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Building Permit #023 - 100 ANDOVER BY-PASS 7/14/2008 (3)
i BUILDING PERMIT of 00" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ # s L � 2 O _ Permit N0: Date Received ,T.o 9SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: i Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.:- Receipt No.: c NOTE c Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor NORTH q TONM Of �` z €o dover, Mass., LAK - COC/i1C�EWICK � ORATED �P�\ '9S S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System INSPECTORBUILDING THIS CERTIFIES THAT . / ..... ........................................................... Foundation ; .� has permission to erect........................................ buildings on .............. .`...:.....`.m a'rr � �" . �`� ............. >� w.................. g. ye,�i✓° s off„ + o4E Cohi to be occupied as...........f...::. ..... :..d..... :.. .:.:.. . .gip.............. ...... �� � ........ ...... .. . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in F al 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. i a `U� ? y PERMIT EXPIRES IN 6 MONTHS ELECTRICAL IN ECTOR UNLESS CONSTRUCTION STARTS Rough .......................... ....... .._..a..:.� n / ' BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAs SPECTO 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. 1L__SEE REVERSE SIDE Smoke Det. Dimension i L Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - 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 ❑ 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/Crossection/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 NOTE: 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 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 S � Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS i CONSERVATION Reviewed on Signature h COMMENTS i I h HEALTH Reviewed on Signature li COMMENTS a � Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 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 no Located at 124 Main Street Fire Department signature/date COMMENTS ` NORTH 'q TO" of No. - �` o dover, Mass., COCHICHEWICK 7�S RATED BOARD OF HEALTH Food/Kitchen Septic System PERMIT T BUILDING.INSPECTOR THIS CERTIFIES THAT... ,5'. f!"/1�....I`TQf.^.�j. ? '...��t 1. ... ................ ..........� ........ Foundation U 0�� 41®G11es"' 5� ........"..... Rough has permission to erect........................................ buildings on..........................................................�o........I.. . g to be occupied as.........1/..F/yl �� .�..0.. . ,t .y�.,.,��';,.ri/►tii ...!/14// f.�?./.l�j Chimney 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 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIONS ARTS Rough .-.,--.- '....Z.+..._......................... Service BUILDING INSPECTOR Final Occupancy Permit Required,t0 Occupy Pudding GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. I ' 0 1C,mmr/I AIA Document Al41"' - 2004 Standard Form of Agreement Between Owner and Design-Builder i AGREEMENT made as of the Second day of July in the year of Two Thousand Eight (In words, indicate day,month and year) BETWEEN the Owner: ADDITIONS AND DELETIONS: (Name, address and other information) The author of this document has added information needed for its j Merrimack Valley Health Services,Inc. completion.The author-may-also have revised the text of the original c/o Alliance Imaging,Inc. AIA standard form.An Additions and 600 Federal Street Deletions Report that notes added Andover,MA 01810 information as well as revisions to the standard form text is available from the author and should be and the Design-Builder: reviewed.A vertical line in the left (Name,address and other information) margin of this document indicates where the author has added Raymond R Houle Construction,Inc. necessary information and where 5 Miller Street the author has added to or deleted Ludlow,MA 01056 from the original AIA text. This document has important legal consequences.Consultation with an For the following Project: attorney is encouraged with respect (Name, location and detailed description) to its completion or modification. Verio 3T MRI Installation Consultation with an attorney is also 100 Andover By-Pass encouraged with respect to North Andover,MA professional licensing requirements MRI N.Andover in the jurisdiction where the Project is located. The Owner and Design-Builder agree as follows. AIA Document A141TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) I I i TABLE OF ARTICLES 1 THE DESIGN-BUILD DOCUMENTS 2 WORK OF THIS AGREEMENT i 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 4 CONTRACT SUM 5 PAYMENTS 6 DISPUTE RESOLUTION I 7 MISCELLANEOUS PROVISIONS 8 ENUMERATION OF THE DESIGN-BUILD DOCUMENTS TABLE OF EXHIBITS A TERMS AND CONDITIONS B DETERMINATION OF THE COST OF THE WORK C INSURANCE AND BONDS ARTICLE 1 THE DESIGN-BUILD DOCUMENTS §1.1 The Design-Build Documents form the Design-Build Contract.The Design-Build Documents consist of this Agreement between Owner and Design-Builder(hereinafter,the"Agreement")and its attached Exhibits; Supplementary and other Conditions;Addenda issued prior to execution of the Agreement;the Project Criteria, including changes to the Project Criteria proposed by the Design-Builder and accepted by the Owner,if any;the Design-Builder's Proposal and written modifications to the Proposal accepted by the Owner,if any;other documents listed in this Agreement;and Modifications issued after execution of this Agreement.The Design-Build Documents shall not be construed to create a contractual relationship of any kind(1)between the Architect and Owner,(2)between the Owner and a Contractor or Subcontractor,or(3)between any persons or entities other than the Owner and Design-Builder,including but not limited to any consultant retained by the Owner to prepare or review the Project Criteria.An enumeration of the Design-Build Documents,other than Modifications,appears in Article 8. §1.2 The Design-Build Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements,either written or oral. §1.3 The Design-Build Contract may be amended or modified only by a Modification.A Modification is(1)a written amendment to the Design-Build Contract signed by both parties,(2)a Change Order,(3)a Construction Change Directive or(4)a written order for a minor change in the Work issued by the Owner. ARTICLE 2 THE WORK OF THE DESIGN-BUILD CONTRACT §2.1 The Design-Builder shall fully execute the Work described in the Design-Build Documents,except to the extent specifically indicated in the Design-Build Documents to be the responsibility of others. ARTICLE 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION §3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a notice issued by the Owner. (Insert the date of commencement if it differs from the date of this Agreement or, if applicable, state that the date will be fixed in a notice to proceed.)Within 5 days of receipt of building permit from the city Init. AIA Document A141TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA`Document,or any portion of it, 2 f may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by ( AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 71512009,and is not for resale. User Notes: (2664611383) i V I If,prior to the commencement of Work,the Owner requires time to file mortgages,documents related to mechanic's liens and other security interests,the Owner's time requirement shall be as follows: (Insert Owner's time requirements.) §3.2 The Contract Time shall be measured from the date of commencement,subject to adjustments of this Contract Time as provided in the Design-Build Documents. (Insert provisions, if any,for liquidated damages relating to failure to complete on time or for bonus payments for early completion of the Work.) §3.3 The Design-Builder shall achieve Substantial Completion of the Work not later than 101 days from the date of commencement,or as follows: (Insert number of calendar days.Alternatively, a calendar date may be used when coordinated with the date of commencement. Unless stated elsewhere in the Design-Build Documents, insert any requirements for earlier Substantial Completion of certain portions of the Work.) Portion of Work Substantial Completion Date ARTICLE 4 CONTRACT SUM §4.1 The Owner shall pay the Design-Builder the Contract Sum in current funds for the Design-Builder's performance of the Design-Build Contract.The Contract Sum shall be one of the following: (Check the appropriate box.) [ X] Stipulated Sum in accordance with Section 4.2 below; [ ] Cost of the Work Plus Design-Builder's Fee in accordance with Section 4.3 below; [ ] Cost of the Work Plus Design-Builder's Fee with a Guaranteed Maximum Price in accordance with Section 4.4 below. (Based on the selection above, complete either Section 4.2,4.3 or 4.4 below.) §4.2 STIPULATED SUM §4.2.1 The Stipulated Sum shall be Four Hundred Fifty-six Thousand Two Hundred Twenty-seven Dollars and Zero Cents ( $456,227.00 ),subject to additions and deductions as provided in the Design-Build Documents. §4.2.2 The Stipulated Sum is based upon the following alternates,if any,which are described in the Design-Build Documents and are hereby accepted by the Owner: §4.2.3 Unit prices,if any,are as follows: Description Units Price($0.00) §4.2.4 Allowances,if any,are as follows: (Identify and state the amounts of any allowances,and state whether they include labor, materials, or both) AIA Document A141 TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 3 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/512009,and is not for resale. User Notes: (2664611383) Allowance Amount($0.00) Included Items I §4.2.5 Assumptions or qualifications,if any,on which the Stipulated Sum is based,are as follows: §4.3 COST OF THE WORK PLUS DESIGN-BUILDER'S FEE §4.3.1 The Cost of the Work is as defined in Exhibit B. E r §4.3.2 The Design-Builder's Fee is: (State a lump sum,percentage of Cost of the Work or other provision for determining the Design-Builder's Fee and the method of adjustment to the Fee for changes in the Work.) §4.4 COST OF THE WORK PLUS DESIGN-BUILDER'S FEE WITH A GUARANTEED MAXIMUM PRICE §4.4.1 The Cost of the Work is as defined in Exhibit B,plus the Design-Builder's Fee. §4.4.2 The Design-Builder's Fee is: (State a lump sum,percentage of Cost of the Work or other provision for determining the Design-Builder's Fee and the method of adjustment to the Fee for changes in the Work.) §4.4.3 GUARANTEED MAXIMUM PRICE §4.4.3.1 The sum of the Cost of the Work and the Design-Builder's Fee is guaranteed by the Design-Builder not to exceed ( $ ),subject to additions and deductions by changes in the Work as provided in the Design-Build Documents. Such maximum sum is referred to in the Design-Build Documents as the Guaranteed Maximum Price. Costs which would cause the Guaranteed Maximum Price to be exceeded shall be paid by the Design-Builder without reimbursement by the Owner. (Insert specific provisions if the Design-Builder is to participate in any savings.) §4.4.3.2 The Guaranteed Maximum Price is based on the following alternates,if any,which are described in the Design-Build Documents and are hereby accepted by the Owner: §4.4.3.3 Unit Prices,if any,are as follows: Description Units Price($0.00) §4.4.3.4 Allowances,if any,are as follows: (Identify and state the amounts of any allowances, and state whether they include labor,materials, or both,) Allowance Amount($0.00) Included Items §4.4,3.5 Assumptions,if any,on which the Guaranteed Maximum Price is based,are as follows: (Identify the assumptions on which the Guaranteed Maximum Price is based.) AIA Document At 41 Im—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 4 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/512009,and is not for resale. User Notes: (2664611383) i i I §4,5 CHANGES IN THE WORK §4.5.1 Adjustments of the Contract Sum on account of changes in the Work may be determined by any of the methods listed in Article A.7 of Exhibit A,Terms and Conditions. §4.5.2 Where the Contract Sum is the Cost of the Work,with or without a Guaranteed Maximum Price,and no specific provision is made in Sections 4.3.2 or 4.4.2 for adjustment of the Design-Builder's Fee in the case of Changes in the Work,or if the extent of such changes is such,in the aggregate,that application of the adjustment will cause substantial inequity to the Owner or Design-Builder,the Design-Builder's Fee shall be equitably adjusted on the basis of the Fee established for the original Work,and the Contract Sum shall be adjusted accordingly. ARTICLE 5 PAYMENTS §5.1 PROGRESS PAYMENTS §5.1.1 Based upon Applications for Payment submitted to the Owner by the Design-Builder,the Owner shall make progress payments on account of the Contract Sum to the Design-Builder as provided below and elsewhere in the Design-Build Documents. §5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month,or as follows: I §5.1.3 Provided that an Application for Payment is received not later than the Thirtieth day of month,the Owner shall make payment to the Design-Builder not later than the Fifteenth day of the following month.If an Application for Payment is received by the Owner after the application date fixed above,payment shall be made by the Owner not later than Fifteen( 15 )days after the Owner receives the Application for Payment. §5.1.4 With each Application for Payment where the Contract Sum is based upon the Cost of the Work,or the Cost of the Work with a Guaranteed Maximum Price,the Design-Builder shall submit payrolls,petty cash accounts, receipted invoices or invoices with check vouchers attached,and any other evidence required by the Owner to demonstrate that cash disbursements already made by the Design-Builder on account of the Cost of the Work equal or exceed(1)progress payments already received by the Design-Builder,less(2)that portion of those payments attributable to the Design-Builder's Fee;plus(3)payrolls for the period covered by the present Application for Payment. §5.1.5 With each Application for Payment where the Contract Sum is based upon a Stipulated Sum or Cost of the Work with a Guaranteed Maximum Price,the Design-Builder shall submit the most recent schedule of values in accordance with the Design-Build Documents.The schedule of values shall allocate the entire Contract Sum among the various portions of the Work.Compensation for design services shall be shown separately.Where the Contract Sum is based on the Cost of the Work with a Guaranteed Maximum Price,the Design-Builder's Fee shall be shown separately.The schedule of values shall be prepared in such form and supported by such data to substantiate its accuracy as the Owner may require.This schedule of values,unless objected to by the Owner,shall be used as a basis for reviewing the Design-Builder's Applications for Payment. §5.1.6 In taking action on the Design-Builder's Applications for Payment,the Owner shall be entitled to rely on the accuracy and completeness of the information furnished by the Design-Builder and shall not be deemed to have made a detailed examination,audit or arithmetic verification of the documentation submitted in accordance with Sections 5.1.4 or 5.1.5,or other supporting data;to have made exhaustive or continuous on-site inspections;or to have made examinations to ascertain how or for what purposes the Design-Builder has used amounts previously paid on account of the Agreement.Such examinations,audits and verifications,if required by the Owner,will be performed by the Owner's accountants acting in the sole interest of the Owner. §5.1.7 Except with the Owner's prior approval,the Design-Builder shall not make advance payments to suppliers for materials or equipment which have not been delivered and stored at the site. AIA Document At 41TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA'Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 5 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) i I §5.2 PROGRESS PAYMENTS-STIPULATED SUM §5.2,1 Applications for Payment where the Contract Sum is based upon a Stipulated Sum shall indicate the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. §5.2.2 Subject to other provisions of the Design-Build Documents,the amount of each progress payment shall be computed as follows: .1 Take that portion of the Contract Sum properly allocable to completed Work as determined by multiplying the percentage completion of each portion of the Work by the share of the Contract Sum allocated to that portion of the Work in the schedule of values,less retainage of Five percent ( 5.00% )on the Work,other than services provided by design professionals and other consultants retained directly by the Design-Builder.Pending final determination of cost to the Owner of Changes in the Work,amounts not in dispute shall be included as provided in Section A.7.3.8 of Exhibit A, Terms and Conditions; .2 Add that portion of the Contract Sum properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the completed construction(or,if approved in advance by the Owner,suitably stored off the site at a location agreed upon in writing),less retainage of Five percent ( 5.00% ); .3 Subtract the aggregate of previous payments made by the Owner;and .4 Subtract amounts,if any,for which the Owner has withheld payment from or nullified an Application for Payment as provided in Section A.9.5 of Exhibit A,Terms and Conditions. §5.2.3 The progress payment amount determined in accordance with Section 5.2.2 shall be further modified under the following circumstances: .1 add,upon Substantial Completion of the Work,a sum sufficient to increase the total payments to the full amount of the Contract Sum,less such amounts as the Owner shall determine for incomplete Work,retainage applicable to such work and unsettled claims;and (Section A.9.8.6 of Exhibit A, Terms and Conditions requires release of applicable retainage upon Substantial Completion of Work with consent of surety, if any.) .2 add,if final completion of the Work is thereafter materially delayed through no fault of the Design- Builder,any additional amounts payable in accordance with Section A.9.10.3 of Exhibit A,Terms and Conditions. §5.2.4 Reduction or limitation of retainage,if any,under Section 5.2.2 shall be as follows: (If it is intended,prior to Substantial Completion of the entire Work,to reduce or limit the retainage resulting from the percentages inserted in Sections 5.2.2.1 and 5.2.2.2 above,and this is not explained elsewhere in the Design- Build Documents, insert here provisions for such reduction or limitation.) i §5.3 PROGRESS PAYMENTS-COST OF THE WORK PLUS A FEE §5.3.1 Where the Contract Sum is based upon the Cost of the Work plus a fee without a Guaranteed Maximum Price,Applications for Payment shall show the Cost of the Work actually incurred by the Design-Builder through the end of the period covered by the Application for Payment and for which Design-Builder has made or intends to make actual payment prior to the next Application for Payment. §5.3.2 Subject to other provisions of the Design-Build Documents,the amount of each progress payment shall be computed as follows: .1 Take the Cost of the Work as described in Exhibit B; .2 Add the Design-Builder's Fee,less retainage of ( % ).The Design-Builder's Fee shall be computed upon the Cost of the Work described in the preceding Section 5.3.2.1 at the rate stated in Section 4.3.2;or if the Design-Builder's Fee is stated as a fixed sum in that section,an amount which bears the same ratio to that fixed-sum Fee as the Cost of the Work in the preceding section bears to a reasonable estimate of the probable Cost of the Work upon its completion; .3 Subtract the aggregate of previous payments made by the Owner; AIA Document A141 TM—2004,Copyright 02004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 6 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) .4 Subtract the shortfall,if any,indicated by the Design-Builder in the documentation required by i Section 5.1.4 or resulting from errors subsequently discovered by the Owner's accountants in such documentation;and .5 Subtract amounts,if any,for which the Owner has withheld or withdrawn a Certificate for Payment as provided in the Section A.9.5 of Exhibit A,Terms and Conditions. §5.3.3 Retainage in addition to the retainage stated at Section 5.3.2.2,if any,shall be as follows: §5.3.4 Except with the Owner's prior approval,payments for the Work,other than for services provided by design professionals and other consultants retained directly by the Design-Builder,shall be subject to retainage of not less than ( % ).The Owner and Design-Builder shall agree on a mutually acceptable procedure for review and approval of payments and retention for Contractors. i §5,4 PROGRESS PAYMENTS-COST OF THE WORK PLUS A FEE WITH A GUARANTEED MAXIMUM PRICE j §5.4.1 Applications for Payment where the Contract Sum is based upon the Cost of the Work Plus a Fee with a Guaranteed Maximum Price shall show the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment.The percentage of completion shall be the lesser of(1)the percentage of that portion of the Work which has actually been completed;or(2)the percentage obtained by dividing(a)the expense that has actually been incurred by the Design-Builder on account of that portion of the Work for which the Design-Builder has made or intends to make actual payment prior to the next Application for Payment by(b)the share of the Guaranteed Maximum Price allocated to that portion of the Work in the schedule of values. � c §5.4.2 Subject to other provisions of the Design-Build Documents,the amount of each progress payment shall be computed as follows: .1 Take that portion of the Guaranteed Maximum Price properly allocable to completed Work as determined by multiplying the percentage of completion of each portion of the Work by the share of the Guaranteed Maximum Price allocated to that portion of the Work in the schedule of values. Pending final determination of cost to the Owner of changes in the Work,amounts not in dispute shall be included as provided in Section A.7.3.8 of Exhibit A,Terms and Conditions; .2 Add that portion of the Guaranteed Maximum Price properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the Work,or if approved in advance by the Owner,suitably stored off the site at a location agreed upon in writing; .3 Add the Design-Builder's Fee,less retainage of ( % ).The Design-Builder's Fee shall be computed upon the Cost of the Work described in the two preceding sections at the rate stated in Section 4.4.2 or,if the Design-Builder's Fee is stated as a fixed sum in that section,shall be an amount that bears the same ratio to that fixed-sum fee as the Cost of the Work in the two preceding sections bears to a reasonable estimate of the probable Cost of the Work upon its completion; .4 Subtract the aggregate of previous payments made by the Owner; .5 Subtract the shortfall,if any,indicated by the Design-Builder in the documentation required by Section 5.1.4 to substantiate prior Applications for Payment,or resulting from errors subsequently discovered by the Owner's accountants in such documentation;and .6 Subtract amounts,if any,for which the Owner has withheld or nullified a Certificate for Payment as provided in Section A.9.5 of Exhibit A,Terms and Conditions. §5.4.3 Except with the Owner's prior approval,payments for the Work,other than for services provided by design professionals and other consultants retained directly by the Design-Builder,shall be subject to retainage of not less than ( % ).The Owner and Design-Builder shall agree on a mutually acceptable procedure for review and approval of payments and retention for Contractors. §5.5 FINAL PAYMENT §5.5.1 Final payment,constituting the entire unpaid balance of the Contract Sum,shall be made by the Owner to the Design-Builder no later than 30 days after the Design-Builder has fully performed the Design-Build Contract, including the requirements in Section A.9.10 of Exhibit A,Terms and Conditions,except for the Design-Builder's I AIA Document A141 Tm—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) responsibility to correct non-conforming Work discovered after final payment or to satisfy other requirements,if any, which extend beyond final payment. ARTICLE 6 DISPUTE RESOLUTION §6.1 The parties appoint the following individual to serve as a Neutral pursuant to Section A.4.2 of Exhibit A, Terms and Conditions: (Insert the name, address and other information of the individual to serve as a Neutral.If the parties do not select a Neutral, then the provisions of Section A.4.2.2 of Exhibit A, Terms and Conditions,shall apply.) §6.2 If the parties do not resolve their dispute through mediation pursuant to Section A.4.3 of Exhibit A,Terms and Conditions,the method of binding dispute resolution shall be the following: If the parties do not select a method of binding dispute resolution, then the method of binding dispute resolution shall be by litigation in a court of competent jurisdiction.) (Check one.) [ X] Arbitration pursuant to Section AAA of Exhibit A,Terms and Conditions [ ] Litigation in a court of competent jurisdiction [ ] Other(Specify) §6.3 ARBITRATION §6.3.1 If Arbitration is selected by the parties as the method of binding dispute resolution,then any claim,dispute or other matter in question arising out of or related to this Agreement shall be subject to arbitration as provided in Section A.4.4 of Exhibit A,Terms and Conditions. ARTICLE 7 MISCELLANEOUS PROVISIONS §7.1 The Architect,other design professionals and consultants engaged by the Design-Builder shall be persons or entities duly licensed to practice their professions in the jurisdiction where the Project is located and are listed as follows: (Insert name, address, license number, relationship to Design-Builder and other information.) Name and Address License Number Relationship to Other Information Design-Builder Steve Drakulich 27 James St Greenfield, MA §7.2 Consultants,if any,engaged directly by the Owner,their professions and responsibilities are listed below: (Insert name, address, license number, if applicable, and responsibilities to Owner and other information.) Name and Address License Number Responsibilities Other Information to Owner §7.3 Separate contractors,if any,engaged directly by the Owner,their trades and responsibilities are listed below: (Insert name, address, license number, if applicable, responsibilities to Owner and other information.) Name and Address License Number Responsibilities Other Information to Owner i i §7.4 The Owner's Designated Representative is: i (Insert name, address and other information.) AIA Document A141 TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init• protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 8 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) John Harty c/o Alliance Imaging,Inc. 600 Federal Street Andover,MA 01810 Telephone Number:603-512-9039 Fax Number:603-668-3923 I I §7.4.1 The Owner's Designated Representative identified above shall be authorized to act on the Owner's behalf with respect to the Project. §7.5 The Design-Builder's Designated Representative is: (Insert name,address and other information.) Timothy S.Pelletier 5 Miller Street Ludlow,MA 01056 §7.5.1 The Design-Builder's Designated Representative identified above shall be authorized to act on the Design- Builder's behalf with respect to the Project. 7.6 Neither the Owner's nor the Design-Builder's Designated Representative shall be changed without ten days § � g P g Y written notice to the other party. §7.7 Other provisions: II §7.7.1 Where reference is made in this Agreement to a provision of another Design-Build Document,the reference refers to that provision as amended or supplemented by other provisions of the Design-Build Documents. §7.7.2 Payments due and unpaid under the Design-Build Contract shall bear interest from the date payment is due at the rate stated below,or in the absence thereof,at the legal rate prevailing from time to time at the place where the Project is located. (Insert rate of interest agreed upon, if any.) ( )per annum (Usury laws and requirements under the Federal Truth in Lending Act, similar state and local consumer credit laws and other regulations at the Owner's and Design-Builder's principal places of business, the location of the Project and elsewhere may affect the validity of this provision. Legal advice should be obtained with respect to deletions or modifications, and also regarding requirements such as written disclosures or waivers.) ARTICLE 8 ENUMERATION OF THE DESIGN-BUILD DOCUMENTS §8.1 The Design-Build Documents,except for Modifications issued after execution of this Agreement,are enumerated as follows: §8.1.1 The Agreement is this executed edition of the Standard Form of Agreement Between Owner and Design- Builder,AIA Document A141-2004. §8.1.2 The Supplementary and other Conditions of the Agreement,if any,are as follows: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Title