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Home My WebLink AboutBuilding Permit #177 - 120 WATER STREET 9/9/2008 BUILDING PERMIT p� NORTH �t,.eo 6�ti0 TOWN OF NORTH ANDOVER ?Abp: op APPLICATION FOR PLAN EXAMINATION , Permit NO: / Date Received 0"t"�y �SSACHU`�� Date Issued: e IMPORTANT:Applicant must complete all items on this page MAIN,go'61 ftl-1114 01 s C T am= '-0i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial Alteration No. of units: El Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'k"Wtp,PIZ 52� N I'M Ron, s DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) Z n OWNER: Name -a 1&CY,C41 Phone: 1-7 Address:--\ �� -�V Z3-f tay-VI `NAM ? ON � lot MR k Mr w r ARCHITECT/ENGINEER �� _� ( Phone: 6 l �1 - $ Irl ` 2.-- Address: ` olv— �i'lS l� � l �v � Reg. No. 0 Lr-L— FEE SCHEDULE:BULDING PERMIT:i$12.00 PER 1000. 0 THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. al Project Cost: T FEE: $ '" "- � > > u" . TotS Check No.:- 0-3 b -�� 3 -� Receipt No.: NOTE: Persons contracting withl unregistered contractors do not Have access to the guaranty fund Srgt��re�af't�gen�0u►�ne , � � � � �� "�' �� i .. . _. r_..�.. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED I PLANNING &_DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS F DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Y 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/S9nature& Date Driveway Permit Located at 384 Osgood Street a �eD�*fai � �gln��ire Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use 0 Notified for pickup - Date _....... _._._..._.._...__.._......f..........._......................... ......_..........._........._...__......._.._..._......................._.........._....__..............._....__.........._.......__...................... _ r , Doc.Building Permit Revised 2007 - i Building Department 1 The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application L3 Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ 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 I Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 1 u 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 o Certified Proposed Plot Plan o Photo of H.I.C. And'C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit + In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal,period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. 77 Date 711 0r NaRTM TOWN OF NORTH ANDOVER ..o Certificate of Occupancy $ s�cNus`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # C7 ?fie ' 2 491 Buil ing Inspector Location /c2"�9 No. Date /;7 r .ORTM TOWN OF NORTH ANDOVER �. A C7d • i + Certificate of Occupancy $ f cMuBuilding/Frame Permit Fee $ s� sa Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 01? 21616 ' x/ / Building InspeEor portrN M 1gs 1CNU5�� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number177(9/9/08 Date November 122008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 120 Water Street - Phoenix Tech MAY BE OCCUPIED AS Commercial Office Tenant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG North Andover Mills 120 Water Street North Andover Ma 01845 U 6u-, Building Inspector i V4®RT H ® of over No. 177 p.*•. yJ �( 0 o dover, Mass.,- 0 -- LAKE �, T COCKICMEWICK V 7�ADRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... �d( ...../.. '......��.......?. ?`.G..l�.... ... : 1.1.�.......... �.`........................ Foundation has permission to erect........................................ buildings on ... �.. ... :. .. �". ................................... tobe occupied as......... 2_w. /71 (rl,�...................... .$.... '�, .r�+......