Loading...
HomeMy WebLinkAboutBuilding Permit #200 - 120 WATER STREET 9/15/2009 OORTH q BUILDING PERMIT o t'-ec ti 6 TOWN OF NORTH ANDOVER c - - °� APPLICATION FOR PLAN EXAMINATION Permit NO:� ®D Date Received e, R,T.o 9SSACHus�� Date Issued: �S IMPORTANT:Applicant must complete all items on this page µ a LOCATION . Yt s.E pri at , PROPERTY OWNER A, � ..-`. e.. =, Print MAP NO L, `PARCEL: ZONING.DISTRICT` Historic District . es no .e y - z v� _ phihe Shop Village es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addi 'on Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed Distract Water/Sewer.-� .- DESCRIPTION OF WORK TO BE PREFORMED: F C- �a r d,lw� �a lv 17'i0-tx' Identification Please Type or Print Clearly) OWNER: Name: � tgyl ® ri Qom-ci-t-c Phone: b Address: - �.- �cr-(a' � I� (�2 L zt-- _' CONTRACTORRame: + Z Phone: , Address: C { M 5"110It Supervisor's CoOstruction License: Expw Date: Tell/ �. Homb Improvement License: Vit- 'C Exp. Date: 6l - •, , ARCHITECT/ENGINEER � ' t Phone: Address:3 b "s�'� , u Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000,W OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -'�''� O ` FEE: $ L i l:� 04- 0" U 0 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignatu`re sof Agent/Owner — -- Signature of_contracto-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 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 Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Loc ted 384 Osgood Street FIRE-DEPARTMENT -Temp Dur Aster on site: fires a no Locaied.at 124=Main Street F1re Department signature/tat COMMENTS . _� 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 c M I f ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 j 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 L3 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 o 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) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off-from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) f ' ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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) Li Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit. In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. X00 Date G NORTH TOWN OF NORTH ANDOVER f. 3? •. • o _ w i 9 �e Certificate of Occupancy $ Eta' Building/Frame Permit Fee $ a� T���l a0 Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �9 22412 Building Inspector B ` v 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: July''22, 2009 ,.. F( � '- Owner: RCG North AdoYerIMill§�" LC LM .. I ,, Cto,RC C �, ..3313. 171va1oo Street, SuiteA0.0" Somerville,3MA.02143 r ,3 Contractor: RCCBuilders'LLC „� V I4a1oo Street Suit-`IP 0 " 3 Somerville, MA 02143 ;; Architect: Burt':Hill ... Project Name: ERS ,100 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 y 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: Type of Insurance Limit of Liability Commercial Gene'ralLiab"ilt $1,0{10;000 N Upon request, and at the cost of the Owner, the Contractor shall obtain a performance bond up to the total Cost of Work. Such costs shall be added to the Construction Volume. The Contractor understands that the Project will be financed by a construction lender and, then, by a permanent lender. The Owner may assign any of its rights under this Contract to the construction lender and the Contractor hereby consents to any such transfer provided no such assignment shall relieve the Owner of any of its obligations under this Contract, unless agreed to in writing by the Contractor. The Contractor shall execute any certificates, lien waivers, releases, receipts, and other documents as may be reasonably required by the construction lender or permanent lender including a subordination of its mechanic's lien rights to the construction lender's and permanent lender's mortgage or deed of trust. The construction lender for the Project will be.