HomeMy WebLinkAboutBuilding Permit # 7/16/2015 OORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Permit NO: tl
Cate Issued.
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TYPE Oi IMPROVEMENT PROPOSED USE
Residential Non-Residential
1:1 New Building ❑ Cine family
0 Addition U Two or more family 1 Industrial
Alteration No. of units: [ CommercialOthers:
`c" Repair, replacement F_.Asessory Bldg C:vJ
u Demolition o Other
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interior remodel to correct Accessibility issues no change in use or occupancy
Identification Please Type or Kirit Clearly)
OWNER: Name: CVS Caremark,LLC Phone: 401-765-1500
Address. 1 CVS Dr Woonsocket,til 02895
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ARCHITECT/ENGINEER william Starck Phone: 5qs-6'79-s733
Address: 126 Cotte St Fall River, NTA 02720 -Reg, No. 3643 8/31/15
FEE SEWEDULE.BULDING PERMIT.$12.00 pER$1000,00 OF TWE TOTAL ES77MAT D COST BASED ON$125.00 PER S_F.
1.5,658.00 FEE:
192.00
Total Project Cast: �
Check No.: Receipt No.:
NOTE,: Persons cuntraetin it u11regrsered eontractors ria not.have raccess to the gtaa atatv�`'aa�e�
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261�No. of -
�D R�'AKE n verb `C�SS,
coc."C"tw.c,
(A�0RATE D O'Q '(5
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T IT . BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT ........Cd!� .............................................................................................. BUILDING INSPECTOR
has permission to erect buildings ono Foundation
......................... j.0-9....... ttl�l.... '�. ........................
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to be occupied as .......Y. ....... .. . .. ................ .a► � •1.�I..:.... ri�. ....� hi
provided that the person a cepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 ®NT ELECTRICAL INSPECTOR
L I S TS Rough
Service
........ ..... ...... ...................................................... 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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Initial Construction Control Document
W
To be submitted with the building permit application by a
M , d Registered Design Professional
for work per the 81h edition of the
S�1b Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: CVS Accessibility pgrades Store 0209 Date: June 26, 2015
Property Address 109 Main Street,North Andover, MA
Project: Check one or both as applicable: New construction [x] Existing Construction
Project description: Accessibility Upgrades to the Restrooms and customer areas
I William C. Starck MA Registration Number: 3643 Expiration date: 08/31/2015 , 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:
[X]Entire Project [ ] Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [ ] Electrical [ ] Other
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:
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.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(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 c s its
Enter in the space to the right a"wet"or
electronic signature and seal:
ALT►i Of M'
Email: WStarck@starckarchitects.com Phone number: 508-679-5733
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 10 09 2012-Draft modified by AIA MA
r
LEASE
This Lease is made on the Date of Lease specified below, between the Landlord and the Tenant
specified below.
PART I
1. Date of Lease: 2007
2. Landlord name, and state of and type of entity: San Lau Realty Trust
A Massachusetts Trust
FID# 04-3287434
3. Landlord business address: 109-123 Main Street
North Andover, MA 01845
Telephone: (978) 686-8683
4. Landlord notice address: 109-123 Main Street
North Andover, MA 01845
with copy to: Kathy A. Faulk P.C.
790 Turnpike Street, Suite #202
North Andover, MA 01845
5. Tenant name, and state of and type of entity: North Andover CVS, Inc.
a Massachusetts corporation
6. Tenant business address: One CVS Drive
Woonsocket, RI 02895
Telephone: (401) 765-1500
7. Tenant notice address: One CVS Drive
Woonsocket, RI 02895
Attn: Property Administration
Department, Store No. 209
8. Guarantor: CVS Caremark Corporation,
a Delaware Corporation
One CVS Drive
Woonsocket, RI 02895
9. Shopping Center: that certain lot or parcel of real estate located at 109-123 Main Street,
North Andover, Massachusetts, as outlined in blue on Exhibit A, including the Premises
described in Section 10 below (the location and size of which Premises are outlined in red on
notice within said 20 day period shall be deemed an approval by Landlord of such plans and
specifications. Upon any such approval, the same shall be deemed to be the Final Tenant Plans.
Notwithstanding the foregoing, however, Landlord and Tenant shall cooperate to make any
change in the Final Tenant Plans necessary to obtain the Permits required by applicable Laws.
(b) Tenant agrees that promptly following substantial completion of the Tenant Work,
Tenant will provide to Landlord a copy of the certificate of occupancy for the Premises,
commence occupancy of the Premises and open the same for business. Tenant shall give at least
15 days' prior written notice to Landlord of the date when Tenant estimates that it will substantially
complete the Tenant Work and the date on which it will open the Premises for business. Such
dates shall be confirmed by execution of the Commencement Date Confirmation in the form as
set forth in Exhibil F, which Tenant shall execute and return to Landlord within five (5) days
after receipt thereof. Notwithstanding anything contained herein to the contrary, Tenant will
substantially complete the Tenant Work in a diligent manner and open for business no later than
120 days following delivery of possession of the Premises, and shall fully complete the Tenant
Work within thirty(30)days following the date of substantial completion thereof, subject in each
case to any delays as described in Article 39 hereof.
(c) Tenant shall not make any alterations or additions(collectively,"Alterations')to the
Premises without, in each instance, obtaining Landlord's written consent, which consent may be
withheld in Landlord's sole discretion as to any exterior Alterations, or Alterations which impair
the structural integrity of, or the efficient and proper operation of the utility or operating systems
of, the Premises or Building or would adversely affect the value or utility of the Premises or
Building, and otherwise shall not be unreasonably withheld, delayed or conditioned. However,
Tenant may,withoutIandlord's consent,make non»structural alterations,to the.Prem ses interior;
(d) Tenant shall do all Tenant Work and Tenant Alterations(i)in a good and
workmanlike manner, (ii)in accordance with the Final Tenant Pians,and employing the
materials and finishes and such contractors or mechanics(who shall provide such insurance)as
may be reasonably approved by Landlord,(iii)at its sole cost, and(iv)in accordance with Laws.
Tenant shall coordinate all such Tenant Work and Tenant Alterations so as not to materially
interfere with or adversely affect any work that Landlord is performing on the Shopping Center.
(e) Tenant shall promptly pay all costs of such Tenant Work and Tenant Alterations,
and discharge,within 30 days(by payment or by filing the necessary bond,or otherwise as may be
reasonably satisfactory to Landlord), any mechanics', materialmen's or other lien against the
Shopping Center and/or Landlord's interest therein, which lien may arise out of any payment due
for,or purported to be due for,any labor,services,materials,supplies,or equipment alleged to have
been furnished to or for Tenant in, upon, or about the Premises, or in connection with the Tenant
Work or any Tenant Alterations. Tenant hereby indemnifies, defends and agrees to hold Landlord
harmless from any such liens and claims of lien, and all other liability, claims and demands
arising out of any work done or material supplied to the Premises by or at the request of Tenant
-21-
IN WITNESS WHEREOF, Landlord and Tenant have duly executed this Lease on the
day and year fust above written.
LANDLORD:
San Lau Realty Trust
ATTESTIWITNESS:
BY:
LE: NAMKNAL5�
TITLE:Trustee as aforesaid and not individually
� y ' BY:
TI E: NAME. u
TITLE:Trustee as aforesaid and not individually
TENANT:
ATTEST: North Andover CVS,Inc.
V � r
B
SECRETARY NAME: 8UFt-
ASSISTANT
TITLE: VNM President
CVS LEGAL APPROVAL:
#903414
-60-
ClIx The Commonwealth of Massachusetts
Department of Industrial Aceidents
Office of In vestigations
600 Washington Street
Boston,MA 02111
www.umss gov/dia
Workers' Compensation Insurance Affidavit: uitders/Contracters/Eteetriicians/Plumbers
Applicant information please PrIU Le ibl
$V
Name (Business/Organization/individual): Diamond Contractors Inc
t,ddress: 1615 N. 7 Hwy
city/state/Zip: independence, MO 64056 Phone#; 816-650-9200
FOI
employer?Check the appropriate box: Type of project(requireft
employer with 15 4. ❑ I am a general contractor and 1 6. ❑ New construction
ees(full andtorport-time).* have hired the sub-contractorssale proprietor or partner- listed on the attached sheet.� 7 ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working; for me in any capacity. workers'comp.insurance. 9. [] Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
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'comp, c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' 13.[]Other
comp, insurance required.)
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informution.
*I lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workcrs'comp,police information.
l um an emptoJ,er that isprovidiuk rtrorkers'compensation iresrerance for mit employees. Below is the polity and Job site
information.
Insurance Company Name: 'Lwin City Fire Ins Co
Policy 4 or Self-ins.Lie.9: 37WBQT9238 Expiration Date: 12/09/15
Job Site Address: 109 Main St City/State/zililorth Andover, NIA 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 Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties ora
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I der hereby certify under the Ins and penalties of perjure,that the information provided above is twee and correct.
5i=nature: Date: 5/28/15
Phone#: 816-650-9200
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/Lieense#
Issuing Authority(circle one):
1. Board or health 2.Building Department 3.CityJTowu Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#'
Information
Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire.
express or implied,oral or written,"
An emp4wr is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant orthe
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority:'
Applicants - -
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and. if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required, Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the ap roriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding,the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,NIA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax#6I7-727-7749
www.mass.gov/dia
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor �
License: CS-105576
JOHN M PERRY ,-
1615 N M7 HIGH WAY
INDEPENDENCE M C
a '
Expiration
Commissioner 09/0312015
I