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HomeMy WebLinkAboutBuilding Permit #815-12 - 1211 OSGOOD STREET 5/14/2012 BUILDING-PERMIT f NORTH TOWN OF NORTH ANDOVER '!'`-st"eO". 0 6 pp APPLICATION FOR PLAN EXAMINATION o ' .r Permit NO: Date Received ° "0 04y Date Issued: /`/ ��SSgcHus �y l v l IMPORTANT:Applicant must complete all it on t -tka .; - �.: ., �• - ems_ his page a 1..`z r•rt :_ .a.._.c ,-.k;:....4�,. ...._,::,.f'�x.i:_�,g:,_..- _7��' _` _:_. ... - +..=ti• - a..1..it.' :���C:iici:�'iz'i�iv�•!�yl.:�_LL: 4 �-p-:. - - ^'{'";- moi.•:_- :;f�.i�� _-. 'G' _ ... .... ..;%.._:�':�. I•"> �,• °."�i.,:..� - -•-".I,'..._�"�.''-_�.-•�:-„_ ,,_. �ci:-:- _ fir' _ _ f.�..(-n.s1 .a_-..4' ._ .>:F: � .. 7 Y_.l�k .._ it..i.''� �"SW-•-J...:y�._. ..._.`k-,�_ _ - _ _ _ "'.�tr''L:9>..h:j�>'�:r�,'-.� .-.:1.,.,,� 1. - -__ - �_ � - :Y"5,"!-'1 1i4�. _ ='•'�`... ^'�� �,'''- --.f.-c- - ..,�..1i_:. 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TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential TYPE Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Demolition Other Others: �n.",�'t`.�-�i_f: _ •T,,:,yfca.�+.,.`'.:,-- c`'y`Y.�x r�S�:,:!�wci�.�7'}a;:�^ -3�:''sr' -.l.';,'k",�_ _ - _ �����fl -�„��,�O���z,�a;�4.'�' �r' `tr �",'����DS� la+l '�" $ } ; ,=y" '�"rgr�• "-� �_�,; � 'mac>'�•� �; i:,�"` I iii J� ..� '°'`�'�o-'��+1L��.��{lu�..�'-�s'S�"i.' , �-..� �:.;"u_:'s=::-^o'Fi Zl:-:._r. ��. - „��:': ��_y_.xx;'~..�• �1 Ncv.;.1..nc e,-p.. rt��":€,,,i2t�{c�+?:: _ _��`�,.:%c<�= >; ''-„�.,.ie��$.��+c�' ^7.�], w•*'�:.;y;b.a£s..,,,•�"}._ -C;�.�.._.nr 1:rr.,''�-_.r•,.'-,•'�: t-:sn� -'-='ir,:� Y¢ "',.tr ',--��"y�,�� � 5�� _- - ,:,5,._ ,..,..t�'_,;.,v%;Y...:;trr_ --ns=�'n',s�rm:�"_I�'�.-i?';✓':::_"`�-,�:;F�;�a't.�i-.''�"c'��`+��. ..T'.�':"z{':,�'��.y�'wt/,��2,,'��;�t!i}�3+�i�t�:'4[,3F� DESCRIPTION OF WORK TO BE PREFORMED: dentification Plea UeasType or Print Clearly) OWNER: Name: (,L Phone: Address: ,r n� '�#., �,`!_�ec.'s��.z� �t'�.s.^s �:�1.e�.fti•.:=:�'!�_. 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No. FEE SCHEDULE:BULD/NG PERM/T:$12.00 PER$9000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ���. 00 FEE: $ 76o- &-o Check No.: Receipt No.: ,-29 iL- NOTE: Persons contracting with unregistered contractors do not have access to th aranty fund � 'nnnz ui fb rA- e - � r __- t:•{= = z ;sem, - � ......-.:.._. .4_....--_' ---ter��' � �"---�•k.+�"`��'”-`.���.� - Plans Submitted Plans Waived Certified Plot:Pian Stamped Pians TYPE OF SEWERAGE DISPOSAL 1 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: Located 384 Osgood Street .. nYR -, EjP7o►��'�l��T.��` ..:. ..r :.•; r.. ............._. .:..�...,.�..:,.=-�..,-. �:•::'mss::'� - - - - L>ocated _�� 11a�n tree - -- f.9 f- z - : ..._. :•qq:':....r,.[ ':..gin::^.a n._^.�{..t:r:.Y.fr:s, - - - - - - �� na' rye/date=� - p _ r_.. _ !t I 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 ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 r ❑ 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 ...c•t• r n.._ lot n� ❑ -el tir led Pr uposed 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) ❑ 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:Building Permit Revised 2008 Location No. /^' Date S�/c • - TOWN OF NORTH ANDOVER • ���ci,t=,r�r,���` s Certificate of Occupancy $ iGU Building/Frame Permit Fee $ �• Foundation Permit Fee $ Other Permit Fee $ TOTAL Check 4 7 i 25296 Btii ai g Inspector 'iotF#3 'C i ,SSICHUSt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 815-12 on 5/14/2012 Date: October 2, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1211 Osgood Street MAY BE OCCUPIED AS office space—Allstate Insurance IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: 1211 Osgood Street LLC 61 Brentwood Circle North Andover, MA 01845 1 Builling Ins ctor Fee: Pre Paid Receipt: 25296 Check : 5087 OTi-j i 0 o f 6 over No. 00 N '1lorthAsidover, Mass.,- 0 CCf_MtC HE'-ICK .p Ao'?ArEo UBOARD OF HEALTH mu Food/Kitchen EL Septic System BUILDING INSPECTOR THIS CERTI S THAT.......... .......... ............ � Foundation buildin s on / has permission to erect........................... ......./4z ... ....... ........................... f Rough to be occupied as Chimney ... .. /P .. ... ............ ...................... provided that the person accepting this permit shall in every respect conform to the term of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 9) Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 3 = Final����'-/"Z D.•!R . - PERMIT EXPIRES IN 6 MON THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION 9TARTS ................................................... ................................... .................... Service BUILDING INS OR Final Occupancy Permit Required to Ocaipy Building GAS INSPECTOR Rough Display in'-a, Conspicuous Place on the Premises — Do Not Remove Fina, No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE NORTH Town 0 .6Andover ., - WO'L No. 77- 0 _=��A K E or, lover, Mass., �y COCHICHEWICK 7�S RATED U BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THISCERTIFIES THAT,................................. .........................................................................0................................................... Foundation has permission to erect........................................ buildings on ...IJ-12 !'!... -j ... ......;................................ Rough Chimney to be occupied as......... rr,t ��� 716- �� Q... .......................... provided that the person accepting this permit shall in Eery responform to the terms of the a lication on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nd 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 STARTS 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 Be Done FIRE.DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i Massachosetts-t}cpakinetil of Public.'iarvt - W(varcl of Building Regulations and Standar(h Construction Supervisor License t_kefl5e: CS 1821 DAVID P .GULEZIAN 428 K-EA,SANT ST N AN©&ER;MA 011145 �> E)W ration: 1QIW2013 a C u�srni ,i flrr Ti.: 4472 A Y �� : 'tJlit f 'tit" ' a� © , 'Po} } f Wi, $;. TOWN OF NORTH ANDOVER i Construction Control Affidavit j Project Number: Architect's Project Number: 12-053 Project Title: Allstate Insurance Tenant Fit-up Project Location: 1211 Osgood Street, Suite 3A(former Dream Dinners Space) North Andover, MA 01845 Name of Building: 1211 Osgood Street Nature of Project: Reconfiguration of existing tenant space into insurance office. Add two new accessible toilets, new finishes. In accordance with Section 107.6.2.1 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural X)000 Structural Mechanical Fire Protection Electrical Other (specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 8T" EDITION OF THE 780 CMR 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 107.6.2.2 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in Chapter 17. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the construction documents and this code. I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS TO THE 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. Signature and Stamp (no facsimile) SUBSCRIBE AND SWORN TO ME THIS w DAY OF '�_ 2012 MY COMMISSION EXPIRES NOTARY kILBOC 11 EW%71+)COMMONWEA:LTHOF A .PELICHNUBLIC MASSACHUSETTSM. June 11,2015 �C>R CERTIFICATE OF LIABILITY INSURANCE oPD xnm 09 09 11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policfiies)must he endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER !COME Macdonald & Pangione Insurance PHONE -------------- - __ P.O. Box 428 — -- ti4�N6f 104 Main Street ADDRESS:PRODUCER _ ,»north Andover MA 01845 cusfamERer DGCON-1�� Phone:978-688-6921 Fax_978-688-5350 INSURER(S)AFFORDWOCOVERAGE NA:CS INSURED INSURER A: Travelers Fsyp s Casualty CS 2567_4_ D G Contractin , Inc wsuRERa: Safety Insurance S 39454 - 428 Pleasant S - North Andover MA 01845 INSURER C: National Union Fire Vas Co of INSLIRER D: INSURER - INSURER E: i INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE P.FFORDED BY THE PMICIES DESCRIBED HERE4RI IS SUBJECT TO AL.L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PARD CLAW. IRTRSR i TYPE OF INSURANCE --- i Y EAP INSR POLICY NUMBER (fPOi IC YEFF {MdUp POLK-,YYYY)� u—-------LIMITS — ^T-- QENERAL U ABILITY t { EACH OCCURRENCE I s 1,00_0,000 AX1 COMMERCIAL cFxETZAL LIABILITY z-iso-lsS3als-f -is05/17/11�05/17/12 PREiWISES ) ►3 300,000 --- CLAIMS.MADE X j OCCUR MW EXP(Any one person) f$5,000 r - PERSONAL s ADV INMRY IS1,000,000 GENERAL AGGREGATE ;T 2,Q0 0,0 Q0 _ cEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMPA]P AGG s 2,000,000 I , I POLICY FX I,I CT LOC s AUTLNMOBILE LIABILITY t COMB24ED SINGLE LWT i (Ea ) !s a,,000,O QO { {ANY AUTO ' BOOILY INJURY(Pei person) is ALL OWNED AUTOS BODILY {Fes acc6derM S B ,X SCHEDULEDAUTCW- 3116553807/72/11 07/1.2/12 �Y, CE s B X +FIRED AUTOS (Per aif B X NON-OWNIED AUTOS - s UMBRELLA LIARHCLAFVIS-MADE� occL/R 4 EACH OCCURRENCE $ EXCESS LIAR j AGGREGATE DEDUCTIBLE f I S RETEMION s + S C WORKERS COMPENSATION NCO098 4107 03/31/1103/311121 X TINCS ATU- ITT ' AND EMPLOYERS'LIABILITY TS Y1N� ANY PROPRIETORIPARTNERIEXEC{JTIS(FT� 1EL.EACH ACCMEW 51,000,000 OFFICERIMEMBER EXCLUDED? 1 (N 1A ff (Mandatory in NH) E-L DISEASE-EA EGIPLOYEd s 1,000,000 describe under *'- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT j$ 1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES yUtacb ACORD iQi,AddRkwa1 Remarks SchadLde,if more space is mqured) Additional Insured Macomber Carpentry & Construction CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATWN DATE THEREOF,NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . _ --- AUTHORIZED REPRESENTATIVE Q 9988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD GENERAL NOTES. O I. THE GENERAL CONTRACTOR IGC) SHALL SUPERVISE AND DIRECT THE WORK. THE GC SHALL ---� PROVIDE AND PAY FOR ALL LABOR,MATERIALS.EQUIPMENT,TOOLS.CONSTRUCTION EQUIPMENT AND MACHINERY.TRANSPORTATION AND OTHER FACILITIES AND SERVICES NECESSARY FOR THE PROPER e7 ❑p EXECUTION AND COMPLETION OF THE WORK.WHETHER TEMPORARY OR PERMANENT AND WHETHER OR NOT N9RTHAlIQQ*,tE� ;3 INCORPORATED OR TO BE INCORPORATED IN THE WORK, ALL WORK BY THE GC AND/OR ALL mkI/ SUBCONTRACTORS SHALL BE COMPLETE AND PROPERLY INSTALLED IN ACCORDANCE WITH ALL d MANUFACTURERS RECOMMENDATIONS. THE SCOPE OF WORK TO BE COMPLETED 15 SHOWN ON THEj DRAWINGS OR CAN BE REASONABLY INFERABLE AS BEING REQUIRED TO BE COMPLETED EVEN THOUGH THE WORK MAY NOT BE SHOWN OR BE PARTIALLY SHOWN ON THE DRAWINGS. ALL WORK AND MATERIAL O SUPPLIED BY THE GC AND/OR THE SUBCONTRACTORS 1 SUPPLIERS SHALL CONFORM WITH THE CONTRAC REQUIREMENTS. ALL PRIMARY CONTRACTS AND SUBCONTRACTS SHALL BE GOVERNED BY THE REQUIREMENTS OF THE GENERAL CONDITIONS OF THE CONTRACT. 