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Miscellaneous - 575 TURNPIKE STREET 4/30/2018 (4)
3981 Date...... ............... 0.';F``� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .<t ., r : s-'...... e,Z" 0. has permission to perform.'`.._.. �.,...::.:• * :-�_:..1 . --�'-' wiring in the building o .._./........ ...... ........................... at .... �� i �......... . ................ . North Andover, Mass. Feel Lic. No� ................... ............. `�L-ECTRICAL INSPECTOR Check # f�n�1 ly Of VUse On Permit No. 3 s*/ Occupancy & Fee Checked ✓W BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) DateC�Z-- To the Inspector of Wires: Toms of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number 7� -� "� P t C.� S 7 Owner or Tenant J &0 &,-( A �y - Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of BuildingG r ;O ti'�c� S Utility Authorization No. E)dsting Service Amps Voits Overhead ❑ Undgmd ❑ No. Of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work L-✓O�` — � s r —(s K C -L.) c INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including pleted Operations Coverage or its substantial equivalent NO = h . valid proof of same to the Office l NO = 11 you have checked YES please indicate the type of coverage by checking the appropriate box NSU = BOND = OTHER = (Please Specify) c7 (Expiration. Date) Estimated Value rical Work$ "7 tsr70 - Work to Start �Z-- inspection Date ResgN� a 2_— Rough Final Signed under a ena ies of per] FIRM NAMES l LIC. NO. S — Lkensee + - `L%ti� A i0__ iii t�P L� dl o - Signatu / LIC. NO. Z i 7l0 C U Bus. Tel No. 6U 3 L' 2c7 -?!I Address O 1.���`-e-'p P-4, SIZj,,, —!J Alt Tel. No. OWNER'S INSURAN E WAIVER: I am aware that the Licenses does nothavethe insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this regtrement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ k � (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets Z— No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total Mo. of Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other —1.k NA of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases tw,ri No. Hvdro Massage Tuds No. of Motors Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including pleted Operations Coverage or its substantial equivalent NO = h . valid proof of same to the Office l NO = 11 you have checked YES please indicate the type of coverage by checking the appropriate box NSU = BOND = OTHER = (Please Specify) c7 (Expiration. Date) Estimated Value rical Work$ "7 tsr70 - Work to Start �Z-- inspection Date ResgN� a 2_— Rough Final Signed under a ena ies of per] FIRM NAMES l LIC. NO. S — Lkensee + - `L%ti� A i0__ iii t�P L� dl o - Signatu / LIC. NO. Z i 7l0 C U Bus. Tel No. 6U 3 L' 2c7 -?!I Address O 1.���`-e-'p P-4, SIZj,,, —!J Alt Tel. No. OWNER'S INSURAN E WAIVER: I am aware that the Licenses does nothavethe insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this regtrement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ k � (Signature of Owner or Agent) Location No. Date Z- R NORTH TOWN OF NORTH ANDOVER � f � ' Certificate of Occupancy $ s�cNusEt� Building/Frame Permit Fee $° Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l 15 6 5 2 Building Inspece 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 .�CCtion for ofIClal Use 0 ., i'.;-, BUILDING PERNIIT NUMBER: / DATE ISSUED: ' a `a d ZZ l0 O � / �./�'I c e SIGNATURE: Building Commissioner/I or of Buildings Date �.: 1.1 Property Address: 1.2 Assessors Map and Parcel Number. 5W (09 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin Distrid Proposed Use Lot Area Frouta R 1.6 BUR DING SETBACKS (ft) Front Yard. Side Yard Rear Yard R red Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record Pr, M4,cw i 12/V-Plr9 5���' siu7o?2> Name (Print) Address for Service Signature Telephone 2.2 Authorized Agent Y.��- Name Print„// Address for Service: s ��,d, ” Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ AW k ge9 g 0Ll3 BGS Address License Number Licensed Construction Supervisor: J /�j /�Q� (,� 7/ � G 8 ~69& [� k Eviration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ C)0M7IWT'! 0V C/o wor ?532 Company Name Registration Number Address Expiration Date , Signature Telephone v n M Workers Compensation Insurance affidavit 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. I Signed affidavit Attached Yea ....... IV. No ....... n IV, AM01411�� S "PRO 77=7 5.1 Registered Architect:, Name: Rte` ArM czww ACT Company Name:Y-') 'd w4a,/t I ewc Responsible in Charge of Construction Not Applicable 0 •YAddress Signature Telephone Area of Responsibility Registration Number Expiration Date Name: 'Address: lei r Signature Total Not applicable 0 Registration Number, Expiration Date Name: Address Signature Telephone Area of-kesp6risibility Registration Number Expiration Date Name Address Signature Telephone Area of. Responsibility Registration Number Expiration Date Name Address Signature Telephone '4 Rte` ArM czww ACT Company Name:Y-') 'd w4a,/t I ewc Responsible in Charge of Construction Not Applicable 0 New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) ; .,. Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ©TONA ' h?,y 4 ID / Am ;00of , Sao 0-11, ❑ IA 1B ❑ ❑ B Business ❑ BUILDING,AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) n In ndent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize - - • - - - to act on My behalf, in all matters relative two work authorized by this building permit application' ' Signature of Owner Date USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 1B ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 ❑ I-2 ❑ 1-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 0 5A 5B ❑ ❑ S Storage 0 S-1 ❑ S-2 ❑ 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 780 CMR. 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: BUILDING,AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) n In ndent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize - - • - - - to act on My behalf, in all matters relative two work authorized by this building permit application' ' Signature of Owner Date ��r>K4 `�'[Pf S+ QR'saiL4Y:Ae. .ay.Z.. £d'R+`5 - '? - cq(.. -. �'_°��;'J'._ +��� +� _.�' �.p`��"s :air_ fa..gm ���.�.b0 I> Mt 94T as Owner/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 penury Jai . t Print Name ::... ; Bei s.; t i .:. ..ti t _ . • t < . _ .. .. // Signature of Owner/AgentDate 1`73 ..19-- Item Estimated Cost (Dollars) to be Completed by applicant permit 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) ! E )sr bb Check Number 1.fY.�?�a8,3 q 5 ;.r ct e_''✓+.+� �p^sfd ,! .ir'�7v!'"'yna] �" -eta /£aa3 t,i .:'%'tea} �,. ham;''tCvr a r,#;'� ni,�s.. {F �2t4�i.';rt •...u.t §` t ;§ $, saT,..�.`g,� k�....h'.f i t Ls.tx y. rel. y� ,a',,T":..1 bt_ 4th .. jyy 5. r.t.f t, > r� ��. 3,:. s�.. n.. rm,..� 3�.„�s" e`' S,x�j� a ,,d! 3f fit. s�t�t r. m_*Xt. o' -}; t�1" -S'" tr'§ R #t?s`p(•, �5' y ,� 4..''.. rtiz' Y: �'� #"v.,5r r's�- 1 ! dt r£zlt F r. xti .... W !'ka?•� 4�'!f;f C 3#:.,j. 3�c 4 x t st n k.. x �>Y. SIS ids Py^,'y%j"}fF 14M;,,. bv,t �' ,d-9t3�, .v it y'�;e' F" # :k l�,xa'St rt3-;s+"� NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr2 ND 3RD SPAN DEMENSIONS 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 .: � � 4 �� t 4'i'^F' � H,t r' 8 Ys- rr„ 3 ��r•�.s �,� � j i �3�''���s��� '1�9����'.�Y.� H:.�'w`e ��� a b t r - ' 1 Print Location:5q ( S +4,4 > City _ At, 4 t h* Phone am a homeowner performing all work myself. �I am a.sole proprietor and have no one working in any capacity �1 am an employer providing workers' compensation for my employees working on this job. company name: IZ14tt (1110"I RACO 1✓ Co 114(d Address LCSY�"- C�rntar►v-name: Address City: Phone#' Failureto securo coverage as mired under Section 25A or i1l1Ct.152 CM, lead to the WposUon of n penaifies. of a fine up to $- 1500.00 and/or one years' imprisonment as'welt as civil penalties in the.fonn of a STOP WORK ORM and a fie of ($10D.00) a day against rne. t understand that a copy of this statement may be forwarded to the Offica, of kwestigations of the. DLA for coverage verification. / do herby certify under the pains and penaftles of peduiy VW theiMamation prov6ded above is blue and -connect 4 Print name "2 Phone # Official use only do not write in this area to be completed by city or town otflcial'BiRdi D n9 Dept 3. ©Check ifimmedrate response is requked Building Dept [] Licensing j Board Q Selectman's Office Contact person: Phone # ij Health Department 0 Ofiter ir'W WORKMAN'S c0>SrPENSATIOM 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: 8n o*' S e`k `'64 kv4 / AV� (Location of Facility) Signature of Permit Applicant Wo8l2me Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I-UHM ;U .-LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary a pprovals/permits fror Boards and Departments having jurisdiction have been obtained. This does not reliev( the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT MAn k 0. PHONE-WR `,(0,57 LOCATION: Assessor's Map Number_2j_ PARCEL_ SUBDIVISION � LOT (S) STREET ��Zi/I21� P i'� �% ST. NUMBER RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS DATE APPROVE=D DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTEDx PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY,PERMIT ty FIRE DEPARTMENT_ RECEIVED BY BUILDING INSPECTO Revised 9197 jm TE Ratte' Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844 Tel. 978-682-4982 COMMERCIAL CONTRACT AGREEMENT This Agreement has legal force and effect and binds those who sign it. This Agreement is made on 6/6/2002 between Ratte' Construction Co., Inc. of 252B Pleasant Street, Methuen, MA 01844 (978) 682-4982, hereinafter called "Contractor" and Michael A. Gogjian M.D., 575 Turnpike Street Suite 22, N. Andover, MA 01845, hereinafter called "Agent". L DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: See attached specifications. H. DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: See attached specifications. III. PRICE Contractor agrees to do all work described in Section I for the total price of THIRTY ONE THOUSAND EIGHT HUNDRED AND FIFTY DOLLARS AND ZERO CENTS ($31,850.00). HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustments to the contract price. In such a case the contractor will inform the Agent of such condition forthwith and where necessary a written amendment of this contract will be negotiated and executed by the parties. IV. PAYMENT Payment will be made as follows: 20% ($6,370.00) upon signing contract; 30% ($9,555.00) upon substantial completion of phase 1; 40% ($12,740.00) upon substantial completion of phase 2; 10% ($3,185.00) upon completion of job; V. COMMENCEMENT AND COMPLETION OF WORK Contractor will begin work on or about 6/24/02. Barring delay caused by circumstances beyond Contractor's control, the work will be completed by 8/16/99. The Agent hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. VL INSURANCE Contractor will be responsible to Agent or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Agent for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION RELATED PERMITS The following construction -related permits will be necessary in order to complete the scope of work included in this Agreement: Town of North Andover building permit The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. IX. MODIFICATION This Agreement, including the provisions relating to Price (Section III) and Payment Schedule (Section IV), cannot be changed except by written statement signed by both Contractor and Agent. X. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 Year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed- upon work. Note: This proposal may be with raven by us if not accepted within 30 days. Agent's Signature �— Date Signed G " �'*--4 ' Contractor's Signature //�.1r1�1 Date SignedCVD z TERMS AND CONDITIONS 1. CHANGE ORDERS: During construction the Owner may order additional work. The amount for such additional work shall be determined in advance if possible, or may be charged for at cost of labor ($40.00/hr) and materials plus 21% of gross for Contractor's overhead and fee. All sums for change orders shall be due and payable before commencement of work on each change order. 2. MATERIALS REMOVED - RUBBISH: All materials removed from structures in the course of alterations except Asbestos or similar hazardous substances, shall be disposed of by Contractor except those items designated by Owner prior to commencement of construction. All construction rubbish to be removed by Contractor at termination of work and premises to be left in neat broom -clean condition. 3. ASBESTOS & HAZARDOUS MATERIAL: Contractor shall not be held responsible for the identification, detection, abatement, encapsulation or removal of asbestos or similar hazardous substances. In the event that Contractor encounters any such products or materials in the course of the performing of the work, Contractor shall have the right to discontinue work and remove employees from the project until no such materials or products nor any hazard -exist as the case may require, and Contractor shall receive an extension of time to complete the work hereunder and compensation for delays encountered as a result of such situation and correction. 4. ALLOWANCES: are included in most contracts. Those allowances are shown at actual cost exclusive of the contractor's overhead and profit. Upon completion of the work the items charged to these categories will be summarized and the result added to or subtracted from the contract amount. Signed lY� wGIZ Signed /�'� s & �S�r� L (Contractor) (Owner) Ratfd Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844-7115 NAME/ADDRESS Michael A. Gogjian M.D. 575 Turnpike Street Suite 22 North Andover MA 01845 DATE 6/6/2002 Specifications PROJECT Office build-out4 DESCRIPTION The following is our estimate for remodeling to Suites 22 and 24 as outlined below. Permit - Obtain the necessary Town of North Andover building permit. PHASE ONE- Unit 24 Contents - Contents of unit to be cleaned out or stored in cabinetry prior to start of project. Files currently in file room to be moved as necessary by contractor. Demo - Remove and dispose of all carpeting and pad. Remove and dispose of all wood baseboard. Remove and dispose of (2) window units in file room. Sound protection - In the corner office. Remove and reinstall cabinetry as necessary. Frame 2x4 partitions on common walls approximately 1" away from existing wall to be framed 16" o.c. past suspended ceiling to top of existing walls. Install soundguard insulation between studs. Install 1/2" soundboard and 1/2" drywall. Tape and finish ready for paint. Block windows - Frame in (2) windows, install 1/2" sheetrock, tape and finish ready for paint. Owner's Acceptant ` Date G (t Page 1 (P/ �/Ow- Rath Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844-7115 NAME/ADDRESS Michael A. Gogjian M.D. 575 Turnpike Street Suite 22 North Andover MA 01845 DATE 6/6/2002 DESCRIPTION Specifications PROJECT Office build-out4 Floor prep - Install screws through existing subfloor into floor framing refastening subfloor to eliminate as many squeaks as possible. Note: Some squeaks may not be able to be eliminated due to construction methods used by original builder. Install 1/4" multi -ply underlayment in the (2) new exam rooms, kitchen and new lab area. Doors - Supply and install (3) 2-6x6-8 and (3) 3-0x6-8 6 -panel pine door units with 4 9/16" clear solid jambs and 3 1/2" clear jalco casings. Reuse existing passage sets. Note: (2) closet doors to remain and get painted. Carpet - Supply and install Shaw Industries 26 ounce Nylon (Starburst or Glory Days choice of 8 colors each) commercial carpet with double stick 6 pound pad in the conference room, file room, transcription area and hallway. Install a coordinated rubber cove base. Vinyl - Supply and install Tarket Commercial Coordinates vinyl flooring with 4" coordinating rubber cove base in the (2) exam rooms, kitchen and lab area. This flooring comes 12' wide so can be installed seamlessly. Plumbing - An allowance of $900.00 is included in this estimate for plumbing on both phases. Electrical - Owner's Acceptance 1(10'1"�- Date 4 0(t", " Page 2 Ratt6 Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844-7115 NAME/ADDRESS Michael A. Gogjian M.D. 575 Turnpike Street Suite 22 North Andover MA 01845 DATE 6/6/2002 DESCRIPTION Specifications PROJECT Office build-out4 An allowance of $1400.00 is included in this estimate for electrical on both phases. Note: We do not plan to install additional emergency and exit lighting but may be forced to comply with codes as directed by the Town of North Andover. Ceiling - Disassemble suspended ceiling in (1) exam room to allow framing of sound partitions. Reassemble using existing panels. Painting- Walls- Remove all wall covering. Patch and prep ready for paint. Prime and apply (2) coats finish. Interior doors and window trim- Prep, prime and apply (2) coats of finish. Exterior doors- Clean, stain, prep and sand and apply finish. Cabinetry - Install salvaged cabinetry in lab area. Additional cabinetry and/or countertops necessary can be done as an extra. Repair and adjust cabinet doors as discussed. PHASE 2 Unit 22- Contents - After completion of Phase 1, customer will relocate the exam rooms, lab and Dr. Gogjians office to the remodeled unit. Contractor will move and reset large furniture pieces only. Prior to carpeting receptionist area to be cleaned out by customer. Contractor to remove and reset files only. Contractor to remove and reset waiting room contents. Owner's Acceptance Date Q fi 9 L Page 3 Vh 12 &N&U-) Ratt6 Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844-7115 DATE 6/6/2002 NAME/ADDRESS I Michael A. Gogjian M.D. 575 Turnpike Street Suite 22 North Andover MA 01845 DESCRIPTION Specifications PROJECT Office build-out4 Demo - Remove cabinetry in existing lab area. Remove and dispose of all carpet and pad. Demo wall in file area. Framing - Frame openings for (1) new door and (1) cased opening. Wall patching - Repair drywall as needed after framing. Tape and finish ready for paint. Doors - Install (1) 3-0x6-8 6 -panel pine door units with 4 9/16" clear solid jambs and 3 1/2" clear jalco casings. Supply and install (1) lever style passage sets. Install (1) 4-0 x 6-8 with a clear jamb and clear 3 1/2" Jalco casings. Note: Openings through common walls will require wide jambs. Note: Now that we are not reframing the door opening in Melanies office its not worth reusing the door only and hanging it in another jamb. Receptionist area - No changes included in this estimate. Carpet - Install Shaw Industries 26 ounce commercial carpet (see above) with double stick 6 pound pad in all areas except (1) exam room and baths. Vinyl - Install Tarket Commercial vinyl flooring with 4" coordinating rubber cove base in the (1) exam room glued to existing floor. Owner's Acceptance i Date /, It � a�- Page 4 m i2 Ratt6 Construction Co., Inc. 252E Pleasant Street Methuen, MA 01844-7115 NAME/ADDRESS Michael A. Gogjian M.D. 575 Turnpike Street Suite 22 North Andover MA 01845 DATE 6/6/2002 DESCRIPTION Painting- Walls- Prep,patch, spot prime and apply finish. New doors- Stain and apply finish to new door units. Stained woodwork- Touch-up as needed. Wall paper in (2) baths to remain. Specifications PROJECT Office build-out4 Floor prep - Install screws through existing subfloor into floor framing refastening subfloor to eliminate as many squeaks as possible. Note: Some squeaks may not be able to be eliminated due to construction methods used by original builder. Miscellaneous - Reuse existing door stops. Above work to be done for the sum of All work is covered under our Workman's compensation liability and contractor's public liability insurance policies. Owner's Acceptan 141VV—` Date rlCy Page 5 T�, rA Cd E xO D a � O w � v v) C4 UO P-' Z A O O w O u: T C U co G x a U p n: c G x w utw wbo p w cn G w ® U V p aw co w w a as cn cn 7 aw �cZ c h �C.-I CL -0 ac aft: CD o o •:� EQ Ok •:� o IL C cs a' �C � E �mmCO C. d o�my m� vy W > >1 _ Ca R o � `E g aC o: av 'moo • :� L IL c 0� a IVRE=CD m o c0o c a Q i ` m c0 •O = m m� N ro+ t LU W o 'sC_ .r H y r a.c c Z CD LU E ca .0 o CJ CD CL occ� O a./ M 0 W III 0 M CD O ID cc Z H y O co CL 0 co Q M. EL— CA O O V CA C 0 C fl. N! 0 ts cpCLCOD C O CM O D '2 m m 0 co co L C3 C- = S cx 0" C ev cc O O Z � CL. CO) C 0 U) uj w W Irw uj U) Date ....�/�� TOWN OF NORTH ANDOVER PERMIT FOR WIRING G This certifies that ........................ �? j j..!..............,...... . r.... .. has permission to perform ....' ..) Ice .... ..`-�� � 4i� :!w: ................................. wiring in the building of....Q..`1 �..................................................................... at'..:� ` ��--2Z.............. ^rth Andover, Mass. F+ze..l............... Lic. No.taf°� ELe ...L INSP TOi Checkit 11648 Commonwealth of Massachusetts Department of Fire Services a s, BOARD OF FIRE PREVENTION REGULATIONS Official UAe my Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK �I All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 4j ' /0 '/,3 City or Town oh NORTH ANDOVER To the Inspector of Wires: N By this application the undersigned gives nogg of his or her intention to perform the electrical work described below. � X41 K Location (Street & Number) J 14 W VJ0 .Z' #V,& i , —A�` qtg! ' 00- y Owner or Tenant %'1le f 66a J�tA #' Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ,� (Check Appropriate Box) Purpose of Building Ot cr- G.i. Utility Authorization No. - Existing Service Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Amps / Volts No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ^P� i9 tPGsT /Q •C • �@ U,L P hT' Comnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed. Luminaires No. of Ceil: Susp. (Paddle) Fans ✓ Tr s Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatingDevices of Ranges TotNo. No. of Air Cond. Tons No. of Alerting Devices HeatPump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: Detection/AlertingDevices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal E] other Connection No. of Dryers Heating Appliances KW Security o Systems:* s 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: Attach additional detail if desired, oras required by the Inspector of Wires. Estimated Value of Electrical Work: �Q . (When required by municipal policy.) Work to Start: '/d .1-3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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 suchVo erage . . force, and has exhibited proof of same to the permit issuing office. CHECK ONE: 1NSURA_NCE�"BOND ❑ OTHER ❑ (Specify:) I certify, under th�s and penre es ofperjury, that the infor91LECZv.-s-e-7,9V ion on this application is true and complete. FIRM NAME`S 1 RM LFS 1�70 V M�?SAN LIC. NO.: C Sib/ Licensee:y JIA E.g KOUVOV �'3�`+�IA7 Sig ��IC. NO.: (If applicable]j enter "exempt" in th icense i mb line.) r` Bus. Tel. No.: �JOZ Address: p.- `ower#, 4• N •&E -4'O -Z Al's A* • �� �6 T Alt. Tel. No.: *Per M.G.L c. 147, S. 57-61, 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 PERMIT FES: $ t2�j Signature Telephone No. at ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: '***"Note: ReApply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL, ROUGH INSPECTION: Pass R Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH CTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: tv e f x�, `-� y Date: FINAL, INSPECTION: Pass Failed'0 Re- Inspection Required ($.) ❑ Inspectors Comments: . t Inspectors Signature:, X�J ' , ,,,z �, Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimae.com I 41 The Commonwealth ofMassachusetts Department of IndustrlqlAccldints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: t avi ex tLe City/State/Zip: IN S. p�WG Hq • 1$�6 Y Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I _,_,�,tMployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. # ship and'have no employees These sub -contractors have working for me in any capacity. 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.t��ctrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they a're 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 requiredunder 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 DTA for insurance coverage verification. I do hereby certify uncle dpenalties ofperjury that the information provided above is true and correct. • ja hp- Official a 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. EIectrical 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 WEE 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 Iicense 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 ofpublic 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 bum 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 ofZndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeX, # 61.7-727-4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Fax # 617-727-7749 wWwamass.goV1dia J ,