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HomeMy WebLinkAboutMiscellaneous - 800 TURNPIKE STREET 4/30/2018 (4)Location 7go— � No. 06 � — 15— Date CX Check 4t� Jc-2sv g— 1 28156 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee -51. yj $ TOTAL �5 $— Build g Inspector v 7i. C) Q N = C) ~ NLO to L 7 W N c OC O V 6i E o a � C O L O Q N cu I � .� U i _ N L Q O p N -0 00- a 0 `~ Z C O 0 O — C c O � O Q "= coCY _ N '- �.O•Ln X O w cnL a)a)o —' a) a) - > c � 0)CO z f O�5 a)E 4) o U U) O U Yo 0 cit 0 0 a) CU O NcOn N 0 a) U) a) cn (DJOf Y � (1) _ : -0 C/) moo~ u 0 0 F- 0 US a) a� O00+,-0 O p E U o 00 O N p ti 0-a) a) ca O O O C O = 0 a •fn = 2) N ' j 25 U (Q o (Q Q > on 60 a OX H M OF�c0 � d� ���o CD CD � w C CD CD I N m C . Id v m m 0 O � a p� � C -4 n T 7 y N LA ff0 i� 0c�w b • � 'C'D' 0 I C , J I N m C . v m m 0 O � a p� � C -4 n T 7 y LA ff0 i� o m C . v m cc, C -4 7 a m C-)r6O 0-(o �-- Ei• O CD �' Q CD 0 cr 09 C . 3 N -0p iZ CD Q =rD] d C1 n m Q 0 co fl1 c 7 O O O m O O O u > ty � O 0 n r CD CD m oo c m M O A N O CD D -n cn O 7 x 3• sQ 8 n a C y Vt .Oi d C W 3 n < E O O m d �' F r' `2 O !'1 T O QCL O O N u a 0 3 O N < m m m M O A N O N 7 x 3• sQ 8 n a C y Vt .Oi d O n W 3 n < E O !D C a m CL d T 3 c 0 � o, � C � 3 K m VJ O KS PARTNERS October 21, 2014 To Whom it May Concern: Please be advised that Expose Signs has permission to apply for a permit to replace the existing signage fixture at the entrance to 790/800 Turnpike Street, North Andover, MA. Should you have any questions, please do not hesitate to contact me at 978-944-3407. Sincerely, Nancy Butter Senior Property Manager KS Partners, LLC As Managing Agent for: Jefferson Equity Office Partners, LLC KS PARTNERS, LLC. 130 Ncw Boston Street / Suite 303 1 Woburn, MA 01801 / T. 978.560.0560 / F: 978.560.0561 / %%-,%v.ksparinersOc.corn 712112014 Detalls Do Official Website of (lie Executive Office of Nblic Sofoly and Security (EOPSS) f,lamcov Home State Agencies Ur,onsee Details emographic Information Full Name: ANDREW CLARK Gender: Dvaier Name: License Address information Ss: ss 2: Northborough MA 01532 rw4 i! License No: CS -107884 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: Issue Date: Expiration Date: 3/4/2018 License Status: Active Today's Date: 7/21/2014 Secondary License: Doing Business As: Status Change: J-IceDse Issuancg rereauisite information iscimin en Close window. © 2011 Commonwealth of Massachusetts irilp:lleilcense.c}>s.state.nta.usNerlficalioNDelalls.aspXtagency_Id=18Jfcense id=774320& Site Policies Contact Us 111 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ti I Congress Street, Suite 100 s Boston, MA 02114-2017 ivww Ynass.govliia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/OrganizationAtidividual): Expose Signs & Graphics Address: 13 Airport Road Hopedale, MA 01747 Phone #: 508-381-0941 Are ,you an employer? Check the appropriate box: 1. ■❑ I am a employer with 13 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I 1.❑ Plumbing repairs or additions I2.n Roof repairs IAM Other Signage *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. I Homeowners wbo submit thisaffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I arrr an employer that is providing ivor/rers' corrrperrsatiou irrsitu•artce for• rrrp employees. Below is fire policy and job site information. Insurance Company Name: The Hartford Policy # or Self -ins. Lie. #: 76 WEG DX5992 Expiration Date: 3/23/2015 790-800 Turnpike St. City/State/Zip: Job Site Address: p North Andover MA 01845 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. 1 do hereby certd y-tirrtf he p i d per re of per jiny that the inforrntion provirded above is true and correct. ` 10/21/2014 Phone #: 508381-0941 Official use only. Do not write in this area, to be cornpdeted by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Elech•ical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORO CERTIFICATE OF LIABILITY INSURANCE L..../ DA7E(MMIDD(YYYY) 10/23/2014 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(ies) 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 endorsement(s). PRODUCER Andrew G. Gordon, Inc. 306 Washington Street Norwell MA 02061 CONTACT F. Cordaro NAME: PHONE(78])659-2262 F X No: (781)659-4725 E-MAIL bill@agordon.cota INSURERS AFFORDING COVERAGE NAIC p INSURERA:SafetY Insurance Co. 39454 INSURED Expose Signs & Graphics, Inca 13 Airport Road ,Hopedale edale MA 01747 INSURER B: INSURERC: INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:No. Andover 10-23-14 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDLSUBR Jima POLICY NUMBER POLICY EFF M IODIYYYY] POLICY EXP iMMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aX OCCUR AUTHORIZED REPRESENTATIVE 1600 Osgood Street, Bldg 20 MaOO16449 1/8/2013 1/8/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ '� AUTOMOBILE LIABILITY ANY AUTO ALL MED X SCHEDULED AUTOS AUTOS X HIRED AUTOS INANUOTNO-OSWNED 6215612 1/8/2013 1/8/2014 COMBINED SINGLE LIMIT Esaccident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PPeOaaRidentDAMAGE $ 1-000,000 Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE =41100001365 1/8/2013 1/8/2014 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH1 II yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU-0TH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION H..umu co (cuTu,uo) ©1988-2010 ACORD CORPORATION. All rights reserved. mdeems@ townofnorthandover . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Maura Deems, via email AUTHORIZED REPRESENTATIVE 1600 Osgood Street, Bldg 20 Suite 2035 �- No. Andover, MA 01845 F. Cordaro/LEE H..umu co (cuTu,uo) ©1988-2010 ACORD CORPORATION. All rights reserved.