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HomeMy WebLinkAboutBuilding Permit #924-16 - 50 HIGH STREET 5/1/2018 r10RTy �Lrl BUILDING PERMIT o`StLEo ;b�tio TOWN OF NORTH ANDOVER 0 r APPLICATION FOR PLAN EXAMINATION _ Date Received Permit No#: �QA�R�TED�PPycS gSSgCHl1`'�t Date Issued: IMPORTANT:Applicantpust complete 411 items on this page LOCATION Print PROPERTY OWNER Lif H , Print 100 Year Structure yes no MAP PARCEL: _ZONING DISTRICT: Historic District a no Machine Shop Village es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other _ Septie Dwell ❑FJootlplain p UVetIands ❑' Watershed District O Wate_r•fSewer_ - - - DESCRIPTION OF WORK TO BE PERFORMED: 01, L�.f 69 Identification- Please Type or Print Clearly -7_ 6 OWNER: Name:�A Vi o ���I N c �N P)hone: Address: g^ V� J, v a Sri- _C0,101 ow i Contractor Name: CdrCr�.11 W G - Phone -6 J Email , . z C-0 NG7uA cms t2_ com . t,4 c�c d'(e-- Address:_Sq 1­6 ) Supervisor's Construction License: CS 06633 fir- Exp. Date: Zt, Home Improvement License: Exp. Date: ARCHITECT/ENGINEER f c)r-s- ` �� 17Phone: -7J— Address:?,6J kcnL4oncJ, Ahmie0fJOJ7 Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. rJ I � 6z 1 Total Project Cost: $ 5111100 -` FEE: $ �� �� Check No.: �`cReceipt No.: a6 NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund I ` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ElTanning/Massage/Body Art ElSwimming 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 c& DEVELOPMENT Reviewed On 2'�j-� Signature_ �ly�r� COMMENTS PR-art&+c ii U�,e 0 , e- 0o 7'b JNTe2ior hr-Up d r�l,� CONSERVATION Reviewed on Signature i COMMENTS OTE: ALTH Reviewed on Signature f COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments h Water.& Sewer Connection/Signature& Date Driveway Permit DPW T�wn Engineer: Signature: �FFIRE�DEPARdTMEN%T,"� Locate 84 good Te ' d 3 Os Street I Located 5 24Main ;ptDUmpster.Qonslte ..,yes, , j.__ ino% __ 'j fat �- �'Firebepartment�signaturEe/date, 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.$1oo-si000 fine NOTES and DATA— (For department use) i i El Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 OTE: 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 LocationI� a No. lal `t� M Date TOWN OF NORTH ANDOVER • Certificate of Occupancy $ yu Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $� TOTAL $_ n Check#'Q, 1 . a r. - Building Inspector Y� On DO in, r. } .( o be SribT�itieti at cm.tIpletis�tt.of t c ristt ct ttr lei t .. in 11 f i. t{ !4 e�;� to ed:DeSf�� Mona! far Wa k per the 'S"Ded txatt of tlae -Nit as., �tatc �utliit�g Coctc, 7£�tl-.C'.14fIz, Sccfiiort Prcaj�:t fi l ttlG:Sufic: 1.6. 2{:,27 artcl 2£i T3ate � �; 6 . Pe-r•trrit N0. l''toi3&ty Address -01 tglr tucc:t,N* Afidgv•er,A F'rolec:t: .ret:It(r 'ot�e or bc�tlrstpplcalie: .. i�levv c c>tsfruc Burt: X li:strag :on5trtt'ition' 1'to} :ct c escriptit}i: Pieutc�v'ation t� u tst rt ot`lier space- Strife 116,?6 aad 28'have been corrrplvtccl to celtnpl` vvitlt all lc7t.al duct ;tate 1iui:[ti'itrg codes. Suite 27 was enclo-ed its part of tl2ss.print ct.bt.tt n�.t uct:upiahle, I, 7ttilit 1'.I �'�'attt a',l�tA Registration N rnbcr: �°�3G Ixpiratiotr crate: 8/3 1, L. 2(#1 ,t arur a rc�t�t�= ccl�c��i�fr�rt>fe�srrrxjx�� and T:lave preparccl or di:rc 4t1�'srt:petv'i:seci lre 'reparauti{�tt ofall clest.glr plans, cosnlxit"7tplrs anal siecs:tcattoils t.e.ta.�,Grtr rr Architectural Structural ;vlechaurtcal h'ire.l'rote tioa:t Electrical. ()they. Describe for the.above.