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HomeMy WebLinkAboutBuilding Permit # 4/27/2015 (2) ,I BUILDING PERMIT �oRTN w• I A��t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received � gA7Eo�'P Ry AC 05 Date Issued: It I -IMPORTANT: Applicant must complete all items on this page 'z:f^, n "l f r..//d' -'f Yr,yf y.: fir .7 1",r'l, rNr •rrT"., /t W f # 1'r f'` f f / G / r ✓ �',F r ;1 f :✓<-3. s f i.�/ r ;r / ..t f rr r rr rr t _rr r fr ,r �s �f' .t�„ �l�ii.r<G,. � ,r 1 �,.;f .✓��l`r'".� ?r r�.Y. ��,�-. ..,s..�'Y r'� J",�_.r. Y r r'r,'`�,.-r �=l ..rrr' r 7 a :r xf r :;; /...r,:,.,: tom' sr.r' ,i''vr r -„�-rrxr� „><•fr rr�ra'i7 fr.�'�rr tea.r � �::: rlf sx,r, x� f rr ��,, r ,� r t �' .r T 3,;r',,�.ja vL .,.1r r Jj ,1 ,L �->,., � ,::r. �^+ ..:cv olC�'r z. rr�./u f ..J�o .;�;” 1 t ✓." r r r..r r r 1,�-'rl� r� Y ,,',',..`! .�;fJJ,". � .�:«., 1 m� : ,� .xk.,.i r[tr1'' t'd.,?` .,r� ,. fi tt� r ✓r r..r ;!.. s' a ,;•°. /.. LOCATION r''m+r��,l�,/r nw,�.A a'r^F�r F,-n�� �Snr`�tr"I"�rr��rr�r CJI f 7 /r f IT r .r��,-,,r'` >'G�f`-. ,,:.rg f.rk.. ,fro�� Ll .r,+' 5:,,r-f ;:�!1``x ,?^r✓:�j: :::"r; �r`r'1` ..1 � ..rfr fjrn" r r...$ �r I :,,f.✓r1!';?�;� v�t��%`v b,,.�.rr, r: � Y�;. -,.�,F��Zr.�'',�, v,/ l`x4..:,eYr,c"sr � .,,r'2 , Is,,� 1 �„xt:'�.rY±"�`� �i .•-c r-�Jr i^a�'C.1`'.''�,r e.•r ^�.",�{;✓Y: �r`:1�1:.e �x�}f� .,1.. r,,�a:,i „rr� ,.rF�."",��rS t Y'.,,. ? er ,.�d� r 1r::, r f ✓ J r,,�'r:�,>=%%:fk�-vsr�P'rf�„�.r� � >'` - �"`� r �`�R ;�u� l�r✓.^r�r�r' I.G:L, v r^ �a f �:r;�.�;r r ,k/ .J: r,.r rr"F' �-.;'r�✓rr �� ":.r r«,r:�.to.,.,rrr�,�'J.�r.t �" ,Y"�` �,r,ltr i��5 a'� yJ .rr r .,,r,�„ „,rr,�y r ✓ r ✓P 1� I �:r, f� .r'',•. ,��. 3 e �r` :P:k �.. �-rrr. a'�r�' .:� r /r. :� lr%�.,.> x''/3._ r fr r .�`� .alt 1100�Yeer�StfuGture.r f f-' �: eS r.;r10 r �i r :: �r Jnr r k>x«"'"�'.�r � .i"e ✓ ur r;�i r,.�tx�`g1'.ai'�^ r.`.a?.%�>�I F''�r',`,��irix rfp�f.- s _-car i 3rr r,r,: t.r'r�,r� al r ,?� } frrr , jfr , ,r/ t 1Machine Sho Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial f;,Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Q'Sepfic�,r ❑rWell r ❑ Floodplain ❑1Netlands ❑ Watershed District ` DESCRIPTION OF WOR11f TO BE P�RFORME Identification- Please Typeor Print Clearly OWNER: Name: k -b :e L c,4:h Phone: �7 27 -LZ6-7 7 Address: Ck Contractor Name Ni Phoney .:..r".r'.1 r/`� rr. rt r �:r r P/,/r�'. rs �,�„traa'.i r r r f r✓ ;�r rr L:r ✓ t'r r -:'fr u r f,f+ r rf fs r'r r r r. S rtr z,.-„,;:-,. %:",,.�✓r�1af r f� r”�u r x r � .r , l/r``f � f ,Iv -'�If r Jr r f r /� ':r r f r r:/ r ..r � � --Y''✓�'�=" s -:l' 1�'r: � rr err rrr�'rx✓�f'�'�r r£o���r� rk� J l r r t l rL -' ' �t 1 /, rr p" !r � 2r7.. �.,v" ,1 F. t r,.z r�,.:Y'Y. ✓ �� r r rfi5 r t r, ��zY'7r✓5,"��`� av"� a ;` r.. � ���r+`� ,ry r�'..'r -X r' ,zu ff�:.�s x fr r it r rr r�-. � (vx .r �r t r rr l�r ? ,rr r�"xr� r f f r-' � r� rr; C�rr � r fu%r � .,✓ a"*: l r�✓ k.: ! ;;.rlt r r' la' d '7,r` ),k,l�:A >� r," 1 Y t r � fi t f't 'r r E✓fp/ 'x t nr=1 Ct r � r- Home Improvement License x ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ t , C) FEE: $ Check No.: q. f� Receipt No.: y r NOTE: Persons contracting with unregistered contractors do not have access tot gu rt'�1 ty n nd Sidnafure of'Agent/Owner Signature of contractor t%oArH -town of d 0h,v Cr-%� r ® ; `•: _ I iy - o ��K� h ver, ass, COCMICNlWKK �'1' �.9 AERATED PP�,��(5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 41 - THIS CERTIFIES THAT � .........I ... !fir .... BUILDING INSPECTOR ..... ...... ....................... Foundation has permission to erect .......................... buildings on ......M....... . ........ .. ............................ .,.... Rough to be occupied as .......... 1�.G`.�. 1,.... ��ry ..:' ..... ................... �........................ Chimney provided that the person accepting this prespect 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 9 IL PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CTI ST RT Rough Service ........................... ...... ...I...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. C fs KEEN CONSTRUCTION CO. e 1175 TURNPIKE STREET 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 1 / f Chapter 142A of the general laws,must be registered Submitted S G `V h(�l l,1 vJ '�tl `��lG`7 with the Commonwealth of Massachusetts. Inquiries To: 111 \ about registration and status should be made to the �j Director,Home Improvement Contract Registration,10 79 U 7 J Park Plaza, Room 5170, Boston, MA 02116 617-973- 1 q 8787 Owners who secure their own construction ��i� .G�Q-f^r Q l' 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. 2 G 15 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 �A' G\�, Gtto See Construction related permits: -____._------'-------.._..—'—'--.—____—_--'--____._....... —.._...__.._.___................._..._._...._...._..................... _._._.._._......_....._.___..._'-------'---____.—._.—'-- WORK S HEDULE Contra 4 nal the work or order the materials before the third day following the signing of this Agreement,unless specified here in ting. kacfor will begin the work on or about aU (date). Barring delay caused by circumstances beyond Contractors 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 work furnished hereunder shall be free from defects in materials and workmanship for a period of \ following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contra tor,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 'e _V\ O L�5��� ���,�n�- �OI �3. �i:�AA4 1 --dollars($ ./ r Payment to be made as follows: J ($ ) upon signing Contract; ROBERT A. KEEN I, Name of Contractor I Designated Registrant ($ ) upon cord io�rt of_ tett 1175 d(ess TURNPIKE ST. ��((��?ncompletion \ / Street Address ($_ ;�,)�( of N. ANDOVER, MA 01845. _ ally r stale j`,,�/ ) shall be made forthwith upon (978)691-5201 (978)682-3231 completion of work under this contract. Te 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 n!Sa/l a an or the total amount of all deposits or payments which the contractor must make,in P/1 -( /"1 advance,to order and/or otherwise obtain delivery of special order materials and Arched ed signature equipment,Whichever amount Is greater. Note:This proposal maybe withdrawn by us it not amepted 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 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. �. l rt k t_li Signature �' C / Dale Signature Date IMPORTANT INFORMATION ON BACK NO- Construe on Co, REMCIUEI_IliG SPECIALISTS 978-69"i—S20�1 Keen ConstructionCo_com Halbach, Rick& Kathy 79 Gray St. N.Andover, MA 01845 Contract#5530;Appendix A April 15, 2015 Repair office walls and ceiling:$2000 • Remove and dispose of ceiling and damaged part of wall • Remove and dispose of existing insulation • Supply& install insulation in ceiling • Supply& install wallboard and skimcoat plaster to walls to smooth finish and ceiling to textured finish • Paint walls Soffits&gable vents:$1394 • Remove existing soffits on front and rear of house and rear of office • Supply& install Musket Brown fully vented vinyl soffits to match existing trim color • Supply& install gable vents on each side of office Living room,stairway and hall:$2892 • Remove existing crown molding • Apply stain blocker and paint walls and ceiling • Supply& install new crown molding and stain &seal to match existing • Remove and replace approx. 20 sq. ft. of flooring to match existing (2%"Bruce Fulton strip "Seashell") Front door: $3110 • Remove front storm and entry door • Supply& install new Masonite 6-panel door with camber top Element glass at the top, with an Oak texture (BLT-137-328-4) • Stain &seal door with Masonite Early American stain kit • Supply& install new exterior trim (PVC)and interior to match • Stain &seal interior trim to match • Supply& install new Emtek door knob (brass interior, nickel exterior) • Supply& install Andersen Contemporary Deluxe full-lite storm door in Bronze with nickel hardware 1175 Turnpike St. Page 1 of 3 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC#108383 7 en ConJ�trt on Co, REMC3"FLIr/G SPECIALISTS 978-69"1-520"1 Keen ConstructionCo_com Main Bathroom: $1550 • Remove wallboard on outside wall • Supply& install blueboard and skimcoat plaster to smooth finish • Install customer supplied 110cfm bath vent and pipe to soffit vent • Paint walls and ceiling Front corner bedroom:$640 • Stain block as needed • Paint walls and ceiling Window sills: $300 • Supply& install new stainable windowsills on 16 windows • Repair exterior sill of vinyl window in mid front bedroom Kitchen window: N/C • Re-secure top casing All prices include disposal of all construction related debris, but do not include cost of permits or repairs to any unusual, unsafe or non-code compliant existing conditions that have not been addressed in this contract. Total Price: $11,886.00 (eleven thousand eight hundred eighty six dollars) 1175 Turnpike St. Page 2 of 3 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 � een '0 ns Co, REMC7UE1_IM4 SPECIALISTS '975-697-520"1 KeenConstructionCo.com Payment Schedule: $1000.00 due upon signing contract $3000.00 due the first day of work(plus permit fees), $2000.00 due when front door is installed $1500.00 due when soffit and gable vents are installed $2000.00 due when plaster is complete $2386.00 due at completion of contracted work Customer Robert A. Keen Date Date 1175 Turnpike St. Page 3 of 3 P: 978-691-5201 N. Andover, MA 01845 F: 978-682-3231 CSL#076691 Sales@KeenConstructionCo.com HIC #108383 The Commonwealth of Massachusetts = y Department of Industrial Accidents s I Congress Street, Suite 100 Boston,MA 02114-2017 'c www mass.gov/dia 01M SV Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PEPMTMG AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: �1210_14r(N1(�S f ru c j c cam, Address: (� TU f n o*e 5' t City/State/Zip: J' CVe_r, 6- v 1 g��Phone#: Are you an employer?Check the appropriate box: Business Type(required): 1.W I am a employer with 3 employees(full and/ 5. ❑Retail or part-time).* 6. E]Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11.L1 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.4 Other � ��SCJ j�✓1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. lam an employer that isproviding workers'compensation insurance for my employees. Belo►v is thepolicy informatioit. Insurance Company Name: Ira 5 111 5 , Insurer's Address: Q©�C 3'25 City/State/Zip: 0,('\ 1, 6 F 2-7d Z Policy#or Self-ins.Lic.# U G-99./ 1 (A 2-" 4 Expiration Date: 10 16/1 0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, rcr�thes and :aloes of perjury that the information provided above is true and correct signafore: 4 Date: Z -7 / S Phone#: Z U Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 03/23/2015 08:56 FAX 781 942 2226 GILBERT 0001/001 DATE(MMIDDrMY) � „�`'C''� CERTIFICATE CSF LIABILITY INSURANUE 4/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPbN THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEDIBY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURENS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does noticonfer rights to the certificate holder in lieu of Such endorsements. PRODUCER COOMT,CT Barbara McDonough 0. Gilbert Insurance Agency, Inc. PONE (7131)9422225 PAX (761)9a:?-2226 137 Main Street 5-pA1LAIRO .bmadonough@gil.ba.vtinsuranoe.cosn IN tiER 5 AFFQRDINO C�VERAGE I NAIC 0 Reading MA 01967-3922 INSURERA:NORFOLK & DEDU M INSURANCE 23965 INSURED INSURER a:$c'fGt Tn8u:C.-1In0e' Keen Consixticti.on Company INSUREnc:Travelars Insurance 0022 1175 Turnpike Street INSURER D f INSURE E! North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER.CL1441500922 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR FHE POLICY PERIOD INDICATED, NOTWTH$TANDING ANY REQUIREMENT,TERM OR CONDITION QF 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 pCLAIMS. ILTR TYPE OF INSURANCE A POLICY NUMBER MMIODY� MOIDDY SCP LIMITS GENERAL LIABILITY EACH OCCURRENCE _ I 5 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAISE E . rtanen I S 100,000 CLAIMS-MADE a OCCUR D-P-010078/000 /13/2015 /13/2015 MED EXP(Any one arson , S 5,000 PERSONALS ADV INJURY I 5 1 t 000'000 GENERAL AGGREGATE 3 2,000,000 GEN'LAGGREGATELIMIT APPLIES PCR; PROD CTS.COMP/OPAGG S 2,000,000 }t POLICY F7 PRO. OC I $ AUTOMOBILE LIABILITYOMBINED SINGLE LIMI Ea accident 1,000,000 IxANY AUTO RQDILY INJURY(Par porson) S ALL OWNED 5CH8DULEO 6228007 05/23/2014 5/23/2015 AUTOS K AUTOS BODILY INJURY(Per aCaldam) $ HIRED AUTOS K NOTOSWNED PR epER bAMAGE $ Unddrirlwtedmotg6v I s 100,000 UMBRELLA LIAB LCLAIM�-MADG EACH OCCURRENCE A EXGE55 UABE AGGREGATE S DEO RETENTION 3 I S G WORKERS COMPENSATION ro Be Provided directly I WC STATU- O7H- AND EMPLOYERS'LIAEILRYtLIM PR ANY PROPRIETOMPARTNERIEXECUTIVE r im tho carrier. E.L.EACH ACCIDENT S 100,000 OFFICERIMEMBER EXCLUDED? N/A 10/8/2010 0/9/2015 IMand.torylnNH) E.LDISEASE-EAEMPLOYE s 100,000 If vs,deeulbe under DESCRIPTION OF OPERATIONS balow I E,L,DISEA8E-PQUCY LIMIT 1 S 500,000 DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES(ANeoll ACORD 101,Additional R4ntatka Soh4Cul4,If Moto*pa041a roqu1r4d) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION (978) 682-3231 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 135 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN Evidence of coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE rs Gilbert, CIC/> R j ACORD 25(2010/05) C 1888.2010 ACORD CORPORATION.(All rights reserved. IN$025(niuos).ot The ACORD name and logo are registered marks of ACORD Rightfax N2-1 3/26/2015 2 :29: 24 AM PAGE 2/002 Fax Server CERTIFICATE 4F LIABILITY INSURANCE DATE n'3/24/201 YYY) [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 PRODUCE D 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 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 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 19 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 (WDMYYYY) (MIADD1YYYY) LIMITS GENERAL LIABILITY :-ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F--1 OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [—]PROJECT F]LOC aRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ 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 LIAROCCUR 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 I LIMITS ANY PROPERITORIPARTNEI' EXECUTIVE OFFICER MEMBER EXCLUDED? I" I Iry[ NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes, IPTI N Older E.L.DISEASE-POLICY LIMIT $ 50(),000 DESCRIPTION OF OPERATIONS below '.. 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��1VE NORTH ANDOVER,MA 01845 <. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD n ��„ 1988-2010 ACORD CORPORATION. Ail rights reserved. Massachusetts - Department of Puhfic Satety Board of Building Regulations and Standards Construction Superlisor License: CS-076691 ROBERT A KEEN-` 12 E WATER ST, North Andover MA 0185 Expiration Commissioner 08/16/2015 T ��e �po�rzt�ztoazcaea��a����ca:recafcare� Office of Consumer Affairs&Business Regulation W'ME IMPROVEMENT CONTRACTOR gistration: 108383 Type: piration: 8118/2016 DBA KEEN CONSTRUCTION CO. Kenneth Keen 1175 TURNPIKE ST g NO.ANDOVER, MA 01845'- Undersecretary