2. THE MODIFICATION OF THE ELECTRICAL AND DATA SYSTEMS ARE TO BE DESIGN/BUILD BY THE ELECTRICAL CONTRACTOR(EC). THE DESIGN SHALL BE IN COORDINATION WITH THE GENERAL • CONTRACTOR IGC) AND THE BUILDING OWNER±S REPRESENTATIVE IOR). THE EXISTING ELECTRICAL . SYSTEMS INCLUDING POWER,FIRE ALARM.EMERGENCY LIGHTING,ALARM SYSTEMS.DATA SYSTEMS.AND GENERAL LIGHTING SYSTEMS ARE CURRENTLY SEPARATED. MODIFY AS NEEDED FOR TENANT SEPARATION AND METERING AS DETERMINED BY THE BUILDING OWNER. PRIOR TO THE START OF ANY WORK THE EC IN EXIST. TENANT DEMISING COORDINATION WITH THE GC AND OR SHALL VERIFY THE PROPOSED LAYOUT AND DESIGN FOR THE . WALLS EXIST, BOX-OUT TO BE EXISTING EQUIPMENT AND THE ELECTRICAL AND CONTROL REQUIREMENTS FOR THE ELECTRICAL SYSTEM REMOVED- PATCH AND INCLUDE ANY AND ALL MODIFICATIONS REQUIRED AS PART OF THEIR SCOPE OF WORK. THE EC SHALL REPAIR REMAINING WALL COORDINATE HIS WORK WITH EXISTING CONDITIONS.AND THE NEW WORK AND WITH ALL OTHER TRADES. AS NECESARY 3. THE MODIFICATION OF THE MECHANICAL SYSTEMS ARE TO BE DESIGN/BUILD BY THE MECHANICAL CONTRACTOR(MC).THE MECHANICAL SYSTEMS.INCLUDING THE HVAC SYSTEMS MAY REQUIRE oo SAWCUT I REMOVE PORTION OF MODIFICATIONS BASED ON THE LAYOUT AND CHANGES IN THE LOADS.PRIOR TO THE START OF ANY E EXISTING SLAB TO EXPOSE EXISTING '1 WORK THE MC IN COORDINATION WITH THE GC AND THE OR SHALL VERIFY THE PROPOSED LAYOUT AND ¢N q WASTE LINE UNDER SLAB.TIE IN NEW NOTE. REPLACE CEILING DE51GN FOR THE MODIFICATION OF THE MECHANICAL SYSTEMS AS PART OF THEIR SCOPE OF WORK. THE ti. v ti TOILETS AND FIXTURES TO EXISTING TILES WITH MATCHING TILES MC SHALL COORDINATE HIS WORK WITH EXISTING CONDITIONS.AND THE NEW WORK AND WITH ALL OTHER U m a5"h 6 DRAIN WHERE REQ'D TYPICAL. TRADES. Z[n 'o m REMOVE EXIST. LIGHTS h c a AND ASSOCIATED 4. ALL WORK SHALL BE EXECUTED IN ACCORDANCE WITH THE LATEST FEDERAL AND LOCAL BUILDING � Q m¢ Q COMPONENTS CODES.INSPECTION AUTHORITIES.AND OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION(OSHA). U p rn REMOVE EXIST. LIGHTS -- 33 AND ASSOCIATED ��E:� 1.. 1 5. ALL WORK REQUIRING PATCHES TO EXISTING ADJACENT FINISHES SHALL MATCH ADJACENT FINISHES. z Fo 3 COMPONENTS I 1 OR THE ENTIRE ADJACENT FINISH SHALL BE REPLACED OR REPAINTED. DEMOLISH WALLS SHOWN SPK Sf K IN DASHED LINES 1 1 L. THE WORK SHOWN ON THE DRAWINGS 15 TO BE COMPLETED WHILE THE EXISTING BUILDING 15 OCCUPIED IN OTHER AREAS. THE PROPOSED DEMOLITION AND CONSTRUCTION SHALL BE UNDERTAKEN 1 REMOVE EXIST. *� WITH PERSONNEL PROTECTION.DUST PROTECTION AND OTHER PRECAUTIONS AS NEEDED FOR RENOVATION DEMOLISH PORTION OF WOPENING CREATE SPEAKERS AND IN OCCUPIED SPACE. ALL REQUIRED MEANS OF EGRESS SHALL REMAIN IN FULL OPERATION DURING NEW OPENI I NG ALL ASSOCIATED SPKR RENOVATIONS. TAKE ALL PROPER PRECAUTION TO PROTECT THE OCCUPANTS AND VISITORS FROM INJURY C COMPONENTS OR PERFORMED WTHYTHE EUNDERSTANDNGRFERENCE NTHAOTNTHEUEX115TINGG CSTRCTON. CFACILLIIITY WILL BE OPENNDURING ERK TO BE THE CONSTRUCTION. ANY REQUIRED WORK WHICH WILL CAUSE DISRUPTION TO THE ELECTRIC OR OTHER UTILITIES r- SHALL BE COORDINATED WITH THE GC AND THE OWNER 48 HOURS BEFORE ANY PLANNED DISRUPTION OF 1 REMOVE EXIST. SERVICES. r" HAND SINK 1 CAP PLUMBING 1. CONTRACTORS AND SUB CONTRACTORS ARE REQUIRED TO VISIT THE SITE PRIOR TO BIDDING THE U CONNECTIONS. O WORK TO VERIFY FIELD CONDITIONS AND TO BECOME FAMILIAR WITH THE SCOPE OF WORK REQUIRED AT I THE SITE.LIMITATIONS ON CONSTRUCTION.AND OTHER IMPACTS OF THE EXISTING CONDITIONS ON THE --- REMOVE EXISTING - WORK REQUIRED. FRP ON WALL SPKR 8. THE GENERAL CONTRACTOR AND ALL SUB CONTRACTORS SHALL GUARANTEE ALL LABOR AND z NOTE: REPLACE CEILING EQUIPMENT FOR A MINIMUM OF ONE (1) YEAR FROM THE DATE OF FINAL ACCEPTANCE BY THE OWNER- ¢ _. DEMOLISH PORTION TILES WITH MATCHING TILES N OF WALL TO FOR NEW WHERE REQ'D TYPICAL. +�. 9. ITEMS DESIGNATED ON THE DRAWINGS TO BE REMOVED FROM THE EXISTING SITE SHALL BE THE + z DOOR TO BE PROPERTY OF THE CONTRACTOR.AND SHALL BE LEGALLY DISPOSED OF.UNLESS SPECIFICALLY H/� i INSTALLED SPKR SPKR I REQUESTED BY THE OWNER FOR SALVAGE PRIOR TO REMOVAL. THE GENERAL CONTRACTOR SHALL IDENTIFY SALVAGE PORTIONS OF THE EXISTING BUILDING FOR USE IN FUTURE CONSTRUCTION PRIOR TO O 1 REMOVE EXIST. LIGHTS AND DEMOLITION. ASSOCIATED COMPONENTS EXIST. TENANT DEMISING WALL 10. THE GC SHALL ENSURE THAT EACH SUBCONTRACTOR BEARS HIS FULL RESPONSIBILITY FOR DAILY o CLEANING AND NECESSARY RUBBISH REMOVAL DURING CONSTRUCTION AND IMMEDIATELY UPON COMPLETION —' OF HIS WORK. 11. THE GC AND ALL SUBCONTRACTORS SHALL COORDINATE ALL OF THEIR WORK WITH THE HVAC. g REMOVE OR CUT I CAP PLUMBING L PLUMBING.FIRE PROTECTION.FIRE ALARM.ELECTRICAL.AND MECHANICAL/ELECTRICAL WORK WITH THE a F CONNECTIONS NOT USED IN NEW REMOVE 1 CAP EXIST. OWNER SUPPLIED EQUIPMENT. ALL SUBCONTRACTORS SHALL BECOME FAMILIAR WITH THE OWNER±S w w ¢ KITCHEN. REMOVE FRP ON EXIST. WALLS. PLUMBING CONNECTIONS. EQUIPMENT TO BE INSTALLED AND LOCATE AND INSTALL THEIR OWN WORK IN ACCORDANCE WITH THE REPAIR DAMAGED GWB OR PROVIDE REPAIR DAMAGED GWB OWNERt5 EQUIPMENT 50 THAT THERE ARE ADEQUATE FACILITIES AND UTILITIES PROVIDED FOR THEco ADDITIONAL 1/2" THICK GWB LAYER AS NECESARY OWNERiS EQUIPMENT. IF A COORDINATION PROBLEM 15 OBSERVED OR 15 PROBABLE,THE SUBCONTRACTOR J to[n LU SHALL IMMEDIATELY NOTIFY THE GC UPON DISCOVERY. THE GC SHALL NOTIFY THE OWNER AND THE ¢p p O /�� PLAN ARCHITECT OF THE COORDINATION ISSUE IN WRITING. s U WOO z Dt�MOLITIONPLA q 12. THESE DOCUMENTS ARE DESIGNED BASED ON EXISTING DOCUMENTATION AND FIELD INFORMATION. = � 0 u)U)¢ SCALE: t/e"-1'-0- 7 ALL VERIFICATIONS OF EXISTING UTILITIES.MANUFACTURERS INFORMATION AND DATA. AND DIMENSIONAL 1 a O w F VERIFICATION 15 THE RESPONSIBILITY OF THE GC AND SUBCONTRACTORS PRIOR TO THE START OF WORK. O`O w - THE GC SHALL VERIFY ALL LOCATIONS AND EXISTING INVERTS OF UTILITIES IN WHICH CONNECTIONS ARE g Q a-U Oz TO BE MADE. ALL VERIFICATION OF UTILITIES SHALL BE MADE PRIOR TO THE START OF CONSTRUCTION. y IF THE INFORMATION SHOWN ON THESE DRAWINGS 15 IN CONFLICT WITH OTHER INFORMATION OR THE LOCATIONS AND INVERTS OF THE EXISTING UTILITIES OR OTHER EXISTING CONDITIONS ARE IN CONFLICT OR E issue Nate. 5-10-2012 DEVIATE FROM THE INFORMATION OR DESIGNS INDICATED ON THE PLANS.OR THE EXISTING CONDITIONS DO _ NOT ALLOW THE WORK TO BE CONSTRUCTED AS DESIGNED.THE SUBCONTRACTORS SHALL IMMEDIATELY revisions: NOTIFY THE GC IN WRITING WHO SHALL THEN NOTIFY THE ARCHITECT IN WRITING. c 13. WHERE MANUFACTURES DATA AND INFORMATION DIFFERS FROM THE INFORMATION SHOWN ON THESE DRAWINGS.THE GC AND ALL SUBCONTRACTORS SHALL IMMEDIATELY NOTIFY THE GC AND THE ARCHITECT S or. chk. r ® 2012 GSD Associates,LLC . '.•:- 5 Um16 Eef4 Ml6X lBOR 0.16N 9FOYAb6EK VO 91E-EH[0eEG19O[ION[R9[9 OtY}I f¢0l91p�6-F1 1[Hd[IYO)A9[ - w NY IUI6WIIf9e W6[KH[IdII MRUO65[[[ RpYO[qll llE MDIp®pl[p4�.Q LL(MK RN pW[H 9[LL[i4A Y([[110DH[1[Q a job number- GSD-12-053 PROJECT LOCAT10nV D1. 1 S -- y --' -- ® QLD' �� — — — — LEGEND No.5688 ti NEW WALLS TO BE CONSTRUCTED Q ANWw X EXISTING WALLS TO REMAIN O � EX = _ = EXISTING WALLS TO BE DEMOLISHED A INTERIOR WALL TO UNDERSIDE OF CEILING GRID - UNRATED 'f? ql O O ROOM NAME AND NUMBER (SEE FINISH SCHEDULE) PLAN 101 113 5/8• GWB TAPED FINISH AND PAINTED ON BOTH SIDES OF STEEL STUDS FROM FLOOR 123 DOOR SYMBOL (SEE DOOR SCHEDULE) TO UNDERSIDE OF CEILING GRID i ACCESS TO COMMON B� WALL TYPE DESIGNATION SYMBOL (SEE WALL TYPE SCHEDULE)EXIT 3 I/2 SOUND INSULATION BATTS. TOILET AROOM YACC SS 1 3 5/8' STEEL STUDS AT O �• . HALLWAY 9 T/8 109 L FLOOR TO UNDER51DE OFCEI NG GRID. . BRACE TO STRUCTURE ABOVE ej Un i� co NEW TOILETS i E:l I5 -0IIS-3 I/8„+/- E FIXTURES :__________ NEW WALLS SHADED n2 N0oe” TYPICAL K INTERIOR FULL HEIGHT WALL - UNRATED U ;;� N LLLIIIoco o co CP a OFFICE#2 `4 N =IOoFNOFFICEARFJI PLAN 5/8 GWB ON BOTH SIDES OF STEEL ¢ t rnWilly-1- Q i STUDS FROM FLOOR TO UNDERSIDE OF � oaLET ATCH N4 ; it STRUCTURE ABOVE TAPED FINISH AND L>s O z F_ O CONCRETi6 PAINTED FLOOR 9 i i a_TOILET t i3 1/2' SOUND INSULATION BATTS. kOl "--.2102 _ _ 3'-0• Y-0 3 5/8' STEEL STUDS AT IC O.C.FROM FLOOR TO UNDERSIDE OF STRUCTURE ABOVE FUTURE WAus\� OPENOFFICEAREA 3 M -- 106 (N.I.C) 101 C C14 TOILET I X 1EXISTING WALL TO REMAIN � r IOT �n NEW TOILET 109 FIXTURES RECEPTIONItT O r 6 r CUBICLES-E5 Co BICICUBICLE 0 T° X 8ES 8 X 1 8 X T ° �� 10 co I NOTE: STEEL OR WOOD STUDS ARE BOTH ACCEPTABLE QS�� EXISTING WALLS r _ WALL TYPES ---------------"--_____________ ------------ H/W 105 PATCH NEW UNSHADED Q CONCRETE m FLOOR 9 TOILET C`+ WAIIIHGAREA O NEW KITCHEN COUNTERTOP 8'BICI ES 8'XCl ES 100 O IOL AND CABINETS EXIS ---- ----------�_ REF u i JAN z PLAN q scat£: r/s = r-o' I CARPET-ALL CARPET 15 TO BE NEW 28 OZ W/SYR GUARANTEE.ANTISTATIC.COORDINATE W/TENANT/OWNER SPECS. F INSTALL NEW CARPET IN AREAS INDICATED. CONTRACTOR SHALL COORDINATE. ALL CARPET TO HAVE UNITARY BACKING WHEN J F-a w AVAILABLE.ALL CARPET SPECIFIED IS TO BE INSTALLED PER MANUFACTURER'S RECOMMENDATIONS. ALL SEAMS MUST BE J U)> ROOM FINISH SCHEDULE SEALED. TENANT SHALL SELECT COLOR FROM SELECTION OF CARPETS TO BE PROVIDED BY THE INSTALLING CONTRACTOR OR ¢ O O GC. GC SHALL CARRY A UNIT PRICE OF$22.00 PER SY INCLUDING INSTALLATION FOR SELECTION. o (� LLJ O O z ROOM NO. ROOM NAME FLOOR BASE WALLS CEILING REMARKS: CPT-1: PATTERN/COLOR TO BE SELECTED BY TENANT 022.00/SY ALLOWANCE). - Q) 10 U)w CPT-2: PATTERN/COLOR TO BE SELECTED BY TENANT.($22.00/SY ALLOWANCE). ` .0 O O U)Fz- 100 WAITING AREA CPT- VB- PTD- EXIST. VINYL BASE-1/8•GAUGE VINYL COVE BASE 9•HIGH TYPICAL AT ALL AREAS.COLORS TO BE SELECTED FROM SAMPLES BY N O TENANT.INSTALL AS PER MANUFACTURERtS RECOMMENDATION. a O z 101 OPEN OFFICE AREA CPT- VB- PTD- EXIST. VB-(:JOHNSONITE VINYL WALL BASE e COLOR TO BE SELECTED BY TENANT 9 VB-2:JOHNSONITE VINYL WALL BASE n COLOR TO BE SELECTED BY TENANT E issue mate: 5-10-2012 102 OPEN OFFICE AREA CPT- VB- I PTD- EXIST. VINYL COMPOSITION TILE -I/8• THICK VINYL FLOOR TILE IN 12•X 11"SQUARES.FEDERAL SPECIFICATION 5ST-31113(1)TYPE IV, revisions: 103 OFFICE a2 CPT- VB- PTD- EXIST. COMPOSITION I.COLOR IN ROOM TO BE SELECTED BY OWNER.EXCELON COLORS AS MANUFACTURED BY ARMSTRONG WORLD § INDUSTRIES OR EQUAL. INSTALL PER MANUFACTURER'S RECOMMENDATION. 109 OFFICE al VCT-I: ARMSTRONG VCT EXCELON,COLOR:TO BE SELECTED BY TENANT CPT- VB- PTD- EXIST. VCT-2: ARMSTRONG VCT EXCELON.COLOR:TO BE SELECTED BY TENANT. 