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HomeMy WebLinkAboutBuilding Permit # 10/11/2016 BUILDING PERMIT cp TOWN OF NORTH ANDOVER ORTH 0 APPLICATION FOR PLAN EXAMINATION Permit No#: OJ r9 Date Received v)IL,�lt S I,CH date Issued: ------ IMPORTANT: Applicant must coinplete all items on thus page; LOCATION Print no PROPERTY OWNER &7e(Z,,ijMecL- Print i00 Year Structure yes MAP PARCEL: ZONING DISTRICT:_--,--.,Historic: District yes no Machine Shop Village yes, no ------------------ TYPE OF IMPROVEMENT PROPOSED USE Residenfiial Non- Residential' flew Building LJ One family 0 Addition 0 Two or more family 0 Industrial I]Alteration No. of units: 0 Commercial ri Repair, replacement El Assessory Bldg 0 Others: 0 Demolition 0 Other ---------- 01 01,111 VI'M I!e DESCRIPTION OF WORK TO BE PERFORMED: Ile, aq f/j ele, j4v 4,w pe or Print Clearly Phone: Address: 3 AVIA e Contractrorame/- 'ok, chone: 7 mail: e, 7rn 3 T7- Y, A Q.I)z7itle . 6�11 Address.- c Supervisor's Construction License: 0' &_g�- Le' Exp. Date: V7 --Home Improvement License: A0 Exp. Date ARCHITECT/ENGINEER Phone: Address: -Reg. No. FEE SCHEDULE;BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $_ « V-0 Check No.: Receipt No.: /Q NOTE: Persons contracting with unregistered contractors (to not have access toj&. fund oao"Ibvw Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TWE OF SEWERAGE DISPOSAL PnblxcSewe�r ❑ TaaaniuglM'assagelSociy.Art ❑ S�"„"�TngPaa� El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ p PAVato(septic taaak,etc. ❑ Permanent Dumpster on Site ❑ i i F THE F'OLLO'WING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM /LAMNING DEVELOPMENT Reviewed On �� Signatures COMMENTS CONSER'V'ATION Reviewed on 7 Signature COMMENTS 1 EALTH Reviewed on Si nate e 14 COMMENTS r Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter Surer ConnectioniSi nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street CRE�DEPARNMENaT Ternpb®dmpster an,site ;yes na� ' Locafedtat`31�24lMa€nyStreet � �..��_�._�M:�•x. _ �� _ � � -�.�.� '`"rre ®epartm�nts[g �tureldae � � 9 � � COM1111ENTS e. ` Dimension Number of Stories: Tonal square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.. ELEGTRIGAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector PA,NGFR ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G rnin.$1o0-$lobo fine NOTES and DATA -- (rerr deparrt rues ra e� 1Gd V— CI Notified for pickup Call Email Date Time Contact Name Doc.Buflding Permit Devised 2014 tkORTly '� Town of -.IF bAndover 0 . ;r 0 No. C,, ,.K. h n ver, Mass, _I O coc"Ic"IWIC.[ � U BOARD OF HEALTH PERMI.T T %; LD Food/Kitchen Septic System THIS CERTIFIES THAT �� S N �ft��� BUILDING INSPECTOR � has permission to erect .......................... buildings on ......��...................,,..,,,,,�,.p../��,0,,,,._„ Foundation to be occupied a5 ......�1�.�G.T.......? . , �o � Rough ENT . . �................ . ............... C h mney provided that the person accepting this permit shall in every respect conform 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRESI MONTHS ELECTRICAL INSPECTOR.. LES CTI T Rough 4 4 .............. .. . .,.. I...................."" Service Final BUILDING INSPECTOR GAS INSPECTOR ®ecu ane emit Required t® ®ecu Buildtn Rough 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 pet. 6'x W harm ing banners(9)total SULLIVAN =Drape total 190'of dtape BUILDING totem with Plasma screen, PARKING LOT ( i� ��h II III °11 I IV����I°'II li 1`s II�SIIII WdYttinlllU �� lo'x5• � �.a 00 ar Coohectar lo.x � Catering I Ga � Ln t=brinNc#Ur I � end [ N r &. LMINIp n b G es. IUr4' IV tf ROAD-VALET Parking Lot GRA 20'x 40' 1 , 8„ catering ® ' 1 3 41 211 11 O i l Sullivan 1, 00' x 131 ' 7 J n � 15' x 25' connections 41 ' x98' 8 4-1 - 0 C a: a Entrance Pathway E The Commonwealth ofMassachusetts Depai-Intent oflnrlrtstrialAl ceiderrts a .Z Congress.Stec=et, .Shiite 100 Bostoit, MA 02114-2017 iviviv.rruiss.gov/tlia _ Workers'Compensation Insurance Affidavit: 13ui1tEers/[ontractorslEEcctrieiarrs/Plntrrhers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le iltl Name (➢usit,e5s/OrgatiizatioiVlndividual):Peterson Party Center Address:36 Cabot Rd City/State/Zip;Woburn,Ma Phone#:781-729-4000 Arc you an employer?Check the appropriatc box: 'Type of project(requireti): l.[]✓ t am a etnployer wish 200 employees(roll and/or part-time).* 7. FINew construction 2.®1 ant a sale proprietor or partnership and have no employees working for me in $, ❑Renlodeling any capacity,[No workers'comp.insurance required.] 3.01 am a 110111eowncr doing al]work tnyscif.[No workers'comp,insurance required-)t 9. ❑Demolition 4,E]l am n homeowner and vvill be hiring contractors to candt:ci all work on my property. [will 10[] Building addition ensure that all contractors either havc workers'cornpensaliorr insurance or are sole 11,0 Electrical repairs or additions proprietors with no employees. l2.❑Pluinbing repairs or additions 5.®t am a general coutraclor-and t have hired the sub-contractors listed on the attached sheet, These subcontractors have employees and have workers'comp.insurance.' 13•❑Roof repairs 6.❑Weare a eorlrnration and its officers have exercised their right ofoxemption per 1vIGI,C. t4,[]✓ Other Temporary Tent 152,§1(4).and we have no employees,[No workers'comp.insurance required.) *Any applicant that checks box 0 must also fill out thcsection belowshowing their workers'compensation policy information. Y Homeowners who submit this affidavit indical€rig they are doing all work and then hire outside confraclors must submit a new affidavit indicating such. tContractors lhat check Ibis box must attached all ad(Injopal sheet showing the na¢ne of the sub•contraclors and suite whctircr or not those entilies have employees. lt•tlte sub-contractr)rs have etnployees,they must provide their workers'cornp.policy nurnber. I aril an employer that is provldinl;rvarlce"S� coitrpeitsatiotr insurance for my emplghees, Below is the policy and job site information. insurance Company Name:A l M Mutual Ins Co Policy ti or Self-ins. Lie, 0:WMZ8008006586 Expiration Date:1019/16 Job Site Address City/state/Zip; Attach a copy of the workers' corn}ensatio'r ]otic (1ecl�l ntit���_ya sc lrossin tine..policy-number-and-expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a critninat violation punishable by a fine tip to$1,500,00 and/or one-year imprisonment,as welt as civil penalties in the form of Ir 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 raider the P 'ris and alties of perjury that the lraforntntion provident above is tt•rre ride rice! Si Mature: t Date: /C? (0 Phone 9:781-729-4000 Official itse only, Do Trot rvr•ite itt oris area, to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Cleric 4, Electrical Inspector 5.Plumbing Inspector 6Other Contact Persou: Phone#i: CERTIFICATE LIABILITY INSURANCE 9%26/2016' 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(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 CONTACT Michael Bonacorso NAME: Bonacorso Insurance Agency, Inc. PHONE Ext1, (781)937--3200 FAIIC No:(781)937-3202 10 Cedar Street EMAIL ADDRESS:michael@bonacorsoins.com Unit # 32 INSURERS AFFORDING COVERAGE NAIC N Woburn MA 01801 INSURERAAcadia Insurance Co. INSURED INSURER B AIM Mutual Insurance Co. PPC EVENT SERVICES INC. INSURER C: PETERSON PARTY CENTER-TABLE TOPPERS OF NEWTON INSURER D: 36 Cabot Road INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER:PPC 2016 / 2017 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, 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. INSR TYPE OF INSURANCE ADUL SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER MMlDDIvYYY IY MMIDDYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETE COMMERCIAL GENERAL LIABILITY PREMISE REM SES a oNcur ante $ 250,000 A CLAIMS-MADE DxOCCUR PA5061026-14 10/9/2016 10/9/2017 MED EXP(Any one person) $ 5,000 PERSONAL 8.ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'(AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000 000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED AAA 5063173 19 10/9/2016 10/9/2017 BODILY INJURY(Por accident) $ AUTOS AUTOS X NON-OWNED PROPERTY pr d c+dent DAMAGE $ HIREDAUTOS AUTOS Ulm IUlm $ 1 000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DEO RETENTION$ rUA 5173916 10/9/207.6 10/9/2017 $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYTORYLIMITS P ANY PROPRIETORIPARTNEWEXECUTIVE[ NIA E.L.EACH ACCIDENT $ l.'...000'000 OFFiCERWEMBEREXCLUDED? �F Ze008006586 0/9/2016 10/9/207.7 (Mandatory in NH) E.L.DISEASE-FA EMPLOYE $ 1.'.00 D 000 1f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLUY LSMIT $ 1,000,_ 000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 S. Bonacorso ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 i7ninnn ni Tln� AC'C1Pn nnma nnrl€nnn nra ranicfc.rnrl mnrlec of Ar..r)Pn IN P 13'sho—Gic"husetts . DOPaMment of PON SaNty V t3cmrd of BuHIng n d St a n d i r ds License: CELOG0219 Mark Traina 33 lbnfurd Rood Stoneham MA 02180 v 04/27/2017