BmldersICOntractors) lectr�iciaus/kZumbexs P licant Inforzn.ation Name (Business/Organization/fndividual): Address: City/State/Zip:_ I ► �l (�p�J�,� Are you an employer? Check the appropriate box: 1 • X am a employer with 4. 0 X am a general contractor and X 21employees(fulland/orpart-time).* 11 am a sole proprietor or havehiredthesub-contractors listed partner ship and have no employees on the attached sheet These sub -contractors Lave working forme in any capacity, [No workers' comp, insurance ❑ workers' comp. insurance. 5. We ate a corporation and its required.] 3. 1 am a homeowner doing all work aofHcers have exercised their right of exemption MGL Myself [No workers' comp. per c.152, §1(4), and we, have no insurance required.] i employees. [No workers' COMM insurance rP.nn;n-A i 1 6 � C - 52e Type ofproject (required): 6. ❑ New construction 7. ❑ Remodeling 8. [I Demblition 9. D Building addition 10.[] Electrical repairs or additions 11.❑ Plumbingrepairs or additions 12.❑ Roofrepairs 13.[] Other . -rr„ y appncant that checks box#1 must also fill out the section below showing their workers' comp ensationpoltcymformafion. .Homeowners who submitthis affidavit indieatingtheyare doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, Policy information. t am an employer that isproviding workers' compensation insurancefor my employees Below is tlaepolicy and jab site 72formation. assurance Company Name: PC r ` G 1-k.-16 b e c�' 'olicy ## or Self -ins. Lic. #:--- L J �� 0 0 ExpirationDate: 3 �,L 12 )b Site Address._.( V I`� 1: o� (J, City/State/Zip: v/ ry ttach a copy of the workers, compensation policy declaration page (slhowingthe policy number and expiration date). BUM to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a ie up to $1,500.00 and/or one imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine, to $250.00 a day against fine violator. Be advised that a copy of this statementmay be forwardedto the Office of restigations of the DM for insurance coverage verification. Iiereby cert y er Elle ,airs nrlpemliles ofperjury that Elie infor"tation provided abo a is tru anti correct. lature: i Date: Z C) Yfrcial use only .Do not write zn this area, to he coinpletecl by city or town official. ity or Town: Permit/i�icense # auing.Authority (circle one): 13oard of Health 2. Building Department 3, City/TgWn Clerk 4. Mectric Other al -Inspector 5 Plumbinglnspector Information'and histrctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...everyperson in the service ofanotherunder any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ox more receiver of the foregoing engaged in a joint enterprise, and including the legal xepresentatives of a deceased employer, or the, owner of a a trustee of an individual, partnership, association or other legal entity, employing employees. However the 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 "everystate 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented 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) namo(s), address(es) andphone numbers) along with their certificates) of Insurance, LimitedLia�llity Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other thanthe members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. De advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation.ofinsurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application fox the permit or license is being requested, not the Department of !ndustrial 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-insurance license number on the appropriate line. City or Town Officials Please be sure thattheaff-idavitiscomplete andprintedlegibly, of the aTheDeparhnenthasprovidedaspaceatthebo#omaffidavit 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'Iaumber. In addition, an applicant that must submit multiple pemiithicense 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 thathas 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 li be censes. Anew affidavit must filled out each year• Where e home owner or citizen is obtaining a license or permit notralated to, any business or commercial venture (i.e, a dog license or permit to bum leaves etc.) said person is NOTrequired to complete this affiddvit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. , The Department's address, telephone and fax number. Tike C01 -M -A Wee -11th of .tdassadausetts Depax-tmeiat Of Zudust l l Accidents Ofce of Investigailoias 600 WashhWon Street Tel. # 417-7274900 ext 406 or 1,$77.MA` 8/22/2011 1:36_'PM FROM'.'