Loading...
HomeMy WebLinkAboutBuilding Permit #1222-2016 - 25 CEDAR LANE 5/23/2016 BUILDING PERMIT o�NO D TOWN OF NORTH ANDOVER z 5,y?- IN APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received rEo c5 gSSACH►15�� Date Issued: ORTANT: Applicant must complete all items on this page LOCATION � ��, a'` L112 Pr nt PROPERTY OWNER ��=�/ � k-/ P",5 r y Ct e7 I � Print foo Year Structure yes ane' MAP /0( PARCEL:ZONING DISTRICT: (Z/1 Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 17VRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands o Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: o f c-ki ('C 10 7 �� r Z i�V4 r h S Identification- Please Type or Print Clearly Do, �� �a Phone: 'G83=�92Z3 OWNER: Name: Address: 1,5' 6,-v/a r- 2-L-q AJ A-1 GIC ' 109 Contractor Name: 1`een 6o Phone: Email: Sa leS -n-6 4rcl - ;'Lv"t-i .� � Address: PO & Supervisor's Construction License: C a 66.9/ Exp. Date: %/�6 (17 t� Home Improvement License 10'i �gJ� Exp. Date: gh 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ — Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tot urn fund I H BUILDING PERMIT o��pOR&ORT4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION14 Permit No#: 02— I Date Received AraD 41 / gSSgcHus�� Date Issued: an_6 ORTANT:Applicant must complete all items on this,'page L ATION 21- L17- 0.6 Print i PROPERTY OWNER ,Print'; 00 Year Structure yes MAP /0( - PARCEL L�� ZONING DISTRICT: _' Historic District yes: Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑TWO or more family' ? 11 Industrial ❑ Alteration No. of units: 0 Commercial EXRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑. Septic ❑ N. ❑1FloodplaJfi. =ands ' 0 Watershed RD sfnct ^y �� 4� mY. DESCRIPTIO_ OF WORK TO BE PERFORMED: C 2a Identification- Please Type or Print Clearly OWNER: Name: Do, 4 Phone: 92 Address: 1, 2-,,-1 lU f Qlt - 117)9 Contractor Name:_J�e?!, �c�va�5 (UCTi v►r► 6 Phone:' 5?z1_!V79_7Ky2 3 Email': 5c les ; _� V", c Address:- PG Supervisor's Construction Licenser C,5 7 0 ?66,9/ Exp. Date., Home Improvement License: 10'3 3.83 Exp. Date- _ =--/ , p ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� (7 'L} FEE: $ PA Check No.: I"1 Receipt No.: 5b4 NOTE: Persons contracting unregistered istered contractors do not have access to th u r n and g .f . -Ph n nTEN TT r - y Location No. — a Date V5 1(,0 j / l L • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# t j j �, 7 Building Inspector :;, _ <- - r yr _ - - .-1 ` t .. .. .. wl� , .. _. - - - ..' - .. . - ,. . -.... .. .. - .. . . .._.. _ .. _ .. .:. _ !w li .. ... r F �, : 'A :', ;.: ... - 1. 1. n .. .... ... ... _. :-: ± _ c ff, :.: _., .__ .. .... .... _.... :... ..._r r .._. .:. yr _ . w -. f ti { s �- ':3 - i _... ., 'C L 1. . ' S w1. :. - - - ., F 4. f. , - - ^S. , . Location = _- �m*�7 _ - . . `No. i tai- Z. a-- 1 1.�, Date 2 . _ �."" .. _ :I ,- i • • TOWN OF NORTH ANDOVER 0 - . - _ _ . . . " Certificate of Occupancy -$ _Rr �. i Building/Frame Permit"Fee =$c�c� µ ) , Y k� Foundation Permit.:Fee �. ��-: ; Other Permit Fee n t TOTAL .•., _ _ ¢.q % - / � �. , - - F Check# # 1 1� . .::.. :a - r � ' ! . Building Inspector' . .. ... .r. ... , .. - ... -.rte._ �:. .. -_-i4 f. ....� .....' .'. .. r. 1. 1. ....:::: .. .. .... t ..:,.. . .. : • � - y - ,. .. -_ - _ ._ �� .. .'e' .: .. :. _ _-...._-t.1..:.�... .. ..:.......... _ .__ __ . _ _ _ 1. ___ .. _ _ ... ...._ ..... ... - ...... a.. ..:; _ ::: .. ..,,� __-.. .. .. _. . - �1 :. ... _ .:, ..� 1--'a_ .. .;.�r. .. . -. .. 1. . al ... _ ..+ - -.- ..:�. .nt. ..,. - I '. _ •_ ^.f .. .. .. - _ - l:�' ... *'.: ..., .I: �. .. I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swhmling Pools ❑ Well ❑ Tobacco Sales ❑ x Food Packaging/Sales El Private(septic tank,etc. Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On�� b _Signatureim, CO MENTS ) �LV)Y)-� I CONSERVATION Reviewed on 10 tP Signature COMMENTS HEALTH Reviewed o, Signature ZrJ COMMENTS �� �'� �i,\L j� p,�l �� �Z-•� 1 �Zor�ng Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes _ I Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: ;iFIREDEPA�RaTMERIT Tem Dump _ ergo ite, _. Located 384 Osgood Street xst n>ts iyes�..� 11Lo4eat>r12;4IVIain�fStreeta kFire�Dep�itmentsignatur&e/date - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL El Sewer Tanning/MassageBody Art El �'�'� Sfg Pools ❑ well . ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. x Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING ®EVELOPB!/IENT Reviewed Onb Signature Ljv�, CMENTS 1 �r,�am- 0 a CONSERVATION Reviewed on I 0 1 Si nature COMMENTS /'HEALTH Reviewed o ��� Si nature Zd COMMENTS ��L` �1 ��� 0ju Q✓�I �� I`Z., Zor_ing 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 DEPARTMENT Temp I Urnpster on Located at 124 Main StreetK '',� °sem ,, f _ �s ,"";,—r"- ;� +, .�,, Fire Departmen �ignatur Ali il '4a e 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 i 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement®f 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.