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HomeMy WebLinkAboutBuilding Permit #563-2017 - 20 HEMLOCK STREET 11/23/2016 11 ✓\ '��CJL V, t10RTM BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION s � I� f R • ti Permit No#: t 1 Date Received N l a 0/K/ 7 ASR Teo gSSACHUSE� Date Issued: 1 IM Po Applicant must complete all items on this page LOCATION Z_ c He-o (Ioc 6t n PROPERTY OWNER ��`�iy1 t e. A e V"� Print 100 Year Structure yes o MAP LA PARCEL:��ZONING DISTRICT: Historic District yes n 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑•Septic ❑Well; Flootlplain. ❑Wetlantls, Watershedstnpt; 0'1lVaterlSewer DE,SC��IONOF WORK TO BE PERFORMED: Identification- Pl?s)Llype or Print Clearly °z-, OWNER: Name: r U© Phone: :t Address: 0 CJ- -0 t n d Contractor ame: O6YI(5 AUG dii Phone: 97$ l z-0 Email ,, IR5 vi e-d . coyfA Address: PC 35 ✓1 d1~ Supervisor's Construction License: �� �� �o�o� Exp. Date: I I(o �('7 Home Improvement License: 10S 3Z 5 Exp. Date: S /1 A ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�?�1, (�0(D FEE: $ � I Check No.: �� �� Receipt No.: S12-42- NOTE: Persons contracting with unregistered contractors do not have access to th u r ty nd 4 RHE c a p rY r— _. _ ._. — f <<c r_ I I - I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimm�g P001s ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY � INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING _ & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i I NcALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: 384 Osgood Street F_ ? `r c . star r +s� -. t• T -+° -•v 'FIRE DEPA aT r- x t..� -9-1 R MENET Ternp D mpsfer�,on sitW,�� yews " %�1o }: y 14' -eated at1�24 Main S reed, " " Fire De G artmen .i nature/date r Y a- �+• M„r,.z.�.i3..� ,� :r7:'. ' ., ,.+?+{�' ti.,,3 "-a ' �i {X• C ��� +�+a{cry .ai ti iii,. � � 7^' '4>, ' , 4aa }COMMENTS ^.. r,..,.,..._�..r. ... ��a .....b;..,a.,.....:4.a-... ..•-.i.a��v l. .i?S�»a1s..._s.f� ..L.+..ar.-r�..a�--• ..,-`�i..Ua `._.:t_._.�...�.a... i 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 foricku Call Email p P Date Time Contact Name I E Doc.Building Permit Revised 2014 it Building Department I` 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 I Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4� 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 i 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) 4. Engineering Affidavits for Engineered products . 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 4 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 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 i 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 Location -26 ��— G. M No. ✓� 2o17 Date • TOWN OF NORTH ANDOVER y.. Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ } TOTAL $ Check# , ' 4Building Inspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 31 ,600.00 m $ - $ 379.20 Plumbing Fee $ 47.40 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 47.40 Total fees collected $ 574.00 20 Hemlock 563-2017 on 11/26/2016 kitcchen remodel - MA � RTown oAndover +� h ver Mass �� � o K@ COCKICKIWICK R^TEO PPa��S U BOARD OF HEALTH Food/Kitchen PERMIT T_ Septic System THIS CERTIFIES THAT ...... ��%►IV �!!. ... ..d .0,0Zkego LD % BUILDING INSPECTOR ..... ............ C. ... .. ........ 0. .. ,......... Foundation has permission to erect . .............. ......... buildings on ......... �� L ..., Rough to be occupied as ......... .. l�I�....� r1�. ..................................................... 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 CONSTRUC41ON STA Rough 4 Service .................... ........... ,............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. 91;" 95 a" 21" 90 233x" 24" 12" 30" 20" 44=," 36" 18" 36" 3'- 90:" 36" 107 30" 20" 43-136" 18" 36" o W1230LW3012 W203012Q W3630 W1 830L W3630 634t5 N 30-RAN E)-:B3D20342�4 996 15 . BEP _. m n � BGDO� CABICO UNIQUE FRAMELESS DOOR 500/1/K MAPLE WITH WHITEWASH FINISH 24 CEILING HEIGHT 90" HANGING HEIGHT 84" N „N Cl) m Cl) N o. � I',Q EPO1SP2484/5/8 - _ CLOSED SOFFIT DM/SHA01S8/5 FOR FASCIA 77F DM/CRW21 SS FOR CROWN DMlFOB01S8/K FOR TOEKICK - N 1-SINK CABINET WITH TILT DOWN FRONT EP01 SP2484/5/8 • rn min " gGBSF0 �i 53X30 1' 2-MICROWAVE ABOVE RANGE 00 '��ml ..