of the Supplementary and Other Conditions exhibit: (Table deleted) AIA Document A141 TM—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 9 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by / AIA software at 09:37:50 on 07/02/2008 under Order No.1000362338_1 which expires on 7/5/2009,and is not for resale. User Notes: (2664611383) , f §8.1.3 The Project Criteria,including changes to the Project Criteria proposed by the Design-Builder,if any,and accepted by the Owner,consist of the following: (Either list applicable documents and their dates below or refer to an exhibit attached to this Agreement.) Title of the Project Criteria exhibit: (Table deleted) §8.1,4 The Design-Builder's Proposal,dated June 09,2008 ,consists of the following: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Title of the Design-Builder's Proposal:Exhibit"D"Bid Documents §8.1.5 Amendments to the Design-Builder's Proposal,if any,are as follows: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Title of the Amendments to Design-Builder's Proposal exhibit: §8.1.6 The Addenda,if any,are as follows: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Title of the Addenda exhibit: (Table deleted) §8.1.7 Exhibit A,Terms and Conditions. (If the parties agree to substitute team and conditions other than those contained in AIA Document A141-2004, Exhibit A, Terms and Conditions, then identify such terms and conditions and attach to this Agreement as Exhibit A.) §8.1.8 Exhibit B,Determination of the Cost of the Work,if applicable. (If the parties agree to substitute a method to determine the cost of the Work other than that contained in AIA Document A141-2004,Exhibit A Determination of the Cost of the Work, then identify such other method to determine the cost of the Work and attach to this Agreement as Exhibit B. If the Contract Sum is a Stipulated Sum, then Exhibit B is not applicable.) §8.1.9 Exhibit C,Insurance and Bonds,if applicable. (Complete AIA Document A141-2004, Exhibit C,Insurance and Bonds or indicate "not applicable.") Not Applicable §8.1.10 Other documents,if any,forming part of the Design-Build Documents are as follows: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Title of the Other Documents exhibit:Exhibit"D"enumeration of contract documents This Agreement entered into as of the day and year first written above. IdItIt, ER(Signature) ESIGN•BUILDER(Signature) John Harty,Construction Project Manager Timothy S.Pelletier,President (Printed name and title) (Printed name and title) i AIA Document A141 T11—2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is Init. protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it, 10 may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 09:37:50 on 07/D2/2008 under Order No.1000362338_1 which expires on 715/2009,and is not for resale. User Notes: (2664611383) I OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: L 100 PROJECT LOCATION: i NAME OF BUILDING: NATURE OF PROJECT: IN ACCOIJDAAICE VM ART LE 1 QF THE MASSACHUSETTS STATE BUILD NG CODE, 1,- 1 REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 4 ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL Q FIRE PROTECTION 0 _ ELECTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE.ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. ROVIeW,for conformance to the design concept,shop drawings,samples and other submittals whkcr are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quaitty control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of com&uctbn to become,generally familiar with6ths progress and qualRy of the work and to determine,in general, if the work Is being performed In a manner consistent with the contraction documents. PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK,I SHALL SUBMIT A FINAL.REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUP SUBSCRIBED AND SWORN TO BEFORE ME THIS 10DAY OF� V Afl� '�)-o o g' NOTARY PUBLIC —Ir'j«�bQ,-� . (S:Z MY COMMISSION EXPIRES, i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insuramce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMC(Business(Organizationfludividual): Address: City/State/Zip: L v LowPhone. : Are.you an employer?Check the appropriate box: Type of project(requiredj•:j . 1.W I am a employer with 4. [] I am a general contractor and I j employees(full andlarpsd-time). 4. have hired the sub-contractors 6. C]New' construction 2.0 I am a sole proprietor or partner- listed on the-attached sheet. � 7. Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and.have workers' g Bildin addition [No workers'comp.insurance comp.insurance. ttg required.] - 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑plumbing repairs or additions myself.(No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also 811 out the section below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating they aro doing all work and then hire outside contractors must submit a new affidavit indicating such. kontractors that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entitles have employees. if the sub-contractors have employees,they must provide their workers'comp_policy numbs•. I ant an employer that isproviding workers'compensation Insurancefor or my employees Below is thepolicy acrd job site information. Insurance Company Name: Policy#or Self-ins.Lie.#:' q'/ZOd Expiration Date: Job Site Address:_/OD Al 1?we-l' PYP4 City/State/Zip:_ o /r oUer/' IVA 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 eoverasre verification. _ I do Hereby cere under t e pains qj ertakies of perjury that the Information protrided above Is true and correct i Sign— ature: Date- Phone#: Ojficlal use only. Do not turtle In thus area,to be cornpkied by city or town offletaL 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#: Client#:31142 RAYHO ACOR®r. CERTIFICATE OF LIABILITY INSURANCE 06111/pgwvvvv> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION James J. Dowd&Sons Ins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14 Bobala Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 10300 Holyoke, MA 01041 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Peerless Insurance Raymond R Houle Construction,Inc. INSURER 8. A.I.M.Mutual Insurance Company 5 Miller Street INSURER C: Ludlow,MA 01056 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 REOUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BF ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-AGGREGATE LIMITS SHOWN MAY HAVE BEEN RFDUCFD BY PAID CLAIMS INbH LTR NSRAUD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE MM/DDNY DATE MM/DD/YY A GENERAL LIABILITY CBP8119703 12/31/07 12/31/08 EACH OCCURRENCE $1,000j000 X COMMERCIAL GENERAL LIABILITY PR MI6ESOEe ocaE enGe $100,000 CLAIMS MADE F—I OCCUR MED EXP(Any one persgn) $5,000 PERSONAL&ADV INJURY $1,()00,000 GENERAL AGGREGATE': s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP,OPAGG $2,000,000 POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY BA8111704 12/31/07 12/31/08 COMBINED SINGLE LIMIT ANY AUTO (Eaaccldenl) $1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Perperson) $ X HIRED AUTOS BODILY INJURY X NON-OWNEDAUTOS (Per acddent) $ PROPERTY DAMAGE (Per accident) GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY CU8116204 12/31/07 12/31/08 EACH OCCURRENCE $3,000,000 -XI OCCUR FI CLAI MS MADE AGGREGATE $ DEDUCTIBLF $ X RETENTION $10000 $ STATUB WORKERS COMPENSATION AND WMZ8005579012007 12/31/07 12/31/08 TORY LIMIT FR OTR EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECLfTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE1$500,000 11 yes,dezwL..Under SPECIAL PROVISIONS below F L DISEASE-POLICY LIMIT $500,000 OTHER I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES,EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATETHERECF,THEISSUING INSURER WILL ENDEAVORTO MAIL I_ DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i - vrLlr 'r ACORD 25(2001/08)1 of 2 #S62976/M60788 PXC © ACORD CORPORATION 1988 I it IIS I i Board of Building Regulat�of�s aandar' 6 Construction Supervisor License License: CS 66227 Birthdate: 7/711967 Tri 15434 FExpFratio�n- 7/712009 "Restriction: 00 TIMOTHY S PELLET ER 418 MOUNTAIN RD` Commissioner WILBRAHAM,MA 01095 I y � AI.I.MNCE YNIAGING Northeast Region 600 Federal Street Andover,Massachusetts 0 18 10 TEt.V8.552.2600 Fax 978.552.2650 rF1.800.229.7226 rAx 877:402.2262 www.allianceimaging,com July 2,2008 Mr.Gerald Brown Inspector of Buildings Town Of North Andover 1600 Osgood Street North Andover,MA 01845 RE 100 Andover By-Pass suite 101 North Andover,MA Dear Mr.Brown, This letter is to certify that for the purposes of the building permit costs;the,; Siemens Medical Systems Verio 3t Magnetic Resonance Imaging System, we will be installing as part of the interior renovations construction to be completed at 100 Andover By-Pass,Suite 101,North Andover Massachusetts is valued at approximately$750,000.00(Seven Hundred and Fifty Thousand Dollars).I have instructed the General Contractor to include this value in his calculations for the building permit fees. If you should have any other questions or concerns please do not hesitate to contact me at 603-512- 9039. Sincerely John Harty Construction Project Manager Alliance Imaging,Inc Northeast Region I Cc Tim Pelletier-Ray Houle Construction Rich Jones-Alliance imaging File MASSACHUSETTS SUBSIDIARIES AND AFFILIA7M I i r r' I NORTH ANDOVER BUILDING DEPARTMENT Tet: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building permit at: f ao v is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Ajso, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will-be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date j i