The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #790 - 1 HIGH STREET 6/4/2010 BUILDING PERMIT o`tt��°NORT/1 TOWN OF NORTH ANDOVER �� : - °� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Too , ��SSACHUSE�� Date Issued: sV--lo IMPORTANT: Applicant must complete all items on this page 00 LOCATION Print PROPERTY OWNER � . Print MAP NO: PARCEL: , ZONING DISTRICT i Jiistoric Distract yep no t Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two.or more family _ Industrial eratio No. of units: c 9 g ffm—e—rcial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well R Floodplain R : Wetlands 'W at District Water/Sewer. ' DESCRIPTION OF WORK TO BE PREFORMED: -7 -ec- CL y0 'X eo' 9=-,5?c>' araa ' %177a0"n* %ems �►-, v oi/r/ O'k, � A/(o/ 2m o0/r�/ Identification Please Type or Print Clearly) OWNER: Name: �,r a �� -e- Phone Address: t x } tQ CONTRACTOR Name: , 7 a� ,� _ Phone ' %7 :- Address:/ 3' 't,✓o , s F. Supervisor's Construction License: 60,;z exp. Date: 7 li, F� L. Horne Improvement Licenser _ 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: $ 93 Crt� �' FEE: $ C� Check No.: S S I Receipt No.:_3 O� V NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Ovuner Signature of contracto � �� "� I', Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpsterr-on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS y HEALTH Reviewed on Signature COMMENTS ZoAng Board of Appeals`.Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE"DEPARTMENT - Temp Dum ter on site yes Located at 124 Main Street fire Department signature/dat y ,4 , cZ COMMENTS� : . 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 requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 1 Building Department The following is a list of the required forms to be filled out for thea appropriate opnate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or.Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Ij ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the'Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTI%IENT:BPFORM07 Revised 2.2008 Location l No. Date MORtiy TOWN OF NORTH ANDOVER f?;o • Op ` Certificate of Occupancy s i �7 J•+^° tt� Building/Frame Permit Fee14 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � �S 23240 Building Inspector OrfrJLL3_PL P[Pff sr��Pr�c Pr�r�cPrJ�rl IMPORTANTDOCUMENT�rJ�rJ��P�PrJ�r��rJ��P�PrJ�cPr�ePrJ� 0 � �r� ' 5 rtiflea of ]lam 5 ISSUED BY 5 Date of Shipment 5 h 5 REGISTRATION o- '` CH®R 5/12/2008 5 INDUSTRIES INC. 5 NUMBER 5 x . 5 rF �i EVANSVILLE, INDIANA 47725 Tent Identification 5 5 5 F140.1 �y E�� MANUFACTURERS OF THE FINISHED 04618268 5 5 TENT PRODUCTS DESCRIBED HEREIN S 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 657150 5 5 PETERSON T CENTER INC 5 r5 139 SWANTON ST5 5 WINCHESTER MA 1890 5 5 5 5 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved e5� 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 5 Serial # 5 5 8108975(2, 5 5 5 SDescription of item certified: 5 5 C_ CENTURY MATE EXPANDABLE MIDDLE 40WX20 SNYDER WHITE VINYL C5J 5 Flame Retardant Process Used Will Not Be Removed By S Fabric f The For The Life O5 5 Washing And Is Effective 5 SNYDER MFG NEW PHILADELPHIA,OH Signed• 55 ANCHORINDUSTRIES INC.Name of APPicato _ f Flame Resistant Finish 5 Pr��Pr1r�r Pr1�l��P�PrJ�r�r�r�rJ�rPrJ�rl�P��Pr��P�r��Pr�r��Pr�rSrJ�rJ�cPr Pr J� Ell P�Pr�rJ�rJ�rJ�rJ�cD�PrprJrjP 1�rJ�rJ�rJ�rJ�rlr�rJ�r�rJ�rlrJ�rJ�cPrJ�cPr�rJ��PrPr Pr�cPrJ�r NORTH O _ __ Andover own ..w,.w.w .,;.F• .r. 0 No. h - o dover, Mass., o �. 11 COCKICKEMCK 7�S RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........... '.................................................................................................................. Foundation has permission to erect........................................ buildings on ....... .................................. Rough �G' �/'�i �G �o tO��l V Chimney to be occupied as.............................�� .......................�.................. .......................................................................... provided that the person accepting this per it shall in every respect co rm to the terms of the application on file i Final 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 CONSTRTI SART Rough Service BUILDING INSPECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 0r�rJ �cPrJ�cPrJ�c.PrJ��c�rJ�r�rJ�t:PrJ�cP�fi IMPORTANT DOCUMENT LJ��[��[��[��[�� a A 5 . 5 .. t aY.r pe Li 5 S REGISTRATION ISSUED BY 5 APPLICATION a ' Date of Shipment 5 5 5 NUMBER :� Q°o NDUSTRIE INC. 5/10/2006 5 � 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 5 MANUFACTURERS OF THE FINISHED S 1'140 I TENT PRODUCTS DESCRIBED HEREIN 04278316 5 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 �. S PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 5 WINCHESTER MA 01890 5 5 5 . 5 5 5 5 1 5 5 <,f. SCertification is hereby made that: S 5 The articles described on this Certificate have been treated with a flame-retardant approved S chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. A!! fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 F7 Serial # S 5 810898 (2) 5 S Description of item certified: S 5 CENTURY MATE EXPANDABLE END 5 5 40WX20 SNYDER WHITE VINYLo 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 55 5SN44)F;R _ i:G Lr 141 PHIIAQgu2WI'4'114 Signed: j Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 ti O LI�LPCPCPCnCnL PCnCICPCnLTCPCnCnC nC I ® �� ®®� q 1/Y �cl��fr�rJ�r P�PrJ�r�cPrJ�rJ�cPcPr�rJ�r� Ok ; 5 Cortif of Fla S } ' ' S REGISTRATION ISSUED BY Date of Shipment 5 5 APPLICATION p SNUMBERINDUSTRIE INC.® 5/10/2006 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 r 140.1 v FINISHEDMANUFACTURERS OF THE ENT P ODUCTS D SHEREIN EREIN 04278316 g HER 5 This is to certify that the materials described have been flame-retardant treatedr. 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 % 5 PETERSON PARTY CENTER INC I 5 139 SWANTON ST 5 5 5 5 WINCHESTER MA 01890 S 5 5 5 5 S S SCertification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S Schemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serial # 5 5 810898 (2) 5 5 SDescription of item certified: 5 CENTURY MATE EXPANDABLE END T 5 40WX20 SNYDER wEnTE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 - 5 Washing And Is Effective For The rife ®f The Fabric 5 5 5 5 cNvnrn N411GNr.�z'curl n9Signed: Pj Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 [-]10 U PrJ�cPr��PrJ�rJ��PcPcP�Pc1rJ�rJ�rJ�rJ�rJ�rP�frJJi?J�rJ�r��lr��l��PrJ��PrJ�cPrJ�rJ�cPrJ�rPrJ�rJ��Pr��PcP�PrJ��r PcP�PrJ� [� ' o r�rJ�rJ�GPrJ�rJ�cPc��f�Pcn�Pr_.(r�rJ��cr ��r r�►�r��n�n��l��r��o � �� IMPORTANT ®OCU DOCUMENT �4 rtlf le t �f Flamm tom? t� 5 ISSUED BY 5 REGISTRATION Date of Shipment 5 5 „6. APPLICATION o- s� �� ® 5/10/2006 5 NUMBER s INDUSTRIE INC. � �h"'; t+ 5 5 Tent Identification EVANSVILLE, INDIANA 47725 5 MANUFACTURERS OF THE FINISHED 04263446 5 NJC Sr' F140 1 TENT PRODUCTS DESCRIBED HEREIN 5 r: 5 This is to certify that the materials described have been flame-retardant treated Sri t; 5 (or are inherently noninflammable) and were supplied to: ` 5 5 5 S 657150 5 PETERSON PARTY CENTER INC 01 ` 5. 5 NS T139 5 5 139 SW ANTO 5 5 � . 5 WINCHESTER MA 01890 S 5 5 S 59r S 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with aflame-retardant approved 5 S 5 chemical and that the application of said chemical was done in conformance with California 5 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 S 5 serial # 8001600(4) 5 5 5 5 5 Description of item certified: 5 FIESTA TOP 20WX20 WHITE 5 5 SNYDER 91023970A 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 55 5 Signed: S Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 ED rJ�r�rJ��nr�rJ��rP�rrJ�r�r r�nr�rJ��nr�rJ�r��P�r�r�r�rJ�r�rnr�rJ�r�r�rJ�r�rl�cPr�c�r�r�rJ�rPrPr�cPrP09.1�P��PcPrJ�rgpnr�rJ�r�rJ��nr��rr�rJ�rJ�cl�rJ�r�rP�P�nr�cPoP a The Commonwealth ofltlassachitsetts i•� Department of Industrial Accidents 7t'! Office of Investigations r— -i 600 Washington Street Boston, MA 02111 `-- rV iviv.in ass.go v/di(t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A ) licant Informatiort Please Print Le(ibly Name (Business/Organization/Individual): /L Address: /3y City/State/Zip: `j o c Phone Are you an employer? Check the appropriate box: 1. I am a employer with -c> 4• ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6• ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees — These sub-contractors have working for me in any capacity. employees and have workers' 8 ❑ Demolition [No workers' comp. insurance comp. insurance. 9• ❑ Building addition required.] - 5. ❑ «'e are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers comp, right of exemption per MGL P insurance required.] c. 452, §1(4),and we have no 12.❑ Roof repairs L employees. [No workers' 13.®Other C7/ 1.. 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. I fo an employer that is providin 7wokers'contpensatio)r_iasuratice for nly-employees. Below is the policy and job site l/ifOY/7iati0/1. Insurance Company Name: _1A Policy#or Self-ins.Lic. C Z/1 tiv O 9 �j Expiration Date: -O `1 �D Job Site Address: �/ City/State/dip: .ti Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalesfine 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify)order the pains an enalties of perjury that the information provided above is tri e and correct. Siznature: ' Date: Phone#: 791, :7 p?`j— e-1 O-X� 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 Inset ctor 6. Other Contact Person: Phone#: Del)a.rimi tlt tjf' 1't1I)l'C B(lil(lln�r ` !!! R�u�uiatil►nx and -stalldal-ds Construction Supervisor License License: CS 60219 Restricted to: 00 .K MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 Tr#: 14425 3 (�/� Client#:6�A3y5556 �p9; �pq�PEETERPAR2 ACRD. CERTIFICATE ®F LIABILITY INSURANCE DATE(MMIDD/YYYY, 4/6/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI Ins Sery of MA,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O BOX 920444 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Needham,MA 02492 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hanover Insurance Company 22292 Peterson Party Center Inc 139 Swanton St INSURER B: Liberty Mutual Insurance Company 23043 Winchester, MA 01890 INSURER C: INSURER D: INSURER E: COVERAGES 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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR1 TYPE OF INSURANCE POLICY NUMBER DATE MM/DD Y DATE IMMIDDNYI LIMITS A GENERAL LIABILITY ZBN6482025 10/09/09 10/09/10 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300000 PREMISES(Ea occurrence) CLAIMS MADE ®OCCUR MED EXP(Any one person) s5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PRO- - JECT X LOC A AUTOM061LE LIABILITY AMN6398554 10/09/09 10/09/10 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY .. X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X $NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLALIABILITY- UHN6482021 _ 10/09/09 10/09/10 EACH OCCURRENCE $5.000.000 50 OCCUR FICLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $None $ B WORKERS COMPENSATION AND WC2Z11259617029 10/09/09 10/09/10 X WC STATU- OTH- EMPLOYERS'LIABILITY TORY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER ander EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER "ESCPIPTION OF OPERATIONS/I OCATIONR/VFHICL.ES I F-e-I USIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S4312552/M4063373 BJECG 0 ACORD CORPORATION 1988