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HomeMy WebLinkAboutBuilding Permit #153-12 - 60 WINDSOR LANE 8/23/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ~ Date Received Date Issued: d 3/' IMPORTANT:Applicant must complete all items on this page LOCATION C�O W i iu d S in a- L N Print PROPERTY OWNER CL IA. a C Print MAP NO:166 ` PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0`Septic (]Well U Floodplain 0 Wetlands U Watersl edrl). strict . DESCRIPTION OF WORK TO BE PERFORMED: i Ide+nj ification Please Type or Print Clearly) Cr 1711i OWNER: Name: V A C— Ic- z Phone. s 3"SE a.Sa Address: CONTRACTOR Name: Phon4a/- S a o 1 Address: TC IA J E Supervisor's Construction License: S 02`(< Exp. Date: 1 a Home Improvement License: 10 %3 4 3 Exp. Date: ^ 1 a- ARCH ITECT/ENGINEER Phone: Address: Reg. N FEE SCHEDULE:BULDING PERM/T.,$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ W ,� 7 6 �g FEE: $ (0 zz Check No.: 7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofrAgerjt/Owner . Signature Of.. vac i E Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I` 1 i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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 I Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes (�o Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 o 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 o Building Permit Application Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o . Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Neter Construction (Single and Two Family) ❑ Building Permit Application o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Yn 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: Doc.Building Permit Revised 2008mi I Location 60 /N No. /.S3' // Date F ' NORTIy TOWN OF NORTH ANDOVER 3? •. • O ►O w 9 • Certificate of Occupancy $ CMUS<� Building/Frame Permit Fee $ 6 7� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #r,777 G 24 4 > 3 Building Inspector NORTFy . Town of over No. 163 - o , dover, Mass., COCHICHEWICK 7�s RATED U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR .:........ ...... ........CERTIFIES THAT . . . . /.. ........ .............................................................................................. Foundation has permission to erect........................................ buildings on ...�.�... r�v(�l s'.4. .... .(!. ........................... Rough GSC `C�e�'! f Chimney to be occupied as............................ Vr.Z ..... . ...... r.................. ........................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 MONS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STS Rough ...... �........... .....................:................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry .Wall To Be Done FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1. „ , f. ."`+.' ,X T.,., ,�F:o,: �'aN .��"p ;h .."�" �'cy�,�,t .+,n»se�� 1 �'.�yti�+�,...�+�'-..a�:.��;f��. .'aa•.�'x 'K 5,:;. _ - ... V „ KEEN CONSTRUCTION CO. GP j a 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 _ All home improvement contractors and subcontractors i. 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 with Submitted , 7 . i the Commonwealth of Massachusetts. Inquiries about To: ?_ �ALM�!_J._4_ .„�...__ ... 1`...._ _ bc `� —_ registration and status should be made to the Director, t Home Improvement Contract Registration,One Ashburton ..,:______. I �i�°s _._.__.__.__.. ._........._. Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will --h... be excluded from the Guaranty Fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. EIN N0. w Z 3 _. 2-5 �? , 2.0 . MA. H.I.C. 108383 26-0462904 > C/S=Customer Supplied S+ I = Supply+ Install DSII See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: _X ....................... ........................... .................................-_---- .................... ............ -------------------- ------------- ------------- ------------­-- ........................__­.......... .......... ............. Construction related permits: ..,.,.._.,:....._...._._.._ ... _........_..._......_.........................._.._,......................................................,..................,...................................................,........................................................................................................................................................... _.._.....__...............-..._,........._,....._.,.,.._._...........................__.._.............._.............................................................................................................