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Home My WebLink AboutBuilding Permit #864 - 27 ABBY LANE 6/29/2007 NORTH BUILDING PERMIT a "U`° 06gtio TOWN OF NORTH ANDOVER c? ' 0�. APPLICATION FOR PLAN EXAMINATION P O Permit NO: f( Y * 44 a ,......�,, Date Received � 6q.,T.p 0P �5 �SSACHUS�� Date Issued: 0 �j 7 IMPORTANT Applicant must complete all items on this page u o 00 TION . 113rirt a - PRC )�ETOWIER ? a WAR',I�? „�' PARCEL Zdl ll r131S 1" 1 � HIST-6 ?STR T ryes n�a 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 peptic i aNell a V1 afefs ed IY�str�ct Wafer=/Sever �w DESCRIPTION OF WORK TO BE PREFORMED: Rd Y-/'V X/0 7 7 D"7 lee e'er /�Identification Please Type or Print Clearly) OWNER: Name: .L/SQ �'i ti Phone: 0'707-1-3°� Address: �v tNTRACTCR s V tpw 8b C flsttaction��cense I x ®ate:.. :g : I✓10�iT1lC1pr43 �1@rit LIGI15Ear � 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting w'th unregistered contractors do not have access to the guaranty fund n 5inaue of AgentlOwrier .. Signature of coritracto T � i Location 9 7 49 f Oz� No. IP6 Cl/ Date �aR�M TOWN OF NORTH ANDOVER 3: OL � 9 ' Certificate of Occupancy $ Building/Frame Permit Fee $ JACHUs Foundation Permit Fee $ Other Permit Fee ' $ TOTAL $ Check # �J N i 203 uilding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL j Public Sewer ❑ Tanning/Massage/Body Art [ Swimming Pools ❑ ' I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ - i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 1 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ El- COMMENTS COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE" EPARTMENStieT Terri'p Dumpstet 'on site s no Located at 124 Mein f " Fllr De a ein si inatureldate "�lET", lday. r.� 5 z ' 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 I Building Department i The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits i ❑ 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/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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH Town of �� Andover No. ?(0 . . . ......... W-7;i7ri , C, o dower, Mass., la, 0 /� COCHICHEWICK V 7,pS RATED C� l BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System + BUILDING INSPECTOR THIS CERTIFIES THAT........ .�, �� Foundation S, has permission to erect........................................ build' s on .0.... ........ ......... ...................... Rough to be occupied as.............. ....... . .-.C/..�° . ... ...... ....... ..... Q.0.... . (�.... ....1. Y16 himney........,.. ... c provided that the person a piing this permit shall in ev respect 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough .................. ......... ........................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. [0jQ@ .ng�aPg'g1��nu��n��nr��ru��r��n�n��nr1� IMPORTANT DOCUMENT EPL'ru��n�L�l-u�!I 5 5 TS 5 QC.-Prfift"rate of if tlRoi5tana 1 5 ISSUED BY REGISTERED _ 5 5 uvF G Date of Manufacture 5 5 APPLICATION Q �iH®R®INC.NUMBER N�usTRIES c. 5 r 5r EVANSVILLE, INDIANA 47711 Order Number 5 FF121.4 [ MANUFACTURERS OF THE FINISHED 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: S 5 5 657150 Dj PETERSON PARTY CENTER INC 5 139 SWANSON ST 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: S 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 S chemical and that the application of said chemical was done in conformance with California Fire 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 Serial #: 8002100(1) 5 Description of item certified: 5S5 FI TOP 20WX40VLWW 5 5 _ Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOHN BOYLE STATESVILLE NC Signed: ✓ 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. � �PrJ�rJ�r_rrJ�rJ�u�rJ�rJ�rJ��rJ�r��r��Pr�rJ�r�rJ�rJ�r�rJ�r�r�r��PrJ�r�r�rJ�rJ�r�rP�n�Pr�rJ�r�rlr.P�.PrJ�r�r��PrJ��P�nr�rJ�r��PrJ�rJ�rJ�rJ�rJ�rJ�rJ��.nrJ�rJ�r�rJ��.nr��nrJ��Pr�rJ�rJ�r.PrJ�rJ�rJ�rJ�rJ�rJ��.nr�rJ� o D �nrJ�rJ�rJ�rJ�r�c1��n�PcP� r 1 O R TA Y E T DOCUMENT iJ�rJ�r�clrJ�r�rJ�rPrJ'r�r�rl�ncJ��P�n o 5 Certifleate of Flame Reds ee 5 SREGISTRATION ISSUED BY Date of Shipment S APPLICATION 5 o- ' �� 0 5 NUMBER :ri INSRIEINC.® 5/10/2006 -13 5 i EVANSVILLE INDIANA 47725 Tent Identification 5 5 5 5 F140 I MANUFACTURERS OF THE FINISHED 04263446 5 5 TENT PRODUCTS DESCRIBED HEREIN SThis is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: S5657150 PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 5 5 5 5 5 S5 Certification is hereby made that: 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 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serial # CCCS 80205000(6) 5 CS Description of item certified: 5 5 VIESTA TOP I#10239 0A(PC)0 SNYD WHITE 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric T 5 cSNYDER ISUC4 NEW purr ADELPHI 4 0I4 Signed: �— 'W & L 5 S Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. Cj HI •�, The Conunonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street + Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): P S 2 lj Address: City/State/Zip: /ne&.s Phone#: Are you an employer?Check the appropriate box: Type of project(required): li 1.54 I am a employer with l�-y 4. ❑ I am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no �- employees.[No workers' 13.�Other��`yj/I �-fq comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors 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. o,� Insurance Company Name d � /�t� I (/ Policy#or Self-ins.Lic.#: 7a{p 9 Expiration Date:zy 9—o7- Job 'oJob Site Address: 0�7 /� ,,4, 1a ge City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ili Ido hereby certify under the airs andpenalties of perjury that the information provided above is true and orrect. Si nature: Date: Phone M Official use only. Do not write in this area,lobe completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: lu/03/2006 15:39 7813584022 PETERSON -ACCOUNTING PAGE 02 KlghtFax 10/3/7006 3:28 PM PAGE 2/003 Fax 30rVCr Client#-46743 PETERPARi ACORIA,. CERTIFICATE OF LIABILITY INSURANCE �onyDa ' PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION U91 Ins.Services of MA,Inc. ONLY AND CONFERa NO RIGHTS UPON TH6 CGRTIFTCATF 12 Gill Street Suite 5500 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 4043 Woburn,MA 01888-4043 INSURERS AFFORDING COVERAGE NAIC 4 INsuaeD INAIRFRA: St.PAUI Fire and Marina Insurance C 24707 Peterson Party Center,Inc. iNaiNERs. North River Insurance CO. 99999 139 Swanton Street INwHRR a Commerce&Industry Insurance Compan 19410 Winchester,MA 01890.1918 INWRERD: INSURER E: COVERAGE$ TNS:POLICY S Or INSUWW CE LISTED BELOW HAVE BEEN IBSUED ID THF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANYREOUIREMENT,TERM OR CONDITION OF ANN'CONTRACTOR OTHER DOCUMENT WITH RFPPE,GTTO WHICH 7"16 CERTIFICATE MAYBE ISSUED OR MAY PCRTAIN,THE INSURANCE AFFORorm DY THE POLICIES DESCRIBED HEREON IS SUBJECT TOA1.L TINE TERMS,EXCLUSIONS ANn CONDITIONSOF SUCH POLICIES AGGREGATE LM ITSSHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS, LTR TYPLI OF IN WRANCE P4.ICYIVUL®ER M LIMTQ A GINt=RAL UASIUTT CK00217138 10103106 10103f0T EACM OCCURRENCE 31,000,000 X CX)MMFRDUB.aENejt4kL LIABILITY 35D DDO LLtY9 CLAIMS MA3E a OCCUR MED EJB ane pomp) $5,000 PERSONA.A AVV*WRY "'080,000 (MNLRAL AGGREGATE 32,000,000 GENL AGGREGATE LIMIT APrLIE$PER: PRODUCTS-COMPreP AGG s2,000,000 POLICY nF a LOC A AUTONOBILEUAL3ILJTY MAGO200291 10103106 10103/07 COMRLNFJ3RtWXPLIMIT 31,000,000 ANY A"", - "Ausdidu) ALL O"ED AUT09 SOMLYINJJRY X ND-IFDULED AUTOS �Pel) _ X NIRFD AUTOf; BODILY N.A1RY X NC 4-ftNF Q AIJIM �ward") 3 01"'A )MCf 3 GAR muAD ILnY AVF0 CMY-EA ACCIDENT s ANY AUTO FA ACC 3 mOTHPIR T'bw wut0ONLY: nOo 3 9 EXCEBaNMORELLA LIAOIUTT 5530892346 1WO3106 10103107 tACH OCCURRENCE 15,000,000 X orxuR CLANS MADE ADCT{F_GATE 15,000,000 1 DFOUr71BLE S X RFTF-N714N 110,000 C WOM=3CCMP IULSATIONANO BINDERWC96I3f269 10/09100 10109107 X YA;ATATu- rnw- EYPLOTFRM'LIARILITY ANY PROPRIETCP/PARTNF_PIEXEQJTIVC El.EAVIIACX7OENT 3S00 000 IFFIC:ERMEMBER EXOLLAED7 EL.DISEASE-EA EMPLOYEE 3500000 LI An.QrrLMLln(YIr w rROvt9 r+sbmaw EL,CISE4ZE-POLICY LIMIT 35000110 OTHER DESCRIPTION OP OPr RwTIONR I LOGTICN81 VEHICLrR I fXCW WONB ADDED BY EHDOR,WMPRT 0 WEOAL PROVIBIONS RE: Innured's operations renting equipment for business&4ocial function», including erecting tents. CERTIKICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOV£D£SCtlti£D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THLI M.-MINO INSURERWILLENOEAVORTOMAIL _"_ DATSTYRITTt'_N R07rC17 T'0 THE CFRTIRCAT£MOLOM MWED TC THF LEFT,RUT rAILURn TO 50nO NHALL iuPO\4F NO 6ZUDATION CR LIAaB.fTY�wvrc V.IRLi un C•i TME 1lISURCR,ITS hCFUTg OR REPRF�ENTATLKS, ALrTNORIZE.OR vR Z:LUTAMVE _ ^.TM.�Y",.�T• �� .-µ-�rn ACORD 25(20(M10B)i cf 2 *91384941M138493 AGDCD a ACORD CORPORATION 4988 92w Z/70-17U1)dCJ2llfPQG[/1. O0 c,-��lTCC6P. Q Board of Building Regulations and Standards Construction Supervisor License I License: CS 60219 Birthdate: 4/27/1954 +•irj Expiration: 4127/2009 Tr# 11766 Restriction: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Commissioner