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HomeMy WebLinkAboutBuilding Permit #160 - Suite 300 8/28/2009 NORTH BUILDING PERMIT 0�<11"° 16."�0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION * ; * ° Date Received q°"A*■° Permit NO: �ssAcaus�� Date Issued: f—dot- IMPORTANT:Applicant must complete all items on this page / A0 fOCATION �� t _. PROPERTY OWNER_ /%;I// Pnnt MAP NO: PARCEL: 10 ZONING DISTRICT: Historic District yes no Machine Shap Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential El Residential New Building One family Industrial Two or more family Amerci No. of units: om Alteration Others: Other Repair, replacement eBldg Demolition Otherr Flood l " an s Watershed District Septic Well p Water/Sewer i DESC IPTI OF ORK TO BEPEI!EFORMEq� S n v den ' cation �le�Se ype or Print Clearly) /�332 keV L L Phone: J l`�`� OWNER: Name: Address: CONTRACTOR Name*Pry 4ll erv1' S Phone: — / Address: Supervisor / 's'Construction License c��c.� /�('oyvr q��� Epp. Date:. " Horne Improvement License: Exp. ARCHITECT/EN GINEE C�r%v' C .' f Phone: Address:oat L/ •- 01 flea Reg. No. �7 15 3 FEE SCHEDULE..BULDING PERMIT.$12.00 PER$10on no OF THE TOTAL_ESTIMATED COST BASED ON$125.00 PER S.F. all ' FEE: $ Total Project Cost: ( SCheck No.: J � Receipt NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -- - -- ------- Si na#ure of contracto 1. Signature of Agent/Owner g. Location/ � 92 �Ccd�-i No. Date ��� MORTIy TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ /�GJ Building/Frame Permit Fee $ _s swCHusa Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 00 Check # 22 � 0 `� Building Inspector 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 _J 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 Building Permit Application Workers Comp Affidavit i/ Photo Copy Of H.I.C. And/Or C.S.L. Licenses d Copy of Contract v( Floor Plan Or Proposed Interior Work Z Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ 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 r _ f NOTM (y BAC1dl��t� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 160(8/28/09) Date: October 23. 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 451 Andover St MAY BE OCCUPIED AS Medical Doctor's Office Unit 300 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: NAOP LLC 451 Andover St North Andover MA 01845 Building Inspector NORTH 04dO" over No. _-= A dover, Mass.,- Q CgCHICHEWICK ,9 ADRATED PPS\ �y `S BOARD OF HEALTH PERMIT T. D Food/Kitchen Septic System NA f BUILDING INSPECTOR THIS CERTIFIES THAT / ` A � !n. ...................�........... ... . .............................................. ..................................... .......... C } Foundation has permission to erect........................................ buildings on 7✓...� � C.pt Rough to be occupied as ............................................' Z ' �.1:: :.. . .. `J..fi (. ....l�r.C.. :.. LD:� Chimney rovided that the person............. p p on accepting this permit shall in every respect conform to the terms of he application on file i Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT104 STARTS Rough �S..........................:... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPART Until Inspected and Approved by the Building Inspector. Burner Street No. / bol DD SEE REVERSE SIDLJ - - Smoke Det. r i O e7M P �S • �aaewrs � CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER e Building Permit Number 160(8/28/09) Date: October 23, 2009 THIS CERTIFIES THAT . THE BUILDING LOCATED ON 451 Andover St MAY BE OCCUPIED AS Medical Doctor's Office Unit 300 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: NAOP LLC 451 Andover St North Andover MA 01845 Building Inspector NORTH . 