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Building Permit #420 - 575 OSGOOD STREET 1/14/2009
BUILDING PERMIT O* NORTH ,g6rD 06 TIO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �2 © Date Received D4 poq�reo'vas q9 ��SSACH�15�� Date Issued: c. MPORTANT:Applicant must complete all items on this page LOCATIONc �.-.~--" Print PROPERTY OWNER . # 1 Print 1 MAP NO: PARCEL: ZONING DISTRICT: Historic District yes l Machine Shop Village yes no� 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 Oth rs: Demolition Other Septic Well Floodplain Wetlands Watershed.District ` `Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: `." `i- •��7' �cI'� .F� `� rc.aX.���i'�l, '' � F'i�T 1►_..t�,�� i3t`,:�`7 �r157 c..� �v ;j-•t c„�_ -z --t gip,t cJ I - i ELA 4�T Foy &,J-T % �a`- ,ix- 4c4t�o st, .� ' I Identific_atio Please Type or Print Cleanly) 1 OWNER: Name: Phone9'70 725 t !1 Address: -7 r > `S CONTRACTOR Name: --- - - t Phone: 60 5 4`Z;>' Z 1 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date; _ ARCHITECT/ENGINEER MA-P,6q�',L_(E-S Phone:—( Address:-?- 08 15T^ 2 c��A Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � , ��d FEE: $ �j �y Check No.: 4- Q f Receipt No.: ( � NOTE: Persons contracting with unre is co tractors do not have access to the guaranty fund $i nature of Ag-e"nt/O T ' �H ure of contractor 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 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) o 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 Building Permit Application .T a Revised 2.2008 Plans Submitted Plans Waived Certified =Plan ta�pedPlans 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 REJEMED- DATA AOPROVED PLANNING & DEVELOPMENT $' COMMENTS / CONSERVATION Reviewed on Signature COMMENTS . 2)E: P �2, ZL HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments U_ _a Water & Sewer Connection/Si nature Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street 'FIRE DEPARTMENT -Temp D Aster on site yes no Located at_124 plain Street �p t Fire Department signs#uretdate COMMENTS i i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.'�'1 � 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 - Date __..................-......_.......-- ---._....-........................................_......................._..._.........-_._..............................._----....... - - Doc.Building Permit Revised 2008 Location � ���� No. Date 40RTM TOWN OF NORTH ANDOVER 3? • • oL f D , s Certificate of Occupancy $ Building/Frame Permit Fee $ s�cHus Foundation Permit Fee $ Other Permit Fee $ ` TOTAL Check # _ f Building Inspector aces+ 41 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 420(1/14/09) Date: December 4. 200 THIS CERTIFIES THAT THE BUILDING LOCATED ON 575 Osgood Street MAY BE OCCUPIED AS CIU - Bldg Phase II IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement 575 Osgood St North Andover MA 01845 ✓iw+- Building Inspector - � is _ x , { t } �-No. Z O i.. _ I_•. _ - - - dover Mass., /O o LA 1 ass., fZ 'p COCMICMEWICK CRA.44 TED �`P� �� x, BOARD O � t 4: - � Food/ICitch 0. _ - Sysrern 11 y THIS CERTIFIES THAT ..,�� .. F F�!/' F,�r�--- -INS OR on ( � r has.permKswn to•erect.......... buildings on to be occupied as. �IC ' C provided that the person accepting this permit shall in eve respect conform to the to of the application onfile in -� , this office, and to the provisions of the Codes-and By-Laws relating to the Inspection, Alteration and,Construction f Buildings in the Town of North Andover. ,_ .:_ � ,.•, � _: . �- P LIMB V101ATION of the Zoning or Building.Regulations Voids this Permit. - - `?' P -_ RI-09u oh - f 5 3 - PERI/n EXPIRES IN 6 MON�S- 1-��, -`. "TRIC-AL vs-UNLESS CONSTRUCTcoR.: Rough -• . .....------ --- ----------.... service BUILDING INSPECTOR Occupancy Permit Required to Omipy Building GAS INSPECTOR:..--.. . Display in a Conspicuous Place on the Premises -- Do Not Remove Rough No Lathing or Dry Wall To Be Done - Until Inspected and Approved. by the Building Inspector. FIRE DEPARTMENT Burner - Street No :SEEAEVERSE_SIDEsmoke Det �. � :=.Z2.0. NORTH c TONM of 0 No. � � o dover, Mass., Q LAKE 1vC 0CMICME WICK V RATED PPS` "`C) qS E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �� BUILDING INSPECTOR THIS CERTIFIES THAT......... ..... .... . � .. 't� �t' .................................................. Foundation has permission to erect..... buildings .... ........ Rough Urso v to be occupied as......... ... .G�: :.. .�.....—.. ............... '........ .. ..................;. ...................................................... provided that the person accepting this permit shall in every respect conform to.terms of the application on file in Final ( this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough ..... . 's- .. ................................................. Service B G INSPECTOR` Final' OCCllPancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do-, Not Remov Final No Lathingor D Wall To Be Done M y FIRE DEPARTMENT Until Inspected and Approved. by the Building Inspector. .r$ Burner•., 'Street No. SEE REVERSE SIDE Smoke Det. �10RTH s APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit# � ADDRESS/LOCATION OF PROPERTY :L�2 0 Map Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (6) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued t0. d w100 lr-2 mLN'-A- Address �57 S 0:5 GQckood SIGNED ' RO TING CONSERVATION l PLANNING DPW-WATER METER 0 'i' d✓ SEWER/WATER CONNECTION © `ry m„,4..01 NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE UPANCY/INSPECTION REQUEST DPW Signature File: Application for OC form revised Jan 2007 SITE PROGRESS REPORT October 2009 To: Gerald Brown, Inspector of Buildings Town Of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 From: John Pearson, AIA, LEED AP, Massachusetts Registration No. 4841 Sr. Associate Margulies Perruzzi Architects Project: Edgewood Retirement Community Continuum of Care & Bistro 575 Osgood Street, North Andover MA 01845 Report date: November 2, 2009. 1 . Visited the site on October 2, 6, 7, 8, 9, 13, 19, 20, 27 2009. 2. Attendees: Danny Bolduc, Eckman Construction 3. Work underway for this period: SITE: Water main relocation, storm-tech install, memory garden fence footings, granite curbs, slab on grade. CIU: gypsum wallboard, window trim, ceramic tile, rough mechanical, millwork install, ceiling grid, boiler room equipment install, light fixtures. 4. Comments: Work proceeding in compliance with Construction Documents In accordance with Section 116 of the Massachusetts State Building Code (Seventh Edition), I certify that, to the best of my knowledge, information and belief, the work on the subject project is being performed in accordance with the construction drawings and specifications and in accordance with the requirements of the Massachusetts State Building Code and all 9 g other pertinent laws and ordinances. Respectfully submitted, Margulies Joh PearsonrrAIA Architects p LEED APp. Sr. Associate 41 Massachusetts Registration No. 4841 = , PC: Kevin Tremblay, EC ai David Mermelstein, Trident Eric Hastings, EC ;" 1 - SITE PROGRESS REPORT November 2009 To: Gerald Brown, Inspector of Buildings Town Of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 From: John Pearson, AIA, LEED AP, Massachusetts Registration No. 4841 Sr. Associate Margulies Perruzzi Architects Project: Edgewood Retirement Community Continuum of Care & Bistro 575 Osgood Street, North Andover MA 01845 Report date: November 30, 2009. 1. Visited the site on November 3, 6, 10, 17, 24, 2009. 2. Attendees: Danny Bolduc, Eckman Construction 3. Work underway for this period: SITE: Ambulance entrance slab, gravel base for bituminous areas, generator pad poured, binder course paving, finish loam and mulch. CIU: Finish painting, Ceramic tile, Ceiling tile, permanent heat and power completed, wood doors, cubicle track, toilet room accessories, carpet installation, finish mechanical-electrical-plumbing, handrail, final millwork install, column enclosures, power shades. 