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Home My WebLink AboutBuilding Permit # 4/26/2016 (2) 1 t%ORT(i BUILDING P MIT ,616 46 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION o Permit No#: t ' w Date Received �R,TEo FP" ay �SSAC HUS�C Date Issued: IM ORTANT: Applicant must complete all items on this page LOCATION 1§6 "reeeJ "46 Print PROPERTY OWNER ��' !: i Print 100 Year Structure yes no MAP b PARCEL: ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: [i Commercial El Repair, replacement ElAssessory Bldg Sthers: 11 - 73� ❑ Demolition ❑ Other ep tI ur � ❑ Food Iain � ❑Wetlands � yr❑ Wafier'shed District ,fr❑rS ❑Weil p r rk F xr d Fr r='r M l��r✓ .` r r ":r r' -"" r r .s,/ r 1� M s� * �, r r r} ra �, � ,rA,a�er/Sewer '.y ,r�r;f§ � � ,�� „r r✓rkr ,r; r..G.,. r�r,,,,��r�< , r r ,r � ,, DESCRIPTION OF WORK TO BE PERFORMED: sue, a & )(/2e?Bawd -A & X-yok-5 �-,41OC4, Keineyi4 CV/%/ he eo Identification- Please Type or Print Clearly OWNER: Name: 84eOAs 5 I-oe)l Phone: Address: /��d c/ Aend . 6 N, wlewer- Contractor Name:_��-151 n �`�y °ka Phone: ' " ` �' Email a ) I jcl ! t s s, 6t Address: - b k"'ve -1 0 /f 1� If Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: A ReHff �'t- 0 8 e / ed d Phone: 76 Address: � !>�1 !� �� e�/�%�, Al/� 43--76 la Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED CO BASED ON$925.00 PER S.F. Total Project Cost: $ `�i C FEE: $ `� Check No.: 1221 Receipt No.: G�6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t%O T H It own of N Andover ;Ak 5. ® C' LAµ ver, ass, 24. 2al((40 cocHICHCWICK 40 9 �1 "?ATED P•V�`,��s S U BOARD OF HEALTH P E IALM- IT LD Food/Kitchen Septic System THIS CERTIFIES THAT S ............... BUILDING INSPECTOR Foundation has permission to erect .......... buildings on ... !� ....el........'i. Rough to be occupied as .. . ....... ... ...&.&50.. .. .. ........ ..... chimney provided that the person accepting this permit shall in every respect conform to the ter of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Al eWion and Construction of Buildings in the Town of North Andover. 56"1PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. r6owkl Final EXPIRESPERMIT MONTHS ELECTRICAL INSPECTOR STARTSUNLESS CONSTRUCTION Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildink Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathingr Be® Wall To Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 4 \\ 6< m BROOKSSCHOOL 1160 Great Pond Road, North Andover, Massachusetts 01845 1. Robert Lehman Art Center 10. Dalsemer Room &Frick Dining Hall 19. Athletic Center 2. Henry Luce III Library 11. Alumni House 20. Blake House 3. Science Center 12. Auditorium 21. P.B.A.Hall 4. Classroom Building 13. Danforth Squash&Rowing 22. Chace House 5. Gardner&Merriman Houses 14. Summer Programs 23. Hettinger East&West 6. Whitney House 15. Thorne House 24. Peabody House 7. Head of School's House 16. Wilder Dining Hall &Student Center 25. Russell House 8. Ashburn Chapel 17. Facilities Office 26. Boathouse 9. Admissions,Health Center& 18. Hockey Rink South Entrance Service Entrance Head of School's Office Admission Parking North Entrance v 01 P � _ a rJJ trJ�cPr3[I3r3--Pr-Pr- r-Prr- Pr-Pr lr�rPtPc.ii �L t[PLI��(�LJ�C�[ [Pclz[PC1 LF�cI� ISSUED BYREGISTRATION � Date of Shipment NUMBER 01USTM INC. � 313r=8EVANSVILLE,INDIANA x€7725 Tent Identification F140.1 MANUFACTURERS OF THE FINISHED 04590588 0 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the Materials described have been flame-retardant treated S or are inherently it inflammable) and were supplied to: 5 5269800 CHRISTIAN DELIVERY&CHAIR SER GSA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 30496576 Certification is hereby made that: S The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was do- Ie In conformance with California Fire Marshal Code. All fabric has been tested and passes INFPA 701-99, CPAI 84, ULC 109. S Serial Description of iters certified: CENMMYeM 60W)=HOLE SNMER WHITE VINYL.WITHOUT WEB GUYS Flame Retardant Process USed Will Not Be Removed By5 Washing is Effectiver The The Fabric SWMEP,MFG NEW PHILADELPHIA,aH Si necl: Nam of Applicator of Flame Resistant Finl.ST � ��CHf3€r INDUSTRIES INC- I� cJ�r�c.rr�r.f�Pr�tfsPc�rllr�I�r�rJ��l�cl�rJ`3�cPr�c1'sc..I�c11€.tc.PcF��t.fr�rlr�cl�c.Cc.I��Pr�r�rlr�rJ�r�r�cl3�rJ��Pr�es�cl�tP��r�r�rlr�tls.S�r�rPr�cl�rPEP�Prnr�r.Pz.t� �-��" s�d !♦ �r�}.�t ted". a[1 3 ai 7 ' CSCL�E�LGC Ii PO , A DOCUMENT � } :- REGISTRATION ISSUED BY Date of Shipment APPLICATION P� NUMBER - 051SWwo, 61{2121306 EVANSVILLE, INDIANA 47725 Tent Identification F140.1 MANUFACTURERS OF THE FINISHED 04247876 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been fis retardant treated r are inherently noninflammable) and were supplied to: 5 268&00 CHRISTIAN DELIVERY&CHAIR SER DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR 5 HOLLIS NH 30490576 5 � 5 Certification is hereby made that: 1 he articles described on this Certificate have been treated with a flame-retardant approvedS chemical and that the applicafion of said chemical was done in conformance with California Fire Marshal Code. All fabric has been tested and passes NEPA 701-994 CPA] 84, ULC log. � Serial 0 8351110(2) cripfion of item Ftifi d: C&N jRY MEDDLE 604'x` 0 SANDER WHITE VINYL WrrHOT-TT WEB GUYS Flame Ratardant Pnocess R d W1.1IN 1 Want Be; P-emoved- By And Is Effective For The Life Of The 8c SANDER MFGNEW PHILADEI PHiA,OHSigned:. ` Name of Applicear of flame Resistant Finish I ANCHOR INDUSTRIES INC. i3 CIBC C.€.CIC.PC E.�E�C.L� LEP L. 0 mulligigimi.PLPCPLSCiLI�L C C_TZE_FC_FCPL� a �G X12 ® >Pr fiE3 ��LPL��LP�� P RTA N T D 4 C U M E N r�P�Pr�c(�r�rJ�1 Pr�r�rJ��PG I��Pr�rJrJ� ° _ leatic of FlanN Resis�ceSc 5 ISSUED BYFi� 5 i 5 Date off Shipment S REGISTRATION ¢ Cnon. 3!312008 5 NU■OBER y�'r INDUSTRIES INC. IY' EVANSVILLE INDIANA 47725 Tent Identification 55j 5 5 , SF140.1 F MANUFACTURERS OF THE FINISHED 04590588 STENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 5 (or are inherently noninflammable) and were supplied to: 5 5 269800 Cj CHRISTIAN DELIVERY&CHAIR SER 5 DBA CHRISTIAN PARTY RENTAL 5 18 CLINTON DR S 5 5 HOLLIS NH 269800 5 5 5 , 5 5 5 SCertification is hereby made that: S SThe articles described on this.Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 5 5 Serial# S 8151310(I) 5 S Description of item certified: 5 5 CENTURY END 60WX20 LOOP SNYDER WHITE VINYL WITHOUT WEB GUYS 5 Flame Retardant Process Used Will Not Be Removed By 5 �LnC L�GCEt s. - _ CPL L�EItEPL�L�G�CPLFLI�t�CI� C' j REGISTRATION ISSUED BY Date of Shipment APPIXAMN NUMBER MBE OUR-r�� W12t2006 � EVANSVILLE, INDIANA 47725 Tent Identification MANUFACTURERS OF THE FINISHED 04297876 F24fl.S TENT PRODUCTS DESCRIBED HEREIN This is to certify that the matterials described have been flame-retardant treated or are inherently noninflammable) and were supplied tee. 269800 CHRISTIAN DELIVERY&CHAIR SER DBA CHRISTIAN PANTY RENTAL 18 CLINTON DR HOLLIS NH 30496576 Certification la hereby made that: The articles described on This Certificate have been treated with a flame-retardant approved chemical and that the application of Bald chemical was done in conformance with California Fire Marshal Code. All fabric has been sted and passes NEPA 701-909, CPI 84. ULC 109. Serial P 8151110(2) Description of Item ifi-a . CENTURY MIDDLE 6OWY30 StNYDEP WHITE VNYL WFTF?CUT WEB GUYS Ce Ret rdantes sed Will Not Be Renicived By Washing n la EffecifiveFor _ _ Lffe Of The a laic sNYDERG Ni+WPxiLaDELF=xI&ox Signed: - - Nance of: ppPi ter of Fiarne ResLstisnt Finish ANCHOR INDUSTRIES INC. Im NJ ISSUED BYRE€�ISTRATION Date of Shipment S 5 NUMBER � lNDfISTRlE !�� 3t3 OOB OEVANSVILLE, € I A X47725 Tent Identification S 5 MANUFACTURERS OF THE FINISHED 04590588 F140.1 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the Materials described have been fla me-retardant treated 5 or are Inherently noninflammable)and were supplied to, 269800 5 CHRISTIAN DELIVERY&CHAIR SER 5 DSA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 30496576 5 5 5 _ 5 5 Certification is hereby made that: S 5 The articles described on this Certificate have been treated!YAI,h a fla d;-etadrd2nt approved chemical and that the application of said chemical was done in conformance with California Fire Narwhal Cede. All fabric has been tested and passes NFPA 701=99, CPAI$4, ULC 109. Serial 8151210(l) 5 Description of item ce ed: S CENTURY END 60WX20 THOLE SNYDER WHITE VINYL WITHOUT WEB GUYS Flame Retardant Process Used Will Not Be Removed 5Washingd is Effective For The Of The Fabric SNMER MFG NEW PMLADMPHIA,OH Signed: Name of Applicator of Flame Resistant Finish ANCHOR BNCri#6TI?€ES 3NG 5 Certificate r i REGS 0C TENTS MAO bUWd� APPi tCi nUN 2665 COLUl9 ST moxruP�ak�aeasd CONCERN No. TORRANCE,CA,00903 2008 (600)2204687 021 Thts is 10 offft Mg Me maftdds desMbodbojowhweahava boon Hsrna of (or aro InhomW nonflammeblo). FOR CHRISTIAN PARTYRENTAL 18 CLINTON DRFVE � r HOLLI ,PIH 03 QT> CerfW cndon Is hemby made that (check"'a"or"b'q (;r) The articles described below thls carfificate have been treated with a flame retardant chemical approved end registered by the.State Fire Marshal and that the,applicationof said chemical was done to confor- mance with the laws of the State of California and the Rules and Regulations of the Stato Fire Marahal. Name*1 chemical used Chen.Reg,Pio. . ..,_......., meathod of application............. „...„....�...,.... ...... ..,,.,, ..,,�,.�..,,.. ....,.. (b) The articles described below hereof are made from a flama-resistant fabric or material registered and approved be the Stdo Fire Marmhal for such use;Fabric hat been tested and oasses NFPA701.96, Trade name of ftama»resistgnt fabric or material used.. .Reg.No..—MAK-- The Flame o..,.,..F,•.fiitA.t.,V..».1Chetatrte Retardant Process lld.Wlt�. ?.orva ....... Removed >btirtg David Bradley Chuck Miller d 'resident CUSTOMER ORDER NO. 8168629 ITEMS MANUFACTURED: 2-ZWO Fey rap VW VI th Double V "-2OK fii d 7'ap CiWWHh Double V rnrt .Jumbofto Top UW 6-4OxlOJ Ir Middle Trop UW P«16WO Sense 2WO Middle UW t 2.2040 Sart"1500 1pe.Topr4 UW 2-20WO Sodas IWO 1jea Torr UW 2-2WO Sodas ISM W.TOP OW t PDF created with pdfl"ectcry trial version www.r)dff tory c_om 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 Please Print Lezibly 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: Type of project(required): 1.Q I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.F_�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ®Building addition 4.❑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 11.❑Electrical repairs or additions proprietors with no employees. 12.EJ Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t p 14.�✓ Other TENTS 6.❑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.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation 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. $Contractors 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:—//V//V/ � 4" 9w lew City/State/Zip: /y ',4,;?W,,Gle.-I N,4QA7 ' 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 under tl: pains and penaltie of erjury t the information provided above is true and correct. Si nature: �I/ f Date: Phone#:603-883-5326 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#: NEW HAMPSHIRE MOTOR TRANSPORT ASSOCIATION P.O.Box 3898 Concord,NH 03302-3898 (603)224-7337 CERTIFICATE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A 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 OR PRODUCER,AND THE CERTIFICATE HOLDER. This is to certify that: Christian Delivery & Chair Service Inc. DBA Certificate#: 1 Christian Party Rental 18 Clinton Drive Hollis, NH 03049 Is,at the issue date of this certificate,insured by the Company,under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and conditions and is not altered by any requirement,term or condition or other document with respect to which this certificate may be issued. COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATE: NH TYPE OF POLICY EXP DATE POLICY NUMBER LIMIT OF LIABILITY Continuous` Extended Policy Term Workers'Compensation 09/01/2016-01/01/2017 P000749NHMTA2016 Bodily Injury By Accident $1,000,000 Bodily Injury by Disease Policy Limit $1,000,000 Bodily Injury by Disease Each Person $1,000,000 ADDITIONAL COMMENTS: '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 applicable unless a number 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: NH MOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST Christian Delivery&Chair Service Inc. dba Christian Party Rental 18 Clinton Street Hollis, NH 03049 Authorized Representative Concord,NH 603-224-7337 03/25/2016 Office Phone Number Date Issued