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HomeMy WebLinkAboutBuilding Permit #1128-2016 - 1160 GREAT POND ROAD 4/26/2016 N`o°T (D BUILDING PERMIT .16 TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION 7D Permit No#: Date Received lV�/ V (`O O p mb �gss124 gc►+�s���5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �v Cs 160,44d Print PROPERTY OWNER E312-0611---S �SCt+Q O i Print 100 Year Structure yes no MAP 1b5 PARCEL: b ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 9-Ethers: T NT-Y ❑ Demolition ❑ Other ❑ Septic [I Well ❑floodplain q Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ()n 0 d by Lit 6-112#6 use, cu a kD X/zo�gild ZD X3D' T 0r7 ower t4eJ4 & Rep ok5 5e D0 femoyat/ L4 he 0n Identification- Please Type or Print Clearly OWNER: Name: 8400A5- 5e-haD1 Phone: 97P �7S ,�34,0 Address: ///OD C:vrgaa� Aand A4 . N, /4laeiler1WI4 / Contractor Name:Gf'Ih/s i j �r /&Aa/ Phone: d '993 " �;-32-1 Email: lAD 1'vl Address' 14DI/1' . A/H- 123®�lf Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: A /U8/ el �OU/61 Phone: lob 3 "�3Ya iV 71P D / �G►Y.i� .�Iv piarry �iv�q L RtittE 1E 11E -R- Address: 1g, e!/�'I pf'. / /1%s /V�/� ®349 Reg. No. FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COBASED ON$125.00 PER S.F. TT Total Project Cost: $ 3, 5 0 FEE: $ Check No.: �wql Receipt No.: 6 6b NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Building Department The following is a list of the required forms to be filled out for the appropriate 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Mass check Energy Compliance Report (If Applicable) 4 Engineering Affidavits for Engineered products OTE: 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) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ° Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ i Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: 84 t ¢ � " � L.c ,e . �3Osgood Street IRE DEN � mtno ee11 Mai .24MfSt�eet F -®e;P Qn s�9n uUr�e�;d � d `a t COMMENTS . Y 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 i NOTES and DATA— (For department use) i I I LI Notified for pickup Call Email Date Time Contact Name ' Doc.Building Pennit Revised 2014 I I Location No. VS - 70(f Date 3 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Z,-" Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# J 3 { Building Inspector r -1 NORT1y - - ic ve'. 0 0 :; No. ChK ver, Mass,,WI - y1. 7�AERATED S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT .......... ... .. . . ,,,�,�, , ............... BUILDING INSPECTOR el has permission to erect .......................... buildings on ...It(& .p �.. Foundation Rough to be occupied as . .� .. ...� .. 1 s ...Q ..' ... .AAAWMChimney provided that the person accepting this permit shall in every respect conform to the ter of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alte io and 1 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR reow*l 51%11� Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STATS Rough Service ...............................................(........�.......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Building 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 Det. AJA s "?° x�.;""y .. .. :. a ,� a ..'.::�'.• ,� �� xx +� .x r w F k a �+ a • 1�`f-ai f23� � • ` aim .. 10 15 21� 22• ..�� 'N M`� . ems: ' 9 x. k f i n r. aY x BROOKS SCHOOL 1160 Great Pond Road, North Andover, Massachusetts 01845 1. Robert Lehman Art Center 10. Dalsemer Room &Frick Dining Hall 19. Athletic Center 2. Henry Luce III Library 11. Alumni House 20. Blake House 3. Science Center 12. Auditorium 21. P.B.A. Hall 4. Classroom Building 13. Danforth Squash &Rowing 22. Chace House 5. Gardner&Merriman Houses 14. Summer Programs 23. Hettinger East&West 6. Whitney House 15. Thorne House 24. Peabody House 7. Head of School's House 16. Wilder Dining Hall &Student Center 25. Russell House 8. Ashburn Chapel 17. Facilities Office 26. Boathouse 9. Admissions,Health Center & 18. Hockey Rink 0 South Entrance Head of School's Office �: ®Service Entrance Admission Parking 0 North Entrance rJrJ EnC(rC I[1 x r�rP rJE PcP r �E ILPEPEPGnCPCItPCIC�GPC�CE P . 5COC,rtff S ISSUED BY S ' REGISTRATION Date ofr.Shiprnent S F NUMBER "WE INc:� t3raoae .S EVANSVIL.LE,INDIANA 47725 Tent Ide»tificatiort >+i4a 1 MANUFACTURERS QF THE FINISHED 009088 TENT PRODUCTS DESCRIBED HEREIN 5 S 'this Is;to certify that,the material`s described have been flame-retardant treated (or are inherently noninflammable) and were suppfied.ta: 5 S 269000 5 CHR18` 1A1�1.# E IVERY'&CHAIR SER 5 DSA CHRISTIAN PARTY RENTAL S 'fib CLINTON D ' S HoLLIS .41430496576 S 5. 5; S � { �5 S S Certification is hereby made that; S The articles described on this Certificate have n-treatedl with'a flame-retardant approved S chemical and that the application of said chemirel:was done in confo>rman—writh California Fire Marshal Code:,All.fabric has been tested and passes l' FPA 70149,CPAI 84, ULCI 169. 5 SSerial#, sI512ifl fl? S Description of item e6diffed. 5 .cEMURY END 6awxao HOLE sNYDER � WHITE VINYL,WtTHOUT WEB.GUYS-__. Flame Retardant Process Used Will Not, Be Removed By S S Washing And Is Effective For The Life Of The Fabric s SMER MFG NEW PHILAbELPHIA,bH Si tte(1`t 4 t `a Haute of A I*or of Flame Ftestatant f inkgh ANCHOR It W'STRIES INC. clatPcJcJ�cP cPt1�EPEPc:.}`c.Ir.PEP[PcPcPE_I'c.I`cP cnEPcll?P cPEPr..f3E'�cP�t_I"� r�rJ'E.f�EPEPrPcnrJ�Ur�rJ'E.C�c.PtttPcPE.PcPEPcTc�1�cJ'ir�r�cPEPEPc.:i'� -`J etcPUMMINOMPORTANT �r �rr c�Pr.Fclii<J"rh�fa EGISI�R�TIQN ISSUED BY R Date of Shipment APPUCATIO 7e 611zrzoo6 NUMBER Tech identification EVANSVILLE, INDIANA 47725 5 ` Fip31 MANUFACTURERS OF THE FINISHED 04297876 TENT PRODUCTS DESCRIBED HEREIN, This is to certifythat the materials describedhave been flamei;r9tardant"tfesated (or are inherently hbrilnMirnmable) and were supplied to. 26880(3 5 CHRISTIAN DELIVERY&CHAIR SER DBA CHRISTIAN PARTY RENTAL 78 CLINTON ISR HOLLIS' NH 30456576 5 i ,5 5 S Certification is hereby made that: The articles described on thisI.0ertificate kave leentreated with a flame-retardant approved 5 chemical and that fhe licmtion of said Chemical was done in conformance With California Fire Marshal Code. All fabric has been,tested and passes: PA,701-99, CPAI 84,.ULC 109. Serial 0slsllio;ca3 ' E*srription of itBrt cdrtif f$: CENTURY MEDDLE bOVJ�;3o SNYDER -� -WHITE VINYL wrrHour WEB GUYS Flame Retardant Process ill Not Be Removed By Washing And Is Effective For The UfaL Of.The Fabric 5 SiIYDERA2F HILADEI;PHIA,OH Signed. - ---- " t Nameof A,plieaior of.Flarne-Resistant,Finish ANCHOR tNI}i!5 t`RIE5 INC,_ w r_M111 T13PefcIli rlr�r t2 felfl� �c l 3r(elcP[lr Cc�tr te3fr�l� r�tPr fr f[Pe Jc!r1r 1� r_IcP rJ z c� o ® ��������������IMPORTANT DOC U M E NTOPRO�22`2`23 �>s�>s' ° 5 Cert ffica.tte of 'Flame Resdstmwe S 5 ISSUED BY 5 5 � Date of Shipment 5 REGISTRATION a CNOR® 3/3/2008 5 NUMBER :t * 1NDUSTRI55 INC. 5 ~5 E INDIANA 47725 Tent identification 5* EVANSVILL , 5 F140.1 MANUFACTURERS OF THE FINISHED 04590588 5 S TENT PRODUCTS DESCRIBED HEREIN 5 i 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 269800 5 CHRISTIAN DELIVERY& CHAIR SER 5 5 DSA CHRISTIAN PARTY RENTAL 5 18 CLINTON DR S 5 5 HOLLIS NH 269800 S 5 5 5 5 5 5 5 5 5 5 5 Certification is hereby made that: 5 c5J The articles described on this.Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 55 5S Serial #5 8151310(l) S cS 5 5 Description of item certified: 5 5 CENTURY END 60WX20 LOOP SNYDER 5 WHITE VINYL WITHOUT WEB GUYS Flame Retardant Process Used Will Not Be Removed By 5 ke �u. .DMPORTANT 'L!7C 1�PCPC IL nGlCPILPC1�t ECSC 1CLlC l ° I rtffleate of l r :.. is REGISTRATION ISSUED BY "- AfPLIC AT1e3N Date of Shipment 5 *,NOs� 5 $1t212i08 S l3Et TRR1 1 �EVANSVILLE, INDIANA 47725 Tent Identification MANUFACTURtRS OF tHE FINISHED Fk40.iU42978'76 TEIN PRODUCTS DESCRIBEDtEREIAi: This, is to certif qthatllhe Mated als;deacri have h flame-retard ant treated: (or are inherently nor6flantmable)and were Supplied to: 269800 S CHRISTIAN DEI IVERY.&CHAIR SER e E)BA CHRISTIAN PARTY,RENTAL S 18 CLINT'ON DR HOLLIS NH 30496676 S S 5 Certification Whereby made that. The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the applldttJon of sad Ct rraacal was done in contorrrra a with Cahfornfa Fire Marshal Code.All falbri has been tested and pasges NOPA 701-99, C PAI 84,-ULC 109. S�riel: sislrto4z}. S k Description of Iterh c6rfiffitdt ,CE9� RY MIDDLE bOk'v O SNIDER ' 5 WHITEVNXL•wr.moUT W6.GUYS S 5 . Flame'Retardant Process Used Will Not'lSe 'Removed Washing, And Is FEtcve For The Life Of Thi Fabric SNYDER MFG NEW HILADELPM&OH Nartie0('0 . ficator of Marne fkaildtont,Finish. ANCNOF4.14 DUS" IES,I NC. _ . CnGI� CP CnGnRIMCSI 7C IC L�C WE EPORGlf Gly [_IC.ICvOt'3r P]rjMrr-I� CI7C ISL nLPCnr MMMMGnC GnCILi� ° a ® ctrli"cP tJitP rJ�ctsc13cP11IMPORTANT . 'rtcPctcPrliJc!cPr�cPcP�Pcf3r1U�t� q Coertfficate 5 = - Plan- ISSUED 8Y REGISTRATION Date of,Shipment 5 NUMBER st3rzoos SEVANSVILLE,MDIANA:47725 n Tent Idetlficatlon 5 FI40.1 MANUFACTURERS OR THE FINISHED 04590589 5 TENT PRODUCTS DESCRIBED HEREIN S This is to certify that the mAterials described have been flame»rettardant_treated S (or are inherently non nfiommable) and were supplied to: 5 269800 CHRISTIAN DELIVERY'&:CHAIR SER 5 5 DBA CHRISTIAN PARTY RImNTAL. S a e CLINT©N DR HOCUS NH 304W76 S S 5 5 5 Certifieatlon is hereby made that:. 5 S The articles described'on this Certificate have,been treated with a flame-retardant approved S Chemical and that the applications of said chemical was done in conformance with California S Fire Marshal Code.All fabric has.been tested and passes NEPA 701-99, CPM 841 ULC 109', 9; Serial#: 5 sasr�la(ij S 5' S Denrlptid n nt item certified; 5 NTURY 1;NI?60WJC26 HOLE SNYDI=R W PTE VINYL:WITHOUT WMB GUYS"` i S Name Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric. 5 SNY-DER WO NEW PHILA155LOH A,0H J Name'af: pIIc:*0r at F1bhie 19t ht:F'ini&#� ANCHOR 2NbUSTRIFES INC5 ® cPcPcjpi0a I ER I a I aM7 Pcl15i'firJ c=PcterPtl3ci�cfcPct��P rl�r_!cPc3ri�rJ�rJ�c t�cicPclr�r�rJr_PrlClrP [ t a .rt.�k.S1r AzJ. h f�f�-mhrh�4�;•4-1.4' 4 ! .c R.�r at�,�'�!. .S r' y, St' h !r>'^i'',1h3 44 4L?ta4�G.S�c�'h' 44vr.s r i o 0,� !t F , b t � r .- ( �. .• I'. r r .'.� ,r t ,'- ''moi• ��,> -,,.. r;ti • 1 ! D, (- ° .4c Sh.•. W' 77 Ki > �11•' i, , 4TT1777, =31 V4161— r�h"���"� C J' x `Y"•I tr' 1 �' C t,k�� �f�i� "`7c YY tba y� la - { �� `�„ L,? 1 C...7 ��• C t' t 7� t-,� �� a +Y=k,!_ ..(,�Y:.!f,�r�'??.I':7h/j t yj�l j�r,�t".pi...�`{r./°4 tF'.?', cj' ';r^e�i "'-y s r1: ,u� f s„t c{ ����•. 4'T c �����'c�y�.�F� �t r li I It r r/ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly 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.F71 I am a employer with 25 employees(full and/or part-time).* 7. E]New construction In I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.M 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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 c. 14.E✓ 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.Lic.#:P000749NHMTAA�20160/'ld Expiration Date: A01-01-2017 Job Site Address: /160 4��'r l" oe / City/State/Zip: /V ,A7, ,lee X4 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 b a fine u to 1 g 9 ,§ P Y p $ ,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 penaltie of erjur t the information provided above is true/and correct. Si nature: `%! Date: Phone#:603-883-5326 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#: NHMTA NEW NAMPSHIPE 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