HomeMy WebLinkAboutBuilding Permit # 5/4/2016 LLCPO EER tl ��'��`'_ " ''� ° 0.
TOWN OF NORTH ANDOVER 0 ; +
APPLICATION FOR PLAN EXAMINATION
Permit O:� � '� Date Receives]
Date Issued: SA
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TYPE OF IMPROVEMENT PROPOSED USE .. "'
Residential Non- Residential
1-:1 New Building -1 One family
[-] Addition r] Two or more family 0 Industrial
FI Alteration No. of units: iJ Commercial
0 Repair, replacement 0 Assessory Bldg Y Others:
Cl Demolition F] Othereii
71,
",1;- l6cawplamt31J1� tl�rd 1 1J]tth c Lts er�t
0,Y)OV'e-P 40"", As
Identification Please Type or P °int C learty)
OWNER: Dame:
'7-)� w .. , ,° 1 We, Phone:
_ _- U�
Address _
_ _
777
OY � t A �� t oo ' ' 77-77,77-77
ho p
tipervtsot' Cot t� o o � I t
�, 77-
' W "'t" tt4lt/ t �t�a �'��
ARCH II ECT/ENGINEER _
Address:_.__
FEE SCHEDULE BULDING PERMIT.$92.00 PEI?$9000.00 OF TNF TOTAL ES77MATED COST ,ASEC ON$125.00 PEP S.F.
TotaChop PIa°oot Co 't: _m«� EEE
. :
L "
_
_ _. .�Recc P�t No.: � '� .
NOTE: Pei-sons contretelhig with utir q istes,ed conli cactoi-s (lo riot hive access Io the gtrczrwity fiind
' " n turghattire of contractor,',� of A entft
��� i
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 req*Oires approval of
Electrical Inspector Yes Flo
DANGERZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
LJ Notified for pickup Call Email
Date Time Contact Name
.............
Doc.Bufld.mg Peliuit Revised 2014
FORTH
Town OfF t E ,
sL - L
lictuver
O t�
i !S
No. 26i�
C, h ver, ass,
O "" AA 1 4.1
SQA COCNICM6WICK �� P
�•9 °RATED PP�`� �S
S �
11 BOARD OF HEALTH
Food/Kitchen
ERM_ JT L �D Septic System
I�A
BUILDING INSPECTOR
THIS CERTIFIES THAT ................ ...... ........ ..... ..........1..1..11..................................... ........ ..................
Foundation
has permission to erect .......................... buildings on ..... . .... .�.�. .... .�:..
c Rough
to be occupied as .Ae ... ..... ..... . ........ .. .......... ..... ................ ...`�.. ...... Chimney
provided that the arson ecce in this ermit shat neve res act conform to the terms of thea lice Ion
p P g p rY p pp 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST
Rough
Service
.............. Fina0j=a7iXN
PECTORBUIL
GAS INSPECTOR
ccupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
Lathing or Dry Wall To Be Done IFIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
orJ�r PLprrri pr prr PC PdapddJ LJPL�ln11r_(jfi T D Oi EPr-PdL 7rJLPLPLPLPL Pr-PrPr��P (�
REGISTRATION ISSUED BY
�.>� Date of Shipment
S APPLICATION � �5 r � 5/12/2005
���I
NUMBER INDU61HI ' S
INC.
5 '`5 Tent Identification� EVAN a'�/1&.,.fi,...E, INDIANA 47725
5 19
F 140.1 MANUFACTURERS OF THE: FINISHED 04048575 5
Ij TENT PRODUCTS DESCRIBED HEREIN a 1
'chis is to certify that the materials described have been flame-retardant treated j
5 (or are inherently noninflammable) and were supplied tua:
C� 657150
S PETERSON PARTY CENTER INC S
S 139 SWANTON ST 5
S
5 WINCHESTER MA 1890
5�
Certification is hereby grade that: S
SThe articles described on this Certificate have been treated with a flame-retardant approved S
Schemical and that the application of said chemicalSAAias dove in conformance with California S
j Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109.
Serial # 810,9985(2) 5
A
c�
Description of item certified: _ 5
ry5
CENTURY IVIATE EXPANDABLE END
40W\20 SNYDER WRITE VINYI,
5 F1� e Retardant Process Used '�ifl Not Be Removed By 5
Washing And 6s Effecti e For The Life Of The Fabric
r5lj. SNYDER MFG NEW 111-1ILADELPHIA,OI-1
SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 51
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1 657150 C�
PETERSON PARTY CENTER INC
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1f 139 SWANSON ST
ICI
WINCHESTER MA 01890 ]
ELi �
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p "�Nu1,C !_fOO� ,., hereby �c +,a • .
h 1901
I� 1 hV-� <a OF ''- C"°; described�V NII,.�ed p r7 i U 1�,I r1.;^r 'a..--F=a", iI" .i,l+'r-n f , '7f,T. r �.,. �,^ l.�� a�";.1�-:d�,.�,...� �. 'tl r�1 n^,i" U@,9"'' a 1i
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CENT MATE EXP MID 40W\20 SNY �
Rlann, pp ulJco ,'� Us41^7nd 1fdu E, ,
For CM,U^z leC Inl
r1i — -- a u°Y C TM ENT F''f9r u'0 a �',DU:TRIES I�IC.
-,:;, , r 7:7`t3Fi" .7. =S p:7"�i"-1 1 `S :7[rl��i!_7,_.1 :. 1=i'7 r7'"l'7 .Y
1,,J 1�1c�G,11..�rJr✓fi?��.fi�l�_Cr.S�f�.Ji����sr i�..��6�fr. e�.l%,i ir_1__9_Ir_Ir..��i_li,�l__�-.f�::.fi_.f�_f�fu_.,1^_ r_._ . ..'.:__:_9.,8�:�..I`11_f_1u_I¢._fi_ltl_13.�..�._c.lt_t!I__a�..lr_.C_ltwlr__I��.iu�.l_:�
The C 0111,1tiontveadth of Alassochitsetts
Dep aptmeiit of hithistrirrlAcciderits
t ;� 1 Coil
street, .S"err` e /00
Boston, HA 02114-20 7
tvim.masS.gOV1fhQ
\l ot•kci-s' Compensation Insurance Affidavit: Builtlens/('ontractors/Electricians/Plumbers,
TO BE FILED NNATII THE. I'LRI,HTTINC AUI'HORYFY.
Aptllicant Information Please Print Legibly
Name t[3usincss/Organization/Individual):Peterson Party Centel'
Address:36 Cabot Rd
(,;t,,,ice„r » Woht_Irn,Ma 781-729-4000
�., iUuntiri]l�. YnOne itt.
Are you an employer?Check the appropriate boy: --
I.�✓ )am a emplover with 200 cmhloyccs(full audlor earl-lime). 'E'ype of project(required):7. l__I New C011S111 1Ct1011
2.E]I am a sole proprietor or partnership and have no employees working forme in
b. Remodeling
any capacity.[No workers'comp, insurance rciluired]
3.01 am it homeowner doing all work myself. 1No workers'comp.insurance required.]t 9. ®Demolition
10 [] Building addition
d 1:1f am a homeowner and will be hn nag contractors to conduct all work on my property. I will
ensure That all coniractor:s either have workers'compensation insurance or arc sole 11.(] I",Iectrieal repairs or additir
propnuors with no employees
12.�Plumbing repairs or
5.0 1 am a general contractor and I have hired the sub-contractors listed on tile attached sheet.
These sub-contractors have emplo'ees and have workers'comp. insurance'- 13.E]Root'repairs
6 E1\vc are a corporation and its officers have exercised their right of exemption per MGr,c.
14.E]Otbel'Temporary Tent
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Am applicant That checks box HI must also fill out the section below showing their workers'compensation policy inlbrnaation.
I lonacowncn who submit this alldivil indicating they are doing all work and then hire outside contractors must submit it new afridavit in<hrating such.
Con(ractors that check This box must attaehed an additional sheet showing the name ol'the sub-contractors rand state whether or not those entities have
eu;pleyecs If 111c Daub contractors have employees.they must provide their workers'comp,policy number.
I tun an employer that is providing workers'compeaasation insurance for njy employees. Below is the policy and job site
iuf oraaaation.
Insurance COnlpany Name:A I M Mutual Ins Co
Pol icy# or Selt-ins. Lie. #:VVMZ8008006586 Expiration Date-,10/9116
Job Site Address:_ J1, City/State/Zip:
Attach a copy of the Nvo rkers' competraation policy declaration pagc_(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 Iierehy certify guider the pants react penalties oj'perjury that the irtfnrnaation provider!above is In a ant/correct
Signature: Date.
Phone#:781-729-4000
Official iise only. Do not write in this area, to be completer)by city or town official
City.or"town: Pcr mit/L,iccnsc # �l
Issuing;Authority(circle one):
I. Board of I-Iealth 2. Building Department 3.CitylTown Clerk 4. Electrical Inspector s. Plumbing Inspector
G. Other
Conhtc6 Person: __ Pllone#: I
LIABILITYCERTIFICATE OF DATE(MMiDDlYYYY)
F9/24/2015
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 NAMPCT Michael Bonacorso
Bonacorso Insurance Agency, Inc. PHONE (781)937-3200 FAX (781)937-3202
A c Not:
10 Cedar Street E-MAIL
ADDRESS:michael@bonacorsoins,coin
Unit # 32 INSURERS AFFORDING COVERAGE NAIC#
Woburn MA 01801 INSURERAAcadia Insurance Co,
INSURED INSURER B:AIM Mutual Insurance Co.
PPC EVENT SERVICES INC / PETERSON PARTY CENTER INSURER C:
TABLE TOPPERS OF NEWTON INSURER D
36 Cabot Road INSURER E:
Woburn MA 01801 INSURER F!
COVERAGES CERTIFICATE NUMBER:2015 / 2016 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERRA 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR 4WD( POLICY NUMBERMhL'DDIYYYY (MhIIDDIYYYY1 LIMITS
GENERAL LIABILITY EACH OCCURRENCE 3 1,000,000
RENTED
X COMMERCIAL GENERAL LIABILDAMAGE TO ITY PREMISES tEa occurrence 3 250,000
A CLAIMS-MADE Q OCCUR PA5061026-13 10/9/2015 10/9/2016 NIEDEXP(Any one demon) 5 5,000
PERSONAL&ADV INJURY 'y 1,000,000
GENERAL AGGREGATE g 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMROP AGG S 2,000,000
POLICY -X] PRO- LOCI I ` g
AUTOMOBILE LIABILITY CObIBIacciNdED SINGLE LIMIT 1,000 000
iEa
ent)
A ANY AUTO I i BODILY INJURY(Per eersen)
ALLOVINED X SCHEDULED 1 L3i1 500'3173 13 10/9/2015 10/9/2016 o
AUTOS �AUTOS i BODILY INJURY(,er acddemt(e
X T c
P11
NOI-O':`!I`iED PROPERTY DAMAGE
HIRED AU0S ALTOS 1Per ac idert' I S
U`f L'f�,l 1,000,000
X UMBRELLA LIAB 1X OCCUR EACH OCCURRENCE $ 10,000,000
A EXCESS UA& CLAINIS-MADE AGGREGATE j 10,000,000
DED 1 1RETENTION 5 UA 5173410 0/9/2015 10/9/2016
S
B VIORKERS COMPENSATIONN!C STATU- 0TH-
AND EMPLOYERS'LIABILITY X v_LI tTSER
ANY PROPRIETOR/PARTNER,'EXECUTIVE YIN E.L.EACH ACCIDENT Is 1,000,000
OFFICERMEMBER EXCLUDED? f 7N N I A
(Mandatory in NH) 7MZ8008006586 10/9/2015 10/9/2016 E.L.DISEASE-EAPJPLOYEdS 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS be'.cw E.L.DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Michael J. Bonacorso
ACORD 25(2010/05) Q 1988-2010 ACORD CORPORATION. All rights reserved.
IN.R025tgnirn�t nt T'hn Ar'()Pn nama-4 Innn ara ranictarafl mnrlec of At'npn
..........
Board 4uf8� 9ai4"rG�ti ......
m'vt i 0
CS-0602,H)
Mark Tr,"'lilm
33 1 Wfurd Road
StOlicham MA W180 M
E x p 0 ri
o i r t e,, 0,412772017