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HomeMy WebLinkAboutBuilding Permit #290 - 351 HOLT ROAD 10/16/2007 00RT11 BUILDING PERMIT °f�t`T-° '° TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION i e (J Date Received7 p�R47ED• 1' Permit NO: �SSAc►+us�c \ 0 Date Issued: \" IMPORTANT:Applicant must complete all items on this page t2 s, OCA'f0#-l +S] H O t leo ati b k PrIT�t P ROPERTY OV117�ERQla Cep "Camay txc `' ; �- t Historic District �� fires -no y d h t �llact►ine Shop�Yilla�e. „°yes. :no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential New Building = One family industrial ; Addition Two or more family Commercial Alteration No. of units: Assessory Bldg Others: Repair, replacement Other Demolition 1Natersted Distr{ct u �tosid�la�ra Wetlands Septic, t 111a1ater%Sewer A DESCRIPTION OF WORK TO BE PREFORMED: Build demising wall-.a rox' a ely 500 If armit Identification Please Type or Print Clearly) OWNER: Name: solo Cup Company Inc. Phone: 978-738-4154 351 Holt Road North Andover, MA 01845 t Address: ssc Cotrtxation Q Inatfhb i 98� 6944131 C01�ITRA�TR Narne x 231 Anlc ver St T 1m�ntn MA 08 a k i Address 'Ian And Superv�s©r's Constructioa� Jcene CS it234 k Exp Tate 5/.4/20x9 Inc. 978_399-0240 Cornerstone Architects Phone: ARCHITECT/ENGINEER _ Bldg Permit 8 Calista Terrace Westford MA 01886Reg. No. 6559 Address: 2.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Board of Appeals FEE SCHEDULE:BOLDING PERMIT:$1 ,proof of recordingFEE: $ Total Project Cost: $ 11� 5•'0 0 � �') G� � Receipt No.: 3 3 3 s Check No.: NOTE: Persons contractin wi registered contractors do not have access to the guaranty fun --.-- _ Sign iure of-Agentl0wra r t -- —_ ; Sigrat�re of contract©r � ��\, Plans Submitted T n'E OF SEWEGE Plans waived - --_-�_ Public DISPOSAL Certified - - Sewer --__ Well d Plan � T Priv anning/Mass a e(septic tam, etc. Tobacco Sales ageB od Stampo.,- Y Art Permanent P_ t •lding )epartMen errnitto be obta1ned• � Buf ropriate P r--- for the apP _ to be filled°ut 1 of the rea�ired forms Permits t n is a list aiiitatl°n e folloW� 9 r Reha CO r-, •rh lnterIo Siding' R°°f ing, licat1On (t er'm�t PPS,L. 1-�censes C b o Building Gom, N \.C. Andjor C• permit ers of \-A c• of Bidg °oto copy ctl riot W ork °ducts for to Is 6�G°py °i con proposed 1�Engineered e pepa,tMefit Pr �-- plan vits fO from F �IOor ° n ineen' P`s1 require sign o .� Aster perm NATE' A11 d F; ion or J)eGks n Add�t licat1O Co it APP Perrneyed plot plan Building ury -i SA-- Lac ork W ith Spr Come pnd c W orko Gopy of H.1.c• an of p rOposed o Ph0 y 01 contraon�Elevation p licab\e) if Applicabie e of Bldg p o c P sect If APP ort c Zonis � o FloorlcrO c t%orGompliance Beed productment prior to issuan Zoning Boar, draul� alcula Hy ss check Eneda its for Enjg tom Fire Depart Piannin mass sign o g Board. � Engineen egm s require C o o durnpster P nd Tw° F am�lyl nservation Decis NATE' N\ Single a Water constru�ti°n l Located Sewer C NeW IiCatlOn at 3g4 °sgooc ing perVA APd plOt plan enses elude Sprinkler F FIRE© o Budd d propose c.S.L• ��c R ed) to In Locate EP..gR .M certifie 1 c And e etij Fire�e t,24 EI y'', o phot° of H• ' Affidavit one-[o B Math 5treej Workers c°mP plans partments�9n01 f Building If Applicable) .CONjM ° Two Sets O Mons ENTS ;: calcula ;i draul►c ct nee Repo ducts _ r to issuance of Hy Of contra comPl►a eered Pro mens pr+o o COPY heck Energy its for Engin om Fire oePart e d an Mass c P•jjidav n fr ecison cop9 ° nine its reQuire sig ° ust stamp th sting office Rebistry°f Deeds. o E g r erm Clerks durnpgte P t Was reQuiree thet,,is recorded at the NOTE' e or ecial permsucat mast th A cases if a vaer.d iOver. ve.nc theaPP apph�tion In at the Wealtped With the h°ding tmnstbe snhmi D�ppRTME�;BPFDVOAO'I Doc:WSPEC110' Al SERVICES Revised 2.2p0'I _ _ �_ 00RTh BUILDING PERMIT °f st��o ""o TOWN OF NORTH ANDOVER , - APPLICATION FOR PLAN EXAMINATION , Date Receivedps•�c►+us Permit NO: s Date Issued: IMPORTANT: Applicant must complete all items on this page s L©CATION 3�1f Ho toady Y Pnnt L pROP,ERTY3�OWNER TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other $Septic tell F1ood�lain' Wetlands WateredshDistrict , DESCRIPTION