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HomeMy WebLinkAboutBuilding Permit # 4/26/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 1 4 261- %i Date Received /24//( Date Issued: IMPORTANT: Applicant must comple TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg C Others: /t/�i �� ❑ Other a Se tic Well ! .�r .. .; Flood ; Cain f etl ds. ,f F 4 p a : ,: u'A p'rrv'+�:`"+An'I r; J `� � �y F f'�.'Y .,. ,��,., ;�iY,r :x ! s�.:1 s�, to ., „�fS,'fi.1F, ,.e, °�1�� r,;.��i, � . u. r:5tt"sr� fir' � zl��� fr. -r.� .y,,/,�; y,Y. _.. :� _,�,�'.i`,,t`�%...,; ,..� „.` l -a, %� ��,-.a. . �+ '�'`' �+;'r�, � tf�kRa'�. �(, /. 'r��?��� 1 , ,, ,Watershed District �1.' 'y. v�� ,. ^,k�,;, r .d .�- r e;?.:. `r,�'„`f ps i' n 1� r� �'"!' �M. ���fs� UY 2', g^ie�'�✓. d,�-` .,;; ,;Y � ,.. ��'� �a.rr rife:, ,- '� F... r ,5?l?'y �� ,, .. . ��� r DESCRIPTION OF WORK TO BE PERFORMED: )1/7 ) v' about- 5 7 v//4 tc'e-- aid/ /17sT4/% 'X/2.6 ' TEA,/ 6 r^ f 34 4 L Dl,/777MJ• fC ze e / aid/ dam' 379/4 Phone: 7%'-- 7Zc- -3c)a OWNER: Name: Identification - Please Type or Print Clearly BR- ors fie, fo 64, Address: Moe oe AT Pc) AJD 12_61z ; -- ,4 2c,4,e / 6-ea cx Address:/ (/h4,r, /�rJ �°� M//is /V' e.3449 Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. ! Aid user , /t A Phone: o3-3V-4769 Total Project Cost: $ l� m? Check No.: FEE:$ — f ��., ( Receipt No.: \' NOTE: Persons contracting with egistered contractors do not have access to the guaranty fund ignatare o B O 0 f° (i)� O O 0 CD 0 u CD C'� D4 O r.O O xx, co O O eD O O a O CD CDLa . 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'E 1-4 a ) 0 'E (1) 0.) V -000 ') U •4., ;-, bl) .- 0 ('6; ,ii • I. 1-4 7; o :__ , LI - ,--,,,, g _0 E c))) u 0 U 0 1-4 """' "-i-4 -1-, ,.. cd c, t) GJ 0 `: 0 E 0 • , u r-0 (1) CU 1-, TZ; () 1 '-T0) Z (1) U C' • Lri4 43 i' 06 a\ csi cr.) : ' • fiL 416 (Oh 42.01,, 04111,6 114„11.,.....141,11141,1."1111111114.131111i1114111.4111101111140,111114,11411111101q Date Manufactured 1/8/2014 AZTEC TENTS 2865 COLUMBIA ST TORRANCE, CA 90503 (800) 228-3687 This is to certify that the materials described below have been flame retardant reeled (or are inherently flame retardant). Christian Party Rentals 18 Clinton Drive Hollis, NH 03049 Certification Is hereby made that the articles described below hereof are made from a flame-retardant fabric or material registered and approved by the California State Fire Marshal for such use. The fabric has been tested and passes NFPA 701 Large Scale, See chart to right for trade name of flame -resistant fabric or material used and additionally referenced on the label of the fabric panel, THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Title of Applicator or Production superintendent P Invoice Number: 0202537-IN Customer P.O.: Customer Number: CHR030 6411/1 C:41,Thrt.4 e.on4 ffr, ii, z6, Itun Lod r‘bocs Otar vinyl 2690 00.1 e-tmox "cro,rvoit Ir.04./Jrtg pAr fr,•565 te.d141V4151 441. POYSOCtui Witt ,e1-4U,b Preantretnt 5151 " 0.44e4,b1 0.4.c.v'nll611.4‘4.ou rop'spijPrtrox Upor — 7,460.61 PVC Te.h. Doc* 0.1,0Ch f V41,on 4444 0440.0r ,r4,93,05 dor (Mt TWO. F422.04 Name of Appltotor or Prooluclion superintendent '16.11.111004101,111111111114,1111111111101M ihafterrtritt ytraitartir IrdtrairterrafreldphisittareardardirlatifilirliOari .111111 ',Mk TN"' 11$111111 leg 0111!' 1111,C 'NOY ITEM CODE ITEM DESCRIPTION %rod*, , Wo+1141,span In VirOya Pirelag S.,4,44. Yilt VAAkkOi '...{..4 4 SuP mi vartoe , , zi ID ,Th 'linage V-440A01 W-iblon 1,4441 .4iV0nt.tyto , - 104.03on-) Col slime. - R 1-/Sibi. V1o1.4 1in toWrs, osts " - it.-510,61 UNIT ORDERED PRODUCED a, Z318T100E040010 #100x40 2pc Series 2000 TP tJW #Old Style to match previous orders# Includes Jumper Ropes Only Blackout While (TIe Downs Not Included w/ Top) Z39900430 5/8" Polydac CP Jumper 45' Z318Z00180BIO "100X20 End 82000 TPLA UW w/ New Plates Includes Jumper Ropes Only Blackout White (Tie Downs Not Included w/ Top) 2318200190B/0 '100x20 End 52000 TPOR UW w/ New Plates Includes Jumper Ropes Only Blackout White (Tie Downs Not Included w/ Top) EACH EACH 2 2 EACH1 1 EACH Continued • ,,,,1111 ,1,,11111Pi '111,,111.11 1.1.111,1.11,1fr 1"11111 &1111111 4141i1'11"11'''110$11?"4: '{1101110111r1i1111111# ,11.11„,111q'iflAiiiii1'44,i11.011,1,,1111ti,(1‘1'1i11.),"1„.111,110","".111A1!"N't i,"111111111111"1"111'0111111,1f6.10p.;!:::,:::0,111111111.11,411111111111,1111,,".1111, 1011'0111.10,"f"11111.11"..16(4,41101,4111:11,411 ii111111111111111111111i11,1111111111111111"1"Itht6'1,41,,,01,0,6111"-j",1 Date Manufactured 1/8/2014 This is to certify that the materials described AZTEC TENTS 2665 COLUMBIA ST TORRANCE, CA 90503 (800) 228-3687 below have been flame retardant treated (or are inherently flame retardant). Christian Party Rentals 18 Clinton Drive Hollis, NH 03049 '114' 111111111111011/111110646111111111111,11:11011001 ,1,111011111 101joe# 11111111111111 Page: Invoice Number 0202537-IN Customer P.O.: Customer Number: CHR030 Certification is hereby made that the articles described below hereof are made from a flame-retardant fabric or material registered and approved by the California State Fire Marshal for such use. The fabric has been tested and passes NFPA 701 Large Scale. See chart to right for trade name of flame -resistant fabric or material used and additionally referenced on the label of the fabric panel, THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Tido of Applicator" or Prooloolion Supelintondent ITEM CODE i,222.o4 u.r!ras 12,14,16,166/ 01o4dFeb u 1-44or1641,1 3694 / )091 a--3,9bE a 0-01.61 6 gooh Cloor1/16,9 1664 "Ext446,ely Expo yE6toon thief Pnuup't 4.40. hvOrax WET . tiata (tato IvOoo 'Ott.. WeeMerseen lltr.(16.1sooi,b ntftu 0.59102 1,434.63 " F1,44441 Noma of Applicator Of PrOCk10100 SuParintePdent ) 4-1,r 41.11, ITEM DESCRIPTION P..444,08 0-56',1,01 0,140.0.1 7.mools ' 0,12124 in,la 1,064 61 7 C000utne t•069,61 )6,63 lifv.neaae 0.4 T", verenee ,hoeueile Webbe Tr{ Vagdeee We "",/,...01,e1,11,1„lefee,I16/011111.1661111yeetI)Illooll,111:11111111111160111411,4IIIII,11".60e111pep,11011)1111411,011111111111111111111:11111:V1v1)/i0111e10111, 6" 1. • lep:1:p "1001 1414 '1.1.1:111111111 "116$ 11,1 "6"...1 "1111, "1"11'lli1111/'1,111'4"0 "..,.,11,"e".::111111111.""'V1"."1"'"'111'°"111..""4,1' 6orosion , UNIT ORDERED PRODUCED Z31 8T1 00E040B/0 #100x40 2pc Series 2000 TP UW #0Id Style to match previous orders# Includes Jumper Ropes Only Blackout White (Tie Downs Not Included w/ Top) Z39900430 5/8Polydac CP Jumper 45" Z318Z001801310 *100x20 End S2000 TPLA UW w/ New Plates Includes Jumper Ropes Only Blackout White (Tie Downs Not Included WI Top) Z31E00190E3/0 100x20 End 52000 TPGR UW wl New Pietas Includes Jumper Ropes Only Blackout White (Tie Downs Not Included wl Top) EACH EACH EACH EACH 2 2 1 Continued Ain "*1111111t111111" Date Manufactured 1/8/2014 AZTEC TENTS 2965 COLUMBIA ST TORRANCE, CA 90503 (800) 228-3087 This is to certify that the materials described below have been flame retardant treated(orarB inherently flame retardant), Christian Party Rentals 18 Clinton Drive Hollis, NH 03049 e,„ P0414104 ttef5000 .ftost,traitIR ibi44450 pv.. feen boo (100 / VilOn Yri"Zeg. F=Lila ' - 66A Certification is hereby made that the articles described below hereof are made Tn Vaniqo 6oL6gbd f 12.1.01 from a flame-retardant fabric oi material registered and approved by the 6s vinat0a 64110 ,, ell %y.0444,61 f rzt lo CalifornInetna guardew()ia State Fire Marshal for such use. The fabric has been tested and Tri Vanug a WOW / txaseine IL0a6,61 passes NFPA 701 Large Scale, See chart to right for trade name of Versidip rwne,,,nbit,), 8150 F-5/0.01 flame -resistant fabric or material used and additionally referenced on the label of the fabric panel, THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Two of Appficetor of Production Supetintenelent 41,1,410110, Invoice Number: 0202537-IN Customer P.O.: Customer Number: CHRQ30 Mr/A oot4o0 tZ (4 th 7 citosfsos ITEM CODE 'gator or „Production Superintendent ITEM DESCRIPTION NIT ORDERED PRODUCED 1'1 '1 101 23181100E0408/0 #10Ux40 2pc Series 2000 TP UW #Old Style to match previous orders# Includes Jumper Ropes Only Blockout White (Tie Downs Not Included w/ Top) Z39900430 5/8" Polydac CP Jumper 45EACH 2 2 2318200180B/0 `100x20 End 52000 TPLA EACH 1 1 UW w/ New Plates Includes Jumper Ropes Only Blockout White (rie Downs Not Included w/ Top) 72182.00190B/0 *10040 End S2000 TPGR uw w/ New Plates Includes Jumper Ropes Only Blockout White (Tie Downs Not Included w/ Top) / EACH EACH Continued „ #ryi411,„„ „„,„„J!„4 0,41 NIC 4111,„,6 0+04 naluSiNN f"'” , ..,!..*:,•••4 • . 64rd„ „ I 1,11, aal Agoir Date Manufactured 1/8/2014 This is to certify that the materials treated (or are inherently flame ret Christian Party Rentals 18 Clinton Drive Hollis, NH 03049 Invoice Number: Customer Customer Number: CHR430 AZTEC TENTS 2665 COLUMBIA ST TORRANCE, CA 90503 (800) 228-3887 described below have been flame retardant ardent). Certification is hereby made that the articles described below hereof are made from a flame-retardant fabric or material registered and approved by the California State Fire Marshal for such use. The fabric has been tested and passes NFPA 701 Large Scale. See chart to right for trade name of flame -resistant fabric or material used and additionally referenced on the label of the fabric panel, THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing TiOe of Applicator or ProduCtIOn Superintenclem ITEM CODE 0202537-IN riearn of Applicator or Production Superintendent ITEM DESCRIPTION UNIT ORDERED PRODUCED i 0 /kVA VI F.227,04 eadowlia rprnb .Tp8ti4, ib, iliac F-4i1cli 7)4144 Nbncp a inn)(16g I / i',411 Oro,of —Ii.40.01 c.warv,no )60k / 744 - FAO 02 6onnvoiy Eopo' ''", nolysotoon Una( '.- F-414.01 torraA ro,ni 502 ,44(.6t re mo.neRooio? o.44.08 %nips Vo%Oon PM nYtaillilur We 'Toth. bhlV,tn ' F.Soabl t. nrier war" P.i.to'.os ,TrIVint0p0 r ix', 14 /eyingay. 1.ti0 500 f 1 iii4 Te..Vantiat 114 TOO 1 VIr/140 *vinquud wow V-ai,62, '5Vanugo nvc-Oon i Cww,.. " "crers,400 Nnision 151 ), alms f.516.61 5,111n,/ei,eelp'm -,400 triaeeir Z318T100E0406/0 #100x40 2pc Series 2000 TP UW #01c1 Style to match previous orders# Includes Jumper Ropes Only Blockout White (Tie Downs Not included w/ Top) Z39900430 5/8" PolydEIC CP Jumper 45' Z318Z00180B/0 *100x20 End S2000 TPLA UW w/ New Plates Includes Jumper Ropes Only Blockout White (Tie Downs Not Included w/ Top) Z318Z00190B/O 100x20 End 32000 TPOR UW WI New Plates Includes Jumper Ropes Only Blockout White (Tie Downs Not Included w/ Top) EACH EACH EACH EACH 2 2 1 Continued The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name (Business/Organization/Individual): Christian Delivery & Chair Service, Inc. / Christian Party Rental Address: 18 Clinton Drive City/State/Zip: Hollis, NH 03049 Phone #: 603-883-5326 Are you an employer? Check the appropriate box: 1.1: I am a employer with 25 employees (full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.01 am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees5 . 1 am a general contractor and 1 have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.t We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Please Print Legibly Type of project (required): 7. 1:1 New construction 8. Li Remodeling 9. El Demolition 10 0 Building addition 11.0 Electrical repairs or additions 12.0 Plumbing repairs or additions 13.D Roof repairs 14. D Other TENTS *Any applicant that checks box 14 I must also fill out the section below showing their workers' compensatio policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: NH Motor Transport Association Policy # or Self -ins. Lic. #: P000749NHMTA2016 Expiration Date: 01-01-2017 Job Site Address: // 6 0 (4-tegi /9///76/ /2d City/State/Zip: • /V ' A/WI/Pr PO III SY!' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify undeiji Signature: Phone #603-883-53 6 : ties of perjur y :pat the information provided above is true and correct. Zyl 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. Cityr Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone #: Contact Person: � /^ "°W "°~°`°`"" ==" `°°°°~""` =^,^""°° TUM { puBox 3898 Concord, wxm302-x890 (603)224-7337 n F U THIS CERTIFICATE 0ISSUED AGA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S) AUTHORIZED REPRESENTATIVE ORPRODUCER, AND THE CERTIFICATE HOLDER. This is to certify that: Christian Delivery & Chair Service Inc. DBA Christian Party Rental 18C|inhon Drive Hollis, NHU2U48 Cortificmto#: 1 Is, at the issue date mthis certificate, insured below. The insurance afforded bythe listed policy(ies) is subject to all their terms, exclusions and conditions and mnot altered by any requirement, term mcondition mother document with respect mwhich this certificate may be issued. COVERAGE AFFORDED UNDER wmLAW opTHE FOLLOWING STATE: wx TYPE OF POLICY EXP DATE Continuous* Extended Policy Term POLICY NUMBER LIMIT OF LIABILITY Workers' Compensation ADDITIONAL COMMENTS: 09/01/2016-01/01/2017 Bodily Injury By Accident Bodily Injury by Disease Policy Limit Bodily Injury by Disease Each Person 'If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (Not applicableunless anumber of days is entered below.) Before the stated expiration date, the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days. Notice of such cancellation has been mailed to: Christian Delivery & Chair Service Inc. dboChristian Party Rental 18 Clinton Street Hollis, NHU5O49 NHMOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST Concord, NH Authorized Representative ��24-7337 O3/2o/2O1O Phone Number Date Issued