HomeMy WebLinkAboutBuilding Permit #644 - 1600 OSGOOD STREET 4/12/2006 • <- - 14OR71i
° TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
SS.ICHUSE +
Permit NO: Date Received: 6
Date Issued: Y l ;-7 f--
IMPORTANT: Applicant must complete all items on this page
LOCATION l9 l
Pri
//
PROPERTY OWNER 1,900 Oso d42 V,R"o
ptd s•l�.
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units:
❑Repair, replacement ❑ Assessory Bldg 0,6mmercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
4 o^. flit Xez
Identification Please Type or Print Clearly)
OWNER: Name 04P T �� Phone: 5--Y-rW
/ J Si nature
Address:
CONTRACTOR Name: r_ G Phone: 9115- 2 'Z
Address:.-17— Ap
Supervisor's Construction License: D � �t` D Exp. Date: o 7!
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER �'�.� �45DG Name: Phone: 9!`�' 616710 S el-7 -
Address: / A-�a �•� � / /Y, "� eg.No.
-.r--•- � a
FEE SCHEDULE:BULDING PERMIT.$10.00 PER S 0k 00 OF THE TOTAL ESTIMATED COST BASED QN 125.00 PER S.F.
Total Project Cost :$�2� �. x10.00=FEE:$ _
Check No.: Receipt No.: /8
Page 1 of 4
I
TYPE OF SEWARGE DISPOSAL
,�/ Tanning/Massage/Body Art F] Swimming Pools 11Public Sewer L'�
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ` 11 � k .
Permanent Dumpster on Site ❑
Private(septic tank,etc.
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent//Oavner.. o ,� --- } s� c� jignature-of Coratrptor,�'
Plans Submitted;;` '' ,Plans Waive ❑ �, _',C;ertified�Plot lar '3'1arhped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
[]Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
-\ DATE REJECTED '\ DATE APPRO`IED .. � V. .
°.' ^"l s `y'^s 2p'} .•!`, ; 'tea �"Li .' a.�' ?,►: . tit 1 ':1 S .-�-
CONSERVATION R
r
COMMENTS
❑ • -`DATE REJECTED ti ' ra)ATE`APPR®rVED
• A .7. ,s z
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
�y
-1
Zoning Decision/receipt submitted yes
Planning Board Decisibn:*' = '�tc'- ��'� Comments
� t
I
Conservation Decision: Comments
Water&Sewer connection signature&date
Temp Dumpster on site yes noV-t- Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
DIMENSION
Number of Stories:. Total square feet of floor area,based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA—(For department use)
Page 3 of 4
Doc:INSPECTIONAL SERVICES DEPARTMENTBPFORM05
Created JMC.Jan.2006
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of
Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and
proof of recording must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
Location 14p0 4 os�a a a
No. Date
NORTH TOWN OF NORTH ANDOVER
�90
Certificate of Occupancy $
•orb+�:�.. ,' a / 1
s^cNus� Building/Frame Permit Fee $ �i
r
Foundation Permit Fee $
F
Other Permit Fee $ _--_
TOTAL $
Check # Flo U
Building
Location
No. Date
40RT#q TOWN OF NORTH ANDOVER
F R
Certificate of Occupancy $
°'Eta' Building/Frame Permit Fee $
s�cNus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # / ,7
Building Inspect r
M
. O
'OSACNW�
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 171 9/8/2005) Date: April 19, 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 1600 Osgood Street
MAY BE OCCUPIED AS Office Fit up - Emoxshia IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: om Properties
1600 Osgood Street
North Andover MA 01845
Building Inspector
i
,r
NORTH
Town of Andover
0
No.
q' JB m4plod)SW
1� C" LA idover, Mass.,—
COCHICHEW11 K
14 RATEDpPp\ C5
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT.....10.9.4.41......A -0 4&4.) BUILDING INSPECTOR
..to
qWrtows A ;� C Oro"*
...... .......................................................................................... Foundation
has permission to erect... buildings an .........1A.6.0 OTS& 00 b rR�o uo'
Iwo efs..3" \1,-Wrnney
A�"til4D fio
to be Occupied as........ ...fl.m.1...........44 .....
.......!!�................................
provided that the person accepting this permit shall in every respect conform to t e terms of e app I on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. a k/As el PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ee ELECTRICAL INSPECTOR
— 12
UNLESS CONSTRUCTION STARTS tr -
# Service
............................................................................................
BUILDING INSPECTOR
t=aV Ar
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 DEWTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
SEE REVERSE SIDE Smoke Det.�j
Location A46-0
No. 11 J-7 U Date
�oRTM TOWN OF NORTH ANDOVER
Certificate of Occupancy $ ..
CNusE<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ S�
Check #
,' J 6 G Building InspeCior
O�MOOTN AN
3�.•.r. ..,,• hoc
t
JJACIW6tA
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTfI ANDOVER
Building Permit Number 357 (11/9/2005) Date: April 19, 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 1600 Osgood Street
MAY BE OCCUPIED AS Office Fit uu— New England Engineering Service
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE
BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: om pmrcies
1600 Osgood Street
North.Andover MA 01845
Building Inspector
v •
F NORTH
TO" Of : 4Andover i
C% = LA dover, Mass.,
IfsCOCMIC (EWICK
A0RA-rEo
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT........ ........... .. . ....... . ... ............................. ............................................................. Foundation
OWL
has permission to erect........................................ buildings n .�.�i..0.0.................. .................... �!� .............. h
to be occupied as........ ..... ................ . ..... ... e
provided that the person accepting this permit shall in every r ect conform to t terms of the applicati n file in inal
this office, and to the provisions of the Codes and Byws re atmg to the Inspects n, Alteration and Construction of
Buildings in the Town of North Andover. "i4� ,» 1446f �' jary m, PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION TARTSELECTRICAL INSPECTOR
... .2.... .......... ... ...... Service
.DING TOR
Final�p�
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 DEP
Until Inspected and Approved by the Building Inspector. Burner -�
Street No.
' � l
• AIa 00 SEE REVERSE SIDE Smoke Det.
Location
No. U Date a
NORT►, TOWN OF NORTH ANDOVER
f � w
9
Certificate of Occupancy $ _
. o, .«mac:.. ,,• ,
ITS CHU" Eta Building/Frame Permit Fee $
s
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # Ln�
` Building Insp&! !
OY NORTN,A
d n
Y
CERTIFICATE OF USE & OCCUPANCY
Building Permit Number 356 (11/9/2005) Date: April 19, 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 1600 Osgood Street
MAY BE OCCUPIED AS Office Fit up — DSA Detection IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE
BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Ozzy Properties
1600 Osgood Street
North Andover MA 01845
Buildinj Inspector
` NORTfy
TO" of
�._. � Andover
No. 36-40
C' s dower Mass. /A
T 0 -- L"' E 1
COCHICHEWICK
RATED PPa\ �C.7
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT................... ..... .. ........ /.................. ................................................................... Foundation
has permission to erect... ......... ............... buildings o / .�a.......I?o. ................. Rough
•
to be occupied as....... C
hprovided that the person accepting this permit shall in eve aspect confo to the terms of the application on file innal
this office, and to the provisions of the Codes and By-La rel ' to jnspection, Alteration and Construction of
Buildings in the Town of North Andover. a-T4 a /40,n PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION ARTS Ro
... . .. . ... .... .... ....... .... .
Service
B L G TOR
in (-o oll"
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 DEP ENT
Until Inspected and Approved by the Building Inspector. Burner cj � 1
-- Street No.
SEE REVERSE SIDE Smoke Det. /
fir.
Location
No. Date "�� 'oe,
r■
MQRToy TOWN OF NORTH ANDOVER
Certificate of Occupancy $ _
Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ ,<5- .�
Check #
--Building Inspector
4
~ o.NO oTh,a
t=... ...... of
t �
[IWst`
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 359 (11/9/2005) Date: April 19, 2006
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 1600 Osgood Street
MAY BE OCCUPIED AS Office Fit up— First Choice IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: om Properties
1600 Osgood Street
North Andover MA 01845
tip-
Building Inspector
NORT►y
t
Town of Andover .
No. 3SIT -
�` Z over, Mass.,
o L A
COCMICHEWICK
ADRATED APa\ �C
`s E BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT
............ ....... ....... ........... ................................. ....................................................... Foundation
has permission to erect........................................ buildings on 14.100............... OI Rough
j'
to be occupied as........
provided that the person accepting this permit shall in every r Zpectgconform to a tfirms of the application on file in
this office, and to the provisions of the Cod s and By-Laws relating to the Insp tion, Alteration and Construction of 1~inal
Buildings in the Town of North Andover. 6"Sho)a PLUMBING; 'SPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTI N START ELECT/R�ICAL INSPECTO
;1� MTMN
.. ... ..............................