4Andover , TONM of w� dover, Mass.,- LA 7, �1� COCHICHEWICN`y Y ATE D PPP �y .s '9S BOARD OF HEALTH Food/Kitchen PERMIT Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � ............. ....................... ........ . Foundation - C / Z�� g • ... buildings on... t1 rU �°,...J�..... .............�. Rough has permission to erect................ •••.•• •�!<� ��,�•.��..............�.��':..�il�.��'G.�F. ...�i..C..��:..s�.:!`�� Chimney to be occupied as........................... ••••• Final provided that the person accepting this permit shall in every respect conform to the termsAlteration and Construction of this office, and to the provisions of the Codes and By-Laws relating to the Inspection, PLUMBING INSPECTOR Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. � Final PERMIT EXPIRES 11v C MONTHS HS ELECTRICAL INSPECTOR UNLESS CONsmucno4 STARTS Rough ../.°.!0t ........................... Service 007 00 .......�-g BUILDING INSPECTOR Final Occupancy Permit Required to Ocaipy Building GAS INSPECTOR Rough is la in- a Conspicuous Place on the Premises — .Do Not Remove Final Display Y P No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. i Smoke Det. SEE REVERSE SIDE / MASSACHUSETTS UNIFORM APPLICATION FOR PERM _ IT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSE-17S 7�l Ah / Date Building Location uOwners Name Permit# Amount T pe of Occupancy New 0 Renovation �_ Replacement Plans Submitted Yes ❑ No FIXTURES F• � a W W W C W U W U to SLDME lASE"M bTMOOR M ILOCR 41H MOOR sM H-0m 61H tliTi+-" 71H RJDOR 9]H L`LDM 0 (Print or type) ertificate Installing Company Name�l s *a Address h<r c��Sfr,s har Business Telephone ASO APS Ps Q �ti !ja Name of Licenser' �P z �� Ot° A� /QA, Insurance Cove Liability insv the °� °� "Q Insurance three insuran, (9 > � �° °f Z& �Q V , 9Signature - ••� �C I hereby certify that all of ti. best of my knowledge and that� :��. - ne fl compliance with all pertinent proviz�. ' By. Title �Ciys aop, City/Town APPRO VED(oFFICE USE ONLY 09 1y des The CommonWea&k of M=achuseft / j t Department of Industrial Accidents Office of Investigations 600 JT'ashington Street �u Boston, MA 02111 r; wives mas1.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele Actrici$as/Plambers • licant aformation. I —�- Please Print Leeibl Name (Business/organization/Individual): y L' R Address: /iee.�2 Q d�y� City/State/Zip: GHelA2, t.Z J pug- 0 ?Pay Phone#: . F;wOrIkeding youn employer?Cheek;the appropriate box: a employer with 4. ❑ I am a genwal contractor and I T�of prelect(required):oyees(full and/or part-time).* have hired the sub-contractors 6• ❑Now c nstrvction .a.sole proprietor.or partner- listed on the attached sheet 2 7. emodel ng and have no employees These sub-contractors haveing for me.in any capacity. workers' comp.instuance. g' ❑Demoirtionorkers'comp,insurance 5. ❑ We are a corporation and its 9• ❑ Building addition ed.] officers have exercised their i0•❑Electrical repairs or additions . rra homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself[NO-workers'comp. c. 152, §I(4),and we have no insurance u' t 12. Roof repairs �I �]. .employees. [No workers' ❑ comp. hisurance required..] 13•0 Other 'Any applicant that checks bot;a t must also fill out the section beiow showing their wari ed'compensation policy infomtafion. ------ ;Any who sobntit this affidavit indicatin th ale iiain aft 1Caahactoas that check this box roust g g "MOS sired then hue outside cvnttactors moat submtt a new afridavit tndiaefieg such at>aahed an edditioaai sheatshowrt 'the t►artra of the sub-eotrtractors end their worksrs'cam.. r ., polies•iafmmadon. .am ran employer drat' s7,so::4r; Workers' - compensation insurance or a to inforntatio2 / f �' niP Pees: Below ir7he poli'and job site . Insurance