Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Permits - Permits - (19)
5/2 6120 1 6 Date: May 26, 2016 20472 This is an e-permit To learn more,scan this barcode or visit northandoverma.viewpointoloud.com/#/records/20472 • * t�LLI [Milk TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that William D Lemos has permission to perform Data Cabling on third floor wiring in the buildings of LOWELL GENERAL HOSPITAL at 203 TURNPIKE STREET U200, North Andover, Mass. Lic. No. 16833 111 M � 6m8 i 1 Official Use Only Commonwealth of Massachusetts 1{ -(y` Permit No. .- 1 Department of Fire Services occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11071 leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ali work to be performed in accordance with the Massachusetts Electrical Code`�M c,�27 r FORMATION) Date: T 1 �!i (PLEASE PRINT IN INK OR TYPE ALL IN City or To�vti of: NORTH ANDOVER To the Inspector of Wires: S this application the undersigned gives notice f his o tier intention to perfor,nthe electrical work described below. it Y 4 c ST Location(Street&Number) d Ur__h--nn Telephone No. Owner or Tenant ,ouv G i'n lvz Owner's Address Ct/m � No ❑ (CheckAppropriate Box) Is this permit in conjunction with a building permit. Xcs Utility Authorization No. Purpose of Building�!� +Gtr Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters �.,�_ Na.of Meters Never ice Amps _��Volts Overhead❑ Und grd ❑ Number of Feeders and Ampacity ` Location and Nature of Proposed Electrical Work: Qr rowirA L oan lotion o the ollom", table in a be tivaived b the Ins ector o Wares, No.of Total No.of Cell.-Susp.(Paddle)Fan m s Transforers KVA No.of Recessed Luminaires Generators No.of Hof Tubs KVA No.of Luminaire Outlets ve In o,o +snergency sg sng No.of Luminaires Siviniming Poo! Abo and. ❑ and. ❑ I3atker Units No.of Oil Burners FIRE ALARMS No.of Zones No.of Receptacle Outlets No,of Detection and No.of Switches No.of Gas Burners Initiatin Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump Number Tons IZW....... Dot ectionlAles tin 1 Devices No.of Waste Disposers Totals: Municipal Other ❑Local No.of Dishwashers Space/Area Heating KW Connection Security yyskems: No.of Dryers Heating Appliances KW No,of Devices or E uivalent No.of No.of Data Wiring: No.of Water KWallasts No.of Devices or E trivalent Heaters Sis ns Telecommttrsications Wsring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER; Attacl,additional detail if desired,or a. of Wires. Estimated Value of Electrical Work: 0000, (When required by municipal policy,) Inspections to be requested in accordance with MEC Rule 10,and upon completion. Work to Start: �' �� 6 _ pical work INSURANCE COVERAGE: Unless waived by the owner,no pled d'itofoer til q eCcoverage or tsesubstantial equivalent, The ss the licensee provides proof of liability insurance including,a comp undersigned certifies that such c verage is in force,and has exhibited proof of same to the permit issuing Office, r , CHECK ONE; INSURANC BOND ❑ OTHER ❑ (Specify') fp J ya r tare and complete. I certify, under the pains and penalties o e, rrr ,drat tfr�srforrr,atio r oat P LIC:NO,: Al 6g33 FIRM NAME: LIC.NO,: 2� �ry+.o S j Licensee: ( Signattrr. � �5 Bus.Tel.No. Z 3O (If amplicable,enter"a): �t" 'aa tlae license num�ier {rase.) �O 9 Address'. g S';a, t ,S+ "Y e"t ne" Q- O 10?-- Alt.Tel.No.: *Per M,G.L c, 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic,No. OWNER'S INSURANCE WAIVER:below, ilherebyeuaive that tthis requirement, I ahe Licensee does notm the(che k one)ave the liability�❑o<vnerco❑ao owner's agent,ge ll required by law. By my signature , Owner/Agent Telephone No. PERMIT FEE: $pc;c7�� # Signature Client##, 26438 MECEL 'ACbRD,nr CERTIFICATE OF LIABILITY INSURANCE pATEIM 6l05120DlYYYY) 2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED I3Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER NAME: Sullivan Insurance Group, Inc. PA�c°ONro ExI;508 791-2241 nlc,No: 508 791.3689 10 Chestnut Street A DDR EMAILESS: �=+ g p' kauclalr suilivan rou com Suite 1010 INSURERS)AFFORDING COVERAGE NAIC# Worcester,MA 01608-2804 INSURER A!Peerless Insurance Company INSURED INSUIMERB.Ohlo Casualty Insurance Company MEC Electrical Contractors, Inc.& INSURER C,The Hartford MEC Technologies, LLC 1NSL1RFcR D PO BOX 158 INSURERE: Chelmsford,MA 01824 INSURERF; 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, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWS) MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUER PMLD EPF POCK EXP LIMITS LTR INSR WVD POLICY NUM&ER MMfDDIYYYY MM1DD YY A GENERAL LIABILITY X X BKS55548008 0610612015 06106/2016 EACH OCCURRENCE $1,000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oNcu..... $30O OOO CLAIMS-MADE N OCCUR MED EXP(Any one person) $15 000 PERSONAL&ADV I NJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPUESPER: PRODUCTS-COMPIOPAGG $2,000,000 POLICY nx PEa Lac $ A AUTOMOBILE LIABILITY BAA5 3548008 6106/2015 06106/201 Eo accdEISINGLE LIMIT 11000/000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED Per accident $ AUTOS B UMBRELLA LIAR OCCUR US055546008 6/0612015 06/06/201 EACH OCCURRENCE $5 OOO OOO EXCESS LIA13 CLAIM&MADE AGGREGATE $9000000 00O 000 D£D X RETENTION$10000 $ C WORKERS COMPENSATION WC Y LIMIT OTH- AND EMPLOYERS'LIABILITY 0$WBCCT4170 6105l2015 06I05l201 X s ER ANY PROPRIETORMARTNERIEXECUTIVEYIN (MEC Tech. MAINH) E.L.EACH ACCIDENT $1000000 OFFICERIM EMBER EXCLUD£D? � N/A (Mandatory In NH) 08WBCCY4171 610512015 061051201GE.L.DISEASE-EAEMPLOYEE $1,000000 If yes,descr{beunder MEC iMiBCt.^MA E.L.DISEASE-POLICY LIMIT $1,000,000 IIESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space fs required} Evidence of Liability Insurance for the Named Insured Issued as evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover, Inspector THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN of Wires ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRI SENTATLVE O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD K JA #5248545/M248303 Commonwealth of Massachusetts Sheet Metal Permit Date: Permit71� # f ;.. Permit Fee: $ Estimated Job Cost: $ �J Plans Submitted: YES NO Plans Reviewed: YES NO Applicant License Business License # "" . pp Business Information: Property Owner/Job Location Information: Name: ' A a�-e. Street: /C' r > Street d� City/Towng �� City/Town — w Telephone: '/t`T�_ �'t? Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO staff Initial J-1 /M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation:' HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide det 'led description of work to be done: w, 0 1 ��� ,�^,.. ,,' 3 it , .:F' F✓` INSURANCE COVERAGE. i i have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑ if you have checked Yes,indicate the type of coverage by checldng the appropriate box below: liability Ins urance oils ❑ Other type of Indemnify ❑ Bond ❑ Alla y Policy OWNER'S INSURANCE WAIVER:i am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. i Check One Only Owner ❑ Agent ❑ Signature of owner or Owner`s Agent By checking this bnxi�,I hereby certify That all of the details and information I have submitted(or entered)rogard[ng this application are true and accurate to the best of my knowledge and of at all sheet Massachusetts s Building Dade and ons performed under the n issued for this application will be nd Chapter 112 of he GeneralLawsit � in compliance with all pertinent provision Prolrress xnsAectinns ate •• C°mments . +'naX Ins ern_. Date Comments Type of license: By Master Title_ E] Master-Restricted City/Town ' []Journeyperson Signature of Licensee d Permit 0 ❑Joumayperson-Restricted IG � License Number: Fee$ ❑ � Check at wwuv=mass.c old I l Inspector signature of Permit Approval 1 i 1 Job Quote Constant Temperature Systems Inc Number: 14316 13 Alexander Road, Unit 5B Alexander Park Quote Date: 12/18/2016 1:39:37PM Billerica, MA 01821 (978)667-5400 (978)667-7770 (fax) Bill to: DMar Construction, LLC Service at: Weight Managment Clinic PO Box 27 203 Trunpike Rd j Danville, NH 03819 N Andoer, MA 01846 Description: Customer 1D: 1977 Items Total Price Duct work with FSK $5,400.00 RGDs $870.00 Air Balalning $1,380.00$360.00 Out door louver 225 exhuist fan $384.00 All Labor $14,375.00 MEC Permit $575.00 Heat pump equipment York $19,560.00 CPVC Piping $1,890.00$864.00 Drane pans Quote Subtotal: $45,648.00 Estimated Tax: $0.00 Quote Amount: $46,648.00 Additional Details: Page 1 of 2 o�� �r�rG c.v�rtrrevrrrvcur►rt of Irlu�otrartrraart� Department of Industrial Accidents Office of Investigations a ° I Congress Street, Suite 100 Boston,MA 02I14-2017 lvlvw.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Li lectricians/Plumbers Applicant Information Please Print Le ibl Name (BttsinesslOrgan€zationlIndividua€): Constant Temperature Systems Inc Address: 13 Alexander Rd unit 5 B City/State/Zip: Billerica Ma 01821 phone#;978-667-5400 Are you an employer? Cheek the appropriate box: Type of project(required): I.0 I am a employer with 9 4. ❑ 1 am a general contractor and l 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship 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. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their L I.El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §I(4),and we have no 13.0 Other employees. [No workers' comp, insurance required.] *Any applicant iliat checks box fi 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 must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, if the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'eonpensatiot insurance for my employees. Below is file policy and job site information. Insurance Company Name: Nub Int Of New England Policy#or Self-ins. Lic. #: IEUB215M951A Expiration Date:02/04/16 Job Site Address: CitylStatc/Zip: Attach a copy of the workers' compensation policy declaration age(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 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 p nalties 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 his statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificalion. I do hereby certify ut der lite p td penalties of perj y that Cite t rforniatlon provided above is true and correct. Si nature. Date: Phone#: 978-66754 0 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4. Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone M J PROJECT SPECIFICATION ADDENDUM AND PURCHASE ORDER This Project Specification Addendum is entered into between DMar Construction, LLC ("Contractor") and Constant Temperature Systems, Inc. ("Subcontractor) and is dated March 21, 2016, The terms and conditions set forth herein shall apply only to the protect identified below. Unless otherwise expressly stated herein, the Master Subcontract executed by the Contractor and Subcontractor shall govern the relationship. By signing below, the parties hereto expressly reaffirm all such terms and conditions as set forth in the Master Subcontract Agreement and incorporate the same by reference as though fully set forth herein, Where any terms of this Addendum are in conflict with any term of the Master Subcontract Agreement, the terms of this Addendum shall prevail. This Addendum, the attached Purchase Order, the Master Subcontract and all other documents referenced therein,including the Contractors'contract with the Owner,shall collectively by referred to as the Subcontract Documents. "Subcontractor shall not be entitled to a ment until this Addendum is signed and returned to Contractor.'* A. NamelLocation of Pro ect Lowell General Hospital North Andover Weight Management Center Renovations Address CitylState Owner Name- 20 Turnpike Street. North Andover,MA 01845 Lowell General_Hos ital B. Work The Subcontractor shall execute the portion of the Work described in the Subcontract Documents,including all labor, materials, equipment, services and other items required to complete such portion of the Work, except to the extent specifically indicated in the Subcontract Documents to be the responsibility of others. Scope of work to Include but Is not limited to: Furnish the necessary labor, materials, insurance and permits to furnish the HVAC scope In accordance with contract drawings dated 2f15116 prepared by Doonan Architects; RFI response dated 3.1.16; Addendums 2 and 3 as follows: Furnish and Install CPVC piping,condensate drain piping, Insulation,ductwork,York heat pumps with drain pans, air balancing,exhaust fan and louver,mechanical permit and obtain all Inspections: The project Is tax exempt. All debris generated form this trade will be disposed of by this trade into DMar Construction supplied dumpster. C. Date of Commencement and Substantial Comp.lotion The Subcontractor's date of commencement shall be the date of this Agreement, as first written above,unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Contractor. • Substantial Completion. The Work of this Subcontract shall be completed no later than May 16,2016. D. Subcontract Sum The Contractor shall pay the Subcontractor Forty Five Thousand Six Hundred Fifty Dollars ($45,650.00)In current funds for performance of the Subcontract and subject to additions and deductions as provided in the Subcontract Documents.Does not include Cost of Controls. E. Insurance Unless otherwise provided, prior to commencement of any Work of the Subcontract, the Subcontractor shall purchase and maintain $1,000,000 general liability and statutory workmen's compensation insurance coverage and shall furnish proof of same upon Contractor's request. Unless specific limits are listed below coverage is to be provided per DMar Construction Master Agreement. Type of Insurance Limits of liability($0.00) _. F. Qt—he r Notwithstanding anything to the contrary in the Master Subcontract Agreement,Contractor may terminate Subcontractor immediately and without prior notice for any default by Subcontractor under the Subcontract Documents. In the event of Subcontractor's default,in addition to ail other rights and remedies under the Subcontract Documents and at law and in equity, Contractor shall be entitled to immediately cease making any payments to Subcontractor and may apply any funds otherwise due or to become due to Subcontractor,either on this project or on any other project on which Subcontractor suppiles or supplied materials or labor for Contractor,to cover any damages,including attorneys'fees,it sustains or incurs as a result of Subcontractor's default on this project or on any other past,present or future project between DMar Construction,LLC and Subcontractor. At least ten days prior to the oommencement of work,Subcontractor shall furnish Contractor a full list of all subcontractors and suppliers that it intends to use on the Project,including the following:(1)current contact information for each subcontractor and supplier;(11)an itemized list of all work and/or materials to be supplied;(ill)the specific dollar amounts of all related subcontracts or supply orders;and(iv)copies of all subcontracts,supply orders,purchase orders,or invoices related to same. With each application for payment required hereunder,in addition to a lien waiver covering the most recent payments to Subcontractor and as an express condition precedent to receiving any payment,Subcontractor shall furnish partial lien waivers from each of its subcontractors or suppliers whose work or materials are covered by such applications for payment acknowledging that each has been paid in full by Subcontractor for all sums owed up to the date of the application for payment. Subcontractor agrees that Contractor shall have the right to pay,either by joint check or directly,each supplier and subcontractor and to deduct all amounts paid from any amounts otherwise due Subcontractor under this agreement. Nothing contained herein shall be construed or Interpreted as creating a contractual relationship between Contractor and any other party other than Subcontractor. By entering into this Subcontract,the parties expressly preserve and do not waive any rights or remedies or obligations under any other agreements,contracts,or notes to which they are parties. Nothing contained herein shall constitute a waiver of any right,obligation,or remedy existing as of the date hereof. SUBCONTRACTOR WAIVES ITS RIGHT TO A TRIAL BY JURY 1N ANY LITIGATION RELATED HERETO. This Agreement entered into as of the day and year first written above. DMAR CONSTRUCTION, LLC CONSTANT TEMPERATURE SYSTEMS, INC. i CONTRACTOR(Signature) RACTOR( tgnature) ;David Marceau,`Mana er i (Printed name and title) (Printed name and title) DULY AUTHORIZED DULY AUTHORIZED /� j�/� Client#: 20744 CONSTANTTE ACORD. CERTIFICATE OF LIABILITY INSURANCE DA1131 IDDIYYYY) 4113r2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER TEACT NA HUB International New England AIC N HONEo Et 978 657-5100 arc No): 978-98"038 x 299 Ballardvale St E-MAIL Wilmington,MA 01887 INSURERIS)AFFORDING COVERAGE NAlca 978 657.5100 INSURER A:Netherlands Insurance Company INSURED INSURER B:Peerless Insurance Co 24198 Constant Temperature Systems Inc INSURER C:Travelers Indemnity Co of Amerl 31194 G&G Realty Trust INSURER D 13 Alexander Rd.,Suite 5B Billerica,MA 01821 INSURER E. INSURERF: 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, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF iow LIMITS LTR TYPE OF INSURANCE 1NSR D POLICY NUMBER MWDD A GENERAL LIABILITY CBP1015745 12/03/2015 URRENCE $1 a00 000 X COMMERCIAL GENERAL.LIABILITY Ea occurrence $100 000 CLAIMS-MADE I OCCUR Any one person) $5 000 &ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X jEG LOC $ A AUTOMOBILE LIABILITY BA1015746 12103/2015 121031201 COMBINED a aocidant .... LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALLOWNFD [*X]SCHEDULED BODILY INJURY(Per accideni) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accldenl X HIREDAUTOS X AUTOS $ Fj UMBRELLALiAB X OCCUR CU88$3659 121a312015 12103r201 EACH OCCURRENCE $5 a00 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 000 000 DEG X RETENTION$100a0 $ C WORKERS COMPENSATION IEUB215M951A 2/04/2016 02/041201 X TORY WC STATU- OTH- AND EMPLOYERS'LIABILITYIN ANYOFF PRRANE ATO ARC NER(E.ECUTIVE Y� N!A E.L.EACH ACCIDENT $5aa a00 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $600 000 Ile, I ee,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I}elew DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD te1,Additional Remarks Sohedute,If mare space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE (EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street, Bldg.20 ACCORDANCE WITH THE POLICY PROVISIONS. Ste 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S15892411M1541843 CWDa1 OORTH A4Y }`�-l_A' ,11 BUILDING PERNi'fi• �� ���". .•:.°•.'6 °t TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: ?o /6 RSSacHus�� IMPORTANT:Applicant must complete all items on this page print [PROPERTY 01�CNER Print SAP NC? ��PARCEI��� ZONING DISTRI�T,�Historlp Dlst�ldt }t�s nQ ' Machirtie 5,hop Vi�,�ge Yes... r>I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building :1 One family IF1 Addition -1 Two or more family a Industrial "Iteration No. of units: [commercial I Repair, replacement _1 Assessory Bldg I_.1 Others: I.1 Demolition 1 Other Septic Ci 1141s11 Floodplarr I Wetlands 1 Wtershd tl�str�ct Ullaterlae—fir /�-''��-1 (et��f�.J j5, F`�•°'�i��e✓ r'�i'/f./�'�i'tr%�:� f•=c�� ���.cam.✓..�'iJ't-'Cd�.,�i''�✓P.� �, '' Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ��1' CQNTRACTOR Name Phone; � ' '�°�°: ��. ' Address Su .ervlr's onstraction l.lcenerxp Home Itnprovment Ltcense„ >=xp Date . ARCHITECT/ENGINEERS ,:�;IVV--',•arbw' � '� �`� Phone: Address:_ _ . ^ l Reg. No.�rk-5 ,-7362 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST"BASED ON$125.00 PER S.P. Total Project Cost: $ `�°, � F� FEE: $ Z, Check No.: Receipt No.: .I©1 7 NOTE: Persons contracting wrt I u r ' ter d contractors do not have access to the guaranty fund Signattare of AgeritL4wn ignature of contractor �. �� oflpo o7H HH CERTIFICATE OF USE & ' 'OCCUPI OCCUPANCY TOWN TO N OF NORTH OT JC�N�P OVER 1 's Building.PermitNumber 1018-2016 on 3/30/2016 Date: June 3, 2016 THIS CERTIFIES THAT THE BUILDING LOCATED at 203 Turnpike Street —Third Floor MAY BE OCCUPIED AS a tenant fit up -- Weight Management Clinic IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Lovell General Hospital 203 Turnpike Street North Andover, MA 01845 Building Inspector Fee: Pre Paid $100,00 Receipt: 30176 Clieck : 2502 & 2511 t� -.-,,'-Town o rAndover o - - 0 No. * . iL 1 0 h , ver, Mass, � r A_ coc"Fc"t WK:K Y ATE 0 U _BOARD OF HEALTH R IT T LD PE M Food/Kitchen r Septic System THIS CERTIFIES THAT ,. Li W t11Qr&, lA • p'. BUILDING INSPECTOR has permission to erect......... ................................ buildings on 3..Tw- .... ............ Foundati J 9 cam .... . . oar .1 .�� ............. - � to be occupied as ....�................. .. ...... .....�. .... .� provided that the person accepting this pe t shall in every respect conform to the terms of the applicatio Final p p p 9 96 on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alt thw. ion and Construction of Buildings in the Town of North Andover. PLUMBING INSP OR i VIOLATION of the Zoning or Building Regulations Voids this Permit. Per I Roug s Final r �� .41 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .............. . Y :., ..1., .:.,.......................... BUILDING INSPECTOR . Fina - GAS INSPECTOR Occupancy Qccypancy Permit Required to OccupV 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-/ C�,' f rr FINAL.CONSTRUCTION CONTROL DOCUMENT PROJECT NAME: #1507--Lowell General Hospital Weight Management Clinic DATE: June 6,2016 PROJECT ADDRESS: 203 Turnpike Street, 31d Floor, North Andover MA 01845 SCOPE OF PROJECT: Alterations Level 2 work to existing interior space. Interior renovations to existing space of approximately 1,829 square feet including construction of new non-structural partitions, installation of new suspended ceiling and light fixtures, installation of new plumbing sinks and toilets. I, Christopher Doonan, MA Registration Number: 10736 Expiration date: 08/31/16 , am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning ARCHITECTURAL for the above named project. I certify that 1, or my designee, have performed the necessary professional services, in accordance with the Professional Standard of Care, and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the contractor of its submittal and other responsibilities. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. The contractor is responsible for the performance of the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. Christopher Doonan AIA, LEED AP t`L -'36 Principal, Doonan Architects S11*0 MA 4� 1 fly[ o'DV Doonari Architects 27 CNI)pewa Road Westford, MA 01886 978.692.5742 www.DoonariArcliitects.caiii Final Construction Control Document N W To be submitted at completion of construction by a u w Registered Design Professional era for work per the 8t" edition of the s e� Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Weight Management Clinic Date: June 15,2016 Property Address: 203 Turnpike Street,North Andover,MA Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: HVAC,Electrical and Plumbing Installation. There is only one design deviation which is the HVAC unit HPAII is putting out less air than is quoted on the design drawings. I,Richard D Cummings Jr,P.E.MA Registration Number: 49023 Expiration date: 6/18, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural X Mechanical Fire Protection X Electrical X Other: Plumbing for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis, To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: B1�0, uc � �11�A1�11Dl9fl23�. t'ii Phone number: 978-658-2616 Email: cummingseng@comeast.net Building Official Use Only Building Official Name: Permit No,: Date: Version 061 l 2013 i 1 i Final Construction Control Document To be submitted at completion of construction by a d Registered Design Professional for work per the 8"' edition of the i Massachusetts State Building Code, 780 CMR, Section 107 j Project Title: Weight Management Clinic Date: June 15,2016 Property Address: 203 Turnpike Street,North Andover,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Fire Alarm Installation. 1,Richard D Cummings Jr,P.E.MA Registration Number: 49023 Expiration date: 6/18, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural Mechanical Fire Protection Electrical X Other: Tire Alarm for the above named project. 1, oi•my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or nay designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. A Id I �\k 4F Mqc ® Enter in the space to the right a"wet"or i1CNARD D. �G electronic signature and seal: CUM Files'dR. I:CTtC11�i "' C PRc.49023 Phone number: 978-658-2616 Email: cummingseng@comcast.net S �� Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 t%ORTH r Town of 3= : : _ ::a* ndover p to z �h , ver, Mass, Z�►l A_ tOCNICHEC„EwACR V 4°Rwrea - S 11 BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT....... vai w`�'. ....�t� ....,....,. '� � .... ............. BUILDING INSPECTOR .. .... .... . ...... .... .. .... ..... ...... , Foundation has permission to erect.......................... buildings on 2&1 TAr a .., Rough to be occupied as .... ..., .. ....�.... .... ..30...�oa ..0�� . .............. �* Chimney p � r provided that the person accepting this pe t shall in every respect conform to the terms of the appllca.... p p Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alte tion 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 CONSTRUCTION STARTS Rough Service 'e ... .r�::..�..L. ..�............................ Final BUILDING INSPECTOR 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. r INITIAL CONSTRUCTION CONTROL DOCUMENT PROJECT NAME: #1507—Lowell General Hospital Weight Management Clinic DATE: March 16, 2016 PROJECT ADDRESS: 203 Turnpike Street, 3rd Floor, North Andover MA 01845 SCOPE OF PROJECT, Alterations Level 2 work to existing interior space. Interior renovations to existing space of approximately 1,829 square feet including construction of new non-structural partitions, installation of new suspended ceiling and light fixtures, installation of new plumbing sinks and toilets. I, Christopher Doonan, MA Registration Number: 10736 Expiration date: 08/31/16, am a registered design professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning Architectural for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care, and be present on the construction site on a regular and periodic basis to: I. Review, for conformance to this Code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official, I shall submit field/progress reports together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. D per JWiER Christopher Doonan AIA, LEED AP n `' NO. 7 ` Principal, Doonan Architects al N " oy� i"' )t1a Doonan Architects OF 9hr. 27 Chippewa lioad Weslrord, MA 01886 1 V ' 978.692.5742 www.DoonanArchitects.com r Initial Construction Control Document M To be submitted with the building permit application by a r A Registered Design Professional for work per the 8"' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Weight Management Clinic- Circle Health Date: March 15,2016 Property Address: 203 Turnpike Street,North Andover,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Fire Alarm Tenant Fit-up. I,Richard D Cummings Jr,MA Registration Number: 49023 Expiration date: 6/16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural Mechanical Fire Protection Electrical X Other: Fire Alarm for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control D I of Mgss�� Enter in the space to the right a"wet"or FllG1JAR0 D. yG electronic signature and seat: Gl1MMIh1OS.JR• FIRE CD EGTION Phone number: 978 658 2616 Email: cummingseng@comeast.net No.49b2� - w� Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supet�Ised.if`other' is chosen, provide a description. Version 06 11 2013 SA' Initial Construction Control Document f'i E H To be submitted with the building permit application by a d Registered Design Professional for work per the 8"' edition of the y ' Massachusetts State Building Code, 780 CMR, Section 107 Project Title; Weight Management Clinic- Circle t C is e Health Date: March 15 2016 J g g , Property Address: 203 Turn ike Street North Andover,MA p �Y p s v Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: HVAC,Electrical and Plumbing Tenant Fit-up. I, Richard D Cummings Jr,MA Registration Number: 49023 Expiration date: 6/16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural X Mechanical Fire Protection X Electrical X Other: Plumbing for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents, 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 790 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Enter in the space to the right a "wet"or v R1uHAnD 1). electronic signature and seal: CD Phone number: 978 658 2616 Email: ctiininiiigsejig@comeast.net Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 i i i BOSTON DEVELOPMENT GROUP A Division of First General Realty Corp. 203 TURNPIKE LLC 93 Union Street, #315 Newton Centre, MA 02459 Telephone: 617-332-6400 Facsimile: 617-527-4176 March 29, 2016 Re: APPROVAL for ;vorlr for Premises field at 203Turn ilce Street N.Andover, Massachusetts To whom it may concern: This fetter shall serve as formal notification that Lowell General Hospital has full permission to perform all scopes of work required for the completion of the approved renovation of the suite located at 203 Turnpike Street, N. Andover, MA. Sincerely, A /!�' 'Fa7 Kevin R Barry Director of Design & Construction cc: Jodie Zussman, COO Heather Legere,PM Michael Desharnais, PM CustAccount#: PURCHASE ORDER PO Number: 173483 Corporation: LOWELL GENERAL HOSMAL Tax Exempt ID) E042103590 Vendor. DMAR CONSTRUCTION,LLC Ship To: WEIGHT CTRlN.ANDOVER Bill To. P.O.SOX 9518 Created On: 03/17/2016 yr►d Na: �t8573 203 TURNPIKE ST 2ND FLR MANCHESTER,NH 03108 N_ANDOVER,MA 01845 Printed On: 03/17/2016 12:31:42 Phone: 603-401-401 S Phone: 978-937-6172 Phone: 978-937-6303 Special Instructions: Fax No: Fax: 978-937-6893 Fax: 978-937-6819 CIP-1083 Weight Management Address: P O BOX 27 Contact Donna Chasse Contact alp CtrlN.Andover, See March 9,2016 Proposal and order as quoted_ DANVILLE,NH 03819 E-mail: donna.chasse@loweiigeneral.org E-mail: Ighinvoices@nedocs.c:orn EstArr Date: 04/08f2016 Ship Via: FOB DESTINATION Terms: No Discount/Net30 Line O y l UOM Item ID/ Description GLAcct / Corporation Order Price Line.Total --Receiving— Pck Ref Vendor Catalog# Notes Deliver to Location 1st 2nd 3rd 4th I 1 ST Proceed as Proposed on 319/16, Work w1G.Slowman& 1300-400 001 $234,500.00000 $234,500.00000 M_Deshamais to schedule_ All changes mast be approved.Any adjustments to po total$,pis advise. 7500-WEIGHT MANAGEMENT CTR Please ref po#on all correspondences. Page 1 of 1 Authorized Signature PO Total- $234,60o.o0 i DMar PO BOX 27 Construction Danville, NH 03819 603.401-4018 PROJECT: LGH NA WMC Renovations DATE: Wednesday,March 09,2016 TO: Mr. Michael Desharnais FROM; David Marceau Construction Coordinator DMar Construction,LLC Saints Campus Lowell General Hospital PO BOX 27 1 Hospital Drive Danville NH 03819 Lowell,MA 01845 ' 1000 General Conditions $29,000 00 2000 Demolition $2,000.00 2500 Abatement $0.00 4000 Masonly $0.00 ; 5000 Metals $0.00 6000 Wood&Plastics $14,300.00 7000 Thermal&Moisture Protection $0.00 8000 Doors&Windows $15,000.00 9000 Finishes $37,000.00 10000 Specialties $8,000.00 11000 Equipment $0.00 , 12000 Flu nislun s $0.00 13000 Special Constriction $0.00 14000 Convey!%Systems $0.00 15300 Fire Protection $0.00 15400 Plumbing $28,000.00 15700 HVAC $49,500.00 15900 HVAC Controls $0.00 16000 113lectrical $31,000.00 16500 Tel/Data $0.04 5 PERMITS $ 2,700,00 CONTINGENCY $ - 6 GI.INSURANCE $ 2,000.00 7 CM FEE $ 16,000.00 N' I DAB.0..!'AIt.M.Cous uTiction Lowell General Hospital Weight Management Clinic North Andover March 9, 2016 DMar Construction is pleased to provide the lump sum price of$234,500.00 for the Weight Management Clinic Renovations at the Circle Health North Andover Campus per drawings by CDoonan Architects dated 2/15/16 and MEP drawings from Cummings Engineering dated 2/19/16. We include Addendums 2 and 3. For your convenience we are also attaching our schedule of values. Thank you for the opportunity to provide pricing for Lowell General Hospital, Please feel free to call with any questions. DMar Construction Qualifications and Assumptions General: We include full time on-site supervision. We include Project Management to coordinate submittals, RFI's,subcontractors,etc. Daily clean-up and trash removal and disposal to our onsite dumpster Is Included. Assume work to he performed in one phase during normal working hours: We include a professional final cleaning. Cleaning to Hospital sanitary standards is by LGH. Division 1-Architect&Engineering: It is assumed the necessary Architectural and Engineering drawings and affidavits necessary to apply for,receive and close out the City of North Andover Building Permit will be furnished by LGH. Division 2—Abatement&Demolition: Hazardous material test results have not been received by DMar Construction. No Hazmat assumed. Select demolition of masonry wall for new exhaust louver. Removal and proper disposal of existing articles In the space is assumed to be performed by LGH prior to the start of construction. Division 6-Wood&Plastics: Furnish and install plastic laminate countertops,lower and upper cabinets as shown. We have carried solid surface countertops at all wet areas: We assumed Corian standard color. Division 8—Doors and Windows: Furnish and install 12 single HM Frames and solid core flush doors and hardware. Furnish and install 1 pair flush doors,HM frame and hardware set 1 modified for a pair of doors. Furnish and install 2 single doors and HM frames with narrowiite%"safety glass. Furnish and install 1 single door with 24"x 24" louver and HM frame. Permanent lock cores by LGH. DMar Construction, LLC PO BOX 27 Danville, NH 03819 Page 1 of 3 1 I DMA .Coi>' str °coon Division 9—Finishes: Drywall: Frame all walls and hard ceilings with 3-5/8"20 gage metal studs and track; 6"studs at chase wall in rest room. 5/8"drywall with level 4 finish ready for paint/ Patch existing walls, Cut new door opening at entrance. Flooring: Furnish and Install Studio Carpet Tile Furnish and install Patcraft broadloom carpet. Furnish and install 4"x 1/8"vinyl cove base on all perimeter walls. Minor floor prep throughout is included. ACT: Furnish and install new Armstrong Dune#1774 ceiling tiles and 15/16" Prelude XL grid system. Paint: Paint new and existing walls throughout. Division 1.0—Specialties: Furnish and install toilet accessories. Furnish and install fire extinguisher cabinet and fire extinguisher. Furnish and install Acrovyn wall protection. Division 12—Equipment: None shown. By LGH. Division 15—Plumbing: Rough and finish plumbing per drawings dated 2-15-16. Per direction of LGH we do not include replacing and Increasing the existing vent or sanitary lines to 41. Furnish and install fixtures as specified on drawings. The specified toilet only comes Ina flusho meter style, That Is what we carried. Insulation on all new water piping. Permits and Inspections. Division 15--Eire Protection: There is no Fire Protection Scope of work on this project. DIUlar Construction, LLC PO BOX 27 Danville, NW O3819 Page 2 of 3 E i DMARConstructiou Division 15—HVAC: Furnish and Install(10)York water source heat pumps, For Trane Feat Pump equipment please add$5,500.00 NOTE: Heat pumps are a(6)week build time plus shipping. Fabricate and Install galvanized ductwork with all associated accessories. Install supply&return,CPVC schedule 40 piping for(10)water source heat pumps. We include condensate piping In our proposal. NOT SHOWN ON DRAWINGS, Provide 1%" Insulation for ductwork Purchase and Install diffusers, Red line as built drawings Permit Provide temperature controls 0 10-HP's(Mount and wire factory supplied thermostats.) 0 1-EF(Furnish and install programmable time clock.) Air and water balancing for the Weight Management Clinic is Included. LGH should budget:additional funds to rebalance the spaces served by the RTU and condenser water loop we are tying Into(We suggest$1,500.00 and have not Included this In our proposal). Division 16 Electrical: Electrical work for the Weight Management Clinic, at 203 Turnpike Street North Andover, MA as per drawings, E1,E2&FA1 dated 2/19/2016 and Addendum 42 A2-SK2(tele/data sleeves). Furnish and Install outlets and mechanical power as per drawing E1. Furnish and Install 100amp 47circuit panel as per drawing E1 Furnish and Install light fixtures as per drawings E2&A3-1. Furnish and Install Fire Alarm devices as per drawing FA1, Furnish and Install tele/data sleeves as per addendum#2 A2-SK2. Data wiring is to be by others. MC Cable is to be used for all electrical wiring. One(1)year material and labor guarantee. Temporary lighting&power. Electrical permit. DMar Construction, LLC PO BOX 27 Danville, NH 03819 Page 3 of 3 I The Conimonivealth of Massachusetts Department oflndltstrialAccidents b I Congress Street,Suite.100 Boston,MA 02.1.14 20I7 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Conn•actors/rlectr'icians/Plurnbers. TO BE PILED WITH THE PERMITTING AUTHORITY. { AnWicant.Information Please Print Le ibl Name DMar Construction, LLC (Business/Organization/Intl€vidual); PO BOX 27 Address: City/S#ate/Zip: Danville, NH 03819 Phone#: 603--401-4018 Are you an employer?Check llte appr•oprlate box: Type of project(required): L XC J I am a employer with employees(frill and/or part-time).* 7. r]New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in g. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing ail work myself,[No workers'camp.insurance required.]t 10❑Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repair's or additions SO I am a general contractor and I have hired the sub-contisetors listed on tho attached sheet. 13. repairs Theso sub-contractors have employees and have workers'camp.insurance.t ❑Roof re p S.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance]required,] *Arty applicant that checks box fit 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 trust 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. If the sub-contractors have employees,they must provide their workers'comp,policy number. I wn an employer that Is providing oviding ivorlrers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name; Acadia Insurance Company Policy#or Self-ins,Lie.I#: WCA 5242201 — 10 Expiration Date: 3�7/17 Job Site Address: 203 Turnpike Street City/State/Zip: 01845 Attach a copy of the Workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fire up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of rip to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do ber,e,�cettlfy arder-the palirs mud pertaltie ofteoymy drat the Information provided above Is tune and correct, Signature: Date Phone#: Of.lcial use only. Do not write In this area,to be completed by city or'town off elal City or Town: Pernrit/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 Person: Phone M ,Client#:27510 DMACO ACORD. CERTIFICATE OF LIABILITY INSURANCE UATE(M#U°°"YYY' 3130/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HQMT^cT Janet B.Oxman,CPCU Sullivan Insurance Group,Inc. Qy o Exi:781 514-1340 F 1 Mercantile Street E�IY1A Arc.No: 781 449-5419 Suite 710 ADDRESS: joxman@sullivangroup.com Worcester,MA 01608 INSURER(S)Af FORDING COVERAGE NAICA INSURERA:Acadia Insurance Company INSURED INSURER B; DMAR Construction,L I-C INSURER c 64 Fairview Dr. { Danville,NH 03819 INSURER n INSURER E: ------------------ 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, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE: MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UB POLICY EFF POLICY EXP LIMITS LTR ! R A POLICY NUMBER MM1DD MMmD A GENERALLIABIurY CPA5241730 3/07/2016 0310712017 EEpACCHqq��OEECCTTURRENCE $1 000 000 PR X COMMERCIA-GENERAL LIABILITY EMISESO aENTE, ce s250 000 CLAIMS-MADE "OCCUR MED EXP(Arty one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE s2,000 000 GEN'LAGGREGATELJMrr APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 X POLICY JECT LOC $ A AUTOMOBILE LIABILITY CAA524219$ 3/07/2016 03/07/201 EQ aB e©SINGLE LIMIT 1,000,000 AUYAUTO BODILY INJURY(Per pmon) $ ALLOYMED X SCHEDULED BODILY INJURY(Per acddenl) $ AUTOS AUTOS NON-0iNNED PE DAMAGE X HIRED AUTOS X AUTOS er PRO acadenl $ $ A X1 UMBRELLA LIAB X OCCUR CUA5241732 3/07/2016 0310712017 EACHOCCURRENCE $1 000 000 EXCESSLIAB CLAIMS-MADE AGGREGATE $1 00O 000 DEA I X RETEM1oN$nil $ A WORKERS COMPENSATION WCA5242201 0310712016 03/07/201 X We STATu- EoTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIErOWPAR:TNERIEXECUTIVE E.L.EACH ACCIDENT $500 0O0 OFFICERtMEMBEREXCLUDED? N NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s500OOO If yes,desk under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,AddRional Remarks Schedule,If more space is required) Project: Lowell General Hospital Weight Management Center CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988 2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2791491M279146 J BO i FP•006 , (Rev. 1.1.2015 , ' PERMIT• City or Town: a ) DIG SAFE NUMBER Date: Permit Number(if applicable); • SEart Date: In accordance with the provisions of KG•i_. Chapter 148, as provided In to this permit is granted ll st ar i or conustaruciont/r Hrm renorvf oA for Locate dump aa on/demoli t on of Restrictions; (Street and#or Describa Location for Adequate Identif7catlon} 1=ea paid$ ICJ This ermlt pire o js Signature of Official Granting permit; Title This permit must be conspicuousi y pasted upon the premises