G INSPECTOR MCe Y J
. :.. ... . .
�r�L
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE D7r4
Until Inspected and Approved by the Building Inspector. Burner
Street No.
ow.310 "' SEE REVERSE SIDE Smoke Det.
NORTH
own of
4Andover
0
No.
C% - Y dover, Mass.,
A.
O COCHICHEWICK
7�S RATEO P'' K
4 BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........16.0D............0J. .0.foC�.........Lefto. .C.
.... .................................... Foundation
has permission to erect...... ... ........................... buildings on ........ . 0...... .....�r............................ Rough
to be occupied as 1.. �i. �..�. ....# .. .....r Chimney
. . ...o .t
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
r' ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI N 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.
M
DOWGIERT CONSTRUCTION CO. INC.
616 ESSEX STREET
LAWRENCE, MA 01840
978 685-0306 fax 978 685-1290
ESTIMATE
Customer
Name 1600 Osgood St. LLC Ozzy Property mgmt Date 3/20/2006
Address 1600 Osgood St Job Loc
City North andover State ma ZIP Job Name PBXNSIP
Phone
Qty Description Unit Price TOTAL
Supply necessary material and labor including necessary
permits and build out approximately 1,226 sq ft. as per
preliminary plan by GSD.
Price includes building of walls as per lay out, installation
of electrical service, including electrical panel
Install parabolic lighting and electrical outlets
as per Ozzy standard. Modify duct work and
registers as per new lay out. Install oak doors in metal
frames, Install windows as per plan. Install 2x4 suspended
ceiling as per Ozzy standard. Adjust sprinkler heads as
per new lay out. Install emergency lighting and horn
strobes per new lay out. Paint new walls and woodwork,
colors to be picked by others. Install carpet and cove base
Ozzy allowance$12 per sq yard installed.
TOTAL CONTRACT PRICE $32,444.00
TO BE PAID IN 3 EQUAL INSTALLMENTS
I
SubTotal $0.00
Price does not include arcitectural or engineering Shipping&Handling
costs, data,telephone wiring, equipment or
furniture installation
TOTAL $32,444.00
Office Use Only
p. Y
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 048040
Birthdate: 1 O&W955
Expires: 1012912007 Tr.no: 8053.0
Restricted: 00
TADEUSZ DOWGIEERT
175 BRADYj-{ 03079 A --L //
VE
SALEM, Commissioner
n,.
The Commonwealth of Massachusetts
= Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
PERMIT Date:
North Andover permit No Dig Safe Number
(City of Town) (]f Applicable)
In accordance with the provisions of M.G.L 1/4 8 Chapter1Q_as provided in section-52-7—CMR 34
Stad ice
This Permit is granted to: )'`sem
Full name of person,Finn or Corporation
Permissionto locate dumpster for construction/renovation/demolition of building
Comments: dumpster must be 25' from structure if unable to place with required
Restrictions: clearance dumpster must be covered with plywood or tarp- end of work day
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$ 50 .00 G,� � �... Fire Chief
This Permit will expire fi (Signature of offical granting permit) Offical granting permit (Tide)
�� TWIC PERMIT MI ICT RF rriAlCPiri Illi ICI V P(ICTi=n I IPr)M TNF PRFMICFC ��
Nov 0'8 05 09: 30a 6038900192 P. 1
FROM :ROBERTS INSURANCE FAX NO. :9786833147 Nov. 08 2005 10:44AM P2/1
ACDM- CERTIFICATE OF LIABILITY INSURANCE 11/912005
PRODUCER TWO CERTIFICATE 0 ISSUED AS A SMATTER OF N FORMATION
1i.8. PK>CBLRTS rilii. .AQENCY, INC. ONLY AND CONFERS NO RIGKM UPON THE CERTIFICATE
1060 OSGOOD STREL-9 �RTHTHIS
I�cA�ED NOT BY THE POLICIES BELOW.
WORTH Al WER, NA 01845
978-683-8073 _ INSURERS AFFORDING COVERAGE NAICM
MNsLAmo DOWGIERT CONSTRUCTIOLI CC aMr INC. NSIIRERA ESSlL7C CE - -- -----
INSURER P:
175 smy AVE ENSURER C: -----
SUM, b= 03079 VmRER Lr. Gtn0D ZWS—URMCE
mum"L: ._.._.. ..
