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Permits - Permits - 203 TURNPIKE STREET G1
J' 1 Commonwealth of Massachusetts Sheet Metal Permit Date : I Permit Estimated Job Cost: Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# /,,, _. / plicant License# ) Business Information: Property Owner/Job Location Information; Name: Name: .—AZ /f (1 Street: // er4'77 ! Street: i City/Town: ;llCr . City/Town: ou i c / - Telephone:q') L- V S 0 :) !Vk Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. -AZ over 35,000 cu, ft, Sheet metal work to be completed; New Work: Renovation: HVAC ✓ Metal Roofing ICitchen_Exhaust System Chimney/Vents Provide brief description of work to be done: L 4, t,.s 1.o �L��ti O.rtTJC �� rn S t I f ; Sheet Metal Commercial Guidelines/Life Safety Critical Sy stems Inspection C.heeldist Yes No MIA,, Set of stamped engineering documents and detailed description of mechanical system to be installed has boon provided All workers performing shoat metal work onsite has valid Massachusetts sheet metal license All sheet metalwork being perfox-med with proper journeyporson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed.. actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly Iocated (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required) and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. proper clea,`ances, fire rated enclosures and pressure testing requited; es,xainis installed W ake require( 'oh equipment aid dr�,.#�:.,)rV Duct penetrations in fire'rdtc °wall-R and floors sealed' i Metal roofing systems installed watertight using proper materials and fasteners Flexible duet runs installed 5'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork(plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct Now/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) • M 1 Pro e .s ,4,1,'' Project Summarygab: Date: Mar 18,2014 zzof Entire House By: MIKE DONAGHEY SG TORRICE COMPANY 80IMUSTRIAL WAY,WILMINGTON,MA01887 Phone:978-857-7110 For; 203 TURNPIKE ST UNIT125, PYNE MECHANICAL N.ANDOVER Notes; 1) Distributor is not responsible for the accuracy of the load calculation If inaccurate/incomplete construction information is provided by the dealer. 2) It is the sole responsibility of the dealer to ensure that the duct system is adequately sized for the airflow capacity of the specified equipment. Weather. Lawrence Muni, MA, US Winter Design Conditions Summer Design Conditions Outside db 3 OF Outside db 94 OF Inside db 72 OF Inside db 75 OF Design TD 69 OF Design TD 19 OF Daily range M Relative humidity 50 % Moisture difference 47 gr/lb Heating Summary Sensible Cooling Equipment Load Sizing Structure 85703 Btuh Structure 67565 Btuh Ducts 23456 Btuh Ducts 9125 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 109159 Btuh Use manufacturer's data n Rate/swing multi tier 0.99 Infiltration Equipment sensible load 75923 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi-tight Fireplaces 0 Structure 13028 Btuh Ducts 6317 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Prea(ftz) 2856 2856 Equipment latent load 19345 Btuh Volume(to) 25706 25706 Air changes/hour 0.28 0.15 Equipment total load 95268 Btuh Equiv.AVF(cfm) 120 64 Req. total capacity at 0.70 SHR 9.0 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coll AHRI ref Efficiency 80 AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 3610 cfm Actual air flow 3610 cfm Air flow factor 0.033 cfm/Btuh Air flow factor 0,047 cfm/Btuh Static pressure 0 in H2O Static pressure 0 In H2O Space thermostat Load sensible heat ratio 0.80 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed brit ri htsoft: 2014-Mar-20 09:age 1 ,f- � Right-Suite®U nNersal 2013 13.O.D8 ftSU2093A Page 1 ...MGS1203 Turnpike street north andmer,ma.rup Galo=MJ8 Front Door faces: N �!Mallfallej Component Constructions Job: Date: Mar 18,2014 Entire House y B MIKE DONAGHEY SG TORRICE COMPANY 80 INDUSTRIAL WAY,INILMINGTON,MA 01887 Phone:978-657.7779 For: 203 TURNPIKE ST UNIT125, DYNE MECHANICAL N.ANDOVER Location: Indoor: Heating Cooling Lawrence Muni, MA, US Indoor temperature (OF) 72 75 Elevation: 151 ft Design TD(OF) 69 19 Latitude: 430N Relative humidity(%) 50 50 Outdoor: Heating Cooling Moisture difference(grAb) 53.7 46.7 Dry bulb(°F) 3 94 Infiltration: Daily range(T) - 18 ( M ) Method Simplified Watbulb(°F) - 77 Construction quality Semi-tight Wind speed(mph) 15.0 7.5 Fireplaces 0 Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain T Bhhff-'F IP-°F/Btuh BMM* 81uh ghhr 61uh Walls 129-0bw:Frm wall,brk 8"ext,3/8"vvood shth,r-11 cav Ins,1/2" no 108 0.097 11.0 6.71 725 1.70 184 gypsum board Int fnsh,2"x4"wood frm se 325 0.097 11.0 6.71 2178 1.70 552 sw 362 0.097 11.0 6,71 2430 1.70 616 nw 606 0.097 11.0 6,71 4064 1.70 1031 all 1400 0.097 11.0 6.71 9397 1.70 2383 Partitions 12C-0sw:Frm wall,stucco ext,r-13 cav ins,2"x4"wood frm 1245 0.091 13.0 6.30 7840 1.50 1864 Windows 1 D-c2ov:2 glazing,cir outr,air gas,vnl frm mat,Or innr,1I4"gap,118" se 18 0,570 0 39.4 690 55.9 978 thk sw 70 0.570 0 39A 2761 55.9 3913 nw 88 0.570 0 39A 3451 45.0 3938 all 175 0.570 0 39.4 6903 50.5 8830 Doors 11J0:Door,mtl fbrgl type n 42 0.600 6.3 41.5 1744 18.8 790 Ceilings C part ceiling,:C part ceiling,frm fir,6"thkns,dead air pinm,suspended, 2855 0.196 1.0 13.6 38760 10.8 30723 piaster board int fnsh floors 22A-cpl:Fag floor,light dry soil,on grade depth,carpet flr fnsh 175 0.989 0 68.4 11977 0 0 W rlgl11ttso I L. 2014-Mar-20 09: e 1 ,� Rig fit-Su itr,� nlv Uersa1201313.0.08RSU20134 Pagagel CN ,..CALCSX203Turnpike street north andover,ma.rup Cat°=MJ8 Front Door{aces: N iI Load Short Form Job, Date: Mar 18,2014 Entire House By: MIKE DONAGHEY SG TORRICE COMPANY 80 INDUSTRIAL WAY,WILMINGTON,MA 01887 Phone:978-657-7779 I - I � ® 9 For: 203 TURNPIKE ST UNIT125, PYNE MECHANICAL N.ANDOVER Htg Cig Infiltration Outside db(OF) 3 94 Method Simplified Inside db(OF) 72 75 Construction quality Semi-tight Design TD(OF) 69 19 Fireplaces 0 Daily range - M Inside humidity(%) 50 50 Moisture difference(grub) 54 47 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80 AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 3610 cfm Actual air flow 3610 cfm Air flow factor 0.033 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.80 ROOM NAME Area Htg load Cig load Htg AVF Cig AVF (ftZ) (Btuh) (Btuh) (cfm) (cfm) ROOM 4 284 14537 8990 481 423 ROOM 5 161 5290 4345 175 205 ROOM 2 192 13988 7624 463 359 ROOM 3 1245 45938 31315 1519 1474 ROOM 1 975 29406 24416 973 1149 Entire House d 2856 109159 76690 3510 3610 Other equip loads 0 0 Equip. @ 0.99 RSM 75923 Latent cooling 19345 TOTALS 2856 109159 95268 3610 3610 Calculations approved by ACCAto meet all requirements of Manual J 8th Ed. 2014-Mar-20 09:10:00 WCCgIft sii$�t' Rfght-Su ReSUnNersa1201313.o.08RSU20134 Pagel ACC k ...CALCS1293 Turnpike street north andover,ma,rup Calc=MJ8 Front Door faces: N i Level 1 aoo�n e fr 4. f-%T \\ SI:H.n1 fii)G'.1 3 Rcom l dioom 2 `fob#' SG TORRICE COMPANY Scale: 1 : 173 Performed by MIKE DONAGHEY for: Page 1 203 TURNPIKE ST UNIT125 80 INDUSTRIAL WAY Right-Suite Universal 2013 WILMINGTON, MA 01887 13.0.08 RSU20134 N.ANDOVER Phone:978-657-7779 2014•Mar-20 09:10:38 ..,Ike street north andover,r»a,rup .................... ... ...... ................ . 0VM -0t Airidover moo ap C, over, Mass., A reWICK A�, c0cmic '-"?A-rE Is, BOARD OF HEALTH Oro% Food/Kitchen E R M I T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................................ ................. ----------- .......................................... .2,AQ 2...OT • • Rough has permission to em@0Ar.4tA1W.q+#..... �gigs"'in.............. V . to be occupied as.. Ch- i .. �e 4(oh:f"S ... .........................................11.......................................................... provided that the person accepting this permit hall in every respect conform to the terms of the application on file 7 this office, and to the provisions of the Codes andjly-Laws relating to the inspection, Alteration and Construction Of PLUMBING SP R Buildings in the Town of North Andover. 0/1;6 q x VIOLATION of the Zoning or Building Regulations Voids this Permit. Fr PERMrr EXPIRES IN 6 MONTHS ELEC'MCAL INSPECTOR UNLESS CONSTRU S Rough ..................... ------- ...............................................----------------- service BUILDING INSPECTOR Occupancy Fermit 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 DEPAR Until Inspected and Approved by the Building Inspector. Burner Street No. E REVERSE SIDE Smoke Det- .................................. ............. ....................... own ot over 0 No. WOO lit) tf._ �A E IC'-C lover, Mass., •COCMiCEW 0RATEI) BOARD OF HEALTH Food/Kitchen IIERMIT Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................................... .... ... ................ Fo ................... ........ .......................... . ........ ... . ............XOP'3. ..... . ...... Rough has permission tovPv81&.1r.f,.*.(W.. b gs n--- 1/7 I Ch- e tobe occupied as..4.&torls-----a t14- ...... .................................. ............ .............................................. provided that the person accepting this permit hall in every respect conform to the terms of the application on file in ([�Final /� / - C this office, and to the provisions of the Codes andjy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING P CAR VIOLATION of the Zoning or Building Regulations Voids this Permit. Pu.3 .ro e' ;�7 PERMrr EXPIRES IN 6 MONTHS ELECTRICAL R'4SPE&OR UNLESS CONSTRU S Rough Service ---------- ................................... BUILDING........ INSPECTOR < 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 D' ENT Until Inspected and Approved by the Building Inspector. Burner--, 7t Street No. I FIF SEE REVERSE SIDE Smoke Der- 1 i i ibASNbN I CERTIFICATE OF USE & OCCUPANCY TOWN OF NOwrl-1 A.1"4D VI±; Building Permit Number 502 Date: June 9 2006 THIS CERTIFIES THAT THE BUILDING LOCATED ON 203 Turnpike Street MAY BE OCCUPIED AS Commercial Fit U --Doctor's Office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Northeast Oral Surgery 203 Turnpike Street North Andover MA 01845 Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING 'iK' "f � rn BUILDING PERMIT NUMBER / DATE ISSUED: a z tD Ma SIGNATURE: z Building Com6ssion6rltns for of Buildings Date SECTION I-SITE INFORMATION I0 1.1 Property Addres,4:f,, 1.2 Assessors Map and Parcel Number: Map Num Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: W Zarin Distrid Proposed Use Lot Areas Fronts (tt 1.6 WELDING SETBACKS tt Front Yard Side Yard Rear Yard Required Providc Required Provided Re red Provided v 1.7 Water Supply M.4.L.CAO. 54) 1.5. Flood Zone Informal€on: 1.8 Sawerago Disposal System: I'rtbtia ❑ Private ❑ Zoae Outside Flood Zone ❑ Munk€pal ❑ Chs Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT D rn 2.1 Owner of Re rd dme,�Print) Address for Service J , f T1 h -�.�[ ��� 1 /�1s11 J' 2.2 Owner of Record: 0 Name Print Address for Service: M Si'nature Telephone SECTION 3-CONSTRUCTION SERVICES $ r: 3 Li ensed Construction Supervisor: Not Applicable ❑. �...�.,, ��� Licensed Construction Su rvisor: r�J License Number t'n LRegozisterl Expiration Date Telephone ome Improvement Contractor Not Applicable ❑ Company Name M Registration Number r r Address Expiration Date Si riahtre .�,,,•_,_ Telephone t FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION'"*****"*****"********** APPLICAN � '� r, �;L PHONE ,3 z ` LOCATION: Assessofs Map Number PARCEL SUBDIVISION LOT ($} "��p lam' STREET _ �''�-� .. V�'ST. NUMBER %L' 4 OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED ` DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVE Y P RMIT f '``FIRE DEPARTMENT ': ' ; 5 � RECEIVED BY BUILDING INSPECTOR ©ATE ROVISW M97Im v Vestibule 6,160�a Roo(z- • F LobbyLeun i t w _ _w Existing stair t 5 � l • I f 1 ' ti - _— Vesnbale i SIF -14 } } Lobby LkkU Existing stair C 1 ( a � 3 r I - 1 4 � 1 f I OBI - 3`d Floor Women's Room Upgrade April 1, 2005 Vanity: American Classic---Monteray Maple CM30D 30"x 2l" $215.00 Sink: American Classic - -9781440 Faucet; Glacier Bay—4", 2 Handle LA, French levers. F50A8200CP 1 A397-720/EZ FIND #D36 North Andover Building Department Tel,. 978-688-9545 j DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in; {Locatio� of Facility) Sign4 a of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Peerless 11orkers Compensation And Employers Liability Insurance Policy Insurance. ` h[em4xr of Lbcnp h5ulualfmup ��, PHYSICAL AUDIT Audit Period: From 09/29/2003 To 09/29/2004 PREMIUM AUDIT STATEMENT DIRECT BILL Policy Number: WC 9119806 Policy Period: From 12:01 AM 0 912 9/2 0 0 3 To 12:01 AM 09/29/2004 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY NCCI Number: 11355 Named Insured and Mailing Address: Agent: BEAUDOIN FAMILY EATON & BERUBE INS AGENCY INC ENTERPRISES INC 365 NASHUA ST C/O CLAUDE BEAUDOIN PO BOX 37 200 DEPOT RD MILFORD NH 03055 HAMPSTEAD NH 03841 Agent Code: 0410001 Agent Phone: (603)-673-0500 Federal Employer ID Number: 020473817 Filing Number: Code Premium Basis Rate Per$100 Earned Number Classifications Actual Remuneration of Remuneration Premium MA 5474 PAINTING OR PAPER HANGING NOC &SHOP IF ANY 8. 2600 0, 00 OPERATIONS, DRIVERS 5403 CARPENTRY NOC IF ANY 16 . 6000 0. 00 Sub-Total................................................................................................................ $ 0. 00 Sub-Total................................................................................................................ $ 0. 00 0032 Loss Constant ..................................................................................................... $ 50. 00 State Total learned Standard Premium................................................................. $ 50. 00 Terrorism Risk Insurance Act of 2002 Coverage...—... ......... .............................. $ 0. 00 0001 MA DIA Assessment 0.03700 ............................................................ $ 2. 00 State Total Earned Cost........................ ......... ............ $ 52. 00 NH 8810 CLERICAL OFFICE EMPLOYEES NOC IF ANY 0, 4500 0. 00 5474 PAINTING OR PAPER HANGING NOC &SHOP 14, 492 15. 0900 2, 187. 00 O;'LftATiONS, DRIVERS 5403 CARPENTRY NOC 40, 895 21 . 4700 8, 780. 00 Sub-Total................................................................................................................ $ 10 , 967. 00 9 807 Premium for Increased Limits Part Two ............................................................... $ 186. 00 Sub-Total................................................................................................................ $ 11 , 153. 00 9898 Experience Modification-using factor 0.8300 ..............I........................... $ -1 , 896. 00 State Total Earned Standard Premium................................................................. $ 9 , 257 . 00 0063 State Premium Discount........................................................... ............................ $ -4 6 3 . 00 Terrorism Risk Insurance Act of 2002 Coverage.................................................. $ 17. 00 State Total Earned Cost......................................................................................... $ 8 , 81 1 . 00 POLICY PREMIUM TOTALS Total Earned Standard Premium........................................................................... $ 9 , 324 . 00 0900 Expense Constant ................................................................................................. $ 244 . 00 Total Premium Discount........................................................................................ $ -463 . 00 Date Issued: 12/30/2004 Copyright,1987 National Council on Compensation Insurance 25-198 (06/94) INSURED COPY PGDMO60D J24579 PCAFPPN 00026634 Page 3 a ,Norkers Compensation And Employers Liability Insurance Policy PHYSICAL AUDIT Audit Period: From 0 912 9/2 0 0 3 To 09/29/2004 PREMIUM AUDIT STATEMENT(continued) Policy Number. WC 9119806 Polic�Perio�d- From M2:07A M 09/29/2003 To 12:01 AM 09/29/2004 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY NCCI Number: 11355 Named Insured: Agent: BEAUDOIN FAMILY EATON&BERUBE INS AGENCY INC ENTERPRISES INC Agent Code: 0410001 Federal Employer ID Number: 020473817 Filing Number: POLICY PREMIUM TOTALS TotalEarned Premium........................................................................................... $ 9, 105. 00 Total Assessments/Funds/Surcharges ................................................................. $ 2 . 00 Total Earned Cost.................................................................................................. $ 9, 107 . 00 Less Previously Charged`...................................................................................... $ 13, 463 . 00 RETURN PREMIUM ...................................................................................... $ -4, 356. 00 If the policy Is on an"installment basis",the final premium is subject to the payment of all installment premiums. Date Issued: 12/30/2004 Copyright,1987 National Council on Compensation Insurance 25-198 (06/94) INSURED COPY PGDM060D J24579 PCAFPPN 00025635 Page 4 XA )RTjj o of Andover V0 No. 0 tt- LAo over, Mass., CO H1 H Wil %AD`'ATED P"P" WARD OF HEALTH Food/Kitchen PER T Dseptic System am BUILDING INSPECTOR THIS CERTIFIES THAT".... ........... ........................................... ... ................. ..................................... ....... Foundation has permission to ereculsovow.*�F ..�........ buildings an................ ......; . ......... ....................................... Rough I to be occupied as..........- Ab As ON -A .. ...........4001LAIALO................................................................. Chimney ;de�slainByi-Laws relating to the Inspection, Alteration and Construction of provided that the person accepting this p it s in every respect conform to the terms of the application on file Final this office, and to the provisions of the Cc ct 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 Fmal UNLESS CONSTRUCTIOT\j ELECTRICAL INSPECTOR Aa�v� Rough ............................................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTIAINT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE -SIDE —JI Smoke D&- .................................... ....................... Commonwealth of Massachusetts Official Use Only l Permit No,_ 'Y41-&r2 ' DLpaif"t!I?GI]'t Of Fire Set"V,►CeS Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be.performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRW IN rNK OR TYPE ALL INFORMATION) Date: Nov. 4, 2008 City or Town of: NORTH ANDOVER Y'o the Inspector of Wires: By this application the undersigned gives notice bf his or her intention to perform the electrical work described below. Location(Street&Number) 203 Turnpike St. Owner or Tenant 3D Dental Telephone No. owner°sAddress Current: 1.1 Chestnut St . , Andover. Moving to Job Site Address Is this permit In conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Office Suites Utility Authorization No. Existing Service Amps 1 Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Low Voltage Data, CATV, CCTV and Speaker Wiring and Termination Labor Only for Dentist Office Suite. Cum letivn ajthe jallowin�table nta be waived by the Inspector of Wires. al No.of Recessed Luminaires No.of CeU.-Susp.(Paddle"Fans o.o Transformers ICV KVA No.of Luminatre Outlets No.of Hot Tubs Generators KVA. No.of Luminaires Swimming Poo A ave ❑ In- ❑ o,o ruergeney ig g nd. rnd. Battery Units No.of Receptacle Outlets No.of Ozl Bu,ners FIRE ALARMS No.of Zones , o.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No,of Waste Disposers Totals-, Pump _„umber„ .ons o.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Beating XW Luca][❑ e cipal ❑ Other Connection No.of Dryers Heat Appliances Security Systems:* ing No.of Devices or E uavalent No.'of Waier KVi' o.of o.o Data Wiring: 42 Heaters 1 Signs Ballasts No.of Devices or l uivnlent No.Plydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: 16 No.of Devices or Equivalent Q7HER: ` Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $4 0 0 0 (When required by municipal policy,) Work to Start: 11/5/2 0 0 8 _Inspections to be requested in accordaneq with MEC Rule 10,and upon completion. INSURANCE COVERAGE,: Unless waived by the owner,no perudt for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ 0-MR [] (Specify;) Business Liab. and Work Comp. I certify,under Cite pains and ponaltles ofperjury,that the information on this application is trae and complete FIRM NAME; Technology Bridge, Inc . LIC.NO.: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the.license nwnber line.) Bus.Tel.No.: Address: 231 7avin Hill Ave. , Boston, MA 02125 Alt.Tel.No.- *Per M,G.L c. 147,s,57-61,security work requires Department of Public Safety"5"License: Lic,No. ' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts u Departmew of Industrial Accidents Office of Investigations a l 600 Washington Street Boston, MA 02111 Wlvw.nrassgovldia . Workers' Compensation lasitranee Affida vif: Builders/Contractors/Electricians/Plumbers AnRlicant Information Please Print Legibly I\alT e(ousinrsslOrgar,izadors/Endividuol}, Technoloq' V _Bri_dge, Inc'. Address: 231 Savin Hill Ave. City/.State/Zip: Boston, MA 02125 phone#i: , .617-825-2323 �/ 617-438-4345 Are you an employer?Check the appropriate box: Type of project(required): 1.Q* I am a employer with_ 4..... 4, ❑ 1 am a general contiWor and l b• Q Now construction employees(full and/or part-time),* have Mired the sub-contractors 2,❑ I am.a.sole proprietor or partner- listed art the attached sheet_t 7, Q Remodeling ship and have no employees 'Those sub-contractors have 8. ❑Demolition working for me In any capacity, workers' comp.insurance. 9, ❑Building addition [No workers'comp.insurance 5..0 We are a corporation and its required,) officers have exercised their 10.©Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MOIL 11.0 plumbing repairs or additions myself,[Nwworkers'camp, c, 152, §1(4);and we have no 1,2,Q Roof repairs insurance required.]t employees.(No workers) 13.Q other Scow Voltage comp.insurance required.) 'Any applicant that ehooks bolt kl must also fill out the seotion below shnwiryg their workors'bompenwion policy information, t Homwwnerp who euhmit this affidavit indicating they are doing all worts and then hire oulsido contmeton must aubmit a now affidavit indicating such. 4Cwwaotors that ahem:this box mastattsehad an addiliowl the name of the sub-contrsetots and their wodcom,comp,policy infanu6on, I 1 ant an employer/hat isproulding•workers'compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: Norfolk & Dedham Insurance Co. , Dedham, MA Policy#or Self ins.Lic.#: WEND3 515 _ Expiration bate: 10/15/2 0 0 9 Job Site Address: 203 Turnpike St. City/Stato/Zip: N. Andover, MA Attach it copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failpre 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.weli as aivil penalties in the form of a STOP WORK OPIDER and a fine of lip 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 veri fication. l do hereby,eed y under t'he pouts and. enalties of perjury Mta ffic information prat+/-.dell above FS/rue and turret':~ ^ Signature, Date: 11 4/2 0 0 8 Phone#: 617-825-2323 (office) , 617-438-4345 (cell) Off claf use only. no not write in i tfr area,to he completed by ei v or fawn official City or Town: PermH/lseocase 4 Issuing Authority(circle one), 1, Board otkl"tth 2,Building Department 3.City/Town Cleat 4. Electrical Inspector S. Plumbing Inspector b,other Contact Person: Phone 4. I i I 1 • z �j .s x2� 7 i <s3- - Lc�c � I f xATERSZC'PS U;^L _ ►, s o- GROUND FLOOR f.L: i1JbtEL1l.4TELY�� . -� --_ 203 Turnpike St. ' -- - �r , No. Andover, MA ryh f 4 '�- _ ]drawing to 1 �. _ �- Accompany Permit �5 C. a Application for Low Voltage Wiring rD VAS xa4ErEO : ... �lf �F ' � � Technology Bridge. AND•.EfiS:.c:.l..PW�ER TO r L UN b`-cS+G USED *FUT IEZ f viEEtnIS iB:Lrt�n.E FLCM:? �pPc7CAB.E.Na -CESS q y�y' PF1:£L FiU9+YATri-FuitSt<E'0 FLCOPj OG-TD;'FCT-DETAjLS. 'fy Y lk.. (j j e --- --- J70 A € rr;coo C C 7 yrarF-. MEW .�..o�e P14S _i .... P2i w,.E ,we:a.w.,,mr xs a, :..- �._;_.: -,...._-, � ��ow-�.,-s�..�-s e.a... ea_�.c+:�•w���..e-�.-.< ^,� �.✓ PX7--��- a.w>vas,s..�e.,...;.ti•�... u.er» o-v..�«r>e., - �.:�r�w .�-o w eo*c }2;�� S T l.c, �_ x�r;.a�. �e ..e,.Fa..'--..:.+•c�...�..-- .55 cG���-�..-.e.�.�w �-..ma....✓.��..i-+a.•e � F .ax��,...s-.•��-'i'. inrr.�..' - .e:.:>.. �� ...T�=..�`• `�� i z ,.- ......P vpp '. wC.e'v..i 4.'..-�_v���•.a� ., ro x��''�y'y M��,.,y_'� - -w.�r.w s�'a. ' .... �.e.,- �"�..c�Y M. �-.. �,�,��,� �4 [. `.rt-.rT.rYn-:w' �N..- t+r.��w .rwn. - r.j N. s✓z• wu...eTa ��.^.'� •_ /+-Y�ru.��a.st.' �n.:fra r� ��-rn.. �.� '-" w�r-evn:v...Kv+� - tw.. ,y,. +a..�T v µ wRr�: Wc+: �C<x� 7C ; a TOWN OF NORTH ANDO ER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OR, OR DEMOLISH ANY BUILDING OTHER TITAN A ONE OR TWO FAMILY DWELLING rt� RTItis Section for®ft"1tci1Il Use BUILDING PERMIT NUMBER DATE ISSUED: SIGNATURE: ' . 4r Building Commissioners or of tuldin Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Ztxtin Dislrid Pr osed Use Loi Area I ronta e A M 1.6 BUILDING SETBACKS(ft) �. Front Yard Side Yard Rear Yard ` Required Provide Required Provided R ired Provided 1.5, rloodZonelnformation: 1.8 Swerage Disposal System: t 1.7 Water S pply M GL C Ao 54) Zone outsido Flow Zone 0Municipal On Sde Disposal Systant LI Public E Private ❑ y� j aZ a 2.1 Owner of Record N b oy,5� F=Rce R-9 ` D ,2�/'�K fir, Mine(P, t) _ Address for Service Si► ure Telephone PD r1 9ss8 � 1-2 Authorized Agent X Name Print Address for Service: O z Signature Telephone M 90 g #° 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number Licensed Construction uervisor: 11/03106 Expiration Date SignAlurc Telephone 3.2 Registered Home improvement Contractor Not Applicable 11 Company Name Registration Number M Address Expiration Date Signature Telephone New Construction ❑ Existing'Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Cr1�;u Brief Description of Proposed Work: c c USE GROUP Check as applicable) CONSTRUCTION'TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A14 ❑ A-5 ❑ I B ❑ B Business ❑ 2A ❑ C Educational ❑ 2B ❑ 1t factory ❑ F-I ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ IInstitutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S.Special Use ❑ Specify: COMPLETE THIS SECTION IT EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CUR 34: _f BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floors ti UO ` � Total Areas Total Height(tl) Independent Structural En&eering Structural Peer Review Required Yes 0 No ❑ SECTION IOa Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OJt CONTRACTOR APPLIES FOR BUILDING PERMIT I, was Owner of the subject property Hereby authorize to act an My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date )RTH Tomm Of Andover No. Via _ dover, Mass., 0 L�A ;OCHICHEWICK BOA" OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...................... ......................6.. .1.... ...... ...... ..... Foundation t 9* 1' Route gs 3.. T has permission toopedo.1rit.A.W.48►..... I. "? . ................X013 to be occupied as..do.dworls-7., frj'iiWC..................................................................................................... Chimney provided that the person accepting this permit in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and jy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 0/44 PLUMBING INSPECTORq VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES N 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough .....................I.................................. ....... .......................................... Service BUMDING INSPECTOR Final acupancy Permit Required t& Ow vy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Firtal 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 DeL ................. i MJS MILLWORK, LLC November 3, 2005 Northeast Oral Surgery North Andover, Mass Proposal: For the renovation of approx. 3600 sq. f1-. of office space. MJS Millwork is proposing to act as the general contractor and be responsible for obtaining all necessary permits. Hiring and managing all subcontractors and there schedules. MJS Millwork is proposing a cost plus basis which MJS Millwork will work with Northeast Surgery to try and meet all necessary dead lines. MJS Millwork is proposing a cost plus basis which MJS Millwork will supply subcontractors invoices with 10% mark up. Design, Drawings: $13,000.00 Estimate (will most likely be less) Permit and Time: $ 4,000.00 Allowance Demo: To include removal of all existing slab cut, removal and replacement debri, disposal, temporary power and lighting $42,275.00 Framing, hang and taping, interior doors (labor and material) Cleaning, Floor Prep, Insulation $88,714.00 • Includes materials price of interior doors, waiting for updated pricing Painting and Wall Finislies: $18,000.00 Allowance Suspended Ceiling $11,580.00 Allowance Plumbing $46,234,00 Allowance Electric $58,500.00 Allowance PO BOX 17 • North Salem - New Hampshire 03073 - Tel 603-893-2173 • Fax 603-890-6963 HVAC $60,325.00 Allowance Flooring $25,447.00 Allowance Casework and Woodwork: To include all cabinets, countertops in all general offices. Woodwork in waiting room and conference room. $40,360.00 Allowance $408,435.00 10% Profit and Overhead $ 40,500.00 Grayed Total: $448,93 5.00 Note: Allowances are only estimates and Bard figures are coining. Note: MJS Millwork will also coordinate Patterson Dentals Insulation of equipment, F Thank you, 1 a Timothy J. rahm MJS Millwork, LLC , rUKM U - LU I KCLCAQG rvr%m INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT P H 0 N E LOCATION: Assessor's Map Number 1 PARCEL SUBDIVISION LOT (S) STREETs 1�r .. ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT `S FIRE DEPARTMENT e . -Rik o ET T r eco 6t AS IOo kLv NY-IVj I V160cc 'f--,it '�;�c,i ia? W V 7ECEIVED BY BUILDING INSPECTOR DATE Rtviad MOT Im C� The cottttttotitventai of massacliusetts Department of hidtistrial Accidesits �- Office of lnvestigatioiis 600 lVashitigion Street Bostott, AtA 02111 wol•l(ers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Itlformatioll Please Print L, ib1Y Name (I3usine,slorgtttuzation/individual): L . Address: City/State/Zip: �cj mt )' phone M. 0 Are you an employer? Check the appropriate box: Type of project (required): i.� 1 ant a employer with 4• 1 am a general contractor and 1 6, ❑ New construction employees (full and/or part-tithe),* have hired the sub-coutractors 4.❑ 1 am a sole proprietor or partner- listed on die. attached sheet. 1 7. Remodeling ship arid have no employees These sub-contractors have 9. ❑ Demolition working for ale in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required] officers have exercised their 3.❑ I ant a ]mottteowtter doing all work right ofexemption per MGL It.[:] 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' 13.❑ Other comp. insurauce required] Any applicant that checks box/It must also tilt out the section below showing their workers'compensation policy information: I iUtnCO\Vr1CTS who submit this affidavit indicating they are`dotng all Work and then hire outside conttuctors nlust sub"t a new affidnvlt indiCRting SUCK. ['ontractors that check this box must attached an additional sheet showing Cite name of the sutrcontractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is fire policy and job site rt fort!i at i UlA nsurance Company Nanre: j I p y :.. . Expiration Dale: 'olic #or Self ins. Lie. #: yob Site Address: >U City/State/Zip: lttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). �ailure to secure coverage as required under Section 25A oFMG1,e. 152 can lead to the unposition ofcriminal penalties of a ine up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a I'tne )[up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. t do hereby cetlify rrtider the pains and penalties of perjury that the inforrrradon provided above is true and correct. i Sip-nature: Ii..s t Date: - Phone Official use only. Do trot write in this area, to be completed by city or town official, City pt'Town: PerniltMeense# Issuing Authority (circle one): 1. Hoard of Health 2. Building Department 3. CityfToivu Clerk 4. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: Phone #: 9 i 1 MJS MILLWORK, LLC SUBCONTRACTORS - PAPPY'S ELECTRIC UPTACK PLUMBING UPTACK AIR DON WALTON DRYWALL ALBRIGHT SYSTEMS PO BOX 17 • North Salem New Hampshire 03073 Tel 603-89MI73 Fax 603-890-6963 Effective 12:01 AM 05/28/2o05 Policy No. WC 670-25-21 Issued to PIJS MI LLWORK L L C By COMMERCE AND INDUSTRY INSURANCE COMPANY Partners In PrcductivitysM AIG RiskTool Systemsm https://www.aigswc.com AIG Specialty Workers' Compensation° American International Group P.O. Box 409 P.O. Box 40029 Parsippany, NJ 07054 Phoenix, Arizona 85067 (800) 645-2259 (800) 645-2259 NOTICE TO POLICYHOLDER This notice is to alert you to AIG Specialty Workers' Compensation's new online, loss prevention and risk management platform, called AIG RiskTool Systems" . AIG RiskTool System can assist you in managing the risks your company and employees face everyday. As a valued customer, you can employ this tool to assess your specific needs, take steps to prevent injuries from occurring, and build and monitor your own loss prevention and risk management program. The AIG RiskTool System can be accessed at our Partners in Productivity wobsite, which also provides you with: information about us, frequently asked questions, and Contact Us access a information on workers' compensation insurance N the ability to locate medical providers for an injured worker the ability to report voluntary premium audits, and news and links to related workers compensation websites When accessing the Partners in Productivity website have your policy close by so that you can enter the following information: Policy Number Agent or Broker Number Issuing Company This valuable service is only available to current policyholders and their brokers. If you have questions, please call us toll free at 1-800-645-2259. https://Www.aigswc.com Member Corn anies of American International Group, Inc American Home Assurance, Inc., American International Pacific Insurance Company, American International South Insurance Company, AIU Insurance Company, Commerce and Industry Insurance Company, Granite State Insurance Company, Illinois National Insurance Co., New Hampshire Insurance Company, National Union Fire Insurance Company of Pa, Insurance Company of the State of Pa SWCPN (Ed. 12/03) RE r �� ✓ � .,-:,ter °i a3yi, �rl 2r } Z,77, 7, - ,... ..., is tRCE AND INDUSTRY INSURANCE COMPANY 69194-0000 WC 670-25-21 r:2 __________________o�-3--82-0505-00 ,• .� �. NEW YORK MJS fP 0 BOX L336 LLC Member Companies of N SALEM, NH 03073-0000 American International Group EXECUTIVE OFFICES: 71) PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE WC990610 1.01 2800 i 86o0 TPA INSURANCE AGENCY, INC. WORKERS COMPENSATION AND EMPLOYERS 10 NEW ENGLAND BUS CTR DR LIABILITY POLICY INFORMATION PAGE ANDOVER, MA 01810-1o96 INSURED IS PREVSOUS POLICY NUMBSI� CORPORATION RENEWAL COF7 �88713 Q'I'MER WORKPLACES NOT SHOWN ABOVE: SEE NAME AND ADDRESS SCHEDULE - WC990610 tTrM 2 POLICY PFRIOD 12:01 A.M.standard time at the insured's Inallingaddress FROM 05/28/05 ro 05/28/o6 IT1=M a A. Workers Compensation Insurance: Part One of the pollev applies to the Workers Compensation Law of the states listed here: NH it. Employers Liability Insurance: Part Two of the policy applies to the work. in each state listed in item 3.A. The limits of our liability under Part Two are: Bodliy Injury by Accident $ 100,000 each accident Bodily injury by Disease $ 500,000 policy limit Bodily Injury bV Disease $ 100 000 each employee C. other States Insurance: Part Three of the policy applies to the states, if any, listed here; AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI 'TEA'n The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Remun©ratlon Premium Classiiicaiinnc Code Number 5100�F Re- Annual [] 3 Year launeration 0 Annual 3 Year SFE EXTENSION OF INFORMATION PAGE - WC7754 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: .....�0`�, �2� ` ��, S��is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws'Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility 'gnature of Permit Applicant Fire Department Sign off; Dumpster Permit Date North Andover CONSTRUCTION CONTROL Project Number Project Title_Northeast Oral Surgery.fit-up Project Location_203 Turnpike Street Name of Building_203 Turnpike Sheet Nature of Project MECHANICAL AND ELECTRICAL In accordance with Section 116.0 of the Massachusetts State Building Code, I LAWRENCE V. ROY Registration No. 38913 & 34505 being a registered professional engineer/architect, hereby certify that I have prepared or directly supervised the preparation of all design plans computations, and specifications concerning: Entire project Architecture Structural Mechanical YES Fire Protection Electrical YES Other For the above-named project and that, to the best of my knowledge, such plans, computations, and specifications kneet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. I further certify that I, or my designated representative shall perform the necessary professional services and be present on the construction Site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents 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 coilstrUCtlQn components requiring controlled materials or construction specified in the accepted engineering practice standards listen in Ant.1—di,x A. Pursuant to Section: 116.2.3, 1 shall submit required progress reports together with pertinent comments to the Westborough building official Upon completion, of the �ork, 1, or my designated representative shall submit a final report as to the satisfactory completion and rea es of the c or•--occupancy. This report shall include date of final inspection and an originates"n signature i�ttttu�irrt ii 2 i ed and sw efore me this ' BEN /�f ®�'Uf 0— ` COMMIS SION MMARYYUBLIC fll�MB�R LAWRENC f Gov ;4MP5` G �� NO3 3450, V} ; �N �Z� R jrPU5 \\\\ r� 'Set;ICIVA OFFICE OF BUILDING INSPEC,' rR TOWN OF NORTH ANDOVEk CONSTRUCTION CONTROL e.N 3�sacwos`i PROJECT NUMBER: DPA Project R05-08--113 PROJECT TITLE: Northeast Oral. Surgery PROJECT LOCATION: Rear of 203 Turnpike St. NAME OF BUILDING:North Andover office ark-Franklin ParJ& Partner Owner NATURE OF PROJECT: Renovation of ground floor approx. 3,800 SQ. FT. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I,_Ang�ela Petrozzelli REGISTRATION NO. 3344 _ BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING; ENTIRE PROJECT 0 ARCHITECTURAL ® STRUCTURAL 0 MECHANICAL FIRE PROTECTION 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES, AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at Intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work Is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS T� l) SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OC C SIGNATURE c7 SUB 4XiiBED.AND SWORN O BEFORE ME THIS / &IDAY OF N60T_AfRY UBLIG f ��� MY COMMISSION EXPIRES '/�U% The Commonwealth of Massachusetts y Department of Fire Services c Office of the State Fire Marshal P.O.Box 1025 State Road,Sto-,v,MA 0177.5 PERMIT Date; 1" North Andover permit No D;g Safe Number (City of Town} (If Appficablc) In accordance with the provisions of M.G.LI 4 8 Chapter 10 as provided in section ��MR 34 Start hate . This Permit is granted to: Pull name of person,Firm or Corporation Pennissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be 25 ' from structure if unable to place with re uired Re,t (;tions: clearance dumpster must be covered with plywood or tarp end of work day at c�v.�" �,��� (Give location by street and no,,or describe in such manner as to provied adg u xte identification of location) l±eePaid$ 50 .00 Fire Chief This Pemut will expire f 3 S Title Gr r! (S i nature of offical granting permit} O tcai graittiiig permit ( ) Tiilq PFt?MIT fllii 1JqT RF ('nhj.gPir-i ini 1C1 Y P()CT;=n l mrw T"P P1w?PME.C, . k ............. ............ r OBI OF NORTH ANDOVER BU DENG DE'PARTKE 1T •'^'--AR,••"'•• . h3?L1C,%'EON?O CONSTRUCT RLAMR—s OVATE E"'.iVICILTD.USE OROMMANC}OR OR D-_v_OLNE iN—:L rt-DING rn O7r�.A BSaM1.:ONP OR"wOea�SS.Y IIUE `tiC .. - _5 acriAuthe:lyd 1-i'mse�er'rrclrlileiaz_iceOwv' BuTzmzC p�l-T l ma-E_'C: �+ DATE xSSL'D: y Kr i U_ = he F o!em,=aad infor=,;O- :en the:O7cern•��app:cauen are tic and 3cuae-to The Lest of me Sigt4 ttndcr he pains and Ix=a1 ticS Of'PC 117Y SIGN_1 : BULlding COMMiMiDnef ofEuildinim Date ?tins Narf� 1.] A'op��\Cdax 12 .t-r,.soes�v�d l'�'�ursUc Si_anlrc cf^wnerfAGmt Date --'- vt�l:—sQ N—e!N11-r- I S€ETfxJ�T:?- SS -_7"D CCaNn`??aN COS? Ilan FStiJ�.tw Cos-(Doll rs)to be/ .-aF'FICIAL USE ONLY . 1-3 Zm. L�io,c�on: t prate-h,•�,.._;�,�- — Cemul ied by ps.citEpplic,>4t 1. Bui'.ding (a; Pailding Permit Zminc Nn ie use t.ac:WafdT Frc�ta4<ff ? m I s"� /----VM. 'Sul Iia• - L6 13UMDLNG SETBACKS Tt) 2 E!ku:ral i rb) E ftmated Total Cost of 3 i I Front Yard Si&Yard P=r Y3.-d 5$ 610C.il Coaaruction from I Rm7iircd € -Pro idc R Pm ided R Prm*ded � = Plumbic //' I Building Peraul f 4•;z(63 }� 1-4 1.7 wma s htu,C.w1 a Mechsn,e l(FNACj in I anw;. o Om Ft-az— u— oe s Dam..t s e Sa Cc.ec - i Fire Pr.;ic�ou :' I 'SSCk'Idl�2=PE4RPE5C4X UPi�$-'I$I�IA�ITHORI�AGHMT ;` 5 TOM] {1+�+j+.t+5) Check Numbs '.t Owncr oz Rrr�rd I eta - --. Name(Pr6i) _-� - Add for gcrnce: -TO of Tekvh sroR>Fs sz i "-i%�-✓L . rn !fin one BASLSEN1.OR SLAB f'arr� r� - '-[t:, V F S Sawr Me I( � SIZE OF FLOOR TIMEIRS gPAAl Name Print Address for Se+hs: Z O DFMIISSIONS OF SILLS DWE,NSIONS OF POSTS - si€n== Telephone m DDAFNSIONSOFGIRD.ERs -SF.Cttd1N-3-CEIN.STI tT�'St}TtE "°:<, 3.1 NqE Aprhmb e C HEIGHT OF FOUNDATION THICKNESS cTZE OF FOOTING X Address L+cwse Number Q NiFTn"RIAI-OF CHIMNEXi. 'rrc�( 317 iu.S r'��.. i� G�7.�- _ _-- _ n 'Lc IId.ED BUILDING ON SOLID OR F LAND Lt Caaawca n i3 gUMI)WG CONNECTED 70 NATLT.AL GAS UNE SiFnamre �-Tclephove -� 3.�,:ce �eteC Hot>K Imoimem-.t^.ors[.-eeor No[Applienbk ❑ ConpouyN�e Repimaeun Nwnba Addrtsa &yirstioa Dale Sicswture Tekphooe - H'.,r1-m Crnnpenrabcu IanRancc a.`Tadx�i'must b<:nmpEM anc snF�ir„:wish ih's senl;cem F:,,w,�;^•��i;:c 3.ath a..-.�;.u?13 Sul*ie:6e de.�sal of ffic y^g[2'YOK bfI�5C.6L1P'ISC}f'1 fSF P?2LS?:SSED3�ORI£(Che"..k t.1T: Sie Te' �cva+ta ofchc buildingit E - Siencd2Td is Mashed Y'c......� No......Z - NeK�Constnaetimt G �dsting Buildizr _ I ti•n:is(s'1 � Alterationsls� G .?dd�tion - S£CITON 5-PROFESSIONAL DFMGN A"COrISZ'RU=O!7 SE MCES FOR BI MDU-IGS A."SMUCV3M SU&WxT TO. COfig=C!'YONCGNTROLPURSCA-*TSTG-, f*:l4IRI1GlCONTAIPIINC,MORETAAND3500C.F M A. ,0 .OFKNCLOSWSPACcC,"seryBldg. ❑ Demolition �Other p Sptci±:' _ 5.1 Reprised Architect Brief Description ofPropowd Work: nv rl,»}`�.. c.�=+'�Is:.l - - - �7„n-1 S.:.CT... AiLi _ti,ILi w'k:, .•,Ia/Ilbytm r i - � _ � Address �, v •1 a �J l Co t P� Siptatrae ".,v" Telephone ' `uP SSCISON7=USE GROUP AND CONSI'RUC'3"IOI+TTXPE USE GROUP(Check as applicablcl CONSTRUCTION TYPE 5.2 RrZisceted Projeasi°°ai A Asseatbl, ❑ A-1 ❑ A-2 G A-3 u IA - - a-:�•� .�� Area of Rcsp(=bIti B Butiinens 0 A-3 ❑ A-5 ❑ 1B FV me C Educational ❑ 'B ❑ 0 �C Rcpstauom Nt>mber F Fsa ❑ F-1 ❑ F 2 .4ddrs: 11 H Iivad [I3A 7 I lnstimtior:al ❑ I-1 ❑ I-2 ❑ 1-3 313 _ Expiration DtAc M mcreantile I❑ J s Signature Total Rrtsidentiol ❑ R-1 0 R-2 C R-3 C cA -- S Storage ❑ S-I W Not applicable U Utility ❑ Specify: M Mixed Use ❑ Specify: ;Name j/ '���rj S Special Use ❑ Specify. Repsamnon Dumber COMPLETE TMS SECT70N IF EXISTING BUMDL"rG UlYDF.RGOING REl~OVATI6kS,ADDITIONS.kND OR CHAN IN USE Add= Ddstnw IIse Group: .:�.[�;�.� ,� Proposed Use Group. 8igt�nac/ i Telephone / Expiratiau Date ExvKing Flvtrd ind�730 CMR�: Propowd Har�rtt Indcc'SO CM1�3a: r� SECfiOIlB'BBIIILi JGH17�l�IH ASFR :�� F`,-a f�/CL%C G%(L� BUTLDAIG AREA EXiSTAIG(iia btablcl PROPOSEDNxac . 1 Area of RcsporL�-ibAin Number of Floors or Stories Include Basement levels Floor Area PCV Floor( Addy J Rcgistr.6on Number Total Total Area �! Total Height ft - Telephone Expiration Date SECFI�:3 I- - 2r1dc=dent Structural Eu - eerixa Structlnal Peer Review RcqmTcct yes a NO C ` S NIILLWORK,LLC SECTION 102 Oxtaer Arthorixation-TO BE COMPLETED WHEI4 ] Area cf Rasp=bility Ov PNERS AGENT OR CONTRACTOR-°PPL.I£5 FOR BUU-D)NG PERWT Tim Rrahm pre;iCcnt t.ull .= C";,3) (— 3 p r,�Q - - Rcg:-tamtion Number ,as Owner of the Subject property No.i+en.:'vW C? phone ExMrion pate t02et On r--603-8"-2173Hereby Fy-503�90.(,°63 Mtuwonrz,cowsrnue„ow, - My be-bal£in U[natters relative two work 2uthon7ed bc'this baildinE peraut nppl—on Renoecurrc - _I 1 S rA i�l' �E��.- Not Applimblc C Date CompauY3mr.-- ^^"� Sigrmn=of owncr RGTmuble in Charm of�Ccnstructon E ,�.'.' ��"�i N" '*? ,?',d^f..ly '' s` x �n J✓ 9 ,.s � ✓�a' �y>�N _7 v: v r ,,:� )t - �->� � ������ aa�� � "r�✓ � ���/'�'��'�..n:,r,�r-w; -.:.,�..�'as r y < x ��,� �rri '.. a.. «� a 'b, „,si ' x° "v: sti s�-✓ ����"h;�:�'r'".✓�v,r- .,rF.. "', rvy:v r ,,° .r ?:� 1r.?" t".yF. trnn� �l��xx. sa`6 CONSTRUCTION CONTROL AFFIDAVIT li PROJECT NUMBER: Lab USA: Suite G I PROJECT LOCATION: 203 Turnpike Street NAME OF BUILDING: North Andover Office Park SCOPE OF PROJECT: Interior Office Build Out. 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 Architectural X 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 tine 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 of the Massachusetts Building Code CMR 7"'Edition: I. 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 116.2.2,1 shall submit periodically,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, Joseph D. LaGrassc,AIA y No, 153 AND®V1rRER.� _ MA nature of Archit ct/ ngineer Date �g1rH OF h�PSSP Offices One Elin Square T 978.470.3675 Andover,MA 01810 F 978.470.3670 1420 Celebration 131vd. www.lagrassearchitectsxonr Celebration,FL 34747 AA26001333 Commonwealth of Massachusetts 011-16,11 [::'e 011k FPermil No. 'AV Department of Fire Services n Occupancy and Fee Chd/cked 6za BOARD OF FIRE PREVENTION REGULATIONS i[Rev. 9,05] cleave hkrirk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail %l ork to he peribi-med in accordance"ith the Nlass"'IcIlt[Sk!US CICOICLII COdt!(\JEC).52"7('-'VIR 12.00 1/1 LE.ISE PRINT 1.,V1,N'K oR TYPE ALL LVF0R,111T1oV) Date: — City or Town of: To the bl'yeour ollvires., By this application the undergli Y11 Id Ives notice of r her intention 9�� e-fjlis 0 to.perrol-Ill the elec(rical Nk-ork described below, Location (Street& Number) 76' Ll L/ Owner or Tenant � Ilt ............... Telephone No, Owner's Address e 3, S 7� Is this perinit in mijunction with a building perinit? ❑Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Anips Volts Overhead E] UndgrdE] No. or Meters New Service Amps Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion Z c11,je intiv be wai ved/n,the lospector 0/')Vil-c-A No.of Recessed Luminaires No. of-Ceii.-Susp.(Paddle).Faas No. of Total Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA -TVFo—yer- -N'0- 6 g 17 mergenZy.Eihiling No.of Luminaires Swimming Pont rnd. El g1lil i i d El Battery Units No.of Receptacle Outlets No. of Oil Burners TIRE ALARMS. No,ofZones No.of Switches No. of Gas Burners o. of Detection and Initiating Devices al No.of Ranges No. of Air Cond, Tons No. of Alerting Devices Na.of Waste Disposers Hen No. of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW LnealEl rvltllllc'pt-;" 11 Other C()flnec loll No.of Dryers Heating Appliances KW Security Systelns:* No,or Devices or Equivalent No.of Water No. of No. of Heaters KW Data Wiring: Ballasts --No.of Devices or Equivalent No. Hydrornassage Bathtubs' 'relcco�mtnunlcations Wiring: No.of Motors Total [IV No.of Devices or Equivalent OTHER: fletailifelesirud, or as Wirt:,. 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. INSURANCE COVERAGE: Unless waived by the owner, no permit ror the Perfbi-niance LA'clectricni tivork 111ay issue (1111es!; the licensee pm ides prooforliabilitv insurance illclmbng"complQted operation-covers c 01' its substantial CLILdIvILIVIII. 'I'lle undersigned certifies thUt such COvCrcwc is in lorcv,and has exhibited prool'orsame to the Permit i-malin, offlec. .Cl-IFECKONF: INSURANCI� [I BOND El orffl,"R 0 tspeciPY:) eer1?1j,, imder the milis attelpeitattlev ofpqjury,Ifiat the hilb"I"OH011 oll thiv eiplWeeithm A bete mi(lemnplefe, F111NI NAME: A/-L LIC. NO.;---- Licensee: ff'd-!; ]N 0.: g 11, �Z-a . LiC. e 3 L-Phl, Bus.Tel, No.,v"1Tjap(..in t/w li"-(Ilse number ihiv.j Address: F�?,4"e'eZz- '5'T IV-a7l1c'.0"e. Alt. Tel, No.-� {Security System Contrinctor License N(lt.lircd for this work; il'applicable,enter the HWISC number here. OWN F-R'S INSURANCE WAIVER: law aw,,iru that the Licensee does not ijuve the liability insurance covQra-, e m—)rmafly required bylulu. By my signature below, I hereby wak"e this reLlUirCiftnt. I rrin the (check one}❑ovvncr [] owner's rent. Ow.ner/Agent :Agilature Tckphont i'lo. PF-R,WT.FFE.- Sa;? MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location Date Permit# -3,,,� OwnerW') Amount NOW Renovation Replacement Plans Submitted Yes No FIXTURES SLRMW MFLOM 2M Him 3MMOM Hit 5MMOM 6THROM 71H EUXR (Print or type) Installing Company Name_LLLLI.q,�,',�16,� Check one: Certificate Corp, Address U-7JI, Partner, Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Co - indicate the type insurance verage. Of coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond n h28—UT211ceWaiver: 1,the undersigned,have been made aware that tile ❑ licensee of this three insurance application does not have any one or the above Signature ❑ Owner Agent I hereby certify that all of the details and information I have's4brnitted(or entered)in above application are true and accurate t th best of my knowledge and that all plumbing work and'nst8lldtiOns Performed under Permit a 0 e compliance with all pertinent provisions of the Masswhusbiit' Issued for this application will be in ts State Plumbin$code and C Ipter 142 Of the General Laws, By: e., ?T --Signa 0 1 censedrju tv Title TYPO of Plumbing License City/Town 6 I APPROVED tare us)3 oNLy Cicense Numurr— Master r—n.' Journeyman U 71 The Commonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations 600 Washington Street Boston, MA-02111 www.mass.gov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address:."., City/State/Zip:. �,-t ��1, i_ r: ' ,.. Phone Are you an employer? Cheep the appropriate box: Type of project(required): 1.❑ I arm a employer with 4. ❑ I am a general contractor and I [] 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. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor in an capacity. workers' comp. insurance. y p ty 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required,] officers have"exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.❑'Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] fi employees. [No workers' 13.❑ Other comp. insurance required.] ;Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. YContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,Policy #or Self-ins. Lic.#: Expiration Date: F 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 ofMOL 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. I do hereby certify,tknder"-%the pains and penalties of perjury that the information provided above is true and correct, Signafore: ra'./( L: f i Date .. ' Phone#: 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: i PT1f AL s S1{ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOV ER Building Permit Number _431 (121712009L., _ Dater Aril 20, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 203 Turn ice St MAY BE OCCUPIED AS Medical Office ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY, Cerfilicate Issued to: Lab USA INC 203 Turnpike Street North Andover Ma 01845 Building Inspector r FORTH 0 " ofr gAndover . O �. -rtr'.+q!-i Mew No. 1411 C% �AK dover, Mass., 12 COCHICHEWICK V'G, 7�A��RTED S E BOARD OF HEALTH Food/Kitchen PERMIT T DSeptic System _ BUILDING INSPECTOR THIS CERTIFIES THAT LAP'...aS N - ?0C• VVtV kAVhN�t �C�a�..• _ ...............................•----------.-- ----.......... .................. . - 71" nhas permission to erect.......................... buildings on 2 :1L�,c.re&!57 C �� 1r - I�ouglr ? ........... ....... ...... ...... .... .................. -......-... s l� _"�--1 Chimney to be occupied as.... Vt..�J. -a.07.......... .: ........ �a................................... `� provided that the person accepting this permit shall in every respect conform to the terms of the application on file in p p P 9 p y � 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. --<, L iNG PECTO VIOLATION of the Zoning or Building Regulations Voids this Permit. Roug �L Z 3 f a U r lowPERMIT EXPIRES IN 6 MONTHS E cA_i.INSP cro -� UNLESS CONSTRU O STARS oug ....... .............................I.......................... ..` ....................... Service Q BUILDING INSPECTOR Occupancy. Permit Required to Occupy Building GAS PECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTNI Until Inspected and Approved by the Building Inspector. Burner7 F Street No. � SEE REVERSE SIDE Smoke Det- / a r r rchxtc � �rlll � l� a y � ARCHITECT'S CONSTRUCTION COMPLETION AFFIDAVIT Project Name: Lab USA,Inc. Project Location: 203 Turnpike Street. No.Andover MA Name of Buildings: North Andover Office Park Architects Project No: 2241 Nature of Project: Interior space planning& build out for service use In accordance with Section 116 of the Massachusetts State Building Code,780 CMR-6",Edition 1, Joseph d LaGrasse,AIA Registration No.4I53 _ Being a Registered Professional Architect hereby certify that I have provided construction observation services on behalf of the owner,that I was 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 airy knowledge, information,and belief,the work of; ❑ Interior floors, wails, & ceiling construction work have been satisfactorily completed in accordance with the Construction documents, © A list of items to be completed or corrected is listed below or attached on a separate sheet. Items not listed that are part of the construction documents remain the responsibility of the contractor to complete in accordance with the construction documents: 1. Plumbing,gas,water,&electric requirements require sign off approvals from town inspectors. 2. X-ray equipment installation(separate permit) XA� Name Jos t D.LaGrasse&Associates,Inc. ED Date No.4153 `n AND MAEtt. qt?n Of b1ASS� One Elan Square T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978,470.3670 Celebration,FL 34747 AA26001333 www lagrassearclutects.corn Commonwealth of Massachusetts Official Use only NEW Department of Fire Services Permit No, 17 ! 0 UV BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev, 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME-C),527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date; ( Z_ City or Town of: NORTH ANDOVER To the Inspector a Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �j i ,t U �-7 1 Owner or Tenant LIAq2, %.AA, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps ! Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion of the linng table may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of Ceil.-Susp. (Paddle)Fans °• Of Total Transformers KVA, No.of Lumfnaire Outlets No, of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency ig ng rnd. rnd. Batter Units No.of Receptacle Outlets No,of Oil Burners FIRE ALARMS No. of pones No.of Switches No.of Gas Burners No. of Detection and InitiatingDevices No,of Ranges No.of Air Cond, TonaTotal No. of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No. of Self- ontained Totals; ..........,..................................................... Detection/Alertin r,Devices No.of Dishwashers Space/Area Heating KW Local n Municipal Connection Other No.of Dryers Heating Appliances , Security Systems:* No.of Water a, of No.of Devices or E uivalent a.of c Heaters KW Signs Ballasts Data Wiring: No.of Devices or t+ uivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: OTHER: No,of Devices or E uivalent ` .Attach additional detail if desired, or as required by the Inspector of Wires. 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. 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the ants and penalties of perjury, that the information on this application is tr a and complete. FIRM NAME: &*AIV14`Ty t,J� r Lr C-Td2-t LIC. NO.: "� ( } Licensee: �� tr Signature- LIC.NO.: ZI (Ifopplicable enter "exempt"in the license number line.) Bus.Tel 2.1 Address: �,D 5� �c./�cxt/ { y 5 *Per M.G.L c. 147,s, 57-61,security work requires Department of Public Safety"S"License: Alt L cl.No OWNER'S INSURANCE WAIVER: I 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 Signature Telephone No. PERMIT FEE: $ r`� I k I LabUSA,In-c. To Whom It May Concern: Lab USA has main location is at 108R Merrimack Street, Haverhill, MA 01830. Lab USA will have blood collection center at 203 Turnpike Street, Unit G-1, North Andover, MA 01845 and will rent rest of the space for doctor's offices. Any question does not hesitate to call me. Sincerely, December 7, 2009 Mohammad F. Afreedi President/CEO 108R Merrimack Street ® Haverhill,IAA 01930 Tel. 978,556.0533 e Fax: 978.556.0534 - 'roll free: 1,866,522.8724 E-mail: blood@labusai)ic.com TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date issued: IMPORTANT:Applicant must complete all items on this page LOCATION CJ?i P/ S / 7/ Prinf . PROPERTY OWNER :Print PARCEL; ZONING DISTRICT:lHistaric-District yes o ;Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial / Alteration ✓ No. of units: Commercial V/ Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Flood plain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: l U YLL z1YE-7—A-e .57&A-5 -R—r- o L'6�lL i J45 , 1XV r4-L C Ter f 24/N% &AJI Identification Please Type or Print Clearly) OWNER: Name: Phone: �' y�5�s7 Address: 11 W-4 Ly MC—THU a1J M A D s CONTRACTOR Name; Z�Hti1 I IZ�} CwP�v Phone, Address: Supervisor's Ccinstruction License Exp Date: l 1 G' Home Improvement License: I `7 ' Exp, Date: ARCH ITECTIENGINEER '7a5 t Lei-60` .GE -AIAPhone: q'7X 70 T3 75 Address: cwF z�I-M AlA&MOVEA 84 Reg. No.� 0'/1?/0 FEE SCHEDULE:BUL.DING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y FEE: $ _ 4� �^ . Check No.: Receipt No.: NOTE: Persons contracting with I11114qui stered contractors do rant have access to the guaranty fund Signature ofAgent/Owner Signature of contractor, .Ir 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:.Building Permit Revised 2008 NORTH TO" Of over 0 No. *Y s = dover, Mass., f -�► `� �1,q A°"?grev p '�2 S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System 'A BUILDING INSPECTOR THIS CERTIFIES THAT �---�� Os lOL I/Ula kwvkr�+-.c r.... ... --'--. ........................................................... .................. .... Foundation has permission to erect........................................ buildings on .....T LJ •����'�`........ - .-...��4- Rough to be occupied as.... v!.. [ ._a-�l' .......... ..�-----°� �! ............................................. ..--------------.---------- =--- Chimney c provided that the person accepting this permit shall.m 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. r Rough Final 7^ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Gx UNLESS CONSTRU As--e... TARTS Rough ............................................ . .... ....................... Service 3 Q BUILDING INSPECTOR Final Occupancy Permit .Required to Om,(py 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 Der. j i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A tion Please Print Legibiy ._. I_ ,,_. Name(Business/Organizationllndividual): / Cl101C'e= Address: _ UGSyr' �yv .tti� , City/State/Zip: 0,fl&L.5FA IV4 0213-V Phone M 4 /7 AYI an employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. El am a general contractor and I 6. ❑ ew construction mployees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet. I 7 Remodeling ship and have no employees These sub-contractors have $. [4Demolition 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.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' camp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp,insurance required.] 13 ❑ Other *Amy applicant that checks box#1 must also fill out the section below shoving 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. tam an employer that isproviding workers'compensation insurance for rtty employees .Below is thepolicy andjob site information, Insurance Company Name: Policy#or Self-ins, Lic.M Expiration Date: i 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 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. I do hereby certrfy and r fire pants aitd pen aldes f perjuol�that the information provided above is true and correct Si mature: C� " +��,. >✓ct�� .'� Date: Phone#: �` ��7 G 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.Other Contact Person: Phone##: