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HomeMy WebLinkAboutMiscellaneous - 102 PETERS STREET 4/30/2018 (3)� � UA � I I � No 96 1 Date��''. Q� LAG AiA A TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. ... .. .. ........... has permission to perform ./� plumbing in the buildings of . /' .-s�'7 .per... Y' � ...... at ........... North Andov r, Mass. Fee � 4.WLic. No,?5.39. ... ... . PLUMBING INSPECTOR Check # 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �s POWNER TYPE OR PRINT CLEARLY i CITY North Andover MA DATE 10/4112 PERMIT # JOBSITE ADDRESS 102 Peters Street OWNER'S NAME Peters Street Associates ADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY 4 ROOF DRAIN SHOWER STALL SERVICE / MOP SINK 2 TOILET 4 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli n with all Pnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Kerry Martin LICENSE # 9320 SIGNATURE MP " JP CORPORATION � # 2135 PARTNERSHIP # LLC # COMPANY NAME K.Martin Pig & Htg Inc ADDRESS 124 Abbott St CITY Lawrence STATE Ma ZIP 01843 TEL 978-685-2521 FAX CELL 508-509-9898 EMAIL a r } c a b c 0 c� x ro r to z c� z ro n \' A O z z \ Cr1 cikl m = M Cl) En � r 0 o O ro z m z Pa m N M O ti Oil z M p m M CA � � O El ego tz" o ITIz k z w b e � y 0 z rA 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/Organization/Individual): Address: / � !� A8 60 -IT ST City/State/Zip: G A Qk) /� A � !r� Y3 Phone #: T e2j "a Are on an employer? Check the appropriate box: 1. I am a employer with i 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. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.ErPlumbing 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. � Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. ram an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. :assurance Company Name: ?olicy # or Self -ins. Lic. #: fob Site Address: Expiration Date: City/State/Zip: ILttach 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 ine 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 )f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the in and penalties of perjury that the information provided above is trate and correct. ;i nature: p(� 0 Date: 'hone#: 7U' G 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 [devised 5-26-05 www.mass.gov/dia C*MONWEALTH OF MASSACHUSETTS � PLUMBER AND'GASFITTER S LICENSED AS AMASTER PLUMBER J, ISSUES THE ABOVE LICENSE KERRY 0' MARTIhJ r: 61 C`URRIER ST "3 a` METHU'EN, MA Q1844 9:320 05/01/14 172555 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASF'ITTERlS REGISTCI�CJ.-AS A PLUf0BIN6COkP ; ISSUES THE'ABOVE'LICENSE TO KERRYU� MARTIN KERRY frltfA' RT.IN PLJ3 ,° NTG= IJJr trt9, , 124 A00TT STREET LAWRENCE MA 01843 1bSOG ' 7135 05./01/14 172531 4 .1?LUMBER: 'AND C�AsFIT1 , LICENSED AS A MAaTEh? VA5F,1 �TFR t P, ;ISSUES,THE'ABOVE LICENSE NO` y 3�!hERRY 'Ll`s:.RTIN$s tis� 'l;: i, C U I" .4't 3> f Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 344,250.00 m $ - $ 4,131.00 Plumbing Fee $ 516.38 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 516.38 Total fees collected $ 5,263.75 102 Peters Street 106-13 on 8/7/12 new building 0022/2013 13:15 FAX 1 978 688 5350 MacDonald & Pangione Q001/001 OP ID: SHHE coo CERTIFICATE OF LIABILITY INSURANCE701/22113 TE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER 978-688-6921 Macdonald & P.O. Box 428 Pangione Insurance 978-688-5350 NAME CT NE 1FAX (AJCNNo. Exit: (AIC. AIC No): EMAIL ADDRESS! 104 Main Street North Andover, MA 01845 Michael Pangione PRODUCER MART/ -5 CUSTOMER ID 0: INSURER(SI AFFORDING COVERAGE MAIC 0 EACH OCCURRENCE INSURED Martin Plumbing & Heating, Inc INSURER A; Preferred Mutual Ins Co 15024 6 Meridian St INSURERS: Hartford Fire Insurance Co 00914 Salem, NH 03079 INSURER C INSURER D : $ 2,000,000 'L AGGREGATE LIMIT APPLIES PER: X POLICYF7 PECjRO LOC INSURER E : $ 2,000,00 INSURER F: A AUTOMOBILE _ X X X 11 CnVFRAr,FS CF_RTIFICATF NUMRFR- RFVISIn1U NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 114SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O --HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C AIMS. INSR LTR TYPE OF INSURANCE ADD WILL BE DELIVERED IN POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR AUTHORIZED REPRESENTATIVE CPP 0160 58 55 11 02/05112 0 13 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 �GEO GENERAL AGGREGATE $ 2,000,000 'L AGGREGATE LIMIT APPLIES PER: X POLICYF7 PECjRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ ' A AUTOMOBILE _ X X X 11 LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PCA 0100 70 66 98 02/05/12 02105/13 INED) accident) LIMIT CO Bl (Eaa $ 1,000,000 BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ S $ A X UMBRELLA LIAB EXCESS LIAB . X OCCUR CLAIMS -MADE UC 0150 59 0183 02/05/12 02105113 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 RETENTION S 10,000 $ X1DEDUCTIBLE $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED9 (MandatoryIn NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 08 WEC TK0572 06/25/12 06/25/13 XDTH• WO�A�TU• I I E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE S 500,000 E.L. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Romarks Schodulo, If moro space Is roquired) wmmra SIMIMIVE�:1s1 ENIMr J.\\rJ vel« Maus-iDUa AGOKU CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE, POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Michael Pangione Maus-iDUa AGOKU CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD r OCT -4-2012 09:29A FROM: TO:19786889542 P.2 AQ®RD . CERTIFICATE OF LIABILITY INSURANCE /ODI DATE042001212 to PRODUCER (978) T.F. Redmond 262 Broadway Methuen 683-6591 Insurance Agency, Inc.NLY 4 cy r , MA 01844- POLICY NUMBER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED KERRY D MARTIN DBA KERRY MARTIN PLUMBING 6 HEATING, INC 124 ABBOTT ST LAWRENCE MA 01843— A INSURER A: PROVIDENCE MUTUAL INSURER B: ASSOCIATED INDUSTRIES INSURER C' INSURER 0: INSURER E: f%AWCOA I2 cQ 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 LT AOD'L INSRp TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION GATE MMIDD/YY LIMITS A GENERAL LIABILITY CPPOS9709 07/16/2012 07/16/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea RENTED $ 50,000 X COMMERCIAL GENERAL LIABILITY MED EXP jAny one arson $ 5,000 CLAIMS MADE F1 OCCUR / / / PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AG G $ 1,000,000 POLICY F JEC LOC AUTOMOBILE LIABILITY ANY AUTO / / / / COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Por accident) $ HIRED AUTOS NON•OWN£D AUTOS / / / / PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO / / / / AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR El CLAIMS MADE $ $ DEDUCTIBLE / / / / $ RETENTION $ WORKERS COMPENSATION AND WWC6005212012003 02/15/2012 02/1 2013 }( DRYLIIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE$ 100,000 OFFICER/MEMBER EXCLUDED? / / / / If yes, describe under SPECIAL PROVISIONS below E.L.DISEASE -POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PLUMING AND HEATING CERTIFICATE HOLDER CANCELLATION ( ) — (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT TOWN OF NORTH ANDOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE BLDG 20 SUITE 2-36 INSURER ITS AGENTS OR REPRESENTATIVES. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE N ANDOVER MA 01845- ACORD 25 (2001/08) aACORD CORPORATION 1981 * INS025 (0108).05 ELECTRONIC LASER FORMS, INC. .(800)327-0545 Pose t or: r in VE�tysV y.. ;1. 6 L a BUILDING DEPARTMENT (ommunity Development Division R Kerry Martin Heating and Plumbing 61 Currier Street Methuen, MA 01844 March 7, 2013 Dear Mr. Martin, We received a gas permit in the mail on March 7, 2013 for 102 Peters Street to install a two roof top units. We are unable to process the permit for a number of reasons. 1) No size of rooftop units noted and the size dictates the fee. 2) No Workman's Comp Affadavit included. I included one with this letter.' 3) No copy of Plumber/Gas Fitter License. r/ 4) Insurance on file the Workman's Comp coverage expired on 2/15/2013.0 In order for us to process the permit we need the aforementioned information. Please call our office with any question at 978-688-9545. Sincerely, env✓ tl ?y aura Deems Building Department Assistant Town of North Andover, MA 01845 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9545 Fax 918.688.9542 Web www.townofnorthandover.com Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... � - R. -1 H C-,. re -4 has permission for gas installation'. ............... - -e in the buildings of ... P - ........ at .... J 0-2-- -eq-4' ............. North Andover, Mass. MD�. lq)t�q 4-4. . ... Lic. No.. t.j�, Fee..IbD .................. ... GASINSPECTOR Check # 8624 MASSACHUS.ERTTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . CITY North Andover MA DATE 2/28/13 PERMIT # JOBSITE ADDRESS 102 Peters Street OWNER'S NAME Peters St. Associates GOWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL v EDUCATIONAL RESIDENTIAL CLEARLY NEW: + RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES'l FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ?BOILER BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT 2 TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am. -aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. C HECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli rice with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� I PLUMBER-GASFITTER NAME Kerry Martin LICENSE # 9320 / SIGNATURE MP -, MGF JP JGF LPGI CORPORATION v # 2135 PARTNERSHIP # LLC # COMPANY NAME: K. Martin Plg & Htg, Inc. ADDRESS 124 Abbott'St CITY Lawrence STATE Ma ZIP 01843 TEL 978-685-2521 FAX CELL 508-509-9898 EMAIL PRM Engineering, LLC April 6, 2013 • Foundation Design • Structural Engineering • Fabric Structures • Building Investigations • Value Engineering • Applied Science and Technolog Structural Consulting Engi PRM Eng Job #: Town of North Andover Building Department, www.townofnorthandover.com Mr. Gerald Brown — Inspector of Buildings; Mr. Brian Leathe — Local Building Inspector 1600 Oswood Street, North Andover, MA 01845 Tel: (978) 688-9545; Fax: (978) 688-9542 Mr. Joseph Leone, Owner's Representative Joseph. leonencomcast.net Re: STRUCTURAL LETTER/STATEMENT for Certificate of Occupancy New One -Story Commercial Building. 102" Pttern Sweet;NorthAia over;#MA 0IS4:5Z_�: -, I, Pedro R. Munoz, Ph.D., P.E., MASCE, hereby notify you that I am a Professional Engineer licensed in the State of Massachusetts (PE Structural License #: 42854). To the best of my knowledge, information, and belief, I notify you that the work of installation of the new structural framing of walls and roof, foundations and footings for the new One -Story building above referenced has been built in conformance with the structural foundation and framing plans, sections, details, specifications, and recommendations prepared by PRM Engineering for this project, and in my professional opinion the work performed is in compliance with the framing and foundation plans and the current applicable MA Building Code, State laws, and Town Ordinances. I therefore herein respectfully request that the Town of North Andover Building Department as it finds it appropriate issue an Approval and Certificate of Occupancy to the completed building. Should you have any question of this project, Please do not hesitate to contact me. Respectfully submitted, signed and sealed: MA PE License #:42854 Pedro R. Munoz, Ph.D., P.E., MASCE PRM ENGINEERING, LLC Newburyport, MA 01950 Date Signed: 04/6/2013 PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 • Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmene(atatt.net 0 Website: www.prmeni!.net Construction Phase Services - 102 Peters Street, North Andover MA 01845 fh� PRM Engineering, LLC • Foundation Design • Structural Engineering • Fabric Structures • Building Investigations • Value Engineering • Applied Science and Technology Structural Consulting Engineers FIELD REPORT No. J12-55-01 PROJECT: One Story Commercial Building at 102 Peters Street, North Andover, MA 01845 Date of Site Visit: Thursday, April 4, 2013 • Date of Report: April 6, 2013 OBSERVATIONS AND RECOMMENDATIONS: 1. The structural framing system for the prefabricated wood roof trusses, conventional wood framing of front dormer, and load bearing exterior and interior wood stud walls system has been installed in conformance with the structural framing plans and in coordination with the architectural floor plans. 2. The reinforced concrete footings, perimeter foundation walls, the concrete slab on grade inside the footprint of the building, and the concrete slab at the front and back of the building have been installed in conformance with the structural framing plans. 3. The exterior brick curtain wall system has been installed, all windows and doors have already being installed as well. The exterior of the building is relatively flat and is being prepared to be completed together with the front parking lot of the building. 4. The roof top units at the back flat section of the roof of the building have been installed and the vertical posts to support the railing and screen around the unit are in place and have been flashed out. 5. The plywood all over the underside of the wood roof trusses has been installed and is fastened to the bottom chord of the wood trusses. The diagonal bracing of the exterior walls is installed and all the interior LVL beams, posts, and non-bearing partition walls for closets, bathrooms, and interior space have been installed and ready to receive the insulation and interior sheet -rock. 6. All the steel lintels above the windows and granite sashes at the bottom of the windows are installed 7. The two front columns at the entrance of the building are still to be installed as well as the railing and screen system around the flat portion of the roof towards the back of the building. 8. A set of photos is attached to the end of this report to document this site visit and record the progress of construction and installation of new foundations. 9. In general it appears that the overall structural framing and structural work for this project have been completed satisfactorily and has been found in accordance with the structural framing plans and the architectural plans. A final letter reporting the satisfactory completion of the structural framing of this project will be released accordingly. 1 PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 • Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmena(q_)att.net 0 Website zwww.prmeng.net Construction Phase Services -102 Peters Street, North Andover, MA 01845 4 PHOTOS PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 • Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmeng(a,att.net 0 Website: www.prmeng.net Construction Phase Services - 102 Peters Street, North Andover MA 01845 PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyjort, MA 01950 0 Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmengAatt.net.t,'W;ebsite: www.prmenLF.net Construction Phase Services - 102 Peters Street, North Andover, MA 01845 - 4 PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 • Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmeng(a,attnet 0 Website: www.prmeng.net Construction Phase Services -102 Peters Street North Andover MA 01845 5 PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 0 Tel: (978) 465-7105 Fax: (978) 465-7002 • E-mail: prmengAatt.net • Website: www.prmeng.net .5" ..::. Construction Phase Services -102 Peters Street, North Andover, MA 01845 © Copyright by PRM Engineering LLC Newburyport 2012 All Rights Reserved ;:..`-The original and copies of this Report or any parts thereof are the property of PRM Engineering, LLC. Reproduction in any form of this Report or any parts thereof is strictly prohibited except by written permission of PRM Engineering, LLC. PRM Engineering, LLC • 6 Woodman Way, Suite #116, Newburyport, MA 01950 • Tel: (978) 465-7105 Fax: (978) 465-7002 0 E-mail: prmengna,att.net 0 Website: www.prmeng.net 1 1 0 Date. � Z�k...... TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that.. �.`=?S`?.1...a-?r�! S.J........ . has permission for mechanical installation in the buildings of .........::. . at ... �b �: .>` ��'!"...... , North Andover, Mads. Fee�.p j�).... Lic. No. 5 �.` �:`?... ........ 6.1 ........... GAS INSPECTOIA WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TOWN OF NORTH ANDOVER 1600 OSGOOD STREET Building 20 Suite 2-36 NORTH ANDOVER MA 01845 FURNACES, BOILERS, ROOF TOP UNITS, AIR CONDITIONERS, EMERGENCY GENEREATORS Date: 12/04/2012 "0 7/ The undersigned applies for a permit to install the following at: Location 301,Peters Street, North Andover, Ma 01844 Owner of premises Dundee Park Prop., LLC Address 102 Peters St.,No. Andover, Ma Name of mechanicRussell BOISvert Address 27 Bumpy Ln. Methuen Ma 01844 Building occupied forCommerclal Material of building Wood Kind of fuel Gas Chimney n/a No. Of flues 0 Size_ Chimney Thickness n/a Lining n/a If steel stack location n/a Diameter n/a DESCRIPTION OF HEATING APPARATUS Kind of heater Rooftop Unithow many 2 Height n/a make Rheem BTU Input 100,000btu Location in building ROOF Protected against fire as required n/a How protected See the State Code (Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS OR EMERGENCY GENERATORS Make Rheern Weight480LBS. Dimension Length4' Width4' Height 3' Location of building ROOF how supported building structure/ Curb Size of roof timbers 2'x6' Material of roof timbers Wood Span of roof timbers12' Distance on center24" Protected against fire as required How protected AIR CONDITIONS Kind of apparatus Rooftop make Rheem HVAC FORM REVISED 11.04 *0 k k 1-3 Fvenflow Heating & Air Conditioning, T T 1-1 27 Bumpy Lane Methuen, MA 01844 Name / Address 102 Peters St Description We propose to famish the materials and perform the labor necessary for the completion of (2) 5 -ton roof top units at 102 Peters St North Andover. -Also furnish 4 exhaust fans and vent to outside. -Purchase and install ECH-1 T -stats, duct smokes, economizers, curbs, crane and labor included. Electric, gas pipe, and roof work not included. Trane model#YHC060XXXX................../.. 7-,374..00 Upgrade to Rheem Hybrid Heat pump ........ $ 17,510.00 Model # RQPW-BO48JKIx-Yx Qty Estimate Date Estimate # 10/17/2012 2079 Rate 12,300.00 Project I Total 12,300.00 Consultants 4 f C� f REV. DATES: oNa0000 a"��aaN�a +oo m zea (0 n 3: m_D V o0m Z � N cn a y o O m -Un a x > D Z =zm m m Cn Ex, in n Project Title 00 N m C � Z .0 m00 (A m0 � � y MD m v z o T- D O n -D m o0 m W c Fn— _r 3 `_ D v, o r c r Drawing No. T fig, m 9 _ mE OJ ga X830 Sz 3n m2� 30 fTl g_ m - non -c = - m 3» gzo 0- 3n gl _° R3 _a _ 5--� m wE Z iq o ,°z�a'o o°o �3 -o >` .° eom ,om in �� Qzg� u - o3 naF -_ = n£° foe 4 g s K g Niim o"a� m a.3 �o R rn 41114, _ fn '-.3 l 5 3n = z f 3� -nm o0o m TI goaS8 s s j- o R nS-_ _ - E? aye _ - - i� ? _ - =1 (n° � ff ag 'Om a3 3 3 f o 3 �u n 3° 30 3 0 3 A _ n 3 S A U A D] Soo ,g Fo m <o no CD Zm �� nazi -10 rp �C H - CC Z nO OZ mo no �N cc or z MA moI- y nAK D 2 OA 91 A N D ZO ' n z c iH $fig o Syn ti �y - 2 F0 o im C m a � O 4 � _ � a n"+ o om O m n Z Nym mm n m A a A > M n m ,z J 07N Q� Z m m O -41 1 z _ n 1 O _ vj mo an� zoco� o �ti � maZo�� mm � py oz �t �n n �o r - zany m y n n; andel � andel z� D g >n> i� C N O A� � n fTl i p y a 1pl n m � C i�� x m a =N- xg r - zany m y >n> i� C O A� p y a 1pl z _ fTl O C N cRl �^ Z N i N r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ,www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name {Business/Organization/Individual): L� V�/®� v G Address: a ' c) //% �Y City/State/Zip: �%� Q'l �%�c� Q.v , /�i Phone #: � 7? <6- vZ - 3 LDQ Are you an employer? Check the appropriate box: 1. (d 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. ❑ 1 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. El 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. f 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: f Q (` ' l� /11 tOLA I Policy # or Self -ins. Lic. #: lU C� S 3 (9q 60 q0 1 0 1 L) Expiration Date: Job Site Address: 106 r-e/'� s T 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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided'} above is true and correct. Signature•(�6� Date: 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia