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HomeMy WebLinkAboutBuilding Permit #614 - Suite 125 4/18/2006Permit NO: (Y d BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received y S�lcv '67 rO\ PROPOSED USE QofA rO 4y Date Issued: " I4 -® r �- IMPORTANT: Annlicant must complete all items on this pane LOCATION q -S-1 "yet^ � � � /y 12 ,, 1 O- f / � r Print PROPERTY OWNER C_ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaae ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: XCommercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer SCRIPTION OF WORK TO BE PREFORME OWNER: Nam Address: l0ig Address: Type or Print en 0V-q1)e-(9 Q -q Supervisor's Construction License: �S ��Z� Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. `13 Total Project Cost: $ FEE: $� Check No.: 07 Receipt No.: �2 1013 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty 4. Signature of Agent/Owner Signature of contractor Rpr 08 08 04:42p M.A.-'O.P Management Office 1-978-687-6043 p.2 \` _ - 4224' xx L4 UNIT 125 Cm B" scuom ANDOWKrA Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH- Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea J64 Usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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) ❑ 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 a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 �SILocation No. / Daft NORTH TOWN OF NORTH ANDOVER • o� Certificate of Occupancy ��s''^•'�<� Building/Frame /Frame Permit Fee $ 9 t— Foundation Permit Fee g Other Permit Fee a TOTAL ! Check # 0Yva-- 2 I " Building Inspector C W M cis r! isa a4 w° Cn cin � or. w° w°' v U w pG EOE a°' x a O w a v O E=4 N m c o dMW � c • o ` +- cc, � vV �o ev c := o 0 CD N , . Ea o C) a H O m 45 O O cm �4 m C H m CD o �' 3 HID cm ID c c ' co c ea H m 0 0 av y m m i :,go :coa CL ot .y Z c .20 o ~ a m N m C = m : m_- 3 CL. O W CO �'O LLm �••• C H .co •� = r.+ O C cc •.4 LU C. .O p 4D !E C_ h a m32 Os ca ti �O f— = $ — am E �7 h hM� h 0 9 CO) C cm ID O F� cm c m P-4 0 cm C N z U 6 H CD y .E CL O C O O C.2 _O CL GO 0 V C 0 �/ ..3 R C cc Q. CO) O V O CL CO) C 0 co 3� �co o 0 Q O C' CL C Q � ea O O Z w CL y C E-MAIdED r#�.� # L7i#SICC43iL #TCfiL # T 4.,L1T4Y A� E-MAILED To'> 3roo1k.Q. Q FGk 31-u I Q'T lUo- o, NADP COMM AMA NA WAY r = Lons+rLAc-4lOil rt,f'Qp� �__ _� Desks -fo be remc>ved TOTAL USEABLE SQUARE FEET: 1632 SQ. FT. TOTAL RENTABLE SQUARE FEET: 1632 X 18% = 1926 SQ FT. WALr=lAr=1' Useabb square footage s ndcated in GR%Y_ useable square footage is the e#ee in which rug can be placed. fbntabb equate footage is the useable square footage times the common area #sib of I891;. C—orF,,- rUCA i on. Fl f-� c!� c)n XxXX3I3e $,9.9Tr70 ACORE M CERTIFICATE OF LIABILITY INSURANCE 7 TEfMMfDDNYYY) DA4/14/08 PRODUCER Fravel Insurance Agency 6 High Street Danvers, MA 01923 THIS CERTIFICATE IS ISSUEDASA MATTEROF INFORMATION ONLYAND CONFERS NO RIGHTS UPON T HECERTIFICATE OLDER THIS CERTIFICATEDOES Nar AMENDE)(TEND OR ALLTERTHE COVERAGEAFFORDEDBYYTHEPOLICIES BROW. INSURERS AFFORDING COVERAGE NAIC # _ INSURED Property Serviced –_— ----� -- — — — INSURER A: Granite State Insurance LIMITS INSURER B: Western World Ins Co North Andover, MA 01845 INSURER C: NPP1156614 INSURER D: 2/14/09 INSURER E: $ 1,000,000 t,vv w+uw 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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. 