105 KITCHEN EXIST. VB- PTD- EXIST. EXISTING FLOOR. TO REMAIN STANDARD PAINTED SURFACES- ALL NEW WALLS WHERE EXPOSED WITHIN SPACE ARE TO BE PAINTED.ALL NEWLY PAINTED SURFACES ARE TO BE CLEANED.PRIMED WITH ONE COAT OF COORDINATED PAINT PRODUCT.AND TWO COATS MINIMUM OF THE 106 JAN. EXIST. VB- PTD- EXIST. EXISTING FLOOR TO REMAIN FINISH PAINT PRODUCT. ALL PAINTS SPECIFIED ARE FROM PITTSBURGH PAINT OR EQUAL.INSTALL PER SPECIFICATIONS AND _ MANUFACTURER'S RECOMMENDATION. dr. chK. LOT HC TOILET NEW VCT VB- PTD- EXIST. PTD-I:PAINT COLOR: TO BE SELECTED BY TENANT PTD-2:PAINT COLOR: TO BE SELECTED BY TENANT $ 0 2012 GSD Associates,LLC 108 HC TOILET PTD-3:PAINT COLOR: TO BE SELECTED BY TENANT = ama®auc¢®a¢uswvmuoanK NEW VCT VB- PTD- EXIST. PTD-9:PAINT COLOR: TO BE SELECTED BY TENANT s noon°a�uuc.omaa Kauwre I►990[-�[IH°06YJ 49°r 106)4 Rf[H 09 HALLWAY EXIST. VB- PTD- EXIST. EXISTING FLOOR TO REMAIN CEILING TILE -ARMSTRONG WORLD INDUSTRIES.INSTALL GRID AND TILES LEVEL AND BRACE PER SEISMIC REQUIREMENTS AS W �nws is na6rowmawlnwwvnsam RECOMMENDED BY MANUFACTURER.INSTALL AS PER MANUFACTURER'5 RECOMMENDATION. N m�o.lwwamow�as®�auc.oK SACT4 ARMSTRONG CEILING TILE TO MATCH EXISTING 2X9 GRID job number: /�/� �q SCHEDULE p ALL521C LAMINATE-998.INSTALL ASSONART OR PER MANUFACTURER'SMICA IGH PRE55URE RECOMMENDATIONINATE OR EQUAL:TO MEET OR EXCEED REQUIREMENTS OF ANSI a GSD-92-053 F�OHV(9S!!3'c CHEDULE PL-I: TO BE SELECTED BY TENANT PL-1: TO BE SELECTED BY TENANT - 1. i KEY e LIGHTED EXIT SIGNS \ FIYF.r�yJf� + `+ __'® X - EXISTING FIXTURE TO COMBINATION DEVICE y REMAIN IN SAME LOCATION LIGHTED EXIT SIGNS No.$M WITH EMERGENCY HEADS XR - NEW FIXTURE IN Cs IWTM �VE�r cn a NEW LOCATION / EMERGENCY LIGHTS N - EXISTING FIXTURE MOVED �7 TO NEW LOCATION O HVAC SUPPLY GRILL VERIFY THAT BOTH UNIT 3B BATHROOMS ARE TIED INTO , UNIT 3B ELECTRICAL METER NEW TELEPHONE/DATA OUTLET FIRE ALARM DEVICE STROBE O NEW TELEPHONE/DATA OUTLET Ell FIRE ALARM DEVICE X TO PARTITION HORN STROBE NEW ELECTRICAL OUTLET © FIRE ALARM DEVICE PULL STATION . NOTE: RE-WIRE LIGHTS ANDC,FCI Q 2X9 LIGHT FIXTURE • PROVIDE MANUAL OR AUTOMATED SWITCHING CONTROLS AS REQUIRED NEW GFCI OUTLET TO BE O SPRINKLER HEAD TO MATCH NEW LAYOUT USED IN KITCHEN COUNTER. STANDARD LIGHT SWITCH LO 00v H I I FURNITURE FEED 3 WAY LIGHT SWITCH X o v U J E D, 0 0 0 0 SENSORCUPAN SWITCHY +: vi v cUi X X X X X % POWER POLE v m n o C a3 > N I i HW 00 3 (� O a0 c`na '-T '�` uuli.c c coo ch2, I I _ 3'-0* 7 3 v0 S C'� Z H D NEW ADA STROBE C o / o AND EMERGENCY XF X LIGHTS IN NEW _ ___ TOILETS AS SHOWN GCI OX L -- 0 --- 0 C X 1 • • • FINISH FLOOR ---GFCI. N N N O O SOLID CORE UOOD VENEER DOOR NR FRAME O DOOR ELEVATIONS FRAME EL EVA TIONS s o i N _ 'O SCALE. I/t"= I'-0" SCACE 1/t"= 1'-0" DOOR SCHEDULE DOOR FRAME ?o N0. SIZE TYPE MATERIAL TYPE MATERIAL HARDWARE RATED NOTES N W o t JL3SET RELOCATE LIGHTS t o=a HVAC REGISTER AS /W 0 w SHOWN �_EITIIER100 EXIST. - - - NO U m N R 0 o o o O 0 101 EXIST. - - - - _j z X X X X — 102 3'-0" X T-0" A WD A HM 1 a o GFCI GFCI M RF 103 3'-0" X T-0" A WD A HM I H 104 3'-0" X 1'-0" A WD A HM I z Iml 105 3'-0" X T-0" A WD A HM 2 a . NOTE: ALL EXIST. GRID 1 TILES TO REMAIN '3' 0" X l'-0" A WD A HM 3 Q W § AS SHOWN. REPAIR GRID AND REPLACE ANY 101 3' 0' X l'-O" A WD A HM 3 �a TILES DAMAGED DUE TO NEW CONSTRUCTION. c~i�Q.Lu RG® 0 SCALE 1/8"= V-0" +.. O O z EXISTING SWITCHES TYPICAL. o .O O O U= ELECTRICAL CONTRACTOR TO REMOVE LIGHT SWITCHES THAT DOOR SCHEDULE GC SHALL VERIFY LOCKING REQUIREMENTS FOR EACH DOOR WITH TENANT. O zz O M ARE NO LONGER IN USE OR Q a,U z REQUfRED. MAKE SAFE PER I CODE. 3'-4' z SET AI SET p2 3 0 E issue date: 5-10-2012 4 I revisions: a I STROBE FIRE �I H.C.MIRROR ALARM OFFICE LOCK SET/LA TCHSET STOREROOM LOCKS ET 3 HINGES 3 HINGES I I/2'DIAMETER PROVIDE ACCESSIBLE DOOR STOP DOOR STOP PAPER TOWEL FAUCETS AND OFFSET SILENCERS SILENCERS GLASS 42"LONG GRAB BARS z I DISPENSER DRAIN ASSEMBLY WITH R WITH TEXTURED FINISH g I WATERr2 � It 42* TRU BLOCKING TRU-BRO PIPE M1 L. Q. ®0 a INSULATION rc 1 MINIMUM CLEARANCE � ' J dr chk. __ =a _ >_ � SET 43 FINISH FLOOR MAX o P BATHROOM LOCKSET O ® 2012 GSD Associates.LLC TO RIM '^ `" 3 - HINGES s uaa5�+u na¢mo6 nrrtwvmuos�cK . O MIRROR N.C.TOILET URINAL DRYER ~ H.C.SINK rv. DOOR STOP TEMPERED GLASS WINDOW a wmraa®.¢oc aa¢ae naaaa.en L A SILENCERS maaa�i[m.e�inlariar�mao:mn I'-L" i maamMel larmetaAa xnawama W mw TYP TOILET RM MOUNTING HEIGHTS w man mswaa wnw�—,m... m..n HARDWARE SCHEDULE WINDQWELE/A�® �$CAL£: !/t"= i'_D- r $%ob numbe,: -NOTE: ALL DOOMS TO HAVE LEVER HANDLE LOCKSET/LATCHS£T F1' SCALE: I/t"= 1'-0" TYPICAL C TOILET GSD- .TYPICAL EJ SCALE.' 1/4"= 1'-0- A 1.2 � zi� �� �P �' ��� ��� � '� I � � . Date..-:3.. . NOwTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING HU YY This certifies that—�,, .............................................. ............. ��p ................................................. has permission to perform......-/ ............................. .................... plumbing in the buildings of... ......................................... at..... ....... 7 North nd?er, Mass. .................................... Fea �6' .....Lic. No. . ..... 44 — .............. . .. ............................. 2 Check# PLU I SPEC OR. 441, 211-711,5- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY v/ce /✓ ou ! f MA DATE i PERMIT# JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESSTEL' ^ FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL E3' EDUCATIONAL RESIDENTIAL�!] PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:Q PLANS SUBMITTED: YES Q NO© FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISANDSYSTEM _J f11—A__ .1 __ __► ___ 1 } _._ _€ _ _I __.. ( 4 DEDICATED GREASE SYSTEM I _ —AE-1 -__--1 -_ -J=J DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR.(INTERIOR) € _._ _I .._�_€ i _.__. f _ _ f _ ! ....w ] ... ._..( I f KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION f WATER HEATER ALL TYPES WATER PIPING OTHER _ A+c 1✓/r s 4 �' I f -11 ---1 -- --- _ f .. ---1 - -J1 ___-- 1 INSURANCE COVERAGE: r 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Er'NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 4 J OTHER TYPE OF INDEMNITY D BOND D OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LdlF� S D�iJJolLd _ f LICENSE# 3-411 SIG TURE MP 0 JP© CORPORATION RJ#�PARTNERSHIP P# LLC COMPANY NAME ADDRESS z CITY . STATE ZIPo/;`e'Z 1 ` TEL 7 �nG�'��f IP CELL EMAIL FAX ,. • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPEC OTES �tGS 3 f l 1Yes No tv THIS APPLICATION SERVES AS THE PERMIT, [:] ❑ FEE: $ PERMIT# PLAN REVIEW NOTES a p, a(tom-c(40.Ad2-,t= The Commonwealth of Massachusetts Department of IndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): jati? Address: City/State/Zip: �J/��� - 6,,�7 Z ( Phone#: I'7F'4-,- s �, Are you an employer?Check the appropriate box: Type of project(required): 1.61 am a employer with employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, [ tfidelmg any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit#his 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 state whether or not those entities have employees. If the sub-coniraciors have employees,'they must provide their workeis'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: g a?1 C Ile-, Expiration Date: Job Site Address:1,Z1 DS G� 2) 5!, /12OA5>( Aer,�a U City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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. Signature: Date: 31z-= Phone#: 9 7 Phone 9 7�J�1'�`J Official 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#: l i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'entertheir self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-N ASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ..%YOOMMONWEALTH OF MA_ A HUSEITS; BOARD.-OFI Pt UMBE:R.5,%',ANb" G'AS F.,,j TTtRS::i' ISSUES T,HIE FOLLOWV.-a ?LiTCEN'SE Gi>G;F#Jr5`E AS A MASTER PL-UMB'ER=» � ....ALEREp A SPOL I DOIat0 fyjj N {{I 2 , :f� Wt ,.k.t.1111:I CA : :1lA 0 182 1—29 83 "G>>>> 05/0.1 >: :' 199171 ->�a; OMMONWEALTH OF MA ;S..' HUSETTS BOARD`C?I~ >'<< PLUMBER-<;AND G'ASF:;IT:T;E s:: F>; > I SSUES THE F O L L OW I>N,Ix'>:>L`I`C E N E;«;: L I GE.N;S'Ei)>`AS A JOURNEYMAN P.L`,UMBE`#2 :,AL<F:.RE_) A SPOL I D0 ... •fit. '1111/ t,�a _ IV 3.Ll ICA .... <MA 01821-29<:; > 16 2J .:`i >'05/Q. .1./:>):>6:::::>::`»; 199170 i s Date.... ..-�....../. .... Noway TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU Et49 This certifies that ........✓..?^!�Y...�.��in.. ........c z-�il<� "� LG n ................................ has permission to perform r %v/J ............................................................................ It wiring in the building of....�Ts....DF—.. - .............................................. at ........2..�....��9 f,�............5> 7 orth Andover,Mass. Fee..t.Z'�� .....Lic.No. 1 71/ 7Zn.e " .......... ./ -/ -� ............... .....�...............,s!�....,. ELECTRICAL INSPECTOR Check# Commonwealth.of M7a6sac4aiel� Official Use Only 2*partment.15i, .Jervscee Permit No._ / 3vi f ?, caand Fee Checked BOARD OF FIRE PREVENTION REGULATIONS JR0cupnCy ev1073 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,S 3 -Z 011-- City or Town of: A!Lrk ANS v e-c,-- To the Inspector of Wires; ' By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 12-11 OS(70-A Sr aeeT Owner or Tenant " !-4TS or- is A-tS " Telephone No. Owner's Address V25 I T'trt a- Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building AeSTtU Aa� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t T_UP Completion of the ollowin table ina be waived by the Inspector of Wires. No.of Recessed Luminaires ;k 5 No.of Cell:Susp.(Paddle)Fans r o ota Transformers KVA 1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires �' ,`y Swimming Pool rnd.Above [I In- No.of Emergency Lighting rnd. ❑ Battery Units 4 No.of Receptacle Outlets 0 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches Ll No.of Gas Burners o.of Detection an Initiatin Devices No.of Ranges / No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump �mn er _ons_ _ _ _ No.-of - ordains p Totals: Detection/Alerting Devices No.of Dishwashers / Space/Area Heating KW Local❑ unit pa ElOther Connection No.of Dryers Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent a of Water KW No.o o.o Data Wiring: Heaters Signs Ballasts Na of Devices or E uivalent No.Hydromassage Bathtubs No,of Motors Total HP Telecommunications tang No.of Devices or Equivalent OTHER: �-- J Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2 000- (When required by municipal policy.) p Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the lieensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such ca erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 1 certify,under the pants and penalties ofperjury,that the information on dols application is true and complete. FIRM NAME SYAT U I A/r 6 L 2:C-T►�+ t-A L- N LIC.NO.: 17q it A Licensee:4 i 1) =AMWA-L7 t Signature LIC.NO.: 3L/y5b e (if applicable,enter"exen:pr' in the license-number fine,)f`!C`�H tft':v Bus.Tel.No.