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Building Permit #033-2016 - 25 CEDAR LANE 7/6/2016
LT- BUILDING PERMIT �� No°TN qti �t 61k. 6 I IVA` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION c���— I� Permit No#•. � Date Received '�4QDR.{7ED gSSACHUs�� Date Issued: ' I ORTANT:Applicant must complete all items on this page LOCATION P- PrI n�t, PROPERTY OWNER ba Y '� Be-Ae� a Print f 100 Year Structure yes r MAP I 0 6 PARCEL: OW ZONING DISTRICT: Historic District yes $ Machine Shop Village yes �sY TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building POne family [I Addition Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑1Nell ❑ Floodplain: T ❑ WatershedlD�stnct I - Water/:Sewer DESCRIPTION OF WORK T-Q BE PERFORMED: � W �dts-I S �`�Qfie— re pCL I r- rb 6q, Identification- P ase Type o Pr t Cle rly OWNER: Name: a akA Phone: Address: 2 ay- Lr-, I ) ' Contractor ame: VA Phone: -6n 5�1 2.0 Email: 5cleS rUc� +'erg �v Gcan^ Address: Supervisor's Construction License— (-D-7 G 9 1 Exp. Date: Home Improvement License: 6S 3'3 3 Exp. Date: vol _ f ARCHITECT/ENGINEER Phone: . No. Address: Reg. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /01 900 FEE: $ 1� Check No.: 1 y - Receipt No.: �2`f NOTE: Persons contracting with unregistered contractors do not have access to a ar my nd - - - / L� No Dr b,q�o BUILDING PERMIT of I TOWN OF NORTH ANDOVER o y APPLICATION FOR PLAN EXAMINATIONANN Permit No#: U Date Received 1L9 A°q�reo�e..,(5 SSACH115fc Date Issued: i EWPORTANT:Applicant must complete all items on this page LOCATION r- �r) PROPERTY OWNER be,Y► �' � B `Print 4P \ �� S �� -� et � Print 100'Year Structure yes r MAP ! © 6 PARCEL: OW ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Kone family ❑Addition b Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 71;�Septic ®Vllell e& _® Flootl ai tft- Wetlands Vatersl%ed stric?. ❑ ester/ ew.er �1o= ` a` i DESCRIPTION OF WORK TQ BE PERFORMED: a+ec ACAO"129, r-ep C,, j UJ -,V-N J<:5 LAJ Identification- Pik e TPr' t Cle rly OWNER: Name: VC ctav Phone: Address: ContractorName: � i � Phone: '(�.91 -- 2-0 Email: eS �`UC. i'cr, C,CA^ Address: ke 6t , gv\ ev-,Or 02,7td 1st Supervisor's Construction LicenseO— 6'7 Exp. Date: 1 11 Home Improvement License: (6 S 3'Z 3 Exp. Date: 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: $ 9:0 FEE: $ V'2) ' Check No.: 1 y 7 51 Receipt No.: vZ`f NOTE: Persons contracting with unregistered contractors do not have access to a tar my nd Location No. 3 3 2.0. Dater I • - TOWN OF NORTH ANDOVER • s ` a I Certificate of Occupancy $ Building/Frame Permit Fee a Foundation Permit Fee $ �. Other Permit Fee $ _ t k a TOTAL $ r; Check# 14179 t n, Build ing,lnspector . . , � � .N77.I I. . i.1.1.1 I I......1�I A '0-:.., ,d.-. . 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Located Osgood Street t _ tgLlocated -t 124 , �` p rtment e �e �. .n ti '.« T.4\ a ,_ ` r. < rt f�* `•'. $ ��5`.tY1 1 ' t 't y" [ •�. . Z.• •t 'COMMENTS,_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swnnmmg 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 Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments J Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street t,EIRE DEPARrINENT - TernpDumpster gn�sitew 6y�es' no •rr �. ,T. .�_ v �r x aa.ri ��}'�t�.:C,i .+i Located at 124 Main Street � � � � . 'Fire Depar=tmeM. nt sigr�atureldate `� l _ . .# �F' ({' e't• 71R >Qv",q A° �"` "Yy ".:a,S wry .z �g+� -1,1011 � .,Y . . >< ♦{ g��,LL' rrt .^ ^r a.473 . s. .a r+ els` r•. ,a,�; , t { .,Y"c . I tr.�t�.. .,i {�t �i,{r nm kt�tiy,XhG T rsx �' a(r1.c Ir ear + k to Jv t ,� {# eI.*n �I° i ? s f xa.. '+`. ..}cam •"Ti,L, r 1 agRkl 4�,{.,. 7 s'r a COMMENTS �; .� . =.=ka . :._ Zr t7s t ;is3 .. ,,, c . 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.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pemit Revised 2014 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses aCopy of Contract 4s 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) 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 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 4. Building Permit Application 4. 