COVERAGES
THE POMES OF INSURANCE LISTED BELOW HAVE BEEN tS&WD TO THE NSURED NAMED AMOE FOR THE POUCV PERIOD WarATEO.NOTWITHSTANDING
ANY REQWREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES OESCMED HEREIN IS SUBJECT TO ALL THE Ti EXCLUSIONS AND CONDRIONS OF SUCH
POUC(ES.AOGREGATELMNt_T_SS_H_O_WNMAYNAVESEEN REDUCEDBYPAM CLAIMS. r
POUCY NUNSIER
GRAt LWALm CACH OCCURRENCE i QOQ poo
][ eeNMEtltultoEMMAt�u(A9ILm PREMIX$LE& erTp)_-_ i 000
CLAaY►swm- t(-s I OCCM MEOEZPINY-0-01 1
A3CP3616 10/26/05 10/26/06 PMONAL4ADvKmw I 1 a pp
_ rpOKMAL ArAM&ATE is 2,000,000
WNL AGGREGATE LMT APPLM9 rElt PRODUCTS-CORP/OP MG s1-0-00,000
P xv m mwc
COMMINUDAUTOEgiILEUASII.ITY
ANYAUTO Ms�vewN)StNGIEUNR S
ALLOWNMDAUTOB BOD4Y INJURY
6pIEciAti (perpwan) i
iARFDAUT09 _•_. ..
BODSYINPJRY i
NOA•OWWDAUTOB (Pr/tYJOm)
PROPERTv OARIACE i
(PsmodMit)
OARAOELIMLIIY AUTOONLV-EAACCIDENT It
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OCCUR I J CIANBMADE - AGOREUXIE i
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RETENTION i i
EMPLOYERS UAWTYTONANDTONY A B- a
Aw"tw"ETpwmnNmwxEcuw DC MCGO0548 10/26/05 10/26/06 e.Lum"Accam t —Soo 000
D `"cdlsRwEOI OVAMI i DISEASE-EA s 5Q0 000
threw wIM __,...
SPECIAL ibebw E.L.DISEASE.POUCYLMW i 500,000
OTHNT
DESCAPYON(w OPERATIONSltOCATIONSr VE)1Ka.Eii EXCLUSIONSADDEDGY ENDORSEMENT I SPECALPROMKINS
Mil Z
CERTIFICATE HOLDER CANCELLATION
oEBY PROPERTIES, LLC. OWNLO ANY OF THE Abaft-oEamaseo Poums se cANCtu.W Eg'FOAE TUR;FJOPIRATION
8 DUNDEE PARK DATE THEREOF.T►iE ISSUING PISURM VALLENDEAVOR TO WC 20 DAYS VATITTEN
ANDOVER MR 01810 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.SH FALi t0 UO So SMALL
IMPOSE NO OBLMATIOU OR Li OF ANY KW UPON THE w=RETL ITS ADENT&OR
ATNE
A7
ACOR025(I001U06) 9ACORO CORPORATN)N its"
TOWN OF NORTH ANDOVER
Construction Control Affidavit
Project Number: 0601005
Project Title: PBXSNIP—Tenant Fit-up
Project Location: 1600 Osgood Street, Building 20, 2nd Floor South Corridor
Name of Building: Osgood Landing
Nature of Project: Tenant Fit-up of office space.
In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control
of the Massachusetts State Building Code, I, Gregory P. Smith,AIA Registration No. 8688 being a Registered
Prefessie nal E flg.ieff/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all
design plans, computations and specifications concerning:
Entire Project Architectural —)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 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 116.2.2
1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are
submitted by the contractor in accordance with the requirements of the construction documents.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the state of construction to become, generally familiar with the
progress and quality of the work and to determine, in general, if the work is being performed in a manner
consistent with the construction documents.
UNDER SECTION 116.4, 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 COMPL ADINESS OF THE PROJECT FOR OCCUPANCY.
��ERED ARI,
Signature and Stamp (no facsimile) ��c,G���ORYP.S,y��T�c�
NO.$666
�1gRTH ANDOVER,
°gtr0tA
SUBSCR BED D S O 0 BEFORE ME THIS, IK DAY OF WzA 2006
s
�/�( � MY COMMISSION EXPIRES 3�/ 1(
NOTA IC