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HomeMy WebLinkAboutBuilding Permit #662 - 120 WATER STREET 3/16/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ' IMPORTANT: Applicant must complete all items on this page LOCATION 0 E:Q- Print PROPERTY OWNER Print MAP NO: PARCEL: 1 ZONING DISTRICT: Historic District Siff no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New BuildingEl One family El Addition ❑Two or more family El Industrial jAlteration No. of units: ❑ Commercial ❑Assesso Bldg ❑ El Repair, replacement rY g Others: - -- - - ❑ Demolition ❑ Other �' �®�'�Watershed Di�cte ® Septa ®;'Well ®lFloodplam� _ €®Wetlands 1 7.1 ®�W.ater Sewera � .=4' 41 DESCRIPTION OF WORK TO BE PERFORMED: 'i J e p e G W kk �' - R x Q AoaL% o vin- S'agN kT-,-6 o i Identification Please Type or Print Clearly) OWNER: Name: n-4\,a :ysV ta4.%scc-CH Phone: � Address: \-imtt CONTRACTOR Name: V,"r<L \A Phone: Address: af"o C� e isor's Construction License: �-S b�33 Exp. Date: Sup ' Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Qv�r2►- F���1 Phone: \s\-I- Address:3 0 2 CPN e�tt S8 i Qo a o. �v Reg. No. 1 0 0 �K L> FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �y FEE: Check No.: 0 \5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .sr ti.-w- oaf,+ of�contract(Nd-1�:��......�: a,,.. ,..�..� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ElTanning/Massage/Body Art ElSwimming Pools ElWell ❑ Tobacco Sales EJ 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 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 Connecilon/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 Osgood Street Located at 124 Main Street _ no 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 oDANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA– For department use ti G I ® Notified for pickup - Date Doc:.Building Permit Revised 2008 r� Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits s ❑ Building Permit Application ❑ Workers Comp Affidavit P 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 I 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) a 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) i ❑ Building Permit Application ❑ Certified Proposed Plot Plan f ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit { ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products - MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ' E i 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 I must be submitted with the building application — ' Y Doc: Doc.Building Permit Revised 2008mi Location 4 ST �-S �(piq"11SI D tl No.�"'7 Date e ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ . Building/Frame Permit Fee Cw.1 Foundation Permit Fee $ '� Other Permit Fee $ TOTAL Check#15S�-)--� 25107 Building Inspector NORTH TO" of ? - Andove ' . . No. - __ o , dover, Mass., I o . 14- Q - LAKE COCMICMEWICK V OA? TED P' C2 BOARD OF HEALTH Food/Kitchen ,PERMIT T D I Septic System t BUILDING INSPECTOR THIS CERTIFIES THAT...�.Q......... .... C'.ivi.4.4. 5:...-...........•.. ....�. ..��....... ISS�. .......... Foundation has permission to erect........................................ buildings on..ao.....( a4.—.�.......�T.................................... Rough �_ Chimney ne to be occupied as..................�.. .." .................. :�1.. ...... ..✓'� ........... 4$'.E� ���.VIS..:........ y .............. provided that the person accepting this permit shall in every respect conform to the term of the application on file in Final this office,-and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final h PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. V �✓ UNLESS CONSTRUCTITRough Service ..............................................................Bi.7ILDING 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S 0 D E Smoke Det. Location 12-0 w oA,--m No. Date ✓ 1 l-L 4 * - TOWN OF NORTH ANDOVER .§ Certificate of Occupancy $ y F $ Building/Frame Permit Fee $ Foundation Permit Fee $ J Other Permit Fee $ TOTAL $ 4©D Check#v�`f' 25342 Building Inspector i_ .,y GNORiq�ti 3?°�``a `• Gt O T M iok ,SSwCH�SE4 CER'T'IFICA'T'E OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 662 on 3/16/12 Date: May 31, 2012 THIS CERTIFIES THAT RCG N.A. Mills LLC THE BUILDING LOCATED ON 120 Water Street MAY BE OCCUPIED AS ERS Expansion IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG N.A. Mills LLC 17 Ivaloo Street Somerville,MA 02143 Building Inspe for Fee: $100.00 Receipt: 25342 Check :016528 %AORTH 0" ® �� .. Andover No. ' WNAWY­ 4LIo *, r lover, Mass., �- l 6 o e�- iAKE cc C.,C ME WICK 4 ��A��AYEC1 PPS` �'� • UU BOARD OF HEALTH e Food/Kitchen Septic System BUILDINGPERM .IT T D e INSPECT OR THISCERTIFIES THAT...�.Q......... .... �'.....AA( .�5...-........... ��2..�.... i.�.�.......... . Foundation � has permission to erect........................................ buildings on ..};A�- .a......( Ali. ..... ......�a..r ................................... ',Rouges to be Occupied as "T�.............. �..� ....:..A...✓' ............1 . ... �l.. SIS..... chi ney p' ........... - ..... .... provided-that the person accepting this permit shall in every respect conform to the termjof the application on file in inai 7 the' rovisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of this office, and to p y g p , ,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 l� ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ................................................................................................................ Service BUILDING INSPECTOR final 4 Occupancy Permit Required to Occitpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fi No Lathing or Dry (Nall To Be Done FIRE-DEP EN Until Inspected and Approved by the Building Inspector. Burner a Street No. SEE REVERSE SIDE smoke Det. f� �. . �, ,fib ► o TM Of ' ®ver .. 0 No. � �✓'. _ F ` ,0E o , dover, Mass., ' c -- COCHICHE`N ICK 4 AOf?ATEo BOARD OF HEALTH Food/Kitchen Septic System PERM .IT T D .II BUILDING INSPECTOR THIS CERTIFIES THAT... Q.............. '.�'4.4. 1�...-............................................2 �?.f S l.B..... .. ouat n ion ... buildings on . .�...... . ...... �+�'..has permission to erect..................................... ....................... ..... IRou g. �.- �.. O� Chi ney to be occupied as........... � ..'C-.............. .v.a.. .........:..A...✓"5�..................... ............. .:��Vl................... provided-that the person accepting this permit shall in every respect conform to the termiof the application on file in inai P P P g P 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 Finaldf•sem. Z_ PERMIT EXPIRES IN 6 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ................................................................................................................. Service BUILDING INSPECTOR Occupancy Permit Required to Occitpy Building GAS INSPECTOR Rough Display in a Conspicuous. Place on .the Premises — Do Not Remove Fi No Lathing or Dry Wall To Be Done FIRE-DEP EN Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Standard Form of Agreement between Owner and RCG LLC where the basis of payment is the Cost, of the Work Plus a Fee without a Guaranteed Maximum Price Date: Owner: Contractor: Architect: Project Name: The Owner and Contractor agree to the terms stated by this contract. This contract supersedes any prior agreements,representations,or negotiations,oral or written. No liquidated damages shall apply to this agreement. This contract consists of the following documents- 1. Obligations of the Parties 2. Contract Sum 3. Project Schedule 4. Signatures Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Project Schedule Exhibit C: Drawings Page 1 of 6 1. Obligations of the Parties Obligations of the Contractor. The Contractor accepts the relationship of trust and confidence established by this Agreement and covenants with the Owner to cooperate with the Architect and exercise the Contractor's skill and judgment in furthering the interests of the Owner,to furnish efficient business administration and supervision; to furnish at all times an adequate supply of workers and materials; and to perform the Work in an expeditious and economical manner consistent with the Owner's interests and in compliance with all applicable governmental codes and regulations. The Contractor shall keep full and detailed accounts and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor shall keep full and detailed records of all books, records, permits, licenses, correspondence, receipts, instructions, data, and drawings associated with the Project including all Subcontractor contracts, invoices,vouchers, insurances, lien waivers, and other correspondence. The Owner and Owner's Accountants shall have access to review, audit, and copy all Contractor documentation. The Contractor shall retain these documents for a period of three years after final payment. The Contractor shall maintain insurance at the following levels with the Owner listed as a co- insured: Type of