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) 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 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 F NORTH own of E ndover No. 3 2 I� . I P h ver, Mass, ��-1 5 � o COCMICNl WICK TED ►'P�,�'�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... k �-`1 BUILDING INSPECTOR ...... A , ....` ................ ......... ............ ...................................... has permission to erect buildings on oZS Foundation Rough to be occupied as .... :^^ ......`....... + ......... .�. . ePl 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 CONSTRUCTION ARTS 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. V r L1 KEEN CONSTRUCTION CO. OPO A L a 1175 TURNPIKE STREET J 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 Submitted II- with the Commonwealth of Massachusetts. Inquiries To: R, s ��/L� �' nr �` about registration and status should be made to the Director,Home Improvement Contract Registration,10 Park Plaza, Room 5170, Boston, MA 02116 617-973- 8787 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 : // / 1�_7-) MA. H.I.C. 108383 46-3783401 > C/S=Customer Supplied S+I=Supply+Install 2'See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: f I I I Construction related permits: ._....___.. ._S._...H..----___._..._.__...... ..... ......................................_........................................................................................_...................................................._.................:_..............._............................_.._...._..................................._................__.............._............................. WORK.... CEDULE_ Contracto wi a t i e work or order the materials before the third day following the signing of this Agreement,unless specified here ti tractor 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 acknowled es and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be consi ere 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 matenals,or damage caused by the Contracto,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. W-te-Propose -hereby to furnish material and labor-complete inaccordancewith above specifications,for the sum of: f\/ 1 y:) l'r�()sc� c1 , �l 11 b � o d, dollars($ �T ), nn). Pay ent to bee ag fo ows: ($ ) upon signing Cont ct; ROBERT A. KEEN Name of Contractor/Designated Registrant % ($ JqP P9.mpletion 1175 TURNPIKE ST. Street Address of N. ANDOVER, MA 01845 City/Slate ������ shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Ph o a Fax Notice: No agreement for home improvement contracting work shall require a {tJ�J�/ >clown payment(advance deposit)of more than one-third of the total contract price Name n!Sal 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 Autno at re equipment,whichever amount is greater. Note:This proposal may be wilhtlrawn 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:Ca cellation must be done in writing. �DO NOT SIGN THIS CONTR C IF THERE ARE ANY BLANK SPACES. Signature I L�^-�• Date / Signature Date IMPORTANT INFORMATION ON BACK j Consv�ucian, Ca;, jew ItEMC�UEI_tWC. SPEGI/�LISTS 978-697-5207 KeenConstructioliCo.com . Pashayan, Betsey& Dave 25 Cedar Ln. N.Andover, MA 01845 Contract#5545;Appendix A July 3, 2015 Water Damage Repairs: • Jack's bedroom: o Remove and dispose of ceiling and investigate mold concerns on insulation o Supply& install new blueboard and skimcoat plaster • Stairway: o Remove and dispose of ceiling and 1' down wall o Supply& install new blueboard and skimcoat plaster • Living room, dining room & entry: o Remove and dispose of ceiling approx.4'from outside wall o Supply& install new blueboard and skimcoat plaster • Kitchen &family room: o Remove cabinet trim o Remove and dispose of ceiling in kitchen through family room o Supply& install new blueboard and skimcoat plaster o Re-install cabinet trim • Center wall clear openings: o Remove and dispose of casing o Supply& install blueboard and skimcoat plaster o Patch base molding as needed • Living room: o Remove chair rail and prep walls for paint • Supply& install six Harvey double hung replacement windows (white)with Energy Star glass and grids in the top sash. Replace all window trim with 2%" flat casing 9 Supply& install four recessed light fixtures • Supply& install new Masonite BFT-215-06E-2 (craftsman style,fir texture, 6-lite, exterior grilles) fiberglass entry door, new hardware and new retractable screen door 1175 Turnpike St. Page 1 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 i Construction C4, eEmc�ut:t.�nc: sNtc.tn��s-rs ' 978-69'x-5X17 Keen Cons tructionCo.corn Total Price: $10,900 ten thousand nine hundred dollars Price does not include cost of permits, painting 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 $2500.00 due when door is installed (plus permit fee) $2500.00 due when windows are installed $2500.00 due when plaster is complete $2400.00 due at completion of contracted work � I'I Customer Robert A. Keen 7 �5 -71,3115 Date Date I 1175 Turnpike St. Page 2 of 2 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 The Commonwealth of Massachusetts - - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 qV www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naffie(Business/Organizatioaffn.dividual): � �1 �(�/1 7 �V L iI �zj , Address =D`r n D t e �- - City/State/Zip: Vl d 6U�'� M A C3 9 t6 Phone#: Are you an employer?Check the appropriate box: Type of project(required): _1. am a employer withI— d• El am a general contractor and I 6. E]New construction employees(full and/or parttime).* have Hired the sub-contractors listed on the attached sheet.I 7• ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.11 Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing.repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.❑Other comp.insurance required.] ?Any applicant that checks box#1 must also fill outthe section below showingtheir workers'compensation policy Won-nation. 'i-Homeowners who submit this affidavit indicating they tiie 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 their workers'comp,policy information. X am an employer that is providing workers'compeitsation insurance for my employees. Bellow is the policy and job site information. Insurance Company Name:- Q-f- r J t ,)U a-C:,,1 C Policy#or Self-ins.Lie. 9 125-2-i+xpixation Date: 1 � - Job Site Address: Z� � - L�-� City/State/Zip: N i 4r n Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 incur e coverage verification. I do ltereby certi der pai and penalties ofperjury that the information provided above is truce and correct. Simature: Date: 71611-3 Phone#• a? 7'6 J Official use only. Do not write in this area,to be completed by city or town offtcia. 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#: RightFax C3-1 3/24/2015 9;51 : 03 AM PAGE 2/002 Fax Server DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T. IFICATE 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 O 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY INC PHONE FAX 137 MAIN STREET (AIC,No,Ext): (A/C,No)- E-MAIL o):E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA KEEN CONSTRUCTION CO INSURER B: INSURER C: INSURER D: 1175 TURNPIKE STREET INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MLWmYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE r__1 OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERAL AGGREGATE $ POLICY PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE _ $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-9991M582-14 10/08/2014 10/08/2015 X LIMITS ANY PROPERITOR/PARTNERIEXECUTIVE a WA E.L EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED4 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT -VE ' NORTH ANDOVER,MA 01845 :;: ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2090 ACORD CORPORATION. All rights reserved. Massachusetts - Department of PUbfic Safety Board of Building Regulations and Standards Construction SuperNisor License: CS-076691 ROBERT A KEEN 12 E WATER ST; North Andover AA J , � . " "` Expiration Commissioner 08/16/2015` �\ Office of Consumer Affairs&Business Regulation WX MEIMPROVEMENT CONTRACTOR gistration: x{08383 Type: piration: _ I18[20 t6 DBA KEEN CONSTRUCTION GO r...�F Kenneth Keen ` 1175 TURNPIKE ST N0.ANDOVER, MA 01845''y Undersecretary