HomeMy WebLinkAboutBuilding Permit #705-2017 - 266 BLUE RIDGE ROAD 1/10/2017AN -� �iBUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 0 ',d -V/ 7 Date Received / OIdel Date Issued: /0 / IMPORTANT: Applicant must complete all items on this page Rr c ... n Pnnt, 10D�Year Structure MAP PARCEL: ZQNING DISTRICT. Hist onci®istnct 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 'Ij Well• ❑ Floodplain 11Wetlands ❑ 1Natershe--istrict D.Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identi7iation - Please T p or Pri t ClearlyOWNER: Name: k C 6� Jr,AA o �� 1 r i e Address: 7—(c d t� d— '` Contractor Name: ._SPhone:._ _977 r �f ,rye Address: Pd OX _ 935 //` 4/iJr Supervisor's Construction License,_Cr5 -.�0 9�_. Exp. Date: / 6 l _icense. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON,$12&00 PER S.F. Total Project Cost: $ 5 c),5 FEE: $ S Check No.:Receipt No.: l NOTE: Persons contracting with unregistered contractors do not have: access to the g n d Signature of Agent/Owner Signature of contractor_, Location Cr io i,. u r �i IC1 ea No. 1 _ s2r,'/7 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $= TOTAL $ Check # (to V f Building Inspector 1 Plans S ub�iniitted ❑ Plans Waived Fl. Certified Plot Plan ❑ Stamped Plans ❑ TYPE-bF SEWERAGE DISPOSAL ❑ assa e/Bod Art ❑ Swimming Pools ❑ Public Sewer Tanning/M g Y Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature 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: c Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osg o Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located,at 124, Main Street Fire Department signature/date COMMENTS limension 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Pennit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I' Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 24,595.00 m $ - $ 295.14 Plumbing Fee $ 36.89 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 36.89 Total fees collected $ 468.93 266 Blue Rodge Road 705-2017 on 1/10/2017 Kitchen Remodel v C � n 0 0 Z cn CD oCL� �0 CL >co. .a o vCD Cr _ CD CD O CL CD CO CD � v z 0 0 CD0 CD �� O D 0 Z O <D N (Q' O W cc CD co 0 0 C: U) N CD o �'o -11 O 2 N <• � CD U)c �, m n C7 0 0- C.)m o =, , = � N. O 0 CL c m N 0''a y O -i CD CD 2 Q. 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S W O D r - 2 REMC�I�Ei_ING: SPED 1/aUSTS 978-69'1-1%240'1 Keen ConstructionCo.com i Nicole & Matt Ehrie 266 Blue Ridge Rd. N. Andover, MA 01845 Contract # 6049; Appendix A December 27, 2016 Cabinet hardware: $4595 • Remove and replace existing hardware on cabinets (hinges, drawer glides and knobs) • Upgrade to slow close hardware • Replace customer supplied towel racks Rebuild two Lazy Susans: $460 • Remove existing hardware and replace with new, re -using existing doors Paint cabinets, inside and out, kitchen walls and ceiling, and all trim and doors in kitchen: $7000 Replace floor with tile: $7140 • Remove and dispose of existing flooring (approx. 300') • Supply & install tile flooring ($5/sq ft material allowance), standard installation Built-in microwave: $900 • Remove and dispose of drawers and doors, reconfigure stiles to accommodate microwave • Supply & install new drawer under micro, approx. 24" x 10" • Supply & install outlet for micro Counter & appliances: $1100 • Remove and dispose of existing counter • Remove and dispose of cabinetry (appliance garage) sitting on counter on inside wall • Coordinate with granite installer for template and install • Install customer supplied fixtures & appliances (sink, faucet, dishwasher, gas cooktop, oven, microwave) Backsplash: $750 • Install customer supplied 3" x 6" tile backsplash Wall behind cooktop: $1650 • Build wall behind cooktop, approx. 42" tall • Supply & install two outlets • Plaster wall to smooth finish • Supply & install trim to match • Paint wall and trim 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 *V!� Co; rttAnoofI.Inc swrCInLIs-rs 978—Es97-520-1 %_ KeenConstructionCo.com i Electrical: $1000 allowance • Replace 12 outlets and switches • Remove phone outlet on backsplash • Add USB outlet on backsplash • Replace undercabinet lighting Misc. items included with project: • Replace customer supplied rear door hardware • Trim cabinet above refrigerator Total Price: $24,595 (twenty four thousand five hundred ninety five dollars) Price does not include cost of permits (approx. $460 total) or repairs to any unusual, unsafe or non -code compliant existing conditions not addressed in this contract. Payment Schedule: $1000 due upon signing contract $5000 due the first day of work (plus permit fees) $5000 due when cabinet work is complete $5000 due when painting is complete (except touch-ups) $5000 due when the floor is complete $3995 at completion of contracted work r n Customer Date PO Box 935 N. Andover, MA 01845 CSL#076691 Robert A Keen Gz/7,,9-1� Date Page 2 of 2 Sales@ Keen Construction Co.com P: 978-691-5201 F: 978-682-3231 HIC #108383 6049 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 1 ( Chapter 142A of the general laws, must be registered '/I/l �+ Submitted to: I 'i 1 _ 4, G(/ l"�� with the Commonwealth of Massachusetts. Inquiries F /2i about registrationand status should be made to the � Director, Home Improvement Contract Registration, �`l //:✓ `' 'i,jr 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 r / J DATE J REGISTRATION NO. EIN NO. MA. H.I.C. 108383 46 -3783401 > US = Customer Supplied S + I = Supply + Install 0"See Attached Appendix'A We hereby submit specifications and estimates for work to be performed and materials to be used: E J1 The contractor and the homeowner hereby mut6ally agree that in the event the contractor has a dispute,concerning this contract, the contractor' may submit the dispute to a private rbitratio�, firm which has been approved by the Secretary of the Executiv�'Office of Consumer Affairs and Business Regulation and the consurn r h lI fie required to submit to such arbitration as provided'n Missachu4/efts General Laws, chapter 142A. j 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. r) Constryction Related Permit;;; > �ij > WORK SCHEDULE Contractor will not begip t or r'o�der the materials before the third day following the signing of this Agreement, unless specified here in wri Tng. Cj�" tractor will begin the work on or about (d5te). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by'� / " ate). The Owner hereby acknowle ges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall ot,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 ' �' 6�~ following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damagb caus4d 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 fu,nish material and labor - complete in accprdanc� with above specifications, for the sum of: ;; j' ,'rt )" i. ;i. I ivv%d I't l,i I ik.. i `r r i� / Yk dollars % ). Payment to be ade as follows: % ($ ) upon signing Contr ct; -' % ROBERT A..KEEN Name of Contractor/ Designated Registrant %i r. 1�uppI i 1 t! ' '.t PO BOX 935 ($p raxjal@Ubr%f Street Address )upon completion of N. ANDOVER, MA 01845 City / State % ($ ) shall be made forthwith upon (978) 691-5201 (978)682-3231 completion of work under this contract. Phg4 / , Fax Notice: No agreement for home improvement contracting work shall require Name of Salesman,/ >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 Author ed 5ign7.re _ materials and equipment, whichever amount is greater. Note: This proposal may be withdrawn by us if not accepted within -days. Acceptance of Proposal - I have read both sides of this document and all attached documents and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outline above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in ylf tl g. ; DO NOT SIGN THIS CONTRACT IF THERE ARE ANY ACES. Signature i--� ` t'•'��{-.{ Date i 'zJt Signature i �'�r= ' -Date IMPORTANT INFORMATION ON BACK ► The Commonwealth of -Massachusetts _ - Department of 1ndustriulAcczdeats X Congress Sheet, ,5`iW 100 - ` SOstOX2, MA 02114-2017 f www mass.gov/alla WaVkers' CompensationbffDanedA.:ffidavzt:BuIdexs/COAUTHOR%1Ly czans/�lmnbers. TO BE FRED WaffMI'E�15�Il'd"I�N bl nnni�rin� Name (Business/Ozganizaiion&dividual):' Address: City/Statefzip:_ Are you an e)­ployer? 0 the appropriate box: 1. I am a employer with employees (fill and/or part idme)•'` 2.01 am a sole proprietor or partnership andhave no employees yaorking forme in C.y capacity. [Noworkers' comp. insurance required.] 3.E] I am a homeowner doing all workmyseli Wo workers' comp. M'mancerequired 1 ' q F]I am ahomeowner and will be hiring contractors to conduct all work onmy properly. I VM ensureihat all coniractbis eitherhave workers' eompeusahon insurance or are sole �s` r� Proprietorswith.no employees. 5.❑1 am a general contracto i and IAape huedthe sub-confractus listed on the attached sheet. These sub-contractorsbave employees and have workers' comp. imtnance. ticlu Per 6, ❑ -We are a corporation andrts• officers have ercoe G urancerequized ]M� c. anl' e kava no empldye [N Type of project (Teq&8cI) 7. ElNeem"d6nsi diion 8. ovkemode&p; 9. ❑ Demolition 10 El Building addition 11.❑ Electrical repairs or additions 12� g plwnbirig repairs ar additions 13'.]�Roofrepa�rs 14.x] Other 152, §1Vv) w r - . iheirworkers' compensationpolicyinforrnaiion *Auy applicant that checks bbx#1 must also fill outt3re section belloDrkand��e outside contractors muss submit a new affidavit indicating such i homeowners who submit this affidavit indicatingthey are doing Contractors that check this box must attached additional sheet showing the name of the subonirac�toe and state wheilier or notthose. eities have P , ,t ,vPea_ 7£the sub -contractors have employees, they must provide thein workers' comp. Policy jam an employer' tliat is providing workers' information. compensation insurancefor° my employees Below is wepolicy a1z Jo sz h• Insurance Company IvaMe:. 1 G Z I D � 9 `� � D ExpiraiionDate"� �.p Policy # ox Sel�ins. UG- #:. 