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Building Permit #856 - 1160 GREAT POND ROAD 6/28/2007
BUILDING PERMIT NORTH o�tt�Eo ibgtio SOL TOWN OF NORTH ANDOVER °� APPLICATION FOR PLAN EXAMINATION ~ " Permit NO. Date Received 9SSACHUS�� Date Issued- IMPORT T: p icant must complete all items on this page a ROPERTY{JitUNEI t � Mi4P NO PARC I � ` Zt I1N Xfl1S 2 CT` � for di�ri yew no G� h Ii1e rJp Village yes <rt0 Wit, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 0 One family NzI Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Xcommercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other fl 'S' 0.® oodpla�h etla�s [ 111/ �Csed��strrct nn ,p3s sR °�`� _ y. 3� W f /se, �e`c ?, D SCRIPTION OF WORK TO BE PR FORME : I� ©t`1V11UP-r r`o N vN °c�nl Ili v'),���1'F t0'n! t�r3 �J � �dI Gc�' �ff gV'cJ� CJC \ , v '1011n n a Identification Pleas Ty a or r' Clearly) OWNER: Name: -yo� ._. OVa Phone: C97 7E 0� Address: r VAvilvgr A C)fl�L1'5 F CANT 2ACT�R t iv `flhonj F 3 a RAM Address• ;` : �x a w.�x z F x SUperrrlSor'S CC3nS rup Jo l "- a ate xr� Home Improvement [cnse t � ARCHITECT/ENGINEER ArcWJrRrm Phone: 617 -_770~ 29-70 Address: 6OLuna ' NMA QQ Reg. No. FEE SCHEDULE:BULD NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 g 6 16-76 FEE: $ .7 09 � Check No.: 1 � 91 Val Receipt No.: NOTE. Perso co r cn w re t red o ractors do not have access to the,guaranty fund Sinat�ii re ofd entJdwn�' 'Signature ofpnt ca t Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) _. ❑ Building Permit Application ❑ Certified Proposed Plot Plan Cu) Photo of H.I.C. And C.S.L. Licenses Cg Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Q Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 9 9 9 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 2.2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam ,,ed Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ I�I Swimming Pools Tanning/Massage/Body Art i`' Well ❑ Tobacco Sales od kaging/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 L D REJECTED DATE APPROVED CONSERVATIO 11 COMMENTS i DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 1 Iy COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street =FIR DEPI?iRTENT�Tp ��� � Steffi'`Cf Cl �1.#�' Lgcatedat,,124zMain Street � � s FE,reeiart�nen sgnatureldate w ❑ < Y �� � v Ni, M a - s 0 CMMEINTS 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.s100-61000 fine NOTES and DATA— For department use i ❑ Notified for pickup - Date ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Doc.Building Permit Revised 2007 Location e a r No. ..r4 Date 4 2,r HORTh TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $ sACHUs Foundation Pefmit Fee dYa Other Permit Fee $ TOTAL $ Check # 20641 /Building Inspector ti NORTH TONM Of Aindover O 4,. t ht' ' V No. - - o '� dower, Mass., �/P0-7 oL K COC HICHEWICK ��• �ds RA7ED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �rI �Q. ............................... .............. ....��.. ... ...... Foundation has permission to erect........................................ buildings on .. .. ..Io.....G... .t. - ... .. Rou �� g to be occupied as . r*?SC- .I...1.�,elf- . .� .............. Q..�'i /few .. ..�... .. .....�I..,. ....E y Q/�/ provided that the arson accepting his permit h II in ev re c conform to the terms f the i i n ' p p a p g t pe s a ery spat co 0 o e a cat on o file in Final r this office, and to the provisions of the Codes an -Laws px� the InspectionA460p, ation and struction of Buildings in the Town of North Andover. ��. 9 N`� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. *77 Rough SIO PERMIT EXPIRES IN 6 MONTHS /it Final UNLESS CONSTRUCTI STARTS ELECTRICAL INSPECTOR Rough ..... .......... ...................... .......... Service BUILDING INSPECTOR Final 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. f NORTH q p �tteo ° ti p ~ 7D RECEIVED OF f &S .o '� * 2001 JUN 27 AM 11: 55 SACHUS� ti;flloi 0 PLANNING DEPARTMENT NORTH "', "` Community Development Division MASSACI-j� � 1600 Osgood Street North Andover, Massachusetts, 01845 NOTICE OF DECISION Any appeal shall be filed within(20)days after the date of filing this notice in the office of the Town Clerk Date: June 27,2007 Date of Hearing: May 1, 2007, June 5, and June 26, 2007 Date of Decision: June 26, 2007 Petition of: Brooks School 1160 Great Pond Road North Andover,MA 01845 Premises Affected: Brooks School,1160 Great Pond Road,Assessors Map 90C,Parcel 25 and Map 103,Parcel 28. Referring to the above petition for a Site Plan Special Permit from the requirements of the North Andover Zoning Bylaw,Sections 8.3, 10.3,and 10.31 and MGL C.40A,Sec.9 So as to allow:the construction of a(+)29,447 sq. ft. Science Building, 12 ft.x 20 ft.greenhouse structure, interior landscaped courtyard, installation of drainage and storm water management system, 2 additional pwl6ag spaces,installation of underground utilities,construction of detention pond and outlet structures,and limited grading work within the Residential 2(R2)Zoning District. After a public hearing given on the above date,and upon a motion by John Simons and 2°d by Jennifer Kusek to APPROVE the Site Plan Special Permit as amended and based upon the following conditions. Vote was unanimous 4-0.. Oii behalf of the North An over Planning Board Richard NardeU Chairman John Simons,Vice-Chairman Richard Rowen Jennifer Kusek 1 Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse The Planning Board herein APPROVES the Site Plan Special Permit to construct a 29,447 sq. ft. Science Building, 12 ft.x 20 ft.greenhouse structure,interior landscaped courtyard,installation of drainage and storm water management system,2 additional parking spaces,installation of utilities,construction of detention pond and outlet structures, and limited grading work. The project is located at 1160 Great Pond Road, North Andover, Massachusetts, 01845, Map 90C, Parcel 25 and Map 103, Parcel 28 in the Residential 2 (R2) Zoning District. The parcels total approximately 7,187,000 s.f. with frontage on Great Pond Road. This Special Permit was requested by Brooks School, 1160 Great Pond Road, North Andover MA 01845. The application was filed with the Planning Board on March 16, 2006. The public hearing on the above referenced application was opened on May 1,2007 and closed by the North Andover Planning Board on June 5, 2007. The applicant submitted a complete application, which was noticed and reviewed in accordance with Section 8.3, 10.3,and 10.31 of the Town of North Andover Zoning Bylaw and MGL C.40A, Sec.9. The Planning Board makes the following findings as required by the North Andover Zoning Bylaws Section 8.3 and 10.3: FINDINGS OF FACT: 1) The specific site is an appropriate location for the project as it is located in the Residential 2 (R2) Zoning District and consists of the construction of a 29,447 sq. ft. Science Building, 12 ft. x 20 ft. greenhouse structure, interior landscaped courtyard, installation of drainage and storm water management system, 2 additional parking spaces, installation of utilities, construction of detention pond and outlet structures, and limited grading work. The proposal is a function of the capital improvements and designed to harmonize with the existing campus architecture and natural landscape and incorporates green and energy efficient technologies into the design. The project is located at the southern end of the campus and will not visually impact the surrounding properties. 2) The use as developed will not adversely affect the neighborhood as a sufficient buffer has been provided. The overall layout of the site has been designed to focus on traditional architecture and provide site amenities designed at a pedestrian scale. 3) There will be no nuisance or serious hazard to vehicles or pedestrians. The proposal will have a negligible impact on pedestrian safety and vehicular circulation within the site as the project will not add additional vehicle trips to the site. The intent of the project is to add additional science classroom space for the current student population and employees of the School. The project will not result in the increase in enrollment or staff. 4) The landscaping and lighting plans approved as part of this plan meet the requirements of Section 8.4 as amended by the Planning Board of the North Andover Zoning Bylaw. The lighting plan consists of shielded downcast lighting that has been arranged to provide adequate safety for students and employees and shall not impact abutting properties. The landscaping has been placed so as to maintain and enhance the appearance of the campus and site. 5) The applicant has met the requirements of the Town for Site Plan Review as stated in Section 8.3 of the Zoning Bylaw; 6) Adequate and appropriate facilities will be provided for the proper operation of the proposed use. The new Science Building and greenhouse will be serviced by town water and sewer. The Division of Public Works, and the outside consulting engineer, Vanasse, Hangen Brustlin, Inc, have reviewed the application, utilities, and drainage and storm water management plan and deemed them to be 2 t Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse adequate. Finally the Planning Board finds that this project generally complies with the Town of North Andover Zoning Bylaw requirements as listed in Section 8.3.5, but requires conditions in order to be fully in compliance. The Planning Board hereby grants an approval to the applicant provided the following conditions are met: SPECIAL CONDITIONS: 1) Permit Definitions: A) The"Locus" refers to the 7,187,000 sq. ft. parcel of land with land fronting on Great Pond Road as shown on Assessors Map 90C, Parcel 25 and Map 103, Parcel 28, and also known as 1160 Great Pond Road,North Andover,Massachusetts. B) The "Plans" refer to the plans prepared by Architerra Inc., 68 Long Wharf, Boston, MA 02110 entitled "Brooks School New Science Building", dated March 16, 2007, revised 4/5/07, and consisting of Sheets A0.00,A2.01,A2.02,C0.01,C0.02,C2.01,C3.01,C3.02,C4.01,L1.00,L2.00, L3.01,L3.02,L4.00,Lighting Plan. C) The "Project" or"Brooks School, 1160 Great Pond Road"refers to the construction of a 29,447 sq. ft. Science Building, 12 ft. x 20 ft. greenhouse structure, interior landscaped courtyard, installation of drainage and storm water management system, 2 additional parking spaces, installation of utilities, construction of detention pond and outlet structures, and limited grading work. D) The"Applicant"refers to Brooks School, 1160 Great Pond Road,North Andover,MA 01845,the applicants for the Special Permit. E) The"Project Owner"refers to the person or entity holding the fee interest to the title to the Locus from time to time,which can include but is not limited to the applicant,developer,and owner. 2) The developer shall designate an independent Environmental Monitor who shall be chosen in consultation with the Planning and Community Development Staff. The Environmental Monitor must be available upon four (4) hours notice to inspect the site with the Planning Board designated official. 3) The applicant shall designate an independent construction monitor who shall be chosen in consultation with the Planning Department. The construction monitor must be available upon four(4) hour's notice to inspect the site with the Planning Board designated official. The construction monitor shall make weekly inspections of the project and file monthly reports to the Planning Board throughout the duration of the project. The monthly reports shall detail area of non-compliance, if any, and actions taken to resolve these issues. 4) Prior to the Endorsement of the Plans by the Planning Board,the Applicant MUST comply with the following conditions: A) The final plans must be reviewed and approved by the DPW and the Planning Department and be endorsed by the Planning Board. The final plans must be submitted for review within ninety(90) days of filing the decision with the Town Clerk. 3 Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse B) The final site drainage system must be designed in accordance with the Town Bylaw requirements and reviewed by the Division of Public Works. All storm water drainage control facilities utilized by the site shall be shown on the site plan. Storm water drainage calculations which support the designof the control facilities shown the plan shall be submitted p to the Department of Public Works for review and approval. Written confirmation of said review and approval by the Department of Public Works must be submitted to the Planning Department. 5) PRIOR TO THE START OF CONSTRUCTION A) A detailed construction schedule shall be submitted to the Planning Staff for the purpose of tracking the construction and informing the public of anticipated activities on the site. B) All applicable erosion control measures must be in place and reviewed and approved by the Planning Department. C) It shall be the responsibility of the developer to assure that no erosion on the site shall occur which will cause deposition of soil or sediment upon adjacent properties or public ways,except as normally ancillary to off-site sewer or other off-site construction. Off-site erosion will be a basis for the Planning Board making a finding that the project is not in compliance with the plan; provided, however,that the Planning Board shall give the developer written notice of any such finding and ten days to cure said condition. D) Yellow"Caution"tape must be placed along the limit of clearing and grading as shown on the plan. The Planning Department must be contacted prior to any cutting and or clearing on site. E) A pre-construction meeting must be held with the developer,their construction employees,Planning Department and Building Department (and other applicable departments) to discuss scheduling of inspections to be conducted on the project and the construction schedule. E) The developer shall provide the Planning Board with copies of permits, plans and decisions received from all North Andover Land-Use Boards. F) A bond in the amount of ten thousand dollars ($10,000.00) shall be posted for the purpose of insuring that a final as-built plan showing the location of all on-site structures. The bond is also in place to insure that the site is constructed in accordance with the approved plan. This bond shall be in the form of a check made out to the Town of North Andover. This check will then be deposited into an interest bearing escrow account. 6) PRIOR TO THE ISSUANCE OF A BUILDING PERMIT A) Three(3)copies of the signed,recorded plans must be delivered to the Planning Department. B) One certified copy of the recorded decision must be submitted to the Planning Department. 7) DURING CONSTRUCTION A) Dust mitigation must be performed weekly, or more frequently as directed by the Town Planner, throughout the construction process. B) Any stockpiling of materials (dirt, wood, construction material, etc.) must be shown on a plan and 4 t Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse reviewed and approved by the Planning Staff. Any approved piles must remain covered at all times and fenced off to minimize any dust problems that may occur with adjacent properties. C) In an effort to reduce noise levels, the developer shall keep in optimum working order, through regular maintenance,any and all equipment that shall emanate sounds from the structures or site. 8) PRIOR TO THE ISSUANCE OF A CERTIFICATE OF OCCUPANCY A) The applicant must submit a letter from the architect and engineer of the project stating that the building, landscaping, lighting and site layout substantially comply with the plans referenced at the end of this decision as endorsed by the Planning Board Alternatively,the applicant and/or property owner may provide a bond, determined by the Planning Board, to cover the full amount of the landscaping materials and installation if weather conditions do not permit the completion of the landscaping prior to the use of the parking area. B) The Planning Staff shall approve all artificial lighting used to illuminate the site. All lighting shall have underground wiring and shall be so arranged that all direct rays from such lighting falls entirely within the site and shall be shielded or recessed so as not to shine upon abutting properties or streets. The Planning Staff shall review the site. Any changes to the approved lighting plan as may be reasonably required by the Planning Staff shall be made at the owner's expense. C) The applicant shall adhere to the following requirements of the North Andover Fire Department and the North Andover Building Department: All structures must contain a commercial fire sprinkler system. The commercial fire sprinkler systems must be installed in accordance with referenced standard NFPA 13D and in accordance with 780 CMR, Chapter 9 of the Massachusetts State Building Code. Certification that the systems have been installed properly in accordance with the above referenced regulations must be provided from both the North Andover Fire Department and the North Andover Building Department to the applicant. The applicant must then provide this certification to the North Andover Planning Department. 9) PRIOR TO THE FINAL RELEASE OF ALL SECURITY AND ESCROWED FUNDS A) The Planning Staff shall review the site. Any screening as may be reasonably required by the Planning Staff will be added at the Project Owner's expense. B) A final as-built plan showing final topography,the location of all on-site utilities,structures, curb cuts,parking spaces and drainage facilities must be submitted to the Planning Department. 10) GENERAL CONDITIONS A) Any plants,tree, shrubs, or fencing that have been incorporated into the Landscape Plan approved in this decision that die or fall into disrepair must be replaced by the project owner in perpetuity. B) Snow removal shall be maintained in accordance with the current facility management plan. C) There shall be no dumpsters or outside storage of materials/refuse on site. All materials/refuse to be stored inside of the building. D) The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 5 s Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse E) Gas, Telephone, Cable and Electric utilities shall be installed underground as specified by the respective utility companies. F) The hours for construction shall be limited to between 7:00 a.m. and 5:00 p.m. Monday through Friday and between 8:00 a.m.and 5:00 p.m.on Saturday. G) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. H) No underground fuel storage shall be installed except as may be allowed by Town Regulations. 1) The provisions of this conditional approval shall apply to and be binding upon the applicant, its employees and all successors and assigns in interest or control. n Any action by a Town Board, Commission, or Department, which requires changes in the plan or design of the building, as presented to the Planning Board, may be subject to modification by the Planning Board. K) Any revisions shall be submitted to the Town Planner for review. If these revisions are deemed substantial,the developer must submit revised plans to the Planning Board for approval. L) This Special Permit approval shall be deemed to have lapsed after June 26,2009(two years from the date permit granted), exclusive of the time required to pursue or await determination of any appeals, unless substantial use or construction has commenced within said two-year period or for good cause. For purposes of this development,the developer shall be deemed to have undertaken substantial use or construction if the developer has begun renovation of the existing structures. M) The following information shall be deemed part of the decision: Plan titled: Brooks School New Science Building Prepared for: Brooks School 1160 Great Pond Road North Andover,MA 01845 Prepared by: Architerra Inc. 68 Long Wharf Boston,MA 02110 Scale: 1"=20' Date: March 16,2007,revised 4/5/07 Sheets: A0.00,A2.01,A2.02,C0.01,C0.02,C2.01,C3.01,C3.02,C4.01,L1.00,L2.00, 13.01,L3.02,L4.00. Plan titled: Drainage Calculations for New Science Building Prepared for: Brooks School 1160 Great Pond Road North Andover,MA 01845 Prepared by: Rist-Frost-Shumway Engineering,P.C. Laconia,New Hampshire Post Development Drainage Analyses Revised May 1,2007 6 Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Site Plan Special Permit-Construction of Science building and greenhouse Scale: Date: 3/15/07 revised 4/30/07 Sheets: Drawings 1 &2 cc: Town Departments Applicant Engineer Abutters Assessor 7 E MORTii TOWN OF NORTH ANDOVER ° '"G' "° OFFICE OF F . p BUILDING DEPARTMENT 1600 Osgood Street Building 20 Suite 2-36 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)68: Inspector of Buildings Fax (978)688-9542 CONTROL CONSTRUCTION-SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, J 119n A. W a fF5 v�- Mtih,+Crta Xn G• ,HEREBY CERTIFY THA' To THS 13ar at- My KNovjWP,, FLAWS "D SPit4FWAT1014S POP. ,THE BUILDINVONSTRUCTED AT B rbo iS S r-6 o l ai- 11&0 6rc&F Po nl R octal, ro 86 Nw% "4 ovre_,r) M A o I g4S DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: G 25 0 7 ��aEo HK�y�� A.rygT dol REGISTRATION: , i4 o. 5 3 3 2 N O BO11. Fq( Th OF MPSgP NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FORM '" OFFICE OF BUILDING INSPECTOR 3+ 04 TOWN OF NORTH ANDOVER 10. y CONSTRUCTION CONTROL ssu�s PROJECT NUMBER: PROJECT TITLE:. Snn nk-5 SGl oo l t4 cy .5 a encs R,,i 1.j PROJECT LOCATION: 11 re O CCea t• P O>nd R n a 1 4&rK / acre T µA- c 18'4-$ NAME OF BUILDING:_ New 5C1CA('-- $yi Q-'*M4 J NATURE OF PROJECT: Z ' S+vru 30. DDo SQ L*K.-fbo t a dUeAj X10 1A1 6%-Id;rV3 IN ACCORDANCE WITH ARTICLE 118 OF THE MASSACHUSETTS STATE BUILDING CODE, I,_ 1� A. Wa tf5 REGISTRATION NO. 5332. C M h) BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL % STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDIN( PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar �tKEu.,,,�, with8the progress and quality of the work and to determine, in general,if the work is being A. �� performed in a manner consistent with the construction documents. v�N 4T, P�p , bG �i � PURSUANT TO SECTION 118.2 .2 t SHALL SUBMIT",MMI'�-PINo. 5 332 R PROGRESS REPORTS TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSIDE UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE � o SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. &/0 rcJaL " IGNATURE SUBSCRIBED AND SWORN T FORE ME THIS DAY OF I S!Z�, LADDIE-LEAH WELL OT URI C UV t'f11UrU1CC1ntd CYDIi7R Notary Public Commonwealth of Massachus:" My Commission ExprE: Ai,nue+OG MA4. NORTti TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT + ; * 1600 Osgood Street �� •�,,.v.�• �g Building 20 Suite 2-36 North Andover,Massachusetts 01845 Gerald A.Brown Telephone(978)68. Inspector of Buildings Fax (978)688-9542 CONTROL CONSTRUCTION—SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BUILDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, Terry Louderback , Souza , True & Partners. ,HEREBY CERTIFY THAT to the best of my knowledge , plans and specifications for THE BUILDING„CONSTRUCTED ATBrooks School at 1160 Great Pond Road to be North Andover , MA 01845 DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: June 25 , 2007 REGISTRATION: Mass . Reg . N o . 28641 ,1 Y TOP1 OU SAO 5T UR 8 41 NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FO ASO 7 E OFFICE OF BUILDING INSPECTOR +OF•w.e;�y0 TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL :_,C„�• PROJECT NUMBER: PROJECTTiTLE: Brooks School New Science Bui 1 di ng PROJECT LOCATIONI1tin Gresat Panri Rd , ,Nnrth AnrinuPr , MA 0124-S NAME OF BUILDING:_ New Science B u i 1 d i n p NATUREOFPROJECT:2-story . 30 ,000 squarp fQoj Pd icational bu=ilding containing teaching laboratories , lab sup_port )) lab prep and seminar facilities . I��I I� IIOiV�q.PfriF��A� IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, .ZP.r r g a - L.mi rIe.c. n k , P F REGISTRATION NO. 2 2 6 41 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE,PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL K2 MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept,shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to b erally familiar with6the progress and quality of the work and to determine,in 1#Ris being performed in a manner consistent with the construction docu ERRY © ASHTON N PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMI LM ;ORT TOGETHER WITH PERTINENT COMMENTS TO THE NORT . N 6 NSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINA SATISFACTORY COMPLETION AND READINESS OF THE PROJ y IS�� DAY /' SIGN URE g".•' ?k '� SUBS D SWORN TO BEFORE ME THOF A PI1 r MY r,[1NAruICClnw FYraiL�FQ - �7� O� 20•'�SSACM'►��U 'fRY QVC NORTH t O�It 16� �0. ... 70 R-CEIVEO T0 s,: . �..i 9 cocwu,awvcw �►�"°��T.o ��"'� 2001 JUN 27 AM 11: 55 SS�CHU Tu V':8 0 PLANNING DEPARTMENT NORTH A NO C-- fit Community Development Division MASSAGR'�5�1+S 1600 Osgood Street North Andover, Massachusetts, 01845 Phone: 978-688-9535 Fax: 978-688-9542 NOTICE OF DECISION Any appeal shall be filed within(20)days after the date of filing this notice in the office of the Town Clerk. Date: June 27,2007 Date of Hearing: May 1, 2007, June 5 and June 26, 2007 Date of Decision: June 26, 2007 Petition of: Brooks School 1160 Great Pond Road North Andover,MA 01845 Premises Affected: Brooks School 1160 Great Pond Road,Assessors Map 90C,Parcel 25 and Map 103,Parcel 28. Referring to the above petition for a Watershed Special Permit from the requirements of the North Andover Zoning Bylaw,Section 4.136.3(b)(ixl). So as to allow: the construction of a detention pond and outlet structures within the Non-Discharge buffer zone of the Watershed Protection District within the Residential 2(R2)Zoning District. Abe'a public hearing given on the above date, and upon a motion by Richard Rowen and 2pd by John Simons to APPROVE a Watershed Special Permit as amended and based upon the following conditions. Vote was unanimous 4-0. On of the North An er Planning Board Richard Nardella,Chairman John Simons,Vice-Chairman Richard Rowen Jennifer Kusek 1 i Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures The public hearing on the above referenced application was opened on May 1,2007 and closed by the North Andover Planning Board on June 5, 2007. On June 26, 2007, upon a motion made by Richard Rowen and seconded by John Simons to GRANT a Watershed Special Permit as amended in order to construct a detention pond and outlet structures within the Non-Discharge buffer zone of the Watershed Protection District associated with Lake Cochichewick. The proposed detention pond and outlet structures are located at 1160 Great Pond Road,North Andover, Massachusetts,01845,Map 90C,Parcel 25 and Map 103,Parcel 28 and is located within the Non-Discharge Zone of the Watershed Protection District under the requirements of Section 4.136& 10.3 of the North Andover Zoning Bylaw.This Special Permit was requested by Brooks School,Trustee, 1160 Great Pond Road,North Andover,MA 01845. The applicant submitted a complete application,which was noticed on April 3& 10,2007,and reviewed in accordance with Section 4.136 of the Town of North Andover Zoning Bylaw and MGL Chapter 40A, Section 9. The lot was created in 1928 and is subject to the Watershed Protection District provisions for lots before October 24, 1994. Public hearings were held on May 1,2007, June 5,2007,and June 26,2007. The Planning Board voted on the motion by Richard Rowen and seconded by John Simons to approve the Watershed Special Permit. A special permit issued by the special permit granting authority requires a vote of at least four members of a five-member board. The applicant is hereby notified that should the applicant disagree with this decision, the applicant has the right, under MGL Chapter 40 Section 17 to appeal to this decision within twee days after the date this �, P � PP t3' Y decision has been filed with the Town Clerk. In accordance with 4.136 the Planning Board makes the finding that the intent of the Bylaw, as well as its specific criteria, are met. This decision specifically stated by the Planning Board makes the following FINDINGS OF FACT: 1) That as a result of the proposed construction in conjunction with other uses nearby,there will not be any significant degradation of the quality or quantity of water in or entering Lake Cochichewick. The Planning Board bases this finding on the following facts: a) The proposed detention pond and outlet structures will have a negligible impact on Lake Cochichewick given the design and function/purpose of the pond and proximity to the Lake. Further, the detention pond and outlet structures will be constructed using Best Management Practices; b) The topography of the site will not be altered substantially. The detention pond and outlet structures were specially designed and located to minimize the amount of grading/topographical changes and take advantage of natural features of the property. Further,construction of the proposed storm water management measures and erosion control measures will use Best Management and Engineering Practices and not substantially alter the topography of the site; c) The limit of clearing and impact is restricted to the minimum necessary to construct the proposed detention pond and outlet structures as shown on the plan;and d) The construction of the detention pond and outlet structures and storm water management plan have been reviewed by the Town's outside consultant and Town Planner and determined that there will be 2 � t Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures no degradation to the quality or quantity of water in or entering the isolated vegetated wetland or Lake Cochichewick. 2) There is no reasonable alternative location outside the Non-Discharge Zone for any discharge, structure or activity. In accordance with Section 10.31 of the North Andover Zoning Bylaw, the Planning Board makes the following FINDINGS OF FACT: 1) The specific site is an appropriate location for the proposed use as all feasible storm water and erosion controls have been placed on the site. The project will be built using Best Management Practices; 2) The use will not adversely affect the neighborhood as the lot is located in a Residential 2 Zoning District; 3) There will be no nuisance or serious hazard to vehicles or pedestrians; 4) Adequate and appropriate facilities are provided for the proper operation of the proposed use; 5) The Planning Board also makes a specific finding that the use is in harmony with the general purpose and intent of the North Andover Zoning Bylaw; Upon reaching the above findings,the Planning Board approves this Special Permit based upon the following SPECIAL CONDITIONS: 1) The Town Planner shall approve any changes made to these plans. Any changes deemed substantial by the Town Planner would require a public hearing and modification by the Planning Board. 2) Prior To Any Work On Site: a. A performance guarantee of two thousand dollars ($2,000) in the form of a check made out to the Town of North Andover must be posted to insure that construction will take place in accordance with the plans and the conditions of this decision and to ensure that the as-built plans will be submitted. b. The limit of work as shown on the plan by the erosion control line must be marked in the field and must be reviewed and approved by the Town Planner and Conservation Department. c. All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner and Department. Deteriorated erosion control measures shall be replaced and maintained throughout the duration of the project. d. If applicable, the site shall have received all necessary permits and approvals from the North Andover Conservation Commission,Board of Health,Zoning Board of Appeals and the Department of Public Works and be in compliance with the above permits and approvals. 3) Prior to issuance of a building permit: a. The Planning Board must endorse the final site plan mylars and three copies of the signed plans must be delivered to the Planning Department. b. The decision must be filed with the North Essex Registry of Deeds. One certified copy of the recorded decision must be submitted to the Planning Department. 3 Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures c. No pesticides,fertilizers or chemicals shall be used in lawn care or maintenance within 325' of Lake Cochichewick or within 325' of wetland resource areas. The applicant shall incorporate this condition as a deed restriction, and a copy of the recorded deed shall be submitted to the Town Planner and included in the file. d. All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner and Conservation Department. 5) Prior to release of the Performance Bond: a) The applicant shall submit an as-built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water management services and other pertinent site features. This as-built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 6) In no instance shall the construction of the project as proposed be allowed to further impact the site than as shown on the plan referenced in Condition# 11. 7) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 8) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 9) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 10)This special permit was issued on June 26, 2007, however, this Special Permit shall be deemed to have lapsed after a two (2) year period on June 26, 2009 unless substantial use or construction has commenced. 11) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: Plan titled: Brooks School New Science Building Prepared for: Brooks School 1160 Great Pond Road North Andover,MA 01845 Prepared by: Architerra Inc. 68 Long Wharf Boston,MA 02110 Scale: 1"=20' Date: March 16,2007,revised 4/5/07 Sheets: A0.00, A2.01, A2.02, C0.01, C0.02, C2.01, C3.01, C3.02, C4.01, L1.00, L2.00, L3.01,L3.02,L4.00 4 Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures cc: Town Departments Applicant Engineer Abutters Assessor 5 a Brooks School, 1160 Great Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures c. No pesticides,fertilizers or chemicals shall be used in lawn care or maintenance within 325' of Lake Cochichewick or within 325' of wetland resource areas. The applicant shall incorporate this condition as a deed restriction, and a copy of the recorded deed shall be submitted to the Town Planner and included in the file. d. All erosion control measures as shown on the plan must be in place and reviewed by the Town Planner and Conservation Department. 5) Prior to release of the Performance Bond: a) The applicant shall submit an as-built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water management services and other pertinent site features. This as-built plan shall be submitted to the Town Planner for approval. The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. b) The Planning Board must by a majority vote make a finding that the site is in conformance with the approved plan. 6) In no instance shall the construction of the project as proposed be allowed to fiuther impact the site than as shown on the plan referenced in Condition# 11. 7) No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 8) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation. 9) The provisions of this conditional approval shall apply to and be binding upon the applicant, it's employees and all successors and assigns in interest or control. 10)This special permit was issued on June 26, 2007, however, this Special Permit shall be deemed to have lapsed after a two (2) year period on June 26, 2009 unless substantial use or construction has commenced. 11) This decision must be filed with the North Essex Registry of Deeds. The following information is included as part of this decision: Plan titled: Brooks School New Science Building Prepared for: Brooks School 1160 Great Pond Road North Andover,MA 01845 Prepared by: Architerra Inc. 68 Long Wharf Boston,MA 02110 Scale: 1"=20' Date: March 16,2007,revised 4/5/07 Sheets: A0.00, A2.01, A2.02, C0.01, C0.02, C2.01, C3.01, C3.02, C4.01, L1.00, L2.00, L3.01,L3.02,L4.00 Plan titled: Drainage Calculations for New Science Building Prepared for: Brooks School 4 F Brooks School, 1160 Creat Pond Road Map 90C,Parcel 25&Map 103,Parcel 28 Watershed Special Permit-Construction of detention pond and outlet structures 1160 Great Pond Road North Andover,MA 01845 Prepared by: Rist-Frost-Shumway Engineering,P.C. Laconia,New Hampshire Post-Development Drainage Analyses Revised May 1,2007 Scale: 1"=40' Date: 3/15/07 revised 4/30/07 Sheets: Drawings 1 &2 cc: Town Departments Applicant Engineer Abutters Assessor 5 Project: Brooks School - New Science Building Location: North Andover, MA FA, aft'l Date: 5.25.07 CONS IG LI Proposal: COST SUMMARY /"'"_`g"` Revised 5/30/07 CSI IDESCRIPTION 90%DD Pricing] Early Release Difference 02010 Site Preparation 66,265 66,265 0 02020 Site Work 322,000 291,935 (30,065) 02030 Site Concrete 15,240 9,164 (6,076) 03010 Formwork 97,336 110,361 13,025 03020 Flatwork 1,150 1,454 304 03030 Reinforcing Materials 15,450 19,300 3,850 03040 Reinforcing Installation 17,000 12,000 (5,000) 03050 Redi-Mix Concrete&Pumping 31,500 38,125 6,625 07010 Damproofing&Waterproofing 7,370 9,030 1,660 07020 Insulation 4,405 4,042 (363) 15020 Plumbing 12,100 12,100 0 16010 Electrical 12,900 1 12,900 0 Sub Total 602,716 586,676 (16,040) General Conditions 118,591 118,591 0 Building Permit(s) 7,213 7,053 (160) Builders Risk Insurance Owner Supplied Owner Supplied 0 GLPD Insurance 5,464 5,342., (122) Subcontractor Bonds 7,200 0 (7,200) Sub Total 741,184 717,662 (23,522) Performance&Payment Bond Not required Not required 0 4.00% Overhead and Fee 29,647 28,706 (941) TOTAL COST 770,831 746,369 (24,463) YICIURI IE SALUfAMUS BROOKSSCHOOL NORTH ANDOVER MASSACHUSETTS 01845-1298 7 June 2007 Mr. Todd McCabe Consigh Construction Company Project Executive 72 Sumner Street Milford, MA 01757 Dear Todd, This letter serves as your Notice to Proceed with Phase 1 of the Brooks School Science Project. The Phase 1 work is per plans and specifications created by Architerra Inc. dated 27 April 20007. We look forward to working with you on this project. Sincerely; BROOKS SCHOOL Trovage Director of Facilities Management Cc: Town of North Andover Building Department CONSCON-02 MENA 'ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATY) 1 PRODUCER (508)852-8500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Protector Group Ins.Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 100 Front Street,Suite 800 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01608-1435 INSURERS AFFORDING COVERAGE NAIC# INSURED Consigli Construction Co.,Inc INSURER A:Acadia Insurance Consigli Northern, Inc. INSURER B: 72 Sumner St INSURER c: Milford, MA 01757- INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION INSURANCELTR INSRD-TYPE OF POLICY NUMBER DTE MM/DD/YY DTE(MM/DD/YYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPA0086238-14 12/30/2006 1213012007 PREMISES Ea occurence $ 250,000 CLAIMS MADE FKOCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PEO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO MAA0086239-14 12/30/2006 12/30/2007 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,00 . A X OCCUR D CLAIMS MADE CUA0086242-14 12/30/2006 12/30/2007 AGGREGATE $ 10,000,00 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCRY STATU- LIMITS ER X OTH- TO A EMPLOYERS'LIABILITY PA0141603-12 12/30/2006 12/30/2007 E.L.EACH ACCIDENT $ 500,00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEq$ 500,000 If es,describe under 500 00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER A Installation Floater CPA0086238-14 12130/2006 12/30/2007 Job Site Limit $25000 A Equipment Floater CPA0086238-14 12/30/2006 12/30/2007 Leased/Equipment $350,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Consigli Construction Co Inc DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 72 Sumner St Milford, MA 01757- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 INSURER'S AFFIDAVIT AS TO WORKER'S COMPENSATION INSURANCE I, 100 Front St , Worcester, MA 01608 (NAME, TITLE AND ADDRESS) authorized representative of Acadia Insurance Co (INSURANCE COMPANY} do hereby affirm that effective 12/30/2006 (DATE) 0Co Inc is insured by said Insurance Company with Policy Number _WPA020. 801-11 for WORKER'S COMPENSATION in accordance with Massachusetts General Laws Chapter 152, and Subsection 7.05A of the Standard Specifications Highways and Bridges of the Massachusetts. High way Department. Anyor discrepancies between the Massachusetts General Laws, Chapter 152 and Subsection 7.05A of the Standard Specifications for Highways, Bridges of the Massachusetts Highway Department shall be resolved in favor of M.G.L.A. c 152. (SIGNED) Subscribed and Sworn to before me thisda of at 16D t ry Public My Commission expires `Z ': LAURIE A. PENNIMAN r = Notary Public Commonwealth of Massachusetts ry„ My Commission Expires Oct 1.2010 BoaYdBG ' fiftfdna��n ""w Construction Supervisor License 5 License: CS 65754 Birthdate:_ 3/27/1973 s ,F Expiration: 3/2V2009 Tr# 10485 Restriction: 00 MATTHEW D CONSIGLI 73 PURCHASE ST MILFORD, MA 01757 Commissioner