-...................................................................................................................................................................................................._ WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by (date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the workfurnished 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 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-'complete,in accordance with above specifications,for the sum of i � )' 1' )j Ya ''Uc OU4ed. E i .,..�... ..,... dollars($ Jam+ �i',00 ). Payment to be m de as follows: % ($ ) upon sig jng Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant ($ etidn"of 21 HEWITT AVE. Street Address ;. N. ANDOVER, MA 01845 g.($ )'Upon completion of ; City/State y shall be made forthwith upon (978) 691-5201 (978) 682-3231 ($ ) completion of work under this contract. Phone Fax 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 Name o! s�n or the total amount of all deposits or payments which the contractor must make, in FJ � e 2, { "` advance, to order and/or otherwise obtain delivery of special order materials and Autnori_zgignature 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 outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO NqT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. �,!�'� Date - Signyi6re Date Signature 'IMPORTANT.INFORMATION ON BACK The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizaton/Individual): C ' � (1nO Address: or? H E W ,' r" f} U e !� D�g�s City/State/Zip: A 9 , 1 � N a Dy I v- 14 1} Phone#: 79 &q ( - a / Are,yyoou an employer?Check the appropriate box: Type of project(required): re 1.�I am a employer with_1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ,— � 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E„remodeling 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.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 131-1 Other 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �•l Insurance Company Name: G rZt7 N” +_c Policy#or Self-ins.Lic.#: Lk) C OO C Es 146 9q9. Expiration Date: V Job Site Address: (4O W 1 VA Sd/i. L (V. City/State/Zip:L�. e5 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 cerci der the pain and enalties of perjury that the information provided above is true and correit Signature: c Date: Phone#: 0/ 7 O •�� ( -S a O l 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#: 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 employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee 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 building appurtenant thereto shall not because of such employment be 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 operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this 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 certificate(s)of insurance. Limited Liability 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 may be 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 requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the 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 sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111. Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.govldia 8/22/2011 1:36 PM FROM: Gilbert Gilbert Insurance Agency, Inc. TO: +1 (978) 682-3231 PAGE: 001 OF 002 ACORD,� CERTIFICATE OF LIABILITY INSURANCE 05/2/2011 PRODUCER (781)942-2225 FAX (781).942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Reading, MA 01867-3922 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW: INSURERS AFFORDING COVERAGE NAIC# INSURED Kenneth Keen & Robert Keen INSURERA NORFOLK & DEDHAM INSURANCE 23965 DBA: DBA Keen Construction Company INSURERS: Granite State Ins. Co. 0077 21 Hewitt Ave. INSURER C: North Andover, MA 01845 INSURER D: INSURER E: COVERAGES 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIESDESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR . TYPEOFINSURANCE- POLICYNUMBER - POLICYEFFECTIVE POLICY EXPIRATION LIMITS GENERALLIABILITY ND-P-010078/000 03/13/2011 03/13/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGETO RENTED $ 50,00( PREMIr CLAIMS MADE M OCCUR _ MED EXP(Any one person)- $ 100,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( - GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/0P AGG $. 2,000,00( X POLICYM j� LOC AUTOMOBILEUABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGELIABILRY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG .$ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE - $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE - $ RETENTION $ $ WORKERSCOMPENSATIONAND V0009646942 08/03/2011. 08/01/2012WCSTATU- OTH- EMPLOYERS'LIABILIrr WC CERT TO BE MAILED B ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 100,00-0 OFFICERJMEM13EREXCLUDED? DI ECTLY VIA INS CARRIER E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under _ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS vidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER-WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Coverage [AUTHORIZED REPRESENTATIVE Mark Gilbert CIC ACORD 25(2001108) ©ACORD CORPORATION 1988 KEEN CONSrRUCrrON CO. GP 21 f(EWI rr AVE. N. ANDOVER, MA 01845 978-691-5201 Kee-nC&n0rucctuxnCc-com Zablocki, Ed &Valerie 60 Windsor Ln. N.Andover, MA 01845 978-683-8252 Contract#5029;Appendix A June 11, 2011 Kitchen Remodel: • Demo existing kitchen to studs • Frame wall between kitchen and dining area to cabinet height with a return of approx. 16"-20" • Insulate exterior walls to code • Plaster walls&ceiling to smooth finish • Install customer supplied cabinets, including matching trim molding as per drawings from Jackson Kitchen Designs ( design date 5/24/2011) • Install customer supplied appliances ($300.00 allowance for range hood installation,which does not include a soffit for cabinets or reframing ceiling) • Paint walls, ceiling&trim (two coat finish, all neutral colors) • Dispose of all debris Plumbing($3700.00 allowance): • Update& relocate necessary plumbing feeds, drains and vents as required • Install customer supplied plumbing fixtures Electrical ($5250.00 allowance): • Update electrical circuits to code • Supply& install 10 recessed light fixtures • Supply& install under-cabinet lighting Total Price: $25,250.00(twenty five thousand two hundred fifty dollars) Price does not include cost of permits, changes required by inspectors,flooring, cabinets, plumbing fixtures or heat. Changes required by inspectors may include the installation of range hood by a certified sheet metal worker which may increase the cost of installation. Allowances for plumbing and electrical work may change when respective sub-contractors view jobsite. Page 1 of 2 XEEN CONST"2uC7-iON CO. GP 21 NEW17 T AVE. N. ANDOVER, MA 01845 978-691-5201 Keen,C&vi4&u.c cn.Co:ccm Payment schedule: $1000.00 due upon signing contract $3000.00 due the first day of work(plus permit fee) $5000.00 due after demo and framing is complete $2000.00 due when rough plumbing is complete $3000.00 due when rough electrical is complete $4000.00 due when plaster is complete $4000.00 due when cabinets are installed $3250.00 due when contracted work is complete Customey' Ke eth B. Keen Date Date N I Page 2 of 2 Hug lb 11 Ub:31a P. 'rill' Jackson order 11211 KITCHEN DESIGNS Transaction # Billing Fax:978.687-5841 338785 1093 Osgood Street, North Andover,MA 01845 Phone: (978)685-7770 Pcd Fax: (978)685-7771 7126/11 A/0 Location LAWRENCE MAIL TO: Jackson Lumber&Millwork Co. Inc. Sales Representative PO Box 449, Lawrence,MA 01842 LUCY ROSS • Ship To: ED ZABLOCKI SAME "CASH ACCOUNT **CASH ACCOUNT*" 60 WINDSOR LANE 60 WINDSOR LANE (978)683-8252 ANDOVER, MA 01810 ANDOVER, MA 01810 OrderDate Oper Purchase Order Ter—ms Ship Via 338785 1 05/04/2011 1. 169. 1 DIRECT/JACKSON UNL -LN# Item Number Ordered Description Delivery first stop right after unloading /2111 12:58 pm another.order in Lawrence Approx. 9:00 AM 1 SOBROOK 1 BROOKHAVEN FRAMELESS EA 21,575.00 21575.00 CABINETRY PER PLAN EDGEMONT DOOR STYLE CHERRY WITH NATURAL FINISH AQ 75741130527 ""• 1 SOBROOK Due on PO#334478LR on 712612011 2 SOGRANITE 1 NAPALITANO GRANITE EA 7,250.00 7250.00 WITH STANDARD EDGE/SOLARIU S GRANITE 1 SOGRANITE Due on PO#334763LR an 7/28,2011 • 28,825.00 Special order and manufactured merchandise is non-returnable. Y Customer agrees that any amount not paid within 30 days of s3 (526-56 invoice date will carry interest at the rate of 1.5% per month U • 30,626.56 and. further agrees to pay all costs incurred in collection, r 0.00 including reasonable attorney's fees. Page 1 of 1 7/23/2011 10:15:57AM fi Office s mej airsiness egu a HOME IMPROVEMENT CONTRACTOR Registration: X108383 Type: Expiration: IAQ912 DBA K CONSTRUClLts7 r iVfERT'J, a er , Kenneth Keen 21 Hewitt Ave �+F No.Andover,MA Undersecretary — Massachusetts - Department of Puhlic Safety Bourd of Building Rc�2ulations and Standards Construction Supervisor License License: CS 58245 Restricted to: 00 \ KENNETH B KEEN 21 HEWITT AVE N ANDOVER, MA 01845 Expiration: 3/24/2012 ( glilt iNsi.mer Tr#: 20523 Massachusetts - Department of Public Sat'etN. Board of Buildin.- Re.-ulatiohs and'Standards . Construction Supervisor License License: CS 76691 Restricted to: 00 ROBERT A KEEN 12 E WATER ST N ANDOVER, MA 01845 Expiration: 8/16/2011 ('i nunissiuncr Tr#: 1690