Insurance Limit of Liability 11 Upon request, and at the cost of the Owner,the Contractor shall obtain a performance bond up to the total Cost of Work. Such costs shall be added to the Construction Volume. The Contractor understands-that the Project will be financed by a construction lender and, then, by a permanent lender. The Owner may assign any of its rights under this Contract to the construction lender and the Contractor hereby consents to any such transfer provided no such assignment shall relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other documents as may be reasonably required by the construction lender or permanent lender including a subordination of its mechanic's lien rights to the construction lender's and permanent lender's mortgage or deed of trust The construction lender for the Project will be: e Obligations of the Owner: The Owner agrees to furnish or approve, in a timely manner, information required by the Contractor and to make payments to the Contractor in accordance with the requirements of this Agreement I ` Dispute Resolution: Claims, disputes or other matters in question between the parties to this Agreement shall be resolved by mediation or by arbitration. Prior to arbitration,the parties shall endeavor to reach settlement by mediation. Page 2 of 6 2. Contract Sum Cost of Work: The Contractor shall provide a detailed estimated Cost of Work to the Owner(see Exhibit A). The sum of these costs, including the fee is as shown below: Change Orders: The Contractor does not guarantee the Contract Sum in any form. In the event of changes to the Contract Sum, the Contractor will present written changes to the owner for costs that exceed the Contract Sum in the form of a Change Order. The Contractor will review all Subcontractor Change Orders before submittal to the Owner and Architect and make a recommendation for payment or non-payment. The Contractor's Fee will be calculated including any approved Change Orders. The Owner, Architect and Contractor will negotiate disputed Change Orders in good faith. Contractor's Fee: 15% of total construction volume up to$1 million, and 10%of construction volume over$1 million. This includes pre-construction and project management services,and field personnel and associated management overhead. The fee is based on actual costs incurred, with final true up, and is booked monthly in arrears. Specifically, 1. The cost of pre-construction and construction management services provided by RCG personnel is booked monthly in arrears based on the hours reported by each employee. 2. Hours are billed at the standard hourly billing rate established from time-to-time for each employee. 3. The cost of pre-construction and construction management services provided by independent contractors is booked when invoiced and carried within the fee. 4. RCG Builders personnel functioning as tradesmen outside their management duties will be charged according to their hourly billing rate. 5. If a project is terminated or suspended by the Owner prior to completion, RCG Builders LLC is compensated for the actual cost of services provided prior to receipt of notice of termination or suspension from the Owner. 6. Total Construction Volume includes all construction trades,general requirements, insurance, bonds and miscellaneous costs deemed necessary to perform the construction of the project but excludes permits and fees. Permits and Fees shall be paid directly by the Owner. 7. Construction management labor, standard tools and equipment, and labor-related overhead are covered"within the fee". Specialty tools or equipment,trade labor supplied by Builders personnel and approved transportation and meals costs shalt be charged directly to the Owner without a fee. Subcontractors: The Contractor plans to hire Subcontractors to perform the majority of construction associated with this project. The Contractor shall provide the Owner and Architect information on all of the bids received by Subcontractors and the names of the Subcontractors selected. Owner shall have the right to reject a proposed Subcontractor, however, in the event that this leads to a higher Cost of Work,the Owner shall pay for the difference. The Contractor reserves the right to reject any Subcontractor, even if it is the lowest bid, and to dismiss Subcontractors from the job that have been previously approved by the Owner. Page 3 of 6 Payments: The Owner shall make progress payments on the Contract Sum according to the Requisition process described below. The Contractor shall, at the conclusion of each calendar month on the project, present to the Owner an application for payment(Requisition)for costs incurred during that month. The Requisition shall include all invoices,vouchers, partial releases of liens, expense reports, and any other evidence to support the validity of the Requisition amount. The Contractor may requisition for completed, but unpaid work based on an expectation of payment upon receipt of funds. The Owner, the Architect, or their representatives shall be afforded five(5) business days to review such application and question the Contractor about its contents. In the event there are no . disputes, the Owner shall pay the Contractor within 10 business days of receipt of the Requisition. Payment by the Owner does not represent that the Owner or Architect have made a detailed examination of the documentation, inspection of the work, or verification of the accounting. At the completion of the project, the Owner shall make a final payment to the Contractor based on a final Cost of Work with a truing up of fees. If further corrections to work are required that are not covered under warranties with Subcontractors, or that are not the outcome of negligence or poor workmanship by the Contractor,the Owner shall pay the Contractor for any work associated with performing the corrections based on the hourly rate agreed to in this contract Retainage: The Owner shall not hold back any fees to the Contractor to ensure completion of the work. The Contractor will be expected to hold back fees from Subcontractors to ensure their performance based on the terms below: Termination of Contract: The Owner shall reserve the right to terminate or suspend the Contract at its sole discretion. Within 15 days of termination or suspension, the Contractor shall present an accounting of all its costs incurred for reimbursement by the Owner. If the Owner elects to proceed with the project without the Contractor,the Owner shall have the right to assume the Subcontracts and agreements related to the Project. Working Capital: RCG Builders shall not bear the costs of Working Capital for the project. If the Owner would like the Contractor to gain beneficial pricing on its behalf by paying subcontractors ahead of the Requisition schedule,the Owner shall either(1) put on deposit with the Contractor a sufficient amount of Working Capital for the Contractor to pay these Subcontractors, or(2) make immediate payment upon request from the Contractor outside of the normal Requisition process. Provision of Working Capital shall entitle the provider to all discounts and savings associated with that capital. Page 4 of 6 3. Project Schedule Date of Commencement: The Contract Time shall be measured from the date of commencement 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 to proceed issued by the Owner. Contract Time: The Contractor shall provide to the Owner a Project Schedule(see Exhibit B). This Schedule is based on assumptions reached prior to the signing of this contract,which assumptions the Contractor shall attempt to clarify in the Schedule. However, the Schedule always assumes the Owner and the Architect respond promptly to requests for information and do not request any significant changes to the construction program. In the event that the Owner or Architect find any discrepancies with the Schedule or its Assumptions,they will promptly notify the Contractor,who shall make adjustments to the Schedule as necessary. According to the attached Schedule, the Contractor shall achieve Substantial Completion of the entire Work as follows: The Contractor does not guarantee the date of completion. However, the Contractor Shall not be entitled to additional fees based on delays in the project unless those delays can be shown to incur extra costs for the Contractor and were caused by the actions or requests of the Owner or Architect. The Contractor shall present an updated Project Schedule to the Owner and Architect on a weekly basis for their review. Page 5 of 6 4. Signatures The Owner's representative is: 9 � §14.4 The Contractor's representative is: This agreement is entered into as of the day and year first written above and is executed in at least thre original copies, one for the Owner, one for the Contractor,and one for the Architect. Owner Contractor S► nature i nature Printed Name and Title I Printed Name and Title Page 6 of 6 d ERS Estimated Cost Schedule of Values 3/15/2012 General Conditions $ 3,500.00 Demolition $ 3,000.00 Frame walls and workstations $ 7,050.00 Drywall&tape $ 5,100.00 Prime and Paint $ 4,500.00 Doors&Windows $ 1,500.00 Carpet&Marmoleum(3000 SF) $ 7,500.00 Vinyl base $ 500.00 Cabinetry&Countertops $ 2,000.00 Plumbing $ 6,500.00 Sprinkler Work $ - Electrical $ 10,000.00 HVAC $ 25,400.00 Cleaning&dumpsters $ 1,050:00 Sub-total $ 77,600.00 RCG Builders fee $ 11,640.00 Total $ 89,240.00 Plus Building Permit $ 1,080.00 ' malssaehusetts- Department of Puhf'e S rfety Boars!of Building Regulations and Standartls Construction Supervisor License License: CS 66334 XIERAN T;WHELAN { , -,31 RICHMONb ST'- ... ' WEYMOUTH,,MA 02 f 88'`'" 1 f 1 r f Expiration: 9/26/2013 ('ommismolier Tr#: 6168 "epuriment uJ inaustriat Aectaents 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): �- 6" L, Address: 1, V d City/State/Zip: So ti\s�I 1 e pt dz•I Lt-? Phone #: i 7 - b Are you an employer?Check the appropriate box: Type of project(required): 12 I am a employer with 4. ❑ 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. ?• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E] Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *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 employee& Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:—W14 C -3 OL j Expiration Date: 1Y I cg- 1_0 %-I— Job Site Address: ' i 4"10 41 �w,oc)J ity/State/Zip:_ R AJ0 V1ly`�, �Y*&S 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 Si ature: Date: 6 Phone#: la " �"g L 16 Oficial 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#: Clients:29552 RESOD ACORD- CERTIFICATE OF LIABILITY INSURANCEPRODUCER arxum THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 306 MAIN STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Worcester,MA 01608 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 753-7233 INSUREDINSURERS AFFORDING COVERAGE NAIC 0 RCG LLC INsuRERA: Philadelphia Insurance Companle 23850 17 Ivaloo Street,Suite 100 INSURER B: Wesco Insurance Company 25011 Somerville,MA 02143-3656 INSURER C: 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. TYPE OF INSURANCE POLICY NUMBER POLICY LIMITS A GENERAL LIABILITY PHPK697768 03/20/11 09/20/12 EACH OCCURRENCE _$1000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CWMS MADE OCCUR MED EXP WW one per) $5000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-cOMP/OP AGG s2.000.000 POLICY JECT El PRO LOC AUTO11081LE LIABILITY ANYAUTO COMB;SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY $ (Per per ) HIRED AUTOS NON OVVNEDAUTOS BODILY s L (Per accident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EAACC S AUTO ONLY: AGG $ E71:G'EBSIUMBRELLA LIABILITY ED OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND W WC302159S 05!15/11 05J15/12 X srAru orH $ EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER11EXECU7ryE E.L.EACH ACCIDENT $W0,000 OFFICERI turd r EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 I desor�e un� ECTAL OTHER IONS below EL DISEASE-POLICY LIMB 5500 OOO DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment / SHOULD ANY OF THE ABOVE ABED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSIJING INSURER WILL ENDEAVOR TO MAIL _ n DAYS WRITTEN 1600 Osgood Street HOT=TO THE CERT"WATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF/MAY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/OS)1 of 2 #IS218272/M218270 GCE 0 ACORD CORPORATION 1988 OFFICE OF BUILDING INSPECTOR 3� TOWN OF NORTH ANDOVER :y a � CONSTRUCTION CONTROL PROJECT NUMBER: 218410072 PROJECT TITLE: FRSExpansion r PROJECT LOCATION: East Mills, Water Street, N. Andover NAME OF BUILDING: Building 3. 3rd Floor NATURE OF PROJECT;Corporate Fit Out IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1,Lind@ S. SMilev REGISTRATION NO. 1 t Q8Q 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, m 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. v 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 qualitycontrol procedures for all code-required OrNHH controlled materials, C 3. Be present at intervals appropriate to the stage of construction to become,generally familiar'3 witMhe progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. � ,r, �::Fxt,, r;j; • PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTs 'f UPON COMPLETION OF THE WORK, I SHAD.SUBMIT A FINAL REPORT AS TO THE SATi$FACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCC PANC . SUBSCRIBED AND SWORN TO BEFORE ME THIS _DAY OF SIGNATURE 14 .21 NOTARY PUBLIC MY COMMISSION EXPIRESI,4�,/J5-