`... ,! ... Chimney provided that the person accepting this permit shall in ivery respect conform to the terms of the application on file in final h provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of ' this office, and to the p y g p ��` Buildings in the Town of North Andover. LUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids.this Permit. Rough Final PERMIT EXPIRES IN.,6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTSou / , 1 /7-40 A,( Service BUILD' SPECTOR Fin /-L 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 (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. =� SEE REVERSE SIDE smoke Det. 013t DO KHALSA DESIGN INCORPORATED Architects & Engineers 17 Ivaloo Street, Suite 400, Somerville, MA 02143 p.617-591-8682 /f. 617-591-2086 s\ FINAL - ARCHITECTURAL AFFIDAVIT November 6, 2008 Town Of North Andover, Inspectional Services Department North Andover, Massachusetts RE: Phoenix Technologies, 120 Water Street 3'd floor, North Andover, MA 01845 building permit#177 Khalsa Design Inc. has visited the above referenced project during the construction period, and has provided construction related services in conformance with the Massachusetts State Building Code, Controlled Construction Section, 780 CMR §116.0. 1 verify that to the best of my knowledge, information and belief, that the building has been constructed in substantial conformance with the construction documents for the project. The detection of, or the failure to detect, deficiencies or defects in the construction during review by this office does not relieve the contractor or its subcontractors of their responsibility to correct all deficiencies or defects, whether detected or undetected, in all parts of the work, and to otherwise comply with all requirements of the Construction Documents. D.ARCS c� IGH KKyq Fc� S' erely Yours, �`` �� 7 n No.6042 CAMBRIDGE ?� MA O� oy�ALTH OF MP�'�Q, ai Singh K ARB Mass Registration Seal #6042 i i KHALSA DESIGN INCORPORATED Architects & Engineers 17 Ivaloo Street, Suite 400, Somerville, MA 02143 = p.617-591-8682 /f.' 617-591-2086 MECHANICAL FINAL AFFIDAVIT November 6, 2008 Town Of North Andover,Inspectional Services Department North Andover,Massachusetts RE: Phoenix Technologies, 120 Water Street 3rd floor, North Andover, MA 01845 building permit#177 Khalsa Design Inc. has visited the above referenced project during the construction period, and has provided construction related services in conformance with the Massachusetts State Building Code, Controlled Construction Section, 780 CMR§116.0. I verify,that to the best of my knowledge, information and belief,that the HVAC system has been completed in accordance with record drawings on file in the owner's office. The detection of, or the failure to detect, deficiencies or defects in the construction during review by this office does not relieve the contractor or its subcontractors of their responsibility to correct all deficiencies or defects,whether detected or undetected, in all parts of the work, and to otherwise comply with all requirements of the Construction Documents. Sincerely Yours, Alfred M. Marzullo PE, CPD Mass Registration Seal#40660E KHALSA DESIGN INCORPORATED Architects & Engineers 17 Ivaloo Street, Suite 400, Somerville, MA 02143 p.617-591-8682 /f. 617-591-2086 ELECTRICAL FINAL AFFIDAVIT November 6, 2008 Town Of North Andover, Inspectional Services Department North Andover, Massachusetts RE: Phoenix Technologies, 120 Water Street 3rd floor, North Andover, MA 01845 building permit#177 Khalsa Design Inc. has visited the above referenced project during the construction period, and has provided construction related services in conformance with the Massachusetts State Building Code, Controlled Construction Section, 780 CMR §116.0. 1 verify, that to the best of my knowledge, information and belief, that the building has been constructed in substantial conformance with the construction documents for the project. The detection of, or the failure to detect, deficiencies or defects in the construction during review by this office does not relieve the contractor or its subcontractors of their responsibility to correct all deficiencies or defects, whether detected or undetected, in all parts of the work, and to otherwise comply with all requirements of the Construction Documents. Sincerely Yours, �a�jViOFQ,,q MW NOL.409M I • Y Alfred M. Marzullo PE, CPD Mass Regi eal #40660E a VkORTH _ ® o over No. ® ww. . �. Vt 1077 LAKE do y dover, Mass., `'"' T O T COC MIC/iEwICK y1. �oRATE D ►Pa�`� v BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D M'nl BUILDING INSPECTOR THIS CERTIFIES THAT........... ..... ...