- Obligations e:Obligations of the Owner: The Owner agrees to furnish or approve, in a timely manner, information required by the Contractor and to make payments to the Contractor in accordance with the requirements of this Agreement. Dispute Resolution: Claims, disputes or other matters in question between the parties to this Agreement shall be . resolved by mediation or by arbitration. Prior to arbitration, the parties shall endeavor to reach settlement by mediation. Page 2 of 6 I ` BUILDERS 2. Contract Sum Cost of Work: The Contractor shall provide a detailed estimated Cost of Work to the Owner(see Exhibit A). The sum of these costs, including the fee is as shown below: °x$,2 616 23, _ 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 Mike Bernier $125/hr Kieran Whelan $125/hr Jason Downing $50/hr Page 3 of 6 z BUILIDERS 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: x'10%"ofbilled costs unless otherwise approbtherOwner ,,,.,, a 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 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. ;,Au ust"28"200' nor such,t me that Notification to Proceed%. by.Owner 9 ., 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: DateMof Substwial'Com let&A6 be no later than December 1X2009 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 BUILDERS 4. Signatures The Owner's representative is: David'`Steiribergh, Prncipaf RCG LLC 17 tualoo Street, Sute'100'. 3 3 3 d 3 1 f fif£ ate$,.' SomervilleMA 0214,3 § 14.4 The Contractor's representative is: Kieran Whelan RCG:Builders LLC 't7 IvI alon street,�S-dffi 100' Somerville;'VIA 02143 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 Signat4fre Signature ,rJ 1%S K*q-^r N t f Cel J c fj c? Printed Name and Titlb Printed Name and Title I' Page 6 of 6 ERS F Schedule of Values 8/27/2009 Demolition $10,500.00 Frame walls and workstations $10,000.00 Drywall &tape $12,000.00 Prime and Paint $12,000.00 Doors &Windows $53,000.00 Carpet(8,000 SF) $18,000.00 VCT (1,000 SF) $3,500.00 $ Vinyl base $2,000.00 Cabinetry& Countertops $10,000.00 Bookshelves &Trim $10,000.00 Plumbing $2,500.00 Sprinkler Work $2,000.00 Electrical $20,000.00 HVAC $36,000.00 Cleaning & dumpsters $6,000.00 Sub-total $207,500.00 RCG Builders fee $31,125.00 Insurance $2,386.25 Total $241,011.25 Building Permit $2,904.00 Total Construction $243,915.25 OFFICE OF BUILDING INSPECTOR * TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 07804.15 PROJECT TITLE: ERS, INC PROJECT LOCATION: EAST MILLS, HIGH & WATER sTREETS, NORTH ANDOVER NAME OF BUILDING: BUILDING 11 SECOND FLOOR NATURE OF PROJECT: RENOVATION FOR TENANT FIT-OUT IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, LINDA SMILEY REGISTRATION NO. 10080 BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL I_X 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 £PRESENT 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 become,generally familiar with6thepprogress and quality of the work and to determine, in general,if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, 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 OG PANCY. • *IGNATIU�2RlE SUBSCRIBED AND SWORN TO BEFORE ME THISZk91:f......DAY OF l0 NOTARY PUBLI MY COMMISSION EXPIRESLlg�- f;c.ACXS KHALSA DESIGN INCORPORATED Architects & Engineers 17 Ivalon Street, Suite 400, Somerville, MA 02143 p.617-501-8662 l f. 617-601-2066 All ELECTRICAL, FIRE PROTECTION, AND MECHANICAL DESIGN AFFIDAVIT September 11, 2009 City of North Andover, Inspectional Services Department North Andover, Massachusetts RE: ERS Inc. 120 Water Street, North Andover MA 01845 Khalsa Design Inc. will visit the above referenced project during the construction period, and 9 p J 9 p , provid 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 will be 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. Final AS Built plans will be submitted. Sincerely Yours, '3 OF ALFRED MRRM?-0 ; Alfr d M. Marzullo P C`A ;rte`" Mass Registration Seal #40660E Then personally appeared above named Alfred M. Marzullo made oath that the statement made by him is true. Before Me, 1. Nota Pub� �e � amEMS Name Commission Expires 1 '"DUnairmeaft ofMan ch ejr D u •ie�rt of fRd�rial.Acride>,� , jrce ofinvest irs a Soso , MA 02111 errkera' C°°aPOatioa fresin once.Affidavit; $tcW= . drat Lafag. eatriciffeel�amben N Plate Pr6i `bIV c C. Addreai' d� . . Ciiyl;ste / ; -�� ric esr I !Kj O A re C110*1he a pmp�bor: MkYw wifh 4. TyPa ofImn a gareerat cmftaetor and I rNo f +ll and/ar pa=t-timc).* have bid du. 6.. [j')dewmon . olepr .ar.p�a. r�on,t�nitsrhed 60a]eve no pI '1 � srtractoa _ �• QRaaoaeiiag far rae a,eary cv iF*, Woricew �jmurffiue. a' [�rNo s. WeamSmr and ifs • l additionhave f� Io.p.• naomeownzr o�mg sA�►orlc ��'additiona. Myself o.w of imper MOL' 11.Q or��.. .c. t j�' §.!(4�.at�dlwe have rro I2.II� ' T� a�aiE;anc • rp a►ye aL[NO workme � . =.rqm. ismmmc:c raquircd.] I3.(].Odrer' `t+fi'�pimeae�r bcnC�i react tlao Sti odify� ,�, • t Hoioso who s�adt mdte�ng B ey ais �owiQg dtOir�vortkart' pg6Y . c that a6��ba=rmntemu�Q� � •end 8ma hde owide timet�rbaa$aae�r a ' add tiorml alraeF dm !'mal ern ean�rer�$ rvarlf ss•` «crimes �`— I cc��Nat.. >k Pony 6 or Self-ms.Lir.#: . e-C- YL, I3afa f D ,tQ Sob S Aadz�ss. _p -DC7 Atdao6 a copy of Me WOrtcet '' MID d v� O l do �- .�mpea'raliont . Policy d�eclat�, 5raa Per o6wim a me po fillt I=surae to secatfe conte tmdar Sm:dcm 2SA of MCIL c• 152 can load to position amber aad.e � Up I,SDaDO andlor one-year mpnsomrrart;as well ass onnuml Pmm}tics of a In es to 25Q.00 a dasy the violator. Se d P in the fora►of a Mp WORK RIC O irroes'Ei 'ons dr$�t$ offhis RD£It and a fine � of�D �Py sta�snettt . IA for irtsuraszrz cavezage��� may be fiorwarded to tho-C�of I do lrer�ebp ander&C . �+dp�ea al,P�+y ryrat,fbe . S• Ohmadoa pvwded s fte ¢enffi �$ l me only. Do not wj7e:ia.fk&&rcj;�be wed by a*ar m,om�rMad — Cssy or Tm me Ewuipgg Aa#6o ' (curie oee)t: Pose L Board orHeaf 2. C Other B 'ag p 3-City/7'0"Qer* 4 M=Wical Iasptrtnr 3 P �I:rapec�or Contact Fernery Phone#: rigMassachusetts- Department of Public Safety Board of Building Regulations and Standards Fconsti•ubtibn Supervisor License -License: G8 66334, Re§tticted-to QQrk �x�. "KIERAN T�WHELANr, • 31 RicHi OND 5T WEYMOUTH' NIA o-2188' ai-- - -0' Expiration: 9/28/2011 C'�mmicvinnec' r Tr#: 3612 R Ctlerft 35SO RCGBU ACORD- CERTIFICATE OF LIABILITY INSURANCE 051220109"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 306 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WORCESTER,MA 01608 508 753-7233 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated Employers Insuranee 21865 RCG Builders LLC INSURER B: do RCG-LLC INSURER C: 17 Ivaloo Street,Suite 100 INSURER O: Somerville,MA 02143 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. INUR;w LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P°Lr EXPIRAnON UMR3 DATE(MMIDDlY)n DATE IMMMD" GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LLABILfTY DAMAGE TO RENTED $ CLAIMS MADE 0 OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ KENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY MFT M LOC AUTOMOBILE LUIBIUTY COMBINED BISINGLE LIMIT. $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (per ) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accidern) $ PROPERTY DAMAGE $ (per acadwq GARAGE LIABILITY AUTO ONLY-FA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WCC5005531012009 05/10/09 05110/10 X WC STATu- DTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $5OO OOO ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $500,000 Ii yes,descdbe under SP IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRIL7M For Informational Purposes DATE THEREOF.THE IsswNG INSURER WILL ENDEAVOR TO HAI. l_ DAYS WRmEH NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT,BUT FAQ TO 00 SO SHALL IMPOSE NOOBLIGAIM OR LABILITY OF ANY NNID UPON THE tNSI@REIt,ITS AGENTS OR ATIVES. AUTHDRMDREPRESMATM ACORD 25(2001/08)1 of 2 #S158999/M158998 GCE 0 ACORD CORPORATION 1988 XAORTH '9 Town of : Andover �d = o © dover, Mass., COCMICKEWICK �d ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..........6cJ �,.. .. .. c...........................:............... ,4.. Foundation has permission to erect........................ buildings on �D g /................................. .......... ough to be occupied as................7E n�,�At,?' � .v, '..............:.... J..... . .. /Y.� .!!Cs°I'�ce �o provided that the person accepting this permit shall in every respect conform to the terms oft application bn 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. I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT, EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough .. ........1. 0000:;;;.r4�X .. .......................... Service BUI Dll�IG INSPECTOR Final OccupancyPermit 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 SIDE Smoke Det.