4. Comments: Work proceeding in compliance with Construction Documents In accordance with Section 116 of the Massachusetts State Building Code (Seventh Edition), I certify that, to the best of my knowledge, information and belief, the work on the subject project is being performed in accordance with the construction drawings and specifications and in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. Respectfully submitted, Margulies Perruzzi Architects John Pearson, AIA LEED AP „ Sr. Associate f °' Massachusetts Registration No. 4841 PC: Kevin Tremblay, EC David Mermelstein, Trident Eric Hastings, EC " `� FINAL AFFIDAVIT To the Inspector of Buildings of the TOWN of NORTH ANDOVER: Inaccordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify, to the best of my knowledge and belief, that the construction located at EDGEWOOD RETIREMENT FACILITY, CONTINUUM OF CARE ADDITION, 575 OSGOOD STREET, NORTH ANDOVER, MASSACHUSETTS was built in accordance with the plans, specifications and computations submitted and approved for permit# . ,and is in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws or ordinances. ARCHITECT NAME #REGISTRATION NO. w,r'"e Pe ��' , John Pearson #4841 ' th No 8 Margulies Perruzzi Architects, 308 Congress Street Boston, MA 02210 MA 617-482-3232 " ° Date: November 30, 2009 t ©r hiFs`7� stamp FINAL INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the. Sixth Edition of the Massachusetts State Building Code: I hereby certify that the structure/renovation was constructed under my or my agent's bservation as per Section 116.2.2 of the Massachusetts State Building Code. (JVhPearson #4841 Mlies Perruzzi Architects, 308 Congress Street oston, MA 02210 617-482-3232 Date: November 30, 2009 Then personally appeared the above named �OhC�10C41?5()M has made an oath that the above statement by him/her is true. Before me, Ae" MARIE E. CALDER ��� 00 NOTARY PUBLIC f wommonv-alth of Massachusetts Date My Crr .mission Expires. Sir . r'Y`�P 28, 2012 My commission expires J:\Edgewood Retirement Community\L.ConAdmin\L.13 Affidavits\Phase 2\Final Affidavit-Architect Phase two.doc e ' FINAL AFFIDAVIT AND FINAL INSPECTION AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify, to the best of my knowledge and belief, that the structural aspects of the construction located at EDGEWOOD RETIREMENT FACILITY,CONTINUUM OF CARE ADDITION 575 OSGOOD STREET NORTH ANDOVER MASSACHUSETTS was built in accordance with the plans,specifications and computations submitted and approved for permit# ,and is in accordance with the structural requirements of the Massachusetts State Building Code and other pertinent laws and ordinances applying to structural considerations. I hereby certify that the structure/renovation was constructed under my or my agent's observations as per Section 116.2.2 of the Massachusetts State Building Code. ENGINEER NAME & REGISTRATION NO. Engineer: Edward Moll, P.E., MA 33718 Company: Structures North Consult. Engrs, Inc .. Address: 60 Washington Street, Salem, MA 01970 "1" OF Pip . Telephone: (978) 745-6817 O , Date: 11-30-09 KAT �� MF^ x 4Q�R �1 stamp Then personally appeared the above named er have made an oath that the above statement by him/her is true. Before e LO �D7l�J Date 13TAC;IA,'M CCJpd q My commission expires ; Commonw�f,"'�:tirassac��}�. MY�art�rrias?'i �E�£Ai.93 �Se�.ta��Qe'rj22,2b't i t c ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S. Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCo@,AOL.com FIRE PROTECTION FINAL AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION 575 OSGOOD STREET,NORTH ANDOVER, MASSACHUSETTS (Address) I I certify that 1, or a design professional under my supervision,have observed the work associated with the referenced project having visited the site on average of once a week throughout the construction period. To the best of my knowledge, information and belief,the work generally conforms to the permit and plans approved by the Inspection Services Department and with the provisions of the Massachusetts State Building Code and other pertinent laws and ordinances. Engineer Name: Mevlut S. Koymen Company Name Zade Partners, LLC ,gAREVIUI[ �p Massachusetts KOY S. Registration Number: 30554 X30554 O h re. STE v T elephone Number: (617) 338-4406 m «4,6L Engine r St mp Date: 30 November, 2009 Then personally appeared the above named Mevlut S. Koymen proved to me through satisfactory evidence of identification, which was personally known , to be the person whose name is signed on the preceding or attached documents, and made the oath that the above statement by him/her is truthful and accurate to the best of his/her knowledge and belief. ``,`�gti►HI�aaunhr�,9 Before me: �.�`�t��AV�'• �' '°�., l ` � `Q`�QV••O�M�8SIpH .� ���i Notary Public My commission expires: j�/'�i� �� n•2 :9r Pot'..; 7/1111 Nt�\N�� Notary Public Stamp ISI ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email:ZadeCo@AOL.com HVAC FINAL AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY CONTINUUM CARE ADDITION 575 OSGOOD STREET,NORTH ANDOVER,MASSACHUSETTS (Address) I certify that I, or a design professional under my supervision,have observed the work associated with the referenced project having visited the site on average of once a week throughout the construction period. To the best of my knowledge, information and belief, the work generally conforms to the permit and plans approved by the Inspection Services Department and with the provisions of the Massachusetts State Building Code and other pertinent laws and ordinances. ' 'M OF�qf Engineer Name: Mevlut S. Koymen s M1EVtUT. Company Name Zade Partners, LLC S. Massachusetts w KOYMEN #30554 p `' Registration Number: 30554 spa�GISTEe`F. L Telephone Number: (617) 338-4406 Engineer Samp Date: 30 November, 2009 Then personally appeared the above named Mevlut S. Koymen proved to me through satisfactory evidence of identification, which was personally known , to be the person whose name is signed on the preceding or attached documents, and made the oath that the above statement by him/her is truthful and accurate to the best of his/her knowledge and belief. er ,� Before me: Notary Public T&�A p�Go��®-2;'20oV�eyy �1lo� nn,w�2J My commission expires: 1 e 21 ®pV-1 a ONW E Nota `mp ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: 617 338-4406 Fax: (617)451-2540 Email:ZadeCo a AOL.com PLUMBING FINAL AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY CONTINUUM CARE ADDITION 575 OSGOOD STREET,NORTH ANDOVER,MASSACHUSETTS (Address) I certify that 1, or a design professional under my supervision,have observed the work associated with the referenced project having visited the site on average of once a week throughout the construction period. To the best of my knowledge, information and belief, the work generally conforms to the permit and plans approved by the Inspection Services Department and with the provisions of the Massachusetts State Building Code and other pertinent laws and ordinances: 4 vt Engineer Name: Mevlut S. Koymen o°�� MEVLUT. Company Name Zade Partners, LLC S. KOYMF.N v Massachusetts 30554 Registration Number: 30554I STSO � AL Telephone Number: (617) 338-4406 Engineer S am Date: 30 November, 2009 Then personally appeared the above named Mevlut S. Koymen proved to me through satisfactory evidence of identification, which was personally known , to be the person whose name is signed on the preceding or attached documents, and made the oath that the above statement by him/her is truthful and accurate to the best of his/her knowledge and belief. HIT Before me: ,moo�`1...•••;' �°��,, ON 21,�p�A��T Notary PublicJAL , My commission expires: 21 , K a ?o RY P Notary Public Stamp ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCo(a,AOL.com HVAC DESIGN&INSPECTION AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY MEADOWS LTC I certify that to the best of my knowledge, information and belief, the plans and computations accompanying the attached application concerning the locus at 575 OSGOOD STREET,NORTH ANDOVER, MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section i 116.2.2 of the Massachusetts State Building Code a! Sti OFAf Mevlut S. Koymen -#30554 ate .,p Engineer-Mass Reg. No. MULUT ��y Zade Partners, LLC g S. N v KOYMEM "' Company .� .� #30554 4 Z 140 Beach Street,Boston,MA 02111 (617) 338-4406 A Phone e Then personally a ared the above-named Mevlut S. Koymen and made oath that the above statement by him is true. Before me N.S T&�ptWK, � Alk aud AQGOVANEB _ 14 .2i?- My Commission expires 0.0 i ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCogAOL.com ELECTRICAL FINAL AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION 575 OSGOOD STREET,NORTH ANDOVER,MASSACHUSETTS (Address) I certify that I, or a design professional under my supervision,have observed the work associated with the referenced project having visited the site on average of once a week throughout the construction period. To the best of my knowledge, information and belief,the work generally conforms to the permit and plans approved by the Inspection Services Department and with the provisions of the Massachusetts State Building Code and other pertinent laws and ordinances. Engineer Name: Muzaffer Muctehitzade MUZAFFERg: Company Name Zade Partners, LLC MUCTEHITZAOE Massachusetts ELECTRICAL _ y No.32579 Registration Number: 32559 'OpQ t`G7 �K SSS/ONAIL E�v� T elephone Number: (617) 338-4406 En ' e r Stamp Date: 30 November, 2009 Then personally appeared the above named Muzaffer Muctehitzade proved to me through satisfactory evidence of identification, which was personally known , to be the person whose name is signed on the preceding or attached documents, and made the oath that the above statement by him/her is truthful and accurate to the best of his/her knowledge and belief. `�,��111 Before me: �•`�J\: ..s:a 0�'�''���i Notary Publicj�0q � a o�G, 1 v o • � N• My commission expires: 0. _ �111111 1�111�� Notary Public Stamp NORTH '9 Town of over ,, 0 411ol o dover, Mass., 0 LA COCMICMEWICN RATED p �C `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ✓ BUILDING INSPECTOR THIS CERTIFIES THAT.... ( :. ' Foundation has permission to erect........................................ buildings on ...,,t 5 Rough 67 to be occupied as............. ...: C,.l'�..... .......................... .. .. �^...... 14!Vf:......................................................... Chimney provided that the person accepting this permit shall in evefy respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS 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. i AFFIDAVIT STRUCTURAL DESIGN Permit No. To the Commissioner,Inspectional Services Department. Re: Edgewood Assisted Living,Cognitivelypaired Unit Renovation and Additions I certify that to the best of my knowledge,information,and belief,the plans and computations accompanying the attached application concerning the locus at 575 Osgood Street,North Andover,MA are in accordance with the requirements of the Massachusetts State Building Code and to other pertinent laws and Ili ordinances related to structural design. ENGINEER-MASS REG.NO COMPANY ADDRESS PHONE H A- 0,C) 20 (-)8 Then personally appeared the above-named Q pial Hol 1 And made oath that the above statement by him is true. Before me, MY COMMISSION EXPIRES: My Commission expires MAY 15,2009 + 2093 t DESIGN AFFIDAVIT To the Inspector of Buildings of the TOWN of NORTH ANDOVER: P g In accordance with Section 116.2.1 of the Massachusetts State Building Code: I hereby certify that, to the best of my knowledge and belief, the Architectural plans, specifications and computations accompanying the attached application concerning EDGEWOOD RETIREMENT FACILITY, CONTINUUM OF CARE ADDITION, 575 OSGOOD STREET NORTH ANDOVER. MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code, and all other pertinent laws or ordinances, including Architectural Access Board Regulations. (CMR 52 1) ARCHITECT NAME & REGISTRATION NO. II John Pearson#4841 V..P44 Architect- Massachusetts Reg. No. Margulies Perruzzi Architects, 308 Congress Street S sTort» Boston, MA 02210 MA 617-482-3232 qG Date: November 21,2008 Qt Of Qsg stamp INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section 1 16. .2 of the Massachusetts State Building Code, and progress reports will be submitted periodically toth TOWN of NORTH ANDOVER. RCHI ECT NAME & REGISTRATION NO. Jo earson#4841 Architect- Massachusetts Reg. No. Margulies Perruzzi Architects, 308 Congress Street Boston, MA 02210 617-482-3232 Date: November 21,2008 Then personally appeared the above named - MVV\• K Q-k,(.S6n have made an oath that the above statement by him/her is true. Before me,-:011111Notwy MONICA KA 1 l zt c COMMO rri�u 7-- jAedgewood Date MY Commkii:i My commission expires 7/ 1 S— 1W Uveh 12, retirement community\I.conadmin\1.13 affidavits\phase 2\design affidavit-architect.doc ZADE ZADE PARTNERS, LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCo(&AOL.com HVAC DESIGN & INSPECTION AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION I certify that to the best of my knowledge, information and belief, the plans and computations accompanying the attached application concerning the locus at 575 OSGOOD STREET, NORTH ANDOVER, MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section 116.2.2 of the Massachusetts State Building Code H OF Mevlut S. Koymen - #30554 �, ss y MEAUT. ���G Engineer- Mass Reg. No. g S. Zade Partners, LLC o<oYMEN rM. Company X30554 ® 140 Beach Street, Boston, MA 02111 �� �, (617) 338-4406 Phone Then personally appeared the above-named Mevlut S. Koymen and made oath that the ,*.gVe'.;§tatppent by him is true. i 0` Before me �1v°c'4�`J My Commission expires r'rE@R�l9kB99'95 ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCo(a�AOL.com PLUMBING DESIGN & INSPECTION AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION I certify that to the best of my knowledge, information and belief, the plans and computations accompanying the attached application concerning the locus at 575 OSGOOD STREET, NORTH ANDOVER, MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section 116.2.2 of the Massachusetts State Building Code Mevlut S. Koymen - #30554 M�VLUT q� Engineer- Mass Reg. No. O KMSN Zade Partners, LLC & #30554 ® Company ����4��`�' 140 Beach Street, Boston, MA 02111 A (617) 338-4406 Phone Then personally appeared the above-named Mevlut S. Koymen and made oath that the above statement by him is true. sow "@�°k�..\2 2p`�'�-,a 9'6♦��i� Before me Vie` "s o° " My Commission expires 0 . OVA �� i►'t 40 lq" ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCoAAOL.com FIRE PROTECTION DESIGN & INSPECTION AFFIDAVIT To the Inspector of Buildings of the Town of North Andover: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION I certify that to the best of my knowledge, information and belief, the plans and computations accompanying the attached application concerning the locus at 575 OSGOOD STREET, NORTH ANDOVER, MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section 116.2.2 of the Massachusetts State Building Code ords� Mevlut S. Koymen - #30554 Engineer- Mass Reg. No. o MEVVLUT y � S. N Zade Partners, LLC KOWEN Company jf30554 140 Beach Street, Boston, MA 02111 �16 (617) 338-4406 �. Phone Then personally appeared the above-named Mevlut S. Koymen and made oath that the above state.rggnt by him is true. ts Before me - Via,°;:: �,..