Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - Bldgs 12+12A
� ?klp ©mCO) J#w@ °°OD$ q%kd OD 14 cp OD w dD S a k 0 @ � CD \ S 3? B J c7r ) \ Q co � �k r 7 Of NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING om Thiscertifies that ... ................. ....................................................... haspermission to perform ............................................... wiring in the building of ...... <�- t�� .............................................. ....... .... -12North Andover, Mass. ...... ........ .. at .... ........ . ..... . ............. Lic. . . ........ ELECTRICAL INSPECTOR 02/16/9912:22 M WHITE: Applicant CANARY: Building 190q, PA'PINK Treasurer TaEC0AM0AWEAL7H0FMASS4CHUS= office Use only DEPARTMENTOFPUBLICS4= Permit No. BOARDOFMEPREVFM70NREGUTATIOA SS2� ' Occupancy & Fees Checked APPLICA.TIONFORPERMITTO PERFORM=CTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 21(12 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) jot A Owner or Tenant 1 A (! / ,v , r, �, (•, P l I �r ,� e �,er I ems. .� ' `� �-ei cr„ ��rY Owner's Address Is this permit in conjunction with a building permit: - Yes ® No a (Check Appropriate Box) Purpose of Building Utility Authorization No. v Existing Service Amps? 77/ Volts Overhead ID Underground M No. of Meters New Service Amps_ / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .F No. 6f Lighting Outlets No. of Hpt Tubs No. of Transformers Total KVA _ Nlof Lighting Fixtures Swimming Pool Above ground M Below ground Generators KVA No. of Receptacle outlets /ry �1 No. of Oil Burners No. of Emergency Lighting Battery Units 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 No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Self Contained No. of Dishwashers Space Area Heating KW Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices / KW (j Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No..rlydro Massage Tubs No. of Motors Total HP OTlk- R IrtstrartceCo� Ptasuart�therac�ana��Gateailaws Iha%eaaxratLiabhykwr&=Pohcym ltdngCar>piete Cae'aW� cristitialegivalat YES F NO IlmeabnkedNebdptocfcfsmr1othe0fne YES F1 NO a IfyoulmedrdcedYFS,pleseintt *therpeot'mwrWbyd the © B� OTR a ) a�dExpiraticnDate vakrdE]eonk2lwair-OGO- sig� k$ WakmSW 2 /it (,q_. htspe`ticnD*Ra� Rough (.�< Fetalcid u xkrTe �1 FIRM NAME DCC e 1 e. Lio�seNa��� L/7/Z S �e'c.Yv e LicenseNo &t�nessTeLNa 436C—:-7Addm�S�1 7&'� < « A1tTel. Na OWNER'SANER;Iamawat dAtheLic=doesnot hgwthe-msuare a-dss±qatialeqmvalatasmgmuJbyMssadnseZCffrralLaus aodfhetn ysigrt>r=cnthis petmitapp5xbmv a'Nesthis m4 i velem (Please check one) Owner = Agent Telephone No. PERMIT FEE $ Location 54 Nd 1.2 J 1,?A- No. S Date 4-41-01 TOWN OF NORTH ANDOVER o F 9 i Certificate of Occupancy $ 1'�s'•^°''��' 9 cMusBuilding/Frame /Frame Permit Fee $ a 7 131 s�t Foundation Permit Fee $ Other Permit Fee �, $ TOTAL $'�� 3' Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING g;ariw,x._,y� "rte,-•r.rv.ci'�Cv r,'� ,�€-" This Section for Official Use Onl x ; BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: BuildiN Commissioner/Inspector of Buildings Date T � � � 1.2 Assessors Map and Parcel Number. / 4 16L A- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area'(sd Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal On Site Disposal System ❑ 14i`. yrs ff gyiN 2.1� of Record jOwner 71Tff- Nake (Print) Address for Service: ►-r ?�- ���- �� 8 Signature Telephone 2.2 Authorized Agent M—oLic -Ik 92�7 /e - l z,4 Name Pnnt Address for Service: A- f�'©- l k Si Telephone ff%�01111 0114 3.1 Licensed ConstructionSupervisorNot Applicable ❑ J �"�- 15UR 1\iS Qy�� Address r License Number {j -,� /� a a!� c) Licensed Constructio pervisor Expiration Date b ign re Telephone egistered Home Improvement Contractor Not Applicable ❑ ` Company Name Registration Number 1 Address Expiration Date Signature Telephone 0 Tm N z z M Lz �I 0 D 3 r v M r r z ^^ Q `SECTI()N'4 - &' 1" Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea .......❑ No ....... ❑ SECTION S - PROFMONALDW 10 CONSTRUCT ON SERVItAS � IJR; � �ttGS i �"�`#tU�'I lR�S SUMCT T�? CONSTRUCTION CO O . P '�i Ti)' ' 1R 1 f C+dNT f 1 Q THA1 I3 35,i GTk'. DF )E Ci 1SED 'A 5.1 Registered Architect: US �)DS6rQ ftc- soCci-tasJ!UC Name: � 19 Quo �--► Stene 1� � �� C . �a Address suEc Signature Telephone :5.2 Reg(sGercd.Prafessist�►a� Eneet�s�:; Area of Responsibility \ Name: Registration Number Address: l Flo? SCr�C P e 3 P� (J 0 �! /�q N4,,�jV I Expiration Date SignaturreS Total �9- Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Name Address E Expiration Date Signature Telephone Company Name: Not Applicable ❑ Responsible in Charge of/Construction New Construction ❑ Existing Building ❑ Repair(s) ❑ TAlterations(s) /1' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ZW�(cio2 '�Ze(NcL � ct,) rta Oftox Q8,, cco - Co? -le �C3 f - TSL r-\ S P , Qgytd!$(/ kunkin, kw—y,/C QW,17 5 S, (Aele —f T%/e - ❑ Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT C,/ Al�,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -I ❑ A-4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 113 ❑ ❑ B Business 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT C,/ Al�,as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date I, 5lj(r-Ns(14ALIfCJl �S as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury — �:&Ps Print Name — j--- 1-t-0 � S�j of Owner/Agent Date Item Estimated Cost (Dollars) to be r Completed by permit applicant 1. Building llL (a) Building Permit Fee I� S66. 00 �C Multiplier 2 Electrical (b) Estimated Total Cost of 0 ( Construction from (6) 3 Plumbing a Building Permit fee (s) x (b) n q 3 a ©� 4 Mechanical (HVAC) nqloo Go 5 Fire Protection Boo 00 6 Total (1+2+3+4+5) Q) Check Number }c 3 S. i 1 BMW £ Yi:f 1.r1: -:: Y: ;t 4S t V 1,9' §-1.....� T'' `l�tn 4c t/�i. kM1y.:.� -�f Z{ Kfdfw�l., .+' f+� i' { h M14 2, SyV'w..ti :3 �v ✓ -, NN i i _z {.[3� : "y +T` ,.xx'i �uf�'�3` . _ .w ,. .. ..a i�x ..:�[ �'� .Hxv .'� S.x -:� ). •awS, £ ..x. ... e.,..e.1 .Vi : •�`' a,; 5� "C.h. } �,.y i, 1 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2ND 3 P SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Nx ��-Widll 11. ON FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards .and Departments having jurisdiction have been obtained. This. does not relieve the applicant and or landowner from compliance with any applicable requirements. Ittttttttttttttttrttttttttrttrtttttttttttttttttttttttrtaatttrttttttrtrtrtta■ APPLICANT Y#le PON41 M1M rMfiq '�J �h�PHONE 270" (y8d- 9y9V ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION �) J LOT NUMBER cru FFT / f %� 9l, �T Req %Zt i Z� STREET NUMBER I�ttttttrrtrtwrtrrtrr0ttta OFFICIAL USE ONLY Irtttttttrttttrtttrttarrrrrttt'■trtrtrttttttttrtttttttrrrtrtttrtttrttrrrtrtr•. RECONEVIENDATIONS OF TOWN AGENTS tt as t t r soon Romano tttttt tr/ttttttttttttt■ttttttttttttt'l tttttttttttttrtttt a 0 COMMENT'S PUBLIC WORKS - SEWER / WATER CONNECTIONS 0 1 FIRE CONOAFNTS DATE APPROVED / DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE DATE APPROVED CONSER VATION ADMINETRATOR DATE REJECTED COM1viENTS DATE APPROVED TOWN PLANNER DATE REJECTED COArIIvIENT S DATE APPROVED FOOD INSPECTOR -'HEALTH DATE REJECTED DATE APPROVED. SEPTIC INSPECTOR - HEALTH DATE REJECTED COMMENT'S PUBLIC WORKS - SEWER / WATER CONNECTIONS 0 1 FIRE CONOAFNTS DATE APPROVED / DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE YA�LJJLJ May 24, 2001 Michael McGuire Building Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Dear Mike, We have reviewed the proposed construction documents for the interior build out and modifications to Building No. 12/12A, 39 High Street, North Andover Mills Complex for our tenant's subtenant — Aurora Imaging Technologies,_ Inc. and `approved as noted' the following construction documents — LPS DESIGN ASSOCIATES, INC. (dated 5/11/01) Drawings T-100, EX -100, PH -200, D-100, LS -200, A-200, A-300, A-800 HF LENZ COMPANY (dated 5/4/01) Drawings M-0, M-1, M-2, M-3, E-1, E-2, E-3, E-4, Revision 1 dated 5/11/01 HF LENZ COMPANY (dated 5/11/01) Drawings E-5 Attached please find three (3) complete sets of plans along with affidavits from all necessary architects and engineers involved. If you should have any questions in regard to these construction documents, please do not hesitate to contact my office at any time. We would like to thank you in advance for your time in reviewing these documents as quickly as possible in order that we may commence construction and realize critical time elements. Sincerely, Y C - David G. Cohan Property Manager for North Andover Mills Yale Properties USA, Inc. One High Street, 1St Floor North Andover, MA 01845 C CE Ea WAY 2 52001 BUILDING DEPT. cc: James E. Lesko 111, Regional Manager for Yale USA, Inc. Gunther Sauntag, Facilities Manager for Aurora Imaging Technologies, Inc. James Mclsaak, Brooktrout Technologies, Inc. Jim Ward, Republic Building Contractors Anthony Cartwright, Republic B i Contractors File, NAM Management Office One High Street, North Andover, Massachusetts 01845 Tel.: (978) 682-8708 Fax: (978) 682-8713 Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax. (978) 688-9542 DEBRIS DISPOSAL FORM ¢ tAORTH O t COCIH[M� K■ 1 \ G �a 0A4TFff %Pp y.tS In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit. # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: \A 1 r scc) - (No Facility location oiature of Applicant Date NOTE. A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. ARCHITECTS AFFIDAVIT To the North Andover Building Department: I certify that the work associated with Building 12 & 12A Water & High Street - North Andover, MA, and to the best of my knowledge, information and belief the construction documents (Phase Two) have been done in conformance with the provisions of the Massachusetts State Building Code and all pertinent laws and ordinances. May 11, 2001 A. W Louis A. Porcaro Mass. Reg. No: 19 Broadway, Stoneham, MA. 02180 Address INFORMATION & INSTRUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law" 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 section 25 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, 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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 Fax # (617) 727-7749 Telephone # (617) 727-4900 ext. 406, 409, or 375 APPLICANT INFORMATION Name: The Commonwealth of Massachusetts Department of IndustrialrAccidents Office of Investations 600 Washington Street Boston, .A 02111 Workers' Compensation Insurance Affidavit Location: City: Telephone #: ❑ I am a homeowner performing all work myself. ❑ I am sole proprietor and have no one working in my capacity 9I am an employer providing workers' compensation for my employees working on this job Company ITAJc Address: SLk -k- &� City:�f1U eQ f' (9 Telephone #: Insurance Company: C 410 r , � L Policy #: Please PRINT Legibly ❑ I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: Cry: Telephone #: Insurance Company: Policy #: Company Name: Address: City: Telephone #: Insurance Company: Policy #: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 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. 1 do hereby certify under the pa's nd penalties of perjury that the information above is true and correct Signature: Date: _ 0? of V0 Print Name:Phone # Official Use ONLY - Do not write in this area City or Town: Permit/License #: o Check if Immediate response is required ❑ Building Department ❑ Licensing Board o Selectmen's Office D Health Department 0 Other z BOARD OF BUILDING REGULATIONS License: CONSTRXTtON SUFMERViSOR Number. CS O455: Birthdate: 03108/1964 Expires: 03/08/2001 Tr. no: 8194 Restricted To: 00 JAMES H BURNS 23 SADDLE HILL RD BOXFORD, NIA 01921 Administratcr ARCHITECTS AFFIDAVIT To the North Andover Building Department: I certify that the work associated with Building 12 & 12A Water & High Street — North Andover, MA, and to the best of my knowledge, information and belief the construction documents (Phase One) have been done in conformance with the provisions of the Massachusetts State Building Code and all pertinent laws and ordinances. Louis A. Porcaro Mass. Reg. No. 19 Broadway, Stoneham, MA. 02180 Address C H. F. LENZ COMPANY AURORA IMAGING TECHNOLOGY, INC. FIRST FLOOR, BUILDINGS 12 AND 12A NORTH ANDOVER MILL, WATER & HIGH STREETS NORTH ANDOVER, MASSACHUSETTS Drawing List (Affidavit) HFL File No. 2001-0170.01 MECHANICAL Date Date Drawing No. Title Issued Revised M-0 Symbols, Abbreviations, and General 05/04/01 - Notes M-1 First Floor Plan Mechanical 05/04/01 - M-2 Mechanical Details 05/04/01 - M-3 Mechanical Specifications 05/04/01 - ELECTRICAL WRM Affidavit DrawList0504011GKR Date Revised Rev. # Rev. # Date Drawing No. Title Issued E-1 First Floor Plan - Power 05/04/01 E-2 First Floor Plan - Lighting 05/04/01 E-3 Symbols and Abbreviations and Electrical 05/04/01 Specifications E-4 Panel Schedules 05/04/01 WRM Affidavit DrawList0504011GKR Date Revised Rev. # Rev. # H. F. LENZ COMPANY AFFIDAVIT FOR ARCHITECT & ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF PENNSYLVANIA COUNTY OF CAMBRIA On this 4th day of May, 2001, before me, the undersigned notary public, personally appeared William R. McGhee, P.E. who being duly sworn, deposes and says that he has reviewed the preparation of the design plans on the attached drawing list for Aurora Imaging Technology, Inc. (First Floor, Buildings 12 and 12A, North Andover Mills, Water & High Streets, North Andover, Massachusetts), and that he will 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 Article I, Section 127, 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. OF fdg0s9�t pZ WILLIAM R. yN McGHEE vMECHANICAL No. 35320 Ql S7EP�� S-ONALEN William R. McGhee, P.E. Massachusetts Certificate Number 35320 H.F. Lenz Company Subscribed and sworn to before me this 4th day oWay, A. D. 2001. Notarial Seal Michele L. Zimmerman, Notary Public Richland Twp., Cambria County My Commission Expires Mar. 17, 2003 Met�ber. P�„ , ;, ,. ,- , k, oci?flarT r,+ wlaries 7-1 6 z 1 W Cd i� . � f c c v X91 s 16 c= cc H C C �:•CML Cc� m C -ESP T to ca CF . O A s • N • E c �Am c.. •U. cm L o. E co�m3�r N � ycc = c :s t N . m o 73 CD CL8 CD N o a y :... = � c c . C N Q �.4oCl 16- m i V y Z O C ` O C CL :d r N m v m COD w ZLLJ m NJ O tea. Cr � cm F •N d Z O C Z �E c • 0 � CLui c.�o N ¢O CO3 a' m:e O� J = eya � c m C s 0..• a•.t.. ig � Ju 0 ICD o, O c CD�- y 3 a �� 3.0 co O CL O O CL cmac oCc v J •� O C Z 0 0 CL V y C CL C C CO) c 0 Lij C!) crW w crW u O W O r as u° x w00 . � f c c v X91 s 16 c= cc H C C �:•CML Cc� m C -ESP T to ca CF . O A s • N • E c �Am c.. •U. cm L o. E co�m3�r N � ycc = c :s t N . m o 73 CD CL8 CD N o a y :... = � c c . C N Q �.4oCl 16- m i V y Z O C ` O C CL :d r N m v m COD w ZLLJ m NJ O tea. Cr � cm F •N d Z O C Z �E c • 0 � CLui c.�o N ¢O CO3 a' m:e O� J = eya � c m C s 0..• a•.t.. ig � Ju 0 ICD o, O c CD�- y 3 a �� 3.0 co O CL O O CL cmac oCc v J •� O C Z 0 0 CL V y C CL C C CO) c 0 Lij C!) crW w crW u Film H. F. LENZ COMPANY June 20, 2001 Mr. Mike McGuire Building Inspector Town of North Andover North Andover, MA Subject: Aurora Imaging Technology, Inc. First Floor, Buildings 12 and 12A North Andover Mills, Water & High Streets North Andover, Massachusetts HFL File No. 2001-0170.01 AFFIDAVIT FOR ARCHITECT & ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS COUNTY OF ESSEX The tenant improvements for Aurora Imaging Technology, Inc. at Buildings 12 and 12A, First Floor, Phase 1, were constructed in c nfor ance with the construction documents issued for building permit dated 5/-.3://0/ , Permit # Z.S` in accordance with 780 CMR Commonwealth of Massachusetts building code. During the course of construction, representatives of our office made periodic visits to the site to observe the progress of the work. H OF MAS 09�y William R. McGhee, p WILLIAM R. G P.E. !dcGHEE R, Massachusetts Certificate MECHANICAL � No. 35320 Number 35320 -o�OA SGIST6PNG��`��� H.F. Lenz Company /ONAL E Subscribed and sworn to before me this 20th day of June, A. D. 2001. /►(y "rpm 1331VrJ /')-0/-01"0 FIS H. E LENZ COMPANY August 1, 2001 Mr. Mike McGuire Building Inspector Town of North Andover North Andover, MA Subject: Aurora Imaging Technology, Inc. First Floor, Buildings 12 and 12A North Andover Mills, Water & High Streets North Andover, Massachusetts HFL File No. 2001-0170.01 AFFIDAVIT FOR ARCHITECT & ENGINEER THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASSACHUSETTS COUNTY OF ESSEX The tenant improvements for Aurora Imaging Technology, Inc. at Buildings 12 and 12A, First Floor, were constructed in conformance with the construction documents issued for building permit dated r 1 _ , Permit # 9L,6-7 , in accordance with 780 CMR Commonwealth of Massachusetts building code. During the course of construction, representatives of our office made periodic visits to the site to observe the progress of the work. .Z�. William R. McGhee, P.E. Massachusetts Certificate Number 35320 H.F. Lenz Company Subscribed and sworn to before me this 1st day of August, A. D. 2001. Notary Public LPS D E S I g N A S S o c 1 A T E S, I N C. ARCHITECTS FINAL AFFIDAVIT To the North Andover Building Department: ARCM TECTURE INTERIOR DESIGN I certify that the work associated with Building 12 & 12A Water & High Street - Phase Two — North Andover, MA,and to the best of my knowledge, information and belief the above mentioned project has been constructed in 1P conformance with the Architectural construction documents and meets the provisions of the Massachusetts State Building Code and all pertinent laws and ordinances. August 1, 2001 8862 P. Louis A. Porcaro Mass. Reg. No. 19 Broadway, Stoneham, MA. 02180 Address 19 BROAdwAy STONEh AM, MA 02180 TEI: 781.279.2016 FAX: 781.279.1175 ARCHITECTS FINAL AFFIDAVIT To the North Andover Building Department: I certify that the work associated with Building 12 & 12A Water & High Street - Phase One — North Andover, MA and to the best of my knowledge, information and belief the above mentioned project has been constructed in conformance with the Architectural construction documents and meets the provisions of the Massachusetts State Building Code and all pertinent laws and ordinances. lune 18, 2001 Mass. Reg. NO. 19 Broadway, Stoneham, MA. 02180 Address Location No.�i r) a Date NORT►i TOWN OF NORTH ANDOVER 3jo� t,`•o •,�oL A Certificate of Occupancy $ Building/Frame Permit Fee $� ��b',•�'''<�' Foundation Permit Fee $ m ssAcMust Other Permit Fee $ _ Sewer Connection Fee $ Water Connection Fee $ TOTAL A lkL.� Building Inspector r �, (2116/94 12:12 1} 462, pp )� 2`63- . 6 3 Div. Public Works f-, I Q tj 0 N � z C � C W z LL •_ G G- W r Ln tl n � n L � L. z o. Ln9 v ry uj r •- U N u z C 2 r. y L ? - Er t:1 J < C C rN_ d in CN E' X C L Q G.. z � z z C.QL� r ^ Y N Y N N � V W Z C., JJ '.0 . J C z z - m Q - tt x Z 2 N z z z ljv u Z C' ►.. - n - :n 2 N N N n � V �• W Q \q W W 5 W < U U y Z x UJ UJ LL W , V� ly C ? N n J 's. z a ^ _ - LU W1 V r d N Qz LU pLLI C ^ z z ce O YL Z C Z ^ fla r LL ryK iI s O L :v z � 0 N . 4i z C � C W z LL •_ G - f W r Ln C Z n � n L � L. z o. Ln9 v ry uj r •- U y z C 2 r. y L ? - Er t:1 J < C O L :v z � 0 . 4i u - O L :v z � 0 . 4i .. J a a y W 3 r •- U j OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER �'►: ; '% CONSTEWCTIQN CONTROL PROJECT NUMSER: PROJECT TITLE: inter SPEED, Inc. PROJECT LOCATION: North Andover Mills, Water and High Streets NAME OF BUILDING: Buildings 12 and 12A NATURE OF PROJECT: Tenant Fit -Out IN ACCORDANCE WITH ARTICLE 118 OF THE MASSACHUSETTS STATE BUILDING CODE. IWilliam R. McGhee REGISTRATION NO. 35320 BEING A REGISTERED PROFESSIONAL ENGINEERIASHIT156H HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISEO THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL Q FIRE PROTECTION ❑ ELECTRICAL El 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 BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIOOIC BASIS TO DETERMINE THAT THE WORK IS PROCEIEEOING 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 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. PldRSWANT Te Not part of 'Ili 2 1 SHAH= � our Professional UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE Contract. SATISFA!+,'TORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPAN Architect to Ovide. fl. - /I// SIoIwTURE SUESISED AND SWORN TO BEFORE ME THIS 8th DAY OF February 19_ 99 ZIP N A tu MY COMMISSION EXPIRES 0101 ra, otary Public al Twp., Somerset County My o fission Expires March 3, 2001 ki.—K— aonmvivnnin association of Notaries : FORM U - LOT RELEASE FORM IN 'T4CTIONS: This form is`VbOgTto 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 PHONE LOCATION: A ssors Map Number PARCEL dW SUBDIVISION t LOT (S) STREET �knS` j - ST, NUMBER ---TM- ---------*--•.***r******""""**"OFFICIAL USE ONLY**`"„**-*" "" RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED. DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT � PECTO--�G DATE / � �- FIRE DEPARTi";VT 1 C �l RECEIVED BY BUILDINC s 444 i C r s !� a z a w N w i w a, N A O = N 1 • ter: - '- s 444 i C r The Commonwealth of Massachusetts Departmenttof Industrial Accidents Me 01layeS1192118as 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit city phone # ri I am a homeowner performing all work myself. <] I am a sole proprietor and have no one working in any capacity am an employer providing workers' 'compensation for my employees ,working -yon thiis job. SQ.11lpiiG.Y name:Is- address• p SitY- DA61 Utlzls f 9 Z3 phone #: 7 / S � /J�� _06 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: company name., address: kyr phone # insurttncrco; Qolicy #. com name pHIlY . gddress. city: phone #. insnrance-co, Failure to secure coverage as required under Section 25A of NIGL 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 5100.00 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. 1 do hereby certify un er the pains and pena ' s of perjury that the information provided above is true and correcto, Signature Date Print name \A of iv� �% �.L J Tone # otTcial use only do not write in this area to be completed by city or town official city or town: permit/license p t-1 Building Department ❑Licensing Board 0 check if immediate response is required C]Selectmen's Office C]Health Department contact person: phone t/; 00ther (rovucd 3195 PIA) Town of North Andover _ GFFICE OF COMMUUITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number 0 cRa is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: leoc4eska l ofd b�Sp6,z- (Location of Facility) fL In{9 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-BuRdingJnspect r BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ' OFFICE OF BUILDING INSPECTOR off, ,4 3: TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL s�'4. ✓gin S=uw` PROJECT NUMBER: PROJECT TITLE: I tVT' m6nU2 , INC PROJECT LOCATION: Noirrg A woyem M t ues ,UJAMS - HI&NSTrzesTS NAME OF BUILDING: r�butLpi m& 12 $ ISA NATURE OF PROJECT: TE W A&):P F-1 Z - OLJ'i IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, L.,l uta '�SMIL-ey REGISTRATION NO. 100$0 BEING A REGISTERED PROFESSIONAL?/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL U STRUCTURAL ❑ MECHANICAL ❑ 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 BE PRESENT 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 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. 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. 1GNATURE SUBS IBED AND SWORN TO BEFORE ME THIS DAY OF 19 NOTARY PUBLIC ke1')da' Lee— ri%r�etsse- MY COMMISSION EXPIRES 02/06/99 MON 15:01 FAX 814 269 9301 r OFFICE OF BUILDING INSPECTOR TOWN QF NORTH ANDOVER CONSTRUCTION CON_TR� H. F. LENZ PROJECT NuM®ax: PROJECT TITLE: inter SPEED, Inc. PROJECT LOCATION: North Andover Mills, Water and High Streets NAME OF BUILDING, Buildings 12 and 12A NATURE OF PROJECT: Tenant Fit -Out IN ACCORDANCE wARTICLE 199 OF THE MASSACHUSETTSEOiRATION NOuILD15 20 ODE. I William R. McGhee BEING A REGISTERED PROFESSIONAL 6 s D TEI)M9* T PREPARATION OF ALL DESIGN PLANS HAVE PREPARED OR DIRECTLY COMPUTATIONS AND SPECIFICATIONS CONCERNIN3: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL Q FIRE PROTECTION [3LJ OTHER (SPECIFY) ELECTRICAL FOR THEUT AEONS NAMED GIFiCATICNS MEET THE APPLICABEST LE PRF my OVISION OF T, E SUCH PLANS. COMPUTATIONS AND S E STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND NAL SERRVIICES AND BE FURTHER CERTIFY THAT I SHALL PERFORM THE NECE3SARY PROFES6 OTO PRESENT ON THE CONSTRUCTION SITE ON ACCORDANCE WUTHE OOCULAR AND BMENTS APPROVED FOR ME BUILDING THE WORK IS ROCEEEDING IN PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPEGIfI@A iN SECTION 118. 1. Revlew, for conformance to the design concept, shop dra+"Inse, samples and other submMais which are submitted by the contractor In accQrI with the requirements of the constnactlon documenro. t ti Is 19002 2. Review and approval of ttte Quality control p=odures for all ccde.required controlled ma e a 3. Se present at intervals appropriate to the stage Of eonstruetion to become, generally familiar with the program and quality the work of with the cd to d ctt rr indoc In general. if the wvric is being pertortned in t manner cone �.Not p _...\�\a ..�. �.,..� art of our Professional :pItil OATH P, EM N Contract. REPORT AS TO THE Architect tc _. r,Q{ylptETION Of THE WORK, KO READINESS OFitHE PROTECT POR OCC pA ovide . ,.r4x;;, tPRY COMPLETION siotw UPA 99 8th OAY OF Februar t8 5�4 D AND SWO N TO BEFORE ME THiS�_. MY COMMISSION EXPIRES 003=01 o16ry PubNc ai ZMrp , gomeraet county Fxphes March 3, 2001 O z /j ts W0 0 cc 'ate • VJ E a (n ` mc Cn CL r o � r x r o •" N EE 0: !:�o .� o m oIn V o v. co duo N 47: Q1 o CL=_ `°C v � : N N cc = o w V E m U m o: m oc Apcm 'Li+r r� C .�.: �� p = H a � w ►-a m d vHo cc c a m H m COD. C C r wo N G d o m =r cc � •tel lAJ O � .. c � • di N C Z cr-LU E V V N o U = C C S o O IF a O a a w A o WG r;V u cn z z r" • ° w , w U a°' � ". Qa UW � w O cn cn ts W0 0 cc 'ate • VJ E a (n ` mc Cn CL r o � r x r o •" N EE 0: !:�o .� o m oIn V o v. co duo N 47: Q1 o CL=_ `°C v � : N N cc = o w V E m U m o: m oc Apcm 'Li+r r� C .�.: �� p = H a � w ►-a m d vHo cc c a m H m COD. C C r wo N G d o m =r cc � •tel lAJ O � .. c � • di N C Z cr-LU E V V N o U = C C S o O IF Location ��� Si 3P�5 �.�%/a u No. v Date c NORT1y TOWN OF NORTH ANDOVEFV Certificate of Occupancy $ i Building/Frame Permit Fee $ Foundatio S 14USE n Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ 1 Water Connection Fee $ 9� co TOTAL $ CU C Building Inspector J ! Div. Public Works D O b W it w A v w° a chi ° z z A w° o v U c w E°� W 4 a w m w a a u 0 a W a�' c% w p U a ° w w x w A x w m 6 cn c o cn U �;� o Lij ��m c c'S oc "-' o C.3 v CL .CL • c ea o m c cc E a t4 :r c m o a O E 0 cw «• � Ca D O; Qf co C 'fl A m O O L N Om :•O O aC) ID CAI: ID N O r � L C_ O Q d C L O • V16A .yZ o a. :a H r N m ~ W CO 4; :S C r .y =� O C L=cm �E v •N U CD 0 FE N* d O� OL 2 A a g m O ,— L �aom E m O cm N m L r 0 Z O s V OF. N a O O E Ots i � O Z co CL O H G C — r l O CM V O E mm cc i H L t O L CL V) !d O d CD 13- CMQ ca c +�+ c O CD CO2•� O � O C Z O cob C.3 CO) � c c— '— c ev = O CO2 o v, G V) u C s C O N z O Ln r V F- X G w G Q � 'r 00 ti O � - z z � C LLI 6 3 � r 3 Ln in z g Z Z 9 u N 2. N _ N Y W ":A W Z E z G E z N N NN ■� L N J y ChiC N W N J � W la. ... 6 z Z � Z Q Z � C J n • � V 6 _L _L L ;yL �I r N N r\ a Z �j� LLJ (� LU W — `Y W W � N ul Y J W Z' v vi L 2 u W a Y n _ n W U J a LU F Z N Cn z W < a Z Z z C 0 J z Z n z a ltayy C: .� - Y - Lou U a c m N[ V G w 00 ti z in z g 9 k 9 u 2. ui z z a :nVA W W ":A W , ..I N U — m N[ 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. --- *^M••*••y**-""'APPLICANT FILLS OUT THIS SECTION* PHONE X h� l> I� ° l,(J)U�l7l/(�S ��8' %��-Oogi APPLICANT ZeQU 1C 11► ��, X LOCATION: Assessor's Map Number ©J� PARCEL 00JIS SUBDIVISION LOT (S) STREET �Ih ��l _ ST, NUMBER .r-..-_---_--*--.*-••..•...'*'*"'**'OFFICIAL USE ONLY***"""'rt"""" RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED_ COMMENTS TOWN PLANNER DATE APPROVED r DATE REJECTED. COMMENTS FOOD INSPECTOR HEALTH DATE APPROVEDDATE REJECTED_ SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED_ COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRJVEW Y PERMIT FIRE DEPARTMENT A, RECEIVED BY BUILDING INSPECTOR DATE 1 t• c � r..' a e d d -IF 1 0 WM1.IAM J. SCOTT Director Town of North Andover , 40RTN OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° • 146 Main Street • _ ; i North Andover, Massachusetts 01845 +,: •�`., ;o .:••`,y 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: �ch2S- �NSp:�(Location of Facility) Signature of Permit Applicant (� 1 z � Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 0 BOARD OF APPEALS 68&9541 BUILDING 688-9545 CONSERVATION 689-9530 HEALTH 688-9540 PLANNING 688-9535 Location J No. �' fJ Date 14ORT1l •.,� TOWN OF NORTH ANDOVER OG a Certificate of Occupancy $ Building/Frame Permit Fee $ Z8 70?, �S., CHUSE<�' Foundation Permit Fee $ Other Permit Fee $ 4 Sewer Connection Fee $ Water Connection Fee $ TOTAL $ %��• Building Inspector Div. Public Works / ,i, yJ S Location J No. Date "ORT1y TOWN OF NORTH ANDOVER • ; : Certificate of Occupancy $ 9 CH Building/Frame /Frame Perm"rt Fee $ cNusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r CJe, Check # .. L , C� / P., / r Building Inspector 9. Aaw 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 S Section for Official use oniv,1,20I BUILDING PERMIT NUMBER: DATE ISSILJED. SIGNATURE: Builft Commissioner/Inspedor of Buildings Date 1.1 q9 Property Address: 1.2 Assessors Map and Parcel Number: c� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDistrict Proposed Use Lot Area (sf) Frontage (fl) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Raired Provided ReqWred Provided 1.7 Water Supply M.GI.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public 0 private 0 zone - Outside Flood Zone 0 Municipal On Site Disposal System 0 act 2.1 Owner of Record Name (Print j Address for Service S C--� cl-79- 91 C/Y?d/ Signature Telephone 2.2 Authorized Agent s -r Name Print Address for Service: 70- oo?7 Signatu6/ Telephone 3.1 Licensed Construction Supervisor Not Applicable 0 �' may.$ . Address License Number aA yftCZcSk Roy""� AkyRc(%( Licensednstruction . sor: C) �Zi IS-OUQ- 6 LO Expiration Date Si a re Telephone 3.2legistered Home Improvement Contractor Not Applicable 0 Company Name., Registration Number Address Expiration Date Signature Telephone 'a M Vv M om R) 0 M X Z 0 Z M 90 0 "n M Z Q SECTION 4 I�OitKEM _MP.NSA'TiONQ.] jG ft` x Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea .......❑ No ....... ❑ SECTION 5.- PROF SSIOXAL DESIGN A WN, , OCT'ION SERVICES -P OR;R10I ,D1 "AN)Ei S'�2UCTCTRES SCR' TO G'ON TB1f3C ION 2220PRRS ANT TO 1" R 116 Ciil�?TA MQ D 3i -O ENC 15%D SflAIGE} 5.1 Registered Architect: pps 6 C � ` Us nm Name: /nil Address /!,,, I �Q , / % 1r�, / / M R/ZT+� d // &Vga 6 9'� ��� Off/ 16 Signature Telephone 5 2 Regtsered:Professienal!DOW : Name: Address: Area of Responsibility Registration Number Expiration Date Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address a Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Company Name: Conii-ad Li, LTivC Not Applicable ❑ Responsible in Charge of Construction V 400. L#Kqnor ,JSCR!"1'i►N..o'0 l�f LAii'�,a1:WaVkf�. New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify B 'ef Description of Proposed Work: MOLL c ov / r / b �r n 2 t5no�Lrh T�S� /002 7-118, C177aeE ❑ ❑ B Business 0 2A 2B 2C Hereby authorize Owner of the subject property My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 AA ❑ A-5 ❑ IA IB ❑ ❑ B Business 0 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory 0 F -I 0 F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 0 I-3 ❑ M Mercantile ❑ 4 0 R residential 0 R-1 0 R-2 0 R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 0 S-2 0 U Utility ❑ M Mixed Use 0 S Special Use 0 Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: fi =;r BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Hereby authorize Owner of the subject property My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date to act on I, r^ ✓2�S �f �bC �Cu, GA G d5 as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Nnts Lq-,-.6 Print Name Si of Owner/Agent Date Item Estimated Cost (Dollars) to be #1'� Completed by permit applicant 'E = .._ 1. Building (a) Building Permit Fee 1E d0 _ G® Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) /S Dco. Ottt <3rg Check Number tkg,i r��`s G+C {.; F j/ ("1fiI I4 y, r',{�;t',F ''tet B $rk M�.a� t e�, >:vt"� ..US t. iia �+.,�.., 3��{u"4 i� Ei,:lr�`L.$)�y51'dix >v�(. 'i .: ta:2 NO. OF STORIES SME BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE mix�1 fiM, D _ - ✓itr• J, rrr»rur p'tr�-.�G(n c -_ tie�u�lt � -- BOARD OF` %lJN8 , License: CONSTRUCTION Number. CS 045437 3 Birthdate: 03/08/1964 Expires: 03/08/2001 Tr. no: 8194 Restricted To: 00 JAMES H BURNS i E HILL RD BOXFORD, NIA 01921 Administrator I v�eif�~:'.�': 1e:6.s'iRC.�4►� �'�:i' '�"i �.:�►.:�'s:."r...i.:�.!��"' � el��{��y���_ ' c :, .. , f—i[ am a homeo,,vner cer:crming all work, myself. 71 Iam a saie proorie:or and have no one worlcinc in an,/ caoactri I am ar, employer provicsg wcr:cers_comcensacion for my empioyees worxing on this job. G 3d7L 7I/ �sv� 163 a sole orocre:cr, tient :l contractor, or homeowner (clrc!e one., and have hired the c�ae-ac-.ors 11s1ed be!aw Room wt o have L: c :o[low ing worker:' c_-mpcnsacier. pclicec: came»V as me: in.—Sir,: r-7. -- .. .. .. .. Fatiurc :o securt cavcrage a: requtrea unuer Sc::ton 2-5A ofNIG L l': can ;Bad to the imoosuton of cnmtnal penzine of a Fine uo to 51 -M.M s<am'or one Year-' imor.--onmcnt as •Nen as c:vii-cnatuc: in the form of .t STOP WORK ORDER and a fine of 5100.00 1 day against ma I undenund sat a coot of :::> sta:emcnt may oc :or-iraea :o the Offc: of Invcsugatiuns of the MA for covcragc vcnticadon. z._._. _ ;Ijfk!rr:he pains ol'orr;ur,, that the in:'orma:ion orovrded sbove is:rlr and Barre S' `/'4 / . 777.t :11=_ — (_ "5 1 atTte:at ase JntY do not 'Nr:tc :n :hu :ren !a be campic:ea by c:ty sr :own •jiTicji 'J - cry or 'own: permtv!ic:n:c : _ cnccx !f irnmcaiatc rc:::unsc :s rccutr canCC: per:on: pnaOc -: Ir ..'I1 ?!.k. Building Dcparmcat Lxcnvng 30ira [_`cicc:mcn's Off c: "Hcatth Dcoar:mcnt ,=()tncr H, , The Commonwealth of Hassachusens Department of Industrial ,accidents =_ 9MCO, 9IlffYest/gat/9ns 7- �' y 600 Washington Street Mass. Y � ass. 03111 v�eif�~:'.�': 1e:6.s'iRC.�4►� �'�:i' '�"i �.:�►.:�'s:."r...i.:�.!��"' � el��{��y���_ ' c :, .. , f—i[ am a homeo,,vner cer:crming all work, myself. 71 Iam a saie proorie:or and have no one worlcinc in an,/ caoactri I am ar, employer provicsg wcr:cers_comcensacion for my empioyees worxing on this job. G 3d7L 7I/ �sv� 163 a sole orocre:cr, tient :l contractor, or homeowner (clrc!e one., and have hired the c�ae-ac-.ors 11s1ed be!aw Room wt o have L: c :o[low ing worker:' c_-mpcnsacier. pclicec: came»V as me: in.—Sir,: r-7. -- .. .. .. .. Fatiurc :o securt cavcrage a: requtrea unuer Sc::ton 2-5A ofNIG L l': can ;Bad to the imoosuton of cnmtnal penzine of a Fine uo to 51 -M.M s<am'or one Year-' imor.--onmcnt as •Nen as c:vii-cnatuc: in the form of .t STOP WORK ORDER and a fine of 5100.00 1 day against ma I undenund sat a coot of :::> sta:emcnt may oc :or-iraea :o the Offc: of Invcsugatiuns of the MA for covcragc vcnticadon. z._._. _ ;Ijfk!rr:he pains ol'orr;ur,, that the in:'orma:ion orovrded sbove is:rlr and Barre S' `/'4 / . 777.t :11=_ — (_ "5 1 atTte:at ase JntY do not 'Nr:tc :n :hu :ren !a be campic:ea by c:ty sr :own •jiTicji 'J - cry or 'own: permtv!ic:n:c : _ cnccx !f irnmcaiatc rc:::unsc :s rccutr canCC: per:on: pnaOc -: Ir ..'I1 ?!.k. Building Dcparmcat Lxcnvng 30ira [_`cicc:mcn's Off c: "Hcatth Dcoar:mcnt ,=()tncr May 3, 2001 Michael McGuire Building Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 Dear Mike, We have reviewed the proposed construction document for the minor demolition and clean-up of Building No.12/12A which is the direct result from the recent flood of March 22, 2001. The attached demolition plan depicts `clean-up only' with minor repairs to damaged drywall. Please keep in mind that once final design has been approved by the new tenant — Aurora Imaging Technology, Inc. full bid packages will be submitted along with permit application. In the event any significant demolition should be performed, this work will be reflected in the submittals. This work to be performed is located in Building No. 12, 39 High Street, North Andover Mills Complex, North Andover, MA 01845 The following document has been `approved as noted' — Drawing No. D-100 — Demolition Plan for Aurora Imaging Technology, Inc. If you should have any questions in regard to this modification, please do not hesitate to contact my office at any time. Thanking you in advance for your time in reviewing this document. Sincerely, David G. Cohan Property Manager for North Andover Mills Yale Properties USA, Inc. One High Street, 1St Floor North Andover, MA 01845 cc: Jim Ward, Republic Building Contractors Gunther Sauntag, Aurora Imaging Technology, Inc. File, Yale Properties Management Office One High Street, North Andover, Massachusetts 01845 Tel.: (978) 682-8708 Fax: (978) 682-8713 x FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ......................n...r.....■■r....■■a■r..................QQ..//.........■ APPLICANT &m �n PHONE g7()-(DU�' ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION (r _ LOT NUMBER AF STREET 1W . ■ ■a.r arra■ .&arra a a a 0 a a 0 a a■ a r... a s a. a a a a a 4 a a a0 OFFICIAL USE ONLY RECONOvENDATIONS OF TOWN AGENTS �.........•.....••aaa........aaarr..arra.a..r.a■■.■•.......a...rrraa..a..r.■ CONS& -NTS PUBLIC WORKS - SEWER / WATER CONNECTIONS ,��DRIVEWAY PERMITE�vRM�IT r1 60,j,rt Kxoe-,j �W i1 1FDr FIRE DEPARTMENT —p-o�;� o,1 o r ,F f e- Pro Tec —(t) CONS/ ENTS DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONS& -NTS PUBLIC WORKS - SEWER / WATER CONNECTIONS ,��DRIVEWAY PERMITE�vRM�IT r1 60,j,rt Kxoe-,j �W i1 1FDr FIRE DEPARTMENT —p-o�;� o,1 o r ,F f e- Pro Tec —(t) CONS/ ENTS DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE ARCHITECTS AFFIDAVIT To the North Andover Building Department: I certify that the work associated with Building 12 & 12A Water & High Street — North Andover, MA, and to the best of my knowledge, information and belief the construction documents (Demolition Plan) have been done in conformance with the provisions of the Massachusetts State Building Code and all pertinent laws and ordinances. May 1, 2001 8862 Louis A. Porcaro Mass. Reg. No. 19 Broadway, Stoneham, MA. 02180 Address O z n A q uA •1 gc� � '' 0 v w o w° a U ca w o H a w a C.) C.) .a a p C7 cc w z w A r� vi o cn i O V co CLy c 0 O v 4.1 • -A m CO CD .y CD LM 92. CD O CD v r.7 H 0 .y O C..3 cc cc h _c p is • O C L H C.) C.) .a ac� cv ev r• m c � = O • � O �a m O :... CLCD yE c r _ c .. O O u CD m cU E c m it Gro ++ C cm itW O `omcm ac3 m cm '0 0 c d C m V y Z 0 ` CM Z 0 o CL C �C m = o NmC :0 3 N W O _ 4:5 .y AD is c=G c H .c. d Z m •N O o t110 1— C+* 2 0- .0 = O eyv d a m i O V co CLy c 0 O v 4.1 • -A m CO CD .y CD LM 92. CD O CD v r.7 H 0 .y O C..3 cc cc h