1NSR TR D' INSR TYPE OF INSURANCEGENERAL POLICY NUMBER POUCYEFFECTIVE POLICY EXPIRATION LIMITS B North Andover, MA 01845 LIABILITY X COMMERCIAL GENERAL LIABILITY ICLAMS MADE 541 OCCUR NPP1156614 2/14/08 2/14/09 EACH OCCURRENCE $ 1,000,000 DAMA O RATED PREMISES Eaoccurenca $ 50,000 MED EXP (Anyone person) $ 5.000 PERSONALSADV INJURY $ 1,000,000 GE14ERALAGGREGATE $ 2 1000,000 -- -- $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG POLICY jE a LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALLOWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGEI (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ _ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- A WORK ERS COMPENSATION AND EMPLOYERS' LIABILITY 2341484 2/26/08 2/26/09 0BY11M9 ft $ 100,000 E.L. EACH ACCIDENT ANY PROFRIETOR/PARTNER/EKECUTNE OFFICERIWEMBER EXCLUDED? $ 100,000 E.L. DISEASE- EA EMPLOYEE K descnbeunder SPECIAL PROV180NS below E.L. DISEASE- POLICYLIMIT I $ 500,000 OTHER D ESCRIPTIO N OF OPERATIONS I LOCATIONS/ VEHICLES 1 EXCL USIONS ADDED BY END ORSEMENT / SPECIAL PROVISIONS NAOP, LLC is listed as additional insured. !`Amr1m I erInm VCJ\I lrlvlllVlNtuu\ � �� "-'- SHOULD ANY OF THE ABOVE DESCRIBED POLICIESSE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 30 D ANS W RITTEN NAOP , LLC. NOTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO D OSO SHALL 451 Andover STreet IMPOSENOOBLIGATION ORLIABILITY OFANY KIND PON THE INSURER, ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRE ACORD 25 (2001108) - v M%I%JI v %,%Jnrvrw11.,114 lave \ . > \\\�. ! %q ). f \ m / . w 2: r k,3 � �.° ■ 2�.� � : o B k � 2 f f . g [ DLn E ' f k | � � Apr 07 08 08:12a .i N.H.O.P Management Office 1-978-687-6043 P.1 To Kim R( O)OFS FIRST GENERAL REALTY CORPORATION April 3, 2008 US Property Services 6 Pleasant Street, Suite 504 Maiden, MA 02148 Re: 451 Andover Street, Suite -125 Carpentry & Painting Dear Frank Gomes: 93 Union Street, Suite 315 Newton Centre, MA 02459 Phone: 617-332-6400 Fax: 617-527-4176 Sent via facsimile: (978) 319 -9033 This is confirmation of the work to be performed at the above referenced address. We mutually agree the amount will not exceed nine tho.rsand five hundred eighty five dollars and 00/100 ($9,585.00), for the work described on the proposal, attached as Exhibit W. Your engagement is acceptable subject to the following conditions: Your engagement is acceptable subject to the following conditions: 1. All work shall be performed in a good workman like manner and in accordance with all town, state and country codes and regulations. 2. Your company and personnel will clean up after completing their work. 3. Your company will provide us with a certificate of insurance to include public general liability and workers compensation, NAOP LLC and First General Realty Corporation, as additional insured. 4. Your company will be responsible for obtaining all necessary permits if applicable. 5. If you cause a violation to the contract, we can send you written notice and remove you from the job within 72 hours of ratification limiting payment obligations to only the work completed. 6. The project will be scheAuled on a mutually agreed upon date by Contractor and Landlord. 7. The payment terms are as follows: $3,195.00 deposit, $3,195.00 work in progress and $3,195.00 paid within 15 days of completion of work. B. Should any part of this agreement contradict Exhibit 'K, this contract shall govern or supersede. Please sign on the line provided below and this will serve as the basis for our contract. Sincerely, m Roge Pro rty Manager Agreed to and accepted by: '_Z�_"'_ — (9 �e—r 0 of Frank G es, resident Date 4. IIo§o IDm<mfDOlpty Iy�.Ip�VIl��s�g LL®l�'llDo PROPOSAL NO. 3472 PAGE NO. 3 P.O. Box 545 Biilesica, MA 01821 DATE 12/06/07 REVISED 03/25/08 (... Continued from the previous page) IV. Terms a. First General Realty, Corp. will provide dumpster for debris. b. Interior Painting: Price includes up to 2 wall colors, and 1 color for the woodwork; additional colors will be billed at $250.00 per color. c. First General Realty, Corp. will provide the wall and trim colors before the start of the project. d. We allow one punchlist at the completion of the project to allow for touch-ups. e. Color selections are final; any changes made may result in additional charges. f. All debris will be removed on a nightly basis. g. U.S. Property Services, Corp. is not responsible for any cracks resulting from the expansion & contraction of wood. h. All U.S. Property Services, Corp. proposals include a one year warranty on all labor performed. **Please check the box next to the amounts) on the previous page to confirm your approval. All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of - To be determined by the above options Dollars ($ - TBD - Payments to be made as follows: 1/3 deposit, 1/3 work in progress, 1/3 at project completion *Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. **Note — This proposal may be withdrawn by us if not accepted within 30 days. Respectfully Submitted Frank Games On behalf of U.S. Property Services, Corp. The above prices, spec' cations and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Paym made as outlined above. Signature Date Signat Date U.S. Property Sen ices, Corp. - TeUFax: 978-319-9033 • info@uspropertyservices.corn * mm PROPOSAL NO. 3472 (207]DDe PAGE NO. 2 P.O. Box 545 Billerica, MA 01821 DATE 12/06/07 REVISED 03/25/08 (... Continued from the previous page) Front Door • Install a new glass front door framed with wood • Follow the style of the picture shown to the right • Use Y4• clear, laminated, safety glass "Allow 4 weeks lead time for delivery • Price for labor and materials to install door Cost: 780.00 12f Sidelights • Remove sheetrock and studs to accommodate new sidelights • Install wood bimwork — match existing corridor sidelight style • Use'/. clear, laminated, safety glass Cost: 475.00 each Y), Painting • Strip wallpaper in entire Construction Area • Skim -coat those wails • Patch holes where needed • Apply 1 coat of primer to all walls in the Construction Area Cost: $ 2,500.00 • Apply 2 coats of finish paint to all walls in the Construction Area Cost $1,500.00 III. Exceptions • Plumbing • HVAC • Carpeting - • Electric • Fire Alarms J Sprinkler Systems U.S. Property Services, Corp. • TeWax 978-319-9033 . irdo@uspropedyservices.com • (Continued on the next page...) E-MAILED 'To Sohn MQw n� er-- �--GK 3 102.-- NAof �t • (� m j� PROPOSAL NO. 3472 �o1ye �1�°®��Il'�� ►J��Il°���.w�9 �L®�°J Ce PAGE NO_ 1 P.O. Box 545 DATE Billerica, MA 01821 12/06/07 REVISED 03/25/08 I. General Information Proposed by. U.S. Property Services, Corp. P.O. Box 545 Billerica, MA 01821 Submitted To- First General Realty, Corp. 93 Union Street, Suite 315 Newton, MA 02459 (617) 332-6400 Work Description: Carpentry & Painting Office Hours: Monday — Friday: 8:00am — 4:00pm Telephone: (978) 319-9033 Fax (978) 319-9033 Work Performed At: 451 Andover St. Suite 125 N. Andover, MA 01845 H. Work Description We hereby propose to furnish the materials and perform the labor necessary for the completion of the work described herein and to commence on the date listed above: Area: 1" Floor — Vacant Space Construction Area is highlighted in blue on faxed plans "Additional Construction Area highlighted in green on faxed plans on 03/18108 Demo - Remove old desks from Offices 1 & 3 - Highlighted in pink on the plans - Remove all cove base in Construction Area - Demo the closet - Demo the wall between the Office 1 and the bathroom - Demo the ceiling in the bathroom Cost: $ 1,350.00 Ef Carpentry • Build a wall to Gose off the Construction Area - Wall connecting Office 6 and Office 2 • Close doorway for Office 1 • Build a box to close in the pipes in Office 1 • Install new ceiling grids and tiles in the bathroom • Adjust ceiling grids and tiles in the old closet area and in _/ Office 1 (connect with bathroom area) Cost $ 2,980.00 (Continued on the next page...) U.S. Property Services, Corp- TeUFax 978-319-9033 • info@uspropertyservices.com - The Commonwealth of Massachusetts Department of Industrial Accidents I-ItW Office of Investigations m ' a 600 Washington Street t Boston, MA 02111 ..." www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: ' 1l(e f-I r�)q i%Z Phone .#: 6 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):, 6. ❑ New construction 7. LR Remodeling 8. Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. . I am an employer that is providing workers' compensation insurance for. my employees. Below is the policy and job site information. 1 A Insurance Company u Policy # or Self -ins. Lic. #:i2� Expiration Date: Job Site Address:e yet' 7� �jetG /�G City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveraee verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. use only. Do not write in this area, to City or Town: or town officiaL Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA – (For department use) ❑ Notified for pickup - Date _ ........................... ..... _............................................................................................................................... _._................... .......... —_._..... _..... _.... ....................................................................................................................................... ................... _.................................................................... --....... . Doc.Building Permit Revised 2008 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) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Date../7./-*—**��e) —0 _q ................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING If?i This certifies that.2_Ie,�",---/ ........................................................................................... has permission to perform ---l*'.-'�6-----------�*-�-. 2-1 .............. I ..................... -/ / . wiring in the building of ... cn........................... ............................... ......... ,North Andover,, Mass. .'-.nU .................... Fee.% .... Lic. Nd�. .................. ECkL I P Check # ;16 8129 r ••%ff.•....,LO„wCaien ar rrassachusetts Official Use Only Department of Fire Services Permit No. ePia9 BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code WORK (PLEASE PRWT BV aW OR TYPE ALL WFORMAYYON) Date: cj, 527 c 5 .o� o, City or Town of: NORTH ANDOVER To the Inspect r o W' L� By this application the undersign gi s notice of his or on to Perform e . Location (Street & N er) I,/ P rk described w. Owner or Tenant O T L... Owner's Address Telephone N �� qG Is this permit in conjuncti�I` tth a building permit? Yes � !-1 I �� No El (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und9rd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Uniigrd ❑ No, of Meters Number of Feeders and Ampacity (7 Estimated Value of Electrical Work: I Attach agillit 11"'iti1 detail if desired, or as required by the Inspector of Wires. Work to Start�3 (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, and upon .completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performanc the licensee provides proof liability ins**a*+ce includi"e of electrical work may issue unless completed operation" coverage or its substantial equivalent The undersigned certifies that such chcoverage force, and ng has CHECK ONE: INSURANCE OND ❑ OTHER exhibited proof of same to the permit issuing office.. I certify, under e E] (Specify:) �+ p ' and penalties of perjury, that the information on this application is true and complete. FIRM NAME, J �,�'i� �� Licensee• LIC. NQ 1 C Sigaatiu e�.�Q 41L�I IC. (If applicableoe er�ez� t •' in tthhee licce a number line. .� 1 Bus. TeL No. NO Address: -j 0 *Per M.G.L c. 147, s. 57-61, security work requires Department of public Safety"S" icense: Alt. TeL No.. OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not have the liable: Lic. No. required by law. By my signaturerequirement I am the (check one) below, I hereby waive this reeE] dance coverage normally Owner/Agent ) ❑wner owner's agent Signature Telephone No. PERMIT FEE: $� The Common wealth of Massacksmeft k� r j i Department of Zndu &hd Accidents Office Investigations .�� of i ;' 600 Washinaion Street Boston, MA 02111 Workers' Compensation is A Iicant Information www-mmsgov/dia . hmnee Affidavit:$nilders/CoatrartorslEiectricians/Plumbers Name (Bminess/Orgwi=6on/individual): Please Print LmQibl I .V. Address: City/State/Zig: ±111'_ (,�� Phone ployer? Check the appropriate-boz: ' FArmeyouS a employer with 4. ❑ I s rr► a general contractor and I. 'l'ype'of project (required): employees {full andlor Port -time).* I have hired }Ire sttb.contracxim 6 [] Naw cons on am.a.sole proprietor or partner- ship and have no employees working for me in listed on the attached sheet t 7 ® odeiing These sub -contractors have g• Q Demolition. any capacity.. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and ifs - 9' El Building addition required.] 3. [� I am a homeowner doing all work officers have exorcised their 10.0 Electrical repairs or additions right of exemption per MGL I I.Q Plumbing n -pairs myself.. [No •workers' comp. insurance required t .- or additions x .152; § I (empti d we have no 12.[] Roof repairs .�nplayees. [No workers' comp• insurance re aired.] 13.0.0ther `f+nY appticam that checks botC# I must also fill out the section below showing their workmV oompenution Polley information *Amy who submit this affidavit indicating they are doing all work and tha11 n hire •omside contrsebm, =Contractors that check this box rnm&ttaehed as additional sheershow' must submit a new affidavit indicating such. mg the tram- of the sub--nowtors and thc& workers' comp. oli I am an employer thrn.tsavrovAding:workers•' co e�rsation ' P c5' ini'onnetion. inforn=don. assurance for nV employees: Below is. the policy mad job site Insurance Company Name:IS C)(Y1r y\c-t—C Q iT- Policy # or Self --ins. Lic. #: &L-1- Expiration Date. Z C� Sob Site Address:�t C• Attach a copy of the .workers' com ity/st�c/Zrp: pensation policy decoration page (showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal 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 s day against the violator. Be advised that a copy of this statement may be forwarded to the Ofiice of Investigations of the DIA for insurance coverage verification. Ido hereby c nder the pairu and penalties o e 'a that the informadon provided above is arks aur! correct fP 'T '�' . Si tore: �_ °� �] Q 6 g Phone #: 1 l 11x7 Offtciat use r niy. Do not write in .this area, to a completed by city or townoffda City or Town: Permit/License # lssuiug Authority (circle one): 1. Board ofHealtb Z 13ulidin9 Department 3. City/Town Clerk 4. Electrical Inspector Piumbino Inspector 6. Other b 11 Contact Person: Phone #: Location t �l •tet M•�1 d ��' No. /.?.� Date � Z MORT1y TOWN OFNORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ S�CMUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 3 S +{ Building Inspector 112 12 /ga 09:20 375.00 PAID Div. Public Works w a 0 Ao 0 m S W � Q N N N a 9i i a I� m u W W for > 3 a C 0 u Z 4 Z a o 0 J J 0 W �m � It at 0 W O 0 0 C 7. W N m IL W 4 1 6 0 2 0 W N N O N d Z m In m 0 H _H X. OC W IL s er 0 vl QI Z V Q F- ] d #lo Q 0' Z D p 0 N Z _ 2 In 9 � � W IWC < E 0 Z Z < O N Z < 0 O N H u W a W Q W W = A Z U Z Z U N O O o < wla N w W Z x U Z I- IA Z p T J O F W J G < Z F N LL 0 Z 0 = W D Z v 00 P 0 U.0 O p U. 