��.... .... /. .. .. .. . ... .................................... r Foundation has permission to erect........................................ buildings on ... .. ... v....... _ ... Rough x �� J.- to be occupied as........ z-- !' .%d ... ..-.......................F#��Wz.x......7e�<> ... imney ,� Ch' provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN ,.6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough . ... BUILB SPECTOR Service Final Occupancy Permit Required �o Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry.Wa�11 To Be Done FIRE DEPARTMENT Until Inspected and Approved .tiV the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. BUILDERS Standard Form of Agreement between Owner and RCG Builders LLC where the basis of payment is the Cost of the Work Plus a Fee without a Guaranteed Maximum Price Date: _ 10 Owner: { Y' rg � r.. Contractor: . ��YN4� s� ��Wsn�jt• �Y'r,�k3��Sid� 8sy, 8`'F S 4+ rt Architect: y t £ 1 � z: r g � , x Project Name: epee � s f 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 7 BUILDERS 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: ..y, Type of Insurance Limit of Liability dt � r�z 3 baw.«F�� A. <a "k1 �,.ll „� ��Y.mr. Mull 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: �`a,,,: A `�.� �n• �': :' .a° '��S"a�._:i ;�.... 't('• ,... m 3`y v t f d ....,,�„ u%,: � ' `>:•. K 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. 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 7 BUILDERS 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. The hourly billing rates effective 1/1/2007 are shown below. 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 shall be charged directly to the Owner without a fee. Employee Rate David Steinber h $125/hr Skip Rose $125/hr Mike Bernier $125/hr Kieran Whelan $125/hr Ken Shea $100/hr Jason Downing $50/hr Page 3 of 7 BUILDERS 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. 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: :: 0��.of�b�led os` P"�'�n�e`s�� ►,�s�� o�� .� :�� :, � � 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 7 I BUILDERS 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. 01,74 1100 M m,... 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: / �� p e" i 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 7 BUILDERS 4. Signatures The Owner's representative is: W!1 WIV, an.a I1'e,G i § 14.4 The Contractor's representative is: ie �(} 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 Co ctor , Si nat re Signature '�' LL4 S S�� Printed Name and Title Printed Name and Title Page 6 of 7 BUILDERS Exhibits Exhibit A: Estimated Cost of Work Exhibit B: Drawing Page 7 of 7 M2, FD 5932 Date TOWN OF NORTH ANDOVER RECEIPT CHU This certifies that • ,,gam ........ has paid...... for Received bycD_,,,,,a L) Department ...... Ilk WHITE: Applicant CANARY:Deaartment PINK:Treasurer r i, .. ✓Iw6 V�?7britGfDtl4Dlu[sl _�i✓6LCSddt' IQ11�' " - . Board of building Reguiatio s and Standards P a Construction Supervisor License q License: CS 66334 Sirthdato: 9/26/1958 j, Expiration: 9/28/2009 TO 3980 i _.. Reside 00" 00," KIERAN T WHELAH 31 RICHMOND ST'S WEYMOUTH,MA 02188 Commissioner ;i r NOTICE N, CE T4 TO LOYEES EN[PLO YEES EMP . The Coonwealth of Massachusetts DEpA,RIWNT OF INDUSTRIAL ACCIDENTS w Washiungton Street,Boston,Massachusetts 02111 617-727-440(! d by Massachusetts General Law,Chapter 152, Sections 21,22& 30,this will give yon ZirTthnar t 1(we)have provided for payment to our injured employees under the above mention' chapter by insuring with: . ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE P.O.BOX 4070 BURLINGTON.MA 01803-01370 ADDRESS OF INSURANCE COMPANY woo 9005531012008 05/10 05/l0{ZA09 EFFECTIVE DATIE�i IPOLICY NUMBER 24 Federal Street 4th Floor HONE Boston Insurance lirokerage Inc Boston,MA 02110 P55&7�� NAME OF 14SURANCE AGENT ADDRESS PHO RCG Builders LLC 17 Woo Strw-suite 10u SomeM11%MA 02143 EMPLOYER ADDRESS 0311 Ot2008 EMPLOYEE'S WOBKEItS COMPENSATION OFFICER(IF ANY) DATE The above named hower is required in cases of personal h*uies aril oat of and is the course d amp t tg fitruisdt adequate and reasonable hospital and medical services in accordance with the pmvisim of the Workers COMPeo lion AeL A copy of the First Report of hairy mit 6e given to the injoed emplogee. Theoyee meq select his or her own pbs. necessary The reasonable,cod of the provided by the tremas Physician wHl be paid by t)l�e insurer,d the trestnceat Is Mw ressouft comeeted to the work related hijury. In eases requiring hospital atten"eruplogees are hereby t OtMd Me the tnsttrer him arranged for arch attention at dw NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER BUILDERS Phoenix Technologies 21 High Street North Andover,MA SCHEDULE OF VALUES 08-Sep-08 Spec Section Description Estimated Amount 02050 Demolition $4,180.00 06400 Millwork $720.00 08080 Doors and Windows $1,600.00 09250 Gypsum board $9,712.50 09650 Resilient flooring $1,276.13 09680 Carpet $15,242.00 09900 Painting $5,500.00 11400 Food Service Equipment $550.00 12500 Furniture&Accessories $45,000.00 15300 Fire Protection $2,500.00 15500 HVAC $3,000.00 16160 Electrical $4,500.00 TOTAL PROJECT VALUE: $93,780.63 Permit Rate: 1.2% PERMIT FEE: $1,125.00 Permit Affidavit Project Number: 27300 Project Title: EAST MILL Phoenix Technologies) Project Location: NORTH ANDOVER MA Name of Building: TWENTY-ONE HIGH STREET Nature of Project: COMMERCIAL TENANT FIT-OUT . -I In accordance with section 116.0 of the Massachusetts State Building Code, I Alfred M. Marzullo Registration No.4 dolfbeing a Registered Professional Engineer/Architect hereby certify that I have prepared of directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project HVAC—X Plumbing X Fire Protection—X Electrical—X Other(Specify) For the above named project and that, to the best of my knowledge, such plans computations and specifications meet the applicable provisions of the . Massachusetts State Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standard listed in Appendix B. Pursuant to section 116.2,3 1 shall submit periodically, a progress report together with pertinent comments to the NORTH ANDOVER Building Inspector. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. IV%o ALFRED Ms. 6i AR7-ULL0 '° p No.40660!. Signature and S p 'Oq <` "' Date ;:. On thisctl'k day of – �, 0 "-'fore me, the undersigned notary public, personally appeared ,L�, NMZALLCI� (name of document signer), proved to me through satisfactory evidence of identification, which were't*CE %p(�o be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its' stated purpose. guru Eo AcUiag Notary Public *Commission 6q)ires October 27,2011 My commission expires OTARY PUB Permit Affidavit Project Number: 27300 Project Title: EAST MILL Project Location: NORTH ANDOVER MA Name of Building: TWENTY-ONE HIGH STREET Nature of Project: COMMERCIAL TENANT FIT-OUT In accordance with section 116.0 of the Massachusetts State Building Code, I Jai Sing Khalsa Registration No. 6042 being a Registered Professional Engineer/Architect hereby certify that I have prepared of directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project HVAC Plumbing Fire Protection Electrical Other(Specify) ARCHITECTURAL For the above named project and that, to the best of my knowledge, such plans computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standard listed in Appendix B. Pursuant to section 116.2,3 1 shall submit periodically, a progress report together with pertinent comments to the NORTH ANDOVER Building Inspector. Upon completion of the work, I sha11 su t a final report as to the satisfactory completion and readiness r occupanc wtp ARCy/P H K/yq Fc� Q g ! No.6042 w */ MgRIDGE v Signature an tamp �o MA Pv� Datt ff 2�FAC TH OF MPSI On day of vsi- e me, the undersigned notary public, personally appeare (name of document signer), proved to me through satisfactory evidence of identification, which were )�W(V w3 No M-Q , to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its' stated purpose. My conimnission expires OTARY LIC Sora E.Addieg Notary Public commonwealth of WassachuseM p✓ My commission empires pctober 27,2011