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HomeMy WebLinkAboutBuilding Permit #548-13 - 50 MAIN STREET 1/31/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7-3 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page e,� u+s".M� �- },{ .Ssy. r y k �L �•i9":+t,�-"t:� tw .-.f y..�. ...y ao. -- - - --a %.P"'�"=,r..e..y;-. _ .-;-�.�—.,.-4...,,,..,a-�.-., q >t,� ,as._c k .a LQCATIQNI_ fI?ROPERT�YOVVNERt /t'►.(.P� ,Cr I �u __�/`7? e -.S ��•c/- - fi�GsCr!`. �1O5xYe4r 01a,1 ucture.,': eyes,, cnor<_ iMAI?,NO ' tPARCEL `. ZONING DISjTRIC:T fHist eic istnct; yesy nog `{ 1 a w - = ,M s, ne,�Sliop�Vi a9e'_.�Y.e,__.... os.: -t ach"i II n 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 f❑ eptict =.❑�Well ,Floodplam�0 Wetlandsa t tO�,Wat rshed District'' -,S t a �f f �OtWater/Sewer ... >� I q q�; _1z T DESCRIPTION OF WORK TO BE PERFORMED: P—XISTr✓ic, .S'AACP il-/—/(zo /IV i `'10 J s �� S S Identification Please Type or learly) OWNER: Name: Phone: Address: kt-;RACTOR Name - icense', Ilione'. • IEx �, fl ARCHITECT/ENGINEER /7o c� ✓trek t r e CTS Phone:00 2r6 - Y06 S Address: 8 L�55-ex Roci , ZASwr Cl.,= l eg. No. S�D� FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /309000,00 FEE: $ Zz,-56 d Check No.: --Z,43 Receipt No.: J1,6/ 2, 2, NOTE: Persons contracting with unr� eyed contractors do not have access to the guaranty fund Sign ature_of Agent/Own r"�;�-- _ Signature 'of contractor Plans Submitted RT Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted � Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 9 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Wel'. ❑ Tobacco Sales ❑ Food Packaging/Sales El Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED 44? e CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature All WINE 1101 lwl I "I e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decis Comments Comm Water & Sewer Connection/signature & Date Driveway Permit I)PW Tovvz ]Engineer: Sign FIRE DEPARTME' NT - Temp Dumpster on site yes= Located at:124 Main` Street:. . Fire Depaftmen- signature/date .COMMENTS Located 384 no sgooa Street Dimension Number of Stories: I Total square feet of floor area, based on Exterior dimensions. > ,L/Y-S- 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 Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application Eli"' 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/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 subm;tted with the building application Doc: Doc.Building Permit Revised 2012 Location Q /Y.�G �,/1/ S/-- No. ` No. Jr�/p=- 0�3 Check # 3 26132 Date / 3/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /.-514U Foundation Permit Fee $ Other Permit Fee $ TOTAL Auild�dg Inspector S" - Il w.,ks 71 T Co (D e UEF CD FP 3 _0 CD Qe S 2 2 ip ------ ----------------------------- - -- ---- - ------------------------------------ ---------- ID 0 w 71 p cl C, EEEI Ira ex Do 'co c E 0 0 --------- - 0 0- 0, /0. AM Architects LaGrasse & Associates, Inc. Joseph D. LaGrasse, AIA --- — - - - - - -- -- - - -- - - —Thomas F. Galvin, AIA Architects, Englneers & Land Planners Julianna E. Hoch, RA Office of Building Inspector December 11, 2012 Town of North Andover 1600 Osgood Street North Andover, MA 01845 RE: Architectural Construction Control Affidavit for renovations to 44-50 Main St., North Andover, MA As a licensed architect, I certify that I have reviewed all plans and specifications related to renovations at 44-50 Main St., North Andover, MA and made periodic site inspections to verify that the work defined within the architectural plans was properly completed. Site inspections included, but were not limited to the following construction phases: - Selective demolition Wood & steel framing - Electrical & plumbing modifications - Insulation - Interior & exterior finishes To the best of my knowledge, all work was completed in a satisfactory manner and all units within the building are ready for occupancy with the exception of 50 Main St. per the qualifying note below. It should be noted that architectural plans and the scope of work defined and supervised under this Construction Control Affidavit did not include improvements to the 1St floor commercial space addressed as 50 Main St., North Andover. It is understood that all improvements to this commercial space, included but not limited to the completion of structural shear wall plywood to be placed on the inside face of the exterior wall framing along with all fire control assemblies and fire control systems would be reviewed and supervised by another design professional at a later date and under a separate permit application. Please contact me if you have any questions regarding the project. oseph D. LaGrasse JD LaGrasse & Associates, Inc. One Elm Square T 978.470.3675 Andover, MA 01810 F 978.470.3670 www.lagrassearchitects.com ;ctural review of this ;DEQ �Cyi No. 4153 NWVEFL MA J`o A OF P 420 Celebration Blvd. Celebration, FL 34747 AA26001333 DAME1 WEbb,, P.E. 291 PEAR[ STREET STRUCTURAL ENGINEER REAdINq, MA 01867 (781) 779.1330 STRUCTURAL AFFIDAVIT Project: Building Renovation 44-50 Main Street N. Andover December 12, 2012 Building Inspector North Andover 1600 Osgood Street North Andover, MA 01845 Dear Building Inspector, 1, Daniel Webb, P.E. was retained to serve as the engineer of record for the above -referenced project. In this capacity, I reviewed the original architectural drawings, performed structural calculations, and prepared structural framing plans. Structural drawings were submitted in a permit package prepared by Verdeco Designs dated May 19, 2012. I completed a final inspection on November 8, 2012. Additional photographs were issued to verify that minor structural comments were addressed. It is our understanding that the build -out of the first floor space required that some interior structural items not be installed at this time. Build -out requirements of the first floor space could result in an alteration of the structural system identified in these plans. Not completed at this time is the interior shear wall plywood and support beams identified in the interior bearing wall. These items should be addressed with the design team retained for the first floor build -out. On the basis of this work, I certify that to the best of my knowledge, information, and belief, the completed structural work associated with the above -referenced project complies with the structural provisions of the Massachusetts State Building Code 780 CMR -8, with my original framing plans and approved field modifications, and with accepted construction practice. Please feel free to call if you have any further questions about the structural work on this project Regards, Daniel Webb, P.E. Webb Structural Services, Inc. OFFICE OF BUILDING INSPECTOR ' TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL. PROJECT NUMBER a �9 PROJECT TITLE AM feu 51, 80I CO%NCS ,5N A L 0 2 F/4 VC(UPlF 96 J d tr/Ari �11J PROJECT LOCATION: - 5-6 M fA iAJ NAME OF BUILDING. /S'ilxFii NATURE OF FROJECT: 8U1fN 6-1(46LL NGcJ le,9 u E2C,; e P IN ACCORDANCE WITH ARTICLE 116 gF THE MASSACHUSETTS STATE BUILDTIG COCE. I, c.Jcf;) 't Et �� �, 5_ AIA REGISTRATION NO. / BEING A REGISTERED PROFESSIONAL ENGINEEWARCHITECH HEREBY CERTIFY TIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL 11 STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER (SPECIFY) FOR THE ABOVE NAMED PROJEE~ AND THAT, TO THE BEST OF MY KNOWLEGE. SUCH PLANS. COMPUTATIONS ANO SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCFPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I` FURTHER CERTIFY THAT I SHAM PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTIOtgi 21TE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCE_EDMG IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE EUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116._0 1. Review, for cOnfcrmance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the corstixtion documents. 2. Review and approvM of the grJality control Procedures for all code -required controlled materia µED q k 3. Be 0. present at intervals appropriate to the stage of construction to become, generally familia with the progress and quality of the work and to determine, in general, if the wOriC is being No. 4153 performed in a manner consistent with the construc ion documents- ANDOVER. PURSUANT TO SECTION 1162 2 I SHALT. SUBMIT WEEKLY. A PROGRESS REPORT MA TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANCOVER BUILDING -INSPECT q�Ai A; M ' UPON COMPLETION OF THE WORK. 1 SHALL SUBMIT A FINAL REPORT AS TO THE . SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME TH15�3 / s OAY OF _')V6 * +Q o�0 / NOTARY PUBLIC «� MY COMMISSION EXPIRES_a _'u, �� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 548-13 on 1/31/2013 Date: April 23, 2013 THIS CERTIFIES THAT Heav'nly Donuts THE BUILDING LOCATED ON 50 Main Street MAY BE OCCUPIED AS a donut shop/cafe IN ACCORDANCEVITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Premier Commercial Properties Realty Trust 44 Main Street North Andover, MA 01845 Bu' ding Inspector Fee: Prepaid Receipt: 26132 Check: 3 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 130,000.00 m $ - $ 1,560.00 Plumbing Fee $ 195.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 195.00 Total fees collected $ 2,050.00 50 Main Street 548-13 on 2/1/13 Build out for Heavenly Donuts �5 cel, � F,� CA m m m m m v N N 0 -0 O CD p O -0 CL 0 A i• Q _ cc cn � -v .�0� <0 CD o CD CL Cr CDCD O C o C. CO C � v O a CDz O CD cMo z Cl) icN cn — 01 o� z cn 155m C � .4z z ic cn O >_ �Cl) cn 0 00-0 0 --I ='CD N Q c �• CD � C7 CD 0 0 0.0 3 m o vi rt rD - N T 0 0.� 0. 0ft =h m CD c1n) m -I CD 7 � O > Co Q. or rt 3 rr n � n S CD O X CD -0 O .0 O to :� h N a 0 CD �o0 o o CL CLCD ^ • :� `< CD r N .. � •� NI 07 O rt f U)CD o � Ort 2) O CLO .L1 Ln 3 V1 W C T �p 7 O I� Vf * ]7 fD O T O w O 3 ii .7o T S+ O O to fD T O (D rD n '* Z S �j S O: ;4 S 'S O. 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C opo =r m e�'r coCD y O N N _..CD CDCD 2 �• O m @ 3 _ O C 0 co CL 7 cc y O OACD CD CO 'O Z o o � m y:' O 'b Cl) CD cc Dc� N 0 � u 7.rt� 7L ;h. �� �° m O =r �' v 'O Z N o n .� •� o pC CD cn c oQ < —� /vQ < N O CD O Z �m rt CL� 5 O CD P Cr CD (D, CD CD CD Z _ vO CQ CD �_ �_ �. N cn 0 E �1 CM � U) - c _ v CD O CD_ Co CD 0 0 O 0n (D CD z: - -�CD v su O m CD o 0; p : a� o •:� ;a o CL (n O f�D 0 (n O 'Y z 0 OJ C T N .Z) C S T N (n 0 m .Z7 C S T p=j .Z) C S T O1 (7 S 7 CD X C S T C IZ v ct o� VI "O c'1 (n T O CL \ h m v M D 3 m --I-IO ^ O r- m n > M m 0 � C W 0 �WrDCD C o z c) m m a 3 0 m o y s ®s 01/30/2013 11:36 19785212751 L0.C- A CERTIFICATE OF LIABIL --�Z t'°ujcER 078)373-5623 FAX (978)521-2751 NTHONY & MALCOLM INSURANCE AGCY., INC. 3 S0, CENTRAL ST. BRADFORD, MA 01835 INSURED Century Builders, PO Box 907 Methuen, MA 01844 ANTHONY&MALCOLM INS PAGE 01/02 ITY INSURANCEDATE(MMIDD"YY) 01/30/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR INSURERS AFFORDING COVERAGE NAIC # INSURERA: Western World Insurance Company POLICY EFFECTIVE 04/01/2012 INSURER R Acadia Insurance LIMITS INSURCRC; Western Surety Company INSURFR 0: NPP8081798 INSURER E: i nc r"1111c0 Ur IfV.7UKArvGC Lis I tU ULLUVV 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 NaIR ADULTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE 04/01/2012 POLICY EXPIRATION 04/01/2013 LIMITS GENERAL LIABILITY NPP8081798 EACH OCCURRENC[ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE IU Q�F.D $ 50, OOO ER (EQMED CLAIMS MADE a OCCUR EXP (Any am parapn) $ 5.(100 A1,000,000, PERSONAL R ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ included PRO• POLICY F7 JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO Me Rccldenq ALL OWNED AUTOS BODILY INJURY $ SCHF,DULEO AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON -OWNED AUTOS (Parecoldenl) PROPERTY DAMAGE. S (Par nccldm4) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANYAUTO OTHER TEA ACC $ HAN AUTO ONLY. AGO S EXCESSlUMBRELLA UA131LITY EACH OCCURRENOE $ OCCUR n CLAIMS MADE AGOREGATE S a DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION AND WC20200001680S 08/16/2012 08/16/2013 X I wCSTATu- OThI• EMPLOYERS' LIABILITY ER B ANY PROPRIETORMARTNERIEXECUTIVE E,L, EACH ACCIDENT $ 100 , OOO OFFICERIMEMBER EXCLUDED? Ilan desUihe! undo r E.L. DISEASE - EA EMPLOYEE $ T001000 SCECIAL PROVISIONS below El DISEASE -POLICY LIMIT $ S00,000 OTHER22169722Bond , 22168722 03/30/2012 03/30/2013 $5,000 own of Methuen DESCRIPTTLLON OF OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS enerai Contracting Town of North Andover Building Department 1600 Osgood St. No. Andover, MA 01845 ACORD 25 (2001/08) FAX: (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 19E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATNE �nn � Frederick Malcolm Jr. JA "P+KYizo�ti�• OACORD CORPORATION 1988 b1/:fi1J/2U1J ll:Jb ly/8b2l 1/51 ANTHONY&MALCOLM INS PAGE 02/02 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. wvvnu Ab (iuu11o51 ACORD. CERTIFICATE OF LIABILITY INSURANCE 01/30/2o 3 PRODUCER (978)373-5623 FAX (978) S21-2751 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ANTHONY & MALCOLM INSURANCE AGCY., INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 S0. CENTRAL ST. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRADFORD, MA 0183S INSURERS AFFORDING COVERAGE NAIC # tNSURED Century Builders, Inc. INSURERA Western World Insurance Company PO Box 907 INSURER B: Acadia Insurance Methuen, MA 01844 INSURERC: Western Surety Company INSURER 0: 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. DL4R I n TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IMMMDMn POLICY EXPIRATIONDATE UMT15 GENERAL LIABILITY NPP8081798 04/01/2012 04/01/2013 RRENCE $ 11000.00 X COMMERCIAL GENERAL LIABILITY PDAMAGERESO OO CLAIMS MADEa OCCUR rty are person) S 5 00 A & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ include POLICY EI jRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Eaaccident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) S HIRED AUTOS BODILY INJURY s NON -OWNED AUTOS (Per acadeM) PROPERTY DAMAGE S (Per acoiderd) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGC s EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S OCCUR 0 CLAIMS MADE AGGREGATE $ s DEDUCTIBLE i RETENTION $ s WORKERS COMPENSATION AND WC202000016805 08/16/2012 08/16/2013 X I "� STATU-oTH- EMPLOYERS' LIABILITY E.L.EACH ACCIDENT $ 100 00 B ANY PROPRIETORIPARTNEWMCUnVE E.L.DISEASE - EA EMPLOYE s 100 00 OFFFFIEMB ICERIMER EXCLUDED? III ySPECIALPROVISIONS below E.L DISEASE - POLICY LIMB E 500,00 treet opening Bond - 22168722 03/30/2012 03/30/2013 SS,000 C own of Methuen DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS :eneralContracting Town of North Andover Building Department 1600 Osgood St. No. Andover, MA 0184S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. �f I AUTHORIZED REPRESENTATIVE — .— . d A� a- � _L L r • "�/'� ACORD 25 (2001108) FAX: (978)688-9542 ©ACORD CORPORATION 1988 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 26 (2009108) Massachusetts - Department of Public SafetN Bom-d of Building Regulations and Standards Construction Supervisor License License: CS 51254 GLENN T SABA 8 BRUSHWOOD DR ATKINSON, NH 03811 ('ununissiuner 11 Expiration: 4/17/2013 Tr#: 13218 CENTURY BUILDERS, INC PO Box 907 Methuen, MA 01844 January 30, 2013 Chris Kombouras Heavenly Donuts 6 Scotland Drive Andover, MA 01810 Re: Heavenly Donuts Build Out Renovations 50 Main St North Andover, MA 01845 Construction Drawings: A-1, A-2, A-3, A-4 & Technical Specifications Designed by: Koch Architects Dear Mr. Kombouras, Century Builders, Inc is pleased to provide the following contract to act as the General Contractor for the build out construction of the new Heavenly Donuts at 50 Main Street, North Andover, MA. Pricing was developed based on the referenced plan drawings, Technical Specifications and site visit. Scope of Work: • Oversee the Build Out construction including all sub -contractors and schedules. • Furnish and install material as specified. • Complete work in order to obtain occupancy permit. Our lump sum price for this scope of work is One Hundred Thousand Dollars, ($100,000.00) and excludes the following items: • Building and Trades Permit Costs. • Town or State Impact Fees and or License Fees. • Fire Alarm and Fire Suppression Systems for the other parts of the building. • Equipment, ovens, refrigerators, freezers, cases, furniture. • Plumbing bid includes material and labor with the exclusion of supplying the following fixtures: o Service Area: ■ Three compartment sink and faucet ■ Hand sink and faucet ■ Back water valves ■ Stamped plans Payments will be due as follows: • $25,000.00 Upon Rough plumbing and electrical inspections • $25,000.00 Upon Sheetrock complete • $25,000.00 Upon Paint and Ceiling Grid Installed • $25,000.00 Upon the completion of Finish Flooring, Plumbing, Electrical It is understood that in the course of the Build Out undecided or unforeseen changes will result in Change Orders. Change Orders will be agreed upon by both parties prior to work being complete including payment schedule. We look forward to working with you on this project and continuing a long term relationship with the Heavenly Donuts Family. Feel free to contact me with any questions. Sin ely, Ian Glenn T. Saba I Treasurer (978)815-7073 I agree to the terms of this contract and auth:sKombouras entury Builders, Inc to begin work, 6 Scotland Drive Andover, MA 01810 Quote ' Date Simultaneous doors 12/27/2012 Sasterif Rakers Supply eo, , ,enc. 1 ea 145 N. WASHINGTON ST. $3,125.00 <Alternate> BOSTON, MA 02114 Tel: 617-742-0228 Project: From: Heavenly Donuts, N. Andover Eastern Bakers Supply Co., Inc. 50 Main St Robert Kalustian North Andover Ma 145 N. Washington St. Boston MA 02114-2115 stainless steel door with window, 12.5 kw (617) 523-2682 (Phone) (781) 789-3350 (Cell) Project Code: 1516 Item Qty Description Sell Sell Total 1 1 ea CONVECTION OVEN $3,125.00 $3,125.00 Vulcan Model No. VC4GD Packed: ea Convection Oven, Gas, 1 -deck, standard depth, solid state controls, Ielectronic spark igniter, 25-3/4" high legs, stainless steel front, top and sides, stainless steel door with window, 44,000 BTU 1 ea 1 year limited parts & labor warranty, standard 1 ea -1 Natural gas (specify elevation if over 2,000 ft.) 1 ea 115v/1ph, 1/2 HP, 9.0 amps, 6' cord & plug standard 3 2 ea BUN PAN RACK $179.00 $358.00 Channel Manufacturing Model No. 401AC Packed: ea Bun Pan Rack, economy, 70-1/4"H, 3" spacing, capacity (20) 18" x 26" bun pans, front loading, aluminum construction, 5" bolted non -marking swivel stem casters, all welded, NSF (FLYER LIST PRICING) 2 ea Lifetime warranty against rust and corrosion, standard Initial: Heavenly Donuts, N. Andover Page 1 of 7 1 ea Simultaneous doors 2 1 ea CONVECTION OVEN $3,125.00 <Alternate> Vulcan Model No. VC4ED Packed: ea Convection Oven, Electric, 1 -deck, standard depth, solid state controls, 60 minute timer, 25-3/4" high legs, stainless steel front, top and sides, stainless steel door with window, 12.5 kw 1 ea 1 year limited parts & labor warranty, standard <Alternate> 1 ea 208v/60/3ph, 35 amps, standard <Alternate> 1 ea Simultaneous doors <Alternate> 3 2 ea BUN PAN RACK $179.00 $358.00 Channel Manufacturing Model No. 401AC Packed: ea Bun Pan Rack, economy, 70-1/4"H, 3" spacing, capacity (20) 18" x 26" bun pans, front loading, aluminum construction, 5" bolted non -marking swivel stem casters, all welded, NSF (FLYER LIST PRICING) 2 ea Lifetime warranty against rust and corrosion, standard Initial: Heavenly Donuts, N. Andover Page 1 of 7 5 1 ea WORKTABLE, 60", STAINLESS STEEL TOP $205.15 $205.15 Eagle Group Model No. UT3060B-1X Packed: ea Budget Series Work Table, 60"W x 30"D, 16/430 stainless steel top with 1-1/2" rear upturn, rolled front edge, square turned down ends, aadjustable heavy gauge galvanized undershelf, (4) 1-5/8" O.D. galvanized legs, Uni-Lok' gusset system, 1" adjustable hi -impact plastic feet, NSF (FLYER) 6.2 1 ea SHELF Custom Model No. WALL SHELF Packed: ea Custom wall shelf for 3 microwave ovens 31 3 ea MICROWAVE OVEN $1,020.60 $3,061.80 ACP Model No. HDC212 Packed: ea ' Amana® Commercial C -Max Microwave Oven, 2100 watts, compact, stackable, stainless steel interior & exterior, X2 quantity pad, 11 power levels, 100 memory settings, auto voltage sensor, side hinged door, full 3 yr warranty, 208 -240v/60/1 -ph, 3200 total watts, 16.4 amps, 20 MCA, 5'6" cord & NEMA 6-20P Initial: Heavenly Donuts, N. Andover Page 2 of 7 Eastern Bakers Supply Co., Inc. Date 12/27/2012 Item Qty Description Sell Sell Total 4 1 ea REFRIGERATED SANDWICH UNIT $1,255.00 $1,255.00 Turbo Air Model No. MST -28-12 Packed: ea M3 Series Sandwich/Salad-Mega Top Unit, 8 cu. ft., self-contained, (1) swing door, (1) adjustable wire shelf, (12)1/6 size pan capacity, cutting board side rail, cold air compartment, CFC free polyurethane insulation, stainless steel construction, 4" casters, 1/5 HP, ETL, cETL, NSF, 3.3amps, NEMA 5-15P 1 ea 1 year parts/labor & 5 yrs compressor warranty, standard 1 ea 115v/60/1, standard 4.1 1 ea REFRIGERATED WORK TOP $1,635.00 $1,635.00 Turbo Air Model No. TWR-48SD Packed: ea lD� Super Deluxe Worktop Refrigerator, two -section, 12 cu. ft., (2) s/s doors w/recessed handles, s/s interior & exterior, ABS door liner, 2 s/s wire shelves, 5" casters, self-contained rear mounted refrigeration system, 1/3 HP, cETLus, NSF 7, Energy Star', 2 Year Parts & Labor Warranty 1 ea Self-contained refrigeration, standard 1 ea 2 years parts/labor & 5 yrs compressor warranty, standard 1 ea 115v/60/1, 6.5 amps, cord w/NEMA 5-15P, standard 5 1 ea WORKTABLE, 60", STAINLESS STEEL TOP $205.15 $205.15 Eagle Group Model No. UT3060B-1X Packed: ea Budget Series Work Table, 60"W x 30"D, 16/430 stainless steel top with 1-1/2" rear upturn, rolled front edge, square turned down ends, aadjustable heavy gauge galvanized undershelf, (4) 1-5/8" O.D. galvanized legs, Uni-Lok' gusset system, 1" adjustable hi -impact plastic feet, NSF (FLYER) 6.2 1 ea SHELF Custom Model No. WALL SHELF Packed: ea Custom wall shelf for 3 microwave ovens 31 3 ea MICROWAVE OVEN $1,020.60 $3,061.80 ACP Model No. HDC212 Packed: ea ' Amana® Commercial C -Max Microwave Oven, 2100 watts, compact, stackable, stainless steel interior & exterior, X2 quantity pad, 11 power levels, 100 memory settings, auto voltage sensor, side hinged door, full 3 yr warranty, 208 -240v/60/1 -ph, 3200 total watts, 16.4 amps, 20 MCA, 5'6" cord & NEMA 6-20P Initial: Heavenly Donuts, N. Andover Page 2 of 7 Eagle Group Model No. SR10-14-5-1-iX Packed: ea Sink Bowl, Drop -In, 1 compartment, 14"W x 10"L x 5"D, heavy gauge stainless steel, #302004 deck mounted gooseneck faucet, 3-1/2" drain hole, basket drain, mounting hardware, NSF (FLYER) 2 ea Faucet hole punched on 4" centers, standard 12 12 ea SHELVING, WIRE Eagle Group Model No. 2472E -X Packed: 2 ea - - _ — Wire Shelving, 24"W x 72"L, patented QuadTruss° design, with mat 1p y wires welded to a four -truss assembly on front and back, and three -truss assembly on each end, EAGLEgard® hybrid epoxy finish with MICROGARD° antimicrobial protection, NSF (FLYER) 18 ea P86 -E -X Post, stationary application, 86"H EAGLEgard® hybrid epoxy finish with MICROGARD® antimicrobial protection, numerically grooved in 1" increments, post cap and leveling bolt, NSF (FLYER) Heavenly Donuts, N. Andover $73.40 $880.74 Initial: Page 3 of 7 Eastern Bakers Supply Co., Inc. Date 12/27/2012 Item Qty Description Sell Sell Total 8 1 ea REFRIGERATOR, UNDERCOUNTER, REACH -IN 771 $1,673.10 $1,673.10 Turbo Air Model No. MUR-72 Packed: ea M3 Series Undercounter Refrigerator, 19 cu. ft., three section self g , ' contained, (3) swing doors, (3) adjustable heavy duty PE coated wire shelves, CFC free polyurethane insulation, stainless steel ext. w/galvanized steel back, 4" swivel casters, 1/2 HP, ETL, cETL, NSF, 9.9 amps, NEMA 5-15P 1 ea 1 year parts/labor & 5 yrs compressor warranty, standard 1 ea 115v/60/1, standard 1 ea 4" swivel casters, standard 9 1 ea SINK, (3) THREE COMPARTMENT $887.18 $887.18 Eagle Group Model No. 414 -16 -3 -18L -X Packed: ea _ .==Y r, 414 Series Sink, Three Compartment, 19" front -to -back x 16"w x 14"D 304 stainless steel bowls, 18" left drainboard, 9-1/2" backsplash with 1" upturn & the edge all 430 stainless steel, 1-1/8" faucet holes on 8" OC, open frame base, 1-5/8" diameter galvanized legs, gussets, crossbracing,1" hi -impact plastic adjustable bullet feet, NSF (FLYER) 10 1 ea FAUCET $103.62 $103.62 T&S Brass Model No. B-0231 Packed: ea Sink Mixing Faucet, 12" swing nozzle, wall mounted, 8" centers on sink faucet with 1/2" IPS eccentric flanged female inlets, lever handles 11 2 ea DROP-IN SINK $124.25 $248.50 Eagle Group Model No. SR10-14-5-1-iX Packed: ea Sink Bowl, Drop -In, 1 compartment, 14"W x 10"L x 5"D, heavy gauge stainless steel, #302004 deck mounted gooseneck faucet, 3-1/2" drain hole, basket drain, mounting hardware, NSF (FLYER) 2 ea Faucet hole punched on 4" centers, standard 12 12 ea SHELVING, WIRE Eagle Group Model No. 2472E -X Packed: 2 ea - - _ — Wire Shelving, 24"W x 72"L, patented QuadTruss° design, with mat 1p y wires welded to a four -truss assembly on front and back, and three -truss assembly on each end, EAGLEgard® hybrid epoxy finish with MICROGARD° antimicrobial protection, NSF (FLYER) 18 ea P86 -E -X Post, stationary application, 86"H EAGLEgard® hybrid epoxy finish with MICROGARD® antimicrobial protection, numerically grooved in 1" increments, post cap and leveling bolt, NSF (FLYER) Heavenly Donuts, N. Andover $73.40 $880.74 Initial: Page 3 of 7 Eastern Bakers Supply Co., Inc. Date 12/27/2012 il Item Qty Description Sell Sell Total IF 13 3 ea SHELVING, WIRE $33.11 $99.33 Eagle Group Model No. 2424E Packed: 4 ea Wire Shelving, 24"W x 24"L, patented QuadTruss® design, with mat wires welded to a four -truss assembly on front and back, and three -truss assembly on each end, EAGLEgard® hybrid epoxy finish with MICROGARD® antimicrobial protection, NSF 14 9 ea SHELVING, WIRE $38.57 $347.13 Eagle Group Model No. 1472E Packed: 2 ea ` Wire Shelving, 14"W x 72"L, patented QuadTruss° design, with mat wires welded to a four -truss assembly on front and back, and three -truss assembly on each end, EAGLEgard® hybrid epoxy finish with MICROGARD® antimicrobial protection, NSF 15 42 ea S -HOOK $1.02 $42.84 Eagle Group Model No. A200012 -X Packed: ea "S" Hook, joins individual wire shelf units end-to-end, back-to-back, or at right angles. Two required per shelf connection (FLYER) 16 1 ea ICE MAKER, CUBE -STYLE $4,488.75 $4,488.75 Hoshizaki Model No. KML-631MRH Packed: ea it Ice Maker, Cube -Style, remote air-cooled, remote condenser (priced separately), approximately 636 -Ib capacity/24-hours, stainless steel finish, crescent cube style, R -404A refrigerant, 208 -230v/60/1 -ph, 7.8 amps, ENERGY STAR® qualified 1 ea 3 -Year parts & labor on entire machine 1 ea 5 -Year parts & labor on evaporator 1 ea NOTE: 3 wire with neutral for 115V required 1 ea B-50OPF Ice Bin, top -hinged front -opening door, approximately 360 -Ib ice storage capacity, for top -mounted ice maker, vinyl clad, painted legs included, protected w/H-GUARD Plus Antimicrobial Agent 1 ea 2 -Year parts & labor for bin 1 ea URC -9F Remote Condenser, R -404A refrigerant, 115v/60/1, for KML-631MRH, KMD-850MRH, KMD-901MRH and KM-901MRH(3) 1 ea R404-5568-2 55' Pre -Charged Tubing Kit, R-404 refrigerant, for URC -9F, URC -12F and URC -14F 1 ea H9320-51 Water Filtration System, single configuration Initial: Heavenly Donuts, N. Andover Page 4 of 7 Eastern Bakers Supply Co., Inc. Date 12/27/2012 Item Qty Description Sell Sell Total 17 1 ea SERVICE FAUCET $97.81 $97.81 Krowne Metal Model No. 16-127 Packed: ea Krowne Royal Series Service Faucet, Splash -Mounted, 8" Centers, " 6-1/2" Long Heavy Cast Spout w/Bail Hook and Hose Thread, Bracket Can Mount Above Or Below, Vacuum Breaker, Rough Brass, NSF, CSA (Best) 1 ea 1 year parts & labor warranty, std. 18 1 ea MOP SINK $314.21 $314.21 John Boos Model No. EMS -2016-6 Packed: ea !' Mop Sink, floor mounted, 24-5/8" L -R,19-1/8" F -B, 6" high water level, 2" heavy duty free flow drain, stainless steel construction 19 1 ea OPEN MERCHANDISER $3,494.19 $3,494.19 Turbo Air Model No. TOM-40SB Packed: ea Horizontal Open Display Merchandiser, slim -line, 39" x 34" x 42", open front, glass front shield and side walls, self-contained, plug-in installation, front air intake & rear air discharge, (3) adjustable stainless steel shelves, temperature range 38°F to 40°F, 300 s/s interior, black exterior, 115v/60/1, 11.0 amps, 1/2 HP, NEMA 5-15P 1 ea 1 year parts/labor & 5 yrs compressor warranty, standard 20 1 ea REFRIGERATOR, MERCHANDISER $2,281.04 <Optional> Turbo Air Model No. TGM-50RS Packed: ea Refrigerated Merchandiser, two -section, 50 cu. ft., self-contained, double pane self-closing swing glass doors, fluorescent light, (8) adjustable PE coated wire shelves, white cabinet or all black color available, bottom mount compressor, 1/2 HP, NSF,UL cUL, ETL, cETL 1 ea 1 year parts/labor & 5 yrs compressor warranty, standard <Optional> 1 ea 115v/60/1, 10.9 amps, cord w/NEMA 5-15P, standard <Optional> 7 1 ea CONVEYOR TOASTER $1,337.65 $1,337.65 Star Mfg. Model No. QCS2-12006 Packed: ea Holman QCS® Bagel Conveyor Toaster, electric, horizontal conveyor, 1-1/2" product opening, 10"W belt (2 halves), 6" extended load area, attached load -up tray, heated holding bin/unload chute, quartz sheathed heaters, 1200 halves per hour, UPS 1 ea 1 Yr, parts & labor warranty, std. 1 ea 208v, 1 -ph, 3.2kw, 15.9 amps, NEMA 6-20 plug 21 1 ea WALK IN COOLER/FREEZER Brown, W.A Model No. WALK IN COOLER FREEZER Packed: ea Heavenly Donuts, N. Andover Initial: Page 5 of 7 27.1 1 ea AMBIENT DISPLAY CASE $3,082.87 $3,082.87 Federal Industries Model No. SGD5048 Packed: ea High Volume Non -Refrigerated Bakery Case (50"L x 35"W x 48"H), sloped thermopane tilt -front glass, top light and lighted shelves, three tiers of adjustable white wire shelves, glass sliding rear doors, white interior, tempered glass ends, choice of laminate with black trim, designed for continuous lineups, UL safety and UL sanitation approvedPLUS SHIPPING 1 ea One year parts & labor warranty 1 ea 120v/60/1, 1.5 amps 1 ea Laminate standard color - Black 30 1 ea MOBILE ICE BIN $465.41 $465.41 Cambro Model No. ICS1251.131 Packed: ea SlidingLid"" Ice Caddy, mobile, 29 -1/4"H,125 -Ib capacity, lid slides back & under, polyethylene body with foam insulation, molded in handles, recessed front drain faucet, no assembly required, (4) 5" casters (2 fixed, 2 swivel -1 with brake), dark brown, NSF 29 1 ea ESPRESSO CAPPUCINO MACHINE $2,811.90 $2,811.90 Grindmaster-Cecilware Model No. ESP1-220V Packed: ea Venezia II Espresso Machine, automatic, 1 group, 6 quart s/s boiler, 240 cups per hour, touch pad controls & LED display, auto cleaning function, hot water dispensing valve, 240v, 2.5kw, 10 amps, ETL, NSF (Cecilware) Merchandise $30,015.18 Tax (6.25%) $1,875.95 Total $31,891.13 Initial: Heavenly Donuts, N. Andover Page 6 of 7 Eastern Bakers Supply Co., Inc. Date 12/27/2012 Item Qty Description Sell Sell Total 22 8 ea TABLETOPS Custom Model No. 24X30 Packed: ea 23 8 ea TABLE BASES Custom Model No. TABLE BASES Packed: ea 24 17 ea CHAIRS Custom Model No. CHAIRS Packed: ea 25 1 ea HANICAP TABLE WITH BASE Custom Model No. HANDICAP TABLE Packed: ea 26 2 ea LOUNGE CHAIRS Custom Model No. LOUNGE CHAIRS Packed: ea 27.1 1 ea AMBIENT DISPLAY CASE $3,082.87 $3,082.87 Federal Industries Model No. SGD5048 Packed: ea High Volume Non -Refrigerated Bakery Case (50"L x 35"W x 48"H), sloped thermopane tilt -front glass, top light and lighted shelves, three tiers of adjustable white wire shelves, glass sliding rear doors, white interior, tempered glass ends, choice of laminate with black trim, designed for continuous lineups, UL safety and UL sanitation approvedPLUS SHIPPING 1 ea One year parts & labor warranty 1 ea 120v/60/1, 1.5 amps 1 ea Laminate standard color - Black 30 1 ea MOBILE ICE BIN $465.41 $465.41 Cambro Model No. ICS1251.131 Packed: ea SlidingLid"" Ice Caddy, mobile, 29 -1/4"H,125 -Ib capacity, lid slides back & under, polyethylene body with foam insulation, molded in handles, recessed front drain faucet, no assembly required, (4) 5" casters (2 fixed, 2 swivel -1 with brake), dark brown, NSF 29 1 ea ESPRESSO CAPPUCINO MACHINE $2,811.90 $2,811.90 Grindmaster-Cecilware Model No. ESP1-220V Packed: ea Venezia II Espresso Machine, automatic, 1 group, 6 quart s/s boiler, 240 cups per hour, touch pad controls & LED display, auto cleaning function, hot water dispensing valve, 240v, 2.5kw, 10 amps, ETL, NSF (Cecilware) Merchandise $30,015.18 Tax (6.25%) $1,875.95 Total $31,891.13 Initial: Heavenly Donuts, N. Andover Page 6 of 7 Of "°"'" OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER t ` CONST `i•� RUCTION CONTROL 'fdgCMU{4� PROJECT NUMBER: 21121 PROJECT TITLE: HEAV'NLY DONUTS - INTERIOR BUILD OUT PROJECT LOCATION: 50 Main Street, North Andover, MA (First Floor) NAME OF BUILDING: 44-50 Main Street NATURE OF PROJECT: Interior Build Out of 1 445 sq.ft. to house a Donut Shop / Cafe IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I,- Rainer Koch REGISTRATION NO. 5056 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 0 FIRE PROTECTION 0 ARCHITECTURAL I STRUCTURAL I MECHANICAL 0 ELECTRICAL 0 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 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 familiar with6the progress and quality of the work and to determine, in general, if the work is being < 'j, performed in a manner consistent with the construction documents.' PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT , TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSP R. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE,r# SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR ObCUPANCY. SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF -)00 UCL-rxSIGNATURE —� NO Y PUBLIC ON EXPIRES IN ' eto Yt n" MN AMON lii"= 9 Ntl930 . BfjB6t sxi);�:x ��. f# SC�Aw ��"u'�'�1:lF8jl« i�ul�cR s;H�!t. �lE�Ml+ N f'6R�'�lSi.