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Home My WebLink AboutBuilding Permit # 4/26/2016 ml �ORTli BUILDING PERMIT of�i�en Ib Iwo TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION !- - j® 1 ' d / r '�99 "Are.rPa��S Permit No#: Date Receive ' I I SS CH Date Issued: � I PORTANT: Applicant must complete all items on this page LOCATION 315- Print PROPERTY OWNER M '"�"�' r��l� Lei r I Print 100 Year Structure yes no MAP 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: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg "thers: [I Demolition ❑ Other F/V7- X r, 55 ❑,Watershed,,D�stnct ,, H ' J D Flood lam y❑Wetlands /A "t7 e. l�Ci.:..s❑Well J ! / ;: l k 3 I F t , r C /' 'k . .. (1. / 5Y' f -1 ✓l Y£M; :,.: s7`wfFj13 ..�,plxv' Y /r , / fI JJ y/-F`l+`/ t ..l r J; tri F Js ✓ zjc aJ 1 J l.'l f 1: /F zlf'`„7 r'/H a��✓/�i''�i'J ✓� �r / /` uVra �Fir , r` r - /riL ✓ r: i -ry 3 � .?r„r ; ^` ✓/,� J r,,,:;M DESCRIPTION OF WORK TO BE PERFORMED: 46 'xg() I , e & 10-errlmli 4- C e4 Identification- Please Type or Print Clearly Phone:9”' OWNER: Name: `�f' s ID - zee Address: i . T 'k-- 0Y-rl , e t�- J_ /V . ® Ver / Contractor Name:(/)riSbA, 1 Pe.� Werk/ Phone C�� Email: '1 e d , am` " +c , e 6 0 Address: I 1o'y`r 1� v� �► r'v Qllrs1. /VP ��34�� Supervisor's Construction License: Exp. Date: Home Improvement License. Exp. Date: .,, if EeTIENGW fEe-rirnlGWER A?A46 �_C)�� Phone:—& Address: Chou oo 12,• tail,s, 1W Z'3ee le Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ � �C FEE: $ �' Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund JAORTy Town of ' fAndover ® s - .h ver, Mass, OLAKE Coc"Ic"t WICK RATE[) Ll BOARD OF HEALTH Food/Kitchen P E r% LD Septic System THIS CERTIFIES THAT . ... . .... BUILDING INSPECTOR . .. ... ...... . . Foundation has permission to erect.......................... buildings on . ..... lwkr ... ll. ,W. A*.... . Rough to be occupied as ......UA.W. .... .. ... .... . . ...�,,..... T... ........ ....................... Chimney provided that the person accepting this permit shall in every respect conf to the terms of the application Final on file in 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 �;MaJ�r ti Zw Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Y3 Service ................................I/............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. i III. i (D (D rn rY�a 4 r I i O C7 C1 4- i..fi. s. . '.�. . �. .]Y . [..]e v A ,,, 'V•- t ,. ,.1 '�": i t .5" '1...-1 ...1: . Y �T V"i0• FY "V' W tlNY Y + Certif trate of if fame Rv5t'!6tanre REGISTERED AZTEC TENTS crate ftabA or APPLICA'noN 2655 COLUMBIA ST manufactured CONCERN No. > roRRANcs,CA 90503 / CAL COMB F-419 b9 flS. (Sl)0)223-3637 ' This is ib eerhTy Mat fhe matailals descHbodbelowhereafhave been flame rotardartf boated(or are inhemnify nonflammable). FOR l CHRISTIAN PARTY RENTAL 18 CLINTON DRIVE , HOLLIS, NH 03049 �-s CertfficaUbn Is hereby made drat:(check«as,or"W9 (a} The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used............................................Chem.Reg.No........................ ldeathodof appilcation............................r.....,.............,.............rr........,..................... (b) The articles described below hereof are made from a flame resistant fabric or material registered and y approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701.96. i "trade name of flame-resistant fabric or material used.. Reg.No.......M?W...... The Flame Retardant Process used etm t�loT..•.... Be Removed by Washing ' {vAII orroAII not) David Bradley Chuck Miller-President ame RWCBWor room MFrAWR Title �1t J J Y J J •`' �4_ ,4 .9�. 4 n .� 0 4 ,�c ,ham,.' ,,.•, r ,,,, .fiti w, o.:.g .,. � �,,,�,, ti.ahoy CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2-2Ox20 Fas&al Top UW with Double Valance 2-2Ox40 twat lop UW with,Double Valance 3-4Ox40 20c,Jumbo Trac Top UIN 0-4Ox2O JumboTrac Middle Top UW I-100x30.Series 2000 Middle UW 2-2Ox20 Series 16W 9po.Top UW 2-20x30 Series 16W 9p-Top UW 2-20x40 Series 9500 9pc.Top UW z PDF created with pdfFactory trial version www.pdffactory_.cam v Cerfif trate of iffame Reot!�tanrp 1 REGISTERED AZTEC TENTS bate traatad or APPLICAnom 2665 COLU14 MA ST manufactured CONCERN NO, TC1iti?ANCE,CA 90503 2008 CAL COMB!-498.01 (800)228-3607 1 Th!s is to cerffy that tate ma6errals dewribed below hareof have been Hama retardant treated(or am Inherently nonflammable). FOR , CHRISTIAN PARTY RENTAL 9S CLINTON DRIVE * . A. •d ✓ 1 HOLLIS, NH 03049 Cerfficaffon is Ir by mane that.(check ta„or"b*9 (a) The articles described below this Certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was done In Confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Nameof chemical used............................................Chem.Reg.No......................... Meathodof application.m.........................................................................._................. 1 (b) The articles described below hereof are made from a game-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701e96. i Trade name of flame-resistant fabric or material used.. " Reg.No.......IfMM...... The Flame Retardant Process Used .MtM21....... Be Removed by Washing < (Wil avA7i aut) David Bradley Chuck Miller- President ameM csta'a' e�rt Trtfe �` r eMINVII 151r` CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2-20x20 pestival Top UW udth Double Valance 2-20x40 Flasilval Top UW with Double Valance 3-40x40 2per JumboTrao Top Uw s-4OX20 JumbaTratc Middle Top UW 1-900x30 Series 2000 Middle UW 2-2Ox2O Series ISW 9pe.Top Ulff 2-20x30 Series 9500 9pe.Top UW 2-20x40 Series 9500 9pc.Top UW f f 4'0 PDF created with pdfFactory trial version www.odffactgry.com 1 fl Y'^V' 1 . �.` .. .1�` F' . K '` ,.1. ..91.,. 'YP ,.y. • I...i `YI .Y Cerfif trate REGISTERED AZTEC TENTS bate troated or APPUCATIOfd 2665 COLUMBIA ST manufactured RN y CONCENO. TORRANCE,CA 90503 CAL COMB x+499.09 (800)228-3887 0212008 77r%s is to certify Phot tape materials dewtibed below hereof have been flame retardant 6vated(or are in fly nonflammable). FOR fit. 18 CLINTON DPJVE HOLLIS, IVH 03049 � Certfflcatfon Is hereby made that: (ch Asa„or"bb,j (a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was done In confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used............................................Chem.Reg.No... ...,...........,.... Meathodof application............................................................................................... (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701.96. r Trade name of flame-resistant fabric or material used.. 1° Reg.No.......M?a.b!...... ' s The Flame Retardant Process Used .!E !TT......e a Removed by Washing (will orvnll not) David Bradley Chuck Miller d President ame orApPY�or ar Tft ! t. CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2 a 20x20 Fasftal Top UW wlth Double Valance 2 a 20x40 Fessilval Top UW/wlfh,Double Valance 3-4Ox4O 2pc,JumboTrac Top UW 6®4WO Jumbo Trac Middle Top UW 9-I00x30 Series 2000 Middle UW 2-2&x10 Series 95M Spa.Top UW 2.2Ox3O Series 9500 Spa'Top UW 2-20x40 Series 9500%pc.Top UW PDF created with pdfFactery trial version www.i)dffaotgry.com j&eq ,,q;taT, S trf ,tatp of jfaMp Cer t t t Ce REGisi ERE® AZTEC TENTS bate treaW or APpucAnoN 2665 COLUMBIA ST manufactured s CONCERN NO, Tf3RRANCE,CA 90503 0212008 CAL COMB r+499.01 (800)22114687 This is to that Me matedals d4scribed below hereof have been Llama rahwdanf ftvaW(or are inherenffy nonflammable). FOR f CHRISTIAN PARTY RENTAL vs Qµ 99 CLINTON DRAO HOLLIS, NH 03049 BOE Cerdficadon is hereby made that. (check"a"or"b'q (a) The articles described below this certificate have been treated witha flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was done In confor- mance with the laws of the state of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used............................................Chem.Reg.No.................. ... � Meathodof application................................................................................................ (b) The articles described below hereof are made from a flame resistant fabric or material registered and 5 h approved be the State Fire Marshal for such use;Fabric has been tested and Passes NFPA701e96. i Trade name of flame resistant fabric or material used.. "' Reg.No.......hf11W...... The Flame Retardant Process UsedYM MqT....... Be Removed by Washing ' (Wil or V41 root) David Bradley Chuck Miller d President amecaor Frrt Trt1a n` ! J l J CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2®20x20 Fas&al Top UW with Double Valance 2 a 20x40 Fes&al Top UW w tih,Rouble Valance 3-40x40 2p o,JumboTrac Top Ulff 6-40X20 JumboTm Middle Top UW 1 b 10WO Sedan 2000 Middle UW 2®2 O Series 15W 1pc�Top Ulff 2.20x30 aeries 1500 9pc,Top UW 2-20x40 Series 9500 9po.Top UW l� PIF created with pdfFactcry trial version www,pdffactory.com The Commonwealth of Massachusetts = Department of Industrial Accidents a I 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.❑✓ I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.M I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3T1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.r__1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL o. 14.[✓ Other TENTS 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. 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.Lie.#:P000749NHMTA20116 Expiration Date:01-01-2017 Job Site Address: �S ��`��/� �/�c City/State/Zip:/f/1 ��f/YC�r, /y 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 th,pains and pe`#lties�of per' that th iformation provided above is true and correct. Si nature: Date: Phone#:603-883-532 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