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Building Permit #083-12 - 100 ANDOVER BY-PASS 7/31/2012
pORT►y BUILDING PERMIT oFt�ED ,bgti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h (y / �Oq< :i w Permit NO: Date Received DAATED �d X13 ��SSACHV`��� Date Issued: 31 X- MPORTANT:Applicant must complete all items on this page LOCATION /0 O 4hdQyevL is u P4-ss j Print PROPERTY OWNER t'hes i'+I' Print MAP NO �'S PARCEL: 79 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Add�Lon Two or more family ustrial ration No. of units: Commercial Repair, replacement Assessory Bldg Ot ers: Demolition Other Septic Well Floodplain Wetlands_ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: onn steLx—t- "Jek-) olpcep s94-c'eqt Fpw-nme2 ,tee ►r4-1 OFF►c l . Identification Please Type or Print Clearly) OWNER: Name: 441114-cc 4 Phone: Address: &00 Fe-be2A1 Sf Ariciovoe-L vK,- CONTRACTOR Name:�y _�} �,Je �a� Phone: 4113 - 5/7- A!5-,(2D Address: 5- rn1)lcrt— sr- 4ucdloc,J Supervisor's Construction License: CS -0 0 T 62- Exp. Date: Home Improvement License: Exp. Date: i.. V ARCHITECT/ENGINEER 4CA r4 0-e-4o4ed-S- Phone:_ (g 1? 7 fig- (o3GLJ V e Address: Ol L�,/1►n�, " 1Z04a ©v►^ev ✓V1 +`I'- Reg. No. ° FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7 , !J'tlt� FEE: $ Ja76 Check No.: a°� 005 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location ADD / ,L/dc No. 3-/.Z Date z F i TOWN OF NORTH ANDOVER {{r Certificate of Occupancy $ EBuilding/Frame Permit Fee $ X76 Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ I Check l 25565 p�p ing Inspector J I II t Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools i 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 CONSERVATION Reviewed on Signature COMMENTS k HEALTH Reviewed on Signature I COMMENTS i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes f Planning Board Decision: Comments • Conservation Decision: Comments . c 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 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup - Date i Doc.Building Permit Revised 2008 i Building Department The followingis a list of the required forms to be filled out for theappropriate ermit to be obtained. Qp d 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 l ❑ Building Permit Application o 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) f ❑ 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 4 New ConstructionSin le and Two Family) � g Y) i ❑ Building App Permit A lication a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit I ❑ 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 1 NORTH Town of : �, ¢ Andover No. Q -_ h ver, Mass ococ�,C .C. 1, �d A�R�ITED A4p�,`4y 7S BOARD OF HEALTH Food/Kitchen PERM 'I'T T LD Septic System j,,; - �� x�)� � �� .,, " — BUILDING INSPECTOR THISCERTIFIES THAT ........:.......... .:......f:..:::..... .5.:..... :....................................................................... has permission to erect ........................... buildings on °'� '' ! �d � ;;Q �;, r ���' ......................... ation to be occupied as ..... ....°; :.:'`E °= .... .... ` ` .>' ' ': �..`: ... :✓ "..:a:.....: ::' provided that the person accepting this permit shall in every respect conform to the terms of the application ;7ney 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ............ .......c:..:....,ac �:;d'a:.... ................................... ' �e y' Final��� BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. a SEE REVERSE SIDE Smoke Det. +Y i kchitects i I ARCHITECT'S FINAL AFFIDAVIT Project Name: Renovations of Existing Pet Suite to Office Space 100 Andover By-Pass N.Andover, MA 01845 I JACA Project No. 12058 This is to certify that during the construction'period a representative from this office has provided periodic site visits. Based on our inspections, and to the best of our knowledge,the construction has been completed in accordance to the plans, specifications and applicable provisions of the Massachusetts Building Code. Rough framing was inspected on August 17, 2012 and a final inspection was performed on September 14, 2012. ' f ' k Architects: JACA Architects Inc. f By: Anthony F. vallaro, AIA Date: September 14, 2012 \��ERED A811 F.Cq�q eco Seal: o Q No.6972 p QUINCY, �p DAA �J`' 9 billings road ���iIOFMPSSPG north quincy,ma 02171 t.617.769.6300 f.617.769.6399 13 jacaarchitects.com NORTH own of 6 ndover No. y h ver, Mass, 7 3/ Ln, 4 coc.acNew¢« �,95 RA TE UP E RMIT T D U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .... Z�fk BUILDING INSPECTOR has permission to erect ............ buildings on .z1_?0A1NdA:,�:'..%�. .-.�!;:F ..... Foundation to be occupied ..... �F .car.r�. F .':`.9LGG ... .... . Rough as .... .........................' Chimney provided that the person accepting this permit shall in every respect 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........... ..... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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 i Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. t f II Massachusetts-Department of Public Safety Board of Buildin g Regulations and Standards Construction Super,kor License: CS-068625 HN J HARTY 400 LOWELL ST' n ' MANCHESTER NH 0 104r f � I a ✓ �.//S(�4-- 11'141 AA Commissioner Expi ration 05112/2014 f t I i l: i r I I iI to ��� Document A141TM - 2004 Standard Form of Agreement Between Owner and Design-Builder AGREEMENT made as of the 31 day of July in the year 2012 (In words, indicate day, month and year.) ADDITIONS AND DELETIONS: BETWEEN the Owner: The author of this document has(Name, legal status, address and other information) added information needed for its completion.The author may also Alliance Imaging have revised the text of the original AIA standard form.An Additions and 600 Federal Street Deletions Report that notes added Andover,MA 01845 information as well as revisions to the standard form text is available from the author and should be reviewed.A and the Design-Builder: vertical line in the left margin of this (Name, legal status, address and other information) document indicates where the author has added necessary information Raymond R Houle Construction,Inc. and where the author has added to or 5 Miller Street deleted from the original AIA text. Ludlow,MA 01056 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. Consultation with an attorney is also Andover PET CT Restoration encouraged with respect to 100 Andover By-Pass professional licensing requirements North Andover,MA in the jurisdiction where the Project is located. The Owner and Design-Builder agree as follows. IM I w I III AIA Document A141——2004.Copyright@ 2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA!Document is protected by Init. U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of lt,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 / 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is notfor resale. User Notes: (1382826572) I I TABLE OF ARTICLES 1 THE DESIGN-BUILD DOCUMENTS 2 WORK OF THIS AGREEMENT 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 4 CONTRACT SUM 5 PAYMENTS 6 DISPUTE RESOLUTION 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.) Init. AIA Document A141 T —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,may result in 2 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) August 10,2012 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 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) October 1,2012 I 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 an 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 Seventy Three thousand ($73,000.00 ),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--2004.Copyright@ 2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by Init. U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA°Document,or any portion of it,may result In 3 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) Allowance Amount($0.00) Included Items § 4.2.5 Assumptions or qualifications,if any,on which the Stipulated Sum is based,are as follows: § 4.3 COST OF THE WORK PLUS DESIGN-BUILDER'S FEE § 4.3.1 The Cost of the Work is as defined in Exhibit B. § 4.3.2 The Design-Builder's Fee is: (State a lump sum,percentage of Cast of the Work or other provision for determining the Design-Builder's Fee and the method of adjustment to the Fee for changes in the Work.) § 4.4 COST OF THE WORK PLUS DESIGN-BUILDER'S FEE WITH A GUARANTEED MAXIMUM PRICE § 4.4.1 The Cost of the Work is as defined in Exhibit B,plus the Design-Builder's Fee. § 4.4.2 The Design-Builder's Fee is: (State a lump sum,percentage of Cost of the Work or other provision for determining the Design-Builder's Fee and the method of adjustment to the Fee for changes in the Work.) 4.4.3 GUARANTEED MAXIMUM PRICE § 4.4.3.1 The sum of the Cost of the Work and the Design-Builder's Fee is guaranteed by the Design-Builder not to exceed ($ ),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. .2 The Guaranteed Maximum Price is based on the following alternates if an which are described in the § 3 g Y, 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 i § 4.4.3.5 Assumptions,if any, on which the Guaranteed Maximum Price is based,are as follows: (Idents the assumptions on which the Guaranteed Maximum Price is based) AIA Document A141--2004.Copyright 02004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by Init. U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in 4 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) E § 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: § 5.1.3 Provided that an Application for Payment is received not later than the day of month,the Owner shall make payment to the Design-Builder not later than the day of the 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 ( )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 f 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. § 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. Init. AIA Document A141 TTM—2004.Copyright 02004 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,may result in 5 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 / 11:13:45 on 0713112012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) § 5.2.2 Subject to other provisions of the Design-Build Documents,the amount of each progress payment shall be j 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 percent( %)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 percent .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 arty.) .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.) § 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 percent( %).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; .4 Subtract the shortfall,if any,indicated by the Design-Builder in the documentation required by 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: AIA Document A141 TM—2004.Copyright 02004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document Is protected by Init. 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 6 / 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) i i § 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 j than percent( %).The Owner and Design-Builder shall agree on a mutually acceptable procedure for review and approval of payments and retention for Contractors. § 5.4 PROGRESS PAYMENTS • COST OF THE WORK PLUS A FEE WITH A GUARANTEED MAXIMUM PRICE § 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. § 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 percent( %).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 percent( %).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 j 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 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 i Neutral, then the provisions of Section A.4.2.2 of Exhibit A, Terms and Conditions,shall apply.) I AIA Document A141 TM—2004.Copyright O 2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by Init. 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 / 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) i § 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 A.4.4 of Exhibit A,Terms and Conditions [ ] Litigation in a court of competent jurisdiction [ ] Other(Spec) § 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 AAA 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 § 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 j § 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 § 7.4 The Owner's Designated Representative is: (Insert name,address and other information.) Ed Cutting Alliance Imaging 600 Federal Street Andover,MA AIA Document A141--2004.Copyright©2004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by Init. U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA!Document,or any portion of it,may result in 8 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) § 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.) Jack Harty Raymond R Houle Construction,Inc. 5 Miller Street f 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 written notice to the other party. § 7.7 Other provisions: § 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.) percent( %) I (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 A 141-2004. § 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.) Document Title Pages § 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.) Init. AIA Document Al 41 TM—2004.Copyright 02004 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,may result in 9 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which expires on 08/21/2012,and is not for resale. User Notes: (1382826572) � I Title Date § 8.1.4 The Design-Builder's Proposal,dated ,consists of the following: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) § 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.) I § 8.1.6 The Addenda,if any,are as follows: (Either list applicable documents below or refer to an exhibit attached to this Agreement.) Number Date Pages § 8.1.7 Exhibit A,Terms and Conditions. (If the parties agree to substitute terms 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 A 141-2004,Exhibit B,Determination of the Cost of the Work,then idents 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.) I § 8.1.9 Exhibit C,Insurance and Bonds,if applicable. (Complete AIA Document A141-2004, Exhibit C,Insurance and Bonds or indicate "not applicable.') I § 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.) This Agreement entered into as of the day and year first written above. OWNER(Signature) IGN-BUILDER(Signature) Timothy S. Pelletier,President (Printed name and title) (Printed name and title) I AIA Document A141^ -2004.Copyright 02004 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by Init. U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in 10 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 t 11:13:45 on 07/31/2012 under Order No.1295779452_1 which epires on 08/21/2012,and is not for resale. User Notes: (1382826572) i Al architects Transmittal To: Mr. Jack Harty Fax No. Renovations of Existing Pet Suite to Company; c/o Raymond R. Houle Construction Project: Office Space Address: 5 Miller Street Project No: 12058 Ludlow, MA 01056 From: Bill Epp Date: July 26, 2012 Re: Drawings Pages: CC: ❑Fax ❑ US Postal ❑Overnight ® Overnight ❑ Courier ❑ Hand Priority Ground Delivered Date Quantity Description 07/26/12 3 sets Sealed and signed drawings 07/26/12 1 Construction Control Affidavit i I i 9 billings road north quincy,ma 02171 t.617.769.6300 CONFIDENTIALITY NOTICE f.617.769.6399 The documents accompanying this telecopy transmission contain confidential information belonging to the sender which is legally privileged. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient,you are hereby notified that that any disclosure,copying,distribution or the taking of any action in reliance on the contents of this telecopied information is strictly prohibited. 13 jacaarchitects.com If you have received this telecopy in error,please notify,us immediately at(617)769-6300 to arrange for the return of the original documents to us. i i CONSTRUCTION CONTROL AFFIDAVIT Project: Renovations of Existing Pet Suite to Office Space Project No.: 12058 Project Owner: Alliance Imaging Project Location: 100 Andover By-Pass N.Andover, MA 01845 Type of Project: Renovations Architect: JACA Architects, Inc. 9 Billings Road, N. Quincy, MA 02171 Tel. 617 769-6300 i In accordance with Section 116.0 of the Massachusetts State Building Code, I, Anthony F. Cayallaro, Registration No.6972, being a registered professional architect, hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: ENTIRE PROJECT X ARCHITECTURAL MECHANICAL FIRE PROTECTION ELECTRICAL OTHER(specify) for the above named project and that,to the best of my knowledge,such plans,computation and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit and approval for the conformance to the design concept. 2. Review and approval of the quality control procedure for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standard listed in Appendix B. Pursuant to Section 116.2.2, 1 shall submit periodically,_daily,_weekly,or_other periods(specify) progress reports together with ments to the Building Inspector. Upon completion of the work, shall submit a final report as completion and readiness f e project for occupancy. fto�.son 01 t ANTHONY F.CAVALLARO MA SUBSCRIBED AND SWORN TO P 26th DAY OF July 2012. NO Y PUBLIC MY COMMISSION EXPIRES: F1A&INE K SULMAN DWAUM"AdM *cam*"> ►28,2612 --- -_ The Commonwealth of Massachusetts ' - ( Department of Industrial Accidents _- 9 011lca o!!�►estlOad®as i 600 Washington Street Boston,Mass 02111 Workers'Compensation Imurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Ml comoanv name- address: ame:address: ,� \\er. ^� city: phone;#• insurance co. M Cr) 00licy11:I ,1 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: j company name address- city- phonen• I r I I insurance co • _ policy#: company name: address- cit ! nh�ro� insurance co.: ;001i #, Failure to secure coverage as required Bader Sectiom 2SA of MGL 152 cam lad to the imposition of aimioal penalties of a Roe up to 51300 00 and/or one years'imprisonment as wdl as civil penalties in the form of a STOP WORK ORDER sad a riot e(Sloo.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for eovcrage veriGotion. I do hereby certify render the pains enaUi of perjury that the information provided above is true and correct Signatur Date t1�1Z�.t a Print name {`pt- t? �e� � phone# official use only do not write in this area to be completed by city or town oMdal j I city or town: permittlicensc9 :CO]Selectmen's ng Department j ing Board j C]check if immediate response is required Onceh Department contact person: phoneN; I I (mk%W 9e"PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied,oral or written. An employer is defined as an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this-chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if You are required to obtain a workers'compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Nia. 02111 fax 9: (617) 727-7749 phone 4: (617) 727-1900 ext. 406 a � 4 1r�TM I -'s CERTIFICATE OF USE & OCCUPANCY KL�4 TOWN OF NORTH ANDOVER Building Permit Number 412 (11-30-2007) Date: March 21. 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 100 Andover By-Pass (Mance Imaging) MAY BE OCCUPIED AS: tenant renovation for Pet CT Scanner System IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Mesiti Develoament 100 Andover By-P----ass North Andaver"MA 01845 Building Inspector I I i I • y ,IpRTN TOWN OF NORTH ANDOVER 0'�=9`,`•o re�ypL OFFICE OF 11 BUILDING DEPARTMENT f `:*# 1600 Osgood Street Building 20 Suite 2-36 C""5 North Andover,Massachusetts 01845 Telept3one(978)688-9545 Gerald A.grown Fax (978)688-9542 Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code,Article 1,Section 110.4 and It 4,2,the total estimated cost of the construction including all related construction costs*of the building located at /04 41 amounts to $� 2 ysC I, V U L A✓y'Y being the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition,plumbing, heating, electrical, air conditioning, painting, carpentry,landscaping,site improvement, etc. Furnishings and portable equipment are not part of the total Construction costs. Signature(;f-Owner COMMONWEALTH OF MASSACHUSETTS dr 5.5. 17 Then personally appeared the able named l our� y and Made an oath that the above statement is true. More, e, Notary Public TU Y q,/ ao16 OFFICIAL USE: c Final Cost: , . •.�L _........ Original Estimate cost of general work: --�---- - � Cost Difference, -� - •� �---�.�•.- _-- Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: - -� �-�� �- ��-- • _- Inspwaonal smites Depanment 20115 F:`.flnalMzEaHidavit{nm7 satc!Code efrPreement maker the town Tafer �ejof¢buying.renting,teasing check zaaing I 130ARA OF APPEALS 688.9341 CONSERVATION 688.95.3() Hf ALTk 688.354(1 PLANNING 689-9535 i i E NORTH 1 TOWN OF NORTH ANDOVER OFFICE OF F s 9 BUILDING DEPARTMENT via ; + 1600 Osgood Street 4 °'w»v.•"`.� Building 20 Suite 2-36 ""'SEt North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)688-95454 Inspector of Buildings Fax (978)685-9542 CONTROL CONSTRUCTION-SECTION 6 0 C 11 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTjIR., BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, Vu, G .HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT ID-0 AuQO)CrFa DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: i AUTHORIZED SIGNATURE: DATE: REGISTRATION: r 0-4 NOTE: ENGINEER"WET STAMP"MUST BE AFF XED TO THIS FO 066 0. .V 130ARD 0F:1PPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNIiNG 688-9535 ri0RTH ® of 0 .No. "N �` � . �_ LAKE o� �` dover, Mass., COCHICHEWICK oRATED BOARD OF HEALTH Food/Kitchen PER,,MIT Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......../......................... .........."T ...................................... c2u zdation has permission to erect............ .. buildings on lop... 5. -�,,, �,g 4 to be occupied as ........ 't '�...............'. � t -S� fes'/ ' ��'�`�;'"„ Ch' ne 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. OLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 2/O PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSP C TOR UNLESS CONSTRUCTION ARTS ou ..................... ....... ...... ............................... Service BUILDING INSPEC R Occupancy Permit Required to Occupy Building GAS INSPECTOR gh 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 1 Street No. ' SEE REVERSE SIDE Smoke Det. ��� i GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stonelfabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat,elec,etc. _ Walls at stair stringers. Windbrace comers and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. P. Girls-solid brick or steel plate bearing at foundations '/Y"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min.2200 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging,clean joints,8"solid @ combust. .DECKS: Lag to house, provide Flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc.pad at stair base. FINISH: Handrails returned to walllnewall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure NORT#q TONM of 0 VO A/iZ 0Y dover, Mass., COCMICMEwICN 1t 7,9 RATED PPa\,t-`� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System c / �� t` BUILDING INSPECTOR ® /�f �` THIS CERTIFIES THAT......�.." ................. ` ......... ......_77. ........ .. .............................. Four ation has permission to erect............ .... buildings on ......leo /' .i .�-�� z' ` ..�f.°� .Asialg ' .. ..p... ... �.................... t0 b8 OCCUpled as................. 1 ' /! t'? �`��"� C" ney . a.........................�"......................r�-. '`. �................... .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. LUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough in O� L/O PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSP R. UNLESS CONSTRUCTION ARTS ou �-� Service . ..................... ....... ...... ................................. BUILDING INSPEC R Occupancy Permit Required to Occupy Building 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. a SEE REVERSE SIDE Smoke Det. �� GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girls/plates between floor joist Penetrations for plumbing,heat, elec,etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations Y"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3'Headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min.20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging,clean joints,8"solid @ combust. .DECKS: La to house provide flashing. Lag , p as ng. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newali post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure Date..,.........`a....... NoRTH s 3?0; TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA US i This certifies that .......................................�- .�-�-�� .... ................ .. ............................. has permission to perform_ .::..'.:a: - wiring in the building of..... ................... r�.......... at ... t I North Andover Mass. > *� .. Lic.No/D14P. , ....................... ...t E EcrxicAL INSP Check # a 8314 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ?3/4 Occupancy and Fee CheckedA. BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S a(po8 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 100 Ahdoxr PVARSS Owner or Tenante Z It Telephone No. Owner's Address 9 00 Awdoer Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) j Purpose of Building M)e-r -7-MQ q t'v+Q ceo--1- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: U7y►YQ .SOo cPS_ �t 4�-�►�Q t Q�(� Mec,nd n i« Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection and No.of Switches No.of Gas Burners No.Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ap Totals: ......."'."""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Svstems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: A Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lect 'cal Work: (When required by municipal policy.) Work to Start: ?'1,;)1P10T Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: N,7 i2/C• FOt^ i/1 LIC.NO.: 10 q J3 i Licensee: ilrn i'el r- Fr-ii-i Signature 0, LIC.NO.:,']0 Jag3 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: i Io2 MC d-A:L A /j n�n�+f l�G t ' Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent p Signature Telephone No. PERMIT FEE: $ RX•O i M�M� Wb PYA s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -�o T-}l'yl - ro4Ljer_5 trJ ec_-6-1C G Le- Address: /la Mc..T;,�4o,5h ed. City/State/Zip: DanVdl24 ,(JH 03;W Phone #: 6703- 879-6571 i Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction e ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Zectrical ding addition [No workers' comp. insurance 5. El We are a corporation and its 10. repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] l3.❑ Other i *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: I )0 e' Date: Phone#: 603- 'S -6SW `i Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i R R o.. 76i S 9' ' November 21,2008 Verification Compliance Report Certification of Radio Frequency Shielding System For the 100 Andover Bypass MRI Room No Andover Ma NELCO has furnished and installed all the Radio Frequency(galvanized) shielding as outlined in the plans and specifications. NELCO certifies that all Mechanical and Electrical systems incorporated on and within the Radio Frequency Shielding were installed as outlined in the plans and specifications as required to maintain the integrity of the RF GUARDIANTM doors,patient-view windows/skylights, HVAC waveguide vents, pipe penetration waveguides, utilities shielding,EMI rated power line and signal electrical filters NELCO has conducted RF qualification and acceptance tests as well as a ground isolation test at the completion of installation i Respectively NELCO Inc. 1 Eric Ewing 800 West Cummings Park,Suite 3950 Woburn Massachusetts 01801(800)635-2613 Phone(781)932-8647 Fax WWW.NELCO-USA.COM 1-800-NELCO-13