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Building Permit # 3/30/2016
o0arn BUILDINGP �1 60 6 a TOWN OF NORTH ADOVER APPLICATION FOR PLAN EXAMINATION - n Permit NO: Date Received Date Issued: ° Acwu IMPORTANT: Ap2licant mttst com fete all items on this pae Print PROPE,RfiY O/ 41 Print, MAP NO �` pARt L..�° ZONING/dlSTF2tCT Historic Qi trice yos no M,8,hine'Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential , Non- Residential ❑ New Building -1 One family F-I Addition -I Two or more family Industrial —WXlteration No. of units: ipdommercial I I Repair, replacement I Assessory Bldg I Others: I_I Demolition I Other septi �Well tj Floodplain a Wetlands 11 Watershed District Vutr/ewer JI /V1 .,. m�.,� ' +^r^r �'0*,!,:+.""'" ,,,, r;,`'"s a°'�^ `L' ^G',.w-'�.",r, =" "�f°' "&`"," " '::� d""'": "';d^'�^""m' .✓^","," ^' ma�,„.w b }P$"'5 Identification Please Type or Print Clearly) OWNER: Name: :, . .,. m �m A. .;, z - ' Phone: M. m Address: : *� ^ C;C NTRACTC7RName Phone: Addr6 ' �'w Superui o' on#Action 4icen �e: --Exp. Date. a, Horne,lrnprovomr Ent Lr Es P,, Cite: ARCH ITECT/ENGINEER w " ��� Phone Address. Z! .. �� "" � � Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$929.00 PER S.F. < mm Total Project Coat: $ FEE: $ ° ^. Check Na.: ��^ ., Receipt No.: .w�, e g NOTE: Persons contracting with u, r ster d contractors do not have access to the guarantyfind Signature of Agent/Own e ° RASignature of contractor i r_1E_q du' i 'lown ot NORTI, v P O 0% 6§4-A- ' h ver, ass 261(p o > > COCNICHEWICK ya. A04ATEDT LP RM I S V BOARD OF HEALTH Food/Kitchen Septic System LiW` QrCV4 �S BUILDING INSPECTOR THISCERTIFIES THAT ................................................................................. ...................... ............... has permission to erect ..... buildings on Foundation p ............... g ...Tyr;�►.�,.��..............•........... Rough to be occupied as ........ . !.:�.............. .. . ......... ....�.. ............. ... Od!�r... ...C��. `.�............ � Chimney provided that the person accepting this pe t shall in very respect conform to the terms of the applicatio Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alt N'6lc n and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITEXPIRES IMONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ................ •.....z .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to ®ccum BuRough Display in a Conspicuous Place on the Premises - Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. INITIAL CONSTRUCTION CONTROL DOCUMENT '?1 �1111�1%111% PROJECT NAME: #1507—Lowell General Hospital Weight Management Clinic DATE: March 16, 2016 PROJECT ADDRESS: 203 Turnpike Street, 3rd Floor, North Andover MA 01845 SCOPE OF PROJECT: Alterations Level 2 work to existing interior space. Interior renovations to existing space of approximately 1,829 square feet including construction of new non-structural partitions, installation of new suspended ceiling and light fixtures, installation of new plumbing sinks and toilets. I, Christopher Doonan, MA Registration Number: 10736 Expiration date: 08/31/16, am a registered design professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning Architectural for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care, and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official, I shall submit field/progress reports together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Docum ASD ASG` 2. Christopher Doonan AIA, LEED AP ; Principal, Doonan Architects %, Doonan Archileo:;lw Qv 27 Chippo.;walW:.d vUadJ`oid, MA 01886 978 '92.5742 vnry .lborcr�r,:r�Fwr�l iG.�r 9d�,.c<.:��rr� Initial Construction Control Document v z To be submitted with the building permit application by a Registered Design Professional for work per the 8"' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Weight Management Clinic- Circle Health Date: March 15,2016 Property Address: 203 Turnpike Street,North Andover,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Fire Alarm Tenant Fit-up. 1,Richard D Cummings Jr,MA Registration Number: 49023 Expiration date: 6/16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural Mechanical Fire Protection Electrical X Other: Fire Alarm for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control D 4MMA 4 OF Enter in the space to the right a"wet"or electronic signature and seal: C) IOTECTIO Phone number: 978 658 2616 Email: cummingseng*comeast.net 0,49023, Building Official Use Only Building Official Name: Permit No.: Date: Note 1,Indicate with an Y project design plans,computations and specifications that you prepared or directly sup�ised.If'other' is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document 47) To be submitted with the building permit application by a Registered Design Professional for work per the 8'h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Weight Management Clinic- Circle Health Date: March 15,2016 Property Address: 203 Turnpike Street,North Andover,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: HVAC,Electrical and Plumbing Tenant Fit-up. 1,Richard D Cummings Jr,MA Registration Number: 49023 Expiration date: 6/16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural X Mechanical Fire Protection X Electrical X Other: Plumbing for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents, 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Enter in the space to the right a"wet"or I'liciiff,K) electronic signature and seal: rC-3 00' Phone number: 978 658 2616 Email: cummingseng@comcast.net Building Official Use Only ylV Building Official Name: Permit No.: Date: Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised.If'other' is chosen, provide a description. Version 06 11 2013 11 1 F' BOS -1 ON DEVELOPMENT GROUP A Division of First General Realty Corp. 203 TURNPIKE LLC 93 Union Street,#315 Newton Centre, MA 02459 Telephone: 617-332-6400 Facsimile: 617-527-4176 March 29, 2016 Re: APPROVAL for work for Premises held at 203Turnpike Street, N.Andover, Massachusetts To whom it may concern: This letter shall serve as formal notification that Lowell General Hospital has full permission to perform all scopes of work required for the completion of the approved renovation of the suite located at 203 Turnpike Street, N. Andover, MA. Sincerely, Kevin F. Barry Director of Design & Construction cc: Jodie Zussman, COO Heather Legere, PM Michael Desharnais, PM CustAccount#: PURCHASE ORDER PO Number: 173483 Corporation: LOWELL GENERAL HOSPITAL Tax Exempt ID: E042103590 Vendor: DMAR CONSTRUCTION,LLC Ship To: WEIGHT CTR/N.ANDOVER Bill To: P.O.BOX 9518 Created On: 03/17/2016 203 TURNPIKE ST,2ND FLR MANCHESTER,NH 03108 Vnd No: 48573 N.ANDOVER,MA 01845 Printed On: 03/17/2016 12:31:42 Phone: 603-401-4018 Phone: 978-937-6172 Phone: 978-937-6303 Special Instructions: Fax No: Fax: 978-937-6893 Fax: 978-937-6819 CIP-1083 Weight Management Address: P O BOX 27 Contact Donna Chasse Contact: a/p Ctr/N.Andover, See March 9,2016 Proposal and order as quoted. DANVILLE, NH 03819 E-mail: donna.chasse@lowellgenerai.org E-mail: Ighinvoices@nedocs.com Est Arr Date: 04/08/2016 Ship Via: FOB DESTINATION Terms: No Discount/Net30 Line Qty/UOM Item!D 1 Description GLAcct / Corporation Order Price Line Total —Receiving-- Pck Ref Vendor Catalog# Notes Deliver to Location 1st 2nd 3rd 4th 1 1 ST Proceed as Proposed on 3/9/16. Work w/G.Slowman& 1300-400 001 $234,500.00000 $234,500.00000 M.Desharnais to schedule. All changes must be 7500-WEIGHT MANAGEMENT CTR approved.Any adjustments to po total$,pis advise. Please ref po#on all correspondences. Page 1 of 1 Authorized Signature PO Total: $234,500.00 D"" Mar PO BOX 27 Construction Danville, NH 03819 603-401-4018 PROJECT: LGH NA WMC Renovations DATE: Wednesday,March 09,2016 TO: Mr. Michael Desharnais �I /���d� FROM: David Marceau Construction Coordinator DMar Construction,LLC Saints Campus Lowell General Hospital PO BOX 27 1 Hospital Drive 1 .�v�� Danville,NH 03819 Lowell,MA 01845 1000 General Conditions 7$29,000.00 2000 Demolition $2,000.00 2500 Abatement $0.00 4000 Masonry $0.00 5000 Metals $0.00 6000 Wood&Plastics $14,300.00 7000 Thermal&Moisture Protection $0.00 8000 Doors&Windows $15,000.00 9000 Finishes $37,000.00 10000 Specialties $8,000.00 11000 Equipment $0.00 a 12000 Furnishings $0.00 13000 Special Construction $0.00 14000 Conveying Systems $0.00 15300 Fire Protection $0.00 15400 Plumbing $28,000.00 15700 HVAC $49,500.00 15900 HVAC Controls $0.00 16000 Electrical $31,000.00 16500 Tel/Data $0.00 SUBTOTAL $213,800,00 5 PERMITS $ 2,700.00 CONTINGENCY $ - 6 GL INSURANCE $ 2,000.00 7 CM FEE $ 16,000.00 AR.Co stf'u€:t.olid MW Lowell General Hospital Weight Management Clinic North Andover March 9, 2016 DMar Construction is pleased to provide the lump sum price of$234,500.00 for the Weight Management Clinic Renovations at the Circle Health North Andover Campus per drawings by CDoonan Architects dated 2/15/16 and MEP drawings from Cummings Engineering dated 2/19/16. We include Addendums 2 and 3. For your convenience we are also attaching our schedule of Values. Thank you for the opportunity to provide pricing for Lowell General Hospital. Please feel free to call with any questions. DMar Construction Qualifications and Assumptions General: We include full time on-site supervision. We include Project Management to coordinate submittals,RFI's,subcontractors,etc. Daily clean-up and trash removal and disposal to our onsite dumpster is included. Assume work to be performed in one phase during normal working hours: We include a professional final cleaning. Cleaning to Hospital sanitary standards is by LGH. Division 1-Architect&Engineering: It is assumed the necessary Architectural and Engineering drawings and affidavits necessary to apply for,receive and close out the City of North Andover Building Permit Will be furnished by LGH. Division 2—Abatement&Demolition: Hazardous material test results have not been received by DMar Construction. No Hazmat assumed. Select demolition of masonry wall for new exhaust louver. Removal and proper disposal of existing articles in the space is assumed to be performed by LGH prior to the start of construction. Division 6-Wood&Plastics: Furnish and install plastic laminate countertops,lower and upper cabinets as shown. We have carried solid surface countertops at all wet areas, We assumed Corian standard color. Division 8—Doors and Windows: Furnish and install 12 single HM Frames and solid core flush doors and hardware. Furnish and install 1 pair flush doors,HM frame and hardware set 1 modified for a pair of doors. Furnish and install 2 single doors and HM frames with narrowlite%"safety glass. Furnish and install 1 single door with 24"x 24"louver and HM frame. Permanent lock cores by LGH, DMar Construction, LLC PO BOX 27 Danville, NH 03819 Page 1 of 3 Division 9—Finishes: Drywall: Frame all walls and hard ceilings with 3-5/8"20 gage metal studs and track;6"studs at chase wall in rest room. 5/8"drywall with level 4 finish ready for paint/ Patch existing walls. Cut new door opening at entrance. Flooring: Furnish and install Studio Carpet Tile Furnish and install Patcraft broadloom carpet. Furnish and install 4"x 1/8"vinyl cove base on all perimeter walls. Minor floor prep throughout is included. ACT: Furnish and install new Armstrong Dune#1774 ceiling tiles and 15/16"Prelude XL grid system. Paint: Paint new and existing walls throughout. Division 10—Specialties: Furnish and install toilet accessories. Furnish and install fire extinguisher cabinet and fire extinguisher. Furnish and install Acrovyn wall protection. Division 12—Equipment: None shown. By LGH. Division 15—Plumbing: Rough and finish plumbing per drawings dated 2-15-16. Per direction of LGN we do not include replacing and increasing the existing vent or sanitary lines to 4". Furnish and install fixtures as specified on drawings. The specified toilet only comes in a flushometer style. That is what we carried. Insulation on all new water piping. Permits and inspections. Division 15—Fire Protection: There is no Fire Protection Scope of work on this project. DMar Construction, LLC PO BOX 27 Danville, NH 03819 Page 2 of 3 DMAR.Construction Division 15—HVAC: Furnish and install(10)York water source heat pumps. For Trane Heat Pump equipment please add$5,500.00 NOTE: Heat pumps are a(6)week build time plus shipping. Fabricate and install galvanized ductwork with all associated accessories. Install supply&return,CPVC schedule 40 piping for(10)water source heat pumps. We include condensate piping in our proposal. NOT SHOWN ON DRAWINGS. Provide 1 Y2"insulation for ductwork Purchase and install diffusers. Red line as built drawings Permit Provide temperature controls 0 10-HP's(Mount and wire factory supplied thermostats.) 0 1-EF(Furnish and install programmable time clock.) Air and water balancing for the Weight Management Clinic is Included. LGH should budget additional funds to rebalance the spaces served by the RTU and condenser water loop we are tying into(We suggest$1,500.00 and have not included this in our proposal). Division 16—Electrical: Electrical work for the Weight Management Clinic, at 203 Turnpike Street North Andover, MA as per drawings, E1,E2&FA1 dated 2/19/2016 and Addendum#2 A2-SK2(tele/data sleeves). Furnish and Install outlets and mechanical power as per drawing E1. Furnish and Install 100amp 42circuit panel as per drawing E1 Furnish and install light fixtures as per drawings E2&A3-1. Furnish and install Fire Alarm devices as per drawing FA1. Furnish and Install tele/data sleeves as per addendum#2 A2-SK2. Data wiring is to be by others. MC Cable is to be used for all electrical wiring. One(1)year material and labor guarantee. Temporary lighting&power. Electrical Permit. DMar Construction, LLC PO BOX 27 Danville, NH 038 .9 Page 3 of 3 The Commonwealth of Massachusetts Department ofIndustrialAceidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. AnWicant Information Please Print L Name (Business/Organization/Individual): DMar Construction, LLC PO BOX 27 Address: City/State/Zip: Danville, NH 03819 Phone#: 603-401-4018 Are you in employer?Check the appropriate box: Type of project(required): l.FXJ I am a employer with employees(full and/or part-time).