_ Gilbert Gilbett Insu:rAnce.Agency, I;nc.. TO:. fl (-978);'682-323 PAGE: 001.OF 002 TM CERTIFICATE; OF 'LIABILITY INSURANCE - DATE (MMIDOrr". o5�zy,201 PRODUCER (781)942-2225 FAX (781)942=2326 :THIS CERTIFICATE IS ISSUED ASIA MATTER OF:,INFORMAtIO.N Gilbert Insurance: Agency, Incr: ONLY -AND CONFERS NO`RIGHTSUPON THE CERTIFICATE 137 Main Street HOLD"ER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE,'. 0 AGE AFFORDED BY THE POLICIES,BELOW:.: - - Reading, MA 01867-3922:: 1N5URERS`AFFORDING.COVERAGE NAIL # INsuREo: Kenneth Keen'< & Robert Keen, INsuRER.A ,NORFOLK & DEDHAM INSURANCE 23965. DBA: DBA Keen Construction Company INSURERS Granite State; Ins. Co:; 0077 .21 Hewitt Ave. .. IN.SURER`C North Andover, MA= 014845 INsuRERo: . - INSURER :E: -' EFt THE FOLICIE8,,& INSURANCE LfSTED BEL01N HAVE=BEEN ISSUED TO THE INSURED NAMED ABOVE:FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER--DOCUMENT.WITH RESPECT TO WHICHgH.1S CERTIFICATE BE. hS MAY PERTAIN,:THE INSURANCE -MAY IJED;OR: AFFORDED BY THE POLICIES DESCRIBED:HEREIN:IS SUBJECT T0: 4LL`THE`.T.-ERMS, EXCLUSIONS.AND CONDITIONS OF SUCH POLICIES AGC�REGATE,LIMITS SHOWN MgYHAVE`BEEN REDUCEDBY PAID C1AIM$. :INSR DD:' TYPE OF INSURANCE <. ' POLICY NUMBERpOLIC,Y-EFFECTIVE —ATWD POLICY,EXPIRATION E: D - - - LIMITS;. cENERALLIaea1TY NDP 01,0078/000''03/13/2011 03/13/2012' EAeH6Cw- RRENee• s' 1` ;000,,00 X COMMERCIAL GENERAL LIABILITY _ - DAMAGETO RENTED' .$: :=CLAIMS MADE X ,OCCUR - �. "MED _ EXPi(My one person),$: :LOO , O0„” PERSONAL 8 ADV INJURY `$(. 1 ,� OOO. 'OO:.: - . GENERAL.AGGREGATE •$' 2.,;000 OO.�. . GENL AGGREGATE PER' .. PM�ITAPPLIES X POLICY PRODUCTS - COMPIOP,AGG ,$; 2 - :JECT .�i:.LOC _ ` AUTOMOBICE,UABILfTY - ANY AUTO - - - - . COMBINEDSINGLE LIMIT (Ea acddenf). .ALLLOWNEDAUTOS :. . :.. SCHEDLILEDAUTOS .; :. _... ,._ .' .,.. _ .. _ ... , _ j ....- '.8erp6rINJURY � DF OR (Per person) .. •- '. _ 'HIRED AUTOS:. .:. - ;.:; - - . _. ...: .; NOWOVJNED.AIfTOS .:-.- :. -. .. .: . BOOIIY;INJURY (P,ercadenq', _ PROPERTY DAMAGE . $ (Per.acadent) GARAGE:LIABILfTY'.:. .. - ALROONL-Y-EAACCIOENi j .. -:AIJY.AUTO- :.. .... - -_ - - . ' . - ,OTHER THAN . .. ... ONLY: AGG ... - FEXCESSIUMBRELLALIABIUTY - EP.ACH OCCURRENCE ,$ OCCUR CLAIMS�IMADE _ AGGREGATE. $ DEDUCTIBLE: WORKERSCOMFENSATION=AND. .- W0009646942 08�03201'1 '.. OH�O3'��201"2 $ WC$TATU- ,` EMPLoYERS':LU18ILlTY _ P.ROPRIETOR/PARTNER/D(ECUTIVP. LE YC CERT TO BE'"MAI!LED - ..:.EL T : .. . - EACH ACCIDENT $ 1OO OO oFFICER%M1tEMBEIDLCCuOE[:)Y. DT ECTLY VIA INS:CARRI�ER yEL If yes::describe under SPECIQCPROVISIONS - ,. - - DISEASE EAEMFLOYE $-;.-. 0, - ..'OTHER. below . .., - -E L. -DISEASE -POLICY: LIMIT DESCRIPTIONOF OPERATIONS I LOCATIONS 'I:VEHICLES EEXCLUSIONS'ADDED'BYENbORSEMENTi:SFECIALPROVISIONS. - vidence of Coverage C O " ` - SHOULD ANYOF THE�ABOVE DESCRIBED POLICIES BE'CANCELLEDBEFORHTHE' - _ - ExPIRATTON,LDATE THEREOF, THE ISSUING INSURER %f ILL ENDEAVOR':TO'MAiI DAYS I:WRT MN,NOTICE:TO':THE-CEffnFICATE-HOLDERNAMED-TO THE LEFT, I, _=BUT�FAILURE-TO"MAIL:SUCH'NpntEESHALL;IMPOSENOOBLIGATIOWOR,LIABILITY - - - - OF ANY KINOUPON THE',INSURER; ITS AGENTS OR REPRESENTATIVES. EVidenCe Of .coverage AUTHORIZED'REPRESENTATIVE Mark Gilbert ,CiC ACORD,,25:(2001108) ACORD CORPORATION 1:988:- VI tssachusetts - Department of Public SafetN Board of Buildim, Re!-ulations and Standards Gorastructiion Supervisor License License: CS 76691. ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2013 ('unimisciuncrZ Tr#: 3772 - Mtssachusetts - Delml-tn►ent of Public Safet:" . Bo u -d of Buildin!(4 Rojulations and Standavd; Construction Supervisor License 1 License: CS 58245 Restricted to: 00 KENNETH B KEEN 21 HEWITTAVE' N ANDOVER, MA 01845 , a Expiration: 3/24/2012 ( unimiscwn�ir fr#. 20523 Officeo um r" f rs iness egu as on HOME IMPROVEMENT CONTRACTOR Registration: - m108383 Type Expiration: -BOAI, 012 DBA K CONSTRUCTIOt _ Kenneth Keen 21 Hewitt Ave < F No. Andover, MA 01845„ —-- Undersecretary KEEN CONsr2uc7'rON CO. 21 REWlrr AVE. N. ANDOVER, Mit 01845 978 -691-5201 KeenConstrractu' YnCo: coves Mello, Jim & Mary 19 Holly Ridge Rd. N. Andover, MA 01845 978-688-1888 Date: March 10, 2012 Contract # 5071; Appendix A Interior Remodeling: • Supply & install eleven cottage style windows and one double hung window on the first floor with Pella Architect Series windows, with removable wood grids, satin nickel hardware and full screens. The windows are white aluminum clad exterior and painted interior (Pella white). Different interior colors will be an additional charge. $10,972.89 • Supply & install air conditioning unit as described on Callahan HVAC quote (#104788) and make minor repairs as needed. 10,600.00 • Supply & install new 3 %2" Jalco casing on all windows and doors on first floor 1,440.00 • Supply & install new 3 5/8" crown and 5 %"base molding on first floor 3,236.00 • Create archway between foyer and kitchen with returns and columns under the returns. 1,550.00 • Create archway at openings at family room/kitchen, dining room/kitchen and dining room/ foyer. 2,100.00 • Supply and install 10 -lite unit pair (French style) door into office 1,200.00 • Remove part of suspended ceiling in basement as needed and re -install, replace stained tiles. 450.00 • Drain heat system and shorten heat in dining room and purge system. 775.00 • Supply & install hollow -core smooth doors on existing jambs on basement, powder room and pantry closet. Replace all hardware on doors. 630.00 • Supply & install 24 position electrical sub -panel 700.00 • Replace hardware on existing Anderson swing patio door 200.00 • Supply & install (2) six -panel hollow core unit pair doors on coat closets in foyer and side hallway. 1,140.00 Total $34,993.89 Page 1 of 2 KEEN CONSr2uCTION CO. 21 HEWITT AVE. N. ANDOVE2, MA 01845 978-691-5201 Kee,nCcim-tru.,--U& t.Ca: caves Payment Schedule: $9000.00 due upon signing contract $5000.00 due the first day of work 1fi=xr $4000.00 due when air conditioner is %2 complete $2000.00 due when interior doors are installed $3000.00 due when crown is installed $3000.00 due when archways are framed $3000.00 due when windows are installed $2593.89 due at completion of contracted work except air conditioner $3400.00 due when air conditioner is complete Payments may become due in different order than shown. Price does not include cost of permits, flooring, painting, fireplace work, cabinetry or door between dining room and family room. 1 � _ stomer Date Robert Keen Date Page 2 of 2 KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE NORTH ANDOVER. MA 01845 Tel: (978) 691-5201 Fax: (978) 682-3231 Submitted / -- 19 Cid ue'. v^ C r - • ...9... .................. _ . PHONE DATE .3 �o r All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. REGISTRATION NO. EIN NO. MA. H.I.C. 108383 26-0462904 > C/S =Customer Supplied S + I = Supply + Install l See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: d` �' e P t h I related permits: ......................... ___.............................................................._....,............................................... WORK SCHEDULE .......... ....... .........._,....,_......,_,_.......,.,_.,.....,,....,......,.,, Contractpy 'II not egin the work or order the materials before the third day following the signing of this Agreement, unless specified here ' fiting C ntractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (date). The Owner hereby acknowledges an agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall n t 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 / st�f, r— 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 subcontractors, 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 - rmmnlPtP in arr,nrrinn, . ,.,irh % ($ ) upon signing Contract; ($ Aupon 91- , {��tio 6f I { %! Iu Opn omplll,,etion of y� shall be made forthwith upon completion of work under this contract. Notice No agreement for home Improvement contracting work shall require a > down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. for the sum of : lars ($ _ � KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor / Designated Registrant 21 HEWITT AVE. Street Address N. ANDOVER, MA 01845 uty / State (978) 691-5201 (978) 682-3231 Phne Fax �sm- 'Authoriz:eign I ure Note: This proposal maybe 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. L.Signature / ( G '. c 41 pate % rlJ % Z Signature Date IMPORTANT IeVFnRxnertnN,nwl