OF WORK TO BE PREFORMED: Build demising wall apprQxjmately 500 if Identification Please Type or Print Clearly) 978-738-4154 OWNER: Name: solo Cup Company Inc. Phone: Address: 351 Holt Road North Andover, MA 01845 r , -d.S`ci'o Co nstr'ar ,tlon. C TRACT-ORMarn77 e ' =Inc Phone 8 6 9 �- 111 Address 23; AncTovert :WA )on , 088 r Supervisor's Eons#�uctio� icerases t192 "C- 3,4 Epp Date S 14 2 00 9 ' lorne'Ir � wz rra�e oaerl"Llcerse._ . Exp , Dae..., f Inc. ARCHITECT/ENGINEER Cornerstone Architects one: 978-399-0240 None: Address: 8 Calista Terrace Westford, MA 01886Reg. No. 6559 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 119 `s 5'.0 o FEE: $ 0 3 3-S Check No.: � 4 :2G Receipt No.: NOTE: Persons contractin wi registered contractors do not have access to the guaranty fund 77 Snatureyof A�enUOwn r Sigraatre o#contractor- --' r Plans Submitted Plans Waived Certified Plot Plan c;,- TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/M-______ Well 161j,16101;Department tmttOae°bta�"ed• Private(septic.ta161j,16101; t gtiate P e Ind out{Ot the aPp ° he teQ�,te f°trtI •On p v1st°f t il�ta" b(� Rehab � -The{OtjOw►ng�s a interiorrk 1 5%6%n9' ,,.,,aavits for Engineered products Rod{ungpster 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 ❑ 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTF/ BUILDING PERMIT °f,tU TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION , 41 ey e 0 C/ Date Received A*I°•'" �`' Permit NO: �SSAc►+us�c Date Issued: D\" . Appli IMPORTANT: cant must complete all items on this page _t T101�I., 353. Htat Roel LOCA Pent 77, w PROPERTIY-011VNER dlas.Cup _Coma erAllt7 e PARCELO1�Il�1G Sal TRIOT tstoncistr�c# ; yes no 1V1AP- 10 k yes r�o F.. n h :NJachine,Sfiop`Viilage TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential New Building - One family Two or more family Industrial Addition Commercial Alteration No. of units: - Assesso BldgOthers: Repair, replacement ry Demolition Other -7777777 Ploodplaan letlar ds Waterst►ivd District , DESCRIPTION OF WORK TO BE PREFORMED. Build demising wall -approximately Identification Please Type or Print Clearly) 978-738-4154 OWNER: Name: Solo Cup Company Inc. Phone: Address: 351 Holt Road North Andover, MA 01 845 A' ' Coal-tr��ta o� ONT°RACTOR Name nC PhDne. 98�64111 h 23 *dotTe St W1�TCtln`gt4n t1887 514/2009 F $ C� 09,234S�. tt Supervisor's`Cons#ructaor� .tcense Epp mate } NJA .;Exp :Date.:=�/A ,Horne improvement'-L�cerse . .: . :.. Inc. ARCHITECT/ENGINEER Cornerstone Architects Phone: 978-399-0240 Address: 8 Calista Terrace Westford, MA 01886Reg. No. 6559 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 118 75'.o o FEE: $ D � Check No.: -Z 4 :22 "7 Receipt No.: 3 3 S NOTE: Persons contractin wi registered contractors do not have access to the guaranty fund Signature of.pgent/Ownr - Signature of contractor �•�- — 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 o h�Oal� .Workers Comp Affidavit` <o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract � a� Floor Plan Or Proposed Interior Work ducts .a . � pro nglneering Affidavits for Engineered 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 ❑ 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ce must stamp the decision from the Board of Appeals In all cases if a variance or special permica tsmust then get this ecordequired the Town Clerks datthe Registry of Deeds. One c py and roof of recording that the appeal period is over. The apph must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 ❑ Notified for pickup - Date I Doc.Building Permit Revised 2007 r Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH ' 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 Located at 384 Osgood Street ' 1 FIRE,DEPARTMENT -?emp Dumpstee on site yes = no ,'L-orated at'124.Main Street:` , , - Fire Department'signature/date -COMMENTS Location --35/ No. d Date HpRTM TOWN OF NORTH ANDOVER a s Certificate of Occupancy $ ,ssACMUStt'�' Building/Frame Permit Fee $ , Y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3U b !;- 2 5-2 0 6 5 5 --------- U Building Inspector NORTH Town of No. 0290 `AK o dover, Mass., COCMICMEWICK �11 ADRATED BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D . G� C6.0 BUILDING INSPECTOR THISCERTIFIES THAT..... ................... ...................................................................... ................. Foundation has permission to erect........................................ buildings on .r�t ...3.C..,......'RO..�......JeA................ Rough t0 be occupied as do.. �.�.�....... ....w ....... 01.5.... Chimney p' ..... 6f provided that the person accepting this ermit shall in every ronfo 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 5 MONTHS(00 ELECTRICAL INSPECTOR UNLESS CONSTRUTS 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. Purchase Order THIS PO#MUST APPEAR PO# Date Rev Page Solo Cup Operating Corporation ON ALL SHIPPING AND BILL 5043610 04-OCT-07 2 1 1700 Old Deerfield Road Payment Terms Freight Terms Ship Via Highland Park,IL 60035 Imir?diate Pre Paid and Allowed United States Buyer: R HAYES Rev Buyer: R HAYES Buyer Phone: 978-738-4107 Fax: 978-738-4163 SHIP TO: ------> 351 Holt Road Vendor: 110745 North Andover,MA 01845 SASSO CONSTRUCTION CO INC United States 231 ANDOVER STREET WILMINGTON, MA 01887 United States Contact: Bill To: Box 3001 Accounts Payable 1700 Old Deerfield Rd Highland Park,IL 60035 United States CONFIRMATION -- DO NOT DUPLICATE!! Line Item/Description Due Date Quantity UOM Unit Price Ext. Price Tax 1 Service,performed by vendor(in 08-OCT-07 119875.00 Each 1 119,875.00 N attached wall construction Job Scope) Supply labor, equipment and materials as provided(in attached quote dated 9- 21-2007)are attached to this purchase order and made part hereof. Note: Payment terms are as follows:40%deposit upon receipt of invoice,40%on completion upon receipt of invoice, balance net 30 says from completion.The terms and conditions attached hereto shall be incorporated herein and shall become part of this purchase order. o SHIP TO: Address at top of page Total 119,875.00 USD This order is subject to the attached terms and conditions of purchase. Acceptance of this order constitutes acceptance of such standard terms and conditions. The Commonwealth of Massachusetts Department of Industrial Accidents Gr Office of Investigations t i 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Organization/Individual): Sasso Construction Co. , Inc . Address: 231 Andover Street Wilmington, MA 01887 City/State/Zip: Wilmington, MA 01887 Phone#: 978-694-4111 A e ou an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �� 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. E] Remodeling 2.[1 I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, E] Demolition working for me in any capacity. employees and have workers' 9 F-1Buildingaddition [No workers' comp.insurance comp. insurance.* 5. E] We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other_ 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. 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: The Insurance Co. of the State Of Pennsylvania Policy#or Self-ins. Lic.#: WC 659-31-50 Expiration Date: 10/08 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 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 a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern under the p 'ns and penalties of perjury that the information provided above is true and correct. Si nature: Date: I d 6 Phone 4: l 7e VIX� 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#: THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA 69194-0000 WC 659-31-50 13889 --------------------------------------------- 013-82-1007-00 WIN SASSO CONSTRUCTION COMPANY INC 2 1 ANDOVER STREET Member Companies of Wl LM I NGTON, MA 01887-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI#: Lei 111161 4o&2 0 r-11 ill 1:1111i I ORA 6161.1 TPA INSURANCE AGENCY, INC. WORKERS COMPENSATION AND EMPLOYERS 10 NEW ENGLAND BUS CTR DR LIABILITY POLICY INFORMATION PAGE ANDOVER, MA 01810-1096 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 008968699 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 10/01/07 TO 10/01/08 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $_ 1 ,000,000 each accident Bodily Injury by Disease $ 1 ,000.000 policy limit Bodily Injury by Disease $ 1 .000.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI ITEM a The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated L_lassifications Code Number Runeration $100 OF Re- Premium Annual [:13 Year muneratlon M Annual ❑3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $870 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $318 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $16, 142 If indicated below,Interim adjustments of premium shall be made: ❑ Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 08/01/07 PARSIPPANY 82 Issue Date Issuing Office Authorized Representiaive WC 00 00 01 39967 ACORD. CERTIFICATE OF LIABILITY INSURANCE ioii j20o PRODUCER (978)887-4900 FAX (978)887-2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfiel d, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Sasso Construction Co., Inc. INSURERA: Mountain Valley Indemnity 231 Andover St. INSURERB: The Employers' Fire Ins. Co. Wilmington, MA 01887 INSURERc: The Ins Co of the State of PA INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(11111111110 1" GENERAL LIABILITY 3200010692-07 10/01/2007 10/01/2008 EACH OCCURRENCE $ 1,000,000. X COMMERCIAL GENERAL LIABILITY DAMAGPRrM E TO RENTED $ 100,00 CLAIMS MADE r A OCCUR MED EXP(Any one person) $ S'00 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,001 POLICYF'j ECOT LOC AUTOMOBILE LIABILITY FB1E64988 05/16/2007 05/16/2008 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSfUMBRELLALIABILITY X20-0005273-08 10/01/2007 10/01/2008 EACH OCCURRENCE $ 5,000,00 OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 A $ DEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION AND WC6593150 10/01/2007 10/01/2008 X I.wc STATU- I OTH- EMPLOYERT LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,00( OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,OO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00( OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Dept BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 120 Main St OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Peter Sennott LA A-rzz - : ACORD 25(2001/08) OACORD CORPORATION 1988 PDF created with FinePrint pdfFactory trial version http://www.pdffactory.com IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) PDF created with FinePrint pdfFactory trial version http://www.Pdffactory.com :2GJl�d :ai WdS2:To f1H1 2002-82-9B3 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUC" 10" CONTRA OCT 16 2007 PROJECT NUMBER: PROJECT TITLE, PROJECT LdCp'ridK: 1=6SA NAME OF SOLOING: .-�f_,,, C> '--&?!E NATURE OF PROJECT, V 10 A IN ACCORDANCE WITH ARTICLE 119 OF THE MASSAICHUSETTS STATE=BUILDING CODE. E, (" tr ✓�c�, �{� _.. REGISTRATION NO. of aa,.q BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING. ENTIRE PROJECT 0 ARCHITECTURAL/!? STRUCTURAL0 MECHANICAL Q FIRE PROTEanON 0 Etr--cTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PUNS, COMPUTATIONS AND SPECIFICATEONS MEET THE APPLICABLE PROMSION OF THE MASSACHUSETTS STATE BUILJ?iNG CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND AP'IJCABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCEJPANCY. I PURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFE=SSIONAL SERVICES AND 6 EpRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCF_,MEDING IN ACCORDANCE wrrH THE DOCUMENTS APPROVE=D FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLCaWING AS SPECIFIED IN SECTION 116.0 1. Review,for conforrr0x*to the design omcept,shoe drawings,samples and Other submittals which are subrMtted by the contrxter In awotdance Wth the requirements of the corMiu&JOA dotxlr w t8. 2. Review and appmvel of the quality contrd procedures fa all oo&4"uired controlled matedartls. 3. Be present at irttelveta appMptiate to the stage of canatnuoeon bD boom*,generally farnigar witI the pnogrm and guelky of V*vim*and to determine,in geraerall,N the work Is being performed in a nv mer consistent with the cor*bvchm documents. PURSUANT TO SECTION 198.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR P SUBSCRIBE D SWO70 TQ E THIS `COCAY OF Q0;)WA— I�RIYIBi`'l�'f�`� ARY B C MY COMMISSIONiI ; My commission e0es Marchl T/T:d 922GbG9eLGT:01 :WONJ d92:L0 2002-82-83A