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O CO2 Z C.3 C CD C.3 vs C C .y . int %—uninlu"weutm u iviassacnuseus - ( Department of Industrial Accidents - _-- Office of/aresUgaUoQs 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit C] 1 am a•sole proprietor, general contractor, or homeowner the following workers' compensation polices: ir~ eitvc below who have official use only do not write in this area to be completed by city or town official city or town: permit/license N r-IBuilding Department []Licensing Board [] check if immediate response is required []selectmen's Office []Health Department contact person: phone q; nOther PROJECT NUMBER: PROJECT TITLE: PROJECT LOCATION:-(Ibz NAME OF BUILDING: OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL Dt2 • MIQ*ft, ���ED ARCy\ Q� e MA' T�c' �� Cp , MASS. o r_ I ?'-s TURE OF PROJECT: I►�1lii {.�% C)Fr-MC, &%C8b I NTO C&)E IN A CO DANCE ITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, �� p • ��i tel. l� REGISTRATION NO. 18159 - BEING A REGISTERED PROFESSIONAL &NGINEEWARCHITECH17HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ClwpueA �Gi�� ENTIRE PROJECT F7 ARCHITECTURAL I�LST UCTURA ANICAL /�� (tie[-::] I�Ip INEQ.�fA�iJIChL pyx, Fora- Morcg FIRE PROTECTIONLECTRICAL2K� OTHER (specify) I1�7 �ayM t FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMIPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. P AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. (,FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE r PRESENT 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 116.2 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 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 INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. /tZNATURE Le SUBSCRIBED AND SWORM4 TO BEFORE ME THIS —Z—DAY OF 19 �- NOTARY PUBLIC MY COMMISSION EXPIRES �— FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/per" from Boards and- 1-partments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. q ments. *****APPLICANT FILLS OUT THIS SECTION ew 'APPLICANT T CG 0 S1'. (T I m rR 4lrn►) PHON %0 3 9�3 "LOCATION: Assessors Map Number CCS '0 PARCEL SUBDIVISION LOT (S) (90 A/ SE T q5 I 1 /� fL©t1�r� 5T t ST. NUMBER_ *********** r****OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED TQWN PLANNER DATE APPROVED w DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS -------------- w A PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT . � N p gyp, �7 —Ay�- RECEIVED BY BUILDING INSPECTOR ' DATE ------------------------- -- C, il),)UJIV,p� � Lj,,dwd )tkf 01 ),)]1 1, IAN i10 r. )2-)Aolpllv 1 ,'r :Np ill 'ill up 01 Uk-,, isS.1 i "'A j .lIlu W11 if" (Till ,)1111 - [c1- 7P � I jo I [I.? ,,i,fJVcf T 00N. be oll () � 1% JOAOPLIV 11 UON Nk)P',JV LPJONJO TIA101 iorj�)dsuj fuipling A-Mltlef " - o� (617) 859-2950 FIELD REPORT Attention: m MARGOLIS INC. 380 Boylston Street Boston, Massachusetts 021161 y 7,)tn og IJ. And~i, AM . 01r4 -r-' Date: Job Naml4e0>'1J /�Oyde4�Q The Following was Noted: / Ir 1 FEB 12 1998 FAX (617) 267-6158 Contractor: JN1 -t Job Location: Owner0„Cli- mc JJ,,LL1I Weather Condjt�'gn�: Present at Site: TfAfe FPV.40& 140 *-�&a a- 64650(.Y- X04* Copy to: v 0 J Signed:,,, (617) 859-2950 FIELD REPORT Attention: MARGOLIS INC. 380 Boylston Street Boston, Massachusetts 02116 7�L w /J, AA61.0— Date: Job Na The Following was Noted: 0 T w n < Copy to: Tu ti"lac-c.. FEB l 2 IQOR FAX (617) 267-6158 FILE Contra 3x , Job Location, Owne�Cli��ii�� Weather/gnditions: 'V/i4,• Present Site: , fe- awU«M& i ��r060 C A � y W ,.. T,w x xto a o M m i O. m 0 m O C c �r m a so a rx 0 o �E7rr d O n � 3 y z ti y Z 0, d v� y y y y CC m a ? z a o O ty On 0 t 0 m n o M m i O. Z, m O C c �r m a so a rx 0 o n cD n � C .a Z 0, O FA C .0 CO3 CM) CD 'O O C7 Z y 06 o �. 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