-narnedlproject;. i, cir.tny cle$it=ttee,11at e:}�or.R) taied tltc necessnYv profs�sio'tia.i sett ices ani_('vv& pre, cutis Crttctioui site our.a rf;gu:qtr arta perisa c t�a'sis.."f a the hest of my knowledge. infartnat't�tr,unci belief the work paoc'ecelccl izt ace arclarree vv i:tl tltt.rcctrtiternei-its of�780 C lr�'lR,at1c1 tl1e:deagn cloc:tttxret�t} approved a pari at tlte.l�tu(ctii��' P rrnit,d tl-rat f or say desirrn'ee; 1. 1lttVe rc v ievt' c1>#i r con:forrrzas3c:e tcf tlrl:s ct�de arld the tlt�Gtgrr corxGept; slxa clrateirr,�,sar1il�l..es.and ot:l�c:r girl titii';t�a.ls . b tlxe contractor in�tccordtt>ce my th the i4quiretrr�xrtts of the eons'tru:ctioll docume:.tt5. 2. ti<i�'e perCc� sZ?e'€1 the-duties Fat -egtstemd design profess) to 780 CIM, Chapter 17 as apfslicafrlc. ,. Rave been precept at intervals�appropri:ate to the Stag of ua�tstru�tit3rt to bt 4otne.gcrr:.t sllt taatrilrar vvi h ihw progrc 4 rrutEl uality ofthe vvlork azacl to OeterniNle'if`the tv.tjt k was p :r fcsrrneci rrz."I'M�tnne'r consistent with.tare 1 ` g� s " . . .. construction and fbis code'.. Nothing ill this rlocu .etrt r1lie-,;es the;ccs.ntt�l for of its ri-sponsibilif regT. rtril n�tlrt;,prov isit>trs i�f 7 1 1'{ " 0 v r:tE'Y in the SpaCC'ta the light ct cl.e.ctrota.ic sig tratur;e"attd t{, Nb6 Phone ra.ttr laet: X719}499-3999 F:txittil.;.c1vv ..tltert�e clarc:ttreivv'111tttz'r.com -- --- - - Building Official Usls'(lI lv l ixM n�iJf#kial rr.z,ae::. PUrTtt`o- Chat ---' versicert 06 11 201."r of MonTH try O A s y,SSq CIIIISES�9 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 26 MAY BE OCCUPIED AS a tenant fit up — Service Channel IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover, MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30056 Check : 2429 o,,O e7M,H 1 ACIIUSE419 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 26 MAY BE OCCUPIED AS a tenant fit up — Service Channel IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover,MA 0.1845 Building Inspector Fee: Prepaid $100.00 Receipt: 30056 Cheek : 2429 of HoRTH yN ti A SA W, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 26 MAY BE OCCUPIED AS a tenant fit up— Service Channel IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover, MA 011845 Building Inspector Fee: PrePaid$100.00 Receipt: 30056 Cheek : 2429 I OT •°7ry 3a d.r. ^.'•�0 O ^ T"so ^Y �1S ACNUSE44g CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 16 MAY BE OCCUPIED AS a tenant fit up —Becket Family Services IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover, MA 01845 Building Inspector ` Fee: PrePaid $100.00 Receipt: 30056 Check : 2429 a O,NORTH Nti O M y; 37S ACeNU5E4,g CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 16 MAY BE OCCUPIED AS a tenant fit up — Becket Family Services IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover,MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30056 Check : 2429 # io ��S AC HUSE4,9 CER'T'IFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 924-2016 on 2/29/2016 Date: May 2, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 50 High Street— Suite 16 MAY BE OCCUPIED AS a tenant fit up —Becket Family Services IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: RCG West Mill LLC 50 High Street North Andover,MA 01845 Building Inspector Fee: PrePaid $100.00 Receipt: 30056 Check : 2429 -r 1 7 NORTH ve. . O - �+ f P h ver, Mass, oLAKS COCMIC«IWICK 1• �.qs R�reo �pa5 Ll BOARD OF HEALTH Food/Kitchen PERMIT T L�D y�� Septic System THIS CERTIFIES THAT k0k...�T.....1 Ire��1. BUILDING INSPECTOR .... ...... .. ..'.. ..:.... ... ........ . ........................................ I Foundation has permission to erect.......................... buildings on M..... ..... .�...y1!�;ll. �A. Rough to be occupied as ........... Chimney ---provided that the person accepting s permit shall in every respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT, TS Rough Service .............. ........ ....... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Isju Ar r.e 9,9 ch Smoke Det. 4000N �' Jly / $P N Na Tot I SAO W% :9 : *9ev 1 V4 I,/d -I' q��cs � � � .y2•h 1 a0 no rmlpl#Asl , � au ,J _ � X17 r+j)vnAI.1 Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 1 57,9'x'0.00 m $ - $ 1,894.80 Plumbing Fee $ 236.85 Gas Fee 100 comm. $ 100.,00 Electrical Fee $ 236.85 Total fees collected $ 2,468.50 50 High Street 924-16 on 2/29/16 Suites 16 and 26 r '1 V NORTFf _ : ver 0 " 1n I � Z o h , ver, Mass, COCHICMlWKM 1' r ��AERATE O S U BOARD OF HEALTH Food/Kitchen PERMIT T Septic System LDMld THIS CERTIFIES THAT ... � . .... BUILDING INSPECTOR hasp ...y .�.�� 1 f� Foundation i permission to erect .......................... buildings on .. ...... .... �I M..`..�,.... Rough to be occupied as .....C.*....... ...... ..'!!................................ .............................. Chimney provided that the person accepting s permit shall in every respect 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 CONSTRUCTITS Rough Service .............. ........ ...... ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildih 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. JK Contracting LLC 31 Richmond Street Proposal Weymouth, MA 02188 Proposal Date: 2/29/2016 Proposal M 208 Project: Bill To: David Steinbergh, Suites 16,26[27&28]. 50 High St N.Andover, MA 01845 f Description Est. Hours/Qty. Rate Total I ---,- ,----- - - - - _ _.. -- [Plans and Permits - _.^ -- ____ 1,896.00'-___ 1- --- 00- Demo 11,000.00 11,000.00 Wall Framing _ -----0,500.00-- --- — — - _ 9,500.00 Doors&T_rim 7,500.00 7,500.00 (Plumbing — --- - T___,__ - --- - - _ - - 4,700 00 ,_ 4,700.00 Heating &Cooling 23,500.00 23,500.00 :El — ectrical& Lighting --------- 17,500 00 17,500 00 - -- Insulation _ � 5,500.00 5,500.00 [interior Walls � �; _ 13,500 00 13,500 00 I Cabinets &Vanities 4,000.00 4,000.00 r loor Coverings 23,400.00 23,400 00 - - - .. _._ Sprinkler Work 4,000.00 4,000.00 [gpecialties,Glass. 3,000 00,!._ - - 3,000 00 _ Painting16,500.00 16,500.00 [Plumbg —__ -- - - - 14,300 00 14,300.D0 Total $159,796.00 ,. Flee Commonwealth of.iMXassaehusetts Department offfidustrial Accidents M 1 Congress Street,Suite 100 +N p d = Boston,IMA 02-114-2017 www mass.go-P/dia ©kkexs'Coaupenx0���,AGED'4I'JC�TEE JPJER(�TxTINGA.UTI�ORRXT�St'.txzczaras/PXuxnbexs. Please Paint T,e 'bl Applicant Inforanation Tja117e(StTsiness/Organizationllndividii Aftess City/State/Zip: �"�� o ems Phone#: A.reyou an employer?Checkthe appropriate box: Type of project )Vequired): em to ees full.and/or part-time)-* '1. El New construction l I am a employer with _ P y 2.❑ no employees workurg forme,in 8. Remodeling I am a sole proprietor or partnership and have any capacity.[No workers'comp.insurance required.] 9. ElDemolition, 3..[�I am a homeowner doing all work myself[No workers'comp.lasurance required.]t JOE]Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.[(Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole prop fetors with no e igYoye s — —- 1�ERIumbing repairsxr—additions..,.,.-._^_ 5.F1 I am a general contractor and I have hired the sub-c0tractors listed on the attached sheet. 13,0 Roof repairs I`hese sub-contractors bade employees and have workers'comp.insurance. 14.❑Other 6.❑We are a corporation and its offigers have exercised their right of exemption per MGI.c. 152,§1(4),and-w ehaveneiemployees.[No workers'comp.insurance required.] - *Any applicant that checks tiox#i must also f11 outthe sectionbelow showingtheirworkers'compensationpolicy Information Homeowners wbo submit this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavitindicating such. xContrabtozs 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. Ifthe sub-con[racfors fiave employees,&t must provide their workers'comp.policy number. .d'am an eMployer that is pi'dpidiizg workers'compensation insurance fog my emproyees'Beloly is the policy and lobi site information. r— f Insurance CompanyName: Policy#or Self-ins,Lic.#: Q '� Z-- Expiration.Dato. f 1; Cit /State/Zip ' fobSiteAddress: "® iGam Attach,a copy of the Work6rs'coxnpepsation policy declaration page(showing the policy number and expiration,5 date). Failure to secure coverage as required under MGI,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. ado hereby c tify render thepain.s and allies ofpe�jure treat the informationpropided ab pe is fru and correct. Date• �/ '� Signature: Phone i ature- Phone#: 0 Offrcial use only. .Do not write in this area,to be completed by city or town official.. City or Town: Pexmit/Dicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#: V 4 ��•� JKCON-1 OP ID:HS ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02/17/2016 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: DeSanctis Insurance Agcy,Inc. PHONE FAX 100 Unicom Park Drive A/C No Ext): (A.. AC No): Woburn,MA01801 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Star Insurance Company 012245 INSURED JK Contracting,LLC. INSURER B:Selective Insurance Company 19259 4 High Street Suite 108 INSURER C North Andover,MA 01845 INSURER D: 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 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 TYPE OF INSURANCE N DL SUB POLICY NUMBER MM/uDD/YYYY MM/DY EFF D/YYYY LIMITS LTR NSD WVD B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE � PREMISESSOCCUR S2205113 02/10/2016 02/10/2017 DAMAGE (Ea occurreRENTEDnce 100,00 $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 X POLICY❑PRO- E]LOC PRODUCTS-COMP/OP AGG $ 3,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO - BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN N A ANY PROPRIETOR/PARTNER/EXECUTIVE WC0853742 02/17/2016 02/17/2017 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) MA E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO WHOM IT MAY CONCERN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD OFFICE OF BUILDING INSPECTORD AR TOWN OF NORTH ANDOVERtv CONSTRUCTION CONTRS)L P {HJ � No.9536 �p 4 o SCITUATE, b M A �, PROJECT NUMBER: 15-071$ �J" PROJECT TITLE: West Mill - SUITE 16, 26, 27 & 28 ���`N�F PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, u IQ Aub h1 t.) A REGISTRATION NO. 9 5 3(, BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ' ARCHITECTURAL STRUCTURAL ' MECHANICAL ' FIRE PROTECTION ' ELECTRICAL ' OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE ALL ACCEPTABLE ENGINEERING G ERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally famili with6the progress and quality of the work and to determine, in general, if the work is bein performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPOR TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INS CTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANC SUBSCRIBED AND SWORM TO BEFORE ME THIS DAY OF e t A ✓CTu ?� I YC-t trRKINSHAW Notary Purblic NOTARY P LIC MY COMMISSION EX Commonwealth of Massachusetts PoIy Commission Expires March 7, 2019 i i t i - Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor ..,, KIERAN T WHELANv 31 RICHMOND STR h WEYMOUTH MA-02 )1 . ^^� Expiration: Commissioner 09/26/2017