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HomeMy WebLinkAboutBuilding Permit #425 - Suite 340 11/18/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r Date Received Date Issued: IMPORTANT:A licant must comlete allitemson this age LOCATION / �! 2161<9 V e'1 S� `<y� �� l - Print PROPERTY OWNER 4 O L LG Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [IIn Two or more family ❑ ustrial *,Alteration No. of units: WCommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t # - '��FloodplamOW�etlandsv I �0' WatershedlDistrict , tp�S�ept�c� i®IbWell r 1 �., .I ESCIRIPTI9.N OF WORK TO BE PERFORMED: a�-ri 42 /A�- 7 2 0 Y? m©YL 6/ems V c Y-00'm ����n�cation Please Type or Print Clearly) OWNER: Name: Phone: l Address: CONTRACTOR Name: ✓vG 1prolov�Y w[ Phone: Address;5l,'� ZO LX/ 1 S ��/J�f .D �'a�J>' zA Supervisor's Construction License: A0 T J6 50Exp. Date: l C2, Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: ��P n �� Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$900000 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ - FEE: $ `t o ) .— fi I Do Check No.: it 2 Receipt No.: NO er SC t ting with unregistered contractors do no ve a ss the guaranty fund Location 4/� 1 ,A/Lave'l IS No. Date NORTH TOWN OF NORTH ANDOVER 3? •. . o y AL / s f V * y �o Certificate of Occupancy $ +�ro SI CMUSEt Building/Frame Permit Fee $ 0 l Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 4 8 L 7 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Poois` _s C7 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 CONSERVATION. Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: -" Located 384 Osg9od.Street FIRE DEPARTMENT - Temp Dump ter on site yes no - .. Located at 124 Main Street Fire Department signature/date COA4M ENTS Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Sw'mmmg Pools' _'` D 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 CONSERVATION Reviewed on Signature COMMENTS... . . HEALTH Reviewed on Si qnature 4 COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Siqnature&Date Driveway Permit DPW Town Engineer: Signature: -" Located 384 Osgood.Street FIRE DEPARTMENT - Temp Dump er on site yes no Located at 124 Main Street Fire Department signature/date COA4MENTS r 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 L � Doc:.Building Permit Revised 2008 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 El 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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 ❑ 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iatr the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Lust be submitted with the building application Doe: Doe.Building Permit Revised 2008mi Architects J D LaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA Architects, Engineers & Land Planners Thomas E Galvin,AIA Julianna E.Hoch,RA ARCHITECT'S CONSTRUCTION COMPLETION AFFIDAVIT Date Project Name: Amanda Bernard Esthetician Project Location: 451 Andover Street,Suite 340,North Andover,MA Name of Buildings: North Andover Office Park Architects Project No: 2300 Nature of Project: Tenant fit-up and handicap bath In accordance with Section 116 of the Massachusetts State Building Code,780 CMR-8,'Edition I, Joseph d.LaGrasse.AIA Registration No.4153 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 my knowledge, information,and belief,the work of, ❑ Interior floors, walls, & ceiling construction work have been satisfactorily completed in accordance with the construction documents. ��D ARC l A46 o Name No,4158 Joseph D.LaGrasse&Associates,Inc. ANWVER MA P� Date OF One Elm Square T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 www.lagrassearchitects.com JDL-Construction Completion Affidavit mss• !4 : Ai d TO" 0 over .. . No. of , dover, Mass., Y Q - LAKEq• COCMICKE".CK 7�S RATED pP� � BOARD OF HEALTH Food/Kitchen ERM IT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................... .'�fA... .......&.......................................4°-... 11�. .. ... .�. !......... Foundation q! has permission to erect........................................ buildings on . �......A d ou ,...... ....�..... ........3 > ough - . to be occupied as... .�.. !!.' ...........,�',�. .t...11. .............. ........ .. t.� ^A*.........d�►.�� ney provided that the person accepting this permit shall in ev respect confto the terms of the application on file in Fi 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. PLTING P TSO, Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. ;7 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTO UNLESS CONSTRUCYM .-7, 3- ........... .... ........ ........... ................................................................... 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-DEPARTMENT Until Inspected and Apprnved by the Building Inspector. Burner Street, No. Vin_ t Smoke Det�� SEE REVERSE SIDE 1°�' NORTH ndove A � .. ® of _ _ O _ -.�;>.. „ C' o , dover, Mass., � � • �� ' � T Q -- LAKE COCHICHEWICK . DRATED C:) S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 1 BUILDING INSPECTOR THIS CERTIFIES THAT...................� 0......6croar ....... suft ..................� 4. .0......... Foundation has permission to erect........................................ buildings on . .I......Primio J ► .i....�...:!lr...3 Rough to be occupied as..... ..�M!r!!.T............St...04 . ........ :...... ..... �.1�Ao.. �.. .. Chimney provided that the arson accepting this permit shall in ev respect conf the terms of the application on file in Final - this P P 9 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 CO.NSTRUCrN TT Rough .. ................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough F Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIREE_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE The Commonwealth ofMassachuset>y Department oflndustrialAccidents AIM% 1 Office o I g ff' f Investigations z; 600 Washington Street Boston,MA 02111 _- www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information . Please PrinfLegibly Name(Busiiiess/Organization/Individual): G1/ J /c/i'G�(' _ . AMC Address: City/State/Zip: & Phone 0: � 9-36 42 G 6 Are you an employer?Check the appropriate box: Type of project(required): I.V I am a employer with _ 4. ❑ I am a general contractor and I 6. EJ Tjew construction employees(full and/or part-time).* have hired the sub-contractors 2.F1 I am a sole proprietor or partner- listed on the attached sheet. t 7. LTJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, El Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their Y0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs " 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(heir workers'compensation policy information. t Homeowneis 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 sub-contractors add 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. i Insurance Company Name-Acl��.1/�l ;rj 7?CC y)'/r�/� c-2 n Policy#or Self-ins.Lie.#: 1116<�9 VYC22 IL91 Expiration Date, Job Site Address: 7. A 'Y1/,)U[/r r City/State/Zip:Z/,C V 14ji/e,, ItIm 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 Iead 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 cef7�under tlieplrins d penalties of perjury that the information provided above is true and correct: Signaturg - Date: Phone#: F only. Do not write in ttzis area;to be compteted by city or town offuiaL n: Permit/License# hority(circle one): Health 2.Building Department 3.CiVrown Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: Information and 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 urlder any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal enti or of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employr,o rtheore 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 of the dwelling house of another who employs persons to do maintenance,constructign or repair work on such dwelling house orzri 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 ofpublic work until acceptable evidence of compliance with the insurance requirements ofthis 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 liave any.questions regarding the law or ifyou 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 appropriate 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�permit/license 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 COMMOUWcaltt of Massachusetts Dcparlmcnt of Industrial Accidents Office Of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-8 MASSAFE Revised 5-26-05 Fax#617-727-7749 RightFax N2-1 11/17/2011 7:23:57 AM PAGE 3/003 Fax Server ISSUE DATE 17!20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DUES NOTAt•FIRMAI.IVELY OR NEGAI'1VELY AMEND,EXTEND OR ALTER TIM UOVEIIAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT SABRINA GILLIS INS NAME: 85 MAIN STREET C7 PHONE FAX (AIC,No,Ext): (A/C,No): PEAOBODY,MA 01960 E-MAIL ADDRESS: PRODUCER CUSTOMER ID V. INSURED INSURER(S)AFFORDING COVERAGE MAIC'## STAR TOUCH DRODPRTV SHRVICB.S INOURER A THE TILAVE11,151tS INDEMNITY COMPANY INC INSURER B 515 LOWELL ST STE 3 INSURER C PEABODY,MA 01960 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM M ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THUS 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.LIIAns SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP Luars LTR INSR WVD D/YYYY) QM/DD GENERAL LIABILITY EACH OCCURRENCE S .DAMAOETORENTED S 0 COMMERCIAL GENERAL LIABILITY PREMISES(Each occwence O CLAIM MADE O OCCUR MID.EXPENSE(Any one S arson O PERSONAL&ADV. S Witmy O ., GENERAL AGGREGATE S OWL AGGREGATE LIMIT APPLIES PER: O POLICY O PROJECT O LOC PRODUCTS-COMPIOP S AOO AUTOMOBILE LIABILITY COMBINED SINGLE S LIh4T (Each accident O ANYAUTO BODILYINJURY S (Per Person)l O ALL OLiR•IFD Auros BODILY INJURY S (Pa Accident O SCHEDULED AUTOS PROPERTY DAMAGE S er accident O HIRED AUTOS S O NON-OWNIDAUTOS S O O UMBRELLA IIAB O OCCUR EACH OCCURRENCE S O EXCESS LIAB O CLAIMS-MADE AGGREGATE S. O DEDUCTIBLE S O PxrENnoN S S WORKERS'COMPENSATION VIC A AND EMPLOYERS LIABILITY ,J STATUTORY YlIV IJMrIR ANYPROPRIETOR/PARTNER! E;xEc T[NEOFFICER tvINMBER Y N/A 6KUB4902P95A 10/28/11 10/28/12 F.L.EACH ACCIDENT 5100,000 EXCLUDED? (MANDATORY IN NH) EL.DISEASE-EACH 5100,000 APLAYFE byes,describe under DESCRIPTION OF E.L.DISEASE-POLICY OPERATIONS below 12M 5100,000 DESCRIPTION OF OPERATLONSILOCATIONSNEHICLES ARac h ACORD 101,Additional R Schedule,h more space is require THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE sr }'URX % I�JY+,aw.`t�'r :�r;;'�,s.x~'.. :.�3�sr,s-._�mr£J,£�?'.x:.,,n.sr Y 7 ,T,`: r r -�-.-�.`z��.�tli��tT.�..9.s�}.a,�z� � :�5 a-,s»r rm;� -^Y'3 . __ I•:°3k --. ux:3:�s 3 s NAOP LLC 415 ANDOVER ST 5MOULU ANY OF 1 Mt At7UVt ULNUMU3tU t"ULIGILU ISE GANGELLtD IStrC7Kt NORTH ANDOVER,MA 01845 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUn10RTIED REPRESFMATIVE 8riawMa.cLecuv Hc,vrsu TM. CERTIFICATE OF LIABILITY INSURANCE 11/091201101i PRODUCER Phone: 413-781-7475 Fax (413)781-0050 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER SPECIAL RISKS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 GOLD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P0BOX 1250 ALTER_Mg COVERAGE AFFORDED-BY TH ES RELOW- AGAWAM MA 01001 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Essex Insurance Company STAR TOUCH PROPERTY SERVICES INC INSURER B: 515 LOWELL STREET,STE 3 INSURER C: ocAcnnv eeA nincn INSURER D: 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. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MMID DATE WD LIMBS GENERAL LIABILITY 3DJ2231 10/19/11 10/19/12 EACH OCCURRENCE $ 1,000,000 _x1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PREMISES(Ea ocmmnce) CLAIMS MADE OCCUR MED.EXP(Any one person) $ 1,000 A X 5250 Dedurrihle PERSONAL&ADV INJURY $ 1-000.000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 1,000,000 X POLICYF_j PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE g (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR U CLAIMS MAGE AGGREGATE $ $ DEDUCTIBLE $ RETENTION$ $ WORKERS COMPENSATION AND v�srATu OTHER EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT & OFFICERAMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER: CERTIFICATE HOLDER CANCELLATION NAOP,LLC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 451 ANDOVER STREET 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 NORTH ANDOVER,MA 01845 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 0 Attention: avid . FIQnan �� Massachusetts- Delru-tment of Public S311'Ct) 7!V Board of Buildin!, Re,-ulations and Standards Construction Supervisor License License: CS 104350 LISA GOMES 40 HIGHLAND ST PEABODY, MA 01960 Expiration: 9/1/2013 uumi••i Hier Tr--: 104350 Proposal 9478 StarTouch Property Services Page 1 515 Lowell Street, Suite 3 Date 1108/2011 Peabody, MA 01960 I. General Information Proposed by: StarTouch Property Services Telephone: 978 836-1206 515 Lowell Street,Suite 3 Peabody,MA 01960 Submitted To: First General Realty Corporation Work Performed At: 451 Andover Street 93 Union.Street,Suite 315 1 3 rd fir Newton Centre,MA 02459 New ADA bathroom 11. Work Description: We hereby propose to furnish the materials and perform the necessary labor for the completion of the work described herein: New A.D.A Unisex bathroom Install one metal frame Install one fire doors with hardware Frame a walls Install insulation Install Sheetrock mud,tape and sand Fire blocking all exterior walls. Install ceramic tiles to match bathrooms on the second floor Install granite countertop to match 2nd floor Install new 2x2 drop ceiling Patch and painting entire. Relocate plumbing as shown on the plans Perform building standard plumbing to bring the space up to code Exclusions: • Dumpster to be supplied by FGR I1I. Terms: All material is guaranteed to be as specified and is to be completed in a substantial workmanlike manner for the sum of. Fourteen Thousand,Seven Hundred and Eighty Dollars($14,593.00) Payments to be made as follows: 1/3 deposit, 1/3 progress payment and 1/3 final payment *Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. **Note—This proposal may be withdrawn by us if not accepted within 30 days Respectfully submitted on behalf of Frank Gomes,StarTouch Property Services By signing below y2e rms and conditions of this contract: DATE —C�Ul(/ ho ized Si ry 1 11'roposal 9476 StarTouch Property Services Page 1 515 Lowell Streets Suite 3 Date 11/08/2011 Peabody, MA.01960 L General Information Proposed by* StarTouch Property Services Telephone. 978 836-1206 515 Lowell Street,Suite 3 Peabody,MA 01960 Submitted To: First General.Realty Corporation Work Performed At: 451 Andover Street 93 Union Street,Suite 315 1 Suite 340 Newton Centre,MA 02459 II. Work Description: We hereby propose to furnish the materials and perform the necessary labor for the completion of the work described herein: Remove and relocate entrance Install one metal frame Install one fire doors with hardware Frame a waiting room Install insulation Install Sheetrock mud,tape and sand Install one interior door with metal frame and hardware Fire blocking all exterior walls. Patch and painting entire office space Install a 6'6" countertop Install a 4x4 drop ceiling system Perform building standard electrical to bring space up to code Install plumbing for one hand sink I11. Exclusions: • Dumpster to be supplied by FGR IV. Terms: All material is guaranteed to be as specified and is to be completed in a substantial workmanlike manner for the sum of: Eighteen Thousand,Eight Hundred and Five Dollars($18,805.00) Payments to be made as follows: 1/3 deposit, 1/3 progress payment and 1/3 final payment *Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. **Note—This proposal may be withdrawn by us if not accepted within 30 days Respectfully submitted on behalf of Frank Gomes,StarTouch Property Services By signing below yo all terms and conditions of this contract: DATE A i 1 Architects J.. D LaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA Architects, Engineers & Lana Planners Thomas F.Galvin,AIA Julianna E.Hoch,RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2161—Suite 340 PROJECT LOCATION: 451 Andover Street,North Andover,MA NAME OF BUILDING:North Andover Office Park SCOPE OF PROJECT: Interior office remodeling for Unit 335, Suite 340 In accordance with the Massachusetts State Building Code Amendment Section 107.6 "Construction Control under IBC 2009 Section 7"submittal documents". 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 107.6.2.2: 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 107.6 as stated above,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.LaGra se,AIA SVI 4� Signature of Archite Date ANDOfile:2161 -Unit 335Suit MA One Elm 47q1tructi0n control affidavi OF T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 www.lagrassearchitects.com