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HomeMy WebLinkAboutBuilding Permit #1063-15 - 30 KITTREDGE ROAD 6/16/2015 BUILDING PERMIT NORT16 H A- A�M TOWN OF NORTH ANDOVER o �- - :.:. . ., APPLICATION FOR PLAN EXAMINATION ` A Permit No#: d Date Received gSSgcHus�c Date Issued: I 0RTANT: Applicant must complete all items on this page LOCATION ..�� � 71 de-a- /Z ef Prin PROPERTY OWNER LI�Y &L �- Print 100 Year Structure yes(noMAP PARCEL: ZONING DISTRICT: Historic District yenoMachine Sho Villa e eno Shop g Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ZNew Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition JZ'Other _ e't'ic� ❑alNell ❑ FloodplWetlands _ E ❑,V�Iate�shetlF®istict p q�i � ` a a } yr f D,W�tet/Se_vver�� � _ �-4, � DESCRIPTION OF WORK TO BE PERFORMED: 7'0 Ft?,ec e, o?o )e Vo 7?MROROLy /--e"-w� ,0VI (,0/—/ �2.rnds/PX A,1 (042,c)y/J I entification- PI se Type or Print Clearly OWNER: Name: Aelbl e theol &CA Phone: EZ - �-a F0 2 Address: 31) ki 4-1z R d Contractor Name: �Ce i2sm 1'Rw 7Ph4ho n e: g 5/0 Email: Address 3 (y af" f.J ► v2�� fyl/4' Gt rat Supervisor's Construction License: Ca G t c/ Exp. Date: y d7 i7 Home Improvement License: /60> 9 d a Exp. Date: rlt /JJ 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: $ /off fJ'� FEE: $ oo Check No.: Qf Receipt t No.:&�53 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/lAassageModyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o 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 Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ,FIR+�DEIp um;i psteriponsite 4,Lo ted�at�124�1111ain#Street, .� a,r°• , .r��:'� =�+ ,� F=s + ;�r. , - ii "f a y .l 1• tT ' a l Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. t.: ELEGTRIDAL: 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.$1oo-$1oo0 fine NOTES and DATA— (For department use) ❑ 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 Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Locatio No/. J'' Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $15a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# n - .: �, Building Inspector c . : ve. ' o lb63 - h ver, Mass, COC NIC MI WICK 1' U BOARD OF HEALTH PERMIT 00# LD Food/Kitchen Septic System THIS CERTIFIES THAT ............... ... .. .. ........ . .C. .... .. ... .. ................................... BUILDING INSPECTOR has permission to erect .......................... buildings on . ..... . ., .../. 1... ,,,,,,, ...... Foundation Rough to be occupied as ....&P.y VV........? ..............� It. ..... 6....� Chimney 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 MO S ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S Rough Service ......... ......... ..................... 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. _- a pet a Party Center, Inc. 568334 Cabot Road . k fl Woburn, 418012 PAY. F14DAY � �oh (781)7294000 D OFUSE. W19 Tent 78I)7 9- " Ctlt; (781)503-2144 . 1:4 Aid TIME OF USE: ax X7813 729-4999 # asttttr � Y RENTAL AL t w.pet Y pec at Event cj aip� W.BILL TO: t f /� z^y a e , F MACH - ! 30 IUTTIUWE RDMA iff rte` +n : i , a x " ! a a 9 AT y ryp/ y i dsxa►12DA 06 4 A _ WEARE PLEASED TO QUOTE THE �`A� 3� +�f��/���[ ♦y IY/ j��{k�f� ItENTa ;1 30 X 30-CENTURY'TENT;,WMT "(900 � � A00fl,t1Q 6 ( I ILLLIIATI41t Y�ITPt • �00 { . :..: a I APPROXIMATE 1�muv � 11� � � � 000 �� �tl t3tl 2{0k.0 1, MARK I TRA SPO TATION'AND BITE R u. 180-00 18 , � c - t in r ➢ k" i Ths :zgm ' X M. : ° T1 �Y P CU40 IS `t{3£�i1R iSP ¢ j'4w.ac w�A }} qKi1� ����}'R�ryw� pi`wg WO wr pn•• ., ,.,s. _ :� ..P `�5''JDD' �i rte'�` •'°�i. �?. er "" f ffar.^ Fi'nt. Ps ment to be ns futlowa. $700.00 DEPQSIT`�°BALA�I�CE CUA?� r� � � � �UB TU`�, ; l,9$D(}p a - The above pnc spehct#oas asx �t ara sawx �tan SALE`FAQ: 1,f3.tifl ` '. LABOR: U� 4 Yi a her iy arapted You a1 a au horizod to do 60 work, a Fa I ad a 6 t#etl abcve� Ileposits ace noir refundable or transfrnablte & stat DELfPU eot" others withoutautborintion is 1,�ubtt e T3 ; AGE $ ,{l•fl� a 00 ..l l �; T�prttttsat may be v+ tdra .by 1F accepter ' s ': ►ate t� wilh t A' 'lean � � - h' lea s � tuaraoa Ct�py t' ts Itis Dalt. /Y MA MRIBWDOUDRE i +�t ►, + r ISh,Peatart� erXtt xref daGte 56 I}amag@ I3'at0ar. tpt red ted stu tr,, ` . lerigrttpm@ Aw e r of rr@d t x� `; 1 ` ' `tlt fI'tt#t t' �' -�ifs►� 1 Q , The Commonwealth of Massachusetts Department of IndustrialAccidents Office oflnvestigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 G''y 5 ey )vfVm nass.cov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lecibly Name (BusinessrOrganizationlIndividual): PETERSON PARTY CENTER Address: 36 CABOT RD City/State/Zip: WOBURN, MA 01801 Phone r: 781-729-4000 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 200 4. ❑ I am a general contractor and I T employees (full and/or part-time).'* have hired the sub-contractors 6. ❑New construction 2.F-1I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance. ❑ We are a corporation required.] 5. oration and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t c. 152, §1(4),and we have no TENT- employees. [No workers D.® OtherTEMP. TENT comp. insurance required.] *Any applicant that checks box"I must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicative such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state`.whether or not those entities have nplo;eeS. 1f t.^.e Sn0-C ,^,t7 'CtG:S h2.:e^f;lOj:eS, _ mst provide their `.t'Gr.erS Co p.pG;'Cv-,UM'- I(1711 an employer that is providin1c,worl.ers' compensation insurance fr my employees. Below is thepolicy and job site Inform ation. Insurance Company Name:A I M MUTUAL INS CO Policy#or Self-ins. Lic. #:WMZ8006586 Expiration Date:10/9/15 Job Site Address: 3o I1, 7�/?tw r City/State/Zip: 11 4/71,e, 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 MGL c. 152 can lead to the imposition of criminal 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 Investigations of the DIA for insurance coverage verification. I do hereby certify u��n�deerr the/pains amend penalties ofperjury that the information provided above is true and correct. Sic-nahre: %"^'�'� [/r/�2.� Date: Phone#: 781-729-4000 Official ccse 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ACO® CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) `� 1 9/28/2014 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 CONTACT Michael Bonacorso NAME: Bonacorso Insurance Agency, Inc. PHOAICNE (781)937-3200 FAX A/C No (781)937-3202 10 Cedar Street E-MAIL michael@bonacorsoins.com ADDRESS: Unit # 32 INSURERS AFFORDING COVERAGE NAIC# Woburn MA 01801 INSURER A Acadia Insurance Co. INSURED INSURERS AIM Mutual. Insurance CO. PETERSON PARTY CENTER INC. INSURERC: TABLE TOPPERS OF NEWTON INSURER D 36 Cabot Road INSURER E Woburn i MA 01801 INSURER F COVERAGES CERTIFICATE NUMBER:2014 Master Certificate 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 TYPE OF INSURANCE DDL S BR POLICY EFF POLICY EXP LTR IN5R WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ 250,000 A CLAIMS-MADE OCCUR PA5061026-12 10/9/2014 10/9/2015 MED EXP(Any one person) S 51000 PERSONAL&ADV INJURY S 1.000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 JFCT r_1 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED 5063173 12 10/9/2014 10/9/2015 AUTOS X AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPER TY DAMAGE AUTOS Per accident) S uMIUlm s 1,000,000 X{ UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 10,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE S 10,000,000 DED FFRETENTIONS BD 10/9/2014 0/9/2015 S B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN T RY LIMITR ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA 26008006586 10/9/2014 0/9/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE.$ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 t ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. WR075mmnns�m Tho Arnpin r,-nnrl 1-gra­„icfo.orA.,,,.1—of Arr)Pn Massachusetts - Department of Public Safety Board of Building Regulations and Standards iOrlstruct-fors Supervisor "�- - i License: CS-060219 Mark Traina -- ' 33 Hanford Road: �� Stoneham MA 02380 i " W Expiration Commissioner 04/27/2017 �r tc1rJ�rJ�r�r�r�c fcPrJ�rJ�r Pr�rJ�rJ��l O POR 7A N 7 R O C U E �P�Pr�c1�rJ�r�cPrJ���Pc�cfr PrJ�rJ�rJ� 5 Cortifileate of �nmcesi is ee s 5 REGISTRATION ISSUED BY Date of Shipment 5 5 APPLICATIONQM® ® 5/10/2006 5 NUMBER L 91019 TFIES INC. S SEVANSVILLE, INDIANA 47725 Tent Identification 5 F]40 1 MANUFACTURERS OF THE FINISHED 04263446 5 5TENT 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: S 5 S 657150 5 �j PETERSON PARTY CENTER INC 5 S139 SWANTON ST 5 5 WINCHESTER MA 01890 5 5 5 5 S 5 5 5 5 5 Certification is hereby made that: 5 SThe articles described on this Certificate have been treated with a flame-retardant approved S 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. S 5 Serial # 8020500c(4) S 55 5 - Description of item certified: S 5 FIESTA TOP 20WX40 SNYD WHITE 5 VL#1023970A(I PC) 5 S Flame Retardant Process Used Will Not Be Removed By S 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 rV��R 1�ar�iiFw PIit6��I r P1I1n,�1� Signed: - -- z c5J S Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 D rJ�rJ��.PrJ�r�c.Pr�rJ��PrJ�rJ�r�r�r�cPrJ��PrJ�cPrJ�r��.Pr1�r�r�r�r�r�r�rJ�r.P�Pr�rJ�cPcI�rJ��r�rJ�r�rPr..lr1rJ�r..Pig..ter.Jr1rJ�rJ�rJ�r��P�r��P�PrJ�rJ�r.Pr��PrJ�P�Pc�rJ��PrJ�rJ�rJ��P O t