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HomeMy WebLinkAboutMiscellaneous - 542 TURNPIKE STREET 4/30/2018E ce Fj" CA,o I oil ee-em"�-. .1. 7 DAI TE T T t -,,E l 32 4 WAX No. NAME 9 J.'�3 '4QLjC--�j TI L"' I CAU DATE: TAYJ go�q LOCATION: �uR OWNERS NAME:OoS:t�ft A qil-- P t 7- Z. GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: c 12 C A I ECTRI GAS RESIDENTIAL (C91AMERC14 TEMPORARY LOCATION OF GENERATOR: mar, at L•iL%vcj *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL-,- �!l Utl---d,,hL( North Andover MIMAP January 6, 2014 A'. ane ki `•` 1 ��. R .k 994 _. :_ ... 125 k � �c et y - 3 12 AV .. .. Y �� . M. •-tel �b1.k: �t;=?'a � j � • � � :: 4 ��5ti �CDl�2, Al - �i3K Andover _ .......•• •-•• � ��. !♦ :: Rail Line -�w Wetlands Zoning Interstates — Interstate 0 Exempt Lands 0 Busine GBusine s 1 Distnct s 2 Distract Hommntal Datum: MA Stateplane Coordinate System, Datum NAD83, — Major Roads — Roads r Easements li:O C Busine O Bus ine ® GeneraBusiness Planne Q Corrido s 3 Distract s 4 Distract NORTN District Ot ao 'aN Commercial Dev ��� r�• O ? yt e O Development Dist Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is C3 MVPC Boundary G Comido 0 Municipal Boundary 0 Corrido Zoning Oveday L Indusia 3 L Development Dist O = ' "'-wighlL to Development Dist M'. .. 9 1 Disldcl ; for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY 8 Adult Entertainment O Indus: n Industra 2 DisMcl • s � ^ # 3 District - °o OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Downtown Overlay Distract O Indusia ,� Jr it S District • • r•a ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ©Historic District ®Water Protection Reside C] Reside 1 Distract �l o�.1tc ���•� '9 2 District SSACMUS� THIS INFORMATION ❑ Parcels d R—ide ce ce 3 DisMct d Hydrographic Features de 1„ = 387 ft ^'�.de ce4 District ce5 Distract --- Streams YYY e d ce 6 DislraG �e a esidential District I n Date . � .... �:..�'�...��..'..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that—....:..... .............................................. r - has permission to perform �- :• �- - `� , !. ; ........... wiring in the building of ..% . 5. .,,.,......6„f-,,,,,,,,,,,,,,,,, �' �� ..'tel— .......................:.............. . North Andover, Mass. W FeeA,.�� ��.. Lic. No:.: ............... Check # ELECTRICAL INSPECTOR�J � U G/. 644' I Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Li c�/ BOARD OF EIRE PREVENTION REGULATIONS Occupancy and Fee Checked�� [Rev. 11/99] (leave blank 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 IN INK OR TYPE ALL INFORMATION) Date: 02/07/06 City or Town of: Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 542 Turnpke Street Owner or Tenant NE Builders Inc. Telephone No. 978-685-3990 Owner's Address 290 Broadwav Suite 137. Methuen. Ma 01844 Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Rental / Retail Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 200 Amps 120/208 Volts Overhead ❑ Undgrd ❑ No. of Meters 1 Number of Feeders and Ampacity 1 set 4/0 200a Location and Nature of Proposed Electrical Work: Misc receptacles, lighting Completion o the ollowin table may be waived hy the Ins ector nf Wires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ n- ❑ rnd. grnd. No. of Emergency Lighting BatteEy Units No. of Receptacle Outlets 8 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 6 No. of Gas Burners o. o tection an Initiating Devices No. of Ranges No. of Air Cond. To No. of Alerting Devices No. of Waste Disposers eat Pumuin Totals: er ' '•�•- ". --r......""'""""'"""'" ons '""""""" "m"""" o. oSelf-Contained Detection/Alertina Devices No. of Dishwashers Space/Area Heating KW Local ❑Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or Equivalent No. o Water Heaters KW o. o o. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicationsiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. INSURANCE COVERAGE: 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 N BOND ❑ OTHER ❑ (Specify:) The Hartford 8/30/06 • Estimated Value of Electrical Work: 5000 (When required by municipal policy.) (Expiration Date) Work to Start: 2/02/06 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Sacca Electric LIC. NO.: 17258A Licensee: Jason Sacca Signature LIC. NO.: 36232E (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.; 603-635-3700 Address: 63 Jeremy Hill Road Pelham, NH 03076 Alt. Tel. No.: 603.231-8763 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/Anent L41 �L\, Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. U Ll orf Occupancy and Fee Checked [Rev. 11/991 leave blank 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 IN INK OR TYPE ALL MFORMATION) Date: 02/07/06 City or Town of Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 542 Turnpke Street Owner or Tenant NE Builders Inc. Telephone No. 978-685-3990 Owner's Address 290 Broadway Suite 137, Methuen. Ma 01844 Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Rental / Retail Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 200 Amps 120/208 Volts Overhead ❑ Undgrd ❑ No. of Meters 1 Number of Feeders and Ampacity 1 set 4/0 200a Location and Nature of Proposed Electrical Work: Misc receptacles, lighting Comnletion nfthv fnllnwina tahlo-mmi ho .,,;,,net A- a- T.,n...,..t,.- ,.Fix/., ... No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans Nf °' ° °n Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ - ❑ end. rnd. o. o mergency Lighting Batte Units No. of Receptacle Outlets 8 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 6 No.. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No: of Alerting Devices No. of Waste Disposers eat p Totals: "um er .ons _ o. oSelf-Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ untcipa ❑ Other Connection -two. of Dryers k o. o Heaters KW ater°' Heating AppliancesKW o °• ° Signs Ballasts Security stems: No of�vices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications irtng: No. of Devices or Equivalent OTHER: Attach additional detail if 'desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: 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 N BOND ❑ OTHER ❑ (Specify:) The Hartford 8/30/06 Estimated Value of Electrical Work: 5000 (When required by municipal policy.) (Expiration Date) Work to Start: 2/02/06 Inspections to be requested in accordance with MEC Rule 10, and upon completion I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: Sacca Electric CLicensee: Jason Sacca Signature Nf applicable, enter "exempt" in the license number line.) Address: 63 Jeremy Hill Road Pelham, NH 03076 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does required by law. By my signature below, I hereby waive this requirement. Owner/Anent LIC. NO.: 17258A LIC. NO.: 36232E Bus. Tel. No.: 603-635-3700 Alt. Tel. No.: 603231-8763 not have the liability insurance coverage normally I am the (check one 0 owner ❑ owner's agent. TTT� AT TTT ffl �O,L,(-rk LAIal s2U S - o O� OK 34-0ff pxz� 4,r-:,Vczs 0 NOR Location--�^-'��- No. &'r" Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /'0/ 18993 Building Inspector b o � a ° Q, U a� ' 4-4 o •° o a a� a 0 rA °a •,�, Y a 5 c Y• 4 �R W o o '00 O o 7 z H 'g n o 00 M o .� .� ts o A a o H v d W Z W 0 0 H z v = a IL � a 0 ~ z LL 0 W a z 0 05 4 Mop, a) O a 0 IL LlO a) N m E cum_ c i5 cu a) o � Z s W Co.00 i O cu C E OI 'O m C ca 0 Q ca a) a o c F i6 0 0 a) O a- 2 O a m -0 O m +. c M -C € o 3 L C) N J Q. E a) 0) c +, comet >% Eu E0 oc.�cu�a�.. o c_w O O y € N vo'uC7 �rENaci�� L C N L. N 0 Ro �u'E�'cnccc� - a) �; a) C Q a O 0 s�0 8Lm c � <woo a) 1 m n ii -n OI 'O m C ca 0 Q ca a) a o c F i6 0 0 a) O a- 2 O a m -0 O m +. c M -C € o 3 L C) N J Q. E a) 0) c +, comet >% Eu E0 oc.�cu�a�.. o c_w O O y € N vo'uC7 �rENaci�� L C N L. N 0 �u'E�'cnccc� E 05 C C �; a) C Q �L � A s�0 8Lm c � L a) o Q.o8.. 0 o 3: c� ... Q CL :. co E +� N c C N O C C C C U o N C t6 L p"yO L O L C y.d y ♦ �%i (n , z Q w C) U CL r N� 0 C O 6 V) U C L ZO C Z ca n ,0) o..o- C/5 v, V) C O) c c N T a) co 0 N 4- a� o p U 1chE°q)a CO- O) Co M CD 0 .� 3 0 0 a� N t L Co O = c... 