The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #210-2012 - Suite 301 9/13/2011 %ORTFI BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION , 0 . e Permit NO: ��D r �� Z Date Received0R,TID SCHU`� �SAE� Date Issued: 3�/ J IMPORTANT: Applicant must complete all items on this page LOCATE r r' Fant PROPE,' .OW+1aJER �Q .�t. _ JX1'P ZOf1GTRtC 1 'istoriasfapf n tt . N`.Jacla�r�e1�Qp V1JJa,�r e 1D TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addi ' Two or more family In Iteration No. of units: ommercial epair, replacement Assessory Bldg s: Demolition Other 11t111 fl�i3dpaln ail/ellanl . . ltershlas#rit Waterl,5ewer D SC RIPTION OF WORK TO BE PREFORMED. ll Y1 �K/ c Ale- 4X/ 411-L7e la , / Identification Please Type or Print Clearly) Phone: /� OWNER: Name:0 v 1� 02 L L C Address: COlT `CT�O'R ,N�ariE r' 1 hone:: k Addr_�ess� f '► J � � . �- t U.113 r��s��r,s construbtlon�:icense. _ . H r 'e., pmer�t ARCHITECT/ENGINEER Phone: f9f-j 'LO Address:Q D Reg. No.TW53 f��-.-� � � C ' FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /, �`� FEE: $ 00 Check No.: 53 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gua u l raafire of A e� JneratareFofacontrato Date......U.`2..Z'.... h NORTH °f' :•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING- �'Ss�cHusEt c This certifies that ... ............................... ' _:T ............... has permission to perform ...t.:.!.T l A) ........ .......................... .................. wiringin the building of.......f..V.. .......................................................... d... Sr...„......_..... , rth Andover,Mass. Fee..�.Z S�ic.No. ..�..,,1�...��.. ...... ... .. .. ... . ... ... ELECT ICAL INSPECTOR Check # -49q 10496 Locatio No. �910 — i�0/2 Date NORTy TOWN OF NORTH ANDOVER � D Certificate of Occupancy $ CMUs t� Building/Frame Permit Fee $ ?' Foundation Permit Fee $ Other Permit Fee $ • TOTAL $ Check # a� 24572 ilding Inspector 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 r Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street li f ��. RTM TV 7��ul��ster_or��tet �e� x�o :L-ocateda'ti2-4-NanStreet; . O I ME- -IN TS 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 J 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 o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o 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 Li 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 Commonwealth of Massachusetts Official/UseC�On�ly f Permit No. L� 7 [ PI Department of Fire Services • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION Date: 1 City or Town of: NORTH ANDOVER To the Insp gtor 6f Wires: By this application the undersigned gives notice 2f his or h r intention to perfo': the el "cal w rk described below. LJ r Location(Street&Number) Owner or TenantTelephone No. Owner's Address Is this permit in conjanctioliffith a buil7g permit? Yes No El (Check Appropriate Box) Purpose of Building (:a— Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ o.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Wor Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:SY•(Paddle))us Fans Transformers KVA 1 No.of Total No.of Luminaire Outlet . No.of Hot Tubs Generators KVA , No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o cy Lighting nd. rnd. Batter Units Units -- No.of Receptacle Outlets No.of Oil BILruers FT.R.E ALAPIMS No.of Zones No.of SwitchesNo.of Gas Burners No..of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices ' Tons No.of Waste Dis osers Heat Pump Number Tons KW No.of Self-Contained p Totals: ` . ........... - Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: z� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Val4C0 ectri al Work:c 2� (When required by municipal policy.) Work to Start: ` Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCERA E: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE L?-30ND ❑ OTHER ❑ (Specify:) I certify, under the�ai s a d penalties of perjury,that the infor�reation on this application is true and complete _ FIRM NAME: t � �� 1 LIC.NO.: rA _3 Licensee: (jj�W� L �� Signature LIC.NO.: (If applicable,e Mhe licens n ber line. W: Lic. Tel.No.: Address: Tel.No.•V1 L / *Per M.G.L c. 147,s.57-61,secunty w rk equires Department of Public Safety"S"LNo. l OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner El owner's agent. Owner/Agent �_ �__ PERMIT FEE:S t ✓ Conemonwealth o� adJacet Official Use Only cc�� cc77 Permit No. . •. .1Jefiartinzn�o�..tire�ervice�. __ - _ _ . BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE LL NFO TION) Date: C Z 2-011 City or Town of: OV�C To the Inspector of Wires: By this application the undersigned ives notice of his l!qr�her intentio to perform the electrical work described below. Location(Street&Number) S�— Owner or Tenant 4121% 0 Telephone No. Owner's Address Is this permit in conjunction with a building permit? YesNo ❑ (Check Appropriate Box) Purpose of Building CDA:=�Fq Utility Authorization No. Existing Service .— idrd m g ❑ No.of Meters dgrd ❑ No.of Meters • Date......�Z::�2�-•-•!.. —77 yJ- '(- - f ,o aT:�ti TOWN OF NORTH ANDOVER table may be waived b the Inspector o Wires. No.of Total o? p PERMIT FOR WIRING Transformers KVA Generators KVA �o • . o.of Emergency Lighting y'-•,,r;, F• Battery Units ,$SACMUS� FIRE ALARMS No.of Zones / / CZE E? No.of Detection and This Certifies that ....... ... Initiatin Devices has permission to perform ......... I .......................................... Jo.of Alerting Devices s �� /3 ?! . lo.of Self-Contained ........... letection/Alertine Devices wiring in the building of....................................... Mun .. S i , ,North Andover,Mass. ocal❑ Connection al ❑ Other .curity Systems:* at......... . ....... No.of Devices or E uivalent CT ... Lic.No... o "�'••�• EC'rRiCAL INSPECTOR Fee......�........... 7 ata Wiring: No.of Devices or Equivalent +lecommunications Wiring: Check # No.of Devices or Equivalent .� 0548 „ ,ru,uetau:I desired,or as required by the Inspector of Wires. ...,,,.. • r I�s�� V 1 (When required by municipal policy.) Work to Start: Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAG Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability i ance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ eci S ( P fY) I certify,under th p ins and penalties of perjury,t at the information on this application is true and comp[ FIRM NAME: �11�� oe . ��—�—� LIC.NO �� Licensee I e Cr,- Signature C � o i.IC.NO.: (Ifapp lica e,e r "xem t"in t e licensg n�{rnber line.) Bus.Tel.No. Address: 1[ �•-� �t ��& �Q(�''�'�"�211 It.Tel.NO.. Q 7 *Per M.G.L.c'147,s. - 1,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/ rganization/Individual): Address: ofo z5-7 b City/State/Zip:!�iUe,�t Phone #: Are you a ployer?Check t appropriate box: Type of project(required): 1. m a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (/�� -��1 C Policy#or Self-ins.Lie.#: J �o Expiration Date: L Job Site Address: QJ� City/State/Zip: i 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 coverage verification. I do hereby ti under the pains nalties o per'ury that the information provided above ' true d correct. Si nature: Date: Phone#: F—C, Q�_,�� 7� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NORTH TO'" of _ Andover o over, Mass., 0 - LAKE COCKICKEWICK V %S RATED P" `Cl BOARD OF HEALTH PERM . IT T D Food/Kitchen Septic System / /+ BUILDING INSPECTOR THISCERTIFIES THAT............... ...A .........�.... .. ................................................................................................ Foundation has permission to erect........................................ buildings on....................................................................:......................... Rough to be occupied as............... ......:.. ........Y..d(. ............I5�.... �O.. ... ....................................................... Chimney provided that the person accepting this permit shall in every 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 CONSTRUCTIO TART 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations = 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): L'� o t� /� Address: / 1G.Yl //_ (� O Ci /State/Zi : O Phone#: 6 �� Are u an employer?Checkthe appropriate box: Type of project(required): 1.VI m a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors _ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. Remodelin ship and have no employees These sub-contractors have emolition working for me in any capacity. employees and have workers' f 9. E]Building addition LNo workers' comp.insurance GVlll�l.ulbuic llVG.T -- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees_ [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name:G 1-^" .t �•//�1P /n (7 Policy#or Self-ins.Lic.#: (�/�� 1a Expiration Date:�� Job Site Address: / A 37 City/State/Zip:/Vo, 4116 ZCX /1*14 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 coverage verification. I do hereby certify under t pa' penalties ofpedury that the information provided above is true/and correct: Si ature / Date: 0 — d Phone# Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 06/06/2011 MON 14;29 FAX 978 683 0028 FRAVEL INSURANCE AGENCY X001/001 A n^nnGEKTIFIGATE OF LIABILITY INSURANCE HVj%" 'uAItIrA fuut"YT) ♦rTw 6/3/11 PRODUCER THS CERTIFICATE ISISSIEDASA MATMROF INFORMATION Fravel Insurance Agency ONLYAND CONFERS HOLDER.TH ERTIFlO RIGH 1~SUNOT AMEIm,WWI AT OR 231 Sutton Street Suite iB ALTH2THE COVERAGEARIORRO®BY THE POLI COS BLOW. • North Andover, Mh 01845 INISIIJIM322nFFOWNGC:OVEUGE NAICs INSURED INSURER A.Zurich Znaurance Co - US Property Services INSURER&Granite State Ins Co _ Lisa H. Gomes DBA WWRRC:Nautilus insurance 515 Lowell St. Suite 3 INSURBRD: Peabody, Iii 01960 — i INSURERS! 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 SUBJECTTO ALL THE TERMS.E)CLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR O E POUCYNUMBER POUCYEP I iOUCYE(PRADN m LIMITS GENERAL LIABILITY ( ( I FACH OCCURRENCE f 1,000,000 a v I enMuFRcw a�Ral IIAM"V -qE'n nAA4ARQAA t n/79/t A �,L ion i1 1�@7 @WTO RENTED n I n-j— � �� ....�..vv�v� •v,�,,+v tv/i//ii PREMISFS(E800CVBIM9)—}i—X UV.UUU I CLAMSMADE lx l OCCUR r MEDEiW(Mymepersm) 1 S 5,000 �PFASONALGADV*&WRY f 1.000,000 _ GM MI-AGGREGATE ;E 2,000.000 GEN'LAGGREGATI:UNITAPPLIES Put! _PRODUCTS-COMP,OPAGG i i 2,000,00.0__ POLICY JPMT 1 1 LDC _ ANYAUTO COMINNED SPOOLS LIMIT S _ ALLOWNEDAUTOS Boollr INJURY f SCHEDULEO AUTOS TPR Pmol) HIRED AUTOS % DILY MITY MS Ell NON-O EDAUTOS ( �W PROPFRTYDAMAGE S {PEr wddW4 ' GAR/U'EW1BILtTY _A_UT_OONLY-EAACCIDENT S _ IANYAl7TU ) EAACC S - AU NTLYY': AGO S -- EIICESSNMBRELLALMBiLT1Y MM OCCURRENCE I S �UV VR ]L Gl%1(NSILVI�E AGGREGATE '$ S CI I �DE DUCT13LE AN002544 10/2/10 10/2/11 �$ S,000,000 RETENTION S I S WORKER SCOMPENWICIN ANDOTFS- B EMPLOYERs'IJAeRm VIC 8266712 11/3/10 11/3/11 X gg'PROMW EL EACH ACCIDENT f 100,000 ff-gy.dvxAbo~ ELDLSEAS'E•EAEMPLOYEE f 100,000 SPEOALPROVIsWs W ELDLSEASE.P000YUMIT f 500,000 OTHER I D ESCREPTEO NOF OPMATTONS ILOCAt10NS I VEM GLES IE XCLUSIONS ADDED BY ExIDomMF7R/SPECLAL IHLOV1sONS is6SL3n ZWO-LOPMOnt WrOUP ez &I and r3giSt General Realty Corp is named as an additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIESSE CANCELLED BEFORE THE WRATION . 1 DATE THEREOF,THE RSUINOINSURER WILL ENDEAVOR TOYAEL 30 OAYSWRTTTEN Boston Development et al NOTICETOTHECERTIFICATEHOLDERNAMEDToTHEL.FFT,BOTFAILURET000SOSMALL and First General Realty Corp EMPOSENOOBLIGATIONORLIABILETYOFANY KIND' INSURER.RSAC YSOR REPRESENTRIVES. of /UTHORUM REPRESENTATIVE n ACORD 25(2001/08) ® CORD CORPORATION 1988 ll;rs�uchrr,ctt�- pclrar trTrcnt of Public S; ` B++�rr'd r►f l3uildin�� Rc• rtct% Construction Supervisor ;rrul �t;urd:trd� pervisor License License: cs 104350 LISA GOMES 40 HIGHLAND ST PEABODY, MA 01960 !„ i ti'Alir Expiration: 9/1/2013 T 104350 i Proposal 9473 U.S. Property Services Page 1 515 Lowell Street, Suite 3 Date 09.05.2011 Peabody, MA 01960 L General Information Proposed by. U.S.Property Services Telephone: (978)836-1206 515 Lowell Street,Suite 3 Peabody,MA 01960 Submitted To: Mrst General Realty Corporation Work Performed At: 451 Andover Street 93 Union Street,Suite 315 1st floor bathroom renovations Newton Centre,MA 02459 IL Work Description: We hereby propose to furnish the materials and perform the necessary labor for the completion of the work described herein in each of the two bathrooms located on the 1 st floor only: Remove vanity and mirror Demo walls,ceiling and floors Demise shell of space and perform fire blocking where needed Install new walls as noted on the architecturalP lans Install new 2x2 drop ceiling Install curved soffit above the sink Install new 12x12 ceramic tile floor Install 4x4 ceramic wall tiles roughly 4 feet high Install new wall hung sink and mirror Install supplied baby changing stations Install grab bars were needed Install supplied paper towel,toilet paper and soap dispenser Supply new electrical wiring to bring the space up to current code requirements Perform plumbing needed to accommodate the new layout Ill. Exclusions: Dumpster to be supplied by FGR IV. Terms: All material is guaranteed to be as specified and is to be completed in a substantial workmanlike manner for the sum of: Eleven Thousand Dollars($11,000.00) Payments to be made as follows: 1/3 deposit, 1/3 progress payment and 1/3 final payment *Any alteration or deviation from the 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 on behalf of Frank Gomes,US Property Services By signing below you acce t alLterms and conditionsof this contract: DATE Authorized Signatory 1 Architects JDLaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA Architects, Engineers &Land Planners Thomas E Galvin,AIA Julianna E.Hoch,RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2320 PROJECT TITLE: North Andover Office Park PROJECT LOCATION: 451 Andover Street IST Floor NAME OF BUILDING: Building 1 SCOPE OF PROJECT: Demolition and construction of 2 IST floor common bathrooms. In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D.LaGrasse,AIA MA.Reg.# 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans,computations as specifications concerning: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 116.4,1 shall submit periodically,a progress report together with pertinent comments to the 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. Joseph D.LaGrasse,AIA �NO►41ds j; 44, One Elm Square T ?g of Archic ngineer 14201�c�bZract.io/n Blvd. 0Andover,MA 01810 78.4367 Celebration,FL 34747 AA26001333 www.lagrassearchitects.com