$1 oo-$1 000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Penuit 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 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) 4. 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 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 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 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) 4. Mass check Energy Compliance Report (If Applicable) 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 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 In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals thathe appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording t PP P must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of 3? LAndover O No. i h ver, Mass 3 o ^K. 1. , cocH,c„ew,c. y A�4ATED S U BOARD OF HEALTH - IT L D Food/Kitchen PERM Septic System THIS CERTIFIES THAT S�Q BUILDING INSPECTOR ................... ... .... ... ..... ...... ... .... . has permission to erect .......... g Foundation Rough to be occupied as . � ..`. 4 ....... .... .. . ...�. )... �.. .......... Chimney provided that the person accepting this permit shall in very respect conform to the termsthe 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 CONSTRUCTIOI -STARTS 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 Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. - _ - 7ew ern: - -.-,t Carie rt( an;Co;, NFM�7OF1_IAC: SPEC:�/_�LIS't'S 978-697-5207 KeenConstructionCo.com Pashayan, Dave and Betsey 25 Cedar Ln. N.Andover, MA 01845 Contract#5581;Appendix A May 1, 2016 Replace front porch: • Frame 6'x 7' deck in place of existing deck(which homeowner will remove) • Dig two holes as needed and install pre-cast cement footings • Frame new 6'wide stairs, landing on exposed aggregate walkway • Supply& install PVC trim and lattice • Supply& install Azek XLM Slate Gray PVC decking with color matched plugged screws • Supply& install white Azek Premier rail system with white balusters and copper post caps Total Price: $6684(six thousand six hundred eighty-four dollars) Price does not include cost of permits, demo or repairs to any unusual, unsafe or non-code compliant existing conditions not addressed in this contract. Payment Schedule:$1000.00 due upon signing contract $1500.00 due when holes are dug(plus permit fee) $2500.00 due when framing is done . $1684.00 due when complete I Customer Robert Keen 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.com HIC#108383 5S KEEN CONSTRUCTION��0.B I 935 PROPOSAL 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 Chapter 142A of the general laws, must be registered Submittedd �0.�-� �; �) _e sey { Ir4lc 4G r-) with the Commonwealth of Massachusetts. Inquiries 11about registration and status should be made to the I Director,Home Improvement Contract Registration,10 r Lr—) Park Plaza, Room 5170, Boston, MA 02116 617-973- n �} 8787 Owners who secure their own construction 45 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. S/1 (� MA. H.I.C. 108383 46—3783401 > C/S=Customer Supplied S+I=Supply+Install See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used:r 5_12�e AP Pei J(_ x ll� > Construction related permits: --........................................-_—___—__.._...._............................_.._._...._....................................................._.........,........,......................................................................................................................................_.._..........__.........-....................-_._-_-_......._........................ WORKSCHEPULE Cont r I tj b gin the work or order the materials before the third day following the signing of this Agreement,unless specified he in riting. o tractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by ?.!J Y (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 no be considered as violations of this Agreement. WARRANTY / Vel 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 complywith 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-compl�ette-in accordance with above specifications,for the sum of dollars($ Payment to bq made as follows: CJ % ($ ) upon signing ontract; ROBERT A. KEEN (� \ Name of Contractor/Designated Registry t T, j� ($ p c 1�tP n bf T V 32)4 Street Address °LV (qq completion of N. ANDOVER, MA 01845 VCity/State ° shall be made forthwith upon (978)691-5201 (978)682-3231 ($ ) completion of work under this contract. PhpFax f � 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 Namen le man _&/ 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 Authorize'sig tut 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.Iff— ust be done in writing. IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SignatureDale C Signature Date IMPORTANT INFORMATION ON BACK ► North Andover " 1 • 11 f .TKi:: s 7 Y,s ifA 3F].. al Alii 'h t 'r �r �� ;1 �t >!.� I'"+ e't� .p.•k t .�� s r� S ! A r"y ` t �33 kr�...,i, s�,i �ti��Y'{ Al � � } � x .',`' ,�� +-` '. ^., r �- a f t y 2 a^• #„rel` Y z "•;, yY# F t' 1 ' »» }t. ai 1,_ :! s ,. ;(ftst3•m L 'p.� .s 1 T `v .i r �.g% i. 1 Rr• 1 1 .�_+f1 �i.per �'y), f att$' Y qt� ,.? {, 4 ""I' f.q:���i� _ h us �"��w�'''��� '� li;. a 5 '",yys'�-�# �t � �,:• ��` Y"A.' la, ��'S's �'�.a"��L 'i '4�t�,+��.i Ze Nt %Yt ',+. $ri ri, '3'♦ F 3 ' �R �4 � - SY ,v �Yl'L: '��`""}y t „ 9 x., 4 `... .#`f'`f s s r .k a• y1�1 2 * � s*-a."t '-a ' s yt 'Y y` + A 14 7.'a .3 ,=1w, •. �'„y ����x^r - �r�t.. Jfy �� r ��`� .�� �..' �'qs .` 1 r' : 1 1 21'^I jr. .• ay'r �c >'. 1 1 1 �•' `-'- m Y _} 4f s-` "� s rvr k •; 4x � fp r`� �' 4� 1�xd\` r � �f���'}! r r x - s Horizontal.. Datum Meters Data Valley Planning Commission(MVPC)using data provided by the Town of North Andover.Additional data provided by the Executive Office of F . let Affairs/MassGIS.The information depicted on this map is for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO .• IMPLIED,CONCERNING ASSOCIATED41 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 0 ASSUME ANY LIABILITY . MISUSE OF - THIS •- The Commonwealth of Massachusetts Department of Industrial Accidents i d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia V Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY.Applicant Information .Please Print Legibly Name(Business/Organization/Individual): ;(p_e1/I Situ Cil ('a/1 o Address: 1 9315 np City/State/Zip: i��1J'� �'r G f�P one#: �3`�fr�`� 572,0 1 Are you an employer?Check the appropriate box: Type of project(required): 1.W I am a employer with 2-- employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. URemodeling 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 0 Building addition 4.0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.1-1 Plumbing repairs or additions 5.0 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.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.0 Other 152,§1(4),and we have no 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. 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. i Insurance Company Name: �(�y�/L I f s 1 5 — Policy#or Self-ins.Lie.#:C� ��f IJ "9 9/ 1 N J?'Z �� Expiration Date: G 25 I Job Site Address: � City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). 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. I do hereby certify u r p and penalties of perjury that the information provided above is true and correct. Si nature: Q Date: fi 12— /Z Phone#: J� D f (a 91-5 2-0� 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#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDIYYYY) 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 D Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 Fax o:(787)942-2226 137 Main Street nDoRE9S;bmedonough@gilbertinsurance.com INSURER(S)AFFORDING COVERAGE NAIC X Reading MA 01867-3922 INSURERA Norfolk 6 Dedham Insurance 23965 INSURED INSURERB:SafetY Insurance Company 39454 Keen Construction Company INSURERC-Travelers Ins. Co. 0031 483 Chickering Road INSURER D: INSURER E: North Andover DIA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER:Cr.1552101779 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. aINSR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 ERTEIY— A CLAIMS�dADE �X OCCUR EMISES Me occurrence $ 100,000 ND-Y-030078/000 3/13/2015- 3/13/2016 'MED EXP(Any onepawn) $ 5,000 PERSONAL A ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ JELOC PRODUCTS-CCMP/OP AGG $ 2,000,000 rl OTHER: $ AUTOMOBILE LIABILITY COMBINEDSl G M S 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ AOS X SCHEDULED 6228807 CON 01 5/23/2015 5/23/2016 BODILY INJURY AUTOS AUTOS (Per eccldard) $ X HIRED AUTOS X AUTON-CWNED PRS E2EOPERTY DAMAGE $ Undedneured motodst $ 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS•LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100 000 C OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) 6HUB-9991MSS-2-15 10/8/2015 10/8/2016 E.L.DISEASE-EA EMPLOYE S 100,000 II es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addttkmal Remarks schedule,may be attached U more space le regWred) CERTIFICATE HOLDER CANCELLATION (978)623-8320 SHOULDANY 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(2014101) The ACORD name and logo are registered marks of ACORD INS025nouon Massachusetts-Department of Public Safety Board of Building Regulations and Standards $ii=EiviS0 r a.vnau u�iiii� License: CS-076691 ROBERT AKEE)Yr r� 12 E WATER ST R North Andover WA 0 Expiration commissioner 08/16/2017 ��n, Cpo-�rtir�za�e.cr.eall�c�U/iGaaaac,�ucrtel�t 4 ice of Consumer Affairs&Business Regulation E IMPROVEMENT CONTRACTOR egistration .>>;pg83°-;;, Type: Expiration8f38�/ Q 16 ; ',' Supplement Car KEEN CONSTRUCTIONCO;: �7 F;_ t 7 Y qG'_'- 1•i ROBERT KEEN ' 1175 TURNPIKE ST NO.ANDOVER, MA 01845 Undersecretary