Loading...
HomeMy WebLinkAboutMiscellaneous - 85 FLAGSHIP DRIVE 4/30/2018 (2)June 1, 2006 Eighty -Five Flagship, LLC Attn: Joe Scott 12 Rogers Rd Haverhill, Ma )tf q5truc0f1% 11�I�. I lc .. DIVISION OF SCOTT COMPANY Proposal for 85 Flagship Dr. N. Andover, MA. Unit D. Plans, Permit, Labor and materials to build a 15'x 33' open office mezzanine with minor modifications to the existing space per Koch Architects plans for Unit D at 85 Flagship Dr. $20,000.00 We Propose hereby to fumish material and labor — complete in accordance with the above specifications, for the following: Twenty Thousand Dollars $20,000.00 The above -proposed prices are valid for 30 days from the date of this proposal. After 30 days, prices are subject to change. i All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. 395 Main Street Salem, New Hampshire 03079 12 Rogers Road Wardhill, Haverhill, Massachusetts 01835 Telephone: (603) 894-4952 (978) 374-0034 Fax: (978) 373-6944 Page 2 Eighty -Five Flagship, LLC Acceptance of Proposal - the above prices, specifications and conditions are satisfactory and are her accepted. Yo a e authorized to do the work as specified. Owner: _ Contractor - SfottCo struction Co., Inc. Signature Signaturc. Date of Acceptance Date '6am5 Construction Control Affidavit Project: 85 Flagship Drive Project Number: N4V IMPROVEMENTS to SUITE D North Andover MA Date: June 09, 2006 In accordance with 780 CMR (Commonwealth of Massachusetts Building Code) Section 116.0 Construction Control, and specifically Sections 116.2.2 Architect's / Engineer's Responsibilities during Construction and 116.4 On Site Project Representation, ........ Rainer Koch. NCARB........................ Architectural Registration No................... MA 5056.. being a registered architect, have prepared or directly supervised the preparation of all design plans, computations and specifications for the above named project and I state, that such plans, computations and specifications meet the applicable provisions of the Commonwealth of Massachusetts Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. As it may be required and applicable for the project, I will monitor the construction process and provide the following tasks: 1. Review for conformance to the design concept: shop drawings, samples and other materials which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approve the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stages of construction, generally familiar with the 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. 4. Be present at the construction site on a regular basis or as proposed in the attached inspection schedule, and/or I will send other appropriately qualified design professionals, to determine that the work is proceeding in accordance with the documents submitted with the building permit application and the applicable provisions of the Commonwealth of Massachusetts Building Code. 5. Provide the building inspector with an original, stamped report for each site visit scheduled or otherwise. 6. issue a Statement of Project Completion at the time the construction is considered substantially complete and ready for occupancy I understand, that no CERTIFICATE OF OCCUPANCY will be issued until all reports and a statement of project completion have been submitted to the satisfaction of the building inspector / code enforcement official. Distribution: Building Department Client Architect Contractor / Field 38 Essex Road, Ipswich, Massachusetts 01938 - 2532 electronic: kocharchitects@verizon.net telephone: 1.978.356.5065 facsimile: 1.978.356.6056 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ''� s•°' www.rnass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Coiatractors/Electricians/Plunnbers DDlicant Information Please Print Legibl Name (Business/Organization/Individual): r/ eoy� �G'1� S C 4;w Address: o/V� City/State/Zip:_` /�' C �' Phone #:- W6 Areou an employer? Check the appropriate box: 1. am a employer with 4. ❑ I am a general contractor and l employees (full and/or part-time).* have hired the sub -contractors 2. El I'am a sole proprietor or partner- listed on the attached sheet. t 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. ] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL 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 1 l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I 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. XContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. p — _ - n n I r<— Insurance Company Name: Policy # or Self -ins. Lic. #: UJM OO OCS6 Expiration Date: 316 Ze Job Site Address:.0�1 . City/State/Zip: !/�w,�, A Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as'iequired 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 ce►7ify under the pains and penalti ja _p-ej;4 that the information provided above is true and cor?•ect ate: 4' /AJ 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. CitytTown Clerk 4. Electrical inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information . and Instructions Massachusetts General Laws chapter 1.52 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), addresses) 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-NASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Construction Control Affidavit Project: 85 Flagship Drive IMPROVEMENTS to SUITE D North Andover MA Date: June 09, 2006 Project Number: AW In accordance with 780 CMR (Commonwealth of Massachusetts Building Code) Section 116.0 Construction Control, and specifically Sections 116.2.2 Architect's / Engineer's Responsibilities during Constrpction and 116.40n Site Project Representation, .................RainerKoch,..NCARB........................ Architectural Registration No...................MA 5056.. being a registered architect, have prepared or directly supervised the preparation of all design plans, computations and specifications for the above named project and I state, that such plans, computations and specifications meet the applicable provisions of the Commonwealth of Massachusetts Building Code, all acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. As it may be required and applicable for the project, I will monitor the construction process and provide the following tasks: 1. Review for conformance to the design concept., shop drawings, samples and other materials which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approve the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stages of construction, generally familiar with the 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. 4. Be present at the construction site on a regular basis or as proposed in the attached inspection schedule, and/or I will send other appropriately qualified design professionals, to determine that the work is proceeding in accordance with the documents submitted with the building permit application and the applicable provisions of the Commonwealth of Massachusetts Building Code. 5. Provide the building inspector with an original, stamped report for each site visit, scheduled or otherwise. 6. Issue a Statement of Project Completion at the time the construction is considered substantially complete and ready for occupancy I understand, that no CERTIFICATE OF OCCUPANCY will be issued until all reports and a statement of project completion have been submitted to the satisfaction of the building inspector / code enforcement official. Distribution: 38 Essex Road, Ipswich, Massachusetts 01938 - 2532 electronic: kocharchitects@verizon.net telephone: 1.978.356.5065 facsimile: 1.978.356.6056 Building Department Client Architect Contractor / Field ACORD', CERTIFICATE OF LIABILITY INSURANCE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR DATE (MM/DDIYYYY) 04/07/2006 PRODUCER M. P . ROBERTS INSURANCE AGENCY INC. 1060 OSGOOD STREET NORTH ANDOVER MA 01845 978-683-8073 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 SCOTT CONSTRUCTION CO . , INC. SCOTT COMPANIES 12 ROGERS ROAD HAVERHILL, MA 01835-6925 INSURER A ACS INSURANCE POLICY EFFECTIVE DATE MM/DDIYY INSURER B: NEW HAMPSHIRE INSURANCE COMPANY LIMITS INSURER c GREAT AMERICAN INSURER D: AIM MUTUAL INSURANCE COMPANY INSURER E: HANOVER INSURANCE COMPANY COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR LTR ADVI. NSRD I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurence $ 50,000 X COMMERCIAL GENERAL LIABILITY CLAIMSMADE I x:l OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL SADVINJURY $ 1,000,000 A 621983706 09/01/05 09/01/06 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 21000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 750 ANYA UTO (Ea accident) x.000 BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) B X HIRED AUTOS AS1312258599 08/28/05 08/28/06 BODILYINJURY $ X NON-OWNEDAUTOS (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO AUTOONLY: qGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CI CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WCSTATT OTH- TORYLIMITS X ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYE $ 11000,000 D OFFICER/MEMBER EXCLUDED? WMZ 8005435012006 03/06/06 03/06/07 If describeunder E.L. DISEASE - POLICY LIMIT $ 1,000,000 PE SPECIAL PROVISIONS below OTHER E MASS AUTOMOBILE AFN 8175076 08/12/05 08/12/06 LI: $1,0001000 CSL C INLAND MARINE IMP 654-51-54 09/01/05 09/01/06 LI:$125,000 DED. $1000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS VOLVO RENTS IS LISTED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY WORKER PERFORMED BY THE NAMED INSURED. FAX: 978-373-6944/978-373-3445 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN VOLVO RENTS 901:S. MAIN STREET RTE.125 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL HAVERHILL, MA 01835 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE A a 1A ACORD 25 (2001 /08) ©ACORD CORPORATION 1988 .Q00 Id Date ...... '7.-- -7--Gv.(.... ° o- TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .............. �./. . �«�' ............................................................... has permission to perform ...... ..................... wiring in the building of ...... ?dN................................ . , North Andover, Mass. Fee... ZS, o_a.. Lic. No. ..3.1-Z. 7 ...... �. f�i�'RICAL INSPECTOR �A-� Check # 7— 6775