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HomeMy WebLinkAboutPermits - Permits - I Application Number: C.1,L).# Official Use Only Commonwealth of Massachusetts Department of Fire Services Permit No BOARD OF FIRE PREVENTION REGULATIONS ccupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM WORK All work to be performed in accordance with the MassachusettsElectrical (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/23/10 City or Town of: North Andover To the Inspector of Wit-es.- By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number): 203 Turnpike St Telephone No. Owner or Tenant: First General Realty Owner's Address 93 Utrion St Newton Ma 1s this permit in conjunction with a building permit? Yes ❑ No ❑ {Check Appropriate Box) Existing Service Amps / Volts Overhead ❑ Undgrd No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd ❑ No.of Meters Location and Nature of Proposed Electrical Work: Corry letiort o the ollo+vin table may be+valved by the Ins ector o IVires. No.of Total No.of Recessed Luminaires No.of Ceil,Susp.(paddle)fans Transformcl s KVA No.of Lurninaire Outlets No.of Hot Tubs GclrePat01'S KVA Nv,of Ellrergency LiglNirrg No.of Luminaires Swimming Pool A`b d e ❑ thud. ❑ Battery Units No.of Oil Burners FIRE ALARNI5 No.of Zones No.of Receptacle Outlets No.of Detection arid 7 No.of Switches No.of Gas Barriers Initiating Devices Total No.of Alerting Devices 6 No.of Ranges Na.of Air Cond. .tons Hot punyp N+unbcr Tons I�1V............. No.of Scif Corrlairlcd """""' . , No.of Waste Disposers Totals. DetectionlAlertin Devices Loclrl ❑ t1"Iunicipal El Other No.of Dishwashers Space/Area Heating iC\V Connection KNV Security Systems: No.of Dryers Vcatilrg Appliances No.of Devices or E uivalent No.of No.of Data Wiring: No.of WI- Kw Ballasts No,of Devices or Equivalent Venters Si ns Total Telccamrnuilications\Vining: No.Hydroniassage Bathtubs No.of motors No,of Devices or Equivalent OTHER: Additions To The Fire Alarm System/WO 81620100 Attach additional detail if desired, or as required by tire Inspector of TVires, INSURANCE COVERAGE: Unless waived by the owner,no permit for(lie performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned cerfifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:)Ins Co Of The State Of PA 2/12/11 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, 1111der lire pants and penalties of perjury,that the hiformation on this application is trite and complete. FIRM NAME: AFA Protective Systems LIC.NO.: 7007 C Licensee: Joseph W.Donovan Signature " ` `� Bus.Tel.No.: (Ifopplicable,eater "exempt"in the license Inrmber line) t Alt,Tel.No.: Address: 200 High St.Boston,Ma 02110 Lie.No.: 001097 *Per M.G.L.c. 147,s 57-611 securit work re uires De arttnent Of Public Safety"S"License: aware that the Licensee does not have the liability insurance coverage normally required by OWNi1R'S INSURANCC WAIVER: 1 am Jaw. By my signature below,I hereby waive this requirement. 1 am the{check one)❑o�vnet owner's agent. Owner/Agent Telephone Na. PERMIT TEE: $ 125.00 Signature i. The Commonwealth of Massachusetts = Department of Industrial Accidents i I Office of Investigations 600 Washington Street Boston,MA 02111 r � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AplAicant Information Please Print Le ibl Name(Business/Organization/individual): 0+-•P6_4A�_c J,i`` A X Address: 9, 00 City/State/Zip: A c9J43ak Phone Are you an employer?Check the appropriate boar. Type of project(required): 1.l� 1 am a employer with 4. am a general contractor and 1 * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). Remodelin 2.❑ I am a sole proprietor or partner- listed on the attached sheet. '1• ❑ g slop and have no employees These sub-contractors have g, []Demolition working for me in any capacity• employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp, insurance.t 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions r myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no ,,...__,,�� employees. [No workers' 13•L�J Uther �� pQ/f_I GNS comp. insurance required.] *Any applicant that checks box H 1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors rnust submit a new affidavit indicating such. tCoutractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -4—_/V SUt't AA!C P C,O /��0/tI f/ rl .&eAAUj n y�i✓�/� Policy#or Self-ins.Lie.#:_ ­2 Expiration Dater 01 O Job Site Address: 0/ l City/State/Zip:Ale / /ylJl�U,f�. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forw6rded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sign Date' � 1d3 or Phone#: CQ l ~� `7 7 � ~� ���O G L only. Do not write in this area,to be completed by city or town official n• PermitlLicense# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: i'- OATP(MMIDDNrM F D, CERTIFICATE OF LIAB tLl TY INSU RANCE z 22 2010 hone: 5I6-Sfi9-8556 Fax: I-51b-869-8765 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOCIATES, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR FiYD1J PARK RD ALTER THE COVERAGE AFFORDED BY THE pOLICI�S BELOW. SUITE 400• NAIC# NEW HYDE PARK NY 11042 INSURERS AFFOROINGCOVERAGE INSURERA:First Me ur i ranee C a INSURE;) 9 3 AFA MASSACHUSETTS, INC. , SUBSIDIARY INSURERD: e i n ura o OF AFA PROTECTIVE SYSTEMS, INC. INSURERC: ns r nGe Co n f St t 9 2 200 HIGH STREET INstiRERD: BOSTON MA 02110 INsuRERi: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,LISTS TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CORTTERMSFIEXTS CLU5ION3BANDSCONDOITIONS OFRSUCH�POLICIBS THE �AGGREGATECE RLIMITS SHOWN ED BY THE OMAY'IHAVE ES EBEEN aREDUCED ED TBYIPAID CLAIMS ALL THE POLIOYEFFOCTIVE Pot ICYEXPIRATION LIMITS INSR DO' POLICYNUMBER mif L I TYPEOEIN 2/12/2010 2/12/2011 EACHOCCURRENC£ b 0 000 A DENERAL LIABILITY FMMT 012 S 3 4 4 PRE Isis Eaoeeumma $3 0 0 COMMERCIAL GENERAL LIABILITY MEOEXP(Any one person) S CLAIMS MADE K]OCCUR PERSONAL dADVINJURY b 1 0 O GENERALAGGREGATE $ 0 00 PRODUCTS-COMPIOPAGG S O 00 G£N'L AGGREGATE LIMIT APPUES PER: X POLICY PRO- LOG AUT061OEILiLU191LI7Y CA8263499 2/12/2010 2/12/2011 COMBINED SINGLE LIMIT b 1 000,000 CA8263500 2/12/2010 2/12/2011 (Eeacclden C X ANY AUTO q ` B b ALLOWNEDAUTOS (Per porsoin) SCHEDULEDAUTOS X HIREDAUTOS B eracul eni) $ (Peracddenl} X NON-OWNEDAUTOS PRgpiRTYDAMAGi $ (Peracddenl) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY EAAC0 b ANYAUTO OTHERTHAN AUTO ONLY; AGG $ 2/12/2010 2/12/2011 iACHOCCURRENCE b 0 00 B EXO£SSIUMBRELLALIABILITY 0145SO196 AGGREGATE $ 0 0 X OCCUR El CLAIMSMADE $ b DEDUCTIBLE S RETENTION $ X WOSTATU- 07H- (.7 WORKERS COMPENSATION AND 4IC20634854 2/12/2010 2/12/2011 iL FACHACCIDEN7 $1 0 0 EMPLOYERS'LIABILITY ANYPROPRIETORIPARTHERIEXECUTNE E,L.DISEASE•EAEMPLOYEE b 1 00�0010 OFFICERIMEMBER EXCLUDED? 114yes,descrbeunder E.L.DISEASi-POLICY LIMIT S c SPECIALPROVISIONSbelow OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS AD DED BY ENDORSEMENT IS PECIAL PROVISIONS VIDENCE ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER FOR EVIDENCE ONLY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTISHALLFICATE IMPOSEHOLDER No OBLIGATOIONO THE LEFT, BUT OR LIABILITY OFFANYURE TO DO K SO KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZ.EDREPR£SEN7AT1 OACORD CORPORATION 1988 ACQRO 25(2001188) it LaMarche Associates 5 North Road, P.O. Box 250 i Chelmsford, MA 01824 800-349-1525 Fax: 978-256-8590 March 4, 2016 i 1 i Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845 Board of Health/Board of Selectmen NORTH ANDOVER, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MAS SACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B i Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws Cha ter 143 Section 6 to be applicable. if any notice under Massachusetts General Laws Cha ter 139 Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, cause of loss and LA file number. Insured: NORTH ANDOVER OFFICE PARK CONDOMINIUM TRUST Loss Location: 203 TURNPIKE ST NORTH ANDOVER, MA 01.845 Policy Number; 612OM15720 Date of Loss: 02/15/2016 Cause of Loss: Water LA File Number: MA-2-31228 On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Kris Kirkpatrick Adjuster LaMarche Assodat�ees.i Inc.1 800-349-1525 The Commonwealth of Massachusetts Executive office of Health and Human Services Department of Public Heald Bureau of Environmental Health rY 250 Washington Street, Boston, MA 02108-4619— DEVAL L.PATRICK is l GOVERNOR JOHN W.POLANOWICZ SECRETARY CHERYL BARTLETT,RN COMMISSIONER July 16, 2014 ,Dr.Michael Shannon,DMD 11 Northeast Oral Surgery \203 Turnpike Street 'North Andover,MA 01845 Dear Dr.Shannon, This letter acknowledges your response of July 14, 2014 to our report regarding violations observed at Northeast Oral Surgery in North Andover during an inspection conducted on June, 116'2014 by staff fi-om the Massachusetts Department of Public Health,Bureau of Environmental Health I, Community Sanitation Program. After a review of the materials you have submitted, including Exhibit A—policies and Procedures, and Exhibit BI/B2—Staff Training Attendance Sheet/Training Acknowledgement form; the Department acknowledges corrections made at the facility regarding the storage, treatments, disposal and tracking of Medical and Biological waste and handling of other biohazardous substances at your facility which address the concerns observed on the day of the inspection. We appreciate your timely response to this matter. Please contact me if you have further questions or concerns. Sincerely, David T.Williams, Senior Analyst Community Sanitation Program CC: Suzanne K. Condon,Associate Commissioner,Director,BER Steven F.Hughes,Director,CSP James Bailin,Deputy General Counsel,DPH Y/ Susan Sawyer,I-jealth.Director,North Andover,MA 480-14-Northeast Oral surgery-POC Acknowledgement 07-16-14 1 �zr�ia; ollp- L-Owe �rto � r Et �4�tiYi SS Y i 5 3 } t ; S , 5 3J - i v Z € 3 l j }x�ita����;E�t��f?�r�r�`j� tyt€r:� 177 c 4 � t � rrt 3 r FOR PE RIM fTd gASSACPiUSETTS UNXFORM APPLICATION (Type or print) Date NORTH ANpOVER'MASSACHUSETTS A,�/� Permit#__47-y �� c� c�`J•.S'( Owners Name Amount j lion � Building L� ;•j r ; e of OCCu anC �^-'� Mans Submitted Yes No New � Renovation Replacement l3 FIXTURES - w a a z a a d w x a a 4 w . � � � � f�• d � a � � d � A S[B•B�'1� � - ISL BJDM 1 2N]FLOCR 419 AM( 6TI 7m ium agm Check one: %=Xt Certificate / Corp. tint or type) Company Name _ Installing Partner. Addresses tJ f , - UirrnlCQ. Business Telephone n 1-14 Name ofI icensed Plumber: type of insurance coverage by checking the appropriate box:Bond Insurance Covera er Indicate Other type of indeittnity Liability insurance policy one of the above ed,have been made aware that the licensee of this app lication does not ha�a any Insurance Waiter: I,the undersign three insurance Agent 4�1 [i Owner 0. ignature application are true and accurate to the b certify that all Of tile details and in£ormatiar<I have submitted or entered)in above app li oh will be in I hereby work and installation Pe� e der Perm• Issued far this app i and that all plumbing lum rig e and hapter I of the neral Laws. best of my knowledge of the Massaehusetts,Sta e P compliance with ail pertinent provisions .� igna o i ns Umer - By: Type of Plumbing License Title um er Master journeyman icen City/Town `' ,APPROVED(OFFICE OSF ONLY commonwealth o �a5��"•■•• permitlvv. Of Fire SerViceS Occupancy and Fee Checked Department g Rev, 1/071 (leaveblank PREVENTION REGULATION t RIGAL VWORK BOARD OF FIRE � ELE,GI 1T �O pERFOR MEG) � C lZ.00 N FOR F R assaclru3e E}ectrtea}Gode(9 ppptlGA edinaecoTdanceWiththeM pate. p}}work to beP DT" ATION� ectol'of Nl lf: PE ALL INFORM To the Inp work d Be d below. IN INK OR TgDO�R erform th electric LEASE PRE OR her rote tion top �P of: N � i �1 City ° TOE° ed gives notice o-, 1�° dersign -� Teleph°ne N�E� By this application the un � ,� t`'.l..��v (Street&N!'mber) i 1 Location(s N(L;a �.� �.,�, (Check ApPr°priate Box) Owner ar Tenant 1 l No Address � -"' errnit`� Yes Owner's A one. ith a binding P Utility Authorizat�i—oyn N°'No,of Meters in conj Undgrd ] Xs this permit Overhead purpose of Building Volts Undgrd Ti of Meters tiing s � Uis Service �- AmP ��volts Overhead Am acity Number of Seeders and AmP � 6e waived b the Ins ector of Fires• e of propo ed Electtrical Work' y � n table maY 1Tott l 1 i(c�— of Location and Nat 1k(�f C A, � Gom 2etion o the ollowi Na. �rCY1 KVAI CC, (paddle}Fans Transformers �"k No.of Ceil:Susp. Generators ig-'Ong No.of Recessed Luminaires �. mergeucy No,of Hat Tubs o.o Outlets Above ❑ rud. $attery Unite No.of zones No.of L"Anaire O S`yimmiugpool d. p�ARMS Na,of Luminaires Na,of Oil Burr'prs �10,of DetectioQ and Initiatin Devices No,of ReCeptsele Outlets Na, of Alerting De'ices No,of Gas DurvLers otal b , e l- eonrntticanpi ne Tons o of D e vices afSvitches f u Cond, ......yo No,oA er on Dtle ...".. ❑ other a Ts " cConnection No,ofRanges l al❑ No.of Waste Drspasexs SpacelArea Seating KW Security Systems.* uivalent Na,of Devices or 1; Na,of Dishf,ashers Heating Appliances Data Rtiring' , , uivalent No.of No,of Devices or L NO,.of Ballasts Teiecommunications�' valent No.of Dryers Si as No.of Devices or ater Total Hp °'°f nesters No.of Motors e Bathtubs OCA aired by tfIe Inspector of Na•gydromassag 1 f� Attach addttional detat!n lPal dre OTSER• } ) (When required by municipal poi and upon comp}ctian. ce with NIEC Rule l0, a issue E��C)' Work' nested in accordance Performance of electrical work p6 alent �,peetions to be req no eux►it for the p e or its substantial eq Estimated�alue�o7 the o�'ner, P o eratioi covers office. Work to Start nlesswaived by completed P tothe permit issuingI ANCE CO g�,GE: �`mcluding bited proof of same XNS roof of liabili msu 1n force,and has exhi the licensee pravrdes p OTHER ❑ (SP -- .1 ticatxalt is true and camp � undersigned certifies that suCEcove BOND ❑ trntion on this aPp I,IC,Nq CHECK Off' IN awl i and penulhes of p�luT3'' that the in LYC.NO• r-- I certifyp under he 1 ( � Bus.Tel,No�- �t�r�--�- FU M N f 0 Sign -� Alt.Tel.No..�- �� r Lic.NO• �-- Licensee:r ii n e b r ��t +Ig"License: enter"exempt"in t insurance coveragc n (If applicabl r) uires Dep ent of Public Safety ❑own( Addess: ecurity work Teri at the Licensee does not have tehecktonle-,)[�ownertpe . c,11,s.5WAIVER• Iair`aware*Per M•G, waive this requirement. I am d' g17T FEE: OWNLRINS B my signature below,I hereby required by law. Y Telephone No. Owner/Agent Signature The Commonwealth of Massachusetts Department of I.ndus'trial Accidents Office of Investigations l 600 ff"ashingion Street i Boston, MA 02111 www massgov/dia . Workelrs' COmPeusation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers A iiicant Information Please Pant Le 'bl e Nalme(Business/organizatiomnidividual): City/Sta'e m, E- q ' lPbone A,rree you a ployer?Check.th appropriate box: ' [.( -f am a em la er with 4 '> 'Pe of project(required): p Y ❑ l am a general contractor and l 5 ❑Nt3w cati edit employees{full and)or part.tt e),* have hired the sub-aotttractor$ 2,❑ I am.a.svle proprietor or partner. listed an the attached sheet t 7. `Remo' delmg Ship and have no employees These sub-contractors have 8. [J Demoiitiart working for me in any capacity. workers" comp, insurance. [No workers'comp. insurance 5. ❑ We are a corporation and its 9. ❑ wilding addition required.] officers have exercised their 10 ❑Electrical repairs or additions 3.❑ 1 a.En a homeowner doing all work right of exemption per Mac, 1!.❑ Plumbing repairs or addifions rrlysel£ [No workers' camp. (4),and we have no 12. Roof insurance- ired. .t ❑ repairs j x1 ) employees, [No workers' t3.❑.Uther comp. insurance required_] Any applicant that ohccks hog fi l must also fill nut the station halow showing their workent'compensation policy infom:ation, Homeowner¢who submit this afrii&vit indicating they am doing all work and then him autslde connectors must submit a now affidavit indicating such. tt;ontmatoa;that check this box mustattaehed an additional shectshowing•the name ofthm sab.contM tors and their::w ems'comp.porlgy imm ion. I am an eMplayer that is providing workers'compensadan irxsurance for mp,employees. Below is the policy and jab site information. ; Insurance Company Name: -------- Policy#or Self=ins. Lie,#:(/,\JC_ Expiration Date: 2�� � Job Site Address:20 �..__ .v Citylstate/ZikA " Attach a coFe of the workers' compensatio© policy declaration page(showing the policy nurnlZer and expiration date). Failure to secure coverage as required!under Section 25A of MOL c, 152 can lead to the imposition of criminal penalties of a fine up to $4500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against.the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the D!A for insurance coverage verification. t do herel)j?ce � nder the pains/a'nd penalties of perjury that the h0rmation provided above is true and eorre04 Si ature: Phone#: Officiat use only. Do not write in This area,to be comp et by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S, Piutmbirtg[nspectar Other Contact Person: Phone#: 1 commonwealth of Massachusetts official Use r�°"ly Permit No. /d Department of Fire Services ell Occupancy and Fee Checked &aL) BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed io accordance with the Massachusetts l;icctrical Code(Mt C),527 CMR 12.00 j (PLEASE PRINT IN INK OR TYPE ALL INP-0RMATION) Date: City or Toivn of: A101?1� �IiPo�LVC- _ To the Itaapeclor ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Strect&Number) J0 3 Owner or Tenant j i ley Tclepho c No. Owner's Address Is this permit In conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building&A j,j p '1 o r vt Utility Authorization No. Existing Service Amps ! Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps 1 Volts Overhead ❑ Undgrd ❑ No, of Meters Number of feeders and Ampacity Location and Nature of Proposed Electrical Work: (1 ald t r 7 .2 vo-1 12 fzc/ jr I AS r� 17t12 t jn .V .. !C ' rt 1 completion of the follo}bin fable inn,be waived b the In eclor of Wires, o, oU Total No,of Recessed Luminaires No,of ceiL-Susp.(Paddle)Fans Transformers KVA No,of Luninaire Outlets No.of Hat Tubs Generators KVA S►vhnmirr Pool Above ❑ In- ❑ o. o Emergency g r ng No. of Luminaires g rud, r•nd, Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zanes o.o Detection an No, of Switches No.of Gas Burners Initiating Devices No,of Air Cond. Total No. of Alerting Devices No, of Ranges No. ' eat Pum Number Tons IC o. o e - ontame No. of Waste Disposers Total p Detection/AlertingDevices 1EunrerpaI No. of Dishwasher s SpacelArea Heating KW Lgcai ElEl Other ul No,of Dryers Beating Appliances KW Sec No. f evic s or Equivalent No, No.o Water IOW No.o ' Ballasts o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wirutgg: No. HYdrorrrassage Bathtubs No.of Motors Total HP No.of Devices or E trivalent OTHER: c-Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: / (When requited by municipal policy,) Work to Start: /-/1-/C'/ Inspections to be requested in accordance with MEC Rule 10, and upon completion, INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance ofelectrical work may issue unless ' the licensee provides pr-oorof liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, larder the pains and penalties of peryinYp, !fiat the inforination our this application is true and complete. FIRM NAME: e dl e "i C LIC. NO.: 1 f -- Licensee: 4 VC,i116 Signature LIC.NO.: (If applicable,enter "exenrpl"in the license number line) Bus.Tel. No.:,I%1 Address: Alt.Tel. No,: *Security System Contractor License required for this work; if applicable,eliter the license nimrber here: OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑owner's agent. Owner/Agent PERM1 T FEE: $ �,�S~ � Signnture Telephone No, i l� / s ,.� r y"wyr � , � x^ � Y- ;✓,..�,.a a _ ..", ftrrhltec� � ..✓r ✓,, r 'rf 'r,�" r ✓ fir��.�.-r��.i�✓"-� y�,^ � ��-`� "r",�✓„"' �,�" i € ..-...e=w r'.err ,x.,,✓✓ i -, ,.'"r' - n ...Ma Ate. r r i r11i1�a � y ✓� r'' "y r, � a r r - 1 1tA �A APIR ARCHITECT'S CERTIFICATION OF SUBSTANTIAL COMPLETION 09 April 2010 Project Name: North Andover Office Park Project Location:_ North Andover,MA Name of Buildings: 203 Turnpike Street Architects Project No: 2161 Nature of Project: 3'd floor common area new mens&womens toilet im rovements In accordance with Section 116 of the Massachusetts State Building Code,780 CMR-6"Edition 1, Joseph Q.LaGrasse Registration No. 4153 Being a Registered Professional Architect hereby certify that I have provided or directly supervised construction observation services on behalf of the owner,being present at the construction site on a regular and periodic basis and that to the best of my knowledge, information,and belief,the work of the project has been executed in conformity with the documents approved for the building permit. To the best of my knowledge, information,and belief,the work of; ©The work has been satisfactorily completed in accordance with the construction documents. 0, Le ' No.4163 ANDOVER y' MA 01 OF?l. ILI ASSPG� Y�Tf' Name n eph D. LaGrasse& Associates,Inc. One Elut Square T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 wtivmlagrassea rchitects.co m 2161-203 3rd F1rToilets.doc I� r' / ✓ z ;. �,,, r �i.- " �,,,'e,��^� "�� �-�.:� �"`a ,y.�""r. m ''..�v yr' � ✓ ,✓ ��, "'� ✓,: -r 7 �,��- : �a ' r✓--r,M.., Qy r " d} 1 �6# 3k11Y� k A i „l 1.1'it �..''i C 9✓ » tMliAll�li s I it ARCHITECT'S CERTIFICATION OF SUBSTANTIAL COMPLETION 09 April 2010 Project Name: North Andover Office Park Project Location: North Andover,MA Name of Buildings: 203 Turnpike Street____ Architects Project No: 2161 Nature of Project: 3rd floor corridor interior improvements In accordance with Section 116 of the Massachusetts State Building Code,780 CMR-6"Edition 1, Joseph D.LaGrasse Re istration No. 4153 Being a Registered Professional Architect hereby certify that 1 have provided or directly supervised construction observation services on behalf of the owner,being present at the construction site on a regular and periodic basis and that to the best of my knowledge, information,and belief,the work of the project has been executed in conformity with the documents approved for the building permit. To the best of my knowledge, information,and belief,the work of; ©The work has been satisfactorily completed in accordance with the construction documents. El so icy No.063 AtVDOVER, MA R(N Or 1hASSPG� Nance Joseph D. LaGra e&Associates,Inc. One Elan Square T 978.470.3675 1420 Celebration Blvd, Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 ivww.lagrassearchitects.com 2161-203 3rd Flr Corridor.doc Commonwealth of Massachusetts )[11cial [:�c 0111% Filerillit No, Department of Fire Services Occupanc), and FeeChecked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 051 1[eme hkink) and Fee � 7� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .III \WL'k-tO Ile j1el-r01'I11CCJ itl ;1CCORIMICe 10(h the\hISMcIwseu,,1'1 ectricA Code 527(AIR 12.110 (PLE.ISE PRINT I.V INK OR TYPE ILL INFOR.1 I TION) Date:, City or Town of: To the limpecifor qflVire.y: By this ilppkilli011 the 1,111del-SiglICd -ices notice ot, iis or-her intention to perform the electrical work described below. Owner or Tenant 5101- Telephone No, Owner's Address d 3 S T' Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) JJ Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhend ❑ Undgrd ❑ No. of Meters New Service Amps I Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Anipacity Location and Nature of Proposed Electrical Work: 77 Completioll(�f the fijllolt i)�k�cable ftfaY Ile irefived by the hj.ctwetor No.of Recessed Luminaires No. oCCcil.-Susp.