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HomeMy WebLinkAboutBuilding Permit #218-15 - 201 SUTTON STREET 5/1/2018 BUILDING PERMIT QL NORTFI `�,1LED TOWN OF NORTH ANDOVER ►0 APPLICATION FOR PLAN EXAMINATION H y'� Permit No#: Date Received gSSACHU`��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION IILLIJItG�1_ ,Sfi ��' /l�, �.±i� ✓'P —r, Pint PROPERTY OWNER _ .S Print I uu Year Structure yes no MAP __ _ PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑Two or more family 11 Industrial KAlteration No. of units: »Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer I DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly ' OWNER: Name: Phone: 8 Address: r Contractor Name: 7 Phone` Address: Supervisor's Construction License: S 0& 7M Exp.. Date: n . Home Improvement License: j4 �3 , _ _ Exp. Date: . _ - ARCHITECT/ENGINEER Phone: Address: Reg. No. t FEE SCHEDULE:BULDING PERMIT:$12.00 PER`$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ OVj FEE: $ Check No.: ? �/ Receipt No.: 2-2 9,a NOTE: Persons contracting with unregistered contractors do not have access t t e g ara fu d Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature s ` COMMENTS f HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments c Nater& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FLRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire DepartmentzignAture/date COMMENTS _ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 ❑ 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/Cross Section/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 Application Permit A lication ❑ Certified Proposed Plot Plan d ❑ 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 2014 Location '�- No. / S� —,Date 5r . • TOWN OF NORTH ANDOVER -�- /bU•C7J e Certificate of Occupancy $ Building/Frame Permit Fee $ 7v Foundation Permit Fee $ 2 Other Permit Fee TOTAL .�o Check# 0 a ei 73 Building Inspector PICC CON�R�ETIO�J Alan Ada Vice President Corporate Development 520 W. 103rd Street,#299 Kansas City, MO 64114 913-782-4646 ext 250 913-390-8402 fax 858-836-2383 direct 858-380-6268 cell aada@pkcc.com www.pkcc.com PICICW t Alan Ada Vice President Corporate Development 520 W. 103rd Street,#299 Kansas City, MO 64114 913-782-4646 ext 250 913-390-8402 fax 858-836-2383 direct 858-380-6268 cell aada@pkcc.com www.pkcc.com Final[ Construction Control Document To be submitted at completion of construction by a a =. Registered Design Professional W < for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: North Andover Renal Center Date: 3/4/2015 Permit No. Property Address: 202 Sutton Street, North Andover, MA 01845 Project: Check one or both as applicable: F New construction A ExistingConstruction on Project description: Facility maintenance and renovations to the 1st and 2nd floor. I Jeffrey Joseph Wyszynski MA Registration Number: 10681 Expiration date: August 2015 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: 70 "TAV 'tit" OF a.kWLVVkt rVl K Y [X] Architectural OUt,`t' ( ] Structural [ ] Mechanical [ ] Fire Protection Electrical [ ] Other: for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: I. Have reviewed, 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. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been 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 was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: L VA Phone number: (860) 548-0802 Email: jeffwQa tectonpc. m OF Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 e� ,ORTN 1h d?•;r�D '•OOt ♦i -y ys wCHOSet CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 218=15 On 8/29/2014 Date: March 10, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 201 Sutton Street MAY BE OCCUPIED AS Daeita Healthcare Partners _IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: ISD Renal,Inc. 201 Sutton Street North Andover,MA 01845 Building Inspector Fee: PrePaid$100.00 Receipt: 27966 Check : 026734 t AN O '. umm.muun uumwMMrm�®mn No. 0,. d ver, Mass, �B $ BOARD OF HEALTH k k pr.,,, KMi r T _ 'Food/Kitchen IE) Septic System �/'' o P 131JBLDING INSPECTOR , THISCER'f'IFIB-S THAT ....�::�°°,°.......'r..'......,' .........c...........y4..- ; .'::'.. ............,,..... ......<............................... F9undatroo,— has permission to erect.......<.................. buiilcllings on . .C> r c•!. ��^,,,,'., ............................... "�J���J/ //�� /y // / . P , Roughh r r to be occul,lied a s .......... . r , u".' s .,a:';..'..:'�;.. yl ......,. . ....,.�'.........................11..... ..L ..... f .