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HomeMy WebLinkAboutBuilding Permit #317-14 - 1160 GREAT POND ROAD 10/3/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I A Date Received Date Issued: i I P RTANT: Applicant must complete all items on this page . Q LOCATIONI ///,00 . (OVl ..,- _ P rmt# PROPERTY OWNER �ch dd/ Rrint. 1OO YearrOld! 6ucture: yes; no MAP-NO' PARCEL _.ZgNLNG'DISTRICT; 'Historic:District' yes no. Machine'Sfiop Village yes. no & Z TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential KNew Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ?Cm/s- Ten ❑ Demolition ❑ Other ❑ Septic, ❑Welly ❑ Floodplain; ❑Wetland's 0 Watershe d1District,• Ij Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OR, /oAlli Re M w-rd P" "-a/�Y/d Identification Please Type or Print Clearly) OWNER: Name: g goo(es -r"CA&n Phone: 7.1S=630r0 Address: //(v O -AAeotrr K /W CON{ TRACTOR' NPme:?ek9J07 -- . K . _t_�,P Phone,7� Address: _ _ Supervisor's,Construction License:D Co 0 a rExp: Date: Home Improvements License; (o 9 a`a _ Exp Date:. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ '�>% — Check No.: �� N Recei t No.: �209 61 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S gnature6fA6 t/Ovvner Sign6ture161rcontractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiv,g, 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 Li Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o 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 app:al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;4ted with the building application Doc: Doc.Bui?ding permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools El Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster 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 HEALTH Reviewed on Signature COMMENTS Zoning 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 Dumpster on site yes no Located at 124.Main'Street - Fire Depart brit sik nature/date ` 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 4 - Doc.Building Permit Revised 2010 I Location 1� W0 9(ea P") No. Date o y • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#q� � 26951 Building Inspector F_ , NORTH �. .c . . ve, 0 No. 3�— I .14 _T - ti z3 ver, Mass, 3. 26 Y O LAKI COCKICKl WICK A04'STED S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......................................a 1 BUILDING INSPECTOR ...... .. ....... ... .... ... .......... . ... .... .. .. ..... too , �.. .� Foundation has permission to erect .......................... buildings on ... .! .............................................................. �. ''\\ Rough to be occupied as2,47m.1;. . . �'� .....re."W.�........IV .1 �1 ........................ imney. .. ch' 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE IMPORTANT DOCUMENT Certificate of Flame W§sistance ISSUED BY Date of Shipment 05/06/11 Registration Number NCHORSTent Identification F444.19 INDUSTRIES INC. �y 14957681 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: PETERSON PARTY CENTER INC 139 SWANTON ST WINCHESTER, MA 01890 G�S"1'E� F CAL Q.hyo a� d �Q Z Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701-04, ULC 109. Serial# 8046015C (4) Description of item certified: NAVITRAC LITE HIP END 25WX12.5 #602 FERRARI BLOCKOUT VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric FERRARI TEXTILES FRANCE Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC IMPORTANT DOCUMENT Certificate of Flame Wpistance ISSUED BY Date of Shipment 05/06/11 Registration A NCH®R 8 4 istration Number INDUSTRIES INC. FAME Tent Identification F444.19 �.j.1 14957681 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: PETERSON PARTY CENTER INC 139 SWANTON ST WINCHESTER, MA 01890 GNSTE� CAC�,�p�O �Q y H q 99��F�RE N►pQ��Q' E'r Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701-04, ULC 109. Serial# 8046015C (4) Description of item certified: NAVITRAC LITE HIP END 25WX12.5 #602 FERRARI BLOCKOUT VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric FERRARI TEXTILES FRANCE Name of Applicator of Flame Resistant Finish Signed: ANAOR INDUSTRIES INC ACC?RD0® CERTIFICATE OF LIABILITY INSURANCE i3 Y)io/i2o1 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 NAME: Michael Bonacorso Bonacorso Insurance Agency, Inc. PHONE (']81)273-3200 JC No:(781)273-0600 83 Cambridge Street AIL ADDRESS,mike@bonacorsoins.com P.O. BOX 1502 INSURERS AFFORDING COVERAGE NAIC# Burlington MA 01803 INSURERAAcadia Insurance Company INSURED INSURER B:C N A Insurance Co. Peterson Party Center, Inc. INSURER C AIM Mutual Insurance Co. 36 Cabot Road INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE 1XIOCCUR X X CPA 5061026 10 10/9/2013 0/9/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED X X 5063173 10 10/9/2013 10/9/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist BI split limit $ X UMBRELLA LIAB X OCCUR X EACH OCCURRENCE $ 10,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,OOC 5085496458 10/9/2013 10/9/2014 $ C WORKERS COMPENSATION X WC OER EMPLOYERS'LIABILITY Y/N ANY PROP RIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) Z8006586 10/9/2013 10/9/2014 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/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 SPECIMEN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS17175i7n1nnr)nt Th.Ar:flPn -1 Innn -16—of Ar:npn r )WIt Massachusetts - Department of Public Safety �=-1) Board of Building Regulations and Standards Construction Supeni�or License: CS-060219 IRE NLaRK TRAiNA - 33 I ANTORD RD Stoneham DL4 02-130 � xY Commissioner 04/27/2015 --- CJizs t,.t�m�r�rtcoecr�c�✓�Zcu�.�!a;et7^. Office of Consumer Affairs&Business Regulation iOME IMPROVEMENT CONTRACTOR _registration: 109922 Type: p n:,,..8!1812Q10: Individual x iratio MARK R TRIANA - - - MARK TR41NA -_ 33 HANFORD RD. STONEHAM,MA 02180 Under secretary License or registration valid for indhidul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,NLN 02116 'ot valid without signature The Commomvealth of Massachusetts Department of Industrial Accidents $ r,� 0 ce of lnvesti rrtions w i 600 ►-Vashrnton Street Boston, AM 02,111 rvtvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/Contr actors/Electricians/Plumbers Applicant Information Please Print Lenibly Nall c (i3usiness.'Or,_,anization/Individual): pe–16 (/Y) �G(124 (ren T-I� __ Address: City/State/Zip: 0 �j ) j2 /�f} /AGI Pholle 791 7d�'- �/o o z� Are�'ou an employer?Check the appropriate box: Type of project (required): 1.® I am a employer with o�C1"L�, 4. ❑ I am a general contractor and 1 employees(full and/'or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 1i Demolition workin for me in employees and have workers'any capacity. 9. ❑ Building addition [\o workers. comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeo%vrtcr doing all work officers pace exercised their 1 l.❑ Plumbing repairs or additions nlyselt. [No workers" comp. right ofexemp,tion per MGL I2.❑ Roof repairs c. 15 2, j 1(4),and we have.no InSUCaIICf rcgUn'ed.] employees. [No workers' comp. insurance required] 'Any applicant that checks box L.I mint also till out the secuon below showing tl;eir workers'compensation policy information. I lamowncrs whn submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new aflidosit indicating such. Contractors that check this boX must artachea an additional sheet shoaim,the nume otti;c sub-contactors and state Miether m not those entities have employees. It the sub-contractors have employees,they'must provide their ,vorkers'crn;tp.Policy number. I nor an employer that is providirr,workers'compensation insurance for nip employees. Mow is the policy lend job site in jornratioar. � // Insurance �.OnName:1pallName: - f � U_.._e Policy t or Sell' ills. Lic.9:ljlJ��Yf 2 EO`U (a F(� -- Expiration Date:—�(����3 Job Sitc Address: &�,o 94ine'l Afo( 1?6(_ City/Stale/Zip:-," - Attach a copy of the workers' compensation policy declaration pi-,e (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of 1�1GL c. 152 can lead to the imposition of eriminai penalties of a Fine up to S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of hlvesti,ations of the DiA for insurance covera_e verification. 1 do hereki,certifj-under the pains and penalties ojpeJurr that the iii brrn«tion provided fly above is true and correct. SiUMALlre Date: s/% Phone ---- — ---- -- Official use onlY. Do not write in this areq, to be completed hp vitt'or town official. Cite or Town: Permit/License 4 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/To.vn Geri.. a. l-'lectrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone#: PAGE 3 OF 4