Company Name: V Policy#or Self-ins.Lie. Expiration Date: O �O Sob Site Address:_ O/V yr City/state/Zip: /Q• A/ Failure to s Attach a copy of the workers',compensation policy declaration page(showing the policy number and expiration date ecure coverage as required under Section 25A of MGL C. 152 can lead to the i fine up to$1,500.00 and/or one-year imprisonment; mposition of criminal as well es civil penalties in the form of a STOP WORK ORpenaj�es of a, D Of up to 5250.00 a day against the violator. Be advised that a copy of this 1:R and a fine statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. J dv her enJ'c under the pains a eaalteer ofPerjrcrY that the information provided above is true and eorreat Si ture: Phone#: 7JO ficial use only. Do not write in this area,to be conrletc-d by dly or town ofcaL City or Town Permit/License# Issuing Authority(circle one): 1.Board of Health 2 Suildiog Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: r Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �U Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (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 PRINTININKORTYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives noticeof is or her intention to perfo the electrical work described below. Location(Street&Number) r (/( ,1� (�^ �T . Owner or Tenant v S e .AQP Telephone No. L%`� �3a 6'Yoo Owner's Address N Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Sd Am . Ps � 2 / �'Volts Overhead ❑ Und rd g ❑ No.of Meters / New Service C-Som-krups / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: _ ,� �, 1 -A Completion of the ollowin table may be waived bv the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp. (Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires (? Swimming Pool Above11In- F7 o. o mergency ig g d. rnd. Butte Units --. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and b Initiatin Devices No.of Ranges No.of Air Cond. TotaTons l No.of Alerting Devices No.of Waste Disposers Heat ump Number..Tons_.... KW No.of Self-Contained Totals: Detection/Alerting Devices . No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water KW v No.of No.of Devices or Equivalent Heaters No.of Si s Ballasts Data Wiring; No.of Devices or E uivalent J No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring: r� No,of Devices or E uivalent `� OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electric Work: >> d CroG (When required by municipal policy.) Work to Start: f rkL _ 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 ii&urance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties ofJP eJu?y that the information on this application is true and complete, C/ FIRM NAME: LIC.NO.: O 7' Licensee: e, Signature (If applicable, enter "exempt"in the license number line.) LIC.NO.: /�r Address: % C3 w ( ( i Bus.Tel.No.: b��Z -" Alt.Tel.No.: *Per M.G.L c. 14 7,s. 57-61,security work requires Department of Public Safety"S"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: $ �. a QQ Date.. HOR7M 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING �o*Al.o ,SSACMUSEt This certifies that ........: ,!,..... :�,c.............................., ............................ has permission to perform .... wiring in the building of. �...::�.... .�...... f - �, . ��, ' .......:.............:...........:.....,_.�:.:c!�... . ........ ,North Andover,Mass. d Fee�'>r..0. Lic.W.I.AV.fY ..... ........... . . .. ... . .. . .. ELECTRiCALINSPE U Check it 89J)D The Commonwealth of Massachusetts k� ! Department of Industrial Accidents Office of Investigations 600 Washington Street . i Boston, MA 02111 r www.nzass.gov/dia . Workers' Compensation Iasi trance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print LeQibl NaUie (Business/Organization/Individual)' (J CC --------------- Address: City/.State/Zip: Phone#: . Are u an employer?Check.the appropriate box: Type of pr®jest required); 1. I am a employer with�_ 4. ❑ I am a general contractor and T employees(full and/or part-time).* have hired the sub-contractors 6 ❑N coristruction 2.❑ I am a:sole proprietor or partner_ listed on the attached sheet.x 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein 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•7 Electrical repairs or additions 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 repair, insurance required.]t employees. [No workers' comp. insurance required.] 11M Other Any applicant that checks bo)r#I must also fill out the section below showing their workers'compensation policy information. t Homeownens who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. •Connectors that check this box must attached an additional sheat showingthe trema of the sub-contractors and their workers'comp_policy information. I am an employer that is.providing workers'compensation insurance for mty.employees: Below is the policy and job stte information. �---n Insurance Company Name: i v Policy#or Self-ins. Lie. /#: Expiration Date: Job Site Address: `t (- .1/l.w d ue-\— WAN" City/State/Zip: o 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 her certify n th pains nd p othat the information provided above is true and correct. Si e: Date. Phone#: Offici:zmely. Do not write in this area,to be completed by city or town of iciat City oPermit/License# j Issuinity(circle one): 1. Boaalth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.OthContan• Phone#: 30 Day TEMPOARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit # 160 Date: September 30, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON: 451 ANDOVER STREET Unit 300a May be occupied as an Office in accordance with the provisions of the Massachusetts State Building Code and other Regulation that may apply. Certificate Issued to: NAOP LLC 451 Andover Street North Andover, Ma 01845 Inspector of Buildings I 03/11/2009 WED 16:01 FAX 978 750 0082 FRAVEL INSURANCE AGENCY 2001/001 ACORD,M CERTIFICATE OF LIABILITY INSURANCE DA1/13/09 PRODUCER THIS CE9TnFICATE IS ISSUED ASA MATTER OF INFORMATION Fravel Insurance Agency ONLYAND CONFERS NO RIGHTS UPONTHECERTIFICATE 6 High Street ALTER TTHE COVERAGE AFFORODE6D SY rHNar E POLICIES SOW. Danvers, MA 01923 INSURERS AFFORDING COVERAGE MAIC# INSURE NSURERA Max Specialty Ins CO. US Property Services I INSURERS, Granite State Lisa Gomes I INSURER C: _ 200 Andover Street, suite 312 INSURER D: Peabody, MA 01960 --'' _ 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. _ •.•.__ INSft D ..._ pOLtGYNUNBFR POUGYEFFECiw' u EXPIRATpNI LIMITS GENAL LIABILITY Im EACH OCCURRENCE _ $... 1,000,000 B X COMMERCIAL GENERAL LIABILITY MAX013902000208 1/9/09 1/9/10 A�� ,;,� E 50 000 CLAMS MADE ❑X OCCUR MED EXP a cn $ 5,000 PERSONALS ADVNJURY $ ], 000 000 GENOMAGGRE S 2,000,000 GEN'L AGGREGATEUMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,O00,000 POUG"El Ma I we /WTOMOBILALIABILITY COMBINED SINGLE LIMIT S (Es WdWKI ANYAUTO .._ ALLOWNEDAUTOS I BODILY INJURY E (Perpwaan) SCHEDUL®AUTOS ' HIREDAUTOS BODILYNJURY $ - (Ptr xddml) NON-OWNED AUTOS PROPERTYOAMAGE E '— (Per Amid") GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT_ I S EAACC S j ANYAUTO OTHER THAN AUTO ONLY: AGG S EXCESSNMBRELLALUIBILITY - EACHOGGURRENCE $ .••-_ OCCUR CIAIMSMADE AGGREGATE S E I DEDUCTIBLE I !RETENTION S $ WC 3TATU- OTH-I WOWM S COMPENSATION AND ER A EMPLOYERS-uABILITY TBA 1/13/09 1/13/10 E.LEACHACCIDENT $ 100,000 ANY FFICERAMEERW(CLU R/DCECuTnE 07'�7Y4C) 100,000 OyyFeefsSICERMEMBEREXCIUDE07 �(-' O,o E•LOLSFJ+SE-EAEMPWVEE $ SPEMALP�(W ONSoeaw I E.LDISEASE-POUCvlIM1T S 500,000 OTHER j I I i aMcaPTIONOFOPERATIONS ILOCATIONSI MHCLES/EXCLUSIONS ADDED BY END ORSEMENTISPECIALPROVISIONS NADP, LLC is named as an additional insured; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO 30 DANSWRITTEN NAOP, LLC. NOTICETD THE CERTIFICATEHOLDER NAMED TOTHE ,BU FAILURBTOOOSO$HALL 93 Union Street IMPOSHNo OBLIGATION OR LIAR OF ANY KIND Un THE 1 SURER,ITS AGENTS OR Suite 315 REPRESENTATIVES Newton Center, MA 02459 AUTHORIZED REPRE5ENTA ACORD 25(2001108) ACORD CORPORATION 1988 Information a lid Wtructions I Massachusetts General Laws chapter I S2 requires all emp Ioyers to provide workers' compensation for their ctnployees. 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 writtzn." ' )` An ernplayer is defined as"an individual partnership,amc:%ciafion, corporation or other legal entity,or any two crmore of the foregoing engaged in a joint enterprise,and fimludi"S the 1 gal representaiaves of a decaasad employer,or the receiver ertarstee•of an individual,partnership,associatiazn or other legal•entity,employing employees.'Howevathe ownar•of a dwelling house having not more that fhr-�apaz-trnerrt�and who resides therein,or lite ocxupant of the dwelling house of another who employs persons tv do rr►aintznanee,construction or repair work on such dweltinrhouse or on the grounds or building appurtenant th=,to shall net b===of such employment be deemed to be an employer." MGL chapter l S2,§25C(6)also states tfrnst:"every state as-local 6censingagency shall withhold the issnanmor renewal of a license or permit to operate a business or *o"construct holidings in the commonwealth for any appTcant who has not produced acceptable evidence oir eomp6ance with the.insurance coverage required." Additionally, MOL chapter I52,§25C(7)states"Neither the earnmenwealfh nor any of its polifical subdivisions shin enter into arty conn act far the p=fa n zw of public worie until-acceptant:evidence of compliance with the roam ae requirements.of this chapter have been presented to the cartt=ting audhority." Apprlcauia Please fill out the workers'compensation•affidavit eompie--tely,by checking the boxes that apply to your situation and,if necessary,supply slab-oorrtractor(s)name;(sl addresKag):quid phone number(s)along with their certificates)of insurance. Limitnd'Liability Companies (LLC)or Limited Umbility Partnerships(LLP)with no employees otherthan the members orpartners,are not required,to carry workers'ca�-respensafson insurance. Van LLC or-LLP does have employees,a policy is required. Be advised that this afftd.- vit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also Eye sure to sign and date the affidavit The a5davit should be returned to the city or town that the application far.tim permit or license is being requested,not'the Department of Industrial Accidents Should you have any questions reqs-ding the law or if you art regaimd to obtain a workanr oMpensation policy,please-caR the Department at the nurmber.listed below. self-insured companies should enter their selfixrsrnr ncc ficonae numii=on tire•appropiiate City or Town Officials Please be sure that the affidavit is complete and printed hgr'bly. The•Department has provided a space at the botfmn of the affidavit for yoir to fill out in the event the Office of Investigations has to contact you regarding tine applicant Please be sure to fill in the permit/license number which w-HI be used as a reference number. In addition,an applicant that must submit multiple peumit/jic ensc applications in any given year,need only submit one affidavit indicatingcurren t policy 1nforrrisfion(if neessary)and under"Job site Address"the applicant should write"all locations in (city or town)"A Dopy Of'ftre affidavit that has bis►offrcisily stamped or marked by the city or town may be provided to the applicant as proof thief a valid affidavit is on file for fdom permits or licenses. A new affidavit must be filled out each year.When a home owner or citizen 151 obfainmg a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum lawns etc.)said parses is NOT.mquired to-complete this affidaviL The Of-rice of Investigations would like to tizaru[c you in advance for your cooperation azid.should you have any questions, please do not hesitate to give us a call. The Deparvnent's address,telephone and fax number. The Cammonrealth of Masa tisetts Dmparlmeut of lmdnsttial Accidents Office of Envemaagaiaotns 600 Washington Street ROSE n, MA 02111 TeL #617-7274900 i, ct 406 or I-8.77-MASSAF'E Fax 9 617-727-7-740 Revised 5-2b-DS Wvvw.II --aqq govidia COMMON UNIT DEMISING WALL OR ExTER10R WALL UNIT INTERIOR WALL UNIT MAIN ENTRY X.xx' WALL DIMENSION G MARKER --- erFTrlrr COMMON SPACE ---- ----� r :_T 20.58' / N II O) COMMON SPACE WRH EXCLUSIVE 1 I ! RIGHTS TO USE m 1 6.58' 1 -X6.33' EASEMENT FOR CORRIDOR EGRESS I--------------- I 451 ANDOVER STREET • a ! • r N FLOOR UNIT NET SF O GROUND 03 934 SF I g b O a aO aO .' — GROUND N 797 SF O o GROUND G4 610 SF L' n n n n n n . - _ 1 > GROUND 5c 904 SF ,41' 1.66' I.SB' I I.661 5.83: !.$.71' '.I I.66' `, 5.29' l GROUND G5■ 270 F GROUND C7 I ROulq _ce SF Ise SF � of j in � 11 �—,I cnOMND c11 __eeosF Oh iI! FII II N iIRST 100 OR F 6.06': d 19.69' n iIR$T 105 1752 5F' I ■ ■ • ° 1 N_ GROUND 105 Y1e61 90 �� FWST 110 666 SF 1 ID I TEL. - 335 I 'd I I a 'FIR-si--120 ---SR)sF f{ zo�esi u I — — FIRST 125 —939 SF 59.66' is ! i 6.33' rlRsr /30 7e1 sF ..1.6,3'_" ibt5T ISO 2a6 SF It ELEv: . .A. .i - ii. �r OH6N N FIRST 160 203 SF FIRST 169 123E SF COM ON m ,i� � %® '�; /• _ FIRST m sea SF 1 ACCE55 TO FIRST 60 165 SF RDOF 24.49' 14.49' 39.94 II FIRST IDS 1012 SF 1 -- - - - 11 6.33'.. FIRST 95 tee SF I II '.I SE 200 See SF I d p _ o r • SE 201 257 F ■ ■ !I ° • '. II — UN1t O UNrt $ m SE 202 13W F uNrr – 315 �_ 305 U°ar SE 205 15"F ' 2558 I' 9.66' _ 4@8F 27e 8F m — II 139'13 I__., If:__' _..- SE 205 1935 F 1 SE 207 960 F 5.83' °,�.16' I I.66' w I I.16' N 11.25' 11 15.20 .I 6.33'.. 5E 209 912 F 1 .. SECOND 209 2946 F SECOND 210 278 SIF I a $ $ $ ZT (, SECOND 211 262 F O pD O (0 SECOND 213 271 F n n O n n n n n ni SECONDz1a 1n F 1 ,-3 ,�: ,a, — — THIRD J00 2559 F — THIRD 305 259 F 1 r THIRD 315 442 SF ----------------- --- -- --------------------- ------------------ 1 ---------------------- T1111ND 330 1397 F �? THIRD 335 2019 F I 6.33' 20.1 TURNPIKE STREET I — = I 6.58' GROUND CI 3192 F 20.58' GROUND G2 W35 F ' L-- --- GROUND G3 1293 F L------------ -------------- — FIRST 100 _ 2050F i1RST 113 — I460 F F9NST 120 640 F FIRST 125 2900 F THIRD FLOOR PLAN SES 201) F THIRD 300 9267 F 5CALE:VB'•I'-0° FOURTH 400 355 F FOURTH 401_ 404 F TH FOUR402 f Nt F FOURTH 403_ _ e95 5F FOURTH 404 $24 F FOURTH 405 372 F FOURTH 407 529 F 'UTZ7.T 79696 SF TOTAL CONMO14 23063 F TOTAL GROSS AREA 1101761 F m :f THIRD FLOOR PLAN THIRD FLOOR THIFV FLOOR a a NORTH ANDOVER OFFICE PARK _ = CONDOMINIUM e a COQ" SECdO FLOOR SECOND FLOOR LOCATED AT 451 ANDOVER STREET, NORTH ANDOVER, MASSACHUSETTS 01845 $ m I certify that this plan shows the units on the third floor plan of the building Oola a a located at 451 Andover Street,and that it fully and accurately depicts the FOR REGISTRY USE ONLY F11"T FLOOR NMIFLOOR —_— _-—-— layout,location,unit number,dimensions,approximate area,main entrance, the immediately adjoining units,and immediate common area to which each of the units has access as built.I certify that this plan has been prepared in sm conformity with the rules and regulations of the Registry of Deeds.The � �D COraa R71 4 GAID FLOOR �Rowc FLooa name of the property IS North Andover Office Park Condominium,Located At5601'IATLS INC,. . —-—-— —-—-— at 203 Turnpike Street and 451 Andover Street,North Andover, 1 AI�HITECTS,ENGINEERS• Massachusetts. / INTERIORS.N LAND PLAMIERS IL ONE ELM UUAIW-,ANDOVER.HA"0 SCALE:118'-V-V 451 Andover Street 451 Andover Street o 4° 11 1s 24' 32' REGISTERED ARCHITECT DATE SUI LPI NO 59CwTI ON A-A W I LPI Nt5 Sal 5-5' DATE: SHEET N: SCALE:UT3',I'-0' SCALE:A'-F-0' JUNE 30,2008 4 OF 10 PWT 7n108 Z 111 z Z 111 FIRST GENERAL REALTY CORPORATION 93 Union Street,Suite 315 Newton Centre,MA 02459 Phone: 617-332-6400 Fax: 617-527-4176 August 27, 2009 US Property Services Sent via facsimile: (978)319-9033 P.O. Box 545 Billerica, MA 01821 Re: 451Andover Street Dr Watchel Suite 300-1 Dear Frank Gomes: This is confirmation of the work to be performed at the above referenced address. We mutually agree the amount will not exceed Sixty-Nine Thousand Seven Hundred Fifty-Six Dollars and 50/100($69,756.50),for the work described on the proposal,attached as Exhibit"A". Your engagement is acceptable subject to the following conditions: Your engagement is acceptable subject to the following conditions: 1. All work shall be performed in a good workman like manner and in accordance with all town,state and country codes and regulations. 2. Your company and personnel will clean up after completing their work. 3. Your company will provide us with a certificate of insurance to include public general liability and workers compensation, NAOP LLC and First General Realty Corporation,as additional insured. 4. Your company will be responsible for obtaining all necessary permits if applicable. 5. If you cause a violation to the contract, we can send you written notice and remove you from the job within 72 hours of notification limiting payment obligations to only the work completed. 6. The project will be scheduled on a mutually agreed upon date by Contractor and Landlord. 7. The payment terms are as follows: 1/3 deposit 1/3 progress payment and 1/3 paid within 15 days of completion of work. 8. Should any part of this agreement contradict Exhibit"A",this contract shall govern or supersede. 9. Allowance: Plumbing $12,700.00 HVAC$10,400.00 Electrical$12,236.00 Construction$34,419.50 Total price: $69,755.50 Please sign on the line provided below and this will serve as the basis for our contract. Sincerely, JoZWMeunie , Chief Operating Officer Agreed to and epted r omes Date Board of Building Regointiona��and Standards Construction Supervisor License _License: CS 98124 ExPsrafi0n::11/412011 Tr# 98124 Restriction= 00 DAVID ROWE 17 DAVIS ROAD UNrr G7 ACTON,MA 01720 Commissioner Architects LaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA JD Architects, Engineers & Land Planners Thomas is Galvin,AIA Julianna E.Hoch,RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161 M PROJECT TITLE: North Andover Office Park PROJECT LOCATION: 451 Andover Street,3`d Floor,Suite 300A NAME OF BUILDING: Building 1 SCOPE OF PROJECT: Construction of Interior Suite 300A,3rd floor for Dr. Watchel,451 Andover St. In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D.LaGrasse,AIA MA.Reg.# 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans,computations as specifications concerning: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix 1. Pursuant to Section 1]6.4,I 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.LaGrasse,AIA PA 3 ka ©9 g ature of ineer Date Offices ��DD gRcy��� One Elm Square �� y� , .� T 978.470.3675 Andover,MA 01810 No 4153 F 978.470.3670 ANDOVER, 1420 Celebration Blvd. ��� MA www.lagrassearchitects.com Celebration,FL 34747 ° AA26001333AttH 0F 41PSSP