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HomeMy WebLinkAboutBuilding Permit #566 - Suite 209 4/29/2009 BUILDING PERMIT OpoRrM �tt`'eD TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION * ,� +� G Permit NO: Date Received '114°�gwreo'°'y4`� �SSACHus�� Date Issued: �L2 k IM ORTANT: Applicant must complete all items on this page LOCATION 5"/ i r r� c <S - .t�Ci/ � Print _ PROPERTY OWNER_ ac, LZ(—' Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesn , Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFO MED: D ou S c.s 's-/' Identification Please tType or Print Clearly) OWNER: Name: ��Ji>7��®� ZV/aJ4,,421 Phone:/79/) %3z-g. 0a Address: Ale, o1J'ti /8 CONTRACTOR NameG `FPhone: Address: /� Js�I -aAs4Z1 dJy� cd f Supervisor's Construction License: l/5� Exp. Date:/ /'v di Home Improvement License: Exp. Date- ARCH ITECT/ENG IN EER ate:ARCHITECT/ENGINEER Phone:/k� 4-;d- 3-4g::} Address: 4 /&Ac� � , 1� � &# - O'5®x Reg. No. 77,;?8 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$100 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /!z KO® FEE: $ 02� Check No.: f 3 Z-- Receipt No.: 01 0 NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner Signature of contractF Location��� Dy` - < No. Date v f 1 NORTp TOWN OF NORTH ANDOVER 3�Oi�•�•o ' ,�00 F ' Certificate of Occupancy $ Building/Frame Permit Fee $ � '� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 S~ Check # 2 9 9 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS 0 CONSERVATION Reviewed on Signature COMMENTS �v HEALTH Reviewed on Signature COMMENTS D a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/si nature& Date Driveway Permit 9 V DPW Town Engineer: Signature: Located 384 Osgood Street �( FIRE DEPARTMENT Temp Dumpster on site yes no 1 Located at 124 Main Street Fire Department signature/date COMMENTS 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 ovu ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o . Building Permit Application L3 Workers Comp Affidavit . o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan L3 Workers Comp Affidavit E3 Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) r @ Building Permit Application ^F*���^�-Proposed P Ian ❑ Photo of H.I.C. An C.S. Licenses o Workers Comp Affidavl �'❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) dnci 70 Copy of Contract Li Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 ron i CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 566-2011 Date: May 3, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 451 Andover Street Suite 209 North'Andover. MA01845 Foot Health.Center of Merrimack Valley PC MAY BE OCCUPIED AS tenant:ft-un doctors office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued too. NADP, CIC (North.Andover Office Park) ` 451 Andover Street North Andover,MA 01845 Building Inspector. Fee: 100.00 previously paid Receipt: 21979 c NORT►.r.q Town of d 0 No. O �- LA o dover, Mass., COC HICMEWICK ORATED OPat�� BOARD OF HEALTH Food/Kitchen ,PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �.�� .-�JLJ O�f.�^ ,� s�G>�"7f �:' Foundation r , has permission to erect........................................ buildings on .......:......... ....... .. .................... :........................:. .... Rough to be occupied as. _ ..... ...........0 chi .... CSG..Q ....�"i .....4hi .......provided that the person accepting this permit shallin every respect conform o terms of the application on file in inat b 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 INSPP CCTTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Finald l ; /rN�— PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS ...........,c..... �`�................................................. Service r BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done F E DEPARTMENT ;. F Until Inspected and Approved by the Building Inspector. Burne ��� Street No. IFSEE REVERSE SIDE - Smoke Det. d ":�. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL ss�cwM r PROJECT NUMBER: la2l PROJECT TITLE: GIJ1 �LI ^I `l PROJECT LOCATION:4EI AN,MeW, 0r, :6) �i � NAME OF BUILDING: NATURE OF PROJECT: QRL� ,,JAY:_�GA~W ►1J Oft IN ACCOR ANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL R/STRUCTURAL 0 MECHANICAL 0 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 ASTHE THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR UP SIGNATU E SUBSCRIBED AND SWORN TO BEFORE ME THIS7_ DAY OF00� NOTARY PUBLIC GLORIA SM/"/Zt SMAS N01'3glViigOO - COMMONWEALT{ OF MASSACHUSETTS A�HtlO H ON MNOWW09 MY COMMISSION EXPIRES 12/04/2009 A311311 'V VIH019 OP ID MA ACORD DATE(MMIDDIYYYY)CERTIFICATE OF LIABILITY INSURANCE STRAT-1 04/22/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles F. Murphy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Storrs Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Braintree MA 02184 Phone: 781-380-0599 Fax:781-380-0686 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Granite State insurance Co. INSURER B: Western World Ins. Company 13196 Stratford Associates, Inc. Mr. John O'Dea INSURER C: One Standish Way INSURER D: Canton MA 02021 INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 $ X COMMERCIAL GENERAL LIABILITY NPP1202724 12/31/08 12/31/09 PREMISES(Ea occurence) $50,000 CLAIMS MADE Fx—]OCCUR MED EXP(Any one person) $1000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY PECOT LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED ALTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ANDTORY LIMITS ER A EMPLOYERS'LIABILITY WC002252385 08/10/08 08/10/09 E.L.EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER CANCELLATION TWNmmo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 451 Andover St. , Suite 305 North Andover MA 01845 REPRESENTATIVES. AUTHO REP SE ATIVE \_ etXtjL ACORD 25(2001108) �/}j ©ACORD CORPORATION 1988 O ❑. C,ann 0 ASSOCIATES 1 Standish Way,Canton,Massachusetts 02021 •Tel(781)828-3797•Fax(781)828-9868 ': Date: 4/10/09 Description of Work: "Specimen Collection" as per Caldarola Design Project Location: Suite 305, N. Andover Status: Budget Quantity Description Unit Price Total Amount 280 sq.ft. remove glued down carpet $3 $840 280 sq.ft. skim coat floor $3 $840 280 sq.ft. Armstrong Excelon VCT $5.25 $1,470 4 ea. clean and rebulb existing 2x4 light fixtures $60 $240 1 ea. recessed fluorescent down light $250 $250 2 ea. tel/data drops (back box and string only) $80 $160 3 ea. duplex receptacle $125 $375 1 I.S. paint walls and trim $1,450 $1,450 10 In.ft. cubicle track and curtain $55 $550 48 m.h. miscellaneous carpentry $65 $3,120 prep and patch for plumbing and electrical work install modular partition (from 620 inventory) install missing entry door stop clean entry door side lite glass install casework install owner furnished equipment 6 In.ft. base, counter and upper cabinet w/sink $350 $2,100 4 In.ft. counter only w/grommets $55 $220 Page 1 of 2 Quantity Description Unit Price Total Amount 20 m.h. supervision $90 $1,800 1 I.S. off hour work allowance $1,000 $1,000 8% overhead and profit $1,153 Total $15,600 Option #1 sink and added counter 11.s. plumbing $2,600 $2,600 21n.ft. casework $350 $700 1 I.S. concrete coring for plumbing $400 $400 8% overhead and profit $296 Total $4,000 Proposal including Option#1 accepted by: Date: '0� Robby Robertson, Director Facility Services Winchester Hospital Page 2 of 2 s� The Commonwealth ofMassachuset& Department o j1Jl P Industrial IK 1 lYi� .f Accidents. Office Of Investigations i �i6T 600 Washington Street Boston 02111 r�' wwrv_mass.got�/din Workers' Compensation Insurance.Affiday..it: guilders/Contraactors/Eieetre Anciacts/Piumbers Iica.nt Information Please Prinf Legibly Name (Business/Organization/Individual): a di Address: Ci /State/Zi. t3' P d94!9 Phone rAre you an employer?Check the appropriate_bow; I an. a employer with 4. I am a o� Type of project(required): beneral contractor and Iemployees(Hill and/or part-time).* have hired the sub-contractors 6• ❑ New construction .❑ 1 am a sole proprietor or partner_ Iisted on the attached sheet 1 ?• remodeling. ship and have no employees These sul�contractors have working for me in any capacity. workers' comp. instuance. g' ❑ Demolition (No workers' comp. insurance 5..❑ We area corporation and its 9' ❑ Building addition 3.❑ required.] officers have exercised-their 10:❑Electrical repairs or additions 1 an a homeowner doing all work right of exemption per MGL 1 l.[] Plumbing repairs or additions Myself [No workers' comp, c. 152, §1(4), and we have no insurance required.] t employees. o. 11D Roof repairs workers'� wo y comp, insurance required_] 13•❑ Other ------------------- *Any applicant.that checks box#1.must also fill out the section below showingthe' i H0,M owoers who subtnii.alis affidev' - _ their workers'compensation policy tt«idicatttt�tice}era,de,in�e6;s.�;.rL: P a} mrormation. xConvactors ihaf check this box must attached an additional sheet showing the a ftp ustne euntrr�eiors mus[su'mnii a new amaavit ireimung such. ctractors and their workers'com t art ar employer that is providing workers'co errsation i p•policy iniannafion. in or"Maom assurance for nT emplo ees. Below ' f Y is the ofi and' Si L_ � ob srte J Insurance Company Name: Policy#or Self.ins. Lic. Expiration Date: S /� Job Site Address: 34 Ci ty/state/Zi : /L Attach a copyof the work ' P workers, compensation policy declaration page(showing the policy number and expi e) .Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition fine up to$1,500.00 and/or one-year imprisonment p on of criminal y rmprisonm..nt,as well as civil penalties in Penalties of a of u to.550.0 P the form of a ST r p 0 a da against WORI. - 3 � the violator. BeB.,advised ORDER and a vrsed that a co fine Investigations of.the DIA for ' A PY of this statement may be forwarded to insurance covers „verification. the Ofizce of g cation. do herekp ce under thesins and penalties of peljurj, that the information provided above is true and correct SiPnatur Date PhD #: 4-12) Official use only. Do not write inthis area, to be cnmp L eted by city or town off ccaL Cit} or'town: PermitlL,icense;r Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PiumbiRg Inspector 6.Other Contact Person: Phone; V40RT#-j TO" of over No.S6 4 dover, Mass., 0 LAKE Ij, COCHICHEWICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......WO. .W �....... �... . *q a- ............................................................. Foundation has permission to erect ..... buildings on ...................... Rough Chimney to be occupied as.........A ......./Q.� ..��..� YI........b. Ad.....O..��......................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES N 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONS NU..XON S ARTS Rough ............................................ Service ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place an the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ALSDnRO DESIGN E E arch it.et in u re ® nlerior design 4 birch street E Berry,new hsmpshlre � � oaoae RELOCATE El rel: moa>sax-e4w LIGHT lex 103143x-1- EP L -----� T � O ■ �^/ wwwnsTr¢ IIIVVVVVV HOSI'1'fAl, 41 Highland Avenue Winchester,MA 01890 E T T E ■ Specimen Collection 451 Andover Street Smte 305 North Andover,MA 01845 EXISTNG CONDITIONS E DEMO PLANS EXISTING/DENO EXISTING/DENO FLOOR PLAN REFLECTED CEILING PLAN ��oT�� NOTE: NOTE: N.7728 1. REMOVE EXISTING CARPET 1. EXISTING CEILING TO REMAIN LO NHE EP EXISTING ELECTRICAL PANEL ® EXISTING SMOKE DETECTOR ''a( •'tr EXISTING LIGHT SNITCH OQ EXISTING SPEAKER 0 �E EXISTING ELECTRIC OUTLET ogre,4/8/09 7T SCALE;1/T=1'-O' EXISTING TELEPHONE JACK EXISTING 2'%4'CEILING TILE h GRID PROJECT o: 1509 DRAWING N0. EXISRNG Gm.DD. CALLED NORTH Al O O SUITE InEINTRRANCE 1 �14 ALDSAROLA DESIGN ��� E E ... lure WALL MOUNTED TUBE RACK&GLOVE BOX iNt°ri°`d°°iy" OFCI T HIGH MODULAR S RELOCATED PARTITION BLOOD DRAW LIGHT 4 blwh street OFCI E APPROX. 8'-1" X 5'-4" deny.xe°he"pshlre (ATTACH WITT COLUMN H �7 ra:iro3i 4ss-eso4 CONT.METAL ORI_Ir xgll ALTERNATE NO.1: ❑" r^.-.cos.»z-z,w WOOD ANGLE) EP �sl, PROVIDE NEW ST.STEEL 15°X 15" HANDWASHING SINK&EXTEND COUNTERTOP ■ oo_ _ 2'q4'COUNTER �I W/CABINET ABOVE IWAITING i U.S�J BY ODESK / -- -- OWNER wmcrtes7'nx UNDER COUNTER BY REFRIGERATOR ttosrtTa� ❑ BY OWNER 91 Highland Avenue �Lh�J Winchester.MA 0 0 01890 TABLE E T �� (TBD) E (TBO) - ■ EXISTING - HEAT/AC UNIT $peahen Collecton 451 Andover Street Swte 305 North Andover,NA 01845 NEW 6^DIA. NEW PLAN NEW P.LAM COUNTER RECESSED FLUORESCENT NEW REFLECTED CENTRIFUGE (HEIGHT TBD) LIGHT FlXTURE(CONNECT CEILING PLAN BY OWNER E TO EXISTING LIGHT SWITCH) /' J� ACTION/REVISIONS: NEW FLOOR PLAN NET REFLECTED CEILING PLAN ��RED ARC �`� V C yT 7oi�'e� �O� O��—t NOTE: 1. PROVIDE NEW ARMSTRONG STANDARD EXCELON VCT. NEW CUBICLE CURTAIN&TRACK(BY OWNER) No.nzR 2. PAINT EXISTING WOOD BASE 2 COATS SEMI—GLOSS LATEX PAINT (COLOR A). 3. PAINT WALLS 2 COATS EG—SHEL LATEX PAINT (COLOR B). OF ^S0 SPG Q NEW HAND SANIBZER DISPENSER BY OWNER DATE;q/B/09 NEW CUBICLE CURTAIN&TRACK BY OWNER scAts:I/4•=1'-0^ NEW TEL/DATA OUTLET(GC PROVIDE BACK BOX) eRwecT.: 1509 oRAwwc xo. NEW DUPLEX RECEPTACLE AT COUNTER HEIGHT NEW DUPLEX RECEPTACLE AT 18°AT A101 CALLED NORTH ALDAROLA DESIGN e — earro. nle a design E birch hem>smrc F-1 El r,r nmr c.z�oa L—LIGHT —J EP T" 91 Highland Avenue Wmdester.MA 01890 E i T Specimen Collecion 951 Andover street Suite 305 No-!h AndoverMA 0I895 EXi3TNG CONDITIONS E DEMO PLANS IC1101-111-11o EXISTING/DEMO EXISTING/DENO FLOOR PLAN REFLECTED CEILING PLAN = NOTE: NOTE: 1. REMOVE EXISTING CARPET 1. EXISTING CEILING TO REMAIN EP EXISTING ELECTRICAL PANEL EXISTING SMOKE DETECTOR 1 EXISTING LIGHT SWITCH OO EXISTING SPEAKER �E EXISTING ELECTRIC OUTLET T , a• EXISTING TELEPHONE JACK EXISTING 2'X 4'CEILING TILE A!GRID Peoeeer I509 a o—o�o EXISTING GYP.BID. CALLED NORTH A100 SUITE ENTRANCE - � P.LDAROLA DESIGN ,' I� � I E E -- ar rniieo lure ii WALL MOUNTED TUBE 1 / /�/- , in leri o,design /y(\ RACK&GLOVE BOX �� OFCI 7'HIGH MODULAR \�T BLOOD DRAW S RELOJ ATED PARTITION _ OFCI E ` APPROX. 8.-8" X 5'-4" Berry��ewnamP.m`e (ATTACH TO COLUMN WITH -- CONT.METAL OR -��� - ❑" b .oa,�..-xroa a e,aao< o=e�� PROVIDE NEW ST.STEEL 15"X 15" 15WOOD ANGLE) IEP HANDWASHING SINK&EXTEND COUNTERTOP -------_--- �x CO 2'4'COUNTER --- C� W/CABINET ABOVE 1 WAITING —--- - �- 30%60 DESK p c ®Y/ or.�s�aatio-:h BY OWNER —REFRIGERATOR COUNTER _nusu REFRIGERATOR BY OWNER 11 Hghland Avven;w ue Wnchester,MA F^ 01890 �U P F C .----TABLE E T (TBD) E (TED) EXISPNG - HEAT/AC UNIT 8penmen Collection - 551 Andover Street Sane 305 North Andover,MA 01855 NEW 6'DIA. NEW PLAN RECESSED FLUORESCENT NEW REFLECT=_D �---NEW P.LAM COUNTER UGHT FIXTURE CONNECT CEILING PLAN BYNOMNERE- E (HEIGHT TBD) TO EXISTING LICHT SWITCH) NEW FLOOR PLAN NFUJ 2FFLECTFD CEILING PLAN NOTE: 1. PROVIDE NEW ARMSTRONG STANDARD EXCELON VCT. NEW CUBICLE CURTAIN&TRACK(BY OWNER) t 2. PAINT EXISTING WOOD BASE 2 COATS SEMI-GLOSS LATEX PAINT (COLOR A). 3. PAINT WALLS 2 COATS EC-SHEL LATEX PAINT (COLOR B). Q NEW HAND SANITIZER DISPENSER BY OWNER CATE:4/_8/09 NEW CUBICLE CURTAIN&TRACK BY OMNER 1/4•=I'-O" NEW TEL/DATA OUTLET(GC PROVIDE BACK BOX) ozn ao 1509 NEW DUPLEX RECEPTACLE AT COUNTER HEIGHT /� N� NEW DUPLEX RECEPTACLE AT 18'AFF CALLED NORI H n101 Date. 6. 88u2 TOWN OF NORTH ANDOVER PERMIT FOR PLUM6,ING �.� SSACMUSE� 4 This certifies that (4. . . . . .I�� . . . . . . . . . . has permission to perform plumbing in the buildings of . . .��.5 cf .`'. . .D-. .�.L at . . .�7 /!./���. . h-�. .(-. r`. . . . . . . 2.).5. -North Andover, Mass. 2?y Fee. v. .+ Lic. No..!.?. .. . . . . . . .. . . . . . !` �.. . . . . . . PLUMBING INSPECTOR Check ." �~�3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: N��� YlG(, - , MA. Date: Permit# Building Location: Ltylc�ot�t Owners Name: Type of Occupancy: Commercial Q�Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ Alteration: ❑ Renovation: Q� Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES z z U) O `1 V W Z N J = IN W rn a z Y Q v w . 0 W � Z w Q' Z Q' to _Z IQ- N Q U) Z = •� 0 W x W M w 0 ~ w cn Y N -j a X Cho O V) w p H Z >- Z U) to C9 0 n. u_ Q O o w Q X = O 0 H S = Z a LL a . Y Q x W w W . u_ 0 x Y rn m I— , 3 O G> ViUB BSMT. BASEMENT FLOOR 2Nu FLOOR l 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR L/ Check One Only Certificate# Installing Company Name: ���� 4 9�� ��m w _�_ � Q 'M El Corporation Address: "- A1'% City/Town: L State: l/ '�. ❑ � !�Z 2�L��s"� 3S 3 Partnership Business Tel: Fax: t' Firm/Company Name of Licensed Plumber: oe. ao INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes No❑ If you have checked Yes,please infl ate the type of coverage by checking the appropriate box below. A liabilityinsurance policy Other a of indemni ❑ Bond ❑ Y type indemnity OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap 4 o General Laws. By Type of License: Title ❑ umber Signa ure f Licensed Plumber Cityrrown Master /�-7 � APPROVED OFFICE USE ONLY) ❑Journeyman License Number' L 9656 9 2.-/- ice Date... .......................... y t NORTI�, 3:;•_t;�``° "�,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUSEt This certifies that �-1-.E�� �� S ... ......................................�.-�..................... has permission to perform ........... 1.O.a.............................. ................ wiring in the building of .... ......... sw ................... ...... at Lj,:5-/...4^11—kPl.!eA....5.T....................... orth Andover,Mass. ( I15S3. .: .. � = Fee.. . -s.......... Lic.No............ t .p tEIiE-c/-rRICAL INSPECTOR ` Check # t o 2?2-- / a.wnr"v IMtra Geo Uff Q - Permit No. Department of Fire Services Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION( FOR PERMIT TO PERFORIN( (ELECTRICAL. WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),521 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 11)ate: City or Town of. IST®R-`g'H ANDOV ER To the Inspec >^of Wires: By this application the undersigned gives notice of his or her intention to perform thi electric work d scribe elow. Location(Street&Number) '-1 �-� Owner or Tenant C, Telephone No. Owner's Address Is this permit in conjuncts building permit? -Yes No 11 (Check Appropriate Box) Purpose of Building c44771C_jc;2— 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 • Locati n and Nature of Proposed Electrical Work: Co e ` e M O 'HT1` CD y Completion of the following table may be waived by the Inspector of Wires No.of Ceil.-Sus (Paddle)Fans of Total No.of Recessed Luminaires N P (P Tr- Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA In- o.o 5 ij: cy ig mg Swimming Pool Above ❑ ❑ No.of Luminaires g rnd. rnd. Satter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiatin Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons g Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/AlertingDevices Municipal El Other No. of Dishwashers Space/Area Heating KW Local❑ Connection Heating Appliances Key Security Systems:* 1 No. of Dryers g pp No.of Devices or Equivalent No.of Water No.of .-No. A Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent .` Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: -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: ':� 2p t(7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO A RGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability msur including"completed operation"coveragee or its substantial equivalent. The undersigned certifies that such cover is in'force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the sins a penalties ofperjury,that the information on this application is true and cora to FIRM NAMI: l �( � pp LIC.NO.: Licensee law(N �\t �erD, Signatu�ez 01C-.. LIC.NO.: (If applicable, e xe "in the lice number lineJ_ ��( 0Z Bus.Tel.No.: 17 Address: V` v Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's Owner/Agent PERMIT FEE: $ Signature Telephone No. i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Burin s/Organization/Individual): Address: O City/State/Zip: \ Phone#: C 0\ �o Are you an employer?Chec he appropriate box: Type of project(required): 1. a em to er with 4. ❑ I am a general contractor and I 6. New construction t_J-�'� p y -�� have hired the sub-contractors ❑ employees(full and/or part-time). h v 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# ❑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 10.[:1 Electrical repairs or additions required.] officers have exercised their 3.❑ I 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.]; employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is pr iding workers'compensation insurance for my employees. Below is the policy and job site information. ---r Insurance Company Name: rT" / Policy#or Self-ins.Lie. (_0 Expiration Date: Job Site Address: ` 1 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. Ido Izereb under the pains andpenalties o perjury that the information provided above is true and correct. Si ature. Date: Phone#: Cp 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#: