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HomeMy WebLinkAboutBuilding Permit #56-12 - 257 BRIDLE PATH 7/22/2011 V10RTH BUILDING PERMIT 0 11%.90 16�'V ° TOWN OF NORTH ANDOVER 32 heti'`- . _ `_' � APPLICATION FOR PLAN EXAMINATION aL Permit NO: Y Date Received .y.0R1TAD 01?11 � SSAC HUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER I (/1 Ct 0-11 e-t, Print MAP NO : PARCEL:'; ZONfNG DISTRICT: HISTORIC.DIST, e 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: ❑ Demolition ❑ Other Q Septic ❑"Wei{. y ❑ Floodplain' D Wetlands ❑ Watershed 0 strict , ❑:.Wa'ter/Sewer _ _// DESCRIPTION OF WORK TO BE PREFORMED: 78 PC:T ,20 x- 3c) 01_� Z6 Identification •Please Type or Print Clearly) OWNER: Name:� eq Phone: I Address: .2 S_-2 >''..��� �41 CONTRACTOR NamePhone: Address: / 17 Qi° ►'t"C' r �' c E: Supervisor's Construction:Licertse. ' � l`� Exp. -Dater 7 '3 Hoene lmprovementbcertse Exp. Date`y 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. r Total Project Cost: $ / sou 0 FEE: $ Check No.: 1 Receipt No.: � �1 NOTE: Persons contracti"withn gistered contractors do not have access to the guarantyfund Signature of contractor Signature of Agent/Owner g �:h �- Location6-2Z � I No. � �'"' Date AORTN TOWN OF NORTH ANDOVER 0� ti,,G0 1 �� I•,• 00 • • • � ; . Certificate of Occupancy $ sqCMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 0�/ 2 4 �'-) Building Inspector i Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. i 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 apse) i I I i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Pp 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) o '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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit E3 Two Sets.of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) _ o 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 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 Doe:Building Permit Revised 2014 NORTH Tovm Of . ......... dover, Mass., ZZ • < Q -- LAKE I� COCMICKEWICK Ids°RAT E O 7 BOARD OF HEALTH Food/Kitchen . .PERM .IT T D Septic System BUILDING INSPECTOR ...........�. ............4.z...................... �............................ ... .............THIS CERTIFIES THAT................. Foundation . .......... has permission to erect........................................ buildings on .....i� '<<. Rough ........... �!.. ...........�.... Rou t0 be OCCUpled as �� ...�............................ Chimney ...... .... ..... ............... ..... .......... 7C!&10WW... ......................provided that the per pting thi permit sha in every rt conform to the terms of the application on file in 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 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS 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. �f f V y t _ar , ACERTIFICATE OF LIABILITY DATE(MMIDDIYYYY) ABILITY INSURANCE 1015�2010 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 (781)273-3200 FAX A/G,No.Exp: (AIC,No):(781)273-0600 83 Cambridge Street _nDDRIESS:mike@bonacorsoins.com P.O. BOX 1502 PRODUCER 00003879 GUS.TOMER ID 9. Burlington MA 01803 INSURER(S)AFFORDING COVERAGE INSURED S-- - NAIC# INSURER ARepub llc Franklin Ins. Co. Peterson Party Center, Inc. INsuRERaTravelers Indemnity 139 Swanton Street INSURER.CHartford Insurance Co. INSURER D: Winchester MA 01890 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2010 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 - - .. ---------- -- IADDL SUER;--------- LTR TYPE OF INSURANCE INR WVD I POLICY NUMBER POLICY EFFT POLICY IXP - - - - --- --- MMIDD/YYYY MWDDIYYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE S 1,000,000 X _COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED - - PREMISES(Ea occurre_nc_e S 500,000 A CLAIMS-MADE :X OCCUR X X CPP 4361629 70/9/201Q 110/9/2011 MED EXPAn ( .y one person) 5 10,000 PERSONAL d ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG S 2,000,000 POLICY� X j PE OT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO _(Ea accident) _ _ S 1,000,000 j B ALL OWNED AUTOS ! X X JIE�A 9296X836110/9/2010 (10/9/2011 BODILY INJURY(Per person ) ;s X SCHEDULEDAUTOS j BODILY INJURY(Per accident i S X .HIRED AUTOS PROPERTY DAMAGE I II (Per accident S _X I NON-0VuNED AUTOS I i Underinsured motorist BI split S 1,000,000 Uninsured motorist BI spid limit s 1,000,000 X ! UMBRELLA LIAB OCCUR EACH OCCURRENCE_ S 5,000,000 EXCESS UA8 ' CLAIMS-MADE_. - AGGREGATE - --- - - S 5,000,000 DEDUCTIBLE S A RETENTION S X X 010 4361631 40/9/2010 10/9/2011 A WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY YIN X WC STATU OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L. ACH ACCIDENT_ :$ OFFICERIMEMBER EXCLUDED? N N I A _ 500,0 00 (Mandatory In NH) WC 4361630 110/9/2010 10/9/2011 I E.L.DISEASE-EA EMPLOYEE s_ _ U es,desaibeunder —. _ 500,000 DESCRIPTION OF OPERATIONS belowI j I I E.L.DISEASE-POLICY LIMIT s 500,000 C Equipment Floater t X ; !rO BE DETERMINED 0/9/2010 0/9/2011 Leased and Rented Equip: i S 100,000 Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space Is required) Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2oosoe) The ACORD name and logo are registered marks of ACORD 1 i ' �I:►..:rchu.( tt. - f)� p;rrtrYrcr�t �►! Puhlir `ul� t� t3�►:rrd Oil f3triltlin` K� �ul:rti�rn: :titcf �tantl:rr cl. Construction Supervisor License License: CS 60219 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 JIL Expiration: 4/27/2013 ( ��nuui��i��n`•t Tr--: 13389 t a W,? 0 rhi Co 1)i i.c!I (hn 1!1 S., A�- C-1 Addrcss� City/State/Zip: Are you an employer?Check the proprinte hoz: El G. U, NmN,c0j',fj-jC(io3,, 2-n I �i`n a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have working fon-me * In any capacity. employees and have workers' 8. ❑ Demolition --- [NO comp. irisuranoe comp. insurance., 9. ❑ Building addition 3.rreqi-lil-Cd] El Z','c are a corporation and its 10.0 Electrical repairs or zdjlliolis l l am a horneowner doing all yj!oyj( officers have exercised their ]'LEI Plumbing repairs Myself- [NTo workers' comp. right of exemption per MGL13-s or additions jcqun-ed] I c- 152, 12.[] Roof repairs §1(4); and we ha\,e no [,NO 13-EK1 011,-:r/ C011,31). iIsui-ancc rcquirci-] -*Any applicant that checks box 9 1 must also fill oui the section below showing their workers'compensation policy informatiori- Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'C'OntTWOrs that check this box must attached an' f - additional sheet Showing the name of the sub-contractors and stz!c\-,he"her or n emploYees. if tie sub-CQ;-- —acioys have employees,they must proviee theirOt those entities have workers'C-Omp-policy number, b1fornialioll. 11'orlers'c07?Te17Yt2'l`iot insuranceformy elulployees. Below is the policy and job site Insurance Company Narne762 & Policy-'or Self-ins-Lic. Expiration Date:—Zo A, Job Site Address: (57 City/State/Zlp-,4�j Attach 1. 0 2 COPY C"tile NVOrkers' conipens2-tion policy declar;ation 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 Penalties of a fulc UP to 51,500.00 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 z� Investigations of the DIA for insurance coverage verification. 1d hereby certify undei-theImiis aildplijallies of aj. PelitilY Mal the information provided abol, istri(eandcorrect. Date: Phone#1: 7F` 74 f—4/,-4qP-t, Official nese o771y. Do not write in this area,to he completed by city or town official. o:- TOWE.: Pc rni i Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbil-.0 j 6. Other Contact Person: Phone V,: a r M P O R�"A If�l T DOCUMENT 2nonrJ�rJ�rPrJ�rJ�cPLnrJ��nr nr rr3 J�rJ� o 5 . o 5 5 Cer tff le gate of Fly Regime ee 5 5 C ISSUED BY 5 5 REGISTRATION a �'F o ��� Date of Shipment 5 5 NUMBER �� aisoizoo7 5 .n INDUSTRIE INC. y 5r ~ Tent Identification 5 5 EVANSVILLE, INDIANA 47725 5 51:140.1 E M ° MANUFACTURERS OF THE FINISHED 04464877 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 5 657150 5 PETERSON PARTY CENTER INC 5 r 5 139 SWANTON ST 5 5 5 5 WINCHESTER MA 1890 5 5 5 5 5 5 5 5 S Certification is hereby made that: 5 5 5 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 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial # 5 5 80205o0C(2) 5 SDescription of item certified: 5 5 S rn_s rA I oP 10�� 20(113C) 5 5 SNYDER WH VL 1023970A 5Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The a Fabricl7 5 5 SNYDFR MFG NEW PHILADELPHIA;01-I Signed: 5 5 Name of Applicator of Flame Resistant Finish 'W ANCHOR INDUSTRIES INC. 5 O rJ�rJ��r�rJ�rJ�r�r�rJ�rJ�cPr�rJ�r�rJ�cPr�r�rJ���rJ�iJ��1�Pr�r�r�rJ��rJ�rJ�rJ���PrJ�rJ�r�r�r��PrJ�rJ�rJ��rJ���J�r�r�rJ�rJ_�rJPrJ_r _C3jr_ff1_rJ�rJ�r�rJ�rJ�rJ�cPcPr PrJ�rJ�rJ�rp 01 1~�`Z. \�.1 r.. ... . i ,c'.; ' 4 � i.' . "C'"... '�""`r''.,�K'".it.z v:' _ _ ..._",fir,-.:..t•+.-Y+�'=}S �1a.,._„_.,:;..::: '. •• :_,1.......,.--='.. ... . ..:�; ...___. ._+'''�L�.:�J.` '�� _�.._..:'.,_.. [�."`'"d.....: �—_1'Y�'`��..�.��-''�' � — r •,•w"c u'1'ss- .. i o d�rPrPrPrP[PrPLPd�d_r:IP IMPORTANT DOCUMENT s f Fla l�esis ee s 5 Certificate ea.te oYl�C.. f�al� 5 S REGISTRATION ISSUED BY � Date of Shipment 5 5 APPLICATION Q y� VNINDUSTRIEICH )R115/10/2006 5 S NUMBER INC. 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 1140 1 a MANUFACTURERS OF THE FINISHED 04263446 5 STENT PRODUCTS DESCRIBED HEREIN S 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 5 5 C S 657150 5 5 PETERSON PARTY CENTER INC 39 SWANTON ST 15 5 S 5 WINCHESTER MA 01890 5 5 S 5 S 5 5 5 5 5 5 S 5 Certification is hereby made that: 5 SThe 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 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # 5 5 8020500C(2) �] 5 Description of item certified: 5 FIESTA TOP 14WX14 SNYD WHITE 5 VL#1023970A(1 PC) 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 Washing And Is Effective For The Life Of The Fabric 5S S c�ivnr_o nnrr.rir.,,„,z-.T.�i nSigned: 5 � DIs6�1=11dl;81=1 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. cj FRI r�rJ�cPrJ�rJ�rJ�rJrJ�r�rJ�rJ�r�r�r�rJ�rJ�cJ�cJflJ�rJrPrJ�r��r�r P�rJ��Pr�r�rJ�c1��Pr�r�rJ�rJ�rJ�r�rJ�rJ�rJ��PrJ��Pr�rJ�r Pr�rJ�cJ�r�r�rJ�rJ�r�rJ�rPrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r1rJ�rJ�rJ�rJ�r� 0 h.����jj�4�.. • ti �, ., ., .ri:r..;�.1.__ ,.a. :+'s,-�.rs',.ad.1.'•i. !�„ krf�,tiY..-:y.y i'"t:, r ........i_: :V.d'_'i.�':Ti�?�y���*v..ti,.>w{prr�-...,�+... _ _ _ __y"---.—....,.'^t—.• CPC�CPCPCPLPCPC nLnCPLnLnCPCPCPCPCJ LSC pd-L3 PCPLIpCPCPCPCPCPLPLLnC PLPE ° ❑° IMPORTANT DOCUMENT 5 E 5 Certificate of Flame 1ReslstapCe c5 4 S REGISTRATION ISSUED BY RES 5 � Date of Shipment S 5 APPLICATION Q i NDusra E� INC,qQ9 8/28/2006 5 S NUMBER sl� 5 5 Tent Identification Cj r r EVANSVILLE, INDIANA 47725 5 5 or MANUFACTURERS OF THE FINISHED 04337696 5 5 l 140.1 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: C5 5 S 657150 S PETERSON PARTY CENTER INC Cj 139 SWANTON ST 5 5 5 5 5 WINCHESTER MA 1890 5 5 5 S 5 5 S 5 5 5 5 5 5 SCertification is hereby made that: 5 SThe articles described on this Certificate have been treated with a flame-retardant approved 5 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. S 5 Serial # S 5 5 5 8020500c 11i 5 5 Description of item certified: 5 1_11:_S'I'A TOP 14W\24 SNYDI R 130 5 5 WHITE VINYL 91023970A 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 � ;n els Signed: - � 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 a ��Ln�.rLn�LnLnLru�Lr�LrLn�LnLnLr�LrLnLnLrLn�LnLnLnLrLnLrLrLnLrLn�Lr�LrLrLrLr�Lr-LrLnLrLrLrLi�LrLrLnLrLn�LrLnLi�LrLrLnLr�nLrLnLr�LrLrLr�LnLrLrLr� o I M P O RTA N T D O C U M E N 5 5 ELI Certificate of F1an1e iesista?ce 5 � 5 REGISTRATION ISSUED BY 5 5 o- '� o Date of Manufacture APPLICATION 5 _ ����� 05/24/02 5 i i Eli NUMBER INDUSTRIE INC 5 I s 5 ~ Order Number 5 rF ��, r EVANSVILLE, INDIANA 47725 5 5 F121.4 �� E w* °' MANUFACTURERS OF THE FINISHED 354594 5 5 TENT PRODUCTS DESCRIBED HEREIN S 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 S657150 S 5 PETERSON PARTY CENTER INC 5 Cj 139 SWANSON ST 5 5 5 WINCHESTER MA 01890 S ' 5 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 5 5 chemical and that the application of said chemical was done in conformance with California S SFire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. S 5 The method of the FR chemical application is: S 5 Serial # 8001800(2) 5 SDescription of item cervN420W x 30 VL w w 5 5 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 .JOHN BOYLE STATESVILLE NC Signed: � -�`��--•� 5 Name of Applicator of Flame Resistant FinishTENT DEPARTMENT-ANCHOR INDUSTRIES INC. �j O rJ�rPr�rJ��PrlrJ�r���PrJ�r�rJ�rJ�rJ�u�r��l�rJ�rJ�r�u�u�rJ�rJ�rJflJ�r�rJ�rJ�r��l�cl�r�r�r�u�rJ��rcrr�t��nr�r�rnr�rJ�rJ�rJ�u��r��Pr�r�u�rPrJ�r�r�u�u�r�r�r��Pr�u�rrrJ�cnrPrJ�r� El