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HomeMy WebLinkAboutBuilding Permit #757-14 - 221 WEBSTER WOODS 4/28/2014BUUNG PERMT ®�aq�eo i6gnV® LIa � C 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONS �1 u Permit NO: Date Received Date Issued: I co-au5�4 I�1[ ®IIgTAI�� e Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non -Residential U New Building ❑ One family Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: U Demolition Otherl`C oR�2 ��til i C � TL -/V7 _7,?,, FOR AA) El/cti:1 1,5,"07 UP 0,Q Al 2-zo /1 C 1/L�✓T 0/V Ii/1 2-3 — 2 A N l7 TIVRG DOM,14) 07(1 /VjAY 2--7 2014 / Mentificaiion 1 le2se'1<ype or Pidnt Deady) OWNER: Name: V I K A S Q6, Ai Phone!178'g79-GJ E ARCHITECT/ENGINEER A 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. Tota Pro�eca Cost: $ -- do ?5-U7- FEE: $ 3 0- cX--1 Check No.: �S 3 (Z Receipt No.: 2-1 q Otq NOTE- Persons contracting with unregistered contractors do not have access to the'raranty 5'44 Signat 2 - -Plans Submitted ❑ --PlansWaived ❑:,- '_Certified Plot Plan ❑ Stamped Plans F1 -TYPE-O SEWERAGE I?ISEOSAL ' Public Sewer ❑ Tanni�ig/Massage/BodyArt ❑ .. Swimming Pools ❑ t Well r ❑. 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 PLAN"NING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: I Com Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW T'odva: Engineer: Signature: Locatea 3u4 us ooa Street FIRE DEPAR-TM:L-N' T .=="Temp Dumpster on site yes no Located at:.124,Main Street `Fire De partme isignatiare/date'-": •, .�. t •.» ;,-:-_....�'; ,., - 'COMMENTS Dimension Number of Stories .Total land -area; sq. ft.: Total square feet of floor area, based on Exterior dimensions. .ELECTRICAL: Movement of. Meter.location, n ast-or service drop requires approval of Electrical Inspector Yes No DANGER.Z®NE LITERATURE: Yes No MGL.Chapter 166.Section 21A -F and G min.$100=$1000. fine NOTES and DATA — (For d 0 Notified for pickup - Date Doc.Building Permit Revised 2010 ent use Building Department The fol;'wing i' ` list of the fequired.forms to be filled out'for the appropriate:permit to'be obtained. Roofh,g, Siding, Interior Rehabilitation Permits - u Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And%OC: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 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 ❑ 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw�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.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location 2-2— 1 No. ,115-1 r 1 Date $ I Check # � � I Y 27499° TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee — $ 30 — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Building Inspector z Ob A R n y C, d 5- m m Ull Z u1r� CD 0 Z C Cr Q �. > CQ O 0 m< C� aa) CDD O CD QO CQ CD N CD O LWT lG 0 0 U) CD CD CD _a U' CD I O O CD O CD O Z m Cl) O cn 0 m X a 55 cn z 07 Z .91 oM�° su i cn cn =^ < CD N 0 CD 0 M0 m o =r= � �. 7 tH � CD'17 OOn m -- CD a1 rr Cl) 0 U) O --I CD CD = Q 2 N CCD > O O 0 � Q. O .+ N � O O n rr n .•r 0 CD O CD O O < cc ;i �. =r . s 00r -h�� C �rt C =r =1 _ D cD � Q. ° n Q 0 CD U) O U) CD ;r N CL CD Am iwo CD N0• �•• o a� 2 ._+ C O � co rt O O Er, CD y CD <D 1 :� O N p S .w CD 2) Ph � o CL � e V1 K W T Z7 T In � T ;O T n ]J T N T 3 7 rD O C N5 m D z o D vZi n �• RL N :5 n O S m czi� m �• RL o ::r HLA V m RLrf _� 7 < o S o Q- O =3 r � mD 0 N n N O \ n 3 (D 3 D O x m _ n f F' 4 x`75 s -- �. s � Jw Jk-S&AA,'U,:Z /�o f " b ,Vet� Apr,16. 2014 9:57AM BERRY INSURANCE SOUTH —.-M. No, 7520 P. 8 rRAAF_3 OP ID- CLI �.� CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DDNYYY) 0411512014 THIS CERTIFICATE I$ 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 certlficate holder is an ADDITIONAL INSURED, the policy(les) 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 Phone: 925-798-3334 James C Jenkins Ins SrvcConcdFax: 925.609-5381 License No. 0545476 P.O. Box 5658 Concord, CA 94524 Dan Sullivan AAI CWCA CPIp NNAM'a CT PHONE a0�; EMAIL A SS: INSURER(S)AFFORDING COVERAGE NAIC>R INSURER A; Nova Casualty COM pany 42552 INSURED Chase Canopy Company, IhC INSURER B; INSURER C; PO BOX 46 4 Nlaky's Lane Mattapoisett, MA02739 INSURER D: X UMBRELLA LIAR FCW�JUMS-MAII A INSURER E INSURER F AGGREGATE COVERAGES CERTIFICATE NUMBER: IteviolulN IvurrlDCK. THIS IS TO CERTIFY THAT THE POI-ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR An POLICY EFF POLICY EX LTR TYPEOFINSURANCE POLcYNUMBEIt MWD IDG GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY RNTCLOO103700 05/01/2013 05101/2014 CLAIMS -MADE � OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: $ 1,000,00 X POLICY PRD- jECT F7 LOC 300,00 AUTOMOBILE LIABILITY A ANY AUTO $ 1,000,000 ALLOWNED SCHEDULED X $ 2,000,000 AUTOS AUTOS S 2,000,000 NON -OWNED X $ 1,000,000 $ 1,000,00 X HIREDAUTOS AUTOS S X $600 COMP X $500 COLL S X UMBRELLA LIAR FCW�JUMS-MAII A EXCESSLUIB DED A RETENTIONS 7 V vuv WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIErORMARTNEWEXECVTINE ❑ N(A OFFICERIMEMEER ExCLUDED7 (Mandatory In NH) A jEqulpment Floater 170 0510112013 10610112014 05101/2013 10510112014 05/01/211113 105101/2014 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1VEHICLES (ACaeh ACORD 101, Additional RemaTKs Scheduled more space Is required) !videmce of Coverage ONLY. D NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMIT.$ EACHDCCURRENCE $ 1,000,00 OXWPREMWerIC01 300,00 MED EXP (Anyone person) S 10,000 PERSONALS ADV INJURY $ 1,000,000 GENERALAGOREGATE $ 2,000,000 PRODUCTS • COM P/OPAGG S 2,000,000 TUBen. Ea accide LE LIMIT $ 1,000,000 $ 1,000,00 BODILY INJURY (Per person) S BODILY INJURY (Par eocident) S PROP cr aocltle $ (.(APD EACH OCCURRENCE 5 160,00 $ 1,000,000 AGGREGATE 5 1,000,000 WCsT LIM. oTH- fiSATUTO S E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE 5 E.L. DISEASE -POLICY LIMIT Spec Form Repl Cost 1 - 111001000 $2,500 Ded PINKLOT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pink Lotus Events TME EXPIRATION DATE! THEREOF, NOTICE WILL BE DELIVERED IN 221Webster Wood Lane ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, NIA 01845 AUTHORIZED REPRESENTATIVE 01988.2010 ACORD CORPORATION. All rights reserved. ACOAD 25 (2010105) The ACORD name and logo are registered marks of ACORD A r, 16. 2014 9: 58AM BERRY INSURANCE SOUTH No, 75203E -3P, 9 OP ID; ES ,4CoRLT CERTIFICATE OF LIABILITY INSURANCE DATE 04116/2014I� 04116/2014 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 NAME: Uamel r oupivan DPS Insurance Group, Inc. kal, Et! . 617-479-5500 ac No : 617-479-8761 500 Granite Ave., Suite 3 E -MAI Milton, MA 02186 Daniel P Sullivan INSURER(S) AFFORDING COVERAGE NAIC k INSURER A: Associated Employers Ins Co INSURED Chase Canopy Company, Inc. INSURER B: Daniel Chase 4 Nicky's Lane, P.O. Box 46 INSURER C: Mattapoisett, MA 02739 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. POLICY EFFPC' UCY EXP ILSR YYPE OF INSURANCE POLICY NUMBER MM/DDMMfDD I LIMITS OBNERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ee o co S CLAIMS -MADE ElOCCUR MED EXP (Any oneperson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGG $ POLICY PRO• LOC $ c MBINED SINGLE LIMIT AUTOMDBILG LIABILITY I&I zmidenl BODILY INJURY (Pet "eson) S AjJYAUTD ALL OWNED SCHEDULED BODILY INJURY (Per aeUdent) S AUTOS AUTOS NON -OWNED PROPDAMAGE $ HIRED AUTOS AUTOS PER ACCIDE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S ExcESs LIAB HCLAIMS-MADE AGGREGATE $ DEC) RETENTIONS$ WC ST OTH- WORKERS COMPENSATION M AND EMPLOYERS' LIABILITY500 A PROPRIETORIPARTNERIEXECUTIVE Y / N CC -500-5012777 01/01/2014 01107/2015 E.L EACH ACCIDENT $ r 00 ANY OFFICEWMEMBER EXCLUDED? � N / A 500 000 E.I. DISEASE -EA EMPLOYE r S (Mandatcry lnNH) ea, deecrlIn under E.L DISEASE . POLICY LIMIT $ $00,000 D IPTION OF OPERA NS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Atwoh ACORD 101, Addltlonal Remarks Soodulo, if more npaCe is raeulrel) PINKLOT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B1= CANCELLED BEFORE THE EXPIRATION BATE THEREOF, NOTICE WILL SE DELIVERED IN Pink Lotus Events ACCORDANCE WITH THE POLICY PROVISIONS. 22dWebster Wood Lane North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CHASE CANOPY LUXURY TENTS I EVENT RENTALS March 6, 2014 To Whom It May Concern: PO BOX 46 MATTAPOISETT, MA 02739 TELEPHONE: 508-758-2055 FAX: 508-758-2083 E-MAIL: infogchasecanopy.com WEBSITE: www.chasecanopy.com Under penalty of law, this letter will certify that the tents to be erected by Chase Canopy Company Inc., at 4 Nicky's Lane Mattapoisett, MA 02739, anywhere in the State of Massachusetts, shall be constructed of flame resistant material. Furthermore, I hereby certify that the tents to be used shall be maintained as flame resistant and shall meet all the standard testing procedure as specified in NFPA Standard 701 Sincerely, Daniel Chase Co -Owner of Chase Canopy Company Inc. On this& -day of 'fOnA .20 /y, personally appeared the signer of the foregoing statement and made oath before me as to the truth of the matter there in contained. Signature of Notary Republic:-'�'J0242 Date:�//4 /Jo1 �/ Date Commission Expires: 6 _ /a - /G IMPORTANT DOCUMENT Certificate of Flame &sistance ISSUED BY Date of Shipment 2/25/10 A,� Registration Number ,NNOCr S INCW Tent Identification F140.01 � �„�� 14835350 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: 266675 CHASE CANOPY COMPANY 4 NICKYS LN P 0 BOX 46 MATTAPOISETTE, MA 02739 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, CPAI 84. Serial # 8108885 (2) Description of item certified: CENTURY MATE EXPANDABLE END 30WX15 SNYDER WHITE VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHILADELPHIA, OH Name of Applicator of Flame Resistant Finish Signed: AN HOR INDUSTRIES INC 04/14/2014 10:25 b 508-758-2083 TO FROM 0^L c Jove CHASE CANOPY P.O. BOX 46 MATTAPOISETT, MA 02739 TELEPHONE: 508-758-2055 FAX* 508-758-2083 E-MAIL: info@chasecanopy.com WEBSITE: www.chasecanopy-com PAGE 01/05 A 5 4 � � a GAG C.(n7`,y � f �q.�Jl9 R TJ�'G� 4 �-7'�/Or.✓ QF %`N� <<x-.ITirs.!% T n /960 Tb/��aor�Ts otic /HP ��: �d,✓ �+ :� �'��Fv e 7A;;. Tom' !6 %+z- tl-a,VE /t4-11�4TAAC6 CZ-A7-/f;C4r/0n/ 51K - ,ewe %~ rlAr G 4 ,0VORY c c> SAN ld e GG-`�' G <7� MA Gv 'I'd" C Z2,L p/+'�v2, S�� ? z 119 A � M 4 AeZ A V1 C<,yj(vsO OR .Pain t c ,ft� 04/14/2014 10:25 508-758-2083 CHASE CANOPY PAGE 02/05 TOWN OF NORTH ANDOVERBULDING PERMIT X11 APPLICATION FOR PLAN EXAMINATION', PPrmiB Wcr: Date Received TeIy 7-.r;> QG GRLere`b =ol? AAy EyatT . I&,,y7 u%o e -y Afy/ 2z Za /,f C 1/00- " O nl U42, 2-3-25, •Q ti D pow t) 0A-) M^ y f Identifficatb®n Pocasc Type or Mnt ckar2y) OWNER: Name: Phone: 0 ARCH ITECT/ENGINEER� Phone: Address: - - - --- Req. No. FEE SCHEDULE: 43UI-DIAIG PERMIT, $42.00 PER $9000.00 OF THE TOTAL ESTIA TED COST BASED 0AI M9.0D PER S -r_ 'Total Project Cost: $� $ 3 d. 00 Check No.: ipt No.: NO)T E: Persons coutracring with 7y have access 8® rhe crawage p�r�4 ROM .� 1,y1,/ i !{�;I,��1 I IC4l�r,U +�ipp;;�'!'!. I hY/.' //�� ����M1;.y LL�' 4�'� .il-t1?.., i.l.• 9.A �,1 �r_i1.S-+: 04/14/2014 10:25 508-758-2083 CHASE CANOPY PAGE 03/05 IMPORTANT DOCUMENT Certificate of Flame Resistance ISSUED BY Date of Shipment 2/25/10 Registration Number . 1 F140.01 INIDUSTR INC, Tent Identification' 14835350 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: 266675 CHASE CANOPY COMPANY 4 NICKYS LN P O BOX 46 MATTAPOISETTE, MA 02739 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, CPAI 84. Serial ## 8108885 (2) Description of item certified: CENTURY MATE EXPANDABLE END 30WX15 SNYDER WHITE VINYL. Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW_PHILADEI_PHIA, OH Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC 04/14/2014 10:25 508-758-2083 CHASE CANOPY PAGE 04/05 CHASE CANOPY LUXURY TENTS I EVENT RENTALS March 6, 2014 To Whore It May Concern: PO BOX 46 MATTAPOISETT, MA 02739 TELEPHONE: 508-758-2055 FAX: 508-758-2083 E-MAIL: i.nfo@chasecaiiopy.com WEBSITE: www.chasecanopy.com Under penalty of law, this letter will certify that the tents to be erected by Chase Canopy Company Inc., at 4 Nicky's Lane Mattapoisett, MA 02739, anywhere in the State of Massachusetts, shall be constructed of flame resistant material. Furtlierm.ore, I hereby certify that the tents to be used shall be maintained as flame resistant and shall meet all the standard testing procedure as specified in NFPA Standard 701 Sincerely, Daniel Chase Co -Owner of Chase Canopy Company ln.c. On thisL�_day of _-,A.20_ZZ, personally appeared the signer of the foregoing statement and made oath before me as to the truth of the matter there in contained. Signature of Notary Republic: �� 2-0--W ell Date: ,� //D /90/ y Date Commission Expires: 10 ~ /6 *Ij COmmonNotary walkh �T�lbF�� q s My C-Mrnissea 3isoti4 'i . '' Ji�7d res DADA1/4 T ©� *fD *,: 04/14/2014 10:25 508-758-2083 CHASE CANOPY PAGE 05/05 'o a