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HomeMy WebLinkAboutBuilding Permit # 8/22/2016 t%0RT" BUILDING PERMIT 0 -COLD 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received C IN Date Issued: iy IMPORTANT: Applicant must complete all items on this page N F­"ffilm'�INII 010 .............................. .. ......... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential E New Building Li One family L Addition 0 Two or more family L Industrial 171 Alteration No. of units: F1 Commercial D Repair, replacement F1 Assessory Bldg D Others: Li Demolition E Other & 9 NN /25/)-c-, Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: WWI g ARCH ITECT/ENGIN EER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No., NOTE: Persons contracting with unwgistered contractors do not have access to the guaranty fund '" �gature'c� grp . ...... ........ 'of pORTH Town of q * 6 ndover po - No. lkl— ;ztjq z : Co „Koh ver, Mass, &%4 COC MIC -C. 4 �.qs SATED Ll BOARD of HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ......... e !�........... ..e&.'M 1Q NS BUILDING INSPECTOR .... has permission to erect ............... . ..... buildings on ..., .. ...... Foundation .... .., t ,... ... .�..+ ...., . . .� Rough to be occupied asTerson .. ... ..... ... ...... . ..... ....�. ..... � Chimney provided that theacts tin this ermit shalPin eve re ect conform to the terms of the a Iicationp 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- , LESS C T IST . Rough Service ... ...... , ..., .. .......... .... .. Final BUILDING INSP OR GAS INSPECTOR By o ®ccM t�drn Rough Occupancy Permit Required to,..........._.........� 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 Approved by the Building Inspector. Burner Street No. Smoke Det. No11 Cushing PI Unit D Status: Reservation Chelmsford,MA 01824 Contract#: 7677 www.twinbrospartyrentals.com Event Beg: Thu 8/25/2016 8:OOAM 978-337-9730 Phone Event End: Sat 8127/2016 11:00PM Operator: Eric ........... us Diner I+ft77' Jeannie Grico 978-665-7455 Phone 999 Osgood St, North Andover, MA 01845 Ordered By: Jeannie Salesman: Kyle Delivery and Pickup Delivery: Thu 8/25/2016 8:OOAM -8:30AM Contact* Pickup Date; Sun 8/28/2016 Phone: Used at Address: 999 Osgood St. ; North Andover, MA 01845 Delivery Notes: Jeanie called in and said we are pulling the permit. Please arrive closer to Sam, Qty Items Rented Each Price 1 16x15Ft.High Peak Frame Tent White $259. —$258,00 Tent can beset upon grass,pavement,or a patio and requires an area of 16"x16'for installation purposes.If being set up on pavement or where we can't stake into the ground,make sure water barrels are on your order so we can anchor It down, 4 50 Gallon Water Barrel $12.00 $48.00 Water barrels include a white barrel cover,Customer Is responsible for making sure that there Is a working water spick at within 125'of where the tent will be being set up so we can fill the water barrels.This should be made sure of before we arrive for delivery, 6 6 Foot Banquet Table $8= $48.00 1 Delivery Green Zone Tentlinfla $50.00 $50.00 Delivery Price Is,For Order Of A Tent or Inflatable I Multi Rental Discount ($75.00) ($75.00) Previous Customer 1 Permit Fee $150.00 $150.00 We ora uliing the permit. Delivery is normally scheduled two weeks prior to your rental date. Payments made on this contract: Rental/Sale Paid $100.00 Credit Card Amex xxxx-xxxxx-41009 Auth:215393 Total —i-1-0-0-00 Rental Contract Payment Is due In full at time of delivery.We accept cash or check at time of delivery.Checks can be made payable to Twin Bros Rental: $280.00 Party Rentals,It paying by credit card please call a minumurn of 48 hours prior to your scheduled delivery date,so we can process your credit card.We will be giving you a courtesy call half an hour before we arrive for delivery and set-upt Deposits reserve rental items.Deposit amounts,orders of$500 or less is$100,orders$600 to$1,000 is$20o.Orders$1,000 to Sales: $150.00 $2,000 Is$400,and orders over$2,000 Is$600,Deposits are not refundable If you cancel within a month of your rental date. Delivery Charge: $50.00 This Is a contract. The attached contract contains Important terms and conditions Including lessors disclaimer from all liability for Injury or damage and details of customers obligations. These terms and conditions are a part of this contract-READ THEMI You can view the contract at(www,twinbrospartyrentals.com/rental-contract-policy) Subtotal: $480.00 1 certify that I have read and agree to all terms of this contract.Contract needs to be signed at time of delivery, Hampshire Sales Tax: $0.00 Total: $480.00 Paid: $100.00 Amount Due: $380.00 ,12016 9Z8:54AM Modification# 7 Printed On Fri 8119 Software by Point-of-RentalSof1wafe www.point-of-rentat.com Conlract-Params,irpt(1) The Commonwealth of Massachusetts Department of Industrial Accidents .l Congress Street, Suite 100 Boston,MA 02.114-20.17 r www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/El lectricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Le ibl NaMe (Business/Organization/individual): 1 y f' W �t3 t"G J rl f Addiress: 1 C U� fit,`/1 P l ti c 0✓1 r`� P City/State/Zip: C dvcl t"t J 0 19-,?C(Phone#: q7 r J 7 - 7 Are you an employer?Check the appropriate box: Type of project(required): 1,[JI am a employer with t q employees(full and/or part-time).* 7. Q New construction 2.Q 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 3.Q I am a homeowner doing alt work myself[No workers'comp.insurance required.]t 14 Q Building addition 4.Q 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.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.Q I am a general contractor and I have hued the sub-contractors listed on the attached sheet. 13.F]Roof repairs These sub-contractors have employees and have workers'comp,insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14,D�Other e G? 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. #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. Z arir an eniployei'drat is providing iporlcers'eornperrsation iiisur atice far•iizy employees. Beloit'is the policy acrd job site information. 1 �r _ Insurance Company Name; Y` eS C ctC ca Policy#or Self-ins.Lie,#; W M,—Ll' 3 0,� 0 a Expiration Date: Y 17. Job Site Address: y � cc �, City/state/Zip: 1116,/•A4 V-.r 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 WORD.ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eertify under the pains and penaltles of perjwy that the information provider/above is true and correct. Signature: Date: Phone#: Official use only. Do not ivrite in this area,to be completed by city or tosyl official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: AC�® DATE(MMlDOlYYYY] CERTIFICATE OF LIABILITY INSURANCE 18/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED 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 NAME: Commercial Lines Syette Insurance Agency, Inc. PHCNN Ext): (978)851-6678C Not(978)851-0306 853 Main Street MAX IL ADDRESS: INSURER{SJ AFFORDING COVERAGE NAIC# Tewksbury MA 01876 INSURERa Wesco Insurance Co 25011 INSURED INSURER B: W_- Tim Aalerud INSURER C,, 11 Cushing Place, Unit D INSURER D: _ ..._.._ . INSURER E Chelmsford MA 01824 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1672712744 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, 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTRR TYPE OF INSURANCE INSDL SUER POLICY NUMBER MMIDD[YYY MMIDDIYYYP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F] OCCUR F'T� PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- 1-1 LOC PRODUCTS-COMP/OP AGG $ _.._.,.. JECT _._ OTHER: $ AUTOMOBILE LIABiLITY COMBINED SINGLE LIMIT $ {Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ � AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED I I RETENTION$ S WORKERS COMPENSATIONx PER OTH- AND EMPLOYERS`LIABILITY Y 1 N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVENIA E.I.EACH ACCIDENT S 500 000 A OFFICEIt1MEMBER EXCLUDED? (Mandatory In NH) WWC3220286 7/7/2016 7/7/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may b6 attached if more space Is required) Job Description: Set up of a 15x15 frame tent for an event from 8/25/16 to 8/27/16. Insurance verification Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER- - . _,._ CANCELLATION �\ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jeannie Grico THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 999 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE K Hendrickson, CIC/KAc� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nntanrn i Certificate of Flame Resistance REGISTERED ISSUED 13Y FABRIC Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 10-23-2015 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier, NAME: Town of North Andover CITY: North Andover, MA 01845 Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701', Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G. FTH133, 15x15 Frame Tent 15x15Ft.White High Peak Frame Tent Serial 100499 Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant VInvI Laminates TENT DEPARTMENT,JOHNSON OUTDOORS INC. "Large Scale C