* 7. El New construction 2,F]I am a sole proprietor or partnership and have no employees working for me in 8. [29 Remodeling any capacity,[No workers'eurrip.insurance required.] 9. ❑Demolition 3.FJ i am a homeowner doing all work myself.[No workers'comp,insurance required,]t 10 Building addition 4.FJ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.iDsurance.t 14.F1 Other 6,n We are a corporation and its officers have exercised their right ofexemption per MGL C. 152,§1(4),and we have no employees.[No workers'comp,insurance required.] I L *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 now affidavit indicating such, tContTactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. laittatiettil)loyei,that ispi'ovidiligivot-Icers'conipeitsationiiisui,aticefar'iiiyeniployees. Below is the policy and job site information. Acadia Insurance Company - Insurance Company Name: -a-- Policy#or Self-ins.Lic.M WCA 5242201 — 10 Expiration Date: 3/7/17 Job Site Address: 203 Turnpike Street City/State/zip:- 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, Vfj iderthepainsandpenal7lie ofpeijivy that the inforinationprovided above is true and correct Idohei,50-sar, Y1� � X Signature: e., Date: Phone#: Official itse only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#:27510 DMACO DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 3/30/2016 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 WANED,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). PRODUCCONTACT Janet B.Oxman,CPCU Sullivan�Insurance Group,Inc. °�No,�t:781 514-1340 aC,No:781 449-5419 1 Mercantile Street ADDR1ESS: joxman@sullivangroup.com Suite 710 INSURER(S)AFFORDING COVERAGE NAIC# Worcester,MA 01608 INSURER A:Acadia Insurance Company INSURED INSURER B: DMAR Construction,LLC INSURER C: 64 Farview Dr. INSURER D: Danville,NH 03819 INSURER E: 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 CONTRACTOR 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. DL- UB POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MM/DD LTRA GENERAL LIABILITY CPA5241730 3/07/2016 0310712017 EACH OCCURRENCE $1,000,000 X CEJMERC(AL GENERAL LIABILITY PRAElAAISET RENTED $250,000 CLAIMS-MADE FyI OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMPIOPAGG $2,000,000 GENT-AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC $ AUTOMOBILE LIABILITY CAA5242198 3/07/2016 03/07/201 (EaaCOMBINEDSINGLE LIMIT 1,000,000 A BODILY INJURY(Per person) $ ANY AUTO ALL OWNED X AU SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPccide DAMAGE $ Per accident) X HIREDAUrOS X AUTOS $ A X UMMBREI r e LIAB X OCCUR CUA5241732 3/07/2016 03/07/201 EACH OCCURRENCE $1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE S1,000,000 D� X RETENTION$nil $ A WORKERS COMPENSATION WCA5242201 3/07/2016 03/07/201 X TORYTL IT ER AND EMPLOYERS'LIABILITY YIN EL EACH ACCIDENT $50O 000 ANY PROPRI EXRC NERA � ECUW HNIA EL DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) OEM= under E.L.DISEASE-POLICY LIMIT $5OO,000 OESCRtFTi�O OF OPERATIONS below DESCRPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Project: Lowell General Hospital Weight Management Center CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD JBO ae...�nA•nMe-f'7n4 An ------------ FP-006 (Rev. 1.1.2015) PERIIT City or Town:, �y�y�/-,� FDIG SAFE NUMBER Date: ------------- Permit Number(if applicable): t Date: In accordance with the provisions of M.G.L. Chapter 148,as provided in to this permit is granted (Full for Locate dumpster for construction/renor-erson,Firm or vation /demolition of Restrictions: .at old,3 Fee Paid$ (Street and#or Describe Location for Adequate Identification) This permit w' pire o Signature of Official Granting Permit: Title y° This permit must be conspicuously posted upon theremise p s Massachusetts Department of Pubfic Safety Su rd of Building RegWations and Standards Ucense: GS-053540 Construction Supervisor DAVID A MARCEAU 64 FARVIEW DR 64 FARVIEW DRIVE DANVILLE NH 03819 CA— Exp�ratiow Commissioner 11/04/2017