��' 3 Address: /1 U 2Kf K KIQ" .�+ w 1�A11 , , +"1� C�i v �1 Alt.Tel.No.: 29—ii—7 159 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,l hereby waive this requirement. I am the(check one)E]owner 0 owneer,agent. Owner/Agent Signature Telephone No. PERMIT EEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of`Invew9ations 600 Washington,Street Boston,MA 0211.1 www.mass gov/dia Workers' Compensation Insurance Affidavit: Buffders/Contractors/JC+lectricians/Plumbers Applicant xnfoxmation Please li'rivat LeObly Name(B.usiness/organization/in(hviduat):__ GT°AT E L.)t j w UPM9A eA#- s-XW G Address: t riN C k S4 m S-r — IXe^Tk, City/State/Zig: K M 0!M , KA QI S y V Phone#: 09 �s8 Z - 5 7 4S' Are you an employer?Check the appropriate box: Type ofproject(required) 1. I am employerwith 4. ❑ 6.I am a general contractor and ❑ have hired the sub-contractors I�Tew construction employees(full-and/orpart tune).'* 2.❑ I am a sole proprietor or pa laex listed on the attached sheet x 7. (]Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any p tY ca aci '. workers'comp.fimn ce. 9. E]Building addition [No workers'comp.insurance 5. ❑ 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 wehave no 12.0 Roof repaim insurance required.]t employees.[No workers' 1311 Other comp.insurance required.] !Any applicant that checks box##1.must also M out the section below showing their workers'compensation policy infoanation. 7 Homeowners who submit this affidavit indicating they are doing ad work and then hire outside contractors must submit a new affidavit indicating such. tContractcrs that check this box must attached an additional sheet showing the name o£the sub-contractors and their workers'comp,policy information. lam rcpt employer that isproWding workers'compensation insurance fbrmy employees Below&thepoltey andfab site information. IusurancecompanyName:i '.;96mi �ys U6ATJ Gb C Policy#or Self-ins.Lic.#: 08— W EC„ -CF-4-I Q y . apiration Date: Job Site Address: I�Z f l 05600D S-mee7 City/stafnmp: !II . ki D 0,V P-/L 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 STOP WORD ORDER,and a fine o£up to$250.00 a day againstthe violator. Be advised that a copy ofthis statementmay be forwarded to the Office of C� Investigations ofthe DIA fo insurance coverage verification. Ido here eertm der epains andpenaldw ofyer-jury that a information provided above is true and correct. . Si e. Dais: 0l Phone#. q78 (09Z• 534.5' EOtlher or�ly. Do not write in this area,to be completed by city or town official n: PermW License# ority(circle one): Sealth 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5 Plumbing Inspector son: Phone#: Date..........�.—].. i.`7........... � of Noarh,h TOWN OF NORTH ANDOVER PERMIT.FOR WIRING �►.� °+„�o ter't,�0 ss�►04U56 This certifies that ......\., !�� t � R � ....................................... ........................................................... has permission to perform ... wiring in the building of....... 1 at ......�. ..�\....... `5�u.�'......... .............North Andov Mass. Fee..............................Lic.No. ................. .............. ....................................... ......... .. ......... _ ELECTRICAL INSP OR `� Check# !�� �-dl c ��, e � . l Commonwealth of Massachusetts Plficial Use I Y Permit No. 12�' Department of Fire Services Occupancy and Fee Checked Q BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /3,11 0 S(,-po f+- , Owner or Tenant �Q I'S o r^ /5�7- f Telephone No. Owner's Address /y L/ "/Ka;�, r+,-e-c t Q id CT-ti� /►� r Is this permit in conjunction with a building permit? Yes 5d No ❑ (Check Appropriate Box) Purpose of Building (Zt o vA 4-i v, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: SC cv r• Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained .... . .. ........................................................ Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Eq uivalent No.Hydromassage Bathtubs No.of Motors Total IIP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. ` Estimated Value of Electrical Work: S"p o o (When required by municipal policy.) Work to Start: CI -13 -t f Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 93 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FH2M NAME: LIC.NO.: Licensee: (1 11;a M 3 e r-c.� Signature IC.NO.: j LLD/(R-, (If applicable,enter "exempt"in the licens number line.) Bus.Tel.No. Address: � /'Kuc,S( m caX w di- vnAIH 63u!Vv Alt.Tel.No.:-- 97.F 609 Q3/ *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE.$ � 5—, Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the.provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed r on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP ION: Pass 2 Failed Re-Inspection Required($.) ❑ Inspectors Comments: 440 4 Inspectors Signature: Date: G--/ r/s-� DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leizibl Name (Business/Organization/Individual): Address: (� City/State/Zip: JC�A, HA Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.k]1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der the pains and pen of perjury that the information provided above is true and correct. Si ature: Date: 3 Phone#• �17dc- (�o Official 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#: I I r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia i � � I I ~ — - Comriaonwealth oflllas Division of Registrati usetts , Boaid of'Electd WILLIA. _p_++ F 28-1 MO �5 I FREMONT O �. Journeyma e 07/31/2013 ( License No. Expiration Date. 006754 - --- Sepal No. OMM 1: ., • • • EAL:H OF MAS :HUSE.7 :S ^;.. C ANS; 1S5UES_ T.HE FOLLOWING LICENSE ! i AS.,A ACG JOURN;E:<YMA,N<:::;>ELE.c�if"C W ��'`AM D BERAR,D Jr �~ i; - lu 8 1 QOSE MEADOW bR I:H 03044-3354 . ,;::< Location No. `� 117 Date . - TOWN OF NORTH ANDOVER . • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ i 7 Check# �" 2 ', ' Building Inspector i J pORrH , Q t1LEDf67q-r� a = TOWN OF NORTH ANDOVER t _ 09�� en A �`KG SIGN PERMIT SSACHUS���� DATE: May 26, 2015 PERMIT: 018-15 THIS CERTIFIES THAT Kanitta Newton has permission to erect signage. on_1200 Osgood Street , two signs 18x20 and 15x99 "Lots of Eats Thai Kitchen" provide that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section #6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspe for of Buildings Amount Paid:$30.00 • Check 335 Receipt 28839 , ,,�1 �� �- ___ DAWN PEASE PRESIDENT _ 33 Flagship Dr. N.Andover,MA 01845 INC.' f ph:(978)208-0012 DawnsSignTechlnc.net cell:(978)609-6170 Dawn@DawnsSignTechlnc"Aet fax:(978)258-0613 „L face book.com/DawnsSignTech C- S3WVdJ-d • DNIH10ll'RSN3d`S(IdVDSS3NISf18 • 0_0 SDl13NDVW • 1NHIldWO:)V& . SNOI1HllViSNI • SNDIS NOIlD313/G'dVA . S'd31131 IVNOISN3 W Ia • S1SOd 12 SNDIS 31ViS]IV3u • S31HdVUDAAOCINIM • SDVIJ 8S213NNVS - S31HdH2i013313 • SdV ]MIS31Hd`d JD31DIH3n - DNI1NIUd 7H11D1O IVWUOj 37MH7 3SnOH NI SUAl NDIS IIV NI 7NIZIIVI:)3dS 4 � e 1600 900d Street Bactftg 20, te 2-36 _ u�➢ nIC+ NORM AMOVER Date: -:Z) • Name of applicant who is purchasing the sign �/ __---- Site,Owner I�Ir(�—ice r1 n P D ! Phone#of applicant who is purchasing the ilgn V7 " • 3 Site Address 2Cin "&,nj .:�j+ . I Name of signcompanLJ)V)�C 4C -rprk1�► phone#�7�{�O�S�C�O/ I Size of Proposed Siy_iS"x J 20" I ' 9(3 " • l�hian l�aa�ll . Illumination: a)Not-illuminated How attachedi a)Against the wall_✓ b)Internally illuminated b)Roof --- c)Ground �_ c Y illuminated d)Othbr Materials: d 11.12(chPCIC_i_I Proposed Colors: Background-. ���f + V' iC- I I nr LBtter111g1 1 P�1[�1s� -i-L 1`1 i'ly Border �- •o• ''�n � I'4�O© ��-b�-�-I, '�n�-{zc 11 e� Re Wait•®d A�elbsn®rots; ,z NOerananentlbem o �otographs of building ' p p mry sign shall be erected,or enlarged until an Material sample application on the Appropriate form fmMished by the Sign Office has been filed Color sample with the Sign Officer containing such information including photographs,plans Site or Plot Plan(Requited for,all free-standing signs) and scale.drawings,as he may require,and a permit for such erection,alteration,-4or enlargement has been issued by him. Such permit shall be issued only of the Odwrt,spar. r. proposed sign Sign Officer determines that the sign complies or will comply with all ` applicable provisions of the By-Law. Will sign Overhang any public road or walkway Yes( ) No If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION VM.L NOT BE ACCEPTED DATE FMED: . Receipt# heck Revised 10.31.2006Form sign Pem*Appllccraon SI AT'LTRE PLiC APPROVED BY clilf 71 77 ^.St rM . ^n I 112OU1011SUISUAII DoiAme q jouladInle o c ooi� gas +-i..- w»"r'y""C" r.r•.�,,,,. ..''�t _._,. .,.,., 771=1 7777=777=,,w;�,na+t. n'rnd»,.�—+.cz ,�„w.r-,+.+{,.c'e ' � .. p� g of Za }u�t77,O/ w,.,;.;,,,.T..�dR�'o� av �`tl�sybYt� ¢ `t»"` Y,, s ''C�,u.•SSt+-, rv ,� f! 4 ' :.. - :•^w !^ ^.i .,r.. �,, pr.,tys,..ry ! '..7 ..G. <�s � G t :� y t i'� '��'. � �', ' `� -..+:.,c„ "a-"i�"%,�'` f ."`^n. 5»t,,,.e.,;•.•F�'- � :`�«1d^7°"^ -r` n . x,'t•. :.'F" c^'< `,d .€ y.,^„ a .<;f z � ?� •:,ea+ u. `+t Yr ' l ... a 77 ka :1 _.._;,, ::-.. .� .0� '.� ,r � `d f.,�y:�: �� �"f.''• �{" '"°? ', a.;s f a �u.`?`t"t.,.� to yypptt s ':� PZy. �a1p�q/d�'('iCaS � `� t! J :d b c :5 :r i+N'r� .�, ''�}' y �; S. s r {r ➢�.,.'.m �tip�' r I. .r��a. '„^'""F'4*x'.' r; a� L 1'.'a,..r.�i i ? 1 r. �:� ,,.y' it C .•v ti ii' a, . .. U{5.'yi6..+srn.:w.:*.�f .yba .m.tw,ar„*�' .� � '..u:a,waf:�:•s k�i.'.i,.,:,:.rHS wrf'".rn f4,: Mimi- FM R a ! r � �..a � iM: Mnlla s acrylic dimeinsional letters 15 x 99� lack cliupaln�+� y� ` Y Permit Listinz Report Date Range:Issued between 01/01/2015 And 04/15/2015 by Permit Type Printed On: Wed Apr 15,2015 SQL Statement:(Street like"OSGOOD STREET"OR Work Location like"*OSGOOD STREET*")and([Type of Permit]="Building") Permit Type Address(Work Location) District Zoning Owner Work Category Est.Cost Proposed Use Details Map/Block/Lot Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check# Building 1600 OSGOOD STREET MOBILE MINI,INC. Commercial Alteration $5,500.00 034.0/0017/ 582-14 OPEN Jan-07-2015 Cubicle Connection Inc.(978)360-7214 Cubicles Suite 203-Strolid $166.00 0632 (650 OSGOOD STREET) TKZ Inc. Single Family Dwelling $562,000.00 633-15 OPEN Feb-05-2015 Thomas Zahariko(978)687-2635 SINGLE FAMILY DWELLING $6,744.00 1358 1211 OSGOOD STREET 1211 OSGOOD STREET,LLC New Commercial $144,458.00 035.0/0008/ 655-15 OPEN Feb-23-2015 DAVID GULEZIAN Tenant Fit up for Thai Restaurant-46 Seats $1,733.00 6696 538 OSGOOD STREET BLAESER,SANDRA Solar Panels $45,000.00 101.0/0012/ 715-15 OPEN Mar-17-2015 Astrum Solar(508)649-4891 Install 38 Roof Top Solar Panels 10.26 KW $540.00 4162 575 OSGOOD STREET Edgewood Retirment Community Residential Alteration $42,000.00 036.0/0003/ 721-15 OPEN Mar-19-2015 Pimental Construction(978)657-9600 Convert Two Existing Units into One Unit $504.00 1163 575 OSGOOD STREET Edgewood Retirment Community Commercial Alteration $1,500,000.00 740-15 OPEN Mar-30-2015 Chapman Construction(617)630-8408 Demo and Renovate 4,000 SF.Two Building Additions 2,500 SF total $18,000.00 33770 GeoTMS®2015 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 Permit Listing Report by Permit Type Permit Type Address(Work Location) District Zoning Owner Work Category Est.Cost Proposed Use Details MapBlock/Lot Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Description Fees Paid Check# Permit Type(BUILDING)TOTALS: ESTIMATED COST: $2,298,958.00 NUMBER OF PERMITS: 6 FEES INVOICED: $27,687.00 FEES PAID: $27,687.00 BALANCE: $.00 GRAND TOTALS: ESTIMATED COST: $2,298,958.00 NUMBER OF PERMITS: 6 FEES INVOICED: $27,687.00 FEES PAID: $27,687.00 BALANCE: $.00 GeoTMS®2015 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 333 Date. . 15. 1.�.��- . . ... . . �ARTp TOWN OF NORTH ANDOVER pf �.ao ,e.,ti0 PERMIT FOR MECHANICAL INSTALLATION 40 SSACHUSt � (� ( � This certifies that . a . . . . . .�. . . . . . has permission for mechanical installation in the buildings or. t . K:r. . . . . . . . . . . . at7 . . �� . . . . . . . . . .. NorthA�nddover, Mass. Fee.16� — Lic. No..C�14 ". . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date 0 M J3 2 Z /S. Permit# L� Permit Fee: $� � Estimated Job Cost: gS (X1 Plans Submitted: YES �NO Plans Reviewed: YES NO Business License# 2 2-Lj 3 Applicant License# r Property Owner/Job Location Information: Business Information: p �' Name: A jVen- Name: _ 0 so,00 Street: �y�J ��� C)Wt-Lq Street: City/Town: City/Town: WTI Telephone: (�I� _3�1 44 � Telephone: Photo I.D.required/Copy of Photo I.D.attached: YES NO Building Type: ` Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu.ft. Sheet metal work to be completed: New Work: K� Renovation: HVAC Metal Roofing Kitchen-Exhaust System,�Chimney/Vents Provide brief description of work to be done: T r1 s�ca.� ng-U-) vQ nA� �o n S�s�arn O,Y-\ INSURANCE COVERAGE: 1 have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes gr'No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy 0--� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the Ilcensee does not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Insuection Date Comments Tasype of License: By Mter Title ❑Master-Restricted Cltyrrown Permit ❑Journeyperson Signature of Licensee Fee$ ❑Journeyperson-Restricted License Number: �7 Check at www.mass.aov/dol Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A„ y Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided y All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampets with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where-required)and operation verified(May also / be verified by fire department during fire alarm testing) Grease/kitchen hood with exhausts stem installed 1 e y i h a l scams and connections welded airtight with properly located cleanouts.Proper cleil`ances,fire rated enclosures and pressure testing required. • •• •1. • •f • • • r S0i arc res,a2intb installed vilic��e'require'�l bfl equipment and dL..ti.-.3rr Duct penetrations in fire•rated•wall.i and floors sealed' /Metal roofing systems installed watertight using proper materials and fasteners �exible duct reins installed 6'-0"maximum length v Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight V Ductwork insulated by means of external covering or internal lining / Volume dampers installed for each supply air branch duct y New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) y 1 12 13 14 15 16 17 1B 19 110 1 1 1 12 113 114 15 1 16 117 1 18 1 19 1 20 1 21 1 22 EXHAUSTFAN P CFM 5,850 Lj E HEATED MAKEUP AIR UNIT CFM 4,680 TO FUSIBLE LINKS DROOF 24�Q4MAKEUPAIR TO REMOTE PULL STATION 24.24 M MAKEUP DUC �—TO EXTINGUISHER 3M FIRE WRAP_ SUPPTO ELECTRIC VALVE NOZZLES DOUBLE INSULATION WIRED TO SUPPRESSION �— —SUPPRESSION H N 0"CLEARANCE _�SUPPLY PLENUM SYSTEM CONTROL BOX 5z- 24X24 EXHAUST DUCT TO MECHANICAL VALVE EXHAUST PLENUMCEILINGA I i-,� LINKED TO SUPPRESSION PYRO-CHEM f" TO'- „ "YY M ATTACHING PLATES SUPPLY RISER WITH SYSTEM PCL 300 SYSTEM M VOLUME DAMPER EXTINGUISHER NOZZLE OPEN STAINLESS STEEL d"'A� 3"INTERNAL STANDOFF PERFORATED PANEL "�,) PYRO CHEM SYSTEM �., 1 �f 4J GREASEVENI WiiH� I I Ai FAGHINGPLAiES SCALE: 3/811 = 1'-011 L REMOVABLE CUP 5' �'I'_6"y L55 SERIES E26 CANOPY LIGHT L O yG FIXTURE-HIGH TEMPERATURE ASSEMBLY,INCLUDE CLEAR THERMAL AND SHOCK RESISTANT ANO 6'-8" y 6'-8" GLOBE(L55 FIXTURE) 13885 K CGASSOOKING 1 K ty` \�� EQUIPMENT MECHANICAL NOTES lL M 1 j r 1-ALL WORK SHOULD COMPLY WITH U LATEST EDITION OF MASS BUILDING CODE r {� 8TH.NFPA 96 17A AND(L.M.C.)MECHANICAL FLOOR CODE CHAPTER 5. HOOD SECTION `�-6 -6 2.DUCT WORK SHALL BE GA#18 BLACK IRON ENGINEER'S SEAL M-2 WELDED. SCALE: 1/4"=I' REF 5-2" l'-4"' 3.CONNECT FIRE SUPPRESSION SYSTEM TO BUILDING FIRE ALARM. CONTROLSEQUENCE. a.FIRE SUPPRESSION SYSTEM IN H ACTIVATION,(AUTO OR MANUAL) H b.GAS VALVE SHUT-OFF EXHAUST FAN c.MAN-1 SHALL CLOSE CFM 5,850 HOOD BELOW d.EF-1(EXISTING EXH.FAN)KEEP RUNNING. {ROOFe.ALL ELECTRIC POWER UNDER HOOD _$-ROOF RISER BELOW SHALL SHUT OFF. G If.BUILDING FIRE ALARM ACTIVATED BY G EXHAUST DUCT TO ROOF FIRE SUPPRESSION SYSTEM. EXHAUST DUCT TO g.REMOTE PULL STATION SHALL BE ROOF 24X24" POSITIONED BY KITCHEN EGRESS EXHAUST P�I'U FAN SCHEDULE F TO SUPPRESSION EXTINGUISHER NOZZLE 18' KITCHEN AREA F CONTROL BOX EXHAUST RISERS FUSIBLE LINKS HOOD T6 PYRO-CHEM { CEILING (1).EXHAUST BLOWER RATED RENAN EIARRETO PCL 300 SYSTEM Y 5,850 CFM.UP BLAST, CENTRIFUGAL.DIRECT DRIVE, 1 1 T 071 B =[Ha ai�� He."A o H,MA E CMOTOR OLLECT/OR AND HINGED BASE. a HA'L TEH.H."1A"aE b."hHE-aAo.Eo� E e�:6 '].938. MAKEUP AIR UNIT CLIENT INFORMATION (1).HEATED AIR SUPPLY UNIT 1 1 RATED AT 4,680 CFM WITH FILTER. Thal Restaurant SECTION TO SUPPLY FAN DRIVEN BY A DIRECT DRIVE MOTOR. D STAINLESS STEEL BACK SPLASH PANEL M2 M2 D i PROJECT LOCATION PCL 300 double tank CONTROL SEQUENCE suppression system 1211 Osgood Street, • • • • • • • • • • • e • e e e Remote pull station EAUST FAN KEEP RUNNING SUPPRESSION SYSTEM IN ACTIVATION C 2XH . c North Andover,MA 3.MAKE UP AIR FAN CLOSE DRAWING TITLE • • • 4.GAS VALVE SHUT OFF 5.BUILDING FIRE ALARM ACTIVATED PLAN-EXHAUST HOOD 1 1 U T_f7 °FLOOR 6.SYSTEM DISCHARGE FIRE SUPPRESSION SYSTEM EQUIPMENT SCHEDULE B e 1 S 4 5 5 1 TE 1.3 BURNER WOK STOVE scALE 1/4'=1'-0" DAFebruary,2015 HOOD SECTION —� M1 HOOD PLAN 'I 2.10 COUNTER TOP PROJECT NO. REVISION NO. 3.COUNTER TOP GRILL NA REF 4.COUNTER TOP CHARBROILER DRAWNBY DRAWING NUMBER SCALE: 1/4"=1' 5.DEEP FRYERS A RB A SCALE:1/4"=l' REF VERIFIED BY M.001 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 110 11 12 1 13 1 14 1 15 1 16 1 17 1 18 1 19 1 20 1 21 22 1 12 13 14 15 16 17 18 19 1 10 1 1 1 12 1 13 1 14 115 1 16 117 1 16 1 19 1 20 1 21 1 22 EXHAUSTFAN P CFM 5,850 P E]5z-HEATED MAKEUP AIR UNIT CFM 4,680 TO FUSIBLE LINKS ° - ROOF TO REMOTE PULL STATION ° SUPPLY DUCTKEUP IR �` ��TO EXTINGUISHER f—SUPPLY DUCT 3M FIRE WRAP- TO ELECTRIC VALVE NOZZLES DOUBLE INSULATION WIRED TO SUPPRESSION .--SUPPRESSION N 0"CLEARANCE ❑ N —SUPPLY PLENUM SYSTEM CONTROL BOX 24X24 EXHAUST DUCT TO MECHANICAL VALVE EXHAUST PLENUM 0,-6„ HCEILING LINKED TO SUPPRESSION PYRO-CHEM M ATTACHING PLATES SUPPLY RISER WITH rrr SYSTEM PCL 300 SYSTEM M VOLUME DAMPER EXTINGUISHER NOZZLE OPEN STAINLESS STEEL p 3"INTERNAL STANDOFF PERFORATED PANEL PYRO-CHEM SYSTEM_ ►' H OF h� UREASEVENIVvIIH—-- � ' \AIYACHINGPI-AILS _ I LSCALE: 3/8" = 1'-0" L REMOVABLE CUP 5'_�'—6" L55 SERIES E26 CANOPY LIGHT L �� yG FIXTURE-HIGH TEMPERATURE ASSEMBLY,INCLUDE CLEAR r+N1 THERMAL AND SHOCK RESISTANT 1 O ti 6'-8" GLOBE(1-55 FIXTURE) K ISA t� GAS 90�COOK CJS EQU PIMENT 1 MECHANICAL NOTES SSJONAL EN 1-ALL WORK SHOULD COMPLY WITH LATEST EDITION OF MASS BUILDING CODE J FLOOR 8TH.NFPA 96 17A AND(L.M.C.)MECHANICAL CODE CHAPTER 5. HOOD SECTION M-2 2.DUCT WORK SHALL BE GA#16 BLACK IRON j ENGINEER a SEAL WELDED. I SCALE: 1/4"=1' REF . 5'—2" 1'_¢ 3.CONNECT FIRE SUPPRESSION 1 SYSTEM TO BUILDING FIRE ALARM. CONTROLSEQUENCE. a.FIRE SUPPRESSION SYSTEM IN ACTIVATION,(AUTO OR MANUAL) H b.GAS VALVE SHUT-OFF N EXHAUST FAN c.MAN-1 SHALL CLOSE CFM 5,850 HOOD BELOW d.EF-1(EXISTING EXH.FAN)KEEP RUNNING. ROOF e.ALL ELECTRIC POWER UNDER HOOD EXHAUST RISER BELOW SHALL SHUT OFF. f.BUILDING FIRE ALARM ACTIVATED BY G EXHAUST DUCT TO ROOF FIRE SUPPRESSION SYSTEM. EXHAUST DUCT TO g.REMOTE PULL STATION SHALL BE ROOF 24X24" POSITIONED BY KITCHEN EGRESS EXHAUST PLENUM F TO SUPPRESSION 12X34" EXTINGUISHER NOZZLE 18KITCHEN AREA FAN SCHEDULE F CONTROL BOX EXHAUST RISERS FUSIBLE LINKS HOOD TO PYRO-CHEM (1).EXHAUST BLOWER RATED PCL 300 SYSTEM CEILING 5,850 CFM.UP BLAST, RENAN BARRETO CENTRIFUGAL.DIRECT DRIVE, I 1 TUR-13 MILL LANE.RANocLnH,NA MOTOR WITH GREASE E-MAIL:RENAN'OARRET0@ -"A-11 E COLLECTOR AND HINGED BASE. E TEL:fit].938.0718 MAKEUP AIR UNIT CLIENT INFORMATION (1).HEATED AIR SUPPLY UNIT RATED18' 1 1 ECT ON TO SUPPLY YAT 4,680 CFM,FIAN DRIVEN TH FILTER. Thal Restaurant D STAINLESS STEEL BACK SPLASH PANEL M2 M2 BY A DIRECT DRIVE MOTOR. D PROJECT LOCATION PCL 300 double tank CONTROL SEQUENCE suppression system 1211 Osgood Street, • • • • • • • • • • Remote pull station 1.FIRE SUPPRESSION SYSTEM IN ACTIVATION North Andover,MA ° • e e e e e 2.EXHAUST FAN KEEP RUNNING C 3.MAKE UP AIR FAN CLOSE DRAWING TITLE • • • 4.GAS VALVE SHUT OFF 5.BUILDING FIRE ALARM ACTIVATED PLAN-EXHAUST HOOD ° 6.SYSTEM DISCHARGE FIRE SUPPRESSION SYSTEM B - FLOOR EQUIPMENT SCHEDULE e 1 2 3 4 5 5 1 1.3 BURNER WOK STOVE SCALE 1/4'=1'-0" DATE February,2015 ! HOOD SECTION - M 1 HOOD PLAN '' 2.10 BURNER STOVE PROJECT N0. REVISION N0. 3.COUNTER TOP GRILL NA 4.COUNTER TOP CHARBROILER A SCALE: 1/4"=1' REF 5.DEEP FRYERS A DRAWN BY RB DRAWING NUMBER SCALE: 1/4"=l' REF VERIFIED BY M.001 1 1 2 1 3 1 4 1 5 1 6 1 7 1 6 9 10 11 12 1 13 1 14 1 15 1 16 1 17 1 16 19 1 20 1 21 1 22 I TION - Job 22403 EXHAUST PLENUM TOTAL FALONE ONFIG. HOOD MAX' R[SER(S) SUPPLY HOOD f NO. TAG MODEL LENGTH COOKING ETOTAL XH. CFM WIDTH LONG. DIA. CFM S.P. CFM CONSTRUCTIONROW 186 9' 0.00' 430 SS ALONE 300 Deg 0 1800 Where Exposed1MISC-PSP 9' 000' 300 Deg 0 430 SS ALONE 1800 Where Exposed 2 MISC-PSP LIGHT(S) UTILITY CABINETS) FIRE HOOD FILTE (S) FIRE SYSTEM ELECTRICAL SWITCHES SYSTEM ANGIN EFFICIENCY GUAR TYPE QUANTITY PIPING WGHT HOOD TAG TYPE TY HEIGHT LENGTH e 9 QTY. TYPE LOCATION SIZE MODEL k NO. MICRONS NO 95 LBS 0 I NO 95 LBS 0 2 PER n suPPLY-PIS Y&5 RISERS) O S�Oc) HOOD TAG POS. LENGTH WIDTH HEIGHTT LONG. OIA. CFM S.P.N0. I Front l08' IB' 6' 20' 600 O.t94' 20'20' 600 0.194' n2 Front 108' 18' 6' 20' 600 0.194' n `�,/20' 600 0.194' MUA I 12' I eU 1 600 0.194' 1�0IZ�C N`[7C)U . IT— T-Tr- 111L j� 2 2f I 2 18" --�--- 36' 36' ATTACHING PLATES 9' 0.00'NOM./9' 0.00 OD 2•75' SUPPLY RISER WITH VOLUME DAMPER 6' PLAN VIEW - Hood A1 18•� 9' 0.00" LONG 186MISC–PSP 23.5% OPEN STAINLESS STEEL PERFORATED PANEL T T J.— 91— 2 ' Wq12 ' 2 18' 36' 36- 9' 0.00'Non./9' 0.00'OD PLAN VIEW - Hood-A-2 9' 0.00" LONG 186MISC-PSP JOB North Andover (w/0 hoods) LOCATION CASTNOW DATE 3/3/2015 JOB � 2240376 w lMertak O D{YG 1 DRAWN BY REV. '- SCALE 3/8' = i0' t FAN 0 0 FAN UNIT TAG FAN UNIT MODEL M CFM ESP. RPM H.P. B.H.P. 0 VOLT FLA WEIGHT (LBS.)SONES N0. I NCA24FA 4500 1.250 839 1 3.000 2.0480 3 1 208 1 9.5 256 15.9 AMA FAN INFORMATION — Job#2240376 FAN UNIT TAG FAN UNIT MODEL M BLOWER HOUSING CFM ESP. RPM H.P. B.H.P. 0 VOLT FLA WEIGHT (LBSHSIINESNO2A2-D.500-GI5 G15-PB A2-D.500 3600 0.500 838 2.000 1.5940 3 208 6.2 FAN ACTUAL INPUT OUTPUT REQUIRED INPUT GAS UNIT TAG AIR BTUs BTUs TEMP. RISE PRESSURE GASATYP'EDENSITY?NO 295826 272160 70 deg F 7 In. w.c. - 14 In. w.c. Na IV OIPTIOArs FAN UNIT TAG OPTION (Qty. - Descr.) NO. 1 I - Grease Box I - Hinge Kit (HD)- Ships Loose For Curb Supplied by Others 2 1 - Size 2 Direct Fired Heater Low CFM Profile Package. Used on Heaters under 2500 cfh. I - Separate 120V Wiring Package (Required and used only for DCV or Prewire with VFD) - Three Phase Only I - Low Fire Start l - Inlet Pressure Gauge, 0-35' I - Manifold Pressure Gauge. -5 to 15' we FAN #1 NCA24FA - EXHAUST FAN 43 3/8 FEATURES RDDF Mp1N1E1 FANS RESTAURANT MODEL -UL705 AND 11L762 AMCA SOUND AND AIR CERTIFIED -WIRING FROM MOTOR TO DISCONNECT SVITCH WEATHERPROOF DISCONNECT -HIGH HEAT OPERATION 300'F(149'C) GREASE CLASSIFICATION TESTING 37 1/2 NORMAL TEMPERATURE TEST 30 5/e EXHAUST FAN MUST OPERATE CONTINUOUSLY WHILE EXHAUSTING AIR AT 300'F(149'C) UNTIL ALL FAN PARTS RAVE REACHED THERMAL EDUILIBRIUM,AND WITHOUT ANY DETERIORATING EFFECTS TO THE FAN VHIC14 REASE DRAIN WOMB CAUSE UNSAFE OPERATION. ABNORMAL FLARE-UP TEST EXHAUST FAN MUST OPERATE CONTINUOUSLY WHILE EXHAUSTING BURNING GREASE VAPORS I I AT 600-F(316-0 FOR A PERIOD OF 15 MINUTES WITHOUT THE FAN BECOMING -23 7/8- DAMAGED TO ANY EXTENT THAT COULD CAUSE AN UNSAFE CONDITION. 2s OPTIONS 33 GREASE BOX Al HINGE KIT (HD)- SHIPS LOOSE FOR CURB SUPPLIED BY OTHERS `\DUUCTWORK BETWEEN EXHAUST RISER ON HOOD JOB North Andover (w/o hoods) AND FAN(BY OTHERS) �y O LOCATION DATE 3/3/2015 JOB Iy 2240376 ITrtsrteK DWG # 2 DRAWN BY REV. FAN #2 A2-D.500-G15 - HEATER 1. DIRECT GAS FIRED HEATED MAKE UP AIR UNIT WITH 15' BLOWER 2. INTAKE HOOD WITH EZ FILTERS 3. DOWN DISCHARGE - AIR FLOW RIGHT -> LEFT 4. PROFILE PLATE CONFIGURATION FOR SIZE 2 DIRECT FIRED UNIT FOR LOW CFM APPLICATIONS. 5. SEPARATE 120VAC WIRING PACKAGE FOR MAKE-UP AIR UNITS. OPTION MUST BE SELECTED WHEN MOUNTING VFD IN PREWIRE SUPPLY SIDE HEATER INFORMATION+ PANEL OR WITH DCV PACKAGE. PROVIDES SEPARATE 120VAC INPUT TO SUPPLY FAN. THIS 120V SIGNAL MUST BE RUN BY ELECTRICIAN FROM DCV TO MUA SWITCH. WINTER TEMPERATURE = 10"F. TEMP. RISE = 70'F. 6. LOW FIRE START. ALLOWS THE BURNER CIRCUIT TO ENERGIZE WHEN THE MODULATION CONTROL IS IN A LOW FIRE POSITION. BTUs CALCULATED OFF STANDARD AIR DENSITY 7. GAS PRESSURE GAUGE, 0-35', 2.5' DIAMETER, I/4' THREAD SIZE OUTPUT BTUs AT ALTITUDE OF 0.0 ft. = 272160 8. GAS PRESSURE GAUGE, -5 TO +15 INCHES WC„ 2.5' DIAMETER, 1/4' THREAD SIZE INPUT BTUs AT ALTITUDE OF 0.0 ft. = 295826 BLOWER DISLlMRGE 10' 0 0 �•LTEV� AIRFLDV 18 3/4' I I 4- 8 5/8' c 16' FLEX CONDUIT FOR FIELD WIRING 95 3/4' 37 3/8' � 40 1/8" 42 1/8' -{ 0 o LIFTING LUG AIRFLOW DIRECT FIRED MODULE f- 39 9/16' AIRFLOW SERVICE DISCONNECT 36 3/4' SWITCH I' NPT BLOWER/MOTOR ACCESS DOOR 24' SERVICE o J- oo CLEARANCE RED. 3 3/T4' I 7 13/16' JOB North Andover (w/o hoods) CAP77%T:CVjww LOCATION DATE 3/3/2015 JOB # 2240376 IM�k ODWG # 3 DRAWN BY REV. SCALE 3/8' = 1'-0' t • PACKA 40376 T� NO. TAG PACKAGE a LOCATION SWITCHES OPTION FANS CONTROLLED C A P T I V E-A I R E DCV V LOCATION QUANTITY TYPE 0 H.P. VOLT FLA I DCV-1111 Walt Mount In SS Box Ship Loose w/ I Light Smart Controls DCV Exhaust 3 3.000 20B 9.5 DEMAND CONTROL KITCHEN Prewire I Fan Supply 3 2.000 208 ..2 Demand Control Ventilation Hood Controt Panel Soecificatlons� VENTILATION SYSTEM • Controls shall be listed by ETL <UL SOBA) • The control enclosure shall be NEMA 1 rated and listed for Installation Inside of the exhaust hood utility cabinet. The control enclosure may be constructed of stainless steel or painted steel. • Temperature probe(s)located in the exhaust duct riser(s) shot( be constructed of stainless steel. A digital y thermysbat controller shprovidedstab to activate the hood exhaust WALL MOUNTED DCV CONTROLS W/ REMOTE MOUNTED LCD SCREEN) inns dynamically based on n SIO degreend listable offset from the room temperature sensor. This function shall meet the requirements of IMC 507.2.1.1 • A digital thermostat controller shall provide adjustable hysteresis settings to FIELD-INSTALLED prevent cycling of the Fans after the cooking appliances have been turned �- ` TEMPERATURE PROBE off and/or the hoot In the exhaust system Is reduced. _ • A digltal thermostat controller shall provide an adjustable minimum fon run-time setting to prevent fan cycling. / • Variable Frequency Drives (VFDs) shall be provided for fans as required. The Hood Co ntrol Pane( shall nodulate the VFDs between a minimum setpotnt and a FIELD-INSTALLED maximum setpoint on demand The duct temperature sensor Input(s) to the f, \�\ TEMPERATURE PROBE dlgltal thermostat controller shall be the speed reference signal. • The VFD speed range of operation shat) be from 0% to 100% for the system, \\ \ with the actual minimum speed set as required to meet minimum ventilation requirenents. • An internal algorithm to the digital thermostat controller shall modutate supply _ Fan VFD speed proportional to all exhaust fans that are located In the some Pan group as the supply fan. \�' — • The system sholl operate in PREP MODE during light cooking load or COOL DOWN \ MODE when sufficient heat rennins underneath the hood system after cooking e — operations have completed.Operotion during either of these periods will disable \ the supply Eons and provide an exhaust fan speed that is equal to the minimum ventilation requirement. — CONTROL BOX • A digital thermostat controller shall disable the supply fan(s),activate the INCLUDES <2) DUCT STATS exhaust fam(s),activate the appliance shunt trip,and disable an electric gas (WALL MOUNT ABOVE OR votve a.tomotically under the following conditions (as applicable)- BELOW CEILING.) n. Fire condition detected on a covered hood b. Excessive temperature detected on any duct temperature sensor In the system(250 F adjustable) T-STAT WIRE (75 FT PROVIDED) • A digital thermostat controller shall allow for external BMS fan control via Dry Contact (external control.shatl not override fan operation Logic as required by code) CATS CABLE (50 FT PROVIDED) • An LCD Interface shall be provided with the following features, a. On/OFF push button fan& light switch activation LCD interface b. Integrated gas valve reset for electronic gas valves(no reset relay w/ fan & light control — FIELD WIRING required) -MOUNTS IN STANDARD DOUBLE C' VFD Fault display with audible 6 visual alarm notification GANG JUNCTION BOX d. Duct temperature sensor foaure detection with audible S visual atorm notification Room Temperature Sensor e. MIs-wlred duct temperature sensor detection with audible 6 visual otarm p mctiflcatlom -Surface-mount on wall in f. A single low vottoge Cat-5 RJ45 wiring connection kitchen area.Do not install directly under the hood or g. Am energy savings Indicator that utilizes measured kWh from the VFDs TYPICAL DCV CONTROL SYSTEM INSTALLATION_ near appliances. FIELD INSTALLED TEMPERATURE SENSOR INSTALLATION DETAIL DETAIL OF REMOTE SIS BOX DETAIL OF LCD TOUCH PAD O O HOOD EXHAUST DUCT CONNECTIDN (External Surface) 1/2' Quik Seal (Adapter Body) rNERMICAT-5 CONNECTION ON REVERSE. O MUTE MAX AIR Part #32-0000 eperuWe Sensor CONNECTED TO HOOD CONTROL 1 1/8' -l 1/4'Diameter Hole PANEL. swlMcs �tt O LIGHTS FANS O DEMAND CONTROL VENTILATION 0 l SAVINGS INDICATOR CATS CABLE ALARM INDICATING LCD SCREEN BUTTON FUNCTIONS VARY BY 0 MODEL TYPE. OPTION FOR RECESSED WALL MOUNTING FITS IN STANDARD DOUBLE V GANG JUNCTION BOX O®O 1/2' Quik Seal (Gasket) Part #32-00002 1/2' Quik Seal (Nut) JOB North Andover (w/o hoods) Part #32-00002LOCATI0N 1/2' Quik Seal (Lock Washer) y DATE 3/3/2015 JOB # 2240376 Part #32-00002 < SUV InterteY O CAPTIV&Wwaff DWG # 7 DRAWN BY REV. SCALE 3/8' = Y-0' MODEL NUMBER `' CRAMaY :cH(uAnc PE DESCRIPTION OF OPERATION: `JOB NO DCV-1111—1IIl INSTALL Denond Control Vcnaotl n,•/I E,houst Fon,t Supply Fan,bdvust on h FYe,Lights wt In Fire.Fens noAlote 2240376 oB NAME CATE DWG NO Dosetl on duct tenperot�.INVERTER DUTY THREE PHASE MOTOR REOUTREO Roon terperoture sensor sNpped loose For Fkld hitollatbn-t dstonce tret•¢en VFD and Motor)oddtN»wl cost Gadd apply If dstonce exceeds 50 Feet North Andover (e/a hoods) 3/3/2015 ECP #1-1 T I Z _--_---_--COMM�H _ BREAKER PANEL TO CONTROL PANEL CONTROL PANEL TO ACCESSORY ITEMS HOOD PANEL _ - - - DRY CONTACT NORMALLY OPEN _ 3 Responsibility, Electrician Responsibility) Electriclnn _______ -- BREAKER SIZE SHOWN IS THE MAXIMUM ALLOWED oN/OFF WITH _ COMMEN CONTROL PANEL COMPONENT SUPPLY FAN __ __ NORMALLY OPEN1 BREAKER PANEL CONTROL PANEL GROUP I SPARE CONTACTS WILL MAKE MICROSVITCH I COMMON TO NORMALLY OPEN E ----------------1bt -- � HOOD PANEL G4WO WHEN SUPPLY FAN IS ON. BREAKER IPH ______________ Hn+tr°l - TO I -_------------ I'.C{��C2'NL, r 120 V _____ _ Ground _ c�rl-fYYa FIRE SYSTEM ( _- ____� DCV SPEED + -------------- -- TO BMS S ISAt VV�i����d VIRE CI TO COMMON(U. _ CONTROL POWER. DO NOT WIRE MICROSWITCH 0-10V OUTPU TO SHUNT TRIP BREAKER. VIRE ARI TO NORMALLY CLOSED(2). T���-------------- CI TO ARI SHOULD HAVE MS-1 ON PCB CONFIGURABLE TO OOUTPUT�NALS. 1ST HOD.LIGHT BREAKER SHARED W/ CONTINUITY WHEN ARMED. C, C SEE ECPH03 OWNERS MANUAL. g __ 1k'/Cm (TOTAL) CONTROL POWER.SNITCH #1 ------------ 't + VFD ANALOG E3-� -------------- - TO BMS BREAKER 3PHF----------------LINE - IF MORE THAN ONE r MS-2 4;N0 0-10V OUTPU 208 V L----------------LINE -� FIRE SYSTEM, VIRE WIRE TO VFD TERMINAL STRIP. 20 AMP L----------------LINE _L43 J IN SERIES AS SHOWN L- 1�C� SNC, IN VFD PROPORTIONAL TO FREQUENCY. --_--G-round __ _ -------------- ----= (EACH VFD) SEE VFD OWNERS MANUAL. L_-__------ ��jFf�� BMS SWITCH 8 I EXH-1 SM-1 -------------- E_ ND VIRE TO VFD QUICK CONNECTOR CONTROL VIRE DIRECTLY TO CONTROL BOARD 1HM1� CONTROL p�t�p�t ----_--_-----_ _��G` PANEL TO `,J CAT-5 CONNECTION I I PANEL TO 6GL SIGNAL SWITCH THROUGH BMS -J 9 I �-F�— REMOTE EXTERNAL WILL ACTIVATE ZONEI FANS AND BREAKER 3PHF----------------LDE MOUNTED PLACE END OF LINE PLUG EOL�20A 2 SWITCH LIGHTS D 208 V I ---------------UNE - I IN EMPTY JACK. PN: EOLl20n I 'Q�I SNITCHES I5 AMP - L_______________c_na.w _ HOOD LIGHTS I ' BLACK SUP-2 SM-2 HOOD PANEL a ---------- WHITE I J D HIRE TO VFD QUICK CONNECTOR TO -I l GREEN----------- I _ HOOD LIGHTS - ----------- --" 1400 W MAX VIRE TO J-BOX ON TOP OF HOOD _ 4 HOOD PANEL ETIK---------------- --- TO B IN ROOM SENSOR MOUNTED N RSM AWAY CONTROL PANEL TO FANS KITCHEN TEMP VIRE TO CONTROLROOM TEMP � ResponsiblUtyl Electrician SENSOR FROM HEAT SOURCES.SEE MANUAL % CONTROL PANEL FANS HOOD PANEL[IM--------------- -- NS FA01 EXH-1 TO ORS TO CUNTR9L BGAR& -SRIF LOOSE L Load Wiring LO'O-C�-I----- ----- ''o "95�lT� --1 - HP, DUCT SENSOR SENSOR MOUNTED IN EXHAUST DUCT DUCT STAT i SM-1 --�p�Ecz-- '------ --_�o vDnzmv IVIRE TO L_ -- _AC4_°--"------�---moo r�-7���TTT-� -------------- - 6 VFD QUICK --- 0---' ------ --Ii' HOOD PANEL -_-- - CONNECTOR VIRE TO I TO i.;e�:F VIRE TO CONTROL BOARD. SHIP IDOSE MUST HAVE ITS OWN CONDUIT DISCONNECT (DUCT SENSOR SENSOR MOUNTED IN EXHAUST DUCT DUCT STAT OO NOT SHARE CONDUITI 17 FANS 02 SUP-2 IFLwsz THE I Load Vlring __l.wD_Lcc-l- --A s —�✓o W.2w] MAY�O3R MAYCPOTEBEIONS -``' *0 LEG z- -.0 M-Aa��,,o v�T-z°e V REQUIRED BASED ON J13BSITE 1 SM-2 [��} - SPECIFICATIONS WIRE TO �U/---- ---- - ' - io SHUNCVFD QUICK FF_' COIL A CONNECTOR NI - - - vw 1 1- HOOD PANEL ----- HOT_TO SHUNT COIL _ ✓\ SIGNAL FOR --- NEUTRAL FROM SHUNT COIL EXTERNAL ST TERMINAL IS ENERGIZED A MUST CONDUHAVE ITS OWN METAL IT. WIRE TO PROVIDED I SHUNT TRIP IN FIRE CONDITION. CONDUIT DROP. COMMON HOOD PANEL _ II REMOVE,XSPER MAKE UP AIR ON PGB IN MUA #1 SPARE FIRE SPARE CONTACTS USED WHENBFI_ DAMPER I I ------------ SYSTEM DRY SYSTEM DISCHARGES TO DISABLE PROVING ----------- -® CONTACT EDUIPMENT OR PROVIDE SIGNALS. II pIM (NOT FOR BUILDING FIRE ALARM INTERLOCK LOW VOLTAGE DAMPER INTERLOCK•SHOO SECTION HOULD 1DO NOT199 WHICH MUST BE WIRED DIRECTLY HAVE CONTINUITY WHEN DAMPER D'wA~Driers TO THE ANSUL ALARM INITIATING IS PROVEN OPEN. SWITCH LOCATED IN ANSUL AUTER II NOT REQUIRED FOR ALL UNITS. SEE MAKE-UP AIR SCHEMATIC. i 21 I 1 ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 8/19/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). 71__r Michelle Cordima PRODUCER Strategic Resource Group (781)246-9002 1 JC.FAX (781)246-9001 27 Water Street, Suite 107 mcordima@strategicresourcegroup.net INSURERS AFFORDING COVERAGE NAIL II Wakefield MA 01880 Arbella Protection Insurance INSURED :Berkle Assurance CO. Al Restaurant Ventilation, Inc. :145 Broadway :: Everett MA 02149 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1481901260 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INT R POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MID Y DIYYYY GENERAL LIABILITY EACH OCCURRENCE E 2,000,10 00 X COMMERCIAL GENERAL LIABILITY PR o rte $ 100,00 B CLAIMS-MADE FX OCCUR 0067750 /18/2014 /18/2015 MEDEXP(Anyoneperson) S PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 1,000,000 X POLICY j'E'Cof F7 LOC 5 AUTOMOBILE LIABILITY COM I LI 1,000,000 Ea accident BODILY INJURY(Per person) $ A ANY AUTO ALL OWNED X SCHEDULED 1020033468-01 /18/2014 8/18/2015 BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE S X HIRED AUTOS X NON-OWNED WNED Per accident UM/UIM $ 100/300 UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ � a DED RETENTION A WORKERS COMPENSATION }( VUC STATU• 0TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE F -IYIN E.L.EACH ACCIDENT a 500 000 014 OFFICERIMEMBEREXCLUDED? NIA 126060814 /18/2 /18/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500 000 Ifyea,describa under E.L.DISEASE-POLICY LIMIT $ S00,000 DESCRIPTION OF OPERATIONS below Bulilding:$800,000 RC Buslnc:$15000 A Commercial Property 00062941 /18/2014 /18/2015 PersonallPropeny:E200,000 Ded: $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE . Jody Crowther/MC � ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025on+nns)m Tho Ar:r1R11 namc and innn arc ronicfarad markt of Ar.ORr1 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 WIMMass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Legibly Name(Business/Organization/Individual): u myh V4,01Q I O Address: S 1'�C�C6 x917► City/State/Zip: Q�JVM4 (� 1 ir, BE)(}, 02t Phone#: �QO 38 )``1'`�i� Are you an employer?Check the appropriate box: Type o�ewcocntstruction required): I.F-1 I am a employer with I employees(full and/or part-time).* '7, 2.Q I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.[No workers'comp.insurance required.] 3.F-11 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. EJ Demolition 10❑Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re ails These sub-contractors have employees and have workers'comp.insurance.t p 6.Q We are a corporation and its officers have exercised their right of exemption per MGI,c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. I.f the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 Insurance Company Name: C 6a I�1 rp T 10 YA In sura n V- Policy#or Self-ins.Lic.#: Expiration Date: CJ I g 20 0 S I n Job Site Address: U S City/State/Zip: Attach a copy of the workers'co ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tueder : es ofpeejuey Heat the information:provided above's true id correct. 93 Signature: Date: Phone#: Official 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if•you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia t <COMMONWEALTH OF MASSACHUSETTS:;::_"<. e • s - e • BOARVOF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE �xiAS A BUSI.<NESS�/-,�77 cc 'a ::.AN I BAL 0 V I LLANUEVA REST:AURANT' VENT I LAT.I.O.N vCOMMONWEALTH OF MASSACHUSETTS BOARD O SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A .MASTER—UNRESI-RICTED 1 ANIBAL. 0 VILLANUEVA � IW I� Al RESTAURANT VENT INC ' 145 BROADWAY EVERETT MA 02149-2418 2243 11, 28/1.5_- 3_ 140881�[2LU�a:a GAMMONWEALTH OF MAS CHUSETTS. • • - • • BOARD WORKERS SHEET MET IS ES THE LLOWING LICENSE AS BUSINESS I� ANI.BAL 0 V _L UEVA \'•• I, a Al RESTA ANT V TILATION INC U 145 BRO DWAY :EVE TT MA 02149 2'�8. . 03/02/15 -Mimx;tTr„M f!S AC HUS.I',"T'ti D / r NONE.. ��6�8.494 e 315 FENNO ST ' REVERE,MA 02151.3800 i ._ 6 0011.03.2011 WvOY•15.20, 3/2/2015 Division of Professional Licensure:License Search The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ............I--...................................................--................ ............. .................................................................................................................................. ........_ Check a License Check A Professional License Locate a Licensed Professional Bythe Division of Professional Licensure Online Address Change Contact the Agency SEARCH CRITERIA More... Profession:Sheet Metal Business REFERENCES& License Number:248 RELATED INFO NEW SEARCH Disclaimer Regarding Website License Searches LIC. BOARD LIC. LIC. NAME CITY/STATE LIC' Glossary of License Status TYPE NUMBER STATUS Codes Sheet Metal Al RESTAURANT VENTILATION Workers Business 24— J 8 INC EVERETT,MA Current More.., Your search has resulted in 1 licenses The page above has been generated by the Division of Professional Licensure web server on Monday,March 02,2015 at 12:59:14 PM. 2007-2011 Gornnxmw ealth of Massachusetts Site Policies Contact Us http:/4 icense.reg.state.rna.us/public/pubLicRang a.asp?profession=Sheet_Metal_Business&licenseNo=248&q uerytype=license&color=blue 1/1 Al RESTAURANT VENTILATION INC Invoice 145 BROADWAY EVERETT,MA 02149 Date Invoice# TEL# 617-389-4488 1/20/2015 11816 FAX# 617-387-0042 Bill To Ship To DG Building Lots of Eats,Inc 1211 Osgood St. North Andover,MA 1845 P.O. No. Terms Rep Item Description Qty Rate Amount Labor increase cost 1 3,000.00 3,000.00 duct work insulated mua duct 1 2,585.00 2,585.00T Note credit -1,700.00 -1,700.00 Note TO BE DONE BY OTHERS:ALL ELECTRICAL, 0.00 0.00 PLUMBING,GAS,CARPENTRY,HOLES IN WALLS &ROOF. TERMS OF PAY... AI RV REQUIRES A 50%DEPOSIT OF$26,382.50 TO 0.00 0.00 START PRODUCTION. SECOND PAYMENT DUE ON DAY OF DELIVERY AND START OF WORK IN THE AMOUNT OF$15,191.25 .A THIRD PAYMENT DUE ON DAY OF FIRE SYSTEM DELIVERY AND START OF WORK IN THE AMOUNT OF$10,941.25. FINAL PAYMENT DUE OF$250.00 Subtotal $48,895.00 Sales Tax (6.25%) $2,170.00 ALL INVOICES NOT PAID ACCORDING TO TERMS WILL RECEIVE LATE Payments/Credits FEES MONTHLY AND COLLECTION FEES IF NECESSARY. 425,000.00 Balance Due $26,065.00 Page 2 � 0ON �,r Q Al RESTAURANT VENTILATION INC Invoice 145 BROADWAY EVERETT, MA 02149 Date Invoice# TEL# 617-389-4488 1/20/2015 11816 FAX# 617-387-0042 Bill To Ship To DG Building Lots of Eats,Inc 1211 Osgood St. North Andover,MA 1845 P.O. No. Terms Rep Item Description Qty Rate Amount hood 18'hood w/front plenum 1 3,935.00 3,935.00T duct work 35'exhaust duct 1 1,560.00 1,560.00T elbow exhaust elbow 2 150.00 300.00T panel access panels 5 140.00 700.00T curb 'roof curbs 2 150.00 300.00T plates curb plates 2 80.00 160.00T fan exhaust fan 1 1,860.00 1,860.00T fan mua fan non tempered 1 1,375.00 1,375.00T Fire System U.L.300 liquid fire suppression system 1 3,140.00 3,140.00T F.S.Labor To deliver&install fire suppression system 1 3,140.00 3,140.00 panel s/s wall panel on back right of hood 1 880.00 880.00T wrap 3M wrap for single wrap layer 1 2,830.00 2,830.00T drawings mechanical plans 1 900.00 900.00T Permits Sheet Metal,Welding,Welding Detail 1 985.00 9,85.00 Labor to deliver and install 1 7,400.00 7,400.00 valve electrical gas valve 1 875.00 875.00T box electrical switch box 1 1,035.00 1,035.00T detector co detectors 1 1,185.00 1,185.00T shipping 1 825.00 825.00T Crane 1 900.00 900.00 Note extras on job 0.00 0.00 EMS energy management system 1 1,600.00 1,600.00T Labor start up system and bat air flow units 1 450.00 450.00 wrap double wrap 1 4,700.00 4,700.00T fan heated mua fan 1 3,975.00 3,975.00T Subtotal Sales Tax (6.25%) Total ALL INVOICES NOT PAID ACCORDING TO TERMS WILL RECEIVE LATE Payments/Credits FEES MONTHLY AND COLLECTION FEES IF NECESSARY. Balance Due Page 1 ,:?/,/ /� /T .73 3 [� Date..'. . /. .. . .... .. .. NORTIy11 TOWN OF NORTH ANDOVER 0 p i '^ PERMIT FOR MECHANICAL INSTALLATION F F K • ,SSA USESI w� This certifies that . .!��.�.!.�. . . . 1 . ? has permission for mechanical installation . . � in the buildings of X. . :.. . . . . . . . .s. .' . `14` t.. . . . . . . . . . . . at . . . . . . . .14. . . . , North Andover, Mass. Fee. . .)6C<. Lic. No.:--? � . . . . .l`.4 . . . . . . . . . . . . . . . . . . . i GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer v i Commonwealth of Massachusetts Date : Sheet Metal Permit •�'" Permit# / Estimated Job Cost: _�y t27D a Permit Fee: $ Plans Submitted: YES 1/ NO Plans Reviewed: YES NO Business License# Applicant License# F55' �p Business Information: ' Property Owner/Job Location Information: Name: �� /> Name: / r� Street: sZ4 Street: /I�Ly2�s J City/Town:/ &Ielt . City/Town:�/t/�riG Telephone: f 7c�(� fo-27��J ;�_____ Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail V*""' Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: 4 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes 'No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy m Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Title ❑ Master-Restricted 1 CitylTown ❑Journeyperson Signature of Licensee Permit / ❑Journeyperson-Restricted Fee$ S0rJ O License Number: El Check at www.mass.-gov/dpl Inspector Signature of Permit Approval a t Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation . _ Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium p exhausts stems installed and operation verified Y (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cle;;`antes,fire rated enclosures and pressure testing required. SeiST, rer'Auinta installed Wl&td zequired'oinegliip t�." ment and�..0. .}:v Duct penetrations in fir'e'rdt& ivall:Y and fla6rs sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) _ t 4 Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" FIexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections scaled substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-oft) t7 COMMONWEALTH OF MASSACHUSE: S BOARD`OF SHEET M"ETAL WORKER: 1 ISSUES.>THE FOLLOWING LICENSE W A5 A' MASTER UNRESTR.I,CTED,: cc J.}HN C RE I D r , Iz 1500 SALEM ST 'z W N..;R ... 0 TH A.t>Lp :ul <; MA 01845 4g t 4< <. 5$.0 11l2$:I:>lb 344792 i:�aeigPtlag:�7AUIVA1(010 1 o Fold,Then Detach Along All Perforations OMMONWEALTH OF MA ::SAdHUSETTS. :: • • • • • • B.O. A.RD OF . SHE ET <M£TAL'WORKERS ISSUES .THE FOLLOWING AS A BlJ51 NESS ..J;OH N;" C R E 10 RE I0 ME:CHANIZAI CORP 27 CHARS ES':ST W V 7..........: NORTH ANDOVER MA 01845 5 .� X3/29/16 183319 x` "•"�"1 REIDMEC-01 KRISTINL `�1�C7I2U' CERTIFICATE OF LIABILITY INSURANCE DATE 1 9//15!215/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu.of such endorsement(s). PRODUCER CONTACT Connie Parent _ Elliot Whittier Insurance Services, LLC NAME:PHONE 978 977 4884 FAX 9 75 Sylvan Street Suite B202 _ No EMJ978)) A/c,No): ( 78)977-0850 Danvers,MA 01923 n DRESS:cparent@elliotwhittier.com INSURER(S).AFFORDING COVERAGE NAIC# ......... . ................. _ .__......_.... .. .... ............".. INSURER a:Excelsior Insurance Co .11045 _ ....._.._...... _...__. ... .. _....."_........" ..................... .... ...._..__....-__ ........ __..._....... INSURED INSURER B:Peerless Insurance Co ............ .... Reid Mechanical INSURER C 27 Charles St#3 INSURER D North Andover,MA 01845.1664 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI11S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR --------'-�ADDL-S08��---'�-�------"-�--�----'"---'—�"-"�- POLICY—EFF— POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MM/DD/YYYY MMIDD/YYYY T LIMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 i.......1 ( DAM'AGETORENTED........ .:... ............. CLAIMS-MADE I X OCCUR I CBP8457320 05/23/2014 05/2312015 PREMISES(Ea occurrence 5 100,000 j MED EXP(Any one person) S 5,000 1 PERSONAL&ADV INJURY $ 1,000,000 GENt AGGREGATE OAPPLIES APPLES PER: GENERAL NERAL AGGREGATE $ 2,000,000 I _.._. .. .__E ' PRO- X POLICY ECT LOC I PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: 5 AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT $ 1,000,000 .. ! .__(Ea accident) A I :ANY AUTO BA8443664 05/23/2014 05123/2015 BODILY INJURY(Per person) $ ALL OWNED X I SCHEDULED BODILY INJURY Per accident 5 AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ $ -- X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LAB ! CLAIMS-MADE 05/23/2014 05/23/2015 IAGGREGATE $ 2,000,000 DED X I RETENTION$ 10,000 $ i WORKERS COMPENSATION1 X PER 0TH IAND EMPLOYERS'LIABILITY ._.. STATUTE ER_ Y/N B iANY PROPRIETORIPARTNER/EXECUTIVE " IWC8458524 05/23/2014 05/23/2015 E L.EACH ACCIDENT $ 500,000 I OFFICERIMEMBER EXCLUDED? . . .... .. ,(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE' $ 500,000 I If yes describe under ! ...... .........__ ..............__...... ... .. DESCRIPTION OF OPERATIONS below j E.L.DISEASE-POLICY LIMIT $ 500,000 I I i DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) HVAC Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of North Andover 1600 Osgood Street (North Andover MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD KOHLER, TRESHAMTfI Features DROP-IN BATHROOM SINK . Vitreous china K-2991 . Drop-in . With overflow pDp . 8"(203 mm)centers(8),4"(102 mm)centers(4), or single-hole(-1) . 21-13/16"(554 mm)x 16-9/16'(421 mm)x 8-1/16" (205 mm) e e Codes/Standards Applicable e Specified model meets or exceeds the following . ASMEA112.19.2/CSA B45.1 . ADA . ICC/ANSI A117.1 Colors/Finishes . 0:White . Other.Refer to Price Book for additional colors/i'mishes Accessories . CP:Polished Chrome Specified Model Model Description Colorsfnishes K-2991-1 Drop-in bathroom sink—single-hole U 0 O Other K-2991-4 Drop-in bathroom sink—4"(102 mm) DO ❑Other K-2991-8 Drop-in bathroom sink—8"(203 mm)(shown) D 0 ❑Other Recommended Accessories K-8998 I Adjustable P-Trap ❑CP Product Specification The drop-in bathroom sink with overflow shall be made of vitreous china.Drop-in bathroom sink shall be 21-13/16"(554 mm) in length, 16-9/16" (421 mm) in width, and 8-1/16" (205 mm) in depth. Bathroom sink shall have 8" (203 mm) centers (K-2991-8), 4" (102 mm) centers (K-2991-4), or single-hole (K-2991-1). Bathroom sink shall be Kohler Model K-2991- Page 1 of 2 USA/Canada: 1-8004KOHLER 1162721-4-B (1-800-456-4537) www.kohler corn Technical Information Installation Notes hnsta9 this product ac3oo>rrEw to The irrs�on cgwJe. Future- WMCE Crnrnteripp m2uwlactuer or celter must use the Basin area 19-13/16'(5ffl mm)x 10-3f16-(259 mm) cxrt-Out template provided with 08 praduct,or a aurent one Water depth 61116"(154 mm) provided by Kohler Co.(cal 11AW 9KOHLER).Kotler Co.is Drain hole 1 01314(44 mm) not responsible for afloat errors when the inoorred cut-" 'Approximate measurements for couparison oily. tenggete is used. VM comply with,ADA when iraslalled per Section 605 Holes K-2991-8 K-29914 K-29914 L walories of the Act_ Spout 01-3W 01-V4 01318" (35 nun) (32 mm) (35 mm) Faucet 0 1-3w 014 (35 mm) (32 mm) hnduded c ornponerds: Cut-out tempta2e 1162T11-i, K-2991-8 3-3/16" (81 mm) 24" (610 mm) 2.7/8" 4" (102 mm) - -I (73 mm) 9-7/16" 34" + (240 mm) (864 mm) \` L- - $, (686 mm) +(203 mm) Min I Min - �11 (152 mm) L10-7/8" 9" (229 mm) Min (276 mm) 2-7/16" Recommended ADA Installation 12" (62 mm) (305 mm) 21-13/16" (554 mm) 16-9/16" (421\ mm)l 2.7/8" K-2991-1 I f (73 mm) L - —�8-1/16" 14-5/16" I (205 mm) (364 mm) 3/8" Hot\ /3/8" Cold K-2991-4 - - - r 4" (102 mm) 2-7/8" 1-1/4" OD I (73 mm) - - 1 4"I-(11'0m 6-2 2 gym) Product Diagram TRESHAMn DROP-IN BATHROOM SINK THE BOLD LOOK Page 2 of 2 OF KOHLER® 1162721-443 North Andover Health Department Community Development Division January 29, 2015 Kanitta Newton 22 Summer St. Biddeford, ME 04005 Re: New food establishment review; Lots of Eats,North Andover, MA 01845 Dear Mrs.Newton, The Health Department received the plan review application submitted for the new establishment to be known as "Lots of Eats" located at 1211 Osgood Street, Unit 4,North Andover. Unfortunately, the application cannot be approved at this time. The following items were noted deficient,missing, or incomplete from your application. Please revise as needed and resubmit to the health department. It is important that the health department ensure compliance with the food code and provide safe food for the public. If you have any questions,please contact our office. WSmcly, Susan Sawyer, S/RS Public Health Director Cc: Gerald Brown, Inspector of Buildings 61 Brentwood Circle,North Andover, MA Property Owner—Frank Terranova 1211 Osgood Street, LLC North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i Items of Deficiency noted Corrective Action Page 5, #3 does not provide information about a dry storage area. Where are Create dry storage area you planning on storing these goods? #4 —how are you planning on storing these goods so that they are off the floor? i Page 6,#1 you answered"no"to foods being prepared 12 hours in advance. Review this question Page 6,92,3 Serve Safe certificates of the 7 employees are missing Please provide these certificates upon completion of the course Page 7, #6 You answered "no"to ready-to-eat foods being pre-chilled before Specify how these foods will being mixed and/or assembled, but did not specify how these foods will be be chilled to the appropriate cooled to 41°F temperature Page 8,#8 Potential Hazardous Food protocol is incorrect Review PHF protocol regarding discarding of food and maintenance of necessary temperatures L -- Page 12, #15 There was no information about the surface and location where Identify the specified area dumpster is to be stored Page 12,#16 No location was provided for grease storage receptacle Identify the location for grease storage receptacle Page 13 did not contain initials from operator Have operator review and initial Page 14,422 no location was provided for ice maker Identify location of ice maker Page 15,#26 "How are backflow prevention devices inspected & Explain how the devices are serviced"was left blank. inspected and serviced Page 16, #32 No indication of the location where Designate a separate area for insecticides/rodenticides are being stored away from cleaning and these items to be stored sanitation agents Page 16,#34 "Where will the MSDS information be kept on display Designate an area for the for easy access in emergency?"was no answered MSDS book to be stored North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i Page 16,#35 No indication on how linens will be cleaned Specify how these linens will be cleaned Page 16,#37 & #38,No storage information provided for clean or Indicate where clean or dirty dirty linens _ linens will be stored Page 16, #39 No container types were indicated to store bulk food Indicate type of containers products that will be used -- — — ---- 'L - - *Please provide drawings A1.0-A1.3 correctly to scale **Identify location for coffee and soda set up as well as submit any specification sheets on any additional equipment North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476