-BF273412 vl- 1diS3X30 m -F 3-BASE CABINET WITH TOP DRAWER _ _ 1 S P28B LL LL N AND DOUBLE TRASH BELOW [12 i 4-BASE CUBBY DRAWER CABINET , 14T"J 53,"' 5-REFRIGERATOR SPACE LEFT 33 X 72 24 i" 6-12"DEEP CABINET WITH FULL HEIGHT DOORS AND SHELF INSIDE 7-WALL CABINETS.PREPPED FOR GLASS WITH MATCHING INTERIOR CABICO DOES NOT PROVIDE GLASS All dimensions_size designations 20 20 r. This is an original design and must Designed: 9/7/2016 given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 11/16/2016 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. JEANTNE CABICO FINAL FOR APPROVAL All Drawing#: 1 No Scale. 7 64W Can:fradian Ca; REMC�UFLIlIC: tiPEC:ILIL/ti7'S 978-697-520'1 KeenConstructionCo.com Jeanine McEvoy 20 Hemlock St. N.Andover, MA 01845 Contract#6041;Appendix A October 30,2016 Remodel kitchen: • Remove and dispose of existing cabinets,counters and wallboard in kitchen • Update electrical to code ($4000 parts and labor allowance) • Disconnect plumbing fixtures, update drains,vents and feeds as needed, and connect new fixtures. Reconfigure heat and add one toe-kick heater($3000 parts and labor allowance) • Frame wall between kitchen and dining room to create approx. 69"opening, install one lally column in the basement • Supply&install new, larger Andersen 400 series casement window over kitchen sink. Size TBD, but approx. 36"x 39" • Insulate exterior wall to code • Supply& install blueboard and skimcoat plaster to smooth finish • Supply& install trim on window,doorway and base to match existing • Supply& install 3 5/8" crown in dining room (extra$850 to install cabinet crown)and living room • Paint walls,trim and ceiling in kitchen and dining room (areas associated with project) • Install customer supplied cabinets and related trim • Install customer supplied appliances • Supply& install vinyl sheet flooring in kitchen ($30 sq yd allowance) Upstairs repair: • Remove wallboard in water damaged area upstirs, investigate for mold • Repair wallboard • Paint affected areas First floor powder room: • Remove and dispose of existing window and flooring • Frame exterior wall to accept new window • Supply& install Andersen double casement to match kitchen • Patch walls and trim • Install customer supplied tile floor • Paint affected areas PO Box 935 Page 1 of 2 P:978-691-5201 N.Andover, MA 01845 — F:978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 _ r .7�en Canstrucfion.Co. NEMC�UELINCi SPEC=IQLIS"1"S 978-69'�-5207 Keenconstructionco.com Total Price:$31,600(thirty-one thousand six hundred dollars) Price does not include cost of permits,flooring, cabinets, counters,appliances,fixtures or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this contract. Payment Schedule: $1000 due upon signing contract $4500 due the first day of work(plus permit fee) $4000 due when windows are installed $4500 due when rough electrical and plumbing is complete $4500 due when plaster is complete $4500 due when cabinets are installed $4500 due when paint is complete(except touch ups) $4100 due at completion of contracted work `^Customer RobertA Keen 1 r 5 Date Date PO Box 935 Page 2 of 2 P:978-691-5201 N.Andover, MA 01845 F:978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 6041 KEEN CONSTRUCTION CO. PROPOSAL PO BOX 935 NORTH ANDOVER, MA 01845 Tel: (978) 691-5201 All home improvement contractors and subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of CChapter 142A of the general laws, must be registered e t� Submitted to: y y) ( vu- �� ��U �1 with the Commonwealth of Massachusetts. Inquiries �.l- about registration and status should be made to the t1 1 ` C>C_ 1 Director, Home Improvement Contract Registration, 7� j ( ):-�. i) /)(�('_ / ryff 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787 J I ' T+� I (% I ' C^� 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. PHONE DATE REGISTRATION NO. EIN NO. /�j Q f�L MA. H.I.C. 108383 46-37834011 > C/S=Customer Supplied S+ I=Supply+Install See Attached Appendix A We hereby submit specifications and estimates for work to be performed and material to be usep: /! } The contractor and the homeowner hereby mutually agree that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Ex�tive 0 fce of Consumer Affairs and Business Regulation and the consumer shall b�quired to submit to such arbitration as provided i�7/a/ ahI s:General Laws,chapter 142A. i Homeowner'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 be i t ,w or orderthe materials before the third day following the signing of this Agreement,unless specified here in riylp-q. or will begin the work on or about ate).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by rf r7 2te),The Owner hereby acknowledges an agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contracto shall 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 �.� following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage ca,sed 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: r -4_1 I I i I� ( "� I v r� YI�)� `_� Y)C. x w 1�� '-C{ -..- - - dollars($ J )(ro o ). Payment to be ma4 as follows: % ($ )upon signing Contract; ROBERT A. KEEN Name of Contractor/Designated Registrant % ($ �, p I or�i�le ion 11 , PO BOX 935 ` --� Street Address upon completion of N. ANDOVER, MA 01845 ) , City/State / % ($ )shall be made forthwith upon (978) 691-5201 (978)682-3231 completion of work under this contract. Phope I Fax I Notice:No agreement for home improvement contracting work shall require a �' 4 �( Name—of Sales( >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 must4� i7 /�- make,in advance,to order and/or otherwise obtain delivery of special order Autho(zed ignat reT— materials and equipment,whichever amount is greater. Note:This proposal maybe 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. DO NOTS)GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. i Signature. '''"— ---����-" 'j-'{- '-'� Date Signature Date U61, IMPORTANT INFORMATION ON BACK ► i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Loe,n �lJLJ 1''U,/) 01 Address: City/State/Zip: e V Ql hone #: Are you an employer? Check the appropriate box: Type of project(required): 1.[X71 am a employer with .Z 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time).* � 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 1 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 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. #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: yp_ fe r5 to Policy#or Self-ins.Lic. #:��; U 1� 9 9 9 M �5(5�Z J Expiration Date: Job Site Address: 2.t) Hfl A 1 U G k 5+- City/State/Zip: &. 1141 l Ph mo _ i 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 er he p i s an enalties of perjury that the information provided above is tr a and correct. it Sig-nature: Date: . A Phone#: /� D � V 91 -2-0` � (, I Official use only. Do not write in this area, to be completed by city or town officiary 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#: ACO® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 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 WANED,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. PHON o . (781)942-2225 ac No: ADDRESS: 5-MAIL bmodonough@gilbertinsurance.com 137 MAIN ST. INSURER(S)AFFORDING COVERAGE NAIC# READING MA 01867 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURERS: KEEN CONSTRUCTION CO INSURERC: INSURER D: PO BOX 935 INSURER E: NORTH ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 94268 REVISION NUMBER: 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. ITR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY OM/LDI D/YYW POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTEU-- _ CLAIMS-MADE F]OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS er accident UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION STATUTE XER OTH- AND EMPLOYERS'LIABILITY y/N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA 6HUB9991M58216 10/08/2016 10/06/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 N/A LLL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if 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/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 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 Daniel M CrO y,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 Massachusetts -Department of Public Safety Board of Building Regulations and Standards I,-- riitiifrrr aurfer'vi>frr License: CS-076691 "V--VT1� UFn ROBERT A KEEN; 12 E WATER ST I IF North Andover Na 0 �l;•rrr.�� :��'�Q � Expiration Commissioner 08f96/204,7 Office of Consumer Affairs&Business Regulation HOME.IMPROVEMENT CONTRACTOR Ie: Supplement Card r Expiration � j 33 08/17/2018 Keen Construeti :yR> rs Robert Keen F= ? 1175 Turnpike No.Andovr,M4sAj __r' Undersecretary