�-ey provided that tkDe person accepting this permit„n'hall in every rea:lpect conform tc,o the terms of thu.,l application inai on file in this ofir ce, and to the provisions crof th, Codes and By-Laws relating tura the Inspection, Akiteration and -- 4 Constructk;on of Buildings iii the Town of No th,ilkndover. 1\11161 GNSPECTO t ��) 44 VIOLATION of the Zoning or B tullding Regulatioir-is Voids this Permit. C0 Final 's PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR' UNLESS CONSTRUCTION T RTS Rough Service .............a�, .... •�• n��g4ia„' '��••• a':;:'�:"hrww�^'rnw..........�..' 'rFinal�.'J � ... t� ✓/`i• ,, BUILDING INSPECTOR t3AS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous F`Iace on th(.,,� Premises .,_ Do Not F,ismove Final tullo Lathing iix Cary Wall To Be C1oi ire FIRE DEPARTMENT �= Until Inspec-ted and Aj:oproved by the Building Inspector. Burner Street No.- Smoke Det. :.mtnuwssu,�w.,wh�i#y,. �< w atw .... � �. y ♦• � .-ter..�w� � � . '°t � � �} . ��� . . ¢� a � � �. — . } � . ��� f '�` ', ` ` � *�' ` 1� � � YI ` '{ ii 1 i _� •_ a a � i� - r- .. �} � ' • ` 1 d { ° + 4 Y - F '_ � �.� ' ' Massachusetts'-Department of Public Safety . Board of Building Regulations and Standards Construction Supen-isor License: CS-063738 ROLAND P GOODICKuj�i JR' 38 DRIFTWAY RD i N WEYMOUTH AVIA J i Expiratior 10/29/201' Commissioner NORTH Town of tAndover ,� oh ver, Mass, y CO[NIt ME WItM 1' ��A00ATED ilk? �(5 ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... 5A�Kq. — -r—, .,, BUILDING INSPECTOR .,�. ................................................. ' haspermission to erect .......................... buildings on ..r� �.... .u �?::y........ ............................... Foundation - Rough to be occupied as .........` F: !'. /� /lr 4c'� �`'� . Chimney .......... ................................................ eY provided that the person accepting this permit shall in every r spect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T RTS Rough Service ............ ....... ... ---Js...... .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. A ' t CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 218-15 On 8/29/2014 Date: March 10,2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 201 Sutton Street MAY BE OCCUPIED AS Davita Healthcare Partners _IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: ISD Renal,Inc. 201 Sutton Street North Andover,MA 01845 Building Inspector Fee: Prepaid$100.00 Receipt: 27966 Check : 026734 : � ,rte. ^fygi t}. .�i,.�� _�. � ^:. 'a�a .. ns^::+w��+WN•�="z"�' .N'w. w'or G 7 n i®mm®i _ am�mn No. . h ver, Mass, r COCa1CHl WICK 1' q°44rE a S U'P1 BOARD OF HEALTH r T o i IL �LIIIPh� 'food/Kitchen ISI ; 1.r Septic System `. L /J. ,� / ,�. -> BUILDING INSPECTOR f THISCERTRIES THAT ..,.� ... "'..r...,,' �.... .... .y�'� � ,.�......n...n.,,.....,,.�....,,...n.n................n... u f " ' .. .................................... Fqundaa ,^� G has permission to erect .......................... I,tuIIl,Iings on .r , ,!° .r.... 1V �L � r-j Rough to be mCCLB�1ied as ...,......1. : :.: "'` !a✓.••. .. . . !,,le�......,. .::.r.:.: ... ............................................�r ... rZna yrovided tduat tl a arson a�,,ce ,�lln this errnrG ,hall In ever .r .1"", conform tc,,,,the terms cof this, a lication p p p i/ I� pp on file in this office, and to the provisions of than! Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 010131tiG JNSPECTOA VIOLATION of the Zoning or Building Regulations Voids this Permit. Final �fSS �21o7c7/`� E PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOFd UNLESS CONSTRUCTION T RTS Rough r, Service .._ ............,a,�, ..... .••fy ta,onl .Se:-:�:^�inwrrw.............. /�' /BUILDING INSPECTOR �'� � /�' GAS INSPECTOR Oecu�ancy Permit Required to Occupy Building Rough Display in a COnspicuoua31 F',lace onithf.,a Premise: n ®o Not Remove Final � No Lathing m.)r Dry V al l To Be Done FIRE DEPARTMENT Until Inspected and Approved by -the Building Inspector. Burner Street No.- Smoke Det. �s L- a -T I 7F'�� `krlr 'A' 1A Document G704 TM - 2000 Certificate of Substantial Completion PROJECT: PROJECT NUMBER:DAV-152-IN/ OWNER: (Name and address) CONTRACT FOR:General Construction ARCHITECT: FM Renovations to CONTRACT DATE:07/30/2014 North Andover Renal Center CONTRACTOR: 201 Sutton Street North Andover,MA 01845 FIELD:❑ TO OWNER: TO CONTRACTOR: OTHER:❑ (Nan:e and address) (Name and address) DaVita,Inc. PKC Construction 100 Main Street 520 WEST 103RD Street Middletown,CT 06457 Suite 299 Kansas City,MO 64114 PROJECT OR PORTION OF THE PROJECT DESIGNATED FOR PARTIAL OCCUPANCY OR USE SHALL INCLUDE: I'and 2'd Floor Renovations The Work performed under this Contract has been reviewed and found,to the Architect's best knowledge,information and belief, to be substantially complete.Substantial Completion is the stage in the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the Work for its intended use.The date of Substantial Completion of the Project or portion designated above is the date of issuance established by this Certificate,which is also the date of commencement of applicable warranties required by the Contract Documents,except as stated below: Warranty Date of Commencement Warranties are for a period of 18 months from date o 02/I9/2015 Substantial Completion, Tecton Architects G- March 4,2015 ARCHITECT Y DATE OF ISSUANCE A list of items to be completed or co ecte ' arta ed here .The failure to include any items on such list does not alter the responsibility of the Contractor to plete all Wo in acc dance with the Contract Documents.Unless otherwise agreed to in writing,the date of commencement warranties r ems the attached list will be the date of issuance of the final Certificate of Payment or the date of final payment. Cost estimate of Work that is incomplete or defective:$0.00 The Contractor will complete or correct the Work on the list of items attached hereto within ( )days from the above date of Substantial Completion. PKC Construction CONTRACTOR BY DATE The Owner accepts the Work or designated portion as substantially complete and will assume full possession at 5:00 pm(time)on 02/19/2015(date). DaVita,Inc. OWNER BY DATE AIA Document G704"'—2000.Copyright m 1963,1978,1992 and 2000 by The American Institute of Architects.All rights reserved.WARNING:this A10 Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any .� portion of it,may result in severe civil and criminal penalties,and will be prosecuted to.the maximum extent possible under the law.This document was produced by AIA software at 17:07:14 on 03104/2015 under Order No.9017143401 1 which expires on 02125/2016,and is not for resale. User Notes: (1110992218) The responsibilities of the Owner and Contractor for security,maintenance,heat,utilities,damage to the Work and insurance shall be as follows: (Note:Owner's and Contractor's legal and insurance counsel should determine and review insurance requirements and coverage.) Responsibility for Security,Maintenance,Heat,Utilities,Damage to the Work and Insurances shall be that of the Owner,for the portions of Work covered by this Certificate,effective February 19,2015. AIA Document 07041*—2000.Copyright©1963,1978,1992 and 2000 by The American Institute of Architects.All rights reserved.WARNING:This Me Document is protected by U.S.Copyright Law and International Treaties.unauthorized reproduction or distribution of this AIA®Document,or any 2 portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 17:07:14 on 0 3/0412 01 5 under Order No.9017143401_1 which expires on 0212512016,and is not for resale. User Notes: (1110992218) 6.et �y A T {p } ARCHITECTURE 17 RAILROAD AVENUE ONE HARTFORD SQUARE WEST onl rc h1 ects INTERIORS WESTERLY,RHODE ISLAND 02891 HARTFORD CONNECTICUT 06106 LAND PLANNING TELEPHONE 401.596.7555 TELEPHONE 860548 0802 FAX 401.596.7227 FAX 860 249 2531 T ECTONARCHITECTS,CO M March 4, 2015 Certificate of Building Use Group/Construction Type RE: North Andover Renal Center 202 Sutton Street North Andover, MA 01845 Use Group.This letter is to certify that, after review of the information presented to our firm and to the best of my knowledge,the existing space is classified as use group B - Business and the proposed intended use as a Davita dialysis clinic is also classified as use group B -Business. Therefore, shall not be considered a change in use as defined in the 8th Edition of the Massachusetts State Building Code(based upon the 2009 International Building Code with 780 CMR Amendments). Construction Classification. We have determined, after staff review of the existing building (under my direct supervision)and to the best of my knowledge, the existing building is identified as Type 2B non-combustible construction as defined in the 8th Edition of the Massachusetts State Building Code (based upon the 2009 International Building Code with 780 CMR Amendments). Please contact me directly should you have any further questions or require additional clarifications relative to the information contained herein. \ Z'11-/ /,,)9 - Are ' sS a e J ey Wys ski ecto h ects MA# 10681 Massachusetts State License Number One Hartford Sq West, Hartford, CT 06106 Business Address R.P. GOODICK CONSTRUCTION SUPERVISOR 100 EAST STREET WEYMOUTH,MA 0218 TEL 781-331-0656 FAX 781-340-5864 CELL 617-212-3691 Rpg327�?a,hotmail.com Town of North Andover Inspectional Services,Dept. 1600 Osgood St. Bldg. 20 North Andover,Ma. 01845 7 Attn. Building Commissioner Mr. Gerald Brown Re: General Contractor Final Affidavit I certify, pursuant to 780 CMR,Article 1, Section 107.6.3 of Mass. State Building Code, I have Observed the work associated with permit 218-15, ISD Renal Inc. 201 Sutton Street North Andover. To the best of my knowledge, information and belief,the work has Been done in conformance with the approved plans, and with the provisions of the Massachusetts State Building Code and all other pertinent laws,rules and regulations of the T wn of o h Andover. R. P. Goodick License#CS-063738 100 East Street Weymouth MA 02189 THEN PERSONALLY APPEARED THE ABOVE NAMED (t if kl� ota Public JODI A.ROBERTS NOTARY PUBLIC Commonwealth of Massachusetts My Commission Expires March 7,2019 Y h'� Construction Control Document To be submitted at completion of construction by a Registered Design Professional ,r for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Renovations to the North Andover Renal Center Date: 8/26/2014 Permit No. Property Address: 201 Sutton St,North Andover, MA 01845 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovations to existing facility. I Jeffrey Joseph Wyszynski,MA Registration Number: 10681 Expiration date: 8/31/2015 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1,or my designee,will perform the necessary professional services and will be present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work will proceed in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: - 1. Will 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. Will perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Will 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 performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor nsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or U- � electronic signature and seal: . �Fl Phone number: 860-548-0802 E l:Je a tonpc.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Construction Control Document = To be submitted at completion of construction by a Registered Design Professional r� for work per the 8`h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Renovations to the North Andover Renal Center Date: 8/26/2014 Permit No. Property Address: 201 Sutton St,North Andover,MA 01845 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovations to existing facility. I Jeffrey Joseph Wyszynski,MA Registration Number: 10681 Expiration date: 8/31/2015 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. I,or my designee,will perform the necessary professional services and will be present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work will proceed in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Will 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. Will perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Will 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 performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor nsibility regarding the provisions of 780 CMR 107. � �sem► W ,,, Enter in the space to the right a"wet"or U 1 electronic signature and seal: Phone number: 860-548-0802 E 'l:Je a tonpc.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 1 l 2013 TedonArchitects Transmittal 1 Hartford Square West Suite 103, Hartford, CT 10106-5133 PROJECT: 721N - N,AndoverJMA- DATE: 11/6/2014 Lavita-.Reno clinic t;A,V521N- -) y SUBJECT: Construction Control Document TRANSMITTAL ID: 00057 PURPOSE: For your use VIA: V2 'Pub-, FROM NAME COMPANY EMAIL PHONE Tony Daleb 1 Hartford Square West Suite 103 Tecton Architects, pc tonyd@tectonpc.com 860-990-6920 Hartford CT 10106-5133 United States TO NAME COMPANY EMAIL PHONE �G7ald.Brown 1600 Osgood Street Building 20 Town of North gabrown@townofnorthandov Suite 2035 Andover er.com 978-688-9545 North Andover MA 01845 United States REMARKS: Gerald Attached is the construction control document for the Davita North Andover renovations project located at 201 Sutton Street, North Andover, MA Please feel free to give me call with any questions. thanks Anthony Daleb Tecton Architects 860-548-0802 ext. 239 DESCRIPTION OF CONTENTS QTY DATED TITLE NOTES 2 8/26/2014 Construction Control Document Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 69206.00 m $ - $ 8,314.75 Plumbing Fee $ 1,039.34 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 1,039.34 Total fees collected $ 10,493.44 201 Sutton Street 218-14 9/9/14 Tenant Fit Up= NA Renal Center Enter construction cost for fee cal- North Andover Fee Cakulatlon Construction Cost $ 6929896.00 m $ - $ 8,314.75 Plumbing Fee $ 1,039.34 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 1,039.34 Total fees collected $ 10,493.44 201 Sutton Street 218-15 on 8/29/2014 Tenant Fit UP i Construction Control Document 1 - To be submitted at completion of construction by a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code,780 CMR, Section 107 Project Title: Renovations to the North Andover Renal Center Date: 8/26/2014 Permit No. Property Address: 201 Sutton St,North Andover,MA 01845 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovations to existing facility. I Jeffrey Joseph Wyszynski, MA Registration Number: 10681 Expiration date: 8/31/2015 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other:Describe for the above named project. I, or my designee,will perform the necessary professional services and will be present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work will proceed in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Will 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. Will perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Will 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 performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor sibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or Q ' electronic signature and seal: it i Phone number: 860-548-0802 E is Je a tonpc.cotn Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 0 ' Coaraapm m mM of assa0meft �U,�pae�atfl,f�'1��Z.�fcc�efa#s • • . O,f ee a,f v ati'oau . 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Be advhadfidacopyofft oMaentmaybefoxwardedtotoOfficeuf InvesgPdow offloDIA for&=am eov=MYmMO89au. ,�da kereby cd�tr�'ar ,Ziaz�rurrlp f�as a,f,,pe�.�y fha�tTis i�brmrr�Yoreptov 'a�iove Eras d eorr�c� 3•- .. yso y "ne- [OjfflIIdeaIo*o*,Do nee M 0 urea totris corrWNCIlby el(yOftOW a 4PkA ffy or xo'P n:nfia A. , oxity(ewe bps}:3oaxdof�eaI�.2.Bu�in�gJDe�artma�3.G�p1�'awaaG'�ar�C �.�'e�cfricaXTns�iecfax 5.>E'XmazbingJfnae,�etrnr CERTIFICATE OF LIABILITY INSURANCE TE(THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R GNCE L81:;/2014 TE HOLDER, CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED HTS UPON THE ABY THE POLICI1ES 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 endorseme s. PRODUCER Thomas McGee,L.C. NA PHONE 920 Main Street fiftdl 6-8424800 No)-J316-472-501 Suite 1700 P.O.Box 419013AI3; Kansas City MO 64105 INSURER(S)AFFORDING COVERAGE NAIC al INSURER A INSURED PKCCO-1 INSURERSTravelers PKC CORStrUCtlOn Co. INSURER C: ** 520 W 103rd St.,Ste.299 Kansas City MO 64114-4503 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2019697279 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. INSR LTftTYPE OF INSURANCE NORL R PoucY NUMBER MUM POLICY EXP LIMITS GENERAL LABILITY TCOSA738691IND13 1!112013 1/1/2014 X EACH OCCURRENCE $1,000,000 COMMERCIAL GENEn U181LfTY -PRWI f $30D000 CLAIMS-MADEOCCUR MED EXP(Any one $5 OOD PERSONAL&ADV INJURY $1.000.000 GENERAL AGGREGATE $2.000 000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $2,000,000 POLICY F PRO LOC $ B AUTOMOBILE LIABILITY BA5A73869113CNS 1111=13 1/1/201414ULE LIMIT acadent $1,000,000 ANY AUTO BODILY INJURY(Per person) $ AALLLOOWNED SCHEDULED UTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED AUTOS PROPERTY DAMAGE $ $ C X UMBRELLA LIAB X OCCUR EXC100D4487200 112014 1/2015 EACHOCCURRENCE $1,000,000 EXCESS LIAO CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$0 $ B AND EMIRS COMPENSATIONLILIABILITY TCUB5A73869113 1/112013 1/1/2014 X WC STATl1- DTH- AND EMPLOYERS'LIABILITY OFFICE BEERPEXCLUDE EXECUTIVE FNIA E.L.EACH ACCIDENT $1_ ,000.000 (Mandatory in NH) B yes deacrme under E.L.DISEASE-EA EMPLOYE $1 000 000 DESG�RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS J VEHICLES(AHach ACORD 101,Additional Remarks Schedule,N more space is required) Project: DaV'Ita#06828-North Andover Renal Center,201 Sutton Street,North Andover, MA 01845. Certificate Holder is named as additional insured as respects this project. i I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ISD Renal,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Ga DaVita Healthcare Parrtners, Inc.-Legal Dept 2000 16th Street Denver CO 80202 AUTHORIZED REPRESENTATIVE I ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD '