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HomeMy WebLinkAboutBuilding Permit #1129-2016 - 1160 GREAT POND ROAD 5/1/2018 BUILDING PERMIT o��t,.eo�IORTy j TOWN OF NORTH ANDOVER �'� h `'`' ".�'' o APPLICATION FOR PLAN EXAMINATION / / P y VL Permit No#: �� Date Received ,/ `°`"'" " 7,�p�kA7Eo I.Ppy.�S SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print / J PROPERTY OWNER 5400,t. Print 100 Year Structure yes no MAP 6� PARCEL: . ZONING DISTRICT Historic Distt"ict yes -no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: T S ❑ Demolition ❑ Other T ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed.District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ` alp Ad 'X/Z� ' T. V 7- 4-n,011,41 - 4-n,0 val wa ,6e 0`1 Identification- Please Type or Print Clearly OWNER: Name: B xor-5 <cHO61- Phone: q7S—7Z9 Soo Address: 11(00 e5 P-,E;4T' NAJD R-00,d /l - A4WOVe-k "A �7ris�•�s7�'AtT}l Contractor Name: _ /_ Phone._fiD3 - S93 Address: . 411 h )L—on ~supervisor's Construction License ,__Exp. Date:_ Home Improvement License: _Exp. Datex.�._g _ _ - /�/G�i�el AD�+t 11-►ri+T/�It^I�Irrp Phone: t,carTrrC�.l/LIYVIIYLLT Address:/? M4kj bgye &s /VV 03U419 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: $ �i FEE: $ Check No.: (Q� Receipt No.:_ � .� NOTE: Persons contracting with egistered contractors do not have access to the guaranty fund 77 5iggnature of ent/Ow0cer. Signature of contractor: z. 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 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/Cross Section/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 u 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 ❑ 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:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ FF SEWERAGE DISPOSALewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY 9 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 a 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 Department signature/date i 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. 3, Date 4z 444, • •+ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ; Check# I / 1ZT 30303 Building Inspector F_ , NORTH - : :. .c ve: + 0 0 No. L C% h ver, Mass 1 01001.11.1.11. y1. ��RAT E to) 5 S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THATBUILDING INSPECTOR 73�16% .... . .. .. ... . . .. ..... Arm Foundation 1 .. has permission to erect .......................... buildin s on .�.1 ... ....... . .. ...�..... .......,,�.. Rough to be occupied as .� .� . . .. Chimney.. ........G � ....**..kl........................................... 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 nspection, Alteration and Construction of Buildings in the Town of North Andover. �� ,� PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ...............................�.,. :.... �1 ,�,r.;............ � . . ... 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. t< ��'�> � ze�„ �. Vii- �' ��.�, �� � '"�: �� • •<��'� 'w w,.i^� , ��'«*��.�,'�::; ter; "�";' � a. =.S d* �:. x '�3`c ?.��."r '�c`a '-'�;,�'^ �°� a��s:e=.� "��• _ � '��''.. � t. ,*�? a.;�„ �. \�m�,� � t< � „ r Vi n 5d wll� n Y � f r w" " .c � rod:,�m�yh�N• ��� r�� e e"�� r�xC�0+N",a�.,�. �N .w",or�0 ��.a�yYw' " n, r. �s. A mvw� .r ,.: � r✓1m�'�' N u ,y� w � 4 v ' `. « �•, � '»a ?n moi. �*w�"�� � + r ' � r v Lai w 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 ®South Entrance Head of School's Office 0 ®Service Entrance Admission Parking 0 North Entrance n.- am3,1x1. ._1F1V M, Pagw. t trate ;. C)ate Ma.nufecwred AZTEC TENTS invoice Number; 0202537-iN 2865 COLUMB1AST Castorner, P.P.: 118f2414 TORRANCE,GA 9ti503' (800)228681 Customer Number: GHR030 This is to certify that.the materials described below,0 been fiarn aSardartt "a ""•*'s� -- xr+ - `treated jour are inherenoy fl�tne.retardant). //�� � �: y��' WUaNs D-. LLQ• 1:1 30oz f-tt5 1 yds'. �tS Christian pry �'} �yy, p ;.� tiW vrq}I 1690 7.300A, 7¢,91 -.�. Christian learty Rentals.' �µ/• a�' / _ CdA'V�n1A i6fto 18 Clinton D&OTOM y.f Hollis,NH 03049I IFI .. F oNWpt. PMI YCx ::a5W 1 H Certification"is hereby made that the articles described below"hereof.are made from;a ffamerretardant fabdo or material registered End apprdVed by the California Mate Fire Marshal for such use.The fabric has been tested and Passes NFf'A 701Large State See chart to right#or#rade name of � 9uraiWn 81 8,5x5 '1 dame-resistanf fabric or material used a'nd:additionally referenced,on the label:of the fabric panel, AlTHE FLAME RETARDANT ORO,CESS USED WILL NOT 13E REMOVED BY WASHING Davin.Bradley General Martager-Manufacturing NsmeofAp aWorPrcdudlw$uperintnWwe Thte9SAppTit lortxPr�tucdonSupedMeaderrt a ITEM CODE 1TEM OESCRIPTiOtV tJNi# ©RfERED PRODUCED Z318T100E040010 #1QUOixr4y0 2peSedes20oo EACH 1 1 #Old Style to match previous orders# includes Jumper Ropes ,Only Blockout White. (T'ie:Downs toot included wi Top) Z39900430 518"Poiydac CP;Jumper 45, EACH 2 2 Z318ZO01808/0 '100k20 End S20bb TPLA EACH i # Uw. w/;New Plates.includes Jumper opes only. Slockout White (tfe-towns Not Included w/ Top) Z318Z00190B/O C'100kX Eh6 S2600 TPGR '� EACH } 1 w!New Piates Jruludes Jumper Ropes.Only Slockout White (fie Oouns Not Included vw/ Top) ��- r - Continued�., �/� d 76 �f fitate r Pager 1. ytttanrt me Reo yi Date Marlufacturetl AZTEC ��tS Invoice Number; .0202537-iN 2665 COf.UMSIA ST ousfonw p.0.; 1/812014 TORP-INCE cnsdst�3 j8flQ)228 38$7 Customer Number. CHRJQ30 }This is W certi#ythat.th�eq znateeriiais descrlbec below have been Aann iardarit treated-(or.are lnherenflyflorno retarda314. Christian Party Rentals ,N�s�,� 1 g Clinton Dfive' Hollist!VH 03049 . ��q ��y�// %' FiIVAfR+sMPt �4 Cert'rfrcatian is hereby made that the articles ttescr%b®d lasbw hareaf ate made from a flarfle-retardafaf#ebnc or niatenal"registered and appraised by the California State Re Varshalfcr.such use.The fabric has been tested and r o�T+�6p1 � -� passes NFPA.701 Large Scaler See chart to right#or trade stoma of Y V' flarrietresistant fabric or material used,and addlfitmal�. referenced 'onVielabel of the.fabric.panel, THE FLAME RETARDANT PROCESS USED WILL NOT BER BY WASHING u'/ k :s David'Bradley General tanager Mar u#actufing of r�ppucera orPy a&*cd-Superintendent" t as x App�cemrrn Prodotflbn sTquAnwT,derrt I'T'EM COBE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z318T1t1OE040B10�#100z40 2" pc Seises oj EACH # 1 #OBI'S to.to:m' ty atilt previous orders# Includes Jumper Ropes, t}nljr $lockout fthe (Tie Downs Not;Inciuded wl Top) Z39900430 578"Poly*a CP Jumjmr.45' EACH 2 2 Z318ZO0180810 `'#00X20-End 52000 T'PLA EACH i 1 Uw. wl New Plates Ipc1vdes Jumper Ropes Only BlockoutWhlte (ie.Downs.Not`indudedwl Top) Z319Z00i9013t0 '10040 End S2000:TPGR- EACH t .UW W NOW Plete's Ine;IWI 4omper Ropes Only t3lo&.mxWhite , Downs;Not Included w! `. X 4V /� �� Continued V,ra of Page.: - .. Rclt4ta 09i . Rafe Niahufectured AZTEC TENTS invore Number. 02025374N. 2B$5 Lt1MiiA Si Customer P.O:. 1!$12014 TolfAiyCA ,.CA9A5Q3 (800).22$3887 Customer Number: CHR030 *s,is_tocerttythattheivaterials.des cribed•below*e,beeiifl, t:udat>i treated{orate+nherentiyflarrxe retardant. ��, �„ f ,. - 2.�%1� ,��1 Wrt ax4 r' :15,' JVl At /'S1,,,g �r}� Nor Lee Christlain i'a�Remi is i j a 18 C11ntOr!t)riye Hallisi NH 43040 � a � � u�ee imcmn�"" "`""""" '.a« m v, €� �� ,a�aA 6�f. P,v�wxr nt.• � , .,_.. rn�e alahl6u inec . AI .. �utkCfBAm. „3 t Certification is hereby meds tha#tfle:ardcles.de ibed betow'hereof,are made n; ;; `° " VIO from a flame-retefdant fabric or'material.registered:ar►d approued:by the sura California State Fire Marshal for-such.use.The fabric has-been tested and passes N1=PA 701.Large Seafe.$ee ehari to right for trade naive of flame=resistant fabric or material used and:additionally referenced on:the label,of thafabric panel, 4. THE FLAME RETARDANT PROCESS USED WILL NO.T BE:REMOVED BY WASHING Favid,Bradley General.Manager--manufacturing NameafApo,cawarProduc9on.SuMinWweret.. tiu061AM CSW crftdiix omS $iWd6nt � ITEM M CODE ITEM CRlP7t3 i / i=s otv UNrr t3i3DEREl? PRODUCED Z3187`1i70E040810 #i 00x40 2pc Series 2000 EACH 1 TP UW_ _.T #Old style ta.,match 'previous-atderst tr dudesdumperkopes Only i3lodmutlfVhtte {lie Downs:Not-lnduded wl TOP) 239900430 5/8"P6 CP Jumper 4S EACH 2 2 Z318Z00180810 `100x20 Erid52000'TPLA EACH 1' 1 uw wl`New Pietes Includes Jumper Ropes.Oniy 8lockout yhke {T ie Downs Not lr4uded w/ top) Z319Z001908t0 '`10040 End S2000_ PGR EACH1 1 UW Vd New Plates:ln iicides. Jumper Ropes Only Blockout hlte (Tie Downs Not included wt TOP) r } S`~ �- V Cnritnued. I 1p F Abd0, f fame' ' r. A. Page; 1 ! GateMantgatxure,:d AZTEC;TENTS t nv0f` Number` 0202537-1N 2605OltINlI1AST customer P.Oy, 118/2014 TORRANCE;CA W503 ' C,Otomer Number: CHRO30 X800)2�$-3$87. This is to.certl� that the materials described below have been�m �elardant treated orarean3lerengy-flame.retardartfj: /������� � ale�/// � /' GIDE. :..tlfnl•T�c . ...1 t.. fi7;U , ' 1rd OM t ➢/ { / Q11 .0 / s� Christian Party Rentals �: /� � �; ��,�;,son.�„ , 1 a Clinton Drive // Hollis,NH "03049 �, �/ d%c y/;�/g erten anwnsrsaiz'.. P. raw '. Mtht�Spifl. :x.14pAc-. T�Ytrrtepg, _ P'Ar4SCt 4. Y. Certifica80n is hereby rrt8de'#ftat'tfte;artic3es:deecribeci belovir hereof are made from a fl8me4et46ant fabric or material re*ered and;approvers by the California State Fire Marshel for such use The fabric has,been tested and " passes NEPA 709 Large Scale.See:charUo right for.trode.name of frame-resistant fabric or material used.and'additionally.r®fereneed on the label of the fabric panel, s . THE FLAME RETARDANT PROCESS USED WILL NOT$F REMOVED BY WASHING David Bradley "General Manager'-Manufacturing +� y Neme�APA��n�'of;Produalcn$�etintenderrt 7'nWoPAPP�c�torarPtothiaiPo�aSugx;dr�a,�en , ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRQDUCED 7_318T100E0401B/0 4j00x402pc.&wes.2000 EACH 9 1 TPUW 4016Style to mateh previous orders# Includes Jumper Ropes Only ftc koutftlte (rte.Downs Not includedW, Top) Z%900430, 5/8"PolYft CP Jumper451 EACH 2 7 Z318Z0018,08/0 tIOU20,FMtt 52000 TPLA"I EACH 1 1 UW----, W/-New W— - W/-New Plates includes; Jumper Rapes Only glockouk'White (Ile Downs of lncludedv/ Top). MM00190B/0 *1110x20 End 52000 TPGR EACH 1 1 t11W Yd Now Plates Includes ,kmper Ropes only BlockoutWhlte Me Downs Not Included w/ Top) (' Continued The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly 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.E]I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.M 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.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.ElI 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 l I.❑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.t p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other TENTS 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 insurancefor my em ployees. Below is the policy and job site information. Insurance Company Name:NH Motor Transport Association -Policy#or Self-ins.Lic../#:P0007749NHM1TA2016 Expiration Date: �01-01-2017 Job Site Address: ���1 [-S1'�j�J 1-1017d/7d �� City/State/Zip: IV c 14T !� ?�Z iv",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 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 unde t ains and pen ies of perjury at the information provided above is true and correct. Si nature: Date: Phone#:603-883-5316 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#: = H A NEW HAMPSHIRE 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