•,, .9,� e My Commission expires `oma�•�(?ui)1��i`���`a�i ^� ,asrs eoa. ZADE ZADE PARTNERS,LLC Consulting Engineers Mevlut S.Koymen P.E. 140 Beach St.,Boston,MA 02111 Muzaffer Muctehitzade M.Sc.,P.E. Phone: (617)338-4406 Fax: (617)451-2540 Email: ZadeCoAAOL.com ELECTRICAL DESIGN & INSPECTION AFFIDAVIT To the Inspector of Buildings of the TOWN of NORTH ANDOVER: Re: EDGEWOOD RETIREMENT FACILITY, CONTINUUM CARE ADDITION I certify that to the best of my knowledge, information and belief, the plans and computations accompanying the attached application concerning the locus at 575 OSGOOD STREET, NORTH ANDOVER, MASSACHUSETTS are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. INSPECTION AFFIDAVIT In accordance with Section 116.2.2 of the Massachusetts State Building Code: I hereby certify that the structure shall be built under my or my agent's observation as per Section 116.2.2 of the Massachusetts State Building Code OFMuzaffer Muctehitzade - #32579 MUZAFFER g, Engineer- Mass Reg. No. MUCTEHITZADE � Zade Partners, LLC ELECTRICAL N9.32579 " Company cISM 140 Beach Street, Boston, MA 02111 sfoNA1 (617) 338-4406 Phone &Lk ek Then personally appeared the above-named Muzaffer Muctehitzade and made oath that the above statement by him is true. �6�Qr�,,e®e�taalnaaete////B Before me ` , ,= My Commission expires PN /1/fill 101110 �, y ts.4♦ r<hz z�l���y44"y,.\ ti, i °�+i',i s �\ .',�.�'Sfi�, *}•fir ''r�iti S+, 9 � ' p.. r e. r to lo W fa }► r r xo i��i "� ?,ylr 3t,Y��� ' - �mk''.' �+r�ra-Yt eE �` �+"..�''d'y..T.�c.�-S'•.�. r'++��f,r 7 'l 1Y, �'�ti - _ +s+rcr�+yn,tan4. n y •4',.J '��r �. Ts ti h r To ""rillt h]a•�.t i.Y} ioll .Y h PP PrrP .. •,tS p: AC 4�,. CERTIFICATE OF LIABILITY INSURANCE ioio8jzoos PRODUCER (603)224-2562 FAX (603)224-8012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Rowley Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 139 Loudon Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 511 Concord, NH 03302-0511 INSURERS AFFORDING COVERAGE NAIC# INSURED Eckman Construction Co. , Inc. INSURERA: Firemen's Ins Co of Wash. DC 00373 84 Palomino Lane INSURERS: Acadia Insurance Company 31325 Bedford, NH 03110 INSURER C: 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 ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPA012120114 09/01/2008 09/01/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 250,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ A X CG0001 1,000,000 X CG2503/CG2504 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- JECT M LOC AUTOMOBILE LIABILITY CAA012120314 09/01/2008 09/01/2009 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA012120414 09/01/2008 09/01/2009 EACH OCCURRENCE $ 10,000,000 X OCCUR FICLAIMS MADE AGGREGATE $ 10,000,000 B $ DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION AND WCA012120715 09/01/2008 09/01/2009 X TORY WC LIMIT FR EMPLOYERS'LIABILITY 3 A STATES: NH, VT, ME, E.L.EACH ACCIDENT S 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? MA, CT. E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER CPA012120114 09/01/2008 09/01/2009 Limit of Liability- $200,000 A Leased/Rented Equipment Deductible- $1,000 ACV Applies DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: Edgewood Retirement Community, North Anodver, MA. Edgewood Retirement Community Inc. , and Trident Building LLC, their subsidiaries, affiliates and parent companyes, and their respective fficers, directors, trustees, managers, building committee members and employees are added as additional insureds on all policies listed above except workers compensation for liability arising ut of the operations of Eckman Construction Co. , Inc. on this project CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Edgewood Reti rment Community Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 575 Osgood Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE 4 Christine Holman/CNH /""1111, ACORD 25(2001/08) ©ACORD CORPORATION 1988 �y 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(2001108)