(Paddle) Fans No. of Total Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No.of Luminaires Swimmin Pool 'kbove Ei In- No, of`1 mergeney Lig I mg g grnd, grod, uatteTy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS. I No. of Zones No. of Switches No.of Gas Burners No. of Detection and il Initiating Devices No. of Ran ges No. of Air Cond. Total No. of Alerting Devices Tolls Heat P1 Illp I Number To�ns Self-Contained I No. of Waste Disposers Toilals. KW o. ofSelf-Co j Detect io n/A lerti ng Devices M1 icipal No.of Dishwashers Space/Area "eating KW Local Connection Ll Other No. of Drers Heating Appliances KW Security Systems..y * No.of Ncnivices or Ec uivalcilt No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydroniassage Bathtubs No.of Motors Total tip 1'elecommunications Wiring: No.of Devices or Eq u iva le nt OTHER: I thIch I iddifto-al 1 10,a I ifdus ovd, Ill,as rvq m)-if h_v the hapt.L 1(jo,IV Estimated VnItie ol'Electrical Work: (When required by 1111.11liCipal Poky.) Work to Start: Inspections to be requested in accordance Nvith MEC Rule 10, and Upon C0111PIC6011. INSURANCE COVERAGE: Unless waived by the 0mno., no Permit 1101•the perrol-Illance of electrical work Illay issue til liuss Elie I iccime pro,,ides pi-oo f o C I iab i I i IV ill sl.11-4111CC ilIC I Liding"completed operation"coverage or its substantial equivalent. HIC undcrsivned certi ries (11',It SLIC11 CO\ffage is ill Come, mid has t2.\Il ibitCd 1)1'00f Or 5,IMC to the IM-111it ill',offiCv, .CHECKONF INSURANCE [I IR)ND F L cerl?liv, wider 1lre�rrriri,c liliftl)enuffies q 'perjury, 11taf ibe infiwnuffiem on This'application A Iri,re mW coml)lefe. F I R Nil NAME: LIC. NO'. Licensee: LIC Bus.Tel. No,, 7 X Z Address: System C Alt, Tel. No. 2—Z-- *Securiiy Contractor Licunse rquh-ud for this��ork, irapplicable,enter the license number here: OWNER'S INSURANCE NkAIVER: I am aware that the Licensee does not havo the lkibility ill'AIRMCC GOVC111-e 1101111011Y icquired by law. By Illy SigIlRtLlrc below, I hereby waive this requimintmL I am the(check one) 0 owner 0 osynt;r's a gejt- Owner/Agent FE�- - 'Agillitury Tdcphonc No. FPF_RAII T 1, ND EMPLOYERS LIABILITY INSURANCE POLICY ^� WORI�RS COMPENSArIIO INFORMATION PAGE THIS P©LICY IS ISSUED BY COMPANY 4.. YORK MUTUAL GREATER NEW Policy New No _62OC1182b Re❑ ❑ vision NCCI Company Code No. 16172 ❑Rewrite of Prior Policy No, 1620C1182 8 ❑ Reissue: % Adj Q Renewal: Co. 009 Town 6605 SG M • Pol.Term 1 Year Pay Terrrr 1 1tA 10-OB- p 07 Acct.No, WITH POLICY PROVISIONS AND ENDORSEMENTS,1F ANY,COMPLETES Page 1 Issue Date AUDITED TBIS INFORMA}`ol. PAGE, Adjustment Date: TIiIS POLICY. Annie.Rate Date: 00301 87 INSURANCE PRODUCER RIC-HARD W.ENDLAR AGENCY, 1• NAMED INSURED AND MAILING ADDRESS BOSTON DEVELOPMENT GROUP �45 ROSEMARY STREET (SEE NAMED NSURED ENDORSEMENT) INC .ET NEEDHAM MA 0249�4 93 UNI SUITE 315 CENTRE MA 02459 NEW other: ra . Partnership X❑ Corporation,or Insured is: lndividuaf ❑ � .., ❑ Other workplaces not shown above: Y?per Nr 'ftF i �i{il' `�`a �tf;! i4a�fl' ,. SEE DESIGNATION OF LOCATIONS SCHED LILE nsured's Identification number(s): i45 }'css�trlg�}r uk, Bldg 1( �gadlis 0[14 MA �d���5 i SEE DESIGNATION OF LOCATIONS 5CIIEI)UI E (rn!) 1) z, The policy period is from 10-02-2007 to �0-02-20os increase$ Decrease$ Each New Installment$ Each Old Installment$ 3. A. Wor kers Compensation insurance:Part One of the Pettey applies to the Workers Compensation Law of the states listed here: M SSACH[JSI'MS lies to the work in each state listed in item,A. each Accident ]o ers Liability insurance:Part Two of the policy app Bodily Injury by Accident 500,000 policy limit B. Emp Y The Limits of our Liability under Part Two are: Bodily injury by Disease Bodily Injury by Disease 100,000 each employee - Bodily Other States Insurance: All states except Ala ska,California, Florida, Hawaii, Maine,Nevada,North Dakota, Ohio, Puerto Rico,Texas, Washingt� West Virginia,Wyoming and states designated in item 3A of the Information Page• t: i. j D. This policy includes these endorsements � NDORS?VNIENTS SEE SCIIEDULE OF FOR1VI5 our Manual of Rules, Classifications, Rates and ]taring Plans. All information required on for o y See Extension of Informallon Page, if indicated,interim adjustment: 4• The premium far this policy will be determined by j; premium shall be made: r Classification Schedule is subject to verification and change by nu t€• ❑ Semi-Annually $ �3 X 028 . 00 TOTAL ESTIMATED ANNUAL POLICY PREMIUMurn premium-A minus ❑ ADJUSTMENT PREMIUM DUE figure oigure mcansReturn Premium) Quarterly ❑ Monthly $ 2,74 . 00 MINIMUM PREMIUM 1.3 r 028 . 00 DEPOSIT PREMIUM See Schedule of Yrsstallmertts $ Servicing Office: riF+sSACHUS TS okFzCZ Date Countersigned by Resident Licensed Agent Agent or Producer WC 40 60 01 A ensation Insurance Copyright 1987 National Council on Comp INSURED COPY APPLICATION FOR PERMIT TO'DO.PLUMBING 'MASSACHUSETTS UNIFORM nt or'f ? Mass. P Date r r Owners Name n Building Locatl.on!�i ot occupancy W p Plans Submitted: Ye�SO Na "Ju Renovation Replacement . New ❑ FIXTURES x x W w 44 .1 M AC • I' z x % IL y� p z w � � m H v w cn s p a b o a w 3" w U) a itis ° w u. 4 m Q w FO- ram- O !C a. O H - 3 .W i O t1 x � x < x x ~ _ ° ° < E a z .o r t1 y r. O y /R t �( a J .1 Q ,� ; ac tr+ 0 SUB—BSMT• BASEMENT ' iST FLOOR 2NDFLOOR SRO FLOOR <-rtt FLOOR STN FLOOR eT}t FLOOR 7Ttt FLOOR aTFt FLOOR ` h Check One:. rtiflcate Name j . installing Company 2 ❑ Corporation Address - (A ❑ p hip Wo mVcO. Business telephon6 l Name of Ucensed Plumber INSURANCE COVE GE: I or Rs substantial equivalent which meets the requirements of MGL Ch. 142: ! Nava a current I ity iNo© Ce policy . Yes coverage by checking the appropriate box. If you have checked yl , pteasa itte the type Bond e of Indemnity Other type ❑ ❑ A liability Insurance policy � net have the insurance coverage required by I am CE WAIVE t m Signature an this fxrmit application waives this requirement. OWNER'S iNoS R Mass Generai•t�ws, a aware that y°licensee d Check one: Chapter 142 Owner ❑ Agent❑ �naturo of U�mer or owner ent licalian are true and accurate to the best of my and omuimW, tans performed under the Parini!is.�ed for this aPpi'�catlarr wilt be in oomplianoe with all 1.1 hereby oerlity that all of tha details and Inlormatian 1 hava�tired Ior 1st 1�o�the Genepal Laws. knowAedge and that all plumbing work pertinent provisions of the Massachusetts State Plurnbi t radt� Pn M o Urn r' type of License:Master Lg" .lourn$yrnarr❑ /Town Lloense Number V UNOFOR APPLWA� 90H FOR PERMT TO ®O V'�1� WNG (Print or Type) 20 Date - City, gown Permit Building (� l owner ' s A °: ocati®n U_� ���Yl t 1� �j� Name Type of Occupancy: New ® Renovation Replacement Plans FIXTURES Su)omitted: yes tac z 9 0 TIH EOJ to D 0 0 � � t° c e w g a to ® 1' UNLL . 0 = i +� �' 39 u m a a 3 a is a ea SUB-�-asMT. BASEMENT IST FLOOR 2ND FLOOR 3RDFLOOR 4THFLOOR $TH FLOOR GTH FLOOR 7THFLOOR $THFLOOR (Print or type) L—Lu Check One: Certificate , O Installing Company NameI l C ❑ Corp. Address 1 ❑ Partnership v I gI ❑ Firm/Cocrtpany l have informed the owner o is agent ghat I do not have liability insurance, including completed operations coverage. Signature of Owner/A e aµr5 � c VI� pct sitaevrj +ram ! I have a current liabi .i surance po11 to Include completed operations coverage. I hereby certify that all of the details and information i have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapt 142 of the General Laws.7CV1 Name of Licensed PL er i G"U t r () lot_ t Sign ture of Licensed Plumber Ty e of Plumbing License I j Business Telephone ��f.s � �d License Number ❑ Master journeyman i ' ERMYT TO DO rLUM$ING IFORM APPLjCAT'�ON FOR P MASSACHSE UTTS UN Date permit�� (Type or print) ?It,MASSACHUSE'IS 1.1,C, Amount NORTH p Tti� Owners Name Nf'� ab3 g.0pol-+� O Ff 1 G No location T e of Occu anc Building plans Submitted Yes Rcpiacement C3 Renovation FIx,TURES r W F U w can � a 3 r �IlD�z 5[IIlTt Certificate- Check one; �IIS�Z � Corp• rii f^V 1,I partner. (Print or type) yCompany Nance Installing Address (� Business Telephone the appr0p bo Bond e by checking) e of rndemnity 1��1one of the above Plumber� e of insurance coverag Name of Licensed Indicate the typ Other typ lication does not have any Coves e:olicy Insurance r,a,),,,I liability insurance p have been made aware that the licensee of this a the undersigned, Agent In u an Waiver• lication are true and accurate to the urane Owner�/ to above app lication will be in t ree or entered}' submitted( of the General Laws. ed under Permit Issuedr this a information I have erforin ter a ure od and lambing w°rk and installations p that all of the details and I hereby certify e and that all p assachusetts State Plumbin knowledg revisions of the M u er best of my 11 eminent p igna ure o icense compliance with a p Type of plumbing License nlan Sourney H Master BY irner itle CityrTown PROVED torFicayss aNUy 1 i `1 N FOR PERMIT TO ©O PLUMBING MASSACHUSETTS UNIFORM APPLIGATiO prx rlt or Type) Zp pate ` - owner l s12 a ;/ NaAle r'LB� r Building L� AT: Location G !! ! Type of occupancy: gepl,acement ❑ RenovationPlans Yes ] No ❑ i3ew ❑ Submitted*-`FIXTURES x x y w x x a ' x a a 0 � o � N h W N H txj,.W N o4cpdc o ° w O w N N x x E- rn A Q ❑ sr p w w (a n1 a a w N ae ae W tz W. H o a Q w 1- }- w 3 G x � h x 0. O w it oC � d o a 0 w 4 d N Va3 6 p 4 'a "a Q a d 3 sr p1 d N J US w 3 a a is s uB--+B S MT. BASUMEHT IS'C FLOOR ZHD FLOOR 3RDFLOOR ATH FLOOR 5TH FLOOR 6TH FLOOR OR FLOOR Certificate STH FLOOR Check One' 1.415 (Print or Type) upLack Plumbing & $eating , Inc 5 Corp. an Name [� partnership installing company 32 Rochambaul t Street Address Haverhill t MA 01832 ❑ Flan!Company 8 Q 3 Name of Licensed plumber 1 asfitter 978 372 Leonard A• Business Telephone to to the best of my anon 1 have submitted(or entered)in above a4P lication are true and ace te with all pertinent onoPerformed su under Permit issued for this application will be in complian f hereby certify that all of the details and w0 ter the General t s and that all pVumbing work and i)dcnsta and Veted operations coverage. knowledge chusetts State Gas Code and Chap insurance including comp provuians of be Maw cr or hi,agent that l do not have Vrability' 1 have informed the ovm S•spmwv of O.rocrf A8�a� completed operations coverage. u uisurancz policy to include !have a current liability' �g ature of Licensed Plumber 8y Type of Plumbing peense $67 8 M-k.aster ❑ Journeyman Title ' C'tt JTown License Number y APPROVED OFFICE USE ONLY) �, rA MY Ap )UCATO� eor prints NiA55AC �BEs p, 1stS �Cy4 AAD©V E 2� Owner's cations r30ding Lo pions Sub replacement enovation � � � � � � '•'� V i' E �( gVT 4c Vt; 13 .13 y.r )titD ' FL (} OR "' lnstallinS COOP" Certift () R �lieck n o it LC Corp. o R C3 pA�er, y & H CQ ' or typZ) e y r�� r'trmjC'�• 20 A9ean laaress 383 8 7$ 6a5' � �•.' �le4hone 9 Check on • No 3ustinzss Gas fitter ed Plumber or Yes an,e of Liccns a uivalent• roPriate boy Bond by GB subsmntiaV Qchecktnb the Al..-� chapter 141 of the _ CpVE[ olicy or it s iSCRA iC� ynsurance 4 e of indemntry uired Y re s current 1'tability base i W-ate the 0 1ti r N4e cove case rGq ,s ve chac�ad r,p have the InstIonhi M uirement, •,ou h olicy ee doe not this re4 „i1'�[y tnsur3n�e 4 at the licens iwaiveS : aware that it ApP Check one1 agent tirid c to. W the. ce W Giver, tam Ature on this Perm pwrer above Application ►t >.rtcion will be to }.vnsr�cn� � awl,and that my Sty or catered)to it(slued for this at?P� vta5 hove submiaed l ed under 4artn I ,� of the G�neralWS, pwner's Wnt ation 1 orm a And Cha ter ; woes or emits and info And installAdons pert ;,,�narure of 0 that all of the d biag work State Gas at all plum ��;eh�certify a and� Oft �lassaehusetts Or Gus pitcec �: v l;nowtedg ertinent provisions ed?lumber c of m• th all p OFL ens :omP3'ianc� Silumber 9��3 bar P lc ease ► um Fitter r � �ourneY�n , ;�rT�Wn 1 t3u1LViIVV r r��xi� i j4- �y`rl. V`6 0� TOWN OF NORTH ANDOVER a = v APPLICATION FOR PLAN EXAMINATION h e * Date Received,_,: =r � s�cHus���� Permit NO, - Date issued: Iicant must complete all items on this a e IMPORTANT: Ap '" fi TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential, ❑ New Building ❑ One family ❑ Industrial ❑ Addition ❑Two or mare family p Commercial ❑ Alteration No. of units: ❑ Others; ❑ Assessory Bldg ❑ Repair, replacement ❑ Ofher ❑ Demolition DESCRIPTION OP WORK TO BE PREFORMED: A(A 0,/L e2)(,AQ-0C,>rn :Z:) oV Identification Please Type air Print Clearly) Phone: OWNER: Name: Address: a n1 ad�a. ARCHITECT/ENGINEER Phone: Reg. No. Address: FEE SCHEDULE:BULDING PERMJT:$'l2.OD PER$1000,0€3 OF THE TOTAL'ESTIMATED COST BAD a�1$325.013 PER S.F. Project Cost: $ FEE: $ Total taro) ow ,. Receipt No.: Check No.: with uliregiste!