0 vv lJ%� yL l g� Job Site Address: Z � (e �i d City/State/Zip: /T licynamber and expiratioll ate) - Attach a copy of the'�voxkers' compensation policy declaration page (s �wm atonhe p°uuishable by a fine up to $1,500-00 Failure to SBCUre coverage as required under MGL G. 152, the§25f is a f a S P. and/or one-year imprisonment as -well as civil penalties in the foam of a STOP WORK ORDER a-nd a fine ofup 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. ain d enalties of PeYjury that ffie inforvnotion provided above i fir u/.e er?d cor��ecTtf XcZo %lereby certify' J'#r t p p, /'l7 � / Official use only. Do notwrite in this area, to he corr�pleted Ziy city or• town of_ fldaL PermiilLicense # City or'Town- XssuingAuthority (circle one): l eetor I. Board of Flealth 7. Euilding Department 3. C�itylTown Clerk 4•. Electrical luspector 5. plumbing Ittsp 6. Other phone #: Contact Person', Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An errrployer is d'efiuied as "an individual; partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferprho, and including the legal representatives of a deceased employer, or the receiver'or trusted of an individual, partnership, association or other legal entity, employing employees:, However the owner of a 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 budding appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to opdrate a business or to construct buildings in the commonwealth for any applica) tt wliti leas 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 of public work untfl acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented 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) name(s), address.(es) and phone number(s) along with their certificates) of insurance. Limited Inability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit: The affidavit should be returned to the city or town that the application for the permit or license is being requ(Fted, not the Department of IndustridIAccidenis. Should you have any questions regarding the law or if you are required to obtain a w' orkers' corapensatioripolicy,pleasecalltheDepartmentatihenumberlistedbelow. Self-insured companies sholild enter their self insurance license number onthe appropriate line. City or Town Officials Please be sure that tile affidavit is complete and printed legibly. The Department has provided a space atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be Saxe to fill in the p ermit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/Rcense 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 that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fatnre permits or licenses. Anew affidavit must be filled out each year. More a home owner or citizen is obtaining a license or permit not related to any business or commercial vent tue (i. e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit, The Department's address, telephone and fax number: The Commonwealth of Massachusetts Depari<ment of TndustrialAccidents 1 Congress Street, Suite 100 Boston, Na 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MA,.SSAFE Fax # 617-727-7749 Revised 02-23-15 www.mags.gov/dia ACORbr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/9/2017 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 CONTANAME: CT Barbara McDonough Gilbert Insurance Agency, Inc. 137 Main streetE-MAIL AICNNo.Extl: 1781) 942-2225 AIC No: (781)942-2226 ADDRESS: g bmcdonou h@g ilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC p Reading MA 01867-3922 INSURERA Norfolk & Dedham Insurance 23965 INSURED Keen Construction Company INSURER B:Saf ety Insurance Company 39454 INSURERC:Travelers Ins. Co. 0031 PO BOX 935 INSURER D: INSURER E : North Andover MA 01845 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 MASTER RFVISION NIIMRFR• 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. IN RI LTR TYPE OF INSURANCE ADDL mign SUBR vivn POLICYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR ,000,000 EACH OCCURRENCE $ 1,000,000' DAMAGE TO RENTED 100,000 PREMISES Ea occurence $ MED EXP (Any one person) $ 5,000 ND -P-010078/000 3/13/2016 3/13/2017 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY❑ PRO- JECT DLOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 accidenB BODILY INJURY (Per person) $ ANY AUTO ATOX SCHEDULED AUUTOSS AUTOS 6228807 CON 02 5/23/2016 5/23/2017 BODILY INJURY Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Underinsured motorist $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N / A To be issued directly by the company. 10/8/2015 10/8/2016 PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Town of North Andover North Andover, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gilbert, CIC/LINDSE '7-;1-1 wl_%- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Surfer visor License: CS -076691 ROBERT AKEVN��-` 12 E WATER ST < IMF North Andover WA 0 Expiration Commissioner 08/16/2017 ��� (QP�77i7720�/ZLUP.CGGGf2 0��%I�LCLOJCGGtLL�P.�4 Office of Consumer Affairs & Business Regulation lugHOME IMPROVEMENT CONTRACTOR Reg istration:;:y,'1..08383 Type: Expirations_;,.--$ -t`8�01,8 DBA KEEN CONSTRUC10 Kenneth Keenr j 1175 TURNPIKE ST $ NO. ANDOVER, MA 0184$x= ''" Undersecretary