Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - Bldg 5
El O FM4 O...V 0 O w Q v v) O O w O w ^C U id x W 7 a: coW w a u pG uu chi i� u. z w ii w w go O V)cn gig O i•+ = m : W .. n= CA 40 cc SER `•� I f1� Qv W �� ��• w m JO Q o 41W O.l E O co •` G �3 N 7t m (C%n m Cc -0 t�= N f -r ► N N 0 E N w U m a: cr- = c om Cf) �.: W ft: tm Q 2 vii m o v m Z G ..:= n �o c m=3 C .0CN m ~=m t , = rhe .3 e 6m =W = -0-- LLA v mmN Zo 1.0 rb cma CL 0 O ti n 0> o= t -cc = E Cow —vt, $ n * m .81U WI o1 Y� �I CD 0 � 0 o � Z o a o` c CD Q' ''ww C �W Q Vi CD 'E m m CD CD CLI.— O � CD 0 Q Q O d C o CJ �o SEL 049 c z CD CL V y C !D .c CO) D Ni, 0 W Ir LliLLJ LLJw U) 111Li %AJIVALYle/11 I' el" 11 V1' 1gt1�U11UJG1 10 —11-c use only DF.PAR7MENT0FPUWCS4FM Permit No. JS -7Y BOARDOFFMPREVFNTEffORMELECMCAL ONSS27CW 12.W Occupancy & Fees Checked APPLICATTONFOR PERMITTWORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TELECTRICAL CODE, 527 CMR 12:00 _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date j - 0 - Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electri al ork described below. l Location (Street & Number) (� \ o,� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead a Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No. of Receptacle Outlets No: of Oil Burners No. of Emergency Lighting Battery Vniks • tv t No. of Switch Outlets No. of Gas Burners FIRE ALARMS ' No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and ;. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal t Other No. of Dryers Heating Devices KW Connections © No. of Water Heaters KW' No. of ' No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP W L&*Ttyh>snat R)LymcktdngCa FI&* CoveWerZakft q vabt YES[71 NO Jvalidp100f0fsame1ode0ffitft YES F,71 r -T 1fyeuliawdmd®dY1 S,pk=ir>dcateftNro'covpby wmabcxI�� 1HR JJ 17 BOND r7oTfmz M ftm) EVimfimDiiie E0ra2dVakr dE1a=cal Wotk $ hspeWmD*RaVmbd Rough Fail LNo. 1�1153� DOMNo LJ 11%1 1L- -) 5'�)� Mon? - 3X -75 R 1'\ .'" AIL TdNa JRANCEWAIVER;IamawaethattheLio wdoesnothmetheirtsut=rovescritssubfacialgmiatasttx}IWbyNI%MdlmnGaulLaws .necndtispmnkapplicatiotlwaivesdlislegAien 1 one) Owner � Agent Telephone No. PERMIT FEE $ G at -S �cvv rgL D -fes 3 - r - os Ta --m lqva M pad LAS 6 iTT 3— I S- c s- pi' M Date. ..�.' a -).... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...�i. ,...�� �. !IA:. r� .................... has permission for gas installation ...UY . ( ................... in the buildings of . ,,�. . A k ..................... at North Andover, Mass. Fee..Lic. No.. AS INSPECTOR Check # SDl�. MASSACHUSETTS UNIFORM APPLICATION/OR PERMIT TO D® GASFITTING (Print or Type) G Building Location New ❑ Renovation Mass. ate ' — Z 6 _ 7,61,61J ' l am' Permit # —a—!vZX ' `d Owner's Name I C/i// ��)�(G ly ah- al s Type of Occupancy eplacement ❑ Plans Submitted: Y Yes ❑ No Installing Company Name 010 nAo C�»)/j�11� 41 C'i Check One: Certificate Address _ �Ni /'] J J✓11 S/J/I'J %>'�a � "T Corporation -- (d/ l7 AIA� i��� ❑ Partnership Business Telephone - %,�J % - 5g� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter DarJG �� �iDnylB INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No If youave checked Yes, please indicate the type of coverage by checking the appropriate box. `�4 A liability insurance policy ❑ Other type of indemnity 0 Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. re of Owner or Check one: ❑ Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in abov application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Cod d Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Signature of Type of License: i Plumber ❑ Gasfitter /i Master ❑ Journeyman License Number /NY Q Y Z Q W ¢ co M O O cn S F� 0 -1 0 U W �- " m z O i= 0 Z L W < U W = Z n F O M 0. >; <W M to O co O w 2 S O O S u. 00 > o a F SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR Ready for Inspection 5TH FLOOR 6rH FLOOR Date Will Call 7TH FLOOR 8TH FLOOR FINAL INSPECTIONS ARE MANDATORY Installing Company Name 010 nAo C�»)/j�11� 41 C'i Check One: Certificate Address _ �Ni /'] J J✓11 S/J/I'J %>'�a � "T Corporation -- (d/ l7 AIA� i��� ❑ Partnership Business Telephone - %,�J % - 5g� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter DarJG �� �iDnylB INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No If youave checked Yes, please indicate the type of coverage by checking the appropriate box. `�4 A liability insurance policy ❑ Other type of indemnity 0 Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. re of Owner or Check one: ❑ Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in abov application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Cod d Chapter 142 of the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Signature of Type of License: i Plumber ❑ Gasfitter /i Master ❑ Journeyman License Number /NY Location__ J ' No. Date _cPs HORTN TOWN OF NORTH ANDOVER • OL 9 ' Certificate of Occupancy $ cMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $�.� Check # 66230 17,79 ✓ Building Inspector Ir 1191,4 lv-s OnA av,3 F/,4 -f- /e-5 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 ✓ Section for ofricia use oniylxz,-�"K, BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Buildi5 Commi o r of Buildings Date sitc,nm t -q% 1.1 Property Address: 1.2 Assessors Map and Parcel Number � 4 0 A) f, I *1,'Z�- 7L Z-3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: e - "Sq . ZoningDistrict Proposed Use Lot Area ( Frontage (ift) 1.6 WELDING SETBACKS (11) Front Yard Side Yard Rear Yard "red Provide Required Provided Required Provided — 1.7 Water Supply MG.1-C.40. 54) 1.5. Flood Zane Information: zow outside Flood Zone 0 1.8 Scwcrap Disposal Systems municipd Ousite Disposal Sydam 0 Public 0 Private 0 1 2.1 Owner of Record �01D /Vt /V Name (Print) Address for Service at ) 8 — q 3 y Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Sibm-ture Telephone Apo. 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number Licensed Construction Supervisor: Ine lee- -5- Expiration Date Signature Telephone 3.2 Registeied Home Improvement Contractor Not Applicable Company Name. Registration Number Address Expiation Deft Signature Telephone I- SECTION 4 - WORK M COIOZMATICM MLQL C 1S2 j 2Sc(0 Workers Compensation Insurance affidavit must becnmpleted and submitted with this application. Failure to provide this affidavit will result in the.denial of the issuance of the building permit. Signed affidavit Attached Yea .......❑ No..... .3 SECTION S - PROFESSIONAL DESM AND CONSTRUCTION. SERVICES FOR BUIMMS AND STRUCT ns SUBJECT TO CONSTRUCTION CONTROL PURSUAR730 7N CMR 11.4 (CONTAINING MORE THAND 35,009 C.F. OF R.KCLOSLD SPACE) 5.1 Registered Architect: Name: Address Signature Telephone 5.2 Regidened Pmf aslatal Ett>P*Met(s)a . Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone �• �� lfliA�tl yl gSo Company Name- /Ll_c_GJi9,s Not Applicable ❑ Responsible in Charge of Construction SECTION `.DESCJKIMON OR PROPOSED WORK (chock all applicable) New Construction 0 Existing Building Repair(s) Alterations(s) ! Addition 7 Accessory Bldg. Demolition 0 Other E Specify Brief Description of Proposed Work: �r ti 7 100 � we <v fJT,6 S , ivy M s 0010N 7 - USE 000 AI D CONNMCtC" TM „ USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ lA IB 0 0 B Business I& 2A 2B 2C 0 0 0 C Educational ❑ F Factory 0 F-1 ❑ F-2 0 H High Hazard ❑ 3A 3B ❑ IInstitutional 0 I-1 0 I-2 ❑ I-3 ❑ M Mercantile 0 4 0 R residential ❑ R-1 0 R-2 ❑ R-3 0 5A 5B 0 ❑ S Storage ❑ S-1 ❑ S-2 ❑ U utility 0 M Mixed Use 0 S Special Use ❑ Specify: Specity: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group:QS�n�� S Existing Hazard Index 780 CMR 34: Proposed Use Group: /7v5r.0 e, 4-/ Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels I Floor Area per Floors ,L:,, Total Areas r Ile — Total Hei t ft �/ If Structural Enotirteering Structural Peer Review Yes ❑ No ISECTION 10a Owner Authorization - TO BE COMPLETED WHEN I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Hereby authorize J - La I �V f9 -- My behalf, in all matters relative two work Signature of Owner Owner of the subject property by this building permit application act on OX I, �('�J2 &1)00-1- r�2— C"D l S ,as Owner/Authorized Agent U,-rPhv Aarlara that the ctatementc and infnrmatinn nn the fnrevnina artnlie-n inn are tnu- anA arrnratp to the )-act of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be WMEUSKNEV Completed by permit applicant 1. Building (a) Building Permit Fee j Multi Tier 2 Electrical (b) Estimated Total Cost of 0�� Construction from (6 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) , O C) 5 Fire Protection r 00D 6 Total (1+2+3+4+5) ® Check Number p 'Y - NO.OF STORIES SIZE NO. O BASEMENT OR SLAB K SIZE OF FLOOR TIMBERS OT 2 3 PD SPAN t� DEMENSIONS OF SILLS DEMENSIONS OF POSTS !( DIMENSIONS OF GIRDERS l( IMIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING (( X MATERIAL OF CBRANEY / IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �� Lec cc u4 11:ula NORTH ANDOVER 9786889542 p.l v � 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. .,�.. APPLICANT FILLS OUT THIS SECTION APPLICANT �saG� PHONE LOCATION: Assessor's Map Number PARCEL LOCATION: (S) 13 SUBDIVISION 1 �� STREETi ST. NUMBER, OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: i CONSERVATION ADMINISTRATOR DATE APPROVED ' DATE REJECTED ' COMMENTS TOWN PLANNER DATE APPROVED - DATE REJECTED COMMENTS FOOD INSpECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATEAPPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT ICQC%� � 3 ��e2 ��� �D� rre lroiecl,d-, So V�o 7_21d� RECEIVED BY BUILDING INSPECTOR DATE_.._ RGVMW OW Im rya.. Workers Compansahon lamuce sffidavr must be'em and submitted with this toted sppiicat on: Fail= to prpv do this Adiwitwiil t+esult in the dwW ofthe issmod of the building if. Sign affidavit Attacfud Yes .,....1) W...,.17 5.1 Registered Archttca Robert J. Stein — Integrated Design Group, Inc Meme: _38 Chauncy Street, Boston, MA 02111 Add= 617-338-1177 Signa Telephone McCarthy - Integrated Design Group, Inc. A oftrical Responsibility Name 4:1548. 38 Chauncy Street, Boston, MA 02111 iteistratiotiNumber Address- U 06 30 06 17- 38-11.7 ExpisationDate igtiafute Total Not.applicable 0 Name _ Reg stfaGrnn Number faip atitin DAW Address ~Signature Telephone % Kevin Gregory — Integrated Design, Inc, Mechanicai Area ofResponsibIly .Name_ . 38 Chauncy Street, Boston, MA 02111 32334-M Regjgralion Number Address 617-338-1177 06/30/06 Expiration We si nue Telephone Arta of. kespoitsi`bility Registration Number Expiration Date Name Address SignatmTelephotre CompartyNanw Nos Applicable 0 Respoogble in Cbarge of Cq OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL irfi _ PROJECT NUMBER: PROJECT TITLE: Tour Andover Controls _ PROJECT LOCATION:-- One High Street Campus NAME OF BUILDING: Building #5W —_ NATURE OF PROJECT: Office Fitup— IN ACCORDANCE WITH ARTICL jQFjTHE MASSACHUSETTS STATE BUILDING CODE, I,_—��t_�—Lel------ -----REGISTRATION N0._ ---- 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 • FIRE PROTECTION • STRUCTURAL • MECHANICAL • ELECTRICAL • OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ARCHITECTURAL PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED -USE AND OCCUPANCY. I FURTHER CERTIFY THAT I OR MY DESIGNATED REPRESENTATIVE SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING 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. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCU NCY. - - t SIGNATURE SUBSCRIBED AND TO BEFORE ME THIS_ S __DAY OF � --- _-20 04 _ NOTARY BLIC MY COMMISSION EXPIRES_ APrl � < (P i DO IO OFFICE OF BUILDING INSPECTOR T TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE:__ Tour Andover Controls PROJECT LOCATION: One High Street _Campus NAME OF BUILDING:_ Building -M NATURE OF OF PROJECT:_Office IN ACCORDANC WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, _____ -------------------- —REGISTRATION 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 • ARCHITECTURAL • STRUCTURAL • MECHANICAL • FIRE PROTECTION •C=ELECTRICAL • 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 USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL 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. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT 'r OGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIG E SUBSCRIBE WORM TO BEFORE ME THIS DAY OF CP - NOTA PUBLI MY COMMISSION EXPIRES _P_�_ OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE:__ Tour Andover Controls PROJECT LOCATION: One High Street -Campus NAME OF BUILDING: Building M _ NATURE OF PROJECT: Office Fitup IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1,--------- C.��[1e��_�[t'�---------------- —REGISTRATION NO._32�34. tv_L 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 • ARCHITECTURAL • STRUCTURAL • CHANIC;L_� FIRE PROTECTION • ELECTRICAL • 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 USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL 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. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SIGNA URE SUBSCRIBED AND -SW BEFORE ME THIS- ____--- DAY OF -- r _20_ (0 NOTARY U LIC MY COMMISSION EXPIRES__APr I I 1.0 Name The Commonwealth of Massachusetts Department of Industrial Accidents Offilce of Investigations Boston, Mass. 02111 . Workers' Compensation Insurance Afdavit Please Print Location: City Phone # I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. I A Company name: , Address City: Phone # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,5W.00 and/or one years' imprisonment_as y+cell_as civli penaltiesjn ihelnr d.af STOP.W.ORK ORDEI�d_a.fine .of.($100.Do)-a AW ag WW.rne. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town PermRJUcensi ❑Check f immediate response is ❑ Building Dept p required Licensing Board C] Selectman's Office Contact person: Phone A, ❑ Health Department ❑ Other AWRD CERTIFICATE OF LIABILITY INSURANCE osiiijioo PRODUCER (781)681-6656 FAX (781)681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J Barry Driscoll Ins Agcy, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 600 Longwater Drive �._ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. \g0. Box 9120 T.NI 2orwel 1 , MA 02061 �� INSURERS AFFORDING COVERAGE NAIC # INSURED J. Calnan &Associates Inc. g INSURERA: Ohio Casualty Group 555888 10 Granite Street nnSdC�\� INSURERB: American International Cos 0004 Quincy, MA 02169 \���\r INSURER C: INSURER D: INSURER E: rnvGQAnCQ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN7 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 D TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR 10/01/2004 LIMBS EACHOCCURRENCE $ 1,0001000 GENERAL LIABILITY BKW0453119614 10/01/2003 X I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PRrMIS (Fa 300,000 CLAIMS MADE ri] OCCUR IP MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO- JECT LOC AUTOMOBILE LIABILITY BA00453119614 10/01/2003 10/01/2004 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 BODILY INJURY ALL OWNED AUTOS A X SCHEDULED AUTOS (Per person) $ BODILY INJURY $ X HIREDAUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY BX00453119614 10/01/2003 10/01/2004 EACH OCCURRENCE $ 10,000,000 OCCUR FICLAIMS MADE AGGREGATE $ 10,000,000 A $ $ DEDUCTIBLE X RETENTION $ $ WORKERS COMPENSATION AND XWO0453119614 10/01/2003 10/01/2004 X 1TW0CgySTAjMTjUfSj OTH- rR AANY EMPLOYERS' LIABILITY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $ S00,000 E.L. DISEASE - EA EMPLOYEE $ S00,000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500 , 000 SPECIAL PROVISIONS below I I OTHER CPLL8088097 10/01/2003 10/01/2004 - $1,000,000 Occurrence B�ontractors rofessional & $1,000,000 ollution Liability Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS lob: 04-102, Andover Bldg. 37. Andover Controls and Schneider Electric and Yale Properties are ncluded as Additional Insureds for General Liaibility as required by a signed, written contract with he Named Insured. vidence of Insurance for work performed within the Insureds scope of normal business operations. otice of Cancellation provision is 30 days except 10 days applies for non-payment of premium. Andover Controls Attn: Ed Howlett 300 Brickstone Square Andover, MA 01810 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE t 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 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE B. Driscoll/JMT z J W ACORD 25 (2001/08) ©ACORD CORPORATION 1988 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: (Location of Facility) Signature of Permit Applicant /7/V/L, Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the. Building Inspector �Z3Z� dnn 10 cuuD 1ua ul-ol rn I= rKVrCKI1tZ rM NU. la104NDJd4 P. Lre/ue January 18, 2005 Michael McGuire Building Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Re: Schneider Electric, North Andover Mitis, One High Stream, North Andover Dear Mr. McGuire: We (as landlord) have approved and are submitting the following construction documents by the integrated Design Group Inc., dated December 21, 2004 pertaining to Building 5 West, Building 37 and Building 6 on behalf of our tenarrt, Schneider Electric, for your approval: Building 5 West: A0.10, AL1.10, ADLI0, ALIO, AS.Ia, A6.10, P0.1, P1.2, FP0.1, '' FPl.2, M0.1, M1.3, MIA E0.1, ED.2, E12, E2.2, E3.2, E6.1 and F.F.2. Building 37: A012, AL1.12, AD1.12, A1.12, A5.12, A6.12, P0.1, P1.3, PIA, PLS, FPO -I, FPI-3, M0.1, MIA MIA E0.1, ED3, E13, EL3, E33, E6.1 and EF3. Building 6: A0.119 A11..11, ADI.I1, A1.11, A5.11, A6.11, P0.1, P1.11, FP0.1, FP1.1, M0.1, MI -1, M12, EA.1, )ED.1, ELI, ELI, E3.1, E6.1 and EF 1. Enclosed are three (3) complete acts of plans along with affidavits from all necessary architects and eugi =m involved.. If you have any questions in regard to these documents, do not hesitate to contact me. Your prompt aacntion to this matter is appreciated. Sincerely, YAL4 FROPERInES LGA J S E. Le3iwnll, RPA D' or of Operations Enclosures cc: Thomas A. Palmer, Schneider Electric (w/o enclosures) $0 Cross Point. 900 Chelmsford Sura, Lowdi. Mwwbua= 01851 71x1.: (978) 453-6666 Fax: (478) 454-6394 Page 1 of 1 Nicetta, Robert From: Dolan, Chief William Sent: Thursday, December 23, 2004 10:58 AM To: rborden@jcalnan.com Cc: Nicetta, Robert; Melnikas, Lt. Andrew; Martineau, Wiliam Subject: Buildings 5w and 6 floors 1, 2,3 Andover Companies - NA Mills- Tour Andover Controls I have reviewed the two sets of plans that you provided for the 'tenant fit up" work to be completed at North Andover Mills for Tour Andover Controls. Thank you for the information. In general I approve of the plans as submitted for fire protection. However the building 6 plans only show the existing plan and we will need to see the plan for alterations of the sprinkler system according to the new construction. Duct detector remote indicators are shown for both buildings but the location of the duct detectors are not shown on the plans. In Building 6 page EF1 an. FATP is shown on the plan with a_ note to see Note 2. 1 could not find that note. I will need clarification as to the purpose of this Fire Alarm Terminal Panel. All tamper and flow switches need to be wired. to alarm and not trouble. Activation of these devices would trip the fire alarm master box. In areas were drop ceilings are being added sprinkler heads may need to be installed in the plenum space between the panels and the structural ceiling/floor if the area is combustible. A ciarification of this area is needed to insure that proper coverage is provided. Thank you for providing these plans. I will be leaving for vacation today December 23 and will return on Monday January 3rd. If you have questions regarding this email in the meantime please contact Deputy Chief 1Mlliam Martineau - 978-688-9593 or at wmartineau cDTownofNorthAndover.com. 12/23/04 rs 0 CO) CD CO) CL CD O Q M C40 0 aimCO2 0 O C a _Q d y 0 3� L CL O a C Q ccc O Z m CLGO C LLI U) U) 19 W 19 o ;cam o a o a ci i ? ce �0< O C U w �. 1 ID y, E �' `A _OoZ y w Q a .a� C=m -ti a y g `. m o O c.c, � • m w o to �a :oma z m c`oCM o CL S = m�mt3 1V Hr W=r O W � Z •. r t N dt C O o� E W o Z O 4D CO � U w CL *..In :IN rA cn cn 0 CO) CD CO) CL CD O Q M C40 0 aimCO2 0 O C a _Q d y 0 3� L CL O a C Q ccc O Z m CLGO C LLI U) U) 19 W 19 ;cam o O • 0ca o ci i ? ce �0< O C �. 1 ID y, E �' `A _OoZ y w Q C=m -ti p� y y g `. m o O c.c, � • m w o to �a :oma z m c`oCM o CL S = m�mt3 1V Hr W=r O W � Z •. r t N dt C O o� E W o Z O 4D CO � a • o 'O CO2 _ .0 EM75O CL *..In :IN 0 CO) CD CO) CL CD O Q M C40 0 aimCO2 0 O C a _Q d y 0 3� L CL O a C Q ccc O Z m CLGO C LLI U) U) 19 W 19 Z Q CL V V 0 od W LL 0 W Q V LL F - w W V 1-4 EgoPlo O IMM4 rG h h cd p L= ., -kM (6 4 U O v y y E m O O V cc M y O a y O V cc C cc d cm i CL C40) C LLI Q W ce u o c � •O.. O V v V CL i o ? ce mo ?mom.. Li � ac t1 w o Q ....t m v E y .s r. 1r Q . N M m3 � y . m .0 4 i'Ec `m :.o 0 41l16�cm W: o o _CD G cm p Q H •� ��-' C _O m �'Z ay p W O � o cm = CDJV 16-5 '0 m w IDS LU W G'0 "OS1 w ~ LL y m m O 42 C_'' G Z V Off% C CIO d $ 16w m ., -kM (6 4 U O v y y E m O O V cc M y O a y O V cc C cc d cm i CL C40) C LLI Q W ce u MECHANICAL FINAL AFFIDAVIT To the Building Commissioner: I certify that, I, or my authorized representative, have reviewed shop drawings and periodically observed the work associated with the Construction at Tour Andover Controls, One High Street Campus, Building #5W. To the best of my knowledge, information and belief, and contingent upon completion of the items noted below, the work has been performed in conformance with the permit mechanical plans and specifications approved by the Town of North Andover Building Department and with the provisions of the Massachusetts State Building Code, and other applied codes and ordinances. 1. Duct smoke detectors shall be installed in the supply air ducts served by Heat Pumps # 1, 2, 3, and 4 in the South Mechanical Room. Each duct smoke detector shall be wired to shut down its respective air handling unit supply fan and signal the building fire alarm system upon detecting products of combustion in the supply air stream, in accordance with NFPA 90A. This work shall be completed by the mechanical and electrical contractors as a correction of existing conditions. 2. All heat pump units and all makeup air units serving the subject space shall be in working condition, in continuous operation, and shall be balanced to provide the minimum fresh air required for ventilation to all occupied spaces in accordance with the State Building Code (based on 20 cfm per person).=b�IV2 Only upon completion of these two items, and contingent upon the planned completion of non- critical punch list items (in accordance with the list provided to the mechanical contractor), the subject space may be considered ready for occupancy. OF KEVIN A. GREGORY MECHANICAL No. 32334 KD -V- 9n 14o_, 20 0 9 Kevin A. Gregory 4 32334 - Engineer - Registration No. Integrated Design Group, Inc. Company 38 Chauncy Street, Boston, MA 02111 Address 617 338 1177 Phone Then personally appeared in the above-named, 'lnA, �r ov , and made oath that the above statement by him/her is true. Before me, My mission Exp)rev. A ,20 10 ARCHITECTURAL FINAL AFFIDAVIT To the Building Commissioner: I certify that, I, or my authorized representative, have reviewed shop drawings and periodically observed the work associated with the Construction at Tour Andover Controls, One High Street Campus, Building #5W and that, to the best of my knowledge, information and belief, the work has been done in conformance with the permit architectural plans and specifications approved by the Town of North Andover Building Department and with the provisions of the Massachusetts State Building Code, and other applied codes and ordinances. The furniture installation is not complete and we cannot confirm minimum clearance requirements. There are a small number of punchlist items that are being completed by the architectural contractor, but these items have no impact on occupancy or the life safety systems in the building. `j J. O i C No. 3997 .y c: Bosto CF u 646. 16 , 20 e�> Robert J. Stein Architect - Registration No. Integrated Design Group, Inc. Company 38 Chauncy Street, Boston, MA 02111 Address 617 338 1177 Phone Then personally appeared in the above-named,i abefA 94-6vi , and made oath that the above statement by him/her is true. Before me, My Corp mission Expires: I (P .20 (C ELECTRICAL FINAL AFFIDAVIT To the Building Commissioner: I certify that, I, or my authorized representative, have reviewed shop drawings and periodically observed the work associated with the Construction at Tour Andover Controls, One High Street Campus, Building #5W, and that, to the best of my knowledge, information and belief, the work has been done in conformance with the permit electrical plans and specifications approved by the Town of North Andover Building Department and with the provisions of the Massachusetts State Building Code, and other applied codes and ordinances. There are a small number of punchlist items that are being completed by the electrical contractor, but these items have no impact on occupancy or the life safety systems in the building. John R. McCarthy Engineer - Registration No. $��(N OF �s�9 JOHN R. �yG� Integrated Design Group, Inc. i MCCARTHY Company ELECTRICAL No. 41548 90,E FGISTE 38 Chauncy Street, Boston, MA 02111 Address 617 338 1177 Phone .� Then personally appeared in the above-named, , and made oath that the above statement by him/her is true. Before me, My Commission Expires: 202 IM I � fz] z U W o N yi G v� N O r�- r.til C:] h O � �' z '� c w p. z z I z H O w Z •- z '' z 4 N N o N o v � h y p z � w tom.+ C J C cn t+Cd p W p H h H N U U U w 1 < G ul O 0. ❑ ,c..7 = O W z O W z O z Wcn O U e c7 n p n O n V F w G G W O W O LUU Q O I U w Z O U U U -a W W W cn - r.til � h O � �' z '� c w p. z z I z H O w Z •- z '' z 4 N o N o v � z � w � � � En 1 I H W - p u cil CAW z z G G w C h.] .0 z V O w U U U U. 'iFy}�y/i z W < w w Z < Z Z < C H w U E p c14 Ln Lnc o z < W BUILDING DEPARTMENT f. ,_.DEBRIS DISPOSAL FORM Inaccordancewith.the provisions of MCL c40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be -disposed of in a property licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: 1'Z6*'gUfn0q / —0 �- Vo 1/0 Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS SS: COUNTY OF ESSEX On this 1st day of December A.D. 1999, before me, !-O&O'Vef—Linda S. Smiley, who, being duly sworn, deposes and says that she will review the preparation of Groupe Schneider Cafeteria entrance vestibule on the first floor of Building 5, in North Andover, Massachusetts; and that she will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by her or her registered professional Designee in accordance with the Controlled Materials Procedure therein defined. o��, P S -J No. 10080 -< c HAVERHILL, MASS. F Linda S. ley of u Subscribed and sworn to before ine this / day of A. D. Notary Public My commission expires on -------------- Notary Pubic Commonwealth of Massacfxsetls \\Ndvfs0l\Projects\Projects\9982701\correspondence\CAF.ENTRANCE AFFIDAVIT.DOC My Commission E�res June 9, 2006 a December 7, 1999 Mr. Robert Nicetta Building Commissioner Town of North Andover 27 Charles Street North Andover, MA 01845 Dear Mr. Nicetta, This letter will serve as my approval as the representative of Yale Properties, Property Manager for North Andover Mills, that the attached construction documents as specified on A201 Cafeteria Vestibule for the addition / alteration to the main entrance of the Schneider Electric Cafeteria — Building No. 5, One High Street - is hereby `approved' based on the scope of work indicated. Attached please find a `signed' copy of this document ( marked Exhibit 1) along with this letter which will serve as Yale's approval with regards to this work. If you should have any questions, please do not hesitate to call either myself or my Building Engineer — Arthur Boujoukos, Yale Properties. Many thanks for your help and advice. Sincerely, David G. Cohan Property Manager North Andover Mills One High Street, North Andover, Massachusetts 01845 Tel.: (978) 682-8708 Fax: (978) 682-8713 C Location �'" ` _S/— ��� No. Date 7--7 TOWN NORTq TOWN OF NORTH ANDOVER f 9 Certificate of Occupancy $ Building/Frame Permit Fee $— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ T Check # q --5j --8 1 � i Building Inspector / /1�1 � S + S �C,1 6 ,5- j' A P 53 PR R t e-/ as - BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SU ERYISOR Number: CS 045457 Birthdate:03M8/1964 4 Expires: 03/08/2001 Tr. no: 8194 Restricted To: 00 JAMES H BURNS _ 23 SADDLE HILL RD ` BOXFORD,� iti 01921 Administrator . The Commonwealth of Massachusetts Department of Industrial Accidents Mice u1/nYestlgaUuns 600 Washington Slreet Boston, Mass. 02111 :; ''��i`_• ' �r- rec':t'.l c �:{:j ar - - �.= �. ; e°. :.+ ►� t • —JIM� •�:� C: (V ,hnnr � [j [ am a homeo'vner perfoaning all work myseft. I am a sole proprietor and have no one working in any capacity Ci [ am an employe: providing workers' compensation for my employees working on this job. c'rv'• 11�� 25 /� �l (� nhonc 6 7R— 7 D `V4 /v 7 I am a sole prooriemr, general contractor, or homeowner (circle one) and have hired fhe conductors listed bellow w have the following worke-s' compensation polices: comninv name: addr=- c -1'r ohnne ii- adure Co secure caveragc as requtrca under Ecc6on '-SA of :'YIGL 151 can lead to the imposition of criminal penalnes of a fine up to 51-400.00 and/or to year-' imonsonmenc as well as civil penaitics in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me_ 1 under -land that a ov of this st.;e nent may be for+2racd to the Office of Investigations of the DIA for coverage vcn(icanon. v hrreby cerijy ander ;hr pains and p�e a! fes u! prriury that the information provided above is tree and corre= - W / Date �/1 Z?G� tna:.e _If P.S !"s' �y1�5 p"!one.; Teal use Only do not write in ;his area to be compieted by city or town otTicial 'J- f or :own: permlullcense X necv. if immediate re_ounse is reaulrcu, pct per.on: phone .:;: 1 :"M ?!A1 -Budding Department L'ccnsing Board [Scieccmen's Office f -Health Denarmcnt r-Othcr /� f Location i No. Date oJ- TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ A � Other Permit Fee „�� $ 3 TOTAL $ 3 d = Check # 6 (1 9a t -(( 4 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:DATE L/ ISSUED: SIGNATURE: Building Corrlrrtissioner/Ifor of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: U 1.2 Assessors Map and Parcel Number: 5-3 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposw Use 1.4 Property Dimensions: Lot Area Frontage (11) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided I.Malct Supply UOI.C.40 54) 1.5. Flood Zoac Infornation: 1.9 Sewerage Disposal System Public 0 -- -Pri%,stc F, 7Anc — Outside Flood Zone 0 Municipal 11 On Site Disposal System D SECTION 2 - PROPERTY OWN ERSHIP/AUTHORIZED AGENT Utter o 1T� game (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Liccnsod Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable x Company Name Registration Number Address Expiration Date I Signature Telephone V 0 Z M 90 0 on r M r r SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit mill result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......G No ....... 0 SECTION 5 Description of Proposed Work checkalI applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Altcmfions(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: T�'NT oN ��� �D�; SCr UP dN46' yo'Y K7 10 CoAfr ej'a,Q T40;r /r 444611 S4'RI-9Gllt d P1���! f//�.r a �'E'C%/D,.v f. e6ko1lF/ulr4e-T SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b4' permit applicant ORFI,CIALUSE �� .. * f , . ` �' tf' � :' ` "t, 4{' I. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fcc (.) x lbl 4 Mechanical MVAC) 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTI/O^N' 7b OWNER/AUT ORIZED AGENT DECLARATION as ON%mer/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief rGJiovlm Print Signature of Owner/Agent Date NO, Of STORIES SIZE BASEMENTOR SLAB SIZE OF FLOOR TIMBERS is[ 2"4D 3Ku SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHUv1NEY IS BL3ILDING ON SOLD OR FILLED LAND IS BUILDING CONNECTED 1'0 NATURAL GAS LINE July 27, 2005 Mr. Michael McGuire Building Inspector Town of North Andover 27 Charles Street North Andover, Massachusetts 01845 Re: Tour Andover Controls, One High Street, North Andover North Andover Mills Dear Mr. McGuire: Tour Andover Controls will be hosting their annual company luncheon at the North Andover Mills on Friday, August 5., 2005. They have requested permission from Yale Properties to erect a - tent which will be installed after 3:00 p.m. on August 4d` or early August 5t'. It will be removed by close of business on Friday, August 5d'. Yale Properties has granted permission, provided that DigSafe has been contacted and that the area is restored to its original condition. Do not hesitate to contact me with any questions. Thank you for your assistance in this regard. Sincerely, YALE PROPERTIES USA Lauren M. Whitton, RPA Assistant Property Manager cc: Ed Howlett, Tour Andover Controls Thomas A. Palmer, Schneider Automation Cross Point, 900 Chelmsford Street, Lowell, Massachusetts 01851 Tel.: (978) 453-6666 Fax: (978) 454-6394 IPJ it 7.;?Ti?JapLFrJG1U�tPr1rJ 1�1�P�P[PrJcPrJ7rJ�cP�rJ�cJ�rPtl�l�JPlc?Pf[PrJ�r�r�IrJ ' Ii J?!rJ Lo 0 o � U J co M d ... C Q. �£U E L tp 0 d7 �p v O yra C LL c C: c°a C l0 y 0 t u c 'aO u n C .. - r�mCL M 0 L E0OM- a'cu U. •f as 0 o H ar �vw r O 0 o v t 2 11 (D to E E t` 0) 0 d d� 0 L s m L U q iL F- ; •d�.�.. ----�SOZS��68Z68:oi-T - _ .w`o a� Ttii S00Z-1s-nnr 0 M 4 LL W Iri 0 z .J C �n ►J1 � N 2 w+ z �, cf o aW i w _ x 41 LL R a �� lu u ; •d�.�.. ----�SOZS��68Z68:oi-T - _ .w`o a� Ttii S00Z-1s-nnr A A 0 W td /� � c H O o H dIO a CL CCU a m c z o a 0 0 � Qi C v w Q w° a°G U �I w p I a°' w Owl fail a v �I w om c w d Ta w ra cn o Cl) -Kill 7sw RM 11 O n/ Cos CD IDO v ev y 0 CLC40 O V O cc COD OCM C 0 co o� m m 3� �D O Ing o CLCL ccc .510 CD Z CD CO)CL C IL W 0 U) U) oC W W oC W c H O dIO CL CCU m c z o 0 0 � Ea m o Co CL y om c w O O a44 � E OI y C C I 32 O: syy .5 c y O m 0 mo cm a� m :gym, CC C O; T io= W yz O CM C CL o N c c C m ui CO e0 .0 z c vi E CLC_ m.ogy Z o LAJ°C LA a :- 1 = 5 W �b.== H t J., dim RM 11 O n/ Cos CD IDO v ev y 0 CLC40 O V O cc COD OCM C 0 co o� m m 3� �D O Ing o CLCL ccc .510 CD Z CD CO)CL C IL W 0 U) U) oC W W oC W 01 Locqtion 44 No. Date NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ --�-- s: Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee` $ TOTAL $ Building Inspector r, v J j 5llc/93 1005 1, "63. GJ �• U Div. Public Works Location No. Date Np^TM TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee $� J�cNUs t� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works Q.3I F, Q �.i Ln V) UI� < c u v u y r _X NNu V„ a Z Z z Z N O a W ic�n. = = z Z m Z l�. U z 5 -Z ul 1 Y t _L L J 00 1 V7 OA rr p (J a C N a a N 2 - V• G /y� Z O CA 'n LLJ Z � 9 '�' f U 0 ? c = O - 5 ¢ ^ 'J Z Z Z ^ 1 — N r 7t 7t ? Z U Z '6 y `+ ¢ W W W Q F R O Q Q O � N_ ^qj rn V, 'z K -Ic Q V Z P -z K z Z w = -�x F a 3 z ✓i ^ " wW z 3 y W \v\r\ L �.i Ln V) UI� < c u v u y r 0 a Z Z z Z N O a W ic�n. = = z Z m Z l�. U W 5 -Z ul 1 ¢ t _L L J 00 I� V7 OA rr p (J a a a N 2 - V• G /y� Z CA 'n LLJ Z � 9 '�' f U 0 ? c = O - 5 ¢ ^ 'J Z Z Z ^ 1 — N r 7t 7t ? Z U Z '6 y `+ ¢ W W W VWI o R L �.i Ln V) UI� c u v u r 0 a Z Z z Z N O W ic�n. M Z Z' Z l�. U W 5 -Z ul 1 ¢ t _L L J 00 V7 V7 V7 rr p (J a a a N - G � f o Q � ^qj V, Q V P -z z Z w W F ¢ z ^ " wW W \v\r\ C1 L K v ^_ Z N `n c N W m Z z z z = Gn Q/ ��/� r z < " ¢ < �. W n 1L Q v, F K N M c Q tu W ` N 3 z CC U Z ¢ W 2 z X z V W Q z z n w z W W � yk z ^ z G z C n 5t w = u C = _- z Z Z<= ^ C _. LU ?Li v7 j z < 1 W L �.i z r 0 0� O t N O M 1 1 00 rr p (J a a a N - AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF ALLEGHENY ) On this 26th day of February, A.D. 1998, before me, Donna M. Dougherty, a Notary Public, duly John E. Kosar, who, being duly sworn, deposes and says that he will review the preparation of the Connector Building for Group Schneider, Water and High Streets in North Andover, Massachusetts; and that he will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by him or his registered professional Designee in accordance with the Controlled Materials Procedure therein defined. ' No. 6774 ?s BUTLER. -A PA John E. Kosar�lN Or Mt' Subscribed and sworn to before me this —2Z cloy of 17 y A.D. /99i. ------.hLota0LPu is Donna M. ouRhe , dal Notary Public Pittsburgh, Allegheny County MY Commission Expires Feb. 25, 1999 e Department of Industrial Accidents -� _-- 011lcea//n�esUgeUods • • - 600 Washington Street .3 Boston, Mass. 02111 Workers' Compensation fnsuratice Affidavit 1111, MIN 5 1 1,01,111,31637M name: location: city ! phone # C] f am a homeowner performing all work myself. E] f am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company mime: RCPV/j,LtC yy 1L014 -t; i RAC`�`l 11vG address: �. �_-0 )-t A, � T .] T ( � cphone#- q%O--T: "OIL 23 insurance -c4. fZ�,A gni �2 l CIA ►4 policy a WC 9 (i- Z70 . C] I am a -sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: companyname• address: City - phone li: insurance co.policy q PlIV11c; ft insurance co-.*: Failure insecure coverage as required under Section 25A of NICL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cert under th pins and penalties of perjury that the information provided above is true and gorrecL Signature_ LI Date Print name l0:� CS T. LAj P1 R.P Phone N l -�y `'Iso — 009 official use only city or town:_ do not write in this area to be,completed by city or town official C] check if immediate response is'required contact person: 09viw t ]NJ P1A) permittlicense # rlBuilding Department pLicensing Board oSdcamen's Office [jHealth Department phone $1. -- 00ther MllAM J. SCOTT Director Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 In accordance with the provisions 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 c 1 11, S 150A. The debris will be disposed of in: �T I—TNAT64t2 WC -7Y &-DrEWATErt— , MA, (Location of Facility) w ature of Permit Applicant Date NOTE: Demolition permit from the Town of'North Andover must be obtained for this project through the Office of the Building Inspector. 30ARD OF APPEALS 689-9541 , a ' Transmittal RECEIVED May 15, 1998 VM from: Linda Smiley MAY 1 8 1998 REPUBLIC Burt Hill Kosar Rittelmann To: cc: Associates Mr. Jim Ward Mr. Tom Palmer (transmittal) Republic Building Contractors 20 Conant Street Danvers, MA 01923 Architecture Engineering Subject/Project Number: Interior Design Groupe Schneider Connector Building Research BH Project No. 97736.01 VIVC�I�ED MAY A S1�9� REPUBLIC Shipping Method: USPS ® Enclosed ❑ Under Separate Cover We are sending you the following: ❑ Bid Documents ❑ Prints ❑ Specifications ❑ Correspondence ❑ Reproducibles ® Other �- Qfybyt D awing No Date Description I Geotechnical Engineering Evaluation & Recommendations, as prepared by Miller Engineering & Testing, Inc. Comments: Dear Jim: Attached you will find the geotechnical engineers report regarding the site for the Groupe Schneider Connector Building. You should assume to follow his recommendations regarding sitework with regard to foundation construction. The structural drawings being prepared by Foley & Buhl will be ready for issue by the middle of next week, and the architectural and MEP drawings will follow shortly thereafter. I will contact you regarding when they can be picked up at my office. 300 Brickstone Square Andover, MA 0 18 10 978.474.6405 FAX 978.474.6401 document2 Page 1 of 1 N PREPARED FOR: _Geotechnical Engineering Evaluation & Recommendations GROUPE SCHNEIDER CONNECTOR North Andover, MA April 14, 1998 RfCFIV ED R IC .ptfi3L Project No. 80116.01 PREPARED BY: Burt Hill Kosar Rittelmann Associates Miller Engineering & Testing, Inc. 300 Brickstone Square 100 Sheffield Road, POB 4776 Andover, MA 01810 Manchester, NH 03108-4776 MILLER ENGINEERING & TESTING, INC. GEOTECHNICAL / SOIL BORINGS / ENVIRONMENTAL / SOILS / CONCRETE / MASONRY / STEEL / ROOFING / ASPHALT INSPECTION Mall all correspondence to: 100 SHEFFIELD ROAD • PA. BOX 4776 • MANCHESTER, NEW HAMPSHIRE 03108 • TELEPHONE (6031668-6016 • FAX (603) 66848641 April 14, 1998 Ms. Linda Smiley Burt Hill, Kosar, Rittelmann, Associates 300 Brickstone Square Andover, MA 01810 RE: Geotechnical Engineering Evaluation and Recommendations Groupe Schneider Connector in North Andover, MA Project No. 80116.01 Dear Ms. Smiley: The purpose of this letter report is to provide to you geotechnical engineering assessment recommendations in support of the design team for the proposed Connector addition planned at Groupe Schneider Automation in North Andover, Massachusetts. Current plans include an enclosed one-story addition, which will project a footprint area of about 28.0 feet by 50.0 feet, between buildings 7 and 5W. The structure and ground floor will be supported on isolated spread footings. This assessment was based on results of an exploration program to determine the character and nature of subsurface conditions at locations of several test pits excavated by others at anticipated column footing locations. The contents of this letter report are subject to the limitations in Appendix A. Test Pit Observations On April 7,1998, six (6) test pits were excavated at proposed column locations under the direction of Republic Building Contractors, Inc. The test pits, labeled TP -1 through TP -6, were located as shown in Figure 1, adjacent to columns supporting the existing building. Test pits were excavated using a Caterpillar 416B backhoe to expose portions of the existing foundation and subsurface utilities. The test pit ranged in depth from 4.5 to 7.5 feet where dense, naturally CORPORATE OFFICE 100 SHEFFIELD ROAD • P.O. BOX 4776 • MANCHESTER NH 03108 • TEL (603) 668-6016 • FAX (603) 668-8641 130 EAST MAIN ST. • P.O. BOX 11 • NORTHBOROUGH, MASSACHUSETTS 01532 • TEL (508) 393-2607 • FAX (50B) 393-8490 U occurring glacial deposits were found. Details of the conditions are provided on the Test Pit Logs attached to this report. The test pits encountered a fill layer overlying the glacial deposits at all locations. The fill layer was 3.0 feet to 6.0 feet thick, with thickest deposits located at TP -1. Fill material consisted of brown to dark brown, fine to medium sand, some organic silt, and little gravel, with occasional presence of red brick, roots and other wood matter. Existing subsurface utility pipes at some locations were surrounded in some areas by light brown sand with little silt and gravel material. Perforated 6 inch PVC perimeter drain pipe, encased in crushed stone bedding, was embedded at approximate depths of 2.5 to 3.0 feet in the backfill layer adjacent to building 5W. Perimeter drain pipe or subsurface utility pipes were not found adjacent to building 7. Beneath the fill layer, naturally occurring, dense, grey/brown, fine to medium sand, some silt and little gravel material was found. Existing spread footings appear to be supported directly upon these deposits. Groundwater was encountered at some test pit location weeping from the sidewalls at the fill/natural soil interface elevation. Groundwater appears to be perched upon the relatively impervious glacial deposits. In addition, water was observed weeping into test pit TP -6 from joint between the existing buildings' wall and footing. The glacial soils generally were moist, not saturated indicating perched groundwater conditions. Geotechnical Engineering Evaluation The results of the subsurface exploration program indicate conditions are favorable for the proposed construction. It is anticipated that a conventional spread footing foundation system can be designed for support of the structural loads of the addition. Spread footings can be supported directly or indirectly by the naturally occurring glacial till deposits or compacted Select Granular Fill material. 2 The controlling subsurface features for foundation design and construction are: • the presence of unsuitable fill and organic materials found beneath the addition footprint area; • the presence of existing subsurface utilities and associated backfill materials; and • the presence of perched groundwater above footing grade. The previously placed fill material and organic topsoil is considered unsuitable for structural bearing purposes. Therefore, these materials should be removed from beneath spread footing areas to expose the naturally occurring glacial till deposits. Many of the filled areas are related to the existing subsurface utility locations and areas of backfill adjacent to the existing structures' foundations. Proposed spread footings should be supported at base elevations coincident with those of existing spread footings. It should be noted that some localized subgrade disturbance occurred during the test pit excavation process; therefore, during foundation construction some over excavation of loose soil and placement of Select Granular Fill will be necessary to provide adequate bearing capacity. Careful observation of the excavation process by a qualified geotechnical engineer or his representative is recommended to ensure that loosened materials are removed to an undisturbed subgrade and the resulting void is properly backfilled. During the excavation and pipe removal process, care should be taken to separate the organic materials and boulders from the inorganic granular material used to backfill the piping, as these materials may be reused to backfill around the structures' foundation elements. It is anticipated that groundwater will be encountered at some spread footing locations. Water was perched in the crushed stone/perimeter drain system adjacent to building 5W and was observed weeping from between the foundation wall/footing joint of building 7. The flow rate into the pits was slow, but continuous. Temporary sumps and pumps located close to footing trench excavations will be necessary for dewatering to properly prepare footing subgrade soils. Seismic Considerations Based upon the criteria established in the Massachusetts State Building Code for seismically induced liquefaction, the naturally occurring glacial till deposits are not considered susceptible to liquefaction due to a credible seismic event in the North Andover area. 3 Geotechnical Recommendations Based upon the engineering evaluation, foundation design and construction recommendations for implementation of a conventional shallow foundation system are as follows: • The first item of earthwork should consist of the removal of topsoil and fill material from within the zone of influence of the proposed footings. The zone of influence is defined as that area within a 1:1 slope projecting outward and downward from the bottom outside edge of the spread footings to the naturally occurring subgrade. It is recommended that excavation to final spread footing elevations be accomplished using a smooth -blade bucket or hand shovel to reduce subgrade disturbance. Existing granular fill, free of boulders and organic matter, may be used as backfill for spread footings and the foundation walls. • Following excavation, the subgrade should be proofrolled. This proofrolling should consist of a minimum of four (4) passes of a 500 -pound vibratory compactor, or the equivalent effort. Select Granular Fill material, conforming to the gradation specifications in Table 1, should be used to elevate over -excavated areas to footing grade. This material should be placed in 8 -inch maximum loose lifts and be compacted to a minimum of 95 percent of the materials' maximum dry density as determined by ASTM Specification D-1557. Care must be taken to avoid undermining the existing structures' footings during the excavation process. • Footings supported directly on the naturally occurring glacial till soils or Select Granular Fill can be proportioned using an allowable net bearing pressure of 2.0 tons per square foot (tsf). This bearing pressure assumes that footings will be at least 24 inches wide where they are placed at depths exceeding their widths and 30 inches wide where they are placed closer to the surface. If smaller footings are used, the net bearing pressure should be reduced in direct proportion to the footing width reduction. Footings designed in this manner should not experience total settlements greater than 0.75 inch. Differential settlement between adjacent footings should be less than 0.5 inch. Spread footing embedment should be at least 4.0 feet W,,. where they will be exposed to exterior temperature fluctuations. 4 • Backfill material used against foundation elements (i.e. walls and spread footings) beneath the ground floor slab can consist of Clean Granular Fill conforming to the gradation specification in Table 1. The naturally occurring deposit free of boulders and organic matter conforms to this specification. The fill should be placed in 12 -inch loose lifts, where a 1.0 -ton vibratory roller is used for compaction, and 8 -inch lifts, where walkbehind plate/roller compactors are used. These materials should be compacted to at least 95 percent of the material's maximum dry density as determined by ASTM Designation D-1557.. • In calculating the total lateral force on the foundation because of seismic base shear, a Site Coefficient of 1.0 should be used. • The final 6.0 inches of material underlying the ground floor slab should consist of Base Course Fill material conforming to the gradation specifications in Table 1. This material should be compacted to a minimum of 95 percent of the materials' maximum dry density as determined by ASTM Specification D-1557. • Representative samples of materials to be used as Clean Granular Fill, Select Granular Fill and Base Course material should be submitted to Miller Engineering & Testing, Inc. for testing to establish their optimum water contents and maximum dry densities, and to compare their gradation characteristics with the requirements in Table 1. In this manner, compaction criteria can be developed which will provide the materials with adequate strength and minimal distortion. • It is recommended that Miller Engineering & Testing, Inc. be retained to review final design plans and specifications. In the event that any changes in the nature, design, or locations of the structures are planned, the conclusions and recommendations contained in this report shall not be considered valid unless the changes are reviewed and the conclusions of this report modified or verified in writing by Miller Engineering & Testing, Inc. C • Lastly, it is recommended that a qualified geotechnical engineer or his/her representative be retained to provide engineering services during the excavation and foundation construction phases of the project. This will become particularly important to the relative monitoring of site excavations and the placement and compaction of engineered fill materials at the project site. This would allow for design changes in the event that subsurface conditions differ from those anticipated prior to the start of construction. We trust the contents of this report are helpful as you proceed with this project. If you have any questions, please do not hesitate to contact us. Very truly yours, MILLER ENGINEERING & TESTING, INC. Frank K. Miller, P.E. Vice President FKM:pam I 'I- • nr r I GRADATION SPECIFICATIONS PERCENTAGE PASSING BY WEIGHT ik SELECT CLEAN SIEVE GRANULAR BASE GRANULAR SIZE FILL COURSE FILL 8" 100 100 100 3" 70 - 100 100 70 - 100 %z" 40 - 90 40 - 80 40 - 100 No. 4 25 - 80 30 - 70 25 - 100 No. 10 15 - 70 20 - 60 15 - 95 No. 40 5 - 40 10 - 30 10 - 70 No. 200 0 - 12 3 - 10 0 - 15 ik LRV11TATIONS Explorations 1. The analyses, recommendations and designs submitted in this report are based in part upon the data obtained from subsurface explorations. The nature and extent of variations between these explorations may not become evident until construction. If variations then appear evident, it will be necessary to re-evaluate the recommendations of this report. 2. The generalized soil profile described in the text is intended to convey trends in subsurface conditions. The boundaries between strata are approximate and idealized, and have been developed by interpretation of widely spaced explorations and samples; actual soil transitions are probably more gradual. For specific information, refer to the boring logs. 3. Water level readings have been made in the drill holes at times and under conditions stated on the boring logs. These data have been reviewed and interpretations have been made in the text of this report. However, it must be noted that fluctuations in the level of the groundwater may occur due to variations in rainfall, temperature, and other factors differing from the time measurements were made. Review 4. It is recommended that this firm be retained to review final design plans and specifications. In the even t that any changes in the nature, design, or location of the structures are planned, the conclusions and recommendations contained in this report shall not be considered valid unless the changes are reviewed and conclusions of the report modified or verified in writing by Miller Engineering & Testing, Inc. Construction 5. It is recommended that this firm be retained to provide soils engineering services during the excavations and foundation construction phases of the work. This is to observe compliance with the design concepts, specifications, or recommendations and to allow design changes in the event that subsurface conditions differ from those anticipated prior to the start of construction. Use of Report 6. This report has been prepared for the exclusive use of Burt Hill Kosar R.ittelmann Associates for the proposed Groupe Schneider Connector addition located in North Andover, Massachusetts in accordance with generally accepted soil and foundation engineering practices. No other warranty, expressed or implied, is made. 7. This soil and foundation engineering report has been prepared for this project by Miller Engineering & Testing, Inc. This report was completed for design purposes and may be limited in its scope to prepare an accurate bid. Contractors wishing a copy of the report may secure it with the understanding that its scope is limited to design to design considerations only. TEST PIT LOG MILLER ENGINEERING & TESTING, INC. Project: GROUPE SCHNEMER CONNECTOR N. Andover, MA Project No: 80116.01 Date: 4/7/98 Test Pit No: TP_1 Surface Elev: Location: see plan 100 91TFHD RWD - PO BOX Ons 1 MMICFESTM, FEW HAhPM 03106 TEifRM (603) 668-6016 1 FAX (603) 668-8641 Excavation Egaipmmt Contractor Republic Building Contractors (G.C.) ME & T Representative F. K. Miller Operator Weather sunny, warm Mike Cat Model 416B 113 cu. yds. Reach 1 -Capacity DEPTH STRATA CHANGE SOIL DESCRIPTION BOULDER SIMCOUNT REMARKS 1.0 1 6" Topsoil (1) 2.0 Dark brown, fine to medium sand, some organic silt, little gravel, trace red brick (FILL) 2.0' 3.0' 6.0' 4.0' Light brown, fine to medium sand, little stilt and gravel. (FILL) 5.0' Grey/brown, fine to medium sand, some silt, little gravel. Terminated test pit @ 7.5' 10.0' 15.0' 20.0' Groundwater Observations pit Dimensions Length 100' Width 3.0' Depth 6.5' Volume Date Time Depth Remarb 4n/98 11:00 5.5' perched water REMARKS (1) 6' perforated PVC pipe with crushed stone bedding @ 3.0'. Water weeping @ pipe level. TEST PIT LOG MILLER ENGINEERING & TESTING, INC. i I Project: GROUPE SCHNEMER CONNECTOR N. Andover, MA Project No: 80116.01 Date: 4n198 Test Pit No: TP -2 Surface Elev: Location: see Alan 100 9ffFk3.D ROAD - PO BOX 4M I hiWESTEi, NM KAA-S RF 03106 MHHOiE (603) 6%06 1 FAX (603) 6668641 Excavation Equipment Contractor Republic Building Contractors (G.C.) ME & T Representative F. K. Miller Operator Weather sunny,Waw Make Cat Model 416B Capacity 1/3 cu. yds. Reach 15 DEPTH STRATA CHANGE SOIL DESCRIPTION BOULDER SIMCOUNr REMARKS 1.0 ' 4' Topsoil difficult excavating 4.0' Dark brown, fine sand, little organic silt (fine roots, wood) (FILL) 2.9 3.0' 4.0' 5.0 5.0' Grey/brown, fine to medium sand, some silt, little gravel. (Glacial Till Terminated test pit @ 5.0' 10.0' 15.0' 20.0' Groundwater Observations Pit Dimensions Length 9.V Width 2.5' Depth 5.0' Volume Date Time Depth Remarks 4x1/98 none observed REMARKS TEST PIT LOG MILLER ENGINEERING & TESTING, INC. Project: GROUPE SCHNEMER CONNECTOR N. Andover, MA Project No: 80116.01 Date: 4/7/98 Test Pit No: TP_3 Surface Elev: Location: see plan tOO %ffFHD ROAD - PO BOX 47T6lII OfM, Kula F%ftE 03108 r19.1 "E (M 01.6016 I FAX (W til Excavation Equipment Contractor Republic Building Contractors (G.C.) ME & T Representative F. K. Miller Operator . Weather sunny. Make Cat Model 416B Capacity 1/3 cu. yds. Reach DEPTH STRATA CHANGE SOIL DESCRIPTION BOULDER SIMCOUI\T REMARKS 1.0 (1) 6.0' Dari` brown, fine to medium sand, some organic silt (wood pieces) 2.0' 3.0' 4.0' s.a 6.5' Grey!brown, fine to medium sand, some silt, tt a grave . (Glacial Till) Terminated Test Pit @ 6.5' 10.0' 15.0' 20.0' Groawdwater Observations Pit Dimensions Length 12.0' Width 3.0' Depth 6.5' Volume Date Time Depth Reoasrks 4/7/98 none observed REMARKS (t) 6- diameter performated PVC pipe with crushed stone bedding @ +/- 3.0 feet Water weeping @ pipe kveL TEST PIT LOG • MILLER ENGINEERING &TESTING, INC. Project: GROUPE SCHNEIDER CONNECTOR N. Andover, MA Project No: 80116.01 Date: 4/7198 Test Pit No: TP_4 Surface Elev: Location: see plan 100 %URU ROAD - PO BOX 47761 MAWfSTEt, IfW WPSFf2E 03108 TalTHOW (601) 668-0 6 1 FAX (603) 668-8611 Excavation Equipment Contractor Republic Building Contractors (G.C.) Operator Make Cat Model 416B Capacity 1/3 cu. yds. Reach 15 ME & T Representative Weather F. K. K11er sunny, warm DEPTH STRATA CHANGE SOIL DESCRIP'T'ION BOULDER SrZF/COt1T REMARKS 1.0 4- Tnp.4;oil 2.0' Light brown, fine sand, some silt, little gravel. (fine roots, FILL) 3.0' 4.0 5.0' 5.51 Grey/brown, fine to medium sand, some silt, little gravel. (Glacial Till) Terminated test pit @ 5.5' 10.0' I5.0' 20.0' Groundwater Observations Pit Dimensions Length 10.0' Width 3.0' Depth 5.5' Volume Date Time Depth Remarks 4/7/98 11:15 5.51 perched water REMARKS TEST PIT LOG MILLER ENGINEERING & TESTING, INC. Project: Project No: Date: GROUPE SCHNEIDER CONNECTOR N. Andover, MA 80116.01 4n198 Test Pit No: TP_5 Surface Elev: Location: see plan 100 9 ERR ROAD . PO BOX 47761 MAN0f3TE t, WWWM 03106 aEPFM (603)668.6016 1 FAX (M 0.8641 Excavation Equipment Contractor Republic Building Contractors (G.C.) ME & T Representative Operator Weather Maw Cat Mold 416B Capacity 1/3 ca yda. Reach 15 F. K. Miller SU my. Warm DEPTH STRATA CHANGE SOIL DESCRIPTION BOULDER SIMCOUNr REhURKS 1.0 6- Topsoil (1) 2.0' 4.0' Dark brown, fine to medium sand, some organic silt, little gravel. (wood chucks) 3.0' 4.0' 5.0' 5 51 Grey/brown, fine to medium sand, some silt, little gravel. faIncial till) Terminated test pit @ 5.5' 10.0' 15.0' 20.0' Groundwater Observations Pit Dimensions Length 8.51 Width 2.5' Depth 5.5' Volume Date Time Depth Remarks 4/7198 none observed REMARKS (1) 6" perforated PVC pipe @ +/- 3.0 feet. Water weeping @ pipe level. FORM U - LOT RELEASE FORM 0VAV/ INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fr6m Boards and Departments having jurisdiction have been obtained. This does not reliete the applicant and/or landowner from compliance with any applicable or requirements. ***************'APPLICANT FILLS OUT THIS SECTION* APPLICANT GSL, Sdiver rz /tie Pa-OP(491HONE 9.57,3 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET > S' /c�L C� LT ST. NUMBER **************OFFICIAL USE ONLY*************** REC JA MENDATIONS OF TOWN AGENTS: ATION AD COMMENTS V TOWN PLANNER I$TRATOR DATE APPROVED LP 1/ d V DATE REJECTED ��— DATE APPROVED DATE REJECTED - FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF ALLEGHENY ) On this 26th day of February, A.D. 1998, before me, Donna M. Dougherty, a Notary Public, duly John E. Kosar, who, being duly sworn, deposes and says that he will review the preparation of the Connector Building for Group Schneider, Water and High Streets in North Andover, Massachusetts; and that he will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by him or his registered professional Designee in accordance with the Controlled Materials Procedure therein defined. O` No. 6774 BUTLER, John E. Kosar ° PA '1llk Of M1 Subscribed and sworn to before me thiso2,'-'-fay of _ A.D. Notaryy*ic'� Notarial Seel U Donna M. Dougherty, Notary Public Pittsburgh, Alieg el ny County My Commission Expires eb. 25,1999 Yt O z T 0 a a :a . UW Z 1 I CD O c• CD Z Q■ O CO) G C I C C" C CD Q ■� H O C .— m m ow L = O� .� 3 ■C CD co L � O d CM Q co C -C c c ev ■CCD Z V y c C C cc CLCA 0 C4 a a C O 7 C � c:, N 1 �. C V O ,C d C O O y'' m C ,L O z z Q c E a 1 a A a a cn as cz o w � o a: W U G w o rx tf l W oco aG w" 110 o w C ii w c as z V) .v E cn T 0 a a :a . UW Z 1 I CD O c• CD Z Q■ O CO) G C I C C" C CD Q ■� H O C .— m m ow L = O� .� 3 ■C CD co L � O d CM Q co C -C c c ev ■CCD Z V y c C C cc CLCA 0 C O 7 C � c:, N 1 �. C V O ,C d C O O y'' m C ,L O G ca E a 1 110 o O �-- t; cm CD c i E ? CL .= N R mm 0 cm Go co :L C N C O O �a� cm m a m .� m cc 0 co O Q q; a,cr 'a m 1 r�^ a O �t CO�i •y Z O .- -1 C O d cm C y m. C m � :moo a N t »- o cc E 5,LU v h o4 Qo a cm C tom„ O�O p h J O cv O C L T 0 a a :a . UW Z 1 I CD O c• CD Z Q■ O CO) G C I C C" C CD Q ■� H O C .— m m ow L = O� .� 3 ■C CD co L � O d CM Q co C -C c c ev ■CCD Z V y c C C cc CLCA 0 V^ w I P, ui 1 � O °r z c o m c c � o 2 . 1 O O v V •dam C m c O �L p E a c Es �`o m cm mi m c E y A � O r„ ; 3 cmgo c A o zip ho C C O O Em � N a 0 m C : CLL � GO O ;cc t Z O O► CM -8 o N O V N O O Z C O co C C H y O C �C S CL 3: o N m0 O Wt C A.Z.;,_ l.. e Z v �C O COD • * O " r 8 CL z 0 W W a a Z 0 Cf) 0 U U) .A —k97. 0 0 O E L �.+ O O V Z °o O y CD D C I ccm O•- y O O Q* O O m m 0 CD CL �3 CD o 0 L O d �Q c O C.) C Z CD V y C • C 0. y D a Oa0 W �qz w u w a a poa F x w 0 z ui a A u a Al x a a , a w � O z w cit 44 w V) cn P, ui 1 � O °r z c o m c c � o 2 . 1 O O v V •dam C m c O �L p E a c Es �`o m cm mi m c E y A � O r„ ; 3 cmgo c A o zip ho C C O O Em � N a 0 m C : CLL � GO O ;cc t Z O O► CM -8 o N O V N O O Z C O co C C H y O C �C S CL 3: o N m0 O Wt C A.Z.;,_ l.. e Z v �C O COD • * O " r 8 CL z 0 W W a a Z 0 Cf) 0 U U) .A —k97. 0 0 O E L �.+ O O V Z °o O y CD D C I ccm O•- y O O Q* O O m m 0 CD CL �3 CD o 0 L O d �Q c O C.) C Z CD V y C • C 0. y D At a W Z Y V I r o; W o ►- J 3 0 Z W 0 J F _J 4 0 0: Z 0 W 0 > J O P Z 0 11 U A IL 0 0 Z N Z ` I Z J z Z V O U A U. 0 LL p 00 0 Z Z n F LL C I 0 ¢ J J [ N I- Al m � i a i � y _ Z O J � m cl F W `V a i < < WW Z I z 0 Z 0 V H W W0 U t Z IJ F Arc � a' < m 0 0 0., f 0 J W 0 W C Z LL z 0 U H J W L L IL 0 O C 0 m z 0 F- i 0' LL z r It W IL 0 it L a, G) Q) cn N } � m WW � L L = U t rc 0 L < o m v W S 0 0-- 0 U 0 CO S � z � N N � f � N w r z z a 0 0 F F a VU J W W V Vl to N 0 0 0 2 J_ Z CV O _J O 0 V Al W W W 0 a r W < < N L L 4 W S 0 0-- 0 CO S � f � � � r Q J UA V ui 2 2 Z CV O 0 V L 19 FL a,urrirnurtwCucua of xtussucnuseirs Department of Industrial Accidents -- Office o//nyesUgaUons _ = 600 Washington Street z Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: Location: addres�t,.D A N f{,4 -T T (ZIT cttvz 12AMyL2,�, kkp, 0(92,5 phone #- C( ZSo'-00 insaranee co: la 0,6Vk \ M 9-1GA)4 noliev # WGq Or 2-16: .1 I am a -sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: - - ----- ---- -- ---- ----r- ....................... �.�..�......... - .......p .v r.,.+w.w ..—us one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Ido hereby cert under t e pains and penalties of perjury that the information provided above is true and coned Signature ti Date (/S -3/(n S `� p Print name TAM 6- J , W A (ZD Phone # � � �` � SO — o d ( q official use only do not write in this area to be completed by city or town official city or town: permit/license M OBuilding Department oLicensing Board 0 check if immediate response is required 0selectmen's Office pHealth Department contact person: phone q; rJOther (revised 7/95 PJA) 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR I DATE (MM/DDIYY) DATE (MM/DD/YY) PROPERTY DAMAGE 1 $ GENERAL LIABILITY < O GENERAL AGGREGATE s2,000, OOO PRODUCTS - COMP/OPAGG 52,000,000 A X COMMERCIAL GENERAL LIABILITY MAC 914-27-06 05/01/97 05/01/98 PERSONAL &ADV INJURY $ 1,000,000 EXCESS LIABILITY j{ UMBRELLA FORM OTHER THAN UMBRELLA FORM CLAIMS MADE OCCUR 05/01/97 05/01/98 EACH OCCURRENCE EACH OCCURRENCE $1,000,000 52,000,000 OWNER'S 6 CONTRACTOR'S PROT $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: REXCL FIRE DAMAGE (Any one fire) $ 50,000 05/01/98 TORY LIMITS TH- TATU-O R EL EACH ACCIDENT $500,000 EL DISEASE -POLICY LIMIT $500,000 EL DISEASE - EA EMPLOYEE S 500 , 000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY (Per Person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILYINJURY (Per accident) $ A X X HIRED AUTOS NON -OWNED AUTOS MAC 914-27-06 05/01/97 05/01/98 PROPERTY DAMAGE 1 $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS Operations usual to the Named Insured. Republic Building Cont. 20 Conant Street Danvers, MA 01923 REPU001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KJKD UPON THE QMPANY, ITS AGE14TS OR REPnSEyTATIVES. GARAGE LIABILITY ANY AUTO < O AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ B EXCESS LIABILITY j{ UMBRELLA FORM OTHER THAN UMBRELLA FORM (98) 7976-45-29 05/01/97 05/01/98 EACH OCCURRENCE s2,000,000 AGGREGATE 52,000,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: REXCL WC9142707 05/01/97 05/01/98 TORY LIMITS TH- TATU-O R EL EACH ACCIDENT $500,000 EL DISEASE -POLICY LIMIT $500,000 EL DISEASE - EA EMPLOYEE S 500 , 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS Operations usual to the Named Insured. Republic Building Cont. 20 Conant Street Danvers, MA 01923 REPU001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KJKD UPON THE QMPANY, ITS AGE14TS OR REPnSEyTATIVES. ` Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street J. SCOTT North Andover, Massachusetts 01845 Dlriector In accordance with the provisions 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 tvfGL c 111, S 150A. The debris will be disposed of in: F Z, f 4 A Tc t -f ,�, o A p� \46.5-T m, -q E W AM,- ftp I JV- A- (Location of Facility) J vv Si nature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Once of the Building Inspector. 3OARD OF APPEALS 688.9541 BUIIAING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9533 Location No. ~Z^"" Date MORTN TOWN OF NORTH ANDOVER p Certificate of Occupancy $ • ; : Building/Frame Permit Fee $ Foundation Permit Fee $ ss�CHU Other Permit Fee $ Sewer Connection Fee $ } Water Connection Fee $ TOTAL $ '6 ,, Building Inspector Qk /03/98 11:04 895.40 PAID Div. Public Works as a 0Ia 0 0 m 0 - W N N a V m N N U- m W W > 3 m _Z W J Z W o f J 0 J F m p 2 al m n _ m W 0 0 H O U 0 IL OM 0 Z W %, m m Lt in 0 I 0 z f aC 0 W N< i C N d z m mIL o m O H z 0 Q IL lK )U V O7 — z J D 0 lu o z p j z 0 j x O 3 �. •� o J (A m I N� LO N W LY aC Z W 6 < W m z Z < 0 0 Z 0 z z < 0 H �. W it U IL W W F O z IZ U z Z u N ,N 0 0 O < m O P r n W mI CC W 0 LC 0 Cr W C m W z Y u �I W H Z 0 C 4 0 J LL 0 < W K 0 z F 0 0 4 0 W N; W z 0 _z J m''' N I H W 0 0 U 4 0 m H Z W I W Ci 17 O CC 0 i « 0 4 z O U 0 _Z O J 7 m J J 0 o V` z 7 m J z C J 0 z r� u 0 J J F i 7 m ( z W v m W I > m ` � N W N V-- z O j I t N C-0IL , � C I < tll N L O J z Z a W O O W IL f Q 0 z z 0 4 W W` C i I W m a i 0 ~ a F a w N co O O_0 0 m J J_ z'' v g 0. } m F 0 t ; co V1 s� W W r W p W W 0 4 d Wa e z 0 U U C d W W V I L F (U� p O G O d< ~ H :.J () J J J U W Z 4 Q F Z0 W j 0 W w 0 a - O V 0 = 0 o V` z 7 m J z C J 0 z u 0 J J F i 7 m ( z W v I > m ` � N W N A z O j I t N N � C I < tll N L O J z Z a W O O W f 0 z W W W W` C C q W m a z 4 W o ~ a F a w N IL a O_0 0 m J J_ _ W 0. F 0 N F m W W 0 W 0 4 d N 4 4 0 o V` �U � W 7 m J z C J 0 z 0 J J F i 7 m z W v I > m ` C W W N A C O I t j I)o I O i z � C I < O J K W Z W 0 W f 0 z m 7 W W` C C q W ,~ W z 4 W o 1 W C w IL a L Y DEPRRihENI 0' FUCLIC RrEiY CONSIP,UCHON SUPERVIS01' LICENSE i�. Nu®her: Expires Birthdate •S 04S457 03/08/1999 03/08/19b4 1 Restricted To: 00 JRhES H BURN: r Town of North Andover OFFICE OF?°.� •. �< , COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street +,°> North Andover, Massachusetts 01845 �, ..•� �� WK11AMJ. SCOTT �Ss�c►+us�1 Director In accordance with the provisions 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 c 111, S 150A. The debris will be disposed of in: t 1rot2>✓5-C S , , tfc A(>2o27 d, P� (Location of Facility) 1 r Signature of Permit Applicant a Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Once of the Building Inspector. r r BOARD OF APPEAU 688.9541 BUILDING 688-9545 CONSERVATION 6W9530 HEALTH 688-9540 PLANNING 688-9333 TI__!�______________L•_ _testi • � Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify u er the pains and penalties of perjury that the information provided above is true and correct Signature - Date S` 8 Print name ES v ARS fLcS L 1Jt+�� Phone # " oo I official use only do not write in this area to be completed by city or town official city or town: permit/license # I1Building Department oLicensing Board C] check if immediate response is required OSelectmen's Office pHealth Department contact person: phone #; rnOther (revised 3/95 PIA) r 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 relie El, the applicant and/or-lar;downer from compliance with any applicable or requirements. . rlr� s ru s n OUT THIS !�!'-/�Tl/Tll�Ft�tl'*�'�'k�'�4�F�i?4���'�YIF�k�Fi A-rLICANT rrc:LS OU t T HIS act. � IO:v APPLICANT Gn Wives Lvvn 11w r^,SS2SSOt S 11r^ap "Umber SUB6 nost.01� STREET 1 0 /22 Ci/zee� -,— RECOMhiENuATI �ielS OF T OvvN AGENTSm CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS PHOGNE 7$-75a-00?? QA df`Ci r !41ivs. � 'LOT (J)/ S 'T No MISER USE DATE APPROVED nA[ae "rcre ,,,,TIE IE REE& --11 I -IJ DATE APPROVED DATE RE�EC T LIn.J DATE APPROVED ^ATE R-JECTE^ DATE APPROVED ►MATE RE IECT`ID. vez 1 L. PUBLIC 'v`rORKS - SEWERIWATER CONNECT IONS DRIY�EYVA I-rnlC.l�Norr EIRE DEPARTMENT - RECol EIVE0a OLD( pvowl ILD1iYeT I lS.P EvTvR DA T AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF ALLEGHENY ) On this 23rd day of February, A.D. 1998, before me, Roberta G. Young, a Notary Public, duly Peter H. Moriarty, who, being duly sworn, deposes and says that he will review the preparation of Tenant Improvements for Groupe Schneider, Water and High Streets in North Andover, Massachusetts; and that he will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by him or his registered professional Designee in accordance with the Controlled Materials Procedure therein defined. Peter H. Moria A4 Subscribed and sworn to before me this ca�3 day of A.D. ' �Toiary Ptd' is v Notarial seat Roberta G. Young, Notary Public Pittsburgh, Allegheny County [my Commission Expires May 17, 2001 Mem*. Pennsylvania Association of Notaries AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF ALLEGHENY ) On this 23rd day of February, A.D. 1998, before me, Roberta G. Young, a Notary Public, duly Peter H. Moriarty, who, being duly sworn, deposes and says that he will review the preparation of Tenant Improvements for Groupe Schneider, Water and High Streets in North Andover, Massachusetts; and that he will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by him or his registered professional Designee in accordance with the Controlled Materials Procedure therein defined. Peter H. 7ona !) Subscribed and sworn to before me this 33 day of )tLt"A.D. 1991'. -W, Notary Public rvutg.- Public Roberta G. Young, Notary pitt3burgh, Allegheny Co 17y2QoI My Commission Expires May Membtr, Pennsylvania Assodafion of Notaries AFFIDAVIT FOR ARCHITECT AND ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF ALLEGHENY ) On this 23rd day of February, A.D. 1998, before me, Roberta G. Young, a Notary Public, duly Peter H. Moriarty, who, being duly sworn, deposes and says that he will review the preparation of Tenant Improvements for Groupe Schneider, Water and High Streets in North Andover, Massachusetts; and that he will review and/or provide for the proper checking of all the working drawings and shop drawings for construction; and all modifications to the existing structures will be designed for construction in accordance with applicable provisions of Chapter 1, Section 116, Massachusetts State Building Code, and that such plans conform to all the applicable provisions of the Massachusetts State Building Code, and that all the materials used in the construction will be selected by specification by him or his registered professional Designee in accordance with the Controlled Materials Procedure therein defined. Peter H. Moria A-6Subscribed and sworn to before me this day of A.D. �. /r is Notarial/S�al Roberta G. YoungMary Public Pittsburgh, Allegheny County My Commission Expires May 17, 2001 Membir, Pennsylvania Association Of Notaries h 0 Z4 40 P O Is � qL-,,., .1.1 14 O •:1 Q� r�� O CD CD Z d O y � C cm CA O O 'i mabut m Lm = 3� O 00 L. O d CL , cn< ca O y.r c ea v C CD �..± ca O C C _c CL CO) 0 a v w a wa a a N a o yv co c U w a a w" "� w m oC w w V o w w" w E m z b cn eo cn O Is � qL-,,., .1.1 14 O •:1 Q� r�� O CD CD Z d O y � C cm CA O O 'i mabut m Lm = 3� O 00 L. O d CL , cn< ca O y.r c ea v C CD �..± ca O C C _c CL CO) 0