°ed contractors do not have access to the guaranty fun NOTE: persons contracting .— The Commonwealth of Massachusetts Department of Industrial Accidents d • Office of Investigations 600 Wiishington Street r` .Boston, MA 021I1 r' www.mass.gov/dia Worlcors' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeObly Name(Business]Organization/individual) lL Address: 20, OuTkP_. S W t}Jt City/State/Zip: Phone.#: Are you an employer? Check the appropriate bat: Type of project(required)i` 1,❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have $, ❑ Demolition , working forme in any capacity, employees and have workers' co insurance,/ -9, ❑Building-addition [No workers' comp, insurance comp. ' required.) 5. [ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work ` officers have exercised,their 11,0Plumbing repairs or additions myself, [No workers' camp, right of exemption per MGL . 152 § ( )� 12,0 Roof repairs c insurance required.]t , 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required,] "Any applicant that checks box#1 must also fill out the section below showing their workers`compensation policy information. t Homeowners who submit this sff'idavit indicating they are doing all work and then hire outside c6nira^tors must submit a now affidavit indicating such, tContractors that check this box must attached an additional shcct showing the narne of the sub-contractors and state whether or not those mtities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I ant.an employer that is providing workers'coinpertsatinit insurance for nay employees, Below is the policy and jab site information. Insurance Company Name; C AL Policy#or Self-ins, Lie, #: Expiration Date: 7oh Site Address: � 'N z � i t. k ('i q {��� t .d:,�lii....t! S City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. 13e advised that a copy of this statement may be forwarded to the Office of a Investi tions of DfA for insurance coveraize verification, I dv here c a e `the pains and penalties of perjure that the information provided above is true and correc4 Si attire: 10 Date: �L) Phone t G , FColntak al,use only. Do not write in this area, to be completed by city or town offciaL r Town:' Permit/License# g Authority(circle one): rd cif Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Person: Phone#: 4ORTH Twn o of over 0 No. 00 dover, Mass., • () LAKG COCHICMSWICK yt 7�hORATED v BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR PERMIT T THIS CERTIFIES THAT 4.. � -•....................................... ..................... ............. Foundation has permission to erect. ... g 0*1.?' ..�►•C . �1.�, Rough bw din s on to be occupied as........ �,/4�.� , ............... .... .. .......rt.44. ..... ...... � 'y �' y 6 �.�• Chinn e provided that the person accepting this permit shall in ev respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final qk PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUC S Rough .. wry......... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det_ Ell, � �°v Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions, Total land area, sq, ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGi_Chapter 186 Section 21A—i"and G min.$100-$1000 fine NOTES and DATA— (For department rase ❑ Notified for pickup - Date Doc—Building Permif Revised 2007 F NORTH Town of over No. S�` o _ C% La E over, Mass., COC HICME WFG Ii ,9 ojt?Areo APR �C5 BOARD OF HEALTH M T Food/Kitchen Septic System PE R I- T THIS CERTIFIES THAT �/ � / '4/ �f BUILDING INSPECTOR ......................................................................'.............. .......------. ....... Fo undation has permission to erect........................................ buildings on GZ�. :� !.{� .. ... .... --!1, "�., �?✓� Rough to be occupied as...........J..,r aea�- ....... " . Chimney .. .................................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCT10W STARTS ELECTRICAL INSPECTOR Rough -------- ---- -1----------- .......................... Service B�NG INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR - Display in a Conspicuous Place on the Premises -- Do Not Remove Rough Fins No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NoRTH qH p��S � 6e6 ING PERMIT BUILD AVER _ ORTH AND =et' TOWN OF N PLAN EXAMINATION APPLICATION FOR Date Received )ermit NO: fete all items on this pale Date issued: / licaat must comp IMPORTANT: APp LOCATION "'t Yes no Print is District es no. PROPERTY OWNER e ZONING DlSTR1CT.�-Machine Shop Villag y MAP NO..: -- T PROPOSED USE Non_ Residential TYPE OF IMPROVEMEN Residential strut . One family Indust6 . New Building Two or mare family Commercial. Addition No, of units: ry Alterab Assessory Bldg Repair, replacement Other Watershed..�is#ricf Demolition Ftoodpain Wetlands" Septic Well ORED E PREF ' TO R G WaterlSewer D CRIpTION OF WORK ` t r Typ Phone e or Print Clearly) 7 �` j denfifictfiona Pile ase , } < OWNER: Name: Address: Phone. . .; .P v i CTOR CONTRA Name c1 Address. k Exp. Date:' Superv+sor's COnstruct1On L4cense: Exp `Date; rn Home tmprovement'L� cerise. ' 5 Phone: ARCHITECTIENGINE Reg. No. l 5 QO PER S.F. PER��000.00 o>=the roraL Esrrn�RrED cosr BASED ON g92 Address: ( FEE SCHEDULE;sULDING PERMIT; ?2.00 FEE: project Cost: $ t NO.: and Total-Prot' � Receipt ua�•arrty f Check No.: ' te1'ed contl•actors do not have access to the g , NOTE: Pei-sQlis conb•actirig�vrtli rin1'e��g1�5 tune of contractor ¢ nrr� P' 1` . : Slona The Coinnion wealth of A2assacirusetts Department of hidustrial Accidents ' Offlee offilvestigations r ' t 600 Washington Street Bostaii, MA 02111 ►vtvw.ntass.gov/dia . Workers' Compensation insurance Affidavit: Buiitiers/Contractol•slElectriciailes/Plumbers Applicant Information Please Print Le ibl Dante (Business/Organiza(ionlindividoal): 't �'7 i Address: . �. )OX T ' �/� r city/state/zip: 'KI, � ��� �/� 01g)(PItone#:_���' � 111,kir, Are you all employer?Check the appropriate box: Type of project(required): 1.92'vi din a employer with i 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full andlor part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached shect.t 7. Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity, workers' comp.insurance. 9, ❑Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOL 1 l.❑ Plumbing repairs or additions myself.[No workers'comp. c• 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees, [No workers' comp. insurance required.] 1310Other 'Any applicant that checks bo)l N I must also fill wit the section below showing(heir workers'compensation pol icy Inlorrnatlon. t Homeowners who submit(his attidavil indiealing they are doing all work and then hire outside contractors must submit a new affidavit indicating such, lConfraclors thal check this box must attached an additional sheet showing the name otthe sub-contractors and their workers'camp.policy inforniation. I am an employer that is providing workers'compePnsatlou lusuranee for my employees. Below is the policy and job site iPrfarnnatloPn• ' Insurance Company Narne: L� —')h _ Policy#or Self ins, Lie. #: Le Expiration Date: /� .JobSiteAddress: t' l �s a< cc, City/State/zip: `." Attach a copy of the workers' con pensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL e• 152 can lead to the imposition of criminal penalties ofa fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORT{ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby cent f&un r the fulls dpernalties of perjury that the informadon provided above is trite and correct. Si Iratur ` Date: Phone M. Official use only. Do Piet write In this area,to be completed by ci(v or town ifftcial• City or Town: Per•tnit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector G.Other Contact Pei-soil: Phone 11: �rT. y r 0 `cr.."j�y,+ '-",. CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161 Z PROJECT TITLE: North Andover Office Park PROJECT LOCATION: 203 Turnpike Street NAME OF BUILDING: Building 2 SCOPE OF PROJECT:. New accessible toilets and janitor closet on third floor,203 Turnpike Street. In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D. LaGrasse,AIA _ MA. Reg.# 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans,computations as specifications concerning: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. 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 proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 116A, 1 shall submit periodically, a progress report together with pertinent comments to the Building Inspector. Upon completion of the work, 1 shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Joseph D. LaGrasse, AIA F 4153 gi tore of Architect/E peer Date Offices AWA One Elm Square 5gP T 978.470.3675 Andover,MA 01810 F 978.470.3670 1420 Celebration Blvd. i"miagrassearclutects.com Celebration,FL 34747 AA26001333 Property m PROPOSAL NO. 9359 wPACE NO. P.O Box 545 1 Billetica, MA DATE 1/19/2010 L General Information Proposed by: U.S. Property Services Telephone: (978) 836-1206 P.O Box 545 Fax: (978) 587-2809 Billerica, MA Submitted To: First General Realty Corporation Work Performed At: Common Bathroom 93 Union Street, Suite 315 203 Turnpike St. Newton Centre, MA 02459 Sd floor 11. Work Description We hereby propose to furnish the materials and perform the labor necessary for the completion of the work described herein and to commence on the date listed above: • Frame demising walls for the men's, woman's and janitorial $12,960,00 closet • Install sheetrock, mud and tape • Install 12xl2 ceramic tile • Install 2'x2' Ceiling tile grid system • Install two new Fire rated doors and reuse one door for the janitorial closet • Install Handicapped bars(4 total) to both restrooms • Install two mirrors to match the ones on the first floor. • FGR to proved and we will install Toilet paper, Paper towels, and soap dispensers • Plumbing $9,650,00 • Electrical $3,425.00 111. Exceptions • HVAC • Carpeting • Fire Alarms/Sprinkler Systems 1V. Terms a. Ali debris will be removed on a nightly basis. b. First General Realty will provide the dumpsters (if applicable) All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of Six Thousand Four Hundred Eighty and 00/100 PER BATHROOM Dollars ($ 26,035.00 ) Payments to be made as follows: 1/3 Deposit, 1/3 Progress Payment and 1/3 Upon Completion *Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. *Note—This proposal may be withdrawn by us if not accepted within 30 days. (Continued on the next page. . .) U.S. Property Services-Tel: 978-587-2809•Fax:978-587-2809 uspropertyservices@hotmail.com U.S. , Corp.g PROPOSAL NO. 9359 PAGE Na P.O Box 545 2 Billerica, MA DATE 1/19/2010 (. . . Continued from the previous page) Respectfully Submitted Frank Gomes On behalf of U.S. Property Services ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date - r Signature, w Date Signature U.S. Property Services•Tel:978-587-2809• Fax:978-587-2809 uspropertyservices@hotmall.com CERTIFICATE OF LIABury INSURANCE 112/23109 t E�lCOL1g9 TW C 30WA'1EIS AMMA5A MA1TTERoriNfusMAMN C" �-acve3. Inasaiafu� Ayevcy OtZYA1�CSB�1�OOWs"�1131�PVTi£CE�i'�7GA7 6 Hicib et.reat KXL43LTHBCVUJF1GATEV0ESNCFf AMatEt.OcrIE OR a►l:verrs, b 03923 :0.1.s6RTWCOVERA(EAFFORI.MDYIRIEPOLICOM MC . c_c T trautzm �fdTI)F ItnCEA4IE ,E ltiA1CA 94UH593A One Beacan -Tmm='nCJE (T$ PropE 5ervicacE IB[SUi�37t;Granite stat, E3m 0. �.. i 200 A lamer street, Sr!" 3=2 t--* Iaaabod_v, *OL 02960 l t r•' F— itr�l�x� C,,i);/E: TrWFDUCiES GF LNSUPAHPAE US•TED 6ELCAV IOAVECEEfi MWEU TU'RiE UlSUREF�lf�hlEO BCT.E FL7FiTKE POLICY P�'JiICk}[�]CRiEJ3.Li071t1T]iSEipptd6 X"RWUIR fXhr TERLiGF,EfINDITOU OF ANY CO[MICT OP OWER ZMLIheml V iTijFMEpWjr-tb WHICLi m4is CER11FVr-k K NA'S BE LS*,1fE0 CR UAYPMIMN,-OLE1MR) AWCAFFORDEUOY1HEF►LKJESC-ESCFIREDHERaK155M&CIYL)ALL-METERUS,E :LUSIONSANOCCMDIRoy5CF411[ti iCIJCIES,FC EGf-TEUfffrm SHOM LIAY HAVE CEEf;115PUCEO UY PSIG r-L.AJM- J<'ISR POULV Wo FilLICSEMF�'C'li KiUG'f 'IQ L jl � R.u�tLnr �ra+r3c��:1: x 1 aoo bOU � 13 E X 1Gt a�t.ursLr r ED &B 2L Wls 10127)09 1212711-0 ` s 5010G{ i CIAW tvt E OCCUR leF9E7 .brie-2x�W S 5.Diu 7 Ff'�-�'ilYFiJl6R'Ri�IF4Y S ] QQQ DID 0 - - I 2,COO,D(!D Q I�SEft#L afi!>BfT�i7E s L'B4'IAJ .TELNII T� POM.HC�-aur EPAs s ,7 4100 DOD RUmv F-sm l i tlDc _ j NUT05yCe.lElL -ay ceut�He s�n�£tMF s ttia AWAMO I0--''J Att[Ir.Y�Nros El.CiLYlRl.l M SItill.H:RE#l�f 1:1 asaf 5 ' HRmAlfI e nC �DAU7C55 6c"Leo�i t]M S E �6ARJCrELLS.IIY � �RUTL=Qtl13-64Cb"�a7e �-� C'� PJrlallTo FAA=I� i mmmum FatAt14&n- j i'rJ�CHOCCUI�$!CE f CCCLIE; CIpSiS WjE 1 AS�LVTE S S &EDUCI mf rs`easm;•scoLCEr�su+cr,Twvu s - 0 sT �- *r•.+� i=7C7leal> ;WE 6256772 11J31O9I 11f:)j10. eLs�alrncl�rr s 1�a,0I}D �/IFi�CE�EB ? U DP ELtD iB - EaAlti!1 S 100,OO9 . RLc�taaaoRsl.�ti �EI.L�r -t�l.lc�'t►sI j s 5t1[l,pDD MEN t !3 i i Os�R�F'fla7t�'aPe'J1nDI�1tuG1L"LbHS15EHGLPS1EYClIR#L4�J[ibCitBTEHoU?99fEKilR�d''EGLlLR3C4+�ol� - Boat.n nemne2cpimant (group at al aw-1 Pi-vat DweYal Real" Corp axoc a31 �rcip�,ios �&Ifag+eed �1C `E'.�r 1.9 r,amc�., addik�vnel inffier�d; CERMCNE HOLDER CANCELLAI ICE1 s1O4ftDAWfUViHEIEUKG=R1TGDP4W-ES9E6AWUlUOEF0M,**E" Am4 IhATE,MLR ,r�ildlQC6'.i�flt�RlYIL1 ENDE,KtirFTot !q tmwmTTm Boston U�ve7t}�K1� CtgAq? � e1 NaMEttu7llECEarnlr�a7EKoLnHMl:n51m7nnwlx�T.Bt1IrALLIRE�>dososll�i XitrsL Genaml Realty Cbrp � �PnsEt�CceutwrC�laKLuauT{aF7onito►nL�DP+1NHe��WLEJegtSACEl�rsoR all pxwperties nanagsd -.t�ersby _ 93 Union St»t, Bute 315 w�crs�em I raT+ti� Houton Cmn► a, Ma 02459 L ACaV2512OD'" U1-aA1 C[1�DR:tiTiKW'�9 C Dimension i Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— department artment use � p ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 NORTH Town" Ofa}, over 11% - iq (�o; >�h ver, Mass, d AXE coc"JeftEwicK V s u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..! �...000airf�...............................0eA � ,,,,, BUILDING INSPECTOR .. has permission to erect .. buildings on . �. �� . Foundation Rough ... ... . .. .... ... . ... to be occupied as ... ... .... ... ... .. �.� ................ Chimney provided that the person accepting this permit shall in every respect conform to a terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR - UNLESS.CON STRUCTIO STARTS Rough .. 6. ........................ Servile ........ _ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous PIace on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ............... ................................. : NoRT" BUILDING PERMIT o�a4�TL�p_ 0 TOWN OF NORTH ANDOVER' APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Alf Date Issued: ACHU IMPORTANT:Applicant must coin fete all items on this page fOCATIbN ! ... . Print PROPERTY �WNER .., MAP NOPARCEL'� �ZONING ©ISTRIGT �Histotic D�stnct yes no Machine Sho .U�Ilage.. 7i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition L7 Two or more family ❑ Industrial ;Q Alteration No. of units: p`Commercial El Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other C]Septt 1 Ullell ❑ Flaod lain; 7 Wetlands ❑ Watershed Q�strct p Q Wafel/S ewe e f r fi r Identification Please Type or Print Clearly) OWNER: Name: Az�l. Phone: . Address: t CNTRACTOI Name _ 7 Phone Address T1, Sup wisor's Construction !_lcense Exp Date ' Horne improuernent license El Date ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:SULDING PERMIT;$12.00 PER$1000.00 OF THE TOTAL ESTIMATED,CO,0,-T�BA{,SED ON$125.00 PER S.F. � Total Project Cost: $ `� ' ' FEE: $ Check No.: Receipt No.: NOTE: Persotts eorttt'actittg with wiregistered colttractors do riot have access to tit guaratttt)ftittd Signature of AgentlOwner.` Signature of contractio .�� The Commonwealth of Massachusetts Department of Industrial Accidents M G Office of Investigations 1 Congress Street, Suite 100 �y Boston,MA 02114-2017 a ° www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly , NaMe(Business/Organization/individual): O[} Tier Site Development COIP. Address:210 Kenneth Welch Dr City/State/Zip: Lakeville, MA 02347 phone , 855-367-8873 Are you an employee?Check the appropriate box: Type of project(required): 1.0 I am a employer with 52 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑Building addition [Na workers' cutup, insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0Roof repairs insurance required.]t Q. 152,§1(4),and we have no employees. [No workers' 13.0 Other wireless communication comp. insurance required.] *Any applicant that checks box it1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all woik and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the suh-contractors have employees,they must provide their workers'comp.policy number. I attt air employer iltrtt is prorldittg workers'conrpensatiott insurance for my ettiployees. Below is the policy rind job site information. Insurance Company Name:Liberty Mutual Policy#or Self-ins. Lic. #:WOS-31 S-382146-014 Expiration Date:913115 Job Site Address:121 0 Z2 1 City/State/Zip: N . N ��+2 Attach a copy of the workers' compeusa ion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un to ains and penalties of rjury that the information provided above is true and correct Signattire: Date: 10/28/2014 Phone#: 8553678873 Official use only. Do not write in this area,to be completed by city or tmvtt official. City or Torun: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: li CERTIFICATE LIABILITY INSURANCE DATE(fdMTo[aYYYYI • �/2tx4 THIS ID ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THI; CERTIFICATE HOLDEN. THIS CERTIFICAIEE DOES NOT AFFIRMATIVELY Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY.THE POLICIES BELOW. TMS CERTIFICATE OF INSURANCE DOES. NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS}, AUrHORi2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. fMPf213Maln ANT: It the oertitloate holder is an ADDITIONAL INSURED,the polloy(ies) must be endorsed. If SUBROGA71ON I$WAIVED,subject to and conditions offbe poflay,certain policies may require an endorsement. A sWfemant on this CertifiratD does not confer rights to the holder in lleu of such endorsemengQ. G U Maria AZIJte Ida Insurance Agency Group, P Ns (508) 298m13za x a. (54s) 235-s7so Street AOI ESS: max a.aZ>�eidaL�l e 8 a nsu;arlae rou .com , MA Q2571 INSURE 5 AFFORDINGCOVf!RAGE NAID4 INSURERS r COmm,ex'ce XnSUT1anae Co Top Tier Sits Development Carp 1NsuReR c;torus Speclalty lrls Co 210 Kenneth Welch Dr INSURER R p:]rS�rt Mutual T,c33CfyV E r MA 02347 INSURER Er INSURER F I COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED-ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERN{OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUF..t3 OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXGLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. JL TYPROFINSURAN06 ADb 5 e POLlCYNUMBER P6I lYEEFYyy) NSM YY�YY WATS A GENERAL.LIABILITY y 2CT5222 9/6/19 9/a/15 EACHCCCURRENCE S 1,000,000 X COWERCIAL GENERA L LIAR ILITY T1AM4GETORENTEO Ou,UM-MADR n OCCUR MEb E)P§AWona p=m) s 15,000 PERSOML&AI)VINJURY S 1,000,000 GENERAL AGGREGATE S '2 000 000 GEMLAGGREGATELL'ITAPPLJESPER. PRODUCTS-COMPIOPAGG I S 2,000,000 POLICY P 0. LOC - S H allTak.?BILELIABILITY BGJRNP ' .9/2/14 9/2/U.5 ce� 01E 1INGLE� Is1 000 000 ANYAUR] BODILY INJURY(Perporvon) S AUTOS XOSULEb BODILY INJURY.(Per racidenl) w� HIREDAUTOS AU OSWNEO PROI AtJtAGE PEf accldy" 3 C UMORELLALM I X OCCUR 700SE131ALI 9/6/-t5 EACHOCCURRENI E s 5,000,000 X MESSLIAO OLAItv13-MAI1> AGGREGATE Is 5,000 .000 DED X RETENTION$ Is D WORKERS COMPENSATRIN XC2-31S--3132146--014 913114 9/3/25 X I WCSrATU- attl AND SIAPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN N!A E.L.EACHACCIDE S 1,000,000 OFF1MFW M9ER E=LDEO7 (Maodefnty In NH) EL,bISEASI -EA pvIPL E 1 QQ(},O0Q O F ID>�S f rlRIPdeaTib"cr 'N"O ' PERATfONBbebtY E.L.OISEASE-POLIO LI IT S 1,000,000 DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLES (AnchACORD101,AddleonalRemtrAs8ohadute,EfmorespscefamgpAred) CERTIFICATE HOWER CANCELLATION LAURLME) OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE TION DATE THEMOF, NOTICE WILL. BE DBLtVERED IN E WITH TN5 POLJGYPjtOVISIONS, ESENTATNE A ®19f18 090 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The AGORD name and logo are registered marks ofACORD knCne: Fax: E-Mail; NORTH o of o � � � � No. a t LA dower, Mass., { C0CHICH�WICK wry. r ��ADRATED ` S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT-------------- ��nr ©� -:... � �=f° .... ..SJ- C -------------------------------._......._. ,. Foundation has permission to erect........................................ buildings on.. r�iar.. ...-G^---- '------..._._._...... Rough .... .. to be occupied as ram- Chimney p' („_... l.d .. /ems z..:. .�w . provided that the person accepting this per shall in every respect conform the terms of the application on file in Final this office, and to the provisions of the Co es and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN d MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ' - iR service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fi" No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. BUILDING PERMIT 0.4 ,`%O oT a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: f = Date Received 7�pbR tTRp w, �ssacHus�t Date issued: IM ORTANT: Applicant must complete all items on this page t_OCATION Print . PROPERTY OWNER- -r�,y •r E'1 c�FF c !�R R -7rR�s Print MAR 2 I0 PARCEL: ZONING DISTRICT' Historic District yes no Machine Shop Village::: .yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family trial atio No. of units: Commercia Repair, replacement Assessory Bldg ers: Demolition Other Septic 1111e11 Floodplain 1Netlands Watershed District Water2Sewer` DESCRIPTION OF WORK TO BE PREFORMED: f� -� �"N "V - v Identification Please Type or Print Clearly) OWNER: Name: qr r uz r — ¢K ,2v Phone: 1-7 .32 - C, Address: 1? tyv T t�'L,,r� „ .r -- CONTRACTOR Name: / �c �r� Cam' Phone; 7 Addtess< �f ,Q ,e Supervisor's Construction License: � 'z. Exp. Date: Home Improvement License _Exp Date: ' 2vy ARCH ITECTIENGINEER '3 1) , G A Phone:_`?» ) �L7s- Address: -4 4'-4* -x y R - �� ��� Reg. No. 4 FEE'SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��� FEE: $_ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do riot have access to the guaranty fisnd Signature of Agent/Owner Signature of contractor Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—Fend G min.$100-$1000 fine NOTES and DATA_ For department use) ❑ Notified for pickup - Date Doe.Building Permit Revised 2010 i The eolJ Monwealth ofmassachusetes 'Department ofliidustrial Accidents A .� i Off,Ce ofli�restigatiarrs 600 W"M119ton Street ` Boston,M4 0.211.7 7 - � 1'MM Mass goPrdia Workers' Compensation Insurance A,.fflidavit: Builders/Contractors/Electriciaus/plumbers. A, Mant Information Please P.raint�e 'bI NaMO(Business/Orgattizationlindividual): e Address: T /yvaQ AFC City/State/Zip: ,�,, c,7-�N Gh Phone Are employer?er,an You Check the appropriate ra riate box: Y P �' ' I.© X am a employer with�w 4. 0 I am a general contractor and I Type of protect(required): employees (.full and/or part-time).* , bave hired the sub-cont-actors 6• 0 New construction 2.El I am a sole proprietor orpartn er- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have worldng forme in any capacity. employees and have workers' $. Demolition [No worlcers' comp.insurance corap. inmrance.t 9: (]Building addition 3.❑ required.] 5. We are a corporation,and its 10.❑Electrical repairs or additions I am a homeowner doing all work Cflfcers have exercised their m self: 1 I-❑Plumbing repairs or additions y [No workers comp, right of exemption per MGL insurance required.] t a. 152, §I(4),and we have no 12•❑ ofrepairs employees.[No workers' 13�Qther Camp.insurance required.] " *Any Applicant that checks box f#i must Also fill out the section below showing their workers'compensation policy Wormation. t Homeowners who submit this afSdavit indieadng they are doing all work and then hire outside contractors must submit o new affidavit indicating suc}a, mpio nes. that cheek this box must employees, ee ,aley additional sheet showing the name of the subcontractors and state whether or not those entities have employees, it thesift-contractors have employees,they must provide tWr.workers'camp.policy number. I am an employer that rsprovidirrg tporltets'compensation insurance for any employees. Below is the polFcy and job site irrfotmation. Insurance Company Name: Policy#or Self-ins.Lic,M Expiration Date: Job Site Address: City/State/zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the:imposition of criminal penalties of a fine up to . a d 00 a d 00 and/or one-year imprisonme of tap to$25050nt,as well as civil penalties in the form of a STOP WORK DRDER and u fine ay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify cinder thepains and pertaldes ofperjury thatthe fnformation provided above,is true and carrect Si ature: { Phone All: 7� �7 7— Official rise only. Do not write in this area,to be completed by city or imps official City or Town: Permit/Licens"e# Issuing Authority(circle one): .I.Board ofRealth 2.Building Depnrtment 3. City/Ti wn Cleric .�.electrical Inspector S.Plumbing Inspector G.Other _.. Contact Person: Phone it: )RODUCER (508)393-7744 FAX (508)393-6983 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pastern Insurance Group LLC - Commercial ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 155 B Otis 5t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 1129 Northboraugh, MA 01532 INSURERS AFFORDING COVERAGE NAIL 11 NSURED Maillet Homes Inc. INSURERA. Western World Insurance Co. 9 Hubbard Lane INSURER W Bolton, MA 01740 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NPPI236292 0811712009 0811712010 EACH OCCURRENCE $ 1,000,00f X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,001 GIICC CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,00 A PERSONAL&ADV INJURY $ 1,000,00C GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY jE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accideni) PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY Lj AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSfUMBRELLALIABILITY EACH OCCURRENCE $ ,i OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ I OTH- WORKERS COMPENSATION AND I TWOUMMU- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPR€[TOIVPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISCASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FORD Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, E TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY D UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. For Insurance Purposes Only EPRESENTATIVE ittred e (EO)/LMG ACORD 25(2001108) OACORD CORPORATION 198E ✓ - / i' ✓,r.�✓ -. l�i" rr'"' !y - ,r���'" r:�.""f-'� /? ..-�����.WC�.� r_ 1 ' lAJI, Ie'�r4'1� 7w�lk., Wa Own � _ al ' � ✓r �z � ..� r _. ,,„sr yr -./''y � - �L1I����A1i��' .��1C11}I�A'. r i CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161D PROJECT TITLE: N.Andover Office Part{ PROJECT LOCATION: 203 Turnpike Street, N. Andover,MA NAME OF BUILDING: Buildhw 203 SCOPE OF PROJECT: New construction—Steel&wood Exterior Canopy In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D. LaGrasse MA, Reg.# 4153 being a registered professional architect hereby certify that I have prepared, directly supervised, or reviewed all design plans, computations and specifications concerning: Entire Project Architectural X Structural X Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that 1 shall perforin 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 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials, 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix I, Pursuant to Section 116.4,I shall submit bi-weekly(every two weeks), a progress report together with pertinent comments to the 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, AL��'Ze' ign ture of Architect Date MOSS (1A One Elm Square OF��e,P T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 www,lagrassearcbitects,corn BUILDING PERMIT "O pr"�ti TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION 4E Permit NO: Date Received °+A`°`"""."� �pSSACFi►3Sfle ���y Date Issued: P IMPORTANT: Applicant must complete all items on this page LOCATIQN 2 :s Print PROPERTY GINNER P int MAP NO PARCEL ZONING ©ISTRICT, Historic I]is.rict yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non Residential New Building One family Addition Two or more family i Alter t oia n No. of units: Commercia Repair eplacemen Assessory Bldg Others: Demolition Other pep#ic Well Flaodplain Wetlands Watershed District::.-' Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: S-dauo ag &SrA ` l Identitae tion Please Typ or Print Clearly) OWNER: Name: ,r hone: Address: 56 Ablit &P&et � .t CONTRACTOR Name. Phone: Address: Supervisor's Construction License, Exp. Date: Home Improvement License: Exp. Date: ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ d i No.:Receipt �1 v Check No.: [�? � p ` NOTE: Persons contl•acting With unr,egisteretl contrAactol•s do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions, Total land area, sq, ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-1=and G min.$100-$1000 fine NOTES and DATA- (For department use) Q s—;-flu Civ&'-21 s aYA -D w� ❑ Notified for pickup - Date Doc,Building Permit Revised 2008 171e Commonwealth o,f Massachusetts Department of In Accidents Office of Investigations 600 TTrashingrton Street Boston 1L4 021.11 .. wWW-Ynass.gov/die - Worli:ers' Co mpei.safion Insurance Af'fidavilt: Builders/Contractors/Electri Acians/plumbars licant Infarmmion Please Print�e 'bl Name (Business/Organization/in(lividual): Address: City/State/Zzp: •R ( Pktone.#; X. 33�. �' •QBI Are you an employer? Check the appr�opHate box: 1.❑ I am a employer with ' 4. [ 1 am a general contractor and I � 'e of piroject(required)} employees (full and/or part-time).* have hired the sub-conlractars 6. El construction 2.❑ I am a'sole proprietor or partner- listcd on the-attached sheet 7, Remodeling . ship and have no crnployees "These sub-corttractors have working for me in any capacity. employees and have workers' 8. ❑Demolition [No workers' comp.insurance comp. insurance.# ' 9. ❑Bdilding.addition , required.) S, We are a coiPoration and its id. 3,❑ I am a homeowner doing all work ❑Electrical repairs or additions fficers have exercised their myself. [No workers' comp, right of exemption per. 11.0'Plumbing repairs or additions insurance required.]t c. 152, §1(4.), and we have no 12-13 Roof repairs employees. [Na workers' 13.❑ Other comp. insuranco required,) `may applicant that checks box a'#I must also fill out the section tsefow showing their workers'co t homeowners who submit this affidavit indicating they are doing all work and them hire outside co tractors must submie-Ation Policy information.now affidavit indicating such ;Contractors that check this box trust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have empiayees. If the sub-contractors have employees,they must provide their workers,comp,policy number, am,an employer that is providing workers' information, ht compensation sur ance far my employees. Below is the palicy.and job site Insurance Company Name; G [ Policy or Self ins.Lic. Expiration)ate. 2 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failuic,to secure coverage as required under Section 25A of MGL c. 152 can lead to,the imposition of criminal penalties of a fine up to$1,SOfl.t)D audlaz one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to tions o a day against the violator. Be advised that a�capy'of this statement may be forwarded to the Office of" Investi atinns of the DIA for insurance coverage verification, I do herebjs art' der the Pains.-and penalties of perjure that the information provided above is true and carrec� Si ature- Date' / Phone#: OffataG.rese only. Do not wrue in this area, to be completed by city or town gfficiai Cite or Town: PerrrritlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.E 6. Others lectrical Inspector 5. Plumbing Inspector Contact,Person: ', Phone#: NORTH Town c of : . aver No. G C4 o �` dover, Mass., d COLtiIC EWILK �M1. AaRATED p �2 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �.�..:. ....6 �. ,............................ Foundation has permission to erect..................................... .. building s on tojcw.- to be occupied as.. �� ............. .. .... .... 11. ! '"! � himney provided that the person accept this per m hall in every respect tform to the terms of thelpplication on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONS, ONS TARTS ELECTRICAL INSPECTOR. Rough Service BUILDING INSPE R Final Occupancy Permit .Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. BUILDING PERMIT 011 "° T#1 a 4Y4R 6 4• TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION oo Permit NO: Date Received * byy ATEQ AC Hi35���9 Date Issued: 'd IMPORTANT: Applicant must complete all items on this page La 'ATION R SST P int PROPERTY OWNER ':�:FIR.S. c Paint MAP NO PARCEL: ZONING DISTRICT: Historic District" yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family u Alteration No. of units: ommercia Repair, replacement Assessory Bldg Others: Demolition Other Septic' Well Flovdplair Wetlands Watershed:D strict WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: ,identification Please Type or Print Clearly} OWNER: Name: JD yL6-r L Phone: Address: f CO"IVTRACTdR Name• 'T 1 h f` Phone �- Address: DS 03 6.13 Supervisor's C on structlon License d " Exp Date III' ]aQ � Horne.:Improvement License: Exp. Date. ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ a21�? ( _ FEE: $ Check No.: . �% _- .. Receipt Na.;. __ NOTE: Persons contracting vitlr unregistered contractors do not have access to the guaran fund Sigrature of AgentlOwner Signature of contractor Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.-. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 16—sm,.,rarotvvcaun or maSSaC17USettS Official Use Only Permit No, lq3 Deparf�'men� of Fire Services BOARD 01= FIRES PREVENTION REGULATIONS Octupancy and Fee Checked f�� ` [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Ma ssachtrset#s Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT INDX OR TYPE ALL INFO&VUTION). Date: R City or Town of: NORTH ANDOVER By this application the undersigned gives notice of his to perform,therelectrical wor dy s or her ine cribed below. Location(Street&Number) G,e / Owner or Tenant /X�% Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes El No ❑ (Check Appropriate lice) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead: ❑ Undgrd ❑ Nn.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical,Work; . Corn letion o f the ollowin -table may be waived by the Inspector of Wires. No, of Recessed Luminaires No.of Ce!L-Su<sp. (paddle)Rang No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming pool .A ove In- a.o mergency zg g nd. � end. � Battery Units No.of Receptacle_Outlets No. of Oil RUMers rl<RE ALARMS r No. of Zones No. of Switches No. of Gas Burners o. o Detection and Initiatin Devices No.of Ranges No. of Air Cond. Total Tone No. of Alerting Devices No.of Waste Disposers eat Pump U1nber on o, Of Self- ontained Totals: »"- Detection/Aler(in Devices No. of Dishwashers Space/Area Heating KW ❑ Municipa Connection Other No.of Dryers Heating Appliiances , Security Systems: No,of Water a, of Na,of Devices or E uivalent Heaters KW Si s 'No. of is. Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing; OTHER; No.of Devices or E uivalent Attach additional detail if desired, or as required bj,the Inspector of Wires, Estimated Value of Electrical Work; .(When required by municipal policy,) Work to Start:Jr �Q Inspections to be requested in accordance with MEC Rule 1 Q,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE.0 BOND ❑ OTHER ❑ (Specify,) I certify,under the afns andpenaldes ofperjury, that the informadWl on this applicadion is true and complete, FIRM NAME: L)1C.NO,: Licensee: !$9%� • /� /��.&,!>._pt1 Sign fat LIC.NO.; (If applicable, ter "exempt' L��lipe a number line Bus.TeL Address: L �CG-Psa� ' c1 r�'�/y" *Per M.G. a 147,s. 57-61, security work requires Department of public Safety"S"License: Alt.Tel.No. OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the Iiability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the( Owner/Agent check one) [] owner ❑owner's agent Signature Telephone No, PEaT21kII7 FEE: ,$t 04/23/2008 19:44 16038906963 MJS MILLWORK LLC PAGE 02 1 t i t 3 't MJS MIU WORK LLC POE Ox 17 NO SALFW NU 03073 December 17, 2008 j North Andover Oflf'ice Park 203 Turnpike Street No. Andover, Mass Attw Joe Dicaco j i MJS Millwork is pleased to submit this pr osal for the installation of a per,meter drainage system at 203 Turnpike Street at t to area's affecting North East a al Sur8ery. , After careful inspection of site conditions i�has been determined a gravity Ilow system will not work, So MJS is offering a catch basin with sump pump proposal t Description of wo& I. Remove all shrubs, tress, bushes et#. in area being affected by work 2. Excavate down to building footing starting at the left side of the m in entrance stairs following around the building to the side entrance stairs. 3. Power-wash and clean existing fou6dation walls to remove dirt. 4. Install a rubberized water proofing rXisting alant on the clean foundation• end also install a-/a"thick draital a board over the foundation. 5. install 6" drainage pipe at footing*it.h a min. of 12" of crushed stoile covering drainage pipe. install a kilter fabri�over the stone and drainage pipe. 6. Install a$' deep catch basin at the 4orner of building with a 11z hor sump pump, i I E 04/23/2000 19:44 16036906963 MJ5 MILLWMK LLC PAGE 03 I I I 7. Wire sump pump into building main panel with a electrical disconnect outside for maintenance. 8, Run tiew perimeter drains into catch basin, Q. IWSWIl upright drainage pipes and connect existing gutter downspouts into taprisghts to collect roof water, 10, Install drastfage line f-om sump pump to catch basin in driveway, Hot top to be cut, removed and replaced, 11, Rc;tttcwe ex,iging landscape beds lowering grade to flow water away from bitildinig, All new landscaping, plating etc. by building,owner, 12. Replace rock wall as best as possible random placement as is now existing. Note: A. MJS Millwork to pull permit/no special permit or drawings if required included, B, foundation waterproofing with the drainage board will carry a 10 year warranty. ('racks tip to 1/16" of an inch are covered C, Under this proposal, any cracks wider than this will need to he handled on a time and material basis to ensure proper waterproofing protection, D. An on site storage area for till will need to be supplied(rear corner of parking, lot) To stack bile materials (sand, gravel etc,) while the project is underway. 1;. ()lttior,nj audio / visual alarm wired to sump pump to contirrn pump failure not included. Your investment is in the sure of- $26,980,00 Contracting Fee $ .Total fnve.stimeut: $30,1100.00 Note: Original Proposal was$38,880.00 Thank you 1�„u,thy J. P'r�thtn M,t� Millwork llc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street j Boston, MA 02111 wwminass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber's Applicant Information Please Print Iletribly Name (Business/Organization/Individual): x � Address: to, )7 • City/State/Zip: N. 561E?M Pl fl 63073 Phone.#: 0:3 17--) Areyou an employer?Checic the appropriate box: Type of project(required): LT lam a employer with � 4. fp I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, C] Demolition working for me in any capacity. employees and have workers' comp. insurance,t ' 9. ❑Building addition [No workers'comp. insurance p� ' required.] 5. E] We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ plumbing repairs or additions myself. [No workers' camp, right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other cQt� M employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'oompensadon policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, 1f the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for lily employees. Below is the policy and job site info►inadon. Insurance Company Name:_ Policy#or Self ins. Lic.#: i�� ��� Date:—.5/3) ff� Expiration Data: �1.�� lobe Job Site Address: 03 0RWT&_ , City/State/Zip: 60500.R YyY (ASS, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the DIA for insurance coverage verification, I do hereby cer ' under the pa'�penaltles of peyjuly that the informatio►t provided above is true and correct, Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by cio)or town official City or Town:' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Others ContactPerson: Phone#: 04/23/2008 19:44 1603B906963 MJS MILLWORK LLC RAGE 04 C"kt,: 4J,712:= r.: A'-V ,,.,,r.•ar, . A. �. CERTIFICATE OF LIABILITY INSURANCE % ---'--- F,'Ts-cdR THIS CERS IF1CA!E lB 15SU�0 A!➢A kIATT CAP kNFOAMAT'CN ONLY AND COWER&NO RIDHTS UPON T "fiFT1]tGv,T6, unto 1RrlurJ mus - �taJ eBJa HOLDER THFS CERTIFICATK DORO NOT A ENf.VXTFN©OR �;t4 i1Aa[r 3tse�t At.TlR THE:OVF11Aat3 AFFCROED DY TH PZYt.ICm,BtLtl1•',' _r,.....- .....I w w,—._.y.�...�-..,...-, :iial�m NH Oa117:) ; Bhono:8b3.040-6�39 T�x;db3-•89t?•�L1 1g 04SURERS AFFORDING CCJV@RAGe i NAW •r F4:7^JEtl'........�. .,..,,.,.- ,..�....,_-__.,r -.... ......_.,.. .,, ,......-....,_..........,�;•Y.a,!!tk.�,�-m.r l.an,llrt.FEutign.5 Fa:'.f.. _.{. ._ ...'....f ..... ....... .. 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IIIIII ' •� 1:sir:rwc•[ ! r r,kr..y( -{' L'w ',�..'T,r ' ....r-�-,. �In^•�_ '! ...,.,,ram-..._W_ i\fA�KER.1.�.:.ldiMiffFwFrgM 41(..w.,..� r •__-,_..._...w....-,. .,........,... ___�.-�_,�.. }(l.r..��..j,Hlj...1. � s.��� ,. .. C1tPtr?'rfat6'�1aP,tirn 'rlC6702 s2^, 05f28/01 05 r2D/00 :. ;� p•y;+a.....__ I' IGdCC"iC'25e"l I b4r28/05 05/28/01 ��ryr,r: Pf';Yr, ��S'';.1•. ' �_ e...._ ..�.-,...« � N_:.• .} .... LLSU4t hUp Y-- •C�C�t�ls NtA'C11Y�'I�'a'�'vfMrlCGaT'is3T�?'�€t�I ��+��ao:wa'7u "ti'�'@i7lR�S �'�..: x��':?r��ry--..�...,-,^ ---�T-•�--- . s S CANCELLATION _ GERTiFIGpT�HOLpEP �.....-.,. ...'..� gTRS'TCi� "�J':uthstnr)rn+issno�gP5C91eE�P:.tC164Kl;Krts:Et'..tGt�a:xpYNea)PIIJ;T��N ?ATr#tf7; CW TFrH•JJ�V►JD f!PlIAFH'n'.lt.l:-GFJ,VS#fl I:,1.4r'sL .�..... :n r!<•+F,IT7Yel. 'AflGf:'rr let 4VtTifr•:A•I{.Ilat0RN Vd mr,F'G!iy7p 4gFT,$:sF 3rt.1.RK!'G*U PP Sirs.! $1Y$t t3t.'1:�p J:S1 RA;a,t}r :.O[t:r 'Mf riA[,1iV 49tJfi•lTl•:,JUrt!It�,isYi Lw;.rr{'+dYa>_'UFh117•.0�h B'.,R"-H.;?37,aH1"Yr:R tlokth kndaVer Ott Ar.R P41k 4�VHB tiCFR>.►IYEi, V91 A4:11'\•8f;' f:tra'r..t �. _.._.__.._..,....•I•.-._..._..._..,.,...---_ --.. Hartit "dctve.r .M 01844: ri+#Ei*._i51td►Rn1�ilY.=ti1" i ]otrt,ee A Santa +►CC1RD (9kli iOCj _�^ �."�—«•---W�w - ;S"AC ORO CORPORATIOR 140N t I 14oRTH own of : � _ _ . Andover O No. � *y z dover, Mass.,. -?ZZ 6 LZZ)LAKE ... CCCHICHEWICK �•9 QATED A CO S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System. BUILDING INSPECTOR THIS CERTIFIES THAT........... .. .L............................................ Foundation has permission to erect........................................ buildings on __99 Xze��rto be occupied as....._...._.�e1�.... ..........�,.,�. :�.:���r.... � ..... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU ELECTRICAL INSPECTORN STARTS Rough ...................... ----------.--- ...................I............................ Service BUILDING INSPECTOR Final Occupancy -Permit Required to OCCUPY Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. EE]SEE REVERSE SIDE smoke Det. BUILDING PERMIT Of N°or bey TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION . y Permit NO: Z-1++ Date Received SacHus�� ©ate Issued; �S MPORTANT: Applicant must complete all items on this page LOCATIONueavF� Print PROPERTY,'OWNER WINO Print MAP 210PARCEL: ZONING DISTRICT Historic Distric# yes no Machine Shop Village:.... .yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family In al teratio> No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic :Well Floodplair Wetlands Vllatershed District WaterLSewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name:._._Wftnt?�� Phone: (,e:L�S- ( Address: i~uNto\,-4 . \\3 C a v 2-4S CONTRACTOR ,Narno:OS '.i2 Phonet t t Address. Super�isar's Construction Licensed _Exp. .Date: _ 1_�y �1 Home Improuermeat License. Exp, Date: ' } ARCHITECTIENGINEER a �� 2 ` . Z ������.c����-���a�C1. Phone: Address: S 'l�t✓a< ��\ `. R ..,_�`-L Reg. No. -, FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. . E Total Project Cost: $ f �' 3 _ _FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgentlOwner Signature of contractor i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL. Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use) ❑ Notified for pickup - Date Doc.Suilding Permit Revised 2010 3 The Cotninonwealth of Massachusetts Department of Industrial Accidents �t Office of Investigations 600 Mashington Street �1 Boston, MA 02111 mot, rvwtv.niass.goir/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Y[timbers Apolicant Information please Print Legibly Naine (Business/Orgaiiiz&•ttion/[ndividuai): s 6- ' / Cj Address: :�0 l t c�i � ST m. �� 1° . City/State/Zip: ? d. n Phone #• . q- ID Are you an employer?Check the appropriate box: Type of project(required): l. 5 1 am a employer with -6 4. ❑ I am a general contractor and 1 G. ❑New construction employees(full and/or part-tinte).* have hired the sub-contractors , 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ 7. { 13emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3,❑ I am a homeowner doing all work right of exemption per MGL € l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 1 ❑ Other camp. insurance required.] *Any applicant that checks bo)t#l must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit it new affidavit indicating such. 1contractors that cheek this box must attached air additional sheet showing the nano ofthe sub-contractors and their workers'comp,policy information. i am an employer that is providing workers'compensation insurance for my emtployees. Below is the policy and Job site inforrnation. Insurance Company Name: r-at;t' n Policy 9 or Self-ins. Lie. #: _Y,`M,�i�c� 1' � Expiration Date:� .lob Site Address:o�t`��.�1C t _S� ��C E' 1p-AkAlk City/State/zip Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. �!do lrereb certifj3 rrr:{le 7fie firs andpenaltles ofperfury that the information provided above is True and correct. Si nature ' Date: 1 _,. Phone 0 r� Offleial use only. Do not write in this area,to be completed by city or totem official. City or Town:` Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: � I AC�R�� CERTIFICATE OF LIABILHY INSURANCE 121231�39 ��� T'F8y CAif1F7Gft7>»I5�1�asA h1lt<1Te�'RCF•II,a��MAl1�3t4 � i g-av-L�a 1beuxgno!4?� A-ge3wy 6 High stra$L HMOULTH15,cal11)CAWX0ESMCF1 AR1t3�C�.E�cra�ort � ALAIRTHEC(NERAQEAFRMUXDRYlisEPOLICIES MLG . Da_Avers, b� 03923 � I )NSUREM/JTOMOC rii11R+S,E EiAICA IL{a1ll[® JS151AMRAL Qae Beaacm TY)SA=arve - C us Fxop=�-k servxc as $cAwRIE:Grar.it_e Stag ZMB Oo ; C 200 Andvar Street, saite 312 W .J z� r -- ELaabodv, � a19bt? rr�F'�r--. �• I— IF�14'>s�>~ CCUEPAGM T>fEFDLICIES CIF INS!P-kHM LM,I BELCAVWVVEJEEIJ I.WED TO THE [9SURS>WhWo XK?it"THE P0.1CY FERJUD `MDJCATM.TiDf1M177iSi1H�R16 ?NY REnUH ERIKNT,ITAU"LL1HDI7t0t4 Of ANY 0afTPA4C7 OR C"HER(ixL)WNT WITH HEVPe�Tw WHICH;His caimrw-k E JAY RE RXIIJED CH UNYPEPWN,MVINWRfWEAFFOP.DEQHY-RIEFGLKIESGESCM BED HERBK]S.UHCG[TO ALL THEFERUS,F]►Ci NONS;NOCCTFDIttd3t8CP�(w � Ft'U.IES,AorL;PTE LJtQPa 5}S4tGfi Ii4Y J1V,1'E ESA HWLlCED E11 M. CLAIM. 1'ibfi QL� POlt�14-I11GE=i 7 F�LI EF "�E iQU4Y 'HiL6RK LFMS CBFJUF.I�BELliY E��IOCI�tF�:E S � 00fJ DCD ', B L71.TSCVLLTEtER+tl3�Lrf 2111©018 10/27109 12f27130 apaWE11,11 S 50,€ c0 j CXAW L C E WX Of !". 014 D Ffl�AM'eiurY S 1 a00 D00 C 4 ru!► reEL�UE �s 2,(100,DCO !.. ea�lo TT L1N{'PRIFSI61w r% IiGte- F S s 2,000.00D pour,,, n n a ' auras►c��twt�nrFr c-cuelHs�s►r�sn�r � � 3 is ° .uLarwx.uras ErnlLvruurrt - '� 9L7IE�[M1H!1�lJT'CE F�-c,!a�o-f s � ',. � k-1f�7lJstK-'E FiPI.'Jkl.'/MLNCi .$ �,,,, natj-ovh4ED.hUMS Imo' 7 n _ TY4}2F� 3E I-- coo '&MwELEMLUY AJJrA1T'A < Elsl1L '. n 1 PLC RC@SLir J.rM -.„$ --..�. RaLrlL4REltJT:' ! ? clG}cOGEUf�''81CF �� CC{yJR CLPSd£Is?+�E i a9�EG341"E. S F C ��rerio♦i s � �s '"� TYYlEft�t&CfJi19F►6`-VFOH/81D i i Al I r� r, FJ IQ1EJ�l1AJ1lIlY ;WC 0266712 11j3110- ELEACHAf7CVEM s 1�O,OOD A'dYF7ablr�l EIGJW+'It i�f'IM Mi rm I faFFJCErin13C61JDEW EJ_[15 -s4ra,+T+ � S 140,OQ0 .� GFStehy I ELLS-P3L1GYll,iF i S 500,pQ0 6TJE R � 1 II I]��TfAJ!'CF RPHt,A7K71�Jl0GR�3i SJLEI3C IE41 EY:Ct I1C7EYS ld It EEI gT�N PAi58FE IFIf SYECT1L..iRC4''60l15 Beetsm Dove2apblent CLroM:) et al amp East Csr-esxl Realty 0DxP and =T r la�pert3es >a$nag�ed thPre3� is t EIC��E3�J91 iII�Li�d; CWWCA11E HOLDER CANCELLAMCK staJw.cJrr u TiJ:E�vxE r, Iau�I�ii.�iiz3J3E6'.V♦`I�l�ID fiF�IrSE I�wvl�-N wrE�I,-I�e�F.ra�re!►�r;s�ntueao�.nt�7orw� � n�awr�rTat Boston Development Group et al JIrniC&1G7TEc13CIT�rJSE13oLn�KwvFr�n�ollf�r.BulrRLut��>aososll� V3rst General Realty Comp & u sec eua►�c�ucF.L►wur;oFvon>!UWAMO+-FHE rrs sat all pmpe:=U4as ucemaged thereby 93 Dnien St meet, ,B;.:.ite 315 1tliYCRLIDlLE1CiE9C117ATfiE / Newton Cm xe, Ha G2459 L G rgQ1025 [s13D3} LAM "MMRATM Me C= i PROPOSAL NO. 9330 U.S. Property Services PAGE NO. 1 200 Andover Sheet, Suite 312 Peabody,MA 01960 DATE 7/1109 I. General.Information Proposed by: U.S. Property Services Telephone: (978) 836-1206 200 Andover Street, Suite 312 Fax: Peabody, MA 01960 Submitted To: First General Realty Corporation Work Performed At: 203 Turnpike Street 93 Union Street, Suite 315 North Andover MA Newton Centre, MA 02459 3`d floor hallway II. Work Description We hereby propose to furnish the materials and perform the labor necessary for the completion of the work described herein and to commence on the date listed above: Painting _apply one coat of primer and two coats of finish paint Cost: $1,765.00 Fire Stoping—Fill all penetrations in the common hallway wall with Fire caulking Cost: $3,400.00 Ceiling tiles - install a suspended ceiling tile system places if needed. Cost:$2,888.00 Install 3 new solid core doors with metal frames with locking doorknobs Cost: $3,120.00 • Carpeting Cost: $2,500.00 • Electric Cost: $4,350.00 • Fire Alarms Cost: $2,300.00 IV. Terms a. All debris will be removed on a nightly basis. b. First General Realty will provide the dumpsters All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of Twenty Thousand, Three Hundred and Twenty-Three Dollars ($ 20,323,00 ) Payments to be made as follows: 113 Deposit, 1i3 Progress Payment and 113 Upon Completion *Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. "Note—This proposal may be withdrawn by us if not accepted within 30 days. Respectfully Submitted Frank Gomes On behalf of U.S. Property Services U.S. Property Services•Tel:978-836-1206 uspropertyservices@hotmail.com ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted You are authorized to do the work as specified. Payments will be made as outlined above. Date 03 •l� Signature Date Signature U.S. Property Services•Tel:978-836-1206 usproperlyservices@hotmail.com IAORTPI owe. of � � a'' Andover a � No. � h ver, Mass, LAKE COC...CN@w.CK 1 BOARD OF HEALTH Food/Kitchen PERMIT -T LD Septic System THIS CERTIFIES THAT ........ . ......... N ,.... V J .......................... BUILDING INSPECTOR has permission to erect.......................... buildings on ...,� .., .,. ,. . Foundation • Rough to be occupied as ........ ON,1Q. .,.... .r. ......... ..... .. r�i !.� .! .................. chimney provided that the person accepting this permit shalt in every respect con f m to t e terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS COSTRU S TS, Rough Service ............... ....... ........... ....,..........NSAECT............O...R... Final B. NG 1 GAS INSPECTOR Occupancy Permit Required to Occupy Building- Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. LSE.E REVERSE SIDE TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y Permit flO: 1 r Date Received Date Issued: IMPORTANT: Applicant must corn fete all items on this page C� it�• ter; ,, /-tvr ✓ LOCATION PROPERTY OWNERf a � `^ Prinl 10d Year OId Sfructure yes no MAP NO PARCEL ZONING DISTRICT His. District yes no Machine Shap ...p age yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family El Industrial XAlteration No. of units: Commercial Ll ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic " ❑Well ❑ Flood lain ❑Wetlands © Watershed District p ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: C4 S iJ Identification Please Type or Print Clearly) � ��2-� r��� OWNER: Name: lIO ®^ � r. Phone: �f Address: ,-•, Is CONTRACTOR Name. 1 ;f.'G°= � � d 'Phone � �� ��•� ���� .Address; : � � � /if Si 's Construction'License. sor upery Exp. !Date: l _-_ Home lmprove.ment`License; Exp. Date:` ARCH ITECTIENGINEER 05-� �, CA LOOSE— Phone: 78 _ 70 — 3611 r Address: �.��� A ')Vz 0� A Reg,1"4 , _R No.. � �� _ -- —� FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. �, � r Total Project Cost: $ FEE: $ - q Check No.:_ �� Receipt No.: �— -- NOTE: Persons corttractirr vith rua ' gistom carttractom do rtot have access to the gu aranty firrrd 'Signature of A ent/Owner ignature of contractor g Plans Submitted ❑ lans1 ived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA — {For department use B Notified for pickup - Date Doc.Puilding Peimit Revised 2010 North Andover M1MAP 203 Turnpike August 8, 2013 133 j I 125 1 114 s q ry r a: a �! n�T Y 1. Andover f; Interstates ._.Interstate —Major Roads I At Datum:MA Stateplane Cocrdnate System,Datum NAD83, Roads Meters Data Sonrces:The data for thte mapms produced by Merrimack ¢`k Easements 14ORTH Valley Planning Commisslon(N%W)using data provided by the Tom of of *ye o 1 6 y North Andover,Add data provided by the Fxecu%e Office of 0MVPCBoundary � �a� •�A0 EnvironmentalABalrmlMitlonai ass=.The lnfarmation depicted on this map Is Parcels L fa planning purposes only.It may not be adequate for legal boundary definition or regslMory inlerpreta6on.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,FKPRESSEU OR IMPLIED,CONCERNING i * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY M i OF THESE.DATA.THE TOWN OF NORTH ANDOVER DOES NOT 4 ASSUME ANY LIADILITY ASSOCIATED WITH THE USE OR WSUSE OF THISINFORMATION ssACNLIS� i I I FIRST GENERAL REALTY CORPORATION 93 Union,Sheet,Suite 315 Newton Centre,MA 02459 Phone: 617-332-6400 Fax: 617-527-4176 July 10,2013 P-B Services 11 Red Maple Road Haverhill,MA 01832 Re:203 Turnpike—Removal&Replacement of Concrete Steps Dear John: This is confirmation of the work to be performed at the above referenced address. We mutually agree the amount will not exceed Two Thousand Two Hundred Fifty Dollars and 00/100 ( 2 250.00),for the work described on the proposal, attached as Exhibit"A" Your engagement is acceptable subject to the following conditions: 1, All work shall be performed in a good workman like manner and in accordance with all town,state and country codes'and regulations. 2. Your company and personnel will clean up after completing their work. 3, Your company will provide us with a certificate of insurance to include public general liability and workers compensation,NAOP CONDO TRUST and First General Realty Corporation,as additional insured. 4. Your company will be responsible for obtaining all necessary permits if applicable. 5. If you cause a violation to the contract,we can send you written notice and remove you from the job within 72 hours of notification limiting payment obligations to only the work completed. 6. The project will be scheduled on a mutually agreed upon date by Contractor and landlord. 7. The payment terms are as follows:Payment within 15 days of completion of work and receipt of invoice. 8. Your company will be responsible for making sure all permits are closed upon completion of work, it applicable. 9. Should any part of this agreement contradict Exhibit"A",this contract shall govern or supersede. Please sign on the line provided below and this will serve as the basis for our contract. Sincerely, J P ppalar enlor Project Manager Agreed to a d ccepted by: al 13 DATE 1 Tlie Commonwealth of.Hasstechusetts .Departme-W offradustdglAceldde is Office of Investigations 600 WashNgloi4 Street y .Boston,MA 02111 ivy mintss.gov/tria 'W`orRers' Compensation Nsurance Affidavit: Butilderq/Contractora)Electricians/Plumberq Applicant Information _ _ _ Please Print Legib�� � 2 C Marine,(Business/Organizatioii4ndividual).._-_� IJ Jet YU"r G -P .Address: Mono#:_._..�� Are you an employer?Cheep the approPiriate box: Type of project(required): L d f am a employer with �4. Q I am a general contractor and I 6 p New construction employees(full and/or part-time).* have hired the sub-contractors 2.N1 I am a sole proprietor ox partner- listed on the attached sheet,r 7. ILemodehng ship and1ave no employees These sub-contractors have 8. ❑Demolition Working for me in any capacity. workers' comp,insurance. g Building addition [No workers' comp,insurance 5. Q We ate a corparati©nand its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right ofoxemption per MUL 11.D Plumbing repairs or addi#ions myself. [No workers' comp. a. 152,§1(9),and we have no 12,Q Roof repairs insurance:requiredj s employees.[No workers' 1g Q OthCr comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing theirworkers'compensation policyinformation, Homeowners who submit this affidavit indicating they{lire doing all vrork and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their woricers'camp,polloy information, -t aiii ai?eil!pXoyei-tltfit is pi-oviflliig iporkeYS'eo7myeiisation iiisuraiiee foi�my era ployees. Below is thepoliey and job site h1for'inallon. Insurance Company Name.. Policy#or SCE ins.Lie.i#: Expiration Date: rob Site Address; City/statelzip; Attach a.copy of the workers' compensation Policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredundor Section 25A of MOL o. 152 can lead to the imposition of criminal penalties of a fmo up to$1,500.00 and/or one-year imprisomnont,as well as civil penalties in the forni of a STOP'WORK ORDER and a fins of up to$250.00 a day against the violator. Be advised that a copy of this statement may bo f warded to tho Of oo of Investigation s of the DIA for insurance coverage verification. rd'o her cart! inlet•the pains andpenalties o ffpefjmy that the h forination provided alcove is tr ae aitd correct. Si iature: �� - Date: 8/8 hone#: 978 -2 Official rise artly. Do not write in Ibis area,to be conWfeted by city of fatvit offtcirc? City orTown- Permit/Mcense g Issuing Authority(circle one): x.Board of Health 2,Building Department 3.CityiTown Clork 4.Electrical Inspector S.Plumbing Inspector G.Other - - Contact Person: Phone#: