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Building Permit #793-14 - 1060 OSGOOD STREET 5/1/2018
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: ^� Date Received f Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION - ".Pint _ PROPERTY OWNER - Print 100 Year Old Structure yes no 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 WAlteration No. of units: 19-Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Vbemolition ❑ Other a =ter/Sewer ptic El Well 11 Floodplain 11 Wetlands ❑ Watershed District DESCRIPTION OF WORK TO E PERFORMED: �i e ��l A Ir 4 ver dentifiCati Pie e Ty e or Print Lear y OWNER: Name: hone: -1 D Address: &Olz CONTRACTOR Name: JCC 'Ilia, t/7011,//- Phone: f7l�-%l.3—Y�/9/ Address: /,11 Supervisor's Construction License: loof —061 '.f Y Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER% C.�iG��rs e- e, A5 Uc . Phone: Address: 4y 1741&4&1z" Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE CSV$1 .00 PER S.F. Total Project Cost: $ '�� FEE: $ Check No.: Receipt No.: . !2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of Agent/Owner Sig=lature of contractor _ Plans Submitted �/J Plans Waived ❑ Certified Plot Plan ❑ Stamp/d Plans ❑ - Plans Submitted ❑ .-- Plans-Waived-El - "_.Certified Plot Plan ❑ Stamped Plans ❑ TYPE OZ{:-SEWERAGE.DISPOS Public Sewer Tannin Swimming Pools Elg/MassageBodyArt ❑ Well ❑ ,Tobacco Sales ❑ Food Packaging/Sales ❑ Private{septic tank,etc.- El on:Site THE..FOLLOWING SECTIONS FOROFFICEUSE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _-DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ COMMENTS I I CONSERVATION Reviewed on_ Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/SDate - Driveway Permit DPW Toss, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTtl,ri�IT `Teri p Dum ster on site p .yes no Located-at 124 Mair, Street ,:-Fire Departine►it•signature/date* COMMENTS t Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ :Total land area; sq. ft.: ELECTRICAL: Move ment:of.Meter,locatl6n, mast-or service drop requires approval of :Electrical Inspector Yes No DANGERZONE LITERATURE: =Yes No MGL.Chapter 166.Section 21A--F and G min.$10041000.fine NOTES and DATA— (For department use 1 �.J X6 o1jell t) �j Cr2 lJ Notified for pickup - Date I Doc.Building Permit Revised 2010 Building Department -`rhe fol;-)wing'it a=list of,the rOuired.forms to be filled outforAhe appropriate:permit to be obtained. R.00firag, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L.-Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster,permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit E3 Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application a Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 apw'�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bP subm_�ted with the building application Doc: Doc.Bui?ding permit Revised 2012 Location No. w / Date GIV . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $_�z7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# B ing Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $, 3.8:18:75.00- m $ - $ 466.50 Plumbing Fee $ 58.31 Gas Fee 100 comm. j$ 1OU& Electrical Fee $ 58.31 Total fees collected $ 683.13 1060 Osgood Street 793-14 on 5/5/2014 Office Space to be Re-Configured NORTH Town Of . E : ndover O ..f• 0 h ," ver, Mass, 44611zl c0ca1C...... y1' RATE D N '�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........���.^.�..r..:.<......G��� ......................................................... BUILDING INSPECTOR U Foundation has permission to erect .......................... buildings on .. .....................' ..P. .Q ..... ................ Rough to be occupied as ......... .. .��.:11..G7C.l .. .t�'�:.. 1.�./?/... . -��1 � ..,................. 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 CONSTRUCT N 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 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts -Department of Public Safety Board of Building Regulations g ations and Standards Con-struct'" Supenisnr -'--^�-- --k License: CS-060354 DAVID MMCCUgJR 37EVEKy. rflYi� WTUA-aVkNTOIN RA Expiration Commissioner 09/17/2014 �t TRAVELERSJ Report Claims Immediately by Catlin 9 1-800-238-6225 peak directly with acamproessona 24 hours a day, days a Y 365 da year *Unless Your Policy Requires Written Notice or Reporting C AT AND EMPLOYERS LIABILITY POLICY ._ A Custom Insurance Policy Prepared for: DAVID M MCCUE DBA DMC & SON 12 BUCKINGHAM STREET WILMINGTON MA 01887 a o— N- - 0 0 .— 000199 TRAVELERS WORKERS COMPENSATION ONE TOWER SQUARE A N D HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IEUB-7B25070-7-14) RENEWAL OF (IEUB-7625070-7-13) INSURER: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 1. NCCI CO CODE: 12637 INSURED: PRODUCER: DAVID M MCCUE DBA DMC & SON HUB INTERNATION N E LLC 12 BUCKINGHAM STREET 299 BALLARDVALE ST UNIT 1 WILMINGTON MA 01887 WILMINGTON MA 01887 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 04-13-14 to 04-13-15 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA 0 0 B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in N- o_ item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SO TN TX UT VA VT WI WV N D. This policy includes these endorsements and schedules: n SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.a s. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-03-14 HC OFFICE: HUDSON/BOSTON 126 DIRECT BILL PRODUCER: HUB INTERNATION N E LLC F6007 000200 Idftk TRAVELERS J WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IEUB-7B25070-7-14) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 1 751 NAI CS: 238350 ----------------------------------------------------------------------------------- STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 305 LOSS CONSTANT 50 PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 250 TERRORISM 1 TOTAL ESTIMATED PREMIUM 606 TAXES AND SURCHARGES 9 DEPOSIT AMOUNT DUE 615 Minimum Premium: $ 500 EMPLOYERS LIABILITY MINIMUM: $ 50 DATE OF ISSUE: 03-03-14 HC OFFICE: HUDSON/BOSTON 126 PRODUCER: HUB INTERNATION N E LLC F6007 COUNTERSIGNED-AGENT b lk TRAVELERS/ J WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IEUB-7625070-7-14) INSURER : THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 12637-MA INSURED'S NAME : DAVID M MCCUE DBA DMC & SON PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 027602005 ENTITY CD 001 MCCUE , DAVID M DBA DMC & SON 12 BUCKINGHAM STREET WILMINGTON, MA 01887 SIC CODE : 1751 NAICS: 238350 CARPENTRY-DETACHED ONE OR TWO FAMILY DWELLINGS 5645 3127 8.68 271 O= N O O O O� 67 MA MANUAL PREMIUM $ 271 0 N ------------------------------------------------------------------------------------ 1 .00% EMPL . LIAB. INCREASED LIMITS(9807) $ 3 ADD FOR INCREASED LIMITS MINIMUM (9848) 47 o� .950 MERIT RATING MODIFICATION (9885) 305 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 305 LOSS CONSTANT (0032) 50 EXPENSE CONSTANT(0900) 250 TERRORISM (9740) 1 MA WC SPECIAL FUND AND TRUST FUND 9 TOTAL ESTIMATED PREMIUM 615 DEPOSIT AMOUNT DUE 615 DATE OF ISSUE: 03-03-14 HC SCHEDULE NO: 1 OF LAST 000201 i�� TRAVELERS WORKERS COMPENSATI, AND ONE TOWER SQUARE EMPLOYERS LIABILITY PO HARTFORD, CT 06183 ENDORSEMENT WC 00 00 01 POLICY NUMBER: (IEUB-7B25070-7-14) LISTING OF ENDORSEMENTS EXTENSION OF INFO PAGE We agree that the following listed endorsements form a part of this policy on its effective date. WC 00 00 01 A - 001 INFORMATION PAGE WC 00 00 01 A - 001 INFORMATION PAGE 2 WC 00 00 01 A - 001 EXTENSION OF INFORMATION PAGE - SCHEDULE WC 00 00 01 A - 001 ENDORSEMENT LISTING WC 00 01 14 00 - 001 PENDING LAW CHANGE TO TERRORISM RISK INS WC 00 04 14 00 - 001 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 00 04 22 A - 001 TERRORISM-REAUTHORIZATION ACT DISCLOSURE WC 20 03 01 00 - 001 MA LIMITS OF LIABILITY ENDORSEMENT WC 20 03 02 A - 001 MASSACHUSETTS - ASSESMENT CHARGE WC 20 03 03 D - 001 MA NOTICE TO POLICYHOLDER ENDORSEMENT WC 20 04 01 00 - 001 MASS PENDING PREM CHANGE ENDT WC 20 04 03 00 - 001 MA. CONST . CLASS PREM. ADO . PROGRAM WC 20 04 05 00 - 001 MASSACHUSETTS PREMIUM DUE DATE ENDT WC 20 06 01 A - 001 MA CANCELLATION ENDORSEMENT o� N� o= 0 o i o m I 0 o� N O r� O� u DATE OF ISSUE: 03-03-14 ST ASSIGN: Page 1 of LAST 000202 The Commonwealth of Massachusetts - Departnent of yidifstriglAccidiints Office oflnvestigations 600 Washington.,street Boston,MA 02111 www.mass govIdla Wgrkexs' Compensation Insurance davit:BuilderefContracfors/Elec€riciansIVIiimbers A heant Information Please Prim Le 'bX Name(Susi.gess/Organization/f dividual): •/V 20� C/jrt Via✓L O .Address: A A/C X/A Z,.. 4,1�- oe City/State/Zip: " ,i fV O6,47 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[3- am.a employer with. 0 4. El I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am.a sole proprietor or partner- listed on the attached sheet. 7• Remodeling ship and'have no.employees 'These sub-contractors have 8. [[Demolition working forme in any capacity. workers'comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. ❑ We area corpora#on and its 10.[Electrical repairs or additions required.] officers have exercised.their 3111 am a homeowner doing all work right of exemption per MGL IL[(Plumbing repairs or additions myself[No workers' comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancerequired.J t employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicaat that checks box#1 must also fill out the section below showingtheir workers'compensatioapolloy infonmtion. -Homeowners who submit this affidavit indicating they 2're doing allworlc and then hire outside contractors must submit anew affidavit indicating such. lContractors that check:this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. -Taman employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Zz',j .�✓✓ Policy#or Self ins.Eic.#l: ,�� L✓� 7Q� 7 ''7 '-� !ration Date: Job Site Address: CitylState/Zip:&/ lA it " Attach a copy of the workers'compensationpolley declaration page(showing the policy number and expiration date). Failure to secure ooverage.as reguiredunder Section 25A ofMGL o.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 maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do liereby cert ori r the ins and penalties o f'perjury that Ate information provided above is true and correct. - Si afore: Date: ` Phone 0: 7 �� official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License 0 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 M Information and instruc ' tons Massachusetts General Laws chapter 152r,quires all employers to provide workers'compensation for their employees. Pursuant to this statate,an employee is defined as"...every person k 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 ox other legal entity,ox any two ox more Of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,ox the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. Iy yrori r the owner of a dwelling Douse 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,contraction 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 employes." MGL chapter 152,§25C(6)also states that"every state or local lie-ening agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required;' Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealthnor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented to.the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(q)name(s),addresses)and phone number(s)along with their ceMcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation,insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain.a Workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted 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 pemmit/license,number which will be used as a reference number, In addition,an applicant thatm-ust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town):'A copy ofthe affidavit that has been officially stamped or marked by the city or town may be,provided to the applicant as proof that a valid affidavitis on file:for future Hermits or licenses. A new affidavit must be filled out each year.More a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.ad og license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Ca of woalt� of�a�sa�;hU�P�� - Depaftent d1udustrial Accldentst • (.��ee o�Ta��e�ti�a�oxt.�. 6.00WAi g�oa Tei,9 617-727-4900 QXt 406 ox 1-877-MASSAF _ .Revised 5-26-05 Fax#617-727-7749 DAVID M. MCCUE,JR. DMC AND SON CONSTRUCTION COMPANY 12 Buckingham Street Wilmington, MA. 01887 978-423-4491 Dr. David Samuels 7 Ridge Hill Road Andover, MA. Estimate of work to include, but not limited to: - Repair tile in three existing offices - Tile shall be removed from fourth office to repair other three offices - Repair and replace ceiling tiles to match existing tiles in former dental office - Demolition of partitions according to plan provided - Reconstruction of new partitions according to plan provided - Electrical work as provided by estimate - Plumbing removed from rear kitchenette - Approximately 945 sq. ft. of new commercial grade nylon carpet installed in new area - All paint work as needed Total materials, labor and demolition $38,875 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 15/2/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT .S`;Md1NMaroe E M P R011ERTS, M A= 339C PHONE {978 Cs83-8073 FAX No:(978)683-3147 1060 Osgood S$zeEt E-MAIL sa ndiAmprobez - ADDRESS Insurance-c= Noxth Andover, IM 01845 INSURERS AFFORDING COVERAGE NAICi! INSURERA S INSURED I= AM S1 IM p INSURER B: DAVM D/B/A INSURER 12 ST INSURER D: NA 01887 INSURER E 878-6558-7335 INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL 5ULSK POLICY EFF POLICY EXP LTR TYPEOF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS $. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 CLAIMS-MADE ®OCCUR c ce $ 500,000 BOP1076622 12/02/1312/02/14 MED EXP(Any oneperson) $ 15 000 A PERSONAL&ADV INJURY $ 3MC7=10 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 aaccident) $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ A AUTOS AUTOS NON-OWNED PMMI001788 12/02/1312/02 PROPERTY DAMAGE HIRED AUTOS AUTOS e accident) $ Id $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y AT TE E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ifyes,describe under DESCRIPTION OF OPERATIONS below .L.DISEASE-P LILIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER N E AT N TOIM OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EW-UMT PlN S ,' IXG 3MPECTOR. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD STREET ACCORDANCE WITH THE POLICY PROVISIONS. ETMG 20 5TR' 2035 AUTHORIZED REPS TATIVE UK 01945 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional a for work per the 8'" edition of the Ye�'w Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Suite 103-104 fit-out Date: March 21,2014 Property Address: 1060 Osgood Street,North Andover,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: To renovate existing office space.To create a new conference room, 2 offices and a break room to create one large office suite at approximately 2,180 Square Feet. I Thomas F. Galvin MA Registration Number: 20285 Expiration date: August 31,2014 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the buildin official a `Final Construction Control Document'. ED AR�yi Enter in the space to the right a"wet"or QwO 'S F. electronic signature and seal: / 2 No.20285 WAKEFIELD w ,WA S.$. QF lt�Pc-�P Phone number. (978)470-3675 Email: t a assearchttects.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description.