'aMUtA00 s O z cc3 Je 3 0 0 U O CL C cu C) c cu .c m O C rn ai U C cu 7 O c cu aD 0 a- 0 O U c a� Q 0 (D E z N 4- W F— a uiV W m �1S 0 Z J �8 o N V J CL IL N LU H W J G a W p J_ Ua Z W Q H z U J a IL 'Q LL O Q z U) Q FINE CLOTHIER &TAILORING Z 12S 1/9� 10 Cummings Park Client: Klass Moda Woburn, MA 1`?AGELLAN 781-938-4321 SIGNS Drawn By: TL 542 Turnpike St. N. Andover 1/ Submitted 2114/06 � � L� Z 12S 1/9� Location No. Date 7 TOWN OF NORTH ANDOVER S Certilicate of Occupancy $ yes "••° •'<� s�CHU Building/Frame Permit Fee $ jjU - as Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d ' a Check # r j 18933 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING rLi: ,This Section for Official Use Gall BUILDING PERMIT NUMBER:j DATE ISSUED: / 7ZO6 01, SIGNATURE: Buildin Commissioner/Ins o of f6ldilagT Date 1. lA PPrjoperty Address: 1.2 Assessors Map and Parcel Number: ��l O\ �f / ►' 1'1 I� � r�� J � . p� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R red Provided Provided —Required 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zane Outside Flood Zone 0 Municipal On Site Disposal System 0 2.,l�O�wnerRecord / ) E/, ;f P �%f OAC f (: v ' � / ✓ !ii f /1 �' �� . ,�rJ/t" Name n Address for Service: f / 7e'Y' 0 0 Signature Telephone 2../2 Authorized \�""A'gent � 1 n �% c . IC^ t^1t t/� u�/ Name Print Address for Service: 118 F/'S S4' Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ S r. S Fo., d boa r yl�, a4401, o a Address_ n L- r r) LS I� a. J ^ License Number Licen Constru Supervisor. f rJi ) 0 1 /, (, 6 (J 94 A — Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 0 Vr M 0 M Z `/ Z M 96 0 r r M r' r Z G) Mo F—YV\ 1, C—Sly —,as 0wner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury A rn tSy Print Name z 00/ Signature of Owner/Age rif) Date Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of CO C9 C*7-) Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number v, NO. OF STORIES SIZE BASEMENT OR SLAB S SIZE OF FLOOR TIMBERS i ST 2 ND 3RD SPAN 13ENIENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE L( ZY'"' SECTION 4 - WORKERS COMPENSATION- G L C T52 Workers Compensation Insurance aflidavtt must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yea .......❑ No ....... ❑ SECTION 5 .PROFESSIONAL RESIGN AND CONSTRUCTION SERVICES, FOR BUIL DINGS AND ST3 UC9[TU RES SUWECT TO CONSTRUCTION CONTROL PURSUANT' TO 780 ClR 11! d (COINTAiNING MORE TIIM4635,i300 G E OF El\1Ci:C►Slu D SPACE) 5.1 Registered Architect: Name: Address Signature 5-2 Registered I'rofessfaiioai Etei eeer{s) Telephone Al otr [&,;,rs Company Name: / p /1 Pitn tr L1 �� Ir ,(j � Responsible m Charge of Cons ction Not Applicable ❑ Name: Area of Responsibility Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date { 1 s Name — Area of Responsibility Address Registration Number i Signature Telephone Expiration Date 5 :Geaetxi;� t+t7txtetpx , Al otr [&,;,rs Company Name: / p /1 Pitn tr L1 �� Ir ,(j � Responsible m Charge of Cons ction Not Applicable ❑ _ L- B4'!lixf'l:6 Ul S(ld[ °Ii�Jlci a PROPOS)�D:WORK (c}± all applica New Construction ❑ Existing Building Repair(s) 0 Accessory Bldg. ❑ Lemolition Other ❑ Specify Brief Description of Proposed Work: Y Alterations(s) ❑ I Addition ❑ USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 ❑ A-2 ❑ A-3 ❑ lA A4 0 A-5 ❑ IB 0 B Business EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels 2A 2B 2C 0 ❑ I ❑ i C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 j ❑ i IInstitutional ❑ 1-1 ❑ I-2 0 1-3 ❑ M Mercantile ❑ 4 ❑ i R residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 0 U Utility M Mixed Use S Special Use ❑ ❑ 0 Specify: Specify: Specify: ' COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 730 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: R ?�� i.AV,t!I;iRlffli�i;:i)IIX: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor st — Total Area s Independent Structural Enginecring Structural Peer Review Required Yes ❑ No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -7--f + C 1"4",e `1 ,as Owner of the subject J property Hereby authorize /<.-n L' to act on My behalf, inet s relative two work autho6drrf this building permit application Signature of Owner ate I 2�: Location �y� , •- - - No. s -a d Date TOWN OF NORTH ANDOVER 9 _ Certificate of Occupancy $ .- '�s::�„5 t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # A/)4 i 190'16 Building Inspector .YC MpRTM , CERTIFICATE OF USE & OCCUPAI CY TOWN OF NORTH ANDOVER BuildinL rmit Number 500 (1/17/06 Date: March 8, 2n, THIS CERTIFIES THAT THE P IL DING LOCATED ON 542 Turnpike Street (Klass M da ::oncep s MAY I ; OCCUPIED AS Retail Business IN ACCORPA� °`-E WITH THE PR )VISIONS OF THE MASSACHUSETTS STATE BUILDING CO-)EA ND S1 CH OTHER 'ECULATIONS AS MAY APPLY. Certificate Issued to: 6ossRoad 550 Turn- St^,ct Nortli`Andi ^r NA 01845 _ Bui!.: Inspector r O z W. 771 I CD 0 LA) OC kcLl C ev 'AN C3 AN cm CD CM LUmo 0 Cf) 7. 0 U U)CO N .2% m CLE -.S LU 'i CB, Lo 04 C.3 CL COO tn .2,— C) cc ca a4 'j co �8 771 I CD 0 LA) OC kcLl C ev 'AN C3 AN cm CD CM LUmo 0 Cf) 7. 0 U U)CO N Q, �Er r. O W • co 9= ca C2 A CD CD =C3 CL) CD rL CL Cc CO) cl CL W cc CIO 6 z 0 t En U) 9 .2% m CLE -.S LU 'i CB, Lo 04 C.3 CL COO tn .2,— C) cc ca Q, �Er r. O W • co 9= ca C2 A CD CD =C3 CL) CD rL CL Cc CO) cl CL W cc CIO 6 z 0 t En U) 9 0 tM March 3rd, 2006 North Andover Building Department Jerry Brown - Bldg. Inspector 400 Osgood Street North Andover, MA 01845 Re: - Renovations for: Tenant - Klass Moda Crossroads Plaza North Andover, MA Dear Inspector Jerry Brown, On March 1 st, 20061 made my final inspection and walk thru for the above i listed project. The work completed to date looks good and conforms with the construction documents. I would recommend that a certificate of occupancy be issued for the building. If you have any questions and or concerns please don't hesitate to contact me at your earliest convenience. Respectfully Yours, Lan Arch'tects Patrick O. Finn R.A. Project Architect Landry Architects (603) 890 6414 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, VIA 02111 w www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name 113usincss/l lrganirauonJlntllvtdual): /V S((q vt Address: cW O P:� r,,q ct d , i �f _ ) _� City/State/Zip: M fAye4n MA .x01134¢ Phone #: q� 9 0 /, y/ q B 4 Are yob an employer? Check the appropriate box: 1. LIZ I am a employer with 4. ❑ 1 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 ;. ❑ 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.] oc_r Type of project (required): 6. ❑ New construction 7. 2r Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I I.[] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box it t must also till out the section below showing their workers' compensation policy inrormation. + Homeowners who submit this atlidavit 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: ,a o— ptlS,_Co C Iq Ll --- -- Policy 4 or Self -ins. Lic. 4: - Expiration Date: Job Site Address: S . City/State/Zip:__— Attach a copy of the workers' compensa ion 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 line 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 tine 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 theAns and penalties of perjury that the information provident above is trite and correct. Si (%ficial use only. Do not write in this arca, to he completed hV city or town ul/ficial. 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 ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: I 4 � ) 4� S �, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section 1 OA. The debris will be disposed of in: C e S � av-- 6U" (Location U" Fire Department Sign off: Dumpster Permit (Location of Facility) Signatur f Permit Applicant Date jan 13 UU UO: 14P P. i uwLHIVL ±SU1LUERS PAGE 02 NEW ENGLAND BUILDERS AND CONTRACTORS, INC. 294 BROADWAY SUITE 137 WnfUEN. MA 01844 TEL. 0978) 685-3990 FAA (978) 682.0590 January 3, 2006 Mr. John Pallone worth Andover Crossroads LP 861 Turnpike Street North Andover, MA 01845 RE: Healthsouth space renovations at Crossroads plaza Turnpike street North Andover. Dear Mr. Pallone: As agreed upon, our firm will perforce removal of the existing accoustiCal ceiling, existing carpet and interior non load beaming walls in accordance with the attached plans. Our firm will also erect on fire rated wall as a seperation between two potential tenants. We will also provide a second means of egress as shown on the print, as well as rough pluetbing for two handicapped bathrooms up to the slab. We will also seperate the electrical to allow each tenant their own meter. The total cost for the above work is Fifty Thousand Dollars ($50,000.00). Pease acknowledge your approval of this proposal by signing Sincerely; / 1 " Henry Sarkis 54Z- f ACORN CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDI-YYY 10/06/2005y PRODUCER (603)224-2562 FAX (603)224-8012 The Rowley Agency, Inc. 139 Loudon Road P.O. Box 511 Concord, NH 03302-0511 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED New England Builders & Contractors, Inc. 290 Broadway, Suite 137 Methuen, MA 01844 INSURER A: Acadia Ins. Co. 00371 INSURERB: Acadia Insurance Company 31325 INSURERc: Liberty Mutual Insurance Co. 00701 INSURER D: INSURER E: 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 LTR DD' :NSRDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION IMMIDD[YYI LIMITS AUTHORIZED REPRESENTATIVE D "O� Danielle Magoon/DIM GENERAL LIABILITY CPA002835519 10/13/2005 10/13/2006 EACH OCCURRENCE $ 1,000,000 MMERCIALGENERAL LIABILITY DAMAGE TO RENTED $ 2renrp) 5O,000 CLAIMS MADE FV OCCUR MED EXP (Any one person) $5,OOO PERSONAL S ADV INJURY $ 1,000,000 A NGEI'CL GENERAL AGGREGATE $ 2,000,000 GREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY M PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO CAA003249419 10/13/2005 10/13/2006 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS. BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA008438313 10/13/2005 10/13/2006 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X OCCUR F-1 CLAIMS MADE $ B $ RXDEDUCTIBLE $ RETENTION $ 0 WORKERS COMPENSATION AND WC231S308361025 11/01/2005 11/01/2006 X we STATU- o R E.L. EACH ACCIDENT $ 500, 000 C EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS e: Phase I - Lobby & Exterior Renovations to Norton Manor, Lowell, MA. CERTIFICATE Hf)I nFR CANCFLLATION ACORD 26 (2001/08) ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY y OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE D "O� Danielle Magoon/DIM ACORD 26 (2001/08) ©ACORD CORPORATION 1988 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. j� APPLICANT FILLS OUT THIS SECTION G / APPLICANT /' d c Gl �M PHONE I j� v 8 4 LOCATION: Assessor's Map Number of PARCEL_ SUBDIVISION LOT (S) STREET5 Turn 10 I S d ST. NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANN DATE APPROVED / DATE REJECTED // COMMENTS _ h v f /Y Jc��ir�=�sf ,1''g•+; �+,eitn,?� �- -� lNtPECT(07R-HE TH DATE APPROVED % f'7 ® . ;:FOOD DATE REJECTED S TIC INSPECTOR-HEALA DATE APPROVED DATE REJECTED COMMENTS 4''�— fir. • , `� Z� �t f-cx� �. PUBLIC WORKS - SEWERIWATER CONNECTIONS C FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '• .` :F CONSTRUCTION CONTROL PROJECT NUMBER: b PROJECTTITLE: PROJECT LOCATION: l� ED PTA &J290 OL . A11A NAME OF BUILDING: NATURE OF PROJECT: A 1(It OLM /S/N G WA -t IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING.CODE, I, f2if-) f , LA/VOtRY REGISTRATION NO. 441r& BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 FIRE PROTECTION 0 ARCHITECTURAL 13 STRUCTURAL 0 MECHANICAL 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED US��F.AND CCUPANCY. op- �Q Pj>�1;-SS .y 41LA44_gi tt-V i2t }�f1-�cSfy?3z'ATiJ� � NY oFr--1Gv I FURTHER CERTIFY THAT I HALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to•the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,. generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. op- '4 tauR�V kWz-se 7vE OF Hy or-F14G PURSUANT TO SECTION 116.2 .2 1/�SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO .THE NORTH ANDOVER BUIL INSPECTOR. CP- PkFC5�Qv �� 3 �7 Hy v'FFicE UPON COMPLETION OF THE WORK, IASHALL SUBMIT A FINAL REPORT S TO H SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FO OC P SUBSCRIBED AND W N TO BEFORE ME THIS_=DAY OF V Z d Ot3� NOTARY PU LIC MY COMMISSION EXPIRES Z % 0 0 �(D �pnC�v�v o 0 0 ~ ^� a <• ,./ N C:.. �d -G, a > a C G3 4 = CD �iie 1°oarvmoozurea��i o� /e�a4az��ivae%ta �CD "" BOARD OF BUILDING REGULATIONS ` License: CONSTRUCTION SUPERVISOR Number: CS 060600 0 Birthdate: 12/01/1966 Expires 12/01/2006 Tr. no: 7036.0 # p� RJ Restricted; 00 0. 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